目的 本文主要分析乳腺癌患者应用蒽环类药物序贯曲妥珠单抗治疗对其心脏毒性的相关危险因素,并按照危险因素选择合适患者的治疗方案。方法 研究纳入了2019年6月—2022年6月在本院接受治疗的300例乳腺癌患者,患者接受蒽环类药物序贯曲妥珠单抗治疗,按照患者治疗期间是否发生心脏毒性进行分组,即为11例发生心脏毒性(观察组),289例患者未发生心脏毒性(对照组)。记录2组患者个人基础资料、肿瘤分期、病史、蒽环类药物以及联合化疗等因素,通过Logistic回归逐一对各项因素展开分析,了解相关危险因素。结果 在本次研究分析中,心脏毒性发生例数为11例,发生率为3.67%。其中289例患者未出现心脏毒性,患者用药后未出现相关反应。2组患者在联合放疗、高脂血症、蒽环类药物种类均有差异,差异有统计学意义(P<0.05)。结论 乳腺癌患者应用蒽环类药物序贯曲妥珠单抗后,发生心脏毒性的几率升高,其危险因素主要包括高脂血症史、应用表柔比星治疗以及左胸放疗史。

目的 探讨小儿肠套叠超声引导下水压灌肠复位治疗的价值。方法 将我院2020年2月—2022年5月期间收治的122例肠套叠患儿按照随机数字表法分为观察组和对照组,对照组61例予以X射线引导下空气灌肠复位治疗,观察组61例予以超声引导下水压灌肠复位治疗,观察2组患儿治疗效果、胃肠激素、应激反应、并发症发生率以及复发率。结果 观察组复位成功率(98.36%)高于对照组(86.89%),复位时间、大便隐血消失时间、肠功能恢复时间、住院时间短于对照组(P<0.05);观察组胃泌素、胃动素水平低于对照组(P<0.05);观察组白细胞、降钙素原、C-反应蛋白水平低于对照组(P<0.05);观察组并发症总发生率(3.28%)低于对照组(14.75%)(P<0.05);观察组复发率(3.28%)低于对照组(13.11%)(P<0.05)。结论 超声引导下水压灌肠复位治疗小儿肠套叠有助于调节胃肠激素水平,减轻炎症反应,提高复位成功率,缩短手术时间,加快肠道恢复,降低复发率和并发症发生率。

目的 探讨我国南方地区鲍曼不动杆菌流行株ST457毒力进化方向。方法 收集南方地区5家大型三甲医院2012年—2015年血和/或痰标本来源的鲍曼不动杆菌菌株,运用不同毒力实验,比较ST457与其他CC92流行克隆株与非流行克隆株的毒力差异。结果 ST457感染患者早期死亡率高;ST457菌株平均产生物膜能力低于ST195和ST208;83.3%的鲍曼不动杆菌临床分离菌株在血清的存活率大于60%,其中43.3%的菌株可在血清内快速繁殖,不同ST型组间、菌血症组和非菌血症组间无差异;不同ST型菌株竞争后,ST457未展现出竞争优势。结论 与传统CC92流行株相比,ST457毒力表型与传统的CC92流行株类似,提示CC92克隆株共进化能力。部分流行株短时间内在血清中快速繁殖,提示其条件致病后潜在的血流感染的能力。

Objective To investigate the virulence of the prevalent clone ST457 of Acinetobacter baumannii in Southern China. Methods Isolates from sputum and/or blood samples from 2012 to 2015 in 5 large differences between clonal complex 92(CC92) and non-CC92 were estimated by biofilm assay, competition assay and serum assay. Results Patients with ST457 infection had high early mortality. The average biofilm production of ST457 was significantly lower than that of ST195 and ST208. In serum assay, 83.3% isolates survived in the serum with over 60% survival rate, of which 43.3% strains reproduced in the serum, with no difference between STs or between bacteremia and non-bacteremia group. After competing with different ST strains, ST457 shows no competitive advantage. Conclusions ST457 had a similar virulence phenotype with the traditional prevalent CC92 clone, suggesting the co-evolutionary ability for CC92 clone. Some clinical isolates were survived in human serum, suggesting the potential capacity of bloodstream infection.

