Characteristics of Patients with Decreased Cognitive Function Undergoing Treatment for Acute Exacerbation of Chronic Heart Failure—Basic Survey for Standardization of Nursing to Prevent Discontinuation of Treatment

The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.

Development of Nursing Protocol for Preventing Interruptions during Clinical Examinations and Treatments in the Early Days of Hospitalization for Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing interruptions during clinical examinations and treatments performed in the early days of hospitalization for acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the research, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 11 nurses in dementia care to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 73 subjects (84.9%) considered effective for patients, in terms of prevention of interruptions during clinical examinations and treatments in the early days of hospitalization. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 84.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We consider that this nursing protocol will be useful especially for newly graduated/employed nurses as a procedure manual which can reduce their anxiety or stress caused by lack of knowledge or experiences.

Development of Nursing Protocol for Preventing Discontinuation of Treatments by Methods Other than Physical Restraint during Acute Exacerbation of Chronic Heart Failure in Patients with Impaired Cognitive Function

The purpose of this study is to prepare a nursing protocol for preventing discontinuation of treatments using a method other than physical restraint during acute exacerbation of chronic heart failure in patients with impaired cognitive function. For the first stage of the study, we prepared a draft of the nursing protocol based on a basic survey. For the second stage, semi-structured interviews were conducted with 5 nurses specialized in chronic heart failure and 10 nurses in dementia case to ensure content validity of the draft protocol. For the third stage, we examined the possibility of clinical application of the revised version of the protocol draft prepared in the second stage of the study. For assessment items, significant points of nursing care, and specific nursing care practice in this revised version, 154 subjects (93.9%) considered effective for patients, in terms of prevention of treatment discontinuation using a method other than physical restraint. All items and contents were considered useful by more than 60% of the nurses. Considering that the nurses working in the clinical setting reported 93.9% of usefulness, we concluded that this nursing protocol remained valid at a certain level. We also received a comment from the certified nurses that we should include the basic contents for newly graduated nurses. We consider that this nursing protocol will be also useful for newly graduated nurses to acquire knowledge. It helped to standardize nursing care in order to predict potential risks for patients with impaired cognitive function.

Development of a Nursing Protocol for Hospitalized Patients with Reduced Cognitive Function in the Process of Recovery from Acute Exacerbation of Chronic Heart Failure

The purpose of this study is to develop a nursing protocol aiming at early recovery of hospitalized patients with reduced cognitive functions in the process of recovery from acute exacerbation of chronic heart failure. At the first stage of the research, a draft nursing protocol was prepared based on a basic survey. At the second stage of research, a semi-structured interview was conducted for 4 nurses certified for chronic heart failure nursing and 11 nurses certified for dementia nursing so as to ensure content validity of the draft nursing protocol. At the third stage of the study, the possibility of clinical application of the nursing protocol revision plan proposed at the second stage of the study was examined. The nursing protocol revision plan was effective for 118 nurses (90.1%) who carried out the protocol for the target patient on assessment items, essential points of nursing care and specific nursing care. There were no items or contents for which confirmation of usefulness was less than 60%. Since 90.1% of the usefulness was confirmed by nurses working in the actual clinical setting, the authors believe that this nursing protocol was secured to a certain level. The nursing protocol developed in this study has been requested by nurses at clinical sites in the past. It is very meaningful in improving nursing for the early recovery of hospitalized patients with reduced cognitive function in the process of recovery from acute exacerbation of chronic heart failure.

Effect of ivabradine in the treatment of acute exacerbation of chronic obstructive pulmonary disease with heart failure

Objective: To observe the effectiveness and safety of ivabradine in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and heart failure. Methods:Patients who were admitted to hospital with AECOPD during the period from August 2017 to July 2018. Then those both had heart failure with reduced ejection fraction(HFrEF) and a resting heart rate>70 beats/min were enrolled. A total of 86 cases were screened and completed, which were randomly divided into two groups for treatment. The control group(41 cases) received standard treatments, such as oxygen, anti-infection, anti-spasmodic, hormone, diuretic, ACEI/ARB, recombinant human brain natriuretic peptide (rhBNP), etc. The bisoprolol was given 2.5~5 mg orally once a day to control heart rate, and the test group(45 cases) was further treated with ivabradine 2.5~5 mg orally twice a day on the basis of the control group. The average heart rate, cardiac function, lung function, and 6-minute walking test were compared between the two groups. Results: After treatment, the average heart rate of the test group was lower than the control group, and the heart rate control rate(<70 beats/min%) of the test group was superior to the control group. The level of N-terminal B-type natriuretic peptide(NT-proBNP) in test group was significantly lower than that in control group. The distance of the 6-minute walking test in e test group was significantly longer than that in control group. Conclusion: Ivabradine combined with bisoprolol could help patients with AECOPD and heart failure to further reduce the heart rates, improve heart function and exercise tolerance. Moreover, the therapeutic safety was acceptable during the short term.

Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection

BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.

Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.

The Lebanese Society of Cardiology Consensus Statement on the Use of Natriuretic Peptides for the Management of Heart Failure

Plasma concentration of Natriuretic Peptide (NP) is a valuable diagnostic tool for heart failure (HF). It can help rule out or confirm a diagnosis of HF based on symptoms, but its use is not clearly defined. NPs should be used in conjunction with physical examination and other diagnostic tests. However, it is important to note that several conditions besides the diagnosis of HF may cause NPs levels to be elevated. Additionally, there are situations when NP concentrations may be below diagnostic thresholds in [1]. This consensus statement aims to provide a straightforward diagnostic flowchart for clinicians in both the emergency department and outpatient settings to aid in diagnosing both acute and chronic HF. The diagnosis of acute HF can be ruled out with a BNP level of 100 pg/mL or NTproBNP level of 300 pg/mL, regardless of the patient’s age. To identify HF, a 3-level cut-off point based on the patient’s age is recommended. Chronic heart failure can be ruled out with a BNP level of 35 pg/mL or NTproBNP level of 125 pg/mL, regardless of thepatient’s age [1].

Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation

BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind.

Effects of low molecular weight heparin on the function of blood coagulation and serum levels of TNF-α, CK-MB, CRP of patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failur

Objective:To study the effects of low molecular weight heparin on the function of blood coagulation and serum levels of tumor necrosis factor-α(TNF-α), creatine kinase isoenzyme (CK-MB), C-reactive protein (CRP) of patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure.Methods:A total of 80 patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure in our hospital from June 2014 to October 2016 were enrolled in this study. The subjects were divided into the control group (n=40) and the treatment group (n=40) randomly. The control group were treated with conventional treatment, the treatment group were treated with the conventional treatment combined with low molecular weight heparin. The two groups were treated for 7 d. The D-dimer (D-D), fibrinogen (FBG), pro thrombin time (PT), thrombin time (TT), TNF-α, CK-MB and CRP of the two groups before and after treatment were compared.Results:There were no significantly differences of the blood levels of D-D, FBG, PT and TT of the two groups before treatment. After treatment, the blood levels of D-D and FBG of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group, the PT and TT of the two groups were significantly higher than before treatment, and that of the treatment group were significantly higher than the control group. There were no significantly differences of the serum levels of the TNF-α, CK-MB and CRP of the two groups before treatment. After treatment, the serum levels of the TNF-α, CK-MB and CRP of the two groups were significantly lower than before treatment, and that of the treatment group were significantly lower than the control group.Conclusion:Low molecular weight heparin can significantly reduce the inflammatory factors of the patients with acute exacerbations of chronic obstructive pulmonary diseases and respiratory failure, can alleviath the patients conditions and reduce the myocardial damage.

Score model for predicting acute-on-chronic liver failure risk in chronic hepatitis B

AIM: To establish a clinical scoring model to predict risk of acute-on-chronic liver failure(ACLF) in chronic hepatitis B(CHB) patients.METHODS: This was a retrospective study of 1457 patients hospitalized for CHB between October 2008 and October 2013 at the Beijing Ditan Hospital, Capital Medical University, China. The patients were divided into two groups: severe acute exacerbation(SAE) group(n = 382) and non-SAE group(n = 1075). The SAE group was classified as the high-risk group based on the higher incidence of ACLF in this group than in the non-SAE group(13.6% vs 0.4%). Two-thirds of SAE patients were randomly assigned to risk-model derivation and the other one-third to model validation. Univariate risk factors associated with the outcome were entered into a multivariate logistic regression model for screening independent risk factors. Each variable was assigned an integer value based on the regression coefficients, and the final score was the sum of these values in the derivation set. Model discrimination and calibration were assessed using area under the receiver operating characteristic curve and the Hosmer-Lemeshow test. RESULTS: The risk prediction scoring model includedthe following four factors: age ≥ 40 years, total bilirubin ≥ 171 μmol/L, prothrombin activity 40%-60%, and hepatitis B virus DNA > 107 copies/m L. The sum risk score ranged from 0 to 7; 0-3 identified patients with lower risk of ACLF, whereas 4-7 identified patients with higher risk. The Kaplan-Meier analysis showed the cumulative risk for ACLF and ACLF-related death in the two risk groups(0-3 and 4-7 scores) of the primary cohort over 56 d, and log-rank test revealed a significant difference(2.0% vs 33.8% and 0.8% vs 9.4%, respectively; both P < 0.0001). In the derivation and validation data sets, the model had good discrimination(C index = 0.857, 95% confidence interval: 0.800-0.913 and C index = 0.889, 95% confidence interval: 0.820-0.957, respectively) and calibration demonstrated by the Hosmer-Lemeshow test(χ2 = 4.516, P = 0.808 and χ2 = 1.959, P = 0.923, respectively).CONCLUSION: Using the scoring model, clinicians can easily identify patients(total score ≥ 4) at high risk of ACLF and ACLF-related death early during SAE.

