基于微信平台的自我管理模式对冠心病患者依从性和生活质量的影响

目的：探讨基于微信平台的自我管理模式对冠心病患者依从性及生活质量的影响。方法采用便利抽样法,抽取120冠心病患者为研究对象,随机分为观察组和对照组,每组各60例,对照组给予常规护理管理模式,观察组行基于微信平台的自我管理模式,两组患者观察随访3个月,比较两组患者生活方式、生活质量及服药依从性。结果干预后,观察组患者服药、门诊随访等依从性评分明显高于对照组患者,差异有统计学意义(P<0.05),两组患者生活方式依从性评分无明显差异(P>0.05),观察组患者生理因素、心理因素等维度评分明显高于对照组患者(P<0.05),两组患者社会关系、环境影响等维度评分无明显差异(P>0.05)。结论基于微信平台的自我管理模式能显著提高患者服药依从性和门诊随访的依从性,改善冠心病患者生活质量。     

微信平台结合反馈式健康指导对冠心病不稳定型心绞痛患者医院、居家健康行为及心脏功能指标的影响

目的 探讨微信平台结合反馈式健康指导对冠心病不稳定型心绞痛（UAP）患者医院、居家健康行为及心脏功能指标的影响。方法 选取2019年1月至2020年1月我院接收的84例冠心病UAP患者进行研究,以护理方案将其分为对照组和观察组,每组42例。对照组采取常规护理干预,观察组于对照组基础上加施微信平台结合反馈式健康指导。比较两组的干预效果。结果 干预后,观察组的病情监测、遵医服药、饮食管理评分均高于对照组（P<0.05）。干预后,观察组的服药依从性、生活方式改善执行、康复锻炼执行、危险因素控制、定期复诊执行评分均高于对照组（P<0.05）。干预后,观察组的LVESD、LVEDD均小于对照组,LVEF高于对照组,6MWT长于对照组（P<0.05）。结论 微信平台结合反馈式健康指导用于冠心病UAP患者的护理中,不仅能改善患者医院、居家健康行为,还能改善心脏功能指标,值得推广。     

基于微信平台的护理干预对化疗患者PICC导管自护能力及生活质量的影响

目的 探讨基于微信平台的护理干预对PICC置管肿瘤患者导管维护依从性、并发症及自我管理能力的影响。 方法 选取2017年6月-2018年6月我院肿瘤一区65例PICC置管恶性肿瘤化疗患者为对照组,选取同时期肿瘤二区65例化疗患者为观察组,对照组给予PICC置管患者常规护理,观察组在对照组基础上实施微信平台管理,比较2组导管维护依从率、导管维护知识知晓率、自我管理能力、生活质量及导管不良事件发生率。 结果 干预后,观察组导管维护依从率、导管维护知识知晓率均高于对照组(χ²=6.307,P=0.012;χ²=6.759,P=0.009);观察组导管相关知识、导管监测行为、心理信念及自我管理总评分均高于对照组(P<0.05),物质生活、躯体功能、心理功能、社会功能及生活质量总分均高于对照组(P<0.05>);导管不良事件发生率低于对照组(χ²=5.876,P=0.015)。 结论 基于微信平台护理管理能有效提高PICC置管患者导管维护知识及导管维护能力,从降低导管相关并发症,提高患者生活质量。     

Tripartite intensive intervention for prevention of rebleeding in elderly patients with hypertensive cerebral hemorrhage

