Elevated lactate levels are a significant biomarker of sepsis and are positively associated with sepsis-related mortality. Sepsis-associated encephalopathy (SAE) is independently associated with increased mortality in clinical sepsis patients. However, the underlying mechanisms of lactate’s involvement in SAE remain unclear. In this study, we demonstrate that H3K18 lactylation (H3K18la) levels are upregulated in LPS-stimulated BV2 microglial cells and the hippocampus of LPS-injected mice. Pharmacological inhibition of H3K18la by sodium oxamate (OXA) or 2-deoxy-D-glucose (2-DG) effectively attenuates neuroinflammation and reduces neuronal necroptosis. Furthermore, CUT& Tag and RNA-seq results revealed that SLC7A11 as a direct downstream target of H3K18la, thereby promoting microglia ferroptosis and amplifying neuroinflammation. Overexpressing SLC7A11 in BV2 cells or microglia-specific overexpression of SLC7A11 in Cx3cr1Cremice can effectively suppress neuroinflammation, reduce neuronal necroptosis and alleviate cognitive impairments in SAE. Taken together, our findings elucidate the role of histone lactylation in SAE, and provide novel insights into potential therapeutic strategies for SAE.

Acinetobacter baumannii is a prominent pathogen linked to ventilator-associated pneumonia (VAP) and has demonstrated widespread multidrug resistance globally. While the exploration of synergistic antibiotic combinations is increasingly viewed as an innovative treatment strategy, the antibacterial potential of plasma activated water (PAW) in neutralizing formulations remains underdeveloped. This study investigates the synergistic interactions between neutral plasma activated water (NPAW) and polymyxin B against multidrug-resistant strains of A. baumannii. We evaluated the antibacterial activity of the combination of NPAW and polymyxin B against polymyxin-resistant A. baumannii strains both in vitro and in vivo, further exploring the underlying mechanisms of synergy. Through checkerboard assay and time-kill studies, we demonstrated that the combination of NPAW and polymyxin B exhibited a synergistic effect against polymyxin-resistant A. baumannii. In the mouse pneumonia model, we confirmed that the combined treatment significantly reduced bacterial colonization in the lungs. Mechanistic studies indicated that NPAW enhances the bactericidal activity of Polymyxin B by promoting the release of reactive oxygen species (ROS). When used together, NPAW and polymyxin B decreased the production of intracellular ATP and membrane potential and compromised outer membrane integrity. In conclusion, the synergistic interactions between these agents may enable the use of lower concentrations of polymyxin B in treating A. baumannii infections, thereby minimizing dose-dependent side effects and providing a novel therapeutic option for managing these infections.IMPORTANCEPolymyxin-resistant Acinetobacter baumannii poses a global threat as last-line therapies fail. We demonstrate that neutral plasma activated water (NPAW), a reactive oxygen species-rich non-antibiotic agent, synergizes with polymyxin B to overcome resistance. Mechanistically, NPAW disrupts membrane integrity, depletes ATP, and amplifies oxidative stress, enhancing polymyxin B's bactericidal activity and reducing lung bacterial burdens in mice. This synergy enables lower polymyxin B doses, a critical advance for treating ventilator-associated pneumonia.

