目的 对从淡水养殖鱼类、青蛙样品以及腹泻病人大便样品分离的菌株作临床常用抗生素的耐药性分析,为相关疾病的治疗提供实验依据。方法 获取临床腹泻病人的新鲜大便标本和在水产品市场采集淡水鱼和青蛙样品取肠道内含物分别涂布选择性培养基,选取疑似菌落进行生化鉴定和16S rRNA基因分子鉴定,确证为香港海鸥型菌的菌株采用纸片扩散法测定分离株对几类临床常见抗菌药物的敏感性。结果 本次检测的24株香港海鸥型菌分离株对八种常用的抗生素药物表现不同程度的耐药性。蛙源株对环丙沙星、阿米卡星、头孢他啶的耐药率高于鱼源株。其中分离的11株分离株(45.8%)对3个种类及以上抗生素表现耐药,为多重耐药株。结论 抗生素作为促生长剂和动物疾病防治被广泛加于动物饲料中,可能导致食源性细菌耐药性增加。人们有可能通过摄入含有香港海鸥型多重耐药株污染的食物而获得抗生素耐药性的潜在危险。

目的 研究限制会阴切开及会阴不同切口对产妇产后出血、疼痛及性功能的影响。方法 选取我院2012年4月—2013年4月头位自然分娩产妇480例,抽签随机分为三组,每组160例,实施限制会阴切开的为限制组,实施会阴侧切的为侧切组,实施会阴正中切开的为正切组,比较三组产妇产后2 h出血量、产后住院时间、产妇会阴阴道裂伤率、产后疼痛程度和性功能满意程度。结果 产后2 h产妇出血量限制组(203.65±76.68)mL较侧切组(241.41±80.63)mL和正切组(239.15±85.19)mL少(P＜0.05);侧切组(1.64±0.87)d产后住院时间较限制组(1.37±0.64)d较长(P＜0.05);限制组会阴Ⅰ/Ⅱ°裂伤率为86.25%较侧切组1.25%和正切组6.88%较高(P＜0.05);侧切组2.50%和正切组3.13%会阴Ⅲ/Ⅳ°裂伤较限制组0%较高(P＜0.05);女性性功能指数限制组(22.69±2.65)分较侧切组(19.12±2.05)分与正切组(18.96±2.16)分较高(P＜0.05)。结论 实施限制会阴切开的产妇术后出血量少,会阴重度裂伤率低,保证了会阴完整性,产后性功能满意度高,值得临床上应用推广。

目的 探讨卵巢上皮性癌患者治疗前后外周血血小板计数(PLT)变化的临床意义。方法 采用全血细胞自动分析仪检测115例卵巢上皮性癌患者治疗前和经过有效治疗后的97例患者血小板计数增多检出率的比较,并分析卵巢上皮性癌患者治疗前血小板计数增多与临床病理因素的相关性。结果 33.04％卵巢上皮性癌患者治疗前伴有血小板计数增多,经过有效治疗后,血小板计数增多者降为9.28%,较治疗前明显下降,差异有统计学意义(P<0.05)。卵巢上皮性癌患者治疗前血小板增多与FIGO分期、残余肿瘤灶直径、腹水细胞学和临床疗效相关(P＜0.01)。结论 血小板作为一种简单、经济、灵敏的临床常用指标,监测其表达对于预测卵巢癌临床疗效和预后评估具有临床价值。

目的 对ChiTaS BSS1200血液核酸检测系统(简称“ChiTaS ”)主要分析性能进行验证,确定该系统是否稳定、准确、可靠。方法 参照美国临床实验室标准化协会(CLSI)相关文件要求,对在ChiTaS上开展的HBV-DNA、HCV-RNA、HIV-RNA项目进行检出限、精密度、准确度及抗干扰等方面验证。结果 ChiTaS 分析系统HBV-DNA、HCV-RNA、HIV-RNA最低检出限分别为3.63(3.16～6.26)IU/mL、12.71(10.37～21.63)U/mL、25.49(21.43～37.48)IU/mL;HBV-DNA、HCV-RNA、HIV-RNA阳性样本总变异系数分别为2.56%、1.03%、3.36%;22个阴性样本和10个阳性样本进行8混样模式检测结果为反应性,拆分检测结果:阳性样本符合率100%、阴性样本符合率100%;溶血血浆(血红蛋白含量为5 g/L)、脂肪血浆(甘油三酯大于6.3 mmol/L)对低浓度HBV(6.3 IU/mL)、HCV(23.3 IU/mL)、HIV(47.6 IU/mL)样本检出无显著影响。结论 ChiTaS检出限、精密度、准确度等均达到生产商的检测性能的要求,实验室该系统的检测能力可以满足本血站对无偿献血者样本的常规核酸检测要求。

