Objective:To explore the effect and the nursing methods of NIPPV(noninvasive positive pressure ventilation) therapy in severe acute pancreatitis complicated with ALI(acute lung injury)/ARDS (acute respiratory distress syndrome).Methods:52 patients with acute critical pancreatitis in our centual ICU from (January,2000 to June,2004)were analyzed.Among them,32 patients with ALI/ARDS,in which 29 patierts were treated by NIPPV and 3 patients were treated by IPPV.Results:Among 29 patients treated with NIPPV,25 patients were cured and 4 patients were further treated with IPPV,among them 3 patients died.Conclusion:There are following advantages for SAP patients complicating with ALI/ARDS treated by NIPPV:less suffering,maintenance of normal function of upper respiratory tract and reduction in the rate of lung infection.Furthermore it also shortens the time of hospitalization and saves money for patients,while increased cure rate combined with comprehensive therapy.

Objective To observe the effects of bundles intervention in intrahospital transport of critically ill patients.Methods The grouping was performed with the intrahospital transport time periods,the intrahospital transport cases from January to March 2015 were set as the control group and adopted the conventional method;those from April toJune 2015 were set as the observation group and adopted the bundles intrahospital transport strategy.The random sampling was conducted by using the proportion of 5％.The sampling results were 110 cases in the control group and 116cases in the observation group.The occurrence situation of adverse events were observed and compared between the two groups.Results No significant differences were found in the status before intrahospital transport between the two groups(P＞0.05).The incidence rate and grade of adverse events during intrahospital transport process in the observation group were lower than those in the cantrel group with statistical difference between the two groups(P＜0.05);in the analysis of the adverse events causes,the factors such as staff,equipments,disease condition and flow process had statistical difference between the two groups (P＜0.05).Conclusion The bundles intervention can reduce the adverse event occurrence of intrahospital transport of critically ill patients and increases the transport security.

Objective:Comparison of oxygen therapy effect between three different enteral nutrition solutions was carried out on AECOPD patients with non-invasive ventilation.Methods:A total of 96 patients with acute exacerbation of COPD were divided into three groups of 32 respectively according to the admission order in this prospective study:a continuous feeding group,an intermittent feeding group,and a regular bolus feeding group.Arterial blood gas parameters including PH,PaO2,PaCO2,PaO2/FiO2 of three groups on third day,fifth day,seventh day were recorded and compared to evaluate the enteral nutrition effect,and meanwhile nutritional support costs,duration of mechanical ventilation,and length of ICU stay between groups were also studied.Results:PH Values of continuous feeding group and intermittent feeding group on 7th day are7.38 ± 0.04、7.39 ± 0.01 respectively,better than that of regular bolus feeding group (P＜ 0.05).ICU stay period and duration of mechanical ventilation for continuous feeding group are 12.83 ± 3.00 days and 9.50 ± 1.45 respectively,for the intermittent feeding group are 11.90 ± 2.35 and 9.59 ± 1.50 respectively,the two groups gain significant cost-effective advantages compared to the regular bolus feeding group.(P ＜ 0.05),for nutrition support costs,continuous feeding is less than the intermittent feeding.(.P ＜ 0.05).Conclusion:Continuous feeding and intermittent feeding could significantly improve hypoxia symptom and reduce the length of ICU stay and shorten duration of mechanical ventilation in COPD patients compared with regular bolus feeding group.

Objective To discuss the clinical application of percutaneous transhepatic cholangiopancreatic drainage (PTCD) combined with CT-guided microwave ablation in treating hepatic hilar cholangiocarcinoma. Methods The clinical data of 29 patients with inoperable Ⅲ and Ⅳ type hilar cholangiocarcinoma complicated by obstructive jaundice, who were admitted to authors’ hospital during the period from December 2012 to August 2014, were retrospectively analyzed. The diagnosis of bile duct adenocarcinoma was confirmed by pathology in all patients. Of the 29 patients, both internal and external biliary tract drainage was employed in 19, external biliary tract drainage in 4, and bilateral (both left and right side) bile duct drainage in 6. CT-guided microwave ablation was carried out when the liver function became improved. A total of 46 procedures of microwave ablation were completed in the 29 patients with a mean of 1.5 times per patient. Hepatic function tests, enhanced CT or MR scan were performed 4-8 weeks after treatment. According to mRECIST criteria the therapeutic results were evaluated; the serum bilirubin levels were recorded; the disease progress and the patient’s survival time were followed up. Results One month after the treatment, complete response (CR) was obtained in 15 patients (15/29, 51.7%), and partial remission (PR) in 17 patients (17/29, 58.6%), with the overall efficacy (CR﹢PR) being 82%. After the treatment, one patient developed hepatic metastasis and another one had pulmonary metastasis. Postoperative serum bilirubin levels showed an obvious decrease in all 29 patients. The 6-month, one-year and two-year survival rates were 68.9% (20/29), 31.0% (9/29) and 6.8% (2/29) respectively; the median survival time was 8.9 months and the overall survival time was 11.7 months. Conclusion For the treatment of hepatic hilar cholangiocarcinoma, PTCD combined with CT-guided microwave ablation is minimally invasive, clinically safe and effective.

