目的 探讨规范化康复护理在脊髓型颈椎病前路手术术后功能恢复的影响。方法 将60例行颈椎前路椎间隙减压植骨融合内固定术的患者分为观察组和对照组各30例。对照组实施常规护理,观察组实施规范化康复护理措施。分别在出院时、出院后1、3、6个月进行日本骨科协会脊髓功能JOA评分、颈椎功能残障指数NDI评分、疼痛视觉模拟VAS评分、生活自理能力评分以及记录两组住院时间、术后并发症发生率。结果 手术后观察组与对照组的平均住院时间、术后并发症、术后脊髓功能恢复情况、颈椎功能恢复、生活自理能力的差异有统计学意义(P<0.05);观察组的平均住院时间均低于对照组(P<0.05);术后脊髓功能功能评分、生活自理能力评分均高于对照组(P<0.05);颈椎功能残障指数评分、术后并发症发生率均低于对照组(P<0.05)。结论 规范化康复护理可以促进脊髓型颈椎病行前路手术术后脊髓、颈椎功能的恢复,减少住院时间,减少术后并发症的发生,提高患者生活自理能力,提高生活质量。

Objective To investigate the effect of standardized rehabilitation nursing on functional recovery of cervical spondylotic myelopathy (CSM) after anterior operation. Methods Sixty patients were divided into two groups: observation group (n = 30) and control group (n = 30). Routine nursing was carried out in the control group and standardized rehabilitation nursing measures were carried out in the observation group. At the time of discharge, 1,3,6 months after discharge, the JOA score of spinal cord function of the Japanese Orthopaedics Association, the NDI score of cervical spine disability index, the VAS score of visual analogue of pain, the score of self-care ability of life were taken. The length of hospitalization of the two groups and incidence of postoperative complications were recorded. Results There were significant differences in average hospitalization time, postoperative complications, recovery of spinal cord function, recovery of cervical spine function and ability of living self-care between the observation group and the control group after operation (P<0.05). The average hospitalization time in the observation group was lower than that in the control group (P<0.05), and the scores of spinal cord function and self-care ability after operation were higher than those in the control group (P<0.05). The score of cervical disability index and the incidence of postoperative complications were lower than those of the control group (P<0.05). Conclusion Standardized rehabilitation nursing may promote the recovery of spinal cord and cervical spine function, reduce hospital stay, reduce postoperative complications, improve the self-care ability of patients and improve the quality of life.

目的 探究客观结构化临床考试(objective structured clinical examination,OSCE)对夜班护士准入培训效果的影响,并总结经验。方法 选取2017年5月—2018年5月期间首次获得执业注册并接受夜班准入培训的护士62名作为研究对象,采用随机数字法划分为观察组和对照组各31例。夜班准入培训时,对照组采用传统的培训考核模式,观察组采用以客观结构化临床考试为理论框架的培训考核模式,考试内容按教学目标设置,并由临床经验丰富的副高级以上导师围绕专业知识、技能、综合能力等对考点进行设计。培训结束后,两组护士均进行客观结构化临床考试、填写教学满意度量表、分析两组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力得分的差异。结果 观察组对培训效果的满意度为83.87%,对照组的满意度为54.84%,差异有统计学意义 (P＜0.05);与对照组比较,观察组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力及总分上分值明显更高,差异有统计学意义(P＜0.05);6个站点得分中,观察组的平均成绩要高于对照组,对实际临床操作、护理诊断和临床判断方面更具优势,差异有统计学意义(P＜0.05)。结论 客观结构化临床考试培训模式应用在护士夜班准入培训中,有效提高其临床能力及综合能力,提升了护士对培训课程的满意度。

Objective To explore the effect of objective structured clinical examination (OSCE) on the admission training of night shift nurses and to summarize the experience. Methods A total of 62 nurses who received the practice registration and night shift admission training from May 2017 to May 18, 2017 for the first time were selected as the study subjects. They were randomly divided into observation group and control group. For night shift admission training, the control group adopted the traditional training assessment mode, and the observation group adopted the training assessment mode with objective structured clinical examination as the theoretical framework. The examination content was set according to the teaching objectives, and was designed by clinically experienced supervisors at deputy senior level or above revolving the knowledge points of professional knowledge, skills, comprehensive ability. At the end of the trainings, nurses in the two groups took objective structured clinical examinations and filled out the teaching satisfaction scale. The differences in scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability in the two groups were analyzed. Results The satisfaction rate in the observation group was 83.87%, higher than that in the control group, which was 54.84%, and the difference was statistically significant (P<0.05). The scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability and the total scores in the observation group were higher than those in the control group, and the difference was statistically significant (P<0.05). The average score of knowledge points in the observation group was higher than that in the control group, with the former group boasting more advantages in actual clinical operation, nursing diagnosis and clinical judgment, with statistically significant difference between the two groups (P<0.05). Conclusion The application of objective structured clinical examination in nurse's night shift admission training may help improve their clinical ability and comprehensive ability, as well as their satisfaction to training courses.