目的 了解急诊科综合病区患者疾病分类构成的特点,为护士进行有针对性的培训,并为合理调配护理人员提供依据。方法 对2020年1月—2021年12月我院急诊科综合病区收治的1 901例患者疾病分类、收治时间等进行回顾性调查分析。结果 研究期间急诊综合病区共收治患者1 901例,收治患者以呼吸系统的患者居多,占比47.71%;以循环系统疾病的患者平均发病年龄最高,为(66.434±11.691)岁;全年各月以1月、12月收治病人居多。结论 根据调查分析,有针对性地对护士进行呼吸系统疾病护理技能培训,并在收治高峰期,合理调配护理人员,实施弹性排班,保障患者安全,提高护理质量。

Objective To understand the characteristics of disease classification and composition of patients in Comprehensive Ward of Emergency Department, provide targeted training for nurses, and provide basis for rational deployment of nursing staff. Methods A total of 1 901 patients in the Comprehensive Ward of Emergency Department of our hospital from January 2020 to December 2021 were investigated and analyzed retrospectively according to different diseases and time of admission. Results A total of 1 901 patients were treated in the Emergency Comprehensive Ward during the study period. Most of the patients were with respiratory system disease, accounting for 47.71%. The average onset age of patients with circulatory diseases was the oldest, which was (66.434±11.691). Most patients were admitted in January and December. Conclusions According to the investigation and analysis, nurses should be trained with the skills of respiratory diseases nursing, nursing staff should be reasonably allocated and flexible shift should be scheduled during the peak period of admission, so as to ensure the safety of patients and improve the quality of nursing.

目的 对 2017—2021年护理岗位人员的职业倦怠相关领域文献中的研究热点进行分析,以期让相关研究人员和卫生行政管理人员更加全面了解护理人员的职业倦怠情况。方法 本文基于共词聚类的研究方法,将从CNKI数据库中获取的护理人员职业倦怠研究文献运用BICOMB、gcluto 2.0和VOSviewer软件进行热点分析。结果 共有1 218篇护理人员职业倦怠相关文献纳入研究,分布在199本期刊中,共有关键词1 495个,出现频次≥10的关键词共有78个。通过共词聚类分析,护理人员职业倦怠研究可归纳为4大聚类热点:巴林特小组改善护理人员职业倦怠、心理资本与护理人员职业倦怠中介作用、护理人员工作压力、心理弹性及社会支持与职业倦怠、护理人员职业倦怠现状、影响因素及应对方式等。 结论 研究揭示了我国护理人员职业倦怠研究领域的研究现状及热点。

Objective Through the analysis of the research hotspots in the literature about job burnout of nursing staff from 2017 to 2021, relevant researchers and health administrators were expected to have a more comprehensive understanding of job burnout of nursing staff. Methods Based on the research method of co-word clustering, this paper used BICOMB and gcluto 2.0 and VOSviewer software to analyze the literatures on nursing burnout obtained from CNKI database. Results A total of 1 218 nursing staff burnout related literatures were included in the study, distributed in 199 journals, with 1 495 high-frequency subject words, 78 words with frequency≥10 times. Through word clustering analysis, nurses' job burnout research can be summarized as four clustering hotspots: bahrain's team to improve nurses' job burnout, psychological capital and the intermediary role of nurses' job burnout, nurses work pressure, resilience and social support and job burnout, nurses' job burnout status, influencing factors and coping methods, etc. Conclusions This study reveals the current situation and hotspots of nursing staff burnout research in China.

目的 探究中医药治疗盆腔炎的用药规律,为中医临床辩证用药提供借鉴。方法 采用主题词联合自由词相,全面检索CNKI、VIP、Wangfang、CBM、PubMed和EMbase、数据库及Cochrane图书馆,收集中、西药对比治疗盆腔炎的随机对照试验。严格按照纳入、排除标准挑选随机对照试验中涵盖的中药药方,采用Excel表格统计分析药方中药的四气、五味、归经和用药频率,随后利用系统聚类软件对使用频率高的中药开展关联、聚类和主成分分析。结果 本文共纳入235个随机对照试验,涉及320首中药处方,平均用药味数13.29味,使用频率前五位的药分别为延胡索、赤芍、当归、蒲公英、丹参;关联规则共得出41对高关联药对,其中包括赤芍-延胡索、莪术-三棱-败酱草等。高频率使用的前30味中药可分为五大类,获取的9个主成分分析结果与系统聚类中的结果一致。结论 本研究采用循证医学和系统聚类分析方法,剖析中医药治疗盆腔炎的用药规律,为临床用药提供参考。

