体外循环心脏术后精神障碍的临床分析及护理策略

目的：为探讨体外循环术后精神障碍的病因、防治及护理方法。方法：对663例心脏手术患者进行回顾性分析，研究心脏术后发生精神障碍的危险因素、临床表现、预后及护理对策。结果：本组16例出现精神障碍并发症，发生率为2．41％，经过治疗15例痊愈出院，1例死亡。结论：体外循环心脏术后并发精神障碍的原因有多种，采取个性化的综合护理策略对病情恢复具有重要作用。     

老年髋部骨折患者术后精神障碍影响因素分析及应对措施研究

目的:探究老年髋部骨折患者术后精神障碍的影响因素以及应对措施。方法:回顾分析2010年1月-2015年6月本院收治因髋部骨折行手术治疗的老年患者250例的临床资料,根据术后是否并发精神障碍分为精神障碍组(n=60)和非精神障碍组(n=190)。统计患者的基础资料及并发症情况,分析精神障碍发病的影响因素。结果:精神障碍组年龄、并发慢性阻塞性肺疾病和进行全身麻醉的比例均高于非精神障碍组,且血红蛋白浓度和血钠水平均低于非精神障碍组,比较差异均有统计学意义(P0.05);Logistic回归分析显示,年龄、血钠含量、血红蛋白浓度、术后并发慢性阻塞性肺疾病以及全身麻醉均是影响患者术后发生精神障碍的危险因素(P0.05)。结论:年龄、血钠含量、血红蛋白浓度、术后并发慢性阻塞性肺疾病以及全身麻醉均是老年髋部骨折患者术后发生精神障碍的危险因素,医护人员应在手术前后根据患者的实际情况制定合理的预防及治疗方案,防止术后出现精神障碍。     

体外循环心脏直视术后并发急性肾功能衰竭的危险因素分析

目的:探讨体外循环心脏直视术后并发急性肾功能衰竭(ARF)的危险因素。方法:对1160例接受体外循环心脏直视手术的高血压、糖尿病、高尿酸血症、周围血管病、脑血管病患者术前1周内进行过冠状动脉造影以及是否口服过ACEI/ARB类药物进行分析,利用回归分析法判定体外循环心脏直视术后并发ARF的术前危险因素。结果:①本组30例患者术后并发ARF,发生率为2.59%;②单因素分析表明:术前患有高血压、糖尿病、高尿酸血症、心力衰竭以及术前1周内行冠状动脉造影与术后并发ARF相关;③回归分析结果表明:高尿酸、术前1周内行冠状动脉造影及心衰是并发ARF的独立危险因素。结论:体外循环心脏直视术后并发急性肾功能衰竭的危险因素众多,术前1周内进行冠状动脉造影、高尿酸、心力衰竭为独立的危险因素,提示临床应适当延长冠状动脉造影与体外循环心脏直视手术的间隔时间,术前纠正心功能衰竭,治疗高尿酸血症,可降低并发ARF的风险。     

心脏术后精神病性障碍的临床分析

目的研究心脏手术后精神病性障碍的病因、发病机理及防治措施.方法对286例心脏手术病人进行回顾性分析,研究心脏手术后发生精神病性障碍的危险因素、临床表现、治疗方法、疗效及预后.结果本组中共有10例病人出现精神病性障碍并发症,发生率为3.49%,10例患者均治愈出院.结论术前的危险因素有高龄、心功能水平低下等;术中因素有手术类型、体外循环及其时间、手术及转流技术;术后因素包括ICU停留时间、过度刺激、药物的不恰当使用以及心肺功能不全、感染等.治疗包括:找出并消除潜在的致病因素;按精神病学疾病治疗,以控制精神症状及行为障碍.     

心脏直视术后并发急性肾功能衰竭危险因素分析

目的探讨心脏直视术后并发急性肾功能衰竭(ARF)的危险因素。方法回顾性分析1012例心脏直视手术患者临床资料,利用回归分析方法分析心脏直视术后并发ARF的危险因素。结果心脏直视术后并发ARF 30例,发生率为2.96%。单因素分析发现术前心功能、心脏射血分数、肾功能;术中体外循环时间、主动脉阻断时间;术后低心排出量综合征、低氧血症、感染以及用主动脉内球囊反搏、属二次手术等与心脏直视术后并发ARF有关(P<0.05或0.01)。多因素logistic回归分析结果显示术前心功能、肾功能、术中体外循环时间及术后低心排出量综合征为其独立危险因素。结论心脏直视术后并发ARF的危险因素较多,术前心功能、肾功能、术中体外循环时间及术后低心排出量综合征为其独立危险因素,必须认真防治。     

