微量注射泵注射生长抑素在肝硬化并上消化道出血治疗中的护理

目的探讨微量注射泵注射生长抑素在肝硬化并上消化道出血治疗中的护理要点,提高临床治愈率。方法将2008年8月—2011年2月32例肝硬化并上消化道出血患者给予微量注射泵注射生长抑素治疗及护理。结果有效21例,有效率65.625%;无效11例,无效率34.375%。结论生长抑素治疗肝硬化并上消化道出血有很好的疗效,强调严格控制药物的浓度、注射速度及操作规范、严密观察病情变化,是保证成功抢救患者和更好地进行后续治疗及防止并发症发生的关键。     

66例宫缩乏力性产后出血护理体会

目的探讨综合护理在宫缩乏力性产后出血治疗中的作用。方法对我院2007年2月至2010年11月收治的66例宫缩乏力性产后出血患者进行治疗及综合护理。随机平均分为2组,护理组和对照组,2组患者均采用欣母沛注射治疗,护理组辅以综合护理。结果护理组33例患者治疗后显效23例,有效10例,无出血性休克出现。对照组显效16例,有效16例,出血性休克1例。2组有效率对比有显著差异,P<0.05。结论综合护理对宫缩乏力性产后出血有积极意义,我们应该加强分娩临床护理工作。     

浅谈上消化道出血患者的内科护理

目的归纳上消化道出血的病因,探索上消化道出血患者的有效护理方法和护理途径。方法对102例上消化道出血患者的内科护理工作做回顾性横断面研究。结果通过密切监视、及时给药、做好饮食、心理护理,102例患者取得了良好的护理和治疗效果。结论上消化道出血患者整个治疗过程中,临床护理观察是临床诊断治疗的科学根据。     

上消化道出血患者的护理体会

目的 归纳上消化道出血的病因,探索上消化道出血患者的有效护理方法和护理途径.方法 对99例上消化道出血患者的内科护理工作进行回顾性分析.结果 通过密切监视、及时给药、做好饮食、心理护理,99例患者取得了良好的护理和治疗效果.结论 上消化道出血患者整个治疗过程中,临床护理观察是临床诊断治疗的科学根据.     

组织胶联合套扎治疗食管胃底静脉曲张的护理

目的观察胃镜下注射组织胶联合套扎治疗食管胃底静脉曲张的疗效与护理。方法选取2017年1-10月天津市第四中心医院收治的34例食管胃底静脉曲张破裂出血患者,采用胃镜下注射组织胶联合套扎治疗,为患者提供全面专业化、人性化的护理,并对此项治疗的护理进行全面总结,以便于更好的运用到现有的临床护理工作,达到患者满意的效果。结果 34例患者中有32例止血成功,其中显效20例,有效12例,无效2例,总止血成功率为94.1%,其中2例无效术后出血患者,经检查与排胶有关,但经过治疗后出血停止,患者住院日期未延长,未增加患者不必要经济负担。结论充分的术前准备,术中熟练配合医生完成治疗,术后的专业化护理可以提高治疗的成功率、降低死亡率、减少患者痛苦、减轻患者经济负担。     

60例产后出血患者的疗效观察及护理体会

目的探讨欣母沛治疗产后出血患者的疗效及护理体会。方法 2010年11月~2012年11月,先后有60例产后出血患者在我院诊疗,将其随机分为对照组（催产素治疗）和观察组（欣母沛治疗）,观察两组产妇的临床疗效、止血速度以及出血量。结果观察组30例产妇注射欣母沛后,27例产妇疗效显著,显效率为90.0%,2例有效,仅有1例效果不明显,总有效率为96.7%;观察组产妇的止血速度快,出血量减少（P〈0.05）。结论欣母沛治疗产妇产后出血给予相应的护理干预,能够显著提高产妇产后出血治疗的质量,值得临床推广应用。     

