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Objective:To evaluate the effect of early enteral nutrition supplemented with synbiotics on the levels of C reactive protein (CRP) and Procalcitonin(PCT)level of patients with severe brain injury.The clinical outcomes were also observed.Methods:Forty-seven patients with identified severe brain injury were randomized into study group (n =24) and control group (n =23).All patients received enteral nutrition via nasogastric tube within 24 to 48 h following admission.Patients in the study group were also given synbiotics.Fasting blood samples were collected for detecting the levels of CRP,PCT on day 1,4,7 and 15,respectively.The incidence of lung infection,the length of ICU stay,the cost,the GCS score,the APACHE Ⅱ score,and the mortality in 30 days after administration were collected and compared between 2 groups.Results:Patients in the study group had a lower level of PCT than control group on day 7 and 15 (P ＜0.05,P ＜0.05),and a lower level of CRP on day 15 (P ＜0.01)was also found in the study group.The incidence of lung infection of the study group was also significantly lower than the control group (P ＜ 0.05).A reduced length of hospital stay and a lower cost were found in the study group (P ＜0.05).The GCS scores in the study group was higher on day 15 when compared with that in the control group (P ＜ 0.05).However,There was no significant change in APACHE Ⅱ score and mortality in 30 days(P ＞ 0.05).Conclusion:Nutrition supplemented with synbiotics leads to a lower rate of infection,a shorter length of ICU stay,a reduced the cost,and a better outcome in patients with severe brain injury.
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Objective To explore the occurrence of enteral feeding intolerance and its influencing factors in patients with severe acute pancreatitis. Methods A retrospective analysis of severe acute pancreatitis patients undergoing enteral nutrition therapy admitted to a tertiary hospital from October 2012 to October 2015 was performed. The occurrence of enteral feeding intolerance was analyzed,and its influencing factors were evaluated by single factor analysis and multivariate logistic regression analysis. Results There were 54 patients suffered from enteral feeding intolerance among 92 patients. The results of single factor analysis and multivariate regression analysis showed that higher APACHE II score,intra-abdominal pressure and central venous pressure were independent risk factors of feeding intolerance,while adding dietary fiber was a protective factor. Conclusion Severe acute pancreatitis patients with higher APACHE II score,intra-abdominal pressure and central venous pressure can aggravate the risk of feeding intolerance,while adding dietary fiber is beneficial for reducing the incidence.
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Objective To probe into the nursing experts' perspectives on the clinical training of master of nursing specialist which was newly set up in our country,and to provide reference for the clinical training model of the master of nursing specialist.Methods In-depth interviews were conducted with thirteen nursing experts from five universities and three affiliated hospitals in our country.The data were analyzed by phenomenological procedures.Results Nursing experts proposed some suggestions on the clinical training of master of nursing specialist from the following aspects:clinical training goal,training content,training mode.Conclusions It is important to explore suitable clinical training pattern for the master of nursing specialist from the national education policy,the different requirements for enrollment,the development requirement of students' clinical competence and the effective operation of cultivating mode,in order to promote the further development of master of nursing specialist education.
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Objective To probe into learning experience of master of nursing specialist students during clinical practice,so as to provide some educational references for their clinical practice training.Methods Thirteen master of nursing specialist students from two universities in Chongqing were selected by homogenous sampling.The data were collected by focus group interview and analyzed by phenomenological procedures.Results The learning experience of master of nursing specialist students during clinical practice were obtained via evaluation on clinical learning and teaching.Conclusions It is important to explore appropriate teaching strategies,strengthen clinical teacher teams and establish a scientific clinical teaching management system during clinical practice of master of nursing specialist students.
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Objective To build model of intestinal motility disorders (IMD) in mice after severe craniocerebral trauma by using modified free fall impact method so as to lay the foundation for further study on development mechanism of postinjury IMD.Methods Severe craniocerebral trauma in mice was induced by a cylindrical sleeve rod impactor.Pathological changes of cerebral and intestinal tissue in mice were observed at 1,6 hours and 1,3,7 days after severe craniocerebral trauma.Brain water content and intestinal propulsion percentage were detected in each time point as well.Results Acute inflammation and congestion of the intestine were observed in phase of cerebral hemorrhage and edema after severe craniocerebral trauma in mice.Brain water content was increased at 6 hours and reached the peak at 24 hours.Intestine propulsion percentage showed a fall at one hour and dropped to the lowest level at 6 hours.Conclusions IMD exists in mice with severe craniocerebral trauma.The device involving modified Feeney free fall impact method can successfully establish animal model of IMD in mice with severe craniocerebral trauma.
