小组合作学习法在规范化培训护士心搏骤停急救培训中的应用研究

目的 探讨小组合作学习法对规范化培训护士心搏骤停急救培训中的应用效果。方法 选取2017年至2019年350名规范化培训期护士,按照规范化培训年限顺序分成对照组和实验组,对照组150人采用传统方法进行培训,实验组200人采用小组合作学习的方法实施培训,比较两组护士培训前后急救知识及心肺复苏技能的掌握情况以及对培训的满意度。结果 实验组护士急救知识掌握优于对照组,差异有统计学意义（P<0.05）;实验组成人心搏骤停急救和除颤操作技能表现优于对照组,差异具有统计学意义（P<0.05）;实验组护士对培训内容、导师的满意度以及独立实施操作的满意度均高于对照组,差异有统计学意义（P<0.01）。结论 小组合作学习法有利于培养团队协作能力及主动学习能力,提升规范化培训护士理论知识和操作技能水平,及其对培训的满意度。     

重型颅脑损伤患者自主神经功能障碍的临床分析

目的 探讨重型颅脑损伤患者自主神经功能紊乱综合征发生率、临床症状、发病危险因素及预后.方法回顾性分析2008年1月-2010年3月收治的142例重型颅脑损伤患者,比较自主神经功能障碍组和对照组(无自主神经功能障碍患者)的临床特征;采用Logistic回归分析自主神经功能障碍发病的危险因素;伤后6个月采用GOS评分分析其预后.结果142例患者中生存并成功随访94例,自主神经功能障碍患者16例(17%),且其在GCS评分、昏迷时间、ICU时间、平均住院时间等方面较对照组差异有统计学意义(P<0.05);自主神经功能障碍患者预后较差(P<0.05),与弥漫性轴索损伤(DAI)密切相关(OR=11.25,95%CI 7.65～16.54).结论 自主神经功能障碍在严重颅脑损伤患者中发生率较高,临床表现重,DAI增加其发作风险,此类患者多预后不良.

Abstract：

Objective To investigate the incidence, clinical symptoms, correlative risk factors and prognosis of dysautonomia in patients with severe traumatic brain injury. Methods A total of 142patients with severe traumatic brain injury treated from January 2008 to March 2010 were retrospectively surveyed to compare the clinical features of dysautonomia group and control group. Logistic regression was used to analyze the risk factors for dysautonomia. At 6 months post-trauma, the Glasgow Outcome Score (GOS) was used to measure the outcome. Results Of all the patients, 94 patients survived and were followed up. There were 16 patients ( 17% ) diagnosed as dysautonomia depended on clinical symptoms,with statistical difference in aspects of GCS, coma duration, ICU time and average length of stay (ALOS)(P < 0.05). The patients with dysautonomia tended to have poorer outcome ( P < 0.05 ) and showed a positive association with diffuse axonal injury (DAI) ( OR = 11. 25, CI 7.65-16.54 ). Conclusion Dysautonomia has high incidence and is usually severe in patients with severe traumatic brain injury,when DAI may contribute to its occurrence and result in poor prognosis.     

大孔吸附树脂纯化垫状卷柏总黄酮的工艺研究

目的研究大孔树脂纯化垫状卷柏总黄酮的最佳提取工艺。方法以总黄酮的得量和含量为考察指标,经大孔树脂纯化后,采用紫外-可见分光光度法测定。结果 HPD-100型大孔树脂纯化效果最好,其最佳工艺参数为树脂:药材≈1:1.3,药液质量浓度为0.8 g·m L-1,p H 3,吸附速率4.0m L·min-1,用5 BV 75%乙醇洗脱,洗脱速率4 BV·h-1,经大孔树脂纯化后垫状卷柏提取液中总黄酮纯度由原来的20.49%提高至51.26%。。结论本法富集纯化垫状卷柏总黄酮工艺稳定可行。     

自体外周血干细胞移植术治疗血栓闭塞性脉管炎患者的护理

<正>血栓闭塞性脉管炎(thromboangiitis obliterans,TAO)主要累及四肢远端的中小动脉,早期出现患肢的局部缺血症状,以至于最后出现患肢的溃疡坏疽,严重影响患者的生活质量。目前,可通过下肢动脉置管溶栓术、下肢动脉支架成形术等腔内治疗手段来改善患者的症状,减轻患者的痛苦。但部分患者因自身血管条件差,失去以上手术的机会。我院血管外科自2010年1月至2013年2月采用自体     

非贵金属材料钴铬合金烤瓷联冠及烤瓷桥修复后基牙咬合力与牙周组织的变化北大核心

背景:测量牙缺失患者修复后的咬合力指标,可有效判断修复效果和患者修复后口腔功能的恢复情况。目的:观察行钴铬合金烤瓷联冠、烤瓷桥修复后患者基牙咬合力及牙周组织的变化。方法:将100例男性烤瓷牙修复患者随机分5组修复,其中20例采用钴铬合金烤瓷联冠修复前牙,20例采用钴铬合金烤瓷联冠修复前磨牙,20例采用钴铬合金烤瓷联冠修复磨牙,20例采用钴铬合金烤瓷桥修复前牙,20例采用钴铬合金烤瓷桥修复后牙。修复前、修复后即刻、修复后6个月,检测基牙咬合力变化及牙周相关指标变化。结果与结论:(1)咬合力:5组修复后即刻、修复后6个月的咬合力均高于修复前(P<0.05);修复前、修复后即刻、修复后6个月,烤瓷联冠磨牙组、烤瓷桥后牙组的咬合力高于烤瓷联冠前磨牙组、烤瓷联冠前牙组、烤瓷桥前牙组(P<0.05),烤瓷联冠前磨牙组咬合力高于烤瓷联冠前牙组、烤瓷桥前牙组(P<0.05);(2)牙周组织:5组组内修复前后的牙周袋探诊深度、菌斑控制指数、临床附着水平、牙龈沟液量比较差异均无显著性意义(P>0.05);5组间各指标比较差异均无显著性意义;(3)结果表明:行钴铬合金烤瓷联冠、烤瓷桥修复治疗能显著提升患者基牙咬合力,并且对牙周影响很小,生物相容性较好。     

