静脉输液拔针后按压血管时间的临床探讨

目的静脉输液拔针后,按压血管多长时间较为合适,目前尚无定论。旨在探讨按压血管的最佳时间,以便最大限度地减少皮下瘀血,减轻病人痛苦,保护静脉血管。方法对200例静脉输液病人拔针后不同按压血管时间的效果进行了观察,并根据统计处理结果进行分析、比较。结果拔针后4min左右较为合适,能够有效地防止瘀血,时间过长,多数病人难以坚持;过短则皮下瘀血率高。结论这种做法,克服了过去静脉输液拔针后,按压血管时间随意性较大的缺陷,应大力推广。     

糖尿病大鼠坐骨神经传导速度变化

目的：探讨链脲佐菌素（Streptozotocin ,STZ）诱导的糖尿病大鼠坐骨神经传导速度（NCV）变化,初步确立糖尿病周围神经病（diabetic peripheral neuropathy ,DPN）大鼠模型的构建和评价方法。方法：选用SD大鼠,随机分为正常对照组和模型组,模型组腹腔注射STZ。检测动物体质量、血糖、触觉、神经传导速度（NCV）变化,并取大鼠坐骨神经组织进行 HE染色,观察其形态结构变化。结果：与正常对照组比较,给予STZ后,模型组动物体质量逐渐下降,4 w 后比较差异有显著意义（ P＜0．05）,血糖显著升高（P＜0．001）;50％机械缩足阈值,于注射STZ 2 w 后明显下降（P＜0．05）,注射STZ后4 w明显上升（P＜0．05）;给予STZ后4 w ,模型组大鼠运动神经传导速度（MCV）和感觉神经传导速度（SCV）显著减慢（P＜0．05）,坐骨神经组织神经纤维松散,密度不均匀。结论：注射STZ 4 W后,大鼠MCV和SCV减慢,触觉敏感度呈双相变化,坐骨神经出现病理形态结构,成功复制出DPN大鼠模型。     

中药瑞康欣胶囊的质量和在戒毒中的疗效观察

目的:评价复方中药瑞康欣颗粒戒毒的临床疗效。方法:比较2774例海洛因依赖者在我院进行西药和中西医结合治疗的治疗情况和疗效。结果:中西医结合治疗组较西药治疗组美沙酮、可乐宁、曲马多等西药的用量减少,但平均住院天数延长,稽延性症状的评分降低程度具有显著性差异。结论:复方瑞康欣中药方剂对海洛因依赖者的戒断症状治疗效果肯定;能减少美沙酮等药物的用量;浓缩中药颗粒具有质控性好、方便实用的特点。     

医院药房退药中的风险管理

医院药房退药的风险问题已经引起广大医护人员的重视。从药品风险管理的基本概念入手,结合我院药房退药的风险问题,有针对性的进行阐述和分析,探讨了医院药房退药过程中的风险因素及对策。建议医院规范药房退药流程,严格药房退药审核,减少药房退药中的风险隐患,保证药品质量,进一步促进医疗安全。     

河南省第3次吸烟现况调查资料分析

按照整群分层随机抽样的方法，河南省第３次吸烟现况调查于１９９５年在本省６个国家级疾病监测点进行。结果显示：人群的总吸烟率为３３．５％，被动吸烟率为４４．１％，总患病率、患病人次率和呼吸系统疾病的发生率等均为吸烟者显著高于非吸烟者；并且开始吸烟的年龄早于１４岁和每天吸烟量大于２０支的吸烟人群，其总患病率也较高。     

Changes in end of life care 5 years after the introduction of a rapid response team: A multicentre retrospective study

Rationale

Rapid response teams (RRTs) are intended to stabilize deteriorating patients on the ward, but recent studies suggest that RRTs may also improve end-of-life care (EOLC). We sought to study the effect of introducing an RRT on EOLC at our institutions, and compare the EOLC care received by patients who were consulted by the RRT with that of patients who were not consulted by the RRT.

Methods

Retrospective review of 450 consecutive deaths at 3 institutions. We compared demographic factors and EOLC received before (2005) and 5 years after (2010) the introduction of an RRT. We also compared these same factors for patients who died in 2010 with and without RRT consultation.

