Objective To investigate the application value of transcranial Doppler ultrasonography(TCD) in critically ill children with cerebral dysfunction.Methods We detected the cerebral blood flow parameters[systolic velocity(Vs),mean velocity(Vm),end of diastolic velocity(Vd),pulsatility index(PI),resistance index(RI)] of middle cerebral artery in cerebral dysfunction group(n=20) and control group(no cerebral dysfunction,n=20),and observed the differences of those parameters between two groups.Children in cerebral dysfunction group were also divided into groups according to Glasgow Coma Score(GCS) and prognosis.The differences of each TCD parameter in diverse groups divided by GCS and by prognosis were analysed.Children in cerebral dysfunction group were checked TCD everyday until TCD parameters were normal.The relation between the days of TCD parameters′ reaching normal and GCS,duration of disorder of consciousness with correlation analysis were analysed.Results Vs,PI,RI in cerebral dysfunction group were higher than those in control group,while Vd was lower (P<0.05).(2)PI in the group of GCS less than 6 points(0.91±0.21) was higher than that in group of GCS 7-13 points(0.83±0.14)(P<0.05).The other parameters between two groups of GCS less than 6 points and GCS 7-13 points were not significantly indistinctive.Between the good prognosis group and the bad prognosis group,there were no significant differences in all parameters.(3) The days of TCD parameters′ reaching normal were negatively correlated with GCS(r=-0.653,P<0.01),but positively correlated with the duration of disorder of consciousness(r=0.923,P<0.01).Conclusion The cerebral hemodynamics of children with cerebral dysfunction is abnormal,the more serious cerebral dysfunction,the higher PI and the longer time for regaining normal TCD parameters.Constantly monitoring TCD could reflect the changes of cerebral hemodynamics and is valuable to assess the state of illness and prognosis.

Objective To investigate the effect of different sputum suction methods on the incidences of pulmonary infections in patients with mechanical ventilation.Methods Four hundred and sixty-six patients with mechanical ventilation were randomly divided into study group(n=219)and control group(n=247).The two groups were treated with continued balloon filling and airway humidification.Besides,the control group received conventional open sputum suction and the study group closed continuous negative pressure sputum suction.The two groups were compared in terms of incidence of pulmonary infections.Result The incidence of the study group(8.2%)was significantly lower than that of the control group(14.6%)(χ2=4.58,P<0.05).Conclusion Compared with the traditional open conventional sputum suction method,closed continuous negative pressure sputum suction may be more effective in reducing the incidence of pulmonary infection in patients with mechanical ventilation.

Objective To explore the application effects of evidence-based nursing in percutaneous endoscopic gastrostomy ( PEG ) postoperative enteral nutrition and the effects of prevention and treatment of complications. Methods A retrospective and prospective cohort study method was adopted. The control group was composed of 58 cases of PEG enteral nutrition patients, on whom evidence-based nursing was not conducted before January 2013, while the intervention group was composed of 60 cases of PEG enteral nutrition patients, on whom evidence-based nursing was conducted after January 2013. Intervention effects of nursing were compared and analyzed between two groups. Results The incidence of complications in the intervention group (11. 67%) was significantly lower than that of the control group (43. 10%) (P<0. 01), and the incidence of infectious complications in the intervention group (5. 00%) was significantly lower than that of the control group (20.69%) (P<0. 01). There was no significant association between feeding time and complications (P >0. 05);there was significant association between ways of nutrition infusion and replacement rate of skin dressing (P<0. 01). Conclusions Application of evidence-based nursing in postoperative enteral nutrition of PEG patients can effectively prevent complications from happening, promote recovery of patients′ gastrointestinal function and overall nutritional status, and eventually shorten the time of hospitalization.

Objective To compare the nursing effect of the percutaneous endoscopic gastrostomy ( PEG) and nasal feeding in the patients with severe traumatic brain injury .Methods Eighty patients with severe traumatic brain injury from May 2010 to May 2013 were chosen and randomly divided into the PEG group and the nasal feeding group .The PEG group received the nutritional therapy through the PEG , and the nasal feeding group received the nutritional therapy through the nasal feeding .The prognosis was evaluated by the Glasgow outcome score ( GOS ) before discharge , and the complication was compared between two groups . Results The cases of the good score of GOS in the PEG group were 29 cases, and were 17 cases in the nasal feeding group, and the difference was statistically significant (χ2 =7.3657,P<0.01).The average days of hospital stays were (32.41 ±3.27) d in the PEG group, and were (38.16 ±5.33) d in the nasal feeding group, and the difference was statistically significant (t =5.816,P <0.01).The cases of reflux, gastric mucosal erosion and aspiration pneumonia were respectively 12, 7, 13 cases in the PEG group, and were lower than those of the nasal feeding group , and the differences were statistically significant (χ2 =4.1779,4.9428, 12.8321, respectively;P<0.05).Conclusions The value of PEG is higher than that of the nasal feeding in the nursing of the patients with severe traumatic brain injury .

