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 探讨A超和IOL Master测量人工晶状体度数的精确性,为白内障手术提供客观的临床数据。方法 选取300例300眼老年性白内障患者,术前采用A 超和IOL Master测量眼轴长度、自动验光仪测量角膜曲率,A超组利用自动验光仪的角膜曲率数据,IOL Master组利用仪器自带的角膜曲率数据,均使用SRK-T公式计算需要植入的人工晶状体度数,观察术后3 m的屈光状态,使用自动验光仪检测患者屈光状态并分析。结果 所有被列入研究的患眼随机分为A超组和IOL Master组, A超组测得的平均眼轴长度为(23.21±0.59)mm,IOL Master组测得的眼轴长度为(23.22±0.59)mm,两组数据对比差异无统计学意义(P>0.05);利用自动验光仪测量的术前平均角膜曲率为(44.01±1.79)D,利用IOL Master测量的术前平均角膜曲率为(44.13±1.62)D,两者比较差异无统计学意义(P＞0.05);A超组和IOL Master组术后的平均绝对屈光误差(mean absolute refractive error,MAE)分别为(0.43±0.26)D、(0.42±0.17)D,两组比较差异无统计学意义(P>0.05)。结论 IOL Master在操作上略优于A超,但在人工晶体度数测量上与A超比较没有发现明显优势,不能完全取代A超,两者结合更能确保人工晶体度数测量的精确性。

Objective By discussing the accuracy of A-scan and IOL Master in intraocular lens power measurement, to offer Objective clinical data for cataract surgery.Methods Three hundred patients(300 eyes)with age-related cataract were included in the study. Before surgery,axial length was measured by A-scan and IOL Master respectively and corneal curvature was measured by auto refractometer. A-scan group used the corneal curvature data of the auto refractometer. IOL Master group used the corneal curvature data from the instrument. Intraocular lens power was calculated according to the SRK-T formula.We observed the refractive state of 3m after operation, detected and analyzed the patient's refractive data by the auto refractometer.Results All patients who were included in the study were randomly divided into A-scan group and IOL Master group.The mean axial length was (23.21±0.59) mm measured by A-scan, the mean axial length was (23.22±0.59) mm measured by IOL Master. There was no significant difference between them (P>0.05). The preoperative mean corneal curvature measured by the auto refractometer was (44.01±1.79)D. The preoperative mean corneal curvature measured by IOL Master was (44.13±1.62)D. There was no statistically significant difference between them (P＞0.05). The mean absolute refractive error ( MAE) in A－scan group was (0.43±0.26)D and in IOL Master group was (0.42±0.17)D. There was no statistically significant difference between them (P＞0. 05).Conclusion IOL Master group operated slightly better than A-scan group, but we did not find a significant advantage in intraocular lens power measurement with A-scan group. IOL Master may not completely replace A-scan. The combination of the two ensures the accuracy of the measurement in intraocular lens power.

目的 探讨Cockcroft-Gault公式(CG公式)以及中国人MDRD公式(c-MDRD)在狼疮(SLE)患者肾小球滤过率(GFR)评估中的作用。方法 本研究纳入193名SLE患者。测量肾小球滤过率(mGFR)、血清肌酐(SCr),根据cMDRD公式,以及C-G公式分别得出估算肾小球滤过率(eGFR)。从不同方面对eGFR进行评估。结果 193名患者中, mGFR中位值为75.01 mL/(min·1.73 m²),eGFR-CG中位值70.22 mL/(min·1.73 m²),eGFR-cMDRD中位值70.67 mL/(min·1.73 m²)。患者分为mGFR≥60/(n=108)和mGFR<60 mL/(min·1.73 m²)(n=85)。对于总体病人而言, CG和 c-MDRD偏差值分别为0.64和3.91 mL/(min·1.73 m²)。在精确度以及准确度上,CG均优于c-MDRD。除了mGFR<60 mL/(min·1.73 m²)组中CG偏差值稍高于c-MDRD外,CG在分组后的表现仍然优于c-MDRD。结论 和中国人MDRD公式相比,CG公式更加适合用在SLE的GFR评估。

Objective Few studies has been conducted concerned Glomerular Filtration Rate(GFR) estimationequations about Cockcroft-Gault equation(CG equation)and Chinese Modification of Diet in Renal Disease equation(c-MDRD equation)in systemic lupus erythematosus(SLE). Our study aims to assess performance of two equations for renal function evaluation in patients with SLE.Methods 193 participants were enrolled in this study. Measured GFR was obtained by renal dynamic imaging method and Serum Creatinine (SCr)was determined for each participant. eGFR was gained by CG equation and c-MDRD equation respectively. Performance of equations were compared from different aspects.Results mGFR(median), eGFR-CG(median), eGFR-cMDRD(median)of the 193 participants were 75.01,70.22,70.67 mL/(min·1.73 m²)respectively. The participants were divided into two groups including mGFR≥60 (n=108)as well as mGFR<60 mL/(min·1.73 m²)(n=85). For overall participants, bias for CG equation and c-MDRD equation were 0.64, 3.91 mL/(min·1.73 m²) respectively. In terms of precision and accuracy, CG equation was better than c-MDRD equation. In subgroup, CG equation was still superior to c-MDRD equation except for bias in CG equation which is higher than c-MDRD equation in mGFR<60 ml(min·1.73 m²).Conclusion Compared with c-MDRD equation, CG performed better in GFR estimation in patients with SLE.

