布地奈德福莫特罗吸入剂联合孟鲁司特钠治疗AECOPD的临床观察

目的 观察布地奈德福英特罗吸入剂(商品名:信必可)联合孟鲁司特钠治疗慢性阻塞性肺疾病急性加重(AECOPD)的临床疗效.方法 80例AECOPD患者,随机分为布地奈德福莫特罗吸入剂联合孟鲁司特钠治疗组(40例),对照组(40例)行常规治疗,治疗14d后,评价所有患者的运动耐力、血气分析与肺功能指标第一秒用力呼气量(FEV1)、第一秒用力呼气量占用力肺活量百分比(FEV1/FVC).结果 对照组与治疗组上述指标均较治疗前改善(P＜0.05或P＜0.01),但治疗组较对照组改善更为明显(P＜0.05).结论 布地奈德福莫特罗吸入剂联合孟鲁司特钠治疗AECOPD,疗效优于常规治疗,能提高运动耐力、改善动脉血气、促进肺功能的恢复.     

白三烯拮抗剂孟鲁斯特钠与舒利迭联合治疗老年哮喘的疗效

目的：观察白三烯拮抗剂孟鲁司特钠以舒利迭联合治疗老年哮喘的临床疗效。方法选择我院2012年1月至2013年12月收治的老年哮喘患者96例,随机分为观察组和对照组,每组48例,对照组在常规内科治疗的基础上加用舒利迭吸入治疗,观察组在对照组治疗方法的基础上联合孟鲁司特钠进行治疗,观察比较两组治疗前后肺功能改变情况以及生存质量。结果观察组治疗后FVE1、FVC以及PEF均明显高于对照组治疗后,差异有统计学意义（P〈0．05）;观察组总有效率为93．75％,明显高于对照组的81．25％,差异有统计学意义（P〈0．05）。结论白三烯拮抗剂孟鲁司特钠以舒利迭联合治疗老年哮喘可以显著的改善患者的肺功能,取得比较显著的临床疗效,值得在临床推广。     

孟鲁司特钠联合舒利迭治疗支气管哮喘疗效分析

目的探讨孟鲁司特钠联合舒利迭治疗支气管哮喘的临床效果及毒副作用。方法将支气管哮喘患者60例随机分为治疗组和对照组,每组30例。对照组给予舒利迭吸入,治疗组给予孟鲁司特钠联合舒利迭治疗,治疗后比较两组肺功能指标变化情况,哮喘控制率及不良反应。结果治疗组有效率高于对照组,差异有统计学意义（P〈0．05）。两组治疗后FEV1、PEFR和FVE水平均高于治疗前水平,差异有统计学意义（P〈0．05）。两组治疗后FEV1、PEFR和FVE水平比较,治疗组均高于对照组,差异有统计学意义（P〈0．05）。在联合治疗过程中两组均未见明显的药物不良反应。结论盂鲁司特钠联合舒利迭治疗支气管哮喘,疗效显著且无明显不良反应。     

孟鲁司特联合舒利迭对慢性阻塞性肺病患者肺功能的影响

目的 探讨孟鲁司特联合舒利迭对中重度慢性阻塞性肺病(COPD)患者肺功能的影响,为COPD的治疗提供方案.方法 将96例中重度COPD患者随机分为对照组、联合用药组,对照组在常规治疗的基础上予舒利迭,联合用药组在对照组治疗的基础上再加用孟鲁司特,疗程8周,比较两组治疗前后第1秒用力呼气容积(FEV1)、FEV1占预计值的百分比(FEV1％预计值)、FEV1/用力肺活量(FEV1/FVC)及动脉血氧分压(PaO2)及二氧化碳分压(PaCO2)的变化.结果 两组治疗前各指标之间的差异均无统计学意义(P＞0.05).治疗后,对照组的FEV1、FEV1％预计值、FEV1/FVC分别为(1.43±0.38)L、71.26％±15.28％、75.42％±11.27％,联合用药组分别为(1.71±0.47)L、79.52％±16.83％、83.57％±11.32％,均明显高于对照组,差异均有统计学意义(P＜0.05,P＜0.01).对照组治疗后PaO2、PaCO2分别为(71.35±7.21)、(48.69±5.23)mm Hg,联合用药组为(78.16±7.47)、(46.32±5.42) mm Hg,联合用药组PaO2明显高于对照组,而PaCO2则明显低于对照组,差异均有统计学意义(P＜0.01,P＜0.05).结论 孟鲁司特联合舒利迭能更好地改善COPD患者的肺功能,安全性高,疗效确切.     

