护理管理自选课题中常见的问题及对策

通过归纳护理管理论文自选课题中常见的错误,即选题重复、过大、偏离、有悖伦理、缺乏实用性和可行性等,提出立题前检索、选择贴近护理管理领域的课题、认真筛选专家进行论证、选择易于操作的课题等改进措施。     

青蒿琥酯抗日本血吸虫童虫和成虫作用的研究

目的 观察青蒿琥酯对不同阶段日本血吸虫的损害作用,揭示青蒿琥酯的杀虫机制.方法小鼠感染尾蚴18 d时给予青蒿琥酯300 mg/kg,24 h后灌注法收集童虫,并用紫外吸收法和Bradford标准曲线法测定青蒿琥酯对日本血吸虫18 d童虫DNA和蛋白质含量的影响;分别将10条虫体在含有3H胸腺嘧啶核苷的培养基中培养24 h后,用滤膜法和匀浆法测定青蒿琥酯对标记核苷掺入童虫DNA的影响;感染血吸虫尾蚴21 d的小鼠一次性灌服青蒿琥酯300 mg/kg,给药后21 d,灌注法收集成虫,观察青蒿琥酯对日本血吸虫成虫生殖器官大小及生殖细胞发育的影响;小鼠感染血吸虫33 d时给予同样的青蒿琥酯进行治疗,24 h和48 h后处死小鼠,将肝脏制作组织切片,在光镜下观察同等剂量青蒿琥酯引起的成虫肝移和形态学变化的影响.结果 青蒿琥酯体内作用18 d的虫体,24 h后,童虫的DNA和蛋白质含量均较对照组明显减少,减少率分别为23.0%和33.6%(P＜0.01);在含有3H胸腺嘧啶核苷的培养基中培养24 h后,童虫摄入标记的核苷及核苷掺入童虫DNA的量较对照组也明显减少,减少率分别为61.1%和40.8%(P＜0.01);21 d给药组小鼠体内雌虫卵巢的成熟、发育受到了抑制;药物作用于虫体33 d后能明显引起虫体形态的变化,特别是虫体体表.结论 青蒿琥酯能减少日本血吸虫童虫蛋白质和DNA的含量,能明显抑制虫体对标记核苷的摄入以及标记核苷掺入虫体DNA的量,能引起虫体体表明显的组织形态学变化,并且能抑制雌虫卵巢的发育,降低或抑制雌虫的产卵,能有效减轻血吸虫病的病情和控制传播.     

大剂量阿托伐他汀预防对比剂肾病

Objective To compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention. Methods All patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n =100) and high dose group received additional atorvastatin 80 nag at 12 to 24 hours before procedure (n =50). Scr, Ccr, blood β2-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups. Results Baseline demographic characteristics and nephropathy risk factors were similar between groups. Cer was significantly reduced while blood β2-M and uric NAG/Cr were significantly increased in low dose group (all P ＜ 0.05) . Blood β2-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35±0.52) mg/L vs. (2.67±0.64) mg/L, P =0.008], day 3[(2.49±0.55)mg/L vs. (2.80±0.64) mg/L,P =0.011] and day 5[(2.29±0.53) mg/L vs. (2.56±0.66) nag/L, P = 0.026] post-procedure respectively; urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19±0.30) U/mmol vs. (1.46±0.34) U/mmol, P ＜ 0.001], day 3 [(1.30±0.30) U/mmol vs. (1.59±0.33) U/mmol, P ＜ 0.001], and day 5 [(1.10±0.30) U/mmol vs. (1.34±0.35) U/mmol, P = 0.001] post-procedure respectively;Cer in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69±20.99) mL/min vs. (65.19±18.72) mL/min,P =0.035], day 3[(64.04±15.82) ml/min vs. (56.79±14.50)ml/min,P =0.019] post-procedure respectively. Conclusion High dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.     

