The effectiveness of labetalol in treating postoperative hypertension

During the postanesthesia recovery period, surgical patients often exhibit an increased arterial blood pressure. Although these transient increases in blood pressure are usually benign, significant morbidity and mortality may result from complications of postoperative hypertension. The purpose of this study was twofold: to determine the frequency of postoperative hypertension in one particular recovery room, and to determine the efficacy of labetalol as an antihypertensive drug in this setting. This study included both a retrospective and prospective component. The retrospective portion involved review of 465 records of patients admitted to the recovery room at a large, private eastern medical college. Nearly 20% of patients admitted were found to have blood pressures in the range of our study's criteria for hypertension. Records were also reviewed for types of therapeutic interventions used to treat hypertension and determinations of their success or failure. The prospective portion of the study evaluated treatment protocols for postoperative hypertension with graduated intravenous injections of labetalol in 30 patients. Blood pressure was effectively controlled with an average of 25 minutes for all patients and remained effective for 24 hours postoperatively.     

逐步肺复张技术在肥胖主动脉夹层患者术后低氧血症中的应用

目的:探讨逐步肺复张技术在肥胖主动脉夹层患者术后低氧血症中的应用价值。方法:回顾性分析华中科技大学同济医学院附属协和医院2016年12月至2019年1月78例肥胖主动脉夹层术后低氧血症患者的资料,根据治疗方式,采取常规机械通气治疗的40例分为对照组,采取逐步肺复张技术治疗的38例分为试验组。比较两组的肺复张前和肺复张后1 h的心率(HR)、呼吸(RR)、收缩压(SBP)、舒张压(DBP)、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)、肺动态顺应性(Cdyn)、血氧饱和度(SpO2),呼吸机使用时间、ICU停留时间、并发症。结果:两组肺复张后1 h的HR比较,差异无统计学意义(P>0.05);对照组肺复张后1 h的RR显著低于试验组,SBP、DBP显著高于试验组,差异均有统计学意义(均P<0.01)。对照组肺复张后1 h的PaO2、PaO2/FiO2、Cdyn显著低于试验组,差异均有统计学意义(均P<0.05);两组肺复张后1 h的SpO 2比较,差异无统计学意义(P>0.05)。对照组呼吸机使用时间、ICU停留时间显著高于试验组,差异均有统计学意义(均P<0.05)。对照组并发症发生率与试验组并发症发生率比较差异无统计学意义(P>0.05)。结论:逐步肺复张技术可显著改善肥胖主动脉夹层患者术后低氧血症,提高其肺通气情况,促进患者早日康复。     

快速康复外科护理策略在老年股骨转子间骨折病人围术期中的应用

目的:探讨快速康复外科(ERAS)护理策略在老年股骨转子间骨折病人手术室护理中的应用效果。方法:随机抽样法选取2017年1月—2018年12月医院100例老年股骨转子间骨折手术病人,使用随机数字表法分为对照组与研究组各50例。对照组采用常规手术室护理,研究组采用手术室ERAS护理。比较两组病人体温(术前、术中、术后)、术中出血量、住院时间、生理应激指标、心理应激状况、术后住院期间并发症发生情况。结果:研究组病人术中、术毕体温高于对照组,术中出血量少于对照组,住院时间短于对照组(P<0.05);干预后研究组病人心率、收缩压、舒张压低于对照组,SAS、SDS评分低于对照组(P<0.05);研究组病人术后并发症发生率仅为4.00%,低于对照组的18.00%(P<0.05)。结论:老年股骨转子间骨折手术室护理中应用ERAS护理可减轻病人手术应激反应,促进术后恢复,预防相关并发症。     

Myocardial infarction and cardiac complications in emergency department patients admitted to the intensive care unit with gastrointestinal hemorrhage

