目的 基于介入造影患者围手术期股动脉穿刺部位监测与管理的最佳证据,实施循证实践,并验证改革措施的安全性及有效性.方法 以基于证据的持续质量改进模型为研究框架,通过证据获取、现状审查、证据引入和效果评价 4 个阶段将循证实践应用于全脑血管造影患者.患者层面采用同期对照方法,比较干预组与对照组患者股动脉相关并发症发生率、腰背疼痛情况、尿潴留发生率,组织者层面采用自身前后对照,比较实践病区证据应用前后护士相关知识知晓率、审查指标执行率.结果 证据应用后,干预组与对照组股动脉相关并发症发生率差异无统计学意义(P＞0.05),干预组腰背疼痛得分和尿潴留发生率低于对照组,差异有统计学意义(P＜0.05).医护人员 16 条审查指标执行率均＞95％,其中 13 条为 100％,高于证据应用前(P＜0.05);护士对证据的知晓率从 37.5％提高至 100％,差异有统计学意义(P＜0.01).结论 介入造影患者围手术期股动脉穿刺部位监测与管理的最佳证据应用,可提升护士股动脉穿刺部位护理的相关认知且规范相关护理措施,提高护理质量.

目的 观察积极心理干预对青年脑卒中患者的抑郁情绪、病耻感的影响.方法 选择2021年4月～2021年7月接诊的75例青年脑卒中患者,随机分为:观察组(纳入37例,在对照组基础上提供积极心理干预)、对照组(纳入38例,提供常规护理);评估组间抑郁情绪[贝克抑郁量表(Beck Depression Inventory,BDI)]、睡眠质量[匹兹堡睡眠质量指数量表(Pittsburgh Sleep Quality Index,PSQI)]、病耻感[脑卒中患者病耻感量表(stroke stigma scale,SSS)]、主观幸福感[总体幸福感量表(general well-being schedule,GWB)]、创伤后成长[创伤后成长量表(Post-traumatic Growth Inventory,PTGI)].结果 干预前,组间 BDI、PSQI、SSS、GWB、PTGI 评分无明显差异(P＞0.05);干预后,观察组BDI、PSQI、SSS、GWB、PTGI评分优于对照组(P＜0.05).结论 对青年脑卒中患者实施积极心理干预,可以减轻其抑郁情绪及病耻感,改善睡眠质量,提高主观幸福感,促进创伤后成长.

目的 探析缺血性脑血管病患者认知功能障碍影响因素.方法 以郑州市医院2018年5月至2021年4月收治且已录入医院病历管理系统中诊断为缺血性脑血管病患者为研究对象开展认知功能障碍随访调查,采用描述性分析方法对该人群认知功能障碍情况进行分析,并采用单、多因素分析方法对该人群认知功能障碍影响因素进行分析.结果 调查有效病例542例,认知功能障碍发生率为56.09％.MoCA平均分(25.07±2.69)分.其中空间执行功能(2.63±1.85)分、延迟记忆(4.67±0.23)分、命名(1.54±0.93)分、语言(2.42±0.23)分、抽象思维(1.45±0.47)分、注意(4.58±0.62)分、定向力(4.23±0.86)分.经多因素Logistic回归分析结果显示,年龄越大(OR=2.196)、小学文化程度(OR=1.773)、高血压(OR=2.228)、糖尿病(OR=1.980)、高血脂症(OR=2.218)、冠心病(OR=1.262)、颈动脉狭窄(OR=1.874)、颈动脉斑块(OR=1.439)为ICVD患者认知功能障碍危险因素;体育锻炼(OR=0.434)为保护因素.结论 缺血性脑血管病患者认知功能障碍发生率较高,高龄、低文化、糖尿病、高血脂症、高血压、冠心病、颈动脉斑块、颈动脉狭窄是其认知功能障碍危险因素,体育锻炼为保护因素,可针对相关影响因素进行评估预判,降低、延缓ICVD患者认知功能障碍的发生.

