目的 探讨新冠疫情影响下日间手术制度在乳腺外科住院模式中的应用情况。方法 2021年1月—12月广州市第一人民医院实施日间手术制度,对乳腺外科30张床位实施预约管理,依据患者病情进行日间手术预约,合理安排患者入院。结果 2021年1月—12月我院乳腺外科共入院2 787人/次,手术人数1 497人,其中日间手术720台,占比48.10%。结论 日间手术制度可提升了医院手术服务能力,增加手术量,缩短了平均住院日,为患者提供方便、高效的医疗服务,值得基层医院推广。

目的 运用DRG分析临床路径管理对患者住院费用的影响。方法 采用BJ-DRGs分组器,选取2016年广州某三级综合医院的出院患者病案首页信息及DRG分组信息,对比是否实施临床路径管理对患者的总体住院费用影响及各DRG组的住院费用差异。结果 路径组中位住院费用为9 239.41元,低于对照组的12 358.06元,差异有统计学意义(P<0.001)。费用构成分析发现,路径组的治疗费、检查费、药品费、手术费和其他费低于对照组,而材料费用相对较高。比较的14个DRG组中,6个DRG组的路径组住院费用低于对照组。结论 实行临床路径管理可降低患者住院费用、改变费用构成。结合DRG积极推进临床路径精细化管理,可有效控制病种成本,遏制医疗费用的不合理增长。

Objective Using DRG to analyze the impacts on inpatient costs of a hospital in Guangzhou as incurred by clinical pathway management. Methods As performed by BJ-DRGs, we selected DRG grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Guangzhou in 2016. Then we compared the impacts of clinical pathway management on overall inpatients costs and the difference of inpatient costs for the DRG group. Results The median of inpatient costs in the clinical pathway group was 9239.41 yuan, was lower than that of control group which was 12358.06 yuan, and the difference was statistical difference (P<0.001). Cost composition analysis found that the costs of treatment, examination, medicine, surgery and the others in the clinical pathway group were much lower than that of the control group, while the cost of materials was relatively high. Among the 14 DRG group study, there were 6 DRG groups which the inpatient costs of the clinical path group was obviously lower than the control group. Conclusion The implementation of clinical pathway management may reduce the inpatient costs and change the makeup of costs. Therefore, combining with DRG, we actively promote the refined management of clinical pathway, which may effectively control the costs of diseases and the unreasonable growth of medical expenses.

目的 探讨骨科手术患者住院费用的影响因素,为疾病负担分析提供线索,为合理有效控制骨科手术患者住院费用增长提供参考依据。方法 提取某院2013年、2018年两年全部骨科手术患者住院病案首页信息,对其进行统计分析,利用单因素分析、多元线性回归分析住院总费用的影响因素。结果 住院年份、性别、年龄、住院天数、出院科室、是否患有慢性内科疾病、切口愈合类型、麻醉方式、是否转科、病例分型、入院途径、手术是否择期和手术级别等是影响住院总费用的因素。合并慢性病患者,住院费用多于未合并者(P<0.000 1),病例分型为疑难危重患者住院费用大于一般患者(P<0.000 1),入院途径为急诊患者住院费用大于门诊患者(P<0.000 1),需转科患者住院费用大于未转科患者(P<0.000 1),三、四级手术患者住院费用高于一、二级手术患者(P<0.000 1)。结论 加强慢性病的防治,提高对疑难、急危重症患者的诊治水平,是缩短平均住院日、降低骨科手术患者住院费的一个重要途径。

