目的 探讨肠道病毒相关性脑炎患儿的临床特点;以期能为临床医师对该病的认识提供一定的帮助。方法 回顾性分析2018年1月—2019年12月广州市妇女儿童医疗中心感染科收治的37例肠道病毒相关性脑炎患儿的临床相关资料。结果 37例患儿男28例,女9例,男女比例3.11:1。主要临床症状体征发热(97.30%)、口腔疱疹和(或)皮疹(54.05%);常见神经系统症状呕吐(56.76%)、头痛(56.76%)、惊厥(29.72%),其中惊厥及呕吐头痛症状≤1岁组与其他年龄组差异有统计学意义;脑脊液检查白细胞升高为主;所有患儿均康复出院且无神经系统后遗症。结论 儿童肠道病毒相关性脑炎近一半患儿临床无咽部疱疹或皮疹表现,1岁以内患儿主要以发热及惊厥为主要表现,大于1岁尤其学龄前期及学龄期患者以发热呕吐伴头疼为主要表现;早期诊治预后良好。

Objective To explore the clinical characteristics of children with enterovirus associated encephalitis, in order to provide some help for clinicians to understand the disease. Methods The clinical data of 37 children with enterovirus related encephalitis treated in the infection department of Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were analyzed retrospectively. Results There were 28 males and 9 females, with a male to female ratio of 3.11:1. The main clinical symptoms and signs were fever (97.30%), oral herpes and/or rash (54.05%); the common nervous system symptoms were vomiting (56.76%), headache (56.76%) and convulsion (29.72%). There were significant differences in convulsion, vomiting and headache symptoms between ≤ 1 year old group and other age groups. The leukocytes level in cerebrospinal fluid was elevated. All children recovered and discharged without neurological sequelae. Conclusions Nearly half of children with enterovirus associated encephalitis had no clinical manifestations of pharyngeal herpes or rash. The main manifestations of children under 1 year old were fever and convulsion. The main manifestations of children over 1 year old, especially preschool and school-age patients, were fever and vomiting with headache. Early diagnosis and treatment had good prognosis.

目的 了解疫情期间医护人员代谢综合征(MS)、高同型半胱氨酸血症(HHcy)的患病率、二者关系及靶器官损害。方法 选取2020年1月—2021年11月在天津市某三级综合医院的1 544名医护人员作为研究对象。测量人体指标,测定血液生化、免疫等指标。分析MS及其组分的患病率、HHcy的患病率及靶器官损害。采用χ²检验,比较MS组、HHcy组与对照组靶器官损害的差异。采用Logistic回归模型分析MS与HHcy的关系。结果 三级综合医院医护人员疫情期间MS患病率为23.7%,MS组分:中心性肥胖、高血压/高血压病、高甘油三酯、低高密度脂蛋白和高空腹葡萄糖/糖尿病的患病率分别为49.4%、19.3%、24.3%、0.5%和37%。HHcy的患病率为29.7%。MS组、HHcy组与对照组靶器官损害程度差异有统计学意义(P<0.001)。HHcy与MS无直接相关性。结论 疫情期间医护人员MS和HHcy患病率较高,与对照组相比有明显的靶器官损害,HHcy不是MS的独立危险因素。

Objective To explore the prevalence of metabolic syndrome (MS) and hyperhomocysteinemia (HHcy), their relationship and target organ damage among medical staff during the pandemic. Methods A total of 1 544 medical staff in a third-class general hospital in Tianjin from January 2020 to November 2021 were selected as the object of study. The indexes of human body were measured, and the indexes of blood biochemistry and immunity were detected. The prevalence of MS and its components, the prevalence of HHcy and target organ damage were analyzed. χ² test was used to analyze the difference of target organ damage among MS group, HHcy group and control group. The relationship between HHcy and MS was analyzed by Logistic regression model. Results The prevalence of MS among medical staff in the third-class general hospital during the pandemic was 23.7%. The prevalence of central obesity, hypertension / hypertension disease, high triglyceride, low high density lipoprotein cholesterol and high fasting plasma glucose/diabetes were 49.4%, 19.3%, 24.3%, 0.5% and 37%, respectively. The prevalence of HHcy was 29.7%. There was significant difference in target organ damage among MS group, HHcy group and control group (P<0.001). There was no direct correlation between HHcy and MS. Conclusions During the pandemic period, the prevalence of MS and HHcy in medical staff were high, and there was obvious target organ damage in those staff compared with the control staff. HHcy is not an independent risk factor of MS.

