冠心病患者的契约式健康教育

目的探讨提高冠心病患者健康教育效果的方法。方法将100例冠心病患者随机分为观察组与对照组各50例。对照组实施常规健康教育,主要采用口头宣教、健康教育处方、图文、示范教育等方法;观察组采用契约式健康教育,运用护患双方约定的契约方式进行健康教育。结果观察组健康教育效果显著优于对照组(P<0.01)。结论对冠心病患者采用契约式健康教育比常规方法更能提高健康教育效果。     

微创型举宫器在腹腔镜下保留盆腔自主神经广泛性子宫切除术中的应用

目的探讨微创型举宫器在腹腔镜下保留盆腔自主神经的广泛性子宫切除术（laparoscopic nerve-sparing radicalhysterectomy,LNSRH）中的临床应用价值。方法 2009年l月～2011年4月,使用微创型举宫器对20例ⅠB～ⅡA期宫颈癌及10例Ⅱ期子宫内膜癌行LNSRH。插尿管后置入举宫器,整个手术过程在腔镜下完成,离断阴道后用举宫器将子宫从阴道拖出。结果手术均获成功,术中无泌尿系损伤。手术时间250～340 min,平均270 min;出血量为50～200 ml,平均110ml;术后拔除尿管时间7～17 d,平均10 d。30例术后随访3～30个月,平均16.7月,所有患者健在,无淋巴囊肿,无肿瘤复发、转移,阴道残端均愈合良好。结论 微创型举宫器有操控简单、能配合高难度妇科腔镜手术、使用过程符合无瘤原则、使用成本低的特点,是行LNSRH的理想手术器械。     

一级学科背景下的高等护理教育改革探析

根据我国国情和护理教育现状,查阅文献,访谈护理专家,提出我国高等护理教育改革措施主要包括护理教育由通才教育转向专科化教育、大力发展护理科研和高等护理教育、扩大招生规模、加强护生综合素质的培养、加强理论和实践的衔接等。     

Radical cystectomy with orthotopic neobladder reconstruction following prior radical prostatectomy

Purpose

To review the perioperative and follow-up outcomes of patients undergoing radical cystectomy with orthotopic neobladder reconstruction for bladder cancer after prior radical prostatectomy (RP) for prostate cancer.

Methods

A retrospective review of more than 1,900 patients treated with radical cystectomy at USC between 1990 and 2011 was conducted. Fifty-six patients were identified who were previously treated with RP for prostate cancer. Twenty-four of these patients (43?%) underwent orthotopic neobladder reconstruction. Perioperative data and follow-up including postoperative continence were analyzed.

Results

The median age at cystectomy for these 24 patients was 68?years (range 55?C89). The types of neobladder reconstruction were Kock neobladder in 3, Sigmoid reservoir in 1, Studer neobladder in 12, and T-pouch ileal neobladder in 8 patients. There were no major intraoperative complications. Of 19 patients eligible for evaluation of post-cystectomy urinary control, 11 patients (57.9?%) with good continence (0?C1 pad/day) after RP regained preoperative level of urinary control after cystectomy within 1?year. The continence rate of 13 post-RP patients with good continence was 84.6?%. Among the 4 patients who received adjuvant radiotherapy after RP, 1 regained good continence. One with poor continence after prostatectomy had an artificial urethral sphincter (AUS) placed 2?months after cystectomy, and 2 with fair and poor continence after prostatectomy had an AUS placed at the time of cystectomy.

Conclusions

Patients undergoing radical cystectomy after prior RP pose a challenge to urologists. Those who are continent post-RP have a fair chance of regaining good urinary control with neobladder reconstruction. Adjuvant radiotherapy for prostate cancer may have a negative impact on continence with neobladder reconstruction.     

胸科手术后并发急性呼吸窘迫综合症的病因分析

目的:对17例胸外科术后并发急性呼吸窘迫综合症患者进行病因分析,探讨胸外科术后并发急性呼吸窘迫综合症的可能病因,针对病因采取相应的措施.方法:对我院自2007年6月～2011年5月胸外科术后被诊断为急性呼吸窘迫综合症的17例患者进行病历资料的回顾性分析,查找胸外科术后并发急性呼吸窘迫综合症的病因.结果:有5例术后并发胸内吻合口瘘,1例术中、术后失血多出现低血压休克.3例术前有慢性支气管炎-肺气肿痛史,1例术前有放疗性肺炎,3例吸烟指数每年大于1500支持续十年以上,1例有高血压病史.结论:有多种病因导致胸外科手术后发生急性呼吸窘迫综合症,积极采取干预措施,防止术后急性呼吸窘迫综合症的发生.     

