October 2019, Volume 22，No.29 Abstracts（B）
Author：尹鹏 Source：CGP Published： [08-29] views： 60
Influencing Factors of Hearing Habits on Hearing Loss and Related Symptoms among Medical Students ZHANG Baodan，WANG Dahui，CHEN Minyan，MA Haiyan，ZHOU Chi，CHEN Yijia，WANG Danni，CHEN Yuan，REN Ying，ZHU Yajun，XU Liangwen*
Medicine School，Hangzhou Normal University，Hangzhou 310036，China
*Corresponding author：XU Liangwen，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background Recently，many studies have assessed the hearing loss （HL） of elderly people，people across occupational groups，and infants，but few have assessed this issue among medical students in China.Objective To investigate the status of HL and hearing related symptoms among medical students，and to explore the effect of hearing habits on them.Methods A total of 1 882 students of four-year （freshman-junior students） and five-year （freshman-senior students） graduation systems were selected by cluster sampling in Medical School，Hangzhou Normal University from March to May 2017.The questionnaire survey and pure-tone hearing tests（PTT）were conducted.The questionnaire comprised three parts：demographic characteristics （age，sex，major，grade），the hearing related symptoms（the occurrence of tinnitus，earache and aural fullness in the last year），and hearing habits（whether to use headphones，type of headphones，frequency of headphone usage，time of headphone usage，time of playing games with headphones，maximum volume of headphone，mode of cell phone conversation，noise environment to improve headphone volume，sleeping with headphones listening to music/radio，frequency of going entertainment places）．The sound-pressure levels of background noise measured at a dedicated sound-isolating room in the university laboratory building were below 30 dB.PTT were measured using a calibrated audiometer （AT235） with standard headphones （TDH-39P）．The speech-frequency HL （>25 dB）and high-frequency HL （>25 dB） were assessed.Factors influencing HL and hearing related symptoms were analyzed by multivariate Logistic regression models.Results A total of 1 882 questionnaires were sent out，1 882 questionnaires were recovered，1 882 questionnaires were valid，with an effective recovery rate of 100.0%.Pure-tone averages of the right ear were higher than those of the left ear at hearing frequency of 0.125，0.250，0.500，1.000，2.000，4.000，6.000 kHz（P<0.05）．The number of students with speech frequency hearing loss （> 25 dB） was 32 （1.7%），high frequency hearing loss （> 25 dB） was 62 （3.3%），tinnitus was 913 （48.5%），earache was 533 （28.3%） and aural fullness was 502 （26.7%）．Among 1 664 medical students（88.4%）who used headphones，there were 963 （57.9%），610 （36.6%） and 91（5.5%） medical students used earplug，in-ear headphones or headset，respectively.The number of students with frequency of using earphones > 2 times/d was 513（27.3%）.Duration of using earphones was >1.0 h/d among 289 medical students（15.4%）．Duration of playing games with using earphones was ≥1 h/d among 547 medical students（29.1%）．Maximum volume of using earphones was ≥60% among 70 medical students（3.7%）．The number of students making phone calls by earphones was 521（27.6%）．Probability to increase earphone volume in a noisy environment was ≥50% among 1 142 medical students（60.7%）．Frequency of sleeping with earphones while listening to music or broadcast was ≥2 times/week among 158 medical students（8.4%）．Frequency of attending entertainment venues was >3 times/month among 36 medical students（1.9%）．The speech-frequency HL and high-frequency HL rates of the tinnitus group were higher than those in the non-tinnitus group（P<0.05）．The speech-frequency HL and high-frequency HL rates did not show any significant difference among ear pain，and aural fullness（P>0.05）．Sex〔female：OR=0.467，95%CI（0.267，0.816）〕was a factor affecting speech-frequency HL among medical students（P<0.05）．Probability to increase earphone volume in a noisy environment〔≥50%：OR=1.567，95%CI（1.282，1.915）〕 was a factor influencing tinnitus among medical students（P<0.05）．Frequency of using earphones〔>2 times/d：OR=1.443，95%CI（1.151，1.810）〕，and duration of using earphones 〔0.5-1.0 h/time：OR=1.447，95%CI（1.151，1.818）；>1.0 h/times：OR=1.648，95%CI（1.214，2.237）〕were factors of ear pain among medical students（P<0.05）．Sex 〔female：OR=1.338，95%CI（1.061，1.686）〕，duration of playing games with earphones〔≥1 h/d：OR=1.315，95%CI（1.053，1.642）〕，probability to increase earphone volume in a noisy environment〔≥50%：OR=1.398，95%CI（1.126，1.735）〕，and frequency of attending entertainment venues 〔>3 times/month：OR=3.324，95%CI（1.686，6.554）〕were factors for aural fullness among medical students（P<0.05）．Conclusion The hearing status is not optimistic among medical students.The hearing status of the right ear is worse than that of the left ear.Improper usage of earphones and exposure to damaging sound levels at noisy entertainment venue can cause hearing damage.Bad hearing habits have long-term influence on the hearing of medical students.We suggest that qualified schools add PTT to the entrance examination，and strengthen the health education related to hearing.
