“递进式模拟”实验教学模式的实践与探索

随着现代医学的发展,护理教育的目的不再着眼于培养单纯被动接受知识的学生,而是注重学生潜在素质和专业能力的培养,以储备必需知识、增强适应能力、塑造整体素质为基本出发点。多年来我们一直致力于探索提高学生的沟通能力、动手能力、获取信息能力、独立解决问题的能力等综合素质的途径。通过几年的教学及实践研究,创建了“递进式模拟”实验教学模式。     

护理专业学生职业相关法律法规认知态度调查

目的了解护生对职业相关法律、法规的认知情况，为在校护生法律教育提供参考。方法采用自行设计的调查问卷，对249名护理大专和185名护理本科护生进行职业相关法律知识认知态度的调查。结果护生了解职业相关法律知识的途径分别为学校（92．4％）、媒体（66．7％）、医院（32．7％）、其他（39．6％）；护生的认知态度总分为51.92±2．43；专科护生对护士管理办法、医疗事故处理条例、民法、医疗用毒性药品管理办法、刑法、刑事诉讼法的认知态度得分显著低于本科护生（P〈0．05，P〈0．01）。结论护生对职业相关法律、法规认知态度积极，其中专科护生相对较差；应采取多种教育方式和途径提高护生认知水平，尤其应加强专科护生的教育力度。     

The effects of gossypol on expressions of transforming growth factor-β1, fibronectin and 11β-hydroxysteroid dehydrogenase in nephridial tissue in rats with diabetes mellitus

Objective To observe the effects of gossypol on expressions of transforming growth factor-β1 (TGF-β1), fibronectin (FN) and 11β-hydroxysteroid dehydrogenase (11β-HSD) in nephridial tissue in rats with diabetes mellitus. Methods Thirty male Sprague-Dawley rats were randomly divided into three groups: normal control, type 2 diabetes and gossypol treatment group . After high-fat feeding for 4 weeks, the later two groups were injected with low dosage strepozotocin (30 mg/kg) intraperitoneally to induce type 2 diabetic rat model. The rats in gossypol treated group were given gossypol at the dosage of 15 mg/kg once per day for 4 weeks by gavage. And since the 5th week, the times of gavages had been changed into once per week at the same dosage and lasted to the 12th week . The levels of blood glucose, total cholesterol (TC), low density lipoprotein-cholesterol (LDL-c) were measured. Additionally, the morphological changes of the kidney were studied by light microscopy and transmission electron microscopy respectively. The mRNA expressions of TGF-β1, FN, 11β-HSD and 11β-HSD2 in nephridial tissue were assayed by semi-quantity RT-PCR. The protein expressions of TGF-β1 and FN in nephridial tissue were determined by immunohistochemistry. Results The blood levels of glucose, TC and LDL- c were increased significantly in type 2 diabetic group compared with normal control group(P<0. 01). The volume of glomerulus and the deposition of PAS positive substance in the glomerular interstitium were increased under light microscopy, and the glomerular basal membrane was thicker in type 2 diabetic group than those in normal control group under transmission electron microscopy. The mRNA and protein expressions of TGF-β1 and FN were increased(P<0. 01), and the mRNA expression of 11β-HSD2 was decreased(P<0. 05), while the mRNA expression of 11β-HSD1 was unchanged in type 2 diabetic group compared with normal control group. After the treatment of gossypol, the level of the blood glucose was significantly decreased(P< 0. 01), and the levels of TC, LDL-c showed a trend of decrease but had no statistical differences compared with type 2 diabetic group. The morphology of nephridial tissue was ameliorated in gossypol treatment group. The mRNA and protein expressions of TGF-β1 and FN were decreased(0. 16± 0. 02,0. 22±0. 05 ; 0. 24±0. 06,0. 33±0. 07, P< 0. 05), while the mRNA expressions of 11β-HSD1 and 11β-HSD2 were unchanged compared with type 2 diabetic group. Conclusions Gossypol can relieve the pathologic changes of nephridial tissue, inhibit the expressions of TGF-β1 and FN through decreasing blood glucose of rats with diabetes mellitus.     