Objective To discuss the medication regularity of traditional Chinese medicine (TCM) in the treatment of pelvic inflammatory disease, and provide new thinking for effective medication in clinical medicine. Methods Keywords combined with free word were used to comprehensively search CNKI, VIP, Wangfang, CBM, PubMed and EMbase, databases and Cochrane library to collect randomized controlled trials of comparative treatment of pelvic inflammatory disease between Chinese and Western drugs. The TCM prescriptions covered in the randomized controlled trial were selected in strict accordance with the standard inclusion and exclusion criteria. Excel was used to statistically analyze the four properties, five flavors, meridian and medication frequency of TCM prescriptions. Then, systematic clustering software was used to carry out correlation, clustering and principal component analysis for the Chinese medicines with high using frequency. Results The study included 235 randomized controlled trial and 320 prescriptions of traditional Chinese medicine were involved, the average number of herbs was 13.29, which Yanhusuo, Chishao, Danggui, Pugongying, Danshen were with top five frequency. A total of 41 drug pairs with high association were obtained by association rules, including Chishao-Yanhusuo, Eshu-Sanleng-Baijiangcao, etc. Thirty traditional Chinese medicine with high using frequency can be divided into 5 categories according to the effect. The obtained results of 9 principal component analysis were consistent with those in the system cluster. Conclusions In this study, evidence-based medicine and systematic cluster analysis were used to analyze the medication regularity of traditional Chinese medicine in the treatment of pelvic inflammatory disease, so as to provide reference for the clinical medication.

目的 通过对中山大学中山眼科中心890例眼内异物病例进行分析,为眼内异物防治提供依据。方法 回顾性分析我中心2005年1月—2019年12月期间住院890例眼内异物病例的临床资料进行统计分析。结果 (1)15年间眼内异物病例中,2005年1月—2009年12月间例数最多,有477例,占总例数的53.6%;(2)发生眼内异物的患者年龄大部分在20~49岁之间,有716例,占80.44%;(3)眼内异物患者中,男性占大部分,有830例,占93.26%,男:女=14:1,右眼424例,左眼466例,右眼:左眼=1:1.1;(4)金属异物占大多数,约90%;(5)眼内异物的患者以工人最多,占60.5%;(6)眼内异物患者住院时间14天以内的患者共828人,占92.8%;(7)眼外伤种类:异物进入眼内为主,共614例,占68.98%;(8)眼外伤并发症:以外伤性白内障为主,共407例,占45.7%。结论 眼外伤发生以青壮年男性多见,异物入眼为主,住院时间为1~2周,治愈概率较高。眼内异物所导致的眼外伤发病率呈逐年下降趋势。

Objective To analyze 890 cases of intraocular foreign bodies in Zhongshan Ophthalmic Center of Sun Yat-sen University, and to provide a basis for the prevention and treatment of intraocular foreign bodies. Methods The clinical data of 890 cases of intraocular foreign body hospitalized in our center from January 2005 to December 2019 were retrospectively analyzed. Results (1) Among the 15-year intraocular foreign body cases, the number of cases from 2005 to 2009 was the highest, with 477 cases, accounting for 53.6%. (2) The majority of intraocular foreign bodies occurred between the ages of 20 and 49, with 716 cases (80.44%). (3) Among the patients with intraocular foreign bodies, males accounted for the majority, with 830 cases, accounting for 93.26%, male:female=14:1, right eye 424 cases, left eye 466 cases, right eye:left eye=1:1.1. (4) Metal foreign bodies account for the majority, about 90%. (5) Workers had the highest number of patients with intraocular foreign bodies, accounting for 60.5%. (6) The number of patients with hospitalization time of less than 14 days was 828, accounting for 92.8%. (7) Type of ocular trauma: foreign body into the eye was the main type, with 614 cases, accounting for 68.98%. (8) Complications of ocular trauma: traumatic cataracts was the mainstay, with a total of 407 cases, accounting for 45.7%. Conclusions Ocular trauma occurs more often in young and middle-aged men, which intraocular foreign bodies is the main reason, and the hospitalization time is about 1 to 2 weeks, with high probability of healing. The incidence of ocular trauma caused by ocular foreign bodies is decreasing year by year.

