目的 探讨健康教育路径联合集束化护理模式在预防脑卒中患者便秘的效果观察。方法 随机选择神经外科收治的脑卒中患者120例,分为实验组与对照组,各60例,其中对照组给予常规护理,而实验组在常规护理基础上应用健康教育路径联合集束化护理模式。比较两组患者便秘发生率、便秘措施落实率、患者满意度、及患者入院前后的健康教育知识知晓率的比较。结果 实验组便秘发生率明显低于对照组,便秘护理评估率,护理措施落实率,病人满意度明显高于观察组,患者入院后的健康教育知识知晓率明显升高(P<0.05),具有统计学意义。结论 健康教育路径联合集束化护理模式能有效的降低脑卒中患者便秘发生率,提高预防便秘发生护理措施落实率,提高患者满意度,提高患者舒适度。

目的 探讨品管圈活动在提高神经外科卧床患者便秘预防措施落实率中的的应用效果。方法 成立品管圈,确定以“提高神经外科卧床患者便秘预防措施落实率”为主题,进行现状调查,设定目标,进行要因分析,制定并实施措施,比较品管圈活动前后护士落实便秘预防措施情况。结果 实施品管圈活动后,神经外科卧床患者便秘预防措施落实率从活动前的41.59%上升至活动后85.6%,差异有统计学意义(P＜0.05)。结论 品管圈活动可以有效提高神经外科卧床患者便秘预防措施落实率,降低便秘的发生率,减轻患者痛苦,改善患者生活质量。

目的 观察社区综合防治健康管理模式对社区高血压患者血压控制疗效及药物经济学的影响。方法 收集2012年7月—2013年7月广州参与研究的三级医院及社区卫生服务中心收治的原发性高血压病患者2 383例,病例入组后随机分为综合管理组和常规治疗组。记录及随访两组高血压患者基线血压值、降压药物使用方案、是否更换药物、血压控制疗效及药物经济学相关费用情况。结果 与常规治疗组相比,综合管理组患者血压治疗效果较好,显效率及总有效率提高[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001];高血压治疗及管理的药物费用虽有升高(t=16.186,P＜0.001),但相关的门诊费用、住院费用、护理费用及总费用降低(t=25.647, t=35.785, t=22.274,t=73.710,P＜0.001);在降压方案方面,从减少抗高血压药物使用,减少费用考虑,单独用药方式适合单纯性轻度高血压患者,从费用效果分析上,成本效果比以单药组最低,联用药组逐渐增大;增量成本-效果比:二药联用降压方案优于其他降压联合方案,因而两药联用降压为兼顾疗效和成本的降压较佳组合。结论 应用社区综合防治模式对高血压患者进行干预,效果满意,能够有效降低成本-效果比,值得临床推广应用。

Objective To investigate the effects of comprehensive prevention and control measures on the therapeutic efficient and pharmacoeconomics in community hypertension patients. Methods 2383 cases of hypertension were collected from July 2012 to July 2013 in the tertiary and community hospitals in Guangzhou, which were randomly divided into general therapy group, in which the patients were treated by general administration of drugs, and comprehensive management group that the patients were visited regularly. The sources of drugs, drugs use and changes in drugs were investigated. Results Compared with the general therapy group, better treatment effects were achieved in the comprehensive group. The apparent efficiency and total efficiency were both increased in the comprehensive group[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001]. Although the therapy and pharmacy fees were slightly increased in the comprehensive group as compared to the control group (t=16.186, P＜0.001), the outpatient expenses,hospitalization expenses, nursing expenses and the total expenses were decreased(t=25.647; t=35.785; t=22.274;t=73.710;P＜0.001). Considering reducing the use of drugs and decreasing the cost, the method of using single drug is beneficial to the patients of low-risk mild hypertension. The method of using calcium antagonist is the most economical and reasonable way. Conclusion Standardizing management of hypertension in community is effective in improving hypertension treatment and decreasing the cost, which is thus worth popularizing.

