阶梯式康复护理干预措施在腰椎间盘突出微创护理中的应用效果及预后中的应用分析

目的分析阶梯式康复护理干预措施在腰椎间盘突出微创护理中的应用效果及预后中的应用。方法选取我院2017年4月至2018年3月收治的腰椎间盘突出症80例患者进行研究,分为对照组40例和观察组40例,分别采用常规护理干预、阶梯式康复护理干预,评价并比较两组的整体应用效果。结果护理干预前两组VAS评分和腰椎功能评分差异无统计学意义(P0.05),而在护理干预后观察组则均要明显优于对照组,差异有统计学意义(P0.05);在并发症发生率方面,观察组和对照组分别为5.0%、20.0%,差异有统计学意义(P0.05)。结论腰椎间盘突出微创护理中,应用阶梯式康复护理干预措施,效果明显,值得推广使用。     

康复治疗对腰椎间盘突出症患者的护理效果

目的 探讨早期康复治疗对腰椎间盘突出症术后患者的护理效果.方法 选取我院2018年5月—2019年2月期间收治的腰椎间盘突出症术后患者86例,随机分为两组,各43例.两组术后均遵医嘱进行药物及物理治疗.对照组实施常规护理干预,观察组在常规护理基础上实施3阶段早期康复训练治疗.比较两组护理效果及康复治疗前后疼痛与腰椎功能恢复情况.结果 观察组康复治疗后优良率93.02％明显高于对照组74.41％,(P<0.05)差异有统计学意义;康复治疗后,两组患者VAS评分均降低,JOA评分均升高(P<0.05)差异有统计学意义,观察组患者康复治疗后VAS评分低于对照组,JOA评分高于对照组(P<0.05)差异有统计学意义.结论 早期康复治疗可显著缓解腰椎间盘突出症患者术后疼痛程度,改善腰椎功能,护理效果满意.     

早期康复护理对腰椎间盘突出症术后恢复及提高生活质量的影响效果观察

目的观察早期康复护理对腰椎间盘突出症术后恢复及生活质量的影响。方法选取2015年6月~2017年1月我院收治的进行手术治疗的102例腰椎间盘突出症患者作为观察对象,按照摸球法分为对照组(n=51)和研究组(n=51),对照组实施常规护理,研究组实施早期康复护理,比较两组患者的术后恢复效果和生活质量情况。结果两组腰椎功能优良率比较,研究组高于对照组(P0.05);两组护理后JOA评分、SF-36评分及VAS评分比较,研究组均优于对照组(P0.05);研究组与对照组护理满意度比较,组间差异明显(P0.05)。结论早期康复护理可显著改善腰椎间盘突出症术后腰椎功能,缓解疼痛,提高生活质量和护理满意度,值得临床广泛推广和应用。     

快速康复外科理念在脊柱微创腰椎间盘突出症围术期护理中的效果

目的:观察快速康复外科理念在脊柱微创腰椎间盘突出症围术期护理中的效果.方法:选取2016年1月至2020年1月收治的140例脊柱微创腰椎间盘突出症围手术期患者为研究对象,根据患者手术时间分为观察组和对照组各70例,观察组在快速康复外科理念指导下进行护理,对照组进行常规护理,比较两组患者各时间点NRS评分、术后恢复指标、并发症发生率及对护理服务的满意度.结果:术前两组NRS评分比较,差异无统计学意义(P>0.05),术后24 h、72 h、出院前观察组患者的NRS评分均低于对照组(P<0.05);观察组患者的下床活动时间、进食时间、术后排气时间、术后垫枕时间、住院时间、术后并发症发生率均低于对照组(P<0.05);观察组患者对护理服务满意率高于对照组(P<0.05).结论:快速康复外科理念应用于脊柱微创腰椎间盘突出症患者围手术期护理可以缓解患者术后疼痛,降低并发症发生率,提高患者对护理服务满意度.     

椎间孔镜技术联合得宝松治疗腰椎间盘突出症的效果观察

目的探讨椎间孔镜技术联合得宝松局部用药治疗腰椎间盘突出症的临床效果。方法选取腰椎间盘突出症患者86例为观察对象,采用随机数字表法分为对照组和观察组,各43例。对照组接受椎间孔镜手术治疗,观察组在对照组的基础上联合得宝松治疗。治疗结束后对比两组患者的手术时间、术中出血量、住院时间等指标。记录两组术前以及术后1 d、1个月、3个月的视觉模拟量表(VAS)评分和日本骨科协会评估治疗(JOA)评分,采用MacNab标准评定治疗效果。结果两组患者的术中出血量、手术时间差异无统计学意义(均P0.05)。观察组并发症发生率低于对照组,住院时间短于对照组(均P0.05)。术后不同时间点两组患者腰腿痛VAS评分与术前比较均明显降低,术后1 d观察组腰腿痛VAS评分低于对照组(P0.05);术后1个月、3个月,两组腰腿痛VAS评分差异无统计学意义(均P0.05)。术后不同时间点两组患者JOA评分与术前比较均明显升高,术后1 d观察组JOA评分高于对照组(均P0.05);术后1个月、3个月,两组JOA评分差异无统计学意义(均P0.05)。观察组MacNab评分优良率明显高于对照组(P0.05)。结论椎间孔镜技术治疗腰椎间盘突出症的疗效显著。联合得宝松局部用药后,患者早期疼痛缓解更彻底、满意度更高,值得临床推广。     

