Construction of early warning indicators of in-hospital cardiac arrest in adult inpatients / 中华危重病急救医学

Objective:To establish early warning indicators for Chinese nurses to recognize in-hospital cardiac arrest (IHCA) of adult inpatients.Methods:Computer retrieval of Chinese and English databases such as CNKI, Wanfang Database, VIP, National Medical Library of the United States PubMed Database, Web of Science, Embase Database of the Netherlands Medical Abstracts, Cochrane Library Database and other international guidelines collaboration network (GIN), National Institute for Health and Clinical Optimization (NICE), Scottish Intercollegiate Guidelines Network (SIGN), BMJ best clinical practice and other guidelines was performed. The retrieval time limit for respiratory and cardiac arrest early warning indicators or risk identification related content of the adult inpatient in the professional website was until June 30, 2020. After literature research and expert group analysis, the research group drew up an expert correspondence questionnaire, and selected 32 medical and nursing experts from Beijing, Tianjin, Jilin, Shandong, Shaanxi, Sichuan, Zhejiang and other grade three first-class general hospitals from July to September 2022. The Delphi method was used to conduct two rounds of expert correspondence, forming the final version of the early warning index of cardiac arrest in adult inpatients.Results:Five first-level indicators, 23 second-level indicators and 41 third-level indicators including vital signs, consciousness and pupils, postoperative blood drainage volume, lab results and other five aspects were initially formed. The effective response rates of the two rounds of expert correspondence were 100% (32/32) and 93.75% (30/32), respectively, the Kendall coordination coefficients W of the first round and the second round were 0.340 and 0.462, respectively, the expert authority coefficients Cr were 0.88 and 0.89, respectively, the mean value of importance assignment was 3.94-5.00, 4.07-5.00, and the coefficient of variation was 0-0.16, 0-0.14, with statistically significant differences (all P < 0.05). Finally, 5 primary indicators, 23 secondary indicators and 43 tertiary indicators were formed, including five aspects of vital signs, consciousness and pupils, postoperative blood drainage, lab results, symptoms and chief complaints. Conclusion:The expert consultation on the early warning indicators of IHCA for adult patients tends to be consistent and scientific, which is applicable to help nurses detect the changes of patients' condition as early as possible.

Visual analysis of critical care research based on Web of Science core set / 中国实用护理杂志

Objective:To analyze the data of critical care related literatures published in Web of Science core set by knowledge map visualizing technology, and summarize the research status and hotspots of critical care.Methods:The core set database of Web of Science from January 2011 to December 2020 was searched, the extracted information was standardized and analyzed by knowledge map visualizing technology.Results:A total of 783 articles in the field of critical care were included, and the number of literatures increased year by year, among which the number of articles published in the American Journal of Critical Care(305) was the most. The United States (437) was the country with the most published literatures, and Australia was the country with the highest centrality (centrality=0.67). The number and centrality of articles published from China were at the lower middle level. There was cooperation among countries, but not close cooperation. The cooperation among authors was in the state of small aggregation and large dispersion. Cluster analysis and keyword emergence analysis showed that many aspects in the field of intensive care had been the research hotspots, among which "post intensive care syndrome" and "children′s intensive care" were the research hotspots in recent years.Conclusions:The research field of intensive care is still in the rising stage of development, and post intensive care syndrome and children's intensive care are the latest hotspots in intensive care research.

Research progress of the impact of payment by disease diagnosis-related group on nursing care / 中国实用护理杂志

The National Medical Insurance Administration launched a national pilot project based on diagnosis-related group (DRG) payment across the country in 2019. It optimizes and reuses limited resources from a clinical perspective, controls hospitalization expenses and medical costs, and reduces average hospital stays based on DRG payment. This article expounds the concept and application of DRG payment, from the perspective of clinical nursing, expounds the research progress of DRG payment at home and abroad, attempts to analyze the relationship between DRG payment and nursing, and further proposes the impact on the development of clinical nursing.