Acinetobacter baumannii balances its remarkable ability to acquire antibiotic resistance genes via horizontal gene transfer (HGT) with the immune defense functions of its CRISPR-Cas system, forming a dynamic equilibrium governed by intricate transcriptional regulation. However, the regulatory mechanisms underlying the I-Fb CRISPR-Cas system in A. baumannii remain poorly understood. This study elucidated a multitiered regulatory axis mediated by BaeR and H-NS that coordinates immune defense and virulence expression in the I-Fb CRISPR-Cas system. Using DNA pull-down and electrophoretic mobility shift assay (EMSA), we demonstrated that H-NS directly binds AT-rich regions within the cas3 promoter, suppressing both interference activity and adaptive immunity of the I-Fb CRISPR-Cas system. Intriguingly, the two-component regulator BaeR controlled this suppression by positively regulating H-NS expression. The results revealed that Δcas3 mutants exhibited increased biofilm thickness, elevated the extracellular matrix component poly N-acetyl glucosamine (PNAG) production, upregulated pilus expression, and significantly enhanced epithelial cell adhesion. Strikingly, Δh-ns-cas3 and ΔbaeR-cas3 double-knockout strains showed no statistically significant differences in virulence phenotypes compared to the Δcas3 single mutants. These findings indicate CRISPR-Cas-mediated inhibition of biofilm formation is abolished upon cas3 deletion, thereby releasing the regulatory constraints imposed by BaeR and H-NS. This dysregulation leads to excessive biofilm and extracellular matrix component accumulation, ultimately amplifying bacterial colonization capacity and pathogenicity in host environments. This discovery reveals the dual regulatory roles of BaeR and H-NS in the A. baumannii I-Fb CRISPR-Cas system, mediating both immune defense and virulence modulation. These insights establish a theoretical foundation for novel antimicrobial strategies targeting CRISPR-Cas regulatory networks.IMPORTANCEA. baumannii, a leading cause of drug-resistant nosocomial infections, evolves antibiotic resistance through horizontal gene transfer (HGT) while employing CRISPR-Cas systems to limit foreign DNA invasion. This study reveals that the I-Fb CRISPR-Cas system, typically a defense mechanism, functions as a repressor of virulence traits in A. baumannii. We demonstrate that the transcriptional regulators H-NS and BaeR form a hierarchical axis suppressing Cas3 expression, thereby constraining biofilm formation and host adhesion. Strikingly, CRISPR-Cas deficiency enhances virulence, thickens biofilms, elevates PNAG production, and enhances epithelial colonization through escape from BaeR-/H-NS-mediated control. This work redefines CRISPR-Cas as a dual-function module balancing immune defense and pathogenicity, exposing the BaeR-H-NS-Cas3 axis as a druggable target for novel anti-infectives aimed at disrupting bacterial adaptive evolution.

Myocardial dysfunction is a prevalent complication of sepsis (septic cardiomyopathy) with a high mortality rate and limited therapeutic options. Naringenin, a natural flavonoid compound with anti-inflammatory and antioxidant properties, holds promise as a potential treatment for sepsis-induced myocardial dysfunction. This study investigated the pharmacological effects of naringenin on septic cardiomyopathy. In vivo and in vitro experiments demonstrated that naringenin improved cardiomyocyte damage. Network pharmacology and database analysis revealed that HIF-1α is a key target protein of naringenin. Elevated expression of HIF-1α was observed in damaged cardiomyocytes, and the HIF-1α inhibitor effectively protected against LPS-induced cardiomyocyte damage. Molecular docking studies confirmed the direct binding between naringenin and HIF-1α protein. Importantly, our findings demonstrated that naringenin did not provide additional attenuation of cardiomyocyte injury on the biases of HIF-1α inhibitor treatment. In conclusion, this study proves that naringenin protects against septic cardiomyopathy through HIF-1α signaling. Naringenin is a promising therapeutic candidate for treating septic cardiomyopathy.

