目的 对3例儿童Rotor综合征的临床特点及SLCO1B1和SLCO1B3基因突变分析,提高儿科医生对Rotor综合征的认识。方法 收集广州市妇女儿童医疗中心2018年—2019年确诊的3例Rotor综合征患儿的临床资料,对患儿及其家系成员肝脏常见遗传代谢性疾病二代测序筛查并家系验证结果进行分析。结果 患儿主要临床表现为反复或持续巩膜和(或)皮肤轻度黄染,实验室检查提示高直接胆红素血症。二代测序发现3例患儿均为SLCO1B1基因c.1738C＞T纯合突变和SLCO1B3基因5号内含子区域大片段插入纯合突变。SLCO1B1基因和SLCO1B3基因2处纯合突变均进行了家系验证。文献报道的SLCO1B1基因c.1738C＞T突变是无义突变,可以造成蛋白功能缺失;SLCO1B3基因的大片段插入突变虽暂未有文献收录或报道,但大片段的插入突变可引起移码突变而造成编码蛋白功能丧失。结论 由于基因检测技术的不断进步,Rotor综合征不断被儿科医生所认识。SLCO1B1和SLCO1B3双基因纯合或复合杂合突变是3例Rotor综合征患儿的分子遗传基础。

Objective To better understand Rotor syndrome(RS)in children,the clinical features and SLCO1B1 and SLC01B3 gene mutations were analyzed. Methods The clinical data of the 3 pediatric cases diagnosed in Guangzhou Women and Children's Medical Center between 2018 and 2019 was collected. Genomic DNA was extracted from the children and their family members, and subjected for second-generation sequencing to screen the known genes for liver genetic metabolic diseases. Then the detected mutations were confirmed by Sanger sequencing analysis. Results The main clinical manifestations were recurrent or persistent mild yellowish sclera and/or skin. Laboratory examinations showed hyperbilirubinemia with direct bilirubin elevating. Second generation sequencing showed that all 3 children were c.1738c＞Thomozygous mutations of SLCO1B1 gene and homozygous mutations of large fragment insertion in SLCO1B3 gene intron 5. Two homozygous mutations in SLCO1B1 gene and SLCO1B3 gene were verified in families.SLCO1B1 gene c.1738C＞T mutation,a nonsense mutation reported in references,could lead to protein function loss.A large insertion mutation of SLCO1B3 gene could cause frame-shift mutation which might lead to protein function loss even though it was neither reported in the references nor recorded in SNP database. Conclusion Due to the progress in the clinical application of gene detection technology, RS has been recognized gradually by pediatricians. Homozygous mutations or compound heterozygous mutations simultaneously occurred in SLCO1B1 and SLCO1B3 gene were the molecular genetics base in these cases of RS.

目的 探讨“分-全带教”在提高门诊实习生处方审核能力的应用效果。方法 对2016届实习生进行“分-全带教”,在实习初期、后期组织实习生对100张门诊处方进行处方审核,登记审核结果。结果 实施“分-全带教”后,处方成功审核例数实习初期的163例(27.17%)提高到后期的487例(81.17%)。结论 应用“分-全带教”模式,有利于门诊实习生掌握处方审核技巧,在提高实习生处方审核能力中有良好应用前景。

Objective To make a discussion of the application result of point-all teaching model in improvement of prescription review ability of interns at outpatient service process. Methods To implement point-all teaching model on interns enrolled in 2016. To ask them to review 100 outpatient prescription at the beginning and ending of the internship respectively and record the results of their review. Results After the implementation of point-all teaching model, the correct review of the prescription has been improved from 163 (27.17%) at the beginning to 487 (81.17%) at the ending. Conclusion The point-all teaching model is conducive for interns at outpatient department to master the technique for review, so it is promising in the improving the prescription review ability of interns.