Patients admitted with significant gastrointestinal hemorrhage (GIH) often experience in-hospital cardiac complications. This retrospective study examined 68 patients admitted from the Emergency Department to the Intensive Care Unit (ICU) over a 1-year period. The patients were 75% Caucasian, 60% male, with a mean age of 57 +/- 19 years. Medical co-morbidity was noted in 70%, and 54% of patients had a history of significant alcohol use. A systolic blood pressure < 100 mm Hg was present in 26%, hemoglobin < 7 mg/dL in 32%, and three patients (4%) expired. Death, acute myocardial infarction or other cardiac complications were noted in 32% of patients. Patients older than 60 years were three times more likely to have a complicated course than were younger patients, and those with a co-morbidity were 14.8 times more likely. Patients with a history of significant alcohol use were 31% less likely to have an inpatient complication than those without such a history. Regression analysis supported the protective effect of a history of significant alcohol use and also demonstrated that a history of peptic ulcer disease was predictive of inpatient complications. Older GIH patients and those with co-morbidities may benefit from ICU disposition given their greater risk. Younger patients presenting with hematemesis and a history of significant alcohol use tended to have fewer complications such that it may be possible to manage these patients outside of the ICU if hemodynamically stable.     

系统化护理在卵巢癌患者手术室护理中的应用及对并发症的影响

目的:探讨系统化护理在卵巢癌患者手术室护理中的应用及对患者并发症的影响。方法:选取2018年6月至2019年6月复旦大学附属肿瘤医院择期进行手术治疗的卵巢癌患者68例,根据护理方式不同分为两组,对照组应用常规护理,研究组应用系统化护理。比较两组患者心率、血压等情况及术后并发症发生情况、心理健康变化情况、血清T淋巴细胞水...     

放松训练联合音乐疗法在局麻手术病人中的应用研究

目的 探讨放松训练联合音乐疗法对局麻手术患者术中、术后的心理、疼痛敏感度及血流动力学的影响。方法 将120例患者按手术安排顺序单双数分为实验组与对照组,每组各60例。对照组患者给予局麻常规护理,实验组在常规护理的基础上对患者进行放松训练联合音乐疗法,观察两组患者术前和术后的疼痛敏感度和焦虑程度的变化及术前一日、入室前、术中、术后心率、血压的变化。结果 组间比较,实验组患者术后焦虑值（SAS）和疼痛视觉模拟量表（VAS）评分明显低于对照组患者,术中、术后30min的收缩压、舒张压、心率均低于对照组（P〈0.01）,实验组术前一日、入室前的收缩压、舒张压、心率与对照组比较,差异无统计学意义（P〉0.05）;组内比较,两组患者入室前的收缩压、舒张压、心率均高于术前一日（P〈0.01）,实验组术中、术后30min的收缩压、舒张压、心率低于入室前（P〈0.01）,而与术前一日比较差异无统计学意义（P〉0.05）;对照组术中、术后30min的收缩压、舒张压、心率与入室前比较,差异无统计学意义（P〉0.05）。结论 放松训练联合音乐疗法,可以减轻患者的焦虑情绪及降低疼痛敏感度,并有利于维持局麻手术患者术中、术后生命体征的稳定。     

Studies on Hemodynamic Instability in Paroxysmal Supraventricular Tachycardia: Noninvasive Evaluations by Head-Up Tilt Testing and Power Spectrum Analysis on Electrocardiographic RR Variation

DOI, A., et al. : Studies on Hemodynamic Instability in Paroxysmal Supraventricular Tachycardia: Noninvasive Evaluations by Head-Up Tilt Testing and Power Spectrum Analysis on Electrocardiographic RR Variation. Hemodynamic instability is a crucial determinant of the best therapeutic option in paroxysmal supraventricular tachycardia (PSVT). However, it is still unclear if hemodynamic instability is tachycardia dependent or independent. We performed frequency-domain analysis of electrocardiographic RR variations during induced PSVT and head-up tilt tests after successful ablation to investigate the role of autonomic vasomotor function in hemodynamic instability during PSVT. Thirty-six patients with (syncope group,  n = 18  ) and without (nonsyncope group,  n = 18  ) syncope and/or presyncope during PSVT were enrolled in this study. Serial blood pressure, heart rate, and variations in heart rate during induced PSVT and head-up tilt tests were examined. Initial blood pressure fall and heart rate changes during induced PSVT were greater in the syncope group than in the nonsyncope group. A significant positive linear relationship was found between these two. Delayed blood pressure fall was observed in the syncope group, independent of heart rate changes. Syncope in PSVT could be predicted from the results of head-up tilt tests with 82% accuracy. Heart rate responses after isoproterenol infusion were significantly greater in the syncope group than in the nonsyncope group. The changes in low frequency to high frequency (LF:HF) values during induced PSVT and head-up tilt tests were significantly greater in the syncope group than in the nonsyncope group, and an exponential correlation was found between LF:HF changes in both tests. We conclude that PSVT rate and vasomotor reaction are related with hemodynamic instability during PSVT and head-up tilt testing is a useful method for determining if patients will have syncope during PSVT.     

