目的 探讨妊娠期甲亢患者血清甲状腺功能和免疫含量变化及其临床应用价值。方法 分别取妊娠期与非妊娠期甲亢病例各250例,于孕15周、孕25周以及孕35周时测定两组血清甲状腺功能各项指标与免疫含量。结果 与对照组相比,观察组患者整个妊娠期T3、T4水平明显更高(P＜0.05);孕中晚期两组FT3、FT4水平差异并无统计学意义(P＞0.05)。结论 血清T3、T4在妊娠合并甲亢患者整个妊娠过程中呈高水平表达,临床应高度重视TRAb阳性率、FT3、FT4表达水平,以明确诊断。

目的 探讨重症急性胰腺炎诊治特点。方法 回顾性分析13例重症急性胰腺炎患者临床资料,包括一般资料、生化检测及影像资料、治疗措施与预后结果,纳入标准为急性胰腺炎合并器官衰竭＞48 h(改良Marshall评分≥2分)。结果 重症急性胰腺炎患者一般资料中普遍突出存在心率增快(121.07±28.09)次/分、APACHE II评分偏高(18.92±7.34),病因排序则是高脂血症(38.5%)＞胆石症(30.8%)＞酒精性(23.1%),SAP合并ARDS发生率可达46.2%,合并AKI则高达69.2%;WBC(12.60±5.57)×10⁹/L、CRP(138.16±67.06)mg/L及PCT(15.76±27.33)ng/L等炎症指标升高提示SAP普遍存在炎症反应,影像学中69.2%患者合并发生肺炎及腹腔积液则提示多处感染部位,其他脏器指标异常升高也提示SAP患者心肺肝肾均存在不同程度的受损;接受CRRT治疗及呼吸支持可分别达46.2%及76.9%,7天内死亡例数为1例(7.7%),28天内死亡例数为4例(30.8%),ICU及总住院时间为(10.77±7.38)及(19.61±13.40)天。结论 重症急性胰腺炎是全身及局部性的炎症反应累及全身各个脏器的急性复杂病变,以合并发生ARDS及AKI为临床特征,需要多器官功能保护与替代、外科干预等多学科综合协作治疗。

Objective To evaluate characteristics of diagnosis and treatment on severe acute pancreatitis. Methods To respective analysis clinical data of 13 patients with severe acute pancreatitis. The data included baseline characteristics, biochemical tests and imaging data, treatment and prognosis, inclusion criteria for acute pancreatitis with organ failure > 48 h (modified Marshall score > 2). Results Higher heart rate(121.07±28.09) times/min and APACHEII scores(18.92±7.34) were universally found in SAP, which primary disease contained hyperlipidemia (38.5%) > cholelith disease (30.8%) > alcohol (23.1%) with incidence of ARDS and AKI being 46.2% and 69.2%; Higher inflammatory biomarkers including WBC(12.60±5.57)×10⁹/L, CRP(138.16±67.06)mg/L and PCT(15.76±27.33)ng/L indicated widespread inflammation with many infection sites revealing by 69.2% pneumonia and peritoneal effusion on imaging; Other abnormally biochemical index prompted some injury of viscera including heart, lungs, kidney and liver; 1 case suffered death within 7 days and 4 cases also did within 28 days, ICU and total length of hospital stay was (10.77±7.38) and (19.61±13.40) days, CRRT treatment and respiratory support respectively reached 46.2% and 46.2%. Conclusion Severe acute pancreatitis is a acute complex pathological changes on various organs induced by acute systemic and local inflammation with feature of mergence with the ARDS and AKI, which need the multidisciplinary integrated collaborative treatment on organ function protection and sustain and surgical intervention.

目的 对急诊留观病历中存在的质量问题予以分析,探索提高其书写质量的有效措施,优化管理流程。方法 根据卫生部《病历书写基本规范》、《医疗机构病历管理规定》和《广东省病历书写与管理规范》对2015年6月—12月某院1200份急诊留观病历进行质量检查,对其问题进行汇总分析。结果 发现存在质量缺陷的病历998份,缺陷数4478项,以缺权利义务告知书、授权委托书或填写漏项、出观记录入观情况简单复制、缺验单、病程记录过于简单等缺陷位居前四位,占78.67%。结论 急诊留观病历缺陷突出。临床医师及医院管理者需要就此进行针对性整改,以提高和控制急诊留观病历质量。

