目的 探讨运用心脏临时起搏器抢救严重心律失常、更换永久性心脏起搏器及心动过缓的外科手术患者围手术期需用临时起搏器保护的临床效果及护理经验。 方法 2008年8月－2011年7月，共对30例缓慢型心律失常者实施临时心脏起搏术。术前做好患者的心理护理，做好器材及药品准备；术中抢救器械、抢救药品处于备用状态，作好术中配合及病情观察；术后护理，观察生命体征及相关症状变化。 结果 安置心脏临时起搏器患者共30例，除1例因合并下壁心肌梗死、严重心力衰竭抢救无效死亡外，其余均取得满意的治疗效果，术中、术后无并发症发生，术后恢复良好，病情稳定出院。 结论 心脏临时起博器运用于抢救严重心律失常患者、赢得进一步抢救时间，更换永久性心脏起博器患者的临时保护，以及心动过缓的外科手术患者围手术期保护，均是一种安全有效的治疗方法。做好术前、术中及术后的护理是必要保证。Objective To investigate the clinical effects and nursing experiences of using temporary cardiac pacemaker in emergency rescue for patients with severe arrhythmia, in renewal of permanent cardiac pacemaker, or in peri-operative patients with bradycardia. Methods From August 2008 to July 2011, 30 patients with bradycardia arrhythmia underwent temporary cardiac pacemaker implantation surgery. We applied psychological nursing to the patients and made a good preparation of necessary equipments and medicine before operation. During the surgery, all required apparatuses and materials were ready at hand, and careful observation of conditions of the patients was carried out. After operation, the vital signs as well as the development of related symptoms in the patients were closely observed. Results There were 30 patients who had temporary cardiac pacemakers implanted. All got satisfying treatment effects except one who died from severe heart failure combined with inferior-wall myocardial infarction. No intraoperative or postoperative complications occurred, and the patients attained good postoperative recuperation before leaving hospital. Conclusion Temporary cardiac pacemaker is safe and effective in the emergency rescue of patients with severe arrhythmia, in temporary heart protection for patients undergoing renewal of permanent cardiac pacemaker, and in perioperative protection for patients with bradycardia. Good nursing before, during, and after the operation should be guaranteed.
目的 探讨异氟醚吸入麻醉对（SD）老年大鼠学习和记忆的影响。 方法 36只SD健康雄性大鼠随机分为异氟醚麻醉组和对照组，每组各18只。麻醉组给予2%异氟醚和40%氧气诱导及维持麻醉3 h，对照组单纯吸入含40%氧气的空氧混合气体3 h。麻醉组或对照组干预结束24 h后开始为期1周的盲法测试学习记忆能力。 结果 麻醉组大鼠与对照组大鼠相比，Y-迷宫测试成绩错误反应次数差异无统计学意义（P＞0.05）；除第7天麻醉组大鼠起步电压高于对照组（P＜0.05）外，其余时间两组大鼠起步电压差异均无统计学意义（P＞0.05）；除第3天麻醉组大鼠跑步电压高于对照组（P＜0.05）外，其余时间两组大鼠跑步电压差异均无统计学意义（P＞0.05）。 结论 2%单纯异氟醚吸入麻醉不改变老年大鼠麻醉后学习和记忆能力。
为实现培养实用型与创新性相结合人才的教育目标,我们对传统的预防医学实验教学模式进行了改革,包括实验内容、考核方式、学生参与实验准备等环节。通过改革,充分激发了学生的积极性和自主性,提高了学生的实际动手能力,增强了学生的团队合作精神和创新意识,有利于学生综合素质的提高。
目的:为了提高漏出性胸腔积液的诊断率对其进行病因分析。方法:对54 例漏出性胸腔积液病例就不同年龄及病变部位进行分析。结果:50 岁以下以肾病综合征居首位;50~ 60岁以岁慢性肺源性心脏病右心衰竭及肝硬化为主;60 岁以上岁以慢性肺源性心脏病右心衰竭居发病之首,其次为冠状动脉粥样硬化性心脏病。左侧以心包积液为主。右侧以慢性肺源性心脏病右心衰竭居发病之首,其次为冠状动脉粥样硬化性心脏病,肝硬化居第三。双侧以慢性肺源性心脏病右心衰竭居首位,其次为肾病综合征,高血压心脏病居第三。结论:漏出性胸腔积液的发病年龄,病变部位不同病因各异。
Objectives To analyze the effect of sling exercise therapy on the walking ability of children with spastic hemiplegia and cerebral palsy, and to provide a scientific basis for clinical treatment. Methods Children with spastic hemiplegia and cerebral palsy who were treated in the Department of Rehabilitation of Children’s Hospital of Shanghai from July 2018 to July 2019 were selected as the research subjects. The children were divided into conventional treatment group and sling exercise therapy group by random number table method. The routine treatment group was given routine rehabilitation training, and the sling exercise therapy group was given combined sling exercise therapy on the basis of routine treatment. The Gross Motor Function Measure (GMFM)-88-item E functional area score, Clinical Spasticity Index (CSI) and Berg Balance Scale (BBS) score were compared between the two groups. Results A total of 36 children were included, with 18 cases in each group. There was no significant difference in gender, age and hemiplegia side between the two groups (P>0.05). All children completed