GIDS在老年AECOPD呼吸衰竭患者病情及预后评估中的应用

目的 探讨胃肠道功能障碍评分(GIDS)与老年慢性阻塞性肺疾病急性加重期(AECOPD)呼吸衰竭患者疾病严重程度的相关性及对预后的预测价值,为疾病严重程度和预后评估提供参考依据。方法 收集2020年1月至2023年8月于该院ICU治疗的264例老年AECOPD呼吸衰竭患者作为研究对象。根据患者GIDS,将患者分为低GIDS组(0~1分)和高GIDS组(2~4分)。比较不同GIDS组患者急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭评估(SOFA)评分,以及患者住院结局指标,包括机械通气时间、ICU入住时间和预后情况。采用Spearman相关分析GIDS与APACHEⅡ评分、SOFA评分的相关性。采用受试者工作特征(ROC)曲线分析GIDS对预后的预测价值。结果 264例老年AECOPD呼吸衰竭患者GIDS为2.00(1.00,3.00)分,其中0分53例(20.1%),1分65例(24.6%),2分53例(20.1%),3分45例(17.0%),4分48例(18.2%)。高GIDS组APACHEⅡ评分和SOFA评分高于低GIDS组(P<0.05)。Spearman相关性分析结果显示,GIDS与APACHEⅡ评分、SOFA评分均呈正相关(r=0.458、0.392,P<0.05)。高GIDS组机械通气时间、ICU入住时间长于低GIDS组,预后不良发生率高于低GIDS组,差异均有统计学意义(P<0.05)。ROC曲线结果显示,GIDS预测老年AECOPD呼吸衰竭患者预后不良的曲线下面积为0.823,灵敏度和特异度分别为93.4%和60.1%。结论 老年AECOPD呼吸衰竭患者GIDS与疾病严重程度密切相关,该评分对患者预后不良具有良好的预测价值。

无创机械通气联合呼吸训练在AECOPD合并呼吸衰竭患者中的应用评价

目的:探讨无创机械通气联合呼吸训练对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的效果。方法:前瞻性纳入2019年2月—2022年2月桂林医学院附属医院急诊科收治的AECOPD合并呼吸衰竭患者共67例,采用随机数字表法将患者分为两组。对照组(n=33)接受间断无创机械通气治疗,观察组(n=34)在对照组基础上增加主动呼吸训练(包括上肢弹力带阻抗训练、缩唇腹式呼吸、呼吸训练器使用)。记录两组2 d内撤机成功率、不良反应发生率,比较两组氧合指数(OI)、动脉血二氧化碳分压(PaCO_(2))、改良版英国医学研究委员会(mMRC)呼吸困难问卷分级、呼吸频率(RR)、自主呼吸潮气量。结果:对照组2 d内撤机成功率为60.6%,观察组为82.4%,观察组的撤机成功率高于对照组(P<0.05);观察组咳痰乏力、呼吸疲劳发生率均低于对照组(P<0.05);与治疗前相比,两组患者治疗2 d后的OI和PaCO_(2)均有显著改善,差异均有统计学意义(P<0.05);治疗2 d后,观察组PaCO_(2)低于对照组(P<0.05),但两组OI比较,差异无统计学意义(P>0.05);与治疗前相比,两组患者治疗2 d后的mMRC呼吸困难问卷分级和RR均有明显下降,自主呼吸潮气量均有明显提升,差异均有统计学意义(P<0.05);治疗2 d后,两组mMRC呼吸困难问卷分级和RR比较,差异均无统计学意义(P>0.05),但观察组患者自主呼吸潮气量明显高于对照组(P<0.05)。结论:AECOPD合并呼吸衰竭患者进行无创机械通气联合呼吸训练,能有效改善呼吸肌疲劳,增加肺通气,提高撤机成功率。

