目的 探讨家庭药师与药物治疗管理对签约患者用药依从性及不合理用药干预效果。方法 选取2017年3月—2021年3月我院收治的慢性病患者100例作为前瞻性研究对象,按照随机余数法分为对照组和研究组各50例。其中,对照组实施首次随访调查,收集患者健康信息建立用药档案,末次随访评价。研究组采用收集患者健康信息,建立用药档案,填写调查表,对在用的药物治疗方案进行评价,家庭药师与家庭医生协作共同干预或直接干预,制定具体的解决方案,帮助患者达到治疗目标。比较2组患者干预前后的药物依从性、生活质量及用药情况的变化。结果 干预前,2组患者的药物依从性评分比较无统计学意义(P ＞0.05),干预后,2组患者药物依从性评分比较随时间增加而改善,而研究组的药物依从性评分显著高于对照组,统计学显示差异有统计学意义(P＜0.05)。2组患者的选择合理、给药频率合理、滴定合理、换药合理、联合用药合理均有明显改善且研究组多于对照组,比较差异有统计学意义(P＜0.05)。结论 家庭药师及药物治疗管理干预能够有效提高患者用药依从性及生活质量,改善用药情况,对慢性病患者干预具有一定参考价值。

Objective To explore intervention the effect of family pharmacist and medication management on medication compliance and unreasonable drug use in contracted patients. Methods A total of 100 patients with chronic diseases from March 2017 to March 2021 in our hospital were selected as prospective study subjects. According to the random remainder method,they were divided into control group and research group with 50 cases in each group. Among them,the control group was surveyed in the first followed-up,and the health information of patients was collected to establish drug use files,and evaluation was performed in the final follow-up. Family pharmacists and family physicians intervened together or directly to formulate specific solutions to help patients achieve the treatment goals and explain the treatment goals. The changes of medication compliance,quality of life and drug use before and after intervention were compared between the two groups. Results Before the intervention,the medication compliance scores of the two groups were not significantly different (P>0.05).After the intervention,the medication compliance scores of the two groups improved with time,while the medication compliance scores of the research group were significantly higher than the control group,statistics analysis showed that the difference was significant (P<0.05).The reasonable selection,the reasonable frequency,the reasonable titration,the reasonable drug change,and the reasonable combined medication in research group were significantly more than the control group,and the differences were statistically significant (P<0.05).Conclusions Family pharmacist and medication management intervention could effectively improve medication compliance and quality of life of patients,improve drug use,had a certain reference value for chronic disease patients.

目的 探究合并下胫腓联合韧带损伤的踝关节骨折患者实施手术固定治疗的临床价值。方法 遴选2018年1月—2020年12月70例合并下胫腓作者联合韧带损伤的踝关节骨折患者,根据随机数字表法分2组,开展石膏外固定治疗35例(记对照组),开展手术内固定治疗35例(记观察组),评估2组治疗优良率、治疗康复情况、踝关节功能(Kofoed评分)以及日常生活能力(ADL评分)、术后并发症率。结果 观察组治疗优良率94.29%相较对照组77.14%更高(P＜0.05);观察组康复速率更快,二次手术率更低(P＜0.05);术前2组Kofoed评分、ADL评分比较,均无统计学差异(P＞0.05),术后观察组Kofoed评分、ADL评分较对照组更高(P＜0.05);观察组术后并发症率低于对照组(P＜0.05)。结论 对合并下胫腓联合韧带损伤的踝关节骨折患者开展实施手术内固定治疗,对骨折早期愈合及修复韧带损伤具有显著价值,降低二次手术率及控制术后并发风险,促进关节功能早日恢复,实现理想的临床疗效。