【Key words】 Ear diseases；Hearing loss；Hearing habit；Recreational noise；Earphone；Medical student
Blood Glucose Screening and Its Influencing Factors in First Trimester of Pregnant Women at High Risk of Diabetes Mellitus PENG Xiaoxiao1，WU Kangjie2，MA Xuetao3，WANG Jingjing4，MA Xiuhua1*
1.Daxing Teaching Hospital of Capital Medical University，Beijing 102600，China
2.Central Health Center of Qingyundian Town，Daxing District，Beijing 102605，China
3.Centeral Health Center of Yufa Town，Daxing District，Beijing 102602，China
4.Jiugong Hospital of Beijing Daxing District，Beijing 100076，China
*Corresponding author：MA Xiuhua，Chief physician，Professor；E-mail：email@example.com
【Abstract】 Background The incidence of gestational diabetes mellitus is increasing，especially among pregnant women at high risk of diabetes mellitus.Early screening and early prevention are very important.However，at present，the methods and diagnostic criteria of early gestational diabetes mellitus screening are still not uniform.Objective To study the blood glucose of high-risk pregnant women with diabetes mellitus in early pregnancy and to analyze the effect of related high-risk factors on early hyperglycemia.Methods Collect the data of high-risk pregnant women with diabetes who were enrolled in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from July 2017 to December 2018，and oral glucose tolerance test （OGTT） was used for diabetes screening before 14 weeks of gestation.Results A total of 596 pregnant women with high-risk diabetes were screened for blood glucose in the first trimester of pregnancy，including 374 cases （62.75%） with normal blood glucose，190 cases （31.88%） with impaired glucose regulation （IGR）and 32 cases （5.37%） with pre-gestational diabetes mellitus （PGDM）．In the IGR group，4 cases （2.11%） only had elevated fasting plasma glucose （FPG） level，177 cases （93.16%） only had higher 2 hours plasma glucose（2 hPG） level，9 cases （4.73%） had elevated FPG and OGTT 2 hPG level.In the PGDM group，6 cases （18.75%） only had elevated FPG，24 cases （75.00%） had only elevated OGTT 2 hPG level，2 cases （6.25%） had elevated FPG and OGTT 2 hPG.There were significant differences in age，height，weight，body mass index （BMI） before pregnancy，number of pregnancy，number of births，neck circumference，waist circumference，proportions of first-degree relatives with diabetes mellitus，previous gestational diabetes mellitus （GDM） history and hypertension among three groups（P<0.05）.The results of multivariate Logistic regression showed that age 〔OR=1.087，95%CI（1.043，1.132）〕，neck circumference 〔OR=1.126，95%CI（1.049，1.207）〕 and first-degree relatives with diabetes 〔OR=1.763，95%CI（1.209，
2.572）〕 were independent influencing factors of IGR （P<0.05）；age 〔OR=1.131，95%CI（1.040，1.230）〕，waist circumference 〔OR=1.063，95%CI（1.030，1.099）〕，GDM history 〔OR=5.260，95%CI（1.641，16.864）〕 and hypertension 〔OR=6.246，95%CI（1.336，29.188）〕 were independent influencing factors of PGDM （P<0.05）．Conclusion The incidence of IGR and PGDM in the early pregnancy in high-risk diabetic women is high，and glucose screening only with FPG in early pregnancy would lead to a higher rate of missed diagnosis of IGR and PGDM.Advanced age，neck circumference enlargement，and first-degree relatives with diabetes are independent determinants of IGR.Advanced age，waist circumference enlargement，hypertension，and GDM history are independent determinants of PGDM.
