目的 探讨右美托咪定（Dex）分别联合丙泊酚或依托咪酯在颅内动脉瘤介入术中的镇静效果及对患者血流动力学的影响。方法 将60例颅内动脉瘤介入术患者按照随机数表法分为A组（Dex+丙泊酚,n=30）、B组（Dex+依托咪酯,n=30）。记录两组不同时间点的平均动脉压（MAP）、心率（HR）,比较苏醒期的镇静效果、呛咳程度、拔管时间、苏醒时间、清醒时间及术后不良反应。结果 A组患者T1MAP、HR为（84.56±5.13）mmHg、（65.87±5.14）次/分和T2（83.29±5.47）mmHg、（65.87±5.14）次/分均低于B组T1（87.89±3.88）mmHg、（70.22±5.67）次/分和T2（86.71±3.75）mmHg、（69.97±5.87）次/分（t分别为2.836、2.825、3.113、3.391,均P<0.001）。两组苏醒期各项指标和躁动（10.00% vs 0%,P=0.757）、呼吸抑制发生率（3.33% vs 0%,P=0.313）比较差异均无统计学意义（均P>0.05）,A组恶心、呕吐发生率（3.33%）较B组（20.00%）更低（χ2=4.043,P=0.044）。结论 Dex联合丙泊酚、依托咪酯麻醉在颅内动脉瘤介入术中均可发挥良好安全的麻醉作用,降低患者术后躁动和呼吸抑制的发生率,使用Dex联合依托咪酯在患者围插管期的血流动力学的稳定性效果更好,但在降低患者术后恶心呕吐的风险方面效果较差。
Objective To evaluate the sedative effect of dexmedetomidine（Dex）combined with propofol or etomidate during cerebral aneurysm intervention and its effect on patient hemodynamics．Methods A total of 60 cerebral aneurysm patients were randomly divided into two groups：Group A（Dex + propofol,n=30）and Group B（Dex + etomidate,n=30）．Mean arterial pressure（MAP）and heart rate（HR）were recorded at different time points in the two groups,and the sedation effect,choking degree,extubation time,waking up time,waking time and postoperative side effects were compared．Results T1 MAP,HR of（84.56±5.13）mmHg,（65.87±5.14）times / min and T2（83.29±5.47）mmHg,（65.87±5.14）times / min in group A were lower than those in group B T1（87.89±3.88）mmHg,（70.22±5.67）times / min and T2（86.71±3.75）mmHg,（69.97±5.87）times / min（t=2.836,2.825,3.113,3.391,all P<0.001）．There was no significant difference in the incidence of emergence agitation（10.00 % vs 0.00 %,P=0.757）and respiratory depression（3.33 % vs 0.00 %,P=0.313）between the two groups（P>0.05）．The incidence of nausea and vomiting in group A（3.33 %）was lower than that in group B（20.00 %）（χ2=4.043,P=0.044）．Conclusions Dex combined with propofol and etomidate anesthesia can have a good and safe anesthesia effect in intracranial aneurysm intervention,and reduce the incidence of postoperative agitation and respiratory depression in patients．Hemodynamic stabilization during the tube phase is more effective,but less effective in reducing the risk of postoperative nausea and vomiting in patients．
目的 探讨分析胃肠道套细胞淋巴瘤的临床病理学特点分析及预后情况。方法 选取2019年1月—2021年2月间赣州市人民医院收治的50例胃肠道套细胞淋巴瘤患者为观察组,选取本院同期就诊的50例非胃肠道套细胞淋巴瘤患者为对照组。结果 50例胃肠道套细胞淋巴瘤患者的主要临床表现以腹痛为主占比50.00%;好发于回盲部、回肠、升结肠、直肠、乙状结肠,占比依次为54.00%、42.00%、36.00%、36.00%、28.00%;以多发性黏膜息肉样病变40.00%多见,死亡16例(32.00%)。年龄＞60岁、伴有脾脏肿大的胃肠道套细胞淋巴瘤死亡率更高(P<0.05)。观察组患者浅表淋巴结侵犯的比例明显高于对照组(P<0.05)。结论 胃肠道套细胞淋巴瘤主要表现为腹痛等,多发于结直肠,浅表淋巴结侵犯相对更多,以多发性黏膜息肉样病变多见,年龄＞60岁、伴有脾脏肿大的患者预后相对较差。
目的 探讨鼻咽癌个案管理模式,并评价临床中运用的效果。方法 回顾性将2017年8月—2018年4月93例新确诊的鼻咽癌患者作为对照组,按鼻咽癌患者的一般护理常规进行护理。2018年5月—2019年8月新确诊的鼻咽癌患者96例为实验组,实施个案管理比较两种方法的临床运用效果。结果 与对照组比,实验组诊断期完成检查时间和首次住院天数短、既定治疗计划完成率和治疗期间复诊依从性高,Ⅳ度骨髓抑制发生率低,差异均有统计学意义(P<0.05)。结论 鼻咽癌个案管理模式可为患者提供全程、连续性、高品质的护理,提高患者复诊依从性、提高治疗计划完成率,提高医疗护理质量,值得临床推广应用。
Objective To explore the case management mode of nasopharyngeal cancer (NPC) and evaluate the effect of clinical application. Methods 93 patients newly diagnosed NPC from August 2017 to April 2018 were used as the control group,and the general nursing routine was followed. 96 patients newly diagnosed NPC from May 2018 to August 2019 were taken as the experimental group,and accepted case management. Results Compared with the control group,the test time of the experimental group was shorter,the first hospital stay was shorter,the completion rate of treatment was higher,the patient's compliance of follow-up during treatment was better,incidence of grade Ⅳ myelosuppression was lower.The difference was statistically significant (P< 0.05). Conclusion The case management mode of NPC may provide seamless and high-quality nursing for NPC patients,improve the completion rate of treatment,improve the patient's compliance of follow-up and improve the quality of medical care,which is worthy of clinical application.