目的 探究青少年首发抑郁症患者治疗中联合应用艾司西酞普兰与重复经颅磁刺激(rTMS)的总疗效及应用价值。方法 选取东莞市第七人民医院2020年5月—2021年10月80例青少年首发抑郁症患者,参考“数字双盲法”,分为对照组和观察组(各40例)2组,对照组接受伪rTMS+艾司西酞普兰治疗,观察组接受rTMS+艾司西酞普兰治疗。评价指标:临床总疗效、抑郁评分(17项汉密尔顿抑郁量表,HAMD-17)、认知功能评分(威斯康星卡片分类测验,WCST)、生活质量(SF-36评分),不良反应发生率(副反应量表,TESS)。结果 观察组患者总有效率95.00%较对照组80.00%明显高(P＜0.05);且2组不良反应率比较(P＞0.05)。观察组治疗1周、2周、4周HAMD-17评分均较对照组低,同时治疗4周后WCST项目中完成分类评分较对照组更高(P＜0.05)。观察组SF-36(角色、社会、躯体、认知)评分均较对照组高(P＜0.05)。结论 青少年首发抑郁症患者,在艾司西酞普兰用药基础上联合rTMS,可获取更为显著的治疗效果,控制病情进展,减轻抑郁症状,同时对认知功能无影响,促进生活质量大幅度提高,且用药安全性有保障。

Objective To explore the total efficacy and application value of escitalopram combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of adolescent patients with first-episode depression.Methods A total of 80 adolescent patients with first-episode depression in Dongguan Seventh People's Hospital from May 2020 to October 2021 were selected.Referring to the “digital double-blind method”,they were divided into control group and observation group (40 cases each).The control group was treated with pseudo rTMS and escitalopram,and the observation group was treated with rTMS and escitalopram.Evaluation indexes: total clinical efficacy,depression score (17-item Hamilton Depression Scale,HAMD-17),cognitive function score (Wisconsin Card Sorting Test,WCST),quality of life (SF-36 score),adverse reaction rate (Treatment Emergent Symptom Scale,TESS).Results The total effective rate of 95.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05); the incidence of adverse reactions was compared between the two groups (P>0.05).The HAMD-17 scores of the observation group at 1 week,2 weeks and 4 weeks were significantly lower than those of the control group.At the same time,the classification scores of WCST items after 4 weeks of treatment were higher in observation group (P<0.05).The SF-36 (role,society,body and cognition) scores in the observation group were higher than those in the control group (P<0.05).Conclusions Adolescent patients with first-episode depression treated with rTMS on the basis of escitalopram can obtain more significant therapeutic effect,control the progress of the disease,reduce depressive symptoms,have no effect on cognitive function,greatly improve the quality of life,and ensure the safety of medication.

目的 探讨复方丹参滴丸联合阿托伐他汀治疗对伴有颈动脉粥样硬化短暂性脑缺血发作患者脑循环动力的影响。方法 将2017年12月—2018年12我院收治入院的98例伴有颈动脉粥样硬化短暂性脑缺血发作患者为研究对象,随机分为观察组(49例,给予复方丹参滴丸联合阿托伐他汀治疗)和对照组(49例,给予阿托伐他汀治疗)。观察对比治疗前及治疗后2组患者每日短暂性脑缺血发作频率及持续时间,血脂水平、血流变指标、粥样硬化斑块及斑块面积。结果 治疗前,两组患者每日短暂性脑缺血发作频率、持续时间、各项血脂水平、脑循环动力学指标IMT 及斑块面积相比,差异无统计学意义(P>0.05);治疗后,2组患者每日短暂性脑缺血发作频率、持续时间、各项血脂水平、脑循环动力学指标IMT 及斑块面积相比均有所改善,其中观察组患者每日短暂性脑缺血发作频率、持续时间、各项血脂水平、脑循环动力学指标IMT 及斑块面积相比优于对照组,差异有统计学意义(P<0.05)。结论 在伴有颈动脉粥样硬化短暂性脑缺血发作患者中采用复方丹参滴丸联合阿托伐他汀治疗效果确切,可有效降低伴有颈动脉粥样硬化的短暂性脑缺血发作患者发作频率及持续时间,同时可有效调节患者血脂水平,改善对脑循环动力学指标,值得临床推广普及。

