论著

多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓影响

Application effect of multidisciplinary integrated nursing pathway combined with high-quality nursing in operating room for patients with lower limb fracture and its effect on postoperative lower limb venous thrombosis

:186-191
 
目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表(VAS)评分低于常规组(P<0.05),二者住院时间以及引流管拔除时间比较差异无统计学意义(P>0.05);经过护理干预后,两组的凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均延长,血浆纤维蛋白原(FIB)降低,联合组优于常规组(P<0.05),且联合组下肢静脉血栓发生率低于常规组(0% vs 17.14%,P<0.05);联合组患者护理满意度更高(P<0.05);术后1个月两组患者日常生活活动能力(ADL)评分、Fugl-Meyer评分均升高,联合组高于常规组(P<0.05)。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。
Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis.Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group.Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room.The nursing effect of the two groups was compared.Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group(P<0.05),and the length of hospital stay and drainage tube removal time were not significantly different between the two groups(P>0.05).After nursing intervention,the prothrombin time(PT)and activated partial thromboplastin time(APTT)of the two groups were prolonged,and the plasma fibrinogen(FIB)decreased,and the change range of the combined group was greater(P<0.05).The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group(0.00% vs 17.14%,P<0.05).The nursing satisfaction of patients in combination group was higher(P<0.05).The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group(P<0.05).Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients.
论著

低浓度布比卡因联合全身麻醉对腹腔镜下直肠癌根治术患者体征及苏醒质量的影响

Clinical study on the effect of low concentration bupivacaine combined with general anesthesia on the physical signs and recovery quality of patients undergoing laparoscopic radical resection of rectal cancer

:295-299
 
目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组(P<0.05);术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组(P>0.05);但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组(P<0.05);联合组的麻醉相关不良反应发生率略高于全麻组(P>0.05);随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组(P<0.05)。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。
Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects.The patients were divided into groups by drawing lots.Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group.Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation.The changes of physical signs and the quality of recovery were compared between the two groups.Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group(P<0.05).After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group(P>0.05).However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group(P<0.05).The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group(P>0.05).During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group(P<0.05). Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe.
论著

重复经颅磁刺激应用于帕金森病失眠患者中的效果及对睡眠质量的影响研究

Effect of repetitive transcranial magnetic stimulation on Parkinson's patients with insomnia and its influence on sleep quality

:382-387
 
目的 探讨重复经颅磁刺激应用于帕金森病失眠患者中的效果及对睡眠质量的影响。方法 选取2021年1月—2022年3月南阳南石医院神经内科收治的帕金森病失眠患者100例,按照随机数字表法均分为参照组(n=50)和研究组(n=50),参照组采用常规西药治疗,研究组在参照组基础上采用重复经颅磁刺激治疗,对比两组治疗效果、神经递质指标水平、帕金森症状表现及睡眠质量评分的差异。结果 研究组治疗总有效率98.00%(49/50)高于参照组82.00%(41/50),对比差异有统计学意义(P<0.05)。治疗后,研究组神经递质多巴胺及5-羟色胺水平分别为(6.84±0.62)、(22.75±0.59),均高于参照组,对比差异均有统计学意义(P<0.05)。治疗后,研究组帕金森病症状表现及睡眠质量总评分均低于参照组,对比差异均有统计学意义(P<0.05)。结论 重复经颅磁刺激应用到帕金森病失眠患者的治疗中,能提升疗效,明显改善患者睡眠质量和帕金森病症状。
Objective To investigate the effect of repetitive transcranial magnetic stimulation(rTMS)on Parkinson's insomnia and its influence on sleep quality.Methods A total of 100 Parkinson's patients with insomnia admitted to the Department of Neurology,Nanyang Nanshi Hospital from January 2021 to March 2022 were selected and divided into the reference group(n=50)and the study group(n=50)according to random number table method.The reference group was treated with conventional western medicine,and the study group was treated with rTMS on the basis of the reference group.The levels of neurotransmitters,symptoms of Parkinson's disease and sleep quality were compared.Results The effective rate of the study group was 98.00%(49/50),which was higher than 82.00%(41/50)of the reference group,with statistical significance(P<0.05).After treatment,the levels of dopamine and 5-hydroxytryptamine in the study group,(6.84±0.62)and(22.75±0.59),were higher than those in the reference group,and the comparison was statistically significant(P<0.05).After treatment,the total score of Parkinson's symptom and sleep quality in the study group were lower than those in the reference group,with statistical significance(P<0.05).Conclusions The application of rTMS in the treatment of Parkinson's patients with insomnia can improve the curative effect,significantly improve the sleep quality and symptoms of Parkinson's disease,and is worthy of further application and promotion.
论著

