Objective To observe whether the high-flow nasal cannulae (HFNC) can reduce the rate of re intubation after extubation in patients with tracheal intubation in the intensive care unit (ICU). Methods 134 patients with mechanical ventilation in ICU were divided into 2 groups according to the order of ICU. The control group and the observation group were divided into 67 groups. Patients in control group were used routine oxygen inhalation (nasal duct and mask) after weaning, while the observation group was HFNC. All the other patients with the same treatment and care. The rate of re intubation was compared between the 2 groups. Results In the observation group, the rate of reintubation was 4.48%(3/67) of all. The control group was 14.92%(10/67), two groups of patients with reintubation rate difference was statistically significant (χ2= 4.17, P < 0.05). Conclusions HFNC can decrease the rate of re intubation after extubation in patients with tracheal intubation.

Objective To explore the relevance of safety culture in hospital nursing and the head nurse leadership behavior.Method The study adopts the method of convenience sampling to diversify the head nurse leadership behavior and nursing safety culture of 344 nurses in 3 first-class tertiary hospital of traditional Chinese Medicine in Heilongjiang Province.All survey data were entered into the SPSS17.0 software for analysis.Finally,conclusion was got.Result The head nurse leadership behavior is the highest score for leadership charm,followed by passive exception management,personalized care,active exception management,charisma,contingent reward and intellectual stimulation.Safety culture of nursing is slightly higher than medium level,in wh ch the team atmosphere,the satisfaction of the work,the unit security atmosphere,the management experience is higher than the medium level.The cognitive score of the pressure is lower than the medium level.Conclusion All dimensions of nurses' perception of head nurse leadership behavior has a positive correlation with each dimension of safety culture in hospital nursing.

Objective To establish a method to determine dicofol and eight pyrethroid pesticides residues in vegetables and fruits by gas chromatography.Methods The crushed samples were extracted with organic solvent,then the extract was analyzed by DM-17 capillary column gas chromatography after being purified by PestiCarb-NH2 cartridge and silica cartridge solid phase extraction.Results The detection curve covered the linear range of 0.10-2.0 ?g/ml .The minimum detection limit was 0.011-0.090 ?g/kg.The rates of recovery were 85.4%-105%.The variable coefficient(RSD) was under 7.0%.Conclusion This method has the advantages of less disturb, simple and high accuracy, and it can be applicable to the routine analysis of dicofol and pyrethroid pesticides residues.

Objective To investigate the autonomic nervous system function of hyperthyroidism and hyperthyroidism by analyzing the heart rate variability of patients with the diseases. Methods 12-synchronous dynamic 24-hour monitoring and man-machine dialogue were used in 36 patients with hyperthyroidism, 30 patients with hypothyroidism and 26 cases of healthy volunteers(controls), and 24-hour electrocardiogram was analyzed.Heart rate variability indicators observed included 24 h consecutive sinus standard deviation of R-R interval (SDNN), standard deviation of sequential five-minute R-R interval (SDANN), percentage of differences between adjacent NN intervals that ＞ 50 ms(PNN50), root mean square standard deviation from adjacent R-R interval (rMSSD), low-frequency power (LF), high frequency power (HF), low frequency power/high frequency power (LF/HF). Results In hyperthyroidism group, SDNN[(80.48 ± 11.95)ms], PNN50[(18.56 ± 3.50)%], rMSSD [ ( 13.56 ± 3.45)ms] were significantly lower than those of the control group[ ( 128.06 ± 12.8)ms, (32.84 ± 7.21)%,(30.84 ± 6.12)ms, all P ＜ 0.05 ], and LF/HF(3.78 ± 1.63) were significantly higher than that of the control group (2.34 ± 1.06, P ＜ 0.05). In hypothyroidism group, SDNN[(65.65 ± 15.55)ms], SDAN[ (80.2 ± 15.72)ms],PNN50[ (16.34 ± 3.56)%], rMSSD [ (15.77 ± 3.58)ms ], LF[ (279.03 ± 91.49)ms2/Hz ] were also significantly lower than those of the control group[ (128.06 ± 12.87)ms, (132.40 ± 21.95 )ms, (32.84 ± 7.21 )%, (30.84 ± 6.12)ms, (525.60 ± 84.11)ms2/Hz, all P ＜ 0.05], but LF/HF (1.08 ± 0.73) was lower than that of the control group,however, the difference was not significant(P ＞ 0.05). Conclusions The heart rate in patients with abnormal thyroid function is lower in the overall performance, but in patients with hyperthyroidism sympathetic activity is dominate, while in patients with hypothyroidism, vagal nerve activity is dominate.

