目的 探讨个体化健康管理对超高龄结直肠癌患者希望水平的影响效果。方法 对66例超高龄结直肠癌患者实施个体化健康管理,3个月后对患者进行希望水平、肛门括约肌功能、生活质量的测评。结果 3个月后患者排便功能恢复良好的达90.91%,与出院前比较差异有统计学意义(P＜0.01);3个月后患者HHI各维度和SF-36各维度的得分明显提高,与干预前比较差异均有统计学意义(P＜0.01)。结论 对超高龄结直肠癌患者实施个体化健康管理,可提高其生存希望水平,改善生活质量。

Objective To explore the effect of individualized health management on the hope level of patients with advanced colorectal cancer. Methods Using individualized health management for 66 elderly patients with colorectal cancer for 3 months, the level of hope, anal sphincter function and quality of life were evaluated. Results After 3 months, the defecation function of the patients recovered well to reach 90.91%, and the difference was statistically significant (P<0.01); After 3 months, the scores of each dimension of Herth Hope Index (HHI) and SF-36 were significantly improved, and the difference was statistically significant (P<0.01). Conclusion The implementation of individualized health management for the elderly patients with colorectal cancer may improve the survival level and improve the quality of life.

目的 了解广东省罗定市中小学教师的职业倦怠情况,为制定政策提供初步依据。方法 采用中文版Maslach职业倦怠量表(C-MBI)对罗定市42所中小学共590名毕业班教师进行评估。结果 受访者的情感衰竭(emotional exhaustion, EE)和知识枯竭(intellectual burnout, IB)因子分显著高于全国常模(P＜0.05),个人成就感降低(reduced personal accomplishment, PA)因子分显著低于全国常模(P＜0.01)。女性受访者的去个性化(depersonalization, DP)、EE和IB因子分均显著高于男性受访者,PA因子分显著低于男性受访者(P均＜0.01)。结论 广东省罗定市中小学毕业班教师的职业倦怠高于全国平均水平,女性教师的职业倦怠感高于男性教师。

Objective To investigate job burnout among primary and secondary teachers in Luoding city and to provide a preliminary basis for policy formulation. Methods We randomly selected 590 graduating class teachers from 42 primary and secondary schools in Luoding. The outcome variable of burnout was measured by the Chinese Maslach Burnout Inventory for primary and secondary school teachers (C-MBI). Results Emotional exhaustion (EE) score and intellectual burnout (IB) score in respondents were both significantly higher than the national norm used as reference (P＜0.05), reduced personal accomplishment (PA) score was significantly lower than the national norm (P＜0.01). The factor scores of DP, EE and IB were obviously higher in female respondents than that those in the male, while the score of PA was obviously lower (all P＜0.01). Conclusion The level of burnout in these teachers is significantly higher than the national average, and the burnout in female teachers is more serious.

目的 探讨阳性强化法对社区门诊静脉输液患儿穿刺疼痛及依从性的影响。方法 选取社区门诊2014年4月—2016年4月收治的100例行静脉输液治疗的患儿作为研究对象,采取随机数字表法将其分成两组,每组50例。观察组患儿给予阳性强化法干预,对照组给予常规护理干预,对比两组患儿穿刺疼痛相关指标、穿刺效果、患儿静脉输液依从性及患儿家长的满意度。结果 观察组患儿疼痛面容持续时间明显短于对照组,穿刺后心率明显慢于对照组,啼哭时间>30s的患儿占比明显低于对照组(P<0.01)。观察组一次穿刺成功率、穿刺耗时>5min占比分别为94.00%、24.00%,对照组分别为74.00%、62.00%,观察组一次穿刺成功率明显高于对照组,穿刺耗时>5min占比明显低于对照组(P<0.01)。观察组患儿静脉输液依从率为90.00%,与对照组的66.00%对比有明显上升(P<0.01)。观察组患儿家长满意度为96.00%,与对照组的80.00%对比有明显上升(P<0.05)。结论 对社区门诊静脉输液患儿实施阳性强化法干预可有效减轻穿刺疼痛,提高患儿的输液依从性,患儿家长满意度高。