唐氏综合征血清学筛查风险值异常孕妇选择接受无创产前基因检测的影响因素及临床价值

Influencing factors and clinical value of non-invasive genetic testing in pregnant women with abnormal risk value of serological screening for Down syndrome

:631-637
 
目的 探讨唐氏综合征血清学筛查风险值异常孕妇选择接受无创产前基因检测(NIPT)的影响因素,为临床制定对应策略提供参考依据。方法 选取2022年1月—2022年12月唐氏综合征血清学筛查风险值异常孕妇229例,根据是否接受NIPT分为接受组(195例)与不接受组(34例)。收集两组临床资料,采用Lasso-Logistic回归分析唐氏综合征血清学筛查风险值异常孕妇接受NIPT的影响因素。结果 单因素分析显示,年龄、文化水平、居住地、家庭平均月收入、孕前优生优育检查、孕前合并生殖相关疾病、受孕方式、不良孕产史、家族史、补充叶酸、配偶意愿、NIPT认知水平、血清学风险等级是血清学筛查异常孕妇接受NIPT的影响因素(P<0.05);Lasso回归分析筛选出7个变量,分别为年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级;Logistic回归分析,年龄(OR=6.269,95%CI:2.413~16.285)、文化水平(OR=4.119,95%CI:1.627~10.430)、家庭平均月收入(OR=5.102,95%CI:2.067~12.594)、不良孕产史(OR=5.247,95%CI:1.833~15.021)、家族史(OR=7.416,95%CI:2.952~18.629)、NIPT认知水平(OR=5.751,95%CI:2.338~14.146)、血清学风险等级(OR=7.866,95%CI:3.057~20.238)是血清学筛查异常孕妇接受NIPT的影响因素(P<0.05)。结论 唐氏综合征血清学筛查风险值异常孕妇选择接受NIPT的影响因素较多,包括年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级,能为临床提高NIPT接受度提供指导信息。
Objective To explore the influencing factors of noninvasive prenatal testing(NIPT)for pregnant women with abnormal risk value of serological screening for Down syndrome,and to provide reference for clinical development of corresponding strategies.Methods A total of 229 pregnant women with abnormal serological screening risk values for Down syndrome from January 2022 to December 2022 were selected and divided into acceptance group(195 cases)and non-acceptance group(34 cases)according to whether they received NIPT.The clinical data of the two groups were collected and Lasso-Logistic regression was used to analyze the factors influencing the acceptance of NIPT in pregnant women with abnormal serological screening risk value for Down syndrome.Results In single factor analysis,age,education level,place of residence,average monthly family income,pre-pregnancy and childbearing examination,pre-pregnancy combined with reproductive diseases,conception method,adverse pregnancy history,family history,folic acid supplementation,spouse intention,NIPT cognition level and serological risk grade were the influencing factors for the acceptance of NIPT in pregnant women with abnormal serological screening(P<0.05).Seven variables were selected by Lasso regression analysis,which were age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level and serological risk level.Logistic regression analysis showed that age(OR=6.269,95%CI:2.413-16.285),education level(OR=4.119,95%CI:1.627-10.430),average monthly family income(OR=5.102,95%CI:2.067-12.594),adverse pregnancy history(OR=5.247,95%CI:1.833-15.021),family history(OR=7.416,95%CI:2.952-18.629),NIPT cognitive level(OR=5.751,95%CI:2.338-14.146)and serological risk level(OR=7.866,95%CI:3.057-20.238)were independent influencing factors for NIPT acceptance in pregnant women with abnormal serological screening(P<0.05).Conclusions There are many influencing factors for pregnant women with abnormal serological screening risk value to accept NIPT,including age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level,serological risk grade,etc.,which can provide guidance information for clinical improvement of NIPT acceptance.
论著

