缬沙坦用于心房颤动伴高血压射频消融术后的疗效和安全性评价

目的评价缬沙坦用于心房颤动伴高血压射频消融术后的疗效和安全性。方法在本院接受治疗的心房颤动伴高血压射频消融术后患者中抽选150例作为本文的观察对象,其接收时间均在2017年12月-2018年12月期间。上述患者经数字随机分组法被分为两组,对照组患者接受氨氯地平治疗,观察组患者给予氨氯地平联合缬沙坦治疗。比较两组患者的血压水平、心功能与心房颤动复发情况,分析两组患者的不良反应发生率。结果术后3个月,观察组患者的CRP水平明显低于对照组(P0.05);术后3个月两组患者的舒张压、收缩压、EF以及LVEDd相比较无统计学差异(P0.05);术后一年,观察组患者的LAD较对照组低,EF较对照组高(P0.05),两组患者术后一年的舒张压、收缩压、LVEDd、CRP相比较无统计学差异(P0.05)。观察组患者术后一年心房颤动复发率明显低于对照组(P0.05),两组患者的不良反应发生率相比较无统计学差异(P0.05)。结论缬沙坦用于心房颤动伴高血压射频消融术后的疗效显著,且安全性高,值得进一步推广实施。     

帕罗西汀对室上性心动过速射频消融术后抑郁障碍的临床疗效观察

目的 探讨室上性心动过速患者行射频消融术后抑郁障碍的发生情况,并观察帕罗西汀治疗对患者抑郁障碍的疗效.方法 采用抑郁自评量表(SDS)、汉密尔顿抑郁量表(HAMD-24)评定室上性心动过速患者行射频消融术术前、术后1个月患者的抑郁障碍发生情况.观察射频消融术后1个月经SDS、HAMD-24共同评定为抑郁障碍的患者,帕罗西汀治疗组合谷维素对照组的临床疗效.结果 射频消融术前合并抑郁障碍率为40.2％,射频消融术后1个月抑郁障碍发生率为47.2％;术前、术后1个月SDS、HAMD-24抑郁评分比较差异有统计学意义(P＜0.01);帕罗西汀治疗3个月后SDS、HAMD-24抑郁评分较干预前明显降低(P＜0.05),且明显低于对照组(P＜0.01).结论 室上性心动过速心律失常患者射频消融术后,与抑郁障碍发生率有关,采用盐酸帕罗西汀治疗能够减轻患者的抑郁障碍程度.     

心房颤动射频消融术后复发相关危险因素的研究

目的探究心房颤动射频消融术后复发的相关危险因素。方法随访100例接受射频消融的心房颤动患者,记录房颤复发情况,分析心房颤动射频消融术后复发的相关危险因素。结果单因素分析显示,房颤持续时间、左心房前后径、电复律方式、转复窦律与房颤复发相关(均P<0.05);多因素分析显示,房颤持续时间和转复窦律方式与房颤复发相关(均P<0.05)。结论异心房颤动射频消融术后复发与术后是否直接转为窦性心律及房颤的持续时间有关,临床上应该对房颤的患者行早期射频消融术,降低患者术后复发的概率。     

阵发性心房颤动患者射频消融术后心房颤动晚期复发的相关因素分析

目的探讨阵发性心房颤动患者进行射频消融术后心房颤动晚期复发的相关危险因素。方法以2009年7月²012年6月间就诊我院的102例阵发性房颤患者为研究对象,均进行射频消融术治疗;治疗3个月后观察复发心房颤动的情况,对复发和未复发病例对比二者在性别、年龄、病程、有无高血压、有无房扑、CRP增高、左房内径、左室大小、LVEF、术后48 h内房颤复发率、术中电复律、破碎电位消融及术后应用ARB的情况进行比较,对有统计学意义的差异项目进行多元Logistic回归分析,找出危险因素。结果术后共有39例术后48 h内复发房颤;随访中发现共有38例患者在3个月后出现房颤,其中男性26例。组间分析发现年龄大小、左房内径和术后48 h内复发房颤等三个因素与房颤3个月后复发可能存在一定联系,差异有统计学意义(p<0.05)。Logistic分析发现术后48 h复发房颤术阵发性房颤患者射频消融术后出现晚期复发房颤的危险因素及临床预测指标(p<0.05),而年龄及左房内径与房颤复发并无直接关系(p>0.05)。结论 48 h内复发房颤是阵发性房颤患者射频消融术后房颤晚期复发的预测因素。     

术前血浆N-末端脑钠肽前体浓度与瓣膜置换同期射频消融术后心房颤动复发的关系

目的 探讨术前血浆N-末端脑钠肽前体(NT-proBNP)浓度与瓣膜置换同期射频消融术后心房颤动复发的关系.方法 58例心脏瓣膜病合并心房颤动患者,行瓣膜置换同期射频消融术,根据患者术后3个月内心房颤动是否复发将患者分为心房颤动复发组(18例)和心房颤动未复发组(40例),两组患者分别于术前1d和术后9d采用放射免疫法检测血浆NT-proBNP浓度.结果 心房颤动复发组术前ld血浆NT-proBNP浓度(中位数为2061.30 ng/L)明显高于心房颤动未复发组(中位数为579.00 ng/L) (P＜ 0.01);心房颤动复发组术后9d血浆NT-proBNP浓度(中位数为996.60 ng/L)显著高于心房颤动未复发组(中位数为209.20 ng/L)(P＜0.01);且两组患者术前ld血浆NT-proBNP浓度均高于术后9 d(P＜0.01).结论 术前血浆NT-proBNP浓度与瓣膜置换同期射频消融术后心房颤动的复发有一定的关系,对预测心房颤动的复发具有一定的临床应用价值.     

