目的 对我院静脉用药调配中心2017年1月—2019年12月期间的不合理医嘱情况进行汇总及分析,以提高合理用药水平。方法 收集2017年1月—2019年12月广州市第一人民医院静脉用药调配中心的不合理医嘱资料进行回顾性分析,归纳不合理医嘱类型、汇总分析不合理医嘱表现以及改正不合理情况。结果 主要不合理医嘱类型包括溶媒选择错误、溶媒量过多或过少、药物剂量不合理、药物配伍禁忌、其他(用药频次错误、药物选择错误、重复用药等)。结论 根据不合理医嘱情况的汇总分析,及时与临床科室沟通改正,保证合理用药。

Objective To summarize and analyze their rational prescriptions in pharmacy intravenous admixture services(PIVAS)of our hospital from January 2017 to December 2019,so as to improve the level of rational drug use. Methods The data of irrational prescriptions from January 2017 to December 2019 in the pharmacy intravenous admixture services of Guangzhou First People's Hospital were collected for retrospective analysis, and the types of irrational prescriptions were summarized, the performance of irrational prescriptions was analyzed and the irrational situation was corrected. Results The main types of irrational prescriptions include incorrect selection of solvent, improper consumption of solvent, improper drug dosage, incompatibility and others(improper frequency of administration, incorrect selection of drug, repeated administration, etc.). Conclusion According to the summary and analysis of irrational prescriptions, we timely communicate with clinical departments and ensure rational drug use.

目的 分析濮阳市人民医院肺炎克雷伯菌(Klebsiella pneumoniae,K. pneumoniae, KPN) 的临床分布、流行病学特点及耐药情况,以促进临床合理用药。方法 回顾性分析濮阳市人民医院2020年1—3月临床送检标本中分离出的209株肺炎克雷伯菌的分布及耐药情况。结果 临床标本中共分离出肺炎克雷伯菌209株,在肠杆菌科细菌中占比为68.30%;标本来源以痰液、血液和尿液为主,分别占75.11%、9.09%、5.74%;分离菌株数量较多的科室为ICU、神经外科一病区、EICU病区和胸外科病区,分别占比47.37%、 17.7%、3.35%和3.35%。产超广谱β-内酰胺酶(ESBLs)菌株检出率为11.48%,耐碳青霉烯肺炎克雷伯菌(CRKP)检出率为58.37%。不同来源KPN的耐药性具有显著差异, 综合ICU KPN的耐药率高于其他病区。结论 濮阳市人民医院临床分离KPN对常用抗菌药物有一定的耐药性,尤其以综合ICU分离菌株耐药严重,应加强监测KPN耐药情况,有针对性的选择抗菌药物,并增强院感防控,以减轻KPN的耐药情况。

Objective To analyze the characteristic of clinical distribution, epidemiological and drug resistance of Klebsiella pneumoniae (KPN) in the People's Hospital of Puyang City,and to provide evidence for rational use of antimicrobial drugs in clinical treatment. Methods A retrospectively analysis was conducted on 209 strains of KPN isolated from the clinical specimens in the People's Hospital of Puyang City from January 2020 to March 2020. Results A total of 209 strains of KPN were isolated from clinical specimens, accounting for 68.30% of enterobacteriaceae bacteria; the sources of specimen were mainly from sputum, blood and urine, accounting for 75.11%, 9.09% and 5.74% respectively; the departments with more isolated strains were ICU department, neurosurgery first department, EICU department, and thoracic surgery department, accounting for 47.37%, 17.7%, 3.35% and 3.35% respectively. Besides, the detection rate of extended spectrum β-lactamase(ESBLs) strains was 11.48%,and the detection rate of carbapenems-resistant klebsiella pneumoniae (CRKP) strains was 58.37%. The results showed that the drug resistance of KPN from different sources was with a significantly difference, and the drug resistance rate of KPN in comprehensive ICU was significantly higher than that of other departments. Conclusion The resistance of KPN isolated from the People's Hospital of Puyang City to common antibiotics is not optimistic. In particularly, the drug resistance of KPN isolated strains from the comprehensive ICU is more serious. Hence, the monitoring of KPN resistance should be strengthened and the effective prevention and control measures of hospital infection should be adopted. Furthermore, antibacterial drugs should be used rationally to reduce the generation of drug-resistant bacteria.

