温针灸治疗中度心衰患者脑钠肽变化分析

目的观察温针灸治疗中度心衰患者血清脑钠肽和左室舒张末期功能的变化。方法选取2015年1月-2016年6月本院收治的中度心衰患者134例,随机分为观察组和对照组,每组各67例。对照组给予常规药物治疗,观察组在对照组基础上增加温针灸治疗。分别于治疗前和治疗后第4周末用ELISA法检测脑钠肽水平,超声检测左室舒张末期内径(LVEDD)、左室功能(LVEF),计算B型尿钠肽下降率(Rate)。结果治疗后第4周末两组患者血清脑钠肽水平均明显低于治疗前,观察组患者血清脑钠肽水平明显低于对照组,差异均有统计学意义(均P0.05)。治疗后第4周末两组患者心率和NYHA分级均明显低于治疗前,观察组患者血清脑钠肽水平明显低于对照组,差异均有统计学意义(均P0.05)。治疗后第4周末两组患者LVEDD明显低于治疗前,LVEF和Rate明显高于治疗前,差异均有统计学意义(均P0.05);治疗后观察组患者LVEDD明显低于对照组,LVEF和Rate明显高于对照组,差异均有统计学意义(均P0.05)。结论中度心衰患者常规药物治疗时联用温针灸治疗可有效改善脑钠肽水平和心脏功能,值得临床推广应用。     

左西孟旦治疗急性心力衰竭的临床效果及其对血清脑钠肽的影响

目的观察左西孟旦在急性心力衰竭患者中的应用效果,及其对患者血清脑钠肽的影响。方法选取2017年10月—2018年10月收治的急性心力衰竭患者74例,根据治疗方法的差异设置观察组和对照组,对照组实施盐酸多巴酚丁胺注射液治疗,观察组实施左西孟旦治疗。结果治疗后,两组血清脑钠肽比较有显著统计学差异(P <0. 05);两组不良反应的比较有显著统计学差异(P <0. 05);两组疗效的比较有显著统计学差异(P <0. 05)。结论左西孟旦能够改善急性心力衰竭患者的血清脑钠肽,减少患者治疗后的心悸、胸痛等不良反应,从整体上提高疾病的临床治疗效果。     

高血压患者血清血管紧张素转化酶水平与心房颤动的相关性分析

目的分析高血压患者血清血管紧张素转化酶(ACE)水平和心房颤动(AF)发生的关系。方法选择2014年1月至2016年12月我院高血压住院患者145例,依据临床诊断将患者分为未合并AF的对照组71例和合并AF的观察组74例。比较两组患者的性别、年龄、BMI、血压,以及高敏C反应蛋白(hs-CRP)、血清脑钠肽(BNP)、左房内径和左心室射血分数(LVEF)、ACE水平,采用Logistic回归分析观察差异因素与AF发生的关系。结果两组患者的性别、年龄和BMI无统计学差异(P>0.05),观察组的收缩压和舒张压显著高于对照组(P<0.05)。两组患者的LVEF水平无统计学差异(P>0.05),观察组的hsCRP、BNP、左房内径和ACE水平均显著高于对照组,差异具有统计学意义(P<0.05)。Logistic回归分析表明左房内径扩大(OR=0.953,P=0.042)和ACE升高(OR=1.072,P=0.002)为AF发生的独立危险因素。结论高血压患者的血清ACE升高和左房内径扩大为AF发生的独立危险因素。     

甲状腺功能减退合并妊娠期糖尿病患者糖、脂代谢水平的变化特点

目的探讨甲状腺功能减退对妊娠期糖尿病(GDM)患者糖脂代谢水平的影响。方法选取GDM患者180例,其中合并甲状腺功能减退42例(甲减组)、单纯GDM患者138例(GDM组),选取同期正常妊娠妇女100例为对照组。结果甲减组、GDM组和对照组的血清TG、HDL-C差异不具有统计学意义(P> 0. 05);甲减组的血清TC、LDL-C水平均高于GDM组和对照组(P <0. 05); GDM组的血清TC、LDL-C水平均高于对照组(P <0. 05);GDM组的FPG、1 h FPG、2 h FPG水平高于对照组和甲减组(P <0. 05),甲减组的FPG、1 h FPG、2 h FPG水平高于对照组(P <0. 05);甲减组、GDM组和对照组的血清FT3差异不具有统计学意义(P> 0. 05);甲减组的FT4水平低于GDM组和对照组(P <0. 05);甲减组的血清TSH水平均高于GDM组和对照组(P <0. 05);甲减组、GDM组和对照组的Scr、BUN、UA、Cys-C水平差异不具有统计学意义(P> 0. 05)。结论甲状腺功能减退可进一步加重GDM患者的糖脂代谢紊乱程度。     

