目的 探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ 4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法 采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65(分):3.06±1.10 比0.85±0.79,P<0.001;PSI(分):144.93±36.48比73.94±27.17,P<0.001; SMART-COP(分):6.54±1.41比 1.67±1.02,P<0.001; APACHEⅡ(分):20.79±5.69比7.94±3.87,P<0.001]。CURB-65≥3分、PSI≥130分、SMART-COP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0.940[95% CI:0.89~0.98, P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001],敏感度分别为65.6%、71.6%、100%、88.1%,特异度分别为100%、100%、78.7%、93.9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHE Ⅱ评分诊断效能更佳。

Objective To evaluate and compare the early diagnosis value of CURB-65,PSI,SMART-COP and APACHEⅡin patients with severe community-acquired pneumonia. Methods This was a prospective study conducted in department of respiratory in Guangzhou First People's Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February of 2014. The lowest scores within 24 hours of CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score,respectively,for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score were higher in SCAP as compared with that of CAP(CURB-65:3.0±1.1 vs 0.9±0.8,P<0.001;PSI:144.6±36.4 vs 73.9±27.1,P<0.001; SMART-COP:6.5±1.4 vs 1.6±1.0,P<0.001; APACHEⅡ:20.6±5.6 vs 7.9±3.8,P<0.001). ROC curve for CURB-65 score≥ 3 scores,PSI score≥ 130 scores,SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0.940[95%CI:0.89~0.98,P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001]. Sensitivity of four kinds of scoring system was 65.6%,71.6%,100%,88.1%, with specificity of 100%,100%,78.7%,93.9% respectively. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score,but the sensitivity was low and easy to miss diagnosis. SMART-COP and APACHEⅡscore systems had a better diagnostic value on SCAP.

目的 对江门市新会区会城街道的严重精神障碍患者监护人进行守护APP干预并评价干预效果影响。方法 以会城街道辖区内登记在国家精神障碍信息系统1 488在册精神障碍患者作为研究对象,随机抽取分为安装守护APP组1 084例和无安装守护APP组404例。安装组通过监护人使用守护APP实现责任医生对患者进行动态监护和实时监护,提供免费咨询、心理干预、服药指导及随访管理服务;无安装组采用常规随访康复管理措施干预。干预满一年后对比分析两组患者康复措施落实情况、服药依从性（治疗率）、病情及社交改善情况、复发住院率、肇事肇祸率及家属疾病知识知晓情况等指标。结果 安装守护App组患者服药依从性（治疗率）及康复措施落实率高于无安装组,家属对精神疾病知识知晓良好率较高;干预后安装组患者的SCL-90评分及心理社交功能评估表评分改善情况优于无安装组,复发住院率和肇事肇祸率明显较低,以上差异均有统计学意义。结论 守护APP平台帮助医生与监护人把严重精神障碍患者的监护工作真正落到实处,康复效果优于传统的康复方法,值得进一步推广应用。

Objective Guardianship APP intervention was conducted for the guardians of severe mental disorders in Huicheng,Xinhui district,Jiangmen city and the effect of intervention was evaluated. Methods 1 488 psychiatric patients in the unit area were taken as the research objects,which were randomly divided into the guardian APP installation group of 1084 cases and the non - installation group of 404 cases. The installation group uses guardian APP to realize the dynamic guardianship and real-time monitoring of the patients,and we provided free charge consultation,psychological intervention,medication guide,case tracking and follow-up management services. The non installation group adopted the routine rehabilitation management measures after discharge. After a year the implementation of rehabilitation measures,compliance,condition and social improvement,relapse rate of hospitalization,accident rate and knowledge of family disease between the two groups of patients were compared and analyzed. Results The compliance and rehabilitation measures of the patients in the App group were higher than those in the non installation group. The rate of knowledge about mental illness was higher in family members,and the improvement of SCL-90 score and psychosocial function assessment score after intervention was better than that of non installation group. The rate of relapse hospitalization and cause trouble were lower. The differences above were statistically significant. Conclusion The guardian APP platform helps doctors and guardians to make the monitoring work of patients with severe mental disorder really practical,and the rehabilitation effect is better than the traditional rehabilitation method,which is worthy of further promotion and application.

