Objective To observe the effect of remifentanil combined with propofol to induce and sustain controlled hypotension in children during endoscopic sinus surgery(ESS). Methods Forty ASA Ⅰ children undergoing adenoidectomy in ESS were divided into control group and controlled hypotension group by random digits table with 20 cases in each group. No controlled hypotension in control group. Anesthesia was induced with propofol,remifentanil and atracurium, and maintained with continuous infusion of propofol 2 min until the target mean arterial pressure (MAP)(55 - 60 mm Hg, 1 mm Hg = 0.133 kPa) was reached,and MAP was maintained at this level during operation in controlled hypotension group. During 15 min before surgical procedure pharynx nasalis blood flow was measured and recorded with laser Dopper flowmetry continuously. The quality of the surgical field in term of blood loss and dryness was established at 15 min after operation starting. Results Controlled hypotension was induced within (2.5 ± 0.3 ) min, the infusion rate ofMAP and heart rate at 15 min after controlled hypotension and 15 min after operation starting were significantly lower than those at controlled hypotension instantly in controlled hypotension group and control group (P ＜ 0.05 ). The pharynx nasalis blood flow decreased at 15 min after controlled hypotension from baseline [(68.3 ± 8.3 )% vs. (99.8 ± 7.9 )%] (P ＜ 0.05 ). The operation time and the quality of the surgical field in term of blood loss and dryness in controlled hypotension group were better than those in control group [(21 ± 4) min vs. (32 ± 6) min and ( 1.8 ± 0.1 ) scores vs. (3.5 ± 0.5) scores] (P ＜ 0.05 ). The awakeextubate time was within 10 min in two groups, and there were no anesthesia related complications.Conclusion Remifentanil combined with propefol can induce and sustain controlled hypotension,reduce pharynx nasal is blood flow and provide good surgical conditions in children for ESS.

Objective To explore application of pulse indicator continuous cardiac output(PICCO)in the treatment of septic shock during continuous renal replacement therapy (CRRT).Methods 34 patients with septic shock who underwent CRRT were randomly divided into the control group and the experimental group.Heart rate(HR),mean arterial pressure(MAP)and central venous pressure (CVP) were monitored in the control group.The experimental group were monitored by PICCO technology in addition to conventional monitoring,the hemodynamics parameters were collected such as end-diastolic volume index (GEDI),extravascular lung water index(EVLWI),and systemic vascular resistance index(SVRI),etc.Dehydration volume and supplementary volume were controlled by means of two group's hemodynamics parameters.The change of Acute Physiology And Chronic Health Evaluation-Ⅱ (APACHE Ⅱ),lactate (Lac),saturation of central venous oxygen(SevO2) and oxygenation index (PaO2/FiO2) were observed.Results After treatment of 72h,the decrease of APACHE Ⅱ and lactate in the experimental group was higher than those in the control group,the increase of ScvO2 in the experimental group was higher than those in the control group,the increase of PaO2/FiO2 in the experimental group was evidently higher than those in the control group.Conclusions During PICCO monitoring technique to guide CRRT therapy in patients with septic shock,the volume status of patients can be accurately controlled,organizational cycle can be improved,oxygenation of lung can be obviously improved,which contributes to treatment of septic shock.

Objective To compare the difference in radiotherapy dose caused by different ways of adding bolus.Methods A total of 20 patients who needed to receive postmastectomy chest wall irradiation from October to December on 2014 were selected.Each patient underwent two CT scans;CT-1 was to perform CT scan directly without bolus, and CT-2 was to perform CT scan after adding bolus to the body surface.An equivalent bolus was added for CT-1 in the radiotherapy planning system, and Plan-1, which met the clinical requirements, was performed.Then Plan-1 was put on CT-2 through image fusion and plan verification to develop Plan-2, which was to develop plans with equivalent boluses at other times and perform radiotherapy with a bolus added to the surface of the body.At last, CT-2 was used to perform radiotherapy Plan-3, which met the clinical requirements.The paired t-test was used for comparison of clinical data between any two plans with SPSS 19.0.Results The V20 of the whole lung, V20 of the diseased lung, V30 of the heart, and Dmax of the healthy breast showed no significant differences across the three plans (P=0.074-0.871).The V50 , V55 , conformity index, and homogeneity index of the planning target showed significant differences across the three plans, and the total number of monitor units showed a significant difference between Plan-1 and Plan-2(P=0.002-0.049).The dose distribution in the target volume and the number of monitor units in each radiation field also showed significant differences.Conclusions When the equivalent bolus is added to the body surface before CT scan, such a plan can accurately reflect the dose distribution of the planning target and the dose to organs at risk.