生脉苓桂救心汤治疗老年心脾两虚型慢性心衰的临床研究

目的探讨生脉苓桂救心汤治疗老年心脾两虚型慢性心衰的临床价值。方法选取本院2016年1月——2018年1月收治的106例老年心脾两虚型慢性心力衰竭患者,按随机数表法分为观察组与对照组,各53例。对照组采取常规西药治疗,观察组在对照组基础上应用生脉苓桂救心汤。两组均连续治疗4周。比较两组总有效率、治疗前与治疗4周后的每搏输出量、心输出量、心指数、左室射血分数、中医证候总积分、六分钟步行距离试验、血清B型钠利尿肽水平及不良反应总发生率。结果观察组总有效率92. 45%,高于对照组77. 36%,差异有统计学意义(P <0. 05)。两组治疗前的搏输出量、心输出量、心指数、左室射血分数、中医证候总积分、六分钟步行距离试验、血清B型钠利尿肽水平的差异无统计学意义(P> 0. 05);治疗4周后,两组的搏输出量、心输出量、心指数、左室射血分数、六分钟步行距离试验均较治疗前增大,中医证候总积分与血清B型钠利尿肽水平均较治疗前减小,差异有统计学意义(P <0. 05)。观察组治疗4周后的搏输出量、心输出量、心指数、左室射血分数、六分钟步行距离试验高于对照组、中医证候总积分与血清B型钠利尿肽水平低于对照组,差异有统计学意义(P <0. 05)。观察组治疗期间不良反应总发生率11. 32%(6/53),对照组9. 43%(5/53),差异无统计学意义(P> 0. 05)。结论生脉苓桂救心汤联合西药治疗老年心脾两虚型慢性心力衰竭可有效改善患者中医证候与心功能,提高患者运动耐力与治疗总有效率,安全可靠,值得推广。     

左西孟旦治疗慢性重度心力衰竭合并肾功能失代偿期患者的疗效分析

目的 评价左西孟旦对慢性重度心力衰竭合并肾功能失代偿期患者的有效性和安全性.方法 选取慢性重度心力衰竭合并肾功能失代偿期患者105例,按随机数字表法分为对照组(53例)和左西孟旦组(52例),检测两组治疗前及治疗后1周血清N-末端脑钠肽前体、尿素氮、肌酐水平,同期应用心脏B超测定左心室射血分数(LVEF),并观察两组不良反应发生情况.结果 对照组不良反应发生率为16.98％(9/53),左西孟旦组为17.31％(9/52),两组比较差异无统计学意义(P＞0.05).左西孟旦组治疗后较治疗前血清N-末端脑钠肽前体、尿素氮、肌酐降低[(1764.19±25.21) ng/L比(7052.95±42.16) ng/L、(9.12±0.31) mmol/L比(16.91±2.98) mmol/L、(138.03±10.12)μmol/L比(222.68±16.16) μmol/L],LVEF升高[(45.08±7.07)％比(34.77±6.10)％],差异均有统计学意义(P＜0.05);对照组治疗后较治疗前血清N-末端脑钠肽前体降低[(2311.58±32.33) ng/L比(6887.56±48.23) ng/L],LVEF升高[(41.11±7.13)％比(36.89±5.05)％],差异均有统计学意义(P＜0.05),血清尿素氮、肌酐降低[(11.29±3.23) mmol/L比(14.84±2.86) mmol/L、(205.89±20.08) μmol/L比(217.51±12.22)μmol/L],但差异无统计学意义(P＞0.05);治疗后左西孟旦组较对照组血清N-末端脑钠肽前体、尿素氮、肌酐降低,差异均有统计学意义(P＜0.05),LVEF升高,但差异无统计学意义(P＞0.05).结论 左西孟旦对慢性重度心力衰竭合并肾功能失代偿期患者具有良好的有效性和安全性,同时还有明显的改善肾功能作用.     

