居家腹膜透析人群开展自我管理教育的效果浅析

目的探索居家腹膜透析人群开展自我管理教育的效果,分析自我管理教育在居家腹膜透析中的应用意义。方法选取2016年10月～2018年10月在本院治疗且出院行居家腹膜透析的72例患者作为此次研究对象,按照随机数字表法将其分为对照组与观察组,每组各36例。对照组患者行常规护理管理,如院外指导、电话随访等;观察组患者在对照组基础上开展自我管理教育。比较两组患者护理后自我管理能力(生活方式、疾病管理、情绪管理及角色管理等)和并发症发生情况;评价两组患者护理后生活质量(全身状况、情感功能及社会功能)和满意度。结果观察组患者护理后生活方式、疾病管理、情绪管理及角色管理评分均明显高于对照组(P0.05);观察组患者并发症发生率明显低于对照组(P0.05);观察组患者护理后全身状况、情感功能及社会功能评分明显高于对照组(P0.05);观察组患者满意度明显高于对照组(P0.05)。结论自我管理教育应用于居家腹膜透析患者中可提高其自我管理能力,减少治疗期间并发症发生,改善患者生活质量,从而提高患者满意度。     

采用相应数学模型分析软硬组织关系的曲线拟合：Ⅱ类错[牙合]自然生长和功能矫治效果比较

背景：随着口腔正畸学成像、模型观测等检查手段数字化程度的提高,越来越多的学者将数学方法应用于正畸学的研究中。 目的：分析功能矫治前后,软硬组织间的关系是否发生改变,并建立相应的数学模型。 方法：选用恒牙早期安氏Ⅱ类1分类患者67例,其中接受功能矫治的患者40例,放弃功能矫治的患者27例。分别在治疗和观察前、后拍摄头颅侧位片。头影测量分析功能矫治前后侧位片软硬组织的变化,数学方法分析评价Ⅱ类错[牙合]功能矫治疗效的4项主要指标[硬组织上下颌骨前后向不调指数（APDI）、软组织上唇突点距审美平面的距离（Ls-EP）、上切牙相对于上颌骨的线距U1-NA（mm）和角度（U1-NA）]。最初使用线性方程分析软硬组织在功能矫治前后的数据。当线性方程无意义时,使用曲线拟合。 结果与结论：结果发现4项主要指标代表的软硬组织间确实存在曲线关系。治疗前曲线拟合的二次方程为：U1-NA（mm）=-0.0127（APDI）^2＋1.7052（APDI）-0.6861,U1-NA=-0.0255（APDI）^2＋3.2343（APDI）-67.8318,Ls-EP=-0.0037（APDI）^2＋0.3802（APDI）-3.2673。治疗后的曲线拟合方程：U1-NA（mm）=-0.0031（APDI）^2＋0.4958（APDI）-14.2484,U1-NA=0.0132（APDI）^2-1.9939（APDI）＋98.1045,Ls-EP=0.0074（APDI）^2-1.2647（APDI）＋55.4124。结果提示功能矫治使颅面部软硬组织关系发生明显改变,并使软组织侧貌发生明显改善。     

刘贵珍内养功

三、意守１活位意守:即按其松静部位的不同,意守部位亦随之变换。２定位意守:即意守丹田。内养功中的丹田是以气海穴为中心,上至神阙,下至关元,命门之前如同自己拳头大小的区域设在小腹内。不可象扎针灸那样拘泥于一点。其丹田部位集气海、神阙、关元、命门于一体,意守此?..     

我院门诊电子处方点评工作的实践与体会

目的:提高医院处方质量,促进临床合理用药。方法:随机抽取2009年1月-2010年12月每月1d中的100张处方,填写处方点评工作表并按用药品种数、抗菌药物使用率、注射剂使用率、基本药物使用率、处方金额等要求进行评价;且自2010年1月起每月抽查3d约2000张处方,以《医院处方点评管理规范(试行)》等为依据检查处方合格率及点评不合格处方。结果:抽取的2400张处方中,用药品种数为2.17种,抗菌药物使用率为29.50%,注射剂使用率为36.46%,基本药物使用率为86.09%,处方金额为188.55元;2010年较2009年用药品种数下降0.04%,抗菌药物使用率上升了3.5%,注射剂使用率下降了1.25%,基本药物使用率降低了3.28%,每张处方金额下降了48.99元。2010年抽取的约24000张处方合格率由1月的86.55%上升至12月的94.98%。结论:我院门诊处方用药品种数符合世界卫生组织制定的标准,基本药物使用率符合国家政策,处方合格率不断提高。处方点评工作应长期开展下去。     