目的 探讨FORCE CT实时迭代ADMIRE重建技术在肝脏CT扫描中的应用价值。方法 临床疑肝病患者50例,行FORCE CT肝脏平扫后,分别采用FBP重建和ADMIRE-1~5级重建,比较6组图像的平均CT值、噪声、SNR、CNR及图像质量的主观评分及诊断效能等。结果 比较6组图像显示,肝实质平均CT值无统计学差异(P>0.05);噪声、SNR、CNR及主观评分间均有差异(P<0.05),ADMIRE-5重建噪声最小、SNR、CNR最大。图像主观评分ADMIRE-1和ADMIRE-5图像评分低于FBP,ADMIRE-2~4高于FBP,绝对评分最高为ADMIRE-3重建,但六种重建图像对病变诊断效能一致。结论 肝脏CT平扫结合FORCE CT 实时迭代ADMIRE重建技术能有效降低图像噪声及提高图像质量,具有潜在降低扫描剂量的作用。

Objective: To discuss the value of ADMIRE reconstruction technique in the liver plain CT scan by the comparison of displays to the liver separately by ADMIRE and traditional FBP reconstructions after DSCT scan. Methods: 48 patients who were clinically doubted to have hepatic lesions were scanned by DSCT in liver, then six groups of images for FBP and ADMIRE 1-5 on the average CT value, noise, signal to noise ratio ( SNR ), contrast to noise ratio (CNR) and subjective scoring on image quality were compared. Results: 6 groups of images were compared,and the average CT value of liver parenchyma has no statistical differences (P>0.05);The differences were statistically significant (P<0.05)on noise, SNR, CNR and subjective scoring,ADMIRE5 reconstruction has the least noise and the largest SNR and CNR.For the images of ADMIRE1 and ADMIRE5, the image subjective scoring is lower than that by FBP; for the images of ADMIRE2 and ADMIRE4, the image subjective scoring is higher than that by FBP; and ADMIRE-3 has the highest score.But for the rate of lesion detection, all the images were the same. Conclusion: ADMIRE reconstruction strength 3 makes the best image quality.ADMIRE reconstruction can decrease noise and improve SNR and CNR,as well as have a potential effect decreasing the scan dose.

目的 观察⁹⁹锝-亚甲基二膦酸盐对前列腺癌骨转移患者骨痛、骨质疏松的治疗效果。方法 对76例前列腺癌骨转移患者给予⁹⁹锝-亚甲基二膦酸盐治疗1年(每疗程15 d,每天静滴22 mg,15 d为一个疗程,共12个疗程),比较治疗前及治疗1年后患者骨密度(BMD)值及血清钙、磷、碱性磷酸酶、骨钙素、I型胶原交联羧基末端肽、1,25二羟维生素D3等指标的变化。结果 云克治疗后腰椎(L1-4)及左股骨颈、大转子及小转子骨密度(BMD)值均较治疗前增加(P＜0.05);云克治疗后AKP、ICTP均较治疗前明显下降(P＜0.01)。OC云克治疗后较治疗前增加(P＜0.05)。血钙、血磷、1,25-二羟维生素D3云克治疗后与云克治疗前相比无明显变化,P<0.05。前列腺癌骨转移轻度骨痛组及中度骨痛组治疗1年后骨痛VAS评分明显降低,差异有统计学意义,P＜0.05。重度骨痛组云克治疗前、治疗后VAS评分比较,差异无统计学意义,P<0.05。结论 ⁹⁹锝-亚甲基二膦酸盐在治疗前列腺癌骨转移的骨痛、骨质疏松方面,具有缓解骨痛,促进骨增殖,抑制骨吸收,提高骨密度,防治骨质疏松的作用。

目的 探讨无创呼吸机辅助常规药物治疗重症哮喘的疗效及对肺功能的影响。方法 选取我院于2014年2月—2017年6月间收治的60例重症哮喘患者作为研究对象,按照随机数字法分为对照组和研究组,对照组30例予以常规药物治疗,研究组30例予以无创呼吸机辅助常规药物治疗。比较两组患者临床疗效、肺功能指标、气血指标、心率、哮喘症状评分以及药物使用情况。结果 研究组临床有效率(96.66%)高于对照组(76.66%)(P＜0.05)。2组患者干预前肺功能指标、气血指标及心率比较无差异(P＞0.05),干预后两组心率、PaCO₂均较干预前降低,PaO₂、FEV1、FEV1/FVC均较干预前升高(P＜0.05),研究组较对照组改善明显(P＜0.05)。两组患者干预前哮喘症状评分比较无差异(P＞0.05),干预后两组哮喘症状评分均较干预前降低,且研究组较对照组降低明显(P＜0.05)。研究组使用茶碱类药物、糖皮质类激素、受体激动剂药物比例均低于对照组(P＜0.05)。结论 无创呼吸机辅助常规药物治疗重症哮喘可显著改善患者血气指标及肺功能,疗效确切。

