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Hypoxia in the pulmonary vein increases pulmonary vascular resistance independently of oxygen in the pulmonary artery

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Animal Models and Experimental Medicine 2024年第2期7卷 156-165页

作者： Sigridur Olga Magnusdottir Carsten Simonsen Dan Stieper Karbing Bodil Steen Rasmussen Benedict Kjaergaard Biomedical Research Laboratory Aalborg University HospitalAalborgDenmark Department of Clinical Medicine Aalborg UniversityAalborgDenmark Department of Cardiothoracic Surgery Aalborg University HospitalAalborgDenmark Department of Health Science and Technology Aalborg UniversityAalborgDenmark Department of anesthesia and intensive care Aalborg University HospitalAalborgDenmark

Introduction:Hypoxic pulmonary vasoconstriction(HPV)can be a challenging clinical *** is not fully elucidated where in the circulation the regulation of resistance takes *** is often referred to as if it is in the arteries,but we hypothesized that it is in the venous side of the pulmonary ***:In an open thorax model,pigs were treated with a veno-venous extra corporeal membrane oxygenator to either oxygenate or deoxygenate blood passing through the pulmonary *** the same time the lungs were ventilated with extreme variations of inspired air from 5%to 100%oxygen,making it possible to make combinations of high and low oxygen content through the pulmonary circulation.A flow probe was inserted around the main pulmonary artery and catheters in the pulmonary artery and in the left atrium were used for pressure monitoring and blood *** different combinations of oxygenation,pulmonary vascular resistance(PVR)was ***:With unchanged level of oxygen in the pulmonary artery and reduced inspired oxygen fraction lowering oxygen tension from 29 to 6.7 kPa in the pulmonary vein,PVR was *** more extreme hypoxia PVR suddenly *** with low oxygenation in the pulmonary artery did not systematic influence PVR if there was enough oxygen in the inspired air and in the pulmonary ***:The impact of hypoxia occurs from the alveolar level and forward with the blood *** experiments indicated that the regulation of PVR is mediated from the venous side.

关键词： animal models cardiopulmonary support Hypoxic pulmonary vasoconstriction pulmonary circulation

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Role of mitochondrial dysfunction in kidney disease:Insights from the cGAS-STING signaling pathway

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Chinese Medical Journal 2024年第9期137卷 1044-1053页

作者： Lu Li Fei Liu Chunyue Feng Zhenjie Chen Nan Zhang Jianhua Mao Department of Nephrology Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiang 310052China Department of Pediatric intensive care unit Children’s HospitalZhejiang University School of MedicineNational Clinical Research Center for Child HealthHangzhouZhejiang 310052China

Over the past decade,mitochondrial dysfunction has been investigated as a key contributor to acute and chronic kidney ***,the precise molecular mechanisms linking mitochondrial damage to kidney disease remain *** recent insights into the cyclic guanosine monophosphate-adenosine monophosphate(GMP-AMP)synthetase(cGAS)-stimulator of interferon gene(STING)signaling pathway have revealed its involvement in many renal *** of these findings is that mitochondrial DNA(mtDNA)induces inflammatory responses via the cGAS-STING ***,we provide an overview of the mechanisms underlying mtDNA release following mitochondrial damage,focusing specifically on the association between mtDNA release-activated cGAS-STING signaling and the development of kidney ***,we summarize the latest findings of cGAS-STING signaling pathway in cell,with a particular emphasis on its downstream signaling related to kidney *** review intends to enhance our understanding of the intricate relationship among the cGAS-STING pathway,kidney diseases,and mitochondrial dysfunction.

关键词： Mitochondrial dysfunction Mitochondrial DNA cGAS-STING pathway Kidney diseases Chronic kidney disease

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Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

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Journal of intensive Medicine 2024年第3期4卷 355-361页

作者： Vasiliki Tsolaki Kyriaki Parisi George E.Zakynthinos Efrosini Gerovasileiou Nikitas Karavidas Vassileios Vazgiourakis Epaminondas Zakynthinos Demosthenes Makris intensive care unit University Hospital of LarissaUniversity of Thessaly Faculty of MedicineLarissaGreece Third Cardiology Clinic University of AthensSotiria HospitalAthensGreece Respiratory Department University Hospital of LarissaUniversity of Thessaly Faculty of MedicineLarissaGreece

