综合干预在下肢静脉曲张腔内射频消融术联合注射泡沫硬化剂中的应用

目的探讨综合干预在下肢静脉曲张患者射频消融术联合注射泡沫硬化剂中的应用效果。方法选取2016年7月至2019年7月收治的下肢静脉曲张射频消融术联合注射泡沫硬化剂治疗的患者120例,随机分为对照组(60例)与观察组(60例)。对照组患者接受普外科常规干预,观察组患者接受基于Caprini风险评估模型的综合干预。收集干预后两组患者下肢深静脉血栓(DVT)的发生率和皮下淤血的发生情况、并发症情况,并比较两组患者的护理满意度。结果接受不同措施干预后,观察组患者DVT的发生率为1.67%,低于对照组患者DVT发生率11.67%(P 0.05)。观察组患者皮下淤血发生率同样低于对照组患者(P 0.05)。观察组患者护理满意度为96.67%,高于对照组的83.33%(P 0.05)。截止术后30 d,观察组患者并发症发生率为1.67%,低于对照组的6.67%(P 0.05)。结论对下肢静脉曲张射频消融术联合注射泡沫硬化剂治疗的患者而言,在术后立即使用Caprini风险评估模型进行分级,并根据病情严重程度给与针对性的综合干预措施,能够显著降低下肢深静脉血栓和皮下出血的发生风险,并提高患者的护理满意度,具有一定的临床意义,值得推广使用。     

健康教育护理干预在股骨颈骨折患者中的护理效果

目的 探讨健康教育护理干预在股骨颈骨折中的护理效果.方法 选择本院60例股骨颈骨折患者,上述患者随机分为观察组和对照组.两组患者均给予髋关节置换术,对照组患者给予股骨颈骨折手术治疗常规护理措施,观察组在对照组的常规护理措施基础上实施健康教育护理干预.采用自行设计的健康知识知晓情况调查表,对两组患者护理干预后健康知识的知晓程度进行调查.结果 观察组患者护理干预后健康知识完全知晓共24例,部分知晓5例,1例患者不知晓,观察组患者中完全知晓和部分知晓所占比例为96.7%;对照组患者护理干预后健康知识完全知晓共15例,部分知晓6例,9例患者不知晓,对照组患者中完全知晓和部分知晓所占比例为70.0%;观察组患者中完全知晓和部分知晓所占比例高于对照组,差异有统计学意义（P＜0.05）.结论 健康教育护理干预能够提高股骨颈骨折患者对疾病健康知识的知晓程度,利于患者术后康复,护理效果显著.     

家庭医生签约服务在2型糖尿病管理中的作用

目的探讨家庭医生签约服务在2型糖尿病治疗中的作用。方法选取120名2型糖尿病患者作为研究对象,随机分为对照组(n=60)和观察组(n=60),对照组患者接受常规糖尿病教育,观察组患者在此基础上接受家庭医生签约服务。对比干预前、干预后12个月患者空腹及餐后2h血糖、BMI指数、糖化血红蛋白、健康知识知晓情况、营养与健身知识—态度—行为得分情况。结果干预后两组患者空腹血糖、餐后2h血糖、BMI指数、糖化血红蛋白均低于干预前,健康知识知晓率、营养与健身知识-态度-行为得分优于干预前,差异有统计学意义(P0.05)。干预后观察组患者空腹血糖、餐后2h血糖、BMI指数、糖化血红蛋白、低于对照组患者,健康知识知晓率、营养与健身知识-态度-行为得分高于对照组患者,差异有统计学意义(P0.05)。结论家庭医生签约服务在2型糖尿病治疗中具有积极的作用,有助于糖尿病患者的病情控制,提高患者健康知识掌握程度,改善患者保健知信行状况。     

健康教育护理干预在急性心肌梗死患者中的护理效果

目的探讨健康教育护理干预在急性心肌梗死患者中的应用效果。方法所选患者均为本院2010年12月至2012年12月期间的住院患者共80例,患者随机分为观察组和对照组。两组患者均给予相似的常规治疗,对照组患者给予常规心肌梗死护理干预,观察组在常规护理干预基础上实施健康教育护理干预。采用自设问卷调查表,调查两组患者在护理干预后对健康知识的掌握情况,调查两组患者对医嘱的遵从情况。记录两组患者在治疗期间并发症的发生情况。结果观察组患者对急性心肌梗死相关知识知晓情况所占比例高于对照组,差异有统计学意义（P〈0.05）;观察组遵从医嘱患者所占比例高于对照组,差异有统计学意义（P〈0.05）;观察组并发症发生情况高于对照组,差异有统计学意义（P〈0.05）。结论健康教育护理干预能够显著提高急性心肌梗塞患者对疾病相关知识的知晓程度,有助于提高患者的遵医行为,提高治疗效果。     

健康教育护理干预在老年慢性支气管炎患者中的应用效果

目的 探讨健康教育护理干预在老年慢性支气管炎患者中的应用效果.方法 选择本院慢性支气管炎患者80例老年病例,上述患者随机分为观察组和对照组.对照组患者给予常规的慢性支气管炎护理干预,了解患者基本情况,对患者休息、饮食及运动服药情况进行护理干预.观察组在上述常规护理干预基础上给予健康教育护理干预.观察两组患者对本病疾病知识的知晓情况.结果 观察组患者在慢性支气管炎疾病知识、健康饮食知识、吸氧危害知识、慢性支气管炎并发症知识的知晓方面优于对照组,差异有统计学意义（P＜0.05）.观察组患者中戒烟共35例,所占比例87.5%,对照组患者中戒烟20例,所占比例为50.0%,观察组患者中戒烟所占比例高于对照组,差异有统计学意义（P＜0.05）.结论 健康教育护理干预在老年慢性支气管炎患者中应用效果显著,能够提高患者对疾病的知晓率,值得借鉴.     

