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Objective:To investigate myocardial fibrosis-related factors in patients with hypertrophic cardiomyopathy.Methods:Ninety-six patients with hypertrophic cardiomyopathy who received treatment in Zhoushan Hospital between January 2019 and January 2021 were included in this study. General data of all patients were collected. Cardiovascular magnetic resonance imaging was performed in all patients. Percentage of late gadolinium enhancement (LGE) was calculated. These patients were divided into positive and negative groups according to whether myocardial fibrosis existed. Related parameters were compared between the two groups. Correlations between related parameters and myocardial fibrosis range were analyzed.Results:Patient age in the positive group was significantly lower than that in the negative group [(42.84 ± 14.38) years vs. (50.71 ± 14.74) years, t = 2.04, P < 0.05]. The percentage of patients with New York Heart Association (NYHA) class III/IV heart function, N-terminal pro-brain natriuretic peptide (NT-proBNP) level, cardiac troponin (cTnI) level, creatine kinase-MB level, and myoglobin level in the positive group were 29.41% (20/68), 2 761.73 (1 505.22, 3 784.62) ng/L, 0.971 (0.447, 1.687) μg/L, (3.25 ± 2.65) μg/L and (66.14 ± 31.17) μg/L, respectively, which were significantly higher than those in the negative group [3.57% (1/68), 862.35 (551.48, 1 094.83) ng/L, 0.146 (0.037, 0.256) μg/L, (0.73 ± 0.22) μg/L, (28.82 ± 2.34) μg/L, t = 12.17, 55.28, 3.17, 5.18, 8.18, all P < 0.05]. Left ventricular ejection fraction and cardiac index in the positive group were (62.31 ± 17.89)% and (2.85 ± 0.71) L·min -1·(m 2) -1, respectively, which were significantly lower than those in the negative group ( t = 2.89, 6.18, both P < 0.05). Left ventricular end-diastolic volume (LVEDV), left ventricular maximum wall thickness (LVMWT) and left ventricular mass index (LVMI) in the positive group were (56.32 ± 17.28) mL/m 2, (2.24 ± 0.41) cm, (126.15 ± 12.34) g/m 2, which were significantly higher than those in the negative group ( t = 2.17, 2.75, 13.10, all P < 0.05). In the positive group, 18 patients had moderate and severe hypertrophy, 20 patients had moderate hypertrophy, and 30 patients had mild hypertrophy. There were significant differences in NT-proBNP, cTnI level and (LGE) extent between positive and negative groups ( t = 43.27, 5.28, 11.18, all P < 0.05). NT-proBNP, cTnI level and LGE extent increased with the increase in hypertrophy. Percentage of LGE was negatively correlated with patient age, and it was positively correlated with NT-proBNP, cTnI, LVDSV, LVMWT and LVMI. The differences were statistically significant (all P < 0.05). Conclusion:Patients with hypertrophic cardiomyopathy have a relatively high incidence of myocardial fibrosis. The extent of myocardial fibrosis is negatively correlated with patient age and it is positively correlated with NT-proBNP, cTnI, LVDSV, LVMWT and LVMI.
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Objective:To investigate the effects of Xueshuan Xinmaining tablet combined with metoprolol on creatine kinase-MB and troponin in patients with coronary heart disease after percutaneous coronary intervention. Methods:A total of 104 patients with coronary heart disease who received percutaneous coronary intervention in Zhoushan Hospital from March 2020 to March 2021 were included in this study. They were randomly divided into observation and control groups ( n = 52/group). The control group was give metoprolol (oral, 25 mg once,3 times/day). The observation group was given Xueshuan Xinmaining tablet (2 tablets once, 3 times per day) based on medication given in the control group. Two groups were treated for 1 month. Clinical efficacy, changes in vascular endothelial function and serum inflammatory factors post-treatment relative to those before treatment, and the incidence of adverse reactions were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [86.54% (45/52) vs. 67.31% (35/52), χ2 = 4.99, P < 0.05]. After treatment, nitric oxide in the observation group was significantly higher than that in the control group [(67.23 ± 9.52) μmol/L vs. (60.49 ± 9.71) μmol/L, t = 3.57, P < 0.001]. Endothelin in the observation group was significantly lower than that in the control group [(53.12 ± 7.28) ng/L vs. (61.25 ± 8.36) ng/L, t = 5.28, P < 0.001]. Tumor necrosis factor α, C-reactive protein and interleukin-6 in the observation group were (39.51 ± 6.37) μg/L, (4.13 ± 1.02) mg/L, and (19.43 ± 2.57) μg/L, respectively, which were significantly lower than (51.37 ± 7.28) μg/L, (5.62 ± 1.15) mg/L, (26.16 ± 3.19) μg/L in the control group ( t = 8.84, 6.99, 11.84, all P < 0.05). Creatine kinase-MB and troponin in the observation group were (30.18 ± 5.89) U/L and (7.32 ± 1.12) ng/L, respectively, which were significantly lower than (41.74 ± 6.76) U/L and (9.63 ± 1.45) ng/L in the control group, respectively ( t = 9.29, 9.09, both P < 0.05). No serious adverse reactions occurred during the treatment period in each group. Conclusion:Xueshuan Xinmaining tablet combined with metoprolol exhibit remarkable therapeutic effects on patients with coronary heart disease subjected to percutaneous coronary intervention. The combined therapy can greatly reduce inflammatory reaction and decrease creatine kinase-MB level and improve vascular endothelial function.
