目的 探讨蓝莓花色苷对2型糖尿病小鼠糖脂代谢紊乱和肠道菌群的调节作用.方法 选取40只小鼠随机分为对照组、高糖高脂组、高糖高脂+蓝莓花色苷组以及高糖高脂+二甲双胍组,每组各10只.对照组和高糖高脂组小鼠采用生理盐水灌胃,高糖高脂+二甲双胍组采用盐酸二甲双胍0.3 g/kg灌胃,高糖高脂+蓝莓花色苷组采用蓝莓花色苷提取物10 mL·kg-1给予灌胃,8周后检测小鼠空腹血糖(FBG)、血清C肽(C-P)、果糖胺(FMN),甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-c)、高密度脂蛋白胆固醇(HDL-c)、超氧化物歧化酶(SOD)和丙二醛(MDA)水平,并通过16s rD-NA扩增测序方法分析高糖高脂+蓝莓花色苷组和高糖高脂组小鼠肠道菌群的差异.基于Operational Taxonomic Units(OTU)聚类分析结果,进行多种多样性指数分析,主要包括群落丰富度指数(Chao1和Ace)、群落多样性指数(Shannon)和测序深度指数(Observed species);基于分类学信息,在各个分类水平上进行群落结构的统计分析,并对样本之间进行beta多样性分析.结果 高糖高脂+蓝莓花色苷组小鼠实验后空腹血糖(FBG)水平显著下降(P＜0.05).与高糖高脂组相比,高糖高脂+蓝莓花色苷组小鼠FMN、TG和LDL-c水平均显著下降(P＜0.05),SOD水平明显升高(P＜0.05).高糖高脂+蓝莓花色苷组小鼠肠道菌群指数Chao1、Ace、Shannon和Observed species相比高糖高脂组增加,但差异无统计学意义(P＞0.05).肠道菌群构成结合LEfSe分析结果显示,相比高糖高脂组,高糖高脂+蓝莓花色苷组小鼠在拟杆菌属、理研菌科以及罗氏菌属的丰度构成上显著升高,紫单胞菌科丰度下降,差异具有统计学意义(P＜0.05).结论 蓝莓花色苷对糖尿病小鼠的肠道菌群具有调节作用,其可以提高肠道菌群丰度,显著改善小鼠血糖、血脂以及氧化应激水平.

在临床上,使用氧气袋转送患者,当氧气袋内的氧气使用一定量后,压力会逐渐降低,须人为在氧气袋外加压,不能按照患者的病情需要给氧,并不能保障患者用氧浓度安全[1].为此,本研究旨在氧气袋外给氧气袋加压,解决患者运送途中氧气吸入不便的问题,现介绍如下.

经皮肾镜取石术具有创伤小、恢复快等微创手术优势,已成为目前治疗上尿路结石的主要手术方法[1-3], 但作为创伤性手术操作,其不可避免地会发生术后并发症,如处理不当,将会严重影响手术治疗效果,不利于患者术后康复[4].经皮肾镜取石术后疼痛不仅会影响患者睡眠质量,使其出现较为严重的焦虑、抑郁等负面情绪,影响术后功能恢复,还会增加术后并发症的发生,甚至误导医师对于病情的判断[5].本研究在微创经皮肾镜取石术患者围术期实施护理干预,取得了较好的临床效果,现报告如下.

良性前列腺增生症是泌尿外科常见的一种良性疾病,且发病率随年龄增加而增高[1],通过手术切除增生的前列腺组织是治愈前列腺增生的金标准.经尿道前列腺电切术(TURP)因其具有创伤面小、手术时间短、术后恢复快等优点,被称为"外科治疗前列腺增生的突破性技术"[2-3],在临床上被广泛的应用.为了预防术后感染的发生及血凝块的形成堵塞导尿管,需要用密闭式无菌生理盐水进行持续膀胱冲洗,但冲洗液温度不当,反而会增加患者术后膀胱痉挛的次数,术后出血量增多,出血时间延长.因此,应进行综合考虑选择一个适宜的膀胱冲洗液温度,减少患者发生膀胱痉挛和术后出血,从而更好的提高患者舒适度,减少术后并发症,促进患者早日康复[4].

