目的 评价经股动脉穿刺肝癌介入术后应用动脉压迫止血器的效果.方法 检索Cochrane Library、PubMed、EMbase、中国知网和万方数据知识服务平台等数据库中关于经股动脉穿刺肝癌介入术后应用动脉压迫止血器的随机对照试验.采用Cochrane Handbook (5.0.1)对文献质量进行评价,并采用RevMan 5.3软件进行Meta分析.结果 共纳入9项研究.6项分析结果显示,使用动脉压迫止血器较常规方法能够缩短压迫止血时间[MD=-4.55,P＜0.001]和肢体制动时间[MD=-15.98,P＜0.001];使用动脉压迫止血器能够降低局部渗血(8项)[RR=0.27,P＜0.001]、血肿形成(8项)[RR=0.30,P＜0.001]和皮肤瘀斑(6项)[RR=0.30,P＜0.001]发生率.结论 肝癌介入术后患者应用动脉压迫止血器相对于常规方法在缩短压迫止血时间和肢体制动时间、降低血管并发症方面效果明显,但是对其可能出现的皮肤瘀斑仍需给予足够重视.

目的：探讨健康教育对行食管胃底静脉曲张套扎术患者心理状况的影响。方法：将80例确诊为食管胃底静脉曲张的患者按照随机数字表法随机分为对照组和干预组各40例。对照组患者按常规护理，给予必要的解释和安慰，干预组在此基础上对患者实施有针对性的健康教育，同时采用焦虑自评量表（ SAS）及抑郁自评量表（ SDS）对患者心理状况进行测评，比较健康教育前后患者情绪和心理状态的变化情况，以此判定实施该健康教育模式的效果。结果：健康教育实施前，两组患者SAS、SDS评分差异无统计学意义（P>0.05）；实施后，干预组焦虑值、抑郁值分别低于对照组，两组比较差异均有统计学意义（t值分别为3.351，2.057；P值分别为<0.01，<0.05）。结论：对实施食管胃底静脉曲张套扎术患者进行健康教育，不仅能够缓解抑郁、焦虑等不良情绪，还能有效改善患者的生活质量，提高了患者的护理满意度。

OBJECTIVE To study the infection rate of hospitalized patients with liver disease and the relevant risk factors and to establish corresponding nursing strategy according to risk analysis .METHODS The clinical data of 864 cases of liver disease patients who were treated in the hospital from Jan 2009 to Dec 2012 were retrospectively analyzed;96 cases of infected patients were divided into infection group and the 768 cases of uninfected patients were divided into control group ;the two groups of patients were compared and the risk factors causing nosocomial infections was discussed ;SPSS 18 .0 software was adopted for statistical analysis ,and Chi-square test was adopted for testing enumeration data .RESULTS Totally ,96 of the 864 cases of liver disease patients suffered nosocomial infections ,with an infection rate of 11 .11% ;35 cases of patients suffered respiratory tract infections ,28 cases of patients suffered digestive tract infections ,18 cases of patients suffered urogenital system infections ,5 cases cases of skin and soft tissue infections and 10 cases of abdominal infections , accounting for 36 .46% , 29 .17% , 18 .75% ,5 .2% and 10 .42% respectively .The patients'old age ,long hospital stay ,complicated diseases , indwelling catheter ,reception of invasive procedure ,irrational use of antibiotics and use of immunosuppressants were those risk factors causing nosocomial infections to liver disease patients ( P< 0 .05 ) .CONCLUSION The incidence rate of nosocomial infections in liver disease patients is high ,and the patients'old age ,long hospital stay ,complicated diseases ,indwelling catheter ,reception of invasive procedure ,irrational use of antibiotics and use of immunosuppressants are the risk factors causing nosocomial infections ,so it is necessary to perform active intervention and nursing according to the above risk factors .

Objective To observe state of crystals dissolved by adopting microwave heating to dissolve crystalliza-tion 20% mannitol injection under different fire position of microwave oven .Method Regenerated crystallization of 20% mannitol injection was packaged with soft plastic bag and placed in the microwave oven for heating .After heat-ing ,residual amount of crystallization of 20% mannitol injection was immediately weighed based set heating and time point ,such the defrost ,low ,midst ,high ,highest fire position ,and set up time point t=15 s ,30 s ,45 s… …420 s .In another hand ,kerosene thermometer was used to measure the temperature of solution within the plastic bag at the time point t=120 s ,180 s ,240 s… …420 s .Each experiment is repeated three times at each time point . Result Mannitol crystals are not dissolved completely by heating before bags explosion in different firepower .Quality of crystalline residue is 0 .86 g to 3 .56 g .The solution temperature exceed 90 ℃ by heated to the highest time point (before the bags burst) .Conclusion 20% mannitol injection should not be suitable for microwave heating to dissolve the crystals .Mannitol solution can not be directly removed by hand after heating due to the high temperature and to avoid the possible bag explosion and cause burns personnel .

