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Objective To investigate the dynamic changes of dead space fraction (VD/VT) and its effect on the prognosis in the patients with acute respiratory distress syndrome (ARDS).Methods Thirtytwo patients with ARDS in EICU of the First Affiliated Hospital of Kunming Medical University from January 2015 to August 2016 were selected and divided into the survival group and the death group according to the 28 d mortality rate.VD/VT on 1-6 d in the two groups was calculated according to the formula.The parameters of basic condition,PaO2/FiO2,APACHE Ⅱ score,LIPS score,PEEP of the two groups were compared.Results LIPS and APACHE Ⅱ scores had statistical difference between the death group and survival group (P＜0.05);VD/VT on 1-3 d had no statistical difference between the two groups (P＞0.05),and VD/VT on 4-6 d in the death group was significantly higher than that in the survival group (P＜0.01).△PCO2,pH and PaO2/FiO2 had statistical difference between the death group and the survival group (P＜0.05).The binary classification Logistic regression analysis found that APACHE Ⅱ,LIPS,△PCO2,VD/VT were the risk factors.VD/VT on the 4th day was selected,its' cut off value was 0.62,and the sensitivity of the prognostic evaluation was 90.0 ％,the specificity was 95.5 ％.Conclusion The dead space fraction is an independent risk factor for the prognosis of ARDS patients,and VD/VT on 4th day could effectively identify the high-risk patients.
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Objective To study the predictive value of lung ultrasound score(LUS) on the extubation success rate in the patients with mechanical ventilation for early identifying the high risk patients with extubation failure and guiding the sequential therapy after extubation.Methods The prospective study method was adopted.Eighty-one cases with mechanical ventilation exceeding 48 h and successfully passing the spontaneous breathing trial(SBT) in EICU were selected.The bedside LUS evaluation was conducted before extubation.The cases were divided into the two groups according to whether successfully weaning.And the LUS differences before extubation were compared between the two groups.The receiver operating characteristic(ROC) curve was used to evaluate the predictive efficiency for extubation failure.Results The age and sex had no statistical difference between the two groups(P＞0.05).In included 81 cases,27 cases were failed to extubation and appeared different degrees of respiratory distress sign:respiratory rate(RR) increase,heart rate(HR) increase,SpO2 decrease,etc.,which needed non-invasive mechanical ventilation or high flow nasal cannula oxygen for alleviating respiratory difficulty.In the extubation failure group,10 cases were ineffective by above treatment and then needed reintubation.One case died within 24 h after extubation.Fifty-four cases succeeded in weaning and extubation.The LUS score was positively correlated with RR and PaCO2 (r=0.43,0.62;P＜0.05) and negatively correlated with SpO2 and PaO2(r=-0.76,-0.58;P＜0.05),while it was not correlated with HR and pH value(r=0.15,0.02,P＞0.05).The area under the ROC curve (AUC) of LUS score was 0.90(95％CI:0.84-0.95),it could be regarded that the accuracy of LUS for predicting extubation failure rate was stable,its sensitivity was 0.84 and specificity was 0.80.The diagnostic cutoff value was 15.00,if the LUS score exceeding 15 points,the extubation failure rate was significantly increased.Conclusion The LUS score has clinical application value for assessing the extubation success rate in the patients with mechanical ventilation.The patients with high risk of extubation failure can be early identified by the LUS score,which can guide the sequential therapy after extubation.
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Objectives This study aimed to understand the attitude of medical students at the undergraduate level towards the learning of first-aid skills and knowledge as well as pre-hospital first-aid services.Furthermore,this study helped to design a more effective strategy of first-aid education in medical schools.Methods A questionnaire survey was conducted among 1219 undergraduates in medical university,using stratified and cluster proportion sampling method.Results When an accident was met,81.26％ of the undergraduates would voluntarily offer pre-hospital first-aid assistance;77.76％ students had studied first aid knowledge through various channels.However,most students did not have a systematic comprehension of first-aid knowledge and skills.Conclusion Undergraduates in medical university have a positive attitude to offering pre-hospital first-aid assistance;however,the majority of students lack the ability to provide correct and effective assistance.Therefore,medicinal university needs to provide the students with more effective first-aid education.
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Objective To study the effect of combination mode of blood purification on insulin resistance in MODS patients and discuss the best mode of blood purification to improve insulin resistance in MODS patients.Methods A total of 60 MODS pa-tients were selected and randomly divided into control group(single mode of blood purification)and treatment group(combination mode of blood purification),each group of 30 cases.Blood glucose (BG),glucose standard deviation (BGSD),coefficient of variation of blood glucose (BGCV),regular insulin dosage (Ins),fasting insulin (FINS),insulin resistance index (HOMA-IR),HbA1c,C-re-active protein (CRP)was observed before and after treatment.Results BG,HbA1c,FINS,CRP,HOMA-IR,Ins of experimental group was lower than that of control group (P 0.05 ).Conclusion Combination mode blood purification may be more effective to insulin resistance in MODS patients.
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Objective To discuss the current status of application of the four kinds of clinical decision‐making method (mode recognition method ,hypothesis deductive method ,event‐driven method and applying regulation method ) in the clinical practice of the emergency resident doctors and to understand their mastery situation of the clinical decision‐making methods and the influencing factors .Methods One thousand and thirty‐five patients collected by 207 resident doctors (5 cases were randomly collected from the patients diagnosed and treated by each resident doctor ) were divided into 3 groups according to different year systems .The clinical decision‐making methods ,diagnosis accuracy of different clinical decision‐making methods and the influencing factors of decision‐making methods were compared among different grades .Results The difference in the decision‐making methods among different year systems had statistical significance (P<0 .05);furthermore ,the difference in the diagnostic accuracy among different decision‐making methods had statistical significance (P< 0 .05) ,the differences in the defensive behaviors and different decision‐making methods were statistically significant (P<0 .05) ,the multi‐classification Logistic regression of different decision‐making methods showed that the differences in the different residency year system ,residency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree had statistical significance (P< 0 .05) .Conclusion The most commonly used decision‐making method by the resident doctors is the applying regulation method .The residency year system ,resi‐dency education ,residency clinical contacting time ,inpatient symptoms ,defensive behaviors and interrogation reliability degree are the influencing factors of application of the clinical decision‐making methods in the clinical practice of the emergency medicine spe‐cialty .