Objective To determine the effects of the early enteric nutrition (EEN) up to scratch on the outcomes of the critical care patients with different degrees of severity of illness. Method There were 192 critically ill patients eligible for enrollment for study during the past 18 months in our ICU. They were classified by using APACHE Ⅱ scores. The aim of this retrospective analysis of the early enteric nutrition was to see if the enteric nufore, the patients were divided into two groups: up to scratch group and not up to scratch group. According to APACHE Ⅱ scores, the patients of each group were further divided into three sub-groups in terms of scores below 15, between15 and 25, and above 25, respectively. Results There were 62 patients in the group of EEN up to scratch, and 130 patients' EEN did not up to scratch. When the scores of APACHE Ⅱ were below 15, the length of hospital stay (LOS) was significantly shorter in group of EEN up to scratch in comparison with that of EEN not up to scratch (t = 6.453, P = 0.000). When the scores of APACHE Ⅱ were between15 and 25, the LOS in ICU (t = 3.966, P = 0.000), in hospital (t = 8.165,P = 0.000), The cost of medical care (t = 4.812,P= 0.000) and the mortality (x2 = 5.421,P = 0.038) were all significantly less in patients with EEN up to scratch. However, when the scores of APACHE Ⅱ were above 25, only the cost of medical care ( t = 7.364, P = 0.000) was significantly lower in patients of EEN up to scratch than that of EEN not up to scratch. Conclusions The EEN up to scratch can significantly improve the outcomes of critical patients and the clinical value of EEN up to scratch depends on the severity of illness.

Objective:To explore the application effect of optimizing the anti-epileptic drug (AED) administration nursing procedure for patients with severe epilepsy at the first time after ICU admission.Methods:A quasi-experiment study was conducted by convenience sampling. The 44 patients with severe status epilepticus admitted in our department from January 2016 to December 2017 were selected as the control group .The 44 patients with status epilepticus admitted in our department from January 2018 to December 2019 were selected as the experimental group .The experimental group was implemented the optimized administration procedure after ICU admission. The control group was implemented the routine administration procedure after ICU admission. Some data of the two groups were compared, including baseline data, first administration time after admission, administration step time, AED dose reserve, and seizures at different time periods and so on.Results:Comparative analysis of the time of the first drug administration after admission into the two groups .The administration time of the control group was 31.0 (10.0-69.0) min, which was significantly longer than that of the experimental group, 25.0 (16.0-31.8) min ( χ2 value was -2.760, P<0.05). Comparison and analysis of the time taken for each step of drug administration: The time taken for step 1(Patient admission—medical order confirmation) in the control group was significantly greater than that in the experimental group ( χ2 value was -2.811, P<0.05); step 2 (medical order confirmation—Prepare medicines)in the control group was significantly greater than that in the experimental group ( χ2 value was -4.327, P<0.05).There was no significant difference in the time taken for step 3(Prepare medicines—Drug delivery to complete)between the two groups ( χ2 value was -1.137, P>0.05). Control group AED reserve ratio 63.6% (28/44), experimental group AED reserve was 100.0% (44/44), and the difference was statistically significant ( χ2 value was 19.556, P<0.05). Epilepsy control in two groups of patients: the total control rate after the first administration of the experimental group was 93.2% (41/44), which was significantly higher than 61.4% (27/44) of the control group ( Z value was -3.445, P<0.001). Conclusion:It can shorten the time to first give AED and improve the patient's clinical symptoms that optimizing the first drug administration procedure for patients with status epilepticus after admission.