Cardiorespiratory effects of naloxone in children

BACKGROUND: Data on the cardiorespiratory changes and complications following administration of naloxone in children are limited. OBJECTIVE: To evaluate the cardiorespiratory changes and complications following naloxone treatment in children. METHODS: The maximal changes in respiratory rate (RR), heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure, and any complications within 1 and 2 hours following naloxone were tabulated. RESULTS: One hundred ninety-five children received naloxone over 3 years. The mean +/- SD age was 9.7 +/- 6 years. The total doses of naloxone ranged from 0.01 to 7 mg (0.001-0.5 mg/kg body weight), with a median dose of 0.1 mg. Group 1 patients consisted of 116 (60%) children who were postoperative and had been given naloxone by an anesthesiologist; group 2 patients consisted of 79 (40%) children who received naloxone in the emergency department or pediatric intensive care unit. Patients in group 1 were older: 10.6 +/- 5.3 versus 8.2 +/- 6.7 years (p < 0.006), but received significantly lower doses of naloxone (0.09 +/- 0.2 vs. 1.1 +/- 0.76 mg; p < 0.001). When the entire cohort was evaluated, a significant increase in RR (15 +/- 7 vs. 21 +/- 8 breaths/min; p < 0.001), HR (102 +/- 29 vs.107 +/- 29 beats/min; p < 0.001), SBP (109 +/- 17 vs. 115 +/- 15 mm Hg; p < 0.001), and DBP (56 +/- 10 vs. 60 +/- 13 mm Hg; p < 0.001) within 1 hour following naloxone was noted. When the 2 groups were compared, only the changes in RR were greater in group 2 patients (6.8 +/- 7.9 vs. 4.7 +/- 5 breaths/min; p < 0.001) following naloxone. Systolic hypertension occurred in 33 of 195 (16.9%) of all patients, while diastolic hypertension occurred in 13 (6.6%) of all patients after naloxone. Only the incidence of diastolic hypertension was higher in group 2 compared with group 1 patients following naloxone (16% vs. 2%; p < 0.001). Hypertension resolved spontaneously. One child developed pulmonary edema and required positive pressure ventilation for 22 hours. CONCLUSIONS: Moderate increases in RR, HR, and BP occur after naloxone administration to children, but development of more serious complications is rare.     

非体外与体外循环冠状动脉旁路移植术的效果及成本比较

[目的]比较非体外循环冠状动脉旁路移植术(OPCAB)与体外循环冠状动脉旁路移植术(CCABG)的效果和成本。[方法]对2003年1月—2005年8月在我院行OPCAB的病人45例及CCABG的病人35例进行回顾性非随机临床对照,对两组病例在手术时间、输血量及出血量、气管插管及留住ICU时间、术后住院时间、并发症、总住院费用等方面进行对比总结。[结果]两组病人的手术时间有统计学意义(P<0.05),输血量、出血量、留住ICU时间、并发症、总住院费用等OPCAB组均少于CCABG组,但无统计学意义(P>0.05)。在气管插管时间、术后住院时间OPCAB组明显短于CCABG组,有统计学意义(P<0.01)。[结论]OPCAB组比CCABG组术中心脏创伤小,术后心脏功能恢复快,并发症少,并能缩短ICU留住时间和住院时间,减少住院费用,降低医疗成本,病人近期生活质量提高。     

