老年慢性心力衰竭患者自我感受负担状况及其影响因素探讨

目的：探讨老年慢性心力衰竭患者自我感受负担状况及其影响因素。方法：将该院2014年～2015年收治的179例老年慢性心力衰竭患者作为本文研究对象,采用自我感受负担量表（SPB）对179例患者进行调查,统计不同程度负担患者的比例及SPB得分状况,同时分析SPB得分的影响因素。结果：179例患者中无负担患者21例,轻度负担患者52例,中度负担患者79例,重度负担患者27例,SPB得分为（32.57±2.16）分。多因素Logistic回归分析显示心功能分级、治疗费用支出方式、病程、文化程度及合并症种类是患者自我负担感受加重的主要因素（P＜0.05）。结论：慢性心力衰竭患者大部分会出现不同程度的自我感受负担,自我感受负担受众多因素影响,常见因素包括心功能分级、经济状况及病程等,临床为减轻患者自我感受负担可从上述影响因素介入重点干预措施。     

膀胱癌尿路造口患者自我感受负担水平及影响因素分析

目的 了解膀胱癌尿路造口患者的自我感受负担水平,并分析其影响因素。方法采用方便抽样法,选取医院门诊复诊的膀胱癌尿路造口患者303例为研究对象。采用一般资料调查表和自我感受负担量表进行问卷调查,并分析自我感受负担量表得分的相关因素。结果89.8%的膀胱癌尿路造口患者存在自我感受负担,平均得分（31.00±6.89）分,处于中度自我感受负担水平。多元逐步回归分析显示,造口自理程度、有无并发症、月均收入、造口时间是膀胱癌尿路造口患者自我感受负担的主要影响因素。结论护士应重视膀胱癌尿路造口患者自我感受负担状况,加强延续护理,针对不同影响因素,采取个性化心理干预措施。     

照顾者反应对胃癌患者自我感受负担的影响

目的:研究照顾者反应对胃癌患者自我感受负担(SPB)的影响。方法:选择2013年1月-2014年12月在本院接受治疗的胃癌患者80例。选择其配偶或直系亲属等长期照顾者为主要照顾者。采用照顾者反应评估量表对照顾者进行调查,采用SPB量表对患者进行自我感受负担调查,分析照顾者反应对胃癌患者自我感受负担的影响。结果:胃癌患者的SPB平均得分为(33.82±4.56)分,其中有10例(12.50%)患者不存在SPB,轻度18例(22.50%),中度35例(43.75%),重度17例(21.25%)。不同自我感受负担组别的胃癌患者的照顾者反应比较差异有统计学意义(P0.05)。胃癌患者的自我感受负担得分与照顾者反应中的经济问题、健康问题、家庭支持缺乏、时间安排受打扰呈正相关,与自尊呈负相关(P0.05)。分层回归分析显示,家庭收入、疾病分期和照顾者反应是胃癌患者自我感受负担的影响因素(P0.05)。结论:照顾者反应会影响胃癌患者自我感受负担,护理人员可以对照顾者进行综合护理干预,以降低胃癌患者的自我感受负担。     

正念减压疗法对乳腺癌患者自我感受负担及家庭功能的影响

目的:探索正念减压疗法对乳腺癌患者自我感受负担及家庭功能的影响。方法:将符合纳入标准的82例乳腺癌患者随机分成正念治疗组和常规对照组各41例。两组均接受相同的治疗方案,常规健康教育和心理护理,正念治疗组还另外接受为期8周的正念减压治疗。比较两组患者干预前后自我感受负担(SPB))及家庭功能(FAD)得分。结果:干预后正念治疗组患者SPB得分、FAD得分均低于常规对照组,差异有统计学意义。组内比较:正念治疗组干预后SPB得分、FAD得分均较干预前下降,差异有统计学意义;对照组干预后SPB得分较干预前下降,差异有统计学意义。结论:正念减压疗法能有效降低乳腺癌患者自我感受负担,提高其家庭功能水平。     

慢性阻塞性肺疾病患者自我感受负担的影响因素

目的：分析慢性阻塞性肺疾病（COPD）患者自我感受负担（SPB）的影响因素。方法：回顾性分析2018年6月至2020年6月该院收治的112例COPD患者的临床资料。采用自我感受负担量表（SPBS）评估COPD患者自我感受负担情况,并采用多元线性回归分析COPD患者SPB的影响因素。结果：112例COPD患者SPBS平均得分为（28.42±6.72）分;单因素分析结果显示,不同性别、年龄、受教育程度、工作情况、婚姻状况、居住地、合并症、医疗费用支付方式的COPD患者SPBS评分比较,差异均无统计学意义（P>0.05）;不同自我效能感、社会支持度、照顾者负担的COPD患者SPBS评分比较,差异均有统计学意义（P<0.05）;多元线性回归分析结果显示,自我效能感低、照顾者负担重、社会支持度低均为影响COPD患者SPB的危险因素（P<0.05）。结论：自我效能感低、照顾者负担重、社会支持度低均为影响COPD患者SPB的危险因素。     

