目的 建立HPLC法测定人血浆中亚胺培南浓度,并基于稳定性试验结果建立临床标本采样流程。方法 以0.01 mol·L^-1乙酸铵缓冲液(pH 6.8)-乙腈(95∶5,V∶V)为流动相,用Agilent Zorbax SB-AQ(4.6 mm×250 mm,5 μm)色谱柱,进样量30 μL,柱温30 ℃,流速1.0 mL·L^-1,紫外检测波长298 nm,分别考察了在不同温度,加入稳定剂等条件下亚胺培南的稳定性。结果 亚胺培南在3.30～105.60 μg·mL^-1线性关系良好(R²=0.999 1),定量下限为0.41 μg·mL^-1,批内回收率在97.83%～103.54%,批间回收率在99.43%～104.24%,日内、日间RSD＜15.0%;在稳定性血浆中,亚胺培南在低温、室温条件下可分别稳定72 h和18 h,在非稳定性血浆中,分别为24 h和6 h。结论 本方法简便、快速、准确,可用于监测亚胺培南浓度,且基于稳定性试验建立临床标本采样流程,能确保血药浓度监测结果准确性。

Objective To determine the concentration of imipenem in human plasma by HPLC method, and establish the sampling process of clinical specimens based on stability investigation result. Methods The mobile phase was consisted of 0.01 mol·L^-1 ammonium acetate buffer(pH 6.8)-acetonitrile(95∶5, V∶V), and using Agilent Zorbax SB-AQ column(4.6 mm×250 mm,5 μm)to investigat the stability of imipenem under different temperature and with or without stabilizer. The injection volume was 30 μL, the colum temperature was 30℃, the flow rate was 1.0 mL·L^-1 and the detection wavelength was 298 nm. Results Imipenem had a good correlation coefficient(R²=0.999 1)at concentration of 3.30-105.60 μg·mL^-1. The lower limit of quantification was 0.41 μg·mL^-1, the intra-batch and inter-batch recovery rate were 97.83%-103.54% and 99.43%-104.24%, the intra-day and inter-day RSD were less than 15.0%. In stabilized plasma, imipenem could maintain stable at low temperature for 72 h and room temperature for 18 h, in non-stabilized plasma for 24 h and 6 h respectively. Conclusions This method was simple, rapid and accurate, which was suitable for the imipenem therapeutic drug monitoring, and establishing the sampling process of clinical specimen based on stability test could ensure the accuracy of plasma concentration monitoring.

目的 分析团体认知行为干预联合揿针全程护理对胃癌晚期癌痛患者心理状态的影响。方法 选取我院115例胃癌晚期癌痛患者(2018年3月—2021年1月),依照干预方案不同分为3组。对照1组(37例)接受团体认知行为干预,对照2组(38例)接受揿针全程护理干预,观察组(40例)接受团体认知行为干预联合揿针全程护理干预,比较3组干预效果。结果 疼痛爆发时疼痛缓解情况:观察组疼痛爆发时疼痛缓解率均较对照1组、对照2组高(P＜0.05);心理状态:干预1个月后,3组心理状态均得到改善,且观察组汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分均较对照1组、对照2组低(P＜0.05);护理满意度:与对照1组、对照2组对比,观察组护理满意度较高(P＜0.05)。结论 团体认知行为干预联合揿针全程护理应用于胃癌晚期癌痛患者,能有效缓解疼痛,改善心理状态,且护理满意度高。

Objective To analyze the effect of group cognitive behavior intervention combined with whole-process nursing of pressing needle on the psychological state of patients with advanced gastric cancer pain. Methods A total of 115 patients with advanced gastric cancer pain in our hospital (from March 2018 to January 2021) were selected and divided into 3 groups according to different intervention methods. Control group 1 (37 cases) received group cognitive behavioral intervention, control group 2 (38 cases) received whole-course nursing intervention of pressing needle, and observation group (40 cases) received whole-process nursing intervention of group cognitive behavioral intervention combined with pressing needle. The intervention effects of the three groups were compared. Results Pain relief when pain burst: the pain relief rate of observation group was higher than control group 1 and control group 2 (P<0.05). Mental state: after 1 month of intervention, the mental state of the 3 groups was improved, and the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the observation group were lower than those in control group 1 and control group 2 (P<0.05). Nursing satisfaction: compared with control group 1 and control group 2, nursing satisfaction of observation group was higher (P<0.05). Conclusions Group cognitive behavior intervention combined with whole-process nursing of pressing needle applied to patients with advanced gastric cancer pain could effectively relieve pain, improve psychological state, and nursing satisfaction.

