目的:观察通督调神针法联合康复训练治疗缺血性脑卒中患者吞咽障碍的临床疗效.方法:选择2017年8月至2019年8月我院收治的缺血性脑卒中患者80例,根据治疗方式不同分为对照组(40例)和观察组(40例),对照组给予常规康复训练,观察组采用通督调神针法联合康复训练,连续治疗4周.比较两组患者治疗后的临床疗效及治疗前后洼田饮水试验评分、标准吞咽功能评价量表(SSA)评分、电视透视吞咽功能检查(VFSS)评分和血清脑源性神经营养因子(BDNF)水平变化情况.结果:两组患者治疗后,洼田饮水试验评分、SSA评分均较治疗前有明显下降,且观察组的洼田饮水试验评分、SSA评分比对照组更低,差异有统计学意义(P＜0.05);两组VFSS评分及血清BDNF水平较治疗前升高,且观察组升高趋势更显著,差异有统计学意义(P＜0.05);治疗后与对照组比较,观察组治疗有效率(92.50％)高于对照组(72.50％),差异有统计学意义(P＜0.05).结论:通督调神针法联合康复训练治疗缺血性脑卒中患者吞咽障碍临床效果显著,有效改善症状,提高吞咽功能,临床应用价值显著.

目的 探讨多学科宣教在早产儿视网膜病变(ROP)筛查中的效果.方法 选择本院行ROP筛查的150例早产儿作为研究对象,随机分为观察组与对照组,每组75例.对照组予以常规健康教育,观察组予以多学科宣教,比较2组的干预效果.结果 观察组干预后家属视网膜病变认知度评分、观察视力发展评分、预防眼部感染评分、定期检查评分显著高于对照组(P＜0.05).观察组早产儿复诊率、重症率、致盲率显著低于对照组(P＜0.05).治疗前,2组临床活动度评分(CAS)比较,差异无统计学意义(P＞0.05).治疗后,观察组CAS评分为(5.43±2.11)分,显著低于对照组的(7.43±2.21)分(P＜0.05).结论 多学科健康宣教可有效提高早产儿家属的疾病认知度及遵医行为评分,有效提高早产儿的复诊率,有利于早产儿及时接受治疗,减少重症率及致盲率,因此干预效果较好.

目的 探究不同口腔护理方案对ICU经口气管插管机械通气患者预后的影响.方法 选取ICU经口气管插管机械通气患者96例,随机分为观察组和对照组,分别接受个性化口腔护理和传统口腔护理.比较两组患者ICU住院天数和气管插管天数、护理前后口腔观察指标、口腔护理效果及呼吸机相关性肺炎(VAP)发生率.结果 观察组患者护理后ICU住院天数和气管插管天数均明显低于对照组(P＜0.05).两组患者护理后口腔情况较护理前显著改善(P＜0.05),且观察组改善情况明显优于对照组(P＜0.05).观察组患者护理后口腔异味、口腔炎症发生率均低于对照组,仅口腔异味和霉菌感染所致炎症发生率比较差异显著(P＜0.05).观察组患者气囊上滞留物量显著低于对照组(P＜0.05),观察组VAP发生率低于对照组(P＜0.05).结论 个性化口腔护理可以显著改善口腔问题,减少呼吸机相关性肺炎发生,有利于患者预后.

[Objective]To evaluate the effect of nurse-led telephone follow-up on self-management and quality of life in cirrhotic patients with esophagogastric variceal hemorrhage.[Methods]A total of cirrhotic patients with esophagogastric variceal hemorrhage from Jan 2016 to Oct 2017 were divided into control group (n=53) and observation group (n=53) randomly according to single or double numbers. All patients were given routine care and Health Guidance Manual and Cirrhosis Self-Management Handbook. Learn diseaserelated knowledge in lecture monthly was provided by our department or WeChat platform. Meanwhile, patients in observation group were given phone-call follow-up by nurse. The self-management ability and quality of life were recorded in both groups at discharge and the end of 6 months after discharged. [Results]At discharge, there were no remarkable differences in the scores of selfmanagement ability and quality of life between the two groups (P＞0.05). However, there were significant differences in the scores of selfmanagement ability and quality of life between the two groups at the end of 6 months after discharge. In the observation group, the subgroup scores of self-management ability were (23.68 ± 3.22) in daily life management, (23.96 ± 1.93) in dietary management, (16.31±1.68) in disease monitoring and (17.45±1.63) in medicine management, which were higher than those in the control group as follows (16.52 ± 3.71), (21.84 ± 2.11), (11.38 ± 1.92) and (11.95 ± 1.81) (P＜0.05). The scores of quality of life were (73.5±11.4) in PF, (67.5±8.6) in RP, (47.3±10.2) in BP, (63.8±9.8) in GH, (64.2±17.2) in VT, (66.3±11.5) in SF, (58.6±8.4) in RE and (64.9±14.5) in MH, which were also higher than those in the control group as follows (63.3±11.1), (60.3±10.2), (40.5±9.8), (56.2±14.6), (53.4±13.4), (59.3±10.), (44.9±10.2) and (56.2±17.7) (P＜0.05). [Conclusion]Nurse-led telephone follow-up can improve short-term self-management ability and quality of life in cirrhotic patients with esophagogastric variceal hemorrhage.

