目的 探讨应用家庭访视护理与中医体质辨识相结合的方式提高居民健康管理能力,改善居民体质。方法 随机抽取广州市越秀区某社区的128例居民为研究对象,通过体检和中医体质辨识了解居民健康状况,责任护士开展家庭访视护理和具有中医特色的干预措施,通过干预前、后研究对象的中医体质量化计分、生存质量变化和健康知识共3个方面评价项目效果。结果 中医体质平和质得分显著升高,气虚质、痰湿质、湿热质、血瘀质、气郁质共5种偏颇体质的得分均降低(P<0.05),阳虚质、阴虚质、特禀质3种体质的得分差异无统计学差异(P>0.05)。简明健康状况调查问卷评分(MOS SF-36)在PCS领域和MCS领域的生命质量得分比干预前增高(P<0. 05)。健康教育知识在中医保健养生、慢性疾病防治、药物使用规范以及家庭护理知识评分有提高(P<0. 05)。结论 家庭访视护理结合中医体质调理措施可以拉近居民与医护人员距离,增强居民健康管理观念和能力,促进居民关注自身体质状况,达到“未病先防”的效果。

目的 探讨两种不同治疗方案治疗老年糖尿病合并初治涂阳肺结核患者的临床疗效。方法 将85例老年糖尿病合并初治涂阳肺结核患者分为每日疗法组(n=43)和间歇疗法组(n=42)。比较两组2、3、6个月及疗程结束痰菌转阴率、胸片吸收情况、并发症发生率。结果 两组治疗2个月痰菌转阴率每日疗程组高于间歇疗法组,但两组间无差异,但5、6个月末及疗程结束转阴率每日疗法均高于间歇疗法(P<0.05);治疗后每日疗程组病灶总吸收率(97.62%)高于间歇疗法组(79.07%),且差异有统计学意义(P<0.05);治疗过程中两组出现不良反应情况相比较差异无统计学意义(P>0.05)。结论 使用每日疗法并适当延长强化期及巩固期疗程治疗老年糖尿病合并初治涂阳肺结核的痰菌转阴率及病灶吸收率均优于间歇疗法,且安全性两者无差异,值得临床借鉴。

目的 探讨功能康复训练与心理干预对全髋关节置换手术患者髋关节功能康复的影响。方法 对2014年3月—2015年12月先后在本院行全髋关节置换手术90例患者,按入院时间分为观察组45例和对照组45例。对照组按全髋关节置换手术功能康复护理要求给予康复护理;观察组在此功能康复护理基础上,同时对患者进行心理评估和相应的心理护理干预;对两组患者在干预前后的心理情况、生活自理能力、髋关节功能和生活质量进行评价。结果 干预前两组患者均有不同程度的焦虑和抑郁反应,不积极的应对方式和自理能力下降;干预后观察组在应对心理反应,降低焦虑和抑郁,主动进行功能锻炼,自理能力和髋关节功能评分均优于对照组。结论 功能康复训练与心理护理干预相结合,对减轻患者心理压力,提高患者心理应对能力、生活自理能力,提高患者生活质量,促进髋关节功能康复有一定的效果。

Objectives To explore the effect of function rehabilitation training and psychological intervention on patients of hip joint function recovery undergoing THA. Methods 90 patients were chosen who were admitted to the hospital from March 2014 to December undergoing THA,2015. These patients were divided into control group and intervention group according to the sequence of admission. The patients in control group were cared by total hip replacement surgery functional rehabilitation; At the same time, the patients in observation group were cared by psychological training. The psychological condition, self-care ability, hip function and quality of life for all patients were evaluated. Results Before the intervention, two groups of patients had some degrees of anxiety and depression, and negative coping style. Their self-care ability were decreased; The response to psychological reaction, reduction for anxiety and depression, initiative exercise, self-care ability and hip function scores of patients in the intervention group were better than that of the control group. Conclusion Combination of rehabilitation training and psychological nursing intervention can relieve the psychological pressure, improve mental health and promote recovery of hip function.

目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.

