领导-成员交换关系在变革型领导与护理差错管理氛围间的中介作用

目的 探讨领导-成员交换关系(LMX)在变革型领导与差错管理氛围间的中介作用,为临床护理管理提供参考。方法 采用 便利抽样方法抽取唐山市4所三级甲等医院的临床护士877人,应用一般资料调查问卷、变革型领导量表、领导-成员交换关系量 表和差错管理氛围量表进行调查。结果 变革型领导总分为94.57±16.68,LMX 总分为56.02±11.67,差错管理氛围总分为 60.94±12.15。变革型领导与差错管理氛围、LMX呈正相关,LMX与差错管理氛围呈正相关(均 P<0.01);变革型领导对差错 管理氛围的间接效应成立,间接效应为0.134;变革型领导作用于差错管理氛围的效应有25.52%是通过 LMX 起作用。结论 变 革型领导能够增强护士长与护士之间的领导-成员交换关系,进而改善差错管理氛围。     

超声显象诊断腹腔动脉瘤伴血栓形成一例

患者男,61岁,上腹痛7个月,就诊检查时发现左上腹肿块。腹痛能自行缓解,不放射,与饮食无关,无恶心呕吐,亦无发热,大便正常。无腹部外伤史。三年来头晕,夜尿增多。吸酒30年。检查:血压160/110,心率80次,心律齐,心尖区可闻Ⅲ级收缩期杂音。腹软,上腹触及3×4cm肿块,边界清,表面光滑,无压痛,肿块伴有搏动,局部可闻间断     

丙种球蛋白联合甲泼尼龙琥珀酸钠治疗婴幼儿毛细支气管炎疗效分析

目的：研究丙种球蛋白（IVIG）联合甲泼尼龙琥珀酸钠（甲泼尼龙）对6个月以下婴幼儿毛细支气管炎的治疗效果。方法54例6个月以下毛细支气管炎患儿按就诊单双号顺序分为对照组和治疗组,两组均采用综合治疗,治疗组在此基础上加用 IVIG（400 mg·kg －1·d －1×3 d）和甲泼尼龙琥珀酸钠（1～2 mg· kg －1·d －1×3 d）,比较两组效果。结果治疗组呼吸困难缓解、咳嗽喘憋消失、肺部啰音消失以及住院天数均短于对照组（均 P ＜0．05）。治疗组痊愈25例（92．6％）,好转2例（7．4％）;对照组分别为18例（66．7％）、9例（33．3％）,两组疗效差异有统计学意义（χ2＝5．59,P ＜0．01）。结论丙种球蛋白联合甲泼尼龙治疗婴幼儿毛细支气管炎效果显著,优于传统治疗方法,值得推广。     

驱动平衡技术在踝关节磁共振T2WI成像中的临床应用

目的通过对磁共振常规T2WI施加驱动平衡技术,探究该技术在保证图像对比度和图像质量的前提下能否显著缩短扫描时间、加快扫描速度。方法随机选取10名志愿者对其踝关节进行磁共振检查。每名志愿者进行3种T2WI扫描,分别为常规T2WI扫描(TR=4250 ms),短TR时T2WI扫描(TR=2500 ms),短TR时且施加驱动平衡的T2WI扫描(TR=2500 ms)。分析各种扫描图像的软组织对比度和图像质量。结果的部分未复制上。结论在T2WI中施加驱动平衡技术,可在保证图像质量的前提下缩短扫描时间,值得推广。     

超声引导经皮肝胆道引流术治疗恶性胆道梗阻102例分析

目的 评价超声引导下经皮肝胆道引流术(PTCD)治疗恶性胆道梗阻的临床疗效。方法 对102例不能手术根治的恶性胆道梗阻患者行超声引导PTCD术。其中肝门部胆管阻塞(A组)68例，胆总管阻塞(B组)34例。内外引流57例，外引流45例。行左路术式88例，右路术式3例，左路 右路术式11例。A组中11例合并右肝管阻塞者行左路 右路术式的左右肝管双管外引流。102例中82例患者完整随访。结果 102例患者置管成功率100％，无1例出现胆漏、出血等穿刺并发症。A、B两组术后疗效优良率分别达到95．6％、100％。经十二指肠乳头的内外引流术较不经十二指肠乳头的内外引流术，术后胆道感染和胰腺炎的发生率明显增高。外引流和内外引流两种引流方式之间的疗效及生存率差异无显著性意义。PTCD换管次数与生存期呈正相关。结论 超声引导PTCD是姑息性治疗手术不能根治的恶性胆道梗阻的有效方法，超声引导左路术式的胆汁引流成功率高且安全，术后监控引流管引流通畅是提高生存期的关键。     

