Objective:To investigate the clinical value of ankle-brachial index (ABI) in evaluating vascular cognitive dysfunction (VCI) in the elderly.Methods:According to the mini mental state examination (MMSE) and Montreal cognitive assessment (MoCA), 200 elderly inpatients from May 2016 to February 2018 in our hospital were selected. MoCA scale was used to evaluate the cognitive function of the patients. The patients were divided into cognitive dysfunction group ( n=110) and cognitive normal group ( n=90). The clinical data of the two groups were analyzed and compared. The correlation between ABI and MMSE, MOCA and clinical indicators was observed. The receiver operating characteristic (ROC) curve of ABI value to the predictive value of VCI in the elderly was drawn. Results:⑴ There was no significant difference between the two groups in terms of gender, the first fasting blood glucose value in hospital and the situation of diabetes, hypertension and hyperlipidemia ( P>0.05); there was significant difference in age, low-density lipoprotein cholesterol (LDL-C) level, history of small cerebral vessels and ABI between the two groups ( P<0.05). ⑵ Logistic regression analysis showed that ABI was the related factor of VCI in the elderly ( P<0.01). ⑶ Pearson correlation analysis showed that MMSE score was positively correlated with ABI ( r=0.887, P<0.01), MOCA score was positively correlated with ABI ( r=0.843, P<0.01). ⑷ The area under ROC curve of ABI prediction value for VCI in the elderly was (0.965±0.01) [95% CI (0.945, 0.985), P<0.01]. When ABI ≤0.9, the sensitivity and specificity were 88.2%, 91.1% respectively; the accuracy and the yordan index were 89.5% and 0.793. Conclusions:⑴ ABI is an influencing factor of VCI in the elderly and is positively correlated with the severity of cognitive impairment in patients. ⑵ ABI has a high predictive value for VCI of the elderly, and ABI≤0.9 can be used as an early warning factor for VCI of the elderly.

[目的]探讨立体化心理干预改善慢性心力衰竭病人心理状况和生活质量的效果.[方法]选择收治的慢性心力衰竭病人86例为研究对象,采用随机数字表法将86例病人随机分为观察组和对照组各43例.对照组予以常规干预,观察组在常规干预基础上予以立体化心理干预,比较两组干预前和干预3个月后的焦虑状况、抑郁状况以及生活质量.[结果]两组经干预后,焦虑、抑郁评分及生活质量均较干预前显著改善(P＜0.05);观察组干预后的焦虑、抑郁、明尼苏达心力衰竭病人生活质量得分分别为36.90分±3.66分、37.02分±3.59分、28.84分±7.65分,均低于同时期对照组,差异有统计学意义(t值分别为4.827、4.935、6.254,P＜0.05).[结论]在常规心理干预的基础上为慢性心力衰竭病人提供立体化心理干预,能够更好地改善病人焦虑与抑郁心理状况,提高病人生活质量.

Objective:To explore the nursing methods of silver ion auxiliary combined with continuous vacuum sealing drainage ( VSD) in the treatment of diabetic foot ulcers ,and to observe the effect of treatment .Methods:A total of 126 cases of diabetic foot ulcer patients in our hospital were randomly divided into group A ,group B,group C with 42 cases.The three groups were given control of blood glucose ,an-ti-infection,surgical debridement therapy .Group A received traditional treatment .Group B was treated with silver ion excipient treatment , and group C was treated with VSD technology combined with silver ion excipient treatment .The treatment effects,change of work load, wound healing conditions and bacterial negative rate were compared between the three groups .Results:The total effective rate of Group B and C was significantly higher than that of group A (P<0.05).The average dressing interval of three groups was a significant increasing trend,and the wound healing time of three groups was significantly decreased (P<0.05).Between the three groups,the ulcer reduction rate increased significantly,and the growth of granulation score was significantly decreased (P<0.05).One and two weeks after the treat-ment,three groups′bacterial clearance rate were significantly increased (P<0.05);4 weeks after the intervention,the negative rate of bac-teria in group B and C was still significantly higher than that in group A (P<0.05).Conclusion:Silver ion excipients combined with VSD technology is effective in the treatment of diabetic foot ulcers .It can improve ulcer reduction rate and bacterial negative rate ,promote gran-ulation growth ,accelerate wound healing and reduce workload ,which has good clinical application value .

