To observe the impact of cardiopulmonary ultrasound - guided fluid resuscitation and goal-directed therapy on the prognosis of patients with septic shock.
Methods
A total of 96 patients diagnosed with septic shock hospitalized in Affiliated Hospital of Zunyi Medical University from March 2023 to December 2024 were selected and randomly divided into cardiopulmonary ultrasoundguided fluid therapy group （ultrasound group） and goal-directed therapy group （GDT group） according to random number table， with 48 patients in each group. Among them， there were 59 males and 37 females and the age ranged from 21 to 80 years， with a median age of 56.5 （44.0， 68.0） years. The baseline data of patients at admission were collected. The patients in the ultrasound group underwent critical care ultrasound examination， including cardiac systolic and diastolic function， inferior vena cava diameter and dilatation index， and lung condition at the time of admission （0 h）， 24 h， 48 h and 72 h after treatment，respectively， to guide fluid therapy. GDT group guided fluid management according to central venous pressure （CVP）， mean arterial pressure （MAP）， central venous oxygen saturation （ScvO2）， urine volume and lactic acid （Lac）. Clinical data， fluid volume， NT-proBNP changes of the two groups were compared and prognostic indicators were observed， including 24-hour resuscitation targeting rate， lactate clearance rate（24 h，48 h，72 h），mechanical ventilation time，length of intensive care unit（ICU）and hospital stay，mortality within ICU and 28 days.
Results
With the prolongation of treatment， the heart rate and NT-proBNP of the two groups gradually decreased， and the MAP gradually increased （P＜0.05）. Compared with the GDT group，the fluid resuscitation guided by the cardiopulmonary ultrasound could increase the 24 h resuscitation targeting rate，increase lactate clearance rate at 24 h，48 h and 72 h，reduce the volume of fluid resuscitation at 24 hours and 48 hours， increase output， fluid balance and urine volume of 48h and 72 h， and accelerate the decline of NT-proBNP. There were no statistically significant differences in the time of mechanical ventilation， length of stay in ICU and hospital， mortality in ICU and 28 days between GDT group and ultrasound group （P＞0.05）.
Conclusion
Cardiopulmonary ultrasound can be used to guide the fluid treatment of patients with septic shock， improve the 24-hour resuscitation targeting rate and lactate clearance rate， reduce the infusion volume during resuscitation， significantly reduce NT-proBNP and therefore alleviate myocardial injury.
To analyze the impact of feedforward control combined with body temperature management on the rescue quality and prognosis of patients with traumatic hemorrhagic shock in the emergency department.
Methods
A total of 80 patients with traumatic hemorrhagic shock admitted to the emergency department of Zhujiang Hospital， Southern Medical University from October 2023 to October 2024 were studied， including 46 males and 34 females， aged 18 to 78 years， with an average age of （48.12±2.63） years. From October 2023 to April 2024， 40 patients were in the control group （without feedforward control combined with temperature management）， and from May 2024 to October 2024， 40 patients were in the experimental group （with feedforward control combined with temperature management）. The changes in body temperature， rescue quality， and prognosis of the two groups were observed.
Results
There was no significant difference in pre-hospital body temperature between the two groups （P＞0.05）. At admission and 1 hour after admission， the body temperature of the experimental group was higher than that of the control group.The effective rewarming rate of the experimental group was 95.00%，which was higher than 80.00%of the control group （P＜0.05）. The rescue time of the experimental group was shorter， and the rescue success rate was 92.50%， which was higher than 75.00% of the control group （P＜0.05）. The complication rate of the experimental group was 10.00%， which was lower than 32.50% of the control group （P＜0.05）.
Conclusion
In patients with traumatic hemorrhagic shock in the emergency department， feedforward control combined with temperature management can effectively increase body temperature， improve rescue efficiency and success rate，and reduce the risk of complications，thereby helping to improve prognosis.
To explore the risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess by analyzing the clinical characteristics of these patients.
Methods
A retrospective collection of data from 161 patients diagnosed with Klebsiella pneumoniae liver abscess at the First Affiliated Hospital of Nanjing Medical University between January 2017 and September 2023 was conducted. The 161 patients were divided into an invasive group of 64 cases （39.8%） and a non-invasive group of 97 cases （60.2%） based on whether invasive syndrome occurred during hospitalization. Basic data，initial symptoms， vital signs， laboratory examination results， and imaging manifestations were compared between the two groups. Univariate analysis and multivariate logistic regression analysis were used to assess the correlation of various indicators with the occurrence of invasive syndrome.
