老年股骨颈骨折患者行人工髋关节置换围手术期临床护理路径的研究

目的 评价老年股骨颈骨折患者行人工髋关节置换围手术期临床护理路径的制定和应用效果.方法 96例单侧股骨颈骨折老年患者随机分为观察组和对照组各48例,观察组采用临床护理路径,对照组采用常规护理,对比两组髋关节恢复情况、生活质量、健康教育效果和满意度.结果 观察组出院当天、术后1个月Harris髋关节功能评分显著高于对照组(P均＜ 0.05).出院时两组SCL-90量表各因子评分差异均有统计学意义(P均＜0.05).观察组健康教育评分和护理满意度均显著高于对照组(P均＜0.05).两组并发症发生率比较差异有统计学意义(P＜0.05).结论 实施临床护理路径能保证老年股骨颈骨折患者在人工髋关节置换围手术期获得良好的医疗服务,提高髋关节功能恢复效果、生活质量、健康教育效果及护理满意度.     

临床路径在老年白内障护理中的研究

目的：分析临床路径在老年白内障患者中的应用效果。方法：选取该院2015年2月～12月在我院治疗的老年白内障患者72例,分为研究组36例和对照组36例。分别给予临床护理路径和常规护理。结果：研究组患者的健康知识知晓率为97．22％,对照组患者的健康知识知晓率为72．22％,差异具有统计学意义（P＜0．05）。研究组患者的护理满意度为94．44％;对照组为77．78％,组间差异显著（P＜0．05）。结论：老年白内障患者给予临床路径护理,能够有效提高患者的健康知识知晓率,提高护理满意度,值得推广。     

临床健康教育路径在老年股骨颈骨折围手术期护理中的应用

目的探讨临床健康教育路径在老年股骨颈骨折围手术期护理中的临床应用价值。方法按入院日期的单双号顺序,将120例需行手术治疗的老年股骨颈骨折患者随机分为观察组和对照组各60例。对照组实施传统的健康教育路径,而观察组实施临床健康教育路径,即针对患者不同住院时段（入院时、术前、术后及出院时）制定标准化的健康教育内容,并按照健康教育流程实施,对两组患者掌握健康知识情况、遵医行为率、对护理工作满意度、住院时间及费用等指标进行评价。结果观察组掌握健康知识情况、遵医行为率及对护理工作的满意度分别为98．3％、95．0％和91．7％,均高于对照组的85．0％、76．7％和53．3％）;而住院时间（13．8±1．3）d短于对照组的（17．4±1．5）d,住院费用（11236．3±129．5）元也少于对照组的（15663．2±131.6）元,组间差异均具有统计学意义（P＜0．05）。结论临床健康教育路径应用于老年股骨颈骨折围手术期护理中,可以缩短住院时间,减少住院费用,提高患者掌握健康知识率、遵医行为率及对护理工作的满意度,具有重要临床应用价值。     

全程护理在肝胆外科患者健康教育中的作用

目的：探讨全程护理在肝胆外科患者健康教育中的应用效果。方法：采用随机分层分组法将我院81例肝胆外科患者分为观察组与对照组,对照组给予常规护理干预,观察组给予全程护理干预,观察两组健康教育效果、心理状态及护理前后生活质量评分。结果：观察组健康知识知晓率、自我保健及健康习惯均显著优于对照组,两组差异有统计学意义（P＜0．05）。观察组抑郁自评量表（SDS）及焦虑自评量表（SAS）评分明显低于对照组,两组间差异有统计学意义（P＜0．05）。观察组护理干预后各项生活质量评分均高于对照组,两组差异有统计学意义（P＜0．05）。结论：全程护理干预能显著提高健康教育效果,改善患者心理健康状态和护理期间生活质量,在肝胆外科患者健康教育中有重要应用价值。     

临床路径对骨质疏松症退休老干部心理健康及满意度的影响

目的：探讨临床路径对骨质疏松退休老干部心理健康及满意度的影响。方法选取该院骨科收治的84例骨质疏松退休老干部为研究对象,根据随机数字表将患者分为观察组及对照组各42例,对照组住院期间实施骨科常规护理,观察组住院期间实施临床路径,干预前后应用汉密尔顿焦虑量表（HAMA）、汉密尔顿抑郁量表（HAMD）对二组患者心理状况进行评估,应用自行设计的患者满意度对二组患者心理健康状况进行评估。对比分析二组干预前后视觉模拟疼痛（VAS）评分及 Oswestry 功能障碍指数（ODI 值）。结果观察组干预后 HAMA 、HAMD 评分显著高于对照组（P ＜0．05）,观察组患者对住院安全环境、护理技术、护理服务、情感支持、沟通交流、健康教育、总护理质量满意度评分高于对照组（P＜0．05）。 观察组干预后 ODI 值、VAS 评分低于对照组,差异有统计学意义（P ＜0．05）。 结论临床健康教育路径能有效改善骨质疏松退休老干部负性情绪及临床症状,提高患者满意度。     

