Objective To formulate an evidence-based nursing strategy of turning over for a patient with the risk of pressure ulcer. Methods The personalized clinical questions were put forward based on the PICO and patient’s condition, and the following databases such as NGC, The Cochrane Library of DARE, CDSR, CCTR, MEDLINE, PubMed and CBM were searched to collect the best clinical evidences of turning over for preventing pressure ulcer. Results One clinical guideline, one systematic review and three randomized controlled trials were included finally. According to the retrieval outcomes, patient’s clinical condition, and patients and their family members’ willingness, a reasonable nursing plan of turning over was formulated: lie on the visco-elastic foam decompression bed, turn over every 4 hours, and combine supine position with alternation of left-oblique 30° position and right-oblique 30° position. During hospitalization, the grade-I pressure ulcer in size of 4×6 cm2 on patient’s sacrococcygeal region was clear, dry and not broken, and the other part of body with pigmentation had no occurrence of pressure ulcer. Conclusion Evidence-based approaches are helpful to provide patient with a nursing plan that meets the needs of both scientificalness and individualization.
Objective To systematically evaluate the effectiveness and safety of Resina Draconis for pressure ulcer. Methods Such databases as The Cochrane Library (Issue 4, 2013), PubMed, Elsevier SDOL, Web of Knowledge, CBM, CNKI, VIP and WanFang Data were searched from inception to May 2013 to collect randomized controlled trials (RCTs) about Resina Draconis for pressure ulcer. Two reviewers were assigned to independently screen the literature according to inclusion and exclusion criteria, extract data, and appraise the methodological quality. Then, meta-analysis was conducted using RevMan 5.2.4 software. Results A total of 14 RCTs were included, involving 610 patients. The results of meta-analysis showed that, Resina Draconis treatment were associated with a higher effective rate for pressure ulcer (RR=1.17, 95%CI 1.08 to 1.26, Plt;0.000 1). The results of descriptive analysis showed that, compared with the control group, Resina Draconis treatment shortened healing time. As for safety, adverse reactions had not been reported. Conclusion Resina Draconis can improve the effective rate for pressure ulcer and shorten the healing time, compared with other drug treatments. However, due to limited quality and quantity of the included studies, this conclusion needs to be proved by more high quality studies.
Objective To review and compare the literatures on studying endoleak via intra-sac pressure (Psac) measurement in order to reveal the characters of all types of endoleak. Methods Measured the intra-sac pressure with miscellaneous pressure transducers in vitro and in vivo endoleak models or patients afflicted with endoleak. Compared the difference of Psac among no endoleak and all types of endoleak. Results Psac＞0 but was obviously lower than Psys in no endoleak. Psac approached Psys in type Ⅰ and type Ⅳ endoleaks. Some researches showed that Psac in type Ⅱ endoleak was higher than that in no endoleak and even approached Psys, however the other researches showed that Psac in type Ⅱ endoleak was lower than that in no endoleak. Conclusion Postoperative Psac dropping greatly eliminated the risk of aneurysm rupture, which symbolized the success of endovascular therapy. Even if the type Ⅰ endoleak of small size might lead to obvious elevation of Psac, which necessitates management. The impairment and management tactics of type Ⅱ endoleak remained equivocal, which required further study.
Objective To assess the risk factors associated with extubation failure in patients who had successfully passed a spontaneous breathing trial.Methods Patients receiving invasive mechanical ventilation for over 48 h were enrolled in the study，they were admitted into Emergency ICU of Zhongshan Hospital during May 2006 and Oct.2007.A spontaneous breathing trial was conducted by a pressure support of 7 cm H2O for 30 min.Clinical data were prospectively recorded for the patient receiving full ventilatory support before and after the spontaneous breathing trial.Regarding the extubation outcome，patients were divived into extubation success group and extubation failure group.Results A total of 58 patients with a mean（±SD） age of 69.4±12.7 years passed spontaneous breathing trial and were extubated.Extubation failure occurred in 11 patients（19%）.The univariate analysis indicated the following associations with extubation failure：elderly patients（78.1±7.9 years vs 67.4±15.1years，Plt;0.05），higher rapid shallow breathing index（RSBI） value（83±12 breaths·min-1·L-1 vs 68±19 breaths·min-1·L-1，Plt;0.05）and excessive respiratory tract secretions（54.5％ vs 21.3％，Plt;0.05）.Conclusion Among routinely measured clinical variables，elderly patients，higher RSBI value and amount of respiratory tract secretions were the valuable index for predicting extubation failure despite a successful spontaneous breathing trial.
