目的 探究质控预警系统在重症患儿连续性血液净化治疗的应用效果。方法 随机选取于2020年1月—2021年12月在我院进行连续性血液净化治疗的共80例重症患儿作为本次研究对象,将80例患儿随机分成研究组和对照组,对照组进行常规护理,研究组则在常规护理的基础上行预警系统质量控制,对比2组患儿连续性血液净化治疗时长及报警频次、2组患儿在不同治疗时间段内滤器凝血发生率、2组非计划下机发生情况及2组患儿家属的护理满意度。结果 研究组平均报警频次为(8.60±3.35),低于对照组(16.52±7.41)的报警频次。而研究组的治疗时长(32.54±6.73 h)较对照组(21.38±5.61 h)延长,研究组患儿在进行连续性血液净化治疗的过程中,在8小时至24小时之间及大于24小时滤器的凝血发生率低于对照组,研究组和对照组护理满意度分别为92.50%和75.00%,对比差异显著。结论 在对重症患儿进行连续性血液净化治疗过程中应用质控预警系统具有较高的临床使用价值,不仅可以有效降低报警频次及滤器凝血发生率,而且对延长治疗时间有显著的促进作用,值得在今后的治疗过程中大力推广。

Objective To explore the application effect of quality control early warning system in continuous blood purification treatment of critically ill children.Methods A total of 80 critically ill children who underwent continuous blood purification treatment in our hospital from January 2020 to December 2021 were randomly selected as the research object, and were randomly divided into observation group and control group.The control group received routine nursing,and the observation group received early warning system quality control on the basis of routine nursing.The duration and alarm frequency of continuous blood purification treatment,the incidence of filter coagulation in different treatment periods,the occurrence of unplanned quitting and nursing satisfaction of the two groups were compared.Results The average alarm frequency of the observation group was (8.60±3.35),which was significantly lower than that of the control group (16.52±7.41).However,the treatment duration of the observation group (32.54±6.73 h) was significantly longer than that of the control group (21.38±5.61 h).During continuous blood purification treatment,the incidence of blood coagulation in the observation group was lower than that of the control group,and the nursing satisfaction of the observation group and the control group were 92.50% and 75.00% respectively,with significant differences.Conclusions The application of quality control early warning system in the continuous blood purification treatment of critically ill children has a high clinical value,which can not only effectively reduce the alarm frequency and the incidence of filter coagulation,but also significantly prolong the treatment time,and it is worth promoting in the future treatment process.

目的 探寻病案首页国际疾病分类(ICD)编码的准确率对按疾病诊断相关分组(DRGs)分值付费影响。方法 整体抽取2019年心血管内科和脊柱关节外科医保病例,分析DRGs分值付费存在的问题,对全院病案首页ICD编码采取相应的干预措施。结果 2019年病案首页ICD编码准确率为81.55%,DRGs分值付费亏损2 812 804.7元,经干预后,2020年病案首页ICD编码准确率为97.13%,DRGs分值付费结余14 089 039.36元。结论 准确、规范的填写病案首页ICD编码,提高病案首页ICD编码的准确率,避免医院在DRGs分值付费模式下出现亏损有重要意义。

Objective To investigate the influence of the front page International Classification of Diseases(ICD) coding accuracy of medical records on diagnosis related groups(DRGs) score payment system.Methods Medical insurance cases of cardiovascular medicine and spine and joint surgery in 2019 were totally selected,the problems of DRGs score payment system were investigated and analyzed,and managements improving the ICD coding on the medical records of discharged patients were carried out.Results In 2019,the accuracy of ICD coding of medical records was 81.55%,and the DRGs score payment system had lost 2 812 804.7 yuan.After improving,in 2020,the ICD coding accuracy achieved 97.13%,and DRGs score payment system had a positive balance of 14 089 039.36 yuan.Conclusions The accuracy and standardization of ICD coding on the medical records is of great significance in avoiding losses on DRGs score payment system.

