小儿急性中毒103例抢救体会

小儿急性中毒是儿科急症,需要紧急处置和抢救。尤其是近年来药物品种增多及家庭对药物管理不善,药物中毒病例明显增多,直接危害患儿健康。为此,我们对1979～1990年住院的103例中毒病例(未包括食物中毒)作回顾性总结分析,提出了小儿急性中毒的特点、诊断及早期治疗。 1 临床资料     

纳洛酮对缺氧诱导大鼠神经元损伤的抑制作用及其机制

目的探讨纳洛酮对缺氧诱导大鼠神经元损伤的作用及其可能的机制。方法体外培养大鼠神经元，将其分为正常对照组、缺氧诱导组、缺氧诱导＋纳洛酮干预组。应用流式细胞术测定大鼠神经元损伤；应用荧光探针2，7-二氯二氢荧光素乙酰乙酸（DCFDA）检测细胞内活性氧的变化；应用比色法检测超氧化物歧化酶（SOD）的活性；应用Westernblot检测NF—KB的活化。结果（1）纳洛酮抑制缺氧诱导的大鼠神经元凋亡，缺氧组大鼠神经元细胞凋亡明显增加，为对照组的3．54倍，纳洛酮干预组为对照组的1．35倍（均P〈0．05）。（2）纳洛酮抑制缺氧诱导的活性氧生成，缺氧诱导大鼠神经元活性氧生成，为对照组的2．66倍，纳洛酮干预组为对照组的1．24倍（均P〈0．05）。（3）纳洛酮抑制缺氧诱导的NF—KB活化（P〈0．05）。（4）抗氧化剂NAC抑制缺氧诱导的NF—KB活化，抑制率达49％（P〈0．05）。结论纳洛酮抑制缺氧诱导的活性氧生成，进而抑制NF—KB活化，从而抑制缺氧诱导的大鼠神经元凋亡。     

三级医院护理术语体系架构和使用现状的质性研究

[目的]分析国内临床医院护理术语的体系架构和使用情况,为护理术语的发展和完善提供科学的研究基础。[方法]采用目的抽样方法选取国内9所三级医院作为研究单位,采用半结构式访谈和临床护理文件分析的方法,对三级医院的护理管理者和临床护理资料进行调查。[结果]各医院护理术语的架构和使用存在较大差异,尚未形成护理术语的规范化、同质化;护理表单基本涵盖护理程序的各环节,但尚未形成完整的体系。[结论]目前的护理术语体系和架构难以成为专业交流和信息共享的有效平台,不能充分发挥有效的决策支持作用,建议基于护理程序构建我国的护理术语框架体系。     

幼年大鼠溺水应激后胰岛素信号传导变化及外源胰岛素治疗反应

Objective To explore the alteration of insulin signal transduction in drowning-induced stress hyperglycemia and to investigate therapeutic effect of insulin on it.Methods Stress hyperglycemia model was induced by drowning.Thirty-two infant rats were randomized into control,drowning,air resuscitation and air-insulin resuscitation groups.Insulin was injected abdominally into the air-insulin resuscitation rats.Fasting serum glucose and insulin were determined routinely,and protein expressions and serine phosphorylation levels of insulin receptor substrate 1(IRS-1) in muscle tissue were detected by Western blot and immunoprecipitation.The expressions of glucose transporter 4(GLUT4) in the intracellular and plasma membranes of muscle tissue were detected by Western blot.Results In the drowning group,insulin resistance index(HOMA-IR) increased significantly as compared with that of the control group,but the level of IRS-1 had no significantly change as compared with the other three groups.As compared with that of the drowning group(0.71±0.12),IRS-1 serine phosphorylation levels of the two resuscitation groups decreased significantly(0.56±0.13 and 0.46±0.08 respectively).The intracellular GLUT4 expression in the two resuscitation groups(1.82±0.11 and 1.96±0.28 respectively)increased significantly in contrast to that of the drowning group(1.45±0.15),and the air-insulin resuscitation groups showed an especially high increase of intracellular GLUT4 expression.Conclusion During the drowning-induced stress hyperglycemia,the alteration of serine phosphorylation and GLUT4 distribution is one of the important mechanism of insulin resistance.Insulin may decrease the blood glucose through decreasing serine phosphorylation levels of IRS-1 and increasing the intracellular GLUT4 expressions.     

