注射贴在静脉输液中的应用观察

[目的 ]观察注射贴在同一病人静脉输液中扩张局部血管和减轻局部疼痛的效果。 [方法 ]观察比较 40例静脉输液病人使用注射贴前后局部血管外径值、局部疼痛的变化。 [结果 ]使用注射贴后局部血管外径大于使用注射贴前 ,两组比较有统计学意义(P <0 .0 0 1) ;使用注射贴后局部疼痛程度也明显轻于使用前 ,两组比较有统计学意义 (P <0 .0 0 1)。 [结论 ]静脉输液前使用注射贴可有效扩张局部血管和局部镇痛。     

炒紫苏子醇提物对血小板聚集活性的影响

目的:探讨炒紫苏子醇提取物对腺苷二磷酸(ADP)、花生四烯酸(AA)和血小板活化因子(PAF)诱导血小板聚集功能的影响。方法:用诱导剂ADP(终浓度3μmol/L)、PAF(终浓度7.2 nmol/L)、AA(终浓度0.35 mmol/L)分别激发血小板聚集,观察炒紫苏子醇提取物对血小板聚集的抑制作用。结果:炒紫苏子醇提取物体外能抑制由ADP、PAF和AA激发的兔血小板聚集,并表现明显的剂量依赖关系。其中,对PAF诱发的血小板聚集作用有更强的抑制作用,80mg/L就表现出明显的抑制作用(P<0.05);而对于ADP和AA激发的兔血小板聚集,640 mg/L炒紫苏子醇提取物表现出明显的抑制作用。结论:炒紫苏子醇提取物具有明显的抗血小板聚集作用。     

The transition to practice of Direct Entry Clinical Nurse Leader graduates

This study looks at Direct Entry Clinical Nurse Leader graduates and how their transition to practice experiences develops over time as well as factors influencing their transition. Graduates were surveyed at graduation, three, six and 12 months. Seventeen participated; eight completed all surveys. Most were from the Millennial generation. The survey consisted of two parts: school satisfaction and the Casey-Fink Graduate Nurse Experience Scale. The results showed the Casey-Fink total score at 12 months was 0.75 points higher than at three months; suggesting a positive transition. The highest score occurred at six months which conversely had the lowest levels of satisfaction with both educational experience and intent to stay in their current role. Despite having 850 precepted/mentored clinical hours, 57.1% of these graduates stated they felt unprepared for the reality of nursing after 12 months. Regardless of feeling unprepared, the results suggest these students displayed a positive transition to practice. At 12 months, 88.2% were still with their first employers which contrasted the results of Casey-Fink and other studies of Millennial gradate nurses, which showed higher actual and intent to leave results. This study suggests that Direct Entry Clinical Nurse Leader students do indeed transition to practice more positively than traditional nursing graduates.     

裂缝性气藏气井的分形渗流产能方程

在裂缝性气藏中, 常规模型难以准确描述裂缝发育的非均质性。如何更准确的评价单井的产能, 是现场开 发生产中面临的紧迫问题。在分形渗流研究基础上, 引入裂缝发育参数, 用于表征井控范围内裂缝的分布与连通情况, 建立了分形渗流稳态产能方程, 明确了裂缝对产能计算结果的影响, 并用塔里木油田克深区块实际井例进行了验证。相 对于常规模型, 分形渗流产能方程使预测产量与实测产量误差由20. 9%下降为3. 53%, 预测结果与现场实测更加吻合。     

再论焦痂薄化术再生烧伤再生疗法中的应用前景

“烧伤再生疗法”的前身是“烧伤湿性医疗技术（ MEBT/MEBO）”,它由烧伤湿润暴露疗法（MEBT）和湿润烧伤膏（MEBO）组成,1991年被列入国家“十年百项”成果首批十项推广技术之一.为了加速创面坏死组织早期液化过程,附加了“耕耘疗法”等项技术,初步形成了具有中国特色的烧伤医疗体系.因为这种疗法能够激活自身成体细胞,使创面实现生理性愈合,又被称为“皮肤原位再生复原技术”,目前已成为我国治疗烧伤的主体技术.为了总结“烧伤再生疗法”治疗深度烧伤的临床经验,探讨加速创面坏死组织液化和缩短再生修复过程的有效方法,作者复习了与之有关的文献.结果发现,耕耘疗法能促进深Ⅱ度深型创面坏死组织液化,使这些创面实现原位再生修复;用其处理Ⅲ度创面,焦痂液化期偏长,从而也延长了烧伤皮肤再生愈合过程.Ⅲ度创面若附以“焦痂薄化术”处理,可有效地缩短液化期,在MEBT/MEBO培植的肉芽组织上移植自体皮肤很容易成活.同时观察到愈合后的皮肤形态近似于正常,组织病理学检查到具有类似于真皮组织的结构.据此认为,“焦痂薄化术”在“烧伤再生疗法”中应用前景十分广阔.     

