3种评分系统评估ICU护士个人管床数的研究

[目的]探讨治疗干预评分系统-28(TISS-28)、改良版护理活动评分量表(NAS)、急性生理与慢性健康状况评分系统Ⅳ(APACHEⅣ)对于重症监护室(ICU)护士管床分配的适用性。[方法]采用3种评分系统于2016年12月15日—2017年6月15日对贵州省某大型三级甲等医院ICU 180d360个班次的护理工作量进行评分,评估病人330例,收集量表14 355份,根据各量表的评估分数计算每个护士管理病人数量。[结果]3种评分系统评估得分差异有统计学意义(P0.001);改良NAS与APACHEⅣ评分呈正相关(P0.001);改良NAS在ICU护士病人管理分配方面优于TISS-28与APACHEⅣ,即改良NAS预测分数段在40.9分～52.9分可参考护患比为1∶2.5,52.9～62.4分可参考1∶2.0,62.4～68.0分可参考1∶1.5,68.0～98.4分可参考1∶1。[结论]NAS在计算护患比时更便捷,量表内容可直接反映护理工作量,改良NAS在评估ICU护士病人管理分配方面更具有适用性。     

儿童综合医院重症医学科护理人力资源配置现状研究

目的 调查儿童综合医院重症医学科护理工作量及护理人力资源配置现状。方法 采用护理活动评分量表,于2019年3月1日至31日连续31 d,每天3个时间点,即每班次下班时的16:00、00:00、8:00,共93个时点对当班所有患儿进行数据采集,评估住院所有患儿所有班次的护理工作量及护理人力资源配置情况。结果 共采集了2 703份护理工作量及护理人力资源配置相关数据。儿童综合医院重症医学科患儿护理活动评分量表得分平均为（58.63±10.81）分;儿童综合医院重症医学科护士总体配置上,每例患儿每班次实际配置的护士数小于理论应配置护士数,两者比较差异具有统计学意义（P<0.01）。各班次每例患儿实际配置的护士数与理论应配置护士数相比,差异具有统计学意义（P<0.01）。结论 儿童综合医院重症医学科护理人力资源配置应该与成人ICU持平或高于成人ICU。儿童综合医院重症医学科护理人力资源总体配置和各班次配置均不足,夜班护士工作负荷尤其过重。护理管理者应努力提高护理人力资源的总体配置水平和各班次配置水平,并根据白夜班护理工作量的差异,进行护理人力资源的精确配置。     

应用治疗干预评分系统评估肝胆外科监护室护理工作量的分析

目的运用治疗干预计评分系统对肝胆外科监护室护理工作量进行评估,对管理者合理排班提供指导意义。方法利用治疗干预评分量表-76每日分3个班次统计当班时患者病情最重时的评分,并统计1周不同工作日的治疗干预计评分系统总分,对1周不同工作日的总分及每个班次的治疗干预计评分系统评分进行比较。结果1周中不同工作日之间的护理工作量比较差异无统计学意义;白班与小夜班工作量差异无统计学意义(P0.05),白班与大夜班及小夜班与大夜班工作量差异有统计学意义(P0.01)。结论护理管理者应根据专科监护室的特点合理调整周末及夜班护理人力资源,以满足护理工作量需求。     

APACHEⅡ评分系统在ICU护理人力资源配置中的应用效果评价

[目的]探讨急性生理学及慢性健康状况评分Ⅱ(APACHEⅡ)在重症监护室(ICU)护理人力资源合理配置中的应用价值。[方法]2011年1月—3月ICU护士长主要依据病人每日三级监测级别评估系统的评估结果对护理人力进行分配。2011年4月—10月护士分配标准及护患比则根据APACHEⅡ评分进行分配,比较改进前后护理工作质量、护士的工作强度、满意度及护理人力剩余情况。[结果]改进后医生和护士长对护理质量评价优于改进前;改进后护士工作强度降低,满意度提升;每周护理人力剩余明显增加。[结论]应用APACHEⅡ评分进行ICU护理工作量分配,使ICU人力资源管理由经验型管理转向了科学型管理。     