国产帕利哌酮缓释片治疗稳定期精神分裂症的疗效与安全性

Efficacy and safety of domestic paliperidone sustained-release tablets in the treatment of stable schizophrenia

:806-809
 
目的 分析国产帕利哌酮缓释片治疗稳定期精神分裂症的疗效与安全性。方法 采用随机数字表法将驻马店市第二人民医院2021年10月—2023年10月收治的108例稳定期精神分裂症患者分为对照组(服用原研帕利哌酮缓释片)与观察组(服用国产帕利哌酮缓释片),每组各54例,以阳性与阴性症状量表(PANSS)评分变化为疗效衡量指标,以不良反应发生率及药物副反应量表(TESS)评分变化为安全性衡量指标。结果 治疗后,两组PANSS评分均比治疗前降低,组内不同时间点评分差异有统计学意义(t=22.147、4.513、3.431、21.369、3.927、3.601,P值分别为<0.001、<0.001、0.001、<0.001、<0.001、<0.001),但组间不同时间点评分比较差异无统计学意义(t=0.281、0.043、0.150,P=0.779、0.966、0.881);观察组不良反应发生率(14.81%)与对照组(12.96%)比较差异无统计学意义(χ2=0.090,P=0.765);两组TESS评分接近,不良反应皆轻微(t=0.185,P=0.856)。结论 国产帕利哌酮缓释片治疗稳定期精神分裂症患者可促进症状改善,且不良反应轻微,疗效及安全性与原研制剂相当。
Objective To analyze the efficacy and safety of domestic paliperidone sustained-release tablets in the treatment of stable schizophrenia.Methods A total of 108 patients with stable schizophrenia admitted to Zhumadian Second People's Hospital from October 2021 to October 2023 were divided into control group(taking the original paliperidone sustained-release tablet)and observation group(taking domestic paliperidone sustained-release tablet)by random number table method,with 54 cases in each group.The change of Positive and Negative Symptom Scale(PANSS)was used as the efficacy measure,and the change of incidence of adverse reactions and Treatment Emergent Symptom Scale(TESS) score was used as the safety measure.Results After treatment,PANSS scores in both groups were lower than before treatment,and the differences in scores at different time points in the groups were statistically significant(t=22.147,4.513,3.431,21.369,3.927,3.601,the P values were<0.001,<0.001,0.001,<0.001,<0.001,<0.001,respectively).However,there was no significant difference in scores at different time points between the groups(t=0.281,0.043,0.150,P=0.779,0.966,0.881).There was no significant difference in the incidence of adverse reactions between observation group(14.81%)and control group(12.96%)(χ2=0.090,P=0.765).TESS scores were similar between the two groups,and adverse reactions were mild(t=0.185,P=0.856).Conclusions The domestic paliperidone sustained-release tablets can improve the symptoms of stable schizophrenia patients,and the side effects are slight,and the efficacy and safety are comparable to the original agent.
论著

个体化肠内营养支持在胃肠术后早期应用的临床观察

Personalized enteral nutrition support in early-stage postoperative gastrointestinal surgery:A clinical observation