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Objective To investigate effect of early enteral nutrition supplemented with probiotics on gastrointestinal motility disturbance and nutritional status in patients with severe craniocerebral trauma.Methods Forty patients with severe craniocerebral trauma were randomized into study group (18patients) and control group (22 patients).Patients of both groups received enteral nutrition via nasogastric tube at 24-72 hours after admission,but the patients of study group were also supplemented with probiotics simultaneously.Rate of abdominal distention,vomiting,gastro-oesophageal reflux,gastric retention,constipation and diarrhea were recorded during the whole study.Time to first defecation and time to targeted nutritional goals were also recorded.Prealbumin and transferrin in serum were detected at days 0,4,7,and 15 after the beginning of enteral nutrition.Length of ICU stay was compared between groups.Results There were no significant differences of the two groups in terms of rate of abdominal distention,vomiting,gastric retention and diarrhea.However,less gastro-oesophageal reflux or constipation patients were observed in study group,as compared with control group (P ＜ 0.05).Time to first defecation and time to targeted nutritional goals were shorter in study group,as compared with control group (P ＜ 0.05).Levels of prealbumin and transferrin had no significant differences between the two groups at days 0,4,and 7,but study group showed both were higher than control group at day 15 (P＜0.05).Moreover,length of ICU stay showed no significant difference between the two groups.Conclusions Compared with simple enteral nutrition,early enteral nutrition with probiotics improves gastrointestinal motility,facilitates the delivery of enteral nutrition,and further ameliorates nutritional status in patients with severe craniocerebral trauma.
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Objective To probe into the effect of the enteral nutrition added with lactobacillus on gastric bacteria of rats with severe brain injury. Methods Severe brain injury was made in rats that were then fed with enteral nutrition (3-9 entire nutrients), lactobacillus (3-9 entire nutrients + lactobacillus) and synbiotics (3-9 entire nutrients + lactobacillus + fiber) respectively. Gastric body and gastric antrum mucosa were collected at day 1, 3 and 7 after injury to detect the change of the gastric bacteria. Results DCCE analysis showed less bacteria in sham operation group. On the first day after severe brain injury, the flora bands were increased remarkably but the number of bacteria was decreased in three groups. The similarity of denaturing gradient gel electrophoresis ( DGGE) map patterns was 65% , 64% and 53% respectively in the enteral nutrition group, lactobacillus group and synbiotics group, with no significant difference in regard of the diversity index. On the third day after severe brain injury, the flora bands showed a tendency of decrease, with the similarity of denaturing gradient gel electrophoresis (DGGE) map patterns for 72% , 58% and 62% respectively. The richness and diversity of total bacteria in the lactobacillus group was remarkably lower than that in the enteral nutrition group and synbiotics group (P＜0.01). On the seventh day after SHI, the flora bands were decreased in three groups, with the minimum number of the bacteria. The similarity of denaturing gradient gel electrophoresis ( DGGE) map patterns was 61% , 51% and 58% respectively, with higher richness and diversity of total bacteria in the synbiotics group compared with the other groups. Conclusion Lactobacillus can help improve gastric bacteria disturbance of rats with severe brain injury. In the meantime, addition of the lactobacillus is better than addition of the synbiotics.
