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《广州医药》编辑部

广州医药杂志服务号
论著

基于超早期阶梯式协同营养管理在改善重症急性胰腺炎患者喂养中的应用

Application of ultra early stepped collaborative nutrition management in improving feeding for patients with severe acute pancreatitis

:548-552
 
目的 分析超早期阶梯式协同营养管理在改善重症急性胰腺炎患者喂养中的应用效果。方法 抽取2020年1月—2022年1月南阳市中心医院收治的80例重症急性胰腺炎患者为研究对象,随机数字表法分为观察组和参照组,各40例,两组患者均给予常规营养干预措施,其中观察组患者在以上基础上给予超早期阶梯式协同营养管理,对比两组患者的临床症状消退时间、营养状况、喂养相关并发症、喂养不耐受发生率。结果 与参照组相比,观察组患者的临床症状消退时间更短(P<0.05),观察组患者的体质量指数、上臂肌围、肱三头肌皮褶厚度及血清清蛋白水平更高(P<0.05);两组患者的喂养相关并发症主要包括恶心呕吐、误吸、腹泻、感染,观察组患者的喂养相关并发症发生率为7.50%,参照组患者的喂养相关并发症发生率为25.00%,观察组患者的喂养相关并发症发生率低于参照组(P<0.05);观察组患者喂养不耐受发生2例(5.00%),参照组患者喂养不耐受发生9例(22.50%),观察组患者喂养不耐受发生率低于参照组(P<0.05)。结论 重症急性胰腺炎患者实施超早期阶梯式协同营养管理可降低喂养不耐受发生率及喂养相关并发症发生率,改善患者营养水平。
Objective To analyze the application effect of ultra early stepped collaborative nutrition management on improving feeding in patients with severe acute pancreatitis.Methods Eighty patients with severe acute pancreatitis admitted to our hospital from January 2020 to January 2022 were selected as research subjects and randomly divided into observation group and reference group,with 40 cases in each group.Patients in both groups were given conventional nutritional intervention measures,among which patients in the observation group were given super-early stepped collaborative nutritional management on the basis of the above.Clinical symptom resolution time,nutritional status,feeding related complications and feeding intolerance rate were compared between the two groups.Results Compared with the reference group,the time of clinical symptoms resolution in the observation group was shorter(P<0.05),and the body mass index,upper arm muscle circumference,triceps skin fold thickness and serum albumin level in the observation group were higher(P<0.05).The feeding-related complications of the two groups mainly included nausea and vomiting,aspiration,diarrhea and infection.The incidence of feeding-related complications in the observation group was 7.50%,and that in the reference group was 25.00%.The incidence of feeding-related complications in the observation group was lower(P<0.05).There were 2 cases of feeding intolerance in the observation group,the feeding intolerance rate was 5.00%,and 9 cases of feeding intolerance in the reference group,the feeding intolerance rate was 22.50%,the feeding intolerance rate in the observation group was lower(P<0.05).Conclusions Implementing ultra early stepped collaborative nutritional management in patients with severe acute pancreatitis can reduce the incidence of feeding intolerance and feeding related complications,and improve nutritional levels.
论著

脑出血患者家属参与治疗共享决策满意度现状及影响因素分析

Analysis of the satisfaction status and influencing factors of family members' participation in treatment and shared decision-making of patients with cerebral hemorrhage

:535-540
 
目的 了解脑出血患者家属参与治疗共享决策满意度现状及其影响因素,为提升脑出血患者的护理质量和家属体验提供参考。方法 采用横断面研究设计,便利抽取2022年1月—2023年7月许昌中医院收治的脑出血患者及其家属进行问卷调查。结果 共回收问卷178份,全部纳入分析。患者家属参与医疗决策的满意度得分为(48.58±6.34)分,其中维度得分最低的为交流协商。多因素分析结果显示,家属教育程度、家属年龄、家庭总年收入以及患者家属对医疗决策知情程度为患者家属参与医疗决策满意度的影响因素(F=30.872,P<0.001),解释40.3%的变异。结论 脑出血患者家属参与治疗共享决策满意度处于中等水平,患者家属对医疗决策知情程度越高、家属教育程度越高、家属年龄较大以及家庭总年收入越高的脑出血患者家属参与治疗共享决策满意度越高。
论著

