医事法学课程中对父权主义理论的批判与继承

在医事法学课程的教学中不断强调病人是医疗中心的这一观念正瓦解着传统的医疗父权。课程中教师对病人自主权的重视与在实践环节病人自主权仍停留在概念阶段形成了一对矛盾。对父权主义在批判基础上的继承能有助于解决这一矛盾,并能在实践中保护和提升病人的自主权。     

论尊重病人自主权

病人的自主权,应为“在维系医患关系中,病人的自由决定的权力”,包括诊疗、经济、法律、伦理等各个方面的内容。尊重病人的自主权,是市场经济条件下医患关系发展和必然趋势和客观要求,是有关法律的规定和要求,是国际医学伦理学理论和实践的启示,是尊重人权的体现,是建立友好合作型医患关系的需要;尊重病人的自主权与保守医密是不矛盾的,病人的自主权也不是绝对的。     

常见护患纠纷的原因及防范对策

护理工作是医疗工作中的重要组成部分，与医疗安全和医疗质量息息相关，护士在临床工作中与病人接触机会多、时间长，难免会发生一些矛盾或冲突，若不及时处理好，容易导致双方情绪波动，对工作及病人的健康都会造成不良的影响，甚至扰乱医院的工作秩序。因此，如何杜绝护理差错和事故，提高护理技术操作和护理质量，避免纠纷的发生，是护理人员应该重视和探讨的问题，现就产生护患矛盾的原因及防范对策进行探讨。     

试谈护患关系及护患冲突

随着医疗护理改革的不断深化 ,人们对护理质量要求的不断提高 ,护士与患者的关系也发生了巨大的变化。目前 ,护患关系紧张 ,护患冲突时有发生 ,如何正确理解和认识护理关系及护患冲突有着重要临床意义。1　护患关系的特点在护理工作实践中 ,护患关系可分为 3种类型 ,即主动与被动型、指导与合作型、共同参与型。近年来 ,随着护理模式的发展 ,改革的深入 ,“以病人为中心” ,“病人选护士”等新的管理理念和护理模式 ,有利于改善护患关系。2　护患冲突的因素护患冲突是护患关系处于不协调的矛盾状态 ,这种矛盾状态有时表现不明显 ,有时很突出…     

老龄人临终关怀服务中的伦理冲突

在我国传统文化视域和现行伦理、法律框架下,老年人临终关怀会遇到一系列的伦理冲突和难题:医疗保护中隐瞒病情与知情同意中告知原则的伦理冲突;中国传统孝道观念与尊重病人自主抉择权利的伦理冲突;临终关怀中的死亡商讨与传统死亡观的伦理冲突;选择临床积极治疗或临终关怀服务的伦理决策冲突;临终关怀的服务理念与传统医德观的伦理冲突.提出解决的对策为:应根据病人的心理状态和实际需要适当告知病情;关注病人意愿,尊重病人的自主权;推广有关生死关怀等相关的教育课程;开展死亡观教育和伦理引导,构建和普及科学的死亡观;医务人员要转变医疗观念,重视对临终老人的身心照护.     

SARS患者医疗保密的伦理思考

在SARS的特殊时期对患者的病情实施保密与患者和公众的知情权发生矛盾。这种矛盾冲突应受到伦理的辩护，并得到社会心理学的支持。以心理评估的结果来决定恰当的保密行为。     

门诊注射室、输液室护患冲突的原因与对策

随着市场经济的发展。法制建设的逐步健全，人们的自我保护意识也不断增强。尤其是近年来新闻媒体对医疗行业医患纠纷、医疗事故案件的大量曝光以及社会舆论的导向作用，病人作为“上帝”对医疗护理服务质量的要求也不断提高，而门诊注射室、输液室作为医院的窗口。一个集中为病人治疗的场所，护患矛盾时有发生，如果处理不当，容易激发成为护理纠纷。这种冲突不仅影响病人就医诊治，而且直接影响护士的身心健康、医院的声誉。因此，近2年对护患冲突进行了原因分析。并探讨防范对策，有效地减少或避免了护患冲突，报告如下：     

医疗服务过程中的医患关系及交流技巧

近年来医患关系矛盾日益突出，医疗纠纷也随之增多，虽然有其深层次原因，但如何从我做起，尽量避免冲突的发生呢？据有关资料显示，患者由于医疗上的矛盾造成不满意或纠纷的有近70％左右是我们的服务问题，只有30％左右是由于技术性的原因。显然加强功能性服务的建设是非常重要的环节。如果为病人提供的技术服务和功能性服务有机地结合起来，我们往往能够在医疗服务中取得良好的效果，怎样提高功能性医疗服务，中间的重要环节是熟练掌握医患关系和与病人之间的良好交流。     

情商在护理工作中的作用

情商又称情绪智力商数，它是人们处理冲突矛盾、人际关系、决策等需要的一种平衡的心态以及同情共感的魅力。随着现代护理模式的转变，强调以人为本、以病人为中心的护理宗旨。而把情商知识运用于护理工作中，通过情商的教育和培养是护理工作人员的综合数值得到提高，更好的服务于这个护理宗旨，也就是更好的服务于病人。     

护理人员与病人自主权

病人自主权是病人一种最基本的权利，临床护理人员在病人自主权的实现中有不可替代的作用。本文就护理人员对病人自主权认识中普遍存在的几个疑问进行探讨，旨在推动临床护理人员更好地认识及实现病人的自主权。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.