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Objective To investigate the effect of early enteral nutrition combined with probiotics on the nutritional status of patients with severe head injury. Methods Thirty-five patients with severe head injury were randomized into early enteral nutrition group ( control group, n = 18 ) and early enteral nutrition combined with probiotics group (observational group, n = 17). All the patients received enteral nutrition via nasogastric tube within 24-48 hours following admission. Hemoglobin, lymphocyte count,plasma concentrations of total protein, albumin, prealbumin, cholinesterase, and fasting blood glucose were determined before enteral nutrition and at days 8, 15, 21 after enteral nutrition. Arm circumference (AC), triceps skinfold thickness (TSF) and ann muscle circumference ( AMC ) were measured at the same time points. Gastrointestinal reactions as well as the time to first defecation were recorded. Glasgow coma scale (GCS) was assessed. Results There was no difference in terms of hemoglobin, lymphocyte count, plasma concentrations of total protein, prealbumin, and GCS score at each time point between the two groups ( P ＞ 0. 05 ). At day 8 after enteral nutrition, the patients in the observational group exhibited significantly lower level of fasting blood glucose than those in the control group (P ＜ 0.05 ). At day 15,the concentration of plasma cholinesterase in the observational group was significantly higher than that in the control group ( P ＜ 0. 05 ). At day 21, the observational group showed a tendency in increase of plasma albumin level in comparison with the control group( P = 0. 054), and the decrease of AC and AMC was obviously lower than that in the control group ( P ＜0. 05 ) compared with pre-enteral nutrition. The observational group showed less gastro-oesophageal reflux and constipation as well as earlier time to first defecation compared with the control group ( P ＜ 0. 05,0. 01 ). Conclusion Compared with the ordinary enteral nutrition, the enteral nutrition combined with probiotics can attenuate metabolic disorders and improve the nutritional status of the patients with severe head injury.
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Objective By taking emergency treatment of craniocerebral trauma for example, we studied the competence characteristic composition for emergency treatment of eraniocerebral trauma aiming at doctors and nurses, besides,their competence characteristics were compared as well. Methods By comprehensive application of qualitative and quantitative methods, the competence characteristic eomposi-tions of doctors and nurses were obtained, the corresponding competence characteristic scale was estab-lished, and underwent subsequent application for its validity and reliability. Results After many times of factor analysis and factor rotation, competence characteristic compositions and scale for doctors and nurses engaged in emergency treatment of eraniocerebral trauma were obtained, accumulative contribution of com- mon factors was 69.33% and 69.99%,ot coefficient was 0.826 and 0.930, split-half reliability was 0.771 and 0.791 ,α coefficient of internal consistency of every subseale ranged from 0.574 to 0.898, which showed good validity and reliability. Conclusions Doctors and nurses engaged in emergency treatment of cranio-cerebral trauma possess different competence characteristic compositions from general medical workers,their competence characteristics are both overlapping and different.
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Objective To observe the changes of SOD and MDA after the rabbits were exposed to acute hypoxia when cured by oxygen therapy.Methods New Zealand rabbits underwent hypoxia imitating the 4500-meter sea level in altitude chamber(group E,n=6),then some received oxygen therapy,the volume ratio of oxygen-nitrogen mixture was 25%,30% and 35% respectively for 10,5 and 3 hours as group B,C and D.Another 5 rabbits received no treatment as normal group.The rabbits samples were collected at the time points of 1,3,5,10 and 24 hours after the oxygen therapy started to detect serum biochemical indicators.Results Comparing with normal control group,serum SOD activity in simple hypoxia group noticeably decreased and the content of MDA noticeably increased;in three oxygen therapy groups,serum SOD activity in 25% oxygen therapy group was highest and the content of MDA was lowest.Serum SOD activity in 25% oxygen therapy group had ascendant tendency and the content of MDA had descendant tendency.Conclusions Low concentration oxygen therapy can prevent acute hypoxia-induced injury in rabbits,besides increase oxygen partial pressure,oxygen therapy may improve superoxide dismutase activity.
