目的 探讨氢吗啡酮对大鼠脑缺血再灌注损伤的影响。方法 45只SD雄性大鼠随机分成3组：假手术组（Sham组）、脑缺血再灌注组（I/R组）和氢吗啡酮组（HM组）。采用Zea-Longa改良线拴法构建动物模型,再灌注24 h后,Zea-Longa评分法评价神经功能;TTC染色检测脑梗死体积;苏木精-伊红（HE）和Nissl染色观察海马神经元病理变化,Tunel染色观察细胞凋亡情况,Western blot、qPCR检测凋亡相关因子B淋巴细胞瘤（Bcl）-2、Bcl-2相关X蛋白（Bax）和半胱氨酸蛋白酶（Caspase）-3蛋白和mRNA表达量。结果 与I/R组相比,HM组神经功能评分下降和脑梗死面积减小（P<0.05）,Tunel阳性细胞数量减少（P<0.05）,Bax和Caspase-3蛋白mRNA表达量减少,而Bcl-2表达量显著增加（P<0.05）。结论 氢吗啡酮具有神经保护作用,可减轻大鼠脑缺血再灌注损伤。

Objective To investigate the effect of hydromorphone on cerebral ischemia-reperfusion injury in rats．Methods Forty-five SD male rats were randomly divided into three groups：sham-operated group（Sham group）, cerebral ischemia-reperfusion group（I/R group）and hydromorphone group（HM group）．The animal models were constructed using the Zea-Longa modified line tethering method, and neurological function was evaluated by the Zea-Longa score after 24 h of reperfusion．TTC staining was used to detect the volume of cerebral infarction, hematoxylin-eosin（HE）and Nissl staining were used to observe the pathological changes of hippocampal neurons, and Tunel staining was used to observe apoptosis, Western blot, qPCR were used to detect apoptosis Bcl-2, Bcl-2-associated X protein（Bax）and cysteine protease（Caspase）-3 protein and mRNA expression．Results Compared with the I/R group, the HM group showed lower neurological function scores and cerebral infarct area（P<0.05）, smaller number of Tunel-positive cells（P<0.05）, less mRNA expression of Bax and Caspase-3 proteins and significantly higher expression of Bcl-2（P<0.05）．Conclusions Hydromorphone has neuroprotective effects and can reduce cerebral ischemia-reperfusion injury in rats．

目的 探讨家庭药师与药物治疗管理对签约患者用药依从性及不合理用药干预效果。方法 选取2017年3月—2021年3月我院收治的慢性病患者100例作为前瞻性研究对象,按照随机余数法分为对照组和研究组各50例。其中,对照组实施首次随访调查,收集患者健康信息建立用药档案,末次随访评价。研究组采用收集患者健康信息,建立用药档案,填写调查表,对在用的药物治疗方案进行评价,家庭药师与家庭医生协作共同干预或直接干预,制定具体的解决方案,帮助患者达到治疗目标。比较2组患者干预前后的药物依从性、生活质量及用药情况的变化。结果 干预前,2组患者的药物依从性评分比较无统计学意义(P ＞0.05),干预后,2组患者药物依从性评分比较随时间增加而改善,而研究组的药物依从性评分显著高于对照组,统计学显示差异有统计学意义(P＜0.05)。2组患者的选择合理、给药频率合理、滴定合理、换药合理、联合用药合理均有明显改善且研究组多于对照组,比较差异有统计学意义(P＜0.05)。结论 家庭药师及药物治疗管理干预能够有效提高患者用药依从性及生活质量,改善用药情况,对慢性病患者干预具有一定参考价值。

Objective To explore intervention the effect of family pharmacist and medication management on medication compliance and unreasonable drug use in contracted patients. Methods A total of 100 patients with chronic diseases from March 2017 to March 2021 in our hospital were selected as prospective study subjects. According to the random remainder method,they were divided into control group and research group with 50 cases in each group. Among them,the control group was surveyed in the first followed-up,and the health information of patients was collected to establish drug use files,and evaluation was performed in the final follow-up. Family pharmacists and family physicians intervened together or directly to formulate specific solutions to help patients achieve the treatment goals and explain the treatment goals. The changes of medication compliance,quality of life and drug use before and after intervention were compared between the two groups. Results Before the intervention,the medication compliance scores of the two groups were not significantly different (P>0.05).After the intervention,the medication compliance scores of the two groups improved with time,while the medication compliance scores of the research group were significantly higher than the control group,statistics analysis showed that the difference was significant (P<0.05).The reasonable selection,the reasonable frequency,the reasonable titration,the reasonable drug change,and the reasonable combined medication in research group were significantly more than the control group,and the differences were statistically significant (P<0.05).Conclusions Family pharmacist and medication management intervention could effectively improve medication compliance and quality of life of patients,improve drug use,had a certain reference value for chronic disease patients.

目的 探讨健康信念对心脏直视手术患者围术期心脏康复的影响。方法 选取我院2015年1月—2015年12月在全麻体外循环下行心脏直视手术患者 312例,按便利抽样法分为观察组159例和对照组153例。对照组按传统的心脏术后护理常规进行护理,观察组在对照组的基础上引入健康信念模式。比较两组患者心理健康状况、术后康复情况、护理满意度情况等。结果 观察组出院前一日SCL评分138.05±19.04,低于对照组155.84±21.27(t=7.1561,P<0.01);观察组拔除气管插管后24h、48h、72h疼痛评分分别为(2.25±1.22,1.98±0.67,1.24±0.57),低于对照组(3.28±1.01,2.71±0.98,1.87±0.86)(t值分别为6.003,7.652,7.597,P<0.01);观察组术后肺部并发症发生率2.52%低于对照组5.88%(χ²=4.550,P<0.05);观察组术后住院时间(10.93±5.58)d,短于对照组(15.79±5.24)d(t =7.933,P<0.01);观察组护理满意度97.48%,高于对照组90.84%(χ²=6.310,P<0.05)。结论 将健康信念模式用于心脏直视手术后患者,能够减轻患者术后不适症状,促进患者早日下床活动,降低肺部并发症的发生率,缩短术后住院时间,提高患者护理满意度。