Passive leg raising as an indicator of fluid responsiveness in patients with severe sepsis

In the management of critically ill patients, the assessment of volume responsiveness and the decision to administer a fluid bolus constitute a common dilemma for physicians. Static indices of cardiac preload are poor predictors of volume responsiveness. Passive leg raising （PLR） mimics an endogenous volume expansion （VE） that can be used to predict fluid responsiveness. This study was to assess the changes in stroke volume index （SVI） induced by PLR as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis. This was a prospective study. Thirty-two mechanically ventilated patients with severe sepsis were admitted for VE in ICU of the First Affiliated Hospital, Zhejiang University School of Medicine and Ningbo Medical Treatment Center Lihuili Hospital from May 2010 to December 2011. Patients with non-sinus rhythm or arrhythmia, parturients, and amputation of the lower limbs were excluded. Measurements of SVI were obtained in a semi-recumbent position （baseline） and during PLR by the technique of pulse indicator continuous cardiac output （PiCCO） system prior to VE. Measurements were repeated after VE （500 mL 6% hydroxyethyl starch infusion within 30 minutes） to classify patients as either volume responders or non-responders based on their changes in stroke volume index （ASVI） over 15%. Heart rate （HR）, systolic artery blood pressure （ABPs）, diastolic artery blood pressure （ABPd）, mean arterial blood pressure （ABPm）, mean central venous pressure （CVPm） and cardiac index （CI） were compared between the two groups. The changes ofABPs, ABPm, CVPm, and SVI after PLR and VE were compared with the indices at the baseline. The ROC curve was drawn to evaluate the value of ASVI and the change of CVPm （ACVPm） in predicting volume responsiveness. SPSS 17.0 software was used for statistical analysis. Among the 32 patients, 22 were responders and 10 were non-responders. After PLR among the responders, some hemodynamic variables （including ABPs, ABPd, ABPm and CVPm） were significantly elevated （101.2±17.6 vs. 118.6±23.7, P=0.03; 52.8±10.7 vs. 64.8±10.7, P=0.006; 68.3±11.7 vs. 81.9±14.4, P=0.008; 6.8±3.2 vs. 11.9±4.0, P=0.001）. After PLR, the area under curve （AUC） and the ROC curve of ASVI and ACVPm for predicting the responsiveness after VE were 0.882±0.061 （95%CI 0.759-1.000） and 0.805±0.079 （95%CI 0.650-0.959） when the cut-off levels of ASVI and ACVPm were 8.8% and 12.7%, the sensitivities were 72.7% and 72.7%, and the specificities were 80% and 80%. Changes in ASVI and ACVPm induced by PLR are accurate indices for predicting fluid responsiveness in mechanically ventilated patients with severe sepsis.

Diagnostic Accuracy of Transthoracic Echocardiography to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill: A Meta-Analysis

Background: Hemodynamic instability is common in critical patients and not all patients respond to fluid challenge, so we need accurate and rapid hemodynamic techniques to help the clinicians to guide fluid treatment. Numerous hemodynamic techniques have been used to predict fluid responsiveness till now. Transthoracic echocardiography (TTE) appears to have the ability to predict fluid responsiveness, but there is no consensus on whether it can be used by passive leg raising (PLR). Methods: We performed a literature search using MEDLINE (source PubMed, from 1947), EMBASE (from 1974) and the Cochrane Database of Systematic Reviews for prospective studies with no restrictions. Pooled effect estimates were obtained by using random-effects meta-analysis. Results: 7 prospective studies involving 261 patients and 285 boluses were identified. The pooled sensitivity and specificity of TTE are 86% (79% - 91%) and 90% (83% - 94%), respectively. The summary receiver operating characteristic (sROC) curve shows an optimum joint sensitivity and specificity of 0.88, with area under the sROC curve (AUC) of 0.94. The result of diagnostic odds ratio (DOR) is 50.62 (95% confidence interval [CI]: 23.70 - 108.12). The results of positive likelihood ratio (+LR) and negative likelihood ratio (?LR) are 7.07 (95% CI: 4.39 - 11.38) and 0.19 (95% CI: 0.13 - 0.28), which indicated strong diagnostic evidence. Conclusions: TTE is a repeatable and reliable noninvasive tool to predict fluid responsiveness in the critically ill during PLR with good test performance. This meta-analysis brings evidence to employ well-trained clinician-echocardiographers to assess patients’ volume statue via TTE to benefit daily work in intensive care units (ICUs).

