目的 观察首诊-复诊-住院-产后管理的模块化护理干预对妊娠期糖尿病(GDM)围产期患者的影响。方法 回顾性收集我院2020年1月—2021年1月GDM患者91例,按照患者意愿及不同护理方案分组。常规护理组45例予以常规护理,模块化管理组46例在常规护理基础上予以首诊-复诊-住院-产后管理的模块化护理。比较2组患者首诊时、分娩后血糖控制水平、围产期患者并发症发生情况、围产期新生儿并发症发生情况、护理工作满意度。结果 分娩前模块化管理组空腹血糖、餐后2 h血糖低于常规护理组(P＜0.05);模块化管理组围产期患者并发症发生率8.70%(4/46)低于常规护理组24.44%(11/45)(P＜0.05);模块化管理组围产期新生儿并发症发生率6.52%(3/46)低于常规护理组22.22%(10/45)(P＜0.05);模块化管理组护理工作满意度93.48%(43/46)高于常规护理组77.78%(35/45)(P＜0.05)。结论 首诊-复诊-住院-产后管理的模块化护理干预可改善GDM患者的血糖水平,降低围产期患者及新生儿并发症发生率,同时能提升患者护理工作满意度。

Objective To observe the effect of modularized nursing intervention on perinatal patients with gestational diabetes mellitus (GDM), including first visit, subsequent visit, hospitalization and postpartum management. Methods Ninety-one patients with GDM in our hospital from January 2020 to January 2021 were retrospectively grouped according to patients' wishes and different nursing plans, and their data were collected. Forty-five patients in the routine nursing group received routine nursing, and 46 patients in the modular management group received modularized nursing in addition to the routine nursing, including first visit, subsequent visit, hospitalization and postpartum management. The blood glucose level at the first visit and after delivery, the incidence of complications in perinatal patients, the incidence of complications in perinatal neonates, and the satisfaction of nursing work were compared between two groups. Results Before delivery, FPG and 2hPG levels in modularized management group were lower than those in routine nursing group (P<0.05). The incidence of perinatal complications in modularized management group was 8.70% (4/46), lower than that in routine nursing group (24.44%, 11/45, P<0.05). The incidence of neonatal complications in the modularized management group was 6.52% (3/46), lower than that in the routine nursing group (22.22%, 10/45, P<0.05). The nursing job satisfaction rate of modular management group was 93.48% (43/46), higher than that of routine nursing group (77.78%, 35/45, P<0.05). Conclusions Modularized nursing intervention of first visit, subsequent visit, hospitalization and postpartum management could improve the blood glucose level of patients with GDM, reduce the incidence of complications in perinatal patients and neonates, and improve patients' satisfaction with nursing work.

目的 对腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况进行回顾性分析,并分析腹腔镜子宫肌瘤切除术围手术期感染的影响因素。方法 选择2018年5月—2021年5月在我院行腹腔镜子宫肌瘤切除术的患者72例进行回顾性分析。收集患者一般资料及抗生素使用情况,根据有无术后感染将患者分为2组,比较2组患者上述各资料,并采用多因素分析法判断各因素对腹腔镜子宫肌瘤切除术后感染的综合作用。结果 本次纳入的72例腹腔镜子宫肌瘤切除术患者共有16例出现术后感染,术后感染率为22.22%。多因素Logistic回归分析结果显示:年龄≥50岁、手术时间≥60 min、合并糖尿病为腹腔镜子宫肌瘤切除术围手术期感染的危险因素,预防性使用抗生素、术前≤2 h抗生素使用、术后抗生素使用≤48 h为保护性因素(P<0.05)。结论 腔镜子宫肌瘤切除术患者术后感染率为22.22%,抗菌药物使用时机及使用时间对腹腔镜子宫肌瘤切除术患者术后感染有重要的影响,此外患者年龄、手术时间、合并糖尿病情况也与患者术后感染有关。

