目的 利用椎间孔镜微创治疗腰椎管狭窄症的手术编码容易出现错编、漏编情况,找到相应的解决办法。方法 通过查阅某院脊柱关节外科2016年引进椎间孔镜微创治疗腰椎管狭窄症的88份出院病案,以2011版 ICD-9-CM-3分类中查找出现的问题。结果 发现存在编码缺陷率达34.8%。结论 对于上述病案进行手术编码时,需要查阅腰椎微创融合手术的相关知识,需要判断手术方式、路径等情况,编码员应积极与临床手术医师进行沟通,加强工作责任心,才能做出准确编码,为临床医、教、研提供最具价值的病案信息。

目的 研究和分析外科Ⅲ类手术切口术后感染的危险因素,达到进一步预防外科Ⅲ类手术切口术后感染的目的。方法 研究对象为我科2014年1月—2016年12月普外科的1 816例Ⅲ类手术切口患者,以术后是否发生切口感染为因变量,以性别、年龄、是否切口贴用医用薄膜、切口是否碘伏冲洗等相关因素为自变量,进行Logistic回归分析,统计分析外科Ⅲ类手术切口术后发生感染的危险因素。结果 1 816例外科Ⅲ类手术切口中,术后发生切口感染有218例,切口感染率为12%。单因素分析显示,8项影响因素与Ⅲ类手术切口术后感染具有相关性(P﹤0.01),对具有统计学意义的8影响因素进行多因素Logistic回归分析,结果显示手术切皮前应用薄膜保护切口、术后切口碘伏冲洗及合理应用抗生素为切口感染保护因素(P﹤0.01),而患者年龄、全麻、急诊手术、输血及住院时间为切口感染独立危险因素(P﹤0.01)。结论 手术皮肤切开前应用医用薄膜、关腹后碘伏冲洗伤口对降低Ⅲ类手术切口术后感染发生率有一定效果,值得临床推广。

Objective: To research and analyze the risk factor which lead to type Ⅲ operation incision infection,and prevent the incision infection.Methods: The clinical data of 1816 typeⅢoperation incision patients from the general surgery department during 2001-2016,With incision infection serving as a dependent variable, gender, age, using medical films, rinsing the incision with iodophor after the abdomen closing and other factors as independent variables, single factor analysis and logistic regression analysis were used to identify risk factor for typeⅢoperation incisions.Results: From 1816 typeⅢoperation incision patients,218 patients suffered from incision infection with a infection rate of 12%,Single factor analysis showed that 8 factors had significant effects on infection of type Ⅲ operation incision(P<0.01). Logistic regression analysis showed that there were 8 related factors out of 9 factors,and age,anesthesia,blood transfusion,the days of hospitalization and emergency surgery were possible independent risk factors of incision infection(P<0.01), and the critical pathway,using medical films,rinsing the incision with iodophor after the abdomen closing,reasonable use of antibiotics were protective factors against incision infection(P<0.01),while age,anesthesia,blood transfusion,the days of hospitalization and emergency surgery were possible independent risk factors of incision infection(P<0.01).Conclusion: Using medical films before the skin incising, rinsing the incision with iodophor after the abdomen closing can reduce the rate of incision infection postoperation, it is worthy of clinical promotion.

目的 了解新疆疏附县人民医院心脑血管疾病发病趋势和分析高血压发病相关危险因素,为高血压及其相关的心脑血管疾病的综合防治提供依据。方法 回顾性分析2007—2011年疏附县人民医院住院患者资料,按年份统计慢性非传染性疾病(以下简称慢性病)住院人数情况,并采用Logistic回归分析法分析维吾尔族人群高血压发病的相关危险因素。结果 新疆疏附县人民医院心脑血管疾病住院人数逐年增长,5年增长了约2.7倍,其中因高血压住院人数增长了3.5倍。BMI、血钠水平升高、血脂异常、年龄是维吾尔族人群高血压的危险因素。结论 新疆疏附县人民医院住院患者中以高血压为主的心脑血管疾病逐年增长。当地高血压及其相关的心脑血管疾病的防治采取生活方式干预基础上给予降压、降脂治疗的综合策略是优选。