Objective To investigate the efficacy and safety of three?dimensional radiotherapy (3DRT) with concurrent chemotherapy for stage IV non?small?cell lung cancer ( NSCLC). Methods A total of 198 eligible patients from 2008 to 2012 were enrolled as subjects. With an age ranging between 18 and 80 years and a Karnofsky Performance Status ( KPS) score of 70 or more, those patients had no contraindication for radiotherapy and chemotherapy, and were newly diagnosed with stage IV NSCLC confirmed by histology or cytology, as well as limited metastatic disease (≤3 organs). Survival rates and acute toxicities in those patients were evaluated. Results The 3?year follow?up rate was 98?? 5% and the 3?year sample size was 165. The median overall survival (OS) and progression?free survival (PFS) were 13?? 0 months (95% CI,11?? 7 ?14?? 3 months) and 9?? 0 months (95% CI,7?? 7 ?10?? 3 months), respectively, while the 1?, 2?, and 3?year OS rates were 53?? 5%, 15?? 8%, and 9?? 2%, respectively. Multivariate analysis showed that a primary tumor volume smaller than 134 cm3 , a stable or increased KPS score after treatment, and a radiation dose of 63 Gy or more were independent prognostic factors for longer survival time ( P=0?? 008;P= 0?? 010;P= 0?? 014). The incidence rates of grade 3?4 neutropenia, thrombocytopenia, anemia, grade 3 radiation esophagitis, and grade 3 radiation pneumonitis were 37?? 9%, 10?? 1%, 6?? 9%, 2?? 5%, and 6?? 6%, respectively. The main cause of death was distant metastasis, and only 10% of the patients died of recurrence alone. Conclusions 3DRT with concurrent chemotherapy achieves satisfactory treatment outcomes with tolerable toxicities for stage IV NSCLC. Primary tumor volume, change in the KPS score after treatment, and radiation dose are independent prognostic factors for OS.Clinical Trial Registry Chinese Clinical Reistry,registration number:ChiCTRC10001026.

OBJECTIVETo analyze the status of maternal health behaviors and it's risk factors for Yi-nationality women in poor rural areas of Sichuan province.

METHODSIn 2012, multi-stage stratified cluster sampling method was used to select 14 villages of two poor counties in Liangshan Yi-nationality autonomous prefecture Sichuan province. At least 10 women who have infants aged 0-12 months were selected in each simple villages, a total of 284. The structured questionnaire was developed on the basis of the theory of reasoned action. Yi-nationality female college students were trained as investigators. Research indicators included prenatal care rate, hospital delivery rate, postpartum examination rate, socio-demographic characteristics, maternal health care knowledge. χ² test was used to compare the differences of above indicators among different groups. The structural equation model were used to statistical analyze.

RESULTSIn the 284 subject women, 51.7% (147/284) women owned more than 2 children, 41.6% (118/284) women were more than 30 years old, 87.3% (248/284) women were illiteracy. The prenatal care rate was 69.7% (197/284), the hospital delivery rate was 26.8% (76/284), and the postnatal check rate was 22.9% (65/284). The influence factors of maternal health behaviors included the number of children, age and education (χ² were 10.92, 13.24, 9.58; P values were 0.027, 0.004, 0.008, respectively).The structural equation model analysis results showed that the maternal health behaviors were directly or indirectly affected by subjective norms (β = 0.236, P < 0.001), women's cognition (β = 0.226, P = 0.020) and women's attitudes on maternal health behavior (β = 0.157, P = 0.001). Among subjective norms, women have high compliance to their husbands (β = 0.850, P < 0.001), their peers (β = 0.708, P < 0.001), and their mothers-in-law (β = 0.636, P < 0.001).

CONCLUSIONThere were still serious problems in maternal health behaviors for Yi-nationality women in poor rural areas. The main factors included not only the women's cognition and attitudes for maternal health, but also the attitudes of important social relationships.

Child ; China ; Ethnic Groups ; Family ; Female ; Health Behavior ; ethnology ; Humans ; Infant ; Maternal Health ; ethnology ; Maternal Health Services ; Postpartum Period ; Pregnancy ; Prenatal Care ; Risk Factors ; Rural Population

