Objective:To document the impact of information-based, stepwise, intensive rehabilitation therapy on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).Methods:Eighty such patients in an intensive care unit (ICU) were randomly divided into a control group and an observation group, each of 40. The control group received routine ICU rehabilitation, while the observation group underwent information-based, step-wise ICU rehabilitation. Upon admission to and discharge from the ICU, the forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, and diaphragm functioning were compared between the two groups. The duration of mechanical ventilation, the incidence of ventilator-associated pneumonia (VAP), length of stay in the ICU, incidence of delirium, and the incidence of deep vein thrombosis (DVT) were also recorded. The number of patients readmitted to the ICU after discharge, and the 28-day hospital mortality rate were recorded as well.Results:Significant improvement was observed in both groups in terms of their lung and diaphragm functioning, as well as in the rehabilitation- and hospital-related indicators. At discharge, significantly greater improvements were observed in the observation group compared with the control group in terms of their average FEV1, FVC, FEV1/FVC, inspiratory and expiratory diaphragm thickness, and diaphragm thickening rate. The average duration of mechanical ventilation and of rehabilitation interruptions was significantly less in the observation group. And incidents of accidental extubation, VAP, delirium and DVT were significantly fewer in the observation group as well. Their ICU stays tended to be significantly shorter without any significant difference between the two groups in the 28-day hospital mortality rate. The control group spent significantly less time in their daily rehabilitation sessions, with the result that significantly fewer of them achieved a grading of 2 or better on the mMRC respiratory questionnaire.Conclusion:Information-based stepwise intensive rehabilitation treatment can effectively improve the pulmonary and diaphragmatic function of AECOPD patients admitted to an ICU, shorten their mechanical ventilation time and the length of their ICU stay, and lower their incidence of VAP and DVT during hospitalization.

Objective To study and estimate the public dose constraint and the atmospheric radiation capacity of an isotope industrial park, and to provide a basis for management of radioactive effluent discharge in isotope industrial parks. Methods We collected the natural environment data, meteorological data, and population distribution and dietary data as well as the source terms of radioactive airborne effluents of an isotope industrial park. The public dose constraint value of the isotope industrial park was determined based on the natural environmental radiation hazard level. The atmospheric environmental radiation capacity of the industrial park was estimated by the all-pathways method. Results The public dose constraint value of the industrial park was 0.2 mSv/a. At the end of industrial park planning, the maximum individual effective dose to the public caused by airborne effluent discharge was 1.07×10⁻⁶ Sv/a, which accounted for 0.54% of the public dose constraint value. The proportions of discharges of airborne radionuclides to respective environmental radiation capacities ranged from 0.04% to 4.34%. Conclusion The determined public dose constraint value of the isotope industrial park can be used as the total radiation capacity of the regional atmospheric environment to constrain the discharge of radioactive effluents. The environmental radiation capacity of each radionuclide can be estimated by the all-pathways method considering the comprehensive impact of radionuclide discharges, which is suitable for the control and management of isotope production enterprises in industrial parks.

Objective:To explore the risk factors of subsyndromal delirium (SSD) after cardiac surgery in adults and construct a risk model.Methods:The convenience sampling method was used to select 620 adult patients undergoing cardiac surgery admitted to the Surgical Intensive Care Unit (SICU) of Zhejiang Provincial People's Hospital from January 1, 2017 to December 31, 2018 as the research object. Patients with postoperative SSD were included in the SSD group, and patients without postoperative SSD were included in the non-SSD group. The preoperative, intraoperative and postoperative clinical data and various indicators of all patients were recorded in detail. Through univariate analysis and binary Logistic regression analysis, the risk factors of SSD after cardiac surgery in adults were explored, and the risk model function was constructed.Results:A total of 569 cases were included in the study. Among them, 399 cases of postoperative subdelirium did not occur (non-SSD group) , 170 cases of postoperative subdelirium occurred (SSD group) , and the incidence of SSD was 29.9%. Univariate analysis found that the influencing factors of adult SSD after cardiac surgery were age, emergency surgery, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, aortic occlusion time, deep hypothermia circulatory arrest time, intraoperative plasma transfusion, SICU stay time and the use of dexmedetomidine, and the differences between the two groups were statistically significant ( P<0.05) . The binary Logistic regression analysis found that age>76 years [odds ratio ( OR) =4.332, 95% confidence interval ( CI) : (2.103, 8.965) , P<0.001], emergency surgery [ OR=3.453, 95%CI: (1.143, 7.534) , P<0.05], APACHEⅡ score> 15 [ OR=5.453, 95% CI: (1.453, 9.536) , P<0.001], deep hypothermia circulatory arrest time > 34.2 min [ OR=2.132, 95% CI: (1.053, 5.532) , P<0.05] and SICU stay time > 50.0 h [ OR=1.675, 95% CI: (0.832, 5.233) , P<0.05] were independent risks of SSD after cardiac surgery in adults, and the use of dexmedetomidine [ OR=1.536, 95% CI: (0.763, 4.862) , P<0.05] was a protective factor. Conclusions:Age > 76 years, emergency surgery, APACHE Ⅱ score > 15, deep hypothermia circulatory arrest time > 34.2 min, and SICU stay time >50.0 h are independent risk factors for SSD after cardiac surgery in adults, and the use of dexmedetomidine can reduce the occurrence of SSD.