大剂量阿托伐他汀预防对比剂肾病

Objective To compare the efficacy of high and low dose atorvastatin on preventing contrast induced nephropathy (CIN) in patients underwent diagnostic and therapeutic coronary intervention. Methods All patients received atorvastatin 10 mg/d on the basis of hydrated therapy (n =100) and high dose group received additional atorvastatin 80 nag at 12 to 24 hours before procedure (n =50). Scr, Ccr, blood β2-M, urine NAG/Cr, and urine osmolality before and after the procedure were compared between the groups. Results Baseline demographic characteristics and nephropathy risk factors were similar between groups. Cer was significantly reduced while blood β2-M and uric NAG/Cr were significantly increased in low dose group (all P ＜ 0.05) . Blood β2-M in the high dose group was significantly lower than that in the low dose group at day 1 [(2.35±0.52) mg/L vs. (2.67±0.64) mg/L, P =0.008], day 3[(2.49±0.55)mg/L vs. (2.80±0.64) mg/L,P =0.011] and day 5[(2.29±0.53) mg/L vs. (2.56±0.66) nag/L, P = 0.026] post-procedure respectively; urine NAG/Cr in the high dose group was also significantly lower than that in the low dose group at day 1 [(1.19±0.30) U/mmol vs. (1.46±0.34) U/mmol, P ＜ 0.001], day 3 [(1.30±0.30) U/mmol vs. (1.59±0.33) U/mmol, P ＜ 0.001], and day 5 [(1.10±0.30) U/mmol vs. (1.34±0.35) U/mmol, P = 0.001] post-procedure respectively;Cer in the high dose group was significantly higher than that in the low dose group at day 1 [(73.69±20.99) mL/min vs. (65.19±18.72) mL/min,P =0.035], day 3[(64.04±15.82) ml/min vs. (56.79±14.50)ml/min,P =0.019] post-procedure respectively. Conclusion High dose atorvastatin use before angiography is superior than low dose atorvastatin on attenuating contrast induced renal dysfunction.     

盐酸芬氟拉明相关性肺动脉高压1例

在欧洲和美国,由芬氟拉明等食欲抑制剂引起的肺动脉高压(PPH)流行引起了政府和临床医师的高度重视,于1997年9月停止了食欲抑制剂的销售和使用,从而有效地控制了此类疾病的进一步流行。1998年在法国Evian举行的第2次WHO PPH工作组会议制定了PPH分类标准,认为阿米雷司、芬氟拉明、右芬氟拉明有明确的致PPH作用。在我国,对服用盐酸芬氟拉明致心脏瓣膜病变、胃肠道反应、低颅内压等毒副作用临床有所报道,笔者遇见1例服用盐酸芬氟拉明致PPH的女性患者,报道如下。患者,女,48岁。因反复胸闷气急发作2年余,加重3～4d于2004年12月15日收入上…     

盐酸替罗非班对急性冠脉综合征急诊经皮冠状动脉介入治疗中血流灌注的影响

目的研究Ⅱb/Ⅲa受体拮抗剂盐酸替罗非班对急诊经皮冠状动脉介入治疗(PCI)的急性冠脉综合征(ACS)患者的血流灌注影响。方法选择2005年12月至2008年2月中国医科大学附属第四医院急诊治疗的147例ACS患者为研究对象。治疗组(72例)行急诊PCI治疗同时静脉推注盐酸替罗非班,对照组(75例)直接行PCI治疗。应用心肌灌注分级(TMP)和心电图ST段变化(sumSTR)法评价急诊PCI时心肌组织的再灌注情况。结果盐酸替罗非班可使PCI前梗死相关血管TIMI血流分级提高,治疗组有68例(94.44%)心肌灌注良好,4例(5.56%)心肌灌注不良;对照组中64例(85.33%)心肌灌注良好,11例(14.67%)心肌灌注不良,两组间比较差异有统计学意义(P<0.05)。sumSTR评价结果:治疗组有68例心肌灌注良好(94.44%),4例心肌灌注不良(5.56%);而对照组中有62例心肌灌注良好(82.67%),13例心肌灌注不良(17.33%),两组间比较差异有统计学意义(P<0.05)。结论盐酸替罗非班可改善急性冠脉综合征患者相关血管的血流灌注。     

