论著

经颅微电流刺激联合自我穴位按摩在 2 型糖尿病患者睡眠障碍中的应用

Application of transcranial microcurrent stimulation combined with self-acupoint massage in patients with sleep disorders of type 2 diabetes mellitus

:187-191
 
      目的 探讨2型糖尿病(T2DM)睡眠障碍患者使用经颅微电流刺激(CES)联合自我穴位按摩干预的效果。方法 使用随机数表法将南昌大学第二附属医院2022年6月—2023年1月收治的T2DM合并睡眠障碍患者100例分为两组,每组各50例。对照组采用CES干预,基于此,观察组加用自我穴位按摩,比较两组临床疗效、睡眠质量及血糖水平。结果 与对照组干预总有效率80.00%(40/50)比较,观察组干预总有效率96.00%(48/50)更高(χ 2 =6.061,P=0.014);两组干预后匹兹堡睡眠质量指数(PSQI)中入睡时间、睡眠效率、催眠药物、睡眠障碍、睡眠时间、主观睡眠质量、日间功能障碍及总分均降低,且观察组[(0.95±0.28)分、(1.05±0.24)分、(0.55±0.14)分、(0.67±0.20)分、(0.92±0.21)分、(0.82±0.20)分、(0.65±0.18)分、(5.61±1.10)分]均低于对照组[(1.42±0.33)分、(1.30±0.33)分、(1.40±0.26)分、(1.14±0.27)分、(1.31±0.30)分、(1.32±0.37)分、(1.22±0.27)分、(9.11±1.26)分](t=7.679、4.332、20.354、9.891、7.531、8.406、12.421、14.797,均P<0.001);两组干预后餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)及空腹血糖(FBG)水平均降低,且观察组2 hPG[(6.14±0.68)mmol/L]、HbA1c[(3.45±0.37)%]、FBG[(5.52±0.48)mmol/L]低于对照组[(7.12±1.25)mmol/L、(4.30±0.34)%、(6.58±0.67)mmol/L](t=4.870、11.961、9.094,均P<0.001)。结论 对T2DM合并睡眠障碍患者使用CES联合自我穴位按摩干预效果满意,可有效提高患者的睡眠质量,调节血糖水平。
医院管理

广州市越秀区 3 所综合医院 93 例医疗损害责任纠纷案件法院审理浅析

Analysis of the court trial of 93 cases of medical damage liability disputes in three general hospitals in Yuexiu District,Guangzhou

:131-138
 
       目的   对医疗损害责任纠纷案的法庭审理进行分析,探究医疗损害责任纠纷案件的处理现状,对此过程中医疗机构应当关注的问题进行分析总结,以期为医院应对医疗损害鉴定工作和法官审理医疗损害责任纠纷案提供参考。方法   对广州市三所综合医院2015—2021年共93例医疗损害责任纠纷案的判决书进行描述性分析。结果  93例案例中79例进行了医疗损害鉴定。79例进行医疗损害鉴定的案例中,71例鉴定结论被法院采信,采信率达90%。有29例案件鉴定人出庭(占比36.7%),其中有25例鉴定意见被法院采信,采信率为86.2%,仅有7例案例当事人申请了专家辅助证人出庭。医方大多数最终承担次要及以下责任占比为73.4%。鉴定结论为责任范围的,法院最后判决偏向于取最高值和中间值(43例出具责任范围的案例中,14例为最高值,13例为中间值)。结论   医疗机构要充分加强对医疗事故技术鉴定和医疗损害鉴定的认识,高度重视医疗损害鉴定工作,尤其加强尸体解剖告知及病历书写管理,充分利用好鉴定人和专家辅助证人出庭两种手段。
      Objective  To analyze the court trial of medical damage liability disputes,to explore the current situation of medical damage liability disputes,to analyze and summarize the problems encountered in dealing with medical damage disputes,so as to provide some references for hospitals to deal with medical damage disputes.Methods  Descriptive statistical analysis performed on the written judgment of 93 cases of medical damage liability disputes in three large comprehensive hospitals in Yuexiu District,Guangzhou from 2015 to 2021.Results  In 93 cases,79 cases had expertise of medical malpractice.In 79 expertise,71 of them were adopted,and the acceptance rate was 90%.Among the 29 cases in which the appraisers appeared in court,25 expert opinions were accepted by the court,the acceptance rate was 86.2%.In only 7 cases,the parties applied for expert witnesses to appear in court.In most cases,hospitals ultimately took secondary and lower responsibilities,accounting for 73.4%.If the appraisal conclusion falls within the scope of responsibility,the court’s final judgment tends to take the highest and middle values.Conclusions  Medical institutions should fully strengthen their understanding of technical identification of medical accidents and medical malpractice identification.Attach great importance to the identification of medical malpractice,especially strengthen the management of autopsy notification and medical record writing,make full use of two methods:appraisers and experts witnesses appearing in court.
护理研究

基于微视频的护理干预对急性胰腺炎患者疾病知晓、自我管理和遵医行为的影响

The impact of micro video based nursing interventions on disease awareness,self-management and compliance behavior in patients with acute pancreatitis

