目的 研究高血压脑出血患者开始建立肠内营养的时间，以揭示其建立肠内营养的最佳时机。 方法 选取2010年7月－2011年9月收治的高血压脑出血患者69例，随机将其分为A、B、C组，A组23例在血流动力学稳定后24 h内采取鼻胃管方式开始建立肠内营养；B组23例在24～48 h内开始肠内营养支持；C组23例在48～72 h开始肠内营养支持，并分别于营养支持前1 d及营养支持后的14 d检测三组患者三头肌皮皱厚度、上臂肌围、血清白蛋白、血红蛋白水平等相关营养指标的波动情况；监测第3、14天各组患者腹泻、便秘、应激性溃疡、肺部感染等临床并发症的发生情况。 结果 相关营养指标监测结果研究发现：建立肠内营养支持14 d后，三组患者其三头肌皮皱厚度及上臂肌围在营养支持前后差异无统计学意义（P＞0.05）；A、B组患者其血清白蛋白及血红蛋白水平在营养支持后较前有增高表现，差异有统计学意义（P＜0.05），且B组患者其血清白蛋白及血红蛋白水平增高程度较A组更为显著；C组患者其血清白蛋白水平在营养支持后有增高表现，且差异有统计学意义（P＜0.05），但血红蛋白水平较前比较差异无统计学意义（P＞0.05）。相关临床并发症发生率的研究结果如下：给予肠内营养支持3 d后，A、C组患者分别与其余两组比较发现，其腹泻、胃潴留、应激性溃疡、肺部感染发生率较其余两组比较差异无统计学意义（P＞0.05）；B组患者与其余两组比较，其应激性溃疡发生率较其余两组减低，且差异有统计学意义（P＜0.05）；腹泻、胃潴留、肺部感染较其余两组比较无显著差异；但随着观察时间的不断延长，在肠内营养支持后的14 d，A组患者较其余两组比较，其腹泻、胃潴留、应激性溃疡发生率仍无显著差异，但其肺部感染的发生率较B组增高，而较C组减低，且差异有统计学意义（P＜0.05）；B组患者较其余两组比较，其腹泻、应激性溃疡、肺部感染的发生率较其余两组均减低，且差异有统计学意义（P＜0.05），并且其肺部感染发生率减低程度较A组明显，其胃潴留发生率与其余两组比较时差异无统计学意义（P＞0.05）；C组患者与其余两组比较，其应激性溃疡、肺部感染个例发生率较其余两组增高，但差异无统计学意义（P＞0.05）。 结论 高血压脑出血患者于血流动力学稳定后的24～48 h内给予建立肠内营养支持，可利于患者相关营养指标的恢复，减少相关临床并发症的发生，可能会在一定程度益于患者的预后。
Objective To explore the type and frequency of oral care practice in intensive care units (ICUs) in Mainland China, and to provide evidence and suggestions for improving oral care practice. Methods Three survey methods, including mailing questionnaires to ICUs of Grade 3A hospitals, consulting experts in this field and visiting accessible ICUs, were used to survey current oral care practice in Mainland China. Results A total of 184 questionnaires were given to the subjects, of which 79 effective ones were collected, and the response rate was 42.93%. All 79 respondents considered oral care very unimportant, and 98.7% of the ICUs performed oral care in different ways. Currently, the cotton ball wipe-off method was the most frequently used for oral care (62.5%), with an average (9.1± 5.1) min per time, twice or three times daily. The mouthwashes often used were saline (76.1%), solutions containing sodium bicarbonate (22.8%), furacilin (13.9%), and hydrogen dioxide (13.9%). Conclusion The oral care practice for the critically-ill patients in ICUs of China is unsatisfactory, although it is perceived as an important item in nursing care. More evidence–based training should be given and it is necessary to establish a national oral care guideline for critically-ill patients.