[目的]探讨知信行模式改善老年高血压病病人自我护理能力及血压控制的效果.[方法]将2016年2月-2017年2月收治的122例社区老年高血压痛病人采用随机数字表法将病人随机分为观察组和对照组各61例,对照组予以常规护理干预,观察组在常规护理基础上基于知信行理论进行干预.两组病人均干预6个月,比较干预前后的自我护理能力、收缩压和舒张压.[结果]观察组病人干预后自我护理能力评分提高,且均高于对照组干预后(P＜0.05);观察组病人干预后收缩压和舒张压均下降且低于对照组(P＜0.05).[结论]知信行模式干预可以提升社区老年高血压病痛人自我护理能力,改善血压控制效果,效果优于常规社区护理干预.

目的 探讨多学科团队健康教育模式在慢性心力衰竭治疗中的应用效果.方法 选取收治的102例慢性心力衰竭患者,随机分为观察组和对照组各51例,观察组实施多学科团队健康教育模式,对照组实施常规护理,对比两组知识、行为改变及复发再入院情况.结果 观察组遵医服药、自测脉搏、心力衰竭知识合格率、血压、控制摄盐量等方面都高于对照组,差异有统计学意义(P<0.05);两组坚持适量运动、饮酒、吸烟等方面改变对比无差异(P>0.05);观察组复发率为9.80%,对照组为47.05%,差异有统计学意义(P<0.05).结论 在慢性心力衰竭治疗中应用多学科团队健康教育能有效改善患者生活质量,提高患者对疾病知识认知率和健康行为依从性,减轻患者焦虑、恐惧心理,值得临床推广应用.

目的：：分析万古霉素致不良反应发生的原因和特点，为临床合理用药提供依据。方法：利用中国知网《中国期刊全文数据库》，检索2015年3月前万古霉素致不良反应的报道，分析其不良反应常见的临床表现、累及器官及预后情况、以及不良反应的发生机制。结果：万古霉素致不良反应，其主要表现有过敏反应、红人综合征、皮肤毒性、肾损害、肝损害、血液系统等反应，偶见有药物热、腹痛、多系统损害等。结论：临床治疗上应合理使用，重视万古霉素导致的药物不良反应，做好用药监护，严格控制联合用药。

目的 探讨多学科干预对慢性心力衰竭患者自我管理能力和效果的影响.方法 选取2013年1月～2015年12月我院收治的慢性心力衰竭患者80例,采用随机数字表法分为观察组和对照组,各40例,对照组患者采用传统护理方案,观察组患者则实施多学科干预,由临床药师参与组成多学科干预团队,自患者入院起保持干预指导直至出院后6周,分别在治疗前、出院前和出院后6周时采用《心力衰竭病人自我管理量表》和《明尼苏达心力衰竭病人生活质量调查表》对患者的自我管理能力及生活质量进行调查对比.结果 在治疗前、出院前两组患者的自我管理能力评分及生活质量评分比较,差异无统计学意义(P＞0.05),在出院后6周时观察组患者的自我管理能力评分及生活质量评分均显著高于对照组,差异有统计学意义(P＜0.05).结论 实施多学科干预能够有效提高慢性心力衰竭患者的自我管理能力,改善患者的生活质量,值得在临床上推广应用.