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 利用分析各种浓度环氧化酶-2(COX-2)特异度抑制剂塞来昔布对食管癌EC109细胞系的作用,进而对COX-2蛋白表达的影响及对细胞凋亡能力的作用,进一步探讨塞来昔布对食管癌细胞凋亡的作用及机制。方法 使用0 μmol/L、20 μmol/L、60 μmol/L、100 μmol/L四个浓度的塞来昔布处理EC109细胞24 h,酶联免疫吸附剂测定(ELISA)法测定COX-2蛋白表达;流式细胞仪测定EC109细胞凋亡情况。结果 与0 μmol/L塞来昔布组比较,20 μmol/L、60 μmol/L、100 μmol/L塞来昔布组EC109细胞内COX-2蛋白表达不断降低(1.581±0.116;1.226±0.089,0.846±0.076,0.521±0.082)(P<0.05);而细胞凋亡率逐步上升(1.700±0.557,13.400±1.735,18.766±1.301,28.100±1.997)(P<0.05)药物浓度依赖于梯度。结论 塞来昔布是一种COX-2抑制剂,可能以浓度梯度的形式抑制COX-2蛋白的表达,从而促进EC109细胞的凋亡。

Objective The effects of celecoxib, a specific COX-2 inhibitor at various concentrations, on EC109 cell line of esophageal cancer were analyzed, and the effect and mechanism of celecoxib on apoptosis of esophageal carcinoma cells were further studied. Methods EC109 cells were treated with celecoxib at concentrations of 0 μmol/L, 20 μmol/L, 60 μmol/L and 100 μmol/L for 24 h. The protein of COX-2 in EC109 cells was determined by enzyme-linked immunosorbent assay (ELISA). Assay of EC109 cell apoptosis were determined by flow cytometry. Results Compared with the 0μmol/L celecoxib group, the expression of COX-2 protein in EC109 cells of 20μmol/L, 60μmol/L, 100μmol/L celecoxib group gradually decreased(1.581±0.116; 1.226±0.089, 0.846± 0.076, 0.521±0.082) (P<0.05); and the apoptotic rate gradually increased (1.700±0.557; 13.400±1.735, 18.766±1.301, 28.100±1.997) (P<0.05) in a drug concentration gradient-dependent manner. Conclusion The COX-2 inhibitor celecoxib may inhibit the expression of COX-2 protein in a concentration gradient and promote the apoptosis of esophageal cancer EC109 cells.

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 探究五加生化胶囊联合热电复合治疗仪对人流术后子宫复旧影响的临床效果。方法 选择2018年4月—2019年8月我院收治的人流术后子宫复旧患者240例,随机分成两组,对照组进行常规术后处理,研究组则在常规术后处理的基础上进行五加生化胶囊联合热电复合治疗仪治疗。结果 研究组的术后疼痛症状评分低于对照组(P＜0.05);研究组的平均流血量、持续流血天数以及术后月经复潮天数均少于对照组(P＜0.05);研究组的子宫内膜厚度高于对照组(P＜0.05),且子宫纵径和横径短于对照组(P＜0.05)。结论 五加生化胶囊联合热电复合治疗仪对人流术后子宫复旧进行治疗具有良好效果,值得推广。

Objective To investigate the clinical effect of Wujia biochemical capsule combined with thermoelectric complex therapy instrument on uterine retroplasia after abortion. Methods 240 cases of uterine rehabilitation after abortion from April 2018 to August 2019 were selected and randomly divided into two groups. The control group were performed routine postoperative treatment, while the research group were performed five plus biochemical capsules combined with thermoelectric complex therapy instruments on the basis of routine postoperative treatment. Results The postoperative pain symptom scores were lower than that of control group(P<0.05). The average blood flow, duration of bleeding and post-operative menarche were all less than that of control group(P<0.05). The thickness of endometrium in the study group was higher than that of the control group(P<0.05), and the longitudinal and transverse diameters of the uterus were shorter than those of the control group(P<0.05). Conclusion Wujia biochemical capsule combined with thermoelectric complex therapy instrument has a good effect on the treatment of involution of uterus after abortion and is worth promoting.

