Objective To investigate the therapeutic effect of liraglutide on acute cerebral infarction(ACI)in patients with type 2 diabetes mellitus(T2DM),and its effect on neurological function and serum vascular endothelial growth factor(VEGF)and basic fibroblast growth factor(bFGF).Methods A total of 160 patients with ACI accompanied by T2DM admitted to Haikou People's Hospital from March 2020 to March 2022 were randomly divided into observation group and control group(n=80,each).Both groups of patients were given routine treatment for ACI.On this basis,the control group was treated with insulin aspart and insulin glargine,while the observation group was treated with liraglutide and insulin glargine.Both groups received continuous treatment for 3 months.In addition to clinical efficacy,fasting blood glucose(FBG)before and after treatment,2-hour postprandial blood glucose(2hPG),hemoglobin A1e(HbA1c),insulin resistance index(HOMA-IR),National Institutes of Health Stroke Scale(NIHSS),and modified Rankin Scale(mRS)scores of two groups of patients was compared.Enzyme linked immunosorbent assay was used to detect the levels of serum VEGF and bFGF before treatment and after 1 and 3 months of treatment in both groups.Results After treatment,the levels of FBG,bFGF,HbA1c,HOMA-IR,and the scores of NIHSS and mRS in the observation group decreased compared to those before treatment,and the above indicators levels in the observation group were significantly lower than those in the control group(P＜0.05).The total clinical effective rate of the observation group was significantly higher than that of the control group[95.00％(76/80)vs 83.75％(67/80),x2=5.331,P=0.021].After treatment,the levels of serum VEGF and bFGF showed a gradual downward trend in both groups(P＜0.05).After 1 month and 3 months of treatment,the serum VEGF and bFGF levels in the observation group were significantly higher than those in the control group(P＜0.05).Conclusion Liraglutide combined with insulin glargine can effectively control blood sugar,reduce insulin resistance,alleviate neurological damage,upregulate serum VEGF and bFGF levels,and improve clinical efficacy in T2DM patients with ACI.

目的 探究人巨细胞病毒(HCMV)感染对老年帕金森病(PD)合并糖尿病视网膜病变(DR)患者视网膜功能、运动症状的影响.方法 选取2018年3月-2021年3月海口市人民医院收治的老年PD合并DR患者87例为研究对象,根据HCMV感染情况,将患者分为感染组(n=38)和未感染组(n=49),比较两组患者的视网膜功能和运动症状,蛋白免疫印迹法检测单个核细胞磷脂酰肌醇-3-激酶(PI3K)、蛋白激酶B(AKT)、雷帕霉素靶体蛋白(mTOR)的表达水平,多因素Logistic回归分析法分析HCMV感染的危险因素.结果 感染组患者的黄斑厚度、视野平均缺损值(MD)和视网膜神经纤维层厚度(RNFL)均小于未感染组,日常生活活动和运动能力评分均高于未感染组(P＜0.05);感染组患者单个核细胞PI3K、AKT和mTOR蛋白表达水平均高于未感染组(P＜0.05);Logistic回归分析结果显示,空腹血糖(FPG)、胰岛素敏感指数(ISI)和CD4+/CD8+是PD合并糖尿病DR患者HCMV感染的危险因素,空腹胰岛素(FINS)是HCMV感染的保护因素(P＜0.05).结论 糖代谢、胰岛素功能及免疫功能与HCMV感染的病理过程密切相关,而HCMV感染会加重老年PD合并DR患者视网膜病变与运动症状,其机制可能与HCMV感染激活PI3K/AKT/mTOR信号通路有关.

目的:探究斯金纳理论下的健康教育配合家属参与式心理干预对脑中风偏瘫患者希望水平、心理弹性、应对方式的影响.方法:选取86例脑中风偏瘫患者,按照随机数字表法分为对照组(n=43)和观察组(n=43),对照组患者给予常规干预,观察组在常规干预基础上给予"斯金纳"理论下的健康教育配合家属参与式心理干预.对比两组患者干预前后的希望水平[Herth希望量表(HHI)]、心理弹性[心理韧性评定量表(CD-RISC)]、应对方式[医学应对方式问卷(MCMQ)]及康复锻炼依从性(脑卒中患者功能锻炼依从性量表)结果差异.结果:干预后,观察组HHI量表对现实和未来的积极态度、采取的积极行动、与他人保持亲密关系及总分显著高于对照组(t=-4.158,3.161,2.234,5.139;P＜0.05);干预后,观察组CD-RISC量表坚韧、自强、乐观评分及总分显著高于对照组(t=5.431,4.598,5.233,8.064;P＜0.05);观察组MCMQ面对评分显著高于对照组干预前(t=4.269,P＜0.05),回避、屈服评分显著低于对照组干预前(t=-4.065,-3.018;P＜0.05);干预后,观察组患者坚持参与锻炼、锻炼效果监督、锻炼时主动学习依从性以及总体依从性均显著高于对照组(x2=5.460,4.914,4.440,3.957;P＜0.05).结论:针对脑中风偏瘫患者采取"斯金纳"理论下的健康教育配合家属参与式心理干预,有助于提高患者希望水平、增强患者心理弹性、转变患者不良应对方式,还可提升患者康复锻炼依从性.

