目的 探讨婴儿过敏性直肠结肠炎的临床特点及肠镜、肠黏膜病理特点。方法 回顾性分析2016年1月—2018年12月我院收治的110例婴儿过敏性直肠结肠炎的临床资料及其结肠镜、肠黏膜病理结果、食物过敏原特异度IgG、血常规、粪常规、血清总IgE检测及治疗情况。结果 110例过敏性直肠结肠炎中男67例,女43例,< 6月龄98例;单纯母乳喂养26例,单纯牛奶喂养19例,混合喂养65例;临床表现均有腹泻,大部分患儿伴有血便(93例),部分患儿伴湿疹(23例)、排便哭闹(67例)、夜眠不安稳(61例)、呕吐(8例)、营养不良(6例);血嗜酸性粒细胞升高63例;血清总IgE升高21例;食物过敏原特异度IgG检测结果,牛奶103例,鸡蛋62例;内镜下病变均累及降结肠、乙状结肠、直肠,累及横结肠76例、升结肠47例、回盲部18例;最常表现为疱疹样改变(106例)、糜烂(97例)、溃疡(13例),组织病理学表现为肠黏膜嗜酸性粒细胞浸润91例,隐窝炎、隐窝增生21例,淋巴滤泡形成18例、浅表溃疡形成4例;18例经母亲规避饮食后好转,8例经先换用氨基酸奶粉喂养1周、再逐渐引入母乳后好转;19例换用深度水解或氨基酸奶粉喂养后好转;65例经换用深度水解或氨基酸配方奶粉喂养、同时母亲规避饮食后好转。结论 婴儿过敏性直肠结肠炎缺乏特异度表现,多数临床经过良好,仅少数并发营养不良;牛奶是最主要的过敏原;腹泻、便血病史、血嗜酸细胞升高、肠镜疱疹样改变、肠黏膜嗜酸细胞浸润,提示过敏性直肠结肠炎可能性大;母亲规避饮食或换用氨基酸或深度水解奶粉治疗有效,也是确诊的标准。

Objective To investigate the clinical features of infantile allergic proctocolitis and its endoscopic lesions and pathological features. Methods A retrospective analysis of 110 cases of infantile allergic proctocolitis admitted to our hospital from January 2016 to December 2018 and its colonoscopy and pathological results, food allergen-specific IgG, blood routine, fecal routine, serum total IgE detection and treatment. Results Among 110 patients with allergic proctocolitis, 67 were male and 43 were female, 98 were < 6 months old; 26 were breastfed exclusively, 19 were fed milk alone, and 65 were mixed feeding. The clinical manifestations were diarrhea, most of children with bloody stools (93 cases), some children with eczema (23 cases), defecation and crying (67 cases), restless sleep (61 cases), vomiting (8 cases), malnutrition (6 cases); blood eosinophils increased in 63 cases,serum total IgE increased in 21 cases. Food allergen-specific IgG test results:103 cases of milk, 62 cases of eggs. Endoscopic lesions involved the descending colon, sigmoid colon, rectum, 76 cases of transverse colon, 47 cases of ascending colon and 18 cases of ileocecal. Most common manifested as herpes-like changes (106 cases), erosion (97 cases), ulcers (13 cases). Histopathology showed 91 cases of intestinal mucosal eosinophil infiltration, 21 cases of cryptitis and crypt hyperplasia, 18 cases of lymphoid follicle formation and 4 cases of superficial ulcer formation. 18 cases were improved after the mother evaded diet. 8 cases were improved by feding with amino acid milk powder for one week, and then breast milk was gradually introduced; 19 cases were improved after switching to deep hydrolysis or amino acid milk powder. 65 cases were improved after switching to deep hydrolysis or amino acid milk powder and simultaneously the mother evaded diet. Conclusion Infantile allergic proctocolitis lack of insufficient specific manifestations, most of the clinical cases are good, only a few are complicated by malnutrition. Milk is the most important allergen. Diarrhea, history of blood in the stool, elevated blood eosinophils, intestinal herpes-like changes, bowel mucosal eosinophil infiltration, are suggesting a high possibility of allergic proctocolitis. Mothers avoiding diet or switching to amino acids or deep hydrolyzed milk powder treatment is also effective, and this is also the standard of diagnosis of proctocolitis.