Background Sepsis is a life-threatening organ dysfunction,and septic cardiomyopathy(SCM)may complicate the course of the *** with multidrug-resistant(MDR)pathogens has been linked with worse *** study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant *** This retrospective study included patients with sepsis/septic shock,hospitalized,and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection *** patients were divided into two groups:non-MDR-SCM group and MDR-SCM *** cardiac function was compared between the two *** A total of 62 patients were included in the ***-four patients comprised the MDR-SCM and 18 the non-MDR-SCM ***-six patients(41.9%)presented with left ventricular(LV)systolic dysfunction,and≤35%right ventricular fractional area change(RVFAC)was present in 56.4%.LV systolic function was more severely impaired in the non-MDR-SCM group(left ventricular ejection fraction,35.8%±4.9%vs.45.6%±2.4%,P=0.049;LV outflow tract velocity time integral,[10.1±1.4]cm vs.[15.3±0.74]cm,P=0.001;LV-Strain,–9.02%±0.9%vs.–14.02%±0.7%,P=0.001).The MDR-SCM group presented with more severe right ventricular(RV)dilatation(right ventricular end-diastolic area/left ventricular end-diastolic area,0.81±0.03 vs.0.7±0.05,P=0.042)and worse RV systolic function(RVFAC,32.3%±1.9%vs.39.6%±2.7%,P=0.035;tricuspid annular plane systolic excursion,[15.9±0.9]mm vs.[18.1±0.9]mm,P=0.165;systolic tissue Doppler velocity measured at the lateral tricuspid annulus,[9.9±0.5]cm/s vs.[13.1±0.8]cm/s,P=0.002;RV-strain,–11.1%±0.7%vs.–15.1%±0.9%,P=0.002).Conclusion SCM related to MDR infection presents with RV systolic dysfunction predominance,while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.

关键词： Septic cardiomyopathy Multidrug-resistant pathogen Left ventricular failure Right ventricular dysfunction Left/right ventricular longitudinal strain Ventriculoarterial Coupling

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Data driven analysis reveals prognostic genes and immunological targets in human sepsis-associated acute kidney injury

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World Journal of Emergency Medicine 2024年第2期15卷 91-97页

作者： Qing Zhao Jinfu Ma Jianguo Xiao Zhe Feng Hui Liu Department of Diagnosis and Treatment of Cadres the First Medical CenterChinese PLA General HospitalBeijing 100853China intensive care unit the 305th Hospital of Chinese PLABeijing 100032China Department of Critical care Medicine the First Medical CenterChinese PLA General HospitalBeijing 100853China Nephrology Department the First Medical CenterChinese PLA General HospitalBeijing 100853China

BACKGROUND:The molecular mechanism of sepsis-associated acute kidney injury(SA-AKI)is *** analyzed co-differentially expressed genes(co-DEGs)to elucidate the underlying mechanism and intervention targets of ***:The microarray datasets GSE65682,GSE30718,and GSE174220 were downloaded from the Gene Expression Omnibus(GEO)*** identified the co-DEGs and constructed a gene co-expression network to screen the hub *** analyzed immune correlations and disease correlations and performed functional annotation of the hub *** also performed single-cell and microenvironment analyses and investigated the enrichment pathways and the main transcription ***,we conducted a correlation analysis to evaluate the role of the hub ***:Interleukin 32(IL32)was identified as the hub gene in SA-AKI,and the main enriched signaling pathways were associated with hemopoiesis,cellular response to cytokine stimulus,inflammatory response,and regulation of kidney ***,IL32 was significantly associated with mortality in SA-AKI ***,macrophages,T cells,and NK cells were closely related to IL32 and were involved in the immune microenvironment in SA-AKI ***32 expression increased significantly in the kidney of septic ***-like receptor 2(TLR2)was significantly and negatively correlated with ***:IL32 is the key gene involved in SA-AKI and is significantly associated with ***2 and relevant immune cells are closely related to key genes.

关键词： Sepsis Acute kidney injury Interleukin 32 Toll-like receptor 2 Bioinformatics analysis

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Epidemiology and risk factors for mortality in critically ill patients with pancreatic infection

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Journal of intensive Medicine 2024年第1期4卷 81-93页