Objective To retrospectively analyze the perioperative application of antibacterial drugs during laparoscopic myomectomy, and to analyze the influencing factors of infection during the perioperative period of laparoscopic myomectomy. Methods Seventy-two patients who underwent laparoscopic myomectomy in our hospital from May 2018 to May 2021 were selected for retrospective analysis. The patients were divided into two groups according to postoperative infection status. The above data were compared between the two groups, and the comprehensive effects of various factors on postoperative infection after laparoscopic myomectomy were determined by multivariate analysis. Results There were 16 cases of 72 patients underwent laparoscopic myomectomy had postoperative infection, and the postoperative infection rate was 22.22%. Multivariate Logistic regression analysis showed that age over 50, operation time over 60 minutes, and with diabetes mellitus were the risk factors of perioperative infection in laparoscopic myomectomy. Prophylactic use of antibiotics, preoperative use of antibiotics in less than 2 hours and postoperative use of antibiotics in less than 48 hours were protective factors (P<0.05). Conclusions The infection rate of patients underwent laparoscopic myomectomy was 22.22%. The time and length of antibiotics use had important influence on postoperative infection of patients underwent laparoscopic myomectomy. In addition, age, operation time and complicated with diabetes mellitus were also related to postoperative infection.

目的 探究血清C反应蛋白与白蛋白比值(CRP/ALB)、中性粒细胞与淋巴细胞比值(NLR)、血糖不稳定指数(GLI)水平对重症肺炎患者预后的预测价值。方法 将我院2020年1月—2021年5月收治的126例重症肺炎患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(93例)和死亡组(33例)。对比2组患者的一般资料,采用多因素Logistic分析重症肺炎患者高危因素,应用ROC曲线评估血清CRP/ALB、NLR、GLI水平对重症肺炎患者预后的预测价值。结果 2组患者一般资料对比,NEU、CRP、APACHEⅡ、CRP/ALB、NLR、GLI水平差异有统计学意义(P<0.05);多因素Logistic回归分析显示APACHEⅡ评分、血清CRP/ALB、NLR、GLI水平是重症肺炎患者死亡的危险因素;ROC曲线分析结果显示,CRP/ALB、NLR、GLI曲线下面积分别为0.837,0.826,0.837。结论 CRP/ALB、NLR、GLI水平对重症肺炎患者预后均具有较高的预测价值,其中以CRP/ALB的预测价值最佳。

Objective To explore the prognostic predictive value of serum CRP/ALB, NLR and GLI in patients with severe pneumonia. Methods A total of 126 patients with severe pneumonia treated in our hospital from January 2020 to May 2021 were divided into survival group (93 cases) and death group (33 cases) according to the prognosis of 28 days of hospitalization. The general data of the two groups were compared, the high-risk factors of patients with severe pneumonia were analyzed by multivariate logistic, and the predictive value of serum CRP/ALB, NLR and GLI levels on the prognosis of patients with severe pneumonia was evaluated by ROC curve. Results There were significant differences in the levels of NEU, CRP, APACHE Ⅱ, CRP/ALB, NLR and GLI between the two groups (P<0.05); multivariate logistic regression analysis showed that APACHE Ⅱ score, serum CRP/ALB, NLR and GLI were the risk factors of death in patients with severe pneumonia; ROC curve analysis showed that the areas under CRP/ALB, NLR and GLI curves were 0.837, 0.826 and 0.837 respectively. Conclusions The levels of CRP/ALB, NLR and GLI had high predictive value in the prognosis of patients with severe pneumonia, among which CRP/ALB had the best predictive value.

目的 探讨艾灸联合五禽戏治疗颈型颈椎病的疗效。方法 选择我院2019年3月—2020年11月收治的116例颈型颈椎病患者作为研究对象,随机分为实验组和对照组,各58例。其中对照组患者给予艾灸常规治疗,观察组患者在上述治疗的基础上外加五禽戏康复治疗。比较2组患者治疗前后的颈部症状积分、颈椎活动度(ROM)评分、McGill疼痛问卷(MPQ)、Northwick Park颈部疼痛量表(NPQ)评分,观察2组疗效、不良反应及预后情况。结果 实验组治疗有效率高于对照组,预后复发率低于对照组(P<0.05)。与治疗前相比,2组患者治疗后的NPQ评分、MPQ 评分、颈部症状积分、ROM评分均降低,且实验组降低更明显(P<0.05)。结论 颈部症状积分、颈椎活动度及NPQ评分可以较好地对五禽戏联合艾灸治疗颈型颈椎病的疗效进行反映评价,具有一定的临床应用价值。

