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Objective:To investigate the correlation between dead space fraction and lung ultrasound score (LUS) and their prognostic value in patients with acute respiratory distress syndrome (ARDS).Methods:The data of 98 patients with ARDS treated in the intensive care unit (ICU) of the First Affiliated Hospital of Jinzhou Medical University from January to December 2020 were collected and analyzed. The gender, age, acute physiology and chronic health evaluationⅡ(APACHEⅡ), oxygenation index, dead space fraction and LUS score immediately and 24, 48, 72 and 96 hours after ICU admission and 28-day outcomes of all patients were collected. Pearson correlation was used to analyze the correlation between dead space fraction and LUS score. Binary Logistic regression was performed to analyze whether the dead space fraction and LUS score could be the risk factors of the prognosis in patients with ARDS. Receiver operator characteristic curve (ROC) was used to analyze the predictive effect of dead space fraction and LUS score on 28-day mortality in patients with ARDS.Results:A total of 98 patients with ARDS were included, of which 76 cases survived and 22 cases died within 28 days. With the prolongation of ICU stay, the dead space fraction and LUS score in the survival group increased first and then decreased. The dead space fraction and LUS score in the death group continued to increase to 96 hours, and were significantly higher than those in the survival group (dead space fraction: 0.569±0.019 vs. 0.491±0.021, LUS score: 20.09±2.39 vs. 15.13±1.91, both P < 0.05). There was a positive correlation between the dead space fraction and LUS score at 48, 72 and 96 hours in ICU ( r values were 0.200, 0.471 and 0.677, all P < 0.05). Binary Logistic regression analysis showed that dead space fraction and LUS score were independent risk factors affecting the prognosis of patients with ARDS [dead space fraction: odds ratio ( OR) was 69.064, 95% confidence interval (95% CI) was 22.680-123.499, P = 0.008; LUS score: OR was 4.790, 95% CI was 1.609-14.261, P = 0.005]. The results of ROC curve analysis showed that the dead space fraction at 48, 72 and 96 hours after ICU admission could be used to predict the 28-day mortality of patients with ARDS, the sensitivity was 59.1%, 90.9% and 95.5%, and the specificity was 89.5%, 80.3% and 98.7%. The area under the curve (AUC) of dead space fraction predicting 28-day mortality was 0.802, 0.952 and 0.998, all P < 0.01. The LUS score of 72 hours and 96 hours in ICU could be used to predict the 28-day mortality of patients with ARDS, the sensitivity was 77.3%, 77.3% and 100.0%, and the specificity was 68.4%, 88.2% and 80.3%, respectively. The AUC of the LUS score to predict the 28-day mortality of patients were 0.935 and 0.959, both P < 0.01. Conclusion:There was significant correlation between dead space fraction and LUS score, both of which were risk factors of 28-day mortality and be used to evaluate the 28-day prognosis of patients with ARDS.
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Objective To compare and analyze clinical effects of Bipolar transurethral plasma kinetic enucleation of prostate (PKEP) and transurethral resection of the prostate(TURP) on the treatment huge benign prostatic hyperplasia.Methods Nine-six cases of huge benign prostatic hyperplasia were selected in this hospital from March 2012 to March 2015.All the patients were divided into two groups according to different operation method,namely PKEP group and TURP group.Then the operative time,bleeding amount,bladder washing time,hospital stay,complications between two groups were compared,and the international prostate symptom score (IPSS),quality of life score (QOL),maximal urinary flow rate (Qmax),residual urine volume 6 months before and after operation were compared between the two groups.Results The operative time [(100.0 ± 3.5)min],bleeding amount [(161.0 ± 9.2) mL],bladder washing time[(15.2 ± 1.2) h],hospital stay[(10.8 ± 2.6) d],complications (6 cases) in PKEP group were less than that in the TURP group,which were(132.0±4.2)min,(198.0±12.1)mL,(36.8±1.3)h,(13.6±2.9)d,complications (18 cases)respectively(P＜0.05).The IPSS,QOL,Qmax,residual urine volume in both group were significantly improved compared with surgery before(P＜0.05),and there were no significant differences between the two groups(P＞0.05).Conclusion PKEP and TURP both are effective surgeries for the treatment of huge BPH,while PKEP has short operation time,less intraoperarive bleeding and low incidence of complications,it is worthy of further clinical promotion.
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Objective To research the clinical effect of transurethral plasmakinetic enucleation of prostate (PKEP) in the treatment of high-risk huge benign prostate hyperplasia(BPH).Methods Fifty-two cases of high-risk huge(＞120 g) BPH in this hospita1 from May 2010 to May 2015 were selected and performed PKEP.International prostate symptoms score(IPSS),quality of life(QOL) score,residual urine(RUV) and biggest urine flow rate(Qmax) were observed after operation.Results The mean operation time was (130.12 ± 12.14) min,the mean intraroperation bleeding amount was (120.24±9.81) mL,the mean hospital stay was (14.52 ± 1.82)d,the mean weight of resected prostate tissues was (113.42 ± 12.53)g.Follow-up lasted for 6 months without serious complications.IPSS、QOL,RUV and Qmax after operation were improved obviously,the difference was statistically significant compared with before operation(P＜0.05).Conclusion PKEP is safe and effective in the treatment of high-risk huge BPH.
