循证护理在急危重症抢救中的作用

目的：探讨循证护理在急危重症抢救中的作用,以提高护士急救应急能力。方法：比较培训前后我院急诊科护理人员理论知识、急救技能、护理操作、模拟演练的成绩、优良率和护理人员参与抢救时间及启动仪器使用时间。结果：经过培训后全科护理人员均能按照规范的要求,独立完成一人操作的急救技能,理论知识、急救技能、护理操作、模拟演练的成绩均显著高于培训前,培训后护理人员考核优良率显著高于培训前,护理人员参与抢救时间及启动仪器使用时间显著少于培训前,以上差异有统计学意义（P〈0.05）。结论：护士在循证护理实践中得到了锻炼,业务水平和综合处理问题的能力得到了提高,推动了护理队伍急救水平的提高,也提高了急危重症患者抢救成功率。     

阶梯式或分层次培训护理人员在急诊科的应用

目的:探讨阶梯式教学在急诊护理人员培训中的应用。方法:对30名急诊护士具体实施以急救技能及急救理论知识、综合模拟急救演练等项目进行学习和培训;通过理论考试、急救技能及护理技术操作的考核、模拟急救考核并总结护士每次考核的成绩,对护士进行年度综合考评的方法,验证实施阶梯式培训后急诊护士的急救技能及整体素质。结果:30名急诊护士考核成绩及护理综合质量考评均有明显提高。结论:实施阶梯式培训,能有效提高急诊护理人员的急救技能和整体素质,也使师资力量得到合理的利用。同时对提高危重病人抢救成功率、护理安全得到有效保证。     

急救模拟培训对妇产科护士急救能力和患者满意度的影响

目的探讨模拟培训对妇产科护士急救能力和患者满意度的影响。方法选取2012年1—12月在妇产科工作的24名护理人员进行急救能力训练的模拟培训,改变过去单纯的理论授课,对培训前后妇产科护理人员的急救理论、急救技能和综合能力水平进行比较,且对患者的满意度进行调查。结果模拟培训后护理人员的理论成绩、急救操作能力以及综合能力都显著高于培训前,差异均有统计学意义（均P〈0.05）。并通过问卷调查结果显示,有100%的护理人员急救能力得到了提高,护士学习的主动性、沟通协调能力、分析解决问题的能力、判断力以及团队协作的意识都有显著的提高。经过模拟培训后护理,患者满意度大大提高（P〈0.05）。结论急救模拟培训可以明显增加妇产科护士对急救知识的了解,并能够主动配合医生应对妇产科的各种急救,且提高了患者满意度,值得进一步推广应用。     

多元护理急救训练在早期心肺脑复苏中的临床研究

目的探讨多元护理急救训练法在早期心肺脑复苏中的临床应用。方法设计心肺脑复苏（CPcR）模拟急救培训法。科学编写CPCR抢救程序。制订标准化、规范化培训模式。设计模拟患者,利用相关模型和仪器进行临床心肺脑复苏模拟演习。定期考核总结。结果2011年2月至2012年10月护士经过多元护理急救培训后,CPCR成功率从37．84％提高到55．26％。多元护理急救培训前后比较,CPCR存活率从14．86％提高到32．89％,两组患者比较,差异有统计学意义（P〈0．05）。从实施CPCR至心跳恢复所用时间由培训前的（6．9±1.3）分钟缩短到（5．1±1．2）分钟,两组患者比较,差异有统计学意义（P〈0．01）。考核平均成绩由培训前的（81．23±14．93）分提高到（92．69±13．57）分,两组护士比较,差异有统计学意义（P〈0．01）。结论多元护理急救训练法能提高护士的应急反应水平和应急能力,并能显著提高患者CPCR成功率,从而提高患者生存质量,这一方法在急救工作中具有很大的应用价值。     

