Objective To investigate the incidence and types of patient-ventilator asynchrony(PVA)in mechanically ventilated patients within the intensive care unit(ICU),and to identify associated high-risk factors,thereby providing a basis for reducing PVA,enhancing mechanical ventilation efficiency,and refining ventilation strategies.Methods A prospective observational study was conducted among patients admitted to the general ICU of the Affiliated Hospital of Guizhou Medical University from October to December 2024 who were receiving mechanical ventilation.Inclusion criteria were as follows:age ≥18 years and mechanical ventilation duration ≥12 hours.Exclusion criteria included complete controlled mechanical ventilation,palliative care or do-not-resuscitate status,and lack of informed consent.Senior respiratory therapists performed daily bedside observations of ventilator waveforms for 10～15 minutes between 08:00 and 12:00.PVA was diagnosed based on pressure-time and flow-time waveforms,with the types of PVA being recorded.Demographic and clinical data,including age,sex,body mass index(BMI),primary diagnosis,comorbidities,APACHEⅡ score at ICU admission,blood gas analysis,ventila-tion mode and parameters,analgesia and sedation status,duration of mechanical ventilation,and length of ICU stay,were collected.The incidence and types of PVA during the observation period were analyzed.Univariate and multivariate logistic regression analyses were performed to identify high-risk factors for PVA.Clinical outcomes were compared between patients with and without PVA.Results A total of 105 patients and 453 episodes of assisted mechanical ventilation waveforms were analyzed.Among these,60.95％(64/105)experienced at least one episode of PVA.Of the 453 ventilation waveforms assessed,35.76％(162/453)demonstrated PVA.The types of PVA,ranked by incidence,were as follows:cycling mismatch(12.58％,57/453),double triggering(11.92％,54/453),ineffective triggering(9.49％,43/453),flow starvation(5.30％,24/453),and exhalation flow limitation(1.77％,8/453).The incidence of PVA varied significantly across different ventilation modes:45.7％in volume-assist/control ventilation(V-A/C),38.1％in pressure-assist/control ventilation(P-A/C),42.9％in synchronized intermittent mandatory ventilation(SIMV),and 16.7％in pressure support ventilation(PSV)(P<0.001).Multi-variate logistic regression analysis revealed that the mechanical ventilation mode[reference:PSV;V-A/C:OR=4.687,95％CI:2.140～10.263,P<0.001;P-A/C:OR=2.922,95％CI:1.489～5.734,P=0.002;SIMV:OR=4.682,95％CI:1.758～12.466,P=0.002]and actual respiratory rate(OR=1.07,95％CI:1.016～1.127,P=0.011)were significant high-risk factors for PVA.Patients with PVA had a significantly longer duration of mechanical ventilation[8.21(5.35,13.91)days vs.3.00(1.96,5.71)days,P<0.001]compared to those without PVA.Conclusions PVA is commonly observed in ICU patients receiving assisted invasive mechanical ventilation,with cycling mismatch,double triggering,and ineffective triggering being the most prevalent types.The incidence of PVA tends to be lower when using the PSV mode.Clinically,real-time monitoring of patient-ventilator synchrony via ventilator waveforms,along with the optimization of ventilator modes and parameters,should be employed to minimize the occurrence of PVA and enhance the efficiency of mechanical ventilation.

Objective To investigate the incidence and types of patient-ventilator asynchrony(PVA)in mechanically ventilated patients within the intensive care unit(ICU),and to identify associated high-risk factors,thereby providing a basis for reducing PVA,enhancing mechanical ventilation efficiency,and refining ventilation strategies.Methods A prospective observational study was conducted among patients admitted to the general ICU of the Affiliated Hospital of Guizhou Medical University from October to December 2024 who were receiving mechanical ventilation.Inclusion criteria were as follows:age ≥18 years and mechanical ventilation duration ≥12 hours.Exclusion criteria included complete controlled mechanical ventilation,palliative care or do-not-resuscitate status,and lack of informed consent.Senior respiratory therapists performed daily bedside observations of ventilator waveforms for 10～15 minutes between 08:00 and 12:00.PVA was diagnosed based on pressure-time and flow-time waveforms,with the types of PVA being recorded.Demographic and clinical data,including age,sex,body mass index(BMI),primary diagnosis,comorbidities,APACHEⅡ score at ICU admission,blood gas analysis,ventila-tion mode and parameters,analgesia and sedation status,duration of mechanical ventilation,and length of ICU stay,were collected.The incidence and types of PVA during the observation period were analyzed.Univariate and multivariate logistic regression analyses were performed to identify high-risk factors for PVA.Clinical outcomes were compared between patients with and without PVA.Results A total of 105 patients and 453 episodes of assisted mechanical ventilation waveforms were analyzed.Among these,60.95％(64/105)experienced at least one episode of PVA.Of the 453 ventilation waveforms assessed,35.76％(162/453)demonstrated PVA.The types of PVA,ranked by incidence,were as follows:cycling mismatch(12.58％,57/453),double triggering(11.92％,54/453),ineffective triggering(9.49％,43/453),flow starvation(5.30％,24/453),and exhalation flow limitation(1.77％,8/453).The incidence of PVA varied significantly across different ventilation modes:45.7％in volume-assist/control ventilation(V-A/C),38.1％in pressure-assist/control ventilation(P-A/C),42.9％in synchronized intermittent mandatory ventilation(SIMV),and 16.7％in pressure support ventilation(PSV)(P<0.001).Multi-variate logistic regression analysis revealed that the mechanical ventilation mode[reference:PSV;V-A/C:OR=4.687,95％CI:2.140～10.263,P<0.001;P-A/C:OR=2.922,95％CI:1.489～5.734,P=0.002;SIMV:OR=4.682,95％CI:1.758～12.466,P=0.002]and actual respiratory rate(OR=1.07,95％CI:1.016～1.127,P=0.011)were significant high-risk factors for PVA.Patients with PVA had a significantly longer duration of mechanical ventilation[8.21(5.35,13.91)days vs.3.00(1.96,5.71)days,P<0.001]compared to those without PVA.Conclusions PVA is commonly observed in ICU patients receiving assisted invasive mechanical ventilation,with cycling mismatch,double triggering,and ineffective triggering being the most prevalent types.The incidence of PVA tends to be lower when using the PSV mode.Clinically,real-time monitoring of patient-ventilator synchrony via ventilator waveforms,along with the optimization of ventilator modes and parameters,should be employed to minimize the occurrence of PVA and enhance the efficiency of mechanical ventilation.

