低分子肝素分别联合阿替普酶、尿激酶治疗老年次大面积急性肺栓塞的疗效比较研究

目的:对比阿替普酶、尿激酶溶栓后序贯低分子肝素抗凝治疗老年次大面积急性肺栓塞(ASPE)的临床疗效与安全性,优化临床救治方案。方法:回顾性分析2012-01-2015-06我院急诊科收治的92例ASPE患者临床资料,根据治疗方案分为A组(n=48)和B组(n=44),在常规综合性支持疗法基础上,A组采用阿替普酶溶栓序贯低分子肝素抗凝方案,B组采用尿激酶溶栓序贯低分子肝素抗凝方案,治疗后每日采血监测动脉血气指标,并于治疗后48h行三维超声心动图检查右心功能,治疗7d后判定临床疗效。结果:治疗48h后,2组PaO_2 、PaCO_2 、P(A-a)O_2均较治疗前显著改善(P0.01);A组治疗后PaO_2 、PaCO_2 高于B组[(87.4±8.0)mmHg vs.(83.9±7.5)mmHg(1mmHg=0.133kPa),P0.05;(38.7±5.7)mmHg vs.(35.9±5.9)mmHg,P0.01],P(A-a)O_2 低于B组[(26.2±4.5)mmHg vs.(28.2±4.9)mmHg,P0.05]。2组患者治疗48h后超声心动图RVESVI、RVEDVI、RVEF均较治疗前显著改善(P0.01);A组治疗后RVESVI数值显著低于B组[(38.7±5.7)ml/m~2 vs.(42.0±5.2)ml/m~2,P0.01],2组治疗后RVEDVI、RVEF比较,差异无统计学意义。治疗7d后,A组总体有效率高于B组,但差异无统计学意义。A组颅内出血、咯血发生率及病死率均略低于B组,但差异无统计学意义。结论:阿替普酶、尿激酶溶栓后序贯低分子肝素抗凝治疗ASPE均具有较高的疗效,前者在改善肺部氧合、右心功能及减少出血并发症方面具有比较优势。     

急性肺栓塞溶栓加抗凝疗法与单纯抗凝疗法的临床观察

目的 观察急性肺栓塞溶栓加抗凝治疗与单纯抗凝治疗的临床效果及远期肺功能变化情况．方法 将肺栓塞病人18例按入院的先后顺序分为A、B两组。A组11例，采用溶栓加抗凝治疗；B组7例，采用单纯抗凝治疗.观察疗效并于6个月后复查肺功、X线胸片、心动超声，判定肺栓塞对远期肺功能的影响和慢性肺栓塞、肺动脉高压形成等改变、结果 A组有效率为88．1％，6个月后复查肺功正常，无慢性肺栓塞及肺动脉高压形成；B组有效率为65．7％，6个月后复查肺弥散功能降低28．3％，无慢性肺栓塞及肺动脉高压形成。结论 溶栓加抗凝疗法治疗PE优于单纯抗凝疗法.     

导管介入治疗急性肺栓塞的临床疗效观察

目的观察经皮导管介入治疗急性肺栓塞的疗效。方法选择2003年1月-2009年6月收治的急性肺栓塞患者15例,采用经皮导管吸栓术、碎栓术及溶栓术治疗。溶栓术用局部灌注加即刻静脉注射尿激酶,总量100万U。溶栓后给予低分子肝素7～10d,口服华法林3～6个月。观察临床症状、体征改善情况、并发症、平均肺动脉压（mPAP）与动脉血氧分压（PO2）的变化,以及肺动脉开通情况。结果 12例肺动脉完全开通,3例部分开通,显效率89%,有效率100%。mPAP从（41.07±6.97）mmHg降到（21.00±5.66）mmHg,PO2从（46.26±9.30）mmHg升到（79.49±8.04）mmHg,治疗前后差异有统计学意义（P〈0.05）。即刻临床症状明显改善,mPAP迅速降低11例。随访3～6个月,疗效持续,未见复发。结论介入治疗急性肺栓塞疗效显著,安全可行,对抢救危重患者、改善临床症状、维持血流动力学稳定有重要作用。     

尿激酶超早期动脉溶栓对急性缺血性脑梗死患者神经功能改善的效果评价与护理

目的 探讨尿激酶动脉溶栓治疗急性缺血性脑梗死的临床疗效,提出护理观察要点.方法 经股动脉插管行脑血管造影后,用尿激酶行溶栓治疗.40例患者进行溶栓前、溶栓后7 d美国国立卫生院卒中评分(MHSS),观察神经功能改善情况.结果 40例患者溶栓前评分(7.35±5.08)分,溶栓后评分(2.825±3.80)分,前后比较差异有统计学意义.结论 动脉溶栓疗法足治愈急性缺血性脑梗死有效的方法之一.溶栓后病情监测、并发症预防处理、有效的健康教育对促进患者恢复有重要作用.动脉溶栓有待推广.     

