【摘要】目的對一線臨床科室參與汶川地震抗震救災的外援護士和本土護士的社會支持系統進行調查研究。方法隨機抽取抗震救災一線科室(ICU、骨科、急診)外援護士及本土護士各175名,設為外援組和本土組,采用對地震的自我認知問卷及社會支持評定量表(SSRS)進行測評。結果兩組護士對地震相關知識的知曉情況、響應抗震救災的行為表現、地震對專業的影響等方面無明顯差異(Pgt;0.05);兩組護士的社會支持總分均低于國內常模 (Plt;0.01),除外援組主觀支持維度得分與國內常模無顯著差異(Pgt;0.05)外,兩組的社會支持其它各維度得分均低于國內常模,外援組的社會支持總分及主觀支持、客觀支持得分均高于本土組(Plt;0.01),兩組對支持的利用度無明顯差異(Pgt;0.05)。結論為抗震救災一線科室護士提供積極的社會支持是保證心理健康的重要措施。【Abstract】ObjectiveTo evaluate the difference of psychological state between local and nonlocal nurses during the Wenchuan Earthquake. Methods A total of 175 local nurses and 175 nonlocal nurses were randomly selected and investigated by SSRS and the earthquake questionnaire. Results There were no significant differences in their knowledge about the earthquake, professional identity and action (Pgt;0.05). The total and the three dimensions scores of SSRS of the two groups were lower than those of the domestic norms (Plt;0.01) except the subjective support dimensions. The total scores, objective support and subjective support dimensions scores of nonlocal group were higher than that in the local group (Plt;0.01). In coping style questionaire, there were significant differences in solving problems and retreat factor(Plt;0.01)and no significant differences in remorse, salvation and illusion(Pgt;0.05). Conclusion The earthquake affected mental health of the nurses and their psychological state need to be much concerned,especially the nonlocal ones.
During the medical rescue of Wenchuan earthquake, on the condition of ensuring the security of producing environment and food, following the four concepts including standard production, instant cooling technology, networking management and nutrition guidance, the CPU of West China Hospital stopped the production of possibly uncontrolled food, developed a reasonable plan for materials in stock, reinforced the inspection of sources of raw materials and quality of food, adjusted styles of dishes, proviced made special food for the wounded and their relatives from different districts and nationalities, new dishes for the wounded and the medical staff, so as not only to assure the nutrition for the slightly wounded, but also to provide the individualized nutrition treatment for the severely wounded. A total of 70 077 person-times for the wounded from the disaster area (36 330 person-times for the wounded and 33 747 person-times for their family members), and 36 273 person-times for doctors and nurses have been served. Meanwhile, the food service has also been offered as regular to other patients and hospital staff, with a maximum of 18 372 person-times per day.
ObjectiveTo explore the effect of rehabilitation training focusing on early exercise on the time of first getting out of bed after surgery, pain during early activities, postoperative infection rate and the length of hospital stay for renal transplant recipients.MethodsThe clinical data of patients undergoing allogeneic renal transplantation in West China Hospital of Sichuan University from June to August 2020 were analyzed retrospectively. According to the time of multidisciplinary postoperative management and the time of early rehabilitation intervention, the patients were divided into the conventional group (from June 2020 to the beginning of multidisciplinary postoperative management) and the rehabilitation group (after multidisciplinary postoperative management). The time to get out of bed for the first time after surgery, the Visual Analogue Score (VAS) during weight monitoring on the second day post operation, the number of days required to complete an independent walk of 100 meters, postoperative complications, the incidence of postoperative infection and the length of hospital stay were compared between the two groups.ResultsA total of 79 patients were included. There were 46 cases in the conventional group and 33 cases in the rehabilitation group. Among the included patients, 14 patients had postoperative infection, 1 patients in the conventional group developed thrombosis, no catheter shedding or bleeding after exercise occurred. The differences between the rehabilitation group and the conventional group in the time to get out of bed for the first time after surgery [(1.1±0.2) vs. (2.2±0.4) d; t=13.224, P<0.001], the VAS during weight monitoring on the day post operation (2.5±0.9 vs. 3.4±1.4; t=3.267, P<0.001), the number of days required to complete an independent walk of 100 meters [(2.2±0.4) vs. (4.0±0.8) d; t=11.312, P<0.001], and the incidence of postoperative infection (6.1% vs. 26.1%; χ2=5.285, P=0.022) were statistically significant. There was no significant difference in the length of stay between the rehabilitation group and the conventional group [(19.8±5.8) vs. (20.7±7.4) d; t=0.584, P=0.561].ConclusionEarly postoperative rehabilitation training reduces the time required for renal transplant recipients to get out of bed for the first time post operation and to walk 100 meters independently, reduce the pain response during early activities, and reduce the incidence of postoperative infection.