目的 分析闽西南地区在院炎症性肠病患者流行病学资料,从而加强对炎症性肠病的认识。方法 回顾性研究炎症性肠病患者临床特点及用药情况。结果 纳入317例炎症性肠病,克罗恩病占212例,男女之比 2.07:1,溃疡性结肠炎占105例,男女比例1.84:1。克罗恩病患者确诊平均年龄29岁,以患A2型为主,溃疡性结肠炎者确诊平均年龄44岁。女性B2型比例明显高于男性。溃疡性结肠炎患者的病变部位主要为E3型(44.8%)。结论 炎症性肠病患者临床表现多样。克罗恩病确诊年龄主要是A2型, L3型是主要病变部位分型,B2型是疾病行为主要分型。E3型是溃疡性结肠炎患者的主要病变部位。克罗恩病多以免疫抑制剂和生物制剂治疗,糖皮质激素和5-ASA类制剂是轻中度的UC患者主要治疗措施。生物制剂、糖皮质激素治疗多用于重度UC患者。

Objective To analyze the epidemiological data of inflammatory bowel disease (IBD)patients in southwest Fujian Province, so as to improve the understanding of IBD. Methods To retrospectively study the clinical characteristics and medication of inflammatory bowel disease patients. Results A total of 317 IBD patients were included.Crohn's disease accounted for 212 cases, with a male-to-female ratio of 2.07:1, and ulcerative colitis accounted for 105 cases, with a male-to-female ratio of 1.84:1.Patients with Crohn's disease were diagnosed at an average age of 29, mainly with type A2, while patients with ulcerative colitis were diagnosed at an average age of 44. The proportion of female with type B2 was significantly higher than that of male.The lesions of ulcerative colitis patients were mainly type E3 (44.8%).Conclusions Patients with IBD had diverse clinical manifestations.The age of diagnosis of Crohn's disease was mainly type A2, type L3 was the main lesion, type B2 was the main disease classification.Crohn's disease was mainly treated with immunosuppressive and biological therapy. Glucocorticoids and 5-ASA were the main treatment for patients with mild-to-moderate ulcerative colitis. Biological agents and glucocorticoid therapy were mostly used in severe patients.

目的 分析中枢神经系统孤立性纤维瘤(SFT)11例患者的临床特点、影像学及病理学表现、手术结果。方法 回顾性分析2013年—2021年于广州医科大学附属第二医院神经外科接受手术并经病理检查证实为中枢神经系统SFT的11例患者的临床资料。结果 11例患者主要症状为头晕、头痛或肢体乏力。MRI:病灶主要表现为T1WI等-低信号,T2WI混杂信号或等-稍高信号。病理组织学:镜下表现为疏密不一的梭形肿瘤细胞呈交替排列。免疫组化:肿瘤细胞主要表现为STAT6阳性、CD34阳性等特点。病灶全切除患者预后较好,病灶次全切除或既往有SFT复发病史患者容易再次复发。结论 中枢神经系统SFT患者MRI T2WI信号有助于诊断,但是最终诊断依靠病理学检查。手术切除是首选的治疗方式。

Objective To analyze the clinical features,radiological and pathological manifestations and surgical results of 11 patients with solitary fibrous tumors (SFT) of the central nervous system (CNS). Methods The clinical data of 11 patients with SFT of CNS confirmed by pathological examination in the Neurosurgery Department of the Second Affiliated Hospital of Guangzhou Medical University from 2013 to 2021 were retrospectively analyzed. Results The main symptoms of 11 patients were dizziness,headache or extremity weakness. MRI: the lesions mainly showed iso-low signal on T1WI,mixed signal or iso-slightly high signal on T2WI. Histopathological features: microscopically,there were alternating rows of spindle tumor cells with irregular density. Immunohistochemistry showed that the tumor cells were STAT6 positive,CD34 positive,etc. Patients with total resection of the lesion had a better prognosis. Patients with subtotal resection of the lesion or previous history of SFT relapse were prone to relapse. Conclusions MRI T2WI signals in patients with CNS SFT were helpful for diagnosis,but the final diagnosis depended on pathology. Surgical excision is the preferred treatment.