Objective To explore positive reinforcement on pain and compliance of puncture to children in community outpatients with intravenous infusion. Methods Select 100 cases of children who receive intravenous infusion in community outpatients from April 2014 to April 2016 as research objectives and divide them into two groups randomly with each group of 50 cases. Provide positive reinforcement to observation group while provide routine nursing to control group. Compare two groups' puncture pain relevant indicator, puncture effect, children's intravenous infusion compliance and parents' satisfaction. Results Children in observation had less duration of pain face expression, lower heart rate after puncture and less children crying >30s than those in control group (P<0.01). Observation group's first puncture success rate, puncture time duration >5mins rate were 94.00% and 24.00% respectively while control group's data were 74.00% and 62.00%. Observation group's first success rate was significant higher than that of control group. Observation group's puncture time duration >5mins rate was significant lower than that of control group (P<0.01). Children's intravenous infusion compliance rate in observation group was 90.00% which was significant higher than control group's 66.00% (P<0.01). Parents satisfaction rate in observation groups was 96.00% which was significant higher than control group's 80.00% (P<0.05). Conclusion Implementing positive reinforcement on children in community outpatient may help to relieve puncture pain, improve children's compliance to intravenous infusion and increase parents' satisfaction.

目的 研究添加与不加甲苯对24 h尿微量总蛋白(MPr)和尿微量白蛋白(UMA)定量测定的影响。方法 收集各个浓度段门诊及住院病人的新鲜随机尿共82份,检测即刻与在低、中、高温度条件下,加和不加甲苯保存24 h后尿液MPr和UMA的浓度,通过配对t检验方法检验差异有无统计学意义。结果 即刻尿MPr的值与低中温条件下、有无甲苯的24 h尿MPr的检测值比较,差异均无统计学意义(P＞0.05),但与在高温条件有无甲苯检测值比较,差异均有统计学意义(P＜0.05);即刻尿UMA的值与低中温条件下、有无甲苯的24 h尿UMA检测值比较,差异均无统计学意义(P＞0.05),与高温条件下有无甲苯检测值相比,差异均有统计学意义(P＜0.05);同一温度保存24 h,得到尿MPr、尿UMA的检测值,有无甲苯的检测结果比较,差异均无统计学意义(P＞0.05)。结论 实验证明甲苯在24h尿MPr与尿UMA的定量检测中无使用的必要性。

Objective To investigate the effect of toluene in the quantitative detection of 24 hour(24 h) urine micro protein(MPr) and urine micro albumin(UMA). Methods Eighty-two random urine of the patients with different concentrations were collected.The group without toluene and the other group with toluene were stored at the low, medium and high tempreture for 24 h respectively. Then MPr and UMA were measured in 0 h and 24 h. Paired t-test was used to test whether the difference was statisticallysignificant. Results When stored at the low and medium temperature,the results of immediate detection of MPr and UMA were compared with those of the addition of toluene or without for 24 h. The difference was not statistically significant (P>0.05). However, there was significant difference in MPr and UMA value of urine at high temperature under the same comparison(P<0.05). Stored at the same temperature for 24 hours, the results of MPr and UMA were compared between the adding groups and the non-adding groups. The results showed that there was no significant difference between them. Conclusion The specimens for the quantitative detection of the 24 h MPr and UMA are not need to be added with toluene, and toluene in the urine is not preservatively effective.

目的 研究超声脐血流与大脑中动脉血流定量检测用于胎儿宫内窘迫的临床应用价值。方法 纳入150例住院分娩孕妇作为研究对象,其中胎儿窘迫组72例,正常对照组78例。对所有孕妇行彩色多普勒超声检查,记录脐动脉(UA)和大脑中动脉(MCA)收缩期末期最大血流速度与舒张末期血流速度比值(S/D)、阻力指数(RI)及搏动指数(PI)。采用受试者工作曲线(ROC)分析超声UA和MCA血流检测在诊断胎儿宫内窘迫中的临床应用价值。结果 胎儿窘迫组UA的S/D、RI及PI均显著高于正常对照组(P＜0.05),MCA的S/D、RI及PI均低于正常对照组(P＜0.05)。UA对预测胎儿宫内窘迫的ROC曲线显示S/D、RI及PI的敏感度为0.986、0.958及0.944,特异度为0.614、0.625及0.534。MCA对预测胎儿宫内窘迫的ROC曲线显示S/D、RI及PI的敏感度为0.897、0.924及0.892,特异度为0.712、0.657及0.684。结论 产前超声联合检测UA和MCA血流参数有助于筛查胎儿宫内窘迫,提高诊断准确性,指导临床。

