Objective:To clarify the incidence and the related risk factors of postoperative delirium in liver transplantation (LT) recipients to provide rationales for early identification of delirium and constructing the related models.Methods:The authors used the "肝移植""移植术""肝移植手术""肝脏移植""移植肝""谵妄""谵语""危险因素""相关因素""影响因素"and "liver transplantation""liver transplant""delirium""delirious""delirium confusion""risk factors""relevant factors""root cause analysis"as the Chinese and English keywords, searching Wanfang data, China Biomedical Literature Database, CNKI, PubMed, Embase, Web of Science, Cochrane Library, BMJ and the literature for the incidence or risk factors of postoperative delirium in LT recipients. The researchers independently performed literature screening, methodological evaluation and data extraction. And RevMan 5.4 and State16.0 software were employed for data processing.Results:A total of 19 articles involving 5003 samples were retrieved and 22 risk factors identifies. Meta-analysis showed that the incidence of POD was 23%(1151/5003). The statistically significant risk factors included preoperative blood ammonia concentration >46 mmol/L ( OR=3.51, 95% CI: 1.53-8.09, P<0.001), model for end-stage liver disease (MELD) score >15 points ( OR=4.24, 95% CI: 2.51-7.16, P<0.001), preoperative hepatic encephalopathy ( OR=3.00, 95% CI: 2.09-4.31, P<0.001), preoperative dosing of diuretics ( OR=2.36, 95% CI: 1.38-4.04, P<0.001), history of alcoholism ( OR=3.16, 95% CI: 1.06-9.40, P=0.040), longer anhepatic period ( OR=1.04, 95% CI: 1.03-1.06, P<0.001) and elevated aspartate transaminase concentration at Day 1 post-operation ( OR=1.33, 95% CI: 1.15-1.53, P<0.001). Conclusions:Preoperative blood ammonia concentration >46 mmol/L, MELD score >15, hepatic encephalopathy, dosing of diuretic, a history of alcoholism, longer anhepatic period and elevated aspartate transaminase at Day 1 post-operation are risk factors for postoperative delirium after LT. Postoperative reintubation is not a risk factor for postoperative delirium.

Objective:To explore the effects of individualized exercise prescription in critically ill patients during enteral nutrition.Methods:From January to August 2018, we selected 120 critically ill patients admitted to the General Surgery Intensive Care Unit (ICU) of General Hospital of Eastern Theater Command. According to admission time, patients were divided into control group and observation group, with 60 cases in each group. Control group used the conventional chest physical therapy, exercise program for passive and active functional exercise of limbs. Observation group implemented the individualized exercise prescription to implement functional exercise orders. After daily rounds, doctors and nurses assessed the condition of the day by combining patient's basic condition and prescribed the individualized exercise prescription, including functional exercise items, requirements, dosages and frequency, performed by a full-time nurse. We compared the muscle strength of patients between two groups with the MRC scores, and observed the intolerance, number of interruptions of enteral nutrition feeding and the ICU hospitalization time during enteral nutrition between two groups.Results:After 168 hours and 366 hours, the differences of MRC scores between two groups were significant ( P<0.05) . After 14 days of intervention, the serum total protein, hemoglobin and body mass index (BMI) of observation group were higher than those of control group also with statistical differences ( P<0.05) . The number of cases of abdominal distension, gastric retention, the total number of intolerance and the number of feeding interruptions during enteral nutrition in the observation group were lower than those in the control group, and the differences were statistically significant ( P<0.05) . The ICU hospitalization time of patients of observation group and control group were (25.28±5.42) d and (27.94±5.65) d respectively also with a statistical difference ( P<0.05) . Conclusions:The individualized exercise prescription functional exercise intervention strategies is beneficial for critically ill patients to improve muscle strength, nutritional indicators, avoid rapid decline in BMI, reduce feeding intolerance and the number of feeding interruptions, ensure continuous implementation of enteral nutrition, and shorten patients' ICU hospitalization time so as to promote accelerated recovery of patients.

Objective:To explore the influences of different lying positions on vital signs and comforts in patients with tracheal intubation removed after intestinal fistula surgery.Methods:From October 2018 to June 2019, convenience sampling was used to select 150 patients with intestinal fistula surgery after general anesthesia in Intensive Care Unit of the General Hospital of Eastern Theater Command were selected as the research object. After waiting for the patient to wake up from anesthesia, the tracheal intubation was removed, and the lying position was changed after normal spontaneous breathing through the nose. Patients were randomly divided into 5 groups, 30 cases in each group. Group A was in the supine position; group B was in the lying position with the head of the bed raised by 15°; group C was in the lying position with the head of the bed raised by 30°; group D was in the lying position with the head of the bed raised by 45°; group E was in the lying position with the head of the bed raised by 15° to 45 °. At the beginning, the head of the bed was shaken to 15 °; and after two hours, the head of the bed was shaken to 30 °, and after another two hours, the head of the bed was shaken to 45 °. After 5 groups of patients fixed the angle of the lying position, when the patient complained of discomfort or the body position changed spontaneously, the patient changed the lying position. The duration of the lying position, uncomfortable symptoms and pain degree of abdominal incision were compared among 5 groups.Results:Patients with tracheal intubation removed after intestinal fistula surgery had a longer persistence in the 15° and 30° lying positions within 6 hours, respectively (72.27±12.41) min and (69.37±9.10) min. There were statistically significant differences in the persistence time of 5 different lying positions ( P<0.01) . The number of patients in group B and C with waist pain was less, and there were more patients with painless incisions, and there were statistically significant differences among 5 groups ( P<0.05) . Conclusions:Among patients with tracheal intubation removed and normal spontaneous breathing through the nose after intestinal fistula surgery, the 15° to 30° lying position within 6 hours after the operation can prolong the patient's adherence to the lying position, reduce the incidence of abdominal incision pain and waist pain, and reduce the probability of dizziness, nausea and vomiting.

