微信平台在肿瘤化疗PICC置管患者全程护理中的应用研究

目的:基于微信平台的全程护理对肿瘤患者化疗PICC置管自我维护的应用效果。方法:按照随机数字表法将60例PICC置管肿瘤患者分为试验组30例和对照组30例。试验组予微信平台的全程护理进行PICC维护指导,对照组按常规方法给予PICC维护指导,比较两组的效果。结果:试验组PICC导管相关并发症发生率低于对照组(P0.05),试验组患者满意度高于对照组(P0.05)。结论:基于微信平台的全程护理运用于肿瘤患者的PICC导管自我维护指导可降低患者导管相关并发症的发生率,提高患者满意度。     

加强护理干预对PICC置管患者导管维护依从性和并发症发生率的影响

目的观察加强护理干预对PICC置管患者导管维护依从性和并发症发生率的影响。方法选取2016年7月至2018年9月于濮阳市人民医院接受PICC置管治疗的92例患者为研究对象,按入院时间分为两组,各46例。对照组接受常规护理,观察组在此基础上接受加强护理干预。对比两组患者导管维护依从性及并发症发生率。结果对照组和观察组导管维护总依从率分别为76.09%(35/46)、93.48%(43/46),并发症发生率分别为23.91%(11/46)、6.52%(3/46),观察组导管维护总依从率较对照组高,并发症发生率较对照组低,差异有统计学意义(均P<0.05)。结论对PICC置管患者加强护理干预,可提高其导管维护依从性,减少并发症。     

PICC标准护理对置管患者自护能力和护理质量的影响

目的 探讨采用PICC标准护理对置管患者自护能力和护理质量的影响。方法 根据是否采用PICC标准护理,将200例患者分为观察组（实施）和对照组（未实施）,各100例。应用问卷调查量表对两组患者的护理人员进行实地考察与现场考核,对两组护理人员护理质量、PICC置管后患者自我护理能力及患者并发症情况进行比较。结果 观察组置管后维护流程、导管固定、导管冲封、无菌操作、穿刺置管所需时间、PICC平均留置时间均明显优于对照组（P〈0.05或P〈0.01）,观察组患者自我护理能力显著高于对照组,差异均有统计学意义（P〈0.05）;PICC置管后观察组并发症发生率明显低于对照组（P〈0.05）。结论 PICC标准护理在置管患者中的应用明显提高了护理人员的护理质量及患者的自护能力,并降低了置管后并发症的发生率,值得推广应用。     

护理干预对PICC导管相关性血栓发生的影响

目的 探讨护理干预对PICC导管相关性血栓发生产生的影响.方法 收集实施PICC置管的120例患者展开研究,随机将其分为观察组与对照组,各60例,对照组给予常规护理措施,观察组在其基础上给予针对性的护理干预,比较观察组与对照组临床护理效果.结果 观察组与对照组发生PICC导管相关性血栓发生率分别为1.67%、21.67%,且观察组(95%)导管维护依从性明显高于对照组(75%),组间数据比较差异具有统计学意义(P<0.05).结论 PICC置管患者实施恰当的护理干预能有效降低PICC相关性血栓发生率,提升临床护理质量,成为临床首选的护理方式.     

知信行健康教育模式在食管癌手术患者经外周静脉穿刺中心静脉置管护理中的应用

目的:探讨知信行健康教育模式在食管癌手术患者经外周静脉穿刺中心静脉置管(PICC)护理中的应用及其效果分析。方法:将84例患者随机分为干预组和对照组各42例,对照组置管后行传统的健康教育模式,干预组采用知信行健康教育模式,包括健康教育、心理护理、出院前教会患者导管维护相关知识等。2组患者均随访3个化疗周期,比较2组患者导管维护依从性,导管相关并发症发生率、导管留置时间及患者对PICC置管的知信行水平。结果:干预组患者出现导管维护延迟例数与对照组差异无统计学意义(P>0.05),干预组导管维护延迟次数明显少于对照组(P<0.01);2组导管相关并发症发生率差异均无统计学意义(P>0.05);干预组导管留置时间明显长于对照组(P<0.01)。对照组知信行各维度评分均明显低于干预组(P<0.01)。结论:知信行健康教育模式应用于食管癌手术患者行PICC的护理中,提高了患者置管维护依从性,延长置管的留置时间,并提高患者的知信行水平,提高了临床护理质量。     

健康教育对中心静脉导管胃管患者的护理体会

目的探讨在中心静脉导管置管(PICC)的患者中进行全程健康教育的效果和护理体会。方法将116例PICC患者随机分为两组,每组58例,对照组以常规护理模式进行护理,观察组在对照组护理的基础上对患者实施全程、系统性健康教育,比较两组的效果。结果观察组患者在置管期间导管位移、堵塞、感染等并发症的发生率显著低于对照组(P<0.05),患者对PICC知识的掌握率以及对护理的满意度显著高于对照组(P<0.05)。结论全程系统性健康教育可显著增加患者对PICC的认知度,提高置管的依从性,减少并发症的发生,提高患者的生活质量,值得临床推广。     