Meta-Analysis of Invasive versus Non-Invasive Techniques to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill

Objective: To analyze the accuracy and specificity of recent studies to compare the ability of predicting fluid responsiveness with Passive Leg Raising (PLR) by using invasive or non-invasive techniques during passive leg raising. Data Sources: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were systematically searched. Study Selection: Clinical trials that reported the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) between the responder and non-responder induced by passive leg raising and Volume Expansion (VE) in critical ill patients were selected. 246 studies were screened, 14 studies were included for data extraction, which met our inclusion criteria. Data Extraction: Data were abstracted on study characteristics, patient population, type and amount of VE, time of VE, definition of responders, position, techniques used for measuring hemodynamic change, number and percentage of responders, the correlation coefficient, sensitivity, specificity, best threshold and area under the ROC curve (AUC). Meta-analytic techniques were used to summarize the data. Data Synthesis: A total of 524 critical ill patients from 14 studies were analyzed. Data are reported as point estimate (95% confidence intervals). The pooled sensitivity and specificity of invasive techniques were 80% (73% - 85%) and 89% (84% - 93%) respectively with the area under the sROC of 0.94. While, the pooled sensitivity and specificity of non-invasive techniques were 88% (84% - 92%) and 91% (86% - 94%) respectively with the area under the sROC of 0.95. The pooled DOR of invasive techniques was 32.2 (13.6 - 76.8), which was much lower than that of non-invasive techniques with the value of 64.3 (33.9 - 121.7). Conclusions: The hemodynamic indexes changes induced by PLR could reliably predict fluid responsiveness. Non-invasive hemodynamic techniques with their accuracy and safety can benefit the daily work in ICUs. Because the number of patients included in the present trials was small, further studies should be undertaken to confirm these findings.

Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients

Background and objective： Stroke volume variation（SVV） has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm（SR） and controlled mechanical ventilation（CV） are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit（ICU） patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of Pi CCO-monitoring（primary endpoint） and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. Methods： The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. Results： In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent： the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter（36.1% vs. 21.9%; P0.001）. Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. Conclusions： The applicability of SVV in a predominantly medical ICU is only about 25%–35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.

Meta-Analysis of Ventilated versus Spontaneously Breathing Patients in Predicting Fluid Responsiveness by Inferior Vena Cava Variation

Purpose: Respiratory variation in inferior vena cava (ΔIVC) has been extensively studied in predicting fluid responsiveness, but the results are conflicting. We performed a systemic review and meta-analysis of studies aiming at investigating the diagnostic accuracy of ΔIVC in predicting fluid responsiveness. Methods: MEDLINE, EMBASE, Cochrane Database and Web of Science were screened for relevant original and review articles from inception to July 2016. The meta-analysis determined the pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUROC). In addition, subgroup analyses were performed in mechanically ventilated patients and spontaneously breathing patients. Results: A total of 20 studies involving 635 patients were included. Cutoff values of ΔIVC varied from 12% to 42%, the pooled sensitivity and specificity was 0.68 (0.62 - 0.75) and 0.80 (0.75 - 0.85), respectively. The DOR was 14.2 (6.0 - 33.6) and the AUROC was 0.86 (0.78 - 0.93). Subgroup analysis showed better diagnostic performance in patients on mechanical ventilation than in spontaneously breathing patients with higher sensitivity (0.75 vs. 0.56), specificity (0.82 vs. 0.78), DOR (22.9 vs. 7.9) and AUROC (0.90 vs. 0.80). The best threshold of ΔIVC in patients on mechanical ventilation was IVC distensibility index (ΔIVC ≥17% ±4%), compared to IVC collapsibility index (ΔcIVC ≥33% ±12%) in spontaneously breathing patients. Conclusion: ΔIVC is not an accurate predictor of fluid responsiveness in patients with acute circulatory failure. In patients on mechanical ventilation, the predicting ability of ΔIVC was moderate with acceptable sensitivity and specificity;in spontaneously breathing patients, the specificity remains acceptable but its sensitivity is poor.