危重新生儿合并上消化道出血的止血效果观察及护理

目的:探讨危重新生儿合并上消化道出血的止血方法及护理。方法:把住院的90例合并上消化道出血的危重新生儿随机分为治疗组和对照组。治疗组在对照组常规治疗的基础上先用1%碳酸氢钠洗胃后,给予立止血0.5KU溶于注射用水5～10ml中经胃管注入,并给予综合性护理措施。结果:治疗组的止血有效率高于对照组(P<0.01),平均止血时间也短于对照组(P<0.01)。结论:采用碳酸氢钠联合立止血治疗新生儿上消化道出血效果显著。同时采取综合性护理措施,科学严密地观察病情是提高危重新生儿合并上消化道出血临床治愈成功率的关键。     

食道静脉曲张破裂出血硬化治疗的配合与护理体会

目的经内镜注射硬化剂治疗食道静脉曲张破裂出血治疗中的配合及护理经验。方法选取我院2011年10月至2012年10月收治的肝硬化合并食管静脉曲张破裂出血的住院病人55例,治疗前做好心理护理及物品、设备准备,术中做好配合协调工作,术后密切观察病情变化,预防并发症的发生,并做好健康宣教、出院指导,以提高治愈率、减少再出血的发生。结果 55例患者中,52例术后3天内未见活动性出血,有3例出现术后出血,再次进镜局部补充组织胶治疗,并予醋酸奥曲肽静脉泵入出血控制,所有患者经2-4次治疗后曲张静脉基本消失。结论内镜下注射硬化剂治疗食道静脉曲张破裂出血安全有效,完善的护理措施是保障手术成功、患者康复的重要条件。     

低分子肝素钠注射部位与皮下出血关系的观察

低分子肝素钠和普通肝素一样属于抗凝血酶依赖性凝血酶抑制剂,其抗血栓活性强于抗凝血活性,作用优于肝素,出血副作用却低于普通肝素,临床上应用广泛。但皮下注射部位易出现疼痛、瘀血、淤斑,造成病人心理紧张,影响治疗效果。为此,许多文献报道了减少腹部皮下注射部位出血的护理措施,如垂直进针[1],不压迫穿刺点[2],规律地轮换注射部位等[3]。笔者在临床操作中发现,不同注射部位皮下出血的机率不同。为此,对2003年1月~2004年12月临床上应用低分子肝素钠的120名患者皮下注射部位与皮下出血的关系进行了观察,报告如下。1临床资料1.1一般资料选…     

16例食管静脉曲张的内镜下硬化治疗及护理

目的探究内镜下硬化治疗食管静脉曲张的临床治疗效果及其护理方法。方法选取四川省人民医院新津分院2011-06/2013-12住院部16例食管静脉曲张患者,观察其治疗效果,并总结护理方法。结果 16例食管静脉曲张患者共治疗33次,均使用聚桂醇行血管内注射。16例患者经过硬化剂治疗后,曲张静脉减少或基本消失;患者进行治疗后,配合给予密切和精心护理,本组病例未出现穿孔、食管狭窄等严重并发症。结论内镜下食管静脉曲张硬化疗法可有效治疗急性出血、根除曲张静脉、减少和预防再出血,较外科手术操作简便、安全,术中默契的护理配合是治疗成功的关键。     

