目的 在糖尿病尿失禁女性患者中使用盆底肌功能训练手册,了解该手册对改善糖尿病女性尿失禁的作用。方法 将260例糖尿病尿失禁患者随机分为观察组、对照组,2组均进行常规盆底肌功能训练,每月提醒患者坚持训练,观察组在此基础上发放盆底肌功能训练手册,指导患者及家属填写方法, 每月检查填写记录情况;在治疗前、后评价2组患者尿失禁改善、观察心理健康改善情况。结果 观察组患者在干预后尿失禁改善、心理健康改善优于对照组。盆底肌功能训练手册准确真实反映患者治疗的落实情况,可督促患者落实治疗,从而提高治疗效果,提高患者生活质量。结论 盆底肌功能训练手册对糖尿病尿失禁患者实用性高,尤其对于记忆力下降的糖尿病患者实用性高。

目的 观察脑血管球囊成形支架置入术治疗急性脑梗死的疗效。方法 选取我院和珠江医院2015年1月—2017年7月收治的急性脑梗死患者40例,根据随机数表法分为观察组及对照组,各20例。对照组单纯施以药物治疗,观察组在对照组基础上加以脑血管球囊成形支架置入术治疗,对比两组治疗前后凝血功能指标水平变化情况及疗效。结果 治疗后,观察组APTT、PT、TT、INR水平高于对照组,Fbg水平低于对照组,治疗总有效率高于对照组,差异有统计学意义(P＜0.05)。结论 脑血管球囊成形支架置入术治疗急性脑梗死疗效确切,患者临床症状得到更好更快的改善,可改善患者凝血功能,对急性脑梗死的早期救治有着极为重要的应用价值。

目的 探讨载脂蛋白E基因多态性在COPD患者合并AD中的意义。方法 通过病例资料进行回顾性研究,收集慢性阻塞性肺疾病70例,阿尔茨海默病81例,健康对照人群566例,进行统计分析。结果 “AD组”和“COPD合并AD组”的LDL水平高于“COPD未合并AD组”;“COPD组”的ApoE水平高于“AD组”,且在“COPD组”中,未合并AD者的ApoE水平明显高于合并AD者;“COPD组”的ε3/ε4基因型均少于“AD组”,且“COPD未合并AD组”的ε3/ε4基因型明显少于“COPD合并AD组”;“AD组”及“COPD合并AD组”的ε4等位基因频率多于“COPD组”及“COPD未合并AD组”;“COPD合并AD组”的ε3/ε3基因型少于“健康对照组”,而ε2/ε4基因型则多于“健康对照组”;“COPD组”的ε3/ε4基因型多于“健康体检组”;“COPD合并AD组”的ε3/ε4基因型多于“健康体检组”;“COPD合并AD组”的ε4等位基因频率高于“健康对照组”。结论 ApoE基因多态性不但参与COPD患者认知功能受损甚至合并AD,而且可能通过影响脂质代谢,参与COPD的发生发展;ApoE的ε4等位基因可能是COPD和AD患病的共同危险因素。

目的 分析与比较不同血运重建策略对急性心肌梗死合并多支血管病变患者的疗效,以探讨其临床价值。方法 选取本院在2012年8月—2015年8月期间收治的急性心肌梗死合并多支血管病变患者,对每个患者均成功行PCI后,按随机数字表法分为实验组与对照组,实验组于发病后7～10天行预防性急诊PCI,并对非梗死相关血管病变进行干预;对照组则根据患者的缺血情况对非梗死相关血管病变行急诊PCI。随访2年,并记录2组患者主要心脏不良事件、其它心血管事件以及再次急诊PCI情况。结果 共有450例患者完成2年的随访,实验组患者有226例,对照组患者有224例。2组患者的全因病死率(χ²=7.040,P=0.008)、心脏不良事件(P均>0.05)以及心力衰竭发生率(χ²=1. 527,P=0.217)均无统计学差异。与对照组相比,实验组再发心绞痛(χ²=21.092,P<0.001)、心因性再住院(χ²=22.893,P<0.001)和再次支架治疗(χ²=17.835,P<0.001)的发生率均明显较低,而其相关血管血运重建率较高。且实验组随访2年时,β受体阻滞剂(χ²=7.040,P=0.008)和硝酸酯类药物(χ²=63.889,P<0.001)服用率均明显较高。结论 急性心肌梗死合并多支血管病变患者在成功行急诊干预梗死相关血管后,且预防性干预非梗死相关血管,可使再发心绞痛、再次支架治疗以及心因性再住院的发生率显著降低。

