Objective To investigate the clinical efficacy of levosimendan injection in the treatment of patients with acute decompensated heart failure.Methods70 patients with acute decompensated heart failure patients were selected from January 2016 to January 2017 in huzhou first people's hospital.35 cases of patients in control group were treated with levosimendan injection, and the other 35 cases of patients in experimental group was treated with dobutamine.BNP, 24 hourly urine volume, LVEF and SV were detected and the systemic clinical conditions were assessed both before and after the treatment.ResultsAfter treatment, all indexes of two groups were better than before(P<0.05).The extent of improvement of systemic symptoms and relevant indicators such as BNP, 24 hourly urine, LVEF and SV in experimental group was larger than that in control group (P<0.05).Adverse reaction rate of experimental group was 16.7%, and adverse reaction rate of control group was 43.8%, the differences were statistically significant (P<0.05).ConclusionLevosimendan injection can relieve symptoms of patients with acute decompensated heart failure,and it has less adverse reactions.

Objective:To correlate diaphragmatic ultrasound parameters and pulmonary function in patients with chronic obstructive pulmonary disease (COPD) and its clinical value in the diagnosis of COPD.Methods:Eighty patients with COPD who received treatment in The First People's Hospital of Huzhou from January 2019 to June 2020 and 80 healthy subjects who concurrently received health examination were included in this study. Pulmonary function index, diaphragmatic ultrasonic parameters and activity endurance index were compared between COPD group and healthy control group. Diaphragmatic ultrasound parameters in COPD patients were correlated with pulmonary function index and activity endurance index.Results:The forced expiratory volume in 1 second/forced vital capacity (FEV 1/FVC) ratio in the COPD group was significantly lower than that in the healthy control group [(56.27 ± 8.98)% vs. (87.42 ± 6.29)%, t = 14.583, P < 0.05]. The residual volume/total lung capacity (RV/TLC) ratio in the COPD group was significantly higher than that in the healthy control group [(54.81 ± 6.95) % vs. (27.59 ± 3.92) %, t = 17.904, P < 0.05]. The walking distance in 6-minute walking test (6MWT) in the COPD group was significantly shorter than that in the healthy control group [(502.36 ± 82.41) m vs. (824.59 ± 63.37) m, t = 11.726, P < 0.05]. The diaphragm mobility using quite breathing (DM QB), the diaphragm mobility using deep breathing (DM DB), and diaphragmatic thickening fractions (TF) in the COPD group were (1.71 ± 0.45) mm, (4.03 ± 0.81) m and (117.56 ± 24.83) %, respectively, which were significantly lower than those in the healthy control groups [(2.24 ± 0.30) mm, (5.36 ± 0.62 ) mm, (159.60 ± 22.35)%, t = 4.736-7.592, all P < 0.05]. DM QB, DM DB and TF in patients with COPD were positively correlated with FEV 1/FVC and 6MWT distance ( r = 0.705-0.819, all P < 0.05), but they were negatively correlated with residual volume/total lung capacity (RV/TLC) ratio ( r = -0.774 to -0.847, all P < 0.05). Conclusions:DM QB, DM DB and TF decrease in COPD patients, and their values are correlated with pulmonary function and activity tolerance index. Ultrasound examination of diaphragmatic morphological change is of certain clinical value for the diagnosis and evaluation of COPD.

A new cool-tip radiofrequency (RF) ablation therapeutic instrument based on impedance control algorithm is introduced in this paper. The equipment is composed of hardware system and software system. The RF power output and real time data acquisition are completed by the hardware system, while the software is used mainly to finish the control of the ablation range, the core of which is impedance control algorithm, and it also used to complete the display of the real time data in the course of the experiment. The impedance algorithm has solved the problem of impedance increased rapidly during the RF ablation, which has also expanded the scope of ablation. The pig liver experiments showed that the impedance control algorithm had strong adaptability. It also obtained a result of ablation range up to 3.5-4.5 cm single needle. It has the high clinical practical value of one-time inactivation of 3-5 cm tumor.
Algorithms ; Animals ; Catheter Ablation ; Electric Impedance ; Humans ; Liver ; Needles ; Software ; Swine

