目的 分析于剖宫产产妇围手术期实施针对性护理对其切口感染率及不良情绪的影响。方法 选取2015年6月—2016年4月于我院择期行剖宫产术的102例产妇,通过随机数表法分为观察组与对照组,各51例。给予对照组常规护理,在此基础上观察组给予针对性护理干预。对比两组术后恢复情况、护理前后疼痛评分(VAS)、抑郁评分(SDS)及焦虑评分(SAS)变化情况,并统计两组并发症发生率、护理满意度。结果 观察组肛门排气时间、切口愈合时间、24 h睡眠时间、住院时间、下床活动时间均少于对照组,差异有统计学意义(P＜0.05);护理前两组SAS评分、SDS评分、VAS评分间无明显差异(P＞0.05),经护理干预,观察组SAS评分、SDS评分、VAS评分低于对照组,差异有统计学意义(P＜0.05);两组切口感染率、并发症发生率(1.96%、7.84%)低于对照组(15.69%、31.37%),差异有统计学意义(P＜0.05);两组护理满意度对比,观察组(98.04%)高于对照组(82.35%),差异有统计学意义(P＜0.05)。结论 给予剖宫产围术期产妇针对性护理疗效确切,可缓解不良情绪,减轻疼痛感,促使机体功能及早康复,减少切口感染与并发症发生。

目的 调查我院处方错误的数量和分类,保障门诊患者用药的安全性、有效性和经济性。方法 采用回顾性分析方法,对我院2016年1月—6月的门诊电子处方统计,对不合理处方及时电话沟通和改正,并将错误处方登记入册分析。结果 其中登记入册的错误处方占总处方数的0.24%,主要包括药物用法用量不合理、给药途径不当、药物相互作用不合理、禁忌证用药、重复用药、电脑输入剂量或单位错误等。结论 我院门诊电子处方仍存在一定的不合理现象,临床药师通过处方审核进行干预,并与医院管理和医师有机结合,努力开展药学监护,提高我院处方质量,促进合理用药,共同保证患者用药正确,有效,安全,经济,合理,降低医疗纠纷的发生。

目的 研究中山市南部镇区医院人员关于继续医学教育的政策知悉程度、参加继续医学教育的途径、障碍因素及动机,为完善继续医学教育管理工作提供决策依据。方法 采用简单随机抽样的方法,选取中山市南部镇区医院200名医务人员,采用问卷调查方法,了解中山市南部镇区医务人员继续教育的参与情况,接受继续教育的主要途径与障碍。结果 24～40岁年龄段、初级职称人员知悉程度较高,而40～48岁年龄段、中高职称人员参与程度较高;晋升和发展是主要参与动机,时间和空间因素是主要参与障碍。结论 医院应根据不同层次专业技术人员继续教育的需要开展继续教育,并创造有利条件,克服时间上和空间上的障碍,更好地使继续教育的效果转化为知识结构的不断优化。

瘦素是维持人体能量代谢平衡的蛋白质,在人体中主要由白色脂肪组织分泌,通过与瘦素受体结合发挥作用。近年来有许多与瘦素相关的研究证明高血压患者及代谢综合征患者的血清瘦素水平较健康人群明显升高。两种疾病均可出现心室肥厚,蛋白尿,动脉粥样硬化等表现,说明二者存在共同的靶器官。瘦素代谢异常可出现瘦素抵抗并通过影响肾素-血管紧张素-醛固酮系统(renin angiotensin aldosterone system, RAAS)及炎症细胞因子来损伤靶器官。本文旨在总结瘦素在高血压及代谢综合征中的作用机制,并探讨瘦素对高血压合并代谢综合征靶器官损伤作用的研究进展。

Leptin is a protein that maintains the balance of energy metabolism in human body. It is mainly secreted by white adipose tissue in human body. In recent years, many studies have shown that the serum leptin level in patients with hypertension complicated with metabolic syndrome is significantly higher than that of healthy people. Both of the diseases can lead to left ventricular hypertrophy, proteinuria, atherosclerosis and other manifestations. The abnormal metabolism of leptin may contribute to leptin resistance which damages target organs by affecting the angiotensin aldosterone system and inflammatory cytokines. The aim of this article is to summarize the mechanism of leptin in hypertension and metabolic syndrome, and to explore its effect on the target organ damage in patients with hypertension complicated with metabolic syndrome.