目的 探究血必净联合乌司他丁治疗重症急性胰腺炎的疗效及对血清细胞因子水平的影响。方法 选择2016年2月—2017年3月我院收治的重症急性胰腺炎患者88例,随机将其为两组,各44例。对照组采用乌司他丁治疗,在此基础上给予观察组血必净治疗,比较2组临床疗效、血清细胞因子及药物不良反应。结果 观察组总有效率较对照组高,TNF-α、IL-6、hs-CRP水平较对照组低,差异有统计学意义(P＜0.05);观察组不良反应率略低于对照组,但差异无统计学意义(P＞0.05)。结论 血必净联合乌司他丁可提高重症急性胰腺炎临床疗效,减轻炎性反应,且不增加不良反应率,安全性较高。

目的 探讨炔雌醇环丙孕酮联合二甲双胍对多囊卵巢综合征(PCOS)患者促排卵结局及性激素水平的影响。方法 选择2015年3月—2016年12月我院收治的多囊卵巢综合征(PCOS)患者90例,将其参照随机数字表法分为2组,各45例。对照组给予炔雌醇环丙孕酮治疗,在此基础上给予观察组二甲双胍治疗,1个疗程后评估两组临床疗效、性激素水平、药物不良反应,并观察治疗6个月后2组促排卵结局。结果 观察组治疗总有效率、排卵率、妊娠率均较对照组高,T、E₂、LH水平较对照组低,差异具有统计学意义(P＜0.05);观察组不良反应率与对照组相比,差异无统计学意义(P＞0.05)。结论 炔雌醇环丙孕酮联合二甲双胍可显著提高PCOS临床疗效,改善性激素水平及促排卵结局,且不增加不良反应率,安全性较高。

目的 探讨揭阳地区急性下呼吸道感染住院患儿病毒病原学特点。方法 对2 125例急性下呼吸道感染患儿应用直接免疫荧光法(DIF)进行A型流感病毒(甲型流感病毒IFA)、B型流感病毒(乙型流感病毒IFB)、呼吸道合胞病毒(RSV)、腺病毒(AdV)、副流感病毒1(PIVⅠ)、2(PIVⅡ)和3型(PIVⅢ)进行病毒学检测。结果 2 125例患儿鼻咽部分泌物标本中有538例检测出至少1种病毒,总阳性率25.3％,其中RSV 阳性率(19.7%)明显高于其他病毒,具有统计学意义。春、夏、冬季的RSV阳性率大致相当,明显高于秋季。婴儿期组RSV阳性率(27.2%)最高,幼儿期组(18.7%)次之,均显著高于学龄前期、学龄期,后2组阳性率无统计学差异,青春期组未检出RSV。结论 病毒是急性下呼吸道感染的重要病原体,而其中又以RSV为著,RSV感染具有显著的季节性和年龄特征性。

Objective To investigate the viral etiology feature in hospitalized children with acute lower respiratory infection in Jieyang area. Methods A total of 2 125 children with acute lower respiratory tract infection were screened by direct immune fluorescence assay (DIF) for influenza virus A (IFA), influenza virus B (IFB), respiratory syncytial virus (RSV), adenovirus (AdV), parainfluenza virus I (PIV Ⅰ), PIV Ⅱ and PIV Ⅲ. Results In 2 125 cases of nasopharyngeal secretory specimens, 538 cases were detected at least one kinds of viruses. The total positive rate was 25.3%, of which the positive rate of RSV (19.7%) was higher than that of other viruses. The positive rate of RSV was similar in spring, summer and winter, much higher than that in autumn.The positive rate of RSV in infancy group (27.2%) was the highest,then the second was the toddler's age(18.7%), both of which were higher than that in preschool age group and school age group. There was no significant difference in the positive rate between preschool age group and school age group. In addition, RSV was not detected in the adolescence group. Conclusion Virus is an important pathogen of acute lower respiratory tract infection. The most common virus is RSV, infection of which has seasonal and age characteristics.

目的 探讨品管圈活动提高出院产妇母乳喂养调查问卷在随访系统回复率中的效果。方法 成立“品管圈组织”,确立“提高出院产妇母乳喂养调查问卷在随访系统的回复率”为主题,对活动前2月~14月回复率低进行原因分析,拟定实施对策,比较实施前后问卷的回复率。结果 出院产妇母乳喂养调查问卷在随访系统的回复率由29.9%提高到了71.7%,差异有统计学意义(P<0.001)。结论 通过品管圈活动可提高出院产妇母乳喂养调查问卷在随访系统的回复率。

Objective To explore the application and effect of the quality control circle(QCC) on the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system. Methods We set up a quality control circle, identified the project of improving the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system, analyzed the reasons of the low response rate from February to April. Then, we established and implemented improvement measures and compared the result before and after implementation. Results The response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system was raised from 29.9% to 71.7% (P<0.001). Conclusion With application of QCC program, the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system is improved.