目的 评估CO2激光治疗宫颈上皮内瘤变Ⅱ级（CIN2）病例的疗效。方法 收集2021年11月至2023年10月在本院行CO2激光治疗的92例CIN2患者的临床资料, 采用液基细胞学检查（LCT）和人乳头状瘤病毒（HPV）联合筛查随访,随访6~12个月, 任一结果异常者转诊阴道镜检查, 必要时行病理活组织检查（活检）观察鳞状上皮内病变情况。结果 92例CIN2患者中, 年龄25~45岁、有人工流产史、性伴侣人数3个及以上、因发现宫颈病变就诊者占比较多,患者均未生育。所有患者就诊时均发现HPV阳性, 20.65%患者报告HPV16阳性, HPV18阳性者占比1.09%, HPV其他12种阳性占60.87%, HPV16阳性伴其他12种阳性占17.39%。79例患者随访6个月后总HPV+LCT均阴率为74.68%（59/79）,LCT和HPV阴转率分别为92.41%（73/79）和74.68%（59/79）。所有患者术后12个月LCT均转阴。29例患者在术后12个月均无病变持续或病变发展。25岁以下患者术后6个月及12个月HPV持续率最低, 45~55岁患者术后HPV持续率最高,且多发生HPV16阳性及合并其他HPV亚型阳性的情况。结论 CO2激光治疗可提高患者术后HPV与LCT阴转率, 所有患者术后6个月及12个月随访均无病变加重,且可明显改善年轻患者HPV感染情况。对于有生育要求且具备适应证的CIN2患者, 应积极采取CO2激光治疗以获得更高健康收益。
Objective To evaluate the therapeutic efficacy of CO2 laser treatment in cervical intraepithelial neoplasia grade 2（CIN2）patients. Methods We retrospectively analyzed data from 92 CIN2 patients who underwent CO2 laser therapy at the institution from November 2021 to October 2023. Postoperative followed-up for 6-12 months, screening with liquid-based cytopathology test（LCT）and high-risk human papilloma virus（HPV）testing. Patients with abnormal results in either test were referred for colposcopy, with biopsy performed to evaluate residual or recurrent squamous intraepithelial lesions. Results Among total of 92 patients, most patients aged 25-45 years old, with a history of induced abortion, had three or more sexual partners, and visited hospital due to cervical lesions, and none of the patients gave birth. All patients were found to be HPV positive at hospital visits, with 20. 65% of HPV16 positive, 1. 09% of HPV18 positive, 60. 87% of other 12 kinds HPV positive, while HPV16 positive with other 12 kinds accounted for 17. 39%. Among the 79 patients after 6-month follow-up, the dual-negative conversion rate（HPV+LCT）was 74. 68%（59/79）, with LCT and HPV negative rates reaching 92. 41%（73/79）and 74. 68%（59/79）, respectively. After 12-month follow-up, all patients achieved LCT negativity, 29 patients with no documented lesion persistence or disease progression. Notably, patients aged <25 years exhibited the lowest postoperative HPV persistence rates between 6- to 12-month follow-up, whereas those aged 45-55 years demonstrated the highest persistence rates, frequently associated with HPV16 positivity or co-infection with other HPV subtypes. Conclusions CO2 laser therapy significantly increases postoperative negative conversion rates for HPV and LCT. No lesion progression was observed in patients between 6- to 12-month follow-ups. The therapy also notably improves HPV clearance in younger patients. For patients with CIN2 who have fertility requirements and meet the indications, CO2 laser therapy should be actively adopted to achieve greater health benefits.