目的 研究乳腺癌根治术中保留乳头乳晕对术后疗效、上肢功能及外观满意度的影响。方法 选取我院2013年3月—2018年5月40例早期乳腺癌的患者为研究对象,按照数字表随机分组的方案分为观察组和对照组各20例。观察组患者采用保留乳头乳晕的乳腺癌根治术治疗;对照组患者采用传统的根治性手术。比较两组手术时间、术中出血量、术后引流量、术后下床时间、住院时间。比较两组患者术后上肢功能情况,采用上肢功能评定量表(disabilities of arm,shoulder and hand scale,DASH)评估。比较两组术后乳房外观满意度及两组患者术后并发症发生率。结果 观察组手术时间、术中出血量、术后引流量及平均住院时间均低于对照组,差异有统计学意义(P＜0.05)。观察组与对照组患者术后患侧上肢水肿及活动受限发生率相当,差异无统计学意义(P＞0.05)。观察组皮瓣缺血发生率为10.0%低于对照组40.0%,差异有统计学意义(P＜0.05)。观察组术后乳房外观优良率为90.0%,高于对照组优良率60.0%,差异有统计学意义(P＜0.05)。观察组患者术后并发症发生率15.0%低于对照组35.0%,差异有统计学意义(P＜0.05)。结论 保留乳头、乳晕的乳腺癌根治术具有手术效果好、与传统根治术相比,对上肢功能损伤较小、美容效果更好,患者满意度较高等优点,值得临床应用和推广。

目的 探讨甲状旁腺全切除加前臂自身移植术(tPTX+AT)对并发继发性甲状旁腺功能亢进(SHPT)的尿毒症患者心脏功能的影响。方法 将50例接受tPTX+AT治疗的尿毒症并发SHPT患者作为手术组,并配对选择50例同期未接受手术治疗的尿毒症并发SHPT患者作为非手术组。对所有患者进行12个月的随访,分析两组随访过程中心室结构、心脏功能及甲状旁腺功能相关指标的变化情况。结果 在随访过程中,手术组LVD、IVSS、LVPWT、NT-proBNP、iPTH、Ga及P均呈现降低趋势,LVEF呈现升高趋势(P<0.05);非手术组LVEF、iPTH及Ga呈现升高趋势,LVD、IVSS、LVPWT、NT-proBNP及P呈现降低趋势(P<0.05)。在随访6个月及随访12个月时,手术组LVD、IVSS、LVPWT、NT-proBNP、iPTH、Ga及P低于非手术组,LVEF高于非手术组(P<0.05)。结论 tPTX+AT可有效的改善尿毒症并发SHPT患者的心室结构及心脏功能,并可在一定程度上改善患者的甲状旁腺功能。

目的 探讨PBL联合SOAP门诊药历在提高门诊药师药学服务质量的效果。方法 开展SOAP门诊药历工作,并围绕实践中的典型案例开展PBL培训,由学员发现案例中的问题进行提问、分析、讨论,培训药师给予适当指导,并及时对问题解答与讨论过程中的问题进行总结。结果 PBL联合SOAP门诊药历提高了门诊药师的处方审核与处方干预水平,促进门诊药学服务工作顺利开展。结论 PBL联合SOAP门诊药历有利于培养药师独立思考和解决具体问题的临床思维能力,让门诊药师在临床实践中逐渐成长,在医院门诊药师向临床转型的实践中有良好的应用前景。

Objective To discuss the effects over the method of combining PBL with SOAP outpatient medicine records to improve the quality of pharmaceutical service of outpatient pharmacists. Methods We put the SOAP outpatient medicine records into practice and carry out the PBL training based on the typical cases in practice. In this process, the trainees can ask questions, analyze and discuss the problems in the cases, while the trainers should give some guidance, answer the questions immediately and conclude what were discussed. Results The method of combining PBL with SOAP outpatient medicine records has improved the outpatient pharmacists' level of prescription audit and intervention, it is helping to smoothly carry out the outpatient pharmaceutical service. Conclusion Combining PBL with SOAP outpatient medicine records will be helpful for pharmacists to develop their independent clinical thinking which may solve the specific problems, making them much more expert in the clinical practice. It is promising in the practice of outpatient pharmacists transforming to be clinical ones.