Results
The prevalence of diabetes in the invasive group was higher than that in the non-invasive group （P＜0.05）； The heart rate of patients in the invasive group was higher than that in the non - invasive group （P＜0.05）； Imaging manifestations showed that the maximum diameter of intra-hepatic abscesses in the invasive group was lower than that in the non-invasive group， while the probability of multiple intra -hepatic abscesses was higher in the invasive group than in the non-invasive group （P＜0.05）； There was no significant difference in the laboratory test indicators between the invasive group and the non-invasive group（P＞0.05）；Logistic regression analysis showed that independent risk factors included a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses （P＜0.05）.
Conclusion
Independent risk factors for invasive syndrome in patients with Klebsiella pneumoniae liver abscess include a history of diabetes， a higher heart rate， and a smaller maximum diameter of intra-hepatic abscesses. Clinically， it is necessary to strengthen the monitoring and early intervention for these high-risk patients to reduce the harm of invasive syndrome.
To observe the effect of different doses of dexmedetomidine nasal drops in the elderly percutaneous vertebroplasty （PVP）.
Methods
A total of 100 elderly patients who underwent elective Percutaneous Vertebroplasty （PVP） at the Traditional Chinese Medicine Hospital of Pi District，Chengdu City from June to December 2023， including 38 males and 62 females. Their ages ranged from 60 to 79 years old， with an average age of （69.08±4.86） years. Patients were divided into 4 groups（n=25） by random number table method： dexmedetomidine 0.8 μg/kg group （D1 group）， 1.0 μg/kg group （D2 group）， 1.2 μg/kg group （D3 group） and normal saline control group （N group）. Ramsay calm score， visual analog scale （VAS）， mean arterial pressure （MAP）， heart rate （HR） and pulse oxygen saturation （SpO2） were compared immediately after entering the operating room （T1）， 30 min after nasal drops （T2）， immediately after cannula reached vertebra （T3）， bone cement injection （T4）， and 5 min after resuming position （T5）between the groups. Intraoperative adverse reactions were recorded.
Results
The sedation score at each time point of D3 group after nasal drip was higher than that of other groups （P＜0.05）.At T3 and T4，the pain score of D3 group was lower than that of other groups （P＜0.05）. There was no significant difference in MAP and HR of D3 group at T3 and T4 compared with T2 （P＞0.05）.Postoperative blood glucose in all groups was higher than that before surgery （P＜0.05）， and the increase of blood glucose in D3 group was lower than that in other groups （P＜0.05）. The amount of lidocaine and operation time in D3 group were lower than those in other groups （P＜0.05）， and the satisfaction score in D3 group was higher than that in other groups （P＜0.05）.The incidence of agitation and intraoperative hypertension in group N was higher than that in other groups（P＜0.05）.However，there was no statistical difference in the occurrence of adverse reactions among all groups（P＞0.05）.
Conclusion
For elderly patients undergoing PVP treatment， 1.2 μg/kg of dexmedetomidine can be effectively sedated and analgesic before operation，and patients are safer，more comfortable and satisfied.
To explore the clinical practice value of intelligent transformation of trauma care.
Methods
A total of 79 trauma patients rescued from our trauma center from January to June 2023 were selected as the control group， and 77 cases of trauma patients rescued from July to December of the same year were selected as the experimental group. The control group used the original trauma intelligent nursing system to carry out integrated trauma rescue combining rapid response and long-term management，while the experimental group improved the technical scheme of the trauma nursing system， and carried out intelligent transformation of trauma nursing through hardware configuration expansion and software function expansion. The rate of timely management of injury treatment， the success rate of treatment， the incidence of anxiety and depression symptoms， and the self-burden of patients were compared between the two groups.
Results
The experimental group was higher than the control group in reaching the standard of time management and the success rate of treatment. The incidence of anxiety and depression symptoms and selfburden of patients were decreased， and the difference was statistically significant （P＜0.05）.