【Key words】 Diabetes；First trimester；Blood glucose；Screening；High risk factors
Incidence of Non-diabetic Fetal Macrosomia and Its Influencing Factors LI Chun，MA Xiuhua*，CHEN Yi，SONG Fengli，CHANG Hongxia，PENG Xiaoxiao，LIANG Feng
Daxing Teaching Hospital of Capital Medical University，Beijing 102600，China
*Corresponding author：MA Xiuhua，Chief physician，Professor；E-mail：firstname.lastname@example.org
【Abstract】 Background In recent years，with the extensive development and active intervention of screening for gestational diabetes mellitus，the incidence of diabetic macrosomia has gradually decreased.However，the proportion of macrosomia in pregnant women with normal glucose metabolism has increased year by year.Objective To explore the incidence of non-diabetic fetal macrosomia （NDFMS） and its influencing factors，and to provide relevant evidence for community interventions.Methods From January 2016 to June 2017，maternity patients who were hospitalized in the Obstetrics and Gynecology Department of Daxing Teaching Hospital of Capital Medical University and the birth weight of whose newborn baby was more than 4 000 g were selected，and 186 women who were excluded from pregnancy with diabetes were selected as the NDFMS group.And 197 women who gave birth to newborns with normal birth weight during the same period were randomly selected as the normal group.General data of maternity women and their spouses，and diet data during pregnancy and exercise-related data were collected in the form of face-to-face interviews within 5 days after delivery.Multivariate Logistic regression was used to analyze the influencing factors of NDFMS.Results The total delivery volume was 9 942 cases，and 785 cases were fetal macrosomia，including 114 cases of diabetic fetal macrosomia and 671 cases of NDFMS.The incidence rate of diabetic fetal macrosomia was 9.77% （114/1 167），and the incidence rate of NDFMS was 7.65% （671/8 775）．The difference was statistically significant （χ2=6.377，P=0.012）．The proportion of primipara，maternal height，gestational weight gain，spouses' height，daily average staple food intake，daily average sugar intake，and daily average fruit intake in the NDFMS group were higher than those of women in the normal group （P<0.05）．Multivariate Logistic regression analysis showed that the parity 〔OR=0.556，95%CI（0.363，0.882）〕，maternal height 〔OR=1.126，95%CI（1.074，1.181）〕，gestational weight gain 〔OR=1.030，95%CI（1.004，1.056）〕，daily average fruit intake 〔OR=0.998，95%CI（0.997，0.999）〕 was the independent factors affecting NDFMS （P<0.05）．Conclusion The incidence of NDFMS is the result of multiple factors.The primiparity，maternal height and the gestational weight gain are the high risk factors of NDFMS.Properly increasing the intake of fruit on the basis of reasonable diet may be the protective factor of NDFMS.
【Key words】 Fetal macrosomia；Pregnant women；Weight gain；Diet；Root cause analysis
Factors Associated with Difficult Mask Ventilation in Emergency Patients CHEN Pingxiong*，WU Peng，SUN Qiong，QI Yun
Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital，Haikou 570208，China
*Corresponding author：CHEN Pingxiong，Attending physician；E-mail：email@example.com
【Abstract】 Background Difficult mask ventilation （DMV） leads to oxygenation and ventilatory failure，causing complications，and fatal consequences associated with failed airway management.However，it has rarely been studied as a primary outcome in emergency patients.Objective To determine the incidence and associated factors of DMV in emergency patients who received tracheal intubation.Methods Adult patients who received tracheal intubation from November 1，2016 to November 1，2017 in Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital were selected.Potential Risk Factors for Difficult Mask Ventilation Form developed by our research group was used to record and evaluate the potential risk factors of DMV，such as physical and disease characteristics，and history of diseases related to airway anatomy by the consulted physician.Logistic regression analysis was used to determine the risk factors of DMV.Results A total of 110 cases were included，among whom 51 （46.4%） developed DMV（DMV group），other 59 （53.6%） did not（control group）．DMV group showed higher percentages of having older age，missing teeth，sunken cheeks，a double chin and a short thick neck than the control group（P<0.05）．Multivariate Logistic regression analysis showed that missing teeth 〔OR=3.41，95%CI （1.50，7.76）〕，sunken cheeks 〔OR=1.76，95%CI （1.41，2.18）〕 and double chin 〔OR=24.00，95%CI （11.53，49.90）〕 were risk factors for DMV in emergency patients with tracheal intubation （P<0.05）．The weighted predictive score showed that double chin was the strongest predictor of DMV，with a weighted score of 5，sunken cheeks of 4 and missing teeth of 2.Conclusion The incidence of DMV is high in emergency patients.Missing teeth，sunken cheeks and double chin are independent risk factors for DMV.