目的 分析院际转运紫绀型先天性心脏病患儿中的流行病学特征,评价院际转运在患儿救治过程中的作用及效果。方法 回顾性分析2016年1月—2019年12月我院院际转运的145例紫绀型先天性心脏病患儿的性别、年龄、体质量、生命体征、转运期间检测指标、支持治疗等资料。结果 145例紫绀型先天性心脏病男105例,女40例,73.1%(106/145)的转诊患儿是新生儿,59.3%(86/145)的转诊患儿来自三级医院,55.9%(81/145)的转诊患儿转诊距离在200 km以上,仅有10.3%(15/145)的转诊患儿转诊距离在50 km以内。转诊过程中44.1%(64/145)的患儿给予呼吸机辅助通气,33.1%(48/145)的患儿给予吸氧处理,仅22.1%(32/145)的患儿无需呼吸支持,所有患儿安全转运到接诊医院,入院后138例接受外科手术治疗手术康复,7例放弃治疗。结论 安全、有效的院际转运紫绀型先天性心脏病是救治的关键环节,为紫绀型先天性心脏病的救治提供前提。

Objective To analyzed the epidemiological characteristics of interhospital transport of cyanotic congenital heart disease in children and evaluate the effect of interhospital transport on treatment. Methods 145 children with cyanotic congenital heart disease from January 2016 to December 2019 transported in our hospital were analyzed retrospectively. Epidemiological data such as sex, age, weight, vital signs, detection indexes during transport and supportive treatment were collected. Results Among 145 children with cyanotic type of congenital heart disease there were 105 male, 40 female. 73.1% (106/145) children were newborn, 59.3% (86/145) children were from tertiary hospitals, 55.9% (81/145) children were transported over 200 km, only 10.3% (15/145) children were within 50 km. 44.1% (64/145) were given assisted ventilation during transporting, 33.1% (48/145) children were given oxygen treatment, only 22.1% (32/145) of the children did not need respiratory support. All children were transferred to the receiving hospital successfully. After admission, 138 of them received surgical treatment successfully, and 7 of them gave up treatment. Conclusion Safe and effective interhospital transport is the key to treating cyanotic congenital heart disease, which provides the basis for the treatment of cyanotic congenital heart disease.

目的 探讨血培养分离菌的分布特点及耐药性,为临床科室诊治血流感染疾病和控制感染提供重要的参考依据。方法 收集某院2016—2020年血培养阳性样本,采用细菌鉴定和药敏分析系统检测,用WHONET 5.6软件进行病原菌分布特点及药敏结果的整理分析。结果 从血培养阳性标本分离出非重复菌3 424株,主要来自老年病科、危重症监护室、急诊留观室等。其中革兰阴性菌1 873株,常见有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等。近五年超广谱β-内酰胺酶革兰阴性耐药菌呈缓慢上升趋势,其余耐药菌变化趋势不大。革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星等总体耐药率均＜30%。革兰阳性菌1 328株,主要是葡萄球菌属,对达托霉素、替加环素均无耐药,对利奈唑胺、万古霉素、替考拉宁耐药率处于较低水平,对复方新诺明和克林霉素等的耐药率近五年呈缓慢下降趋势。结论 血流感染主要常见分离菌为肠杆菌属和葡萄球菌属,临床应重视早期规范血培养和药敏结果,科学合理规范使用抗菌药。

Objective To investigate the distribution characteristics and drug resistance of isolates from blood culture, and to provide important reference for the diagnosis and treatment of bloodstream infection and infection control in clinical practice. Methods Positive blood culture samples of a hospital from 2016 to 2020 were collected and detected by bacteria identification and drug sensitivity analysis system. The distribution characteristics of pathogenic bacteria and drug sensitivity results were analyzed by WHONET 5.6 software. Results A total of 3 424 non-repeating strains were isolated from positive blood culture specimens, which were mainly from geriatrics department, critical care unit, emergency observation room, etc.Among them, 1 873 strains of Gram-negative bacteria were found, including Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. In recent five years, the extended-spectrum beta-lactamases Gram-negative drug resistant bacteria was slowly increasing, while other drug resistant bacteria showed little change. The overall drug resistance rates of Gram-negative bacteria to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, gentamicin, tobramycin and amicacin were all less than 30%. There were 1 328 Gram-positive strains, mainly Staphylococcus, showed no resistance to datoromycin and tegacycline, and the resistance rates to linezolid, vancomycin and teicolanin were at a low level, while the resistance rates to cotrimoxazole and clindamycin showed a slow declining trend in recent five years. Conclusion Enterobacteria and Staphylococcus were the most common isolates of bloodstream infection. In clinical practice, attention should be paid to the early blood culture and drug sensitivity results, and the antimicrobial drugs should be used scientifically and rationally.

