目的 探讨与观察思维导图教育模式对肠造口患者生活质量与心理情绪的影响。方法 选择2021年5月—2022年4月本院胃肠外科收治的低位直肠癌术后患者80例为研究对象,按入院顺序随机编号,对应随机数字为偶数的分到思维导图组（n=40）,奇数的分到传统组（n=40）。传统组给予常规健康教育干预,思维导图组在传统组护理的基础上给予思维导图教育模式干预,思维导图组与传统组护理观察时间为3个月。结果 思维导图组护理期间的造口感染、坏死、水肿、出血、旁疝等并发症发生率与传统组相比都降低（P<0.05）。思维导图组与传统组护理后的焦虑与抑郁评分与护理前相比降低（P<0.05）,护理后思维导图组评分与传统组相比降低（P<0.05）。思维导图组的术后住院时间、术后排气时间、术后下床活动时间与传统组相比均减少（P<0.05）。思维导图组护理后的副作用、共性症状、尿路症状、特异躯体症状、特异心理、性功能、尿袋问题等生活质量评分与传统组相比都减少（P<0.05）。结论 思维导图教育模式在肠造口患者的应用能促进缓解心理负面情绪,促进患者康复,提高患者的生活质量,减少术后造口并发症的发生。

Objective To explore and observe the effects of mind map education mode on the quality of life and psychological emotions of patients with enterostomy．Methods From May 2021 to April 2022, 80 cases of patients with postoperative low rectal cancer who were admitted to the Gastrointestinal Surgery Department of our hospital were selected as the research subjects, and all the cases were numbered according to the random admission sequence, and those with even random numbers were assigned to the mind map group（n=40）, and odd numbers were assigned to the traditional group（n=40）．The traditional group was given routine health education intervention, the mind map group was given mind map education mode intervention additionally, and the nursing observation time of both groups was 3 months．Results The incidences of complications such as stoma bleeding, parastomal hernia, stoma necrosis, stoma edema and stoma infection during nursing in the mind map group were lower than that in the traditional group（P<0.05）．The anxiety and depression scores in both groups after nursing were significantly lower than those before nursing（P<0.05）, and the scores in the mind map group after nursing were also significantly lower than those in the traditional group（P<0.05）．The postoperative hospital stay, postoperative exhaust time, and postoperative ambulation time of the mind map group were significantly shorter than those of the traditional group（P<0.05）．The quality of life scores of common symptoms, side effects, urinary tract symptoms, specific somatic symptoms, specific psychology, urine bag problems and sexual function in the mind map group after nursing were significantly lower than those in the traditional group（P<0.05）．Conclusions The application of mind map education model in patients with enterostomy can promote the relief of psychological negative emotions, promote the recovery of patients, reduce the occurrence of postoperative complications, and improve the quality of life of patients．

目的 探讨基于5A模式对急性心肌梗死经皮冠状动脉介入治疗（PCI）术后患者早期心脏康复的应用效果。方法 根据随机数字表法将2021年1月—2022年6月来我院接受治疗的80例急性心肌梗死PCI术后患者分为对照组40例与干预组40例。对照组患者在常规护理模式下进行早期心脏康复,干预组患者在基于5A模式下进行早期心脏康复。对比2组患者的心功能与运动能力情况、自我管理能力以及护理依从性。结果 干预2个月后2组患者的左室射血分数、6分钟步行试验距离水平高于干预前,且干预组高于对照组（P<0.05）;左室收缩末期内径水平低于干预前,且干预组低于对照组（P<0.05）;2组患者干预2个月后的日常生活、疾病管理、情绪控制以及自我管理总分均高于干预前,且干预组高于对照组（P<0.05）;干预组的护理总依从率高于对照组（P<0.05）。结论 对急性心肌梗死PCI术后患者给予基于5A模式进行的早期心脏康复可改善其心功能,提升预后自我管理能力,增强护理干预依从性。

