目的 探讨精神科急救培训用护士作为标准化病人的培养方法。方法 2013年9月挑选了4名精神科护士参加标准化病人系统培训,考核合格后成为护士标准化病人在2013年10月—11月对30名新护士自缢、噎食急救培训和考核中使用。结果 对急救培训中使用护士标准化病人,30名新护士中认为“新颖,第一次接触”19人(63%)、“满意”的26人(87%);4名作为标准化病人的护士都认为“非常有意义”。结论 精神科急救培训应用护士标准化病人丰富了培训的形式和内涵,得到了绝大部分参与人员的肯定。

Objective To explore the methods of training nurses as standardized patients for psychiatric first aid. Methods 4 nurses were selected to participate in the psychiatric standardized patient training program and all passed the examination. Using these nurse standardized patients to train the 30 new nurses for psychiatric first aid. Results After the first aid training, 19 of the 30 new nurses(63%) felt that it was “novelty and interesting”. 26 nurses(87%) felt “being satisfied”. And those 4 standardized patients felt “very meaningful”. Conclusion Training and application of nurses as standardized patients for psychiatric first aid may enrich the form and content of training program, and gains most of the participants affirmation.

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 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

成人急性呼吸窘迫综合征死亡率居高不下,而当前治疗手段大多以对症支持为主且效果欠佳。通过早期识别ARDS高危患者,及早施加干预措施阻断疾病进展是目前研究的新方向。较之传统机械通气模式,气道压力释放通气因其特有的肺保护作用备受国内外学者关注,APRV下肺泡持续开放并保持稳定可减少肺损伤发生,将APRV应用于ARDS预防理论上前景可观,本文将围绕早期实施APRV对预防ARDS应用价值展开论述。

The mortality of adult acute respiratory distress syndrome(ARDS) remains high. Supportive care measures are main treatments to ARDS currently while the effect is poor. Early application of airway pressure release ventilation in patients who are at high risk for ARDS is a new direction of research. Compared with traditional mechanical ventilation, more and more scholars both at home and abroad pay attention to the airway pressure release ventilation APRV because of its unique lung protection. Under APRV the alveoli maintain stable continuously which may reduce the incidence of lung injury. Applying APRV to ARDS prevention is promising theoretically. This paper will focus on the value of preemptive airway pressure ventilation for high-risk ARDS patients.

目的 采用Meta分析系统定量地评价我国高中生与大学生艾滋病健康教育的干预效果,为在学生群体中开展艾滋病健康教育提供科学依据。方法 以“艾滋病”、“健康教育”、“大学生”和“高中生”为主题词和关键词联合检索PubMed、中国知网和万方数据库的相关文献,各数据库检索时间范围限定在2006年1月—2017年6月。对符合纳入排除标准的文献进行质量评价及摘录所需数据,以健康教育前后艾滋病常识得分作为效应值,运用Revman 5.3软件进行Meta分析。结果 共纳入19篇合格文献。Meta分析结果显示,健康教育对中学生与大学生艾滋病常识得分影响的标准均数差(Standard Mean Difference,SMD)=1.17(95% CI=0.88～1.47)。结论 健康教育对提高我国高中生与大学生艾滋病相关知识的知晓有较好的效果。

目的 调查新疆疏附县基层医务人员对男童外生殖器畸形的认知及筛查能力,为制定新疆少数民族地区医务人员培训计划提供数据支持。方法 采用自行设计的问卷调查表,对新疆疏附县人民医院、乡卫生院及村医进行问卷调查,确定其对男童外生殖器畸形的认知程度。采用SPSS 13.0进行数据分析,比较维、汉两族医务人员的认知差异。结果 发放调查问卷400份,收回有效问卷365份,占91.25%。调查发现,新疆疏附县基层医务人员对外生殖器畸形相关知识认知正确率超50%的占参与问卷调查的54.79%。其中男性21.92%,女性32.87%。汉族医务人员对外生殖器畸形相关知识认知正确率超50%的占参与问卷调查的汉族医务人员50%,维族约57.40%,统计分析显示差异无统计学意义(P＜0.05);有关外生殖器畸形相关知识获取途径中,未参加相关知识培训占61.64%,参加过培训者38.36%;在临床实践中主动筛查新生儿外生殖器畸形者86.30%,发现外生殖器畸形病例者27.39%。结论 新疆疏附县基层医务人员普遍缺乏男童外生殖器畸形相关诊疗知识,在实际工作中发现并恰当处置此类疾病的能力亦相对欠缺。因此提高新疆少数民族地区基层医务人员对男童外生殖器畸形的诊断和治疗能力非常必要。