目的 通过对医院保洁员针刺伤危害认知和相关知识问卷调查,检视保洁员自身和其管理者存在的问题,提出有针对性整改措施。方法 采用现场问卷调查的方法,对我院三个院区共304名病房保洁员进行调查,其中男保洁员82人(占27.0%),女保洁员222人(占73.0%)。上岗前接受针刺伤防护知识培训62人(占20.4%),没有接受培训242人(79.6%),P<0.05差异有统计学意义。结果 调查显示,保洁员在工作中曾发生过针刺伤共174人(占57.2%);发生针刺伤后没有上报107人(占35.2%);防护知识缺乏及自我防护意识欠缺,其中不知晓针刺伤的危害性101人(占33.2%);在处理锐器垃圾不戴手套有81人(占26.6%);处理锐器盒时机不正确220人(占72.4%);不知道发生针刺伤后如何处理91人(占29.9%),P<0.05差异有统计学意义。男性保洁员对针刺伤防护认知低于女性保洁员,其中不清楚针刺伤的危害性男性41人(占50.0%),女性占60人(占27.0%),处理锐器垃圾不戴手套男性30人(占36.6%),女性51人(占23.0%);两组比较,差异有统计学意义(P<0.05)。结论 医院保洁员在处理医疗垃圾工作中,针刺伤风险系数高。医院对保洁员上岗前针刺伤培训非常必要,但岗前培训不能完全让保洁员在工作中长期保持对针刺伤的安全认知和防范意识。医院应加强对保洁员工作岗位动态培训和监管,尤其对男性保洁员。管理者不断尝试运用新的管理手段,在思想上建立流程式思维和工作方法,日常工作中不断强化保洁员对针刺伤的防护意识,减少针刺伤的发生,从而保障了保洁员的身心健康。
Objective To investigate the problems of cleaners and their managers,and put forward targeted rectification measures through questionnaire survey on the hazard cognition and related knowledge of needle stick injuries of cleaners in hospitals. Methods On-site questionnaire survey was used to investigate a total of 304 ward cleaners in our hospital. Among them,82 were male cleaners (27.0%) and 222 were female cleaners (73.0%). 62 people (20.4%) were trained in acupuncture protection before taking up work,and 242 people (79.6%) were not trained. There was statistically significant P<0.05. Results The survey showed that a total of 174 cleaning staffs had acupuncture injuries (57.2%)); 107 people (35.2%) were not reported after acupuncture injuries. For lack of knowledge and self-protection awareness,of which 101 people (33.2%) were not aware of the dangers of acupuncture injuries; There were 81 people (26.6%) didn't wear gloves when handling sharps trash;and 220 people (72.4%) had incorrect timing of sharps boxes; 91 people (29.9%) did not know how to handle after a needle stick injury. Male cleaners had a lower awareness of needle stick injuries than female.There were 30 male cleaners (36.6%) and 51 females (23.0%) who did not wear gloves when handling sharps. 41 men (50.0%) and 60 women (27.0%) were not aware of the harmfulness of needle stick injuries. Those difference between the two groups was statistically significant (P<0.05). Conclusion The risk of needle stick injuries is high for hospital cleaners in the treatment of medical waste. It is very necessary to take acupuncture injuries for the cleaning staffs before they take up their posts,but the pre-job training cannot completely keep the cleaning staffs' awareness and prevention awareness of acupuncture injuries for a long-term. Hospitals should strengthen the dynamic training and supervision of cleaning staff,especially for male cleaners. Managers need to constantly try use new management methods to establish process-type thinking and working methods in their minds. In daily work,they continuously strengthen the cleaning consciousness of needle stick injuries and reduce the incidence of needle stick injuries,thereby protecting the physical and mind health of the cleaning workers.