MRI在临床触诊阳性的乳腺X线非对称性致密影病变诊断中的价值

目的:探讨MRI在临床触诊阳性的乳腺X线非对称性致密影病变中良、恶性疾病的诊断价值。方法;收集2009年3月～2012年3月临床触诊阳性的乳腺X线非对称性致密影病变80例,病变不伴肿块、钙化及结构扭曲,于术后分别与病理对照,观察病灶形态、分布、动态增强、时间-曲线及周围影像改变等显示情况,并统计诊断准确率。所有患者在手术前2周内均进行乳腺X线及MRI检查。结果:肿块型强化22例,非肿块型强化58例;病灶强化均匀14例,强化不均匀66例;其内伴多发脓肿,壁呈均匀或非均匀环形强化34例;患侧乳内异常血管增粗并较对侧丰富28例,皮肤局部或广泛性增厚32例,皮下水肿27例,腋下淋巴结实性增大15例;时间-曲线Ⅰ型36例,Ⅱ型22例,Ⅲ型22例。乳腺良性病变48例,其中乳腺增生症8例,硬化性腺病2例;乳腺炎症37例(慢性炎症23例,肉芽肿性乳腺炎8例,浆细胞性乳腺炎2例,囊肿伴感染4例),纤维腺瘤1例;乳腺癌32例,其中乳腺导管癌23例,乳腺小叶癌5例,乳腺血管肉瘤2例,乳腺导管癌合并乳腺小叶癌2例。结论:对临床触诊阳性的乳腺X线非对称性致密影病变中,乳腺MRI在发现病变及良、恶性疾病定性诊断具有重要价值,特别是乳腺癌的早期诊断。     

Interpersonal Processes of Care and Patient Satisfaction: Do Associations Differ by Race,Ethnicity, and Language?

Objective. Describe association of patient satisfaction with interpersonal processes of care (IPC) by race/ethnicity.
Data Sources/Study Setting. Interview with 1,664 patients (African Americans, English- and Spanish-speaking Latinos, and non-Latino Whites).
Study Design/Methods. Cross-sectional study of seven IPC measures (communication, patient-centered decision making, and interpersonal style) and three satisfaction measures (satisfaction with physicians, satisfaction with health care, and willingness to recommend physicians). Regression models explored associations, controlling for patient characteristics.
Principal Findings. In all groups: patient-centered decision making was positively associated with satisfaction with physicians ( B =0.10, p <.0001) and health care ( B =0.07, p <.001), and "recommend physicians" (OR=1.23, 95 percent CI 1.06, 1.43); discrimination was negatively associated with satisfaction with physicians ( B =0.09, p <.05) and health care ( B =0.17, p <.001). Unclear communication was associated with less satisfaction with physicians among Spanish-speaking Latinos. Explaining results was positively associated with all satisfaction outcomes for all groups with one exception (no association with satisfaction with physicians for Latino Spanish-speakers). Compassion/respect was positively associated with all outcomes for all groups with two exceptions (no association with satisfaction with health care among English-speaking Latinos and Whites).
Conclusions. All IPC measures were associated with at least one satisfaction outcome for all groups except for unclear communication.     

Life satisfaction in early rheumatoid arthritis: A prospective study

The aim of this study was to describe life satisfaction prospectively in patients with early rheumatoid arthritis (RA) and to investigate its correlation with disease activity. The early RA group was compared with RA patients with longstanding disease and with a reference group. Gender differences were also compared. Patients with early RA, treated by a multidisciplinary team, reported their life satisfaction by completing a questionnaire. Disease activity score, patient global assessment, and pain were scored at onset of disease and after two years. The patients with early RA were less satisfied with life as a whole at disease onset compared with the reference group, as was a cohort of patients with longstanding disease. Patients with early RA also reported low levels of satisfaction with self-care activities, work, and sexual life. The women reported themselves more satisfied than men. After two years, a slight increase in the reported levels of satisfaction could be seen for life as a whole and for five of the eight domains. No correlation was found between disease activity variables and satisfaction with life as a whole. There were, however, positive correlations between disease activity and satisfaction both with partnership and with family life after two years, i.e. the higher disease activity the higher satisfaction with partnership relation and family life. In contrast, patients with greater disease activity were less satisfied with self-care activities. The results of this study indicate that greater effort is needed to assist patients with early RA to cope with problems concerning self-care activities, sexual life, and work.     

