围手术期优质护理配合心理护理对子宫脱垂合并肠疝患者的效果观察

目的观察围手术期优质护理配合心理护理对子宫脱垂合并肠疝患者的应用效果。 方法选取2017年2月至2020年7月阜阳市妇女儿童医院收治的子宫脱垂合并肠疝患者60例作为研究对象,所有患者均接受阴式子宫切除术联合阴道前后壁修补术,随机分为2组,每组患者30例。对照组接受围手术期常规护理方案,观察组则在对照组的基础上接受围手术期优质护理配合心理护理方案。比较2组患者干预前后的子宫脱垂情况、与发病机制相关的氧化应激因子以及生活质量影响情况。 结果观察组优质护理干预后的子宫脱垂测量点表现优于对照组（P<0.05）;观察组干预后转化生长因子-β1、基质金属蛋白酶-2及基质金属蛋白酶组织抑制因子-2较对照组有改善（P<0.05）;观察组在干预后及出院3个月的生活质量评分优于对照组（P<0.05）。 结论给予子宫脱垂合并肠疝患者围手术期优质护理配合心理护理的应用具有显著的临床疗效,不仅有效改善患者的子宫脱垂情况及氧化应激水平,还可提高患者的生活质量。     

雷火灸治疗急性期带状疱疹临床疗效观察

目的 观察雷火灸治疗急性期带状疱疹（HZ）的临床疗效。方法 将60例HZ患者随机分为治疗组和对照组各30例,对照组口服伐昔洛韦和甲钴胺治疗,治疗组在口服伐昔洛韦、甲钴胺的基础上加用雷火灸治疗。观察2组患者治疗前后疼痛评价指标视觉模拟评分（VAS）、匹兹堡睡眠质量指数（PSQI）评分的变化及水疱止疱和结痂的时间,比较2组患者临床疗效的差异。结果 治疗后治疗组总有效率高于对照组（96.7%比76.6%）,2组比较差异有统计学意义（P<0.05）。治疗后2组VAS评分均较治疗前降低,且治疗组降低更显著[（2.20±1.27）分比（5.03±1.40）分],差异有统计学意义（P<0.05）。治疗后2组PSQI评分均降低,且治疗组在改善PSQI评分上效果更好[（6.07±1.96）分比（9.19±2.54）分],差异有统计学意义（P<0.05）。治疗组止疱时间、结痂时间较对照组明显缩短[止疱时间：（3.10±1.15）d比（4.63±1.59）d,结痂时间：（5.30±1.18）d比（6.70±1.56）d]。治疗组水疱止疱时间早于对照组,差异有统计学意义（P<0.05）...     

趣味游戏结合家庭教育-环境改良护理模式对哮喘患儿治疗配合度及症状控制情况的影响

目的 探讨趣味游戏结合家庭教育-环境改良护理模式对哮喘患儿治疗配合度及症状控制情况的影响。方法 选取2021年1月至2022年1月我科收治的150例哮喘患儿为研究对象,以随机数字表法将其分为对照组和观察组,各75例。对照组实施常规护理,观察组在常规护理基础上实施趣味游戏结合家庭教育-环境改良护理模式。比较两组的干预效果。结果 观察组的治疗配合度优良率高于对照组,差异具有统计学意义（P<0.05）。干预后,观察组的活动受限、喘息症状、患儿对哮喘控制及自我评估评分均高于对照组,差异具有统计学意义（P<0.05）。干预后,观察组的用力肺活量（FVC）、第1秒用力呼气量（FEV1）及最大呼气流量（PEF）均高于对照组,差异具有统计学意义（P<0.05）。干预后,观察组的症状、情感功能及活动评分均高于对照组,差异具有统计学意义（P<0.05）。结论 趣味游戏结合家庭教育-环境改良护理模式能提高哮喘患儿治疗配合度及症状控制效果,也能促进肺功能改善及生活质量提高,值得推广。     

