PRECEDE模式对改善慢性心力衰竭患者生活质量的干预效果研究

目的运用PRECEDE模式建立适用于慢性心力衰竭患者的健康促进计划,并观察其对心力衰竭患者生活质量的干预效果,探讨其可行性。方法便利抽样法选取2014年3月至2015年2月长沙市某三级甲等医院老年心血管科和心血管内科住院的慢性心力衰竭患者62例为研究对象,采用随机数字表法将其分为观察组和对照组。对照组患者给予常规护理,观察组患者除接受常规护理和治疗外还将接受为期3个月的基于PRECEDE模式设计的健康促进计划干预。结果干预在情绪维度、其他维度、总分上比较,差异有统计学意义(P0.05),观察组在干预后3个月MLHFQ各维度及总分高于对照组,差异有统计学意义(P0.05)。时间对各维度及总分的比较,差异均有统计学意义(均P0.05),干预和时间在情绪维度、其他维度及总分上存在交互效应(P0.05)。结论 PRECEDE模式健康促进计划有效可行,能提高慢性心力衰竭患者生活质量。     

耐多药肺结核患者呼吸道感染的病原菌耐药性分析

目的了解耐多药肺结核患者呼吸道感染的病原菌分布及耐药性,为正确选择抗菌药物治疗提供依据。方法选取2007年1月-2013年1月治疗的耐多药肺结核患者87例,采集患者痰标本进行培养及药敏试验,分析病原菌种类及耐药性,数据采用SPSS13.0软件进行统计分析。结果 87例患者痰标本培养出病原菌178株,其中革兰阴性菌124株占69.66%,革兰阳性球菌12株占6.74%,真菌42株占23.60%;金黄色葡萄球菌对氨苄西林、阿奇霉素及青霉素G的耐药率分别为100.00%、85.71%及100.00%;肺炎克雷伯菌对头孢噻肟、氨曲南、环丙沙星的耐药率分别为97.37%、94.94%、97.37%;真菌对酮康唑、氟康唑、伊曲康唑、伏立康唑有不同程度的耐药性,对两性霉素B的耐药率为0。结论革兰阴性杆菌是耐多药肺结核患者呼吸道感染的主要病原菌,真菌感染的比例较大,革兰阳性菌和革兰阴性菌均对常用的抗菌药物的耐药性较高,临床应根据细菌培养及药敏试验结果选用合理的抗菌药物,以增强疗效及降低耐药率。     

CO-ADMINISTRATION OF FUROSEMIDE AUGMENTS TACROLIMUS-INDUCED IMPAIRMENT IN KIDNEY FUNCTION IN RATS

Sodium-depletion in rats reproduces functional and morphological tacrolimus nephrotoxicity observed in man. Potent diuretics induce sodium-depletion. Our objective was to determine the effect of a loop diuretic furosemide on tacrolimus-mediated functional and pathological impairment of the kidney in rats. Sprague-Dawley rats were divided into four groups; group 1, rats received vehicle (saline) only; group 2, rats were treated with tacrolimus (1mg/kg body weight) and furosemide (5mg/kg body weight); group 3, rats were treated with tacrolimus alone; and group 4, rats were treated with furosemide (5mg/kg body weight) alone. On day 28, tail blood pressure was measured and the rats were placed in metabolic cages for urine collection. After 24 hr the rats were sacrificed. Tacrolimus alone tended to cause growth retardation, hypotension, hypomagnesemia and a rise in blood urea nitrogen. Furosemide co-administration enhanced the effects of tacrolimus on hypotension, hypomagnesemia and a rise in blood urea nitrogen. The renal histology characterized by cytoplasmic vacuolization of the proximal tubules was not different between the rats treated with both tacrolimus and furosemide and the rats treated with tacrolimus alone. A strong immunostaining for FKBP-12, a tacrolimus-binding protein, was observed in the medulla of the kidneys of rats treated with tacrolimus either with or without furosemide.These results indicate that furosemide further augments tacrolimus induced impairment in kidney function, and that furosemide should be used with discretion in patients on tacrolimus therapy.     

右心房、左心室起搏治疗慢性心力衰竭伴左束支传导阻滞患者的短期疗效

目的:观察右心房、左心室起搏治疗慢性心力衰竭(心衰)伴左束支传导阻滞患者的短期疗效.方法:选择纽约心功能分级(NYHA)Ⅲ级～Ⅳ级、左心室射血分数≤0.35、体表心电图QRS时限≥120 ms、窦性心律的心衰患者26例,成功植入三腔起搏器后,以右心房、左心室起搏模式治疗7天,以起搏器植入术前及术后第7天的6分钟步行距离、明尼苏达生活质量评分、QRS波时限、左心室舒张末期内径、左心室射血分数、左心室室间隔部与侧壁基底段收缩期达峰时间差值、N末端脑钠肽为疗效评价指标,观察右心房、左心室起搏治疗慢性心衰的短期疗效.结果:右心房、左心室起搏治疗术后第7天较术前比较,6分钟步行距离由术前的( 279±46)m提高至(312±37)m；明尼苏达生活质量评分由术前的(28±7)下降至(22±5)；体表心电图QRS波时限由术前的(167±22)ms缩短至(132±8)ms;左心室射血分数由术前的(0.29±0.07)提高至(0.33±0.05)；左心室舒张末期内径由术前的(75±8)mm减小至(69±7)mm；左心室室间隔部与侧壁基底段收缩期达峰时间差值由术前的(105±29)ms下降至(62±8)ms；N末端脑钠肽由术前的(3 086±1 265)pg/ml下降至(1 976±760)pg/ml；患者的各疗效评价指标均得到明显改善,差异均有统计学意义(P＜0.05).结论:对窦性心律、完全性左束支传导阻滞的慢性心衰患者右心房、左心室起搏的短期疗效确切.     

Prognostic factors of single‐visit endodontic and restorative treatment under general anaesthesia for special needs patients

The aim of this study was to evaluate the longevity of teeth with single‐visit endodontic and restorative treatment under general anaesthesia (GA) for special needs patients and to investigate factors associated with survival and success. Data were collected from 381 teeth in 203 patients [mean (s.d.) age = 27·0 (14·1)]. All endodontic and restorative procedures were performed during a single GA session except for cementation of crowns in the cases requiring crown restoration (38%). A total of 267 teeth (70·6%) were followed‐up for 6–81 months [mean (s.d.): 32·7 (20·0)]. Patients and teeth with and without follow‐up were compared. Kaplan–Meier analysis with generalised Wilcoxon test was used to compare the mean survival and success period. Cox proportion hazard regression model was applied for multivariate analysis. At the end of the observation period, 10 teeth had a crown fracture (5‐year survival rate = 89·8%), and an additional 10 teeth had primary or secondary caries (5‐year success rate = 86·4%). Risk factors associated with survival were age (>40), non‐parental caregiver, cooperation level and periodontal disease. A soft diet was an additional risk factor against the success of teeth. Single‐visit endodontic and restorative treatment under GA showed favourable outcomes, suggesting a promising treatment option for special needs patients. Patient‐ and dental‐specific circumstances need to be carefully considered to enhance the longevity of reconstructed teeth.