目的 探讨以家庭为中心的患教模式对糖尿病患者代谢控制水平的影响。方法 选取168例2016年9月—2017年8月在我院治疗的糖尿病患者,根据不同的健康教育模式干预将其分为观察组和对照组,每组各84例。对照组患者采用传统的综合患教模式,观察组患者在对照组的基础上采用以家庭为中心的患教模式,比较两组患者的自我管理水平及血糖、血脂控制效果。结果 干预后,观察组自我管理总得分、饮食控制、运动锻炼、血糖监测、足部护理、高低血糖处理均优于对照组(P＜0.05);观察组的FBG、PBG、HbA1C、TC、TG、LDL-C水平均低于对照组(P＜0.05)。结论 以家庭为中心的患教模式可辅助患者规范自己的行为,加强自我管理,改善血糖控制水平。

Objective To study the effects of two health education models on the level of metabolic control in diabetic patients. Methods 168 patients with diabetes admitted to our hospital from September 2016 to August 2017 were selected as subjects. According to different health education model interventions, they were divided into observation group and control group, with 84 cases in each group. The patients in the control group adopted a comprehensive health education model, and the patients in the observation group adopted a family-centered health education model based on the control group. The self-management level and blood glucose and blood lipid control effects of the two groups were compared. Results After intervention, the observation group self-management total score, diet control, exercise, blood glucose monitoring, foot care, high and low blood glucose treatment were better than that of control group (P<0.05); observation group FBG, PBG, HbA1C, TC, TG, LDL-C level were lower than that of the control group (P<0.05). Conclusion A family-centered health education model may help patients regulate their behavior, strengthen self-management, and improve their blood sugar control levels.

目的 探究基于微信平台的健康管理对糖尿病老年患者焦虑、抑郁、主观幸福感、血糖水平和生存质量的影响。方法 采取便利抽样方法选取我院老年病科2型糖尿病患者106例,随机分为干预组和对照组各53例。干预组进行基于微信平台的健康管理,主要包括心理干预和健康宣教,对照组实施传统心理干预和健康宣教,比较2组患者的焦虑、抑郁、主观幸福感、空腹血糖、餐后2 h血糖、HbA1C和生存质量。结果 干预后,干预组焦虑发生率低于对照组(P＜0.05),而抑郁发生率与对照组比较,差异无统计学意义(P＞0.05);干预组患者SAS评分、GDS评分、主观幸福感总分空腹血糖、餐后2 h血糖水平、HbA1C、PCS和MCS评分降低或升高效果优于对照组,差异有统计学意义(t=2.823,3.231,-18.956,5.152,7.401,7.528,-3.165,-3.232;P＜0.05)。结论 基于微信平台的健康管理能有效控制糖尿病老年患者的血糖水平,降低焦虑抑郁症状水平,提升主观幸福感和生存质量。

Objective To explore the effect of health management based on WeChat platform on depressive symptoms and quality of life of elderly patients with diabetes. Methods 106 elderly patients with type 2 diabetes hospitalized in geriatrics department in our hospital were selected by convenient sampling method and divided into two groups randomly, with 53 cases in each group. The intervention group was given psychological nursing and health education based on WeChat platform, while the control group received traditional psychological nursing and health education. Finally, the levels of anxiety and depressive symptoms, subjective well-being, fasting blood-glucose, 2h postprandial blood glucose, HbA1C and quality of life, were compared in both groups. Results After the intervention, the incidence of anxiety in the intervention group was lower than that in the control group (P＜0.05), while the incidence of depression did not have statistical difference compared with that in the control group (P＞0.05). The decrease or evaluation of SAS, GDS, subjective well-being, fasting blood-glucose, 2h postprandial blood glucose, HbA1C, PCS and MCS of the intervention group were greater than those in the control group, (t=2.823,3.231,-18.956,5.152,7.401,7.528,-3.165,-3.232;;P＜0.05). Conclusion Psychological intervention and health education by WeChat may control the blood glucose level of elderly patients with diabetes, reduce the level of anxiety and depression symptoms and improve subjective well-being and quality of life effectively.