“医教协同”背景下构建专业学位硕士研究生朋辈心理辅导模式的思考

临床医学专业学位硕士研究生与住院医师规范化培训相结合是医疗教育的重大改革,对提高专业学位硕士研究生整体素质和临床诊疗能力具有重大意义。但并轨后对硕士专业学位研究生的培养提出了更高的要求,给学生造成巨大压力,以致并轨培养后部分学生存在心理失衡、焦虑抑郁、情绪低落等心理问题,甚至选择休学、转向科学学位研究生等,严重影响住院医师规范化培训质量,也背离了医教协同培养高素质医学人才的初衷。朋辈心理辅导是同学之间或年龄相仿的人之间进行的心理辅导,具有便于取信、形式多样、时间自由和针对性强的特点,是为适应硕士专业学位研究生心理辅导的一种有益尝试。笔者在临床带教实践中以实现教学相长为出发点,以朋辈心理辅导模式为抓手,以同一时期轮转同一科室的临床医学专业学位硕士研究生为小组,对其存在的心理问题,有针对性地请临床带教老师和既往规培中优秀的高年级学长进行梳理分析解答、一对一辅导;定时展开“茶歇会、书友会、科研沙龙、规培论坛”等分享规培轮转中遇到的临床问题、科研难题、生活情感困扰等;利用网络云平台定时推送临床医案分析、科研小技巧等,对解决临床医学专业学位硕士研究生心理问题具有重要意义。     

NSCLC非经典EGFR突变患者临床特点及治疗预后分析

目的 了解表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitor,EGFR-TKI)对非经典突变非小细胞肺癌(non-small-cell lung cancer,NSCLC)的治疗疗效,为非经典突变患者选择最合适的靶向药物...     

苏州地区无偿献血者血小板抗体检测及结果分析

目的 研究苏州地区无偿献血者血小板抗体阳性发生率,通过对血小板抗体阳性标本进行鉴定,分析本地区无偿献血者血小板抗体分布特点,并探讨献血者血小板抗体检测对降低临床血小板输血不良反应的意义。方法 采用固相免疫吸附实验技术对本地区2 178例无偿献血者标本进行血小板抗体筛检,阳性标本采用商品化试剂盒分析抗体特异性,其中的抗-CD36阳性标本进一步采用流式细胞术鉴定和基因测序分析。结果 血小板抗体筛检共检出阳性标本12例,阳性率0.55%(12/2 178),其中男性5例[阳性率0.33%(5/2 178)]、女性7例[阳性率1.06%(7/2 178)];阳性标本中鉴定出抗-HLA-Ⅰ类2例,抗-CD36 1例,其余9例未鉴定出抗体特异性。其中1例抗-HLA-Ⅰ类PRA阳性率为31.3%(31/99),主要是抗-B15、抗-B35、抗-B40等特异性;另1例抗-HLA-Ⅰ类PRA阳性率为45.5%(45/99),主要是抗-A2、抗-A11、抗-A24、抗-A29、抗-A33、抗-A66、抗-B15、抗-B35等特异性。1例抗-CD36阳性标本经流式细胞术检测,该献血者为I型CD36缺失,其外...     

肌少症动物模型的造模方法研究进展

肌少症是与增龄相关的肌肉质量减少和功能减退,其增加了摔倒、骨折、死亡及住院等风险,严重威胁老年人健康。构建动物模型是开展肌少症发病机制、临床干预及治疗方案设计研究的基础。由于肌少症表型的复杂性,使得选择合适的造模方法、构建恰当的动物模型至关重要。本文综述了近年来肌少症动物模型造模方法的相关进展,为开展肌少症发病机制、预防、治疗等相关研究提供参考。     

