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Post-intensive care syndrome (PICS) is the most common complication in patients discharged from intensive care unit (ICU), which seriously affects the life quality of the patients. At present, there is still lack of standardevaluation methods for PICS. Continuous and dynamic assessment can earlyidentify PICS, moreover, early identification and intervention of PICS can improve the life quality of patients those patients, which is critical to improve the long-term outcome of the patients. In this paper, we reviewed the current research states of evaluation timing, contents, tools and modalities of PICS domestic and abroad, analyzed the problems and prospects of the existing evaluation methods, aiming to provide a reference for clinical staff to effectively and comprehensively evaluate PICS.
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Due to the reform of medical system, sudden infectious diseases and the increasing demand of patients, the problems of insufficient allocation of human resources and low quality of nursing human resources in China not only affect the treatment and prognosis of patients, but also hinder the development of nursing itself. In order to improve the current situation of nursing staffing in China, this paper summarizes the RAFAELA system of nursing resource allocation in Finland and the need for improvement. In order to promote the improvement and development of the optimal allocation of nursing human resources in China.
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Abstract@#This study carried out a systematic review of research on sexuality education interventions in China by using CNKI, Web of Science, and other Chinese and English databases.A total of 82 articles and reports were included for analysis. With regard to the intervention modes and content, this systematic review found that comprehensive sexuality education has not been fully implemented in China, and school-based sex education primarily focuses on adolescents. The content of sex education mainly included puberty, abstinence, and HIV/STI prevention. In terms of intervention effectiveness, the results showed that sexuality education intervention is more effective in enhancing an awareness of sexuality issues and in changing the attitudes of children and adolescents, while it is less effective in sexual behavioral changes. Several suggestions are provided for sexuality education and future intervention.
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Objective To observe the effect of sodium acetate Ringer solution on serum levels of electrolytes, blood glucose (Glu) and lactic acid (Lac) in peri-operational stage of children undergoing neurosurgery. Methods Forty cases of children prepared to undergo neurosurgery admitted into Hunan Children's Hospital from December 2018 to April 2019 were enrolled, and according to the criteria of American Society of Anesthesiologists (ASA), they were classified into Ⅰ-Ⅱ grade. They were divided into a sodium acetate Ringer solution group and a sodium lactate Ringer solution group by random number table method, 20 cases in each group. Sodium acetate Ringer solution group was given the sodium acetate Ringer solution; sodium lactate Ringer solution group was given the sodium lactate Ringer solution, and both groups used intravenous infusion of their own respective solution at a rate of 10 mL·kg-1·h-1. Arterial blood gas detections were measured after anesthesia induction (T1), 1 hour after administration (T2), 2 hours after administration (T3) and at the end of surgery (T4); the changes in serum levels of electrolyte concentrations, blood Glu and Lac were observed in the patients of two groups. Results With the prolonged operation time, the levels of Glu and Lac in the two groups showed an increasing trend, compared with the levels at T1 and T2 , the levels were increased at T3 and T4 [the sodium lactate ringer solution group: Glu (mmol/L) were 5.85±1.02, 6.95±1.21 vs. 5.28±0.72, 5.20±0.62, and Lac (mmol/L) were 1.53±0.74, 1.91±1.41 vs. 1.23±0.71, 1.38±0.69; sodium acetate ringer solution group: Glu (mmol/L) was 5.44±0.86, 5.85±1.12 vs. 5.05±0.85, 5.14±0.74, Lac (mmol/L) were 1.58±1.31, 1.61±1.23 vs. 1.14±0.65, 1.28±0.95, all P < 0.05], the Lac and Glu levels at T4 in sodium acetate Ringer solution group were significantly lower than those in sodium lactate Ringer solution group (both P < 0.05). There were no statistically significant differences in pH value, Na+, K+ and residual base (BE) levels between the two groups at different time points (all P > 0.05). Conclusion Sodium acetate Ringer solution used in pediatric neurosurgery for more than 2 hours can reduce the blood lactic acid level without rising blood glucoselevel. Therefore, it is more suitable for infusion during pediatric neurosurgery.