参附注射液治疗心肾阳虚型慢性心力衰竭急性加重的临床研究

目的:观察参附注射液治疗心肾阳虚型慢性心力衰竭急性加重的临床疗效。方法:选取2023年10月—2024年1月在安徽中医药大学第一附属医院住院的慢性心力衰竭急性加重病人60例,按照随机数字表法分为观察组与对照组,各30例。观察组给予参附注射液加西医常规治疗,对照组仅给予西医常规治疗,比较两组治疗前后血浆氨基末端B型钠尿肽前体(NT-proBNP)、超敏肌钙蛋白I(hs-cTnI)、6 min步行试验(6MWT)、明尼苏达州心力衰竭生活质量问卷评分(MLHFQ)、中医证候积分及纽约心脏病协会(NYHA)心功能分级。结果:与治疗前比较,两组治疗后NT-proBNP、hs-cTnI水平降低(P<0.05),两组治疗后NT-proBNP、hs-cTnI水平比较差异均无统计学意义(P>0.05);与治疗前比较,两组治疗后6MWT、MLHFQ评分均明显改善(P<0.05),观察组改善程度优于对照组(P<0.05);两组治疗后各单项中医证候积分低于治疗前(P<0.05),观察组治疗后喘促气短、倦怠乏力、畏寒肢冷及言语声低评分低于对照组(P<0.05)。观察组总有效率为96.7%,对照组为80.0%,两组比较差异有统计学意义(P<0.05)。结论:参附注射液联合西药常规治疗可改善心肾阳虚型慢性心力衰竭急性加重病人心功能,提高病人运动耐量和生活质量。

人工肝多模式联合序贯治疗乙型肝炎病毒相关慢加急性肝衰竭患者的疗效

目的 观察慢加急性肝衰竭(乙型肝炎病毒相关)患者采用人工肝多模式联合序贯治疗的疗效。方法 选择2022年5月—2023年5月本院诊治的112例慢加急性肝衰竭患者作为研究对象,根据治疗方法不同分为序贯联合组(47例)和常规组(65例)两组。常规组患者进行常规模式治疗,行血浆置换联合连续性肾脏替代治疗,根据患者肝功能与凝血功能情况,选择血浆置换联合双重血浆分子吸附或血浆透析滤过。序贯联合组患者第1天予以血浆置换、连续性肾脏替代治疗,第2天予以血浆置换、双重血浆分子吸附,第3天予以血浆透析滤过;3 d后观察患者肝功能与凝血情况,以上述模式再进行3次人工肝治疗。比较两组患者实验室检查结果、临床疗效、细胞因子水平、并发症发生情况。结果 序贯联合组患者白细胞计数与肌酐水平为(6.2±2.0)×10^(9)/L、(61.1±14.7)μmol/L,均低于常规组[(7.9±2.4)×10^(9)/L、(74.6±21.3)μmol/L](P<0.05)。序贯联合组患者治疗好转率、治疗有效率及12周存活率分别为61.7%、66.0%、59.6%,均高于常规组的30.8%、13.8%、27.7%(P<0.05)。序贯联合组患者治疗后γ干扰素诱导蛋白10、白细胞介素-6、白细胞介素-8水平分别为(91.3±8.1)ng/L、(30.6±7.4)ng/L、(78.4±7.2)ng/L,均低于常规组[(96.2±11.3)ng/L、(35.1±7.7)ng/L、(82.4±7.7)ng/L](P<0.05)。序贯联合组患者并发症总发生率为10.6%,低于常规组的26.2%(P<0.05)。结论 慢加急性肝衰竭(乙型肝炎病毒相关)患者采取人工肝多模式联合序贯治疗疗效确切,可有效清除细胞因子,促使肝功能得到明显改善,延长患者生存期。

