目的 分析河源地区医疗机构临床用血合理性现状,提高临床合理输血水平。方法 选择本地区临床用血量前三位的3家综合性医院,随机抽取其2017年住院患者1 012例输血病例,判断每次输血合理性并对不合理输血原因进行分析。结果 1 012份输血病例中合理输血病例718例,合理性输血比例为70.94%。不同血制品和临床科室间用血合理性比例差异具有统计学意义(χ²=6.734、6.119,P=0.000、0.000)。红细胞输注不合理原因主要为指征过宽和无指征输血,血浆、血小板、冷沉淀输注不合理原因主要为无指征输血。结论 加强医疗机构临床用血管理,真正做到科学用血、合理用血,节约用血。

目的 探讨重组人表皮生长因子滴眼液联合玻璃酸钠治疗白内障术后干眼症的随机对照情况。方法 选取2017年度在本院实施白内障术后发生干眼症患者120例,采取随机分组方法分成观察组、对照组各60例,观察组给予重组人表皮生长因子滴眼液联合玻璃酸钠治疗,对照组给予玻璃酸钠滴眼液治疗,比较两组患者的临床疗效情况。结果 观察组有效率90%高于对照组73.33%,有差异;两组患者治疗前FL、BUT、SIT比较均无差异,P>0.05;治疗后,两组FL、BUT、SIT比较有差异,P<0.05; 两组患者治疗前视力评价比较均无差异,P>0.05;治疗后,两组视力评价比较有差异,P<0.05。结论 给予白内障术后干眼症患者采取重组人表皮生长因子滴眼液联合玻璃酸钠治疗,可提高临床疗效,对于改善相关临床体征、视力指标均具有重要临床价值。

目的 研究对比胃癌患者术前胃镜活检病理与外科术后病理的异同并进行观察。方法 选取我院消化科于2016年7月—2017年12月收治的64例胃癌患者作为此次研究对象,术前均展开胃镜活检,术后展开外科病理检查,判断两种诊断方法的异同。结果 胃癌确诊率对比,术前胃镜活检后确诊胃癌患者占比85.9%(55/64),疑似胃癌患者占比10.9%(7/64),排除胃癌患者占比3.1%(2/64),术前胃镜活检确诊率85.9%,低于术后病理诊断95.3%,组间比较差异无统计学意义(P>0.05);胃镜活检病理结果对比,术前胃镜检查黏液腺癌占比35.9%,乳头状腺癌占比51.6%,均高于术后病理检查的25.0%、28.1%,组间比较差异具有统计学意义(P＜0.05);胃镜活检分化程度结果对比,胃镜病理与术后病理检查结果对比有明显差异,具有统计学意义(P＜0.05)。结论 对胃癌进行诊断时,尽管术前胃镜活检病理检查与外科术后病理检查结果存在差异,但术前胃镜活检对胃癌确诊率较为理想,可作为术前诊断参考,外科术后病理检查对全面评估胃癌病情具有较高应用价值,值得在临床中应用。

目的 调查广州市市级(三级)妇幼医院与广州市农村地区区级(二级)妇幼医院护士离职意愿与工作满意度情况。方法 以广州市某三级甲等妇幼医院和4所(花都、南沙、从化、增城)地区二级妇幼医院的3 026名护士为研究对象。应用护士工作满意度量表(MMSS)及离职意愿量表(TIQ)进行问卷调查,并比较分析不同级别妇幼医院护士的离职意愿和工作满意度的差异。结果 相比二级妇幼医院,三级妇幼医院护士的平均年龄较大、学历、职称和奖金均较高、有编制人数所占比例较大,差异有统计学意义(P<0.05)。二、三级妇幼医院护士离职意愿平均得分依次为(2.38±0.682)分、(2.87±0.570)分,工作满意度平均得分依次为(3.34±0.702)分、(3.00±0.482)分。差异均有统计学意义(P<0.05)。结论 相比二级妇幼医院,三级妇幼医院护士离职意愿更强,工作满意度更低,护理管理者可采取有效措施提高护士工作满意度。

Objectives To investigate the current status of nurses' turnover intention and job satisfaction in secondary and tertiary women and children's hospitals in Guangzhou. Methods 3 026 nurses were enrolled in this study, which were from a tertiary hospital in Guangzhou urban area and another 4 secondary hospitals located in rural districts, namely Huadu, Nansha, Conghua, Zengcheng. Systematic sampling was adopted. The Mueller/McCloskey Nurse Job Satisfaction Scale (MMSS) and Turnover IntentionQuestionaire(TIQ)were applied to carry out this investigation. Differences of nurses' turnover intention and job satisfaction between different levels' hospitals were compared and analyzed. Results Compared with those in the secondary hospitals, nurses in the tertiary maternity hospital were at higher average age, had better academic backgrounds with higher professional titles, more bonus and more positions of establishment. The differences all were statistically significant (P<0.05). The average scores of turnover intention for nurses from the secondary and tertiary hospitals were2.38±0.682 and 2.87 ±0.570 respectively. All the differences were statistically significant (P<0.05). Conclusion Compared with those in the secondary maternal and child health hospitals, nurses in the tertiary hospitals were more willing to leave and had lower job satisfaction. Nurse's managers may take effective measurses to increase nurse's satisfaction.

