中药保留灌肠治疗溃疡性结肠炎临床研究

目的：观察中药保留灌肠治疗溃疡性结肠炎的疗效以及对血清炎症因子水平的影响。方法：102例溃疡性结肠炎患者随机分为对照组和观察组,每组各51例。对照组给予口服柳氮磺吡啶治疗,每次1．5～2．0 g,每日3次;观察组给予中药保留灌肠治疗,15 d为1个疗程。治疗4个疗程后采用ELISA法检测血清肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）和白介素-6（interleukin-6,IL-6）的浓度,同时观察两组患者腹痛、腹泻、黏液脓血便、里急后重等症状体征改善情况并结合肠镜检查比较两组患者临床疗效。结果：两组患者治疗后血清TNF-α和IL-6水平较治疗前相比均明显下降（P＜0．05）,但观察组患者下降程度甚于对照组（P＜0．05）。观察组患者各种症状改善率明显优于对照组（P＜0．05）。对照组有效率为84．31％,观察组有效率为96．08％,两组比较,差异有统计学意义（P＜0．05）。结论：中药保留灌肠治疗溃疡性结肠炎能够显著抑制患者体内炎症因子水平,临床疗效显著。     

乡镇卫生院护理人员工作现状及离职意愿研究

目的:描述乡镇卫生院护理人员工作现状和离职意愿,并分析工作量和工作内容对离职意愿的影响,为改善基层护理工作提出建议。方法:采用多阶段分层整群随机抽样,对我国三个省45家乡镇卫生院的167名护理人员进行问卷调查,并深度访谈44名护理人员。结果:深化医改以来,农村基层护理人员工作量增加,62%认为自己的工作量大。护理工作占护理人员平均工作时间的60%;公共卫生服务工作占平均工作时间的21%。30%的被调查者具有离职意愿。在控制省份、工作量、婚姻状况、编制、文化程度和从医年限等混杂因素后,公共卫生服务参与情况与护理人员离职意愿显著相关(P0.05)。结论:医改后乡镇卫生院护理人员工作内容扩展、工作量增加,工作内容的扩展降低了护理人员的离职意愿。     

改进保留灌肠法治疗慢性肾功能衰竭的护理

目的观察传统保留灌肠法与改进保留灌肠法在慢性肾功能衰竭治疗中的不同效果。方法慢性肾功能衰竭患者40例,分为传统灌肠法组及改进灌肠法组各20例,采用中药保留灌肠治疗,观察两种方法灌肠液在肠腔内保留时间及病人满意度。结果改进灌肠法组灌肠液在肠内保存时间及病人满意度均优于传统灌肠法组。结论慢性肾功能衰竭病人采用中药保留灌肠时,改进法保留灌肠可延长药液在肠内的保留时间,提高疗效,且病人乐于接受。     

A giant retention cyst of the pancreas (cystic dilatation of dorsal pancreatic duct) associated with pancreas divisum

We describe a rare case of pancreas divisum associated with a giant retention cyst (cystic dilatation of the dorsal pancreatic duct), presumably formed following obstruction of the minor papilla. The patient was treated by pancreatico(cysto)jejunostomy. A 50-year-old man was admitted with complaints of increasing upper abdominal distension and body weight loss. There was no previous history of pancreatitis, gallstones, drinking, or abdominal injury. An elastic-hard tumor-like resistance was palpable in the upper abdomen. Computed tomography and ultrasound (US) examinations revealed a giant cystic lesion expanding from the pancreas head to the tail. Endoscopic retrograde cholangiopancreatography findings showed a looping pancreatic duct which drained only the head and uncinate process of the pancreas to the main papilla. A US-guided puncture to the cystic lesion revealed that the lesion continued to the main pancreatic duct in the tail of pancreas. The lesion was connected to a small cystic lesion, which was located inside the minor papilla, and ended there. The amylase level in liquid aspirated from the cyst was 37 869 IU/l, and the result of cytological examination of the liquid showed class II. A pancreatico(cysto)jejunostomy was performed, with the diagnosis being pancreas divisum associated with a retention cyst following obstruction of the minor papilla. The histological findings of a specimen from the cyst wall revealed that the wall was a pancreatic duct covered with mildly inflammatory duct epithelium; there was no evidence of neoplasm. The patient is currently well, and a CT examination 2 years after the operation showed disappearance of the cyst and normal appearance of the whole pancreas. Received: April 24, 2001 / Accepted: September 14, 2001     

