临终护理路径在安宁疗护实践中应用的效果分析

目的：探讨临终护理路径在安宁疗护临床实践中的应用效果。方法：收集2016年2月—2017年11月我院收治的临终患者94例作为对照组并行常规护理;收集2017年12月—2019年9月我院收治的临终患者107例作为路径组,遵循预先制定的临终护理路径行全程管理。采用医院自编量表对两组患者的护理质量进行调查,比较两组患者生存时间、不良事件发生率和患者家属满意度。结果：路径组的生活质量各项指标均高于对照组,差异有统计学意义（P <0.05）;两组患者生存时间比较无明显差异（P> 0.05）,路径组患者不良事件发生率低于对照组,患者家属满意度高于对照组（P <0.05）。结论：临终护理路径应用于安宁疗护临床实践中能够减轻临终患者躯体症状,改善患者生存质量,提高护理满意度。     

疼痛管理干预在晚期恶性肿瘤患者安宁疗护中的应用

目的 探讨疼痛管理干预对实施安宁疗护晚期肿瘤患者的影响。方法 选择2018年1月—2019年4月大冶市人民医院收治的62例晚期恶性肿瘤患者,按随机数字表法分为2组,各31例。对照组实施常规安宁疗护,观察组在对照组基础上实施疼痛管理,2组患者均护理2周。对比2组患者疼痛缓解程度、心理状态、日常生活能力及生存质量。结果 护理后观察组疼痛缓解率为67.74%,高于对照组的41.94%,差异有统计学意义（P<0.05）;护理后观察组焦虑自评量表（SAS）、抑郁自评量表（SDS）评分均低于对照组,差异有统计学意义（P<0.05）;护理后观察组日常生活能力指数量表（ADL）评分高于对照组,差异有统计学意义（P<0.05）;护理后观察组生理、心理维度评分均低于对照组,个人存在、社会支持及整体生存质量评分均高于对照组,差异均有统计学意义（P<0.05）。结论 疼痛管理干预联合安宁疗护能够缓解晚期恶性肿瘤患者疼痛程度与负性情绪,利于提高其日常生活能力与生存质量。     

舒缓疗护病房癌症临终患者安宁护理体会

目的探讨给癌症临终患者提供舒缓疗护病房,给予安宁护理的效果。方法选取我院收治的40例癌症临终患者作为研究对象。给患者提供舒缓疗护病房,并实施环境护理、症状护理、心理护理等服务,观察护理效果。结果 40例患者的住院时间为1~80d。患者的疼痛评分为(0-1)分。该疼痛评分采用数字分级法,0分为无痛感,10分为痛感难以忍受。患者家属对舒缓疗护的满意度为97.6%。结论给癌症临终患者提供舒缓疗护病房,并给予安宁护理后,缓解了患者的身心痛苦,提高了他们人生末期的生活质量,从而以正确的心态面对死亡。因此,值得在临床上推广。     

心理危机干预对晚期癌症安宁疗护患者的影响分析

目的：分析心理危机干预对晚期癌症安宁疗护患者的影响。方法：选取2020年1-9月152例缓和医学中心安宁疗护病区晚期癌症患者作为研究对象,随机数字表法分为观察组和对照组,每组76例。对照组采用安宁疗护症状控制、舒适护理、家庭社会支持,观察组在对照组基础上给予心理危机干预。分析两组患者在接受不同护理后的护理效果。结果：观察组患者护理后抑郁自评量表评分、简式简明心理问卷评分、自我感受负担量表、医院焦虑抑郁量表评分、疼痛强度差评分均明显优于对照组患者,差异具有统计学意义(P<0.01)。观察组患者对护理的总满意度高于对照组,差异有统计学意义(P<0.05)。结论：晚期癌症安宁疗护患者进行心理危机干预措施更有利于改善患者心理状态以及生活质量。     

安宁疗护对老年肿瘤临终患者主要照顾者负性情绪及心理应激的影响

目的分析安宁疗护对老年肿瘤临终患者主要照顾者负性情绪及心理应激的影响。方法随机将2017年6月至2018年10月我院老年病科收治的136例老年肿瘤临终患者的主要照顾者分成两组,针对A组68例患者及家属实施常规基础护理,针对B组68例患者及家属实施安宁疗护,对比两组的护理效果。结果两组护理后对比的心理状态评分、家属应激评分及护理满意度评分存在显著差异(P0.05),有统计学意义。结论老年肿瘤临终患者主要照顾者存在较大的心理应激反应及负性情绪,护理人员给予相应的安宁疗护能显著改善照顾者的心理状态及应激水平,促进生活质量的改善。     