Autonomic nervous functions in fetal type Minamata disease patients: assessment of heart rate variability

In order to assess the cardiovascular autonomic nervous functions in patients with fetal type Minamata disease (FMD), we investigated blood pressure (BP), and conducted time and frequency domain analysis of heart rate variability (HRV). Subjects were 9 patients in Meisuien recognized as FMD, and 13 healthy age matched control subjects. HRV and BP were assessed after subjects rested in a supine position for 10 minutes. Electrocardiographic (ECG) data were collected for 3 minutes during natural breathing. Time domain analysis (the average of R-R intervals [Mean RR], standard deviation of R-R intervals [SD RR], coefficient of variation [CV]), and frequency domain analysis by fast Fourier transformation (FFT) (power of low frequency [LF] and high frequency [HF] component, expressed in normalized units[nu]) were then conducted. In the time domain analysis, the mean RR of the FMD group was significantly lower than that of the control group. Neither SD RR nor CV showed significant differences between the two groups, but both tended to be lower in the FMD group. In the frequency domain analysis, the HF component of the FMD group was significantly lower than that of the control group. Pulse pressure (PP) was significantly lower in the FMD subjects. These findings suggest that parasympathetic nervous dysfunction might exist in FMD patients, who were exposed to high doses of methylmercury (MeHg) during the prenatal period. Decrease of PP might be due to degenerative changes of blood vessels driven by exposure to high doses of MeHg.     

Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: A Systematic Review and Meta-analysis

Purpose

Major postoperative complications translate into increased health care resource utilization, prolonged hospital stays, and increased mortality. We aimed to assess the effects of perioperative dexmedetomidine use on postoperative mortality and the prevalence of major complications after cardiac and noncardiac surgery.

冠心病病人非心脏手术后心肌缺血原因分析

目的 :为探讨冠心病病人术后麻醉苏醒期发生心肌缺血加重的原因及临床表现特点。方法 :对16 3例冠心病病人术后进行持续血压、脉搏血氧饱和度 (SPO2 )、肛温、心电监护、中心静脉压 (CVP)监测 ,观察心电图ST -T变化。结果 :发现术后低温、低氧血症、心动过速、血压异常可引起ST -T改变。结论 :冠心病病人术后出现心肌缺血 ,甚至心肌梗死可无临床症状 ,提示应加强监护 ,及时发现各种危险因素 ,防止心脏严重并发症的发生。     

Assessment of depth of midazolam sedation using objective parameters

Objective To determine the relationship between the clinically evaluated depth of midazolaminduced sedation and the cardiac beat-to-beat variability (RR variability) in ICU patients in the intensive care unit (ICU).Design Prospective study.Setting ICU of a university hospital.Patients 20 consecutive patients studied during weaning from mechanical ventilation and withdrawal of midazolam-induced sedation.Measurements and results After clinical evaluation of depth of sedation according to the Ramsay sedation score, the RR variability over 512 RR intervals and predominant respiratory rate were measured. The power spectrum of RR variability was calculated by a fast Fourier transformation and the resulting total frequency band (0.016–0.35 Hz) was subdivided into a very low, a low, and a high frequency band. Stepwise multiple regression analysis in the first 10 patients (group 1) showed a significant relationship between depth of sedation and measures of RR variability combined with respiratory rate (r ²=0.59;F=12.1;p<0.001). The more effective sedation was, the more depressed were both RR variability and predominant respiratory rate. Mean heart rate, mean respiratory rate, median deviation of RR intervals from the mean, and the ratio between spectral power density in the high and the low frequency bands proved to be the most important predictors of the Ramsay score (±1 level accuracy: 87%,p<0.001). Using this regression equation, the Ramsay score was predicted in the remaining 10 patients (group 2) with a ±1 level of accuracy of 81% (p<0.001).Conclusion In ICU patients, a significant correlation is found between the depth of midazolam-induced sedation as assessed by the Ramsay sedation score and RR variability, with a clinically sufficient prediction accuracy. RR variability can serve as an objective, continuously available, and non-invasive measurement to monitor midazolam-induced sedation in intubated and mechanically ventilated patients.     