BACKGROUNDHypertensive cerebral hemorrhage (HICH) is the rupture and bleeding of vessels of the cerebral parenchyma caused by continuously elevated or violently fluctuating blood pressure. The condition is characterized by high disability and high mortality. Hematoma formation and resulting space-occupying effects following intracerebral hemorrhage are among the key causes of impaired neurological function and disability. Consequently, minimally invasive clearance of the hematoma is undertaken for the treatment of HICH because it can effectively relieve intracranial hypertension. Therefore, special attention should be given to the quality of medical and nursing interventions in the convalescent period after minimally invasive hematoma clearance.AIMThe study aim was to determine the value of intensive intervention, including doctors, nurses, and patient families, for the prevention of rebleeding in elderly patients with HICH during the first hospitalization for rehabilitation after the ictal eventMETHODSA total of 150 elderly HICH patients with minimally invasive hematoma evacuation in our hospital between May 2018 and May 2020 were selected and equally divided into two groups of 75 each by their planned intervention. The control group was given conventional nursing intervention and the observation group was given tripartite intensive intervention. The length of hospital stay, cost, complication rate, satisfaction rate, and rebleeding rate during hospitalization were recorded. Changes in cerebral blood flow indicators were recorded in both groups. Changes in the National Institutes of Health Stroke Scale (NIHSS) score, quality of life index (QLI) score, and health behavior score were evaluated at the National Institutes of Health.RESULTSDuration of hospitalization was shorter in the in the observation group than in the control group, the hospitalization cost was less than in the control group, and the rate of rebleeding during hospitalization was lower than in the control group (all P < 0.05). There were no significant differences between the two groups before treatment (all P > 0.05). The mean flow rate (Q_mean) and mean velocity (V_mean) of the two groups increased (P < 0.05), and the dynamic resistance and peripheral resistance decreased (P < 0.05). The Q_mean and V_mean in the intervention group were higher than those in the control group (P < 0.05). Moreover, the dynamic resistance and peripheral resistance of the blood vessels were also lower in the intervention group than in the control group (P < 0.05). The difference in health behavior scores between the two groups before treatment was not significant (P > 0.05). In both groups, the scores for healthy behaviors such as emotion control, medication adherence, dietary management, exercise management, and self-monitoring were higher after than before treatment (P < 0.05), and the scores of healthy behaviors in the intervention group were higher than those in the control group (P < 0.05). There was no significant difference in the NIHSS and QLI scores between the two groups before treatment (P > 0.05). The QLI scores of the two groups increased (P < 0.05), and the NIHSS scores decreased (P < 0.05). The QLI scores of the intervention group were higher than those of the control group (P < 0.05), and the NIHSS score was correspondingly lower than that of the control group (P < 0.05). The incidence of respiratory infections, pressure sores, central hyperpyrexia, and deep venous thrombosis was lower in the intervention group than in the control group. Accordingly, the satisfaction rate was higher in the treatment group than that in the control group (P < 0.05).CONCLUSIONIntensive intervention by doctors, nurses, and families of elderly patients with HICH reduced the rate of rebleeding during hospitalization. It also reduced the incidence of complications, promoted rehabilitation, improved the quality of life, and enhanced nerve function. Additionally, it improved satisfaction and promoted healthy behaviors.     

基于微信平台的反馈式健康教育结合个体化饮食指导对妊娠期糖尿病患者自护能力、自我效能感及胰岛素状态的影响

目的探讨基于微信平台的反馈式健康教育结合个体化饮食指导对妊娠期糖尿病患者自护能力及自我效能感、胰岛素状态的影响。方法选取2018年4月至2020年4月收治的妊娠期糖尿病患者100例进行观察,随机将其分为对照组和观察组,各50例。对照组实施常规护理干预,观察组在此基础上实施基于微信平台的反馈式健康教育结合个体化饮食指导干预。比较两组的自护能力、自我效能感及胰岛素状态变化情况。结果干预后,观察组的ESCA各维度评分和GSES各维度评分均高于对照组(P<0.05)。干预后,观察组的HOMA-IR低于对照组,HOMA-β高于对照组(P<0.05)。结论基于微信平台的反馈式健康教育结合个体化饮食指导应用于妊娠期糖尿病患者中,不仅有助于提高其自护能力及自我效能感,也能促进患者胰岛素状态的改善,值得应用和推广。     

激励式护理对血液透析患者生活质量和自我护理能力的改善效果研究

目的: 探讨激励式护理对血液透析患者生活质量和自我护理能力改善的效果。方法: 将120例血液透析患者随机分为观察组和对照组各60例。对照组采用常规护理,观察组在此基础上给予激励式护理。比较两组患者的生活质量、自我护理能力、疾病防治知识掌握情况和并发症发生情况。结果: 观察组患者的生活满意、健康指数、一般感情指数以及情感得分评分均高于对照组,差异有统计学意义（P<0.05）;观察组患者自我概念、健康知识水平、自我护理技能和自护责任感评分值均明显高于对照组(P<0.05);两组患者护理后的遵医行为、并发症防治、高危因素、饮食注意事项、急救知识和技能评分观察组明显高于对照组(P<0.05);观察组患者高血压、心力衰竭、呼吸困难、低血压并发症发生率低于对照组(P<0.05)。结论: 激励式护理可以改善血液透析患者的生活质量和自我护理能力,减少并发症的发生。     

Analysis of N-terminal pro-B-type natriuretic peptide and cardiac index in multiple injured patients: a prospective cohort study

Introduction

Increased serum B-type natriuretic peptide (BNP) has been identified for diagnosis and prognosis of impaired cardiac function in patients suffering from congestive heart failure, ischemic heart disease, and sepsis. However, the prognostic value of BNP in multiple injured patients developing multiple organ dysfunction syndrome (MODS) remains undetermined. Therefore, the aims of this study were to assess N-terminal pro-BNP (NT-proBNP) in multiple injured patients and to correlate the results with invasively assessed cardiac output and clinical signs of MODS.

