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《广州医药》编辑部

广州医药杂志服务号
医院管理

医院药房代煎代送服务的质量控制管理探讨

Discussion on quality control management of hospital pharmacy decoction and delivery services

:1761-1766
 
       目的   探讨医院药房外包代煎代送服务的质量管理。方法   成立中药代煎质量控制管理小组,研究给出完善质量控制体系的策略,涉及建立标准化操作流程、加强人员培训、优化信息化管理系统以及健全监督评估机制。   通过对中药库房的采购、入库验收、在库管理、调剂环节的审方、调剂、煎药质量管理以及物流、发药人员全流程管理,提高了患者的满意度,更多的患者选择了中药代煎服务。结论   实施有效的质量控制措施可提高代煎代送服务的质量,为医院药房提升服务质量给予理论依据与实践指导。
       Objective  To explore quality management of outsourced decoction preparation and delivery services in hospital pharmacies.Methods  A quality control management team for traditional Chinese medicine(TCM)decoction preparation was established to develop strategies for improving the quality control system.These strategies involved establishing standardized operating procedures,strengthening personnel training,optimizing the information management system,and improving the supervision and evaluation mechanism.Results  Through comprehensive process management,covering procurement,warehouse acceptance,inventory management,prescription review in the dispensing stage,dispensing itself,quality control of decoction preparation,logistics,and management of dispensing personnel,patient satisfaction was enhanced,leading more patients to opt for the TCM decoction service.Conclusions  Implementing effective quality control measures can improve the quality of decoction preparation and delivery services,providing a theoretical basis and practical guidance for hospital pharmacies to enhance their service quality.

论著

残余胆固醇对糖尿病合并冠心病患者心力衰竭的预测价值

The predictive value of residual cholesterol for heart failure in patients with diabetes and coronary heart disease

:1745-1753
 
      目的   残余胆固醇(RC)是反映动脉粥样硬化性血脂异常的重要指标,其在糖尿病合并冠心病患者中的临床意义尚不明确。本研究旨在探讨RC水平对糖尿病合并冠心病患者心力衰竭风险的预测价值,并分析其相关性。方法   本研究为回顾性横断面研究,纳入2021年1月—2024年1月期间在鹤壁市人民医院接受诊治的292例糖尿病合并冠心病患者。根据是否存在心力衰竭分为心力衰竭组(128例)和无心力衰竭组(164例)。对基线特征进行比较,采用单因素和多因素Logistic回归分析RC与心力衰竭的相关性。同时,通过限制性立方样条(RCS)分析探讨RC与心力衰竭风险的线性关系,并通过受试者操作特征(ROC)曲线和曲线下面积(AUC)评估RC的预测价值。结果   心力衰竭组患者的男性比例、高血压患病率、RC水平等高于无心力衰竭组,而估算肾小球滤过率水平显著降低(P<0.05)。单因素分析显示,RC>0.7 mmol/L显著增加心力衰竭风险(OR=1.854,95%CI:1.161~2.960,P=0.010)。多因素Logistic回归分析中,全调整模型结果显示,RC作为分类变量时,RC>0.7 mmol/L的患者心力衰竭风险显著增加1.891倍(OR=1.891,95%CI:1.047~3.415,P=0.035);作为连续变量时,RC每增加1单位,心力衰竭风险增加2.464倍(OR=2.464,95%CI1.495~4.064,P<0.001);Log10RC的风险比为6.411(95%CI:2.246~18.302,P=0.001);标化RC的风险比为1.687(95%CI:1.262~2.255,P<0.001)。限制性立方样条分析表明RC与心力衰竭风险呈线性正相关,ROC分析显示RC预测心力衰竭的AUC为0.621(95%CI:0.555~0.687,P<0.001)。结论  RC水平与糖尿病合并冠心病患者心力衰竭风险显著相关,且呈线性正相关。RC具有一定的预测价值,可作为该人群心力衰竭风险评估的潜在指标。
       Objective  Residual cholesterol(RC)is  an important marker  reflecting  dyslipidemia  associated with atherosclerosis.Its clinical significance in patients with diabetes and coronary heart disease(CHD)remains unclear.To explore the predictive value of RC level for the risk of heart failure(HF)in patients with diabetes and CHD and analyze their association.Methods  This retrospective cross-sectional study included 292 patients with diabetes and CHD who were treated at Hebi People’s Hospital between January 2021 and January 2024.Patients were divided into the HF group(128 cases)and the non-HF group(164 cases)based on the presence of HF.Baseline characteristics were compared,and univariate and multivariate Logistic  regression analyses were performed to assess the association between RC and HF.Additionally,restricted cubic spline(RCS)analysis was used to explore the linear relationship between RC and HF risk,and the predictive value of RC was evaluated using receiveroperating characteristic(ROC)curves and the area under the curve(AUC).Results  The HF group had significantly higher proportions of males,hypertension prevalence and RC levels,while estimated glomerular filtration rate were significantly lower compared to the non-HF group(P<0.05).Univariate analysis showed that RC>0.7 mmol/L significantly increased the risk of HF(OR=1.854,95%CI:1.161–2.960,P=0.010).In the fully adjusted multivariate Logistic regression model,RC(RC>0.7 mmol/L)was associated with a 1.891-fold increased risk of HF as a categorical variable(OR=1.891,95%CI:1.047–3.415,P=0.035).As a continuous variable,each increased unit in RC was associated with a 2.464-fold increased risk of HF(OR=2.464,95%CI1.495–4.064,P<0.001).The odds ratios for Log10RC and standardized RC were 6.411(95%CI:2.246–18.302,P=0.001)and 1.687(95%CI:1.262–2.255,P<0.001),respectively.ROC analysis indicated a linear positive association between RC and HF risk(P=0.002).ROC analysis showed that RC had predictive value for HF,with an AUC of 0.621(95%CI:0.555–0.687,P<0.001).Conclusions  RC levels are significantly associated with the risk of HF in patients with diabetes and CHD,demonstrating a linear positive correlation.RC has potential predictive value and may serve as a useful indicator for assessing HFrisk in this population.
论著

