集束化护理在预防脑梗死鼻胃管食物逆流中的应用体会

目的探讨集束化护理在预防脑梗死患者留置鼻胃管期间发生食物逆流的应用体会。方法选择我院ICU2016年6月至2016年12月收治的100例脑梗死患者,随机分为对照组和观察组各50例,对照组给予鼻胃管一般护理;观察组给予集束化护理,比较两组发生食物逆流的例数等。结果观察组发生食物逆流的患者例数和胃管留置天数明显少于对照组;且护理满意率明显高于对照组,比较差异有统计学意义(P0.05)。结论集束化护理能有效预防脑梗死患者留置鼻胃管期间发生食物逆流、呛咳,从而减少胃管留置时间,提高患者满意度。     

集束化护理策略预防泌尿外科患者导管滑脱的效果

目的探讨集束化护理策略在预防泌尿外科患者导管滑脱的应用效果。方法选取泌尿外科带管患者270例,将其随机分为对照组和试验组。对照组采取导管常规护理措施,试验组在常规护理措施的基础上采取集束化护理策略,对护理后两组患者的脱管率及患者满意度进行观察。结果试验组各种导管滑脱发生率明显低于对照组,试验组患者满意度明显高于对照组,差异具有统计学意义(P0.05)。结论对泌尿外科患者的管道管理实施集束化护理策略,可有效降低导管滑脱发生率,提高患者满意度,可在临床上广泛应用。     

集束化护理策略对ICU患者肠内营养相关性腹泻的影响

目的：探讨集束化护理策略对预防肠内营养相关性腹泻的效果。方法以重症医学科肠内营养患者作为研究对象,其中2011年1—12月111例患者,采用传统护理方法作为对照组;2012年1月—2013年6月179例患者,采用集束化护理为观察组,比较二组肠内营养相关性腹泻发生率。结果对照组111例发生腹泻44例,发生率39．6％,观察组179例发生腹泻34例,发生率18．9％,二组比较肠内营养相关性腹泻发生率差异有统计学意义（P＜0．01）,且集束化护理组在机械通气时间及入住ICU 的时间明显低于对照组（ P＜0．001）。结论采用有效的集束化护理,可以降低肠内营养相关性腹泻发生率,减少通气时间和入住时间。     

浅谈对外科胃肠减压患者的护理体会

目的探讨胃肠减压临床护理体会和护理措施。方法回顾将我院普外科2006年8月至2010年8月共61例施行胃肠减压的患者列为观察对象,回顾分析胃肠减压患者护理措施和方法,并进行总结分析,结果一次性留置胃管成功57例,一次性留置胃管成功率93.4%。脱落3例,自行拔除胃管1例。结论胃肠减压应重视心理护理,熟练插管技术操作,细致执行胃肠减压期间的护理措施,会减轻患者的痛苦,促进疾病的痊愈。     

普外科胃肠减压常见并发症分析及护理措施

目的探讨普外科患者胃肠减压的常见并发症及护理措施。方法对2012年6月—2013年6月我院普外科收治的98例行胃肠减压患者，出现的常见并发症进行分析，并采取相应的护理措施。结果胃管插入困难、咽部不适、口干舌燥、咳痰困难、恶心呕吐、入睡困难等是留置胃管期间的常见并发症，经给予相应的护理措施，均取得了良好的治疗效果。结论对于普外科胃肠减压患者，良好、有效的护理措施能减轻患者的痛苦，促进早日康复。     

胃肠减压常见故障及排除方法

胃肠减压是普外科常见的治疗手段,通过胃管吸出胃内容物从而减轻胃肠负担,有利于吻合口的愈合,以减轻腹胀。正确有效的胃肠减压是普外科大手术顺利康复的重要条件,笔者通过对103例胃肠减压病人的护理及观察,对胃肠减压常见故障及排除方法总结下。1临床资料胃管插入深度不够13例,占12%;负压吸引无效20例,占19%;胃管堵塞7例,占6%;胃管脱落6例,占5%。胃肠减压最常见的故障是负压吸引无效;其次是胃管插入深度不够,胃管堵塞,胃管脱落也不少见。2常见故障原因分析及排除方法2.1插管深度不够胃管插入深度不够,引流量少。插管深度不够的原因:①测量…     

