集束化护理干预对预防ICU机械通气患者呼吸机相关性肺炎的效果观察

目的观察集束化护理干预对预防ICU机械通气患者呼吸机相关性肺炎的效果,评价集束化护理的临床价值。方法选取我院重症监护室2016年1月至2016年12月收治的232例患者,将所有患者随机分成观察组和对照组,观察组在常规护理的基础上采用集束化护理,对照组患者采用常规护理,分析两组患者的护理效果。结果观察组患者ICU住院时间(7.8±5.6)h,住院时间(13.6±8.3)h,呼吸机相关性肺炎发生率5.8%;对照组患者ICU住院时间(13.5±9.7)h,住院时间(25.2±10.3)h,呼吸机相关性肺炎发生率15.8%,集束化护理对比常规护理的临床效果更为显著,差异有统计学意义(P0.05)。结论对于重症监护的患者采用集束化护理可以显著降低患者呼吸机相关性肺炎发生率,可大大促进患者的康复,临床效果显著,值得在临床上广泛推广。     

集束化护理在ICU预防呼吸机相关性肺炎的应用

目的 探讨集束化护理在ICU预防呼吸机相关性肺炎的应用效果.方法 选取我院2015年6月-2016年6月收治的112例肺炎患者作为研究对象,将其平均分为2组,每组56例.对照组行常规护理,观察组在此基础上行集束化护理,对比2组患者的护理总有效率以及呼吸机相关性肺炎发生率.结果 观察组患者的护理总有效率为94.6%,对照组患者的护理总有效率为82.1%,2组比较有显著差异(P<0.05);观察组患者呼吸机相关性肺炎的发生率为3.4%,对照组患者呼吸机相关性肺炎的发生率为16.1%,2组比较有显著差异(P<0.05).结论 集束化护理干预可以有效降低ICU患者呼吸机肺炎发生率,提高护理效果.     

集束化护理对ICU呼吸机相关性肺炎的预防效果观察

目的观察集束化护理对ICU呼吸机相关性肺炎的预防效果。方法选择2016年1月至2017年6月在我院ICU行机械通气的患者76例,依据随机数表法分为两组,各38例。对照组予以常规护理干预,观察组予以集束化护理干预,并于干预后对两组患者的护理效果进行分析和对比。结果与对照组比较,观察组呼吸机相关性肺炎发生率较低,机械通气时间及入住ICU时间均较短,差异有统计学意义(P0.05)。结论采取集束化护理模式,能有效减少ICU呼吸机相关性肺炎发生,缩短机械通气时间,改善患者预后。     

集束化护理预防ICU呼吸机相关性肺炎的效果观察

目的探讨集束化护理干预预防ICU呼吸机相关性肺炎(VAP)的效果。方法将213例使用呼吸机的患者按照住院治疗的先后顺序随机分为观察组109例、对照组104例,对照组采用常规护理,观察组在此基础上采用集束化护理干预,在患者转出ICU时进行效果评价。结果观察组患者VAP发生率、病死率明显低于对照组(P<0.05);观察组患者呼吸机使用时间、住ICU的时间明显短于对照组(P<0.05)。结论在ICU内对使用呼吸机患者采用集束化护理干预,可以有效预防VAP的发生,降低患者病死率,提高患者生存质量,缩短患者呼吸机使用时间和住ICU的时间,减轻患者经济负担。     

集束化护理干预策略对预防老年患者呼吸机相关性肺炎的作用

目的分析集束化护理干预策略对预防老年患者呼吸机相关性肺炎的作用。方法应用数字随机法,抽取本科室2016年9月至2018年9月收治的60例ICU60岁及以上机械通气患者作为本次研究的对象,将其分为两组,即对照组26例、观察组34例。对照组使用一般护理方法,观察组实施集束化护理干预策略,对比分析两组患者的护理效果。结果研究组患者VAP发生率、机械通气时间、ICU住院时间显著低于对照组,且P 0.05,两组比较存在统计学意义。结论集束化护理干预策略用于预防老年患者呼吸机相关性肺炎中效果比较显著,对预防及降低VAP的发生有重要意义,可显著缩短患者的机械通气时间及住院时间,值得临床推广与应用。     