Objective To explore the effects of estrogen on oxidative stress of the lung tissue induced by acute paraquat (PQ) poisoning. Methods Thirty-two male adult New Zealand rabbits were randomly divided into model group and estrogen intervention group, 16 rabbits in each group. The model of lung injury induced by PQ poisoning was reproduced by feeding 16 mg/kg of 20% PQ through gastric tube. The rabbits in estrogen intervention group received intravenous infusion of 5 mg/kg estrogen after PQ challenge for 7 days, and the rabbits in model group received an equal volume of normal saline. Three rabbits in each group were sacrificed at 1, 2 and 3 days respectively after exposure. The lung tissue was harvested, the levels of reactive oxygen species (ROS) was determined by 2',7'-dichlorofluorescin diacetate (DCFH-DA), malondialdehyde (MDA) was determined by thiobarbituric acid (TBA), the mRNA expression of manganese-containing superoxide dismutase (MnSOD) was determined by reverse transcription-polymerase chain reaction (RT-PCR), and adenosine triphosphatase (ATP) content in mitochondrion was determined by enzyme linked immunosorbent assay (ELISA). The pathological changes in lung were observed under light microscopy using hematoxylin and eosin (HE) staining, and the lung injury was evaluated with lung injury score. Results The contents of ROS and MDA in lung within 3 days after PQ poisoning were gradually increased, and MnSOD mRNA expression and ATP content were gradually decreased. Estrogen intervention could significantly reduce the production of ROS and MDA after PQ poisoning [3-day ROS (fluorescence intensity): 161.05±30.04 vs. 188.30±31.80, 3-day MDA (mmol/L): 98.71±0.92 vs. 122.12±1.24], up-regulate MnSOD mRNA expression (integral A value: 3.05±0.90 vs. 1.22±0.24), and increase ATP content in mitochondrion (ng/L: 3.75±0.92 vs. 2.28±0.29) with statistically significant differences (all P < 0.01). In lung tissue after PQ poisoning, congestion, edema, focal pulmonary consolidation, pulmonary interstitial and alveolar space were infiltrated by a large number of neutrophil, alveolar interval were thickened obviously and the above phenomenon were most serious at 3 days after poisoning as shown under optical microscope. Estrogen intervention could significantly improve lung injury as compared with that of model group, and the lung injury score at 3 days was significantly lower than that of model group (11.8±0.7 vs. 13.5±1.0, P < 0.01). Conclusions The oxidative stress indicators in the lung tissue after PQ poisoning were obviously abnormal, the pathological damage was serious with time dependence. The administration of estrogen can reduce acute lung injury after PQ poisoning by reducing the oxidative stress.

目的：分析舒适护理干预在心血管护理中的效果。方法选取2012年2月至2014年2月来我院就诊的心血管疾病患者中选取150例，随机分成两组即观察组和对照组，每组75例。其中观察组建立在常规护理干预方法护理基础上，还进行舒适护理；其中的参照组则采取常规性护理干预方法进行护理，比较两组的护理效果，主要观察指标有便秘、尿潴留、腰背疼痛、失眠、住院时间、患者满意度。并采取数学统计法进行统计处理，比较各个指标的护理差异。结果观察指标中，便秘、尿潴留、腰背疼痛、失眠指标，观察组的发生率都要比对照组明显要低，住院时间比参照组明显要短，P小于0．05，具有统计学意义。患者满意度而言，观察组要比参照组明显要高。 P小于0．05，具有统计学意义。结论对于心血管疾病患者而言，舒适护理更有利于改善其治疗时所产生的各种不良症状，能够缩短住院时间，降低因为住院给患者造成的身心痛苦，患者的满意度大大提高，值得推广使用。

目的：为临床安全、合理地使用他汀类药物提供参考依据。方法检索万方医学网数据库，收集致横纹肌损害的他汀类药物的通用名称、患者性别、年龄；肌酸激酶、肌红蛋白等变化；他汀类药物用法用量；横纹肌损害出现时间、临床表现、联合用药情况、治疗与转归等进行统计分析。结果共纳入35篇文献，共40例患者。发生横纹肌损害的病例中，60岁以上的患者占了70%，各他汀药物发生横纹肌损害与每天服用剂量有一定关联，往往在较高的剂量水平上发生的例数更多些。结论药物相互作用或许是引发服用他汀类药物后出现不良事件的一个重要原因；转氨酶、肌酸激酶、肌红蛋白是服用他汀类药物的临床药学监护指标；而肌无力、肌肉疼痛、茶色尿则是服用他汀类药物出现不良事件的常见临床表现。