目的 通过构建结构方程模型,分析某三级甲等综合医院腹股沟疝患者住院费用的影响因素,旨在为合理控制腹股沟疝单病种费用提供依据。方法 收集4 328份高州市人民医院2016—2022年主要诊断疾病名称为腹股沟疝且行腹股沟疝手术的患者的病历资料,预分析单个影响因素,采用AMOS28.0拟合构建模型。结果 结构方程模型拟合达到标准。性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝对总费用所产生的总效应数值分别为0.008、-0.044、0.062、0.014、-0.119、0.106、0.236;性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝通过住院时间间接对住院费用产生影响。结论 对住院费用产生的影响因素有性别、年龄、费别、住院次数、入院途径、伴随病、单双侧疝、住院时间,建议推行患者预住院模式及日间手术,在正式住院前完成相关检查,优化医疗服务流程,从而合理有效控制单病种住院费用。
Objective By utilizing a structural equation model, to analyze determinants that affect the hospitalization costs for individuals with inguinal hernia at a tertiary-level comprehensive medical center, offering insights for the potential management of costs associated with this specific ailment. Methods This study entailed the compilation of 4 328 patient files from individuals who received surgical treatment for inguinal hernia at a third-level general hospital over the period spanning 2016 to 2022. Preliminary analysis was conducted on isolated variables, followed by the development of a model using AMOS 28. 0 for fit assessment. Results The fitting of structural equation model reached the standard. The total effect values of gender, age, cost, number of hospitalizations, admission route, concomitant disease, unilateral and bilateral hernia on the total cost were 0. 008, -0. 044, 0. 062, 0. 014, -0. 119, 0. 106, 0. 236, respectively. Gender, age, cost, number of hospitalizations, admission route, concomitant disease, unilateral and bilateral hernia indirectly affected hospitalization expenses through hospitalization days. Conclusions Gender, age, cost, number of hospitalizations, of admission, concomitant diseases, unilateral and bilateral hernia, and length of hospital stay have an impact on hospitalization costs. It is suggested to implement the pre-hospitalization mode and day surgery, complete relevant examinations before formal hospitalization, and optimize the medical service process, so as to reasonably and effectively control the hospitalization cost of single disease.
目的 探讨对注意缺陷多动障碍（ADHD）患儿联合应用维生素D与盐酸托莫西汀的效果及对其行为功能障碍和神经功能损伤的影响。方法 选择于我院接受治疗的105例ADHD患儿,纳入时间为2023年7月—2024年3月,按照计算机分组法分为对照组52例给予盐酸托莫西汀治疗,观察组53例给予维生素D联合盐酸托莫西汀治疗,比较两组临床疗效、神经与行为功能、不良反应。结果 观察组总有效率（96.23%）高于对照组（78.85%）（P<0.05）。治疗后,与对照组比较,观察组神经元特异性烯醇化酶水平与行为、学习、躯体、冲动多动、焦虑及多动指数评分更低（P<0.05）。两组不良反应发生率对比差异无统计学意义（P>0.05）。结论 对于ADHD患儿,使用维生素D联合盐酸托莫西汀显示出更为显著的疗效,能有效缓解行为功能障碍,减少神经功能损伤,且具有良好的安全性。
Objective To explore the effect of combined use of vitamin D and atomoxetine hydrochloride on children with attention deficit hyperactivity disorder（ADHD）and its impact on their behavioral dysfunction and neurological damage. Methods A total of 105 children with ADHD treated in the hospital were included from July 2023 to March 2024. They were divided into control group with 52 cases treated with atomoxetine hydrochloride, and observation group with 53 cases treated with vitamin D combined with atomoxetine hydrochloride using a computerized grouping method. The clinical efficacy, neurological function, behavioral function, and adverse reactions were observed in both groups. Results The total effective rate of the observation group（96. 23%）was higher than that of the control group（78. 85%）（P<0. 05）. After treatment, compared with the control group, the levels of neuron-specific enolase in the observation group were significantly lower in terms of behavior, learning, physical fitness, impulsivity hyperactivity, anxiety and hyperactivity index scores（P<0. 05）. The comparison of the incidence of adverse effects between the two groups was not significant（P>0. 05）. Conclusions The combined use of vitamin D and atomoxetine hydrochloride has a more significant therapeutic effect on children with ADHD, which can effectively alleviate behavioral dysfunction, reduce neurological damage, and has good safety.