QT离散度在冠状动脉搭桥术中的意义及其应用

为阐明冠状动脉搭桥术(CABG)对QT离散度(QTd)的影响,并探讨其临床意义,我们记录并分析了我院24例冠心病患者(心绞痛2例,陈旧性心肌梗塞19例,冠心病心力衰竭3例)行CABG术前及术后不同时间的心电图,测算其QTd和心率校正的QT离散度(QTcd),同时观察其心绞痛缓解程度、心功能改善状况及左室射血分数的变化。结果显示:术前病人QTd、QTcd(91.47±27.57、96.76±25.88ms)均明显高于正常(40～50ms),而术后dl即明显减小(64.80±23.38、76.18±21.12、P<0.001),术后10d基本恢复正常(35.91±11.59、40.19±9.83),且这一结果与其它临床指标明显相关。结论:CABG能有效地改善心肌供血,缓解心绞痛,提高心功能;QTd、QTcd无论在CABG术前病情判断还是在术后疗效观察中,都是一项可靠而敏感的指标。     

湿润烧伤膏与蜂蜜敷料在Ⅱ度烧伤创面治疗中的随机对照试验

目的当今有很多局部外用产品可用于Ⅱ度烧伤创面的治疗,笔者从天然抗菌性、抗炎性及创面愈合3方面对湿润烧伤膏（MEBO）及蜂蜜进行了比较。在烧伤创面治疗中,此两种药物已被证明均优于磺胺嘧啶银。方法本实验为随机对照试验,为期6个月,研究样本均为30％TBSA以下的急性Ⅱ度烧伤患者。本试验共有34名患者被随机编入MEBO组及蜂蜜组（蜂蜜为印尼当地生产）,创面每日换药1次．并给予相应处理措施。人院时评估创面深度及烧伤面积,此后2周内每周再评估1次;使用视觉模拟量表（VAS）评估患者疼痛水平;每周进行创面拭子分泌物培养获得创面微生物情况;同时,记录各组的每日治疗成本。结果相比于蜂蜜组,MEBO组的Ⅱ度烧伤创面愈合较快,VAS疼痛评分较低;两组在创面拭子分泌物培养的细菌类型中无差异,但MEBO在细菌繁殖方面具有更有效地抑制作用;MEBO组的全程治疗费用亦低于蜂蜜组。结论作为治疗Ⅱ度烧伤的外用药,MEBO在愈合速度,疼痛缓解程度,细菌繁殖率及成本一效益率4个方面均优于当地生产的蜂蜜。     

Why 4 years when 3 will do? Enhanced knowledge for rural nursing practice

In Australia, debates over the appropriate length of undergraduate nursing programs have a long history. Submissions from both universities and industry to key government reports have consistently argued that the current minimum entry level of practice, a three-year program, is too short to enable students to gain the knowledge and skills necessary for the contemporary nursing role. Despite these submissions, the established entry level for nursing practice in Australia remains a three-year undergraduate bachelor degree. However, there is a small group of high-achieving students who will begin practice at the end of a four-year program. Little is known about these programs, or the students who are currently enrolled in them. Designed as a collaborative endeavour, based on co-operative inquiry, the study discussed in this article aimed to provide an insight into aspects of a four-year undergraduate nursing program. Potentially, the broader theoretical and clinical preparation that is possible in a four-year program provides students with enhanced learning opportunities that will enable them to graduate with more confidence and greater ability. In this study a four-year program provided an opportunity for a regional university to prepare students for the demanding realities of a complex area of practice, rural nursing.     

晚期癌症病人需求评估问卷的综合评价

[目的]评价“晚期癌症病人需求评估体系”问卷的科学性。[方法]采用问卷调查法,以作者研究构建的“晚期癌症病人需求评估问卷”和英国圣克利斯多弗医院“临终关怀结果评估量表——病人问卷”为调查工具,选取西安地区两所三级甲等医院7个临床科室中住院癌症病人96例和非癌症病人40例为调查对象,进行问卷调查。[结果]①本次调查问卷回收率为98.0%,重复测量回收率87.5%(35/40),完成率为97.9%,完成问卷时间为13.0min±3.5min,调查对象对调查问卷的评估认为好的占82.0%。②两次测量总分值相关系数为r=0.827,生理、心理、精神和社会4个方面的相关系数分别为0.823、0.636、0.796、0.875。③问卷在4个领域的Cronbach’sα系数分别为:生理需求0.7219,心理需求0.6412,精神需求0.7502,社会需求0.8275。④经主成分及因子分析,得到载荷较大的12个因子,基本涵盖了生理、心理、精神、社会4个方面。⑤与“临终关怀结果评估量表——病人问卷”的相关系数为0.87。⑥该问卷在社会需求方面有较好的区分度。[结论]“晚期癌症病人需求评估问卷”有较好的可行性,较高的信度和效度,可以用于晚期癌症病人需求评估。     

循环质量反馈模式对精神科家属满意度和护理质量的影响观察

目的：分析循环质量反馈模式对精神科护理质量及患者家属对护理满意度的影响。方法将我院精神科自2013年3月至2015年3月收治的90例患者作为研究对象,按随机数字表法分为对照组与观察组各45例,对照组采取常规护理措施,观察组则应用循环质量反馈模式,比较不同护理模式对精神科护理质量及家属满意度的影响。结果护理4周、8周后,观察组NOISE-30量表评分分别为(18.1±4.2)分、(10.2±3.4)分,护理质量评分分别上升至(89.4±5.6)分、(95.6±2.7)分,与对照组相比差异有统计学意义(P<0.05);观察组总满意度为100.0%,与对照组的86.7%对比差异有统计学意义( P<0.05)。结论在精神科护理中,采用循环质量反馈模式,可提高家属满意度,优化整体病房护理质量,应用价值高,值得推广。