目的 观察清化血浊中药对大动脉粥样硬化型(LAA)缺血性脑卒中患者的临床疗效。方法 将105例发病24 h内符合标准的大动脉粥样硬化型缺血性脑卒中患者,随机分为观察组52例和对照组53例,对照组予以西医综合治疗,观察组在西医综合治疗的基础上加用清化血浊中药(化浊和血颗粒),疗程为14 d。两组患者分别于治疗前及治疗后7 d、14 d评定NIHSS评分;治疗前及发病1个月后分别测定mRS评分,以判定临床转归;治疗前及治疗后14 d分别采集空腹血测定低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋浓度。结果 清化血浊中药可降低大动脉粥样硬化型缺血性脑卒中患者治疗后7 d及14 d的NIHSS评分(P<0.05)、增加好转率且不增加患者复发、死亡及出血性转化,并能降低患者血低密度脂蛋白胆固醇、纤维蛋白原、血浆粘度及超敏C反应蛋白。结论 清化血浊中药可减低大动脉粥样硬化型缺血性脑卒中患者的神经功能缺损,促进神经功能恢复,提高临床良好转归, 且不增加出血性转化。

目的 探讨延续性健康指导联合预见性干预对慢性脑卒中患者脑功能影响。方法 选取2019年6月—2020年6月我院收治的慢性脑卒中患者118例,使用随机数字表法将其分为两组,对照组进行预见性干预,研究组进行延续性健康指导联合预见性干预。比较两组效果、神经运动功能、不良反应。结果 研究组效果大于对照组(P＜0.05);研究组神经运动功能大于对照组(P＜0.05);研究组不良反应少于对照组(P＜0.05)。结论 慢性脑卒中护理中,延续性健康指导联合预见性干预效果较好,值得应用。

Objective To investigate the effects of continuous health guidance and combined predictive intervention on cerebral function in patients with chronic stroke. Methods A total of 118 patients with chronic stroke admitted to our hospital from June 2019 to June 2020 were selected and divided into two groups using the random number table method. The control group received predictive intervention, and the study group received continuous health guidance combined predictive intervention. The effects, neuromotor functions and adverse reactions of the two groups were compared. Results The effect of the study group was greater than that of the control group (P<0.05). The neuromotor function of the study group was higher than that of the control group (P<0.05). The adverse reactions in the study group were less than those in the control group (P<0.05). Conclusion In the nursing of chronic stroke, the effect of continuous health guidance combined with predictive intervention is good, and it is worth applying.

目的 观察紧密连接蛋白在高尿酸血症致大鼠肾损害模型中的表达变化以及非布司他的干预疗效。方法 将SD大鼠分为正常组,高尿酸血症组(模型组),非布司他组(干预组);氧嗪酸联合尿酸诱导制作高尿酸血症大鼠模型,给予非布司他进行干预,分别于6周后检测各组大鼠血中尿素氮(BUN)、血肌酐(Scr)、尿酸(UA)水平,免疫组化及RT-PCR方法检测紧密连接蛋白包括膜周蛋白-1(ZO-1)、跨膜蛋白(occludin) 的表达变化,采用Masson染色检测大鼠肾间质病理改变。结果 6周时,模型组、干预组ZO-1、occludin表达较正常组降低(均P<0.05);干预组ZO-1、occludin表达较模型组增加,差异有统计学意义(均P<0.05),与正常组相比,模型组、干预组RIF指数均增高(均P<0.05),干预组RIF指数低于模型组,高于正常组(均P<0.05)。结论 紧密连接蛋白表达的降低在高尿酸血症肾间质纤维化发展过程中起着举足轻重的作用,并与血尿酸水平及肾功能损害密切相关。非布司他通过降低血尿酸水平,能改善紧密连接蛋白的表达,延缓肾功能损害,起到肾保护作用。

Objective To observe the expression of tight junction protein in hyperuricemia induced renal damage model in rats and the intervention effect of febuxostat. Methods SD rats were randomly divided into three groups: normal control group, model control group, febuxostat treatment group. Hyperuricemia was induced in rats with oxonic acid per time for three times per day, by gavage and combined with uric acid added in drinking water, while febuxostat were administered by gavage in febuxostat treatment group.The blood of rats were collected to analyse the differences of control, model and treatment group on changes of blood urea nitrogen (BUN), creatinine (Cr), uric acid (UA). Immunohistochemistry was used to assay ZO-1 and occludin protein expression and quantitive real time PCR to detect the expression of ZO-1 and occludin in renal tissue of renal interstitial fibrosis model rats induced by hyperuricemia. Paraffin section of kidney was maked and then performed Masson staining to make sure the model is successful. Results At 6 weeks, the expressions of ZO-1 and occludin in the model group and treatment group were lower than those in the normal group (all P<0.05). The expressions of ZO-1 and occludin in the treatment group were higher than those in the model group (all P<0.05). Compared with the normal group, the RIF index in the model group and treatment group were higher (all P<0.05), and the RIF index in the treatment group was lower than that in the model group and higher than that in the normal group (all P<0.05). Conclusion The downregulated expression of ZO-1 and occludin plays a crucial role during the development of hyperuricemia in renal interstitial fibrosis, and are closely related to UA level and renal function impairment. Febuxostat may improve the expression of tight junction by downregurating UA, reduce renal fuction impairment and play a role in renal protection.

