目的 探讨精细化护理在消化性溃疡出血治疗中的应用.方法 选择温州医科大学附属第二医院2016年1月至2017年12月收治的消化性溃疡伴出血患者179例,采用随机数字表法分为对照组(80例)和干预组(99例),对照组进行常规护理干预,干预组应用精细化护理.护理干预2周后观察两组止血时间、胃肠道症状消失时间和住院时间,评估患者健康知识评分、依从性、满意度、生活质量,应用Zung焦虑自评量表(SAS)评估患者焦虑状况.结果 干预组止血时间、胃肠道症状消失时间和住院时间分别为(4.54 ±0.96)d、(7.15 ±l.01)d和(11.40±3.72)d,均短于对照组的(5.90±1.03)d、(9.82±0.94)d和(13.85±3.51)d,差异均有统计学意义(t=8.96、9.57、10.38、12.45,均P＜0.05);干预组护理依从性、健康知识评分、护理满意度、胃肠道症状、全身症状、情感功能、社会功能评分分别为(96.51±7.64)分、(93.70±8.62)分、(98.61±10.14)分、(60.81±4.32)分、(31.50±2.07)分、(77.56±5.92)分,均高于对照组的(90.85±6.97)分、(81.39±9.30)分、(91.24±9.36)分、(54.60±4.51)分、(28.32±1.85)分、(73.18±5.59)分和(28.03±2.62)分,差异均有统计学意义(t=11.06、11.89、11.76、10.81、9.67、10.05,均P＜0.05),干预组干预后SAS评分结果为(50.73±6.20)分,低于对照组的(55.26±6.42)分,差异有统计学意义(t=11.24,P＜0.05).结论 应用精细化护理对消化性溃疡出血患者进行护理干预,能够显著缩短患者止血时间、胃肠道症状消失时间和住院时间,改善患者负性情绪,提高患者依从性、满意度和生活质量,值得推广应用.

Objective To observe the effect of psychological intervention on serotonin and anxiety scores in patients with ulcerative colitis,thus to guide the treatment.Methods All 72 cases were selected from January,2016 to December,2016 diagnosed in our hospital as digestive ulcerative colitis,and were randomly divided into observation group and control group.Based on different symptoms and severity of the disease,we made individualized medication plan.The observation group had psychological intervention in addition to clinical medication.With 36 cases in each group,after 14 days of treatment we used SAS and SDS scales to compare anxiety and depression before and after treatment,and serotonin expression in mucosal mucosa before treatment and 2 months after treatment.Results There was no significant difference in SAS scores between the two groups before treatment (P ＞ 0.05).SAS scores were lower in both groups after treatment (P ＜ 0.05).The improvement rate of SAS in the observation group was better than that in the control group (P ＜ 0.05).There was no significant difference in the scores of SDS scores between the two groups before treatment (P ＞ 0.05).The scores of SDS in the observation group and the control group were lowered after treatment(P ＜ 0.05).And the level of improvement in the observation group outperformed that in the control group(P ＜ 0.05).There was no significant difference in the expression of serotonin between the two groups before treatment (P ＞ 0.05).The levels of serotonin in both groups were lowered after treatment (P ＜ 0.05).The improvement level of the observation group was better than that of the control group(P ＜ 0.05).Conclusion Psychological intervention can alleviate the anxiety of patients with ulcerative colitis and improve the symptoms of gastrointestinal dysfunction by inhibiting the expression level of serotonin in the intestine,which is worthy of clinical application.

目的:通过改变延续性护理的单一模式,以提高出院患者对护理工作的满意度.方法:找出延续性护理展开受阻的原因,通过改变延续性护理展开的模式及流程.采用短信调查问卷比较活动实施前、3个月后患者对护理工作的满意度情况.结果:多样化延续性护理模式实施后出院患者对护理工作中护士服务态度和主动性、工作能力、关爱与沟通、健康教育的满意度及总体满意度均显著高于实施前(P＜0.05),但实施前后出院患者对护理工作中病区管理的满意度之间的差异不显著(P＞0.05).结论:开展多样化的延续性护理模式有利于提高出院患者对护理工作的满意度.

