循证护理在重型颅脑损伤患者中的应用效果观察

目的探究在重型颅脑损伤患者中行循证护理的临床效果。方法截取我院2009年3月至2011年10月共240例患者,按随机数字表分为循证组及常规组各120例。常规组采用传统护理方法,循证组采用循证护理模式,对比两组患者间临床资料差异性。结果循证组持续高热16例,肺部感染27例,压疮3例,1周内死亡2例,比较常规组分别低11.67%、15.00%、4.17%、5.83%;循证组Barthel指数:(88.9±16.9)分、Fugl-Meyer评分(59.5±9.2),较常规组分别高(14.2±4.8)分、(17.0±2.5)分,差异存统计学意义(P<0.05)。结论在重型颅脑损伤患者中行循证护理能有效降低重型颅脑损伤患者并发症的发生率、一周内死亡率和提高康复后生活自理能力。     

坎地沙坦对慢性心力衰竭患者脑钠肽水平及心功能的影响

目的探讨坎地沙坦对慢性心力衰竭(CHF)患者脑钠肽(BNP)水平和心功能的影响。方法已接受常规治疗,按照纽约心脏病协会(NYHA)分级标准,心功能3～4级的CHF患者80例,随机分为2组:治疗组40例,对照组40例。治疗组在常规治疗基础上加用坎地沙坦8mg治疗12周。对比分析治疗前后两组患者的血浆BNP水平、NYHA分级、血压、超声心动图等指标。结果治疗组较对照组左室舒张末期内径(LVEDd)[(61±6)mmvs.(57±5)mm]、左室收缩末期内径(LVESd)[(51±7)mmvs.(45±4)mm]显著下降(P均<0.05),左室射血分数(LVEF)显著升高[(40±10)%vs.(48±7)%](P<0.05),血浆BNP[(131±52)ng/Lvs.(71±8)ng/L]显著降低(P<0.05);此外,坎地沙坦治疗前后,患者血浆BNP降低值与左室舒张末期内径(r=0.80)、左室收缩末期内径(r=0.79)减少呈正相关(P均<0.01),而与LVEF的增加呈负相关(r=-0.86,P<0.01)。结论坎地沙坦治疗充血性心力衰竭(CHF)的总有效率达92%以上,坎地沙坦能阻断CHF的发展进程,改善心功能及降低血清BNP水平,血浆BNP可作为评价血管紧张素Ⅱ受体拮抗剂治疗CHF的监测指标之一。     

老年急性心肌梗死急诊冠状动脉介入治疗分析

目的评价急诊经皮冠状动脉介入治疗(PCI)对老年性急性心肌梗死(AMI)的临床疗效。方法对我院1997年12月至2004年12月接受急诊PCI治疗大于60周岁的AMI患者72例(PCI组),同期病年龄大于60周岁未行急诊PCI治疗的AMI患者中随机抽取70例(对照组),比较两组住院和随诊期间不良心血管事件(再发心绞痛、心肌梗死、猝死)的发生率。结果PCI组72例住院死亡7例、左室射血分数(LVEF)(33.4±4.2)%、平均住院天数20.3(19.2±1)d,随诊期间再发心绞痛16例、猝死1例。对照组70例住院死亡16例、LVEF(28.8±9.3)%、平均住院天数27.4(25.1±6.3)d,随诊期间再发心绞痛39例、心肌梗死6例、猝死5例。结论急诊PCI治疗能较好地提高老年心肌梗死抢救成功率、缩短住院天数,减少心血管事件的发生率。     

中急性意识障碍患者采用循证护理的效果分析

目的探讨循证护理在急性意识障碍患者中的应用及其临床疗效。方法选择2010年4月至2012年1月,我院收治的急性意识障碍患者60例,按随机数字表将其分为两组,一组接受常规护理(常规组,n=30例),另一组接受循证护理(循证组,n=30例)。比较和分析治疗后两组患者的临床疗效、APACHE评分及住院时间等。结果循证护理组ADC患者治愈率和总有效率为33.33%和93.33%,显著高于常规护理组(P<0.05),无效率为6.67%,显著低于常规护理组(P>0.05);住院48h和出院前4hAPACHEⅡ评分为(15.5±8.9)分和(12.3±7.0)分,显著低于刚住院时和常规护理组的评分(P<0.05);住院时间和肺部感染率为(24.2±12.4)d和10%,显著低于常规护理组(P<0.05)。结论对急性意识障碍患者实施循证护理干预,能够缩短患者住院时间、改善身体状况,提高生存质量,临床疗效显著。     

