Objective To investigate the efficacy of continuous blood purification ( CBP) in the treatment of severe sepsis, and explore the related immune regulatory mechanisms. Methods Forty-eight patients with severe sepsis were randomly divided into a control group ( n =23) and a CBP group ( n =25) .CD4 + CD25 + regulatory T cells ( Treg% ) in peripheral blood and APACHEⅡ score were measured dynamically before treatment and 12, 24, 36, 48, 60, 72 hours after treatment. Meanwhile the length of ICUstay, duration of mechanical ventilation, and 28 day mortality were determined. Results Compared with the control group, the length of ICU stay, ventilator time, incidence of multiple organ failure, and mortality decreased significantly in the CBP group ( P lt; 0. 05) . And CBP also decreased Treg% and APACHEⅡ score significantly. There was a positive correlation between Treg% and APACHEⅡ score ( r =0. 804, P lt;0. 01) .Conclusion Early CBP treatment can reduce Treg%, improve cellular immunity and improve the prognosis of sepsis.
In this article, the first time use of continuous veno-venous hemofiltration(CVVH) combined with toxic absorption for the treatment of a crush syndrome patient injured in earthquake is described. Correct therapeutic regimen, close observation and prescription condition are crucial for the success of management. The evidence for the application of this method is also discussed in detail.
ObjectiveTo research the influence of anticoagulation to blood clotting function in patients who experienced cardiopulmonary bypass surgery under continuous renal replacement therapy (CRRT) with regional citrate anticoagulation (RCA), low molecular weight heparin (LMWH) anticoagulation and non-anticoagulation.MethodsWe retrospectively analyzed the clinical data of 146 patients who underwent CRRT after cardiopulmonary bypass surgery between January 2014 and December 2016. There were 98 males and 48 females at age of 60.51±14.29 years. All CRRT patients were allocated into three groups including a RCA group, a LMWH group, and a non-anticoagulation group, which were compared in terms of convention coagulation tests, platelet counts, thromboelastography, circuit lifespan and transfusion.ResultsThree hundred and fifty four CRRT patients were selected from patients above, including 152 patients in the LMWH group, 160 in the RCA group, and 42 in the non-anticoagulation group. The difference of CRRT circuits time among three groups was statistically different (P=0.023). And multiple comparison showed that the circuit lifespan of the RCA group was significantly longer than that of the non-anticoagulation group (34.50 h ranged 14.00 h to 86.00 h vs.15.00 h ranged 12.00 h to 50.88 h, P=0.033). One hundred and fifty-five CRRT patients last beyond 24 hours with same anticoagulation were selected, the results of coagulation tests, and the difference between CRRT starting and after 24 hours were compared. The difference of Angle and maximum amplitude(MA) of pre- and post-CRRT were significantly different among three groups by one-way ANOVA (P=0.004, 0.000), as well as between the RCA group and the LMWH group by multiple comparison (P=0.004, 0.000). There was no statistical difference in frequencies and doses of the transfusion of fresh frozen plasma and platelet among three groups.ConclusionRCA is an effective anticoagulation which may prolong circuit lifespan and has small impact on the coagulation function of patients who undergo CRRT after cardiopulmonary bypass surgery.
