目的 探讨引阳入阴推拿对剖宫产后心脾两虚证睡眠障碍产妇睡眠障碍以及负性情绪的影响.方法 选取产科病房行剖宫产的100例心脾两虚证睡眠障碍产妇为研究对象,随机分为观察组和对照组,每组50例.对照组实施常规产后心理护理,观察组在对照组基础上实施引阳入阴推拿.比较2组匹兹堡睡眠质量指数量表(PSQI)评分、中医证候积分、焦虑自评量表(SAS)评分以及抑郁自评量表(SDS)评分.结果 干预后,观察组产妇PSQI评分以及中医证候积分均低于对照组,SAS和SDS评分均低于对照组,差异有统计学意义(P＜0.05).结论 引阳入阴推拿能有效改善心脾两虚证剖宫产产妇的睡眠障碍,缓解负性情绪.

目的 探讨阿司匹林+低分子肝素对子痫前期孕妇妊娠结局、胎盘血流灌注及内皮损伤的临床研究.方法 2018年1月—2019年8月间上海中医药大学附属曙光医院收治的子痫前期患者126例,参照随机数表法将入组患者分为对照组、观察组各63例.对照组患者接受硫酸镁注射液干预,观察组患者在此基础上加入阿司匹林+低分子肝素治疗.对比两组患者的妊娠结局及治疗1周后胎盘血流灌注指标[动脉收缩期最高血流速度与舒张期最低血流速度比值(S/D)、阻力指数(RI)及搏动指数(PI)]、内皮损伤指标[内皮素-1(ET-1)、一氧化氮(NO)、可溶性血管内皮生长因子受体(sFlt-1)及可溶性内皮因子(sEng)]水平的差异.结果 两组患儿的妊娠结局差异无统计学意义(P＞0.05).治疗1周后,观察组患者超声S/D、RI及PI的水平低于对照组患者,差异均有统计学意义(均P＜0.05);血清ET-1、sFlt-1及sEng的水平低于对照组患者,NO的水平高于对照组患者,差异均有统计学意义(均P＜0.05).结论 阿司匹林+低分子肝素可有效改善子痫前期孕妇的胎盘血流灌注并减轻血管内皮损伤.

目的 探讨血清miR-21、miR-125b在子痫前期患者中的相对表达水平变化及其临床意义.方法 以2018年7月至2019年10月在上海中医药大学附属曙光医院诊治的子痫前期孕妇60例为研究对象,其中轻度子痫前期患者28例为轻度组,重度子痫前期患者32例为重度组.另选取同期健康妊娠孕妇58例为对照组.检测孕妇血清miR-21、miR-125b的相对表达水平及其他临床指标,采用Pearson相关进行相关性分析,并采用受试者工作特征曲线(ROC曲线)分析血清miR-21、miR-125b对子痫前期的诊断价值.结果 轻度组 、重度组子痫前期患者收缩压 、舒张压均较对照组明显升高,新生儿体质量明显下降(P<0.05);重度组子痫前期患者收缩压 、舒张压明显高于轻度组(P<0.05),新生儿体质量明显低于轻度组(P<0.05).轻度组子痫前期患者血清miR-21、miR-125b的相对表达水平明显高于对照组(P<0.05);而重度组子痫前期患者血清miR-21、miR-125b的相对表达水平明显高于轻度组(P<0.05).孕妇血清miR-21、miR-125b与收缩压 、舒张压 、24 h蛋白尿 、血清肌酐 、尿素氮呈正相关(rmiR-21=0.208、0.503、0.649、0.539、0.457,均P<0.05;rmiR-125b=0.273、0.444、0.522,0.380、0.364,均P<0.05),与新生儿体质量呈负相关(rmiR-21=-0.249,P<0.05;rmiR-125b=-0.207,P<0.05).ROC曲线结果显示,血清miR-21、miR-125b对子痫前期联合检测的诊断效能高于单独检测,差异有统计学意义(P<0.05).结论 血清miR-21与miR-125b在子痫前期患者中相对表达水平升高,对子痫前期具有一定的诊断价值.