目的 通过建立急性心力衰竭（AHF）患者服药依从性预测模型,提高AHF患者的服药依从性和临床管理效果。方法 纳入2021年1月—2023年12月在广州市番禺区何贤纪念医院住院治疗的580例AHF患者,通过收集患者的一般人口学资料、疾病相关资料及出院后6个月的服药依从性数据,应用Logistic回归模型分析患者服药依从性的影响因素,并基于影响因素建立预测模型。结果 患者服药依从性总体良好（75%）。依从性良好组与依从性差组的年龄、独居情况、合并基础病、服药种类、疾病了解评分、治疗信心评分和自我控制信心评分比较差异有统计学意义（P<0.05）。Logistic 回归分析显示危险因素包括年龄≥60岁（OR=1.774）、独居（OR=1.871）、合并基础病≥2种（OR=1.719）和服药种类≥7种（OR=1.456）。而疾病了解评分（OR=0.923）、治疗信心评分（OR=0.946）和自我控制信心评分（OR=0.901）是保护因素（P<0.05）。基于上述因素建立的预测模型,通过ROC曲线验证,曲线下面积为0.815（95%CI：0.780~0.850）,提示所构建的模型具有良好的区分度。对该模型的校准度进行评价,P=0.528,提示该预测模型拟合度良好。此外,该预测模型的一致性指数为0.738,说明模型的预测性能良好。绘制的决策曲线中,曲线位于极端线之上,当阈概率取值在9%~59%时,对应的净获益率为0~27%,提示建立的模型具有优秀的临床有效性。结论 AHF患者的服药依从性受到多种因素的影响,包括年龄、居住状态、合并基础病种类及服药种类等。
Objective To establish a predictive model for medication compliance among acute heart failure（AHF）patients in order to enhance their therapeutic compliance and optimize clinical outcomes. Methods A total of 580 AHF inpatients at He Xian Memorial Hospital in Panyu District, Guangzhou between January 2021 and December 2023 were enrolled. Demographic information, disease-specific data,as well as post-discharge medication compliance records within six-month were collected by investigators. Utilizing logistic regression analysis revealed several influential determinants affecting medication compliance which formed the basis for constructing our predictive model. Results Generally,patient compliance was good（75%）. The comparison between the good compliance group and the poor compliance group showed that there were significant differences in age, living alone,combined with underlying diseases, types of medication, disease understanding score, treatment confidence score and self-control confidence score（P<0. 05）. Logistic regression analysis showed that independent risk indicators including individuals aged ≥60 years（odds ratio[OR]=1. 774）, those living alone（OR=1. 871）, presence of two or more underlying diseases（OR=1. 719）, along with consumption of seven or more medications daily（OR=1. 456）. Conversely,disease awareness score（OR=0. 923）, treatment confidence score（OR=0. 946）, and self-control confidence score（OR=0. 901）were identified as independent protective factors. Validation using receiver operating characteristic curves demonstrated robust predictive performance with an area under curve value of 0. 815（95%CI：0. 780-0. 850）, affirming its efficacy. The calibration of the model was evaluated, with a P-value of 0. 528, indicating good fit of the predictive model. Additionally, the concordance index（C-index）of the model was 0. 738, suggesting its excellent predictive performance. The decision curve analysis revealed that the curve was above the extreme lines, with a net benefit rate ranging from 0 to 27% when the threshold probability falls between. Conclusions The medication compliance of AHF patients is influenced by various factors, including age, living arrangement, the number of underlying diseases, and the number of medications taken. Targeted interventions such as enhancing patient education, simplifying treatment regimens, and improving social support can effectively improve the medication compliance of AHF patients. The predictive model established in this study provides a scientific basis for clinicians to develop more precise and effective individualized intervention measures,thereby improving the prognosis and quality of life.
