老年糖尿病患者人工髋关节置换术的围手术期处理体会

探讨老年糖尿病患者人工髋关节置换术围手术期的治疗方法。对2000年1月~2006年3月54例糖尿病患者行人工髋关节置换术进行术后随访,利用临床关节功能及放射学检查进行分析。54例手术患者血糖控制满意且顺利度过围手术期。按Harris评分标准,术后髋关节功能优良率分别为人工股骨头置换组74%(14/19),人工全髋关节置换组91%(32/35)。未发现感染及假体松动现象等并发症。老年糖尿病患者如果有髋关节置换手术指征,没有严重的并发疾病,在重视围手术期处理的情况下,可以行人工髋关节置换术,且疗效肯定。     

人工髋关节置换术后翻修治疗体会

近年来,随着我国开展人工关节置换术,临床取得了较好的效果,为老年股骨颈骨折、股骨头无菌性坏死、成人先天性髋关节脱位等患者解除痛苦。随着人工髋关节置换术的广泛开展,因手术人员的技术原因,以及假体的长期使用,术后并发症也随之增多,翻修术也成为必然。针对我院30例人工髋关节术后翻修适应证选择及假体选择。谈一些治疗体会。     

有关治疗老年股骨颈骨折最优方案的思考

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准.本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案.     

老年髋部骨折围手术期医疗风险的分析与对策

髋部骨折是老年人的常见病之一,髋部骨折对老年人生命的危害最大.随着人口老龄化,老年髋部骨折发病率呈逐年上升趋势.老年骨质疏松髋部骨折围手术期的医疗风险临床较常见,如何降低老年骨质疏松髋部骨折围手术期的医疗风险,是临床骨科需要解决的问题.分析存在的风险问题,明确各种风险因素,尽可能降低老年髋部围手术期的医疗风险.     

老年髋部骨折围手术期医疗风险的分析与对策

髋部骨折是老年人的常见病之一,髋部骨折对老年人生命的危害最大。随着人口老龄化,老年髋部骨折发病率呈逐年上升趋势。老年骨质疏松髋部骨折围手术期的医疗风险临床较常见,如何降低老年骨质疏松髋部骨折围手术期的医疗风险,是临床骨科需要解决的问题。分析存在的风险问题,明确各种风险因素,尽可能降低老年髋部围手术期的医疗风险。     

先天性心脏病患儿围手术期心理护理程序研究

为提高先天性心脏病患儿围手术期护理质量,应用心理评估和临床实验方法,对４～１２岁无陪护患儿的心理特点和心理护理程序进行了系列研究。结果发现,先天性心脏病患儿性格较正常儿童内向．情绪不稳定,其智力和适应能力都明显低于正常儿童,根据上述特点确定了围手术期心理护理目标和行为训练等护理方法．通过对１０６例患儿的实验对比观察,提出建构围手术期少理护理程序的理论依据和基本模式．     

老年粗隆间骨折内固定与关节置换术的治疗策略分析

股骨粗隆间骨折临床常见,多发于老年人.手术治疗方法很多,主要分为髓内、髓外的内固定治疗及人工关节置换等.然而,目前没有统一的标准采指导如何选择手术方式.虽然绝大多数的手术治疗方法都能取得较好的效果,但出现问题的病例也较为多见.本文通过文献复习,对近年来的老年粗隆间骨折内固定治疗与关节置换的治疗策略进行分析,为临床治疗提供参考.     

康复队伍建设对实现残疾人康复服务的影响

老年股骨颈骨折是常见的骨科病,但其治疗方案的选择并没有统一的标准。本文回顾了骨折治疗原则的发展历程和股骨颈骨折现有的治疗方法,旨在从系统论的最优化原则角度,初步讨论治疗老年股骨颈骨折的最优方案,认为应结合患者的生理年龄、预期寿命、骨的质量、骨折情况和经济条件等因素来选择治疗方案。     

腰-硬联合麻醉在高海拔高龄患者髋关节置换术中的应用

探讨腰-硬联合麻醉及全身麻醉用于高海拔高龄低氧患者行人工髋关节置换的临床优势。分析2010年1月～2013年11月来我院进行人工髋关节置换术的高龄（年龄＞69岁）低氧患者86例,其中全麻31例,腰-硬联合麻醉55例,记录麻醉后5min、15min、30min及术毕血压、心率,术中低血压发生率,术后转ICU比例等指标。与全麻相比,腰-硬联合麻醉组血流动力学稳定、术中低血压发生率降低（P＜0．05）、入住ICU几率显著降低（P＜0．05）。在高海拔高龄低氧患者行人工髋关节置换术中采用腰-硬联合麻醉可以使患者麻醉效果突出,血流动力学平稳,安全有效,比全麻更有临床应用优势。     

