[Influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage for inpatients in burn unit].

Objective: To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit. Methods: From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients' medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test. Results: (1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ(2)=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ(2)=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ(2)=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ(2)=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ(2)=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ(2)=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01). Conclusions: Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.

Dexmedetomidine protects against ischemia/reperfusion injury in rat kidney.

OBJECTIVES: Ischemia/reperfusion (I/R) injury in the kidney during perioperative period remains the leading cause of acute renal failure. The purpose of this experimental study was to determine the role of dexmedetomidine (Dex) on renal I/R injury in rats. MATERIALS AND METHODS: Male Wistar rats, subjected to renal ischemia for 45 min, were either untreated or treated with dexmedetomidine 30 min prior to renal ischemia. A sham-operated group served as the control. Renal function [serum creatinine, blood urea nitrogen, serum Cystatin C and neutrophil gelatinase-associated lipocalin (NGAL)], histology, apoptosis and expression of the phosphorylations of Janus kinase 2 (JAK2) and signal transducer and activator of transcription 3 (STAT3) were assessed. RESULTS: The animals treated with dexmedetomidine improved renal functional recovery, especially reducing the level of serum Cystatin C and NGAL at early time after ischemia, attenuated histological lesions, reduced tubular epithelial apoptosis and inhibited the phosphorylation of JAK2 and its downstream molecule STAT3, contributing to ameliorating renal I/R injury. CONCLUSIONS: Our data suggest that anti-apoptosis effect contributes to the renoprotection of dexmedetomidine, via inhibiting JAK2/STAT3 signaling pathway partially.