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。     

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。     

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。     

实施心理护理+个性化音乐干预对肠癌患者化疗后睡眠质量的影响

目的 研究心理护理+个性化音乐干预对肠癌患者化疗后睡眠质量的影响。方法 选取本院2019 年6 月至2020 年5 月收治的86 例肠癌患者,依据随机双盲法分成两组,每组各43 例,对照组给予常规护理,研究组在常规护理基础上给予心理护理+个性化音乐干预,护理前后分别测定两组的HAMD（汉密顿抑郁量表）、HAMA（汉密顿焦虑量表）、睡眠障碍评分,出院时发放满意度调查表,比较两组护理结果。结果 护理前,两组的HAMD、HAMA 对比差异无统计学意义（P＞0.05）,护理后两组评分均明显减低,但研究组评分更低于对照组,差异有统计学意义（P＜0.05）。护理前,两组的睡眠时间、睡眠障碍、睡眠效率、睡眠质量评分对比,差异无统计学意义（P＞0.05）,护理后两组评分均明显减低,但研究组评分低于对照组,差异有统计学意义（P＜0.05）。研究组满意度（93.02%）高于对照组（76.74%）,差异有统计学意义（P＜0.05）。结论 心理护理+个性化音乐干预运用在肠癌化疗后的效果极为突出,能够有效减轻患者焦虑与抑郁的情绪,使其保持积极心态,并改善睡眠质量,值得推广。     

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。     

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.     

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.     

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.