光甘草定醇质体与立方液晶纳米粒皮肤滞留量比较及抗豚鼠皮肤光老化作用观察

目的 制备光甘草定醇质体与立方液晶纳米粒,通过测定2种纳米制剂在离体豚鼠皮肤中的滞留量优选出适合光老化经皮给药的制剂。建立光老化模型,通过观察优选制剂对豚鼠光老化模型的治疗效果来评价药物的疗效。方法 采用注入法制备光甘草定醇质体,高压均质法制备光甘草定立方液晶纳米粒,利用Franz扩散装置考察光甘草定醇质体、立方液晶纳米粒凝胶离体鼠皮中的滞留量,优选出光甘草定经皮给药治疗光老化的纳米制剂。紫外线照射背部剃毛豚鼠建立皮肤光老化模型。雌性豚鼠随机分为模型组、基质（给予空白凝胶0.5 g/只）组、维甲酸（阳性对照,0.5 g/只）组和甘草定立方液晶纳米粒凝胶高、低剂量（0.50、0.25 g/只）组,治疗2周后,通过肉眼观察、HE染色、Masson染色等评价其治疗效果,用水份测定仪观察其对豚鼠皮肤含水量的影响。结果 2种纳米制剂凝胶的鼠皮滞留量最高者为光甘草定立方液晶纳米粒凝胶。豚鼠皮肤光老化模型建立成功,HE染色、Masson染色等结果表明光甘草定立方液晶纳米粒对光老化有明显的治疗效果,使光老化皮肤的含水量显著升高（P<0.05）。结论 光甘草定立方液晶纳米粒在离体鼠皮中的滞留较高,对豚鼠皮肤光老化模型治疗效果显著,为光甘草定的临床应用提供了新的方法与思路。     

健脾肥儿糖浆辅助治疗小儿厌食症脾虚食积型41例临床观察

目的观察健脾肥儿糖浆辅助治疗小儿厌食症脾虚食积型的临床疗效。方法选取2014年9月至2018年6月高邮市中医医院儿科就诊的厌食症脾虚食积型患儿82例,按随机数字表法分为治疗组和对照组,各41例。对照组给予双歧杆菌四联活菌片治疗,治疗组在对照组治疗方法的基础上给予健脾肥儿糖浆治疗,2组均治疗1个月后统计临床疗效。结果治疗组总有效率为87.80%(36/41),显著高于对照组的60.97%(25/41),2组比较,差异有统计学意义(P<0.05)。结论健脾肥儿糖浆辅助治疗小儿厌食症脾虚食积型临床疗效满意,值得临床推广应用。     

医疗失效模式与效应分析对无痛分娩患者的影响

目的探讨医疗失效模式与效应分析(HFMEA)对无痛分娩患者的影响。方法选取2018年1—12月医院实施HFMEA前收治的无痛分娩患者1437例为对照组,选取2019年1—12月医院实施HFMEA后收治的无痛分娩患者1465例为观察组。比较HFMEA实施前后失效模式危急值(RPN)的变化情况、风险优先下降率、尿潴留发生率、留置尿管率及护理质量评分。结果观察组产前护理不当、分娩过程处置不当、产后护理不当、产妇依从性差的RPN值显著低于对照组;观察组产后首次排尿时间与阴道出血量明显小于对照组;观察组产后尿潴留发生率与留置尿管率明显小于对照组;观察组患者对医护人员的宣教评分、医护人员管理评分、问题解决效率以及服务态度评分明显高于对照组;差异均有统计学意义(P<0.05)。结论HFMEA能够排序优先解决的问题,降低产后尿潴留与留置尿管的潜在发生风险,提高产后护理质量。