工作中有欣慰也有遗憾

我是一名护士,是百万护士中极其普通的一员。在我的工作岗位上,整天打交道的是一些特殊的人,接触到的是人的生老病死。生的笑容,病的愁容,死的戚容;整天在耳边回荡的是痛苦的呻吟,以及一些扰乱人内心平静的声音;看到的面孔有微笑的,也有依赖的,无奈的,痛苦的,绝望的。这些,在我的心中都留下了不可磨灭的印象。这些印象有的是成功后的欣慰,有的是无法挽回后的遗憾。     

五月放歌

五月的天空是湛蓝的，土地是肥沃的，花儿是清香的，叶儿是嫩绿的，树木是茂盛的，鸟儿的歌声是清脆的，婉转的，五月的护士是骄傲的，自豪的。在这鸟语花香的五月，我要顷情歌唱。歌唱我们的姐妹，我们的天使。     

护士的微笑

轻盈的脚步,洁白的衣帽。和蔼可亲的面容,带着真诚的微笑。护士的微笑,如温暖的春风轻飘,驱散着病痛中人们心中的烦恼。护士的微笑,是赢得患者信赖的良青,他们欣慰的目光,是即将康复的先兆。护士的微笑,给了病人精神的治疗。那真诚的微笑,是宾善美的写照。护士的微笑@赵净$辽宁新民县人民医院~~     

护理专业教师人格魅力的构建

教师的人格魅力对学生的影响是耳濡目染的、潜移默化的、受益终生的，主要体现在高尚的人品、渊博的学识、较强的能力、良好的性格、高雅的气质、迷人的风采、精湛而又娴熟的教学艺术及富有创新精神等。构建教师的人格魅力，树立教师的完美形象，应是每一位教师终生为之追求的最高人生境界。     

浅谈在急诊科实施健康教育的沟通技巧

要求教育者具备一定的知识和技能，掌握一定的传播技巧。加强教育知识和技能的学习，以适应社会医学模式的转变；语言教育方法，主要是通过口头语言进行教育的方式；人际传播的技巧，社会与文化的差异，传播对象的消极态度，理解力和记忆力的低下，矛盾的信念，与教育对象的沟通与交谈，讲究运用语言的技巧，恰当的称呼，采用听者能够理解的语言和易于接受的方式向听者提供个人需要的信息，达到表达思想，形成共识的目的。采取正确的教育方法和途径，掌握一定的传播技巧，是作好健康教育的基本务件，健康教育的开展，提高了病人家属的健康意识和自我保健能力，收到良好的社会效果。     

心理治疗效果的评价及其影响因素

1心理治疗效果的评价 1.1评价的依据 1.1.1心理症状的改变：患者的心理症状,如感到焦虑、抑郁、紧张、恐惧等,是自觉的、不舒适的、病态的精神状态.通常可用已有的症状问卷来测量,或单靠患者主观的申诉描写.假如患者本来的主诉是严重的恐慌、惧怕或其他心情上的症状,可作为治疗效果的主要评价指标.但要注意的是,从心理治疗的经验来看,有些患者随治疗的进行会有起伏性的变化.     

护士心理健康状况研究进展

心理健康指的是一种良好的、持续的心理状态与过程，是指个人具有生命的活力，积极的内心体验，良好的社会适应能力，能够有效地发挥个人的身心潜力以及作为社会一员的积极的社会功能。职业心理压力的研究是健康心理学研究的重要课题。护士作为一个高应激的职业群体。工作对象是活生生的患者，其良好的心理健康状况对工作质量及患者的康复进程有着积极的作用，     

髋关节置换患者的护理现状及研究进展

探讨髋关节置换手术患者的护理现状及进展,分析对患者采取不同的护理方法所取得的疗效。通过对患者进行针对性的、人性化的、合理化的、有效性的、持续性的系统护理可以改善患者的精神状态和身体状态,提高患者的依从性,促进患者术后的恢复,降低术后并发症的发生率,从而提高手术的成功率与患者的生活质量。     

护士心理品质的培养

做一名合格的护士，应当具备良好的心理品质、高尚的道德和真挚的同情心、敏锐的观察力和准确的记忆力、积极而又稳定的情绪和良好的性格、美好的语言和娴熟的技术等。护士的优良心理品质并非生来就有的，而是靠崇高的理想和坚强的意志，并在实践中刻苦磨炼慢慢发展和培养起来的。     

