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@#Objective To explore the natural changes of procalcitonin (PCT) in the early period after pediatric cardiac surgery with cardiopulmonary bypass (CPB). Methods A prospective and observational study was done on patients below 3 years of age, who underwent cardiac surgery involving CPB, with the risk adjustment of congenital heart surgery (RACHS) score of 2 to 5 and free from active preoperative infection or inflammatory disease. Blood samples for measurement of PCT, C-reactive protein (CRP) and white blood cell (WBC) were taken before surgery and daily for 7 days in postoperative period. Infections and complications within 7 days after operation were investigated. According to the presence or absence of infection and complications within 7 days after operation, the enrolled children were divided into an infection+complications group, a simple infection group, a simple complication group, and a normal group. Results Finally, 429 children with PICU stay≥ 4 days were enrolled, including 268 males and 161 females, with a median age of 8.0 (0.7, 26.0) months. There were 145 children in the simple infection group, 38 children in the simple complication group, 230 children in the normal group and 16 children in the infection+complications group. The levels of PCT, CRP and WBC were significantly higher after CPB. CRP and WBC peaked on the second postoperative day (POD) and remained higher than normal until POD7. PCT peaked on POD1 and would generally decrease to normal on POD5 if without infection and complications. Age, body weight, RACHS scores, the duration of CPB and aortic cross-clamping time were correlated with PCT level. There was a statistical difference in PCT concentration between the simple infection group and the normal group on POD 3-7 (P<0.01) and a statistical difference between the simple complication group and the normal group on POD 1-7 (P<0.01). A statistical difference was found between the simple infection group and the simple complication group in PCT on POD 1-5 (P<0.05). Conclusion WBC, CRP and PCT significantly increase after CPB in pediatric cardiac surgery patients. The factors influencing PCT concentration include age, weight, RACHS scores, CPB and aortic cross-clamping time, infection and complications.
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Objective:In order to analyze the current research status of handover shift in nursing management, summarize, analyze and judge the existing literature, in order to provide reference for clinical nursing practice.Methods:Through literature review, it is planned to review the current situation, shortcomings and future development of nursing handover classes.Results:The handover process was generally divided into four stages, of which SBAR was the best practice tool for handing over key information. For the performance of handover shifts, NASR, PVNC-BR, HES and Handoff CEX were often used to evaluate the performance of shifts, and for the results of shifts, evaluations were mostly conducted at the levels of patient safety, process elements, and organizational management. At present, the use of electronic information systems, benign organizational culture and patient and family-centered clinical practice could effectively improve the efficiency and effectiveness of handover.Conclusions:The process and elements of the current shift mode are relatively complete, and the communication strategy is reasonable, but there are still many shortcomings and defects. This suggests that nursing managers should adopt scientific intervention methods and evaluation tools when paying attention to and reforming nursing handover in the future to continuously improve the quality of handover.
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@#Objective To investigate the timing and clinical efficacy of diaphragmatic plication in the treatment of diaphragmatic paralysis after congenital heart disease (CHD) operation. Methods From January 2013 to February 2019, 30 children with CHD who were treated in Fuwai Hospital were collected, including 17 males and 13 females with a median age of 19.5 (3, 72) months. There were 6 patients with bilateral diaphragmatic paralysis (bilateral group) and 24 patients with unilateral diaphragmatic paralysis (unilateral group). The clinical data of the two groups were compared. Results Among the 6 bilateral diaphragmatic paralysis patients, 2 underwent bilateral diaphragmatic plication, and the other 4 patients continued their off-line exercise after unilateral diaphragmatic plication. Patients in the unilateral group had shorter ventilator use time (266.77±338.34 h vs. 995.33±622.29 h, P=0.001) and total ICU stay time (33.21±23.97 d vs. 67.33±28.54 d, P=0.008) than those in the bilateral group. One patient died in the bilateral group, and there was no statistical difference between the two groups (P=0.363). There was no statistical difference in the ICU stay time after diaphragm plication between the two groups (11.68±10.28 d vs. 29.83±27.73 d, P>0.05). Conclusion Diaphragmatic plication is an effective treatment for diaphragmatic paralysis after CHD operation once the conservative treatment failed. The prognosis of bilateral diaphragmatic paralysis is worse than that of unilateral diaphragmatic paralysis. Strict control of indications for surgery is beneficial to the early recovery of patients.
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Objective: To explore the relationship between erythrocyte sedimentation rate (ESR) and myocardial infarction (MI) occurrence in patients with rheumatoid arthritis (RA) combining coronary artery disease (CAD). Methods: A total of 106 consecutive patients with RA combining CAD were studied. There were 46 male and 60 female patients and divided into 2 groups:RA with MI group, n=46 and RA without MI group, n=60. The base line condition was compared between 2 groups, and multivariate regression analysis was conducted to explore the risk factors for MI occurrence in relevant patients. Results: Compared with RA without MI group, RA with MI group had the lower level of cholesterol and higher levels of inlfammatory indexes of ESR, high sensitivity C-reactive protein (hs-CRP) and CRP, P0.05. Multivariate regression analysis indicated that ESR was the independent risk factor of MI occurrence, OR=1.024, 95%CI 1.024 (1.007-1.043), P=0.007. Conclusion: ESR was independently related to MI occurrence in patients with RA combining CAD.