目的 研究结肠癌组织中转录因子KLF8的表达及下调KLF8的表达对结肠癌细胞的影响。方法 收集结肠癌组织和癌旁正常组织,检测KLF8的蛋白含量;培养结肠癌Lovo细胞株,转染KLF8 siRNA后检测细胞侵袭、迁移以及上皮-间质转化(EMT)。结果 结肠癌组织中KLF8的蛋白含量高于癌旁正常组织;转染KLF8 siRNA的结肠癌细胞组迁移距离低于阴性对照组,且侵袭至transwell微孔膜外侧面的细胞数少于阴性对照组;转染KLF8 siRNA的结肠癌细胞组内E-cadherin的表达升高,Vimentin、N-cadherin的蛋白含量低于阴性对照组。结论 结肠癌组织中KLF8的表达量升高,下调结肠癌细胞中KLF8的表达可抑制结肠癌细胞侵袭、迁移及上皮-间质转化过程。

Objective To study the expression of transcription factor KLF8 in colorectal cancer tissue and its effect of downregulation KLF8 on colorectal cancer cell. Methods Collecting cancer tissues and adjacent normal color tissue and detecting the protein level of KLF8. Culturing the colorectal cancer Lovo cell lines and detecting cell invasion, cell migration and epithelial-mesenchymal transition after transfecting of KLF8 siRNA. Results KLF8 was highly expressed in colorectal cancer tissues compared with adjacent normal colon tissue. After transfection of KLF8 siRNA, the migration distance of colorectal cancer cell and the cell population transferred to the lateral surface of transwell microporous membrane were lower than those of negative control siRNA. E-cadherin of KLF8 siRNA group were higher than those of negative control siRNA group. Vimentin and N-cadherin were lower than those of negative control siRNA group. Conclusion The expression of KLF8 in colorectal cancer tissue is elevated;downregulation of KLF8 expression in colorectal cancer cell lines may inhibit cell invasion, cell migration and epithelial-mesenchymal transition processes.

目的 探讨腰椎间盘手术护理路径对经皮椎管成型下腰椎间盘摘除手术患者腰腿功能康复效果。方法 选择2018年1月—2019年11月住院进行经皮椎管成型下腰椎间盘摘除手术患者60例,按住院时间先后分为对照组和实验组各30例,对照组患者术后按椎间盘摘除手术给患者进行病情观察、腰腿功能康复锻炼、腰围配戴和康复护理知识宣教等护理;实验组患者在实施对照组护理措施基础上按腰椎间盘手术护理路径对患者进行有计划的康复护理知识宣教,按制定的康复护理路径对患者进行个性化康复活动训练指导。术后1周和出院时分别对患者掌握康复护理训练知识、腰椎功能障碍指数(ODI)、服务满意度进行评价。结果 实验组患者在术后首次进行康复训练时间早于对照组,差异有统计学意义(P=0.000 4);掌握康复护理知识得分实验组高于对照组,差异有统计学意义(P=0.002 3);掌握康复训练活动实验组高于对照组,差异有统计学意义(P<0.05);腰椎功能障碍指数(ODI)实验组低于对照组,差异有统计学意义(P<0.05);护理服务满意度实验组高于对照组,结果差异有统计学意义(P<0.05)。结论 椎间盘手术护理路径能促进患者早期进行康复训练,提高患者对腰椎间盘术后康复护理知识和康复训练技能的掌握,降低患者腰椎功能障碍指数,促进术后患者机体功能的康复。