Objective To assess the application effect of the catheter management software on the management of Indwelling urinary catheter in the Emergency intensive care unit (EICU). Methods A prospective control study of targeted surveillance of catheter-associated urinary tract infection was conducted from January 2014 to December 2015 in EICU. The patients were divided into two groups. The patients in control group (131 patients) were treated from January 1, 2014 to December 31, 2014 and received routine catheter management, and the patients in test group (135 patients) were treated from January 1, 2015 to December 31, 2015, and received catheter management by software. The catheter management software was developed and applied, and the process specification which collaborated with the software was established. The quality of the catheter management including the omission rate of the catheter management, the rate of urinary catheter-associated urinary tract infections (CAUTI) and the rate of catheter used etc were evaluated after the software's application. Results Through software applications, the omission rate of the catheter management, the omission rate of urine drainage bag replacementand the omission rate of urinary catheter replacement in test group were significantly lower than those in control group:0 vs. 36.64%(48/131), 0 vs. 15.27%(20/131) and 0 vs. 9.92%(13/131), P<0.01 or<0.05. The performance rate of catheter daily management in test group was significantly higher than that in control group: 99.26%(134/135) vs. 64.12%(84/131), P<0.01. The rate of CAUTI in test group was significantly lower than that in control group: 1.90‰ vs. 9.16‰, χ2=4.843, P=0.028. The rate of catheter used in test group was significantly lower than that in control group: 60.74%(82/135) vs. 73.28%(96/131), P<0.01. Conclusions The development and the establishment of the management software can improve the rate of implement, and declinethe rate of CAUTI.

Objective To study the effect of early entreat nutrition (EN) standardized treatment on optimization of blood glucose control and prognosis in acute respiratory distress syndrome (ARDS) patients with mechanical ventilation (MV). Methods Forty-two patients with MV of ARDS admitted to Huzhou First Municipal People's Hospital from April 2015 to March 2017 were enrolled. April 1st, 2016 was taken as the time node, the patients treated from April 1st, 2015 to March 31st, 2016 were assigned in the control group (n = 20), while the patients treated from April 1st, 2016 to March 31st, 2017 were included in the experimental group (n = 22). The patients in experimental group were given conventional treatment, in 24-48 hours after admission gastrointestinal decompression was stopped and early EN was begun through a nasointestinal tube; the patients in control group received conventional treatment and routine EN (given 48 hours after admission). The differences in nutritional support indexes, the blood glucose variability indexes and the prognostic related indicators were compared between the two groups. Results Compared with the control group, the initiation time for EN tolerance, first defecation time, time of reaching target feeding amount were significantly earlier in the early EN standardized treatment process management [time of initial EN tolerance (hours): 106.82±42.84 vs. 157.29±56.76, first defecation time (hours): 71.29±23.43 vs. 104.69±26.94, time of reaching target feeding amount (days): 6.24±1.25 vs. 9.86±2.36], the proportions of EN/EN+parenteral nutrition (PN) and the nasointestinal tube feeding reaching the standard on 7 days in experimental group were significantly increased [the proportion of EN/EN+PN:98.69% vs. 78.69%, the nasointestinal tube feeding reaching standard: 68.18% (15/22) vs. 45.00% (9/20)], average level of blood glucose (GLUave), maximum value of blood glucose (GLUmax), standard deviation of blood glucose (GLUsd), coefficient of variation of blood glucose (GLUcv), hyperglycemia incidence, incidence of multiple organ dysfunction syndrome (MODS), 28-day mortality were significantly decreased [GLUave (mmol/L): 9.4±2.6 vs. 11.5±3.9, GLUmax (mmol/L): 14.19±2.36 vs. 16.26±4.89, GLUsd (mmol/L): 4.86±1.27 vs. 6.87±2.46, GLUcv: (49.86±6.32)% vs. (59.95±5.81)%, hyperglycemia incidence: 59.09% (13/22) vs. 80.00% (16/20), incidence of MODS: 59.09% (13/22) vs. 80.00% (16/20), 28-day mortality: 36.36% (8/22) vs. 45.00% (9/20)], minimum value of blood glucose (GLUmin) was significantly increased (mmol/L: 5.86±2.32 vs. 4.18±1.86), invasive MV time was significantly shorted (hours:156.82±26.84 vs. 169.93±32.34) with statistically significant differences (all P < 0.05). Early EN could also improve the patient's pulmonary oxygenation function. Since 9 days of disease course, the oxygenation index (PaO2/FiO2) in the experimental group was significantly higher than that of the control group [mmHg (1 mmHg = 0.133 kPa): 256.97±18.63 vs. 239.82±21.72, P = 0.068], but there was no significant difference in the length of ICU stay (days: 13.9±3.6 vs. 14.8±3.4, P > 0.05). Conclusion The early EN standardized treatment process management can improve the nutritional status, decrease blood sugar fluctuations, and further benefit the improvement of the prognosis of ARDS patients with MV.

Objective To assess the application effect of reminder software for the management of indwelling catheter in catheter associated with urinary tract infection in emergency intensive care unit (EICU). Methods We conducted a comparative study among patients with catheter-associated urinary tract infection from January 2014 to December 2015 in emergency intensive care unit (EICU). By applying with reminder software, we assessed the omission rate of indwelling urethral catheterization management, the incidence rate of catheter associated urinary tract infection (CAUTI), the utilization rate of urinary tract intubation and the average time of indwelling urethral catheterization.Results By the application of reminder software, the omission rate of indwelling urethral catheterization management was decreased. The incidence rate of CAUTI declined from 9.16‰ to 1.90‰ (x2=4.843,P<0.05),while the utilization rate of urinary tract intubation declined from 73.60% to 60.67% (P<0.01), and the average time of catheterization also shortened from (10.21±2.28) days to (8.20±1.67) days (t=2.47,P<0.05).Conclusions Reminder software applied in the control of indwelling catheter related infections has achieved good effectiveness and it can be used widely in clinical work.