Objective To analyze the status of maternal health behaviors and it's risk factors for Yi-nationality women in poor rural areas of Sichuan province. Methods In 2012, multi-stage stratified cluster sampling method was used to select 14 villages of two poor counties in Liangshan Yi-nationality autonomous prefecture Sichuan province. At least 10 women who have infants aged 0-12 months were selected in each simple villages, a total of 284. The structured questionnaire was developed on the basis of the theory of reasoned action. Yi-nationality female college students were trained as investigators. Research indicators included prenatal care rate, hospital delivery rate, postpartum examination rate, socio-demographic characteristics, maternal health care knowledge. χ2 test was used to compare the differences of above indicators among different groups .The structural equation model were used to statistical analyze. Results In the 284 subject women, 51.7%(147/284) women owned more than 2 children, 41.6%(118/284)women were more than 30 years old, 87.3%(248/284)women were illiteracy. The prenatal care rate was 69.7%(197/284), the hospital delivery rate was 26.8%(76/284), and the postnatal check rate was 22.9%(65/284). The influence factors of maternal health behaviors included the number of children, age and education (χ2 were 10.92,13.24,9.58;P values were 0.027, 0.004, 0.008, respectively).The structural equation model analysis results showed that the maternal health behaviors were directly or indirectly affected by subjective norms (β= 0.236, P<0.001), women's cognition (β= 0.226,P=0.020) and women's attitudes on maternal health behavior (β=0.157, P=0.001). Among subjective norms, women have high compliance to their husbands (β=0.850, P<0.001), their peers (β=0.708, P<0.001), and their mothers-in-law (β=0.636, P<0.001). Conclusion There were still serious problems in maternal health behaviors for Yi- nationality women in poor rural areas. The main factors included not only the women's cognition and attitudes for maternal health, but also the attitudes of important social relationships.

Objective To analyze the status of maternal health behaviors and it's risk factors for Yi-nationality women in poor rural areas of Sichuan province. Methods In 2012, multi-stage stratified cluster sampling method was used to select 14 villages of two poor counties in Liangshan Yi-nationality autonomous prefecture Sichuan province. At least 10 women who have infants aged 0-12 months were selected in each simple villages, a total of 284. The structured questionnaire was developed on the basis of the theory of reasoned action. Yi-nationality female college students were trained as investigators. Research indicators included prenatal care rate, hospital delivery rate, postpartum examination rate, socio-demographic characteristics, maternal health care knowledge. χ2 test was used to compare the differences of above indicators among different groups .The structural equation model were used to statistical analyze. Results In the 284 subject women, 51.7%(147/284) women owned more than 2 children, 41.6%(118/284)women were more than 30 years old, 87.3%(248/284)women were illiteracy. The prenatal care rate was 69.7%(197/284), the hospital delivery rate was 26.8%(76/284), and the postnatal check rate was 22.9%(65/284). The influence factors of maternal health behaviors included the number of children, age and education (χ2 were 10.92,13.24,9.58;P values were 0.027, 0.004, 0.008, respectively).The structural equation model analysis results showed that the maternal health behaviors were directly or indirectly affected by subjective norms (β= 0.236, P<0.001), women's cognition (β= 0.226,P=0.020) and women's attitudes on maternal health behavior (β=0.157, P=0.001). Among subjective norms, women have high compliance to their husbands (β=0.850, P<0.001), their peers (β=0.708, P<0.001), and their mothers-in-law (β=0.636, P<0.001). Conclusion There were still serious problems in maternal health behaviors for Yi- nationality women in poor rural areas. The main factors included not only the women's cognition and attitudes for maternal health, but also the attitudes of important social relationships.

Objective:To explore effects of the specialist nurse training program of based on the context, input, process, product (CIPP) evaluation model in the training of junior nurses in the Department of Otolaryngology.Methods:From April 2018 to May 2020, convenience sampling method was used to select 80 specialist nurses who received training in the Shandong ENT Hospital as research objects. A total of 40 nurses who received traditional training from April 2018 to March 2019 were divided into a control group. From April 2019 to May 2020, 40 nurses who were trained in a specialist nurse training program based on the CIPP evaluation model were divided into observation groups. This study compared nurses' core competence and training qualification rate.Results:After training, the core competence score of observation group was higher than that of control group, and the difference was statistically significant ( P<0.05) . The training qualification rate of observation group and control group was 92.50% (37/40) and 70.00% (28/40) respectively, also with a statistical difference ( P<0.05) . Conclusions:The training program for specialist nurses based on the CIPP evaluation model can improve the theoretical knowledge and practical ability of nurses, and then improve the quality of clinical care, and promote the long-term development of the hospital, which is worthy of promotion.