Conclusion
The use of advanced information technology to explore the driving force of medical nursing data can promote the construction of a complete trauma treatment chain and improve the efficiency and effect of trauma care.
To understand the risk degree of hazard events faced by intensive care unit（ICU）by carrying out Kaiser model-based hazard vulnerability analysis （HVA），so as to provide reference for formulating and improving ICU emergency plans.
Methods
In March 2024， A standardized HVA questionnaire was established according to the Kaiser model， and HVA team of Jintan Hospital affiliated to Jiangsu University conducted HVA questionnaire survey among the department staff. The questionnaire included a comprehensive assessment of 38 potential ICU disaster events， their potential impact on the department （including personnel injuries， property losses， and operational disruptions）， as well as the preventive measures implemented by the department （such as emergency preparedness， internal response protocols， and external response strategies）. All survey data were entered into Excel 2019 for statistical analysis. The Kaiser model calculation formula was used to calculate the relative RISK value of each potential risk event， and the relative risk degree of disaster risk events was ranked according to the relative risk value.
Results
The total number of questionnaires distributed was 40， with a recovery rate of 100%.The top ten RISK values observed in the ICU were as follows： hospital infection outbreaks （71.94%）， public health emergencies （62.59%）， incidents of medical disputes/violence against doctors （54.06%， ventilator failure （53.13%）， medical care error （48.34%）， difficulty or failure of tracheal intubation （43.84%）， patient unplanned extubation （42.32%）， patient aspiration （35.85%）， medical gas failure （31.84%） and improper management of medical waste （28.26%）.
Conclusion
Disaster risk events with high relative risk values in ICU based on Kaiser model primarily revolve around personnel injuries and technical accidents，necessitating the formulation and enhancement of emergency plans to improve response capabilities towards such high relative risk events and ensure safe and orderly operations within the ICU.
To investigate the potential mechanism of intestinal mucosal barrier injury caused by intestinal epithelial cell autophagy in high-fat-diet fed mice.
Methods
Forty specific pathogenfree mice were randomly divided into normal control group （NCD group）， high fat diet group （HFD group），normal severe acute pancreatitis group （NSAP group）， and high fat diet plus severe acute pancreatitis group（HSAP group），with 10 mice in each group.The normal control group was fed with normal diet，and the highfat diet group was fed with high - fat diet for 8 weeks. Mice in the NSAP and HSAP groups were intraperitoneally injected with 20% L-arginine （L-Arg） （3.5 g/kg， 1 hour interval， 2 times in total） as a stress stimulus， while rats in the NCD and HFD groups were intraperitoneally injected with the same amount of normal saline. ELISA method was used to detect the serum TC， TG， AMY， LPS， IL-6， the content of TNF-α.HE staining was used to observe the pancreas， colon and lung tissue pathological changes.Immunohistochemistry was used to observe the distribution of tight junction proteins Claudin， ZO -1，Occludin， autophagy-related protein LC3 Ⅱ， and pathway-related proteins TLR4 and NF-kB in colon epithelium.Western Blot was used to detect the expression levels of Claudin，ZO-1，Occludin，TLR4，NF-kB and LC3Ⅱin colon.
Results
Compared with NCD group， HFD mice body weight and serum TG， TC level increased obviously.After 20%L-Arg stimulation，compared with NCD group，the levels of serum AMY，TNF-α，LPS and IL-6 in NSAP group were significantly increased （P＜0.05）， and the expression levels of colon Claudin，Occludin and ZO-1 protein were significantly decreased （P＜0.05）.TLR4，NF-κB protein expression significantly increased （P＜0.05）， LC3II protein expression decreased significantly （P＜0.05）. Compared with the NSAP group，the body weight and serum levels of TG，TC，AMY，TNF-α，LPS and IL-6 in the HSAP group were significantly increased （P＜0.05）， and the expression of Claudin， Occludin and ZO-1 in the colon was significantly decreased （P＜0.05）. At the same time， the expression of TLR4 and NF-κB protein in the colon was significantly increased， and the expression of LC3II protein in the colon was significantly decreased （P＜0.05）.
Conclusions
High-fat diet reduces the ability of intestinal mucosal barrier stress in mice， and the mechanism may be related to the regulation of TLR4/NF-κB signaling pathway mediated autophagy.