振幅整合脑电图联合头颅磁共振预测早产儿矫正12月龄时神经发育的价值

Predictive value of aEEG combined with cranial MRI on neurodevelopment for preterm infants at corrected age of 12 months

:513-518
 
目的 探讨振幅整合脑电图(aEEG)联合头颅磁共振成像(cMRI)对早产儿矫正12月龄时神经发育的预测价值。方法 选取110例早产儿为研究对象,并在矫正12月龄时采用Gesell 发育量表评估发育商(DQ),依据DQ分为Gesell 正常组(DQ≥85,n=83)、Gesell 异常组(DQ<85,n=27)。采集早产儿及母亲临床资料,对比两组出生后72 h内aEEG、矫正胎龄37周时cMRI检查指标差异。结果 两组早产儿及母亲基线资料比较差异无统计学意义(P>0.05)。相较于Gesell 正常组,Gesell 异常组双顶径(BPW)降低[(70.68±5.32)mm vs(66.54±3.69)mm],睡眠-觉醒周期(SWC)不成熟率(20.48% vs 85.19%)、aEEG异常率(30.12% vs 70.37%)、两半球间距(IHD)增高[(2.95±0.83) mm vs(3.56±0.72)mm](P<0.05)。Pearson相关分析结果显示,DQ值与IHD呈负相关,DQ值与BPW呈正相关(r=-0.361、0.598,P<0.05)。二元Logistic回归分析结果显示,BPW增高是Gesell 异常的独立保护因素(P<0.05),IHD增高、SWC不成熟及aEEG异常是Gesell 异常的独立危险因素(P<0.05)。结论 早产儿出生后72 h内aEEG异常、矫正胎龄37周时cMRI异常可能提示矫正12月龄时不良神经发育结局。
Objective To evaluate the predictive value of amplitude-integrated electroencephalogram combined with cranial magnetic resonance on neurodevelopment for preterm infants at corrected age of 12 months.Methods A total of 110 preterm infants were selected as study subjects,and Gesell developmental scale was used to evaluate developmental quotient(DQ)at corrected age of 12 months.According to DQ,they were divided into normal Gesell group(DQ≥85,n=83)and abnormal Gesell group(DQ<85,n=27).Clinical data of preterm infants and their mothers were collected,and the differences of amplitude-integrated electroencephalogram and cranial MRI(cMRI)were compared between two groups.Results There was no significant difference in baseline data between two groups(P>0.05).Compared with the normal Gesell group,the biparirtal width(BPW)in the abnormal Gesell group was decreased(70.68±5.32mm vs 66.54±3.69mm),the immaturity rate of sleep-wake cycle(SWC)(20.48% vs 85.19%),the abnormal rate of aEEG(30.12% vs 70.37%),and(IHD)(2.95±0.83mm vs 3.56±0.72mm)were increased(P<0.05).The results of Pearson correlation analysis showed that DQ was negatively correlated with IHD,and DQ was positively correlated with BPW(r=-0.361、0.598,P<0.05).Binary Logistic regression analysis showed that increased BPW was an independent protective factor for abnormal Gesell(P<0.05),and increased IHD,immature SWC and abnormal aEEG were independent risk factors for abnormal Gesell(P<0.05).Conclusions Abnormal aEEG within 72h after birth and abnormal cMRI at corrected age of 37 weeks may lead to adverse neurodevelopmental outcomes at corrected age of 12 months.
医院管理

南沙区某市属公立医院人力资源管理创新策略研究

Innovative strategies for human resource management in a public hospital in Nansha District

