优质护理服务模式在急诊教学中的应用及效果

优质护理是患者在新时期对医疗护理服务提出的更高要求.我院贯彻落实卫生部开展的优质护理活动,并于2011年获全国优质护理示范医院.为深化"优质护理服务"活动,为患者提供安全、优质、满意的服务,我科探索将优质护理服务运用于急诊教学管理中,扎实抓好岗位培训,实行责任制整体护理,建立一套系统的教学管理模式,调动学生的积极性和主动性,激励优质服务,逐步实现了护生责任分管病人,摸索出有利于护生职业发展的学习工作模式,取得良好的效果.现将优质护理教学体会报告如下.     

酚妥拉明、多巴胺联合黄芪注射液治疗慢性肺心病心衰的临床观察

目的 探讨酚妥拉明、多巴胺联合黄芪注射液治疗慢性肺心病的临床疗效.方法 对64例肺心病心衰的住院患者在常规综合治疗的基础上加用多巴胺、酚妥拉明、黄芪注射液治疗,并观察临床效果.结果 显效46例,好转13例,无效5例,总有效率92.19%.结论 在常规治疗的基础上加用酚妥拉明、多巴胺联合黄芪注射液治疗慢性肺心病心衰的疗效显著,且经济实用,值得推广.     

细化健康教育在小儿肠造口术的应用

目的 探讨细化健康教育在小儿肠造口护理中的应用效果.方法 选择2012年1~12月在我科行小儿肠造口术的患儿(实施细化健康教育后)为观察组,选择2011年1～12月小儿肠造口术患儿(未实施细化健康教育)为对照组,比较两组患儿肠造口并发症发生率的差异性.结果 两组患儿肠造口并发症发生率比较,观察组明显低于对照组,差异有统计学意义(P＜0.05).结论 在小儿肠造口护理中实施细化的健康教育,可减少护理并发症,促进患儿康复,值得临床推广.     

院前急救在急性脑卒中患者的应用

目的 观察院前急救在脑卒中患者救治的应用效果.方法 选择2005年1月~2013年6月我院救治的脑卒中患者200例,分为观察组和对照各100例.观察组予院前急救护理,对照组予常规护理,并观察两组患者的致死率、致残率及护理效果.结果 观察组的致死率、致残率低于对照组(P＜0.05),观察组患者的满意度高于对照组(P＜0.05).结论 院前急救能降低患者的致死率、致残率,提高患者的满意度.     

全髋关节置换术治疗老年股骨颈骨折的效果分析

目的 探讨全髋关节置换术治疗老年股骨颈骨折的临床疗效.方法 对2007年8月~2012年5月我院收治的120例股骨颈骨折患者采用全髋关节置换术治疗,术后随访1~3年,按Harris评分进行评定髋关节功能.结果 本组患者Harris评分总优良率达到90.8%,无1例出现感染、脱位、假体松动下沉等严重并发症.结论 全髋关节置换术对老年股骨颈骨折的疗效显著,能有效提高患者的生活质量,远期效果佳.     

联苯菊酯降解菌株BF-3的分离筛选、鉴定和降解特性

【背景】联苯菊酯是人工合成的类似天然除虫菊素的一种仿生杀虫剂,近年来被广泛应用于农业病虫害的防治。联苯菊酯化学性质较稳定,在环境中的残留期长,是我国出口果蔬、茶叶中残留较严重的农药之一。微生物降解具有降解速度快、无二次污染等优点,被认为是有效去除农药残留的绿色生产技术。【方法】通过富集驯化,从农药厂排污口的污泥中筛选分离能够降解联苯菊酯的菌株,经形态学观察、生理生化特性测定及16SrRNA序列分析对其进行鉴定,通过单因素试验对菌株的降解特性进行研究。【结果】分离到1株联苯菊酯的降解菌株BF-3。菌株BF-3为革兰氏阳性菌,被鉴定为蜡状芽孢杆菌;该菌株在联苯菊酯质量浓度为100mg·L^-1的无机盐液体培养基（MSM）中呈现s型生长,7d后对联苯菊酯的降解率达到87．9％。单因素试验表明,菌株最适降解条件为pH7．0、30oC,初始菌株D600am=1．0。【结论与意义】蜡状芽孢杆菌BF．3能够有效降解联苯菊酯,在环境中联苯菊酯残留的生物修复方面具有应用潜力。     

Comparative effects of insecticides with different mechanisms of action on Chrysoperla externa （Neuroptera＂ Chrysopidae）＂ Lethal,sublethal and dose-response effects