对人性化护理理念的思考

目的正确完整的解读人性化护理的实质，不要把人性化护理简单化、庸俗化，促进护理事业健康发展。方法用理论分析的方法，在护理发展的历史沿革和现实需要中阐述护理发展的必然趋势；从人的生活的角度深刻理解人的本性，对人性作多层面的剖析；对人性化护理的要点和误区提出作者的观点，对如何满足患者的合理、正当的多样性需求并抑制其不适当的欲望提出看法。结果对人的护理才是护理的逻辑起点；能否体现对人的生理、社会和心理感受的充分重视是人性化服务的一个关键。结论理性的看待目前日渐高涨的人性化护理的热情，莫使人性化护理走入误区；正确区分人性化和人情化、商业化的不同，杜绝华而不实的形式，维护护理的技术性和科学性。     

异丙酚对犬急性心肌缺血再灌注损伤心电活动的影响

目的以再灌注心律失常（ＲＡ）为观察指标,探讨了不同剂量的异丙酚对犬缺血再灌注心肌电活动的影响。方法２４只犬随机平均分三组：对照组、高剂量异丙酚组和低剂量异丙酚组,建立急性心肌缺血再灌注损伤在体模型,观察各组ＲＡ的发生性质和发生例数。结果再灌注心律失常的发生,与异丙酚组比较,对照组性质严重、发生率高。结论异丙酚对犬再灌注心肌电活动有一定保护作用。     

缺血-再灌注不同时间点给予尼可地尔对犬心肌梗死范围的影响

目的　证实尼可地尔是通过激活心肌细胞 KATP通道而起到使梗死心肌范围明显缩小的作用 ;进一步了解在冠状动脉 (冠脉 )闭塞心肌缺血前后和再灌注时给予尼可地尔产生的心肌保护作用是否相同 ,为临床上应用 KATP通道开放剂防治急性心肌缺血性疾病提供依据。方法　 35条犬随机分为 5组 ,每组 7只。缺血再灌注组 (IR组 ) :冠脉左前降支 (L AD)闭塞 90 min,再灌注 12 0 min。缺血前给予尼可地尔组 (PNIC组 ) :L AD闭塞前 10 min经静脉给予尼可地尔 10 0μg/ kg,随后给予 10μg· kg- 1 · min- 1 持续静脉滴注至再灌注结束。缺血后 15 m in给予尼可地尔组 (INIC组 ) :L AD闭塞后 15 m in经静脉给尼可地尔 10 0μg/ kg,随后给予10 μg· kg- 1· min- 1持续至再灌注结束。再灌注开始时给予尼可地尔组 (RNIC组 ) :L AD闭塞 90 min,再灌注开始时立即静脉给尼可地尔 10 0 μg/ kg,随后给予 10 μg· kg- 1· m in- 1持续至再灌注结束。KATP通道阻滞剂组(GL IB+INIC组 ) :在 L AD闭塞前 10 min经静脉给予优降糖 0 .3m g/ kg 10 min,随后步骤同 INIC组。各组均在冠脉闭塞前、冠脉闭塞后 1h、再灌注 2 h测定血流动力学指标 ;再灌注 2 h后用图像分析仪测量氯化三苯四唑 (TTC)染色的梗死心肌范围 (IA)和危险心肌范围 (     

实验性顿抑心肌微灌注及局部功能与细胞凋亡的关系

目的 评价计算机辅助心肌造影(MCE)对顿抑心肌微灌注定量研究的可行性,探讨顿抑心肌的微灌注及局部功能与细胞凋亡的关系.方法 根据阻断和再灌注冠脉时间不同,将家兔分为三组:阻断15 min再灌注30 min(Ⅰ组)、阻断30 min再灌注60 min(Ⅱ组)和阻断120 min再灌注60 min(Ⅲ组).于冠脉阻断时和再灌注后行MCE,造影图像经自制计算机辅助软件处理后,自动得出每个节段的标化造影剂密度(CI);对危险心肌的室壁增厚率(WT)进行计算;应用末端脱氧核糖核苷酸转移酶介导的dUTP缺口末端标记法(TUNEL)检测心肌细胞凋亡情况,并计算凋亡指数(AI).结果 ①阻断时,各组危险心肌的WT均降至零点或呈负值,且标化CI值均明显减低,与基础状态比较差异有统计学意义(P＜0.01).再灌注后,各组危险心肌的WT均明显低于基础状态;而Ⅰ组和Ⅱ组危险心肌标化CI值比阻断时增高(P＜0.01),与基础状态时相比仍减低(P＜0.01),Ⅲ组危险心肌标化CI值与阻断时相比无明显差别(P＞0.05).②各组危险心肌的AI分别为(13.70±5.48)%、(36.25±5.55)%和(62.06±6.70)%,组间比较差异均有统计学意义(P＜0.05或P＜0.01;危险心肌WT和标化CI与AI均呈负相关(r=-0.87和r=-0.77,P＜0.05).结论 计算机辅助心肌造影可定量评估心肌微灌注,短时间缺血再灌注不会引起心肌坏死,但会导致心肌细胞发生凋亡,出现心肌顿抑现象,长时间缺血后,即使给予充足的再灌注,也会导致凋亡和坏死同时发生.