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Objective To study the influence of probiotics on the gut microflora,digestive enzymes and small intestinal propulsive rate of rats with severe head injury. Methods The rat model of severe head injury was prepared, SD rats were randomly divided into group A (enteml nutrition) , group B (enteral nutrition plus probiotics) , and group C (normal diet) . The intestine mucesa and faeces were collected on the third day,7th day and 14th day after head injury in order to detect gut microflora,digestive enzymes and small intestinal propulsive rate. Results Compared with group C, the number of Lactobacillus and Bacillus bifidus group in group A and group B declined in two weeks after trauma, however, the number of Escherichia coli increased significantly. Bacillus bifidus amounts of group A were significantly lower than that of group B at every time point, the diversity of Escherichia coli was opposite. No difference was seen in content of Lactobacillus 7 days after trauma in group A and B. The level of disaecharidases, Na+- K+- ATPase and small intestinal propulsive rate declined significantly at every time point, compared with group C.Though the contents of digestive enzymes was higher in group B than that of group A, and small intestinal propulsive rate was higher in group A and B than that in group C, but the two groups showed no difference. Conclusions Probiotics can alleviate the in-testine microflora disorder,modulate the activities of digestive enzymes, therefore lessen malabsorption of rats with severe head injury.
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0.05),but significant difference existed on the 7th day after injury. The Cor content of group Arg was noticeably lower than that of group EN on each time point(P
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Objective To study the mechanism of acute lung injury secondary to isolated severe head injury.Methods Twenty-two male SD rats were randomly divided into normal group(NG,n=4),and trauma group(TG,n=18)which were sacrificed respectively on day 1,3,7.The pathomorphological changes were observed by light and electron microscope.The levels of tumor necrosis factor-alpha(TNF-?)and interleukin-8(IL-8)in bronchoalveolar lavage fluid(BALF)were investigated by radioassay(RIA).The level of soluble intercellular adhesion molecule-1(sICAM-1)in BALF was measured by enzyme linked immunosorbent assay(ELISA).Results Capillary congestion,inflammatory cell infiltration and thickening of alveolar septum were detected in TG from day 1 to 7 by light microscope.The histological score of lung on day 3 in TG was significantly higher than that on day 1 and 7.The ultramicroscopic structure of lung showed swelling of vascular endothelial cells,infiltration of polymorphonuclear neutrophil and monocyte,injury of pulmonary epithelial cells in TG from day 1 to 7.The levels of TNF-?,IL-8 and sICAM-1 in BALF in TG were significantly higher than that in NG and the peak values were on day 3.The histologic score in TG was positively correlated with the levels of TNF-?,IL-8 and sICAM-1 in BALF.Conclusion Isolated severe head injury could induce acute lung injury that reached the most severe degree on day 3.The elevation of such proinflammatory cytokines as TNF-?,IL-8 and sICAM-1 in BALF plays an important role in the development of excessive inflammatory response of lung injury secondary to isolated severe head injury.
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Objective To investigate the occurrence of postural hypotension (PH) in patients suffering from type 2 diabetes mellitus with or without hypertension (DMH or DM), and the relationship of PH and diabetic neuropathy, hyperinsulinemia and insulin resistance. Methods A total of 30 cases of type 2 DM and 30 cases of DMH were included in this study. The blood pressure of all subjects were measured in supine and standing body positions respectively and PH was defined as a decline from supine to standing was ≥20 mmHg in systolic blood pressures (SBP). The concentrations of blood glucose and plasma insulin were measured to calculate the insulin sensitive index (ISI). Autonomic and peripheral function was determined by measuring the postural heart rates and the conduction speeds of superficial peroneal and communicating branch of peroneal nerves etc respectively. Results Significant difference (P<0.01) was found in the occurrence of PH in the patients with DM (40%) and those with DMH (67%). The changes of postural blood pressure were more obvious in those with DM+PH and DMH+PH than in those with simple DM (P<0.01). The conduction speeds of newes were significantly lower in those with DMH+PH than with simple DM (P<0.05), but the occurrence of autonomic neuropathy had no difference between the 2 groups. There was no difference in postural heart rate, body mass index and blood glucose levels in fasting and 2 h after meal among the DM, DM+PH and DMH+PH groups. The concentrations of plasma insulin of those with DMH+PH were significantly higher, but their ISI significantly lower than those of the patients with DM respectively (P<0.01). The decline of postural SBP in patients with DMH+PH had a significantly positive correlation with their plasma insulin levels in fasting condition (r=0.689, P<0.01). Conclusion The patients with DMH are more prone to PH compared with those only with DM and PH damages their peripheral nerves. Most of diabetic patients with PH suffer from obvious IR and hyperinsulinemia, and if with hypertension, the above metabolic disturbances are more severe.