目的 探讨分阶段延续护理对改善留置输尿管支架管老年农民患者并发症的效果。方法 按时间顺序将106例患者分为对照组52例和观察组54例,对照组给予常规电话随访,观察组实施三个阶段的延续护理。30天后测评患者并发症持续时间和发生率、自我管理能力。结果 观察组腰痛、血尿、膀胱刺激征持续时间缩短,尿路感染、支架管移位和滞留的发生率下降,自我管理能力各维度评分升高,与对照组比较差异均有统计学意义(P＜0.01)。结论 分阶段延续护理能提高留置输尿管支架管老年农民患者的自我管理能力,增强依从性,减少并发症的发生,促进早日康复。

Objective To investigate the effect of staged continuous nursing on complications in elderly agricultural-workerpatients with indwelling ureteral stent. Methods According to the chronological order, 106 patients were divided into control group (52 cases) and observation group (54 cases). The control group received routine telephone follow-up, and the observation group received three stages of continuous care. 30 days later, the complications' duration, incidence and self-management ability were assessed. Results In the observation group, pain, hematuria and bladder irritation were obviously shorten. Urinary tract infection and the incidence of stent displacement and retention were decreased. Scores in all dimensions of self management ability were increased. Comparing with the control group, it had significant difference (P<0.01). Conclusion The phased continuous nursing may improve the self-management ability of the elderly agricultural-worker with indwelling ureteral stents, strengthen the compliance, reduce the occurrence of complications and promote early rehabilitation.

目的 探究全科诊疗过程中健康管理流程再造的效果。方法 选取深圳市龙岗区第二人民医院(东方半岛社区健康服务中心)的病例,即2015年1月—2015年12月的病例作为对照组(使用旧流程);2016年6月—2017年5月的病例作为观察组(使用新流程),对2组相关数据进行回顾性分析整理,观察2组全科诊疗的健康管理情况并实施比较。结果 观察组全科诊疗人次、妇女儿童保健人数、老年保健人数、新增慢病管理人数、家庭医生签约户数、高危人群早期干预人数等同比增长率均高于对照组,2组比较差异有统计学意义(P<0.05)。结论 全科诊疗过程中健康管理流程再造,能够为更多的居民提供优质健康服务,故对于提高全民健康水平具有重要意义,因而值得临床借鉴应用。

Objective To explore the effect of health management process reengineering on the process of general practice.Methods The cases of Shenzhen Longgang District Second People's Hospital from January 2015 to December 2015 were selected as the control group (using the old process), and that from June 2016 to May 2017 were selected as the observation group (using the new process). The clinical data in the two groups were retrospectively analyzed, and the health management of the two groups of general medical was observed and compared.Results The growth rates in the observation group, such as visits of outpatient service, the numbers of women and children health care, the numbers of elderly health care, the numbers of new chronic disease management, the numbers of family doctors signed and the numbers of early intervention of high-risk groups, were higher than that in the control group (P<0.05).Conclusion The health management process reengineering in the process of general practice may provide better health services to more residents, and it is important for improving the health of all people. It is well worth to clinical reference and application.

目的 探讨不同分化程度前列腺癌患者的直肠超声图像特征,为前列腺癌分化程度的诊断提供依据。方法 纳入我院收治的前列腺癌患者120例,均接受直肠超声检查,根据Gleason评分评估分化程度分成低分化组(n=41)、中分化组(n=39)与高分化组(n=40)。分析不同分化程度患者的结节大小、血流分级、回声、边界是否清晰以及包膜完整性,并对血流频谱进行观察。结果 低分化组的结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、边界欠清晰、包膜欠完整、高回声占比高于高分化组,且低分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于中分化组,中分化组结节≥10 mm、肿瘤组织周围血流分布Ⅱ~Ⅲ级、高回声占比高于低分化组,差异有统计学意义(P<0.05)。结论 不同分化程度前列腺癌患者的直肠超声表现存在差异,随着分化程度越低,肿瘤边界清晰度、包膜完整性越差,血流越丰富。

目的 探讨高血压性脑出血在不同时点给药丹参酮ⅡA磺酸钠的疗效分析及对神经保护作用。方法 选取我院2014年10月—2016年10月期间收治的66例高血压性脑出血患者作为研究对象,按照随机数字表的方法分为观察组(n=33)和对照组(n=33),对照组患者于入院后第10天采用丹参酮ⅡA磺酸钠进行治疗,观察组则于入院后第3天采用丹参酮ⅡA磺酸钠进行治疗,分别对2组患者的临床疗效、不良反应、治疗前后的神经功能以及随访一年的脑卒中影响量表(SIS)进行客观比较。结果 经比较,观察组患者的临床总有效率为90.90%,对照组的临床总有效率为69.70%,2组比较,差异有统计学意义(P<0.05);观察组患者的不良反应稍低于对照组,但2组比较差异无统计学意义(P>0.05);此外,观察组患者治疗后的神经功能评分优于对照组和治疗前,差异有统计学意义(P<0.05);在随访一年的时间里发现,观察组患者的SIS量表亦更优于对照组(P<0.05)。结论 早期采用药丹参酮ⅡA磺酸钠治疗高血压性脑出血的临床疗效显著,不良反应相对较小,且在一定程度上发挥了保护患者神经功能的作用,值得推广。