目的 采用二维斑点追踪技术(2D-STI)检测冠状动脉左前降支供血区心肌纵向应变,探讨其评估缺血心肌局部收缩功能的价值。方法 使用2D-STI检测不同狭窄程度(＜50%、50%~75%、＞75%)及未见明确狭窄的左前降支供血区心肌纵向应变参数:心内膜下、心外膜下及区域心肌收缩期纵向应变峰值-LS-endo、LS-epi、LS-Territorial,计算收缩期心肌跨壁纵向应变(LS-mural)。观察PCI术后供血区心肌纵向应变的变化。结果 各组内LS-endo均高于对应的LS-epi(均P<0.01)。随着左前降支狭窄程度增加,LS-endo、LS-epi、LS-Territorial、LS-mural逐渐减低(均P<0.01)。术后LS-endo、LS-epi、LS-Territorial逐渐增高,LS-mural先增高后缓慢减低再增高。结论 2D-STI可定量检测不同层次的心肌纵向应变,反映心肌局部收缩功能,为早期识别缺血心肌、评价PCI术后疗效提供参考依据。

Objective To detect myocardial longitudinal strain in the area supplied by left anterior descending coronary artery (LAD) via two dimensional speckle tracking image (2D-STI), and to investigate its estimated value of myocardial systolic function of ischemic myocardium. Methods Detection of myocardial longitudinal strain parameters in the area supplied by the LAD with different stenosis degree(＜50%、50%~75%、＞75%) and no definite stenosis via 2D-STI:subendocardial longitudianl strain (LS-endo), subepicardial longitudianl strain (LS-epi) and territorial longitudianl strain (LS-Territorial). Calculate transmural longitudinal strain (LS-mural) in the systole.Then observe the changes of myocardial longitudinal strain in the blood supply area after percutaneous coronary interventional therapy (PCI). Results LS-endo, LS-epi, LS-Territorial and LS-mural gradually decrease with the increase of LAD stenosis (all P<0.01). After operation, LS-endo, LS-epi and LS-Territorial increase progressively (all P<0.01). LS-mural increases first and then decreases and finally increases slowly. Conclusion Layer-specific quantification of myocardial longitudinal strain by 2D-STI may reveal the regional myocardial systolic function. It is useful to identify the ischemic myocardium in the early stage and evaluate the treatment effect of PCI.

目的 探讨腹腔镜治疗肝右叶癌的疗效。方法 2011年6月—2014年9月我院对78例肝右叶癌行手术治疗,其中18例行全腹腔镜肝癌切除术,60例行开腹肝癌切除术。比较两组患者的手术时间、术中出血量、术后住院时间、术后并发症发生率、术后一年生存率。结果 腹腔镜组手术时间为(348.8±98.8)min,长于开放手术组,差异具有统计学意义(P<0.05);腹腔镜组术中出血量、术后住院时间、术后并发症发生率均少于开放手术组,相比差异具有统计学意义(P<0.05);两组患者术后1年复发率及生存率比较未见统计学意义(P>0.05)。结论 腹腔镜治疗肝右叶癌手术难度大,但相比开腹手术,腹腔镜肝右叶癌切除术具有术中出血量少、术后住院时间短、术后并发症发生率低的优点。

Objective To evaluate the clinical efficacy of laparoscopic treatment of carcinoma of the right lobe of the liver. Methods from June 2011 to September 2014 in our hospital 78 cases of liver cancer of right lobe underwent surgical treatment, including 18 cases of pure laparoscopic liver resection, 60 cases underwent open resection of hepatocellular carcinoma. Comparing the two groups of patients with operation time,intraoperative bleeding volume,postoperative hospitalization time, postoperative complication rat and one year survival rate. Results The operative time of laparoscopic group was 348.8±98.8 min, longer than the open surgery group, the difference has statistical significance (P<0.05); The intraoperative bleeding volume,postoperative hospitalization time,postoperative complication rate in the laparoscopic group was less than that of the open surgery group, the difference has statistical significance (P<0.05); Two groups of patients with postoperative 1 year survival rate and recurrence rate were not statistically significant (P>0.05). Conclusion Laparoscopic treatment of the liver cancer of the right lobe is difficult, but compared to open surgery, laparoscopic resection of the liver cancer of the right lobe has advantages of less bleeding, shorter postoperative hospitalization, lower postoperative complication rate.