Background: The misplacement of subclavian vein catheter increases the risk of catheter-related deep vein thrombosis (DVT). We hypothesized that rapid rehydration may contribute to the high incidence of catheter-related DVT, and aim to search for potential preventing or treatment strategies for thrombosis.Methods: This study collected basic information and ultrasound monitoring data of patients who underwent internal jugular vein or subclavian vein puncture and catheterization. A computational hemodynamic model of deep vein catheter infusion was established to simulate blood flow direction and catheter infusion direction under two different situations, analyzing changes in blood flow velocity and drug distribution concentration at different locations.Findings: The thrombosis incidence rate in patients with catheter reversal is significantly higher than that in internal jugular vein catheterization (83.33% vs 12.42%). The effectiveness of heparin anticoagulation treatment through the deep vein catheter was significantly higher in patients with reversed catheters than in those with properly placed catheters (100% vs 12.5%). Ultrasonography showed that when the infusion velocity increased from 100ml/h to 1000ml/h, the blood flow around the reversed catheter changed from unidirectional to bidirectional and a "cloud sign" appeared around the catheter. The following findings can be predicted using the hemodynamic model: 1. Different from the catheters in the correct position, there was an obvious stasis region at the tip of the catheters in the misplaced position, under the 1000ml/h infusion velocity condition. 2. According to the intravascular blood flow streamline diagram, turbulent flow was developed around the misplaced tip of the catheter when the infusion velocity came to 1000ml/h. 3. Unlike correct position catheters, a high drug concentration area was formed around misplaced direction catheters when pumping drugs.Interpretations: A higher incidence rate of catheter-related DVT in misplaced than in correct position catheters was observed, which may be explained by the formation of turbulent flow and slow blood flow velocity around the misplaced catheter tip during rapid rehydration. Besides, the development of a high drug concentration area around misplaced catheters when pumping drugs might introduce us novel ideas for the prevention or treatment of catheter-related DVT.Funding: This work was supported by Medical School of Yangzhou UniverDeclaration of Interest: The authors declared that there are no conflicts of interEthical Approval: For human participants and data, this study was approved by the Institutional Review Board of the Affiliated Hospital of Yangzhou Univers

Abstract Background: Sepsis is one of the most common critical illnesses, with approximately 40% of patients experiencing complications of myocardial injury. Naringenin (Nar) is a natural flavonoid with benign biological effects, including anti-inflammatory, anti-bacterial, anti-oxidant, and anti-cancer effects. However, the specific effect of Nar on myocardial injury in sepsis has not yet been determined. Methods: In vivo, the severity of cardiac histopathology and serum inflammatory factors were detected in the mouse model of lipopolysaccharide (LPS)-induced sepsis with/without naringenin treatment. Similarly, in vitro, a myocardial cell injury model was constructed by treating H9C2 cells with lipopolysaccharide (LPS), and the cell activity and apoptosis was detected by LDH and flow cytometry. Carry out transcriptome sequencing, bioinformatics analysis, Western blot and the molecular docking analysis to determine its molecular mechanism. Results: Our study found that Nar treatment improved cardiac histopathological manifestations and reduced serum levels of inflammatory markers in a model of lipopolysaccharide (LPS)-induced sepsis. In addition, Nar attenuated LPS-induced cardiomyocyte apoptosis in vivo and in vitro. Mechanistically, Nar inhibited nuclear factor-kappa B translocation by activation of the phosphoinositide 3-kinase (PI3K)/protein kinase B(AKT) signaling pathway. Molecular docking results showed that Nar binds directly to the PI3K protein. Conclusion: Nar has novel therapeutic potential for LPS-induced myocardial dysfunction, which provides a new target for the clinical prevention and treatment of septic cardiomyopathy.

目的 探讨基于血流向量测量颈动脉血流量的不同方法及其稳定性.方法 选取健康志愿者15例和40例患者为研究对象,5名重症医学科医师采用三角函数双切面测量法、三角函数单切面测量法、横切固定角度测量法、纵切测量法、最大血流速度近似法、流速均值近似法和改良环形近似法通过超声检查对颈总动脉血流量进行测量,并对测量结果进行稳定性分析以寻找稳定性较好的血流量的测量方法.结果 三角函数单切面测量法稳定性高于三角函数双切面测量法、横切固定角度测量法、纵切测量法,差异有统计学意义(P＜0.05).最大血流速度近似法与流速均值近似法的稳定性比较,差异无统计学意义(P＞0.05).改良环形近似法与最大血流速度近似法的稳定性比较,差异无统计学意义(P＞0.05),但分析结果显示,前者的稳定性优于后者,差异有统计学意义(P＜0.05).结论 三角函数单切面测量法可测得较为稳定的血流速度.颈动脉斑块患者采用改良环形近似法可获得较稳定的血流量,但评估稳定性仍然有待进一步提高.