:958-962
 
本文分析了广州市南沙区某公立医院人力资源管理现状,并基于SWOT分析法探索其发展策略。研究发现,该医院的人力资源管理具有成熟的管理体系和一体化管理的实施优势,但也面临财政支持不足和人才及岗位结构不均衡的劣势。政策支持与区域医疗资源扩展为其提供了重要的机遇,但日益增长的行业竞争和人才吸引与保留的难题构成了威胁。医院应优化管理架构,加强顶层设计,改善学科和人才结构,采取一体化与差异化发展策略,以构建高效的人才队伍,提升医院竞争力。本文通过对优势、劣势、机遇和威胁的综合分析,制定了针对性的管理对策,为同类医疗机构提供了参考。
This paper analyzes the current state of human resource management(HRM)in a public hospital in Nansha District,Guangzhou,and explores development strategies based on a SWOT analysis.The study reveals that the hospital’s HRM benefits from a mature management system and the implementation of integrated management.However,it also faces challenges such as insufficient financial support and an imbalance in the structure of personnel and positions.Policy support and the expansion of regional medical resources present significant opportunities,while increasing industry competition and challenges in attracting and retaining talent pose threats.The hospital should optimize its management structure,enhance top-level design,improve the discipline and personnel structure,and adopt integrated and differentiated development strategies to build an efficient talent team and enhance its competitiveness.Through a comprehensive analysis of strengths,weaknesses,opportunities and threats,this paper formulates targeted management strategies,providing valuable references for similar medical institutions.
论著

内托生肌法治疗肉芽肿性乳腺炎溃后期的临床疗效

Clinical efficacy of endotropic muscle-generating therapy in treating late-stage ulcerative granulomatous mastitis

:888-894
 
目的 研究内托生肌法治疗肉芽肿性乳腺炎溃后期的临床疗效。方法 63例符合肉芽肿性乳腺炎溃后期的患者,分为西药组31例和中药组32例。西医药组予常规激素、抗生素等治疗,中药组予内托生肌法,加减组方,两组治疗时间为6个月。比较两组患者的疾病转归、乳房外形评价、临床症状观察评分等指标。结果 中药组6个月治愈率高于西药组,中药组临床治愈18例(56.2%)、痊愈11例(34.4%),相较于西药组临床治愈11例(35.5%)和痊愈9例(29%);治疗后中药组乳房外形评价优于西药组,中药组临床症状评分较低,组间比较差异具有统计学意义。两组患者治疗前后免疫球蛋白IgA、IgG、IgM水平比较差异均未见统计学意义。中药组相较于西药组不良反应更少,患者依从性更高。结论 内托生肌法治疗肉芽肿性乳腺炎溃后期能促进肉芽肿创面愈合,加快肉芽组织新生,改善破溃流脓症状以及在恢复乳房外观方面具有明显的优势。
Objective To study the clinical efficacy of endotropic muscle-generating therapy in treating late-stage ulcerative granulomatous mastitis.Methods Sixty-three eligible patients were included in the western medicine group(31 cases)and the traditional Chinese medicine group(32 cases).The western medicine group received conventional hormones and antibiotics,while the traditional Chinese medicine group received the endotropic muscle-generating method with adjustments.The treatment duration for both groups was six months.Disease regression,breast shape evaluation,clinical symptom observation scores,and other relevant indices of both groups were compared.Results The study found that the six-month cure rate in the traditional Chinese medicine group(56.2% clinically cured,34.4% cured)exceeded that of the western medicine group(35.5% clinically cured,29% cured).Breast appearance evaluation in the traditional Chinese medicine group significantly better that of the western medicine group post-treatment,and clinical symptom scores were lower,demonstrating a statistically significant difference.Before and after treatment,there was no significant difference in the levels of immunoglobulins A,G,and M observed between the two groups.The traditional Chinese medicine group exhibited fewer side effects and higher patient compliance compared to the western medicine group.Conclusions The endotropic muscle-generating method,when employed to treat granulomatous mastitis in the late ulcerative stage,proves effective in promoting granulomatous wound healing,accelerating the generation of new granulation tissue,and improving ulceration and pus flow symptoms.Additionally,it contributes to the restoration of breast appearance.
论著

血清胱抑素C、同型半胱氨酸及尿微量白蛋白在高血压患者肾损害早期评估中的应用价值

The application value of serum cystatin C,homocysteine and urinary microalbumin in early assessment of renal damage in hypertensive patients