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Objective To evaluate the efficacy of general anesthesia combined with ultrasoundguided epidural block for laparoscopic surgery in neonates.Methods Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ neonates,aged 20-60 days,scheduled for elective radical operation for Hirschsprung's disease,were divided into 2 groups (n=30 each) using a random number table:general anesthesia group (group Ⅰ) and general anesthesia combined with ultrasound-guided epidural block group (group Ⅱ).Anesthesia was induced by inhaling 8％ sevoflurane.Anesthesia was maintained with Ⅳ sufentanil 0.2 μg/kg,cisatracurium 0.1 mg/kg and then with additional sufentanil 0.1 μg/kg and cisatracurium 0.05 mg/kg every hour and 2％-3％ sevoflurane was simultaneously inhaled in group Ⅰ.In group Ⅱ,anesthesia was maintained by inhaling 2％-3％ sevoflurane,epidural block was performed at L1.2 interspace,the catheter was caudally advanced into the epidural space under ultrasound guidance,0.8％ lidocaine was injected at a loading dose of 6 mg/kg,the local anesthetic diffusion in the epidural space was observed,and additional 0.8％ lidocaine 3 mg/kg was given every 30 min.Heart rate and mean arterial pressure were recorded at 5 min before pneumoperitoneum,during pneumoperitoneum,at extubation and after extubation.The extubation time,duration of recovery room stay and development of assisted ventilation after extubation were recorded.Pain was assessed and scored at 5 min before discharge from recovery room.The development of epidural block-related complications was recorded in group Ⅱ.Results Operation was smoothly completed with stable anesthesia in two groups.Compared with group Ⅰ,the mean arterial pressure was significantly decreased during pneumoperitoneum and after extubation,the extubation time and duration of recovery room stay were shortened,and the requirement for assisted ventilation after extubation and pain scores were decreased in group Ⅱ (P＜0.05 or 0.01).No epidural block-related complications were found in group Ⅱ.Conclusion General anesthesia combined with ultrasound-guided epidural block is safe and effective for laparoscopic surgery and is helpful for postoperative recovery in neonates.
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Objective To investigate the relationship between polymorphisms of N-acetyltransferase 2(NAT2)genes and anti-tuberculosis drug induced hepatic-injury(ADIH).Methods A 1:1 matched case-control study was conducted.One hundred and six cases fulfilling the criteria of ADIH were selected as ADIH group from the patients who received anti-tuberculosis therapy.whereas those patients without any hepatic inj ury related elinical symptoms during three months of follow-up period were selected as control.The genetic polymorphisms of the loci,NAT2481C/T,NAT2-590G/A and NAT2-857G/A,were determined by polymerase chain reaction and restriction fragment length polymorphism technique(PCR-RFLP)in patients who received antituberculosis therapy.The major environmental factors and genotypes were analyzed by univariate and multivariate conditional Logistic analyses.Results The T,AA allele frequencies of NAT2-481C/T,NAT2-590G/A and NAT2-857G/A were 7.5%,28.8%and 17.9%respectively in ADIH group,and 6.6%,18.9%and 17.5%,respectively in the control group.Univariate analysis demonstrated that the frequency of NAT2 slow acetylation genotype in ADIH group was significantly higher than that in control group with a crude OR(95%CI)of 2.250(1.140-4.441).Among 6 potential risk factors,i.e.education level,occupation,body mass index(BMI),smoking,drinking and the type of tuberculosis,the low BMI and drinking were two risk factors for ADIH.In multivariate analysis,ADIH remained associated with acetylation genotype after adjusting for BMI and drinking status.The adjusted OR(95%CI)was 2.246(1.086-4.644).Conclusion NAT2 slow acetylation genotype may be associated with the occurrence of ADIH.
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Bone metastases are a major problem in the clinical management of patients with prostate cancer. Despite the use of analgesic for the relief of such pain, the outcomes are not often satisfactory. Strontium-89 (89Sr) is a pure beta-emitting radioisotope to be avidly concentrated in the areas of high osteoblastic activity. The aim of this study was to evaluate the efficacy of 89Sr in the therapy for bone metastases of prostate carcinoma. 116 patients received intravenous injection of 89Sr at the dose of 3mCi (111MBq). All patients underwent physical examination and Karnofsky's Performance Score (KPS) evaluation before and after administration; the analgesic effects were evaluated by scores of pain. The complete response (CR) was defined as scores of pain > 75%; no response (NR) was defined as scores of pain < 25% the remaining was partial response (PR). The changes of bone metastases were screened by CT, MRI and 99mTc-MDP bone scintigraphy according to the standards of WHO. After the treatment with 89Sr, the total response rate was 80.2%. In the 116 cases, 21 cases (18.1%) displayed complete response and 72 cases (62.1%) displayed partial response, but 23 cases (19.2%) showed no response. The mean score on Karnfsky's performance status (KPS) was 20.0% higher. About 1/3 cases exhibited an obvious decrease in the number of metastases, and some foci disappeared. Thirteen cases (12%) showed a greater decrease in prostate-specific antigen (PSA) value. 89Sr chloride is an effective and safe therapy of the bone metastases from prostate cancer.
