微量泵输注高浓度氯化钾在心力衰竭合并低钾血症中的应用及护理

目的：探讨微量泵输注高浓度氯化钾在心力衰竭合并低钾血症中的应用及护理.方法：随机选取2013年3月至2014年10月我院收治的82例重度心力衰竭合并低钾血症患者,依据随机数字表法将这些患者分为两组,即观察组和对照组,每组41例.观察组运用静脉留置针补钾,对照组运用留置针或静脉穿刺补钾,然后对治疗前后两组患者的血钾水平进行统计分析.结果：治疗前两组患者的血钾水平之间的差异不显著（P〉0.05）;治疗后1d、2d观察组患者的血钾水平均明显比对照组高（P〈0.05）,但治疗后3d、4d两组患者的血钾水平之间的差异均不显著（P〉0.05）.结论：微量泵输注高浓度氯化钾在心力衰竭合并低钾血症中的应用效果良好,临床应积极给予患者有针对性的护理.     

口服补钾治疗老年患者低钾血症的疗效观察

目的观察口服补钾治疗老年患者低钾血症的疗效。方法随机分成观察组和对照组,观察组予10%氯化钾注射液口服;对照组予10%氯化钾注射液稀释后静滴。比较两组治疗后2小时、4小时的血钾水平、心电图异常情况及有效率。结果①治疗后2小时和治疗后4小时观察组血钾均显著高于对照组,差异有统计学意义(P0.01);②观察组总有效率(95.45%)显著高于对照组(84.09%),差异有统计学意义(χ2=6.188,P=0.013)。结论口服补钾治疗老年低钾血症患者的短期疗效优于静脉补钾。     

胰岛素泵与诺和灵30R治疗糖尿病合并肺部感染的临床效果比较

目的 探讨胰岛素泵与诺和灵30R治疗2型糖尿病合并肺部感染患者的不同临床效果,以达到最合理方式治疗2型糖尿病合并肺部感染的目的.方法 2007年6月-2012年6月选取住院治疗的2型糖尿病合并肺部感染患者共90例,按照治疗的先后顺序将90例患者随机分为两组,其中对照组40例,给予诺和灵30R治疗;观察组50例,给予胰岛素泵治疗,分组治疗后观察其临床疗效和血糖控制情况.结果 两组临床疗效观察组治愈39例、好转7例、无效4例,对照组治愈29例、好转7例、无效4例,总有效率分别为92.0％和90.0％,两组治疗效果差异无统计学意义;分组治疗后,观察组患者空腹血糖、餐后血糖、血糖达标时间和胰岛素用量分别为(6.2±0.9)mmol/L、(8.1±0.8)mmol/L、(4.3±0.9)d、(31.6±2.2)U,对照组分别为(7.0士1.1)mmol/L、(9.3±1.2) mmol/L、(8.9±1.3)d、(9.8±2.7)U,观察组均明显低于对照组,差异有统计学意义(P＜0.05).结论 胰岛素泵与诺和灵30R在治疗2型糖尿病合并肺部感染临床疗效均确切有效,其中胰岛素泵更能有效控制血糖,能更快的使患者血糖达标.     

曲美他嗪联合中药方剂对老年心力衰竭合并肺部感染的疗效观察

目的观察和分析曲美他嗪联合中药对老年心力衰竭合并肺部感染的疗效,为制定合理的治疗方案提供研究依据。方法选取2015年7月-2017年7月120例老年心力衰竭合并肺部感染患者作为研究对象,按是否应用中药辅助治疗分为研究组和对照组,每组60例。对照组患者给予常规对症疗法联合口服盐酸曲美他嗪治疗,研究组患者在对照组疗法基础上给予口服自拟中药汤剂治疗,观察并记录两组患者治疗后心衰和肺部感染改善情况,比较两组患者治疗前后血清脑钠肽(BNP)和左室射血分数(LVEF)水平的差异。结果治疗后研究组患者心衰临床有效率和肺炎有效率分别为88.33%和96.67%,高于对照组的65.00%和71.67%,差异均有统计学意义(χ~2=9.130,14.070;均P<0.05);研究组患者治疗后血清BNP水平为(126.35±22.19)ng/L,LVEF水平为(56.56±11.14)%,分别优于对照组的(253.64±27.31)ng/L和(45.06±9.87)%,两组比较差异均有统计学意义(P<0.05);研究组患者体温恢复正常时间、咳嗽消失时间和住院时间相比对照组均缩短(P<0.05)。结论应用曲美他嗪联合中药治疗老年心力衰竭合并肺部感染,能够提高针对心衰和肺炎的治疗效果,减轻心肌损害,促进心室射血功能的恢复,有利于改善患者的预后。     

