目的：探讨特重烧伤患者早期胃肠道营养护理的实用方法。方法对40例特重烧伤患者早期的心理疏导、管饲营养液等相关护理资料进行回顾性分析。结果严重烧伤患者给予足量的肠道营养，较好保持了患者水、电解质平衡，减少了血浆及液体的输入量。管饲期间未见严重并发症。3例（7.5%）胃内残留量＞150ml，3例（7.5%）出现腹泻，给予及时处理后均得以缓解。结论特重度烧伤患者通过心理疏导、肠道营养支持等，对于促进创面早期愈合，减少并发症有重要意义。

<正>近几年在河南、安徽等地相继出现发热伴血小板减少综合征布尼亚病毒(SFTSV)感染后引起的疾病,其中少数患者病情危重,因多脏器功能衰竭而死亡[1]。我院感染科于2011年6月,首例在浙江省内确诊后[2-3],相继收治了3例患者,现报道如下:1病例资料1.1一般情况2011年6月19日至8月12日,我院收治了3例由SFTSV感染导致的发热伴血小板减少综合征患者。其中女2例,男1例,年龄59～86岁,平均72岁;

This article summarizes the prevention and management measures of decubitus in cirrhosis patients in the decomposition period.Through brainstorming,reasons for the occurrence of decubitus during the decompensation period of cirrhosis patients were detected.Then the reasons were made into a fishbone diagram and rectification scheme was put forward according to the reasons.Through rectification,the incidence rate of decubituss in cirrhosis patients in the decompensation period was reduced,providing safeguard to the decubitus high-risk patients and the quality of nursing was improved.

<正>患者女,57岁,因"乏力3年,再发2周"于2010年12月7日以"慢性中度乙型病毒性肝炎"收住病房。患者3年前无明显诱因下出现乏力、纳差,查肝功能异常,在当地医院予"拉米夫定、阿德福韦酯"护肝抗病毒治疗后好转,定期复查肝功能无明显异常。半年前查肝功能正常、HBV-DNA低于检测值,遵医嘱停用拉米夫定,继续服用阿德福韦酯,4个月前自行停用阿德福韦酯,2周前患者再次出现乏力、肝功能异常来本院就诊。复查肝功ALT495U/L,AST366U/L,HBV-DNA4.7×106copies/mL。既往体健,否认"结核、疟疾、高血

目的:探讨对发热伴血小板减少症的隔离和防护、护理、液体管理、出院指导。方法:通过对3例患者周密的心理护理、基础护理、病情观察和预防感染和出血等措施的实施,促进了疾病的转归。结果:3例患者均未出现护理并发症及感染和出血现象,最后临床症状消失,实验室检验指标恢复正常,顺利出院。结论:通过对3例病患的规范化的护理,促进了疾病康复,减少了患者的痛苦,也总结了经验,提高了护理水平。

The microRNAs (miRNAs) can post-transcriptionally regulate gene expression and heart development. The Pax-8 gene knockout mice have apparent heart abnormalities. This study investigated the role of miRNAs in regulation of cardiac apoptosis and development in the knockout mice. MicroRNA microarrays demonstrated differential expression of microRNAs between Pax-8-/- and Pax-8+/- mice, confirmed by real-time PCR. The miR-122 was up-regulated by 1.92 folds in Pax-8-/- mice. There were ventricular septum defects in Pax-8-/- mice, and increased numbers of apoptotic cells in the left ventricular wall and interventricular septum in Pax-8-/- mice. In H9C2 myocytes, treatment with miR-122 mimics or miR-122 inhibitor affects the expression of CCK-8 and activity of Caspase-3. The miR-122 is up-regulated in the myocytes of Pax-8-/- mice and may participate in the apoptotic gene expression and pathogenesis of heart development defect.

