Feasibility of three-dimensional CT axial sequence assisted volumetric measurement for atrial septal defect evaluation / 中华放射学杂志

Objective:To explore the feasibility of three-dimensional CT axial sequence assisted volumetric measurement (CTAS) in evaluating atrial septal defect (ASD).Methods:The patients with single secundum ASD who successfully underwent interventional therapy in Fuwai Hospital from January 2016 to December 2019 were retrospectively collected. The patients underwent coronary CT angiography (CTA) before and on the second day after closures, and DSA examinations during operation. A total of 52 cases met the inclusion conditions, among them, there were 37 patients with large defects which had deficient inferior rims ≤3 mm, and 15 patients with severe pulmonary arterial hypertension that occluded with fenestrated ASD occluder. The CT data of patients before and after operation were reconstructed by CTAS. Then the anatomical structure of ASD before the operation was evaluated, including the long diameter and short diameter of ASD, and the CT three-dimensional volume diameter of ASD was calculated by using the equivalent circle conversion formula of ellipse. The waist diameter of occluder and rims of the ASD were measured after occlusion on postoperative CT three-dimensional volume reconstruction images. Meanwhile, the deployed occluder waist dimension was measured in DSA examination during the operation by simulating the balloon measurement of ASD. Lastly, paired t-test and consistency analysis were carried out among the values of parameters. Results:Before operation, the equivalent circle diameter of ASD was (32.3±5.4) mm measured by CTAS. After ASD occlusion, the size of the waist dimension measured by DSA and CTAS were (32.5±4.9) mm and (32.6±4.9) mm. There were no significant differences between them ( P>0.05). There were also no significant differences for each rims of the ASD pre and post operation on CTAS except for the inferior rims and the total length of atrial septum in superior-inferior direction ( P>0.05). Conclusion:As an alternative to balloon sizing, CTAS can be used as a reference standard to conduct ASD interventional treatment.

Clinical analysis of 46 cases of idiopathic hemothorax / 中国基层医药

Objective idiopathic hemothorax .Methods 46 patients wifh idiopathic hemothorax To explore the treatment method of were first closed thoracic drainage catheter ,of which 12 patients underwent emergency explor-atory thoracotomy,with video-assisted thoracic surgery in 10 cases,non-surgical treatment of 24 cases.Results 46 patients were cured without complications ,were followed up 3 months to 5 years.without recurrence .Conclusion Idi-opathic hemothorax once diagnosed , treatment principles that should be placed closed thoracic drainage , and timely surgical treatment,especially video-assisted thoracic surgery ,patients can reduce the amount of blood transfusion ,ef-fective,less invasive,faster recovery,less bleeding,the patient easy to accept .

Evaluation of application effect of evidence- based nursing in reducing ventilator - associated pneumonia of patients with severe head injury / 中国实用护理杂志

Objective To evaluate the application effect of evidence-based nursing in reducing ventilator-associated pneumonia (VAP) of patients with severe head injury. Methods 100 patients with severe head injury using mechanical ventilation were randomly divided into the control group and the observation group with 50 patients in each group.The observation group explored evidence from nursing of ventilator tube,oropharyngeal and sound sects care,airway care,balloon sleeves care to prevent biofilm on the endotracheal tube(ETT-BF) to fall off,enteral nutrition care,decubitus care,ward environment and the hand disinfection of medical staff and was given evidence- based nursing.The control group took routine care.The incidence of VAP,off-line time and mortality rate of the two groups were compared during the same time period. Results The incidence of VAP,off-line time,mortality rate showed significant difference between the two groups.The observation group showed better effect. Conclusions Implementation of evidence-based nursing can significantly reduce the off-line time of patients with severe traumatic brain injury using mechanical ventilation.It can decrease the incidence of VAP and mortality rate,improve the prognosis and reduce medical cost.

Effect of positive pressure ventilation extubation on arterial blood gas indexes of patients undergoing cardiac surgery / 中国实用护理杂志

Objective To study the effect of positive pressure ventilation extubation on arterial blood gas indexes of patients undergoing cardiac surgery. Methods 50 patients with orotracheal intubation after intracardiac opening operation under direct vision were randomly divided into the control group and the experimental group with 25 cases in each group. We used traditional method to pull out tracheal intubation in the control group. And positive pressure ventilation at 5 ～15 cm H2O during inspiration and pulling out tracheal intubation during expiration in the experimental group. The change of arterial blood PaO2, PaCO2, SaO2, pH and respiratory rate before and 1min、5min、10min after extubation was observed,and also the incidence rate of air tube obstruction was recorded. Results The change amplitude of arterial blood gas indexes of patients in the experimental group was obviously lower,and the length of change time reduced more than 50%. There were 4 air tube obstructions in the control group and there was no obstruction in the experimental group. The difference was statistically significant. Conclusions Positive pressure ventilation extubation can raise lung's compliance and improve oxygenation. And arterial blood gas indexes are more stable. It can decrease the incidence rate of hypoxemia and is a much more safe method.