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The awake prone position plays an important role in the treatment of hypoxemia and the improvement of respiratory distress symptoms in non-intubated patients. It is widely used in clinical practice because of its simple operation, safety, and economy. To enable clinical medical staff to scientifically and normatively implement prone position for awake patients without intubation, the committees of consensus formulation, guided by evidence-based methodology and Delphi method, conducted literature search, literature quality evaluation and evidence synthesis around seven topics, including indications and contraindications, evaluation, implementation, monitoring and safety management, termination time, complication prevention and health education of awake prone position. After two rounds of expert letter consultation, Expert consensus on implementation strategy of awake prone positioning for non-intubated patients in China (2023) was formulated, and provide guidance for clinical medical staff.
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Humanos , Consenso , Decúbito Ventral , Vigília , China , DispneiaRESUMO
Objective:To explore the influencing factors of frailty in elderly patients with coronary heart disease (CHD), and to compare and analyze the value of different frailty scales in screening elderly patients with coronary heart disease.Methods:Using cross-sectional research methods，elderly patients with coronary heart disease from November 2019 to January 2020 in the Department of Cardiology of a tertiary hospital in Zhenjiang City were selected as the research objects. The frailty status of the patients was evaluated by the frailty index scale, and the patients were divided into frailty group (54 cases) and non-frailty group (149 cases) according to the evaluation results. F-test was used for the comparison between measurement data groups conforming to normal distribution, and χ 2 test or exact probability method was used for the comparison of counting data. Multivariate Logistic regression was used to analyze the main influencing factors of elderly patients with coronary heart disease. The correlation and consistency of clinical frail scale, frail scale and frail index were compared and analyzed were analyzed by Spearman correlation and Kappa test. ROC curve was used to analyze the sensitivity, specificity and the area under the working characteristic curve. Results:The age ((78.96±6.78) years), the percentage of monocytes >10% (31.48% (17/54)), the specific index for coronary heart disease ≥4 points (57.41% (31/54)), Barthel index <100 points (85.19% (46/54)), the mini nutritional assessment scale <24 points (66.67% (36/54)) of the patients in the frail group was higher than these in non-frail group ((73.94±5.89) years old, 12.08%(18/149), 7.38%(11/149), 22.15%(33/149), 14.77%(22/149)), the differences were statistically significant (statistical values were t=5.15, χ 2=10.46, χ 2=60.45, χ 2=66.26, χ 2=52.32; P values were <0.001,0.001,<0.001,<0.001,<0.001,respectively). The results of multivariate Logistic regression analysis showed that the percentage of monocytes >10% ( OR=5.927, 95% CI:1.854-18.947), the mini nutritional assessment scale <24 ( OR=7.026, 95% CI:2.660-18.555),the specific index for coronary heart disease ≥4 points ( OR=3.333, 95% CI:1.889-26.850,) and Barthel index <100 points ( OR=15.649, 95% CI:5.403-45.321) are the main effects of frailty in elderly patients with coronary heart disease factors ( P values were 0.003,<0.001,<0.001, and <0.001, respectively). Taking the frailty index as the gold standard, the sensitivity of the clinical frailty scale and FRAIL scale were 85.19% and 85.19%, respectively, and the specificity was 90.60% and 94.63%, respectively, with no significant difference (χ 2 values were 0.000 and 1.767; all P>0.05). The Kappa of the clinical frailty scale scale was <0.75, while the Kappa of the FRAIL scale was >0.75. The consistency of the frail scale with the gold standard was better than that of the clinical frailty scale scale. Conclusion:The percentage of monocytes, the specific index for coronary heart disease, the mini nutritional assessment scale and Barthel index are the main factors affecting the frailty of elderly patients with coronary heart disease. Taking the frailty index score as the standard, the consistency between the screening results of frail scale and frailty index score is better than that of clinical frailty scale scale, which has clinical application value.
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ObjectiveTo investigate the effect of β-adrenoceptor (β-AR) blockers on G protein and heart function changes in rats with acute myocardial infarction (AMI) MethodsWistar rats with AMI induced by left anterior descending coronary branch ligation were randomly divided into compared with sham operation group. Eight weeks after therapy, hemodynamics was assessed by inserting catheters and the level of G protein was detected by Western blot analysis. ResultsCompared with the sham operation group, systolic blood pressure(SBP), diastolic blood pressure (DBP), left ventricular systolic pressure(LVSP) and left ventrieular pressure maximal rate of rise and fall(±dp/dtmax) in AMI group were significantly decreased, while left ventricular end diastolic pressure (LVEDP) and Gs and Gi protein levels were significantly increased (all P<0.05). Compared with AMI group, LVSP and ± dp/dtmax were increased, but LVEDP and Gi protein level were significantly decreased in metoprolol and carvedilol group. LVEDP and Gi protein level were decreased in carvedilol group compared with metoprolol group. ConclusionsCarvedilol can effectively suppress the change of G protein and improve the heart function after AMI, and the effect is better than that of metoprolol. This may be related with its β2-AR blocking effect.
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The study is to investigate the relationship between dyslipidemia and impaired glucose tolerance (IGT). Ninety elderly nondiabetic patients (60 -84 years old) were under long-term follow-up in outpatient department. Blood lipid measurement and oral glucose tolerance test (OGTr) were performed,the two-hour glucose levels (2 hPBG) between normal and abnormal blood lipid groups were compared. We found that patients with hypertriglyceridemia had a significantly higher 2 hPBG than patients with normal blood triglyceride(P＜0. 01 ). But there were no differences in 2 hPBG levels between other dyslipidemias and normal lipid patients. OGTT screening in elderly patients with hypertriglyceridemia can be helpful in early detection and prevention of diabetes.
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Objective To observe the therapeutic effect of liver-soothing and spleen-strengthening herbal medicine for metabolic syndrome(MS).Methods Ninety-three MS patients were randomized into group A(N=51)and group B(N=42).The two groups received the basic treatment including dietary control and exercises.Group A received liver-soothing and spleen-strengthening herbal medicine(such as Radix Bupleuri,Rhizoma Atractylodis Macrocephalae,Radix Paeoniae Alba,Radix Angelicae Sinensis,Poria,Radix Rehmanniae,Radix Astragali,Rhizoma Alismatis,Semen Coicis,Cortex Moutan,Rhizoma Dioscoreae,Radix Glycyrrhizae,etc.)additionally.The treatment course lasted 3 months.After treatment,the therapeutic effect was evaluated,and the changes of blood pressure,body weight index(BWI),blood glucose(BG)and insulin levels,insulin sensitivity index(ISI),and the blood lipid levels were observed.Results After treatment,23 patients were cured,26 effective,2 ineffective,and the total effective rate was 96.08% in group A;in group B,12 were cured,21 effective,9 ineffective,and the total effective rate was 78.57%.The therapeutic effect in group A was better than that in group B(P0.05).Fasting BG,2-hour BG and BWI were decreased in the two groups(P0.05).Total cholesterol(TC)and triglyceride levels decreased,and high density lipoprotein cholesterol(HDLC)increased in the two groups(P0.05).Conclusion Liver-soothing and spleen-strengthening herbal medicine exerts an effect for metabolic syndrome,not only decreasing blood pressure,blood lipid levels and body weight,but also improving insulin resistance and increasing ISI.
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80 years.The 104 patients had hypertension and 63 no hypertension.Average Scr level was(104.3?14.1)?mol/L,in normal range.The correlation coefficients between Cockcroft-Gault equation and age was the best(r=0.665,P