目的 研究术中麻醉深度监测在全麻下行下腹部手术患者苏醒质量和护理工作应用。方法 选取择期全麻下行下腹部手术患者120例(ASAⅠ~Ⅱ级),随机分成NT组和NNT组,NT组患者(60)术中用Narcotrend监测,NNT组患者(60)术中不用Narcotrend监测。记录术中丙泊酚用量;记录术后气管导管拔管时间和麻醉恢复室(postanesthesia care unit, PACU)留观时间;记录恢复室Ricker镇静—躁动评分;记录恶心呕吐及术后谵妄的发生率。结果 NT组患者术中麻醉药物丙泊酚的用量比NNT组明显减少(P<0.05);NT组患者术后的拔管时间与PACU留观时间比NNT明显缩短(P<0.05);NT组患者术后的Ricker 镇静-躁动评分比NNT明显降低(P<0.05);NT组患者与NNT组术后恶心呕吐及术后谵妄发生率无明显差别。NT组比NNT组降低了护理工作量(P<0.05)。结论 在麻醉深度监测仪Narcotrend下行下腹部手术,通过有效的麻醉深度监测,可以改善患者术后的苏醒质量,这些有利于减少PACU护理工作量,提高了护理质量,也有助于PACU护理规范化。

Objective To investigate the effect of anesthesia depth monitoring on the recovery quality and nursing quality of patients treated with lower abdominal surgery under general anesthesia. Methods A total of 120 patients who underwent the lower abdominal surgeries from June 2015 to December 2015 were randomly divided into 2 groups: non-Narcotrend monitoring group (non NT group) and Narcotrend monitoring group (NT group). And each group contains 60 cases. All patients were set in the same induce plan, and maintained by propofol-fentanyl during the operation. The dosage of propofol, the time of tracheal extubation, the PACU staying time, the Ricker sedation-agitation scale, the incidence of PONV and POD, the nursing quality and nursing working load were recorded in the project. Results Using Narcotrend to monitor the anesthesia depth could significantly decrease the dosage of propofol (P<0.05). The tracheal extubation time and the PACU staying time of patients in NT group were much shortened than patients in non NT group (P<0.05). In NT group the Ricker scores of patients were much lower than patients in non NT group (P<0.05). And the effective anesthesia depth monitoring using Narcotrend could significantly decrease the nursing working load and improve the nursing quality (P<0.05). Conclusion Effective anesthesia depth monitoring using Narcotrend may improve the recovery quality in the PACU, which may decrease the working load of nurses and improve the nursing quality in PACU.

目的 探讨胰腺神经鞘瘤的临床特点和诊治方法。方法 总结并回顾性分析我院肝胆外科收治的胰腺神经鞘瘤患者1例及文献报道的71例患者临床资料。结果 共计72例胰腺神经鞘瘤患者纳入总结和分析。患者平均年龄54岁(范围17～89岁),其中女性40例(56%)。临床表现包括上腹痛、体重减轻,或体检偶然发现胰腺肿物。肿瘤平均大小6.1 cm(1～20 cm)。肿瘤位于胰头部29例(40%)、胰体/尾部32例(44%),沟突部6例(8%)。肿瘤表现为实性肿物27例(38%)、囊性28例(39%)、囊实性10例(14%)。2例通过术前超声内镜下穿刺活检病理确诊,其余均为手术后标本病理诊断证实。手术治疗行胰十二指肠切除术23例、局部剜除术16例、胰体尾切除术15例、胰腺中段切除1例。5例 (7%) 患者术后病理为恶性神经鞘瘤,恶性组肿瘤大小明显大于良性组[(13.8±6.2)cm vs (5.6±4.1)cm,P=0.0004)]。手术切除患者术后随访3～65月,均无肿瘤复发、转移及患者死亡。结论 胰腺神经鞘瘤临床表现缺少特异性,术前诊断困难,肿瘤大小与良恶性具有明显相关性,手术治疗可取得良好效果。

