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Objective:To explore the effect of bundle management strategy in early mobility of patients with mechanical ventilation.Methods:Seventy-two mechanically ventilated patients admitted to the respiratory intensive care unit (RICU) of Fenyang Hospital of Shanxi Province from December 2019 to June 2020 were enrolled. The patients were divided into routine nursing control group (routine control group) and early mobility bundle management group (bundle group), with 36 cases in each group. The routine control group received regular nursing, including monitoring vital signs, raising the head of the bed, turning over and buttoning the back every 2 hours, daily awakening, airway humidification, prevention of digestive tract ulcer, analgesia and sedation management, prevention of deep vein embolism, pipeline management, regular monitoring of blood gas analysis and electrolytes according to the changes of the condition, prevention of aspiration, prevention of bacterial colonization, correct hand hygiene, and so on. The bundle group implemented the cluster early mobility strategy based on routine nursing. Firstly, set up a professional team to execute the standards. The team determined the plan and implemented the 4-level mobility plan, companied with psychological intervention, decided the termination standard and quality control. The incidence of intensive care unit acquired weakness (ICU-AW), ventilator-associated pneumonia (VAP), delirium, the duration of mechanical ventilation and the length of intensive care unit (ICU) stay were evaluated.Results:Compared with the routine control group, the incidences of ICU-AW, VAP, and delirium in the bundle group were significantly lower (the incidence of ICU-AW: 36.11% vs. 69.44%, χ 2 = 8.025, P = 0.005; the incidence of VAP: 8.33% vs. 30.56%, χ 2 = 5.675, P = 0.017; the incidence of delirium: 5.56% vs. 36.11%, χ 2 = 10.180, P = 0.001), the duration of mechanical ventilation was significantly shorter (days: 7.13±1.34 vs. 10.46±1.48, t = -10.145, P < 0.001), and the length of ICU stay was also significantly decreased (days: 9.03±2.43 vs. 13.06±3.63, t = -5.535, P < 0.001). Conclusions:The implementation of bundle management strategy of early mobility can promote the rehabilitation of mechanical ventilated patients, improve the prognosis and the quality of life. The effect is noticeable and it is worth popularizing.
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Objective To investigate the biochemical and routine blood parameters in hepatocellular carcinoma (HCC) patients with portal vein blood thrombus (PVBT) or portal vein tumor thrombosis (PVTT), as well as the expression level and clinical significance of inflammatory indices in patients with different types of PVBT. Methods A total of 51 HCC patients with PVBT and 37 HCC patients with PVTT who were diagnosed and treated in The Second Affiliated Hospital of Zhengzhou University from January 2016 to December 2020 were enrolled as PVBT group and PVTT group, respectively, and 50 HCC patients without portal vein thrombosis who were hospitalized during the same period of time were enrolled as control group. General clinical data and laboratory test results were collected from the three groups. The chi-square test or the Kruskal-Wallis rank sum test was used for comparison of categorical data between groups; a one-way analysis of variance was used for comparison of normally distributed continuous data between groups, and the Kruskal-Wallis rank sum test was used for comparison of non-normally distributed continuous data between groups. The receiver operating characteristic (ROC) curve was plotted to investigate the expression levels of albumin (Alb), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukin-6 (IL-6) in the PVBT group and the PVTT group, and the area under the ROC curve (AUC) was calculated to analyze their value in predicting different types of thrombosis. Results There were no significant differences in general data and conventional biochemical parameters between the three groups (all P > 0.05), while there were significant differences in the inflammatory indices Alb, CRP, ESR, and IL-6 between the three groups ( H =10.207, 24.465, 8.917, and 37.584, P =0.006, P < 0.001, P =0.012, and P < 0.001), and further analysis between two groups showed that the PVTT group had a significantly lower level of Alb and significantly higher levels of CRP, ESR, and IL-6 than the PVBT group and the control group, and the PVBT group had significantly higher levels of CRP and IL-6 than the control group (all P < 0.05). The ROC curve analysis showed that Alb, CRP, ESR, and IL-6 had an AUC of 0.659, 0.826, 0.679, and 0.873, respectively, in the PVTT group, as well as an AUC of 0.508, 0.635, 0.503, and 0.701, respectively, in the PVBT group. Conclusion HCC patients with PVTT tend to have high expression levels of the inflammatory indices IL-6, CRP, and ESR and a low expression level of Alb, and their predictive value decreases successively, while HCC patients with PVBT tend to have relatively low expression levels IL-6, CRP, and ESR and a relatively high expression level of Alb. IL-6 and CRP have a certain value in predicting PVBT, while ESR and ALB have little predictive value.
