ABSTRACT
Objective:To explore the effects of pressure controlled ventilation-volume guaranteed (PCV-VG) mode on intraoperative pulmonary ventilation and postoperative pulmonary complications (PPC) in elderly patients undergoing thoracoscopic lobectomy.Methods:Sixty patients of American Society of Anesthesiologists (ASA) classification Ⅱor Ⅲ, aged 65-80 years old, with body mass index (BMI) 18-30 kg/m 2, received thoracoscopic lobectomy under general anesthesia from November 2021 to June 2022 in the Second Hospital of Shanxi Medical University were recruited. The patients were divided into PCV-VG and volume-controlled ventilation (VCV) groups using the randomized number table method, with 30 patients in each group. The ventilatory parameters of two-lung ventilation were set to respiratory rate (RR) at 10-12 breaths/min, with a tidal volume (VT) of 8 ml/kg (ideal body weight). The ventilatory parameters of one-lung ventilation (OLV) were set at 12-16 breaths/min, with a VT of 6 ml/kg (IBW). The peak airway pressure (Ppeak), plateau airway pressure (Pplat), driving pressure (ΔP), dynamic lung compliance (Cdyn), end-tidal carbon dioxide (ETCO 2), heart rate (HR), mean arterial pressure (MAP), partial pressure of oxygen (PaO 2) and partial pressure of carbon dioxide (PaCO 2) were obtained at 1 min before OLV (T 0), 30 min after OLV (T 1) and 60 min after OLV (T 2). The incidence and severity of PPC, chest tube duration time and postoperative hospital stay time were recorded. Results:The Ppeak, Pplat and ΔP were higher and Cdyn was lower in both groups at T 1-T 2 than at T 0 (all P<0.001). The Ppeak, Pplat and ΔP were higher and Cdyn was lower in PCV-VG group than in VCV group (all P<0.05). There were no statistical differences in HR, MAP, ETCO 2, PaO 2 and PaCO 2 between the two groups (all P > 0.05). There were no statistical differences in the incidence of PPC [43.3% (13/30) vs. 30.0% (9/30)] and chest tube duration time [(4.4±0.9) d vs. (4.2±1.2) d] between VCV group and PCV-VG group (all P>0.05). Compared with VCV group, the proportion of patients with ≥grade 2 PPC was lower in PCV-VG group [10.0% (3/30) vs. 36.7% (11/30), χ2=5.96, P<0.05]. The postoperative hospital stay time in PCV-VG group was shorter than that in VCV group [(6.4±1.3) d vs. (8.0±1.9) d, t = 4.85, P<0.05]. Conclusions:PCV-VG mode can effectively reduce the severity of PPC, shorten the postoperative hospital stay time and improve the prognosis in elderly patients undergoing thoracoscopic lobectomy.