Objective To explore the clinical value of surgical fixation in patients with ankle fracture with lower tibiofibular syndesmosis injury.Methods A total of 70 patients with ankle fracture and lower tibiofibular syndesmosis injury from January 2018 to December 2020 were selected and divided into two groups according to the random number table method.Thirty-five cases were treated with external plaster fixation (control group) and 35 cases were treated with internal surgical fixation (observation group).The treatment and rehabilitation outcomes,ankle function (Kofoed score) and ability of daily living (ADL score),postoperative complication incidence rate of the two groups were evaluated.Results The effective rates of treatment were 94.29% and 77.14% in observation group and control group (P＜0.05).The observation group has a faster recovery rate and a lower rate of secondary operations (P＜0.05).There were no significant difference in Kofoed score and ADL score between the two groups before operation (P>0.05).After operation,the Kofoed score and ADL score in the observation group were significantly higher than those in the control group (P<0.05). The postoperative complication incidence in the observation group was significantly lower than that in the control group (P<0.05).Conclusions The implementation of internal surgical fixation in patients with ankle fracture and lower tibiofibular syndesmosis injury had significant value for early fracture healing and ligament injury repair,reduced the secondary operation rate and controlling the postoperative complication risk,promoted the early recovery of joint function and achieved ideal clinical effect.

目的 运用品管圈管理方法,提高临床全肠外营养合理应用率,规范TPN的合理应用,保证临床营养支持的安全性与合理性。方法 按照品管圈问题解决型的方法,对影响临床全肠外营养合理应用率的原因进行分析、寻找对策、实践检验,提高临床全肠外营养合理应用率。结果 通过品管圈活动,找出造成TPN不合理应用的关键环节,制定相关制度并优化流程。结论 运用品管圈模式提高临床全肠外营养合理应用率(由65.22%上升为85.32%),改善全肠外营养液成品质量,为患者提供了安全有效经济合理的营养支持治疗。

目的 探讨便携式内窥镜视频系统辅助鼻咽喉检查治疗效果。方法 2019年1月1日—2019年12月31日,选取本院眼耳鼻颌面外科院内住院查房、门急诊中实施的168例患者作为研究对象,采用随机法对纳入患者进行分组,各分为84例。实验组采用自主研制的便携式内窥镜视频系统,对照组采用传统的喉镜腔镜系统。比较两组患者检查治疗效果、医务人员使用过程中的满意度和患者检查治疗过程中的满意度并进行效果评价。结果 两组患者鼻咽喉镜腔镜系统检查治疗时间比较,实验组时间为13.4 min;对照组时间为22.9 min;患者对鼻咽喉镜腔镜系统检查治疗的满意度比较主要从检查治疗效果、检查治疗体验效果进行评价,实验组满意度91.67%,对照组满意度86.91%,两组比较差异有统计学意义(χ²=4.695,P=0.030);医务人员对两组鼻咽喉镜腔镜系统检查治疗使用的满意度评价主要从性能参数、检查治疗使用效果等方面进行评价,性能参数主要包括便携性、图像质量、操作方法、运营成本等方面,实验组满意度92%,对照组满意度77%,两组比较差异有统计学意义(χ²=6.834,P=0.009)。结论 便携式内窥镜视频系统操作简单、使用方便,不仅能够满足患者的诊疗需要并减少患者的诊疗时间,而且能够满足医务人员使用过程中的便携性,能够提高医疗质量,非常适合临床使用。

Objective To investigate the therapeutic effect of portable endoscopic video system assisted nasopharynx examination. Methods From January 1, 2019 to December 31, 2019, 168 patients in the department of ophthalmology, otorhino-maxillofacial surgery in our hospital were selected as the research objects. The patients were randomly divided into 84 cases. The experimental group used the self-developed portable endoscope video system, while the control group used the traditional laryngoscope system. The treatment effect, satisfaction of medical staff and satisfaction of patients in the process of examination and treatment were compared between the two groups, and the effect was evaluated. Results Compared to the treatment time of nasopharynx and laryngoscope system between the two groups, the experimental group time was 13.4 min; the control group time was 22.9 min; the patients' satisfaction with nasopharyngoscope system examination and treatment was mainly evaluated from the examination and treatment effect, the experimental group satisfaction was 91.67%, while the control group was 86.91%, the difference was statistically significant (χ²=4.695, P=0.030); medical staffs' satisfaction evaluation on the use of nasopharynx and laryngoscope system in the two groups was mainly evaluated from the performance parameters, examination and treatment effect, and the performance parameters mainly included portability, image quality, operation methods, operating costs and other aspects. The satisfaction of the experimental group was 92%, and that of the control group was 77%. The difference between the two groups was statistically significant (χ²=6.834, P=0.009). Conclusion The portable endoscopic video system is easy to operate use. It can not only meet the needs of patients and reduce the diagnosis and treatment time of patients, but also meet the portability of medical staffs in the process of using, and can improve the quality of medical treatment, which is very suitable for clinical use.

