劳力性热射病（EHS）是重症中暑的一种，指高温、高湿环境下高强度运动造成的一种重症疾病。进入夏季，军校学员往往面临着野外驻训、毕业体能考核、综合演练等多项大型任务的挑战。紧张的训练节奏、高涨的训练热情和不断攀升的气温，使大家成为EHS 的潜在易感人群；另一方面，EHS 的初发症状同轻症中暑类似，容易引起参训人员（甚至包括患者本人）的忽视。而 EHS 发生后若得不到及时妥善的救治，死亡率高达10％～50％［1］，会严重损害官兵士气和战斗力发挥。因此，做好军校劳力性热射病防治，对于提高官兵健康水平、促进教学训练意义重大。

目的：了解高校新生结核病预防服药总体情况和未按全程服药原因。方法通过结核菌素试验(PPD)筛检和X线透视检查，确定结核病预防服药人员，按预防服药方案严格规范化管理，将预防服药人员登记情况予以统计学处理及分析。结果2013~2015年新生PPD强阳性率、预防服药率年度间差异有统计学意义(<0.05)，未按全程预防服药率年度间差异无统计学意义(>0.05)；连续3年未按全程预防服药主要原因是拟预防服药人员主观上不接受，年度间比较差异无统计学意义(>0.05)，且结核病新发病例均来自未按全程服药人员。结论对PPD强阳性新生有必要进行结核病预防服药治疗，预防服药应规范化管理，同时加强结核病健康宣教，提高服药依从性。

Objective To observe the post-treatment lung function changes of bronchial asthma acute attack in patients with application of salmeterol xinafoate and fluticasone propionate(50μg/250μg)inhalation,to discuss the clinical value of lung function detection.Methods To retrospectivly analyze the clinical data of 106 cases about bronchial asthma acute attack treated in respiratory department of General Hospital of Beijing Military Region from 2009 March to 2010 March.All patients adopted the treatment of salmeterol xinafoate and fluticasone propionate inhalation,12 h/time,2 times /d.To observe the lung function changes after treatment,and use asthma control test(ACT)to evaluate asthma control.Results The lung function had significant improvement after treatment,forced expiratory volume in one second,forced expiratory volume in one second/forced vital capacity,peak expiratory flow which reflect pulmonary function indices before and after treatment had a significant difference(P<0.05).Asthma control before and after treatment had a significant difference(P<0.05).There had no obvious adverse reaction.Conclusion The salmeterol inhalation can improve the pulmonary function in patients with bronchial asthma acute attack.Determination of lung function could be used to evaluate the control degree of asthma as one important basis,had some clinical value.

当前,随着社会的快速发展,人际关系与沟通对任何人来讲都成为其工作和生活的重要内容.对于医院的医务人员(包括医、药、护、技人员)来讲更是如此.

目的探讨进食训练对吞咽障碍所致吸入性肺炎患者的康复效果.方法将186例吸入性肺炎患者按住院时间段分为两组,对照组90例(1990年12月至2000年12月)行常规护理,观察组96例(2001年1月至2004年12月)在此基础上进行进食训练.结果进食训练14 d后,进食有效率、体重增加率观察组显著优于对照组(均P＜0.01);观察组治愈率、病死率及住院天数与对照组比较,差异有显著性意义(均P＜0.01).结论进食训练对吞咽障碍致吸入肺炎患者的治疗与转归及功能康复效果显著.

我们于2003年5月3日～6月18日对解放军小汤山医院13例严重急性呼吸道综合征(SARS)康复期患者进行了肺功能检测,现分析报告如下.

吸入性肺炎在临床上常见,尤其在老年人当中发病率更高.有研究表明,包括隐性误吸在内,正常人在睡眠中可能有45%发生误吸,有意识障碍的病人则高达70%.在社会逐渐老龄化的今天,吸入性肺炎越来越引起临床医护人员的重视[1～3].本文就老年人吸入性肺炎的易患因素及护理干预予以概述。

Objective:To investigate the potential impact of SARS virus on immunological function in medical personnel who had close contact with SARS patients and further to provide theoretical basis for prevention and treatment of the disease.Methods:Colloidal gold assay (CGA) and ELISA were adopted to detect antibody IgG against SARS virus in SARS patients and the medical personnel who had kept close contact with these patients at a SARS special hospital as well as a non-special SARS hospital.Moreover,Special Protein Analyzer was used to measure levels of C-reactive protein (CRP),complement component 3 and 4 (C3,C4) and circulating immune complex (CIC) in the SARS patients and the medical personnel.Thirteen normal subjects were selected as controls to undergo the same tests.Results:In controls,no specific IgG antibody against SARS virus was detected;in the medical personnel from the non-special hospital,specific antibody against SARS virus was found in one person by CGA and one by ELISA with a positivity of 1.14%.The 11 patients with SARS were all positive for specific antibodies against SARS virus and the positivity was 100%.The CRP level in the SARS patients was as much as 3.1 times,3.5 times and 2.84 time higher than in controls,medical personnel from the non-special hospital and from the the special SARS hospital (Xiaotangshan Hospital) with a significant difference (P0.01).Compared with the controls,the concentrations of C3 and C4 in medical personnel from the non-special hospital were decreased by 25.2% and 27.59%,respectively,while C3 dropped by 13.39% in the personnel from Xiaotangshan Hospital (P0.05).When compared with those in the personnel from Xiaotangshan,C3 and C4 were reduced by 13.64% and 22.22% respectively;there was a significant difference between the two groups of medical personnel;CIC concentration was increased by 20.02% (P0.05).Conclusions:Silent SARS virus infection might be present.CRP was related with the clinical symptoms of the infection and it might serve as a indicator for monitoring the SARS patient's condition.The results of immunological function in the medical personnel shown that immunoreaction in those from Xiaotangshan Hospital was slighter than from the general hospital,indicating that Xiaotangshan Hospital was very well equipped with a isolation and protective system.

