目的 探讨特发性肺纤维化(IPF)患者和结缔组织病相关性纤维化间质性肺疾病(CTD-fILD)患者急性加重(AE)的短期内死亡的危险因素。方法 回顾性分析2017年10月—2019年9月在深圳大学和广州医科大学附属第一医院住院的25例 AE-CTD-fILD和26例AE-IPF患者临床信息,Kaplan-Merier法对两组患者进行生存分析,Cox回顾分析年龄、性别、吸烟、白细胞总数、C反应蛋白、红细胞沉降率及肿瘤指标在急性加重患者死亡中的作用。结果 与AE-CTD-fILD比较,AE-IPF患者组男性比例、年龄、吸烟比例较高,红细胞沉降率较低(24/26 vs 10/25,P<0.001;63.77±9.97 vs 58.00±10.32,P=0.048;16/26 vs 9/25,P=0.02;28.07±29.45 vs 64.35±40.34,P=0.002 );90天内,26例AE-IPF患者11例死亡,25例AE-CTD-fILD患者5例死亡,死亡率无明显差异(42.3% vs 20%,P=0.073);Cox回归分析显示,白细胞计数是AE-IPF和AE-CTD-fILD患者的死亡危险因素(HR=1.305,P=0.001;HR=1.529,P=0.009);CA15-3是AE-IPF患者死亡危险因素(HR=1.015,P=0.005)。结论 急性加重IPF和CTD-fILD患者短期内死亡风险相似,白细胞计数及外周CA15-3水平可能是肺纤维化急性加重患者短期内死亡的危险因素。

Objective To explore the risk factors for acute exacerbation (AE) in patients with idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated with fibrotic interstitial lung disease (CTD-fILD). Methods We retrospectively reviewed 25 patients with AE-CTD-fILD and 26 patients with AE-IPF, and Kaplan-Merier was used to analyze the survival of the two groups of patients. The impact of age,gender, smoking,WBC,CRP,ESR and tumor markers on acute exacerbation death were performed by Cox regression analysis. Results The AE-IPF patients had a higher proportion of men,age and smoking,and a lower ESR compared with AE-CTD-fILD patients(24/26 vs 10/25,P<0.001;63.77±9.97 vs 58.00±10.32,P=0.048;16/26 vs 9/25,P=0.02;28.07±29.45 vs 64.35±40.34,P=0.002 ). 11 cases of 26 patients with AE-IPF and 5 cases of 25 patients with AE-CTD-fILD died within 90 days, Log-rank tests showed patients with CTD-fILD had similar mortality rate compared with IPF patients after AE(42.3% vs 20%,P=0.073). The WBC count was negatively correlated with survival and the independent predictors for patients with AE-IPF and AE-CTD-fILD after adjusting for other clinical variates in Cox regression models(HR=1.305,P=0.001;HR=1.529,P=0.009). CA15-3 may be a risk factor for death of AE-IPF patients(HR=1.015,P=0.005). Conclusion AE-CTD-fILD and AE-IPF were associated with similar poor short-term survival, WBC count and plasma CA15-3 may be the independent survival predictors respectively for patients with acute exacerbation of pulmonary fibrosis in short term.

目的 研究早、晚期关节镜下前交叉韧带重建术治疗前交叉韧带损伤(ACL)的临床效果。方法 选取我院2017年12月—2019年12月收治的100例ACL损伤患者,根据不同手术治疗时间分为早期重建组(≤3周,54例)和晚期重建组(4～12周,46例)。比较两组术前及术后14周膝关节功能Lysholm及国际膝关节文献委员会(IKDC)评分,分析两组术前及术后14周膝关节活动度及肌力情况,对比两组术后2、4、8周的患膝屈曲角度,比较两组围术期临床指标。结果 两组患者术后均无早期并发症发生,手术切口均Ⅰ期愈合。两组术后14周Lysholm及IKDC评分较治疗前升高(P＜0.05);早期重建组术后14周Lysholm及IKDC评分与晚期重建组比较差异无统计学意义(P＞0.05)。两组术后14周屈曲受限角度、伸膝受限角度及萎缩指数较治疗前降低(P＜0.05);早期重建组术后14周屈曲受限角度、伸膝受限角度及萎缩指数与晚期重建组比较差异无统计学意义(P＞0.05)。早期重建组术前及术后2、4、8周的患膝屈曲角度与晚期重建组比较差异无统计学意义(P＞0.05)。早期重建组疼痛消除时间、肿胀消除时间及关节恢复正常时间显著长于晚期重建组(P＜0.05)。结论 行早、晚期关节镜下前交叉韧带重建术治疗ACL损伤患者的疗效相近,但晚期重建患者术后恢复效果显著,利于改善预后。