Results

There were no differences in the proportion of patients who had Patient/Family Conferences or orders to limit life support on the ward between 2005 and 2010. Although the RRT was consulted for 30% of patients eligible to be seen by the RRT, the RRT was involved in only 11.1% of Patient/Family Conferences that took place on the ward. The prevalence of palliative care consultation and orders for opioids as needed was higher in 2010 than 2005, but those seen by the RRT were less likely to receive a palliative care consultation (30.2% vs. 55.9%), spiritual care consultation (25.4% vs. 41.3%) or an order for sedatives as needed (44.4% vs. 65.0%) than those who were not seen by the RRT. There was no change in the proportion of patients admitted to the ICU in 2010 compared with 2005, and multivariable logistic regression showed that the year of death did not influence the likelihood of ICU admission based on any comorbid or demographic factors.

Conclusions

The introduction of an RRT was not associated with significant improvements in EOLC at our institutions. However, almost 1/3 of dying patients were consulted by the RRT, suggesting that the RRT could play a role in facilitating improved EOLC for some inpatients.     

长期注射地西泮对小鼠痛阈及吗啡镇痛作用的影响

目的:探讨长期注射地西泮(diazepam)对小鼠痛阈及吗啡(morphine)镇痛作用的影响。方法:30只昆明种小鼠,随机分为生理盐水组(NS)、地西泮D1(8mg/kg)组、地西泮D2(16mg/kg)组(n=10),连续给药8d后停药并正常饲喂24h,第10天各组小鼠均注射吗啡(0.125mg/kg)。在地西泮注射之前、吗啡注射之前以及吗啡注射后10min通过热甩尾实验测定小鼠的热甩尾潜伏期(tail withdraw latency,TWL)。结果:生理盐水对小鼠热甩尾潜伏期无显著影响,不同浓度的地西泮不同程度地延长了小鼠热甩尾潜伏期;长期注射地西泮对吗啡的镇痛作用无显著影响。结论:长期注射地西泮能够显著延长小鼠热甩尾潜伏期,但对吗啡镇痛作用无显著影响。     

癫癎样放电在抗癫癎药物应用及复发预测中的意义

癫癎首次发作后脑电图检出癫样放电异常率在儿童为18%~56%,成人为10%~50%,脑电技术是最常用的癫神经病学检查手段,特征性脑电图异常能够帮助对发作类型及癫综合征的分类、确定治疗方案及判断预后。在特定病例,脑电图能检测到更加细微的发作,包括失神、肌阵挛或部分性发作。癫治疗中不同的抗癫药物对癫样放电的抑制存在差异,癫样放电在复发预测及决定撤除抗癫药物方面起着重要作用。     

辣椒素受体在肠易激惹综合征内脏痛觉过敏中的作用

目的研究辣椒素受体（VR1）在肠易激综合征（IBS）内脏痛觉过敏中的作用。方法新生雄性SD大鼠21只分为痛觉过敏阳性对照组（P组）、阴性对照组（N组）、去辣椒素受体神经元组（D组）,出生第2天D组背部皮下注射辣椒素50mg/kg。出生第8天起P组和D组给予结肠内充气刺激每天一次,连续2周,7周时给予结直肠扩张（CRD）刺激,进行腹部收缩反射（AWR）评分和腹直肌肌电记录。结果D组AWR评分低及腹直肌放电活动少（P〈0.01,与P组相比）。结论辣椒素受体参与了发育期幼鼠肠激惹致IBS内脏痛觉过敏。     

新生儿机械通气时撤机失败原因分析

目的分析新生儿机械通气时呼吸机撤机失败原因。方法对自1999年4月至2006年2月我院儿内科新生儿重症监护病房（NICU）,应用人工呼吸机235例中出现撤机失败的29例进行临床分析。结臬应用机械通气治疗新生儿呼吸衰竭时,撤机失败率早产儿组较足月儿组和过期产儿组高（P〈0．01）;多脏器功能损害组较非多脏器功能损害组高（P〈0．01）;机械通气时间3d以上组较机械通气0—3d组高（P〈0．05）;无静脉营养支持组较静脉营养支持组高（P〈0．05）。结论及时治疗原发病、合理使用呼吸机、加强机械通气管理、及时适时撤机、正确诊治呼吸机相关性肺炎、加强营养支持,是减少呼吸机撤机失败的关键。