Objective To assess the efficacy of recoil of inflating syringe plunger in limiting laryngeal mask airway (LMA) cuff pressure.Methods Sixty ASA Ⅰ or Ⅱ patients aged 22-64 yr with body mass index of 18-30 kg/m2 undergoing elective surgery under general anesthesia with LMA were enrolled in this study.LMA Supreme (Laryngeal Mask Co.Singapore) size # 3 (for patients with body weight ≤50 kg) or # 4 (for patients with body weight ＞ 50 kg) was placed after induction of anesthesia.Correct position of LMA was confirmed by fiberoptic bronchoscopy.The LMA cuff was inflated to 60,80,100 and 120 cm H2O step by step using a 20 ml-syringe.The cuff pressure was measured with a monometer through a 3-way stopcock and maintained at each level for 10 seconds.The plunger was then allowed to recoil.The cuff pressure at the end of recoil (residual cuff pressure) was recorded.The patients were mechanically ventilated.The inspiratory pressure was limited to 30 cm H2 O.The airway pressure at which the air started to leak between LMA and larynx (leak pressure-Pleak) was recorded.Results The residual cuff pressure following the 4 inflating pressures was all ＜ 60 cm H2 O.The Pleak was ＞20 cm H2O.There was no significant difference in residual cuff pressure and Pleak between size # 3 and # 4.Conclusion Recoil of inflating syringe plunger can limit LMA pressure to safe level.

Objective Both QBC Star and Sysmex XP-100 hematology analyzers are convenient to carry,which can be used nor-mally under the condition of the field(emergency).This study would compare their test results and operating performance,so to provide guidance for rational use of the instruments.Methods 100 fresh blood samples of 100 health soldiers anti-coagulated by EDTA-K2 were detected by QBC Star and Sysmex XP-100 haematology analyzers respectively,the results of two analyzers were comparatively analyzed and their test time and operating convenience were analyzed.Results There was no significant difference in the results of hemoglobin concentration (HGB),hematocrit (HCT)tested by the two methods (P >0.05).There were significant difference of the mean corpuscular hemoglobin concentration (MCHC),the sum of lymphocyte percent and middle type cells (LYM%+MID%),neutrophil percentage(NEUT%),white blood cell count(WBC),platelet count(PLT)tested by the two meth-ods(P <0.05).The values of MCHC and LYM%+MID% tested by the QBC Star were significantly lower than that detected by Sysmex XP-100(P <0.05),while the rest indicators tested by the former were higher than that of the latter.It took about 5 minutes to complete a blood sample analysis with QBC Star,while about 1 min was needed for Sysmex XP-100.Conclusion The test results of QBC Star and Sysmex XP-100 hematology analyzers couldn′t exchanged except for that of HCT and HGB.Under the condition of field(emergency),QBC Star hematology analyzer is suitable for individual medical examination,and Sysmex XP-100 hematology an-alyzer can be used for the batch medical examination.

This article reviews the nursing care of recent years to assist neurotic patients to turn over to prevent pressure sore. The present situation of nursing research on the prevention effect of pressure sore with different turn over method, different turn over angle, different turn over interval time combined with the nature of mattress and patient's condition were introduced, and the effect of preventing pressure sore with different turn over auxiliary appliance was introduced in order to provide a reference for the development of individual nursing guidelines for neurocritical patients.

Objective: To discuss the correlation between different muscle strength of lower extremitiess and the formation of deep vein thrombosis (DVT) in neurological ICU patients, and to provide evidence for effective nursing intervention. Methods: A questionnaire was developed to investigate the factors related to lower extremities DVT in patients with neurological ICU.By collecting clinical data of 195 patients from neurological ICU in Xuanwu Hospital of Capital Medical University, using the UK Medical Research Council(MRC) scale of freehand muscle strength for grading evaluation, patients were divided into a muscle strength grade 4-5 group (at least one extremities muscle strength grade 4) and a muscle strength grade 0-3 group (both lower extremities muscle strength grade 3).Gender, age, deep venous catheterization, Glasgow Coma Scale(GCS) score, bed time, fibrinogen value, D-dimer value were compared between the two groups.The main influencing factors of lower extremities DVT with different muscle strength were analyzed, and the incidence of lower extremities DVT with different muscle strength was compared. Results: The comparison between muscle strength grade 4-5 group and muscle strength grade 0-3 group in neurological ICU patients showed that bed time, GCS score, and D-dimer of the 0-3 muscle strength group were 18.96(14.00, 27.00) d, 9.00(6.00, 10.15), and 2.15(1.24, 3.58) mg/L, while those of the 4-5 muscle strength group were 13.50(5.75, 22.00)d, 13.50(10.00, 15.00), 1.52(0.76, 2.99) mg/L, the difference was statistically significant (Z=-3.767, -5.811, -2.296, P<0.01 or 0.05).While gender, catheterization, fibrinogen, anticoagulant use and age had no statistical significance (P > 0.05). Grouping comparison of unilateral lower extremities muscle strength showed that the left lower extremities muscle strength group,the incidence of thrombosis in grade 0-3 group was 26.9%(32/119), and that in grade 4-5 group was 14.5%(11/76), the incidence of left lower extremities DVT had statistical significance (χ²=4.160, P<0.05),and the right lower extremities muscle strength group,the incidence of thrombosis was 32.8%(41/125) in the 0-3 group and 15.7%(11/70) in the 4-5 group, the incidence of right lower extremities DVT had statistical significance (χ²=6.698, P<0.05). Conclusions Patients with grade 0-3 lower extremities muscle strength in neurological ICU have more factors influencing DVT.The incidence of DVT is high in the lower extremities with unilateral extremities muscle strength grade 0-3, and early monitoring of lower extremities DVT should be strengthened to prevent the occurrence of lower extremities DVT.