目的 探讨规范化康复护理在脊髓型颈椎病前路手术术后功能恢复的影响。方法 将60例行颈椎前路椎间隙减压植骨融合内固定术的患者分为观察组和对照组各30例。对照组实施常规护理,观察组实施规范化康复护理措施。分别在出院时、出院后1、3、6个月进行日本骨科协会脊髓功能JOA评分、颈椎功能残障指数NDI评分、疼痛视觉模拟VAS评分、生活自理能力评分以及记录两组住院时间、术后并发症发生率。结果 手术后观察组与对照组的平均住院时间、术后并发症、术后脊髓功能恢复情况、颈椎功能恢复、生活自理能力的差异有统计学意义(P<0.05);观察组的平均住院时间均低于对照组(P<0.05);术后脊髓功能功能评分、生活自理能力评分均高于对照组(P<0.05);颈椎功能残障指数评分、术后并发症发生率均低于对照组(P<0.05)。结论 规范化康复护理可以促进脊髓型颈椎病行前路手术术后脊髓、颈椎功能的恢复,减少住院时间,减少术后并发症的发生,提高患者生活自理能力,提高生活质量。

Objective To investigate the effect of standardized rehabilitation nursing on functional recovery of cervical spondylotic myelopathy (CSM) after anterior operation. Methods Sixty patients were divided into two groups: observation group (n = 30) and control group (n = 30). Routine nursing was carried out in the control group and standardized rehabilitation nursing measures were carried out in the observation group. At the time of discharge, 1,3,6 months after discharge, the JOA score of spinal cord function of the Japanese Orthopaedics Association, the NDI score of cervical spine disability index, the VAS score of visual analogue of pain, the score of self-care ability of life were taken. The length of hospitalization of the two groups and incidence of postoperative complications were recorded. Results There were significant differences in average hospitalization time, postoperative complications, recovery of spinal cord function, recovery of cervical spine function and ability of living self-care between the observation group and the control group after operation (P<0.05). The average hospitalization time in the observation group was lower than that in the control group (P<0.05), and the scores of spinal cord function and self-care ability after operation were higher than those in the control group (P<0.05). The score of cervical disability index and the incidence of postoperative complications were lower than those of the control group (P<0.05). Conclusion Standardized rehabilitation nursing may promote the recovery of spinal cord and cervical spine function, reduce hospital stay, reduce postoperative complications, improve the self-care ability of patients and improve the quality of life.

目的 探究客观结构化临床考试(objective structured clinical examination,OSCE)对夜班护士准入培训效果的影响,并总结经验。方法 选取2017年5月—2018年5月期间首次获得执业注册并接受夜班准入培训的护士62名作为研究对象,采用随机数字法划分为观察组和对照组各31例。夜班准入培训时,对照组采用传统的培训考核模式,观察组采用以客观结构化临床考试为理论框架的培训考核模式,考试内容按教学目标设置,并由临床经验丰富的副高级以上导师围绕专业知识、技能、综合能力等对考点进行设计。培训结束后,两组护士均进行客观结构化临床考试、填写教学满意度量表、分析两组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力得分的差异。结果 观察组对培训效果的满意度为83.87%,对照组的满意度为54.84%,差异有统计学意义 (P＜0.05);与对照组比较,观察组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力及总分上分值明显更高,差异有统计学意义(P＜0.05);6个站点得分中,观察组的平均成绩要高于对照组,对实际临床操作、护理诊断和临床判断方面更具优势,差异有统计学意义(P＜0.05)。结论 客观结构化临床考试培训模式应用在护士夜班准入培训中,有效提高其临床能力及综合能力,提升了护士对培训课程的满意度。

