目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

目的 探究尿毒症继发性甲状旁腺功能亢进经甲状旁腺切除术治疗效果及安全性分析。方法 选取2017年6月—2019年5月于我院就诊的90例尿毒症继发性甲状旁腺功能亢进患者为研究对象,随机分为对照组与观察组,两组各45例。均采取同一药物治疗,对照组行次全切除治疗,观察组行甲状旁腺全切除术+前臂移植术。对比分析两组治疗效果、血生化指标及并发症。结果 观察组疗效优于对照组(P<0.05);观察组术后1周、1个月钙、iPTH、磷、钙磷乘积及ALP水平均低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论 甲状旁腺全切除+前臂移植治疗尿毒症继发性甲状旁腺功能亢进疗效显著,并发症风险低,值得推广。

目的 评价经椎间孔镜术和显微镜下髓核摘除术治疗腰椎间盘突出症的临床疗效及优缺点,并探讨该术式的有效性、安全性,以期找到更优的手术治疗腰椎间盘突出症方法及临床应用价值。方法 通过回顾性分析我院2019年1月—2019年12月经椎间孔镜下髓核摘除术及显微镜下椎板开窗减压髓核摘除术患者,总随访251例,其中椎间孔组229例,显微镜组22例。采集数据包括病例数、性别、年龄、手术时间、出血量及切口感染情况,术前、术后的JOA评分、VAS评分、ODI功能指数、改良MacNab标准,并对数据进行统计学分析。结果 椎间孔组手术采用局麻下进行,显微镜组采用全麻下进行,其中椎间孔镜组有2例患者因术中腰部剧痛不能配合完成,余患者手术完成顺利。椎间孔镜组平均病程5个月,手术时间(96±10)min,术中出血量(25.8±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为14.23±3.08、6.08±1.64、30.18±7.92,术后JOA评分、VAS评分、ODI功能指数分别是22.65±1.58、1.77±0.5、19.67±3.89,改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%。显微镜组平均病程8个月,手术时间(45±10)min,术中出血量(62±10.6)mL,术前JOA评分、VAS评分、ODI功能指数依次为15.13±2.06、6.85±1.27、29.42±7.47,术后JOA评分、VAS评分、ODI功能指数分别是23.25±1.31、1.98±0.53、20.12±4.03。椎间孔镜组改良MacNab标准为优150例,良42例,可26例,差9例,总优良率84.6%;显微镜组改良MacNab标准为优17例,良2例,可3例,差0例,总优良率86.4%;两组患者性别、年龄与术前JOA评分、VAS评分、ODI功能指数相关性无统计学意义;9例椎间孔镜术后患者因效果差择期行显微镜下开窗手术治疗。结论 经皮椎间孔镜手术及显微镜下开窗减压髓核摘除手术治疗腰椎间盘突出症疗效均可靠,能有效改善患者下肢放射痛等临床症状,提高患者的生活质量及减轻功能障碍,但椎间孔镜组更具有微创、出血量少、术后恢复快等优势。

目的 系统评价手术与保守治疗无骨折脱位型颈脊髓损伤的疗效。方法 应用计算机检索 PubMed、Cochrane Library、EMbase、OVID、CNKI、维普及万方数据库,纳入关于手术及保守治疗无骨折脱位型颈脊髓损伤疗效比较的随机或非随机对照试验。由2名研究人员独立对文献进行筛选、提取和纳入文献评价,采用 Rev-Man 5.3软件对两种治疗的JOA评分、ASIA运动评分、神经功能恢复率、ASIA分级改善进行Meta分析。结果 ①共纳入13 篇研究,共598例患者,手术和保守治疗组分别371例和227例;②Meta分析显示,与保守治疗相比,手术治疗后的JOA评分更高[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01];神经功能恢复率更高[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01];ASIA分级改善更明显[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006];在ASIA运动评分方面,两者无差异[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]。结论 对于无骨折脱位型颈脊髓损伤的患者,手术治疗更有利于患者神经功能的改善。

Objective To systematically assess the clinical efficacy of surgical treatment versus conservative treatment for CSCIWFD from previously clinical investigations. Methods A systematic search of all the studies published was conducted on the PubMed, Cochrane Library, EMbase, OVID, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between surgical treatment and conservative treatment for CSCIWFD were identified. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the quality of included studies. Meta-analyses were performed to assess variables including Japanese Orthopaedic Association scores(JOA), Neurological function recovery rate, ASIA impairment scale grade, ASIA motor scores. Results ①A total of 13 articles were included, involving 598 patients, of which 371 and 227 patients received sugical or conservative treatment. ②The results of the meta-analysis indicated that, compared with conservative group, surgical group has higher JOA scores[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01], better Neurological function recovery rate[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01], better ASIA impairment scale grade improvement[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006], and there were no significant differences in the ASIA motor scores[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]. Conclusion These result suggests that surgical treatment can improve the neurological function more effectively for patients with cervical spinal cord injury without fracture and dislocation.

