个案管理护理模式概述

护理模式决定着护理质量的内涵,随着我国护理逐渐与国际接轨,个案管理模式月越来越受到人们的关注。笔者主要就个案管理的发展情况加以介绍,希望对我国个案管理模式的推广和运用起到借鉴作用。     

维持性血液透析患者炎症状态对促红细胞生成素有效性的影响

目的 探讨促红细胞生成素(EPO)对维持性血液透析(MHD)患者贫血的疗效及炎症状态对其影响.方法 28例MHD患者均规范使用国产EPO(济脉欣)及常规治疗;用药前、用药后2、4、8 周查血红蛋白(Hb)、红细胞压积(Hct)、网织红细胞(RCT)各1次,行自身对照;8周后Hb≥110 g/L、Hct≥32%为达标组,低于此指标为非达标组;对比两组炎症反应及血清C反应蛋白(CRP)、Hb、Hct、铁蛋白(SF)变化情况.结果 均在治疗2周后RCT开始上升,4周后Hb、Hct开始上升,8周上升更明显;Hb、Hct达标19例(67.85%);未达标者多有炎症存在,CRP升高,SF无差异;血浆CRP水平与Hb、Hct成负相关,与SF无相关性.结论 EPO治疗肾性贫血疗效肯定;但炎症反应时CRP升高,疗效降低.     

胃癌患者血清肝细胞生长因子的检测及意义

Objective To explore the clinical significance of serum HGF level changes in gastric cancer pa-tients. Methods 60 cases of patients who operatied and clinicopathological confirmed gastric cancer, were detected serum HGF level by enzyme linked immunosorbent assay(ELISA) .40 cases were administered radical gastrectomy,20 cases of patients who had distant metastasis and loss operative chance were detected 7 days and 3 months preopera-tive,postoperative serum HGF level respectively. At the same time 40 cases of chronic gastritis patients and 40 cases of healthy examination people were selected as control group. Results Serum HGF level in patients with gastric canc-er was significantly higher than that of chronic gastritis and normal controls(P <0. 01). The serum HGF level of pa-tients with tumor vascular invasion significantly increased(P <0. 05). The patients with lymph node metastasis,serum HGF level was significantly higher than that patients with no lymph node metastasis(P <0. 05). The serum HGF level of patients with liver metastasis was significantly higher than that patients with no liver metastasis(P <0. 05). The se-rum HGF level of gastric cancer patients whose maximum diameter of the tumor ≥3cm were significantly higher than that maximum diameter of the tumor <3cm(P<0. 05). According to TNM staging of gastric cancer,the serum HGF level of Ⅰ phase and Ⅱ phase patients were significantly lower than that Ⅲ phase and Ⅳ phase patients(P <0.05).The serum HGF level of gastric cancer patients had no significant correlation with sex ,age and histological type(P <0.05). The serum HGF level of 40 cases of patients who were 1 week after surgery were significantly decreased,the patients who were 3 months after surgery were more obvious(P <0. 05 and P <0. 001). Conclusion HGF may play an important role in gastric cancer occurrence and development. The detection of serum HGF level can become an im-portant index for monitoring the degree of gastric cancer and prognosis of patients.     

真菌性鼻窦炎的CT诊断

近年来,随着CT的普及应用和鼻内窥镜技术的开展,临床上确诊的鼻窦真菌感染日趋增多,我院在2002年4月至2006年12月共收治了经手术证实的真菌性鼻窦炎患者23例,术前均行鼻窦CT检查,现将其CT表现作一回顾性分析,旨在提高对本病的认识和诊断水平。1资料与方法1.123例患者中,男10例,女13例;年龄21~65岁,平均36岁。全部病例均经手术和病理证实。主要临床表现:经常流脓涕、涕中带血或回吸性血涕12例,鼻塞、间隙性擤出或吸出豆渣样碎屑4例,头痛面颊部痛或胀感10例。体检见鼻腔脓血性分泌物10例,中鼻甲黏膜浅表糜烂9例,鼻息肉5例,鼻中隔偏曲6例。1…     

脉冲场凝胶电泳在沙门菌食物中毒溯源中的应用研究

目的用脉冲场凝胶电泳（PFGE）方法,追踪某次沙门菌食物中毒的来源,确定中毒食品,快速控制传染源。方法对食物中毒中分离的肠炎沙门菌用XbaI酶切总DNA,用脉冲场凝胶电泳（PFGE）法进行分子分型,用BioNumerics软件对PFGE分型图谱进行电子化数据分析,绘出聚类分析图。结果脉冲场凝胶电泳（PFGE）分型方法对患者样本分离的242株肠炎沙门菌进行分子分型,型别基本一致,表明是同一批食物中毒;从三文治等蛋糕制品中分离的9株菌株与患者分离株图谱完全一致,表明此次食物中毒的源头为某蛋糕厂生产的三文治等食品。结论脉冲场凝胶电泳技术适用于菌株的同源性的分析和传染源的追踪。     

