Objective To explore the effect of solution-focused group dance on improving anxiety and depression, uncertainty in illness and self acceptance of Parkinson's disease (PD) patients in the early stage. Methods Eighty cases of PD patients in the early stage from January 2016 to January 2017 were divided into observation group and control group. The control group received routine psychological care, while the observation group received solution-focused group dance. The level of anxiety, depression, disease uncertainty and self acceptance of 2 groups after the intervention were compared. Results Before the intervention, the level of anxiety, depression, illness uncertainty and self acceptance of the 2 groups had no significant difference (P>0.05). But the level of anxiety, depression and uncertainty in illness was lower (P＜0.05) and the score of self-acceptance was significantly higher in the observation group than those in the control group 1 month and 2 months after the intervention (P＜0.05). Conclusion Solution-focused group dance can effectively improve anxiety and depression in PD patients in the early stage, eliminate their uncertainty in illness and enhance their self acceptance.

目的 旨在分析脑卒中康复期患者心理弹性与创伤后应激障碍(PTSD)相关性.方法 选取我院神经内科于2016年1月～2017年4月期间收治124例康复期脑卒中患者作为观察对象.分别使用一般情况自制调查问卷、心理弹性量表和创伤后应激障碍问卷调查患者一般情况、家庭情感支持和创伤后应激障碍.结果 康复期脑卒中患者心理弹性量总分(61.19±8.62)分,创伤后应激障碍总分(40.54±10.81)分.患者心理弹性与创伤后应激障碍呈现显著负相关性(P＜0.01).结论 脑卒中康复期患者具有较高的PTSD的发生率,且心理弹性较差.患者的心理弹性程度与PTSD严重程度有负相关,临床中应重视对此类患者及早的予以心理干预.

Objective To explore the correlation between social support and social avoidance distress in patients with mild aphasia. Methods 236 mild stroke aphasia patients were randomly selected as the research object from our hospital during January 2015 to January 2017. Social support were evaluated using Social Support Rating Scale (SRRS), and social avoidance distress were evaluated using Social Avoidance and Distress Scale (SADS). The association between social support and social avoidance and social distress were analyzed using pearson correlation. Results The social support score of male stroke patients with mild aphasia was significantly higher than that of female patients (P<0.05). The social avoidance and distress score of male stroke patients with mild aphasia was significantly lower than that of female patients (P<0.05). Social support score was significantly decreased with the increase of age. The social avoidance and distress score was significantly increased with age growth (P<0.05). The higher level of education was associated with higher social support and lower social avoidance and distress (P<0.05). The social support score of urban patients was significantly higher than that of rural patients (P<0.05). The social avoidance and distress score of urban patients was significantly lower than that of patients in rural areas (P<0.05). There was a negative correlation between social support and social avoidance and distress in patients with mild aphasia (P<0.05). Conclusion The nursing staff should effectively guide social support to the patients with mild aphasia, improve their self-confidence to communicate with others, and be optimistic about the ability of daily life.

Objective To analysis correlation of quality of social relationships a nd emotional symptoms in stroke hemiplegia patients.Methods 72 cases of stroke hemiplegia patients were selected as the observation object in the Department of Neurology of our hospital's from January 2016 ～ December 2016.Social relationship quality scale (SRQS)assessment of patients with quality of social relations.17 item Hamilton Depression Rating Scale (HAM D-17),14Hamilton Anxiety Scale (HAMA) and Beck-rafaelsdn Mania Rating Scale (BRMS) were used to measure the emotional symptoms.Pearson correlation analysis between social relationship and emotion symptoms.Results In these stroke hemiplegia patients,the total score of Social Relational Quality Scale (SRQS) is 32.8 ± 7.4.For the subscale analysis,Family Intimacy score is 13.8 ± 4.9;Family Commitment score is 10.2 ± 3.8,and Friendships score is 9.7 ± 2.9.For the emotion symptoms,the HAMD score is 54.8 ± 6.6,HAMA score is 48.1 ± 5.2,and BRMS score is 38.4 ± 4.5.Pearson correlation analysis showed that the total SRQS is negative associated depression,anxiety and mania symptoms in stroke hemiplegia patients (P＜ 0.01).The three subscale score of SRQS (Family Intimacy,Family Commitment and Friendships) were also negative associated depression,anxiety and mania symptoms in stroke hemiplegia patients (P ＜ 0.01).Conclusion There is a negative correlation between the quality of social relationship and emotion symptoms in stroke hemiplegia patients.Increasing the quality of social relationship may weaken the emotion symptoms.