Investigation on sleep quality and mental health of nurses in public health emergencies / 中国实用护理杂志

Objective:To understand the sleep quality and mental health status of nurses in public health emergencies, and analyze the correlation between them.Methods:A total of 128 first-line nursing staff participating in public health emergencies on February 22-23, 2020 in Tianjin Beichen Hospital, Tianjin First Central Hospital, Tianjin Fourth Central Hospital were investigated by the general data questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Symptom Checklist 90 (SCL-90).Results:70.3%(90/128) of nursing staff had poor sleep quality, and the total score of PSQI was (9.71±4.01) points, which was statistically significant compared with the domestic norm ( t value was 16.479, P<0.01). The total score of SCL-90 was 1.59±0.52, which was statistically significant compared with the domestic norm ratio ( t value was 4.505, P<0.01). One-way ANOVA showed that the nursing staff's age had a significant impact on sleep quality, and the difference was statistically significant ( F value was 4.092, P<0.05). Pearson correlation analysis showed that the Pittsburgh sleep quality scale index scores and symptom self-assessment scale and somatization, force, sensitive interpersonal relationship, depression, anxiety, hostile, terrorist, paranoia, and psychosis were positively correlated( r values were 0.292-0.444, P< 0.01). Conclusions:The sleep quality and mental health status of nurses in public health emergencies are poor, and the sleep quality is correlated with mental health status.

Effects of mindfulness therapy on self-burden, hope and sleep in patients undergoing perfusion chemotherapy for bladder cancer / 中国实用护理杂志

Objective:To explore the effect of mindfulness therapy on self burden, hope and sleep of middle-aged bladder cancer patients undergoing bladder sparing chemotherapy.Methods:Sixty patients with bladder cancer treated by intravesical instillation chemotherapy with bladder preservation from January 2018 to December 2019 were selected as the study subjects. They were divided into control group and intervention group according to the sequence of chemotherapy time, with 30 cases in each group. Both groups received routine nursing and rehabilitation training in urology, and mindfulness therapy was added to the intervention group for 6 weeks. Before and 6 weeks after the intervention, the sleeping and mental status of the two groups were compared by the Self-Burden Feeling Scale (SPBS), Herth Hope Scale (HHI) and Insomnia Severity Index Scale (lSI).Results:There was no significant difference in SPBS, HHI and ISI scores between the two groups before intervention ( P > 0.05). After 6 weeks of intervention, SPBS score of patients in the intervention group was 47.00±1.41, and that of the control group was 49.50±0.62.After 6 weeks of intervention, the total score of HHI was 32.61±1.94 in the intervention group and 27.22±2.67 in the control group.After 6 weeks of intervention, ISI score of patients in the intervention group was 19.17± 1.72, and that of the control group was 20.67±2.24. The difference between the two groups was statistically significant ( t values were 6.454, -7.042, 2.097, P < 0.01 or 0.05). Conclusions:Mindfulness therapy can effectively improve insomnia and cancer emotional problems in patients with bladder cancer who underwent bladder preservation and perfusion.

Research progress on the causes and preventive measures of central venous catheter blockage / 中国实用护理杂志

Central venous catheters (CVCs) are now widely used in critical care for critical care, fluid resuscitation, drug infusion, parenteral nutrition, hemodynamic monitoring, chemotherapy, and continuous blood purification treatment. Although the application of CVCs can facilitate clinical medical care work, the proportion of patients with various catheter complications will exceed 15%, and the incidence of catheter blockage is about 25%. At present, adequate flushing and effective sealing are considered to be important means to reduce and prevent catheter blockage. This article reviews the prevention of central venous catheter occlusion with different sealing fluids, in order to provide reference for clinical nurses to prevent central venous catheter occlusion.

Research progress on the causes and preventive measures of central venous catheter blockage / 中国实用护理杂志

Central venous catheters (CVCs) are now widely used in critical care for critical care, fluid resuscitation, drug infusion, parenteral nutrition, hemodynamic monitoring, chemotherapy, and continuous blood purification treatment. Although the application of CVCs can facilitate clinical medical care work, the proportion of patients with various catheter complications will exceed 15%, and the incidence of catheter blockage is about 25%. At present, adequate flushing and effective sealing are considered to be important means to reduce and prevent catheter blockage. This article reviews the prevention of central venous catheter occlusion with different sealing fluids, in order to provide reference for clinical nurses to prevent central venous catheter occlusion.