目的 探讨罗伊适应模式对肺癌患者术后生活质量的影响。方法 将2012年3月—2015年7月来我院就诊的178例肺癌术后患者,随机分为试验组85例和对照组93例;对照组患者按护理常规进行护理,试验组在常规护理基础上给予罗伊适应模式护理干预;出院时分别比较两组患者住院适应性、治疗依从性、病人满意度及患者生活质量评分。结果 试验组住院适应率为87.1%(74例),对照组住院适应率为66.7%(62例),两组差异有显著性(P<0.01);试验组治疗依从性优良率为88.2%(75例)、对照组治疗依从性优良率72.0%(67例),两组差异有显著性(P<0.01);试验组患者满意度为89.4%(76例),高于对照组患者满意度73.1%(68例),两组差异有显著性(P<0.01);试验组生活质量评分,总体健康得分(74.1±8.3)高于对照组(56.7±5.9),且差异有统计学意义(P<0.01)。结论 罗伊适应模式护理干预,可以提高肺癌患者手术后的住院适应性、治疗依从性及病人满意度,显著改善患者生活质量,在临床推广罗伊适应模式护理干预具有现实意义。

Objective To investigate　the effect of Roy adaptation model on quality of life in patients for lung cancer after surgery. Methods 178 cases of　patients with lung cancer after surgery operation　were randomly divided into observation groups(85 cases) and control groups(93 cases). The control group was treated with routine nursing care and the observation group was treated on the basis of routine nursing care plus Roy adaptation model nursing interventions. When the two groups were compared in patients hospitalized and discharged adaptability, treatment compliance, patient satisfaction and patient quality of life score. Results Hospitalization adaptation in the observation group was 87.1%(74 cases) and control group was 66.7%(67 cases). There was statistically significant difference between two groups(P<0.01); Excellent treatment compliance of observation group was 88.2%(75 cases) and control group was 72.0%(67 cases). There was statistically significant difference between two groups(P<0.01); the observation group patient satisfaction were 89.4%(76 cases), it was higher than 73.1%(68 cases) of control group. There was statistically significant difference between two groups(P<0.01); quality of life in general health score(74.1±8.3) in the observation group was higher than that of control group(56.7±5.9),and there was statistically significant difference between two groups(P<0.01). Conclusion Roy adaptation model nursing intervention may improve the adaptability hospitalized the patients with lung cancer after surgery, treatment compliance and the patient satisfaction, and significantly improve the quality of life of patients. It is worthy of promotion clinically.

目的 探讨婚恋家庭取向心理干预对系统性红斑狼疮患者家庭功能和幸福感指数的效果。方法 将2012年6月1日—2014年5月31日就诊于东莞康华医院内分泌及风湿免疫中心的62名15~58岁的系统性红斑狼疮患者作为研究对象,根据随机化原则将其分成两组,其中30名为干预组,参加本研究设计的婚恋家庭取向的心理干预,余32名为对照组,采用家庭功能评定量表、幸福指数量表及狼疮活动指数量表,对两组进行干预前、干预后、干预后3月和干预后6月作问卷调查。采用重复测量的方差分析进行评估。结果 家庭功能中的问题解决、情感反应、情感介入、总的功能分量表和总分两组干预后重复测量的方差分析两两比较均有统计学差异(P<0.05)。幸福感指数总分两组重复测量的方差分析无统计学意义,但如扩大置信空间至P<0.1,则两组重复测量的方差分析两两比较中干预后3月及6月有一定统计学意义(P=0.08<0.1)。结论 本研究中婚恋家庭取向的心理干预对SLE患者即家庭功能中问题解决、情感反应、情感介入、总的功能及家庭功能总分均有显著的改善作用,对幸福感指数总分则有一定的增进作用,而对已通过心身疾病方式表达了的SLEDAI没有干预作用。

Objective To explore the effect of marital family-based psychological intervention in SLE patients on family assessment device FAD and index of well-being. Methods A total of 62 SLE patients, aged between 15 and 58, who were treated in out-patient of endocrine immune rheumatism center of Dongguan Kanghua hospital from June 1,2012 to May 31,2014. The experimental group was made up of 30 patients who, at random, volunteered to participate in an added marital family-based psychological intervention and the control group was composed of rest 32 cases. At the time of pre-intervention,post-intervention,3 months and 6 months after intervention, both groups were investigated with questionnaires of family assessment device, index of well-being, index of general affect, and systemic lupus erythematosus disease activity index. The results were analyzed with repeated measure variance analysis to explore the effect. Results There were significant multiple-comparison differences by repeated measure variance analysis in the score of FAD's total and sub-scale problem solving, affective responsiveness, affective involvement, general functioning(P<0.05) between experimental and control group after intervention. There were no significant repeated measure variance analysis differences in the score of index of well-being' total, but if enlarging confidence space to P<0.1, there were partial multiple-comparison differences between experimental and control group at the time of 3 months and 6 months after intervention(P=0.08<0.1). Conclusion Marital family-based psychological intervention may significantly improve FAD's problem solving, affective responsiveness, affective involvement, general functioning, and sum of FAD, and partially improve index of well-being, but can not improve SLEDAI which had developed by psychosomatic disease.