Arterial Pulse Pressure Variation versus Central Venous Pressure as a Predictor for Fluid Responsiveness during Open Major Abdominal Operations

Introduction: Fluid resuscitation is the cornerstone in the management of hemodynamically unstable patients. Dynamic parameters of fluid responsiveness, like pulse pressure variation, have the advantage of being more reliable index for fluid management. Objective: The aim of our study was to compare between arterial pulse pressure variation (PPV) versus central venous pressure (CVP) as a predictor for fluid responsiveness during major open abdominal operations. Patients and Methods: 60 adult patients under general anesthesia with mechanical ventilation underwent open major abdominal surgical procedures were included in our prospective randomized controlled study. Intravenous fluid was infused and monitored by CVP in control group or by PPV in the other group. Hemodynamic variables (heart rate, invasive blood pressure, PPV and CVP) were measured at baseline after anesthesia induction and every 10 min, during first hour of operation, and then every 15 min, till end of surgery. Blood loss and total i.v. fluid & blood transfusion given to patients were recorded and compared between two groups intraoperatively. Results: Patients in the PPV group required more intraoperative fluid and blood transfusion than patients in CVP group to achieve more stable hemodynamic parameters. The fall in blood pressure (>20% of baseline) and increase in heart rate are more common in CVP group (p Conclusion: PPV is a better predictor and a good guide for fluid responsiveness. More stable hemodynamic variables are observed in PPV group.

Effect of Systolic Cardiac Function on Passive Leg Raising for Predicting Fluid Responsiveness： A Prospective Observational Study

Background：Passive leg raising （PLR） represents a ＂self-volume expansion （VE）＂ that could predict fluid responsiveness,but the influence of systolic cardiac function on PLR has seldom been reported.This study aimed to investigate whether systolic cardiac function,estimated by the global ejection fraction （GEF） from transpulmonary-thermodilution,could influence the diagnostic value of PLR.Methods：This prospective,observational study was carried out in the surgical Intensive Care Unit of the First Affiliated Hospital of Sun Yat-sen University from December 2013 to July 2015.Seventy-eight mechanically ventilated patients considered for VE were prospectively included and divided into a low-GEF （〈20%） and a near-normal-GEF （〉20%） group.Within each group,baseline hemodynamics,after PLR and after VE （250 ml 5% albumin over 30 min）,were recorded.PLR-induced hemodynamic changes （PLR-△） were calculated.Fluid responders were defined by a 15% increase of stroke volume （SV） after VE.Results：Twenty-five out of 38 patients were responders in the GEF 〈20% group,compared to 26 out of 40 patients in the GEF 〉20% group.The thresholds of PLR-△SV and PLR-△ cardiac output （PLR-△CO） for predicting fluid responsiveness were higher in the GEF 〉20% group than in the GEF 〈20% group （△SV：12% vs.8%;△CO：7% vs.6%）,with increased sensitivity （△SV：92% vs.92%;△CO：81% vs.80%） and specificity （△SV：86% vs.70%;△CO：86% vs.77%）,respectively PLR-△ heart rate could predict fluid responsiveness in the GEF 〉20% group with a threshold value of-5% （sensitivity 65%,specificity 93%） but could not in the GEF 〈20% group.The pressure index changes were poor predictors.Conclusions：In the critically ill patients on mechanical ventilation,the diagnostic value of PLR for predicting fluid responsiveness depends on cardiac systolic function.Thus,cardiac systolic function must be considered when using PLR.Trial Registration：Chinese Clinical Trial Register,ChiCTR-OCH-13004027;http：//www.chictr.org.cn/showproj.aspx？proj=5540.

Computational Fluid Dynamics Approach for Predicting Pipeline Response to Various Blast Scenarios: A Numerical Modeling Study

