加强ICU护士素质教育与培训

ICU工作特点决定ICU护士应具备良好素质和技能,因此护士素质的培训尤为重要。本文从强化岗前培训、上岗培训、上岗实习培训、低年资护士培训、高年资护士培训等角度论述了ICU护士培训工作的重点。     

中国人民解放军第三五九医院

解放军第三五九医院又称镇江金山医院,位于镇江市中心,是一所集医疗、教学、科研、预防、保健为一体的三级乙等综合医院,是镇江市医疗保险定点医院、全军首家优抚医院,爱婴医院,曾被表彰为“全国残疾人康复工作先进单位”、“全军为部队服务先进医院”、“全军文明卫生军营”“     

维护患者知情同意权构建和谐医患关系

享有知情同意权是法律赋予患者的权利,医方履行告知义务是法定义务.医学模式的转变要求医务人员要重视医患之间的沟通,尊重和维护患者知情同意权,全面、通俗、精确、真实、及时地履行告知义务,以减少医疗纠纷,构建和谐医患关系.     

公平解决医患纠纷的有益尝试——引进驻院律师

医患纠纷一直以来是困扰医院管理者的难题之一,本文从通过驻院律师与法律顾问的区别,其在医疗纠纷的预防和处理中的作用,解决医疗纠纷的途径等问题为切入点,探索医院、患者、第三方驻院律师三者的有效结合,公平解决医患纠纷的一种途径。     

切实提高常见慢性呼吸道疾病防控水平

随着社会前进，我国许多慢性呼吸道疾病，如慢性阻塞性肺疾病、支气管哮喘等的患病率逐年上升，成为我国人群主要死因之一和造成重要社会负担的原因。至今许多人还没有充分认识到这一点，因而没有广泛采取有效的医疗服务模式来解决这个问题。     

Comparative study of open tension-free and laparoscopic inguinal hernia repair in hernioplasty and simultaneous laparoscopic cholecystectomy

Objective: To evaluate the clinical value of laparoscopic inguinal hernia repair in hernioplasty and simultaneous cholecystectomy. Methods: Twenty-eight patients with symptomatic chronic calculous cholecystitis and synchronous unilateral primary inguinal hernia were performed combined surgery between October 2001 and March 2005. Of them, 10 cases underwent laparoscopic totally extraperiloneal mesh hernia repair (TEP) and laparoscopic cholecystectomy (LC), 3 cases underwent laparoscopic transabdominal preperitoneal mesh hernia repair (TAPP) and LC, and 15 cases underwent LC and open tension free hernia repair. Results: All the procedures were performed successfully, 2 patients occurred urinary retention in LC + open group and 1 patient occurred scrotum seroma in LC + TEP procedures. During the 6 to 24 months' follow-up, no hernia recurrences occurred in all patients. There were 6 patients (40%) in LC + open group had discomfort pain in the inguinal region and lasted 1 to 3 months. The operating time was longer in the totally laparoscopic group (TEP + LC and TAPP + LC) (104±31 min) than in the LC+open group (80±28 min) (P<0. 05). The intensity of postoperative pain at rest was greater in the LC + open group at 24 h (P<0. 05) and 48 h (P<0. 05). No differences between the 2 groups were found in the mean operating costs and oral intake of the postoperative period. But the time resume to walking (2. 9 vs 1. 8 d) (P<0. 01) and the mean hospital stay (8. 2 vs 4. 6 d) (P<0. 001) was longer in the LC + open group than in the totally laparoscopic group. Conclusion: In the same operating costs, the totally laparoscopic precedure has more advantages of low postoperative pain, quicker resume to walking and less hospital stay than open tension-free hernia repair in hernioplasty and simultaneous LC. Thus, the totally laparoscopic approach is considered to be advantage of the hernioplasty and simultaneous LC.     

Effects of varied interferons in combination with all-trans retinoic acid （ ATRA ） on proliferation and differentiation of ATRA-resistent APL cell

Objective：To investigate the effects and mechanisms of interferon in combination with alltrans retinoic acid （ATRA） on proliferation and differentiation of ATRA-resistent APL cell. Methods ：After MR2 cells （ATRA-resistance cell line） were treated with IFN-α, IFN-γ and ATRA alone or IFN-α and IFN-γ in combination with ATRA respectively. The cell proliferation was tested by MTT test and the cell differentiation was tested through light microscope by NBT test and flow cytometry （FCM）. The expres sion of promyelocytic leukemia （PML） protein was observed by indirect immune fluorescent method. Results： Both IFN-α and IFN-γ could inhibit the proliferation and induce the differentiation of MR2 cells to some extent. The effects were more obvious after both interferons in combination with ATRA respectively （P〈0.05）. Moreover, the maturation of MR2 cells induced by IFN-γ＋ATRA group was more higher than that by IFN-α＋ATRA group （P〈0. 05）. Both interferons could induce the expressions of PML protein. Conclusion：Both interferons can inhibit MR2 cells proliferation, which may be related to the expression of PML protein induced by both interferons. The inducing differentiation effects of IFN-γ＋ATRA group on MR2 cells are more powerful than those of IFN-aq-ATRA group, which may be related to the different signal transduction pathway of both interferons.     

癫(癎)患儿月服用丙戊酸镁缓释片治疗前后认知功能的变化

目的观察丙戊酸镁缓释剂治疗癫的疗效及其对癫患儿认知功能的影响。方法对38例患儿予丙戊酸镁缓释剂治疗,并密切观察其发作控制的程度、服药期间的不良反应,定期复查肝功能和血常规,治疗前、治疗后6个月分别予患儿智商、P300测定,与正常对照组40例比较。结果完全控制18例(47.4%),显效11例(28.9%),有效6例(15.8%),无效3例(7.9%),总有效率92.1%;治疗前、治疗后6个月癫组智商与正常对照组相比,差异均有显著性(P均<0.01);治疗后6个月癫患儿的P300潜伏期、波幅治疗6个月后较治疗前有所改变,但均无显著性差异(P均>0.05)。结论丙戊酸镁缓释剂治疗儿童癫疗效显著,使用方便,无明确的不良反应,且对儿童认知功能的影响不明显。     

正常幼儿畸变产物耳声发射听力筛查

目的探讨畸变产物耳声发射(DPOAE)在幼儿听力筛查中的应用。方法应用DPOAE对100名幼儿园儿童(200耳)进行听力筛查,纯音对2、3、4 kHz 3个频率两次测试,耳声发射响应点在通过/转介线以上,信噪比>10 dB为筛查通过。结果94名儿童双耳通过筛查,4名儿童因耵聍栓塞双耳未通过筛查,取出耵聍后复筛通过;2名儿童单耳因分泌性中耳炎未通过筛查,治疗后复筛通过。结论DPOAE适用于幼儿听力筛查,建议将其列为每年的幼儿体检项目。     

早产儿脑室周围白质软化的发病机制

脑室周围白质软化(PVL)为早产儿所特有的缺氧缺血性脑损伤。PVL发病机制主要与早产儿血管发育缺陷、发育阶段特异相关的少突胶质细胞前体对多种损伤因素高度敏感及早产儿体内缺乏保护机制有关,PVL早期多无明显临床表现,诊断依赖影像学诊断。头颅B超、MRI弥散成像、脑电图、近红外光谱测定有助于诊治。目前尚无有效治疗方法。