目的 探讨基于循证的康复护理在出血性脑卒中患者中的应用价值.方法 100例出血性脑卒中患者随机分为两组,对照组予以常规护理,观察组在对照组基础上予以基于循证的康复护理,比较两组的日常生活活动能力、运动功能以及并发症.结果 干预3个月后,观察组的ADL、上肢运动功能、下肢运动功能评分均高于对照组,并发症发生率低于对照组(P<0.05).结论 基于循证的康复护理能够改善出血性脑卒中患者的肢体运动功能,降低并发症发生风险,提高日常生活活动能力.

目的 分析基于质量控制理论的护理干预在急性脑梗死(ACI)介入治疗中的应用效果.方法 选取2019年2月-2020年1月郑州市某医院收治的87例急性脑梗死患者为研究对象,根据不同护理方式将其分为研究组(n=52)和对照组(n=35).对照组患者给予常规护理,研究组患者在对照组护理基础上给予基于质量控制理论的护理干预,2组患者均持续护理至出院.比较2组患者护理前后的神经功能[美国国立卫生研究院卒中量表(NIHSS)评分]、生活质量[SF-36健康调查简表(SF-36)评分],比较2组患者并发症发生情况及护理满意度.结果 护理前,2组患者NIHSS评分比较,差异无统计学意义(P＞0.05);护理后,2组患者NIHSS评分均低于护理前,研究组低于对照组,差异均有统计学意义(P＜0.05).研究组患者并发症发生率为5.77％,低于对照组的20.00％,差异有统计学意义(x2=4.154,P=0.041).护理前,2组患者SF-36评分比较,差异无统计学意义(P＞0.05);护理后,2组患者SF-36评分均高于护理前,研究组高于对照组,差异均有统计学意义(P＜0.05).研究组患者护理满意度为96.15％,高于对照组的82.86％,差异有统计学意义(x2=4.230,P=0.035).结论 在ACI患者介入治疗中应用基于质量控制理论的护理干预,可有效改善患者神经功能及生活质量,降低术后并发症发生概率,提高患者对护理工作的满意度,值得在临床上推广应用.