目的 对信息协作平台的社区结直肠癌三级防治及干预体系进行探索与实践。方法 对纳入本次研究的2 492名社区人群进行问卷调查,包括健康人群1 118人,1 374例肿瘤患者。分析健康人群和肿瘤患者关于肿瘤防治知识及途径的认知情况,比较健康人群和肿瘤患者就诊首选医院,了解肿瘤患者就诊流向和行为以及发现患癌的途径。结果 在肿瘤患者中知道癌前病变、早期肿瘤症状、高危人群的比例显著高于健康人群[26.93%(370/1 374)、39.96%(549/1 374)、46.00%(632/1 374)比14.49%(162/1 118)、21.91%(245/1 118)、26.92%(301/1 118)]。健康人群认为肿瘤三级防治网络可行、会参加三级防治网、有必要开展癌症筛查、会参加筛查的比率显著高于肿瘤患者[98.83%(1 105/1 118)、91.95%(1 028/1 118)、98.12%(1 097/1 118)、98.03%(1 096/1 118)比81.95%(1 126/1 374)、79.98%(1 099/1 374)、80.93%(1 112/1 374)、85.95%(1 181/1 374)],差异均有统计学意义(P<0.05)。健康人群把三甲医院视为就诊首选医院的比率显著低于肿瘤患者[32.56%(364/1 118)比86.97%(1 195/1 374)](P<0.05)。肿瘤患者中发现肿瘤及确诊医院、肿瘤复诊、康复医院的选取主要以三甲综合医院为主。在肿瘤患者中因身体不适到医院就诊发现患癌的比率显著高于单位员工体检、自检发现、社区卫生服务中心体检发现的比率。结论 我国目前肿瘤发病率和死亡率正处在快速上升的阶段,利用网络优势,加大肿瘤防治知识的宣传力度,建立社区、区域二级医院、三级医院优势互补的三级肿瘤防控体系,是当前我国肿瘤防治的迫切需求。

Objective To explore and practice the community tertiary prevention and intervention system for colorectal cancer based on information collaboration platform. Methods A questionnaire survey was conducted among 2 492 community residents which were included in this study, including the healthy crowd of 1 118 people, 1 374 cases of tumor patients. The study was to analyze the knowledge of cancer prevention and treatment in healthy people and cancer patients, to contrast the preferred hospital by healthy people and cancer patients, to acquaint the flow direction in seeking medical service, behavior and way to diagnosis cancer of tumor patients. Results In patients with cancer, the understanding proportion of patients with precancerous lesions, early tumor symptoms, and high risk groups was significantly higher than that in healthy people [26.93% (370/1 374), 39.96% (549/1 374), 46.00% (632/1 374) vs 14.49% (162/1 118), 21.91% (245/1 118), 26.92% (301/1 118)]. In healthy people, the proportion of identification of tumor three-grade prevention and control network, willing to participate in the tertiary prevention and control network, necessity to carry out cancer screening, willing to participate in screening was significantly higher than that in patients with cancer [98.83% (1 105/1 118), 91.95% (1 028/1 118), 98.12% (1 097/1 118), 98.03% (1 096/1 118) vs 81.95% (1 126/1 374), 79.98% (1 099/1 374) and 80.93% (1 112/1 374), 85.95% (1 181/1 374)]. There were significantly differences (P<0.05). Healthy people preferred to choose common hospital instead of 3A hospital as the first choice [32.56% (364/1 118) vs 86.97% (1 195/1 374)] (P<0.05). Discovery and diagnosis of cancer, further consultation, and rehabilitation were mainly carried out in 3A hospital. In patients with cancer, the cancer discovery ratio because of physical discomfort for medical attention was significantly higher than that in unit staff physical examination, self-inspection found, and physical examination in community health service center. Conclusion At present, the incidence and mortality of cancer in our country is in a stage of rapid rising. It's an urgent need for cancer prevention and control in China that making use of the advantage of network to improve the propaganda of the knowledge of cancer prevention and control, and establishing complementary advantages of the tertiary cancer prevention and control system by community, regional hospitals, and 3A hospitals.