正交实验法优选垫状卷柏总黄酮的提取工艺

目的探讨垫状卷柏中总黄酮的最佳提取工艺。方法采用正交实验法,以总黄酮含量为考察指标,优化垫状卷柏总黄酮的提取工艺。结果经过正交实验得出的最佳工艺条件为乙醇浓度95%,料液比1:12,提取时间为2 h,回流提取2次。结论根据验证实验结果,该方法工艺合理,稳定可行。     

多发伤合并脊柱脊髓损伤的特点分析

目的 探讨多发伤患者合并脊柱脊髓损伤的临床特点.方法 回顾性分析2004年3月-2009年3月收治的143例合并脊柱脊髓损伤的多发伤患者,统计致伤原因、脊柱损伤节段、合并伤、并发症、治疗方式和转归.结果 高处坠落伤和交通伤是主要致伤原因,分别为77例(53.8%)和55例(38.5%),损伤节段依次为腰椎101处(50.8%)、胸椎61处(30.7%)、颈椎29处(14.6%)及骶尾椎8处(4.0%);合并伤依次为胸部163处(38.6%)、腹部84处(19.9%)、头颈部77处(18.3%)、四肢65处(15.4%)、面部17处(4.0%)和体表16处(3.8%).早期并发症依次为电解质紊乱33例(16.8%)、呼吸系统感染30例(15.3%)和腹胀19例(9.7%);晚期并发症依次为营养不良26例(13.3%)、肌萎缩23例(11.7%)和深静脉血栓11例(5.6%).治疗方式依次为手术治疗106例(74.1%),保守治疗37例(25.9%).治疗前美国脊柱损伤协会(ASIA)评级E级20例(14.0%),治疗后E级53例(37.1%).死亡12例,病死率为8.4%,主要死亡原因为MOF、脑疝、营养衰竭等.随着ASIA残损分级的提高,各组并发症和病死率也显著增加(P＜0.05).结论 高能量损伤是多发伤合并脊柱脊髓损伤的主要致伤因素,患者病情重,合并伤复杂,并发症多,治疗棘手,病死率高.

Abstract：

Objective To analyze the clinical features of the multiple trauma patients combined with spine and spinal cord injuries.Methods A retrospective study was performed in 143 multiple trauma patients combined with spine and spinal cord injuries admitted to our department between March 2004 and March 2009.The parameters including injury cause,segment of injuries,associated injuries,complications,treatment methods and outcomes were analyzed.Results Falling and traffic accidents were the main causes for the injuries of spine and spinal cord,accounting for 53.8%(77 cases)and 38.5%(55 cases),respectively.The injured segments involved 101 lumbar vertebrae(50.8%),61 thoracic vertebrae(30.7%),29 cervical spines(14.6%)and 8 sacrococcygeal vertebrae(4.0%).The associated injuries were located at chest(163 regions,38.6%),abdomen(84 regions,19.9%),head and neck(77 regions,18.3%),extremity(65 regions,15.4%),face(17 regions,4.0%)and body surface(16 regions,3.8%).The early complications included electrolyte disturbances in 33 patients (16.8%),respiratory infection in 30(15.3%)and abdominal distention in 19(9.7%).The late complications were malnutrition in 26 patients(13.3%),amyotrophy in 23(11.7%)and deep vein thrombus in 11(5.6%).Treatment methods were operations and expectant treatments in 106 patients (74.1%)and 37(25.9%)respectively.According to American Spinal Injury Association(ASIA)scale,there were 20 patients(14.0%)at grade E before treatment and 53(37.1%)at grade E after treatment.Of all,12 patients were died of mainly multiple organ failure(MOF),cerebral hernia and malnutrition,with mortality rate of 8.39%.There showed an increase of complication and mortality rate with increase of ASIA grade(P ＜ 0.05).Conclusions The spine and spinal cord injuries in patients with multiple trauma are mainly caused by high energy injuries and characterized by high injury severity,complex associated injuries,multiple complications,difficult management and high mortality rate.     

反应控制神经机制研究新进展

隶属于执行功能的反应控制包括启动、评价、选择和抑制等过程,涉及以额叶为主的多个神经功能网络,但目前仍缺乏公认一致的神经机制模型解释其灵活多样性特点。本文在回顾近年来反应控制的实验范式、理论模型和实证研究的基础上,力图建构一个系统的神经网络动态演化模型,为未来反应控制的基础和临床研究提供理论框架。     

宫腔镜检查前软化宫颈药物应用的临床观察

目的选择一种简单、有效宫腔镜检查前软化宫颈的药物.方法选择202例宫腔镜检查患者,随机分成A、B、C三组,分别采用米索前列醇联合利多卡因宫颈注射(A组)、米索前列醇口服(B组)、利多卡因宫颈注射(C组),将镇痛效果、心脑综合征RAAS发生率、宫颈松弛情况及出血量进行比较.结果A组镇痛效果、宫颈松弛情况与B、C组相比,差异极显著(P＜0.01),心脑综合征发生率A组显著低于B、C组(P＜0.01).结论米索前列醇联合利多卡因用于宫腔镜检查前镇痛和扩张宫颈是一种安全有效的方法.