目的 分析曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗卵巢子宫内膜异位囊肿(OEC)患者的效果。方法 选取我院2019年1月—2020年5月期间收治的OEC患者108例,采用随机抽签法分成研究组与对照组,各54例。对照组行腹腔镜下卵巢囊肿剥除术治疗,研究组基于对照组加用曲普瑞林治疗,统计对比2组疗效、妊娠率以及术前、术后6个月、1年血清性激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、抗苗勒管激素(AMH)]、血清高迁移率组蛋白B1(HMGB1)、视黄醇结合蛋白4(RBP4)、糖类抗原125(CA125)水平。结果 研究组治疗总有效率92.59%高于对照组75.93%(P＜0.05);术后6个月、1年研究组LH、FSH低于对照组,AMH高于对照组(P＜0.05);术后6个月、1年研究组CA125、RBP4、HMGB1低于对照组(P＜0.05);研究组妊娠率59.26%高于对照组29.63%(P＜0.05)。结论 曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗OEC患者时,可改善性激素水平,提高妊娠率,降低血清CA125、RBP4、HMGB1水平。

目的 探究不同麻醉方式对患有冠心病的老年患者外科介入不良心血管事件作用的对比。方法 选取2020年1月—2021年1月,我院确诊的冠心病患者,且无心脏外科干预手术80 例,随机分为研究干预组(n=40)和空白对照组(n=40),研究组采用2%的七氟醚,对照组用丙泊酚联合瑞芬太尼,维持麻醉血浆靶浓度在3.0～6.0 mg/L 之间,方式为静脉泵注;分析2组病人外科术后负性心脏情况控制影响; 结果 研究组和对照组患者的肌酸激酶存在差异,同时心脏肌钙蛋白T的高低也存在差异(P均<0.05);研究组在术后的负性心血管情况发病率均低于空白对照组,其中研究组的心源性猝死、心律紊乱不齐和心脏源性的休克等的病变率要远低于对照组,统计学差异存在意义(P均＜0.05);而其中研究组的心力衰竭与对照组相比,差异不具有统计学意义(P＞0.05)。结论 相比于静脉麻醉,吸入式麻醉能够趋好性降低非心脏手术术后负性心脏相关风险的发生率,该研究对于临床实践有一定的参考意义和实践可操作性,可以考虑普及推广。

目的 分析团体认知行为干预联合揿针全程护理对胃癌晚期癌痛患者心理状态的影响。方法 选取我院115例胃癌晚期癌痛患者(2018年3月—2021年1月),依照干预方案不同分为3组。对照1组(37例)接受团体认知行为干预,对照2组(38例)接受揿针全程护理干预,观察组(40例)接受团体认知行为干预联合揿针全程护理干预,比较3组干预效果。结果 疼痛爆发时疼痛缓解情况:观察组疼痛爆发时疼痛缓解率均较对照1组、对照2组高(P＜0.05);心理状态:干预1个月后,3组心理状态均得到改善,且观察组汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分均较对照1组、对照2组低(P＜0.05);护理满意度:与对照1组、对照2组对比,观察组护理满意度较高(P＜0.05)。结论 团体认知行为干预联合揿针全程护理应用于胃癌晚期癌痛患者,能有效缓解疼痛,改善心理状态,且护理满意度高。

Objective To analyze the effect of group cognitive behavior intervention combined with whole-process nursing of pressing needle on the psychological state of patients with advanced gastric cancer pain. Methods A total of 115 patients with advanced gastric cancer pain in our hospital (from March 2018 to January 2021) were selected and divided into 3 groups according to different intervention methods. Control group 1 (37 cases) received group cognitive behavioral intervention, control group 2 (38 cases) received whole-course nursing intervention of pressing needle, and observation group (40 cases) received whole-process nursing intervention of group cognitive behavioral intervention combined with pressing needle. The intervention effects of the three groups were compared. Results Pain relief when pain burst: the pain relief rate of observation group was higher than control group 1 and control group 2 (P<0.05). Mental state: after 1 month of intervention, the mental state of the 3 groups was improved, and the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the observation group were lower than those in control group 1 and control group 2 (P<0.05). Nursing satisfaction: compared with control group 1 and control group 2, nursing satisfaction of observation group was higher (P<0.05). Conclusions Group cognitive behavior intervention combined with whole-process nursing of pressing needle applied to patients with advanced gastric cancer pain could effectively relieve pain, improve psychological state, and nursing satisfaction.

