门诊专病管理对慢性心力衰竭患者预后的影响

①目的探讨成立心力衰竭专病门诊对慢性心力衰竭患者预后的影响。②方法入选住院的心力衰竭患者256例,纽约心功能分级（NYHA分级）Ⅱ～Ⅳ级,左室射血分数（LVEF）≤45%及pro-BNP〉1500ng/L。根据个人意愿分为心衰门诊管理组和对照组,心衰门诊管理组给予患者定期专病门诊就诊、健康教育指导、电话随访等干预措施。于分组24个月后比较两组患者的各项结果。③结果专病门诊管理组患者的血管紧张素转换酶抑制剂（ACEI）/血管紧张素Ⅱ受体拮抗剂（ARB）、β受体阻滞剂、醛固酮拮抗剂的使用率及靶剂量达标率明显高于对照组,心功能指标及生活质量指标明显高于对照组;其再住院率、病死率、住院总天数、医疗费用均明显低于对照组,两组间差异有统计学意义（P〈0.05）。④结论实施心衰专病门诊管理可显著改善心衰患者的治疗依从性,增加规范化用药率及靶剂量达标率,改善患者的心功能并降低病死率。     

电话随访对慢性心力衰竭出院患者的应用效果研究

目的 通过电话随访对慢性心力衰竭患者出院后进行健康教育,提高患者的自我护理能力,降低再入院率.方法 将64例慢性心力衰竭患者随机分为干预组和对照组各32例.对干预组患者于出院1周后开始定期电话回访,回访时间是6个月;对照组不实施干预.出院时及出院6个月后对2组患者自我护理行为及再入院率进行分析比较.结果 干预组自我护理能力明显高于对照组,差异有统计学意义（P＜0.05）,干预组的再入院率低于对照组.结论 电话回访式健康教育提高了出院后患者自我护理能力,从而降低再入院率.     

慢性心力衰竭52例综合护理干预效果观察

目的：观察对慢性心力衰竭患者实施综合护理干预的效果。方法将我院收治的104例慢性心力衰竭患者随机分为对照组和观察组各52例,对照组给予常规护理,观察组在对照组基础上实施综合护理干预。比较2组治疗前后心功能、明尼苏达心力衰竭生活质量问卷（MLHF）评分、1年内再入院率及病死率。结果出院时观察组较对照组心功能改善更为明显（P〈0.05）,MLHF评分显著降低（P〈0.01）;随访1年,观察组1年内再入院率及病死率显著低于对照组（P〈0.05）。结论综合护理干预能明显提高慢性心力衰竭患者的治疗效果,改善健康相关生活质量,降低患者的再入院率和病死率,值得临床推广。     

健康教育护理干预对慢性心力衰竭患者的影响

目的探讨健康教育护理干预对慢性心力衰竭患者的护理效果。方法对82例慢性心力衰竭患者的病例资料进行回顾性分析,将以上患者随机分为观察组和对照组。两组患者均给予相同或者相似抗心力衰竭治疗。对照组患者给予常规慢性心力衰竭护理干预;观察组在对照组护理干预基础上实施健康教育：心理教育、饮食教育、生活教育、服药教育、出院健康指导。对两组患者出院后进行6个月随访,记录两组患者再入院情况和患者病死情况。结果两组患者失访率分别为2．4％、4．8％,两组失访率比较差异无统计学意义（P〉0.05）;观察组再入院率和病死率分别与对照组比较,差异有统计学意义（P〈0．05）。结论健康教育护理干预能够显著降低慢性心力衰竭患者再入院率和病死率,有利于改善患者近期预后。     

专科护理干预对老年慢性心力衰竭病人的影响

目的 探讨专科护理干预对老年慢性心力衰竭病人的影响.方法 将2008年6月～2009年6月收治的老年慢性心力衰竭病人随机分为实验组和对照组,对照组予以常规内科治疗及一般内科护理,实验组除接受对照组的常规内科治疗护理外,还接受专科护理干预,随访12个月后,收集比较两组的死亡率、再入院率、治疗费用及治疗效果.结果 两组的死亡率比较无统计学意义;实验组再入院率(40.80%)显著低于对照组(P＜0.05);实验组治疗费用(928±623元)明显低于对照组(P＜0.05);治疗效果明显优于对照组(P＜0.05).结论 专科护理干预能降低老年慢性心力衰竭病人的再入院率,降低医疗费用,提高治疗效果和病人的生活质量.     

社区护理干预对老年慢性心力衰竭患者生活质量以及再入院率的影响效果观察

目的:观察社区护理干预对老年慢性心力衰竭患者生活质量以及再入院率的影响效果.方法:用简单随机分组的方式将本院2015年5月至2016年7月收治的老年慢性心力衰竭患者90例分为两组,接受常规护理为对照组,给予社区护理干预为观察组,比较两组患者的生活质量及半年再入院率.结果:观察组和对照组患者的各项生活质量评分比较,差异明显,观察组明显更佳;此外观察组患者的半年再入院率明显低于对照组,P＜0.05.结论:社区护理干预可提升老年慢性心力衰竭患者的生活质量,降低其再入院率.     