广州市某三甲医院老年住院患者服务需求现状及影响因素分析

Current status and influencing factors of elderly patients’ service needs in Guangzhou

:1736-1744
 
       目的   调查老年人照护服务需求现状并分析其影响因素,为构建基于需求为导向的老年照护服务体系提供参考依据。方法  采用便利抽样法,选取广州市某三甲医院212名老年人作为调查对象,采用日常生活能力量表、Fried衰弱评估量表及自行编制的老年人需求评估问卷进行调查。结果   老年人对运动与营养(1.96±0.90分)、心理慰藉(2.63±0.85分)、安宁服务(2.73±1.07分)的需求水平较高。多因素线性回归分析结果显示养老方式、日常生活活动能力、爱好数量、性别、衰弱等级、有无主要照顾者是照护服务需求的影响因素(P均<0.05),可解释61.5%的变异量。   老年人的照护服务需求受多种因素的影响。应根据老年人的不同特征,构建供需匹配的多元化,多层次照护体系。
       Objective  To investigate the status quo of care service needs of the elderly and analyze its influencing factors,so as to provide a reference for the construction of a needs-oriented care service system for the elderly.Methods  A total of 212 elderly people from a tertiary hospital in Guangzhou were selected by convenience sampling method and investigated with the Activity of Daily Living scale,Fried frailty scale and the self-designed elderly needs assessment questionnaire.Results  Elderly patients had higher demands for exercise,nutrition,psychological comfort and hospice services.The results of multivariate analysis showed that the influencing factors of care service demand included pension style,activities of daily living,number of hobbies,gender,frailty level,and having main caregivers(all P<0.05),which could explain 61.5% of the variation.Conclusions  The care needs of elderly patients are affected by many factors.A diversified and multi-level care system with matching supply and demand should be constructed according to the different characteristics of the elderly.
论著

认知行为疗法联合治疗性沟通对 ESD 术后患者心理及治疗依从性的效果

Effect of cognitive behavioral therapy combined with therapeutic communication on psychological health and therapy compliance of ESD patients