目的 探讨45°半坐卧位对良性前列腺增生患者膀胱压力容积测定的影响。方法 按照入选标准和排除标准选取临床确诊为良性前列腺增生(Benign Prostatic Hyperplasia,BPH)患者。按照二阶段交叉设计的方法将入选患者随机分入A、B两组。A组患者先进行45°半坐卧位膀胱压力容积测定(Cystometry,CMG),再进行平卧位CMG,B组患者先进行平卧位CMG,再进行45°半坐卧位CMG。统计以下CMG参数:膀胱初始感觉容量、膀胱初始尿意容量、膀胱最大容量及逼尿肌过度活动发生率。结果 与平卧位相比,45°半坐卧位对膀胱初始感觉容量、膀胱初始尿意容量、膀胱最大容量的测定无影响,且能提高逼尿肌过度活动的检出率(45°半坐卧位37.21% vs.平卧位11.63%,P=0.006)。结论 45°半坐卧位能代替平卧位作为CMG的检查体位。

Objective To investigate influence of 45 degree semi-reclining position in cystometry in patients with benign prostatic hyPerplasia(BPH). Methods Patients with BPH were enrolled according to the inclusion and exclusion criteria. They were divided into two groups randomly by two stage cross-over design. Group A took the 45 degree semi-reclining position firstly then supine position, while group B used a reverse order.CMG parameters included volume of first sensation to void (FS), volume of first urge to void (FU), maximum cystometric capacity (MCC) and detrusor overactivity(DO). Results 45 degree semi-reclining position had no effect on volume of FS、volume of FU、MCC, and could increase the detection rate of DO(45 degree semi-reclining Position 37.21% vs. supine 11.63%,P=0.006). Conclusion 45 degree semi-reclining position may be used as a substitution for supine in FC.

目的 探讨老年2型糖尿病患者牙周病发生情况及相关因素,为开展综合预防和治疗措施提供参考。方法 选取到我院住院治疗的老年2型糖尿病患者273例,检查其牙周病患病情况,同时收集年龄、性别、文化程度、体重指数、病程、吸烟、空腹血糖、糖化血红蛋白、刷牙习惯等资料,比较牙周病患病组与未患病组之间上述资料的差异,探讨导致牙周病发生的影响因素。结果 273例研究对象中患有牙周病154例(56.41%),其中,牙龈炎60例,牙周炎94例。牙周病组平均存留牙数(18.54±6.31)颗,未患牙周病组平均存留牙数(21.62±7.48)颗(t=3.679,P<0.001)。年龄较大(P<0.001)、病程较长(P<0.001)、吸烟(P<0.001)、空腹血糖(P<0.001)和糖化血红蛋白(P<0.001)水平较高是老年2型糖尿病患者发生牙周病的危险因素,而文化程度高(P=0.017),刷牙>1次/d(P<0.001),竖刷(P=0.004),使用牙线(P=0.004)是其保护因素。结论 老年2型糖尿病患者中牙周病患病率较高,临床上应做好三级预防措施,降低牙周病发生风险因素的暴露。

Objective To explore the periodontal disease occurrence and its factors for elderly type 2 diabetes patients, providing reference for comprehensive prevention and treatment measures. Methods 273 cases of elderly in-patients with type 2 diabetes in our hospital were enrolled. We checked their periodontal disease conditions, collected information including age, sex, educational level, body mass index, disease duration, smoking, fasting blood glucose, glycosylated hemoglobin, brushing habits. These values were compared between periodontal disease group and no periodontal disease group. Results People with periodontal disease in 273 cases of the object of study included 154 patients (56.41%), among them, gingivitis 60 cases, 94 cases of periodontitis. The teeth number was (18.54±6.31) for periodontal disease group on average, with (21.62 ±7.48) for no periodontal disease group (t=3.679, P<0.001). Older (P<0.001), longer course of disease (P<0.001), smoking (P<0.001), higher fasting blood glucose (P<0.001) and higher glycosylated hemoglobin (P<0.001) were risk factors of periodontal disease for elderly patients with type 2 diabetes. And well-educated (P=0.017), brushing teeth frequency > 1 / d (P<0.001), vertical brush mode (P=0.004), the use of dental floss (P=0.004) were the protective factors. Conclusion Periodontal disease prevalence is high in elderly patients with type 2 diabetes. The three level preventive measures should be strengthened to reduce the exposure of the periodontal disease risk factors.

