扁平化管理在妇科优质护理服务中的实施

目的在优质护理服务过程中进一步提高护理管理及护理服务满意度。方法在妇科病区采用扁平化管理模式,即取消责任护士组长,按3个管床教授组将病区18名护士均分为3组,每组A班(7:30～17:00)2人,N班(17:00～8:00)1人,轮休3人;每人分管患者≤8例,另6名护理人员分别上辅助班、计算机操作班及主班等。每个月按护理部制定的标准进行护理质控,实施10个月后评价效果。结果患者对优质护理服务及责任护士知晓率≥95%,入院介绍、技术操作等10项满意度评分9.28～9.66分,均为满意和非常满意。结论扁平化管理模式的运用有利于护理人力资源的合理利用,从而提高护理质量和患者满意度。     

Shortening fasting time of children after pharyngolaryngeal operation under general anesthesia: feasibility study

目的 探讨咽喉部患儿全身麻醉术后适宜的禁食时间,促进患儿术后恢复.方法 将102例择期咽喉部全麻手术患儿(3～14岁)随机分为观察组(53例)和对照组(49例).观察组在患儿意识清醒且吞咽功能恢复的前提下2h后开始进食,先饮少量凉开水,如无误吸现象可进纯奶油冰洪淋或流质;对照组按照常规护理,即患儿麻醉清醒6h后开始进食.比较两组患儿术后6h、24h疼痛、恶心、呕吐、口渴、饥饿等不适发生率.结果 观察组患儿术后6h疼痛、恶心、口渴、饥饿不适症状发生率显著低于对照组(均P＜0.01).结论 早期进食能有效缓解咽喉部患儿全麻术后的不适症状,有利于患儿尽快恢复.     

哈乐在良性前列腺增生伴急性尿潴留中的应用

目的 :探讨α1A肾上腺素能受体阻滞剂哈乐 (tamsulosin)对良性前列腺增生 (BPH)伴急性尿潴留病人的治疗作用。方法 :对 72例BPH伴急性尿潴留病人采用随机、对照研究 ,分为治疗组和对照组。病人均行保留导尿 ,口服抗生素治疗。治疗组加用哈乐 0 .4mg ,1次 /d ,连续服用 3次。 72h后拔除导尿管。　结果 :拔除导尿管后 4 4 % (32 / 72 )的病人能自行排尿。有效率治疗组为 6 1% (2 2 / 36 ) ,对照组为 2 8% (10 / 36 ) ,两组比较差异有显著性 (P <0 .0 1)。　结论 :对BPH伴急性尿潴留应用哈乐治疗 ,可提高早期拔除导尿管后病人自行排尿的成功率 ,且疗效与前列腺体积大小无关。     

川芎嗪联合氨胍对糖尿病大鼠肾脏一氧化氮的影响

目的：探讨川芎嗪联合氨胍对糖尿病肾脏病变的保护作用及其机制。方法：用链脲佐菌素制作糖尿病大鼠模型，分为正常对照组、糖尿病模型组、川芎嗪治疗组、氨胍治疗组和川芎嗪联合氨胍治疗组，于第12周测定各组大鼠肾组织一氧化氮合酶的活性和一氧化氮含量。结果：川芎嗪联合氨胍治疗纪、川芎嗪治疗组、氨胍治疗组大鼠肾组织NOS活性显高于模型组(P＜0．01)，NO的含量增加(P＜0．01)。川芎嗪治疗组、氨胍治疗组NOS活性低于正常对照组(P＜0．01)，NO的合量降低(P＜0．01)；川芎嗪合氨基胍治疗组与正常组相比无差异。结论：川芎嗪联合氨基胍能够增强糖尿病大鼠肾组织NOS活性，增加NO的含量，从而对糖尿病性肾病起一定治疗作用。     

Study on changes of partial pressure of brain tissue oxygen and brain temperature in acute phase of severe head injury during mild hypothermia therapy

Ahighdeathrateofseverebraininjurieshasattractedmuchattention .Mildhypothermiatherapyandmonitoringbrainoxygenmetabolismandcerebralbloodflowhavebeendoneinmanyhospitals.Wimaretal1elucidatedthevalueofmonitoringbrainoxygeninseverebraininjuries.Butthemechanismofmildhypothermiaremainsunclear .Zhang2 reportedthatmildhypothermiatherapycouldrecoverthebrainoxygentonormal.Gupta3 usedanesthesiacoolingandobservedduringmildhypothermiathebrainoxygenwasdecreased .Wehavetreated 116patientswithseverebraininjuri…     

人工合成小分子RNA对前列腺癌细胞周期及增殖的影响

目的 研究人工合成的dsP21-555对前列腺癌细胞株PC-3和LNCaP细胞周期和增殖的影响。方法 合成dsP21-555（实验组）和dsControl（阴性对照组）,分别转染至PC-3和LNCaP。使用Real-time PCR及Western blotting分别检测分析前列腺癌细胞转染后的p21mRNA及p21蛋白的表达情况。流式细胞术检测细胞周期分布,使用MTT实验及集落形成实验检测细胞的活力及增殖能力。结果 转染dsP21-555后PC-3和LNCaP细胞中的p21 mRNA水平分别上调至2.90倍(P<0.01)和2.05倍(P<0.01)。Western blotting实验结果符合这一趋势。流式细胞术检测显示,转染dsP21-555后,在S期和G2/M期的细胞比例下降,在G0/G1期的细胞比例则增加。MTT实验显示,与dsControl组相比,转染dsP21-555后,PC-3和LNCaP细胞的活力明显降低。集落形成实验显示,dsP21-555组的集落的数量较少,细胞增殖能力降低。结论 人工合成的dsP21-555能明显激活前列腺癌细胞中p21基因的表达,并显著抑制前列腺癌细胞周期的进展和增殖。     