河南省县级医院临床医生循证医学继续教育初探

目的对河南省县级医院临床医生循证医学观念及实践状况等进行调查分析,为卫生决策部门制定循证医学继续教育政策提供重要依据。方法 2013年12月至2014年2月,对该省10余所县级医院的医生进行自制问卷调查。结果 县级医院临床医生对循证医学的了解和应用程度不足。工作太忙、应用循证医学(EBM)费事(31.6%),对EBM认识不够(24.3%),受单位条件限制(19.9%)成为阻碍EMB在临床中应用主要影响因素,另外英语、计算机水平也制约了EBM的应用。结论 EBM继续教育任重道远,医学继续教育政策可根据EBM水平高低制订不同的学习策略,培养临床医生运用最有效的方法解决问题的良好习惯,更好地为人民健康服务。     

缓激肽介导的治疗心血管和糖尿病药物致血管性水肿的研究进展

目的 本研究旨在调查慢性射血分数降低的心力衰竭(HFrEF)患者神经内分泌抑制剂-血管紧张素转换酶抑制剂(ACEI)或血管紧张素II受体阻滞剂(ARB)、β受体阻滞剂(BB)和醛固酮受体拮抗剂(MRA)使用现状及其与指南的差距。方法 搜集并分析2018年01月到12月HFrEF住院患者基本资料和三类神经内分泌抑制剂使用情况。结果 共纳入301例慢性HFrEF患者,平均年龄为71.3±11岁,男性占56.5%,平均EF值32.1±7.2%,51.8%合并有高血压,心衰最常见的病因是心脏瓣膜病。ACEI/ARB、BB和MRA使用率分别为77.4%,60.5%和94.0%,剂量达标率分别为44.2%、22.5%和100%。48.8%患者采用指南推荐的联合用药,包括1.3%两药联合(ACEI/ARB+BB)和47.4%三药联合(ACEI/ARB+ BB+MRA)。结论 该院慢性HFrEF患者神经内分泌抑制剂应用现状与指南仍有差异,ACEI/ARB和BB使用率和剂量达标率不足,而MRA使用过度,需进一步提高医生对指南依从性。     

老年2型糖尿病患者护理中循证护理的应用效果探讨

目的观察老年2型糖尿病患者护理中循证护理的应用效果。方法我院2018年2月至2019年2月收治的84例老年2型糖尿病患者为本次研究对象,按照护理中是否行循证护理干预将所有患者分为对照组(42例:未行循证护理)与实验组(42例:行循证护理),比较两组患者护理干预效果。结果实验组患者护理干预总有效率(95.23%)明显高于对照组(80.96%),P<0.05。结论老年2型糖尿病患者护理中循证护理干预效果明显优于常规护理干预效果。     

急性老年阑尾炎的临床及病理特点观察

目的探讨老年急性阑尾炎的临床及病理特点。方法选择本院阑尾手术患者作为研究对象,年龄60岁以上患者作为观察对象(老年组),按照1∶1比例选择59岁以下作为对照病例(非老年组),比较两组患者性别、合并症、临床症状、体格检查、实验室检查、病理、治疗结果等方面上的差异。结果实施阑尾手术880例,其中老年患者40例(4.54%);老年组转移性右下腹痛52.50%、典型麦氏点压痛62.50%、白细胞增高57.50%、单纯性阑尾炎47.50%低于非老年组的80.00%、85.00%、90.00%、70.00%;合并症75.00%、发热、呕吐、腹泻等77.50%、误诊35.00%、化脓坏疽穿孔阑尾炎52.50%、死亡10.00%高与于非老年组的25.00%、45.00%、12.50%、30.00%(P<0.05);老年组确诊时间(16.48±6.24)h、住院时间(12.34±5.23)d长于非老年组的(8.34±4.56)h、(9.12±2.34)d(P<0.05)。结论老年急性临床及病理学其特点,预后较差,应提高早期诊断准确性;积极手术治疗。     