Methods

Twenty-six multiple injured patients presenting a New Injury Severity Score of greater than 16 points were included. The MODS score was calculated on admission as well as 24, 48, and 72 hours after injury. Patients were subdivided into groups: group A showed minor signs of organ dysfunction (MODS score less than or equal to 4 points) and group B suffered from major organ dysfunction (MODS score of greater than 4 points). Venous blood (5 mL) was collected after admission and 6, 12, 24, 48, and 72 hours after injury. NT-proBNP was determined using the Elecsys proBNP^® assay. The hemodynamic monitoring of cardiac index (CI) was performed using transpulmonary thermodilution.

Results

Serum NT-proBNP levels were elevated in all 26 patients. At admission, the serum NT-proBNP values were 116 ± 21 pg/mL in group A versus 209 ± 93 pg/mL in group B. NT-proBNP was significantly lower at all subsequent time points in group A in comparison with group B (P < 0.001). In contrast, the CI in group A was significantly higher than in group B at all time points (P < 0.001). Concerning MODS score and CI at 24, 48, and 72 hours after injury, an inverse correlation was found (r = -0.664, P < 0.001). Furthermore, a correlation was found comparing MODS score and serum NT-proBNP levels (r = 0.75, P < 0.0001).

Conclusions

Serum NT-proBNP levels significantly correlate with clinical signs of MODS 24 hours after multiple injury. Furthermore, a distinct correlation of serum NT-proBNP and decreased CI was found. The data of this pilot study may indicate a potential value of NT-proBNP in the diagnosis of post-traumatic cardiac impairment. However, further studies are needed to elucidate this issue.     

三主体双轨道互动护理干预模式在永久心脏起搏器植入术患者中的应用

目的:探讨三主体双轨道互动护理干预模式在永久心脏起搏器植入术患者中的应用效果。方法:选取2017年1月1日~2019年12月31日收治的110例行永久心脏起搏器植入术患者为研究对象,根据随机数字表法分为观察组和对照组各55例。对照组采取常规护理干预,观察组在常规护理干预基础上实施三主体双轨道互动护理干预模式。比较两组入院时、出院后3个月的负性情绪[采用状态特质焦虑量表(STAI)、贝克抑郁自评量表(BDI)]、自护能力[采用自我护理能力测评量表(ESCA)]、生活质量[采用生活质量综合评定量表(GQOLI-74)],并通过自拟问卷的方式评估两组干预后的干预依从性,记录其干预过程中相关并发症发生情况。结果:出院后3个月,两组STAI、BDI评分低于入院时(P<0.05),且观察组低于对照组(P<0.05);出院后3个月,两组ESCA中护理技能、健康知识水平、自护责任感、自我概念得分高于入院时(P<0.05),且观察组高于对照组(P<0.05);出院后3个月,两组GQOLI-74中躯体功能、心理功能、社会功能、物质生活状态得分高于入院时(P<0.05),且观察组高于对照组(P<0.05);出院后3个月,观察组干预依从性优于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05)。结论:三主体双轨道互动护理干预模式可明显提高行永久心脏起搏器植入术患者的自护能力及干预依从性,且有利于缓解负性情绪,提高生活质量,值得临床推广。     

Clinical observation of Kuntai capsule combined with Fenmotong in treatment of decline of ovarian reserve function

