Objective To explore the clinical effect of refined nursing in patients undergoing indocyanine green labeled full fluorescence laparoscopic radical distal gastrectomy for gastric cancer.Methods A total of 136 patients with gastric cancer admitted to the Affiliated Union Hospital of Fujian Medical University from January 2020 to October 2020 were selected.All patients underwent indocyanine green labeled total fluorescence laparoscopic radical distal gastrectomy.They were randomly divided into a control group and an observation group with 68 cases each.The control group received routine care,while the observation group received refined care on the basis of routine care.The perioperative indicators and stress reactions of the two groups were compared.Results The observation group had significantly shorter surgical procedures,first time of ambulation,ventilation time,and defecation time compared to the control group,and had significantly lower intraoperative fluid replacement and blood loss compared to the control group(P<0.05).The postoperative levels of diastolic blood pressure,systolic blood pressure,and heart rate in the observation group were significantly lower than those in the control group(P<0.05).Conclusion The clinical effect of refined nursing applied in indocyanine green labeled full fluorescence laparoscopic radical distal gastrectomy for gastric cancer is significant,which helps to improve perioperative indicators and reduce stress reactions in patients.
加强医保基金使用常态化监管,对保障医保基金安全运行、提高基金使用效率、规范医疗服务行为、减轻群众看病就医负担具有重要意义.医保费用智能审核系统的应用为医保基金监管提供了有力支撑.本文以辽宁省医保费用智能审核系统应用情况为例,分析应用过程中的问题及成效,最后从系统优化、队伍建设等方面,提出医保费用智能审核系统应用的优化对策,不断提升智能监控效能,守护医保基金安全,为医保同仁提供有效参考.
Objective To explore the impact of prospective management in disinfection supply centers on hospital infection rates.Methods A total of 230 nursing items,6 staff members,and 80 patients from the disinfection and supply center of Longyan Second Hospital from January 1,2021 to December 31,2022 were selected as the research subjects.Among them,115 nursing items,6 staff members,and 40 patients from the disinfection and supply center from January 1,2021 to December 31,2021 were selected as the control group,and the other 115 nursing items,6 staff members,and 40 patients from the disinfection and supply center from January 1,2022 to December 31,2022 were selected as the the observation group.The control group implemented general management,while the observation group implemented prospective management.Evaluate the qualified management of two groups of items,the quality of staff work,and the occurrence of patient errors,complaints,and hospital infections.Results The qualified rates of item management,washing,sterilization,packaging,and distribution in the observation group were significantly higher than those in the control group(P<0.05).The occurrence of errors,complaints,and hospital infections in the observation group were significantly better than those in the control groups(P<0.05).The observation group's staff had significantly higher scores in prevention awareness,service awareness,recycling efficiency,and supply quality than the control group(P<0.05).Conclusion The application of prospective management in disinfection and supply centers has a good effect,which can effectively improve the work quality of disinfection and supply center staff,reduce the incidence of errors,complaints,and hospital infection rates,and is worth promoting and applying.
目的 探讨老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者病耻感和社会支持的相关性研究.方法 采用便利抽样法,对2021年11月—2022年3月厦门大学附属中山医院就诊的160例老年T2DM患者进行问卷调查.调查工具为一般资料表和中文版自我病耻感量表(China self stigma scale,C-SSS)、社会支持量表.结果 160名调查对象病耻感总分为(61.98±16.99)分,社会支持水平总分为(41.17±8.19)分,病耻感水平与社会支持呈负相关关系(r=-0.844,P＜0.01);多元线性回归分析显示,老年T2DM患者的社会支持、性别、婚姻状况等是病耻感的主要影响因素,其中社会支持影响最大.结论 通过此次调查发现,老年T2DM患者的病耻感处于中等偏高水平,患者的社会支持处于中等水平,病耻感水平和社会支持呈负相关关系.糖尿病的治疗需要先解决病耻感问题,医护工作者应在病耻感动态的形成过程中及时评估,尽早发现,对易产生高病耻感水平的患者采取针对性的干预措施,帮助患者拓展获得社会支持资源,提高社会支持利用度,从而降低患者病耻感水平,提高治疗依从性和自我管理能力,改善临床预后.
