每搏量变异度指导老年腹腔镜胃癌根治术容量管理的临床研究

目的观察每搏量变异度(SVV)指导的目标导向性液体治疗(GDFT)与常规补液对老年腹腔镜胃癌根治术患者术中循环动力学及术后胃肠功能恢复的影响。方法选择择期行腹腔镜胃癌根治术的老年患者80例,采用随机数字表法分为目标组和常规组,常规组采用常规补液方案进行补液;目标组采用SVV为指导的目标管理补液方案进行补液。比较两组术中血流动力学指标和血管活性药物使用情况;比较两组术中输液量及其种类、失血量、尿量、术前术后1d血色素(Hb)、血球压积(Hct)、尿素氮(BUN)、肌酐(Ccr)水平以及术后胃肠功能恢复情况和术后并发症情况(包括恶心呕吐、心力衰竭、肺部感染、吻合口渗漏或腹腔感染、肠梗阻等)。结果 1两组患者基础值(T1点)平均动脉压(MAP)、心率(HR)比较差异均无统计学意义(P>0.05),两组患者麻醉不同时间段比较发现,全麻诱导后即刻(T2)、建立气腹后(T3)、标本切除时(T4)MAP、HR与T1的差值目标组均显著低于常规组(P<0.05),而胃肠吻合时(T5)、手术结束后即刻(T6)MAP、HR与T1的差值两组比较均无统计学意义(P>0.05),两组术中血流动力学不良事件和血管活性药物使用有统计学差异(P<0.05);2术中液体总输入量、晶体输入量目标组均低于常规组(P<0.05),胶体液的输入量目标组高于常规组(P<0.05);3目标组尿量和出血量均低于常规组(P<0.05);4两组术前术后1dHb、Hct、BUN、Ccr水平无明显差异(P>0.05);5目标组术后恢复排气时间、进食流质食物时间和排便时间明显短于常规组(P<0.05),术后并发症低于常规组(P<0.05)。结论以SVV为指导的GDFT方案不仅能够维持老年腹腔镜胃癌根治术患者术中血流动力学的平稳,而且术后胃肠功能恢复快,并发症少,是较传统补液方案更为理想的液体治疗方案。     

子宫切除患者出院随访及护理指导

为了了解子宫切除患的生活质量，通过电话和走访，我们对234例子宫切除患在术后一个月进行随访。结果发现患术后一个月内的情绪、食欲、体力、妇科症状及性生活等方面存在着很多问题，这说明对这类患应加强术前教育和术后随访来帮助她们克服生理、心理和社会适应障碍。     

循证护理在神经内科压疮高危患者中的应用

目的:探讨循证护理在神经内科压疮高危患者中的应用效果。方法:将208例压疮高危患者随机分为实验组和对照组各104例,对照组给予常规的临床护理干预,实验组给予循证护理干预;比较两组患者压疮预防情况和患者满意度。结果:实验组压疮发生率明显低于对照组(P<0.05),患者满意度明显高于对照组(P<0.01)。结论:在神经内科采用循证护理,可有效减少压疮高危患者的压疮发生率,提高患者的生存质量,增加患者对护理工作的满意度。     

彷徨与呐喊——来自商家的关于国Ⅱ车销售的声音

在国Ⅱ标准与国Ⅲ标准的切换问题上,最有发言权的仍旧是渠道生意人。国Ⅲ标准就像悬在上空的达摩剑,随时都可能降落在行业人士头上,而今的他们战战兢兢、如履薄冰,一方面眼睁睁看着自己所在地区的总销量继续下滑,手上的品牌无论强势弱势均同比下滑30%～40%;一方面看着自己的国Ⅱ车库存只能极其缓慢地消化,就像《精神病患者》里面的凶手看着受害者的轿车缓缓沉入泥潭。那种焦灼不安,以及等待的无助和凄凉日渐明显,在这种黑云压城城欲摧的情势下,渠道商家的态度划分为以下几种。     

用于防治失眠的中国传统药香的制备

在中医失眠的辨证论治思想的指导下,运用中华传统古方制备具有安神功效的药香,以达到防治失眠的功效。选取玫瑰、薰衣草、安息香、佛手柑、鼠尾草、甘松、香蜂草、洋甘菊、广藿香9种具有镇定安神效用的香草药,借鉴合药的原则进行合香,中国传统炮制方法炮制。     

老年胃癌患者全胃切除后早期肠内膳食纤维素营养液的作用

目的　探讨老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液肠内营养 (EN)的可行性。方法　 5 0例 6 0岁以上胃癌全胃切除患者 ,随机分为实验组 2 5例 ,用能全力 (TPF) 9d ;对照Ⅰ组 2 5例 ,用等氮、等热卡、等时间肠外营养 (PN)。另随机抽取同期 6 0岁以下同样患者 2 5例为对照Ⅱ组 ,支持方法和时间与实验组相同。结果　①营养指标。三组患者体重、三角肌皮折厚度、肌酐身高比、白蛋白 ,手术后第 9天都分别恢复到近于手术前 1d水平 (P >0 .0 5 ) ,仅谷氨酰胺对照Ⅰ组降低明显 (P <0 .0 5 )。术后第 4天至第 9天氮累积水平对照Ⅰ组也较低 (P<0 .0 5 )。②安全性。全部患者均无严重不良反应 ,都安全渡过术后恢复期。实验组比对照Ⅰ组肛门排气恢复显著提前 (P <0 .0 1)。结论　老年胃癌患者全胃切除后 ,早期使用膳食纤维素营养液EN ,安全适宜 ,效果良好 ,和较年轻患者近似 ,比同龄患者PN疗效高。     

