OBJECTIVE To establish a method for determination of hesperidin in rat plasma by UHPLC-MS/MS,investigate in vivo pharmacokinetics of hesperidin in Chenpi Decoction in rats.METHODS After rats were gavaged with Chenpi Decoction,UHPLC-MS/MS was used to determine hesperetin in plasma at different times.BEH-C18 column (100 mm× 2.1 mm,1.7 μm) was adopted and eluted with mobile phase of acetonitrile-water containing 0.05％ formic acid in a gradient mode,with flow rate at 0.3 mL·min-1,column temperature at 35 ℃ and injection volume of 5 μL.RESULTS Pharmacokinetic parameters of hesperidin were calculated by DAS 2.0 software:AUC(0-t) were (2 672.13 ± 464.35),(2 002.24 ± 342.64),(1 498.35 ± 250.63) ng·h·mL-1;AUC(0-∞) were (2 765.52 ± 525.14),(1 962.52 ± 452.72),(1 502.42 ± 257.63) ng·h·mL-1;MRT were (2.69±0.72),(2.71±0.57),(2.65±0.21) h;t1/2 were (1.39±0.15),(1.42±0.08),(1.51 ±0.14) h;Cmax were (1 124.63±356.62),(914.35±244.52),(742.24±51.25)ng·mL-1;Tmax were (1.45±0.03),(1.46±0.02),(1.51± 0.01) h.CONCLUSION This method is specific,rapid,and sensitive for determination of hesperidin pharmacokinetics.

目的 探讨超声心动图及心电图在急性肺动脉栓塞(简称肺栓塞)的诊断作用.方法 回顾性分析36例急性肺栓塞患者入院时、溶栓后及治疗2～4周后的超声心动图及心电图变化.结果 急性大块肺栓塞后心电图即可出现SⅠQⅢ及右束支阻滞的心电图表现.TⅢ及TV1 ～ V3倒置往往在发病1～2h后按一定顺序相继出现.超声心动图显示右心系统内可见活动或附壁实质性中低等回声.右房、右室增大,主肺动脉及分支增宽,肺动脉压增高,肺动脉频谱形态见特征性的“指拳征”.肺动脉频谱加速时间及射血时间缩短.溶栓或抗凝治疗后心电图显示,窦性心动过速消失;Ⅰ和V5 ～ V6导联的S波明显缩小甚至消失;V1～V3(V4)导联T波倒置加深;右束支阻滞消失;TⅢQⅢ及RⅢ的变化则呈双向性.当肺栓塞发病后数小时至3d内即溶栓者溶栓后RⅢ递减,QⅢ进行性加深增宽,TⅢ倒置进行性加深;反之,肺栓塞发病1周后进行溶栓者溶栓后QⅢ明显缩小,TⅢ由倒置很快变直立.右房、右室、肺动脉附壁血栓消失,右室恢复正常或内径较前缩小,肺动脉内经恢复正常或较前缩小,肺动脉收缩压下降.结论 急性肺栓塞的超声心动图及心电图变化呈一过性及多变性,动态观察超声心动图及心电图结合有助于诊断及对疗效的判断.

Objective To investigate the effect of the clinical nursing pathway(clinical pathway for short) for health education in patients with new smear positive pulmonary tuberculosis. Methods 400 patients with new smear positive pulmonary tuberculosis were assigned equally to a clinical pathway group and a control.The clinical pathway group included 94 male and 106 female and average age was(54±15.9).The control group included 99 male and 101 female and average age was 56±14.2.Patients received health education with clinical nursing pathway in clinical pathway group and received health education with conventional care programmes in the control.Change of life behavior,nursing satisfaction and compliance of taking anti-tuberculosis drugs were compared between the clinical pathway group and the control.Data were analyzed with chi-square test.P-value<0.05 was considered to be statistically significant. Results The score of treatment compliance in the clinical pathway group were 4 scores in 140 cases,3 scores in 20 cases,and 2 scores in 10 cases.In the control group,the scores of treatment compliance were 4 scores in 170 cases,3 scores in 30 cases,2 scores in 21 cases and 1 scores in nine case.Cognitive behavior change in the clinical pathway group were basic apprehension in 144 cases,partial apprehension in 51 cases and inapprehension in 5 cases.In the control group,basic apprehension in 78 cases,partial apprehension in 71 cases and inapprehension in 51 cases.Nursing satisfaction in the clinical pathway group were satisfactory in 170 cases,partial satisfactory in 20 cases,basic satisfactory in 10 cases and unsatisfactory in 0 cases.In the control group,satifactory in 130 cases,partial satifactory in 40 cases,basic satifactory in 20 cases,and unsatifactory in 10 cases.Three above assessment indicators between the clinical pathway group and the control were significantly different.The chi-square value were 17.806,60.686 and 35.33 respectively,P values were less than 0.01.The indicator in the clinical pathway group was higher than those in the control(P<0.01). Conclusions Management of clinical pathway can improves treatment compliance,nursing care satisfaction and cognitive behavior change in patients with pulmonary tuberculosis.

