目的 探讨护理质量持续改进对康复医学科护理质量管理的影响。方法 制定康复医学科护理管理标准,比较改进前后护理专业基本技能评分和护患关系情况评分。结果 经过持续质量改进,康复医学科的护理质量显著提高。基础护理、护理文书和消毒隔离的评分显著提高,与改进前相比较,两组间的差异有统计学意义。护患关系融洽度和患者满意率提高,与改进前相比较,两组间差异有统计学意义;护理纠纷发生率降低,两组间差异有统计学意义。结论 在康复医学科护理管理中引进持续质量改进,可有效地提高护理质量,确保护理安全。

目的 对比观察海桐皮汤熏洗应用于膝骨性关节炎关节镜清理术后的临床疗效。方法 于2012年1月—2014年1月,从我院骨科住院患者中选取因膝骨性关节炎行关节镜清理术病例60例,随机分为两组,对照组术后给予常规康复治疗措施,治疗组在常规康复治疗的基础上于术后2周拆线后配合海桐皮汤熏洗治疗,治疗周期4周。对比两组患者治疗前后的WOMAC评分,分析其疗效差异。结果 两组患者WOMAC评分术后2周比较无差异P＞0.5;治疗4周后,两组患者较术后2周有所降低(P＜0.5),但治疗组疗效优于对照组(P＜0.5)。结论 海桐皮汤熏洗疗法可改善膝骨性关节炎关节镜清理术后膝关节功能,操作简便,成本低廉,无副作用,值得临床推广应用。

目的 调查结直肠癌患者癌因性疲乏状况,研究其动态变化趋势,为临床护理提供理论依据。方法 选用癌症疲乏量表(CFS)对96例结直肠患癌患者于术前一周、术后3~4天、出院前1~2天进行调查分析。结果 三次调查患者的癌因性疲乏水平有差异(P＜0.01),术后3~4天疲乏程度最重,出院前1~2天次之,术前一周最轻;三次调查结肠癌患者的疲乏水平均高于直肠癌患者,两组疲乏水平有差异(P＜0.05)。结论 结直肠癌患者于住院不同时期存在不同程度的疲乏,应针对疾病各时期特点为患者量身裁定护理干预措施,改善其疲乏症状。

Objective To investigate the dynamic changes of cancer-related fatigue (CRF) in patients with colorectal cancer. Methods Totally 96 patients with colorectal cancer were investigated by Cancer Fatigue Scale in three times: a week before patients' surgery, 3~4 days after patients' surgery and 1~2 days before discharge, respectively. Results Scores of fatigue of colorectal cancer patients were significantly different among three measurement points(P＜0.01). The scores of fatigue in the second survey were the highest. The third survey took second place and the first survey was the lowest. The score of fatigue in colon cancer patients were higher than rectal cancer patients in survey, with significant difference(P＜0.05). Conclusion There were obvious differences of fatigue in different periods for colorectal cancer patients in hospital. Inventions should tailor for patients according to characteristics of different periods to improve fatigue.

目的 探讨妇女阴道健康状况及阴道分泌物清洁度、线索细胞及唾液酸酶法检测细菌性阴道病(BV)的相关性。方法 随机抽取2013年4月—2014年6月本院妇科疑似细菌性阴道病患者标本835例,分别采用生理盐水直接涂片及分泌物直接涂片进行革兰氏染色两者相结合检查清洁度、线索细胞;唾液酸酶法检测BV。结果 清洁度Ⅰ～Ⅱ占27.55%,BV阳性率为2.40%,线索细胞检出率1.32%;清洁度Ⅲ～Ⅳ占72.45%,病原菌阳性率为46.23%,其中BV阳性率为30.55%,线索细胞检出率为23.48%。结论 清洁度异常率比正常率偏高;清洁度正常不一定没有细菌性阴道病; BV的出现严重威胁妇女身体健康,正确的诊断有重要意义,唾液酸酶法检测BV虽有快速、操作简单、显色结果易判断,但温度、时间、取材问题等受多种因素影响。