The study about the change of the blood oxygen saturation and pulse rate of the nursing staff under abrupt highland advancing / 中国实用护理杂志

0bjective To evaluate the changes in blood oxygen saturation and pulse rate of the nurses under abrupt highland advancing and provide the fundamentals for those nurses under abrupt highland advancing to Tibet. Methods We selected 12 nursing staffs abruptly advanced to Lhasa at an altitude of 3 650 meters for Abrupt Advancing Group then chose 12 nursing staffs over there for Highland Group from November 2017 to December 2017. To assess whether there is a difference about the change of blood oxygen saturation and pulse rate between these two groups, we measured them in 24 nurses and 360 shifts before work and at 0.5, 1.0, 3.0, 6.0 h after work. Then, we compared the changes in blood oxygen saturation and pulse rate between different ages, sexes, shifts. Results No significant difference in blood oxygen saturation was observed between the two groups before starting work (P > 0.05). Blood oxygen saturation of Abrupt Advancing Group (0.5, 1.0, 3.0, 6.0 h) after work was respectively 0.91±0.01, 0.91±0.02, 0.91±0.02, 0.91±0.01. Meanwhile, the parameters of Highland Group was separately 0.94± 0.02, 0.93 ± 0.01, 0.94 ± 0.01, 0.94 ± 0.01. There was a significant difference between the two groups (t=5.153-8.151, P<0.05 or 0.01). Before work, the pulse rate was (85.38±2.38), (91.62±2.79),(89.79±2.05), (89.12±2.29), (89.72±2.31) times/min for Abruptly Advancing Group, (93.52±2.64), (93.52±2.82), (94.52± 2.73), (94.52±2.56), (93.52±2.96) times/min for Highland Group. The difference between the two groups was statistically significant (t=3.875-10.182, P<0.01). Besides, no difference about the changes in blood oxygen saturation of Abruptly Advancing Group between different shifts was observed (t=3.561-8.321, P<0.05 or 0.01). The difference of pulse rate in Abruptly Advancing Group was statistically significant (t=1.529-4.968, P<0.05 or 0.01). There was no significant difference of blood oxygen saturation and pulse rate in Abruptly Advancing Group between the age of 21 to 30 and 31 to 40 years old, whether before or after work (P > 0.05). A positive difference between the sexes could be found about the changes in the blood oxygen saturation of Abruptly Advancing Group at 0.5, 1.0, 3.0 and 6.0 h after work. What′s more, there was a significant difference in pulse rates before and after work (t=3.283-6.719, P<0.05 or 0.01). Conclusions The nursing staff in the Abruptly Advancing Group shows decreased blood oxygen saturation and increased pulse rate compared to those in the Highland Group during working period. In addition, the changes show more significant in those working at night, but they adapted gradually. Gender and working time have a significant effect on the change in blood oxygen saturation and increased pulse rate of the nursing staff.

Study on the influence and intervention strategy of nursing staff rushing to plateau on sleep quality / 中国实用护理杂志