Objective To explore the efficacy of moxibustion combined with Wuqinxi in treating cervical spondylosis. Methods The 116 patients with cervical spondylosis admitted to our hospital from March 2019 to November 2020 were selected as the research objects, and they were divided into experimental group and control group by random number method, with 58 cases in each group. The patients in the control group were given conventional moxibustion treatment, and the patients in the observation group were treated with Wuqinxi rehabilitation therapy on the basis of moxibustion. The scores of neck symptom, cervical spine range of motion (ROM), McGill pain questionnaire (MPQ), Northwick Park neck pain questionnaire(NPQ) scores before and after treatment were compared between the two groups, and the differences in clinical efficacy and prognosis of the two groups were observed. Results The effective rate of treatment in the experimental group was significantly higher than that of the control group, and the recurrence rate was significantly lower than that of the control group (P<0.05). Compared with that before treatment, NPQ score, MPQ score, neck symptom score, ROM score were significantly reduced in both groups after treatment, and the reduction of these indicators was more significant in the experimental group, with statistically significant differences (P<0.05). Conclusions The neck symptom score, cervical ROM and NPQ score could better reveal and evaluate the efficacy of Wuqinxi combined with moxibustion in the treatment of cervical spondylosis, and had certain clinical application value.

目的 比较广东云浮市进行药品专区执行国家药品集中采购(GPO)前后呼吸系统疾病患儿住院医疗费用,分析其住院医疗费用的影响因素。方法 选择云城区2019—2020年0~14岁城乡儿童呼吸系统疾病住院患儿,采用单因素和多元回归统计方法分析住院医疗费用的影响因素。结果 呼吸系统疾病儿童平均住院医疗费用国家集采前(4 872.38元)高于国家药品集采后(4 620.25元,P<0.05),药费分别占参保及参合患儿住院医疗费用的35.35%和27.39%,统筹支付费用参保与参合儿童分别占46.85%和57.59%。年龄、住院天数、转归、有无合并症、疾病分类、应用GPO药物、入院分类为呼吸系统疾病患儿住院医疗费用的共同影响因素,其中住院医疗费用随着患儿年龄增加、转归良好及应用GPO药物费用而减少,为负性联系;余住院天数、有无合并症、疾病分类、入院分类则与住院总费用有着正性联系。结论 提高患儿的转归,缩短平均住院日,做好药品专区及集中采购工作可降低儿童呼吸系统疾病的住院费用。

Objective To compare the inpatient medical expenses of children with respiratory diseases before and after the implementation of national group purchasing organization(GPO) in Yunfu City, Guangdong Province, and analyze the influencing factors of inpatient medical expenses. Methods The hospitalized children aged 0~14 with respiratory diseases from 2019 to 2020 in Yuncheng district implemented the GPO were selected. The influencing factors of hospitalization expense were analyzed by single factor and multiple regression statistical methods. Results The average hospitalization expense of children with respiratory diseases before the GPO implemented (4 872.38 yuan) was higher than after (4 620.25 yuan, P<0.05); the drug expense accounted for 35.35% and 27.39% of the hospitalization expense of the insured urban and rural children, and integrated payment accounted for 46.85% and 57.59%. Age, hospitalization days, outcome, comorbidities, disease classification, application of GPO drugs and admission classification were the common influencing factors of hospitalization expense of children with respiratory diseases. Hospitalization expense decreased with the increase of age, good outcome and application of GPO drugs, which was a negative correlation. And there was a positive relationship between the rest factors and the total cost of hospitalization. Conclusions To improve the outcome of children, shorten the average length of stay, doing a good job in drug zone and group procurement can reduce the hospitalization cost of children with respiratory diseases.

