Objective:To investigate the effects of survival status in Stanford type A aortic dissection (TAAD) patients over 70 years old by different treatment methods.Methods:The clinical data of 151 TAAD patients over 70 years old from January 2012 to January 2022 in the Affiliated Hospital of Jining Medical University were retrospectively analyzed. Among them, 60 patients were treated with surgery (surgical treatment group), and 91 patients with conservative method (conservative treatment group). The duration of hospitalization and complications (including pericardial effusion, acute myocardial infarction, pericardial tamponade, shock, stroke, mesenteric ischemia and acute renal failure) were recorded. The patients were followed up within 30 d after the onset of illness. The survival status was recorded. The multivariate Cox regression analysis was used to analyze the independent risk factors of death in TAAD patients over 70 years old.Results:The duration of hospitalization in surgical treatment group was significantly longer than that in conservative treatment group: 14.00 (7.00, 19.75) d vs. 5.00 (2.00, 10.00) d. The incidences of pericardial tamponade, shock and acute renal failure: 1.7% (1/60) vs. 13.2% (12/91), 8.3% (5/60) vs. 24.2% (22/91) and 0 vs. 9.9% (9/91), with statistical differences ( P<0.01 or <0.05), but no statistical differences in the incidences of pericardial effusion, acute myocardial infarction, stroke, mesenteric ischemia between two groups ( P>0.05). Patient follow-up for 30 d, the mortality rate in surgical treatment group was significantly lower than that in conservative treatment group: 15.0% (9/60) vs. 46.2% (42/91), with statistical difference ( χ2 = 15.69, P<0.01). The multivariate Cox regression analysis result showed that conservative treatment, female, increased aortic root diameter and concomitant stroke were the independent risk factors of death in TAAD patients over 70 years old ( RR = 2.311, 2.135, 1.051 and 3.737; 95% CI 1.056 to 5.057, 1.083 to 4.212, 1.004 to 1.100 and 1.393 to 10.026; P<0.05 or <0.01). Conclusions:The early surgical treatment is recommended in TAAD patients over 70 years old with surgical indications.

AbstractBackground To construct a risk stratification score for acute aortic syndrome (AAS) with high predictive value for AAS. Methods Patients suspected of having AAS who visited the emergency department of the Affiliated Hospital of Jining Medical University between August 2019 and July 2022 were enrolled. The patients were divided into AAS and non-AAS groups according to the AAS diagnostic criteria. The independent risk factors for AAS were analyzed by binary logistic regression analysis, the AAS risk stratification score (AAS-RSS) was constructed, and a receiver operating characteristic (ROC) curve was drawn to evaluate the AAS-RSS. Results A total of 23 variables were effectively integrated into the AAS-RSS according to the size of the logistic regression analysisBvalue and were combined with the ADD-RS score. AAS-RSS and ADD-RS predicted that the areas under the AAS curve were 0.919(0.898 ~ 0.941) and 0.734 (0.694 ~ 0.773), respectively. Conclusions The AAS-RSS has high predictive value for risk stratification of AAS.

目的 探讨协同护理措施在重症患者失禁相关性皮炎中的应用效果.方法 选择我院70例重症患者作为研究对象.采用随机数字表法将患者分为对照组和观察组,每组各35例.对照组采用常规护理,观察组采用协同护理.比较两组的失禁相关性皮炎、皮肤完整性及护理满意度.结果 观察组的失禁相关性皮炎、皮肤完整性及护理满意度优于对照组(P<0.05).结论 协同护理可有效改善患者皮肤完整性,降低患者失禁相关性皮炎的发生风险.

目的:分析探究急诊重症监护室危重患者护理技术安全措施.方法:2018年1月～2019年6月期间收治的235例危重患者,对其临床资料进行分析.总结护理技术安全事件发生情况,然后采取针对性的防范措施.结果:急诊重症监护室危重患者中一共发生27例护理技术安全事件,占比11.49％.进一步分析发现,VAP事件与压疮事件发生率较高.结论:急诊重症监护室危重患者护理技术安全事件主要包括VAP、压疮、非计划性拔管、血流感染以及用药错误等方面,需要给予针对性的干预措施.