ABSTRACT
Objective To explore the clinical effect and safety of bedside hand jejunal nutrition tube placement in the treatment of severe acute pancreatitis. Methods The clinical data of 120 patients with severe acute pancreatitis treated in Dazhou Central Hospital from December 2014 to December 2016 were retrospectively analyzed. The patients in the control group(60 cases) were treated with nasogastric tube enteral nutrition on the basis of routine treatment. The patients in the observation group(60 cases) were treated with bedside bare hands on the basis of routine treatment, placement of jejunal feeding tube for jejunal nutrition treatment. The changes of gastrointestinal function,blood and urine amylase content,ICU stay time and the incidence of complications such as reflux and aspiration pneumonia were observed. Results In the observation group,the success rate was 96. 7％ (52 / 60),and the catheterization time was (23. 5 ± 8. 4)min,without any adverse reactions. The recovery time of bowel sounds and anal defecation time of the observation group were (2. 01 ± 0. 47)d and (2. 69 ± 0. 42)d,respectively,which were significantly shorter than those of the control group[(3. 63 ± 1. 52)d and (3. 96 ± 1. 36)d],and the differences were statistically significant(t = 7. 887, 6. 911,all P < 0. 01). There was no statistically significant difference in serum amylase level between the two groups before treatment(t = 1. 364,P > 0. 05). After treatment,the serum amylase level in the observation group was (163 ± 104)IU/ L,which was lower than that in the control group[(302 ± 136)IU/ L](t = 6. 289,P < 0. 01). The recovery time of urinary amylase and the stay time in ICU in the observation group were (9. 28 ± 1. 25)d,(11. 24 ± 0. 84)d, respectively,which were shorter than those in the control group[(16. 32 ± 3. 26) d,(18. 35 ± 2. 42) d],and the differences were statistically significant(t = 15. 619,21. 499,all P < 0. 01). Conclusion Enteral nutrition by beside manual placement of jejunal feeding tube in the treatment of patients with severe acute pancreatitis is simple and safe. It can effectively promote the recovery of intestinal function and shorten the time for ICU. It is worthy of application in clinical practice.
ABSTRACT
Objective To explore the optimization of intubations for severe brain injury patients in ICU. Methods Seventy-six severe brain injury patients were divided into research group and traditional group through the envelop method, with 38 patients in each group. Patients in research group was induced by dexmedetomidine, while patients in traditional group was induced by midazolam or propofol. Throat and intratrachea surface anesthesia was taken with 3 ml of 1%lidocaine on two groups before intubation, and they were intubated through direct laryngoscope. Patients were connected with breathing machines after intubation, and the arterial carbondioxide partial pressure was maintained at 30-35 mmHg (1 mmHg=0.133 kPa). Intubations time, one-time success rate, cardiovascular reaction index, myocardial damage and heart failure biomarkers, adverse reaction, patients comfort and intubationists satisfaction of the two groups were compared. Results The intubation time on research group was significantly shorter than that on traditional group [(27.1 ± 14.2) s vs. (42.2 ± 18.7) s], and there was statistical significance (P0.05). The heart rates and mean arterial pressure (MAP) at pre-intubation, post-intubation, 5 min after intubation and 10 min after intubation in research group were significantly lower than those in traditional group:heart rate:(77.8 ± 8.5) bpm vs. (85.1 ± 7.6) bpm, (85.3 ± 9.1) bpm vs. (106.4 ± 12.5) bpm, (84.4 ± 10.4) bpm vs. (96.4 ± 11.9) bpm, (80.5 ± 12.1) bpm vs. (89.0 ± 10.5) bpm;MAP: (82.6 ± 10.1) mmHg (1 mmHg = 0.133 kPa) vs. (93.2 ± 14.3) mmHg, (88.3 ± 13.2) mmHg vs. (113.7 ± 15.1) mmHg, (85.4 ± 14.0) mmHg vs. (101.3 ± 9.9) mmHg, (83.7 ± 10.7) mmHg vs. (90.3 ± 13.4) mmHg, and there were statistical significances (P0.05). For 6 and 12 h after intubation, creatine kinase isoenzyme MB (CK-MB), cardiac troponin T (cTnT) and brain natriuretic peptide (BNP) levels in research group were significantly lower than those in traditional group:CK-MB:(30.5 ± 7.2) U/L vs. (35.2 ± 10.1) U/L, (25.7 ± 5.7) U/L vs. (27.7 ± 6.5) U/L;cTnT:(0.6 ± 0.2) μg/L vs. (0.8 ± 0.1) μg/L, (0.5 ± 0.2) μg/L vs. (0.6 ± 0.2) μg/L;BNP:(152.6 ± 13.7) pg/L vs. (189.4 ± 19.3) pg/L, (89.7 ± 27.5) pg/L vs. (111.8 ± 20.4) pg/L, and there were statistical significances (P<0.05). There were no significant adverse reactions in two groups after topical anesthesia. The comfort and intubationists satisfaction scores in research group were significantly higher than those in traditional group: (2.5 ± 0.4) scores vs. (1.8 ± 0.5) scores and (8.8 ± 1.1) scores vs. (7.1 ± 0.9) scores, and there were statistical significance (P<0.01). Conclusions Combining dexmedetomidine induction with topical anesthesia to intubate is safe and effective, which is the optimization of tracheal intubations to severe brain injury patients.
ABSTRACT
With the development of modem clinical medical engineering,especially some large medical equipment,medical engineering section needs more talents in management and maintenance profession.Aiming at problems in the section construction,some viewpoints and suggestions are put forward.It is expected that the leadership could attach importance to medical engineering section,make good use of the talents and lay solid foundation for the development of hospitals.