Objective To analyze deficiencies of medical records from emergency observation room and explore effective procedures to enhance writing quality of medical records and its management. Methods One thousand two hundred medical records from emergency observation room during June to December 2015 were analyzed according principles of medical records writing,regulations for medical records management in medical institutions by Ministry of Health and regulation for medical records writing and management in Guangdong province. Results 998/1200 medical records were found with deficiency and the total deficiencies were 4478 items. The prominent four types of deficiencies, occupying 78.67%, included absence or incompleteness of the notification of the rights and obligations and power of attorney, simple copy and paste of the medical records, absence of medical test results and too simplicity of the recording of the disease process. Conclusion Prominent deficiencies were found in medical records from emergency observation room. The clinical physicians and hospital administrators should take effective procedures to improve and control the quality of the medical records.

目的 观察康复路径在髋关节置换术后的临床应用效果,探讨其临床应用价值 。方法 将广州市第一人民医院2014年10月—2015年10月收治行髋关节置换术患者100例为研究对象,随机分为对照组与观察组各50例。对照组采取常规围手术期护理,观察组按照康复路径护理,比较两组患者术后并发症、住院时间、费用、患肢功能以及日常生活自理能力。结果 观察组住院时间和住院费用均少于对照组(P<0.01);两组术后并发症发生率、患肢功能评分及日常生活自理能力比较,差异均有统计学意义(P<0.01 )。结论 康复计划护理用于髋关节置换术后效果显著,可明显降低患者术后并发症,缩短住院时间,降低住院费用,有利于促进患者术后功能以及自理能力的恢复。

Objective To observe the effect of clinical application of rehabilitation in the path of a hip replacement, and to explore its clinical application value. Methods October 2014 to October 2015 in Guangzhou First People's Hospitalhip arthroplasty cases werecollected of 100 patients as the research object, randomly divided into control group and observation group with 50 cases in each group. The control group adopted conventional perioperation period nursing care, observation group in accordance with the recovery paths. We compared two groups of patients complications, hospitalization time, expense, limb function and activities of daily living. Results In the observation group, the hospitalization time and cost of hospitalization were significantly less than that of the control group (P<0.01); The incidence of limb function score, ability of daily living and postoperative complications were compared between the two groups, the differences were statistically significant (P<0.01). Conclusion Rehabilitation nursing care plans for after hip replacement effect is significant. It can significantly reduce the postoperative complications, shorten the time of hospitalization, reduce hospitalization expenses, and is beneficial to the recovery of the function of promoting postoperative and self-care ability.

目的 探讨内科治疗的高血压基底节区出血的疗效及预后相关的因素。方法 回顾性分析2005年4月—2014年12月贵阳市第二人民医院神经外科收治的174例高血压脑出血患者的临床资料,所有患者均采用内科保守治疗,对疗效及影响患者预后的因素进行分析。结果 174例患者中,死亡50例,持续植物生存状态4例,对124例存活患者进行随访,随访时间2~117个月,随访ADL分级Ⅰ级43例,Ⅱ级53例,Ⅲ级21例,Ⅳ级3例,Ⅴ级4例,预后较好者(ADL分级Ⅰ~Ⅱ级)96例,预后不良者(ADL分级Ⅲ~Ⅴ级)28例。χ²检验显示入院 GCS评分和出血量是影响患者预后的因素。结论 影响高血压基底节区脑出血患者的预后因素较多,GCS评分较高、出血量少的患者可采用内科治疗,多数患者预后较好。

Objective To investigate treatment efficacy and the factors influencing prognosis of conservative treatment of hypertensive intracerebral hemorrhage in basal ganglia. Methods A retrospective analysis was conducted on the clinical data of 174 patients with hypertensive intracerebral hemorrhage in basal ganglia who were admitted to our hospital during the period from April 2005 to December 2014. All the patients were given internal medicine conservative treatment and followed up to observe the clinical curative effect to analyze the prognosis. Results Of the 174 patients, 50 patients died and 4 patients were persistent vegetative state. 124 patients were followed up for 2-117 months and they were classified according to ability of daily life(ADL) prognosis scale: 43 cases were in I grade, 53 cases in II grade, 21 cases in III grade, 3 cases in IV grade, 4 cases in V grade. 96 cases achieved favourable outcomes and 28 cases got poor outcomes.The results of Chi square test revealed that GCS scale and intracerebral hemorrhage volume were the factors influencing prognostic of hypertensive intracerebral hemorrhage in basal ganglia. Conclusion There were many prognosis factors related with hypertensive intracerebral hemorrhage. The curative effect and prognosis in patients with conservative treatment is obvious in these patients with high GCS scale and less intracerebral hemorrhage volume.