:786-790
 
目的 探讨个体化肠内营养支持在胃肠术后早期应用的可行性及安全性。方法 选取2022年1月—12月安徽省亳州市中医院普通外科收治的胃肠手术患者100例。使用随机数字表法将患者随机为观察组和对照组,每组各50例。观察组在常规治疗基础上实施个体化肠内营养,持续7 d。对照组则接受术后常规处理。术后第7天测定实验室指标,并比较两组胃肠功能的恢复情况。结果 观察组术后肛门首次排气时间短于对照组[(55.41±19.63)h vs (81.46±19.39) h],前白蛋白水平高于对照组[(241.14±65.73)g/L vs(217.35±51.63)g/L],组间比较差异有统计学意义(P<0.05)。血清总蛋白水平[(70.55±18.89)g/L vs (68.16±20.05)g/L]、血清白蛋白水平[(53.22±17.76)g/L vs(50.76±18.54)g/L]、淋巴细胞计数[(1.60±0.54)×109/L vs (1.56±0.55)×109/L]以及肛门排便时间[(89.67±22.31)h vs (97.77±21.27)h ]在组间比较差异无统计学意义(P>0.05)。结论 根据个体情况在胃肠术后早期实施个体化的肠内营养支持是安全可行的,能够促进胃肠功能的快速恢复,从而改善患者的营养状况。
Objective To investigate the feasibility and safety of personalized enteral nutrition support during the early postoperative period of gastrointestinal surgery.Methods A total of 100 patients who underwent gastrointestinal surgery at the Department of General Surgery,Bozhou Hospital of Traditional Chinese Medicine,who were enrolled in this study during January 2022 to December 2022.Patients were randomly allocated into either the observational or control group,with 50 patients in each group.The randomization was performed using a random number table.The observational group received personalized enteral nutrition support in addition to routine treatment for 7 days.The control group received standard postoperative care.Laboratory indicators were measured on the 7th postoperative day to compare recovery of gastrointestinal function between the two groups.Results The observational group exhibited a significantly shorter time to the first passage of flatus from the anus compared to the control group(55.41±19.63 h vs 81.46±19.39 h,P<0.05),as well as higher prealbumin levels(241.14±65.73 g/L vs 217.35±51.63 g/L,P<0.05).However,there were no significant differences between the two groups in terms of serum total protein levels(70.55±18.89 g/L vs 68.16±20.05 g/L),serum albumin levels(53.22±17.76 g/L vs 50.76±18.54 g/L),lymphocyte counts[(1.60±0.54)×109/L vs (1.56±0.55)×109/L],and time to the first defecation from the anus(89.67±22.31 h vs 97.77±21.27 h)(all P>0.05).Conclusions Personalized enteral nutrition support based on individual conditions is safe and feasible in the early postoperative period of gastrointestinal surgery.It can promote the rapid recovery of gastrointestinal function and improve patients' nutritional status.
医院管理

医科类高校研究生校院二级管理体制现状与对策研究

Research on current situation and countermeasures of secondary management system of graduate students in medical colleges and universities

:1089-1094
 
目的 以临床二级学院附属医院的管理为例,对当下医科类高校研究生校院二级管理存在问题进行探讨。方法 对某医科高校附属医院474名临床医学研究生及9名辅导员进行调查。结果 55.56%的研究生表示导师的约束力最大,但42.56%的学生与导师是不定期沟通;39.83%的学生不认可在培养方式上严格区分培养,其中学术型硕士二年级学生中44.3%认为有一定区别,但区别不大;学院配备的学生工作管理专职人员不足、学院层级的管理制度和机制不健全和二级学院权责不清运行机制不顺畅。结论 明确医科类高校与二级附属医院之间的关系、提高治理效能激活医科类高校二级附属医院人才培养的自主性和内生动力、医科类高校二级附属医院研究生施行差异化培养和整合资源,共同提升医科高校与附属医学院的整体水平。
Objective To discuss the existing problems of secondary management in medical colleges and universities,taking the management of secondary college of affiliated hospital as an example.Methods Through the investigation of 474 clinical medical graduate students and 9 counselors in the affiliated hospital of a medical university.Results There was 55.56% of the graduate students said that the supervisor was the most binding force,but 42.56% of the students communicated with the supervisor irregularly;39.83% of the students do not recognize the strict differentiation of training methods,44.3% of the students in the second year of study believed that there was a certain difference,but the difference was not big.The college was equipped with insufficient full-time staff for student work management,the management system and mechanism at the college level were not perfect,and the power and responsibility of the second-level college were not clear and the operation mechanism is not smooth.Conclusions Clarify the relationship between medical colleges and secondary affiliated hospitals,improve governance efficiency and activate the autonomy and endogenous motivation of talent training in secondary affiliated hospitals of medical colleges and universities,implement differentiated training the graduates of secondary affiliated hospitals of medical colleges and universities,integrate resources,so as to jointly improve the overall level of medical colleges and universities and affiliated medical schools.
论著

喹硫平联合帕利哌酮治疗精神分裂症疗效及对代谢功能与血清因子的影响

Efficacy of quetiapine combined with paliperidone in the treatment of schizophrenia and its effect on metabolic function and serum factors