Objective To investigate the effect of continuous positive airway pressure (CPAP) on sleep disorder and neuropsychological characteristics in patients with early Alzheimer’s disease (AD) combined with obstructive sleep apnea hypopnea syndrome (OSAHS). Methods A total of forty-two early AD patients with OSAHS were randomly divided into a CPAP combined treatment group (20 cases) and a simple medicine treatment group (22 cases). The changes of neurocognitive function were assessed by Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE) and Hopkins Verbal Learning Test-revised (HVLT). Patient Health Questionnaire-9 (PHQ9) was used to evaluate the depression mood changes. The sleep characteristics and respiratory parameters were evaluated by polysomnography. The changes of the patients’ sleep status were assessed by Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). The changes of sleep status, cognitive function and mood in the CPAP combined treatment group were compared before and three months after CPAP treatment, and with the simple medicine treatment group. Results After three months of CPAP treatment, the ESS, PSQI and PHQ9 scores in the CPAP combined treatment group were significantly decreased compared with those before treatment, whereas MoCA, MMSE and HVLT (total scores and recall ) in the CPAP combined treatment group were increased compared with those before treatment (P<0.05). After CPAP treatment, the respiratory parameters apnea hypopnea index in the CPAP combined treatment group was significantly lower than that before treatment (P<0.05), and the minimum blood oxygen saturation was significantly higher than that before treatment (P<0.05). However, the sleep characteristics and parameters did not show statistically significant changes compared with those before treatment (P>0.05). The ESS, PSQI and PHQ9 scores were significantly reduced in the CPAP combined treatment group compared with the simple medicine treatment group (P<0.05), while there was no statistically significant changes of cognitive scores between the two groups (P>0.05). Conclusions The degree of low ventilation and hypoxia is alleviated, and the daytime sleepiness and depression is improved in early AD patients with OSAHS after three-month continuous CPAP treatment. Cognitive function is significantly improved, whereas there is no significant change in sleep structure disorder.
Objective To analyze the main problem of continuous hand hygiene improvement by PDCA cycle, find out the causes and carry out corresponding measures, in order to improve hand hygiene management continuously. Methods Between January and June 2014, PDCA cycle was used to strengthen comprehensive training, enhance awareness of hand hygiene, reinforce supervision, and evaluate the effect of continuous hand hygiene improvement. The knowledge of hand hygiene, increase of hand hygiene facilities, use of hand hygiene products and hand hygiene implementation before (from July to December 2013) and after PDCA application (from January to June 2014) were compared and analyzed. Results After the implementation of PDCA cycle, the pass rate of hand hygiene knowledge increased from 61.0% to 88.3%; the total amount of hand hygiene use increased from 1 817 046 mL to 3 347 386 mL; the hand hygiene compliance rate increased from 43.03% to 71.31%; and the correct rate of hand hygiene implementation increased from 62.68% to 87.68%. All the above differences were statistically significant (P<0.05). After the implementation of PDCA cycle, the compliance rate of different hand hygiene indications became significantly different (P<0.05). The growth rate of hand hygiene implementation before aseptic manipulation and after contact with body fluids were relatively higher (34.56% and 34.01%, respectively). Conclusion Through the application of PDCA cycle, hand hygiene compliance rate and correct rate have gradually increased.
Objective To investigate the therapeutic effect of continuous renal replacement therapy (CRRT) plus hemoperfusion (HP) on patients with diabetes and uremic encephalopathy. Methods Fifty-five patients with diabetes and uremic encephalopathy from January 2010 to December 2017 were retrospectively collected in this study and divided into CRRT plus HP (CRRT+HP) group (n=28) and hemodialysis (HD) plus HP (HD+HP) group (n=27). The changes of vital signs, related biochemical indicators before and after treatment and curative effects were compared between the two groups. Results The two groups were comparable in general. No significant differences were found in blood pressure or heart rate before and after treatment between the two groups (P>0.05). The incidence of hypotension events in CRRT+HP group was significantly lower than that in HD+HP group (P<0.05), and the effective rate of cardiac function improvement in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). After treatment, the blood urea nitrogen, creatinine, parathyroid hormone, β2-microglobulin, phosphorus, C-reactive protein and brain natriuretic peptide in the two groups were significantly decreased than those before treatment (P<0.05). Parathyroid hormone, β2-microglobulin, C-reactive protein and brain natriuretic peptide were significantly decreased in CRRT+HP group as compared with those in HD+HP group (P<0.05). The remission rate of uremic encephalopathy in CRRT+HP group was significantly higher than that in HD+HP group (P<0.05). Conclusions As compared with HD+HP pattern, CRRT+HP pattern is more stable in the hemodynamics, and more effective in the improvement of heart failure and the clearance of inflammatory mediators, middle molecular and macromolecular substances associated with uremic encephalopathy. CRRT+HP pattern is suitable for the treatment of patients with diabetes and uremic encephalopathy.