Objective To survey on the recognition and diagnosis capability of frontline healthcare workers in boy's genital malformation in Shufu, Xinjiang. Thereby to provide data support for the healthcare workers training there. Methods We designed a questionnaire and carried out a survey in Shufu people's hospital, township clinics and village doctors. Based on SPSS 13.0 data analysis, we made comparison on recognition difference between the Han and Uygur healthcare workers. Results 400 questionnaires were handed out, among them 365 were valid which accounted for 91.25%. The survey showed that there were 54.79% survey participators whose recognition correct rate was over 50% in Shufu, Xinjiang (21.92% for man, 32.87% for woman), 50% Han healthcare workers whose recognition correct rate was over 50% and that of 57.4% in Uygur peers.There was no significant difference in statistics(P<0.05). It accounted for 38.36% that participating in training as the access to relevant knowledge of genital malformation,but 61.64% was not. In clinical practice, 86.3% of survey participators screen the possibility of newborn genital malformation. And 27.39% of screened newborn have genital malformation. Conclusion The frontline healthcare workers in Shufu, Xinjiang at large are short of diagnosis knowledge on boy's genital malformation, as a result that they are difficult to recognize and give proper treatment on such cases in practice. The status thereby shows that it is critical to improve the diagnosis and treatment capability of frontline healthcare workers in boy's genital malformation in Xinjiang ethnic group area.

目的 了解广州综合医院内分泌科门诊就诊者中抑郁焦虑障碍的患病率。方法 对广州市第一人民医院的内分泌科门诊就诊的患者进行横断面调查。采用医院焦虑抑郁量表(HADS)对105名入选的患者进行筛查,精神科医生对HADS≥8 分的患者进行国际神经精神科简式访谈问卷( MINI ) 的诊断性评估。结果 MINI诊断的抑郁障碍、焦虑障碍、抑郁和焦虑共病的患病率分别为3.80%、0.95%和2.86%。结论 抑郁和焦虑障碍是综合医院内分泌科门诊就诊者中的常见问题,但识别率和治疗率均不高。

Objective To investigate the prevalence rates of depressive and anxiety disorders of the endocrinology outpatients in a general hospital of Guangzhou. Methods A cross-sectional survey was conducted in the endocrinology outpatient department of Guangzhou First People's Hospital. A total of 105 outpatients were screened with hospital anxiety and depression scale(HADS). The patients with the HADS score of 8 and over were investigated and diagnosed by psychiatrists with the mini-international neuropsychiatric interview(MINI). Results The prevalence rates of MINI-diagnosed depressive disorder, anxiety disorder, and depressive-anxiety co-morbid disorders were 3.80%, 0.95% and 2.86%, respectively. Conclusion Depression and anxiety disorders are common problems in the endocrinology outpatient department of general hospitals,but few outpatients were well-diagnosed and treated.