目的 研究中药熏洗、中药离子导入加CPM综合疗法对膝关节功能障碍患者的作用效果。方法 从2014年4月—2016年4月,于我院共有78例膝关节功能障碍病患就诊。以数字法随机分成观察组(39例)和对照组(39例)。观察组给予中药熏洗以及中药离子导入再加以CPM综合疗法进行护理,对照组仅给予CPM综合疗法护理。观察两组患者护理后膝关节疼痛程度以及活动范围。结果 观察组患者膝关节功能优者占比51.28%,总有良率为84.62%,均高于对照组的25.64%,51.28%;观察组患者膝关节活动范围优者占比51.28%,总优良率为89.74%,均高于对照组的28.21%,66.67%;观察组患者WOMAC评分中膝关节疼痛以及膝关节僵硬和膝关节功能得分均低于对照组,WOMAC总分也低于对照组,差异均有统计学意义(P均＜0.05)。结论 中药熏洗、中药离子导入加CPM综合疗法能显著改善患者膝关节功能,增加活动度数,减轻疼痛等级,值得临床推广使用。

Objective To study the effect of traditional Chinese medicine fumigation, traditional Chinese medicine iontophoresis combined with CPM combined therapy on patients with knee joint dysfunction. Methods From April 2014 to April 2016, in our hospital there were a total of 78 cases of knee joint dysfunction disease patient treatment. With digital method they were randomly divided into observation group (39 cases) and control group (39 cases). The observation group was treated with Chinese herbal fumigation and washing and Chinese medicine iontophoresis and CPM combined therapy nursing, control group only received CPM combined therapy nursing. Observation of nursing care of the patients in the two groups were knee pain and range of motion. Results The observation group of patients with knee joint function was accounted for than 51.28%. The total yield was 84.62%. They were significantly higher than those in the control group of 25.64%, 51.28%; Observation group of patients with knee joint range of motion was accounted for than 51.28%. The total excellent and good rate was 89.74%, were significantly higher than those in the control group of 28.21%, 66.67%; Observation group, WOMAC score of knee pain and knee stiffness and knee joint function score were significantly lower than those of the control group. WOMAC score was significantly lower than that of the control group. The differences were statistically significant (P<0.05). Conclusion Traditional Chinese medicine fumigation, traditional Chinese medicine iontophoresis combined with CPM therapy could significantly improve the patient's knee function, increase the degree of activity, reduce the pain level. It is worth to have clinical application.

目的 了解河源市无偿献血人群中丙型肝炎病毒(HCV)感染情况及HCV感染合并乙型肝炎病毒(HBV)、人类免疫缺陷病毒(HIV)以及梅毒螺旋体(TP)感染的情况,为当地预防和控制输血传播性疾病提供实验室依据。方法 选择2010年1月1日—2015年12月31日河源市中心血站无偿献血者71 618例,采用酶联免疫吸附试验(ELISA)方法检测其血浆抗-HCV、乙型肝炎表面抗原(HBsAg)、抗-TP及HIV(Ag/Ab),统计分析抗HCV阳性无偿献血者合并感染HBV、HIV和TP的情况。结果 71 618例无偿献血者标本中抗-HCV、HBsAg 、抗-TP及HIV(Ag/Ab) 阳性率分别为0.56％(402例)、1.48％(1 062例)、1.14％(821例)、0.09％(61例);初次献血者抗-HCV、HBsAg 、抗-TP及HIV(Ag/Ab)阳性率均高于多次献血者(P＜0.05);402例抗-HCV阳性无偿献血者中合并HBsAg、抗-TP、HIV(Ag/Ab) 阳性率分别为1.74%(7例)、4.98%(20例)、0.25%(1例)。结论 抗-HCV阳性献血者合并TP感染率显著高于抗-HCV阴性无偿献血者, HCV合并HBV、HIV感染率低。

目的 通过对我院健康体检人群眼科体检的数据分析,探讨眼科健康管理对眼部疾病防治的重要性。方法 分析2015年1月—12月眼科体检人群的数量、来源、性别、年龄。分析各类眼部疾病的检出率及不同年龄、性别的分布情况。结果 眼科疾病主要为屈光不正、结膜炎、白内障、眼底动脉硬化、黄斑变性等。屈光不正多以青壮年为主,结膜炎在中老年人群中检出率较高,白内障及眼底疾病的检出率在中老年人群中随年龄的增加而增加。结论 对于常见病和隐匿性疾病的防治,眼科体检具有较好的指导意义。