<正>乙肝病毒e抗原(HBeAg)阳性是乙肝病毒(HBV)持续高水平复制和传染性强的标志,其与乙肝病毒核心抗原(HBcAg)、HBVDNA密切相关,并具有明显的平行关系。HBeAg对促进病毒持续感染有免疫调节作用,在免疫耐受机制中起重要作用[1-2]。单纯的HBeAg能对新生儿产生什么影响尚不明确。本研究观察了HBV高载量母亲所产的新生儿

20%甘露醇注射液是临床常用的高渗性脱水剂和降压药,常用于由各种原因引起的脑水肿、药物逾量蓄积的排泄、早期肾衰、眼内和肠道手术的术前准备等.当室温低于15℃时极易产生甘露醇微粒,甚至析出结晶,因此应用前应通过热水浴方法、热接触方法、电热台板方法、暖气片、暖液袋、预真空灭菌器的余热、高压蒸气锅、恒温箱、太阳能以及电磁炉和微波加热等方法溶解甘露醇结晶,待结晶完全溶解后再使用.本文将近年来有关甘露醇注射液结晶溶解方法进行了综述.

Objective:To establish the perfect clinical nursing pathway of nursing for percutaneous transhepatic biopsy.And investigate the effect of the clinical nursing pathways on anxiety of liver biopsy and postprocedure pain.Methods:A total of 120 patients were divided into experimental group(60 cases) and control group(60 cases) randomly.The anxiety level was measured by Zung′s Self-Rating anxiety scale(SAS).Postprocedure pain was measured by McGill′s scale.Results:Compared with the control group,the experimental group had lower scores of anxiety(P0.05).The incidence of postprocedure pain was less in the experimental group,and the level of pain was also lower in the experimental group.The difference between the two groups was significant(P0.05).Conclusion:With the clinical nursing pathways,the anxiety of liver biopsy and postprocedure pain can be alleviated significantly.

Objective To investigate the effects of health education path on breastfeeding compliance of HBsAg positive puerperae.Methods Using convenience sampling method,238 HBsAg positive puerperae from January 2009 to January 2011 were selected as observational group to receive health education path.263 HBsAg positive puerperae from December 2006 to December 2008 were selected as control group toreceive routine health education.The inter-group maternal breastfeeding compliance and awareness of maternal breastfeeding knowledge were compared.Results Compared with the control group,the awareness of maternal breastfeeding knowledge was significantly higher and 70.59% of the puerperae gained 80 points or higher(P0.01).Compared with the control group,69.75% of the puerperae' breastfeeding time are more than six months,19.75% are less than six months,only 10.50% without breastfeeding in the observational group,and the differences are significant(P0.01).Conclusion Breastfeeding of HBsAg-positive mothers does not increase the HBV infection of infants.Health education path can effectively improve the compliance of maternal breastfeeding and awareness of feeding knowledge.

OBJECTIVE:To determine the effective dose of hepatitis B immunoglobulin (HBIG) for clearing maternally-transmitted hepatitis B virus (HBV) from a newborn.METHODS:Full-term neonates born to HBV-infected mothers were tested for hepatitis B surface antigen (HBsAg) and HBV DNA in venous blood, Individuals with positive results within two hours after birth were selected for study, and divided among two treatment groups: research group receiving HBIG continually adjusted to quantitative levels of neonatal HBsAg and HBV DNA levels; control group receiving standard HBIG 200IU dose. All neonates were also treated with 10 micrograms of recombinant vaccine. The decreases in HBsAg and HBV DNA over 12 months were comparatively analyzed between the two treatment groups.RESULTS:The two treatment groups (HBIG adjusted vs. standard) were statistically similar in Apgar score (9.38+/-0.49 vs. 9.37+/-0.48), neonate body weight (3458.67+/-374.93 vs. 3558.61+/-322.85 g), maternal age (26.33+/-3.63 vs. 25.33+/-3.03), and initial HBsAg and HBV DNA levels (rank sum test Z = 1.381, and Z = 0.700, respectively) (all, P more than 0.05). Successful clearance of HBV infection within 12 months was achieved in significantly more neonates in the HBIG adjusted therapy group than in the standard therapy group (82.8% vs. 57.4%; x2 = 9.696, P less than 0.05).CONCLUSION:Adjusting the neonatal HBIG dose according to HBsAg and HBV DNA levels can improve the success rate of clearing maternally-transmitted HBV.