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Objective To explore the relevance of safety culture in hospital nursing and the head nurse leadership behavior.Method The study adopts the method of convenience sampling to diversify the head nurse leadership behavior and nursing safety culture of 344 nurses in 3 first-class tertiary hospital of traditional Chinese Medicine in Heilongjiang Province.All survey data were entered into the SPSS17.0 software for analysis.Finally,conclusion was got.Result The head nurse leadership behavior is the highest score for leadership charm,followed by passive exception management,personalized care,active exception management,charisma,contingent reward and intellectual stimulation.Safety culture of nursing is slightly higher than medium level,in wh ch the team atmosphere,the satisfaction of the work,the unit security atmosphere,the management experience is higher than the medium level.The cognitive score of the pressure is lower than the medium level.Conclusion All dimensions of nurses' perception of head nurse leadership behavior has a positive correlation with each dimension of safety culture in hospital nursing.
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Objective To observe whether the high-flow nasal cannulae (HFNC) can reduce the rate of re intubation after extubation in patients with tracheal intubation in the intensive care unit (ICU). Methods 134 patients with mechanical ventilation in ICU were divided into 2 groups according to the order of ICU. The control group and the observation group were divided into 67 groups. Patients in control group were used routine oxygen inhalation (nasal duct and mask) after weaning, while the observation group was HFNC. All the other patients with the same treatment and care. The rate of re intubation was compared between the 2 groups. Results In the observation group, the rate of reintubation was 4.48%(3/67) of all. The control group was 14.92%(10/67), two groups of patients with reintubation rate difference was statistically significant (χ2= 4.17, P < 0.05). Conclusions HFNC can decrease the rate of re intubation after extubation in patients with tracheal intubation.
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Objective To investigate the effect of sufentanil combined with remifentanil on anesthesia in emergency traumatic brain injury . Methods Retrospective analysed a total of 80 the clinical data of patients with traumatic brain treated in Yuyao Municipal People’s Hospital from March 2015 to August 2016 received surgical treatment in emergency, accorded to the intraoperative anesthesia were divided into remifentanil group and combined anesthesia group(remifentanil combined with sufentanil anesthesia group).The changes of MAP,HR and stress indexes in two groups were observed,awakening quality and complication rate between the two groups were compared.Results Before anesthesia,there was no difference between the two groups of MAP and HR levels,10 minutes after the anesthesia,the beginning of the operation and the end of the operation,the combined anesthesia group was higher than that of the remifentanil group ( P<0.05 );there was no significant difference in blood glucose and cortisol levels between the two groups before and after anesthesia,and the indexes of 12h after operation were lower than those in the remifentanil group (P<0.05);two groups of patients with respiratory recovery time,recovery time,eye opening time command and extubation time showed no significant difference between the two groups;nausea and vomiting,incidence of bradycardia and other complications had no significant difference.Conclusion Sufentanil combined with remifentanil in emergency brain trauma surgery anesthesia was better,has little effect on the mean arterial pressure and heart rate,low complication rate.
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Objective To observe the high-flow nasal cannulae can reduce indoor postoperative intensive care patients with tracheal intubation in offline acute respiratory failure after extubation reintubation rates. Methods 53 cases of postoperative acute hypoxia type patients with respiratory failurein the ICU in offline after extubation were divided into two groups, control group of 24 patients, 29 cases of observation group patients. Control group patients in the event of a failure after using non-invasive mechanical ventilation (NIMV) and observation group of patients using HFNC. All other patients with same treatment and nursing. Compare two groups of patients reintubation rates. Results Observation group of reintubation rate was 20.69%(6/29), the control group was 45.83%(11/24), reintubation rate difference of two groups of patients were statistically significant (χ2=3.81, P < 0.05). Conclusions HFNC can reduce postoperative extubation after weaning reintubation rates in patients with acute respiratory failure.
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Objective To evaluate effect of preventing ventilator associated pneumoia (VAP) of patients with oral cavity endotracheal intubation by air impulse clearing away secretion drainage. Methods 348 patients with oral trachea cannula and mechanical ventilation (MV) in intensive care unit (ICU) were divided into control group (n=174) and observational group (n=174). The control group adopted conventional airway management methods without the subglottic secretion drainage while the observational group adopted conventional airway management methods on the basis of combining air impact method remove stranded on airbags. Other treatment and care for all of patients were basically the same. The MV time, duration in ICU and incident rate on VAP were compared between the two groups. Results The average of MV time in control group was (5.25±1.18) days, (5.62±3.20) days in ICU and the rate of VAP was 10.34%(18/174). In observational, it was (8.96 ±5.43) days, (10.43 ±4.96 ) days and 34.48%(60/174), respectively. The MV time, duration in ICU and incident rate on VAP were significantly different (P<0.05), with statistical significance. Conclusions The air impact method to remove airbags retentate could shorten time of MV and during time in ICU, and could reduce the rate of VAP.