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Adult , Aged , Aged, 80 and over , Humans , Male , Middle Aged , Bone Neoplasms , Radiotherapy , Prostatic Neoplasms , Pathology , Radiotherapy , Strontium Radioisotopes , Therapeutic UsesABSTRACT
<p><b>BACKGROUND</b>To study the clinical effects of ¹⁵³Sm-EDTMP plus chemotherapy in the treatment of bone metastasis of lung cancer.</p><p><b>METHODS</b>One hundred and ten lung cancer patients with one metastasis [male 82 and female 28, aged from 32 to 76 yrs; squamous cell carcinoma 28, adenocarcinoma 27, small cell lung cancer (SCLC) 7, mix type 41, alveolar carcinoma 7] who did not undergo an operation were entered into this study. The patients were divided into 3 groups: ¹⁵³Sm-EDTMP therapy only (37 cases), ¹⁵³Sm-EDTMP plus chemotherapy after 3 days (42 cases), 30 days after chemotherapy plus ¹⁵³Sm-EDTMP (31 cases). The dosages of ¹⁵³Sm-EDTMP ranged from 1 111 to 2 660 MBq. The patients with SCLC were adapted CCNU, MTX and CTX; those with non-small cell lung cancer (NSCLC) were adapted MMC, VCR and DDP. Statistic analysis of the data was performed by Chi-square test.</p><p><b>RESULTS</b>Total pain relief rate for ¹⁵³Sm-EDTMP only was 89.2% , for ¹⁵³Sm-EDTMP plus chemotherapy was 92.8%, and for chemotherapy plus 153 Sm EDTMP was 90.3% . The foci disappeared in 9 cases with ¹⁵³Sm-EDTMP only, in 12 cases with ¹⁵³Sm-EDTMP plus chemotherapy, and in 9 cases with chemotherapy plus ¹⁵³Sm-EDTMP. The 1 year survival rate was 29.7%(11/37) by 153 Sm only, 40.5%(17/42) by 153 Sm plus chemotherapy, 38.7%(12/31) by chemotherapy plus ¹⁵³Sm-EDTMP.</p><p><b>CONCLUSIONS</b>¹⁵³Sm-EDTMP plus chemotherapy is effective in the treatment of bone metastasis of lung cancer.</p>
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Objective:To investigate the methods of the anesthetization of the foreign body extraction in respiratory tract of infants.Methods:This clinical study compared two anesthetic methods in foreign body extraction of respiratory tract of infants:Ketamine+Sodium r-hydroxybutyrate intravenous (group A) and Ketamine+propofol intravenous (group B) and analyzed the advantages and disadvantages of both methods.Results:Compared with group B,the extent of the changes of heart rate and blood oxygen saturation in patients of group A is littler,and the incidence rate of breath holding and asphyxiation is littler too.Conclusions:The anesthetic effect of Ketamine+Sodium r-hydroxybutyrate intravenous in better than that of Ketmaine+propcfol intravenous.
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Objective To investigate the effect of the general anesthesia combined with peridural anesthesia on hirschsprung's radical operation through children abdominoscope. Methods 40 children patients with hirschsperung were elective eradicative operated by using endotrachal intubation complex vein general anesthesia combined with continuons peridural anesthesia.ECG,HR,MAP,SPO 2,P ET CO 2 were monitored, and blood gas were recorded and analyzed before pneumoperitoneum,15 minutes and 40 minutes after pneumoperitoneum,1 minute after deflation,before decannulation at the operation termination.Results Compared with before pneumoperitoneum date,HR inereased obviously 40 minutes after pneumoperitoneum,and before decannulation at the operation termination,peak pressure in airway increased obviously after pneumoperitoneum,the difference was notable,SPO 2 decreased after pneumoperitoneum,the difference was also significant.pH decreased gradually with the time prolongation,there was obviously difference.The trend of P ET CO 2 and PaCO 2 changes were analogous,P ET CO 2 had much notable difference after pneumoperitoneum,PaCO 2 had notable difference at the operation termination,and before decannulation,it was decreased to the basic value.Conlusions Hirschsprung's Disease eradical operation using general anesthesia combined with peridural anesthesia under abdominoscope guide,can immobilize ill children completely,relieve pain perfectly,muscular relaxation satisfactory,the physical interference to body is little and less complication.