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Objective:To explore the optimum time of ambulation of atrial fibrillation patients after radiofrequency ablation, to provide basis for patients' early postoperative rehabilitation.Methods:By convenient sampling method, a total of 120 patients with atrial fibrillation after radiofrequency ablation were collected at Yanghu Branch and City Branch of Changzhou Second People's Hospital from January 2020 to May 2021. They were divided into the early group, middle group and late group according to the random number table method, each group were 40 cases. All patients received routine postoperative intervention, the time of ambulation were 4, 6 and 12 h after operation in the early group, middle group and late group, respectively. The complication rate within 24 h after operation was compared among the three groups, and the comfort level of the three groups at 24, 48 and 72 h after operation was evaluated with Comfort Status Scale (GCQ).Results:Finally, 111 patients were included, including 37 in the early group, 38 in the middle group and 36 in the late group. There was no significant difference in the incidence of bleeding or hematoma, urinary retention, lumbago within 24 h after operation among the three groups ( P>0.05). The incidence of postural hypotension within 24 h after operation in the early group was 2.7% (1/37), which was lower than 21.1% (7/38) and 25.0% (9/36) in the middle and late groups, with a statistically significant difference ( χ2=4.86, 7.67, both P<0.05). At 48 and 72 h after operation, the scores of physiological dimension, psychological dimension and the total score of GCQ in the early group were (20.68 ± 3.07), (22.54 ± 3.35), (81.68 ± 6.11) and (22.54 ± 3.73), (24.38 ± 2.49), (84.92 ± 6.37), higher than those in the middle group (19.16 ± 2.19), (21.32 ± 2.27), (78.24 ± 5.58), (20.93 ± 2.85), (22.32 ± 2.04), (81.66 ± 6.56), and those in the late group (18.44 ± 1.50) (21.31 ± 1.99), (78.06 ± 4.32), (20.89 ± 2.25), (21.58 ± 1.86), (80.28 ± 6.44), the differences were statistically significant ( t values were 2.19-4.15, all P<0.05). Conclusions:Ambulation at 4 h after operation does not increase peripheral vascular complications, but can reduce the incidence of postural hypotension and improve the comfort of patients with atrial fibrillation after radiofrequency ablation.
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Objective:To explore the effects of hospital-to-community model-based case management on outcomes and life quality of patients with atrial fibrillation.Methods:By convience sampling method, a total of 90 cases of atrial fibrillation patients admitted to Changzhou Second People′s Hospital from January 2019 to May 2020 were randomly divided into control group and experimental group, with 45 cases in each group. The patients in the control group received routine nursing care, the experimental group implemented hospital-to-community model-based case management. The beliefs about medicine, medication compliance, quality of life and readmissions of cardiovascular events were compared between 2 groups before and 6 months after intervention.Results:Finally, 41 cases were included in the experimental group and 38 cases in the control group. Before intervention, there were no significant differences in various indexes between the two groups ( P>0.05). After 6 months of intervention, the scores of specific-necessity in Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) and Morisky Medication Adherence Scale-8 (MMAS-8) were (16.98 ± 4.22) and (7.15 ± 0.69) points in the experimental group, higher than in the control group (14.95 ± 4.33) and (6.32 ± 1.07) points; the scores of specific-concerns in BMQ-Specific were (6.83 ± 1.91)points in the experimental group, lower than in the control group (8.42 ± 2.73) points. The differences were statistically significant ( t = 2.11, 4.07, 2.98, all P<0.05); the scores of physical function, role-physical, pain, general health, mental health dimensions and total scores in SF-36 were (80.37 ± 3.46), (46.63 ± 14.54), (90.37 ± 5.78), (70.07 ± 9.98), (84.20 ± 8.73) and (584.88 ± 25.71) points in the experimental group, higher than in the control group (70.13 ± 11.20), (37.34 ± 10.25), (83.37 ± 6.89), (59.55 ± 7.98), (77.58 ± 9.09) and (533.87 ± 31.62) points, the differences were statistically significant ( t values were 3.30-7.89, all P<0.05). At 6 months after discharge, the re-admission of cardiovascular events were 5 cases (12.2%) in the experimental group and 12 cases (31.6%) in the control group, the difference was statistically significant ( χ2=4.74, P<0.05). Conclusions:Hospital-to-community model-based case management can effectively promote beliefs about medicine and medication compliance, improve quality of life and decrease re-admission of cardiovascular events of patients with atrial fibrillation.
