持续静脉应用胰岛素、胰岛素泵用于治疗糖尿病酮症酸中毒病患的临床效果分析

目的:调研和分析持续静脉应用胰岛素和胰岛素泵用于治疗糖尿病酮症酸中毒患者的临床效果。方法:选择2017年1月~2019年1月到本院糖尿病科接受治疗糖尿病酮症酸中毒的68例患者作为调研对象,以随机法分为对照组(34例)和观察组(34例)。其中,对照组患者接持续静脉应用胰岛素治疗,观察组患者接受胰岛素泵应用胰岛素治疗。观察并对比两组患者相关指标情况以及低血糖发生情况。结果:观察组患者的尿酮转阴时间、血糖达标时间、尿酮体消失时间、血浆pH值恢复正常时间明显短于对照组,胰岛素应用剂量少于对照组(P<0.05);观察组患者的低血糖发生率2.94%明显低于对照组14.71%(P<0.05)。结论:在糖尿病酮症酸中毒患者接受治疗的过程中,相比较于持续静脉应用胰岛素,胰岛素泵应用胰岛素的临床治疗效果较好。     

腹腔镜胃癌根治或2D、3D腹腔镜胃癌根治术的临床疗效观察

目的:探讨观察腹腔镜胃癌根治或2D、3D腹腔镜胃癌根治术的临床疗效。方法:选择本院2017年2月~2018年11月收治的60例胃癌患者且将其随机分成对照组与研究组,每组各30例。对照组30例行2D腹腔镜胃癌根治术,研究组30例行3D腹腔镜胃癌根治术,对比观察临床疗效。结果:(1)比较两组患者的手术时间、术中出血量,研究组显著优于对照组,差异有统计学意义(P<0.05);(2)统计显示,研究组并发症发生率与对照组并无明显差异(P>0.05)。结论:腹腔镜胃癌根治术是治疗胃癌的有效术式,相比2D腹腔镜胃癌根治术,3D腹腔镜胃癌根治术的优势更明显。     

Santé mentale et Santé bucco-dentaire : de l’intérêt de faire tomber le masque

The mouth is at the heart of our daily life. However, oral health is often overlooked, especially in people with mental illness. The objectives of this review were to identify the factors that can increase their vulnerability toward oral diseases, to describe the consequences in terms of health and quality of life, and to explore solutions for preventing and managing oral diseases in this population.Why are patients with mental illnesses more at risk of poor oral health?The mental illnesses themselves, which can alter one's self-image and perception of the body, may decrease motor skills or disorganize daily life, contribute to a decrease in the practice of daily oral hygiene or in seeking healthcare services. The presence of vomit or gastroesophageal reflux stimulates the demineralization of dental surfaces. Addictive substances, the consumption of which is frequent in this population, particularly tobacco, have a direct impact on the oral mucosa and contribute to poor oral health as well as to a reduction of the effects of pharmacological treatments used to treat psychiatric pathologies. By stimulating the appetite, they promote snacking. By inhibiting the production of saliva, they prevent it from playing its role as a natural oral lubricant. It has a negative effect on self-cleaning dental surfaces, the neutralization of oral acidity and defensive power but also on food pre-digestion, chewing, swallowing and speaking. Finally, by inducing abnormal movements of the lips, tongue or jaw, problems of lip incompetence, breathing through the mouth or bruxism may develop. Difficulties in accessing oral care can also contribute to patients’ poor oral health. They may be related to mental pathology: the failure to keep appointments, refusal of care, anxiety, to the lack of information and understanding of their rights for health insurance and transportation to a dental office. They can also be linked to a stigmatizing or critical attitude or a rush to provide care from some dentists that can discourage the patient from continuing his/her oral follow-up.What are the consequences?Xerostomia has several consequences: difficulty in chewing, swallowing, speaking, wearing removable dentures and altered taste, bad breath, cracked lips, and burning mouth. The patient will then modify his/her diet and increase their consumption of soft drinks and soft foods, which adhere more to dental surfaces. Patients have an increased risk of carious lesions, erosion of the teeth, and periodontal lesions accentuated by smoking. People with substance addiction are roughly three times more likely to have periodontal pockets than control groups. People with eating disorders are five times more likely to have dental erosion, responsible for sensitive teeth than control groups due to vomiting or gastroesophageal reflux. Finally, the problem of dental caries is more severe in people suffering from mental illness: People with schizophrenia seem to be the most affected with 7.7 more tooth decay, missing and filled teeth on average than do control participants. Oral afflictions are responsible for acute and chronic pain and infection. Patients with severe mental illness are 2.8 times more likely to lose all their teeth than those in control groups. Edentulism has many repercussions for the patient's health and quality of life, (eating disorders, speech impediments, and deformed smiles, all of which can lead to low self-esteem and social isolation).What are the solutions?A set of measures can be proposed against xerostomia: frequent intake of unsweetened, non-acidic drinks, chewing sugar-free chewing gum with xylitol, salivary substitutes or salivary stimulants. Support measures to encourage patients to quit smoking, when possible and compatible with the patient's clinical condition, should be offered during psychiatric follow-up. Patients could be encouraged, as soon as their mental pathology has stabilized, to select a dentist and to consult him/her at least once a year for dental care and preventative measures and to become accustomed to receiving dental care. The continuum between psychiatric care and oral care is important, as is the training of medical teams. The number of dental treatments and/or the mental pathology of some patients can cause them to be uncooperative and may necessitate the use of a general anaesthesia during oral care, but this procedure has many limitations. For long-term health improvement and to avoid the accumulation of comorbidities, therapeutic patient education seems to be an appropriate complementary approach. Integrating oral health with psychiatric care would make it possible to encourage patients to develop habits of healthy eating and good oral hygiene, to seek dental care, and to acquire improved social behaviours.     