目的 探讨产后出血(PPH)应用一次性囊式宫颈扩张器治疗的临床效果。方法 选取我院2001年1月—2016年12月收治的50例PPH产妇,按就诊先后顺序进行分组,2001年1月—2015年12月就诊的25例为对照组(予以宫腔填塞纱布治疗);2016年1月—2016年12月就诊的25例为观察组(给予一次性囊式宫颈扩张器治疗),并按照分娩方式不同分为阴道分娩组(15例),剖宫产组(10例)。记录比较观察组和对照组的治疗与预后情况;阴道分娩组与剖宫产组的治疗情况。结果 与对照组比较,观察组在操作时间、填塞物留置时间及起效时间方面,均显著更优(P<0.01);两组放置后12 h出血量、显效率相比,差异无统计学意义(P>0.05);观察组子宫切除、子宫动脉结扎及产褥感染等发生率均低于对照组,但差异均无统计学意义(P>0.05);阴道分娩组的起效时间、留置时间、T2时间段阴道总流血量、显效率及产褥感染率,较剖宫产组比较,差异均无统计学意义(P>0.05),阴道分娩组T1时间段阴道总流血量显著低于剖宫产组(P<0.01)。结论 PPH产妇应用一次性囊式宫颈扩张器治疗操作简便,更有利于缩短操作时间,改善预后,效果切实,且对于阴道分娩与剖宫产产妇的疗效相当,适用于基层医院,具有较高临床推广价值。

目的 探讨腹腔镜手术与传统开腹手术对右半结肠癌患者免疫功能指标及临床疗效的影响。方法 选取80例右半结肠癌患者,随机分成两组,各40例分别行腹腔镜手术及传统开腹手术,分别比较两组患者手术前后免疫功能指标及相关临床疗效的差异。结果 腹腔镜组及开腹组术后免疫指标CD3⁺、CD4⁺、CD8⁺均出现不同程度下降,但腹腔镜组免疫指标CD3⁺、CD4⁺均优于开腹组(P＜0.05);腹腔镜组术中出血量、术后胃肠排气功能恢复时间、住院时间均优于开腹组(P＜0.05);两组手术时间及淋巴结清扫个数方面无显著差异(P＞0.05)。结论 腹腔镜手术治疗右半结肠癌不仅对患者免疫功能损害较低,还较开腹术具有术中出血量少、术后恢复快等优点,值得临床推广。

目的 探讨血管介入治疗糖尿病足的疗效以及术后血管再狭窄的影响因素。方法 选取2013年2月—2015年3月在我院接受治疗的糖尿病足患者96例,采用随机数表法将患者分为观察组和对照组两个各48例,观察组患者给予血管微创手术介入治疗,对照组患者给予常规治疗,比较两组患者治疗后的临床疗效、住院费用、住院天数、Wagner分级以及患者观察组患者术后血管再狭窄的影响因素。结果 治疗后,观察组患者的总有效率为93.75%高于对照组72.91%,两组比较差异有统计学意义(P<0.05);将观察组患者术后发生发生血管再狭窄的22例患者作为A组,未出现血管再狭窄的26例患者作为B组。A、B两组患者病程、TG、LDL-C、MDA含量、HbA以及BMI比较差异无统计学意义(P>0.05);术后,A组患者的TC明显高于B组,两组比较差异有统计学意义(P<0.05),由此可见,TC是导致患者术后出现血管再狭窄的危险因素;观察组患者的住院费用以及住院天数低于对照组,两组比较差异显著(P<0.05)。结论 采用血管介入治疗糖尿病足患者疗效显著,高TC是患者术后血管再次发生狭窄的影响因素。

目的 调查分析中山市某三甲医院抗菌药物不良反应的发生和分布情况,为临床合理应用抗菌药物提供相关信息。方法 以中山市某三甲医院2013—2015年上报国家药品不良反应监测系统的528例抗菌药物的不良反应为考察对象,按照给药途径、不良反应严重程度、年龄、性别、药物种类、不良反应累及的系统-器官、不良反应发生时间进行分类、整理、归纳和总结。结果 累及系统-器官涉及皮肤及其附件、血液系统、神经系统、消化系统、泌尿系统等。其中皮肤及其附件损害、神经系统、胃肠道反应容易发现,消化系统、血液系统、泌尿系统、肝胆系统的反应具有隐匿性。结论 临床在使用抗菌药物时,既要关注其抗菌效应,也要高度警惕其不良反应的危害性。避免无指征用药,合理选用抗菌药物,科学地开展ADR 监测工作,确保临床安全、有效、合理用药。

Objective To investigate occurrence and distribution of adverse drug reaction ADR of antibiotic drugs in a hospital of Zhongshan, in order to provide relevant information for clinical rational use of antibacterial drugs. Methods We classified and analyzed 528 cases of adverse drug reaction of antibiotic drugs which was reported to National center for ADR Monitoring during 2013～2015, according to the administration route、the severity of ADRs、age、sex、types of drugs、the organs systems involved by ADRs, the time of ADRs occurrence. Results Adverse drug reaction of antibiotic drugs involved in skin and its appendix、hematological system、nervous system、digestion system、urinary system and so on. Among them skin and its appendix、nervous system and gastrointestinal reactions were easy to acquire, others were obscure and difficult to find. Conclusion When the clinical use of antibacterial drugs, should not only focus on its antibacterial effect, also need to keep high vigilance against the dangers of its adverse reactions. To ensure the clinical safety, effective and rational drug use, we need to avoid no indication of medicine, take rational use of antibiotic drugs,scientifically to carry out the ADR monitoring.