慢性心力衰竭患者血浆N端片段脑钠肽与心脏功能指标的相关性研究

目的探讨慢性心力衰竭(CHF)患者血浆N端片段脑钠肽(NT-proBNP)水平与心功能的相关性及其临床意义。方法本实验为病例-对照研究。选取74例为CHF组和26例健康对照组,心力衰竭的诊断标准采用欧洲心脏病学会(ESC)心力衰竭工作组推荐的标准,心功能按纽约心脏病学会(NYHA)分级,将CHF患者分4个亚组:Ⅰ级11例、Ⅱ级18例、Ⅲ级25例、Ⅳ级20例。用化学发光免疫分析法测定CHF患者(CHF组,心功能Ⅰ～Ⅳ级)及26例体检正常者(对照组)血浆NT-proBNP的水平,超声心动图测定CHF组及对照组左室射血分数(LVEF)和左室舒张末期内径(LVEDD),统计学方法以SPSS11.5软件包进行统计分析,计量资料以均数±标准差(χ—±s)表示,计量资料组间比较采用非配对t检验,结果以P<0.05具有统计学意义,各变量间进行Pearson相关分析。结果①CHF组与对照组患者血浆BNP水平比较及其与心功能分级的关系:对照组和CHF组心功能Ⅰ、Ⅱ、Ⅲ、Ⅳ级患者NT-proBNP平均水平分别为(161±114)和(466.6±8.65)、(559±88)、(1359.52±408)、(5114±2535)pg/mL,CHF组各亚组的NT-proBNP水平与对照组比较,有显著性差异(P<0.01)。CHF组组间两两比较NT-proBNP水平,有显著性差异(P<0.01),并随着心功能分级的增加和心功能的恶化,NT-proBNP水平逐渐增加,二者呈正相关(r=0.708,P<0.01)。②心力衰竭组患者按LVEDD分两组,LVEDD≥60mm组16例,LVEDD<60mm组58例,前者血浆NT-proBNP水平[(5812±2354)pg/mL]显著高于后者[(1008±607)pg/mL,P<0.01],而LVEDD<60mmCHF组血浆NT-proBNP水平与对照组比较显著升高(P<0.01)。CHF组LVEF<40%患者的血浆NT-proBNP水平([3059±2558)pg/mL]显著大于LVEF>50%患者([562±177)pg/mL,P<0.01]。血浆NT-proBNP水平与LVEF呈负相关(r=-0.848,P<0.01),与LVEDD呈正相关(r=0.935,P<0.01)。结论NT-proBNP是反映心功能受损的敏感指标,与心功能状态及左心室重塑有明显的相关性。NT-proBNP的检测可对不同程度的CHF患者进行评估,对指导CHF治疗、评价预后均具有重要临床价值。     

经尿道电切术与双极等离子切除术治疗膀胱肿瘤的对比分析

目的对比经尿道电切术(TURBt)与经尿道双极等离子电切术(PKRBt)治疗非肌层浸润性膀胱肿瘤的疗效和安全性。方法将96例非肌层浸润性膀胱肿瘤患者随机分两组:TURBt组50例,肿瘤直径(19.3±6.2)mm,其中膀胱侧壁肿瘤27例;PKRBt组46例,肿瘤直径(18.7±5.8)mm,膀胱侧壁肿瘤20例。对比分析两组患者的手术时间、术中出血量、闭孔神经反射发生率、术后保留导尿时间、术后住院天数和术后2年内复发率。结果 96例均手术成功,TURBt组平均手术时间(35.3±11.3)min,术中出血量(49.1±25.1)ml,术后保留导尿(4.0±0.7)d,术后住院(4.9±0.8)d,2年内复发率16.0%;PKRBt组平均手术时间(34.7±12.1)min,术中出血量(47.1±21.1)ml,术后保留导尿(4.0±0.8)d,术后住院(4.9±0.8)d,2年内复发率15.2%,两组比较差异无统计学意义(P>0.05)。膀胱侧壁肿瘤患者发生闭孔神经反射率:TURBt组59.3%(16/27例),PKRBt组25%(5/20例),两组比较差异有统计学意义(P<0.05)。结论 PKRBt是一种治疗非肌层浸润性膀胱肿瘤安全、有效的手术方法。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.