加强精神科护理安全管理的探讨

目的:探讨基于护患关系加强精神科护理安全管理的措施与成效。方法:选取医院精神科150例患有精神障碍的患者,随机分为对照组和观察组,每组各75例患者。对照组患者给予常规护理管理模式,观察组患者则加强护患关系的调节,对患者实施更加人性化的护理,比较分析两组患者的睡眠指数、焦虑指数、疼痛指数效果,同时通过填写调查问卷的方式,了解患者家属的态度和建议。结果:观察组患者在睡眠指数、焦虑指数、疼痛指数等方面,与对照组比较差异显著(P0.05);患者家属更倾向于患者和医护人员有着良好的护患关系,良好的护患关系可以提高患者及其家属的满意程度。结论:对于精神科的患者来说,在护理工作中,患者随时可能做出伤人、毁物等过激行为,因此如何加强对患者的护理,塑造一个良好的护患关系,成为加强精神科护理安全管理的关键。     

双侧大脑前动脉梗死区临床特点及发病机制探讨

目的探讨双侧大脑前动脉分布区梗死的临床特点和机制。方法回顾分析3例急性双侧ACA分布区脑梗死患者的临床特点和头MRI、MRA等资料。结果 3例患者均有脑血管病危险因素,包括高血压、糖尿病、吸烟、高HCY等。临床症状包括淡漠、欣快、不同程度肢体瘫痪和尿便障碍。存在严重的动脉硬化和(或)血管变异。结论情感障碍、肢体瘫痪和尿便障碍是主要临床表现,ACA解剖变异伴ICA/ACA局部狭窄或双侧ACA和MCA严重狭窄是双侧ACA分布区梗死发病的重要因素。     

脑卒中偏瘫后遗症期老年患者抑郁的治疗研究

目的 评价道家认知疗法对脑卒中偏瘫后遗症期老年患者抑郁及生活质量的影响.方法 77例脑卒中偏瘫后遗症期伴发抑郁的老年患者,按随机数字表法分为常规治疗组(38例)和综合治疗组(39例),常规治疗组采用抗抑郁剂联合一般支持性心理治疗,综合治疗组在此基础上进行道家认知治疗,两组均治疗8周,随访6个月.于治疗前,治疗后2、4、8周末及随访期末,采用汉密尔顿抑郁分级量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)分别对患者的抑郁症状及生活质量进行评定,并进行统计学分析.结果 常规治疗组治疗后HAMD评分逐渐下降,治疗后8周[(22.35±4.69)分]与治疗前[(29.62±5.95)分]比较差异有统计学意义(t=6.425,P＜0.01);随访期末HAMD评分[(24.48±4.12)分]又升高,与治疗后8周比较差异有统计学意义(t=2.014,P＜0.05),但较治疗前HAMD评分仍显著降低(t=4.836,P＜0.01).常规治疗组SS-QOL评分在治疗后逐渐升高,治疗后8周[(105.39±25.84)分]与治疗前[(86.63±23.84)分]比较差异有统计学意义(t=4.933,P＜0.01);随访期末SS-QOL评分[(96.09±21.37)分]较治疗后8周又有所下降(t=2.543,P＜0.05),但较治疗前仍显著升高(t=2.790,P＜0.05).综合治疗组治疗后HAMD评分持续下降,治疗后8周[(20.08±4.60)分]及随访期末[(15.21±3.42)分]与治疗前[(30.14±4.92)分]比较差异均有统计学意义(t=8.341、15.443,P＜0.01),并且随访期末HAMD评分显著低于治疗后8周(t=4.724,P＜0.01).综合治疗组治疗后SS-QOL评分呈逐渐升高趋势,治疗后8周[(117.56±26.22)分]及随访期末[(126.57±21.82)分]较治疗前[(86.54±23.90)分]显著升高(t=6.716、8.916,P＜0.01);随访期末SS-QOL评分也较治疗后8周显著升高(t=2.378,P＜0.05).综合治疗组治疗后8周及随访期末HAMD评分显著低于常规治疗组同时间点评分(t=2.118,P＜0.05;t=8.405,P＜0.01),SS-QOL评分显著高于常规治疗组同时间点评分(t=3.123,P＜0.05;t=6.580,P＜0.01).结论 抗抑郁剂联合一般支持性心理治疗或在此基础上进行的道家认知治疗均可不同程度地改善脑卒中偏瘫后遗症期老年患者的抑郁症状,提高其生活质量.道家认知疗法起效虽慢,但远期疗效好.

Abstract：

Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.     