米非司酮配伍利凡诺引产260例临床分析

目的比较利凡诺羊膜腔内引产和米非司酮配伍利凡诺引产的效果。方法回顾性分析本院2004年1月至2006年12月两种方法引产共380例,比较胎儿胎盘排出时间、清宫率、阴道出血量。结果利凡诺羊膜腔内引产胎儿胎盘娩出的平均时间48-50h,清宫率为45．8％,阴道流血量150-400ml之间;米非司酮配伍利凡诺引产胎儿胎盘娩出的平均时间36-38h,清宫率为123％,阴道流血量均在150ml以内。结论米非司酮配伍利凡诺引产效果优于单用利凡诺羊膜腔内引产。     

微超声探头对大肠黏膜下肿瘤的诊疗价值

目的 探讨经内镜微超声探头检查大肠黏膜下肿瘤的诊断及治疗价值.方法 应用微超声探头对大肠黏膜下肿瘤进行肠镜下超声检查,根据其起源层次及性质决定治疗方案.结果 20例结直肠黏膜下肿瘤中,间质瘤9例,脂肪瘤5例,类癌3例,肠间壁脓肿2例,肠气囊肿症1例.4例源于黏膜肌层的良性间质瘤及2例类癌经内镜切除,2例肠间壁脓肿及1例肠气囊肿症行内镜下穿刺治疗;3例源于固有肌层的良性间质瘤、2例恶性间质瘤、2例脂肪瘤、1例类癌,经手术切除.病理符合率为88.24%.其余3例脂肪瘤则内镜随访.结论 超声内镜能够对消化道黏膜下肿瘤进行起源和定性诊断,对黏膜下肿瘤治疗方案的选择具有重要的指导意义.     

老年心力衰竭合并谵妄患者的临床特点分析

目的:探讨老年心力衰竭合并谵妄患者的临床特征。方法:回顾性分析18例老年心力衰竭合并谵妄患者的临床资料。结果:心功能分级:NYHAⅢ级10例,Ⅳ级8例;临床分型:活动抑制型7例,活动亢进型5例,混合型6例;合并症:肺部感染14例,低氧血症16例,电解质紊乱12例,贫血9例,恶病质8例,肾功能不全8例;转归:完全缓解4例,不完全缓解6例,死亡8例。结论:老年心力衰竭合并谵妄多出现在终末期心衰患者,提示病情较重或有严重合并症的存在,病死率高,应及早采取积极防治措施。     

青年肺腺癌患者CT影像特点及病理

目的分析青年人群肺腺癌CT影像学表现特点及病理。方法回顾性分析2012年1月～2013年6月经临床病理确诊为原发性肺腺癌57例患者的临床、影像学资料及病理结果。结果从出现症状到明确诊断平均时间为（3.6±0.4）个月。16例（28%）误诊或延误诊疗。57例肺腺癌中,表现为中央型4例,周围型52例,弥漫型1例;多原发肺癌2例。肺内原发灶表现为肿块和结节的46例,其中磨玻璃结节2例,其余为实性。出现分叶征39例,毛刺征29例,胸膜凹陷征27例。可判断病理分化程度的51例,其中原位腺癌1例,微浸润腺癌1例,浸润型腺癌中高分化腺癌4例,中高分化2例,中分化14例,中低分化9例,低分化20例。确诊时已发生转移44例,胸部转移共38例,胸腔积液14例。结论青年肺腺癌以周围型为主,CT主要表现为肿块、结节,分化程度差,多数病例确诊时已发生转移,误诊及延误诊疗多见。     

Dietary Patterns and Weight Status in Italian Preschoolers with Autism Spectrum Disorder and Typically Developing Children