目的 探讨家庭行为认知干预用于慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)合并抑郁焦虑情绪患者的效果.方法 选择2015年1月至12月在我院接受治疗的140例合并抑郁焦虑情绪的COPD患者,用随机数表法分为对照组和干预组,每组各70例.对照组给予常规的COPD护理干预,干预组在对照组的基础上给予家庭行为认知干预.结果 干预前两组患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分组间对比无明显差异(P＞0.05),干预后两组患者的SAS和SDS评分均出现明显下降,且干预组患者的SAS和SDS评分低于对照组,上述差异均有统计学意义(P＜0.05).干预前两组患者的第1秒用力呼气量(FEV1)、第1秒用力呼气容积占预计值百分比(FEVJFVC)和用力肺活量(FVC)等肺功能指标比较,差异无统计学意义(P＞0.05),干预后两组患者的肺功能指标与干预前相比均明显改善,且干预组患者的肺功能指标明显优于对照组,差异有统计学意义(P＜0.05).干预前两组患者的圣乔治呼吸问卷(SGRQ)评分中症状部分、活动能力、疾病影响和总分组间差异无统计学意义(P＞0.05),干预后两组患者的上述指标评分均明显下降,且干预组患者的评分低于对照组,生活质量更高,差异有统计学意义(P＜0.05).干预前两组患者缩唇呼吸、腹式呼吸和全身性呼吸体操等康复训练的依从性相近(P＞0.05),干预后两组患者的依从性均出现提高,且干预组患者的依从性高于对照组,差异有统计学意义(P＜0.05).结论 在常规护理干预措施的基础上增加家庭行为认知干预,可以更明显改善COPD合并抑郁焦虑情绪患者的不良情绪,提高康复训练依从性,从而提高肺功能和生活质量.

目的 探讨预见性护理对脑梗死继发抑郁症患者的临床效果.方法 选取2014年1月至2015年10月期间,我院住院治疗的脑梗死后继发抑郁症患者96例,按照随机数字表法平均分为观察组与对照组,每组48例.对照组患者予以常规护理1个月,观察组在予以常规护理的基础上予以预见性护理1个月.对比两组护理干预前后汉密尔顿抑郁量表评分(HAMD)、神经功能缺损量表评分(NIHSS)、生活活动能力量表(ADL)评分以及护理满意度量表评分的差异.结果 两组患者护理前HAMD、NIHSS、ADL评分对比均无明显差异(P＞0.05);两组患者护理后HAMD、NIHSS评分均明显低于护理前,ADL评分明显高于护理前(P＜0.05);且护理后观察组HAMD评分及NIHSS评分均显著低于对照组(P＜0.05),ADL评分显著高于对照组(P＜0.05);观察组的护理满意度为95.83％,显著高于对照组的85.42％(P＜0.05).结论 在常规护理的基础上,对脑梗死继发抑郁症患者实施预见性护理能够更有效地改善患者的抑郁症状及神经功能,提高日常生活能力,提高患者对护理的满意度,值得临床推广应用.

僵人综合征(stiff-man syndrome,SMS;stiff-person syndrome,SPS)是持续的强直性痉挛状态,表现为躯干和四肢近端肌僵硬和强直,伴痛性痉挛,下肢明显,是散发的缓慢进展性疾病[1].2009年11月我科收治1例僵人综合征患者,经过积极治疗和精心的护理,取得良好的效果,现报道如下. 病例介绍 患者,女,38岁,以"进行性肢体僵硬痉挛1年加重半年"收入院.患者1年前无明显诱因反复出现摔倒,家属述其摔倒时向左后方身体垂直摔倒,自觉左下肢无力,并逐渐出现左足趾变异畸形,并向上逐渐发展到整个左下肢,表现为左下肢僵硬伸直,左足趾间关节均明显屈曲,起立行走时自觉左足底疼痛,伴双髋部酸痛感,近半年来上述症状加重,不能行走及站立,并出现左上肢及右下肢僵硬感.症状持续,无波动性,无肌肉酸痛,无肌跳.经过积极治疗和精心的护理,患者症状明显改善,取得良好的效果.

果糖二磷酸钠是存在于人体内的细胞代谢物,能调节葡萄糖代谢中多种酶系的活性,改善细胞缺氧、缺血的状态,目前临床广泛应用于脑血管、心血管疾病患者,如心梗急性发作、脑梗死急性发作.但在临床使用过程中,发现果糖二磷酸钠注射液与多种药物存在配伍禁忌[1],为了规避因药物之间相互作用造成的风险,现对该药物的配伍禁忌谱做一个归纳.