目的 分析中山市博爱医院妊娠合并哮喘急性发作患者相关危险因素。方法 选取2019年7月—2021年2月中山市博爱医院收治100例的妊娠合并哮喘患者作为研究对象,将100例妊娠合并患者分为哮喘急性发作组(n=46)与未发作组(n=54),采用多因素Logistic回归分析进行调查分析。结果 100例患者中发作人数为46例,占46.0%。Logistic回归分析显示孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的危险因素(P<0.05)。发作组剖宫产率发生率、住院时间以及并发症发生率均高于未发作组,差异有统计学意义(P<0.05)。结论 孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的独立危险因素,应对此类患者给予高度重视。

Objective To analyze the risk factors of pregnancy complicated with acute attack of asthma in Zhongshan Bo'ai Hospital.Methods A total of 100 patients with pregnancy complicated with asthma treated in Zhongshan Bo'ai Hospital from July 2019 to February 2021 were selected as the research objects.Patients were divided into acute attack group (n=46) and no attack group (n=54).Multivariate logistic regression analysis was used for investigation and analysis.Results The patient number of attack was 46,accounting for 46.0%. The incidence of cesarean section,length of hospital stay and complications in the attack group were higher than those in the no attack group,and the difference was statistically significant (P<0.05).Conclusions Gestational age,use of asthma drugs,anxiety and IL-17 level were independent risk factors for pregnancy complicated with acute attack of asthma.Great attention should be paid to these patients.

目的 探究青少年首发抑郁症患者治疗中联合应用艾司西酞普兰与重复经颅磁刺激(rTMS)的总疗效及应用价值。方法 选取东莞市第七人民医院2020年5月—2021年10月80例青少年首发抑郁症患者,参考“数字双盲法”,分为对照组和观察组(各40例)2组,对照组接受伪rTMS+艾司西酞普兰治疗,观察组接受rTMS+艾司西酞普兰治疗。评价指标:临床总疗效、抑郁评分(17项汉密尔顿抑郁量表,HAMD-17)、认知功能评分(威斯康星卡片分类测验,WCST)、生活质量(SF-36评分),不良反应发生率(副反应量表,TESS)。结果 观察组患者总有效率95.00%较对照组80.00%明显高(P＜0.05);且2组不良反应率比较(P＞0.05)。观察组治疗1周、2周、4周HAMD-17评分均较对照组低,同时治疗4周后WCST项目中完成分类评分较对照组更高(P＜0.05)。观察组SF-36(角色、社会、躯体、认知)评分均较对照组高(P＜0.05)。结论 青少年首发抑郁症患者,在艾司西酞普兰用药基础上联合rTMS,可获取更为显著的治疗效果,控制病情进展,减轻抑郁症状,同时对认知功能无影响,促进生活质量大幅度提高,且用药安全性有保障。

Objective To explore the total efficacy and application value of escitalopram combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of adolescent patients with first-episode depression.Methods A total of 80 adolescent patients with first-episode depression in Dongguan Seventh People's Hospital from May 2020 to October 2021 were selected.Referring to the “digital double-blind method”,they were divided into control group and observation group (40 cases each).The control group was treated with pseudo rTMS and escitalopram,and the observation group was treated with rTMS and escitalopram.Evaluation indexes: total clinical efficacy,depression score (17-item Hamilton Depression Scale,HAMD-17),cognitive function score (Wisconsin Card Sorting Test,WCST),quality of life (SF-36 score),adverse reaction rate (Treatment Emergent Symptom Scale,TESS).Results The total effective rate of 95.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05); the incidence of adverse reactions was compared between the two groups (P>0.05).The HAMD-17 scores of the observation group at 1 week,2 weeks and 4 weeks were significantly lower than those of the control group.At the same time,the classification scores of WCST items after 4 weeks of treatment were higher in observation group (P<0.05).The SF-36 (role,society,body and cognition) scores in the observation group were higher than those in the control group (P<0.05).Conclusions Adolescent patients with first-episode depression treated with rTMS on the basis of escitalopram can obtain more significant therapeutic effect,control the progress of the disease,reduce depressive symptoms,have no effect on cognitive function,greatly improve the quality of life,and ensure the safety of medication.

