基层医院医患沟通技巧

作为工作在基层医院的医护工作者，掌握一些医患沟通技巧，对医院的长远发展和个人业务的开展都是十分必要的。现就本院的实际情况，发表一下个人观点。     

普通外科病人围手术期的护理

围手术期是指从患者入院准备接受手术治疗开始到与本次手术相关的治疗结束。围手术期护理不仅包括术前准备和术后护理，更重要的是将原本分离的术前、术中和术后三个阶段视为一个整体加以通盘考虑，更好地应对手术治疗过程中的各种情况，采取相应的护理措施，从而减少并发症促进患者康复取得满意的疗效。     

护理干预对老年高血压患者自我管理行为的影响研究

目的分析护理干预对老年高血压患者自我管理行为的影响。方法以174例老年高血压患者作为观察组,对患者进行综合护理干预,另选我院同期150例老年高血压患者作为对照组,对该组进行常规护理干预,对比两组护理前后患者健康知识知晓程度、依从性以及血压控制情况。结果观察患者接受综合护理干预后,健康知识得分、服药依从性和血压控制人数显著高于对照组,差异有统计学意义(P<0.05)。结论护理干预可提高老年高血压患者自我行为管理,护理干预值得应用和推广。     

硒芪合剂对肝细胞保护作用研究

目的研究硒芪合剂对肝细胞保护作用。方法通过给大鼠25％CCl4(0.2ml/100g),1/3d,sq,连续30d制备肝损伤模型,测定大鼠血清一些酶活性及某些肝维化指标。结果用硒芪合剂4.66g/d和2.33g/d治疗,连用60d,能显著预防CCl_4诱发肝损伤,能降低大鼠血清AST、ALT、GGT及LDH等。同时也能降低PCⅢ、LN、HA等。结论硒芪合剂对CCl_4诱发大鼠肝损伤有保护及治疗作用。其机制可能与该药具有抗氧化损伤,保护细胞膜有关。     

碘缺乏和甲状腺功能减退对大鼠仔鼠小脑细胞外信号调节激酶1/2蛋白表达的影响

目的 观察碘缺乏和甲状腺功能减退(甲减)对大鼠仔鼠小脑细胞外信号调节激酶1/2(extracellular signal-regulate kinase,ERK1/2)蛋白表达的影响.方法 健康Wistar大鼠28只,雌性,60日龄.将大鼠按体质量随机分为对照组、碘缺乏病组、甲减组,甲减组根据饮水中含丙基硫尿嘧啶(PTU)剂量分为5 mg/L组和15 mg/L组.每组各7只.母鼠妊娠后,分别选用低碘饲料及PTU饮水诱导建立低碘及甲减大鼠动物模型.仔鼠出生7、14、21、28、42 d时分别处死,测定仔鼠小脑质量;取小脑组织进行镀银染色和免疫组织化学链霉菌抗生物素蛋白-过氧化物酶(S-P)染色,光镜下观察小脑形态学变化,图像分析仪下观察ERK1/2蛋白表达.结果 仔鼠出生14、21、28、42 d时,小脑质量各组间比较差异有统计学意义(F=6.325、8.870、16.191、21.574,P均<0.05);碘缺乏病组仔鼠小脑质量[(0.0945±0.0233)、(0.1347±0.0046)、(0.1542±0.0094)、(0.1949±0.0048)g]明显低于对照组[(0.1856±0.0123)、(0.2049±0.0098)、(0.2268±0.0065)、(0.2606±0.0086)g,P均<0.05]和甲减组[5 mg/L组:(0.1741±0.0172)、(0.1927±0.0103)、(0.2181±0.0064)、(0.2583±0.0054)g,P均<0.05;15 mg/L组:(0.1604±0.0083)、(0.1682±0.0103)、(0.1996±0.0073)、(0.2579±0.0067)g,P均<0.05].出生7 d时,对照组、甲减组仔鼠小脑皮质具有典型的层状结构,各层之间界限清晰,但碘缺乏病组各层之间界限模糊;出生21 d时,与对照组比较,15 mg/L组和碘缺乏病组仔鼠小脑外颗粒细胞消失延迟,仍有2～3层外颗粒细胞;出生28、42 d时,甲减组和碘缺乏病组仔鼠小脑分子层厚度低于对照组.小脑组织ERK1/2平均积分光密度,在出生7 d时,组间比较差异无统计学意义(F=1.102,P>0.05);在出生14、21、28、42 d时,各组间比较差异有统计学意义(F=16.131、13.543、26.953、41.583,P均<0.01);碘缺乏病组(7.3245±0.5070)、(8.3606±1.0683)、(9.1217±1.0402)、(12.1587±0.7581)和甲减组[5 mg/L组:(11.4307±15200)、(14.919±0.8497)、(169082±1.1130)、(15.7721±0.82913);15 ms/L组:(7.8538±0.9775)、(11.2461±0.8138)、(12.7800±1.3783)、(13.0871±1.1450)]明显低于对照组[(16.2831±0.5143)、(20.2653±0.9551)、(22.7485±1.0267)、(22.1725±0.9939),P均<0.01].结论 碘缺乏和甲减可使仔鼠小脑产生明显的形态学改变,降低大鼠仔鼠小脑组织ERK1/2蛋白表达.影响神经系统的发育.     

