目的 探讨老年患者在手部静脉输液后用手握塑料输液瓶固定法的效果及患者手部的舒适度。方法 将160例次手部静脉输液患者随即分为试验组和对照组,试验组在静脉穿刺成功固定后再采用手握塑料输液瓶固定法固定手部,对照组在静脉穿刺成功固定后后再采用传统夹板固定法固定手部。结果 试验组患者在静脉输液中手握输液瓶固定的效果和舒适度高于对照组(P<0.05)。结论 手握塑料输液瓶固定法能减少针头移动或滑脱,减少老年患者在长时间输液时的疲劳感,增加舒适感,满意的固定效果有效地保证静脉输液顺利进行,减少重复穿刺,提高患者满意度。

目的 观察对应手术时点小剂量丙泊酚抑制无痛人工流产手术孕者应激反应的有效性。方法 选择门诊自愿在全麻下行无痛人工流产手术的早孕妇女80例,ASAⅠ或Ⅱ级,随机分为前臂头静脉组(A组)、下肢踝前大隐静脉组(B组)。两组早孕者分别在抬臀铺入无菌臀巾时(T₁)、置入窥器即刻(T₂)、钳夹宫颈即刻(T₃)时点,推注不同剂量丙泊酚,观察记录麻醉效果相关指标。结果 A组追加丙泊酚次数与B组相比少(P<0.01),A组丙泊酚用量与B组相比减少(P<0.01),A组术毕到唤醒睁眼的时间与B组相比缩短,差异有统计学意义(P<0.01)。结论 对应手术操作时点经上肢头静脉小剂量推注丙泊酚能较好的抑制无痛人工流产手术孕者应激反应,且苏醒快,并发症少。

目的 了解河源市无偿献血者的人群结构特征及其与血液检测结果的关系,为完善该地区安全血源招募和献血者筛查策略提供依据。方法 收集2014年1月1日—2014年12月31日该市15184例首次无偿献血者登记表及检测结果,统计分析无偿献血者的年龄、性别、职业、文化程度等分布情况及其血液检测结果不合格率。结果 该地区无偿献血者以男性(78.91%)、年龄以35岁以下(63.44%)、在职职员(34.08%)、大学专科以上文化程度(39.59%)为主体;献血模式以个人自愿(53.58%)和团体自愿(38.41%)为主。该市无偿献血者血液检测结果总体不合格率为4.29%,其中不同性别、年龄、职业、文化程度、献血模式的无偿献血者组间不合格率差异有统计学意义(χ²值分别为 19.079、38.103、61.042、41.191、44.079,P值均<0.05);多因素Logistic 回归分析显示性别、年龄、职业、文化程度和献血模式为血液检测结果不合格率的主要影响因素。结论 应根据无偿献血者人群结构特点有效开展献血知识宣传教育,认真做好献血前筛查。

目的 观察有创-无创序贯通气治疗慢性阻塞性疾病(COPD)急性加重并呼吸衰竭的疗效。方法 选取2013年3月—2015年3月在兴宁市人民医院呼吸科收治的COPD急性加重并II型呼吸衰竭、需行机械通气的患者80例,随机进行有创-无创序贯通气治疗组A和单一有创通气治疗组B,两组除了机械通气的方式不同之外,其他的常规治疗均相同,主要观察两组患者进行相关机械通气方式前后的呼吸、循环及血气指标的变化情况以及进行机械通气的总时间和住院时间及呼吸机相关肺炎(VAP)的发生例数。结果 治疗组患者的血气、呼吸及循环内的各项生化指标改善程度均与对照组无统计学意义(P>0.05),同时治疗组患者的VAP的发生率,总的住院时间,进行机械通气的总时间少于对照组患者,有统计学意义(P<0.05)。结论 采用有创-无创序贯通气治疗慢性阻塞性疾病(COPD)急性加重并呼吸衰竭综合治疗效果要好于采用单一有创通气治疗,值得临床推广应用。