Objective To observe the heart rate variability in patients with hypothyroidism, and to analyze the effect of 131Ⅰ therapy on autonomic nervous system of patients with the diseases. Methods A total of 56 cases of hyperthyroidism from the Second Affiliated Hospital of Harbin Medical University and the Second Hospital of Harbin City were enrolled as research subjects. 12-synchronous dynamic 24-hour monitoring and man-machine dialogue were used 6 months before and after 131Ⅰ treatment, and 49 cases of healthy volunteers were selected as controls.Heart rate variability indicators observed included 24 h consecutive sinus standard deviation of R-R interval (SDNN), standard deviation of sequential five-minute R-R interval (SDANN), percentage of differences between adjacent NN intervals that > 50 ms(PNN50), root mean square standard deviation from adjacent R-R interval (rMSSD), very low frequency power(VLF), low frequency power(LF), high frequency power(HF), and low frequency power/high frequency power(LF/HF). Results In hyperthyroidism group before 131Ⅰ therapy, SDNN[(85.25 ± 13.59)ms], SDANN [( 95.47 ± 33.15)ms], PNN50 [( 15.26 ± 4.84) %], rMSSD [( 14.47 ~ 3.49) ms], LF [(435.57 ± 75.74)ms2/Hz], and HF[(129.81 ± 63.21 )ms2/Hz] were significantly lower than those of the control group [(155.24 ±15.87), ( 134.02 ± 24.15)ms, (29.41 ± 6.21 )%, (26.64 ± 6.11 )ms, (515.69 ± 74.83)ms2/Hz, and (265.93 ± 58.84)ms2/Hz, all P < 0.05], VLF[(1765.21 ± 315.22)ms2] and LF/HF(3.95 ± 1.89) were significantly higher than that of the control group[(374.25 ± 54.47)ms2, 2.94 ± 1.55, all P < 0.05]. In hyperthyroidism group after treatment,SDNN [(126.91 ± 16.32)ms], SDANN[(125.2 ± 43.22)ms], PNN50[(26.34 ~ 7.56)%], rMSSD[(24.85 ± 7.85)ms],LF [(489.35 ± 91.49)ms2/Hz], and HF [(209.45 ± 75.32)ms] were also significantly higher than those before 131Ⅰ therapy, VLF[(571.80 ± 97.41)ms] and LF/HF(2.41 ± 0.93) were lower than that before 131Ⅰ therapy,but SDNN, PNN50 and HF were lower and VLF was higher than those of the control group (all P < 0.05). Conclusions The heart rate variability in patients with hyperthyroidism is lower in the overall performance, sympathetic activity is dominate, 131Ⅰ therapy partly corrects abnormal autonomic nerve function.

Objective To observe the high-flow nasal cannulae can reduce indoor postoperative intensive care patients with tracheal intubation in offline acute respiratory failure after extubation reintubation rates. Methods 53 cases of postoperative acute hypoxia type patients with respiratory failurein the ICU in offline after extubation were divided into two groups, control group of 24 patients, 29 cases of observation group patients. Control group patients in the event of a failure after using non-invasive mechanical ventilation (NIMV) and observation group of patients using HFNC. All other patients with same treatment and nursing. Compare two groups of patients reintubation rates. Results Observation group of reintubation rate was 20.69%(6/29), the control group was 45.83%(11/24), reintubation rate difference of two groups of patients were statistically significant (χ2=3.81, P < 0.05). Conclusions HFNC can reduce postoperative extubation after weaning reintubation rates in patients with acute respiratory failure.

Objective To evaluate effect of preventing ventilator associated pneumoia (VAP) of patients with oral cavity endotracheal intubation by air impulse clearing away secretion drainage. Methods 348 patients with oral trachea cannula and mechanical ventilation (MV) in intensive care unit (ICU) were divided into control group (n=174) and observational group (n=174). The control group adopted conventional airway management methods without the subglottic secretion drainage while the observational group adopted conventional airway management methods on the basis of combining air impact method remove stranded on airbags. Other treatment and care for all of patients were basically the same. The MV time, duration in ICU and incident rate on VAP were compared between the two groups. Results The average of MV time in control group was (5.25±1.18) days, (5.62±3.20) days in ICU and the rate of VAP was 10.34%(18/174). In observational, it was (8.96 ±5.43) days, (10.43 ±4.96 ) days and 34.48%(60/174), respectively. The MV time, duration in ICU and incident rate on VAP were significantly different (P<0.05), with statistical significance. Conclusions The air impact method to remove airbags retentate could shorten time of MV and during time in ICU, and could reduce the rate of VAP.

