门诊急诊儿科输液室的个体化护理

目的:探究个体化护理应用于门诊急诊儿科输液室的临床效果。方法:选择门诊急诊儿科输液室接受治疗的142例患儿为研究对象,分为对照组与观察组,每组71例。对照组给予常规护理措施,观察组在对照组的基础上给予个体化护理措施,对比两组的效果。结果:对照组中,投诉8例,投诉率为11.3%,观察组中,投诉1例,投诉率为1.4%。观察组的投诉率明显低于对照组。对照组中,出现医疗纠纷9例,医疗纠纷发生率为12.7%,观察组中,医疗纠纷1例,医疗纠纷发生率为1.4%,观察组的医疗纠纷发生率远远低于对照组。对照组满意度为84.5%,观察组满意度为97.2%。观察组的患者满意度明高于对照组。结论:个体化护理应用于门诊急诊儿科输液室有利于提高患者满意度,值得在临床上推广。     

HFMEA模式干预对儿科门诊留观输液室 儿童静脉输液渗漏发生率的影响研究

目的 探讨医疗失效模式与效应分析（healthcare failure mode and effect analysis, HFMEA）模式在儿科门诊留观输液室患儿静脉输液治疗中的应用及其对预防静脉输液渗漏的价值。方法 选取2021年1月至2021年12月于温州市中西医结合医院儿科门诊留观输液室进行静脉输液治疗的3680例患儿开展回顾性分析,按照就诊时间,2021年1月至6月HFMEA干预前的患儿为对照组（n=1835）,2021年7月至12月HFMEA干预后的患儿为研究组(n=1845)。对比开展HFMEA前后的患儿失效模式风险优先指数（risk priority number,RPN）评分、统计开展HFMEA前后的患儿静脉输液渗漏发生率和家属投诉率,并对患儿家属进行护理满意度调查。结果 开展HFMEA模式后,儿童静脉输液渗漏主要影响因素RPN评分均低于开展前,差异均有统计学意义（P<0.05）;开展HFMEA模式后,患儿静脉输液渗漏率（1.68%）、家属投诉率（0）分别低于开展前（2.67%、0.33%）,而家属护理满意度（89.27%）则高于开展前（86.54%）,差异均有统计学意义（P<0.05）。结论 HFMEA模式干预在儿科门诊留观输液室护理管理中,能够有效降低儿童静脉输液渗漏发生风险,继而减少患者家属投诉情况,家属认可度更高。     

人性化护理干预在门诊输液室护理中的应用效果研究

目的：探析人性化护理干预在门诊输液室护理中的应用效果。方法选取输液患者300例,随机分为2组,各150例。对照组给予常规护理,观察组开展人性化护理干预措施。比较2组患者护理后护理质量及满意度情况。结果观察组不良事件总发生率为2.00%,显著低于对照组(P<0.05);另外观察组患者的护理满意度评分中操作水平为（9.0±0.5）分,环境设施为（9.4±0.2）分、舒适程度为（9.2±0.3）分、服务态度为（9.5±0.4）分,均显著优于对照组(P<0.05)。结论在门诊输液室护理工作中开展人性化护理干预措施,可有效降低不良事件发生率和避免医疗纠纷,起到提高护理质量和患者满意度、和谐护患关系的积极作用,值得临床推广应用。     

系统化护理干预对门急诊静脉输液患者的影响

目的探讨实施系统化护理干预措施,对门急诊静脉输液不良反应及护理满意度的影响。方法 200例患者根据随机数字表法分为干预组（实施系统化护理干预措施）和对照组（根据医嘱实施对症护理）,各100例,比较两组患者静脉输液中发生的不良反应及护理满意度。结果干预组静脉输液总的不良反应发生率为17%,明显低于对照组（38%）（P〈0.05）。干预组静脉穿刺例次及巡视中发现输液管内残余液体量均明显少于对照组,而干预组静脉穿刺首次穿刺成功率明显高于对照组（P〈0.05）。干预组护理满意度评分明显高于对照组,其中干预组在输液室环境及管理、护理操作技术、护理人员的工作态度方面评分也分别明显高于对照组（P〈0.05）。结论对门急诊静脉输液患者系统化护理干预,有利于降低门急诊静脉输液不良反应,提高护理满意度,值得广泛推广和应用。     

优质护理在老年科临床输液患者中的应用

目的：探究优质护理在老年科临床输液患者中的应用效果。方法选取242例临床输液患者,按照就诊先后顺序随机均分为实验组与参照组,各121例。实验组患者给予优质护理方式,参照组患者给予常规护理方式。比较2组患者对护理工作的满意度以及投诉率。结果实验组患者护理满意度为95.04%,参照组患者护理满意度为79.34%,实验组患者护理满意度显著高于参照组（P<0.05）;实验组患者投诉率为1.65%,参照组患者投诉率为9.92%,实验组患者护投诉率显著低于参照组（P<0.05）。结论在老年科临床输液患者中,给予优质护理,能够满足老年患者的就诊需求,减少护患纠纷,提高患者对护理工作的满意度,值得广泛推广及实施。     