Objective To investigate the effect of compound Danshen dripping pills combined with atorvastatin on cerebral circulation dynamics in patients with transient ischemic attack accompanied by carotid atherosclerosis. Methods A total of 98 patients with transient ischemic attack with carotid atherosclerosis admitted to our hospital from December 2017 to December 2018 were randomly divided into observation group (49 cases, receiving compound danshen drop pill combined with atorvastatin) and control group (49 cases, receiving atorvastatin), to observe and compare the frequency and duration of transient ischemic attack, blood lipid level, hemorheological indexes, atherosclerotic plaque and plaque area of the two groups before and after treatment. Results Before treatment, there was no significant difference in frequency, duration, blood lipid levels, IMT and plaque area between the two groups (P>0.05). After treatment, 2 groups of patients with transient ischemic attack daily frequency, duration, the lipid levels and cerebral circulation dynamics index IMT and plaque area were improved. Compared with observation group of patients with transient ischemic attack daily frequency, duration, the lipid levels and cerebral circulation dynamics index IMT and plaque area were better than control group, the differences were statistical significance (P<0.05). Conclusion Patients in associated with carotid atherosclerosis with transient ischemic attack using compound danshen dropping pill with atorvastatin therapy have good effects. This may effectively reduce frequency and duration in patients with transient ischemic attack associated with carotid atherosclerosis, regulate blood lipid levels at the same time, and improve the dynamics of cerebral circulation index. It is worthy of clinical popularization.

目的 报道1例新生儿单纯疱疹病毒中枢神经系统感染病例,并通过文献回顾和复习,提高临床上对此类少见病的认识,减少该病的误诊、漏诊。方法 回顾性分析1例新生儿单纯疱疹病毒中枢神经系统感染患儿的发病、诊断和治疗过程,结合以往的文献报道,总结该病的临床表现和诊治要点。结果 回顾文献显示:新生儿单纯疱疹病毒中枢神经系统感染非常少见。病死率高,存活者大多存在神经系统不良结局。本例为14天大新生儿,因发热入院,原因未明,入院即予阿昔洛韦抗病毒治疗取得良好疗效,随访至今(3月大),未见神经系统异常表现。提示及早有效的抗病毒治疗是影响预后的关键因素。结论 新生儿单纯疱疹病毒中枢神经系统感染临床无特异性表现,此病少见。尽早、足程的抗病毒治疗,可明显改善患儿的预后。对于不明原因发热的新生儿(特别是社区获得者),早期经验性予以阿昔洛韦抗病毒治疗,利大于弊。

Objective To report a case of herpes simplex virus central nervous system infection in a neonate and to review literatures about this disease, and to improve clinical understanding of this rare disease and reduce misdiagnosis and missed diagnosis. Methods The clinical manifestation,diagnosis and treatment of the patient with herpes simplex virus central nervous system infection were analyzed.The epidemiology,clinical manifestation and key points of diagnosis were summarized from literature review. Results Literature review showed that: neonatal herpes simplex virus central nervous system infection is very rare. The mortality rate is high, and most of the survivors have adverse neurological outcomes. This case is a fourteen days newborn who was admitted to the hospital due to fever for unknown reasons. He was given acyclovir antiviral therapy immediately after admission and achieved good results. Follow-up of 3 months showed no neurological abnormalities. It suggested that early and effective antiviral therapy is a key factor affecting the prognosis. Conclusion Neonatal herpes simplex virus central nervous system infection has no specific clinical manifestations, and this disease is rare. Early, full-course of antiviral therapy can greatly improve the prognosis of children. For newborns with unexplained fever (especially those obtained in the community), early empirical antiviral treatment with acyclovir is more beneficial than harmful.