目的 探讨精细化管理模式对消毒供应中心风险事件发生率的影响。方法 选取2020年6月—2022年5月为研究阶段,抽取本院消毒供应室1 000件医疗器械作为研究对象,随机分为对照组和研究组,各500件。对照组采用常规管理模式,研究组采用精细化管理模式,对比2组医疗器械不良事件发生率,观察30名工作人员分别在不同管理模式下发生职业风险暴露人数的变化,并进一步比较工作效率的不同。结果 研究组发生数量不等、物品过期、标签错误、型号错误、零部件差错等不良事件发生率均低于对照组（P<0.05）。研究组工作人员利器损伤和血制品污染者发生率低于对照组（P<0.05）,研究组工作人员工作效率评分高于对照组（P<0.05）。结论 精细化管理模式可有效减少消毒供应室医疗器械不良事件,降低工作人员职业暴露风险事件发生率,提高工作人员工作效率,改善管理工作质量。

Objective To explore the influence of refined management mode on the incidence of risk events in disinfection supply center. Methods From June 2020 to May 2022,1 000 pieces of medical devices were selected from the disinfection supply room of our hospital as the research object,and were randomly divided into control group and research group,with 500 pieces in each group. The control group adopted the conventional management mode,while the research group adopted the refined management mode. The incidence of adverse medical device events in the two groups was compared,and the changes in the number of 30 staff exposed to occupational risks under different management modes were observed,and the differences in work efficiency were further compared. Results The incidences of adverse events involving unequal quantities,expired items,mislabeling,modeling errors and parts errors were lower in the study group than in the control group(P<0. 05). The number of sharps injuries and blood product contamination among the staff in the study group was significantly lower than that in the control group(P<0. 05),and the staff efficiency scores of the study group were higher than those of the control group(P<0. 05). Conclusions Refined management mode can effectively reduce the adverse events of medical devices in disinfection supply room,reduce the number of occupational exposure risk events of staff,improve the work efficiency of staff and improve the quality of management.

目的 探索老龄化形势下广州市白云区西部卒中防治工作的新模式。方法 通过完善组织结构、管理架构、建立稳定高效运行的(1+1+N)紧密型医联体模式,创建优质高效的卒中救治区域联盟,实现高质量的基层首诊,双向转诊,快速响应的卒中绿道急救和全程管理。结果 初步完成构建广州市白云区西部区域性卒中救治中心,区域内卒中患者及时救治,溶栓效率,血管再通等均有显著提升,整体提升白云区西部医疗机构的卒中救治水平。结论 区域性的协同救治是提高卒中救治水平的重要举措。(1+1+N)紧密型医联体模式能提高卒中患者救治率,具有可行性和必要性。

Objective To explore the effectiveness of a new stroke prevention and treatment pattern in the western part of Baiyun District, Guangzhou city, under an aging situation. Method We aim to build a high-quality and efficient stroke treatment regional alliance based on a (1+1+N) compact medical consortium, expecting to improve the overall abilities of stroke treatment in the western part of Baiyun District through high-quality primary care, two-way referrals, rapid response to stroke greenway emergency and full-process management. Results We have initially established a regional stroke treatment center in the western part of Baiyun District, Guangzhou. Stroke patients in that region can be treated in time, and the efficiency of thrombolysis and vascular recanalization have been significantly improved. Conclusion Regional coordinated treatment is an effective measure to reduce the disability and fatality rate of stroke. The (1+1+N) compact medical consortium model can improve the treatment effect in stroke patients, which is feasible and necessary.