目的 了解中山市儿童社区获得性肺炎病原学特点及其与年龄、抗生素使用的相关性,为疾病诊断和抗生素合理使用提供参考依据。方法 对中山市妇幼保健院儿科住院部2016年1月—2016年4月收治的小儿社区获得性肺炎临床资料、入院前使用抗生素和病原学检测结果进行回顾性分析。结果 共有155例研究对象纳入研究,细菌检出95株,其中革兰氏阴性菌61株,革兰氏阳性菌34株。流感嗜血杆菌,金黄色葡萄球菌,肺炎链球菌,大肠埃希氏菌,副流感嗜血杆菌的占构成比前五位。支原体和衣原体现症感染率约7.7%～8.4%。RSV检出率达25.8%。年龄在3 a以上、入院前使用过抗生素者,革兰阳性菌检出率较低(P<0.05)。入院前使用过抗生素者,革兰阴性菌检出率较高,且使用4 d及以上者高于使用3 d及以下者(P<0.05)。结论 住院儿童CAP的治疗,应综合考虑病人的年龄、入院前的抗生素使用情况,结合当地CAP 的可能优势病原选择合适的治疗方案。

Objective To explore the etiological characteristics and factors of community-acquired pneumonia(CAP) in children in Zhongshan for providing reference for the diagnosis and rational use of antibiotics for CAP. Methods Retrospective analysis were applied on clinical data and etiology results of CAP in children admitted to the pediatric inpatient department of Maternal and Child Health Hospital in Zhongshan from January to April, 2016. Results 155 children were enrolled. The number of bacteria detected was 95, including 61 Gram-negative bacteria, 34 Gram-positive bacteria. Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Haemophilus parainfluenzae accounted the top five. The recent infection rate of Mycoplasma and Chlamydia were from 7.7% to 8.4%. RSV detection rate was 25.8%.The Children who were over 3 years old, pre-use of antibiotics, associated with lower detection rate of Gram-positive bacteria (P<0.05). The Children who were the pre-use of antibiotics, associated with higher detection rate of Gram-negative bacteria, and the use of four days and more higher than three days or less(P<0.05). Conclusion For the treatment of CAP in children, the patient's age and pre-use history of antibiotics should be considered, combined with local common type of disease pathogens, to select the appropriate treatment.

目的 分析社区综合干预对小儿反复呼吸道感染的影响,为社区临床治疗小儿反复呼吸道感染性疾病提供理论依据。方法 采用随机抽签方式,从我社区2012年10月—2014年10月期间收治的小儿反复呼吸道感染患儿中,随机抽取60例纳入本项研究,依据就诊单双顺序,分为研究组30例(社区综合干预方式)和对照组30例(常规性治疗和常规措施进行干预),对两组患儿干预结果进行对比分析。结果 研究组治疗总疗效高于对照组(93.33% vs 76.67%),差异有统计学意义(P<0.05)。对比治疗干预过程中疾病发作次数、就诊次数状况,研究组优于对照组,差异有统计学意义(P<0.05)。干预后研究组小儿呼吸道感染致病因素改善情况(除滥用抗生素外)优于对照组,差异有统计学意义(P<0.05)。结论 针对小儿反复呼吸道感染疾病可采用社区综合干预方式,可显著提升治疗有效率,缓解病情,降低反复感染发生率,效果突出,具有广阔应用前景。

目的 探讨阳性强化法对社区门诊静脉输液患儿穿刺疼痛及依从性的影响。方法 选取社区门诊2014年4月—2016年4月收治的100例行静脉输液治疗的患儿作为研究对象,采取随机数字表法将其分成两组,每组50例。观察组患儿给予阳性强化法干预,对照组给予常规护理干预,对比两组患儿穿刺疼痛相关指标、穿刺效果、患儿静脉输液依从性及患儿家长的满意度。结果 观察组患儿疼痛面容持续时间明显短于对照组,穿刺后心率明显慢于对照组,啼哭时间>30s的患儿占比明显低于对照组(P<0.01)。观察组一次穿刺成功率、穿刺耗时>5min占比分别为94.00%、24.00%,对照组分别为74.00%、62.00%,观察组一次穿刺成功率明显高于对照组,穿刺耗时>5min占比明显低于对照组(P<0.01)。观察组患儿静脉输液依从率为90.00%,与对照组的66.00%对比有明显上升(P<0.01)。观察组患儿家长满意度为96.00%,与对照组的80.00%对比有明显上升(P<0.05)。结论 对社区门诊静脉输液患儿实施阳性强化法干预可有效减轻穿刺疼痛,提高患儿的输液依从性,患儿家长满意度高。