目的 观察及探讨电子纤维喉镜抽吸法结合保守疗法治疗成年人分泌性中耳炎与单纯保守疗法治疗成年人分泌性中耳炎的疗效对比。 方法 86例成年人分泌性中耳炎患者按就诊先后顺序分成电子纤维喉镜抽吸法结合保守疗法治疗组及单纯保守疗法对照组两组,治疗6个月后, 统计分析临床治疗情况。 结果 电子纤维喉镜抽吸法结合保守疗法治疗组的临床疗效明显优于单纯保守疗法对照组 (P<0.05)。结论 电子纤维喉镜抽吸法结合保守疗法是一种高效、副作用小的治疗成年人分泌性中耳炎的方法,明显改善患者的症状、体征,提高疗效,缩短疗程,降低鼓膜穿刺及中耳手术概率。

Objective To observe and explore the difference on the treatment of secretory otitis media between the effect of electronic fiber laryngoscope suction combined with conservative therapy and the effect of the simple conservative therapy only. Methods The 86 adult patients with secretory otitis media were divided into two groups according to the order of treatment, One group used the electronic fiber laryngoscope suction combined with conservative therapy and the other used simple conservative therapy. After 6 months of treatment, the clinical treatment was statistically analyzed. Results The group used the electronic fiber laryngoscope suction combined with conservative therapy has a better effect(P<0.05). Conclusion The treatment of secretory otitis media electronic fiber laryngoscope suction combined with conservative therapy is a high efficiency and less side effect. What more, it improves the patient's symptoms, improves the curative effect and shortens the course of treatment and reduce the probability of tympanic membrane puncture and surgery.

目的 调查临床护士对新型冠状病毒肺炎的知信行现状,为制定相关培训策略提供依据。方法 采用便利抽样法,2020年3月选取我院的1 007名临床护士作为研究对象,采用一般资料及临床护士对新型冠状病毒肺炎知信行问卷对其进行调查。结果 1 007名临床护士对新型冠状病毒肺炎的知识、态度、行为得分分别为(28.82±9.22)分、(52.04±5.52)分、(55.38±7.93)分,新型冠状病毒肺炎知信行总分为(136.24±14.52)分。不同年龄、职称、职务、工作年限、何时参加过穿脱防护服操作培训及考核新型冠状病毒肺炎知识得分比较,差异均有统计学意义(P<0.05);工作年限、何时参加过穿脱防护服操作培训及考核,其新型冠状病毒肺炎态度得分比较,差异均有统计学意义(P<0.05);是否参加过穿脱防护服操作的培训及考核、何时参加过穿脱防护服操作培训及考核、是否参加过咽拭子采集的培训及考核的新型冠状病毒肺炎行为得分比较,差异均有统计学意义(P<0.05)。结论 临床护士对新型冠状病毒肺炎的知识得分处于较低水平,态度和行为得分较好,建议护理管理者需加强临床护士对新型冠状病毒肺炎的知识学习及相关培训,以提高护士知识及技能水平。

Objective To investigate the current status of nurses' knowledge, attitude and behavior to new coronavirus pneumonia, to provide the basis for formulating relevant training strategies. Methods In March 2020, 1 007 clinical nurses in our hospital were selected as the research object. The general information and questionnaire about the new coronavirus pneumonia were investigated in these nurses. Results Scores of 1 007 nurses answered the knowledge, attitude and behavior to new coronavirus pneumonia were(28.82±9.22),(52.04±5.52), and(55.38±7.93), respectively. The total score of knowledge, attitude, and behavior to the new coronavirus pneumonia was(136.24±14.52). The differences of scores of knowledge about new coronavirus pneumonia between different ages, job titles, duties, working years, and when they participated in the training and evaluation of wearing and taking off protective clothing were statistically significant (P<0.05). There was a statistically significant difference in the attitude scores of the new coronavirus pneumonia between different working years and when they participated in training and evaluation of wearing protective clothing (P<0.05). There were statistically significant differences in the behavior scores to new coronavirus pneumonia between whether and when they have participated in the training and evaluation of wearing and taking off protective clothing, and whether they had participated in the training and evaluation of pharyngeal swab collection (P<0.05). Conclusion Nurses' knowledge scores for new coronavirus pneumonia are at a low level, but their attitude and behavior scores are higher. It is recommended that new coronavirus pneumonia knowledge and related training should be strengthened for nurses to improve nurses' knowledge and skills.