目的 观察失效模式与效应分析(FMEA)在医务人员血源性职业暴露监测分析及防护的应用。方法 采用FMEA回顾性分析2018年1月—2019年6月我院医务人员血源性职业暴露高危因素,计算风险指数(RPN),优先处理最高风险因素,制定改进措施,且于2019年7月—2020年12月采用改进后方案,对照分析方案实施前后失效模式RPN值、血源性职业暴露情况、医院安全氛围量表中文版。结果 采用FMEA后,RPN、权重系数(W_i)均降低,且RPN实施前为2 633分,实施后为853分,降幅为67.60%,W_i实施前为0.729 9,实施后为0.268 0,降幅为63.28%,均达到预定目标。采用FMEA前,血源性职业暴露率为28.74%,采用FMEA后,血源性职业暴露率为4.65%。实施整改方案后的安全工作阻碍(11.99±2.16)分、清洁度和整洁度(11.48±1.89)分、管理与支持(28.58±3.24)分、冲突与沟通(22.54±2.83)分、反馈和培训(13.82±2.55)分均高于实施前(10.67±2.68)分、(10.06±2.36)分、(26.80±3.86)分、(20.85±2.62)分、(12.52±1.19)分,P<0.05。结论 在医务人员血源性职业暴露管理中采用FMEA,可以细化高风险环节,提高改进措施的针对性,减少职业暴露。

Objective To observe the application of failure mode and effect analysis (FMEA) in monitoring analysis and protection countermeasures of blood-borne occupational exposure of medical personnel. Methods FMEA was used to retrospectively analyze the high risk factors of blood-borne occupational exposure of medical staff in our hospital from January 2018 to June 2019, to calculate the risk priority number (RPN), to give priority to the highest risk factor, to formulate improvement measures. The improved scheme was adopted from July 2019 to December 2020. The RPN value of failure mode, blood-borne occupational exposure and Chinese Hospital Safety Atmosphere Scale (C-HSCS) before and after the implementating of the scheme were compared and analyzed. Results After implementating FMEA, RPN and weight coefficient (W_i) decreased, and the RPN scores were 2 633 and 853 before and after implementation, with a decrease of 67.60%, W_i was 0.729 9 before implementation and 0.268 0 after implementation, with a decrease of 63.28%. Before FMEA, the blood-borne occupational exposure rate was 28.74%, and after FMEA, the rate was 4.65%. After the implementation, the scores of safety work obstruction was (11.99±2.16), cleanliness and tidiness was (11.48±1.89), management and support was (28.58±3.24), conflict and communication was (22.54±2.83), feedback and training was (13.82±2.55), which were higher than those before the implementation: (10.67±2.68), (10.06±2.36), (26.80±3.86), (20.85±2.62), (12.52±1.19), P<0.05. Conclusions Using FMEA in the management of blood-borne occupational exposure of medical personnel could refine high-risk steps, improve the pertinence of improvement measures and reduce occupational exposure.

目的 针对胆结石手术患者,评价应用快速康复外科(ERAS)理念辅助护理的实践效果,同时分析其对患者术后并发症以及机体康复情况的影响。方法 选取本院在2019年8月—2020月5月间收治的84例胆结石手术患者为研究对象,采取随机数字表法对纳入患者进行随机分组:实施常规护理干预的患者作为本研究的对照组,实施快速康复外科护理干预的患者作为本研究的干预组;对比术后患者并发症发生情况及恢复情况。结果 干预组患者术后拔管、首次肛门排气、排便及住院时间较对照组均有缩短(P<0.05);且干预组穿孔、感染、胰腺炎等总并发症发生几率低于对照组(2.38% vs 14.28%,P<0.05)。结论 在护理胆结石手术患者中,采取快速康复外科护理干预可有效预防多种术后并发症的发生,并能够有效加快患者术后康复进程,建议推广。

Objective To evaluate the practical effect of assisted nursing with the concept of enhanced recovery after surgery (ERAS) for patients underwent cholelithiasis surgery, and analyze its impact on postoperative complications and physical rehabilitation. Methods Eighty-four patients underwent cholelithiasis operation in our hospital from August, 2019 to May,2020 were selected as the research objects, and the patients were randomly divided into two groups by random number table. The control group was given routine nursing intervention, while the observation group was given nursing intervention based on ERAS.The postoperative complications incidence and recovery of patients were compared. Results Data showed that the postoperative extubation time, first anal exhaust, defecation time and hospitalization time in the observation group were significantly shorter than those in the control group (P<0.05). The total incidence of complications in the observation group was significantly lower than that in the control group (2.38% vs 14.28%, P<0.05). Conclusions In nursing patients undergoing cholelithiasis surgery, ERAS nursing intervention can effectively prevent the occurrence of a variety of postoperative complications, and can effectively speed up the process of postoperative rehabilitation, which is recommended to popularize.

