延续干预对COPD出院患者自护行为及生活质量的影响

目的探讨延续干预对慢性阻塞性肺疾病出院患者自护行为和生活质量的影响。方法将105例病情稳定的慢性阻塞性肺疾病出院患者采用随机数字表法分为观察组(53例)和对照组(52例)。观察组实施院内和院外干预,院内干预包括出院前肺康复技能指导和自我管理培训,院外干预包括门诊复查、定期随访和举办健康教育活动等。对照组出院时接受常规健康教育,出院后进行不定期随访。连续干预1年后评价效果。结果干预后观察组SpO2及最大呼气峰流速值、自我护理行为及生活质量得分显著优于对照组(P0.05,P0.01)。结论延续性干预有利于提高患者自护行为,从而改善肺功能,提高患者生活质量。     

个案管理师主导的糖尿病足部溃疡患者照护方案实施

目的 实施个案管理师主导的糖尿病足部溃疡患者照护方案，提高糖尿病足护理效果。方法 选取伤口治疗师担任个案管理师，依托创面治疗医生、康复师、骨科专科护士、糖尿病专科护士组成多学科协作团队，对146例糖尿病足部溃疡住院患者实施个案管理。结果 146例患者均没有新发足部溃疡，患者出院后6个月的Wagner分级较干预前显著改善(P<0.05);患者出院后6个月空腹血糖及糖化血红蛋白水平较出院前显著下降(均P<0.05)。患者出院后糖尿病自我管理活动评分、足部护理知识和行为得分较入院时显著提高(均P<0.05)。结论 实施个案管理师主导的照护方案可以有效提高糖尿病足部溃疡患者自我管理活动能力，改变其足部护理知识和行为，有效控制血糖，促进创面愈合。     

老年慢性阻塞性肺疾病患者的综合家庭肺康复研究

目的 制定适合老年慢性阻塞性肺疾病患者的综合家庭肺康复方案,以提高肺康复效果。方法 将60例病情稳定出院的老年慢性阻塞性肺疾病患者随机分为对照组和干预组各30例。对照组实施常规护理,干预组实施基于证据的综合家庭肺康复方案,干预6个月。采用呼吸困难评分、6 min步行试验、圣乔治呼吸问卷进行效果评价。结果 干预3个月、6个月干预组呼吸困难评分及圣乔治呼吸问卷得分显著低于对照组,6 min步行试验距离显著长于对照组(均P<0.05)。结论 对老年慢性阻塞性肺疾病稳定期患者实施综合家庭肺康复,有助于改善呼吸困难症状、提高机体活动能力、改善生活质量。     

肺功能档案在稳定期COPD患者肺康复治疗中的应用

目的 探讨肺功能档案用于稳定期COPD患者肺康复治疗的效果.方法 将62例稳定期COPD患者随机分成两组各31例.对照组出院后采用常规专科门诊电话随访(每个月1次),要求患者每年复查肺功能;观察组在此基础上出院前建立肺功能档案,提出每年确保FEV1下降≤50 mL的目标,要求患者出院后3、6、12个月分别复查肺功能,根据肺功能档案内容进行动态干预.结果 干预12个月后,观察组肺功能指标及相关健康行为显著优于对照组(P＜0.05,P＜0.01).结论 建立稳定期COPD患者肺功能档案能使患者动态了解肺功能情况,增强患者自我健康管理行为,提高肺康复效果.     

个案管理模式在慢性心力衰竭患者管理中的应用

目的 探讨个案管理模式在慢性心力衰竭患者管理中的应用效果.方法 将慢性心力衰竭患者120例随机分为对照组与个案管理组各60例.对照组按医院现有诊疗护理常规,出院后接受定期随访和返院复查;个案管理组由以个案管理师为核心的管理团队实施入院时管理、住院期间管理、出院前管理和出院后跟组管理的个体化综合治疗护理.调查两组患者住院期间不良事件发生率、住院天数、费用及出院后满意度、心功能、焦虑状态及生活质量改善情况.结果 个案管理组住院天数、住院费用显著低于对照组(均P＜0.01),部分心血管不良事件发生率、生活质量及焦虑评分显著低于对照组(P＜0.05,P＜0.01);个案管理组患者出院后满意度评分及心功能显著优于对照组(P＜0.05,P＜0.01).结论 个案管理模式能提高患者满意度,改善慢性心力衰竭患者心功能及生活质量,并能降低患者的焦虑,减少心血管不良事件发生率,缩短住院天数,降低住院费用等.     

