Orem自理模式在90例口腔鳞癌患者游离组织瓣移植术后的应用价值评价

目的 探讨Orem自理模式在口腔鳞癌患者游离皮瓣移植术后护理中的应用效果。方法 选择上海交通大学医学院附属第九人民医院浦东分部口腔综合病房2019年8月—2020年9月接受游离组织瓣移植术治疗的90例口腔鳞癌患者为研究对象,随机分为常规组（42例）和管理组（48例）。常规组采取常规护理模式,管理组在常规护理的基础上采用Orem自理模式干预的综合护理模式。采用心理状态评估量表(MSSNS)评估2组患者的心理状态,比较2组患者术后的心理状态,分析干预后2组患者生活质量改善情况以及并发症发生情况。采用SPSS 25.0软件包进行统计学分析。结果 管理组的不良情绪发生率低于常规组,差异有统计学意义（P<0.05）。管理组干预后的各项功能领域指标均高于常规组,并发症发生率低于常规组,差异均有统计学意义（P<0.05）。结论 对行游离组织瓣移植术口腔鳞癌患者采用Orem自理模式的综合护理模式,能够改善患者的心理状态,有利于减少术后并发症发生、缩短住院时间、改善患者生活质量,促进患者尽快康复。     

生长因子在牙槽骨组织再生中的应用与研究进展

实现牙槽骨组织再生是口腔医学领域的热门研究方向。许多国内外研究表明,生长因子在牙槽骨组织再生中起到重要作用,无论是在口腔种植,牙周治疗,还是拔牙位点保存等多个领域均有广阔的应用前景。本文对生长因子在口腔领域中促进牙槽骨组织再生的应用及研究进展进行综述。     

Lesões Plexiformes em Modelo Experimental de Hipertensão Arterial Pulmonar Induzida por Monocrotalina

Background The monocrotaline (MCT)-induced pulmonary arterial hypertension model is one of the most reproduced today, presenting as a limitation the absence of plexiform lesions, typical manifestations of the severe disease in humans.Objective To evaluate the severity of MCT-induced pulmonary arteriopathy by pathological findings of lung and heart tissue samples, clinical course and 37-day survival.Methods Fifty male Wistar rats were divided into one of the four groups – control (CG) (n = 10) and three intervention (MCT) groups. The MCT groups received intraperitoneal injection (60 mg/kg) of MCT and remained exposed to the substance for 15 days (G15, n = 10), 30 days (G30, n = 10) and 37 days (G37, n = 20). At the end of each period, the animals were sacrificed, and pulmonary and cardiac tissues were collected for anatomopathological and morphometric analysis. The Kruskal-Wallis test was used, considering a level of significance of 5%.Results In the lungs of MCT animals, lesions related to pulmonary arteriopathy were found, including muscularization of the arterioles, hypertrophy of the middle layer and concentric neointimal lesions. Complex lesions were observed in MCT groups, described as plexiform and plexiform-like lesions. Right ventricular hypertrophy was evidenced by increased thickness and diameter of the cardiomyocytes and a significant increase in the right ventricular wall thickness (p <0.0000).Conclusion The MCT model was able to generate moderate-severe pulmonary arteriopathy associated with secondary right ventricular hypertrophy. The 37-day survival rate was 50%. To our knowledge, this study was the first to note the presence of complex vascular lesions, similar to those observed in patients with severe pulmonary arterial hypertension, in an isolated MCT model. (Arq Bras Cardiol. 2020; 115(3):480-490)     

护士职业精神及其影响因素的研究进展

阐述护士职业精神的概念与内涵,介绍国外护士职业精神测评工具研究现状,综合论述了护士职业精神的影响因素包括个人因素、组织因素和职业因素,并提出构建我国护士职业精神的理论体系和评价方式、倡导护士职业精神培育和营造健康的护理职业环境等建议,为发展我国护士职业精神理论和提高护士职业精神提供参考。     

Are There Differences in Arteriovenous Fistulae Created for Hemodialysis between Nephrologists and Vascular Surgeons?

