Objective To explore the causes of venous thrombosis after peripherally inserted central catheter ( PICC) in tumor patients and corresponding nursing precautions. Methods A total of 105 patients with tumors under-going long-term infusion and chemotherapy in this hospital were selected as the research subjects. All patients were trea-ted with PICC catheterization. Nursing measures were observed and administered at the beginning of catheterization. Results A total of 6 patients developed venous thrombosis, and the patients'condition gradually recovered after antico-agulation therapy. It was found that venous thrombosis was not only directly related to catheterization, but also related to drug use in the course of disease treatment and activity of patients. Conclusion Skilled puncture techniques and re-lated nursing measures can effectively reduce the occurrence of venous thrombosis in patients with PICC.

目的:对舒芬太尼与地佐辛预防瑞芬太尼麻醉后疼痛过敏效果进行对比.方法:将我院收治的腰椎椎弓根内固定术患者78例,随机分为A组39例及B组39例,两组患者均采取瑞芬太尼进行麻醉.A组手术结束前10min给予舒芬太尼,B组手术结束前给予地佐辛,对比两组患者麻醉后VAS评分及疼痛过敏反应情况.结果:A、B两组患者拔管后VAS无明显差异.A组患者疼痛过敏反应发生率为15.38％;B组疼痛过敏反应发生率为28.21％,A组疼痛过敏反应发生率要低于B组(P＜0.05).结论:与地佐辛相比,舒芬太尼预防瑞芬太尼麻醉后疼痛过敏效果更好.

Objective:To observe the effect of patients with type 2 diabetes mellitus in community standardized management and inves-tigate the Influence of the community health service on the type 2 diabetes mellitus .Methods:94 cases of type 2 diabetes mellitus treated in our center were randomly divided into two groups, the experimental group(n=47) and the control group (n=47) .The experimental group was given the community comprehensive intervention and standardized management on the basis of conventional drug treatment;the control group was given the general management and conventional drug treatment, two groups of time is one year, comparing two groups of patients in the changes of the fasting plasma glucose, 2 hours postprandial blood glucose, glycosylated hemoglobin, body mass index and lifestyle.Results:one year later, the experimental group in the levels of fasting plasma glucose, 2 hours postprandial blood glucose, gly-cosylated hemoglobin index, body mass index and life behaviors was significantly improved than that of the control group, the differences were statistically significant(P﹤0.05).Conclusion:In the community standardized management, the patients with type 2 diabetes mel-litus can effectively change the unhealthy life style and behavior habits, control blood sugar levels, improve the quality of life and prevent the occurrence of complications, which is worth spreading in community.

目的 观察厄贝沙坦联合硝苯地平控释片治疗原发性高血压的临床疗效及安全性.方法 选取中心2013年5月-2014年4月门诊收治的92例原发性高血压患者,随机分为治疗组和对照组,治疗组47例给予厄贝沙坦片0.15g+硝苯地平控释片30 mg晨服,1次/d,对照组45例给予厄贝沙坦片0.15g晨服,1次/d,两组用药均为8周,治疗结束后比较两组治疗前后的临床疗效、血压、心率变化及不良反应.计量资料采用t检验,计数资料采用x2检验,P＜0.05为差异有统计学意义.结果 治疗8周后治疗组总有效率为93.62％,对照组为73.33％,治疗组明显高于对照组,两组比较差异有统计学意义(P＜0.05).治疗组治疗后收缩压与舒张压分别为[(123.9±7.3)、(74.7±5.8) mmHg](1 mm Hg=0.133 KPa)均显著低于治疗前[(161.7±9.6)、(102.5±7.9) mmHg],对照组治疗后收缩压与舒张压[(136.5±6.8)、(87.5±6.1) mmHg]明显低于治疗前[(160.8±9.2)、(101.8±7.3)mmHg],比较差异均有统计学意义(P＜0.05).治疗后治疗组收缩压与舒张压[(123.9±7.3)、(74.7±5.8) mmHg]显著低于对照组治疗后[(136.5±6.8)mmHg、(87.5±6.1) mmHg],比较差异均有统计学意义(P＜0.05).治疗组与对照组治疗后心率与治疗前比较,差异均无统计学意义(P＞ 0.05),所有患者未发生严重的不良发应.结论 厄贝沙坦联合硝苯地平控释片治疗原发性高血压疗效优于单用厄贝沙坦,且作用持久,耐受性、安全性较好,适合临床推广使用.

Objective Propofol intravenous anesthesia and the contrast research of compound epidural anesthesia. Methods Select our hospital from January 2013 to January 2014,68 patients with gynecological laparoscopic surgery; Divided into two groups,control group given propofol intravenous anesthesia,the team given intravenous general anesthesia compound epidural anesthesia,compared two groups of postoperative nausea and vomiting for 24 h. Results Postoperative,the team the incidence of nausea and vomiting is lower than the control group,comparing the difference was statistically significant (P<0.05). Conclusion Intravenous general anesthesia compound epidural anesthesia in laparoscopic surgery application effect is better,worthy of popularization and application in clinic.

