目的:探讨象皮生肌膏对压疮模型大鼠创面愈合的影响及其作用机制.方法:将72只大鼠随机分为空白组、模型组、湿润烧伤膏组、象皮生肌膏组,每组各18只.空白组不予造模,其余3组建立Ⅲ期、Ⅳ期压疮模型.造模成功后空白组与模型组给予0.9％氯化钠注射液冲洗,湿润烧伤膏组给予湿润烧伤膏外用,象皮生肌膏组给予象皮生肌膏外用.干预14d.于干预第3、7、14天观察创面愈合率,组织病理情况,白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、血管内皮生长因子(VEGF)水平,p38丝裂原激活的蛋白激酶(p38MAPK)、MAPK激活蛋白激酶2(MK2)蛋白表达情况.结果:与模型组比较,湿润烧伤膏组、象皮生肌膏组治疗第3、7、14天创面愈合率均升高(P＜0.05).组织病理结果显示,治疗第14天,模型组可见少量毛细血管,湿润烧伤膏组、象皮生肌膏组可见大量成纤维细胞,毛细血管丰富.湿润烧伤膏组、象皮生肌膏组治疗第3、7、14天IL-6、TNF-α、VEGF、p38MAPK蛋白、MK2蛋白含量与模型组比较,差异均有统计学意义(P＜0.05).象皮生肌膏组治疗第7、14天IL-6含量及第7天TNF-α、VEGF含量与湿润烧伤膏组比较,差异均有统计学意义(P＜0.05).结论:象皮生肌膏能促进压疮创面修复,其作用机制可能与抑制p38MAPK、MK2蛋白表达,减少IL-6、TNF-α释放、调控VEGF合成有关.

Objective:To explore the teaching experience of clinical teaching teachers in master of integrated traditional Chinese and western medicine nursing, so as to provide a reference for improving the training quality of master of integrated Chinese and western medicine nursing.Methods:From March to May 2022, a total of 14 clinical teaching teachers of integrated traditional Chinese and western medicine nursing in the First Affiliated Hospital of Hunan University of were enrolled using the objective sampling method and investigated by the semi-structured face-to-face interview. Content analysis was used to analyze the interview results.Results:Five themes were extracted, namely, the practice ability of nursing graduate students needs to be improved, the evaluation methods of clinical practice ability of graduate students need to be more diversified, teaching benefits teachers as well as students; difficulties of teaching (conflicts between teachers' clinical work and teaching, unclear orientation of postgraduate clinical practice learning) , hope to get support (improve scientific research ability, improve theoretical knowledge of traditional Chinese medicine, guarantee the clinical practice and study time of graduate students) .Conclusions:A variety of practice approaches should be provided for the training in master of integrated traditional Chinese and western medicine nursing graduate students, to improve students' clinical practice ability and professional identity, strengthen clinical teacher training, improve teachers' ability, and continuously improve the clinical practice training model and the quality of talent training for nursing graduate students.

目的:观察抗阻训练联合八段锦对慢性心力衰竭(CHF)患者心功能、生活质量和不良心脏事件的影响.方法:纳入2019年6月～2020年7月期间湖南中医药大学第一附属医院心血管内科收治的120例CHF患者,按随机数表法分为对照组、研究组各60例.两组均采取常规抗心衰治疗,在此基础上,对照组接受抗阻训练,研究组接受抗阻训练联合八段锦训练,两组均干预6个月.对比两组疗效以及干预前、干预6个月后的心功能、生活质量,记录随访期间不良心脏事件发生情况.结果:研究组的临床总有效率高于对照组(P＜0.05).干预6个月后,研究组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)小于对照组,左心室射血分数(LVEF)大于对照组(P＜0.05).干预6个月后,研究组SF-36各维度(躯体健康、心理健康、总体健康、情绪功能、躯体功能、社会功能、躯体疼痛、精力)评分高于对照组(P＜0.05).研究组的不良心脏事件发生率低于对照组(P＜0.05).结论:抗阻训练联合八段锦可有效改善CHF患者心功能,提高其生活质量,并降低不良心脏事件发生率.

目的:观察祛腐生肌合剂联合表皮细胞生长因子对压疮创面修复的影响.方法:复制压疮大鼠模型,随机分为模型组、阳性药物组(表皮细胞生长因子凝胶组)、中药组(祛腐生肌合剂组)、联合干预组(表皮细胞生长因子+祛腐生肌合剂组),每组10只,另选取10只健康SD大鼠作为假手术组,仅同部位置入磁性装置不予施加压力.干预后观察各组大鼠创面愈合情况及创面病理情况,流式法检测各组大鼠血清T淋巴细胞亚群水平,ELISA法检测各组大鼠创面肉芽组织血管内皮生长因子(vascular endothelial growth factor,VEGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)、肿瘤坏死因子-α(Tumour necrosis factor-α,TNF-α)、白细胞介素-36(Interleukin-36,IL-36)、γ干扰素(Interferon-γ,IFN-γ)蛋白的阳性表达水平,Western Blot法检测创面肉芽组织JAK2、STAT3、SOCS1蛋白表达水平.结果:各组大鼠创面肉芽组织病理存在不同程度改善;与假手术组比较,模型组大鼠的血清CD8+、VEGF,bFGF,TNF-α、IL-36、IFN-γ水平与创面肉芽组织JAK2、STAT3、SOCS1的蛋白表达水平明显上升(P＜0.05),而创面愈合率、血清CD4+水平、CD4+/CD8+数值显著降低(P＜0.05);与模型组比较,阳性药物组、中药组、联合干预组大鼠的血清CD8+、TNF-α、IL-36、IFN-γ水平、创面肉芽组织的JAK2、STAT3蛋白表达水平明显下降(P＜0.05),其中联合干预组下降程度最大(P＜0.05),创面愈合率、血清CD4+、VEGF,bFGF水平、CD4+/CD8+数值及创面肉芽组织的SOCS1蛋白表达水平明显升高(P＜0.05),其中联合干预组上升程度最大(P＜0.05).结论:祛腐生肌合剂能有效促进压疮大鼠模型创面修复,同时与表皮细胞生长因子联合使用起到协同增效作用,其作用机制可能与祛腐生肌合剂能够提升血清T淋巴细胞亚群水平,上调SOCS1的蛋白表达水平抑制JAK2/STAT3信号通路表达及创面炎性反应相关.

