目的 探讨健康教育路径联合集束化护理模式在预防脑卒中患者便秘的效果观察。方法 随机选择神经外科收治的脑卒中患者120例,分为实验组与对照组,各60例,其中对照组给予常规护理,而实验组在常规护理基础上应用健康教育路径联合集束化护理模式。比较两组患者便秘发生率、便秘措施落实率、患者满意度、及患者入院前后的健康教育知识知晓率的比较。结果 实验组便秘发生率明显低于对照组,便秘护理评估率,护理措施落实率,病人满意度明显高于观察组,患者入院后的健康教育知识知晓率明显升高(P<0.05),具有统计学意义。结论 健康教育路径联合集束化护理模式能有效的降低脑卒中患者便秘发生率,提高预防便秘发生护理措施落实率,提高患者满意度,提高患者舒适度。

目的 探讨蛛网膜下腔注射布比卡因与舒芬太尼预防剖宫产术中寒战效果的影响。方法 选取我院拟行剖宫产手术的产妇158例随机分为对照组(n=79)和观察组(n=79),两组均行蛛网膜下腔注射麻醉下的剖宫产术,对照组给予麻药为质量浓度为5 g/L的布比卡因,观察组为质量浓度为5 g/L的布比卡因+小剂量舒芬太尼,观察两组术中预防寒战效果。结果 观察组寒战发生率(16.64%)低于对照组(39.25%)(P<0.05);MAP、HR组内各时间点间有差异(P<0.05),组间同时间点比较无差异(P>0.05);观察组牵拉痛程度轻于对照组(P>0.05);两组新生儿1min Apgar评分和5min Apgar评分无差异(P>0.05);观察组产妇不良反应发生率为6.33%,与对照组的12.66%比较,无差异(P>0.05)。结论 剖宫产术进行蛛网膜下腔注射布比卡因和舒芬太尼,对预防产妇术中寒战的效果的具有积极影响。

随着时代的发展,医学模式更具综合性,预防医学专业特性不仅体现其医学范畴,其综合性特点日益突出。因此预防医学专业医学生综合素质及创新能力的培养显得愈发重要。为了提高预防医学学生的综合素质及创新能力,我们从预防医学理论教学及实验教学开展了教学改革探讨。

目的 探讨品管圈活动在提高神经外科卧床患者便秘预防措施落实率中的的应用效果。方法 成立品管圈,确定以“提高神经外科卧床患者便秘预防措施落实率”为主题,进行现状调查,设定目标,进行要因分析,制定并实施措施,比较品管圈活动前后护士落实便秘预防措施情况。结果 实施品管圈活动后,神经外科卧床患者便秘预防措施落实率从活动前的41.59%上升至活动后85.6%,差异有统计学意义(P＜0.05)。结论 品管圈活动可以有效提高神经外科卧床患者便秘预防措施落实率,降低便秘的发生率,减轻患者痛苦,改善患者生活质量。

目的 对临床护士实施预防住院患者误吸教育干预,评价干预措施对护士预防误吸知识及护理行为的影响。方法 选取我院神经系统相关科室的110名护士为研究对象,通过一系列教育干预,对比干预前后护士在预防误吸知识及护理行为等方面的改变,评估干预措施的效果。结果 110名护士均对培训满意;培训前护士预防误吸知识的平均得分为(65.6±9.6)分,培训后平均得分为(92.5±6.5)分,培训前后得分的差异有统计学意义(P<0.05)。培训后89份(89%)跟踪调查卷明确表示护士在工作中运用了培训所学的知识。结论 对护士进行有组织、有计划的教育干预能提高护士预防与处理患者误吸的知识水平,并能对护士预防和处理患者误吸的行为产生积极影响。

Objective To evaluate the effect of educating nurses on how to prevent and reduce aspiration rate of patients. Methods 110 nurses were recruited from neurological department in our hospital and were trained systematically about the prevention and nursing of aspiration. We compared the scores they had before and after training. Results 110 nurses were all satisfied with the training. The pre-education test score about the aspiration knowledge was 65.6±9.6 while the post-education test score was 92.5±6.5. The difference of the score before and after training was statistically significant difference (P<0.05). The follow-up study indicated that 89% nurses are applying the knowledge gained from the training to their clinical work. Conclusion It's suggested that well-organized educational training may improve nurses' performance of preventing patients from aspiration and treating patients when they had aspiration, which left a positive effect on nurses' behavior.