重症监护护理评分系统在脑外科监护室护理人力资源管理中的应用

[目的]探讨重症监护护理评分系统(ICNSS)在脑外科监护室护理人力资源管理中的应用。[方法]将120例入住脑外科监护室的病人按入院时间先后分为对照组和观察组各60例,对照组病人采用传统的平均分床法来分配护理人员,观察组首先应用ICNSS量表评估护理工作量,护士长依据评估结果进行护理人力资源配置。比较两组病人重症监护室(ICU)住院时间、期间不良事件发生情况、病人或家属对脑外科监护室护理工作满意情况和护士对护理管理的满意度及离职情况。[结果]观察组病人在脑外科监护室住院时间和期间不良事件发生率低于对照组(P0.05),病人及家属对护理工作的满意度高于对照组;观察组护士对护理管理的满意度均高于对照组(88.9%vs 55.6%,P0.05),两组护士的离职率比较,差异无统计学意义(P0.05)。[结论]ICNSS在评估脑外科监护室护理工作量并指导护理人力资源管理方面有优势,能够提高护理质量,提高病人及家属和护士的满意度。     

重症监护室护理工作量测量的研究进展

综述了重症监护室(ICU)常用的护理工作量测量方法,比较不同方法的适用性与优缺点,目的在于为ICU护理管理者提供参考依据,合理准确地配置每个ICU护士的病人管理数量。     

智慧ICU平台下TISS-28和NAS评分在ICU护理工作量评估中的应用研究

目的:基于治疗干预评分系统-28(TISS-28)和护理活动评估量表(NAS)评分调查重症监护室(ICU)护理工作量现状,以期了解智慧ICU平台下护理人员护理工作量的分配情况。方法:检索国内外文献,基于TISS-28和NAS条目初步构建ICU护理工作量测量条目函询问卷,采用德尔菲法对来自10所综合性三级甲等医院的10名护理专家进行2轮专家函询,确定测量条目。在2周内采用现场实时测量法对4个外科重症监护室病人的护理工作量进行一对一跟随记录,并统计各类项目所占用的工时以及构成比。结果:2轮专家函询问卷有效回收率均为100%,2轮专家函询权威系数分别为0.89,0.91,最终确定了14类护理工作量测量条目。4个重症监护室占工作总时间比例较大的护理项目各不相同,其中护理评估、治疗项目、基础护理、器官支持及行政管理工作占比较高。4个监护室直接护理工时相较间接护理工时占比高。结论:通过ICU护理工作量的测量发现不同专科ICU护理工作量有差异,可为科学的护理人力资源配置提供参考。     

治疗干预评分系统在重症监护室护理人力资源配置中的应用

目的探讨治疗干预评分系统(therapeutic intervention scoring system-28,TISS-28)在重症监护室(intensive care unit,ICU)护理人力资源配置中的应用效果。方法 2011年4-5月,采用TISS-28对北京市某三级甲等医院神经外科、神经内科、胸血管外科、呼吸科、心脏科等5个ICU进行测评,每个月随机抽取1周(2个月共计14d)进行测评,共评估患者716例次合计1432个班次的护理工作量。结果 5个ICU工作总量由高到低依次为神经外科、神经内科、胸血管外科、心脏科、呼吸科,分别为(405.14±32.15)、(230.07±13.92)、(213.64±47.15)、(122.14±12.23)、(153.00±35.60)分;平均每班护士工作量由高到低依次为神经外科、呼吸科、胸血管外科、心脏科、神经内科,分别为(62.96±9.22)、(48.86±4.89)、(46.62±9.38)、(44.64±8.81)、(38.35±2.32)分。神经外科ICU护士缺编较为严重。结论部分ICU护士处于超负荷工作状态;护理管理者应合理有效地配置各ICU护理人力资源,以确保护理工作质量。     