Percutaneous dilational tracheostomy or conventional surgical tracheostomy?

OBJECTIVE: Percutaneous dilational tracheostomy (PDT) is increasingly used in intensive care units (ICU), and it has a low incidence of complications. The aim of this study was to compare the costs, complications, and time consumption of PDT with that of conventional surgical tracheostomy (ST) when both procedures were performed in the ICU. DESIGN: The study was a prospective, randomized trial. SETTING: The procedures were performed routinely in the ICU of Satakunta Central Hospital. PATIENTS: During a 23-month period from December 1995 to November 1997, 30 patients underwent PDT and 26 patients had ST. In one patient, PDT was converted to ST. All patients were receiving ventilation in the ICU, and all tracheostomies were performed at the patient's bedside in the ICU. The Portex percutaneous tracheostomy kit was used for all PDTs. RESULTS: The mean time to perform PDT was 11 mins (SD, 6; range, 2-40), and the mean time to perform ST was 14 mins (SD, 6; range, 3-39). In the PDT group, five patients had moderate bleeding during the procedure. In three patients, the bleeding was resolved with compression; in one patient, it was resolved with ligation of the vessel; and in one patient, it was resolved with electrocoagulation. Bleeding did not cause any complications afterward. In the PDT group, one patient had minimal oozing from the wound edge on the first postoperative day and it was resolved spontaneously. In the ST group, there were no intraprocedural complications. One patient had bleeding from the wound on first postoperative day. The sutures were removed, and the bleeding vessel was ligated. The mean cost (in U. S. dollars) of PDT was $161 (SD, 10.4; range, $159-$219), and the mean cost of ST was $357 (SD, $74; range, $239-$599). The cost of PDT was significantly lower than the cost of ST (p < .001). CONCLUSION: We found that PDT is a cost-effective procedure in critically ill ICU patients. Although we performed ST at the bedside in the ICU to avoid the risks associated with moving critically ill patients to the operating room, we found PDT to be a simple and safe procedure.     

Prediction of postoperative cardiac surgical morbidity and organ failure within 4 hours of intensive care unit admission using esophageal Doppler ultrasonography.

OBJECTIVE: To compare esophageal Doppler ultrasonography with standard hemodynamic variables used in postoperative care for the prediction of postoperative complications after cardiac surgery. DESIGN: Prospective, observational pilot study. SETTING: University hospital, multidisciplinary intensive care unit PATIENTS: Postoperative cardiac surgical patients. INTERVENTIONS: Standard postoperative management as guided by routinely measured hemodynamic variables. MEASUREMENTS: An esophageal Doppler ultrasound probe was inserted for measurement of stroke volume (SV), cardiac output (CO), and other flow-related variables. Both these and routine hemodynamic variables (mean arterial pressure, central venous pressure, heart rate, arterial base deficit, urine output, core-toe temperature difference) were recorded at half-hourly intervals for the first 4 postoperative hrs. The incidence of systemic inflammatory response syndrome at 24 hrs, Acute Physiology and Chronic Health Evaluation II, and multiple organ failure scores, postoperative complications, and length of ICU and hospital stays were recorded. MAIN RESULTS: Twenty consecutively admitted patients were studied: eight after emergency bypass grafting and 12 after elective bypass grafts and/or valve replacement. Of the nine patients who developed postoperative complications, two died. At admission, significant differences were seen between patients with a complicated and those with an uncomplicated surgical procedure for SV, heart rate, and standard base excess, but not for cardiac output. By using receiver operator characteristic curves, SV was the best marker for predicting postoperative complications during the initial postoperative period. CONCLUSIONS: A low SV and a high heart rate, both at ICU admission and during the subsequent 4 hrs, were the best prognostic factors for development of complications after cardiac surgery. Cardiac output values were not useful. This pilot study suggests that the minimally invasive technique of esophageal Doppler ultrasonography may be a useful tool to assist early prognostication.     