目的 探讨功能康复训练与心理干预对全髋关节置换手术患者髋关节功能康复的影响。方法 对2014年3月—2015年12月先后在本院行全髋关节置换手术90例患者,按入院时间分为观察组45例和对照组45例。对照组按全髋关节置换手术功能康复护理要求给予康复护理;观察组在此功能康复护理基础上,同时对患者进行心理评估和相应的心理护理干预;对两组患者在干预前后的心理情况、生活自理能力、髋关节功能和生活质量进行评价。结果 干预前两组患者均有不同程度的焦虑和抑郁反应,不积极的应对方式和自理能力下降;干预后观察组在应对心理反应,降低焦虑和抑郁,主动进行功能锻炼,自理能力和髋关节功能评分均优于对照组。结论 功能康复训练与心理护理干预相结合,对减轻患者心理压力,提高患者心理应对能力、生活自理能力,提高患者生活质量,促进髋关节功能康复有一定的效果。

Objectives To explore the effect of function rehabilitation training and psychological intervention on patients of hip joint function recovery undergoing THA. Methods 90 patients were chosen who were admitted to the hospital from March 2014 to December undergoing THA,2015. These patients were divided into control group and intervention group according to the sequence of admission. The patients in control group were cared by total hip replacement surgery functional rehabilitation; At the same time, the patients in observation group were cared by psychological training. The psychological condition, self-care ability, hip function and quality of life for all patients were evaluated. Results Before the intervention, two groups of patients had some degrees of anxiety and depression, and negative coping style. Their self-care ability were decreased; The response to psychological reaction, reduction for anxiety and depression, initiative exercise, self-care ability and hip function scores of patients in the intervention group were better than that of the control group. Conclusion Combination of rehabilitation training and psychological nursing intervention can relieve the psychological pressure, improve mental health and promote recovery of hip function.

目的 了解非结核分枝杆菌肺病患者营养风险、营养不足发生率,以及营养支持的应用状况,为临床实施营养干预提供参考依据。方法 对2012年10月—2014年10月在广州市胸科医院就诊的非结核分枝杆菌肺病患者(符合NRS2002评定标准)的营养风险筛查与营养支持状况进行回顾性分析。结果 402例患者中,营养不足和营养风险的发生率分别为35.8％(144/402)和66.7％(268/402);所有患者中,总体营养支持率为60.0%(241/402), 使用肠外营养与肠内营养的比例为3.2∶1;老年患者,女性患者,复治患者更是发生营养风险和营养不足的高危人群;存在营养风险患者的营养支持率为82.1%(220/268),不存在营养风险患者营养支持率为15.7%(21/134)。结论 非结核分枝杆菌肺病患者存在较高比例的营养不足和营养风险,肠外肠内营养临床应用存在不合理性;应推广和使用NRS2002营养评定方法和肠内肠外营养指南,作为实施营养支持的依据。

Objective To investigate prevalence of nutritional risk, undernutrition, and nutritional support of hospitalized patients with non-tuberculosis mycobacteria. Methods Adult patients in Guangzhou Chest Hospital from October 2012 to October 2014 were enrolled by fix-point consecutive sampling. Nutritional Risk Screening 2002 (NRS2002) was performed and nutritional support was evaluated in all patients. Results A total of 402 patients were enrolled.Overall prevalence of undernutrition was 35.8%, and nutritional risk was 66.7%. Among all the patients, the rate of nutritional support was 60.0%, including 82.1%of patients with nutritional risk and 15.7% of non-risk patients. Gerontal patients, retreatment patients and female patients are in the greater possibility of being expose to nutritional risk or undernutrition. Conclusion A large proportion of inpatients with non-tuberculosis mycobacteria were at nutritional risk or undernutrition.The application of parenteral or enteral nutritional support currently maybe inappropriate. NRS2002 and parenteral or enteral nutrition guideline are required to affording nutritional support.

