老年急腹症患者围手术期的观察与护理

老年患者由于各器官功能减退,反应及活动能力降低,重要脏器机能代偿能力减弱,相当一部分老年患者存在各系统慢性疾病,因此,老年急腹症患者术后并发症多,病死率高,在治疗护理方面具有特殊性,围手术期密切观察病情,加强护理,对预防和减少并发症、提高治愈率是十分重要的.我科自2001年6月至2003年6月共收治老年急腹症患者48例.现将观察与护理体会介绍如下.     

老年急腹症56例观察及护理体会

急腹症是腹部急性疾病之总称,是临床上发病急、变化快,需要紧急处理或手术的急性腹部脏器疾病。老年患者由于各器官功能减退,反应及活动能力降低,重要脏器功能代偿能力减弱,且相当一部分老年患者存在各系统慢性疾病。故老年人急腹症患者病情变化快,易发生术后并发症及药物不良反应,病死率高。因此,手术前后的严密观察和护理对促进疾病早期恢复,预防和减少术后并发症,提高治疗效果,降低病死率是十分重要的。现就2005年7月至2008年6月在我院就诊的56例老年急腹症患者的观察及护理体会进行分析和总结,介绍如下：     

老年急腹症74例观察及护理体会

目的：探讨老年急腹症患者的术前术后护理。方法：对74例老年急腹症患者加强术前原发病、并存症的病情观察和心理护理，术后对重要系统脏器功能监测结果及护理，合理输注药物，加强引流管护理，预防并发症的发生，注重营养支持等做综合分析。结果：痊愈72例，自动出院2例（急性肾脏功能衰竭1例，放弃手术治疗1例）。结论：加强老年急腹症术前、术后护理，可减少手术的风险及并发症，提高手术的成功率。     

92例老年急腹症患者术后并发症的观察及护理

９２例老年急腹症患者术后并发症的观察及护理杜家福老年人因全身各脏器的功能相对降低，因而术后恢复较慢，并发症相对较多，其中不少并发症与护理的水平密切相关。本文收集我院自１９９２年１月至１９９４年６月，６０岁以上高龄急腹症患者９２例。现将术后并发症的护理...     

整体护理在老年急腹症患者急救中的应用分析

目的：探讨整体护理在老年急腹症患者急救护理中的应用效果。方法我院2012年1月-2014年1月收治407例老年急腹症患者,依据不同护理方法分为观察组205例,对照组202例,比较2组抢救情况及患者满意度。结果观察组抢救成功率为93.6%,并发症发生率为13.1%,患者满意度为97.0%;对照组抢救成功率为78.2%,并发症发生率为35.1%,患者满意度为85.6%,2组对比具有显著性差异（P〈0.05）。结论充分掌握老年急腹症的特点,仔细观察,及时实施整体护理,可有效提高抢救成功率,降低并发症发生率,并提高急救护理满意度。     

老年外科急腹症的临床特点及护理体会

目的掌握外科急腹症的特点,通过临床护理,减少术后并发症的发生。方法对我院2008-2010年收治的184例老年急腹症的临床观察护理体会进行分析。结果除外伤性腹腔大出血2例经积极救治无效死亡,其余182例老年急腹症患者,均完全康复出院。结论老年外科急腹症发病急,病情变化快,应早期治疗尽早手术、护理工作在老年医学中占有重要地位,针对老年患者的心里、生理特点及急腹症疾病的特点,进行针对性的护理,能使患者提高治疗效果,提高疾病的治愈率和降低死亡率,在疾病的发生、发展和转归中,起着十分重要的作用。     

老年急腹症病人手术前后护理

目的:总结老年急腹症的护理经验,提高老年急腹症的治愈率.方法:收集老年急腹症病人79例,通过对原发病、合并症的病情观察、心理护理、术前准备及术后生命体征的观察、重要脏器功能监测及护理、引流管护理、并发症的预防、营养支持等.结果:痊愈77例,自动出院2例.结论:加强老年急腹症病人术前术后护理,可减少手术风险及并发症,提高手术治愈率.     

整体护理模式在外科急腹症患者诊治中的应用效果

目的:观察整体护理模式在外科急腹症患者诊治中的应用效果。方法:回顾性分析2017年6月至2018年6月于本院收治的64例外科急腹症患者的临床资料,根据护理方法不同分为两组,其中对照组30例应用常规护理,观察组34例应用整体护理模式。比较两组继发病变、手术并发症情况和护理质量评价。结果:观察组患者继发病变率、手术并发症发生率均显著低于对照组(P<0.05);观察组护理质量评分显著高于对照组(P<0.05)。结论:整体护理模式在外科急腹症患者诊治中的应用效果优于常规护理效果。     

对69例老年急腹症患者的观察与护理

目的:探讨老年急腹症的护理方法.方法:本次选择老年急腹症患者129并随机按观察组69例及对照组60例划分,对照组采用常规护理,观寨组加强病情观察,并行整体、全面的护理干预.结果:观察组患者或家庭对护理的满意度为98.6％,对照组患者或家庭对护理的满意度为83.3％,观察组的并发症发生率为1.4％,对照组的并发症发生率为8.3％,各指标比较有统计学意义(P＜0.05).结论:加强老年急腹症患者的病情观察及整体全面的护理干预可显著提高护理质量,改善预后,具有非常积极的临床意义.     

老年急腹症的临床特点与护理

<正> 老年急腹症的临床特点是:并发症多,死亡率高,怎样把握老年急腹症的特点进行观察和护理,以提高疗效,笔者经过多年临床实践对老年人急腹症的临床特点观察与护理,体会如下。 1.密切观察病情的特点 1·1 老年急腹症症状及体征多不典型,主要是反应能力下降,应密切观察病情变化,争取时间,做好一切抢救及准备工作,立即建立两组静脉通道,观察患者神志,有无脱水表现。因老年人的渴中枢迟钝,平时或患     

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.