Objective To investigate the clinical value of closed-type mono-lumen drainage tube(M) and open double-lumen drainage tube(D)for hepstectomy.Methods The data from 99 patients who un-derwent hepatectomy in our depamnent from July 2005 to May 2008 were analyzed retrospectively.All patients were divided into two groups according to the draining methods:group M (n=59)used closed-type mono-lu-men drainage tube and group D(n=40) used double-lumen drainage tube.The incidence of pipe blockage,ef-fusion under diaphragm,the duration of drainign and the duration of hospitalization between the two groups was compsred.Results M group was better than D group in the patency of drainage tube,effusion under di-aphragm,the duration of draining and the duration of hospitalization,P＜0.05.Condusions It is advocated to apply closed-type mono-lumen drainage tube after refined hepsteetomy.

Objective To investigate the level of disaster nursing ability and cognitive status of nursing manager,explore the characteristics and influencing factors,in order to provide a basis for intervention in improving the capacity of disaster nursing care.Methods 113 nursing managers were recruited by convenience sampling from a first-class ternary hospitals in Anhui province.They were investigated by a self-designed demographic data questionnair and disaster nursing and cognitive scale.Results The score of the disaster nursing ability of the nursing managers was 114.12±18.21,the mean score was 2.65±0.42,both below the medium level.Regression analysis showed that the nursing age of nurse manager,whether accepted disaster nursing training after work were the influencing factors of the disaster nursing ability of the nursing managers and explained 33.5％ of the variance.Conclusions The capacity of disaster nursing care of nurse managers is not high.The nursing age of nurse manager,whether accepted disaster nursing training after work were the influencing factors of the disaster nursing ability of the nursing managers.

Objective To investigate the clinical effects of open decompression drainage on acute pulpitis.Methods Totally 180 acute pulpitis patients hospitalized during January 2012 to September 2014 in our department were selected and randomly divided into control group and observation group (n=80 each).The control group was treated with pulp inactivating agent and the observation group was given open decompression drainage.The clinical effects,analgesia efficiencies at 7d after treatment,treatment course and the complications were compared between the 2 groups.Results There was significant difference in the effective rate between control and observation groups after treatment [61.3％ (49/80 cases) vs.86.3％ (69/80 cases),P＜0.05].The analgesia efficiencies at 7d after treatment was 46.3％ (37/80 cases) in control group and 73.8％ (59/80 cases)in observation group (P＜0.05).There was no significant difference in treatment course between two groups [(7.7±1.4) times vvs.(6.1± 1.2) times,P＞0.05]].6 patients developed periapical periodontitis in control group,and only 4 cases in the observation group (P＞0.05).Conclusions Early open decompression drainage has good clinical effects and analgesia efficiencies in treatment of acute pulpitis,which is worthy of clinical application.

Objective To detect nuclear DNA degradation of bone marrows and brains in rat cadavers at different temperatures,and develop a new parameter for estimating early postmortem interval(PMI).Methods The brain and bone marrow were taken out for every 4h,during 0~40h after death at 10℃ and 20℃,respectively.And the single cell gel electrophoresis(SCGE) was carried out to detect the nuclear DNA degradation.Linear regression analysis was used to assay the relationship of the comet parameter HeadDNA%,Tail Length(TL) and Olive TailMoment(TM) with PMI.Results Different decline degrees of comet HeadDNA% were found in both brain cells and bone marrow cells after death,the decline of HeadDNA% in brain cells at 20℃ was faster.Compared with degradation in marrow cells,the linear relation between degradation of brain cells and PMI was better.Conclusion with that of comet parameters TL and TM,the perfect linear relationship between HeadDNA% and PMI was also observed.Conclusion Brain tissues are more suitable for PMI estimation by detecting degradation of DNA with SCGE.The HeadDNA% is more valuable for PMI estimation than TL and TM.