舒利迭治疗老年中重度慢性阻塞性肺疾病的疗效及对肺功能和血气指标的影响

目的:研究药物舒利迭对于治疗老年中重度的慢性阻塞性肺疾病的效果和其对病人的肺功能与血气指标的作用.方法采用随机表法选取在医院中于2013年9至2015年9月接受治疗的老年中重度慢性阻塞性肺疾病的病人共有180例,平均地分成两个组,即对照组与实验组,其中对照组进行常规止咳平喘的治疗方法,而实验组在进行常规止咳平喘的同时增加舒利迭治疗,然后比较两组病人的治疗有效率和病人的肺功能与血气指标.结果实验组病人的治疗总有效率是100%,对照组病人则是82.29%(P<0.05).两组病人在治疗后的用力肺活量、1秒用力呼气容积以及气道阻塞的肺量测定指标都显著高于治疗前(P<0.05),实验组病人在治疗后的用力肺活量、1秒用力呼气容积以及气道阻塞的肺量测定指标都显著高于对照组的病人(P<0.05).在治疗后,两组病人的血气指标都比治疗前显著改善(P<0.05),实验组病人在治疗后的血气指标比对照组更优异(P<0.05).结论:舒利迭对于中老年慢性阻塞性肺疾病的治疗效果优异,能够显著改善病人的肺功能和血气指标,增加病人的生活质量.     

孟鲁司特钠联合吸入舒利迭在支气管哮喘治疗中的作用观察

目的:研究白三烯拮抗剂孟鲁司特钠联合舒利迭对支气管哮喘患者肺功能的改善作用以及对细胞因子IFN—γ、IL—12、IL—13的影响.方法:2008年9月—2011年8月义乌市第二人民医院呼吸科就诊的支气管哮喘患者60例随机分为对照组和观察组.对照组患者吸入舒利迭,每天2次.观察组患者吸入舒利迭,每天2次;口服盂鲁司特钠,每次10mg,每天1次.两组患者疗程均为4周.治疗前及治疗4周测定两组患者的肺功能(FEV1、PEF和FVC)以及外周血清细胞因子IFN—γ、IL—12、IL—13水平.结果:治疗4周时两组患者的FEV1、PEF、FVC和FEV1/FVC均较治疗前显著升高(P＜0.01);并且两组FEV1、PEF和FVC差异具有统计学意义(P＜0.01).治疗后两组患者血清IL— 12和IFN—γ升高(P＜0.01),血清IL—13降低(P＜0.01);并且两组差异具有统计学意义(P＜0.01).结论:白三烯拮抗剂孟鲁司特钠联合吸入舒利迭在改善支气管哮喘患者的肺功能方面优于单用吸入舒利迭,可能与其降低血清IL—13、IFN—γ水平以及升高IL—12水平有关.     