BACKGROUNDDecreased ovarian reserve function is an ovarian hypofunction disease that occurs in women before 40 years of age, leading to a decline in fertility and perimenopausal symptoms, such as irregular menstruation, amenorrhea, infertility, decreased libido, and autonomic nervous dysfunction. Fenmatong (FMT) is a compound mixture of estradiol tablets and estradiol didroxyprogesterone tablets, which can improve ovarian reserve function by supplementation of exogenous estrogen. However, this treatment has also been shown to cause breast pain, gastrointestinal discomfort, irregular vaginal bleeding, and changes in sexual desire. In severe cases, FMT can promote the development of breast cancer, endometrial cancer, and venous embolic disease.AIMTo observe the effects of Kuntai capsules and FMT on endocrine indexes and uterine artery blood circulation in patients with decreased ovarian reserve function.METHODSPatients (130) with decreased ovarian reserve function, who were treated in our hospital from May 2018 to May 2020, were divided into two groups: The FMT group, in which patients were treated with FMT, and the observation group, in which patients were treated with Kuntai capsules. Chinese medicine symptom scores, uterine artery blood flow parameters, ovarian ultrasound test indexes, pictorial blood loss assessment chart (PBAC) scores, and hormone levels were recorded, and total effective rates were calculated for both groups.RESULTSThe total effective rate in the observation group was higher than that in the FMT group (P < 0.05).After treatment, primary symptoms, including low menstrual volume, delayed menstruation, red color and thick consistency of menses, dizziness, palpitation, weakness at the waist and knee, insomnia and excessive dreaming, irritability, and dryness and astringency of the pudendal canal in the observation group decreased, and scores for primary and secondary symptoms in the observation group were significantly lower than those in the FMT group (P < 0.05).The systolic peak flow rate (PSV), end-diastolic flow rate (EDV), ovarian diameter, sinus follicle count, and resistance index (RI) of the uterine arteries in the observation group and FMT group increased after treatment. Notably, the PSV, EDV, ovarian diameter, and antral follicle count in the observation group were higher than those in the FMT group, whereas the RI in the observation group was lower than that in the FMT group (P < 0.05).The PBAC scores in the observation and FMT groups increased after treatment, with that in the observation group becoming significantly higher than that in the FMT group (P < 0.05). After treatment, estradiol (E2) and anti-Mullerian hormone (AMH) levels increased, whereas follicle-stimulating hormone (FSH) levels decreased in the observation group and FMT group; E2 and AMH levels became significantly higher and FSH levels became significantly lower in the observation group than in the FMT group (P < 0.05).CONCLUSIONCompared with FMT, Kuntai capsules promoted uterine artery blood circulation, improved menstruation, relieved symptoms, regulated endocrine function, and improved curative effects.     

Participatory continuous nursing using the WeChat platform for patients with spinal cord injuries

ObjectiveThe study aim was to analyse the effect of participatory continuous nursing using the WeChat platform on the complications, family function and compliance of patients with spinal cord injuries.MethodsThis was a randomized controlled trial. Seventy-eight patients with stable disease treated by internal fixation were enrolled in the study from August 2017 to August 2019 and assigned equally to an observation group and a control group. The control group received regular care from the time of discharge. The observation group used the WeChat platform to participate in continuous care.ResultsSix months after discharge, the continuous nursing group had a significantly lower incidence of pressure ulcers, urinary tract infections, joint contractures and muscle atrophy than the control group. The continuous nursing group showed a significant improvement in family function level and compliance behaviour at 3 and 6 months after discharge.ConclusionA participation-based continuous nursing intervention using the WeChat platform can reduce the incidence of pressure ulcers, urinary tract infections, joint contracture and muscle atrophy; improve patient family function; and promote healthy compliance behaviour.     

High-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide in acute heart failure: Data from the ACE 2 study

BackgroundTo assess if cardiac troponins can improve diagnostics of acute heart failure (AHF) and provide prognostic information in patients with acute dyspnea.MethodsWe measured cardiac troponin T with a high-sensitivity assay (hs-cTnT) in 314 patients hospitalized with acute dyspnea. The index diagnosis was adjudicated and AHF patients were stratified into AHF with reduced or preserved ejection fraction (HFrEF/HFpEF). The prognostic and diagnostic merit of hs-cTnT was compared to the merit of N-terminal pro-B-type natriuretic peptide (NT-proBNP).ResultsIn the total population, median age was 73 (quartile [Q] 1–3 63–81) years and 48% were women. One-hundred-forty-three patients were categorized as AHF (46%) and these patients had higher hs-cTnT concentrations than patients with non-AHF-related dyspnea: median 38 (Q1-3 22–75) vs. 13 (4–25) ng/L; p < 0.001. hs-cTnT concentrations were similar between patients with HFrEF and HFpEF (p = 0.80), in contrast to NT-proBNP, which was higher in HFrEF (p < 0.001). C-statistics for discriminating HFpEF from non-AHF-related dyspnea was 0.80 (95% CI 0.73–0.86) for hs-cTnT, 0.79 (0.73–0.86) for NT–proBNP, and 0.83 (0.76–0.89) for hs-cTnT and NT-proBNP in combination. Elevated hs-cTnT remained associated with HFpEF in logistic regression analysis after adjusting for demographics, comorbidities and renal function. During median 27 months of follow-up, 114 (36%) patients died in the total population. Higher hs-cTnT concentrations were associated with increased risk of all-cause mortality after adjustment for clinical variables and NT-proBNP: hazard ratio 1.30 (95% CI 1.07–1.58), p = 0.009.Conclusionhs-cTnT measurements improve diagnostic accuracy for HFpEF and provide independent prognostic information in unselected patients with acute dyspnea.     