Surgery is a classic traditional method for the treatment of early-stage esophageal cancer, and it is also recognized as an effective first-choice method in the medical community. With the development of endoscopic technology, esophagus-preserving comprehensive treatment of esophageal cancer has almost the same or even better effects in some aspects in the treatment of early esophageal cancer than surgery. Many clinical guidelines have also recommended it as the first-choice treatment for early esophageal cancer. The room for surgical treatment of esophageal cancer has been further compressed. This article discusses the comprehensive treatment model of esophageal cancer from the perspective of thoracic surgery, aiming to find a new position of thoracic surgery in the treatment of esophageal cancer.
ObjectivesTo systematically review the differences of operative outcomes between early surgery and delayed surgery in multiple ligament injury of knee joint (MLIK) patients.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data and VIP databases were searched to collect cohort studies about operative outcomes of different surgery times in MLIK patients from inception to September 23rd, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 8 cohort studies involving 153 early and 90 delayed operatively treated patients were included. The results of meta-analysis showed that: compared with delayed surgery, early surgery received higher Lysholm score (MD=7.52, 95%CI 2.00 to 13.04, P=0.008) and superior IKDC score rate (OR=2.97, 95%CI 1.51 to 5.84, P=0.002). There were no significant differences in Tegner score (MD=–0.08, 95%CI –1.07 to 0.92, P=0.88) and ROM (MD=4.08, 95%CI –2.38 to 10.55, P=0.22) between two groups. The main adverse reactions of MLIK included neurovascular injury, deep venous thrombosis of lower extremities, common peroneal nerve injury, tourniquet paralysis and limited joint activity. Early surgery had a lower incidence of complications than delayed surgery (7.1% vs. 30%).ConclusionThe current evidence shows that early surgery can receive higher Lysholm score and superior IKDC score rate in treatment of MLIK, and have a lower incidence of complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To systematically analyze and compare the casualties’ medical evacuation (ME) in Wenchuan and Yushu earthquakes, so as to provide useful references for earthquake casualties’ ME in the future. Methods The data about casualties’ ME in Wenchuan and Yushu earthquakes were collected from the field research, work statement of the Ministry of Health, official websites, and literatures. And the descriptive analysis was then performed. Results From Wenchuan to Yushu, the principle of ME tended to be “early evacuation, all evacuation”; the evacuation level was gradually simplified, the casualties were evacuated directly from the disaster area to the rear hospital through highway and railway, or air evacuation became the major method of ME; triage became less prominent, while specialist treatment was strived as early as possible. Conclusion The early establishment of appropriate evacuation principles, building of a simplified evacuation system, ensuring adequate medical transport capacity, and scientific assessment of treatment capacity at all levels are the main issues of effective and safe ME after earthquakes that require to be solved urgently.
Objective To investigate the status of deciduous caries and early childhood caries among 3-5 year-old children of Uyghur and Chinese in Urumqi, and to explore the correlative factors of early childhood caries. Methods According to the criteria recommended by the Third National Oral Health Investigation, and Oral Health Surveys: Basic Methods of World Health Organization, the deciduous caries of 474 Urghur and Chinese children aged from three to five in nine kindergartens were clinically examined. Data were collected by questionnaire from their parents, and the result waw analyzed using Logistic regression analysis. Results The result of logistic regression analysis showed that the variables including nationality, frequency of drinking milk, eating cookie or drinking sweet beverage before sleep, brushing teeth with help, and educational background of the mother were closely related to the incidence of infantile caries. Conclusion The nationality, frequency of drinking milk, eating cookie or drinking sweet beverage before sleep, brushing teeth with help, and educational background of the mother are correlative factors of early childhood caries. Necessary methods for prevention of deciduous caries must be taken into consideration as early as possible, and the bilingual propaganda for preventing and treating caries should be also highly emphasized.
ObjectiveTo explore fibrinogen (Fbg) variety in the patients wounded in Lushan and Wenchuan earthquake.
MethodsAs the research subjects, 276 Lushan earthquake victims (from April 20th to 24th, 2013) and 503 Wenchuan earthquake victims (from May 13th to 17th, 2008) were divided into five groups according to the admission date, and then the Fbg variety in those earthquake victims were analyzed. We carried out pairwise comparison among these groups in the Lushan earthquake and Wenchuan earthquake respectively on the Fbg variety. Ninety-one fracture patients in the Lushsan earthquake and 130 fracture patients in the Wenchuan earthquake were divided into two groups according to clinical diagnosis:multiple fracture and single fracture, and then we evaluated the Fbg values in patients with different degrees of disability.