Objective To study the clinical value of ultrasonic quantitative detection in blood flow and middle cerebral artery blood flow in fetal distress. Methods 150 hospitalized pregnant women were included in the study, including fetal distress group (n=72) and normal control group (n=78). Color Doppler ultrasonography was performed on all pregnant women. The maximal systolic blood flow velocity and end diastolic blood flow velocity ratio(S/D), resistance index (RI) and pulsatility index (PI) of the umbilical artery (UA) and the middle cerebral artery (MCA) were recorded. The application value of ultrasonic UA and MCA blood flow detection were analyzed by the receiver operating curve (ROC). Results The S/D, RI and PI of UA in fetal distress group were significantly higher than those in normal control group(P＜0.05). The S/D, RI and PI of MCA in fetal distress were significantly lower than those in normal control group(P＜0.05). The ROC of UA and MCA showed that S/D, RI and PI of sensitivity were[0.986,0.958,0.944 vs 0.897,0.924,0.892],the specificity were[0.614, 0.625,0.534 vs 0.712,0.657,0.684]. Conclusion The prenatal ultrasound combined detection UA and MCA blood flow parameters are helpful for screening fetal distress, improving diagnostic accuracy and guiding the clinical.

目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

目的 本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法 选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果 本研究患者的平均年龄(84.23±4.92)a,按eGFR<60 mL·min^-1·1.73 m^-2定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 ①肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。②年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people's hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of (84.23±4.92),had being divided into two groups according to eGFR< 60 ml·min^-1·1.73 m^-2:renal insufficiency group (n=52) and normal renal function group (n=51).There were statistical significance in the number of lacunar lesions,score of white-matter hyperintensity,mixed lesions between groups(P<0.05). Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is positively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI,and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.

目的 探讨高黏度骨水泥在治疗骨质疏松性椎体压缩性骨折中的临床疗效分析。方法 随机选取本院2012年1月—2016年1月收治的80例骨质疏松椎体压缩性骨折患者。将患者随机分为对照组和观察组,每组各40例,均采用骨水泥联合经皮椎体后凸成形术治疗,对照组采用低黏度骨水泥,观察组采用高黏度骨水泥。采用视觉模拟量表(VAS)评分比较手术前后患者疼痛情况,Oswestry指数(Oswestry disability index,ODI)评分评估患者腰背部功能。观察并比较两组患者VAS、ODI评分,骨水泥渗漏及相关并发症情况。结果 所有患者均顺利完成手术,术后随访1年以上,期间未发生严重并发症。所有患者VAS评分,ODI评分均明显高于术前。两组均出现骨水泥渗漏及其他并发症,低黏度骨水泥组骨水泥渗漏率为66.7%,明显高于高黏度骨水泥组的33.3%,P<0.05,但均无明显神经功能损伤。结论 高黏度骨水泥在骨质疏松椎体压缩性骨折中的应用能显著改善患者临床疗效,明显降低骨水泥渗漏及并发症的发生率。

Objective To investigate the clinical effect of high viscosity bone cement for treatment of osteoporotic vertebral compression fractures. Methods From Jan. 2012 to Jan. 2016, 80 patients with osteoporosis vertebral fractures were enrolled into this study. They were randomly divided into control group and observation group, with 40 cases in each group. They were all adopted PKP methods for treating, while the observation group got the high viscosity bone cement and the control group got the low one. Clinical outcomes were assessed in terms of back pain visual analogue scale (VAS), Oswestry disability index (ODI) after surgery.The outcomes of back pain VAS score, ODI, venous leakage rate, discoidal leak rate, rate of around vertebral body, rate of contiguous vertebral fracture were compared between two groups. Results All patients were successfully completed surgery. We took postoperative follow-up more than one year, there were severe complications occurred. VAS score, ODI score were significantly higher than that of before operation. Two groups had both bone cement leakage and other complications. Low viscosity bone cement group of bone cement leakage rate was 66.7%, significantly higher than the 33.3% of the high viscosity of bone cement group, P<0.05, but no obvious neurologic injury. Conclusion The high-viscosity bone cement for osteoporotic vertebral fractures provides better clinical outcomes. It may reduce bone cement leak rate and complications.

目的 探讨小骨窗显微手术不同手术时机对高血压脑出血患者疗效及神经功能的影响。方法 选取我院2014年5月—2016年5月收治的80例高血压脑出血患者作为研究对象,脑出血量约30～40 mL,根据出血到手术时间不同分为两组,每组40例。从出血到手术时间<6 h者为超早期作为观察组,出血到手术时间处于6~24 h间者为早期作为对照组,比较两组患者治疗后1个月GOS(格拉斯哥预后)优良率,治疗后3周、6周的斯堪的纳维亚(SSS)评分,治疗后3个月、6个月的生存质量评分及治疗后的生存情况、再出血情况。结果 观察组治疗后1个月GOS优良率为77.50%,相对于对照组明显上升(P<0.05);观察组治疗后3周、6周的SSS评分较对照组明显降低(P<0.01);观察组治疗后3个月、6个月的生存质量评分较对照组明显升高(P<0.01);两组治疗后的生存率差异有统计学意义(P<0.05),再出血率差异无统计学意义(P>0.05)。结论 对高血压脑出血患者在超早期行小骨窗显微手术可提高疗效,明显改善患者神经功能,提高生活质量及生存率,值得临床推广。