目的 探索视频喉镜下经食道超声(TEE)探头插入在急诊重症患者中的应用。方法 全麻下行非心脏手术的急诊重症患者60名,美国麻醉医师协会分级Ⅱ-Ⅳ级,采用随机数字法分成A组(n=30)和B组(n=30)2组。A组采用盲法插入TEE探头,B组采用视频喉镜辅助插入TEE探头。比较2组探头一次插入成功率、插入所需时间、插入时血流动力学变化、插入时不良反应的情况。结果 B组一次插入成功率(82.8%)高于A组(58.6%),差异有统计学意义(P<0.05)。B组第一次尝试成功插入所需时间长于A组,(24.6±3.1) s vs (15.5±3.0) s, 差异有统计学意义(P<0.05)。成功插入探头所需的总时间2组无差异,差异无统计学意义(P>0.05)。咽喉部损伤B组少于A组(3.4% vs 27.6%),差异有统计学意义(P<0.05)。探头插入时2组患者平均动脉压、心率无明显差异,差异无统计学意义(P>0.05)。结论 视频喉镜可以改善经食道超声探头插入的条件,提高插入成功率,减少相应并发症,可安全用于急诊重症患者的TEE探头插入。

Objective To explore the application of transesophageal echocardiography (TEE) probe insertion under video laryngoscopy in acute severe patients. Methods Sixty acute severe patients, ASA grade II-IV, underwent non-cardiac surgery under general anesthesia were divided into two groups (A and B) evenly by random number method.TEE probe was blindly inserted into the group A patients, and in group B, a video laryngoscope was used to assist the insertion.The first insertion success rate, the time required for insertion, the changes of hemodynamics during insertion, and the adverse reactions incidence during insertion of the two groups were compared. Results The first insertion success rate of the group B (82.8%) was significantly higher than that of the group A (58.6%), the difference was statistically significant (P<0.05). The time required for the first successful insertion of the group B was significantly longer than that of the group A, (24.6±3.1) s vs (15.5±3.0) s, and the difference was statistically significant (P<0.05). The total time required to insert the probe was not significantly different between the two groups (P> 0.05). Throat injury in the group B was significantly less than that in the group A (3.4% vs 27.6%), the difference was statistically significant (P<0.05). The hemodynamics (MAP and HR) of the two groups during insertion were not significantly different (P>0.05). Conclusions Video laryngoscope can improve the conditions of transesophageal ultrasound probe insertion, increase the success rate of insertion, and reduce the corresponding complications.It can be safely used for TEE probe insertion in acute severe patients in an emergency.

目的 比较早产胎膜早破(PPROM)≥34周的肥胖孕妇与非肥胖孕妇的早产儿住院结局。方法 回顾性分析2016年1月—2020年12月在本院出生并入住新生儿科的所有出生胎龄≥34周的PPROM早产儿。根据孕妇分娩时体质量指数(BMI),分为肥胖组(BMI≥30 kg/m²)和非肥胖组(BMI＜30 kg/m²),比较2组间的一般情况、妊娠结局及所生晚期早产儿的住院结局,组间比较采用两独立样本t检验及χ²检验。结果 与非肥胖孕妇相比,肥胖孕妇的晚期早产儿分娩后呼吸道并发症发病率高,主要表现为新生儿呼吸窘迫综合征,辅助通气、吸氧和表面活性物质的使用、败血症、感染性肺炎发病率高,母亲妊娠期糖尿病发病率增高,差异均具有统计学意义(P＜0.05),其余新生儿高胆红素血症、新生儿坏死性小肠结肠炎、脑室内出血、早产儿支气管肺发育不良等并发症比较无统计学意义(P＞0.05)。结论 PPROM≥34周的肥胖孕妇与非肥胖孕妇相比,所生晚期早产儿呼吸道并发症和败血症等不良结局的发生率增加。