:1730-1735
 
       目的   探究认知行为疗法联合治疗性沟通在对内镜黏膜下剥离(ESD)术患者心理及治疗依从性的效果。方法   前瞻性选取2023年3月至2025年3月鹰潭市一八四医院收治的122例行ESD术的患者作为研究对象,采用随机数字表法将患者分为A、B组,B组56例患者采取治疗性沟通干预,A组66例患者采用认知行为疗法联合治疗性沟通干预,两组均连续干预2个月。比较两组患者干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分、心理弹性量表(CD-RISC)评分、Herth希望指数量表(HHI)评分差异,对比两组干预依从性。结果   干预后,两组SAS、SDS评分均下降且A组低于B组(t分别为12.096、10.326,P<0.05);干预后,两组CD-RISC量表各项评分均提高且A组高于B组(t分别为18.483、12.060、13.622,P<0.05);干预后,两组HHI量表各项评分均上升且A组高于B组(t分别为1.289、11.568、12.527、13.794,P<0.05);A组患者总依从率96.97%(64/66)高于B组80.36%(45/56)(χ 2 =8.782,P<0.05)。论   认知行为疗法联合治疗性沟通在ESD术患者中干预效果理想,能够明显改善患者负性情绪,提高心理弹性及对疾病康复的希望水平,有效提升依从性。
       Objective  To explore the effect of cognitive behavioral therapy combined with therapeutic communication on psychological  health and therapy compliance of patients undergoing endoscopic submucosal dissection(ESD).Methods  Prospectively,122 patients who underwent ESD at Yingtan 184 Hospital from March 2023 to March 2025 were selected as the research subjects.These patients were randomly divided into Group A and Group B using the random number table method,and 56 patients in group B were treated with therapeutic communication,66 patients in group A were treated with cognitive behavioral therapy combined with therapeutic communication,and both groups were continuously intervened for 2 months.The  scores of Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Connor-Davidson Resilience Scale(CD-RISC)and Herth Hope Index(HHI)were compared between the two groups before and after treatment.Therapy compliance between the two groups was compared.Results  After treatment,the SAS and SDS scores of the two groups were decreased,and the scores of group A was lower than that of group B(t=12.096,10.326,P<0.05)after the intervention,the scores of the CD-RISC scale of the two groups were improved,and the score of group A was higher than that of group B(t=18.483,12.060,13.622,P<0.05).After intervention,the scores of HHI scale in both groups increased and score of group A was higher than that ofgroup Bt=11.289,11.568,12.527,13.794,P<0.05).The total compliance rate of patients in group A was 96.97%(64/66),which was significantly higher than 80.36%(45/56)in group B(χ 2 =8.782,P<0.05).Conclusions  Cognitive-behavioral therapy combined with therapeutic communication has an ideal effect in ESD patients,which can significantly improve patients’ negative emotions,psychological resilience and hope for disease recovery,and also therapy compliance.
论著

经颅多普勒超声参数联合屏气指数对 ICA 狭窄或闭塞所致急性脑梗死的评估价值

The evaluation value of transcranial Doppler ultrasound parameters combined with breath holding index for acute cerebral infarction caused by ICA stenosis or occlusion