:1084-1088
 
目的 针对精神分裂症患者接受喹硫平与帕利哌酮联合治疗对其代谢功能及血清因子的影响。方法 纳入2022年1月—2023年3月驻马店市第二人民医院收治的120例精神分裂症患者,根据住院号进行编号,并通过通过随机抽签方法分为两组,对照组60例应用单一喹硫平治疗,观察组60例应用喹硫平与帕利哌酮联合治疗,对比两组的治疗效果。结果 经治疗,观察组临床总疗效高于对照组(P<0.05);该组各项代谢功能指标均与对照组比较差异无统计学意义(P>0.05);该组各项血清因子测定该结果均高于对照组(P<0.05);该组各项精神症状评分均低于对照组(P<0.05);该组不良反应发生率与对照组比较差异无统计学意义(P>0.05)。结论 采用喹硫平与帕利哌酮联合的方式治疗精神分裂症患者,可以提升临床疗效,对患者各种精神症状及血清因子改善效果更好,虽然药物会对患者代谢功能产生一定的影响,但是联合用药与单独用药的影响情况无差异,未增加不良反应发生率,安全性良好。
Objective To evaluate the combination of quetiapine and paliperidone on metabolic function and serum factors in schizophrenia.Methods A total of 120 patients with schizophrenia admitted to Zhumadian Second People's Hospital from January 2022 to March 2023 were included,numbered according to the hospitalization number,and divided into two groups by random drawing method.Sixty patients in the control group were treated with quetiapine alone,and 60 patients in the observation group were treated with quetiapine combined with paliperidone,and the therapeutic effects of the two groups were compared.Results After treatment,the total clinical efficacy of the observation group was higher than that of the control group,P<0.05;the metabolic function indexes comparison were P> 0.05;the serum factor of observation group was higher,P<0.05;the scores of psychiatric symptoms in the group were all lower than the control group,P<0.05;the incidence of adverse reactions in the observation improve group was not different from the control group,P>0.05.Conclusions Using quetiapine and schizophrenia,can improve clinical curative effect,various mental symptoms and serum factors,although certain effect on patient metabolic function may occur,but did not significantly increase the incidence of adverse reactions,with high safety.
论著

恶性梗阻性黄疸患者行经皮肝穿刺胆道引流术后出院准备度现状及其影响因素

Current status and influencing factors of discharge readiness in patients with malignant obstructive jaundice undergoing percutaneous liver puncture biliary drainage surgery

:1020-1026
 
目的 分析恶性梗阻性黄疸患者实施经皮肝穿刺胆道引流术后出院准备度情况,探究此类患者出院准备度的影响因素。方法 选择2020年9月—2023年4月于天津市人民医院消化内科接受经皮肝穿刺胆道引流术的80例恶性梗阻性黄疸患者,选择院内系统对入组患者的性别、年龄等资料进行统计,并使用出院准备度量表评估患者出院准备度,应用出院指导质量量表评估患者出院指导质量,选择Pearson相关性分析的措施对影响患者出院准备度和出院指导质量的关联进行分析,并分析患者出院准备度影响因素。结果 合并慢性疾病以及居住方式方面,不同亚组患者间出院准备度得分比较差异具有统计学意义(P<0.05);Pearson相关性分析显示出院准备度量表各维度得分与出院指导质量得分呈正相关(均P<0.05);Logistic回归分析显示,居住方式得分为出院准备度量表得分的独立影响因素(P<0.05)。结论 经皮肝穿刺胆道引流术恶性梗阻性黄疸患者出院准备度得分较低,通过改变患者居住方式、提高患者出院指导质量,将有助于提高患者出院准备度。
Objective To analyze the discharge readiness of patients with malignant obstructive jaundice after percutaneous transhepatic biliary drainage,and explore the influencing factors of discharge readiness of such patients.Methods A total of 80 patients with malignant obstructive jaundice who underwent percutaneous transhepatic biliary drainage in Tianjin People's Hospital from September 2020 to April 2023 were selected as the research objects.The data such as sex and age of the patients were statistically analyzed in the hospital system,and the discharge readiness scale was used to evaluate the discharge readiness of the patients.The discharge guidance quality scale was used to evaluate the discharge guidance quality of patients.Pearson correlation analysis was selected to analyze the relationship between the discharge readiness and the discharge guidance quality,analyze factors influencing patient discharge readiness.Results There was a statistically significant difference(P<0.05)in the comparison of discharge readiness scores between different subgroups of patients with combined chronic diseases and living habits.Pearson correlation analysis showed that the scores of each dimension of the discharge readiness measurement table were positively correlated with the scores of discharge guidance quality(all P<0.05).Logistic regression analysis showed that the residential style score was an independent influencing factor(P<0.05)for the discharge readiness scale score.Conclusions The discharge readiness score of patients with malignant obstructive jaundice undergoing percutaneous liver puncture biliary drainage was low.By changing the patient's living style and improving the quality of discharge guidance,will help to improve the patient's discharge readiness.
论著