Objective:To explore the effect of dialectical diet on traditional Chinese medicine (TCM) syndrome score of cirrhotic ascites patients based on "Gu Ben Kai Qu" theory.Methods:From March 2019 to January 2020, 84 patients with liver cirrhosis and ascites admitted to Shuguang Hospital Affiliated to Shanghai University of TCM were randomly divided into two groups according to the different dialectical types of the subjects, 14 cases in each group. Three non-syndrome differentiation diet groups were given routine nursing care of liver cirrhosis ascites. On the basis of routine nursing, the corresponding medicinal diet was selected according to syndrome differentiation based on "Gu Ben Kai Qu" theory. Patients with spleen and kidney yang deficiency syndrome selected Shenqi lean meat decoction. Patients with Yin deficiency of liver and kidney selected Wolfberry and ophiopogon spareribs decoction. Patients with qi stagnation and blood stasis syndrome selected Danggui Sanqi spareribs decoction. The TCM syndrome score scale for liver disease and the curative effect evaluation of cirrhosis ascites were used to evaluate the effect.Results:Eighty effective cases were included. On the first day of admission, the 14th day and the second week after discharge, the TCM syndrome scores of liver disease were as follows: the group (a1b1) with the spleen and kidney yang deficiency syndrome was 46.38±8.56, 34.20±8.42, 31.40±4.22, respectively. The group (a1b2) with the liver kidney yin deficiency syndrome was 41.50±8.71, 31.35±8.63, 31.12±4.94. The group(a1b3) with the qi stagnation and blood stasis syndrome was 45.92±7.86, 35.17±7.57, 30.83±7.32, respectively. The non-syndrome differentiation diet group (a2b1) with the spleen and kidney yang deficiency syndrome was 46.29±8.38, 39.79±7.65, 36.64±6.83, respectively. The non-syndrome differentiation diet group (a2b2) with the liver and kidney yin deficiency syndrome was 40.50±8.12, 38.10±8.93, 35.38±8.24, respectively. The non-syndrome differentiation diet group (a2b3) with the qi stagnation and blood stasis syndrome was 45.62±7.99, 41.83±7.31, 38.83±7.96, respectively. The comparison of TCM syndrome scores of liver disease at three time points was statistically significant ( χ2 value was 63.998, P<0.05), and the comparison between groups was statistically significant ( χ2 value was 20.993, P<0.05). On the 14th day and the second week after discharge, there were significant differences between the groups with the syndrome differentiation diet and another three groups with non-syndrome differentiation diet ( F values were 3.244, 3.489, all P<0.05). Conclusions:Based on the theory of "strengthening the foundation and opening channels", the syndrome differentiation group can effectively reduce the TCM syndrome score of patients with cirrhosis ascites, improve the symptoms and enhance the curative effect. With the development of time, the score of TCM syndrome in patients with liver disease become lower. On the 14th day of admission, patients with Yin deficiency of liver and kidney given medicated diets had significant effect; patients with spleen kidney yang deficiency syndrome or qi stagnation and blood stasis had significant effect in 2 weeks after discharge; which can effectively improve the clinical symptoms of patients with cirrhosis ascites to worthy of clinical application.

目的 回顾性调查某精神卫生中心双相抑郁患者药物规范化治疗情况,为制定针对性的临床药师干预方案提供依据.方法 通过面对面访谈的形式,利用问卷、量表以及病史记录等方式收集相关数据.基于《中国双相障碍防治指南》(第2版)将纳入的病例分为一致组(与指南推荐意见一致)和不一致组(与指南推荐意见不一致).结果 纳入的76例双相抑郁患者中,与指南推荐意见不一致率达到42.1％.一致组患者的汉密尔顿抑郁量表17项疗效、临床疗效总评(CGI)中疗效总评(GI)与疗效指数(EI)均优于不一致组,差异均具有统计学意义(P＜0.05);一致组患者的不良反应发生率低于不一致组;2组间用药依从性、CGI中病情严重程度(SI)和治疗方案经比较,差异无统计学意义(P＞0.05).结论 双相抑郁患者的药物规范化治疗情况不理想,医疗机构的管理与监控力度、精神科医师业务水平、患者及监护人等因素均对双相抑郁患者的治疗产生影响.临床药师可依据相关的国内外指南,对双相抑郁患者药物治疗进行全程监控与优化干预,从而提高双相抑郁患者药物治疗的规范性、有效性和安全性.