Recent industrial explosions globally have intensified the focus in mechanical engineering on designing infras-tructure systems and networks capable of withstanding blast loading.Initially centered on high-profile facilities such as embassies and petrochemical plants,this concern now extends to a wider array of infrastructures and facilities.Engineers and scholars increasingly prioritize structural safety against explosions,particularly to prevent disproportionate collapse and damage to nearby structures.Urbanization has further amplified the reliance on oil and gas pipelines,making them vital for urban life and prime targets for terrorist activities.Consequently,there is a growing imperative for computational engineering solutions to tackle blast loading on pipelines and mitigate associated risks to avert disasters.In this study,an empty pipe model was successfully validated under contact blast conditions using Abaqus software,a powerful tool in mechanical engineering for simulating blast effects on buried pipelines.Employing a Eulerian-Lagrangian computational fluid dynamics approach,the investigation extended to above-surface and below-surface blasts at standoff distances of 25 and 50 mm.Material descriptions in the numerical model relied on Abaqus’default mechanical models.Comparative analysis revealed varying pipe performance,with deformation decreasing as explosion-to-pipe distance increased.The explosion’s location relative to the pipe surface notably influenced deformation levels,a key finding highlighted in the study.Moreover,quantitative findings indicated varying ratios of plastic dissipation energy(PDE)for different blast scenarios compared to the contact blast(P0).Specifically,P1(25 mm subsurface blast)and P2(50 mm subsurface blast)showed approximately 24.07%and 14.77%of P0’s PDE,respectively,while P3(25 mm above-surface blast)and P4(50 mm above-surface blast)exhibited lower PDE values,accounting for about 18.08%and 9.67%of P0’s PDE,respectively.Utilising energy-absorbing materials such as thin coatings of ultra-high-strength concrete,metallic foams,carbon fiber-reinforced polymer wraps,and others on the pipeline to effectively mitigate blast damage is recommended.This research contributes to the advancement of mechanical engineering by providing insights and solutions crucial for enhancing the resilience and safety of underground pipelines in the face of blast events.

医用臭氧联合水胶体敷料在ICU患者压疮治疗中的应用效果分析

目的探讨医用臭氧联合水胶体敷料在重症监护室(ICU)患者压疮治疗中的应用效果。方法选取2020年6月至2021年6月河南科技大学第一附属医院收治的60例并发压疮的ICU患者作为研究对象,按照不同治疗方法将其分为观察组(30例)和对照组(30例),观察组患者压疮创面采用医用臭氧联合水胶体敷料治疗,对照组患者压疮创面单纯采用水胶体敷料治疗,对比观察两组患者创面面积、渗液量、疼痛程度与血清炎症指标水平、创面病原菌检出率及临床疗效。结果治疗14 d后,观察组患者创面渗液量明显少于对照组(t=2.134,P=0.037),视觉模拟评分法(VAS)评分及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平均明显低于对照组(t=3.504、3.665、3.685,P均<0.001),而创面面积及白细胞计数与对照组无明显差异(t=1.113、0.714,P=0.270、0.478)。治疗28 d后,观察组患者创面均未检出病原菌,明显低于对照组患者的创面病原菌检出率26.67%(χ^(2)=9.231,P=0.002)。治疗28 d后,观察组患者治疗总有效率为96.67%,明显高于对照组患者的治疗总有效率76.67%(χ^(2)=5.192,P=0.023)。结论医用臭氧联合水胶体敷料治疗ICU患者压疮创面,可有效减少创面渗液量,缓解创面疼痛,降低机体炎症反应程度,抑制创面病原菌定植,提高治疗效果。

以ICU护士为主导的程序化镇痛镇静方案结合预见性护理干预对ICU多发伤患者康复情况的影响

目的探究以ICU护士为主导的程序化镇痛镇静方案结合预见性护理干预对ICU多发伤患者康复情况的影响。方法选取2019年4月至2022年7月我院收治的70例ICU多发伤患者为研究对象,以入院接受治疗时间差异将其分为对照组和观察组,每组35例。对照组接受常规护理,观察组在对照组护理方案基础上加施以ICU护士为主导的程序化镇痛镇静方案结合预见性护理干预。比较两组的干预效果。结果观察组的机械通气时间、ICU入住时间、导管留置时间以及住院时间均短于对照组(P<0.05)。干预后,观察组的促肾上腺皮质激素(ACTH)、前列腺素E2(PGE2)水平及视觉模拟评分法(VAS)评分均低于对照组(P<0.05)。观察组的感染总发生率低于对照组(P<0.05)。结论以ICU护士为主导的程序化镇痛镇静方案结合预见性护理干预可减轻ICU多发伤患者疼痛反应,促进康复,值得推广。

VIBRATION NUMERICAL ANALYSIS OF COUNTER-ROTATING TURBINE WITH WAKE-FLOW USING FLUID-STRUCTURE INTERACTION METHOD

The design of counter-rotating turbine is one of new techniques to improve the thrust-weight ratio of jet propulsion engines.Numerical analysis of a low pressure（LP）counter-rotating turbine rotor blade is presented by using ANSYS/CFX software.Interaction of aerodynamics and solid mechanics coupling in the computation is applied.In some rating of turbine,stress distribution and vibration characteristics of low pressure turbine（LPT）blade are computed.The wake aerodynamic forces and LPT blade vibration are transformed in frequency domain using fast Fourier transform（FFT）method.The results show that under wake aerodynamic force excitation,the first order modal vibration is more easily aroused and the higher order response cannot be ignored.Moreover,with different temperature fields,the vibration responses of blade are also different.