Objective To explore positive reinforcement on pain and compliance of puncture to children in community outpatients with intravenous infusion. Methods Select 100 cases of children who receive intravenous infusion in community outpatients from April 2014 to April 2016 as research objectives and divide them into two groups randomly with each group of 50 cases. Provide positive reinforcement to observation group while provide routine nursing to control group. Compare two groups' puncture pain relevant indicator, puncture effect, children's intravenous infusion compliance and parents' satisfaction. Results Children in observation had less duration of pain face expression, lower heart rate after puncture and less children crying >30s than those in control group (P<0.01). Observation group's first puncture success rate, puncture time duration >5mins rate were 94.00% and 24.00% respectively while control group's data were 74.00% and 62.00%. Observation group's first success rate was significant higher than that of control group. Observation group's puncture time duration >5mins rate was significant lower than that of control group (P<0.01). Children's intravenous infusion compliance rate in observation group was 90.00% which was significant higher than control group's 66.00% (P<0.01). Parents satisfaction rate in observation groups was 96.00% which was significant higher than control group's 80.00% (P<0.05). Conclusion Implementing positive reinforcement on children in community outpatient may help to relieve puncture pain, improve children's compliance to intravenous infusion and increase parents' satisfaction.

目的 了解广州市社区医务人员对颈动脉狭窄防治知识的认知程度、认知途径及对相关健康教育的需求情况。方法 对37家社区卫生服务中心194名广州市社区医务人员进行问卷调查,分析调查结果。结果 社区医务人员中52.58%能够指出颈动脉狭窄与脑卒中的关系,但对症状性颈动脉狭窄定义、颈动脉狭窄的外科治疗方法知晓率偏低(14.95%、18.56%),97.94%能够指出颈部彩超是颈动脉狭窄最常用的筛查方法,但对彩超结果判读、干预方法指导等方面内容掌握率偏低。对颈动脉狭窄知识来源目前最主要的是用药指南和药品说明书(33.89%)认为最有效获得颈动脉狭窄知识的途径是专题继续教育培训班(26.12%)。结论 社区医务人员已经形成了脑卒中和颈动脉狭窄的基本观念,但是不能达到足够的“深度”,通过开展多种形式继续教育,增进社区医务人员对颈动脉狭窄认知的广度和深度,引导和拓宽获得知识的途径将是必要和有效的。

Objective To understand the knowledge and needs of carotid stenosis prevention among community health workers in Guangzhou. Methods A Kirkpatrick model-based questionnaire survey was conducted among 194 health workers in community health service center in Guangzhou. Results 52.58% of the community medical staff could point out the relationship between carotid stenosis and stroke, but few of them could accurately point out the definition and surgical treatment of symptomatic carotid stenosis(14.95%,18.56%). 97.94% of them could pointed out that the most commonly used screening methods for cervical carotid stenosis, but most of them didn't know how to interpret the inspection result of color doppler ultrasound. Medication guide were the main knowledge source of carotid stenosis(33.89%) and post-graduate training was the most promising approach(26.12%). Conclusion Community health workers have formed the basic concept of stroke and carotid stenosis, but it was limited in extent. It is necessary to carry out various forms of continuing education to improve the level of awareness of community health workers on carotid artery stenosis.