目的 探讨广州市第一人民医院2008—2019年所有就诊的肿瘤患者的具体情况,研究各类肿瘤的发病趋势和危害程度,为制定预防措施和工作重点提供依据。方法 根据广州市恶性肿瘤病例登记报告系统数据,对2008—2019年在广州市第一人民医院就诊的23 778例肿瘤病例从基本情况、肿瘤部位和随访情况等几方面进行回顾性统计分析。结果 2008—2019年位列前三位的肿瘤分别是结直肠癌、肺癌和肝癌,甲状腺癌占比呈明显上升趋势。30岁以下年龄组肿瘤种类以白血病为主,30～60岁年龄组肿瘤种类以结直肠癌为主,60岁以上年龄组肿瘤种类以肺癌为主。甲状腺癌的预后最好,胰腺癌的预后最差。纯手术组疗效最佳。结论 在广州地区合理优化资源进行重点肿瘤的筛查,才可以有限降低罹患肿瘤的风险,提高肿瘤患者生命质量。

Objective The aims of study were to explore the situation of all patients with cancer in Guangzhou First People's Hospital from 2008 to 2019, to find the incidence trends and hazards of different types of tumors, and to provide evidence for developing preventive measures. Methods According to the data of the Guangzhou tumor case report system, a retrospective statistical analysis was performed on the basic situation, tumor location and follow-up of 23 778 tumor cases in Guangzhou First People's Hospital from 2008 to 2019. Results The top three tumors in 2008—2019 were colorectal cancer, lung cancer and liver cancer. The tumor types under 30 years old were leukemia, the tumor types in the 30-60 age group were colorectal cancer, and the tumor types above 60 years old were mainly lung cancer. The prognosis for patients with thyroid cancer was the best, and the prognosis for patients with pancreatic cancer was the worst. The effect of the operation group was the best. Conclusion Rational optimization of resources for screening key tumors could reduce tumor incidence and improve the quality of life of cancer cases in Guangzhou area.

目的 探讨鼻咽癌个案管理模式,并评价临床中运用的效果。方法 回顾性将2017年8月—2018年4月93例新确诊的鼻咽癌患者作为对照组,按鼻咽癌患者的一般护理常规进行护理。2018年5月—2019年8月新确诊的鼻咽癌患者96例为实验组,实施个案管理比较两种方法的临床运用效果。结果 与对照组比,实验组诊断期完成检查时间和首次住院天数短、既定治疗计划完成率和治疗期间复诊依从性高,Ⅳ度骨髓抑制发生率低,差异均有统计学意义(P<0.05)。结论 鼻咽癌个案管理模式可为患者提供全程、连续性、高品质的护理,提高患者复诊依从性、提高治疗计划完成率,提高医疗护理质量,值得临床推广应用。

Objective To explore the case management mode of nasopharyngeal cancer (NPC) and evaluate the effect of clinical application. Methods 93 patients newly diagnosed NPC from August 2017 to April 2018 were used as the control group,and the general nursing routine was followed. 96 patients newly diagnosed NPC from May 2018 to August 2019 were taken as the experimental group,and accepted case management. Results Compared with the control group,the test time of the experimental group was shorter,the first hospital stay was shorter,the completion rate of treatment was higher,the patient's compliance of follow-up during treatment was better,incidence of grade Ⅳ myelosuppression was lower.The difference was statistically significant (P< 0.05). Conclusion The case management mode of NPC may provide seamless and high-quality nursing for NPC patients,improve the completion rate of treatment,improve the patient's compliance of follow-up and improve the quality of medical care,which is worthy of clinical application.

目的 本研究通过调查中国华南地区一间大型医疗机构(综合医院)中护士日间过度嗜睡的发生率及相关影响因素。方法 纳入了1 102名在职护士要求他们在一段规定的时间内完成一份自我报告问卷,其中包括人口学资料采集、生活习惯(BMI、小睡习惯、打鼾等)、失眠、抑郁、焦虑、MEQ分型、倒班、工作兴趣等与工作及睡眠相关的特征。了解EDS在被试人群中的发生率及其影响因素。结果 共有1 048名护士有效的完成了问卷(应答率为95.1%)。其中169名(16.1%)护士存在日间过度嗜睡(EDS)。抑郁症状(校正后的OR值= 2.24,95%的可信区间 1.51～3.31)、焦虑症状(1.65; 1.02～2.67)、失眠(2.29; 1.56～3.36)、倒班工作(1.98; 1.03～3.83)和对工作的低兴趣(1.74; 1.01～2.99)是EDS发生的独立危险因素。结论 日间过度嗜睡(EDS)在华南地区的综合医疗机构中的青年护士群体中普遍存在。EDS的发生可能与抑郁症状、焦虑症状、失眠、倒班工作和对工作的低兴趣存在相关。

