目的 探讨暴露喉返神经的甲状腺手术后患者发生声音嘶哑的原因。方法 选取于2019年1月—2020年12月间在我院接受甲状腺手术且在术中暴露喉返神经的患者,对出现术后声音嘶哑的19例患者进行为期12个月的临床随访,观察研究对象术后声音嘶哑的发生特点、持续时间并进行直接喉镜及颈部超声检查。结果 发生声音嘶哑的19例患者中,5例存在术中喉返神经损伤情况,其余14例患者术中喉返神经暴露及保护良好。直接喉镜检查示,该14例患者中,4例存在声带充血水肿现象,1例发生勺状软骨半脱位。术后1周左右的超声检查显示,该14例患者中有11例存在不同程度的创腔内积液。结论 虽常规暴露喉返神经减少了术后声嘶的发生率,但术中喉返神经损伤仍然是造成患者术后声嘶的原因之一。此外,术后创腔积液、麻醉插管导致的声带损伤及其他插管相关并发症等非直接手术因素也是造成这些患者术后声嘶的重要原因,应引起临床重视。

Objective To explore the cause of hoarseness of voice in patients after thyroidectomy with recurrent laryngeal nerve exposure. Methods The patients from January 2019 to December 2020 underwent thyroidectomy with exposure of recurrent laryngeal nerve during operation were selected. There were 19 cases of hoarseness of voice after operation followed up for 12 months. Postoperative observations included the characteristics of the hoarseness of voice, duration, and direct laryngoscope neck ultrasonography. Results A total of 19 patients had voice hoarseness, only 5 of them had recurrent laryngeal nerve injury during operation, the other 14 patients had good exposure and protection of recurrent laryngeal nerve. Direct laryngoscope showed that 4 of 14 patients had vocal cord edema and 1 had subluxation of arytenoid cartilage. About 1 week after operation, ultrasound examination showed that 11 of 14 patients had varying degrees hydrops of wound cavity. Conclusions Although the routine exposure of recurrent laryngeal nerve reduces the incidence of postoperative hoarseness of voice, the injury of recurrent laryngeal nerve is still a cause of postoperative hoarseness of voice. In addition, non-operative direct factors, such as fluid accumulation in the operative field, vocal cord injury caused by anesthetic intubation and other intubation related complications, are also important reasons for postoperative hoarseness of voice in these patients, which we should pay more attention to.

目的 了解急诊科综合病区患者疾病分类构成的特点,为护士进行有针对性的培训,并为合理调配护理人员提供依据。方法 对2020年1月—2021年12月我院急诊科综合病区收治的1 901例患者疾病分类、收治时间等进行回顾性调查分析。结果 研究期间急诊综合病区共收治患者1 901例,收治患者以呼吸系统的患者居多,占比47.71%;以循环系统疾病的患者平均发病年龄最高,为(66.434±11.691)岁;全年各月以1月、12月收治病人居多。结论 根据调查分析,有针对性地对护士进行呼吸系统疾病护理技能培训,并在收治高峰期,合理调配护理人员,实施弹性排班,保障患者安全,提高护理质量。

Objective To understand the characteristics of disease classification and composition of patients in Comprehensive Ward of Emergency Department, provide targeted training for nurses, and provide basis for rational deployment of nursing staff. Methods A total of 1 901 patients in the Comprehensive Ward of Emergency Department of our hospital from January 2020 to December 2021 were investigated and analyzed retrospectively according to different diseases and time of admission. Results A total of 1 901 patients were treated in the Emergency Comprehensive Ward during the study period. Most of the patients were with respiratory system disease, accounting for 47.71%. The average onset age of patients with circulatory diseases was the oldest, which was (66.434±11.691). Most patients were admitted in January and December. Conclusions According to the investigation and analysis, nurses should be trained with the skills of respiratory diseases nursing, nursing staff should be reasonably allocated and flexible shift should be scheduled during the peak period of admission, so as to ensure the safety of patients and improve the quality of nursing.

