Myocardial remodeling is one of the important pathological basis when myocardial infarction or pressure overload occurs, whereas mangiferin which is a naturally occurring xanthone has a broad range of therapeutic effect on postinfarction myocardial remodeling. Mangiferin attenuates myocardial infarction by preventing the accumulation of myocardial collagen and the development of intercellular fibrosis. Mangiferin's inhibition to p38 mitogen activated protein kinases plays an important role in the cardioprotective effect. Inhibition of p38 mitogen activated protein kinases significantly decreases TNF-α and then brings the cardioprotective effect. Similarly, p38 mitogen activated protein kinases in pressure overload disease also play a very important role. Understanding of these has direct implications for clinical therapy.
With chronic kidney disease becoming a public health problem in the world, dialysis treatment model has also become the focus of attention from all walks of life. Sustained low-efficiency dialysis, which adopts the mode of low blood flow and low dialysis volume, is a kind of hybrid renal replacement therapy combining continuous renal replacement therapy and intermittent hemodialysis. It has unique advantages in the treatment of patients with acute and severe renal injury, as well as the dialysis duration, patient activity range and cost. It is the most widely used hybrid renal replacement therapy too. This review summarizes the clinical application and nursing points of sustained low-efficiency dialysis to provide guidance for clinical practice.
目的:观察W-F168-B型和RENATRONⅡ型透析器复用机临床应用对患者透析质量的影响。方法:符合纳入标准的受试者随机分为2组,试验组和对照组的透析器分别用W-F168-B和RENATRONⅡ复用。测定受试者透析前后血红蛋白、白蛋白、肌酐、尿素氮,计算尿素清除率除以分布容积(Kt/V,K为尿素清除率,t为透析时间,V为分布容积)。结果用均数±标准差表示,采用成组设计的t检验,spss13.0统计软件包分析。结果:试验组和对照组Kt/V值分别为1.25±0.26和1.24±0.19,透析前后血红蛋白差值分别为(1.32±0.14)g/L和(1.34±0.27)g/L,白蛋白差值分别为(0.86±0.05)g/L和(0.79±0.18)g/L。t 检验示两组以上各值比较差异无统计学意义(Pgt;0.05)。结论:两种透析器复用机对受试者透析充分性的影响无明显差异,能达到较好的透析质量。
In the management of diabetic nephropathy patients with hemodialysis, diabetes link nurse (DLN) can realize the continuity of nursing management, simplify the communication between multiple disciplines, and play multiple roles such as relieving patients’ psychology, participating in scientific research and clinical management. In this paper, by introducing the origin and development status of DLN in foreign countries, and summarizing the function and clinical contribution of DLN in the management of diabetic nephropathy hemodialysis patients. This article combines the current development status of DLN in China, to arouse the attention of clinical nursing colleagues, and provide some reference for the management of diabetic nephropathy patients with hemodialysis and the training of DLN in China.
ObjectiveTo explore the impact of continuous quality improvement on the quality of life and complications in end-stage hemodialysis patients. MethodWe reviewed the clinical data of 128 end-stage renal disease patients undergoing hemodialysis from January 2013 to January 2014. The patients were divided into observation group and control group randomly with 64 patients in each. Patients in the control group received routine nursing only during hemodialysis, while those in the observation group received extra continuous quality improvement nursing on the basis of routine one. Quality of life of the two groups of patients was evaluated by World Health Organization Quality of Life Scale-brief before and after intervention. Adverse reactions during hemodialysis were also observed in these two groups. ResultsThe incidences of hypotension, malnutrition, thrombosis, infection and arrhythmia in the observation group were significantly lower than those in the control group (P<0.05). Psychological dimension, social dimension, physiological adaptability and total scales of quality of life in the observation group were significantly better than those in the control group (P<0.05). ConclusionsContinuous quality improvement of nursing reduces the rates of complications and improves patients' quality of life.