Objective To explore the effect of objective structured clinical examination (OSCE) on the admission training of night shift nurses and to summarize the experience. Methods A total of 62 nurses who received the practice registration and night shift admission training from May 2017 to May 18, 2017 for the first time were selected as the study subjects. They were randomly divided into observation group and control group. For night shift admission training, the control group adopted the traditional training assessment mode, and the observation group adopted the training assessment mode with objective structured clinical examination as the theoretical framework. The examination content was set according to the teaching objectives, and was designed by clinically experienced supervisors at deputy senior level or above revolving the knowledge points of professional knowledge, skills, comprehensive ability. At the end of the trainings, nurses in the two groups took objective structured clinical examinations and filled out the teaching satisfaction scale. The differences in scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability in the two groups were analyzed. Results The satisfaction rate in the observation group was 83.87%, higher than that in the control group, which was 54.84%, and the difference was statistically significant (P<0.05). The scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability and the total scores in the observation group were higher than those in the control group, and the difference was statistically significant (P<0.05). The average score of knowledge points in the observation group was higher than that in the control group, with the former group boasting more advantages in actual clinical operation, nursing diagnosis and clinical judgment, with statistically significant difference between the two groups (P<0.05). Conclusion The application of objective structured clinical examination in nurse's night shift admission training may help improve their clinical ability and comprehensive ability, as well as their satisfaction to training courses.

目的 分析比较总额控制下的病种分值付费和单病种付费支付方式的应用效果。方法 回顾性分析2015年—2018年总额控制下病种分值付费和单病种付费模式下的平均住院费用、医保基金支出以及医保基金收入等基本情况,比对分析总额控制下单病种付费模式下与病种分值付费模式的总体运行效率。结果 2015年—2018年总额控制下病种分值付费情况存在轻微波动,但不出现明显上涨现象,稳定于9 000元左右的水平,并且总额控制下病种分值付费的医保基金结余率处于17%的水平,同时具有稳定的医保基金支出与医保基金收入水平。相比较总额控制下病种分值付费,单病种付费模式下的平均住院费用更高,且呈现出逐年增加的发展趋势;相比较2015年的平均住院费用,2018年平均住院费用高出500元。2015年—2018年总额控制下单病种付费的医保基金结余率具有较大波动,表示医保基金支出与医保基金收入水平不稳定。结论 总额控制下的病种分值付费模式具有明显的医疗费用以及医保基金费用支出控制效果,但同时也具有较大的基础投入水平以及较高管理成本等缺陷端,总额控制下的单病种付费模式具有方便管理的优势,但是在费用控制、病种涵盖等方面不如病种分值付费,总额控制下的单病种付费与病种分值付费各具优势和不足,需要依据区域情况,取长补短,因地制宜以及择优而用,确保健全医保支付方式。

Objective To analyze the application effect of the payment of disease type and the payment of single disease payment under the control of total amount. Methods A retrospective analysis of the basic hospitalization expenses, medical insurance fund expenditures and medical insurance fund income under the control of the total value of the disease and the single-income payment model under the total control from 2015 to 2018 were taken, and to have comparative analysis of the total control of the single disease overall operational efficiency of the payment model with the payment model. Results There was a slight fluctuation in the payment of disease value under the control of total amount from 2015 to 2018, but there was no obvious increase, which was stable at around 9 000 yuan, and the balance of medical insurance fund paid for the disease value under the total control was at 17% level and has both stable medical insurance fund expenditure and medical insurance fund income level. Compared with the total score control under the total amount control, the average hospitalization cost under the single disease payment mode was higher, and showed a trend of increasing year by year; compared with the average hospitalization cost in 2015, the average hospitalization cost in 2018 was higher, out of 500 yuan. From 2015 to 2018, the balance of the medical insurance fund paid for the control of the single disease had a large fluctuation, indicating that the medical insurance fund expenditure and the medical insurance fund income level were unstable. Conclusion The disease-based payment model under total control has obvious control effect of medical expenses and medical insurance fund expenses, but it also has a large basic input level and high management cost and other defects. The payment model has the advantage of convenient management, but it is not as good as the cost control and disease coverage, and the single disease payment and the disease value payment under the total control have their own advantages and disadvantages, which need to be based on the regional situation. We need to make use of the strengths and weaknesses, adapt to local conditions and choose the best, to ensure a sound medical insurance payment method.