ABSTRACT
To compare the intra cuff pressure changes during improved and the traditional method of cuff pressure measurement, then evaluate the effects of ventilator-associated pneumonia (VAP) prevention. The results highlighted practical recommendations in the process of ETT cuff pressure measurement. Methods① Experimental studies were carried out on the tracheal model with two groups: traditional pressure measurement group and improved pressure measurement group. The traditional pressure measurement group was connected to a handheld pressure gauge with the indicate cuff to get the intra-cuff pressure. The improved method was to insert a 3-way stopcock between the handheld pressure gauge and the indicate cuff. The 3-way stopcock to stabilize handheld pressure gauge reading at 32 cmH2O (1 cmH2O = 0.098 kPa) before measure the intra-cuff pressure. The pressure loss caused by two pressure measurement methods and the leakage of liquid on the balloon after 10 minutes was compared.② Clinical researches: a historic cohort study, patients with mechanical ventilation (MV) admitted to intensive care unit (ICU) of Guangxi Medical University Cancer Hospital from June 2014 to May 2018 were enrolled. The control group (249 cases) was treated with traditional method during June 2014 to May 2016, and the observation group (314 cases) was treated with improved method during June 2016 to May 2018. Clusters of strategies and actions of VAP prevention were applied in both groups. Incidence of VAP, duration of MV, and the length of ICU stay were compared between the two groups. Results ① Experimental study: the pressure leakage of the traditional pressure measurement group was (10.18±0.47) cmH2O, and that of the improved pressure measurement group was (1.33±0.42) cmH2O, with statistically significant difference between the two groups (t = 32.535, P = 0.000). All fluid on the cuffs leak after 10 minutes of traditional ways of measurement, however, no visible fluid on the cuffs leaked with improved procedures. ② Clinical research: the incidence of VAP in the observation group was slightly lower than that in the control group, however there was no significant difference [5.10% (16/314) vs. 8.43% (21/249), P > 0.05]. The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group (days: 9.93±3.14 vs. 16.77±5.45, 11.63 ±2.28 vs. 19.12±5.10, both P < 0.01). Conclusion The improved procedures of intra-cuff pressure measurement is a practical method to avoid the pressure leakage and fluid leakage, and the clinical course of MV patients can be significantly improved by combining the clusters of nursing strategies and actions.
ABSTRACT
Objective To observe the curative effects of octreotide on gastrointestinal cancer and its influenee on the serum level of IGF-1.Methods 33 patients diagnosed as advanced gastrointestinal cancer were randomized into 2 groups.15 cases in therapy group received octreotide 400μg/d subcutaneous injection or intravenous injection,other patients were taken as control.Curative effects of octreotide and serum level of IGF-1 on different time were observed before and after therapy.Results 4 cases in therapy group kept stable condition during treatment,all 18 cases in control group deteriorated gradually.The median survival time of octreotide therapy was 6.9 months,longer than that of control group(2.3 months)(P＜0.05),the feeling of well being in therapy group was reported a remarkable improvement.Serum level of IGF-1 decreased obviously after octreotide injection(P＜0.05),but no significant difference in control group.Conclusion Octreotide can prolong the survival duration and improve living quality of patients with advanced gastrointestinal tumors.The mechanism of antitumor is probably through suppression of IGF-1.