目的 探讨p16免疫细胞化学、人乳头瘤病毒(HPV)DNA基因分型单独和联合检测在宫颈细胞学不能明确诊断意义的非典型鳞状上皮细胞(ASC-US)分流中的价值。方法 收集2017年3月—2022年1月,585例液基薄层细胞学(TCT)诊断为ASC-US患者的宫颈细胞学标本,使用免疫细胞化学法行p16蛋白检测,生物芯片法行HPV DNA基因分型检测,患者于8周内行阴道镜下病理活检术。以组织学诊断结果为金标准,探讨p16免疫细胞化学和HPV DNA基因分型单独和联合检测方法在同一级别宫颈病变中阳性率的差异,对比同一检测方法在不同级别宫颈病变中阳性率的差异,比较p16免疫细胞化学、HPV DNA基因分型单独和联合检测对高级别鳞状上皮内病变(HSIL)以上病变诊断效能的差异,综合评定一种最优的ASC-US分流方法。结果 ①(p16+HPV DNA)联合检测在同一级别宫颈病变中阳性率高于p16免疫细胞化学、HPV DNA基因分型检测。②p16免疫细胞化学、HPV DNA基因分型、(p16+HPV DNA)联合检测的阳性率均随着宫颈病变程度的加重而递增。③(p16+HPV DNA)联合检测的综合诊断效能最佳,其灵敏度、特异度、符合率和约登指数分别为99.07%、62.55%、69.23%、0.62。结论 p16免疫细胞化学检测法与HPV DNA基因分型单独和联合检测均有助于ASC-US分流,但是,(p16+HPV DNA)联合检测具有更优的灵敏度和约登指数,同时保持了较高的特异度和符合率,可有效进行ASC-US分流。

Objective To investigate the value of p16 immunocytochemistry and human papillomavirus (HPV) DNA genotyping alone and combined in atypical squamous cells of undetermined significance (ASC-US) shunt which cervical cytology can not clearly diagnose. Methods From March 2017 to January 2022, cervical cytological specimens of 585 patients with ASC-US diagnosed by liquid based thinprep cytology test (TCT) were collected. p16 protein was detected by immunocytochemistry, HPV DNA genotype was detected by biochip and the patients underwent colposcopy pathological biopsy within 8 weeks. Taking the histological diagnosis results as the gold standard, the differences of the positive rate of p16 immunocytochemistry and HPV DNA genotyping in the same level of cervical lesions, differences of the positive rate of the same detection method in different levels of cervical lesions and differenes of p16 immunocytochemistry HPV DNA genotyping alone and combined detection of the diagnostic efficacy of lesions severer than high-grade squamous intraepithelial lesion (HSIL) were compared to comprehensively evaluate an optimal ASC-US shunt method. Results ①The positive rate of combined detection of (p16+HPV DNA) in the same level of cervical lesions was higher than that of differences of p16 immunocytochemistry and HPV DNA genotyping. ②The positive rate of combined detection of (p16+HPV DNA), p16 immunocytochemistry and HPV DNA genotyping increased with the aggravation of cervical lesions. ③The combined detection of (p16+HPV DNA) had the best comprehensive diagnostic efficiency and its sensitivity, specificity, coincidence rate and Yoden index were 99.07%, 62.55%, 69.23% and 0.62 respectively. Conclusions p16 immunocytochemical assay and HPV DNA genotyping, both alone and in combination, contributed to ASC-US shunt. However, the combined detection of (p16+HPV DNA) had better sensitivity and Yoden index, with high specificity and coincidence rate, which can effectively carry out ASC-US shunt.

目的 探究冠心病患者实施血清胆红素与尿酸检验的临床诊断价值。方法 遴选时段2020年6月—2021年6月内100例冠心病患者记观察组,另择取同时段健康体检对象100例记对照组,检测血清胆红素、尿酸水平并2组相对比,同时观察组患者根据冠脉狭窄程度(Gensini法)分组为A、B、C、D组,比较冠脉不同狭窄程度分级下上述指标的变化;评估对比血清胆红素、尿酸单项指标检验与联合检验对冠心病患者的诊断效能。结果 观察组较对照组血清胆红素(总胆红素、直接胆红素、间接胆红素)水平更低,尿酸水平更高,对比有统计学差异(P＜0.05);随着冠脉狭窄程度越严重患者血清胆红素水平呈下降趋势,尿酸水平呈升高趋势,且4组组间比较均差异有统计学意义(P＜0.05);冠心病患者血清胆红素联合尿酸检验的诊断敏感度96.00%、特异度95.00%均高于单项检验敏感度及特异度(P＜0.05)。结论 血清胆红素与尿酸水平可作为冠心病患者诊断的敏感性指标,其与冠心病的发生及发展密切相关,可反映患者病情严重程度,且联合检验诊断价值更高。

