尿毒症并发左心衰患者的护理体会

目的 探讨尿毒症并发左心衰的护理措施.方法 对15例尿毒症并发左心衰除采取常规护理措施外,还做到以下几点特殊护理:(1)密切观察血压、呼吸、血氧饱和度、近期尿量变化;(2)有效控制血压;(3)采取不同的透析方式,适时适量透析超滤并加强透析中的护理;(4)改善全身营养状况、纠正贫血、预防肺部感染;(5)牢记护理程序体位-吸氧-血管扩张药-血液透析;(6)严格控制入量.结果 15例患者中抢救成功13例,死亡2例.结论 采取积极治疗和针对性护理对抢救尿毒症并发左心衰患者有较好效果.     

39例透析病人对医疗保险制度的心理反应及护理

在对39例尿毒症透析病人的临床护理实践中，发现尿毒症透析病人在医疗保险制度实施的初期阶段，有其特殊的心理反应。通过向患者宣传医保知识；关心患者经济，为其节约医疗费用；协助中请特殊病种管理，门诊治疗；及时发现病人心理问题，有针对性采取心理辅导措施及对患者家属，陪伴进行心理疏导等护理对策，患者情绪稳定，顺应医护计划。既提高了医疗，护理质量，又减少了医疗纠纷的发生。     

尿毒症维持性血液透析患者并发急性肺水肿的护理分析

目的:探讨尿毒症维持性血液透析并发急性肺水肿患者的急救护理效果。方法:选取112例尿毒症维持性血液透析并发急性肺水肿病患,按入院时间随机分为急诊血液透析组和药物综合治疗组,各56例。探讨急性肺水肿发生的诱因及应采取的护理措施,比较急诊血液透析与药物综合治疗的临床疗效以及血液透析组护理前后患者血压变化率、住院率及满意度。结果:引起尿毒症维持性血液透析并发急性肺水肿的主要因素为患者血压过高、摄水量大使体重快速增长、肺部受到感染等。血液透析组患者治疗的缓解率明显高于综合治疗组(P<0.05),血液透析组护理实施后血压异常发生率、住院率明显低于护理前,满意程度较高,两组比较,差异有统计学意义(P<0.05)。结论:急诊血液透析对抢救维持性血液透析并发急性肺水肿病患的效果较好,同时给予维持性血液透析患者并发急性肺水肿安全有效的护理措施是成功治愈的关键。     

慢性尿毒症患者血液透析中血压观察与护理

目的 观察慢性尿毒症患者血液透析中的血压变化以及临床护理。方法 透析前后和透析中每小时和连续进行血压监测。结果 68例慢性尿毒症透析患者在透析中血压升高18例，SBP上升25—40mmHg，DBP上升12—23mmHg；透析后血压上升11例，SBP上升20-35mmHg，DBP上升10-22mmHg。透析前后发生血压升高29例。占同期患者的42．6％；低血压发生6例，占8．8％。结论 透析过程中血压变化是常见的现象，密切观察与护理，及早发现和处理血压变化占有非常重要的地位，应提醒医护工作者高度重视。     

56例尿毒症并发急性肺水肿的护理

目的探讨尿毒症并发急性肺水肿的诱因及护理对策。方法对56例尿毒症并发急性肺水肿的临床资料进行回顾性分析。结果尿毒症并发急性肺水肿与尿量和高血压的关系极为密切。结论有效利尿及降低血压是治疗尿毒症并急性肺水肿的关键,早期发现、及时处理能提高抢救成功率。     

急性心肌梗塞并发心律失常的早期发现及护理

目的通过护理干预提高急性心肌梗塞并发心律失常的抢救成功率。方法对129例急性心肌梗塞并发心律失常病人进行严密心电监测、血压监测，正确识别各种心律失常的表现，采取相应的抢救及护理措施；同时做好病人的心理护理。结果129例急性心肌梗塞并发心律失常病人得到及时的抢救治疗、护理，病人仅5例死亡。结论护士严密观察病情，早期发现问题，采取有效抢救措施及护理措施是降低本病死亡率的关键。     

尿毒症并急性肺水肿115例次临床分析

本文报告我院近22年来收治的尿毒症并急性肺水肿115例次,分析发生急性肺水肿的诱因,其中与尿量和高血压的关系最密切。提出正确使用血管扩张剂,及时和合理的透析治疗,保证足够的超滤,是抢救尿毒症并急性肺水肿成功的关键。     

非透析治疗47例尿毒症性肺水肿及临床分析

尿毒症性肺水肿在尿毒症患者中发病率高达50～80%,死亡率也很高,在未透析尿毒症死亡的病例中有50%有尿毒症性肺水肿。鉴于目前基层医院尚未能广泛采用透析疗法,本文将我院非透析治疗尿毒症性肺水肿资料较完整的47例作一分析,以供参考。临床资料一、一般资料我院从1972～1989年共收治尿毒症387例,其中未采用透析方法的47例尿毒症性肺水肿。男30例,女17例。年龄16～69岁,平均38.8岁,原发     

457例次尿毒症并急性肺水肿的透析护理

４５７例次尿毒症并急性肺水肿的透析护理吴南娇，王伟鸿，胡映平，刘少芬我院血液净化中心自１９９０年１０～１９９５年９月共救治尿毒症并急性水肿患者１２７例，采用血液净化方法治疗，取得了较满意的效果，现将透析护理体会报告如下。１临床资料１．１一般资料本组１...     

尿毒症维持性血液透析患者高血压急症的治疗与护理

目的研究尿毒症维持性血液透析患者并发高血压急症的原因,探讨提高防治的疗效和护理措施。方法选择从1995年12月-2010年12月间在血液净化中心采取维持性血液透析的且门诊病历齐全的52例并发高血压急症的尿毒症患者。应用硝酸甘油的24例患者为A组,应用硝普钠的28例患者为B组,对两组患者的临床表现、治疗与护理进行回顾性分析。结果 50例经紧急降压、强心、利尿、扩血管及纠正电解质、酸碱平衡紊乱及血液透析治疗后高血压得到控制,临床症状改善。另2例死亡,其中,A组中1例死于脑出血,B组中1例死于急性心肌梗死并发心力衰竭。结论紧急降压、充分透析、超滤脱水和控制透析间期体重,维持透析间期血压稳定,病情观察及护理,是防治尿毒症维持性血液透析患者高血压急症的重要措施。     

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.