:1724-1729
 
       目的   探讨经颅多普勒超声(TCD)参数联合屏气指数在颈内动脉(ICA)狭窄或闭塞所致急性脑梗死的评估价值。方法   选择2022年1月—2024年12月,在广州市花都区人民医院连续入组发病72 h内ICA狭窄或闭塞所致的急性脑梗死患者。记录患者人口统计学资料、临床资料及TCD相关参数,包括搏动指数(PI)、阻力指数( RI)、大脑中动脉平均血流速度(Vm)及屏气指数等。依据患者数字减影血管造影(DSA)结果分为侧支循环良好组及侧支循环不良组。比较两组人口统计学、临床资料及TCD相关参数,采用单因素分析、多因素Logistic回归分析及ROC曲线。结果   共纳入ICA狭窄或闭塞所致急性脑梗死共136例,其中侧支循环良好组46例,侧支循环不良组90例。单因素分析提示:侧支循环良好组与侧支循环不良组在PI[0.95(0.80,1.03)vs 1.01(0.88,1.13)]、RI[0.58(0.51,0.62)vs 0.60(0.54,0.65)]、Vm[57(44,65)vs 50.5(41,63)]及屏气指数[0.78(0.75,0.85)vs 0.72(0.59,0.79)]方面,差异具有统计学意义(P<0.05)。多因素Logistic回归分析提示Vm(OR=1.029,95%CI:1.006~1.053,P=0.014)、屏气指数(OR=723.401,95%CI:14.524~3 6031.859,P<0.001)是侧支循环不良的独立危险因素。屏气指数和Vm评估侧支循环情况的ROC曲线下面积(AUC)分别为0.713(95%CI:0.627~0.799)和0.605(0.505~0.705),两者的AUC值比较差异无统计学意义(P0.05)。结论   屏气指数和Vm可以评估ICA狭窄或闭塞所致急性脑梗死的侧支循环,屏气指数和Vm的评估效能相当。
       Objective  To explore the evaluation value of transcranial Doppler ultrasound(TCD)in acute cerebral infarction caused by internal carotid artery(ICA)stenosis or occlusion.Methods  From January 2022 to December 2024,patients with acute cerebral infarction caused by ICA stenosis or occlusion within 72 hours of onset were enrolled in our hospital.Patient’s demographic data,clinical data,and TCD related parameters,including pulsatility index(PI),resistance index(RI),average blood flow velocity(Vm)of the middle cerebral artery,and breath holding index(BHI)were recorded.According to the results of digital silhouette angiography(DSA),patients were divided into good collateral group and poor collateral group.Demographic,clinical data,and TCD related parameters were compared between two groups using univariate analysis,multivariate Logistic regression analysis and ROC curve.Results  A total of 136 cases of acute cerebral infarction caused by  ICA stenosis or occlusion were included,including 46 cases in the collateral good group and 90 cases in the collateral poor group.Univariate analysis showed that the good collateral group and the poor collateral group were different in PI(0.95[0.80,1.03]vs 1.01[0.88,1.13]),RI(0.58[0.51,0.62]vs 0.60[0.54,0.65]),Vm(57[44,65]vs 50.5[41,63]),BHI(0.78[0.75,0.85] vs 0.72[0.59,0.79])(P<0.05).Multivariate Logistic regression analysis showed that Vm(OR=1.029,95%CI:1.006-1.053,P=0.014)and BHI(OR=723.401,95%CI:14.524-36 031.859,P<0.001)were independent risk factors for collateral circulation disorders.The area under the ROC curve(AUC)for predicting collateral circulation using BHI and Vm were 0.713(95%CI0.627~0.799)and 0.605(0.505~0.705),respectively.There was no statistically significant difference in AUC values between the BHI and Vm.Conclusions  The BHI and Vm can predict the collateral circulation of acute cerebral infarction caused by ICA stenosis or occlusion,and their predictive power is comparable.
论著

经皮冠状动脉介入治疗后恐动症患者不良心理健康状态的影响因素分析

Analysis of the influencing factors of adverse psychological health status in patients with kinesiophobia after percutaneous coronary intervention