目的 分析酶联免疫法(ELISA)联合核酸检测技术(NAT)在献血者血液筛查和输血残余风险分析中的应用价值。方法 选取2019年1月—8月惠州市中心血站2 514例无偿献血者为研究对象,采集血液标本,分别应用两种不同ELISA试剂盒检测乙肝病毒表面抗原(HBsAg)、丙肝抗体(抗-HCV)、艾滋病抗体(抗-HIV),并以核酸扩增技术(NAT)进行HBV DNA、HCV RNA、HIV RNA检测,对ELISA检测阴性,而NAT检测阳性的标本进行进一步追踪分析。结果 ELISA检测结果显示27例阳性,阳性率1.07%,其中2例同时HBsAg阳性、丙肝抗体(抗-HCV)阳性。NAT技术检测结果显示12例阳性,阳性率0.48%,其中1例同时HBV DNA阳性、HCV RNA阳性。27例ELISA检测阳性中,10例经NAT技术检测证实为阳性,17例为阴性;2 487例ELISA检测阴性中,2例NAT技术检测HBV DNA阳性,2 485例为阴性。对2例ELISA检测阴性、NAT技术检测阳性者进行随访追踪证实HbsAg阳性。结论 2次ELISA筛查献血者血液仍然存在漏检误检风险,存在输血残余风险,联合应用NAT技术能够降低输血残余风险。

目的 探讨品管圈(Quality Control Circle, QCC)活动对降低造影剂外渗的效果观察。方法 根据QCC的方法和步骤,成立QCC小组,通过比较和分析QCC活动实施前后外渗率的变化,找出导致CT增强扫描前接受高压静脉造影剂注射外渗的主要原因,提出针对性的改进措施并分析其效果。结果 QCC活动实施前外渗率达0.17%,而实施后外渗率为0.07%,差异有统计学意义(P<0.05)。结论 开展QCC活动可降低CT增强扫描前造影剂外渗发生率,值得临床推广应用。

Objective To investigate the effect of quality control circle (QCC)activity on reducing contrast agent extravasation. Methods According to the steps and methods of the quality control circle, a QCC group was set up to compare and analyze the data before and after the implementation of QCC activities to find out the main reason for the extravasation of high-pressure intravenous contrast agent injection before CT enhanced scanning, and put forward targeted improvement measures to analyze its effect. Results The extravasation rate before QCC activity was 0.17%, and the extravasation rate after implementation was 0.07%, the difference was statistically significant (P <0.05). Conclusion Carrying out QCC activities may reduce the incidence of contrast agent extravasation before CT enhanced scanning, which is worthy of clinical application.

新型冠状病毒肺炎是一种新发的急性呼吸道疾病,如何准确、完整、及时的记录好新冠肺炎患者的病历信息,为医学研究提供科学的依据是医院病案管理统计的工作重点。本文结合国家相关的规定和某新冠肺炎定点救治医院疫情防控工作经验,提出针对新冠肺炎病历的管理方案,包含病历的书写、编码、运行管理三方面,配合医院做好疫情防控工作的同时妥善记录好新冠肺炎患者病历信息。

Coronavirus disease 2019 is a new type of acute respiratory disease. Recording accurately, completely and timely the medical records of patients with COVID-19 and providing a scientific basis for medical research are the focus of the medical records management statistics. This paper proposes a management plan including writing, coding, and operation management for COVID-19 medical records, combining with the relevant national regulations and a COVID-19 designated hospital's experiences of epidemic prevention and control. This management plan cooperates with the hospital to do epidemic prevention and control work, and properly recordes the medical records of COVID-19 patients.