Objective To discuss the clinical application of preoperative tumor-feeding artery emboli -zation in treating hypervascular giant meningiomas.Methods A total of 71 patients with giant meningioma (maximum diameter ＞5 cm),who were admitted to authors' hospital during the period from April 2013 to August 2014,were selected for this study.Preoperative MRI demonstrated that the lesions showed obvious enhancement with rich blood supply.The patients were divided into the study group (using preoperative embolization,n =38) and the control group (not using preoperative embolization,n =33).Based on preoperative DSA findings,the lesions were classified into type Ⅰ and type Ⅱ.Tumor-feeding artery embolization with PAV particles (200-300 μm) was employed in the patients of the study group,while only cerebral angiography was adopted in the patients of the control group.The amount of intraoperative blood loss,tumor resection time and embolization complications in both groups were recorded.Postoperative MRI scan was performed to observe the degree of tumor resection.Results The amount of intraoperative blood loss and the tumor resection time in the study group were (562±178) ml and (5.45±2.13) h respectively,which in the control group were (833±234) ml and (7.23±2.45) h respectively;the differences between the two groups were statistically significant (both P＜0.05).The tumor resection degree of Simpson classification Ⅲ and ＜ Ⅲ was obtained in 27 patients of the study group (27/38,71.0％) and in 19 patients of the control group (19/33,57.6％),the difference between the two groups was statistically significant (P＜0.05).After embolization,cerebral edema became aggravated in 7 patients,ischemic necrosis of the scalp was observed in 2 patients,and one patient developed epileptic seizure during the operation.After symptomatic treatment,all the above complications were relieved.Conclusion For the treatment of hypervascular giant meningiomas,preoperative tumor-feeding artery embolization can strikingly reduce the amount of intraoperative blood loss,shorten the operation time,and improve the tumor resection degree,therefore,this therapy is worthy of clinical promotion and application.

Objective Investigate the current situation of emergency nurses' perception of hospital safety climate in tertiary hospitals. MethodsA total of 866 emergency nurses from 114 hospitals in 29 provinces,municipalities and autonomous re.gions were randomly selected,and the self-designed general information questionnaire and Chinese version of the hospital safety climate scale were used to investigate. ResultsThe overall hospital safety climatel was(3.97+0.61). Univariate analysis of variance showed that there were statistically significant differences in the hospital safe.ty climate of emergency nurses with educational background and employment form (P<0.05). ConclusionThe e-mergency nurses have a better sense of the overall hospital safety climate,but the obstruction of' the safety work and the cleanliness and neatness of the. working: environment need to be improved. Therefore,il is suggested Lhal the construction of hospital safety climate should be further strengthened in the rational allocation of human re-sources and emergency working environment.

ObjectiveTo study the advanced training status for emergency department nurses in Chongqing,and to improve the training program.MethodsThe basic and professional information of 208 emergency department nurses who obtained advanced training for emergency nursing in the previous 5 years was analyzed and the self-designed Satisfaction Survey on Teaching and Self-evaluation on Training Outcome were applied to learn about the feedback of trainees.ResultsThe average age of trainees was ( 29.24 ± 5.44 ),among whom 65.86％ with junior college education experience,49.51％ with 2-5 years of working experience,50.48％ at primary professional rank,61.53％ from second level hospitals.Their average score ( 77.91 ± 7.69 ),and teaching satisfaction score was ( 87.01 ± 7.63 ).The survey indicated that self-evaluation on training outcome was significant to enhance emergency nursing knowledge and skills,while weak to improve research and managing capability.ConclusionNurses attending advanced training for emergency nursing are characterized with short working time,low professional ranks,jagged education experiences and various levels of hospital. It is suggested to adopt leveled training in accordance with education experience and working hospital of trainees,and to strengthen nursing research and team managing competencies.

