目的:观察中西医结合护理方法对全膝关节置换术后患肢疼痛改善以及康复效果的影响.方法:将96例在我科住院的全膝关节置换术后患者随机分为对照组48例以及中西组48例,其中对照组患者给予术后常规护理措施,中西组患者在此基础上给予中西医结合治疗及护理干预,观察并记录两组患者术后第1、7、14天疼痛评分[采用视觉模拟评分法(VAS)],干预后两组患者膝关节HSS评分比较,两组患者术前及术后第1、3、7、14天膝关节ROM比较,以及两组术后6个月并发症发生率比较.结果:两组患者术后第1、7、14天膝部疼痛时VAS比较、干预后两组患者膝关节HSS评分比较、以及两组术前及术后第1、3、7、14天膝关节ROM比较差异均有统计学意义(P＜0.05),中西组优于对照组;两组患者术后6个月并发症发生率中西组并发症发生率明显低于对照组(1.72％,8.62％,P＜0.05).结论:采用中西医结合的方法治疗护理全膝关节置换术后能有效改善患者患肢循环和代谢,能够起到保证手术效果、促进康复、提高患者生活质量的作用,值得临床推广应用.

目的 探讨协同护理对人工全髋关节置换术患者自我护理能力及情绪的影响,为临床建立护理模式及推广应用提供参考依据.方法 选取行人工全髋关节置换术患者84例为研究对象,采用随机数字表法分为护理组与对照组,每组42例.其中对照组予以常规措施干预,护理组在行常规措施的基础上给予患者行协同护理模式进行干预,比较2组患者实施干预前后焦虑情况、抑郁情况,并比较干预后2组自我护理能力及功能恢复情况.结果 干预前2组焦虑评分(SAS)与抑郁评分(SDS)比较差异无统计学意义(P均 >0.05);干预后观察组 SAS、SDS评分改善情况均明显优于对照组(P均 <0.05);干预组患者自我概念、自我护理技术、健康知识、自我护理能力及自我责任得分均高于对照组(P均 <0.05);干预后干预组髋关节功能恢复情况优于对照组(P <0.05).结论协同护理模式能够明显提高患者的自我护理能力,减轻焦虑抑郁负面情绪,促进患者髋关节功能恢复,可推广使用.

Objective To study the influence of insulin pump and subcutaneous injection of Novolin on improving function of pancreaticβcells and impact of response to oxidative stress, and to provide strong theoretical support for clinical treatment of type-2 diabetes. Methods Eighty-two paotients with incipient type-2 diabetes were randomly divided into group A and group B with 41 cases in each group. Patients of group A were treated by intensive treatment of subcutaneous injection. Every day they were given subcutaneous injection at half an hour before breakfast and supper, twice one day. Pa-tients of group B were given Novolin by continuous subcutaneous infusion with insulin pump. There were half basic dose and half high-dose before meal and doses of three meals were assigned evenly. Results Fasting blood glucose and postprandial blood glucose of patients of two groups had significant reduction after treatment. It was lower than group A obviously that dosages of insulin, standard time of blood glucose and times of hypoglycemia of group B after treatment. But there were no obvious differences in fasting blood glucose and postprandial blood glucose between the two groups after treatment. MDA and HOMA-IR of patients of two groups significantly reduced after treatment, while SOD, HOMA-BE signifi-cantly increased. There was no obvious difference between the two groups. Conclusions It can strive the best treat-ment time for patients to use intensive treatment of insulin pump and reduce injury of toxicity of hyperglycemia. It plays a positive role in improving and restoring normal function of pancreatic β cells, helps patients maintain stable blood glucose levels effectively, which is worthy popularizing widely.