作者： Marie Dejonckheere Massimo Antonelli Kostoula Arvaniti Koen Blot Ben CreaghBrown Dylan Wde Lange Jan De Waele Mieke Deschepper Yalim Dikmen George Dimopoulos Christian Eckmann Guy Francois Massimo Girardis Despoina Koulenti Sonia Labeau Jeffrey Lipman Fernando Lipovestky Emilio Maseda Philippe Montravers Adam Mikstacki JoseArtur Paiva Cecilia Pereyra Jordi Rello JeanFrancois Timsit Dirk Vogelaers Stijn Blot the Abdominal Sepsis Study(AbSeS)group on behalf of the Trials Group of the European Society of intensive care Medicine Department of Internal Medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium Department of Anesthesiology Intensive Care and Emergency MedicineFondazione Policlinico Universitario A.Gemelli IRCCSRomeItaly UniversitàCattolica del Sacro Cuore RomeItaly intensive care unit Papageorgiou University Affiliated HospitalThessaloníkiGreece Department of Epidemiology and Public Health SciensanoIxellesBelgium Surrey Perioperative Anaesthetic Critical care Collaborative Research Group(SPACeR) Royal Surrey County HospitalGuildfordUK Department of Clinical and Experimental Medicine University of SurreyGuildfordUK Department of intensive care Medicine University Medical Center UtrechtUniversity UtrechtUtrechtthe Netherlands Department of intensive care Medicine Ghent University HospitalGhentBelgium Data Science Institute Ghent University HospitalGhentBelgium Department of Anesthesiology and Reanimation Cerrahpasa School of MedicineIstanbul University-CerrahpasaIstanbulTurkey rd Department of Critical care “EVGENIDIO”HospitalNational and Kapodistrian University of AthensAthensGreece Department of General Visceral and Thoracic SurgeryKlinikum Hannoversch-MuendenGoettingen UniversityGöttingenGermany Division of Scientific Affairs-Research European Society of Intensive Care MedicineBrusselsBelgium anesthesia and intensive care Department University Hospital of ModenaModenaItaly UQ Centre for Clinical Research Faculty of MedicineThe University of QueenslandBrisbaneQLDAustralia nd Critical care Department Attikon University HospitalAthensGreece Department of Nursing Faculty of EducationHealth and Social WorkUniversity College GhentGhentBelgium Jamieson Trauma Institute The University of QueenslandBrisbaneQLDAustralia Nimes University Hospital University of MontpellierNimesFrance Critical care Department Hospital of the Interamerican Open University(UAI)Buenos AiresArgentina Surgical Critical care Department of AnesthesiaHospital Universitario

Background:The AbSeS-classification defines specific phenotypes of patients with intra-abdominal infection based on the(1)setting of infection onset(community-acquired,early onset,or late-onset hospital-acquired),(2)presence or absence of either localized or diffuse peritonitis,and(3)severity of disease expression(infection,sepsis,or septic shock).This classification system demonstrated reliable risk stratification in intensive care unit(ICU)patients with intra-abdominal *** study aimed to describe the epidemiology of ICU patients with pancreatic infection and assess the relationship between the components of the AbSeS-classification and ***:This was a secondary analysis of an international observational study(“AbSeS”)investigating ICU patients with intra-abdominal *** patients with pancreatic infection were included in this analysis(n=165).Mortality was defined as ICU mortality within 28 days of observation for patients discharged earlier from the *** with mortality were assessed using logistic regression analysis and reported as odds ratio(OR)and 95%confidence interval(CI).Results:The overall mortality was 35.2%(n=58).The independent risk factors for mortality included older age(OR=1.03,95%CI:1.0 to 1.1 P=0.023),localized peritonitis(OR=4.4,95%CI:1.4 to 13.9 P=0.011),and persistent signs of inflammation at day 7(OR=9.5,95%CI:3.8 to 23.9,P<0.001)or after the implementation of additional source control interventions within the first week(OR=4.0,95%CI:1.3 to 12.2,P=0.013).Gramnegative bacteria were most frequently isolated(n=58,49.2%)without clinically relevant differences in microbial etiology between survivors and ***:In pancreatic infection,a challenging source/damage control and ongoing pancreatic inflammation appear to be the strongest contributors to an unfavorable short-term *** this limited series,essentials of the AbSeS-classification,such as the setting of infection onset,diffuse

关键词： Pancreatic infection intensive care unit Mortality Intra-abdominal infection Sepsis

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Extracorporeal membrane oxygenation versus cardiopulmonary bypass during transcatheter aortic valve implantation: a meta-analysis of survival benefits

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World Journal of Emergency Medicine 2024年第4期15卷 306-310页

作者： Huiruo Liu Liangshan Wang Xing Hao Zhongtao Du Chenglong Li Hong Wang Xiaotong Hou Centre for Cardiac intensive care Beijing Institute of HeartLung and Blood Vessel DiseasesBeijing Anzhen HospitalCapital Medical UniversityBeijing 100029China

Since its approval by the Food and Drug Administration in 2011,transcatheter aortic valve implantation(TAVI)has rapidly evolved to become the preferred ultimate intervention for high-and intermediate-risk patients with severe symptomatic aortic stenosis.[1]This is due to its non-open-heart,minimally invasive and off-pump advantages.[1]Nevertheless,as a result of the frequent frailty and comorbidity profiles of patients undergoing TAVI,such as advanced cardiac dysfunction and extensive coronary artery disease,or technically difficult anatomy for the procedure itself,[2-4]it is common for these patients to experience critical circulatory collapse *** factors are linked to elevated mortality rates,necessitating suitable mechanical circulatory support(MCS)to reverse the disastrous situations.[5]