目的 回顾分析2017—2018年汕头中心医院50例腹泻儿童鼠伤寒沙门菌的标本信息及药敏结果, 得出汕头地区这两年鼠伤寒沙门菌感染特性及指导临床合理用药。方法 从腹泻儿童粪便标本中分离沙门氏菌, 采用纸片扩散法检测其对抗菌药物的敏感性, 采用血清学凝集试验沙门氏菌血清型, 记录鉴定为鼠伤寒沙门菌的标本数据进行分析。结果 50例腹泻儿童鼠伤寒沙门氏菌中,易感时间多为夏秋季节;0～1岁为易感人群;感染后多出现发热、腹泻症状,可出现血便症状,较少出现呕吐;鼠伤寒沙门菌对亚胺培南、替加环素、厄他培南有100%的敏感率,对呱啦西林/他唑巴坦、头孢呱酮/舒巴坦有96%和92.68%的敏感率,队阿莫西林/克拉维酸有80.48%的敏感率,对阿米卡星、头孢呋辛酯、头孢呋辛、头孢西丁都为100%耐药,对其他抗生素有不同程度的敏感性及耐药性。结论 在夏秋季节,0～1岁儿童应加强对鼠伤寒沙门菌感染的预防,若出现发热、腹泻症状需及时就医,医生需向鼠伤寒沙门菌的方向考虑治疗,鼠伤寒沙门菌对多抗生素产生耐药性,临床上需根据药敏结果合理使用抗生素。

Objective To retrospectively analyze information and drug susceptibility of 50 cases of Salmonella typhimurium isolated from children with diarrhea in Shantou Central Hospital from 2017 to 2018, and to obtain the characteristics of Salmonella typhimurium infection in Shantou area in the past two years and to guide rational drug use in clinic. Methods Salmonella was isolated from fecal specimens of children with diarrhea. The susceptibility of Salmonella to antimicrobial agents was detected by disk diffusion method. Serological agglutination test was used to determine the serotype of salmonella. Sample data identified as Salmonella typhimurium were recorded and analyzed. Results Among the 50 children with diarrhea, the susceptibility time of Salmonella typhimurium was summer and autumn; the age of 0～1 was susceptible population; fever and diarrhea were common after infection, and hematochezia and vomiting were rare; Salmonella typhimurium had 100% susceptibility to imipenem, tegacycline and ertapenem, 96% and 92.68% to guacillin/tazobactam, cefotaxone/sulbactam. The sensitivity rate of amoxicillin/clavulanic acid was 80.48%. It was 100% resistant to amikacin, cefuroxime axetil, cefuroxime and cefoxitin. It had different sensitivity and resistance to other antibiotics. Conclusion In summer and autumn, children aged 0～1 should strengthen prevention of Salmonella typhimurium infection. If symptoms of fever and diarrhea occur, doctors should consider the direction of Salmonella typhimurium treatment. Salmonella typhimurium is resistant to multi-antibiotics, and rational use of antibiotics in clinic should be based on the results of drug sensitivity.

介绍我院应对新型冠状病毒感染防控工作的护理管理措施,包括发热病区的组建,护理应急队伍的建设,工作流程指引的修订和完善,院感防护措施的严格落实,后勤保障的严密管理等,并进行护理质量控制与持续改进,为其他医院的防控工作提供借鉴。

It introduces nursing management measures of novel coronavirus infection prevention and control in our hospital, including the establishment of fever ward, the construction of nursing emergency team, the revision and improvement of working process guidelines, the strict implementation of hospital sensory protection measures, tight management of logistical support, and quality control and continuous improvement of nursing. It offers experiences for other hospitals.

目的 结合临床现状分析影响护士护患沟通能力的相关因素,并根据影响因素制定相关应对方案。方法 采用《护士临床沟通能力量表》对广州市某三甲医院的941名护士进行调查。结果 护士沟通能力得分为(4.19±0.43)(评分范围为1～5分),其中情感支持能力维度得分最低(4.05±0.37),护士性别、婚姻状况、职称、职务和培训次数不同,其护患沟通能力得分有差异(P<0.05))。结论 护士的情感支持能力有待提高,性别、婚姻状况、职称、职务和接受培训的次数是护患沟通能力的影响因素,管理者应根据护士特征应加强对护士的培训,以提高其护患沟通能力。

Objective Combined with the clinical situation, this paper analyzes the relevant factors that affect the nurse-patient communication ability, and makes relevant countermeasures according to the influencing factors. Methods 941 nurses in a tertiary hospital in Guangzhou were surveyed using the Nurse Clinical Communication Competence Scale. Results The communication competence score of nurses in the hospital was (4.19±0.43) (the score was ranged from 1 to 5), among which nursing staffs' emotional support competence were scored in lowest (4.05±0.37). There was statistically significant in communication competence between nurses with different gender, marital status, job title, position and training times. (P<0.05). Conclusion The emotional support competence of nurses needs to be improved. The gender, marital status, professional title, position and number of trainings are the influencing factors of nurse-patient communication ability. Nursing managers could improve nurses' communication competence by increasing the training of nurses according to their charateristics.