Objective To explore the correlation between the health of women's vagina and vaginal cleanness, clue cells and bacterial vaginosis(BV)which is tested by the sialic acid enzymatic method. Methods Randomly select 835 suspected cases of bacterial vaginosis in our hospital gynecology department in April 2013-June 2014. Every case was respectively done saline direct smear and vaginal secretion direct smear gram staining to check vaginal cleanness and clue cells. BV is tested by sialic acid enzymatic method. Results The cleanness of I-II accounted for 27.55%, BV positive rate was 2.40%, the positive rate of clue cells was 1.32%;the cleanness of degree III-IV accounted for 72.45%, the positive rate of pathogenic bacteria was 46.23%, the positive rate of BV was 30.55%, the positive rate of clue cells leads to 23.48%. Conclusion The rate of abnormal vaginal cleanness is higher than the normal.The nomal vaginal cleaness does not show no bacterial vaginosis. The emergence of BV seriously affects women's health, so the correct diagnosis is of great importance. Although the of the saliva acid enzyme to test BV is fast, operates easily and the color results are easily to be judged, but it can be influenced by other factors such as temperature, time, materials issues.

目的 探讨体感音乐疗法对青少年视疲劳患者症状缓解的影响。方法 选择青少年视疲劳患者72例,随机分为观察组和对照组各36例,两组患者均给予矫正用眼习惯、多运动、均衡饮食等护理,观察组在此基础上给予体感音乐疗法,3个月后比较两组视疲劳症状缓解情况。结果 干预后观察组视疲劳症状缓解程度及症状评分优于对照组,两组比较差异有统计学意义(P＜0.05)。结论 对青少年视疲劳患者实施体感音乐疗法,可起到促进眼部肌肉放松,改善微循环,增强睫状肌收缩力,改善虹膜睫状体调节功能,缓解视疲劳的效果。

Objective To explore the influence of vibroacoustic therapy on visual fatigue teenagers. Methods 72 visual fatigue teenagers were randomly and equally divided into the observation group and the control group. Both groups were accepted nursing in terms of the correction of eye habits, doing more sports and balanced diet, while the observation group was also accepted vibroacoustic therapy. After three months the conditions of these two groups in terms of visual fatigue were compared. Results After the intervention the degree of visual fatigue relief and the score of symptoms in the observation group were higher than those in the control group, and these differences have statistic significance (P＜0.05). Conclusion Vibroacoustic therapy can help visual fatigue teenagers to relax muscles of eyes, improve microcirculation, strengthen ciliary muscle contractile force, improve the regulatory function of iris ciliary and relieve visual fatigue.

目的 探讨NCPM理论指导下的临床营养诊疗工作在疾病治疗中解决临床营养问题的重要作用与临床价值。方法 对我院临床营养医师运用NCPM理论参与治疗的典型病例进行分析与总结。结果 临床营养医师运用NCPM理论指导临床诊疗工作,可按照临床营养诊疗工作流程,梳理临床营养诊疗思路,确定并围绕临床营养问题诊断,制定和调整临床治疗方案,提高临床疗效、缩短疗程、降低患者医疗风险。结论 临床营养医师将NCPM理论知识和临床实践相结合,有助于医院临床营养工作流程建立并有效实施;有助于临床医生与临床营养医生建立规范临床营养诊疗思路;在参与制定住院患者临床营养诊疗工作中,体现为提高临床疗效、缩短疗程、降低患者医疗风险,改善临床疗效等临床价值,应推广应用NCPM开展临床诊疗工作。

