肝硬化部分脾动脉栓塞患者的康复指导

肝硬化门脉高压患者约83％合并有不同程度的脾功能亢进，严重影响着患者的生命质量。目前应用部分脾动脉栓塞术治疗脾功能亢进因为能改善脾亢症状，还能降低门静脉压力，改善患者的肝功能，且创伤小，病人痛苦小，操作简单，并发症少且轻，疗效好且费用低，临床应用日渐广泛，治疗上取得很好疗效的同时，临床宣教及护理工作也积累了较多的经验。     

西部民族地区留守老年人心理健康状况与心理干预

[目的]调查西部民族地区留守老年人的心理健康状况,并进行心理干预,以减轻他们的心理压力,保持心理健康。[方法]选取湘、鄂、渝、黔四省（市）西部边区290名留守老年人进行问卷调查并对132名老人进行心理干预。[结果]有290名留守老年存在不同程度的心理应激,经常焦虑86名,占29.7,经常有不同程度的兴趣下降146名,占50.3;132名老年人经心理干预后心理健康状况明显改善。[结论]对西部民族地区留守老年人应加强关心,进行心理调节,并及时对他们进行心理疏导。     

有创血压在ICU中监测与护理探讨

有创血压监测就是通过压力监测仪直接测量动脉压的方法。它有以下的优点：可及时准确地反应患者动脉血压的动态变化，协助病情分析；间接用于判断血容量、心肌收缩力、周围血管阻力以及心脏压塞等情况；应用于心脏病患者手术以及重症患者能够及时反应病情的发展状态，指导血管活性药物的使用和调节；可随时抽取动脉血行血气分析，避免频繁穿刺给患者带来疼痛或血管壁的损伤。     

职场新鲜人：停看听三步走

社会新鲜人找到工作的喜悦，很快会被上班带来的惶恐给冲淡，毕竟学校与职场大不相同，将让充满理想有冲劲的新鲜人面临种种挑战，例如能否胜任工作、压力调解、人际关系以及利益冲击等。     

Influence of moderate hypothermia on cerebral oxygenation in pigs with intracranial hypertension

BACKGROUND: Moderate hypothermia is one of the effective therapeutic methods for head injury in recent years, there are many mechanisms of moderate hypothermia for brain protection, and its influence on cerebral oxygenation is also one of them. OBJECTIVE: To observe the influence of moderate hypothermia on cerebral oxygenation of animals with acute intracranial hypertension, and further investigate the protective mechanism of moderate hypothermia. DESIGN: A randomized controlled trial. SETTING: Department of Neurosurgery, Renji Hospital affiliated to the Medical College of Shanghai Jiao Tong University. MATERIALS: Twenty healthy little pigs, either male or female, weighing 4.5–5.5 kg, were used. Neurotrend-typed multiparameter monitoring system (Diametrics Company, British); CMA/100 micro-injection pump (Carnegie Company, Sweden). METHODS: The experiment was conducted in the Changzheng Hospital affiliated to the Second Military Medical University of Chinese PLA in November, 2001. The pigs were randomized into two groups: the normothermia group (control group, n =10) and moderate hypothermia group (n =10). ① Bilateral femoral arteries were separated, one was connected to pressometer for monitoring mean arterial pressure (MEP), and the other for analysis of blood gases [including peripheral blood pH value, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of carbon dioxide (PaCO2), HCO3–]. ② Rectal temperature was monitored with mercurial thermometer. ③ Intracranial pressure was monitored using Camino optic ICP probe placed in the subdural space. ④ Neurotrend multiparameter monitoring sensor was inserted into the white matter for about 4 cm to determine cerebral perfusion pressure (CPP, CPP=MAP(ICP), brain tissue partial oxygen pressure (PO2), partial pressure of carbon dioxide (PCO2), HCO3– and brain temperature. The rectal temperature of animals in the moderate hypothermia group was lowered to 34 ℃ using ice bags, and the body temperature was maintained at 33–35 ℃ for 2 hours. The changes of the parameters were observed continuously, and the pigs in the normothermia group were not treated with cooling. MAIN OUTCOME MEASURES: ① MAP, ICP, rectal temperature, CCP; Indexes of cerebral oxygenation detected with Neurotrend-typed multiparameter monitoring system; ② Results of blood gases analysis in the moderate hypothermia group. RESULTS: All the 20 pigs were involved in the analysis of results. ① MAP, ICP, rectal temperature, CCP and indexes of cerebral oxygenation: In the moderate hypothermia group, the ICP after cooling was obviously lower than that before cooling [(3.31±1.19), (5.33±0.95) kPa, P < 0.05], CCP was higher, brain tissue PCO2 [(12.03±1.73), (10.59±2.01) kPa, P < 0.05], and brain tissue pH value was higher [(7.03±1.63), (9.40±1.30) kPa, P < 0.05], whereas the brain temperature was decreased as compared with that before cooling [(34.9±0.3), (37.2±0.2) ℃, P < 0.05]. ② Results of blood gases analysis in the moderate hypothermia group: There were no significant differences in the parameters of peripheral arterial blood gases analysis before and after cooling in the moderate hypothermia group (P > 0.05) CONCLUSION: Moderate hypothermia will not impair the cerebral oxygenation, and it can reduce brain tissue CO2 and decrease brain tissue acidosis.     