基于三度空间模型的精细化护理在AECOPD并呼吸衰竭患者中的实践研究

目的探讨基于三度空间模型的精细化护理在慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭患者中的应用效果。方法选取无锡市第二人民医院2020年8月至2022年3月收治的98例AECOPD并呼吸衰竭患者进行随机对照试验,利用随机数字表法分为观察组(49例)与对照组(49例)。对照组男性31例,女性18例,年龄51~79(64.56±8.15)岁,给予常规护理;观察组男性29例,女性20例,年龄53~80(66.23±7.36)岁,在对照组的基础上给予三度空间模型的精细化护理。比较两组患者护理前后自护能力、动脉血气指标、肺功能指标、生活质量以及并发症发生情况。统计学方法采用t检验、χ^(2)检验。结果护理后,两组患者自我护理技能、健康知识水平、自我概念、自护责任感评分均较护理前升高,且观察组均高于对照组[(40.92±10.23)分比(33.56±8.39)分、(49.83±12.21)分比(39.62±9.91)分、(32.96±8.24)分比(23.49±5.87)分、(28.76±7.19)分比(22.26±5.57)分],差异均有统计学意义(t=3.89、4.55、6.55、5.00,均P<0.05)。护理后,两组患者氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、用力肺活量占正常预计值百分比(FVC%)、第一秒用力呼气量占正常预计值百分比(FEV_(1)%)、第一秒用力呼气量占用力肺活量百分率(FEV_(1)/FVC%)均较护理前升高,且观察组均高于对照组,二氧化碳分压(PaCO_(2))低于对照组[(96.86±24.22)%比(84.12±21.03)%、(88.79±22.19)mmHg(1 mmHg=0.133 kPa)比(73.21±18.30)mmHg、(2.63±0.66)%比(2.29±0.57)%、(1.46±0.37)%比(1.28±0.32)%、(0.67±0.17)%比(0.58±0.15)%、(46.58±11.65)mmHg比(58.67±4.67)mmHg],差异均有统计学意义(t=2.78、3.78、2.73、2.58、2.78、4.52,均P<0.05);护理后,两组患者疾病影响、症状评分、圣乔治呼吸问卷(SGRQ)总分均较护理前降低,且观察组均低于对照组,活动能力评分高于对照组[(20.74±4.15)分比(29.46±5.89)分、(37.86±7.57)分比(49.58±9.92)分、(29.56±7.39)分比(38.76±9.69)分、(62.85±12.57)分比(52.32±10.46)分],差异均有统计学意义(t=8.47、6.58、6.61、4.51,均P<0.05);观察组患者并发症总发生率低于对照组[6.12%(3/49)比24.49%(12/49)],差异有统计学意义(χ^(2)=5.04,P<0.05)。结论基于三度空间模型的精细化护理应用于AECOPD并呼吸衰竭患者,有利于改善患者的肺通气、换气功能,提高患者自护能力和生活质量,降低并发症发生率,值得临床推广。

Performance measures for management of chronic heart failure patients with acute coronary syndrome in China： results from the Bridging the Gap on Coronary Heart Disease Secondary Prevention in China （BRIG） Project

Background Chronic heart failure （CHF） is a severe clinical syndrome associated with high morbidity and mortality, and with high health care expenditures. No nationwide data are currently available regarding the quality of clinical management of CHF patients in China. The aim of this study was to assess the quality of care of CHF inpatients in China. Methods The American College of Cardiology/American Heart Association Clinical Performance Measures for Adults with Chronic Heart Failure （Inpatient Measurement Set） with slight modifications was used to measure the performance status in 612 CHF patients with acute coronary syndrome （ACS） from 65 hospitals across all regions of China. Results The implementation rates of guideline recommended strategies for CHF management were low. Only 57.5% of the CHF patients received complete discharge instructions, 53.6% of the patients received evaluation of left ventricular systolic function, 62.8% received an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker at discharge, and 52.7% received a p-blocker at discharge, 56.3% of the smokers received smoking cessation counseling. The rate of warfarin utilization was only 9.7% in CHF patients with atrial fibrillation. Most patients （81.4%） did not receive all the first four treatments. There were marked differences in the quality of CHF management among patients with different characteristics. Conclusions Performance measures provide a standardized method of assessing quality of care, and can thus highlight problems in disease management in clinical practice. The quality of care for CHF patients with ACS in China needs to be improved.

