中西药物预防人工髋关节假体置换后下肢深静脉血栓形成

背景：药物治疗和物理疗法对人工髋关节假体置换后下肢深静脉血栓形成的预防和治疗有积极作用。目的：探讨中西药物预防人工髋关节假体置换后下肢深静脉血栓形成的疗效。方法：收集中药和西药预防人工髋关节假体置换后下肢深静脉血栓形成的相关文献,分析不同药物对下肢深静脉血栓的作用机制,比较中药和西药在治疗和预防人工髋关节假体置换后下肢深静脉血栓形成的疗效及安全性。结果与结论：磺达肝癸钠在预防骨科大手术后总深静脉血栓形成的作用大于依诺肝素,利伐沙班在减少关节置换后患者隐性失血量方面优于低分子肝素。中药在人工髋关节假体置换后下肢深静脉血栓形成的预防上选用益气活血和改善血液循环的方法,如活血通脉汤、桃红四物汤等,还有补阳还五汤、佛手通瘀汤、活血通栓饮、加味桃核承气汤等,在下肢深静脉血栓预防和治疗效果方面均较好。中西药的比较研究中发现,中药或中西药联合对预防人工髋关节假体置换后下肢深静脉血栓形成与西药效果相同,且安全性较高。     

低分子肝素对老年股骨转子间骨折围术期隐性失血的影响

目的：探讨老年股骨转子间骨折围术期使用低分子肝素对隐性失血量及深静脉血栓发生率的影响。方法回顾性分析上海市浦东新区周浦医院2009年3月至2011年3月采取股骨近端抗旋髓内钉（PFNA ）治疗的232例股骨转子间骨折患者的临床资料,按照围术期是否应用低分子肝素分为两组。对照组（123例）围术期未使用低分子肝素,试验组（109例）入院后即给予低分子肝素;比较两组患者的隐性失血量及深静脉血栓发生率。结果对照组和试验组患者隐性出血量分别为（404．0±7．3）m L、（425．4±3．9）m L ,两组比较差异无统计学意义（ P＞0．05）;试验组患者下肢深静脉血栓发生率（4．59％）明显低于对照组（12．20％）,两组比较差异有统计学意义（P＜0．05）。结论老年股骨转子间骨折围术期应用低分子肝素,能降低术后深静脉血栓的发生率,同时隐性失血量并未增加,值得临床推广。     

人工股骨头假体置换与高龄股骨转子间粉碎性骨折

目的:探讨人工股骨头假体材料的选择,以及人工股骨头假体在治疗高龄患者股骨转子间粉碎性骨折的疗效.方法:作者用计算机检索中国期刊全文数据库(CNKI:1977/2009)和Medline database(1977/2009)数据库,检索词分别为"股骨转子间粉碎骨折;人工股骨头置换术;高龄患者"和"femur intertrochanteric fracture;artificial femoral head arthroplasty;elderly patient",语言分别设定为中文和英文.共检索到83篇文献,按纳入和排除标准对文献进行筛选,共纳入34篇文献.分别以人工股骨头假体的材料学研究、老年股骨转子间骨折的治疗和人工股骨头假体置换治疗老年股骨转子间骨折的临床应用等问题出发进行归纳和总结,探讨人工股骨头假体治疗高龄股骨转子间骨折的疗效.结果:人工股骨头假体在治疗各种股骨转了间骨折中均得到了广泛的临床应用,已有多种材料类型的人工股骨头假体如金属材料、高分子聚乙烯、陶瓷材料以及碳质材料等应用于临床,并取得了显著的疗效.人工股骨头假体的功能日趋完善,在临床应用中愈加广泛,是目前治疗高龄股骨转子间粉碎性骨折的最有效方法,但此方法仍存在着手术风险大、并发症多等需要解决的问题.结论:人工股骨头假体选择的材料有很多种,各有其优缺点,目前临床上多采用复合型人工股骨头假体材料;人工股骨头假体是治疗高龄股骨转子间粉碎性骨折较为理想的方法.     

Gamma钉与人工股骨头置换修复老年股骨转子间粉碎性骨折的比较

背景：近年国内外有较多文献报道对比内固定与人工股骨头置换治疗老年股骨转子间骨折的疗效,意见均不统一;并且较多文献内固定治疗包含Richard钉、鹅头钉及动力髋等髓外固定方法,可能导致结论不准确。目的：通过 Gamma钉内固定与人工股骨头置换治疗老年股骨转子间骨折的临床指标的比较,探讨人工股骨头置换治疗股骨转子间骨折的经验,适应证及置换后并发证的处理。 方法：回顾性分析154例80岁以上股骨转子间粉碎性骨折的老年患者;其中98例患者采用Gamma钉内固定治疗,56例患者采用人工股骨头置换治疗,对比分析两组患者手术时间、住院天数、手术中出血量及离床活动时间;末次髋关节功能恢复情况（根据 Harris 评分）和内固定后并发症的发生率;将所得结果进行比较和评估,并进行统计学分析。 结果与结论：Gamma钉组平均随访时间为6.6年;人工股骨头组平均随访时间为5.7年。两组数据在手术时间、住院天数及手术中出血量方面比较,差异无显著性意义（P 〉0.05）,离床活动时间差异有显著性意义（P 0.05）;内固定后并发症：深静脉血栓形成、肺部感染及泌尿系感染方面,差异无显著性意义（P 〉0.05）;内固定后置入物松动断裂或假体松动、下沉、脱位,以及双下肢不等长方面,差异有显著性意义（P 〈0.05）。选用人工股骨头置换治疗老年股骨转子间骨折患者,有助于患者早期离床活动,改善患者部分生活质量;人工股骨头置换后髋关节功能恢复较 Gamma 钉内固定无明显差异;但早中期并发症的发生率较低;出现假体松动、下沉及脱位等严重并发症后,处理较为困难,对患者日常生活影响较大,需严格掌握其手术适应证及手术技巧。     