Objective To investigate the correlation between dynamic intrinsic positive endexpiratory pressure ( PEEPidyn) and volume dependence of elastance and resistance of respiratory system ( Evd/Rvd) derived from nonlinear analysis of respiratory mechanics in COPD patients during pressure support ventilation ( PSV) . Methods Twenty-five COPD patients mechanically ventilated using mode of PSV were ventilated at a PSV level of no less than 20 cm H2O in a period of 15 minutes to attain so-callednear-relaxation state. The pressure( P) , flow( V′) and volume( V) data were analyzed by nonlinear mode of respiratory motion. PEEPidyn was determined by esophageal balloon-tipped catheter technique. The correlations between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were analyzed. Results The correlation coefficients between PEEPidyn and Evd, Rvd as well as Evd ×Rvd were 0. 85,0. 80, and 0. 90, respectively. Conclusions Nonlinear mode of respiratory motion is suitable to analyze respiratory mechanics of COPD patients mechanically ventilated using mode of PSV. There are good correlations between PEEPidyn and Evd,Rvd as well as Evd ×Rvd which may be used to noninvasively monitor PEEPidyn in mechanically ventilated COPD patients using mode of PSV.
Objective To investigate the change law of the intracapsular pressure in vitro without outside force and the pressure of the expander upon the skin soft tissue in vivo during clinical routine expansion so as to provide some references for the safe application of the expander. Methods The rectangle expanders of 50, 80, 100, 150, 200, 250, 300, and 400 mL were used for in vitro expansion at room temperature to 400% volume of the expander capacity. The pressures before and after saline injection were recorded. Twelve patients who needed scar plastic surgery were enrolled; 17 rectangle expanders were implanted in 5 areas (cheek, trunk, forehead and temporal, limb, and head) and expanded routinely. The pressures before and after saline injection were recorded. The pressure of the expander upon the skin soft tissue was calculated and the values of the pressure at 50%, 100%, 150%, and 200% volume of 5 areas were chosen and analyzed statistically. Results The intracapsular pressure of the expanders at different volumes in vitro without outside force during routine expansion before and after saline injection was beyond 0 mm Hg (1 mm Hg=0.133 kPa) at around 100% volume, increased rapidly from 100% to 250% volume, and kept stable from 250% to 400% volume. In vivo, 16 expanders within 200% volume had the maximum pressure before saline injection, 15 had the maximum pressure after saline injection. Before saline injection, the pressure of the expander upon the skin soft tissue was lowest in the cheek, showing significant difference when compared with those of the forehead and temporal and head (P lt; 0.05); the pressure in the trunk was significantly lower than that in the head (P lt; 0.05); and there was no significant difference between the other body sites (P gt; 0.05). After saline injection, the pressure of the expander upon the skin soft tissue was lowest in the cheek, and showed an increasing trend in the trunk, the limb, the forehead and temporal, and the head; no significant difference was found between in the cheek and in the trunk, and between in the forehead and temporal and in the limb (P gt; 0.05), and significant differences were found between the other body sites (P lt; 0.05). Conclusion The pressure of expander upon skin soft tissue at early stage or middle stage is higher than that at late stage during expansion. The pressure is high in the head, and low in the cheek comparatively, and the pressures in the trunk, the forehead and temporal, and the limb are between them.