Objective To investigate the relationship between underweight and pulmonary function in the general population. Methods A total of 2 350 patients who underwent a pulmonary function examination at Chongqing Three Gorges Central Hospital from January to June 2019 were selected as the study subjects. The subjects were divided into three groups based on their BMI value including underweight (<18.5 kg/m²), normal weight (BMI between 18.5 kg/m2 and 25 kg/m²), and overweight and obese (≥25 kg/m²). Results Subjects in the overweight group had significantly worse biochemical indicators compared with underweight and normal weight subjects, but the frequency of strenuous exercise of the underweight subjects was significantly lower than that of the other two groups (P<0.001). Compared to the normal weight and overweight groups, the underweight group had lower level of forced expiratory volume in first second (FEV1), predicted FEV1(%), forced vital capacity (FVC), predicted FVC(%), and peak expiratory flow (PEF) (P<0.001), but higher level of FEV1/FVC, as well as predicted FEV1 (%)<80% and predicted FVC (%)<80%. Multivariate logistic regression model analysis showed that after adjusting for multiple confounding factors, the risk of reduced lung function in underweight group increased significantly, and the odd ratios were 2.10 (95%CI 1.98–2.21) and 4.90 (95%CI 4.62–5.18) for FEV1(%)<80% and FVC%<80%, respectively. Conclusion This study demonstrated that in the general population, the underweight was significantly associated with reduced lung function.

Objective:To investigate the value of systemic inflammatory response syndrome (SIRS), pediatric sequential organ failure assessment (pSOFA) and pediatric critical illness score (PCIS) in predicting mortality of pediatric sepsis in pediatric intensive care units (PICU) from Southwest China.Methods:This was a prospective multicenter observational study. A total of 447 children with sepsis admitted to 12 PICU in Southwest China from April 2022 to March 2023 were enrolled. Based on the prognosis, the patients were divided into survival group and non-survival group. The physiological parameters of SIRS, pSOFA and PCIS were recorded and scored within 24 h after PICU admission. The general clinical data and some laboratory results were recorded. The area under the curve (AUC) of the receiver operating characteristic curve was used to compare the predictive value of SIRS, pSOFA and PCIS in mortality of pediatric sepsis.Results:Amongst 447 children with sepsis, 260 patients were male and 187 patients were female, aged 2.5 (0.8, 7.0) years, 405 patients were in the survival group and 42 patients were in the non-survival group. 418 patients (93.5%) met the criteria of SIRS, and 440 patients (98.4%) met the criteria of pSOFA≥2. There was no significant difference in the number of items meeting the SIRS criteria between the survival group and the non-survival group (3(2, 4) vs. 3(3, 4) points, Z=1.30, P=0.192). The pSOFA score of the non-survival group was significantly higher than that of the survival group (9(6, 12) vs. 4(3, 7) points, Z=6.56, P<0.001), and the PCIS score was significantly lower than that of the survival group (72(68, 81) vs. 82(76, 88) points, Z=5.90, P<0.001). The predictive value of pSOFA (AUC=0.82) and PCIS (AUC=0.78) for sepsis mortality was significantly higher than that of SIRS (AUC=0.56) ( Z=6.59, 4.23, both P<0.001). There was no significant difference between pSOFA and PCIS ( Z=1.35, P=0.176). Platelet count, procalcitonin, lactic acid, albumin, creatinine, total bilirubin, activated partial thromboplastin time, prothrombin time and international normalized ratio were all able to predict mortality of sepsis to a certain degree (AUC=0.64, 0.68, 0.80, 0.64, 0.68, 0.60, 0.77, 0.75, 0.76, all P<0.05). Conclusion:Compared with SIRS, both pSOFA and PCIS had better predictive value in the mortality of pediatric sepsis in PICU.