Traumatic brain injury (TBI) is characterized by high mortality, high disability rate and poor prognosis. Early assessment of the prognosis of TBI patients has important guiding significance for their diagnosis and treatment, clinical intervention and allocation of medical resources. The purpose of this article is to discuss the research progress of various scales, imaging manifestations, cerebral metabolic monitoring, mathematical models, etc. commonly used in clinical practice in the prognosis evaluation of TBI.

Objective:To apply an artificial neural network (ANN) in patients with craniocerebral injury to characterize its prognostic ability.Methods:Based on the completed quadratic polynomial stepwise regression analysis, data of 130 patients with brain injury from January 2013 to August 2017 in the Department of Critical Care Medicine of the Affiliated Hospital of Yangzhou University were collected. A prognostic prediction model was established based on artificial neural network technology. Then the clinical data of 46 patients with craniocerebral injury admitted from October 2017 to March 2019 were used for external verification, the correlation coefficient, sensitivity and specificity were calculated, and compared with the quadratic polynomial stepwise regression model.Results:Artificial neural network technology could be used to establish a prognosis prediction model for patients with craniocerebral injury. The correlation coefficient was 0.8935. In internal verification, the sensitivity of "poor outcome" (GOS score 1 or 2 points) was 94.8% (55/58), the specificity was 82.1% (55/67); the sensitivity of "good outcome" (GOS score 4 or 5 points) was 95.5% (42/44), and the specificity was 87.5% (42/48). The external verification correlation coefficient was 0.7138, the sensitivity of "poor outcome" was 43.8% (7/16), the specificity was 100.0% (7/7); the sensitivity of "good outcome" was 100.0% (26/26), the specificity was 66.7% (26/39).Conclusion:The mathematical model established by artificial neural network technology has a better fitting than the quadratic polynomial stepwise regression model for predicting the prognosis of patients with brain injury. However, for the sensitivity and specificity of prognostic evaluation, the neural network model does not show obvious advantages.

目的 评价神经丝蛋白H磷酸化亚型(pNF-H)、基质金属蛋白酶-9(MMP-9)联合振幅整合脑电图(aEEG)对早产儿脑损伤的早期预测价值.方法 选择2018年9月至2019年12月收入徐州医科大学附属医院新生儿重症监护室的具有高风险脑损伤的早产儿为研究对象,根据头颅影像学结果,将56例早产儿分为脑损伤组26例和无脑损伤组30例.两组早产儿均于生后6 h进行aEEG检查,并采用酶联免疫吸附法(ELISA法)检测早产儿生后1 d、3 d、7 d血浆中pNF-H、MMP-9水平.以生后第3天血浆pNF-H、MMP-9水平、aEEG结果及三者联合得到的总体预测概率变量为自变量,疾病诊断结果为因变量,绘制ROC曲线,计算灵敏度、特异度及曲线下面积(AUC).结果 脑损伤组早产儿生后1 d、3 d、7 d血浆pNF-H和MMP-9水平较无脑损伤组显著升高,差异均有统计学意义,且脑损伤组血浆pNF-H、MMP-9水平在生后3 d时检测浓度最高.脑损伤组与无脑损伤组中aEEG异常的比例差异有统计学意义.三者联合诊断的曲线下面积(AUC)显著大于单独检测pNF-H、MMP-9水平及aEEG,诊断的灵敏度达到96.2％,特异度达到90.0％.结论 pNF-H、MMP-9联合aEEG诊断对早产儿脑损伤具有早期预测价值.