目的 评估重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（rhTNRF：Fc）治疗难治性慢性痛风性关节炎的临床疗效及安全性。方法 选取2022年1月一2023年12月广州中医药大学顺德医院风湿科门诊收治的46例难治性痛风性关节炎患者,分为观察组和对照组两组,对照组规范使用降尿酸药物治疗,观察组在对照组治疗的基础上联合使用rhTNRF：Fc至少12周,在0、12、24、48周观察两组的血尿酸（sUA）、肿瘤坏死因子-α（TNF-α）、关节肌肉骨骼超声变化、痛风发作例数、肝肾功能等指标。结果 观察组与对照组sUA无明显差别（P>0.05）,TNF-α水平明显下降（P<0.05）,滑膜炎、关节积液影像表现减少（P<0.05）,痛风发作例数明显减少（P<0.05）,观察期间肝肾功能正常,无患者因不良反应退出研究。结论 rhTNRF：Fc对难治性慢性痛风性关节炎安全有效。
Objective To explore the efficacy and safety of recombinant human type II tumor necrosis factor receptor-antibody fusion protein（rhTNRF：Fc）in refractory chronic gouty arthritis. Methods From January 2022 to December 2023, 46 cases of refractory chronic gouty arthritis in the Rheumatology Outpatient Department,Shunde Hospital Guangzhou University of Chinese Medicine were selected and divided into an observation group and a control group. The control group received routine treatment,while the observation group received rhTNRF：Fc treatment additionally for at least 12 weeks, two groups of indicators such as serum urine acid（sUA）, TNF-α, changes in musculoskeletal ultrasound,number of gout attacks,hepatic and renal function at 0, 12, 24, and 48 weeks were observed. Results There was no significant difference in sUA between the observation group and the control group（P>0. 05）, TNF-α significantly decreased（P<0. 05）, synovitis and joint effusion imaging manifestations reduced（P<0. 05）, number of gout attacks decreased（P<0. 05）. During the observation period, liver and kidney function were normal, and no patients withdrew from the study due to adverse reactions. Conclusions Using rhTNRF：Fc is safe and effective in treating refractory chronic gouty arthritis.
目的 深入了解河源市某综合医院职业暴露的真实情况,评估健康风险,从而提出有效的控制措施,并提升医院员工的职业防护意识,以保障他们的健康和安全。方法 采用回顾性调查,从暴露类型、环节、病原体种类、职业类别、工龄等方面,对河源市某综合医院在2022—2023年所发生的职业暴露事件进行统计分析。结果 在2022—2023年期间,该综合医院共计发生了93例血源性病原体职业暴露事件,以锐器伤为主,共80例,占86.02%;职业暴露最多的是护理人员,共发生61例,占65.59%;工作人员中工龄≤2年的职业暴露比例最多,共有71例,占76.34%;职业暴露的发生环节主要集中在处理丢弃锐器物以及进行检查、治疗、护理操作的过程中,均为30例,占32.26%;发生职业暴露的原因主要是缺少防护,出现34例,占36.56%;职业暴露主要发生在普通病房,为37例,占39.78%;其次为门急诊,均为15例,占16.13%;职业暴露发生的暴露源传染病病原体种类以不明病原体为主,为36例,占38.70%;其次是乙型肝炎病毒,为32例,占34.40%;所有发生职业暴露的员工均接受了全面的暴露风险评估、合理的预防性用药措施以及定期的健康监测。结论 医院管理部门需加强职业安全培训,特别是针对护理人员和低年资员工,严格执行标准操作规程,提供充足防护用品,改进医疗设备设计,建立完善的监测报告和保障体系,并强化监督和管理,以降低职业暴露风险,保障员工职业安全。
Objective To gain a deep understanding of the actual situation of occupational exposure in a general hospital in Heyuan City, assess health risks, propose effective control measures,and enhance the awareness of occupational protection among hospital staff to safeguard their health and safety. Methods A retrospective study was conducted to statistically analyze the occupational exposure events that occurred in a general hospital in Heyuan City from 2022 to 2023, in terms of exposure types, links, types of pathogens, occupational categories, and years of service. Results During the period from 2022 to 2023, a total of 93 cases of occupational exposure to blood-borne pathogens occurred in the general hospital, with sharp instrument injuries being the most common, accounting for 80 cases（86. 02%）; nurses accounted for the majority of occupational exposures, with 61 cases（65. 59%）; among the staff, those with a service time ≤ two years had the highest proportion of occupational exposures, with 71 cases（76. 34%）; the main occurrence of occupational exposures was in the processes of disposing of discarded sharp instruments and conducting inspections, treatments, and nursing operations, both accounting for 30 cases（32. 26%）; the main reason for occupational exposures was lack of protection, with 34 cases（36. 56%）; occupational exposures occurred mainly in general wards, with 37 cases（39. 78%）, followed by outpatient and emergency departments, both with 15 cases（16. 13%）; the types of infectious pathogens exposed in occupational exposures were mainly unknown, with 36 cases（38. 70%）, followed by hepatitis B, with 32 cases（34. 40%）; all staff who experienced occupational exposures received comprehensive exposure risk assessments,reasonable preventive medication measures, and regular health monitoring. Conclusions Hospital management departments need to enhance occupational safety training, particularly for nursing staff and junior-level employees, strictly enforce standard operating procedures, provide adequate protective equipment, improve medical device design, establish a comprehensive monitoring and reporting system, strengthen supervision, and manage to reduce the risk of occupational exposure and ensure the occupational safety of employees.
