目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.

目的 探讨罗伊适应模式对肺癌患者术后生活质量的影响。方法 将2012年3月—2015年7月来我院就诊的178例肺癌术后患者,随机分为试验组85例和对照组93例;对照组患者按护理常规进行护理,试验组在常规护理基础上给予罗伊适应模式护理干预;出院时分别比较两组患者住院适应性、治疗依从性、病人满意度及患者生活质量评分。结果 试验组住院适应率为87.1%(74例),对照组住院适应率为66.7%(62例),两组差异有显著性(P<0.01);试验组治疗依从性优良率为88.2%(75例)、对照组治疗依从性优良率72.0%(67例),两组差异有显著性(P<0.01);试验组患者满意度为89.4%(76例),高于对照组患者满意度73.1%(68例),两组差异有显著性(P<0.01);试验组生活质量评分,总体健康得分(74.1±8.3)高于对照组(56.7±5.9),且差异有统计学意义(P<0.01)。结论 罗伊适应模式护理干预,可以提高肺癌患者手术后的住院适应性、治疗依从性及病人满意度,显著改善患者生活质量,在临床推广罗伊适应模式护理干预具有现实意义。

Objective To investigate　the effect of Roy adaptation model on quality of life in patients for lung cancer after surgery. Methods 178 cases of　patients with lung cancer after surgery operation　were randomly divided into observation groups(85 cases) and control groups(93 cases). The control group was treated with routine nursing care and the observation group was treated on the basis of routine nursing care plus Roy adaptation model nursing interventions. When the two groups were compared in patients hospitalized and discharged adaptability, treatment compliance, patient satisfaction and patient quality of life score. Results Hospitalization adaptation in the observation group was 87.1%(74 cases) and control group was 66.7%(67 cases). There was statistically significant difference between two groups(P<0.01); Excellent treatment compliance of observation group was 88.2%(75 cases) and control group was 72.0%(67 cases). There was statistically significant difference between two groups(P<0.01); the observation group patient satisfaction were 89.4%(76 cases), it was higher than 73.1%(68 cases) of control group. There was statistically significant difference between two groups(P<0.01); quality of life in general health score(74.1±8.3) in the observation group was higher than that of control group(56.7±5.9),and there was statistically significant difference between two groups(P<0.01). Conclusion Roy adaptation model nursing intervention may improve the adaptability hospitalized the patients with lung cancer after surgery, treatment compliance and the patient satisfaction, and significantly improve the quality of life of patients. It is worthy of promotion clinically.

目的 探讨婚恋家庭取向心理干预对系统性红斑狼疮患者家庭功能和幸福感指数的效果。方法 将2012年6月1日—2014年5月31日就诊于东莞康华医院内分泌及风湿免疫中心的62名15~58岁的系统性红斑狼疮患者作为研究对象,根据随机化原则将其分成两组,其中30名为干预组,参加本研究设计的婚恋家庭取向的心理干预,余32名为对照组,采用家庭功能评定量表、幸福指数量表及狼疮活动指数量表,对两组进行干预前、干预后、干预后3月和干预后6月作问卷调查。采用重复测量的方差分析进行评估。结果 家庭功能中的问题解决、情感反应、情感介入、总的功能分量表和总分两组干预后重复测量的方差分析两两比较均有统计学差异(P<0.05)。幸福感指数总分两组重复测量的方差分析无统计学意义,但如扩大置信空间至P<0.1,则两组重复测量的方差分析两两比较中干预后3月及6月有一定统计学意义(P=0.08<0.1)。结论 本研究中婚恋家庭取向的心理干预对SLE患者即家庭功能中问题解决、情感反应、情感介入、总的功能及家庭功能总分均有显著的改善作用,对幸福感指数总分则有一定的增进作用,而对已通过心身疾病方式表达了的SLEDAI没有干预作用。