Objective To study the affecting factors of the activities of daily living in patients after abdominal surgery.Methods Using survey methodology,95 abdominal surgery patients were investigated br general condition questionnaire and Barthel index scales.The data were analyzed using descriptive analysis,t test,variance analysis and multiple regression analysis.Results The total number of valid return was 91.and the valid usable return rate was 95.8% .The affecting factors of recovery to ADL2 of abdominal surgery patients after operation were gender,age,education level,economic condition,type of illness,postoperation complications,operation times,nutrition risk scores and activities of daily living of preoperation,and the differences were significant.The affecting factors of recovery to ADL1 of abdominal surgery patients after operation were age,education level economic condition,marital status,type of illness,postoperation complications,nutrition risk scores and activities of daily living of preoperation,the differences wen significant.Conclusions The affecting factors of ADL of abdominal surgery patients after operation were gender,age,education level economic level,type of illness,postoperation complications,marital status,operation times,nutrition risk scores and activities of daily living of preoperation.

Objective To study the clinical application of dynamic monitoring of mainstream endtidal carbon dioxide in neonatal respiratory distress syndrome.Methods All of 23 premature neonates diagnosed with NRDS and placed on mechanical ventilation were admitted in this study.Their PetCO_2 was continuously monitored and paired with PaCO_2 at 112 different time points.The correlation between PetCO_2and PaCO_2 was compared.Results This study showed that the average PaCO_2 measured for 112 times was(38.2±5.6)mm Hg(1 mm Hg=0.133kPa)and the corresponding PetCO_2 was,(32.4±4.9)mm Hg;it also showed that PetCO_2 was positively correlated with PaCO_2 and PetCO_2 was even more closely correlated with PaCO_2 in infants with second degree of NRDS than in patients with third and fourth degree of NRDS.Conclusions Dynamically monitoring mainstream PetCO_2 is applicable in mechanically ventilated premature infants with NRDS,it can accurately reflect the level of PaCO_2;Thereby reducing the blood gas analysis,thus reducing the suffering of nursing workload and children.But it has limited significance in cases of severe NRDS.

Objective To explore the feasibility and application value of combined C2 laminar screw fixation technique in treatment of cervical vertebral injury. Methods Dense axial CT scanning was done on C2 laminar of 32 specimens of cervical vertebra to measure the length and height of the axis, the thickness of upper, middle and lower parts of the axis as well as the angle between the axial ray and the sagittal plane. There were eight patients with cervical vertebral injury including two with type Ⅱ odon-told process fractures combined with backward dislocation of atlanto-axial joint, one with forward disloca-tion of atlanto-axial joint, one with nonunion of odontoid process fractures, two with type Ⅲ odontoid process fractures combined with atlanto-axial joint instability and transverse ligament rupture, one with type Ⅱ Hangman fracture combined with instability of C2～3 and one with forward dislocation of atlanto-axial joint combined with transverse ligament rupture. With accomplishment of traction reduction, combined fixation with axis laminar screws and posterior autogenous lilac graft fusion were done based on injury se-verity of the patients. Results The length and height of axis laminar was (26.2±1.2) mm and (12.8±1.6) mm, respectively. The thickness of upper, middle and lower parts of the C2 laminar was (3.0±1.4) mm, (6.0±1.6) mm and (5.6±1.2) mm, respectively. The mean angle between the axial ray and sagittal plane was 43.5°. All patients were followed up for 6-14 months ( mean 6 months), which showed that all patients obtained favourable bone union and all screws remained at sound position, without deflexion of the screws or any perioperative or postoperative complications. No screw loosening or breakage occurred. Conclusions C2 laminar screw fixation technique can prevent the risk of vertebral artery injury during screw insertion. In the meantime, such technique is simple to operate and free from limitation of the vertebral artery in the cervical foramen. Whole course of visualization during C2 laminar screw insertion may facilitate it as a supplementary method for conventional posterior C2 screw fixation.