Objective By analyzing and comparing the effects of different revascularization strategies on patients with acute myocardial infarction complicated with multi-vessel disease, to explore its clinical value.Methods Selecting the patients with acute myocardial infarction complicated with multi-vessel disease from August, 2012 to August, 2015 in our hospital (Zhaoqing No.2 People's Hospital), after each patient was successfully treated with PCI, divided them into experimental group and control group by random number table method, the experimental groups were treated with preventive emergency PCI after the onset 7-10 days, and the intervention of non-infarct-related vascular diseases were done;the control groups were treated with emergency PCI for the non-infarct-related vascular diseases according to the patient's lack of blood. Visiting them randomly for 2 years, the main cardiac adverse events, other cardiovascular events and one more emergency PCI situation in the two groups were recorded.Results A total of 450 patients completed two years of follow-up, with 226 patients in the experimental group and 224 patients in the control group. All-cause mortality (χ2=7.040,P=0.008), cardiac adverse events (P> 0.05)and incidence of heart failure (χ2=1. 527,P=0.217) were no statistically significant difference between the two groups. Compared with the control group, the incidence of angina pectoris (χ2=21.092,P<0.001), cardiologic rehospitalization (χ2=22.893,P<0.001)and one more stent treatment (χ2=17.835,P<0.001) of the experimental group was significantly lower, but the revascularization rate was higher of their related blood vessels. And when the experimental group was followed up for 2 years, the taking rate of β-blockers (χ2=7.040,P=0.008) and nitrates (χ2=63.889,P<0.001) was significantly higher.Conclusion After the patients with acute myocardial infarction complicated with multi-vessel disease were successfully treated with emergency PCI to intervene the infarct-related blood vessels, and at the same time the intervention of the non-infarct-related blood vessels were done, the recurrence of angina pectoris, stent treatment and cardiopulmonary rehospitalization was significantly reduced.

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 探究聚乙二醇筛查法在高泌乳血症诊断中的临床意义。方法 选取260例HP患者作为观察组以及80例健康体检者作为对照组。应用雅培I2000全自动化学发光检测仪对两组标本进行PRL浓度测定,并将标本进行PEG筛查法沉淀后再次进行PRL浓度测定,将所得数据进行对比。结果 观察组检出MP67例,检出率25.77%,对照组检出MP3例,检出率3.75%,二者差异有统计学意义(P＜0.05);HP组、MP组和对照组之间PEG沉淀前PRL浓度差异有统计学意义(P＜0.05),沉淀后HP组和MP组以及对照组差异有统计学意义(P＜0.05),MP组和对照组差异无统计学意义(P＞0.05);MP在HP引起的各种临床疾病中检出情况差异无统计学意义(P＞0.05)。结论 应用聚乙二醇筛查法对于排除MPRL对HP诊断的干扰具有可行性,对降低HP的误诊率有着重要的意义。

Objective To explore the clinical signification of polyethylene glycol screening method on the diagnosis of hyperprolactinemiat.Methods We selected 260 patients with hyperprolactinemia as observation group and 80 healthy individuals as control group. The two groups were measured with Abbott laboratories I2000 automatic chemiluminescence detector about the concentration of PRL. Then the groups were measured again after they were precipitated by the polyethylene glycol and the result data were analyzed.Results 78 cases of MP were checked out from the observation group and 3 cases were checked out from the control group. The proportion was 25.77% and 3.75% respectively, and the differences were statistically significant (P＜0.05). The difference of the concentration of PRL before precipitated by PEG among the HP group, the MP group and the control group were statistically significant (P＜0.05). After precipitating, the difference of the concentration of PRL between the HP group and the MP group were statistically significant (P＜0.05), as well as the HP group and the control group. However, there was no difference between the MP group and the control group (P＞0.05). The checking conditions of MP in some diseases caused by HP had no difference(P＞0.05).Conclusion The use of polyethylene glycol screening method is a practicable method to eliminate the interference of MPRL on the diagnosis in HP. It has significance reducing misdiagnosis rate of HP.