目的 探究阿司匹林联合低分子肝素治疗高凝状态复发性流产(RSA)的临床效果。方法 选择2018年9月—2019年9月我院收治的80例高凝状态RSA患者,随机分为两组,各40例。比较两组胎儿的结局情况;比较两组治疗前、妊娠12周后D-二聚体、血小板聚集率;比较两组用药安全性。结果 观察组足月产率、活产率高于对照组,流产率低于对照组,差异有统计学意义(P＜0.05);治疗后,观察组D-二聚体、血小板聚集率均低于对照组,差异有统计学意义(P＜0.05);两组不良反应率之间,差异无统计学意义(P＞0.05)。结论 阿司匹林、低分子肝素联合治疗高凝状态RSA的效果显著,可以改善胎儿结局,降低D-二聚体、血小板聚集率,改善孕妇机体高凝状态,且安全性高。

目的 探讨低机械指数诊断超声及低声压治疗超声对造影剂微泡的作用效果。方法 低机械指数的诊断超声及不同声压下低能量治疗超声体外辐照造影剂微泡,通过获得的超声造影图像间接分析微泡总浓度的变化,探讨不同机械指数诊断超声及不同声压治疗超声下微泡发生稳定空化及惯性空化情况。结果 低机械指数(<0.2)诊断超声及低声压(<0.15 MPa)治疗超声下微泡以稳定空化为主,随着机械指数增高或声压增高,微泡以稳定空化和惯性空化两种方式并存,当机械指数>0.3或声压>0.2 Mpa时,微泡以惯性空化为主。结论 微泡在低机械指数及低声压作用下发生不同空化效应,随着机械指数或声压增加,微泡破坏增加,以惯性空化效应为主。

Objective To investigate the effect of low mechanical index diagnostic ultrasound and low acoustic pressure therapy on contrast agent microbubbles. Methods Microbubbles were irradiated by diagnostic ultrasound with low mechanical index(MI) and low energy therapy under different acoustic pressure. To obtain the images, and analyze the change of microbubble concentration,the movement trend of microbubbles under different MI and different acoustic pressure were analyzed, to estimated stable cavitation or inertial cavitation of microbubbles. Results Stable cavitation was the main form of microbubbles under low mechanical index (< 0.2) diagnostic ultrasound and low acoustic pressure (< 0.15Mpa). With the increase of mechanical index or acoustic pressure, stable cavitation and inertial cavitation coexisted. When mechanical index > 0.3 or sound pressure > 0.2MPa, microbubbles were mainly inertial cavitation. Conclusion The cavitation effects of microbubbles under low mechanical index and low acoustic pressure are different. With the increase of mechanical index or acoustic pressure, the damage of microbubbles increases, and main effect is the inertial cavitation.

目的 探讨扩张型心肌病采用诺欣妥治疗的效果及对其心功能的影响。方法 本文将2020年2月—2020年10月收治的扩张型心肌病患者50例作为研究对象,对所有患者按照随机方式进行分组,对照组25例患者以常规抗心衰治疗与依那普利治疗,观察组25例患者在常规抗心衰治疗的基础上给予诺欣妥治疗,统计分析用药后有效率、治疗前后心功能指标、6 min步行距离及炎症因子水平。结果 两组之间炎症因子水平相比,观察组较对照组低;6 min步行距离、用药后有效率相比,观察组较对照组高;心功能指标相比,观察组SV、LVEF较对照组高,LVESD、LVEDD较对照组低,P＜0.05。结论 采用诺欣妥治疗扩张型心肌病效果显著,总有效率较好,可有效改善患者心功能指标,增加6 min步行距离,减轻炎症因子水平,改善患者预后。