目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

目的 探讨循证护理干预在肺功能检查中对检查准确性的影响。方法 选取行肺功能检查患者80例,随机分为2组,分别记录为观察组40例和对照组40例,分别实施循证护理干预和常规护理干预,比较两组患者肺功能检查时间、肺功能检查结果及护理满意度。结果 观察组患者平均肺功能检查时间短于对照组(P<0.05);观察组患者肺功能检查正常率高于对照组;且观察组患者对护理服务的满意度高于对照组,组间对比差异有统计学意义(P<0.05)。结论 对行肺功能检查的患者实施循证护理干预效果显著,有利于缩短患者肺功能检查时间,并可提高检查的准确率,且有利于改善护患关系,值得在临床上推广应用。

Objective To investigate the influence of evidence-based nursing intervention on the accuracy of the examination in pulmonary function test. Methods 80 cases of patients with lung function examination, were randomly divided into 2 groups, were recorded in 40 cases of observation group and control group 40 cases, respectively. The implementation of evidence-based nursing intervention and routine nursing intervention were taken, to compare times of patients with pulmonary function test, pulmonary function test results and nursing satisfaction in two groups. Results In the observation group the average lung function examination time was shorter than that of the control group (P<0.05); normal pulmonary function tests was higher than that of the control group; satisfaction with nursing service was higher than the control group, there was statistical significance the differences between the two groups (P<0.05). Conclusion The pulmonary function test for patients with the implementation of evidence-based nursing intervention has significant effect. It can shorten the time in patients with pulmonary function examination, improve the inspection accuracy, and improve the relationship between nurses and patients, it is worthy of clinical application.

目的 探讨临床路径带教模式在胸外科带教中的应用价值。方法 选取2017年1月—2018年1月于我院胸外科进行规范化培训的学员84人,根据培训时间分为两组,其中2017年1月—2017年6月的42名学员为对照组,采用常规带教模式,2017年7月—2018年1月的42名学员为观察组,采用临床路径带教模式。两组带教时间均为3个月,分别在带教前、带教期满时采用《简易临床评估实习量表（Min-CEX）》评价两组学员的临床工作能力,采用《评判性思维能力测量表（CTDI-CV）评价学员的评判性思维能力。结果 观察组带教后反射检查、组织效能、沟通技能、定位诊断、专业态度、临床胜任能力、处理建议、感觉系统检查、运动系统检查、定性诊断评分及总分高于对照组,差异有统计学意义（P<0.05）。观察组带教后寻求真相、分析能力、评判性思维的自信心、认知成熟度、开放思想、系统化能力评分及总分高于对照组,差异有统计学意义（P<0.05）。结论 临床路径带教模式能提高培训学员的临床工作能力与评判性思维能力,在胸外科带教中的应用价值较高。

目的 总结预防接种认知干预对儿童预防接种效果的影响。方法 对2018年5—9月在东莞企石镇接种百白破疫苗的儿童家属按接种时间顺序分为对照组254名、实验组248名,对照组家属按常规方法进行预防接种,实验组在常规接种基础上,结合不按时接种、延迟接种等问题对幼儿家属开展多种多样的百白破疫苗预防知识、不良反应观察处理、接种注意事项等知识宣教和培训干预,总结两组儿童在按时接种、延迟接种、疫苗接种知识、不良反应表现与处理、接种注意事项知识的掌握、服务满意度等情况。结果 实验组幼儿按时接种率比对照组高,延迟接种率比对照组低,结果有差异(P＜0.05);家属对疫苗接种知识、不良反应表现和处理、接种注意事项等知识的掌握比对照组高,结果有差异(P＜0.05)。结论 实施家属预防接种认知干预管理能提高家属掌握预防接种知识和不良反应护理知识;提高儿童疫苗接种率和及时接种率,提高预防接种服务管理效果。

Objective To summarize the effect of cognitive intervention on children's vaccination. Methods The family members of children vaccinated with DPT vaccine in Qishi Town of Dongguan City from May to September 2018 were divided into control group 254 and experimental group 248 according to the sequence of vaccination time. The family members of control group were vaccinated by routine methods. On the basis of routine vaccination, the experimental group carried out a variety of preventive knowledge and adverse reactions observation of DPT vaccine to the family members of children in combination with the problems of untimely vaccination and delayed vaccination. The knowledge propaganda and training intervention of treatment and vaccination precautions were summarized. The situation of two groups of children in timely vaccination, delayed vaccination, vaccination knowledge, adverse reaction performance and treatment, knowledge of vaccination precautions and service satisfaction were summarized. Results The vaccination rate of children in the experimental group was higher than that in the control group, and the delayed vaccination rate was lower than that in the control group. The results showed statistical difference (P＜0.05). The knowledge of vaccination, adverse reactions, treatment and matters needing attention of family members were higher than that in the control group, and the results showed statistical difference (P＜0.05). Conclusion Implementing cognitive intervention management of family vaccination may improve family members'knowledge of vaccination and nursing of adverse reactions, improve children's vaccination rates and timely vaccination rates, and improve the management effect of vaccination service.

