Objective:To explore the effect of reduction, readiness, response and recovery (4R) crisis management concept in sepsis nursing.Methods:From March 2018 to January 2021, 140 patients with sepsis admitted to the First Affiliated Hospital of Zhengzhou University were selected by convenience sampling. The patients were divided into the control group (69 cases) and the observation group (71 cases) according to the hospital odds and even numbers. The control group adopted the traditional nursing of sepsis, and the observation group adopted the 4R crisis management concept. The condition, the incidence of complications of the two groups of patients were compared.Results:After nursing, the Quick Sequential Organ Failure Assessment (qSOFA) scores of the two groups were lower than those before nursing, and the qSOFA score of the observation group was lower than that of the control group, with statistical differences ( 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) . Conclusions:The application of the 4R crisis management concept in sepsis nursing has a good effect, which can effectively relieve the patient's condition, reduce complications.

Objective:To compare the effects of three heating methods on intraoperative temperature and postoperative resuscitation in patients undergoing three-incision radical resection of esophageal cancer under full endoscope.Methods:A total of 145 patients undergoing endoscopic three-incision radical resection of esophageal cancer were randomized to receive forced-air warming respectively on the under-body blanket(UB group, n=48), over-body blanket (OB group, n=48), underbody blanket in combination with over-body blanket(Combined group, n=49). The nasopharyngeal temperature were recorded at the time of entering the operating room, at the beginning of the intubation, at the beginning of the operation and every 30min after the operation, at the end of the operation. The incidence of hypothermia, hypothermia related adverse reactions and postoperative resuscitation indicators of the three groups were compared. Results:During the operation, the patients' temperature fluctuation showed two processes of decrease and two processes of increase. The temperature of Combined group showed a lower fall and a faster rise. The average temperature of the Combined group were higher than the other two group at each time point from the beginning of the intubation, the incidence of hypothermia was 4.08% (2/49), which was lower than the OB group [22.92% (11/48)] and the UB group [18.75% (9/48)], The difference was statistically significant ( χ2 value was 7.397, P=0.025). The temperature of the UB group was (36.52±0.18),(36.31±0.35)℃ at the beginning of intubation and at the end of the operation, respectively, which were higher than that of the OB group (36.44±0.15),(36.13±0.32)℃ ( t value was 2.393, 3.723, P < 0.05). The temperature comfort score of the combined group was 7.81±0.52, higher than that of the other two groups ( F value was 19.962, P<0.01), and the scores of chills, agitation and chills in the recovery period were lower than that of the other two groups ( F value was 8.186, 6.705, 4.051, all P < 0.05). The extubation time and the waking time of the combined group was (15.90±2.97)min, (31.47±4.42)min, respectively, which were both lower than those of the other two groups ( F value was 69.094, 114.549, P < 0.01). Conclusions:In endoscopic three-incision radical resection of esophageal cancer, combined heating makes the patients' temperature rise rapidly to offset the loss of heat, which is conducive to maintain a stable temperature. At the same time, the incidence of intraoperative hypothermia, postoperative chills and agitation is reduced, the temperature comfort of patients is improved, the extubation time and waking time are shortened, which is conducive to promote postoperative recovery of patients, thus reduce postoperative hypothermia related complications.

Objective? To explore and evaluate the effectiveness of the subspecialized fixed tutor training model on the training of the new nurses in the operating room, in order to quickly improve the competency of the new nurses. Methods? A total of 20 new nurses from July 2013 to June 2015 in Sun Yat-sen University Cancer Hospital were selected as the control group. The new nurses from July 2015 to July 2017 were enrolled in the observation group. All the new nurses relied on head nurses and the head supervisory teacher to arrange their training goals and rotation plans. According to the training plan, the control group was randomly assigned to the tutors who were on duty to be responsible for the sub-specialist surgery tour and hand washing training. When the observation team entered a sub-specialty every rotation, the fixed tutor performed one-on-one surgery tour and hand washing training. The scores and comprehensive abilities of the two groups of nurses were compared. The evaluation of the training methods by the new nurses and the satisfaction of the doctors with the new nurses were also compared across the two groups. Results? After the training, the scores of the newly recruited nurses in the theoretical knowledge, operational skills, and surgical coordination were (92.77±3.31), (94.19±2.02), and (95.27±2.55), respectively, and the control group was (90.38±2.63), (88.84±2.44), (90.35±4.92) (t=2.379, 6.891, 3.521, respectively; P＜ 0.05); The observation group's pass rate was 100.0%, and the control group pass rate was 92.5%. The difference was statistically significant (χ2=4.955, P=0.034). After the training, the scores of the new nurses' comprehensive ability in the work initiative, emergency response ability, collaborative communication ability, and learning ability were (9.45±0.21), (9.29±0.33), (9.06±0.34), and (9.08±0.24) in the observation group. The scores were (9.04±0.23), (8.78±0.33), (8.53±0.29), and (8.61±0.39), respectively, in the control group (t=5.332, 4.549, 4.938, 4.185, respectively; P＜0.001). After the training, there was no statistical difference between the two groups in the teaching content of teaching evaluation (P＞0.05). The teaching attitude, teaching method, and training effectiveness scores were higher in the observation group than the control group (t=9.854, 4.758, 9.613, respectively; P＜0.001). After the training, the satisfaction rate of the new nurses in the observation group was 100.0%, and that in the control group was 95.0%. The difference was statistically significant (χ2=12.509, P＜0.05). Conclusions? The subspecialized fixed tutor training model for newly recruited nurses in the operating room is beneficial for the new nurses to grasp the theoretical specialized knowledge in the operating room in a more solid way, to strengthen the practical operation ability of new nurses. Therefore,its implementation is worthy of promoting in the operating room.