目的 探讨D-二聚体在急诊胸痛中心早期鉴别诊断急性主动脉综合征(AAS)的重要性,以及讨论如何结合D-二聚体检测优化现有胸痛中心的急救流程。方法 收集近1年来我院胸痛中心收治的50例以胸痛为主诉的患者资料,其中25例最终确诊AAS的患者作为AAS组,以同一时期诊治的25例进行了急诊经皮冠状动脉介入治疗(PCI)确诊的急性非ST抬高型心肌梗死(NSTEMI)患者作为对照组。所有患者在首诊时检测血D-二聚体,通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),分析D-二聚体对AAS与NSTEMI的鉴别诊断价值,并探讨其优化胸痛中心救治流程的实际意义。结果 AAS组D-二聚体水平明显高于NSTEMI组,差异具有统计学意义(P<0.001),且在D-二聚体为89 500 μg/L时取得最佳截止点。结论 对于胸痛患者早期鉴别诊断,D-二聚体具有重要参考价值。

Objective To explore the importance of D-dimer in early differential diagnosis of acute aortic syndrome (AAS) in the emergency chest pain center. And to discuss how to combine D-dimer detection with optimizing the first aid process of existing chest pain centers. Methods The data of 50 patients who complained of chest pain in the chest pain center of our hospital in the past 1 year was collected, including 25 patients who were finally diagnosed as AAS group. Other 25 patients with acute non-ST elevation myocardial infarction (NSTEMI) diagnosed by emergency percutaneous coronary intervention (PCI) were included as control group. Blood D-dimer was detected in all patients at the first visit. By drawing receiver operating characteristic curve (ROC), the value of D-dimer in differential diagnosis between AAS and NSTEMI was analyzed, and the practical significance of optimizing the treatment process of chest pain center was discussed. Results The level of D-dimer in AAS group was significantly higher than that in NSTEMI group (P<0.001), and the best cutoff point was obtained when D-dimer was 895.00 μg/L. Conclusion D-dimer has reference significance for early differential diagnosis of patients with chest pain.

目的 探讨医护合作护理程序教育模式在轻度认知功能障碍血透患者中的应用效果。方法 对65例患者实施医护合作护理程序教育模式,2个月后对患者的健康教育知识掌握程度、自体动静脉内瘘自我护理能力、维持性透析依从性、满意度进行测评。结果 医护合作护理程序教育模式后患者的健康教育知识掌握程度为92.31%、自体动静脉内瘘自我护理能力为27.11±3.26、维持性透析依从性是48.22±4.67、护理满意度是92.31%,均比护理程序教育前提高,护理程序教育前后比较差异均有统计学意义(P＜0.01)。结论 医护合作护理程序教育模式能提高患者的认知能力、自我护理能力和满意度,减少并发症,利于患者生活质量的提高。

Objective To explore the effect of the application of nursing process education model under doctor-nurse cooperation in hemodialysis patients with mild cognitive impairment.Methods 65 patients received nursing process education model under doctor-nurse cooperation. After 2 months, these patients were assessed in terms of the level of knowledge about health education, autologous arteriovenous fistula self-care ability, compliance of maintenance dialysis and satisfaction.Results After the nursing process education model under doctor-nurse cooperation, the percentage of patients who became proficient at knowledge about health education was 92.31%, that of patients who showed autologous arteriovenous fistula self-care ability was 27.11±3.26, that of the patients who became compliant to maintenance dialysis was 48.22±4.67, and nursing satisfaction was 92.31%. These performances improved significantly, comparing to those before the nursing process education model under doctor-nurse cooperation. The differences between before and after the model have statistical significance (P<0.01).Conclusion The nursing process education model under doctor-nurse cooperation may improve patients' cognitive ability, self-care ability and satisfaction. It also reduces complications and helps patients to increase the quality of life.

