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婴幼儿体外循环术后机械通气模式的选择

目的比较先天性心脏病婴幼儿体外循环术后容量控制通气（VCV）、压力控制通气（PCV）和压力调节容量控制通气（PRVC）3种呼吸模式的治疗效果。方法将2003年10月到2005年5月收治的106例婴幼儿先天性心脏病（CHD）患者分为3组，组Ⅰ（42例）为一般CHD患者，组Ⅱ（40例）为复杂CHD患者，组Ⅲ（24例）为伴有肺动脉高压（PH）的CHD患者。根据随机原则选择VCV、PCV、PRVC3种呼吸模式进行支持治疗。记录血流动力学、呼吸力学和血气分析指标并进行统计分析。结果组Ⅱ和组Ⅲ患者PRVC模式可以明显改善血气和降低气道压力，同时对血流动力学无明显影响；3种呼吸模式对组Ⅰ患者差异无统计学意义。结论婴幼儿体外循环术后3种呼吸模式对一般CHD患者无明显差异，对复杂CHD和伴有PH的CHD患者PRVC模式在呼吸力学和血气分析方面优于VCV和PCV模式。

神经生长因子-β、脑源性神经营养因子、胶质细胞源性神经营养因子对体外压力作用下视网膜神经细胞的保护作用

临床护士的职业压力分析与对策

目的:探讨妇幼保健系统临床护士工作压力源产生的原因,以及压力源对护士的心身健康、工作、人际交往等产生负面影响。方法:分析总结护士压力源及相应对策。结果:缓解和减轻护士工作压力,有利于提高护士心身健康和护理质量。结论:管理者以人性化和制度化管理结合,促进护士身心健康发展,有助于提高护理质量。

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study

ObjectiveTo evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB).MethodsThe clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. ResultsThe PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. ConclusionAmong adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

Affective Stress Rating Method Based on Improved Hidden Markov Model

To solve the defect which is recognizing but not rating the stress, or rating but not considering the influence of the previous stress state to the current state of the existing affective stress evaluation method, this paper proposes an approach of affective stress rating model on electrocardiogram (ECG). An affective stress rating algorithm based on hidden Markov model (HMM) was established with the theory of affective computing. The individual's affective stress was rated using this affective rating model combining the investigation questionnaire. Features like complexity and approximate entropy of ECG were used in the model, and a matching process suggested that it improved the accuracy of affective stress rating. The result of the experiment illustrated that the model considering the environmental factors and the influence of previous stress state to the current state was an effective method in affective stress rating, and the accuracy of rating was improved by this affective stress rating method.

Effect of airway pressure release ventilation on the hospital mortality of patients with acute respiratory distress syndrome: a cumulative meta-analysis

ObjectiveTo evaluate the effect of airway pressure release ventilation (APRV) on the hospital mortality of patients with acute respiratory distress syndrome (ARDS) by using cumulative meta-analysis. MethodsThe PubMed, Web of Science, Cochrane Library, WanFang Data, CNKI, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) related to the objective from inception to June 30, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. A cumulative meta-analysis was then performed by using StataSE 12.0 software. ResultsA total of 9 RCTs involving 533 patients were included. The results of meta-analysis showed that APRV could reduce the hospital mortality of patients with ARDS (RR=0.70, 95%CI 0.54 to 0.91, P<0.01) compared with traditional mechanical ventilation. ConclusionCurrent evidence shows that APRV can reduce the hospital mortality of patients with ARDS. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

Methods and Applications of Psychological Stress State Assessment

In this paper, the response of individual's physiological system under psychological stress state is discussed, and the theoretical support for psychological stress assessment research is provided. The two methods, i.e. the psychological stress assessment of questionnaire and physiological parameter assessment used for current psychological stress assessment are summarized. Then, the future trend of development of psychological stress assessment research is pointed out. We hope that this work could do and provide further support and help to psychological stress assessment studies.

Safety and Efficacy of Intermittent Pneumatic Compression in The Treatment of Deep Venous Thrombosis