目的 探讨广州地区老年住院患者营养状态与日常生活能力(ADL)的相关性。方法 选取2018年7月—2019年6月在广州市第一人民医院住院年龄≥60岁的老年人共275例,收集其一般资料信息,各项临床营养指标(BMI、血清白蛋白、血红蛋白、总胆固醇、甘油三酯)、并运用营养风险筛查2002(NRS2002)评估营养风险、采用Barthel指数评定量表评估日常生活能力;分析老年住院患者营养状态与ADL之间的相关性。结果 在本组研究中,根据NRS2002评分(营养风险:NRS2002≥3;无营养风险NRS2002＜3),营养风险发生率58.9%(162/275);无营养风险发生率41.1%(113/275)。老年住院患者的NRS2002评分与ADL评分呈负相关关系(r=-0.393,P＜0.05);ADL评分与BMI、血清白蛋白、总胆固醇、血红蛋白水平呈正相关关系(P＜0.05)。结论 广州地区老年住院患者NRS2002为日常生活能力的影响因素,通过降低NRS2002评分来减少营养风险可改善老年人的日常生活能力;老年人的营养风险发生率高,应当尽早进行营养干预。

Objective To investigate relationship between nutritional status and activities of daily living(ADL) in elderly inpatients in Guangzhou. Methods Total of 275 people older than 60 were included in this study from Guangzhou First People's Hospital from July 2018 to June 2019. Their nutritional markers(including BMI, plasma albumin, hemoglobin, total cholesterol, triglyceride),the activities of daily living(ADL) were evaluated with Barthel index and the nutrition risk screening 2002(NRS2002)used to assess the nutritional risk status were collected to analyze the relationship between nutrition and ADL. Results In these subjects, based on the NRS2002 scores(nutritional risk that the NRS2002 scores were equal or greater than 3, and the non-nutritional risk that the NRS2002 scores were less than 3),58.9%(162/275) patients were having nutritional risk and 41.1%(113/275) were having non-nutritional risk. In elderly inpatients,NSR2002 were negatively associated with ADL(r=-0.393,P＜0.05). ADL was positively associated with BMI, plasma albumin and hemoglobin level(P<0.05). Conclusion In the old, the NRS2002 is an influencing marker of activities of daily living in Guangzhou. Reducing the nutritional risk by lowering the NRS2002 scores can improve ADL in the elderly. The incidence of nutritional risk is highly prevalent in elderly and early nutritional treatment will be needed.

目的 比较替格瑞洛片与氯吡格雷片在临床住院急性冠状动脉综合征患者使用中的出血风险。方法 选择2016年1月—2016年11月于我院心血管内科住院的264例急性冠状动脉综合征患者。将患者随机分为两组,替格瑞洛组(A组)131例,氯吡格雷组(B组)133例。对两组患者出血情况进行比较。结果 住院期间两组患者均无严重心血管不良事件(MACE),均未见黑便及需要输血的严重出血。轻微出血患者数,A组:17例占13.0%(17/131),B组:3例占2.3%(3/133),A组轻微出血风险高于B组,差异有统计学意义(P＜0.01)。结论 替格瑞洛轻微出血风险发生率高于氯吡格雷,均未见MACE发生及严重出血病例,临床使用中需注意此问题,并建议更多的临床研究出现。

Objective To compare the risk of bleeding between Clopidogrel and Ticagrelor in inpatients with acute coronary syndrome. Methods 264 patients with acute coronary syndrome who were admitted to our hospital from January 2016 to October 2016 were selected. The patients were divided into two groups randomly, 131 cases with taking Ticagrelor tablets and 133 cases with taking Clopidogrel tablets. The risk of bleeding of the two groups were compared. Results There were no serious adverse cardiovascular events (MACE) between two groups. Severe bleeding events were not obsereved in Ticagrelor and Clopidogrel group. The number of cases with mild bleeding were 17 in Ticagrelor group(13%) and 3 in Clopidogrel group (2.3%). The incidence of minor bleeding risk in Ticagrelor group was significantly higher than the Clopidogrel group(P<0.01). Conclusion The incidence of minor bleeding risk in Ticagrelor group was higher than Clopidogrel.There was no MACE occurrence and serious bleeding among two groups. We need to pay more attention to this problem in clinical use, and more clinical research should be proposed.