氯化钾注射液两种给药方式治疗低钾血症的临床分析

目的探讨氯化钾注射液联合氯化钾缓释片治疗低钾血症的临床疗效。方法将我院急诊科就诊的低钾血症患者86例随机分为两组，对照组45例给予氯化钾注射液传统静脉滴注；观察组45例给予氮化钾微泵深静脉注射。观察补钾6h、12h、24h后血清钾水平，并比较两组的疗效。结果观察组的总有效率为100．00％，对照组为85．72％，两组比较差异有统计学意义（P〈0．05），观察组在6h、12h、24h血清钾恢复情况均优于对照组，且两组比较差异有统计学意义（均P〈0．05）。结论高浓度氯化钾微泵深静脉补钾是一种见效快速、安全、可靠并明显优于传统的静脉滴注补钾，患者依从性高。     

ICU应用微量泵中心静脉高浓度补钾有效性及安全性评价

目的 探讨ICU应用微量泵中心静脉高浓度补钾的有效性及安全性.方法 回顾性分析ICU发生低钾血症78例患者的临床资料.随机分为常规组和高浓度组,每组各39例,补钾均在心电监护下进行.常规组钾浓度为40 mmol/L,补钾速度为10-20 mmol/h;高浓度组钾浓度为100-300mmol/L,补钾速度为40～200mmol/h,同时计算达到目标血钾浓度所需补钾量,监测两组血钾浓度、每小时尿量、达到目标血钾浓度所需时间及患者局部不良反应.结果 两组患者治疗前均存在低钾血症,设定目标血钾浓度为4.0mmol/L,两组治疗前血钾浓度、所需补钾量比较差异无统计学意义,分别为(2.9±0.2)、(3.0±0.2)mmol/L和(85.2±8.7)、(92.3±7.6)mmol.常规组与高浓度组相比达到目标血钾浓度所需时间较长[(17.25±4.49)h比(5.67 4±0.75)h,P<0.01].结论 在ICU严密监护下应用微量泵中心静脉高浓度补钾安全、有效,有一定的临床应用价值.     

低钾血症的内科急诊疗效及临床观察

目的:探讨低钾血症的内科急诊疗效及临床观察。方法:对2015年12月-2016年12月我院收治的60例低钾血症患者根据其血清钾浓度情况分类治疗,轻度缺钾者给予进食含钾丰富的饮食,对于中重度缺钾患者静脉滴注10%氯化钾15-30m L,比较患者治疗前后的血清钾浓度。结果:治疗前患者的血钾浓度为(2.10±0.32)mmol/L;治疗12h后,患者的血钾浓度为(3.29±0.22)mmol/L。与治疗前血钾浓度相比P0.05,具有统计学差异。所有患者治疗过程中无严重并发症,未发生肾功能下降与高钾血症。有2例患者在治疗过程中产生局部疼痛,2例心率失常,总不良反应发生率为6.7%。结论:根据患者血清钾浓度选择合适的治疗方法,可有效提高临床治疗率,减少不良反应发生率。     