【Key words】 Intubation，intratracheal；Face mask ventilation difficulties；Emergency treatment；Root cause analysis
Relationship between Blood Glucose Changes and Hospital Mortality in Patients with Multiple Injuries WU Yi*，WANG Deyu，ZHAO Xianggeng
Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital，Haikou 570311，China
*Corresponding author：WU Yi，Attending physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Hyperglycemia with unknown mechanism plays a predictive role in determining the prognosis of patients with multiple trauma.However，the time of blood sugar measurement and the role of blood sugar changes in the monitoring of these patients have not been well reported.Objective To explore the relationship between the blood sugar level at admission （BS） and the blood sugar level at 3 hours after admission （BS3），the difference between them （ΔBS） and their relationship with in-hospital mortality.Methods Patients with multiple trauma who came to the Department of Emergency，Central South University Xiangya School of Medicine Affiliated Haikou Hospital from September 2015 to September 2017 were selected.After admission，patients were assessed according to Advanced Traumatic Life Support （ATLS）guidelines，and emergency treatment measures were taken.Gender，age，hospital mortality，injury site，vital signs，injury severity score （ISS） and revised trauma score （RTS） were recorded.Blood samples were sent to the laboratory for emergency examination within 20 minutes after admission.The hemoglobin，hematocrit （HCT），BS，BS3，ΔBS，international normalized ratio （INR），lactic acid and base excess （BE） were recorded.Univariate and multivariate Cox proportional hazard regression model was used to analyze the influencing factors of in-hospital mortality in patients with multiple injuries.Results There were 963 patients with multiple injuries，683 of whom were excluded and 280 were enrolled in the group.Among them，18 cases （6.4%） died in hospital．Multivariate Cox proportional hazard regression analysis showed that：heart rate 〔HR=4.297，95%CI（1.277，14.458）〕，ΔBS 〔HR=2.910，95%CI（1.477，5.733）〕，INR 〔HR=2.228，95%CI（1.346，3.687）〕 were independent influencing factors of hospital mortality in patients with multiple injuries in emergency department （P<0.05）.Conclusion For patients with multiple trauma，ΔBS maybe helpful in predicting hospital mortality，but further large sample studies are needed.In addition，tachycardia may and coagulation dysfunction increase hospital mortality.
【Key words】 Wounds and injuries；Multiple injuries；Blood glucose；Hospital mortality；Emergency service，hospital
Model Construction and Analysis of Factors Influencing Life Quality of Community-dwelling Elderly from the Perspective of Personality Theory HAO Ran1，DONG Huan1，2，SONG Yuanyuan2，ZHU Yufang1，HU Jie1*
1.Clinical Humanistic Care and Nursing Research Center of Hebei Medical University，Shijiazhuang 050031，China
2.Department of Nursing，Aerospace Central Hospital，Beijing 100049，China
*Corresponding author：HU Jie，Professor；E-mail：email@example.com
【Abstract】 Background When facing aging population in China，scholars have paid more attention to quality of life among the elderly，especially their mental health.As is known，mental health is determined by internal factors，of which personality traits plays a very important role.However，there is a lack of research on the effect of personality traits on the life quality of the elderly.Objective To investigate relevant factors，particularly personality traits，that affect the life quality of community-dwelling elders，so as to provide ideas for exploring new nursing interventions.Methods A cross-sectional survey was conducted by semi-random method from March to August 2017.First，eight communities in Shijiazhuang were randomly selected by lottery，and then the elderly who met the criteria were selected by convenient sampling as subjects.General Data Questionnaire，36-Item Short Form Health Survey （SF-36），General