Background and purpose:Since the number and tumor size of localized liver metastases can be controlled, local minimally invasive treatment can improve the survival of patients. Hence, microwave ablation has become an important treatment method for liver metastases. This study was to investigate the value of percutaneous microwave ablation in the treatment of tumor metastases. Methods: From Sep. 2011 to Oct. 2014, 26 advanced nasopharyngeal carcinoma patients with post-chemotherapy consolidation, liver metastases were collected. All the patients with the number of tumor lesions less than 3, diameter less than 5 cm, no other distant metastases was excluded. The ultrasound-guided percutaneous microwave ablation was used for 26 patients. Finally, 43 ablations were completed followed by liver function test, enhanced CT and MRI diagnosis 1 month later. mRECIST criteria was used to evaluate the effcacy of cancer treatment. Progression-free survival (PFS) and overall survival (OS) were calculated. Results:Twenty-six cases of a total of 53 lesions, including complete ablation (CA) 20 patients (20/26, 77.0%), partial ablation (PA) 3 patients (3/26,11.5%). The overall effciency was 88.5%(CA+PA) with no serious complications. 6 months, 1-, 2-year survival rates of 26 patients were 96.1%, 65.3%and 23.0%. PFS was 11.4 months. The median survival time (MST) was 11.9 months, while OS was 23.7 months. Conclusion:Percutaneous microwave ablation for limited liver metastases of nasopharyngeal carcinoma is a minimally invasive, safe and effective treatment method.

Objective:To construct a reasonable and efficient clinical nursing pathway for elderly patients with acute chest pain in the emergency department, and to provide a standardized and rapid treatment process for such patients.Methods:Through literature review and theoretical analysis, the basic framework of clinical nursing pathway was preliminarily drawn up. Twenty one clinical medical and nursing experts from all over the country were selected to conduct two rounds of expert consultation with Delphi method, and the clinical nursing path was finally determined.Results:The recovery rates of the two rounds of questionnaires were 100.00% and 95.24%, and the rates of submission expert suggestions were 61.90% and 45.00%, the authority coefficients of experts were 0.85 and 0.88, and the coordination coefficients were 0.23 and 0.30. Finally, the clinical nursing pathway was constructed after two rounds of consultation.Conclusion:The positive coefficient and authority coefficient of the two rounds of experts were both high, and the variable coefficient and coordination coefficient were in line with the statistical requirements, so the clinical nursing path of the elderly patients with acute chest pain had high scientificity and reliability.

Objective:To analyze and compare the demographic and clinical characteristics of patients with different types of hyperglycemic crisis, so as to provide clinical basis for the prevention and treatment of hyperglycemic crisis.Methods:The data of patients with hyperglycemic crisis in six First-level general hospitals in Chongqing from Jan. 2015 to Dec. 2020 were retrospectively collected and divided into diabetic ketoacidosis (DKA) , hyperglycemic hyperosmolar state (HHS) and diabetic ketoacidosis with hyperglycemic hyperosmotic state (DKA-HHS) . The demographic and clinical characteristics of each group were analyzed by descriptive method.Results:A total of 1668 patients were collected, among whom1388 were DKA, 113 were HHS and 167 were DKA-HHS. The proportion of T2DM in DKA was 90.1%, the proportion of urban residents’ medical insurance, farmers and retirees was higher in the three groups, and the incidence of hyperglycemic crisis in patients above 60 years old was the highest in all age groups. The incidence of DKA and HHS changed little during the six years, but increased significantly in the DKA-HHS group. Shock, disturbance of consciousness, hospitalization expenses and mortality in the DKA-HHS group were higher than those in the other two groups.Conclusions:There are differences in demographic and clinical characteristics among different types of hyperglycemic crisis. Clinically, more attention should be paid to patients above 60 years old and patients with hyperglycemic crisis such as DKA-HHS. Health education and guidance for diabetic patients in high-risk groups should be strengthened in order to reduce the occurrence of diabetic hyperglycemic crisis.