目的 探讨早期功能训练对环状软骨上喉部分切除术后喉癌患者吞咽功能的影响效果。方法 将54例患者按入院时间的先后分为对照组26例和干预组28例,对照组按常规护理,干预组进行早期吞咽功能训练,于患者出院前、出院后1个月和3个月进行效果测评。结果 干预组于出院前、出院后1个月、出院后3个月吞咽功能恢复正常和SSA评分下降优于对照组,两组比较差异均有统计学意义(P＜0.05)。结论 对环状软骨上喉部分切除术后喉癌患者实施早期功能训练可改善患者吞咽功能障碍、促进快速康复。

Objective To investigate the effect of early functional training on the swallowing function of laryngectomy patients after partial laryngectomy with cricoid. Methods According to the admission time, 54 patients were divided into control group (26 cases) and intervention group (28 cases). The control group was given routine nursing, while the intervention group received early swallowing function training. The effect was evaluated before and after discharge, 1 months and 3 months after discharge. Results In the intervention group, the swallowing function returned to normal and the SSA score in the intervention group before discharge, 1 months after discharge and 3 months after discharge was lower than that in the control group. The difference between the two groups was statistically significant (P<0.05). Conclusion Early functional training for laryngectomy patients after partial laryngectomy may improve the patient's swallowing dysfunction and promote rapid rehabilitation.

目的 探讨持续负压吸引在微通道经皮肾镜取石术治疗鹿角形肾结石的临床效果。方法 选取2016年1月—2017年12月在我院确诊鹿角形肾结石并行经皮肾镜取石术治疗的病例138例;根据通道大小、有无负压吸引装置分为观察组和对照组,其中观察组66例,采用20F微通道联合持续负压吸引,对照组72例,采用22F标准通道,无负压吸引。比较两组的术中生命体征变化、肾盂内压力以及术后发热的发生率。结果 观察组在术中血压和心率等生命体征变化、肾盂内压力以及术后发热的发生率均低于对照组,差异有统计学意义(P<0.05)。结论 微通道联合负压吸引行经皮肾镜取石术治疗鹿角形肾结石可以有效降低肾盂内压力,有效维持生命体征的稳定,减少术后发热的发生率,提高手术安全性。

Objective To explore the clinical effect of percutaneous nephrolithotomy for treatment of staghorn kidney stonesusingmicro-channel combined with vacuum suction. Methods A total of 138 patientsofstaghorn kidney stones with PCNL in our hospital from January 2016 to December 2017 were included and divided into experimental group and control group according to the size of the channel and the vacuum suction device. Y-type minimally invasive dilatation drainage kit of 20F micro-channelandvacuum suctionwere used in experimental group within 66 patients.A standard channel (22F diameter) without vacuum suction was used in control group within 72 patients. The changes in vital signs, intrapelvic pressureand incidence of postoperative fever were compared between experimental and control groups. Results The vital signs variety of blood pressure and heart rate, intrapelvic pressure and incidence of postoperative fever in experimental group were lower than those in control group(P<0.05). Conclusion Micro-channel combined with vacuum suctioninpercutaneous nephrolithotomy for treatment of staghorn kidney stones could effectively maintenance of stable vital signs, reduce intrapelvic pressure and the incidence ofpostoperative fever, and improve the safety of surgery.

目的 研究护理干预对慢性阻塞性肺疾病患者抑郁焦虑情绪的效果。方法 选取2015年2月—2017年3月我院收治的慢性阻塞性肺疾病患者84例为观察对象。2015年2月—2016年2月入院患者42例为对照组,遵医嘱给予治疗,同时均予以常规慢性阻塞性肺疾病知识宣教。2016年3月—2017年3月入院患者42例为观察组在对照组基础上予以优质护理干预。分别比较干预前后两组患者抑郁、焦虑及干预前后肺功能变化、患者满意度、生活质量。结果 干预后观察组抑郁自评量表(SDS)、焦虑自评量表(SAS)评分分别为(20.05±5.24)分、(21.57±6.03)分,均低于对照组(28.57±5.29)分、(31.72±6.14)分,差异有统计学意义(P＜0.05)。干预后观察组FEV1水平(2.00±0.33)L,高于对照组的(1.68±0.25)L、观察组FEV1/FVC水平分别为(69.50±7.95)%,高于对照组的(65.18±8.43)%,差异有统计学意义(P＜0.05)。观察组患者满意度为95.24%(40/42),高于对照组的73.81%(31/42),差异有统计学意义(P＜0.05)。观察组患者各项SF-36评分均高于对照组,均P＜0.05差异有统计学意义。结论 优质护理干预可缓解患者负性情绪,改善肺功能,提高满意度及生活质量。

