Objective To evaluate the effects and the clinical significances of liquid resuscitation on blood gas analysis， acid-base balance， electrolytes， acute physiology and chronic health evaluationsⅡ（APACHEⅡ） score of patients with septic shock， and then to analyze the relations between serum chlorine （Cl－） level and APACHEⅡscore and the volume of liquid resuscitation. Methods According to the target of resuscitation （centre venous pressure 8-12mm Hg and mean arterial pressure≥65mm Hg）， 21 patients with septic shock received enough fluid for resuscitation during 24h . The results of blood gas analysis， acid-base balance， electrolytes， and APACHE Ⅱ score were compared between pre-resuscitation and 24h post-resuscitation by self-controlled prospective study. The relationships of the level of serum Cl－ and APACHEⅡ score with the volume of liquid used in resuscitation were analyzed . Results The mean resus-citation duration was （18.09±4.57） h， and the volume of liquid during 24 h resuscitation was 5 320-11 028mL with mean volume of （7 775±1 735） mL in 21 patients with septic shock. Serum sodium （Na＋， mmol/L） and Cl－（mmol/L）levels of post-resuscitation were significant higher than those of pre-resuscitation （Na＋：138.71±5.67 versus 135.62±7.23， P=0.024；Cl－：109.10±4.90 versus 101.67±8.59， P=0.000）. Compared with the levels of pre-resuscitation， the blood pH value， hematocrit （Hct，%）， anion gap （AG， mmol/L）， lactic acid （mmol/L）， and APACHE Ⅱscore significantly decreased （pH：7.31±0.05 versus 7.37±0.06， P=0.000；Hct：28.48±2.56 versus 32.76±9.19， P=0.049；AG：8.33±3.45 versus 14.17±8.83， P=0.004；lactic acid：1.66±0.89 versus 2.96±1.23， P=0.001；APACHEⅡ：10.90±3.73 versus 17.24±4.06， P=0.000） after 24h resuscitation. The correlation analysis showed that the level of serum Cl- was positively correlated with the volume of liquid used in resuscitation （r=0.717，P＜0.01）. However， there was no correlation between APACHEⅡscore and the volume of liquid used in resuscitation （P＞0.05）. Conclusions The target of liquid resuscitation in patients with septic shock should be cautiously determined， including control of the volume of crystal liquid for resuscitation， in order to avoid acid-base imbalance or hyperchloraemia. At the same time， the change in internal environment should be monitored. An optimistic fluid resuscitation to decrease APACHE Ⅱ score in patients with septic shock is unrelated to the volume of liquid resuscitation.
Objective To investigate the status of nutrition, nutritional support, and postoperative nutrition-related complications in patients with spinal deformity during orthopedic perioperative period. Methods From February to August 2021, patients who underwent spinal orthopedic surgery for spinal deformity in Peking University Third Hospital were collected. A survey was conducted using self-designed questionnaire, including patient’s general information (gender, age, and type of spinal deformity), nutrition-related information (risks of malnutrition, forms of nutritional support), and postoperative nutrition-related complications. Results A total of 39 patients with spinal deformity were enrolled, and 46.2% (18 cases) were at risk of malnutrition. There were a total of 174 times of nutritional support, and 96.0% (167 times) were parenteral nutrition. The patients’ energy intake from nutritional support accounted for 34.41% of the daily goal energy intake averagely. At admission, one day after operation, and at discharge, the prealbumin was (215.51±34.69), (172.85±31.85), and (163.67±29.15) mg/L, respectively, and the hemoglobin was (138.08±15.67), (119.92±18.01), and (117.69±14.76) g/L, respectively, which were significantly lower one day after operation and at discharge than those at admission (P<0.01). The incidence of postoperative nutrition-related complications during hospitalization was 5.1% (2/39). Conclusions Patients undergoing spinal deformity orthopedics are at high risk of overall malnutrition during the perioperative period, their clinical nutritional interventions are mostly based on parenteral nutrition with a single infusion of nutritional preparations, and the nutritional status is not significantly improved. However, the incidence of postoperative nutrition-related complications is low. Standardized nutrition interventions should be strengthened in the future.