<正>急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)是胸部创伤后的一种严重并发症,是胸外伤死亡的主要原因之一[1]。2006—2009年,我们收治重症胸外伤并发ARDS患者35例,经过精心治疗和护理,取得满意效果,兹将护理体会总结如下。

目的:探讨应用持续质量改进理念,对静脉输液流程再造的实际应用效果。方法:选择按传统输液流程进行输液的住院输液病人为对照组(n=40例);选择应用持续质量改进的理念,改变传统输液流程,采用分段操作的方法,由辅助护士先行挂液和输液前宣教,再由专职输液护士为其进行评估穿刺的住院输液病人为实验组(n=40例);分别对两组病人平均每日穿刺完成时间、一针穿刺成功率、病人满意度进行比较。结果:两组平均每日穿刺完成时间显著缩短,一针穿刺成功率和病人满意度明显提高,两组比较有显著性差异(P<0.01)。结论:持续护理质量改进在静脉输液流程中的应用效果显著,可有效提高工作效率和护理质量,从而提高病人满意度。

目的 评价阿莫西林钠克拉维酸钾对难治性结核性腹膜炎的疗效.方法 将76例难治性结核性腹膜炎患者随机均分为两组,对照组38例给予抗结核治疗及常规处理,观察组38例在此基础上加用阿莫西林钠克拉维酸钾375 mg、每日3次口服,疗程1个月.结果 观察组显效率为94.74%,对照组显效率为52.63%,观察组疗效明显优于对照组(P<0.01).结论 阿莫西林钠克拉维酸钾用于治疗难治性腹膜炎,能促进腹腔积液吸收,减少肠粘连等并发症的发生.

目的:探讨静脉输液流程与静脉输液护理专业化的关系。方法:由输液专职护士采用改进流程为病人输液操作。即由辅助护士先行挂液及输液前宣教,再由输液专职护士评估病人,选择治疗给药部位、途径、输液工具并实施穿刺。结果:在输液穿刺速度、导管留置时间、病人满意度、导管相关并发症发生率、导管耗用数量方面比较,差异有显著性意义(P<0.05)。结论:静脉输液流程改进在降低费用、提升病人满意度等方面意义重大。

目的 探讨闭式胸膜活检(closed pleural biopsy,CPB)对不明原因胸腔积液老年患者的诊断价值.方法 采用改良的cope针对78例不明原因胸腔积液老年患者行CPB.结果 78例患者共穿刺1 20例次,77次取得胸膜组织,阳性率为64.2%(77/120),58例取得特异性结果,阳性率达48.30%(58/1 20).经CPB确诊病因58例,确诊率为74.40%(58/78).行组织结核菌PCR检查9例,阳性4例,试验性治疗后好转确诊.并发症发生率为16%(19/120),其中发生胸膜反应0.06%(7/120).气胸0.09%(11/120),小量咯血0.01%(1/120).结论 CPB操作简单、安全,对原因不明的胸腔积液诊断、鉴别诊断有重要意义,尤其对肿瘤、结核等胸腔积液价值更大,组织结核菌PCR检查的临床价值有待进一步观察.

静脉输液是护理工作的主要内容之一,是患者接受治疗的有效给药途径.护理集体静脉输液流程再造是一种管理上的创新.我们自2006年6月对传统静脉输液流程进行了改进(即流程再造),实现了护理管理方式的根本转变,报告如下.

临床上有些免疫球蛋白(IgA)缺乏和有IgA抗体的患者如果输注含有血浆的血液产品将导致严重的过敏反应,这些患者需要输注去除血浆的血小板浓缩液(PC)或输注没有IgA抗体的献血者捐献的血液成分,但是这样的献血者不容易找到.即便是输注用血小板添加液(PAS-ⅢM)替代了80%血浆的PC也不能解决患者对血浆过敏的问题,这些患者只能选择输注洗涤PC.

目的 探讨评价肿大淋巴结病变性质的各种超声影响指标.方法 对118例患者的218个浅表淋巴结进行超声检测,采用灰阶和彩色多普勒超声高频探头检测浅表肿大的淋巴结(颈部、锁骨上窝、腋下、腹股沟).观察淋巴结的L/S、形态、结构、内部回声、血管类型RI、PI、Vmax、Vmin.并与病理结果对照分析.结果 相关因素逻辑回归分析显示L/S和VS可作为预测各种淋巴结病变的有意义的参数,这种联合诊断标准的敏感性为91%,特异性为89%.结论 二维超声和彩色多普勒血流显像联合诊断在浅表淋巴结病变鉴别诊断中有较高的诊断价值,可作为各种淋巴结病变的可靠诊断依据.