Objective:To evaluate the application value of metagenomic next-generation sequencing(mNGS) for patients with severe pneumonia of unknown pathogen.Methods:The clinical data of 8 patients with unknown pneumonia pathogens who were assisted by the alveolar lavage fluid mNGS technology treated in Affiliated Hospital of Yangzhou University from June 2019 to February 2020 were retrospectively analyzed, including alveolar lavage fluid smear, culture, and the sequencing result.The clinical characteristics and mNGS detection results were comprehensively analyzed.According to the results of mNGS and the judgment of the clinician, the patients were divided into confirmed pathogens group and undetermined pathogens group, and the Simpson's diversity index of two groups was compared.Results:Among 8 cases, there were 5 males and 3 females, and the median age was 62.5 years (ranged from 41 to 71 years). All of them had chronic diseases except 1 case, including diabetes, chronic obstructive pulmonary disease and kidney transplantation.mNGS was positive in 8 patients, and conventional test was positive in 3 patients.The comparison of the Simpson's diversity index between the identified pathogenic group and the undetermined pathogenic group showed statistically significant difference [(0.398 ± 0.222) vs.(0.763 ± 0.061), t=2.709, P=0.035]. The positive results of mNGS were different from that of conventional test in 2 patients.The nucleic acid number in 3 cases of Pneumocystis carinii with mNGS positive results ranged from 120 to 15 580, with genomic coverage rates from 24.6% to 99.8%. Conclusion:mNGS can help physicians acquire information of the pathogenic bacteria quickly and comprehensively, especially for patients with unknown pneumonia pathogenic bacteria.

Purpose Disease severity and inflammatory response status are closely related to a poor prognosis and must be assessed in patients with severe traumatic brain injury (STBI) before intensive care unit (ICU) discharge. Whether elevated serum procalcitonin (PCT) levels can predict a poor prognosis in STBI patients before ICU discharge is unclear. Methods This retrospective observational cohort study enrolled 199 STBI patients who were in the ICU for at least 48 hours and survived after discharge. Based on serum PCT levels at discharge, patients were divided into the high-PCT group (PCT ≥ 0.25 ng/mL) and the low-PCT group (PCT < 0.25 ng/mL). We assessed the relationship between serum PCT levels and a poor prognosis. Results The high-PCT group had a higher rate of adverse outcomes compared with the low-PCT group. Multivariate logistic regression analysis showed that the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, white blood cell (WBC) count, C-reactive protein (CRP) level, and PCT level at discharge were significantly associated with adverse outcomes. Conclusions Elevated PCT levels at ICU discharge were associated with a poor prognosis in STBI patients. The serum PCT level as a single indicator has limited value for clinical decision-making.

Cellular senescence is mainly characterized as a stable proliferation arrest and a senescence associated secretory phenotype (SASP). Senescence is triggered by diverse stimuli such as telomere shortening, oxidative stress, oncogene activation and DNA damage, and consequently contributes to multiple physiology and pathology outcomes, including embryonic development, wound healing and tumor suppression as well as aging or age-associated diseases. Interestingly, therapeutic clearance of senescent cells in tissues has recently been demonstrated to be beneficial for extending a healthy lifespan and for improving numerous age-related disorders. However the molecular mechanisms of senescence regulation remain partially understood. Theoretically, senescence is tightly regulated by a vast number of molecules, among which the p16 and p53 pathways are the most classical. In addition, intracellular cellular calcium signaling has emerged as a key regulator of senescence. In the last few decades, a growing number of studies have demonstrated that microRNAs (miRNAs, small non-coding RNAs) are strongly implicated in controlling senescence, especially at the transcriptional and post-transcriptional levels. In this review we will discuss the involvement of miRNAs in modulating senescence through the major p16, p53, SASP and calcium signaling pathways, thus aiming to reveal the mechanisms of how miRNAs regulate cellular senescence.

