呼吸湿化治疗联合咳痰机对脑卒中合并吞咽困难患者咳痰的影响

目的 探讨呼吸湿化治疗联合咳痰机对脑卒中合并吞咽困难患者咳痰的影响。方法 将80例研究对象按住院时间顺序分为对照组(41例)和治疗组(39例),治疗组采用呼吸湿化治疗仪进行呼吸道湿化治疗6h后用无创气道咳痰机辅助排痰; 对照组采用传统的翻身、拍背、雾化、吸痰等常规辅助排痰措施; 观察2组患者治疗结束后总的排痰量、血氧饱和度(SpO₂)、呼吸频率(R)、心率(HR)、口干例数和肺部感染发生率。结果 治疗组患者的排痰量和血氧饱和度显著高于对照组,呼吸频率、心率、口干和肺部感染发生率均显著低于对照组(P<0.05)。结论 呼吸湿化治疗和无创气道咳痰机联合应用能够有效清理患者呼吸道分泌物,提高患者血氧饱和度,促进患者咳痰,降低患者脑卒中相关性肺炎的发生率。     

老年脑梗死合并肺部感染的危险因素与防治措施

目的观察老年脑梗死合并肺部感染的危险因素,并对防治措施进行讨论。方法对2013-01—2014-12至河南中医药大学第一附属医院神经内科治疗的老年脑梗死132例患者的临床资料进行回顾性分析,根据住院期间是否合并肺部感染将患者分为观察组和对照组,观察组51例为并发肺部感染患者,对照组81例为未并发肺部感染患者,统计患者入院时的年龄、状态、基础性疾病情况,以及是否合并延髓性麻痹、脑梗死的范围。观察年龄、意识障碍、延髓性麻痹、合并慢性疾病等因素对脑梗死合并肺部感染是否有影响,进行单因素分析,并比较2组患者病死率和住院时间。结果与对照组比较,年龄75岁、有意识障碍、有慢性疾病、有延髓性麻痹的患者合并肺部感染的比例更高,且差异具有统计学意义(P0.05)。观察组病死率17.65%,对照组为8.64%,观察组明显高于对照组,而住院时间观察组也明显比对照组长,差异均具有统计学意义(P0.05)。结论肺部感染是老年脑梗死常见的并发症之一,年龄、意识障碍、慢性疾病、延髓性麻痹均为影响该并发症的重要因素。对于出现肺部感染的患者及时抗炎治疗,可降低患者病死率,减少住院时间,改善预后。     

综合护理干预在老年脑梗死患者肺部感染预防中应用观察

目的对综合护理干预在老年脑梗死患者肺部感染预防中的应用进行观察和分析。方法选取驻马店市中心医院2015-01—2016-01收治的92例老年脑梗死患者,采用随机数表法将患者平均分为观察组和对照组,观察组患者接受综合护理干预,对照组患者接受常规护理,比较2组患者护理效果以及肺部感染情况。结果观察组患者肺部感染率以及感染时间低于对照组患者,术后情绪情感评分、领悟家庭支持评分以及治疗总有效率(97.83%)高于对照组(84.78%),以上指标组间比较均存在显著差异(P0.05)。结论综合护理干预是预防和降低老年脑梗死患者肺部感染和感染率的有效途径,也是改善患者情绪、提高治疗效果的有效途径,值得推荐使用。     

预见性护理在老年肺性脑病防治中的作用及意义

目的分析预见性护理在老年肺性脑病防治中的作用,为临床治疗提供指导。方法选取2009-01—2011-03来我院救治的肺部疾病患者136例为研究对象,对照组64例采用常规护理,研究组72例采用预见性护理,观察分析2组患者治疗前后数字连接试验复常率,住院时间,肺性脑病的发生率,病死率及肺性脑病的严重程度。结果治疗后,2组患者数字连接试验异常率、复常率存在明显差异(P0.05);对照组肺性脑病发生率高于研究组,差异有统计学意义(P0.05),对照组病死率高于研究组(P0.05)。结论对老年肺部疾病患者采用预见性护理可以减少肺性脑病的发生率和病死率,且病情较轻,效果显著,值得推广。     

综合护理干预对老年脑梗死合并下肢静脉血栓的影响

目的探讨综合护理干预对老年脑梗死合并下肢静脉血栓的影响。方法随机选取2015—09来我院住院的84例老年脑梗死患者,随机分为观察组和对照组,每组各42例,观察组行综合护理,对照组行基础护理。观察并记录2组患者下肢静脉血栓的发生率及住院时间。结果观察组并发下肢静脉血栓的患者0例,对照组4例,2组比较差异有统计学意义(P0.05);观察组住院时间(45.3±6.8)d,对照组(67.2±5.9)d,2组住院时间比较差异有统计学意义(P0.05)。结论综合护理干预不仅能够有效预防老年梗死下肢静脉血栓的发生,且能够明显缩短住院时间,对早日康复及提高生存质量有积极作用。     