目的 探讨PBL联合SOAP门诊药历在提高门诊药师药学服务质量的效果。方法 开展SOAP门诊药历工作,并围绕实践中的典型案例开展PBL培训,由学员发现案例中的问题进行提问、分析、讨论,培训药师给予适当指导,并及时对问题解答与讨论过程中的问题进行总结。结果 PBL联合SOAP门诊药历提高了门诊药师的处方审核与处方干预水平,促进门诊药学服务工作顺利开展。结论 PBL联合SOAP门诊药历有利于培养药师独立思考和解决具体问题的临床思维能力,让门诊药师在临床实践中逐渐成长,在医院门诊药师向临床转型的实践中有良好的应用前景。

Objective To discuss the effects over the method of combining PBL with SOAP outpatient medicine records to improve the quality of pharmaceutical service of outpatient pharmacists. Methods We put the SOAP outpatient medicine records into practice and carry out the PBL training based on the typical cases in practice. In this process, the trainees can ask questions, analyze and discuss the problems in the cases, while the trainers should give some guidance, answer the questions immediately and conclude what were discussed. Results The method of combining PBL with SOAP outpatient medicine records has improved the outpatient pharmacists' level of prescription audit and intervention, it is helping to smoothly carry out the outpatient pharmaceutical service. Conclusion Combining PBL with SOAP outpatient medicine records will be helpful for pharmacists to develop their independent clinical thinking which may solve the specific problems, making them much more expert in the clinical practice. It is promising in the practice of outpatient pharmacists transforming to be clinical ones.

目的 探讨以家庭为中心的患教模式对糖尿病患者代谢控制水平的影响。方法 选取168例2016年9月—2017年8月在我院治疗的糖尿病患者,根据不同的健康教育模式干预将其分为观察组和对照组,每组各84例。对照组患者采用传统的综合患教模式,观察组患者在对照组的基础上采用以家庭为中心的患教模式,比较两组患者的自我管理水平及血糖、血脂控制效果。结果 干预后,观察组自我管理总得分、饮食控制、运动锻炼、血糖监测、足部护理、高低血糖处理均优于对照组(P＜0.05);观察组的FBG、PBG、HbA1C、TC、TG、LDL-C水平均低于对照组(P＜0.05)。结论 以家庭为中心的患教模式可辅助患者规范自己的行为,加强自我管理,改善血糖控制水平。

Objective To study the effects of two health education models on the level of metabolic control in diabetic patients. Methods 168 patients with diabetes admitted to our hospital from September 2016 to August 2017 were selected as subjects. According to different health education model interventions, they were divided into observation group and control group, with 84 cases in each group. The patients in the control group adopted a comprehensive health education model, and the patients in the observation group adopted a family-centered health education model based on the control group. The self-management level and blood glucose and blood lipid control effects of the two groups were compared. Results After intervention, the observation group self-management total score, diet control, exercise, blood glucose monitoring, foot care, high and low blood glucose treatment were better than that of control group (P<0.05); observation group FBG, PBG, HbA1C, TC, TG, LDL-C level were lower than that of the control group (P<0.05). Conclusion A family-centered health education model may help patients regulate their behavior, strengthen self-management, and improve their blood sugar control levels.

目的 探究基于微信平台的健康管理对糖尿病老年患者焦虑、抑郁、主观幸福感、血糖水平和生存质量的影响。方法 采取便利抽样方法选取我院老年病科2型糖尿病患者106例,随机分为干预组和对照组各53例。干预组进行基于微信平台的健康管理,主要包括心理干预和健康宣教,对照组实施传统心理干预和健康宣教,比较2组患者的焦虑、抑郁、主观幸福感、空腹血糖、餐后2 h血糖、HbA1C和生存质量。结果 干预后,干预组焦虑发生率低于对照组(P＜0.05),而抑郁发生率与对照组比较,差异无统计学意义(P＞0.05);干预组患者SAS评分、GDS评分、主观幸福感总分空腹血糖、餐后2 h血糖水平、HbA1C、PCS和MCS评分降低或升高效果优于对照组,差异有统计学意义(t=2.823,3.231,-18.956,5.152,7.401,7.528,-3.165,-3.232;P＜0.05)。结论 基于微信平台的健康管理能有效控制糖尿病老年患者的血糖水平,降低焦虑抑郁症状水平,提升主观幸福感和生存质量。