目的 了解住院老老年心房颤动(atrial fibrillation,AF)患者的临床特征及抗凝现况。方法 收集2015年6月—2017年9月住院老老年(≥80岁)房颤患者的抗凝用药,合并疾病,合并用药等临床信息,统计并分析,非正态分布的计量资料以中位数表示,采用秩和检验,两组计数资料采用χ²检验。结果 621例老老年患者根据性别分为男女两组,男354人,女267人,159例患者(25.6%)使用华法林,33例患者(5.31%)使用达比加群,30例患者(4.83%)使用利伐沙班,抗凝总人数为222例(35.75%)。174例患者(28.02%)使用阿司匹林,27例患者(4.35%)使用氯吡格雷,抗血小板总人数为201例(32.37%)。余198例患者(31.89%)未使用任何抗血小板或抗凝药物。结论 老老年房颤患者目前抗凝率低,抗凝药物以华法林为主。

Objective This study investigated the clinical characteristics and antithrombotic status in elderly patients with atrial fibrillation AF. Methods In this study, we collected, analyzed and characterized the data of the patients hospitalized at the First Affiliated Hospital of Shihezi Medical University from June 2015 to September 2017. Results 621 cases of elderly patients were divided into two groups according to their gender between men and women, 159 patients (25.6%) take warfarin, 33 patients (5.31%) with dabigatran, 30 patients (4.83%) uses of rivaroxaban, the total number of anticoagulation is 222 (35.75%),174 patients (28.02%) were treated with aspirin, and 27 patients (4.35%) used clopidogrel, and the total number of antiplatelet agents was 201 (32.37%). 198 patients (31.89%) did not use any antiplatelet or anticoagulant drugs. Conclusion patients with atrial fibrillation anticoagulant rate is low, and the anticoagulant is mainly warfarin.

目的 探讨揭阳地区急性下呼吸道感染住院患儿病毒病原学特点。方法 对2 125例急性下呼吸道感染患儿应用直接免疫荧光法(DIF)进行A型流感病毒(甲型流感病毒IFA)、B型流感病毒(乙型流感病毒IFB)、呼吸道合胞病毒(RSV)、腺病毒(AdV)、副流感病毒1(PIVⅠ)、2(PIVⅡ)和3型(PIVⅢ)进行病毒学检测。结果 2 125例患儿鼻咽部分泌物标本中有538例检测出至少1种病毒,总阳性率25.3％,其中RSV 阳性率(19.7%)明显高于其他病毒,具有统计学意义。春、夏、冬季的RSV阳性率大致相当,明显高于秋季。婴儿期组RSV阳性率(27.2%)最高,幼儿期组(18.7%)次之,均显著高于学龄前期、学龄期,后2组阳性率无统计学差异,青春期组未检出RSV。结论 病毒是急性下呼吸道感染的重要病原体,而其中又以RSV为著,RSV感染具有显著的季节性和年龄特征性。

Objective To investigate the viral etiology feature in hospitalized children with acute lower respiratory infection in Jieyang area. Methods A total of 2 125 children with acute lower respiratory tract infection were screened by direct immune fluorescence assay (DIF) for influenza virus A (IFA), influenza virus B (IFB), respiratory syncytial virus (RSV), adenovirus (AdV), parainfluenza virus I (PIV Ⅰ), PIV Ⅱ and PIV Ⅲ. Results In 2 125 cases of nasopharyngeal secretory specimens, 538 cases were detected at least one kinds of viruses. The total positive rate was 25.3%, of which the positive rate of RSV (19.7%) was higher than that of other viruses. The positive rate of RSV was similar in spring, summer and winter, much higher than that in autumn.The positive rate of RSV in infancy group (27.2%) was the highest,then the second was the toddler's age(18.7%), both of which were higher than that in preschool age group and school age group. There was no significant difference in the positive rate between preschool age group and school age group. In addition, RSV was not detected in the adolescence group. Conclusion Virus is an important pathogen of acute lower respiratory tract infection. The most common virus is RSV, infection of which has seasonal and age characteristics.