清热凉血组方干预免疫性血小板减少症临床研究

目的探讨影响免疫性血小板减少症(ITP)复发的因素,分析相应干预措施对其效果的影响,降低ITP患者的复发率。方法回顾性分析邢台市第一医院2011年3月～2017年6月收治的106例ITP患者复发的临床资料作为观察组,通过酶联免疫法检测患者的单疱病毒(HSV)、腺病毒(ADV)、EB病毒(EBV)、血清巨细胞病毒(CMV)特异性IgM抗体量,并与正常50例人群作为健康对照组,对比分析病毒感染对ITP复发的影响。同时,106例观察组患者按照治疗方法不同分为激素组和中药组2组,各53例,其中激素组给予激素干预治疗,中药组在上述基础上给予中药治疗,比较两组患者治疗前后血清IG水平、临床效果以及在感染率复发率的变化。结果 ITP复发患者检出HSV抗体4例,ADV抗体8例,EBV抗体16例,CMV抗体30例,总病毒抗体有58例,占54.72%,明显高于健康对照组患者的病毒抗体检出率(P 0.05)。干预前两组患者的血清IgM、IgA以及IgG水平差异不显著(P 0.05)。干预后,中药组患者的血清IgA和IgG水平明显高于激素组(P 0.05),而血清IgM水平差异不显著(P 0.05);血小板达正常时间和出血症状控制时间明显低于激素组患者(P 0.05);患者的感染率和复发率明显低于激素组(P 0.05)。中药组治疗总有效明显高于激素组。结论病毒感染是引发免疫性血小板减少症病情复发的重要因素,给予中药干预可以增强机体免疫力,缩短血小板恢复时间,改善出血症状,降低患者的感染率和复发率。     

认知护理干预对改善耳鸣患者焦虑、抑郁情绪的效果

目的探讨认知护理干预对改善耳鸣患者焦虑、抑郁情绪的效果。方法选取我院收治的耳鸣患者120例作为研究对象,并随机分为对照组和观察组各60例,对照组行常规护理,观察组在对照组基础上行认知护理干预,护理前后行抑郁自评量表(SDS)、焦虑自评量表(SAS)评分,并评估护理后对耳鸣的适应程度。结果观察组治疗后SDS评分和SAS评分分别为(35.26±4.29)分、(41.36±3.58)分,均显著低于对照组(均P<0.05);观察组护理后耳鸣适应率为31.67%,显著高于对照组15.00%,差异具有统计学意义(P<0.05)。结论认知护理干预可提高耳鸣患者对疾病相关知识的认知度,缓解负面情绪。     

低温等离子下切除咽喉良性肿瘤的效果观察

目的为了深入研究低温等离子射频消融术在咽喉良性肿瘤切除中的应用效果。方法此次入选人员均为2017年1月-2018年1月我院收治的咽喉良性肿瘤患者46例,按照入组时间分为治疗组(低温等离子射频术)与对照组(喉钳钳取术),各23例,比较两组患者总有效率、治疗前后VAS评分,以及手术情况和复发情况。结果比较两组患者的治疗效果,P> 0.05,缺少差异性。治疗后,手术情况、复发情况均优于对照组,P <0.05,差异有统计学意义。结论在喉部良性肿瘤的临床治疗中,低温等离子射频消融术不仅具有时间少、创伤小,而且还具有复发率低、疗效好等优势。     

团体心理干预在社区高血压患者中的作用

目的探讨分析团体心理干预在社区高血压患者中的作用,为实施有效的干预措施提供科学依据。方法以我社区的80例高血压患者为研究对象,随机分为观察组与对照组,所有患者均进行常规药物控制与营养支持治疗,对照组进行传统干预,观察组进行团体心理干预,8周后,比较两组患者血压控制情况、干预前后焦虑自评量表(SAS)和抑郁自评量表(SDS)分值情况[5]及患者对两组护理工作方法的满意度情况之间的差异。结果观察组患者血压恢复正常率(72.5%)优于对照组(40%);观察组护理后SAS自评分情况(28.3±4.5)和SDS自评分情况(29.8±4.3)优于对照组(40.6±5.2)和(38.0±5.3);观察组患者对于干预方法的满意度(95%)高于对照组患者(77.5%),差异均具有统计学意义(P<0.05)。结论团体心理干预可以有效促进患者血压控制与健康恢复,改善患者心理状态,同时符合患者及家属的需求,值得推广与运用。     

手术室系统性护理干预对肺癌根治术应激反应的影响

目的 探究肺癌根治术患者采取手术室系统性护理干预对手术应激反应及负性情绪的影响。方法 选择2016年3月—2017年3月在本院接受肺癌根治术治疗的36例患者作为对照组,选择2017年4月—2018年4月在本院接受肺癌根治术治疗的36例患者作为观察组;予以对照组患者采取常规护理,予以观察组患者采取手术室系统性护理干预,比较2组患者手术前、后负性情绪、手术应激反应以及术后并发症发生率。结果 2组患者术后抑郁自评量表(SDS)、焦虑自评量表(SAS)评分均较术前降低,且观察组低于对照组,差异有统计学意义(P<0.05);2组患者手术治疗后皮质醇(Cor)、超敏C-反应蛋白(hs-CRP)水平均高于术前,但观察组较对照组低,差异有统计学意义(P<0.05);观察组患者并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论 手术室系统性护理干预肺癌根治术患者可缓解其负性情绪,降低手术应激反应,减少并发症发生,改善预后。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.