目的 探讨长期吸烟史对高危脑卒中患者口服阿司匹林二级预防效果的影响。方法 将2012年8月—2014年8月医院口服阿司匹林二级预防的高危脑卒中患者115例作为研究对象,根据有无吸烟史分为无吸烟史组(34例)和吸烟史组(81例),其中36例吸烟时间≥20 a(长期吸烟史组)、45例吸烟时间1～19 a(短期吸烟史组)。随访12个月,测定血小板颗粒膜蛋白(GMP-140)、D-二聚体(D-D)、纤维蛋白原(FIB)、组织型纤溶酶原激活物(t-PA)、血小板膜糖蛋白CD61、CD62p,记录1年阿司匹林抵抗和临床终点事件发生率。结果 长期吸烟史组治疗前后GMP-140、D-D、FIB、CD61、CD62p高于短期吸烟史组和无吸烟史组,t-PA低于短期吸烟史组和无吸烟史组,且短期吸烟史组和无吸烟史组组间比较,差异有统计学意义(P＜0.05);长期吸烟组阿司匹林抵抗发生率和临床终点事件发生率分别为33.33%、30.56%,高于无吸烟史组的8.82%、8.82%,差异有统计学意义(P＜0.05),其余组组间比较差异无统计学意义(P＞0.05)。结论 长期吸烟史会使脑卒中患者存在血栓前状态,增加阿司匹林抵抗和临床终点事件的发生几率。

Objective To explore effects of long-term smoking on secondary prevention for oral aspirin in high-risk stroke patients. Methods A total of 115 high-risk stroke patients who orally took aspirin for secondary prevention in our hospital from August 2012 to August 2014 were selected as the study subjects. According to smoking or not, they were divided into non smoking history group (34 cases) and smoking history group (81 cases). Among them, 36 cases whose smoking time was ≥ 20 years were included in the long-term smoking history group, and 45 cases whose smoking time was 1 to 19 years were included in the short-term smoking history group. The patients were followed up for 12 months. The platelet granule membrane protein (GMP-140), D-dimer (D-D), fibrinogen (FIB), tissue plasminogen activator (t-PA), platelet membrane glycoprotein CD61 and CD62p were determined. The incidence rates of 1-year aspirin resistance and clinical outcome events in the three groups were recorded. Results Before and after treatment, GMP-140, D-D, FIB, CD61 and CD62p in long-term smoking history group were higher than those in short-term smoking history group and non smoking history group while T-PA was lower, and there were significant differences between short-term smoking history group and non smoking history group (P<0.05). The incidence rates of aspirin resistance and clinical outcome events in long-term smoking history group (33.33%, 30.56%) were higher than those in non smoking history group (8.82%, 8.82%)(P<0.05), but there was no significant difference among other groups (P>0.05). Conclusion Long-term smoking history will cause prethrombotic state in stroke patients and increase the incidence rates of aspirin resistance and clinical outcome events.

成人急性呼吸窘迫综合征死亡率居高不下,而当前治疗手段大多以对症支持为主且效果欠佳。通过早期识别ARDS高危患者,及早施加干预措施阻断疾病进展是目前研究的新方向。较之传统机械通气模式,气道压力释放通气因其特有的肺保护作用备受国内外学者关注,APRV下肺泡持续开放并保持稳定可减少肺损伤发生,将APRV应用于ARDS预防理论上前景可观,本文将围绕早期实施APRV对预防ARDS应用价值展开论述。

The mortality of adult acute respiratory distress syndrome(ARDS) remains high. Supportive care measures are main treatments to ARDS currently while the effect is poor. Early application of airway pressure release ventilation in patients who are at high risk for ARDS is a new direction of research. Compared with traditional mechanical ventilation, more and more scholars both at home and abroad pay attention to the airway pressure release ventilation APRV because of its unique lung protection. Under APRV the alveoli maintain stable continuously which may reduce the incidence of lung injury. Applying APRV to ARDS prevention is promising theoretically. This paper will focus on the value of preemptive airway pressure ventilation for high-risk ARDS patients.