护士工作压力现状分析

护士工作压力作为一个突出的问题，近年来已受到越来越多的国内外学者的关注，相关报道更是层出不穷。护士这个被公认为是“高级保姆”的职业，能引起社会各界和相关学者的关心，笔者作为护士中的一员深感欣慰，但现实是护士压力状况在一定条件下并没有得到切实的改善。以儿科为例：工作现状更是让人担忧。就此，笔者调查了两家大医院的儿科护理工作者的现状。     

神经外科NICU护士的职业压力与释放

目的：进一步分析探讨NICU护士的职业压力，并寻求相应的对策，以减轻护士压力，保持身心健康。方法：2007年6月-2008年6月，每月定期应用Zung焦虑白评量表（SAS）对NICU护士进行焦虑问卷调查。结果：根据问卷调查显示NICU护士所承受的不同压力，采取应对方式，使护士压力得到有效的释放。结论：了解NICU护士工作中主要的压力源及应对策略，为有效地帮助护士减轻工作压力，保持身心健康提供依据。     

左向右分流先心病心电图与肺动脉压的关系

目的探讨左向右分流先心病心电图表现与肺动脉压力关系,及心电图在左向右分流先心病诊断中的作用.方法171例左向右分流先心病患者,均经心导管证实,分析心电图表现与肺动脉高压的关系.结果1.PDA和VSD患者心电图正常或左心室肥大;合并肺动脉高压,可出现右心室肥大,与肺动脉压力正常组有显著差异(P<0.05).2.ASD患者心电图为正常、右束支传导阻滞或右心室肥大,肺动脉压力正常组与肺动脉高压组无显著差异.3.复合左向右分流患者右心室或双心室肥大,多伴有肺动脉高压,与肺动脉压力正常组有显著差异(P<0.05).结论体表心电图虽能较好分析左向右分流先心病的类型,评价分流量大小及肺动脉压力情况,可作为先心病诊断中的一个重要辅助检查,但仍有一定局限性,须结合临床症状、体征和辅助检查进行综合评判.     

鼓膜置管治疗腭裂合并分泌性中耳炎疗效观察

目的探讨鼓膜置管术对腭裂合并分泌性中耳炎的疗效. 方法对45例(72耳)患有腭裂合并分泌性中耳炎经鼓膜穿刺抽液无效的患者行鼓膜置管术和随访. 结果随访1～4年,治愈36耳;好转24耳;无效和复发 8耳;并发症 4耳.腭裂修补组有效率93.3%;非腭裂修补组有效率 66.7%,总有效率 83.3%. 结论鼓膜置管治疗腭裂合并分泌性中耳炎有利于改善听力,但不能改善咽鼓管阻塞状况,已行腭裂修补术后置管的疗效明显优于非修补组.早期行腭裂修补术后置管对咽鼓管功能恢复,听力改善,提高生活质量至关重要.     

加速多巴酚丁胺负荷超声心动图诊断冠心病的临床观察

目的 探讨加速多巴酚丁胺负荷超声心动图(ADSE)对于冠心病的诊断价值及其安全性.方法 对144例已诊断为冠心病或疑似心绞痛的患者随机分组并分别进行ADSE(观察组86例)及传统多巴酚丁胺负荷超声心动图(DSE)检查(对照组58例),动态观察其阳性指标终止率、有效负荷剂量、终止时间及主要不良反应等相关指标.结果 观察组患者总体阳性指标终止率达到93.0%,多巴酚丁胺灌注剂量为(298.56±102.13)μg/kg,灌注时间为(6.2±2.7)min,均显著优于对照组的相关指标[分别为81.0%、(359.46±85.70)μg /kg、(8.1 4-2.4)min].且两组出现的不良反应比较差异无统计学意义.结论 ADSE对于诊断冠心病具有重要的临床实用价值,并具有不良反应少、易处置等优点.