目的 动态观察乳腺癌患者辅助内分泌治疗5年后的血脂及肝功能水平的变化,探求辅助内分泌治疗与高脂血症及脂肪肝发病率的关系。方法 56例乳腺癌患者实行辅助内分泌治疗,术后随访5年动态抽血测定其总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL)、高密度脂蛋白胆固醇(HDL)及谷草转氨酶(AST)、谷丙转氨酶(ALT)、直接胆红素(DBIL)、总胆红素(TBIL)等参数的变化,B超监测其肝脏变化。结果 经过2年内分泌治疗TG由(1.203±0.723)mmol/L上升至(1.701±1.271)mmol/L,5年内分泌治疗后TG降至(1.389±0.706)mmol/L。经过2年内分泌治疗LDL由(2.497±0.990)mmol/L上升至(2.950±0.984)mmol/L,5年内分泌治疗后LDL为(2.867±0.886)mmol/L。结论 辅助内分泌治疗2年会导致其TG和LDL的升高,5年随访仅发现LDL升高,辅助内分泌治疗会增加乳腺癌患者诱发心血管疾病的风险。

目的 探讨连续护理在提高乳腺癌保乳患者生存质量中的应用效果,号召我院为病人提供持续性、连续性护理开展APN排班。方法 随机抽取2011年1月—2014年1月我院收治的117例乳腺癌患者的临床资料。观察两组患者术后生存质量、焦虑情况、抑郁情况、术后上肢水肿情况。结果 两组患者术后1周生存质量比较,差异无统计学意义(P＞0.05);观察组术后1个月、3个月、6个月、1年生存质量高于对照组,差异有统计学意义(P＜0.05)。两组患者术后1周焦虑情况比较,差异无统计学意义(P＞0.05);观察组术后1个月、3个月、6个月、1年忧郁情况优于对照组,差异有统计学意义(P＜0.05)。观察组患者术后上肢水肿情况优于对照组,差异有统计学意义(P＜0.05)。结论 连续护理在提高乳腺癌保乳患者生存质量中的应用效果较好,能够改善患者术后生存质量、焦虑抑郁情况、术后上肢水肿情况,值得临床推广。

Objective To explore the effects of continuous nursing intervention on the quality of life for breast cancer patients after breast conserving therapy. Methods 117 cases of patients with breast cancer were randomly divided into observation group(59 cases) and control group(58 cases). The control group were cared by routine postoperative care, including health education. On the basis of the control group, the observation group were cared by continuous nursing intervention, including cognitive intervention, psychological intervention, social support, life care, functional exercise, the prevention of complications and discharge instruction. The quality of life, anxiety situation, depression amd upper limb edema were compared in the two groups. Results There has no significant difference on the quality of life after 1 week in the two groups(P＞0.05); The quality of life after 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). There has no significant difference on the anxiety situation after 1 week in the two groups(P＞0.05); The anxiety situation after 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). The depression situation after 1 week, 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). The upper limb edema situation for the observation group were better than the control group(P＜0.05). Conclusion The effects of continuous nursing intervention on the quality of life for breast cancer patients after breast conserving therapy is good. It can improve the quality of life, situations of anxiety, depression and upper limb edema. It is worthy of clinical promotion.

目的 了解近5年来阴沟肠杆菌在我院的临床分布及耐药性的变迁情况。方法 采用K-B纸片法进行药物敏感性测定,再用双纸片法检测超广普β-内酰胺酶(ESBLs)。结果 2010年1月—2014年12月我院共分离阴沟肠杆菌261株,其中2010年分离48株(18.4%)、2011年50株(19.2%)、2012年52株(19.9%)、2013年54株(20.7%)、2014年57株(21.2株%);主要分布于重症监护室(ICU)、呼吸内科、肝胆外科,分别占49.%(130株)、14.9%(39株)、11.9%(31株),标本来源主要为痰液、尿液及伤口分泌物,分别占52%、13.5%、12.8%,ESBLs菌株的检出率为29.9%(78株),产酶株的耐药性高于非产酶株,全部菌株对亚胺培南敏感。结论 阴沟肠杆菌主要引起呼吸道、尿路和各种伤口感染,多发于ICU患者,并且呈逐年增多趋势,产ESBLs在阴沟肠杆菌中广为流行,合理使用抗菌药物(尤其是第三代头孢菌素)是减少产ESBLs株流行的重要措施。