Objective To explore the effect of intracavitary therapy on acute pulmonary embohsm.Methods Fifteen patients were selected as our subjects,who suffered acute pulmonary embolism and received percutaneous catheter thrombus crashing and catheter directed thrombolysis in Beijing Military.Region General Hospital from January 2009 to June 2011.Local injection of Urokinase was performed with a total amount of 500 000 U in catheter directed thrombolysis.After thrombolysis,low molecular Heparin was administered to patients for 7-10 days and oral administration of Warfarin was performed for 3-6 months.Clinical symptoms,improvement of physical signs,complications,changes of mean pulmonary arterial pressure(mPAP) and arterial partial pressure of oxygen(PO2),and the opening of pulmonary artery were recorded.Results The pulmonary arteries of the 12 patients were completely opened,and partially opened in 3 patients.The effective rate was 100％ (15/15).mPAP was reduced from (40.07 ±5.97) mmHg to (20.00 ±4.66) mmHg (t =-1.128,P ＜ 0.05),PO2 was increased from (50.26 ± 9.30) mmHg to (80.49 ± 9.04) mmHg (t =1.246,P ＜ 0.05).Patients were followed-up for 3-6 months and no recurrence case was seen.Conclusion The interventional therapy is effective,safe and practicable in the treatment of acute pulmonary embolism.

Objective To investigate the effect of sufentanil combined with remifentanil on anesthesia in emergency traumatic brain injury . Methods Retrospective analysed a total of 80 the clinical data of patients with traumatic brain treated in Yuyao Municipal People’s Hospital from March 2015 to August 2016 received surgical treatment in emergency, accorded to the intraoperative anesthesia were divided into remifentanil group and combined anesthesia group(remifentanil combined with sufentanil anesthesia group).The changes of MAP,HR and stress indexes in two groups were observed,awakening quality and complication rate between the two groups were compared.Results Before anesthesia,there was no difference between the two groups of MAP and HR levels,10 minutes after the anesthesia,the beginning of the operation and the end of the operation,the combined anesthesia group was higher than that of the remifentanil group ( P<0.05 );there was no significant difference in blood glucose and cortisol levels between the two groups before and after anesthesia,and the indexes of 12h after operation were lower than those in the remifentanil group (P<0.05);two groups of patients with respiratory recovery time,recovery time,eye opening time command and extubation time showed no significant difference between the two groups;nausea and vomiting,incidence of bradycardia and other complications had no significant difference.Conclusion Sufentanil combined with remifentanil in emergency brain trauma surgery anesthesia was better,has little effect on the mean arterial pressure and heart rate,low complication rate.

Objective To investigate the primary repair methods and efficacy of island pedicled pectoralis major muscle flap in soft tissue defect after the operation of head and neck malignant tumors .Methods From April 2011 to September 2012 ,27 patients from this hospital who underwent primary repair using island pedicled pectoralis major muscle flap after a head and neck extensive soft tissue defect were investigated ,including 11 cases of tongue cancer defect ,2 cases of parotid gland defect ,3 cases of gum cancer defect ,2 cases of oropharyngeal cancer defect ,9 cases of floor of the mouth cancer defect .Results 27 patients were safety in periop-erative ,27 cases of island pectoralis major muscle flap survived ,patients were satisfied with both the appearance and function .There was postoperative neck hematoma in 1 patient ,it was eliminated through timely remove the hematoma and hemostasis completely ;There was 1 case of removing the epidermal necrolysis skin as flap necrosis ,while it was acceptable efficacy as the muscle flap sur-vival and surface granulation repaired .Conclusion Island pectoralis major muscle flap obtains unique advantages in repairing a large area of soft tissue defect in head and neck cancer patients after operation ,such as abundant of tissue ,a constant arterial anatomy of thoracoacromial ,easy to operate ,rich blood supply ,strong resistance to infection ,high survival rate and so on .A fine surgery opera-tion is the key of island pectoralis major muscle flap survival .