目的 探讨胰岛素联合乌司他丁在高脂血症性重症胰腺炎中的临床疗效。方法 研究资料来自广州市花都区人民医院肝胆胰外科自2018年—2020年收治的72例高脂血症性重症胰腺炎患者资料,所有患者按照不同治疗方案随机分为3组,每组各24例。对照组采用急性胰腺炎常规治疗(即生长抑素+液体疗法);乌司他丁组则于常规组上联用乌司他丁;而研究组在常规及联合乌司他丁治疗基础上加用胰岛素强化治疗,比较3组患者腹痛及胃肠功能恢复的时间、甘油三酯下降的水平,治疗前、治疗后第3天、7天的APACHE Ⅱ评分的变化情况。结果 研究组患者腹痛症状缓解及胃肠功能恢复时间均较对照组明显缩短、腹痛症状缓解时间较乌司他丁组缩短,且研究组甘油三酯下降水平较对照组和乌司他丁组快,而研究组第3天和第7天的APACHE-Ⅱ评分较常规组及乌司他丁组低,以上差别均有统计学意义(P<0.05)。结论 胰岛素联合乌司他丁可明显改善高脂血症合并重症急性胰腺炎腹部症状、缩短胃肠功能恢复时间、迅速降低血清甘油三酯水平,对患者近期疗效确切。

Objective To explore curative effect of insulin combined with ulinastatin in therapy of severe hyperlipidemic pancreatitis. Methods A total of 72 patients with hyperlipidemia complicated with severe acute pancreatitis were randomly divided into three groups according to different treatment plans, 24 cases in each group. The regular treatment of acute pancreatitis (somatostatin+liquid therapy) was carried out in control group. Base on the regular treatment of acute pancreatitis, ulinastatin was added in ulinastatin group. Base on the treatment of ulinastatin group, insulin was added in study group, and the time of abdominal pain and gastrointestinal function recovery, glycerin level and the APACHE Ⅱ score before and after treatment among three groups were compared. Results Compared with the control group and ulinastatin group, the time of abdominal pain relief and gastrointestinal function recovery in the study group were significantly shorter, the time of triglycerides level back to normal in the study group was shorter than the other two groups, while at the third and seventh day, the APACHE Ⅱ score of the study group was lower than that of other two groups, with statistical significance (P<0.05). Conclusions Insulin combined with ulinastatin could significantly improve abdominal symptoms of hyperlipidemia complicated with severe acute pancreatitis, promote the recovery of gastrointestinal function, and rapidly reduce the level of serum triglyceride.

目的 探讨自拟补肝益肾壮腰汤联合脊柱推拿、牵引对腰椎间盘突出症(LDH)患者肌电图和腰椎功能的影响及临床效果。方法 选取106例LDH患者采用随机数字表法分为观察组和对照组各53例。对照组行脊柱推拿及牵引治疗,观察组在此基础上加用自拟补肝益肾壮腰汤。记录2组患者治疗前及治疗3个月后的腰椎功能程度[Oswestry功能障碍指数(ODI)]、肌电图[平均功率频率(MPF)、中位频率斜率(MFs)、平均肌电波幅(AEMG)]、运动功能障碍程度[日本骨科协会下腰痛量表(JOA)]及疼痛程度[视觉模拟评分法(VAS)]评估结果差异。结果 治疗3个月后,2组JOA评分、VAS评分及各项肌电图参数(MPF、MFs、AEMG)均较治疗前有提升,且观察组均高于对照组(P均＜0.05);ODI评分则较治疗前下降(P均＜0.05),且观察组低于对照组(P＜0.05)。结论 自拟补肝益肾壮腰汤联合脊柱推拿及牵引能明显改善LDH患者腰椎功能,促进肌力恢复、缓解肌肉疲劳、减轻疼痛,有较高的临床实用价值。

