Objective:To investigate clinical characteristics of cerebrovascular disease complicated with secondary epilepsy in the elderly, and to provide the targeted health care measures.Methods:The 106 elderly patients with epilepsy secondary to cerebrovascular diseases treated in Three Gorges Hospital Affiliated to Chongqing University were enrolled as the epilepsy group, and another 106 patients with single cerebrovascular disease without secondary epilepsy during same period were included as the control group.Clinical features and epileptic seizure activity were observed and analyzed, and the targeted health care measures were developed.Results:The proportions of patients with cerebral hemorrhage, cerebral lobe infarction, cortical dysfunction and abnormal brain waves were higher in the epilepsy group [ 66.99%(71 cases), 68.87%(73 cases), 83.02%(88 cases), 70.75%(75 cases), respectively]than in the control group(43.40% or 46 cases, 46.23% or 49 cases, 61.32% or 65 cases, 53.77% or 57 cases)( χ2=11.921、11.121、12.424、6.505, all P<0.05). NFD scores before treatment had no significant difference between the epilepsy group and the control group(22.7±4.8 vs.23.4±5.1, t=1.029, P=0.152). NFD score after 3 months of treatment was higher in the epilepsy group than in the control group(14.3±2.9 vs.10.1±2.5, t=11.294, P=0.000). Conclusions:Epilepsy is a common complication of various cerebrovascular diseases, among which the cerebral hemorrhage is the most common.Polyloencephalopathy and cortical involvement can increase the risk of epilepsy in patients with cerebrovascular diseases.Therefore, it is very important to provide the necessary treatment and health care, so as to reduce the impact of epileptic seizure on the disease condition and improve prognosis in patients with cerebrovascular disease.

Objective:To investigate the effects of positive end-expiratory pressure (PEEP) setting of mechanical ventilation guided by esophageal pressure in the treatment of patients with traumatic craniocerebral injury combined with acute respiratory distress syndrome (ARDS).Methods:The retrospective cohort study was conducted. From June 2016 to June 2018, 55 patients with traumatic craniocerebral injury combined with ARDS who met the inclusion criteria were admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University. According to PEEP setting method, 28 patients were allocated to esophageal pressure group (17 males and 11 females, aged (40±13) years) and 27 patients were allocated to PEEP-fractional concentration of inspired oxygen (FiO 2) table group (18 males and 9 females, aged (38±10) years). Patients in the 2 groups were treated with mechanical ventilation guided by lung protective ventilation strategy, and the optimal PEEP at 0 (immediately), 24, 48, and 72 h after treatment was determined according to esophageal pressure and PEEP-FiO 2 table, respectively. The mechanical ventilation parameters in the 2 groups were adjusted according to the optimal PEEP. The transpulmonary end-expiratory pressure, pulmonary compliance, oxygen index, central venous pressure, mean arterial pressure, and intracranial pressure at 24, 48, and 72 h after treatment were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, independent sample t test, and Bonferroni correction. Results:The optimal PEEP of patients in esophageal pressure group at 0, 24, 48, and 72 h after treatment was (12.4±3.9), (11.2±3.5), (13.4±2.6), and (13.2±3.6) cmH 2O (1 cmH 2O=0.098 kPa), respectively, which was significantly higher than (8.2±2.5), (7.4±2.2), (8.3±2.3), and (8.5±2.5) cmH 2O in PEEP-FiO 2 table group, respectively ( t=4.702, 4.743, 7.849, 5.623 , P<0.01). The transpulmonary end-expiratory pressure and pulmonary compliance at 24, 48, and 72 h after treatment and oxygen index at 48 and 72 h after treatment of patients in esophageal pressure group were significantly higher than those in PEEP-FiO 2 table group ( t=17.852, 20.586, 19.532, 4.752, 5.256, 7.446, 2.342, 4.178, P<0.05 or P<0.01). The central venous pressure of patients in esophageal pressure group at 24, 48, and 72 h after treatment was significantly higher than that in PEEP-FiO 2 table group ( t=12.632, 5.247, 8.994, P<0.01), and there was no statistically significant difference in mean arterial pressure of patients between the 2 groups at 24, 48, and 72 h after treatment ( P>0.05). The intracranial pressure of patients in esophageal pressure group was higher than that in PEEP-FiO 2 table group at 24, 48, and 72 h after treatment, but there was no statistically significant difference between the 2 groups ( P>0.05). Conclusions:For patients with traumatic craniocerebral injury combined with ARDS, the optimal PEEP can be set under the guidance of esophageal pressure method, and the mechanical ventilation parameters adjusted according to the optimal PEEP can improve lung compliance and accelerate recovery of lung function more effectively, with no adverse effect in mean arterial pressure and intracranial pressure.

Objective:To explore the influencing factors of dietary behavior change of young and middle-aged patients after percutaneous coronary intervention (PCI) from the perspective of the family system, so as to provide the basis for home dietary intervention of patients.Methods:Using the phenomenological research method, 32 young and middle-aged PCI patients and their family members from Department of Cardiology, Xuanwu Hospital, Capital Medical University were interviewed in a semi-structured in-depth way by purposive sampling method from May to October 2022, and the data were analyzed by Colaizzi 7-step analysis method.Results:Among the 32 surveyed individuals, there were 17 males and 15 females, aged 22-61 years old. Two themes of dietary behavior change facilitators and barriers of young and middle-aged patients after PCI were extracted. The facilitators included six subthemes: behavioral autonomy, adaptive change, small family size, motivation for family responsibility, internal family resources, and external family resources. The barriers included five subthemes: bad learned habits, special physical conditions, lack of nutritional literacy, passive dietary environment, and limited economic level.Conclusions:Dietary behavior changes in young and middle-aged patients after PCI were affected by individual and family factors in the family. Medical staff should establish a family-centered dietary management model and integrate the advantages of family resources to give patients targeted individualized nutrition intervention.