目的 探讨血浆BNP预测急性肺栓塞患者发生心血管疾病的临床价值。方法 选择2017年1月—2017年12月在我院诊断为急性肺血栓栓塞患者97例为研究对象,根据有无出现心血管并发症分为观察组(21例)和对照组(76例)。比较两组间实验室指标的差异性和相关性,并采用ROC曲线分析BNP预测急性肺栓塞患者发生心血管疾病的临床价值。结果 观察组共出现21例心血管并发症,占21.65%。观察组中BNP、Hs-CRP 、TnI 、AST、CK和DD的浓度分别为(413.01±33.09)(pg/mL)、(20.49±2.88)mg/L、(0.154±0.103)μg/L、(131.23±27.05)U/L、(421.64±50.70)U/L和(1.95±0.18)mg/L,高于对照组(P<0.05)。Spearman相关性分析,血浆BNP水平与Hs-CRP 、TnI 、AST、CK和DD水平呈正相关(r=0.802、0.718、0.683、0.705、0.753,P<0.05)。ROC曲线分析,BNP的AUC面积最高,为0.834(95%CI:0.795~0.935),敏感度和特异度分别为90.5%和87.5%,联合诊断的AUC面积为0.892(95%CI:0.811~0.976),敏感度和特异度分别为84.6%和91.3%。结论 血浆BNP对于预测急性肺栓塞患者发生心血管疾病具有极高临床价值,采取多指标联合检查可以更加有效发现心血管疾病的发生。

Objective To investigate the clinical value of plasma BNP in predicting cardiovascular disease in patients with acute pulmonary embolism. Methods 97 cases of acute pulmonary thromboembolism diagnosed in our hospital from January to December 2017 were selected.The patients were divided into the observation group (21 cases) and control group (76 cases) according to whether there were cardiovascular complications.The differences and correlations of laboratory indexes between the two groups were compared, and the ROC curve was used to analyze the clinical value of BNP in predicting the occurrence of cardiovascular disease in patients with acute pulmonary embolism. Results 21 cases of cardiovascular complications occurred in the observation group, accounting for 21.65%.The concentration of BNP, Hs-CRP, TnI, AST, CK and DD in the observation group were (413.01±33.09) (pg/mL), (20.49±2.88) mg/L, (0.154±0.103) μg/L, (131.23±27.05) U/L, (421.64±50.70) U/L and (1.95±0.18) mg/L, which were higher than those of the control group(P<0.05). Spearman correlation analysis showed that plasma BNP levels were positively correlated with the levels of Hs-CRP, TnI, AST, CK and DD (r=0.802,0.718,0.683,0.705,0.753,P<0.05). The ROC curve analysis showed that the area of AUC of BNP was 0.834 (95%CI:0.795~0.935) of the highest, the sensitivity and specificity were 90.5% and 87.5% respectively. The area of combined diagnosis of AUC was 0.892 (95%CI:0.811~0.976),the sensitivity and specificity were 84.6% and 91.3%, respectively. Conclusion Plasma BNP is of high clinical value for predicting the incidence of cardiovascular disease in patients with acute pulmonary embolism. Multi-index combined examination may be more effective to detect the occurrence of cardiovascular disease.

目的 了解医院感染及抗菌药物使用现状,进一步制定有效的预防控制措施。方法 采用横断面调查方法,应用SPSS 17.0行统计分析。结果 3次调查实查率100%。其中社区感染255例,现患率31.14%;高发科室为儿科;感染部位以下呼吸道为主(62.75%);感染病原以革兰氏阳性菌(G⁺)为主。医院内感染6例、现患率0.73%;高发科室为妇产科、外科;感染部位以浅表切口为主(50%);感染病原以革兰氏阴性菌(G^-)为主(66.6%)。三年内医院抗菌药物平均使用率32.23%。结论 调查结果反映了医院感染及抗菌药物使用现状。依此制定干预措施,防控多重耐药菌感染,减少医院感染发生。