类风湿性关节炎患者维生素D和免疫球蛋白水平及相关性分析

目的探讨类风湿性关节炎患者血清中维生素D和免疫球蛋白水平变化。方法选取本院2017年3月-2019年3月的80例RA患者作为观察组,同期健康体检者64例作为对照组,检测2组血清中25羟基维生素D[25(OH) D]水平,同时检测2组血清免疫球蛋白Ig G、Ig A、Ig M,补体C3、C4水平,并分析维生素D和免疫检测指标的相关性。结果类风湿性关节炎患者体内25羟基维生素D3水平显著低于健康体检者,差异有统计学意义(P 0. 05),Ig G、Ig A、Ig M水平显著高于健康体检者,差异有统计学意义(P 0. 05),C3、C4与对照组相比没有统计学差异,维生素D与红细胞沉降率(ESR)、抗环瓜氨酸肽(CCP)抗体呈显著负相关,与类风湿因子(RF)、免疫球蛋白等无明显相关性。结论类风湿性关节炎患者维生素D和免疫球蛋白水平与正常人相比存在显著差异,可帮助提高疾病的诊断准确性。     

血清脑钠肽及心肌酶谱对手足口病合并脑炎患儿的诊断意义

目的探讨血清脑钠肽及心肌酶谱检测对手足口病合并脑炎患儿的临床意义。方法分别选取本院的手足口病合并脑炎患儿、单独手足口病患儿以及正常体检患儿各40例,分析比较三组患者的血清BNP和心肌酶谱,同时亦比较手足口病合并脑炎患儿中轻症和重症患者的BNP和心肌酶谱。结果三组患者BNP及心肌酶谱间经方差分析差异有统计学意义,且观察组患者BNP和心肌酶谱指标显著高于对照组和健康组,差异有统计学意义(P0.05);观察组中重症患者的BNP和心肌酶谱高于对照组,且差异有统计学意义(P0.05)。结论血清脑钠肽和心肌酶谱可以用于手足口病合并脑炎患儿的诊断,值得推广。     

替格瑞洛对急性冠脉综合征经皮冠状动脉介入治疗围手术期C反应蛋白和心功能的影响

探讨替格瑞洛对急性冠脉综合征(ACS)经皮冠状动脉介入治疗(PCI)围手术期C反应蛋白(CRP)和心功能的影响。方法将2018年1月—2019年1月于我院行PCI术的80例ACS患者纳入研究,随机分成两组,对照组40例给予西医常规治疗,观察组40例在对照组的基础上给予替格瑞洛治疗。比较患者的C反应蛋白(CRP)与脑尿钠肽(BNP);血小板聚集率;心功能;不良事件发生率;临床综合疗效。结果两组患者用药后CRP、BNP含量有所下降,观察组明显低于对照组(P <0. 05);两组患者用药后血小板聚集率下降,观察组血小板聚集率低于对照(P <0. 05);观察组术后左室射血分数(EF)大于对照组,左室舒张末期内径(LVEDD)小于对照组,差异有统计学意义(P <0. 05);观察组不良事件发生率低于对照组,差异显著(P <0. 05);观察组治疗总有效率为85%,高于对照组的60%,差异显著(P <0. 05)。结论替格瑞洛对经皮冠状动脉介入治疗的急性冠脉综合征患者的疗效显著,对围手术期C反应蛋白和心功能产生了积极的影响,具有一定的临床意义。     

高尿酸血症患者血浆中脑钠肽水平与心房颤动的相关性研究

研究高尿酸血症患者血浆中脑钠肽水平与心房颤动(简称房颤)的关系。选择2014年6月~2015年10月,大连大学附属中山医院住院的阵发性房颤组(56例)、持续性房颤组(52例)作为房颤组,同期选择无房颤临床症状的患者50例作为对照组,记录各组患者的年龄、脑钠肽水平以及血清尿酸水平。分析对照组、阵发性房颤组以及持续性房颤组患者血尿酸以及血清中脑钠肽含量的差异,同时采用logistic回归分析各因素的相关性,探讨血尿酸以及脑钠肽与房颤的相关关系。结果显示,对照组患者血尿酸水平(310.5±67.9)μmol/L与阵发性房颤组患者(313.3±78.3)μmol/L差异无统计学意义(t=1.02,P=0.61),而持续性房颤患者血尿酸水平(383.1±73.6)μmol/L较对照组(t=4.19,P0.01)和阵发性房颤组(t=4.77,P0.01)提高,差异均有统计学意义。阵发性房颤组患者血清脑钠肽水平(299.7±46.5)mg/L以及持续性房颤组(383.1±73.6)mg/L较对照组(37.2±9.5)mg/L升高,差异均有统计学意义(t=21.20、29.10,均P0.01)。logistic回归分析表明尿酸水平以及血清中脑钠肽水平是房颤的独立危险因素,监测血清脑钠肽含量的变化对房颤的早期诊断有重要意义。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.