目的 对 2017—2021年护理岗位人员的职业倦怠相关领域文献中的研究热点进行分析,以期让相关研究人员和卫生行政管理人员更加全面了解护理人员的职业倦怠情况。方法 本文基于共词聚类的研究方法,将从CNKI数据库中获取的护理人员职业倦怠研究文献运用BICOMB、gcluto 2.0和VOSviewer软件进行热点分析。结果 共有1 218篇护理人员职业倦怠相关文献纳入研究,分布在199本期刊中,共有关键词1 495个,出现频次≥10的关键词共有78个。通过共词聚类分析,护理人员职业倦怠研究可归纳为4大聚类热点:巴林特小组改善护理人员职业倦怠、心理资本与护理人员职业倦怠中介作用、护理人员工作压力、心理弹性及社会支持与职业倦怠、护理人员职业倦怠现状、影响因素及应对方式等。 结论 研究揭示了我国护理人员职业倦怠研究领域的研究现状及热点。

Objective Through the analysis of the research hotspots in the literature about job burnout of nursing staff from 2017 to 2021, relevant researchers and health administrators were expected to have a more comprehensive understanding of job burnout of nursing staff. Methods Based on the research method of co-word clustering, this paper used BICOMB and gcluto 2.0 and VOSviewer software to analyze the literatures on nursing burnout obtained from CNKI database. Results A total of 1 218 nursing staff burnout related literatures were included in the study, distributed in 199 journals, with 1 495 high-frequency subject words, 78 words with frequency≥10 times. Through word clustering analysis, nurses' job burnout research can be summarized as four clustering hotspots: bahrain's team to improve nurses' job burnout, psychological capital and the intermediary role of nurses' job burnout, nurses work pressure, resilience and social support and job burnout, nurses' job burnout status, influencing factors and coping methods, etc. Conclusions This study reveals the current situation and hotspots of nursing staff burnout research in China.

目的 通过对中山大学中山眼科中心890例眼内异物病例进行分析,为眼内异物防治提供依据。方法 回顾性分析我中心2005年1月—2019年12月期间住院890例眼内异物病例的临床资料进行统计分析。结果 (1)15年间眼内异物病例中,2005年1月—2009年12月间例数最多,有477例,占总例数的53.6%;(2)发生眼内异物的患者年龄大部分在20~49岁之间,有716例,占80.44%;(3)眼内异物患者中,男性占大部分,有830例,占93.26%,男:女=14:1,右眼424例,左眼466例,右眼:左眼=1:1.1;(4)金属异物占大多数,约90%;(5)眼内异物的患者以工人最多,占60.5%;(6)眼内异物患者住院时间14天以内的患者共828人,占92.8%;(7)眼外伤种类:异物进入眼内为主,共614例,占68.98%;(8)眼外伤并发症:以外伤性白内障为主,共407例,占45.7%。结论 眼外伤发生以青壮年男性多见,异物入眼为主,住院时间为1~2周,治愈概率较高。眼内异物所导致的眼外伤发病率呈逐年下降趋势。

Objective To analyze 890 cases of intraocular foreign bodies in Zhongshan Ophthalmic Center of Sun Yat-sen University, and to provide a basis for the prevention and treatment of intraocular foreign bodies. Methods The clinical data of 890 cases of intraocular foreign body hospitalized in our center from January 2005 to December 2019 were retrospectively analyzed. Results (1) Among the 15-year intraocular foreign body cases, the number of cases from 2005 to 2009 was the highest, with 477 cases, accounting for 53.6%. (2) The majority of intraocular foreign bodies occurred between the ages of 20 and 49, with 716 cases (80.44%). (3) Among the patients with intraocular foreign bodies, males accounted for the majority, with 830 cases, accounting for 93.26%, male:female=14:1, right eye 424 cases, left eye 466 cases, right eye:left eye=1:1.1. (4) Metal foreign bodies account for the majority, about 90%. (5) Workers had the highest number of patients with intraocular foreign bodies, accounting for 60.5%. (6) The number of patients with hospitalization time of less than 14 days was 828, accounting for 92.8%. (7) Type of ocular trauma: foreign body into the eye was the main type, with 614 cases, accounting for 68.98%. (8) Complications of ocular trauma: traumatic cataracts was the mainstay, with a total of 407 cases, accounting for 45.7%. Conclusions Ocular trauma occurs more often in young and middle-aged men, which intraocular foreign bodies is the main reason, and the hospitalization time is about 1 to 2 weeks, with high probability of healing. The incidence of ocular trauma caused by ocular foreign bodies is decreasing year by year.