目的 探讨八段锦联合呼吸训练对社区慢性阻塞性肺疾病(COPD)患者的疗效研究。方法 选取本社区2016年6月—2017年4月期间收治的重度及极重度稳定期COPD患者70例。随机分为A组(25例)、B组(23例)和C组(22例)。A组患者采用八段锦联合呼吸训练治疗,B组患者仅采用呼吸锻炼,C组患者不采用锻炼方式。记录对比三组患者治疗前后的肺功能、六分钟步行距离和圣乔治呼吸评分。结果 A组和B组患者肺功能均比治疗前及比C组改善(P＜0.05),且A组改善更明显(P＜0.05);A组和B组步行距离均比治疗前及C组增加(P＜0.05),且A组比B组增加程度更大(P＜0.05);A组和B组圣乔治呼吸评分均比治疗前及C组降低(P＜0.05),且A组比B组降低更多(P＜0.05)。结论 对COPD患者,八段锦联合呼吸训练可改善患者肺功能和运动能力,缓解呼吸困难,对患者活动及生活各方面的影响。具有较好的临床效果,值得临床推广应用。

Objective To study the effect of Baduanjin exercise combined with breathing training on patients with chronic obstructive pulmonary disease (COPD) in community. Methods We selected 70 patients with severe and extremely severe COPD at stable period in the community from June 2016 to April 2017. The patients were randomly divided into group A (25 cases), group B (23 cases) and group C (22 cases). Patients in group A were treated with Baduanjin exercise combined breathing training, while group B patients only used breathing exercise, and group C patients did not have exercise. We recorded and compared the lung function, six-minute walking distance and St Georges breathing score before and after treatment in the three groups. Results The pulmonary function of patients in group A and group B had been improved more than that before the treatment and of group C (P<0.05), and group A had been improved (P<0.05); the walking distance in group A and group B increased more than that before the treatment and of group C (P<0.05), and group A increased a greater degree than that of group B (P<0.05); The St Georges breathing score in group A and group B decreased than before the treatment and of group C (P<0.05); and group A decreased more than that of group B (P<0.05). Conclusion The Baduanjin exercise combined with breathing training may improve the pulmonary function and athletic ability of the patients with COPD, relieve dyspnea, reduce the influence of the illness on the activities activities of daily living of the patients. It has good clinical effect and is worthy of clinical application.

目的 了解番禺区市桥街居民卫生服务利用和卫生服务需求现况,为城市社区卫生服务发展指明方向。方法 采用自行编制的社区居民健康需求调查问卷,通过7个社区卫生服务机构的义诊活动进行一对一问卷调查。结果 被调查的居民以女性为主,占67.2%;35岁以上居民占71.4%;初中以下文化程度占22.6%; 医疗保险覆盖率为91.2%;两周社区就诊率39.0%;患病后首选社区卫生服务机构占51.6%;调查居民的生活行为和方式总体状况较好,但健康危险因素仍普遍存在。总体对疾病预防、饮食及心脑血管的系统疾病的健康知识需求以及对社区应提供的六种基本服务需求较高。结论 针对健康服务的需求次序,合理配置卫生服务资源,促使居民合理利用社区卫生资源。

目的 探讨红细胞分布宽度(RDW)与老年重症社区获得性肺炎(CAP)患者病情严重程度及预后的相关性。方法 将103例老年重症CAP患者按照近期预后分为存活组(n=83例)及死亡组(n=20例),按照RDW的水平分为RDW≥14.5%组(n=83例)和RDW＜14.5%组(n=20例);记录患者的一般临床资料及相关实验室检查指标,比较各组之间的差异,并利用Logistic回归模型分析老年重症CAP患者近期死亡的危险因素。结果 死亡组中的患者入院APACHEⅡ评分、CRP、PCT、RDW水平均高于存活组,差异有统计学意义(P＜0.05)。RDW 异常率随着PSI 级别的增高而增高,RDW 异常率分别为PSIⅠ-Ⅱ级7.32%(3/41、 PSI Ⅲ级16.67%(6/36)、PSI Ⅳ级39.13%(9/23)、PSIⅤ级 66.67%(2/3),差异有统计学意义(P＜0.05)。Spearsman相关性分析显示:RDW与APACHEⅡ评分、CRP、PCT、PSI评分呈正相关(r_s分别为=0.353,0.363,0.432,0.362,P均＜0.05)。多因素Logistic回归分析显示: RDW(OR=2.024,P＜0.05)是老年重症CAP患者近期死亡的独立危险因素。结论 RDW水平随着老年重症CAP患者病情严重程度的增加而增加,RDW增高亦是患者近期死亡的高危因素。