微信强化健康教育在哮喘患儿中的应用

目的: 观察微信应用在小儿哮喘家属强化健康教育的效果。方法: 选取哮喘患儿124例,采用随机数字表法随机分为观察组和对照组各62例,干预过程中观察组有4例,对照组有9例脱落,最终观察组和对照组完成干预分别为58例和53例。观察组在对照组常规健康教育的基础上增加微信公众号、群聊及短信等强化健康教育方法。统计分析两组患儿哮喘控制情况、比较两组患儿家长哮喘知识掌握程度,随访患儿半年内院外治疗依从性及再发哮喘情况。结果: 观察组患儿哮喘控制情况更佳（P=0.028）,患儿家长小儿哮喘知识掌握程度更高（P=0.009）;且干预后观察组患儿治疗依从性高（P<0.001）,半年内再发哮喘比例低（P=0.005）。结论: 强化健康教育有助于提高患儿哮喘的控制效果,提高患儿家长对哮喘相关知识的掌握微信程度及治疗依从性。     

非透析慢性肾脏病患者sST2、NT-proBNP、hs-cTnT与左心室构型的相关性

目的 左室重构和肥厚在慢性肾脏病（Chronic Kidney Disease, CKD）患者中十分常见,并与其不良预后相关。可溶性生长刺激表达基因2蛋白（soluble growth Stimulation expressed gene 2, sST2）是一种与心脏重构相关的新型循环标志物。本研究探讨了CKD患者sST2和传统心脏标志物与左心构型的相关性。 方法 纳入2019年8月至2020年12月在上海复旦大学附属中山医院肾病科诊治的CKD患者。收集患者临床资料,检测心脏标志物sST2、N端脑钠肽前体（N-terminal pro-B-type natriuretic peptide, NT-proBNP）、高敏肌钙蛋白T（high-sensitivity cardiac troponin , hs-cTnT）。采用经胸超声心动图评估左心室结构,根据左心室质量指数（Left Ventricular Mass Index, LVMI）和相对室壁厚度（Relative Wall Thickness, RWT）定义左心室几何构型。采用受试者工作特征（Receiver operating characteristic , ROC）曲线分析各心脏标志物对左心室肥厚（Left Ventricular Hypertension, LVH）的预测效能。采用事后检验分析各左心构型间心脏标志物的组间差异。采用多元线性回归分析心脏标志物与心脏结构参数之间的相关性。 结果 共纳入CKD患者652例。LVH的检出率为33.4%,检出率随着肾功能的恶化而增加,在CKD5期患者为64.3%。与正常构型患者相比,NT-proBNP和cTNT水平在向心性或离心性肥厚组中均显著升高,而sST2水平仅在向心性肥厚组中显著升高。多元线性回归分析示NT-proBNP与左房内径、左心室舒张末期内径、左心室收缩末期内径、后壁厚度、室间隔厚度、左心室射血分数、左心质量和LVMI相关,hs-cTNT与左房内径、后壁厚度、室间隔厚度、左心质量、RWT和LVMI相关,sST2与左房内径、LVMI相关。 结论 sST2在向心性肥厚的CKD患者中明显升高,这一特征不同于传统心脏标志物。ST2/白细胞介素-33通路在CKD患者心脏重构过程中的作用机制有待进一步研究。     

Combined Use of the Novel Biomarkers High-Sensitivity Troponin T and ST2 for Heart Failure Risk Stratification vs Conventional Assessment

ObjectiveTo assess an innovative multimarker strategy for risk stratification of death in a real-life ambulatory heart failure (HF) cohort.Patients and MethodsThe study included 876 consecutive outpatients (median age, 70.3 years; left ventricular ejection fraction, 34%) between May 22, 2006, and July 7, 2010, prospectively followed up in a structured HF unit. A combination of biomarkers reflecting myocardial stretch (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), myocyte injury (high-sensitivity cardiac troponin T [hs-cTnT]), and ventricular fibrosis and remodeling (high-sensitivity ST2 [hs-ST2]) were added to an assessment based on established mortality risk factors (age, sex, left ventricular ejection fraction, New York Heart Association functional class, diabetes mellitus, estimated glomerular filtration rate, ischemic etiology, sodium level, hemoglobin level, and pharmacologic treatment).ResultsDuring median follow-up of 41.4 months, 311 patients died. The combined addition of hs-cTnT and hs-ST2 to the model yielded good measurements of performance (C statistic, 0.789; Bayesian information criterion, 3611; integrated discrimination improvement, 4.1 [95% CI, 2.5-5.6]; and net reclassification index, 13.9% [95% CI, 6.2-21.6]). Reclassification did not significantly benefit after NT-proBNP addition into the full model; some indices even worsened with all 3 biomarkers. Separate addition of NT-proBNP provided prognostic discrimination only in the subgroup of patients with either hs-cTnT or hs-ST2 levels below the cutoff points (hazard ratio, 2.97; 95% CI, 2.24-9.39; P<.001).ConclusionA multimarker strategy seems useful for stratifying risk in chronic HF. However, NT-proBNP in addition to the new-generation biomarkers hs-cTnT and hs-ST2 had a limited effect on risk stratification.     

Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome

BACKGROUNDGRACE and SYNTAX scores are important tools to assess prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, there have been few studies on their value in patients receiving different types of therapies.AIMTo explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies. METHODSThe data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups. A total of 195 patients who received agents alone comprised the medication group, 156 who received medical therapy combined with stents comprised the stent group, and 35 patients who were given agents and underwent coronary artery bypass grafting (CABG) comprised the CABG group. General information was compared among the three groups. GRACE and SYNTAX scores were calculated. The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events (MACEs) was analyzed. Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS. Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model. RESULTSThe incidence of MACE increased with the elevation of GRACE and SYNTAX scores (all P < 0.05). The incidence of MACE was 18.5%, 36.5%, and 42.9% in the medication group, stent group, and CABG group, respectively. By comparison, the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups (all P < 0.05). The incidence of MACE was 6.2%, 28.0% and 40.0% in patients with a low GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 31.0%, 30.3% and 42.9% in patients with a medium GRACE score in the medication group, stent group, and CABG group, respectively (P > 0.05). The incidence of MACE was 16.9%, 46.2%, and 43.8% in patients with a high GRACE score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 16.2%, 35.4% and 60.0% in patients with a low SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). The incidence of MACE was 37.5%, 40.9%, and 41.7% in patients with a medium SYNTAX score in the medication group, stent group, and CABG group, respectively (P > 0.05). MACE incidence was 50.0%, 75.0%, and 25.0% in patients with a high SYNTAX score in the medication group, stent group, and CABG group, respectively (P < 0.05). Univariate Cox regression analyses showed that both GRACE score (hazard ratio [HR] = 1.212, 95% confidence interval [CI]: 1.083 to 1.176; P < 0.05) and SYNTAX score (HR = 1.160, 95%CI: 1.104 to 1.192; P < 0.05) were factors influencing MACE (all P < 0.05). Multivariate Cox regression analyses showed that GRACE (HR = 1.091, 95%CI: 1.015 to 1.037; P < 0.05) and SYNTAX scores (HR = 1.031, 95%CI: 1.076 to 1.143; P < 0.05) were independent predictors of MACE (all P < 0.05). CONCLUSIONGRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients, and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.     

Birthing ball on promoting cervical ripening and its influence on the labor process and the neonatal blood gas index

BACKGROUNDTerm pregnancy-induced labor refers to the use of artificial methods to induce uterine contractions and terminate pregnancy after 37 wk. It is a common method to prevent overdue pregnancy and to deal with high-risk pregnancies. In addition, it can alleviate maternal complications and cause the fetus to leave the adverse intrauterine environment early, which is beneficial to the outcome of pregnancy.AIMTo explore the effect of a birthing ball on labor by inducing cervical ripening and its influence on labor and the neonatal blood gas index.METHODSTwenty-two women who were scheduled to undergo labor induction and delivery in the obstetrics department of our hospital were randomly divided into two groups: the delivery ball group (childbirth ball combined with COOK balloon induction) and the conventional group (COOK balloon induction alone). The cervical Bishop score before and after intervention, duration of labor at each stage, mode of delivery, neonatal umbilical venous blood pH, oxygen partial pressure (PO₂), carbon dioxide partial pressure (PCO₂), and the 1-min Apgar score were recorded.RESULTSAfter the intervention, the cervical Bishop score of the delivery ball group (7.84 ± 1.52) was significantly higher than that of the conventional group (7.32 ± 1.29) (P < 0.05), and the cervical Bishop scores of the two groups after intervention were significantly higher than those before intervention (P < 0.05). After the intervention, the first stage of labor (510.9 ± 98.7 min), the second stage of labor (43.0 ± 8.5 min), and the total duration of labor (560.0 ± 120.9 min) in the delivery ball group were lower than those in the routine group, with a first stage of labor of 602.1 ± 133.2 min, a second stage of labor of 48.4 ± 9.1 min, and a total duration of labor of 656.8 ± 148.5 min (P < 0.05). There was no significant difference in the time of the third stage of labor between the two groups (P > 0.05). There was no significant difference in the pH, PO₂, and PCO₂ values of newborns between the delivery ball group and the conventional group (P > 0.05). The 1-min Apgar score of the delivery ball group was higher than that of the conventional group (9.10 ± 0.38 points vs 8.94 ± 0.31 points, P < 0.05). The natural delivery rate of the delivery ball group was higher than that of the conventional group (91.00% vs 78.00%, P < 0.05).CONCLUSIONThe use of a birthing ball combined with a COOK balloon for inducing labor has a better effect on promoting cervical ripening, shortening the time of labor, and improving the Apgar score of newborns.     