ICU中超声监测技术与容量反应性

容量反应性被认为是严重感染和感染性休克患者复苏的基石.超声是监测容量反应时下腔静脉、上腔静脉、外周血管、心功能等随呼吸周期和被动抬腿实验变化的参数的重要工具.多项研究表明,超声监测ICU容量反应时血流动力学参数具有无创、实时动态的优势.

醒脑静注射液对ICU重症肺炎患者血清细胞因子含量变化的影响

目的:探讨醒脑静注射液对重症肺炎患者血清细胞因子含量变化的影响。方法:按随机分组法将40例重症肺炎患者随机分为两组:治疗组20例在常规西药及人工机械通气治疗基础上加用醒脑静注射液;对照组20例仅用西药及人工机械通气等常规治疗;并将同期门诊健康体检者设为正常组进行比较。测定正常组及40例重症肺炎患者治疗前后血清TNF-α、IL-6及C反应蛋白(CRP)含量。结果:重症肺炎患者血清TNF-α、IL-6及CRP含量水平较正常组明显增高(P<0.05或P<0.01);治疗组治疗后d 5、7 TNF-α、IL-6水平下降幅度与本组治疗前及对照组治疗后比较有统计学差异(P<0.05);而治疗后治疗组与对照组CRP含量比较则无统计学差异。结论:TNF-α和IL-6是参与重症肺炎炎性反应的细胞因子,醒脑静可通过减轻细胞因子介导的炎性反应对重症肺炎的肺损伤起到保护作用。

我院实施综合ICU主责护士代班负责制的效果研究

目的:评价我院实施综合ICU主责护士代班负责制管理前、后的临床效果。方法:采用回顾性对比,随机选择病人,设立对照组,观察实施此管理方式前、后基础护理、护理文书、病房管理及消毒隔离合格率,医疗纠纷及护理差错发生率等指标的变化。结果:以上各指标经自身对照研究,差异明显(P<0.01)。结论:(1)实施综合ICU质量保证管理模式,采取主责护士代班负责制对本班次病区的临床护理工作进行指导和管理,可以达到护理管理工作24小时不间断,在护理工作的发生过程中实施控制,将问题消灭在萌芽状态。同时,解决了规章制度和护理工作落实不到位的问题,切实提高了危重病人护理质量和安全。(2)该管理方式有利于护理管理人才梯队的建设,可以全面提高护理管理的质量。

综合ICU实行医护一体化模式下责任护理组长负责制的管理实践

[目的]探讨综合ICU实行医护一体化模式下责任护理组长负责制实施效果。[方法]在综合ICU实行"医护一体化模式下的责任护理组长负责制",明确其岗位职责和工作流程,制定并实施绩效考核方案,对护士分层培训。比较实施前后护理文件书写合格率、专科护理操作考核合格率、特级护理落实合格率、抢救成功率、治疗目标达成率检查结果;通过自设问卷调查医生、病人及家属对护理工作的满意度。[结果]实行医护一体化模式下责任护理组长负责制后护理满意度及各项危重护理质量指标得到提高。[结论]医护一体化模式下责任护理组长负责制的实行,激发了护士的工作积极性,从而提供更专业的护理服务、规范化的培训,并推动科室团队文化的良性发展,但人力资源分配及绩效考核等仍需进一步探讨。

氧驱雾化吸入与持续气道湿化液泵入在ICU气管切开患者中的临床疗效观察

目的:探讨氧驱雾化吸入与持续气道湿化液泵入在ICU气管切开患者中的临床疗效。方法:选取100例ICU气管切开患者法分为对照组和观察组,对照组给予持续气道湿化液泵入,观察组给予氧驱雾化吸入,比较两组湿化方法的临床效果。结果:湿化21 d后,观察组平均痰液量及黏液黏稠度(Ⅲ度)患者比例明显低于对照组;观察组肺部感染率、气道黏膜出血、痰痂形成、院内感染率、死亡率患者明显低于对照组,ICU转出率高于对照组,比较差异均具有统计学意义(P<0.05)。结论:氧驱雾化吸入在ICU气管切开患者中的应用效果优于持续气道湿化液泵入,可提高ICU转出率,降低院内感染率、死亡率,值得临床推广应用。