Objective? To investigate the feasibility and safety of vacuum modelling pad for patients with lateral position in thoracic surgery to improve the convenience and comfortable experience for medical staff and patients. Methods? From May 2017 to March 2018, 100 patients who underwent thoracic surgery under general anesthesia with lateral position in the operating room of Sun Yat-sen University Cancer Center were randomly selected and divided into observation group(n=50) and control group (n=50) according to random number table. The polyurethane vacuum modelling pad was used for to secure the patients' position in the observation group, while the sand bag baffle was used to secure the patient's position in the control group. Position placement time and skin pressure blisters were recorded in both groups. Questionnaires were sent out after operation to collect the satisfaction of medical staff with this position. The patients' comfort was followed up within 24 hours after operation. Results? The position placement time in the observation group was (183.56±10.36) s, shorter than the control group with (290.80±14.71)s and the difference was statistically significant(P＜ 0.01); there were 11 cases of skin reddening under pressure and 2 cases of blister in the observation group, which is statistically different from the control group with 24 cases of skin reddening under pressure and 9 cases of blister(P＜ 0.05). Patients' comfort score was(6.72±0.39) in the observation group, higher than the control group with (6.02±0.44) and the difference was statistically significant(P＜ 0.01). In terms of the 4 items of "the convenient operation", "comfortable standing position", "patient safety" and"overall evaluation", the observation group scored higher than the control group with statistical differences (P＜0.01); in terms of the "surgical field exposure" and "fasten effects", there was no statistical difference (P＞0.05). Conclusions? The use of modelling pad for patient lateral position in thoracic surgery can not only prevent organ and skin damage and ensure patient safety, but also simplify the operation procedure, improve the comfort of standing position and the working efficiency and satisfaction of the medical staff.

Objective? To analyze the application effect of logistics robot in the distribution management of consumables and materials in Operating Room and to explore its application value. Methods? From December 1st to 11th in 2018, the intraoperative distribution of consumables and materials in Operating Room of Sun Yat-sen Unviersity Cancer Hospital was divided into the robot distribution group (logistic robot was used in distribution) and manual distribution group(manual power was used in distribution) based on rooms. The service time, number of service of the logistic robots and manual delivery were recorded and the incidence of logistic robots' collision was counted. Every delivery time, the error rate of the delivered goods, number and time of operation suspension for waiting for the goods in both of the two groups were counted separately and the differences between the two groups in delivery time, delivery error rate, number of times and time of operation suspension for goods waiting were compared, and the satisfaction of medical staff to the distribution of the two groups were compared. Results? Robot distribution group delivered 1 295 trips in total, with an average of 3.8 rooms per trip, and no collisions happened. In the robot distribution group, time required for each delivery(72.62±7.8) s, the error rate of delivery(0.13%), number of waiting during operation(93 times) and waiting time during operation (25.58±3.8)s were all lower than those in the manual distribution group [(160.50±20.2)s, 0.76%, 157 times, (43.75±6.8)s], with statistically significant differences(P＜ 0.01). The satisfaction of medical staff in the robot distribution group was higher than that in the manual distribution group, and the difference was statistically significant (χ2=7.103,P=0.029). Conclusions? The application of logistic robots to distribute consumables and materials in the Operating Room can partly reduce the workload of the scout nurses, reduce the waiting time in the operation, achieve swiftness and accuracy, realize intelligent management of high-value consumables, and improve the working efficiency and management quality in the Operation Room.