目的 探讨规范二级预防下老老年人轻型卒中复发的危险因素。方法 收集我院80岁及以上、既往有轻型卒中病史、并进行规范二级预防半年以上的老老年患者的临床资料:一般资料、既往病史及用药情况、入院时血压及基础生化指标、影像学资料、缺血性卒中复发情况。根据有无复发缺血性卒中将患者分为复发组和无复发组两组,分析以上因素在两组间的差异。结果 80例患者中复发缺血性脑卒中共26例,复发率32.5%。统计结果显示,轻型卒中复发组与合并高血压病、入院时收缩压、D二聚体水平呈正相关,其相关系数分别为0.265(P=0.018)、0.232(P=0.038)和0.222(P=0.048)。复发组收缩压升高比例高于无复发组(χ²=6.919,P=0.031)。非条件Logistic多因素分析显示:合并高血压病[OR 95%CI=(1.162,10.230)]、收缩压升高[OR 95%CI=(0.997,68.840)]与轻型缺血性卒中复发相关。结论 合并高血压病、收缩压升高是老老年人轻型卒中规范二级预防下复发独立危险因素。

Objective To analyze the recurrence risk factors of aged patients with minor ischemic stroke under standardized secondary prevention. Methods Patients over 80 years old and with minor ischemic stroke history were enrolled, and the following data were collected: demographic characteristics, medical history, current medicine, blood test, imaging findings and recurrence of ischemic strokes. Patients were divided into two groups: the recurrence group and the non-recurrence group. Chi-square test,logistic regression models were performed to assess correlations between baseline variables and recurrence of minor stroke events. Results In our study, 26 patients had recurrent minor ischemic stroke(32.5%). The prevalence of recurrence of minor stroke was positively correlated with hypertension(CI 0.265, P 0.018), SBP(CI 0.232,P 0.038), d-2-dimer(CI 0.232,P 0.048). Patients in recurrence group are more likely to presented with SBP elevation compared to non-recurrence group(χ²=6.919, P=0.031). Unconditional logistic regression analysis showed that hypertension, especially high SBP significantly related to minor ischemic stroke recurrence. Conclusion Hypertension,especially elevated SBP, were considered as an independent risk factors for aged old patients with minor ischemic stroke who received standardized secondary prevention.

目的 观察以“五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效及其社区应用价值。方法 90例符合纳入、诊断标准的患儿随机分观察组与对照组,观察组以“五物甘草生摩膏”为介质膏摩法干预;对照组服用玉屏风颗粒;疗程均为2个月,观察服药后1个月(治疗)以及停药后1年内(预防)的疗效。结果 不论是从近期疗效还是远期疗效观察,观察组的疗效更显著;观察组儿童外感咳嗽症状的发生率也明显低于对照组。结论 “五物甘草生摩膏”为介质的膏摩法对小儿外感咳嗽的疗效影响显著,值得在家庭和基层医疗机构中推广应用。

目的 探讨联合运用透明质酸钠及雌激素预防人工流产术后子宫内膜炎的临床疗效。方法 选择2015年1月—2015年6月在我院接受人工流产术者97例,随机分为观察组48例及对照组49例。对照组术后服用雌激素,观察组同时服用雌激素及透明质酸钠。于术后1周、3周时检测两组患者子宫内膜炎症状评分及宫颈分泌物炎症指标。结果 经过21天的干预之后,两组患者子宫内膜炎症状相比较,观察组患者下腹疼痛、白带增多及发热得分都低于观察组(P<0.05)。宫颈分泌物的CRP、IL-6、IL-9水平检测,术前两组患者之间差异不显著;治疗1周时,两组炎症因子水平均升高,但对照组变化更为明显;干预3周后,两组炎症因子水平较之1周时有所下降,但观察组基本降至正常水平,与对照组相比,差异有统计学意义(P<0.05)。结论 透明质酸钠联合雌激素预防人工流产术后子宫内膜炎效果明显,值得临床推广。