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Objective·To compare the efficacy of video-assisted thoracic surgery (VATS) and conventional lung volume reduction surgery for the treatment of patients with severe chronic obstructive pulmonary disease with a meta-analysis.Methods·Randomized controlled trials (RCT) and non-randomized control studies of VATS (the VATS group) and conventional lung volume reduction surgery (the thoracotomy group) for treating patients with severe chronic obstructive pulmonary disease were collected from databases,including Web of Science,EMbase,PubMed,the Cochrane Library,CNKI,CBM disc,WanFang Data,and VIP.The latest literature was published in November 2016.The assessment included the quality of literature and RevMan5.3 software was used to perform the meta-analysis.Results·Of 779 retrieved articles,12 studies involving 966 patients were included according to the inclusion criteria.The results of meta-analysis showed that the operation time of bilateral LVRS was longer in the VATS group than in the thoracotomy group,but the difference in the operation time of single LVRS between the two groups was not statistically significant.The difference in the duration of chest tube drainage for bilateral LVRS between the two groups was not statistically significant,while the duration of chest tube drainage for single LVRS was significantly shorter in the VATS group than in the thoracotomy group.The amount of intraoperative blood loss postoperative drainage was significantly smaller in the VATS group than in the thoraeotomy group.Postoperative pulmonary function and blood gas analysis showed that the 6 min walking distance was longer in the VATS group than in the thoracotomy group.The differences in FEV1 and PaO2 between the two groups were not statistically significant,as well as the difference in postoperative complications between the two groups.Conclusion·Comparing to conventional lung volume reduction surgery,Video-Assisted thoracic lung volume reduction surgery is a better choice.However,randomized control trials with higher quality and larger scale are required for verification this conclusion due to limitations of the quality and samples of these studies.
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OBJECTIVE To investigate the drug-resistance of Enterobacter cloacae(ECL) and its carrying rate of gene encoding aminoglycosides modifying enzymes(AMEs).METHODS Totally 132 clinically isolated ECL strains were identified with VITEK-32.Their drug susceptibility was tested with K-B disc diffusion.The presence of ESBLs and AmpC was tested with three dimensional test.The genes encoding AMEs were detected with PCR and confirmed by sequence.RESULTS All strains of ECL were susceptible to IMP and MER.The resistance rate to AMK,LVX,FEP,CFS and CIP was 21.2%,35.6%,37.9%,46.2% and 48.5%,respectively with gradually increasing.Their resistance rate to other antibiotics ranged from 50.0% to 87.7%.Among 132 strains of ECL,45 strains producing ESBLs,accounted for 34.1%,27 strains producing AmpC,accounted for 20.5%,11 strains producing ESBLs and AmpC,accounted for 8.3% and 49 strains producing neither ESBLs nor AmpC,accounted for 37.1%.Seven strains without positive detection of ESBLs were resistant to CTX and CAZ,but carried the genes of resistance to TEM and SHV.The detection rate of genes encoding AMEs was about 62.1%,among which subtypes of aac(6′)-Ⅰb dominated with detection rate of 51.5%.Meanwhile the detection rate of subtype aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅱ,ant(3″)-Ⅰ,ant(2″)-Ⅰ and aph(3′)-Ⅵ was 15.9%,12.9%,18.9%,37.1%,6.8% and 9.8%,respectively.The detection rate of carrying more than two types of AMEs was about 89.0%.There were 5 strains of presenting phenotypic resistance without detection of genes encoding AMEs.CONCLUSIONS The clinically isolated ECL strains are not only severe resistant to drug and but also multi-drug resistant.The carrying rate of genes encoding ESBLs,AmpC and AMEs is higher than estimated which is the leading cause of resistance to antibiotics.