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ObjectiveTo investigate the clinical effect of endoscopic sphincterotomy with balloon dilation (ESBD) versus sphincterotomy (EST) alone in the treatment of large common bile duct stones. Methods Foreign databases (including PubMed, CochraneCentral, and Embase) and Chinese databases (including CNKI and Wanfang Data) were searched for randomized controlled trials (RCTs) on the clinical effect of ESBD versus EST in the treatment of large common bile duct stones published up to July 8, 2019. Related data were extracted and RevMan5.3 was used for analysis. Results A total of 13 RCTs with 1926 patients were included, with 973 patients in the ESBD group and 953 patients in the EST group. The meta-analysis showed that there were significant differences between the ESBD group and the EST group in stone clearance rate (odds ratio ［OR］=1.53, 95% confidence interval ［CI］: 1.03-2.29, P=0.04), one-time clearance rate (OR=1.77, 95%CI: 1.06-2.93, P=0.03), rate of use of mechanical lithotripsy (OR=0.40, 95%CI: 0.25-0.63, P＜0.000 1), bleeding rate (OR=0.23, 95%CI: 0.11-0.50, P＜0.001), incidence rate of cholangitis (OR=0.31, 95%CI: 0.12-0.78, P=0.01), incidence rate of early complications (OR=0.59, 95%CI: 0.42-0.84, P=0.003), and time of operation (mean difference=-8.89, 95%CI: -17.56 to -0.22, P=0.04), while there were no significant differences between the two groups in perforation (OR=0.27, 95%CI: 0.05-1.30, P=0.10) and pancreatitis after endoscopy (OR=1.03, 95% CI: 0.66-1.61, P=0.91). ConclusionIn endoscopic treatment of large common bile duct stones, ESBD has several advantages over EST in stone clearance rate, rate of use of mechanical lithotripsy, bleeding rate, incidence rate of cholangitis, and time of operation.
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Objective To explore β-sodium aescinate on vascular endothelial function ( FMD ) , homocysteine ( Hcy ) and hypersensitive C-reactive protein ( hs-CRP) and clinical efficacy in patients with acute cerebral infarction.Methods 198 acute cerebral infarction patients from March 2013 to April 2015 were randomly divided into observation group (n=100) and control group (n=98).Control group were treated according to the condition of the disease, observation group were treated by β-sodium aescinate base on control group, 20mg was added to 250mL saline for intravenous drip,one times per day.Continuous used 14d for one treatment courses.Compared the change of vascular endothelial function, Hcy and hs-CRP and clinical efficacy.Results The total effective rate of observation group was 90.00%, which was significantly higher than that of 71.42% in control group (χ2 =11.01,P<0.05).Post-treatment the value of FMD significantly increased, Hcy and hs CRP were significantly decreased both in observation group and control group respectively, which the difference had a statistically significant as compared with Pre-treatment (P<0.05);but, the value of FMD was significantly higher, Hcy and hs CRP was significantly lower in observation group than that of control group (P<0.05).Conclusion It has a significant β-sodium aescinate clinical effect in treatment of acute cerebral infarction, and FMD are significantly higher, Hcy and hs-CRP are significantly decrease.
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The changes of the levels of C-reactive protein,endothelin and nitric oxide before and after pioglitazone treatment in type 2 diabetic patients suggested that inflammation participated in the pathogenesis of diabetic macroangiopathy and pioglitazone can protect vessels