Objective:To investigate the workload of extracorporeal membrane oxygen(ECMO) patients, estimate the number of hours of care based on the amount of nursing work, and to analyze the status of human resources, improve the quality of care and the effect of nursing.Methods:The Nursing Activity Assessment Scale was used to evaluate the daily workload of ECMO patients in the Intensive Care Unit of Zhejiang Province People′s Hospital, and the relevant factors affecting the workload were analyzed.Results:The average daily workload of ECMO patients was (76.06 ± 7.23) points, the daily nurse care ECMO patients time was 10.31 h, and the number of ideal nurses who needed to participate directly in the daily patients was 2.28. The workload was related to age, whether heparin and vasoactive drugs were used, and prognosis( t values were -3.184-7.291, P<0.05 or 0.01). Conclusions:The workload of ECMO patients is relatively large. At this stage, the ratio of nurse to patient is reasonable in our hospital. The patients′ age, use the heparin, vasoactive drugs and prognosis affect the level of nursing workload of ECMO patients.

Objective:To explore the effect and nursing experience of vein-artery extracorporeal membrane oxygenation (V-A-ECMO) combined with continuous renal replacement therapy(CRRT) in the treatment of fulminant myocarditis.Methods:From January 2014 to October 2019, 15 cases of fulminant myocarditis were treated by V-A-ECMO combined with CRRT in the department of critical care medicine of Zhejiang People′s Hospital. During the operation of V-A-ECMO combined with CRRT, heart rate, blood pressure, coagulation function, troponin, creatinine and other indicators were closely monitored, strict liquid management and extracorporeal circulation pipeline management were implemented, and various complications such as arrhythmia, hypotension, bleeding and acral circulation disorder were timely observed and treated.Results:After 48 hours of treatment with V-A-ECMO and CRRT, the troponin value, lactic acid and creatinine of the patients were (21.53 ± 3.19) μg/L, (2.24 ± 0.37) mmol/L, and (58.13 ± 2.41) μmol/L, which were significantly lower than the start of the machine (79.65 ± 6.08) μg/L, (7.65 ± 1.28) mmol/L, (185.24 ± 5.63) μmol/L, the difference were statistically significant ( t values were -32.784, -15.726, -80.386, P<0.01), except for one dead patient, the left ventricular ejection fraction was significantly increased, reaching 45%-55% within 72 hours, and the left ventricular systolic and diastolic function was normal. Among the 13 patients who successfully withdrew the machine, 11 were cured, 3 were discharged automatically and 1 died. The success rate of withdrawing the machine was 86.67% and the cure rate was 73.33%. Conclusions:V-A-ECMO combined with CRRT can effectively improve cardiac renal function, maintain the stability of internal environment and improve the survival rate of patients. High-quality nursing can effectively improve the healing of patients, clinical need to continue to summarize the relevant nursing experience, improve the level of nursing, prevent various complications, improve the success rate of treatment, promote the recovery of patients.