急诊科联合病房早期肺康复程序在AECOPD患者中的应用

目的 促进慢性阻塞性肺疾病急性加重期（AECOPD）患者肺康复。 方法 按急诊就诊时间将82例AECOPD患者分为对照组40例、观察组42例，两组均予常规治疗及护理，在此基础上对照组行常规肺康复措施；观察组组建多学科肺康复团队、制订和实施为期4周的三阶段肺康复方案。 结果 干预后，观察组患者的肺功能指标、动脉血氧饱和度、上下肢运动耐力评分、日常生活活动能力评分显著高于对照组，焦虑抑郁评分显著低于对照组（均P＜0.05）。 结论 多学科协作下急诊科联合病房早期分阶段肺康复方案可有效改善AECOPD患者肺功能及运动耐力，从而改善患者心身状态。     

体外膈肌起搏在慢性阻塞性肺疾病患者康复护理中的应用

目的 探讨体外膈肌起搏在慢性阻塞性肺疾病患者康复护理中的应用效果。方法 将60例慢性阻塞性肺疾病患者随机分为观察组30例和对照组30例。对照组进行传统呼吸肌训练,观察组在传统呼吸肌训练基础上辅以体外膈肌起搏治疗,均干预20 d。干预前后采用慢性阻塞性肺疾病评估测试(CAT)评分、改良Barthel指数、用力肺活量 (FVC)、第1秒用力呼气容积(FEV1)评价干预效果。结果 干预后两组CAT评分、改良Barthel指数评分、FVC和FEV1比较,差异有统计学意义（均P＜0.01）。结论 体外膈肌起搏能有效改善慢性阻塞性肺疾病患者肺功能,提高患者日常生活活动能力和生活质量。     

改良呼吸肌功能训练对COPD康复期患者肺功能的影响

目的 探讨改良呼吸肌功能锻炼对慢性阻塞性肺疾病(COPD)康复期患者肺功能的影响.方法 将COPD康复期患者100例分为常规组和改良组各50例,分别采用常规呼吸功能锻炼和改良呼吸肌功能锻炼方法,后者将腹式呼吸改为呼吸操并分卧、坐、立3种姿势交替进行,连续6个月后评价效果.结果 改良组肺通气功能各项指标及SaO2显著优于常规组(均P＜0.01).结论 改良呼吸肌功能训练法可有效改善康复期COPD患者肺功能,可作为其常规康复护理手段.     

慢性阻塞性肺疾病出院患者护理结局及其影响因素分析

目的探讨慢性阻塞性肺疾病出院患者的护理结局及其影响因素。方法采用慢性阻塞性肺疾病患者护理结局测评表对病情稳定准备出院的200例慢性阻塞性肺疾病患者进行调查。结果慢性阻塞性肺疾病待出院患者的护理结局中,感知的健康领域(1.97±0.70)、心理社会健康领域(1.53±0.68)分值较低。职业、医疗费用报销情况、文化程度、饮酒、月收入、性别、并存疾病、吸烟、膳食习惯、婚姻状况是慢性阻塞性肺疾病出院患者护理结局的影响因素(P0.05,P0.01)。结论对待出院慢性阻塞性肺疾病出院患者进行宣教时,应重点关注感知的健康领域、心理社会健康领域情况,根据护理核心结局得分情况及时识别其危险因素,为其出院制定个性化护理措施。     

慢性阻塞性肺疾病合并自发性气胸的临床护理

目的:探讨慢性阻塞性肺疾病(COPD)并发气胸患者的有效护理措施,提高护理质量.方法:2007年8月至2011年7月,对72例患者通过合理用药；氧疗；有效的护理措施及心理护理,健康教育等.结果:72例患者中,60例入院时肺压缩＞20％,均立即行胸腔闭式引流术；12例肺压缩＜20％,采用内科保守治疗,8例治愈,4例经观察肺通气量增多,症状加重于入院24h后行胸腔闭式引流术.经规范治疗和有效护理,70例痊愈出院,2例经持续低负压吸引治疗半月,肺未复张,转胸外科继续治疗.结论:护理人员熟悉慢性阻塞性肺疾病的病理生理,发病机制及观察病情变化,及时采取护理措施,减轻患者的痛苦,有效的治疗和护理使患者满意出院.     

