Application of BIPAP ventilation in children patients with severe hand foot and mouth disease complicating neurogenic pulmonary edema / 重庆医学

Objective To investigate the influence of two different mechanical ventilation modes of bi-level positive airway pressure ventilation(BIPAP)and synchronized intermittent ventilation (SIMV)on the respiratory function and clinical curative effect in children patients with severe hand foot and mouth disease(HFMD)complicating neurogenic pulmonary edema.Methods Thirty children patients with severe HFMD complicating neurogenic pulmonary edema receiving mechanical ventilation were divided into the SIMV group (control group)and BIPAP group (experimental group).The lung protective ventilation strategy was applied in both groups.After 30 min use of SIMV and positive end expiratory pressure (PEEP)ventilation,the experimental group changed to use the BIPAP ventilation mode,while the control group still used the initial parameters.The airway peak pressure,alveolar plat-form (Pplat)pressure,lung compliance,pH value,arterial blood CO2 partial pressure (PaCO2 )and oxygenation index (PaO2/FiO2 )at 0 h (baseline value),24,48,72 h after mechanical ventilation were monitored.Besides,the duration of mechanical ventila-tion,28 d mortality rate and the length of ICU stay were observed.Results Thirty children patients smoothly spent their acute re-spiratory failure period.One case in each group during the later period of treatment was transferred to the other hospital for contin-uous therapy.Among them the transferred case in the control group finally died due to give up treatment.The rest 28 cases all were cured and discharged from hospital.The 28 d mortality rates in the two groups were 6.67% and 0% respectively,with no statistical difference (P >0.05).Compared with the control group,the airway peak pressure,Pplat and PaCO2 after mechanical ventilation for 24,48,72 h in the experimental group were significantly decreased(P <0.05);the lung compliance and PaO2/ FiO2 improvement was significantly higher than that in the control group(P <0.05);meanwhile the duration of mechanical ventilation and the length of ICU stay in the experimental group were shorter than those in the control group (P <0.05).Conclusion The BIPAP mode used in the mechanical ventilation therapy of the children patients with severe HFMD complicating neurogenic pulmonary edema can pro-vide better effective ventilation,improve oxygenation and respiratory function,and shorten the duration of mechanical ventilation.

Influential factors and nursing measures for mental disorders after liver transplantation / 现代临床护理

Objective To investigate the influential factors and nursing measures for mental disorders after liver transplantation. Methods Seventy-two patients had undergone liver transplantation and thirty-eight of them affected mental disorders and 34 of them did not. The mental disorder group and the non-mental disorder group were compared in terms of sex, age, mechanical ventilation time, pressure percentage mean of arterial pressure, intraoperative blood loss, duration of operation time, ICU stay time, postoperative pain duration and degree, Bullock complex (tacrolimus, FK506) blood drug concentration, history of preoperative hepatic encephalopathy, postoperative use of sedatives, postoperative constraint, postoperative metabolic abnormalities and disorders and infection. The plain logistic regression analysis was used to abstract the risk factors for mental disorders. Results The independent influential factors for the complicated mental disorders included the mean arterial pressure lower than that of pressure percentage> 20%, postoperative pain duration > 5 h and score by the numerical rating scale ( NRS ) > 4 , FK506 blood drug concentration> 13 ng/mL, postoperative abnormality, disturbance of metabolism and infection (P < 0.01). Conclusion The incidence rate of postoperative mental disorders is high among the patients having undergone liver transplantation. The influential factors for the mental disorder include blood pressure and postoperative pain duration and degree , FK506 blood drug concentration and metabolic abnormalities and disorders, and infection. The nursing measures like family nursing, effective control of blood pressure, postoperative analgesia, monitoring the drug concentration, maintaining a stable environment and preventing infection after liver transplantation are critical for the reduced rate of mental disorder.

Influencing factors of delirium of elderly patients with mechanical ventilation in ICU / 现代临床护理

Objectives To explore the influencing factors of delirium in elderly patients with mechanical ventilation in ICU. Methods Using a self-designed questionnaire,the investigation was done among 210 patients undergoing mechanical ventilation to evaluate the delirium condition and look into the influence factors of delirium.Results 112 cases(53.3%)of the elderly patients were affected with delirium.The major influencing factors included duration of mechanical ventilation,acute physiology and chronic health evaluation(APACHEⅡ),hypoxia,sleep deprivation.Conclusion The incidence of delirium is higher among the elderly patients with mechanical ventilation.As for nursing strategy,providence of family nursing,close observation of the disease changes, enhanced respiratory function and practical orientation cognitive training are important for the reduction of the incidence of delirium in the elderly patients with mechanical ventilation.