干细胞移植改善股骨头坏死缺血状态的实验及临床效应：20只模型兔及188例患者资料分析

BACKGROUND: Ischemic femoral head necrosis is caused by local vascular injury and blood-supply insufficiency. There exists no optimal treatment for the ischemic femoral head necrosis. Thus, the improvement of the blood supply to the femoral head seems to be a key point for the treatment. OBJECTIVE: To verify the curative effects of autologous bone marrow mesenchymal stem cell transplantation induced vascular regeneration on the improvement of ischemic femoral head necrosis via animal experiments and clinical observations. DESIGN: Contrast animal experiment and self-controlled clinical observation. SETTING: Cell Therapy Center, the 463 Hospital of Chinese PLA. MATERIALS AND PARTICIPANTS: ① Animals: Twenty Japanese white rabbits in either gender and weighing 3.0-4.0 kg were purchased from Animal Experimental Center, General Hospital of Shenyang Military Area Command of Chinese PLA. The animal experiments were coincident with the ethical standards. ② Participants: 188 patients with ischemic femoral head necrosis (335 hips) having whole following-up data were selected from Cell Therapy Center, the 463 Hospital of Chinese PLA from July 2004 to July 2007. There were 113 males and 75 females, and their ages ranged from 18 to 72 years. Diagnosis was done by using X-ray photographs, nuclide scanning, MRI and CT examinations. All patients provided the informed consent, and the study was approved by the local research ethics committee. METHODS: ① Animal experiments: The experiment was carried out at the Animal Experiment Center, General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2004. Ischemic femoral head necrosis models were established at both hindlimbs by using liquid-nitrogen refrigeration. The right side was regarded as transplantation group and the left one as control group. Mononuclear cells extracted from bone marrow were poured in the right femoral artery, while saline was poured in the left femoral artery. ②Clinical observations: Mononuclear cells were separated from autologous bone marrow of patients with ischemic femoral head necrosis after density gradient centrifugation. MAIN OUTCOME MEASURES: ①Four weeks later, angiogenesis at both femoral arteries was observed by arteriography by using digital subtraction anglography (DSA). Moreover, bilateral femoral head samples underwent pathological sections to observe bone regeneration and repair of femoral head 4 and 12 weeks later. ②Items including hip pain, walking distance and gait, abduction and internal rotation function changes of hip joint were observed in 3, 6, 12 and 24 months after stem cell transplantation in media femoral circum flex artery, lateral femoral circum flex artery and obturator artery. In 6 months after stem cell transplantation, angiogenesis and blood supply of femoral head were observed by using arteriography. In 6, 12 and 24 months after stem cell transplantation, morphological and ischemic changes of femoral head were observed by using CT, X-ray and MRI examinations. Harris scores were used to evaluate function of hip joint before and in 3, 6, 12 and 24 months after stem cell transplantation. RESULTS: Animal experiment: Twenty rabbits were involved in the final analysis. ① DSA-arteriography results: In 4 weeks after transplantation, blood-supply arteries in femoral head of right hindlimb in the transplantation group were more than those in the control group. ② Pathological results: In 12 weeks after transplantation, cartilage, lamellar bone and bone trabecula in the left femoral head were repaired remarkably, but left femoral head necrosis was not improved. Clinical observations: 188 patients were involved in the final analysis. ① Improvement of symptoms: Among 188 patients, 164 (87.3%) had remission of hip pain, 147 (78.4%) had function improvement, and 150 (80.0%) had elongation of walking distance. ② Imaging changes: At 6 months after transplantation, DSA-arteriography in 12 patients demonstrated that blood-supply arteries in femoral head were increased and thickened remarkably as compared with those before transplantation, and the blood flow was rapid. At 12-24 months after transplantation, lesion of bone matrix in 24 patients was improved under the X-ray, CT and MRI examinations. ③ Harris scores of hip joint: The scores at 6, 12 and 24 months after transplantation were significantly higher than those before transplantation (t= -3.423, -6.714, -9.039, P < 0.01). CONCLUSION: Autologous bone marrow mesenchymal stem cell transplantation can effectively improve and treat ischemic femoral head necrosis.     

HLA-B27的检测及其临床意义的探讨

HLA-B27与强直性脊椎炎(ankylosing sponelylitis,AS),Reiter病,急性前葡萄膜炎等疾病相关[1],对于临床上怀疑为AS的患者,检查HLA-B27有诊断及鉴别诊断的价值,为进一步了解HLA-B27与AS的关系, 笔者对被检标本同时采用血清学和聚合酶链反应-序列特异性引物(PCR-SSP)两种方法进行了检测,报告如下. 1 材料与方法 1.1 检测对象对照组:正常健康献血者22例;实验组:临床上诊断为AS的患者28例为AS组,因临床表现不典型及病情发展阶段不同而未能进行确诊的患者34例定为可疑组. 1.2 检测方法 1.2.1 血清学方法取静脉血用肝素抗凝,采用国际标准微量淋巴毒试验技术,HLA-B27分型血清含阴/阳性对照及两种不同批号的抗血清,其相关系数(r)为0.95,强度指数(SI)为85%.