Well-being Schedule （GWBS），Social Support Rating Scale （SSRS），General Self-Efficacy Scale （GSES） and Eysenck Personality Questionnaire （EPQ） were used to investigate the elderly.The influencing factors and their relationship on the quality of life of the elderly was evaluated by multivariate linear regression and path analysis.Results A total of 450 questionnaires were issued and 436 valid questionnaires were recovered，with an effective recovery rate of 96.9%.In 436 elderly patients，the SF-36 score was （111.4±30.6），the MCS score was （56.8±16.6），the PCS score was （54.6±16.7），the proportion of good，moderate and poor quality of life was 40.1% （175/436），51.6% （225/436），8.3% （36/436），respectively；the GWBS score was （77.0±12.2），the SSRS score was （39.2±8.2），the GSES score was （24.7±4.0），and the score of sub-scale Extraversion （E） in EPQ was （62.7±12.8），the score of sub-scale Neuroticism （N） was （61.2 ±14.4），and the score of sub-scale Psychoticism （P） was （71.3±22.2）．Multivariate linear regression analysis showed that education level （β=-7.724），current monthly income （β=7.229），GWBS （β=1.143），E score （β=-0.249） were factors influencing the quality of life of the community-dwelling elderly （P<0.05）．The results of path analysis further showed that personality traits with E，N and P as the core can influence the quality of life of the elderly through mediating variables，i.e.general well-being.Conclusion The quality of life of the elderly in Shijiazhuang communities is at a moderate level，which is closely related to the E of personality characteristics.It is suggested that，based on their personality characteristics，specific care interventions need to be formulated to target social support and general self-efficacy for the elderly in the community，so as to improve overall well-being.
【Key words】 Community-dwelling elderly；Quality of life；Personality；General well-being
Qualitative Research on Somatic Symptoms in Depression CHEN Li1，JIA Shoumei1*，LI Ping2，LI Yang1
1.School of Nursing，Fudan University，Shanghai 200032，China
2.Putuo Mental Health Center，Shanghai 200065，China
*Corresponding author：JIA Shoumei，Senior lecturer；E-mail：firstname.lastname@example.org
【Abstract】 Background It has been found that 65.0% to 98.2% of patients with depression have somatic symptoms，which severely affect the quality of patients' life.To understand patients' experiences can provide better targeted medical services to meet individual needs and improve their quality of life.However，there is a lack of experience and understanding of somatic symptoms in depression at home and abroad.Objective To understand experience of people with depressive disorder about somatic symptoms.Methods Fifteen patients with unipolar depression admitted to a psychiatric hospital in Shanghai from October to December 2017 were selected by sampling method，and a semi-structured interview was conducted by descriptive research.MAXQDA10 software was used to organize，encode，classify，induce and extract the topic.Results Two topics and five sub-topics were extracted，including：（1） descriptions of somatic symptoms in patients，which were mainly in the neuromuscular system，circulatory respiratory system，gastrointestinal system and some symptoms without obvious systemic classification；besides located somatic symptoms，patients also had somatic discomforts that were difficult to explain or could not be accurately located.Physical discomfort experience was more severe than the result of objective examinations；（2） patients' understanding of somatic symptoms，including insufficient understanding of somatic symptoms and the inability to link somatic symptoms to mental disorder.Conclusion Patients with depression who have various types of somatic symptoms with different degrees can bring adverse effects on patients and reduce their quality of life.Therefore，clinical medical staff should pay more attention to the somatic symptoms of patients with depression.