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Objective:To observe the effect of systematic graded rewarming measures on body temperature and prognosis of patients with moderate and severe trauma [revised trauma score (RTS) < 12] requiring emergency operation.Methods:A prospective randomized double-blind controlled study was conducted. From January 2020 to January 2021, 104 patients who underwent emergency trauma surgery in the Second Affiliated Hospital of Wenzhou Medical University were selected as the research object. According to random number table method, the patients were divided into traditional rewarming group and systematic graded rewarming group, with 52 cases in each group. Patients in traditional rewarming group (only record the body temperature without intervention, and start the rewarming process when the body temperature at any time was less than 36 ℃); the patients in the system graded rewarming group start the preventive measures as soon as they were admitted to the hospital, and record the body temperature. When the body temperature at any time was less than 36 ℃, start the graded rewarming process. Observe the rewarming effect, coagulation function, blood gas analysis and postoperative anesthesia recovery time of the two groups and final outcome.Results:With the extension of time, the body temperature of the two groups increased gradually. The body temperature of the systematic grade rewarming group was significantly higher than that of the traditional rewarming group at 2 hours after rewarming and at discharge (℃: 36.23±0.77 vs. 35.84±0.93 at 2 hours after rewarming, 36.54±0.87 vs. 35.82±0.92 at discharge, both P < 0.05). The incidence of subsequent hypothermia was significantly lower than that in the traditional rewarming group [7.7% (4/52) vs. 25.0% (13/52), P < 0.05]. The postoperative activated partial thromboplastin time (APTT) of the two groups was significantly shorter than that at admission (s: 35.74±8.05 vs. 45.55±28.02 in the systematic rewarming group, P < 0.05; 38.35±6.48 vs. 42.40±13.18 in the traditional rewarming group, P < 0.05); the intraoperative and postoperative pH values in the systematic rewarming group were significantly higher than those at admission (7.33±0.05, 7.36±0.06 vs. 7.30±0.07, both P < 0.05), while there was no significant difference between the intraoperative and postoperative pH values in the traditional rewarming group and those at admission (7.31±0.06, 7.33±0.06 vs. 7.31±0.05, both P > 0.05). The postoperative prothrombin time (PT) and anesthesia recovery time in the systematic graded rewarming group were significantly shorter than those in the traditional rewarming group [PT (s): 15.05±2.44 vs. 17.94±3.48, anesthesia recovery time (hours): 14.40±11.76 vs. 17.35±10.51, all P < 0.05], and the pH value was significantly higher than that in the traditional rewarming group (7.36±0.06 vs. 7.33±0.06, P < 0.05). The systematic graded rewarming group had higher improvement rate and lower disability rate than the traditional rewarming group (76.9% vs. 65.4% and 17.3% vs. 25.0%, both P < 0.05). Conclusion:Systematic graded rewarming measures can improve the hypothermia of emergency trauma patients who received surgery, reduce the incidence of subsequent hypothermia of trauma patients, shorten the time of postoperative resuscitation, improve the coagulation function and blood gas indexes, improve the treatment rate, and reduce the incidence of disability.
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Objective:To analyze retrospectively the risk factors for pulmonary infection after traumatic cervical spinal cord injury.Methods:The 154 patients with a cervical spinal cord injury studied included 120 with a pulmonary infection and 34 uninfected controls. Regressions were evaluated using data on their genders, ages, the cause of injury, affected segments, the neurological level of the injury (NLI), and the presence of a vertebral fracture or dislocation.Results:Age, complete injury, NLI at C 1 to C 4, and an injury-to-treatment time of more than 8 hours were found to be independent risk factors for secondary pulmonary infection. Conclusion:Elderly spinal cord injury patients, with a complete injury, an NLI between C 1 and C 4 or an injury-to-treatment time of more than 8 hours have a higher risk of pulmonary infection.