Objective To analyze clinical presentation, diagnosis, treatment options, and outcome of pancreatic schwannoma. Methods A retrospective study of clinical data of a case in our hospital and 71 cases reported in literature with pancreatic schwannoma. Results 72 cases were analysed. The mean age was 54 years (range 17-89 years), with 56 % of patients being female. Mean tumor size was 6.1 cm (range 1-20 cm). Tumor location was the head (29 cases), body and tail (32 cases), and uncinate process (6 cases). 27 cases exhibited solid tumors and 28 cases exhibited cystic tumors. Treatment included pancreaticoduodenectomy (23 cases), distal pancreatectomy (15 cases), enucleation (16 cases). 5 cases (7%) were malignant schwannoma. Tumor size of malignant group was significant larger than benign group (13.8±6.2 cm vs 5.6±4.1 cm,P=0.0004). There was no local recurrence metastasis,or death at the follow-up after operation (range 3-65 months). Conclusion The clinical manifestations of pancreatic schwannoma are lack of specificity and preoperative diagnosis remains difficulty. The tumor size was significantly related to classification of malignant or benign. Pancreatic schwannoma has satisfactory prognosis with surgical treatment.

目的 探讨肌电生物反馈对正常人脑血流动力学的影响及其变化规律。方法 总数30人的健康正常受试者纳入研究,按照表格法随机分为生物反馈实验组和对照组。其中生物反馈组20人,对照组10人。该试验采用肌电生物反馈作为反馈方法,记录两组试验前后双侧大脑前动脉、大脑中动脉和大脑后动脉的平均血流速度和脉动指数。每次生物反馈试验后间隔3天,作为一个生物反馈阶段,总共进行7个阶段。结果 生物反馈组大脑中动脉的平均血流速度在试验前、后高于对照组(P<0.05),而其脉动指数则低于对照组(P<0.05)。生物反馈组在试验前、后大脑中动脉的平均血流速度随着生物反馈次数的增加而增快(P<0.05),而脉动指数则随之而降低(P<0.05)。结论 肌电生物反馈能够增加正常人大脑中动脉的平均血流速度和降低其脉动指数,且随着生物反馈次数的增加而呈现累积效应。

Objective To discuss the effect of electromyographic biofeedback on cerebral hemodynamics in health people. Methods A total of 30 healthy volunteers were enrolled in this study, and randomly divided into biofeedback group (n=20) and control group (n=10). The biofeedback group had been done with electromyographic biofeedback for seven times with 3 days intervals after each test. The data including the mean velocity (Vm) and pulse index (PI) of anterior cerebral artery, middle cerebral artery (MCA) and posterior cerebral artery were collected bilaterally before and after the test using transcranial Doppler in the two groups. Results The values of Vm (P<0.05) were higher and PI (P<0.05) were lower in biofeedback group than those in control group before and after the test. The values of Vm (P<0.05) increased and PI (P<0.05) decreased gradually in biofeedback group from 1st to 7th tests. Conclusion The electromyographic biofeedback can induce to the increasing of velocity of cerebral blood flow and decreasing of PI in MCA, and the additive effect was observed during the 7 tests in biofeedback group.

目的 对不同周龄的KO小鼠与WT小鼠进行悬尾实验进行观察,探讨KO小鼠与WT小鼠的行为差别。方法 采用健康的试验动物180只分两组:①KO组(4、6、8周龄,各周龄30只,雌雄各半,共90只)②WT组(4、6、8周龄,各周龄30只,雌雄各半,共90只);通过悬尾实验观察性别,年龄对不动时间的影响。结果 同龄KO雌性小鼠比雄性小鼠的静止时间差别不大;随着年龄增大,静止时间增长。 同龄同性别的KO鼠比WT鼠的不动时间长。P<0.05;同龄雄性小鼠比雌性小鼠的不动时间短; 随年龄增长各种系小鼠不动时间增长,KO鼠的不动时间比WT鼠长,P<0.05。结论 KO小鼠存在抑郁行为表型。

