临终关怀及护理

探讨临终关怀的护理及所带来的问题,认为:1、不仅绝症患者有临终的问题,实际上人人都将走向临终.所以,临终关怀的性质不应局限在仅仅对绝症患者及家属的照顾,而应理解为一种广义的死亡教育.2、一个事物的发展总有两面性,临终关怀也带来诸多的问题需要医护工作者去挑战.     

对晚期肿瘤患者临终关怀的体会

临终关怀是一个帮助病人走向死亡的过程，是为生命即将结束的患者提供全面的身心护理与支持，宗旨是减少患者痛苦，增加患者舒适、提高生命质量、维护临终患者尊严，使他们在有限的生命里，无遗憾的，安详的到达终点。临终关怀也包括了对家属的安抚和关心，帮助他们从痛苦中解脱出来，并做到日后随访，使家庭尽快恢复正常生活。[第一段]     

绝症患者的临终关怀

生老病死 ,是人类的自然规律 ,而临终意味着走向死亡 ,任何人也无法抗拒。医务人员无法挽回不可避免的绝症死亡 ,但可以发扬人道主义精神 ,使患者临终前体验到人间的温情 ,死而无憾。1　临终关怀的意义临终患者多患了绝症 ,已失去治疗的价值或目前尚无良好的、可知的治疗方法。这时给患者临终关怀 ,不仅可减轻患者生理上的痛苦 ,而且也减轻了心理上对死亡的恐惧不安 ,从而能协助病人提高尚存的生命质量 ,在有限的时光里体验到人间最后的温情[1] 。2　临终关怀的内容2 1　心理疏导沟通　医务人员不仅要密切观察患者的心理变化 ,而且要正确认…     

尊严死教育在ICU临终患者疗护中的应用

目的 探讨尊严死教育在ICU临终患者中应用的效果.方法 比较尊严死教育实施前后患者临终前治疗的选择,心肺复苏实施次数以及患者家属的满意度;并比较临终关怀治疗组和积极治疗组两组患者的死亡质量、临终前治疗的时间、治疗费用的差异.结果 对临终患者家属进行尊严死教育后,临终前选择积极治疗患者比例较前明显下降（P＜0.01）,选择临终关怀治疗的患者比例明显升高（P＜0.01）,临终患者平均心肺复苏次数减少（P＜0.01）,患者家属满意率无统计学差异（P=0.17）;和临终前积极治疗患者相比,选择临终治疗的患者临终前治疗时间缩短（P＜0.01）,治疗费用降低（P＜0.01）,死亡质量较高（P=0.01）.结论 在ICU临终患者的家属中开展尊严死教育能够让更多临终患者的家属选择临终关怀治疗,实现患者尊严死,减少无效治疗.     

我国中小城市及乡村开展临终关怀模式探讨

临终关怀运动始于英国的志克里斯多弗医院，由桑德斯博士创立，其目的就是帮助临终患者安详地、舒适地、有尊严地走到生命的终点，同时为临终者的家属提供心理、社会及精神上的支持，以使他们以健康的方式应对和适应。临终是指由于疾病末期或意外事故而造成人体主要器官生理功能衰竭不能用现在医疗技术治愈，死亡即将发生的过程。目前世界上不同的国家对临终的时期尚未有统一的标准。     

社区卫生服务中心对晚期肿瘤患者的临终关怀

临终关怀指的是对肿瘤晚期患者、各种疾病终末期、治疗无效及生命即将结束的患者所实施的全面关怀与照料，是对临终患者和家属提供姑息性和支持性医护措施，把患者和家属作为护理的整体。临终关怀的宗旨是将临终阶段看成是一种特殊类型的生命阶段，减少临终癌症患者的痛苦，增加患者的舒适程度，提高患者的生命质量，维护临终患者的尊严，同时希望赋予患者家属精神上的支持，给予他们承受所有事实的力量，进而坦然接受死亡的问题。     

临终护理的进展

临终护理是指对那些在医学上已经判明无法治愈，将在3～6个月内死亡的患者进行护理，它的宗旨是减少临终病人的痛苦，增加病人的舒适程度，提高病人的生活质量，维护临终病人的尊严。同时希望给予患者家属精神上的支持，给予他们承受所有事实的力量，进而坦然地接受一切将面对的问题，为临终患者家属提供包括沮丧期内的生理、心理关怀的立体化社会卫生服务，临终关怀是新的医学模式的体现。     

临终关怀护理工作讨论

凡是生命，都有生老病死，有死必有临终阶段。科学研究表明，人的临终阶段具有特殊的发展规律性。让濒死者安详而有尊严地走向生命终点，为临终者的家属提供社会和心理学的支持，是每一个医护人员应重视的问题。     

临终病人的心理特点及护理

死亡是人的自然回归，临终是生命结束的必经之路。但对人类而言，无论如何是一件非常痛苦的事，因为它不仅意味着与亲人、家属及整个社会的永久分离，而且在临终过程中人会遇到难以想象的痛苦与折磨。对临终病人而言，当死亡不可避免时，如何减轻痛苦与不适，在有限的生命岁月中淋浴在充满人间温暖的气氛中，安祥、舒适而有尊严地走完自已人生的最后旅程是非常重要的。     

临终患者的护理

随着人口老龄化的发展趋势，临终病人这一特殊的群体越来越受到人们的重视，而临终病人的临终关怀作为医学界的一门学科，也日益受到人们的关注。WHO的临终关怀服务的概念为：为晚期患者及家属提供全面积极的全人照顾。其服务哲理是：以照料为中心，维护人的尊严，提高临终生存的质量，共同面对死亡。在临终阶段生存质量至少包括反映临终患者生活中以功能的、     

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.