Objective To understand the changing characteristics of sleep quality of acute plateau nursing staff during the period of assistance to Tibet, formulate comprehensive intervention measures, improve the support ability of nursing staff, and provide the basis for effectively completing the work of plateau assistance to Tibet. Methods From November to December 2017, 12 nurses who participated in the assistance work for Tibet in Lhasa region with an altitude of 3,650 m were selected as the emergency group, and 12 nurses from a hospital in Tibet were selected as the plateau group. Pittsburgh sleep quality index (PSQI) was used to investigate the sleep quality of the acute group before and after Tibet entry and the plateau group respectively. A sleep quality survey scale was designed to investigate the sleep quality of nursing staff in the emergency group and the plateau group at 5 different shifts on the same night after admission to Tibet. Results The scores of total sleep score, sleep quality, sleep time, sleep time, sleep efficiency and daytime dysfunction in the acute group were 3.77 ± 1.79, 0.89 ± 0.47, 0.78 ± 0.36, 0.76 ± 0.41, 0.19 ± 0.05, 0.54 ± 0.07, and 5.37 ± 1.23, 1.57 ± 0.36, 1.53 ± 0.43, 1.21 ± 0.38, 0.72 ± 0.10, 0.99 ± 0.91 respectively. The differences before and after Tibet were statistically significant (t=2.327-4.399, P <0.05).The scores of sleep time, sleep time, sleep efficiency and sleep disorder in the acute group were 1.53±0.43, 1.21±0.38, 0.72±0.19, 1.16 ± 0.21, and 1.04 ± 0.21, 0.86 ± 0.32, 0.39 ± 0.31 and 0.76 ± 0.33 respectively. The differences between the two groups were statistically significant (t=2.441-3.547, P<0.05 or 0.01).Radical groups after Tibet plateau and nursing staff sleep quality scale scores compare, radical group day shift, middle shift, night after night under three different shifts the total score of sleep quality, respectively 11.76 ± 0.12, 11.98 ± 0.23, 12.43 ± 0.52, higher than that of plateau group 11.18 ± 0.04 11.23 ± 0.57, 11.98±0.54, the difference between two groups was statistically significant (t=15.554, 4.227, 2.07, P<0.01 or 0.05). The sleep quality score (11.38±0.36) in the night of the rest class was lower than that of the plateau group (11.92±0.38), and the difference was statistically significant (t=-3.574, P=0.002). The score of sleep quality and sleep delay of the acute group were 1.87±0.57, 1.93±0.61, and 1.39± 0.39, 1.25±0.42 respectively. The difference between the two groups was statistically significant (t=2.408, 3.181, P<0.05 or 0.01). Conclusions It is a common sleep problem for medical and nursing personnel in Tibet who rush into the plateau. Comprehensive intervention measures should be taken in advance, scientific popularization, education and health technical guidance should be carried out in the early stage, mental health conditions should be improved, and drug prevention should be taken when necessary to help medical and nursing personnel in Tibet sleep quality.

Causual analysis of liquid leakage from the urethral meatus and nursing intervention in patients indwelled with urinary catheter after transurethral resection of the prostate / 中国实用护理杂志

Objective To investigate the causes of liquid leakage from the urethral meatus in patients indewelled with urinary catheter after transurethral resection of the prostate(TURP), and provide the basis for improving the nursing quality. Methods A retrospective study was conducted in 179 patients who underwent TURP from January 2015 to February 2018. Data included in the analysis were age, IPSS, storage and voiding symptom scores (IPSS-S, IPSS-V), QoL, maximum free flow rate (Qmax), post-voided residual urine volume, first sensation of bladder filling(FS), bladder compliance(BC), BC grade, maxmium cystometric capacity(MCC), MCC grade, maximum detrusor pressure, detrusor pressure at Qmax, obstruction grade, detrusor overactivity(DO) and detrusor underactivity(DUA). Acorrding to the status of liquid leakage from the urethral meatus after TURP, patients were divided into leakage positive (LP) and negative(LN) groups. The above mentioned parameters were compared between the two groups and these with statistical significance were further analyzed in the Logistic regression model. Results There were 76 and 103 patients in LP and LN groups, respectively. There were significant differences in age, IPSS score, IPSS-S score, BC score, BC grade, FS score, MCC score, MCC grade, Qmax and the prevalence of DO between LP and LN groups [(72.9±7.1)years old vs. (67.9±6.8)years old, (23.7±5.7)vs. (20.9±6.7), (11.4±2.9)vs.(8.8±3.3), 10.5(5.6, 16.4)ml/cmH2O vs.37.0(24.3, 57.3)ml/cmH2O, (3.6±3.3)vs. (9.4±5.0), (85.2±53.2)ml vs.(130.8±69.7)ml, (161.6±97.5) ml vs. (323.7±163.6)ml, (3.8±2.0)vs.(6.7±2.5), (6.1 ± 2.8)ml/s vs.(7.4 ± 3.3)ml/s, 57.9% (44/76) vs.17.4% (18/103)] ( P<0.05 for each). Logistic regression analysis showed that high IPSS-S ( OR=1.617, P=0.001), DO ( OR=3.615, P=0.024), MCC ( OR=0.591, P=0.002) and BC grades ( OR=0.745, P=0.001) were risk and protective factors of liquid leakage from the urethral meatus after TURP. Conclusion When indwelled with urinary catheter, the patients with high IPSS-S, low MCC, low BC, and DO have high risks of liquid leakage from the urethral meatus after TURP. For these patients, we should give psychological guidance, and inform them of disease condition preoperatively; and after surgery we should take appropriate measures to improve nursing quality.