护理干预对高龄胃肠手术患者术后并发症发生率的效果研究

目的：探讨高龄胃肠手术患者术后并发症的护理干预效果。方法选择2011年5月—2015年4月我科收治的高龄胃肠手术患者332例，2011年5月—2013年4月160例为对照组，采用常规护理；2013年5月—2015年4月 172例为试验组，采用护理干预，比较2组患者术后胃肠功能恢复时间、住院时间及并发症发生情况。结果试验组患者肛门排气时间、肛门排便时间、住院时间明显短于对照组，差异有统计学意义（P<0.05）。试验组术后肺部感染34例（19.76%）、腹腔感染6例（3.48%）、切口感染8例（4.65%）、吻合口出血1例（0.58%）；对照组术后肺部感染43例（26.88%）、腹腔感染9例（5.63%）、切口感染10例（6.25%）、吻合口出血1例（0.62%），2组比较差异无统计学意义（P>0.05）。结论采用护理干预措施能有效促进胃肠手术患者术后肠蠕动，减少胃肠功能恢复时间，减轻术后并发症，减轻痛苦，缩短住院时间，促进早日康复，提高患者满意度。     

集束化护理措施在无肝素连续性血液净化治疗中的应用效果观察

目的：观察并分析在无肝素连续性血液净化治疗中应用集束化护理措施的临床效果。方法：选取该院2014年3月至2016年3月期间治疗的86例患者并将其平均分为试验组和对照组。对照组患者采用常规的护理方式,试验组患者实施集束化护理方式。对比两组患者的平均治疗完成时间和完成目标时间比状况。结果：试验组患者的平均治疗时间为（7.29±2.52）h,优于对照组的（14.95±1.68）h,试验组完成目标时间比为31.05％,优于对照组患者的63.52％,两组患者的一般差异具有统计学意义（P＜0.05）。结论：在无肝素连续性血液净化治疗中应用集束化护理措施能够有效的缩短平均治疗时间以及完成治疗目标时间,具有很好的临床应用效果,集束化护理措施适合在临床治疗中推广应用。     

集束化护理在预防重型颅脑损伤患者ICP监测并发症的临床观察

目的： 探讨集束化护理干预在预防重症颅脑损伤患者颅内压（ICP）监测并发症的效果。方法：选取2015年5月至2016年2月我院神经外科重症医学科（ICU）收治的82例急性重型颅脑损伤患者作为研究对象，按随机数字法分为试验组和对照组，其中对照组行常规ICP护理管理，试验组给予ICP集束化护理管理，分别比较两组置管后肺部感染、泌尿感染、颅内感染、静脉导管感染以及颅内血肿和引流管阻塞等并发症的发生情况，同时记录并计算两组患者机械通气时间、入住ICU时间、住院时间、费用和满意度评分。所得数据利用统计学软件SPSS 17.0建模分析处理。结果：与对照组相比较，试验组患者的肺部感染、泌尿感染、颅内感染、静脉导管感染和引流管堵塞等并发症发生率均显著降低，差异均有统计学意义（P＜0.05），但两组患者在ICP监测相关颅内血肿发生情况方面则无显著区别（P＞0.05）。结论：集束化护理在预防重型颅脑损伤患者ICP置管相关并发症方面的临床效果显著，能显著降低感染和引流管阻塞等并发症的发生率，明显缩短住院时间和减少患者经济负担，大大提高了患者的满意度。     

集束化护理在预防消化内科患者胃管非计划拔管中的应用研究

目的探究在消化内科疾病患者中应用集束化护理对于胃管非计划拔管的预防作用。方法随机选取本院消化内科在2015年1月~2016年12月收治的60例留置胃管的患者作为观察对象,分为集束化护理组与常规组,每组各30例,对常规组消化内科疾病患者给予基础性护理措施,集束化护理组在常规护理基础上采用集束化护理,比较两组效果。结果常规组中出现非计划拔管的患者为3例,发生率为10.0%;集束化护理组中出现非计划拔管的患者为1例,发生率为3.3%。结论集束化护理模式可以有效预防留置胃管的消化内科疾病患者发生非计划拔管事件。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.