In order to identify the incidence of nosocomial pulmonary infection in surgical critical care patients in our hospital, we studied 800 patients discharged from surgical intensive care unit between May 1992 to Dec. 1994. One hundred and six episodes of pulmonary infection were found in 96 cases, in which 20 cases had been re-infected. The infection rate was 12.0%. The age of patients, APACHE- Ⅱ score and duration in ICU were closely related to the incidence of pulmonary infection. Tracheal intubation, tracheotomy and mechanical ventilation were the predisposing factors. The prevalent pathogens were pseudomonas aeruginosa, acinetobacter, staphylococcus aureus and candida albicans. 54.7% of cases were infected with more than one pathogens, and 36.8% of cases had fungal infection. The prevention and treatment are also discussed.
Objective To analyze the current situation and demand of emergency and critical care training for medical staff in plateau areas, and to provide a reference for further emergency and critical care training for medical staff in plateau areas. Methods From July 1, 2018 to July 30, 2020, medical staff (including physicians, nursing staff, and other medical staff) from hospitals in various regions of Tibet were surveyed anonymously, to investigate the content and demand of medical staff in plateau areas receiving emergency and critical care training. The content and demand of medical staff from different levels of hospitals receiving emergency and critical care training were further compared. Results A total of 45 questionnaires were distributed in this study, and a total of 43 valid questionnaires were collected, with an effective response rate of 95.6%. The average age of medical staff was (35.67±9.17) years old, with a male to female ratio of 1∶1.5. The proportion of tertiary, secondary, and lower level hospitals to which medical staff belong were 23.3%, 27.9%, and 48.8%, respectively. The number and proportion of medical staff receiving training on chest pain, heart failure, stroke, gastrointestinal bleeding, respiratory failure, metabolic crisis, and sepsis diseases were 25 (58.1%), 25 (58.1%), 24 (55.8%), 23 (53.5%), 20 (46.5%), 14 (32.6%), and 12 (27.9%), respectively. The number and proportion of medical staff who believed that training in the heart failure, respiratory failure, metabolic diseases, stroke, gastrointestinal bleeding, chest pain, and sepsis needed to be strengthened were 38 (88.4%), 36 (83.7%), 35 (81.4%), 34 (79.1%), 34 (79.1%), 33 (76.7%), and 29 (67.4%), respectively. Thirteen medical staff (30.2%) hoped to acquire knowledge and skills through teaching. There were no statistically significant differences in gender, age, job type, professional title, and department type among medical staff from tertiary, secondary, and lower level hospitals participating in the survey (P>0.05). The proportion of medical staff in hospitals below secondary receiving training on chest pain was lower than that in second level hospitals (38.1% vs. 91.7%). The proportion of medical staff in hospitals below secondary receiving training on heart failure was lower than that in secondary and tertiary hospitals (38.1% vs. 75.0% vs. 80.0%). The proportion of medical staff in hospitals below secondary receiving training on respiratory failure was lower than that in tertiary hospitals (28.6% vs. 80.0%). The demand for sepsis training among medical staff in hospitals below secondary was higher than that in tertiary hospitals (85.7% vs. 30.0%). There was no statistically significant difference in the other training contents and demands (P>0.05). Conclusion The content of critical care training for medical staff in plateau areas cannot meet their demands, especially for medical staff in hospitals below secondary. In the future, it is necessary to strengthen training support, allocate advantageous resources to different levels of hospitals, expand the scope of training coverage, and enrich training methods to better improve the ability of medical personnel in plateau areas to diagnose and treat related diseases.
Pulmonary rehabilitation is a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behavior change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviors. It has been proven beneficial in reducing dyspnea and improving functional capacity and quality of life for patients with stable chronic respiratory disease. However, recent randomized clinical trials reported conflicting results on the timing of intervention, protocol and effectiveness of acute exacerbation or intensive care unit pulmonary rehabilitation to improve patient outcomes. We should find a balance between " dynamic” and " static” to maximize the benefit of patients from early pulmonary rehabilitation.