Objective To observe tail suspension test in Fmr1 gene knockout mice and to explore whether there are differences in mobility of KO and WT mice. Methods 180 test mice were divided into two groups: ① KO group (4,6,8 weeks old, each age group of mice is 30, male and female in half, a total of 90) ② WT group (4,6, 8 weeks old, each group of mice is 30, male and female on half, a total of 90). Through forced swimming test and tail suspension test to observe gender, age effect on immobility time. Results With the same age of the same sex,the KO mice's immobility time was longer than WT mice's. P<0.05. With the same age,the male mice's immobility time was shorter than female mice's. With the age increase, the immobility time of KO mice was longer than WT mice. P<0.05. Conclusion Fmr1 gene knockout mice have anxiety and depressive behavior.

目的 初步探讨黄芩苷防治支气管哮喘的作用机理。方法 用卵蛋白致敏大鼠制备支气管哮喘动物模型,经黄芩苷干预治疗,运用免疫组化法及Western Blot法检测各组大鼠肺组织匀浆中p38 MAPK磷酸化蛋白表达量。结果 两种检测方法均显示,p38 MAPK磷酸化蛋白水平在模型组中有明显的增加,地塞米松组、黄芩苷高剂量组和低剂量组的p38 MAPK磷酸化蛋白水平均低于模型组(P<0.05)。结论 黄芩苷能有效治疗哮喘的作用与抑制哮喘大鼠p38 MAPK信号通路的表达密切相关。

Objective To explore the mechanism of Baicalin in treatment of bronchia asthma. Methods Animal models of bronchia asthma were made in rats sensitized with egg albumen. After the treatment of Baicalin, immunohistochemistry and western-blot methods were used to test expression quantity of phosphorylated p38 protein of lung tissue in all groups of guinea rats. Results Our data confirmed that the level of phosphorylated p38 protein increased significantly in model group, but it decreased in hexadecadrol group, high dose and low dose Baicalin group (P<0.05). Conclusion The effects of Baicalin in asthma model were associated with inhibition of P38 MAPK signal pathways in a dose-dependent manner.

目的 研究鸟胞内分枝杆菌复合群(MAC)MAV3104基因编码蛋白与药物外排的关系。方法 以MAC标准株基因组为模板,扩增MAV3104基因,构建pMV261-MAV3104c重组质粒;测序正确后,转化重组质粒到大肠杆菌DH5并在MAC标准株中诱导表达, Western Blot鉴定MAV3104表达;按照CLSIM24-A2的操作要求检测MAC标准株对克拉霉素的敏感性及外排泵抑制试验。结果 经基因测序及Western Blot蛋白表达验证重组质粒构建成功;MAV3104过表达能提高鸟分枝杆菌对克拉霉素的MIC,且硫利达嗪能抑制该作用;MAV3104过表达也能提高胞内分枝杆菌对克拉霉素的MIC,但硫利达嗪对其没有抑制效应。结论 MAV3104转运蛋白介导的药物外排在鸟分枝杆菌耐克拉霉素中起重要作用。

Objective To investigate the association of the protein coded by Mycobacterium avium-Mycobacterium intracellulare complex in MAV3104 in drug efflux of Clarithromycin. Methods According to the Mycobacterium avium-Mycobacterium intracellulare complex standard strain, the MAV3104 gene was amplified by PCR and cloned into expression vector pMV261 to generate the recombinant plasmids. After verification by sequence analysis, the recombinant plasmids was transformed into E. coli DH5 andMycoba ctenum avium-Mycobacterium intracellulare complex standard strain. To identify the protein expression by western blotting and investigate the sensitivity of clarithromycin and efflux pump inhibition test in the light of CLSIM24-A2 protocol. Results It was verified by sequence analysis and western blotting that the recombinant plasmids were successfully constructed. Over expression of Mycobacterium avium MAV3104 gene could enhance clarithromycin MIC, which could be inhibited by thioridazine. Over expression of Mycobacterium intracellulare MAV3104 gene also could enhance clarithromycin MIC, but it could not inhibited by thioridazine. Conclusion This study demonstrates that efflux pumps mediated by MAV3104 protein play an important role in Mycobacterium avium resistance to clarithromycin.

