健康教育在小儿哮喘护理中的临床应用效果

目的：评价健康教育在小儿哮喘护理中的临床应用效果。方法：取我院哮喘患儿90例展开调查,依据电脑随机分配法分组,对照组(常规护理)和观察组(健康教育)各45例,评价对比两组患儿干预效果。结果：干预前两组患儿的肺功能指标和各项生活质量对比差异无意义,干预后观察组患儿的各指标与对照组比较,统计差异有意义(P<0.05);观察组患儿干预后的各项遵医行为评分均显著比对照组高,统计结果P<0.05;相比于对照组,观察组患儿家长对健康知识的掌握度更高,结果P<0.05。结论：在小儿哮喘护理中实施个性化健康教育,不仅能规范患儿的治疗行为,还能提高其生活质量,改善肺功能,值得临床推广。     

回授法对支气管哮喘患者吸入技术的影响

目的 探讨回授法对支气管哮喘患者吸入技术的影响,为回授法的推广及支气管哮喘患者吸入技术的改善提供参考依据.方法 选取我院呼吸科2013年1月至2014年12月收治的支气管哮喘患者60例,按照随机数字表法分为观察组和对照组各30例,均接受吸入技术讲解,观察组患者加用回授法.比较两组患者吸入技术的掌握程度.结果 两组患者干预4周后健康知识、健康信念、健康行为、健康技能及健康素养总分均显著提高,观察组变化更为明显,差异有统计学意义(P<0.05).两组患者吸入装置打开错误、上药错误发生率比较,差异均无统计学意义(P>0.05);观察组患者呼气错误、吸药错误、屏气错误、漱口错误发生率均显著低于对照组,差异有统计学意义(P<0.05).结论 回授法能够显著提高支气管哮喘患者吸入技术及健康素养、降低吸入操作的错误率,有望提高患者临床症状控制效果,值得推广应用.     

支架辅助弹簧圈治疗颅内复杂动脉瘤

目的探讨支架辅助弹簧圈治疗颅内复杂动脉瘤的方法和疗效。方法本组17例复杂颅内动脉瘤,1例采用2枚支架重叠置入动脉瘤段载瘤动脉内,16例经支架网眼送入弹簧圈行瘤腔栓塞。结果17例置入支架20枚,其中1例栓塞后出现肢体轻度麻木无力,对症处理后恢复;7例夹层动脉瘤和1例梭形动脉瘤疏松填塞。随访6￣24个月。DSA复查,示8例动脉瘤消失,1例发现置入支架上段又出现夹层动脉瘤,再次置入支架1枚及弹簧圈栓塞后,动脉瘤消失。1例置入2枚支架者1年后MRA复查示动脉瘤缩小70%。1例栓塞后2个月出现短暂性脑缺血发作者,行TCD检查,发现支架段血管狭窄,服抗凝药继续观察;其余6例行MRA、CTA检查未见动脉瘤复发。结论支架辅助弹簧圈治疗颅内复杂动脉瘤是行之有效的方法。     

自体全血在慢性难愈合创面中的应用研究进展

慢性难愈合创面的治疗具有耗时长、费用高、难治愈等特点.近年来,随着慢性难愈合创面发病原因及防控关键技术的进一步研究,其诊疗技术逐渐呈现多样化,且最近研究发现,自体全血中含有的血浆及具有生物活性、生物相容性以及代谢活性等的活细胞能够通过促进修复细胞的增殖、分化,缩短炎症反应期,加快肉芽组织生长等多种途径加速创面的愈合,且...     

辅助性T细胞在支气管哮喘患者的表达及其意义探讨

目的探讨CD+4CD+29辅助性T细胞在支气管哮喘发病机制的作用。方法选取非急性发作期支气管哮喘患者及肺炎患者各30例,以及30例健康志愿者作为对照,使用流式细胞术检测外周血CD+4CD+29辅助性T细胞及其胞内细胞因子γ干扰素(IFN-γ)及白介素4(IL-4)的频率。哮喘患者使用氨茶碱片进行治疗,4周后复测CD+4CD+29T细胞及其细胞因子。结果哮喘患者患者CD+4CD+29T细胞及IL-4均明显高于肺炎组及健康志愿者组(P0.05),但后两者无组间统计学差异;哮喘组与肺炎组IFN-γ无组间显著性差异,但均显著低于对照组(P0.05)。治疗后哮喘组患者CD+4CD+29T细胞含量明显降低,IFN-γ明显回升,IL-4明显下降(均为P0.05)。结论 CD+4CD+29辅助性T细胞含量升高是哮喘的一个免疫机制,该细胞分泌的IL-4诱发Th2类免疫反应,可介导哮喘的体液免疫从而加重病情。     