目的 分析药物性肝损伤(DILI)的临床特点和发生规律,为临床合理诊疗护理提供依据.方法 对 2015 年8 月至2018 年8 月在上海中医药大学附属曙光医院诊断为DILI的 113 例患者的基本信息、病史等临床资料进行回顾性分析.结果 共收集1 13 例DILI 患者,男35 例,女78 例,年龄主要集中在50～69 岁,有基础疾病患者84 例(74.34％);主要临床分型是肝细胞损伤型占70.80％;最常见的临床症状是乏力占 73.45％,其次是纳差、皮肤巩膜黄染、恶心、肝区疼痛、呕吐等;导致DILI 的药物西药73 例(64.60％),中草药和中成药36 例(31.86％),保健品或减肥药 4 例(3.54％),两种及以上药物联合61 例(58.41％).不同分型之间的年龄、性别、饮酒史、过敏史、RUCAM评分比较,差异均无统计学意义(P均>0.05).不同分型之间有无基础疾病史有统计学意义(P<0.05).结论 DILI以女性、中老年、有基础疾病及多种药物联用多见,临床分型以肝细胞损伤型居多;应提高患者对于 DILI 的认识及关注,避免多药联合及随意滥用药物和保健品,保证临床用药安全.

介绍了症状群相关的概念、研究方法与测评工具,主要综述了肝炎后肝硬化症状群纵向研究现状,提出应制定有效的症状应对策略和积极的心理应对方式,提高病人自我管理效能、依从性、生存质量和幸福指数.

目的 探讨舒心养气操对改善老年稳定性心绞痛住院失眠患者睡眠质量的效果.方法 选择2017年18月我院收治的76例老年稳定性心绞痛住院失眠患者,随机分为对照组与观察组各38例;对照组采用常规护理,观察组在常规护理的基础上辅以舒心养气操.应用匹茨堡睡眠质量指数量表(PSQI)、心绞痛症状积分量表和医院焦虑抑郁量表(HADS)分别于干预前后对患者睡眠质量、心绞痛症状、焦虑抑郁情绪等进行评估.结果 观察组患者干预后的主观睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、睡眠药物的应用和PSQI总分均优于对照组,差异有统计学意义(P＜0.05);观察组患者干预后的失眠疗效、HADS的焦虑情绪和抑郁情绪均优于对照组,差异有统计学意义(P＜0.05).结论 舒心养气操能有效提高老年稳定性心绞痛住院失眠患者的睡眠质量,缓解其焦虑和抑郁情绪,提高生存质量,值得临床推广应用.

Objective: To evaluate the effects of manual hyperinflation(MH/MHI)on open endotracheal suctioning in mechanically ventilated patients.Methods: Papers involving the effect of manual hyperinflation on open endotracheal suctioning in mechanically ventilated patients were searched in The Cochrane Library,JBI Library,Pubmed,Medline,EMbase,OVID,Chinese national knowledge infrastructure(CNKI),Chinese biomedical literature database(CBM),VIP and Wanfang database from the database establishment to July 2017 to collect the randomized controlled trials(RCTs).Results indexes included the incidence of complications,such as pulmonary atelectasis,mucosal lesions,and ventilator associated pneumonia(VAP),ventilator associated in-dexes such as airway resistance,airway pressure,and pulmonary compliance,as well as haemodynamics indexes such as heartbeat rate and blood oxygen saturation.Results: A total of 12 RCTs were included.The results of Meta-analysis showed that the inci-dence rate of pulmonary atelectasis,mucosal lesions and VAP,in MH/MHI group were significantly lower than those of control group(P<0.01).Airway resistance,airway pressure,pulmonary compliance within 1 min and 5 d,and blood oxygen saturationin in MH/MHI group were significantly lower than those of control group(P<0.05 or P<0.01).But there was no difference in the heartbeat rate between two groups(P=0.25).Conclusion: Manual hyperinflation can significantly reduce the incidence of pulmo-nary atelectasis,mucosal lesions,VAP rates,and lower airway resistance as well as airway pressure.In addition,manual hyperinfla-tion can improve pulmonary compliance,blood oxygen saturation and have less influence on the heartbeat.

