ABSTRACT
Objective:To identify the feasibility of inferior vena cava variability (ΔDIVC) combined with rectus femoris atrophy fraction in predicting the outcome of weaning from invasive mechanical ventilation (IMV).Methods:From January to December 2021, the patients with the need for IMV admitted to the Affiliated Yixing Hospital of Jiangsu University were recruited into prospective case-control study. The patients who met the withdrawal criteria were treated with a 2-h spontaneous breathing trial (SBT) and then extubated immediately. Patients with stable spontaneous breathing after extubation for more than 48 h were classified as successful weaning group, and on the contrary, the other patients were classified as failed weaning group. The clinical data and withdrawal indexes of the two groups were evaluated. The correlation between ΔD IVC and rectus femoris atrophy fraction was assessed. The influencing factors of weaning outcome were observed. The diagnostic value of ΔD IVC, rectus femoris atrophy fraction and the combination of two indexes in predicting weaning success were calculated by a plotting receiver operating characteristic (ROC) curve. Results:Sixty IMV patients were included in this study, including 38 cases of successful weaning and 22 cases of failed weaning. The two groups were comparable with regard to clinical data (all P>0.05). The rectus femoris cross-sectional area in the two groups diminished gradually with the length of ICU stay ( F=3.266, 3.625, both P<0.05). The rectus femoris cross-sectional area at the first SBT was significantly lower than that on the first day of admission in both groups [the successful weaning group: (2.54±0.88) cm 2vs. (3.08±0.98) cm 2; the failed weaning group: (2.22±0.87) cm 2vs. (3.02±1.10) cm 2, both P<0.05], but there was no significant difference between the two groups (all P>0.05). Patients in the successful weaning group had higher ΔD IVC and higher rectus femoris atrophy fraction than those in the weaning failure group [ΔD IVC: (25.02±4.65)% vs. (20.30±3.16)%; rectus femoris atrophy fraction: (81.89±5.09)% vs. (72.68±8.98)%, both P<0.05]. There was a positive correlation between ΔD IVC and rectus femoris atrophy fraction ( r=0.346, P=0.007). Both ΔD IVC and rectus femoris atrophy fraction played an important role in affecting weaning success (all P<0.05). The area under the curve (AUC) of ΔD IVC combined with rectus femoris atrophy fraction for predicting the weaning success was 0.880, which was significantly higher than that of ΔD IVC (AUC=0.791) or rectus femoris atrophy fraction (AUC=0.826). Conclusions:The predictive value of ΔD IVC combined with rectus femoris atrophy fraction for successful weaning of patients undergoing IMV is relatively accurate, which can be used to guide weaning.
ABSTRACT
Objective:To evaluate the effect of problem-based learning (PBL) combined with scene simulation in the cardiopulmonary resuscitation (CPR) teaching of standardized training of general practitioner, and explore a high-quality teaching method that will help students develop their clinical thinking and practical skills.Methods:Forty students of the Grade 2018 general practitioner training program in Yixing Hospital Affiliated to Jiangsu University were randomly divided into experimental group ( n=20) given PBL combined with scene simulation teaching method and control group ( n=20) given traditional teaching method. The pre-class preparation, classroom discussions, actual combat simulations, and analysis and summary were conducted in the experimental group (4-hour CPR training), while classroom teaching, teaching rounds, analysis and discussion, skills training were conducted in the control group (4-hour CPR training). Furthermore, both groups received the same theoretical test, skill assessment, and questionnaires. t-test or chis-quare test was performed for comparison between the two groups using SPSS 18.0. Results:The average score of theoretical test in the experimental group was significantly higher than that in the control group [(87.5±4.3) vs. (81.2±4.7), P<0.05]; the average score of the skill assessment in the experimental group was significantly higher than that in the control group [(91.0±1.5) vs. (83.1±1.8), P<0.05]. The questionnaire survey showed more students of the experimental group who reported greater improvement in their abilities than those of the control group ( P<0.05). Conclusion:PBL combined with scene simulation teaching method can effectively improve the quality of CPR teaching for standardized training of general practitioners, help students improve clinical thinking and comprehensive processing capabilities.
ABSTRACT
OBJECTIVE:To investigate therapeutic efficacy and safety of edaravone and nimodipine in the treatment of acute large area cerebral infarction. METHODS:101 patients with acute large area cerebral infarction were analyzed retrospectively and divided into control group (53 cases) and observation group (48 cases) according to drug use. After admission,control group re-ceived routine treatment as relieving cerebral edema,anticoagulant and antiplatelet agglutination. Observation group was additional-ly given Edaravone injection 30 mg added into 0.9%Sodium chloride injection 100 mL intravenously,within 30 min,twice a day+Nimodipine injection 12 mg added into 0.9%Sodium chloride injection 500 mL intravenously,once a day,at dripping speed of 0.5μg/(kg·min),for 10 days,and then given Nimodipine tablet 60 mg orally instead,3 times a day,for 5 d,on the basis of control group. Treatment course of 2 groups lasted for 15 d. Clinical efficacies of 2 groups were observed as well as SpO2,hemoglobin (Hb),total hemoglobin (HBT),reduced hemoglobin (MHb),NIHSS score and the occurrence of ADR before and after treat-ment. RESULTS:Total response rate of observation group was significantly higher than that of control group,with statistical signifi-cance(P0.05). After treatment,the levels of SpO2,HBT and MHb in 2 groups were significantly higher than be-fore,and the observation group was significantly higher than the control group;NIHSS score of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;Hb level of 2 groups were significantly low-er than before,with statistical significance(P0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:On the basis of conventional therapy,edara-vone combined with nimodipine in the treatment of acute large area cerebral infarction has significant therapeutic efficacy,can im-prove neurological impairment,but doesn't increase the occurrence of ADR.