偏头痛的针刺治疗与护理

偏头痛是一种反复发作的神经血管性头痛,常呈一侧或两侧疼痛,少数患者有发作前视觉、感觉和运动等先兆。它是一种常见的、发病率较高的病种之一,在国内,成年人中发病率为7.7%～18.7%,其中男性为1%～19%、女性为3%～29%。常与精神因素、体内激素水平、各种理化因素的刺激有关。笔者就我院疼痛科自2003～2008年间,针对偏头痛患者采用针刺治疗和综合护理进行了临床研究,现报道如下。     

69例老年性高血压患者的整体护理体会

老年性高血压是以收缩期血压升高为主，脉压差显著增大，同时伴有明显的心脑肾等靶器官受损为主要临床特点的一组临床症候群。本病以其高发病率、高致残率、高死亡率尤其受到临床医护人员的重视。我院内科自2008年8月～12月以来收治69例老年性高血压病患者，经精心治疗和整体护理后，病人恢复良好，现将整体护理体会报告如下。     

毫火针点刺根结穴疗法改善慢性非特异性下腰痛临床症状和满意度的疗效观察

目的:观察毫火针点刺根结穴疗法对改善慢性非特异性下腰痛(NLBP)患者临床症状和满意度的有效性及安全性。方法:将80例患者按照随机数字表法随机分为毫火针疗法组和对乙酰氨基酚组(每组各40例)。毫火针疗法组取病变部位夹脊穴、阿是穴、肾俞(双)、命门、腰阳关、委中(双)、睛明(双)、至阴(双)进行毫火针点刺治疗,隔日治疗1次,每周3次,2周为一疗程,共治疗2个疗程;对乙酰氨基酚组口服对乙酰氨基酚片,每天1次,每次1片,共治疗4周。两组均在治疗前、治疗2周时、治疗结束时记录各个时间点的Oswestry功能障碍指数评分(ODI)、视觉模拟评分(VAS)和患者治疗满意度评分,并对治疗过程的安全性进行评价。结果:治疗结束时,毫火针疗法组脱落2例,对乙酰氨酚组脱落4例,最终完成74例,两组患者在治疗过程中均未出现严重不良反应。与治疗前比较,两组治疗后各个时间点的ODI评分、VAS评分和患者治疗满意度评分均显著改善(均P0.05)。两组间比较,治疗2周时两组的ODI评分和VAS评分组间比较无统计学差异(均P0.05);治疗结束时毫火针疗法组的ODI评分和VAS评分均低于对乙酰氨基酚组,差异均有统计学意义(均P0.05);治疗2周时毫火针疗法组的满意度优于对乙酰氨基酚组(P0.05),治疗结束时其满意度显著优于对乙酰氨基酚组(P0.01)。结论:毫火针点刺根结穴疗法对改善NLBP患者的临床症状疗效确切,满意度高,安全性高,其综合疗效优于具有高等级循证医学证据的一线用药对乙酰氨基酚片,值得临床推广应用。     

大鼠睾丸支持细胞对骨髓问充质干细胞免疫抑制作用的影响

目的探索睾丸支持细胞（Sertoli细胞）对骨髓间充质干细胞（BMSC）免疫抑制作用的影响,为二者在移植免疫中的联合应用提供思路。方法二步酶解法处理大鼠睾丸,分离Sertoli细胞;Percoll法分离大鼠BMSC;Ficoll法分离淋巴细胞;刀豆蛋白A（ConA）刺激进行T细胞转化试验;将Sertoli细胞、BMSC和Sertoli细胞＋BMSC分别加入未经ConA处理的静止淋巴细胞培养体系和经ConA处理后的T细胞转化体系,MTT法测定淋巴细胞增殖情况,观察BMSC、Sertoli细胞或二者共培养对T细胞活化、增殖的影响。结果 BMSC、Sertoli细胞以及二者共培养对静止的淋巴细胞无明显作用。BMSC、Sertoli细胞及二者共培养对T细胞的活化、增殖均有明显的抑制作用,且Sertoli细胞与BMSC共培养时抑制作用呈现一定的协同性。结论 BMSC和Sertoli细胞均具有负性免疫调节作用,二者共培养可以进一步增强BMSC的免疫抑制效应。     