建立全程跟踪护理体系对留置PICC患者的影响

目的:探讨建立全程跟踪护理体系对留置中心静脉导管(PICC)患者的影响。方法:留置PICC患者103例,按留置PICC期间是否行全程跟踪护理分为观察组50例和对照组53例,观察2组心理健康症状自评量表(SCL-90)评分、一次置管成功率、穿刺点渗血、过敏反应、导管堵塞、非计划拔管、静脉炎发生率、导管相关性感染、留管时间等情况。结果:观察组的穿刺点渗血、过敏反应、导管堵塞、非计划拔管、静脉炎等并发症发生率均低于对照组(P<0.05);2组导管相关性感染发生差异无统计学意义(P>0.05);观察组一次置管成功率、留管时间和SCL-90评分均优于对照组(P<0.05~P<0.01)。结论:建立全程跟踪护理体系对留置PICC患者可以减少并发症、提高其身心舒适度,值得推广。     

健康教育对中心静脉导管胸腔置管患者的影响

目的 探讨健康教育对中心静脉导管（PICC）胸腔置管患者自护能力、自我效能及PICC相关并发症的影响.方法 收集晚期肿瘤伴恶性胸腔积液的患者100例,2012年5月前纳入的47例患者作为对照组,2012年5月及以后纳入的53例患者作为观察组,对照组给予常规护理及健康教育,观察组实施以提高患者自我护理能力和自我效能为目的的健康教育方案.结果 出院前观察组自我护理能力明显优于对照组,ESCA表的自护技能、责任感、自我概念、疾病健康知识得分及总分均高于对照组,差异有统计学意义（P＜0.05）.观察组置管期间自我效能量表不适症状管理、自我护理任务管理得分及总分均高于对照组,差异有统计学意义（P＜0.05）,观察组PICC依从性问卷调查得分高于对照组,差异有统计学意义（P＜0.05）.观察组置管期间导管最大流速变化值、月均非计划性导管维护次数PICC相关并发症发生率低于对照组,差异有统计学意义（P＜0.05）.结论 以认知行为干预、互动自我护理指导为主的健康教育有助于提高患者PICC置管期间自我护理技能、自我效能,降低导管阻塞及并发症发生率.     

护理干预措施对PICC置管患者导管维护依从性和并发症的影响研究

目的 探讨护理干预措施对经外周静脉穿刺中心静脉导管（PICC）置管患者导管维护依从性和并发症的影响。方法 选择2019年5月—2020年6月南昌市第三医院收治的肿瘤PICC置管患者88例,按随机数字表法分为2组,各44例。对照组实施常规PICC维护,观察组采取综合性护理干预措施,比较2组导管维护依从性、自我管理能力、生命质量、并发症情况及护理满意度。结果 观察组导管维护总依从率（95.45%）较对照组（77.27%）高,差异有统计学意义（P<0.05）。干预前2组自我管理能力、生命质量评分比较,差异无统计学意义（P>0.05）;干预后观察组自我管理能力量表中各因子评分、生命质量测定量表中功能领域和总体健康状况评分较对照组高,症状领域和单项领域评分较对照组低,差异有统计学意义（P<0.05）。观察组并发症发生率（6.82%）较对照组（25.00%）低,护理总满意度（95.45%）较对照组（79.55%）高,差异有统计学意义（P<0.05）。结论 综合护理干预措施可提高PICC置管患者导管维护依从性和自我管理能力,改善生命质量,并减少并发症的发生,患者更为满意。     

集束化护理在PICC全静脉营养支持治疗肿瘤患者中的应用效果观察

目的探讨集束化护理在经外周静脉置入中心静脉导管（PICC）全静脉营养支持治疗肿瘤患者中的应用。方法选择120例行PICC全静脉营养支持治疗患者作为对照组,以及120例PICC集束化护理的全静脉营养支持患者作为观察组。观察组在常规护理基础上应用集束化护理干预,对照组采用常规护理。干预13个月后,比较两组患者导管相关性血流感染、导管堵塞、导管移位等并发症的发生情况和PICC自我管理能力和自我护理能力。结果观察组导管相关性血流感染2例、导管堵塞1例、导管移位1例,对照组导管相关性血流感染9例、导管堵塞7例、导管移位8例,观察组并发症发生率均低于对照组（P＜0.05）。观察组PICC自我管理、带管运动、带管日常生活、导管维护依从性、日常导管观察、信息获取、导管异常情况处理、导管管理信心评分均高于对照组（均P＜0.05）;两组PICC自我管理、带管运动、带管日常生活、导管维护依从性、日常导管观察、信息获取、导管异常情况处理、导管管理信心评分均高于干预前（P＜0.05）。护理干预前,两组自我护理能力评分无统计学差异（P＞0.05）;干预后观察组自我护理能力评分高于对照组（P＜0.05）,两组干预13个月后自我护理能力评分均高于干预前（P＜0.05）。结论对PICC置管全静脉营养患者进行集束化护理,可有效降低导管相关性血流感染、导管堵塞、导管移位的发生率,提高患者的PICC自我管理能力和自我护理能力,值得在临床推广。     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.