Atypical eating habits are more common in children with autism spectrum disorders (ASD) than typically developing (TD) peers. Feeding problems may lead to the double burden of specific nutrient deficiencies and excessive weight gain, with a consequent increase in obesity prevalence. The dietary intake of Italian preschoolers with ASD compared to their TD peers and the impact of their dietary choices on their weight status and relationship to food selectivity (FS) were investigated. Dietary patterns and their associations with body mass index (BMI) were evaluated in 65 children with ASD and 82 peers with TD aged 1.3–6.4 years. Eating habits were assessed with a modified version of a parent-rated semi-quantitative Food Frequency Questionnaire. Moreover, the prevalence of FS and possible links with dietary patterns and BMI were investigated in the ASD group. Children with ASD consumed significantly higher amounts of simple sugars, processed and ultra-processed carbohydrates, both low- and high-fat animal proteins, and lower amounts of vegetables and fruits compared to peers with TD. The obesity rate was 1.5% in children with TD and more than fourfold (6.2%) in children with ASD, although the difference between groups was not statistically significant. FS was significantly more frequent in children with ASD than in peers with TD. Children with ASD and FS showed significantly lower annual intakes of vegetable proteins and fiber (considered essential nutrients for a healthy diet) than children with ASD without FS. Our results showed that children with ASD showed different dietary habits than those with TD, with the higher consumption of energy-dense foods and lower amounts of food-sourced fibers, which could place them at increased risk to develop overweight, obesity, and micronutrient deficiencies later in life.     

感染乙型肝炎病毒不同基因型和亚型患者的临床特点分析

目的明确乙肝病毒不同基因型和亚型在国内的分布及其与病情的相关性。方法收集来自国内8个地区884例慢性乙型肝炎病毒感染者的血清和临床资料,用PCR-RFLP方法鉴定病毒基因型和亚型,分析不同基因(亚)型与病情间的相关性。结果乙肝病毒B(20.77%)和C (78.22%)基因型为最常见,仅1例为D基因型;所有B基因型均为Ba亚型,C基因型中仅发现C2和C1亚型。北方地区患者多感染C基因型(83.62%)/C2亚型(90.32%)。B基因型患者的年龄明显小于C基因型患者(P<0.000)。不同年龄段B基因型和C基因型比较发现,感染B基因型的患者在30岁以下、30～50岁和50岁以上年龄段中所占比例逐渐下降,感染C基因型的患者比例呈现相反趋势(P=0.000)。C1和C2亚型患者的年龄相近。各基因型在肝硬化、慢乙肝和无症状携带者中的分布无差别。B和C基因型(C1和C2亚型)患者的病毒量之间无差别。B基因型患者的肝脏炎症和纤维化评分明显低于C型患者(P<0.05)。结论北方地区以C基因型和C2亚型为主。B基因型患者的年龄明显小于C基因型。B和C基因型(C1和C2亚型)患者的肝脏炎症和病毒量之间无差别。B基因型患者的肝脏炎症和纤维化评分明显小于C型患者。     

婴儿巨核细胞减少型特发性血小板减少性紫癜的特点

目的:探讨婴儿巨核细胞减少型特发性血小板减少性紫癜(ITP)的发病机制、诊治效果与特点。方法:对55例血小板减少婴儿进行血常规、病毒抗体、血小板抗体及骨髓细胞形态学等相关检查,确诊特发性血小板减少性紫癜,39例给予抗感染+丙种球蛋白+激素治疗,16例仅给予抗感染治疗。结果:病初有感染史30例,病毒抗体阳性14例,支原体(MP)抗体和衣原体抗体阳性共4例,血小板抗体阳性1例,骨髓19例可见原始和幼稚粒细胞增多,14例见原始和幼稚淋巴细胞增多,39例巨核细胞数减少,15例巨核细胞数正常,1例巨核细胞数增多。经丙种球蛋白与激素治愈38例,1例血小板抗体阳性伴巨核细胞数增多者转化为慢性ITP,16例仅给予抗感染治疗患儿全部治愈。结论:婴儿ITP特点是绝大多数可能与直接感染特别是病毒感染有关,血小板抗体阴性,不存在自身免疫紊乱,多数患儿骨髓中幼稚细胞增多,巨核细胞减少,控制感染后血小板逐渐恢复正常。