Objective To investigate the trends of nosocomial infections and use of antimicrobial agents,in order to effectively prevent and control program of hospital infection. Methods Cross-sectional survey method was adopted,the SPSS17.0 were used to statistical analysis. Results The check real rate was 100％.Among them 255 cases were community infection, the infection rate was 31.14%; the high frequent incidence was in the pediatric department; lower respiratory tract infection was the primary infection sites(62.75%);gram-positive bacteria (G +) was the main pathogenic bacteria. 6 cases were nosocomial infection, the infection rate was 0.73%; the obstetrics and gynecology /surgery were the primary incidence; superficial incisional wound infection was the primary infection sites(50%);gram-negative bacteria (G-) was the main pathogenic bacteria(66.6%).The antimicrobial drug utilization rate averaged 32.23% in the three years. Conclusion The investigation reflects the nosocomial infection rates and the present situation of the use of antibacterial drugs. intervention measures were formulated based on the results of the survey. multiple drug-resistant bacteria infection should be prevented and controlled to reduce the incidence of hospital infection.

目的 分析本科医学生对临床技能学培训课程的满意度,探索可提高临床技能学课程的改进措施。方法 抽取2015级不同专业医学生参加临床技能学课程的学生,通过问卷调查学生对培训课程的满意度。结果 临床技能学体系改革后,学生对临床技能学课程设置和老师的满意度都很高,对课程设置非常满意有18.31%,满意有58.03%,基本满意有21.69%,不满意的只有1.41%;对老师非常满意有36.9%,满意有49.86%,基本满意有12.68%,不太满意只有0.56%。结论 临床技能学可提高学生的临床综合能力和思维能力,可以持续的开展。

Objective To Through the analysis of the satisfaction surveys of clinical skills course, we aimed to make improvements on the teaching of clinical skills course. Methods With the method of stratified sampling, we chose medical students of different majors in the grade 2015 who attended the clinical skills course, and carried out the surveys of their satisfaction on the course. Results Students were satisfied with the design and the teaching of clinical skills course after the reform of clinical skills teaching. With the design of clinical skills course, 18.31% students were very satisfied, 58.03% were satisfied, 21.69% were basically satisfied, and just 1.41% were unsatisfied; With the teachers of clinical skills, 36.9% students were very satisfied, 49.83% were satisfied, 12.68% were basically satisfied, and just 0.56% were unsatisfied. Conclusion Clinical skills course may improve students' clinical comprehensive abilities and clinical thinking. It should be carried out continuously.

目的 探讨STAF评分(the score for the targeting of atrial fibrillation,STAF)对心源性脑卒中(cardioembolism, CE)的预测价值,以辅助急性缺血性卒中患者病因学分型。方法 本研究为回顾性病例研究,连续入选2009年1月—2010年12月在暨南大学附属第一医院神经内科住院的急性缺血性卒中患者。所有患者严格按照STAF评分标准进行评分,按TOAST(the trial of org 10172 in acute stroke treatment,TOAST)病因学分型标准进行分型,采用SPSS 13.0软件进行统计分析,采用受试者工作特征曲线(receiver operator characteristic,ROC)来评判STAF评分对CE的预测价值。结果 共收集317例患者,其中CE 37例(11.67%)。STAF≥5提示为CE的灵敏度为89%,特异度为91%。结论 STAF评分对CE的预测有较好的作用价值,可辅助急性缺血性卒中病因学分型。

目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。

目的 本研究观察应用鼻喷激素联合白三烯受体拮抗剂在腺样体肥大患儿中治疗的效果。方法 选择2016年2月—2018年3月期间在广州市某区妇幼保健院耳鼻咽喉科确诊腺样体肥大的患儿,在患儿及家长知情同意的基础上,按照随机数字表法将87例耳鼻咽喉科诊断为腺样体肥大的儿童分为研究组和对照组。前者给予鼻喷激素联合白三烯受体拮抗剂进行治疗,后者独立使用白三烯受体拮抗剂进行治疗,比较两组患儿的临床治疗效果和不适症状的改善程度。结果 研究组腺样体肥大患儿临床症状得分小于对照组,优于对照组的治疗效果,差异有统计学意义(P＜0.05);且对比对照组,研究组患儿经鼻呼吸困难、入睡时打鼾、鼻部阻塞感等不适症状明显减轻。结论 鼻喷激素联合白三烯受体拮抗剂治疗儿童腺样体肥大,临床症状改善较为明显,具有经济性,家属及患儿接受度较高,相比手术创伤小,在基层医院推广有一定的价值。