Objective To observe the changes of force bearing area and pressures of the rabbit tibiofemoral contact area and the biomechanical reconstruction level of joint after meniscal allograft. Methods A total of 28 Japanese rabbits were involved, weighing 3.0-3.5 kg, male or female. Of 28 rabbits, 7 were selected as meniscus donors, the remaining 21 rabbits were randomized into group A (n=7), group B (n=7), and group C (n=7). Group A underwent single knee opening and suturing, group B underwent medial meniscus excision and suturing, and group C underwent medial meniscus allograft after medial meniscus excision and suturing. The rabbits were sacrified at 12 weeks after operation for biomechanical observation through biomechanical machine and color imaging system. The meniscus tissue specimens were harvested from groups A and C to perform histological and immunohistochemical staining. Results After operation, all rabbits in 3 groups survived to the end of experiment. There were significant differences in the force bearing area and pressures at 0-90° flexion between group B and groups A, C (P lt; 0.05) at 12 weeks, showing no significant difference between group A and group C (P gt; 0.05); and there were significant differences in the force bearing area and pressures at 120° flexion among 3 groups (P lt; 0.05). The histological observation showed that the number of cartilage cells and collagen fibers returned to normal in group C, and the immunohistochemical staining showed that transplanted meniscus of group C contained large amounts of collagen fibers consisting of collagen type I and collagen type II. After 12 weeks of operation, the collagen type I contents were 0.612 5 ± 0.059 8 in group A and 0.587 2 ± 0.063 9 in group C, showing no significant difference (t=0.765, P=0.465); the collagen type II contents were 0.772 4 ± 0.081 5 and 0.814 3 ± 0.051 7, respectively, showing no significant difference (t= —0.136, P=0.894). Conclusion The allograft of rabbit meniscus can significantly increase the force bearing area of the tibiofemoral contact area and reduce the average pressure. Therefore, biomechanically speaking, the meniscus allograft can protect the articular cartilage and reconstruct the biomechanical balance.
Objective To quantitatively evaluate the effect of 2 types of pressures induced injury by using threedimensional (3D) reconstruction of rats loaded tibial is anterior muscle from two-dimensional (2D) image of serial histological sections. Methods Twenty female or male Sprague Dawley rats, aged 10-12 weeks and weighing 280-300 g, were randomlydivided into experimental group (n=10) and control group (n=10). The random side of tibial is anterior muscle was givenintermittent gradient (8.0-21.3 kPa) and sustained (13.3 kPa) pressure in 0.12 cm2 area in experimental group and controlgroup, respectively; the experiment was terminated and the general condition of rats was observed after 3 cycles, and a single cycle included 2 hours of compression and 30 minutes of release. The general observations of pressed skin and tibial is anterior muscle were done after 24 hours of pressure rel ief, and the tibial is anterior muscle was harvested integrally from the loaded side, then made into interval 4 μm serial sections. After HE staining, 2D images were obtained. Necrosis and injury areas were distinguished by Image Pro Plus (IPP) 6.0 software and image registration was conducted by Photoshop 8.0.1 after 2D panorama images acquired by digital microscope (× 40) and IPP mosaic software. 3D reconstruction was establ ished via data processing using Mimics 10.1 software so as to get the volume, the surface area, and 3D images of the whole piece of tibial is anterior muscle and injury areas respectively. Results All rats of 2 groups survived till experiment terminated and no skin ulcers occurred after 24 hours. Edema and indentation were observed on press side skin and tibial is anterior muscles of 2 groups, fadeless maroon area was observed in control group. A total of 994 sl ices were obtained from 20 samples of tibial is anterior muscles. 3D images suggested that injury of control group was severe, which penetrated the whole piece of tibial is anterior muscle and expandedalong the tibia bony prominence. By contrast, injury of experimental group was less, but had similar width to the contact surface of indentor. There was no significant difference in the volume and the surface area of tibial is anterior muscle between 2 groups (P gt; 0.05), while the injury volume and the injury surface area were significantly smaller in experimental group than in control group (P lt; 0.05). Conclusion 3D reconstruction is an effective method to quantitatively evaluate pathological changes inside the integrity tissue and can provide the visual basis for the mechanical property distributed in the loaded muscle. Intermittent gradient pressure can reduce deep tissue injury.