:1712-1723
 
       目的   识别经皮冠状动脉介入治疗(PCI)后恐动症患者抑郁、焦虑和压力的影响因素。方法   采用横断面研究,纳入780例行PCI术后恐动症患者。应用系列量表评估恐动症患者的不良心理健康状况、生活质量、自我感受负担、社会支持和运动自我效能,并通过问卷收集了患者的社会人口学数据。线性回归和Logistic回归用于识别抑郁、焦虑和压力等不良心理状态的影响因素,应用中介分析探索潜在的中介机制。结果  271例(34.7%)、304例(39.0%)和153例(19.6%)恐动症患者存在不同程度的抑郁、焦虑和压力。恐动症患者的抑郁、焦虑和压力水平呈正相关。线性回归和Logistic分析结果表明,较高的家庭月收入与较高的抑郁水平相关(线性回归:β为0.908和1.937;Logistic:OR2.05和5.47),社会支持程度与抑郁水平呈负相关(线性回归:β=-0.079;Logistic:OR=0.93)。单身/离异/寡居患者的焦虑水平显著高于已婚患者(线性回归:β=1.613;Logistic:OR=2.28)。与家庭月收入低于5 000元者相比,家庭月收入为5 000~10 000元之间的患者的压力水平较高(线性回归:β=1.065;Logistic:OR=3.14)。此外,自我感受负担较重的患者具有更高的压力水平(线性回归:β=0.077;Logistic:OR=1.05)。中介分析结果表明,焦虑和压力是社会支持/自我感受负担与抑郁之间关联的潜在中介因子。结论  PCI术后恐动症患者广泛存在心理健康问题,其家庭月收入、年龄、婚姻状况、生活方式和病史等因素对患者的不良心理健康状态具有显著影响。医务人员应关注这些患者的心理健康状况及影响因素,制定综合管理策略以改善其预后。
       Objective  To identify the risk factors associated with depression,anxiety  and  stress in  patients with kinesiophobia after percutaneous coronary intervention(PCI).Methods  In this cross-sectional study,780 patients who developed kinesiophobia after undergoing PCI were enrolled.A series of scales were used to assess the psychological health status,quality of life,self-perceived burden,social support,and exercise self-efficacy of patients with kinesiophobia,and socio-demographic data of the patients were collected through a questionnaire.Linear regression analyses and Logistic regression analyses were used to identify risk factors of adverse psychological outcomes,including depression,anxiety,and stress.Furthermore,mediation analysis was employed to explore the potential mediating mechanisms.Results  Among the 780 patients with kinesiophobia,271(34.7%),304(39.0%)and 153(19.6%)were found to have varying degrees of depression,anxiety,and stress,respectively.The levels of depression,anxiety and stress in patients with kinesiophobia were positively correlated with each other.The results of both linear regression and Logistic regression analyses indicated that higher levels of family monthly income were associated with higher levels of depression(linear:β=0.908 and 1.937;Logistic:OR=2.05 and 5.47),while the degree of social support was negatively correlated with depression levels(linear:β=-0.079;Logistic:OR=0.93).For patients who were single,divorced or widowed,their levels of anxiety were significantly higher than those of married patients(linear:β=1.613;Logistic:OR=2.28).Compared to patients with a monthly household income of less than 5 000 yuan,those with a monthly income between 5 000 and 10 000 yuan reported higher levels of stress(linear:β=1.065;Logistic:OR=3.14).Additionally,patients who perceived a higher personal burden also experienced greater stress(linear:β=0.077;Logistic:OR=1.05).Mediation analysis indicated that anxiety and stress were potential mediating factors in the relationship between social support/self-perceived burden and depression.Conclusions  This study  reported the widespread psychological health issues among patients with kinesiophobia after PCI and the interactions between these issues.Factors such as monthly household income,age,marital status,lifestyle and medical  history were found to  be significantly associated with these negative psychological outcomes.Clinicians and nurses should focus on the psychological health and influencing factors of these patients and develop comprehensive management strategies to improve their prognosis.
论著

急性 DVT 患者 CDT 治疗中血管导管相关感染危险因素及病原菌分析

Risk factors and pathogens analysis of vessel catheter associated infection in acute DVT patients undergoing CDT treatment

:1705-1711
 
       目的   通过对急性深静脉血栓形成(DVT)患者经导管接触性溶栓治疗(CDT)中,影响血管导管相关感染(VCAI)危险因素及病原菌分析,为VCAI的预防提供合理、有效的措施。方法   收集2019年1月—2022年12月徐州市肿瘤医院介入科行CDT治疗的急性DVT患者的临床资料,回顾性调查患者诊疗相关资料及血培养结果,并对发生VCAI和病原菌情况进行分析。结果   本研究共调查急性DVT行CDT治疗的患者437例,发生VCAI的患者共21例,千日感染率为0.543‰。多因素Logistic回归分析结果显示:溶栓频率>3次/天[OR=3.49(95%CI:1.86~6.45)]、导管留置时间>7 dOR=3.86(95%CI:1.26~10.18)]和有导管回送[OR=8.67(95%CI:4.83~12.65)]是患者发生VCAI的危险因素(P<0.05)。发生VCAI的21例患者,血培养共培养出24株病原菌,有3例患者出现复合病原菌感染情况。其中以革兰阳性球菌最为常见,共培养出13株,占比54.17%,革兰阴性菌9株,占比37.5 %。结论   导管留置时间>7 d、溶栓频率>3次/天和有导管回送是急性DVT患者CDT治疗中发生VCAI的危险因素。VCAI的病原菌以单一病原菌为主,可合并其他病原菌感染,其中以革兰阳性球菌为主。
        Objective  By analyzing the risk factors and pathogens of vessel catheter associated infection(VCAI)in patients with acute deep vein thrombosis(DVT)undergoing catheter directed thrombolysis(CDT),to provide  reasonable and effective measures for the prevention and treatment of VCAI .Methods  Clinical data of patients undergoing CDT treatment for acute DVT in the interventional department of the hospital from January 2019 to December 2022 was collected,patient diagnosis and treatment related data and blood culture results were retrospectively investigated and organized,and the occurrence of VCAI and pathogenic bacteria was statistically analyzed.Results  This study investigated 437 patients undergoing CDT treatment for acute DVT,and a total of 21 patients developed VCAI,with an infection rate of 0.543‰.The  results of multiple Logistic  regression analysis show that thrombolysis frequency>3 times/day(OR=3.49[95%CI:1.86-6.45]),catheter retention days>7 daysOR=3.86[95%CI:1.26-10.18]),and the presence of catheter return(OR=8.67[95%CI:4.83-12.65]) were risk factors for the occurrence of VCAI in patients.Among the 21 patients with VCAI,a total of 24 strains of pathogenic bacteria were discoveredin blood culture,and 3 patients developed composite pathogen infections.Among them,Gram  positive cocci were the most common,with a total of 13 strains cultured,accounting for 54.17%,9 strains of Gram negative bacteria,accounting for 37.5%.Conclusions  The duration of catheter retention>7 days,thrombolysis frequency>3 times/day,and the presence of catheter return are risk factors for VCAI in acute DVT patients undergoing CDT treatment.The pathogen of VCAI is mainly single pathogen,which can be combined with other pathogens,among which Gram positive cocci are the main pathogen.
论著

