家庭医生责任制对社区高血压患者血压控制的效果研究

目的:观察家庭医生责任制的实施对社区高血压患者血压控制的效果,探讨社区高血压病患有效控制血压的模式。方法:随机选取2013年5月~2014年5月期间来社区诊治的100例高血压病患,分为研究组和对照组,每组50例。给予对照组常规诊疗方法,研究组在常规诊疗方法的基础上采用家庭医生责任制管理模式,实施干预1年后比较分析两组患者治疗前后的血压控制水平以及自我管理能力。结果:干预1年后两组患者的收缩压、舒张压较干预前均明显降低,且研究组的降压效果显著优于对照组,差异有统计学意义(P0.05);研究组自我管理能力(规律用药、血压监测、科学锻炼、食盐减量、定期复查、心理调整)所占比均较干预前显著增加,且研究组的自我管理能力改善水平显著高于对照组,差异有统计学意义(P0.05)。结论:对社区高血压病患实施家庭医生责任制,能够有效控制患者的血压并提升高血压病患的自我管理能力,从而提高生活质量。     

护理干预对社区高血压患者血压控制的效果评价

目的研究护理干预对社区高血压患者的血压控制效果。方法选取2012年11月至2013年11月我社区高血压患者150例,在患者知情同意下,按照随机数字表法,将患者分为研究组和对照组,每组75例,两组患者均给予常规药物治疗,对照组给予常规护理,研究组给予护理干预,比较两组干预后服用依从性以及血压。结果干预后研究组患者服药依从性82.7%(62/75)显著高于对照组患者服药依从性57.3%(43/75),两组比较差异具有统计学意义(P<0.05);干预后研究组血压显著低于干预前血压,与干预前比较差异具有统计学意义(P<0.05),且研究组血压显著低于对照组血压,两组比较差异具有统计学意义(P<0.05)。结论护理干预对社区高血压患者具有较好的效果,能显著提高社区高血压患者的服药依从性,降低其血压。     

社区护理对老年高血压病的综合干预

目的探讨社区护理对老年高血压疾病的综合干预效果,为临床提高老年高血压患者疗效及生活质量提供可靠依据。方法对照组老年高血压患者给予常规护理措施;研究组老年高血压患者在进行常规护理措施基础上给予社区护理干预措施,观察并记录两组患者护理前后血压变化情况及用药治疗依从性,给予统计学分析,得出结论。结果两组患者护理前血压对比结果无统计学意义(P>0.05);护理后两组患者血压均较护理前有所下降,但研究组患者下降幅度更为明显,且研究组患者遵医嘱服药情况显著优于对照组,P<0.05,两组患者对比结果具有统计学意义。结论老年高血压患者在进行社区常规护理基础上,给予针对性的护理干预措施,能够有效提高其临床治疗效果,且治疗依从性较好,提高患者生活质量及生命安全,值得临床推广应用。     

中医护理干预对高血压患者血压控制水平及生活质量的影响

目的探讨中医护理干预对高血压患者血压控制水平及生活质量的影响。方法选取96例老年高血压患者,根据入院单双号将受试者分为对照组和研究组,每组48例,对照组患者给予传统的护理干预,研究组患者在对照组的基础上给予中医护理干预,比较干预前后两组患者血压控制情况及生活质量评分变化。结果干预后两组患者的血压水平较治疗前均显著降低,各生活质量评分较干预前均显著提高,且研究组优于对照组(P <0.05)。结论中医护理干预有助于控制患者的血压水平,提高生活质量,在老年高血压护理中具有重要应用意义。     

在提高社区老年高血压患者服药遵从行为中采用基于跨理论模型的社区家庭访视护理干预的作用

目的探究在提高社区老年高血压患者服药遵从行为中采用基于跨理论模型的社区家庭访视护理干预的作用。方法选取2016年1月～2017年6月就诊于我院及我院下属的社区卫生服务站的老年高血压患者63例,随机分为对照组和研究组,对照组31例,研究组32例,对照组给予常规家庭访视护理方案,研究组采用跨理论模型进行社区家庭访视护理干预,为期6个月,比较干预后两组患者的服药依从性、行为改变阶段跨越率、血压。结果干预后研究组和对照组的正确用药率分别为90.6%和61.3%,研究组显著高于对照组(P 0.05);研究组的阶段向前跨越率显著高于对照组(71.9%和32.3%,P 0.05);干预1个月、6个月后研究组的收缩压均显著低于对照组(P 0.05),舒张压无明显差异(P 0.05)。结论在干预老年高血压患者的服药遵从行为时采用跨理论模型进行社区家庭访视护理可提高患者的正确用药率,进而良好控制其血压。     