幼年大鼠溺水应激后胰岛素信号传导变化及外源胰岛素治疗反应

Objective To explore the alteration of insulin signal transduction in drowning-induced stress hyperglycemia and to investigate therapeutic effect of insulin on it.Methods Stress hyperglycemia model was induced by drowning.Thirty-two infant rats were randomized into control,drowning,air resuscitation and air-insulin resuscitation groups.Insulin was injected abdominally into the air-insulin resuscitation rats.Fasting serum glucose and insulin were determined routinely,and protein expressions and serine phosphorylation levels of insulin receptor substrate 1(IRS-1) in muscle tissue were detected by Western blot and immunoprecipitation.The expressions of glucose transporter 4(GLUT4) in the intracellular and plasma membranes of muscle tissue were detected by Western blot.Results In the drowning group,insulin resistance index(HOMA-IR) increased significantly as compared with that of the control group,but the level of IRS-1 had no significantly change as compared with the other three groups.As compared with that of the drowning group(0.71±0.12),IRS-1 serine phosphorylation levels of the two resuscitation groups decreased significantly(0.56±0.13 and 0.46±0.08 respectively).The intracellular GLUT4 expression in the two resuscitation groups(1.82±0.11 and 1.96±0.28 respectively)increased significantly in contrast to that of the drowning group(1.45±0.15),and the air-insulin resuscitation groups showed an especially high increase of intracellular GLUT4 expression.Conclusion During the drowning-induced stress hyperglycemia,the alteration of serine phosphorylation and GLUT4 distribution is one of the important mechanism of insulin resistance.Insulin may decrease the blood glucose through decreasing serine phosphorylation levels of IRS-1 and increasing the intracellular GLUT4 expressions.     

先天性痛觉缺失综合征伴无汗症1例

患儿女，１岁。出生后家长发现患儿无痛觉，皮肤烫伤、肌肉注射及静脉输液时不知疼痛，也不知躲避，经常玩弄舌尖，喜咬手指，多次将舌尖及手指咬破出血，均不知疼痛。患儿从不出汗，于天气炎热时出现发热，体温波动在３８０℃～４００℃之间，抗生素及退热药治疗无效，需物理降温。患儿为第１胎孕４２周，胎头吸引助产，生后窒息５分钟。父母均系农民，非近亲婚配，家庭中无类似病患者。体检：体温３８５℃，脉搏１２０／ｍｉｎ，呼吸２４／ｍｉｎ，身长７０ｃｍ。表情淡漠，发育落后，皮肤光滑无皮疹。眼、耳、鼻未见异常，牙釉质发…     

儿童术中低体温列线图预测模型构建

目的 建立儿童术中低体温列线图预测模型,为术中儿童低体温评估与预防提供参考.方法 选取接受手术治疗的1086例患儿,在医院病历系统中收集相关资料.采用x 2检验、秩和检验和logistic回归分析确定影响因素,利用R软件绘制儿童术中低体温列线图预测模型.结果 儿童术中低体温发生率为17.31％;年龄、术前体温≤36.9...     

儿童及青少年肿瘤患者症状特征研究

目的了解10～18岁儿童及青少年肿瘤患者症状的发生率、频率及困扰程度,识别影响其症状的因素,为临床开展症状管理提供依据。方法采用记忆症状评估简表对101例10～18岁肿瘤患儿进行问卷调查。结果儿童及青少年肿瘤患者躯体症状发生率居前5位的分别是出汗、没有胃口、恶心、对食物的味觉改变和没有精力;症状困扰程度居前5位的分别为疼痛、恶心、没有胃口、掉头发和便秘。在心理症状中,发生率最高的为感到紧张。性别、教育水平、治疗阶段及治疗环境不同的肿瘤患儿,其部分维度症状得分差异有统计学意义(P<0.05,P<0.01)。结论肿瘤患儿症状有其自身特点,肿瘤科护士需根据患儿的不同性别、生长发育阶段、治疗阶段和治疗环境,提供针对性的症状管理。     

对儿童血液肿瘤科护理人员进行能力本位培训的效果评价

目的确定开展能力本位培训对儿童血液肿瘤科护理人员专科知识及技能的影响。方法选择2003年在上海儿童医学中心血液肿瘤科全体临床护理人员26名。根据美国St.Jude儿童研究医院的认证经验和相关文献设立儿童血液肿瘤科护理人员的专科能力本位培训内容与方法;每项项目是重复3次的滚动式标准培训,培训共持续8个月。根据培训内容设计知识试卷和操作评分标准;培训前用知识试卷进行前测,培训结束后用同一张试卷进行后测,比较前测和后测结果。同时培训后用操作评分标准测试操作技能。结果培训后临床护理人员的知识水平比以前有显著提高,P=0.000;培训后护理人员操作第1次合格率为96.2%。结论系统的标准临床专科能力本位培训能显著提高儿童血液肿瘤科护理人员的专科核心能力。     

护士长胜任力模型的介绍

<正>以往管理与领导界限不清[1],管理者多凭经验感觉来决策,我们称之为感觉决策者[2]。研究[3]表明,缺乏人际沟通、倾听和冲突管理技巧的管理者并不能很好地完成本职工作。本文为了进一步描述优秀管理者的特质,提出了胜任力的概念,并就国外护士长胜任力模型的相关研究报道进行综述。1胜任力的概述1.1胜任力的定义胜任力的概念最早由McClelland[4]在1973年提出。胜任力是一种最基本的特