慢病管理对系统性红斑狼疮治疗效果的评价

目的观察慢病管理对系统性红斑狼疮治疗的干预效果.方法将120例系统红斑狼疮患者随机分为观察组60例和对照组60例.对观察组进行慢病管理干预,对照组未进行干预.采用疾病认知、依从性、生活方式测定量表对患者进行评价.结果观察组干预后疾病认知度、治疗依从性及生活方式积分较干预前明显提高,干预前后比较,差异均有显著统计学意义(p<0.01);干预后积分与对照组比较,差异均有极显著统计学意义(p<0.05).对照组干预前后治疗依从性评分比较,差异有统计学意义(p<0.05),疾病认知度及生活方式积分观察前后比较,差异无统计学意义(P>0.05).结论实施慢病管理干预可以提高系统红斑狼疮患者对系统红斑狼疮的认知度及治疗依从性,改善不良的生活方式.     

医院社区一体化管理对高血压患者防治效果的影响分析

目的 分析医院社区一体化管理对高血压患者防治效果的影响.方法 选取我门诊2012年6月—2014年6月管理的高血压患者150例作为研究对象,患者均实行医院社区一体化管理模式.对比患者实施前后高血压疾病知识知晓率、高血压行为改变状况、高血压服药依从性改变状况.结果 实施医院社区一体化管理模式后,患者高血压疾病知识知晓率明显提高,且患者高血压行为改变情况较好,高血压服药依从性提高,与实施前相比均存在统计学差异(P<0.05).结论 通过运用医院社区一体化管理模式,可有效提升患者疾病知识知晓率,帮助患者形成良好的生活方式,按时测量血压,提高治疗依从性,值得在临床大力推广使用.     

生活方式干预常见慢性非传染性疾病高危人群的初步研究

目的探讨综合生活方式与行为干预对常见慢性非传染性疾病高危人群的影响。方法将我院公共卫生科174例慢性非传染性疾病高危人群分为3组,其中,血脂异常组60例,血糖异常组56例,血压异常组58例,分别进行综合生活方式和行为干预。干预12个月后,记录三组研究对象干预前后血脂、血糖及血压水平,并比较三组干预前后健康知信行情况。结果干预12个月后,研究对象健康知信行知晓率显著提升,实验室指标下降,差异显著。结论综上所述,生活方式与行为干预应用于慢病高危人群中,有助于提升健康知信行知晓率,培养健康生活方式,控制血脂、血糖及血液等异常指标,避免慢病的发生与发展,值得临床深入研究与推广。     

慢病管理对慢性乙型肝炎治疗效果的评价

目的观察慢病管理对慢性乙肝治疗的干预效果。方法将180例慢性乙肝患者随机分为观察组90例和对照组90例。对观察组进行慢痛管理干预,对照组未进行干预。采用疾病认知、依从性、生活方式测定量表对患者进行评价。结果观察组干预后疾病认知度、治疗依从性及生活方式积分较干预前明显提高,干预前后比较差异有统计学意义（P〈0．01）;干预后积分与对照组比较,差异有统计学意义（P〈0．05）。时照组干预前后治疗依从性评分比较,差异有统计学意义（P〈0．05）,疾病认知度及生活方式积分观察前后比较,差异无统计学意义（P〉0．05）。结论实施慢病管理干预可以提高乙肝患者对乙肝的认知度及治疗依从性,改善不良的生活方式。     

先天性肾上腺皮质增生症21-羟化酶缺陷患儿83例慢病管理模式的可行性和效果分析

目的探讨慢病管理模式对先天性肾上腺皮质增生症21-羟化酶缺陷患儿复诊依从性、患儿家长知识知晓率的影响。方法选择2016年4月至2018年2月本院83例先天性肾上腺皮质增生症21-羟化酶缺陷患儿,运用慢病管理的理念和模式对83例患儿进行规范管理,对干预前后复诊频率、知识知晓率进行评价。结果慢病管理的理念和模式运用到21-羟化酶缺陷患儿的管理中,为患儿提供了全面、全程的服务,干预后患儿复诊的次数、患儿家长知识知晓率较干预前明显改善,差异均有统计学意义,P0.05。结论应用慢病管理模式,为先天性肾上腺皮质增生症患儿提供连续性、互动的健康教育和用药指导,能有效提高患儿家长知识掌握水平和复诊依从性,促进规范治疗。     

慢性疾病轨迹模式护理在脑梗死后偏瘫患者中的应用观察

目的:探讨慢性疾病轨迹模式护理应用于脑梗死后偏瘫患者中的效果.方法:选取2017年11月—2018年7月间郑州人民医院脑梗死后偏瘫患者150例,2017年11月—2018年2月间的74例患者为对照组,接受常规护理干预,2018年3月—2018年7月间的76例患者为观察组,在对照组基础上接受慢性疾病轨迹模式护理.比较两组疾病知识知晓率、干预前后抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分、功能锻炼依从性.结果:观察组疾病知识知晓率、功能锻炼依从性96.05％、94.74％高于对照组70.27％、81.08％(P<0.05);干预后,观察组SDS评分、SAS评分低于对照组(P<0.05).结论:慢性疾病轨迹模式护理应用于脑梗死后偏瘫患者,可提高疾病知识知晓率,改善焦虑、抑郁负性情绪,增强功能锻炼依从性.     