Objective To explore the effect of health management based on WeChat platform on depressive symptoms and quality of life of elderly patients with diabetes. Methods 106 elderly patients with type 2 diabetes hospitalized in geriatrics department in our hospital were selected by convenient sampling method and divided into two groups randomly, with 53 cases in each group. The intervention group was given psychological nursing and health education based on WeChat platform, while the control group received traditional psychological nursing and health education. Finally, the levels of anxiety and depressive symptoms, subjective well-being, fasting blood-glucose, 2h postprandial blood glucose, HbA1C and quality of life, were compared in both groups. Results After the intervention, the incidence of anxiety in the intervention group was lower than that in the control group (P＜0.05), while the incidence of depression did not have statistical difference compared with that in the control group (P＞0.05). The decrease or evaluation of SAS, GDS, subjective well-being, fasting blood-glucose, 2h postprandial blood glucose, HbA1C, PCS and MCS of the intervention group were greater than those in the control group, (t=2.823,3.231,-18.956,5.152,7.401,7.528,-3.165,-3.232;;P＜0.05). Conclusion Psychological intervention and health education by WeChat may control the blood glucose level of elderly patients with diabetes, reduce the level of anxiety and depression symptoms and improve subjective well-being and quality of life effectively.

目的 探讨规范化康复护理在脊髓型颈椎病前路手术术后功能恢复的影响。方法 将60例行颈椎前路椎间隙减压植骨融合内固定术的患者分为观察组和对照组各30例。对照组实施常规护理,观察组实施规范化康复护理措施。分别在出院时、出院后1、3、6个月进行日本骨科协会脊髓功能JOA评分、颈椎功能残障指数NDI评分、疼痛视觉模拟VAS评分、生活自理能力评分以及记录两组住院时间、术后并发症发生率。结果 手术后观察组与对照组的平均住院时间、术后并发症、术后脊髓功能恢复情况、颈椎功能恢复、生活自理能力的差异有统计学意义(P<0.05);观察组的平均住院时间均低于对照组(P<0.05);术后脊髓功能功能评分、生活自理能力评分均高于对照组(P<0.05);颈椎功能残障指数评分、术后并发症发生率均低于对照组(P<0.05)。结论 规范化康复护理可以促进脊髓型颈椎病行前路手术术后脊髓、颈椎功能的恢复,减少住院时间,减少术后并发症的发生,提高患者生活自理能力,提高生活质量。

Objective To investigate the effect of standardized rehabilitation nursing on functional recovery of cervical spondylotic myelopathy (CSM) after anterior operation. Methods Sixty patients were divided into two groups: observation group (n = 30) and control group (n = 30). Routine nursing was carried out in the control group and standardized rehabilitation nursing measures were carried out in the observation group. At the time of discharge, 1,3,6 months after discharge, the JOA score of spinal cord function of the Japanese Orthopaedics Association, the NDI score of cervical spine disability index, the VAS score of visual analogue of pain, the score of self-care ability of life were taken. The length of hospitalization of the two groups and incidence of postoperative complications were recorded. Results There were significant differences in average hospitalization time, postoperative complications, recovery of spinal cord function, recovery of cervical spine function and ability of living self-care between the observation group and the control group after operation (P<0.05). The average hospitalization time in the observation group was lower than that in the control group (P<0.05), and the scores of spinal cord function and self-care ability after operation were higher than those in the control group (P<0.05). The score of cervical disability index and the incidence of postoperative complications were lower than those of the control group (P<0.05). Conclusion Standardized rehabilitation nursing may promote the recovery of spinal cord and cervical spine function, reduce hospital stay, reduce postoperative complications, improve the self-care ability of patients and improve the quality of life.