目的 总结预防接种认知干预对儿童预防接种效果的影响。方法 对2018年5—9月在东莞企石镇接种百白破疫苗的儿童家属按接种时间顺序分为对照组254名、实验组248名,对照组家属按常规方法进行预防接种,实验组在常规接种基础上,结合不按时接种、延迟接种等问题对幼儿家属开展多种多样的百白破疫苗预防知识、不良反应观察处理、接种注意事项等知识宣教和培训干预,总结两组儿童在按时接种、延迟接种、疫苗接种知识、不良反应表现与处理、接种注意事项知识的掌握、服务满意度等情况。结果 实验组幼儿按时接种率比对照组高,延迟接种率比对照组低,结果有差异(P＜0.05);家属对疫苗接种知识、不良反应表现和处理、接种注意事项等知识的掌握比对照组高,结果有差异(P＜0.05)。结论 实施家属预防接种认知干预管理能提高家属掌握预防接种知识和不良反应护理知识;提高儿童疫苗接种率和及时接种率,提高预防接种服务管理效果。

Objective To summarize the effect of cognitive intervention on children's vaccination. Methods The family members of children vaccinated with DPT vaccine in Qishi Town of Dongguan City from May to September 2018 were divided into control group 254 and experimental group 248 according to the sequence of vaccination time. The family members of control group were vaccinated by routine methods. On the basis of routine vaccination, the experimental group carried out a variety of preventive knowledge and adverse reactions observation of DPT vaccine to the family members of children in combination with the problems of untimely vaccination and delayed vaccination. The knowledge propaganda and training intervention of treatment and vaccination precautions were summarized. The situation of two groups of children in timely vaccination, delayed vaccination, vaccination knowledge, adverse reaction performance and treatment, knowledge of vaccination precautions and service satisfaction were summarized. Results The vaccination rate of children in the experimental group was higher than that in the control group, and the delayed vaccination rate was lower than that in the control group. The results showed statistical difference (P＜0.05). The knowledge of vaccination, adverse reactions, treatment and matters needing attention of family members were higher than that in the control group, and the results showed statistical difference (P＜0.05). Conclusion Implementing cognitive intervention management of family vaccination may improve family members'knowledge of vaccination and nursing of adverse reactions, improve children's vaccination rates and timely vaccination rates, and improve the management effect of vaccination service.

目的 探讨不同中医体质老年糖尿病患者心率变异性与自主神经功能的关系。方法 选取2016年3月—2017年4月在我院治疗的老年糖尿病患者250例,检测各中医体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF、HF、LF/HF以及空腹血糖(FBG)、糖化血红蛋白(HbA1c)。结果 总偏颇体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF和HF分别为(88.37±10.02)ms、(78.82±9.44)ms、(41.14±11.43)ms、(22.28±6.53)ms、(10.03±4.33)ms、(203.38±78.23)ms²和(122.21±80.03)ms²,低于平和质患者(P＜0.05),而LF/HF为(1.68±0.43),高于平和质患者(P＜0.05);血瘀质患者SDNN、SDANN、SDNNI、RMSSD和PNN50低于气虚质、阴虚质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF、HF低于气虚质、血瘀质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF/HF低于气虚质、血瘀质、痰湿质、湿热质患者(P＜0.05);其他型患者SDNN、SDANN、SDNNI、RMSSD、PNN50、LF、HF高于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05),而LF/HF低于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05);不同中医体质患者FBG、HbA1c比较差异无统计学意义(P＞0.05)。结论 糖尿病患者偏颇体质较平和质患者心率变异性降低,表现为交感神经张力增大,迷走神经张力降低,其平衡协调破坏。