小檗碱对2型糖尿病大鼠肺泡和腹腔巨噬细胞氧化低密度脂蛋白及脂蛋白脂酶的影响

目的探讨小檗碱对2型糖尿病大鼠血脂及肺泡和腹腔巨噬细胞氧化低密度脂蛋白(oxidized low-density lipoprotein,ox-LDL)、脂蛋白脂酶(lipoprotein lipase,LPL)表达的影响。方法SD大鼠分4组,正常对照组、高脂组、糖尿病组、小檗碱治疗组,治疗结束后测定各组大鼠血清葡萄糖、胰岛素和血脂含量,并检测肺泡巨噬细胞和腹腔巨噬细胞ox-LDL含量和LPL mRNA的表达水平。结果(1)小檗碱对糖尿病大鼠具有降低血糖、胰岛素水平和调节脂代谢紊乱等作用;(2)经小檗碱治疗后糖尿病大鼠肺泡和腹腔巨噬细胞ox-LDL含量下降,LPL mRNA表达降低。结论推测小檗碱对糖尿病大鼠的治疗作用可能与提高胰岛素敏感性,降低巨噬细胞ox-LDL、LPL表达有关。     

银杏叶提取物对糖尿病大鼠血液、睾丸组织中内皮素和一氧化氮水平的影响

目的:探讨银杏叶提取物(EGb)对糖尿病大鼠血液、睾丸组织中内皮素(ET)和一氧化氮(NO)水平的影响.方法:将SD大鼠分为三组:正常对照组、糖尿病组、EGb治疗组.EGb治疗5 w后,分别测定三组大鼠血液中葡萄糖、胰岛素、ET和NO水平以及睾丸组织中ET、NO水平和一氧化氮合酶(NOS)活性.结果:EGb治疗组与糖尿病组大鼠比较血糖明显降低(P＜0.01),血清胰岛素水平轻度升高(P＞0.05).各组大鼠血浆中ET水平无明显差异(P＞0.05),血浆NO水平糖尿病组显著高于对照组,而EGb治疗组明显低于糖尿病组(P＜0.05).睾丸组织中ET水平糖尿病组显著高于对照组(P＜0.05),EGb治疗组低于糖尿病组(P＞0.05);EGb治疗组大鼠睾丸组织中N0水平、NOS和iNOS活性显著低于糖尿病组(P＜0.01和P＜0.05).结论:EGb可通过降低糖尿病大鼠血液中葡萄糖和NO水平及睾丸组织中ET、N0水平和NOS活性,从而减轻糖尿病对睾丸组织所造成的损害.     

小檗碱对2型糖尿病大鼠巨噬细胞MMP-9和TIMP-1表达的影响

目的： 探讨小檗碱对2型糖尿病大鼠肺泡巨噬细胞（AM）和腹腔巨噬细胞（PM）基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶组织抑制因子-1（TIMP-1）表达的影响。 方法：SD大鼠随机分成4组，正常对照组、高脂组、糖尿病组、小檗碱治疗组。治疗12周后，测定各组大鼠血清葡萄糖、胰岛素和血脂含量，并检测肺泡和腹腔巨噬细胞氧化修饰低密度脂蛋白（ox-LDL）含量、MMP-9和TIMP-1的基因表达水平。结果：糖尿病组大鼠血糖、血胰岛素、血总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）浓度明显高于对照组，AM和PM内ox-LDL浓度、MMP-9 mRNA表达明显高于对照组；而TIMP-1 mRNA的表达低于对照组。小檗碱治疗组大鼠血糖、血胰岛素、LDL、TC、TG浓度低于糖尿病组，AM、PM内MMP-9 mRNA的表达低于糖尿病组，而TIMP-1 mRNA的表达高于糖尿病组。 结论：小檗碱具有降低血糖、调节血脂、防治2型糖尿病动脉粥样硬化的作用，其机制可能与其减少ox-LDL生成，直接下调巨噬细胞中MMP-9的表达有关。     

女性尖锐湿疣患者焦虑、抑郁与社会支持的相关性研究

目的了解女性尖锐湿疣患者焦虑、抑郁与社会支持的现状及两者间的相关性,为制定更具人性化的整体护理措施提供依据。方法采用一般情况调查表、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depressionscale,SDS)和社会支持评定量表(social support rating scale,SSRS)对2011年1-9月在绍兴市7所医院门诊治疗的女性尖锐湿疣患者进行问卷调查。结果患者的SAS、SDS得分、SSRS总分及其3个维度的得分均低于国内常模(P<0.01)。文化程度、就业和婚姻状况等因素对患者的焦虑、抑郁和社会支持有显著影响(P<0.05);患者的焦虑、抑郁与社会支持呈显著负相关(P<0.05)。结论患者的焦虑和抑郁发生率较高,症状较为严重,社会支持状况不佳。医护人员应为患者提供适当的心理支持,改善患者的社会支持现状,从而提高其生活质量,帮助其早日恢复身心健康。     

糖尿病病人的健康教育

叙述了糖尿病健康教育的方法，从心理、饮食、运动、药物指导、病情监测叙述了糖尿病健康教育的内容。     

基于仿真医疗情景下的开放式综合性护理技能训练实验

目前我国护理服务市场正向多层次、多形态发展[1],对护理人员的临床综合技能提出了更高的要求.