Effect of nursing intervention based on 6-hour resuscitation goal theory on quality of life and various functions of sepsis patients / 中国中西医结合急救杂志

Objective To explore the effect of nursing mode based on 6-hour resuscitation goal theory on various functions and quality of life of patients with sepsis. Methods One hundred and forty-two septic patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from April 2016 to July 2018 were enrolled. A total of 71 patients selected to use traditional nursing intervention strategy were assigned in the routine nursing group;in the 6-hour resuscitation target theory group, 71 patients were given nursing care based on 6-hour resuscitation target theory on the basis of traditional routine nursing. The differences in oxygenation function indexes [central venous blood oxygen saturation (ScvO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2)], circulatory function indexes [central venous pressure (CVP), mean arterial pressure (MAP) and heart rate (HR)], renal function indexes [urine volume and serum creatinine (SCr)] before and after intervention for 6 hours were compared between the two groups of patients; at the same time, the survival rate, treatment status and life quality improvement of the two groups after 1 month of intervention were recorded. Results After 6 hours of intervention, CVP, MAP, ScvO2, PaO2, PaO2/FiO2, urine volume and quality of life scores of patients in the 6-hour resuscitation target theory group and the routine nursing group were all increased compared with those before intervention, while the HR and SCr levels were lower than those before the intervention, moreover, the changes above indexes in the 6-hour resuscitation target theory group were more significant than those in the routine nursing group [CVP (cmH2O, 1 cmH2O = 0.098 kPa): 11.89±2.94 vs. 7.33±2.37, MAP (mmHg, 1 mmHg = 0.133 kPa): 84.11±6.13 vs. 66.15±5.27, HR (bpm):89.05±6.00 vs. 102.41±5.86, ScvO2: 0.78±0.03 vs. 0.66±0.04, PaO2 (mmHg): 154.71±20.75 vs. 106.54±24.66, PaO2/FiO2 (mmHg): 364.13±38.47 vs. 331.21±33.26, urine volume (mL/h): 71.13±10.22 vs. 37.42±13.41, SCr (μmol/L): 113.10±14.35 vs. 125.12±13.87, role function scores: 87.82±4.52 vs. 71.28±4.92, cognitive function scores: 89.23±4.63 vs. 71.75±5.34, body function scores: 90.24±4.43 vs. 72.74±5.03, emotional function scores:88.92±5.71 vs. 73.42±3.48, social function scores: 94.31±2.71 vs. 75.21±4.83, all P < 0.05]. One month after intervention, the survival rate in the 6-hour resuscitation target theory group was higher than that in the routine nursing group [69.01% (49/71) vs. 42.25% (30/71), P < 0.05], compared with routine nursing group, stay time in intensive care unit (ICU) and mechanical ventilation time in the 6-hour resuscitation target theory group were significantly shortened [stay time in ICU (days): 7.34±3.31 vs. 9.42±3.60, mechanical ventilation time (days): 3.52±0.84 vs. 5.83±0.85, both P < 0.05]. Conclusion The application of nursing intervention based on 6-hour resuscitation target theory for patients with sepsis has very significant effects on promoting the patients' oxygenation, renal and circulatory functions, and improving their survival rate and quality of life.

Lay emphasis on circulatory state research after fluid resuscitation in early burns / 中华烧伤杂志

In this article, we discuss future development of circulatory state research after fluid resuscitation in early burns from its history and difficulties confronted. We believe that the Chinese fluid resuscitation formula to predict initial volume of fluid infusion of extensive burn patients is still useful and effective, while we should attach more importance to advances in the research of burn pathophysiology, basic theory and clinical practices of Chinese fluid resuscitation formula, so as to provide strategy of fluid resuscitation in early burns for international burn world. We should know clearly circulatory state of patients from circulatory driving force, microcirculation, and cell oxygenation. Besides, multidisciplinary cooperation should be strengthened, such as promoting communication and technological convergence between burn discipline and critical care discipline, to make preparation for future of intelligent and individualized fluid resuscitation.

Evaluation of cardiac function in pediatric intensive care unit / 中国小儿急救医学

Cardiac function is closely related to circulatory function,and both terms can be integrated together as" hemodynamics". Thus the author will use the collective term"hemodynamic evaluation" rather than "cardiac function". There are several ways to evaluate hemodynamic status. Briefly,we can use physical examination as clinical indices of hemodynamics. The physical examination method can detect cardiac impulse position,liver size, peripheral edema, distension of jugular vein to identify circulatory dysfunction. Besides relative simple basic method,there are other means to detect circulatory function. We usually divided them into 2 categories:invasive versus non-invasive means. The non-invasive means include echocardiography and impedance electrocardiography. Echocardiography can provide portable, easily operated platform to evaluate classical cardiac function including fractional shortening,cardiac wall thickness,pressure gradient evaluation and ejection fraction(EF). The impedance electrocardiography can provide continuous index for circulatory functional evaluation. The invasive means include arterial pressure wave analysis, central venous pressure monitoring,floating catheter for capillary wedge pressure monitoring and cardiac output. The relatively newer device includes pressure index countour cardiac output( PiCCO) method,using similar but simple not only to derive cardiac output,but also lung water and other complex indices. In summary,hemodynamic evaluation of circulatory functional status is rather complex, a thorough understanding of ongoing pathophysiology is of prime importance. All clinicians working in the intensive card unit should carefully select the most appropriate ones according to the accessibility and familiarity and mechanism of operation.