目的 探讨脑卒中患者应用NNN-链接延续护理模式对患者生活质量及护理结局影响。方法 将 2019年6月—2020年12月收治的60例患者按纳入研究对象,以NNN-链接为结构框架,从入院到出院后3个月实施NNN-链接延续护理模式,收集延续护理患者护理诊断、护理结局、护理措施及三者的链接,比较延续护理不同阶段脑卒中患者护理结局评分。结果 使用频率最高的护理诊断及NNN-链接分别为生活自理能力缺陷、有跌倒的危险、知识缺乏、营养失调:低于机体需要量、有误吸危险;出院后3个月,从功能健康、健康知识和行为、生理健康Ⅱ、心理社会健康、家庭健康5大领域进行护理结局评分,分值均比出院时第一个月有提高(P<0.05)。结论 NNN-链接延续护理模式能有效提高病人的健康知识与行为,提高照顾者照护能力,降低意外事件发生。

目的 观察失效模式与效应分析(FMEA)在医务人员血源性职业暴露监测分析及防护的应用。方法 采用FMEA回顾性分析2018年1月—2019年6月我院医务人员血源性职业暴露高危因素,计算风险指数(RPN),优先处理最高风险因素,制定改进措施,且于2019年7月—2020年12月采用改进后方案,对照分析方案实施前后失效模式RPN值、血源性职业暴露情况、医院安全氛围量表中文版。结果 采用FMEA后,RPN、权重系数(W_i)均降低,且RPN实施前为2 633分,实施后为853分,降幅为67.60%,W_i实施前为0.729 9,实施后为0.268 0,降幅为63.28%,均达到预定目标。采用FMEA前,血源性职业暴露率为28.74%,采用FMEA后,血源性职业暴露率为4.65%。实施整改方案后的安全工作阻碍(11.99±2.16)分、清洁度和整洁度(11.48±1.89)分、管理与支持(28.58±3.24)分、冲突与沟通(22.54±2.83)分、反馈和培训(13.82±2.55)分均高于实施前(10.67±2.68)分、(10.06±2.36)分、(26.80±3.86)分、(20.85±2.62)分、(12.52±1.19)分,P<0.05。结论 在医务人员血源性职业暴露管理中采用FMEA,可以细化高风险环节,提高改进措施的针对性,减少职业暴露。

Objective To observe the application of failure mode and effect analysis (FMEA) in monitoring analysis and protection countermeasures of blood-borne occupational exposure of medical personnel. Methods FMEA was used to retrospectively analyze the high risk factors of blood-borne occupational exposure of medical staff in our hospital from January 2018 to June 2019, to calculate the risk priority number (RPN), to give priority to the highest risk factor, to formulate improvement measures. The improved scheme was adopted from July 2019 to December 2020. The RPN value of failure mode, blood-borne occupational exposure and Chinese Hospital Safety Atmosphere Scale (C-HSCS) before and after the implementating of the scheme were compared and analyzed. Results After implementating FMEA, RPN and weight coefficient (W_i) decreased, and the RPN scores were 2 633 and 853 before and after implementation, with a decrease of 67.60%, W_i was 0.729 9 before implementation and 0.268 0 after implementation, with a decrease of 63.28%. Before FMEA, the blood-borne occupational exposure rate was 28.74%, and after FMEA, the rate was 4.65%. After the implementation, the scores of safety work obstruction was (11.99±2.16), cleanliness and tidiness was (11.48±1.89), management and support was (28.58±3.24), conflict and communication was (22.54±2.83), feedback and training was (13.82±2.55), which were higher than those before the implementation: (10.67±2.68), (10.06±2.36), (26.80±3.86), (20.85±2.62), (12.52±1.19), P<0.05. Conclusions Using FMEA in the management of blood-borne occupational exposure of medical personnel could refine high-risk steps, improve the pertinence of improvement measures and reduce occupational exposure.