目的 研究麻醉恢复室(PACU)全麻患者气管内吸痰的最佳时机与按需吸痰的可行性。方法 选取2021年6月—2021年10月行经口气管插管静吸复合全身麻醉的择期手术患者240例,随机分为A组(拔管前吸痰组)、B组(入室吸痰组)、C组(入室按需吸痰组)3组,每组80例。A组苏醒时拔除导管前常规气道内及口腔吸痰;B组入PACU时提前气道内及口腔吸痰,苏醒时拔除导管,拔管后清理口腔;C组入室后参考吸痰指征评估患者气道分泌物,有吸痰指征患者吸痰,无吸痰指征者不吸痰,苏醒时拔除导管后清理口腔。分别记录患者术后入PACU时、吸痰及拔管后1 min患者的心率、血压、患者因气管刺激引起的呛咳、恶心呕吐及气道痉挛等发生例数,记录躁动评分、术后咽喉痛评分并进行评估。结果 A组与B组比较,每位患者均有吸痰,A组患者心率、血压、血氧饱和度,在吸痰后及拔管后较B组变化幅度大,差异均有统计学意义(P <0.05),气道应激反应方面,C组有20例患者按需吸痰,3组患者均未出现气道痉挛患者,A组有2例患者因拔管时剧烈呛咳引起呕吐,C组呛咳例数低于A组和B组,差异有统计学意义(P <0.05),气道刺激引起的躁动及术后咽喉疼痛C组低于A组,差异有统计学意义(P <0.05)。结论 患者在入室时按需吸痰,拔管时不再吸痰,可减少患者的心血管及气道应激反应,减少术后咽痛。

Objective To investigate the best time for endotracheal suction and the feasibility of on-demand suction in general anesthesia patients of post anesthesia care unit (PACU).Methods A total of 240 selective surgical patients who underwent oral endotracheal intubation with general anesthesia from June 2021 to October 2021 were selected.They were randomly divided into group A (sputum suction before extubation),group B (sputum suction in the room),and group C (in-room sputum suction on demand),80 cases in each group.In group A,routine airway and oral sputum suction was performed before removing the catheter when the patients were waking up.Group B had sputum sucked in the airway and mouth before entering the PACU,removed the catheter when waking up,and cleaned the oral cavity after extubation.In group C,the patients were assessed with reference of suction indications after entering the room.Sputum suction was performed for those with indications,but not for those without indications,and the mouth was cleaned after removing the catheter when awaken.Patient's heart rate,blood pressure,coughing,nausea and vomiting and airway spasm caused by tracheal irritation in 1 minute after suction and extubation were recorded after the patients entered the PACU.The tremor score and sore throat score were recorded and analyzed.Results Comparing group A with group B,each patient had sputum suction.The heart rate,blood pressure,and oxygen saturation of group A changed more significantly than group B after sputum suction and extubation (P<0.05).In terms of airway stress response,20 patients in group C needed suction,none in the three groups had airway spasm.Two patients in group A had vomiting due to severe coughing during extubation.The patients of coughing in group C were significantly less than that of group A and group B,respectively (P<0.05).The dysphoria caused by airway stimulation and postoperative throat pain in group C was significantly lower than that of group A (P<0.05).Conclusions The patient on-demand suction when enter the room,and no suction when extubation,can reduce the patient's cardiovascular and airway stress response and reduce postoperative sore throat.