Evaluation of cardiac function in pediatric intensive care unit / 中国小儿急救医学

Cardiac function is closely related to circulatory function,and both terms can be integrated together as" hemodynamics". Thus the author will use the collective term"hemodynamic evaluation" rather than "cardiac function". There are several ways to evaluate hemodynamic status. Briefly,we can use physical examination as clinical indices of hemodynamics. The physical examination method can detect cardiac impulse position,liver size, peripheral edema, distension of jugular vein to identify circulatory dysfunction. Besides relative simple basic method,there are other means to detect circulatory function. We usually divided them into 2 categories:invasive versus non-invasive means. The non-invasive means include echocardiography and impedance electrocardiography. Echocardiography can provide portable, easily operated platform to evaluate classical cardiac function including fractional shortening,cardiac wall thickness,pressure gradient evaluation and ejection fraction(EF). The impedance electrocardiography can provide continuous index for circulatory functional evaluation. The invasive means include arterial pressure wave analysis, central venous pressure monitoring,floating catheter for capillary wedge pressure monitoring and cardiac output. The relatively newer device includes pressure index countour cardiac output( PiCCO) method,using similar but simple not only to derive cardiac output,but also lung water and other complex indices. In summary,hemodynamic evaluation of circulatory functional status is rather complex, a thorough understanding of ongoing pathophysiology is of prime importance. All clinicians working in the intensive card unit should carefully select the most appropriate ones according to the accessibility and familiarity and mechanism of operation.

Protective effect of creatine phosphate sodium pretreatment on circulatory function in total knee replace-ment surgery using bone cement implantation / 临床麻醉学杂志

Objective This study is to investigate the protective effect of creatine phosphate so-dium on circulatory function in unilateral total knee replacement surgery using bone cement implanta-tion.Methods Forty patients undergoing unilateral total knee replacement surgery with bone cement were randomly assigned into 2 groups:test group (group CP,n=20)and control group (group NS, n=20).The easophageal doppler ultrasound probe was placed at the level of the third rib transorally after induction in each patient.In group CP,creatine phosphate sodium (2 g in 100 ml normal saline) was infused (within 30 min)at 30 min before the operation,as well as normal saline 100 ml in group NS.SBP,DBP,HR,SpO2 ,PET CO2 and BIS were monitored and recorded before (T0 )and 1 (T1 ),3 (T2 ),5 (T3 ),10 (T4 )min after insertion of bone cement.Cardiac output (CO),stroke volume (SV)and left ventricular end-diastolic volume (LVEDV)were simultaneously monitored and recorded with esophageal doppler ultrasound.WhileⅡ-lead electrocardiogram were recorded to monitor ven-tricular arrhythmia perioperatively.Results SBP,DBP and HR decreased at T2 and T3 in group NS, and were lower than those in group CP (P <0.05 );Meanwhile,compared with group CP,CO and SV were significantly lower,while LVEDV was significantly higher in group NS (P <0.05 ).Com-pared with T0 ,CO and SV decreased and LVEDV increased at T2 and T3 in group NS (P <0.05 ). After insertion of bone cement,the incidence of arrhythmia in group CP was obviously lower than that in group NS (P < 0.05 ).Conclusion Pretreatment with creatine phosphate sodium can effectively prevent the incidence of bone cement implantation syndrome (BCIS)by stabilizing hemodynamic in elderly patients undergoing total knee replacement with bone cement.

Effects of patient controlled epidural analgesia on postoperative changes of circulatory and pulmonary function in elderly with hypertension / 吉林大学学报(医学版)

Objective To evaluate the effects of patient controlled analgesia(PCEA)on the perioperative changes of circulatory and pulmonary function of elderly with hypertensions after abdominal surgery.Methods Twenty-eight patients of ASAⅡ-Ⅲ aged more than 60 years undergoing uratomy were randomly divided into two groups:control group and PCEA group.Preoperative and postoperative circulatory and pulmonary functions were measured with noninvasion circulatory monitor and pocket lung function meter respectively.Results In control group,the systolic pressure,diastolic pressure,and heart rate increased by 19%,17% and 19%,respectively,as compared with preoperation.The percentage of forced vital capacity(FVC%),percentage of forced expiratory volume in first second to forced vital capacity(FEV1%) and percentage of maximal ventilatory volume(MVV%) of postoperation in control group were significantly decreased compared with preoperation(P