目的 探讨基于国际医疗卫生机构认证联合委员会(JCI)标准的优质护理在冠状动脉搭桥术患者中的应用效果.方法 回顾性分析2018年3月—2022年3月于濮阳市油田总医院行冠状动脉搭桥术的106例患者的临床资料,根据护理干预方式的不同分为研究组(n=54)与对照组(n=52),对照组患者采用常规护理,研究组患者采用基于JCI标准下的优质护理.比较2组患者干预后自我护理能力、疾病相关康复知识掌握情况、治疗依从情况、生活质量,干预前后心理状态及护理满意度.结果 研究组患者干预后疾病相关康复知识、治疗依从性、自我护理能力及生活质量评分均高于对照组,差异均有统计学意义(P＜0.05).2组患者干预后焦虑自评量表(SAS)及抑郁自评量表(SDS)评分均低于干预前,且研究组低于对照组,差异均有统计学意义(P＜0.05).研究组患者护理满意度为96.30％,高于对照组的82.69％,差异有统计学意义(x2=5.271,P=0.022).结论 在冠状动脉搭桥术患者中应用基于JCI标准的优质护理干预,有助于提升患者自我护理能力、生活质量及治疗依从性,改善患者心理状态,促进患者对疾病相关康复知识的了解,具有良好的应用价值.

目的:探讨改变食物性状结合康复护理干预对脑卒中后吞咽障碍患者进食安全及营养状况的影响.方法:选取2019年11月1日～2021年3月31日就诊的150例脑卒中后吞咽障碍患者为研究对象,根据随机数字表法将其分为观察组和常规组各75例.常规组接受常规康复治疗及护理干预,观察组在常规组基础上接受改变食物性状干预,两组均干预3周;比较两组干预前后吞咽功能[采用洼田饮水试验评分、功能性吞咽困难量表(FDS)]及误吸、肺部感染、留置胃管情况和营养状况[包括血清白蛋白(ALB)、甘油三酯(TG)、总胆固醇(TC)、三头肌皮褶厚度(TSF)、体质量指数(BMI)].结果:干预3周后,两组洼田饮水试验评分、FDS评分低于干预前(P<0.05),且观察组低于常规组(P<0.05);干预3周后,两组误吸、肺部感染、留置胃管比例低于干预前(P<0.05),且观察组低于常规组(P<0.05);干预3周后,两组血清ALB、TG、TC水平、TSF、BMI均高于干预前(P<0.05),且观察组高于常规组(P<0.05).结论:改变食物性状结合康复护理干预可有效降低脑卒中后吞咽障碍患者误吸、肺部感染、留置胃管比例,提高进食安全,改善患者吞咽功能及营养状况.

目的 探讨全程护理模式在雾化吸入治疗老年慢性阻塞性肺气肿患者中的应用效果.方法 选取我院2019年3月至2021年3月接收的102例老年慢性阻塞性肺气肿患者,根据随机数字表法将其分为对照组(51例,雾化吸入治疗+常规护理)和观察组(51例,雾化吸入治疗+全程护理).比较两组患者的肺功能指标、护理效果及护理满意度.结果 干预后,观察组的FEV1、FVC、FEV1/FVC均高于对照组(P<0.05).观察组的护理总有效率为96.08％,显著高于对照组的82.35％(P<0.05).观察组的护理满意度为96.08％,显著高于对照组的82.35％(P<0.05).结论 全程护理模式在雾化吸入治疗老年慢性阻塞性肺气肿患者中的应用效果显著,能够有效促进患者肺功能恢复,提高护理效果和护理满意度.

