护患交流在整体护理中的应用

不论是责任制护理还是整体护理，均以护理程序作为核心，而护患交流在护理程序中起着重要的作用。随着医学模式的转变和护理观念的更新，以病人为中心的整体护理模式正逐步地取代原有的护理模式。护患交流使护士了解病人的身心状况，促进护患间的理解与支持，提高护理质量。护患交流包括以下几方面。     

前列通瘀提取液对前列腺平滑肌细胞增殖与凋亡的作用

目的:研究前列通瘀提取液对体外培养前列腺基质平滑肌细胞增殖与凋亡的作用。方法:分别以1、2、10、50、100×10-5g/L 5种不同浓度前列通瘀提取液作用体外培养前列腺基质平滑肌细胞,采用MTT和TUNEL法分别测定抗增殖指数和凋亡指数。结果:5种不同浓度前列通瘀提取液作用48 h后抗增殖指数分别为50.61%、53.52%、56.92%、65.53%、72.94%,抗增殖效果随着浓度增大而增大。100×10-5g/L前列通瘀提取液作用24、48、72 h后凋亡指数与对照组比较差异无显著性。结论:(1~100)×10-5g/L前列通瘀提取液体外作用前列腺基质平滑肌细胞具有显著的抗增殖作用。     

载氧血红蛋白纯化工艺研究

目的改善心脑血管缺氧载氧药物是一种创新药物。由于它半径比红细胞小400~1 000倍,易于通过毛细血管,给缺血组织及时供氧,迅速缓解或纠正缺氧状态,达到治疗抢救目的。血红蛋白的纯化工艺是载氧药物研制的重要工艺步骤。方法本研究建立了一套通过热敏法分离纯化人脐带血血红蛋白的工艺以及较为完善的纯化血红蛋白质量检测指标。结果与现有的纯化方式相比,热敏法操作简便,仪器设备造价低廉,纯化与病毒灭活同时进行,得到的纯化产品损失少,纯度高,各项理化指标达到国际水平。结论本工艺适用于规模制备纯化血红蛋白,为进一步研制治疗心脑血管缺氧载氧药物创造了有利条件。     

曲安奈德PLGA微球对兔上腭部创面瘢痕形成影响的实验研究

目的:探讨曲安奈德PLGA微球对创面瘢痕愈合中瘢痕生成的抑制作用,研究局部应用曲安奈德的最佳给药途径。方法:3组共24只兔的上腭部创面模型,分别应用曲安奈德PLGA微球以及曲安奈德悬浊液,在瘢痕形成不同时间后切取瘢痕标本进行HE、VG染色及酶组织化学染色并电镜观察其组织形态学改变来分析曲安奈德不同给药途径的差异。结果:三组兔上腭创面愈合时间不同,表面颜色、质地不一样。电镜、常规染色以及免疫组织化学染色皆说明曲安奈德PLGA微球有明显的瘢痕抑制作用,且效果高于曲安奈德悬浊液。结论:曲安奈德PLGA微球能抑制瘢痕的增殖过程,使瘢痕组织纤维化过程明显减轻。合并手术一次性给药治疗瘢痕有很好的临床价值。     

深静脉血栓形成患者凝血因子ⅩⅢ Val34Leu基因多态性检测

目的:探讨凝血因子ⅩⅢ(FⅩⅢ)Val34Leu基因多态性与中国人群深静脉血栓形成(DVT)发病的相关性.方法:利用聚合酶链反应和限制性片段长度多态性(PCR-RFLP)方法,检测了103例DVT患者与106例正常对照的FⅩⅢVal34Leu基因多态,并加以对照分析.结果:103例DVT患者FⅩⅢVa134Leu基因型均为野生型V/V,未见突变类型;106例对照组中发现1例突变杂合子V/L.2组基因型频率、等位基因频率相互比较,差异均无统计学意义(P＞0.05).结论:FⅩⅢVal34Leu对中国人群DVT有保护作用的可能性极小.     

The effect of skin surface warming during anesthesia preparation on preventing redistribution hypothermia in the early operative period of off-pump coronary artery bypass surgery.

OBJECTIVE: Redistribution hypothermia adversely affects hemodynamics and postoperative recovery in patients undergoing cardiac surgery. In off-pump coronary bypass surgery (OPCAB), maintaining the temperature is important because warming by cardiopulmonary bypass is omitted. Pre-warming studies reported earlier showing pre-warming as an effective means of preventing redistribution hypothermia was time consuming since it required at least 1-2h to pre-warm the patients before the surgery. Because pre-warming for such a long time is impractical in clinical practice, this study evaluated the efficacy of active warming during the preanesthetic period for the prevention of redistribution hypothermia in the early operative period of OPCAB. METHODS: After gaining the approval of Institutional Review Board and informed consent from the patients, 40 patients undergoing OPCAB were divided into control and pre-warming groups. The patients in control group (n=20) were managed with warm mattresses and cotton blankets, whereas patients in pre-warming group (n=20) were actively warmed with a forced-air warming device before the induction of anesthesia. Hemodynamic variables and temperature were recorded before anesthesia (Tpre) and at 30 min intervals after anesthesia for 90 min (T30, T60, and T90). RESULTS: Active warming duration was 49.7+/-9.9 min. There were no statistically significant differences in skin temperature, core temperature and hemodynamic variables between the two groups at preinduction period except for mean arterial pressure and central venous pressure. The core temperature at T30, T60, and T90 was statistically higher in pre-warming group than that in control group. Core temperature of six (30%) and seven patients (35%) in control group was reduced below 35 degrees C at T60 and T90, respectively, whereas core temperature of only one patient (5%) in pre-warming group was reduced below 35 degrees C at T90 (P=0.02). CONCLUSIONS: Active warming using forced air blanket before the induction of anesthesia reduced the incidence and degree of redistribution hypothermia in patients undergoing OPCAB. It is a simple method with reasonable cost, which does not delay the induction of anesthesia nor the surgery.     

