院前急救护理之隐患及对策

目的:分析院前急救护理中的隐患,寻求最佳应对措施,减少医疗护理纠纷,提高抢救成功率。方法:总结分析1677例院前急救病例资料,探讨院前急救护理中存在的问题及采取的有效应对措施和效果。结果:本组病例经及时抢救护理,尤其是及时消除院前急救护理中的隐患,为院内急救赢得了时间,纠纷发生率为0,患者满意率达99.5%。结论:及时发现院前急救护理中的诸多隐患,并采取有效的应对措施,可为院内急救赢得时间,大大提高抢救成功率,减少或杜绝医疗护理纠纷和差错事故。     

创伤患者院前急救与护理

目的 探讨创伤患者院前急救与护理的重要性.寻求最佳应对措施,减少医疗护理纠纷,提高抢救成功率.方法 对我院451例创伤患者施行院前急救与护理的病例资料进行总结分析.结果 抢救451例创伤患者,成功抢救434例,死亡17例,抢救成功率为96.2%.结论 院前急救是急诊医疗服务体系的首要环节,是急救医学的重要组成部分,急诊科护士应该掌握院前急救的各种措施,熟练院前急救各项操作,为院内急救赢得时间,降低致残率和死亡率,为提高医院成功抢救患者打下一个良好的基础.     

创伤患者院前急救的护理体会

目的探讨严重创伤患者的院前急救方案及措施,提高抢救成功率,减少医疗护理纠纷。方法收集我科2009年8月—2011年12月1 024例院前急救创伤患者的病历资料,对严重创伤患者的致伤原因、伤情、急救护理进行分析和探讨。结果 1 024例创伤患者中,抢救危重患者430例,成功403例,死亡27例,抢救成功率为93.72%。结论院前急救是急救医学的重要组成部分,急诊科护士应当掌握院前急救的各种措施,熟练院前急救的各项操作,培养及时、迅速、准确、有效的院前急救护理能力,为严重多发创伤患者成功救治争取宝贵时间,从而降低病死率、致残率和并发症的发生率。     

院前急救的护理安全问题与应对措施

目的综合分析院前急救的护理安全和应对措施,提高急救成功率。方法回顾性分析我区2007年5月～2009年10月记录在册的有关院前急救纠纷资料。结果院前急救安全隐患主要表现为急救前隐患、现场急救隐患、转运途中安全隐患三个方面。结论针对原因采取相应的防范措施,能进一步提高院前急救的质量,最大限度地减少和杜绝医疗纠纷与事故的发生。     

院前成功救护体会

如何做好院前急救病人的护理工作，是现代急诊医疗服务体系中必不可少的重要组成部分；因为只有及时采取紧急而正确的急救措施和护理，赢得时间，才能真正降低急诊病人的死亡率，因此，院前急救及护理也成为院内急救的前提。下面笔者就所参加的院前急救，浅谈一下院前急救护理中成功救护体会。     

急性有机磷农药中毒院前急救护理体会

探讨急性有机磷农药中毒患者院前急救的护理方法。总结了68例急诊接诊的急性有机磷农药患者院前、院内急救护理的过程。包括院前急救、清除毒物、运送过程的护理等,急性有机磷农药中毒具有发展迅速、病情凶险、病死率高,抢救难度大等特点,认为及时实施院前救护措施,可为转院赢得宝贵时间,大大降低了院外死亡率,有利于院内抢救,提高了急性有机磷农药中毒抢救的成功率。     

院前急救的护理体会

在院前急救中充分调动急救护理思维,采取行之有效的护理措施,在院前急症、重症患者的急救中起重要作用,熟练掌握院前急救现场和途中监护并及时有效给予心理护理,显著提高了院前抢救的成功率,为病人转入院内做进一步治疗打下良好基础。     

院前急救护患纠纷成因分析与防范

院前急救是急诊医疗体系的首要环节和重要基础,及时有效的院前急救,对于维持患者生命、防止再损伤、减轻患者痛苦、提高抢救成功率及减少致残率均具有极其重要意义.随着社会法制化建设的加强,人们的维权意识不断增强,由于院前开放性的急救环境,医护人员对患者实施的急救、治疗、护理,家属或目击者均亲眼目睹,导致医疗纠纷在院前急救中更容易发生.院前急救护士作为急救单元中的重要一员,对减少医疗纠纷、提高救治水平和救治成功率均将起到重要的作用.现对本急救中心2006年12月至2009年12月发生的22例院前急救护患纠纷的成因进行分析,探讨如何加强防范的措施.     

创伤性休克急救护理体会

目的：提高创伤性休克患者院前急救技能,提高抢救成功率,降低死亡率。方法：通过分析60例创伤性休克患者急救护理,有组织的创伤急救体系（EMS）,迅速正确评估患者伤情及危重程度,快速制定并实施抢救方案,转运过程中全面监测患者生命体征。结果：60例病例中院前死亡6例,抢救成功率为90%。结论：及时有效的止血、抗休克等急救措施及健全的急救机制,缩短急救时间是抢救创伤使休克患者的关键。     

急性颅脑损伤患者的院前急救与护理

目的 探讨急性颅脑损伤患者院前急救与护理的方法，为进一步抢救治疗患者创造必要的条件，提高急救成功率，降低致残率和病死率。方法 对我院2007年1月-9月56例急性颅脑损伤患者的院前急救及结果进行回顾性分析。及时出诊，观察患者意识、瞳孔、生命体征，保持呼吸道通畅及吸氧，止血包扎，建立静脉通道等熟练的急救护理技术，配合心理护理并适时安全转运患者。结果 急救56例，48例抢救成功，8例死亡，成功率85．7％，病死率14．3％。结论 急性颅脑损伤患者病情重、进展快、病死率高，快速有效的院前急救为急性颅脑损伤患者抢救赢得了宝贵时间，对提高生存率与生存质量，改善预后具有十分重要的意义.     

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.