老年睑板腺功能障碍蠕形螨感染率及茶树精油联合氟米龙的疗效

目的：研究老年睑板腺功能障碍(MGD)蠕形螨感染率及茶树精油联合氟米龙的疗效。

方法：回顾性病例对照研究。选择2017-09/2018-03在宁波市眼科医院门诊就诊的老年MGD患者59例118眼。将睫毛蠕形螨镜检为阳性的38例患者76眼进行症状评分、蠕形螨数量、泪膜破裂时间(BUT)、角膜荧光素染色(FL)、Schirmer I试验(SIaT)等检查,并按不同治疗方法分成3组,A组使用0.02%氟米龙滴眼液滴眼24眼; B组使用茶树精油(TTO)湿巾敷眼26眼; C组用0.02%氟米龙滴眼液滴眼联合TTO湿巾敷眼26眼,随访4wk。

结果：118眼中76眼(64.4%)睫毛蠕形螨镜检为阳性。睫毛蠕形螨阳性的三组患者治疗后的主观症状评分均较治疗前有改善(P<0.05)。治疗后A组蠕形螨数量较治疗前无显著差异(P=0.11); B、C组较治疗前明显减少(均P<0.01)。三组患者BUT治疗前后比较,A组BUT无显著差异(P=0.22); B、C组BUT明显延长(均P<0.05)。治疗后C组的BUT较A、B组明显延长(均P<0.05)。三组患者治疗前后的FL评分均较治疗前明显改善(P<0.05)。

结论：老年MGD患者睫毛蠕形螨感染率较高,睑板腺热疏通后TTO湿巾联合0.02%氟米龙滴眼液能有效驱螨、缓解MGD患者局部症状。     

Neuromuscular electrical stimulation in the intensive care unit prevents muscle atrophy in critically ill older patients: A retrospective cohort study

Critically ill patients in the intensive care unit (ICU) develop muscle atrophy and decreased physical function. Though neuromuscular electrical stimulation (NMES) therapy has been shown to be effective in preventing this, but its effect on older patients is unknown.To examine the course of critically ill older patients treated with NMES in the ICU and to define the impact of its use.A retrospective cohort study was conducted using older ICU patients (≥65 years) categorized into a control group (n = 20) and an NMES group (n = 22). For subgroup analysis, each group was further classified into pre-old age (65–74 years) and old age (≥75 years).The control group showed significant decrease in muscle thickness during ICU and hospital stay. The NMES group showed lower reduction in muscle thickness and showed decrease in muscle echo intensity during hospital stay, compared to the control group. NMES inhibited decrease in muscle thickness in the pre-old age group versus the old age group. The decreasing effect of NMES on echo intensity during hospital stay manifested only in the pre-old age group. We did not find much difference in physical functioning between the NMES and control groups.Lower limb muscle atrophy reduces in critically ill older patients (≥65 years) with NMES and is pronounced in patients aged < 75 years. The impact of NMES on the physical functioning of older patients in ICU needs to be further investigated.     

微白蛋白尿与危重患者预后

微白蛋白尿被认为是反映全身毛细血管渗透性增加的一个重要指标.目前,已经发现许多常见的内科疾病如:糖尿病、肾脏疾病和心血管疾病,都会出现微白蛋白尿,且有文献报道微白蛋白尿与危重患者的预后相关.本文就微白蛋白尿与危重患者预后的关系、预测危重患者疾病严重程度的价值进行简要综述.     

健康教育路径对提高肠造口病人自我护理能力的效果观察

目的 探讨健康教育路径对提高肠造口病人自我护理能力的效果.方法 将83例肠造口病人随机分为观察组(42例)和对照组(41例,),观察组采用肠造口病人健康教育路径方法,对照组采用随机健康教育方法.结果 两组病人在自我护理能力和满意度的差异均有统计学意义(P<0.05).结论 对肠造口病人采用健康教育路径方法,能提高病人的自我护理能力和满意度.     