目的:探讨枯草杆菌二联活菌颗粒联合利巴韦林治疗轮状病毒肠炎患儿的临床效果.方法:选取2018年2月～2019年10月收治的轮状病毒肠炎患儿97例,将在常规治疗基础上采用利巴韦林治疗的48例患儿纳入对照组,在对照组基础上联合枯草杆菌二联活菌颗粒治疗的49例患儿纳入观察组.比较两组疗效、免疫指标(T淋巴细胞亚群CD3+、CD4+、CD8+)、炎症介质指标(白细胞介素-8、白细胞介素-6).结果:观察组治疗总有效率为95.92％,高于对照组的81.25％(P<0.05);治疗3 d后,观察组CD3+、CD4+水平高于对照组,CD8+、白细胞介素-8、白细胞介素-6水平低于对照组(P<0.05).结论:枯草杆菌二联活菌颗粒联合利巴韦林治疗轮状病毒肠炎患儿,疗效显著,可减轻机体炎症反应,改善免疫功能.

Objective:To analyze the possible influencing factors of postoperative pulmonary infection in patients with intracranial tumor, so as to provide reference for formulating reasonable prevention and treatment plan.Methods:A total of 82 patients with intracranial tumors who received surgical treatment in Henan Provincial People’s Hospital from June 2018 to October 2019 were selected as the research subjects. And they were divided into the occurrence group and the non occurrence group according to whether postoperative pulmonary infection occurred. A general questionnaire was designed to investigate and record the baseline data of patients. All possible factors were taken into account, and the influencing factors of postoperative pulmonary infection in patients with intracranial tumor were found out by univariate and multivariate analysis.Results:Among the 82 patients with intracranial tumor, 15 patients were complicated by pulmonary infection, and the incidence was 18.29%. The proportions of chronic history of lung and invasive operation in the occurrence group were higher than those in the non occurrence group ( P<0.05). Compared with the non occurrence group, the occurrence group had more sputum aspiration times per day, long tracheotomy time and lower Glasgow Coma Scale (GCS) score ( P<0.05). Multivariate regression analysis showed that chronic history of lung disease, invasive operation, frequent suction, longer tracheotomy time and low GCS score are the influencing factors of postoperative pulmonary infection in patients with intracranial tumor ( OR>1, P<0.05). Conclusions:Chronic pulmonary history, invasive operation, frequent suction, longer tracheotomy time, and lower GCS score in patients with intracranial tumor will increase the risk of postoperative pulmonary infection. Clinicians should promptly optimize and adjust surgical procedures for intracranial tumor patients with the above risk factors of pulmonary infection, and carry out targeted intervention for patients as soon as possible.

目的 观察家属参与式健康管理模式在川崎病(MCLS)患儿延续性护理中的应用.方法 以2016年3月至2017年3月112例MCLS患儿为研究对象,随机分为对照组(常规延续性护理,56例)和观察组(家属参与式健康管理护理,56例).比较两组患儿治疗依从性、患儿家属对护理技术、护理态度及健康教育的满意度及患儿住院时间、2年再住院率及冠脉病变发生率.结果 观察组患儿治疗依从性为96.43％,高于对照组的82.14％,患儿家属对护理技术、护理态度及健康教育的满意度为96.43％、98.21％、94.64％,均高于对照组的83.93％、85.71％、78.57％,观察组住院时间为(7.36±1.58)d,短于对照组的(8.92±1.71)d,2年再住院率及冠脉病变发生率为3.57％、8.93％,低于对照组的17.86％、25.00％(P<0.05).结论 将家属参与式健康管理模式应用到MCLS患儿延续性护理中,不仅能改善预后,还能提高患儿治疗依从性及患儿家属对护理的满意度.

目的:探讨咽部冰刺激联合电子生物反馈治疗在脑卒中吞咽障碍患者早期康复中的应用效果。方法:选取该院接受治疗的脑卒中吞咽障碍患者60例为研究对象，随机分为对照组和试验组各30例。对照组实施常规康复治疗，试验组在常规康复治疗的基础上实施冰刺激(口腔、咽部)联合电子生物反馈治疗。对比两组临床治疗效果。结果:试验组的治疗总有效率为96.67%，明显高于对照组的66.67%( P<0.05)。 结论:咽部冰刺激联合电子生物反馈治疗有利于提升早期脑卒中吞咽障碍患者口腔、咽部肌肉功能，具有广阔的临床应用前景。

