综合实践教学模式的实施与护生综合能力的培养

目的在《护理学基础》教学中，运用整体护理思维，探讨课堂综合实践教学模式的实效性，以提高护生的职业素质和能力。方法随机确定实验班和对照班，对照班采取传统的实践教学模式授课，实验班采取小群体综合实践模式教学。结果实验班护生的规范操作能力、沟通能力和知识运用能力与对照班比较有显著提高。结论小群体综合实践教学模式对护生综合能力的培养具有实际意义。     

环境线索对戒断期海洛因依赖者神经电生理的影响

Objective To explore the changes of craving and neuro-electrophysiological reactions under the exposure of heroin-related cues in abstinent heroin dependents.Methods In this self-controlled study,382 abstinent heroin dependent patients watched video of heroin smoking and injecting situations,and in the meantime were exposed to herein simulacrum and apparatus after relaxation exercises.The neuroelectrophysiological reactions were mcagured with a multi-biofeedback instrument before and after the cue exposed.Self-reported craving was also assessed before and after cue exposed.Results The craving were increased[(18±22)mm vs.(29±29)mm,P＜0.01]after cue exposures compared to pre-exposure,EMG[(12±7)μN vs.(14±10)μV,P＜0.01]and SC[(6.8±4.3)μS vs.(7.4±4.3)μS,P＜0.01]also increased.But the percentages of δ,θ,α,SMR,low β,high β decreased compared to that under the cue exposures[8:(10.8±4.7)%vs.(9.7±4.4)%,P＜0.01;0:(6.8±2.0)%vs.(6.3±2.0)%,P＜0.01;α:(4.8±1.8)%vs.(4.5±1.7)%,P＜0.01;SMR:(3.0 ±1.2)%vs.(2.8±1.2)%,P＜0.01;low β:(2.6±1.1)%vs.(2.5±1.1)%,P＜0.01 and high β:(4.6 ±1.5)%vs.(4.5±1.5)%.P＜0.05].Conclusions The results indicate that drug-related cue induce heroin craving and electrophysiological reactions.     

浅议中医理论的科学美

科学美是美学形态分类中的一种 ,它从本质上反映事物运动的内在联系 ,属于美的深层形式。中医理论中存在简明、对称、新奇等科学美     

糖尿病患者超声乳化白内障吸除手术的临床观察

目的:探讨糖尿病患者进行超声乳化白内障吸除联合人工晶状体植入手术的临床效果。方法:50例(61只眼)糖尿病患者(设为A组)和同期163例(174只眼)血糖正常患者(设为B组)接受超声乳化白内障吸除联合人工晶状体植入手术。糖尿病患者手术前通过饮食疗法、口服药物或肌注胰岛素治疗,使空腹血糖降到 10mmol/L以下。术后随访 1～28个月(平均 8.6个月),复查视力、裂隙灯及眼底检查。结果:术后矫正视力≥0.5者,A组为77.1%;B组为80.5%。两组经统计学处理差异无显著性(P>0.05)。两组术中出现后囊破裂及术后发生角膜水肿和前房渗出等并发症的差异无显著性(P>0.05 )。结论:糖尿病患者进行超声乳化白内障吸除手术前只要有效控制血糖,其手术效果与对照组患者相同。但术后血糖的控制仍然十分重要。眼科学报2003;19:98-100。     

The Application of Topical Anesthesia Combined with Subconjunctival Anesthesia for Glaucoma Surgery

Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5％ Alcaine eye drops combined with subconjunctival anesthesia with 2％ Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes (85.2％) were painless (Grade Ⅰ), 50 eyes (14.0％) were slight painful (Grade Ⅱ), and 3 eyes (0.8％) were more painful (Grade Ⅲ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow vi     

静脉注射美托洛尔、地尔硫卓治疗快速心房纤颤的临床疗效观察

目的:观察美托洛尔注射液和地尔硫卓注射液治疗快速房颤的有效性和安全性。方法:105例符合入选标准的快速房颤患者被随机分为3组,美托洛尔组39例:5mg美托洛尔缓慢静脉注射,观察5min,如无效重复一次,连续用药3次,总量15mg;地尔硫卓35例:地尔硫卓15mg稀释后静脉注射,观察15min,如无效重复1次,继以15mg/h维持。西地兰组31例:西地兰0.2～0.4mg稀释后静脉注射,观察10min,如无效追加0.2～0.4mg,连续用药3次;总量0.6～1.0mg。记录用药前、后心室率和血压变化,并比较在各观察时间点上的有效率。结果:与西地兰相比,美托洛尔和地尔硫卓起效更快[(36.9±11.6)min∶(8.2±4.5)min∶(9.1±3.8)min,P<0.05],心室率下降幅度更明显(25.22%∶33.32%∶37.50%,P<0.05),治疗有效率更高(71.0%∶89.7%∶91.4%,P<0.05)。而美托洛尔组和地尔硫卓组之间无显著性差异。三组均无严重不良反应发生。结论:美托洛尔注射液和地尔硫卓注射液均能快速、安全、有效控制快速房颤的心室率。     