Abstract： Objective To explore the application of lower sternal incision with on-pump， beating heart intracardiac procedures in mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 42 patients （minimal incision group） with valvular heart diseases who underwent MVR via lower sternal incision under the beating heart condition in Xinqiao Hospital of the Third Military Medical University from January 2011 to December 2011. There were 16 male and 26 female patients with their average age of 42.3±12.7 years in the minimal incision group. We also randomly selected 42 patients with valvular heart diseases who underwent MVR via routine midline sternotomy during the same period in our department as the control group. There were 18 male and 24 female patients with their average age of 43.8±13.1 years in the control group. Operation time， cardiopulmonary bypass time， major complications， chest drainage in postoperative 24 hours， skin incision length and average postoperative hospital stay were observed and compared between the two groups. Results There was no major perioperative complication such as in-hospital death. There was no reexploration for postoperative bleeding， complete atrioventricular block， embolism or perivalvular leakage in the minimal incision group. There was no statistical difference in cardiopulmonary bypass time， operation time， or the incidence of reexploration for postoperative bleeding， wound infection and perivalvular leakage between the two groups（P＞0.05）. The skin incision length in the minimal incision group was shortened by 5.2 cm compared to that in the control group （7.9±1.4 cm vs. 13.1±3.3 cm， P=0.000）. Chest drainage in postoperative 24 hours in the minimal incision group was significantly less than that of the control group （183.6±40.2 ml vs. 273.4±59.9 ml， P=0.000）. Postoperative hospital stay in the minimal incision group was significantly shorter than that of the control group （8.1±1.3 d vs. 10.6±2.1 d， P=0.000）. Forty patients in the minimal incision group were followed up for 3-15 months and 2 patients were lost during follow-up. Four patients had postoperative wound pain， and the majority of patients didn’t have significant wound scar formation but a satisfactory quality of life. Thirty-eight patients in the control group were followed up for 3-15 months， 4 patients were lost during follow-up， and 17 patients had postoperative wound pain. Conclusion Lower sternal incision with beating heart can reduce the surgical injury， simplify the operation procedure and improve the therapeutic efficacy. It is a safe， effective and esthetic surgical approach for MVR.
ObjectiveTo evaluate the mid-term recovery of cardiac function after heart valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation (AF). Methods Clinical data of 191 patients with heart valve disease and AF in the same surgical team of Xinqiao Hospital from January 2011 Jan to December 2013 was retrospectively analyzed. Heart valve replacement was performed for a control group (n=93), which includes 31 males and 62 females with their age of 48.33±7.55 years and AF duration of 4.80±2.03 years. Valve replacement and concomitant bipolar radiofrequency ablation was performed for a synchronism ablation group (n=98), which includes 27 males and 71 females with their age of 46.95±7.70 years and AF duration of 5.06±2.26 years. The echocardiogram, electrocardiogram and complications at hospitalization, 6 months, 1 year and 2 year after operation were analyzed. ResultsNo in-hospital death occurred. There were statistical differences in aortic cross-clamp time, cardiopulmonary bypass time, tricuspid ring, ICU stay, total volume of postoperative drainage between the two groups. All the patients were followed up for 2 years. Two years postoperatively, in the synchronism ablation group, 85 patients (86.73%) were followed up, 1 patient with cerebral embolism, 2 patients with cerebral hemorrhage. In the control group, 85 patients (91.40%) were followed up, 4 patients with cerebral embolism, 2 patients with cerebral hemorrhage. There were no death, cardiac rupture, and permanent cardiac pacemaker implantation in the two groups during the follow-up. One year and 2 years postoperative fractional shortening of the synchronism ablation group was significantly higher than those of the control group (37.18%±5.35% vs. 34.72%±6.40%, P=0.007; 37.95%±7.99% vs. 35.18%±5.15%, P=0.008). One year and 2 years postoperative left ventricular ejection fraction of the synchronism ablation group was significantly higher than that of the control group (66.27%±6.99% vs. 63.33%±8.14%, P=0.012). The rate of self-feeling cardiac function improvement in 1 year and 2 years after surgery of the synchronism ablation group was significantly higher than that of the control group (85.39% vs. 72.94%, P=0.005; 84.71% vs. 68.24%, P=0.005). ConclusionCardiac function of the mid-term after the valve replacement and concomitant bipolar radiofrequency ablation for atrial fibrillation obviously improves.