Objective: To observe the effect of atorvastatin on TRAIL expression in the myocardiocytes and apoptosis in the rats with acute myocardial infarction(AMI) and the possible role of TRAIL in cardiovascular disease.Methods: The rats with AMI were estab-lished by ligation of the left anterior descending coronary artery.Male Sprague-Dawley rats were randomly divided into three groups: the sham group;the untreated MI group;the group treated with Atorvastatin 10 mg·kg-1·d-1.The level of lipid was analyzed by automatic biochemi-cal analyzer,infarction size was determined by histomorphometric analysis,the expression of TRAIL,Bax and Bcl-2 in the myocardium was measured with real time RT-PCR and immunohistochemistry,myocardiocytes apoptosis was determined with TUNEL stain.Results: The number of apoptotic cells was significantly increased in the MI group to compare the sham group and atorvastatin markedly inhibited apoptosis in the myocardium after MI(P 0.01),the level of Bcl-2/Bax was down-regulated in the MI group to compare the sham group and signifi-cantly up-regulated in the group treated with Atorvastatin(P 0.05),the level of TRAIL protein and gene expression was significantly decreased in the MI group to compare the sham group and markedly increased in the group treated with Atorvastatin(P 0.01).Conclusion: Atorvastatin increases the expression of TRAIL in the myocardium in the rats with acute myocardial infarction.the possible role of TRAIL may participate in the anti-apoptosis of atorvastatin in the myocardium.

Experimental evidence indicates that hypertension is a multifactorial disorder and that the products of several genes may contribute to its development. The aim of this study was to investigate the expression of hypertension-related genes in spontaneous hypertensive rats (SHRs). A microarray screening for hypertension-related genes was conducted in SHRs and Wistar-Kyoto (WKY) rats using total-RNA extracted from second-order mesenteric arteries and kidneys. The FXYD5 mRNA expression in vascular smooth muscle cells (VSMCs) was silenced by RNA interference (RNAi). Meanwhile, the FXYD5 mRNA overexpression in renal tubular epithelial cells (RTECs) was induced by the recombinant plasmid pcDNA3.1(+)-FXYD5. The expression of FXYD5 mRNA was found to be 14.8-fold lower in SHR rats compared to that in WKY rats (P<0.01). The levels of FXYD5 mRNA expression were the highest in kidneys of SHR 13-week-old rats when the blood pressure reached the highest levels. The down-regulated FXYD5 mRNA expression inhibited the migration of smooth muscle cells (P<0.01) and cell membrane Na⁺-K⁺-ATPase activity (P<0.01). Up-regulated FXYD5 mRNA expression enhanced the renal tubular epithelial cell membrane Na⁺-K⁺-ATPase activity (P<0.05) and cell proliferation (P<0.05). FXYD5 is related to the migration of smooth muscle cells and cell membrane Na⁺-K⁺-ATPase activity in rodents. The results of the present study suggest that FXYD5 may have profound impact on the regulation of blood pressure, and that this gene may be a potential target for anti-hypertensive therapy.

文章通过对临床护理带教中易发风险的原因进行分析,使临床带教老师了解自已在带教中所面临的风险.探索护理风险预防对策,降低风险发生.

目的:了解急性梗阻性化脓性胆管炎(AOSC)患者胆汁细菌培养病原菌菌谱及药敏反应情况。方法:应用Vitek60全自动细菌鉴定及药敏分析系统对65例AOSC患者胆汁样本进行细菌鉴定及药敏分析。结果:胆汁细菌培养阳性率为90%,主要菌种有大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、粪肠球菌、阴沟肠杆菌等。致病菌中革兰氏阴性菌对亚胺培南、呋喃妥因、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦敏感性较好,革兰阳性菌对万古霉素、四环素敏感性较好。结论:本组AOSC患者胆汁病原菌主要由大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌、粪肠球菌构成,病原菌最敏感的药物为亚胺培南、呋喃妥因、头孢哌酮-舒巴坦、哌拉西林-他唑巴坦及万古霉素。

