综合护理干预对老年髋部骨折术后下肢深静脉血栓形成的影响

目的 探讨综合护理干预对老年髋部骨折围术期下肢深静脉血栓形成的影响.方法 将124例老年髋部骨折患者按护理方式不同分为对照组和观察组各62例,对照组给予常规治疗和护理,观察组在对照组基础上加强综合护理干预,观察并比较两种护理模式的临床效果.结果 观察组DVT发生率、下肢疼痛、肿胀发生率显著低于对照组(P<0.05);观察组术后平均住院时间显著短于对照组,术后对疾病的知晓情况显著高于对照组.结论 对老年髋部骨折患者加强围术期综合护理干预可有效预防和减少下肢静脉血栓的形成,促进患者早日康复,值得临床推广应用.     

SBAR沟通模式联合改良早期预警评分在老年髋部骨折患者术后的应用研究

目的 探讨现状-背景-评估-建议(SBAR)沟通模式联合改良早期预警评分(MEWS)应用于高龄髋部骨折患者术后的效果。方法 选择2020年12月至2022年2月本院收治的104例高龄髋部骨折患者，按护理方式不同将术后行常规护理的52例作为对照组，将行SBAR沟通模式联合MEWS对患者术后深静脉血栓栓塞(DVT)进行预警和评估的52例作为观察组，比较两组应用的效果。结果 观察组护理后VAS评分低于对照组(P<0.05);观察组DVT发生率低于对照组(P<0.05);观察组患者及家属、护士、医生对护理工作满意度评分高于对照组(P<0.05)。结论 高龄髋部骨折护理应用SBAR沟通模式联合改良早期预警评分能够提高满意率，对术后DVT预警效果显著。     

风险管理在高龄髋部骨折护理中的应用

目的 探讨风险管理在高龄髋部骨折护理中应用效果.方法 将我科58例高龄髋部骨折患者,依据护理方式的不同分为观察组38例,对照组20例;对照组采用常规护理,观察组在此基础上给予风险管理.结果 观察组患者风险事件的发生率明显低于对照组;患者对护理满意度及护理质量均明显高于对照组;患者并发症的发生率明显低于对照组,两组比较差异有统计学意义(P< 0.05).结论 风险管理应用于高龄髋部骨折护理中,其全面效果显著,值得推广.     

预见性护理干预预防髋部骨折患者术后DVT的临床价值分析

目的观察预见性护理干预在预防髋部骨折术后深静脉血栓形成的临床价值。方法选取我院骨科2011年3月-2013年3月收治的100例髋部骨折的患者,随机分为两组。实验组和对照组各50例。对照组给予常规护理,实验组在常规护理的基础上进行预见性护理干预,观察两组患者的护理效果。结果实验组术后DVT的发生率为2％,对照组术后DVT的发生率为14％,差异有统计学意义（P〈0．05）。实验组在住院时间、护理满意度、生化指标等方面均优于对照组,差异具有统计学意义（P〈0．05）。结论对髋部骨折患者实施预见性护理能有效降低DVT的发生率,提高患者对护理服务的满意度。     

髋部手术后预防下肢深静脉血栓的护理体会

目的探讨预防髋部手术后下肢深静脉血栓（DVT）的护理措施。方法 138例全髋关节置换术后患者随机分为对照组79例和预防组59例。对照组给予常规护理,预防组给予预防护理措施,观察2组DVT发生情况。结果预防组DVT发生率为15.3%低于对照组的29.1%,差异有统计学意义（P〈0.05）。结论加强髋部手术后患者的护理可有效减少DVT的发生。     

老年髋部骨折术后并发深静脉血栓形成的预防及护理

目的探讨老年髋部骨折术后并发深静脉血栓形成（DVT）的预防及护理方法。方法将216例老年髋部骨折术后患者随机分为治疗组（124例）和对照组（92例）。治疗组实施围术期预防护理措施和早期正确的功能锻炼,对照组给予目前临床预防DVT的常规护理．观察两组DVT的发生率。结果治疗组术后并发DVT（6／124,4．8％）少于对照（10／92,10．9％）,差异有统计学意义（P〈0．05）;治疗组1例继发肺栓塞死亡,余均康复出院。结论加强对老年髋部骨折患者进行围术期护理干预,有利于预防下肢DVT,提高患者生活质量。     

专科护理对关节置换术围术期深静脉血栓的预防作用

目的探讨专科护理对关节置换术围术期深静脉血栓（DVT）的预防作用。方法选取2012年1-6月的45例关节置换患者为对照组,围术期采用关节置换常规护理;选取2012年7～12月的45例关节置换患者为观察组,围术期在关节置换常规护理基础上采用专科护理,包括采用Autar量表式进行前瞻性的分析、评估,筛选出中、高风险患者。制订防范的优先行动计划,同时进行护理干预措施,重视疼痛管理,早期提供功能训练椅及循环驱动冰桶冷敷仪联合弹力绷带、圆筒垫、沙袋、进行个案护理。三级护理质量监控,比较两组的Homans征、Neuhof征、DVT发生率、健康教育知识评分及护理满意度。结果观察组的Homans征、Neuhof征、DVT发生率均低于对照组,健康教育知识评分及护理满意度均高于对照组。差异有统计学意义（P〈0．05）。结论有预见性、有计划性地采用专科护理预防,可提高护理管理的科学性和客观性,有效预防关节置换术后DVT的发生。     

早期护理干预对糖尿病患者髋部骨折术后深静脉血栓形成的影响

目的 观察早期护理干预对糖尿病患者髋部骨折术后深静脉血栓形成( DVT)的影响.方法 将我院骨科2008年6月至2011年11月共收治的糖尿病髋部骨折并需手术的患者93例随机分为早期干预组48例和常规护理组45例,早期干预组在入院第1天开始实施护理干预措施,而常规护理干预组是在术后才开始护理干预.比较两组患者术后DVT的发生情况,结果 早期护理干预组DVT发生率6.2％,常规护理组DVT发生率26.7％,早期护理干预组明显低于常规组,差异有统计学意义(P＜0.01).结论 实行早期护理干预对预防糖尿病患者髋部骨折术后深静脉形成有明显效果,对减少患者术后并发症促进患者早日康复有十分重要意义.     

足底静脉泵预防老年髋部骨折术后深静脉血栓的护理

目的探讨足底静脉泵预防老年髋部骨折术后深静脉血栓的护理。方法选取我院老年髋部骨折患者50例,收治时间在2013年2月至2014年6月,并将老年髋部骨折患者随机分为两组(观察组和对照组),两组患者均采用足底静脉泵物理疗法,对照组患者再采用常规护理,观察组患者采用护理干预。结果观察组患者护理后深静脉血栓发生率8.00%显著低于对照组,观察组老年髋部骨折患者的满意度96.00%显著高于对照组患者的满意度64.00%(P<0.05)。结论通过给予老年髋部骨折患者采用足底静脉泵与护理干预,能有效预防深静脉血栓发生。     

高龄髋部骨折患者预防深静脉栓塞的护理

目的高龄髋部骨折患者预防深静脉栓塞的护理措施。方法针对高龄髋部骨折患者具有易发生深静脉栓塞这一特点,进行术前评估,心理护理,宣教,观察护理,预防性抗凝预防性抗凝治疗护理等。结果通过积极有效的护理措施,有效地避免深静脉栓塞的发生。结论通过精心的护理可以大大降低高龄髋部骨折患者深静脉栓塞的发生。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.