Study on the influence and intervention strategy of nursing staff rushing to plateau on sleep quality / 中国实用护理杂志

Objective@#To understand the changing characteristics of sleep quality of acute plateau nursing staff during the period of assistance to Tibet, formulate comprehensive intervention measures, improve the support ability of nursing staff, and provide the basis for effectively completing the work of plateau assistance to Tibet.@*Methods@#From November to December 2017, 12 nurses who participated in the assistance work for Tibet in Lhasa region with an altitude of 3,650 m were selected as the emergency group, and 12 nurses from a hospital in Tibet were selected as the plateau group. Pittsburgh sleep quality index (PSQI) was used to investigate the sleep quality of the acute group before and after Tibet entry and the plateau group respectively. A sleep quality survey scale was designed to investigate the sleep quality of nursing staff in the emergency group and the plateau group at 5 different shifts on the same night after admission to Tibet.@*Results@#The scores of total sleep score, sleep quality, sleep time, sleep time, sleep efficiency and daytime dysfunction in the acute group were 3.77±1.79, 0.89±0.47, 0.78±0.36, 0.76±0.41, 0.19±0.05, 0.54±0.07, and 5.37±1.23, 1.57±0.36, 1.53±0.43, 1.21±0.38, 0.72±0.10, 0.99±0.91 respectively. The differences before and after Tibet were statistically significant (t=2.327-4.399, P <0.05).The scores of sleep time, sleep time, sleep efficiency and sleep disorder in the acute group were 1.53±0.43, 1.21±0.38, 0.72±0.19, 1.16±0.21, and 1.04±0.21, 0.86±0.32, 0.39±0.31 and 0.76±0.33 respectively. The differences between the two groups were statistically significant (t=2.441-3.547, P<0.05 or 0.01).Radical groups after Tibet plateau and nursing staff sleep quality scale scores compare, radical group day shift, middle shift, night after night under three different shifts the total score of sleep quality, respectively 11.76±0.12, 11.98±0.23, 12.43±0.52, higher than that of plateau group 11.18±0.04 11.23±0.57, 11.98±0.54, the difference between two groups was statistically significant (t=15.554, 4.227, 2.07, P<0.01 or 0.05). The sleep quality score (11.38±0.36) in the night of the rest class was lower than that of the plateau group (11.92±0.38), and the difference was statistically significant (t=-3.574, P=0.002). The score of sleep quality and sleep delay of the acute group were 1.87±0.57, 1.93±0.61, and 1.39±0.39, 1.25±0.42 respectively. The difference between the two groups was statistically significant (t=2.408, 3.181, P< 0.05 or 0.01).@*Conclusions@#It is a common sleep problem for medical and nursing personnel in Tibet who rush into the plateau. Comprehensive intervention measures should be taken in advance, scientific popularization, education and health technical guidance should be carried out in the early stage, mental health conditions should be improved, and drug prevention should be taken when necessary to help medical and nursing personnel in Tibet sleep quality.