:125-130
 
       目的   探讨基于微视频的护理干预对急性胰腺炎患者疾病知晓、自我管理和遵医行为的影响。方法   根据中心随机法将郑州大学第二附属医院2021年1月—2023年1月收治的88例急性胰腺炎患者作为研究对象,其中传统组44例给予常规干预,微视频组44例在传统组的基础上结合微视频的护理干预,比较两组患者疾病知晓情况、自我管理能力和遵医行为情况。结果   干预2个月后,微视频组病例脱落3例,传统组病例脱落4例,两组疾病知晓各维度高于干预前,且微视频组高于传统组,其中疾病病因(t=3.151,P=0.003)、临床症状(t=7.165,P<0.001)、并发症(t=5.497,P<0.001)、如何预防疾病复发(t=8.195,P<0.001);两组自我护理能力量表(ESCA)各维度评分高于干预前,且微视频组高于传统组,其中各维度评分结果为自我护理技能(t=2.787,P=0.007)、自我概念(t=2.272,P=0.026)、自护责任感(t=2.644,P=0.011)、健康知识水平(t=3.321,P=0.001);两组遵医行为各维度评分高于干预前,且微视频组高于传统组,其中各维度评分结果为饮食依从性(t=6.271,P<0.001)、用药依从性(t=3.539,P=0.001)、锻炼依从性(t=4.469,P<0.001)、定期复查(t=2.764,P=0.007)。结论   通过运用微视频的护理干预能够提高急性胰腺炎患者疾病知识的掌握,促进机体自我管理水平的恢复,进而提高遵医行为。
       Objective  To explore the impact of micro video based nursing interventions on disease awareness,self-management and compliance behavior in patients with acute pancreatitis.Methods  According to the central randomization method,88 patients with acute pancreatitis admitted to the Second Affiliated Hospital of Zhengzhou University from January 2021 to January 2023 were selected as the research subjects.Among them,44 patients in the traditional group received routine intervention,and 44 patients in the micro video group received nursing intervention combined with micro video on the basis of the traditional group.The disease awareness,self-management ability and compliance behavior of the two groups of patients were compared.Results  After two months of intervention,three cases were dropped out in the micro video group and four cases were dropped out in the traditional group.The disease awareness in both groups was higher than that before intervention,and the micro video group was higher than the traditional group,including disease etiology(t=3.151,P=0.003),clinical symptoms(t=7.165,P<0.001),complicationst=5.497,P<0.001) and how to prevent disease recurrence(t=8.195,P<0.001).The scores of ESCA in both groups were significantly higher than those before intervention,and the micro video group was higher than the traditional group in terms of self-care skills(t=2.787,P=0.007),self-concept(t=2.272,P=0.026),self-care responsibility(t=2.644,P=0.011) and health knowledge level(t=3.321,P=0.001).The scores of all dimensions of compliance behavior in both groups were significantly higher than those before intervention,and the micro video group had higher scores than the traditional group in terms of dietary compliancet=6.271,P<0.001),medication compliance(t=3.539,P=0.001),exercise compliance(t=4.469,P<0.001) and  regular follow-up(t=2.764,P=0.001).Conclusions  The use of micro video nursing interventions can improve the mastery of disease knowledge in patients with acute pancreatitis,promote the recovery of the body’s self-management level,and thereby improvemedical compliance behavior.
论著

基于 Python 语言探析《圣济总录》中腰痛病用药规律研究

Study on medication rule of low back pain in Shengji Zonglu based on Python language

:99-105
 
      目的   应用 Python语言对《圣济总录》中腰痛病篇中的中药进行用药规律分析,提取腰痛病治疗方法及用药特色指导临床腰痛病治疗思路。方法   运用 Python语言中的语言提取对《圣济总录》中腰痛篇章中的所有中药方剂识别,提取方剂组成,统计并分析方剂中中药的规律并将其结果可视化呈现。结果   最终共纳入62首方剂,包含药物86味。其中使用频次≥7次、频率≥1.6%的药物共20味,频次频率最高的为桂枝;所用中药四气以温性为主,占56.74%;五味以辛、甘、苦为主,共约占90%,归经以肝肾经为主;药物功效以补虚类为主,占27.13%;关联规则分析显示提升度最高的组合为麻黄-独活,置信度最高的组合为巴戟天-牛膝、牵牛子-牛膝,支持度最高的组合为川芎-当归、川芎-杜仲;通过聚类分析得到3个聚类结果。结论   《圣济总录》治疗腰痛病方面善用通法和补法,强调活血通络,补益肝肾,尤擅长治疗肝肾亏虚或风寒所客等腰痛病证。
       Objective Python language was used to analyze the rules of traditional Chinese medicine in the chapter of low back pain in Shengji Zonglu,and to extract the treatment methods and medication characteristics of low back pain to guide the clinical treatment of low back pain.Methods The language extraction in Python language was used to identify all the Chinese medicine prescriptions in the chapter of low back pain in Shengji Zonglu,extract the composition of the prescription,and analyze the rules of Chinese medicine in the prescription to visually present the results.Results A total of 62 prescriptions were included,including 86 drugs.Among them,with there were 20 kinds of drugs,the frequency of use ≥7 times,the frequency ≥1.6%,and cmnamomi Mmulus highest frequency.Four gas used in traditional Chinese medicine is given priority to with warm,accounted for 56.74%.The five flavors were mainly pungent,sweet and bitter,accounting for about 90%,and the liver and kidney meridians were the main meridians.The drug efficacy was mainly deficiency tonic,accounting for 27.13%.The association  rule analysis showed that the combination with the highest improvement was Ephedrae Herba- Angelicae Pubescentis Radix,the combination with the highest confidence was Morindae Officinalis Radix- Achyranthis Bidentatae Radix,Pharbitidis Semen- Achyranthis Bidentatae Radix.and the combination with the highest support was Chuanxiong Rhizoma- Angelicae Sinensis Radix,Chuanxiong Rhizoma- Eucommiae Cortex.Three clustering result is obtained by cluster analysis.Conclusions In the treatment of low back pain,Shengji Zonglu is good at using both blocking methods and reinforcing methods,emphasizing circulating blood and unblocking meridians supplementing liver and kidney,especially in the treatment of low back pain syndrome caused by liver and kidney deficiency or wind and cold.
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