ResultsThe whole Fbg level[(2.70±1.15) g/L] in Lushan earthquake was below the level[(4.47±1.94) g/L] in Wenchuan earthquake, and the difference was statistically significant (P<0.01). The Fbg level in the patients whose admission date was within 48 hours was significantly different with that in patients whose admission date was more than 48 hours (P<0.01). The Fbg level in Lushan earthquake was below the level in Wenchuan earthquake, not only in the multiple fracture group but also in the single fracture group[in Lushan earthquake, the former was (2.21±0.76) g/L, and the latter was (1.98±0.85) g/L; in Wenchuan earthquake, the former was (3.35±1.48) g/L, and the latter was (3.11±1.05) g/L], and the difference was statistically significant (P<0.01).
ConclusionBlood coagulation, especially Fbg level, has different degrees of changes in acute stress caused by emergency and in different treatment times, and it is better to take preventive measures.
ObjectiveTo study the early out-of-bed activities of patients after Mako robotic-assisted total hip arthroplasty.MethodsWe prospectively included inpatients planned to undergo primary unilateral total hip arthroplasty in the Department of Orthopaedics of the First Affiliated Hospital of Chongqing Medical University from April to July 2020. Using a randomized numerical table, the patients were divided into trial group to undergo robotic-assisted total hip arthroplasty and control group to undergo traditional total hip arthroplasty, and both groups received the same nursing measures and instructions for training to get out of bed after surgery. Postoperative active pain (assessed with Visual Analogue Scale), the proportion of patients willing to get out of bed within 24 h after surgery, the time and duration for the first out of bed activity, the proportion of patients with a walking distance ≥5 m for first activity, and the level of activity in the first 3 d after surgery between the two groups were compared.ResultsA total of 38 patients were included in this study, with 17 patients in the trial group and 21 patients in the control group. There was no statistical significance in the baseline demographics between the two groups (P>0.05). There were statistically significant differences in postoperative 6-hour and 24-hour Visual Analogue Scale scores between the two groups (P<0.05). Two hours after oral administration of perioperative energy preparations on the day of surgery, the proportion of patients who were willing to get out of bed early in the trial group was higher than that in the control group (100.0% vs. 57.1%, P<0.05). The first time to get out of bed ［(4.39±0.17) vs. (8.74±4.70) h］, the duration of getting out of bed ［(10.89±3.60) vs. (8.37±3.31) h］, and the proportion of patients with a walking distance ≥5 m for first activity (94.1% vs. 61.9%) were better than those of the control group (P<0.05). There were statistically significant differences between the trial group and the control group in the average level in the first 3 days after surgery, postoperative first-day level, and postoperative second-day level of getting out of bed (P<0.05). There were no falls, dislocation of the prosthesis, fractures around the prosthesis, or deep vein thrombosis in the two groups of patients during their hospitalization.ConclusionThe precise surgery method with the help of Mako orthopedic robot-assisted system can help promote patients to get out of bed early after surgery, and can providea reference for how to improve the rehabilitation of patients after traditional total hip replacement in the future.
ObjectiveTo explore the effect of early enteral nutrition (EEN) on immune status of patients in intenseive care unit (ICU).
MethodsA prospective control study was conducted from July 2011 to December 2012, and 80 patients after trauma and surgery were admitted to ICU. The Patients were divided into EEN group and normal enteral nutrition (NEN) group randomly. Enteral nutrition in EEN group began within 24 hours after admitted to ICU, while within 48 hours in NEN group.
ResultsIn 80 patients, 78(37 in EEN group and 41 in NEN group) completed the end point. The baseline in two groups was consistent (P>0.05). The indicators of lymphocyte, IgA, IgG, IgM and CD4+, CD8+, natural kill cell and pre-albumin values in EEN group were higher than those in NEN group (P<0.05). The incidence of diarrhea (8.1%, 26.8%) and infection of wound (2.7%, 17.1%) in EEN were less than those in NEN group. The hospitalization duration in ICU in EEN group[(7.94±3.72) days] was also shorter than that in NEN group[(10.62±3.14) days].
ConclusionEarly enteral nutrition improves immune function and nutrition status in ICU patients; it also protects gut barrier function and reduces the ICU hospitalization duration.