ObjectiveMany studies have reported insufficient support from surgical services, resulting in nephrologists creating arteriovenous fistulas in many centers. The aim of this study was to compare risk factors of arteriovenous fistula dysfunction in patients whose fistulas were created by nephrologists versus vascular surgeons.MethodsThis was a retrospective, analytical study of interventions by nephrologists and vascular surgeons during a period of 15 years. Out of a total of 1,048 fistulas, 764 (72.9%) were created by nephrologists patients, while vascular surgeons were responsible for 284 (27.1%) fistulae. Laboratory, demographic, and clinical parameters which might affect functioning of these arteriovenous fistulae were analyzed.ResultsPatients whose arteriovenous fistula was formed by nephrologists differed significantly from those created by vascular surgeons in relation to the preventive character of the arteriovenous fistula (p = 0.011), lumen of the vein (p < 0.001) and systolic blood pressure (p = 0.047). Multivariate logistic regression of arteriovenous fistula dysfunction showed that risk factors were female gender (odds ratio [OR] = 1.56, 95% CI 1.16–2.07), whether the fistulae were created by vascular surgeons or nephrologists (OR = 1.38; 95% CI 1.01–1.89) and the site of the arteriovenous fistula (OR = 0.64; 95% CI 0.48–0.85).ConclusionsArteriovenous fistulae created by vascular surgeons, female gender, and the location are risk factors of dysfunction.     

短肽型肠内营养指导在胎儿生长受限孕妇中的应用效果

目的 探究短肽型肠内营养指导应用于胎儿生长受限孕妇中的效果。方法 选取2017年9月至2019年5月如皋市人民医院收治的胎儿生长受限孕妇的116例,采用随机数字表法分为对照组和观察组,各58例。对照组给予常规营养指导,观察组给予短肽型肠内营养指导。对比干预1周后两组孕妇宫高、腹围与体质量情况,胎儿双顶径、头尾、腹围、股骨长、体质量及孕妇护理满意度。结果 干预前,两组孕妇宫高、腹围与体质量差异无统计学意义（P>0.05）;干预后,观察组宫高、腹围与体质量的差值均高于对照组,差异有统计学意义（P<0.05）;干预前,两组胎儿双顶径、头尾、腹围、股骨长及体质量差异无统计学意义（P>0.05）。干预后,观察组胎儿双顶径、头尾、腹围、股骨长及体质量的差值均高于对照组（P<0.05）。观察组干预1周后孕妇满意度高于对照组,差异有统计学意义（P<0.05）。结论 短肽型肠内营养指导应用于胎儿生长受限孕妇中,可提高孕妇宫高与腹围、胎儿双顶径与头尾,并提高孕妇护理满意度,值得推广。     

沙利度胺联合放疗治疗食管癌长期生存分析

目的 研究沙利度胺下调食管癌患者放疗中血清血管内皮生长因子(vascular endothelial growth factor,VEGF)水平对食管癌患者长期生存的影响。方法 根据81例食管癌患者放疗中血清VEGF水平分为用药组(沙利度胺)32例和未用药组49例,通过随访观察分析其总生存率(OS)和无进展生存率(PFS),根据32例使用沙利度胺处理后的血清VEGF水平变化,又分降低组20例和升高组12例,分析其OS和PFS。对预后因素进行单因素和多因素分析。结果 用药组和未用药组的中位生存期及1、3年生存率分别为17.0个月、59.4%、31.5%和18.7个月、56.4%、28.6%;两组的OS和PFS分别比较,差异均无统计学意义。VEGF水平降低组和升高组的中位生存期及1、3年生存率分别为19.7个月、65.0%、42.1%和10.7个月、43.3%、8.3%;两组OS和PFS比较,差异均有统计学意义(χ²=4.345、4.157,P<0.05)。多因素分析显示,临床分期是食管癌患者总生存率的独立预后因素,性别、病变部位对患者预后没有影响。结论 对于用药后VEGF水平降低患者,沙利度胺联合放疗能够增加食管癌患者远期疗效。