目的 观察右美托咪定作为佐剂对罗哌卡因在锁骨上入路臂丛神经阻滞效果的影响。方法 将55例上肢择期手术的受试者随机分为右美组和对照组。右美组:30 μg右美托咪定(0.3 mL)＋0.5%罗哌卡因,对照组:生理盐水(0.3 mL)＋0.5%罗哌卡因。在臂丛神经阻滞操作后,按步骤评估和记录臂丛感觉、运动阻滞程度和起效时间。在术中定期监测和记录生命体征、不良事件的发生。手术后评估和记录术毕24小时生命体征、术后镇痛时间、臂丛神经感觉、运动阻滞的持续时间、术后恶心呕吐评分、补救镇痛药物用量和不良事件等数据。结果 在臂丛神经的感觉和运动起效时间、感觉和运动阻滞持续时间、术后镇痛时间方面,右美组长于对照组,存在统计学差异(P<0.05)。两组间在术后生命体征变化、补救镇痛药物用量、术后恶心呕吐评分、不良事件等数据的比较,未见明显统计学差异(P>0.05)。结论 右美托咪定(30 μg)作为佐剂能加快罗哌卡因在锁骨上入路对臂丛神经阻滞的起效时间,增加其术后镇痛时间和对臂丛神经的感觉、运动阻滞时间,同时较少影响患者生命体征,具备一定的有效性和临床安全性。

Objective To observed the effect of dexmedetomidine as an adjunction with ropivacaine in supraclavicularbrachial plexus block. Methods 55 subjects with elective upper extremity operation were randomly divided into two groups: DEX group and control group. The drugs in DEX group was 30 μg dexmedetomidine (0.3 mL) + 0.5% ropivacaine, 20 mL in total. And the one in control group was normal saline (0.3 mL) +0.5% ropivacaine, 20 mL in total. After the operation of brachial plexus block, the value of sensory and motor block of brachial plexus and the onset time were evaluated and recorded according to the protocol. Vital signs and adverse events were monitored and recorded regularly during the operation.Postoperative vital signs, postoperative analgesia time, duration of brachial plexus sensationsensory and motion block, postoperative nausea and vomiting score, dosage of remedial analgesics and adverse events were assessed and recorded in 24 hours after surgery. Results In terms of sensory and motor onset time of brachial plexus, duration of sensory and motor block and postoperative analgesia, DEX group was longer than the control group, with statistical differences (P<0.05).There were no significant statistical differences between the two groups in postoperative vital signs, the amount of remedial analgesic drugs, postoperative nausea and vomiting scores, adverse events etc(P>0.05). Conclusion As an adjuvant, dexmedetomidine (30 μg) can accelerate the onset time of ropivacaine in the supraclavicular approach of brachial plexus block.It can also increase the postoperative analgesia time and sensory and motor block time of brachial plexus.With less impact on the vital signs of patients, the efficacy and clinical safety of dexmedetomidinecan be found in our study.

目的 分析上消化道早癌与癌前病变内镜下治疗的效果。方法 将2017年10月—2020年10月接诊且行传统外科手术治疗的75例上消化道早癌与癌前病变患者作为对照组,将同期接诊且行内镜黏膜下剥离术(ESD)治疗的75例上消化道早癌与癌前病变患者作为观察组,对组间围手术期指标、生活质量、疼痛评分、病灶切除情况、治疗效果、并发症发生率展开分析。结果 (1)观察组术中出血量(17.66±2.25)mL、手术用时(96.79±9.25)min、住院时间(10.95±1.88)d、治疗费用(1.74±0.41)万元均少于对照组(87.73±5.63)mL、(190.52±10.68)min、(22.75±2.69)d、(4.96±0.37)万元(P<0.05);(2)组间生活质量、疼痛评分在术前无差异(P>0.05);观察组生活质量、疼痛评分在术后优于对照组(P<0.05);(3)观察组治愈性切除率(98.67%)、整块完整切除率(100.00%)与对照组(96.00%、98.67%)无差异(P>0.05);(4)观察组总有效率(96.00%)与对照组(97.33%)无明显差异(P>0.05);(5)观察组发生2例并发症(2.67%),对照组发生11例并发症(14.67%,P<0.05)。结论 对上消化道早癌与癌前病变患者行ESD治疗,疗效显著,可以减少并发症,减轻疼痛感与经济压力,改善生活质量,值得推广。