目的 通过采用本体感觉神经肌肉刺激技术（PNF）对慢性颈痛患者进行治疗,观察患者颈部肌肉力量是否得到增强,以及颈椎的Cobb角是否得到改善。方法 将符合纳入标准的30例慢性颈痛患者纳入研究对象（PNF组）。研究对象接受为期4周的PNF技术治疗,对比治疗前（基线）和治疗4周后颈部最大等长收缩肌力（MIS）,并比较治疗前后Cobb角。结果 共30例患者完成研究。治疗后颈椎Cobb角明显改善,治疗4周后对比基线Cobb角差异具有统计学意义（t=4.925,P<0.001）。颈椎屈曲和伸展的力量经过4周治疗后都得到明显的改善,颈椎伸展的MIS从（15.8±2.5）lbs增加到（19.3±3.1）lbs,比较基线差异具有统计学意义（t=5.685,P<0.001）。颈椎屈曲的MIS从13.9（10.3,15.6）lbs增加到17.8（15.3,18.8）lbs,治疗4周后对比基线差异具有统计学意义（Z=-4.783,P<0.001）。结论 PNF技术能有效增强颈部肌肉力量,可有效增大颈椎Cobb角,可能为颈椎变直的慢性颈痛患者的治疗带来积极的影响。
Objective To observe whether the strength of the neck muscles and the Cobb angle of the cervical vertebra are improved by proprioceptive neuromuscular facilitation（PNF）in the treatment of patients with chronic neck pain. Methods Thirty patients with chronic neck pain who met the inclusion criteria were included in the study group（PNF group）. They were treated with PNF for four weeks, maximal isometric strength（MIS）and Cobb angle in the neck were compared at before（baseline）and four weeks after treatment. Results A total of 30 participants completed the study. The Cobb angle of cervical spine was significantly improved after treatment,and the Cobb angle before treatment was significantly different from that after four weeks of treatment（t=4. 925, P<0. 001）. The strength of cervical flexion and extension improved significantly after four weeks of treatment,and the MIS of cervical extension increased from（15. 8±2. 5）lbs to（19. 3±3. 1）lbs, which was statistically significant compared to baseline（t=5. 685, P<0. 001）. Cervical flexion MIS increased from 13. 9（10. 3,15. 6）lbs to 17. 8（15. 3,18. 8）lbs,and the difference was statistically significant compared to baseline after four weeks of treatment（Z=-4. 783, P<0. 001）. Conclusions PNF can effectively enhance the strength of neck muscles,and can effectively increase the Cobb angle of cervical spine, which may have a positive impact on the treatment of chronic neck pain patients with cervical straightening.