一种保护型的上肢约束衣在儿童洗胃中的应用

Application of a protective upper extremity restraint garment in children's gastric lavage

:1700-1704
 
      目的 探讨一种保护型的上肢约束衣在儿童洗胃中的应用。方法   自制并获得实用新型专利“一种保护型的上肢约束衣”,包括背单和两条前襟连接单,三条可调节性约束带,以及下肢延伸固定。选取2023年1月—2023年12月在我院急诊科因急性中毒施行洗胃的患儿为研究对象,依据住院时间,将2023年1月—2023年6月收治患儿为对照组(58例),将2023年7月一2023年12月收治患儿为观察组(58例)。观察组使用本研究发明的保护型上肢约束衣进行约束,对照组则采用传统的约束方法。对两组患儿的洗胃时间、协助人员数量和重复置管次数进行了记录和比较。结果   观察组协助洗胃人数、洗胃时间、重复置管次数分别为1.00(1.00,1.00)人、28.00(26.00,32.00)min、0.00(0.00,0.00)次,均低于对照组的3.00(3.00,3.00)人、32.00(29.00,35.25)min、0.00(0.00,0.00)次,差异有统计学意义(P<0.05)。结论   儿童洗胃中应用保护型上肢约束衣,能显著减少协助洗胃人数和重复置管次数,缩短洗胃时间,提高了洗胃效率。
       Objective  To explore the application of a protective upper extremity restraint in gastric lavage in children.Methods  A new patent for“A protective upper extremity restraint garment” was designed,which includes a back sheet and two front-flap connecting sheets,three adjustable restraint bands,and an extension fixation of lower extremity.From January 2023 to December 2023,children who underwent acute gastric lavage due to accidental ingestion in the emergency department of a hospital were selected as the research subjects,according to the admission date,the control group(58 cases)was selected from January 2023 to June 2023,and the observation group(58 cases)was selected from July 2023 to December 2023.The observation group was restrained by the protective upper extremity restraint garment,while the control group was restrained by the traditional restraint method.The time of gastric lavage,the number of assistants and the times of repeated intubation were recorded and compared between the two groups.Results  The gastric lavage assistance,lavage time,and number of repeated intubations in the observation group were 1.00[1.00,1.00]person,28.00[26.00,32.00]min,and 0.00[0.00,0.00]times,lower than in the control group(3.00[3.00,3.00]person,32.00[29.00,35.25]min,0.00[0.00,0.00]times),the differences were statistically significant(P<0.05).Conclusions  The application of a protective upper extremity restraint suit during pediatric gastric lavage significantly reduces the number of required assistants,decreases repeated intubation attempts,shortens lavage time,and enhances procedural efficiency.
论著

2014—2023 年广西某三级综合医院法定传染病疫情分析

Analysis of notifiable infectious diseases in a class Ⅲ general hospital in Guangxi from 2014 to 2023