目的 对信息协作平台的社区结直肠癌三级防治及干预体系进行探索与实践。方法 对纳入本次研究的2 492名社区人群进行问卷调查,包括健康人群1 118人,1 374例肿瘤患者。分析健康人群和肿瘤患者关于肿瘤防治知识及途径的认知情况,比较健康人群和肿瘤患者就诊首选医院,了解肿瘤患者就诊流向和行为以及发现患癌的途径。结果 在肿瘤患者中知道癌前病变、早期肿瘤症状、高危人群的比例显著高于健康人群[26.93%(370/1 374)、39.96%(549/1 374)、46.00%(632/1 374)比14.49%(162/1 118)、21.91%(245/1 118)、26.92%(301/1 118)]。健康人群认为肿瘤三级防治网络可行、会参加三级防治网、有必要开展癌症筛查、会参加筛查的比率显著高于肿瘤患者[98.83%(1 105/1 118)、91.95%(1 028/1 118)、98.12%(1 097/1 118)、98.03%(1 096/1 118)比81.95%(1 126/1 374)、79.98%(1 099/1 374)、80.93%(1 112/1 374)、85.95%(1 181/1 374)],差异均有统计学意义(P<0.05)。健康人群把三甲医院视为就诊首选医院的比率显著低于肿瘤患者[32.56%(364/1 118)比86.97%(1 195/1 374)](P<0.05)。肿瘤患者中发现肿瘤及确诊医院、肿瘤复诊、康复医院的选取主要以三甲综合医院为主。在肿瘤患者中因身体不适到医院就诊发现患癌的比率显著高于单位员工体检、自检发现、社区卫生服务中心体检发现的比率。结论 我国目前肿瘤发病率和死亡率正处在快速上升的阶段,利用网络优势,加大肿瘤防治知识的宣传力度,建立社区、区域二级医院、三级医院优势互补的三级肿瘤防控体系,是当前我国肿瘤防治的迫切需求。

Objective To explore and practice the community tertiary prevention and intervention system for colorectal cancer based on information collaboration platform. Methods A questionnaire survey was conducted among 2 492 community residents which were included in this study, including the healthy crowd of 1 118 people, 1 374 cases of tumor patients. The study was to analyze the knowledge of cancer prevention and treatment in healthy people and cancer patients, to contrast the preferred hospital by healthy people and cancer patients, to acquaint the flow direction in seeking medical service, behavior and way to diagnosis cancer of tumor patients. Results In patients with cancer, the understanding proportion of patients with precancerous lesions, early tumor symptoms, and high risk groups was significantly higher than that in healthy people [26.93% (370/1 374), 39.96% (549/1 374), 46.00% (632/1 374) vs 14.49% (162/1 118), 21.91% (245/1 118), 26.92% (301/1 118)]. In healthy people, the proportion of identification of tumor three-grade prevention and control network, willing to participate in the tertiary prevention and control network, necessity to carry out cancer screening, willing to participate in screening was significantly higher than that in patients with cancer [98.83% (1 105/1 118), 91.95% (1 028/1 118), 98.12% (1 097/1 118), 98.03% (1 096/1 118) vs 81.95% (1 126/1 374), 79.98% (1 099/1 374) and 80.93% (1 112/1 374), 85.95% (1 181/1 374)]. There were significantly differences (P<0.05). Healthy people preferred to choose common hospital instead of 3A hospital as the first choice [32.56% (364/1 118) vs 86.97% (1 195/1 374)] (P<0.05). Discovery and diagnosis of cancer, further consultation, and rehabilitation were mainly carried out in 3A hospital. In patients with cancer, the cancer discovery ratio because of physical discomfort for medical attention was significantly higher than that in unit staff physical examination, self-inspection found, and physical examination in community health service center. Conclusion At present, the incidence and mortality of cancer in our country is in a stage of rapid rising. It's an urgent need for cancer prevention and control in China that making use of the advantage of network to improve the propaganda of the knowledge of cancer prevention and control, and establishing complementary advantages of the tertiary cancer prevention and control system by community, regional hospitals, and 3A hospitals.