健康教育干预对64层螺旋CT冠状动脉造影老年患者焦虑、抑郁情绪及图像质量的影响

目的 探讨健康教育干预对64层螺旋CT冠状动脉造影老年患者焦虑、抑郁情绪及图像质量的影响.方法 回顾性分析来我院进行64层CT冠状动脉造影检查的患者86例,分为对照组及观察组各43例.对照组在检查前实施传统护理模式;观察组实施健康教育.结果 ①观察组健康教育前后SAS、SDS评分差异有统计学意义,观察组健康教育后SAS、SDS评分明显低于对照组（P＜0.05）;②观察组检查相关知识知晓率、主动配合率、患者满意度、图像质量总体合格率明显高于对照组（P＜0.05）;③观察组心率波动次数≥10次的患者比例明显低于对照组（P＜0.05）.结论 对64层螺旋CT冠状动脉造影老年患者实施健康教育能显著缓解焦虑、抑郁情绪,有利于图像质量的提高,可以在临床推广应用.     

老年股骨颈骨折的临床护理

目的:分析老年股骨颈骨折患者的临床护理方法及效果。方法:随机选取该院2013~2015年收治的老年股骨颈骨折患者78例,等分为对照组和观察组,对照组采用常规护理,观察组患者采用临床路径护理,对比两组患者的护理效果和护理满意度。结果:观察组患者护理效果明显优于对照组患者,同时护理满意度明显高于对照组患者(P0.05)。结论:在对老年股骨颈骨折患者护理中应用临床路径护理服务,能够明显提高护理效果和患者的满意度,有利于患者的康复和预后。     

早期康复护理在股骨颈骨折患者围手术期护理中的应用分析

目的探讨早期康复护理对股骨颈骨折患者预后的影响。方法回顾性分析2008年9月-2011年9年实行早期康复护理的68例股骨颈骨折患者的临床资料,并以同期采用常规护理的68例患者为对照组,比较两组患者预后情况。结果观察组患者Banhel指数评分结果明显高于对照组,组间比较差异具有统计学意义（P〈0．05）。观察组患者并发症发生率明显降低,住院时间明显缩短,患者满意度提高,组问比较差异具有统计学意义（P〈0．05）。结论早期康复护理可有效改善股骨颈骨折术后肢体功能,提高患者生活质量,值得临床推广。     

股骨颈骨折的术后护理干预

目的：探讨患者股骨颈骨折术后护理干预的临床效果。方法：选取本院收治的34例股骨颈骨折患者,分为对照组和干预组,每组各17例,干预组在对照组的基础上给予心理护理、饮食指导、术后康复指导、并发症的护理和出院指导,比较2组患者的Harris髋关节评分及术后并发症。结果：术后1个月时2组患者的Harris髋关节评分差异无统计学意义（P＞0．05）,术后3、6个月时干预组患者的Harris髋关节评分均优于对照组,2组间比较,差异有统计学意义（ P＜0．05）。干预组患者的总并发症发生率为0％,明显低于对照组的5．9％,2组间比较,差异有统计学意义（P＜0．05）。结论：对股骨颈骨折的术后护理干预,可以提高患者的生活质量,降低并发症发生率。     

临床护理路径在慢性肾衰竭患者健康教育中的应用

目的：探讨慢性肾衰竭患者健康教育中实施临床护理路径应用效果。方法：选取我院2010年1月～2011年12月间80例慢性肾衰竭患者为研究对象,将其按照随机数字法分为对照组和研究组,对照组40例患者给予常规的健康教育,研究组40例患者应该临床护理路径进行健康教育,观察两组的临床应用效果。结果：研究组患者的临床护理满意度评分明显的高于对照组患者,差异有统计学意义（ P＜0．05）;研究组患者遵医依从性为92．5％,对照组患者遵医依从性为62．5％,差异有统计学意义（P＜0．05）。结论：在慢性肾衰竭患者健康教育中应用临床护理路径具有较好的应用效果,能够有效的提高患者的护理满意度和遵医依从性。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.