:1693-1699
 
       目的   对2014—2023年广西梧州市某三级综合医院法定传染病疫情及流行病学特征进行分析,为地市级医院制定传染病防控策略提供科学依据。方法   采用描述性流行病学方法和Excel软件对该院法定传染病报告数据进行统计分析。结果  2014—2023年该院共报告法定传染病29 569例,其中,无甲类传染病报告,乙类传染病12 375例(41.85%),丙类传染病15 479例(52.35%),其他需监测报告的传染病1 715例(5.80%)。报告病例数排前4位的传染病依次为手足口病6 726例(22.75%)、感染性腹泻病6 451例(21.82%)、病毒性肝炎5 539例(18.73%)、肺结核3 552例(12.01%)。报告病例数在2014—2017年逐年增加,2017—2023年传染病报告病例降升交替,每年发病高峰期主要集中在5—10月;男性报告病例多于女性,男女之比为1.64∶1;0~10岁年龄段病例最多(46.89%),其次为40~60岁(26.91%);职业分布集中于散居儿童(33.90%)、农民和牧民(18.08%)、工人和民工(9.47%)及幼托儿童(8.48%);患者主要来自梧州市(79.17%)、广东省(17.34%)。传播途径构成比从高到低依次为肠道传染病(46.38%)、呼吸道传染病(26.03%)、血液及性传播传染病(24.92%)、其他传染病(2.66%)。结论  手足口病、感染性腹泻、病毒性肝炎、肺结核是该院传染病防治工作的重点,其中尤其要注重儿童手足口病和感染性腹泻病的预防,根据不同季节、疾病流行趋势,采取有针对性的传染病防控策略。
       Objective  To analyzed the epidemic and epidemiological characteristics of notifiable infectious diseases in a class Ⅲ general hospital in Guangxi Wuzhou from 2014 to 2023,to provide scientific basis for municipal hospitals to formulate infectious disease prevention and control strategies.Methods  Descriptive epidemiological method and Excel were used to sort out and analyze the data.Results  From 2014 to 2023,there were 29 569 cases of notifiable infectious diseases,with category B infectious diseases 12 375 cases(41.85%),category C infectious diseases 15 479 cases(52.35%),and others diseases 1 715 cases(5.80%).No category A infectious diseases were reported.The top 4 infectious diseases were 6 726 cases of hand-foot-and-mouth disease(HFMD)(22.75%),6 451 cases of infectious diarrhea(21.82%),5 539 cases of viral hepatitis(18.73%)and 3 552 cases of tuberculosis(12.01%).The number of reported cases increased year by year from 2014 to 2017,and the reported cases of infectious diseases decreased and increased alternately from 2017 to 2023,with the annual peak period mainly presented from May to October.Males reported cases were more than females,the ratio of males to females was 1.64∶1.The number of cases between 0 to 10 years old was the highest(46.89%),followed by 40-60 years old(26.91%).The occupational distribution was concentrated in scattered children(33.90%),farmers and herdsmen(18.08%),workers and migrant workers(9.47%)and children in childcare(8.48%).The patients were mainly from Wuzhou City(79.17%)and Guangdong Province(17.34%).The composition ratio of transmission route from high to low was as follows:intestinal infectious diseases accounted for 46.38%,respiratory tract infectious diseases accounted for 26.03%,blood-borne and  sexually transmitted infectious  diseases accounted for 24.92%,and other infectious diseases accounted for 2.66%.Conclusions  HFMD,infectious diarrhea,viral hepatitis and tuberculosis are the focus of the hospital’s infectious disease prevention and control work,especially the prevention of HFMD and infectious diarrhea in children,and the prevention and control strategies of infectious diseases are adopted according to different seasons and epidemic trends.
论著

慢性阻塞性肺疾病急性加重期血嗜酸性粒细胞比例、血清IL-5 水平与肺功能的相关性

Correlation between blood eosinophils ratio,serum IL-5 levels,and pulmonary function during acute exacerbation of chronic obstructive pulmonary disease