健康教育对乳腺癌患者非保乳术后患肢功能恢复的影响

目的 探讨健康教育对乳腺癌术后患者患肢功能恢复的作用.方法 98例单侧乳腺癌根治术后患者随机分为实验组和对照组,并对实验组实施健康教育.结果 实验组患者患侧肢体功能锻炼效果明显优于对照组,两组有明显差异性.结论 健康教育有助于乳腺癌术后患者功能恢复.     

碘缺乏和甲状腺功能减退对大鼠仔鼠小脑细胞外信号调节激酶1/2蛋白表达的影响

Objective To study the effects of iodine deficiency and hypothyroidism on protein expression of extracellular signal-regulate kinase(ERK1/2) in the cerebellum of rots. Methods Twenty-eight healthy Wistar rots, female, 60 days old, were randomly divided according to their body weight into control group, iodine deficient group and hypothyroidism groups. Hypothyroidism groups in accordance with drinking water containing propylthiouracil(PTU) were divided into doses of 5 mg/L and 15 mg/L groups, 7 rats in each group. Rats after pregnancy, iodine deficient rats were administered with iodine-deficient diet and hypothyroid rats were administered with PTU in drinking water. Pup's cerebellum in each group were weighed on day 14,21,28 and 42. Cerebellum tissue was observed for cerebellar morphology using silver staining and detected for ERK1/2 protein using immunohistochemistry on day 7,14,21,28 and 42. Results On day 14,21,28 and 42, cerebellum weight of pups from iodine-deficient[(0.0945±0.0233), (0.1347±0.0046), (0.1542±0.0094), (0.1949±0.0048)g]were significantly lighter than control[(0.1856±0.0123), (0.2049±0.0098), (0.2268±0.0065), (0.2606±0.0086)g, all P < 0.05]and hypothyroidism groups [for 5 mg/L group: (0.1741±0.0172), (0.1927±0.0103), (0.2181±0.0064), (0.2583±0.0054)g, all P<0.05; for 15 mg/L group: (0.1604±0.0083), (0.1682±0.0103), (0.1996±0.0073) and (0.2579±0.0067)g, all P< 0.05]the difference had statistical significance(F=6.325,8.870, 16.191 and 21.574, all P<0.05). Compared to the controls on day 7, iodine-deficient group didn't have clear layers; on day 21, disappearance of external granule cells from iodine-deficient and 15 mg/L groups was delayed, still two or three layer external granule cells remained; on day 28 and 42, molecular layer from 5, 15 mg/L and iodine-deficient groups and became thinner. Immunohistochemistry showed that on day 7, there was no statistical difference of integrated optical density average of ERK1/2, in all the groups(F=1.102, P>0.05); on day 14,21,28 and 42, integrated optical density average of ERK1/2 in iodine-deficient group[(7.3245±0.5070), (8.3606±1.0683), (9.1217±1.0402), (12.1587±0.7581), all P<0.01]and hypothyroidism groups [for 5 mg/L group: (11.4307±1.5200), (14.919±0.8497), (16.0082±1.1130), (15.7721±0.8293), all P< 0.01; for 15 mg/L group: (7.8538±0.9775), (11.2461±0.8138),(12.78±1.3783), (13.0871±1.1450), all P < 0.01]was significantly lower than those of controls [(16.2831±0.5143), (20.2653±0.9551), (22.7485±1.0267), (22.1725±0.9939), all P < 0.01], the difference having a statistical signifieance(F=16.131,13.543,26.953,41.583, all P<0.01). Conclusions Iodine deficiency and hypothyroidism during critical periods of brain development may change eerebellar morphology and down regulate the protein expression of ERK1/2, which may result in damage of cerebellum development.     

