Objective To construct an early activity program for children with mechanical ventilation,and to explore the safety and efficacy of its clinical application. Methods On the basis of literature analysis,the early activity program was constructed. The convenience sampling method was used to select 50 cases of 3~14-year-old children with mechanical ventilation into an experimental group from December 2020 to July 2021 at the pediatric intensive care unit（PICU） of a tertiary children’s hospital in Hunan province. A nurse-led early activity program was implemented on the basis of the routine nursing. 50 children admitted from April 2020 to November 2020 were selected into a control group,and the routine nursing was given. The heart rate,respiration,systolic blood pressure and oxygen saturation of the experimental group were collected 5 mins before the activity,at the 15th min of the activity and 5 mins after the activity,as well as the occurrence of adverse events such as unplanned extubation,falling and bed falling during the activity. Meanwhile,the completion rate of the early activity program was calculated to evaluate the safety and feasibility of the early activity. Muscle strength level,incidence of delirium,duration of mechanical ventilation and duration of PICU were compared between the 2 groups on day 1,day 3 and day 6,and the effect of the early activity program was evaluated. Results There were no statistically significant differences in heart rate,respiration and blood oxygen saturation of the experimental groups at 5 mins before the activity,at the 15th min of the activity and 5 mins after the activity（P>0.05）,while there were statistically significant differences in systolic blood pressure（P<0.001）. There were no unplanned extubation,fall and bed falling during the activity. The overall completion rate of the early activity program was 86.96%. There was no significant difference in muscle strength between the 2 groups on day 1 and day 3 （P>0.05）,and the muscle strength of the experimental group was higher than that of the control group on day 6（P<0.001）. The incidence of delirium in the experimental group was lower than that in the control group,and the time of mechanical ventilation and PICU stay were both shorter than that in the control group,with statistically significant differences（P<0.05）. Conclusion The early activity program for children with mechanical ventilation is safe and feasible,which can improve the muscle strength level of children,reduce the incidence of delirium,shorten the time of mechanical ventilation and PICU stay,and contribute to the early recovery of children.
Objective To explore the application effect of advance care planning in hemodialysis patients.Methods A total of 80 hemodialysis patients who were treated in a tertiary hospital in Zhengzhou from October 2020 to June 2021 were selected as the research subjects. According to the random number table method,they were divided into a control group and an intervention group with 40 cases each. The intervention group was implemented with a 4-week advance care planning,and the control group received the routine care. The death attitude profile-revised scale,the Chinese version of the meaning in life questionnaire and the patient dignity inventory scale were used to compare the differences in death attitude,meaning of life and dignity between the 2 groups of patients.Results After the intervention,the patients in the intervention group changed their attitude toward death;the score of meaning of life was higher than that of the control group;the score of dignity was lower than that of the control group;the differences were statistically significant（P<0.05）.Conclusion Advance care planning can help hemodialysis patients change into a positive attitude toward death,increase the sense of meaning in life,and maintain the dignity of patients.
Objective To explore the effect of hospital-home continuum nursing based on a cloud follow-up platform in elderly patients with radical prostatectomy. Methods Convenience sampling method was used to select 80 prostate cancer patients who planned to receive radical surgery in a tertiary A a hospital in Xinjiang from July 2020 to February 2022 as the research subjects,and they were divided into an experimental group and a control group according to the operation time（40 cases in each group）. The experimental group received hospital-home continuous care based on a cloud follow-up platform,while the control group received routine perioperative care and discharge follow-up.The degree of urinary incontinence and pelvic floor muscle strength were compared between the 2 groups on the day,2 weeks,1 month,3 months,and 6 months after extubation,and the quality of life and health knowledge of urinary incontinence at 6 months after catheter removal were compared. Results With the help of the cloud follow-up platform,the hospital-home continuous care was implemented at 2 weeks,1 month,3 months,and 6 months after the removal of the urinary catheter. The pelvic floor muscle strength scores of the experimental group were higher than those of the control group,and the urinary incontinence scores were all lower than the control group.The difference was statistically significant（P<0.001）;the scores of quality of life and urinary incontinence health knowledge in the experimental group at 6 months after extubation were 93.50（88.25,100.00） and 20.00（20.00,20.00）,which were higher than those in the control group of 57.00（42.75,77.00） and 1.00（9.00,11.00）. The difference was statistically significant（P<0.001）. Conclusion The application of hospital-home continuum nursing based on the cloud follow-up platform in elderly patients with radical prostatectomy can improve the patient’s pelvic floor muscle strength and urinary incontinence health knowledge,improve the patient’s urinary incontinence problem,and improve their quality of life.
To summarize the infusion management of 15 infants with severe diabetic ketoacidosis for 48 hours. The main measures include：rapid assessment and rapid establishment of venous access,standardized and reasonable rehydration and the application of low-dose insulin, good assessment and monitoring in the process of rehydration,early detection and early intervention of various potential transfusion complications. The ketoacidosis was corrected within 48 hours, and the blood glucose was stable after follow-up treatment.
Objective To explore the risk factors of Post-Intense Care Syndrome-Cognitive Impairment（PICS-CI） in critically ill patients,and to build their risk prediction model. Methods A total of 481 ICU patients from 2 Level A tertiary hospitals in Fujian Province were selected,and divided into a cognitive impairment group（n=215） and a non-cognitive impairment group（n=266） according to their cognitive score of 7 days after being transferred out of ICU. The demography,disease,treatment,physiological and laboratory indicators between the 2 groups were compared;the risk factors of PICS-CI were screened out,and Logistic regression was used to establish a risk prediction model. 118 patients from another 4 hospitals were selected to verify the model prediction. Results Age（OR=1.035）,delirium（OR=10.488）,sepsis（OR=1.925）,propofol dose（OR=1.098）,sleep disorder（OR=0.932） are the independent risk factors of PICS-CI. These 5 factors are used to construct a prediction model,which was internally verified by the modeling group. The calibration curve of the calibration chart is close to the ideal curve;the area under the ROC curve is 0.838;the risk prediction value 0.521 corresponding to the maximum Youden index is the best value;the prediction critical value is 50 points. The external verification shows that the calibration curve of the calibration chart is near the ideal curve,and the area under the ROC curve drawn is 0.797. Conclusion The PICS-CI prediction model constructed in this study shows good prediction efficiency. ICU patients with scores≥50 should receive close attention and early interventions in early stage.
Objective To observe and investigate the occurrence regularity and risk factors of acute moderate and severe abdominal pain after transarterial chemoembolization（TACE）,and to establish a prediction model of postoperative pain after TACE. Methods Retrospective cohort study was used to collect patients with primary liver cancer treated by TACE from January to June 2018 in a hospital. The patients were divided into abdominal pain group and non-pain group. The data of 2 groups was analyzed by univariate analysis. The statistically significant factors were analyzed by multivariate Logistic regression analysis,and the pain prediction model was established. The model evaluation and internal verification were carried out. Results A total of 367 patients were enrolled in this study and 425 times of TACE were performed in half a year. The statistical results showed that no moderate and severe abdominal pain occurred after preventive TACE. Multiple liver tumors（the number of tumors≥3）,a history of pain after TACE,transarterial chemoembolization with drug-eluting beads and a low number of TACE were independent predictors of acute moderate and severe abdominal pain. The area under the predicted ROC curve was 0.794（95%CI0.736~0.852）,and the test result of Hosmer-Lemeshow showed that χ 2=2.205,P=0.974. Conclusion The prediction model constructed in this study can predict acute moderate and severe abdominal pain after TACE,and can provide references for medical staff with management measures of preventive pain.