关键词： anatomy bypass elevated

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Low interleukin-10 level indicates a good prognosis in Salmonella enterica serovar typhimurium-induced pediatric hemophagocytic lymphohistiocytosis:A case report

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World Journal of Clinical Cases 2024年第9期12卷 1660-1668页

作者： Yuan-Yuan Chen Xiang-Zhi Xu Xiao-Jun Xu Division/Center of Pediatric Hematology Oncology Children’s HospitalZhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina Pediatric intensive care unit Children’s Hospital of Zhejiang University School of MedicineHangzhou 310003Zhejiang ProvinceChina

BACKGROUND Secondary hemophagocytic lymphohistiocytosis(sHLH)triggered by Salmonella enterica serovar Typhimurium is rare in pediatric *** is no consensus on how to treat ***-triggered *** SUMMARY A 9-year-old boy with intermittent fever for 3 d presented to our hospital with positive results for ***,human rhinovirus,and Mycoplasma pneumoniae *** the time of admission to our institution,the patient’s T helper 1/T helper 2 cytokine levels were 326 pg/mL for interleukin 6(IL-6),9.1 pg/mL for IL-10,and 246.7 pg/mL for interferon-gamma(IFN-γ),for which the ratio of IL-10 to IFN-γwas *** this study,the patient received meropenem,linezolid,and cefoperazone/sulbactam in combination with high-dose methylprednisolone therapy(10 mg/kg/d for 3 d)and antishock supportive treatment *** careful evaluation,this patient did not receive HLH chemotherapy and recovered *** *** infection-triggered sHLH patient had a ratio of IL-10 to IFN-γ≤1.33,an IL-10 concentration≤10.0 pg/mL,and/or an IFN-γconcentration≤225 pg/mL at *** antimicrobial and supportive treatment was sufficient,and the HLH-94/2004 protocol was not necessary under these conditions.

关键词： Hemophagocytic lymphohistiocytosis Cytokine pattern Interferon gamma Interleukin-10 Salmonella enterica serovar Typhimurium Case report

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Natural long-chain saturated fatty acids doped LNPs enabling spleen selective mRNA translation and potent cancer immunotherapy

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Nano Research 2024年第3期17卷 1804-1817页

作者： Fazhan Wang Meng Zhang Meiling Tian Jia Lou Longze Pan Xiaoke Gao Lijing Zhang Xiaohan Lou Linyu Zhu Yuqiao Sheng Ming Wang Rui Xue Wenjing Deng Shuai Shao Zhihai Qin Medical Research Center The First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhou 450052China Translational Medical Center The First Affiliated Hospital of Zhengzhou UniversityZhengzhou UniversityZhengzhou 450052China Department of Neuro-intensive care unit The First Affiliated Hospital of Zhengzhou UniversityZhengzhou 450052China Academy of Medical Sciences Zhengzhou UniversityZhengzhou 450052China

Rationally tailored lipid nanoparticles(LNPs)with efficient and tunable delivery of mRNA in vivo are crucial for mRNA *** expression of antigenic protein in lymphoid tissues/organs could improve the immunostimulatory efficacy and safety of LNPs-based mRNA *** by the metabolic behavior that long-chain saturated fatty acids tending to enter lymphoid tissue rather than the liver,we developed fatty acid-doped LNPs capable of mediating differential protein expressions in the liver and spleen when administered *** the molar ratio of saturated fatty acid located 60%–70%,the doped LNPs achieved the spleen selective mRNA *** mechanism could be attributed to the different cellular uptake behaviors of saturated fatty acids in *** with a model antigen(ovalbumin)mRNA-loaded spleen selective LNPs,we observed enhanced antigen-specific T cell immune responses,and potent immunotherapeutic and immunoprophylactic efficacy in the mouse lymphoma *** natural long-chain saturated fatty acids metabolic characteristics-inspired design of LNPs for spleen-selective mRNA vaccines delivery will provide references for designing mRNA vaccines with high efficacy and safety for tumor immunotherapy.