Causual analysis of liquid leakage from the urethral meatus and nursing intervention in patients indwelled with urinary catheter after transurethral resection of the prostate / 中国实用护理杂志

Objective@#To investigate the causes of liquid leakage from the urethral meatus in patients indewelled with urinary catheter after transurethral resection of the prostate(TURP), and provide the basis for improving the nursing quality.@*Methods@#A retrospective study was conducted in 179 patients who underwent TURP from January 2015 to February 2018. Data included in the analysis were age, IPSS, storage and voiding symptom scores (IPSS-S, IPSS-V), QoL, maximum free flow rate (Qmax), post-voided residual urine volume, first sensation of bladder filling(FS), bladder compliance(BC), BC grade, maxmium cystometric capacity(MCC), MCC grade, maximum detrusor pressure, detrusor pressure at Qmax, obstruction grade, detrusor overactivity(DO) and detrusor underactivity(DUA). Acorrding to the status of liquid leakage from the urethral meatus after TURP, patients were divided into leakage positive (LP) and negative(LN) groups. The above mentioned parameters were compared between the two groups and these with statistical significance were further analyzed in the Logistic regression model.@*Results@#There were 76 and 103 patients in LP and LN groups, respectively. There were significant differences in age, IPSS score, IPSS-S score, BC score, BC grade, FS score, MCC score, MCC grade, Qmax and the prevalence of DO between LP and LN groups [(72.9±7.1)years old vs. (67.9±6.8)years old, (23.7±5.7)vs. (20.9±6.7), (11.4±2.9)vs.(8.8±3.3), 10.5 (5.6, 16.4) ml/cmH2O vs.37.0 (24.3, 57.3) ml/cmH2O, (3.6±3.3)vs. (9.4±5.0), (85.2±53.2)ml vs.(130.8±69.7)ml, (161.6±97.5) ml vs. (323.7±163.6)ml, (3.8±2.0)vs.(6.7±2.5), (6.1±2.8)ml/s vs.(7.4±3.3)ml/s, 57.9% (44/76) vs.17.4% (18/103)] (P<0.05 for each). Logistic regression analysis showed that high IPSS-S (OR=1.617, P=0.001), DO (OR=3.615, P=0.024), MCC (OR=0.591, P=0.002) and BC grades (OR=0.745, P=0.001) were risk and protective factors of liquid leakage from the urethral meatus after TURP.@*Conclusion@#When indwelled with urinary catheter, the patients with high IPSS-S, low MCC, low BC, and DO have high risks of liquid leakage from the urethral meatus after TURP. For these patients, we should give psychological guidance, and inform them of disease condition preoperatively; and after surgery we should take appropriate measures to improve nursing quality.

Sodium citrate anticoagulation in continuous plasma adsorption treatment of clinical research / 中华急诊医学杂志

Objective Explore the sodium citrate anticoagulation in the continuity of plasma adsorption closed-circuit circulation of anticoagulation therapy method and effect. Methods Line into the continuity of plasma adsorption treatment of 156 cases of acute drug poisoning patients were randomly(random number) divided into two groups, 78 cases in each group, respectively adopt low molecular heparin (group A), sodium citrate anticoagulation (group B). Contrast analysis of two groups after the therapy began 30 min, 3 h, 6 h before the filter in patients with pressure, transmembrane pressure, pressure drop, at the same time to compare two groups of 10 min before the start of treatment, after treatment began to 3 h, 6 h platelet, coagulation time live enzymes, vein in the body of free Ca2+, Na+and HCO3- 24 h and internal bleeding. Results Two groups in gender, age, clinical diagnosis, blood purification time comparative differences had no statistical significance (P>0.05);Two groups of 30 min after the start of treatment, 3 h, 6 h patients before pressure, transmembrane pressure, filter pressure drop compared differences were no statistical significance (P>0.05); Part of coagulation treatment after low molecular heparin group live enzymes the sodium citrate group significantly prolonged (P<0.01);Platelets, HCO3- the two groups after treatment, intravenous free Ca2+ and Na+ differences had no statistical significance (P>0.05). Conclusions In the continuous plasma adsorption treatment process using sodium citrate anticoagulation with clinical feasibility, safety.