Objective To investigate the prevalence and correlates of excessive daytime sleepiness EDS in a population of hospital nurses in South China. Methods A total of 1 102 nurses working in a large medical center were invited to participate in this cross-sectional study (females 96.9%,mean age 29.6 years). They all completed a self-reported questionnaire consisting of items on demographic variables,lifestyle factors,insomnia,anxiety,depression,and both work-related and sleep related characteristics. Results A total of 1 048 nurses gave a valid response (response rate 95.1%). Among them,169 (16.1%) reported EDS as defined as an Epworth Sleepiness Scale≥14. Depression (adjusted odds ratio=2.24,95% confidence interval 1.51～3.31),anxiety (1.65; 1.02 ～2.67),insomnia (2.29; 1.56～3.36),rotating shift work (1.98; 1.03～3.83) and low interest in work (1.74; 1.01～2.99) were all independent risk factors of the occurrence of EDS. Conclusion EDS were common among this relatively young and healthy nurse population in south China. There were clear associations with EDS and depression,anxiety,insomnia,rotating shift work and low work-related interest.

目的 观察实施微信式延续护理干预对真菌性外耳道炎患者心理状态及治疗效果的影响。方法 选取我院2018 年12月—2019年12 月期间门诊治疗的110例真菌性外耳道炎患者为观察对象,将所选患者随机分为常规组和干预组,常规组55例,采取常规护理;干预组55例,在常规护理的基础上实施微信式延续护理干预。观察两组患者的心理状态及治疗依从性、治疗效果的变化。结果 干预组患者心理状态的改善、治疗依从性、治疗效果均优于常规组,差异有统计学意义(P＜0.05)。结论 在给予真菌性外耳道炎患者实施护理干预的过程中,加入微信式延续护理干预,患者的心理状态得到改善、治疗依从率增加及患者治疗的总有效率提高。因此微信式延续护理干预值得在临床护理中进一步推广。

Objective To observe WeChat continuous nursing intervention on mental state and therapeutic efficacy of fungal external auditory meatus. Methods 110 cases of fungal external auditory meatus treated in our hospital from December 2018 to December 2019 were selected as the observation objects,The selected patients were randomly divided into the conventional group and the intervention group,There were 55 cases in the conventional group,taking regular care; there were 55 cases in the intervention group,on the basis of routine nursing,WeChat continuous nursing intervention was implemented. The psychological status and treatment compliance of the two groups were observed,also changes in treatment outcomes. Results The improvement of psychological state,treatment compliance and treatment effect in the intervention group were better than that in the conventional group.The difference was statistically significant(P＜0.05). Conclusion In the course of nursing intervention for patients with fungal external auditory meatus,WeChat continuous nursing intervention was added.The psychological state of the patients has been improved,the rate of treatment compliance is increased and the total effective rate of treatment is increased greatly.Therefore,WeChat continuous nursing intervention is worthy of further promotion in clinical nursing.

目的 通过对医院保洁员针刺伤危害认知和相关知识问卷调查,检视保洁员自身和其管理者存在的问题,提出有针对性整改措施。方法 采用现场问卷调查的方法,对我院三个院区共304名病房保洁员进行调查,其中男保洁员82人(占27.0%),女保洁员222人(占73.0%)。上岗前接受针刺伤防护知识培训62人(占20.4%),没有接受培训242人(79.6%),P<0.05差异有统计学意义。结果 调查显示,保洁员在工作中曾发生过针刺伤共174人(占57.2%);发生针刺伤后没有上报107人(占35.2%);防护知识缺乏及自我防护意识欠缺,其中不知晓针刺伤的危害性101人(占33.2%);在处理锐器垃圾不戴手套有81人(占26.6%);处理锐器盒时机不正确220人(占72.4%);不知道发生针刺伤后如何处理91人(占29.9%),P<0.05差异有统计学意义。男性保洁员对针刺伤防护认知低于女性保洁员,其中不清楚针刺伤的危害性男性41人(占50.0%),女性占60人(占27.0%),处理锐器垃圾不戴手套男性30人(占36.6%),女性51人(占23.0%);两组比较,差异有统计学意义(P<0.05)。结论 医院保洁员在处理医疗垃圾工作中,针刺伤风险系数高。医院对保洁员上岗前针刺伤培训非常必要,但岗前培训不能完全让保洁员在工作中长期保持对针刺伤的安全认知和防范意识。医院应加强对保洁员工作岗位动态培训和监管,尤其对男性保洁员。管理者不断尝试运用新的管理手段,在思想上建立流程式思维和工作方法,日常工作中不断强化保洁员对针刺伤的防护意识,减少针刺伤的发生,从而保障了保洁员的身心健康。