Objective To analyze the functional recovery and comparative clinical efficacy between minimally invasive surgery and conventional conservative treatment for ankle degenerative joint ,and to provide refer‐ence for clinical treatment .Methods Two hundred forty patients with ankle degenerative joint in hospital from August 2013 to February 2015 were selected ,the patients were randomly divided into minimally inva‐sive group and control group .The control group of patients was taken trentment of conventional conserva‐tive treatment ,while the minimally invasive group of patients was taken trentment of minimally invasive surgery .Clinical function recovery and efficacy of patients were compared .Results All the patients were successfully followed up ,no infection .The efficacy of the minimally invasive group (85 .8% ) and the con‐trol group (82 .5% ) was quite ,the difference was not statistically significant (P>0 .05) .Before treatment , the MaZur scores and Terner score was no significant difference (P<0 .05) between the two groups ,after treatment ,Mazur score and Tegner scores were significantly improved ,Mazur score of the minimally inva‐sive group (87 .51 ± 6 .84) was significantly higher than the control group (81 .26 ± 6 .39)(P<0 .05) .Be‐fore treatment ,there was no significant difference in pain scores (P<0 .05) between the the two groups , after treatment ,the pain scores were significantly lower in both groups ,it was significantly lower in the minimally invasive group (2 .43 ± 0 .51) than the control group (3 .08 ± 0 .16) (P< 0 .05) .Conclusion Minimally invasive surgery and conventional conservative treatment of ankle degenerative bone joint has a good effect ,minimally invasive surgery can improve the therapeutic effect ,and relieve pain .

目的:观察氨氯地平阿伐他汀钙片应用于高血压合并冠心病治疗中的效果及安全性. 方法:随机抽取2012 年7月~2014年7月在我院进行治疗的80例高血压合并冠心病患者,将其分为治疗组与参照组. 治疗组采用氨氯地平阿托伐汀钙片治疗,参照组采用硝苯地平控释片治疗,比较2组的疗效及不良反应发生率. 结果:治疗组的总体疗效显著优于参照组,2组之间差异明显( P<0.05). 结论:对于高血压合并冠心病患者,采用氨氯地平阿托伐他汀钙片的治疗方案,效果显著,安全性好.

目的：探讨依达拉奉联合吡拉西坦应用于大面积脑梗死治疗中的临床效果。方法随机选取我院收治的74例大面积脑梗死患者并平均分为观察组（37例）和对照组（37例），给予观察组患者依达拉奉联合吡拉西坦治疗，给予对照组患者单纯吡拉西坦治疗，对比2组患者治疗后的总有效率。结果观察组经治疗后总有效率（91.89%），明显优于对照组（70.27%），差异有统计学意义（P<0.05）。结论依达拉奉联合吡拉西坦应用于大面积脑梗死治疗中，能够有效改善患者的临床症状，使患者的生活质量得到提高，具有临床推广价值。

目的：探讨综合护理干预预防初产妇产后出血的效果。方法选取188例自然分娩的产妇分成2组，正常组94例进行常规护理，实验组94例实施综合护理干预措施，比较其产后出血的预防效果。结果实验组对此次护理满意率为95％，远高于正常组的83％；实验组产后失血量、总产程时间以及不良反应发生率等均显著优于正常组（P均＜0．05）。结论综合护理干预对于预防初产妇社产后出血的效果极为理想，能够有效减少产妇产后出血量，从而提高产科疗效，值得临床推广。

骨科患者肢体肿胀较常见，骨折后24～72h疼痛剧烈。如不及时处理，将导致患肢血液循环障碍，影响手术的进行及康复效果。严重的肢体肿胀可致骨筋膜综合征而使肢体发生坏死。临床上常采用生物冰袋进行肢体冷敷，接触面积小，容易从患肢滑落，需多次重新放置，增加护士的工作量，且患肢不能随意活动。我科自2012年3月以来，采用全棉毛巾对急性期肿胀肢体进行冷敷，效果满意。现介绍如下。

带状疱疹是由亲神经的水痘-带状疱疹病毒侵犯脊髓后根感觉神经所致，临床上多见胸、背、腹部皮肤群集小水疱，沿神经走向单侧分布，神经痛为本病的特征［1］。因老年人生理功能衰退，免疫力下降，抵抗力差，所以易患本病。中医学称之为蛇串疮，是由风、火、湿、毒滞留经脉，郁于皮肤，灼伤气血所致［2］。西医主要采用抗病毒、抗感染药物治疗。2008-06-2012-07，我们在常规西医治疗基础上加用中医疗法及综合护理治疗脑血管病并发带状疱疹45例，并与单纯西医常规治疗34例对照观察，结果如下。

目的:探讨中西医结合治疗急性胰腺炎的的疗效及护理体会.方法:将148例急性胰腺炎患者随机分为治疗组与对照组各74例,对照组给予西医方法治疗及护理,治疗组在对照组上予以中西医结合治疗及护理,比较两组之间治疗效果及护理并发症.结果:治疗组患者恢复更快,治疗效果明显优于对照组;其护理并发症明显低于对照组.结论:采用中西医结合的方法治疗护理急性胰腺炎是一种很有效的治疗方法.