Effect of scenario simulation training on improving rescue ability of ICU nurses in military hospital / 中国实用护理杂志

Objective To explore the effect of scenario simulation training to nurses in improving the rescue ability at ICU. Methods A total of 84 nurses were enrolled and divided into12 groups, who received 6 scenarios training developed by researchers. The score of theoretical knowledge, time of practice completion and 7 operating practices were compared before and after training. Results The theoretical knowledge score of the nursing staff before the exercise was 72.21 ± 3.14, and the score was 91.77 ± 4.55 after the exercise, and the difference before and after the exercise was statistically significant (t=2.77, P<0.05). After practice, nursing staff in cardiopulmonary resuscitation (CPR), intestinal spillover, limb fracture, pelvic fractures, burns, bleeding, glass into the seven skills score 96.23 ±4.80, respectively 96.92±4.12, 96.59±3.97, 93.79±3.45, 97.71±4.18, 95.58±4.16, 91.67±3.31, were higher than drills before 85.43± 4.55, 65.44± 4.21, 74.05± 3.25, 66.35± 2.95, 85.31± 4.05, 81.41± 3.11, 69.59± 3.96.There was a significant difference in 7 operational skills between before and after operation (t=4.010-9.780, P<0.01) . After practice,six scenario completion time was (265.45 ± 41.37), (274.90 ± 43.15), (296.52 ± 42.09), (285.44 ± 47.15), (296.42 ± 43.51), (303.50 ± 36.92) s respectively, than drills before (366.29 ± 41.12), (363.54 ± 32.94), (367.78 ± 33.75), (371.29 ± 40.16), (370.57 ± 34.69), (372.98 ± 35.32) s. There was a significant difference in time of finishing 6 scenarios between before and after operation exercises (t =2.190-6.210, P< 0.05). Conclusions Scenario simulation model training can improve the theoretical knowledge, time of practice completion andpractices ability of ICU nursing.

A descriptive analysis of triage,surge,and medical resource use in a university affiliated hospital ;after 8·12 explosion and burn at Tianjin Port / 中华急诊医学杂志

Objective To analyze the massive explosions and burn at Tianjin Port in 2015 resulted in a mass casualty event,and the entire course of response of a hospital to deal with such major sudden accident in order to find a rational strategy for optimal use of medical resources and reduce the critical mortality.Methods This study was done by a retrospective analysis of data from one trauma center at an academic hospital.Data including outcome,triage,severity and pattern of injuries,patient flow,and medical resources used were obtained by the review of hospital records.Results This disaster caused 165 deaths,8 missing contact,and 797 non-fatal casualties.The Pingjin Hospital admitted 298 casualties,and 29 of them were seriously injured referred to by Tianjin Emergency Medical Center.Excessive triage rate made after transfer to another hospital was 62.07% with 11 of the 29 severely injured patients.Maximum (also the first)surge had 147 injured patients arrived around one hour after incident,the second surge had 31 seriously injured patients occurred around 4 hours after incident.Of them,17 patients needed surgery and 17 patients were admitted to the intensive care unit.Conclusions These data showed that the number of casualties in the first surge was substantially larger than predicted and those casualties had less severe trauma,whereas the number of the injured in the second surge was less but the trauma was more severe.In order to maintain the hospital surge capacity,an effective re-triage and a hospital-wide damage control principle can be used to deal with.

Clinical effectiveness study on artificial airway sequential mechanical ventilation patients withdraw machine pull out / 中国实用护理杂志

