危重患者家属应对方式调查分析及干预研究

目的 探讨危重患者家属应对方式及干预方法.方法 将简易应对方式自评量表发放给62例危重患者家属,根据调查结果实施干预措施.结果 实施干预前,危重患者家属积极应对维度平均得分(1.50±0.39)分低于全国常模(1.78±0.52)分,消极应对维度平均得分(1.83±0.39)分高于全国常模(1.59±0.60)分,经比较差异有高度显著性(P均＜0.01).实施干预后,积极应对维度平均分(1.81士0.36)分、消极应对维度平均分(1.60±0.41)分分别与实施护理干预前比较,差异均有高度显著性(P均＜0.01).结论 对危重患者家属实施护理干预后,能主动采用积极应对方式,减少消极应对方式,改善危重患者家属的负性心理状况,提高其生活质量.     

实施声带息肉摘除术临床护理路径的应用分析

目的分析声带息肉临床护理路径实施的应用效果。方法利用医院信息系统提供的声带息肉病案、收费的数据资料及患者满意度测评结果,将择期住院在全麻支撑喉镜下行声带息肉摘除术患者分为两组,根据临床护理路径标准住院流程实施临床护理路径,将实施临床护理路径前声带息肉摘除术患者261例设为对照组,将实施临床护理路径后声带息肉摘除术患者249例设为观察组,回顾性分析对比两组患者的平均住院天数、住院费用和患者满意度测评。结果实施临床护理路径的观察组平均住院天数[（4.00±1.00）d]显著短于对照组[（5.50±2.00）d],住院费用[（3 200.00±289.30）元]显著少于对照组[（4 000.00±256.80）元],患者满意度[（96.00±2.50）分]显著高于对照组[（93.00±1.96）分],差异均有统计学意义（均P〈0.01）。结论在声带息肉手术患者中应用临床护理路径,可有效降低住院天数和住院费用,提高患者满意度,推动优质护理服务示范工程的进程,减少护理差错事故的发生,提高医院的护理质量     

产科施行优质护理的临床效果分析

目的:对照分析优质护理服务在产科病房施行的临床效果,为患者提供更加安全、优质、满意的护理服务。方法:比较分析实施优质护理服务前后产科各项护理指标及患者对护士的满意度。结果:实施优质护理前产科各项护理指标考评总分为(90.15±2.20)分,患者满意度总评分为(91.65±2.43)分。实施优质护理后产科各项护理指标考评总分为(96.32±2.51)分,患者满意度总评分为(97.46±2.31)分。比较差异有统计学意义(P0.05)。结论:在产科实施优质护理服务,能够增强护理人员的责任感,调动护理人员的主观能动性,提高住院孕产妇及家属对护理工作的满意度,促进护患关系进一步融洽、和谐,有效提高护理服务质量。     

开展品管圈活动对精神科实施优质护理服务的推动作用

目的 探讨开展品管圈活动对精神科实施优质护理服务的推动作用。 方法 开展品管圈活动,分析现阶段推行优质护理服务过程中存在缺陷的原因,选定活动主题后制定针对性的对策及整改计划并组织实施,开展相关的优质护理服务。 结果 开展品管圈活动后,在精神科继续推行优质护理服务使护理质量整体评价合格率明显上升,由干预前的155例(82.45%)上升为干预后的197例(96.57%),差异有统计学意义(χ2=17.47,P＜0.001),护理文件整理、健康教育宣传、掌握患者病情、基础护理、规范性专科护理的合格率均显著高于活动前(P＜0.001);住院患者的整体满意度明显提高,由干预前的满意151例(80.32%)上升至194例(95.10%),差异有统计学意义(χ2=20.25,P＜0.001)。与对照组相比,护士服务态度、护士服务主动性、护理技术、病室环境、提供便民服务、健康宣教方面的满意度均显著提高(P＜0.001)。 结论 品管圈活动的开展明显降低了优质护理服务实施过程中存在的问题缺陷,改善了患者对优质护理服务的满意度和护理质量,可以有效推广优质护理服务在精神科护理的应用。      

健康教育对提高妇科住院患者满意度的研究

目的探讨健康教育在提高妇科住院患者对护理工作满意度方面的影响。方法对2011年2月—4月在我院妇科住院的89例患者进行健康教育,在实施教育前后各进行一次满意度调查。结果实施健康教育前,妇科住院患者对护理工作满意度调查得分为（85.180±12.664）分,实施健康教育后,住院患者满意度调查得分为（95.040±6.263）分,差异有统计学意义（P〈0.05）。结论健康教育在提高妇科住院患者对护理工作满意度方面有明显的促进作用。     