目的 了解社区医护人员的心理健康状况,评估心理干预措施效果,找到提高社区医护人员心理健康状况的有效措施。方法 采用《症状自评量表 SCL-90》对社区医护人员的心理健康状况进行基线调查,在干预3、6、9个月时分别进行SCL-90复测,以评估心理干预措施效果;根据《医护人员工作压力测试量表》的调查结果制定有针对性的心理干预措施并适时调整。结果 社区医护人员SCL-90测评总分和躯体化、强迫、人际敏感、焦虑、敌对、恐怖、偏执7个因子得分均高于全国常模水平(P<0.05);经过综合干预,随访期间SCL-90测评总分呈逐步下降趋势,干预6个月时,除人际敏感因子外,SCL-90测评总分及各因子分已趋于正常水平,与全国常模比较差异没有统计学意义(P<0.05)。至9个月时,人际敏感因子得分也恢复至正常水平。结论 社区医护人员心理健康状况低于全国常模水平,进行针对性的综合干预可提高其心理健康水平,实验显示干预时长应不低于6个月。

Objective To understand the mental health status of community health care workers, assess the effect of psychological intervention measures, and find effective measures to improve the mental health status of community health care workers.Methods With the help of Symptom Checklist SCL-90, we firstly carried out baseline survey on community medical staff mental health; then retested that at 3, 6 and 9 months later. Thus, we could assess the effect of psychological intervention. According to the results of the medical staff working pressure test questionnaire, we could develop targeted psychological intervention measures and adopt prompt adjustment.Results Community health care personnel SCL-90 evaluation score and 7 factors scores(physical,forced,interpersonal sensitivity,anxiety,hostility,terror,and paranoia) were higher than the national norm(P<0.05);after comprehensive intervention in the 9 months follow-up,the SCL-90 evaluation score was decreasing gradually.After intervention for 6 months,except for the interpersonal sensitivity factor,SCL-90 total scores and the other factor scores tend to normal levels, to compare the national norm, there was no statistical significance in differences (P<0.05). 9 months later, the scores of interpersonal sensitivity also return to normal levels.Conclusion The mental health status of community health care workers was lower than the national norm,the comprehensive intervention may improve their mental health level, and the experiment showed that the intervention should be no less than 6 months.

目的 探讨低中心静脉压(LCVP)对肝癌肝切除术的影响及意义。方法 选择我院2010年3月—2012年3月期间拟行肝切除术的原发性肝癌患者60例,随机分为LCVP组(30例)和NCVP(30例)。LCVP组术中采用相关技术控制CVP<0.5 kPa;NCVP组术中CVP和血压控制在基础值10%上下范围内。两组的麻醉方法、切口、切肝方法、输血指征均一致。分别记录:心率、血压、CVP值和血常规;手术时间、手术切除肝组织范围、手术期间各阶段出血量、输注血制品的数量;术后第1、3、7天的肝肾功能以及凝血功能,所需补充的外源性白蛋白量;术后并发症的发生率、住院时间和费用。结果 ①2组术前一般临床资料比较均无差异(均P>0 05)。②LCVP组手术时间、手术总出血量、肝离断时出血量、RBC输注量均低于NCVP组(P<0.05);③2组术后肝功能、肾功能指标比较无差异(P>0.05),LCVP组患者术后白蛋白补充量比NCVP组减少(P<0.05);④2组患者术后肝功能衰竭、膈下积液、胆瘘、大量腹水、肺部感染、空气栓塞、死亡的发生率比较,均无差异(P>0.05);⑤LCVP患者住院天数、住院总费用均比NCVP组减少(P<0.05)。结论 术中应用LCVP可减少肝癌肝切除术中出血量,缩短住院时间和住院费用,有利于患者的术后恢复。

Objective To evaluate the effect of LCVP applied during the operation of hepatectomy.Methods Sixty patients underwent hepatectomy were enrolled in the study from March 2010 to March 2012 in our hospital which were randomized into LCVP group and normal CVP (NCVP) group by the sealed envelope method. CVP was kept<0.5 kPa during entire procedure of hepatectomy in LCVP group, and the value of CVP and blood pressure were controlled within 10% of the baseline. The same anesthesia, incision and hepatectomy technique and indications of blood transfusion in LCVP group were undertaken as those in NCVP group. Intraoperative CVP, blood pressure, HR and blood routine were recorded. The time of operation, the amount of bleeding, the extent of removed hepatic tissue, the amount of transfused blood products,liver and renal function index, and coagulation function index were detected on the 1st, 3rd and 7th day after operation. Also the supplement of albumin, the rate of postoperation complications and the length of hospital stay and the expense in hospital were recorded.Results ① The general clinical data of patients were similar in the two group (P>0.05). ② The operation time, total bleeding volume, bleeding volume and RBC infusion volume in LCVP group were significantly lower than those in group NCVP (P<0.05). ③ There were no significant difference of postoperative liver and renal function index between the two groups (P>0.05). But the supplement of albumin in LCVP group after operation was significant less than that in NCVP group (P<0.05). ④ There were no significant difference of the postoperative complication, the length of hospital stay and the expense in hospital between the two groups (P>0.05).Conclusions The application of LCVP in hepatectomy cause less blood loss, shorten the length of hospital stay and decrease the expense in hospital, which is beneficial for the postoperative recovery.