Objective:To investigate the efficacy of Yupingfeng powder combined with extensively hydrolyzed milk formulas in the treatment of milk protein allergy in infants and its effects on immune function, interleukin-10 (IL-10) and IL-22 levels. Methods:Eighty infants with milk protein allergy who received treatment in Hangzhou Children's Hospital from January 2020 to January 2021 were included in this study. They were randomly assigned to Yupingfeng powder and conventional treatment groups, with 40 infants per group. An additional 80 infants who concurrently received health examination in the same hospital were included in the control group. The conventional group was treated with extensively hydrolyzed milk formulas. The Yupingfeng powder group was treated with Yupingfeng powder combined with extensively hydrolyzed milk formulas. All infants were treated for 30 successive days. Clinical efficacy, serum total immunoglobulin (IgE), milk specific IgE (sIgE), peripheral blood CD 4+CD 25+ Treg, IL-10 and IL-22 levels were compared between groups. Results:Total response rate in the Yupingfeng powder group was significantly higher than that in the conventional treatment group [92.50% (37/40) vs. 72.50% (29/40), χ2 = 5.54, P < 0.05]. Serum total IgE and milk sIgE levels in the Yupingfeng powder group were (132.93 ± 14.61) IU/L and (0.62 ± 0.14) IU/L, respectively, which were significantly lower than (150.27 ± 16.22) IU/L and (0.85 ± 0.17) IU/L in the conventional treatment group ( t = 5.02, 6.61, both P < 0.05). The expression of CD 4+CD 25+ Treg in the Yupingfeng powder group was significantly higher than that in the conventional treatment group [(13.29 ± 1.40)% vs. (11.84 ± 1.27)%, t = 4.85, P < 0.05). CD 4+CD 25+ Treg expression in the Yupingfeng powder group was not significantly different from that in the control group [(13.40 ± 2.03)%, t = 0.31, P = 0.759]. IL-10 in the Yupingfeng powder group was significantly higher than that in the conventional treatment group [(34.57 ± 4.07) μg/L vs. (22.19 ± 2.15) μg/L, t = 17.01, P < 0.05]. IL-22 level in the Yupingfeng powder group was significantly lower than that in the conventional treatment group [(2.20 ± 0.42) ng/L vs. (5.28 ± 0.79) ng/L, t = 21.77, P < 0.05]. IL-10 and IL-22 levels in the Yupingfeng powder group were not different from those in the control group [(35.53 ± 3.85) μg/L, (2.13 ± 0.53) ng/L, t = 1.26, P = 0.209; t = 0.73, P = 0.468]. Conclusion:Yupingfeng powder combined with extensively hydrolyzed milk formulas is highly effective on milk protein allergy. The combined therapy can improve the immune function of infants, enhance IL-10 level, and decrease IL-22 level.

Objective To explore the care burden and its influencing factors of primary caregiver of patients with spinal cord injury. Methods A total of 120 primary caregiver of spinal cord injury patients were selected as research object. The general information of SCI patients and their primary caregiver were investigated by SCI patient general data questionnaire and primary caregiver in SCI patient general data questionnaire, caregiver burden of spinal cord injury were investigated bycaregiver burden inventory. The relationship between the general information of patients and caregivers and the care burden analyzed. Results Caregiver burden of elderly patients was significantly lower than that of younger ones (F=54.053,P<0.01). The more serious of spinal cord injury, the higher of care burden (F=315.104,P<0.01). The patients with neck and multiple segmental spine injury and postoperative complications had a higher care burden (F=199.203,t=6.462, 32.195,P<0.01). When the caregivers were female, spouses or children, with poor health condition, with higher education degree, and as cadres or workers, caregiver burden was higher (t=6.061,F=22.073-52.392,P<0.01). Multiple linear regression analysis showed that the degree of spinal cord injury, complications, gender, and the relationship between the patients were the main factors that influenced the care burden. Conclusions The main factors influencing the care burden are spinal cord injury degree, complications, gender, and the relationship between the patients. Clinical managers needs to develop appropriate social support system for the factors which affect the caregiver, in order to ease the caregiver′s care burden.

Objective To explore the effect of multimodal analgesia in patients with hip replacement . Methods A total of 108 cases were divided into two groups equally:control group and observation group . Patients in the control group were given PCA (patient controlled analgesia ) for 48 hours,and then we changed to oral analgesics(celecoxib) for 4 days.Patients in observation group were given both PCA and oral analgesics (celecoxib) for 6 days.NRS pain score was applied to assessed the analgesia effect in two groups .Results In the observation group, NRS scores in operative day,postoperative day 1, day 3 and day 6 were (4.4 ±1.8), (4.4 ±1.5),(3.5 ±1.3)and (2.0 ±1.6) respectively,those were lower than the scores in the control group . The difference between the two groups was statistically significant ( t=74.131,106.335,223.316,217.195, respectively;P<0.01).Conclusions PCA combined oral analgesia (celecoxib) can improve the analgesic effect obviously .