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Objective:To evaluate and summary the relevant evidence of emergency target blood pressure management in acute aortic dissection, so as to provide guidance for the evidence-based practice of emergency target blood pressure management.Methods:According to the "6S" evidence pyramid model, the evidence about emergency target blood pressure management of acute aortic dissection in various databases and professional association websites at home and abroad was retrieved, including clinical decision, guidelines, expert consensus, systematic evaluation, randomized controlled trial, cohort study, case series, etc. Two researchers used corresponding literature quality evaluation tools to evaluate the quality of the included literature, extracted and summarized the evidence of the literature above grade B.Results:A total of 22 articles were included in this study, including 6 clinical decisions, 5 guidelines, 7 expert consensus, 1 systematic evaluation, 1 randomized controlled trial, 1 cohort study and 1 case series, forming 37 best evidences, including 9 topics such as target value setting, management strategies, disease observation, medical history collection, monitoring methods, vasoactive drugs, non vasoactive drugs, auxiliary examination, health education.Conclusions:The summarized best evidence provides a reference for emergency medical staff to manage the emergency target blood pressure of acute aortic dissection. It is recommended that emergency medical staff follow the summarized best evidence to formulate an individualized target blood pressure management scheme for patients.
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Objective:To explore the effect of irbesartan in the treatment of the patients with hypertension complicated with diabetes mellitus and its influence on urine trace albumin. Methods:Totally 62 cases of patients with hypertension complicated with diabetes mel-litus were divided into the observation group and the control group randomly with 31 patients in each. The patients in the control group were given the conventional blood sugar and blood pressure control, and the patients in the observation group were treated with irbesartan additionally. The treatment course was 3 months. The changes of blood pressure and urine trace albumin of the patients in the two groups before and after the treatment were compared, and the effect of blood pressure control and the adverse effects were evaluated as well. Re-sults:The total effective rate of the observation group was 96. 8%, which was much higher than that of the control group (83. 9%, P0. 05). Conclusion:The clinical effect of irbesartan in the treatment of patients with hypertension complicated with diabetes mellitus is promising with low incidence of adverse effects,which can effectively protect renal function as well.
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Objective To analyze the clinical significance and features of patient s' with inconsistent antineutrophil cytoplasmic antibodies (ANCA) test results between indirect immune fluorescence (IIF) and enzyme-linked immunosorbent assay (ELISA).Methods ANCA were detected with IIF and ELISA method jointly among 12 386 in-patients and a retrospective analysis on the proportion of clinical features and significance was made in 589 cases with inconsistent results using Microsoft Excel 2007 statistical software.Results Among the 589 patients,68 (11.5％) were diagnosed as vasculitis,in which 51 cases as ANCA-associated vasculitis,and 521(88.4％) were diagnosed as non-vasculitis including 181 connective disease and 340 non-connective diseases in which hypertension and cardiopathy were common.The common inconsistent results of ANCA were p-ANCA/ELISA (-),IIF (-)/anti-MPO (+),IIF (-)/anti-PR3 (+),IIF (-)/anti-PR3 (+) anti-MPO (+) accounted for 24.4％ (144/589),29.5％ (174/589),15.9％ (94/589),18.5％ (108/589) respectively,these accounted for 88.3％(520/589) of total inconsistency.Conclusion The spectrum of diseases and clinical characteristics varies widely and often presents with multiorgan involvement in patients with inconsistent ANCA results.These reasons make it easy to be misdiagnosed.Attention should be paid to identify and different these inconsistency.
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Objective To evaluate the efficacy of Six Sigma management for shortening the waiting time of outpatients accepting radiography and improving patient satisfaction. Methods Six Sigma management was applied to identify the key points critical to quality in the process of radiography,analyze the factors influencing the waiting time,and take targeted measures to modify the process. Results The waiting time of patients accepting radiography was reduced by an average of 25.2min and the rate of dissatisfaction was decreased by 18%. Conclusion The application of Six Sigma management can effectively shorten the waiting time of outpatients accepting radiography and increase patient satisfaction.
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Objective To evaluate the monitoring value of serum albumin and plasma von willebrand factor in patients with stroke.Methods Serum albumin and plasma von willebrand factor were measured from 145 patients with stroke(95 patients with nonpoor outcome and 50 patients with poor outcome) in two weeks and after six months from stroke onset to study the relationships with prognosis.Results Serum albumin level was significantly higher in patients with nonpoor outcome(mRS≤2) after six months stroke onset than those with poor outcome(mRS≥3) and was lower after six months stroke onset than in two weeks from stroke onset.On the other hand,plasma vWF level in patients with stroke was significantly higher than that in healthy controls and was higher in two weeks than after six months from stroke onset.Patients with poor outcome had higher plasma vWF level than patients with nonpoor outcome in two weeks and after six months from stroke onset,but had no significant difference.Conclusion The level of serum albumin and plasma von willebrand factor is related with nutritional status,active extent and prognosis in patients with stroke.