目的 探讨老年颅脑损伤患者执行功能障碍的状况.方法 选取2016年该院收治的老年颅脑损伤患者90例为研究组,选取同期健康体检者90例为对照组,应用行为学评价测验(BADS)筛选执行功能缺陷,对比两组研究对象的执行功能状况.结果 两组研究对象BADS评分方面,研究组患者的BADS单项标准分以及总标准分均明显优于对照组(P<0.05);额叶损伤以及非额叶损伤患者BADS评分对比,单项标准分以及总标准分差异均无统计学意义(P>0.05).结论 颅脑损伤患者普遍存在执行功能障碍,不存在额叶损伤特异性.

[Objective] To investigate the effect of extended nursing service in patients with malignant disease who underwent percutaneous transhepatic cholangial drainage (PTCD) treatment to relieve obstructive jaundice.[Methods] Fifty discharged patients with PTCD from Jan,2015 to Dec 2016 in Shaanxi Provincial People's Hospital were divided into two groups randomly.The Observation group (n=25) was given extended nursing guidance and service (including telephone follow-up and home visit),but the Control group (n=25) received routine discharge guidance only (telephone follow-up).Self-care ability score and satisfaction were compared between two groups.[Results] The total score of self-care ability in Observation group were (119.75 ± 6.62),which was higher than that in Control group with and (74.10 ± 5.40)(P＜0.05).The satisfaction score in Observation group was (95.88 ± 5.94),which was higher than that in Control group with (94.12-± 5.85)(P＜0.05).[Conclusion] The extended care service improves the self-care ability for patients with PTCD treatment,and increases the satisfaction to nursing work.

新生儿没有对疼痛的描述能力 ,而且神经系统的发育不够完善 ,疼痛的敏感性较差 ,由疼痛刺激产生的应激反应不太显著 ,因此新生儿的疼痛没有引起人们的关注.但疼痛会致使新生儿发生一些行为反应和生理反应 ,这些反应可能会对其产生近期和远期的不良影响[1 ] .

Objective To explore the effect of non nutrition sucking and massage on gastrointestinal function in very low birth weight infants in NICU.Methods A total of 62 very low birth weight infants in NICU of our hospital were selected as study subjects.According to the order of entering NICU time,they were divided into observation group (33 cases) and control group (29 cases).The control group only treated with gastric tube feeding and the observation group was treated with non nutrition sucking and massage on the basis of the control group.The changes of body weight and gastrointestinal function in two groups were analyzed and compared.Results There was no significant difference in birth weight of the neonates in two groups at birth (P ＜0.05).At 7th,14th and 28th day after birth,the body mass of the observation group were significantly higher than those of the control group (P ＜ 0.05).The indicators of defecation and feeding in the observation group were better than that of the control group (P ＜ 0.05).In addition,the incidence rates of vomiting,abdominal distention,gastric retention and pathoglycemia of the observation group during feeding period were significantly lower,and the symptoms improved times were significantly lower than that in the control group (P ＜ 0.05).Conclusion Non nutrition sucking and massage can promote maturation of gastrointestinal function,reduce the occurrence of feeding intolerance,accelerate the early growth and development of very low birth weight infants.

Objective To analyze the reasons of high lateral episiotomy rate of primiparae with full term infant and without pregnancy complications and to explore the strategies to reduce the lateral episiotomy rate and improve quality of midwifery by application of Pareto Principle.Methods A total of 365 primiparae with full term infant but without pregnancy complications gave birth in Shaanxi Provincial People’s Hospital from April to August in 2014, and they were selected as control group.The RCA method was applied to do the regression analysis of the reason of lateral episiotomy and draw Pareto chart in the control group to look for major problems.Meanwhile, another 346 primiparae with full term infant but without pregnancy complications were selected as experimental group.Under the guidance of the Department of Nursing, Science and Technology Commission, the Pareto Principle was applied to select obstetricians and midwives. The selected staff applied brainstorms to consult medical experts, read relevant references, and analyzed Pareto chart to investigate the measures of reducing lateral episiotomy rate.Results The reasons of lateral episiotomy between two groups were significantly different (χ2 =53.34,P<0.001).Among the reasons, the fetal and technical factors had higher proportion in the experimental group while the factors of traditional values, maternal and technical factors had higher proportion in the control group.There were significant differences in episiotomy rate and perineum situations between two groups (χ2 value was 120.25 and 8.66, respectively, both P<0.05).The postpartum blood loss of the experimental group was significantly lower than the control group (t=5.75,P<0.001), but there was no obvious difference in birth asphyxia between two groups (χ2 =0.01,P>0.05).Conclusion Pareto Principle for delivery room management can improve midwife’s active management consciousness on perinatal period.Through effective assessment and nursing care of targeted intervention measures, the lateral episiotomy rate can be greatly reduced and the quality of obstetrics can be improved.