Assessment of Inhalation Technique in Children in General Practice: Increased Risk of Incorrect Performance with New Device

In a general practice based population 76% of 530 children inhaling asthma medication inhaled correctly. However, important differences among inhalers were found. Children with a pressurized metered-dose inhaler without a spacer device performed worst, with only 22% inhaling without essential errors. At a second evaluation of the inhaler technique, one year after the first assessment, performances with a new device were more often incorrect versus the unchanged devices (21.1% and 10.8%, respectively; p = 0.01). Providing children with a new device should be carefully controlled over time especially because these children are error prone.     

Beliefs About Asthma Medications: Patients Perceive Both Benefits and Drawbacks

Patients have diverse beliefs about asthma medications that may be influenced by asthma characteristics. The objective of this qualitative analysis was to identify patients' beliefs about asthma medications and to assess these beliefs according patient and asthma characteristics, including asthma severity and patient-reported medication adherence. From interviews with 52 patients (mean age 43 years, 87% women, 71% taking maintenance medications), 17 categories of beliefs about medications were discerned which were grouped into perceived benefits (e.g., permit activities, thwart symptoms) and perceived drawbacks (e.g., establish a medication routine, ensure supply). Beliefs were not mutually exclusive, with 56% of patients citing both benefits and drawbacks. Beliefs did not differ based on asthma severity or type of current therapy, however, patients who cited drawbacks were more likely to have worse self-reported Morisky Medication Adherence Questionnaire scores (possible range 0–4, higher is worse adherence) compared to those who did not cite drawbacks (1.9 ± 1.3 vs 0.9 ± 0.9; p =. 02). Providers should be aware of patients' beliefs about medications in order to reinforce perceived benefits and address perceived drawbacks.     

Relationship Between Peak Expiratory Flow Rate and Shoulders Posture in Healthy Individuals and Moderate to Severe Asthmatic Patients

Introduction. Asthma overloads respiratory muscles causing changes in posture. Objectives. To evaluate shoulder position in asthmatics and its correlation to the peak expiratory flow rate (PEFR). Methods. A cross-sectional study involving 19 asthmatics (study group) and 20 healthy volunteers (control group). Assessment of PEFR was used to determine airway obstruction. Shoulder position was quantified as the ratio between the front and back measurements, in centimeters, of the distance between the two outermost points of each scapula. Shoulder position measurement (SPM) ratio data from both groups were compared and correlated to PEFR. Results. The asthmatics presented lower PEFR (279 ± 64 L/min) and SPM (0.88: range 0.83–0.9) than did control subjects (555 ± 100 L/min and 0.97: range 0.95–1, respectively) (p < 0.001). There was a correlation between PEFR and SPM (asthmatics r = 0.8; controls r = 0.5). Conclusion. Determining SPM ratios allowed us to identify those postural alterations that correlated with pulmonary function in asthmatics and in healthy individuals. Further investigation is needed before SPM can be used as a tool for clinical evaluation of asthma patients.     

孟鲁司特钠治疗儿童哮喘的临床症状和肺功能评估

目的观察孟鲁司特钠对哮喘儿童的临床症状以及肺功能改变的影响。方法收集2010年1月~2013年12月我院哮喘专科门诊支气管哮喘急性发作的患儿共450例,随机分为治疗组(加用孟鲁司特钠)和对照组,观察患儿治疗前、治疗后、治疗3个月及停药3个月(即6个月)时的日间和夜间临床症状及测定患儿的肺功能(用力肺活量、最大吸气后用力快速呼气1秒用力呼气量、呼气峰流速)。结果治疗前两组患儿日间哮喘症状评分、夜间哮喘症状评分、肺功能(用力肺活量、最大吸气后用力快速呼气1秒用力呼气量、呼气峰流速)无显著差别(P0.05),治疗后、3个月、6个月时治疗组患儿的日间哮喘症状评分、夜间哮喘症状评分降低,肺功能(用力肺活量、最大吸气后用力快速呼气1秒用力呼气量、呼气峰流速)较对照组改善,两组比较均有统计学差异(P0.05),且治疗组3个月后患儿哮喘的临床控制率、显效比例,较对照组增加,差异有统计学差异(P0.05),治疗有效率对照组为(76.92%),治疗组为(91.32%),两组间差异有统计学意义(P0.05)。结论孟鲁司特钠不仅能控制哮喘临床症状,还能改善肺功能。