:875-880
 
目的 探讨血清胱抑素C(SCys-C)、同型半胱氨酸(Hcy)及尿微量白蛋白(UmAlb)在高血压患者肾损害早期评估中的应用价值。方法 选择2022年9月—2023年9月期间福建中医药大学附属第三人民医院接收的150例高血压患者作为观察组,另选择健康体检者150例为对照组,测定肾小球滤过率(GFR)、SCys-C、Hcy、UmAlb,比较不同血压程度及对照组的各指标水平,比较观察组各指标检测阳性率及诊断符合率,依据GFR值评估肾损害程度,比较不同肾损害程度患者的SCys-C、Hcy、UmAlb水平。结果 高血压2级、高血压3级患者SCys-C、Hcy、UmAlb水平高于高血压1级患者(t=5.255、10.976、21.578,P<0.05;t=7.378、18.012、23.708,P<0.05)及对照组患者(t=8.308、19.675、31.891,P<0.05;t=10.661、31.511、21.578,P<0.05),高血压3级患者高于高血压2级患者(t=2.776、12.725、7.779,P<0.05)。观察组肾损害患者SCys-C、Hcy、UmAlb的阳性率79.41%、73.53%、83.82%高于无肾损害患者的阳性率6.10%、4.88%、6.10%(χ2=83.733、76.040、92.613,P<0.05)。观察组中重度肾损害、轻度肾损害患者的SCys-C、Hcy、UmAlb水平高于无损害患者(t=7.567、24.214、30.836,P<0.05;t=5.783、16.054、25.164,P<0.05),中重度肾损害高于轻度肾损害患者(t=2.685、7.179、9.561,P<0.05)。结论 高血压分级越高患者的SCys-C、Hcy、UmAlb水平越高,各指标联合检测的阳性率高,而且SCys-C、Hcy、UmAlb水平越高,肾损害程度越严重。
Objective To explore the application value of serum cystatin C(SCys-C),homocysteine(Hcy) and urinary microalbumin(UmAlb)in early assessment of renal damage in hypertensive patients.Methods A total of 150 hypertensive patients admitted to the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from September 2022 to September 2023 were selected as the observation group,and 150 healthy individuals were selected as the control group.Glomerular filtration rate(GFR),serum cystatin C(SCys-C),homocysteine(Hcy),and UmAlb were measured,and the levels of various indicators in different blood pressure levels and the control group were compared.The positive rate and diagnostic accuracy of each indicator in the observation group were compared,and the degree of renal damage was evaluated based on GFR values.The levels of SCys-C,Hcy and UmAlb in patients with different degrees of renal damage were compared.Results The levels of SCys-C,Hcy and UmAlb in patients with grade 2 and grade 3 hypertension were significantly higher than those in patients with grade 1 hypertension(t=5.255,10.976,21.578,P<0.05;t=7.378,18.012,23.708,P<0.05),as well as in the control group(t=8.308,19.675,31.891,P<0.05;t=10.661,31.511,21.578,P<0.05),patients with grade 3 hypertension were significantly higher than those with grade 2 hypertension(t=2.776,12.725,7.779,P<0.05).The positive rates of SCys-C,Hcy and UmAlb in patients with renal injury in the observation group were 79.41%,73.53% and 83.82%,which were significantly higher than the positive rates of 6.10%,4.88% and 6.10% in patients without renal injury(χ2=83.733,76.040,92.613,P<0.05).The levels of SCys-C,Hcy and UmAlb in patients with severe and mild kidney damage in the observation group were significantly higher than those in patients without damage(t=7.567,24.214,30.836,P<0.05;t=5.783,16.054,25.164,P<0.05),patients with moderate to severe kidney damage were significantly higher than those with mild kidney damage(t=2.685,7.179,9.561,P<0.05).Conclusions The higher the grading of hypertension,the higher the levels of SCys-C,Hcy and UmAlb in patients,and the higher the positive rate of combined detection of various indicators.Moreover,the higher the levels of SCys-C,Hcy and UmAlb,the more severe the renal damage.
论著

同轴微导管PVA栓塞介入治疗动脉性下消化道出血的研究

Study of coaxial microcatheter PVA embolization in the treatment of arterial lower gastrointestinal hemorrhage

