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Objective:Analysis of influencing factors of enteral nutrition interruption in critically ill patients in general surgery department and its impact on prognosis.Methods:A total of 91 cases of critically ill patients in general surgery department were selected who were admitted to the general surgery of General Hospital of Eastern Theater Command of the Chinese People′s Liberation Army in Nanjing from June 2021 to March 2022 by convenient sampling method, demographic and enteral nutrition interruption data were collected,and patients were divided into enteral nutrition interruption group and enteral nutrition uninterrupted group to investigate the analysis of the factors of affecting enteral nutrition interruption and its impact on prognosis by Logistic regression analysis.Results:There were 59 cases in the enteral nutrition interruption group and 32 cases in the enteral nutrition uninterrupted group. There were statistically significant differences in gender, analgesic and sedatives, Gastro-kinetic agent and feeding intolerance between both groups ( χ2 values were 4.51-9.97, all P<0.05). Logistic regression analysis results showed that gender ( OR=4.566, 95%CI 1.332-15.657, P<0.05), analgesic and sedatives ( OR=3.437, 95%CI 1.112-10.621, P<0.05), and feeding intolerance ( OR=4.116, 95%CI 1.257-13.479, P<0.05) were the factors of enteral nutrition interruption. There were statistically significant differences between the two groups in the number of days of enteral nutrition up to goal in 3 days, 3-7 days and 7 days, albumin,length of stay in intensive care unit, total length of stay and hospitalization expenses between both groups ( Z values were -2.80 - -0.73, all P<0.05). Conclusions:Female, analgesic and sedatives and feeding intolerance are the risk factors of enteral nutrition interruption in critically ill patients in general surgery department, and enteral nutrition interruption has an adverse impact on the prognosis.Medical staff should avoid excessive use of analgesic and sedatives, and do well in feeding tolerance management to reduce the occurrence of enteral nutrition interruption.
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Objective:To evaluate the hemostatic effect of self-expanding polyurethane foam in an animal model of fatal hepatic trauma and hemorrhage.Methods:The fatal liver trauma hemorrhage model with swine was established. Then the damage-controlled resuscitation was performed. Thirty minutes after injury, the experimental animals were randomly divided into the gauze packing group (GP), foam packing group (FP) and blank control group (BC). The survival time, vital signs, the bleeding volume, coagulation function and other lab indicators were recorded for 48 h. Liver histopathological examination was performed after death or execution.Results:All the three groups had severe hemorrhagic shock after modeling. The 48-h survival rate of the FP group and the GP group was significantly higher than that of the BC group (6/6 vs 4/6 vs 0/6). The average survival time of the FP group was not statistically different from that of the GP group [48 h vs (44.58±5.53) h, P>0.05], and was significantly longer than that of the BC group [48 h vs (1.64±0.17) h, P<0.01]. The bleeding volume of the FP group was significantly less than the GP group and BC group [(19.2±7.3) g/kg vs (41.3±8.6) g/kg, (51.5±7.3) g/kg, both P<0.01]. Compared with the GP group and the BC group, the cardiac output of the FP group was significantly improved [(5.00±0.53) L/min vs (4.13±0.41) L/min, (2.38±0.48) L/min, both P<0.05]. The coagulation function, liver and kidney function and blood lactate level of the FP group and the GP group were better than those of the BC group; the intra-abdominal pressure of the FP group was significantly higher than that in the GP group [(18.83±3.25) cmH 2O vs (3.83±1.47) cmH 2O, P<0.05]. There was no abnormal increased in intra-abdominal pressure in the BC group. According to the histopathology examination, there was no obvious secondary damage in the FP group. Conclusions:The application of self-expanding polyurethane foam for intraperitoneal packing to stop bleeding can effectively reduce the amount of bleeding in the fatal liver trauma hemorrhage model, effectively maintain vital signs, and improve the short-term survival rate.
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Objective:To offer experience for preventing thrombosis-related complications in patients receiving extracorporeal membrane oxygenation (ECMO).Methods:A case of mural thrombosis occurred in a patient with acute respiratory distress syndrome (ARDS) during ECMO therapy. The key points for nursing included: intensive monitoring of the ECMO parameters, repeated assessment of the thrombosis and appropriate preventive measures, adequate nutritional support, active mobilization and rehabilitation, and psychological care.Results:No severe thrombosis-related complication occurred during hospitalization and the patient was discharged 62 days after admission.Conclusion:Mural thrombosis related complication could be well prevented with active and individualized nursing.
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Objective:To explore the effects of 30° and 45° angles on the time and comfort of mechanical ventilation and extubation for patients undergoing abdominal surgery.Methods:A total of 64 patients who underwent oral tracheal intubation at SICU in the General Surgery Center of the Critical Care Medical Center of our hospital from January 2018 to November 2018 were selected. A total of 64 patients were randomly divided into group A and group B by random number table method, of which there were 31 people in group A and 33 people in group B. During the experiment, 1 people in group A and 3 people in group B experienced dyspnea during the withdrawal process and terminated treatment. Finally, 30 patients in group A and 30 patients in group B were selected. The bedside angle during group A treatment was 30°, and the bedside angle during group B treatment was 45°. The bedside angle card was used by both groups to measure the height of the bedside during the weaning. The two groups of patients were compared during the weaning period (improved Visual Analogue Scale score), weaning to extubation time, aspiration rate, intubation time, pressure ulcer rate, pulmonary function and hemodynamic changes after extubation.Results:Patients with ventilator to extubation time, during the machine during oxygenation index, pulled machine comfort score in group A were 117.50 (45.25, 189.00) min, (348.20±59.72) mmHg(1 mmHg=0.133 kPa), 1.00 (1.00, 2.00) points, group B were respectively 30.00 (13.50, 42.75) min, (314.60±67.13) mmHg and 3.00 (2.00, 3.00) points, two groups comparing the difference was statistically significant ( Z values was -2.411, -4.806, t value was 2.048, P<0.05 or 0.01). Conclusion:Lifting the bedside 30° during mechanical ventilation withdrawal in patients with abdominal surgery can shorten the time from patient withdrawal to extubation, improve the patient's oxygenation index, and improve the comfort during patient withdrawal. It can be used as an early patient for abdominal surgery. One of the auxiliary intervention measures for withdrawal.
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This report summarized the nursing experience of caring for twice skin grafts in a patient with enteroatmospheric fistula after trauma.Keys to nursing success including:monitoring vital signs closely to prevent septic shock,blocking enteroatmospheric fistula (EAF) and sucking overflowed intestinal juice timely,promoting the protection of the graft on abdominal wall wounds,strengthing drainage and lavage with the application of abdominal double cannula to control abdominal infection,early nutrion support with parenteral nutrition in combination with trophic enteral nutrition to improve intestinal immune function,and attaching importance to post-traumatic stress disorder.Timely blocking of EAF is the bases of skin graft healing.