目的 探讨应用56孔冷盐水(STSF)压力导管高功率消融模式治疗老年阵发性房颤患者的有效性和围手术期安全性。方法 回顾性分析广州市第一人民医院2019年1月—2021年6月使用STSF导管高功率消融模式行射频治疗的老年阵发性房颤患者68例(STSF组),匹配同期年龄、性别、左房直径、左室射血分数无差异且使用6孔冷盐水 (ST)压力导管常规功率消融的老年房颤患者71例(ST组),比较2组患者之间的即刻环肺静脉隔离成功率、单圈隔离成功率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。结果 2组患者都成功完成环肺静脉电隔离,STSF组单圈隔离成功率与ST组无差异(左侧肺静脉92.6% vs 90.1%,P>0.05;右侧肺静脉83.8% vs 87.3%,P>0.05),与ST组比较,STSF组手术及消融时间缩短[(70.9±10.0)min vs (79.1±14.2)min,P<0.001;(25.4±4.5)min vs(30.5±6.3)min,P<0.001],灌注量更低[(406.5±46.3)mL vs (729.2±106.1)mL;P<0.001],X线透视时间相近[(6.5±2.5)min vs(7.3±2.6)min;P=0.056]。2组围手术期并发症率均较低(2.9% vs 3.9%;P=0.39),STSF组2例术中发生气体爆破,但未引起心包填塞,ST组有2例术后出现心衰,利尿后好转,1例出现持续性胸痛,胃镜提示食道糜烂,予流质饮食及质子泵抑制剂治疗后恢复。结论 应用STSF导管高功率消融模式在老年阵发性房颤患者行肺静脉大环隔离可提高消融效率,减少术中液体负荷,且不增加围手术期风险。

Objective To investigate the effectiveness and perioperative safety of ThermoCool SmartTouch SurroundFlow (STSF) catheter high-power ablation mode in the treatment of elderly patients with paroxysmal atrial fibrillation. Methods A total of 68 elderly patients with paroxysmal atrial fibrillation who used STSF catheter high-power ablation mode (STSF group) in Guangzhou First People's Hospital from January 2019 to June 2021 were analyzed retrospectively. There were 71 elderly patients with atrial fibrillation who had no significant difference in age, sex, left atrial diameter and left ventricular ejection fraction, used ThermoCool SmartTouch (ST) catheters for conventional power ablation (ST group) at the same time. The success rate of immediate circumferential pulmonary vein isolation, single lap isolation, operation time, X-ray fluoroscopy time, ablation time, intraoperative saline perfusion volume and the incidence of complications were compared between the two groups. Results Both groups of patients successfully completed circular pulmonary vein electrical isolation. There was no significant difference in the success rate of single-circle isolation between STSF group and ST group (left pulmonary vein 92.6% vs 90.1%, P>0.05; right pulmonary vein 83.8% vs 87.3%, P>0.05). Compared with ST group, STSF group had shorter operation and ablation time [(70.9±10.0) min vs (79.1±14.2) min, P<0.001; (25.4±4.5) min vs (30.5±6.3) min, P<0.001], lower perfusion volume [(406.5±46.3)mL vs (729.2±106.1)mL, P<0.001], similar X-ray fluoroscopy time [(6.5±2.5)min vs (7.3±2.6)min, P=0.056 ]. The perioperative complication rate of the two groups was low (2.9% vs 3.9%, P=0.39). Two cases of STSF group had steam pops during operation but did not cause pericardial tamponade, and 2 cases of ST group had postoperative heart failure occurred and improved after diuresis. One case developed persistent chest pain, which gastroscope indicated esophageal erosion, and recovered after liquid diet and PPI treatment. Conclusions Using STSF catheter high-power ablation mode to perform pulmonary vein isolation in elderly patients with paroxysmal atrial fibrillation could improve ablation efficiency, reduce intraoperative fluid load, and without increasing perioperative risk.