Objective? To compare the effects of constant pressure urination and timed urination during indwelling catheterization in elderly patients with coma in the emergency intensive care unit (EICU). Methods? Totally 100 elderly patients with coma admitted in EICU, the First Affiliated Hospital of Huzhou University from January 2015 to June 2017 were selected by convenient sampling. The 49 patients admitted from January 2015 to March 2016 were included into the control group, while the 51 patients admitted between April 2016 and June 2017 were included into the treatment group. Patients in the control group were allowed urination every 3-4 hours, while patients in the treatment group were monitored for continuous bladder pressure using a

Objective:To analyze the factors related to the duration of chest compression pause time during the manual-mechanical conversion process in cardiopulmonary resuscitation (CRP).Methods:A retrospective study was devised in a cohort comprising patients with out-of-hospital cardiac arrest, who were assigned to receive mechanical CRP in the Department of Emergency of Huzhou First People's Hospital from January 2019 to December 2020. Patient’s general characteristics, CRP data and data on CRP-free intervals were collected multiple linear regression to analyze associations with the duration of chest compression pause time during the manual-mechanical conversion process in CRP. At the same time, the effect of CPR treatment qualification of nurses on CPR compression quality was evaluated.Results:The study selected 32 eligible patients. Patient's height, actual body weight, and body mass index showed a positive liner correlation with the duration of chest compression pause time ( r=0.61, 0.92, 0.49; P<0.01). Multiple stepwise regression analysis showed that actual body weight was an independent risk factor for prolonged duration of chest compression pause time ( P<0.01). Moreover, responsible nurses with advanced cardiac life support (ACLS) certification had significantly higher compression scores than those without ACLS certification (χ 2=0.002, P<0.01). Conclusions:The actual body weight of patients and the ACLS qualification of nurses on duty have a certain relationship with the duration of chest compression pause time during the manual-mechanical conversion process in CRP, which is worthy of further research.

Continuous chest compressions during the transportation of patients with cardiac arrest have always been a difficult part in the field of pre-hospital emergency cardiopulmonary resuscitation (CPR). How to ensure continuous high-quality chest compressions is an important part of the patient's entire rescue process. At present, mechanical compression devices are commonly used to provide continuous high-quality chest compressions during the transportation. However, the installation process of the mechanical compression device involves posture changes of the patient, the placement of the device base, etc., and it is very likely to affect the continuous high-quality CPR treatment in the pre-hospital emergency process with limited human resources. Therefore, the First Affiliated Hospital of Huzhou University and Huzhou University jointly designed a rescue stretcher dedicated for CPR mechanical compression device, and has obtained the national utility model patent (ZL 2019 2 1005444.9). The main design feature of this stretcher is that the base of the compression device is combined with the stretcher, which eliminates the installation and fixation process of the base during the installation of the mechanical compression device, shortens the installation time. It has certain clinical applications value.

Objective: To investigate the modification of the classic techniques of total auricle reconstruction with skin expansion, and its clinical application. Methods: We performed three-dimensional measurement of the normal auricle and the expanded flap on 150 microtia patients. According to the data, we carried out total auricle reconstruction using extended postauricle expanded flap techniques for 82 patients of the group. Firstly, a 50 ml kidney-shaped expander was inserted subcutaneously in the mastoid region. Approximately 65 ml saline was injected in about 30 days, and expansion was kept without injection for another 30 days. In the second stage, we removed the expander and dissected the scalp 4-5 cm around the expanded skin, to make a composite flap consisted of expanded skin and extend scalp. Then we used the flap to encapsulate the three-dimensional rib cartilage framework to accomplish total auricle reconstruction. Results: The blood supply and venous drainage of the flap was good. No obvious postoperative flap swelling was observed. Only 2 cases of helix skin necrosis happened in 48 hours after operation. Small area of skin defect was treated by debridement and suture, while larger area of skin defect was repaired with postauricular fascia flap and free skin graft. Postoperative follow-up period was 4-15 months, about 6.7 months in average. Bilateral ear size and position were similar with clear structures and shapes. Helix seemed more slim, auriculocephalic sulcus was obvious, auriculocephalic angle was similar to the other side. There was no color abberration between the front and back side of reconstructed ear. Scars of retroauricular hairline incision and costal cartilage harvesting incision were not obvious. Conclusions The novel surgical techniques is reasonable and simple without fascia flap or skin graft, which is worthy of application by more plastic surgeons.