服务于社区与农村慢性病患者的医学生健康教育实践性课业的研究与实践

目的:研究医学生健康教育社会实践对学生沟通能力的影响,探索可操作性健康教育能力培养模式。方法:选取大二护理专业与康复专业52名学生作为实验组,同年级同专业52名学生作为对照组,实验组学生在专业教师指导与督导下对社区与农村慢性病患者实施健康教育,对照组按传统方式培养。结果:服务对象满意度达98%,所有接受服务者均认为对其健康有利。学生的信息获取(实验组40.12±5.43,对照组27.27±3.43,t=9.13)、重视沟通(实验组39.35±4.98,24.73±4.08,9.78)、信息告知(实验组25.91±3.83,对照组18.37±2.91,t=5.31)、沟通意识(实验组19.34±3.12,对照组12.37±2.01,t=5.09)、尊重意识(实验组20.46±3.27,对照组13.72±2.18,t=4.98)得分均明显高于对照组学生,教师的专业能力得到一定程度提高。结论:社会实践性健康教育对培养医学生的沟通能力与教师的教学能力有重要的促进意义,同时也可作为基层人民群众健康服务的补充力量。     

人工智能决策工具对患者安全的影响因素分析

人工智能在医疗行业中给医生和患者带来了很多帮助,与此同时人工智能技术也带来了一定的安全隐患。分析人工智能决策工具对患者安全的影响因素,并从四个层面找出威胁患者安全的原因,进而提出减少和杜绝患者安全影响的改进策略,最大限度的提高人工智能知识决策工具辅助医生服务于患者的安全性。     

Effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome patients with insulin resistance

Objective To investigate the effects of pioglitazone on serum leptin and adiponectin in polycystic ovary syndrome (PCOS) patients with insulin resistance (IR). Methods Thirty-five PCOS patients with IR were treated with pioglitazone 15mg/d for 12 weeks. The results of ovulation induction were observed. The changes of fasting plasma glucose (FPG), fasting serum insulin (FINS), serum levels of leptin, adiponectin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T) and blood fat were examined at the baseline and after the therapy by enzyme-linked immunosorbent assay (ELISA) and radioimmunoassay (RIA). Results After the treatment, the rate of ovulation per cycle was improved in 31 (88.5%) out of the 35 patients. After treatment, the level of serum leptin was decreased (P<0.05) while the level of serum adiponectin was increased (P<0.05). After 12 weeks'treatment, waist-to-hip ratio and F-G score were significantly decreased (P<0.05), BMI declined but without significant difference (P>0.05). The levels of LH, T, FINS, Homa-IR, total cholesterol, triglyceride and low density lipoprotein-cholesterol were significantly decreased (P<0.01, P<0.05), whereas the level of high density lipoprotein-cholesterol was significantly increased (P<0.01). No significant difference was seen in FSH and FPG following treatment (P>0.05). Conclusion Pioglitazone treatment can effectively improve PCOS with IR patients'clinical syndromes, insulin sensitivity, glucose and lipid metabolism at least partly through improving the profiles of leptin and adiponectin.     

Significance of intensive glycemic control on early diabetic nephropathy patients with microalbuminuria

Objective To investigate the therapeutic effect of intensive glycemic control on patients with early diabetic nephropathy. Methods A total of 41 type 2 diabetes patients who developed microalbuminuria were divided into two groups randomly. Patients in Group A received intensive glycemic control and the blood glucose in Group B was regularly controlled. Glycemic monitoring and control were followed for 12 weeks to observe the changes of microalbuminuria in both groups; meanwhile the levels of serum lipids and coagulation indices were also recorded. Results The urine albumin excretion rate (UAER) in Group A decreased significantly from (47.91±13.86)mg/24h to (35.31±14.56)mg/24h after 12 weeks (P<0.05), and this decrease was significantly greater than that in Group B. However, Group B had no significant difference in UAER decrease [(48.93±13.32)mg/24h to (40.48±19.62)mg/24h, P>0.05]. The decrease of triglyceride (TG) and low-density lipoprotein cholesterol (LDL cholesterol), and the increase of high-density lipoprotein cholesterol (HDL cholesterol) showed no significant differences (P>0.05). And the level of plasma fibrinogen (FIB) showed no significant decrease after 12 weeks, either (P>0.05). Conclusion Intensive glycemic control reduces the level of microalbuminuria and may ameliorate the progression of early diabetic nephropathy.