目的 探讨肝癌根治术后恶心呕吐现状及影响因素。方法 选取2022年5月—2024年5月天津市第二人民医院收治的70例肝癌患者进行回顾性分析,所有患者均行肝癌根治术,分析其术后恶心呕吐情况。并依照恶心呕吐发生情况进行分组,将30例术后发生恶心呕吐的患者分为观察组,其余40例患者为对照组。对比两组患者临床病理特征及围术期指标。并建立Logistic回归模型以术后恶心呕吐为因变量分析肝癌患者手术切除术后恶心呕吐的影响因素。结果 肝癌患者手术切除术后恶心呕吐发生率为42.86%（30/70）,其中Ⅰ度14例（20.00%）、Ⅱ度10例（14.29%）、Ⅲ度4例（5.71%）、Ⅳ度2例（2.86%）;观察组与对照组性别、体质量指数（BMI）、病理类型、临床分期、术前禁食时间对比差异无统计学意义（P>0.05）,观察组与对照组年龄及是否化疗情况对比差异有统计学意义（P<0.05）;观察组与对照组手术时间、术后VAS评分、麻醉方式、术后合并其他并发症情况对比差异无统计学意义（P>0.05）,观察组与对照组肝门阻断时间、术中失血量及术后腹胀情况对比差异有统计学意义（P<0.05）;年龄、是否化学治疗、术中失血量、术后腹胀情况为肝癌患者手术切除术后恶心呕吐的影响因素（P<0.05）。结论 肝癌患者手术切除术后恶心呕吐发生率较高,且年龄、是否化疗、术中失血量及术后腹胀情况可能为恶心呕吐发生的影响因素,针对此类患者高风险患者需及时采取相关措施进行干预,预防患者术后恶心呕吐情况及减轻严重程度。
Objective To explore the status and influencing factors of nausea and vomiting after radical resection of liver cancer. Methods A retrospective analysis was conducted on 70 liver cancer patients admitted to the Second People’s Hospital of Tianjin from May 2022 to May 2024. All patients underwent radical surgery for liver cancer,and their postoperative nausea and vomiting conditions were analyzed. According to the occurrence of nausea and vomiting, 30 patients who experienced nausea and vomiting after surgery were divided into an observation group, and the remaining 40 patients were divided into a control group. The clinical and pathological characteristics as well as perioperative indicators between two groups of patients were compared. A logistic regression model was established to analyze the influencing factors of postoperative nausea and vomiting in liver cancer patients after surgical resection,with postoperative nausea and vomiting as the dependent variable. Results The incidence of postoperative nausea and vomiting in liver cancer patients was 42. 86%（30/70）, including 14 cases of grade I, accounting for 20. 00%, 10 cases of grade II, accounting for 14. 29%, four cases of grade III,accounting for 5. 71%, and two cases of grade IV,accounting for 2. 86%. There were no significant differences in gender,body mass index（BMI）, pathological type,clinical stage,and preoperative fasting time between the observation group and the control group（P>0. 05）. However, there were significant differences in age and chemotherapy status between the observation group and the control group（P<0. 05）. There were no significant differences in the operation time,postoperative VAS score,anesthesia method and postoperative complications between the observation group and the control group（P>0. 05）, but with differences in the portal block time,intraoperative blood loss and postoperative abdominal distension between the observation group and the control group（P<0. 05）. Age, chemotherapy, intraoperative blood loss, and postoperative abdominal distension were independent influencing factors for postoperative nausea and vomiting in liver cancer patients undergoing surgical resection（P<0. 05）. Conclusions The incidence of nausea and vomiting after surgical resection in liver cancer patients is relatively high, with age, chemotherapy, intraoperative blood loss, and postoperative abdominal distension may be influencing factors for nausea and vomiting. Therefore, relevant measures should be taken in a timely manner to intervene in high-risk patients to prevent postoperative nausea and vomiting and reduce its severity.
目的 建立大鼠急性心肌梗死缺血再灌注后无复流模型,并初步验证细胞焦亡在其中的发生情况。方法 选用20只标准成年雄性Sprague Dawley大鼠（体质量260~320 g）,随机分为对照组（n=5）和手术组（n=15）。对照组仅穿线冠状动脉,未行结扎;手术组结扎左前降支0.5 h后解除,进行再灌注4 h,以建立无复流模型。通过Evens blue和硫磺素S染色,评估心肌的正常供血区、再灌注区及无复流区,并对两组大鼠心肌组织进行病理分析。结果 对照组大鼠全部存活,未出现无复流现象,心肌组织中未见细胞焦亡。手术组存活13只,形成明确的正常供血区（n=13）、再灌注区（n=13）和无复流区（n=10）。在无复流区的心肌细胞中均观察到细胞焦亡（n=10）,而正常供血区未见（n=0）,再灌注区部分出现（n=4）,差异具有统计学意义（P<0.05）。结论 细胞焦亡现象主要存在于大鼠急性心肌梗死缺血再灌注后无复流区域中,细胞焦亡可能作为一种区域特异性程序性死亡方式,在心肌无复流的发生与发展中发挥重要作用。
Objective To establish a rat model of myocardial no-reflow after acute myocardial infarction with ischemia-reperfusion injury and to preliminarily explore the occurrence of pyroptosis in the affected myocardium. Methods Twenty adult male Sprague-Dawley rats（260-320 g）were randomly divided into a control group（n=5）and a surgical group（n=15）. In the control group,the coronary artery was encircled with suture but not ligated. In the surgical group,the left anterior descending artery was ligated for 30 minutes, followed by 4 hours of reperfusion to induce the no-reflow model. Evans blue and thioflavin S staining were used to evaluate the normal perfusion area,reperfusion area,and no-reflow area of the myocardium. Histopathological analysis was conducted on myocardial tissues from both groups. Results All rats in the control group survived without evidence of no-reflow or pyroptosis in myocardial tissue. In the surgical group, 13 rats survived and showed distinct regions of normal perfusion, 13 with reperfusion, and 10 with no-reflow. Pyroptosis was observed in all no-reflow areas（n=10）, absent in the normal perfusion zones（n=0）, and partially present in the reperfusion zones（n=4）. The differences were statistically significant（P<0. 05）. Conclusions Pyroptosis predominantly occurs in the no-reflow zones following acute myocardial infarction and ischemia-reperfusion injury in rats. As a region-specific form of programmed cell death, pyroptosis may play an important role in the development of myocardial no-reflow.