IVF早观察及其中不同授精密度对人工授精周期的影响

目的 探讨对体外授精(IVF)周期实施短时授精结合早观察的方法以及早观察周期中不同的授精密度对受精、胚胎发育及临床妊娠率等的影响.方法 对2009年9月至201 1年2月接受常规IVF治疗的350个周期采用常规过夜授精和早观察的方法.其中早观察周期采用了3种不同的授精密度,分别统计了各自的正常受精率、多PN受精率、优质胚胎率和妊娠率等指标.结果 IVF早观察周期的临床妊娠率显著高于常规IVF周期(P＜0.05),多PN受精率也显著高于常规IVF周期(P＜0.0 5).但早观察周期的正常受精率和总受精率显著低于常规IVF周期(P＜0.05).授精密度为(0.6～0.7)×106/ml时,正常受精率、总受精率等与授精密度为0.3×106/ml和(0.8～1)×106/ml比较差异无统计学意义(P＞0.05),优质胚胎率和移植周期临床妊娠率在三组中最高.结论对IVF周期早观察的方法结合适合的授精密度可得到理想的妊娠结局.     

PICC置管失败转颈内静脉置管的探讨

目的 对PICC置管失败患者转颈内静脉置管,以减轻患者经济负担,减少医疗资源浪费,确保患者完成化疗.方法 对PICC置管失败的11例乳腺癌患者,在严格无菌操作下中转右侧颈内静脉置管术.结果 11例均一次置管成功,导管留置时间132～186 d,顺利完成6～8周期化疗.结论 对PICC置管失败者采取颈内静脉途径置管补救,可达到预期效果.     

骨科责任护士工作流程单的设计与应用

目的 探讨优质护理服务过程中斯型护理管理模式,提高护理质量和患者满意度.方法 成立责任护士工作流程单(下称流程单)设计小组,制定患者由入院到出院护理过程的5类流程单,责任护士根据工作流程单进行日常护理工作.实施4个月后评价效果.结果 流程单应用后护理质控检查评分显著高于应用前(均P＜0.01);患者满意率相对提高,但差异无统计学意义(P＞0.05).结论 流程单的应用有利于提高护理质量,确保护理安全.     

Aldosterone Induces Kidney Fibroblast Proliferation via Activation of Growth Factor Receptors and PI3K/MAPK Signalling

Background/Aims: The mineralocorticoid hormone, aldosterone, has pro-fibrotic properties which can cause kidney damage. The severity of kidney interstitial fibrosis is dependent on the accumulation of fibroblasts, which result largely from local proliferation; however, it is unknown whether aldosterone stimulates kidney fibroblast proliferation. Therefore, we examined the effects of aldosterone on the proliferation of cultured kidney fibroblasts. Methods: Uptake of (3)H-thymidine and cell number quantitation were used to determine the proliferative effects of aldosterone on a rat kidney fibroblast cell line (NRK49F cells) and interstitial fibroblasts extracted from mouse kidneys after unilateral ureter obstruction. The role of different mitogenic signalling pathways in aldosterone-induced proliferation was assessed using specific inhibitors of receptors and kinases. Results: Physiological levels of aldosterone induced a doubling of proliferation of kidney fibroblasts (p < 0.0001), which was inhibited by pre-treatment with the mineralocorticoid receptor antagonist, eplerenone. Aldosterone-induced fibroblast proliferation was dependent upon the kinase activity of growth factor receptors [platelet-derived growth factor receptor (PDGFR) and epidermal growth factor receptor]. Notably, PDGF ligands were not involved in aldosterone-induced PDGFR activation, indicating receptor transactivation. Aldosterone-induced fibroblast proliferation also required signalling via PI3K, JNK and ERK pathways, but not via the transforming growth factor-β(1) receptor. Conclusion: Aldosterone ligation of the mineralocorticoid receptor in kidney fibroblasts results in rapid activation of growth factor receptors and induction of PI3K/MAPK signalling, which stimulates proliferation. This suggests that increased levels of aldosterone during disease may promote the severity of kidney fibrosis by inducing fibroblast proliferation.     

新护士对优质护理服务认知状况调查

目的了解新护士对优质护理服务的认知状况,为医院开展优质护理服务、落实政策要求、制定培训计划提供依据。方法自行设计优质护理服务认知状况调查问卷,对125名新护士进行调查。结果知道优质护理服务相关政策条例,愿意做基础护理和生活护理的新护士均在80%以上;41.6%～63.2%新护士了解优质护理服务的具体要求;对低年资护士从事基础护理的认可年限:1年占55.2%,2年占25.6%、3年占14.4%、4年占3.2%、5年占1.6%。结论新护士对优质护理服务相关政策条例及基础护理都有正确的理解和认同,对实施过程中的具体要求尚不够了解,应在临床工作中适时引导培训,进行角色定位。