Objective: To investigate the effect of tanshinone II A sulfonate treatment on hypertensive cerebral hemorrhage at different time and the neuroprotective effect. Methods: In our hospital from October 2014 to October 2016 66 cases of hypertensive cerebral hemorrhage patients were enrolled as the research object, according to the random number table method divided into observation group (n=33) and control group (n=33), patients in the control group on the tenth day after admission of sodium tanshinone A sulfonate treatment, The observation group was treated with tanshinone A sodium sulfonate on the third day after admission. The clinical efficacy, adverse reactions, neurological function before and after treatment, and Stroke Scale (SIS) were compared between the two groups. Results: by comparison, the observation group of patients with clinical total efficiency 90.90%, clinical control group in the total efficiency 69.70%, compared with significant difference (P<0.05); to observe the adverse reaction of patients was slightly lower than that of control group, but the difference between the two groups was not statistically significant (P>0.05); in addition, the patients in the observation group the neurological score was significantly better than the control group and before treatment, the difference was significant (P<0.05); Conclusion: the early treatment of sodium tanshinone II A sulfonate in the treatment of hypertensive intracerebral hemorrhage has a significant clinical effect, a relatively small adverse reaction, and to a certain extent, it plays a protective role in patients with neurological function, and is worthy of promotion.

目的 以临床病例为研究对象,探讨年龄与性别对鼻咽癌自我病情延误的影响,寻找鼻咽癌科普宣教的重点靶标人群。方法 收集2015年4月—2015年12月广州医科大学附属肿瘤医院放疗科鼻咽癌病区收治的经活检病理确诊初治鼻咽癌患者62例(年龄28～77岁,中位年龄49岁),记录患者主诉症征出现至病理确诊鼻咽癌其相关症状的持续时间,采用t检验和Pearson相关分析探讨性别及年龄对鼻咽癌确诊前相关症征持续时间的影响。结果 62例患者确诊前均自我发现鼻咽癌相关症征,其中43例(69.4%)发现鼻咽原发灶相关症状,35例(56.5%)发现颈部淋巴肿大症状。Pearson相关分析显示,鼻咽癌确诊前颈部淋巴结肿大持续时间与年龄呈正相关(P＜0.05);t检验结果显示,男性患者鼻咽癌确诊前症状持续时间大于女性患者(P＜0.05)。结论 年龄较大和男性人群鼻咽癌自我病情延误较为严重,应该作为包括临床症状在内的鼻咽癌科普宣教的重点人群。

目的 对比纤维支气管镜肺灌洗治疗和常规治疗重症肺部感染患者的临床疗效。方法 将2015年5月—2017年4月间在我院接受治疗的92例重症肺部感染患者作为研究对象,按照随机数字表分为实验组(n=46)和对照组(n=46),其中对照组采用常规对症治疗,实验组加以实施纤维支气管镜肺灌洗治,治疗后,纤支镜气道灌洗检测两组患者的血气分析指标变化,采用ELISA测定血清炎症因子含量,及放射免疫法测定血清应激激素含量。结果 经比较,实验组患者治疗后的PaO₂、SaO₂、PaCO₂高于对照组患者(P<0.05);实验组患者的血清炎症因子hs-CRP、IL-6、IL-8水平低于对照组患者(P<0.05);此外,实验组患者的Ang-II、NE、Cor含量低于对照组患者(P<0.05)。结论 纤支镜气道灌洗可有助于改善重症肺部感染患者的肺通气功能,降低全身炎症应激程度,促进疾病康复。

Objective To compare the clinical efficacy of bronchoalveolar lavage and conventional treatment in patients with severe pulmonary infection. Methods 92 patients with severe pulmonary infection treated in our hospital from May 2015 to April 2017 were selected as research objects. They were randomly divided into experimental group (n=46) and control group (n=46). The control group was treated with conventional symptomatic treatment, The experimental group implemented bronchoscopy lung lavage treatment. After treatment, blood gas bronchoscopic airway lavage in two groups were detected with analysis indexes. Serum inflammatory factors were determined by ELISA, and the serum levels of stress hormones were determined by radioimmunoassay. Results After the treatment, the PaO₂, SaO₂ and PaCO₂ in the experimental group were higher than those in the controlgroup(P<0.05). The levels of serum inflammatory factors hs-CRP, IL-6、IL-8 in the experimental group were lower than those in the control group (P<0.05); in addition, the levels of Ang-II, NE and Cor in the experimental group were lower than those in the control group(P<0.05). Conclusion Bronchoscopy airway lavage may help to improve the pulmonary ventilation function of patients with severe pulmonary infection, reduce the degree of systemic inflammatory stress, and promote disease recovery.