Objective To explore the efficacy of cognitive behavioral intervention in perioperative period of relative renal transplantation donor.Methods From June 2003 to June 2013,90 cases of renal transplantation surgery patients from the Second Mfiliated Hospital of Harbin Medical University were evenly and randomly divided into intervention group and control group (n =45) according to random number table method.Not only given routine care for intervention group,but also separately in the preoperative 24 h,12 h and postoperative 24 h,72 h cognitive behavior intervention for half an hour.Two groups of patients with anxiety,depression,bloodpressure,heart rate and pain score were observed.Results There was no significant difference between the first two groups in the patients with SAS,SDS,VAS,etc.(P ＞ 0.05),two groups of patients after intervention with SAS,SDS,VAS,etc were lower than the control group (P ＜ 0.05).Conclusion Cognitive behavioral intervention can reduce the relatives living donor renal transplantation state of anxiety,depression and pain effectively.It is quite important to ensure the operation smoothly and postoperative rehabilitation.

Objective To explore the effect of motivational interviewing in the early stage rehabilitation of patients with total knee arthroplasty .Methods By convenience sampling ,totally 90 total knee arthroplasty pa-tients were assigned into the control group(45 cases)and the experimental group(45 cases) .The experimental group was applied with motivational interviewing .The rehabilitation compliance and knee joint function assessment score were compared .Results The results showed that the patients’ rehabilitation compliance and knee joint function scores in the experimental group were significantly better than the control group (all P<0.05) .Conclusion The motivational interviewing-based interventions can effectively improve the patients’ rehabilitation compliance and the recovery of joint function ,thus to improve the patient’s quality of life .

目的 了解恶性骨肿瘤患者希望水平、人格特征及生活质量现状,并探讨患者希望水平和人格特征与生活质量的相关性.方法 应用Herth希望量表(Herth hope index,HHI)、艾森克人格问卷简式量表(Eysenck personality questionnaire,EPQ)及生活质量核心问卷(quality of life questionnaire-core 30,QLQ-C30)对160例恶性骨肿瘤患者进行调查.恶性骨肿瘤患者希望水平和人格特征与生活质量的影响采用Pearson相关分析.结果 本组恶性骨肿瘤患者整体生活质量量表得分为(57.05±20.09)分,HHI总分(32.88±4.05)分,EPQ量表中的内外向、神经质、精神病质、掩饰倾向得分分别为(54.05±12.29)分、(50.97±11.07)分、(49.14±20.07)分、(52.75±9.01)分.患者希望水平与生活质量呈正相关(P＜0.05).患者人格的内外向和掩饰倾向与其生活质量均呈正相关;患者人格的神经质和精神病质与其生活质量均呈负相关(P＜0.05).结论 恶性骨肿瘤患者生活质量较差,护士应根据患者的希望水平及人格特征采取针对性干预策略,以提高其生活质量和心身健康状况.

目的 探讨单孔腹腔镜(LESS)在肾上腺肿瘤切除术的优势与可行性.方法 比较25例单孔腹腔镜组与50例传统腹腔镜组在肾上腺肿瘤切除术患者的术后切口长度、皮下气肿的发生率、视觉模拟疼痛评分(VAPS)、手术时间及术中出血量等方面有无差异.结果 所有手术均获成功,在肾上腺肿瘤切除术中,单孔腹腔镜组在术后切口长度、皮下气肿发生率及VAPS等方面与传统腹腔镜组相比有统计学意义(P＜0.05),其他指标差异均无显著性(P＞0.05).结论 LESS在肾上腺肿瘤切除术的临床应用上是可行的,而且其在刀口的美观上、减少术后皮下气肿和缓解疼痛等方面效果明显优越于传统腹腔镜手术.