Objective To study effects of nursing intervention in paitents with chronic obstructive pulmonary disease. Methods 84 patients with chronic obstructive pulmonary disease admitted to our hospital from February 2015 to March 2017 were selected as the observation objects. From February 2015 to February 2016, 42 patients admitted to the control group were treated with conventional therapy. From March 2016 to March 2017, 42 patients admitted to the hospital as the observation group were given quality nursing intervention on the basis of the control group. The depression, anxiety, lung function changes, patient satisfaction and quality of life before and after intervention were compared between the two groups before and after intervention. Results After the intervention, the SDS and SAS scores of the observation group were (20.05±5.24), (21.57±6.03), which were lowered than that of the control group (28.57±5.29), (31.72±6.14), the difference was statistical significance (P<0.05). After intervention, the level of FEV1 in the observation group (2+0.33) L was higher than that in the control group (1.68+0.25) L, and the FEV1/FVC level in the observation group was (69.50+7.95)%, which was higher than that in the control group (65.18+8.43)%,the difference was statistical significance (P<0.05). Satisfaction of patients in the observation group was 95.24% (40/42), higher than the control group 73.81% (31/42),the difference was statistical significance (P<0.05). The SF-36 scores of the observation group were higher than those of the control group, P<0.05, the difference was statistical significance. Conclusion High quality nursing intervention may effectively alleviate depression, anxiety and other negative emotions, improve lung function, satisfaction and quality of life.

目的 比较改良包皮环切缝合器法(缝合器组)与传统包皮环切法(传统手术组)治疗包皮过长及包茎的临床疗效。方法 分析本专科近2年收治的300例手术患者(缝合器组209例,传统手术组91例)。对比手术时间、术中出血量、术后疼痛、术后排尿情况、愈合后外观满意度。采用视觉模拟评分(VAS)评估术后疼痛。结果 缝合器组手术时间为(5.41±1.39)min,术中出血量(2.41±1.66)mL,术后疼痛评分(3.59±0.89)分, 切口愈合时间(7.36±1.33)d。传统手术组手术时间为(33.96±2.62)min。术中出血量(15.40±3.66)mL,术后疼痛评分(4.76±1.17)分, 切口愈合时间(8.15±2.13)d。缝合器组在手术时间、出血量、术后疼痛评分、切口愈合时间、愈合后外观方面均优于传统手术组(P<0.05),且疼痛主要在术后6 h内。而术后出血、血肿发生率两组相近。上述并发症分别经血肿清除、切口再缝合、加压包扎及口服抗炎消肿药物等处理后愈合。术后1月内缝合钉未脱落18例(8.61%),返院人工去除。两组均未出现切口裂开,包皮口狭窄。结论 一次性包皮环切缝合器行包皮环切术具有创伤小、痛苦小、并发症少、安全性高、外观整齐美观等优点,但也要掌握手术关键环节的技巧以减少并发症的发生。

Objective To compare the clinical efficacy of modified disposable circumcision stapler and conventional circumcision in the treatment of redundant prepuce. Methods 300 patients with redundant prepuce or phimosis from May 2014 to May 2016 with who underwent modified disposable circumcision stapler (n=209) or traditional circumcision (n=91) were reviewed retrospectively. Comparisons were made between the two groups in the operation time, blood loss, postoperative pain score, time of wound healing, post-circumcision bleeding and postoperative satisfaction with penile appearance. Results The disposable circumcision stapler group showed great advantages over the traditional circumcision group in mean operation time, blood loss, postoperative visual analog scale (VAS) score for pain, time to wound healing and postoperative satisfaction with the penile appearance (P<0.05). However, there were no significant difference in post-circumcision bleeding, and other complications (P>0.05). Conclusion The disposable circumcision stapler is of convenience, safety and efficacy with shorter operation time, less pain and less complication. However, we should improve operative skills and avoid postoperative complications.