ICU应用床旁超声技术评估患者容量反应性的可行性研究

目的初步研究ICU应用床旁超声技术测量下腔静脉塌陷指数(IVC-CI)和心输出量(CO)的可行性。方法采用前瞻性研究方法,对转入右江民族医学院附属医院ICU的30例成年患者,由ICU医师和超声科医师分别各自应用床旁超声仪对每位患者测量IVC-CI和CO;并分别对两者的操作时间(T)、测量的IVC-CI和CO之间的差异进行统计学分析。结果两组T、IVC-CI和CO比较差异无统计学意义(P>0.05)。结论该院ICU医师可独立应用床旁超声技术测量下腔静脉塌陷指数和心输出量,并能保证较准确可靠的测量结果,对ICU患者的快速诊治具有广泛的临床应用价值和前景。

降钙素原对ICU全身炎症反应综合征患者病因诊断及预后的价值

目的探讨分析ICU全身炎症反应综合征患者测定降钙素原后对其病因诊断及预后的价值。方法选择我院2015年1月~2016年12月收治的80例ICU全身炎症反应综合征患者(脓毒症),作为实验组,另外选取同时期来我院ICU就诊的80非脓毒症患者作为对照组,两组患者均进行外周静脉血血清降钙素原(PCT)、c-反应蛋白(CRP)测定,观察两组患者的PCT、CRP动态测定效果,针对死亡组与存活组患者的PCT、CRP动态测定效果进行对比分析,并且分析影响预后的危险因素。结果经测定分析,实验组ICU全身炎症反应综合征患者在第1天、第3天、第5天的PCT水平均高于对照组,两组差异有统计学意义(P<0.05),CRP水平差异无统计学意义;另外,所有入选患者中,有119例患者存活,41例患者死亡,死亡组患者在第1天、第3天、第5天的PCT水平均高于存活组,两组差异有统计学意义(P<0.05),CRP水平差异无统计学意义;针对PCT水平进行分析,当PCT水平大于5.3μg/L时是影响预后的独立危险因素。结论降钙素原对于诊断ICU全身炎症反应综合征具有非常好的意义,并且可通过分析其水平评估预后效果,对于患者的健康非常重要。

目标责任制在ICU护理管理中的应用观察

目的探讨目标责任制在ICU护理管理中的应用效果。方法选取2017年12月~2018年12月于我院ICU住院治疗的92例患者作为分析对象,按照随机数字表法将其分为观察组与对照组各46例。对照组患者予以常规护理,观察组患者予以目标责任制护理。出院时,评估两组ICU护理质量(基础护理、护理技能、病房管理、健康教育、护理流程);观察两组患者在ICU住院时间、院内感染发生率、病死率差异。比较两组患者出院4周后生活质量[健康状况调查问卷(SF-36)]评分差异。结果出院时,观察组ICU护理质量明显高于对照组(P均<0.05);观察组患者ICU住院时间明显低于对照组(P<0.05),两组患者院内感染发生率、病死率比较差异无统计学意义(P均>0.05)。出院4周后,观察组患者生活质量明显高于对照组(P均<0.05)。结论目标责任制护理能提高ICU护理质量,能缩短患者ICU住院时间,降低院内感染发生率及病死率,提高患者生活质量。

控制性升压与限制性液体复苏应用于ICU多发伤休克患者中的价值

目的探析对ICU多发伤休克患者采取控制性升压与限制性液体复苏的临床价值。方法方便选取该院2011年1月—2016年11月期间收治的102例ICU多发伤休克患者,均采取控制性升压,根据不同的复苏方法将其分为两组,研究组和对照组,各51例,对照组采取常规液体复苏,研究组给予限制性液体复苏,比较两组复苏时间、临床效果及并发症情况。结果研究组复苏时间(90.0±25.3)min、复苏后PT(10.1±1.1)s、复苏后C-反应蛋白(101.2±11.6)ng/L,复苏后Hgb(102.7±12.6)g/L、复苏后CVP(7.3±1.1)cmH_2O与对照组比较差异有统计学意义(P<0.05);研究组DIC发生率11.76%、MODS发生率5.88%、病死率1.96%与对照组比较差异有统计学意义(P<0.05)。结论对ICU多发伤休克患者采取控制性升压与限制性液体复苏疗效明确,安全性好,值得临床应用。