目的 对比分析甲氨蝶呤(methorexate,MTX)联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术(uterine artery embolization,UAE)联合清宫治疗停经7周内Ⅱ-Ⅲ型剖宫产瘢痕妊娠(ceasarean scarpregnancy,CSP)的效果。方法 回顾性分析我院自2016年1月—2017年12月收治的停经7周内Ⅱ-Ⅲ型CSP患者的临床资料,按随机、平衡、对照原则分别筛选69例MTX+清宫治疗患者作为A组,68例MTX+UAE+清宫治疗患者作为B组,对比两组治疗成功率、一般治疗情况及术后并发症发生率,并统计两组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间。结果 两组术后恢复良好,术中、术后均未发生不可控制宫腔出血现象,胎囊组织均全部清出,A组术中出血量、子宫切除发生率、发热、术后盆腹腔疼痛及肝功能损伤发生率均低于B组,术后第1天血β-hCG下降超过50%及治疗成功率、住院时间均高于B组,且该组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间亦较B组短(P﹤0.05)。结论 于停经7周内Ⅱ-Ⅲ型CSP患者而言,行MTX+清宫治疗或可在不增加出血风险基础上避免UAE相关并发症及副反应。

Objective To comparatively analyze the effects of methotrexate (MTX) combined with uterine curettage under ultrasonic monitoring and MTX, uterine artery embolization (UAE) combined with uterine curettage in the treatment of cesarean scar pregnancy (CSP) within 7 weeks of menopause. Methods The clinical data of patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause who were admitted to the hospital from January 2016 to December 2017 were analyzed retrospectively. Another 69 cases treated with MTX combined with uterine curettage were selected as group A and 68 cases treated with MTX+UAE+uterine curettage were selected as group B. The success rate of treatment, general situation of treatment and the incidence of adverse reactions were compared between the two groups. The time of menstrual recovery, the recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions were statistically analyzed. Results The two groups recovered well after operation, and there was no uncontrollable uterine bleeding. All fetal sac tissues were cleared. The intraoperative blood loss, hysterectomy rate, incidence rates of fever, postoperative abdominopelvic pain and liver function injury in group A were less/lower than those in group B, The rate of blood β-hCG decreasing more than 50% on the 1st day after operation, the success rate of treatment and hospitalization time of groups A were higher/longer than those of group B, while the time of menstrual recovery, recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions was shorter than that of group B(P<0.05). Conclusion MTX combined with uterine curettage may avoid complications and side effects of UAE in patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause, without increasing the risk of bleeding.

目的 探讨拔岗晋级结合激励机制在护士岗位管理的实践和体会。方法 在护士岗位管理中运用拔岗晋级结合激励机制,收集实施岗位管理前后1年护士满意度、患者满意度、护士职业获益感、护士职业投入、离职率资料,进行统计学分析。结果 实施后护士满意度、患者满意度、护士职业获益感、护士职业投入较实施前提高(P<0.05),离职率下降(P<0.05),差异有统计学意义。结论 建立在拔岗晋级及激励机制上的护士岗位管理能提高护士满意度,降低护士离职率,稳定护士队伍,能够提高护士职业获益感、护士职业投入,从而提高护士工作的主观能动性和工作积极性,为高质量护理服务和优质护理服务长效机制的建立奠定了基础,促进优质护理服务的可持续发展,提高护理管理效能。

Objective To explore the application and experience of job promotion combing with excitation mechanism in nurses position management. Methods We used job promotion combing with excitation mechanism in nurses position management to compare the satisfaction rate, perceived career benefit, work engagement and separation rate of nurses. Results After the application, the satisfaction rate, perceived career benefit and work engagement of nurses were increased, while separation rate of nurses was decreased(P<0.05), the difference has statistical significance. Conclusion The application may increase the satisfaction rate, perceived career benefit and work engagement of nurses, and decrease the separation rate of nurses, elevate the subjective initiative and work enthusiasm. Nursing quality is improved continuously. The management efficacy is promoted.