Abstract：

Objective To evaluate a new computer-aided technique applicable for myocardial contrast echocardiography(MCE) to quantitate automatically calibrated myocardial contrast intensity(CD and to test the feasibility of calibrated CI in assessing myocardial perfusion. To analyze the relationship on myocardial perfusion,regional contractile function and cell apoptosis in stunned myocardium. Methods According to coronary occlusion and reperfusion at different times, rabbits were divided into three groups: 15 min occlusion/30min reperfusion (group Ⅰ ),30 min occlusion / 60min reperfusion (group Ⅱ ) and 120 min occlusion / 60min reperfusion (group Ⅲ ). MCE was performed on all rabbits at baseline,occlusion and after reperfusion,and its images were analyzed by a new computer-aided technique. Myocardial calibrated CI of each segment was measured automatically by software. Percentage wall thickening (WT) of each risk segment at each stage were also measured by echocardiography. The apoptotic index(AI) in regional left myocardial dysfunction was calculated by terminal deoxynucleotidyl transferease-mediated biotinylated deoxyuridine triphosphate nick end labeling(TUNEL ). Results (1) During occlusion, WT in the areas at risk decreased to zero or negative and the calibrated CI values were significantly lower than those at baseline ( P ＜0.01 ). After reperfusion, WT in all risk segment remained depressed, but calibrated CI significantly improved in group Ⅰ and Ⅱ while those remained unchanged in group Ⅲ. (2)AI in risk myocytes were (13. 70 ± 5.48 ) %, (36.25 ± 5.55 ) % and ( 62.06 ± 6. 70 ) %, respectively, both statistically significant difference between the two groups ( P ＜0.05 or P ＜ 0.01 ). AI were negatively correlated to WT and calibrated CI ( r = - 0. 87 and r = - 0. 77, P ＜0.05). Conclusions MCE with computer-aided technique can assess quantitatively myocardial perfusion and regional contractile function. Short-term ischemiareperfusion does not cause myocardial necrosis, but it will lead to myocardial cell apoptosis and the phenomenon of myocardial stunning. Prolonged ischemia, even if given sufficient reperfusion, can lead to apoptosis and necrosis simultaneously.     

Haemodynamic and renal effects of urodilatin in healthy volunteers

Urodilatin (ANF(95-126)), an analogue of the atrial natriuretic factor (ANF(99-126)), has recently been isolated from human urine. To study haemodynamic and renal effects of synthetic urodilatin, 18 healthy male volunteers (age 26.1 +/- 0.8 years; X +/- SEM) received i.v. bolus injections of urodilatin at doses of 1, 2 or 4 micrograms kg-1 body weight (bw) (n = 6 per dosage group). Urodilatin dose-dependently increased heart rate and cardiac index. A dose-dependent increase in plasma cyclic GMP levels was also observed. Urinary cyclic GMP excretion, urine flow and natriuresis increased 7-fold, 5-fold and 4-fold, respectively. Renal effects were not different between dosage groups. Compared with ANF(99-126), after urodilatin the reduction in mean pulmonary arterial pressure (PAP) was more pronounced (2 micrograms kg-1, n = 6; ANF -1.8 +/- 0.5, URO: -5.5 +/- 1.1 mmHg, P less than 0.05). Furthermore, after urodilatin the reduction of PAP lasted continuously from 2 up to 90 min after injection, while ANF(99-126) produced only a transient decrease of PAP. Similarly the reduction of pulmonary capillary wedge pressure (PCWP) by urodilatin from 9.3 +/- 1.2 to 3.8 +/- 0.9 mmHg (P less than 0.05) was also sustained up to 90 min post administration. These data in healthy volunteers suggest that, due to prolonged reduction of PAP and PCWP with increases of cardiac index and reduction of systemic vascular resistance, urodilatin might exhibit beneficial effects in cardiovascular disease.     