153例住院儿童甲型流感病毒肺炎及混合感染的临床特征

Clinical characteristics of 153 hospitalized children with influenza A virus pneumonia and mixed infection

:1009-1014
 
目的 探讨住院儿童甲型流感病毒肺炎合并其他病原菌感染的临床特征。方法 通过回顾性研究方法,分析2021年6月—2023年6月广州市妇女儿童医疗中心住院治疗的153例甲型流感病毒肺炎患儿的临床资料,针对有无合并其他病原菌感染,分为混合感染组及非混合感染组两组,分别为98例及55例,分析并对比两组的临床特征。结果 甲型流感病毒肺炎患儿以发热、咳嗽、呕吐/腹泻等症状为主,其中混合感染组患儿呕吐/腹泻症状占比高于非混合感染组(P<0.05);两组患儿其他症状及并发症对比差异无统计学意义(P>0.05);儿童甲型流感病毒肺炎患儿检出合并细菌感染的患儿65例(29.41%),合并肺炎支原体感染的患儿33例(21.57%);合并病毒感染的患儿20例(13.07%)。与非混合感染组比较,混合感染组患儿乳酸脱氢酶水平更高,白细胞计数<4×109/L的人数占比更少(P<0.05);其他实验室指标对比差异无统计学意义(P>0.05);经过抗病毒及对症治疗后,150例(98.04%)患儿痊愈出院,3例出现严重并发症,其均伴有其他病原菌感染。与非混合感染组比较,混合感染组患儿住院天数更长、住院费用更高(P<0.05);其他预后指标对比差异无统计学意义(P>0.05)。结论 甲型流感病毒肺炎患儿易感染其他的病原菌,导致疾病治疗难度加大,因此临床要提高警惕,以防混合感染情况发生,尽早采取有效的诊治措施,提高疾病早期治愈率。
Objective To explore the clinical characteristics of hospitalized children with influenza A virus pneumonia complicated with other pathogens.Methods The clinical data of 153 children with influenza A virus pneumonia hospitalized in Guangzhou Women and Children Medical Center in the past two years(June 2021 ~ June 2023)were analyzed retrospectively. According to whether they were infected with other pathogens,they were divided into mixed infection group and non-mixed infection group,with 98 cases and 55 cases respectively.The clinical characteristics of the two groups were analyzed and compared.Results Fever,cough,vomiting and diarrhea were the main symptoms in children with influenza A virus pneumonia,and the proportion of vomiting and diarrhea in children with mixed infection group was higher than that in children without mixed infection group(P<0.05).There was no significant difference in other symptoms and complications between the two groups(P>0.05).There were 65 children(29.41%)with influenza A virus pneumonia and 33 children(21.57%)with mycoplasma pneumonia,20 children(13.07%)with virus infection.Compared with non-mixed infection group,the level of lactate dehydrogenase in children with mixed infection group was higher,and the proportion of children with white blood cell count<4×109/L was less(P<0.05).There was no significant difference in other laboratory indexes(P>0.05).After antiviral and symptomatic treatment,150 cases(98.04%)were cured and discharged,and 3 cases had serious complications,all of which were accompanied by other pathogens.Compared with non-mixed infection group,children in mixed infection group had longer hospitalization days and higher hospitalization expenses(P<0.05).There was no significant difference in other prognostic indicators(P>0.05).Conclusions Children with influenza A virus pneumonia are easily infected with other pathogens,which makes it more difficult to treat the disease.Therefore,we should be vigilant in clinic to prevent mixed infection and take effective diagnosis and treatment measures as soon as possible to improve the early cure rate of the disease.
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