基于SEER数据库分析老年胃癌患者内镜手术与传统术式的治疗效果及预后

目的基于SEER数据库分析老年胃癌(GC)患者内镜黏膜下剥离术(ESD)与传统术式的治疗效果及预后的影响因素。方法筛选2014年1月-2014年12月SEER数据库登记的ESD或传统术式治疗的老年T1期原发性GC患者,共865例。分析ESD与传统术式的手术效果,并分析预后的影响因素。结果865例患者男女比例为1.00∶0.64,29.02%和49.02%的患者合并营养不良(差)与合并慢性疾病,其中接受ESD和传统术式治疗者分别为406和459例,占46.94%和53.06%,5年总生存率为66.36%。ESD和传统术式治疗的老年患者治愈性切除率、完整性切除率和术后复发率比较,差异均无统计学意义(P>0.05);但与传统术式相比,ESD治疗者手术时间和术后住院时间短(P<0.05)、术中出血量少(P<0.05)、术中输血率低(P<0.05);ESD治疗者术后出血率、切口感染率、肺部感染率及总并发症发生率均明显低于传统术式(P<0.05)。单因素分析显示,性别、年龄、吸烟史、合并慢性疾病、原发病灶部位、肿瘤大小、病理类型及治疗方式,差异均无统计学意义(P>0.05);而营养状态、分化程度、淋巴结转移与否、术中是否输血和术后是否复发比较,差异均有统计学意义(P<0.05);多因素COX回归分析显示,营养差(RR=1.640,95%CI:1.207~2.235)、中低分化(RR=1.510,95%CI:1.113~2.049)、淋巴结转移(RR=1.412,95%CI:1.013~1.927)、术中输血(RR=1.394,95%CI:1.157~1.679)、术后复发(RR=3.529,95%CI:3.003~4.147)均为影响老年T1期原发性GC患者预后的独立危险因素(P<0.05)。结论ESD与传统术式治疗老年GC患者的临床效果相当,但前者具有手术时间短、出血量少、并发症发生率低和术后恢复快的优点,预后的影响因素有营养状态、分化程度、淋巴结转移、术中输血和术后复发。     

无创正压通气治疗创伤性湿肺的临床研究

目的 观察无创正压通气（NIPPV）治疗创伤性湿肺的疗效。方法 选择30例行无创正压通气治疗的创伤性湿肺患者为治疗组，24例未用NIPPV治疗的创伤性湿肺患者为对照组，通过对2组患者进行心电监测、血氧饱和度、呼吸频率、血气分析等指标的监测，比较2组患者呼吸频率和动脉血气参数、肺部病变吸收时间、气管插管率、ICU住院时间及预后。结果 30例创伤性湿肺患者经NIPPV治疗后动脉血气指标与临床表现明显改善（P〈0．01）；与对照组相比，NIPPV治疗组患者临床症状改善时间、肺部病变吸收时间、ICU住院时间明显缩短（P〈0．01），肺实变率显著减低（P〈0．05），但2组患者气管插管率和病死率差异却无显著性。结论 NIPPV通过调节压力支持与呼吸末正压水平，早期应用可明显改善创伤性湿肺患者病情及缩短病程，但并不能改善其预后。     

重症医学科重度子痫前期产妇围手术期临床路径的应用

目的 评价综合重症医学科(ICU)开展重度子痫前期产妇围手术期临床路径(CP)的效果,并分析其变异情况以促进质量改进.方法 比较福建医科大学附属第二医院ICU内实行CP前1年(2009年1月至12月,14例)和实施CP后1年(2010年1月至12月,22例)收治的重度子痫前期产妇ICU停留时间、住院费用、并发症发生率、病死率以及术后前3 d血压控制的总有效率.结果 与实施CP前1年组比较,实施CP后1年组ICU停留时间(h)明显缩短(65.5±24.9比86.3±28.2,t=2.321,P＜0.05),ICU住院费用(元)明显减少(6 463.6±1 838.2比8 136.5±2 142.8,t=2.496,P＜0.05),并发症发生率有所下降(36.4%比42.8%,x2=0.100,P＞0.05);血压控制的总有效率术后1 d、2 d明显提高(1 d:59.1%比14.3%,2 d:86.4%比50.0%,均P＜0.05),而术后3 d则无明显差异(95.4%比85.7%,P＞0.05).实施CP前1年组死亡1例,实施CP后1年组无死亡.结论 通过对重度子痫前期产妇围手术期实施CP管理,降低了患者的医疗负担,促进了医疗质量持续改进.

