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Objective:To observe the application effect of respiratory stepwise management in patients with septic shock combined with acute lung injury (ALI).Methods:100 patients with septic shock combined with ALI were selected as the research objects in Haikou Hospital Affiliated to Xiangya Medical College of Central South University from January 2018 to June 2020. Fifty patients were given endotracheal intubation or invasive ventilation on the basis of conventional treatment (conventional treatment group). According to the respiratory situation and blood gas, 50 patients were given systematic respiratory support step-by-step treatment according to the principle of simple to complex, and appropriate and scientific respiratory support was given according to the sequence from unarmed to mechanical (respiratory stepwise management group). The differences of cardiac index (CI), central venous pressure (CVP), mean arterial pressure (MAP), extravascular lung water index (EVLWI), arterial partial pressure of carbon dioxide (PaCO 2), arterial partial pressure of oxygen (PaO 2), oxygenation index (PaO 2/FiO 2) before and after treatment were compared between the two groups, the therapeutic effects of the two groups were evaluated, and the resuscitation effect, postoperative complications rate, tracheotomy rate, utilization rate of invasive ventilator of the two groups were recorded. Results:After treatment, CI, CVP, EVLWI, PaO 2, PaO 2/FiO 2 levels of the two groups were significantly higher than before treatment, MAP and PaCO 2 levels were significantly lower than before treatment; MAP and PaCO 2 levels after treatment of the respiratory stepwise management group were significantly lower than those of the conventional treatment group [MAP (mmHg, 1 mmHg = 0.133 kPa): 68.2±7.0 vs. 74.4±6.8, PaCO 2 (mmHg): 37.82±4.05 vs. 41.76±4.59], the levels of EVLWI, PaO 2 and PaO 2/FiO 2 in the respiratory stepwise management group were significantly higher than those in the conventional treatment group [EVLWI (mL/kg): 15.34±3.03 vs. 13.64±3.32, PaO 2 (mmHg): 84.44±4.83 vs. 79.03±5.54, PaO 2/FiO 2 (mmHg): 452.42±51.32 vs. 431.73±50.03, all P < 0.05]. There was no significant difference in CI or CVP after treatment between respiratory stepwise management group and conventional treatment group [CI (mL·s -1·m -2): 70.01±21.67 vs. 66.68±18.34, CVP (mmHg): 11.1±3.2 vs. 12.3±3.2, both P > 0.05]. Compared with the conventional treatment group, the average recovery time of the respiratory stepwise management group was earlier (hours: 2.04±0.54 vs. 4.29±0.20, P < 0.05), the stable breathing time was shorter (hours: 3.07±0.22 vs. 5.36±0.35, P < 0.05), the total effective rate and the success rate of recovery were significantly improved [86.0% (43/50) vs. 60.0% (30/50), 94.0% (47/50) vs. 74.0% (37/50), both P < 0.05], the incidence of ventilator associated pneumonia (VAP) and airway complications were significantly reduced [14.0% (7/50) vs. 32.0% (16/50), 12.0% (6/50) vs. 40.0% (20/50), both P < 0.05], and the tracheotomy rate and the utilization rate of invasive ventilator were significantly reduced [8.0% (4/50) vs. 28.0% (14/50), 30.0% (15/50) vs. 60.0% (30/50), both P < 0.05]. Conclusion:Respiratory stepwise management can effectively improve the resuscitation effect of septic shock patients with ALI, improve cardiopulmonary function, blood gas index and the treatment efficiency, effectively reduce the incidence of iatrogenic trauma and complications.
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Objective@#To explore the effects of sequential mechanical ventilation on pulmonary function, blood gas analysis, quality of life and patientsundefined satisfaction with nursing care in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure (COPD) treated by sequential mechanical ventilation.@*Methods@#From March 2016 to March 2017, 90 COPD patients with respiratory failure treated by sequential mechanical ventilation were selected and divided into two groups according to the digital random method. 45 patients in the control group were treated with routine nursing. 45 patients in the observation group were treated with intensive care mode. The forced vital capacity (forced vital capacity, FVC), 1s forced expiratory volume (forced expiratory volume in one second, FEV1) was compared between the two groups before intervention (on admission) and after intervention (1 day before discharge). Arterial partial pressure of carbon dioxide (PaCO2) and partial pressure of blood oxygen (PaO2) were different. The quality of life (QOL) was evaluated by using QOL-74 (Generic Quality of Life Inventory-74, GQOL-74 before and after intervention.@*Results@#There was no significant difference in FVC, FEV1, FEV1/FVC, PaCO2, PaO2 between the two groups (P > 0.05). After nursing intervention, the FVC of the patients in the observation group was (2.75±0.62) L and FEV1 was (2.05±0.51) L, respectively. FEV1/FVC was (49.1±5.3)%, PaCO2 was (36.62±2.73) mmHg, PaO2 (94.72±4.57) mmHg, and control group was (2.38±0.74) L, (1.69±0.45) L, (62.6±4.4)%. (48.45±5.36) mmHg, (88.25±4.02) mmHg, t=2.571, t=3.551, t=13.147, t=13.193, t=7.130,group was superior to the control group (P < 0.05). There was no significant difference in cognitive function, somatic function, social function and psychological status between the two groups before nursing (P > 0.05), but the scores of four dimensions in the control group were (66. 4 ±10.5) after nursing. (70.3±12.8), (72.2±13.6), (70.7±11.8), (72.8±9.7), (81.5±15.2), (78.4±12.9), (79.6 ±15.5), t=3.003)、t=3.780、t= 2.219、t= 3.065, P < 0.05. The success rate of rescue was 86.67%in the observation group, the mortality was 6.67%, the average hospitalization time was (12.8±4.2) days, the satisfaction degree for nursing was 94.87%, and the four items in the control group were 68.89% and 26.67%, respectively. (17.1±3.3) d, the satisfaction degree for nursing was 77.42%, P < 0.05. The difference between the two groups was statistically significant (P < 0.05), and there was a significant difference between the two groups (P < 0.05), and the difference between the two groups was statistically significant (P < 0.05), and the difference between the two groups was statistically significant (P < 0.05).@*Conclusion@#COPD patients with respiratory failure can significantly improve the success rate of rescue, promote the recovery of pulmonary function, improve the quality of life, and enhance the recognition of medical services.
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ObjectiveTo assess the current situation of postgraduates knowledge about medical research design and optimize the curriculum setting of research design.MethodsAn investigation was carried out in the postgraduates of 2011 using questionnaires in a medical university..The questionnaire ineluded basic information of participants and cognition of basic methods of research design.ResultsA total of 473 postgraduates participated in the investigation.Among them,311 systematically learned medical statistics before enrollment,and 275 ( 58.14％ ) once participated in scientific researches.Most of them ( ＞80％ ) knew about the 10 basic methods of research design listed in the questionnaire,but only a few of them were familiar with them,and some even didn't know about the methods.ConclusionWe should pay attention to the culture of scientific research thought in statistical design,strengthen the practice of research design teaching,and the curriculum of research design should be led into undergraduate course.
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Medical statistical methods and theory is an indispensable tool for the medical researchers in their study. Under the information condition,the traditional teaching in class has been difficult to meet the researchers’ requirement on a wide range of statistical knowledge. The department built a pluralism "Medical Statistics" teaching model which includes "Inquiry training model,Extension teaching window,Combination of inside and outside training". The result provides a new way of medical statistics teaching revolution.