ObjectiveTo investigate the effect of PDCA circulation management on pain, psychology and prognosis of patients with thoracic aortic aneurysm in the perioperative period.Methods The clinical data of seventy-six patients with thoracic aortic aneurysm who received perioperative nursing based on PDCA circulation management from April 2016 to March 2017 were retrospective analyzed and these patients were selected as the study group, including 44 males, 32 females, aged 23–65 (47.27±5.87) years. At the same time, 72 patients with thoracic aortic aneurysm who received routine perioperative nursing from April 2015 to March 2016 were selected as the control group, including 41 males, 31 females, aged 24–67 (48.30±5.26) years. The nursing effects of the two groups were compared and analyzed.ResultsThe operation time (t=11.342, P<0.05) and hospitalization time (t=5.986, P<0.05) of the study group were significantly shorter than those of the control group. The visual analogue scale (VAS) scores of the two groups had no significant difference before nursing (t=0.914, P=0.361), but the VAS scores in the study group after nursing were obviously lower than those in the control group (t=5.475, P<0.05). The self-rating depression scale (SDS, t=1.026, P=0.307) and self-rating anxiety scale (SAS) scores (t=7.866, P<0.05) of the two groups had no significant difference before nursing, while the SDS (t=7.657, P<0.05) and SAS (t=7.866, P<0.05) scores in the study group after nursing were obviously lower than those in the control group. The incidence of adverse reactions in the study group was significantly lower than that in the control group (χ2=4.292, P=0.038).ConclusionPDCA circulation management used in patients with thoracic aortic aneurysm in the perioperative period can effectively relieve patients' pain, depression and anxiety, reduce the incidence of adverse reactions, and the prognosis is good.
ObjectiveTo analyze the roles of three scoring systems, i.e. Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Ranson’s criteria, and Sequential Organ Failure Assessment (SOFA), in predicting mortality in patients with severe acute pancreatitis (SAP) admitted to intensive care unit (ICU), and explore the independent risk factors for mortality in SAP patients.MethodsThe electronic medical records of SAP patients who admitted to ICU of West China Hospital, Sichuan University between July 2014 and July 2019 were retrospectively analyzed. Data of the first APACHE Ⅱ, Ranson’s criteria, SOFA score, duration of mechanical ventilation, the use of vasoactive drugs and renal replacement therapy, and outcomes were obtained. The receiver operator characteristic (ROC) curve was used to evaluate the value of APACHE Ⅱ score, Ranson’s criteria, and SOFA score in predicting the prognosis of SAP. Logistic regression models were created to analyze the independent effects of factors on mortality.ResultsA total of 290 SAP patients hospitalized in ICU were screened retrospectively, from whom 60 patients were excluded, and 230 patients including 162 males and 68 females aged (51.1±13.7) years were finally included. The ICU mortality of the 230 patients with SAP was 27.8% (64/230), with 166 patients in the survival group and 64 patients in the death group. The areas under ROC curves of APACHE Ⅱ, Ranson’s criteria, APACHE Ⅱ combined with Ranson’s criteria, and SOFA score in predicting mortality in SAP patients admitted to ICU were 0.769, 0.741, 0.802, and 0.625, respectively. The result showed that APACHE Ⅱcombined with Ranson’s criteria was superior to any single scoring system in predicting ICU death of SAP patients. The result of logistic regression analysis showed that APACHE Ⅱ score [odds ratio (OR)=1.841, 95% confidence interval (CI) (1.022, 2.651), P=0.002], Ranson’s criteria [OR=1.542, 95%CI (1.152, 2.053), P=0.004], glycemic lability index [OR=1.321, 95%CI (1.021, 1.862), P=0.008], the use of vasoactive drugs [OR=15.572, 95%CI (6.073, 39.899), P<0.001], and renal replacement therapy [OR=4.463, 95%CI (1.901, 10.512), P=0.001] contributed independently to the risk of mortality.ConclusionsAPACHE Ⅱ combined with Ranson’s criteria is better than SOFA score in the prediction of mortality in SAP patients admitted to ICU. APACHE Ⅱ score, Ranson’s criteria, glycemic lability index, the use of vasoactive drugs and renal replacement therapy contribute independently to the risk of ICU mortality in patients with SAP.