Effects of mindful breathing combined with sleep-inducing exercises in patients with insomnia

BACKGROUNDInsomnia is the most common sleep disorder. It disrupts the patient’s life and work, increases the risk of various health issues, and often requires long-term intervention. The financial burden and inconvenience of treatments discourage patients from complying with them, leading to chronic insomnia.AIMTo investigate the long-term home-practice effects of mindful breathing combined with a sleep-inducing exercise as adjunctive insomnia therapy.METHODSA quasi-experimental design was used in the present work, in which the patients with insomnia were included and grouped based on hospital admission: 40 patients admitted between January and April 2020 were assigned to the control group, and 40 patients admitted between May and August 2020 were assigned to the treatment group. The control group received routine pharmacological and physical therapies, while the treatment group received instruction in mindful breathing and a sleep-inducing exercise in addition to the routine therapies. The Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7-item (GAD-7) scale, and Insomnia Severity Index (ISI) were utilized to assess sleep-quality improvement in the patient groups before the intervention and at 1 wk, 1 mo, and 3 mo postintervention.RESULTSThe PSQI, GAD-7, and ISI scores before the intervention and at 1 wk postintervention were not significantly different between the groups. However, compared with the control group, the treatment group exhibited significant improvements in sleep quality, daytime functioning, negative emotions, sleep latency, sleep duration, sleep efficiency, anxiety level, and insomnia severity at 1 and 3 mo postintervention (P < 0.05). The results showed that mindful breathing combined with the sleep-inducing exercise significantly improved the long-term effectiveness of insomnia treatment. At 3 mo, the PSQI scores for the treatment vs the control group were as follows: Sleep quality 0.98 ± 0.48 vs 1.60 ± 0.63, sleep latency 1.98 ± 0.53 vs 2.80 ± 0.41, sleep duration 1.53 ± 0.60 vs 2.70 ± 0.56, sleep efficiency 2.35 ± 0.58 vs 1.63 ± 0.49, sleep disturbance 1.68 ± 0.53 vs 2.35 ± 0.53, hypnotic medication 0.53 ± 0.64 vs 0.93 ± 0.80, and daytime dysfunction 1.43 ± 0.50 vs 2.48 ± 0.51 (all P < 0.05). The GAD-7 scores were 2.75 ± 1.50 vs 7.15 ± 2.28, and the ISI scores were 8.68 ± 2.26 vs 3.38 ± 1.76 for the treatment vs the control group, respectively (all P < 0.05).CONCLUSIONThese simple, cost-effective, and easy-to-implement practices used in clinical or home settings could have profound significance for long-term insomnia treatment and merit wide adoption in clinical practice.     

共享决策对冠心病经皮冠状动脉介入治疗术后患者健康行为、治疗依从性的影响

目的探讨共享决策对冠心病经皮冠状动脉介入治疗(PCI)术后患者健康行为、治疗依从性的影响。方法选取2017年2月至2019年2月该院收治的100例行PCI术治疗的冠心病患者作为研究对象,按照入院单双号顺序分为对照组(50例)和观察组(50例)。对照组患者给予常规干预,观察组患者给予共享决策干预,比较两组患者治疗依从率、健康行为、自我护理能力、并发症发生率及患者满意度。结果观察组患者干预后治疗依从率为94.00%,满意度为96.00%,均明显高于对照组的76.00%和80.00%,差异均有统计学意义(P<0.05);观察组患者干预后心理健康、健康责任感、压力管理、营养、躯体活动、人际关系及总分均明显高于对照组,差异均有统计学意义(P<0.05);观察组患者干预后自我护理概念、自我护理技能、自我护理责任感评分及健康知识评分均明显高于对照组,差异均有统计学意义(P<0.05);观察组患者干预后并发症发生率(6.00%)明显低于对照组(24.00%),差异有统计学意义(P<0.05)。结论共享决策可提高冠心病PCI术后患者治疗依从性、健康行为及自我护理能力,降低并发症发生率。     

