This study summarizes the holistic nursing management of high-output stomas in three cases of refractory Crohn's disease following double stoma surgery.The nursing highlights encompassed management of high-output stomas(including assessment of high stoma output,use of octreotide ace-tate combined with Bifidobacterium and montmorillonite powder to reduce high stoma output,and dual stoma management),dynamic assessment of nutritional risk,stepped nutritional support,psychological intervention,and continued care at home.After treatment and nursing,the high stoma output in all three patients was effectively controlled,their nutritional status gradually improved,and they were dis-charged in an improved condition.

Objective : To analyze the length of hospital stay of patients with heart failure in a multicenter cohort in order to explore the influencing factors of length of stay and provide data support for further intervention. Methods: A total of 2 794 patients enrolled in the multicenter prospective heart failure cohort were divided into two groups: long hospital stay group (≥9 days) and short hospital stay group ( < 9 days) . The general data of the two groups were compared, and the factors with statistical difference in univariate analysis were included in Logistic multifactor regression analysis to explore the difference in length of hospital stay between the two groups. According to left ventricular ejection fraction(LVEF), patients were divided into heart failure with preserved reduced ejection fraction (HFpEF)group, heart failure with mildly reduced ejection fraction(HFmrEF)group and heart failure with reduced ejection fraction(HFrEF) group, and Logistic multifactor regression analysis was performed to find influencing factors. Results : Logistic multifactor regression analysis showed that LVEF, pneumonia, N⁃terminal pro⁃B⁃type natriuretic peptide(NT⁃proBNP), serum sodium, cardiac resynchronization therapy( CRT) or implantable cardioverter defibrillator(ICD)implantation, β blockers, aldosterone receptor antagonists, positive inotropic drugs and vasodilators were all factors influencing the hospitalization of HF patients. In the HFpEF, HFmrEF, and HFrEF groupsCRT/ICD implantation, positive inotonic drugs, and vasodilator use were suggested to be common factors affecting length of hospital stay in all three groups. Conclusion LVEF, pneumonia, NT⁃proBNP, serum sodium, CRT or ICD implantation, β blockers, aldosterone receptor antagonists, positive inotropic drugs and vasodilators are the influencing factors of hospitalization time in HF patients.

Objective: To analyze the predictors of left ventricular reverse remodeling in patients with III? atrio-ventricular block (AVB) combining left ventricular systolic dysfunction after cardiac re-synchronization therapy (CRT). Methods: A total of 65 III? AVB patients received CRT in our hospital from 2009-01 to 2015-05 were enrolled. Clinical information before and after the operation were recorded. Left ventricular reverse remodeling was deifned by left ventricular end systolic volume (LVESV) decreased 15% or left ventricular ejection fraction (LVEF) increased≥5% at 12 months after CRT. The patients were divided into 2 groups: Reversal group,n=36 and No reversal group,n=29. Clinical condition was compared between 2 groups, predictors for CRT reversing left ventricular remodeling were evaluated by two classiifcation Logistic regression analysis. Results: The patients' average age was (62±14) years and 36/65 (55.4%) with reverse remodeling. In Reversal group, the ratios of female (P=0.011), baseline QRS width>120ms (P=0.001), inter-ventricular mechanical delay (IVMD)≥40 ms (P=0.027) and standard deviation of time-to-minimum systolic volume of 16 segments [Tmsv16-SD (%R-R)≥8.3%, (P=0.001)] were higher than those in No reversal group. Two classiifcation Logisitic regression analysis indicated that female (OR=6.228, 95%CI 1.561-24.842, P=0.01), QRS duration>120 ms (OR=7.778, 95% CI 1.996-30.769,P=0.003) and Tmsv16-SD (%R-R)≥8.3% (OR=8.134, 95% CI 2.064-32.057,P=0.003) were the independent predictors for ventricular reverse remodeling . Conclusion: Female, QRS>120ms and Tmsv16-SD (%R-R)≥8.3% could be used as the predictors for CRT reversing left ventricular remodeling in III? AVB patients combining left ventricular systolic dysfunction.

Objective: To observe the impact of cardiac resynchronization therapy (CRT) on ventricular remodeling in patients with III°atrio-ventricular block (AVB) combining systolic dysfunction.
Methods: A total of 49 III °AVB patients received CRT in our hospital from 2009-01 to 2014-10 were studied. Echocardiography was conducted at pre-operation and 6, 12 months post-operation to measure left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and mitral regurgitation (MR) grade in order to observe the changes of cardiac structure and function in relevant patients.
Results: Compared with pre-operative condition, at 6 months post-operation, LVEF was increased (4.92±5.24)%and at 12 months post-operation, it was further increased (5.02±6.52)%, both P<0.05;at 6 months post-operation, LVESV reduced (25.02±17.95) ml and at 12 months post-operation, it was further reduced (24.79±22.49) ml, both P<0.05. Compared with pre-operative condition, at 6 months post-operation, LVEDV dropped (25.61±24.24) ml, LVEDD dropped (3.22±2.91) mm, LVESD dropped (4.43±2.86) mm and MR grade dropped 0.49±0.76, all P<0.05. Compared with 6 months post-operation, at 12 months post-operation, LVEDV declined (28.18±22.36) ml, LVEDD declined (4.17±3.14) mm, both P<0.05, LVESD declined (4.92±4.40) mm, P<0.01 and MR grade declined (0.22±0.55), P<0.05.
Conclusion:CRT may reverse ventricular remodeling and improve cardiac function in patients with III°AVB combining systolic dysfunction.

Objective: To explore the inlfuence of diastolic iflling pattern on cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy.
Methods: A total of 61 patients with ischemic cardiomyopathy received CRT in our hospital from 2012-03 to 2014-03 were studied. According to pre-CRT diastolic iflling pattern, the patients were divided into 2 groups:Non-restrictive iflling (NRF) group, n=36 and RF group, n=25. All patients were followed-up for 12 months, based on NYHA classiifcation, CRT efifcacy was assessed by echocardiography;the endpoints included re-hospitalization for heart failure or cardiac death. Kaplan-Meier survival curve was used to assess the prognosis.
Results: ①NRF group had CRT response rate at 66.7%(24/36) which was higher than RF group 28.0%(7/25), (χ2=8.826, P=0.003);the post-operative NYHA classiifcation, LVEF, FS, LVEDV and LVESV were signiifcantly improved, all P<0.01.② RF group showed the improved post-operative NYHA classification, P<0.01, while no obvious changes of LVEF, FS, LVEDV at 6 months after operation, and LVESV increased than it was before, P<0.05. Signiifcant differences were observed between 2 groups at 6 months after operation, P<0.01. Logistic regression analysis indicated that diastolic iflling pattern was the independent impact factor for CRT response. There were 2 patients died during 12 months of follow-up period;the endpoints in RF group was 76.0%(19/25) which was higher than NRF group 44.4%(16/36), (χ2=5.213, P=0.022).
Conclusion: Diastolic iflling pattern affected CRT efifcacy in patients with ischemic cardiomyopathy;NRF patients were more beneifciary for CRT, while RF patients had lower response to CRT which associated to poor prognosis.