急性缺血性脑卒中自然预后差,病死率和致残率高,及时的溶栓治疗能够再通堵塞血管,挽救缺血半暗带,被认为是最有希望治疗急性缺血性脑卒中的方法.重组组织型纤溶酶原激活剂(rt-PA)是惟一经循证医学证实能有效治疗发病3 h内急性缺血性卒中的药物,本药的活性成分是一种糖蛋白,与纤维蛋白结合后可直接激活纤溶酶原转化为纤溶酶,导致纤维蛋白降解,血块溶解[1].

Chiari 畸形是以小脑扁桃体下疝畸形为特征的先天性疾患,常合并脊髓空洞症及环枕畸形[1].夏科关节是一种慢性无痛性关节破坏性疾病,多由脊髓空洞症引起,好发生于肘关节及踝关节.我院于2009-06收治1例Chiari 畸形下颈段脊髓空洞合并左肘夏科关节患者,经后正中入路环枕减压术治疗和围手术期护理痊愈出院,现将护理体会报告如下.

恶性胸腔积液(MPE)是指由肺癌或其他部位恶性肿瘤累及胸膜的胸膜腔积液,是晚期恶性肿瘤的常见并发症,其中肺癌约占MPE的1/3,乳腺癌居第二. 目前恶性胸水的治疗主要包括胸水引流、局部化疗加高频热疗,能使胸水减少及血性胸水逐渐变淡,呼吸困难等症状减轻,其疗效确切,有效遏制疾病恶化.我科2008年3月至2009年1月应用循证护理对32例患者实施评估、分析,制定护理计划并实施,取得了较满意的效果.介绍如下.

神经内科主要收治脑梗死和脑出血患者,收治对象以老年人为主,具有年龄大、病情重、合并疾病多、检查项目多的特点,加之老年人思维迟缓、听觉理解和判断力障碍、记忆力减退.

为了消除患者的病痛和心理障碍,提高生活质量、增加治疗的信心,恢复患者的社会角色和家庭角色[1],我科运用护理程序对肿瘤热疗患者实施健康心理教育,取得了较好的效果,现将护理体会介绍如下.

目的:通过循证护理使化疗患者能够减少痛苦,延长生命,提高生活质量。方法:通过对患者进行心理护理、胃肠道反应护理、骨髓抑制护理、黏膜、皮肤反应、泌尿系毒性反应等方面的护理,及时为其解除痛苦,使其树立信心并坚持全程治疗。结果:患者能正确对待疾病,解除思想顾虑,更好地配合治疗。结论:全方位的循证护理是完成化疗计划的基础保证。

求医行为是人们感到自己身体有了不适感觉或出现了某种疾病症状,主动请求医护人员诊治、护理的过程,而癌症患者除有以上求医行为外,同时还具备特殊性心理,医务人员应了解患者的心理,循循诱导,取得患者的信任,听从医务人员指导、配合治疗,充分发挥主观能动性,对癌症患者的身心治疗及康复有重要意义[1].

收集2006-02-01～2007-02-31在我科治疗鼻咽癌患者29例,护理效果较好[1],总结如下.

目的探讨家庭护理干预对白血病缓解期患者预后的影响.方法将50例白血病缓解期患者随机分为对照组与观察组各25例,对照组进行常规出院指导,观察组进行家庭护理干预.比较两组遵医率、白血病复发再住院率、并发症发生率及生活质量.结果观察组较对照组遵医率显著提高,复发率显著降低,生活质量显著提高(P<0.05,P<0.01).结论家庭护理干预可以明显改善白血病缓解期患者的预后.

便秘是癌症化疗患者常见的并发症之一,其发生率约占15%[1].而由便秘引起的并发症如恶心、呕吐、腹胀、腹痛、食欲不振、烦躁、心慌,甚至大便用力造成的出血、晕厥等严重影响患者的生活质量,使化疗不能顺利进行.因此,针对化疗患者便秘发生的原因进行预见性的健康指导,对降低这类患者便秘的发生率及减轻排便伴随的不适症状有积极的作用.现报道如下.

目的 探讨静脉化疗时调控推注速度和压力对血管内膜产生的影响,寻求较理想的推注方式。方法 选择对血管 具有强刺激性的化疗药阿霉素作为代表性药物,在12只新西兰大白兔的耳缘静脉上进行推注。右耳采用微量泵推注（研究 组）,调控速度为99ml／h,压力为1bar;左耳采用手工摧注（对照组）,两组推注时间均为3min。48h后分别将两组耳缘静脉制 作成标本,在光学显微镜下观察。结果 研究组耳缘静脉血管内膜损伤程度明显轻于对照组（P＜0．01）;研究组穿刺处按压 止血所用时间少于对照组;研究组进行药物推注时较对照组安静。结论 应用微量泵调控推注速度及压力,形成恒速衡压进 行静脉化疗,能明显减轻对血管内膜的损伤,有效保护血管,减少静脉炎的发生。