低位直肠癌保肛手术40例临床分析

目的探讨低位直肠癌保肛手术的临床意义。方法对2005年1月至2009年12月在我科治疗的距肛缘7cm以下、行保留肛门括约肌功能的直肠癌根治术的病人进行回顾性分析。结果所有病人无手术死亡,术后吻合口漏2例,6个月～1年吻合口癌肿复发2例,远期发生吻合口轻度狭窄无梗阻5例。结论严格掌握手术适应证,规范TME操作,行低位直肠癌保肛手术,既能起到癌症根治作用,又能提高患者生活质量。     

低分子肝素联合乌司他丁治疗急性百草枯中毒大鼠肺纤维化的实验研究

目的探讨低分子肝素联合乌司他丁减轻急性百草枯（PQ）中毒大鼠肺纤维化的可能作用机制。方法55只雄性SD大鼠,随机分成正常对照组（A组）、模型组（B组）、治疗组（C组）;B、C组禁食1h后经口一次灌胃百草枯75mg／kg制作PQ大鼠肺纤维化模型,A组经口一次性注人等量生理盐水;c组造模后皮下注射低分子肝素钠1000U／d,同时腹腔注射乌司他丁10万U,共14d,A、B组给予0．2ml／d生理盐水皮下注射。分别于造模后1、3、7、14、28d测定血清转化生长因子β1（TGFβ1）、基质金属蛋白酶9（MMP-9）含量;并取肺组织做HE染色。结果与A组比较,B组血清TGF-β1第3天始明显升高（P〈0．01）,血清MMP-9于第7天逐渐上升（P〈0．05）,第28天明显升高（P〈0．01）;与B组各相同时间点比较,C组MMP-9水平下降,至第7天差异有统计学意义（P〈0．05）,第28天出现明显下降（P〈0．01）;而血清TGF．131在第14天开始出现明显下降（P〈0．01）。B组于造模后早期即出现肺泡壁增厚,炎症细胞浸润明显,毛细血管充血、水肿等,14d肉眼可见肺表面溃疡形成,镜下可见肺泡间隔成纤维母细胞、肌纤维细胞增生,肺泡塌陷;C组于14d时镜下可见有肺泡壁毛细血管充血,炎性细胞浸润较B组轻,肺纤维化程度也有所减轻。结论低分子肝素联合乌司他丁可减少MMP-9的合成,从而减轻大鼠纤维化程度,其途径可能通过减少TGF．Bl的合成。     

医疗机构减少药品调配和给药差错的研究

医疗机构中用药差错比较普遍,而调配和给药错误在用药差错中占有较高比例。美国的研究表明,虽然总体上调配和给药错误的发生率比较低,但是由于医疗机构中药品使用量大,一个比较繁忙的医疗机构药房7个月内共发生5075次差错,其中79％被发现。另有研究指出,备药和发药错误占用药差错的11％～21％。我国对调配和给药错误尚缺乏全国性的实证数据,但个别医院的研究表明,调配和给药错误对病人安全的影响是比较显著的。本文从调配和给药差错的影响因素、国外减少相关差错的先进技术与干预措施角度进行分析,提出建议,供国内药学工作者参考。     

降钙素对大白兔糖尿病骨质疏松模型假体骨密度及生物力学的影响

Objective To investigate the influence of calcitonin on bone mineral density and biomechanics around the artificial pros-thesis in ovariectomized diabetic rabbit model. Methods Fourteen femina New Zealand white rabbits at the age of 5 months old were select-ed, which weight 2.24 -2.65kg, averaging 2.26kg. First, the model of rabbit with diabetic osteoporosis was successfully established by the compound method of ovariectomy plus streptozotocin. Osteotomy in the middle part of femur was performed in both groups, fixation of artifi-cial prosthesis was done with 3.0 kirschner wire. After that, Rabbit models with diabetic osteoporosis were randomly divided into experimen-tal group and control group. Rabbits in the experimental group were treated with calcitonin 6U intramuscular injection once every other day. In control group, intramuscular injection of normal saline solution 1.5ml once every three days. Rabbit models of two groups were sacrificed in the 24th week. The BMD of the region of interest (ROI) around the prosthesis were detected before experiment and 8, 16 and 24 weeks after injection. After rabbits were killed, experimental femurs in both groups were complete removal and soft tissues were rejected. Determi-nation of the pull-out and torsion bone biomechanics experiments of prosthesis was done in both groups respectively. Results The BMD of ROI in the experimental group before operation was (0.1863±0.004)g/cm2 and (0.1753±0.005)g/cm2 in 24 weeks after operation, in control group before operation was (0.1865±0.002)g/cm2 and (0.1638±0.005)g/cm2 in 24 weeks after operation. There were significant difference between the two groups(P < 0.05). Biomechanical show that the pull-out strength in the experimental group was (312.68±8.73 )N/cm2 and (205.43±12.45 ) N/cm2 in control group. There were significant difference between the two groups(P < 0.05). The tor-sion strength in experimental group was (80.47±2.51) N/cm2 and (38.52±0.64) N/cm2 in control group. There were significant differ-ence between the two groups(P < 0.05). Conclusion Salmon calcitonin can reduce the bone turnover rate around prosthesis and decrease bone absorption in the rabbit of diabetic osteoporosis models, accelerate the bone formation around prosthesis, and increase the BMD. It can ameliorate the quality of bone around prosthesis, improve its biomechanics property, and increase the holding power between prosthesis and body mass. It is of clinical significance for the prevention and treatment of aseptic loosening artificial prosthesis.     