Objective To explore the effect of goal attainment theory combined with "317 nursing" health education on discharge readiness of patients with first ischemic stroke. Methods A total of 86 patients with first ischemic stroke hospitalized in the neurology department of a tertiary hospital in Haikou from February to May 2021 were selected as the study objects by convenience sampling method. The patients were divided into control group（43 cases, from February to March 2021） and observation group（43 cases, from April to May 2021） according to the admission time. In the observation group, one patient was transferred to the intensive care unit of neurology department due to the deterioration of the disease,and 42 patients were finally included. The control group was given routine health education, and the observation group was given goal attainment theory combined with "317 nursing" health education. The scores of discharge readiness, disease uncertainty and self-care ability were compared between the two groups. Results The scores of each dimension of discharge readiness and total score in the observation group were higher than those in the control group（P＜0.05）. At discharge and 1and 3 months after discharge, the disease uncertainty score in the observation group was lower than that in the control group, and the self-care ability score was higher than that in the control group（P ＜0.05）. Conclusion Goal attainment theory combined with "317 nursing" health education can effectively improve the discharge readiness and self-care ability of patients with first ischemic stroke, and reduce the disease uncertainty of patients.

Objective:To explore the effect of situational simulation training combined with Miller pyramid teaching on emergency response ability and nursing skills of specialized nurses in operating room.Methods:A total of 56 disaster nursing trainees who received specialized nurse training in the operating room of Mianyang Central Hospital from June 2019 to June 2020 were selected in the study, and they were divided into control group and research group in average according to the order of training time. The control group adopted clinical one-to-one teaching, while the research group adopted situational simulation training combined with Miller pyramid teaching. After the training, the teaching effect of specialized nurse training was evaluated by their professional theoretical knowledge and nursing skill operation results, and self-designed assessment scale was used to evaluate the emergency response ability and satisfaction with the training effect of the nurses. SPSS 22.0 was used for t test and chi-square test. Results:The results of theoretical knowledge and nursing skills operation of specialize nurses in operating room in the research group were significantly higher than those in the control group, and the differences were statistically significant ( P<0.001). The scores of emergency capability assessment in the research group were significantly higher than those in the control group, with statistical significance ( P<0.001). The study group was better than the control group in 7 aspects of satisfaction, such as the improvement of the operation level of emergency ability, team cooperation ability, analysis and problem solving ability, clinical nursing decision-making ability, independent thinking ability and nurse-patient communication ability, with significant differences ( P<0.05). Conclusion:Situational simulation training combined with Miller pyramid teaching can significantly improve the emergency response ability, nursing skill operation and training satisfaction of operating room nurses, which is better than the traditional clinical teaching method, and is worthy of application and promotion in clinical nursing teaching.

目的 了解缺血性脑卒中患者出院准备度与疾病不确定感及自我护理能力的相关性.方法 采用一般资料调查表、RHDS、MUIS-A、ESCA量表对307例缺血性脑卒中患者进行调查.统计缺血性脑卒中患者的RHDS、MUIS-A以及ESCA评分情况;分析影响缺血性脑卒中患者出院准备度的相关因素;分析RHDS评分与MUIS-A、ESCA评分的相关性.结果 患者RHDS评分为(88.23±16.55)分.多元线性回归分析结果显示,学历、婚姻状态、居住地、合并症数量、MUIS-A和ESCA评分是出院准备度的影响因素(P<0.05).Pearson相关性分析结果显示,RHDS评分与MUIS-A评分呈负相关,与ESCA评分呈正相关(P<0.05).结论 缺血性脑卒中患者出院准备度处于中等水平,与其疾病不确定感及自我护理能力相关.护士应采用个体化的健康教育方式降低患者疾病不确定感以及提高其自我护理能力,进而提高患者的出院准备度.