ObjectiveTo investigate the safety and efficacy of intermittent pneumatic compression (IPC) in the treatment of deep venous thrombosis (DVT). MethodsThe clinical data of 496 patients with DVT who were treated in our hospital from January 2010 to October 2014 were analyzed retrospectively, to compare the time of venous pressure decreased to normal (T1) and time of circumference difference decreased to normal (T2) in patients received pure therapy (control group) and pure therapy combined with IPC (combination group), according to different types of patients in acute, sub-acute, and chronic phase. In addition, comparison of the remission rate of pulmonary embolism (PE), incidence of PE, and recurrence of DVT was performed between the control group and combination group too. Results① For DVT patients in acute stage, the time of T1 and T2 of patients in central type, peripheral type, and mixed type who received anticoagulant therapy/systemic thrombolysis/catheter thrombolysis+IPC, were significantly shorter than those patients who received only anticoagulant therapy/systemic thrombolysis/catheter thrombolysis (P<0.05). For DVT patients in sub-acute stage, the time of T1 and T2 of patients in central type and mixed type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.05), the time of T1 of patients in peripheral type who received anticoagulant therapy/systemic thrombolysis+IPC, were significantly shorter than those of patients who received only anticoagulant therapy/systemic thrombolysis (P<0.01), but the time of T2 of patients in peripheral type didn't differed between patients who received only anticoagulant therapy/systemic thrombolysis and anticoagulant therapy/systemic thrombolysis +IPC (P>0.05). For DVT patients in chronic stage, the time of T1 and T2 of patients in central type and mixed type didn't differed between patients who received only anticoagulant therapy and anticoagulant therapy +IPC (P>0.05); the time of T1 of patients in peripheral type who received anticoagulant therapy+IPC, were significantly shorter than those of patients who received only anticoagulant therapy (P<0.05), but the time of T2 didn't differed with each other (P>0.05). ② There were 63 patients in control group and 47 patients in combination group had PE before treatment. After the treatment, the PE symptom of control group relieved in 56 patients (88.89%, 56/63) and maintained in 7 patients (11.11%, 7/63), the symptom of combination group relieved in 44 patients (93.62%, 44/47) and maintained in 3 patients (6.38%, 3/47), so the remission rate of PE symptom in combination group was higher (P<0.05). There were 6 patients suffered from new PE in control group[4.26% (6/141)] and 0 in combination group[0 (0/245)] after treatment in patients who hadn't PE before treatment, and the incidence of PE was lower in combination group (P<0.05). ③ There were 325 patients were followed up for 3-36 months with the median time of 27 months, including 157 patents in control group and 168 patients in combination group. During the follow-up period, 74 patients recurred[47.13% (74/157)] in control group and 46 patients recurred[27.38% (46/168)] in combination group, and the recurrence rate was lower in combination group (P<0.05). In addition, 41 patients suffered from post-thrombotic syndrome[26.11% (41/157)] in control group and 27 patients[16.07% (27/168)] in combination group, and the incidence of post-thrombotic syndrome was lower in combination group (P<0.05). ConclusionsIPC can significantly shorten the time of venous pressure and the circumference difference decreased to normal for DVT patients in acute stage and majority DVT patients in sub-acute stage, and it can relieve the clinical symptoms of PE, reduce the incidence rate of PE and recurrence rate of DVT. Therefore, IPC is a safe, reliable, and effective treatment for DVT patients in acute stage and majority DVT patients in sub-acute stage.

Effect of Hydrogen Sulfide on Arterial Baroreflex in Rat with Sepsis

ObjectiveTo investigate the potential role and mechanism of hydrogen sulfide (H2S) in regulating arterial baroreflex (ABR) in septic rats. MethodsThe rat model of cecal ligation and puncture (CLP) induced sepsis was established. Fortyseven male SpargueDawley rats were randomly divided into 9 groups: ① Sham operation (SO)+0.9% NaCl (NS) intravenous injection (i.v.) group; ② SO+NaHS i.v. group; ③ CLP+NaHS i.v. group; ④ SO+artificial cerebrospinal fluid (aCSF) bilater nucleus tractus solitarii (NTS) microinjection group; ⑤ SO+NaHS bilater NTS microinjection group; ⑥ SO+vehicle (DMSO)+NaHS group; ⑦ SO+Gli+NaHS group; ⑧ CLP+vehicle (DMSO) group; ⑨ CLP+Gli group. The ABR function was measured before administration and 5 min and 30 min after administration. Results① The ABR value of rats at different time in the same group: Compared with the ABR value before administration in the SO+NaHS i.v. group, CLP+NaHS i.v. group, SO+NaHS bilater NTS microinjection group, and SO+vehicle+NaHS group, the ABR values of rats significantly decreased at 5 min and 30 min after administration (Plt;0.05, Plt;0.01), which significantly increased in the CLP+Gli group at 5 min and 30 min after administration (Plt;0.05). ② The ABR value of rats at the same time in the different groups: Before administration, the ABR value of rat in the CLP+NaHS i.v. group was significantly lower than that in the SO+NS i.v. group or SO+NaHS i.v.group (Plt;0.05). At 5 min and 30 min after adminis tration, the ABR value of rat in the CLP+NaHS i.v. group was significantly lower than that in the SO+NS i.v. group or SO+NaHS i.v. group (Plt;0.05), which in the SO+NaHS i.v. group or SO+NaHS bilater NTS microinjection group was significantly lower than that in the SO+NS i.v. group or SO+aCSF bilater NTS microinjection group, respectively (Plt;0.05, Plt;0.01), in the SO+Gli+NaHS group or CLP+Gli group was significantly higher than that in the SO+vehicle+NaHS group or CLP+vehicle group, respectively (Plt;0.05). ConclusionsH2S plays an adverse role in septic ABR function, and opening KATP channel located at the pathway of ABR, may be the mechanism involved in the downregulation of ABR function in septic rat. Notably, the NTS may be also responsible for reduction of ABR value.

Clinical Observation of Combined Air Pressure Wave and Oral Glucosamine in the Treatment of Knee Osteoarthritis

ObjectiveTo investigate the clinical effect of combined air pressure wave and oral glucosamine in the treatment of knee osteoarthritis. MethodsWe chose 200 patients with knee osteoarthritis treated in the Department of Rehabilitation between April 2013 and March 2015 as our research subjects. The patients were randomly divided into observation group and control group with 100 in each. The control group accepted conventional physical therapy, while the observation group underwent normal physical therapy in combination with air pressure wave and oral glucosamine treatment. We compared the two groups in terms of curative effects. ResultsThe total effective rate was not significantly different between the two groups (P＞0.05) , but in terms of efficiency rate, the observation group (85.0%) was significantly superior to the control group (73.0%) (P ＜ 0.05) . ConclusionCombined air pressure wave and oral glucosamine treatment for knee osteoarthritis is high efficient, which is worthy of being popularized.