集束化护理干预策略对重型颅脑损伤患者呼吸机相关性肺炎的影响

目的探讨集束化护理干预策略在重型颅脑损伤患者预防呼吸机相关性肺炎中的实施效果。方法选取2012年1—12月蚌埠医学院第一附属医院ICU收住的重型颅脑损伤机械通气患者30例作为集束化护理干预组,另选取2011年1—12月蚌埠医学院第一附属医院ICU收住的重型颅脑损伤机械通气患者30例作为对照组。比较2组呼吸机相关性肺炎（VAP）发生率,机械通气时间和ICU住院天数。对照组实施常规护理：半卧位;口腔护理每日2次;每日唤醒和每天评估拔管脱机的可能;预防应激性溃疡。集束化护理干预组在常规护理的基础上增加了持续声门下吸引;预防深静脉血栓和增加口腔护理的频次为每日6次;重视？肖毒隔离。结果集束化护理干预组VAP发生率比对照组低,机械通气时间和ICU住院时间也较对照组缩短,2组差异有统计学意义（P〈0．05）。结论集束化护理干预措施能有效降低重型颅脑损伤患者呼吸机相关性肺炎发生率,缩短患者机械通气时间和ICU住院时间。     

呼吸机相关性肺炎患者的护理体会

目的探讨研究呼吸机相关性肺炎患者的护理。方法选择2013年1月到2015年1月于本院就诊的呼吸机相关性肺炎患者共70例,作为本次研究的对象。将所有患者随机分为观察组和对照组,35名对照组患者予以常规肺炎护理,观察组患者应用集束化护理干预,比较两组患者的治疗效果。结果观察组患者的机械通气时间和平均住ICU时间显著优于对照组患者,对照组患者VAP发生率为25.71%,观察组患者为5.71%,对照组患者护理满意度为77.14%,观察组为94.29%,观察组患者VAP发生率和护理满意度显著优于对照组,两组患者比较有统计学意义(P0.05)。结论在呼吸机相关性肺炎患者治疗中实施护理干预,可显著降低患者的VAP发生率、减少机械通气时间和平均住ICU时间,提升护理满意度,值得在临床上大力推广。     

集束化护理在重症肺炎合并呼吸衰竭的应用

目的分析研究集束化护理在重症肺炎合并呼吸衰竭的临床效果。方法选取本院在2017年8月至2018年8月期间ICU收治的80例机械通气患者作为研究对象,随机分成观察组和对照组两组,每组患者均为40例。对观察组ICU机械通气患者实施集束化护理,而对照组患者实施常规护理。对比分析这两组ICU机械通气患者的ICU停留时间、机械通气时间、患者呼吸机相关性肺炎发生率。结果观察组ICU机械通气患者护理后的ICU停留时间、机械通气时间、患者呼吸机相关性肺炎发生率与照组患者比较均降低,即P0.05,具有统计学意义。结论实施集束化护理,可有效降低患者并发症发生率,预防机械通气患者呼吸机相关性肺炎发生率,临床应用价值显著。     

实施集束化护理干预对ICU呼吸机相关性肺炎患者治疗效果的影响

目的：探讨实施集束化护理干预对ICU呼吸机相关性肺炎患者治疗效果的影响。方法选取2012年1月~2014年1月我院ICU收治的呼吸机相关性肺炎患者100例,根据护理方法不同随机分为研究组和对照组两组,对照组实施常规护理,研究组实施集束化护理干预,比较两组患者的祛痰效果、两组机械通气时间及入住ICU时间。结果研究组的祛痰效果明显优于对照组,研究组的祛痰总有效率达94%,与对照组的总有效率比较,差异有统计学意义（P〈0.05）。研究组患者机械通气时间明显短于对照组（P〈0.05）。研究组患者平均入住ICU时间明显短于对照组（P〈0.05）。结论实施集束化护理干预有利于提高ICU呼吸机相关性肺炎患者的祛痰效果,缩短住院时间,值得推广和应用。     

集束化护理干预对ICU人工气道患者机械通气时间及相关并发症发生率的影响

目的 探讨集束化护理干预对ICU人工气道患者机械通气时间及相关并发症发生率的影响.方法 收集2013年1月-2015年8月我院收治的82例ICU人工气道患者为研究对象,随机均分为实验组及对照组,各41例,对照组实施常规护理干预,实验组实施集束化护理干预,观察2组护理效果(以机械通气时间、ICU入院时间评估)、呼吸机相关并发症发生率及30天再入院率.结果 实验组机械通气时间、ICU入院时间较对照组明显短,护理干预后实验组呼吸机相关并发症总发生率26.83％、30天再入院率12.20％较对照组明显低,有统计学意义(P＜0.05).结论 集束化护理干预可明显缩短ICU人工气道患者机械通气及住院时间,显著降低呼吸机相关并发症发生率及再入院率.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.