每日目标化健康教育对住院糖尿病患者疾病知识的影响

目的:探讨每日目标化健康教育模式对糖尿病患者疾病知识的影响。方法:选取糖尿病患者205例,按照入院先后顺序分为分为对照组和观察组。对照组采用常规的健康教育模式,观察组采用每日目标化健康教育模式,比较两组患者干预前、后健康教育效果。结果:两组患者干预前糖尿病知识的知晓情况无统计学差异(P0.05),干预后两组患者糖尿病知识的知晓情况存在显著差异(P0.001)。两组患者干预前胰岛素知识的知晓情况无统计学差异(P0.05),干预后两组患者胰岛素知识的知晓情况存在显著差异(P0.001)。干预后胰岛素注射合格率,观察组82.35%;对照组59.15%。结论:每日目标化健康教育路径可以提高健康教育的效率,增加患者的积极性和主动性,是适合住院糖尿病患者健康教育模式。     

腔内激光联合泡沫硬化剂治疗减少下肢隐神经损伤临床观察

目的评价腔内激光联合泡沫硬化剂方法在减少治疗下肢静脉过程中的隐神经损伤的临床疗效。方法将360例下肢静脉曲张患者随机分为两组,观察组180例接受腔内激光联合聚桂醇泡沫硬化剂治疗,对照组180例只接受腔内激光治疗,比较两组患者的临床疗效及隐神经损伤发生率。结果观察组治愈率90.0%,总有效率98.89%,对照组治愈率85.56%,总有效率97.22%,两组临床疗效比较差异无统计学意义(P0.05);观察组术后3天,3个月,6个月,24个月时的隐静脉损伤率均显著低于同期的对照组(P0.05)。结论应用腔内激光联合泡沫硬化剂方法可明显减少治疗下肢静脉手术过程中的隐神经损伤。     

大隐静脉高位结扎联合泡沫硬化剂治疗静脉曲张疗效观察

目的:观察大隐静脉高位结扎联合泡沫硬化剂治疗静脉曲张的疗效。方法:将原发性下肢大隐静脉曲张93例患者根据不同的治疗方法,随机分为2组:观察组采用大隐静脉高位结扎联合泡沫硬化剂治疗;对照组采用传统手术方式大隐静脉高位结扎+剥脱术治疗。观察并比较2组患者的平均手术时间、平均出血量、术后首次行走时间、住院时间、复发率及并发症等指标情况。结果:2组患者手术均获成功,观察组在平均手术时间、平均出血量、术后首次行走时间、住院时间等优于对照组(P<0.05),2组并发症比较,差异无统计学意义(P>0.05)。术后随访6~24月,效果良好,曲张静脉消失,无复发病例。结论:高位结扎联合泡沫硬化剂治疗大隐静脉静脉曲张具有创伤小、手术时间及住院时间短、恢复快、术后并发症少、美容效果好等优点。     

知信行模式健康教育联合心理行为干预在社区慢性疾病管理中的应用研究

目的探讨知信行模式的健康教育联合心理行为干预在社区慢性疾病管理中的效果。方法采用方便抽样的方法选取在我中心参与慢性疾病规范化管理依从性差、血压不达标的高血压患者60例,按随机数字表法随机分为观察组和对照组,每组各30例,观察组采用知信行模式的教育联合心理行为干预;对照组采用常规的健康教育。两组患者均干预随访12个月,比较两组患者在高血压知识知晓率、参与慢性病管理的依从性、自我管理行为情况、心理状况、高血压的达标情况。结果两组患者在慢性病知识知晓情况、参与慢性病管理的依从性、自我管理行为情况、心理状况及高血压达标较干预前均有提高,但观察组优于对照组,观察组血压达标显著高于对照组,差异有统计学意义(χ~2=5.440,P=0.034 <0.05)。结论知信行模式的健康教育联合心理行为干预在社区慢性疾病管理中的效果显著,有助于提高患者在慢性疾病管理中的依从性、缓解患者的焦虑抑郁状况、提高慢病管理的临床效果,是做好社区慢性疾病管理工作的有效方法之一。     

健康教育对消化性溃疡患者的影响观察

目的 探讨消化性溃疡患者的健康教育效果.方法 将108例消化性溃疡患者随机分为观察组(54例)和对照组(54例).对照组给予药物治疗和常规的出入院卫生宣教;观察组在药物治疗基础上采取综合健康教育措施.结果 观察组患者的治疗依从性、Hp根除率、疾病治愈率均较对照组明显提高(P≤0.05);两组病例在健康教育前后的知识、态度得分差异有统计学意义(P≤0.05),但行为得分差异无统计学意义(P>0.05);疾病远期复发率差异有统计学意义(P≤0.05).结论 对消化性溃疡病患者进行综合性健康教育,可明显提高疗效.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

基层医院护士在临床合理用药中的作用

目的充分利用护士在医师和患者间的特殊地位和作用,促进基层临床合理用药。方法从护士的工作性质出发,论述护士参与促进合理用药的方便和优势。结果通过实践,护士在促进合理用药中的作用得到有效发挥,基层合理用药环境得到极大改善。结论充分利用护士与医师和患者间的特殊桥梁作用,在基层医院促进合理用药,规范医师用药行为,防止药物滥用,引导患者安全用药,降低药源性疾病。