目的 观察喉罩通气下全凭七氟醚吸入麻醉在妇科宫腔镜手术中的应用价值。方法 60例拟行妇科宫腔镜手术的患者随机分为七氟醚和丙泊酚组,每组30例,记录不同时间点两组患者的平均动脉压(MAP),脉搏血氧饱和度(SpO₂)、苏醒时间以及术后恶心,呕吐、躁动的发生率。结果 A组患者血流动力学指标波动较少,苏醒时间A组明显短于B组,差异有显著性(P<0.05)。两组患者诱导后MAP,HR均较诱导前显著下降(P<0.05)。B组患者术中MAP,HR值显著低于A组(P<0.05),拔除喉罩即刻两组MAP,HR差异无显著性(P>0.05)。结论 喉罩下全凭七氟醚吸入麻醉对患者的血流动力学的影响较小,适用于妇科宫腔镜手术。

Objective To observe the effect of laryngeal mask airway(LMA) combined with sevoflurane inhalation anaesthesia in gynecological hysteroscopy operation. Methods Sixty patients, classified from ASAⅠtoⅡscheduled for hysteroscopic operation were randomly divided into sevoflurane inhalation anesthesia group (group A) and propofol intravenous anesthesia group(group B).The mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), recovery time and the incidence of nausea, vomiting and recovery time were recorded at different time points of the two groups. Results The hemodynamic index of the patient in the group A fluctuated seldom,and the recovery time was significantly shorter than that in the B group, and the differences were significant (P<0.05).The MAP and the HR were all decreased after anesthesia induction compared with those of before in both groups (P<0.05).The MAP and the HR in the group B was significantly lower than that in the group A (P<0.05), there were no significant differences in MAP and HR between the two groups of patients with laryngeal mask airway removal. Conclusion Small hemodynamic influence is taken with the technique of laryngeal mask airway(LMA) combined with sevoflurane inhalation anesthesia. It is suitable for gynecological hysteroscopic operation.

目的 调查药学本科大学三年级学生在毕业实习前对实习的整体观念及心态。方法 采用问卷表方式调查,将回收问卷表进行数据统计并分析结果。结果 占总比63.2%学生对未来实习方向较模糊,并期望获得相关指导;72.8%学生认为药学专业知识对实习有帮助;90.0%学生认为实习是为即将就业打基础;对于寻找实习单位的方式,三分之一以上学生比较倾向于药学专业老师介绍推荐,大约三分之一的学生有意自己联系实习单位。结论 该调查结果较为真实反映某高校药学本科生实习前的心态及其对实习整体观念,为高校实习管理及学生工作部门了解学生的实习想法提供可靠数据依据,也为教务部门制定“以人为本”实习计划提供了科学依据。

Objective To investigate the overall concept and state of mind of the undergraduates in the grade three undergraduate students before internship. Methods The questionnaire was used to investigate the form of the questionnaire, and the data were collected and analyzed. Results 63.2% of the students for the future practice direction was fuzzy, and hope to get the guidance;72.8% of the students thought pharmacy specialized knowledge is helpful to practice; 90.0% students thought practice was foundation for employment; To find the internship units, more than one third of the students tend to get recommend by pharmacy professional teachers. About one third of students wished to contact their internships by themselves. Conclusion The survey results showed mentality and the overall concept in practice of pharmacy students in our school. It can provided reliable data basis for the practice of management to understand the students practice idea, and also for the educational administration department to develop the “people-oriented” internship program.

目的 观察自体巩膜倒扣包裹羟基磷灰石(HA)义眼台一期植入术临床效果、术后并发症及随访预后情况。方法 选取我院2012年7月—2014年3月期间26例需植入HA义眼台患者,采用进口材料HA义眼台,直径18~22 mm,重量约2 g,施行眼球摘除术后,予眼内容剜除,自体巩膜壳倒扣包裹于HA义眼台前端,一期植入肌锥的方法。结果 随访2～20个月,2例发生结膜充血水肿(7.69%),3例发生结膜创口愈合不良(11.54%),行保守治疗或于手术室清创缝合后痊愈,余未发生义眼台排斥、暴露、感染、移位及眼球假体固定。结论 羟基磷灰石(HA)义眼台具有高度的生物相容性,无毒性、无抗原性,纤维结缔组织可长入内联多孔,不引起明显异物排斥反应,是目前较理想的眼座材料。自体巩膜倒扣包裹HA的应用减少了义眼台植入术后并发症的产生,术后眼窝饱满,眼球假体活动度可,外观恢复满意,临床效果好,是眼眶整形术中较为理想的方法。