高血压患者的中医时间护理干预分析

目的分析中医时间护理干预对高血压患者的影响。方法选取该院2013年2月至2014年2月收治的高血压患者128例,随机分为对照组和研究组,各64例,对照组患者予以常规降压药物治疗及护理指导,研究组患者于对照组基础上予中医时间护理干预,比较两组患者血压控制情况、血压控制临床疗效、护理满意度及生活质量评分。结果研究组患者治疗后舒张压、收缩压均显著低于对照组,而血压控制总有效率、生活质量评分、护理满意度均显著高于对照组,差异有统计学意义(P<0.05)。结论中医时间护理干预应用于高血压患者可有效控制其血压水平,提高护理满意度及患者的生活质量,值得临床推广及应用。     

中医护理干预对老年高血压患者的血压控制及自护能力的影响

目的探讨中医护理干预对老年高血压患者的血压控制及自护能力的影响。方法对我院2016年2月至2018年2月57例老年高血压患者的临床资料进行回顾性研究,根据随机数字表法将受试者分为对照组28例和研究组29例,对照组患者给予常规护理干预,研究组患者在对照组的基础上给予中医护理干预,比较干预前后两组患者血压控制情况、自护能力评分及护理满意率。结果干预后两组患者的血压水平较治疗前显著降低,自护能力评分较干预前显著提高,且研究组优于对照组(P <0.05),研究组护理满意率为93.10%,对照组护理满意率为75.10%(P <0.05)。结论中医护理干预有助于控制患者的血压水平,提高自护能力及护理满意率,值得在老年高血压护理中应用推广。     

护理干预对社区老年高血压病人的作用分析

目的探讨针对性社区护理干预对社区老年高血压病人的应用效果。方法选择2013年1月~2015年1月期间我社区医院收治的高血压患者156例,根据随机数字表将其平均分为研究组与对照组,每组备78例。对照组采取常规治疗措施,研究组在此基础上给予针对性的护理干预。结果研究组干预后收缩压及舒张压显著低于对照组(P均<0.05)。研究组服药依从性、日常饮食控制、坚持运动、情绪管理、定期血压监测、良好的生活习惯、控制体质量各项自我管理能力评分均高于对照组(P均<0.05)。结论针对性社区护理措施能够有效强化高血压老年患者的自我管理能力,保证血压控制水平,减缓疾病的进展。     

个体化延续护理应用于老年高血压患者中的价值评价

目的主要是为了研究对患有高血压的老年病患实施个体化延续护理对病患的生活质量有何影响。方法选择2018年2月至2019年2月来我院进行诊治的90例患有高血压的老年患者作为此次的实验对象。将随机选择的45例老年病患设为对照组,另外的45例患者设为研究组。对照组给以传统的护理措施,研究组给以个体化延续护理措施。比较两组护理后降压的效果与社会功能和情感职能的评分情况。结果在护理前,两组老年病患的血压水平无明显差异(P> 0.05);经一段时间的护理后,两组老年病患的血压水平都有一定程度的下降,且研究组血压下降的程度高于对照组,差异有明显的统计学意义(P <0.05);护理后,两组老年病患社会功能和情感职能的评分都有不同程度的提高,且研究组的评分显著高于对照组,P <0.05。结论对患有高血压的老年病患来说,实施个体化延续护理干预对病患的病情有很大的帮助,能明显的降低血压,提高病患的生活质量,因此可在临床上推广。     

延续性护理干预对高血压患者生活质量的影响

目的 探讨系统的护理干预对高血压患者血压控制效果和生活质量的影响.方法 选择2009年1～6月接受治疗的高血压患者108例,随机分为研究组和对照组,每组各54例.对照组采用常规的高血压用药治疗和一般性的护理,研究组在此基础上,进行饮食、休息、运动、心理和疾病的认知等方面延续性系统的护理干预,比较实施前、后动态血压变化和生活质量的变化.结果 干预后,研究组血压控制效果及生活质量得分均优于对照组（P ＜ 0.05）;对照组干预后血压水平、生活质量的得分与干预前比较,差异无统计学意义（P ＞ 0.05）;研究组干预后生活质量得分高于干预前（P ＜ 0.05）,高血压程度减轻（P ＜ 0.05）.结论 系统的护理干预可有效降低高血压,提高患者的生活质量.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.