重症脑卒中患者临床护理评估与动态监测的护理策略

对近年来重症脑卒中患者的护理相关文献进行整理,总结出重症脑卒中患者生命体征的评估以及颅内压、格拉斯哥昏迷评分、血糖、压疮、营养等评估与监测的护理策略,以期为临床护士在护理重症脑卒中患者的过程中及时、准确、安全、有效地实施护理干预提供参考。     

运用TISS-28评分系统评价外科ICU护理工作量的研究

目的分析外科ICU不同时间段的护理工作量,探索合理安排护理人力、提高护理效率的方法。方法应用TISS-28评分系统对北京市某综合医院外科ICU患者的护理工作量进行测定。结果护士人均工作量较大,为（61．31±6．71）分;各班次护士人均工作量存在差别,其中夜班护士人均工作量较高;1周护理工作量周三得分最高。结论应用TISS-28评分系统进行护理工作量测定,为护理人力资源有效管理提供了依据。     

A high molecular weight form of somatostatin-28 (1-12)-like immunoreactive substance without somatostatin-14 immunoreactivity in the rat pancreas. Evidence that somatostatin-14 synthesis can occur independently of somatostatin-28

Synthesis of somatostatin-14 (S-14) could occur through direct enzymatic processing of precursor somatostatin (prosomatostatin) or via sequential breakdown of prosomatostatin leads to somatostatin-28 (S-28) leads to S-14. If direct processing is important, it should theoretically generate S-14 and a molecule equivalent to prosomatostatin without the S-14 sequence. In an attempt to identify such a molecule, I characterized the molecular forms of S-28(1-12)-like immunoreactivity (S-28(1-12) LI) in the rat pancreas and compared the relative amounts of these forms with those of S-14-like immunoreactivity (S-14 LI). Pancreatic extracts were chromatographed on Sephadex G-50 and Sephadex G-75 columns (Pharmacia Fine Chemicals Inc., Piscataway, NJ) under denaturing conditions and immunoreactivity in the eluting fractions was analyzed by region-specific radioimmunoassays (RIAs). For RIA of S-28(1-12) LI we used a newly developed rabbit antibody R 21 B, 125I-Tyr12 S-28(1-14), and S-28(1-12) standards. This system detects S-28, S-28(1-12), high molecular weight forms of S-28(1-12), but not S-14. S-14 LI was measured using antibody R149, which detects S-14, S-28, and higher molecular weight S-14-like substances, but not S-28(1-12). Three forms of S-28(1-12) LI were identified: Mr 9,000-11,000, Mr 1,200 (corresponding to S-28(1-12), and Mr less than 1,000, comprising, respectively, 35, 53, and 12% of total immunoreactivity. The relative abundance of the 9,000-11,000 mol wt S-28(1-12) LI material was unchanged following removal of S-14 LI from pancreatic extracts by affinity chromatography before gel filtration. Serial dilutions of fractions containing 9-11,000 and 1,200 mol wt materials exhibited parallelism with synthetic S-28(1-12). The total pancreatic concentration of S-28(1-12) LI was 1.56 pmol/mg protein, of which S-28(1-12) accounted for 0.83 pmol/mg protein and 9-11,000 S-28(1-12) LI comprised 0.55 pmol/mg protein. Pancreatic S-14 LI concentration was 2.07 pmol/mg protein, of which 98% corresponded to S-14. S-28-related peaks accounted for <1% of immunoreactivity in both RIAs. I concluded that (a) S-14 is the main form of pancreatic S-14 LI; (b) S-28 is present in very small quantities, in the pancreas; (c) S-28(1-12) LI consist mainly of S-28(1-12) and 9-11,000 mol wt S-28(1-12) LI; (d) 9-11,000 l wt S-28(1-12) LI could represent prosomatostatin without the S-14 sequence; (e) the finding of high concentrations of 9-11,000 mol wt S-28(1-12) LI suggests that S-14 synthesis can occur independently of S-28 and that direct processing of prosomatostatin is an important pathway for S-14 synthesis in the pancreas.     