OBJECTIVE: To analyze the extubation indications of tracheotomy patients with severe neuropathy by Meta-analysis in order to determine the effective indication parameters for successful extubation. METHODS: The literatures in databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed and Cochrane Library were retrieved from their establishment to April 2019. The literatures were case-control studies, cohort studies, randomized controlled trials (RCTs) or surveys related to indication parameters for successful extubation in patients with severe neuropathy. Two researchers identified and extracted literatures and data independently. The quality of literatures was assessed by the Newcastle-Ottawa scale (NOS). Meta-analysis was performed by RevMan 5.3 software. The stability of the results were evaluated by assessing the statistical models (the fixed effects model or the random effects model) and literatures quality (inferior or superior), and by sensitivity analysis. The publication bias of literatures was assessed by funnel plot. RESULTS: Eleven studies involving 1 357 participants were enrolled, and the rate of successful extubation was 46.7%-97.5%. Nine studies defined successful extubation as no need of re-intubation, and other two did not explain. All studies were high quality research, with NOS score of 6-8. Meta-analysis showed that the correlation between the level of consciousness [Glasgow coma score (GCS) ≥ 8 vs. < 8: odds ratio (OR) = 3.34, 95% confidence interval (95%CI) was 2.22-5.03, P < 0.001], the amount of tracheal secretions (less vs. more: OR = 13.07, 95%CI was 5.64-30.32, P < 0.001), cough reflex (with vs. without: OR = 14.33, 95%CI was 6.36-32.28, P < 0.001), swallowing function (good vs. bad: adjusted OR = 18.56,95%CI was 8.16-42.21, P < 0.001) and successful extubation was statistically significant, and the correlation between the pulmonary infection (with vs. without: adjusted OR = 1.94, 95%CI was 0.87-4.35, P = 0.11), oxygen saturation (≥ 0.95 vs. < 0.95: OR = 2.34, 95%CI was 1.11-4.91, P = 0.12), tolerance of tube plugging (good vs. bad: OR = 2.12, 95%CI was 0.67-6.71, P = 0.20), method of tube drawing (gradually vs. abruptly: OR = 0.99, 95%CI was 0.95-1.04, P = 0.93) and successful extubation was not statistically significant. Sensitivity analysis showed that the results were stable. Funnel plot showed that the studies distributed in both sides of the funnel symmetrically, indicating the publication bias of literatures was small. CONCLUSIONS The effective indication of extubation is consciousness level (GCS score ≥ 8), less secretion, cough reflex and good swallowing function.
Airway Extubation ; China ; Cohort Studies ; Humans ; Odds Ratio ; Tracheostomy

Objective: To analyze the extubation indications of tracheotomy patients with severe neuropathy by Meta-analysis in order to determine the effective indication parameters for successful extubation. Methods: The literatures in databases including China National Knowledge Infrastructure (CNKI), Wanfang, VIP, Web of Science, PubMed and Cochrane Library were retrieved from their establishment to April 2019. The literatures were case-control studies, cohort studies, randomized controlled trials (RCTs) or surveys related to indication parameters for successful extubation in patients with severe neuropathy. Two researchers identified and extracted literatures and data independently. The quality of literatures was assessed by the Newcastle-Ottawa scale (NOS). Meta-analysis was performed by RevMan 5.3 software. The stability of the results were evaluated by assessing the statistical models (the fixed effects model or the random effects model) and literatures quality (inferior or superior), and by sensitivity analysis. The publication bias of literatures was assessed by funnel plot. Results: Eleven studies involving 1 357 participants were enrolled, and the rate of successful extubation was 46.7%-97.5%. Nine studies defined successful extubation as no need of re-intubation, and other two did not explain. All studies were high quality research, with NOS score of 6-8. Meta-analysis showed that the correlation between the level of consciousness [Glasgow coma score (GCS) ≥ 8 vs. < 8: odds ratio (OR) = 3.34, 95% confidence interval (95%CI) was 2.22-5.03, P < 0.001], the amount of tracheal secretions (less vs. more: OR = 13.07, 95%CI was 5.64-30.32, P < 0.001), cough reflex (with vs. without: OR = 14.33, 95%CI was 6.36-32.28, P < 0.001), swallowing function (good vs. bad: adjusted OR = 18.56, 95%CI was 8.16-42.21, P < 0.001) and successful extubation was statistically significant, and the correlation between the pulmonary infection (with vs. without: adjusted OR = 1.94, 95%CI was 0.87-4.35, P = 0.11), oxygen saturation (≥ 0.95 vs. < 0.95: OR = 2.34, 95%CI was 1.11-4.91, P = 0.12), tolerance of tube plugging (good vs. bad: OR = 2.12, 95%CI was 0.67-6.71, P = 0.20), method of tube drawing (gradually vs. abruptly: OR = 0.99, 95%CI was 0.95-1.04, P = 0.93) and successful extubation was not statistically significant. Sensitivity analysis showed that the results were stable. Funnel plot showed that the studies distributed in both sides of the funnel symmetrically, indicating the publication bias of literatures was small. Conclusion The effective indication of extubation is consciousness level (GCS score ≥ 8), less secretion, cough reflex and good swallowing function.