ObjectiveTo investigate the health status of elderly peptic ulcer patients in Haikou city and its influencing factors. MethodsSeventy-eight elderly peptic ulcer patients treated in the Department of Gastroenterology, Haikou Hospital between February 2012 and December 2014 were chosen to be the observation group, and at the same time, another 78 healthy elderly people examined in the same hospital were designated as the control group. The general information and health status of the study subjects were investigated for correlation analysis. ResultsThe health status, physical function, body pain, life quality and mental health scores in the observation group were significantly lower than those in the control group (P<0.05). Univariate analysis showed that age, smoking, high-salt diet, body mass index (BMI) were significantly associated with the incidence of peptic ulcer (P<0.05). Multivariate logistic regression analysis showed that age, smoking, high-salt diet, BMI were all independent risk factors for peptic ulcer occurrence (P<0.05). ConclusionThe health status of elderly peptic ulcer patients in Haikou city is relatively low. Age, smoking, high-salt diet and BMI are the major independent risk factors for the occurrence of peptic ulcer. We need to actively strengthen symptomatic prevention and intervention.
Objective To explore the application value of self-made visual teaching aids in gynecological and obstetrical nursing education. Methods A total of 240 nursing students in grade 2009 from Fujian Medical University and Fujian Health College were selected by cluster sampling and divided by simple randomization into 2 groups (the trial group and the control group). Besides the multimedia combined with traditional teaching adopted in both groups, the visual teaching aids for fetal intrauterine condition was also adopted in the trial group rather than the control group. Questionnaire survey and focus group interview were adopted to appraise the satisfactory degree of all nursing students and the teaching effects evaluation of students in the trial group. Results There were no significant differences between the two groups in education background, and intelligibility evaluation of theoretical study on both the fetal intrauterine condition and the complications in pregnancy and delivery periods (Pgt;0.05), while the difference was statistically significant in the satisfactory degree between different teaching methods (Plt;0.05). 85.0% of nursing students in the trial group thought that visual model could help them to better understand the complications in pregnancy and delivery periods, and the intrauterine condition, 99.17% of students thought that the teaching effect of visual model was better than traditional teaching, and 95.83% of students considered that visual model was favorable for course study. Conclusion The application of self-made visual teaching aids for fetal intrauterine condition makes gynecological and obstetrical nursing education more visual, facilitates students to better understand fetal intrauterine situation and part of the mechanism of pregnancy complications, arouses students’ learning interests, and lays a theory and practice foundation for follow-up internship, so as to enhance the quality of nursing teaching.
ObjectiveTo explore the relationship between the natural environment of residential areas and subjective well-being of the elderly and the role of the elderly’s evaluation of the environmental protection work in both. MethodsBased on the China social survey database (CSS) in 2019, Rstudio and Stata software were used to process the data screened according to the restricted conditions, and multi-classification logistic regression analysis and Bootstrap mediation effect test were used to test the effect relationship among variables. ResultsAir pollution, water pollution, noise pollution, land pollution, electromagnetic ionizing radiation pollution and other pollution in residential areas have no direct effect on the subjective well-being of the elderly (P>0.05). The evaluation of the elderly on the environmental protection work had a positive impact on the elderly’s subjective well-being (P<0.01) and played a completely mediating role in the impact of the natural environment in the residential area on the elderly’s subjective well-being. ConclusionThe government should continue to play a leading role in coordinating environmental protection and pollution control work. In addition, establish an open and transparent environmental protection information disclosure system and strengthen communication with the elderly.