Objective To explore the effect of applying syndrome differentiation and medicated diet in patients with liver cirrhosis as cites based on"Gu Ben Kai Qu"theory of TCM. Methods Seventy patients of liver cirrhosis as cites were randomly divided into observation group (35 cases) and control group(35 cases).The control group was cared with care routine of liver cirrhosis as cites,The observation group was based on care routine traditional nursing and implementation of dialectical medicalated meal which based on "Gu Ben Kai Qu" theory of TCM. The two groups of patients were used to assess the efficacy of liver cirrhosis as cites,urine volume,abdominal circumference,weight,TCM syndrome scale of liver disease. Results The urine volume on the 7th day, the 14th day, 2 weeks after discharge,the weight and the abdominal circumference on the 2 weeks after discharge from the patients in the observation group were respectively(1.90±0.52)L,(2.09±0.56)L,(2.02±0.35)L,(59.36±8.19)kg,(89.56±7.24)cm,while they were(1.63±0.36)L,(1.79±0.40)L,(1.82±0.38)L,(63.33±8.21)kg,(93.57±7.56)cm in the control group,the difference between the two groups was statistically significant (F=6.083, 6.484, 5.030, 4.108, 5.144,all P<0.05). The efficacy of liver cirrhosis as cites from the patients in the observation group were cured 40.0%(14/35),improved 42.9%(15/35),not cured 17.1%(6/35),while they were cured 22.9%(8/35),improved 40.0%(14/35),not cured 37.1%(13/35),the difference between the two groups was statistically significant (Z=2.012,P<0.05). The efficacy of TCM Syndromes on liver disease from the patients in the observation group were respectively[significant effect 37.1%(13/35),valid 45.7% (16/35),invalid 17.2%(6/35)],[significant effect 60.0%(21/35),valid 28.6%(10/35),invalid 11.4%(4/35)], while they were respectively [significant effect 20.0%(7/35), valid 42.9%(15/35), invalid 37.1%(13/35)], [significant effect 40.0%(14/35),valid 25.7%(9/35),invalid 34.3%(12/35)],the difference between the two groups was statistically significant(Z=2.065,2.104,all P<0.05). Conclusions Based on"Gu Ben Kai Qu"theory of TCM,the implementation of dialectical diet can effectively improve efficacy of liver cirrhosis as cites, reduction rate of TCM symptoms scale, urine volume,reduce the weight,shrink down the abdominal circumference,worthy of clinical application.

This review is about advantages of exclusive breastfeeding and status, the necessity of improving exclusive breastfeeding rate, the importance of improving exclusive breastfeeding rate within 1weekafter delivery, and the related factors influencing the exclusive breastfeeding. On the basis of this, the paper points out the future research direction, aims to find out the main cause which reduce breastfeeding rate within one week after delivery, and then provide new evidence for intervention measures, in order to improve breastfeeding rate within one week after delivery, so as to improve the rate of exclusive breastfeeding.

目的 探讨舒心养气功对稳定性心绞痛患者焦虑症状的影响.方法 将92例伴有焦虑症状的稳定性心绞痛患者随机分为观察组(46例)和对照组(46例),对照组采用常规护理,观察组在常规护理的基础上辅以舒心养气功护理.采用焦虑自评量表(SAS)、心绞痛症状评分量表和患者满意度调查表对两组患者焦虑症状、心绞痛症状和满意度等进行评价.结果 观察组患者焦虑症状评分明显低于对照组,满意度评分明显高于对照组;两组心绞痛症状评分干预后明显低于干预前,差异均具有统计学意义(P＜0.05).结论 舒心养气功能有效缓解稳定性心绞痛患者的焦虑症状,提高住院患者满意度,在改善心绞痛症状方面,与常规护理无明显差异,值得临床推广应用.

Objective To observe motherwort injection combined carboprost for the prevention and treatment of postpartum hemorrhage and to analyze the value of nursing care.Methods A total of 120 patients,who underwent cesarean section due to medical indications or social factors,were randomized into two groups.The observation group was treated by motherwort injection combined with carboprost, while the control group was treated with motherwort injection.The blood loss,change in blood pressure and adverse reaction were com-pared.Results In the observation group,the amount of blood loss during operation and after 24 h was (173.83 ±31.51),(237.67 ± 36.10)mL,which was significantly less than (243 ±41.03),(334.50 ±40.52)mL in the control group (P <0.001).The blood pressure was not increased after the drug intake in both groups.In the observation group the systolic blood pressure was (117.37 ± 9.07)mmHg before drug intake,and the highest,lowest and average systolic blood pressures after the treatment were (129.93 ± 18.69),(105.30 ±16.07)and (116.67 ±15.24)mmHg,respectively,which were not significantly different from (117.93 ±4.26), (126.65 ±16.38),(100.42 ±15.25)and (113.38 ±14.47)mmHg in the control group (P >0.05).In the observation group the diastolic blood pressure before treatment was (69.40 ±6.14)mmHg,the highest,lowest and average diastolic blood pressures after the treatment were (86.35 ±14.58),(50.46 ±17.37)and (69.23 ±15.23)mmHg,respectively,which were not significantly different from (70.86 ±7.36),(82.56 ±16.48),(53.88 ±16.52)and (67.51 ±13.39)mmHg in the control group (P >0.05).There were 16 cases of adverse reactions in the observation group,significantly higher than 6 cases in the control group (P <0.05).Conclusions Motherwort injection combined with carboprost in preventing postpartum hemorrhage of cesarean section is simple,safe and effective, which is worthy of promotion.But special attention should be paid to the adverse reactions.