目的 学习母细胞性浆细胞样树突细胞肿瘤(BPDCN)的临床病理及免疫表型特征,总结该少见肿瘤的病理诊断经验。方法 回顾分析2例BPDCN患者临床资料,通过苏木素-伊红(HE)染色分析肿瘤组织及细胞形态,通过免疫组织化学染色分析肿瘤免疫表型,通过流式细胞学检测骨髓有无肿瘤侵犯,并结合文献分析。结果 本报道中1例为97岁女性,临床以皮肤瘀斑结节为首发症状,肿瘤细胞真皮内弥漫浸润,不侵犯表皮,细胞中等大小,核形不规则,核仁不明显。另1例为69岁男性,临床以淋巴结肿大为首发症状,淋巴结结构完全破坏,肿瘤细胞弥漫浸润,细胞呈中等大小的母细胞样,核仁明显。2例免疫表型均表达CD123、CD4、CD56、TDT,不表达B系、T系淋巴细胞及髓系标志物,肿瘤均累及骨髓。结论 BPDCN是一种罕见的淋巴造血肿瘤,临床常以皮肤病变或淋巴结肿大为首发症状,临床过程具高度侵袭性,通常伴有骨髓侵犯。该肿瘤需与具有母细胞形态的淋巴系肿瘤和白血病相鉴别,诊断需结合临床信息、HE形态及免疫组化结果综合判断。

Objective To summarize the diagnostic experiences of blastic plasmacytoid dendritic cell neoplasm (BPDCN) based on the study of its clinicopathological features and immunophenotypes. Methods The clinical data of 2 patients with BPDCN were collected, the structure alteration and cell morphology were observed by HE staining, the immunophenotype of tumor cells were studied by immunohistochemistry staining and flow cytometry was adopted to confirm the bone marrow involvement. Results Two patients, one of whom was a 97 year-old female, presented with cutaneous ecchymosis nodules as the first symptom. The epidermis, but not the dermal, was diffusedly infiltrated by tumor cells, which were medium-sized with irregular nuclei without prominent nucleoli. The other case was a 69 year-old male with lymph node enlargement as the first symptom. The skin was normal, but the lymph nodes were invasively destroyed by tumor cells, which were medium-sized blast-like with prominent nucleoli. The immunophenotypes of the two patients were both positive for CD123, CD4, CD56 and TDT, but negative for B, T lymphocyte derived and myeloid origin markers, both of which involved bone marrow. Conclusions BPDCN is a rare form of hematological neoplasm, skin symptoms or lymph node enlargement may be presented as the initial symptom, the clinical course were highly aggressive with high frequency of bone marrow involvement. The blastic-like lymphoma and leukemia entities should be considered into account for differential diagnose. The precise diagnosis of BPDCN should be established by integrating histomorphology, immunophenotype and clinical presentation information comprehensively.

目的 了解维持性血液析透析（MHD）合并糖尿病患者与非合并糖尿病患者人体成分的差异,对MHD合并糖尿病患者透前体液分布特点进行分析。方法 选择MHD患者66例,按是否合并糖尿病分为MHD合并糖尿病组27例和MHD非合并糖尿病组39例,收集患者的临床资料、生化指标,应用生物电阻抗法测量患者细胞外液等人体成分参数,并进行比较。结果 MHD合并糖尿病组患者细胞外液、细胞外液/总体水量、脂肪组织指数、收缩压、超滤量、血糖高于MHD非糖尿病组,差异有统计学意义;MHD合并糖尿病组患者血红蛋白低于MHD非糖尿病组,差异有统计学意义。结论 相比较MHD非糖尿病患者,MHD合并糖尿病的患者透前细胞外液、细胞外液/总体水量、脂肪含量分布异常情况更明显,高血压及贫血情况更严重。MHD合并糖尿病患者容量控制较非糖尿病组差,故需对糖尿病患者加强宣传教育,严格控制血糖水平和液体的摄入。