Objective To explore the effect of marital family-based psychological intervention in SLE patients on family assessment device FAD and index of well-being. Methods A total of 62 SLE patients, aged between 15 and 58, who were treated in out-patient of endocrine immune rheumatism center of Dongguan Kanghua hospital from June 1,2012 to May 31,2014. The experimental group was made up of 30 patients who, at random, volunteered to participate in an added marital family-based psychological intervention and the control group was composed of rest 32 cases. At the time of pre-intervention,post-intervention,3 months and 6 months after intervention, both groups were investigated with questionnaires of family assessment device, index of well-being, index of general affect, and systemic lupus erythematosus disease activity index. The results were analyzed with repeated measure variance analysis to explore the effect. Results There were significant multiple-comparison differences by repeated measure variance analysis in the score of FAD's total and sub-scale problem solving, affective responsiveness, affective involvement, general functioning(P<0.05) between experimental and control group after intervention. There were no significant repeated measure variance analysis differences in the score of index of well-being' total, but if enlarging confidence space to P<0.1, there were partial multiple-comparison differences between experimental and control group at the time of 3 months and 6 months after intervention(P=0.08<0.1). Conclusion Marital family-based psychological intervention may significantly improve FAD's problem solving, affective responsiveness, affective involvement, general functioning, and sum of FAD, and partially improve index of well-being, but can not improve SLEDAI which had developed by psychosomatic disease.

目的 探讨45°半坐卧位对良性前列腺增生患者膀胱压力容积测定的影响。方法 按照入选标准和排除标准选取临床确诊为良性前列腺增生(Benign Prostatic Hyperplasia,BPH)患者。按照二阶段交叉设计的方法将入选患者随机分入A、B两组。A组患者先进行45°半坐卧位膀胱压力容积测定(Cystometry,CMG),再进行平卧位CMG,B组患者先进行平卧位CMG,再进行45°半坐卧位CMG。统计以下CMG参数:膀胱初始感觉容量、膀胱初始尿意容量、膀胱最大容量及逼尿肌过度活动发生率。结果 与平卧位相比,45°半坐卧位对膀胱初始感觉容量、膀胱初始尿意容量、膀胱最大容量的测定无影响,且能提高逼尿肌过度活动的检出率(45°半坐卧位37.21% vs.平卧位11.63%,P=0.006)。结论 45°半坐卧位能代替平卧位作为CMG的检查体位。

Objective To investigate influence of 45 degree semi-reclining position in cystometry in patients with benign prostatic hyPerplasia(BPH). Methods Patients with BPH were enrolled according to the inclusion and exclusion criteria. They were divided into two groups randomly by two stage cross-over design. Group A took the 45 degree semi-reclining position firstly then supine position, while group B used a reverse order.CMG parameters included volume of first sensation to void (FS), volume of first urge to void (FU), maximum cystometric capacity (MCC) and detrusor overactivity(DO). Results 45 degree semi-reclining position had no effect on volume of FS、volume of FU、MCC, and could increase the detection rate of DO(45 degree semi-reclining Position 37.21% vs. supine 11.63%,P=0.006). Conclusion 45 degree semi-reclining position may be used as a substitution for supine in FC.

目的 探讨老年2型糖尿病患者牙周病发生情况及相关因素,为开展综合预防和治疗措施提供参考。方法 选取到我院住院治疗的老年2型糖尿病患者273例,检查其牙周病患病情况,同时收集年龄、性别、文化程度、体重指数、病程、吸烟、空腹血糖、糖化血红蛋白、刷牙习惯等资料,比较牙周病患病组与未患病组之间上述资料的差异,探讨导致牙周病发生的影响因素。结果 273例研究对象中患有牙周病154例(56.41%),其中,牙龈炎60例,牙周炎94例。牙周病组平均存留牙数(18.54±6.31)颗,未患牙周病组平均存留牙数(21.62±7.48)颗(t=3.679,P<0.001)。年龄较大(P<0.001)、病程较长(P<0.001)、吸烟(P<0.001)、空腹血糖(P<0.001)和糖化血红蛋白(P<0.001)水平较高是老年2型糖尿病患者发生牙周病的危险因素,而文化程度高(P=0.017),刷牙>1次/d(P<0.001),竖刷(P=0.004),使用牙线(P=0.004)是其保护因素。结论 老年2型糖尿病患者中牙周病患病率较高,临床上应做好三级预防措施,降低牙周病发生风险因素的暴露。