ABSTRACT
<p><b>OBJECTIVE</b>To study the relationship between fibrotic focus (FF) and carbonic anhydrase (CA) IX in invasive ductal carcinomas (IDC) of the breast.</p><p><b>METHODS</b>In 167 cases of IDC, the FF was assessed morphologically, and expression of ER, PR and CA IX was evaluated using MaxVision immunohistochemistry.</p><p><b>RESULTS</b>The expression of CA IX in IDC with and without FF was 56.3% (45/80) and 28.7% (25/87) respectively, with significant difference (P=0.001). In IDC with FF, the CA IX expression of tumor cells in tumors with CA IX-positive fibroblasts (35/40, 87.5%) was significantly (P<0.001) higher than that in tumors with CA IX-negative fibroblasts (10/40, 25.0%). In IDC with FF, the CA IX expression of fibroblasts of FF in grade 3 IDC (23/33, 69.7%) was significantly (P=0.006) higher than that in grade 1+2 tumors (17/47, 36.2%). The ER and PR expression of tumor cells in tumors containing CA IX-negative fibroblasts was 72.5% (29/40) and 65.0% (26/40) respectively, whereas the ER and PR expression of tumor cells in tumors containing CA IX-positive fibroblasts was 50.0% (20/40) and 42.5% (17/40) respectively; the difference was statistically significant (for both ER and PR, P=0.04). The age of patients with tumors containing CA IX-negative fibroblasts was significantly (P=0.002) older than those containing CA IX-positive fibroblasts. The FF diameter/tumor diameter in tumors containing CA IX-positive fibroblasts was significantly larger than those containing CA IX-negative fibroblasts. (3) For the groups of tumor size≤2 cm and tumor size between 2 cm to 5 cm, the diameter of the fibrotic focus was significantly (P<0.01) smaller than the fibrotic focus size of tumors>5 cm in size.</p><p><b>CONCLUSIONS</b>CA IX expression is correlated with FF, and that in fibroblasts of FF correlated with patients' age, tumor grade, hormone receptors and FF diameter/tumor diameter. CA IX expression in FF might be a marker for poor prognosis in patients with breast cancer.</p>
Subject(s)
Female , Humans , Age Factors , Antigens, Neoplasm , Breast Neoplasms , Metabolism , Pathology , Carbonic Anhydrase IX , Carbonic Anhydrases , Carcinoma, Ductal, Breast , Pathology , Fibroblasts , Metabolism , Immunohistochemistry , Neoplasm Grading , Neoplasm Proteins , Receptors, Estrogen , Metabolism , Receptors, Progesterone , MetabolismABSTRACT
Objective To study the effect of evidence-based nursing combined with KAP model on health education to the parturients from suburbs.Methods According to problems in 200 pregnant women from suburban areas, health education was performed to them using evidence-based nursing and KAP model. The rate of access to knowledge, confidence about laboring, spontaneous participation in action to promote delivery, natural birth rate, episiotomy rate, breastfeeding rate and rate for satisfaction with midwives were compared between pre-and post-health education.Results After intervention, their access to knowledge, confidence about laboring, spontaneous participation in action to promote delivery were obviously improved than those before intervention(P<0.05). The rate of natural birth, cesarean delivery, forceps delivery and satisfaction with midwives were 66.0 %, 30.0 %, 1.0% and 94.4 %, respectively.Conclusion Evidence-based nursing and KAP model is effective in the health education to pregnant women from suburbs.
ABSTRACT
Objective To observe the nursing efficacy of cluster-based care for bronchial asthma.Methods 100 cases with bronchial asthma were randomly divided into the study group and the control group with 50 patients in each group.The control group received usual care,and the study group received cluster-based care model.Curative effect,the total of the cases received inhalation therapy correctly,compliance of inhalation therapy,degree of satisfaction to nursing services in the two groups were compared.Results The curative effect in the study group were better significantly than the control group (86％ vs 58％).The cases received inhalation therapy correctly in the study group were more than the control group (92％ vs 72％).The compliance of inhalation therapy in the study group was significantly higher than the control group(90％ vs 80％).The degree of satisfaction to nursing services in the study group were significantly higher than the control group (98％ vs 86％).Conclusions Cluster-based care had good effect on patients with bronchial asthma.
ABSTRACT
Objective To study the effects of collaborative care model on the negative mood and the quality of life of lung cancer patients. Methods Sixty patients were randomized into the observation group and the control group with 30 cases in each.The control group only received usual care,the observation group Was treated with collaborative care,encouraging patients and their families to participate in health care.Using SDS、SAS、activities of daily living(ADL)scale and St.George's Respiratory Question-naire(SGRQ)to evaluate the effects ofthe patients in both groups on admission and one months after the discharge.Results One months after the discharge,the scores of anxiety and depression among the observation group were lower than those of the control group;ADL grade and quality of life score in the observation group compared with the control group were significantly improved,the difference was statistically significant. Conclusions Application of collaborative care management can improve the state of anxiety and depression,reduce hospitalization time and medical costs as well as improve quality of life.