医院推进后勤服务社会化对优质护理示范工程的影响

目的：探讨医院后勤服务社会化对优质护理工程的支持和影响。方法：建立新的医院后勤管理、服务体制,保洁、绿化、食堂、被服洗涤、物资运送等实施社会化、专业化服务,落实非护理专业项目的减负工作。结果：直接护理时间后勤服务社会化实施前2.97±0.40h,后勤服务社会化实施后3.86±0.50h（t=13.9138,P〈0.01）;非护理时间后勤服务社会化实施前1.97±0.40h,后勤服务社会化实施后0.35±0.30h,实施前后比较差异有统计学意义（t=13.9137,P〈0.01）;开展优质护理示范病区患者满意度实施前调查349例,满意332例（95.13%）,实施后调查356例,满意335例（94.10%）,实施前后比较差异有统计学意义（χ^2=15.03,P〈0.01）;开展配套支持系统优质护理服务前后护理质量平均得分由（96.11±0.70）分提高到（99.38±0.53）分,实施前后护理质量比较差异有统计学意义（χ^2=10.44,P〈0.01）。结论：医院后勤服务社会化的开展有助于缓解护理工作的各项压力,护士可以专心从事护理工作,直接护理患者时间增加,护士满意度提高,患者满意度提高,促进优质护理工程的开展。     

患者满意度和护士工作满意度的相关性分析

目的：探讨患者满意度和护士工作满意度的相关性,为优质护理服务的实施提供理论依据。方法通过院内第三方调查我院优质护理服务实施前、优质护理服务全面实施后及优质护理服务部分科室试施（试行实施）时各个科室的患者满意度及护士工作满意度。结果患者满意度和护士工作满意度分别由优质护理服务实施前的(92.47±3.04)分、(92.88±2.96)分上升到优质护理服务全面实施后的(96.17±1.95)分、(95.47±2.03)分,差异均具有统计学意义(P<0.01);优质护理服务部分科室试施时,优质护理服务非试点科室和试点科室的患者满意度及护士工作满意度分别为(93.85±3.14)分、(94.74±2.14)分和(95.94±2.37)分、(93.28±1.87)分,患者满意度差异具有显著统计学意义(P<0.01),护士工作满意度差异无统计学意义(P>0.05);患者满意度和护士工作满意度呈正相关。结论在优质护理服务工程实施时,增强护士工作满意度,有助于提高患者满意度,促进优质护理服务快速稳步的发展。     

病区管家在优质护理服务中的应用效果

目的:探讨病区管家在优质护理服务中的应用效果.方法:2011年3月我院护理部组织内科、外科护理人员集中学习并实施《2010年优质护理服务示范工程》,实施6个月后,在优质护理服务的基础上,内外科分别成立多名病区管家,负责本科室的预约服务、住院指导、陪检、健康宣教、出院指导等.观察病区管家成立前(2011年3~8月)、后(2011年9月~2012年2月)患者对护理工作的评价、护理质量评分和患者的护理服务满意度变化.结果:病区管家成立后,患者对护理工作的评价明显高于成立前,P<0.05.病区管家成立前,护理质量评分和护理满意度分别为(94.36±1.47)和87.33%,显著低于成立后的(97.08±1.73)和94.67%,P<0.05.结论:病区管家明显提高优质护理服务质量和患者护理服务满意度.     

绩效考核在呼吸内科护理管理中的应用

目的 探讨绩效考核在呼吸内科护理管理中的应用,提高科室护理管理质量.方法 制订考核标准及护士绩效评价表,对护士进行综合绩效评价,比较实施绩效考核前后的护理质量及患者满意度.结果 实施绩效考核前,18名护士综合绩效评价得分为(86.66±4.92)分,低于绩效考核后的(96.09±6.87)分,差异有统计学意义(P＜0.01).绩效考核后,患者对护理人员工作满意度为97.78%,明显高于考核前的86.67%(P＜0.01).结论 实施绩效考核能使薪酬分配趋于合理,进一步激发护士工作积极性.     

优质护理服务前后住院患者满意度的调查

目的对医院开展优质护理服务后出院患者的满意度进行效果评价。方法采用问卷方式,随机选择我院开展优质护理服务后的相关科室患者100例进行满意度调查,采用两个样本配对T检验进行统计分析。结果开展优质护理服务前满意度评分为38.97±2.35分,开展优质护理服务后满意度评分为39.80±1.87分（P＜0.01）,两组比较差异有统计学意义。结论优质护理服务开展实施效果较好,住院患者满意度明显提高。     

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.