目的 探讨妇科肿瘤围手术期发生静脉血栓栓塞症（VTE）的高危因素及预防措施。方法 回顾性分析2018年1月—2021年5月于中山市人民医院妇科收治的围手术期VTE患者38例（9例术前发生血栓、29例术后发生血栓）的临床特征、诊疗过程,并根据高危因素提出针对性的预防措施。结果 9例术前血栓的患者,其中恶性肿瘤、血浆D-二聚体阳性（>500 mg/L）与对照组比较差异有统计学意义（P<0.05）,而年龄、BMI、合并内科疾病与对照组比较,差异无统计学意义（P>0.05）;29例术后血栓的患者,BMI>25 kg/m²、恶性肿瘤、合并内科疾病、手术时间大于3小时、术后使用止血药物与对照组比较差异有统计学意义（P<0.05）;而年龄与手术方式与对照组比较差异无统计学意义（P>0.05）。结论 恶性肿瘤、血浆-D二聚体阳性、手术时间大于3小时、术后使用止血药物均为妇科围手术期血栓发生的高危因素,针对上述高危因素积极预防可显著降低VTE的发生。

Objective To study the high-risk factors and preventive measures of venous thromboembolism in gynecological periopreative surgery．Methods The clinical characteristics and the diagnosis and treatment of thirty-eight cases with perioperative deep venous thrombosis（nine cases with preoperative deep venous thrombosis and twenty-nine cases with postoperative deep venous thrombosis）in the department of gynecology of Zhongshan People's Hospital were analyzed retrospectively．Targeted preventive measures were put forward according to high risk factors．Results Compared with the control group,there were significance differences in malignant tumor,positive D-dimer（>500 mg/L）in nine cases with preoperative thrombosis（P<0.05）,but no significance differences in age,body mass index（BMI）,complicated with internal diseases（P>0.05）．BMI>25,malignant tumor,complicated with internal diseases,operation time more than 3 hours,postoperative usage of hemostatics in twenty-nine cases with postoperative deep venous thrombosis had statistical significance compared with the control group（P<0.05）．But age and surgery method had no statistical significance（P>0.05）between the two groups．Conclusions Malignant tumor,positive D-dimer（>500 mg/L）,operation time more than 3 hours,postoperative usage of hemostatics were the high-risk factors in gynecological periopreative surgery,active prevention against these high-risk factors can significantly reduce the incidence of venous thromboembolism.

目的 调查儿科急诊非急诊手术患儿输血后红细胞恢复的影响因素。方法 回顾2020年1月—2020年12月期间广州市妇女儿童医疗中心珠江新城院区儿科急诊1月~18岁患儿的输血情况,其中分为Hb提升达预期组（n=93）,Hb提升未达预期组（n=156）,根据年龄、性别、体质量、是否恶性肿瘤、是否发热、有无延迟输血、输血前血红蛋白水平、输注红细胞类型情况,分析输血疗效及影响因素。结果 2组患儿的性别、年龄、体质量、有无恶性肿瘤、是否发热、输血等待时间、输血前后血红蛋白值、输注红细胞悬液量以及有无及时输血均无统计学差异;输注红细胞类型组间存在显著差异,Hb提升未达预期组更多输注了洗涤红细胞悬液（13.5% vs 5.4%,P=0.044）,输血后 Hb 值较低（中位数,73 g/L vs 84 g/L,P<0.001）,变化 Hb 值较小（中位数,18 g/L vs 30 g/L,P<0.001）,归因分析未发现影响因素。结论 输注洗涤红细胞可能是降低输血后红细胞提升的影响因素,输注洗涤红细胞时需严格输血指征同时注意红细胞提高预值的设定。