Objective To explore the periodontal disease occurrence and its factors for elderly type 2 diabetes patients, providing reference for comprehensive prevention and treatment measures. Methods 273 cases of elderly in-patients with type 2 diabetes in our hospital were enrolled. We checked their periodontal disease conditions, collected information including age, sex, educational level, body mass index, disease duration, smoking, fasting blood glucose, glycosylated hemoglobin, brushing habits. These values were compared between periodontal disease group and no periodontal disease group. Results People with periodontal disease in 273 cases of the object of study included 154 patients (56.41%), among them, gingivitis 60 cases, 94 cases of periodontitis. The teeth number was (18.54±6.31) for periodontal disease group on average, with (21.62 ±7.48) for no periodontal disease group (t=3.679, P<0.001). Older (P<0.001), longer course of disease (P<0.001), smoking (P<0.001), higher fasting blood glucose (P<0.001) and higher glycosylated hemoglobin (P<0.001) were risk factors of periodontal disease for elderly patients with type 2 diabetes. And well-educated (P=0.017), brushing teeth frequency > 1 / d (P<0.001), vertical brush mode (P=0.004), the use of dental floss (P=0.004) were the protective factors. Conclusion Periodontal disease prevalence is high in elderly patients with type 2 diabetes. The three level preventive measures should be strengthened to reduce the exposure of the periodontal disease risk factors.

目的 探讨2型糖尿病肾病(DN)患者肾组织中STOML2的表达及作用。方法 免疫组化检测临床2型糖尿病肾病患者肾组织STOML2的表达及定位,采用慢病毒转染方法建立稳定过表达STOML2的HK-2细胞系,并应用Western blot检测肾小管上皮细胞钙粘蛋白(E-cadherin)、Fibronectin和STOML2的表达。结果 STOML2在DN患者肾组织的肾小管上皮细胞胞浆中表达明显升高。在高糖刺激HK-2细胞建立的EMT模型中,STOML2呈时间依赖表达上调。STOML2稳定高表达时,E-cadherin表达下调,而Fibronectin明显上调,即能促进肾小管上皮细胞发生EMT。结论 STOML2可能通过促进肾小管上皮细胞向间充质细胞分化,进而参与糖尿病肾病肾脏纤维化的发生发展。

Objective To investigate the expression and role of STOML2 in renal tissue of patients with type 2 diabetic nephropathy. Methods To detect he expression and localization of STOML2 in clinical renal tissue in patients with type 2 diabetic nephropathy by immunohistochemistry, and use lentiviral transfection method to establish a stable cell line of over-expressing STOML2, lastly apply western blot to detect the expression of E-cadherin, Fibronectin and STOML2 in renal tubular epithelial cells. Results STOML2 was significantly increased in renal tubular epithelial cytoplasm of patients with DN. In the EMT model of HK-2 cells stimulated by high glucose, STOML2 was increased in a time dependent. Overexpression of STOML2 led to E-cadherin down-regulated, while Fibronectin up-regulated, which promoted the occurrence of EMT in renal tubular epithelial cells. Conclusion STOML2 may be involved in the development and progression of renal fibrosis in diabetic nephropathy by mediating epithelial- mesenchymal transition of renal tubular epithelial cells.

目的 研究右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用的有效性及安全性。方法 选择择期行阴式子宫切除术患者40例(ASA Ⅰ～Ⅱ级),随机分成两组,选择硬腰联合麻醉下手术,麻醉平面固定后以超声引导给予患者双侧腹横肌膜神经阻滞,Ⅰ组患者选用0.5 μg/kg右旋美托咪啶+0.2%罗哌卡因,每侧20 mL,Ⅱ组以相同方法给予同量生理盐水。记录麻醉前(T₀)、麻醉平面确定后(T₁)、手术开始(T₂)、牵拉子宫(T₃)、术毕(T₄)患者的HR、MAP、SpO₂及NTI评分;评价并记录牵拉反应、术后认知功能障碍及谵妄的发生及患者舒适度及满意度。结果 两组患者一般情况无显著性差异(P>0.05);与I组相比,Ⅱ组HR在T₃时刻有显著性降低,差异有统计学意义(P<0.05),牵拉反应评价Ⅰ组评为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05);Ⅰ组舒适度及满意度评定为优的患者个数明显多于Ⅱ组,差异有统计学意义(P<0.05)。结论 右旋美托咪啶联合低浓度罗哌卡因腹横肌膜神经阻滞在老年患者阴式子宫切除术中应用是安全有效的。