肠造口患者自我感受负担与自我效能及生活质量相关性研究

目的 调查肠造口术后自我感受负担情况,并分析与自我效能及生活质量相关性以及影响因素。 方法 采用便利抽样法选取2016年1月-2017年6月在宁波市鄞州人民医院外科接受造口术的151例患者,用自行设计的一般资料调查问卷、健康促进策略量表、造口生活质量问卷,对肠造口术后患者进行研究。共发放问卷160份,有效问卷151份,有效率为94.38%。对数据进行统计学分析,用均数、标准差、频数和频率等描述造口患者一般资料,用t检验、方差分析进行单因素分析,用Pearson相关分析法对SPB、自我效能和生活质量进行统计分析。将有统计学意义的变量作为自变量引入回归模型,进行多重线性回归分析。 结果 肠造口患者术后自我感受负担得分(39.64±8.83)分,处于中等水平,50.3%的患者为高水平。SPB与自我效能和生活质量均为负相关关系,相关系数r分别为-0.441、-0.459(P<0.05)。多重线性回归分析结果显示,文化程度、粪便泄漏散发臭味频率、自我效能为自我感受负担的影响因素。 结论 肠造口患者术后自我感受负担较为严重,护理人员应鼓励患者采取积极地面对困难与挑战,主动学习造口护理技能,更多地与他人进行交流。同时更加关注文化程度较低的患者,最终提高患者生活质量。      

结肠癌患者内镜下黏膜切除术后自我感受负担的影响因素

目的 分析结肠癌(CC)患者内镜下黏膜切除术(EMR)后自我感受负担(SPB)情况及相关影响因素。方法 选取南阳市第一人民医院2019年5月至2020年7月接受EMR治疗的83例CC患者研究对象，采用自我感受负担量表(SPBS)评估患者SPB情况，设计一般资料填写表，询问并记录患者相关资料，比较不同资料特征患者SPB情况，分析可能影响CC患者EMR术后SPB的相关因素。结果 83例CC患者EMR术后均伴有不同程度SPB,SPBS得分为33.00(17.00,42.00)分；自觉经济能力不足、家庭关怀一般、消极应对的CC患者SPBS评分均高于自觉经济能力充足、家庭关怀良好、积极应对的患者，差异有统计学意义(P<0.05);其他不同资料特征的CC患者SPBS评分对比，差异无统计学意义(P>0.05);多重线性回归分析结果显示，自觉经济能力不足、家庭关怀一般、消极应对均可能是CC患者EMR术后SPB严重的影响因素(P<0.05)。结论 CC患者EMR术后伴有不同程度SPB,自觉经济能力不足、家庭关怀一般、消极应对可能是影响CC患者EMR术后SPB的主要因素。     

心理护理干预对乳腺癌术后化疗患者自我感受负担的影响

目的探讨心理护理干预对乳腺癌术后化疗患者自我感受负担(SPB)的影响.方法 将62例乳腺癌术后化疗患者随机分为对照组(n=31)和观察组(n=31),两组患者均采用常规护理,观察组在常规护理基础上实施心理护理干预,比较两组护理干预前、中、后的SPB得分.结果 观察组护理干预中、后的SPB得分为69.31±13.52、61.94±8.63,均明显低于对照组的88.35±17.46和90.28±16.51(P均<0.05).观察组护理干预前、中、后的SPB得分比较,差异有统计学意义(P<0.05).结论 有针对地实施有效的心理护理干预对乳腺癌术后化疗患者SPB的改善具有积极作用.     

食管癌患者失志综合征现状及影响因素分析

目的 了解食管癌患者失志综合征现状及影响因素,为临床采取针对性干预措施提供依据。方法 选取213名食管癌患者为研究对象,采用第2版失志量表（DS-Ⅱ）、自我感受负担量表和社会支持评定量表等进行调查。结果 食管癌患者DS-Ⅱ得分为（13.70±9.82）分,在性别、年龄、职业、文化程度、家庭月收入、婚姻状况、居住地、医疗费用支付方式、疾病分期、是否手术、是否合并其他疾病、自我感受负担、社会支持水平方面比较差异有统计学意义。职业、家庭月收入、是否合并其他疾病、自我感受负担及社会支持是食管癌患者失志状况的主要影响因素。结论 食管癌患者失志综合征发生率较高,应采取针对性措施,重视心理护理,调动患者积极情绪,降低其失志水平,提高生活质量,促进患者康复。     

胰腺癌患者失志现状及影响因素研究

  目的  了解胰腺癌患者失志综合征现状及影响因素,为制定干预措施提供理论依据。  方法  采用便利抽样法选取2019年1月—2021年6月温州医科大学附属第二医院收治的162例胰腺癌患者为研究对象。采用一般资料调查问卷、失志量表、领悟社会支持量表、自我感受负担量表进行问卷调查。  结果  胰腺癌患者失志量表得分为(35.45±11.93)分,领悟社会支持量表得分为(55.64±7.04)分,自我感受负担量表得分为(34.09±8.53)分;不同年龄、性别、学历、婚姻状况、家庭人均月收入、疾病分期、治疗方式的胰腺癌患者失志得分差异有统计学意义(均P＜0.05);Pearson相关分析结果显示,胰腺癌患者领悟社会支持总分及各维度得分均与失志得分呈负相关关系(均P＜0.01),自我感受负担总分及各维度得分均与失志得分呈正相关关系(均P＜0.01);多元线性回归分析结果显示,学历、疾病分期、自我感受负担、领悟社会支持是胰腺癌患者失志综合征的主要影响因素(均P＜0.05),可解释总变异的42.1%。  结论  胰腺癌患者失志综合征程度较高,应根据患者的学历、疾病分期、自我感受负担、领悟社会支持情况采取针对性的干预措施,缓解患者的失志综合征,提高胰腺癌患者的生活质量。      

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.