目的 应用中国膳食平衡指数(DBI-07)对活动期溃疡性结肠炎(Ulcerative Colitis,UC)患者进行膳食质量评价,并分析其与营养指标、活动度等的关系,为UC患者制订科学的营养干预措施提供依据。方法 选取我院符合纳入标准的82例UC患者进行研究,用食物频率法对患者进行膳食调查,应用膳食平衡指数DBI-07评分系统进行评价,同时进行人体测量及营养指标测定。数据用SPSS 17.0软件进行处理分析。结果 本研究中68.3%的UC患者体质量近半年有不同程度降低,40.2%的患者存低白蛋白血症,34.1%的合并贫血。UC患者TS平均值-20.02±7.97; LBS平均值-22.15±6.78, 其中54.9%存在轻度膳食摄入不足、37.8%存在中度摄入不足;DQD平均值24.27±6.21,其中轻、中度失衡分别占80.5%、17.1%。LBS绝对值与体质量减轻程度呈正相关,P<0.05,与血清白蛋白负相关,P<0.01;DQD与白蛋白呈负相关,P<0.01;4 UC患者LBS绝对值与UC活动度呈正相关,P<0.01;DQD值与UC活动度负相关,P<0.01。结论 以中国膳食平衡指数DBI-07评价UC患者膳食质量,92.7%的患者存在低、中度摄入不足,97.6%的UC患者存在膳食失衡,均明显高于健康人群。摄入不足是UC患者营养不良的重要原因,应对UC患者进行营养补充或营养支持。

Objective To survey the diet quality of UC patients using Chinese diet balance index(DBI-07) and explore their relationship with nutritional index and activity of disease, thereby to provide evidences of nutritional therapy for UC patients. Methods 82 adult UC patients who met the inclusion criteria were included in our study. They were investigated with food frequency questionnaires(FFQ) and diet quality was assessed with DBI-07. Anthropometric measurement and blood examinations were done. Data were analyzed with SPSS 17 software. Results 68.3% of the UC patients loss their weight during the recent 6 months. 40.2% of the patients were found hypoalbuminemia and 34.1% were complicated with anemia. The mean TS,LBS and DQD were -20.02±7.97, -22.15±6.78 and 24.27±6.21 respectively. Percentage of patients in slightly or moderately deficit of food intake were 54.9% and 37.8%. Percentage of the UC patients in slightly or moderately dietary imbalance were 80.5% and 17.1%.The absolute value of LBS and DQD were negatively correlated with serum albumin respectively, and both of them were positively correlated with activity of UC. Conclusion Evaluating the quality of UC with DBI-07,92.7% of UC patients were in slightly or moderately deficit of food intake,97.6% were in slightly or moderately dietary imbalance. These percentages were higher than that of healthy people. It indicated that deficit of food intake is an important reason resulting in malnutrition. Nutrition therapy is essential for UC patients.

目的 分析并探讨T细胞斑点技术诊断结核性胸膜炎的临床价值。方法 将2014年5月—2016年5月收治61例的结核性胸膜炎的患者和61例非结核性胸膜炎的患者同时行外周血和胸水的T细胞斑点实验,对各组数据进行统计学处理与分析。结果 结核组血T-SPOT的阳性率为88.52%,高于非结核组的16.39%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为88.52％、83.61%、85.71%、86.44%、5.40、0.14、0.72。结核组胸水T-SPOT的阳性率为90.16%,高于非结核组的8.20%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82。联合外周血及胸水T-SPOT检测阳性率为91.80%,特异度为93.44%,阳性似然比为14.00,阴性似然比为0.09,youden指数为:0.85。结论 T细胞斑点实验检测对结核性胸膜炎有较高的临床诊断价值,外周血及胸水T-SPOT联合检测可提高诊断率,可作为结核性胸膜炎快速早期诊断的有效辅助手段。

Objective To analysis the value of T-SPOT.TB in the diagnosis of tuberculous pleurisy. Methods A total of 61 patients with clinically suspected tuberculous pleurisy (group A) and 61 cases of other diseases caused by pleural effusion (group B)admitted from May 2014 to May 2015 from the Guangzhou Chest Hospital had peripheral blood T-SPOT.TB and pleural effusion T-SPOT.TB,for each group of data for statistical processing and analysis. Results The positive rate of T-SPOT in the blood of the group A was 88.52%, which was higher than group B, (P<0.001) (16.39.0%). And the sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 88.52%, 83.61%,85.714%, 86.44%, 540, 0.14, 0.72 respectively by peripheral blood T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of pleural effusion T-SPOT in the group A was 90.16%, which was also higher than group B (P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82 respectively by pleural effusion T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of the joint tests of T-SPOT in peripheral blood and in peripheral blood was 91.80%, the specificity was 93.44%, the positive likelihood ratio was 14, the negative likelihood ratio was 0.09, and the youden index was 0.85. Conclusion T-SPOT.TB for the diagnosis of tuberculous pleurisy has a higher clinical value in the diagnosis. The joint tests of T-SPOT in peripheral blood and in pleural effusion may improve the positive rate in the diagnosis of tuberculous pleurisy. The joint tests of T-SPOT in peripheral blood and in pleural effusion have an important reference for diagnosing suspected tuberculous pleurisy quickly, early and accurately.