目的探讨振幅整合脑电图（aEEG）联合晚期氧化蛋白产物（AOPP）、可溶性凝集素样氧化型低密度脂蛋白受体1（sLOX-1）在早产儿脑损伤早期诊断中的价值。方法选择2018年9月至2019年9月有脑损伤高风险因素的住院早产儿63例,根据磁共振成像结果分成脑损伤组（27例）及非脑损伤组（30例）。于早产儿出生后6小时内行aEEG监测;在早产儿出生后6小时、3天、7天时采集血浆,以酶联免疫吸附法（ELISA）检测AOPP、sLOX-1;行logistic回归分析,创建受试者工作特征曲线（ROC）,计算aEEG、AOPP、 sLOX-1单独及联合检测对诊断早产儿脑损伤的灵敏度、特异度及曲线下面积（AUC）。结果两组间胎龄、出生体质量、性别差异均无统计学意义（P＞0.05）。脑损伤组aEEG异常率（88.9%）高于非脑损伤组（26.7%）,aEEG图形的连续性（Cy）、睡眠觉醒周期（Co）、宽带（B）评分及总评分（T）低于非脑损伤组,差异均有统计学意义（P＜0.05）。脑损伤组生后6小时、3天、7天时血浆sLOX-1及AOPP水平高于非脑损伤组,差异均有统计学意义（P＜0.001）。血浆sLOX-1及AOPP联合aEEG诊断早产儿脑损伤的灵敏度、特异度及AUC高于单项检测,分别为0.93、0.90和0.96。结论 aEEG联合AOPP、sLOX-1可明显提高早产儿脑损伤早期诊断效能,对其早期诊断具有较好的临床应用价值。

Objective To explore the influence of prognosis indicators of multiple indicators and their interactionat hospital admission in patients with brain injury. Methods We analyzed the clinical data of 130 patients with craniocerebral trauma who were admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Yangzhou University from January 2013 to August 2017. We performed a mathematical model to identify the correlation between data at hospital admission and outcome. The clinical data of 26 patients with craniocerebral trauma from October 2017 to December 2018 were collected for external validation. Results Sedation score (RASS) squared item, Grasse coma (GCS) score and RASS score interaction item, age and acute physiology and chronic health status (APACHEⅡ) score interaction item, heart rate and lactic acid (LAC) interaction term were significantly associated with outcome. Conclusion Mathematical models can be used to assess prognostic indicators in patients with brain injury. Key words: Brain injury; Admission indicators; Prognosis indicators; Mathematical model

Objective To explore the predictive value of dynamic changes of postoperative neutrophil lymphocyte ratio (NLR) in patients with craniocerebral trauma secondary intracranial infection. Methods One hundred sixteen patients with craniocerebral trauma secondary intracranial infection admitted to the Department of Critical Care Medicine, the Affiliated Hospital of Yangzhou University from January 2012 to December 2018 were included in the study. Patients were divided into a high NLR group (NLR≥3) and a low NLR group (NLR<3) based on the NLR measured on the third day after surgery. The difference in clinical outcome between the two groups was compared. Results NLR values were significantly higher in the high NLR group on the third postoperative day, and there was a significant statistical difference compared with the low NLR group (2.24±0.68 vs 4.72±1.21, P<0.05). In the high NLR group, 10 patients (19%) had intracranial infection, and 4 patients (6%) in the low NLR group. There was a significant statistical difference between the two groups (P=0.033). NLR: area under the curve (AUC)=0.894, 95%CI: 0.795-0.993; PCT: AUC=0.895, 95%CI: 0.764-1.027; CRP: AUC=0.898, 95%CI: 0.814-0.981. The ICU staying time and mechanical ventilation time were higher in the high NLR group than in the low NLR group. There was a statistical difference between the two groups (18.4±8.7 vs 13.2±5.4, P=0.000; 10.3±4.7 vs 5.3±4.1, P=0.000). The difference in mortality between the two groups was statistically significant. The mortality rate was higher in the high NLR group than in the low NLR group (P=0.026). Conclusion The elevated neutrophil lymphocyte ratio after surgery has a good clinical predictive value for the occurrence of intracranial infection in patients with craniocerebral trauma. The elevated NLR value is closely related to the poor prognosis. Key words: Neutrophil lymphocyte ratio; Craniocerebral trauma; Intracranial infection