目的 探讨罗伊适应模式对肺癌患者术后生活质量的影响。方法 将2012年3月—2015年7月来我院就诊的178例肺癌术后患者,随机分为试验组85例和对照组93例;对照组患者按护理常规进行护理,试验组在常规护理基础上给予罗伊适应模式护理干预;出院时分别比较两组患者住院适应性、治疗依从性、病人满意度及患者生活质量评分。结果 试验组住院适应率为87.1%(74例),对照组住院适应率为66.7%(62例),两组差异有显著性(P<0.01);试验组治疗依从性优良率为88.2%(75例)、对照组治疗依从性优良率72.0%(67例),两组差异有显著性(P<0.01);试验组患者满意度为89.4%(76例),高于对照组患者满意度73.1%(68例),两组差异有显著性(P<0.01);试验组生活质量评分,总体健康得分(74.1±8.3)高于对照组(56.7±5.9),且差异有统计学意义(P<0.01)。结论 罗伊适应模式护理干预,可以提高肺癌患者手术后的住院适应性、治疗依从性及病人满意度,显著改善患者生活质量,在临床推广罗伊适应模式护理干预具有现实意义。

Objective To investigate　the effect of Roy adaptation model on quality of life in patients for lung cancer after surgery. Methods 178 cases of　patients with lung cancer after surgery operation　were randomly divided into observation groups(85 cases) and control groups(93 cases). The control group was treated with routine nursing care and the observation group was treated on the basis of routine nursing care plus Roy adaptation model nursing interventions. When the two groups were compared in patients hospitalized and discharged adaptability, treatment compliance, patient satisfaction and patient quality of life score. Results Hospitalization adaptation in the observation group was 87.1%(74 cases) and control group was 66.7%(67 cases). There was statistically significant difference between two groups(P<0.01); Excellent treatment compliance of observation group was 88.2%(75 cases) and control group was 72.0%(67 cases). There was statistically significant difference between two groups(P<0.01); the observation group patient satisfaction were 89.4%(76 cases), it was higher than 73.1%(68 cases) of control group. There was statistically significant difference between two groups(P<0.01); quality of life in general health score(74.1±8.3) in the observation group was higher than that of control group(56.7±5.9),and there was statistically significant difference between two groups(P<0.01). Conclusion Roy adaptation model nursing intervention may improve the adaptability hospitalized the patients with lung cancer after surgery, treatment compliance and the patient satisfaction, and significantly improve the quality of life of patients. It is worthy of promotion clinically.

目的 探讨婚恋家庭取向心理干预对系统性红斑狼疮患者家庭功能和幸福感指数的效果。方法 将2012年6月1日—2014年5月31日就诊于东莞康华医院内分泌及风湿免疫中心的62名15~58岁的系统性红斑狼疮患者作为研究对象,根据随机化原则将其分成两组,其中30名为干预组,参加本研究设计的婚恋家庭取向的心理干预,余32名为对照组,采用家庭功能评定量表、幸福指数量表及狼疮活动指数量表,对两组进行干预前、干预后、干预后3月和干预后6月作问卷调查。采用重复测量的方差分析进行评估。结果 家庭功能中的问题解决、情感反应、情感介入、总的功能分量表和总分两组干预后重复测量的方差分析两两比较均有统计学差异(P<0.05)。幸福感指数总分两组重复测量的方差分析无统计学意义,但如扩大置信空间至P<0.1,则两组重复测量的方差分析两两比较中干预后3月及6月有一定统计学意义(P=0.08<0.1)。结论 本研究中婚恋家庭取向的心理干预对SLE患者即家庭功能中问题解决、情感反应、情感介入、总的功能及家庭功能总分均有显著的改善作用,对幸福感指数总分则有一定的增进作用,而对已通过心身疾病方式表达了的SLEDAI没有干预作用。

Objective To explore the effect of marital family-based psychological intervention in SLE patients on family assessment device FAD and index of well-being. Methods A total of 62 SLE patients, aged between 15 and 58, who were treated in out-patient of endocrine immune rheumatism center of Dongguan Kanghua hospital from June 1,2012 to May 31,2014. The experimental group was made up of 30 patients who, at random, volunteered to participate in an added marital family-based psychological intervention and the control group was composed of rest 32 cases. At the time of pre-intervention,post-intervention,3 months and 6 months after intervention, both groups were investigated with questionnaires of family assessment device, index of well-being, index of general affect, and systemic lupus erythematosus disease activity index. The results were analyzed with repeated measure variance analysis to explore the effect. Results There were significant multiple-comparison differences by repeated measure variance analysis in the score of FAD's total and sub-scale problem solving, affective responsiveness, affective involvement, general functioning(P<0.05) between experimental and control group after intervention. There were no significant repeated measure variance analysis differences in the score of index of well-being' total, but if enlarging confidence space to P<0.1, there were partial multiple-comparison differences between experimental and control group at the time of 3 months and 6 months after intervention(P=0.08<0.1). Conclusion Marital family-based psychological intervention may significantly improve FAD's problem solving, affective responsiveness, affective involvement, general functioning, and sum of FAD, and partially improve index of well-being, but can not improve SLEDAI which had developed by psychosomatic disease.