Objective:To explore the method and curative effect evaluation of repairing and rebuilding the long segmental bone defect after resection of long bone malignant tumors in adolescents.Methods:Reviewed our experience in 10 patients. Among them, 4 were male and 6 were female. The age was 10.2 years old (range, 6-16 years old). Including 7 cases of osteosarcoma, 3 cases of Ewing's sarcoma; 2 cases of humerus tumors, 7 cases of femoral tumors, and 1 case of tibial tumors-who presented between April 2015 and October 2019, in which the proportion of bone defect account for 71.4%-89.3% of the total length of diseased bone after tumor resection, with an average value of 80.9%. Considering the epiphyseal growth of young people, on the premise of ensuring enlarged tumor resection, we use traditional fibula autograft and prosthesis combined with steel plate, 3D printing design to retain the super-prosthesis of the epiphysis, and 3D printing bone trabecular was processed for the sake of making it grow successfully into the binding part of prosthesis and bone as we expect, simultaneously, the design of the short-force arm retaining the bilateral epiphysis can assit the steel plate and interlocking screws to enhance the stability.Results:The operation was completed successfully, and there were no complications such as nerve and blood vessel injury during the operation. After follow-up of 4-8 months, with an average follow-up of 22.9 months. One patient's review of X-ray film after 2 years of the operation showed that the transplanted fibula had a sign of bone resorption, and the internal fixation was in it's original position without obvious abnormalities. Two cases' auxiliary steel plates had fractured within one and a half to two years after surgery. With replacing the fractured steel plates, the internal fixation was good until now. According to the evaluation standards of the International Society of Limb Salvation: 2 cases of humerus osteosarcoma were respectively scored 23 points, 26 points, an average of 24.5 points; 4 cases of femoral osteosarcoma and 3 cases of femoral Ewing's sarcoma respectively scored 26 points and 25 points, 19 points, 30 points, 27 points, 24 points, 28 points (average, 25.6 points); 1 case of tibial osteosarcoma scored 26 points; all obtained relative satisfying treatment results.Conclusion:The combination of 3D printing and traditional machining techniques to produce an individualized long segmental prosthesis that preserves the epiphysis which applicated in the limb salvage treatment of bone malignant tumors can achieve excellent therapeutic effect.

Objective:To explore the effects of multifunctional butterfly-shaped chassis ostomy bag for faeces drainage in incontinence-associated dermatitis (IAD) .Methods:From January to September 2019, this study selected 84 fecal incontinence patients with IAD of Intensive Care Unit in Zhejiang Provincial People's Hospital by convenient sampling. All of patients were divided into observation group ( n=42) and control group ( n=42) with the method of random number table. Control group carried out the IAD skin management trilogy combined with the common ostomy bag, while observation group implemented the IAD skin management trilogy combined with the multifunctional butterfly-shaped chassis ostomy bag. We compared the overall effective rate of treatment for IAD, nursing time of nurses for IAD, average retention time, average use time and replacement frequency of ostomy bag, family members satisfaction of patients between two groups. Results:The overall effective rate of treatment for IAD in observation group was 95.24% (40/42) higher than that 73.81% (31/42) in control group with a statistical difference ( P<0.05) . The nursing time and retention time of observation group was (1.89±0.32) h/d and (5.2±0.4) days per person respectively shorter than those [ (5.73±1.64) h/d and (9.4±1.2) days per person] of control group with statistical differences ( P<0.05) . The use time of observation group was (98.27±12.18) hours per bag longer than that (72.18±4.63) hours per bag of control group with a statistical difference ( P<0.05) . The replacement frequency of observation group was (1.20±0.10) times per person also statistically less than that [ (3.10±0.70) times per person] of control group ( P<0.05) . Family members satisfaction of observation group was significantly higher than that of control group ( P<0.05) . Conclusions:Compared with traditional ostomy bag, the multifunctional butterfly-shaped chassis ostomy bag has effective treatments for IAD can shorten the nursing time for IAD, lengthen the use time of ostomy bag, reduce the average retention time and replacement frequency and improve family members satisfaction which can be widely used in clinical application.

Objective:To explore the effects of early goal-directed mobilization (EGDM) in rehabilitation of patients after cardiac surgery.Methods:Totally 200 patients admitted into ICU after cardiac surgery in Zhejiang Provincial People's Hospital were selected. A total of 100 patients admitted between January and April 2019 were included into the control group who received routine care, while 100 patients admitted from May to August 2019 were included into the observation group received EGDM on this basis. The postoperative rehabilitation indicators (indwelling time of tracheal intubation, time of first exhaust, time of admission to ICU, complication cases) and satisfaction before transferring to ICU were compared between the two groups of patients.Results:The indwelling time of tracheal intubation, time of first exhaust and time of admission to ICU was (25.93±2.42) h, (28.44±1.62) h and (38.63±4.91) h in the observation group, which were shorter than that in the control group, and the difference was statistically significant ( t=45.932, 78.464, 32.702; P<0.01) ; the incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) ; before transferring to ICU, the patient satisfaction of the observation group was (57.58±1.15) , while that of the control group was (49.32±1.26) , and the difference was statistically significant ( t=-48.420, P< 0.01) . Conclusions:EGDM is conducive to the early recovery of patients after cardiac surgery and can improve patient satisfaction.