目的：探讨2型糖尿病患者全膝关节置换术术后实施护理干预的相关措施。方法：2007年2月至2013年3月期间，我院骨科合并糖尿病患者进行全膝关节置换术的有38例，对其进行有效的术后护理干预，对比干预前后患者疗效。结果：实施干预前VAS评分明显高于实施干预后，且Ly-sholm关节功能评分明显低于实施干预后，同时实施干预前患者的空腹血糖和饭后2h血糖都明显比实施干预后的高，差异有统计学意义（ P＜0．05）。结论：对2型糖尿病患者全膝关节置换术术后实施有效的护理干预，可显著改善患者术后的各项指标，如血糖的控制、疼痛感的减弱、关节功能的增强等，值得临床进一步推广应用。

Objective :To investigate methods of care of patients with fractures of the calcaneus .Methods :A retrospective analysis of 100 cases of calcaneal fracture surgery patient care information ,including preoperative care ,postoperative drainage tube care ,pain care ,diet and the prevention and treatment of complications .Results :100 cases were cured .Maryland foot function score (Maryland Foot Score):excellent (90 ~ 100) 70 feet , good (75~89) 35 feet ,(50~74) 4 feet ,excellent rate of 96 .1% ,with no complications happen .Conclusion:strengthen the calcaneal fracture rehabil-itation patients actively meticulous observation of the disease ,proper rehabilitation exercises guidance ,is conducive to the rehabilitation of patients and reduce complications .

目的：探讨循证护理干预在青壮年断指再植患者中的作用。方法：从我院抽样选取2010年3月至2013年3月医治青壮年断指再植病例42例，且均分成两组，即正常组21例采用常规正常化的护理，而实验组21例则给予循证护理干预，比较两组的疗效状况。结果：实验组21例患者26根再植指数中，血管危象发生率为8％、成活率为96％；相比于正常组的25根再植指数的血管危象率28％、成活率76％；并且实验组21例患者相比于正常组的HAMA评分要明显低得多，差异比较具有统计学意义（ P＜0．05）。结论：循证护理干预对于青壮年断指再植患者的治疗效果是极其优秀的，能够改善患者的消极情绪、减少血管危象的发生率的同时提高断指再植的成活率，从而达到完善理想的辅助治疗效果。

目的：探讨失效模式以及效应分析（ FMEA）在预防膝关节置换术（ TKA）后深静脉血栓（ DVT）时的疗效。方法：以在我院治疗的284例TKA患者作为探究对象，根据治疗期间的不同管理模式随机分为对照组和观察组，分别142例，前者接受常规的治疗与护理，后者在此基础上，采用FMEA 理论对下肢可能产生DVT进行预防。结果：分别在FMEA前后统计患者的RP N分数，结果显示前后的差距较大，四个评价项目在 FMEA 后明显的改善 P＜0．01，差异存在统计学意义；在观察组经过FMEA以后，通过问卷考察发现观察组的142例患者的分数高达（98．4±1．2）分，而对照组是（81．8±1．1）分，t＝121．51，P＜0．01，差距存在统计学意义；同时调查患者在院时对医护工作的看法，满意度结果表明，观察组的满意度高于对照组，前者是90．14％，而后者仅有68．31％，X2＝3．94，，P＜0．01，差异存在统计学意义。结论：应用FMEA理论评估和分析膝关节置换术的患者，能够对术后风险进行及时的防范，同时减少深静脉血栓发生率，提高预后生活品质。

经过伦理价值取舍的临床决策,对于实现医学科学真、善、美的统一、患者利益与医学善行的统一具有重要意义.以医疗实践为载体的临床决策,蕴涵着服务、交际、规则、底线和诚信等伦理问题.强化决策者的伦理价值意识、临床伦理困境分析、患者利益最大化原则和基于不同病患群的决策模式设计是临床伦理决策的基本内容.