Objective To explore the effects of changes in the length of the patella on patellofemoral contact areas and pressures, to provide a theoretical foundation for treatment of lower pole of patella fracture. Methods Using homemadeloadingequipment, pressure sensitive films of 100 mm × 100 mm in size were placed on the force platform, vertically downwardload (0-19.6 N) was given. The pressure-sensitive response curve was obtained by computer image analysis of the pressuresensitive tablets and calculation. Six male left fresh knee specimens from voluntary donation were placed in homemade-test fixed load device, and the double-layer pressure sensitive film was placed on the patellofemoral joint surface; under loading of 196 N at flexion of 0, 15, 30, 45, 60, 75, 90, 105, 120, and 135° for 2 minutes, respectively, the pressure sensitive film was removed as the control group. Patellas were transected cut and in situ fixed by Kirschner wire and steel-wire as in situ fixation group. Bone fragments obtained from the corresponding 1/6 and 2/6 of contralateral patella, were embedded in the interspace between osteotomy with internal fixation with Kirschner wire and steel-wire respectively as lengthening group. Followed by the amputating patella length of 1/6, 2/6, 3/6 from proximal to distal and internal fixation with Kirschner wire and steel wire by turns as a shortening group. Repeat the above steps of each experiment. By image analysis the pressure sensitive film, the patella joint contact area were measured, and patellar contact pressure (including the peak pressure and average pressure) was calculated according to pressure-sensitive response curve. Results The actural contact area were significantly smaller in the shortening groups than in the control group at flexion of 30-135° (P lt; 0.05); the pressure was significantly bigger in shortening 1/6 group at flexion of 0, 15, 60, and 75°, in shortening 2/6 group at flexion of 0° and 75-135°, and in shortening 3/6 group at flexion of 0-30°and 75-135° than in the control group (P lt; 0.05); the peak pressure was significantly bigger in shortening 1/6 group at flexion of0, 15, and 60-105°, in shortening 2/6 group at flexion of 0, 15, and 75-105°, and in shortening 3/6 group at flexion of 0, 30, and 60-135° than in the control group (P lt; 0.05). The actural contact area was significantly smaller in the lengthening groups than in the control group at flexion of 15, 60, and 90°, and it was bigger at flexion of 105, 135° in lengthening 2/6 group than in the control group (P lt; 0.05); the pressure was significantly bigger in the lengthening groups at flexion of 15-75° than in the control group and it was smaller in the lengthening groups at flexion of 105, 135°, and smaller in lengthening 2/6 group at flexion of 120° (P lt; 0.05); the peak pressure was significantly smaller in lengthening 1/6 group than in the control group at flexion of 0, 90, and 105° and smaller in lengthening 2/6 group at flexion of 0° (P lt; 0.05). The actural contact area was significantly bigger in all lengthening groups than in all shortening groups at flexion of 30, 45, and 75-135° (P lt; 0.05). The pressure was significantly bigger in shortening 1/6 group than in lengthening groups at flexion of 0, 60, and 90° (P lt; 0.05), in shortening 2/6 group at flexion of 0, 60, and 90-120° (P lt; 0.05), in shortening 3/6 group at flexion of 0-135° (P lt; 0.05). The peak pressure was bigger in shortening groups than in lengthening 1/6 group at flexion of 0, 90, and 105° (P lt; 0.05), bigger than lengthening 2/6 group at flexion of 0° (P lt;0.05余请见正文.....
Objective To evaluate the prel iminary cl inical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for patient with discogenic chronic low back pain (CLBP) and fail ing to respond to conservative treatment. Methods From June 2007 to May 2008, 52 patients with CLBP and fail ing to respond to conservative treatment were treated, including 15 males and 37 females aged 29-46 years old (average 38.2 years old). Those patients were diagnosed ith discogenic pain by low pressure discography. Duration of CLBP was 6-110 months with an average of 32.1 months. MRI exam revealed 108 “black intervertebral discs” low in signal on T2 image, including 3 discs of L2,3, 17 of L3,4, 48 of L4,5 and 40 of L5-S1. Pressure-controlled discography showed positive response, fluoroscopy or intraoperative CT confirmed annulus fibrosus tears of posterior intervertebral disc in 79 discs. PELD was performed. Visual analogue scale (VAS) was evaluated before operation, 1 month after operation and at the final follow-up. The cl inical outcome was determined by modified Macnab criteria at the final follow-up. Results The average operation time of each disc was 30.7 minutes (range 21-36 minutes), and the mean length of postoperative hospital stay was 3.7 days (range 2-5 days). No compl ications such as infection and the injury of blood vessels and nerves occurred. Transient paralysis of nerve occurred in 5 cases on operation day, and those symptoms were disappeared at the final follow-up visit without special treatment. Fifty-two cases were followed up for 3-15 months (average 7.3 months). VAS score before operation, 1 month after operation and at the final follow-up was (7.34 ± 1.52), (3.62 ± 0.92) and (1.57 ± 0.48) points, respectively, indicating there were significant differences compared with preoperative score (P lt; 0.01). According to the modified Macnab criteria, 11 cases were graded as excellent, 23 as good, 13 as fair, 5 as bad, and the excellent and good rate was 65.38%. Conclusion Prel iminary study suggests that PELD is safe and effective in treating patient with discogenic CLBP and fail ing to respond to conservative treatment.