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Objective:To analyze the failure rate of enteral nutrition feeding in patients with mechanical ventilation, explore the influencing factors, and find out the existing problems and deficiencies in the process of nutrition support.Methods:Patients who were admitted to the ICU of Zhejiang People′s Hospital from June 2020 to January 2022 for mechanical ventilation and continuous enteral nutrition through the nose were retrospectively collected as the research subjects. The patients were divided into a standard group and a substandard group. Comparing the feeding status of enteral nutrition patients in the two groups on the 7th day, Logistic regression was used to analyze the influencing factors of feeding substandard.Results:A total of 82 patients (57.34%, 82/143) had feeding failure. Logistic regression analysis showed that complications ( OR=34.47, 95% CI 9.49 to 125.21) and infusion speed ( OR=0.21, 95% CI 0.08 to 0.57) were the influencing factors of feeding failure in ICU mechanical ventilation patients ( P<0.05). Conclusions:The feeding failure rate of ICU mechanical ventilation patients is higher than the feeding failure rate, and the slow infusion speed caused by complications and feeding intolerance is the main reason for the failure. It is suggested to set personalized feeding program for patients, optimize feeding measures, and improve the feeding failure rate.
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Objective:To explore the effect and nursing experience of vein-artery extracorporeal membrane oxygenation (V-A-ECMO) combined with continuous renal replacement therapy(CRRT) in the treatment of fulminant myocarditis.Methods:From January 2014 to October 2019, 15 cases of fulminant myocarditis were treated by V-A-ECMO combined with CRRT in the department of critical care medicine of Zhejiang People′s Hospital. During the operation of V-A-ECMO combined with CRRT, heart rate, blood pressure, coagulation function, troponin, creatinine and other indicators were closely monitored, strict liquid management and extracorporeal circulation pipeline management were implemented, and various complications such as arrhythmia, hypotension, bleeding and acral circulation disorder were timely observed and treated.Results:After 48 hours of treatment with V-A-ECMO and CRRT, the troponin value, lactic acid and creatinine of the patients were (21.53 ± 3.19) μg/L, (2.24 ± 0.37) mmol/L, and (58.13 ± 2.41) μmol/L, which were significantly lower than the start of the machine (79.65 ± 6.08) μg/L, (7.65 ± 1.28) mmol/L, (185.24 ± 5.63) μmol/L, the difference were statistically significant ( t values were -32.784, -15.726, -80.386, P<0.01), except for one dead patient, the left ventricular ejection fraction was significantly increased, reaching 45%-55% within 72 hours, and the left ventricular systolic and diastolic function was normal. Among the 13 patients who successfully withdrew the machine, 11 were cured, 3 were discharged automatically and 1 died. The success rate of withdrawing the machine was 86.67% and the cure rate was 73.33%. Conclusions:V-A-ECMO combined with CRRT can effectively improve cardiac renal function, maintain the stability of internal environment and improve the survival rate of patients. High-quality nursing can effectively improve the healing of patients, clinical need to continue to summarize the relevant nursing experience, improve the level of nursing, prevent various complications, improve the success rate of treatment, promote the recovery of patients.
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Objective:To construct an early comfort assessment and management plan for ICU patients with high flow nasal cannula, and to provide reference for clinical nursing practice and management.Methods:The domestic and foreign databases were retrieved, and the literatures on high flow nasal cannula were obtained and evaluated. The first draft of the early evaluation and management scheme of nasal high-flow humidification oxygen therapy was developed. Two rounds of expert consultation were conducted by Delphi method.Results:The early comfort assessment and management plan for ICU patients with high flow nasal cannula was formed, including 3 primary indicators, 12 secondary indicators, and 32 tertiary indicators. The authoritative coefficients of 2 rounds of expert consultation were 0.915 and 0.931, respectively. The coordination coefficients were 0.221, 0.130 and 0.278( χ 2 values were 8.000, 27.140, 163.824, P<0.05 or 0.01). Conclusions:The early comfort assessment and management plan of ICU patients with high flow nasal cannula are consistent with the advice of experts at all levels. The enthusiasm and authority of the experts is high, which provides a basis for the scientific management of ICU patients with nasal high-flow humidification oxygen therapy.
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Objective:To investigate the workload of extracorporeal membrane oxygen(ECMO) patients, estimate the number of hours of care based on the amount of nursing work, and to analyze the status of human resources, improve the quality of care and the effect of nursing.Methods:The Nursing Activity Assessment Scale was used to evaluate the daily workload of ECMO patients in the Intensive Care Unit of Zhejiang Province People′s Hospital, and the relevant factors affecting the workload were analyzed.Results:The average daily workload of ECMO patients was (76.06 ± 7.23) points, the daily nurse care ECMO patients time was 10.31 h, and the number of ideal nurses who needed to participate directly in the daily patients was 2.28. The workload was related to age, whether heparin and vasoactive drugs were used, and prognosis( t values were -3.184-7.291, P<0.05 or 0.01). Conclusions:The workload of ECMO patients is relatively large. At this stage, the ratio of nurse to patient is reasonable in our hospital. The patients′ age, use the heparin, vasoactive drugs and prognosis affect the level of nursing workload of ECMO patients.