Objective To investigate the problems of cleaners and their managers,and put forward targeted rectification measures through questionnaire survey on the hazard cognition and related knowledge of needle stick injuries of cleaners in hospitals. Methods On-site questionnaire survey was used to investigate a total of 304 ward cleaners in our hospital. Among them,82 were male cleaners (27.0%) and 222 were female cleaners (73.0%). 62 people (20.4%) were trained in acupuncture protection before taking up work,and 242 people (79.6%) were not trained. There was statistically significant P<0.05. Results The survey showed that a total of 174 cleaning staffs had acupuncture injuries (57.2%)); 107 people (35.2%) were not reported after acupuncture injuries. For lack of knowledge and self-protection awareness,of which 101 people (33.2%) were not aware of the dangers of acupuncture injuries; There were 81 people (26.6%) didn't wear gloves when handling sharps trash;and 220 people (72.4%) had incorrect timing of sharps boxes; 91 people (29.9%) did not know how to handle after a needle stick injury. Male cleaners had a lower awareness of needle stick injuries than female.There were 30 male cleaners (36.6%) and 51 females (23.0%) who did not wear gloves when handling sharps. 41 men (50.0%) and 60 women (27.0%) were not aware of the harmfulness of needle stick injuries. Those difference between the two groups was statistically significant (P<0.05). Conclusion The risk of needle stick injuries is high for hospital cleaners in the treatment of medical waste. It is very necessary to take acupuncture injuries for the cleaning staffs before they take up their posts,but the pre-job training cannot completely keep the cleaning staffs' awareness and prevention awareness of acupuncture injuries for a long-term. Hospitals should strengthen the dynamic training and supervision of cleaning staff,especially for male cleaners. Managers need to constantly try use new management methods to establish process-type thinking and working methods in their minds. In daily work,they continuously strengthen the cleaning consciousness of needle stick injuries and reduce the incidence of needle stick injuries,thereby protecting the physical and mind health of the cleaning workers.

目的 了解血脂异常在青少年人群中的分布及影响因素。方法 以江门市棠下中学1 449名学生为研究对象,对其进行问卷调查、InBody人体成分仪检测和实验室检查。结果 血脂异常总检出率是8.3%,高胆固醇(TC)、高甘油三脂(TG)、高低密度脂蛋白胆固醇(LDL-C)和低高密度脂蛋白胆固醇(HDL-C)血症的检出率分别为8.3%、7.8%、10.6%和7.2%,女生血脂异常检出率(26.4%)高于男生(19.8%)(P<0.001);多因素分析显示性别(参照男性,OR=1.39,95%CI=1.08~1.80)和体脂百分比(参照正常组,超重、肥胖和重度肥胖组OR和95%CI分别OR = 1.62 / 2.89 / 4.45,95% CI = 1.13~2.32 / 1.85~4.51 / 2.48~7.96)与血脂异常间存在统计学关联(P<0.05)。结论 性别、体脂百分比是青少年血脂异常的影响因素。相对于青少年男生,青少年女生检出血脂异常的比例更高,体脂百分比高的青少年血脂异常的风险更高。

Objective To study the distribution and influencing factors of dyslipidemia among teenagers. Methods A questionnaire survey,InBody body composition test and laboratory examination were conducted on 1 449 students from the Tangxia Middle School in Jiangmen city as study objects. Results The total detection rate of dyslipidemia was 8.3% and the detection rates of high total cholesterol (TC),triglyceride (TG),high low-density-lipoprotein cholesterol (LDL-C) and low high-density-lipoprotein cholesterol (HDL-C) were 8.3%,7.8%,10.6% and 7.2%,respectively. The detection rate of dyslipidemia among teenage girls (26.4%) was higher than that among teenage boys (19.8%) (P<0.001). Multivariate analysis indicated that gender (with reference to male,OR=1.39,95%CI=1.08-1.80) and body fat percentage (with reference to normal group,for overweight,obesity and severe obesity groups,OR=1.62,2.89,4.45 and 95%CI=1.13-2.32,1.85-4.51,2.48-7.96,respectively) were statistically related to dyslipidemia (P<0.05). Conclusion Gender and body fat percentage are the influencing factors of dyslipidemia among teenagers. Compared with teenage boys,the teenage girls have a higher detection percentage of dyslipidemia. Teenagers with higher percentage of body fat show a higher risk of dyslipidemia.