半月板桶柄状撕裂的MRI诊断与关节镜下分类的相关研究

目的 探讨MRI对半月板桶柄状撕裂的诊断与关节镜下分类的比较研究.方法 分析63例患者65个经关节镜检查证实为半月板桶柄状撕裂的术前MRI的特征性表现,并将5种MRI征象(双后交叉韧带征、半月板翻转征、空领结征、碎块内移征和外周残半月板征)与关节镜下Dandy分型进行比较.结果 MRI桶柄状撕裂诊断符合率89.2%.碎块内移征和空领结征阳性率最高,分别为84.6%和81.5%;双后交叉韧带征(双PCL征)、半月板翻转征(双前角征)、外周残半月板征不如上二者普遍(阳性率分别为43%、21.5%、29.3%).未发现外侧半月板双PCL征;内侧半月板交锁Ⅰ型和Ⅱ型及外侧半月板半长全宽型、全长半宽型与MRI碎块内移征和空领结征有相关性;2例为半月板撕裂Ⅲ级信号,5例为假阴性.结论 5种MRI征象中最少2种(碎块内移征和空领结征阳性率最高)以上出现应高度怀疑为桶柄状撕裂. Abstract： Objective To evaluate the arthroscopic findings of meniscal bucket handle tears and to correlate them with the proposed MR imaging signs of meniscal bucket handle tears suggested in the literature. Methods Sixty-three patients who had a diagnosis of bucket handle tear in arthroscopy were included in our study.Meniscal tears were evaluated in arthroscopy according to Dandy's classification.The MRIs were retrospectively analyzed regarding the following findings:absence of bow tie sign,presence of double posterior cruciate ligament(PCL), fragment within the intercondylar region,flipped meniscus sign, abnormal circumferential meniscus sign. Sensitivity were evaluated for the presence of each individual sign. Results Locked types Ⅰand Ⅱfragment of medial meniscus and half-length,whole-width and whole length-half-width fragement of lateral meniscus in arthroscopy were correlated with fragement within the intercondylar notch and absent bow tie signs in MRI.We didn't find the double PCL sign in any of the patients with a lateral meniscal bucket handle tear.The most common signs in MR imagings of meniscal bucket handle tears were the fragement in the notch sign and the absent bow tie sign.They were observed with frequency of 84.6% and 81.5% respectively.The presence of double posterior cruciate ligament, flipped meniscus sign, abnormal circumferential meniscus sign were less common(43%,21.5% and 29.2%,respectively). Conclusions The presence of at least two of the five MRI signs should be regarded as highly suggestive for bucket handle tears of menisci.     

妊娠期糖尿病患者孕期血糖监测与妊娠结局分析

目的探讨妊娠期糖尿病患者血糖控制对妊娠结局的影响。方法分析2007年7月至2008年7月住院分娩的153例妊娠期糖尿病患者,74例孕期血糖控制满意（A组）,79例控制不满意（B组）,将两组妊娠结局进行比较分析。结果A组子痫前期、羊水过多、巨大儿、新生儿低血糖、新生儿高胆红素血症发生率低于B组（分别为5．41％比17．72％、4．05％比20．25％、12．16％比31．65％、5．41％比20．25％、8．11％比30．38％）（P〈0．05）;A组胎膜早破、早产、产后出血、胎儿宫内窘迫发生率低于B组,但两组比较差异无统计学意义。结论妊娠期糖尿病对母婴近、远期危害大,孕期控制好血糖可减少母婴并发症。