目的 研究盐酸氨溴索对急性呼吸窘迫综合征(ARDS)大鼠肺纤维化的影响及作用机制.方法 将60只雄性Wistar大鼠随机分为对照组(n=20)、模型组(n =20)及实验组(n =20).模型组及实验组大鼠均用气管滴注 3 mg·kg-1脂多糖(LPS)100 μL,构建ARDS大鼠模型.造模成功后,实验组大鼠腹腔注射盐酸氨溴索注射液40.0 mg·kg-1·d-1,对照组与模型组则注射等量生理盐水,连续干预21 d.用酶联免疫吸附法检测肺组织肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平及羟脯氨酸(HYP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物(GSH-Px)含量,用蛋白质印迹法检测大鼠肺组织中核因子-κB(NF-κB)P65蛋白表达水平.结果 对照组、模型组及实验组大鼠肺组织炎性因子TNF-α分别为(10.87 ± 1.22),(36.93 ± 3.14),(17.86 ± 2.38)pg·g-1,IL-6 分别为(14.73 ± 1.56),(37.12 ± 4.61),(20.96 ± 2.03)pg·g-1,HYP 分别为(319.55 ± 46.37),(743.22 ± 91.31),(415.38 ± 57.88)μg·g-1;MDA 分别为(12.78 ± 1.96),(33.45 ± 5.16),(18.02 ± 3.34)μmol·g-1;SOD 分别为(69.76 ± 10.32),(28.63 ± 2.89),(56.12 ± 5.33)kU·g-1,GSH-Px 分别为(46.23 ± 4.81),(15.04 ± 2.39),(37.73 ± 3.68)kU·g-1,大鼠肺组织中 NF-κB P65 蛋白相对表达量分别为0.09 ± 0.04,0.81 ± 0.15,0.34 ± 0.11.模型组和实验组与对照组比,以上各指标差异均有统计学意义(均P＜0.05);实验组与模型组比较,差异均有统计学意义(均P＜0.05).结论 盐酸氨溴索可降低炎症因子水平、减少氧自由基生成,抑制肺组织NF-κB P65蛋白表达,进而减轻ARDS大鼠肺损伤及肺纤维化.

目的 基于微信平台为帕金森病患者提供延续性护理,改善帕金森病患者的生活质量,并满足护理服务的需要.方法 将80例帕金森病患者随机分为观察组和对照组,对照组接受常规出院健康指导,观察组接受继续健康指导,对比两组护理效果.结果 开展微信延续性护理服务工作以来,观察组的生活质量评分和护理满意度评分明显高于对照组.结论 微信平台可为帕金森病患者提供有效的延续性护理,提高帕金森病患者的生活质量和其对护理服务满意度,受到患者家属及医护人员的一致好评.

OBJECTIVE To evaluate the efficacy and safety of high maintenance dose of teicoplanin in treatment of methicillin-resistant Staphylococcus aureus (MRSA) pulmonary infection so as to provide objective basis for clinical treatment of the infection.METHODS A total of 96 patients with MRSA pulmonary infection who were treated in the hospital from Jan 2015 to Dec 2016 were recruited as the study objects and divided into the experimental group and the control group,with 48 cases in each group.The control group was given the routine maintenance dose of teicoplanin (400mg/d),while the experimental group was treated with high maintenance dose of teicoplanin (600mg/d).The curative effect indexes and trough plasma.concentration (Cmin) of teicoplanin were observed and compared between the two groups of patients;the clearance effect of pathogens,clinical therapeutic effect and adverse reactions during the treatment were observed.RESULTS The curative effect indexes of the experimental group were better than those of the control group(P＜0.001),and the Cmin of teicoplanin of the experimental group was higher than that of the control group(P＜0.001).The clearance effect of pathogens of the experimental group was better than that of the control group (P＜0.001).There were no significant differences in the adverse reactions between the two groups of patients.CONCLUSION The high maintenance dose of teicoplanin may boost the curative effect of the patients with MRSA pulmonary infection,accelerate the recovery of clinical symptoms,raise the clearance rate of pathogens and maintain high plasma concentration without increasing the incidence of adverse reactions,with the safety high.