Objective To observe the efficacy of Palonosetron hydrochloride injection for preventing chemotherapy-induced nausea and vomiting in hepatocellular carcinoma treated with TACE(transcatheter arterial chemoembolization).Methods 48 patients with hepatocellular carcinoma who underwent TACE were randomly divided into two groups: observation group and control group.Palonosetron hydrochloride was given to the observation group intravenously in a dose of 0.25 mg 30 min before TACE while Granisetron hydrochloride to the control group in a dose of 6 mg.The symptoms of nausea and vomiting and adverse reaction were compared in both groups on day 1,3 after TACE.Results The total effective rate for nausea was 95.83% and 87.50% in the observation group and control group respectively on day 1 after TACE,while the total effective rate for vomiting was 100.00% and 87.50% respectively.Significant difference was found in the two groups(both P0.05).The total effectiveness rate for nausea was 91.67% and 54.16% in the observation group and control group respectively on day 3 after TACE,while the total effectiveness rate for vomiting was 83.33% and 50.00% respectively.There was significant difference between the two groups(both P0.05).The incidence of adverse reaction was 4.16% in both groups,which showed no significant difference(P0.05).Conclusions Palonosetron hydrochloride is an efficient antiemetic for hepatocellular carcinoma treated with TACE.The long lasting action makes it more effective for late onset vomiting.

Objective To observe the clinical feasibility and safety of peripherally inserted central catheters(PICC) for parental nutrition during concurrent chemoradiotherapy in patients with head and neck cancer.Methods Thirty-six cases with head and neck cancer who had received concurrent chemoradiotherapy were selected.All patients received ultrasound-guided PICC for parenteral nutrition,and were rated for the success rate of PICC puncture and the number of cases who had finished their treatment.Side effects of PICC were also observed.Results Ultrasound-guided PICC has a higher success rate and a lower incidence of complications.Thirty-two cases completed concurrent chemoradiation with parenteral nutrition support by PICC;2 cases abandoned treatment for adverse reactions;2 cases switched to using gastric tube for nutrition support due to complications of PICC(vein thrombosis developed in one case,pain at intubation site in another).Conclusions For concurrent chemoraidotherapy in the head and neck cancer,PICC for parental nutrition is safe,effective and helpful in the treatment.

目的 观察吸入氧化亚氮联合丙泊酚与芬太尼用于无痛人工流产的麻醉效果与安全性.方法 选择自愿实施无痛人工流产的孕妇120例,随机分为A、B两组,A组为对照组60例,为丙泊酚+芬太尼；B组为治疗组60例,丙泊酚+芬太尼+氧化亚氮.记录两组患者术前、术中的心率(HR)、平均动脉压(MAP)、血氧饱和度(SPO2),手术中镇痛的效果,患者术后清醒时间及术后定向力的恢复时间,记录丙泊酚用量,观察和记录术后不良反应.结果 A组HR、MAP术中均有所下降,B组HR、MAP麻醉前后变化比较,无统计学意义,A、B两组SPO2麻醉前后变化比较,无统计学意义(P＞0.05).A、B两组丙泊酚总量对比,以及清醒时间、准确定向时间对比,差异有统计学意义(P＜0.05).麻醉效果B组优于A组,术后注射部位痛、呼吸抑制的发生率两组对比,差异均有统计学意义(P＜0.05).结论 丙泊酚和芬太尼复合氧化亚氮麻醉用于人工流产术中,具有对呼吸、循环抑制轻,术中、术后镇痛效果好,苏醒快等优点,并可减少丙泊酚的用量,是无痛人工流产较理想的麻醉方法.

<正>对于恶性肿瘤,静脉化疗和胃肠外静脉营养在提高肿瘤的治愈率、延长生存期、改善患者的生活质量等方面发挥着重要作用,为了避免化疗、高渗药物和反复穿刺对表浅静脉血管的损伤,特别是对表浅静脉条件不好的患者,中心静脉置管是必要的选

Objective To evaluate the therapeutic effect of simple homemade hiccup therapeutic apparatus in resistant hiccup.Methods 60 patients with resistant hiccup were treated with simple homemade hiccup therapeutic apparatus.Their mouths and noses were sealed with masks.The patients,in supine position,respired with the apparatus for 3 to 5 minutes after a deep inspiration.If hiccup was continuous,the time should be longer than 5 minutes and can be repeated 2-3 sessions.HR,SBP,DBP,RR,PETCO2 were observed in the course of treatment.Results The cure,efficient,inefficient,and total effective rates of 31 resistant hiccup patients caused by tumor were 29.0%,54.8%,16.1%,83.9% respectively while the ones of other 29 patients caused by other diseases were 82.8%,17.2%,0,100.0% respectively.There was statistical significance between the beginning and three minutes of treatment in the HR,SBP,DBP,RR,PETCO2.Conclusion The simple homemade hiccup therapeutic apparatus is a safe,effective,and easy method to treat resistant hiccup.

近年来,医患纠纷逐年增加,各种不良的医患关系正处于矛盾的激化点上.建立良好医患关系是保证医疗服务质量及消除医患矛盾的基础.而医患沟通是贯穿于整个医疗活动过程中并很大程度上决定医疗服务质量的特殊人际关系过程,它是建立良好医患关系的前提.为此,应大力倡导良好的医患沟通,努力提高沟通的技巧和水平.

双硫仑样反应又称双硫醒样反应或戒酒硫样反应,实质是乙醛中毒反应.某些药物能抑制肝脏线粒体内的乙醛脱氢酶,使乙醇在体内氧化为乙醛后不能再继续氧化分解,导致乙醛在体内的蓄积,引起乙醛中毒反应.近年来成人应用某些药物期间饮酒发生该反应的报告已很多,但小儿发生此反应的病例报道少见,现就我院2000～2006年6年间先后出现的16例由于药物治疗期间医疗酒精使用不当、使用含乙醇或使机体产生乙醇的药物、食用含乙醇食物引起的双硫仑样反应报告如下,提醒临床予以重视.