目的 探究全科诊疗过程中健康管理流程再造的效果。方法 选取深圳市龙岗区第二人民医院(东方半岛社区健康服务中心)的病例,即2015年1月—2015年12月的病例作为对照组(使用旧流程);2016年6月—2017年5月的病例作为观察组(使用新流程),对2组相关数据进行回顾性分析整理,观察2组全科诊疗的健康管理情况并实施比较。结果 观察组全科诊疗人次、妇女儿童保健人数、老年保健人数、新增慢病管理人数、家庭医生签约户数、高危人群早期干预人数等同比增长率均高于对照组,2组比较差异有统计学意义(P<0.05)。结论 全科诊疗过程中健康管理流程再造,能够为更多的居民提供优质健康服务,故对于提高全民健康水平具有重要意义,因而值得临床借鉴应用。

Objective To explore the effect of health management process reengineering on the process of general practice.Methods The cases of Shenzhen Longgang District Second People's Hospital from January 2015 to December 2015 were selected as the control group (using the old process), and that from June 2016 to May 2017 were selected as the observation group (using the new process). The clinical data in the two groups were retrospectively analyzed, and the health management of the two groups of general medical was observed and compared.Results The growth rates in the observation group, such as visits of outpatient service, the numbers of women and children health care, the numbers of elderly health care, the numbers of new chronic disease management, the numbers of family doctors signed and the numbers of early intervention of high-risk groups, were higher than that in the control group (P<0.05).Conclusion The health management process reengineering in the process of general practice may provide better health services to more residents, and it is important for improving the health of all people. It is well worth to clinical reference and application.

目的 探讨分析品管圈在提高腔镜肾癌术后护理流程管理中的应用,以提高肾癌术后患者的存活率也避免术后并发症出现。方法 对我院肾癌术后护理流程管理的现状进行分析,并将目前我院在肾癌术后护理流程管理当中出现的问题进行分析探讨和总结,并制定出详细的工作目标拟定可行的工作计划,并组织人员进行实施,并将实施之后的结果与预期的结果进行对比分析总结。结果 在实施了品管圈活动之后,我院对腔镜肾癌术后护理流程的管理得到了显著的提升,其中人员操作不规范的发生率由实施活动之前的13.2%(5/38)减低到了5.3%(2/38),同时患者发生术后并发症的例数也由之前的7例降低到了3例,结果对比较之前的差异有统计学意义。结论 使用品管圈活动不仅能够有效的提高对腔镜肾癌术后护理流程管理中的效力,而且还能够减少患者术后并发症的发生几率。

        目的   分析刃针联合关节错缝术治疗第三腰椎横突综合征（TLVTPS）的疗效。方法   采用视觉模拟评分法、Oswestry功能障碍指数评分以及腰部活动度，分析2023年1月至10月于广州市第一人民医院就诊的274例TLVTPS患者。其中，对照组（137例）采用刃针治疗，观察组（137例）采用刃针联合关节错缝术，比较两组疗效。结果   观察组的视觉模拟评分（0.46分）和Oswestry功能障碍指数评分（10.32分）低于对照组（P＜0.05）；同时，腰部活动差（53.69 cm）高于对照组（P＜0.05）；此外，痊愈及显效率83.93%（115/137）和总有效率93.42%（128/137）高于对照组（P＜0.05）。结论    刃针联合关节错缝术可有效缓解TLVTPS患者疼痛，改善腰部功能，疗效显著。

       Objective  To analyze the therapeutic effect of blade needle combined with joint misalignment therapy in third lumbar verterbrae transverse process syndrome（TLVTPS）．Methods  This study  retrospectively analyzed 274 TLVTPS patients from January 2023 to October 2023 in Guangzhou First People’s Hospital，using the Visual Analogue Score，Oswestry Disability Index scores，and lumbar range of motion．Among them，the control group（137 patients）were treated with blade needle therapy，while the observation group（137 patients）were treated with blade needle therapy combined with joint misalignment therapy．Results  The Visual Analogue Score（0.46）and Oswestry Disability Index scores（10.32）of the observation group were lower than that of the control group（P＜0.05）．Meanwhile，the lumbar range of motion（53.69 cm）was higher than that of the control group（P＜0.05）．Moreover，the recovery and effective rate was 83.93%（115/137）and the total effective rate was 93.42%（128/137），which were higher than that of the control group（P＜0.05）．Conclusions  The combination of blade needle therapy and joint dislocation manipulation alleviate pain effectively，improve lumbar function，and is clinically effective in patients with TLVTPS．