Objective:To investigate the effect of TRIM52 antisense RNA 1 (TRIM52-AS1) on injury of brain cortex neurons induced by hypoxia/re-oxygenation (H/R) and its possible mechanism in rats.Methods:(1) The cortical neurons were cultured in vitro and divided into control group and model group. In the model group, H/R-induced cell injury models were prepared. Real-time quantitative PCR (RT-qPCR) was used to detect the expressions of TRIM52-AS1 and micro RNA (miR)-28-5p in neurons of the two groups. (2) The cortical neurons were divided into control group, model group, small interfering (si)-TRIM52-AS1 transfection group, and nonsense sequence transfection group. Cells in the model group were prepared for H/R-induced cell damage models. After cells in the latter two groups were transfected with si-TRIM52-AS1 or its nonsense control sequence for 6 h, they were prepared for H/R-induced cell damage models. RT-qPCR, CCK-8, and flow cytometry were used to detect the TRIM52-AS1 expression, and proliferation and apoptosis of neurons in the 4 groups; enzyme-linked immunosorbent assay (ELISA) and Western blotting were used to detect the lactate dehydrogenase (LDH), malondialdehyde (MDA) and superoxide dismutase (SOD) levels and protein expressions of Cyclin D1, Bcl-2 and Bax. (3) The cortical neurons were divided into miR-28-5p transfection group and nonsense sequence transfection group. After the cells were respectively transfected with miR-28-5p or its nonsense control sequence for 6 h, they were prepared for H/R-induced cell damage models. RT-qPCR, CCK-8, and flow cytometry were used to detect the TRIM52-AS1 expression, and proliferation and apoptosis of neurons in the two groups; ELISA and Western blotting were used to detect the LDH, MDA and SOD levels and protein expressions of Cyclin D1, Bcl-2 and Bax. (4) The cortical neurons were divided into wild-type TRIM52-AS1+miR-28-5p mimic transfection group, wild-type TRIM52-AS1+miR-28-5p nonsense control sequence transfection group, mutant TRIM52-AS1+miR-28-5p mimic transfection group, and mutant TRIM52-AS1+miR-28-5p nonsense control sequence transfection group. After the cells were co-transfected for 6 h, the culture medium was replaced with fresh medium and they were cultured for another 12 h, and then, the luciferase activity of cells in each group was detected by dual luciferase reporter gene experiment. (5) Cortical neurons were divided into nonsense sequence transfection group, miR-28-5p inhibitor transfection group, nonsense sequence+si-TRIM52-AS1 transfection group, and miR-28-5p inhibitor+si-TRIM52-AS1 transfection group, and these cells were transfected with miR-28-5p inhibitor nonsense control sequence, miR-28-5p inhibitor, miR-28-5p inhibitor nonsense control sequence+si-TRIM52-AS1, miR-28-5p inhibitor+si-TRIM52-AS1; 6 h after transfection, H/R-induced cell damage models were prepared. RT-qPCR, CCK-8, and flow cytometry were used to detect the miR-28-5p expression, proliferation and apoptosis of neurons in the two groups, respectively; ELISA and Western blotting were used to detect the LDH, MDA and SOD levels and protein expressions of Cyclin D1, Bcl-2 and Bax. Results:(1) As compared with those in the control group, the TRIM52-AS1 expression statistically increased, but the miR-28-5p expression significantly decreased in the model group ( P<0.05). (2) As compared with the control group, the model group and nonsense sequence transfection group had significantly increased LDH content in the culture supernatant, statistically decreased MDA and SOD content in the cells, significantly decreased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly increased apoptosis rate and Bax protein expression ( P<0.05). As compared with the model group and nonsense sequence transfection group, si-TRIM52-AS1 transfection group had significantly decreased si-TRIM52-AS1 expression, statistically decreased LDH content in the culture supernatant and MDA content in the cells, significantly increased SOD content in the cells, significantly increased A value and protein expression of Cyclin D1 and Bcl-2, significantly decreased apoptosis rate and Bax protein expression ( P<0.05). (3) As compared with the nonsense sequence transfection group, the miR-28-5p transfection group had significantly increased miR-28-5p expression, significantly decreased LDH content in the culture supernatant and MDA content in the cells, and significantly increased SOD content in the cells, significantly increased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly decreased apoptotic rate and Bax protein expression ( P<0.05). (4) The luciferase activity of the wild-type TRIM52-AS1+miR-28-5p mimic transfection group was significantly lower than that of the wild-type TRIM52-AS1+miR-28-5p nonsense control sequence transfection group (0.43±0.04 vs. 1.00±0.09, P<0.05). (5) As compared with the nonsense sequence transfection group, the miR-28-5p inhibitor transfection group had significantly decreased miR-28-5p expression, significantly increased LDH content in the culture supernatant and MDA content in the cells, significantly decreased SOD content in the cells, significantly decreased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly increased apoptosis rate and Bax protein expression ( P<0.05). As compared with the nonsense sequence+si-TRIM52-AS1 transfection group, the miR-28-5p inhibitor+si-TRIM52-AS1 transfection group had significantly decreased miR-28-5p expression, significantly increased LDH content in the culture supernatant and MDA content in the cells, significantly decreased SOD content in the cells, significantly decreased A value and protein expressions of Cyclin D1 and Bcl-2, but significantly increased apoptosis rate and Bax protein expression ( P<0.05). Conclusion:TRIM52-AS1 down-regulation may inhibit H/R-induced oxidative stress and apoptosis of rat brain cortical neurons by negatively regulating the miR-28-5p expression, which reduces neuronal cell damage.

目的 探究结局描述式教育联合促排尿护理在全脑血管造影术患者中的应用效果.方法 选择医院2017年5月—2019年5月收治的全脑血管造影术患者280例,按照组间基本特征具有可比性的方法分为观察组与对照组,对照组采取常规护理,观察组在此基础上加以结局描述式教育联合促排尿护理,比较两组患者焦虑抑郁水平及术后尿潴留发生率.结果 观察组术后尿潴留发生率低于对照组,首次排尿量大于对照组,膀胱剩余尿量少于对照组,排尿完全恢复时间短于对照组,术后焦虑评分低于对照组,差异均有统计学意义(P<0.05).结论 结局描述式教育联合促排尿护理在全脑血管造影术患者中的应用,能缓解患者焦虑抑郁情绪,促进排尿功能的完全恢复.