目的 探究全科诊疗过程中健康管理流程再造的效果。方法 选取深圳市龙岗区第二人民医院(东方半岛社区健康服务中心)的病例,即2015年1月—2015年12月的病例作为对照组(使用旧流程);2016年6月—2017年5月的病例作为观察组(使用新流程),对2组相关数据进行回顾性分析整理,观察2组全科诊疗的健康管理情况并实施比较。结果 观察组全科诊疗人次、妇女儿童保健人数、老年保健人数、新增慢病管理人数、家庭医生签约户数、高危人群早期干预人数等同比增长率均高于对照组,2组比较差异有统计学意义(P<0.05)。结论 全科诊疗过程中健康管理流程再造,能够为更多的居民提供优质健康服务,故对于提高全民健康水平具有重要意义,因而值得临床借鉴应用。

Objective To explore the effect of health management process reengineering on the process of general practice.Methods The cases of Shenzhen Longgang District Second People's Hospital from January 2015 to December 2015 were selected as the control group (using the old process), and that from June 2016 to May 2017 were selected as the observation group (using the new process). The clinical data in the two groups were retrospectively analyzed, and the health management of the two groups of general medical was observed and compared.Results The growth rates in the observation group, such as visits of outpatient service, the numbers of women and children health care, the numbers of elderly health care, the numbers of new chronic disease management, the numbers of family doctors signed and the numbers of early intervention of high-risk groups, were higher than that in the control group (P<0.05).Conclusion The health management process reengineering in the process of general practice may provide better health services to more residents, and it is important for improving the health of all people. It is well worth to clinical reference and application.

目的 分析稳定期慢性阻塞性肺疾病患者血浆可溶性尿激酶型纤溶酶原激活因子受体(suPAR)、IL-8和MMP-9的水平,探讨其在慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者中的临床意义。方法 入选60例稳定期COPD患者设为观察组,再根据肺功能分为Ⅱ级、Ⅲ级及Ⅳ级亚组;同时选取同期健康体检者70例作为对照组,检测两组的血清suPAR、IL-8和MMP-9水平及肺功能,比较观察组跟对照之间的差异,同时比较Ⅱ级、Ⅲ级、Ⅳ级亚组及对照组之间的差异。结果 观察组血清suPAR、IL-8和MMP-9水平高于对照组;Ⅱ级、Ⅲ级及Ⅳ级各亚组的血清suPAR、IL-8和MMP-9均高于对照组;Ⅲ级及Ⅳ级组高于Ⅱ级组;以上差异均有统计学意义(P<0.05)。但Ⅲ级与Ⅳ级比较无差异(P>0.05)。结论 血清suPAR、IL-8和MMP-9在稳定期COPD患者中水平增高,且反映了其严重程度,有望成为COPD病情评估新指标及未来分子水平治疗的新靶点。

Objective To analyze the serum soluble urokinase-type plasminogen activator receptor, IL-8 and MMP-9 levels in stable chronic obstructive pulmonary disease and explore its clinical significance.Methods 60 patitents with stable COPD were selected as the observation group, and subdivided to subgroups stage Ⅱ, Ⅲ and Ⅳ. Meanwhile, 70 healthy individuals were enrolled as the control group. And then suPAR、IL-8 and MMP-9 levels and pulmonary function were measured in both groups. The differences between both groups as well as all the subgroups were compared.Results The suPAR level of the observation group was higher than that of the control group. Also, compared with the control group, stage Ⅱ, Ⅲ and Ⅳ subgroups showed much higher level of suPAR,IL-8,MMP-9. And it was higher in stageⅢand Ⅳthan in stageⅡ. However, there was no difference between Stage Ⅲ and Ⅳ.Conclusion The suPAR,IL-8 and MMP-9 level are higher in COPD patients and are related to the severity of stages. Therefore, it could be an appropriate biomarker as well as a novel target for future therapy and further evaluation.