人工股骨头假体置换与高龄股骨转子间粉碎性骨折

中以"人工股骨头假体,置换,高龄,股骨转子间粉碎性骨折"或"artificial femoral head prosthetic,replace,elderly patients,femur intertrochanteric comminuted fracture"为检索词进行检索.选择文章与检索方法:第一作者应用计算机检索PubMed数据库及CNKI数据库,在标题和结果:人工股骨头假体在治疗各种股骨转子间骨折中均得到了广泛的临床应用,已有多种材料类型的人工股骨头假体如金属材料、高分子聚乙烯、陶瓷材料以及碳质材料等应用于临床,并取得了显著的疗效.人工股骨头假体的功能日趋完善,在临床应用中愈加广泛,是目前治疗高龄股骨转子间粉碎性骨折的最有效方法,但此方法仍存在着手术风险大、并发症多等需要解决的问题.结论:人工股骨头假体选择的材料有很多种,各有其优缺点,目前临床上多采用复合型人工股骨头假体材料;人工股骨头假体是治疗高龄股骨转子间粉碎性骨折较为理想的方法.     

髋关节置换后利伐沙班与低分子肝素预防下肢深静脉血栓的比较

背景：低分子肝素可显著降低髋关节置换后下肢深静脉血栓的发生率,但其因需皮下注射而存在局限性。目的：比较全髋关节置换后应用利伐沙班与低分子肝素预防下肢深静脉血栓疗效和安全性的差异。方法：58例全髋关节置换患者按随机数字表法分为2组,利伐沙班组28例,低分子肝素组（达肝素）30例。置换后行双下肢彩色多普勒检查评估DVT形成情况,并观察治疗期间出血情况。结果与结论：利伐沙班组与达肝素组患者在预防下肢深静脉血栓疗效上差异无显著性意义（P〉0.05）。两组在治疗期间均无严重出血,置换后非严重出血差异也无显著性意义（P〉0.05）。提示利伐沙班在预防全髋置换后下肢深静脉血栓的疗效与安全性上与低分子肝素作用相当。     

髋关节置换后利伐沙班与低分子肝素预防下肢深静脉血栓的比较

背景:低分子肝素可显著降低髋关节置换后下肢深静脉血栓的发生率,但其因需皮下注射而存在局限性。目的:比较全髋关节置换后应用利伐沙班与低分子肝素预防下肢深静脉血栓疗效和安全性的差异。方法:58例全髋关节置换患者按随机数字表法分为2组,利伐沙班组28例,低分子肝素组(达肝素)30例。置换后行双下肢彩色多普勒检查评估DVT形成情况,并观察治疗期间出血情况。结果与结论:利伐沙班组与达肝素组患者在预防下肢深静脉血栓疗效上差异无显著性意义(P>0.05)。两组在治疗期间均无严重出血,置换后非严重出血差异也无显著性意义(P>0.05)。提示利伐沙班在预防全髋置换后下肢深静脉血栓的疗效与安全性上与低分子肝素作用相当。     

人工髋关节置换与下肢深静脉血栓形成

目前国内外对于人工髋关节置换后下肢深静脉血栓形成的发病机制与危险因素基本已达成一致意见;应用低分子肝素是目前最常用、效果最可靠的手段;对于低分子肝素的不良反应尚存在一定争论,多数研究认为,除了少量增加置换后出血以外,低分子肝素的应用是安全的.     

物理预防联合低分子肝素钙在预防高龄髋部骨折患者深静脉血栓形成中的效果观察

目的探讨物理预防联合低分子肝素钙在预防高龄髋部骨折(包括股骨颈及股骨粗隆间骨折)患者下肢深静脉血栓形成中的疗效。方法将2016年1月—2017年12月符合纳入标准的150例高龄(均≥75岁)髋部骨折患者随机分为A组——物理预防组50例、B组——低分子肝素钙组50例、C组——物理预防组联合低分子肝素钙组50例。入院后即开始进行三组对比研究。结果物理预防组发生下肢深静脉血栓12例,发生率为24%;低分子肝素钙组发生下肢深静脉血栓4例,发生率为8%;物理预防联合低分子肝素钙组发生下肢深静脉血栓1例,发生率为2%。结论物理预防联合低分子肝素钙能够有效预防高龄髋部骨折患者深静脉血栓形成,效果显著。     

股骨近端防旋髓内钉治疗老年股骨转子间粉碎性骨折17例临床分析

目的评价股骨近端防旋髓内钉治疗老年股骨转子间粉碎性骨折的疗效。方法回顾性分析行股骨近端防旋髓内钉固定治疗17例老年股骨转子间粉碎性骨折患者的临床资料。结果疗效优15例,较好1例,良1例;1例术后发生患肢深静脉血栓,经及时治疗痊愈;术后随访5～14个月,骨折均达骨性愈合,患髋关节伸屈活动良好,未发生断钉、松动、骨不连和感染等并发症。结论股骨近端防旋髓内钉治疗老年股骨转子间粉碎性骨折操作简便、创伤小、术中出血量少、手术时间短、骨折固定可靠。     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.