Objective To analyze the causes of 154 benign tracheal stenosis and to evaluate the efficacy and safety of APC and associated with cryotherapy.Methods Totally 154 patients with benign central airway stenoses in our hospital from 2012.1 to 2014.12 were retrospectively analyzed.Patients were randomly treated by APC or combined with cryotherapy,respectively 85 cases and 69 cases.Contrast the improvement of the airway stenosis,and assessment the asthma symptoms and shortness of breath index before and after therapy,and follow-up the situation of the airway restenosis.Results Totally 154 cases of benign tracheal stenosis were recruited to our study.The main causes of benign tracheal stenosis were as follows:secondary to tracheal intubation or tracheotomy in 63％ (tracheal intubation 58,tracheotomy 39).tuberculosis 18.8％ (29),benign tumor in 5.8％ (9),polychondritis in 3.2％ (4)and other 9.1％.APC group were totally treated 290 times,the combined treatment group 202 times,the airway stenosis of the two groups postoperative were significantly improved,the total effective rate of combined treatment group was 94.2％ (65/69) and in the APC was 74.1％ (63/85).The airway stability time treated by the two ways was significantly longer than the APC group.Conclusion In the causes constituents of the benign tracheal stenosis,tracheal intubation and tracheotomy is common,followed by tracheal tuberculosis;In interventional therapy,the total effective rate of the combined treatment is higher than APC,fewer treatment numbers and maintained longer.

OBJECTIVE To study the related factors of pulmonary infections in the patients with acute exacerbation of chronic obstructive pulmonary disease(COPD) and analyze the drug resistance so as to reduce the incidence of pulmonary infections in the patients with acute exacerbation of COPD.METHODS A total of 68 cases of acute exacerbations of COPD patients complicated with pulmonary infections,who were treated in the hospital from Jan 2009 to Jun 2012,were selected as the pulmonary infection group,while 68 cases of acute exacerbation of COPD patients without pulmonary infections were chosen as the non-pulmonary infection group,then the clinical data of the two groups of patients were retrospectively analyzed,and the related factors for the fungal infections were analyzed.RESULTS A total of 81strains of fungi were isolated,among which the Candida albicans was the predominant species,accounting for 45.68%,followed by Aspergillus fumigatus(25.93%) and other Candida(17.28%).The drug resistance rates to flucytosine,amphotericin B,the ball erythromycin,mepartricin,g mycophenolate Ling,fluconazole and itraconazole were less than 30.00%.The univariate analysis indicated that the long-term use of antibiotics and hormones,hypoalbuminemia,and mechanical ventilation were the risk factors;the multivariate logistic analysis showed that the complication of diabetes,hypoproteinemia,and long-term use of antibiotics were the important risk factors that resulted in the pulmonary infections in the elderly patients with acute exacerbations of COPD.CONCLUSION The pulmonary infections in the elderly patients with acute exacerbation of COPD are mainly associated with the long-term use of antibiotics,hypoalbuminemia,or diabetes.The fungi are highly drug resistant,it is necessary for the hospital to reasonably use antibiotics.

近年来经皮微创胸腔闭式引流应用于自发性气胸的治疗临床多有报道,并取得了很好的效果[1],我科自2006年3月至2006年9月借鉴其方法用于胸腔积液的治疗,取得了很好的疗效,现报道如下: 1 资料与方法

低分子量肝素钙是一种新型的抗凝血酶Ⅲ依赖性抗血栓形成药,其药理作用与普通肝素基本相似.具有抗血栓形成和溶解血栓的作用.我科2001年3月开始应用于临床.使用初期,我们发现部分患者注射部位出现大块瘀血斑.为探讨瘀血斑发生的原因,我们对注射法进行了总结和改进,收到了满意的效果.