Objective To explore the effects of modified herringbone-Trendelenburg position in the laparoscopic anterior resection for rectal cancer patients. Methods A total of 108 patients undergoing laparoscopic anterior resection were recruited and randomly assigned to observation group(54 cases) and control group (54 cases). Patients in the observation group were positioned in modified herringbone-Trendelenburg position, while the patients in the control group were placed in conventional Trendelenburg position. The data of heart rate (HR), mean arterial pressure (MAP) were recorded at 3minutes before body position change and 3 minutes after body position change, 3 minutes before recover horizontal position and 3 minutes after recover horizontal position. Intraocular pressure (IOP) were measured at 3 minutes after general anesthesia in supine position (T0), and 3 minutes after pneumoperitoneum while in the operation position (T1), every 1 hour (T2 to T3), 3 minutes before recover horizontal position at the end of pneumoperitoneum (T4), 3 minutes after recover horizontal position (T5) and 30 minutes after recover horizontal position(T6). Investigate the satisfaction of the surgeons regarding the surgical position of the patients.Followed up investigation at 24h and 48h after surgery were enforced to record the situation of the pain in the shoulder and postoperative complications of the lower limbs. Results The heart rate pre-and post the change of body position in observation group were (2.11±0.92), (-2.78±1.01) beats/min respectively, while the control group were (5.98±2.98), (-6.03±1.98) beats/min, the differences were statically significant (t=9.111,9.851, P<0.01).The mean arterial pressure pre-and post the change of body position in observation group were (1.67 ± 1.23), (2.21 ± 0.89) mmHg(1mmHg=0.133kPa) respectively, while the control group were (7.20±2.30), (6.41±1.87)mmHg, the differences were statically significant(t=15.512, 14.811, P<0.01).The differences of intra-ocular pressure between 2 groups had no statistical significance at T0 and T6 (P>0.05). The intra-ocular pressure were (13.64±1.66), (16.56±1.82),(19.78±1.70),(21.00±1.71),(18.53±1.77)mmHg respectively from T1 to T5, lower than that of control group (15.59±2.03),(19.40±1.89), (23.22±2.15), (25.38±2.09), (22.35±1.76)mmHg, the differences were statically significant (t=5.442-11.907, P<0.01).The incidence of shoulder pain and low leg pain in observation group were 9.26％(5/54), 7.41％(4/54) respectively, lower than that of control group 46.29％(25/54),31.48％(17/54), the differences were statically significant (t=17.778,9.755,P<0.01). The scores of shoulder pain and low leg pain in observation group were (1.38±0.38), (2.02±0.34) points, lower than that of control group (4.44 ± 0.48), (3.85 ± 0.57) points, the differences were statically significant (t=36.761, 20.162, P<0.01). The satisfaction rate of surgeons was 87.04％(47/54) in the observation group, higher than that in the control group 55.56％ (30/54), the difference was statically significant (χ2=5.119, P=0.024). Conclusion Modified herringbone-Trendelenburg position can maintain the circulatory system stability better without affecting the operation, reduce the elevation of IOP, effectively improve the comfort of the operation position of the patients,reduce the postoperative complications of the lower limbs and the incidence rate of the shoulder pain in the laparoscopic anterior resection for rectal cancer patients.

OBJECTIVE:To evaluate the rationality of cefoxitin use in our hospital. METHODS:Evaluation index and evalua-tion criteria were established on the basis of DUE. The relative weight of evaluation index were calculated by using attribute-based AHM weight method,and the gas between medical orders and complete rational ones were evaluated by using TOPSIS processing method. The proportion of rational medical orders were calculated to evaluate the rationality of drug use. RESULTS:Among 116 medical records,there were 19%reasonable medical orders(including 4.3%complete reasonable medical orders,5 cases),50%ba-sically reasonable medical orders(58 cases)and 31% unreasonable medical orders(36 cases). CONCLUSIONS:It is reasonable and feasible to use AHM weighted TOPSIS method to evaluate the rationality of cefoxitin. The utilization of cefoxitin in our hospital is basically reasonable,but there are still many problems.