急性肺栓塞的腔内治疗效果观察

目的 观察急性肺栓塞的腔内治疗效果.方法 选择2009年1月至2011年6月我院收治的急性肺栓塞患者15例,采用经皮导管碎栓术及溶栓术治疗.局部灌注尿激酶,总量50万U;溶栓后给予低分子肝素钠7～10d,口服华法林钠3～6个月.观察临床症状和体征改善情况、并发症、平均肺动脉压（mPAP）与动脉血氧分压（PaO2）的变化,以及肺动脉开通情况.结果 12例肺动脉完全开通,3例部分开通,有效率100％（15/15）.mPAP较术前降低[（40.07±5.97）、（20.00±4.66） mmHg],PaO2明显升高[（50.26±9.30）、（80.49±9.04） mmHg],差异均有统计学意义（t值分别为-1.128和1.246,P均＜0.05）.随访3～6个月,疗效持续,未见复发.结论 急性肺栓塞介入治疗效果显著,安全可行.     

溶栓抗凝治疗急性肺栓塞9例临床护理

目的：探讨溶栓抗凝治疗急性肺栓塞（FFE）患者的护理方法。方法：对9例PTE患者溶栓抗凝治疗前后做好病情评估、各项准备工作，并进行有针对性的心理护理、知识宣教、生命体征和凝血功能的监测。结果：9例PTE患者6溶栓抗凝治疗和精心护理后未发生任何并发症且临床症状明显改善，3例患者的生存质量得到提高，无死亡病例。结论：PTE患者溶栓抗凝治疗前后给予精心护理可明显改善病情，提高患者生活质量，降低病死率。     

急性肺栓塞30例护理体会

急性肺栓塞(APE)是内源性或外源性栓子堵塞肺动脉或其分支引起肺循环障碍的临床和病理生理综合征[1].欧洲心脏病学会2000年发布的<急性肺动脉栓塞的诊断与治疗指南>将急性肺栓塞分为大面积肺栓塞和非大面积肺栓塞(包括次大面积肺栓塞) 两大类,近几年随着诊疗技术水平的提高, 肺栓塞的诊断率明显增加.回顾分析本院120病房近5年来收治确诊的30例肺栓塞病例的临床资料,经溶栓、抗凝对症治疗及科学的护理,疗效满意.现将护理体会报告如下.     

急性肺栓塞中危组的溶栓与抗凝治疗观察

目的观察急性肺栓塞(APE)中危组的溶栓与抗凝治疗效果。方法选取2011年1月至2017年1月我院收治的APE中危组患者120例,采用随机数表法分为观察组、对照组各60例,观察组实施溶栓联合抗凝治疗,对照组给予单纯抗凝治疗,对比两组治疗有效率及治疗前后动脉血氧分压(PaO_2)及血清肌钙蛋白I(cTnI)、脑利钠肽(BNP),测定两组右心室舒张末期前后径(RVED)、主肺动脉径(PA)、肺动脉收缩压(PASP),并观察治疗后不良事件。结果观察组治疗总有效率、PaO_2高于对照组(P0.05),血清c Tn I、BNP低于对照组(P0.05);治疗后两组RVED、PA、PASP均低于治疗前(P0.05),但组间差异无统计学意义(P0.05);两组治疗后6个月不良事件发生率差异无统计学意义(P0.05)。结论 APE中危组患者采用溶栓联合抗凝或单纯抗凝治疗,均可明显改善PaO_2、cTnI、BNP水平及右心功能,但前者整体疗效更好,不良事件没有明显增加。     

中西医结合治疗肺栓塞疗效分析

目的:探讨溶栓、抗凝联合复方血栓通胶囊治疗肺栓塞的临床疗效。方法:选取2014年3月~2016年3月我院收治的肺栓塞患者70例为研究对象,随机分为对照组和观察组各35例。对照组采用溶栓+抗凝治疗,观察组采用溶栓+抗凝+复方血栓通胶囊联合治疗,比较两组治疗效果。结果:观察组患者治疗效果显著高于对照组(P<0.05);治疗后,两组患者动脉血气检查结果均较治疗前明显改善(P<0.05),但两组比较差异无统计学意义(P>0.05)。结论:应用溶栓+抗凝+复方血栓通胶囊联合治疗肺栓塞效果显著,可有效改善患者动脉血气,临床应用价值较高。     