Objective To explore the effect of nursing path of lumbar disc operation on the rehabilitation of lumbar and leg function in patients undergoing percutaneous laminoplasty. Methods From January 2018 to November 2019, 60 patients who were hospitalized for percutaneous laminoplasty were divided into the control group and the experimental group with 30 patients in each group according to the length of stay. The patients in the control group were given nursing care including condition observation, waist and leg function rehabilitation exercise, waist circumference wearing and rehabilitation nursing knowledge propaganda and education after the operation. On the basis of the nursing measures of the control group, patients in the experimental group received the planned rehabilitation nursing knowledge education according to the nursing path of lumbar disc operation, and individualized rehabilitation activity training guidance according to the established rehabilitation nursing path. One week after the operation and at the time of discharge, the patients' mastery of rehabilitation nursing training knowledge, lumbar dysfunction index (ODI) and service satisfaction were evaluated. Results The first time of rehabilitation training in the experimental group was earlier than that in the control group, the results were statistically significant (P=0.000 4); the score of mastering rehabilitation nursing knowledge in the experimental group was higher than that in the control group, the results were statistically significant (P=0.002 3); the experimental group of mastering rehabilitation training activities was higher than that in the control group, the results were statistically significant (P<0.05); lumbar dysfunction index ODI in the experimental group was lower than that in the control group, the results were statistically significant (P<0.05); the satisfaction of nursing service in the experimental group was higher than that in the control group, the results were statistically significant (P<0.05). Conclusion The nursing path of lumbar disc surgery can promote the early rehabilitation training of patients, improve the mastery of postoperative rehabilitation nursing knowledge and rehabilitation training skills of patients, reduce the lumbar dysfunction index of patients, and promote the rehabilitation of patients' body function.

目的 探讨近期大咯血对支气管镜诊疗操作相关出血的影响。方法 回顾性分析2015年12月—2019年12月我院支气管镜操作导致出血超过30 mL患者的临床资料,根据近1周是否发生大咯血,分为观察组(大咯血组)和对照组(无大咯血组),比较2组间的出血量以及大出血、血凝块、窒息的发生率。结果 观察组的出血量以及大出血的发生率高于对照组,2组间差异有统计学意义,血凝块、窒息的发生率两组间差异无统计学意义。结论 近期大咯血的患者支气管镜操作发生大出血的风险高。

Objective To explore the effect of short-term massive hemoptysis on the procedure-related bleeding of bronchoscopy. Methods The clinical data of patients with more than 30 mL bleeding caused by bronchoscopy operation in Guangzhou Chest Hospital from December 2015 to December 2019 were analyzed retrospectively. According to whether massive hemoptysis occurred in the past week, the patients were divided into observation group (massive hemoptysis group) and control group (no massive hemoptysis group). The bleeding volume, the incidence of massive hemorrhage, blood clot and asphyxia were compared between the two groups. Results The amount of bleeding and the incidence of massive hemorrhage in the observation group were higher than those in the control group, that there was a statistical significance between the two groups. There was no statistical significance between the two groups in the incidence of blood clots and asphyxia. Conclusion Patients with recent massive hemoptysis have a higher risk of massive haemorrhage due to bronchoscopy.

目的 探讨影响孕晚期死胎伴胎动减少延迟就诊的临床因素,加强围产期宣教。方法 回顾性分析2017年1月—2019年10月广州市妇女儿童医疗中心住院分娩的孕晚期(孕周≥28周)单胎死胎病例的相关临床资料。结果 在79例死胎中,有59例(74.68%)孕妇感知胎动减少,但只有27人(45.76%)在感知胎动减少后24小时内就诊。妊娠未合并胎儿生长受限可能会导致延迟就诊(P=0.03<0.1)。结论 胎动减少和死胎发生密切相关,但大部分孕妇可能会出现延迟就诊。加强孕期产检,规范孕期宣教,尤其是合并胎儿生长受限等高危妊娠时的孕期严密监测,强调胎动的重要性,在感知胎动减少后强调早期就诊,有助于减少孕晚期死胎风险。

Objective To explore the clinical factors that affect the consultation time of stillbirth after perceptive reduction of fetal movement in the third trimester of pregnancy, and to strengthen the perinatal education. Methods A retrospective analysis of single stillbirth in late pregnancy (gestational weeks≥ 28 weeks) in Guangzhou Women and Children's Medical Center from January 2017 to October 2019 was taken, and the relevant clinical data were summarized and evaluated. Results Out of 79 stillbirth cases, 59 (74.68%) cases had decreased fetal motility. Only 27 pregnant women (45.76%) visited the doctor in 24 hours after they perceived the reduction of fetal movement. Pregnancy without fetal growth restriction may lead to delayed consultation (P=0.03<0.1). Conclusion Perception of decreased fetal movement is closely related to the occurrence of stillbirth, but most pregnant women may have delayed visits. To strengthen the prenatal examination, standardize the propaganda and education during pregnancy, especially the close monitoring of high-risk pregnancy such as fetal growth restriction, emphasize the importance of fetal movement, and emphasize the early consultation after perceiving the reduction of fetal movement, are helpful to reduce the risk of stillbirth in late pregnancy.