个体化灸法治疗产后身痛的临床研究

Objective:To evaluate the clinical therapeutic effect and safety of individualized moxibustion in treatment of postpartum pantalgia.Methods:A total of 99 patients with postpartum pantalgia were divided into three group at the ratio of 1:1:1 according to random number table,i.e.an individualized moxibustion group,a quantitative moxibustion group and a voltaren group.The same acupoints were selected in the individualized moxibustion group and the quantitative moxibustion group.With the patient in supine,Zhongwǎn(中脘CV12),Guānyuán(关元CV4),bilateral Tiānshū(天枢ST25),bilateral Xuèhǎi(血海SP10),bilateral Yanglingquan(阳陵泉GB34),bilateral Zúsānlǐ(足三里ST36) and bilateral Sānyīnjiāo(三阴交SP6) were selected.With the patient in prone,Dàzhuī(大椎GV14),bilateral Géshū(膈俞BL17),bilateral Píshū(脾俞BL20),bilateral Shènshū(肾俞BL23),Mìngmén 命门(GV4),bilateral Wěizhōng(委中BL40) and bilateral Yǒngquán(涌泉KI1) were selected.In the individualized moxibustion group,the moxibusion dose was determined by patient’s constitution and conditions as well as no occurrence of dry throat,thirst and local skin lesion.In the quantitative moxibustion group,the moxibustion dose was fixed as 1 cone at each acupoint in treatment.In these two groups,the treatment was given once every two days,three times a week and the treatment for 2 weeks was as 1 course.Totally,2 courses of treatment were required.In the voltaren group,voltaren ointment was used externally at the pain area,once a day,for 4 weeks totally.Separately,before treatment,at the end of treatment course and in follow-up,the symptom score of traditional Chinese medicine(TCM),pain score of visual analogue scale(VAS) and patient’s treatment satisfaction score were observed in the patients of the three groups.Results:In comparison within group,TCM symptom score,VAS score and the treatment satisfaction score at the end of treatment were all reduced obviously as compared with those before treatment in each of the three groups(P <0.05).In 4,12 and 24 weeks of followup after treatment,the differences in these data were not significant as compared with those at the end of treatment in the individualized moxibustion group and the quantitative moxibustion group respectively(all P> 0.05).In the voltaren group,these data were not different as compared with those at the end of treatment in 4 weeks of follow-up(all P> 0.05),but these data were all increased as compared with those at the end of treatment in 12 and 24 weeks of follow-up(all P <0.05).In comparison among three groups,at the end of treatment and in 4,12 and 24 weeks of followup,the above-mentioned three therapeutic effect indicators were all different significantly(all P <0.05).In comparison between two groups,in the individualized moxibustion group,TCM symptom score,VAS score and the patient’s treatment satisfaction score were all lower than those in the quantitative moxibustion group at the end of treatment and at each time point of follow-up successively,indicating the significant differences(all P <0.05).Conclusion:Individualized moxibustion and quantitative moxibustion improve the short-term and longterm therapeutic effect on postpartum pantalgia as compared with the external application of voltaren ointment.The therapeutic effect and patient’s satisfaction of individualized moxibustion for replenishing kidney and nourishing blood are better than the quantitative moxibustion.The individualized moxibustion therapy for replenishing kidney and nourishing blood achieves a satisfactory effect on postpartum pantalgia and is excelled to voltaren ointment that is strongly recommended in modern medicine.Individualized moxibustion is an external therapy of TCM with optimal short-term and long-term therapeutic effect and reliable safety.Hence,it deserves to be promoted in practice.     