目的 了解我院药品不良反应(ADR)发生的规律和特点,为临床合理用药提供参考。方法 收集广州市第一人民医院南沙医院2015年1月1日—2019年12月31日上报国家药品不良反应监测中心的224例ADR,统计分析发生ADR的患者性别、年龄、药品种类、剂型、给药途径、累及系统等情况。结果 224例ADR报告中,女性报告数(51.79%)高于男性(48.21%),50岁以上的病人报告数占48.6%,其中60岁以上属于高发年龄段(30.8%);抗感染药ADR报告数最多(43.3%),其次是心血管系统用药(12.95%),第三是中枢神经系统用药(12.50%);静脉给药ADR报告数最多(57.14%),其次是口服给药(40.18%),剂型因素中,最高为注射液(32.59%),其次为普通片剂(28.57%),第三位粉针剂(24.55%);ADR累及系统中,皮肤及附件损害最多(26.43%),其次是胃肠系统损害(20.70%)和中枢及外周神经系统损害(18.06%);上报来源以药师上报为主(72.77%),护士上报率为0。结论 临床应加强合理用药,尤其抗菌药物使用,减少静脉给药途径,重点关注50岁以上ADR高发人群,加强ADR监测医护宣教,提高ADR上报率和报告质量。

Objective To investigate the occurrence and distribution of adverse drug reaction ADR from 2015 to 2019 in our hospital and provide relevant information for clinical rational usage of medication. Methods 224 ADR reported to National Center were collected from Nansha hospital of Guangzhou First People's Hospital monitoring during 2015~2019.Those ADR were analyzed in terms of gender and age of patients,type of drugs, route of administration,dosage form,etc. Results Among 224 ADR reports,the occurrence rate of ADR in female(51.79%)was higher than male,patients over the age of 50 accounted for 48.6% and age over 60 were at high risk of ADR.The top three of medicine were anti-infectious agent(43.3%),cardiovascular medicine(12.95%)and central nervous system medication(12.50%). Intravenous administration and oral medication accounted for 57.14%,40.18% respectively.For the dosage form factor,the top three were injection (32.59%), ordinary tablet (28.57%) and powder-injection (24.55%).Major systems involved in ADR were lesion of skin and its appendages(26.43%),gastrointestinal system(20.70%),central and peripheral nervous systems(18.06%).Sources of ADR were mainly composed of pharmacist(72.77%)and the nurse reported 0. Conclusion Clinical rational drug use should be strengthen especially antibacterial agents. The intravenous route should be decreased.Patients over the age of 50 deserved special attention. It is necessary to enhance awareness and education of medical workers to improve the reported rate and quality of ADR.

目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

目的 探讨广州市第一人民医院2008—2019年所有就诊的肿瘤患者的具体情况,研究各类肿瘤的发病趋势和危害程度,为制定预防措施和工作重点提供依据。方法 根据广州市恶性肿瘤病例登记报告系统数据,对2008—2019年在广州市第一人民医院就诊的23 778例肿瘤病例从基本情况、肿瘤部位和随访情况等几方面进行回顾性统计分析。结果 2008—2019年位列前三位的肿瘤分别是结直肠癌、肺癌和肝癌,甲状腺癌占比呈明显上升趋势。30岁以下年龄组肿瘤种类以白血病为主,30～60岁年龄组肿瘤种类以结直肠癌为主,60岁以上年龄组肿瘤种类以肺癌为主。甲状腺癌的预后最好,胰腺癌的预后最差。纯手术组疗效最佳。结论 在广州地区合理优化资源进行重点肿瘤的筛查,才可以有限降低罹患肿瘤的风险,提高肿瘤患者生命质量。

Objective The aims of study were to explore the situation of all patients with cancer in Guangzhou First People's Hospital from 2008 to 2019, to find the incidence trends and hazards of different types of tumors, and to provide evidence for developing preventive measures. Methods According to the data of the Guangzhou tumor case report system, a retrospective statistical analysis was performed on the basic situation, tumor location and follow-up of 23 778 tumor cases in Guangzhou First People's Hospital from 2008 to 2019. Results The top three tumors in 2008—2019 were colorectal cancer, lung cancer and liver cancer. The tumor types under 30 years old were leukemia, the tumor types in the 30-60 age group were colorectal cancer, and the tumor types above 60 years old were mainly lung cancer. The prognosis for patients with thyroid cancer was the best, and the prognosis for patients with pancreatic cancer was the worst. The effect of the operation group was the best. Conclusion Rational optimization of resources for screening key tumors could reduce tumor incidence and improve the quality of life of cancer cases in Guangzhou area.