       目的   研究慢性非特异性腰痛患者腰椎正侧位X线中腰椎侧弯、L1-5棘突偏歪和椎体滑脱情况，总结规律，为慢性非特异性腰痛患者治疗提供依据。方法   选取164例慢性非特异性腰痛患者，观察并记录每例患者腰椎正侧位X线中腰椎侧弯、L1~L5棘突偏歪和椎体滑脱情况。用统计学软件分析腰椎侧弯、棘突偏歪和椎体滑脱情况。结果   共有59例发生腰椎侧弯，占35.98%，其中Cobb角5°~10 °有47例，占28.66%；Cobb角＞10°有12例，占7.32%。腰椎侧弯发病以L4为下端椎为主。以L3为下端椎有12例患者，占20.34%；以L4为下端椎有37例患者，占62.71%；以L5为发椎有10例患者，占16.95%。共119例发生棘突偏歪，占总例数的72.56%。L5棘突偏歪最常见，发生率为57.93%；L4次之，发生率为48.17%。L5棘突偏歪率与L1~L3棘突偏歪率比较差异均有统计学意义（χ ²  分别为14.580，11.771，7.484，P分别为＜0.001，0.001，0.006），但与L4棘突偏歪率比较差异无统计学意义（χ ² =3.124，P=0.077）。共30例患者存在椎体滑脱，占18.29%。L5最常发生滑脱，发生率为8.54%；L4次之，发生率为7.93%。L4与L5椎体滑脱率比较差异无统计学意义（χ ²  =0.040，P=0.841）；L4分别与L1，L2，L3以及L5分别与L1，L2，L3椎体滑脱率差异均有统计学意义（L5与L1、L2、L3：χ ²  分别为14.580、11.771、7.484，P分别为＜0.001、0.001、0.006；L4与L1、L2、L3：χ ²  分别为13.495、10.712、6.550，P分别为＜0.001、0.001、0.010）。结论   慢性非特异性腰痛患者较常发生腰椎侧弯，侧弯以L4为下端椎为主；慢性非特异性腰痛患者较常发生棘突偏歪，L5棘突偏歪最常见，L4次之；L5和L4是慢性非特异性腰痛患者最常发生滑脱的椎体。在治疗慢性非特异性腰痛患者时，与L5和L4相关的肌肉、筋膜等软组织损伤以及关节退行性变或紊乱应引起重点关注。

       Objective  To study the lumbar scoliosis，L1-5  spinous process deviation and  spondylolisthesis in  spine X-ray of patients with chronic non-specific low back pain（CNLBP），and summarizing the existing rules，so as to provide imaging theoretical support for the treatment of CNLBP．Methods  A total of 164 patients with CNLBP were selected．The lumbar scoliosis，L1-5 spinous process deviation and spondylolisthesis were observed and recorded in the anteroposterior and lateral X-ray films of each patient．The lumbar scoliosis，spinous process deviation and spondylolisthesis were statistically analyzed by statistical software．Results  A total of 59 people had lumbar scoliosis，accounting for 35.98%．There were 47 patients with 5°-10° Cobb angle，accounting for 28.66%．There were 12 patients with Cobb angle ＞10°，accounting for 7.32%．L4 was the main lower apical vertebra of lumbar scoliosis．There were 12 patients with L3 as the lower apical vertebra，accounting for 20.34%；37 patients with L4 as the lower apical vertebra，accounting for 62.71%；10 patients with L5 as the lower apical vertebra，accounting for 16.95%．A total of 119 people appeared spinous process deviation，accounting for 72.56%．L5 spinous process deviation was the most common，with proportion of 57.93%，and L4 was the second，with proportion of was 48.17%．The  results of chi-square test showed that there were significant differences between L5 and L1-L3 spinous process deviation（χ ²   was 14.580，11.771，7.484，and P values were ＜0.001，0.001，0.006 respectively），but no significant difference between L5 and L4 spinous process（χ ²  =3.124，P=0.077）．A total of 30 patients had spondylolisthesis，accounting for 18.29%．L5 was the most common of spondylolisthesis，with an occurrence rate of 8.54%．L4 was the second，with an occurrence rate of 7.93%．There was  no significant difference in spondylolisthesis rate between L4 and L5（χ ²  =0.040，P=0.841）．The spondylolisthesis rates of L4 and L5 were significantly different from those of L1，L2 and L3（L5 and L1，L2，L3：χ ²   was 14.580，11.771，7.484，and P values was ＜0.001，0.001，0.006 respectively；L4 and L1，L2，L3：χ ²  was 13.495，10.712，6.550，P values were ＜0.001，0.001，0.010 respectively）．Conclusions  Lumbar scoliosis is more common in patients with CNLBP，and L4 is the main lower apical vertebra of lumbar scoliosis．Patients with CNLBP often have spinous process deviation，and the most common is L5 spinous process deviation，followed by L4．L5 and L4 are the most common vertebrae with spondylolisthesis in patients with CNLBP．The soft injury and joint degeneration or disorder related to L5 and L4 should be paid more attention in the treatment of patients with CNLBP．