目的:探讨卒中健康管理师岗位的设立与临床实践方式.方法:通过对脑卒中健康管理师的选拔,并进行系统的理论和技能培训、考核,设立医院卒中健康管理师岗位,明确其岗位的工作职责和流程,包括入院健康评估、健康宣教、出院指导、随访管理、高危人群筛查以及卒中中心数据上报等.结果:通过有卒中健康管理师参与的、多学科协作的卒中中心建设,卒中中心制度更加规范,卒中中心病人的再次住院率从实施前的10.8％降低至实施后的6.1％.结论:卒中健康管理师全程、全面的管理病人是医院改善病人就医体验方面的尝试,为专科护士角色的拓展提供了经验和参考,但也需规范的培养、认证及长期管理.

目的 探讨正念减压疗法(MBSR)对烟雾病患者术后心理压力及睡眠质量的影响.方法 采用偶遇抽样法选取2018年3—12月在河南省某三级甲等医院接受手术治疗的106例烟雾病患者为研究对象,采用随机数表法分为研究组(53例)和对照组(53例),研究过程中脱落1例,最终研究组52例、对照组53例完成研究.对照组术后接受常规护理及健康教育,研究组在此基础上接受MBSR.采用焦虑自评量表(SAS)、中文版压力知觉量表(CPSS)和匹兹堡睡眠质量指数(PSQI)比较两组患者心理压力及睡眠质量.结果 干预后,研究组SAS、CPSS得分低于对照组(P<0.05).研究组干预后PSQI量表中睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能及睡眠总分均低于对照组(P<0.05).结论 MBSR可有效改善烟雾病患者术后心理压力及睡眠质量.

目的 探讨聚焦解决模式对颅内动脉瘤患者焦虑情绪及睡眠质量的影响,为改进患者围手术期护理提供参考.方法 选取2018年1—6月收治于河南省人民医院脑血管病专科的颅内动脉瘤住院患者153例,住院期间给予常规护理及聚焦解决模式心理护理干预.采用焦虑自评量表(SAS)及匹兹堡睡眠质量指数(PSQI)于入院时及出院前对患者进行测评.结果 干预后患者的焦虑评分、睡眠指数总分及各维度得分均明显低于干预前,差异有统计学意义(均P<0.05).结论 应用聚焦解决模式对颅内动脉瘤患者进行心理干预,能有效减轻其焦虑心理,改善患者睡眠质量.

Objective:To investigate whether astragaloside (AST) IV can improve spatial learning and memory abilities by alleviating oxidative stress damage to the frontal cortex and hippocampus in vascular dementia (VD) rats induced by chronic cerebral ischemia.Methods:Totally, 72 adult male Wistar rats were randomly assigned to four groups: sham-operated group ( n=12), model group ( n=20), AST-IV 10 mg group ( n=20), and AST-IV 20 mg group ( n=20); chronic cerebral ischemia-induced VD models in the later three groups were established by permanent bilateral common carotid artery occlusion (BCCAO); 3 h after BCCAO, these rats were administered with saline, 10 mg/kg AST-IV, or 20 mg/kg AST-IV once daily for a consecutive 90 d. Ninety-four d after modeling, spatial learning and memory abilities were assessed by Morris water maze; the activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT), and malondialdehyde (MDA) levels were measured by enzyme linked immunosorbent assay (ELISA). The levels of lipid peroxidation and oxidative DNA damage were assessed by immunohistochemical staining for 4-hydroxynonenal (4-HNE) and 8-hydroxy20-deoxyguanosine (8-OhdG), respectively. Results:(1) On the 3 rd, 4 th and 5 th d of place navigation test, the escape latency in rats of the model group was significantly longer than that in the sham-operated group, and that in the AST-IV 20 mg group was significantly shorter than that in the model group ( P<0.05); spatial probe test showed that the time percentage of rats spending in platform region in the model group (20.3%±1.7%) was significantly smaller than that in the sham-oprated group (48.2%±3.6%), and that in the AST-IV 20 mg group (39.7%±3.2%) was significantly larger than that in the model group ( P<0.05). (2) As compared with those in the sham-operated group, the SOD, GSH-Px and CAT activities were statistically decreased while MDA level was significantly increased in the frontal cortex and hippocampal CA1 area of rats in the model group ( P<0.05); as compared with those in the model group, the SOD, GSH-Px and CAT activities were statistically increased while MDA level was significantly decreased in the frontal cortex and hippocampal CA1 area of rats in the AST-IV 20 mg group ( P<0.05). (3) As compared with those in the model group, the numbers of 4-HNE and 8-oHdG positive cells in the frontal cortex and hippocampal CA1 area of rats in the AST-IV 20 mg group were significantly smaller ( P<0.05). Conclusion:Intraperitoneal injection of high dose AST-IV can ameliorate oxidative damage in the frontal cortex and hippocampal CA1 area in chronic cerebral ischemia-induced VD models, and has the potential to reverse spatial learning damages and memory dysfunction.

