精准化护理干预在冠心病患者介入治疗中的应用

【摘要】 目的 探讨精准化护理干预在冠心病（CHD）患者介入治疗中的应用效果。方法 选择2016年6月～2019年3月海南医学院第一附属医院心内科收治的行经皮冠状动脉介入术（PCI）治疗的CHD患者132例作为研究对象。根据护理方法不同分为研究组72例和对照组60例。对照组采用常规护理，研究组在常规护理基础上实施精准化护理干预。比较两组患者术后住院时间及肿胀值，干预前后焦虑自评量表（SAS）、抑郁自评量表（SDS）、视觉模拟法（VAS）及匹兹堡睡眠质量指数量表（PSQI）评分，干预后两组患者血管并发症发生情况，干预前后两组患者36项健康调查量表（SF 36）评分及护理满意度。 结果 研究组术后住院时间明显短于对照组（P＜0.05）；研究组肿胀值明显小于对照组（P＜0.05）；两组患者SAS及SDS评分均较治疗前降低（P＜0.05），但干预后研究组SAS、SDS、VAS及PSQI评分均低于对照组（P＜0.05）；干预后研究组血管并发症发生率及皮下血肿发生率均低于对照组（P＜0.05），而SF 36各项评分均高于对照组（P＜0.05）；研究组护理总满意率高于对照组（P＜0.05）。〖HT5"H〗结论〖HTK〗〓精准化护理干预能有效降低冠心病患者介入术后皮下血肿等血管并发症的发生率，同时可缓解患者疼痛，提高其睡眠及生活质量，有利于促进术后康复，并获得良好的护理满意度。     

整体护理干预在胸腰椎骨折内固定术围手术期的应用效果观察

目的探讨整体护理干预在胸腰椎骨折患者经后路钉棒系统内固定术中的应用效果。方法随机选择60例因胸腰椎椎骨折行后路钉棒系统内固定术患者,以随机数字表法分为观察组和对照组各30例。对照组给予常规护理,观察组在对照组的基础上给予整体护理干预,比较两组患者日常生活活动能力(ADL)评分、患者满意度及术后并发症发生率。结果观察组ADL评分及患者满意度明显高于对照组(P0.05),术后并发症发生率明显低于对照组(P0.05)。结论整体护理干预在胸腰椎骨折经后路钉棒系统内固定术患者中的有效应用,促进了患者日常生活自理能力的恢复,也显著了提高患者生活质量。     

多维度延续性护理模式对慢性硬膜下血肿患者术后生活质量及护理工作满意度的影响

【摘要】 目的 观察多维度延续性护理模式对慢性硬膜下血肿（CSDH）患者术后的影响。方法 选取我院2019年2月至2021年2月85例CSDH患者为研究对象，按照入院顺序编号分组，对照组42例采取常规院外护理，观察组43例采取多维度延续性护理模式。比较2组患者干预期间并发症发生率及再入院率、干预结束后的护理依从性及护理工作满意度、干预前后的生活质量。结果 观察组并发症发生率4.65%（2/43）、再入院率6.98%（3/43）低于对照组21.43%（9/42）、26.19%（11/42）（P＜0.05）；观察组护理依从率高于对照组（P＜0.05）；干预后观察组活动能力、家庭及朋友支持、健康感觉、日常生活、对生活的认识评分高于对照组（P＜0.05）；观察组护理工作满意度93.02%（40/43）高于对照组73.81%（31/42）（P＜0.05）。结论 CSDH患者采用多维度延续性护理干预，不仅能降低并发症发生率及再入院率，改善患者护理依从性，还能提升患者的生活质量和护理满意度。     

医护配对CNP干预策略对慢性硬膜外血肿患者术后康复及护理工作满意度的影响

目的探讨医护配对临床护理路径(CNP)干预策略对慢性硬膜外血肿患者术后康复及护理工作满意度的影响。方法选取2019年7月至2020年8月我院慢性硬膜外血肿患者93例,依照建档顺序不同分为研究组(n=51)、对照组(n=42)。对照组实施常规护理,研究组于上述基础上实施医护配对CNP干预策略,统计比较两组干预前后神经功能(NIHSS)、Barthel指数评分及住院情况(平均术前住院时间、住院费用、住院时间)、并发症情况、护理工作满意度。结果研究组平均术前住院时间、住院时间较对照组短,平均住院费用较对照组低(P<0.05);干预后研究组NIHSS评分较对照组低,Barthel指数评分较对照组高(P<0.05);研究组并发症发生率为3.92%,低于对照组(19.05%,P<0.05);研究组护理工作满意度为94.12%,高于对照组(76.19%,P<0.05)。结论医护配对CNP干预策略可促进硬膜外血肿患者术后康复,改善患者神经功能及生活自理能力,减少并发症,且患者护理满意度高。     