Objective Through the data analysis of eye common diseases in our hospital physical examination population to discuss the importance of eye health management for eye common disease prevention and control. Methods To analyze the quantities, source, gender and age of the eye examination population from Jan to Dec 2015.To analyze relevance ratio of all kinds of eye common disease and the distribution of different age and gender. Results Ophthalmic diseases included mainly ametropia, conjunctivitis, cataracts,fundus arteriosclerosis,macular degeneration and so on. Ametropia mainly happened at young adults, conjunctivitis detection rate was higher in the elderly crowd. The detection rate of cataract and retinal diseases in the elderly crowd increased with their ages. Conclusion For the prevention and treatment of common diseases and latent glomerular diseases, ophthalmic examination has a good guiding significance.

目的 了解近五年某地市级综合医院传染病病例疫情情况,分析其流行病学特征,为探索医院传染病预防控制工作提供科学依据。方法 采用描述性流行病学方法和Excel 2007软件对传染病疫情报告资料进行分析。结果 2010—2014年法定报告的传染病发病例数基本呈持续上升趋势。2010—2014年共报告传染病11 673例次,发病数居前5位的传染病依次为手足口病、乙型肝炎、梅毒、生殖道沙眼衣原体感染、肺结核,分别占21.17%、12.44%、12.16%、8.51%和7.52%;总死亡数为21例,病死率为1.799‰。5年来,不同传染病发病数呈现出不同的变化趋势。结论 及时掌握当地传染病的发病情况,加强对常见传染病的防控力度,提高病原检测力度,做好传染病的筛查工作,防止传染病在医院内传播。

Objective To analyze the characteristic features of notifiable diseases in a general hospital from 2010 to 2014, and provide basis information for notifiable diseases' prevention and control. Methods Using descriptive epidemiological methods and microsoft Excel 2007, the report data of notifiable diseases was statistically analyzed. Results The number of notifiable diseases increased during 2010 to 2014. 11 673 cases of notifiable diseases were reported in the hospital at the same time.The top five reported cases of notifiable diseases were hand-foot-and-mouth disease(HFMD),hepatitis B virus, syphilis, chlamydia trachomatis infection and tuberculosis, account for 21.17%,12.44%,12.16%,8.51% and 7.52% accordingly. Moreover, there are total 21 death cases have been reported and case fatality rate was 1.799‰.Different infectious diseases showed different trend variation during the above mentioned period. Conclusion We should understand and grasp the local incidence of infectious disease, strengthen the prevention and control, improve the pathogen detection, make an effort on screening, and prevent the spread of infectious diseases in the hospital.

目的 研究探讨重症监护病房(ICU)病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法 回顾性分析2015年ICU住院患者送检细菌分离培养及药敏试验结果。结果 ICU共送检标本1 326份,分离出病原菌554株,其中革兰阴性病原菌462株(83.4%),革兰阳性病原菌48株(8.7%),真菌44株(7.9%)。革兰阴性杆菌前5位依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌,且多耐药菌株比例较高。革兰阳性病原菌以金黄色葡萄球菌为主,32株(66.7%),MRSA检出率78.3%(25/32)。结论 加强重症监护病房的细菌及药敏监测,根据病原菌药敏结果指导临床合理使用抗菌药物,控制耐药菌株的产生,预防及控制院内感染及感染暴发。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in intensive care unit(ICU) and provide scientific evidence for clinically reasonable use of antibiotics. Methods Specimens from hospitalized intensive care unit patients in 2015 were obtained for routine bacterial isolation and culture. Results A total of 554 bacterial strains were isolated from 1326 specimens, in which Gram-negative bacilli accounted for 462 stains (83.4%),Gram-positive cocci accounted for 48 stains (8.7%),and fungi accounted for 44 stains (7.9%). Gram-negative bacilli of the top five were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Serratia marcescens and Escherichia coli,and the rate of multiple resistant bacteria was relatively high.Staphylococcus aureus were the main Gram-positive cocci, including MRSA accounted for 78.3%(25/32). Conclusion The monitoring of ICU clinical pathogens and their resistance should be strengthened. It is a great significance to use antibiotics rationally according to the results of susceptibility testing, in order to control the occurrence of resistant bacteria , prevent and control hospital infection and infection outbreak.