体外循环心脏术后并发精神障碍45例原因分析和护理体会

目的 探讨体外循环心脏术后精神障碍的病因及护理体会.方法 对1258例心脏手术患者进行回顾性分析,研究心脏术后发生精神障碍的危险因素、临床表现、预后及护理策略.结果 本组有45例患者出现精神障碍并发症,发生率为3.58%,其中2例死亡,其余43例患者均治愈出院.结论 体外循环心脏术后精神障碍的发生是多种因素共同作用的结果,应采取综合护理措施,提高治愈率,改善疾病预后.     

体外循环心脏术后并发精神障碍19例临床分析

目的:提高对体外循环心脏手术后并发精神障碍的认知与防治。方法:对19例体外循环术后并发精神障碍的病例进行回顾性分析。结果:本组并发精神障碍的发生率为3.55%(19/536),18例患者精神障碍治愈,1例有阳性精神病家族史的患者好转出院。结论:体外循环中脑血流灌注不足,术后并发心、脑、肺、肾功能障碍及感染和环境因素是患者出现精神障碍的主要原因。对于有阳性精神病家族史的患者,手术创伤可能是精神障碍的诱发因素。及时治疗躯体疾病及心理治疗,患者大多可获治愈。     

老年人骨科术后急性精神障碍相关因素分析及对策

目的:分析老年人骨科术后并发精神障碍发生率及相关因素。方法:回顾我院1994年1月至2010年1月收治的老年骨科手术患者529例分析,统计年龄、性别、术前合并症及手术部位、时间、术后电解质紊乱、镇痛及急性精神障碍发生等情况。结果:术后并发急性精神障碍患者58例,其中49例痊愈,5例手术失败,2例出现老年性痴呆,2例死亡,总发生率为10.96%;其中脊柱组术后急性精神障碍患者发生率为12.34%,骨盆组为12.86%;四肢长管骨组为8.16%,脊柱及骨盆组较四肢长管骨组术后并发急性精神障碍发生率高,有显著性差异(P<0.05);患者年龄、手术暴露时间、术前合并糖尿病、高血压、术后电解质紊乱及镇痛泵使用情况与术后障碍密切相关。结论:对于骨科大手术的高龄患者,术前应积极治疗基础性疾病,围手术期控制血压、血糖、及时纠正水电解质紊乱及酸碱平衡,缩短手术时间,术后防止或及时纠正各种并发症,从而减少骨科术后急性精神障碍的发生。     

心脏手术后精神障碍发生相关因素临床分析

目的 通过观察患者临床资料及手术后精神障碍发生情况,分析研究与心脏手术后精神障碍发生可能的相关因素.方法 统计2005～2006 年期间300例心脏直视手术患者的临床资料,术后通过PTSS-10精神障碍诊断量表对患者进行心脏手术后精神障碍的诊断,回顾分析其中出现精神障碍的24例患者的临床资料和随访资料,对患者的一般资料及围手术期资料中是否存在与心脏手术后精神障碍有关的因素进行统计分析.结果 从全因素的Logistic回归模型上来看,性别、年龄、入院心功、脑梗史、心梗史、手术所用时间、体外循环及患者在ICU中时间可能为术后精神障碍的危险因素,其中又以年龄、在ICU中时间、手术时间、性别与术后精神障碍密切相关.结论 心脏术后精神障碍的发生是包括生理机能、环境、心理因素在内的多种因素共同作用的结果,高龄、ICU中滞留时间长、手术时间长、女性可能更易患术后精神障碍,应对这些患者早期给予关注并采取综合防治措施.     

非体外微创冠状动脉旁路移植术后精神障碍分析

目的提高非体外微创冠状动脉旁路移植术(OPCAB)后并发精神障碍的预防和治疗水平。方法回顾性分析287例接受OPCAB的患者,讨论发生精神障碍的的危险因素、临床表现及治疗方法。结果精神障碍发生率为7.23%。高龄、围术期血糖控制不良、血脂控制不良、术前脑卒终史、术后呼吸机使用时间大于24h、监护室环节等因素与术后精神障碍发生密切相关。结论维持患者围术期血糖、血脂、呼吸及循环功能的稳定,对于减少OPCAB术后精神障碍有重要意义。     

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…