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Objective@#To understand the emotional and behavioral problems among preschool children in Ezhou city, and to analyze its association with screen time,to provide a reference for making preventive measures.@*Methods@#1 720 children were selected from 9 kindergartens in Ezhou by cluster sampling method. Questionnaires were completed by the children’s parents or primary caregivers.@*Results@#High total difficulty score accounted for 9.8%(169/1 720) of all participants,the abnormal proportion of peer communication problems is the highest. The average screen time was (1.95±1.88) hours, among them 2.6% spent more than 2 hours. The average screen time on weekends was (2.84±2.58) hours, among them 19.1% spent more than 2 hours. The results of multiple linear regression analysis showed that weekday, weekend and total screen times was associated with children’s total difficulty score, emotional problems, conduct problems, peer interaction and hyperactivity(P<0.05). Furthermore, with the duration of screen time increased, the susceptibility of emotional and behavioral problems in these four dimensions increased.@*Conclusion@#Screen time is associated with emotional and behavioral problems among preschool children. Schools and parents should pay attention to interventions that target family TV viewing practices, and parent-child interaction and communication.
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Objective To evaluate the effect of adenosine receptor antagonist SCH442416 on the expression of Kir2.1,Kir4.1 and TASK-1 in rat Müller cell at an elevated hydrostatic pressure in vitro.Methods Thirty SPF Sprague Dawley rats were purchased from Shanghai Slack Laboratory Animals Ltd.Cultured Müller cells were divided into normal control group (n =6),40 mmHg/24 hours (1 mmHg =0.133 kPa) group (n =6) and adenosine + SCH442416 intervention group (n =6).Müller cells were treated with 40 mmHg pressure for 24 hours in 40 mmHg/24 hours group,and Müller cells were treated with 40 mmHg pressure for 24 hours + 10 μ mol/L adenosine + 100 nmol/L SCH442416 in adenosine + SCH442416 intervention group.The real-time PCR,Western blot,whole-cell patch-clamp recordings and immunohistochemistry were used to detect Kir2.1,Kir4.1 and TASK-1 expression and Müller cells Kir currents.The experimental procedures were in accordance with the National Institutes of Health (NIH) guidelines for the Care and Use of Laboratory,and follow the 3R principle.Results Western blot assay showed that,following 40 mmHg pressure cultured for 24 hours,the expression of Kir4.1 and TASK-1 protein in Müller cell were significantly decreased by 38.6％ and 52.6％ compared with the normal control group,with significant differences between the two groups (both at P =0.000);Kir2.1 protein expression decreased by 14.7％,with insignificant difference between the two groups (P =0.082).Kir4.1 and TASK protein expression in adenosine + SCH442416 intervention group was increased by 60.7％ and 61.4％ compared with the 40 mmHg/24 hours group,with significant differences between the two groups (both at P =0.000);Kir2.1 protein expression in adenosine + SCH442416 intervention group was increased by 8.8％ compared with the 40 mmHg/24 hours group,with insignificant difference between them (P =0.354).Real-time PCR assay showed that,following 40 mmHg pressure cultured for 24 hours,Kir2.1,Kir4.1 and TASK-1 mRNA expression in Müller cells were significantly decreased compared with the normal control group,with significant differences between the two groups (P =0.047,0.001,0.000);Kir4.1 and TASK-1 mRNA expression in Müller cells in the adenosine + SCH442416 intervention group was significantly increased compared with the 40 mmHg/24 hours group,with significant differences between the two groups (P =0.038,0.030);however,there is no significant change in Kir2.1 mRNA expression (P =0.612).Conclusions SCH442416 upregulates the expression of Kir4.1 and TASK-1 mRNA and protein,but weakly affects the expression of Kir2.1.
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This nursing interactive system, based on hospital information system, minimizes manual repetitions of nurses and their cross-space communication problems. It provides an accurate and intuitive information display and communication channel for clinical nursing care, which can also provide a preliminary evaluation of its application effects. On such basis, the authors propose that building such a system is a necessity in nursing informationization, as it elevates nursing efficiency, scientific management and patient safety.
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Objective To explore the better lock solutions of temporary catheter for patients with cont inuous renal replacement therapy (CRRT) in intensive care unit. Methods A total of 235 patients with insertion of temporary central venous catheters were divided into two groups randomly. 500 U/ml heparin saline was used in the observational group (123 cases) and 1 000 U/ml heparin saline was used in the control group (112 cases). Two groups adopted positive pressure seal tube method, and the situation of catheters and bleeding were observed. Results There were no statistical significance of two groups in the situation of catheters and bleeding (P>0.05). Logistic regression:8 observational factors (machine type, dilution method, catheter placement, blood flow velocity, the use of anticoagulants, whether to use immunity inhibitors, whether for high blood pressure, diabetes) in the Logistic regression, no factors was found to have association with the situation of catheters (P>0.05 ), 2 factors were found to have association with bleeding (P0.05 ), all of them had positive effect: APACHEⅡ,APTT; two factors were found to have association with bleeding (P < 0.05), all of them had hazard effect: APACHEⅡ,APTT. Conclusions Compared with 1 000 U/ml, 500 U/ml heparin lock solutions doesn′t increase the thrombosis of temporary catheters, and also decrease the rate of bleeding,so 500 U/ml heparin lock solutions can use in CRRT patients who use anticoagulant.
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The ancient books on traditional Chinese medicine in Jiangsu Province were recorded and analyzed, fol-lowed by an introduction of their holdings in Jiangsu Province, and suggestions were put forward for their systemiza-tion, such as enforcing the role of special libraries of traditional Chinese medicine, promoting the general survey and report of ancient books on traditional Chinese medicine, and compiling《Jiangsu union catalogue of ancient books on traditional Chinese medicine》.