目的 研究疫情下护理人员的情绪障碍和睡眠障碍情况。方法 应用广泛性焦虑障碍量表(GAD-7),病人健康问卷(抑郁)(PHQ-9),病人健康问卷(躯体症状)(PHQ-15)和匹兹堡睡眠质量指数(PSQI)量表对临床一线护理人员进行心理和睡眠问卷调查,统计情绪和睡眠障碍的发病率,以及其相关性。结果 126名完成量表的临床一线护理人员,焦虑,抑郁,躯体症状,睡眠障碍的发病率分别为:41.9%、31.5%、9.5%和30.8%。相关性分析显示学历,年龄,婚育情况及是否为独生子女与上述情绪、睡眠障碍有相关,差异有统计学意义(P <0.05)。结论 临床一线护理人员焦虑和睡眠障碍发病率高,且二者明显相关,存在相互影响。建议医院随时更新知识指南,加强对护理人员的心理疏导和人文关怀,以减轻护理人员的心理压力。

Objective To study the emotional and sleep disorders of nursing staff under the emerging infections diseases. Methods The generalized anxiety disorder scale anxiety (GAD-7), patient health questionnaire 9(depression)(PHQ-9), patient health questionnaire 15 (somatic symptoms)(PHQ-15), and Pittsburgh sleep quality index (PSQI)were used in our investment. Statistics on the incidence of emotional and sleep disorders, and their correlation were done in our study. Results The incidence of anxiety, depression, physical symptoms, and sleep disorders in 126 nurses were 41.9%, 31.5%, 9.5%, and 30.8%, respectively. Correlation analysis showed that education, age, marital status, and whether or not they were the only children in the family were related to the above-mentioned emotions and sleep disorders (P<0.05). Conclusion The incidence of anxiety and sleep disorders in clinical front-line nurses is high. There are high and significant correlation and interaction between mood and sleep disorders. It is recommended that hospital need to update the knowledge and strengthen the psychological counseling and humanistic care of the nursing staff to reduce the psychological pressure of the nursing staff.

目的 比较细胞因子TGF-β、IL-10、TNF-α、Th17在不同妊娠结局的妊娠期亚临床甲减孕妇血清中的差异,探索细胞因子在不同妊娠结局中的作用。方法 随机选择2018年1月—2018年12月在我院就诊的66例确诊为因妊娠期亚临床甲减而出现不良妊娠结局的孕妇与同期妊娠结局正常的66例孕妇进行病例对照研究,比较不同妊娠结局孕妇的血清TGF-β、IL-10、TNF-α、Th17的差异;结果 ① 亚临床甲减组的TPOAb、TgAb、TRAb阳性率高于正常妊娠组,同时TNF-α、Th17均高于正常妊娠组,而TGF-β、IL-10均低于正常妊娠组,差异有统计学意义(P<0.05)。② 因子分析发现:在TPOAb、TgAb、TRAb、TGF-β、IL-10、TNF-α、Th17七个影响妊娠期亚临床甲减不良妊娠结局的相关因素中,TGF-β、IL-10、TNF-α、Th17在第1影响因子,特征值达2.347;TPOAb、TgAb、TRAb是次要影响因子,特征值为1.162。结论 TGF-β、IL-10、TNF-α、Th17与妊娠期亚临床甲状腺功能减退症的不良妊娠结局有密切关系,TGF-β、IL-10、TNF-α、Th17是影响妊娠期亚临床甲减不良妊娠结局的主要因子;TPOAb、TgAb、TRAb是影响妊娠期亚临床甲减不良妊娠结局的次要因子。

