目的 探讨频发室性早搏与四级非心脏手术术后心衰发生率的相关性。方法 回顾性分析2020年7月—2021年6月于我院治疗的201例四级非心脏手术患者,根据术后是否发生心衰,将其分为心衰组和非心衰组,其中出现心衰者20例,未心衰者181例。分析2组患者临床资料、频发室性早搏次数,随后经单因素分析及Logistic回归分析术后心衰发生率的相关性。结果 心衰组临床资料中性别、糖尿病史、饮酒史、吸烟史、手术危险性分级、BMI、血红蛋白、红细胞宽度、左室舒张末径、左室射血分数值与非心衰组比较,差异无统计学意义(P>0.05);心衰组年龄大于非心衰组,胆固醇值、甘油三酯、室性早搏次数、术前肌酐水平均高于非心衰组(P<0.05);经多因素Logistic回归分析,分析结果显示年龄(OR=1.400,95%CI:1.060~1.848)、胆固醇值(OR=4.318,95%CI:1.122~16.622)、甘油三酯(OR=12.889,95%CI:1.232~134.808)、室性早搏次数(OR=1.010,95% CI:1.001~1.020)、术前肌酐(OR=34.071,95% CI:1.186~978.753)为四级非心脏手术术后发生心衰的危险因素(P<0.05)。结论 频发室性早搏为四级非心脏手术术后心衰发生的危险因素,其中年龄、胆固醇值、甘油三酯、术前肌酐也为术后心衰发生的危险因素。

目的 探究麦默通（Mammotome）微创旋切术加置引流对乳腺良性肿物患者术后疼痛、炎性应激指标及并发症的影响。方法 选取本院2020年1月—2022年1月收治的100例乳腺良性肿物患者,简单随机法进行分组,每位患者赋予1位随机数,1~51号为实验组,采用Mammotome微创旋切术加置引流,52~100号为对照组,实施Mammotome微创旋切术。对比2组治疗效果、围术期指标、术前及术后1 d、3 d疼痛程度（NRS评分）、术前及术后3 d炎性应激指标及并发症情况。结果 2组病灶清除率（100.00%、97.96%）、并发症发生率（3.92%、16.32%）间无差异（P>0.05）;相较于对照组,实验组手术时间较长,残腔积液较少,住院时间较短（P<0.05）;术后1 d、3 d实验组NRS评分低于对照组（P<0.05）;术后3 d 2组C反应蛋白、白介素-6、白介素-1β、降钙素原水平较术前上升,且实验组上升幅度小于对照组（P<0.05）。结论 Mammotome微创旋切术加置引流治疗乳腺良性肿物能减少残腔积液,降低炎症反应程度,有助于术后切口愈合,缓解术后疼痛,且不增加并发症风险。

Objective To investigate the effect of Mammotome minimally invasive excision with drainage on postoperative pain,inflammatory stress indexes and complications in patients with benign breast tumors．Methods A total of 100 patients with benign breast tumors admitted to our hospital from January 2020 to January 2022 were selected and grouped by simple random method,each patient was assigned a random number．Patients No.1 to No.51 were included in the experimental group,treated with Mammotome minimally invasive excision with drainage．Patients No.52 to No.100 were included in the control group,treated with Mammotome minimally invasive excision．The treatment effect,perioperative indicators,pain level（NRS score）and inflammatory stress indexes before and 1st and 3rd days after operation and complications were compared between the two groups．Results There were no significant differences in the lesion clearance rate（100.00% vs 97.96%）and the complication rate（3.92% vs 16.32%）between the two groups（P>0.05）．Compared with the control group,the experimental group had longer operation time,less residual cavity liquid and shorter hospital stay（P<0.05）．The NRS score of the experimental group was lower than that of the control group at 1st and 3rd days after operation（P<0.05）．On the third day after operation,the levels of C-reactive protein,interleukin- 6,interleukin-1β and procalcitonin in the two groups were increased compared with those before operation,and the increase in the experimental group was smaller than that in the observation group（P<0.05）．Conclusions Mammotome minimally invasive excision with drainage in the treatment of benign breast tumors can reduce residual cavity fluid accumulation,reduce the degree of inflammatory response,help postoperative incision healing,relieve postoperative pain,and without increasing the risk of complications．

目的 探讨精细化管理模式对消毒供应中心风险事件发生率的影响。方法 选取2020年6月—2022年5月为研究阶段,抽取本院消毒供应室1 000件医疗器械作为研究对象,随机分为对照组和研究组,各500件。对照组采用常规管理模式,研究组采用精细化管理模式,对比2组医疗器械不良事件发生率,观察30名工作人员分别在不同管理模式下发生职业风险暴露人数的变化,并进一步比较工作效率的不同。结果 研究组发生数量不等、物品过期、标签错误、型号错误、零部件差错等不良事件发生率均低于对照组（P<0.05）。研究组工作人员利器损伤和血制品污染者发生率低于对照组（P<0.05）,研究组工作人员工作效率评分高于对照组（P<0.05）。结论 精细化管理模式可有效减少消毒供应室医疗器械不良事件,降低工作人员职业暴露风险事件发生率,提高工作人员工作效率,改善管理工作质量。