ObjectiveTo explore the factors of affecting the prognosis of pancreatic ductal adenocarcinoma (PDAC) after radical resection based on the preoperative systemic immune-inflammation index (SII) and the controlling nutritional status (CONUT) score and to establish a prognostic prediction model.MethodsThe clinicopathologic data of patients diagnosed with PDAC from January 2014 to December 2019 in the Second Hospital of Lanzhou University were retrospectively analyzed. The X-tile software was used to determine the optimal cut-off value of SII. The Kaplan-Meier method was used to analyze survival. The Cox proportional hazards regression model was used to conduct multivariate analysis of prognostic factors of PDAC after radical surgery. R4.0.5 software was used to draw a nomogram prediction model of 1-, 2-, and 3-year survival rates, then evaluate the effectiveness of the prediction model and establish a web page calculator.ResultsA total of 131 patients were included in the study. The median survival time was 18.6 months, and the cumulative survival rates at 1-, 2-, and 3-year were 73.86%, 36.44%, and 11.95%, respectively. The optimal cut-off value of preoperative SII was 313.1, and the prognosis of patients with SII>313.1 was worse than SII≤313.1 (χ2=8.917, P=0.003). The results of multivariate analysis suggested that the age>65 years old, clinical stage Ⅲ and Ⅳ, preoperative SII>313.1, and CONUT score >4 were the independent factors influencing the prognosis (overall survival) for PDAC after radical resection (P<0.05). The internal verification consistency index (C-index) of the nomogram prediction model including age, clinical stage, preoperative SII, CONUT score and postoperative chemotherapy was 0.669. The survival predicted by the nomogram correction curve fitted well with the observed survival. The decision curve analysis showed that the nomogram prediction model had a wider clinical net benefit (Threshold probability was 0.05–0.95), and the web calculator worked well.ConclusionsAge, clinical stage, preoperative SII, CONUT score are independent influencing factors for prognosis after radical PDAC surgery. Nomogram prediction model included these independent influencing factors is more accurate and web calculator will be more convenient for doctors and patients.
ObjectiveTo compare the the effectiveness of robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS), in stageⅠ lung adenocarcinoma.MethodsFrom January 2012 to December 2018, 291 patients were included. The patients were allocated into two groups including a RATS group with 125 patients and a VATS group with 166 patients. Two cohorts (RATS, VATS ) of clinical stageⅠ lung adenocarcinoma patients were matched by propensity score. Then there were 114 patients in each group (228 patients in total). There were 45 males and 69 females at age of 62±9 years in the RATS group; 44 males, 70 females at age of 62±8 years in the VATS group. Overall survival (OS) and disease-free survival (DFS) were assessed. Univariate and multivariate analyses were performed to identify factors associated with the outcomes.Results Compared with the VATS group, the RATS group got less blood loss (P<0.05) and postoperative drainage (P<0.05) with a statistical difference. There was no statistical difference in drainage time (P>0.05) or postoperative hospital stay (P>0.05) between the two groups. The RATS group harvested more stations and number of the lymph nodes with a statistical difference (P<0.05). There was no statistical difference in 1-year, 3-year and 5-year OS and mean survival time (P>0.05). While there was a statistical difference in DFS between the two groups (1-year DFS: 94.1% vs. 95.6%; 3-year DFS: 92.6% vs. 75.2%; 5-year DFS: 92.6% vs. 68.4%, P<0.05; mean DFS time: 78 months vs. 63 months, P<0.05) between the two groups. The univariate analysis found that the number of the lymph nodes dissection was the prognostic factor for OS, and tumor diameter, surgical approach, stations and number of the lymph nodes dissection were the prognostic factors for DFS. However, multivariate analysis found that there was no independent risk factor for OS, but the tumor diameter and surgical approach were independently associated with DFS.ConclusionThere is no statistical difference in OS between the two groups, but the RATS group gets better DFS.