Abstract：

Objective To evaluate the effect of implementation of perioperative clinical pathway (CP)for severe preeclampsia patients in intensive care unit (ICU), and to discuss variation factors in order to improve clinical quality. Methods Thirty-six patients treated in ICU in the Second Clinical Hospital of Fujian Medical University were divided into two groups according to time of 1 year before implementation of CP (from January to December in 2009, n = 14) and 1 year after implementation of CP (from January to December in 2010, n = 22). The length of stay in ICU, cost of hospitalization, occurrence of major complications and mortality, as well as the total effective rate of control of blood pressure in the first 3 days after operation were compared. Results Compared with the group of patients of 1 year before implementation of CP, in the group of patients of 1 year after implementation of CP, the length of stay in ICU (hours) was significantly shorter (65. 5 ±24. 9 vs. 86. 3 ±28. 2, t = Z. 321, P＜0. 05), the cost of hospitalization (yuan) was significantly lower (6 463. 6±1 838.2 vs. 8 136. 5±2 142.8, r = 2. 496, P＜ 0. 05), the occurrence rate of major complications was lower (36. 4% vs. 42. 8%, x2 = 0. 100, P＞0. 05), the total effective control rate of blood pressure was significant improved on the 1st and the 2nd postoperative day (1 day: 59. 1 % vs. 14. 3%, 2 days: 86. 4% vs. 50. 0%, both P＜0. 05), but there was no significant change on the 3rd postoperative day (95. 4% vs. 85. 7%, P＞0. 05). One patient died before the application of CP,and none after its application. Conclusion These results suggested that it was beneficial to implement the program in preeclampsia patients to improve medical quality.     

重症监护病房髋部骨折患者术后谵妄的回顾性分析

目的探讨重症监护病房（ICU）髋部骨折术后谵妄的发生率及相关危险因素。方法选择髋部骨折手术后转人ICU的67例,采用ICU意识紊乱评估方法进行监测,针对骨折前痴呆史、合并血管危险因素、贫血、低蛋白血症、脱水、电解质紊乱、低氧血症等7项谵妄的危险因素进行分析。结果本组19例（28．4％）术后6d内发生谵妄,单因素分析有统计学意义的变量为既往痴呆病史（OR=3．16,95％CI1．24～8．15）、术后脱水（OR=3．64,95％CI 1．02～7．44）、合并三个及以上的血管危险因素（OR=3．76,95％CI1．38～10．53）;多因素回归分析有统计学意义的相关因素为既往痴呆病史（RR=3．06,P=0．014）、合并三个及以上的血管危险因素（RR=3．74,P=0．021）。结论ICU髋部骨折术后谵妄发生率较高,骨折前痴呆病史、合并三个及以上的血管危险因素、低体重指数是术后发生谵妄的高危因素。     

加强监护室内有创序贯无创机械通气的临床撤机方法研究

目的：探讨无创压力支持通气在加强监护室（ICU）内的辅助撤机作用。方法：以2008年11月-2011年3月入住ICU接受气管插管机械通气的32例患者为研究对象,通气模式以同步间歇指令通气（SIMV）和压力支持通气（PSV）为基础,必要时联合呼气末正压（PEEP）;根据患者的血气分析值,合理调整吸入氧浓度分数（FiO2）、呼吸频率（RR）、吸气相压力（IPAP）、呼气相压力（EPAP）值,比较有创通气与无创通气状态下RR、心率（HR）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、pH、动脉血氧饱和度（SaO2）值。结果：有创通气与无创通气各项监测指标均无明显变化（P〉0．05）,经无创通气过渡数日后均可离开ICU。结论：无创正压机械通气作为一种有效的撤机治疗方法,建议临床推广应用。