shRNA介导的RNA干扰对小鼠T淋巴细胞CD28基因的沉默效应

目的 探讨短发夹状RNA(shRNA)对C57BL/6J小鼠T淋巴细胞CD28共刺激分子基因沉默效应,评价shRNA对目的 基因干扰效应的时效性和稳定性,筛选出高效的干扰序列用于后期的动物实验.方法 首先构建3个载有CD28特异性shRNA(shRNA1～3)的表达质粒和1个非特异性shRNA表达质粒,将其分别转染小鼠脾淋巴细胞,以非特异性的shRNA表达质粒组和未转染组分别作为阴性对照和空白对照,采用实时荧光定量PCR和Western blot方法分别从基因和蛋白质水平评价转染l～20 d内CD28 shRNA对CD28基因的干扰效应,并筛选出干扰效率最高的序列.结果 ①成功构建了CD28 shRNA表达载体;②3种CD28 shRNA均可在mRNA和蛋白质水平有效沉默目的 基因,与实验对照组比较差异有统计学意义(P＜0.01):CD28 mRNA拷贝数持续降低,3种CD28 shRNA转染C57BL/6J小鼠脾细胞20 d,小鼠脾细胞CD28 mRNA拷贝绝对数分别下降了99.62%、99.89%和99.80%;CD28蛋白表达水平分别降低了(84.90±0.65)%、(96.49±0.03)%和(91.76±0.32)%,以CD28 shRNA 2组的抑制效率最高(P＜0.01).结论 ①特异性的CD28 shRNA可长期、稳定地介导CD28基因沉默;②针对CD28基因不同位点的不同shRNA也有干扰效率的差异.     

DAS28- CRP与DAS28- ESR两种疾病活动评分在类风湿关节炎疾病评估中的比较分析

目的 探究C反应蛋白(C-reactive protein ,CRP)和红细胞沉降率(Erythrocyte sedimentation rate ,ESR)的两种DAS28(Disease activity score,DAS)评分方法在评估类风湿关节炎(Rheumatoid arthritis,RA)患者疾病活动方面的关系。方法 采用回顾性研究方法,观察我院住院治疗的69例RA患者,记录分析患者的临床资料,分别计算DAS28-ESR和DAS28-CRP两种评分,采用Pearson,s相关分析分析两种评分方法之间的关系、比较两种评分的分布差异以及两种评分与患者资料之间的关系。结果 DAS28-ESR与DAS28-CRP评分具有很好的线性关系,且有统计学意义(y=0.771x+1.805, r=0.821, P<0.001),DAS28-CRP评分(4.73±1.01)低于DAS28-ESR评分(5.45±0.95),二者的差异有统计学意义(P<0.001)。结论 DAS28-ESR与DAS28-CRP两种评分方法在评价患者疾病活动度时虽有相关关系却也有显著差异,可能会影响医生对RA患者病情的评估和治疗用药的选择,应予以关注。     

