目的 分析区级医院甲型流行性感冒患者的临床特征,为基层医院甲型流感的早期诊断及防控工作提供科学依据。方法 对2019年12月广州市番禺区中心医院发热门诊就诊的具有流感样症状的发热患者共628例,进行咽拭子甲型流感病毒核酸检测,收集患者临床资料,包括性别、年龄、体温、症状、血常规,根据核酸检测结果分为阴性组及阳性组,2组结果进行比较。结果 甲型流感病毒核酸检测阳性患者共116例,阳性率为18.5%。阳性组发病年龄以14～19岁所占比例最大,共91例(78.4%)。阳性组平均年龄小于阴性组(P＜0.05)。阳性组发病体温以38.1～39 ℃所占比例最大,共47例(46.5%)。阳性者平均体温高于阴性组(P＜0.01)。症状方面,阳性组仅鼻塞流涕比例较阴性组高(P＜0.05)。阳性组白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值、淋巴细胞百分比均低于阴性组(P＜0.01)。结论 2019年冬季甲型流感患者以青少年为主,单纯症状较难区分甲型流感及普通感冒,需结合血常规特别是白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值的降低进行分析。

Objective The clinical characteristics of patients with influenza A in district hospital were analyzed to provide scientific basis for early diagnosis, prevention and control of influenza A in primary hospital. Methods A total of 628 patients with influenza-like symptoms from Guangzhou Panyu Central Hospital in December 2019 were enrolled, and the clinical data was collected, including gender, age, body temperature, symptoms, and blood test results. According to the result of influenza A nucleic acid detection, patients were divided into negative group and positive group, and the clinical data of these two groups were compared. Results A total of 116 patients were positive in influenza A virus nucleic acid detection, which positive rate was 18.5%. In the positive group, patients aged 14-19 accounted for the largest proportion, with 91 patients (78.4%). The mean age of the positive group was significantly lower than that of the negative group (P＜0.05). Body temperature ranged from 38.1 to 39 ℃ accounted for the largest proportion in the positive group, with 47 patients (46.5%). The mean body temperature of the positive group was significantly higher than that of the negative group (P＜0.01). In terms of symptoms, only the proportion of nasal congestion in positive group was higher than that in negative group (P＜0.05). In terms of blood test results, WBC count, neutrophil absolute value, lymphocyte absolute value and lymphocyte percentage in the positive group were significantly lower than those in the negative group (P＜0.01). Conclusions The majority of patients with influenza A in the winter of 2019 were teenagers, and it was difficult to distinguish influenza A from the common cold only by symptoms. The differential diagnosis should be carried out in combination with the blood routine analysis, especially the decrease in the white blood cell count, the absolute value of neutrophil and the absolute value of lymphocytes.

目的 探讨甲状腺Bethesda Ⅲ类(AUS/FLUS)结节的诊断原因,以及亚分类在预测结节恶性风险(risk of malignancy,ROM)中的价值。方法 收集356例Bethesda Ⅲ结节患者,对其诊断原因, ROM及亚分类进行总结分析。结果 在97例手术切除标本中,72例恶性肿瘤均为甲状腺乳头状癌(papillary thyroid carcinoma,PTC),Bethesda Ⅲ类的ROM为74.2%。影响PTC诊断的主要原因有病灶小、穿刺细胞量稀少、缺乏乳头状结构及细胞核特征不典型;次要原因有间质显著纤维化或钙化、涂片不合格、固定不当、染色不佳及细胞学诊断经验欠缺等。Bethesda Ⅲ类的亚分类:132例为低风险组,其中12例手术切除,ROM为8.3%;122例为高风险组,其中70例手术切除,ROM为92.9%;102例为中风险组,其中15例手术切除,ROM为40.0%;高风险组和低/中风险组之间的差异有统计学意义(P＜0.05)。结论 Bethesda Ⅲ类的诊断具有一定的主观性和经验性,而对Bethesda Ⅲ类结节进行风险相关的亚分类,有助于实现更好的ROM分层并改善此类病变的临床管理。