Objective To investigate the effect of self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction on electromyography and lumbar function and clinical efficacy in patients with lumbar disc herniation (LDH). Methods A total of 106 patients with LDH were randomly divided into observation group and control group. The control group was treated with spinal massage and traction, and the observation group was treated with self-made Bugan Yishen Zhuangyao decoction on this basis. The degree of lumbar spine function [Oswestry disability index (ODI)], electromyography [mean power frequency (MPF), median frequency slope (MFS), average EMG amplitude (AEMG)], the degree of motor dysfunction [Japanese Orthopaedic Association (JOA) score] and the degree of pain [visual analog scale (VAS)] before and 3 months after treatment were recorded and compared. Results After 3 months of treatment, JOA score, VAS score and EMG parameters (MPF, MFS and AEMG) in the two groups were significantly higher than those before treatment, and those in the observation group were higher (P<0.05); ODI score was significantly lower than that before treatment (all P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusions The self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction can significantly improve the lumbar function of patients with LDH, promote the recovery of muscle strength, relieve muscle fatigue and pain, and with high clinical practical value.

目的 探讨左卡尼汀联合生脉注射液对维持性血液透析低血压心脏功能的影响。方法 选取我院2016年1月—2020年2月收治的维持性血液透析反复低血压患者120例,随机分为对照组(n=40)、左卡尼汀组(n=40)和联合组(n=40)。3组均采用常规治疗,左卡尼汀组加用左卡尼汀,联合组加用左卡尼汀联合生脉注射液。分析3组治疗前后低血压发生率、血压指标、心肌酶谱、心肌梗死定量指标及超声心动图指标变化。收集3组治疗过程中发生不良反应情况。结果 联合组低血压发生率低于对照组和左卡尼汀组(P＜0.05);联合组治疗后透析中最低收缩压、透析中平均动脉压、透析后收缩压、透析后平均动脉压均高于对照组和左卡尼汀组(P＜0.05);联合组治疗后心肌谱酶、心肌梗死定量指标均低于对照组及左卡尼汀组(P＜0.05);3组治疗前后肺动脉收缩压、右室壁舒张末期厚度、右室舒张末期内径、左室舒张末期内径、右室收缩末期面积、右室舒张末期面积差异无统计学意义(P＞0.05);联合组治疗后左室射血分数高于对照组和左卡尼汀组(P＜0.05);3组不良反应发生率差异无统计学意义(P＞0.05)。结论 左卡尼汀联合生脉注射液可降低维持性血液透析患者低血压的发生率,改善患者心功能,具有较好的疗效及安全性。

Objective To investigate the effect of L-carnitine combined with Shengmai Injection on cardiac function in patients with maintenance hemodialysis hypotension. Methods A total of 120 maintenance hemodialysis patients with recurrent hypotension in our hospital from January 2016 to February 2020 were randomly divided into control group (n=40), L-carnitine group (n=40) and combination group (n=40). The three groups were treated with conventional treatment, L-carnitine group was added with L-carnitine, and the combination group was given levocarnitine combined with Shengmai Injection. The incidence of hypotension, blood pressure index, myocardial enzyme spectrum, quantitative index of myocardial infarction and echocardiography index were obtained and analyzed before and after treatment. The adverse reactions in the three groups were collected. Results The incidence of hypotension in combination group was lower than that in control group and L-carnitine group (P<0.05). After treatment, the minimum systolic blood pressure, mean arterial pressure during dialysis, systolic blood pressure after dialysis and mean arterial pressure after dialysis in the combination group were higher than those in the control group and L-carnitine group (P<0.05). After treatment, the myocardial spectrum enzyme and myocardial infarction quantitative indexes in the combination group were lower than those in the control group and L-carnitine group (P<0.05). There were no significant differences in pulmonary artery systolic pressure, diastolic right ventricular wall thickness, diastolic right ventricular width, diastolic left ventricular width, systolic right ventricular area and diastolic right ventricular area among the three groups before and after treatment (P>0.05). The left ventricular ejection fraction of the combination group was higher than that of the control group and L-carnitine group (P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusions L-carnitine combined with Shengmai Injection could reduce the incidence of hypotension in maintenance hemodialysis patients, improve the cardiac function, with good efficacy and safety.