:1684-1692
 
       目的   探讨慢性阻塞性肺疾病急性加重期血嗜酸性粒细胞(EOS)、血清白细胞介素-5(IL-5)水平与第一秒用力呼气容积(FEV1)、第一秒用力呼气容积与用力肺活量的比值(FEV1/FVC)、用力肺活量(FVC)的相关性。方法   纳入2023年3月—2024年3月于佛山市顺德区第五人民医院住院的73例慢性阻塞性肺疾病急性加重期患者,以2%作为外周血EOS比例(EOS%)截断值分为两组,研究组(EOS%≥2%)34例,对照组(EOS%<2%)39例,收集两组患者的一般临床资料、实验室检查结果、肺功能检查结果(FEV1、FVC、FEV1/FVC),比较组间差异,分析指标间的相关性。结果   对照组与实验组患者EOS%分别为0.5(0.1,0.9)%、5.15(2.60,10.05)%,两组患者EOS%差异有统计学意义(P<0.05)。对照组与实验组患者IL-5水平分别为0.98(0.56,1.78)ng/L、3.6(1.73,6.77)ng/L,两组IL-5水平差异有统计学意义(P<0.05)。对照组FEV1(L)、FVC(L)、FEV1/FVC水平分别为1.32(1.18,1.58)、2.07(1.92,2.62)、0.62(0.57,0.67);实验组分别为1.24(1.00,1.52)、2.22(1.94,2.56)、0.58(0.47,0.67),两组FEV1、FVC、FEV1/FVC水平差异均无统计学意义(P>0.05)。Spearman等级相关检验结果显示,EOS%与IL-5水平呈正相关(rs=0.870,P<0.001);按组别进行分层后结果显示,对照组、试验组EOS%与IL-5水平均呈正相关(rs=0.820,P<0.001;rs=0.938,P<0.001)。EOS%、IL-5水平与FEV1、FEV1/FVC呈负相关(P<0.05),与FVC不相关(rs=0.039,P>0.05)。对照组EOS%、IL-5水平与FEV1、FEV1/FVC、FVC不相关(P>0.05);实验组EOS%、IL-5水平与FEV1、FEV1/FVC呈负相关(P<0.05),与FVC不相关(P>0.05)。结论 慢性阻塞性肺疾病急性加重期血EOS%与血清IL-5水平呈正相关,外周血EOS%≥2%时血EOS%、血清IL-5与FEV1、FEV1/FVC呈负相关,与FVC无关。
       Objective  To explore the correlation among blood eosinophil levels,serum interleukin-5(IL-5)levels,and forced expiratory volume in one second(FEV1),the ratio of forced expiratory volume in one second to forced vital capacity(FEV1/FVC),and forced vital capacity(FVC)during the acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods  From March 2023 to March 2024,73 patients hospitalized for AECOPD at Shunde District Fifth People’s Hospital of Foshan City were included,and divided into two groups based on a cutoff value of 2% for peripheral blood eosinophil(EOS%).The experimental group(EOS%≥2%)included 34 patients,while the control group(EOS%<2%)included 39 patients.General clinical data,laboratory test results,and pulmonary function test results(FEV1,FVC,FEV1/FVC)were collected from both groups.Results  The median quartiles of EOS% for the control group and experimental group were 0.5(0.10.9)% and 5.15(2.60,10.05)%,respectively.There was a statistically significant difference between the EOS% of two groups(P0.05).The median quartiles of IL-5 levels for the control group and experimental group were 0.98(0.56,1.78)ng/L and 3.6(1.73,6.77)ng/L,respectively.There was also a statistically significant difference in IL-5 levels between the two groups(P0.05).For the control group,the median quartiles of FEV1,FVC,and FEV1/FVC were 1.32(1.18,1.58),2.07(1.92,2.62)and 0.62(0.57,0.67),respectively.For the experimental group,they were 1.24(1.00,1.52),2.22(1.94,2.56)and 0.58(0.47,0.67)respectively.There was no statistically significant difference between the two groups in FEV1,FVC and FEV1/FVC levels(P<0.05).Spearman rank correlation analysis showed a positive correlation between EOS% and IL-5 level (rs=0.870,P<0.001).Stratified by group,both the control and experimental groups showed a positive correlation between EOS% and IL-5 level (rs=0.820,P0.001;rs=0.938,P<0.001).There was a negative correlation between EOS%,IL-5 level,and FEV1,FEV1/FVC(P<0.05),but no correlation with FVC(P>0.05).In the control group,there was no correlation between EOS%,IL-5 level,and FEV1,FEV1/FVC,or FVCP>0.05).In the experimental group,there was a negative correlation between EOS%,IL-5 level,and FEV1,FEV1/FVC(P<0.05),but no correlation with FVC(P>0.05).Conclusions  During AECOPD,blood EOS% is positivelycorrelated with serum IL-5 levels.When peripheral blood eosinophils are ≥2%,blood EOS%,serum IL-5,and FEV1,FEV1/FVC are negatively correlated,while there is no correlation with FVC.
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