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.
目的 比较无创双水平正压通气（BiPAP）平均容积保证压力支持（AVAPS）模式与同步/时间控制（S/T）模式在肥胖的慢性阻塞性肺疾病（COPD）患者并发急性Ⅱ型呼吸衰竭中的治疗作用。 方法 选取2012年3月－2013年6月入院治疗且体质量指数（BMI）＞25 kg/m2的COPD发生急性Ⅱ型呼吸衰竭患者36例，按数字随机表法分为AVAPS组与S/T组。两组的基础治疗相同，AVAPS组采用飞利浦伟康V60呼吸机BiPAP AVAPS模式进行无创通气治疗，S/T组采用相同机型BiPAP S/T模式治疗。分别比较两组患者治疗1、6、24、72 h的格拉斯高昏迷（GCS）评分变化、血气分析结果、呼吸机监测数据。 结果 AVAPS组患者在最初治疗的6 h内GCS评分高于S/T组[1 h：（13.2 ± 0.6）、（11.9 ± 0.6） 分，P＜0.05；6 h：（13.8 ± 0.5）、（12.1 ± 0.6）分，P＜0.05]；24 h内的动脉血气酸碱度pH值改善[1 h：7.31 ± 0.03、7.26 ± 0.02，P＜0.05；6 h：7.37 ± 0.05、7.31 ± 0.04，P＜0.05]；24 h：7.40 ± 0.04、7.33 ± 0.03，P＜0.05]及二氧化碳分压下降[1 h：（65.2 ± 5.1）、（69.5 ± 4.1）mm Hg（1 mm Hg=0.133 kPa），P＜0.05；6 h：（61.4 ± 4.2）、（66.7 ± 4.3） mm Hg，P＜0.05；24 h：（58.2 ± 4.5）、（64.3 ± 5.4） mm Hg，P＜0.05）]优于S/T组，24 h内浅快呼吸指数低于S/T组[1 h：（35.2 ± 8.1）、（62.8 ± 13.2）次/（min·L），P＜0.05]；6 h（33.4 ± 7.8） 、（54.8 ± 11.6）次/（min·L），P＜0.05]，同时，减少了额外的人工参数调整次数[3.4 ± 1.1、1.2 ± 0.6），P＜0.05] 结论 对超重的COPD合并急性Ⅱ型呼吸衰竭患者采用AVAPS模式进行无创通气治疗，较S/T模式能更快地恢复意识水平，更快地降低血二氧化碳分压、改善pH值，同时减少了呼吸治疗师的人工操作次数。
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.
【Abstract】Objective To investigate the influent factors on normal intraabdominal pressure （IAP） and establish the IAP regressive equation. Methods The IAPs of 106 hospitalized patients were determined through monitoring the bladder pressures. The relationship between IAP and 14 factors including age, gender, height, weight, body mass index （BMI）, previous and recent abdominal surgical history, reasons for admission，complications and their quantities were analyzed，respectively.Results The mean IAP of the hospitalized patients was 5.5 mm Hg with a range from 0.4 mm Hg to 12.8 mm Hg. The difference among IAPs of different grades of BMIs had statistical significance （F=5.550，P＜0.01）. The male IAPs were 2.0 mm Hg higher than the female IAPs，which had statistical significance （t=3.122，P＜0.01）. The other 12 factors had no significant effects on IAP （Pgt;0.05）. Conclusion Normal IAP is possibly influenced by gender and BMI，and it is individually different.
SD mice were selected for Collin’s solution (4℃) infusion into the portal vein with different pressure to preserve the liver transplants. The following parameters were determined ①liver tissue aderine ribonucleotide including adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), ②cytoplasmic free Ca２＋ in single liver cell (［Ca２＋］i) and ③tissue pathologic ultrastructure change by highperformance liquid chromatography into quantimeter and pathologic examination respectively. The result suggested that with the infusion pressure becoming higher, the liver free Ca２＋(［Ca２＋］i), tissue aderine ribonucleotide, EC and tissue pathologic ultrastructure changed obviously. This result shows ［Ca２＋］i, EC and tissue aderine ribonucleotide might indicate the viability of liver transplant, and using low pressure infusion has benefit effect on liver preservation.Key wordsCold infusion pressureViability of liver transplantEnergy metabolismLiver cell free Ca２＋
To investigate the cause of septicemia in patients with obstructive jaundice,the correlationship between intra-biliary tract pressure(IBTP),portal veinous flow rate(PVFR)and interleukin-2(IL-2),soluble interleukin-2 receptor(sIL-2R),T lymphocyte subpopulation in patient with obstructive jaundice(Group A)has been studied.Group A was subdivided into A1,emergency operation group;A2,elective surgery group;A3,patient’s age over 60 years and A4,age under 60.Ninety patients with simple gallstone(Group B)were also tested as a contrast.The result showed that of all Group A,CD3+,CD4+,CD8+ before operation were much lower than those 10 days after operation(Plt;0.05 or Plt;0.01),while the postoperative sIL-2R was significantly higher than that of 10 days after operation(Plt;0.01),in Group A1,emergency surgery,the preoperative sIL-2R was much more higher than that in others of the jaundice group(Plt;0.01).Corralation analysis showed IBTP was negatively corralated to IL-2,CD3+,CD4+,CD8+,but it had positive correlation with sIL-2R(Plt;0.01).PVFR was positively correlated to IL-2(Plt;0.01).These indicate that obstructive jaundice with infection is closely related to the decreased host immunity.
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.