目的 探讨优质护理对大面积烧伤患者创面换药时对疼痛及不良情绪的影响。方法 收集我院大面积烧伤的患者,分为研究组和对照组。两组基础护理相同,研究组加用优质护理。对比两组护理前护理4周时焦虑评分,以及两组护理前、护理4周时创面换药时的疼痛评分。结果 ①研究组和对照组护理前焦虑评分结果比较无差异;研究组和对照组护理4周焦虑评分结果比较有差异。②研究组和对照组护理前创面换药时的疼痛评分结果比较无差异;研究组和对照组护理4周创面换药时的疼痛评分结果比较有差异。结论 本次研究认为通过优质护理能够明显提高大面积烧伤患者创面换药时的疼痛程度,对减少住院期间焦虑不良情绪有重要的意义。

目的 通过研究4CH8的健康管理模式对社区更年期女性冠心病危险因素的干预效果,为制定慢病防控对策提供依据。方法 选择我社区,具有完整个人档案的更年期女性400例,经三甲医院确诊为冠心病患者为对照组134例,未患冠心病的266例为干预组,并进行危险因素分析。对未患冠心病的更年期女性进行4CH8健康管理模式干预,随访1年后对冠心病的危险因素进行前后对比分析。结果 对照组与干预组的BMI、高血压、糖尿病、低密度脂蛋白、高密度脂蛋白及空腹血糖相比较,差异有统计学意义(P<0.05)。年龄、尿酸及糖尿病两组相比较,差异无统计学意义。冠心病的危险因素与BMI、高血压、糖尿病、冠心病、低密度脂蛋白水平及空腹血糖呈正相关,与高密度脂蛋白呈负相关。干预组干预一年后BMI、高血压、低密度脂蛋白及空腹血糖水平与干预前相比较,差异有统计学意义(P<0.05),干预前各指标异常人数比干预后少。结论 4CH8模式对社区更年期女性冠心病危险因素管理效果较好,值得推广应用。

目的 观察多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗幽门螺杆菌(Hp)感染消化性溃疡的临床疗效和不良反应。方法 选取于2013年7月—2015年7月收治的98例Hp感染消化性溃疡患者,根据不同的治疗方式,随机将其分为治疗组和对照组,每组各49例,治疗组患者给予多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗;对照组给予克拉霉素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗, 两组患者连续服用10天后,均口服泮托拉唑40 mg,每天1次,总疗程为4周。疗程结束4周后,予胃镜复查和Hp检查,观察两组患者的临床疗效、溃疡愈合率、Hp根除率及不良反应。结果 治疗组与对照组患者的临床效果总有效率分别是95.91％、81.63％;治疗组与对照组患者的溃疡愈合率分别是83.67％、61.22％ ;治疗组与对照组患者的Hp根除率分别是89.79％、65.30％;治疗组患者的临床疗效总有效率、溃疡愈合率和Hp根除率均明显优于对照组,差异均有统计学意义(P<0.05),两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗Hp感染消化性溃疡疗效显著、溃疡愈合率高、Hp根除率高、且安全无明显不良反应,值得临床广泛推广使用。

目的 探讨心理健康干预对复治肺结核患者在整个治疗过程中生活质量影响,为加强结核病的宣教奠定坚实的基础。方法 选取广州市结核病防治所在治的复治肺结核病人72例,随机分成宣教组和普通组,选取2名有丰富经验的主管护师,经专业心理师培训指导,护长考核,负责宣教组的工作,而普通组则由轮班护士进行,无作特别要求。对比两组心理健康干预前后的变化。结果 两组症状自评量表(SCL-90)测评相比较,宣教组优于普通组,差异有统计学意义(P<0.05)。宣教组的生理健康总评及精神健康总评比对照组好,差异均有统计学意义(P<0.05)。结论 通过对门诊复治结核病患者进行心理健康干预,能有效改变复治病人的心理和生理健康,提高生活质量。