Objective To explore the influence of refined management mode on the incidence of risk events in disinfection supply center. Methods From June 2020 to May 2022,1 000 pieces of medical devices were selected from the disinfection supply room of our hospital as the research object,and were randomly divided into control group and research group,with 500 pieces in each group. The control group adopted the conventional management mode,while the research group adopted the refined management mode. The incidence of adverse medical device events in the two groups was compared,and the changes in the number of 30 staff exposed to occupational risks under different management modes were observed,and the differences in work efficiency were further compared. Results The incidences of adverse events involving unequal quantities,expired items,mislabeling,modeling errors and parts errors were lower in the study group than in the control group(P<0. 05). The number of sharps injuries and blood product contamination among the staff in the study group was significantly lower than that in the control group(P<0. 05),and the staff efficiency scores of the study group were higher than those of the control group(P<0. 05). Conclusions Refined management mode can effectively reduce the adverse events of medical devices in disinfection supply room,reduce the number of occupational exposure risk events of staff,improve the work efficiency of staff and improve the quality of management.

目的 对比不同血管通路运用于血液透析中的透析充分性及并发症发生率分析。方法 选取我院2018年5月—2020年10月收治的其中60例血液透析患者作为研究对象,根据患者不同血管通路分为3组,甲组30例,采取自体动静脉内瘘为通路方式,乙组15例,采取聚四氟乙烯移植血管内瘘为通路方式;丙组15例,采取带隧道和涤纶套的透析导管为通路方式。观察并记录3组患者透析后的血红蛋白、高密度脂蛋白、总胆固醇、C反应蛋白、血浆清蛋白、低密度脂蛋白、尿素清除指数、甘油三酯、尿素降低率水平,并对患者随访10个月,观察3组患者血管通路并发症(感染及血栓栓塞)的发生情况。结果 透析后3组患者血红蛋白、总胆固醇、高密度脂蛋白、甘油三酯、血浆清蛋白、C反应蛋白、低密度脂蛋白、尿素清除指数、尿素清除率比较,差异无统计学意义(P>0.05)。甲组的感染和血栓栓塞发生率低于乙组和丙组,而乙组的感染率又低于丙组,差异有统计学意义(P<0.05)。结论 自体动静脉内瘘可以做为血液透析治疗中血管通路的首选方式,若患者自体血管条件有限,可考虑建立移植血管内瘘来保证透析的充分性,降低并发症发生率,提高患者透析安全性及生活质量。

Objective To compare the dialysis adequacy and complication incidence of different vascular access in hemodialysis. Methods A total of 60 hemodialysis patients treated in our hospital from May 2018 to October 2020 were selected as the research objects. They were divided into three groups according to different vascular access. Thirty patients in group A took autologous arteriovenous fistula (AVF) as the access, and 15 patients in group B took polytetrafluoroethylene graft (arteriovenous grafts,AVG) as the access, 15 cases in group C were treated with dialysis catheter with tunnel and polyester sleeve (tunnel-cuffed catheter,TCC). The levels of hemoglobin, high density lipoprotein, total cholesterol, C-reactive protein, plasma albumin, low density lipoprotein, urea clearance index, triglyceride and urea reduction ratio (URR) were observed and recorded. The patients were followed up for 10 months to observe the incidence of vascular access complications (infection and thromboembolism) in the three groups. Results There was no significant difference in hemoglobin, total cholesterol, high density lipoprotein, triglyceride, plasma albumin, C-reactive protein, low density lipoprotein, urea clearance index and URR among the three groups after dialysis (P>0.05). The incidence of infection and thromboembolism in group A was lower than that in group B and group C, while the infection rate in group B was lower than that in group C, the differences were statistically significant (P<0.05). Conclusions AVF can be used as the preferred way of vascular access in hemodialysis treatment. If the patient's autologous vascular conditions are limited, it can be considered to establish transplanted vascular fistula (AVG) to ensure the adequacy of dialysis, reduce the incidence of complications and improve the dialysis safety and quality of life of patients.

