心理干预对全麻患者苏醒期气管拔管时合作程度的影响

目的观察术前心理干预对接受气管内全麻患者在苏醒期气管拔管时合作程度的影响。方法选择拟行气管内全麻下进行乳癌根治术的成年患者40例（ASAⅠ～Ⅱ级）,随机分为两组,即观察组和对照组,每组20例。对照组常规进行麻醉前访视和会诊。观察组在手术前1d由麻醉医师和手术室护士进行术前访视及心理准备,系统讲解此类手术特点和麻醉相关知识,重点解释气管内全身麻醉前后可能存在的咽喉部异物感或轻度疼痛、吞咽不适感等,以及如何配合气管拔管（包括平静呼吸、听指令动作、不焦不躁等）;在手术当日麻醉前30min再次对观察组患者进行麻醉苏醒期相关知识宣教。由专人按照统一标准实施麻醉。重点观察患者在麻醉苏醒期及气管导管拔出前后是否合作及合作程度,手术后24h随访并询问患者对麻醉过程是否满意。结果两组患者一般情况、手术时间及麻醉时间差异无统计学意义（P〉0.05）;在麻醉苏醒期及气管导管拔出前后观察组患者合作程度评分明显高于对照组（P〈0.05）;患者对麻醉过程满意度,观察组明显高于对照组（P〈0.05）。结论术前心理干预可以提高气管内全麻患者苏醒期气管拔管时的合作程度。     

高龄食管异物患者手术中的配合

1999~2004年我科共收治80岁以上高龄食管异物患者20例,经过精心准备和手术,均顺利取出异物,没有一例造成食管穿孔及其他严重并发症。1临床资料本组20例,男9例,女11例,年龄80~99岁,其中90岁以上5例,异物的部位:食管入口12例,主动脉弓横跨食管处4例,左支气管横越食管前壁2例,食管     

额面手术碘伏消毒致化学性眼灼伤12例的护理

目的：探讨额面手术时碘伏消毒引起的化学性眼灼伤的临床特点及其护理。方法：对12例18眼的临床资料、治疗及护理措施进行分析。结果：经相应积极处理和护理后，所有患者均治愈。结论：对于额面手术消毒应预防碘伏流人结膜囊，而对引起的化学性眼灼伤患者应注重急性期综合护理，避免并发症发生。     

150例尿毒症患者腹膜透析临床分析

腹膜透析(简称腹透)已是治疗尿毒症的一种比较成熟的替代方式,与血液透析比较,具有可居家治疗、操作简单、心血管稳定性好、较少血源感染、残余肾功能丢失较慢、相对费用省等优点,但存在腹膜感染的可能性,且腹透患者的管理亦是一个新的课题。当前慢性肾脏病(CKD)发病率越来     

中西医结合治疗早期糖尿病肾病36例

目的观察中西医结合治疗早期糖尿病肾病的临床疗效。方法 68例早期糖尿病肾病患者随机分为两组,治疗组36例,对照组32例。两组均予常规西医治疗,治疗组加用中药内服。治疗3个月后评价疗效。结果治疗1个月后两组24h尿白蛋白均较治疗前显著下降,两组改善程度相当。治疗3个月后,治疗组疗效优于对照组。结论中西医结合治疗早期糖尿病肾病疗效满意。     

中西医结合治疗IgA肾病67例

IgA肾病是临床上较常见的一类免疫病理病变的特殊肾病,在中国肾小球疾病中占30%～40%[1].临床表现多种多样,从单纯尿检异常至水肿、高血压、大量蛋白尿、肾功能不全等.临床上我们发现该病并非初始所理解的预后良好,许多患者治疗不及时.随着时间的延长,逐渐步入慢性肾衰尿毒症.     

肝豆状核变性误诊为系统性红斑狼疮讨论

肝豆状核变性(heptolenticular degeneration,HLD)是目前少数能用药物治疗的先天遗传性代谢病之一,如能早期诊断、治疗,预后良好。但本病临床表现多样,极易误诊,文献报道误诊率达67%[1],如在病程的晚期方明确诊断开始治疗,则预后不佳。因此,早期诊断、早期治疗是改善本病的预后的关键。我科近期收治HLD 1例,曾误诊为系统性红斑狼疮,现报告如下。1病例资料女,15岁。以双下肢水肿50余天为主诉入院。患者于50余天前因左足皮肤破溃后出现双下肢水肿,就诊于县医院,查尿蛋白( ),白细胞( )。按“急性肾炎”予对症治疗,水肿未见明显好转。转诊另…     

