湖北省统一护理技能高考考试结果分析与对策

目的通过对2013年湖北省统一护理技能操作考试结果进行分析，对中职教学提出指导性建议。方法对2013年参加湖北省统一护理技能操作考试的661名中职毕业生进行分类统计和综合评价。结果专业技能应知考试及格率仅为32．38％，不及格率达到67．62％；专业技能实际操作考试（共3个项目6个操作）及格率均在96％以上，总评成绩及格率为98．44％，不及格率为1．56％。结论重视技能高考，才能取得满意的成绩，提高考试通过率。     

社区护理两阶段实践教学方法及效果的探讨

目的为提高社区护理课程的教学质量，培养能适应社区护理工作的实用人才。方法实施两阶段实践教学方案：（1）在理论教学过程中，为居民体检、建立健康档案、健康指导；（2）临床实习前，对特殊人群进行生活护理、卫生宣教、康复训练等。结果97．5％的社区居民及工作人员认同社区护理实践的教学方式；96．4％学生认为实践教学对他们的口头表达能力、独立思考解决问题能力、健康教育能力的提高以及护理观念的转变有较大的帮助；98．2％的学生对社区护理实践内容及时间安排满意。结论两阶段实践教学有助于学生了解不同人群的健康保健状况，提高其对社区工作、预防保健的认识，激发学生主动学习的兴趣，是培养实用型护理人才的好方法。     

实习初期护生的临床带教方法探讨

根据护牛实习初期的特点进行分析，对80名护生实习初期的特点进行分析，实施精选带教老师、加强护理安銎教吾、关心尊重信任学生、注重礼仪教育、为学生创造学习机会、指导学生正确对待夜班、注重信息反馈等方法，及时了解学生的心理感受，通过以问卷及面对面问答方式对其进心理素质自测及带教老师评价。结果发现，对带教老师教学态度满意度由83．5％上升到98．5％，护生临床操作与理论考核优秀率达95．5％。因此，加强护生实习初期临床带教工作，是提高临床带教质量的关键。     

神经内科开展优质护理服务模式的构建与效果分析

目的探索优质护理服务工作模式，为患者提供安全、舒适、满意的优质护理服务。方法通过充分调研、周密计划、改革临床工作方式、强化优质护理理念、丰富专科护理内涵、注重护士培养和人文关怀等措施。结果护理工作质量检查合格率由2009年的92．5％提高95．8％；陪护率由开展工作前的140％下降至98％；患者对护理工作满意度由93．23％提高至97．30％。结论正确理解卫生部文件精神，结合地区、医院实际情况，转变观念、创新管理模式，不断总结经验，稳步推进，形成合适的护理管理模式是优质护理服务的重要内涵。     

护理操作技能考核方法改革初探

目的探讨护理操作技能考核方法。方法随机抽取2009级2班护生作为实验组和对照组,对照组采用仅由教师考核的传统考核方法,实验组采取“小考官”考核点评与教师考核相结合的方法。通过技能考核和调查问卷比较2组教学效果。结果实验组技能考核成绩高于对照组（P〈0．01）,所有学生增加了课后练习次数,90．54％的学生提高了学习兴趣,94．59％的学生增进了彼此的交流,95．95％的学生消除了侥幸心理,所有学生认为改革后的考核方法有助于提高考核成绩。结论“小考官”考核点评与教师考核相结合的方法有助于激发学生学习兴趣,培养学生独立思考能力和自主学习能力,提高了学生整体操作水平。具有可行性。     

全口义齿四手操作配合及患者满意度调查

目的：探讨全口义齿制作过程中四手操作护理配合要点及患者的满意度。方法选择行全口义齿修复患者64例,按照全口义齿四手操作护理配合要点参与修复治疗全过程,调查患者满意度。结果（1）患者对全口义齿制作过程中护理操作、医护配合、人文关怀、护理态度评价为满意分别占98．4％、96．9％、93．8％、100．0％。（2）患者对全口义齿外观、语言、咀嚼能力、义齿稳固性、舒适性评价为满意分别占90．6％、98．4％、89．1％、93．8％、96．9％。（3）患者预期目的完全达到58例（90．6％）;基本达到6例（9．4％）。结论四手操作在全口义齿诊疗中可提高医生工作效率和患者满意度,并减轻医护工作的疲劳;应积极提倡培养口腔护士四手操作的能力。     

风险管理在急诊护理管理中的应用

目的为强化急诊护理风险管理，降低护理风险的发生率，为患者提供优质、安全的护理。方法健全完善护理风险管理制度，强化安全和护士素质教育，提高护理安全认识，加强业务素质培训，提高护理工作质量，规范仪器设施的应用和管理。结果护理缺陷发生率由2005年的2．9％（7／238）降至2006年的0．7％（1／150），护理投诉降至为零，患者及家属满意率由95．0％提高至98．9％，急救物品完好率由98．8％提高至100．0％，护理质量由95．7分提高至98．0分。结论实施急诊护理风险管理，对预防护理安全隐患，提高护理质量起到了积极重要作用。     

基于人文关怀理念的护理操作技术教学改革

目的探讨培养护理专业学生的人文精神，为护理对象提供人性化的护理技术操作。方法设立实验组，通过改革护理技术操作流程、增加角色体验、更新技术操作考评标准、创建以人为本的考核方法等措施，培养学生的人文关怀精神。结果教学改革后的学生在护理操作全程中都能注意沟通，与对照组相比，对病人的关怀程度明显提高。结论在专业课中渗透人文关怀是培养学生人文精神的关键，在护理技能操作流程中加入人文关怀的程序，加大操作流程中态度指标的分值比重，是培养护理专业学生人文素质的有效方法。     

护理本科生临床教学中存在的问题及对策

目的调查分析护理本科生临床实习期间存在的问题，并提出相应改进措施。方法研究采用无记名调查问卷的形式，问卷分为学生（n=98）和教师（n=22）两部分。结果多数学生对实习安排、教学态度满意，有44％的学生认为教学方法有待提高；教师主要反映学生的基础理论知识需要加强，不同实习阶段存在不同问题。结论通过对问卷分析，提出改进措施。     

新生儿泪囊炎治疗的技术探讨和护理体会

目的 探讨新生儿泪囊炎治疗的疗效、操作技术和护理要点。方法 160例(210眼)新生儿泪囊炎采用泪道冲洗加探通术进行治疗。随防6-12个月。结果 治疗160例210眼，1次治愈率93．81％(197眼)，2次治愈率4．76％(10眼)，总治愈率98．57％(207眼)，未愈率1．43％(3眼)。无1例出现手术并发症。结论 早期的治疗加上熟练的技术操作和护理，能提高新生儿泪囊炎的治愈率。     

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.