:869-874
 
目的 研究同轴微导管聚乙烯醇颗粒(PVA)栓塞治疗动脉性下消化道出血患者的应用效果。方法 本研究为前瞻性研究,选择河南科技大学第一附属医院2022年1月—2023年6月收治的118例动脉性下消化道出血患者为研究对象,以计算机随机分组法将其分为常规组和试验组,各59例。两组均行数字减影血管造影检查明确出血情况,常规组予以内镜下注射止血治疗,试验组经同轴微导管PVA栓塞进行止血治疗,比较两组患者的治疗效果及预后情况。结果 在不同治疗方案下,试验组的技术成功率、临床成功率分别为89.83%(53/59)、84.75%(50/59),均高于常规组[71.19%(42/59)、64.41%(38/59)](χ2=11.071、10.911,P<0.05);试验组的止血时间、凝血酶原时间(PT)、凝血酶时间(TT)分别为(50.25±10.37)min、(10.25±2.31)s、(16.33±4.47)s,均低于常规组[(55.36±10.72)min、(12.44±3.61)s、(19.35±4.23)s](t=2.632、3.925、3.769,P<0.05);试验组治疗后的动脉搏动指数(PI)、阻力指数(RI)分别为(1.12±0.33)(0.51±0.21),均低于常规组[(1.65±0.41)(0.73±0.22)](t=7.735、5.556,P<0.05);试验组治疗7、14、30 d后的再出血率分别为5.08%(3/59)、8.47%(5/59)、10.17%(6/59),均低于常规组[20.34%(12/59)、25.42%(15/59)、28.81%(17/59)](χ2=10.495、10.207、11.071,P<0.05);试验组的并发症发生率8.47%(5/59)低于常规组22.03%(13/59),差异均具有统计学意义(χ2=7.113,P<0.05)。结论 与常规内镜下止血相比,同轴微导管PVA栓塞可显著提升动脉性下消化道出血患者的止血成功率,对缩短患者止血时间、促进凝血系统恢复、降低再出血风险及相关并发症发生风险均有积极意义。
Objective To study the effect of coaxial microcatheter PVA embolization in the treatment of patients with arterial lower gastrointestinal bleeding.Methods This study is a prospective study,118 patients with arterial lower gastrointestinal bleeding admitted between January 2022 and June 2023 were selected as the study subjects.They were randomly divided into a conventional group(59 cases)and an experimental group(59 cases)using computer randomization.Both groups underwent digital subtraction angiography examination to determine the bleeding situation.The conventional group received conventional endoscopic hemostasis treatment,while the experimental group received coaxial microcatheter PVA embolization for hemostasis treatment.The treatment efficacy and prognosis were compared between two groups.Results Under different treatment plans,the technical success rate and clinical success rate of the experimental group were 89.83%(53/59)and 84.75%(50/59),respectively,which were higher than those of the conventional group [71.19%(42/59)and 64.41%(38/59)](χ2=11.071、10.911,P<0.05).The hemostatic time,PT,and TT of the experimental group were(50.25±10.37)min,(10.25±2.31)seconds,and(16.33±4.47)seconds,respectively,which were shorter than those of the conventional group [(55.36±10.72)min,(12.44±3.61)seconds,and(19.35±4.23)seconds](t=2.632、3.925、3.769,P<0.05).The arterial PI and RI of the experimental group after treatment were(1.12±0.33) and(0.51±0.21),lower than those of the conventional group [(1.65±0.41)and(0.73±0.22)](t=7.735、5.556,P<0.05).The rebleeding rates of the experimental group after 7 days,14 days and 30 days of treatment were 5.08%(3/59),8.47%(5/59) and 10.17%(6/59),respectively,which were lower than those of the conventional group [20.34%(12/59),25.42%(15/59) and 28.81%(17/59)](χ2=10.495,10.207,11.071,P<0.05).The incidence of complications in the experimental group was 8.47%(5/59),which was lower than that in the conventional group 22.03%(13/59)(χ2=7.113,P<0.05).Conclusions Compared with conventional endoscopic hemostasis,coaxial microcatheter PVA embolization can significantly improve the success rate of hemostasis in patients with arterial lower gastrointestinal bleeding,shorten the hemostasis time,promote coagulation system recovery,reduce the risk of rebleeding and related complications,with a positive significance.
论著