目的：分析超声引导下经皮无水乙醇注射治疗原发性肝癌的护理方法。方法：选择超声引导下经皮无水乙醇注射治疗的原发性肝癌患者70例作为研究对象，采用随机分组的方式将患者分为观察组与对照组，每组35例。对照组采用常规护理模式，观察组在对照组的基础上实施术前、术中和术后围手术期护理，对两组患者的护理效果进行分析对比。结果：所有患者均顺利完成手术，护理前观察组患者焦虑值评分及疼痛、恶心、呕吐发生率比较差异无统计学意义（P＞0.05）；护理后观察组患者焦虑值评分及疼痛、恶心、呕吐发生率明显低于对照组（P＜0.05）。结论：对超声引导下经皮无水乙醇注射治疗的原发性肝癌患者实施围手术期护理具有良好的临床效果，能有效缓解患者的焦虑情况和疼痛情况，并降低患者恶心、呕吐等不良反应发生率，值得在临床应用上推广。

Objective To investigate the effects of human parathyroid hormone (hPTHl-34) on the osteoporosis of o-variectomized rats. Methods 50 female 7-month-old SD rats were used for this experiment and 30 of them were o-variectomized and another 20 received sham operation. After 12 weeks of ovariectomy the osteoporosis model was con-firmed by use of 10 ovariectomized and sham-operated rats. The osteoporotic rats of 20 were randomly divided into 2 treatment groups:hPTHl-34 and OVX placebo groups with 10 rats in each group, the other 10 rats were sham-oper-ated as the control for SHAM group. Totally hPTHl-34 (20μg/kg) were subcutaneous injected into the rats of hPTHl-34 group once every other day. The rats of the OVX placebo group and SHAM group were injected with 0.5 mL saline once every other day. The bone mineral density (BMD), serurn Ca, P, bone alkaline phosphatase (BALP), serum tartrate-resistant acid phosphatase 5b (Trap-5b) were measured after 3 months therapy. Results After 12 weeks’treatment the femoral and lumbar BMD in the hPTHl-34 group increased obviously compared with those of OVX placebo group [(0.151±0.008) g/cm2 vs (0.135±0.013) g/cm2, (0.181±0.010) g/cm2 vs (0.159±0.008) g/cm2, P< 0.01]. After treated with hPTHl-34 serum Ca, P, BALP and Trap-5b significantly increased compared with those of OVX placebo group (P<0.05 or P < 0.01). There was no significant difference in hPTHl-34 and SHAM groups. Conclusion hPTHl-34 can stimulate osteoblast activity, inhibite bone resorption, promote bone mass effect and is effective on protection against os-teoporosis.

目的 探讨百草枯中毒患者肺损害时的护理措施.方法 对我院于2009~2012年间收治的34例百草枯中毒患者的救护资料进行分析,并详细介绍护理措施及经验.结果 让患者取半坐卧位,可以改善呼吸困难,缩小肺纤维化的范围;创造良好的室内环境,加强口腔护理,可有效地预防肺部感染.高度谨慎应用氧疗,正确掌握用氧指征及用氧方法,避免增强百草枯的毒性,加强肺纤维的护理,提高患者的生存质量.严密观察病情变化,严格掌握输液量及速度,避免发生和加重肺水肿,是百草枯中毒患者肺护理的关键.结论 对急性百草枯中毒患者采取积极、合理的护理措施,对预防或减轻肺损害,降低病死率有重要意义.

