情景急救模拟演练在急诊科专科护士的培训应用

目的：探讨应用情景模拟急救演练在急诊专科护士的培训运用效果,旨在提高急诊专科护士在急救过程中的综合素质。方法：选急诊常见的危重症,如心脏猝死、过敏性休克、颅脑外伤及创伤性休克病例,以情景模拟的形式进行急救演练,演练结束后进行考核评价。结果：使参加的急诊科专科护士身临其中,寓教于乐,在有经历感的工作环境中,更加深理解和记忆,提高急诊护士的抢救配合能力。结论：情景急救模拟演练在急诊专科护士中的培训效果显著,特别是使低年资护士综合素质得以提高。     

实施应急预案演练 提高护士急救能力

目的探讨模拟仿真急救演练的方法,提高急诊科护士急救能力。方法对急诊科护士开展应急预案学习及仿真模拟急救演练,即采用确定内容、制订计划、拟定演练方案、角色配置、现场实景模拟急救,演练结束后进行分析、总结。结果急诊科护士经4次的演练,2007年基本技能操作评分、综合能力评分较2006年明显(P均<0.01)。结论模拟急救演练是全面提高急诊科护士综合素质,急救能力和整体协调能力的有效方法。     

应急预案演练提高护士综合能力的效果评价

目的:提高急诊科护理人员应对突发公共卫生事件的能力和强化急救意识.方法:制定突发公共卫生事件应急预案,模拟演练突发公共卫生事件的应急处理流程,观察模拟演练前后护士的急救综合能力.结果:急诊科护士的临床护理急救技能考核成绩和医生对护理人员的抢救配合满意度均较演练前提高(P＜0.01).结论:突发事件应急预案情景演练,能够稳步提高护理人员的急救综合素质,更好地应对突发性公共卫生事件.     

急诊科低年资护士应急能力的培训模式研究

目的提高急诊科低年资护士的应急能力。方法以湖北省护理质量控制中心制定的《急诊科专科护士培训大纲》的内容及要求为培训指南,应用VCD光盘学习、操作演练、情景模拟、护理教学查房等培训模式,对急诊科工作0~5年的护士进行常见急危重症的抢救流程和急救技能的培训。结果培训3个月后低年资护士理论、模拟应急能力、实际应急能力的考核成绩显著高于培训前(均P0.01)。结论对急诊科低年资护士进行规范化的应急能力培训有助于急诊科护士应急能力和急救能力的提高。     

情景模拟抢救配合演练在急诊专科护士培训中的应用

目的探讨应用情景模拟抢救配合演练在急诊专科护士培训中的运用效果,旨在提高急诊专科护士在抢救过程中的综合素质。方法选择急诊常见危重症的病例,以情景模拟的形式进行急救演练,演练结束后进行考核评价。结果情景模拟法使护士进一步提高了自身的临床操作技能水平,使护士进一步提高了自身应对突发事件的能力和团队协作能力,且对于护士评判性思维方式的培养起到了良好的促进作用。结论在急诊专科护士培训中应用情景模拟抢救配合演练,取得的效果明显,有助于提高护士的综合素质。     

多部门联合急救演练提高护士综合能力的效果评价

目的：提高病区护理人员应对突发事件的能力、强化急救意识,缩短抢救配合的时间。方法：运用情景演练的模式,模拟各类危重症患者的抢救,观察模拟演练前后护士的急救综合能力。结果：护士完成演练配合所需时间较演练前缩短,护士的应急配合能力考核较演练前提高（P〈0.01）。结论：多部门联合的急救演练,能够提高护士综合能力,更好的应对突发情况下的急救配合。     

初级创伤救治培训模式在急诊科护士培训中的应用效果

目的：探讨初级创伤救治（ PTC）培训对提高急诊科护士的初级创伤救治能力的影响。方法按PTC教程的要求,对急诊科护理人员40人进行创伤急救技能理论培训、技能操作培训、综合模拟演练。培训前及培训后对接受培训的每位护士进行理论考核、技能操作考核和现场演练考核,比较培训前后的各项考核指标的变化。结果培训后40位护士理论考核合格率为87．50％（35／40）,明显高于培训前的52．50％（21／40）（P＜0．05）;培训后技能操作考核、现场演练考核各项目合格率均明显高于培训前（P＜0．05）。结论 PTC培训能有效提高急诊科护士的初级创伤救治能力。     

分层级规范化培训对提高急诊科护士急救能力的影响

目的：探讨分层级规范化培训对提高急诊科护士急救能力的影响。方法针对我院急诊科护士现状,制订分层级规范化培训计划,内容包括理论知识、急救技能、常见急诊分诊急救程序、护患沟通技巧等,采用多种形式结合进行培训。比较实施分层级规范化培训前后护士的理论与技能考核成绩、应急能力、抢救配合及医生对护士工作的满意度。结果经分层级规范化培训,急诊科护士的理论与技能考核成绩、应急能力、抢救配合及医生对护士工作满意度较实施前均明显提升（ P ＜0．01或 P ＜0．05）。结论分层级规范化培训能有效提高急诊科护士的急救综合能力,使医护配合更加默契。     

急救护理路径在培养年轻护士应急能力中的应用

目的探讨应用急救护理路径培养年轻护士的应急抢救能力。方法制定呼吸内科常见急症的急救护理路径,以模拟演练与实际抢救相结合,有计划有针对性地对年轻护士进行专科理论知识和应急能力培训。结果明显提高了年轻护士的应急能力和专科护理水平,护理综合技能有不同程度的提高。结论专科急救护理路径培训和其他培训考核有助于提高年轻护士的应急能力和整体业务素质。     

案例学习法结合情景模拟在手术室低年资护士应急能力培训中的应用

目的探讨案例学习法结合情景模拟在手术室低年资护士应急能力培训中的应用效果。方法根据多年抢救患者的经验,应用案例学习法结合情景模拟的方法,对手术室工作0～5年低年资护士进行应急能力的培训。并反复强化演练,培训小组每月逐个进行考核,实行个体评价。结果通过培训,手术室低年资护士的急救知识、急救操作技能、临床综合应急能力和医生的手术配合满意度明显提高。结论案例学习法结合情景模拟可以强化手术室低年资护士急救意识、增强临床应急能力、拓展急救理论知识、增强交流沟通能力和团队凝聚力、提高护士的自信心、减轻护士的心理压力,适合手术室的工作特点。     

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.