The Application Effect of Optimization Design of County-level Hospitals Electronic Admission Nursing Evaluation Table / 昆明医科大学学报

Objective To study the application effect of optimization design of electronic admission nursing evaluation table.Methods We investigated the nursing staff satisfaction,hospitalized patients satisfaction and nursing quality sensitive indicators (expected pressure sores,pipe slips,falls / falling bed) before and after optimization design,and compared the difference between them.Results The nursing staff satisfaction was significantly higher than that before optimization design (P＜0.05),patient satisfaction was significantly higher than that before optimization design (P＜0.01),nursing quality sensitive indicators was significantly lower than that before optimization design (P ＜0.05).Conclusion The optimized design of electronic admission nursing evaluation table is detailed,objective,simple to use,and more objective and scientific in quality sensitive indicators control,and has good clinical practibility.

Effects of Bosentan in Treatment of Severe Pulmonary Hypertension Related to Congenital Heart Disease / 昆明医科大学学报

Objective To observe the clinical efficacy of bosentan in treatment of severe pulmonary hypertension related to congenital heart disease (CHD-PAH) .Methods 5 patients with severe CHD-PAH patients received bosentan therapy, then pulmonary artery pressure, pulmonary vascular resistance (PVR), 6min walk test,right ventricular end-systolic diameter (RVSD) changes were observed and statistically analyzed after six months medication. Results Pulmonary arterial systolic pressure (sPAP) was significanfly decreased from (96±11) mmHg to (86±10) mmHg, <0.01.pulmonary arterial diastolic pressure (dPAP) was significanfly decreased from (56±10) mmHg to (46±9) mmHg ( <0.01),pulmonary arterial mean pressure (mPAP) was significanfly decreased from (73 ±11) mmHg to (59 ±10) mmHg ( <0.05), pulmonary vascular resistance was significanfly decreased from (17.8±1.9) Wood to (13.1±1.7) Wood (<0.01) . 6min walk test was improved from (136±40) m to (198±55) m, <0.01.right ventricular end-systolic diameter significanfly decreased from (40±5) mm to (36±6) mm after 6 months therapy ( <0.05) . Conclusion Bosentan can decrease pulmonary arterial systolic pressure, improve exercise tolerance, improve right ventricular function in patients with severe CHD-PAH.

Relationship of Arrhythmia and Electrical Parameters after Transcatheter Closure of Ventricular Septal Defect / 昆明医科大学学报

Objective To study the ralationship of arrhythmias and heart electrical parameters changes after transcatheter closure of ventricular septal defect (VSD) .Method 50 patients had been successfully finnished the transcatheter closure of ventricular septal defect,and then we observed ralationship of arrhythmias and heart electrical parameters changes. Results (1) Compared with the situation of VSD occluder preoperative and postoperative, during follow-up there were 20 arrhythmia cases, including bundle branch block 16 cases, including the complete left bundle branch block 2 cases,complete right bundle branch block 4 cases,a transient third-degree trioventricular conduction block 1 case, most return to normal in the follow-up. 2 Intracavitary electrogram showed before and after transcatheter closure:A-V conduction parameters A-H,H-V value of (75.10 ± 14.34) ms vs (80.67±23.03) ms and (47.9±12.61) ms vs (50.07±15.23) ms,the difference was not statistically significant ( >0.05) . Conclusions (1) Some patients with new ECG changes after transcatheter closure of VSD, manifested as an increase in bundle branch block in a week, but most return to normal,the prognosis is good. (2) Intraoperative A-H,H-V extension is not related with with postoperative slow arrhythmia;(3) Arrhythmia is a common complication after VSD transcatheler closure, to strictly selecte indications,and to avoid too large diameter are the effective measures to reduce the arrhythmias after transcatheter closure of ventricular septal defect (VSD) .

Clinical Application of Advanced Echocardiography in Cardiac Mechanical Contraction Synchronization Test in Patients with Heart Failure / 昆明医科大学学报

Objective To test synchronization of cardiac mechanical contraction by means of advanced echocardiography and investigate the correlation of left ventricular ejection fraction (LVEF) and the indexes of mechanical dyssynchrony, and the relationship between DTI, STI and RT-3DE.Methods Control group (20 cases), chronic heart failure with a widened QRS complex (12 cases) and chronic heart failure with a shortened QRS duration (10 cases) were selected. We evaluated mechanical dyssynchrony with the DTI, the STI and the RT-3DE, and analyzed the correlation between the improvement degree of cardiac function and indexes of mechanical dyssynchrony, and the correlation between DTI, STI and RT-3DE. Results (1) In CHF groups (including shortened QRS group and widened QRS group), the indexes of synchronization of cardiac mechanical contraction were higher than control group ( 0.05) . (3) In CHF groups (including shortened QRS group and widened QRS group), the indexes of mechanical dyssynchrony before operation were higher more than after operation ( 0.05) . (5) There was a significant negative correlation between the LVEF and the indexes of mechanical dyssynchrony (<0.01) . (6) .In the indexes of synchronization of cardiac mechanical contractions, there are significant positive correlations between the DTI, the STI and the RT-3DE ( <0.01) . Conclusion Echocardiography can be used to screen CHF patients,and patients with left ventricular synchronous (including shortened QRS duration) can also be benefited from CRT.