Objective To investigate the influencing factors of blood transfusion efficacy in patients without emergency operations in pediatric emergency．Methods A retrospective analysis of the blood transfusion of pediatric emergency children（1 month~ 18 year of age）in Zhujiang New Town Branch of Guangzhou Women and Children's Medical Center from January 2020 to December 2020 was carried out,patients were divided into Hb elevation up to expectation group（n=93）and Hb elevation not up to expectation group（n=156）．The efficacy of blood transfusion and the factors affecting it were analyzed according to age,gender,body mass,with or without malignant tumor,whether fever was present,whether there was delayed transfusion,pre-transfusion hemoglobin level,and the type of red blood cells transfused．Results There were no significant differences in gender,age,weight,malignant tumor,fever,waiting time for blood transfusion,hemoglobin level before and after blood transfusion,infusion volume of red blood cell suspension and whether had timely blood transfusion between the two groups．Significant differences were found between groups of transfused red blood cell types,with more washed red blood cell suspensions transfused in the Hb elevation not meeting expectations group（13.5% vs 5.4%,P=0.044）,which had lower post-transfusion Hb values（median,73 g/L vs 84 g/L,P<0.001）,and smaller change Hb values（median,18 g/L vs 30 g/L,P<0.001）,and attribution analysis did not reveal influencing factors．Conclusions Transfusion of washed red blood cell may be an influencing factor that reduces the RBCs elevation after transfusion．Attention should be paid to strict indications for washed red blood cell transfusion and setting the expected Hb level.

目的 分析华北地区某医院院前急救医疗服务的资源利用状况,并依据相关影响因素针对院前急救医疗服务过程中存在问题提出相应对策。方法 收集2021年3月—2022年4月期间就诊于华北地区某医院急诊科患者的一般资料、就诊过程、症状特征。依据是否接受过院前急救服务、是否为疾病急性发作的危重症患者将患者分为4组,分析比较4组患者在一般资料、疾病病症特点两个方面是否存在统计学差异,探索影响院前急救医疗资源合理利用的相关因素。结果 本研究总计收纳患者病例5 800例,其中接受院前急救医疗服务的患者共840例占总调查人数的14.5%,其中危重症患者530例（63.1%）,非危重症患者310例（36.9%）;未接受院前急救医疗服务的患者为4 960例占总调查人数的85.5%,其中危重症患者803例（16.2%）。对所得数据采用多因素回归方法分析得知,在急诊科接受的危重症患者中急性胸痛与突发性头痛是选择不使用院前急救医疗措施的独立影响因素。在非危重症患者中发热、外伤、腹痛是非急重症患者接受院前急救医疗服务的独立影响因素。结论 院前急救医疗服务资源的提供与利用在实际应用的过程中存在资源闲置与服务空缺的问题。危重症患者在入院前仍有较大比例的患者没有选择接受院前急救医疗服务。该情况表明当前居民对危重症患者危重症状及院前急救医疗服务了解与认知不足,对此有必要加强对居民关于院前急救服务的科普宣教工作,并借助现有医疗服务力量支持院前急救医疗服务的规范与准则,这对保障患者生命安全,争取危重症患者存活机会,促进急救资源合理利用具有重要意义。

Objective To analyze the resource utilization status of pre-hospital emergency medical services in a hospital in North China,and to propose corresponding countermeasures for problems in the process of pre-hospital emergency medical services according to relevant influencing factors．Methods From March 2021 to April 2022,the general data,treatment process and symptom characteristics of patients who were treated in the emergency department of a hospital in North China were collected．According to whether they had received pre-hospital emergency services and whether they were critically ill patients with acute onset of disease,the patients were divided into four groups．Whether there were statistical differences in the general data and disease characteristics of the four groups of patients,and the relevant factors affecting the rational utilization of pre-hospital emergency medical resources were explored．Results This study included 5 800 patients,of which 840 patients receiving pre-hospital emergency medical services,accounted for 14.5% of the total survey,including 530（63.1%）and 310 non-critically ill patients（36.9%）;4 960 patients not receiving pre-hospital emergency medical services accounted for 85.5% of the total survey,including 803（16.2%）of critically ill patients．Analysis by multivariate regression methods on the obtained data showed that acute chest pain and sudden headache in critically ill patients in the emergency department were independent influencing factors in choosing not to use pre-hospital emergency medical measures．Fever,trauma,and abdominal pain in non-critically ill patients were independent factors influencing the reception of pre-hospital emergency medical services．Conclusions The provision and utilization of pre-hospital emergency medical service resources have the problem of idle resources and service vacancies in the process of practical application．A significant proportion of critically ill patients still do not choose to receive pre-hospital emergency medical services before admission．This situation shows that the current residents have insufficient understanding and cognition of critical symptoms and pre-hospital emergency medical services,and it is necessary to strengthen the scientific popularization and education of residents on pre-hospital emergency services,and support the norms and guidelines of pre-hospital emergency medical services with the help of existed medical services,which is of great significance for ensuring the safety of patients' lives,striving for the survival opportunities of critically ill patients,and promoting the rational use of emergency resources．