微创固定系统治疗股骨远端复杂骨折57例围术期护理

2004年3月~2008年2月,我们采用微创固定系统(LISS)治疗股骨远端复杂骨折57例,经精心护理,取得满意疗效.现报告如下.1 资料与方法1.1 临床资料 本组57例,男41例,女16例;年龄19~72岁,平均46.8岁.致伤原因:摔伤17例,交通伤33例,压砸伤4例,坠落伤3例.按AO分型:A1型2例,A2型13例,A3型11例,C1型3例,C2型16例,C3型12例.其中开放性骨折13例,均行急诊清创术后予胫骨结节或跟骨牵引,伤口稳定后择期手术.27例合并髌骨骨折"胫腓骨骨折"肱骨骨折等.此外,3例曾在受伤前1.5~5年接受过患侧肢体的人工髋关节置换术.本组均为新鲜骨折,受伤至手术时间3~16 d,平均8.6 d.骨折采用股骨干骺端骨折闭合复位,小切口插入LISS钢板后经皮内固定.     

上颌侧切牙腭根遗漏、钙化伴侧壁穿孔显微根管外科手术一例

目的 报道一例上颌侧切牙根管治疗术后腭根遗漏、钙化伴侧壁穿孔病例,探讨根管治疗规范及侧壁穿孔显微根管外科手术治疗方法.方法 患者,女,40岁,主诉左上前牙唇侧脓包1周,查体见22牙颊侧黏膜见瘘管口,舌窝见树脂补体,影像学检查示22牙单根双根管,颊根充填达尖,腭根遗漏且根尖1/3段无明显根管影像,根中1/3段远中根面处高...     

原发性胆汁性肝硬化93例临床及病理特点分析

目的总结原发性胆汁性肝硬化（PBC）患者的临床及病理学特点,以加深对该病的认识,指导临床诊疗。方法回顾性分析93例经肝活组织穿刺病理检查确诊为PBC患者的临床表现、生化指标、免疫学指标、病理学特点以及不同病理分期与生化指标相关性。结果93例患者临床症状中以乏力、皮肤瘙痒、黄疸最为常见。PBC患者均有不同程度肝功能异常,以ALP、GGT升高最为多见,异常比例分别为94．6％、95．7％。69．9％患者血清AMA和（或）AMA—M2亚型阳性,64．5％患者ANA阳性。93例肝脏病理学检查,符合I期为25例,Ⅱ期37例,Ⅲ期21例,Ⅳ期10例。病理分期与TBil、TBA呈正相关,与CHE呈负相关（P〈0．05）。结论诊断PBC应重视病理学检查,对病情及预后判断可参考TBil、TBA、CHE等指标,也应综合分析其临床症状、生化指标、自身抗体检测及组织学检查等。     

烟曲霉暴露对哮喘大鼠气道微环境的影响及药物干预的作用

目的 探讨烟曲霉孢子吸入对哮喘气道微环境的影响及地塞米松/头孢曲松钠的作用。方法 40只大鼠随机分为：空白对照组、单纯哮喘组、哮喘+孢子组、地塞米松组、头孢曲松组。采用OVA激发构建哮喘模型,烟曲霉孢子滴鼻模拟烟曲霉吸入。药物组于OVA激发前腹腔注射。检测肺泡灌洗液(BALF)及血中pH值、电解质、LDH、总蛋白水平,PDA培养法观察曲霉菌生长。结果 与单纯哮喘组比较,哮喘+孢子组血和BALF的K⁺浓度差减少以及总蛋白量增加(P<0.05)。与哮喘+孢子组比较,头孢曲松组血清和BALF总蛋白量减少(P<0.05),地塞米松组指标无显著变化。各组肺组织/BALF培养阳性率为0/0、0/0、50%/50%、100%/57%、50%/50%。结论 烟曲霉孢子吸入影响哮喘气道微环境,地塞米松和头孢曲松钠增加烟曲霉定植风险。