Objective To explore the relationship between heart rate variability and autonomic nervous function in elderly diabetic patients with different constitutions of traditional Chinese medicine. Methods 250 elderly patients with diabetes mellitus in our hospital from March 2016 to April 2017 were selected; the SDANN, SDNNI, RMSSD, PN50%, LF, HF, LF/HF, fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) were measured. Results In patients with general biased constitution, SDANN, SDNNI, RMSSD, PN50%, LF and HF were (88.37±10.02) ms, (78.82±9.44) ms, (41.14±11.43) ms, (22.28±6.53) ms, (10.03 ±4.33) ms, (203.38±78.23) ms² and (122.21±80.03) ms², which were lower than those in patients with plain constitution (P＜0.05), while LF/HF was (1.68±0.43), which was higher than that in patients with plain constitution (P＜0.05); in patients with blood stasis, SDANN, SDNNI, RMSSD and PN50 were lower than those with Qi deficiency, Yin deficiency, phlegm-dampness, damp-heat and other types (P＜0.05); LF and HF in Yin deficiency type patients were lower than those in Qi deficiency type, blood stasis type, phlegm-dampness type, damp-heat type and other types (P＜0.05); LF/HF in Yin deficiency patients was lower than that in Qi deficiency patients, blood stasis patients, phlegm-dampness patients and damp-heat patients (P＜0.05); SDANN, SDNNI, RMSSD, PN50, LF and HF in other types of patients were higher than Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05), while LF/HF was lower than those with Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05); there was no significant difference in FBG and HbA1c in patients with different constitutions of TCM (P>0.05). Conclusion The heart rate variability of biased constitution patients with diabetes mellitus was lower than that of patients with mild constitution, manifested by increased sympathetic nerve tension, decreased vagal nerve tension and destroyed balance and coordination.

目的 探讨影响初次机采血小板献血者再次捐献的相关因素,为制定机采献血者保留策略提供依据。方法 选择2016年1月1日—2016年12月31日在广州血液中心首次成功捐献机采血小板的13 899例献血者为研究对象,分析每个献血者献血时性别、年龄、文化程度、是否发生献血不良反应与下一年度是否再次捐献机采血小板的相关性。结果 男性献血者再次捐献率(10.68%)高于女性献血者再次捐献率(8.94%),差异有统计学意义(P＜0.01);献血者年龄18～25岁组再次捐献率最高为12.86%,46～60岁组再次捐献率最低为6.46%,差异有统计学意义(P＜0.001);献血者文化程度高中或职中组再次捐献率最高为11.23%,本科或以上组再次捐献率最低为8.94%,差异有统计学意义(P＜0.001);未发生不良反应献血者再次捐献率(10.37%)高于发生不良反应献血者再次捐献率(5.56%),差异有统计学意义(P＜0.01)。结论 男性、年龄较小、文化程度较低和未发生献血不良反应的献血者更愿意返回再次捐献机采血小板,对这部分献血者采取针对性保留措施,有利于建立起一支固定捐献机采血小板的献血者队伍。

Objective To explore the related factors affecting the re-donation of the first apheresis platelet donors, and to provide a basis for the retention strategy. Methods A total of 13 899 blood donors who successfully donated apheresis platelets for the first time in Guangzhou Blood Center from January 1, 2016 to December 31, 2016 were selected as subjects. The correlation among gender, age, education level, adverse reactions of blood donation and whether platelet collection was re-donated in the next year was analyzed. Results Re-donation rate of male blood donors (10.68%) was higher than that of female blood donors (8.94%). The difference was statistically significant (P<0.01). Re-donation rate of blood donors aged 18～25 was the highest 12.86%, and that of 46～60 was the lowest 6.46%. The difference was significant (P<0.001). Re-donation rate of high school or vocational college blood donors was the highest 11.23%. The lowest re-donation rate was 8.94% in the undergraduate group or above, and the difference was statistically significant (P< 0.001). The re-donation rate of donors without adverse reactions (10.37%) was higher than that of donors with adverse reactions (5.56%). The difference was statistically significant (P<0.01). Conclusion Male, younger, less educated and no adverse reactions to blood donation are more willing to return to donate platelet again. Targeting these donors for reserve measure will conducive to the establishment of a fixed platelet donor team.