放大内镜在ESD治疗食管早期癌及癌前病变中的作用

The role of magnifying endoscopy in ESD for early esophageal cancer and precancerous lesions

:137-140
 
目的 研究与分析放大内镜在内镜下黏膜剥离术(ESD)治疗食管早期癌及癌前病变中的作用。方法 选取2020年1月—2022年7月我院收治的明确诊断为食管癌的患者为观察对象,研究者为其一级亲属40岁以上经普通内镜发现食管异常病灶同时行放大内镜检查者。据疑病处食管黏膜上皮乳头内毛细血管袢(IPCL)变化,判断病变性质估计侵犯深度。疑早期食管癌及癌前病变者行ESD治疗,疑进展期食管癌者行外科手术治疗,送整体标本病理检查。结果 食管癌一级亲属40岁以上患者经普通内镜发现食管异常病灶同时行放大内镜检查者共128例,其中行ESD和外科手术取得整体病理标本102例。对比放大胃镜术前判断和术后整体病理标本,判断性质方面放大内镜对食管早期病变诊断的总体准确率为87.3%,诊断食管早期鳞癌的灵敏度为97.8%,特异度为15.4%,阳性预测值88.8%,阴性预测值50%。判断浸润层次方面,放大内镜对食管早期鳞癌深度诊断的总体准确率为69%,B1型血管对浸润深度正确诊断率为90.6%,灵敏度为70.6%,B2型血管对浸润深度正确诊断为32.2%,灵敏度为76.9%,B3型血管对浸润深度正确诊断为66.7%,灵敏度为33.3%。结论 放大内镜在ESD下治疗食管早期鳞癌及癌前病变患者,可对食管病变性质准确判断,提升病变检出率,实践价值较高。
Objective To investigate and analyze the role of magnifying endoscopy in endoscopic submucosal dissection(ESD)in the treatment of early esophageal cancer and precancerous lesions.Methods Esophageal cancer patients in our hospital from January 2020 to July 2022 were selected as the observation objects,the investigator was a first-degree relative over 40 years old who found abnormal esophageal lesions through ordinary endoscopy,and underwent magnifying endoscopy,according to suspected esophageal mucosal epithelial nipple capillary loop(IPCL)changes,defined the nature of the lesion to estimate the invasion depth.Patients with suspected early esophageal cancer and precancerous lesions were given ESD treatment,and those with suspected progressive esophageal cancer underwent surgical treatment,and were sent to the whole specimen for pathological examination.Results A total of 128 patients with first-degree relatives of esophageal cancer over 40 years old were found to have simultaneous enlarged endoscopy simultaneously through common endoscopy,among which 102 patients had obtained overall pathological specimens by ESD and surgery.Comparing the preoperative diagnosis of magnifying gastroscopy and the postoperative overall pathological specimens,the overall accuracy of magnifying endoscopy for the diagnosis of early esophageal lesions was 87.3%,the sensitivity of detecting early esophageal squamous cell carcinoma was 97.8%,specificity was 15.4%,the positive predictive value was 88.8%,and the negative predictive value was 50%.In terms of invasion level,the overall accuracy of magnifying endoscopy for the depth diagnosis of early esophageal squamous cell carcinoma was 69%,90.6% accuracy and 70.6% sensitivity of B1 vessels,32.2% and 76.9% of B2 vessels,66.7% and 33.3% of B3 vessels.Conclusions The magnifying endoscopic treatment of patients with early esophageal cancer and precancerous lesions under ESD can accurately diagnosis the nature of esophageal lesions,improve the detection rate of lesions,and has high practical value.
论著

耳内镜下超薄耳屏软骨-软骨膜修补鼓膜大穿孔的应用研究

Clinical investigation of endoscopic ultrathin tragus cartilage-perichondrium myringoplasty for treatment of large tympanic membrane perforations