目的探讨老年结核性脑膜炎患者治疗的新方法。方法选择我院近7年来收住院的老年结核性脑膜炎患者107例,随机分为治疗组和对照组,对持续高颅压或椎管梗阻粘连的患者,对照组采用常规抗痨、激素、椎管注药及对症治疗。观察组在对照组的基础上采用(1)持续高颅压者腰穿放脑脊液,每次10~20ml,(2)椎管梗阻粘连者采用脑脊液置换,每周2次。时间2~3个月。结果治疗组在应用抗痨药物治疗的同时加放脑脊液及脑脊液置换的新方法,使死亡率由26.3%下降至8.0%,治愈率由15.8%提高到38.0%,有效率由26.3%提高到42.0%。结论脑脊液置换及放脑脊液的方法简单可行,安全可靠,可在临床治疗中广泛推广。

经皮胸膜活检术在胸膜病变的诊断中已广泛应用,但大多数患者对此项技术认识不足,因此,及时正确的术前健康教育能有效地防止术后气胸出血等并发症的发生,对患者的康复非常重要.

耐多药结核病(MDR-TB)是严重影响人类健康的慢性传染病,其病程长、费用高、疗效差、传染性强,使患者的生理、心理、精神、社会机能全面下降,有研究表明,社会支持是影响慢性病护理的重要因素,社会支持起着直接和间接的舒缓作用[1].

Objective To explore the diagnostic value of color Doppler ultrasound in in neck lymphadenitis of sarcoidosis.Methods The L/S ratio,internal echo,CDFI,the characteristics of flow shape,distribution and RI frequency spectrum feature were measured respectively with color doppler ultrasound in 36 cases of sarcoidosis lymph nodes,34 cases of tuberculous lymph nodes and 32 cases of malignant lymph nodes located around neck.Results The average L/S rotio and Resistant Index(RI) of sarcoidosis lymph node group were 2.0±0.61 and 0.53±0.08 respectively,and the blood distribution of the group showed "branch" shape blood flow,regular formation.The average L/S rotio and RI of tuberculous lymph node group were 2.6±0.29 and 0.49±0.22 respectively,and the blood distribution of the group showed very small spectrum.The average L/S rotio and RI of maligant lymph node group were 1.5±0.36 and 0.72±0.11 respectively,and the blood distribution of the group showed deformation disorder spectrum.There were significant differences in the three groups(P0.05).Conclusion Combined with chest X-ray and clinical findings,the color doppler ultrasound has important diagnostic value for neck lymphadenitis of sarcoidosis.

我院对2003年1月至2007年5月94例经皮穿刺胸膜活检术患者采用心理干预,与92例未经心理干预经皮穿刺胸膜活检术患者进行对照,在减少并发症和提高操作成功率方面取得显著效果,报告如下.

我院近5年来共收治肺结核并咯血患者162例,经严密观察情和制定有效的护理对策,提高了疾病的治愈率,降低了病死率,护理体会如下. 1 临床资料 我院自2003年1月至2007年12月,共收治肺结核并咯血患者162例,男85例,女77例;年龄14～85岁,平均年龄46岁;结核病史1～20年.诊断符合1991年全国结核病防治工作手册制定的标准,表现为咯血痰52例,中等量咯血74例,大咯血36例.经积极综合治疗,除3例自动出院,2例窒息死亡外,其余157例均好转出院.

临床上静脉补充维生素C和氯化钾最为常见,护理人员抽吸剂量为2 ml的维生素C注射液和10 ml的10%氯化钾注射液是最普遍的操作,但护理人员常不能遵循护理教科书[1]示范的抽吸药液方法(简称教科书法),而自行创造的临床方法(以下简称临床法),在全国范围内普遍存在,因此该实验选用上述2种常用注射液,采用2种不同抽吸药液方法,通过记录抽吸每支注射液所用时间和抽吸过程中药液损失情况的比较,阐述临床法存在的现实意义.

浓缩血小板(PC)的制备方法有富含血小板血浆(PRP)法、白膜层(BC)法和单采PC.我国临床应用的主要是单采PC,手工采集全血制备的PC在临床应用中占的比例很小.而国外尤其是欧美国家BC法制备的血小板添加液(PAS)汇集血小板(PAS汇集BC-PC)在临床应用中占有很大比例,而且还有增长趋势.我们就汇集BC-PC的起源及发展、国内外应用现状、具有的优势及发展前景介绍如下.

胸膜活检技术在呼吸系统疾病的诊断和鉴别诊断中应用广泛,但在穿刺前大多数患者由于对此项技术比较陌生,恐惧穿刺痛苦,顾虑医生技术等问题,往往产生不同程度的焦虑,导致患者血压升高、心率加快,严重者甚至影响活检过程的顺利完成.本文运用心理护理[1]对212例胸膜活检术患者进行术前心理干预.