Objective:To explore the influences of abdominal pressure monitoring in different positions on patients with abdominal hypertension.Methods:From January to June 2019, convenience sampling was used to select 100 critical ill patients with abdominal hypertension who were admitted to the Intensive Care Unit of General Surgery of the General Hospital of Eastern Theater Command as the research object. The abdominal pressure was monitored by indirectly measuring the bladder pressure. We measured the abdominal pressure when patients were in stable condition and in 30° lying position, 45° lying position as well as the supine position respectively, recorded the single measurement data of the patient's abdominal pressure in different positions, and performed another position measurement rest for 15 minutes after changing the position.Results:The abdominal pressures measured in 100 critical ill patients with abdominal hypertension in the supine position, 30° lying position and 45° lying position were (19.18±3.95) , (23.40±3.87) and (28.17±3.60) mmHg (1 mmHg=0.133kPa) respectively, and the difference was statistically significant ( P<0.01) . The abdominal pressure monitored in the supine position was lower than those in the 30° lying position and 45° lying position, the difference was statistically significant (supine position vs. 30° lying position, P<0.01; supine position vs. 45° lying position, P<0.01) . The abdominal pressure monitored in the 30 ° lying position and 45 ° lying position was higher than that in the supine position by one to two levels. With the increase of the bed head elevation angle, the abdominal pressure value is getting higher and higher, regardless of the level of abdominal pressure in critical ill patients with abdominal hypertension. Conclusions:The abdominal pressure monitoring in actual positions can reflect the true situation of the patient well, and can provide a relatively true and reliable monitoring data for clinical nursing decision-making.

Objective? To summarize the key content of nursing of stepped drainage new model for severe acute pancreatitis (SAP) patients with necrosis and infection. Methods? From January 2014 to December 2016, we selected 417 SAP patients with infected pancreatic necrosis (IPN) in General Surgery Intensive Care Unit at Nanjing General Hospital, People's Liberation Army. The "four-step" stepped drainage model was adopted during treatment including four stages, percutaneous catheter drainage, continuous negative pressure irrigation drainage, endoscopic drainage and laparotomy necrotic tissue debridement drainage. All stages of nursing had something in common and different emphasis points. Nursing care paid attention to strengthening the nursing for abdominal puncture catheter, abdominal double pipe, endoscopic operation cooperation and postoperative nursing of laparotomy. Results? Among 417 SAP patients with IPN, a total of 413 patients were with percutaneous catheter drainage and single patient was with one to seven drainage tubes, a total of 2 252 tubes; 315 patients were with abdominal double pipe irrigation drainage and single patient was with two to seven double pipes, a total of 1 386 double pipes; 186 patients were with endoscopic drainage and single patient was with two to five times of endoscopic necrotic tissue debridement, a total of 725 times; 91 patients were with laparotomy and single patient was with laparotomy one to three times. During nursing care, totals of 13 percutaneous drainage catheters and abdominal double pipes slipped off; 109 cases of poor drainage happened to double pipe drainage with 56 cases of obstructed drainage;there were 30 cases of folding, 7 cases of hemorrhage and 16 cases of shifting. Those problems were all found and handled timely with no consequence caused by poor drainage and improper nursing care. Conclusions? Among SAP patients with IPN, keys to guarantee high quality of nursing included mastering nursing emphasis of all stages, taking targeted nursing, keeping abdominal puncture catheter unobstructed, abdominal double pipes effectively sucking, cooperating on endoscopic necrotic tissue debridement and strengthening postoperative monitoring and wound management.

Objective To investigate antimicrobial resistance of Escherichia coli (E.coli)and Klebsiella pneumoniae (K.pneumoniae),antimicrobial use density(AUD),as well as relation between antimicrobial resistance and AUD in a ter-tiary first-class hospital.Methods Antimicrobial resistance rates of clinically-isolated E.coli and K.pneumoniae,AUD of carbapenems and quinolones,as well as relation between resistance and AUD in 2013-2015 were statistically analyzed. Results Correlation analysis of antimicrobial resistance of bacteria and AUD showed that the decrease in resistance rate of E.coli to levofloxacin was related to the decrease in the use density of quinolones(r=0.61,P=0.03);increase in resist-ance rate of K.pneumoniae to imipenem was related to the increase in the use density of carbapenems(r=0.78,P<0.01). Conclusion Antimicrobial use is one of the causes of bacterial resistance,management on antimicrobial use needs to be strengthened to reduce the threat of bacterial resistance to human health.