体位是病人休息和适应医疗需要所采取的一种姿势.适当的体位对治疗疾病、减轻症状、进行各种检查、预防吸入性肺炎、减少疲劳均有良好的作用.但是,病人或家属通常不能或不知道如何选择正确的体位,这就要求护士在家庭护理中根据病人的个体差异(年龄、性别、身体状况等)及病情需要,选择适合于个体的体位护理.

在英国拥有处方权的护士数量在逐渐增加,但是护士同时也处在一个极为难的位置.她们在尊重与保护病人和保护自我问题上,潜在的与法律之间的牵连却不为人所知.

老年人的健康教育是一种有计划、有组织、有评价的教育活动,其教育的核心是通过卫生知识的传播和行为干预,改变人们的不健康行为.满足老年人的健康需要,并提供优质的护理,提高老年人的生活质量,已成为护理学科的重要课题之一.现就老年人健康教育的现状与成人教育理论的进展加以介绍.

随着我国人口老龄化,吸入性肺炎在老年人中的发病率增多,文献报道[1],其死亡率高达40%～60%.但是,老年吸入性肺炎的特点又与成年人吸入性肺炎不同,老年人吸入性肺炎的临床症状不典型,多因进食水呛咳误吸入引起的吸入性肺炎.由于老年人体弱,各脏器处于衰竭状态,免疫力下降,并伴有多种基础病,因而使老年吸入性肺炎治愈率低,死亡率高.本文回顾了我院1990年12月～2000年12月住院病人中吸入性肺炎30例,对其临床资料、护理分析讨论如下.

老年吸入性肺炎是常见病,多发病.最初常常因误吸引起肺部感染,继而引起病人的全身症状.病人可出现烦躁、失眠,甚至精神错乱.随着现代科学技术的不断发展,对误吸引起的研究逐渐深入.目前,以各种中毒、手术后并发吸入性肺炎或脑梗塞后引起的吸入性肺炎报道较多,人们已经认识到因误吸而引起的肺炎占整个肺炎病死率的1/3,病人病情危重,病死率较高.[1]因此,近年来人们对吸入性肺炎的治疗、护理日益重视起来.

睡眠障碍的发病率非常高,睡眠的缺乏很可能会导致意想不到的事故发生.作者简述了睡眠障碍的分类和原因,重点介绍了睡眠障碍的护理措施.

目的:为适应形势的需要,进一步抓好在职学习,提高科室护理人员的公共卫生理论、基本技能、专科护理理论、抢救技能.方法:采取以问题为基础的在职学习(ProblemBasedLearning简称PBL),护士、护师、主管护师,分别采用的以问题为基础进行个人理论学习和小组讨论的方法.利用晨间交班后全体护士学习讨论相关的理论知识,小教员指导操作训练,并进行现场考核.结果:参加训练的护士均反映以问题为基础的学习训练灵活新颖、印象深刻,加强了理论与实践的结合,提高了解决临床护理问题的能力.结论:激发了护士的学习兴趣和欲望,改变了传统课堂讲授方式,使讲解、讨论与实践紧密结合起来.对有一定临床经验的护士运用PBL模式学习与训练是非常合适的.

目的:为了满足病人的需求,提高护士静脉穿刺能力.方法:护理部拟订学习、训练计划,统一规范操作程序.以各护理单元为小组进行学习训练,训练前后分别进行理论知识及操作的考核,并记录百针穿刺的训练结果.结果:214名参加静脉输液训练的护士,90%以上认为目标化教学训练方法灵活新颖、印象深刻,提高了静脉输液穿刺的能力.理论与操作考核成绩有了比较大的提高.训练前后理论知识考核比较,并对考核结果进行χ2分析统计显示:训练后成绩明显高于训练前,两组对比(P<0.01),差异有统计学意义;训练前后静脉输液考核比较结果进行χ2统计,两组比较(P<0.01),差异有统计学意义.尤其训练后成绩100分者达到22名(10.3%),90分以上者达到172名(80.4%);训练前后静脉输液考核标准扣分分布情况比较,训练前被扣分的人数为140名,占参加训练总人数的2/3,而训练后被扣分人数仅为74名.两组对比,差异有统计学意义(U=6.525,P<0.001);"静脉穿刺"成功率记录结果显示出穿刺技术是薄弱环节,提示护理人员应加强对病情危重、一级护理病人的穿刺技术.结论:在年轻护士中运用目标化教学与多种多样管理形式是必不可少的,本研究结果充分证明应用目标化教学在"静脉穿刺"量化管理中的有效性.