Incidence of acute kidney injury in hospitalized children

Objective To investigate the prevalence, missed diagnosis rate and causes of acute kidney injury (AKI) in hospitalized children, and its impact on hospitalization cost, length of stay and outcome. Methods The data of children admitted in Children's Hospital Affiliated to Capital Institute of Pediatrics from December 1st to 31st 2014 were collected, and those whose serum creatinine (Scr) were measured at least two times were selected. Patients were diagnosed as AKI according to the diagnostic criteria of 2012 Kidney Disease: Improving Global Outcomes, then divided into AKI group and non-AKI group, the former of which was further divided into AKI1 group (Scr peak value in normal range) and AKI2 group (Scr peak value above normal range). The causes and impact of AKI on hospitalization cost, length of stay and outcome in different groups were compared and analyzed. Results (1) Among 921 patients with at least two Scr results, 170 patients met with the diagnostic criteria of AKI, including 100 males and 70 females. There were 112(65.9%) in AKI stage 1, 43(25.3%) in stage 2, and 15(8.8%) in stage 3. The overall prevalence of AKI was 18.5%. With only 7 cases getting diagnosed, the diagnostic rate was 4.1%, while 95.9% of patients missed diagnosis. (2) Among AKI patients, 67 cases had pre-renal causes, 103 cases had intra-renal causes and mixed factors. 100(58.8%) cases got complete recovery, 34(20.0%) cases recovered partially and 36(21.2%) cases did not improve, including 4 cases of death. (3) The prevalence of AKI among those below 1-year old was higher than children elder than 1-year (23.0% vs 15.5%, P=0.004). The prevalence of AKI in surgical ward was higher than medical ward (30.7% vs 15.8%, P＜0.001). (4) Compared with those in non-AKI group, there was lower age [1.1(0.2, 3.5) year vs 2.0(0.3, 4.9) year] and higher hospitalization time[12.5(8.0, 20.0) d vs 8.0(6.0, 11.0) d], hospitalization costs [25 279.2(13 822.8, 48 856.7) yuan vs 12 616.9(8680.1, 19 345.1) yuan] and mortality (2.4% vs 0.3%) in AKI group (all P＜0.05). (5) There were 126 cases in AKI1 group and 44 cases in AKI2 group. The costs of hospitalization, outcome and mortality showed no difference between two groups (all P＞0.05). The hospitalization time in AKI2 group was shorter than that in AKI1 group (P=0.038). Conclusions Among hospitalized children the missed diagnosis rate of AKI is high. Pre-renal factor is the main cause of AKI. Children younger than 1-year old are more susceptible to AKI. AKI children have lower age and higher hospitalization time, hospitalization costs and mortality than non-AKI children. The effect of Scr fluctuation within normal levels needs to be further studied.     

短视频在父亲支持母乳喂养健康教育中的应用

目的 探讨基于短视频的健康教育在父亲支持母乳喂养中的应用效果。方法 选取103对住院分娩的初产妇及其配偶按照住院时间顺序分组。对照组52对,给予常规健康教育;干预组51对,在常规健康教育的基础上增加基于短视频的健康教育。结果 干预组产后42 d父亲支持母乳喂养自我效能评分、初产妇对配偶参与母乳喂养满意度评分、产后3 d及42 d纯母乳喂养率显著优于对照组（均P<0.05）。结论 基于短视频的健康教育能够提高父亲支持母乳喂养自我效能,提升产妇对配偶参与母乳喂养的满意度,进而促进纯母乳喂养。     

膝关节周围骨折伴腘动脉损伤救治的临床研究

目的观察膝关节周围骨折伴腘动脉损伤的保肢治疗过程及功能恢复情况,探讨保肢手术的治疗方案。方法对27例膝关节周围骨折伴腘动脉损伤患者,急诊行骨折固定、腘动、静脉探查修复术,2例行大腿下段1例行膝关节水平截肢术,其余患者的肢体经3~5次(平均4次)手术治疗,肢体得以保留。3例患者的肢体软组织缺损经行背阔肌皮瓣游离移植,其余患者的软组织缺损经行腓肠肌内侧头肌皮瓣或局部直接随意筋膜皮瓣转移修复。术后随访12~24(16±2.39)个月。参照Puno等的标准对康复后肢体功能进行评定。结果患者无死亡,3例患者行患肢截肢,24例患者肢体得以保留,其中4例患者存在明显的足下垂、垂趾等畸形,功能评定为差。结论膝关节周围骨折伴腘动脉损伤的治疗,关键在于早诊断及早治疗,疑有腘动脉损伤者尽早探查;对伴有足踝部软组织及踝关节损伤,或足底难以恢复保护性感觉,估计小腿肌肉会发生广泛的坏死和感染者,应考虑一期行截肢术。