Objective To investigate the incidence trend of cardio-cerebrovascular disease and the related risk factors about hypertension in Shufu people's hospital of Xinjiang. Moreover, to provide evidence of making prevention and controlling strategies for hypertension and the related cardio-cerebrovascular diseases.Methods A retrospective review was did on case data of the inpatients in Shufu people's hospital during 2007-2011.We counted the number of inpatients of chronic non-communicable diseases(NCDs)by year and collected the information of hypertensive inpatients and non-hypertensive inpatients to analyze the risk factors of hypertension in Uygurs using Logistic regression.Results The number of inpatients with cardio-cerebrovascular disease in Shufu people's hospital was increased by 2.7 times in 5 years, while the number of hypertensive inpatients was increased by 3.5 times. BMI, elevated blood sodium, and dyslipidemia, age are risk factors for hypertension in Uygur population.Conclusion The inpatients with cardio-cerebrovascular disease especially those with hypertension in Shufu people's hospital were increasing in recent 5 years. The strategy of lifestyle intervention combined with antihypertensive as well as lipid-lowering therapy is better to the prevention and treatment of hypertension and the related cardio-cerebrovascular diseases.

目的 分析神经营养类药物单唾液酸四己糖神经节苷脂(monosialotetrahexosylganglioside,GM1)与胞磷胆碱(citicoline)联合使用在新生儿缺血缺氧性脑病(neonatal hypoxic-ischemic encephalopathy,NHIE)的临床疗效并探讨其可能的作用机制。方法 收集2014年1月—2017年6月在广州市第一人民医院新生儿病房住院的54例新生儿缺血缺氧性脑病患儿的临床资料,将收集到的患儿随机分为2组,对照组27例,治疗组27例。治疗组与对照组的治疗的不同在于前者予以单唾液酸四己糖神经节苷脂GM1联合胞磷胆碱治疗,而对照组仅用单唾液酸四己糖神经节苷脂GM1,无用胞磷胆碱。治疗三个疗程后,比较2组用药前后的临床表现、神经功能评分及MRI变化情况。结果 治疗组中临床总有效24例(88.9%);对照组中总有效17例(63.0%)(P<0.05);经过三个疗程后2组的神经功能评分均有上升,且治疗组的效果更明显(P<0.05);MRI检查示2组较用药前病灶范围减少,水肿减轻,治疗组改善更明显(P<0.05)。即经过三个疗程治疗后,两组患儿病情均有好转,且治疗组疗效更明显。结论 神经营养类药物GM1联合胞磷胆碱通过修复、重构神经元、改善其代谢等促进受损的神经功能的恢复,在新生儿缺血缺氧性脑病的应用中具有良好的疗效。

Objective To analysis the clinical therapeutic effect of monosialotetrahexosylganglioside and citicolineon neonatal hypoxic-ischemic encephalopathy, and explore its possible mechanism.Methods A total of 54 newborn with hypoxicischemic encephalopathy were enrolled from January 2015 to June 2017 in Guangzhou First People's Hospital, and they were divided into control group and treatment group according to the treatment methods, with 27 cases in the control group and 27 cases in the treatment group. Both groups were treated with conventional treatment, the control group added gangliosides, and the treatment group used ganglioside and citicoline. The clinical effects, neurological score and MRI were observed in the two groups.Results The total effective rate was 88.9% in the treatment group,which was higher than 73.0% in the control group (P<0.05). There was no significant difference on neurological score between the two groups before treatment (P>0.05). After treatment, the neurological scores of the two groups were significantly improved, and the score of the treatment group was higher than that of the control group (P<0.05). MRI examinations found that the lesions were significantly improved in the two groups after treatments, and the effect of the treatment group was higher than that of the control group (P<0.05).Conclusion Monosialotetrahexosylganglioside combined with citicolineinthe in treatment of newborn with hypoxicischemic encephalopathy has good effects through repairing and rebuilding the neurons, improving the metabolism to promote the recovery of neurological functions.