Objective To explore the clinical diagnostic value of serum bilirubin and uric acid detection in patients with coronary heart disease. Methods A total of 100 patients with coronary heart disease from June 2020 to June 2021 were selected as the observation group, and another 100 healthy subjects in the same period were selected as control group. Serum bilirubin and uric acid levels were detected and compared between the two groups. Meanwhile, the patients in the observation group were divided into groups A, B, C and D according to the degree of coronary artery stenosis (Gensini method). The changes of the above indexes were compared among different grades of coronary stenosis. And the diagnostic efficacy of each single detection and combined detection of serum bilirubin and uric acid in patients with coronary heart disease were evaluated and compared. Results Compared with the control group, the serum bilirubin (total bilirubin, direct bilirubin, indirect bilirubin) level of the observation group was lower, and the uric acid level was higher, with statistical differences (P<0.05). With the increased severity of coronary artery stenosis, the serum bilirubin level of patients showed a downward trend, while the uric acid level showed an upward trend, and there were significant differences among the four groups (P<0.05). The sensitivity and specificity of serum bilirubin combined with uric acid detection in patients with coronary heart disease were 96.00% and 95.00% respectively, which were higher than those of single detection (P<0.05). Conclusions Serum bilirubin and uric acid levels can be used as sensitive indicators in the diagnosis of patients with coronary heart disease, and are closely related to the occurrence and development of coronary heart disease, which can reflect the severity of the disease, also the diagnostic value of combined detection is higher.

目的 探讨慢性阻塞性肺疾病(COPD)并发低氧血症患者抢救中使用小剂量肾上腺素及布地奈德的价值。方法 纳入50例COPD并发低氧血症患者研究(2018年4月—2021年4月),按双盲法分为对照组(n=25,采用布地奈德雾化吸入治疗)、观察组(n=25,在对照组基础上采用肾上腺素治疗),统计2组抢救成功率、临床指标、预后效果。结果 (1)抢救成功率:观察组(96.00%)高于对照组(76.00%),组间对比P<0.05。(2)临床指标:观察组PaCO₂(43.29±4.92 mmHg)低于对照组,PaO₂(86.77±8.25 mmHg)、SpO₂(92.14±2.82%)、pH(7.43±0.12)、FVC(2.41±0.28 L)、FEV1(1.72±0.72 L)、FEV1/FVC(70.95±8.22%)高于对照组,组间对比P<0.05。(3)预后效果:观察组气喘(3.22±1.08 d)、哮鸣音(5.21±1.11 d)消失时间及住院时间(9.61±2.24 d)短于对照组,组间对比P<0.05。结论 小剂量肾上腺素联合布地奈德在COPD并发低氧血症治疗中效果确切,可提高抢救成功率,亦可改善其肺功能及血气指标,值得临床参考。

Objective To explore the value of low dose epinephrine and budesonide aerosol inhalation in the rescue of patients with chronic obstructive pulmonary disease(COPD) complicated with hypoxemia. Methods Fifty patients with COPD complicated with hypoxemia(April 2018 to April 2021)were enrolled and divided into control group(n=25,treated with budesonide aerosol inhalation)and observation group(n=25,treated with epinephrine additionally)according to double-blind method.The rescue success rate,clinical indicators and prognosis of the two groups were statistically analyzed. Results (1)The success rate of rescue of the observation group(96.00%)was higher than that of the control group(76.00%,P<0.05). (2)Clinical indicators:PaCO₂(43.29 1±4.92 mmHg)in the observation group was lower than that of the control group,PaO₂(86.774±8.25 mmHg), SpO₂(92.14±2.82%), pH(7.43±0.12), FVC(2.41±0.28 L), FEV1 (1.72±0.72 L), FEV1/FVC (70.95±8.22%)were higher than that in the control group(P<0.05). (3)Prognosis effect:asthma duration in the observation group(3.22±1.08 d),wheezing disappeared time(5.211±1.11 d)and hospitalization time(9.611±2.24 d)were shorter than that of the control group(P<0.05). Conclusions Low dose epinephrine combined with budesonide in the treatment of COPD complicated with hypoxemia has definite effect, which can improve the success rate of rescue,also improve lung function and blood gas index. It is worthy of clinical reference.