the trial without adverse reactions. Before treatment, there was no significant difference in BBS, CSI and GMFM-88 E functional area scores between the two groups (P>0.05). After 3 months of treatment, the above scores of the two groups were improved compared with those before treatment (P<0.05). The improvement of the above scores in the sling exercise therapy group after treatment was better than that in the conventional treatment group. The difference of BBS, CSI, and GMFM-88 E functional area scores in the sling exercise therapy group before and after treatment was 8.94±4.15, 2.44±0.71, and 7.28±3.23, respectively, the difference of the above scores before and after treatment in the conventional treatment group was 4.50±4.15, 1.83±0.79, and 2.89±1.64, respectively, and the differences were statistically significant (P<0.05). Conclusion Combined use of sling exercise therapy can better improve the walking ability of children with spastic hemiplegia and cerebral palsy, which is worthy of clinical promotion and application.
ObjectivesTo evaluate the efficacy and safety of four antiplatelet regimens after coronary drug-eluting stents by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) of the comparison of different antiplatelet regimens after coronary drug-eluting stenting from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Network meta-analysis was then performed by using Gemtc14.3 software, Stata16.0 software and RevMan5.3 software.ResultsA total of 23 RCTs involving 45 837 patients were included. The results of network meta-analysis showed that: in terms of prevention of myocardial infarction (MI) recurrence, the aspirin monotherapy after short-term dual antiplatelet therapy was inferior to the triple antiplatelet therapy (OR=2.13, 95%CI 1.08 to 4.03). In terms of reducing the incidence of ischemic compound events, the triple antiplatelet therapy was superior to the standard dual antiplatelet therapy (OR=0.53, 95%CI 0.39 to 0.72), the aspirin monotherapy after short-term dual antiplatelet therapy (OR=0.49, 95%CI 0.35 to 0.69) and the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (OR=0.51, 95%CI 0.35 to 0.73). There was no statistically significant difference among the four interventions in reducing the rate of in-stent thrombosis and all-cause mortality (P>0.05). In terms of safety, the bleeding rate of aspirin monotherapy after short-term dual antiplatelet therapy was lower than that of standard dual antiplatelet therapy (OR=0.70, 95%CI 0.55 to 0.86) and triple antiplatelet therapy (OR=0.58, 95%CI 0.36 to 0.90), and the bleeding rate of P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was also lower than that of standard dual antiplatelet therapy (OR=0.51, 95%CI 0.39 to 0.65) and triple antiplatelet therapy (OR=0.43, 95%CI 0.26 to 0.67). The probability ranking diagram showed that: in terms of the recurrence rate of MI, the rate of in-stent thrombosis and the incidence of ischemic compound events, triple antiplatelet therapy was the lowest and aspirin monotherapy after short-term dual antiplatelet therapy was the highest. However, in terms of all-cause mortality and bleeding rate, aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was the lowest and triple antiplatelet therapy was the highest.ConclusionsThe available evidence suggests that when the risk of ischemia is low, we should choose aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy, and P2Y12 inhibitor monotherapy may have a lower risk of ischemia and bleeding. When the risk of ischemia is high and bleeding is low, the triple or standard dual antiplatelet therapy should be selected, and the efficacy of triple antiplatelet therapy is superior, while the safety may be inferior.