目的 分析难治性痛风的治疗效果及经验总结。方法 收集30例难治性痛风性关节炎患者分长病程及短病程组,对比各组基线指标及治疗后的血尿酸水平,肾功能情况及受累部位关节超声变化,及患者VAS评分比较,最后统计分析组间差异及探讨难治性痛风预后与降尿酸控制水平、炎症指标、血肌酐变化的相关性。结果 30例痛风患者治疗前后对比,短病程组患者VAS评分从5.6±3.3下降至3.2±1.1,血沉从59.3±12.4下降至20.6±6.9,受累关节滑膜厚度从（3.57±0.63）mm下降至（1.96±0.65）mm,血尿酸从（589.3±146.2）μmol/L下降至（403.8±96.4）μmol/L,P<0.05;短病程组及并发症少的患者改善更明显,血尿酸控制更低的患者相关指标下降更明显,P<0.01;患者的血尿酸下降趋势跟关节滑膜厚度与炎症指标（ESR）、血肌酐的变化趋势符合,通过回归分析有相关性意义,P<0.05。结论 难治性痛风的处理核心还是有效的控制尿酸,但需要对影响预后的因素,包括感染、肾功能不全、消化性溃疡等并发症进行风险管理,降低相关风险及合并症治疗对难治性痛风的有效治疗管理非常重要。
目的 探究全程护理干预在门诊鼻咽喉部疾病检查中的应用效果,为纤维鼻咽喉镜应用的临床护理方式提供理论依据。方法 选择2015年7月—2016年6月在本院行纤维鼻咽喉镜检测的患者458例为研究组,同时选择2014年7月—2015年6月行纤维鼻咽喉镜检测的患者400为对照组例。对照组患者行常规护理模式,研究组患者行全程护理干预模式。对比两组患者护理效果、并发症率以及患者满意度。结果 研究组患者的呼吸频率、心率、舒张压以及收缩压均低于对照组患者指标,且两组数据对比差异有统计学意义(P＜0.05)。研究组患者的总并发症率为4.58%,对照组患者的总并发症率为24.00%,两组数据对比差异有统计学意义(P＜0.05)。研究组患者的总并发症率为4.58%,对照组患者的总并发症率为24.00%,两组数据对比差异有统计学意义(P＜0.05)。结论 在对老年患者行纤维鼻咽喉镜检查时,相对于常规护理模式,采用全程护理干预措施,可以提升患者的护理效果,降低并发症机率,同时可以提升患者的满意度,具有较高的临床应用和推广价值。
胰源性门静脉高压（PSPH）是由脾静脉（SV）流通受阻引起的一种临床综合征，在临床较为罕见且对患者造成生命威胁，但却为门静脉高压唯一可治愈的类型。其主要发病诱因是胰腺原发疾病，通常为胰腺急（慢）性炎症、胰腺占位性病变和胰腺手术操作导致。1型孤立性食管胃底静脉曲张、脾大、脾功能亢进是PSPH的主要临床表现特征，其中食管胃底曲张静脉破裂出血是PSPH最为严重的并发症；患者若表现为肝功能正常但出现原因不明脾肿大并伴有消化道出血症状，应考虑可能出现了PSPH。PSPH的治疗可分为胰腺原发病、门静脉高压及并发症的综合性诊治。本文旨在回顾PSPH的相关文献，对其有关临床诊断与治疗现状进行综述，以期指导医务工作者在临床中尽早发现PSPH并对患者及时有效治疗。
Pancreatic segmental portal hypertension（PSPH）is a clinical syndrome caused by spleen vein（SV）occlusion or stenosis．It is a rare and life-threatening hemorrhagic disease of the upper digestive tract，but it is the only curable type of portal hypertension．The main cause is primary pancreatic disease，which is usually due to acute or chronic pancreatic inflammation，pancreatic space-occupying lesions and pancreatic surgery．Type 1 isolated esophagogastric varices，splenomegaly and hypersplenism are the main clinical features of PSPH，and esophagogastric variceal bleeding is the most serious complication of PSPH．PSPH should be considered in patients with normal liver function but unexplained splenomegaly accompanied by gastrointestinal bleeding．The treatment of PSPH can be divided into a comprehensive diagnosis and treatment of primary pancreatic disease，portal hypertension and complications．Therefore，the purpose of this paper is to review relevant literature of PSPH，the relevant clinical diagnosis and treatment status quo were summerized，in order to guide the medical workers in clinical PSPH，early detection and timely and effective treatment for patients．