Objective To compare the serum levels of TGF-β, IL-10, TNF-α and Th17 in pregnant women with subclinical hypothyroidism in different pregnancy outcomes. Methods A case-control study was conducted in 66 pregnant women with adverse pregnancy outcomes due to subclinical hypothyroidism during pregnancy and 66 pregnant women with normal pregnancy outcomes during the same period. The differences of serum TGF-β, IL-10, TNF-α and Th17 among pregnant women with different pregnancy outcomes were compared. Results ①The positive rates of TPOAb, TgAb and TRAb in subclinical hypothyroidism group were higher than those in normal pregnancy group, and TNF-α and Th17 were higher than those in normal pregnancy group, while TGF-βand IL-10 were lower than those in normal pregnancy group (P<0.05). ②Factor analysis found that TPOAb, TgAb, TRAb, TGF-β, IL-10, TNF-α and Th17 were the factors related to adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy. TGF-β, IL-10, TNF-α and Th17 were the main influencing factors with a characteristic value of 2.347; TPOAb, TgAb and TRAb were the second influencing factors,with a characteristic value of 1.162. Conclusion ①TGF-β, IL-10, TNF-α, Th17 are closely related to the occurrence and pregnancy outcome of subclinical hypothyroidism in pregnancy. ②TGF-β, IL-10, TNF-α and Th17 are the main factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy;TPOAb, TgAb and TRAb are the secondary factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy,

目的 探讨流程化(CICARE)沟通模式在中下段尿路结石患者中的应用价值。方法 回顾性分析2018年8月—2019年11月我院80例中下段尿路结石患者,均行输尿管镜下钬激光碎石术,2018年8月—2019年5月的37例患者作为对照组,采用常规沟通流程,2019年6月—2019年11月的43例患者作为研究组,采用CICARE沟通模式。对比两组手术时间、沟通满意度及干预前后手术室注意事项知晓程度、贝克焦虑量表(BAI)、贝克抑郁量表21项版(BDI-21)评分。结果 研究组手术时间较对照组短(P＜0.05);干预后,研究组手术室注意事项知晓程度较对照组高(P＜0.05);干预后,研究组BAI、BDI-21评分较对照组低(P＜0.05);研究组沟通满意度95.35%(41/43)较对照组81.08%(30/37)高(P＜0.05)。结论 CICARE沟通模式应用于中下段尿路结石患者,可提高患者手术室注意事项知晓程度,减轻负性情绪,缩短手术时间,且具有较高沟通满意度。

Objective To explore the application value of CICARE communication model in patients with middle and lower urinary calculi. Methods From August 2018 to November 2019, eighty patients with middle and lower urinary calculi in our hospital were analyzed retrospectively. All patients underwent ureteroscopic holmium laser lithotripsy.Thirty-seven patients from August 2018 to May 2019 served as a control group, using a routine communication process, forty-three patients from June 2019 to November 2019 served as the study group and adopted the CICARE communication model. The two groups were compared in surgical time, communication satisfaction, awareness of operating room precautions before and after intervention, Baker Anxiety Scale (BAI), and Baker Depression Scale 21 item (BDI-21)scores. Results The operation time in the study group was shorter than that in the control group (P＜0.05). After the intervention, the awareness degree of the operating room precautions in the study group was higher than that in the control group (P<0.05). After the intervention, the BAI and BDI-21 scores in the study group were lower than those in the control group (P<0.05). The communication satisfaction of the study group was 95.35% (41/43),higher than the control group of 81.08% (30/37)(P<0.05). Conclusion The application of CICARE communication mode in patients with middle and lower urinary calculi may improve patient's awareness of precautions in the operating room. It may reduce negative emotions, shorten the operation time, and has higher communication satisfaction.

目的 探讨肺炎支原体核糖核酸恒温扩增技术(MP RNA-SAT)对儿童社区获得性肺炎(CAP)诊治的价值。方法 选择310例CAP的临床资料进行回顾性分析,其中肺炎支原体肺炎(MPP)和非肺炎支原体肺炎各155例,比较这两组的MP RNA-SAT和MP-IgM的检测结果。结果 以临床诊断为标准,RNA-SAT的特异度(97.4%)及阳性预测值(92.2%)高于IgM(分别为72.3%、74.4%),而敏感度(30.3%)及阴性预测值(58.3%)则低于IgM(分别为80.6%、78.9%),差异有统计学意义(P＜0.05);年龄＞3岁、检测前不使用大环内酯类药物以及选择肺泡灌洗液作为检测标本均能提高RNA-SAT的检出率(P＜0.05)。结论 RNA-SAT能特异度识别出MP的活动性感染,联合使用RNA-SAT和IgM检测,能更加快速、准确地诊断MP感染,对儿童肺炎的诊治具有较高的价值。尽量在使用大环内酯类药物治疗前进行RNA-SAT检测,必要时可选择肺泡灌洗液作为检测标本以提高检出率。

