ABSTRACT
To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement. Methods① Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared.② Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups. Results ① Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. ② Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01). Conclusion The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.
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Objective To explore the clinical significance of the serum brain?derived neurotrophic factor( BDNF) level in severe neonatal hyperbilirubinemia. Methods One hundred and twenty term and birth weight>2500 g infants admitted to the Neonatal Intensive Care Unit of Bethune nternational Peace Hospital of People Liberation Army were divided into severe hyperbilirubinemia group and control group according to their total bilirubin concentration. Total bilirubin( TBIL) concentration,BDNF and albumin in serum were determined in two groups. In addition, craniocerebral MRI was performed in severe neonatal hyperbilirubinemia before discharge. The correlation of the BDNF, TBIL, B/A, MRI results between severe hyperbilirubinemia group and control group were compared. Results The serum BDNF levels in severe hyperbilirubinemia group was ( 8. 84 ±3. 26) μg/L,significantly higher than that in control group((6. 24±1. 71) μg/L,t=3. 88,P0. 05). The serum BDNF level with craniocerebral MRI abnormal was ( 9. 53 ± 2. 77 ) μg/L, higher than that with craniocerebral MRI abnormal ((7. 81±3. 76) μg/L),but there was no statistical difference between them(t=1. 439,P>0. 05). Conclusion In severe neonatal hyperbilirubinemia, the body can secrete BDNF increasely. BDNF level is positivelycorrelated with B/ A level. As a marker of brain damage,BDNF is sensitive than craniocerebral MRI.
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Objectives To investigate the clinical characteristics of hypoglycemic brain damage, and to assess the ifndings of amplitude-integrated electroencephalography (aEEG) and its predictive value in hypoglycemic brain damage. Methods Twenty-four neonates diagnosed with hypoglycaemia were selected. 12-hour continuous aEEG recordings were performed on the day when hypoglycaemia was diagnosed and second aEEG tracings was performed on the same day or the day after. The variability of aEEG background, appearance of sleep-wake cycling, bandwidth span and amplitude of lower border were analysed and compared with the results of brain MRI. Results Different degrees of epileptic seizures were found in neonates with severe hypoglycemic brain damage and were persisted after the blood sugar was corrected. aEEG in hypoglycemic brain damage was characterized by calyptriform or jagged epileptiform activity, disappearance of the sleep-wake cycle, but little impact on amplitude of lower border and bandwidth span. The recovery of sleep-wake cycle was a sign of brain function recovery. The aEEG and MRI had a good consistency in monitoring the hypoglycemic brain damage. Conclusions aEEG have signiifcant changes in hypoglycemic brain damage and can be used to monitor dynamically hypo-glycemic brain damage.
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Objective To study the clinic value of brain edema detected by ultrasound examination in high risk term infants. Meth-ods The study group included 140 term infants who were found having brain edema in cranial ultrasound examinations. 152 term infants with normal ultrasound scan were selected as a control group. The risk factors of brain edema were collected, and univariate analysis and multivariate logistic regression analysis were performed. Results (1) There was no difference of incidence of brain edema between the infants with or without maternal ill historys, fetal distress or hypoalbuminemia, with P > 0.05. (2) In the univariate regression model, as-phyxia,hypoxic -ischemic encephalopathy (HIE) ,ventilation and metabolic acidosis were associated with an increased risk of brain ede-ma. In the multivariate logistic regression model, HIE was associated with a greater risk of brain edema and ventilation was possibly asso-ciated with brain edema. Conclusion Brain edema detected by ultrasound examination in high risk term infants has close relationship with HIE. It suggest that there is a consistency between ultrasound results and clinic situation. The detection of brain edema by ultrasound can assist doctor in clinic practice.
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Extract of Ground Beetle was found to affect rat rheology. when given orally to rats for 10 consecutive days, it resulted in the lowering of packed corpuscular volume, high and low whole blood shear viscosity, RBC aggregation and rigidity indices and sedimentation rate,but the constant of SR equation was raised and without effect on Plasma viscosity and fibrinogen content. These results suggested that the effect of ground beetle extract is by way of its action on RBC