Objective To explore the inter-fraction setup errors and affecting factors from data of daily fan-beam megavoltage computed tomography(MVCT). Methods A total of 37consecutive NPC patients treated with tomotherapy were hospitalized during the period of February 2015 to September 2015. For each patient,one MVCT scan was obtained after conventional positioning ,online correction and tomotherapy delivery daily ,and the scans were put into the planning computed tomography to determine inter-fraction setup errors. The MPTV was calculated with the equation:MPTV=2.5∑+0.7σ(∑:systematic error;σ:random error). Results The average absolute errors of the inter-fraction were(2.102 ± 0.0406)mm,(1.490 ± 0.0348)mm,(1.306 ± 0.335)mm and(1.392 ± 0.0384)° at three dimensions. The total MPTV accounting for inter-error was 3.4675 mm,2.9795 mm,and 2.8885 mm. Gradual increases in both inter-fraction three-dimensional displacement were observed with time and treatment(P < 0.05). Univariate analysis revealed that weight loss and retraction of neck lymph nodes were affecting factors of set-up errors. Conclusions 3 mm margins uniformly expended from clinical target volume to planning target volume may not be suitable. The personalized margin should be adopted for the design of IMRT planning. Displacement increases as a treatment course is prolonged.

Objective To evaluate the inter-fraction setup error during the treatment with megavoltage computed tomography (MVCT) and provide theoretical basis for clinical target volume-planning target volume (CTV-PTV) margins for nasopharyngeal carcinoma (NPC) patients treated with tomotherapy.Methods Thirty-seven consecutive NPC patients treated with tomotherapy were prospectively enrolled for the study between February 2015 and September 2015.For each patient,one MVCT scan was obtained after conventional positioning,online correction and tomotherapy delivery daily,and the scan was registered to the planning CT to determine inter-fraction setup error.The expanding margin for PTV (MPTV) was calculated with the recipe:MPTV =2.5∑ + 0.76 (∑:systematic error;6:random error).Results The average absolute errors of the inter-fraction were (2.102 ± 0.040 6) mm,(1.490 ± 0.034 8) mm,(1.306 ± 0.335) mm and (1.392 ± 0.038 4) ° in the three dimensions.Gradual increases in both inter-fraction three-dimensional displacement were observed with time and treatment (P ＜ 0.05).The total MPTV ac counting for inter-error were 3.467 5 mm,2.979 5 mm and 2.888 5 mm.Conclusions Tomotherapy irradiation technology personalized MPTV should be adopted for the design of tomotherapy plan.Displacement increased as a function of time.

ObjectiveTo investigate comprehensive treatment and obstruction in adherence of the patients newly diagnosed with breast cancer,and to provide the theoretical basis for improving the comprehensive treatment adherence.Methods A total of 22 patients newly diagnosed with breast cancer received semi-structured interview by phenomenological research approach of qualitative research. Colaizzi′s data analysis method was performed to analyze and conclude the theme.Results Eight themes of the application were obtained from the experience of 22 patients:economic difficulties,weak family support,serious treatment side effects,tortile religious faith,incorrect internet information,indifference in combined treatment,complex formalities and complications. Conclusions The affecting factors,such as economic difficulties,are the most frequently endorsed barrier to combined treatment compliance. The management of affecting factors is critically significant to increase patients′ compliance to comprehensive treatment. Medical staff should offer individual economic and medical information as well as emotion supports,and encourage breast cancer patients to actively complete the comprehensive treatment.

Objective It is a tough job to rescue batches of patients with severe blast injury .The article aimed to construct specific technique system management in the rescue of batches of patients with severe blast injury and evaluate its effects . Methods Retrospective analysis was made on 9 patients with severe blast injury who hospitalized simultaneously .According to the difficulties in the nursing process of treating severe blast injury such as management of respiratory tract , continuous renal replacement therapy , vascular access, nutritional supply, skin nursing, etc, specific technique system management was constructed to evaluate technical support key points at different phases , including personalized nursing scheme with disease progression , professional nursing instruction on key points of different phases from specialists as well as corresponding nursing decision and professional caring . Results Specific technique system management was applied in these 9 patients with severe blast injury .Only 1 patients developed ventilator related pneumonia when receiving mechanical ventilation and no procedure related complications occurred in the aspects of blood purification , skin management , vascular access and nutrition support .6 patients discharged from hospital after recovery . Conclusion Specific techniques and systemic management in batch treatment of severe bast injury patients could help collaborative nursing , improve the management of specific management and prevent complication .