运动锻炼对武汉市某医院慢性心力衰竭患者运动耐量和生活质量的影响

目的：探讨运动锻炼对慢性心力衰竭患者运动耐量和生活质量的影响.方法：选择武汉市某医院80例慢性心力衰竭患者,随机分为对照组（40例）和观察组（40例）.对照组采用常规的治疗和护理,观察组在常规药物治疗基础上加早期运动锻炼,观察比较两组患者出院后3个月的运动耐量、生活质量及再入院率.结果：观察组出院3个月内再入院率为17.5％,对照组为32.5％,两组差异有统计学意义（P＜0.05）;观察组运动后3个月运动耐量明显提高且显著高于对照组（P＜0.01）,生活质量评分与运动前比较,差异有统计学意义（P＜0.01）;且与对照组相比,观察组生活质量显著提高（P＜0.05）.结论：早期运动锻炼能够提高慢性心力衰竭患者运动耐量,减少复发率及再入院率,改善临床症状及预后,减轻经济负担,提高生活质量.     

慢性心力衰竭患者尿酸变化的临床价值探讨

目的：观察慢性心力衰竭患者病程中尿酸水平变化的规律,探讨其临床意义。方法：130例慢性心力衰竭患者作为研究对象(心力衰竭组),入院后第2天清晨及病情改善出院前空腹测定血清尿酸水平。另随机选取在本院进行健康体检的正常人50例作为对照。结果：心力衰竭组入院时尿酸水平为(530.67±87.45)μmol/L,高于对照组尿酸水平(370.45±78.45)μmol/L(P＜0.05);心力衰竭组高尿酸血症发生率为46.15%,显著高于对照组(12.00%)(P＜0.05)。随着心功能分级的增加尿酸水平、高尿酸血症发生率相应增加(P＜0.05);经过治疗以后心力衰竭组出院时尿酸水平下降为(438.12±69.11)μmol/L、高尿酸血症发生率为16.15%,较入院明显下降(P＜0.05)。治疗后随访(2.67±0.75)年,高尿酸血症组死亡率为16.67%、住院(3.12±0.44)次/年、住院时间(51.45±11.43) d/年,分别高于尿酸正常组的4.29%、(1.78±0.39)次/年、(35.45±10.20) d/年(P＜0.05)。结论：高尿酸与慢性心力衰竭患者的发生、发展及预后密切相关,可用于慢性心力衰竭的严重程度及预后评估。     

早期电话随访对慢性心力衰竭出院患者30天再次入院率的影响

目的:探讨早期电话随访能否减少慢性心力衰竭出院患者的30天再次入院率。方法:2012年6月-2013年6月期间在本院心内科住院的确诊慢性心力衰竭患者700例患者,随机分为早期电话随访组(出院1周内电话随访的患者250人),常规电话随访组(出院1周到1月内随访的患者260人),未随访组(出院后未随访的患者190人),观察30天内3组患者因心衰加重的再次入院率、再次入院死亡率及再次入院心衰诱因的分析。结果:早期电话随访组30天内再次入院比例(49例次,19.6%),明显低于常规电话随访组(61例,23.4%),明显低于未随访组(50例,26.3%)(P均0.05),早期电话随访组30天内再住院死亡比例(7例,2.8%),明显低于常规电话随访组(12例,4.6%),明显低于未随访组(13例,6.8%)(P均0.05)。结论:早期电话随访可能是显著降低慢性心力衰竭患者再入院率的一种有效方法。     

高血压心力衰竭与扩张型心肌病心力衰竭的远期预后比较

目的 比较高血压心力衰竭与扩张型心肌病心力衰竭远期预后的临床效果.方法 收集心力衰竭患者134例,分为高血压心力衰竭与扩张型心肌病心力衰竭2组,入院后给予血管紧张素转换酶抑制剂及β受体阻滞剂等常规治疗.观察记录治疗前后2组治疗方法 的有效率,并对患者5min步行距离及心功能指标如心脏收缩压、舒张压、左室收缩末内径及左室舒张末内径等的变化进行统计分析.结果 随访5年发现,高血压心力衰竭组再住院率42.3%,病死率1.9%,显著低于扩张型心肌病心力衰竭组的56.1%,7.3%(P＜0.05),且高血压心力衰竭组心功能指标如5min步行距离、舒张压、左室收缩末内径等改善情况较扩张型心肌病心力衰竭组更加显著(P＜0.05).结论 治疗慢性心力衰竭时应考虑长期足量应用神经内分泌拮抗剂,以保证患者安全.     

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…     

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.     

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.     

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.     

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.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…