Objective On patients with mechanical ventilation spontaneous breathing trial (SBT) success, out of breath machine smoothly pulled out after endotracheal intubation for active airway moist sequential therapy of clinical new method and new technology. Methods Between January 2013 and May 2014 respiratory endotracheal intubation implementation of mechanical ventilation with intensive medicine successful withdraw machine pulled out of 135 patients with tracheal intubation, they were divided into group A(68 cases) and group B(67 cases) by random digits table method. The patients in group A were treated with buoy type oxygen device, group B with active airway moist heat treatment unit. The breathing rate, PaO2, SpO2, heart rate, Clinical Pulmonary Infection Score(CPIS) were measured after 72 h of pull out endotracheal intubation in two groups. Sputum viscosity was evaluated by Airway Secretions Score before pull out endotracheal intubation and after 24, 48, 72 h of pull out endotracheal intubation in two groups. Results There were no significant differences between two groups in gender, age, clinical diagnosis, mechanical ventilation time, acute physiology and chronic health evaluation systemⅡrating etc (P>0.05). The breathing rate, heart rate and CPIS score respectively (20.94 ± 0.89), (80.79±4.67) times/min and (7.13 ± 2.54) points after 72 h of pull out endotracheal intubation in group B, and (24.12 ± 0.97), (86.32 ± 5.12) times/min and (8.79±3.56) points in group A, and there were significant differences(t=5.113, 7.298, 5.597, all P0.05). After 24, 48 and 72 h of pull out endotracheal intubation, group B of patients with sputum viscosity was suitable in group A (Z=-2.684,-2.870,-2.771, all P < 0.01). Conclusions Mechanical ventilation in patients with ventilator buoy type oxygen device for the pull out after endotracheal intubation success does not favor the sputum drainage, improve patients with dyspnea and hypoxemia is not obvious. By positive airway plus temperature humidity to sequential therapy is helpful to correct hypoxemia, improve the patients' respiratory function, reduce the breathing difficulties, reduce sputum viscosity, promote the airway drainage unblocked, shortening the time of lung infection.

Analysis of prognostic value of initial serum paraquat concentration in patients with paraquat poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To investigate the prognostic values of initial serum paraquat (PQ) concentration and time lag after PQ ingestion in patients with PQ poisoning.</p><p><b>METHODS</b>A retrospective analysis was performed on 189 patients who ingested PQ between 2.5 and 48 h before admission. The values of initial serum PQ concentration and time lag after PQ ingestion for the prognosis after poisoning were analyzed by the receiver operating characteristic (ROC) curve and multiple logistic regression analysis.</p><p><b>RESULTS</b>The serum PQ concentration of non-survivors was significantly higher than that of survivors (P<0.01) , and the time lag after PQ ingestion of non-survivors was significantly longer than that of survivors (P<0.01). The ROC curve analysis showed that the area under the ROC curve (AUC) showed no significant difference between initial serum PQ concentration and serum PQ concentration-time data when the time lag after PQ ingestion was between 2.5 and 48 h (z=0.563, P=0.574) ; the AUC showed a significant difference between initial serum PQ concentration and serum PQ concentration-time data when the time lag after PQ ingestion was between 2.5 and 6 h (z=2.199, P=0.034) and between 6 and 48 h (z=2.525, P=0.012).</p><p><b>CONCLUSION</b>Initial serum PQ concentration has a better predictive power than serum PQ concentration-time data in evaluating the prognosis of patients when the time lag after PQ ingestion is within 6 h. However, serum PQ concentration-time data has a better predictive power than PQ concentration alone in evaluating the prognosis of patients when the time lag after PQ ingestion is between 6 and 48 h.</p>

The clinical progress of haemoperfusion in the treatment of paraquat poisoning / 中国医学装备

The high mortality of paraquat (PQ) poisonings is mainly due to the lack of effective treatments. Most toxicologists recommend rapid initiation of charcoal haemoperfusion (CHP) to lower plasma PQ levels and to limit pulmonary and other organs uptake of PQ. Although there are considerable evidences of CHP efficacy in the reversion of the fatal outcome resulting from PQ poisonings, the usefulness of this therapy has been the subject of significant controversy with several evidences published in the literature showing a lack of clinical benefit in numerous cases. Considering that the blood concentration at a given time is directly related to clinical outcome, the rebound in plasma paraquat concentration after haemoperfusion may be partly relate to the poor clinical benefit, but may indicate the necessity for prolonged haemoperfusion. Continuous rather than intermittent haemoperfusion has been advocated for treatment of paraquat poisoning. However, 24h daily conventional pump driven haemoperfusion is usually impossible to carry out due to bleeding complications. Plasmapheresis is also a blood purification process. Unselective therapeutic plasma exchange is the first technology used for therapeutic apheresis (TA). However, limited efficacy by restricted plasma volume that can be exchanged in a single session is one of the severe limitations. To further increase the clearance of target molecules, plasma perfusion (PP) techniques was developed. modification of the conventional plasma perfusion in patients with paraquat poisoning has been reported and plasma levels of paraquat were reduced effectively.