缬沙坦联合氨氯地平治疗社区老年原发高血压合并糖尿病疗效观察

目的观察缬沙坦联合氨氯地平治疗社区老年原发高血压合并糖尿病疗效。方法选择2016年4月—2017年1月期间在我院接受治疗的社区老年原发高血压合并糖尿病患者56例作为研究对象,随机划入观察组和对照组,其中观察组28例,对照组28例,分别接受缬沙坦联合氨氯地平治疗和氨氯地平单用治疗,比较两组患者的血糖和血压水平。结果观察组患者空腹血糖(5.2±0.6)mmol/L,餐后2 h血糖水平(8.2±0.9)mmol/L,收缩压(117.3±5.2)mm Hg,舒张压(86.5±5.9)mm Hg;对照组患者空腹血糖(7.3±0.8)mmol/L,餐后2 h血糖水平(10.8±0.7)mmol/L,收缩压(138.4±5.6)mm Hg,舒张压(97.3±6.3)mm Hg;组间差异有统计学意义(P0.05)。结论缬沙坦联合氨氯地平治疗社区老年原发高血压合并糖尿病疗效优于氨氯地平单用,值得临床应用与推广。     

老年慢性肾功能不全合并细菌感染的抗生素治疗分析

目的 探索应用抗生素治疗慢性肾功能不全失代偿期合并下呼吸道感染的老年患者的临床效果和对其肾功能的影响.方法 选取某院自2008年5月～2011年10月治疗的60例肾功能不全合并肺部感染的老年患者纳入观察组,同期选取60肾功能正常的老年下呼吸道感染的患者纳入对照组.两组患者应用头孢哌酮进行治疗,观察两组患者的总体治疗效果差异以及观察组患者治疗前后的肾功能血肌酐、尿素氮、尿酸、肌酐清除率水平差异.结果 观察组和对照组患者平均治疗时间分别为(10.15±3.23)d和(7.32±2.18)d,差异有统计学意义(P＜0.05);两组患者的总体治疗效果差异无统计学意义(P＞0.05),但痊愈率差异有统计学意义(P＜0.05);观察组治疗前后患者的血肌酐、尿素氮、内生肌酐清除率水平与治疗前比较差异有统计学意义(P＜0.05).结论 肾功能不全的老年患者一旦发生下呼吸道感染,应用抗生素治疗的难度增大,治疗过程中应密切留意患者的肾功能情况,并合理控制药物用量,一旦出现肾功能衰竭应立即停药,必要时进行血液透析.     

老年脑出血患者肺部感染物理治疗的疗效探讨

目的探讨老年脑出血患者肺部感染物理治疗的影响及相关安全性,为临床治疗提供参考。方法选择2010-2013年收治的133例老年脑出血患者为研究对象,随机分为对照组66例、观察组67例,对照组行常规性手术治疗,观察组在对照组基础上采取肺部物理治疗,对比两组患者治疗期间每日排痰量、血氧饱和度(SaO2)、住院时间及肺部感染率。结果经治疗后,观察组患者肺部感染率及住院时间分别为2.99%、(12.80±2.10)d,显著低于对照组的19.70%、(22.60±2.50)d,差异均有统计学意义(P<0.05);观察组患者每天排痰量(19.00±1.20)ml及SaO2(5.20±1.20)%,显著高于对照组的(12.11±0.90)ml及(2.30±0.10)%,差异均有统计学意义(P<0.05);观察组患者治疗优良率为94.03%,显著高于对照组的68.18%,差异有统计学意义(P<0.05)。结论对老年脑出血患者进行肺部物理治疗,疗效显著,可降低患者肺部感染率、减少住院时间,且安全性较高,值得临床广泛推广使用。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Qualitative research with people with intellectual disability

Qualitative research methods are gaining popularity in disability research, in particular as a way to explore the personal experience of disability. However, using these methods can be problematic with people traditionally regarded as vulnerable in the research relationship. People with intellectual disability are often so regarded. This paper discusses ethical concerns and issues of research credibility in qualitative research with this group of disabled people. An ethnographic study about the parenting experience of parents with intellectual disability is used to illustrate strategies to achieve credibility in qualitative studies in intellectual disability research.