Objective To observe the effectiveness and safety of ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine in elder vaginal hysterectomy. Methods Forty scheduled for vaginal hysterectomy (ASAⅠ～Ⅱ)were randomly assigned to 2 groups. All patients received spinal anesthesia, and ultrasound-guided subcostal transverses abdominis plane block then, Group Ⅰ: 0.5 μg/kg dexmedetomidine and 0.2% ropivacaine 20 mL for each side, and saline was used for Group Ⅱ. HR、MAP SpO₂ and NTI scale were recorded at the time points of pre-anesthesia(T₀), confirmation of anesthesia plane (T₁), beginning of surgery (T₂), pulling uterus (T₃), surgery end(T₄). Effect of dragging reaction, POCD and delirious and degree of comfort and degree of satisfaction of patients were valuated. Results The general condition did not differ between the two groups(P>0.05). Compared to Group Ⅰ, HR of Group Ⅱ at the time point of T3 was significant lower(P<0.05), number of patients with excellent dragging reaction of Group Ⅰ was significant higher (P<0.05)and patients of Group Ⅰ were more comfortable and satisfied than patinents of Group Ⅱ(P<0.05). Conclusion Ultrasound-guided subcostal transverses abdominis plane block with dexmedetomidine and low-concentration ropivacaine is effective and safe for vaginal hysterectomy in elderly female.

目的 研究术中麻醉深度监测在全麻下行下腹部手术患者苏醒质量和护理工作应用。方法 选取择期全麻下行下腹部手术患者120例(ASAⅠ~Ⅱ级),随机分成NT组和NNT组,NT组患者(60)术中用Narcotrend监测,NNT组患者(60)术中不用Narcotrend监测。记录术中丙泊酚用量;记录术后气管导管拔管时间和麻醉恢复室(postanesthesia care unit, PACU)留观时间;记录恢复室Ricker镇静—躁动评分;记录恶心呕吐及术后谵妄的发生率。结果 NT组患者术中麻醉药物丙泊酚的用量比NNT组明显减少(P<0.05);NT组患者术后的拔管时间与PACU留观时间比NNT明显缩短(P<0.05);NT组患者术后的Ricker 镇静-躁动评分比NNT明显降低(P<0.05);NT组患者与NNT组术后恶心呕吐及术后谵妄发生率无明显差别。NT组比NNT组降低了护理工作量(P<0.05)。结论 在麻醉深度监测仪Narcotrend下行下腹部手术,通过有效的麻醉深度监测,可以改善患者术后的苏醒质量,这些有利于减少PACU护理工作量,提高了护理质量,也有助于PACU护理规范化。

Objective To investigate the effect of anesthesia depth monitoring on the recovery quality and nursing quality of patients treated with lower abdominal surgery under general anesthesia. Methods A total of 120 patients who underwent the lower abdominal surgeries from June 2015 to December 2015 were randomly divided into 2 groups: non-Narcotrend monitoring group (non NT group) and Narcotrend monitoring group (NT group). And each group contains 60 cases. All patients were set in the same induce plan, and maintained by propofol-fentanyl during the operation. The dosage of propofol, the time of tracheal extubation, the PACU staying time, the Ricker sedation-agitation scale, the incidence of PONV and POD, the nursing quality and nursing working load were recorded in the project. Results Using Narcotrend to monitor the anesthesia depth could significantly decrease the dosage of propofol (P<0.05). The tracheal extubation time and the PACU staying time of patients in NT group were much shortened than patients in non NT group (P<0.05). In NT group the Ricker scores of patients were much lower than patients in non NT group (P<0.05). And the effective anesthesia depth monitoring using Narcotrend could significantly decrease the nursing working load and improve the nursing quality (P<0.05). Conclusion Effective anesthesia depth monitoring using Narcotrend may improve the recovery quality in the PACU, which may decrease the working load of nurses and improve the nursing quality in PACU.