Objective The purpose of this article was to explore the clinical value of clinical nutrition diagnosis and treatment which was in the instruction of NCPM theory and the important role to solve the problem of clinical nutrition in treating disease. Methods We analyzed and summarized the typical cases that were treated using the theory of NCPM by clinical dietitians in our hospital. Results Clinical dietitians applied the theory of NCPM to guide clinical diagnosis and treatment work,and organizedthe clinical nutrition diagnosis and treatment clearly, indentified the clinical nutrition issues and around the issues they made and adjusted clinical treatment plan according to clinical nutrition diagnosis process, which increased the clinical curative effect,shortened period of treatment and reduced the patients' medical risk. Conclusion Clinical dietitiansorganizedNCPM theoretical knowledge with clinical establishment and implement effectively of clinical nutrition work process in hospital, practice, which contributed to the meamwhile whichhelp clinical doctors and clinical dietitians estabish the thought of clinical nutrition diagnosis and during the clinical nutrition diagnosis work which reflected improving the clinical curative effect, shortened period of treatment and reduced the patients' medical risk and improving the clinical outcome. Therefore it is important to popularize NCPM to carry out clinical diagnosis and treatment work.

目的 分析立体定向体部放射治疗(SBRJ)应用于孤立性肺肿瘤的疗效,探讨其临床价值。方法 采用拓能(TOPSLANE)全身X线立体定向放射治疗系统治疗15例孤立性肺肿瘤患者,其中I期非小细胞肺癌患者8例,单个肺转移瘤患者7例。单次剂量为5~8Gy／次,每天1次,每周3次,共8~10次,总剂量50~64Gy,生物有效剂量(BED)75~115Gy。分析治疗的近期疗效、急性放射损伤和局部控制率。结果 3例患者完全缓解(20.0%),10例患者部分缓解(66.7%),2例患者病灶稳定(13.3%),没有疾病进展的患者。15例患者总有效率为86.7%(13/15)。BED<90Gy的患者有效率为33.3%,而BED>90Gy的患者有效率为100%,差异有统计学意义(P＜0.05)。3例患者出现2级急性放射损伤,未见3级以上毒副反应。1年和2年局控率分别为92.3%和81.2%。结论 SBRT治疗孤立性肺肿瘤可获得较好的近期疗效和局部控制率,急性放射损伤较轻。

Objective To analyze the efficacy of stereotactic body radiation therapy(SBRT) onsolitary pulmonary tumor and explore its clinical value. Methods TOPSLANE X-ray stereotactic body radiation therapy system was used for treatment of fifteen patients with solitary pulmonary tumor, including eight patients with stage I non-small cell lung cancer and seven patients with single lung metastasis. Fraction dose of 5 to 8Gy was prescribed once a day, three times a week, totally 8 to 10 times to a total dose of 50 to 64 Gy and biological effective dose(BED) of 75 to 115Gy. Short-term efficacy, acute radiation injury and local control rate were analyzed. Results After treatment, there were three patients with complete response (CR) (20.0%), ten patients with partial response (PR) (66.7%), tow patients with stable disease (SD) (13.3%), and no patients with progressive disease (PD). The total response rate was 86.7% (13/15). The response rate was 33.3% in patients with BED <90 Gy, while it was 100% in patients with BED> 90 Gy, and the difference was statistically significant (P<0.05). Grade 2 acute radiation injuries were observed in three patients, and no toxicity greater than grade 3 was observed. The 1-year and 2-year local control rate was 92.3% and 81.2%, respectively. Conclusion SBRT on solitary pulmonary tumor has good short-term efficacy and local control rate with mild acute radiation injury.

目的 观察等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛的临床疗效。方法 将183例椎间盘源性腰痛患者随机分为对照组91例、治疗组92例,分别予综合疗法联合神经阻滞治疗、等离子消融髓核成形术联合神经阻滞治疗,观察两组患者治疗前后目测类比疼痛(Visual Analog Scale VAS)评分、改良Stauffer-Coventry评定系统术后日常活动及满意率等指标。结果 治疗组VAS评分和日常活动及满意率均优于对照组(P<0.05或P<0.001)。结论 等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛疗效显著,值得临床推广。

Objective To observe the effect of percutaneous low-temperature disk plasma ablation (PLDA) and nerve block(NB) on discogenic low back pain. Methods 183 patients were randomly divided into two groups: the control group (n=91) and the treatment group (n=92). Corresponding methods were used to treat everyone, to observe two groups VAS before and after the treatment, daily activities and satisfaction rate of improved Stauffer Coventry evaluation system etc. Results The VAS, daily activities and satisfaction rate of the treat group were distinctly more than that's of the control group (P<0.05 or P<0.001). Conclusion PLDA and NB has the therapeutic effects on the discogenic low back pain patients which is worth promoting.