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 通过回顾分析某三级医院神经外科近5年发生的意外跌倒事件,以指导改进护理防范策略。方法 对2012年3月—2017年6月期间某三级医院神经外科发生的21例住院期间意外跌倒事件进行数据采集、对照研究及回顾分析。结果 61.9%事件发生于00:00~07:59时间段,71.4%无陪人在旁,85.71%年龄大于等于60岁。与非跌倒组相比,跌倒组患者有更多例数的肢体乏力(P=0.005),依从性差的比例更高(P＜0.001),特殊药物应用及跌倒史未见统计差异。结论 应重视跌倒事件多发时间段,加强对无陪人、年龄大、肢体乏力、依从性差患者的护理,优化跌倒风险评估体系及预防措施。

目的 探讨焦虑障碍与冠心病经皮冠状动脉介入治疗(PCI)患者术后发生对比剂肾病(CIN)的相关性及机制,为早期发现CIN高危人群及其预防提供理论依据。方法 入选2014年6月—2016年12月于天津市第四中心医院心内科住院确诊冠心病并接受PCI患者,进行综合医院焦虑/抑郁情绪测定表(HAD)及汉密尔顿焦虑量表(HAMA)评价,依据量表的评分标准,最终纳入研究共120例,其中焦虑障碍组60例,非焦虑障碍组60例。观察2组患者PCI术前及术后72 h肌酐(SCr)、肌酐清除率(Ccr)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)、C反应蛋白(CRP)、白细胞介素-18(IL-18)的变化情况,并记录CIN的发生率。结果 2组患者PCI术前Scr、Ccr水平差异无统计学意义(P>0.05);2组患者PCI术后Scr水平均较术前升高,Ccr水平较术前降低(P<0.01)。PCI术后,焦虑障碍组Scr水平高于非焦虑障碍组,Ccr水平低于非焦虑障碍组(P<0.05)。2组患者PCI术前sICAM-1、CRP、IL-18、TNF-α差异无统计学意义(P>0.05);2组患者PCI术后sICAM-1、CRP、IL-18、TNF-α水平较术前均升高(P<0.01);PCI术后焦虑障碍组sICAM-1、CRP、IL-18、TNF-α水平高于非焦虑障碍组,差异有统计学意义(P<0.05)。PCI术前,焦虑障碍组HAD、HAMA评分高于非焦虑障碍组,差异有统计学意义(P<0.01);非焦虑障碍组患者PCI术后较术前HAD、HAMA评分差异无统计学意义(P>0.05);焦虑障碍组PCI术后HAD、HAMA评分高于术前,差异有统计学意义(P<0.01);PCI术后,焦虑障碍组HAD、HAMA评分高于非焦虑障碍组,差异有统计学意义(P<0.01)。结论 焦虑障碍可能是冠心病患者PCI术后发生对比剂肾病的危险因素之一。

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 分析广州市区2014—2016年无偿献血血液报废情况,探讨降低血液报废措施,减少血液报废。方法 收集并统计广州市区2014—2016年血液报废情况,分别统计报废血液比例。结果 2014—2016年报废血液产品共170 576 U,报废率为5.99%;非检验原因报废率(3.11%)高于检验原因报废率(2.88%),检验原因报废率呈逐年下降趋势,其中ALT及HBsAg报废率较高,非检验原因报废率呈逐年上升,其中乳糜血报废率较高。结论 进一步加强献血宣传和征询工作,以及做好团队献血的快速筛查工作,提高工作人员的操作水平,均有利于进一步降低血液报废率。

Objective To analysis blood products and disposal situation in Guangzhou from 2014-2016 to provide measures for reduce the scrap rate. Methods Collecting and statistical analysis of blood products scrap rate from 2014-2016 in Guangzhou respectively. Results A total of 170 576U blood products were scrapped in 2014-2016 and the scrap rate was 5.99%, in which non-detection scrap rate (3.11%) was higher than detection scrap rate (2.88%). Non-detection scrap rate was decreasing these years, among which ALT and HBsAg had a large proportion, while detection scrap rate was increasing, in which chylaemia scrap rate was the most highest. Conclusion We need to strengthen and publicize blood donation, as well as do well rapid screening of team blood donation and improve the operating level of staff.

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.