ABSTRACT
Objective To study the protective role of continuous veno-venous hemofiltration (CVVH) in cardiac insufficiency refractory to diuretic therapy after acute myocardial infarction.Methods A total of 104 acute myocardial infarction patients admitted from march 2012 to march 2016 were recruited.According to their wishes,the patients were divided into two groups,continuous veno-venous hemofiltration combined with routine therapy as experimental group (n =52) and conventional treatment as control group (n =52).Mortality rate within one month,the mean length of ICU stay,the mean length of hospital stay,ventilator usage and urine output volume were documented.Then the difference in BW between pre-and post-treatment was determined for evaluation of fluid retention,and blood plasma C-reactive protein (ΔCRP),interleukin 6 (ΔIL-6),interleukin 8 (ΔIL-8),tumor necrosis factor-α (ΔTNF-α) and left ventricular ejection fraction (ΔLVEF) were measured and calculated.A multiple linear regression model to predict ΔLVEF was established.Data recorded at different intervals in the same group were analyzed by ANOVA.Data of the monitoring biomarkers,the mean length of ICU stay,the mean length of hospital stay of two groups were recorded at the same given intervals were analyzed by t test.Data of mortality rate within one month,drugs and ventilator usage in two groups were analyzed by x2 test.P value less than 0.05 was considered statistically significant.Results There were significant differences in mortality rate within one month,the mean length of ICU stay,the mean length of hospital stay,and the duration of ventilator usage between the two groups (P ＜ 0.05).Total volume of fluid output (urine and ultrafiltration volume) was higher in experiment group than that in control group in 48 hours after the treatment (P ＜ 0.01).The levels of CRP,IL-6,IL-8 and TNF-α decreased significantly (P ＜ 0.05) in experiment group after treatment but not in control group (P ＞ 0.05) as compared with those before the treatment.BW was decreased and LVEF was increased in both groups after treatment (P ＜ 0.05) compared with those before the treatment.Levels of CRP,IL-6,IL-8 and TNF-α were lower in experiment group than those in control group after treatment (P ＜ 0.05).BW was meagerly lower and LVEF was meagerly higher in experiment group than those in control group without statistical significance (P ＞ 0.05).However,the degrees of ΔLVEF andΔBW were greater in experiment group than those in control group (P ＜ 0.01).In experiment group,significantly positive correlations were found among ΔBW,ΔCRP,ΔIL-6,ΔIL-8,ΔTNF-α and ΔLVEF (P ＜0.05).Multiple linear regression analyses showed that ΔBW and ΔTNF-α were the independent factors forΔLVEF and ΔBW was the main independent factor for ΔLVEF in control group.ΔLVEF was positively correlated with ΔBW (P＜0.01) but had no correlation with ΔCRP,ΔIL-6,ΔIL-8 and ΔTNF-α (P ＞0.05).Multiple 1inear regression analyses showed that only ΔBW was the independent factor for ΔLVEF.Conclusion CVVH plays protective role in acute myocardial infarction patients with consequent cardiac insufficiency refractory to diuretic therapy by clearance of inflammatory cytokines and removal of retained fluid,and the removal of retained fluid is the most import mechanism to protect heart function.
ABSTRACT
Objective To explore the methods of training emergency nurses under the Trinitarian Mode.Methods 77 emergency nurses were distributed to different groups and received different training contents and assessment criteria stratifiedly as well as in phases according to their working ages.The training content contained emergency capability,emergency specialist skills,evidence based nursing,nursing scientific research,and clinical practice,etc.Results Through the on-the-job training,their emergency caring ability were overall improved,the human resource was effectively utilized,and the overall ability for coping with public health emergencies had made great progress.Conclusions Under the Trinitarian emergency treatment mode,a diversified on-the-job training for the emergency nurses will promote the development of emergency care,as well as help keep pace with the rapid development of emergency medical sciences.