Objective To evaluate the effect of airway pressure release ventilation (APRV) in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS), to evaluate the extent of ventilator-induced lung injury (VILI), and to explore its possible mechanism. Methods A prospective study was conducted in the Department of Critical Care Medicine of the First Hospital of Hebei Medical University from December 2010 to February 2012. The patients with ALI/ARDS were enrolled. They were randomly divided into two groups. The patients in APRV group were given APRV pattern, while those in control group were given lung protection ventilation, synchronized intermittent mandatory ventilation with positive end-expiratory pressure (SIMV+PEEP). All patients were treated with AVEA ventilator. The parameters such as airway peak pressure (Ppeak), mean airway pressure (Pmean), pulse oxygen saturation (SpO2), mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), arterial blood gas, urine output (UO), the usage of sedation and muscle relaxation drugs were recorded. AVEA ventilator turning point (Pflex) operation was used to describe the quasi-static pressure volume curve (P-V curve). High and low inflection point (UIP, LIP) and triangular Pflex volume (Vdelta) were automatically measured and calculated. The ventilation parameters were set, and the 24-hour P-V curve was recorded again in order to be compared with subsequent results. Venous blood was collected before treatment, 24 hours and 48 hours after ventilation to measure lung surfactant protein D (SP-D) and large molecular mucus in saliva (KL-6) by enzyme linked immunosorbent assay (ELISA), and the correlation between the above two parameters and prognosis on 28 days was analyzed by multinomial logistic regression. Results Twenty-six patients with ALI/ARDS were enrolled, and 22 of them completed the test with 10 in APRV group and 12 in control group. The basic parameters and P-V curves between two groups were similar before the test. After 24 hours and 48 hours, mechanical ventilation was given in both groups. The patients' oxygenation was improved significantly, though there were no significant changes in hemodynamic parameters. The Pmean (cmH2O, 1 cmH2O = 0.098 kPa) in APRV group was significantly higher than that in control group (24 hours: 24.20±4.59 vs. 17.50±3.48, P < 0.01; 48 hours: 18.10±4.30 vs. 15.00±2.59, P < 0.05). After ventilation for 24 hours, the ratio of patients with increased Vdelta in APRV group was higher than that in control group (90% vs. 75%), but without statistical difference (P > 0.05). The SP-D level (μg/L) in serum in APRV group showed a tendency of increase (increased from 19.70±7.34 to 27.61±10.21, P < 0.05), in contrast there was a tendency of decrease in control group (decreased from 21.83±7.31 to 16.58±2.90, P > 0.05), the difference between the two groups was statistically significant (P < 0.05). After 48-hour ventilation, SP-D in APRV group was decreased, but no change was found in control group, and no significant difference was found as compared with that of the control group (16.45±8.17 vs. 17.20±4.59, P > 0.05). There was no significant difference in serum KL-6 between the two groups before and after ventilation. The SP-D and KL-6 levels in serum were unrelated with 28-day survival rate of the patients. The odds ratio (OR) of SP-D were 0.900 [95% confidence interval (95%CI) = 0.719-1.125], 1.054 (95%CI = 0.878-1.266), 1.143 (95%CI = 0.957-1.365), and the OR of KL-6 were 1.356 (95%CI = 0.668-2.754), 0.658 (95%CI = 0.161-2.685), 0.915 (95%CI = 0.350-2.394) before the test, 24 hours and 48 hours after ventilation (all P > 0.05). Conclusions APRV was similar to lung protective ventilation strategy in oxygenation and improvements in the lung mechanics parameters. APRV with a higher Pmean can recruit alveolar more effectively, and it had no impact on hemo-dynamics, but might exacerbate VILI.

Objective To comprehensively grasp the grassroots medical institutions blood transfusion(blood) management present situation,put forward improvement strategy for the universality of existence weak link,the stand-ardized management of clinical blood transfusion to strengthen grass -roots medical institutions to provide necessary theoretical support.Methods 62 grassroots medical institutions blood transfusion(blood)in Yantai district were selected as the research subjects,to set the planning,layout,basic construction standards,related technology and equipment application aspects of quantitative evaluation,preliminary conclusions.Results By examination of 62 grassroots medical institutions transfusion quality management level both in terms of hardware and software facilities, emergency plan formulation,system file support informatization construction,staff education training,etc,found many problems,there was a certain gap between the existing department of blood transfusion standards.Conclusion The current grassroots medical institutions transfusion management is conditioned by the objective conditions,there are many problems,such as not improved,will cause a certain hidden trouble on the safety of clinical blood transfusion. Therefore,should combine their own reality,strengthen the quality of blood transfusion management system construc-tion,and give full play to the supervision and management of the hospital transfusion quality management committee. At the same time,the local administrative department of health also should formulate corresponding policies,ensure transfusion management level significantly increased.