痛泻四神汤腹泻型肠易激综合征的胃肠激素水平变化及临床意义观察

目的:探究痛泻四神汤对腹泻型肠易激综合征胃肠激素水平的影响。方法:选取2017年2月至2018年6月西安市中医医院收治的腹泻型肠易激综合征患者124例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组62例。对照组给予西医常规治疗,观察组在对照组基础上加用痛泻四神汤加减治疗,均治疗2周。观察和比较2组治疗前后淋巴细胞指标CD3^+、CD4^+、CD8^+、CD4^+/CD8^+变化,观察并比较2组治疗前后胃肠激素指标血浆胃动素(MOT)、降钙素相关基因肽(CGRP)、血管活性肠肽(VIP)、生长抑素(SS)、一氧化氮(NO)变化;观察并比较2组治疗前后在γ-干扰素(IFN-γ)、5-羟色胺(5-HT)、神经肽Y(NPY)含量变化;观察并比较2组治疗前后临床症状腹痛、腹胀、肠鸣失气、急躁易怒、神疲乏力、纳呆食少症状评分变化;治疗过程中进行不良反应记录,治疗结束后进行统计。结果:1)2组患者治疗前CD3^+、CD4^+、CD8^+、CD4^+/CD8^+比较,差异无统计学意义(P>0.05),治疗后2组CD3^+、CD4^+、CD4^+/CD8^+较治疗前均显著上升,CD8^+显著下降(均P<0.05);治疗后观察组患者CD3^+、CD4^+、CD4^+/CD8^+显著高于对照组,CD8^+显著低于对照组(P<0.05)。2)2组治疗前MOT、CGRP、VIP、SS、NO比较,差异无统计学意义(P>0.05),治疗后2组MOT、NO较治疗前显著升高,CGRP、VIP、SS显著下降(P<0.05);治疗后观察组CGRP、VIP、SS显著低于对照组,MOT、NO显著高于对照组(P<0.05)。3)2组治疗前IFN-γ、5-HT、NPY比较,差异无统计学意义(P>0.05),治疗后2组IFN-γ、5-HT、NPY较治疗前均显著下降(P<0.05);治疗后观察组IFN-γ、5-HT、NPY显著低于对照组(P<0.05)。4)2组治疗前腹痛、腹胀、肠鸣失气、急躁易怒、神疲乏力、纳呆食少积分比较,差异无统计学意义(P>0.05),治疗后2组以上各症状评分较治疗前显著下降(P<0.05);治疗后观察组以上各积分显著低于对照组(P<0.05)。5)2组口干、头痛、皮疹、胃肠道反应发生率比较,差异无统计学意义(P>0.05)。结论:痛泻四神汤能改善腹泻型肠易激综合征胃肠激素水平,改善临床症状,提高机体免疫力,提高疗效。     

颈椎手法牵引复位联合舒适护理在颈椎病患者中的应用效果

目的探讨颈椎手法牵引复位联合舒适护理在颈椎病患者中的应用效果。方法选择2017年8月-2019年6月收治的80例颈椎病患者,采用随机数字表法分为2组,各40例。在颈椎手法牵引复位的基础上,对照组采用常规护理,观察组采用舒适护理,比较2组临床疗效、生活质量。结果干预后,较对照组相比,观察组总有效率高、WHOQOL-BREF各维度评分高,差异有统计学意义(P<0.05)。结论颈椎病患者采用颈椎手法牵引复位联合舒适护理可提高治疗效果,改善患者生活质量。     