探讨安宁疗护对肿瘤癌痛患者生命质量的影响

目的探讨安宁疗护对肿瘤癌痛患者生命质量的影响。方法选取2018年7月至2019年2月我院收治的114例肿瘤癌痛患者,应用随机数字表格法分为两组,观察组57例接受安宁疗护护理干预,对照组57例接受常规护理,比较两组生命质量。结果研究显示,护理干预后,观察组疼痛评分低于对照组(P0.05);而观察组生命质量优于对照组(P0.05)。结论对肿瘤晚期癌痛患者实施安宁疗护护理干预,有助于减轻患者癌痛,缓解其不良情绪,改善患者生命质量,值得推广。     

安宁疗护模式在老年终末期患者中的应用效果

目的探讨安宁疗护模式在老年终末期患者中的实施效果。方法对2017年1月至2019年5月在中国科学技术大学附属第一医院老年科住院的30例老年终末期患者实施安宁疗护护理模式,内容包括终末期患者的症状护理、心理社会支持、优逝教育、患者家属的哀伤辅导。比较实施前及实施2周后患者及家属焦虑抑郁状况、患者营养、疼痛、日常生活能力、生活质量、患者满意度。结果实施安宁疗护2周后,患者及家属焦虑抑郁程度、患者疼痛程度较实施前缓解,差异有统计学意义(P <0. 05),患者营养状况、日常生活能力、生活质量和满意度较实施前提高,差异有统计学意义(P <0. 05)。结论安宁疗护可缓解老年终末期患者及家属焦虑抑郁情绪,减轻患者疼痛,改善患者营养状况,提高患者生活质量及满意度。     

安宁疗护在肿瘤急性应激障碍患者中的应用

目的探究安宁疗护在肿瘤急性应激障碍(ASD)患者中的应用效果。方法选取2018年1月至2019年1月我院1500例肿瘤患者,经筛查[焦虑自评量表(SAS)、抑郁自评量表(SDS)均53分时]发现500例肿瘤ASD患者,根据入院顺序分为对照组和实验组,分别给予常规护理,常规护理+安宁疗护。统计2组遵医行为,对比干预前后焦虑及抑郁程度。结果实验组与对照组比较,实验组遵医率较高(P0.05);与对照组比较,干预后实验组SDS、SAS评分较低(P0.05)。结论安宁疗护用于肿瘤ASD患者,有助于消除负面心理,建立遵医行为。     

中西医结合护理对癌症晚期患者疼痛控制效果的研究

目的 探讨中西医结合护理对癌症晚期患者疼痛的控制效果。方法 选择2019年6月—2020年4月江西省肿瘤医院收治的癌症晚期患者86例,按随机数字表法分为观察组与对照组,各43例。对照组实施常规护理,观察组在此基础上实施中西医结合护理,对比2组疼痛情况、情绪状态、生存质量、患者舒适度与护理满意度。结果 观察组干预后疼痛评分低于对照组,差异有统计学意义（P<0.05）;观察组干预后焦虑自评量表（SAS）、抑郁自评量表（SDS）评分均低于对照组,差异有统计学意义（P<0.05）;观察组干预后生存质量综合评定问卷（GQOLI-74）中躯体功能、心理功能、社会功能及物质生活状态评分均高于对照组,差异均有统计学意义（P<0.05）;观察组患者舒适度评分高于对照组,差异有统计学意义（P<0.05）;观察组护理满意度（95.35%）高于对照组（81.40%）,差异有统计学意义（P<0.05）。结论 中西医结合护理能够有效减轻癌症晚期患者疼痛,改善情绪状态,提升生存质量、舒适度,患者护理满意度高。     

安宁疗护对恶性肿瘤晚期患者的应用效果

目的:探讨安宁疗护对恶性肿瘤晚期患者的应用效果。方法:选取90例恶性肿瘤晚期患者为研究对象,采用随机数字表法分为观察组和对照组各45例。对照组患者给予常规护理,观察组在对照组基础上给予安宁疗护,两组均干预4周,比较两组护理效果。结果:两组焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均较护理前降低,且观察组显著低于对照组,差异有统计学意义(P<0.05);观察组视觉模拟评分法(VAS)评分低于对照组,白蛋白水平高于对照组,差异均有统计学意义(P<0.05);观察组患者护理满意度明显高于对照组,差异有统计学意义(P<0.05)。结论:在常规护理基础上采用安宁疗护可以缓解恶性肿瘤晚期患者焦虑及抑郁情绪,减轻疼痛,提高白蛋白水平及护理满意度,其效果优于单纯常规护理。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.