ABSTRACT
Objective:To discuss the effect of optimized catheter management strategy on reducing the incidence of catheter-related adverse events in interhospital patients transition with extracorporeal membrane oxygenation (ECMO).Methods:A historical control trial was conducted. The patients transferred with ECMO to the Second Affiliated Hospital of Nanchang University from January 2018 to December 2020 were enrolled. From January 2019 to December 2020, 38 patients with interhospital transport using optimized catheter management strategy were as observation group; from January to December in 2018, 30 patients with routine catheter management method were selected as the control group. The incidence of catheter-related adverse events during transition was compared between the two groups.Results:There were no significant differences in clinical data such as age, number of catheters, transit time, transit distance, ECMO operation time between the observation group and the control group [age (years old): 58.26±10.38 vs. 54.00±16.61, number of catheters (roots): 6.03±1.32 vs. 5.51±1.37, transit time (hours): 2.48±0.30 vs. 2.51±0.39, transfer distance (kilometers): 155.27±20.45 vs. 165.56±25.62, ECMO operating time (days): 8.47±1.28 vs. 9.11±1.99, all P > 0.05]. The incidence of catheter-related adverse events in the control group was 26.67% (8/30), among them, 2 patients had ECMO catheter discount after getting over the bed, causing the flow alarm; 1 patient's central venous catheter (CVC) was not placed with U-shape and twisted, the vasopressors were not entered in time, which caused hypotension; 3 patients had more bleeding at the puncture points and film crimping; the urinary catheters were clamped in 2 patients and not opened in time. In the observation group, the patients did not have catheter-related adverse events during transition. There was statistically significant difference in the incidence of catheter-related adverse events between the two groups (χ 2 = 7.814, P < 0.05). Conclusion:The implementation of optimized catheter management strategy can greatly reduce the incidence of catheter-related adverse events and provide an effective safety guarantee for the interhospital transit of ECMO patients.
ABSTRACT
Objective To explore predictive value of endometrial receptivity and pregnancy outcome by hysteroscopy examination at the phase of implantation window in unexplained infertile women.Methods From Oct.2007 to Mar.2009,93 unexplained infertile women underwent hysteroscopy examination at 7-9 days after a spontaneous ovulation in Family Planning Research Institute of Guangdong Province.According to the endometrial glandular openings and vascular shape,79 cases without pathological endometrial changes were divided into 60 cases in good endometrium group and 19 cases in poor endometrium group.The following clinical parameters were analyzed and compared between two groups,including endometrial configuration,thickness,secretion,the development and number of pinopodes,vascular distribution,and the level of sex hormone,leukemia inhibitory factor (LIF) and glycodelin in the uterine flushing,and pregnancy outcome.Results (1)There was no statistical difference in the level of serum estrogen and progesterone at the phase of implantation window,which were (518 ± 176)pmol/L,(40 ±20)nmol/L in good group and (513 ±244) ptnol/L,(37 ± 19) nmol/L in poor group (P<0.05).The endometrium thickness at periovulatroy and implantation window days (1.06 ±0.10)cm/(1.16 ± 0.08)cm in good group did not show significant difference with (0.93 ±0.12) cm /(1.02 ±0.10) cm in poor group (P>0.05).The proportion of type A,B and C endometrium at periovulatory days were 63% (12/19),37% (7/19) and 0 (0/19) in good group and 23% (14/60),77% (46/60) and 0 (0/60) in poor group.When compared with those of type A or B between two groups respectively,it all showed statistical difference (P<0.05).However,at phase of implantation window,endometrium configurations were all type B at both groups.(2)90% (17/19)of women in good group and 7% (4/60)of women in poor group showed normal endometrial secretion function,which showed significant differences (P< 0.01).(3)The percentage of fully developed pinopodes and abundant pinopodes [84% (16/19) and 90% (17/19)] in good group were significantly higher than 42% (25/60)and 57% (34/60) in poor group (P<0.05).(4) The level of CD_(34) expression and microvessel density[MVD; (40.1 ± 1.2) positive unit(PU) and(21.7 ±4.0)/high power field (HP)] in good group were significantly higher than(18.1 ± 1.3) PU and (8.5 ± 1.3)/HP in poor group (P< 0.01).(5)The level of LIF and glycodelin in uterine flushing [(72 ± 54)ng/L and (196 ±20)μg/L] in good group were significantly higher than (15±16) ng/L and (116 ±26) μg/L in poor group (P<0.05).(6) The rate of clinical pregnancy,spontaneous abortion and term delivery were 74% (14/19),0 (0/14) and 100% (14/14) in good group and 23% (14/60),14% (2/14) and 86% (12/14) in poor group,the rate of clinical pregnancy and term delivery in good group were significantly increased when compared with those in poor group (P<0.01).Conclusions Hysteroscopy examination at the phase of implantation window could reflect the development of glandular openings and vasculature.It is a preferable method to evaluate the endometrial receptivity and predict pregnancy outcome.