ObjectiveTo construct a training program for traditional Chinese medicine （TCM） nurses specializing in cerebrovascular diseases.MethodsThe training program for TCM nurses specializing in cerebrovascular disease was preliminarily determined using literature analysis and semi⁃structured interview methods.A total of 21 experts were invited to conduct two rounds of consultation using the Delphi method.ResultsThe enthusiasm of the two rounds of expert letter inquiries were 100.0% and 95.3%，respectively；the expert authority coefficients were 0.91 and 0.92，respectively；the Kendall concordance coefficients of the first⁃level items were 0.224 and 0.246，respectively.The differences were statistically significant by the chi square test（P<0.05）.The final established training program for TCM nurses specializing in cerebrovascular diseases included 5 first⁃level items，16 second⁃level items，and 77 third⁃level items.ConclusionsThe established training program for TCM nurses specializing in cerebrovascular diseases in Hunan province was scientific，comprehensive，and reliable，which could be used to train TCM nurses specializing in cerebrovascular diseases.

目的:观察以习练八段锦功法为主的延续性护理对腰椎间盘突出症患者生活质量的影响.方法:将腰椎间盘突出症患者84例随机分为观察组和对照组,每组各42例.对照组给予常规护理,观察组在对照组的基础上实施以习练八段锦为主的延续性护理.出院3、6个月后比较2组Oswestry功能障碍指数(SCODI)和自我管理行为量表评分.结果:2组SCODI值和自我管理行为量表评分出院后不同时期组内比较以及组间比较,差异均有统计学意义(P＜O.05).结论:对腰椎间盘突出症患者给予以习练八段锦功法为主的延续性护理,可有效改善患者疼痛、运动功能障碍等症状,降低其复发率,提高患者的生活质量,建议临床推广.

目的 回顾我国近10年中药治疗脑卒中后抑郁(PSD)的研究动态,分析中药治疗PSD的研究现状和发展趋势,以期对开展中药治疗PSD的研究提供参考.方法 运用中国知网(CNKI)、万方数据知识服务平台、维普资讯中文期刊服务平台检索2008年1月1日—2019年12月31日发表于国内期刊上的中药治疗PSD的相关文献,采用NoteExpress 3.2.0和Excel数据管理软件进行计量分析.结果 共检索出符合纳入标准的文献614篇,分别发布于183种期刊,其中载文量前3的期刊为《陕西中医》《中西医结合心脑血管病杂志》《四川中医》,排名前15位的期刊级别占比为普通期刊56.0％、科技核心期刊33.5％、北大核心期刊10.5％.中医治疗PSD的方式包括中药汤剂内服法、口服固体剂中成药、中医护理技术治疗,其中应用最多的中药汤剂和固体剂中成药分别为柴胡疏肝散、舒肝解郁胶囊,应用前3位的单味中药为柴胡、郁金、石菖蒲.单味中药药性以温、寒为主,味以辛、苦为主,归肝、心经为主.结论 我国中药治疗PSD领域取得一定的进展,发表文献数量呈上升波动趋势,但文献质量仍处于中下水平.

目的 观察穴位贴敷对急性期脑梗死气阴两虚证患者细胞免疫功能的影响.方法 将92例急性期脑梗死气阴两虚证患者随机分为治疗组和对照组,每组46例.对照组采用脑血管病基础治疗及常规护理,治疗组在对照组基础上采用穴位贴敷治疗.观察两组治疗前后Barthel指数、各项免疫功能指标(CD4﹢、CD8﹢、CD4﹢/CD8﹢)及安全性指标[白细胞计数(WBC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐(Scr)、尿素氮(BUN)]的变化情况.结果 治疗组治疗2个疗程后Barthel指数明显升高,与同组治疗前比较,差异具有统计学意义(P<0.05).治疗组治疗1、2个疗程后Barthel指数明显高于对照组,两组比较差异具有统计学意义(P<0.05).两组治疗后各项免疫功能指标及各项安全性指标(WBC、AST、Scr、BUN)与同组治疗前比较,差异均有统计学意义(P<0.05).治疗组治疗后各项免疫功能指标与对照组比较,差异均具有统计学意义(P<0.05).结论 穴位贴敷能调节急性期脑梗死气阴两虚证患者机体细胞免疫功能,提高其日常生活活动能力和免疫力.