<正>高血压病是一种全球性的慢性病,其发病率随着生活水平的提高及人口老龄化而逐年上升,已成为21世纪社区护理的主要对象[1]。经过两年来的社区调查、健康讲座、发放健

目的:探讨奥曲肽在预防内镜下逆行胰胆管造影(ERCP)术后高淀粉酶血症和急性胰腺炎发生的作用。方法:回顾性分析浙江省台州医院2000年1月至2007年12月间3350例次ERCP的临床资料,根据ERCP术后是否应用奥曲肽预防高淀粉酶血症和急性胰腺炎的发生,设立治疗1组和治疗2组,比较两组间高淀粉酶血症和急性胰腺炎发生率的差异。结果:两组间高淀粉酶血症和急性胰腺炎的发生率并无显著的统计学差异。结论:本组资料提示奥曲肽并不能有效预防ERCP术后高淀粉酶血症和急性胰腺炎的发生。

<正>病例1患者男,65岁,农民。因乏力、腹胀、纳差、尿黄1周,拟诊为"病毒性肝炎,戊型,急性黄疸型"入院。无药物过敏史。入院时神志清,精神软,皮肤巩膜黄染明显,生命体征正常,心肺无

狼疮性肾炎(LN)是继发于系统性红斑狼疮(SLE)的一种继发性肾炎,环磷酰胺(CTX)冲击治疗在较大程度上阻止或减缓了LN慢性损害的进程,使疾病的远期预后得到改善[1].冲击治疗期间的护理亦十分重要,现将21例LN患者环磷酰胺冲击治疗的护理体会介绍如下.

目的:使糖尿病患者症状得到控制,血糖下降,减少并发症发生。方法:为患者制定平衡饮食,严格遵守执行,合理运动锻炼,指导患者正确合理服药,讲解并发症的病因、症状及预防,现场演示血糖仪的操作。结果:患者的空腹、餐后血糖明显下降,体重减轻,基本掌握了血糖仪的操作技能。结论:通过对糖尿病患者进行饮食和运动锻炼,用药指导等,使患者的血糖得到了有效控制,延缓和减轻了临床并发症的发生。

重症肝炎病死率达70%以上[1].人工肝支持系统(ALSS)可提高重症肝炎的治愈率[2],是目前治疗重症肝炎肝衰竭及其他一些疾病最重要和最常见的治疗方法之一[3].血浆置换(PE)是ALSS的一种,因其具有操作简单、方便、易行、有效等特点,是目前最常用的人工肝支持治疗方法.

干扰素目前作为有效的抗病毒药物被临床广泛应用,而且被公认对慢性乙型肝炎具有长期确切的疗效.但在应用中有一定的不良反应,常见的有感冒样综合征、骨髓抑制、消化道症状、神经系统症状,也有引起血小板急剧下降并导致眼底出血及血尿、心脏不良反应、肾功能衰竭的报道[1-2].2005年1-10月,本院应用α-2b干扰素治疗慢性乙型肝炎患者64例,其中出现中性粒细胞绝对值减少50例,缺乏4例,现将该类患者护理体会介绍如下.

我院从2003年2月开始,制定了<健康教育处方>,利用电视视屏、录像、幻灯、黑板专栏给病员集中宣传常见病、慢性病的预防及自我护理措施,增强病员的保健能力,收到了良好的效果.

食管、胃底静脉曲张破裂所致大出血是肝硬化病人最危急的并发症之一,临床表现以呕血和黑便或血便为主,并伴有不同程度血压下降和血色素降低.由于肝功能差,凝血功能障碍,故出血量大,病情凶险,如不及时抢救,常可在短时间内致出血性休克而危及生命,因此,及时、有效地止血治疗尤为重要.本院自1998年1月～2001年7月共收治肝硬化并发食管静脉曲张破裂所致上消化道大出血病人75例,用施他宁(瑞士Serono公司产品)治疗的41例 ,取得满意疗效,现报道如下.