Objective To analyze the effect of endoscopic treatment of early upper gastrointestinal cancer and precancerous lesions. Methods From October 2017 to October 2020, 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by traditional surgery were selected as the control group, and 75 patients with early cancer and precancerous lesions of upper digestive tract who were treated by endoscopic submucosal dissection (ESD) were selected as the observation group. The therapeutic effect and the incidence of complications were analyzed. Results (1) The intraoperative blood loss was (17.66±2.25) mL, operation time was (96.79±9.25) min, hospitalization time was (10.95±1.88) d, treatment cost was(17.4±4.1)thousand yuan in the observation group, which were less than those in the control group [(87.73±5.63) mL, (190.52±10.68) min, (22.75±2.69) d, (49.6±3.7) thousand yuan, (P＜0.05)]. (2) There were no significant differences in quality of life and pain score between groups before operation. The quality of life and pain score of the observation group were better than those of the control group after operation (P<0.05). (3) The curative resection rate (98.67%) and complete resection rate (100.00%) of the observation group were not significantly different from those of the control group (96.00% and 98.67%,P＞0.05); (4) The total effective rate (96.00%) of the observation group was not significantly different from that of the control group (97.33%,P＞0.05); (5) The total effective rate of the observation group was significantly higher than that of the control group (97.33%). There were 2 cases of complications in the observation group (2.67%), and 11 cases in the control group (14.67%, P<0.05). Conclusion ESD treatment for patients with early upper gastrointestinal cancer and precancerous lesions has significant effect, can reduce complications, relieve pain and economic stress, and improve the quality of life, which is worthy of promotion.

目的 探讨超声引导下宫颈癌根治术的应用效果及对患者远期生存率的影响。方法 选取本院2015年1月—2017年12月共收治的70例宫颈癌患者作为研究对象,将2016年7月—2017年12月纳入的患者作为观察组,2015年1月—2016年6月纳入的患者作为对照组,各35例,给予对照组患者常规腹腔镜根治术,给予观察组患者超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗。对比两组患者的治疗效果、远期生存率与复发率以及术后6个月、1年、2年、3年的FACT-G评分情况。结果 两组疾病控制率对比无差异(97.14% vs 85.71%,P＞0.05);观察组的治疗总有效率为高于对照组的(85.71% vs 60.00%,P＜0.05);观察组和对照组患者1年生存率对比无差异(P＞0.05),观察组2年、3年生存率高于对照组(P＜0.05),观察组和对照组1年局部复发率对比无差异(P＞0.05),观察组的2年、3年局部复发率低于对照组(P＜0.05);观察组术后6个月、1年、2年、3年的FACT-G评分高于对照组(P＜0.05)。结论 应用超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗宫颈癌能够提升患者的治疗效果,减少疾病复发和提高远期生存率,提升患者的生存质量,值得临床应用推广。

Objective To investigate the application effect of ultrasound-guided radical hysterectomy for cervical cancer and its influence on the long-term survival rate of patients. Methods A total of 70 patients with cervical cancer admitted from January 2015 to December 2017 were selected as the research subjects, and the patients enrolled from July 2016 to December 2017 were selected as the observation group, patients from January 2015 to June 2016 as the control group, each with 35 cases. The control group was given conventional laparoscopic radical hysterectomy, and the observation group was given ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation technology. The treatment effect, long-term survival rate, recurrence rate and FACT-G scores 6 months, 1 year, 2 years and 3 years after operation were compared between the two groups. Results There were no significant differences in disease control rates between the two groups (97.14% vs 85.71%, P>0.05); the total effective rate of treatment in the observation group was higher than that in the control group (85.71% vs 60.00%, P<0.05). There was no significant difference in the 1-year survival rate between the observation and the control group (P>0.05). The 2-year and 3-year survival rate of the observation group were higher than that of the control group (P<0.05). There was no significant difference in comparison of 1-year local recurrence rate between the observation group and the control group (P>0.05). The 2-year and 3-year local recurrence rate of the observation group were lower than that of the control group (P<0.05). FACT-G scores in the observation group after surgery at 6 months, 1 year, 2 years, and 3 years were significantly higher than the control group (P<0.05). Conclusion The application of ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation in the treatment of cervical cancer can improve the treatment effect, reduce disease recurrence rate, increase long-term survival rate, and improve the quality of life of patients, which is worthy of clinical application and promotion.