伪士的宁对人结肠癌HT-29细胞的增殖及细胞周期的影响

目的研究伪士的宁对人结肠癌HT-29细胞的增殖及细胞周期的影响。方法通过MTT法比较在31.25μmol/L、62.50μmol/L、125μmol/L、250μmol/L、500μmol/L、1000μmol/L共6个浓度的伪士的宁培养24小时、48小时、72小时后对HT-29细胞增殖的抑制作用;通过显微镜细胞观察法检测细胞生长状态;利用流式细胞术检测250μmol/L伪士的宁对HT-29细胞周期的影响。结果伪士的宁对人结肠癌HT-29细胞有一定的抑制作用,其抑制作用与浓度和作用时间呈正相关,1000μmol/L培养72小时作用最显著,抑制率为97.47%;随着伪士的宁浓度增加,作用时间增大,HT-29细胞密度逐渐变小,局部可见固缩细胞或死亡细胞。伪士的宁(250μmol/L)作用于HT-29细胞后,与空白组相比,G1期细胞数量明显增加,S期细胞数量不变,G2期细胞数量减少,差异有统计学意义(P<0.05),表明伪士的宁可诱使HT-29细胞在G1期发生阻滞,诱导细胞凋亡。结论伪士的宁对人结肠癌HT-29细胞增殖具有显著抑制作用,且其作用呈现时间依赖和剂量依赖关系,其抑制作用机制可能与阻滞细胞周期有关。     

PBL教学法在临床心肺复苏术教学中的应用分析

目的 分析重症医学科PBL教学法在临床心肺复苏术教学中的应用效果.方法 本次实验的开展基础数据选择2016年9月—2018年7月进入医院重症医学科实习学生64例,按照学生自身意愿以及学校安排将参与实验学生分为均数相同的两个小组(对照组、观察组),每组实验人数均为32例,其中对照组(n=32)采用传统教学方法 ,观察组(n=32)则应用PBL教学法教学,对比两组学生在学期结束后整体的学习质量情况和教学满意率.结果 观察组学生经过测试后理论知识和专业技能得分均对比对照组更高,教学效果更加理想,观察组学生对于教学的满意率评价更高,P<0.05.结论 重症医学科临床心肺复苏术教学中应用PBL教学法,将理论与实践进行结合,对教学方法 进行改进,全面提升学生的思维理解能力,培养良好的动手能力,促进理论教学与实践的结合,为学生以后的职业生涯提供更加理想的条件.     

椎体成形术联合补肾健骨汤治疗老年骨质疏松性压缩骨折的临床效果

目的:分析椎体成形术联合补肾健骨汤治疗老年骨质疏松性压缩骨折的临床效果。方法:选择2016年9月-2019年4月本院收治的73例老年骨质疏松性压缩骨折患者,按随机数表法分为两组,对照组(36例)采用椎体成形术治疗,研究组(37例)在对照组的基础上加用补肾健骨汤治疗,对比两组临床效果、腰椎功能及疼痛度。结果:研究组治疗总有效率94.59%(35/37)比对照组高(P<0.05);研究组腰椎功能评分(16.36±1.69)分,明显比对照组优(P<0.05);研究组治疗后腰椎疼痛度为(3.13±0.23)分,明显比对照组低,差异具有统计意义(P<0.05)。结论:老年骨质疏松性压缩骨折采用椎体成形术联合补肾健骨汤治疗,可减轻疼痛度,改善腰椎功能,还能提高治疗效果,值得临床推广。     

三位一体无缝隙护理在妊娠期高血压中的应用

目的对三位一体无缝隙护理在妊娠期高血压中的应用进行观察和分析。方法选择了2018年6月—2018年12月在本院进行了妊娠期高血压护理的60例患者进行研究,对所有患者均采取了三位一体无缝隙护理,对所有患者干预前后血压控制情况、生命质量评分以及心理健康评分进行对比。结果在进行干预之后,患者的血压控制情况、生命质量以及心理健康情况均显著优于干预之前,P<0.05差异有统计学意义。结论在对妊娠期高血压患者护理时,采取三位一体无缝隙护理措施可以对患者血压情况进行控制,缓解患者负面情绪,能够给予患者以及胎儿一定的保障。     

FLAG方案治疗难治复发性急性白血病临床疗效

目的探究FLAG方案治疗难治复发性急性白血病的临床疗效。方法择取2017年3月—2018年12月期间医院收治的76例难治复发性急性白血病患者为研究对象,随机分为对照组与观察组,每组38例。对照组患者行MEA方案治疗,观察组患者行FLAG方案治疗,比较两组患者肿瘤控制效果以及不良反应发生率。结果观察组患者肿瘤控制效果73.68%高于对照组50.00%,差异有统计学意义(P<0.05);观察组患者总不良反应发生率31.58%低于对照组55.26%,差异有统计学意义(P<0.05)。结论FLAG方案治疗难治复发性急性白血病效果较为理想,同时具有较高的安全性。