目的 探讨能全力在溃疡性结肠炎患者肠内营养支持中的重要性.方法 2015年1～4月选择在我院成人消化内科住院的30例溃疡性结肠炎患者,采用能全力肠内营养,观察患者治疗前后的体重、白蛋白水平、血红蛋白及生命体征变化及大便次数.结果 治疗3个月后能全力不仅能明显改善患者的营养状况,而且能有效控制腹泻的发生.治疗后的白蛋白、血红蛋白及体重水平同治疗前的水平比较差异有统计学意义(t=4.025、4.246、4.104,P=-0.023、0.025、0.027).治疗后同治疗前的生命体征比较差异无统计学意义(P＞0.05).结论 对于溃疡性结肠炎患者,选择能全力肠内营养支持是可行的.肠内营养是符合生理需求的、且并发症少、费用低.既能减少溃疡性结肠炎患者的肠道损伤又能满足基本的营养需求,也能节约患者的治疗费用,可广泛应用.

目的:探讨“一对一导乐”模式对产妇分娩的影响.方法:选取2015年8月～2016年1月在温州医科大学附属第二医院妇产科住院的70名初产妇为导乐组,采取“一对一导乐”模式,由1名有经验的导乐助产士为产妇提供全程陪伴,给予心理支持和分娩指导.选取2015年1～7月分娩的70名初产妇为对照组,接受常规三班轮换的产时管理.比较两组产妇的分娩方式、阴道分娩的产程时间、母婴结局和产妇满意度.结果:导乐组的阴道分娩率显著高于对照组,剖宫产分娩率显著低于对照组(P＜0.05);导乐组第一、第二产程时间均显著短于对照组(P＜0.05);导乐组胎儿窘迫和新生儿窒息发生率显著低于对照组(P＜0.05);导乐组产妇产后出血量显著少于对照组,产妇满意度显著高于对照组(P＜0.05).结论:“一对一导乐”模式有利于减轻产妇的紧张情绪,提高产妇分娩效果,保证产妇安全.

目的 探讨静脉输液港(VAP)和PICC置管在消化道恶性肿瘤患者中的应用效果和对其生活质量的影响.方法 选取VAP和PICC患者各60例,置入VAP或PICC后维护和随访1年,观察置管效果和置管后对患者生活质量的影响.结果 两组置管并发症、留置时间和患者的生活质量比较,VAP组显著优于PICC组(P＜0.05,P＜0.01).结论 VAP在降低置管并发症,延长留置时间和改善长期使用患者的生活质量上显著优于PICC,但费用较昂贵;需要长期化疗的消化道肿瘤患者应根据临床情况合理选择深静脉置管方式,建议首选VAP.

The effectiveness of risk management and routine nursing for assuring patient safety in 120 gastroenterology VPA patients which 60 patient were in treatment group(risk management) and 60 patients in control group were comparably analyzed. The main indictors included complication rate after VPA, time of VPA, patient's satisfaction and the changes of nursing behavior before and after implementing risk management. It shows that complication rate is significantly decreased, VPA time is extended and patient's satisfaction is improved and nursing behavior is significantly promoted. It is considered to apply VPA risk management in nursing to improve VPA patient's safety.

To investigate the relationship between postmenopausal osteoporosis(PMOP)and the estrogen receptor α gene polymorphisms(ERα)and other relevant factors,203 postmenopausal women were randomly selected and divided into normal group,bone mass loss group and PMOP groups according to the osteoporosis diagnosis standards,their Lumbar BMD were measured,and genotypes were detected,meanwhile their dietary behavior and exercise habits etc were surveyed.The result shows:(1)Older age,lower educational level.shorter height,lower weight and BMI,more pregnancies and childbirth were related with PMOP.Intake of more Milk,soy milk,tea,sea food,beans or bean products,meet,eggs,fruit,nuts and more exercise monthly were associated with high BMD.After adjusting for age,educational level,BMI and other confounding factors,intake more tea,fruits and nuts were positively correlated with BMD.(2)There was no relationship between ERα found in this study,which suggest that dietary behavior,environmental factors and PMOP are closely related,but the association of ERα polymorphisms and BMD is not clear,the predictive value of osteoporosis needs further study.