Graves病介入栓塞治疗的病理研究

目的观察Graves病栓塞后的甲状腺组织动态病理变化。方法15例甲状腺动脉150 mm聚乙烯醇（PVA）微粒及平阳霉素栓塞治疗的Graves病患者,于术前、术后7天、3个月、6个月、1年、3年分别行甲状腺穿刺活检,共行44次穿刺活检,其中动脉栓塞术前15例、栓塞术后7天2例、3个月3例、6个月6例、1年5例次、3年13例次。结果栓塞后7天主要表现为凝固性坏死;栓塞后3-6个月表现为纤维组织增生变性和淋巴细胞浸润,滤泡灶性坏死为主;栓塞后1-3年主要表现为间质纤维组织增生明显和滤泡萎缩,部分散在增生滤泡被纤维间质分隔包裹,难以形成腺小叶结构,滤泡周围血管网减少。结论经甲状腺动脉栓塞治疗Graves病,甲状腺组织的病理变化是在栓塞后近期内主要表现为急性缺血坏死,然后表现为持续的慢性炎性破坏、滤泡萎缩、部分滤泡增生被明显增生的纤维组织分隔包裹的变化过程。提示微循环栓塞能肯定地破坏甲状腺组织,达到治疗Graves病较好的疗效。     

超声引导下VacoraTM旋切系统的实验研究

目的探讨VacoraTM真空辅助活检系统的准确性和安全性,为临床应用奠定基础。方法选用里脊肉和鱼丸作为实验材料,根据鱼丸大小将实验分为5组:0.5、0.8、1.0、1.5及2.0cm组,每组鱼丸3~5个。采用VacoraTM活检系统,先行灰阶超声扫查肌肉后将鱼丸置入肌肉中,超声扫查置入的鱼丸,同轴套管针在超声引导下插入鱼丸底部,在套管针引导和超声监视下行旋切真空抽吸术;旋切后取出采样腔内的组织标本,用超声检查肌肉内的残腔,确定无鱼丸残留声像图。结果每次旋切组织条比较完整,其大小为20.0mm×0.6mm,旋切次数随鱼丸大小的增加而增加;0.5、0.8、1.0、1.5及2.0cm组里脊肉内鱼丸全部切除的平均旋切次数分别为12、15、19、26和31。所用的平均时间分别为15、18、23、27和34min。结论VacoraTM真空辅助活检系统定位准确、取样完整、操作简便。可为良恶性病变的诊断提供足够量的病理检查标本,为良性病变的完全切除提供具有潜在价值的手段。     

酪氨酸激酶抑制剂抑制骨髓瘤细胞的增殖及Rac1的表达

目的:观察酪氨酸激酶抑制剂STI571对骨髓瘤细胞系RPMI8226细胞增殖、细胞周期以及Rac1 mRNA表达的影响。方法:采用MTT法检测STI571对骨髓瘤细胞增殖的影响;流式细胞仪检测对细胞周期的影响;半定量RT-PCR研究Rac1mRNA水平的变化。结果:STI571明显抑制RPMI8226细胞的增殖,24、48、72 h IC50值分别为(34.52±2.31)μmol/L、(28.46±1.58)μmol/L、(25.74±2.44)μmol/L。25μmol/L STI571处理24 h,G1期细胞由55.8%增加至72.4%,S期细胞由34.8%减至15.6%。半定量RT-PCR显示,Rac1 mRNA水平在25μmol/L STI571处理24 h后明显下降。结论:STI571能抑制RPMI8226细胞的增殖,并可下调其Rac1 mRNA水平。     

Comparison of the effects of three different combinations of general anesthetics on the electroretinogram of dogs

The objective of this study is to compare the effects of three different anesthetic combinations on the electroretinogram in the same animals under similar laboratory conditions. Thiopental–isoflurane (TI), medetomidine–ketamine (MK), and xylazine–ketamine (XK) were used on each of 12 healthy miniature schnauzer dogs (MS) with a period of at least 3 weeks in between subsequent anesthesia protocols, using the Dog Standard Protocol. The scotopic ERGs consisted of scotopic low stimulus strength (S) responses designated S1, S2, S3, S4, and S5, at 1, 5, 10, 15, and 20 min after dark adaptation, respectively, and scotopic standard stimulus strength (S-ST) responses. The photopic ERGs consisted of a photopic single flash (P) response and 31 Hz flicker (P-FL) responses. For S-ST (2.5 cd s/m²), the amplitude of the a-wave using TI was significantly lower than that using MK (adjusted P = 0.05) and XK (adjusted P = 0.03), and the implicit time of the a-wave was significantly shorter than that using MK (adjusted P = 0.04). For P (2.5 cd s/m²), the amplitude of the b-wave using XK was significantly higher than that using MK (adjusted P = 0.01). The implicit times of the b-wave using TI was significantly longer and shorter than that of MK for S1, S2 and P-FL and for S4 and S-ST, respectively, and than that of XK for S2 and P-FL and for S5 and S-ST, respectively. The results of the present study showed that TI affected both the amplitude and the implicit time of the a-wave for S-ST and the implicit time of the b-wave relatively more so than was the case when using XK or MK. Therefore, it appears that either XK or MK could be advantageous to use rather than TI for clinical studies.