目的 探讨2型糖尿病肾病(DN)患者肾组织中STOML2的表达及作用。方法 免疫组化检测临床2型糖尿病肾病患者肾组织STOML2的表达及定位,采用慢病毒转染方法建立稳定过表达STOML2的HK-2细胞系,并应用Western blot检测肾小管上皮细胞钙粘蛋白(E-cadherin)、Fibronectin和STOML2的表达。结果 STOML2在DN患者肾组织的肾小管上皮细胞胞浆中表达明显升高。在高糖刺激HK-2细胞建立的EMT模型中,STOML2呈时间依赖表达上调。STOML2稳定高表达时,E-cadherin表达下调,而Fibronectin明显上调,即能促进肾小管上皮细胞发生EMT。结论 STOML2可能通过促进肾小管上皮细胞向间充质细胞分化,进而参与糖尿病肾病肾脏纤维化的发生发展。

Objective To investigate the expression and role of STOML2 in renal tissue of patients with type 2 diabetic nephropathy. Methods To detect he expression and localization of STOML2 in clinical renal tissue in patients with type 2 diabetic nephropathy by immunohistochemistry, and use lentiviral transfection method to establish a stable cell line of over-expressing STOML2, lastly apply western blot to detect the expression of E-cadherin, Fibronectin and STOML2 in renal tubular epithelial cells. Results STOML2 was significantly increased in renal tubular epithelial cytoplasm of patients with DN. In the EMT model of HK-2 cells stimulated by high glucose, STOML2 was increased in a time dependent. Overexpression of STOML2 led to E-cadherin down-regulated, while Fibronectin up-regulated, which promoted the occurrence of EMT in renal tubular epithelial cells. Conclusion STOML2 may be involved in the development and progression of renal fibrosis in diabetic nephropathy by mediating epithelial- mesenchymal transition of renal tubular epithelial cells.

目的 研究术中麻醉深度监测在全麻下行下腹部手术患者苏醒质量和护理工作应用。方法 选取择期全麻下行下腹部手术患者120例(ASAⅠ~Ⅱ级),随机分成NT组和NNT组,NT组患者(60)术中用Narcotrend监测,NNT组患者(60)术中不用Narcotrend监测。记录术中丙泊酚用量;记录术后气管导管拔管时间和麻醉恢复室(postanesthesia care unit, PACU)留观时间;记录恢复室Ricker镇静—躁动评分;记录恶心呕吐及术后谵妄的发生率。结果 NT组患者术中麻醉药物丙泊酚的用量比NNT组明显减少(P<0.05);NT组患者术后的拔管时间与PACU留观时间比NNT明显缩短(P<0.05);NT组患者术后的Ricker 镇静-躁动评分比NNT明显降低(P<0.05);NT组患者与NNT组术后恶心呕吐及术后谵妄发生率无明显差别。NT组比NNT组降低了护理工作量(P<0.05)。结论 在麻醉深度监测仪Narcotrend下行下腹部手术,通过有效的麻醉深度监测,可以改善患者术后的苏醒质量,这些有利于减少PACU护理工作量,提高了护理质量,也有助于PACU护理规范化。

Objective To investigate the effect of anesthesia depth monitoring on the recovery quality and nursing quality of patients treated with lower abdominal surgery under general anesthesia. Methods A total of 120 patients who underwent the lower abdominal surgeries from June 2015 to December 2015 were randomly divided into 2 groups: non-Narcotrend monitoring group (non NT group) and Narcotrend monitoring group (NT group). And each group contains 60 cases. All patients were set in the same induce plan, and maintained by propofol-fentanyl during the operation. The dosage of propofol, the time of tracheal extubation, the PACU staying time, the Ricker sedation-agitation scale, the incidence of PONV and POD, the nursing quality and nursing working load were recorded in the project. Results Using Narcotrend to monitor the anesthesia depth could significantly decrease the dosage of propofol (P<0.05). The tracheal extubation time and the PACU staying time of patients in NT group were much shortened than patients in non NT group (P<0.05). In NT group the Ricker scores of patients were much lower than patients in non NT group (P<0.05). And the effective anesthesia depth monitoring using Narcotrend could significantly decrease the nursing working load and improve the nursing quality (P<0.05). Conclusion Effective anesthesia depth monitoring using Narcotrend may improve the recovery quality in the PACU, which may decrease the working load of nurses and improve the nursing quality in PACU.