现实主义综述在护理领域的应用进展

介绍现实主义综述的定义、哲学基础和实施步骤，以及该方法学在护理领域的研究范围、应用现状及优势和不足，旨在提高护理研究者对现实主义综述的认识，为开展现实主义的护理相关研究提供思路。     

Early kidney injury during long-term adefovir dipivoxil therapy for chronic hepatitis B

AIM: To evaluate urine β2-microglobulin(β2-M), retinol-binding protein(RBP) excretion, and renal impairment with adefovir dipivoxil(ADV) for chronic hepatitis B. METHODS: We enrolled 165 patients with chronic hepatitis B infection who were treated with ADV monotherapy(n = 90) or ADV plus lamivudine combination therapy(n = 75). An additional 165 chronic hepatitis B patients treated with entecavir were recruited as controls. We detected serum creatinine, urine β2-M, and RBP levels, and estimated the glomerular filtration rate(e GFR) at the initiation of antiviral therapy and every 6 mo for a period of five years. RESULTS: Urine β2-M abnormalities were observed in patients during the first(n = 3), second(n = 7), third(n = 11), fourth(n = 16), and fifth(n = 21) year of ADV treatment. Urinary RBP abnormalities were observed in patients during the first(n = 2), second(n = 8), third(n = 12), fourth(n = 15), and fifth(n = 22) year of ADV treatment. e GFR decreased 20%-30% from baseline in 20 patients, 30%-50% in 12 patients, and > 50% in 3 patients during the five years of treatment. Further analysis indicated that decreases in e GFR of ≥ 30% relative to the baseline level correlated significantly with urine RBP and β2-M abnormalities. In contrast, both serum creatinine and e GFR remained stable in patients treated with entecavir, and only one of these patients developed a urine β2-M abnormality, and two developed urine RBP abnormalities during the five years of treatment. CONCLUSION: Urine RBP and β2-M are biomarkers of renal injury during long-term ADV treatment for chronic hepatitis B, and indicate when treatment should be switched to entecavir.     

Increased activity of Rho kinase contributes to hemoglobin-induced early disruption of the blood-brain barrier in vivo after the occurrence of intracerebral hemorrhage

This study is to examine whether the activation of Rho kinase (ROCK) accounts for hemoglobin (Hb)-induced disruption of blood-brain barrier (BBB) after the occurrence of intracerebral hemorrhage. A model of intracerebral injection of Hb was established in rats. Changes in the levels of mRNA of RhoA, ROCK2 and matrix metalloproteinase-9 (MMP-9) were measured using quantitative real-time polymerase chain reaction. Protein expression of RhoA, ROCK2, claudin-5 and MMP-9, as well as ROCK activity, were determined using Western blotting. Immunohistochemical assay was performed to visualize the expression of RhoA, ROCK2, claudin-5 and MMP-9 in endothelial cells. Hb injection produced a significant increase in BBB permeability and water content in the brain. Significant reduction of claudin-5 expression was detected by Western blotting and immunofluorescence in Hb group. The levels of RhoA and ROCK2 were significantly up-regulated from 6 h to 12 h after Hb injection and were concomitant with the increase in ROCK activity. Immunofluorescence double staining showed enhanced p-myosin light chain immunoreactivity but diminished claudin-5 staining in endothelial cells. Significant up-regulation of MMP-9 expression was detected after Hb injection, and statistical analyses further confirmed a positive correlation of MMP-9 expression with ROCK activity. The results showed that ROCK was activated in endothelial cells by Hb. This may account for the early disruption of the BBB via up-regulation of p-myosin light chain expression and aggravation of injuries to TJ proteins. The activation of ROCK may also increase MMP-9 expression, thereby leading to further BBB disruption.     

正常小肠血管与小肠腺癌血管对比研究

目的：建立正常小肠血管形态及小肠腺癌血管形态。材料与方法：对１０例正常小肠标本、１６例经病理证实的手术切除标本，其中８例术前已作肠系膜上动脉造影，分别采用血管铸型、血管造影、解剖镜观察及图像分析。结果：正常小肠血管的形态、分布与传统观点不尽相同。血管密度以十二指肠球部最低、在空、回肠呈由低增高，继而降低的变化规律。小肠腺癌术前血管造影确诊率较低（３／８）例，血管造影呈现：供血动脉增粗、杵状中断、狭窄，癌体内造影剂池，癌周血管增多、扭曲，肿块实质血管减少等特征。与正常组比，小肠腺癌血管面密度（目标总面积／统计场总面积）显著性减少（Ｐ＜０．０５）。结论：认识正常小肠血管分布规律，有助于小肠肿瘤的介入诊断和治疗。小肠腺癌癌周血管增多、变形，癌体内血管少、常见造影剂池征。     