精神病患者机械通气治疗急性左心衰竭时的丙泊酚镇静效果

目的：探讨丙泊酚对精神病患者机械通气治疗急性左心功能衰竭时的镇静效果。方法：将急性左心衰住院精神病患者38例随机分成度冷丁组（n=20）和丙泊酚组（n=18）,机械通气治疗期分别间断静脉注射度冷丁50—100mg及持续静滴丙泊酚（0．5—1．0）mg／（kg·h）;比较两组镇静效果达Ramsay分级Ⅲ-Ⅳ级时间、生命体征、循环参数的变化。结果：治疗后1h,两组血流动力学指标均较治疗前有显著改善;与度冷丁组相比,丙泊酚组的心脏指数（CI）显著升高,肺动脉压（PAP）、肺毛细血管楔压（PCWP）和外周血管阻力（SVR）明显下降,P均〈0．05,心率（HR）、中心静脉压（CVP）无明显差别,P〉0．05。结论：精神病患者机械通气治疗急性左心衰时使用丙泊酚镇静效果较度冷丁好。     

自制心肌超声造影定量分析软件的设计与评价

目的评价自制心肌超声造影(MCE)图像定量分析软件对心肌灌注研究的可行性。方法根据阻断和再灌注冠状动脉时间不同,家兔被分为两组:阻断15min再灌注30min(Ⅰ组)和阻断120min再灌注60min(Ⅱ组)。分别于基础状态、冠状动脉阻断时和再灌注后行MCE,应用基于淘汰粒子群优化(EPSO)聚类算法的自制计算机图像定量分析软件对造影图像进行自动处理,获得多个心肌灌注定量参数。结果 (1)阻断时,Ⅰ组与Ⅱ组危险心肌的标化CI值均明显减低,与基础状态比较差异有统计学意义(t=5.104和t=4.327,P0.01)。再灌注后,Ⅰ组危险心肌标化CI值比阻断时增高(t=2.933,P0.01),与基础状态时相比仍减低(t=2.653,P0.01),Ⅱ组危险心肌标化CI值与阻断时相比差异无统计学意义(P0.05);(2)Ⅱ组危险心肌红色编码区和TTC中梗死心肌面积分别为(21.4±12.3)%和(18.0±9.5)%,且与TTC结果呈正相关(r=0.89,P0.01);(3)阻断时,危险心肌节段直方图呈偏态分布,再灌注后,Ⅰ组危险心肌基本恢复至正态分布,而Ⅱ组危险心肌仍呈偏态分布。结论基于淘汰粒子群优化聚类算法的心肌超声图像分析软件在定量评价心肌微灌注和识别灌注异常方面具有较好的可行性和较高的应用价值。     

Effect of different therapeutic time windows of mild hypothermia on neurological protection from ventricular fibrillation in rabbit models北大核心CSCD