目的 探讨改良型音乐治疗对慢性精神分裂症患者临床康复效果的影响。方法 选取2010年4月—10月在我院住院的病情稳定的慢性精神分裂症患者76例,随机分为研究组和对照组各38例,两组患者在同等环境下维持原来的药物治疗和护理,研究组同时予以改良型音乐治疗,观察6个月,采用护士用住院病人观察量表(NOSIE)对两组进行评估。结果 两组经过治疗后,NOSIE各项因子分均较前有明显提高,差异有统计学意义;研究组 NOSIE总积极分、社会能力、社会兴趣、个人整洁等得分较对照组有明显提高,差异有统计学意义;总消极分激惹、精神病表现、迟缓、抑郁较对照组有较明显降低,差异统计学意义。结论 改良型音乐治疗,对慢性精神分裂症患者的临床康复有积极的促进作用。

Objective To explore the effect of modified music therapy on the rehabilitation of patients with chronic schizophrenia. Methods 76 patients with chronic schizophrenia who were hospitalized in our hospital from October to April of 2010 were randomly divided into study group and control group (38 cases). The patients in the two groups were treated with the same environment. The research group was treated with modified music. The two groups were evaluated by using the observation scale (NOSIE). Results Two groups after treatment, the NOSIE of the factors were significantly improved, the difference was statistically significant; the study group NOSIE total score, social ability, social interest, personal cleanliness, etc, compared with the control group were significantly improved. The difference was statistically significant; the total negative score, mental disease, depression, and the control group were significantly lower than the control group, the difference was statistically significant. Conclusion Modified music therapy has a positive effect on the rehabilitation of patients with chronic schizophrenia.

目的 探讨经针刺治疗爆裂性眶壁骨折伴眼球运动障碍的临床疗效及安全性。方法 选取2013年10月—2015年9月在我院接受治疗的70例(70只眼)爆裂性眶壁骨折致眼球 运动障碍患者,按照治疗方式的不同分为常规组和针刺组,每组各35例,其中常规组给予常规药物治疗,针刺组除了接受常规治疗外,依据眶壁骨折部位的不同选取相应临近眼外肌穴进行针刺,每日1次,每次留针30 min,15天为一个疗程,两组患者均持续治疗两个疗程。对比分析两组患者治疗前后的角膜缘移动范围、眼球运动障碍级别以及临床疗效。结果 经过治疗后,两组患者的角膜缘移动范围均较治疗前明显改善,且与常规组患者相比,针刺组患者改善得更显著(P<0.05);经过治疗后,针刺组0级、I级、II级、III级的眼数分别为14、15、3、3只眼,其中0级的眼数明显多于常规组患者,差异有统计学意义(P<0.05);针刺组的治疗总有效率高达91.43%,明显高于常规组的62.86%,差异有统计学意义(P<0.05)。结论 针刺眼外肌穴有助于改善爆裂性眶壁骨折伴眼球运动障碍患者的角膜缘移动范围,促进患者眼外肌功能的恢复而降低眼球运动障碍级别,明显提高治疗总有效率,在临床上值得推广应用。

Objective To explore the clinical effect of eye-acupuncture on eye movement disorders caused by orbital blowout fracture and its security. Methods 70 eyes movement disorder patients with burst orbital wall fracture treated in our hospital from October 2013 to September of 2015 were selected and divided into two groups, each group contains 35 cases. The routine group was given routine drug treatment, beside this, we gave the therapy of eye-acupuncture for 30 minutes to the acupuncture group according to the type to select the corresponding extraocular muscle holes. Both with 15 days was for a course of treatment. After two courses, compared the eye movement disorder level changes and the limbus range of movement of the two groups before and after treatment, we evaluated the efficacy based on efficacy standard. Results After treatment, the corneal limbus range of movement were significantly improved of both groups, and the acupuncture group were better than that of the routine group(P<0.05);after treatment, the eye movement disorder rating of the acupuncture group was as follows: the number of level 0,1,2,3 was 14,15,3,3,respectively, among which the number of level 0 was significantly higher than that of the routine group(P<0.05);The total effective rate of the acupuncture group was 91.43 %, which was significantly higher than that of the control group, the difference was statistically significant (P<0.05). Conclusion Eye-acupuncture may improve the corneal limbus range of movement in patients with eye movement disorders caused by orbital blowout fracture. It could promote the recovery of extraocular muscles function and thus lower the level of eye movement disorders. It significantly improves the total efficiency and is worthy of popularization and application clinically.