Objective:To investigate the effects of nutritional support on chemotherapeutic efficacy and safety in patients with acute myeloid leukemia.Methods:A total of 130 patients with acute myeloid leukemia who received treatment in Lishui Municipal Central Hospital from January 2021 to December 2021 were included in this study. They were divided into a control group and an observation group ( n = 65/group) according to different nutritional support methods. Patients in the control group were given routine intervention, while patients in the observation group were given nutritional support based on routine intervention. These two interventions were administered till 1 month after chemotherapy. Chemotherapeutic efficacy and safety were compared between the two groups. Results:Total response rate in the observation group was significantly higher than that in the control group [92.3% (60/65) vs. 78.5% (51/65), Z = 4.91, P < 0.05]. After chemotherapy, waist-to-hip ratio, arm girth, and body mass index in the observation group were (0.9 ± 0.1), (25.7 ± 1.2) cm, (21.9 ± 2.1) kg/m 2, respectively, which were significantly greater than (0.8 ± 0.1), (24.4 ± 1.1) cm, (20.6 ± 2.1) kg/m 2 in the control group, respectively ( t = 4.13, 6.63, 3.64, all P < 0.05). Transferrin, albumin, prealbumin, and total serum protein in the observation group were (1.4 ± 0.3) g/L, (27.5 ± 3.1) g/L, (171.3 ± 11.3) mg/L, and (61.2 ± 4.3) g/L, respectively, which were significantly higher than (1.3 ± 0.3) g/L, (25.2 ± 2.9) g/L, (154.3 ± 10.3) mg/L, (56.6 ± 4.0) g/L respectively in the control group ( t = 2.24, 4.48, 8.93, 6.31, all P < 0.05). The scores of emotional state, social status, role cognition, and somatic perception in the observation group were (57.5 ± 4.6) points, (64.5 ± 3.8) points, (56.5 ± 4.1) points, (62.0 ± 4.2) points, which were significantly higher than (47.9 ± 4.2) points, (56.4 ± 3.2) points, (47.7 ± 4.5) points, (55.5 ± 5.4) points in the control group ( t = 12.34, 13.04, 11.55, 7.65, all P < 0.05). The total incidence of adverse reactions in the observation group was 9.2% (6/65), which was significantly lower than 24.6% (16/65) in the control group ( χ2 = 4.43, P < 0.05). Conclusion:Nutritional support can substantially improve chemotherapeutic efficacy in the treatment of acute myeloid leukemia, decrease the incidence of adverse reactions, and is safe. Therefore, nutritional support for patients with acute myeloid leukemia deserves clinical promotion.

Objective:To investigate the effects of propofol and sevoflurane on post-traumatic stress disorder (PTSD) after emergency surgery in trauma patients.Methods:A total of 160 trauma patients undergoing emergency surgery under general anesthesia were randomly divided into the propofol group and the sevoflurane group. The perioperative clinical data of the two groups were collected. The incidence of PTSD was evaluated by PCL-5 score one month after the operation in the two groups. The relevance of the injury time and PCL-5 score was assessed by Spearman correlation analysis. Logistic regression analysis was used to analyze the risk factors of PTSD.Results:The incidence of PTSD in the propofol group was significantly higher than that in the sevoflurane group at postoperative 1 month (24.0% vs 10.8%, P=0.034). The injury time was negatively correlated with PCL-5 score in the propofol group ( r=0.229, P<0.01). There was no correlation between the injury time and the PCL-5 score in the sevoflurane group ( r=0.001, P=0.804). Logistic regression analysis showed that the use of propofol was an independent risk factor for PTSD ( P=0.004). Conclusions:Sevoflurane anesthesia is more effective than propofol anesthesia in reducing the occurrence of PTSD in emergency surgery for trauma patients.

