Objective To investigate the effect of Dexmedetomidine hydrochloride combined with Butorphanol tartrate on stress state in elderly patients with severe illness.Methods A total of 120 elderly patients with severe illness admitted into our hospital from March 2016 to March 2018 were randomized into group A,B and C(n=40,each).Group A was given intravenous Midazolam for analgesia,group B was treated with intravenous Medetomidine for analgesia,and group C received Dexmedetomidine combined with Butorphanol tartrate for analgesia.The differences in mean artery pressure(MAP),heart rate(HR),C-reaction protein(CRP),interleukin-6 (IL-6),visual analogue scale (VAS)score and Ramsay score were compared among the three groups.Results The levels of MAP,HR,CRP,IL-6 and VAS score after 24,48 and 72 hours of combined treatment of dexmedetomidine and butorphanol tartrate were lower in group C than in group B(P ＜0.05).There was no significant difference in the levels of MAP,HR,CRP,IL-6 and VAS score between group A and B after 24,48 and 72 hours of administration(P＞0.05).Ramsay score was higher in group C (intravenous both Dexmedetomidine and Butorphanol tartrate) than in group B (intravenous Dexmedetomidine alone)at 24,48 and 72 hours after administration (P ＜ 0.05).There was no significant difference in Ramsay score after 24,48 and 72 hours of administration between group A and B(P＞0.05).The incidence of adverse reactions was lower in group C than in group A and B(10.0％ vs.35.0％ and 32.5％,x2 =7.168 and 6.050,P =0.007 and 0.014).There was no significant difference in the incidence of adverse reactions between group A and BCx2=0.056,P =0.813).Conclusions Dexmedetomidine hydrochloride combined with Butorphanol tartrate can effectively improve hemodynamics,and alleviate inflammatory reaction and pain in elderly patients with severe illness,with a good security.And it is worthy of clinical generalization.

Objective To explore the clinical pathway teaching method application effection end-stage renal disease( ESRD) teaching practice. Methods From May 2013 to July 2014, a total of 80 nursing intern students in Nephrology Department, the Fifth Hospital of Wuhan, were divided into observation group (40 cases) and control group (40 cases) according to a random number table method. Conventional teaching method was applied in the control group whereas the observation group used clinical pathway teaching method. Four weeks after the internship,the quality of clinical teaching programs scores, nursing students theoretical knowledge, skills assessment excellent rates and patient satisfaction levels of both groups were compared. Results Statistical analysis of the quality of clinical teaching programs filled by nursing intern students showed that the observation group nursing students in the teachers′ teaching management, teaching attitude, knowledge level and teaching skill level four aspects were higher than those in the control group (P<0. 05). The average total score of the observation group was (91. 3 ± 4. 1) while the control group was (79. 6 ± 3. 2), and the difference was statistically significant (P <0. 01). Nursing students theoretical knowledge and skills excellent rates of the observation group were 55. 0% and 57. 5%, significantly higher than those ofthe control group ( 22. 5%, 17. 5%). Patients in the observation group of nursing students satisfaction rate was 76. 58%, significantly higher than these of the control group which was 51. 89% (P<0. 05). Patients′ nursing students satisfaction rate in the observation group was 76. 58%, higher than that of the control group (51. 90%), and the difference was statistically significant (P <0. 01). Conclusions Clinical pathway teaching method which can promote effective communication between teachers and students, strengthen teacher-student communication, and improve the learning efficiency of nursing intern students is also conducive to nursing intern students′ practice, improve their theoretical knowledge, operation skills, and comprehensive ability. Satisfaction of patients with end-stage renal disease can be improved as well.