目的 分析游离腓骨移植修复四肢骨肿瘤瘤段切除后骨缺损患者的围术期护理,探讨综合护理干预在围手术期护理中的价值.方法 2010年12月至2014年6月收治的64例不同类型的骨肿瘤行局部彻底切刮除后所致的骨缺损患者,采用游离腓骨移植治疗,收集所有患者的术前护理和术后护理资料并进行分析.结果 64例患者移植腓骨瓣均成活,与受区对位固定,愈合良好,供区小腿无明显功能障碍.结论 术前及术后对患者进行综合护理干预,能有效预防术后并发症的发生,提高手术的成功率.

Objective To understand the experience of self-perceived burden and the related influencing factors in patients with advanced osteosarcoma .Methods Twelve patients with advanced osteosarcoma received the in-depth interview through the phenomenological methods of qualitative research , and the data were analyzed and the theme was refined by Giorgi .Results The patients with advanced osteosarcoma had the experience of self-perceived burden , and its influencing factors included the prognosis of the disease ,the family income,the needs of nursing , the traditional concept of death and so on .The self-perceived burden had effects on the feelings of self-worth, treatment and prognosis at different degrees .Conclusions The patients with advanced osteosarcoma had pain experience of self-perceived burden due to disease and their family , and the nurses should carry out targeted and personalized health education and psychological nursing according to the different the content and influencing factors of self-perceived burden .

Diabetic nephropathy (DN) is the main microvascular complications of diabetes (DM),and it is also one of the main causes of death in diabetic patients.It is a complex genetic disease caused by genes and environmental factors,in which genetic factors were important risk factors.Previous studies showed that endothelial nitric oxide synthase (eNOS.) gene plays an important role in the pathogenesis of diabetic nephropathy.The polymorphisms of eNOS gene were associated with the development of diabetic nephropathy,but the research findings do not consistently.In this review,we will summary the progress of the association between gene polymorphisms of eNOS and diabetic nephropathy.

Objective To understand the Chinese Hospital ICU patient safety status.Methods Using questionnaires and personal interviews conducted in-depth investigation,and using factor analysis,factor analysis method.Results Two-level target hospitals' mainproblems are:inadequate regulations,lack of equipment configuration,staff training,ineffectiveness,and critical patient identification process needed to be strengthened.The main impact of ICU patient safety factors are:the quality of staffing and personnel,personnel access,the layout process,supervision and management,financial and material resources,rules and regulations,communication and collaboration,and work intensity.Conclusion ICU management should be enhanced because of the weak points of ICU management.

Objective To understand the status of the national hospitals operating room safety management.Methods By using surveys and in-depth interviews,36 representative hospitals are studied and divided by the national economic to 3 levels.Results There are still many problems on the operating room personnel,rules and regulations,operating room layout,device configuration and the operation.Conclusion Rational allocation of the hospital's human resources on the operating room should not only be done,but also the quality of professional nursing be improved;the rules and regulations be established and improved,and the implementation of them be strictly monitored;operating room layout be scientifically improved;the operating room equipment be rationally allocated;the preoperative evaluation and patient identification work be strengthened;and error reporting system be completed,and patient safety be improved.

Objective: Through the status investigation of Ankang Hospital,the Compulsory treatment medical institutions in Heilongjiang Province,the study wants to know the quantity and the quality of human resources in the hospital,to know the status of employee training and stuff mobility and working conditions,to find out the problems exist in the human resources management and propos the improvement strategies.Methods:In this study,literature review was used to know the human resources status in drug addiction treatment center at home and abroad.Questionnaire and in-depth personal interview were used to know the human resources status of the target hospital.Brainstorming was used to propose the improvement strategies.Results: There are 100 employees in target hospital,the ratio of doctor and nurse is 1:0.85,ratio of doctor nurse and bed is 1:0.85:2.78.The stuff access way is Civil Service Examinations.In the past five years,the doctors have been transferred in the hospital for about 2.4 in average,and the nurses are 1.4 in average.43.3 % nurses work over 15 hours per day,and over 22 days per month.The workers are dissatisfied with the employee training.The most needed training for the employees include: medication knowledge,psychotherapy,psychiatric knowledge,the latest nursing techniques and information,psychological care,equipment operation and simple troubleshooting.The employees are under pressure and the sources include working environment,busy work,the patient,interpersonal relationships and career development,the lack of occupational protection.80 % doctors and 93.3 % nurses are generally satisfied with their work,but only 50 % doctors and 44 % nurses are satisfied with their own salary.Conclusions: The stuff of target hospital is stable.The number of doctor basically meets the needs of work,but the hospital needs more nurse,for the nurse is under great workload and pressure.The employee training does not fit for the actual work.With less occupational protection,the work satisfaction is quite low.