早期康复护理预防腰椎间盘突出症术后神经根粘连效果分析

目的分析早期康复护理预防腰椎间盘突出症术后神经根粘连效果。方法选取2015年10月至2017年4月我院收治的94例腰椎间盘突出症手术患者作为观察对象,按照单双号法分为对照组和研究组,各组均为47例。对照组予以常规护理,研究组予以早期康复护理,比较2组护理效果的差异。结果术前2组JOA评分比较,差异无统计学意义(P0.05);研究组术后2周、术后3个月、6个月的JOA评分均高于对照组(P0.05);对照组康复优良率显著低于研究组,组间具有统计学差异(P0.05)。结论早期康复护理对腰椎间盘突出症术后神经根粘连具有预防作用,且效果确切,安全可行。     

青少年腰椎间盘突出症个性化微创治疗策略的临床研究

目的研究个性化微创治疗青少年腰椎间盘突出症的临床效果。方法收集我院自2015年6月~2017年1月收治的青少年腰椎间盘突出症患者84例,按随机数字表法分为观察组与对照组,各42例。对照组给予传统开放手术治疗,观察组则给予微创椎间孔镜技术治疗,两组术后均给予超微粉碎"消痹止痛散"穴位热敷加贴敷行辅助治疗。对比两组切口长度、手术时间、术中出血量、卧床时间以及住院时间等术中及术后一般情况,比较两组疼痛状况和并发症情况。结果两组手术时间比较差异无统计学意义(P0.05),观察组术中出血量、切口长度、卧床时间及住院时间等指标均明显优于对照组(P0.05);治疗前,组间VAS评分、JOA评分比较差异无统计学意义(P0.05);治疗后,两组患者的VAS评分和JOA评分均改善,且观察组改善效果更佳,差异有统计学意义(P0.05),观察组治疗总有效率显著高于对照组(P0.05);观察组术后并发症发生率明显低于对照组(P0.05)。结论针对青少年腰椎间盘突出症患者,给予微创椎间孔镜技术治疗,疗效确切,对患者创伤小,术后恢复快,具有较高的推广价值。     

早期护理对腰椎间盘突出症患者术后康复的影响

目的:观察早期护理对腰椎间盘突出症患者术后康复的影响。方法:选取腰椎间盘突出症术后患者90例作为研究对象,采用随机数字表法分为观察组和对照组各45例,对照组采用日常护理,观察组在对照组基础上采用早期护理,对比两组护理前后的腰椎功能(腰椎JOA评分)和并发症发生率。结果:治疗后,观察组JOA评分明显高于对照组(P<0.05),并发症发生率明显低于对照组(P<0.05)。结论:在日常护理基础上,采用早期护理有助于促进腰椎间盘突出症患者术后康复和减少并发症发生率,效果优于单纯日常护理效果。     

针对性护理在射频消融术治疗腰椎间盘突出症患者中的应用效果

目的 探讨针对性护理模式在腰椎间盘突出症患者射频消融术围术期的应用效果。方法 选择48例腰椎间盘突出症患者为研究对象,采用随机数字表法将患者分为观察组和对照组,每组24例。患者均接受射频消融术治疗,其中对照组患者围术期接受常规护理,观察组患者在常规护理的基础上接受针对性护理干预。比较两组患者术后相关时间、VAS评分、日本骨科协会评估治疗量表(JOA)和Oswestry功能障碍指数(ODI)评分。结果 观察组患者术后首次下床时间、术后首次排便时间、术后首次进食时间和术后住院时间均明显短于对照组,差异均有统计学意义(均P<0.05)。观察组患者术后第1天、第3天的VAS评分均明显低于对照组,差异均有统计学意义(均P<0.05)。术前,两组JOA、ODI评分差异均无统计学意义(均P>0.05);术后2周,观察组JOA评分明显高于对照组,ODI评分明显低于对照组,差异均有统计学意义(均P<0.05)。结论 腰椎间盘突出症患者在行射频消融术治疗期间予以针对性护理模式干预,能够促进患者康复,减轻疼痛症状,进一步改善腰椎功能。     

基于微信平台的中医护理在腰椎间盘突出症患者中的应用效果

目的:观察基于微信平台的中医护理在腰椎间盘突出症患者中的应用效果。方法:选取90例腰椎间盘突出症患者为研究对象,按照随机数字表法分为对照组和观察组各45例。对照组采用常规护理,观察组在对照组基础上给予基于微信平台的中医护理。护理28 d后,比较两组护理前后疼痛程度[视觉模拟评分法(VAS)]评分、腰椎功能[Oswestry功能障碍指数(ODI)]评分、[日本骨科学会腰椎功能(JOA)]评分和睡眠质量[匹兹堡睡眠质量指数(PSQI)]评分,以及护理满意度。结果:护理后,两组VAS、ODI和PSQI评分均低于护理前,且观察组低于对照组,两组JOA评分均高于护理前,且观察组高于对照组,差异有统计学意义(P<0.05);观察组护理满意度为97.78%,高于对照组的82.22%,差异有统计学意义(P<0.05)。结论:在常规护理基础上给予基于微信平台的中医护理可提高腰椎间盘突出症患者JOA评分、护理满意度,降低VAS、ODI和PSQI评分,优于单纯常规护理效果。     

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.