>中心供氧和吸引装置是医院抢救治疗的必备设施,而急救设备的完好率、日常保养和维护也是临床护理安全管理工作的重点。以往湖北医药学院附属人民医院骨关节外科采用同等直径的塑料盖直接扣在中心供氧和吸引装置插孔处,在使用过程中经常出现不易取下或丢失的弊端,影响抢救成功率和设备的完好率。针对以上情况,我科自2012年5月

目的观察对老年股骨颈骨折患者实施护理干预的临床效果及对术后排便的影响。方法 78例老年股骨颈骨折患者随机分为观察组与对照组,对照组患者实施常规护理,观察组患者在此基础上实施护理干预,对比观察2组患者的临床效果及术后排便情况。结果观察组与对照组相比较,术后肠鸣音出现时间、肛门排气时间及首次排便时间明显缩短,术后焦虑、抑郁程度及大便通畅度评分明显较低,相关知识掌握度、舒适度及满意度明显提高。结论对老年股骨颈骨折患者实施护理干预,能够有效缓解患者情绪,提高患者舒适度,促进其术后康复,并明显改善术后排便情况,具有临床推广应用的价值。

Objective To investigate the clinical effects of high-flexion prosthesis in total knee replacement.Methods Total 70 knees in 56 patients with knee joint injury were given total knee replacement.The high-flexion prosthesis was replacd through center incision and patellar medial approach.The fixed situation of prosthesis was observed with X-ray,and the scores of knee and knee function were evaluated with KSS scoring system.Results At final follow-up examination,the range of knee motion was improved from(64.71 ± 24.27) ° preoperatively to(126.79 ± 8.60) ° postoperatively.The maximum flexion was(132.07 ± 9.03) °.The average Knee Society knee scores improved from(36.36 ± 10.36) preoperatively to(90.91 ±4.46),and the average Knee Society function scores improved from(32.50 ± 10.14) scores preoperatively to(78.61 ±11.61) scores.The X-ray examination of two of knees in patients with OA and three of knees in patients with RA showed lucencies around the tibial prosthesis,but the radiolucencies were lower than 2 mm and were nonprogressive.Conclusion Total knee replacement with high-flexion prosthesis can provide satisfactory improvement in knee function for patients with knee joint disease.The short-term effect is definite,but the long-term effect needs further studies.

骨盆前环是由双侧耻骨、坐骨支以及耻骨联合连接构成,是骨盆相对脆弱的部分,因此骨盆前环骨折较其他部位常见.对移位的骨盆耻骨支骨折特别是高位耻骨支骨折保守治疗效果欠佳,目前倾向于手术治疗[1-2].手术治疗的目的主要是恢复骨盆环的对称性和稳定性,从而可以让患者开始早期锻炼,以促进周围组织及脏器的功能恢复,并明显减少骨盆骨折的并发症及后遗症.传统的手术入路包括髂腹股沟入路和Pfrannsentiel入路.此两种入路需解剖股血管、股神经及精索或子宫圆韧带等重要结构,手术在多个窗口内操作,操作复杂,手术时间较长.

目的探讨骨科老年患者围术期下肢深静脉血栓并发症形成原因以及对症的护理措施。方法回顾性分析骨科老年患者围术期临床资料,对下肢深静脉血栓形成的原因进行相关因素分析,根据相对应的因素予以有效护理措施进行护理,将干预前的240例患者设为对照组,实施干预措施后随机选择240例患者设为观察组,比较2组患者的临床效果。结果实施干预前240例患者中有10例患者出现深静脉血栓,发生率为4.2%;制动、有多种并发症(≥2种)、全麻、频繁静脉采血、原发性高凝状态、创伤均是深静脉血栓形成的危险因素(P<0.05)。而与年龄、性别、住院时间、侵袭性操作、恶性肿瘤下肢静脉曲张等因素无关(P>0.05);实施干预后,240例患者中有3例患者出现深静脉血栓,发生率为1.25%,实施干预措施前后,患者静脉血栓的发生几率比较有显著性差异(P<0.05)。结论制动、有多种并发症、全麻、频繁静脉采血、原发性高凝状态、创伤是发生骨科老年患者围术期下肢深静脉血栓的重要因素,有效的临床护理可降低并发症的发生率。