目的:观察外伤性肾损伤出血行肾动脉栓塞术及护理效果。方法:本组26例，其中12例有失血性休克。均采用Seldinger技术，经股动脉穿刺选择性肾动脉造影，超选择性插管后注入栓塞剂。术前重点监测生命体征，及时补液、止血、输血防治休克。术中顺应医师的操作，观察生命体征、小便量、色的变化。术后:重点预防穿刺点出血，观察下肢血液循环，处理疼痛，发热等并发症。结果:26例患者临床症状很快缓解，血压均在12h内恢复正常，血尿在1～2天消失，有效率达100%。结论:外伤性肾损伤出血，采用肾动脉栓塞术即可立刻止血，又可为患者保全功能正常的肾脏。
Objective To investigate the comprehensive interventions of hypertension in urban community, and to provide evidence for the hypertension intervention of urban community. Methods A stratified random sampling method was used to enroll 136 patients with essential hypertension in Shuangnan community of Chengdu city, including 77 males and 59 females. Their average age was 59±3.9. The indexes of compliance index (CI) and control rates for blood pressure by using different kinds of antihypertensive drugs were observed after 3 months. With the same medications, the level and control rates for blood pressure were evaluated at baseline and after 3 months of participation in the program of therapeutic lifestyle changes (TLC). Results The group of combination of antihypertensive drugs (n=12) had the highest control rate (83.3%). The group of long-acting calcium antagonist (n=31) had high index of control rate (54.8%) and CI (91.4%). The group of short-acting agents (n=25) had the lowest index of control rate (8.0%) and CI (41.2%). The patients had greater reduction in the level for blood pressure after TLC with significant difference (Plt;0.05). Conclusion It is necessary to strengthen and standardize the measures of comprehensive interventions on community treatment of hypertension. The program of reasonable antihypertensive drugs based on TLC should be developed positively.
本文通过总结护士与老年患者进行一般性沟通和治疗性沟通的临床护理经验,提出改善临床护患沟通的重要性和意义,旨在增进老年病房护士的临床沟通技巧,适应不断增长的老年患者服务需求,提高老年病房护理质量。
ObjectiveTo investigate the effects of esophageal cooling (EC) on lung injury and systemic inflammatory response after cardiopulmonary resuscitation in swine.MethodsThirty-two domestic male white pigs were randomly divided into sham group (S group, n=5), normothermia group (NT group, n=9), surface cooling group (SC group, n=9), and EC group (n=9). The animals in the S group only experienced the animal preparation. The animal model was established by 8 min of ventricular fibrillation and then 5 min of cardiopulmonary resuscitation in the other three groups. A normal temperature of (38.0±0.5)℃ was maintained by surface blanket throughout the experiment in the S and NT groups. At 5 min after resuscitation, therapeutic hypothermia was implemented via surface blanket or EC catheter to reach a target temperature of 33℃, and then maintained until 24 h post resuscitation, and followed by a rewarming rate of 1℃/h for 5 h in the SC and EC groups. At 1, 6, 12, 24 and 30 h after resuscitation, the values of extra-vascular lung water index (ELWI) and pulmonary vascular permeability index (PVPI) were measured, and meanwhile arterial blood samples were collected to measure the values of oxygenation index (OI) and venous blood samples were collected to measure the serum levels of tumor necrosis factor-α (TNF-α) and inerleukin-6 (IL-6). At 30 h after resuscitation, the animals were euthanized, and then the lung tissue contents of TNF-α, IL-6 and malondialdehyde, and the activities of superoxide dismutase (SOD) were detected.ResultsAfter resuscitation, the induction of hypothermia was significantly faster in the EC group than that in the SC group (2.8 vs. 1.5℃/h, P<0.05), and then its maintenance and rewarming were equally achieved in the two groups. The values of ELWI and PVPI significantly decreased and the values of OI significantly increased from 6 h after resuscitation in the EC group and from 12 h after resuscitation in the SC group compared with the NT group (all P<0.05). Additionally, the values of ELWI and PVPI were significantly lower and the values of OI were significantly higher