Objective:To explore the establishment of a cluster intervention strategy by multi-criteria decision analysis (MCDA) to provide a basis for the early removal of indwelling catheters in severe neurological patients.Methods:Through literature retrieval and MCDA, the catheter cluster intervention strategy was constructed, and the expert consultation was adopted to finally form 7 item cluster intervention strategies. The convenience sampling method was used to select 122 patients with severe neurological diseases as the research objects. A total of 61 patients with indwelling catheters from November 2018 to April 2019 were selected as the control group, and routine nursing care was performed according to indwelling catheters. A total of 61 patients with indwelling catheters from May 2019 to October 2019 were selected as the intervention group to compare the success rate of removing catheters, the number of days of indent catheters and the incidence of catheter-associated urinary tract infection ( CAUTI) in the two groups, as well as to analyze the indicators related to indent catheters in the intervention group with different diagnoses. Results:CAUTI incidence, successful catheter removal rate, indwelling days of catheter in the intervention group were 39.3% (24/61), 32.79% (20/61), 17 (14,22) days, which were significantly higher than 59.0% (36/61), 8.19% (5/61), 21 (15, 27) days in the control group, and the difference was statistically significant (χ 2 values were 4.723, 11.775, Z value was -9.211, P<0.05 or 0.01); In the intervention group, stroke patients′ indwelling time of catheter were 7-20 days, and the highest success rate of removing urinary catheters 36.6% (15/41), compared with other diseases, the difference was statistically significant ( Z values were -2.448, -2.109, P<0.05). Conclusion:MCDA construction of early catheter removal strategy can significantly shorten the indwelling time of the catheter in patients with severe neurological diseases, improve the success rate of early catheter extubation, reduce the CAUTI rate, to provide evidence-based basis for clinical nursing.

Objective To observe the influence of edaravin combined with cerebroside-kinin on the level of glial fiber acidic protein (GFAP) and ubiquitin carboxyl terminal-L1 (UCH-L1) in the treatment of severe craniocerebral injury.Methods From January 2016 to December 2017,a total of 123 patients with severe craniocerebral injury were selected in our hospital,and randomly(random number) assigned to the observation group (61 cases) and control group (62 cases).Patients in the control group were given cerebroside-kinin,and patients in the observation group were given cerebroside-kinin and edaravone.The acute physiology and chronic health evaluation score (APACHE Ⅱ),activities of daily living (ADL) score,serum malonaldehyde (MDA),superoxide dismutase (SOD),myeloperoxidase (MPO),matrix metalloprotein 9 (MMP-9),GFAP and UCH-L1 before and after treatment were observed.The side effects were also recorded.Results The APACHE Ⅱ score was significantly reduced in both groups after treatment (P=0.008;P=0.003),and was lower in the observation group than that in the control group (P=0.013).The ADL score of both groups increased after treatment (P=0.025;P=0.008),and was higher in the observation group than that in the control group (P=0.012).After treatment the levels of MDA,SOD and MPO in the observation group were significantly higher than those in the control group (P＜0.05);the level of MMP-9 in the observation group was significantly lower than that in the control group (P=0.012);the levels of GFAP and UCH-L 1 in the observation group were significantly higher than those in the control group (P=0.014;P=0.035).There was no significant difference of the total side effect incidence between the observation group and the control group (8.06％ vs 9.83％,x 2=0.088,P=0.719).Conclusions The treatment by edaravone combined with cerebroside-kinin on severe craniocerebral injury may effectively protect the nerve cells,improve nerve function,clinical efficacy and the body's antioxidant capacity,reduce the serum levels of GFAP,UCH-L1,and have better safety.