肺栓塞介入治疗的临床观察

目的总结经皮介入溶栓治疗肺栓塞的疗效。方法经DSA确诊,并行介入治疗肺栓塞12例,采用普通造影导管,局部灌注加即刻全身应用尿激酶,总量约100万单位,在溶栓后12h,给与低分子肝素7～10d,口服华法林3～6个月,疗效判定依据临床症状,平均肺动脉压,血氧分压,D-二聚体。结果所有患者均获得显著疗效,平均肺动脉压从39.33±7.73mmHg到20.00±4.26mmHg(P<0.01),动脉血氧分压从48.67±10.60mmHg到78.75±9.84mmHg(P<0.01)。结论经皮局部灌注溶栓加全身应用尿激酶治疗肺栓塞安全有效,可显著改善临床症状。     

Communicating with clients and colleagues with hearing loss

Abstract:

Aside from elderly relatives, some of us may have never had any direct personal experience with a person who is deaf or hard of hearing, and so may be unfamiliar with how to effectively communicate with these people. This can make for a very awkward, frustrating and possibly embarrassing experience for both parties. This author is a wearer of hearing aids herself, and would like to share some information on hearing loss and tips on effective communication with a person with hearing loss.     

Doing more with less and less with more

The "devil is in the details" of any policy response. What forms such changes may take, and what research informs them, are critical to the profession as a whole and to practitioners on a daily basis. Research partnerships between home care agencies and university professors may provide rigorous, systematic, and validated findings necessary for meaningful solutions (Plotkin & Roche, 2000). The evidence of a dialogue between nursing researchers, home healthcare practitioners, and policymakers anticipating impacts on practice of changing fiscal and information-gathering requirements is scant. Such issues are in need a priority discussion by agencies, and collaborative investigative efforts between all involved.     

Mindfulness and Coping with Dysphoric Mood: Contrasts with Rumination and Distraction

Past research has shown that rumination exacerbates dysphoric mood whereas distraction attenuates it. This research examined whether the practice of mindfulness meditation could reduce dysphoric mood even more effectively than distraction. A dysphoric mood was induced in 139 female and 38 male participants who were then randomly assigned to a rumination, distraction, or meditation condition. As predicted, participants instructed to meditate reported significantly lower levels of negative mood than those in either of the two other conditions. Distraction was associated with a lessening of dysphoric mood when compared to rumination but was not as effective as mindfulness meditation. The implications of these findings are discussed.     

Special problems with children and adolescents with diabetes.

Treatment of children and adolescents with insulin-dependent diabetes mellitus (type 1) is different in many ways than it is for adults. Physical, cognitive, and emotional development changes affect therapeutic goals and modalities. Neonatal, early childhood, school-age, and adolescent patients all have unique needs. Further, diabetes can affect psychosocial maturation and the likelihood of difficulties with mood.     

Interaction of peptidoglycans with anti-IgGs and with complement.

This report describes the interaction of peptidoglycan (Streptococcus group A, Staphylococcus epidermidis and Micrococcus lysodeikticus) with 2 serum mediator systems, namely with the anti-IgG system and with complement. The observation that the majority of rabbits hyperimmunized with A-variant streptococcal vaccine produced anti-group carbohydrate antisera containing anti-IgGs and antibodies directed to peptidoglycan suggested that the production of these 2 latter antibodies was related. This view was supported by the finding of a monoclonal 7S anti-IgG with antibody specificity for the pentapeptide of peptidoglycan as evidenced by inhibition of the coprecipitation of 7S anti-IgG with antigen-antibody complexes by the pentapeptide. Inhibition of the anti-idiotype reaction by the pentapeptide provided further evidence for the antibody specificity of 7S anti-IgG for peptidoglycan. When added to normal human sera all peptidoglycan preparations inhibited the hemolytic activity of the sera. Consumption of C3 in C2 deficient serum and consumption of C2 in normal serum indicated the activation of both known complement pathways. Activation of the classical pathway of complement was more efficient since 50 mug of peptidoglycan consumed approximately 70% of C2 per ml normal serum whereas more than 2 mg of the same preparations was required to inactivate 17-24% of C3 in C2 deficient sera. Each of the different peptidoglycan preparations consumed similar amounts of complement in all 20 sera tested. This finding suggested that activation of the classical complement pathway by peptidoglycan was not mediated by anti-peptidoglycan antibodies present in only 20-40% of normal human sera.     

Hemosuccus pancreaticus: diagnosis with CT and MRI and treatment with transcatheter embolization

We report the case of a 56-year-old woman with a presyncopal episode followed by melena. A sentinel clot sign in the pancreatic duct on precontrast computed tomography and the presence of a splenic artery aneurysm on postcontrast computed tomography strongly suggested a fistula between the aneurysm and the duct, as visualized by magnetic resonance imaging. The patient was treated successfully by complete embolization of the splenic artery aneurysm. Received: 25 January 2000/Accepted: 21 February 2001