目的 观察以瑞芬太尼镇痛为基础的镇静对重症监护病房(ICU)机械通气患者血糖波动的影响.方法 65例ICU需有创机械通气超过72 h的患者随机分为瑞芬太尼组(30例)及芬太尼组(35例),分别给予瑞芬太尼和芬太尼持续静脉泵入镇痛,初始用右美托咪定镇静,如未达到镇静目标加用丙泊酚镇静治疗,比较两组血糖标准差(GluSD)、血糖不稳定指数(GLI)、平均绝对血糖改变值(MAG)、机械通气时间、住ICU时间及费用、呼吸机相关肺炎(VAP)、28 d存活率.结果 两组24h血糖标准差(GluSD)、血糖不稳定指数(GLI)、平均绝对血糖改变值(MAG)、住ICU费用、械通气时间、住ICU时间、右美托咪定用量无统计学差异(P＞0.05);72 h瑞芬太尼组GluSD、GLI、MAG明显低于芬太尼组(P＜0.05);瑞芬太尼组丙泊酚用量、VAP发生率明显少于芬太尼组(P＜0.05),28 d存活率两组无统计学差异(P＞0.05).结论 以瑞芬太尼镇痛为基础的镇静可以减少ICU机械通气患者血糖的波动.

目的 研究超声引导下中心静脉置管术并发症发生率,以探讨胸片作为超声引导下中心静脉置管术后常规检查的必要性.方法 选取我院2016年1月～2018年6月于我院ICU行超声引导下中心静脉置管术患者的临床资料,我们计算了超声引导下中心静脉导管置入术后气胸及导管位置错误的发生率,以探讨胸片作为超声引导下中心静脉置管术后常规检查的必要性.结果 2057例超声引导下中心静脉置管术中发生气胸的共9例,发生率为0.44％(95％CI,0.15～0.72％).其中左侧锁骨下静脉穿刺置管气胸发生率最高,明显高于右侧锁骨下静脉、右颈内静脉及左颈内静脉置管(P值分别为0.025、0.000、0.512).发生导管位置错误共41例,发生率为1.99％(95％CI,1.39％～2.60％).其中,右侧颈内静脉置管导管位置错误发生率最低,与右侧锁骨下静脉、左侧锁骨下静脉及左颈内静脉置管比较,皆有明显统计学差异(P值分别为0.000、0.000、0.000).结论 超声引导下中心静脉置管尤其是右颈内静脉置管术后无需常规行胸部DR检查.

目的 研究影响重型颅脑损伤患者院内转运的危险因素.方法 本研究是一项前瞻性观察研究.由医护人员在转运后24小时内完成相关数据的观察及记录.结果 共114例重型颅脑损伤患者的数据被纳入到本项研究.转运过程中共有27例(23.7％,95％CI=19.7％-27.7％)发生不良事件共36项.其中白天有专业转运团队行CT检查共80例有10例(12.5％,95％CI=8.8％-16.2％)出现不良事件.夜间有值班医护人员行CT检查共34例有17例(50％,95％CI=41.4％-58.6％)出现不良事件.专业团队携带转运监护仪、氧气瓶、便携式呼吸机及简易呼吸气囊等设备转运,患者出现不良事件概率显著低于由值班医护人员转运患者出现不良事件的概率(P<0.05).结论 转运医护人员的培训及转运过程中监护仪器、生命支持设备及药物的使用可有效降低重型颅脑损伤患者的转运风险.而重型颅脑损伤患者转运不良事件的发生与转运人员职称高低无明显相关性.

Objective:To regulate operation requirement for electric instrument using in surgery and eliminate hidden danger so as to ensure their safety in using.Methods: Through discussed the regulation of operative process for electric instrument using in surgery to develop a insulation detector which can adapt the particular case of hospital, and then to carry out relevant management for this kind of electric instrument.Results: The simplest insulation monitoring method got best reliable data, and it provide accuracy basis for clinical electric instrument. Therefore, it ensured the safety of clinical application of electric instrument.Conclusion: The special insulation monitor detects electric instrument in surgery has series of merits including low investment, fast detection and reliable performance, it not only can ensure the safety of surgery but also can provide traceable basis for preventing relevant medical dispute.