口腔修复门诊老年病人心理特点分析及对策

老年患者占口腔修复科临床接诊病人的很大部分，本文从医学伦理学角度入手对门诊老年病人心理状态进行分析，探讨相应对策，以寻求临床上医患更好地合作。作者的建议主要包括：(1)提高医师自身综合素质。(2)尊重、爱护老年患者，满足老年患者的合理要求。(3)治疗过程中应树立高度的道德责任感与正确的伦理道德观。     

多形式健康教育干预对老年COPD患者健康行为的影响*

目的：探讨多形式健康教育对老年COPD患者健康行为的影响。方法：将76例老年COPD患者分为试验组40例,对照组36例,试验组患者在讲座教育、个体化教育与出院随访中运用多媒体、健康教育手册、口头宣教、技能示范、网络学习、经验介绍等多形式健康教育进行干预,对照组按常规方式进行健康教育。在干预前与干预6个月后,对两组患者进行焦虑情绪、家庭支持、控烟情况及呼吸功能锻炼依从性评价。结果：干预6个月后试验组患者焦虑情绪、家庭支持、控烟情况及呼吸功能锻炼依从性比对照组患者有所缓解,差异有统计学意义（P<0.05）。结论：多形式健康教育可缓解老年COPD患者的焦虑情绪,提高家庭支持率,降低吸烟率,提高呼吸功能锻炼依从性。运用健康信念模式教育可明显提高老年COPD患者的自我护理能力,提高患者的生存质量。     

大龄近视患者LASIK的特点及临床分析

目的:探讨对大龄近视患者施行准分子激光原位角膜磨镶术(LASIK)的手术设计特点及疗效。方法:对48例、96眼≥40岁的近视患者行LASIK治疗,并对术前屈光度、预矫度数、手术疗效等与对照组(<40岁,54例、108眼)进行比较分析。结果:大龄近视患者术后6月时远视力平均为0.97±0.30,虽然低于同期低龄对照组足矫视力(1.18±0.19),但优于拟矫度数眼镜时对应的平均视力(0.74±0.16)。近视力达到J1的比例低于对照低龄组,干眼的症状比低龄组明显。结论:大龄近视患者进行LASIK手术安全、有效。鉴于年龄所造成的老视,需减少实际度数矫正,以兼顾术后远、近视力。     

女性尿毒症患者血液透析前后心理变化

目的：研究女性尿毒症患者开始血液透析前后的心理变化。方法在血液透析前及血液透析后2月,采用症状自评量表（ SCL-90-R）进行调查。结果所选72例女性尿毒症患者血液透析前躯体化,强迫,抑郁,恐怖,精神病性心理变化高于血液透析后,前后比较具有显著性差异（t值分别为6．207、10．160、3．425、9．596和5．808,均P＜0．01）,血液透析前后人际关系、焦虑、敌对、偏执比较无显著性差异（t值分别为1．069、1．058、1．758和1．944,均P＞0．05）。结论女性尿毒症患者透析前后心理变化不同,血液透析可减轻女性尿毒症患者的心理负担。     

重症患者发生腹泻的相关因素分析和护理现状(综述)

重症患者因基础疾患多、免疫功能低下、抗生素联合长期应用、侵袭性操作多及肠内营养等因素,易导致腹泻,既加重了患者原有的病情,延长了病程,又增加了经济负担。目前重症患者腹泻的预防和处理已成为护理研究的重要内容,越来越受到人们的重视。     

Can Botulinum Toxin-A Contribute to Reconstructing the Physiological Homeostasis of the Masticatory Complex in Short-Faced Patients during Occlusal Therapy? A Prospective Pilot Study

The physiological homeostasis of the masticatory complex in short-faced patients is too robust to be disintegrated and reconstructed due to the powerful masseter muscle. This study innovatively introduced the botulinum toxin-A (BTX-A) into the field of dental occlusal treatment, providing a novel and minimally invasive therapy perspective for the two major clinical problems in these patients (low treatment efficiency and high rates of complications). In total, 10 adult patients with skeletal low angle seeking occlusal treatment (age: 27.0 ± 6.1 years; 4 males and 6 females) were administered 30–50 U of BTX-A in each masseter muscle and evaluated before and 3 months after injection based on cone-beam computed tomography (CBCT). We found a significant reduction in the thickness of the masseter muscle (MMT) (p < 0.0001). With regards to occlusion, we found a significant increase in the height of the maxillary second molar (U7-PP) (p < 0.05) with significantly flattened occlusal curves (the curve of Spee [COS] (p < 0.01), and the curve of Wilson [COW] (p < 0.05)). Furthermore, the variations in the temporomandibular joint exhibited a significant reduction in the anterior joint space (AJS) (p < 0.05) and superior joint space (SJS) (p < 0.05). In addition, the correlation analysis of the masticatory complex provided the basis for the following multiple regression equation: MMT = 10.08 − 0.11 COW + 2.73 AJS. The findings from our pilot study indicate that BTX-A, as a new adjuvant treatment attempt of occlusal therapy for short-faced patients, can provide a more favorable muscular environment for subsequent occlusal therapy through the adjustment of the biting force and may contribute to the reconstruction of healthier homeostasis of the masticatory complex. However, further research is required to establish the reliability and validity of these findings.