Objective To investigate the diagnostic causes of Bethesda Ⅲ (AUS/FLUS) thyroid nodules and the value of subcategories in predicting risk of malignancy (ROM) of thyroid nodules. Methods The data of 356 cases of Bethesda Ⅲ nodules were collected, and the causes, ROM and subcategories were summarized. Results In 97 resected specimens, 72 were diagnosed as papillary thyroid carcinoma (PTC), and the ROM of Bethesda Ⅲ was 74.2%. The main factors affecting the diagnosis of PTC were small lesions, few puncture cells, atypical nuclear features and lack of papillary structure. Secondary factors included significant interstitial fibrosis or calcification, unqualified smear, improper fixation, poor staining and lack of cytological diagnosis experience. According to the subcategories of Bethesda Ⅲ, 132 cases were included in low-risk group, nodules of 12 cases in the group were resected, which ROM was 8.3%; 122 cases were included in high-risk group, nodules of 70 cases were resected, which ROM was 92.9%; 102 cases were included in middle-risk group, nodules of 15 cases were resected, which ROM was 40.0%. The differences between high-risk group and low/medium-risk group were statistically significant (P＜0.05). Conclusion The diagnosis of Bethesda Ⅲ is subjective and empirical in some degree, and the risk related subcategories of Bethesda Ⅲ nodules is helpful to achieve better ROM stratification and improve the clinical management of the disease.

目的 探讨双侧会阴神经阻滞麻醉配合综合护理在降低单胎初产妇顺产会阴侧切率中的应用效果。方法 选取2019年7月—2019年12月在我院经阴道分娩的顺产初产妇110例为研究对象,按照随机数字表法分成两组,每组各55例,所选产妇对照组产妇给予常规护理模式,给予局部浸润麻,观察组产妇在对照组基础上采用综合护理模式,给予双侧会阴神经阻滞麻醉,比较两组产妇会阴侧切情况、会阴裂伤情况、产程持续时间、VAS评分、新生儿Apgar评分、依从性情况及护理效果等相关指标。结果 和对照组相比,观察组患者会阴侧切发生率少于对照组(P＜0.05),第一、第二产程时间短于对照组(P＜0.05);同对照组相比,观察组产妇在VAS评分、依从性及满意度指标均优于对照组(P＜0.05),而新生儿窒息、产后出血发生情况比较差异无统计学意义(P＞0.05)。结论 双侧会阴神经阻滞麻醉配合综合护理可以有效降低初产妇会阴侧切的发生率,减轻分娩时的疼痛,缩短产程,提高产妇依从性及满意度,具有较高的临床推广价值。

Objective To explore the effect of bilateral perineum nerve block anesthesia combined with comprehensive nursing in reducing the rate of perineum side cutting of primipara. Methods 110 primiparas who delivered vaginally in our hospital from July 2019 to December 2019 were selected as the research objects. According to the random number table method, they were divided into two groups, 55 in each group. The control group was given the routine nursing mode and local infiltration anesthesia. The observation group was given the comprehensive nursing mode and bilateral perineum nerve block anesthesia on the basis of the control group. The perineum side cutting status, perineum laceration, duration of labor, VAS score, Apgar score, compliance and nursing effect of the two groups were compared. Results Compared with the control group, the incidence of perineum side cutting was lower in the observation group than that in the control group (P<0.05).The first and second stages of labor were shorter in the observation group than the control group (P<0.05); compared with the control group, the VAS score, compliance and satisfaction index were better in the observation group than the control group (P<0.05), but there was no significant difference in neonatal asphyxia and postpartum hemorrhage (P>0.05). Conclusion Bilateral perineum nerve block anesthesia combined with comprehensive nursing may effectively reduce the incidence of perineum lateral incision of primipara, reduce the pain during delivery, shorten the labor process, improve the compliance and satisfaction of parturients, and has a high clinical value.