试析脊柱后路手术患者的体位护理要点

目的研究脊柱后路手术患者的体位护理要点及效果。方法选取2017年2月至2017年7月收治的94例脊柱后路手术患者,抽取47例作为对照组,另根据配对原则抽取47例作为观察组。对照组采用常规护理,观察组采用体位护理。对比术后并发症发生率、护理满意度及干预前后疼痛评分、生活质量评分。结果观察组术后并发症发生率(4.26%)少于对照组(29.78%),护理满意度(97.87%)高于对照组(74.47%),P0.05,对比差异,有统计学意义。干预前,2组疼痛评分、生活质量评分对比,P0.05,无统计学意义。干预后,观察组疼痛评分、生活质量评分均优于对照组,组间对比差异具有统计学意义(P0.05)。结论对脊柱后路手术患者实施体位护理可有效降低术后并发症发生风险,但护理过程中需要着重观察患者状态,避免对其造成负面影响。     

细节护理对手术室护理质量及患者满意度的影响

目的 探讨细节护理对手术室护理质量及患者满意度的影响。方法 研究共纳入100 例在我院接受手术治疗的患者，病例起始时间为2018 年7 月，截止时间为2019 年7 月，将所有患者按照住院号排序分组（每组50 例），其中序号为偶数者为对照组，给予常规护理；而序号为奇数者为研究组，在常规护理的基础上实施细节护理，比较两组的医院感染发生率、护理不良事件发生率、护理质量评分及护理满意度。结果 研究组护理后的医院感染发生率较对照组明显降低（P＜0.05）。研究组护理后的护理不良事件总发生率较对照组明显降低（P＜0.05）。研究组护理后的护理质量评分较对照组明显提高（P＜0.05）。研究组的护理满意度较对照组明显升高（P＜0.05）。结论 细节护理开展于手术室中能够显著提高手术室整体护理质量，降低不良事件发生率，同时还可改善护患关系，提升患者对护理工作的满意度，因此值得在临床上进行深入研究和推广。     

综合护理对植入式静脉输液港留置期间并发症发生率的影响

目的 探讨综合护理对植入式静脉输液港留置间期并发症发生率的影响。方法 选取2018年1月～2019年1月乳腺外二科二病区拟行植入式静脉输液港患者396例,依照入院时间不同分为研究组(198例)、对照组(198例)。对照组予以常规护理,研究组于常规护理基础上予以综合护理干预。比较两组并发症发生率、患者满意度、干预前后自我护理能力量表(ESCA)评分。结果 研究组并发症总发生率为4.04%(8/198),低于对照组12.12%(24/198,P＜0.05);干预后研究组自我护理能力量表(ESCA)评分高于对照组(P＜0.05);研究组患者满意度为97.98%(194/198),高于对照组78.79%(156/198)(P＜0.05)。结论 综合护理应用于植入式静脉输液港留置期间,能降低并发症发生率,提高护理满意度。     

人性化护理干预在脊柱外科护理中的价值探讨

目的探讨人性化护理干预在脊柱外科护理中的价值。方法选取我院收治的脊柱外科手术患者108例依据随机平均原则划分为对照组与研究组各54例。对照组54例患者采取常规护理,研究组54例患者在此基础上采取人性化护理。对两组患者护理前后焦虑、抑郁情绪变化、护理满意度情况进行记录与分析。结果两组护理干预后SAS评分、SDS评分显著低于干预前,P0.05;研究组护理干预后SAS评分、SDS评分改善程度显著优于对照组,P0.05;研究组护理满意度显著高于对照组,P0.05。结论对脊柱外科手术患者在常规护理的基础上实行人性化护理干预能取得显著效果,可有效对患者的负性情绪进行改善,逐步提升临床护理满意,值得临床推广。     

延续性护理对青年高血压脑出血患者治疗依从性及预后的影响

目的探讨延续性护理对青年高血压脑出血患者治疗依从性及预后的影响。方法 选取2016 年1 月～2019 年6 月在本院进行高血压脑出血手术治疗的102 例青年患者为研究对象,随机设为研究组与对照组。对照组进行常规干预,研究组在常规干预的基础上进行延续性护理干预。比较两组的总遵医率、临床护理效果、并发症发生情况及生活质量评分。结果 研究组总遵医率高于对照组（P＜0.05）;研究组干预后的神经功能评分低于对照组,而巴氏指数评分高于对照组（P＜0.05）;研究组并发症总发生率少于对照组（P＜0.05）;研究组干预后各项生活质量评分均高于对照组（P＜0.05）。结论 对青年高血压脑出血患者采用延续性护理干预,能够促使其治疗依从性得到显著提高,预后情况得到明显改善,利于临床应用及推广。     

细节管理护理预防脊柱俯卧位手术患者术后发生压疮的应用效果

目的： 探究细节管理护理在预防脊柱俯卧位手术患者术后发生压疮的应用效果。方法：选取我院106例脊柱俯卧位手术患者（2014年10月20日至2016年10月20日）作为本研究的观察对象，使用随机数字表法对106例脊柱俯卧位手术患者进行分组。常规组53例患者应用常规护理，细节组53例患者应用细节管理护理，研究对比两组脊柱俯卧位手术患者的压疮发生率及满意度评分。结果： 细节组患者的压疮发生率为1.89%，相比常规组（18.87%）明显更低，P＜0.05；细节组患者护理后的满意度评分为（88.36±4.35）分，相比常规组[（78.69±4.71）分]明显更高，P＜0.05。结论： 对脊柱俯卧位手术患者采取细节管理护理切实可行，能显著降低患者发生压疮的机率。     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.