目的 探究客观结构化临床考试(objective structured clinical examination,OSCE)对夜班护士准入培训效果的影响,并总结经验。方法 选取2017年5月—2018年5月期间首次获得执业注册并接受夜班准入培训的护士62名作为研究对象,采用随机数字法划分为观察组和对照组各31例。夜班准入培训时,对照组采用传统的培训考核模式,观察组采用以客观结构化临床考试为理论框架的培训考核模式,考试内容按教学目标设置,并由临床经验丰富的副高级以上导师围绕专业知识、技能、综合能力等对考点进行设计。培训结束后,两组护士均进行客观结构化临床考试、填写教学满意度量表、分析两组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力得分的差异。结果 观察组对培训效果的满意度为83.87%,对照组的满意度为54.84%,差异有统计学意义 (P＜0.05);与对照组比较,观察组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力及总分上分值明显更高,差异有统计学意义(P＜0.05);6个站点得分中,观察组的平均成绩要高于对照组,对实际临床操作、护理诊断和临床判断方面更具优势,差异有统计学意义(P＜0.05)。结论 客观结构化临床考试培训模式应用在护士夜班准入培训中,有效提高其临床能力及综合能力,提升了护士对培训课程的满意度。

Objective To explore the effect of objective structured clinical examination (OSCE) on the admission training of night shift nurses and to summarize the experience. Methods A total of 62 nurses who received the practice registration and night shift admission training from May 2017 to May 18, 2017 for the first time were selected as the study subjects. They were randomly divided into observation group and control group. For night shift admission training, the control group adopted the traditional training assessment mode, and the observation group adopted the training assessment mode with objective structured clinical examination as the theoretical framework. The examination content was set according to the teaching objectives, and was designed by clinically experienced supervisors at deputy senior level or above revolving the knowledge points of professional knowledge, skills, comprehensive ability. At the end of the trainings, nurses in the two groups took objective structured clinical examinations and filled out the teaching satisfaction scale. The differences in scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability in the two groups were analyzed. Results The satisfaction rate in the observation group was 83.87%, higher than that in the control group, which was 54.84%, and the difference was statistically significant (P<0.05). The scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability and the total scores in the observation group were higher than those in the control group, and the difference was statistically significant (P<0.05). The average score of knowledge points in the observation group was higher than that in the control group, with the former group boasting more advantages in actual clinical operation, nursing diagnosis and clinical judgment, with statistically significant difference between the two groups (P<0.05). Conclusion The application of objective structured clinical examination in nurse's night shift admission training may help improve their clinical ability and comprehensive ability, as well as their satisfaction to training courses.

目的 分析比较总额控制下的病种分值付费和单病种付费支付方式的应用效果。方法 回顾性分析2015年—2018年总额控制下病种分值付费和单病种付费模式下的平均住院费用、医保基金支出以及医保基金收入等基本情况,比对分析总额控制下单病种付费模式下与病种分值付费模式的总体运行效率。结果 2015年—2018年总额控制下病种分值付费情况存在轻微波动,但不出现明显上涨现象,稳定于9 000元左右的水平,并且总额控制下病种分值付费的医保基金结余率处于17%的水平,同时具有稳定的医保基金支出与医保基金收入水平。相比较总额控制下病种分值付费,单病种付费模式下的平均住院费用更高,且呈现出逐年增加的发展趋势;相比较2015年的平均住院费用,2018年平均住院费用高出500元。2015年—2018年总额控制下单病种付费的医保基金结余率具有较大波动,表示医保基金支出与医保基金收入水平不稳定。结论 总额控制下的病种分值付费模式具有明显的医疗费用以及医保基金费用支出控制效果,但同时也具有较大的基础投入水平以及较高管理成本等缺陷端,总额控制下的单病种付费模式具有方便管理的优势,但是在费用控制、病种涵盖等方面不如病种分值付费,总额控制下的单病种付费与病种分值付费各具优势和不足,需要依据区域情况,取长补短,因地制宜以及择优而用,确保健全医保支付方式。