<正>疼痛作为一种常见的临床症状,是患者就医最常见的原因;但不充分的疼痛治疗仍然普遍存在。近年来,国内也开始越来越多的关注疼痛教育,研究表明,有效疼痛管理的主要障碍是护理人员及患者对于疼痛相关知识的缺乏。对护士开展疼痛继续教育培训可显著提高护士的疼痛知识水平,改善护士的疼痛管理行为。故对相关人员实施疼痛教育不仅是迫在眉

Objective To explore the needs of the flexible management for clinical practicing nurses so as to provide basis for improving the clinical teaching mode.Methods From June 2008 to March 2010,122 practicing nurses were investigated with the self-designed questionnaires.Results The student nurses' needs of the flexible management were varied,mainly in the emotional,psychological and incentives forms.The leading five needs were psychological communication and strengthened emotional support(91.8%),explanation of special knowledge and technical abilities(77.87%),respect and affection of the student nurses(71.31%),flexible arrangement for the student nurse(69.67%) and soliciting opinions and mutual appraisal between the teachers and the student nurses(67.21%).Conclusion The management of clinical teaching for the student nurses reflects five areas of the flexible management,including emotional management,democratic management,incentive management,human resources management and organizational behavior management.Implementation of the people-oriented flexible management can give full play to the enthusiasm and creativity of student nurses,which is necessary to improve the quality of clinical teaching.

在明确医院绩效管理价值的基础上,对医院绩效管理诊断的内容从医院绩效管理基础工作完善度诊断、绩效管理制度诊断、绩效管理系统结构诊断、绩效考评指标体系诊断、绩效考评运作体系诊断、绩效管理结果应用体系诊断等6个方面进行了全面系统的阐释,并提供了各部分诊断可采用的技术与方法,论文所提供绩效管理诊断的具体实施内容与技术可对各级医院进行绩效管理诊断提供科学的指导。

报告42例骶骨肿瘤病人术后常见并发症的预防与护理经验.术前充分的肠道准备及括约肌收缩功能训练;对术后可能出现的并发症进行严密的观察,采取相应的预防和护理措施,以减轻病人痛苦,提高手术成功率及生存质量.

Objective To explore the correlation between self-management condition and quality of life (QL) of the patients with total cystectomy and urinary diversion.Methods Ninety-two patients with total cystectomy and urinary diversion were studied with a descriptive correlational design and surveyed with a self-designed questionnaire of scales for self-management and QL.Results The levels of self-management condition and quality of life in most patients were at middle level.Self-management condition and quality of life were positively correlative(P0.01).Conclusion Medical care personnel should strength the health-education and raise the level of self-management for the patients with total cystectomy and urinary diversion and their families to improve the QL.

Objective To investigate the psychological demands of living relatives donors in renal transplantation in order to provide reference for medical staff to relieve the donors' psychological problems and promote the recovery of mental and physical health.Method Fifty living relatives donors were recruited by convenience sampling method in the study and were investigated with a self-designed questionnaire.Results Among the donors,64.00%and 52.00%required cordial service attitude of medical staff and comfortable environment,respectively.Most of them required the information about the influence of health to donors (96.00%),clinical outcomes of recipient(92.00%),health care of the remained kidney(90.00%),and labor capacity after kidney donation(96.00%). Moreover,94.00%of them hoped to get the support and understanding of relatives;66.00%reported demands on the rational medical charge.Conclusion The living relatives donors of renal transplantation have a strong psychological demands especially in the information of their own health conditions and labor capacity after kidney donation.The medical staff should take measures to meet their psychological needs and promote the recovery of mental and physical health of living donors.