Plasma brain natriuretic peptide,platelet parameters,and cardiopulmonary function in chronic obstructive pulmonary disease

BACKGROUNDChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with worldwide occurrence and high disability and mortality rate. It occurs mostly in the elderly population with pulmonary heart disease, type II respiratory failure, and other serious complications.AIMTo investigate the correlation of plasma brain natriuretic peptide (BNP) and platelet parameters with cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease. METHODSFrom June 2016 to June 2019, 52 patients with COPD-pulmonary heart disease (pulmonary heart disease group), 30 patients with COPD (COPD group), and 30 healthy individuals (control group) in our hospital were enrolled in the study. The pulmonary heart disease group was further divided into subgroups according to cardiac function classification and pulmonary artery pressure. Plasma BNP and platelet parameters were estimated and compared among each group and subgroup. The correlation of plasma BNP and platelet parameters with cardiac function classification and pulmonary artery pressure was then analyzed.RESULTSIn the pulmonary heart disease group, the COPD group, and the control group, the levels of plasma BNP, platelet distribution width (PDW), and mean platelet volume (MPV) showed a decreasing trend (P < 0.05), while an increasing trend was found in platelet count (PLT) and plateletcrit (PCT) levels among the three groups (P < 0.05). In the pulmonary hypertension mild, moderate, and severe subgroups, the levels of plasma BNP, PDW, and MPV showed an increasing trend (P < 0.05), while a decreasing trend was observed in PLT levels (P < 0.05); however, PCT levels showed no significant difference among the three subgroups (P > 0.05). In the cardiac function grade I, II, III, and IV subgroups, the levels of plasma BNP, PDW, and MPV showed an increasing trend (P < 0.05), while a decreasing trend was noted in PLT and PCT levels among the four subgroups (P < 0.05). Correlation analysis showed that the levels of plasma BNP, PDW, and MPV in patients with pulmonary heart disease were positively correlated with their pulmonary artery pressure (P < 0.05), while PLT was negatively correlated with their pulmonary artery pressure (P < 0.05). Moreover, plasma BNP, PDW, and MPV levels were positively correlated with cardiac function grade (P < 0.05) of these patients, while PLT and PCT levels were negatively correlated with their cardiac function grade (P < 0.05).CONCLUSIONPlasma BNP and PLT parameters are significantly correlated with the cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease, indicating that these parameters have high clinical relevance in reflecting the health condition of these patients and for guiding their treatment.     

Effects of nursing care in fast-track surgery on postoperative pain,psychological state,and patient satisfaction with nursing for glioma

BACKGROUNDThe brain is the most complex organ in the human body. Treatment for a glioma always involves a multi-disciplinary team. Nursing care in fast-track surgery or enhanced recovery after surgery is such kind of work implemented by an interdisciplinary team to provide services to patients to improve their outcomes. AIMTo explore the effects of nursing care in fast-track surgery on postoperative pain, psychological state, and patient satisfaction with nursing for glioma. METHODSFrom June 2018 to June 2020, 138 patients who underwent operation for glioma at Cancer Hospital Affiliated to Chongqing University were selected. They were categorized into groups according to different nursing care that they received. Of them, 69 patients receiving nursing care in fast-track surgery were included in an experimental group, and 69 patients receiving conventional postoperative nursing were included in a control group. Visual analogue scale was used to evaluate postoperative pain in the two groups immediately after the operation and at 3 d after the operation. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the psychological status of patients immediately after operation and on the 3^rd postoperative day. A self-made satisfaction scale for patient satisfaction with nursing was used to evaluate and compare patient satisfaction with nursing between the two groups. RESULTSTime to excretion, time to out-of-bed activities, and length of hospital stay were significantly shorter in the observation group than in the control group (P < 0.05). There was no significant difference in duration of operative time or intraoperative bleeding between the two groups (P > 0.05). There was no significant difference in postoperative pain score between the two groups (P > 0.05). The pain score was significantly lower in the observation group than in the control group at 3 d after the operation (P < 0.05). There was no significant difference in postoperative SAS or SDS score between the two groups (P > 0.05). SAS and SDS scores were significantly lower in the observation group than in the control group at 3 d after operation (P < 0.05). The rate of patient satisfaction with nursing was 94.2% in the observation group, which was significantly higher than that (81.2%) of the control group (P < 0.05). CONCLUSIONNursing care in fast-track surgery can relieve postoperative pain, anxiety, and depression, and improve patient satisfaction with nursing in patients with glioma, which is worthy of clinical application.