真两性畸形超声表现1例

患者，18岁，社会心理性别女性，因青春期后无月经来潮来我院就诊。入院后查体：外观发育正常，无明显喉结突出，乳房发育同正常成人女性，双腋下及会阴部无腋毛阴毛，会阴呈女性生殖器外形，可见尿道口及阴道，阴蒂发育较差。盆腔CT报告“子宫缺如，左髂血管前方不规则肿块，考虑隐睾”。     

综合医院病区护士院内转岗现象的相关研究进展

综合医院病区护士院内转岗到非临床科室或非护理岗位的现象普遍存在,成为临床一线护理人力不足的原因之一。本文综述了护士流失的现状、原因及病区护士院内转岗的高危科室、转岗原因、结果和国内外相关绩效管理的措施,以期能够引起护理管理者对这一问题的重视,采取有针对性措施控制这一现象的蔓延,保证病区护士与实际开放床位比达到0.6∶1的国家标准,减轻病区护士工作负担,保障护理安全与护理质量。     

骨髓间充质干细胞移植治疗系统性红斑狼疮

BACKGROUND: The non-specific immune suppression method is generally used for treatment of systemic lupus erythematosus, but poor prognosis, such as infection and high recurrence rate, exists. OBJECTIVE: To evaluate the therapeutic effect of bone marrow mesenchymal stem cell transplantation on systemic lupus erythematosus in mice. METHODS: Sixteen mice with systemic lupus erythematosus were equivalently randomized into control and experimental groups, or then subjected to passage 3 bone marrow mesenchymal stem cell transplantation or the equal volume of normal saline via the tail vein, respectively. Mouse urine samples were collected to detect urine protein levels by Bradford method. Blood samples from the tip of the mouse tail were extracted to detect serum anti-ds-DNS antibody concentration by radioimmunoassay. Mouse kidney tissues were taken and observed pathohistologically through hematoxylin-eosin staining and immunohistochemistry staining under microscope. Flow cytometry was used to detect the expression of CD4+CD25+T cells in the inner canthus blood, fresh spleen and thymus. RESULTS AND CONCLUSION: Within 10 weeks after cell transplantation, the urine protein levels in the two groups were gradually increased, and the rising velocity was higher in the control group than in the experimental group. From the 4th to 10th week, the urine protein levels in the experimental group were significantly lower than those in the control group (P < 0.05). In the control group, lymphocyte infiltration was visible in the kidney tissues with a few of plasmocytes, and pathological findings showed the mice presented with interstitial nephritis; in the experimental group, the mice had no pathological changes in the kidney. In the two groups, immune complexes were found in the mesangial area, which showed a patch-like distribution in the control group and a punctate distribution in the experimental group; the relative proportion of the occupied area in the experimental group was significantly lower than that in the control group. The expression level of CD4+CD25+T cells in the blood and thymus were significantly higher in the experimental group than the control group (P < 0.05), and the expression level of CD4+CD25+T cells in the spleen was slightly higher in the experimental group than the control group with no significant difference (P > 0.05). The serum anti-ds-DNA antibody concentration in the experimental group was significantly lower than that in the control group (P < 0.05). Taken together, bone marrow mesenchymal stem cell transplantation can improve the pathological damage in systemic lupus erythematosus mice, and has a certain therapeutic effect on systemic lupus erythematosus.       

骨髓瘤病人血清某些免疫学性质的研究

本文对21例多发性骨髓瘤病人(MM)和1例巨球蛋白血症(WM)血清Ig、补体C_3、溶菌酶含量及循环免疫复合物(CIC)进行了测定,观察了血清及血中单克隆Ig(M-蛋白)对正常人淋巴细胞功能的影响。本实验的结果表明MM血清功能性Ig、C_3、溶菌酶含量均明显下降;血清CIC阳性率显著高于正常人;血清及M-蛋白对正常人淋转均有抑制作用。上述结果提示,MM血清中某些免疫成分的异常可能对病人机体免疫功能产生影响。     

团体心理训练结合阅读疗法对在职护士职业认同、心理弹性的影响

目的:探究团体心理训练结合阅读疗法对在职护士职业认同、心理弹性的影响。方法:选取唐山中心医院120例在职护士为研究对象,随机分为对照组、观察1组、观察2组、观察3组,每组30例。对照组予以常规干预,观察1组予以团体心理训练,观察2组予以阅读疗法,观察3组予以团体心理训练+阅读疗法。比较4组干预前后护士职业认同感量表(Professional Identity Scale,PIS)、心理弹性量表(Connor-Davidson Resilience Scale,CD-RISC)评分。结果:对照组PIS各维度评分及CD-RISC各维度评分在干预前后均无明显变化(均P>0.05)。观察1组、观察2组、观察3组干预后的PIS各维度评分及CD-RISC各维度评分均较干预前明显提高(均P<0.05),且观察3组的PIS各维度评分及CD-RISC各维度评分均明显高于观察1组、观察2组(均P<0.05)。结论:团体心理训练结合阅读疗法可明显提高在职护士的职业认同感、心理弹性,促进护士心理健康,稳定护理队伍。