碘缺乏和甲状腺功能减退对大鼠仔鼠小脑cAMP反应元件结合蛋白表达的影响

目的 研究碘缺乏和甲状腺功能减退对大鼠仔鼠小脑cAMP反应元件结合蛋白(CREB)表达的影响.方法 分别选用低碘饲料及丙基硫尿啼啶(propylthiouracil,PTU)饮水诱导建立低碘及甲状腺功能减退Wistar大鼠动物模型,按体重随机分成对照组、甲状腺功能减退组(5 mg/L PTU组、15 mg/L PTU组)和碘缺乏组,出生后第14天(PN14)、PN21、PN28、PN42时,测定仔鼠小脑重量,PN7、PN14、PN21、PN28、PN42时取小脑组织进行免疫组织化学链霉菌抗生物素蛋白-过氧化物酶(SP)染色,用图像分析方法分析大鼠仔鼠小脑皮质CREB表达情况.结果 PN14、PN21、PN28、PN42时,碘缺乏组小脑重量显著低于对照组和甲状腺功能减退组(P＜0.05).PN7时,各组之间小脑组织CREB平均积分光密度值差别不明显,而PN14,PN21,PN28和PN42时,5、15 mg/L PTU组和碘缺乏组平均积分光密度值均低于对照组(P＜0.05).结论 碘缺乏和甲状腺功能减退可降低大鼠仔鼠小脑组织CREB表达,影响神经系统的发育.

Abstract：

Objective To study the effects of iodine deftcieney and hypothyrosis on protein expression of CREB in the cerebellum of rats.Methods Iodine deficient rats were administered with iodine-deficient diet and hypothyroid rats were administered with PTU in drinking water.Female Wistar pregnant rats (n=28)were randomly divided into four groups:control group,iodine deficient group,5 mg/L PTU group and 15 mg/L PTU group.On PN14,PN21,PN28,pups cerebellum in each group were weighed.On PN7.PN14,PN21,PN28,cerebellum tissue were determined for CREB protein detection by immunohistochemistry.Results Cerebellum weights of pup from iodine-deftcient were significantly lighter than control,5 mg/L and 15 mg/L groups on PN14,PN21,PN28 and PN42.In the result of immunohistochemistry:on PN7,there was no significant difference in all the groups.On PN14,PN21,PN28 and PN42,CREB expression in 5,15 mg/L and iodine-deficient groups was significantly lower than that of the control group(P＜0.05).Conclusion Iodine deficiency and hypothyrosis during critical periods brain development may down regulate the protein expression of CREB,which may result in damage of serebellum development.     

青年缺血性脑卒中相关危险因素分析

近年来，青年脑卒中患者日益增多，国内外对其危险因素的研究结果存在分歧，有学者认为其主要因素是高血压及动脉硬化，也有的认为脂代谢异常起重要作用。本文选取我院1999年1月至2004年8月收治的青年缺血性脑卒中患者80例，并对其临床资料分析如下。