围手术期库存红细胞悬液复温后输注的临床效果分析

目的观察围手术期库存红细胞悬液在不同温度复温后输注的临床效果。方法选择择期手术成年患者80例,均为在围手术期接受临床输注红细胞悬液,随机均分为4组,按复温水温起始温度不同分为1组(32℃)、2组(35℃)、3组(38℃)及对照组,每组20例,每例输注红细胞悬液2U。红细胞悬液由血库取出后,对照组红细胞悬液放置于室温中30min以上再进行输注,1~3组分别在起始温度为32、35、38℃水中复温15 min后再进行输注。观察输注前30min和输注后30min患者肛温变化、输注过程中血管痉挛性收缩发生率、麻醉苏醒期寒战发生率。结果对照组和1组患者输注后体温明显低于输注前体温(P<0.05),2组和3组输注前后体温变化无统计学意义(P>0.05),2组和3组患者输注后体温分别与对照组输注后比较差异有统计学意义(P<0.05)。2组和3组患者均未发生血管痉挛性收缩而影响输注速度,明显好于对照组和1组(P<0.05)。麻醉苏醒期寒战发生率,对照组>1组>2组>3组,4组之间比较差异有统计学意义(P<0.05)。结论库存红细胞悬液输注前采用35~38℃水温进行复温后输注的临床效果优于室温条件下和32℃水温复温者。     

应用生长激素释放肽心力衰竭大鼠心肌胆碱能神经纤维密度分布的变化

BACKGROUND： Changes in the cardiac autonomic nerve are considered to be important factors in the mechanisms of heart failure. It is possible to reduce or slow down nerve degeneration and necrosis, provided that patients take effective neuroprotectants during the early stages of heart failure. Moreover, it is possible to relieve the pathological process and reduce the risk of death. OBJECTIVE： To study the effect of growth hormone releasing peptide （GHRP） on cardiac cholinergic nerve fiber density distribution in a rat model of heart failure, and verify whether GHRP can ameliorate denervation. DESIGN, TIME AND SETTING： A randomized controlled study was performed at the Key Laboratory of Anatomy, Harbin Medical University, between June and October 2009. MATERIALS： Fifty adult, healthy, female, Wistar rats, weighing （200± 20） g, were randomly divided into GHRP （n = 30）, model （n = 10）, and sham operation （n = 10） groups. GHRP-2 was made in Shanghai, China （batch No. z071212-03）. METHODS： Acute myocardial infarction was established by ligating the left anterior descending coronary artery in the GHRP and model groups. Five weeks later, myocardial function was detected using color ultrasound electrocardiograph a successful marker of chronic heart failure models Ejection fraction 〈 60% was considered to be However, the left anterior descending coronary artery was not ligated in the sham operation group. The GHRP group was injected with 100 μ g/kg GHRP-2, and the other two groups were injected with the same volume of physiological saline, once per day. MAIN OUTCOME MEASURES： After 4 weeks, pathological changes in cardiac cholinergic nerve fibers were detected under optic microscopy following hematoxylin/eosin staining. In addition, density distribution was measured using a multi-function color pathological image system. RESULTS： In the sham operation group, myocardial cells were regular, uniformly stained, and no inflammatory cells were present. In the model group, myocardial cells were unevenly stained, exhibited nuclear atrophy, degeneration, dissolution, or disappearance. In the GHRP group, myocardial damage was less than in the model group; cardiac muscle fibers exhibited slight degeneration. The myocardium in the sham operation group was serried, spreading the cholinergic innervations along the cardiac fiber. In the model group, there was a decreased number of cholinergic nerve fibers decreased, which also became shorter and smaller, compared with the sham operation group （P 〈 0.01）. In the GHRP group, cholinergic positive nerve fibers were significantly increased compared with the model group （P 〈 0.01）, but still less than the sham surgery group （P 〈 0.05）. CONCLUSION： GHRP delayed denervation and reduced nerve reconstitution following heart failure in rats.     

86例老年人血液流变学检查分析

自1993年以来,我们对86例55岁以上住院病人进行血液流变学检查,并将其检查结果与年龄及脑梗塞发病率进行相应比较分析,现报告如下: 1 临床资料 本组病人86例,男62例,女24例,分为两个年龄