目的 探讨在早期早产儿配方奶(PF)喂养失败下,更换母乳(HM)或深度水解奶(eHF)对极低出生体质量儿喂养不耐受(FI)的改善情况。方法 选择2016年1月—2018年1月在广州市妇女儿童医疗中心出生、生后PF喂养失败、出现FI的极低出生体质量儿84例,根据家长HM喂养意愿及条件,分为HM喂养组38例和eHF喂养组46例,比较2组患儿更换喂养配方后FI消失时间、FI改善率、达全肠内喂养时间及体质量增长情况等喂养结局。结果 相对于eHF喂养组,HM喂养组FI消失时间更快,FI改善率更高,达全肠内喂养时间更快,差异有统计学意义。HM喂养组平均每日体质量增长量、出院时体质量均明显大于eHF喂养组,住院时间更短,出院时宫外发育迟缓(EUGR)发生率更低,差异有统计学意义。2组患儿坏死性小肠结肠炎、胆汁淤积症、院内感染发生率比较无统计学差异。结论 当极低出生体质量儿PF喂养失败、出现FI时,选择HM或eHF均可改善FI,但HM效果更好,达全肠内喂养时间更快且体质量增长更理想,出院时EUGR发生率较低。

Objective To investigate the improvement of feeding intolerance (FI) by changing human milk (HM) or extensively hydrolyzed formula(eHF) after failure of preterm formula (PF) feeding in very low birth weight (VLBW) infants. Methods Eighty-four VLBW infants who were born in Guangzhou Women and Children's Medical Center from January 2016 to January 2018 with PF feeding failure and FI were divided into HM feeding group (n=38) and eHF feeding group (n=46) according to their parents' HM feeding willingness and conditions.The time of FI disappearance, FI improvement rate, total enteral feeding time and weight gain were compared between the two groups after changing feeding formula. Results Compared with the eHF feeding group, the disappearance time of FI, the time of getting total intestinal feeding in the HM feeding group were shorter, and the improvement rate of FI was higher,the differences were statistically significant.The average daily weight increase and discharge weight of the HM feeding group were significantly more than those of the eHF feeding group, and the length of hospital stay, the incidence of extrauterine growth retardation(EUGR) at discharge were lower, the differences were statistically significant.There was no significant difference in the incidence of necrotizing enterocolitis, cholestasis and nosocomial infection between the two groups. Conclusions In the case of failure of PF feeding and FI in VLBW infants, both HM and eHF could ameliorate FI, but HM had a better effect, with a shorter time of getting total intestinal feeding, better weight gain and a lower incidence of EUGR at discharge.

目的 研究羌活胜湿汤对风湿外感头痛患者的疗效。方法 选择2018年1月—2020年12月我院收治的62例风湿外感头痛患者,随机分为2组。对照组服用5 mg的氟桂利嗪胶囊,每晚1次;观察组联用羌活胜湿汤。比较2组风湿外感头痛患者的有效率,治疗前后的睡眠质量评分和视觉模拟评分法(VAS)评分。结果 观察组风湿外感头痛患者的有效率(96.77%)高于对照组(80.64%) (P<0.05);治疗前,2组风湿外感头痛患者的VAS评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的VAS评分降低(P<0.05),且观察组风湿外感头痛患者的VAS评分更低(P<0.05);治疗前,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分降低(P<0.05),且观察组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分低于对照组(P<0.05)。结论 羌活胜湿汤对风湿外感头痛患者有显著的疗效,与其能明显减轻疼痛程度和改善睡眠质量有关。

Objective To investigate the effect of Qianghuo Shengshi decoction on patients with wind-damp headache. Methods A total of 62 cases of patients with wind-damp headache who were treated in our hospital from January 2018 to December 2020 were selected and divided into two groups randomly. The control group took 5 mg of flunarizine capsules once a night; the observation group took Qianghuo Shengshi decoction additionally. The effective rate, sleep quality score and visual analogue scale(VAS) score before and after treatment were compared between the two groups of patients. Results The effective rate of the observation group (96.77%) was significantly higher than that of the control group (80.64%, P<0.05). Before treatment, the VAS scores of the two groups of patients with exogenous wind-damp headache were not significantly different (P>0.05). After treatment, the VAS scores of the two groups were significantly reduced (P<0.05), and the score drop of the observation group was significant (P<0.05). Before treatment, there were no significant differences in night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition score between the two groups (P>0.05), after treatment, the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in both groups were significantly decreased (P<0.05), and the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in the observation group were significantly lower than those in the control group (P<0.05). Conclusions Qianghuo Shengshi decoction had a significant effect on patients with wind-damp headache, and its was related to its ability of significant pain reduction and sleep quality improvement.