目的 探讨分析氨茶碱治疗早产儿呼吸暂停的临床疗效及其在治疗过程中所出现的不良事件。方法 选取2014年9—2016年3月广州市第一人民医院新生儿科接受住院治疗的胎龄＜34周,生后2 h内入住新生儿科的早产儿42例。随机分为对照组和氨茶碱组,对照组(20例)给予保暖、吸氧、补充能量、保持呼吸道通畅、物理刺激等对症治疗,不使用氨茶碱及其它改善呼吸的药物;氨茶碱组(22例)患儿除给予对照组治疗措施外,同时给予氨茶碱静脉滴注,首剂负荷量5 mg/kg,在20min内完成,12 h后以2～2.5 mg/kg维持量,每隔12 h一次。观察两组的疗效与不良影响。结果 ①两组患儿性别、出生胎龄、出生体重、产前孕母糖皮质激素的应用、受孕方式、分娩方式、多胎妊娠、5min Apgar评分、机械通气及CPAP辅助通气例数、低-中流量吸氧(箱内或头罩给氧)例数等方面差异均无统计学意义(P均＞0.05)。②与对照组相比,氨茶碱组早产儿呼吸暂停(AOP)发生的次数较少,AOP消失所需时间较短,差异均有统计学意义(P＜0.05)。③不良影响方面,氨茶碱组脑白质发育不良发生率(63.6%,14/22例)显著高于对照组(25%,5/20例),差异有统计学意义(P＜0.05);两组患儿在听力检查异常、喂养不耐受、血糖紊乱、血脂代谢紊乱、血红蛋白下降、电解质紊乱、出院时体重及住院时间等方面均无统计学意义(P均＞0.05)。④氨茶碱组视网膜发育不完全的发生率(40.9%,9/22例)明显高于对照组(15.0%,3/20例),但差异无统计学意义(P＞0.05)。结论 小剂量氨茶碱在防治AOP方面的作用是值得肯定的,但它有可能增加早产儿脑白质发育不良的风险与视网膜发育不完全的风险。

Objective To investigate the clinical efficacy and adverse effects of aminophylline in prevention of apnea of prematurity. Methods Forty-two infants with gestational age ＜34 weeks admitted to department of pediatrics, Guangzhou first people's hospital between Sep. 2014 and Mar. 2016 were randomly divided into 2 groups: control group and aminophylline group. Control group(n=20): 20 infants received warming, oxygen inhalation, supplement energy, maintain airway patency, physical stimulation, such as symptomatic treatment, without aminophylline or any other drugs for improving breathing. Aminophylline group(n=22): In addition to the control group treatment measures, 22 infants received a loading dose of 5 mg/kg of aminophylline and then maintained by a dose of 2mg/kg with intravenous drip q 12 h. Then we compared the efficacy and adverse effects of the two groups. Results ①There was no significant difference in gender, gestational age, birth weight, maternal antenatal glucocorticoid application, pregnancy(including multiple pregnancy) and delivery,5 min Apgar score, oxygen therapy, the application of mechanical ventilation, nasal continuous positive airway pressure, and the low-medium flow oxygen inhalation between the 2 groups(all P＞0.05). ② Compared with the control group, the incidence of apnea in aminophylline group were significant lower, and the time needed for apnea to disappear were significant shorter(all P＞0.05). ③ The incidence of cerebral white matter development dysplasia of aminophylline group(63.6%,14/22 cases) were significant higher than the control group(25%,5/20 cases, P＜0.05). There was no statistically significant difference in hearing loss, feeding intolerance, blood glucose disturbance, blood lipid metabolism disorder, hemoglobin decrease, electrolyte disorder, body weight at discharge, the duration and cost of hospitalization between the 2 groups(all P＞0.05). ④ The incidence of retinal incompleted development of aminophylline group(40.9%, 9/22 cases) were higher than control group(15.0%, 3/20 cases), but there was no statistical significance between the 2 groups(P＞0.05). Conclusion Effects of aminophylline in treating apnea of prematurity is positive, but it is likely to increase the risk of premature brain white matter development dysplasia and the risk of retinal incompleted development.