孟鲁司特钠联合舒利迭治疗支气管哮喘的临床效果观察

目的:对支气管哮喘患者应用孟鲁司特钠+舒利迭治疗观察其临床治疗效果,以寻求支气管哮喘的理想治疗方案。方法:以我院接诊收治的70例支气管哮喘患者为研究对象,采用分组研究的方式对比单一孟鲁司特钠治疗方案(对照组,35例患者)和孟鲁司特钠+舒利迭治疗方案(观察组,35例患者)的疗效,具体以治疗总有效率和FEV1、FVC、PEF%等肺功能指标为观察指标。结果:两组治疗前肺功能指标(FEV1、FVC和PEF%)比较无显著性差异(P0.05)。但经治疗后,各项肺功能指标均优于治疗前,治疗前和指标后比较有显著性差异(P0.05)。且观察组各项肺功能指标均优于对照组,两组比较有显著性差异(P0.05)。另外,两组临床疗效对比结果显示,观察组治疗总有效率94.3%高于对照组治疗总有效率77.1%,两组比较有显著性差异(P0.05)。结论:支气管哮喘患者应用孟鲁司特钠+舒利迭治疗对于治疗总有效率的提升和肺功能指标的改善都有积极的临床意义。     

孟鲁司特联合舒利迭和单用舒利迭治疗咳嗽变异性哮喘的疗效比较

目的：比较孟鲁司特联合舒利迭和单用舒利迭治疗咳嗽变异性哮喘的疗效和安全性。方法：将72例咳嗽变异性哮喘患者按随机数字表法分为两组,对照组36例单用舒利迭吸入,治疗组36例在此基础上加孟鲁司特口服,两组疗程均为8周。观察两组的临床疗效及肺功能变化。结果：治疗后两组的FEV1%pred、PEF%pred及咳嗽症状评分均较治疗前均显著改善,差异均有统计学意义（P〈0.05）,而治疗组较对照组改善更显著（t=2.6380、2.2572、3.6836,P〈0.05）。治疗组的总有效率显著高于对照组,差异有统计学意义（字2=4.5714,P〈0.05）。结论：口服孟鲁司特钠联合吸入舒利迭治疗咳嗽变异性哮喘,比单用舒利迭起效快、疗效高,且不增加不良反应。     

孟鲁司特钠联合布地奈德治疗哮喘的疗效分析

目的分析孟鲁司特钠联合布地奈德治疗哮喘的疗效。方法选择2016年2月至2018年6月我院收治的支气管哮喘患者128例为研究对象,随机分为两组各64例。对照组给予布地奈德气雾剂治疗,研究组在对照组基础上给予孟鲁司特钠咀嚼片治疗。比较两组的疗效及不良反应,以及治疗前后的一秒用力呼气容积占预计值百分比(FEV1%)、一秒用力呼气容积比用力肺活量(FEV1/FVC)、呼气流速峰值占预计值百分比(PEF%)等肺功能指标。结果研究组的总控制率为93.8%,显著高于对照组的78.1%(P <0.05);治疗后,研究组的FEV1%、 FEV1/FVC、 PEF%均显著高于对照组(P <0.05);两组的不良反应发生率无统计学差异(P>0.05)。结论孟鲁司特钠联合布地奈德治疗哮喘的效果显著,可快速缓解患者的症状,改善肺功能,且安全性较高。     

孟鲁司特钠联合布地奈德用于小儿咳嗽变异性哮喘的临床效果观察

目的:观察孟鲁司特钠联合布地奈德用于小儿咳嗽变异性哮喘的临床效果。方法:选择本院诊治的92例小儿咳嗽变异性哮喘患儿随机划分为对照组和治疗组,对照组(n=46例)接受布地奈德治疗,治疗组(n=46例)在对照组基础上联合孟鲁司特钠治疗。对比两组临床疗效、肺功能指标变化情况及不良反应发生率。结果:治疗组用药有效率95.65%较对照组的80.43%高(P0.05);治疗后两组一秒用力呼气量(FEV1)、用力肺活量(FVC)、FEV1/FVC等肺功能指标测定值均高于治疗前(P0.05),且治疗组均高于对照组(P0.05)。结论:对小儿咳嗽变异性哮喘患儿实施孟鲁司特钠与布地奈德联合治疗,其临床疗效高于单用布地奈德治疗,同时能够明显改善肺功能,且不会增加药物不良反应。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.