目的 观察饮食干预管理和健康教育对糖尿病酮症酸中毒(DKA)患者的干预效果。方法 90例DKA患者根据数字表法随机分为2组,对照组(n=45)予以常规治疗及护理措施,观察组(n=45)在对照组治疗及护理基础上予以饮食干预管理和健康教育,比较两组患者干预后血糖控制时间、酸中毒纠正时间和住院治疗时间;采用相关效果量表调查两组患者干预前后相关知识知晓程度及健康饮食依从度;通过生活质量评分表和问卷表比较两组患者两组生活质量和护理满意度。结果 观察组干预后血糖控制时间、酸中毒纠正时间均早于对照组(P<0.05),而住院治疗时间少于对照组(P<0.05);两组干预前相关知识知晓程度比较无差异(P>0.05),观察组干预后相关知识知晓程度及健康饮食依从度均优于对照组(P<0.05);观察组干预后生活质量及护理满意度均优于对照组(P<0.05)。结论 饮食干预管理和健康教育可明显改善DKA患者症状及生活质量,提高相关知识知晓程度及健康饮食依从度。

目的 了解社区医护人员的心理健康状况,评估心理干预措施效果,找到提高社区医护人员心理健康状况的有效措施。方法 采用《症状自评量表 SCL-90》对社区医护人员的心理健康状况进行基线调查,在干预3、6、9个月时分别进行SCL-90复测,以评估心理干预措施效果;根据《医护人员工作压力测试量表》的调查结果制定有针对性的心理干预措施并适时调整。结果 社区医护人员SCL-90测评总分和躯体化、强迫、人际敏感、焦虑、敌对、恐怖、偏执7个因子得分均高于全国常模水平(P<0.05);经过综合干预,随访期间SCL-90测评总分呈逐步下降趋势,干预6个月时,除人际敏感因子外,SCL-90测评总分及各因子分已趋于正常水平,与全国常模比较差异没有统计学意义(P<0.05)。至9个月时,人际敏感因子得分也恢复至正常水平。结论 社区医护人员心理健康状况低于全国常模水平,进行针对性的综合干预可提高其心理健康水平,实验显示干预时长应不低于6个月。

Objective To understand the mental health status of community health care workers, assess the effect of psychological intervention measures, and find effective measures to improve the mental health status of community health care workers.Methods With the help of Symptom Checklist SCL-90, we firstly carried out baseline survey on community medical staff mental health; then retested that at 3, 6 and 9 months later. Thus, we could assess the effect of psychological intervention. According to the results of the medical staff working pressure test questionnaire, we could develop targeted psychological intervention measures and adopt prompt adjustment.Results Community health care personnel SCL-90 evaluation score and 7 factors scores(physical,forced,interpersonal sensitivity,anxiety,hostility,terror,and paranoia) were higher than the national norm(P<0.05);after comprehensive intervention in the 9 months follow-up,the SCL-90 evaluation score was decreasing gradually.After intervention for 6 months,except for the interpersonal sensitivity factor,SCL-90 total scores and the other factor scores tend to normal levels, to compare the national norm, there was no statistical significance in differences (P<0.05). 9 months later, the scores of interpersonal sensitivity also return to normal levels.Conclusion The mental health status of community health care workers was lower than the national norm,the comprehensive intervention may improve their mental health level, and the experiment showed that the intervention should be no less than 6 months.

目的 观察ST段抬高型急性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中应用不同转运模式的应用疗效。方法 选取我院80例行急诊PCI的STEMI患者,有31例患者的12导联心电图由救护车上的急救人员通过手机微信传输到指定的东莞市大朗医院胸痛中心微信群(远程早期干预组),有49例患者自行来院就诊(传统就诊组),比较两组患者的临床疗效。结果 远程早期干预组患者的D-to-B时间低于传统就诊组(P<0.01),D-to-B达标率高于传统就诊组(P<0.01);远程早期干预组患者住院费用、平均住院天数、住院期间病死率及心力衰竭发生率均低于传统就诊组(P<0.05)。结论 相比较传统就诊模式,远程转运模式能显著提高STEMI患者PCI术的治疗效果,并有效改善其预后情况,临床效益较好,值得实践推广。