Serial CT findings of Paragonimus infested dogs and the Micro-CT findings of the worm cysts.

OBJECTIVE: To investigate the serial CT findings of Paragonimus westermani infected dogs and the microscopic structures of the worm cysts using Micro-CT. MATERIALS AND METHODS: This study was approved by the committee on animal research at our institution. Fifteen dogs infected with P. westermani underwent serial contrast-enhanced CT scans at pre-infection, after 10 days of infection, and monthly thereafter until six months for determining the radiologic-pathologic correlation. Three dogs (one dog each time) were sacrificed at 1, 3 and 6 months, respectively. After fixation of the lungs, both multi-detector CT and Micro-CT were performed for examining the worm cysts. RESULTS: The initial findings were pleural effusion and/or subpleural ground-glass opacities or linear opacities at day 10. At day 30, subpleural and peribronchial nodules appeared with hydropneumothorax and abdominal or chest wall air bubbles. Cavitary change and bronchial dilatation began to be seen on CT scan at day 30 and this was mostly seen together with mediastinal lymphadenopathy at day 60. Thereafter, subpleural ground-glass opacities and nodules with or without cavitary changes were persistently observed until day 180. After cavitary change of the nodules, the migratory features of the subpleural or peribronchial nodules were seen on all the serial CT scans. Micro-CT showed that the cyst wall contained dilated interconnected tubular structures, which had communications with the cavity and the adjacent distal bronchus. CONCLUSION: The CT findings of paragonimiasis depend on the migratory stage of the worms. The worm cyst can have numerous interconnected tubular channels within its own wall and these channels have connections with the cavity and the adjacent distal bronchus.     

烧伤后早期应用中/长链甘油三酯对患者免疫功能的影响

目的　探讨烧伤后早期肠内喂养中链甘油三酯 (MCT) /长链甘油三酯 (LCT)对机体免疫功能的影响及其可能机制。　方法　选取 30例烧伤面积 >30 %TBSA的患者 ,随机分为两组 (每组 15例 )。F组 ,饲以含MCT/LCT的肠内营养制剂Fresubin 75 0MCT ;N组 ,饲以只含LCT的肠内营养制剂Nutrison。于伤后 2 4h内进行完全肠内营养支持 ,共持续 10d。于伤后 1、4、7、10d检测两组患者血浆白细胞介素 (IL) 2、IL 4、前列腺素 (PG)E2 及外周血T淋巴细胞转化率的改变。　结果　伤后各时相点F组患者血浆IL 2水平与N组相比 ,无明显差异 (P >0 .0 5 ) ;伤后 4dF组PGE2 水平较N组明显降低 (P <0 .0 1) ;伤后 4、7、10dF组IL 4水平及外周血T淋巴细胞转化率均明显高于N组 (P <0 .0 5～ 0 .0 1)。　结论　在改善烧伤后机体的免疫功能方面 ,含MCT/LCT的肠内营养制剂较单纯LCT制剂更具优势。     

三联药物治疗未破裂异位妊娠的临床研究

目的 :观察甲氨蝶呤(Methotrexate,MTX)、米非司酮(Mifepristron,Ru486)及中药三联用药治疗未破裂型异位妊娠的临床疗效。方法 :对171例未破裂型异位妊娠病人 ,按药物治疗方法不同分为两组进行对照研究 :A组使用MTX注射 +Ru486口服 +中药联合治疗。B组单独使用MTX注射治疗。测定法定期测定两组病人血HCG值以监测血HCG下降情况 ,测量异位妊娠包块三径线值以监测病灶包块缩小情况 ,同时观察临床症状持续时间、副反应发生率及总有效率。结果 :血HCG下降及病灶包块缩小A组较B组明显 ,差异有显著性(p<0 05,p<0 01);临床症状持续时间A组较B组短 ,差异有显著性(p<0 05);副反应发生率两组间无显著差异(p>0 05);A、B两组的总有效率分别为 :95 74%和71 43% ,A组较B组高 ,差异有显著性(p<0 05)。结论 :三联使用甲氨蝶呤、米非司酮及活血化瘀消包块杀胚的中药既有很强的杀胚功能 ,又能消除病灶包块 ,保留生育功能。三联药物联合治疗未破裂异位妊娠具有疗效肯定、安全