Objective: To probe the relationship between postmenopausal osteoporosis(PMOP)and the estrogen receptor α gene polymorphisms and other relevant factors.Methods: Two hundred and three postmenopausal women were randomly selected and devided into nomal control group,bone loss group and PMOP group.Lumbar BMD was measured,and genotypes were detected.Meanwhile,the dietary behavior and exercise of the women were also surveyed.Results: Age,lower educational level.shorter height,lower weight,BMI,more pregnancies and childbirth were related with PMOP.Intake of more milk,soy milk,tea,sea food,beans or bean products,meet,eggs,fruit,nuts and more exercise monthly were associated with high BMD.The frequencies distribution of PvuII was PP:26.6%,pp:27.6% and Pp:45.8%,respectively,and the frequencies distribution of XbaI was XX:9.9%,xx:57.1% and Xx:33%,respectively.Logistic regression indicated that age,coffee and XbaI XX were the risk factors of bone loss,the high degree of culture,BMI,often drinking tea or intake of fruit were the protection factors of PMOP.Conclusion: The frequen-cies distribution of ERα is different from other regions,and the relationship between BMD is not clear,the predictive value on PMOP remains to need further study.Close relationship between and dietary behavior and environmental factors is found in our rcescarch.

类克通过与具有生物学活性的可溶性和膜结合型肿瘤坏死因子相结合,达到抑制肿瘤坏死因子与受体相结合的目的,使得肿瘤坏死因子的信号传导被阻断而抑制相关的病理活动[1].经过国外多年的应用证实,类克具有较好的临床效果,但在输注过程中需要严格控制输注速度.我科2011年6月至2012年2月使用类克治疗患者8例,在输注类克的过程中应用流速控制单,取得了满意的效果,现报道如下.

随着生活水平的改善与医疗技能的提高,因膳食原因引起的慢性非传染性疾病的发病率明显提高。营养学作为现代临床医学综合治疗中不可缺少的一个组成部分,在慢性非传染性疾病的治疗、康复及转归中发挥着重要作用。但目前我国高等医学院校临床相关专业尚未独立开设《营养与食品卫生学》课程,《卫生学》或《预防医学》中设置的有关营养学部分授课时数仅4～12学时,这就使得临床医(学)生营养学知识相对匮乏,不能很好地适应现阶段医疗卫生服务的需求。因此,医学院校应重视《营养与食品卫生学》的教学改革,使在校学生能较系统地获取营养学知识以提高临床医务人员的营养治疗水平。

To study the effects of soybean isoflavone(SI)on born mass and ultrastructural in ovariectomized rats of osteoporosis,after ovariectomized 1 week,46 female sprague-dawley rats were randomly divided into estrogen,low,middle,high dose and normal control groups according to total cholesterol level in serum before the trial and intragastric administration with different dose of SI and estrogen.Weight was measured ad unam vicem per week and vena caudalis serum collected at ovariectomized、administer 4 w、8 w、 killed,serum alkaline phosphatase(AKP)activity and bone density were measured after experiment.The results showed that intervention group AKP enzyme activity had significantly higher than NG group,there was almost effect between high dose intervention and estrogen on bone density.Bone loss due to ovariectomized was relieve after intervention soybean isoflavone and estrogen.There was resemble mirror image in estrogen、high dose SI group with normal control group.It concluded there are effect soybean isoflavone on bone mass and ultrastructural in ovariectomized rats of osteoporosis,serum AKP enzyme activity and bone density had significantly higher after middle,high dose intervention,but combine capability an-ideal between phytoestrogen and estrogen receptor(ER),soybean isoflavone interfere in dosage and long-term effect in clinical practice that is still need more proof for long term effect.