痰热清对脑梗死并发肺部感染患者的疗效

目的观察痰热清注射液对脑梗死并发肺部感染患者的临床疗效。方法选择我院神经内科2010-01—2012-06收治的脑梗死并发肺部感染患者50例,分为研究组和对照组,每组25例。研究组使用痰热清注射液静滴;对照组不使用。对比2组的治疗效果、体温恢复时间、肺部杂音消失时间、咳嗽停止时间及后遗症出现情况。结果研究组治疗总有效率为92%,对照组为64%。研究组患者体温恢复、肺部杂音、咳嗽停止时间均早于对照组;研究组共出现后遗症1例,对照组6例。结论痰热清对脑梗死后并发肺部感染患者的辅治效果较理想。     

人性化护理干预在老年结肠癌合并肠梗阻患者中的效果分析

目的探讨人性化护理干预在老年结肠癌合并肠梗阻患者中的护理效果。方法选择我院2009-11—2012-11结肠癌合并肠梗阻患者60例,随机分为观察组和对照组。观察组在常规护理基础上给予人性化护理干预,对照组给予常规护理。观察2组患者术后并发症情况及护理满意度。结果观察组切口感染发生率1.0%,肺部感染发生率3.3%,无下肢静脉血栓发生,粘连性肠梗阻发生率3.3%。对照组切口感染发生率为40.0%,肺部感染发生率33.3%,下肢静脉血栓发生率20.0%,粘连性肠梗阻发生率为30.0%。观察组发生率均低于对照组,差异有统计学意义(P0.05)。观察组患者对护理满意度为93.4%,对照组为63.3%,观察组护理满意度高于对照组,差异有统计学意义(P0.05)。结论人性化护理干预能够降低老年结肠癌合并肠梗阻患者术后并发症的发生率,提高患者对护理的满意度,护理效果显著。     

护理指导对脑梗死并延髓性麻痹患者肺部感染发生率的影响

目的探讨护理指导对脑梗死并延髓性麻痹患者肺部感染发生率的影响。方法 88例脑梗死并延髓性麻痹患者随机分为2组,A组44例,给予常规抗血小板聚集和康复治疗、护理;B组44例,在A组基础上给予防止肺部感染的护理指导。观察2组住院期间肺部感染发生率的差异。结果 A组肺部感染发生率高于B组(68.18%vs 25.00%),差异有统计学意义(P0.05)。结论护理指导能够降低脑梗死并延髓性麻痹患者肺部感染的发生率,值得进一步推广。     

不同体位咳痰对气管切开术后继发肺部感染病人体温恢复的影响

目的 比较坐位咳痰与侧卧位咳痰对神经外科气管切开术后继发肺部感染病人体温恢复的影响。方法 选取2015年6月至2017年6月收治的气管切开术后合并肺部感染120例。采用座位排痰58例（观察组），侧卧位排痰62例（对照组）。两组咳痰前均予胸背部联合叩击，观察组叩击后采取坐位进行有效咳痰；对照组叩击后采取侧卧位进行有效咳痰。结果 与对照组相比，观察组排痰后1周内每日咳痰量明显增加（P<0.05），排痰后7、14 d肺部听诊评分均明显提高（P<0.05），排痰后14 d咳痰显效率明显增高（P<0.05），排痰后第二周每日最高体温明显降低（P<0.05）。结论 对于神经外科气管切开术后继发肺部感染病人，坐位咳痰对病人体温恢复效果优于侧卧位咳痰。     

护理干预在降低脑卒中患者获得性下呼吸道感染的作用

目的探讨护理干预在降低脑卒中患者获得性下呼吸道感染的作用。方法选择2012-03—2014-03我院收治的脑卒中无下呼吸道感染脑卒中患者100例,随机将其分为观察组和对照组各50例,均给予基础治疗,对照组在治疗的基础上给予常规护理措施,观察组在治疗的基础上给予卒中单元护理措施,比较2组感染发生及感染时间、住院时间、住院费用增加等情况。结果观察组获得性下呼吸道感染的发生率为6.0%,对照组为16.0%,观察组明显低于对照组;与对照组相比,观察组感染时间、住院时间均有明显缩短,住院费用增加有明显降低,差异具有统计学意义(P0.05)。结论卒中单元护理措施应用于脑卒中临床护理,能够有效降低患者获得性下呼吸道感染的发生率,具有较高的临床应用价值。     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.