目的 探究支气管镜下肺泡灌洗并局部使用阿米卡星治疗老年支气管扩张合并感染患者的疗效及对血清炎性因子水平的影响。方法 选取我院2018年3月—2019年5月确诊支气管扩张症、合并感染的符合纳入标准的患者共64例,按照1:1比例抽签分为2组,32例纳入观察组,应用支气管镜下肺泡灌洗阿米卡星治疗;32例纳入对照组,以单纯的支气管镜下肺泡灌洗治疗。观察并比较2组患者的治疗效果、血清炎性因子水平、肺功能情况等。结果 疗效比较显示观察组的96.9%总有效率高于对照组的75.0%(P＜0.05);血清炎性因子水平在患者用药前检测无差异(P＞0.05),经过治疗后,观察组水平均优于对照组P＜0.05;经治疗后,观察组静态肺活量、补呼气量、补吸气量、用力肺活量均优于对照组,差异具有统计学意义(P＜0.05)。结论 对老年支气管扩张合并感染患者应用支气管镜下肺泡灌洗阿米卡星治疗,促进临床效果改善,患者的症状、炎症及肺功能等指标均得到明显改善,值得推广。

Objective To investigate the efficacy of bronchoscopic alveolar lavage and local application of amikacin in the treatment of elderly patients with bronchiectasis complicated with infection and its effect on the level of serum inflammatory factors.Methods A total of 64 patients with bronchiectasis complicated with infection diagnosed in our hospital from March 2018 to May 2019 were selected.They were divided into two groups evenly by proportional drawing. Thirty-two cases were included in the observation group that were treated with bronchoscopic alveolar lavage with amikacin.The other 32 cases were included in the control group that were treated with the bronchoscopic alveolar lavage only.The therapeutic effect,serum inflammatory factor level and pulmonary function of the two groups were observed and compared.Results The total effective rate of 96.9% in observation group was higher than 75.0% in control group (P<0.05).There was no difference in the levels of serum inflammatory factors before treatment (P>0.05).After treatment,the levels of the observation group were better than those of the control group (P<0.05).After treatment,the slow vital capacity,expiratory reserve volume,inspiratory reserve volume and forced vital capacity of the patients in the observation group were better than those in the control group (P<0.05).Conclusions Bronchoscopic alveolar lavage of amikacin in elderly patients with bronchiectasis complicated with infection could improve the clinical effect.The symptoms of the patients,the serum inflammatory factors and lung function of the patients were significantly improved.The treatment is worthy of promotion.

目的 分析术前血清鳞状细胞癌相关抗原(SCCA)对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值。方法 选取2018年1月—2021年1月于我院肿瘤科治疗的128例宫颈鳞癌患者作为研究对象,根据其是否发生盆腔淋巴结转移将其分为转移组(42例)和非转移组(86例)。对比2组宫颈鳞癌患者一般资料,采用多因素Logistic分析宫颈鳞癌患者发生盆腔淋巴结转移的高危因素,采用ROC曲线评估术前血清SCCA对宫颈鳞癌患者发生盆腔淋巴结转移的预测价值,通过约登指数确定最佳截断值。结果 2组患者一般资料对比,宫颈鳞癌细胞分化程度、宫颈鳞癌临床分期、宫颈鳞癌肿瘤直径大小、是否出现宫旁转移现象、是否出现脉管浸润现象、浸润深度、SCCA水平的差异有统计学意义,P<0.05;多因素Logistic分析显示宫颈鳞癌细胞分化程度、脉管浸润阳性、浸润深度、SCCA水平是宫颈鳞癌患者发生盆腔淋巴结转移的危险因素;ROC曲线分析结果显示,SCCA水平曲线下面积为0.909,最佳截断值为0.597 5 μg/L。结论 术前血清SCCA水平对宫颈鳞癌患者发生盆腔淋巴结转移具有预测价值。