科学研究的DNA共享与协作精神

股骨头坏死、髋关节脱位是骨科常见病,随着人们生活模式的改变发病率有所上升。对该病的成因、流行病学、病理转归、临床治疗策略与髋关节严重病损后功能重建等问题,学术界存在很大争议。作者提出从生物进化的角度、用自然重建理念做指导,应用髋关节分离牵拉术治疗股骨头坏死、骨盆补充截骨术重建青少年严重病损的髋关节功能人、组合性矫形手术治疗年长儿先天性髋关节脱位,获得了优良效果。因此呼吁:用自然重建理念治疗青少年股骨头坏死、髋关节脱位,降低人工假体置换对此类疾病的手术指证。     

长柄假体置换治疗高龄粉碎性粗隆间骨折的随访研究

为了探讨长柄假体置换治疗高龄粉碎性粗隆间骨折的短期疗效,我们对31例符合要求的研究对象进行了平均22个月的随访,指标包括Charnley及Harris评分以及X-ray平片,结果最近一次X—ray观察3例出现异位骨化,无一例假体松动,Charnley分级Ⅳ级及以上90．0％,Harris评分优良率88．3％,因此长柄假体置换是治疗高龄粉碎性粗隆间骨折的理想选择之一。     

大转子延长截骨在THR术后感染一期翻修中的临床应用

评价大转子延长截骨并行单纯钢丝捆扎在人工髋关节置换（THR）术后感染一期翻修中的作用及对翻修假体的影响.选取2010年10月~2013年10月期间30例髋关节置换术后假体感染性松动并行一期翻修术的患者,随访时间（34.8＆#177;13.2）月,对患者手术时间、截骨长度和愈合时间、术前术后Harris评分及术后感染控制情况进行统计.30例患者髋关节术后评分明显高于术前,手术时间为（132.4＆#177;23.6）min,经大转子截骨长度为（11.4＆#177;2.6）cm,截骨愈合时间（3.8＆#177;1.3）个月.术后感染未见复发.因此THR术后感染的一期翻修术中应用大转子延长截骨方法能缩短手术时间,髋关节功能较术前明显改善.     

Mismanagement of Panic Disorder in Emergency Departments: Contributors, Costs, and Implications for Integrated Models of Care

Panic disorder (PD) is associated with the rapid onset of fear-related symptomatology, often somatic in nature. As a result, individuals with the disorder often fear that they are experiencing a life-threatening emergency and present in hospital emergency departments (EDs). As the operating heuristics of EDs are geared toward identifying organic causes and allow only brief physician–patient contact, the diagnosis of PD is more often than not overlooked. Those with the disorder go on to incur enormous costs as they seek out an explanation for their symptoms. Efforts to alleviate this problem, including increased physician education and the development of screening instruments, have been largely unsuccessful. The continued misidentification and mismanagement of this disorder argues for greater incorporation of mental health professionals into the ED, allowing collaborative efforts that recognize the relationship between physiological and psychological aspects of panic.     

Issues in Pastoral Care and Counseling for the Fourth Quarter of Life

Issues and risks for pastoral care and counseling from the perspective of old age (here, ages 75 to 100) include identification of old age as a problem and its association with death in a death-denying culture. Two elements are fundamental: existential experiential deficits between the old and their younger caregivers (e.g., age cohort experiences, health status, gender, culture, privilege, etc.); and boundary issues that push the old, and pastoral care, to the edge of experience, where choices must be made between creativity and negativity (e.g., moving to dependent living, disability, etc.). Loss of doing (versus being) as a viable option is a major edge experience. The resulting sense of emptiness carries with it the potential for a sacramental awareness in which absence of doing becomes an outward and visible sign of an inward and spiritual grace.     

肿瘤临终关怀医疗对医疗资源需求和医患关系影响的初步研究

为了研究肿瘤患者临终的医疗需求和对医患关系的影响,我们收集肿瘤死亡病例,研究临终表现、治疗、住院时间及费用。乏力、纳差、咳嗽、疼痛是最痛苦的症状;末次住院平均天数为25．7日;末次住院人均医疗费用12946．428元。结果表明,临终患者治疗的重点是症状的改善,这能减轻患者的痛苦、营造和谐的医患关系。     

Dissemination and Implementation of Cognitive Behavioral Therapy for Depression in the Kaiser Permanente Health Care System: Evaluation of Initial Training and Clinical Outcomes

Notwithstanding its empirical status and strong recommendation in clinical practice guidelines, cognitive behavioral therapy (CBT) continues to be delivered infrequently and with low fidelity on the clinical front lines. Recently, organized efforts and policies within the public sector to disseminate and implement CBT and other evidence-based psychotherapies have yielded encouraging results and provided optimism for bridging the research-to-practice-gap. Following from these efforts, the current article examines the initial impact and experience of the implementation of an individualized approach to CBT training and treatment within the Kaiser Permanente health care system. Initial training outcomes, including changes in general and specific competencies, were assessed using divergent assessment methods within the initial cohort of therapists undergoing training. Initial patient outcomes, including changes in depression and anxiety, were assessed among patients receiving treatment from therapists in training. Results revealed training in and implementation of CBT-D was associated with overall large improvements in therapist competencies and in clinically significant improvements in both depression and anxiety among patients. Findings from the initial phase of dissemination and implementation within a large private system provide support for, and extend recent findings related to, the feasibility and effectiveness of training in and implementation of CBT-D in a real-world context.