Objective To investigate the clinical distribution and antimicrobial resistance of infections caused by enterobacter cloacae in our hospital. Methods Antimicrobial susceptibility tests were done by Kirby-Bauer disk diffusion method. The extended-spectrum β-Lactamases (ESLBS) were detected by double disc diffusion test. Results A total of 261 strains of E cloacae were isolated from Jan 2010 to Dec 2014. The percentages of these strains isolated in 2010, 2011, 2012, 2013, 2014 were 18.4%, 19.2%, 19.9%, 20.7%, 21.2% respectively. E cloacae were mainly isolated from intensive care unit (ICU) (49.0%), respiratory medicine (14.9%) and surgery (11.9%) respectively. The percentages of these strains isolated from sputum, urine and wound secretion were 52.0% 13.5% and 12.8% respectively. The percentages of ESBLS producer was 29.9% (78 strains).Their resistance was obviously higher than that of non-ESBLS producer. But all strain were sensitive to imipenem. Conclusion E Cloacae caused infections of respiratory tract, urinary and wound principally in clinic. The most of which occured in ICU. The ESBLS are popular in E cloacae and show the increasing trend year by year. The restricted use of antimicrobial drug is a considerable measure which reduces prevalence of ESBLS producing strains.

目的 探讨分析白带涂片多功能染色技术(BTR 法)在妇科疾病患者中的临床应用价值。方法 选取300 例有明显感染症状的妇科疾病患者取白带,采用BTR 法、盐水法和巴氏染色法进行检测。结果 BTR 法病原体阳性率:滴虫42%、霉菌36.7%、线索细胞17.3%、纤毛菌12%、淋球菌6.7%、球杆菌86%、核异质细胞6.3%和癌细胞2.7%,阴道清洁度95%;阳性率高于盐水法和巴氏染色法,差异有统计学意义(P<0.01);而且BTR法操作简单,耗时少,检出率高,成本低,优于盐水法和巴氏染色法,差异有统计学意义(P<0.01)。结论 BTR 法可在几分钟内检出滴虫性或霉菌性或细菌性阴道炎、宫颈炎、宫颈癌、卵巢癌等异常情况,可提高妇科疾病病原体的检出率,为诊断和治疗提供可靠依据,适用于大型妇科普查和癌症筛查,值得在基层医院推广应用。

Objective To explore and analysis the application of leucorrhea smear multi-function BTR staining techniques(method) in gynecological disease. Methods Leucorrhea were taken in 300 gynecological disease patients with obvious infection symptoms, BTR, saline smear, pap staining were performed at the same sample. Results Pathogene positive rate ofBTR method of trichomonad, mould, clue cell, leptotrichia, gonococci, coccobacillus, dyskaryotic cell, cancer cell and vaginal cleanliness detection rate is 42%,36.7%,17.3%,12%,6.7%,86%,6.3%,2.7% and 95% respectively. The pathogens detection rate of BTR was higher than saline smear, pap staining. It showed statistical difference(P<0.01). BTR method operated simply, timely, low cost, positively than saline smear, pap staining,it showed statistical difference(P<0.01). Conclusion BTR method can detect bacterial vaginitis, colpitis mycotica, cervicitis, cervical carcinoma and ovarian cancer. It can provide reliable evidence for gynecological disease diagnosis and treatment. It can be applied in big gynecological and cancer screening. BTR method is deserved to popularize and apply in primary hospital.

目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.