Objective To analyze the predictive value of preoperative serum squamous cell carcinoma antigen (SCCA) on pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.Methods A total of 128 patients with cervical squamous cell carcinoma treated in the oncology department of our hospital from January 2018 to January 2021 were selected as the research objects,and divided into metastatic group (42 cases) and non-metastatic group (86 cases) according to whether pelvic lymph node metastasis occurred.The general data of the two groups of patients with cervical squamous cell carcinoma were compared.Multivariate logistic analysis was used to analyze the risk factors for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma.ROC curve was used to evaluate the predictive value of preoperative serum SCCA for pelvic lymph node metastasis in patients with cervical squamous cell carcinoma,and the optimal cut-off value was determined by Yoden index.Results When comparing the general data of the two groups of patients,the differences in the degree of cervical squamous carcinoma cell differentiation,clinical stage of cervical squamous carcinoma,tumor diameter of cervical squamous carcinoma,whether the phenomenon of parametastasis was present,whether the phenomenon of choroidal infiltration was present,depth of infiltration,and SCCA level were statistically significant,P<0.05; multi-factor logistic analysis showed that the degree of cervical squamous carcinoma cell differentiation,positive vascular invasion,depth of invasion and SCCA level were risk factors for pelvic lymph node metastasis in cervical squamous cell carcinoma patients.The results of ROC curve analysis showed that the area under the curve of SCCA level was 0.909 and the optimal cut-off value was 0.597 5 μg/L.Conclusions Preoperative serum SCCA level had good predictive value for the occurrence of pelvic lymph node metastasis in patients with cervical squamous carcinoma.

目的 了解广东肇庆怀集县农村妇女两年来“两癌”检测的阳性情况及高危型人乳头瘤病毒(HPV)的感染特点。 方法 对2018年1月—2019年12月24 146名参与“两癌”免费检测的35~64 岁、农村妇女的宫颈癌筛查结果进行分析。以高危型HPV检测作为初筛方法,结果为HPV16、18型阳性的转诊阴道镜检查,其它高危型HPV阳性则进行薄层宫颈液基细胞学检查(TCT),TCT结果严重于或等于未明确意义的非典型鳞状上皮(ASC-US)者转诊阴道镜,阴道镜结果可疑或异常者进行组织病理学检查。 结果 高危型HPV总检出率为9.35%,单独HPV16、18和其它高危型HPV的阳性检出率分别为0.70%、0.32%、7.72%,混合感染检出率为0.61%,高危型 HPV 总检出率最高的年龄段是 60~64岁,检出率为11.22%。细胞学转诊率为65.63%,阴道镜转诊率为61.23%。宫颈癌前病变检出率为323.03/10 万,宫颈癌的检出率为45.56/10 万,早期诊断率为87.64%。宫颈癌前病变和宫颈癌的HPV16、18及混合感染占70.79%。 结论 该地区高危型HPV阳性率、宫颈癌前病变及宫颈癌检出率均较高,宫颈癌筛查异常者细胞学及阴道镜转诊率较低,提示该地区存在更高的宫颈癌发病风险。

Objective To understand the positive screening results and the infection characteristics of high-risk human papillomavirus (HPV) in Huaiji County,Guangdong Province,in the two years of the free standardization testing for rural women's “two cancers”. Methods The cervical cancer screening results of 35~64 year-old women with rural household registration who volunteered to participate in the “two cancers” free testing for rural women in the region were analyzed. High-risk HPV testing was used as the primary screening method for cervical cancer. The results of HPV16 and 18 positive patients were directly referred to colposcopy. If other high-risk HPV was positive,thin-layer cervical fluid-based cytology(TCT) was perform on those patients,whose TCT result severer than atypical squamous cells of undetermined significance (ASC-US) were referred to colposcopy,and those with suspicious or abnormal colposcopy results were referred to histopathological examination. Results The total positive detection rate of high-risk HPV was 9.35%. The positive rates of HPV16,18 and other high-risk HPV were 0.70%,0.32% and 7.72% respectively,mixed infection rate was 0.61%. The age group with the highest overall positive rate of high-risk HPV is 60-64 years old,and the rate is 11.22%. The referral rate for cytology was 65.63%,and the referral rate for colposcopy was 61.23%. The positive rate of cervical precancerous lesions was 323.03/100 000,the positive rate of cervical cancer was 45.5/100 000,and the early diagnosis rate was 87.64%.HPV16,18 and HPV mixed infections of cervical precancerous lesions and cervical cancer accounted for 70.79%.Conclusions The positive rate of high-risk HPV,cervical precancerous lesions and cervical cancer positive rate were high in this area. The being referred rate of cytology and colposcopy in cervical cancer screening was low,suggesting that there was a higher incidence of cervical cancer in this area risk.