目的 探讨<34周早产儿发生晚发型败血症的危险因素及其病原分布,为防控及治疗用药提供依据。方法 选择2015年1月—2017年12月本院收治的<34周早产儿,根据是否发生晚发型败血症分为感染组及对照组,回顾性分析两组临床资料,对其可能的危险因素采用多因素Logistic回归分析。分析感染组患儿所感染的病原菌及其药敏情况。结果 感染组27例,对照组73例,单因素分析显示感染组患儿出生体重低于对照组,出生窒息、机械通气、使用H₂受体阻滞剂、多种抗生素使用、经外周中心静脉置管（PICC）及PICC留置≥14天比例均高于对照组,差异有统计学意义（P<0.05）。多因素logistic回归分析显示出生体质量、PICC留置是<34周早产儿发生晚发型败血症的独立危险因素。感染组中血培养阳性20例,真菌培养阳性11例（55.0%）,G⁺菌5例（25.0%）,G^-菌4例（20.0%）。药敏结果中两性霉素B和氟康唑敏感性高。结论 早期早产儿发生晚发型败血症受多重因素影响,真菌已成为主要致病菌,应针对高危因素加强感染防控,根据血培养及药敏结果合理使用抗菌药物。

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 探究不同类型职业病危害因素对暴露工人生命质量的影响。方法 在某市电子制造业、灯饰制造业、金属冶炼业等能够接触到粉尘、铅、苯以及噪声的6家企业中,采用整群随机抽样法,共计抽取742人为研究对象,对上述企业2015—2017年的职业病危害因素检测报告进行回顾性分析,主要对各企业的职业病危害因素以及暴露水平实施分析,并对企业员工的生命质量情况实施调查。结果 三种不同行业之间的有机溶剂检测合格率比较差异均有统计学意义(P＜0.05),其中有机溶剂检测合格率最低的是金属冶炼业;三种不同行业的粉尘检测合格率差异以及噪声检测合格率比较差异无统计学意义(P＞0.05),其中灯饰制造业的噪声及粉尘检测合格率最低;各行业工作人员的生理、社会功能,心理、情感职能,精神健康,身体疼痛、活力以及总计健康评分差异有统计学意义(P＜0.05),电子制造企业的各项评分均高于金属冶炼业以及灯饰制造业。多重线性回归分析结果发现,电子制造企业的生理与心理健康维度得分均高于灯饰制造业、金属冶炼业,差异有统计学意义(P＜0.05),且主要与运动锻炼以及所从事的行业有较大关联。结论 不同类型的职业病危害因素暴露水平存在一定差异,企业职工的生命质量也会因此受到不同程度的影响,应对存在噪声、粉尘以及大量使用有机溶剂等职业病危害因素企业作为健康监护的重点。

目的 了解医务人员临床工作中血源性职业暴露的情况、暴露后的心理健康状况及其影响因素,采取干预措施,保障医务人员身心健康。方法 对医院2013年1月—2017年12月上报的79例血源性职业暴露者,在1个月内进行现状调查,同时采用自填式问卷症状自评量表(SCL-90)对调查对象进行调查,对其暴露后的心理影响程度进行评估。结果 医务人员在发生血源性职业暴露后其中躯体化因子、人际关系敏感因子、抑郁因子、焦虑因子在职业暴露前后的比较及与未发生职业暴露的医务人员相比较,均有不同程度的提高,差异均有统计学意义(P<0.001)。单因素分析显示影响血源性职业暴露后医务人员的心理健康状况的因素有年龄、职业、工龄、既往发生职业暴露史和患者患传染病种类(P<0.05)。其中年龄在21~25岁年龄的医务人员的得分较高,职业为医生和陪护工人的得分较高,工龄在1~5年的得分较高,既往发生过职业暴露的医务人员得分较高,患者患传染病类型为梅毒及暴露源不明的得分较高。结论 医务人员在发生血源性职业暴露后,其心理健康状态可受到较大影响;工龄、既往发生职业暴露史和患者患传染病种类是医务人员发生血源性职业暴露后心理状况健康的独立影响因素。医院管理者在重视预防及减少职业暴露的同时,更应关注血源性职业暴露后的心理变化,及时提供心理支持和医疗帮助。

目的 探讨影响初次机采血小板献血者再次捐献的相关因素,为制定机采献血者保留策略提供依据。方法 选择2016年1月1日—2016年12月31日在广州血液中心首次成功捐献机采血小板的13 899例献血者为研究对象,分析每个献血者献血时性别、年龄、文化程度、是否发生献血不良反应与下一年度是否再次捐献机采血小板的相关性。结果 男性献血者再次捐献率(10.68%)高于女性献血者再次捐献率(8.94%),差异有统计学意义(P＜0.01);献血者年龄18～25岁组再次捐献率最高为12.86%,46～60岁组再次捐献率最低为6.46%,差异有统计学意义(P＜0.001);献血者文化程度高中或职中组再次捐献率最高为11.23%,本科或以上组再次捐献率最低为8.94%,差异有统计学意义(P＜0.001);未发生不良反应献血者再次捐献率(10.37%)高于发生不良反应献血者再次捐献率(5.56%),差异有统计学意义(P＜0.01)。结论 男性、年龄较小、文化程度较低和未发生献血不良反应的献血者更愿意返回再次捐献机采血小板,对这部分献血者采取针对性保留措施,有利于建立起一支固定捐献机采血小板的献血者队伍。