Objective To analyze the application effect of the payment of disease type and the payment of single disease payment under the control of total amount. Methods A retrospective analysis of the basic hospitalization expenses, medical insurance fund expenditures and medical insurance fund income under the control of the total value of the disease and the single-income payment model under the total control from 2015 to 2018 were taken, and to have comparative analysis of the total control of the single disease overall operational efficiency of the payment model with the payment model. Results There was a slight fluctuation in the payment of disease value under the control of total amount from 2015 to 2018, but there was no obvious increase, which was stable at around 9 000 yuan, and the balance of medical insurance fund paid for the disease value under the total control was at 17% level and has both stable medical insurance fund expenditure and medical insurance fund income level. Compared with the total score control under the total amount control, the average hospitalization cost under the single disease payment mode was higher, and showed a trend of increasing year by year; compared with the average hospitalization cost in 2015, the average hospitalization cost in 2018 was higher, out of 500 yuan. From 2015 to 2018, the balance of the medical insurance fund paid for the control of the single disease had a large fluctuation, indicating that the medical insurance fund expenditure and the medical insurance fund income level were unstable. Conclusion The disease-based payment model under total control has obvious control effect of medical expenses and medical insurance fund expenses, but it also has a large basic input level and high management cost and other defects. The payment model has the advantage of convenient management, but it is not as good as the cost control and disease coverage, and the single disease payment and the disease value payment under the total control have their own advantages and disadvantages, which need to be based on the regional situation. We need to make use of the strengths and weaknesses, adapt to local conditions and choose the best, to ensure a sound medical insurance payment method.

目的 运用DRG分析临床路径管理对患者住院费用的影响。方法 采用BJ-DRGs分组器,选取2016年广州某三级综合医院的出院患者病案首页信息及DRG分组信息,对比是否实施临床路径管理对患者的总体住院费用影响及各DRG组的住院费用差异。结果 路径组中位住院费用为9 239.41元,低于对照组的12 358.06元,差异有统计学意义(P<0.001)。费用构成分析发现,路径组的治疗费、检查费、药品费、手术费和其他费低于对照组,而材料费用相对较高。比较的14个DRG组中,6个DRG组的路径组住院费用低于对照组。结论 实行临床路径管理可降低患者住院费用、改变费用构成。结合DRG积极推进临床路径精细化管理,可有效控制病种成本,遏制医疗费用的不合理增长。

Objective Using DRG to analyze the impacts on inpatient costs of a hospital in Guangzhou as incurred by clinical pathway management. Methods As performed by BJ-DRGs, we selected DRG grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Guangzhou in 2016. Then we compared the impacts of clinical pathway management on overall inpatients costs and the difference of inpatient costs for the DRG group. Results The median of inpatient costs in the clinical pathway group was 9239.41 yuan, was lower than that of control group which was 12358.06 yuan, and the difference was statistical difference (P<0.001). Cost composition analysis found that the costs of treatment, examination, medicine, surgery and the others in the clinical pathway group were much lower than that of the control group, while the cost of materials was relatively high. Among the 14 DRG group study, there were 6 DRG groups which the inpatient costs of the clinical path group was obviously lower than the control group. Conclusion The implementation of clinical pathway management may reduce the inpatient costs and change the makeup of costs. Therefore, combining with DRG, we actively promote the refined management of clinical pathway, which may effectively control the costs of diseases and the unreasonable growth of medical expenses.

目的 盾叶冠心宁片与复方丹参滴丸治疗冠心病稳定型心绞痛临床疗效比较。方法 选取于2017年10月—2018年10月至延安大学附属医院诊治的120例冠心病稳定型心绞痛患者。随机将所有患者分为2组,观察组患者在常规西药治疗基础上加服盾叶冠心宁片,对照组患者在常规西药治疗基础上加服复方丹参滴丸,比较两组患者治疗6个月后的临床疗效。结果 经过6个月治疗后,观察组患者的治疗有效率为66.7%,对照组患者的治疗有效率为40.0%。观察组与对照组治疗效果相比,差异有统计学意义(P＜0.05)。盾叶冠心宁片治疗冠心病稳定型心绞痛的综合疗效优于复方丹参滴丸。结论 冠心病稳定型心绞痛患者在常规西药治疗不变的基础上加用盾叶冠心宁片,不仅能改善临床心绞痛症状,还能调节血脂异常及降低同型半胱氨酸水平,以及缓解患者情绪及睡眠问题,且安全性高,有较高临床应用价值。