目的 观察并评估内毒素性急性肺损伤大鼠吸入一氧化氮后外周血中内皮祖细胞和炎症介质的变化情况。方法 90只SPF级健康大鼠分为3组,A组为正常对照组(n=30),B组为急性肺损伤组(ALI)(n=30), C组为一氧化氮(NO)组(n=30)。分别计算各组外周血内皮祖细胞(Endothelial progenitor cells,EPCs) 数量,同时监测肺组织中白细胞介素-10(Interleukin-10,IL-10)水平和髓过氧化物酶(Myeloperoxidase,MPO)活性。结果 我们成功建立了大鼠的ALI肺损伤模型, C组EPCs数量、MPO活性上升幅度均小于B组、而IL-10上升水平均高于B组,差异有统计学意义(P<0.05)。结论 大鼠吸入一氧化氮可减轻内毒素所致急性肺损伤程度,其机制可能与外周血中内皮祖细胞数量及MPO水平下降和IL-10水平上升有关。

Objective To investigate the effect of nitric oxide(NO) inhalation in endotoxin-induced acute lung injury mice. Methods Ninety SPF mice were randomly assigned to the normal group(group A), ALI group(group B)and ALI+NO group(group C). The number of endothelial progenitor cells was counted and the level of Interleukin-10(IL-10) and myeloperoxidase (MPO) were measured. Results Endotoxin administration resulted in pulmonary edema. The pulmonedema was lightened and the level of MPO were decreased by the inhalation of nitric oxide while the level of IL-10 increased. Conclusion NO inhalation can mitigate acute lung injure. The decline of EPCs and MPO and the increase of IL-10 may be one of the mechanism.

目的 探讨中青年医护人员血尿酸(UA)水平与心血管危险因素的关系。方法 利用国人缺血性心血管疾病发病危险的评估方法及简易评估工具“心血管危险积分”评价982名中青年医护人员的心血管危险因素,计算其危险评分积分值,用四分位法根据UA值将研究对象分为四组,比较不同分组间的临床资料,分析UA水平与心血管危险因素的关系。结果 UA水平与心血管危险因素存在正相关(P＜0.01);Ⅲ、Ⅳ组心血管危险积分均高于Ⅰ、Ⅱ组,差异有统计学意义(P＜0.01)。结论 UA增高是心血管疾病的一个重要危险因素,重视高尿酸血症的防治,对预防中青年医护人员的心血管疾病的发生具有重要意义。

Objective To study the relationship between serum uric acid levels and risk factor of cardiovascular disease in young and middle-aged medical staff. Methods Using of risk assessment method and simple assessment tools of cardiovascular risk score of Chinese ischemic cardiovascular disease, the study appraised risk factors of cardiovascular disease about 982 young and middle-aged medical staffs, calculated the risk score integral value. The study divided objects of study into four groups with quartile's method according to serum uric acid levels, compared clinical data between different groups, analyzed the correlation between uric acid level and cardiovascular risk factors. Results Serum uric acid level and cardiovascular risk factors had positive correlation(P<0.01); Ⅲ,Ⅳ group's cardiovascular risk score were higher than Ⅰ, Ⅱ group; the difference had statistics significance(P<0.01). Conclusion Hyperuricemia is an important risk factors in cardiovascular disease. Paying attention to hyperuricemia prevention has important significance to prevention of cardiovascular disease in young and middle-aged medical staff.