目的 探讨家庭医生契约式服务对婴儿生长发育及肺炎发生率的影响。方法 选取2019年7月—2020年2月龙凤社区出生的婴儿200例作为研究对象,随机分为签约组与未签约组,每组100例。其中,签约组婴儿接受家庭医生契约式服务,未签约组婴儿则接受社区常规儿童保健服务。记录两组婴儿出生后第1、3、6、9、12个月时的生长发育指标(身长、体质量)、神经心理发育指标(大动作、精细动作、个人-社会、语言、适应性)以及肺炎发生率,进行对比分析。结果 出生后第1个月和第3个月,两组婴幼儿身高与体质量差异无统计学意义(P＞0.05)。自出生后第6个月开始,签约组婴幼儿的身高与体质量水平均高于未签约组婴幼儿(P＜0.05)。两组中出生后1月龄的婴幼儿在发育商5项指标中差异均无统计学意义(P＞0.05)。在12月龄时,签约组婴幼儿的大动作、精细动作、个人-社会、语言、适应性5项指标评分均高于未签约组婴幼儿(P＜0.05)。截止出生后第12个月,签约组共发生2例肺炎患儿,肺炎发生率2%;未签约组发生10例肺炎患儿,肺炎发生率10%,高于签约组肺炎发生率。所有肺炎患儿均给予积极对症治疗后痊愈。结论 家庭医生契约式服务能够促进婴幼儿出生后第1年内身心发育水平,同时还能有效降低肺炎的发生风险,有利于婴幼儿身心全面、健康地发育和生长,具有比较显著的卫生和社会学价值,值得推广应用。

Objective To explore the effect of family doctor contract service on infant growth and development and incidence of pneumonia. Methods From July 2019 to February 2020, 200 infants in Longfeng community were selected as the research objects and randomly divided into contract group and non contract group, with 100 cases in each group. Among them, the infants in the contract group received the family doctor contract service, while the infants in the non signing group received the community routine child health care services. The growth and development indexes (body length, body weight), neuropsychological development indexes (big movements, fine movements, personal society, language, adaptability) and the incidence of pneumonia were recorded and analyzed in the first, third, sixth, ninth and twelfth months after birth. Results There were no significant differences in height and weight between the two groups at the first and third month after birth (P>0.05). From the 6th month after birth, the height and weight of infants in the signing group were higher than those in the non signing group (P<0.05). There were no significant differences in the 5 indexes of development quotient between the two groups (P>0.05). At the age of 12 months, the scores of big movement, fine movement, personal society, language and adaptability of infants in contract group were higher than those in non contract group (P<0.05). By the end of the 12th month after birth, there were 2 cases of pneumonia in the signing group, the incidence of pneumonia was 2%; in the non signing group, there were 10 cases of pneumonia, the incidence of pneumonia was 10%, which was higher than that of the signing group. All children with pneumonia were cured after active symptomatic treatment. Conclusion Family doctor contract service can promote the physical and mental development level of infants and young children in the first year after birth, at the same time, it can effectively reduce the risk of pneumonia, which is conducive to the comprehensive and healthy development and growth of infants and young children. It has significant health and sociological value and is worthy of promotion and application.

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.

目的 通过开展QC活动降低PICU患儿补液外渗发生率。减轻患儿不适,强化护士主动服务的意识,提高护理质量,提升管理效果。方法 成立QC小组,按照PDCA循环法,调查PICU患儿补液外渗情况及存在问题,制定对策,组织实施,定期对效果进行评价、总结。结果 外渗发生率由活动前的15.48%下降至活动后的10.44%,严重外渗发生率由活动前的2.38%下降至活动后的0.55%,P<0.05,差异有统计学意义。结论 QC活动有效降低PICU患者补液外渗发生率。

Objective To conduct QC activities to reduce the incidence of fluid extravasation in PICU patients. Relieve discomfort in PICU patients,and strengthen the awareness of nurses active service,improve quality of care and management effectiveness. Methods Establishing QC circle,applying the method of PDCA cycle,investigating fluid extravasation in PICU patients,analyzing the main reasons for fluid extravasation,developing countermeasures,Implementing strategies,summarizing and evaluating the effects regularly.Comparing the incidence of fluid extravasation in PICU patients before and after the activity. Results After the activity,the incidence of fluid extravasation decreased from 15.48% to10.44%,the incidence of severe fluid extravasation decreased from 2.38% to 0.55%,P<0.05,the difference was statistically significant. Conclusion The QC activity effectivelycan reduce the incidence of severe fluid extravasation in PICU patients.

目的 通过对银行从业人员动脉硬化发生率及相关分析,了解该群体的血管状况,并分析引起动脉硬化发生的相关危险因素,为银行从业人员提供切实可行的健康指导方案。方法 以2013年1月—2014年12月在我单位进行体检的银行从业人员实验组1534例,非银行从业人员对照组1479例为研究对象,利用OMRON BP-203RPE III型动脉硬化检测仪测量出bapwv的数据,并对所有人员的体检数据进行分析整理。结果 实验组(银行从业人员)1534例,年龄(35.32±7.14)岁,动脉硬化发生率28.6%;对照组(非银行从业人员)1479例,年龄(37.45±6.33)岁,动脉硬化发生率13.5%;吸烟、体重指数、高血压、糖尿病、睡眠障碍五个方面,P<0.05,差异有统计学意义;银行内部工作性质不同,动脉硬化发生率也不同,P<0.05,差异有统计学意义。讨论 通过健康体检,及时发现银行从业人员动脉硬化发生率高于非银行从业人员,对于控制和延缓银行从业人员心血管事件的发生有重要意义。