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Observation and Nursing for Patients with Middle and Advanced Pancreatic Carcinoma Due to Treatment of 125I Particle Implantaion

【摘要】　目的　探讨125I粒子植入治疗中晚期胰腺癌的临床并发症及相关护理措施。　方法　回顾分析2006年10月-2010年4月121例行125I粒子植入治疗的胰腺癌患者的临床治疗及护理，采取积极有效的护理措施，预防及处理并发症，促进患者康复。　结果　121例患者接受放射性125I粒子植入治疗后，7例出现胰瘘，13例出现胃肠道反应，经对症处理和精心护理后均治愈。　结论　125I粒子组织间植入近距离治疗中晚期胰腺癌近期疗效好、安全、副反应少，良好的护理对改善中晚期胰腺癌患者预后具有重要意义。【Abstract】　Objective　To observe the complications in patients with middle and advanced pancreatic carcinoma due to treatment of 125I particle implantation, and the investigate the proper nursing methods.　Methods　The clinical data including the therapy and nursing methods for the complications in 121 patients with middle and advanced pancreatic carcinoma due to treatment of 125I particle implantation from October 2006 to October 2010 were retrospectively analyzed. The treatment and care for complication were analyzed.　Results　In the 121 patients who had been treated by 125I particle, pancreatic fistula occurred in seven, and severe gastrointestinal upset was found in 13. The patients with the complications recovered after postoperative treatment and nursing.　Conclusion　125I particle implantation for patients with middle and advanced pancreatic carcinoma is effective and safe with a few side reactions; proper nursing is important to improve the prognosis.

腹腔镜全胰切除术合并 2 型糖尿病患者的围手术期护理一例

功能性胰岛素瘤患者术后观察与护理

目的探讨功能性胰岛素瘤患者术后的观察要点及护理措施。 方法回顾性2010年1月－2012年12月行手术治疗的54例功能性胰岛素瘤患者的病历资料，并就围手术期数据进行分析。 结果54例患者手术均获得成功。15例患者出现术后并发症，其中10例发生反跳性高血糖；2例胰瘘；3例出血；无术后胰腺炎发生。所有患者经积极有效的治疗和护理后均痊愈出院。 结论严密的术后观察与有效的护理措施能够促进功能性胰岛素瘤患者术后恢复。

腹腔镜胰十二指肠切除术后胰瘘的护理体会

目的探讨腹腔镜胰十二指肠切除术后胰瘘的观察要点及护理措施。 方法回顾性分析2010年10月－2013年5月24例腹腔镜胰十二指肠切除术患者中5例胰瘘患者的临床治疗及护理措施。 结果通过综合治疗和护理，5例胰瘘患者中4例痊愈出院，1例因多器官功能障碍综合征死亡。 结论胰瘘是胰十二指肠切除术后常见的并发症，早期发现胰瘘，给予正确的治疗和精心的护理，对提高患者预后和生活质量具有重要意义。

手助式腹腔镜下肝切除术并发症的观察及护理

目的　探讨手助式腹腔镜下肝切除术的临床并发症及相关护理措施。 方法　回顾性分析2008年1月－2010年12月收治的24例原发性肝脏肿瘤行手助式腹腔镜下肝切除术患者的病例资料、围手术期数据、术后并发症及恢复情况。 结果　24例患者腹腔镜肝切除术均获成功，其中左外叶切除13例，其余患者为不规则肝叶切除，无中转开腹手术。3例患者出现术后并发症，其中胆瘘1例，膈下脓肿1例，胸腔积液1例，经对症处理和精心护理后均顺利康复出院。 结论　手助式腹腔镜肝切除术是一种安全有效的微创治疗方法，通过严密观察及精心护理能有效的预防及处理并发症，提高其安全性和有效性。

Nursing Care of Early Enteral Nutrition through Nasointestinal Tube after Pancreatoduodenectomy

目的　总结胰十二指肠切除术后早期行肠内营养的护理效果。 方法　对2010年5月－12月30例胰十二指肠切除术后经鼻肠管行肠内营养患者的护理方法及措施进行回顾总结。 结果　全部患者术前均顺利完成留置鼻肠管，术后除7例患者分别发生堵管、咽炎、腹胀、营养液返流等并发症予以及时处置外，其余患者均顺利安全完成肠内营养治疗，患者营养状况在短时间内得到有效改善和恢复。 结论　胰十二指肠切除术后经鼻肠管行早期肠内营养，能促进肠功能早期恢复，良好的护理可保证肠内营养的顺利实施，显著改善患者围术期的营养状况。