【Key words】 Depressive disorder；Somatoform disorder；Symptomatic experience；Dizziness；Insomnia；Palpitation；Qualitative research
Value of Game Therapy Combined with Comprehensive Training in Rehabilitation of Children with Spastic Cerebral Palsy BAI Yan，WANG Xiuxia*，CHEN Haiying
The Second Hospital of Hebei Medical University，Shijiazhuang 050000，China
*Corresponding author：WANG Xiuxia，Chief physician；E-mail：email@example.com
【Abstract】 Background Rehabilitation therapy for children with spastic cerebral palsy is very important，but routine comprehensive training can not achieve ideal benefits.Game therapy can help children release their nature by setting up individualized rehabilitation mode，and stimulating their multiple joints.Objective To analyze the role and value of game therapy combined with comprehensive training in rehabilitation of children with spastic cerebral palsy.Methods A total of 260 children with spastic cerebral palsy admitted to the Department of Pediatrics of the Second Hospital of Hebei Medical University from January 2015 to January 2016 were selected as subjects and randomized into training group and combination group，each of 130 cases.Within six months，all children in the training group received comprehensive training，and children in the combination group received comprehensive training combined with game therapy.The changes of fine motor function and fine motor development quotient，the changes of knee flexion angle，and the changes of muscle tension before and after treatment，as well as the rehabilitation benefits were compared between the two groups.Results After treatment，grasp，visual motor integration scores and fine motor development quotient of the combination group were higher than those of the training group （P<0.05）；of which the two groups were significantly higher than those before treatment（P<0.05）．The knee flexion angle and muscle tension scores of the combination group were lower than those of the training group（P<0.05）；of which the two groups were significantly lower after the treatment （P<0.05）．There was a significant difference in the rehabilitation benefit distribution between the combination group and the training group （Z=15.362，P<0.001），and the excellent and good rate in the combination group was 81.5%（106/130），much higher than that in the control group of 57.7%（75/130）（χ2=17.474，P<0.001）．Conclusion Game therapy combined with comprehensive training can improve the fine motor function and development quotient，reduce the knee flexion angle and muscle tension in children with spastic cerebral palsy，so as to obtain ideal rehabilitation benefits.
【Key words】 Cerebral palsy；Play therapy；Comprehensive training；Treatment outcome；Rehabilitation
Effect of Early Weight-supported Treadmill Training on Functional Recovery and Bone Tunnel Changes after Anterior Cruciate Ligament Reconstruction ZHAO Weiwei1*，SHAO Chenlan1，FU Peng1，ZHANG Jianjun2
1.Department of Rehabilitation Medicine，People's Hospital of Deyang City，Deyang 618000，China
2.Department of Orthopedics，People's Hospital of Deyang City，Deyang 618000，China
*Corresponding author：ZHAO Weiwei，Associate chief physician；E-mail：firstname.lastname@example.org
【Abstract】 Background Anterior cruciate ligament （ACL） injury is a common knee injury.Early surgical reconstruction has been a currently recognized treatment，but some patients still have problems such as poor proprioception and decreased walking ability after operation.Body weight-supported treadmill training （BWSTT） is a hotspot in the field of sports rehabilitation in recent years.However，it is mostly used in the walking training of patients with central nervous system injury in clinic.BWSTT has not been widely reported in ACL reconstruction.Objective To investigate the effect of early BWSTT on functional recovery and bone tunnel changes after ACL reconstruction.Methods Sixty patients after ACL reconstruction in People's Hospital of Deyang City from May 2017 to May 2018 were selected and randomly divided into observation and control group，each with 30 cases.The control group began progressive lower limb function training one day after operation，while the observation group received early BWSTT one week after operation on the basis of training of the control group，that is，to integrate proprioceptive training into early BWSTT.The recovery of proprioceptive sensation was assessed by electromyography （EMG） at 12 weeks after operation，and the integral electromyogram （iEMG） of electromyography of medial femoral muscle was measured at 12 weeks after operation.Routine MRI at 4 weeks and 12 weeks was used to detect the width of bone marrow canal，signal intensity of graft，and T2 value of tendon and bone node.The motor function was evaluated by 2000 International Knee Documents Committee （IKDC） Subjective Knee Evaluation Scale and Lysholm score.The balance function was evaluated by Fugl-Meyer Balance Scale and Berg Balance Scale （BBS）．Results The width of bone marrow canal in the observation group at 4 and 12 weeks after operation was narrower than that in the control group，signal intensity of graft and T2 value of tendon and bone node in the observation group at 4 weeks was higher than that in the control group，while the signal intensity of graft and T2 value of tendon and bone node in the observation group at 12 weeks was lower than that in the control group（P<0.05）．The width of bone marrow canal at 12 weeks after operation in both groups was higher than that at 4 weeks after operation，and the signal intensity and T2 value of tendon-bone node were lower than that at 4 weeks after operation （P<0.05）．Reproducibility deviation of passive range of motion （ROM） and iEMG in 0 °-40 °，41 °-80 °，81 °-120 ° in the observation group at 12 weeks after operation were better than those in the control group （P<0.05）．The 2000 IKDC Subjective Knee Evaluation Scale score of the observation group was higher than that of the control group at 12 weeks postoperatively （P<0.05）；the Lysholm score，Fugl-Meyer Balance Scale score and BBS score of the observation group were higher than those of the control group at 4 and 12 weeks after operation （P<0.05）．The 2000 IKDC Subjective Knee Evaluation Scale score，Lysholm score，Fugl-Meyer Balance Scale score and BBS score of the two groups at 12 weeks after operation were higher than those at 4 weeks after operation （P<0.05）．At 12 weeks after operation，the enlargement of bone marrow canal was negatively correlated with Lysholm score and BBS score （r=-0.32，r=-0.35，P<0.05）．Conclusion Adding proprioceptive training to early walking training can accelerate the recovery of tendon and bone，increase muscle strength and proprioception，and improve motor and balance function.