Objective To investigate the effects of mild hypothermia on post-resuscitation neurological outcome after ventricular fibrillation (VF) in rabbits. Methods Forty-five adult New Zealand rabbits were induced VF by direct current of electricity. The rabbits were randomly(random number) divided into following groups: normothermic resuscitation group (NR), mild hypothermia pre-arrest group (HP), mild hypothermia resuscitation 30 min group (HRe30), mild hypothermia resuscitation 90 min group (HRe90), normothermic sham group (NS), and hypothermia sham group (HS). The rabbits of NR group were observed for 600 min in room temperature after restoration of spontaneous circulation (ROSC). The mild hypothermia was induced by surface cooling, and maintained for 600 min after the aimed low temperature reached. The arterial blood samples were collected for determining neuron-specific enolase (NSE) and thioredoxin (Trx) and the mean arterial pressure (MAP), left ventricular end-diastolic pressure (LVEDP) and left ventricular pressure raise and fall rate (dp/dtmax) were observed at 15 min before CA, and 30 min, 60 min, 120 min, 360 min and 600 min after ROSC. After the animals were sacrificed at 600 min after ROSC, the whole brain of animals was harvested and observed under light microscope to calculate the apoptotic index of the hippocampal CA1 neurons by using TUNEL method. One-way ANOVA was used to determine the statistical significance between two groups, a two-tailed value of P<0.05 was considered statistically significant. Results (1) Hemodynamically compared with normal temperature groups, HR was lower in hypothermia groups. Compared with NR, HRe30, and HRe90 group, LVEDP was higher in HP group at 30 min after ROSC(3.40.8 vs. 4.61.0, 4.10.5, 4.30.2, F=9.85, P=0.019).In HP group, the level of+dp/dtmax was higher than that in NR, HRe30 and HRe90 groups at 30 min and 120 min after ROSC. In HP group, the level of -dp/dtmax was higher than that of NR group at 30 min, 60 min, 120 min, 360 min and 600 min after ROSC. (2) Serologically compared with HP, HRe30 and HRe90 group, NSE levels were higher in NR group at 60 min, 120 min and 360 min after ROSC. Compared with NR, HRe30, and HRe90 group, Trx levels in NR group were lower at 60 min,120 min, 360 min and 600 min after ROSC. Compared with HP group, Trx levels in HRe30 and HRe90 groups were higher at 60 min, 120 min, 360 min and 600 min after ROSC. (3) Pathologically compared with NR group, histopathological changes in hippocampus CA1 area were milder found in HP, HRe30 and HRe90 groups. AI (%) was lower in HP, HRe30 and HRe90 groups than that in NR group[(62.2510.43)% vs. (20.615.02)%, (25.083.92)%, (30.337.15)%, P=0.001]. Concusions This study shows that hypothermia should be initiated as soon as possible, and especially early intra-arrest cooling appears to be significantly better than post-ROSC cooling and normothermia. © 2018 Chinese Medical Association. All Rights Reserved.     

七氟醚预处理延迟相对大鼠心肌缺血再灌注损伤的保护作用

[目的]探讨七氟醚预处理延迟相对大鼠心肌缺血再灌注(IR)损伤的保护作用.[方法]将18只健康成年雄性大鼠随机分成3组:假手术组(C组)、缺血再灌注组(IR组)和七氟醚组(S组).C组仅开胸并分离冠状动脉左前降支,但不阻断血流150 min;IR组行冠状动脉左前降支阻断30 min,再灌注120 min; S组予以吸入...     

促红细胞生成素对兔心肌缺血/再灌注损伤保护作用的研究

目的 建立兔心肌缺血/再灌注损伤(I/R)模型,观察促红细胞生成素(EPO)对兔血清CK-MB 浓度及心肌细胞凋亡的影响,探讨EPO 对兔心肌I/R 的保护作用及机制.方法 新西兰大白兔16 只,随机分为I/R 组和EPO 组.结扎兔左冠状动脉前降支制备兔I/R 模型.EPO 组于结扎左冠状动脉前降支的同时经耳缘静脉注入重组EPO,I/R 组注入等量的生理盐水.检测指标:(1)分别于缺血前5 min、缺血60 min、再灌注60 min 和再灌注180 min 检测血清CK-MB 浓度.(2)再灌注180 min 时取缺血区心肌组织,检测凋亡指数.(3)制作心肌组织标本,观察心肌组织的病理变化.结果 血清CK-MB 浓度随缺血及再灌注时间的延长而增加(与前一时间点比较,P <0.01);缺血前EPO 组与I/R 组血清CK-MB 浓度无统计学差异(P >0.05);缺血60 min、再灌注60 min、再灌注180 min 时,EPO 组血清CK-MB 浓度均显著低于I/R 组(均P <0.01).与I/R 组相比,EPO 组的缺血区心肌细胞的凋亡指数显著下降(P <0.01).结论 EPO 对兔心肌I/R 具有明显的保护作用,其机制可能与稳定心肌细胞膜结构,减少心肌酶的释放和抑制心肌细胞凋亡有关.     

心肌声学造影评价实验性顿抑心肌的微血管功能改变

目的 探讨心肌顿抑时心肌微血管功能改变以及静脉心肌学造影方法的价值。方法 制备左前降支冠脉（ＬＡＤ）不同阻断时间后再 灌注犬心肌凶模型,在不同观察时间点静脉注射含全氟丙烷声振白蛋白微泡造影剂,采用二次谐波成像和间歇发剂技术行心肌声学造影（ＭＣＥ）。由主动脉根部分别注射乙酰胆碱（ＡＣＨ）和硝酸甘油（ＮＧ）后重复ＭＣＥ并计算用药后,前二维超声上所示心肌灰阶峰值（ＰＶＩ）和峰值比值（ＰＶＩＲ）。结果（地