Objective To investigate the change of nurses' job satisfaction by using King's interactive and goal attainment theory in clinical nursing.Methods 13 nurses working in the chronic liver disease Ⅰward and using the King's interactive and goal attainment theory were recruited as experiment group,13 nurses working in the chronic liver disease Ⅱward and using usual care modes were recruited as comparison group.Use 'Minnesota Satisfaction Questionnaire' to investigate the nurses' job satisfaction before and after using King's interactive and goal attainment theory.Compare the result within groups.Results The two groups' internal,external and general job satisfaction had no difference before using King's theory(all P>0.05);The experiment group nurses' internal job satisfaction scores were higher than themselves and comparison group after using the King's theory(all P<0.05),but the external and general job satisfaction had no difference(all P>0.05).Conclusion Nurses using King's interactive and goal attainment theory in clinical nursing can improve their internal job satisfaction.

Objective To explore the collection time of femoral vein blood in neonates of HBsAg-positive puerpera so as to provide the evidence for protecting infections of neonates.Methods From October 1999 to January 2010,21348 full-term neonates were delivered by HBsAg-positive mother in our inpatient and outpatient department.The 21348 neonates were randomized into observation group(n=10 826) and control group(n=10 522).The neonates in the observation group were collected of femoral vein blood to test hepatitis B makers and HBV-DNA between 2 h and 4 w after birth.While the neonates in the control group were collected of femoral vein blood for the same test between 4 w and 52 w after birth.Comparison was conducted on the one-time success rate of acupuncture for blood collection.Results The one-time success rate for taking blood of the newborns of the observation group was significantly higher than that of the control group(χ2=233.868,P0.01).Conclusion Collection of femoral vein blood of the newborns within 4w after birth is more convenient for five tests of Hepatitis B and quantitative HBVDNA test,with timely clinical information of neonates with HBV infection,which is of clinical significance for blocking hepatitis B.

Objective To observe the HBsAg neutralization capability of hepatitis B immune globulin(HBIG) in vitro test and in vivo among newborn infants.Methods A group of 63 infants born to HBsAg-positive mothers were successfully immunized with HBV vaccine and HBIG.Forty-three of the infants had serum HBsAg less than or equal to 40 ng/ml(group Ⅰ) and 17 of the cases had serum HBsAg greater than 40 ng/ml(group Ⅱ).The concentration of anti-HBs was evaluated on day 4-7 after the application of 200 IU HBIG.The HBsAg neutralization capability of HBIG in vivo was compared the capability in vitro.Results The average amount of anti-HBs was 226.4 IU in newborn infants on day 4-7 after the application and HBIG and HBV vaccine.One IU HBIG neutralized 42 ng HBsAg in vitro,while 1 IU neutralized only 2.04 ng and 1.87 ng HBsAg for the infants of Group Ⅰ and Group Ⅱ in vivo as evaluated,respectively.The HBsAg neutralization capability of HBIG was around 20 times higher in vitro than in vivo.Conclusions The HBsAg neutralization capability of HBIG was different in vitro test vs in vivo evaluation.HBsAg levels in blood and other tissues may difference.

目的探讨King互动达标理论在肝穿患者临床护理中的应用效果,并对相关影响因素进行分析。方法将就诊于慢性肝病Ⅰ科应用King理论实施互动达标护理的180名肝穿患者设为实验组,就诊于慢性肝病Ⅱ科采用常规护理模式的132名肝穿患者设为对照组;应用自制"护理目标单"等工具实施对两组肝穿患者的达标率测评,比较应用King理论后的两组之间的差异。结果实验组患者的达标率高于对照组(P<0.05),而且患者的达标率受其年龄、文化程度的影响较大,两组年龄≤30岁的患者占研究总人数的56%,其达标率高于其他年龄段的患者,与其患病时间短,理解力、接受力强有关;但文化程度越高的患者,其达标率反而在下降,与患者过度关心自身疾病,受多重渠道(网络、广告)良莠不齐信息的影响有关。结论King互动达标理论的应用,促进了肝穿患者健康目标的实现;护士应根据患者的不同特点实施个体化的达标方案;King理论在护士和患者群体间应用切实可行。