“五常法”在门诊药房规范化管理中的应用

目的探讨门诊药房应用＂五常法＂对提高药品管理质量,提升药学服务的作用。方法运用＂五常法＂对工作环境,药品摆放、储存及使用等工作流程进行管理,并定期进行检查、评估与更新。结果药房工作环境及病人取药环境得到明显改善,药品调配差错率明显下降,药品管理质量及患者取药满意度、服药依从性均得到提高,同时也提升了药学人员的工作效率及药学服务能力。结论 ＂五常法＂是药房质量精细化、科学化管理的有效方法,易实施,见效快,值得推广。     

医源性老年期神经质性焦虑抑郁障碍76例报告

目的 探讨一类医源性老年期神经质性焦虑抑郁障碍的发病原因、临床特点及治疗方法.方法 对76例以头部不适为主诉、伴有明显情绪障碍的老年患者,进行艾森克人格问卷(EPQ)N量表24个项目及医学应对方式问卷(MCMQ)测评,给予为期4周的抗焦虑及心理治疗,在治疗开始前及用药1周末、2周末、4周末及6月末随访时分别进行Zung...     

中医护理在脑卒中卧床患者经鼻肠管泵入肠内营养中的应用效果研究

目的:观察中医护理在脑卒中卧床患者经鼻肠管泵入肠内营养中的应用效果。方法:选择64例脑卒中卧床患者,采用随机数字表法分为试验组与参照组,每组32例。参照组经鼻肠管泵入肠内营养,期间实施常规护理,试验组在参照组基础上实施中医护理。比较2组干预前后营养指标、美国国立卫生研究院卒中量表(NIHSS)、生活能力评分及吸入性肺炎发生率。结果:干预后,试验组转铁蛋白、白蛋白水平均高于参照组,体质量指数、三头肌皮褶厚度、上臂围均大于参照组,差异均有统计学意义(P0.05)。干预1周、1个月,试验组NIHSS评分低于同期参照组,生活能力评分高于同期参照组,差异均有统计学意义(P0.05)。试验组发生吸入性肺炎1例,占比3.13%;参照组发生吸入性肺炎6例,占比18.75%,2组比较,差异有统计学意义(P0.05)。结论:在脑卒中卧床患者经鼻肠管泵入肠内营养过程中实施中医护理,可以改善其营养状况和神经功能,预防吸入性肺炎发生。     

机采浆异常反应3例及处理

1998～1999年,甘肃省有3家采浆站在应用血浆分离机对供浆者进行单采血浆中,曾出现3例异常反应.经检查系热原及溶血反应,紧急处理后恢复.笔者旨在加强血源管理,严格把好器材质量关和提高采浆工作人员责任心方面予以警示.     

酶联免疫吸附试验中HBsAg室内质控参考品的制备和应用

目的建立室内质控参考品以鉴别诊断试剂的质量和控制操作误差,提高乙型肝炎病毒表面抗原的检测准确度。方法以国家标准品为标准制备灵敏度系列参考品、特异性参考品及精密性参考品。检测其稳定性,并进行同厂家、不同批号试剂的比较及不同厂家、三批试剂的比较。结果制备的室内质控参考品在-20℃与4℃保存3～4周检测结果无统计学差异。采用同一厂家、不同批号的HBsAg诊断试剂检测室内质控参考品,结果无统计学差异。采用不同厂家、同一批号的HBsAg诊断试剂检测结果有统计学差异。结论我们建立的室内质控参考品适宜作HBsAg室内质控,提醒我们在更换试剂厂家时应特别注意室内质控参考品的变化。     

电针对脑卒中患者软瘫肢体肌张力及运动功能的影响

Objective To investigate the effects of electro-acupuncture on muscular tension and motor function in the flaccid,paralytic limbs of stroke survivors.Methods Seventy-two stroke survivors with flaccid,paralytic limbs were divided randomly into a control group and an electro-acupuncture group.Both grourps received routine therapy and rehabilitation training,but the electro-acupuncture group was also treated with electro-acupuncture.Muscular tension and motor function in the flaccid,paralytic limbs in both groups were evaluated by modified Ashworth scale (MAS)and Fugl-Meyer scores before treatment and at the end of 4 weeks.Results After treatment,in 24 patients of the electro-acupuncture group and 10 patients of the control group muscular tension had increased 1-2 grades.The effectiveness rate(68.57%)in the electro-acupuncture group wag higher significantly than that(27.03%)in the control group(P＜0.01).Fugl-Meyer scores in the electro-acupuncture group were significantlv higher than those in the control group(P＜0.01).Conclusion Electro-acupuncture supplementing traditional rehabilitation improves muscle tension in flaccid,paralytic limbs and promotes the recovery of motor flunction after stroke.