目的 分析新生儿无乳链球菌（B族链球菌,GBS）败血症的临床特点、围产期高危因素及预后,提高临床对GBS败血症的认识。方法 选择21例GBS败血症新生儿（收集病例时间为2018年2月—2021年11月）,采用回顾性调查法分析临床资料;对新生儿临床资料、实验室检查、影像学资料进行统计和对比,分析临床特征,同时比较患儿合并症情况及评估治疗预后结果等。结果 GBS败血症新生儿中早发型（90.48%）明显高于迟发型（9.52%）,P<0.05;GBS败血症新生儿主要症状表现为发热、发绀、气促、呻吟、抽搐等,以气促、呻吟为主;通过实验室检查,发现患儿普遍存在C反应蛋白、降钙素原、白细胞计数等指标异常情况;经头颅MRI检查提示蛛网膜下腔出血6例;X线提示新生儿吸入性综合征6例、双肺新生儿肺炎4例;部分患儿存在合并症,其中1例合并脑膜炎、3例合并蛛网膜下腔出血、4例合并黄疸、2例合并新生儿低血糖;所有患儿接受抗菌药物治疗,以青霉素、头孢他啶为主,平均住院时间（14.86±2.33）d,治愈19例（占比90.48%）、1例患儿好转后家属要求签字出院,1例家属要求转上级儿童医院。结论 新生儿无乳链球菌败血症有早发型和迟发型之分,两者的临床表现及特征有明显差异,该病病情较凶险,临床需高度重视本病的防治工作,早期诊断及时治疗干预,以提高新生儿预后。

Objective To analyze the clinical characteristics,perinatal high-risk factors and prognosis of neonatal Streptococcus agalactiae（group B Streptococcus,GBS）sepsis,and to improve the clinical understanding of Streptococcus agalactiae sepsis．Methods Twenty-one newborns with GES sepsis were selected（the cases were collected from February 2018 to November 2021）,and the clinical data were analyzed by retrospective investigation．The clinical data,laboratory examination and imaging data of newborns were summarized and compared,and the clinical characteristics were analyzed．At the same time,the complications of children were compared and the prognosis of treatment was evaluated．Results In newborns with GBS sepsis,the early-onset rate（90.48%）was significantly higher than the late-onset（9.52%）,P < 0.05．The main symptoms of newborns with GBS sepsis were shortness of breath,moaning,fever,cyanosis,convulsions,etc．Through laboratory examination,it was found that there were common abnormalities in C-reactive protein,procalcitonin,leukocyte count and other indicators in children．Transcranial MRI results showed 6 cases with subarachnoid hemorrhage;X-ray showed 6 cases with neonatal aspiration syndrome and 4 cases with both lungs neonatal pneumonia．Some children had complications,including 1 case with meningitis,3 cases with subarachnoid hemorrhage,4 cases with jaundice,and 2 cases with neonatal hypoglycemia．All children were treated with antibiotics,mainly penicillin and ceftazidime．The average hospital stay was（14.86 ± 2.33）days,and 19 cases were cured（accounting for 90.48%）．One case of the child's family member asked to sign and leave the hospital after improvement,and one case of the family member asked to be transferred to a superior children's hospital．Conclusions Neonatal Streptococcus agalactiae sepsis can be divided into early-onset and late-onset type．There are significant differences in clinical manifestations and characteristics between them．The disease is dangerous,clinical attention should be paid to the prevention and treatment of the disease,early diagnosis and timely treatment and intervention,so as to improve the prognosis of newborns．