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Objective To explore the safety and efficiency of patients with impacted upper ureter calculus combined with renal intrarenal infection treated by ureteroscopic pneumatic lithotripsy (URL ) and minimally invasive percutaneous nephrolithotomy (MPCNL) .Methods 126 cases of impacted upper ureteral calculi combined with renal intrarenal infection were treated in this hos-pita1 from July 2007 to July 2011 ,including 58 cases of URL ,68 cases of MPCNL .The success rate of primary lithotripsy ,stone-free rate ,postoperative adjuvant therapy ,operative time ,hospital stay ,incidence of postoperative complications and other data were analyzed .Results The success rate of group URL was 82 .76% (48/58) ,the success rate of group MPCNL was 100 .00% .The stone-free rate seven day after operation :URL was 62 .07% (36/58) ,MPCNL was 98 .53% (67/68)(P0 .05) .Conclusion It has higher successful rate and stone-free rate in patients with upper ureter calculus combined with renal intrarenal infection by MPCNL than those treated by URL .The safety and efficency of the former is better that of the latter .MPCNL can be the first choice for the upper ureter calculus combined with renal intrarenal infection .
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Objective To investigate the autonomic nervous system function of hyperthyroidism and hyperthyroidism by analyzing the heart rate variability of patients with the diseases. Methods 12-synchronous dynamic 24-hour monitoring and man-machine dialogue were used in 36 patients with hyperthyroidism, 30 patients with hypothyroidism and 26 cases of healthy volunteers(controls), and 24-hour electrocardiogram was analyzed.Heart rate variability indicators observed included 24 h consecutive sinus standard deviation of R-R interval (SDNN), standard deviation of sequential five-minute R-R interval (SDANN), percentage of differences between adjacent NN intervals that ＞ 50 ms(PNN50), root mean square standard deviation from adjacent R-R interval (rMSSD), low-frequency power (LF), high frequency power (HF), low frequency power/high frequency power (LF/HF). Results In hyperthyroidism group, SDNN[(80.48 ± 11.95)ms], PNN50[(18.56 ± 3.50)%], rMSSD [ ( 13.56 ± 3.45)ms] were significantly lower than those of the control group[ ( 128.06 ± 12.8)ms, (32.84 ± 7.21)%,(30.84 ± 6.12)ms, all P ＜ 0.05 ], and LF/HF(3.78 ± 1.63) were significantly higher than that of the control group (2.34 ± 1.06, P ＜ 0.05). In hypothyroidism group, SDNN[(65.65 ± 15.55)ms], SDAN[ (80.2 ± 15.72)ms],PNN50[ (16.34 ± 3.56)%], rMSSD [ (15.77 ± 3.58)ms ], LF[ (279.03 ± 91.49)ms2/Hz ] were also significantly lower than those of the control group[ (128.06 ± 12.87)ms, (132.40 ± 21.95 )ms, (32.84 ± 7.21 )%, (30.84 ± 6.12)ms, (525.60 ± 84.11)ms2/Hz, all P ＜ 0.05], but LF/HF (1.08 ± 0.73) was lower than that of the control group,however, the difference was not significant(P ＞ 0.05). Conclusions The heart rate in patients with abnormal thyroid function is lower in the overall performance, but in patients with hyperthyroidism sympathetic activity is dominate, while in patients with hypothyroidism, vagal nerve activity is dominate.
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<p><b>OBJECTIVES</b>To understand the role cellular immunology plays in the pathogenesis of chronic hepatitis B (CHB) through analysis of T cell receptor (TCR) beta chain variable region gene (BV) family dominant usage and beta chain complementarity determining region3 (CDR3) sequences of peripheral blood mononuclear cells of the patients.</p><p><b>METHODS</b>TCR BV families were amplified by inverse polymerase chain reaction (RT-PCR), and the dominant usage of BV families and CDR3 repertoire were analyzed by immunoscope technology for 8 CHB patients during their acute exacerbations and for 4 healthy blood donors who served as controls. The clonality of the T cells suspected by immunoscope was further confirmed by CDR3 sequencing.</p><p><b>RESULTS</b>The TCR BV CDR3 repertoire of the 4 healthy blood donors showed a Gaussian distribution. In the 8 CHB patients, however, the clonal expansion of T cells showed different TCR BV families with each patient. The T cells of the clonal expansion shared different CDR3 sequences.</p><p><b>CONCLUSION</b>The peripheral blood T cells of CHB patients during their acute exacerbation showed significantly a clonal expansion and their T cell clonal expansion may be stimulated by several HBV epitopes. These results indicate that cellular immunology is involved in the pathogenesis of the liver inflammation process of CHB.</p>