目的 探究曲美他嗪对慢性心力衰竭患者血清炎症因子水平及心功能的影响。方法 选择2015年4月—2016年3月我院收治的慢性心力衰竭患者94例,根据随机数表法分为两组,每组47例。对照组实施阿托伐他汀治疗,观察组在此基础上予以曲美他嗪治疗。比较两组患者治疗6个月后血清炎症因子和脑利钠肽(BNP)、心功能以及临床疗效。结果 观察组血清C-反应蛋白(CRP)、BNP、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异有统计学意义(P＜0.05);观察组左收缩末期内径(LVESD)、左室舒张末期内径(LVEDd)水平较对照组明显降低,而左室射血分数(LVEF)高于对照组,差异有统计学意义(P＜0.05);观察组患者治疗有效率与对照组相比明显提高,差异有统计学意义(P＜0.05)。结论 对慢性心力衰竭患者实施曲美他嗪治疗,能有效提高患者临床疗效,降低患者血清炎症因子,改善心功能,值得临床推广与应用。

Objective To investigate the effect of Trimetazidine on serum inflammatory factors levels and cardiac function in patients with chronic heart failure (CHF). Methods 94 CHF patients admitted into our hospital from April 2015 to March 2016 were divided into two groups randomly, 47 cases in each. Control group took Atorvastatin, and on this basis observation group was given Trimetazidine. The serum inflammatory factors levels, brain natriuretic peptide (BNP), cardiac function and clinical efficacy of two groups after treatment for 6 months were compared. Results The serum C-reactive protein (CRP), BNP, Tumor necrosis factor-α (TNF-α) levels of observation group were lower than control group (P<0.05); The left ventricular end-systolic diameter (LVESD), Left ventricular end-diastolic diameter (LVEDd) levels of observation group significantly decreased compared with control group, but left ventricular ejection fraction (LVEF) was higher than control group (P<0.05); The curative effective rate of observation group significantly increased compared with control group (P<0.05). Conclusion Trimetazidine for treating CHF patients may effectively increase clinical efficacy, decrease serum inflammatory factors and improve cardiac function, which is worthy of clinical promotion and application.

目的 运用灵龟八法配合面瘫针治疗Bell麻痹患者,探讨该法治疗Bell麻痹的有效性及其机理。方法 随机分组的4组Bell麻痹患者,A组:灵龟八法配合面瘫针组、B组:面瘫针组、C组:常规针刺组、D组:西药组。治疗≤2个疗程,每个疗程4周,治疗前及发病2,4,8周后进行House-Brackmann面神经分级与症状积分、瞬目反射(BR)、肌电图(EMG)、神经电图(ENoG)及红外热像测定。结果 根据House-Brackmann面神经分级与症状积分评定疗效,4组有效率比较A组疗效最好,疗程最短(P＜0.05)。各项神经电生理检查及红外热像结果在治疗后变化中A组变化差异均最显著(P＜0.05)。结论 灵龟八法配合面瘫针治疗Bell麻痹在疗效及疗程方面均有较大的优势。且该疗法取穴简便、安全,使患者易以接受,值得临床推广。

Objective Through the clinical observation of Jin's 3-needle with eight methods of Intelligent Turtle(Traditional Chinese Medicine) in the treatment of Bell's palsy,to explore the impact mechanism of this method in the treatment of Bell's palsy. Methods Patients with Bell's palsy were randomly divided into study groups. 30 cases were in Jin's 3-needle with eight methods of Intelligent Turtle treatment group (Group A); 30 cases were in the Jin's 3-needle treatment group (Group B); 30 cases were in the routine acupuncture group(Group C);30 cases were in the oral medicine group (Group D). The course of the treatment took 4 weeks. Before the treatment and in 2,4,8 weeks after the diseases onset in each group, House-Brackmann facial nerve grading and symptom score,BR,EMG,ENoG and infrared thermography were observed and compared. Results Each group of treatment was effective in House-Brackmann facial nerve grading and symptom score(P＜0.05). However, Group A were better than the other three groups.The results of electrophysiological examination and infrared thermal imaging were statistically significant after treatment(P＜0.05). The difference was the most significant in group A. Conclusion Jin's 3-needle with eight methods of Intelligent Turtle treatment has a great advantage in curative effect and shortens the course of treatment. The method is simple and safe. It is worthy to be widely used in clinical practice.