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Ventilator-associated pneumonia (VAP) is one of the most common infectious diseases in patients undergoing mechanical ventilation in intensive care unit (ICU). Although the use of closed sputum suction tube for sputum suction is the most common nursing measure for patients with tracheal intubation in ICU, and it is also an important measure to reduce the occurrence of VAP, the existing clinical technology still needs to use external flushing solution for humidification and flushing. In the process of use, the flushing operation has the risk that the amount of flushing fluid cannot be controlled, resulting in a large amount of flushing fluid entering the patient's airway, causing the patient to suffocate. The sputum attached to the wall of the sputum suction tube cannot be completely flushed, and the prolonged retention of the sputum leads to the proliferation of colonized bacteria, aggravating the infection of patients. Repeated pipe flushing not only increases consumables, but also increases the workload of medical staff. For this reason, the author has designed a fully enclosed sputum suction tube flushing device, which has obtained the National Utility Model Patent of China (patent number: CN 2019 2 1198740.5). This device is an integrated design, and the materials used for sputum suction, humidification and flushing are fully enclosed, without air exposure, and can be operated strictly without bacteria. Pulse flushing with syringe can clean the sputum attached to the inner wall and reduce the incidence of VAP. The volume of flushing fluid can be effectively controlled during use to ensure patient safety and reduce waste. It is worth popularizing and applying in clinical practice to optimize the operation steps and reduce the workload of medical staff.
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Objective To compare the efficacy and safety of interventional therapy and direct interventional therapy after thrombolysis in the treatment of senile acute myocardial infarction.Methods From January 2014 to July 2017,a total of 110 elderly patients with acute myocardial infarction admitted to the First People's Hospital of Hangzhou were enrolled in this study.The patients were randomly divided into two groups according to the digital table,with 55 cases in each group.The observation group received combination of intravenous thrombolysis and coronary intervention,and the control group received arterial intervention.The blood flow of IRA before and after treatment,TIMI level 3 open situation,cardiac function improvement (including LVEF,LVEDD),and electrocardiogram ST segment down after treatment,chest pain relief,stent implantation success or failure,incidence of complications were compared between the two groups.Results Before treatment,there were no statistically significant differences in the number of TIMI3 blood flow patients(10 cases,15 cases) and number of TIMI3 patients (12 cases,18 cases) between the two groups (P ＞ 0.05).After treatment,those in the observation group increased to 50 cases and 51 cases,respectively.Those in the control group only increased to 39 cases and 40 cases.The observation group increased more significantly (x2 =7.698,P ＜ 0.05).After treatment,the LVEF values of the two groups were increased,the LVEDD decreased significantly.The LVEF [(57.38 ± 4.23) ％] and LVEDD [(44.32 ± 2.93)mm] in the observation group were improved more significantly than those in the control group [(51.07 ± 4.17) ％,(50.09 ± 2.97) mm,t =7.878,10.257,all P ＜0.05].The incidence rate of ST segment depression(92.73％) and chest pain relief rate(90.91％) in the observation group after treatment were higher than those in the control group(65.45％,61.82％,x2 =12.369,12.894,2.633,all P ＜0.05).The total incidence rate of complications of the observation group was 9.09％,which was lower than that of the control group(29.09％),the difference was statistically significant(x2 =7.122,P ＜ 0.05).Conlusion Interventional therapy after thrombolysis in the treatment of elderly patients with acute myocardial infarction,can effectively improve the patients'cardiac function,the effect is significant,safe and reliable,it is worthy of further study.
ABSTRACT
Objective To explore the effect of tetramethylpyrazine (TMP) on serum cytokines and cardiac function in patients with sepsis myocardial injury.Methods Fifty patients with sepsis myocardial injury were admitted in Hangzhou First People's Hospital from June 2015 to September 2016,and according to the computer generated random number,they were divided into conventional treatment group and TMP treatment group,25 cases in each group.The patients in the conventional treatment group were treated with antimicrobial agents,vasoactive drugs,fluid resuscitation and organ function support,etc.;TMP treatment group was treated with traditional Chinese medicine (TCM) TMP on the basis of routine treatment.TMP 120 mg was added to 250 mL normal saline (NS) for intravenous drip once a day for a therapeutic course of 10 days.Plasma N-terminal pro-B type natriuretic peptidec (NT-proBNP) and serum tmnor necrosis factor-oα (TNF-α) levels were measured before treatment and on 1,5 and 10 days after treatment.Left ventricular internal systolic dimension (LVIDs),fractional shortening (FS) and left ventricular ejection fraction (LVEF) were measured by cardiac ultrasound,3 cardiac cycles were measured and the average results were taken.The intensive care unit (ICU) hospital stay and mortality were calculated in the two groups.Results The levels of NT-proBNP and TNF-α in the two groups after treatment were lower than those before treatment,the differences in the levels were statistically significant between those before treatment and 5 days after treatment in the conventional treatment group [NT-proBNP (ng/L):334.25 ± 36.46 vs.577.72 ± 60.34,TNF-α (ng/L):388.48 ± 43.38 vs.507.74-± 31.63,both P ＜ 0.05],and in TMP treatment group,the levels from 1 day after treatment compared with those before treatment,there were statistical significant differences [NT-proBNP (ng/L):387.44 ± 36.39 vs.571.67-± 56.34,TNF-α(ng/L):403.79 ± 23.20 vs.505.82 ± 31.31,both P ＜ 0.05];the degrees of decrease in TMP treatment group were more obvious than those in conventional treatment group (all P ＜ 0.01).After treatment in the two groups,the LVIDs was decreased gradually,FS and LVEF were increased gradually,reaching the lowest or highest level on 10 days after treatment,and the changes of TMP treatment group were more significant than those in the conventional treatment group,LVIDs and LVEF of the two groups showed statistically significant differences on 5 days after treatment [LVIDs (mm):43.23 ± 5.57vs.48.21 ± 2.29,LVEF:0.47 ± 0.02 vs.0.41 ± 0.02,both P ＜ 0.05],FS on 1 day after treatment showed a statistically significant difference [FS:(23.92 ± 1.81)％ vs.(22.84 ± 1.79)％,P ＜ 0.05].The ICU stay in the TMP group was shorter than that in the conventional treatment group (days:13.16 ± 2.67 vs.16.48-± 3.08,P ＜ 0.05),and the mortality was lower than that of conventional treatment group [20％ (5/25) vs.36％ (9/25)],the difference being not statistically significant (P ＞ 0.05).Conclusions In septic myocardial injury,TNF-α plays an important role;after TMP treatment in patients with myocardial injury caused by viral myocarditis,the serum TNF-α level is decreased showing it has antagonizing TNF-α activity,thus it has protective effect on sepsis myocarditis,improves heart function and the disease prognosis.
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The composition of S95-100 field mobile medical system was introduced, and some practices were summarized such as rational grouping, enhanced organization, proper allocation and etc. The problems of the system were analyzed from three aspects of the fixation of the internal devices, the rapid deployment in the plateau and maintenance in field conditions, and some measures were put forward to improve the medical support ability of the system in the plateau.