多维痛苦筛查在吉林省老年肿瘤患者中的应用

目的调查老年肿瘤患者心理社会问题的现状。方法采用痛苦评估及应答系统对吉林省长春市等5个地区7家医院就诊的患者按照1∶1抽样进行问卷调查,并采用Pearson相关分析和χ~2检验探讨心理痛苦评分与患者年龄分布的差异。结果共有58例肿瘤患者接受调查,根据年龄分为老年组和中青年组,两组患者症状的发生情况差异无统计学意义(疼痛:χ~2=0.017,P=0.897;疲劳:χ~2=2.698,P=0.100;恶心:χ~2=0.220,P=0.639);老年组抑郁的发生比率为46.16%,中青年组抑郁的发生率为40.62%,两组差异无统计学意义(χ~2=0.025,P=0.875);老年组焦虑的发生率为30.77%,中青年组焦虑的发生率为46.87%,两组差异无统计学意义(χ~2=1.555,P=0.212)。结论老年肿瘤患者普遍存在焦虑抑郁等心理问题,同时存在较多躯体症状,心理痛苦温度计在肿瘤患者中的应用可及时发现具有严重心理负担的患者,应尽早进行心理干预。     

骨髓细胞学对老年人贫血病因诊断的临床价值

目的　总结老年贫血骨髓像的特点 ,明确老年贫血的病因。方法　 1 2 0 0例贫血患者分为老年组 (≥ 60岁 )和对照组 (<60岁 ) ,每组各 60 0例。行骨髓穿刺术进行骨髓细胞学检查 ,同时做外周血细胞形态学检查。结果　 (1 )红细胞减少时其减少幅度老年贫血组与对照组比较无明显差异 (P>0 .0 5) ,红细胞在正常范围时老年贫血组明显低于对照组 (P<0 .0 1 )。 (2 )老年贫血患者 ,轻度贫血时血红蛋白量减少程度明显小于对照组 (P<0 .0 1 ) ,在中度与重度贫血时两组比较无明显差异 (P>0 .0 5)。 (3)老年人贫血伴有外周血细胞形态改变者占 65.0 % ,对照组占 59.3% (P<0 .0 1 )。结论　 (1 )老年人贫血骨髓增生以减低为多见。 (2 )贫血病因以巨幼细胞贫血和缺铁性贫血为主。 (3)病因为急、慢性白血病时 ,常为少见类型的低增生性白血病。 (4)临床表现虽为贫血 ,但真正的病因可能是恶性肿瘤。 (5)骨髓细胞学是老年人贫血有意义的检查项目 ,能够对 96.3%的老年人贫血的病因作出诊断和鉴别诊断     

手术室QC小组活动应注意的几个问题

全面质量管理做为一种科学的质量管理方法在全国各部门得到了广泛运用。做为全面质量管理四大支柱之一的QC小组活动在手术室全面质量管理工作中,有着重要的地位和作用。在开展QC小组活动中应注意如下几个问题:     

尿微量蛋白测定对糖尿病肾病的临床诊断价值

目的:测定尿微量蛋白在糖尿病肾病(DN)的意义。方法:用美国Beckman公司生产的Array360system免疫发光仪测定105例糖尿病患者尿微量蛋白含量。结果:无蛋白尿组、蛋白尿组α1-MG、β2-MG、Alb均升高(P<0.05。结论:联合检测可以判断肾脏受损程度,对早期诊断糖尿病肾病提供可靠依据。     

“三合一”式医患沟通能力培养模式的探索与研究

目的:探索和建立临床带教中"三合一"式医患沟通能力培养的新模式,加强和提高医学生医患沟通能力和水平,着力培养医德修养高、技术业务精、沟通能力强的医疗卫生人才。方法:选取2016年7月~2017年6月我科实习的学生70人作为观察组进行"三合一"式医患沟通能力培养模式培训,2015年7月~2016年6月我科实习的学生70人对照组作为采用传统临床带教医患沟通方法,培训结束后进行考核。结果:通过在临床带教中采用"三合一"式医患沟通能力培养模式,针灸科实习学生的理论知识、实践技能、沟通能力显著高于既往考核情况。结论:在临床带教中"三合一"式医患沟通能力培养模式能够显著实习学生的理论储备、专科技能及沟通能力,值得临床推广应用。