Objective: To analyze the urinary iodine status of urban and rural residents in some areas of Gansu Province and its related influencing factors, and to provide certain references for scientific iodine intake of urban and rural residents in Gansu Province. Methods: Subjects in Gansu Province with normal thyroid function were recruited in the investigation of thyroid diseases and iodine nutritional status, conducted a questionnaire survey and measured height, weight, waist circumference, collected 1 urine sample, and tested their urinary iodine levels. The urinary iodine levels of different groups were compared based on different gender, region, age, body weight, the waist, and salt intaking. The affecting factors of urinary iodine levels were analyzed by multiple linear regression models. Results: Totally 1 964 subjects were recruited, including 1 099 males, and 865 females. The age was (41.23 ± 14.75) years old. The median urinary iodine of the selected group was 225.60 (158.80, 311.58) μg/L. The urinary iodine level of rural residents was significantly higher than that of urban residents [μg/L: 249.80 (180.58, 336.88) vs 206.25 (148.03, 280.33), Z=-8.015, P < 0.05], and there was no significant difference between the urinary iodine levels of male and female [μg/L: 222.40 (161.60, 298.90) vs 230.60 (158.00, 326.40), P > 0.05]. The composition ratio of < 100 μg/L group in rural areas was lower than that in urban areas (5.14% vs 8.27%, χ²= 7.45, P < 0.05), and the composition ratio of ≥300 μg/L group was higher than that in urban areas (34.93% vs 21.51%, χ²= 43.87, P < 0.05). The composition ratio of ≥300 μg/L group in male was lower than that in female (24.57% vs 31.21%, χ²= 10.73, P < 0.05). The multiple linear regression analysis showed that lived in rural areas, age, moderate and severe salt intaking, student, and weight were independently correlated with urinary iodine levels (β= 0.074, -0.001, 0.059, 0.034, 0.096, -0.003, P < 0.05). And the urinary iodine levels were decreased with age and weight increased (P < 0.05). Conclusions At present, the iodine nutrition level of urban and rural residents in some areas of Gansu Province is generally over the adequate level. The urinary iodine level of rural residents is higher than that of urban residents. In the future, we should pay attention to the impact of different living areas, salt intaking and body weight on urinary iodine levels to prevent thyroid diseases.

Objective? To explore the effects of standardized nutritional nursing process in severe acute pancreatitis (SAP) patients. Methods? From January 2015 to June 2016, we selected 85 SAP patients at Zhejiang Province People's Hospital & People's Hospital of Hangzhou Medical College in control group by convenience sampling. From July 2016 to December 2017, we selected 88 SAP patients in observation group. Two groups all carried out enteral nutrition. Control group received routine nutritional nursing, while observation group implemented standardized nutritional nursing process. We compared the feeding intolerance, feeling related complications, standard-reaching rate of nutrition and nutritional status of patients between two groups. Results? There were 2 cases with vomit, 10 cases with abdominal distension, 5 cases with constipation, all with diarrhea (2.4±0.6) times a day, 5 cases with elevated intra-abdominal pressure and 1 case with abdominal compartment syndrome in observation group less than those in control group with statistical differences (P＜0.05). The incidence of feeling related complications of observation group was lower than that of control group with a statistical difference (P＜0.01). At the seventh day, the standard-reaching rate of nutrition of observation group and control group was 89.8% and 71.8% respectively with a statistical difference (χ2=8.083, P＜0.01). At the fourteenth day, the nutrition indicators such as prealbumin, serum albumin, triceps skin-fold thickness and arm muscle circumference of patients in observation group were higher than those in control group (P＜ 0.05). The residence time in intensive care unit, proportion of mechanical ventilation and time of mechanical ventilation of observation group were statistically lower than those of control group (P＜ 0.05). Conclusions? The implementation of standardized nutritional nursing process in SAP patients can reduce the feeling related complications and feeding intolerance to improve nutritional status which is worth to be used widely in clinical application.