噻托溴铵治疗慢性阻塞性肺疾病急性加重期合并急性呼吸衰竭的临床研究

目的探讨慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并急性呼吸衰竭患者应用噻托溴铵治疗的临床疗效。方法选取2019年3月至2022年3月湖州市第一人民医院收治的106例AECOPD合并急性呼吸衰竭患者,根据随机数字表法将其分为观察组和对照组,每组各53例。两组患者均给予常规治疗,对照组予以无创双相气道正压通气治疗,观察组在对照组的基础上加用噻托溴铵治疗。两组患者均治疗14d。比较两组患者的临床疗效、肺功能、血气指标、炎症因子及不良反应发生情况。结果观察组患者的治疗总有效率显著高于对照组(94.34%vs.79.25%,χ2=5.267,P=0.023)。治疗后,观察组患者的第1秒用力呼气容积、第1秒用力呼气容积/用力肺活量、呼气流量峰值、pH、经皮动脉血氧饱和度、动脉血氧分压均显著高于对照组(P<0.05),动脉血二氧化碳分压、白细胞介素-6、白细胞介素-8、肿瘤坏死因子-α及超敏C反应蛋白均显著低于对照组(P<0.05)。两组患者的用药不良反应及呼吸机不良反应发生率比较差异均无统计学意义(P>0.05)。结论噻托溴铵治疗AECOPD合并急性呼吸衰竭可显著提升疗效,改善患者的肺功能及动脉血气,但需要注意口干等不良反应的及时处理。

痰热清注射液治疗慢性阻塞性肺疾病合并呼吸衰竭的系统评价

目的:对痰热清注射液应用于慢性阻塞性肺疾病伴呼吸衰竭的有效性及安全性做出系统评价和Meta分析。方法:检索国家知识基础设施数据库(CNKI)、中国生物医学文献数据库(CBM)、中国学术期刊数据库(CSPD)及中文科技期刊数据库(CCD)、PubMed、Cochrane Library、Web of Science、Embase医学文献数据库,筛选出痰热清注射液治疗慢性阻塞性肺疾病伴呼吸衰竭的随机对照试验,使用RevMan 5.4软件对纳入研究进行系统评价和Meta分析,并使用GRADE评价系统对结局指标质量进行分级。结果:本研究纳入13项临床研究,共1 007例患者,观察组505例,对照组502例;痰热清注射液联合西医常规-治疗慢阻肺伴呼吸衰竭患者,在临床总有效率(OR=3.52,95%CI为2.35~5.27,P<0.000 01)、动脉血气pH值(MD=0.04,95%CI为0.02~0.05,P<0.000 01)、氧分压(MD=7.86,95%CI为7.24~8.48,P<0.000 01)、二氧化碳分压(MD=-6.85,95%CI为-8.99~-4.77,P<0.000 01)、肿瘤坏死因子(TNF-α)(SMD=-2.56,95%CI为-4.11~-1.01,P<0.01)方面,联合痰热清注射液的观察组与对照组比较,差异有统计学意义(P<0.01);GRADE证据分级提示,GRADE证据分级结果提示,总有效率、动脉血气pH值、动脉血气氧分压、动脉血气二氧化碳分压为低级质量证据,肿瘤坏死因子-α(TNF-α)为极低质量证据。结论:西医常规结合痰热清注射液治疗慢阻肺合并呼吸衰竭可以提高临床治疗总有效率,改善低氧血症和(或)二氧化碳潴留,减轻炎症状况,安全性较好,值得推广应用。

误诊为多种心外系统疾病的老年冠心病心力衰竭临床分析

目的探讨老年人冠心病心力衰竭多系统表现和早期误诊原因。方法分析2021年1月—2023年6月老年冠心病心力衰竭误诊8例临床资料。结果8例中2例咳嗽、咳痰,胸闷气促,两肺底湿啰音,肺纹理增粗紊乱,心电图示ST-T段压低,有慢性支气管炎病史,误诊“慢性支气管炎急性发作”;3例中2例恶心、呕吐,剑突下轻压痛,1例腹痛、腹泻、脐周轻度压痛,心电图示ST-T段压低3例、室性早搏2例,有慢性胃炎病史,误诊“急性胃肠炎”;1例腹胀、食欲不振、乏力,双下肢轻度水肿,丙氨酸转氨酶轻度升高,误诊为“慢性肝炎”;2例头晕、失眠、烦躁不安,心电图示窦性心动过速,有高血压、高脂血症史,误诊“脑动脉硬化症”。经详细询问病史、相关治疗史及认真查体,会诊后完善相关检查,确诊冠心病心力衰竭。误诊时间2~5 d。后予抗心力衰竭治疗,预后良好。随访半年,病情稳定。结论当老年患者以心外系统症状为首诊症状就诊时,应详细询问心脏病史,充分了解伴随症状,认真查体,避免遗漏相关阳性体征,及时行超声心动图、心电图等辅助检查,可有效避免误诊。