:284-288
 
目的 探讨耳内镜下超薄耳屏软骨-软骨膜修补鼓膜大穿孔的效果。方法 回顾性分析31例应用超薄耳屏软骨-软骨膜行耳内镜下夹层法鼓膜修补术的患者资料,随访6个月,分析术后鼓膜愈合率、听力恢复情况。结果 30例鼓膜愈合,成功率96.8%,无移植物外移、内陷、钝角愈合;术前平均气导听阈为(38.3±3.3)dB HL,骨气导差为(23.5±3.1)dB HL,术后平均气导听阈为(22.3±1.6)dB HL,骨气导差为(6.3±2.5)dB HL,听力较术前提高(P<0.001)。结论 超薄耳屏软骨-软骨膜在耳内镜下鼓膜大穿孔修补术中效果较好,并发症少,是可靠的修复材料,值得临床推广应用。
Objective To investigate the clinical efficacy of endoscopic ultrathin tragus cartilage-perichondrium as graft material for treatment of large tympanic membrane perforations. Methods A total of 31 cases(31 ears)which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were performed endoscopic myringoplasty with ultrathin tragus cartilage-perichondrium by sandwich technique.The pure tone threshold average(PTA)of speech frequency and the air-bone gap were assessed at 6 month safter surgery. Results Successful closure without reperforation was obtained in 30 of 31 patients(96.8%).There was no graft lateralization,anterior blunting .Average postoperative air conduction and bone-air conduction gap were(22.3±1.6)dB HL and(6.3±2.5)dBHL compared with(38.3±3.3)dB HL and(23.5±3.1)dB HL preoperatively(P<0.001). Conclusions The ultrathin tragus cartilage-perichondrium is liable repair material for large tympanic membrane perforation with excellent graft take and significant improvement of hearing,which is worthy of clinical promotion.
护理研究

系统化护理流程干预对脑出血患者急救效果及预后的影响

The impact of systematic nursing process intervention on the first aid effect and prognosis of patients with cerebral hemorrhage

:437-442
 
目的 探讨系统化护理流程干预对脑出血患者急救效果及预后的影响。方法 采用回顾性分析的方法,选取2022年2月—2023年2月新乡医学院第三附属医院急诊收治的210例脑出血患者,将2022年2月—2022年8月采取常规护理干预的105例患者作为常规组,将2022年9月—2023年2月采取系统化护理流程干预的105例患者作为研究组。对比两组患者抢救效率、急救效果、并发症发生率、预后水平、护理满意度情况。结果 研究组患者抢救总时间、会诊至确诊、分诊至会诊、接诊至分诊以及出诊反应时间短于常规组(P<0.05);研究组急救总有效率高于常规组,并发症发生率低于常规组(P<0.05);出院1个月、3个月后,两组患者神经功能缺损量表(NIHSS)评分均降低,简易智能状态检查量表(MMSE)评分升高,研究组变化幅度更大(P<0.05);研究组患者护理满意度高于常规组(P<0.05)。结论 针对脑出血患者在急救过程中采取系统化护理流程干预能够提升患者的抢救效率和急救效果,并发症发生率低,改善患者的神经功能缺损情况,提升预后水平,且患者满意度较高。
Objective To explore the impact of systematic nursing process intervention on the emergency response and prognosis of patients with cerebral hemorrhage.Methods By retrospective analysis,210 patients with cerebral hemorrhage admitted to the emergency department of the Third Affiliated Hospital of Xinxiang Medical College from February 2022 to February 2023,105 patients with routine nursing intervention from February 2022 to August 2022 were selected as the routine group,and 105 patients with systematic nursing process intervention from September 2022 to February 2023 were selected as the study group.The rescue efficiency,first aid effect,complication rate,prognosis levels and nursing satisfaction of the two groups were compared.Results The total rescue time,consultation to diagnosis,triage to consultation,reception to triage and the response time to visit in the study group were significantly lower(P<0.05).The total emergency response rate of the study group was higher than that of the conventional group,and the incidence of complications was significantly lower(P<0.05).One month and 3 months after discharge,NIHSS score decreased in both groups,MMSE score increased,and the change range was greater in the study group(P<0.05).The nursing satisfaction of the study group was significantly higher(P<0.05).Conclusions For patients with cerebral hemorrhage,systematic nursing process intervention in the first aid process can improve the rescue efficiency and first aid effect of patients,reduce the incidence of complications,improve the neurological function defect of patients,improve the prognosis level,and the patient satisfaction is higher.
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