Objective To explore the clinical effect and influence of hemocoagulase on bleeding control and coagulation function in neu -rosurgery .Methods A total of 300 patients with surgical treatment in our hospital from June 2013 to June 2014 were randomly divided into control group (n=150) and observation group (n=150).The patients in control group were treated with physiological saline 10 mL topical spraying,while the patients in observation group were treated with physiological saline 10 mL plus hemocoagulase 4U topical spraying.The clinical effect and coagulation index were compared between the two groups .Results The bleeding volume of the observation group was sig-nificantly lower than that of the control group (P<0.01).No significant difference was found in the coagulation index of the two groups (P>0.05).Conclusion Hemocoagulase treatment during the operation can reduce the volume of bleeding and transfusion of blood ,and do not affect the coagulation function in the patients .

0.05) except BSR ( P

Objective To probe the effect of perioperative therapeutic regime on breast reconstruction after surgery in breast cancer patients.Methods We retrospectively reviewed the clinical data of 145 consecutive breast cancer patients with 162 reconstructions.Results 127 of 145 patients got an excellent or good appearance (87.6％),and 42 cases had complications occurring in 162 operations (25.9％).After a median follow-up of 38.4 months,recurrences were found in 9 patients,3 cases died,and the disease free survival rate was 93.1％.Multivariate analysis showed that radiation therapy,without nipple-sparing and one-stage prosthesis implant were independent risk factors for negative postoperative aesthetic outcome;Delayed reconstruction and implant reconstruction were found to be protective factors for the postoperative complications.Conclusions Although the survival rate appears to be scarcely affected,different treatment modalities in reconstruction strategy bring different clinical results and outcomes.The perioperative decision-making of reconstruction strategy should be based on oncological safety,postoperative complications,aesthetic outcomes and subsequent therapies.

ObjectiveTo explore the clinical role of island flap nourished by sural nerve nutrition blood vessel for repairing of the deep burn wounds of the lower extremities.MethodsIsland flap nourished by sural nerve nutrition blood vessel were performed to repair the deep burn wounds of the lower extremities below the knee in 22 cases,aged 10 ～58 years old,average aged 34 years old,including flame burns in 6 cases,electrical burns in 10 cases,chemical burns in 4 cases,scalding hot water in 2 cases.All were deep skin damage,The island flaps,including anterograde and retrograde flaps,was from 5cm ×4cm to 13cm × 10cm in size,The defect at the donor site was sutured primarily or repaired by a skin graft.ResultsAll the flaps survived well,18 patients were follow-up postoperatively for 4 ～24 months.The color,texture,shape of the flaps were satisfactory,but the sensory recovery was unsatisfactory.ConclusionSural neurovascular flap had a constant anatomy and reliable blood supply without the sacrificeof the major blood vessels.The procedure was simple and easy,and an effective method of repairing the skin and soft tissue defects below the knee.

Objective To investigate risky factors,and predictability of portal vein thrombsis in patients with portal hypertension caused by hepatic cirrhosis after spleenectomy and portaazygous devascularization. Methods Between Jan 2004 to Nov 2009,clinical data of 27 patients suffering from postoperative PVT were compared with 37 patients admitted during the same period without postoperative PVT. Results There were 4 factors proved to be risk factors for PVT.Perioperative peripheral platelet count (postoperative to preoperative) 、D-dimer、the whole blood viscosity and the blood flow of portal vein postoperatively.The right predictive rate of PVT was 87.3%. Conclusion The risk factors of PVT are the ratio of platelets、D-dimer、the whole blood viscosity and the blood flow of portal vein postoperatively.By this method it is probable that postoperative PVT is predictable.

Objective To investigate the current situation of nursing research based on Omaha system in China. Methods All the nursing research based on Omaha System were retrieved and collected by using China National Knowledge Infrastructure, Wanfang database and VIP database, NoteExpress software for the management of documents was used. Based on the classification of nursing research literature, a content analysis of system analysis model analyzed the documents had been retrieved. Results Sixty-four pieces of literature were included, and thirteen categories system were formed. The transverse reliability coefficient of all kinds of system were 0.940-1.000, the longitudinal reliability coefficient were 0.658-1.000. Conclusions The study of nursing research based on Omaha system in China is booming, which is also facing challenges, and has a broad space for exploration.