目的 探讨长期吸烟史对高危脑卒中患者口服阿司匹林二级预防效果的影响。方法 将2012年8月—2014年8月医院口服阿司匹林二级预防的高危脑卒中患者115例作为研究对象,根据有无吸烟史分为无吸烟史组(34例)和吸烟史组(81例),其中36例吸烟时间≥20 a(长期吸烟史组)、45例吸烟时间1～19 a(短期吸烟史组)。随访12个月,测定血小板颗粒膜蛋白(GMP-140)、D-二聚体(D-D)、纤维蛋白原(FIB)、组织型纤溶酶原激活物(t-PA)、血小板膜糖蛋白CD61、CD62p,记录1年阿司匹林抵抗和临床终点事件发生率。结果 长期吸烟史组治疗前后GMP-140、D-D、FIB、CD61、CD62p高于短期吸烟史组和无吸烟史组,t-PA低于短期吸烟史组和无吸烟史组,且短期吸烟史组和无吸烟史组组间比较,差异有统计学意义(P＜0.05);长期吸烟组阿司匹林抵抗发生率和临床终点事件发生率分别为33.33%、30.56%,高于无吸烟史组的8.82%、8.82%,差异有统计学意义(P＜0.05),其余组组间比较差异无统计学意义(P＞0.05)。结论 长期吸烟史会使脑卒中患者存在血栓前状态,增加阿司匹林抵抗和临床终点事件的发生几率。

Objective To explore effects of long-term smoking on secondary prevention for oral aspirin in high-risk stroke patients. Methods A total of 115 high-risk stroke patients who orally took aspirin for secondary prevention in our hospital from August 2012 to August 2014 were selected as the study subjects. According to smoking or not, they were divided into non smoking history group (34 cases) and smoking history group (81 cases). Among them, 36 cases whose smoking time was ≥ 20 years were included in the long-term smoking history group, and 45 cases whose smoking time was 1 to 19 years were included in the short-term smoking history group. The patients were followed up for 12 months. The platelet granule membrane protein (GMP-140), D-dimer (D-D), fibrinogen (FIB), tissue plasminogen activator (t-PA), platelet membrane glycoprotein CD61 and CD62p were determined. The incidence rates of 1-year aspirin resistance and clinical outcome events in the three groups were recorded. Results Before and after treatment, GMP-140, D-D, FIB, CD61 and CD62p in long-term smoking history group were higher than those in short-term smoking history group and non smoking history group while T-PA was lower, and there were significant differences between short-term smoking history group and non smoking history group (P<0.05). The incidence rates of aspirin resistance and clinical outcome events in long-term smoking history group (33.33%, 30.56%) were higher than those in non smoking history group (8.82%, 8.82%)(P<0.05), but there was no significant difference among other groups (P>0.05). Conclusion Long-term smoking history will cause prethrombotic state in stroke patients and increase the incidence rates of aspirin resistance and clinical outcome events.

成人急性呼吸窘迫综合征死亡率居高不下,而当前治疗手段大多以对症支持为主且效果欠佳。通过早期识别ARDS高危患者,及早施加干预措施阻断疾病进展是目前研究的新方向。较之传统机械通气模式,气道压力释放通气因其特有的肺保护作用备受国内外学者关注,APRV下肺泡持续开放并保持稳定可减少肺损伤发生,将APRV应用于ARDS预防理论上前景可观,本文将围绕早期实施APRV对预防ARDS应用价值展开论述。

The mortality of adult acute respiratory distress syndrome(ARDS) remains high. Supportive care measures are main treatments to ARDS currently while the effect is poor. Early application of airway pressure release ventilation in patients who are at high risk for ARDS is a new direction of research. Compared with traditional mechanical ventilation, more and more scholars both at home and abroad pay attention to the airway pressure release ventilation APRV because of its unique lung protection. Under APRV the alveoli maintain stable continuously which may reduce the incidence of lung injury. Applying APRV to ARDS prevention is promising theoretically. This paper will focus on the value of preemptive airway pressure ventilation for high-risk ARDS patients.

目的 了解广州市社区医务人员对颈动脉狭窄防治知识的认知程度、认知途径及对相关健康教育的需求情况。方法 对37家社区卫生服务中心194名广州市社区医务人员进行问卷调查,分析调查结果。结果 社区医务人员中52.58%能够指出颈动脉狭窄与脑卒中的关系,但对症状性颈动脉狭窄定义、颈动脉狭窄的外科治疗方法知晓率偏低(14.95%、18.56%),97.94%能够指出颈部彩超是颈动脉狭窄最常用的筛查方法,但对彩超结果判读、干预方法指导等方面内容掌握率偏低。对颈动脉狭窄知识来源目前最主要的是用药指南和药品说明书(33.89%)认为最有效获得颈动脉狭窄知识的途径是专题继续教育培训班(26.12%)。结论 社区医务人员已经形成了脑卒中和颈动脉狭窄的基本观念,但是不能达到足够的“深度”,通过开展多种形式继续教育,增进社区医务人员对颈动脉狭窄认知的广度和深度,引导和拓宽获得知识的途径将是必要和有效的。

