急诊患者及家属的心理护理

急诊患者抢救治疗过程中，患者及家属往往在情绪上表现为焦虑不安、惊慌、难以接受。对医护人员的紧急抢救治疗措施有时还有盲目性和抵触情绪，甚至还有不积极配合治疗等情况，本文着重探讨急诊患者护理及家属的心理需求。     

ICU护士和患者家属沟通的技巧与效果分析

分析并了解ICU护士和患者家属沟通的障碍因素，把握与患者家属沟通的技巧，积极主动地与患者家属加强沟通，可以大大缓解ICU护士和患者家属之间的矛盾，减少护患纠纷的发生，使患者及其家属在护理活动中积极配合，达到提高抢救成功率和促进患者康复的目的。     

86例严重复合性损伤患者的急救护理

目的 探讨严重复合性损伤患者早期急救与护理干预的临床意义.方法 患者入院后尽早给予紧急的处理,采取急救和护理干预措施.结果 本组86例患者,通过积极采取急救措施和早期的护理干预,抢救成功82例,抢救成功率95.3%,死亡3例,家属放弃治疗1例.结论 通过对86例严重复合性损伤患者给予早期积极有效的急救措施与护理干预,提高了医护人员的急救意识与抢救水平,降低了死亡率,使抢救工作更系统化、制度化和规范化.     

急救护理工作中定位分工抢救配合法的应用

目的探讨急救护理工作中定位分工抢救配合法的实际应用效果。方法以我院急诊科2015年8月至2017年8月收治90例重症抢救病人为观察组,收集同一时期急诊科收治的90例重症抢救病人为对照组。观察组行定位分工抢救配合法、对照组实施传统抢救方法。对比两组患者抢救成功率、患者及家属对护士护理的满意度。结果观察组抢救成功率、护理满意度明显高于对照组(P0.05)。结论急救护理工作中行定位分工抢救配合法可以显著提高抢救成功率,提高患者及家属对患者护理满意度,提高急救团队抢救能力,保证患者生命健康。     

急性有机磷农药中毒的临床救治

目的:分析AOPP患者的抢救,总结经验.方法:回顾分析36例AOPP患者临床资料,根据不同中毒表现,采取洗胃,辅助通气和血液透析灌流及时抢救.结果:抢救成功91.7%,自动出院8.3%.结论:对AOPP救治应果断及时,应尽快彻底洗胃,合理使用抗胆碱药物及复能剂,血液净化,在患者及家属的积极配合和医护人员的共同努力下,预防并发症,提高抢救成功率.     

急诊医护人员抢救路径在院外心肺复苏中的应用

目的：探讨急诊医护人员在院外心肺复苏中应用抢救路径的效果。方法选择我院急诊科2011年5月-2013年6月按照《2010国际心肺复苏指南》在院前急救工作中实施心肺复苏患者98例,将经科室统计医护人员按照我科制定的抢救路径实施抢救者52例设为试验组,未按照该路径抢救者46例设为对照组,对照组实施传统的医护配合模式,试验组按照设计的医护人员心肺复苏实际抢救路径。比较2组患者复苏成功率及医护人员配合默契度。结果试验组患者心肺复苏成功率及医护人员配合默契度均高于对照组,差异具有统计学意义（P〈0.05）。结论急诊医护人员抢救路径在院前心肺复苏中的应用,可以有效提高心肺复苏成功率,同时也能提高医护人员的默契度,值得在临床工作中推广。     

浅谈对危重病人家属的心理对策

目的探讨及总结对危重急诊患者家属实施心理护理的方法和体会。方法通过对45例危重急诊患者家属的心理状态观察给予分型,按不同类型给予心理护理及对策。结果对危重急诊患者家属实施心理护理,使得家属顺利渡过情感危机,积极配合和支持医护人员的抢救,最大限度地争取时间,挽救病人生命。结论重视危重急诊患者家属的心理,及时正确实施相应心理护理,是非常重要的环节,不但提高了抢救工作质量,还在一定程度上避免或减少了不必要的医疗纠纷发生。     

46例上消化道出血患者的临床护理体会

目的总结46例上消化道出血患者的临床观察和护理经验。方法针对上消化道出血期间的护理重点、难点,制定并实施积极全面的急救、观察和护理的方法、措施。结果抢救成功44例,成功率为92%。结论做好出血期观察与护理,配合医生积极进行抢救,加强出院的健康指导,有利于提高护理质量及抢救成功率。     

感染性休克的抢救及护理

目的 探讨感染性休克病人的抢救及护理方法,提高感染性休克病人的抢救成功率.方法 及时、快速、足量的补充血容量及积极治疗原发病.结果 手术成功救治25例,非手术治疗成功6例,3例病人抢救无效死亡,2例病人家属因为各种原因放弃治疗,抢救成功率86%.结论 通过医护人员积极的、分秒必争的抢救及护理是感染性休克病人抢救成功的关键.     

急性脑出血患者家属焦虑恐惧心理的应对

脑出血的发病特点是 :起病急、来势凶猛、常危及生命 ,多伴有不同程度的意识障碍、偏瘫、失语等表现。我国脑出血发病率占脑卒中的 4 0 %～ 5 0 % ,是脑卒中最多的临床类型〔1〕。在抢救中 ,如果忽视与家属的及时沟通 ,或无瑕顾及家属焦虑、恐惧的心理 ,可导致医护人员 -患者 -家属的配合不佳 ,影响患者的救治及康复。因此 ,医护人员不仅要重视和关注生理、生物因素对患者的影响 ,同时 ,也要重视社会因素对患者的影响。针对家属的各种心理反应 ,采取相应的对策 ,充分发挥社会支持和亲属护理 ,以提高抢救成功率及生命生存质量。1　争分夺秒抢…     

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.