All of the thrombolytic agents currently approved for use in humans are plasminogen activators, the application of which is limited by bleeding complications at vascular injury sites and plasminogen content in the thrombus. Plasmin is rapidly neutral-ized in the circulation by α2-antiplasmin and tolerated without bleeding. With the application of catheter-based delivery, the unique bio-chemical properties of plasmin make it a safe and effective direct fibrinolytics. Plasmin derivatives, including miniplasmin,Δ-plasmin and microplsmin, display more thrombolysis efficacy and better hemostatic safety in preclinical study and clinical trials. This review sum-marizes the current information on plasmin and its derivatives, including the advances on biochemical properties, preclinical and clinical trials.

Objective To evaluate the influence of different positive end-expiratory pressure (PEEP) on prognosis in infants with septic shock and acute respiratory distress syndrome(ARDS).Methods Sixty infants who were diagnosed with septic shock and ARDS in PICU of Guangxi Maternity and Child Health Hospital were enrolled,which were randomly divided into low PEEP(3 cmH2O,1 cmH2O =0.098 kPa) group,medium PEEP (6 cmH2 O) group and high PEEP (9 cmH2O) group,with 20 cases in each group.All patients received pressure control ventilation mode and small tidal volume (6 ～ 8 ml/kg) strategy,meanwhile implemented liquid recovery according to the septic shock guidelines (2009)enacted by the American Association of Pediatric Advanced Life Support (PALS).The changes of O1,Cdyn and CI before and 6 h,24 h and 48 h after the experiment were monitored,fluid intake/output of all infants were counted.The lengths of mechanical ventilation,hospital stays in PICU and 28-day mortality were compared.Results 6 h,24 h and 48 h after mechanical ventilation,the changes of OI,Cdyn in medium PEEP group and high PEEP group were better than those of low PEEP group respectively (P ＜ 0.01,respectively).The values of CI in low PEEP group and medium PEEP group were higher than that of high PEEP group respectively(P ＜0.01,respectively).There were no significant differences in urine output among three groups (P ＞ 0.05).The lengths of mechanical ventilation and hospital stays in PICU in medium PEEP group [(5.40 ± 0.61) d,(7.00±0.61) d]were shorter than those of the high PEEP and low PEEP groups [(6.23 ±0.90)d,(7.51 ± 1.09) d; (8.23 ± 0.90) d,(9.14 ± 1.21) d] (P ＜ 0.01,respectively).There were no significant differences in mortality among three groups (P ＞ 0.05).Conclusion Medium PEEP can significantly improve lung function of infants who are diagnosed with septic shock and ARDS,shorten the lengths of mechanical ventilation,and has no serious adverse effect on hemodynamics.

Objective To evaluate the concordance on cardiac index (CI) measured with arterial pressure based cardiac output (APCO) and pulmonary artery catheter (PAC) during cesarean section in parturients with congenital heart disease combined with severe pulmonary hypertension.Methods Forty-five congenital heart disease combined with severe pulmonary hypertension parturient who scheduled for cesarean section were selected,APCO and PAC were used for cardiac output and other parameters of hemodynamics monitoring during operation in all patients.Continuous epidural anesthesia was performed.CI was recorded immediately before epidural administration (T1),at 5 and 10 min after epidural administration (T2,T3),immediately before delivery (T4),and at 2 and 5 min after delivery (T5,T6).The correlation of CI between APCO and PAC (A-CI and P-CI,respectively) was tested by Pearson correlation analysis and agreement test.Results The P-CI was significantly higher than A-CI,there was statistical difference (P ＜ 0.05).Compared with T1,no significant differences between A-CI and P-CI were found at T2-T4 and T6 (P ＞ 0.05),The A-CI at T5 [(4.5 ± 1.1) L/(min·m2) vs.(4.2 ± 0.8) L/(min ·m2)] and P-CI [(6.2 ± 1.5) L/(min·m2) vs.(5.4 ± 1.2) L/ (min· m2)] were significantly higher,there were statistical differences (P ＜ 0.05).The correlation analysis showed that there was positive correlation between A-CI and P-CI at T1-6 (r =0.931,0.955,0.945,0.892,0.960,0.913 ; P ＜ 0.05).Bland-Altman analysis showed poor agreement between CI measured with the two methods.Conclusion CI value obtained with APCO agrees poorly with that obtained with PAC during cesarean section in parents with congenital heart disease combined with severe pulmonary hypertension,but agrees well in monitoring the changing trend of CI.