目的：观察黄芪注射液对早期糖尿病肾病（ DN）患者内皮素及降钙素基因相关肽的影响，探讨黄芪注射液对早期DN的疗效及可能机制。方法72例早期DN患者分成2组：对照组（36例）采用贝那普利治疗；黄芪组（36例）采用贝那普利＋黄芪注射液联合治疗。两组患者均连续治疗30 d。分别检测两组患者治疗前后尿白蛋白排泄率（UAER）、平均动脉压（MAP）、糖化血红蛋白（HbA1c）、甘油三酯（TG）、总胆固醇（TC）、尿素氮（BUN）、血肌酐（SCr）、内皮素（ET-1）、一氧化氮（NO）、降钙素基因相关肽（CGRP）等指标的变化。结果治疗前，两组患者的 UAER、MAP、HbA1c、TG、TC、BUN、SCr、ET-1水平均显著高于健康组，NO、CGRP水平均显著低于健康组（均P＜0.01），而两组之间比较差异无统计学意义（均 P＞0.05），具有可比性。治疗30 d后，两组患者的UAER、TG、TC、ET-1、NO、CGRP均较治疗前显著改善（P＜0.05，或P＜0.01），但黄芪组改善更显著（P＜0.05或P＜0.01）；应用黄芪注射液未发现不良反应。结论早期 DN患者 UAER、MAP、血HbA1c、TG、TC、BUN、SCr、ET-1水平明显升高，NO、CGRP明显降低；黄芪能减少早期DN患者的尿白蛋白排泄，并通过降低血TG、TC、ET-1，提高NO、CGRP，以实现对肾脏的保护作用，其肾脏保护作用独立于降压及降糖之外。

Objective:To explore the effective training model of the clinical comprehensive abilities of junior nurses through the assee -ment of the new nurses in actual operation of intravenous infusion .Methods:The actual operation of the new nurses ( employed for 3 months in the same year ) in intravenous infusion was examined and assessed ,and the individual ,team and collevtive training program and continu-ous improvement plan was developed according to the exposed problems in the assessment and 11 relevant items in clinical work and com-bined with patient satisfaction and colleague appraisal ,then the same assessment was respectively made again half a year and one year lat -er.Results:The defects of working index exposed in the actual operation of intravenous infusion from high to low were as follows :the safety consciousness in nursing care ,aseptic concept ,first aid ability ,humanistic care ,the initiative study consciousness ,ability of communication with patients,prevention of occupational exposure ,working efficiency,adaptability,consciousness of hospital infection and venipuncture a-bility,the 11 relevant items in clinical work of new nurses significantly improved after training (P<0.05).Conclusion:The asseement of the new nurses in actual operation of intravenous infusion can effectively and rapidly improve the comprehensive ability of new nurses .

<正>商陆radix phytolaccae又名夜呼(《本经》)、野萝卜、为商陆科植物商陆phytolacca acinosa roxb.或垂序商陆Phylolacca americana Ⅰ.的根,多生于疏林下、林缘、路旁、山沟等湿润地方,我国大部分地区有分布[1]。性味苦、寒;有毒,归肺、脾、肾、大肠经,因其有毒被列为下品,也非常用药物。商陆始载《神农本草经》,其后南北朝·陶弘景《本草经集注》、唐·苏敬《新修本草》、宋·唐慎微《证类本草》、明·李时珍《本草纲

Objective:To observe the effect of Astragalus injection on urinary albumin and cytokines in patients with early diabetic nephropathy.To evaluate the efficacy and possible mechanisms in patients with early diabetic nephropathy.Method:Seventy-seven patients with early diabetic nephropathy were randomly divided into two groups: the control group(38 cases) was given Benazepril;Astragalus group(39 cases) was given Benazepril and Astragalus injection.These patients of two groups were treated for 30 days.Indicator of urinary microalbumin,β2-microglobulin(β2-MC),urinary albumin excretion rate(UAER) and serum β2-MC,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),vascular endothelial growth factor(VEGF),transforming growth factor β1(TGF-β1) were observed before and after treatment.Result: Before the treatment,Indicator of urinary microalbumin,urinary albumin excretion rate,β2-microglobulin and serum β2-microglobulin,interleukin-6,tumor necrosis factor-α,vascular endothelial growth factor,transforming growth factor β1 were significantly higher than the health group(all P0.01),there were no significant difference in these indicators between two groups(all P0.05),it has comparability.After 30 days,there indicators had significantly improved compared with before treatment in patients of two groups(P0.05 or P0.01),but patients in Astragalus group improved more significantly(P0.05 or P0.01);Application Astragalus injection were no adverse reactions.Conclusion: It was safe and effective that Astragalus injection in the treatment of patients with early diabetic nephropathy,reduce the urinary mAlb,UAER,β2-MG and serum β2-MG significantly,inhibit the expression of IL-6,TNF-α,VEGF,TGF-β1 may be one of the mechanism of the protective effect of kidney.