Objective To investigate the value of Mycoplasma pneumoniae RNA simultaneous amplification and testing(MP RNA-SAT)in the diagnosis and treatment of community acquired pneumonia(CAP) in children. Methods The clinical data of 310 children with CAP were selected for retrospective analysis,including 155 Mycoplasma pneumonia pneumonia(MPP)and 155 non-MPP,and the results of MP RNA-SAT and MP-IgM in both groups were compared. Results With the results of clinical diagnosis as reference, the specificity (97.4%)or positive predictive value (92.2%)by RNA-SAT was higher than that by IgM (72.3% and 74.4%, respectively), while the sensitivity (30.3%)or negative predictive value (58.3%)was lower than that by IgM (80.6% and 78.9%, respectively).The difference was statistically significant (P<0.05). Age>3 years, no macrolide treatment before testing, or choosing bronchoalveolar lavage fluid as testing samples, that can improve the detection rate of RNA-SAT(P<0.05). Conclusion RNA-SAT may specifically identify active infection of MP, and the combined use of RNA-SAT and IgM test may more quickly and accurately diagnose infection of MP.It has high value for the diagnosis and treatment of community acquired pneumonia in children. RNA-SAT should be performed before the application of macrolide treatment as early as possible. If necessary, bronchoalveolar lavage fluid could be chosen as testing samples to improve the detection rate of RNA-SAT.

目的 探讨双侧会阴神经阻滞麻醉配合综合护理在降低单胎初产妇顺产会阴侧切率中的应用效果。方法 选取2019年7月—2019年12月在我院经阴道分娩的顺产初产妇110例为研究对象,按照随机数字表法分成两组,每组各55例,所选产妇对照组产妇给予常规护理模式,给予局部浸润麻,观察组产妇在对照组基础上采用综合护理模式,给予双侧会阴神经阻滞麻醉,比较两组产妇会阴侧切情况、会阴裂伤情况、产程持续时间、VAS评分、新生儿Apgar评分、依从性情况及护理效果等相关指标。结果 和对照组相比,观察组患者会阴侧切发生率少于对照组(P＜0.05),第一、第二产程时间短于对照组(P＜0.05);同对照组相比,观察组产妇在VAS评分、依从性及满意度指标均优于对照组(P＜0.05),而新生儿窒息、产后出血发生情况比较差异无统计学意义(P＞0.05)。结论 双侧会阴神经阻滞麻醉配合综合护理可以有效降低初产妇会阴侧切的发生率,减轻分娩时的疼痛,缩短产程,提高产妇依从性及满意度,具有较高的临床推广价值。

Objective To explore the effect of bilateral perineum nerve block anesthesia combined with comprehensive nursing in reducing the rate of perineum side cutting of primipara. Methods 110 primiparas who delivered vaginally in our hospital from July 2019 to December 2019 were selected as the research objects. According to the random number table method, they were divided into two groups, 55 in each group. The control group was given the routine nursing mode and local infiltration anesthesia. The observation group was given the comprehensive nursing mode and bilateral perineum nerve block anesthesia on the basis of the control group. The perineum side cutting status, perineum laceration, duration of labor, VAS score, Apgar score, compliance and nursing effect of the two groups were compared. Results Compared with the control group, the incidence of perineum side cutting was lower in the observation group than that in the control group (P<0.05).The first and second stages of labor were shorter in the observation group than the control group (P<0.05); compared with the control group, the VAS score, compliance and satisfaction index were better in the observation group than the control group (P<0.05), but there was no significant difference in neonatal asphyxia and postpartum hemorrhage (P>0.05). Conclusion Bilateral perineum nerve block anesthesia combined with comprehensive nursing may effectively reduce the incidence of perineum lateral incision of primipara, reduce the pain during delivery, shorten the labor process, improve the compliance and satisfaction of parturients, and has a high clinical value.