优质护理在老年科临床输液患者中的应用

目的 探讨优质护理在老年科临床输液患者中的应用效果。方法 选取我院2011年11月的临床输液患者481例作为研究组,在原来常规模式的基础上选派专职护士进行优质护理;选取2010年11月的临床输液患者513例作为对照组,按照原来的常规模式对患者进行输液治疗和护理。调查研究两组患者对输液知识的掌握情况、对临床输液室治疗护理工作的满意情况及护理投诉情况。结果 研究组和对照组患者对输液知识的知晓度和对护理工作的满意度比较,差异具有统计学意义（P〈0.01）;护理投诉情况比较,差异有统计学意义（P〈0.01）。结论 优质护理能增加患者对输液知识的知晓度、提升输液患者对护理工作的满意度、降低输液患者护理投诉率,它要求护士具有较高的专业水平与良好的职业素养。     

卡通标识输液器在门急诊输液室学龄前儿童中的应用

目的:观察卡通标识输液器在门急诊输液室学龄前儿童静脉输液中的应用效果。方法:选取本院门急诊输液室治疗的学龄前儿童140例为观察对象,随机分为对照组和观察组,每组70例。对照组采用普通输液器进行输液,观察组采用卡通标识输液器进行输液,比较两组患儿对输液的恐惧程度、配合程度、一次性穿刺成功率及家长满意度。结果:观察组患儿Ⅰ级恐惧程度比例为62.86%,高于对照组的30.00%(P<0.05);Ⅱ级和Ⅲ级恐惧程度比例分别为21.43%和15.71%,均低于对照组的37.14%和32.86%(P<0.05)。观察组患儿主动配合率、一次性穿刺成功率、家长满意度均高于对照组,差异均有统计学意义(P<0.05)。结论:使用卡通标识输液器可降低学龄前儿童对静脉输液的恐惧程度,提高一次穿刺成功率和患儿依从性,减轻患儿痛苦,提高家长满意度,利于儿科门急诊输液室护理人员的工作开展。     

静脉输液安全管理的方法及效果分析

目的：探讨静脉输液安全管理的方法及其效果。方法选取2013和2014年的静脉输液患者195510例为研究对象，其中2014年的105620例为观察组，2013年的89890例为对照组；对2013年本院输液安全不良事件和输液护理满意度进行回顾性分析，2014年开始加强静脉输液安全风险管理。结果观察组输液安全不良事件的发生率为0.012%，明显低于对照组的0.045%（P<0.01）；观察组患者对输液护理的满意度为96.8%，对照组的满意度为92.5%，2组对比差异有统计学意义（P<0.05）。结论实施静脉输液安全管理能有效保障患者的用药安全，提高患者对输液护理的满意度，也是医院护理服务质量的体现，因此值得各大医院推广应用。     

门诊输液室工作流程的优化

目的提高门诊输液室的工作效率和患者满意度,减少差错的发生。方法将2008年6月和2009年4月各月连续15天输液的前100例次（各1 500例次）分为传统组和改进组,选派7名输液室工作经验丰富的主管护师来完成。传统组在配药室前设接待窗口连续接单,病人交单后自己找空位坐好等候注射护士前往输液,由2名护士负责接单和配药;4名护士负责推车至病人座位前输液,其间或协助巡视班接瓶、拔针等;1名护士负责巡视等。改进组则尝试应用电脑排队系统,病人在门口自动取号排队,接待班在门口根据配药进度分批接单,接单后病人即可进入＂静脉穿刺区＂等候输液,输上液体的病人由巡视护士护送到座位上继续输液;接待、配药、注射和巡视各班人员配置是1∶2∶2∶2。比较两组每天各完成100例次静脉输液（输上液体为准）所用的平均时间、差错失误次数及患者满意度。结果改进组完成100例次所用平均时间（78.2±7.5）min,少于传统组的（108.2±8.6）min（P〈0.05）;总差错失误率0.4%,低于传统组的3.2%（P〈0.01）;患者满意度95.6%,高于传统组的91.3%（P〈0.01）。结论改进门诊输液室操作流程有利于提高工作效率,减少输液等候时间及差错失误,同时提高患者满意度。     

细节护理在儿科门诊输液中的应用效果观察

目的：探讨细节护理在儿科门诊输液中的应用效果。方法选取2012年5月—2014年5月于我院儿科门诊输液的100例患儿,随机将其分为对照组与观察组各50例,对照组患儿给予常规护理,观察组患儿则施行细节护理。比较2组患儿护患纠纷发生率、静脉重注率及家属满意度,记录患儿疼痛程度及焦虑评分结果。结果观察组患儿疼痛评分为（1.80±0.37）分,焦虑状态评分为（28.14±5.33）分,均明显低于对照组患儿,组间对比差异有统计学意义（P<0.05）。观察组静脉重注率为20.00%,护患纠纷发生率为0.00%,均明显低于对照组;且观察组护理满意度为96.00%,明显高于对照组的80.00%,组间对比差异均有统计学意义（P<0.05）。结论在儿科门诊输液中应用细节护理,不仅可提高儿科门诊护理质量,同时可提高静脉穿刺成功率,避免重复穿刺,提高治疗依从性,值得推广应用。     

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.