关键词： mRNA vaccine lipid nanoparticles spleen long-chain saturated fatty acid cancer immunotherapy

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Clinical analysis of colistin sulfate in the treatment of pneumonia caused by carbapenem-resistant Gram-negative bacteria

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World Journal of Clinical Cases 2024年第13期12卷 2173-2181页

作者： Hai-Chang Xu Yan Cui Xue-Ying Wang Hai-Bo Wu Wei Li Dan Wang Na Lin Lin Lin Ying-Hui Zhang Department of intensive care Medicine The General Hospital of the Northern Theater Command of the People's Liberation Army of ChinaShenyang 110016Liaoning ProvinceChina

BACKGROUND Multidrug-resistant Gram-negative bacteria,exacerbated by excessive use of antimicrobials and immunosuppressants,are a major health *** To study the clinical efficacy and safety of colistin sulfate in the treatment of carbapenem-resistant Gram-negative bacilli-induced pneumonia,and to provide theoretical reference for clinical diagnosis and *** This retrospective analysis involved 54 patients with Gram-negative bacilli pneumonia admitted to intensive care unit of The General Hospital of the Northern Theater Command of the People's Liberation Army of China from August 2020 to June *** bacteriological culture,the patients'airway secretions were collected to confirm the presence of Gram-negative *** patients were divided into the experimental and control groups according to the medication *** research group consisted of 28 patients who received polymyxin sulfate combined with other drugs through intravenous,nebulization,or intravenous combined with nebulization,with a daily dosage of 1.5–3.0 million *** control group consisted of 26 patients who received standard dosages of other antibiotics(including sulbactam sodium for injection,cefoperazone sodium sulbactam for injection,tigecycline,meropenem,or vaborbactam).RESULTS Of the 28 patients included in the research group,26 patients showed improvement,treatment was ineffective for two patients,and one patient died,with the treatment efficacy rate of 92.82%.Of the 26 patients in the control group,18 patients improved,treatment was ineffective for eight patients,and two patients died,with the treatment efficacy rate of 54.9%;significant difference was observed between the two groups(P<0.05).The levels of white blood cell(WBC),procalcitonin(PCT),and C-reactive protein(CRP)in both groups were significantly lower after treatment than before treatment(P<0.05),and the levels of WBC,PCT,and CRP in the research group were significantly lower than those in the control group

关键词： Colistin sulfate Extensively drug-resistant Pneumonia Intravenous combined with nebulization Sepsis Nephrotoxicity Neurotoxicity

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儿科重症监护护士腹内压监测知信行的现状调查

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International Journal of Nursing Sciences 2024年第3期11卷 381-386,I0005页

作者：李志茹卢芳燕戴燕红盛美君苏丽丹姚萍王华芬 Department of Nursing The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina Hepatobiliary and Pancreatic Surgery The First Affiliated HospitalZhejiang University School of MedicineHangzhouChina Surgical intensive care unit Children’s HospitalZhejiang University School of MedicineHangzhouChina Pediatric intensive care unit The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina Pediatric intensive care unit Huzhou Central HospitalHuzhouChina

目的旨在评估儿科重症监护护士对腹内压监测的知识、态度和实践现状及培训需求,为临床制订相关培训方案和操作流程提供参考依据。方法采用横断面调查法。2023年4月-6月选取浙江省8所三级甲等医院212名儿科重症监护护士为研究对象。采用... 详细信息

目的旨在评估儿科重症监护护士对腹内压监测的知识、态度和实践现状及培训需求,为临床制订相关培训方案和操作流程提供参考依据。方法采用横断面调查法。2023年4月-6月选取浙江省8所三级甲等医院212名儿科重症监护护士为研究对象。采用自行编制的腹内压监测知信行评估问卷进行调查,包括知识(14个条目)、态度(6个条目)和实践(8个条目)3个维度,共28个条目。结果护士问卷总分为(60.73±8.35)分;知识维度得分为(7.84±2.35)分,得分率为56.0%;态度维度得分为(25.16±3.23)分,得分率为83.9%;实践维度得分为(28.44±6.46)分,得分率为69.3%。接受过腹内压监测培训的护士问卷总分、知识和行为维度得分均高于未接受培训的护士;年龄≤30岁的护士知识维度得分高于年龄>30岁的护士(P<0.05)。55.7%的护士认为目前的知识不足以有效地进行腹内压监测。难以识别腹内高压高危人群(64.6%)、不熟悉腹内压测量的操作流程(55.6%)和护患比分配不合理(52.8%)是护士实施腹内压监测的主要障碍因素。结论儿科重症监护护士对腹内压监测持积极的态度,但其知识水平和实践行为仍有待加强,特别是对已发表的共识定义、腹内压测量方法和监测频率方面的知识是不充分的。护理管理人员要根据护士的培训需求和实施腹内压监测的潜在障碍因素,实施针对性的腹内压监测培训方案,以促进腹内压监测的标准化和科学性。

关键词：态度重症监护室腹内压知识监测护理人员儿科行为

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