目的 分析广州市番禺区户籍和流动人口肺结核病发现延误情况,为研究结核病防治基本公共卫生服务均等化策略提供参考依据。方法 根据中国疾病预防信息系统登记的数据,对2013—2016年番禺区登记的肺结核病人进行统计。采用卡方检验的方法,对比分析户籍和流动肺结核病人发现延误的差异。结果 结核病发现延误中,男性患者户籍与流动患者延误天数比较差异有统计学意义(χ²=19.067,P<0.01),户籍患者延误天数30 d以上的比例高于流动患者。户籍与流动患者的医生延误天数比较差异有统计学意义,流动患者的医生延误比例高于户籍患者(χ²=18.001,P<0.01)。结论 广州市番禺区肺结核发现延误主要由户籍病人患者延误和流动病人医生延误所构成,需采取综合性干预措施,减少结核病患者的发现延误,从而进一步体现结核病防治基本公共卫生服务均等化。

目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.

目的 探讨多措施协作在中药注射剂药物警戒工作的应用效果。方法 2012年1月—2014年12月,采取建立多措施协作,应用于中药注射剂药物警戒工作中。通过对中药注射剂的用药频度(DDDs)、日用金额(DDC)、有效率及引起不良反应(ADR)变化等进行比较分析,以评价中药注射剂使用的安全性和有效性变化情况。结果 2012—2014年,中药注射剂使用有效率从76.5%上升至91.2%,不良反应发生率则由3.12%下降至0.72%,没有重大不良反应事件发生。中药注射剂用药频率DDDs则呈下降趋势,在医院药品总DDC上升的情况下,中药注射剂DDC反而下降。结论 多措施协作有助于建立有效的药物警戒体系,有效地降低了中药注射剂不良反应发生率,提高监测工作数据分析效率和发现药物警戒信号的能力,为中药注射剂的“合理,安全,有效,经济”提供有力的保障。

目的 调查重症监护病房(ICU)医院感染的常见细菌分布及耐药性变化,为合理使用抗生素和医院感染的预防控制提供相关科学依据。方法 回顾性分析医院2007—2011年ICU收治的381医院感染患者感染菌株分布特点及耐药性情况。结果 ICU医院感染常见菌株主要来源于痰液标本,占78.2%,其次是血液。381 株临床分离菌中共检出革兰阴性杆菌262 株、革兰氏阳性球菌70例和真菌49例,分别占68. 8%、24.9%和占17.4%。革兰阴性杆菌中鲍氏不动杆菌(24.7%)、肺炎克雷伯氏杆菌(10.8%)、铜绿假单胞菌(9.2%)排前三位。其中除碳青霉烯类药物及抑酶制剂,鲍氏不动杆菌对其余抗菌药物耐药率均＞40%。革兰氏阳性球菌以金黄色葡萄球菌为主。对青霉素、庆大霉素、红霉素的耐药率均＞50%。结论 呼吸道仍是ICU最常见的感染部位。病原菌以革兰阴性杆菌为主,且对常用抗菌药物的耐药率逐渐升高,临床应加强抗菌药物规范使用,避免耐药菌株的产生。

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit(ICU)causing nosocomial infections so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The specimen sources and the clinical distribution of the 381 pathogens isolated from 2007 to 2011 were retrospectively analyzed. The drug resistance was observed in ICU that causing nosocomial infections. Results The sputum was the major specimens source in ICU, accounting for 78.2%. Of the 381 pathogens causing nosocomial infections in ICU, the 262 gram-negative bacilli (68.8%), 70 gram-positive cocci (24.9%),and 49 fungi (17.4) were isolated, Among gram-negative bacilli the top three were acinetobacter baumannii (24.7%), klebsiella pneumonia(10.8%),and pseudomonas aeruginosa (9.2%). The drug resisitance rate of baumannii to antibiotics were more than 40%,beside carbapenem and B-Lactamaseinhibitors. The main gram-positive cocci of causing nosocomial infections was saphylococcus aureus in ICU. The drug resisitance rate of S. aureus to penicillin, erythromycin and gentamicin were higher than 50.0%. Conclusion The main distribution area of nosocomial infections was the respiratory tract and the gram-negative bacilli were the common pathogens in ICU. It was benefit to avoid presenting of drug resistant strain, and antibiotics should be reasonably used in clinic.