from 12 h after resuscitation in the EC group than those in the SC group [ELWI: (13.4±3.1) vs. (16.8±2.7) mL/kg at 12 h, (12.4±3.0) vs. (16.0±3.6) mL/kg at 24 h, (11.1±2.4) vs. (13.9±1.9) mL/kg at 30 h; PVPI: 3.7±0.9 vs. 5.0±1.1 at 12 h, 3.4±0.8 vs. 4.6±1.0 at 24 h, 3.1±0.7 vs. 4.2±0.7 at 30 h; OI: (470±41) vs. (417±42) mm Hg (1 mm Hg=0.133 kPa) at 12 h, (462±39) vs. (407±36) mm Hg at 24 h, (438±60) vs. (380±33) mm Hg at 30 h; all P<0.05]. The serum levels of TNF-α and IL-6 significantly decreased from 6 h after resuscitation in the SC and EC groups compared with the NT group (all P<0.05). Additionally, the serum levels of IL-6 from 6 h after resuscitation and the serum levels of TNF-α from 12 h after resuscitation were significantly lower in the EC group than those in the SC group [IL-6: (299±23) vs. (329±30) pg/mL at 6 h, (336±35) vs. (375±30) pg/mL at 12 h, (297±29) vs. (339±36) pg/mL at 24 h, (255±20) vs. (297±33) pg/mL at 30 h; TNF-α: (519±46) vs. (572±49) pg/mL at 12 h, (477±77) vs. (570±64) pg/mL at 24 h, (436±49) vs. (509±51) pg/mL at 30 h; all P<0.05]. The contents of TNF-α, IL-6, and malondialdehyde significantly decreased and the activities of SOD significantly increased in the SC and EC groups compared with the NT group (all P<0.05). Additionally, lung inflammation and oxidative stress were further significantly alleviated in the EC group compared with the SC group [TNF-α: (557±155) vs. (782±154) pg/mg prot; IL-6: (616±134) vs. (868±143) pg/mg prot; malondialdehyde: (4.95±1.53) vs. (7.53±1.77) nmol/mg prot; SOD: (3.18±0.74) vs. (2.14±1.00) U/mg prot; all P<0.05].ConclusionTherapeutic hypothermia could be rapidly induced by EC after resuscitation, and further significantly alleviated post-resuscitation lung injury and systemic inflammatory response compared with conventional surface cooling.
Chronic wounds have a high incidence and a long course of disease, and will bring a heavy economic burden to patients, which is the difficulty of clinical treatment at present. Therefore, it is urgent to find an effective method to promote chronic wound healing. In recent years, the application of therapeutic ultrasound in chronic wound treatment has gradually gained attention, and has become a promising adjuvant therapy. This article reviews the process of wound healing, the mechanism of therapeutic ultrasound in promoting wound healing, the biological effects of therapeutic ultrasound in different stages of wound healing and its application in diabetic ulcer, venous ulcer of lower limbs and pressure ulcer, in order to provide new ideas and directions for the treatment of chronic wounds.
Objective To summarize the research progress of gene-based therapeutic angiogenesis in lower limb ischemia, so as to provide a new method for non-invasive treatment of lower limb ischemia. Method The literatures on studies of gene-based therapeutic angiogenesis in lower limb ischemia in recent years were read and reviewed. Results The incidence of peripheral arterial disease had been increasing annually. How to effectively reduce the amputation rate and mortality rate of patients with critical limb ischemia was still a clinical problem that needs to be solved urgently. A large number of basic and clinical studies had shown that gene-based therapeutic angiogenesis could effectively induce angiogenesis and collateral circulation in ischemic tissue of lower limb, leading to the significant improvements of blood perfusion in ischemic areas. Additionally, the construction of many kinds of new non-viral gene delivery vectors could also improve the safety and effectiveness of gene therapy to a certain extent. Conclusion Although promising therapeutic effect of gene-based therapeutic angiogenesis brings new ideas and strategies for the treatment of lower limb ischemia, issues still exist that have not been solved.