Objective To understand the knowledge and needs of carotid stenosis prevention among community health workers in Guangzhou. Methods A Kirkpatrick model-based questionnaire survey was conducted among 194 health workers in community health service center in Guangzhou. Results 52.58% of the community medical staff could point out the relationship between carotid stenosis and stroke, but few of them could accurately point out the definition and surgical treatment of symptomatic carotid stenosis(14.95%,18.56%). 97.94% of them could pointed out that the most commonly used screening methods for cervical carotid stenosis, but most of them didn't know how to interpret the inspection result of color doppler ultrasound. Medication guide were the main knowledge source of carotid stenosis(33.89%) and post-graduate training was the most promising approach(26.12%). Conclusion Community health workers have formed the basic concept of stroke and carotid stenosis, but it was limited in extent. It is necessary to carry out various forms of continuing education to improve the level of awareness of community health workers on carotid artery stenosis.

目的 对中医治未病在社区孕妇孕期保健应用中效果进行探讨。方法 选取符合条件的300名社区孕妇,随机分为对照组和干预组,对照组不采取干预措施,干预组依据孕妇的中医体质判定表实施相应的中医干预方法,持续二个月,并对两组孕妇进行随访。对比分析两组孕妇的分娩和产后情况。结果 干预组孕妇自然分娩95例,剖宫产55例,自然分娩率高于对照组孕妇,差异有统计学意义(P<0.05);干预组新生儿巨大儿的发生率为6.7%,低于对照组的16.7%,差异有统计学意义(P<0.05);此外,干预组孕妇先兆流产、早产、妊娠期高血压和妊娠期糖尿病的发生例数低于对照组孕妇(P<0.05)。结论 应用中医治未病思想指导孕期保健,有助于减少孕产妇并发症和巨大儿发生率,保证母儿健康。

目的 探讨规范二级预防下老老年人轻型卒中复发的危险因素。方法 收集我院80岁及以上、既往有轻型卒中病史、并进行规范二级预防半年以上的老老年患者的临床资料:一般资料、既往病史及用药情况、入院时血压及基础生化指标、影像学资料、缺血性卒中复发情况。根据有无复发缺血性卒中将患者分为复发组和无复发组两组,分析以上因素在两组间的差异。结果 80例患者中复发缺血性脑卒中共26例,复发率32.5%。统计结果显示,轻型卒中复发组与合并高血压病、入院时收缩压、D二聚体水平呈正相关,其相关系数分别为0.265(P=0.018)、0.232(P=0.038)和0.222(P=0.048)。复发组收缩压升高比例高于无复发组(χ²=6.919,P=0.031)。非条件Logistic多因素分析显示:合并高血压病[OR 95%CI=(1.162,10.230)]、收缩压升高[OR 95%CI=(0.997,68.840)]与轻型缺血性卒中复发相关。结论 合并高血压病、收缩压升高是老老年人轻型卒中规范二级预防下复发独立危险因素。

Objective To analyze the recurrence risk factors of aged patients with minor ischemic stroke under standardized secondary prevention. Methods Patients over 80 years old and with minor ischemic stroke history were enrolled, and the following data were collected: demographic characteristics, medical history, current medicine, blood test, imaging findings and recurrence of ischemic strokes. Patients were divided into two groups: the recurrence group and the non-recurrence group. Chi-square test,logistic regression models were performed to assess correlations between baseline variables and recurrence of minor stroke events. Results In our study, 26 patients had recurrent minor ischemic stroke(32.5%). The prevalence of recurrence of minor stroke was positively correlated with hypertension(CI 0.265, P 0.018), SBP(CI 0.232,P 0.038), d-2-dimer(CI 0.232,P 0.048). Patients in recurrence group are more likely to presented with SBP elevation compared to non-recurrence group(χ²=6.919, P=0.031). Unconditional logistic regression analysis showed that hypertension, especially high SBP significantly related to minor ischemic stroke recurrence. Conclusion Hypertension,especially elevated SBP, were considered as an independent risk factors for aged old patients with minor ischemic stroke who received standardized secondary prevention.