剖宫产术后自控镇痛泵并发症的护理体会

目的 探讨剖宫产术后患者自控镇痛泵并发症的护理体会.方法 回顾性分析2013年6月—2014年12月我科20例剖宫产术后使用自控镇痛泵发生并发症患者的临床护理资料.结果 本组20例患者出现并发症,予以相应的护理措施,均痊愈出院.结论 预见性观察、合理防治、及时有效的护理干预可减少或避免剖宫产术后使用自控镇痛泵不良反应的发生,促进患者康复.     

普外术后应用自控镇痛泵患者的护理

目的对普外术后应用自控镇痛泵患者给予综合护理干预,观察其护理效果。方法随机抽取在2010年1月至2013年12月间我院收治的100例普外术后应用自控镇痛泵患者,将他们随机分成研究组和对照组,每组50例,研究组患者采用综合护理干预,对照组患者采用常规护理。结果研究组患者术后护理疗效显著优于对照组,差异具有统计学意义（P〈0.05）。结论对普外术后应用自控镇痛泵的患者进行有针对性的综合护理干预能够有效减少并发症发生,提高患者生存质量,值得在临床上推广应用。     

高龄骨折患者术后静脉镇痛的疗效观察及护理干预

目的 总结高龄骨折患者术后静脉留置镇痛泵,避免不良反应的疗效观察及护理.方法 通过对100例高龄骨科手术患者使用了静脉镇痛泵,并对其进行了严密的观察,针对麻醉镇痛药的不良反应及并发症采取护理干预.结果 静脉自控镇痛可以抑制机体应激反应,有利于患者术后镇痛、呼吸循环的稳定,减少术后并发症.结论 术后良好的静脉镇痛可以减轻疼痛带来的一系列不良反应,将不良反应降至最低,以增加高龄患者使用自控镇痛泵的安全性,使患者的舒适度明显改善,有利于骨折的愈合.     

护理干预自控镇痛泵在腹部手术中的临床应用

目的:探讨护理干预对腹部术后应用自控镇痛泵(PCA)的患者发生不良反应的影响。方法:将腹部术后应用PCA的患者160例随机分为观察组和对照组,对照组予常规护理,观察组除常规护理外,同时实施系统、规范的护理干预,观察两组结果并进行比较。结果:观察组不良反应降至30%以下(P<0.01),疼痛值降低,肠功能恢复快、肛门排气平均提前8.5h(P<0.01),患者满意率、住院时间及平均住院费用均有差异,对照组血压有的偏高,心率稍快,呼吸、血氧饱和度(SPO2)无明显差异。结论:在腹部术后应用PCA过程中,实施必要的护理干预,可确保PCA正常运行、镇痛效果好,能避免或减少不良反应的发生,为患者减轻痛苦,促进术后转归。     

施行前瞻性护理对剖宫产术后自控镇痛效果的影响分析

目的：分析对行自控镇痛的剖宫产术后患者进行前瞻性护理的效果。方法：将214例择期行剖宫产术的产妇随机分为对照组和观察组，为两组产妇在术后采取硬膜外接镇痛泵法进行自控镇痛，为对照组患者进行常规护理，为观察组患者在进行常规护理的基础上施行前瞻性护理，对比分析两组患者的镇痛效果及发生不良反应的情况。结果：观察组患者的疼痛程度及不良反应发生率明显低于对照组患者，差异显著（P<0.05），有统计学意义。结论：为行自控镇痛的剖宫产术后产妇实施前瞻性护理可增强其镇痛效果，减少其发生不良反应的几率，值得在临床上推广应用。     

术后应用静脉自控镇痛泵的护理体会

目的：为术后应用静脉自控镇痛泵的护理提供依据。方法：对60例术后应用PCA静脉自控镇痛泵患者进行调查。结果：本次调查镇痛有效率为96.67%,满意率为96.67%。结论：术后应用静脉自控镇痛泵,患者能自我控制疼痛积极参与到术后镇痛过程;针对可能发生的不良反应进行预防和护理使患者舒适     

骨科患者术后使用静脉自控镇痛泵的护理

目的骨科患者术后普遍存在一定程度的疼痛,本文总结了100例骨科患者术后使用静脉自控镇痛泵的不良反应的观察与护理。方法应用一次性静脉自控镇痛泵,并妥善固定,镇痛药液配置：生理盐水100ml、芬太尼1mg、吗啡20mg配置成100ml加入PCLA泵中,以2ml/h的速度持续给药使用72小时,密切观察呼吸及不良反应,加强巡视。结果通过对镇痛泵使用的观察和护理,术后镇痛获得了满意的效果。结论护理人员应了解泵内药物的种类、含量、作用及毒副作用,密切观察患者病情变化,预防或减少并发症的发生。     

术后使用自控镇痛泵产生的不良反应分析及护理措施

目的：总结急诊科病人100例术后使用自控镇痛泵产生不良反应的护理体会.方法：针对出现不良反应,了解其原因,落实措施.结果：有效地提高了术后镇痛的效果,降低了患者并发症的发生,使患者受到精心的治疗和护理.结论：考虑术后使用自控镇痛泵,术前应评估病人的身体状况,对于体质差及年老者,应适当减少自控镇痛泵的剂量.     

术后使用电子自控镇痛泵的管理模式在麻醉科的应用

目的：探讨术后使用电子自控镇痛泵的管理模式在麻醉科的应用效果。方法：对现有的电子自控镇痛泵的管理模式进行改进,选取术后使用电子自控镇痛泵的71例患者作为研究对象,并分为研究组和对照组,采用常规管理模式管理对照组患者的电子自控镇痛泵,采用改进后的管理模式管理研究组患者的电子自控镇痛泵。结果：实施管理前两组患者的 VAS 评分（疼痛视觉模拟评分法）比较存在的差异无统计学意义（P＞0．05）,实施管理后研究组患者的 VAS 评分低于对照组患者（P＜0．05）;研究组患者的镇痛不良反应发生率为5．6％,低于对照组患者的20．0％（P＜0．05）。结论：对术后使用电子自控镇痛泵进行科学的管理,能够改善患者镇痛效果,减少镇痛不良反应的发生,有利于减少麻醉科纠纷事件的发生。     

开胸术后应用自控镇痛泵镇痛的疗效观察与护理体会

目的观察开胸术后使用自控镇痛泵用于止痛的效果及总结护理方法。方法将开胸术后,使用自控镇痛泵患者345例作为观察组,术后常规使用吗啡镇痛的患者324例作为对照组,对两组患者术后镇痛情况、不良反应、并发症的发生率等进行对比观察,记录结果。结果观察组镇痛效果明显优于对照组;恶心呕吐较对照组有显著性差异;血压降低较对照组有显著性差异。结论开胸术后,应用自控镇痛泵止痛效果好,不良反应及术后并发症少,提高术后患者生活质量。     

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.