The comprehensive knowledge that the delayed systemic and reproduction side effects can be even more deleterious than acute toxicity, has caused a shift in focus toward sublethal effects assessment on physiology and behavior of beneficial insects. In this study, we assessed the risks posed by some insecticides with different mode of action through lethal and delayed systemic sublethal effects on the pupation, adult emergence, and repro- duction of the chrysopid Chrysoperla externa （Hagen, 1861; Neuroptera： Chrysopidae）, an important predator in pest biological control. The maximum field recommended dose （MFRD） and twice （2xMFRD） for chlorantraniliprole, tebufenozide, and pyriproxyfen were harmless to C. externa. In contrast, all the tested chitin synthesis inhibitors （CSIs） were highly detrimental to the predator, despite of their lack of acute lethal toxicity. There- fore, the safety assumed by using IGRs toward beneficial insects is not valid for chrysopids. Dose-response data showed that although all CSIs have a similar mechanism of action, the relative extent of toxicity may differ （novaluron 〉 lufenuron 〉 teflubenzuron）. For CSIs, the delayed systemic effects became obvious at adult emergence, where the predicted no observable effect dose （NOED） was 1/2 048 of the MFRD for novaluron （0.085 ng/insect）, and 1/256 of the MFRD for both lufenuron （0.25 ng/insect） and teflubenzuron （0.6 ng/insect）. Finally, this work emphasized the significance of performing toxicity risk assessments with an adequate posttreatment period to avoid underestimating the toxicities of insecticides, as the acute lethal toxicity assays may not provide accurate information regarding the long-range effects of hazardous compounds.     

Instrumented Indentation Investigation on the Viscoelastic Properties of Porcine Cartilage

Articular cartilage lubricates the contact surfaces in human joints and provides a shock-absorbing effect which protects the joint under dynamic loading. However, this shock-absorbing effect is gradually reduced as the result of normal wear, tear and aging-related cartilage loss. Thus, with the increasing average human life expectancy, the issue of joint health has attracted significant interest in recent decades. In developing new materials for the repair or regeneration of damaged articular cartilage, it is essential that the difference in the mechanical properties of healthy and damaged cartilages is well-understood. In the present study, the hardness and Young＇s modulus of damaged and healthy porcine articular cartilage samples are evaluated via a quasi-static nanoindentation technique. A dynamic mechanical analysis method is then applied to determine the viscoelastic properties of the two samples. The results presented in this study provide a useful insight into the mechanical properties of articular cartilage at the mesoscale, and therefore fill an important gap in the literature.     

Formaldehyde induces toxic effects and regulates the expression of damage response genes in BM-MSCs

In this study, we assessed the toxic effects of formaldehyde （FA） on mouse bone marrow mesenchymai stem cells （BM- MSCs）. Cytotoxicity was measured by using MTT assay. DNA strand breakage was detected by standard alkaline comet assay and comet assay modified with proteinase K （PK）. DNA-protein crosslinks （DPCs） were detected by KCI-SDS precipitation assay. We found that FA at a con- centration from 75 to 200 μM inhibited cell survival and induced DPCs over 125 μM. The PK-modified comet assay showed that FA-induced DNA strand breakage was increased in a dose-dependent manner from 75 to 200 μM. On the other hand, standard alkaline comet assay showed that DNA strand breakage was decreased with FA concen- tration over 125 μM. We confirmed by using Pearson cor- relation that there was a negative linear correlation between DPCs and survival rate （r = -0.987, P 〈 0.01） and positive linear relationships between DPCs and （i） sister chromatid exchange and （ii） micronucleus （r = 0.995, P〈 0.01; r = 0.968, P〈 0.01）. DNA damage RTz profiler polymerase chain reaction array was used to investigate the changes in the expression of damage response genes. Xpa and Xpc of the nucleotide excision repair pathway and Brca2, Rad51, and Xrcc2 of the homologous recombination pathway were all up-regulated in both 75 and 125 μM FA. However, the same genes were down-regulated with 175 μM FA. The expressions of Chekl and Husl, which are involved in cell cycle regulation, were altered in the same manner with 75, 125, and 175 μM FA. These results indicated that Xpa, Xpc, Brca2, Rad51, Xrcc2, Chekl, and Husl were essential for the BM-MSCs to counteract the effects of FA.     

贝伐单抗辅助的23G玻璃体切割术治疗严重增生性糖尿病视网膜病变的疗效观察

目的：2011年,我国糖尿病患者人数高达9240万。糖尿病视网膜病变（diabeticretinopathy,DR）作为糖尿病患者的常见并发症,在糖尿病人群中的患病率为37％,是导致成人获得性盲的最主要原因之一。严重增生性糖尿病视网膜病变以牵拉性视网膜脱离、玻璃体出血为特征,具有致盲率大,手术难度高等特点。针对与此,本文主要探讨术前注射贝伐单抗对23G玻璃体切割手术治疗严重增生性糖尿病视网膜病变患者效果的影响。方法：回顾性病例对照研究。共收集严重增生性糖尿病视网膜病变患者70例,药物辅助手术组（A组）21例,术前3—7天行玻璃体腔注射贝伐单抗（1．25mg／O．05mL）;单纯手术组（B组）49例,行23G玻璃体切割术。分析两组术前及术后视力、手术时间、医源性裂孔、电凝、术后出血的不同。结果：在术后3月,两组视力提高有统计学意义（P〈O．05）。A组平均手术时间为74分钟,而B组平均手术时间为85分钟（P〉0．05）。医源性裂孔在A组中有1例,而B组中有16例（P〈0．05）,在A组中有3例使用电凝,B组中有25例使用电凝（P〈0．05）。A组有1例出现术中及术后出血,B组为20例（P〈O．05）。结论：在这个回顾性研究中,我们发现对于严重增生性糖尿病视网膜病变的病人,术前玻璃体腔注射1．25mg／O．05ml贝伐单抗可以显著减少医源性裂孔的发生,减少术中电凝使用及术中术后出血的发生。