Objective To assess the efficacy of timolol,brinzolamide and travoprost on primary open-angle glaucoma(POAG) and ocular hypertension(OHT).Methods Patients with intraocular pressure(IOP)>18 mmHg(1 kPa=7.5 mmHg) after single treatment with travoprost for 6 weeks were randomly divided into treatment group and control group.The treatment group(40 cases,40 eyes) added with 10 gL-1 brinzolamide(2 times per day),the control group(40 cases,40 eyes) with timolol(2 times per day).IOP,blood pressure and heart rate were followed up at 2 weeks,8 weeks,14 weeks,20 weeks and 26 weeks,the ocular symptom and physical sign were observed,the parameters related with baseline,such as visual field,visual electrophysiology,retinal nerve fiber layer thickness,neurovetinal rim area and tear function,were measured at 26 weeks.The percentage of patients with IOP≤18 mmHg was also calculated at 26 weeks.Results Compared with baseline,IOP in two groups all decreased,there were significant differences(both P<0.01).IOP in treatment group sustained and stabled,but the rising trend appeared after 20 weeks in control group."IOP in 24 hours" showed the treatment group reduced IOP stably at night and day,but in control group,IOP reduced poor.There were no influence on blood pressure in two groups,no effect on the heart rat in treatment group,but heart rate suppression appeared at 20 weeks in control group.In control group,the sensitivity of vision decreased,and the tear film stability declined,there was no influence in treatment group.The common adverse reactions in treatment group were ocular stimulate symptoms,abnormal taste and dry mouth,that in control group were foreign body sensation and dry eye.Conclusion When single-agent therapy with travoprost is insufficient,adding timolol and brinzolamide can further reduce IOP.The long-term and short-term fluctuation of IOP with brinzolamide is smaller than that with timolol,and the local and system adverse reactions are also smaller.

我科自1999年10月至2002年12月共行翼状胬肉切除联合羊膜移植术39例,效果满意.现将护理体会介绍如下.

青光眼小梁切除术后,最常见的并发症是术后浅前房或前房延缓形成.如不及时得到适当的处理,将可能发生一系列严重的并发症.现将我们收治的126例(148眼)浅前房的处理体会报告如下.

· AIM: To explore the therapeutic effect of combined triple surgery of small incision extracapsular cataract extraction (ECCE), intraocular lens (IOL) implantation and trabeculectomy.· METHODS: Glaucoma trabeculectomy combined with ECCE and IOL implantation was performed through small scleral tunnel incision on 46 eyes of 42 patients with cataract and glaucoma.· RESULTS: At 1wk after the operation, the corrected visual acuity was ≥0.5 in 39 eyes (85%); at 1mo the corrected visual acuity was ≥0.5 in 40 eyes (80%).At1wk after the operation the mean intraocular pressure was (2.24±0.35)kPa, and3.12kPa lower than the preoperative pressure. The proportion of functional blebswas 89%. The average postoperative astigmatism was 1.69±1.05D at 1wk and decreased to 0.65±0.77D at 1mo.· CONCLUSION: Through combined triple surgery intraocular pressure can be controlled well,and cornea astigmatism can be decreased significantly. The patients can quickly obtain good vision with fewer complications, thus it is worth of being spread.·

目的:总结80岁以上高危高龄前列腺增生患者行经尿道前列腺电切气化治疗的安全性和经验.方法:对80岁以上,合并两个以上重要器官病变的前列腺患者85例实施经尿道前列腺电切气化治疗,并对治疗效果进行分析.结果:85例患者全部临床治愈.按国际前列腺症状评分(I-PSS)由术前平均32.6分减至8.6分(P＜0.01),生活质量评分(QOL)由术前平均5.4分下降至2.1分(P＜0.05),残余尿量从术前70～520ml,减少至术后15～50ml,23例患者最大尿流率(Qmax)从术前5～10ml/s增加至术后12～18ml/s.结论:经尿道前列腺电切气化治疗80岁以上高危高龄患者前列腺增生安全,简便,疗效可靠.

1 一般资料 本组青光眼患者75例,其中男33例,女42例,最大年龄85岁,最小年龄24岁,闭角型青光眼60例,开角型青光眼15例.