临床药学服务干预对社区慢性病患者社会支持生活质量及治疗依从性的影响

目的 探讨临床药学服务干预对社区慢性病患者社会支持、生活质量、治疗依从性的影响.方法 对86 例2级甲等以上医院按照有关诊断标准确诊的相关慢性疾病患者进行临床药学服务干预,用社会支持评定量表、世界卫生组织生存质量测定量表简表及治疗依从性观察其效果.结果 研究组与对照组干预前社会支持各维度的评分均无差异(P＞0.05),而干预1周后观支持[(11.24±4.15)分;(9.02±3.25)分]、支持利用度维度[(8.05±2.40)分;(5.79±3.01)分]的评分差异即有显著性(P＜0.05或＜0.01).研究组从干预1周后,社会支持各维度的评分较干预前即有显著提高,差异有显著性(P＜0.05或＜0.01).研究组与对照组干预前生活质量各维度的评分均无差异(P＞0.05),而干预1周后生理领域、心理领域、社会领域、环境领域的评分差异即有显著性(P＜0.05或＜0.01).研究组从干预1周后,生活质量各维度的评分较干预前即有显著提高,差异有显著性(P＜0.05或＜0.01);干预前治疗依从性的评分无差异(P＞0.05),而干预1周后治疗依从性的评分差异即有显著性(P＜0.05或＜0.01).研究组从干预1周后,治疗依从性的评分较干预前即有显著提高,差异有显著性(P＜0.05或＜0.01).相关分析,显示社会支持各维度与治疗依从性均呈显著正相关,主观支持、客观支持、支持利用度的相关系数分别为0.41,0.39和0.44.结论 临床药学服务干预能提高社区慢性病患者的社会支持、生活质量、治疗依从性;并发现社会支持与治疗依从性具有显著正相关性.     

强化健康教育对慢性肾功能衰竭高磷血症患者的影响

目的 探讨强化健康教育对慢性肾衰竭高磷血症患者的影响.方法 选择89例慢性肾功能衰竭患者,随机分为干预组45例和对照组44例,在持续给予肠道磷结合剂治疗的同时分别实施强化健康教育和常规健康教育.结果 干预3个月两组血磷水平和钙磷乘积均较干预前显著降低,两组干预前后血磷水平和钙磷乘积差异有统计学意义（P＜0.05）.干预后3、6个月干预组甲状旁腺激素均显著低于干预前（P＜0.05）.干预组疾病基础知识、治疗知识、生活行为知识、饮食知识维度和总分均显著高于对照组（P＜0.05）.干预组治疗、生活行为、饮食依从性维度及总分均显著高于对照组（P＜0.05）.结论 实施床边宣教、健康指导手册、多媒体教学和个性化指导等综合的强化健康教育有助于提高慢性肾功能衰竭高磷血症患者疾病知识的认知和依从性,促进降低血磷、调节钙磷代谢效果的提高和稳定持续.     

老年2型糖尿病病人进行健康教育的干预效果观察

目的:观察分析老年2型糖尿病病人进行健康教育的干预效果.方法:选取96例2型糖尿病老年患者,按照是否行健康教育将其分为观察组和对照组,对照组仅给予常规治疗,观察组在常规治疗的同时进行健康教育,观察比较两组患者干预前后血糖指标水平变化情况、糖尿病知识知晓率及治疗依从性.结果:干预后两组患者的FPG、2hPG、HbA1c水平较干预前均明显降低,且干预后观察组患者的FPG、2hPG、HbA1c水平明显低于对照组(P＜0.05).观察组在糖尿病知识知晓率及治疗依从性方面明显优于对照组(P＜0.05).结论:对老年2型糖尿病病人进行健康教育可提高病人对糖尿病的认知,更好地控制血糖,提高患者治疗依从性,值得推广应用.     

全程管理模式对门诊疑似乳腺癌患者诊疗依从性的影响研究

目的 探讨全程管理模式综合性干预对提高门诊疑似乳腺癌患者诊疗依从性的影响.方法 选取2018年1月至2019年12月在四川大学华西医院乳腺专科门诊首次就诊的疑似乳腺癌患者518例,随机分为干预组(n=286)和对照组(n=232).收集两组患者的基本信息,对照组给予常规指导及健康宣教;干预组在常规指导及健康宣教的基础上,通过电话、短信等综合性干预措施为患者在检查、诊断、复诊、治疗过程中提供全程管理.结果 两组患者的一般资料差异无统计学意义(P＞0.05);干预组患者的检查、复诊、治疗方面的依从性依次为95.8％、79.3％、99.3％,均高于对照组,恶性检出率高于对照组(P＜0.05);患者满意度高于对照组(P＜0.05).结论 基于全程管理模式综合性干预提高了疑似乳腺癌患者诊疗依从性,有利于乳腺癌的早发现、早诊断、早治疗,值得临床推广应用.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.