目的?分析缺血性烟雾病围手术期管理方法和缺血事假对疾病预后的影响.方法?选择在河南省人民医院进行缺血性烟雾病手术治疗的120例病患为研究样本,其治疗时间均在2016年10月—2019年10月之间.对120例病患的临床资料实施回顾性分析,了解缺血性烟雾病病患围手术期管理方案,观察缺血事件对临床预后的影响.结果?120例病患均手术成功,其中110例病患脑缺血和偏瘫症状消失或有显著改善.有1例病患出现短暂性脑缺血症状;有28例病患在手术后24h内出现颜面部水肿;有1例癫痫病患在手术后出现癫痫症状.结论?缺血性烟雾病病患强化围手术期管理,可提升治疗效果,改善缺血事假对疾病预后的不利影响,促进病患机体尽快恢复.

总结1例脑出血气管切开术后合并肺部感染患者的护理经验.护理要点包括:密切观察生命体征,做好治疗护理、气管切开护理、呼吸训练、生活护理、严格消毒隔离、心理护理、健康教育.

目的 研究脑动脉瘤介入治疗患者引进心理行为干预对其心理状况及生活质量的影响.方法 选取河南省人民医院2018年3月-2019年5月期间收治的300例脑动脉瘤介入治疗患者,根据干预方式不同分为两组,每组均150例,其中对照组采取常规干预方式,研究组实施心理行为干预,对两组患者的情绪评分、并发症及生活质量评分进行比较.结果 干预前两组汉密尔顿焦虑量表(hamilton Anxiety Scale,HAMA)、抑郁量表(hamilton Depression Scale,HAMD-24)评分均无显著差异,干预前两组患者生活质量评分无显著差异,P>0.05;干预1周、干预结束研究组HAMA、HAMD-24评分均低于对照组,干预后研究组生活质量评分均高于对照组,差异显著,P<0.05.结论 对于脑动脉瘤介入治疗实施心理行为干预,可有效改善患者生活质量,患者情绪明显好转,值得应用.

目的总结介入治疗布加综合征的护理体会。方法对96例患者进行术前、术中、术后相应的护理。结果 96例患者中治愈95例,1例因无法开通而失败。结论术前心理护理,术后严密观察、精心护理、及时发现并发症和有效的健康教育是确保手术成功的关键。

目的:探讨下肢动脉硬化闭塞症介入术后并发症的观察重点及措施。方法:对138例下肢动脉硬化闭塞症患者,将血管成形、内支架置入、血栓及斑块旋切、溶栓、血栓抽出等介入治疗术后出现的并发症进行分类、分析,针对性实施护理。结果:本组138例患者有32例出现术后并发症,其中穿刺部位巨大血肿9例、下肢过度灌注综合征2例、假性动脉瘤3例、消化道出血3例、支架内急性闭塞4例、支架再狭窄10例,造影剂迟发型变态反应1例,占手术的23.2%。结论:下肢动脉硬化闭塞症介入治疗并发症发生率较高,认真细致的观察护理,及早发现问题,及时地采取有效的措施对疾病的预后非常关键。