Objective To investigate the curative effects of microsurgical treatment with small bone flap craniotomy in patients with hypertensive cerebral hemorrhage and on their nerve function in different timing of surgery. Methods To select 80 cases of hypertensive cerebral hemorrhage in our hospital from May 2014 to May 2016 as the research object. The amount of cerebral hemorrhage of the patients was about 30-40 mL. According to the different time of bleeding, they were divided into two groups, 40 cases in each group. The super early period that the time from bleeding to operation was less than 6 h was regarded as the observation group, and the early period that the time from bleeding to operation is during 6~24 h was regarded as the control group. To compare the GOS (Glasgow outcome) excellent rate of patients in two groups in 1 month after treatment, the Scandinavia (SSS) score in 3 weeks and 6 weeks after treatment, and the quality of life score and survival and re-bleeding condition after treatment in 3 months and 6 months. Results Compared with the control group, the GOS excellent rate in the observation group in 1 month after treatment was 77.50% which increased significantly (P<0.05); the SSS score in the observation group in 3 weeks and 6 weeks after treatment was significantly lower than that in the control group (P<0.01); The quality of life score in the observation group in 3 months and 6 months after treatment was significantly higher than that in the control group (P<0.01); There was statistically significant difference in survival rate between the two groups after treatment (P<0.05), and the re-bleeding rate showed no significant difference (P>0.05). Conclusion The curative effects of microsurgical treatment with small bone flap craniotomy on patients with hypertensive cerebral hemorrhage is significant, which can improve the patients' neurological function, the life quality and survival rate, thus it is worthy of clinical promotion.

目的 探讨宫腔积血对于中晚期妊娠结局的影响以及影响的因素。方法 结合477例中晚期宫腔积血孕妇的临床资料分析,根据妊娠结局分为正常妊娠结局组(NP)及不良妊娠结局组(AP)。结果 AP的平均孕周(23.22±6.87周)明显大于NP(16.11±4.76周),两组有明显差异性(P<0.001)。两组首次B超宫腔积血平均体积分别为8.01(2.22~28.67)(NP),13.05(3.54~26.34)mL(AP)(P=0.001),但相邻第二次测量结果两组相差不大(P=0.230)。AP组中胎盘下血肿的比率(53.4%)明显大于NP组(24.2%),而绒毛膜下血肿比率(44.0%)明显小于NP(73.8%),两组有明显差异性(P<0.001)。宫缩也是影响因素之一,在AP组可扪及宫缩的病例(88例55.3%)明显高于NP(38例11.9%),两组有明显差异性(P<0.001)。但在阴道流血率方面两组没有明显差异(P=0.407)。结论 妊娠中晚期宫腔积血可能会导致不良妊娠结局,而首次出现的孕周,急性大量宫腔出血、宫腔积血位置以及是否伴有宫缩都是影响妊娠结局的重要因素。

Objective To study the poor pregnancy outcomes of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors. Methods We analyzed the clinical data of 477 patients who underwent routine examination in our hospital from January 2010 to June 2016 and classified them into normal pregnancy (NP) group and adverse pregnancy (AP) group according to their pregnancy outcomes. Results Gestational age at first detection of hematoma of AP group(23.22±6.87 weeks) was more than NP group (16.11±4.76 weeks)(P<0.001). The volumes of hematoma during the first detection were significantly different between the two groups (P=0.001).The average hematoma volume were 8.01(2.22-28.67)(NP),13.05(3.54-26.34)mL(AP)respectively. However, the hematoma volumes recorded in the second B-ultrasound examination were not significantly different between the two groups (P=0.230). In the AP group, the incidence of retroplacental hematoma (53.4%) was significantly higher than in the NP group (24.2%), while the incidence of subchorionic hematoma (44.0%) was significantly lower than in the NP group (73.8%)(P<0.001). The incidence of palpable contractions in the AP group (62.8%) was significantly higher than in the NP group (12.1%), P<0.001. However, the incidence of vaginal bleeding was similar (P=0.407). Conclusion Intrauterine hematoma in the second and third trimester may lead to adverse pregnancy outcomes. Risk factors for poor pregnancy outcomes are included gestational age at first diagnosis, acute and large intrauterine bleeding, location of hematoma and accompanying contraction.