反面模拟录像考核法对低年资护士进行急救护理技能培训的实施

[目的]探讨反面模拟录像考核法在低年资护士急救护理技能强化培训中的应用与效果。[方法]选择2005。2008年大专和本科护理专业毕业的临床护士198人,选择4项常用的急救护理技术操作为培训考核项目,通过真人及模拟人操作演示并录像后制作成光盘,在操作演示中共设置了19处操作错误点,护士通过观看录像按要求笔试作答,判断操作流程中出现的错误操作方法,并分析其对患者造成的不良影响,同时写出正确的操作方法。[结果]强化培训后护士的判断、分析和操作能力均有显著提高,与培训前差异均有统计学意义（P〈0．01）。[结论]反面模拟考核培训法能进一步巩固护士操作的熟练程度,更重要的是从根本上解决实际应用与理论脱节的问题,并有效提高急救护理技术的应用能力。     

急诊专科护士的培训探讨

目的 探讨急诊专科护士的培训对急诊科护理人员的急救护理水平,患者抢救成功率和满意程度的影响.方法 对各级护理人员,采用不同的培训方法,理论与实践相结合,并对接受能力差的部分人员实行专人带教,学、做融为一体.结果 实施急诊专科培训后的各级护士的三基理论水平与操作技能均有显著提高.结论 通过急诊专科护士的培训,可提高护理人员急诊、急救水平,改善护理质量,提高抢救成功率和患者满意度.     

应用模拟技术进行急救护理培训的研究进展

通过对目前护理人员掌握急救护理技术的现状和需求的调查,了解护理人员急救技术掌握状况及急救护理培训方法、途径及效果。探讨一种对护理人员急救技能培训的有效途径及新方法,通过将高端仿真模拟技术培训方法对护理人员进行急救培训,提高护士综合急救护理技能及临床应急能力。     

急诊护士综合素质的培养与院前急救培训的探讨

为探讨提高急诊科护士院前急救能力培养的对策,提高急诊科护士的选择标准,对急诊科在岗护士进行理论知识和急救技能的培训。急诊科护士院前急救能力和业务水平显著提高,患者抢救成功率明显提升。也是提高患者抢救成功率的重要途径。急诊抢救的患者病情复杂多变,急救措施也不尽相同,要求急诊科的护士必须具备健康的体魄,良好的心理素质,熟练掌握各种急诊急救技能和各种抢救流程,因此,急诊科护士综合素质的培养是提高急诊科护理质量及患者生存率的重要环节。     

ICU护理技能培训考核方法的创新

目的 创新ICU护理技能培训考核方法,提高ICU护士综合监护、抢救水平.方法 将ICU传统的带教秘书示范操作培训改为分小组病历式情景模拟培训,即组织I C U护士"真人真做"分组分别扮演患者和护士,由护士长及组长拟订抢救病历,对I C U护理人员进行仿真抢救情景模拟培训,提高ICU护士综合实践技能及监护、抢救水平.结果 创新前后ICU护士护理技能考核成绩比较.ICU创新护理技能培训的满意率由创新前的90%提高至99%.结论 创新护理技能培训方法,提升了ICU护士的综合技术业务素质,提高了ICU护士整体监护、抢救水平.     

重症监护室护理人员技术准入管理的现状评估

目的：了解北京市部分医院重症监护室的护理人员对技术准人概念的了解程度及护理技术准入的开展情况。探索ICU护理人员技能水平提高的有关因素,为制定技术准入管理的标准,提供重要依据：方法设计《重症监护室护理人员临床技术准入认知情况调查表》,随机选取北京市16所医院46个重症监护室559名护士进行问卷调查．录入数据,应用统计学卡方检验和精确概率法对数据进行分析处理。结果：65．6％的ICU护士对“技术准入”的概念有一定的了解,34．4％的护士对此概念不了解;76．8％护理人员认为实行技术准入管理后,基础与专科护理质量会提高;护理人员职称提高后,认为技能水平会提高的人数占大多数,且有显著差异（P〈0．01）;而护理人员学历提高后,认为技能水平不能提高的人数占大多数,且有显著差异（P〈0．01）;某项操作经过专科理论培训、操作培训或考核后认为可以提高护理人员的技能水平的人数占多数,且有显著差异（P〈0．01）：结论：应对护理人员进行清晰合理的分层次使用管理,建立起完善的护理技术准入管理体系。职称的高低以及某项操作经过专科的理论培训、操作培训及考核四个因素均可以在探索ICU护理技术准入的条件时作为有关的因素。学历高低能否影响技能水平,应作为继续探讨的问题之一。     

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.