目的 对我院静脉用药调配中心2017年1月—2019年12月期间的不合理医嘱情况进行汇总及分析,以提高合理用药水平。方法 收集2017年1月—2019年12月广州市第一人民医院静脉用药调配中心的不合理医嘱资料进行回顾性分析,归纳不合理医嘱类型、汇总分析不合理医嘱表现以及改正不合理情况。结果 主要不合理医嘱类型包括溶媒选择错误、溶媒量过多或过少、药物剂量不合理、药物配伍禁忌、其他(用药频次错误、药物选择错误、重复用药等)。结论 根据不合理医嘱情况的汇总分析,及时与临床科室沟通改正,保证合理用药。

Objective To summarize and analyze their rational prescriptions in pharmacy intravenous admixture services(PIVAS)of our hospital from January 2017 to December 2019,so as to improve the level of rational drug use. Methods The data of irrational prescriptions from January 2017 to December 2019 in the pharmacy intravenous admixture services of Guangzhou First People's Hospital were collected for retrospective analysis, and the types of irrational prescriptions were summarized, the performance of irrational prescriptions was analyzed and the irrational situation was corrected. Results The main types of irrational prescriptions include incorrect selection of solvent, improper consumption of solvent, improper drug dosage, incompatibility and others(improper frequency of administration, incorrect selection of drug, repeated administration, etc.). Conclusion According to the summary and analysis of irrational prescriptions, we timely communicate with clinical departments and ensure rational drug use.

目的 探讨增强T2FAIR系列在结核性脑膜炎(TBM)中的诊断价值。方法 选择临床疑似TBM并初次行MR检查的患者80例,根据TBM诊断评分标准和颅内结核影像学分型专家共识作为临床确诊依据。最终56例经临床确诊为TBM(脑脊液结核杆菌抗酸检测阳性)。行常规系列颅脑扫描后增加增强T2FIR系列扫描。由三位经验丰富从事影像专业诊断不同级别的医师分别进行独立分析诊断,以明显强化、轻度强化和无明显强化对比分析增强三维快速扰相梯度回波T1WI(T1GRE3D-FS)序列和增强T2FIR系列对TBM脑膜病变和脑实质的显示程度。结果 增强T2FLAIR系列52例显示脑膜明显强化占92.5%;4例不明显强化占7.5%。T1GRE3D-FS序列 8例明显强化占14%,39例轻度强化占70%;9例无明显强化占16%。增强T2FLAIR系列43例显示脑实质明显强化占76.8%;13例轻度强化占23.2%。T1GRE3D-FS序列48例明显强化占86%;8例轻度强化占14%。两系列对脑实质的显示均有轻度强化。结论 增强T2FAIR系列可作为TBM早期常规系列用于TBM的MR增强检查,能显著提高TBM影像诊断的准确性,,弥补了常规MR增强TlWI对结核性脑膜炎诊断的不足。

Objective To investigate the diagnostic value of enhanced T2FAIR series in tuberculous meningitis (TBM) patients. Methods 80 patients with suspected clinical TBM and initial MR examination were selected as the basis for clinical diagnosis according to the TBM diagnostic scoring standard and the expert consensus of intracranial tuberculosis imaging classification. Finally,56 cases were clinically confirmed as positive for acid resistance in TBM. Enhanced T2FIR series scans were added after routine series craniocerebral scanning. Independent diagnostic analysis was performed by three experienced imaging specialists. By different levels of diagnosis with significant enhancement, mild enhancement and no mild enhancement, we made contrast analysis in display of enhanced three-dimensional fast scrambling phase gradient echo T1WI (T1GRE3D-FS) sequence and enhanced T2FIR series on TBM meningeal lesions and brain parenchyma. Results 52 cases of enhanced T2FLAIR series showed significant enhancement of the meninges in 92.5%; in 4 cases,7.5% were not significantly enhanced. 8 cases of T1GRE3D-FS sequences were significantly enhanced, accounting for 14%, 39 cases of mild enhancement accounted for 70%; no significant enhancement was found in 9 cases, accounting for 16%. Enhanced T2FLAIR series of 43 cases showed significant enhancement of brain parenchyma accounted for 76.8%; 13 cases of mild enhancement accounted for 23.2%. 48 cases of T1GRE3D-FS sequences were significantly enhanced accounted for 86%; 8 cases of mild enhancement accounted for 14%. Both series showed mild enhancement of brain parenchyma. Conclusion The enhanced T2FAIR series can be used as TBM early routine series for MR enhanced examination, it may significantly improve the accuracy of TBM imaging diagnosis, to make up the deficiency of conventional MR.

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.