应聘护理专业学生的心理健康状况调查与分析

【摘要】　目的　了解应聘护理专业学生的心理健康状况，为选择性录取提供依据，为录取后的护士规范化培训方案的修订提供基础资料。　方法　2009年12月以症状自评量表（SCL）-90对参加应聘面试的护理专业学生进行心理健康测试。　结果　以SCL-90总均分≥160分作为标准，筛查出有中度心理问题的学生94人（16.6%）；以SCL-90至少1个因子分≥2分作为标准，筛查出有中度心理问题的学生118人（20.9%）。受试学生的总均分和强迫因子、焦虑因子、敌意因子等明显高于全国青年常模，差异有统计学意义（Plt;0.001）。　结论　将SCL-90作为检测工具来筛检出紧张、焦虑的应聘护理专业学生是有必要的，学校及用人单位应当高度重视应聘护生的心理问题。

Effects of TWEAK/Fn14 pathway on the process of cell proliferation in pancreatic cancer

Objective To investigate the effect of TNF-related weak inducer of apoptosis/fibroblast growth Factor-inducible 14 (TWEAK/Fn14) on the cell proliferation by transfecting Fn14 shRNA to PANC-1 cells. Methods The shRNA gene targeting Fn14 gene was constructed and transfected into pancreatic cancer cell line PANC-1 to specifically silence the expression of Fn14 gene. The effect of shRNA interference sequence on the expression of Fn14 was detected by flow cytometry and immunofluorescence. CCK-8 was used to detect the cell proliferation of PANC-1 after blocking TWEAK-induced signal pathway. Western blotting method was used to detect the expressions of downstream factors such as nuclear factor-kappa B (NF-κB), TWEAK and caspase-3 to explore the pathway mechanism of TWEAK/Fn14. Results The absorbance value (A value) in the Fn14 shRNA group was significantly lower than the control groups in 24 hours after transfected (P<0.000 1). After the specific shRNA sequences transfected PANC-1 cells, NF-κB, TWEAK and caspase-3 protein expressions were also significantly lower than the control group (P<0.05), and the apoptosis of PANC-1 cells increased after inhibition of TWEAK/Fn14 signaling pathway. Conclusions TWEAK/Fn14 involved in the progression of pancreatic cancer. The Fn14 expression could influence the process of cell apoptosis.

The efficacy and safety of new oral anticoagulants for cancer-associated venous thromboembolism: a meta-analysis

ObjectivesTo systematically review the efficacy and safety of new oral anticoagulants (NOACs) for cancer-associated venous thromboembolism.MethodsStudies about the efficacy and safety of NOACs versus low molecular weight heparins (LMWHs) or vitamin K antagonists (VKAs) for cancer-associated venous thromboembolism were collected by searching PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and CBM databases from inception to August, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software.ResultsA total of 8 studies involving 2 448 patients were included. The results of meta-analysis showed that: there was no significant difference in the recurrent VTE rate (OR=0.74, 95%CI 0.49 to 1.11, P=0.15) or bleeding rate (OR=0.80, 95%CI 0.57 to 1.13, P=0.21) between NOACs group and VKAs group. The major bleeding rate was significantly higher in the VKAs group than in the NOACs group (OR=0.47, 95%CI 0.27 to 0.84, P=0.01). The incidences of recurrent VTE (OR=0.84, 95%CI 0.16 to 4.14, P=0.83), bleeding (OR=0.46, 95%CI 0.18 to 1.20, P=0.11), major bleeding (OR=0.45, 95%CI 0.12 to 1.60, P=0.21) were similar between NOACs group and LMWHs group.ConclusionsThe current evidence indicates that for cancer patients with VTE, NOACs are superior to warfarin and comparable to LMWHs. Due to limited quantity and quality of the included studies, more high quality studies are required to verify the above conclusion.

品质管理圈在提高胃肠减压有效率中的应用

目的探讨品质管理圈（品管圈）对提高胃肠减压有效率的作用。 方法2013年5月－10月开展品管圈活动，确立“提高胃肠减压有效率”为活动主题，对行胃肠减压的患者实施以品管圈活动主题为导向的护理管理，比较实施品管圈前后患者胃肠减压留置效果。 结果开展品管圈活动后胃肠减压有效率提高22.61%，圈员的责任心、观察力、观察沟通协调能力等提高40%～75%，达到预期效果。 结论品管圈活动不仅提高了胃肠减压有效率及临床护理质量，也使护士学会用科学的方法解决临床护理问题，增强了团队的凝聚力、协作力，值得推广。