目的 探讨新冠疫情影响下日间手术制度在乳腺外科住院模式中的应用情况。方法 2021年1月—12月广州市第一人民医院实施日间手术制度,对乳腺外科30张床位实施预约管理,依据患者病情进行日间手术预约,合理安排患者入院。结果 2021年1月—12月我院乳腺外科共入院2 787人/次,手术人数1 497人,其中日间手术720台,占比48.10%。结论 日间手术制度可提升了医院手术服务能力,增加手术量,缩短了平均住院日,为患者提供方便、高效的医疗服务,值得基层医院推广。

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 探讨高通量透析模式对改善维持性血液透析(MHD)患者β2微球蛋白清除率及高血压的影响。方法 选择2018年9月1日—2018年10月31日期间在广州市增城区新塘医院血液净化中心接受MHD患者40例为实验对象(除外因自身耐受因素长期使用低通量透析患者)。采用随机数表法分两组,每组20例。对照组接受低通量血液透析,观察组接受高通量血液透析。比较两组治疗效果,并记录0个月、3个月、6个月、12个月、18个月治疗前后β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、心率、血压变化,并对两组心血管疾病情况进行统计。结果 观察组总有效率为95.00%,高于对照组的20.00%(P<0.05);治疗后,观察组β2-MG、iPTH均降低,而3个月后对照组略有升高,观察组[(12.48±2.10)mg/L、(210.13±18.12)ng/L]低于对照组[(30.21±2.37)mg/L、(289.41±17.02)ng/L],观察组治疗3个月、6个月、12个月、18个月的β2-MG清除率高于对照组(P<0.05);与治疗前比较,两组的平均动脉压、收缩压均降低,且观察组低于对照组(P<0.05);对照组各时间点24小时舒张压及收缩压差异无统计学意义(P>0.05);与治疗前比较,观察组24小时舒张压、收缩压治疗后1个月、3个月、6个月、12个月、18个月均降低,且低于对照组(P<0.05);两组患者心血管疾病发生率比较:观察组有1例因急性心肌梗死住院行PCI术;对照组有2例因心力衰竭住院治疗,1例因急性冠脉综合症住院治疗。两组并发症发生率比较P>0.05。结论 高通流量透析模式可有效提高MHD患者的治疗效果,有效清除血液毒素,降低患者的高血压,减少并发症,可在临床推广使用。

Objective To investigate the effect of high flux dialysis mode on the improvement of β2-microglobulin clearance and hypertension in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD at the Blood Purification Center of Xintang Hospital, Zengcheng District, Guangzhou from September 1, 2018 to October 31, 2018 (except for long-term low-flux dialysis patients due to self-tolerance factors)were selected. Random number table method was used to divide the patients into two groups,20 patients in each group. The control group received low flux hemodialysis, and the observation group received high flux hemodialysis. The treatment effects of the two groups were compared, levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), changes in heart rate and blood pressure, and statistics on cardiovascular disease in the two groups before and after treatment at 3, 6, 12, and 18 months were recorded. Results The total effective rate in the observation group was 95.00%, which was higher than the 20.00% in the control group (P<0.05). After treatment, the levels of β2-MG and iPTH of the two groups decreased, and the observation group [(13.02±2.10) mg/L, (210.13±18.12) ng/L] was lower than the control group [(19.78±2.37) mg/L, (289.41±17.02)ng/L]; the β2-MG clearance rate of the observation group was higher than that of the control group at 3 months, 6 months, 12 months, and 18 months (P<0.05).Compared with that before treatment, the average arterial pressure and systolic blood pressure of the two groups were reduced, and the observation group was lower than that of the control group (P<0.05); the differences between diastolic blood pressure and systolic blood pressure at each time point in the control group were not significant (P>0.05); the 24-hour diastolic blood pressure and systolic blood pressure of the observation group decreased after 1, 3, 6, 12 and 18 months, compared with those before treatment (P<0.05), and were lower than those in the control group (P＜0.05).Comparison of the incidence of cardiovascular disease between the two groups: 1 case in the observation group was hospitalized for acute myocardial infarction; 2 cases in the control group were hospitalized for heart failure and 1 case was hospitalized for acute coronary syndrome; complications incidence in the two groups were compared (P>0.05). Conclusion The high flux dialysis mode can effectively improve the treatment outcomes of MHD patients, effectively remove blood toxins, lower blood pressure, and reduce the incidence of complications. It can be used in clinical practise.