Objective To investigate the effect of nursing weak links intervention on postpartum breastfeeding within one week. Methods Four nursing weak links during breastfeeding in the department were intervened from October 2015. Mastery of knowledge, breast swelling rate and exclusive breastfeeding rate in postpartum were analyzed and compared one week before and after the intervention. Results The mastery rate of knowledge before and after the intervention was with statistical significance (P<0.01). The incidence rate of breast swelling after intervention was lower than that before intervention, showed statistical significance (P<0.01). The exclusive breastfeeding rate in postpartum within one week was higher than that before intervention, showing statistical significance (P<0.01). Conclusion The intervention in the nursing weak can significantly improve the exclusive breastfeeding rate one week after postpartum.

冠心病是指冠状动脉粥样硬化使血管腔狭窄或阻塞,或(和)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死而引起的心脏病,是一种心身疾病[1].抑郁症是冠心病患者常见的伴随疾病,其症状通常是慢性的、且持续存在,容易被医护人员和家属忽略,从而引起更严重的不良事件. 医护人员应及早识别冠心病患者的抑郁症,通过多种治疗和护理方法共同干预,使患者释放抑郁情绪、提高认知、改变行为模式、保障安全、提高生活质量.笔者就冠心病合并抑郁症患者的护理干预进行综述,以期为制订有效的护理干预提供理论指导,现报道如下.

目的:探讨中药雾化配合穴位贴敷应用于慢性鼻窦炎术后的效果与护理.方法:将90例鼻内镜下鼻窦开放术的慢性鼻窦炎患者随机分为观察组和对照组.对照组45例对其进行常规护理,观察组45例在常规护理基础上进行中药雾化配合穴位贴敷,比较两组鼻腔粘膜、鼻塞、头疼、头昏及流涕情况.结果:观察组总有效率明显高于对照组,差异有统计学意义(P<0.05).结论:中药雾化配合穴位贴敷在提高慢性鼻窦炎术后治疗效果,促进术后恢复,值得临床推广应用.

为了推动中医护理学科的发展,培养适应社会需求的全面发展的高素质中医护理人才,提出将人文护理理论和实践研究贯穿于课程体系构建、临床实习、临床护理、护理科研等方面,提高中医护理人员的综合素质.

冠心病是指冠状动脉粥样硬化使血管腔狭窄或阻塞，或(和)因冠状动脉功能性改变(痉挛)导致心肌缺血缺氧或坏死而引起的心脏病，称之为冠状动脉性心脏病，包括以下五种类型：无症状性心肌缺血，心绞痛，心肌梗死，缺血性心肌病，猝死。随着人们生活水平的提高和人均寿命的提高，冠心病成为我国老年人最常见的心脏疾病。医学模式已经从单纯的生物医学模式转为生物心理社会医学模式，人们已经认识到心理因素在冠心病发病、预后和治疗中的重要作用。抑郁症一直以来被认为是冠心病发病和影响疾病预后的重要因素，本文就冠心病与抑郁症关联的研究进展做一综述。

目的:观察心理干预配合穴位按压对复杂性肛瘘术后疼痛的影响。方法:将78例患者采用随机抽样的方法分为观察组和对照组各39例,对照组采用肛肠科术后常规护理,遵医嘱使用止痛剂;观察组在采用肛肠科术后常规护理基础上给予心理干预配合穴位按压。结果:术后24h、48h,2组疼痛视觉模拟评分分别比较,差异均有显著性意义(P<0.05)。结论:心理干预配合穴位按压对减轻复杂性肛瘘术后疼痛有意义。

[目的]观察中药治疗女孩性早熟的效果,总结护理措施。[方法]将54例性早熟女孩患儿应用自拟清热滋阴泻火中药进行治疗,配合服药、饮食、情志等方面的护理。采用复测骨龄、B超复测子宫卵进行效果评价。[结果]中药治疗前后病人第二性征比较差异有统计学意义(P均<0.05)。[结论]中药能有效治疗女孩性早熟,控制性早熟女孩的第二性征的发育,控制骨骺提前闭合现象,使性早熟儿童提前发育的子宫、卵巢体积变小。