Nodular pulmonary amyloidosis

A 72-year-old woman with a diagnosis of suspected rheumatoid arthritis was admitted with multiple pulmonary nodules in the bilateral lung field. To obtain a diagnosis, a nodule was resected using video-assisted thoracic surgery. Microscopically, amorphous eosinophilic acellular substances were surrounded by inflammatory infiltrates, which were confirmed to be amyloid deposits by congo red staining. Thus, a diagnosis of pulmonary amyloidosis was obtained. The clinical features and diagnostic process are discussed.     

Late pulmonary artery stump thrombosis with post embolic pulmonary hypertension after pneumonectomy

Ten years after right pneumonectomy for primary lung cancer, a 51 year old man developed a pulmonary artery stump thrombosis which produced microemboli in the remaining lung and, in turn, led to chronic pulmonary hypertension. This case strongly suggests that prolonged postoperative thromboembolic prophylaxis should be considered in patients undergoing right pneumonectomy.     

全胸腔镜肺叶切除术治疗肺结核病55例临床分析

目的：分析全胸腔镜肺叶切除术治疗肺结核病的临床效果。方法全胸腔镜手术治疗55例肺结核患者,其中47例行全胸腔镜肺叶切除术,8例中转开胸行肺叶切除手术。结果无围手术期死亡病例;术后并发症15例,其中术后持续肺漏气4例,胸腔出血3例,支气管胸膜瘘1例。均经保守治疗后痊愈。术后随访1年,结核病均得到有效控制。结论全胸腔镜肺叶切除术是治疗肺结核病的一种安全有效的方法。     

Primary pulmonary sarcomas: Etiology,clinical assessment and prognosis with a comparison to pulmonary carcinomas —A review of 41 cases and 394 other cases of the literature

Primary sarcomas of the lungs occur at frequencies of 1:100, as compared with carcinomas reported in our retrospective studies covering 394 cases reported in the literature from 1957 to 1972 and 41 cases from 1957 to 1974. The average age was 45 years, the disease usually occurred between the ages of 35 and 65, the peak being between 45 and 60 years. Distribution between sexes was much the same as that seen in general. X-ray with rapid thoractomy provided the best clinical results. The literature showed a postoperative survival time of 5 years in 19% and 44% of our own cases. The general metastasis, haematologenous and lymphogenous were more or less equal and recidive tendency in 7% essentially varied, as related to the single histological forms. Lymphosarcomas (28.6%) were the most frequent, the group of spindle-celled sarcomas, inclusive of leiomyosarcomas, occurred in 40%. Histological maturity of the tissues and the prognosis according to active therapy were in parallel. A comparison of 41 primary sarcomas of the lung with the 192 cases of carcinomas seen in our clinic showed no connection between sarcomas of the lungs and smoking of cigarettes, pollution of the environment, industrial toxins or chronic bronchitis. These findings relate to the peripheral localization as well as to the lack, of incidence among men, with regard to pulmonary adenocarcinomas. An overall view of the characteristics led to the assumption of a probable endogenous tumour. A summarization of the characteristics of pulmonary sarcomas and carcinomas revealed the role of primary sarcomas in the total complex of malignant tumours of the lungs.     

Pulmonary blastoma: Report of a case

(Received for publication on Aug. 19, 1997; accepted on May 15, 1998)     

Pulmonary thromboendarterectomy for chronic pulmonary thromboembolism in protein C deficiency

Pulmonary thromboendarterectomy was performed on a patient with chronic pulmonary thromboembolism showing thrombophilia. The patient was a 56-year-old female with the above condition complicated by congenital protein C deficiency. She was admitted to our hospital with severe dyspnea accompanied by right ventricular failure. A pulmonary arteriogram showed occlusion and stenosis from lobar to segmental arteries Cardiac catheterization showed marked pulmonary hypertension. A lung perfusion scintigram revealed multiple defects in the right and left lungs. After the insertion of an inferior vena cava filter, she was operated on Following a median sternotomy, thromboendarterectomy of the bilateral pulmonary arteries was performed using deep hypothermia and intermittent circulatory arrest. Circulatory arrest was employed in three periods totaling up to 36 minutes. After surgery, she had improvements in pulmonary hypertension and pulmonary vascular resistance. She maintained improved lung functions, and remained in the New York Heart Association functional class I for more than two years and eight months after surgery.