Objective Watch KangHuiEr and glue and silver ions series dressing in the treatment of diabetes foot,bedsore etc infectious the treatment effect of the wound.Methods Will diabetes foot 60 cases,bedsore 20 cases were randomly divided into observation group in the control group and the 40 cases and control the traditional external use plus gauze change medicine,the observation group using KangHuiEr debridement glue and silver ions dressing change medicine.Results The observation group patients wound healing time,mechanical damage,pain and around the wound skin ulcers are obviously reduced the incidence of control group,the difference was statistically significant.Conclusion KangHuiEr debridement glue and silver ions antibacterial dressing in the treatment of diabetes foot,bedsore the effect is good.Wound healing time is short,complications or discomfort are relatively low.

目的探讨老年糖尿病合并骨质疏松症患者病区安全管理的危险因素并提出干预措施。方法对47例住院患者存在的安全隐患进行分析。结果患者合并严重的骨质疏松、糖尿病神经血管病变和视网膜病变、出现低血糖反应、意识障碍、药物因素以及住院环境设施不完善等是导致安全隐患的主要危险因素。结论患者在上述危险因素作用下易导致如跌倒、坠床、烫伤等安全事故,护理人员应针对危险因素,采取有效的干预措施和健康教育,建立病区安全管理制度,强化护理人员的安全责任意识,减少和预防各类意外伤害事件的发生。

Objective In order to discuss nursing to intervene to diabetes nephrosis patient from a medical line of influence.Methods 268 patients including the inpatients and the outpatients made a follow-up from August,2006 to December,2010 were divided into the experimental group and control group.There were 134 patients in every group.The control group uses conventional nursing,tests besides conventional nursing,but also implements the health education to the patient,the nursing intervention.Results Through the health education,the nursing intervention,the experimental group and the control group diabetes nephrosis patient has statistics significance from the medical behavior after the comparison difference(P<0.01).Conclusion Implements the nursing intervention to diabetes nephrosis patient,may enhance the patient from the medical behavior.

目的:观察胰岛素泵强化治疗对血糖控制的临床效果,探讨护理方法。方法:选择2006年12月～2008年12月我科新入院的1型糖尿病和2型糖尿病患者104例,随机分为两组,对照组52例,采用多次胰岛素皮下注射;观察组52例,采用胰岛素泵持续皮下注射胰岛素。通过测定两组患者治疗前后空腹和三餐后2h血糖值、血糖达标时间,观察两组临床效果。结果:两组均能有效控制空腹和餐后血糖,但观察组更能有效、迅速、平稳地控制血糖,使血糖达标时间缩短。结论:使用胰岛素泵持续皮下注射胰岛素治疗对糖尿病患者的血糖控制临床效果更佳,并能减轻患者痛苦,缩短住院天数。

Objective:To observe the influence of exercise intervention on quality of life of type 2 diabetes mellitus patients.Methods:A total of 196 inpatients with type 2 diabetes mellitus were selected accepted exercise intervention.Patients relied on drug therapy before exercise intervention.Then patients were guided to participate in moderate-intensity aerobic exercise as exercise intervention.Blood glucose of them was regularly monitored.After 2 months of exercise intervention,we observed and compared the intervention effect of them.Results:Biochemical parameters of patients with type 2 diabetes mellitus after intervention were lower than that of before intervention.The total effective of disease control before exercise intervention was 65.31%,and was 92.86% after exercise intervention.Quality of life of patients after intervention was markedly improved.Complications of diabetes mellitus patients after intervention were improved remarkably.Conclusion:Effective exercise intervention is one of the important measures for treatment of type 2 diabetes mellitus patients.

Objective:To study the curative effects and mechanism of Xuebijing injection on the treatment of acute pancreatitis. Methods:76 patifnts were divided into treatment group and control group. Patifnts in control group were treat with routine therapy,while treatment group accepted Xuebijing injection on the basis of control group. Results:The treatment group alleviated sympton rapidly (abdominal pain,pai stool ),and the time of restoring normality of laboratory criteria(amylase, while blood cell)was shorter than the other group.There was significantly difference between two group (P<0.05) .Conclusion:Xuebijing injection has a beneficial effect on the treatment of acute pancreatitis.