c-myc脱氧核酶对白血病细胞端粒酶活性的抑制作用

目的:探讨c-myc脱氧核酶的切割作用及对白血病细胞端粒酶活性的影响.方法:合成针对c-myc mRNA的"10～23"型脱氧核酶DzMycI及其类似物DzMycI'提取总RNA在细胞外切割c-myc mRNA;转染白血病细胞系HL-60后,用RT-PCR扩增c-myc基因片段和端粒酶蛋白亚基hTERT的片段,用PCR-ELISA法测定端粒酶活性.结果:脱氧核酶DzMyel在细胞外和细胞内均能够有效地切割c-myc mRNA;在转染HL-60后,DzMycI显著抑制白血病细胞生长(P<0.05),下调端粒酶蛋白亚基hTERT的表达,显著降低HL-60细胞端粒酶活性(P<0.05).DzMycI催化中心的一个碱基被替换后形成的脱氧寡核苷酸DzMycI'在胞外和胞内均不表现对c-myc mRNA的切割作用.结论:脱氧核酶DzMycI确实能够高效特异地切割c-myc mRNA,降低白血病细胞端粒酶活性,抑制白血病细胞生长,有可能作为c-myc抑制剂用于白血病的基因治疗领域中.     

前列腺癌CT诊断分析

目的:分析CT对前列腺癌的诊断价值。方法:回顾性分析27例经病理证实的前列腺癌患者的CT扫描征象。结果:24例诊断为前列腺癌,3例诊断为前列腺增生。结论:CT对中晚期前列腺癌患者诊断价值较大,早期诊断需要结合其他检查。     

肺癌患者Th1/Th2细胞因子的免疫反应状态变化及临床意义

目的:分析肺癌患者外周血分泌不同细胞因子的T细胞数以及血清中6种细胞因子的水平,为肿瘤的免疫治疗提供实验依据。方法:先用刺激物刺激外周血T细胞,以增加细胞内细胞因子的表达,继用流式细胞仪分析特异性细胞因子表达水平。同时用酶联免疫吸附试验(ELISA)检测血清中相应的细胞因子量。结果:肺癌患者Th1型细胞因子干扰素-γ(IFN-γ)、白细胞介素-2(IL-2)、白细胞介素-12(IL-12)表达水平较正常对照组显著降低,Th2型细胞因子白细胞介素-4(IL-4)和白细胞介素-10(IL-10)表达水平较正常对照组升高,差异有显著性。肿瘤坏死因子-a(TNF-a)表达水平较正常对照组升高,差异有显著性意义。结论:肺癌患者体内Th2型细胞因子模式占优势状态,这可能是肿瘤细胞发生免疫逃逸的原因之一。     

浅析影响新护士护理操作的因素及对策

由于新护士不能掌握护理操作基本程序、护患沟通能力较差、紧张、缺乏自信及带教等原因,影响了新护士进行临床护理技术操作。我们采取了加强护理操作技能培训,加强新护士沟通能力的培养,强化临床老师的带教等有效对策,为新护士以后的工作打下良好的基础。     

胃癌患者血清肝细胞生长因子的检测及意义

Objective To explore the clinical significance of serum HGF level changes in gastric cancer pa-tients. Methods 60 cases of patients who operatied and clinicopathological confirmed gastric cancer, were detected serum HGF level by enzyme linked immunosorbent assay(ELISA) .40 cases were administered radical gastrectomy,20 cases of patients who had distant metastasis and loss operative chance were detected 7 days and 3 months preopera-tive,postoperative serum HGF level respectively. At the same time 40 cases of chronic gastritis patients and 40 cases of healthy examination people were selected as control group. Results Serum HGF level in patients with gastric canc-er was significantly higher than that of chronic gastritis and normal controls(P <0. 01). The serum HGF level of pa-tients with tumor vascular invasion significantly increased(P <0. 05). The patients with lymph node metastasis,serum HGF level was significantly higher than that patients with no lymph node metastasis(P <0. 05). The serum HGF level of patients with liver metastasis was significantly higher than that patients with no liver metastasis(P <0. 05). The se-rum HGF level of gastric cancer patients whose maximum diameter of the tumor ≥3cm were significantly higher than that maximum diameter of the tumor <3cm(P<0. 05). According to TNM staging of gastric cancer,the serum HGF level of Ⅰ phase and Ⅱ phase patients were significantly lower than that Ⅲ phase and Ⅳ phase patients(P <0.05).The serum HGF level of gastric cancer patients had no significant correlation with sex ,age and histological type(P <0.05). The serum HGF level of 40 cases of patients who were 1 week after surgery were significantly decreased,the patients who were 3 months after surgery were more obvious(P <0. 05 and P <0. 001). Conclusion HGF may play an important role in gastric cancer occurrence and development. The detection of serum HGF level can become an im-portant index for monitoring the degree of gastric cancer and prognosis of patients.