目的 探讨肺结核合并肺癌患者的CT影像特征,为临床疾病诊断提供参考依据。方法 选取2015年—2018年我院收治的肺结核合并肺癌患者50例作为观察组,另选取同期于我院治疗的单纯肺结核患者50例为对照组。观察两组患者临床症状及CT影像表现并作出对比分析。结果 两组患者临床症状及体征相比,差异无统计学意义(P>0.05);观察组患者分叶征、毛刺状结节比例高于对照组患者,差异有统计学意义(P<0.01),观察组患者实质内空洞比例低于对照组患者,差异有统计学意义(P＜0.01),两组患者肿物及条索影发生比例相比差异无统计学意义(P>0.05)。结论 肺结核合并肺癌患者的CT影像学特征主要在分叶征、毛刺状结节和空洞症,临床应根据这些特征并结合其他检查进行定性诊断。

Objective To investigate the CT images of patients with pulmonary tuberculosis complicated with lung cancer and provide reference for the diagnose. Methods 50 cases of pulmonary tuberculosis and lung cancer treated in our hospital in 2015~2018 in January were selected as observation group, and 50 cases of simple pulmonary tuberculosis treated in our hospital for the same period were selected as control group. The clinical symptoms and CT imaging findings of the two groups were observed and compared. Results There was no significant difference in clinical symptoms and signs between the two groups (P>0.05), and the proportion of lobular sign and burr nodular nodules in the observation group was higher than that of the control group (P<0.01), and the proportion of parenchymal cavities in the observation group was lower than that of the control group (P<0.01). There was no significant difference between the two groups in the incidence of tumor and streak shadow (P>0.05). Conclusion The CT imaging features of patients with pulmonary tuberculosis and lung cancer are mainly lobular sign, burr like nodules and cavities, which should be qualitatively diagnosed according to these features combined with other tests.

目的 探讨科学的出院后营养管理对肠道术后新生儿体格追赶的效果,分析影响体格追赶的相关因素。方法 通过营养门诊对出院术后婴儿及社区婴儿进行个体化营养喂养指导和营养咨询,比较两组每月体质量、身长及头围,并随访至生后9月龄。两组生后半年生长趋势行重复测量检验。结果 第1月龄时,手术组患儿体质量、身长、头围均落后于对照组婴儿(P<0.001, P=0.004, P=0.008),第2月龄时,手术组患儿体质量、头围仍落后于对照组(P=0.003,P=0.031),第4月龄时,手术组体质量低于对照组(P=0.012),第5～9月龄,两组体格指标均无明显差异。生后半年内两组的生长趋势差异无统计学意义。前半年身长的增长与出生身长、父母文化以及父亲的不良习惯存在负相关关系,头围的增长与住院天数呈明显负相关关系、与出生以及首诊时的体格状况呈正相关关系。结论 合理喂养对新生儿肠道术后体格追赶有利,帮助其接近正常生长曲线。再次手术可能是导致体质量增长下降的主要因素,但未明显影响身长、头围的正常增长。出生时和就诊时的体格状况、父母教育程度和不良习惯以及住院天数均是影响体格追赶的相关因素。

Objective To investigate the effect of scientific nutrition management after discharge on neonatal physical catch-up after intestinal operation, and to analyze the related factors affecting physical catch-up. Methods Individualized nutritional feeding instruction and nutrition consultation were performed on infants and community infants after discharge from hospital through nutrition clinic. The monthly body weight, body length and head circumference were compared between the two groups, and followed up to 9 months old. The growth trend of the two groups in half a year after birth was tested by repeated measurement. Results At the first month of age, the body weight, body length and head circumference of the patients in the operation group were lower than those in the control group (P<0.001, P=0.004, P=0.008). At the second month, the body weight and head circumference of the operation group were still behind those of the control group (P=0.003, P=0.031), and at the fourth month of age, the weight and head circumference of the patients in the operation group were still lower than those in the control group. The body weight of the operation group was lower than that of the control group (P=0.012), and there was no diffence in the physical indexes between the two groups at the age of 5~9 months. There was no statistical significance in growth trend between the two groups within half a year after birth. The growth of body length in the first half of the year had a negative correlation with the length of birth, parents' culture and father's bad habits. The growth of head circumference had a negative correlation with the length of stay in hospital, and had a positive correlation with the physical condition at birth and at first visit. Conclusion Reasonable feeding is beneficial to the physical catch-up of the newborn after intestinal operation and helps them approach the normal growth curve. Reoperation may be the main cause of weight loss, but it does not affect the normal growth of body length and head circumference. The physical condition at birth and medical visit, parents' education level, bad habit and hospitalization days were all related factors of physical catch-up.