【Key words】 Anterior cruciate ligament reconstruction；Early body weight-supported treadmill training；Knee joint；Bone tunnel
Clinical Study of Enteral Nutrition Pathway by ‘Sandwich’ Blind Placement of Nasojejunal Tubes XIAO Yan，FENG Ping，ZHU Zigui，YAO Hongyi，LIU Wei，HE Chengjian*
Intensive Care Unit，Affiliated Nanhua Hospital，University of South China，Hengyang 421002，China
*Corresponding author：HE Chengjian，Associate chief physician；E-mail：email@example.com
【Abstract】 Background Early enteral nutritional support therapy for critically ill patients has been widely used in clinical practice.After pyloric feeding through the nasal-jejunal nutrient tube，food reflux in gastric retention，aspiration and other complications can be effectively reduced.However，there is a certain difficulty in placing nasal jejunum nutrient tubes in clinical practice.How to find a quick and easy way to place nasal-jejunal nutrient tube is an urgent problem for clinicians to solve.Objective To introduce a new method of catherterizing the nasojejunal tube by using "sandwich" method，and to evaluate its safety and clinical value.Methods In this clinical study，we enrolled 234 patients who needed enteral nutrition therapy in the ICU of Affiliated Nanhua Hospital，University of South China during September 2015 to January 2017.Subjects were divided into endoscope group （51 patients），and “sandwich” group （183 patients）.In endoscope group，we inserted the nasojejunal tube with the assistance of endoscope，and in “sandwich” group，we performed air-nsufflation and wire-guided “sandwich” method.We assessed and compared the catherterizing time，success rate，complication rate and respiratory and cardiac data changes between two groups.Results The average catheterization time in the “sandwich” group 〔（20±13）min〕 was shorter than that in the endoscope group 〔（24±7）min〕（t=-2.264，P=0.025）.There was no significant difference in the success rate of catheterization between two groups 〔96.7%（177/183） vs 100.0%（51/51），χ2=0.655，P=0.418〕.The complication rate of the “sandwich” group was lower than that of the endoscope group 〔13.1%（24/183） vs 78.4%（40/51），χ2=85.636，P<0.001〕.Heart rate，respiration and systemic pulse oximetry saturation （SpO2） of two groups before catheterization showed no significant difference （P>0.05）.However，the mean arterial pressure （MAP） in the “sandwich” group was higher than that in the endoscope group （P<0.05）.SpO2 of two groups after catheterization showed no significant difference （P>0.05）.However，the heart rate，respiration and MAP in the “sandwich” group were lower than those in the endoscope group （P<0.05）.SpO2 in the endoscope group before and after catheterization showed no significant difference （P>0.05）.However，the heart rate，respiration and MAP in the endoscope group after catheterization were higher than those before catheterization （P<0.05）.There was no statistically significant differences in MAP in the “sandwich” group before and after catheterization（P>0.05）.However，the heart rate，respiration and SpO2 in the “sandwich” group after catheterization were higher than those before catheterization （P<0.05）.Conclusion The “sandwich” method can shorten the catheterization time，and reduce the occurrence rate of complication.The “sandwich” method is safe，efficient and has less adverse effect on cardiopulmonary function，which is worthy of clinical promotion.
【Key words】 Enteral nutrition；Intubation，gastrointestinal；Intensive care units
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