Protection against lethal toxic shock by targeted disruption of the CD28 gene

Toxic shock syndrome (TSS) is a multi system disorder resulting from superantigen-mediated cytokine production. Nearly 90% of the clinical cases of TSS arise due to an exotoxin, toxic shock syndrome toxin-1 (TSST-1), elaborated by toxigenic strains of Staphylococcus aureus. It is clearly established that besides antigen-specific signals a variety of costimulatory signals are required for full T cell activation. However, the nature and potential redundancy of costimulatory signals are incompletely understood, particularly with regards to superantigen- mediated T cell activation in vivo. Here we report that CD28-deficient mice (CD28-/-) are completely resistant to TSST-1-induced lethal TSS while CD28 (+/-) littermate mice were partially resistant to TSST-1. The mechanism for the resistance of the CD28 (-/-) mice was a complete abrogation of TNF-alpha accumulation in the serum and a nearly complete (90%) impairment of IFN-gamma secretion in response to TSST-1 injection. In contrast, the serum level of IL-2 was only moderately influenced by the variation of CD28 expression. CD28 (-/-) mice retained sensitivity to TNF-alpha as demonstrated by equivalent lethality after cytokine injection. These findings establish an essential requirement for CD28 costimulatory signals in TSST-1-induced TSS. The hierarchy of TSST-1 resistance among CD28 wild-type (CD28+/+), CD28 heterozygous (CD28+/-), and CD28-/- mice suggests a gene-dose effect, implying that the levels of T cell surface CD28 expression critically regulate superantigen-mediated costimulation. Finally, as these results demonstrate the primary and non-redundant role of CD28 receptors in the initiation of the in vivo cytokine cascade, they suggest therapeutic approaches for superantigen-mediated immunopathology.     

A physiologic role for somatostatin 28 as a regulator of insulin secretion.

Somatostatin 28 (S-28) is a peptide produced in the intestinal tract which rises in the circulation during nutrient absorption. We tested the hypothesis that S-28 regulates B-cell function by (a) studying the effects on insulin secretion of "physiologic" infusions of S-28 and (b) measuring insulin responses during elevated nutrient-stimulated endogenous S-28 levels. (a) Synthetic S-28 was infused on separate days into six healthy men at rates of 25 and 50 ng/kg per h which mimicked postprandial levels. Subjects were given a bolus of glucose (0.1 g/kg) after 120 min. Insulin responses during S-28 infusions were compared to a control study using a saline infusion in the same individuals. Glucose-stimulated insulin secretion was inhibited during the infusion of 50 ng/kg per h S-28 when compared to control (P less than 0.05). (b) Insulin secretion during elevations of endogenous S-28 was studied in healthy men who received a bolus of 2.5 g arginine (n = 14) or 25 U of secretin (n = 8) 120 min after swallowing 50 g fat, or, on a separate day, an equivalent volume of water. S-28 levels rose significantly after fat ingestion but did not change after water. Arginine and secretin-stimulated insulin secretion was inhibited following ingestion of fat compared with intake of water (P less than 0.05). Arginine-enhanced glucagon secretion was not changed by fat ingestion. We conclude that elevations in plasma S-28 levels, occurring during the postprandial state, attenuate B-cell secretion and this peptide may be a physiologic modulator of nutrient-stimulated insulin release.     

膀胱肿瘤中端粒酶逆转录酶和c-myc的表达研究

目的检测膀胱肿瘤组织、尿脱落细胞和外周血中的端粒酶逆转录酶(hTERT)和c-myc mRNA表达,探讨二者的临床意义及关系.方法采用RT-PCR法同时检测28例膀胱移行细胞癌(TCCB)患者和15例对照的组织、尿脱落细胞和血细胞中的hTERT和c-myc mRNA表达.结果肿瘤组织hTERT和 c-myc的mRNA阳性表达率分别为100%(28/28) 和 67.8%(19/28),对照组为0(0/15)和26.7%(4/15);两指标在尿脱落细胞中的阳性率分别为85.7%(24/28)和71.4%(20/28),对照组为13.3%(2/15)和26.7%(4/15);血细胞中为78.6%(22/28)和57.1%(16/28),对照组为6.7%(1/15)和33.3%(5/15);肿瘤组与对照组比较具有显著性差异(P＜ 0.01),两指标不同组间比较具有相关性(P＜ 0.01).结论 hTERT和c-myc mRNA在TCCB中的表达具有相关性,在TCCB不同标本中表达具有一致性,可作为膀胱肿瘤的良好诊断指标,hTERT较c-myc优;以尿脱落细胞对TCCB的诊断更准确和方便.     