Objective To explore the related factors affecting the re-donation of the first apheresis platelet donors, and to provide a basis for the retention strategy. Methods A total of 13 899 blood donors who successfully donated apheresis platelets for the first time in Guangzhou Blood Center from January 1, 2016 to December 31, 2016 were selected as subjects. The correlation among gender, age, education level, adverse reactions of blood donation and whether platelet collection was re-donated in the next year was analyzed. Results Re-donation rate of male blood donors (10.68%) was higher than that of female blood donors (8.94%). The difference was statistically significant (P<0.01). Re-donation rate of blood donors aged 18～25 was the highest 12.86%, and that of 46～60 was the lowest 6.46%. The difference was significant (P<0.001). Re-donation rate of high school or vocational college blood donors was the highest 11.23%. The lowest re-donation rate was 8.94% in the undergraduate group or above, and the difference was statistically significant (P< 0.001). The re-donation rate of donors without adverse reactions (10.37%) was higher than that of donors with adverse reactions (5.56%). The difference was statistically significant (P<0.01). Conclusion Male, younger, less educated and no adverse reactions to blood donation are more willing to return to donate platelet again. Targeting these donors for reserve measure will conducive to the establishment of a fixed platelet donor team.

目的 探讨脑动静脉畸形(AVM)破裂出血发生的危险因素。方法 回顾性研究2014年—2018年我院收治的AVM病例42例,根据有无破裂出血,分为出血组和非出血组,对AVM破裂出血发生的相关因素进行统计学分析。结果 通过相关性及逐步回归分析,表明AVM破裂出血的独立危险因素为: 深部静脉引流和低龄患者。结论 对于引流静脉为深部静脉引流类型和低龄的AVM患者,应积极尽早治疗。

Objective To analyze the risk factors related to cerebral arteriovenous malformation(AVM)with hemorrhage. Methods The clinical data of 42 patients with AVM between 2014 and 2018 were respectively studied. According to the presence of rupture, the cases were divided into bleeding group and non-bleeding group. The factors associated with the occurence of AVM rupture were statistically analyzed. Results The correlation and logistic regression analysis suggested that the deep venous drainage and young patients were the independent risk factors for AVM rupture. Conclusion The young patients and the patients with deep venous drainage should be operated as soon as possible to avoid hemorrhage.

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 通过评估非直属附属医院临床教学质量的影响因素,探讨保障非直属附属医院同质化教学的方法。方法 将实习同学分为院校组和混合组两组,运用德尔菲法调查法对非直属附属医院临床教学过程中所遇到的困难进行分析,并提出教学改革的意见和评价。结果 得出的调查结论对教师、学生、医院教学管理人员和学校教学管理人员都提出了更高的要求,可以为达到同质化教学提供参考。结论 有针对性的开展临床教学工作,变被动教学为主动的教与学,使临床教学达到同质化,从而达到更佳的教学效果。

Objective To explore the methods of guaranteeing homogeneity teaching in Non-affiliated hospitals by assessing the factors affecting the quality of clinical teaching in Non-affiliated hospitals. Methods Divide the students into two groups:college group and mixed group,to meet the process of clinical teaching in Non-affiliated hospitals in difficulty were analyzed by using the Delphi survey method, and put forward opinions and evaluation. Results the survey findings put forward higher requirements for teachers, students, hospital teaching administrators and school teaching administrators, which can provide references for achieving homogeneity teaching. Conclusion targeted clinical teaching should be carried out to change passive teaching into active teaching and learning, so that clinical teaching can be homogenized, so as to achieve better teaching effect.

目的 探讨孕妇学校改革创新后,孕妇对孕妇学校授课的效果和满意度及影响因素分析。方法 2016年8月—2017年6月,通过师资授课比赛、课后孕妇满意度、对相关知识知晓率排名相结合方式竞争产生孕妇学校授课师资队伍,随机选取部分听课孕妇作为调查对象。结果 授课后,孕妇对相关知识的知晓得分提高约20分(P＜0.05),孕妇对核心知识点知晓率提高明显(P＜0.05),孕妇对课程讲授效果各方面满意度均在94%以上。对课程不满意的维度主要有授课PPT制作、教学计划、授课形式等,不满意比例分别为19.1%、18.0%和16.3%。对课程不满意组孕妇较满意组孕妇年龄偏大(P＜0.05),其余孕妇基本特征差异无统计学意义。结论 孕妇学校师资改革成效明显,行之有效,值得推广。

Objective To explore the effect of pregnant women's school after reform and innovation. Methods FromAugust 2016 to June 2017, teachers of pregnant women's school were produced by teaching competition and pregnant women's satisfaction and degree of knowledge. Survey objects were randomly selected. Results After teaching, knowledge degree of pregnant women improved about 20 points (P<0.05). The awareness rate of pregnant women on core knowledge points increased (P<0.05). Satisfaction degree of pregnant women on the course was over 94%. The main dimensions of dissatisfaction with the course included PPT production, teaching plan and teaching form. The proportions of dissatisfaction were 19.1%, 18.0% and 16.3% respectively. Unsatisfied women ages were older than satisfied women (P<0.05). Conclusion Reform and innovation is effective, and it is worth promoting.