Objective To compare the hospitalization outcomes of 34 weeks or over preterm infants with preterm premature rupture of membranes (PPROM) in obese and non-obese pregnant women. Methods A retrospective analysis of PPROM preterm infants born in our hospital and admitted to the neonatology department from January 2016 to December 2020 with a gestational age of 34 weeks or over was carried out. According to the pregnant women's body mass index (BMI) at delivery, they were divided into obese group (BMI≥30 kg/m²) and non-obese group (BMI<30 kg/m²). The general conditions, pregnancy outcomes and late premature infants hospitalization outcomes between the two groups were compared using two independent samples t test and χ² test. Results Compared with non-obese pregnant women, the incidence of respiratory complications after delivery in late preterm infants of obese pregnant women was higher, mainly manifested as high incidence of neonatal respiratory distress syndrome, assisted ventilation, oxygen inhalation and the use of surfactants, sepsis, and pneumonia, also maternal gestational diabetes incidence was increased, and the differences were statistically significant (P<0.05); other complications of neonatal hyperbilirubinemia, necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia were not statistically significant (P>0.05). Conclusions Compared with non-obese pregnant women with 34 weeks or over PPROM, obese pregnant women had an increased incidence of adverse outcomes in late preterm infants such as respiratory complications and sepsis.

目的 探讨加味益气固冲汤在生育期血瘀证崩漏患者治疗中的应用价值及对雌激素水平的影响。方法 按照随机数字表法将2018年11月—2021年1月我院符合诊断标准及选例标准的112例生育期血瘀证崩漏患者分为常规组、实验组,每组56例。常规组予以基础治疗,实验组在常规组基础上采用加味益气固冲汤治疗。比较2组治疗效果、不良反应情况、治疗前后经期出血量、子宫内膜厚度、雌激素水平及血液流变学指标。结果 同常规组总有效率82.14%相比,实验组96.43%较高(P＜0.05);治疗后实验组经期出血量、子宫内膜厚度改善幅度大于常规组(P＜0.05);治疗后实验组黄体生成素、孕酮、卵泡刺激素、雌二醇水平较常规组低(P＜0.05);治疗后实验组红细胞聚集指数、纤维蛋白原、全血低切黏度、血浆黏度均小于常规组(P＜0.05);实验组不良反应总发生率5.36%与常规组10.71%对比,无差异(P＞0.05)。结论 加味益气固冲汤联合西药治疗生育期血瘀证崩漏患者效果显著,调节性激素水平,改善子宫形态,改善血液微循环,缓解经期出血症状。

Objective To explore the application value of Jiawei Yiqi Guchong Decoction in the treatment of patients with blood stasis syndrome of metrorrhagia and metrostaxis and its influence on estrogen level. Methods According to the random number table method, 112 patients with blood stasis syndrome of metrorrhagia and metrostaxis in their reproductive period, who met the diagnostic criteria and case selection criteria in our hospital from November 2018 to January 2021, were divided into conventional group and experimental group, with 56 cases in each group. The conventional group was given basic treatment, and the experimental group was treated with Jiawei Yiqi Guchong Decoction on the basis of the conventional group. The treatment effect, adverse reactions, menstrual bleeding, endometrial thickness, estrogen level and hemorheology indexes before and after treatment were compared between the two groups. Results The total effective rate of experimental group was 96.43%, higher than that of conventional group (82.14%, P<0.05). After treatment, the improvement of menstrual bleeding and endometrial thickness in the experimental group was greater than that in the conventional group (P<0.05). After treatment, the levels of luteinizing hormone, progesterone, follicle stimulating hormone and estradiol in the experimental group were lower than those in the conventional group (P<0.05). After treatment, erythrocyte aggregation index, fibrinogen, whole blood low shear viscosity and plasma viscosity in the experimental group were lower than those in the conventional group (P<0.05). There was no significant difference in the total incidence of adverse reactions between the experimental group (5.36%) and the conventional group (10.71%, P>0.05). Conclusions Jiawei Yiqi Guchong Decoction combined with Western medicine had a significant effect on the treatment of patients with blood stasis syndrome of metrorrhagia and metrostaxis in reproductive period, which can regulate the levels of sex hormones, improve the morphology of uterus, blood microcirculation and relieve the symptoms of menstrual bleeding.