Objective To compare the curative effect of arthroscopic transtibial single-bundle posterior cruciate ligament(PCL) reconstruction using LARS artificial ligament and hamstring tendon autograft.Methods Thirty-seven patients who underwent isolated single-bundle PCL reconstruction with remnant preservation technique were evaluated.They were divided into LARS group(n=19) and 4-strand hamstring tendon autograft (4SHG) group (n =18).Minimum follow-up was 2 years.Patients were evaluated preoperatively and postoperatively at the latest follow-up with several parameters,including the international knee documentation committee(IKDC) score,Lysholm knee score,Tegner activity rating and physical examination.Results After operation,in LARS group,Lysholm sorce was 89 (51,100) points,Tegner sorce was 6 (1,9) points,IKDC sorces were normal of 5 cases,nearly normal of 10 cases,abnormal of 3 cases,and obviously abnormal of 1 case,significantly improved compared with before operation (62 (28,98) points,2 (1,5) points,abnormal IKDC score of 8 cases,obviously abnormal of 11 cases;P＜0.001).In 4SHG group,Lysholm sorce was 84(36,100) points,Tegner sorce was 6(1,9) points,IKDC sorces were normal of 5 cases,nearly normal of 9 cases,abnormal of 3 cases,and obviously abnormal of 1 case,better than before operation (64 (28,98) points,2 (1,5) points,IKDC score abnormal of 8 cases,obviously abnormal of 10 cases;P＜0.001).There was significant difference about Lysholm sorce between two groups after operation (P=0.037).The drawer test results show that,after operation,there were 15 case of grade 0,4 cases of grade 1 in LARS group,3 cases of grade 0,11 cases of grade 1,4 cases of grade 2 in 4SHG group,all improved significantly compared with before operation,and the differences were statistically significant(LARS group:x2 =38.000,P＜0.001;4SHG group:x2 =29.143,P＜0.001),and the grade of patients in LARS group were superior to 4SHG group after operation (x2 =15.251,P ＜0.001).Conclusion The clinical effect of using a LARS ligament for PCL reconstruction is more useful than using a 4SHG.

OBJECTIVE:To explore the establishment of DUE criteria for the evaluation of glucocorticoids(GCs)use in oncol-ogy department of our hospital,and to evaluate the rationality of glucocorticoid use. METHODS:DUE criteria for GCs in our hos-pital was established preliminary,and used to evaluate medication indication,medication course,medication results,etc. Medical records of 300 patients receiving GCs were collected from oncology department of our hospital during Apr. to Dec. in 2013(before intervention)and Jun. 2014 to Mar. 2015(after intervention)via hospital information system. The application of GCs was evaluat-ed. RESULTS:Pexamethasone sodium phosphate injection was used most frequently in our hospital(82.34%),followed by Dexa-methasone acetate tablet(15.33%)and prednisone asetate tablets(2.33%). The mest common purpose of GCs use in oncology de-partment of our hospital is radiotherapy and chemotherapy induced vomiting prevention and treatment(55.55% of total case),fol-lowed by anti-inflammatory therapy(14.19%)and chemotheraphy drug pretreatment(12.76%). After intervention,rational use of GCs for tumor had been improved greatly,and the rate of unqualified drug dosage and medication course decreased from 6.87% to 3.95%,and that of decreased from 3.58% to 2.74%. CONCLUSIONS:The establishment of DUE criteria and continuous criteria improvement during clinical rational drug use guidance can promote rational use of GCs in oncology department.

Objective To explo the antioxidant effect and molecular mechanism of gastrodin (Gas) in epilepsy (EP) rats induced by LiCl-pilocarpine (PILO) . Methods Eighty male SD rats were randomly divided into 5 groups: sham group, EP group, therapy groups (pretreated with 60 mg/kg, 90 mg/kg, 120 mg/kg of gastrodin respectively) . The EP model was esteblished by peritoneal injection of LiCl-PILO. Therapy groups were pretreated with various concerntration of Gas. The control group was given the same dosage of normal saline. The alteration of behavior was observed, the concentration of catalase (CAT), glutathion (GSH), superoxide dismutase (SOD), glutathion reductase (GR), total antioxidtion (T-AOC) and malondialdehyde (MDA) in rats brain cortex were detected by chemical colorimetric method, phosphorylation of p38 was determined by western blot. Results There was no EP seizure in sham group,and the EP seizure degree in therapy groups (gas pretreated groups) was significantly decreased,and had statistically significant difference with EP group (P<0.05) . The EP model rats exhibited a significant decrease in the concentration of endogenous antioxidants (CAT, GSH, SOD, GR and T-AOC), while an increase of the concentration of MDA and phosphorylation p38 protein as compared to sham group (P<0.05) . After treatment of the Gas,treatment group rats attenuated the seizure degree,exhibited a significant increase of the concentration of endogenous antioxidants (P<0.05),while a decrease in concentration of MDA and phosphorylation of p38 as compared to model group (P<0.05) . Conclusion Gas may have a neuroprotective role in central nervous system of epileptic rats modle by down-regulateing the seizure degree and the activity of p38 kinase and up-regulateing the content of endogenous antioxidants.