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Objective To explore the effect of establishment of green nursing channel for emergency patients with severe acute traumatic shock on quality of nursing care. Methods Fifth-six patients with severe acute traumatic shock who received nursing by green nursing channel admitted to Department of Adult Emergency of Second Affiliated Hospital of Wenzhou Medical University (Yuying Children's Hospital) from October 2016 to November 2017 were assigned in the research group, and at the same time, 42 patients with the same disease adopted conventional nursing mode from March 2015 to September 2016 were in the control group. The emergency treatment time, special inspection time, emergency to the operating room time, admission to operation time of patients, the incidences of the asphyxia and multiple organ dysfunction syndromes (MODS), and success rate of rescue in the two groups were recorded; the degree of patients satisfaction were observed. Results The emergency room treatment time (minutes: 13.51±3.62 vs. 20.84±3.96), special inspection time (minutes: 16.30±4.05 vs. 23.71±4.16) and admission to operation time (minutes:42.61±7.98 vs. 57.83±7.46) in the study group were significantly shorter (all P ＜ 0.05), the incidences of asphyxia and MODS in the study group were obviously lower than those in the control group [asphyxia: 1.79% (1/56) vs. 11.90% (5/42), MODS: 3.57% (2/56) vs. 16.67% (7/42), both P ＜ 0.05], and the success rate of rescue in the study group was significantly higher than that in the control group [100.00% (56/56) vs. 92.86% (39/42), P ＜ 0.05]; the degree of patients satisfaction in the study group was obviously higher than that in the control group [96.43% (54/56) vs. 83.3% (35/42)], and the differences between the two groups were statistically significant (all P ＜ 0.05). Conclusion The establishment of a green nursing channel for emergency patients with severe acute traumatic shock is helpful to improve the emergency working efficiency, shorten the time for nursing emergency response, and its application effect is good.
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Objective To investigate the level of knowledge, attitude and practice (KAP) of cardiopulmonary resuscitation (CPR) and analyze its related influencing factors in order to provide the basis for the construction of CPR training and management model and enhance the knowledge level and operational skills of CPR among community residents in Shacheng district of Wenzhou City. Methods From June 2015 to June 2016, a total of 560 community residents in Shacheng district of Wenzhou City were randomly selected as the subjects based on community house number using the random number table method, and they were investigated by general information questionnaire, CPR training questionnaire, and CPR KAP questionnaire. Univariate and multivariate linear regression analyses were used to analyze the influencing factors on KAP of CPR among community residents; the bivariate correlation analysis was used to analyze the correlations between KAP of CPR and the dimensions of KAP in the community residents. Results Of the 560 community residents, 33.39% knew CPR, only 15.89% had received CPR training and 12.14% knew how to handle cardiac arrest (CA), the average score of CPR KAP in community residents was (42.50±11.34) scores, which was positively correlated with knowledge, attitude and behavior dimensions (r = 0.56, 0.45, 0.49, all P ＜ 0.05). The average scores of CPR KAP of residents with various occupations were as follows: farmers, workers, students, teachers, company staff, medical workers, and other residents (respectively 37.24±9.34, 38.28±8.12, 43.12±8.45, 45.45±10.23, 44.89±9.89, 49.67±7.45, 40.00±10.45), the average scores of CPR KAP of residents with various educational levels were as follows: elementary school and below, junior high school, senior high school or secondary technical school, college education, bachelor degree or above (respectively 35.65±8.76, 37.67±10.65, 40.87±9.87, 44.56±10.78, 49.87±9.23), the average scores of CPR KAP were differed by whether they knew CPR or not (47.34±8.76 vs. 40.07±11.23), whether they had received CPR training or not (49.56±9.56 vs. 41.17±11.78), and whether they knew how to deal with CA or not (51.89±9.34 vs. 41.20±11.18), which were statistically significant (all P ＜ 0.05). Multiple linear regression analysis showed that the education level [95% confidence interval (95%CI) =1.12 - 2.24, P = 0.00), whether they knew the CPR or not (95%CI = 0.87 - 1.89, P = 0.00), and whether they had received CPR training or not (95%CI = 1.32 - 2.58, P = 0.00) and whether they knew how to deal with CA or not (95%CI =1.87 - 3.23, P = 0.00) were the factors affecting the residents' KAP of CPR. Conclusions The CPR KAP level of community residents in Shacheng district of Wenzhou city is low, and the level is influenced by many factors such as education level, etc. Local public health departments should actively carry out effective training of CPR knowledge and skills, and from the CPR knowledge, attitude and practice aspects, comprehensively enhance the residents' level of CPR KAP.