超声造影诊断炎症型肝细胞腺瘤的临床应用

目的:探讨炎症型肝细胞腺瘤(inflammatory hepatocellular adenoma,I-HCA)的超声造影(contrast-enhanced ultrasound,CEUS)特征。方法:回顾性分析2009年4月至2019年11月在复旦大学附属中山医院经病理及免疫组织化学证实的28例I-HCA患者28个...     

Circulating somatostatin-28 is not a physiologic regulator of gastric acid production in man

Abstract. Studies were designed to establish the acid inhibitory potency and plasma kinetics of somatostatin-28 (S-28) in humans and to determine whether the amount of S-28 released into the circulation after a meal is sufficient to regulate gastric acid secretion. A liquid meal induced a significant increase of S-28 ( P < 0·01) whereas S-14 levels did not change. Postprandial S-28 concentrations were then mimicked by exogenous infusions and tested on basal and pentagastrin-stimulated gastric acid secretion. Expressed in terms of circulating plasma concentrations measured by specific radioimmunoassays, S-14 was 10 times more potent than S-28 in inhibiting gastric acid production. The plasma half-life of S-28 (1·86 min) was longer than that of S-14 (1·00 min) due to a slower plasma clearance rate. S-28 did neither affect basal and stimulated gastric acid secretion nor postprandial intragastric acidity.
These studies suggest that postprandial plasma concentrations of S-28 are unlikely to regulate gastric acid secretion in man. They also show that S-28 is several times less potent than S-14 with respect to inhibition of gastric acid output.     

原发性肺黏液腺癌的临床表现及CT征象

目的 探讨原发性肺黏液腺癌（PPMA）的临床表现及CT征象。方法 收集经病理证实的27例PPMA患者的临床资料及影像资料,归纳总结其临床表现及CT特征。结果 27例患者中,仅2例（2/27,7.41%）表现为典型的咳白色泡沫痰,余无特异性表现,其中13例（13/27,48.15%）患者体检发现病灶。27例患者共检出28个病灶,24个（24/28,85.71%）为周围型,4个（4/28,14.29%）为中央型。实性病灶15个（15/28,53.57%）,囊实性10个（10/28,35.72%）,磨玻璃结节3个（3/28,10.71%）;病灶内空泡征11个（11/28,39.29%）,短毛刺10个（10/28,35.72%）,浅分叶11个（11/28,39.29%）,胸膜侵犯3个（3/28,10.71%）。对10例患者行增强扫描,9例表现为轻度强化,1例为中度强化。27例患者中11例（11/27,40.74%）发生淋巴结或/和脑、骨、胸膜转移。结论 PPMA临床症状不典型,CT表现有一定的特异性、对提高其早期诊断率有一定的帮助。     

Expression of bcl-X(L) restores cell survival, but not proliferation off effector differentiation, in CD28-deficient T lymphocytes

Lymphocytes deficient in the T cell costimulatory molecule CD28 exhibit defects in cell survival, clonal expansion, and differentiation into effector cells. It is known that CD28-mediated signaling results in the upregulation of the Bcl family member Bcl-X(L). To investigate the role that Bcl-X(L) plays in the various functions of CD28, we expressed Bcl-X(L) in CD28-deficient primary T lymphocytes using retrovirus-mediated gene transfer. T cells were activated in vitro and infected with Bcl-X(L) or control retroviruses; this method allows gene expression in activated, cycling cells. Expression of Bcl-X(L) in naive T cells was achieved by reconstitution of the immune system of lethally irradiated recipient mice with retrovirus-infected purified bone marrow stem cells from CD28(-/)- or wild-type donor mice. Our studies demonstrate that Bcl-X(L) prolongs the survival of CD28(-/)- T cells but does not restore normal proliferation or effector cell development. These results indicate that the various functions of CD28 can be dissociated, and provide an experimental approach for testing the roles of downstream signals in the functions of cellular receptors such as CD28.