住院患者的心理活动与疾病的严重程度、家庭经济状况及个人心理素质息息相关.笔者收集2008-10至2012-10 住院患者1200例进行心理分析和护理干预,旨在对临床护理有一定的借鉴作用,现报告如下. 1 临床资料 1200例住院患者,涉及心内、呼吸内科、普外科、神经外科等临床科室六个病区,男540例,女660例,年龄15～90岁,平均48.4岁,其中,心内科200例,诊断高血压、冠心病148例,心律失常52例;呼吸内科150例,肺肿瘤21例,支气管肺炎97例,肺心病32例;神经内科350例,脑出血186例,脑梗塞144例,帕金森症20例;神经外科112例:脑外伤90例,脑肿瘤10例,脑出血12例;普外科264例:急腹症4例,胆道结石186例,消化道肿瘤74例;泌尿外科120例:泌尿系结石100例,泌尿系肿瘤20例.

目的了解气管切开患者医院呼吸道感染发生率及危险因素,探讨预防措施。方法回顾性调查2009年5月至2011年5月神经外科收治患者中,其中28例气管切开,发生感染的部位、原因、病原菌。结果发生医院感染6例,病原菌主要是金黄色葡萄球菌、铜绿假单胞菌;查找感染的相关因素,积极采取措施。结论针对发生医院感染各种危险因素进行检测,做好呼吸道的护理工作,加强基础护理、合理使用抗生素、做好清洁消毒工作,能有效预防或减少医院内上呼吸道感染的发生。

<正>胸部创伤是常见的创伤之一,近年来随着交通事故、工业创伤发病率的上升,胸部创伤也呈现增多和加重趋势[1]。创伤性血气胸在胸部损伤中极为常见,病情往往危重,而胸

1998年1月至2007年12月,本院共采用内镜诊治患者13 843例,现将内镜诊治的配合体会总结如下.

伤宁霜由制川乌、大黄等数味中药制成,有活血行气,散瘀止痛,消肿续伤之功效[1].用于急性闭合性软组织损伤或骨折复位后出现的肿痛发热,瘀斑及功能障碍等损伤性疾患的辅助治疗.由于原标准中已有君药乌头碱的含量限度控制,为进一步控制其质量,本次对其主药大黄进行含量测定研究很有必要.笔者用HPLC法测定大黄酚与大黄素的总含量,该法快捷、灵敏、准确.

糖尿病临床营养治疗(Medical nutrition山erapy,MNT)的主要目的是平衡膳食摄入并与胰岛素或口服降糖药和体力活动相配合,将血糖维持在理想水平;维持理想的血脂水平;合理的能量摄入达到或维持理想体重;减少急性和慢性并发症的危险;并且通过良好的营养进一步改善营养状况.在营养治疗与咨询中不可避免的要涉及到患者食谱的设计.合理控制热能是糖尿病营养治疗的首要原则.糖尿病患者的热能供给计算方法统一,但在咨询和营养治疗中,依据已定热能值设计食谱的方法原理不一[1].本文就此进行综述.

现将新加坡陈笃生医院住院病人的财务制度及管理方法介绍如下. 1 管理制度 新加坡医院病人的财物管理由医院和科室共同负责,医院在住院部办公室设立病人财物等贵重物品的存放保险柜,在院安全办公室设立身份证、工作证、护照等的保存柜,病人住院后可直接存放在住院部或科室,金额超过500元的财物要统一存放在住院部,金额少于500元的可存放在护士站保险柜内,保存的手续在住院部由接诊护士负责处理,在科室由当班接诊护士负责处理,班班交接,责任到人.

Objective To evaluate the clinical significance of KTP Nd∶YAG laser with dacryagogue intubation in treatment of difficult cured dacryagogatresia. Methods The dacryagogic probe with core was used to find out the position of dacryagogatresia. To remove the probe core followed by insertion of laser transmitting optic fiber to the position of dacryagogatresia. To emit laser until the position of dacryagogatresia to be opened. Put a 0 6-0 8 mm silicon tube through probe core and insert it to the dacryagogue. Take out the probe core. Put the silicon tube into the dacryagogue for 8-10 weeks. Results Using this method to treat 31 cases (32 eyes) with various difficult cured dacryagogatresia. Twenty seven cases (28 eyes) were cured. Four cases (4 eyes) showed no effect. The cure rate was 87 5%. Conclusion KTP Nd∶YAG laser with dacryagogue intubation is a good method for treating difficult cured dacryagogatresia at present.

难治性泪道阻塞是指泪小管、泪总管及鼻泪管的阻塞已经多方的治疗,仍有溢脓及泪道冲洗不通畅者.我院自1999年9月～2001年9月,采用KTP倍频Nd:YAG激光(以下简称KTP激光)加泪道插管治疗难治性泪道阻塞31例32眼,疗效满意,现报告如下.