目的 探讨入院准备中心制度在我院乳腺外科住院预约统筹管理的实践情况。方法 2017年1月—12月广州市第一人民医院入院准备中心对乳腺外科30张床位实施病床集中预约管理,依据患者病情进行预约,合理安排患者入院。结果 2017年1至12月我院乳腺外科共预约入院1225人/次,成功办理预入院1096人/次,约占乳腺外科总入院人数的77.85%。预入院进行手术患者415人/次,其中3日内手术患者为285人/次,预入院三日内手术率为68.67%。结论 预入院制度对乳腺外科病床进行集中预约管理能有效保证床位充分使用,为患者提供方便、有效的医疗服务,值得基层医院推广。

目的 探讨运用巴林特沟通模式对老年住院患者满意度的影响。方法 选取我院2016年1月—2016年12月老年科收治的120名患者作为对照组,实施常规护理;另选取2017年1月—2017年12月间老年科接收的120名患者作为观察组,在对照组的护理基础上运用巴林特沟通模式,对比两组患者满意度评价。结果 运用巴林特培训后临床护士的沟通能力（包括困难情景沟通能力、情感感知能力、情感支持能力、基本语言沟通能力、基本非语言沟通能力、团队沟通能力）得分较培训前有提高,且观察组患者对护理人员的工作态度、疑问解答、业务指导以及沟通反馈等方面的满意度评价均优于对照组,差异有统计学意义（P<0.05）。结论 运用巴林特沟通模式不仅能够显著提升老年患者对住院医疗服务的满意度评价,同时能够提高护士的沟通能力,为提升医院医疗服务水平和良好的社会形象奠定有利基础,值得推广。

Objective To study Communication mode of Balint group in elderly inpatient's satisfaction. Methods 120 patients undergoing the conventional nursing care from January 2016 to December 2016 in our geriatric department were selected as control group;120 patients undergoing the conventional nursing care plus Balint communication mode from January 2017 to December 2017 were selected as observation group. The clinical satisfaction was evaluated. Results After the Balint training,the communication abilities including communication ability at the difficult scenes,emotional perception ability,emotional support ability,basic verbal communication ability,basic non-verbal communication ability,team communication ability were higher than before;the clinical satisfaction on the nurse's working attitude,frequently asked question,professional guidance,and communication and feedbacks in the observation group was higher than that of control group （P<0.05）. Conclusion The Balint communication mode may remarkably improve the patient's satisfaction on the nursing services and the nurse's communication abilities. It is of great importance to increase the hospital's medical service and establish a good social image. It is worthy of promotion.

目的 了解本地区住院疾病谱的特征,为疾病防治工作及合理配置医疗资源提供参考依据。方法 收集2014年佛山市主要二级以上医院的病案首页资料,根据ICD-10进行分类统计。结果 前五位疾病类型为:肿瘤、循环系统疾病、损伤和中毒、妊娠分娩和产褥期、消化系统疾病,与全国城市医院住院疾病谱不同。结论 佛山市的疾病控制重点有其特点,医院的发展和配置应围绕这些相关学科作为重点。

Objective To investigate the characteristics of the spectrum of diseases of inpatients in the region,which is aimed to provide reference for disease control and allocating medical resources reasonably. Methods Collecting the medical record front pages of inpatients of most secondary or above hospitals in Foshan city in 2014. The diseases identities of the included cases were counted according to ICD-10. Results The top five diseases spectrum were tumor, diseases of the circulatory system, injury, poisoning and certain other consequences of external causes, pregnancy, childbirth and the puerperium, diseases of the digestive system,which was different from that of the urban hospitals of the whole country. Conclusion There is a characteristic about the key emphasis in disease control in Foshan city. We should focus on these related subjects for the hospital development and configuration.