Objective To compare the clinical efficacy of Dunye Guanxinning tablets and Compound Danshen dropping pills in the treatment of stable angina pectoris caused by coronary heart disease. Methods 120 patients with stable angina pectoris were selected from the affiliated hospital of Yan'an University from October 2017 to October 2018.All patients were randomly divided into two groups. The observation group was treated with Dunye Guanxinning tablets on the basis of conventional western medicine, while the control group was treated with Compound Danshen dropping pills on the basis of conventional western medicine. The clinical efficacy of the two groups was compared after 6 months of treatment. Results After 6 months of treatment, the effective rate was 66.7% in the observation group and 40.0% in the control group. The treatment effect of the observation group was statistical different from that of the control group (P<0.05). The comprehensive curative effect of Dunye Guanxinning tablets in treating stable angina pectoris of coronary heart disease is better than that of Compound Danshen dropping pills. Conclusion The use of Dunye Guanxinning tablets in patients with stable angina pectoris after conventional western medicine treatment may not only improve the symptoms of clinical angina pectoris, but also regulate dyslipidemia and reduce homocysteine level, as well as alleviate the patients' emotional and sleep problems. It has high safety and high clinical application value.

目的 回顾分析2017—2018年汕头中心医院50例腹泻儿童鼠伤寒沙门菌的标本信息及药敏结果, 得出汕头地区这两年鼠伤寒沙门菌感染特性及指导临床合理用药。方法 从腹泻儿童粪便标本中分离沙门氏菌, 采用纸片扩散法检测其对抗菌药物的敏感性, 采用血清学凝集试验沙门氏菌血清型, 记录鉴定为鼠伤寒沙门菌的标本数据进行分析。结果 50例腹泻儿童鼠伤寒沙门氏菌中,易感时间多为夏秋季节;0～1岁为易感人群;感染后多出现发热、腹泻症状,可出现血便症状,较少出现呕吐;鼠伤寒沙门菌对亚胺培南、替加环素、厄他培南有100%的敏感率,对呱啦西林/他唑巴坦、头孢呱酮/舒巴坦有96%和92.68%的敏感率,队阿莫西林/克拉维酸有80.48%的敏感率,对阿米卡星、头孢呋辛酯、头孢呋辛、头孢西丁都为100%耐药,对其他抗生素有不同程度的敏感性及耐药性。结论 在夏秋季节,0～1岁儿童应加强对鼠伤寒沙门菌感染的预防,若出现发热、腹泻症状需及时就医,医生需向鼠伤寒沙门菌的方向考虑治疗,鼠伤寒沙门菌对多抗生素产生耐药性,临床上需根据药敏结果合理使用抗生素。

Objective To retrospectively analyze information and drug susceptibility of 50 cases of Salmonella typhimurium isolated from children with diarrhea in Shantou Central Hospital from 2017 to 2018, and to obtain the characteristics of Salmonella typhimurium infection in Shantou area in the past two years and to guide rational drug use in clinic. Methods Salmonella was isolated from fecal specimens of children with diarrhea. The susceptibility of Salmonella to antimicrobial agents was detected by disk diffusion method. Serological agglutination test was used to determine the serotype of salmonella. Sample data identified as Salmonella typhimurium were recorded and analyzed. Results Among the 50 children with diarrhea, the susceptibility time of Salmonella typhimurium was summer and autumn; the age of 0～1 was susceptible population; fever and diarrhea were common after infection, and hematochezia and vomiting were rare; Salmonella typhimurium had 100% susceptibility to imipenem, tegacycline and ertapenem, 96% and 92.68% to guacillin/tazobactam, cefotaxone/sulbactam. The sensitivity rate of amoxicillin/clavulanic acid was 80.48%. It was 100% resistant to amikacin, cefuroxime axetil, cefuroxime and cefoxitin. It had different sensitivity and resistance to other antibiotics. Conclusion In summer and autumn, children aged 0～1 should strengthen prevention of Salmonella typhimurium infection. If symptoms of fever and diarrhea occur, doctors should consider the direction of Salmonella typhimurium treatment. Salmonella typhimurium is resistant to multi-antibiotics, and rational use of antibiotics in clinic should be based on the results of drug sensitivity.