目的探讨King互动达标理论在肝脏穿刺患者中应用后,对患者的医学应对方式的影响。方法取就诊于慢性肝病Ⅰ科180名肝脏穿刺患者为研究对象,在应用King互动达标理论实施前后,应用医学应对问卷进行测评、比较。结果实施前本组患者的面对分值低于国内常模,回避和屈服分值高于国内常模(P<0.05),实施后,面对分值提高,而回避和屈服分值降低,并与实施前比较差异有统计学意义(P<0.05)。结论肝脏穿刺患者较多采取回避和屈服来应对自身疾病。通过应用King互动达标理论,实现护患互动,患者对自身疾病有了准确的感知和认识,由消极转向积极,由回避和屈服转向了面对,改变了应对方式。

Objective To assess the quality of life of elderly patients with chronic type B hepatitis,and to discuss the relation between the quality of life and level of depression.Methods General questionnaire,senium depression scale and the MOS 36-item Short Form Health Survey(SF-36) were used to survey 43 hospitalized patients with chronic type B hepatitis.Results Depression incidence rate in senium chronic type B hepatitis was 83.7%,with light depression accounting for 69.7% and severe depression accounting for 14%.All indices except idiosoma pain,were lower in our group than in aged-matched normal controls(P<0.01),with psychological health deteriorated mostly.In addition,except for society function,other indices had a negative correlation with depression level(P<0.01),with sentiment function being the most severely effected.Conclusion Elderly patients with chronic hepatitis B have a low quality of life,which is closely connected with depression level.Effective measures should be taken to improve the quality of life and depression level during clinical nursing.

体温计的消毒一直是医院质控检查的重点工作,体温计属于中度危险性物品,但在消毒技术规范中明确提出,对于体温计的消毒必须采用高水平消毒法消毒[1].

乙型病毒性肝炎是一种全球性传染病,我国人群乙型肝炎病毒(HBV)感染率高达60%左右,仅慢性HBV携带者约占总人口10%,是我国HBV传播重要的传染源[1].传染病医院由于服务对象与工作环境的特殊性,医护人员面临高危的职业风险.慢性HBV携带孕产妇分娩、手术操作无疑加大了职业风险的概率.手术室必须建立严格的管理制度和防护系统,加强对HBV携带孕产妇手术室管理和监测是落实各项隔离措施,防范致病因子传播的可靠保证,现报道如下。

Objective To study the relation between coping style,social support and living quality of chronic hepatitis B patients.Methods Sixty-six chronic hepatitis B patients were surveyed with medical coping questionnaire,comprehending society support scale and SF-36 heahhy measure- ment.Results Living quality of chronic hepatitis B patients was lower than that of the control group(P=0.00).The healthy coping style score was lower than the norm (P0.05);the esca- ping and giving up coping style scores were higher than the norm(P0.01).The healthy coping style was positively related to the physical function,physical ache,general health condition,ener- gy,emotional function and psychological health;escaping coping style was negatively correlated to general health condition and emotional function;giving up coping style was negatively related to social function;and comprehending society support was positively related to life quality.Conclusion Living quality of chronic hepatitis B patients is low and is influenced by coping style and social support.The coping style and social support of chronic hepatitis B patients should be assessed in clinical practice.Effective psychological intervention should be employed to help patients with ac- tive coping style and efficient social support,so as to improve the living quality of chronic hepatitis B patients.

目的评价慢性乙型肝炎患者的生活质量,以及生活质量与焦虑、抑郁水平的相关性。方法采用焦虑自评量表、抑郁自评量表和健康调查简表(SF-36)进行问卷调查。结果慢性乙型肝炎患者焦虑、抑郁评分与常模比较差异有统计学意义(P<0.01);生活质量各维度与慢性非传染疾病组及健康对照组比较,经F检验差异有统计学意义(P<0.01);焦虑、抑郁与生活质量呈负相关。结论慢性乙型肝炎患者的生活质量偏低,焦虑、抑郁水平与生活质量密切相关,在临床工作中应通过有效的心理支持及行为干预,减轻患者的焦虑及抑郁状态,提高其生活质量。

Objective: To discuss the relationship between type A anxiety and depression of the viral hepatitis patients. Method: 63 viral hepatitis patients measured by the queseionnaires of the anxiety self-vealuation table and depression self-evaluation table and table of type A. Result: The viral hepatitis pateients are quite different from common ones on anxiety and depression(P0.01).Clearly,anxiety is related with type A (r=0.247,P0.05),while depression not(r=0.115,P0.05). Conclusion: Hepatitis patients have significant negative emotion,such as anxiety and depression,and anxiety is related with type A.So,nurses should evaluate the behavior mode,anxiety and depression state of patients.By effective psychology support and behavior interference,the anxiety and depression of patients can be decreased,thus promoting their rehabilitation.