ObjectiveTo investigate the pathogenesis and treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) by detecting the changes of serum interleukin-23 (IL-23) and C-reactive protein (CRP) levels of the OSAHS patients before and after treatment with continuous positive airway pressure (CPAP).MethodsFifty-eight patients with moderate to severe OSAHS diagnosed by polysomnography were recruited as an experimental group, 57 out-patient healthy subjects with matched age, sex and body mass index of the experimental group were enrolled as a control group. The serum concentrations of IL-23 and CRP in the experimental group were detected and compared before and after CPAP application for 3 months. The serum concentrations of IL-23 and CRP in the control group were also measured.ResultsThe serum levels of IL-23 and CRP in the OSAHS patients were significantly higher than those in the normal control subjects (P<0.05). The serum levels of IL-23 and CRP in the OSAHS patients after CPAP treatment were significantly lower than those before CPAP treatment (P<0.05). The serum concentrations of IL-23 and CRP were positively correlated with apnea hypopnea index (r=0.756, r=0.345, P<0.05, respectively), and negatively correlated with mean oxygen saturation (r=–0.715, r=–0.334, P<0.05, respectively).ConclusionsThe serum levels of IL-23 and CRP are positively correlated with the severity of OSAHS. After CPAP treatment, the levels of IL-23 and CRP decrease, which indicates that CPAP treatment may reduce the inflammatory reaction and correct anoxia of OSAHS patients.
This paper introduces the background, significance, definition and types of clinical audit and describes five stages of clinical audit, including preparing for clinical audit, selecting criteria, measuring performance and sustaining improvement. This paper also introduces the international and national status quo of implementing clinical audit in nursing practice and describes the reporting guideline for articles of clinical audit. Finally, this article suggests that providing methodological training and creating a supportive environment are crucial strategies to promote the implementation of clinical audit and bridge the gaps between evidence and practice.
ObjectiveTo observe the effect of continuous renal replacement therapy (CRRT) on serum phosphate level in patients after cardiac surgery. MethodA single-center retrospective observational study was conducted on 30 patients received CRRT after cardiac surgery. There were 14 males and 16 females with mean age of 57.0±10.8 years (ranged 37-79 years). A total of 16 patients underwent CRRT with continuous veno-venous hemofiltration (CVVH), and 14 patients with continuous veno-venous hemodiafiltration (CVVHDF). The serum phosphate level was measured before treatment, at 24 h, and 48 h during therapy and 24 h after phosphate salt supplementation. ResultsThe level of serum phosphate at 24 h and 48 h during CRRT was decreased (0.6±0.4 mmol/L vs. 0.4±0.2 mmol/L vs. 1.1±0.3 mmol/L, P<0.01). After intravenous phosphate salt supplementation, serum phosphate level got increased (0.6±0.3 mmol/L, P<0.01). There was no statistical difference in serum phosphate level between CVVH and CVVHDF (P>0.05). ConclusionHypophosphatemia occurs frequently during CRRT, particularly with long treatment time. Phosphate salt supplementation is necessary. The dosage of the supplementation should be adjusted personally based on the regularly monitoring results of serum phosphate tests.
Continuous renal replacement therapy (CRRT) is a term of blood purification technique that can continuously remove the body's solute and water for 24 hours without any interruption throughout each day. It has several advantages such as hemodynamic stability, accurate capacity control, stable internal environment, and inflammatory regulation, which is especially suitable for patients with severe hemodynamic instability. In clinical practice, critically ill patients treated with CRRT are often associated with different types of acidosis, including metabolic acidosis, lactic acidosis, citrate acidosis, ketoacidosis and hypercapnic acidosis. Different types of acidosis can be treated in different ways. This paper reviews the CRRT for special types of acidosis.