目的 探讨基于品管圈活动构建健康体检重要异常结果的追踪管理模式对提高电话随访率的影响。方法 选取2022年5月—2023年4月在中山大学孙逸仙纪念医院健康管理中心体检重要异常结果的328例受检者作为研究对象。成立品管圈活动小组,实施追踪管理模式。干预后时间段为2022年11月—2023年4月,期间针对不同样本分别实施了干预措施一至四及全面实施措施,分析随访1个月后成功随访人数。比较干预前后圈员综合能力变化及患者对健康管理中心的满意度。结果 电话随访率在干预措施一实施后为85.02%,干预措施二实施后为88.59%,干预措施三实施后为90.23%,干预措施四实施后为95.27%,全面实施干预措施一至干预措施四后为95.80%,均较干预措施实施前电话随访率（75.91%）有所增长;干预成功随访人数中,复诊率为84.34%（210/249）,全面实施措施后成功随访人数中复诊率为94.74%（216/228）。相较于干预前,干预后,圈员解决问题能力、责任心、沟通协调、团队凝聚力、积极性、品管手法、自信心、和谐感分值均升高（P<0.05）。干预前患者满意度为85.37%,干预后患者满意度为87.80%,干预后满意度有所升高,差异具有统计学意义（P<0.05）。结论 通过开展品管圈活动,使重要异常结果电话随访率明显提高,有利于提升体检机构的服务质量和服务能力,有利于疾病的早发现、早干预。
Objective Exploring the impact of establishing a tracking and management model for important abnormal results of health check ups based on quality control circle activities on improving telephone follow-up rates. Methods A total of 328 subjects with important abnormal results in Health Management Center of Sun Yat-sen Memorial Hospital of Sun Yat sen University from May 2022 to April 2023 were selected. The quality control circle activity group was set and the tracking management mode was carried out. The post intervention period was from November 2022 to April 2023, during which intervention measures 1-4 and comprehensive implementation measures were implemented for different samples. The number of successful follow-up after 1 month of follow-up was analyzed. Changes in the comprehensive ability of the circle staff before and after the intervention and the patients’ satisfaction with the health management center were compared. Results The telephone follow-up rate after intervention 1 was 85. 02%, 88. 59% after intervention 2,90. 23% after intervention 3,95. 27% after intervention 4 and 95. 80% after all intervention,which was higher than 75. 91% before intervention implementation. Among the single intervention individuals, the re-visit rate was 84. 34%（210/249）, and after the comprehensive implementation of measures, the re-visit rate among the successfully intervened individuals was 94. 74%（216/228）. After the intervention,the problem solving ability,responsibility, communication and coordination,team cohesion, enthusiasm,quality control techniques,self-confidence,and sense of harmony all significantly increased（P<0. 05）. The patient satisfaction rate before intervention was 85. 37%, and after intervention it was 87. 80%. The satisfaction rate increased after intervention, and the difference was statistically significant（P<0. 05）. Conclusions Through the quality control circle activities, the telephone follow-up rate of important abnormal results is significantly improved,which is conducive to improving the service quality and service capacity of physical examination institutions,is conducive to the early detection and early intervention of diseases.