局麻微创经皮肾镜对全身炎症反应及肾功能损害的影响

目的通过对局麻微创经皮肾镜治疗肾结石及输尿管上段结石导致的全身炎症反应、肾功能损害等临床资料进行分析,评估局麻微创经皮肾镜的安全性、有效性、可行性、经济效益及其临床推广应用价值。方法东莞市大朗医院泌尿外科在2012年8月至2014年8月将经皮肾镜患者随机分成观察组及对照组(各40例),观察组行局麻,对照组行腰硬联合麻醉。对比两组术前晨、手术结束时及术后一周血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、β2-微球蛋白(β2-MG)、C-反应蛋白(CRP)、肌酐(Cr)及尿素氮(BUN)的表达水平;同时对比两种麻醉状态对患者心率(HR)、血氧饱和度(SPO2)及平均动脉压(MAP)的影响;并比较两组间手术时间、术中出血量、住院时间、住院费用及残石率的差异。结果两组患者术前晨血BUN、Cr、β2-MG、IL-6、TNF-α及CRP组间比较差异无统计学意义(P>0.05),两组各项参考指标在手术结束时明显高于术前。对照组术后一周血清IL-6、TNF-α、CRP含量高于观察组,两组术后一周血清BUN、Cr、β2-MG低于术前,差异有统计学意义(P<0.05)。观察组及对照组MAP、HR、SPO2在手术开始前、手术中与麻醉前比较差异有统计学意义(P<0.05)。两组间手术时间、术中出血量及残石率比较无统计学差别(P>0.05),观察组住院时间及住院费用明显低于对照组,差异有统计学意义(P<0.05)。结论局麻微创经皮肾镜治疗肾结石及输尿管上段结石引起的全身炎症反应较轻,总费用及住院时间明显低于腰硬联合麻醉组,两组患者肾功能损伤差别无统计学意义。     

血必净注射液对系统性红斑狼疮小鼠脾脏T淋巴细胞的免疫调节作用

目的：：探讨血必净注射液对系统性红斑狼疮(SLE)小鼠T淋巴细胞的免疫调节作用。方法：以清洁级EB病毒膜抗原BLLF1基因转基因小鼠30只为SLE模型小鼠,随机分为模型组(8周龄和10周龄各5只)、8周龄治疗组(10只)和10周龄治疗组(10只)。两治疗组给予血必净注射液6.4 ml/kg腹腔内注射,每日1次,连续14 d。治疗14 d后处死,分离脾脏,提取DC和T淋巴细胞,荧光定量PCR和酶联免疫吸附试验检测T细胞孵育上清和脾组织匀浆液IL-2和TNF-α基因及细胞因子表达水平。结果：与正常对照组比较,SLE小鼠IL-4、TNF-α含量显著升高,而IL-2、IFN-γ水平明显降低,脾脏组织及T淋巴细胞IL-2的基因表达显著下降,而TNF-α基因表达则明显升高(P<0.05或P<0.01)。给予血必净注射液治疗后,与模型组比较,狼疮鼠 IL-4、TNF-α含量显著降低,而 IL-2、IFN-γ水平明显升高,IL-2基因表达显著升高,TNF-α基因表达明显降低,差异具有统计学意义(P<0.05或P<0.01)。两个治疗组之间比较差异无统计学意义(P>0.05)。结论：血必净治疗能够将脾脏的Th2细胞转化为 Th1细胞,改变Th1/Th2的比例和机体的免疫应答类型,对系统性红斑狼疮的免疫功能产生影响。     

老年患者关节置换术后发生急性精神障碍的原因分析

目的：回顾性总结老年患者在人工髋／膝关节置换术后发生急性精神障碍的原因和防治措施。方法2006年1月至2011年12月,本组收治70岁以上老年人工关节患者1650例,出现术后精神障碍67例,发生率为4.1％。分析这67例患者精神障碍出现时间、持续时间,麻醉方式、麻醉用药、髋膝手术方式、基础疾病和电解质失衡情况与术后精神障碍的关系。结果精神障碍多发生于术后6h～5d内,主要表现有谵妄、定向力障碍、躁动、烦躁不安、神智不清、嗜睡、胡言乱语、昼夜颠倒等。术后3.77％椎管内麻醉和4.10％全身麻醉患者出现急性精神障碍,但两者无统计学差异。髋关节置换术组出现精神障碍的比例为5.09％,显著高于膝关节置换术组的2.39％。67例精神障碍患者中合并有高血压42例（62.7％）,合并糖尿病39例（58.2％）,合并酗酒18例（26.9％）。67例精神障碍患者中术后电解质检查提示低钾（50例,74.7％）、低钠（42例,62.7％）、低钙血症（37例,55.2％）,合并低氧血症52例,占77.6％。结论高龄、基础疾病、电解质紊乱、低氧血症和术后疼痛是人工髋／膝关节置换术后发生急性精神障碍的高危因素。术前应重视和纠正老年患者各种病理状态,加强围术期呼吸循环的管理,防止低血压、低氧血症、脑水肿的发生,术后给予良好的镇痛和人文关怀,尽量消除促使术后精神障碍发生的各种因素。     

偏心改向髋臼内衬的设计与模拟手术

目的：设计出偏心改向髋臼内衬,以解决臼杯位置不良时内衬补救或翻修,及小髋臼关节置换问题。方法在Solidworks2012软件平台上,利用三维实体建模技术,设计一套偏心改向髋臼内衬,并进行模拟手术,预测手术效果。结果成功设计出一套偏心改向髋臼内衬,改向规格有0°、10°、20°、30°;偏心规格有球心偏向非负重侧2 mm的外径／内径的比值分别为42 mm／28 mm、40 mm／28 mm和38 mm／24 mm、36 mm／24 mm四种。模拟手术显示髋关节置换或翻修术后防脱位效果和活动范围。结论偏心改向髋臼内衬设计合理,用于臼杯位置不良时内衬补救或翻修及小髋臼大球头置换,模拟手术提示有防脱位功能。