目的 探讨不同剂量阿托伐他汀治疗能否作用于脑血管储备能力机制,进而影响卒中后轻度认知功能障碍患者的认知功能水平及神经功能。方法 纳入2018年5月—2020年5月期间,在本院神经内科住院的100例卒中后轻度认知障碍患者。随机分为大剂量(阿托伐他汀40 mg/d)组和小剂量(阿托伐他汀10 mg/d)组。记录半年后的简易精神状态量表(MMSE)评分、神经功能评分(NIHSS)和脑血管储备能力。结果 大剂量组的MMSE评分、NIHSS评分优于小剂量组,大剂量组的脑血管储备能力改善明显,2组之间有统计学差异。脑血管储备能力提高与认知功能改善有相关性。结论 大剂量阿托伐他汀治疗可明显改善卒中后轻度认知功能障碍患者的脑血管储备能力,并促进患者认知功能及神经功能恢复。

Objective To investigate whether different doses of atorvastatin can contribute to the mechanism of cerebrovascular reserve capacity, and then affect the level of cognitive function and neurological function in patients with mild cognitive impairment after stroke. Methods A total of 100 patients with mild cognitive impairment after stroke hospitalized in the department of neurology from May 2018 to May 2020 were recorded. They were randomly divided into high-dose (atorvastatin 40 mg/d) group and low-dose (atorvastatin 10 mg/d) group. The Mini-Mental State Examination (MMSE), National Institute of Health Stroke Scale (NIHSS) and cerebrovascular reserve capacity were recorded half a year later. Results The scores of MMSE and NIHSS in the high-dose group were higher than those in the low-dose group. The cerebrovascular reserve capacity of the high-dose group was significantly improved, and there was significant difference between the two groups. There was a correlation between the improvement of cerebrovascular reserve capacity and cognitive function. Conclusions High dose of atorvastatin could significantly improve the cerebrovascular reserve capacity of patients with mild cognitive impairment after stroke, and promote the recovery of cognitive function and neurological function.

目的 研究在急危重症创伤患者的急诊抢救过程中,急诊创伤护理专业团队发挥的优势。方法 2019年1月—2020年12月,选取北京怀柔医院急诊抢救室接诊的严重创伤患者160例为研究对象,随机将其分为研究组和对照组,每组80例。对照组患者采用常规护理方法,而研究组患者采用专业创伤护理团队护理。观察2组患者的指标:术前抢救用时、影像学完成用时、接诊用时、住院时间。结果 研究组患者的接诊用时、术前抢救用时、影像学完成用时和住院时间与对照组相比较短,差异均有统计学意义(均 P<0.05);对照组患者的抢救成功率为86.25%,短于研究组的96.25%,差异有统计学意义(P<0.05);研究组在感染、凝血功能障碍和死亡方面的不良事件发生率低于对照组,差异有统计学意义(P＜0.05)。结论 创伤护士团队在急危创伤患者治疗抢救中优势明显,进一步使患者的生命安全得到保证,提升救援成功的几率。

Objective To grope for positive character of trauma nursing team in the emergency rescue of cases with serious trauma. Methods From January 2019 to December 2020, we retrospectively analyzed the data of 160 severe trauma patients admitted to the emergency room of Beijing Huairou Hospital. All patients were divided into control group and observation group, with 80 cases in each group. Patients in control group took the usual care nursing, and observation group patients adopted professional trauma care nurse team caring. The time of consultation, imaging completion time, preoperative rescue time and length of hospital stay of the two groups were compared. Results The consultation time, imaging completion time, preoperative rescue time and length of hospital stay of the observation group were shorter than those of control group, and the differences were statistically significant (P<0.05). The success rate of salvage for patients in the control group was 86.25%, which was lower than the observation group(96.25%), the difference was statistically significant (P<0.05). The incidence of infection, coagulation dysfunction and death in the observation group were lower than those in the control group, and the difference was statistically significant (P<0.05). Conclusions The trauma nursing team had obvious advantages in the emergency rescue of serious trauma patients, which can increase the success rate of rescue.