Objective To explore the effect of lead-free pacemakers in the treatment of middle-aged and elderly patients with bradyarrhythmia.Methods A total of 94 middle-aged and elderly patients with bradyarrhythmia who underwent lead-free pacemaker implantation treatment at Meizhou People's Hospital from May 2020 to May 2022 were selected.They were divided into an elderly group(≥60 years old)of 80 patients and a young and middle-aged group(<60 years old)of 14 patients.All patients underwent Micra lead-free pacemaker implantation treatment,and surgical related indicators,changes in pacemaker electrical parameters,and complications were compared between the two groups.Results There was no significant difference in implantation success rate(both 100.00%),surgical time,X-ray projection time,and Micra release frequency between the two groups(P>0.05).During the one-year follow-up period after surgery,the pacemaker threshold,perception,and impedance of the two groups remained within the normal range,with no significant difference(P>0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Micra lead-free pacemaker implantation is safe and effective in the treatment of middle-aged and elderly patients with bradyarrhythmia,and has advantages,such as short surgical time,high implantation success rate,and good electrical parameter stability.It is worth promoting and using.
Objective To investigate the epidemiological characteristics and surveillance quality of hand-foot-mouth disease(HFMD)in Yangluo street,Xinzhou District,Wuhan from 2011 to 2021,and to provide evidence for the prevention and control of HFMD.Methods Descriptive epidemiological methods were used to analyze the three distribution characteristics of HFMD cases in Yangluo Street and the timeliness of medical treatment,report and review in the infectious disease reporting information management system of China CDC from 2011 to 2021.Results A total of 3 887 cases were reported,with an average annual incidence of 208.28/100 000,which was 2.24 times of the average annual incidence of 92.97/100 000 in the whole region.Patients with mild symptoms accounted for 99.20%,and the rate of severe symptoms was 0.80%.No severe cases occurred after 2018.The main pathogens were EV71 and other enteroviruses,accounting for 45.77%and 26.06%,respectively.There were two incidence peaks,the large peak was from April to July,and the small peak was from November to December,accounting for more than 3/4 of the incidence.The male to female ratio was 1.49:1,the main patients were scattered children and children in childcare,accounting for 97.17%;The age of onset in children aged 1-5 years accounted for 87.39%.Children in urban areas accounted for 85.82%.The mean time from onset to diagnosis was 2.26d,and the median time was 1.67d.The timely treatment time decreased gradually,but it was extended in the post-COVID-19 phase in the last two years.The rate of timely card application was 99.69%,and the rate of timely audit was 99.87%.Conclusion The epidemic situation of HFMD in Yangluo street in Xinzhou district is very serious,and there are obvious seasonal and regional clusters of the disease.It is important to strengthen the relevant health education and child health protection aiming at children's parents and nurseries,especially the scattered children and nurseries in urban areas in the early period of high seasonal incidence.It is necessary to improve the ability of pathogenic detection and the quality of information reporting in hospitals.
目前,放射治疗已广泛应用于胸部肿瘤的局部治疗,具有控制肿瘤增长及杀灭肿瘤等作用,对肿瘤患者的治疗有重大意义,但是在胸部肿瘤的治疗中也会对肺组织产生毒副作用.文章对放射性肺损伤的国内外研究情况进行综述,以便为临床上放射性肺损伤的治疗提供借鉴.
目的 分析周宁县2013-2022年非结防机构疑似肺结核患者转诊、追踪情况,确保周宁县发现活动性肺结核患者的能力及水平得到一定程度提升.方法 通过中国疾病预防控制中心"结核病信息管理系统"收集周宁县2013-2022年结核病的相关资料信息,对非结防机构网络直报疑似肺结核患者转诊及追踪情况进行统计学分析.结果 2013-2022年周宁县通过网络直报疑似肺结核患者1 690例,实际网络直报病例1 292例,其中非结防机构共上报1 120例,占比86.7%,总体到位人数1 007例,总体到位率89.9%,总体到位率由2013年的80.3%提升到2022年的100%.在非结防机构疑似肺结核患者网络直报的到位患者中,有312例被确诊为活动性肺结核,占比78.2%.结论 对非结防机构网络直报的疑似肺结核患者的转诊、追踪进行有效强化,不仅有助于及时发现活动性肺结核患者,对后期治疗方案的制定发挥着积极作用,可帮助患者获得准确、有效的治疗干预,并且可进一步减少结核病社会面再传播风险,达到科学管控结核病的目的,对维护社会公共卫生安全具有一定意义.
为进一步规范口腔诊疗行为,提升口腔医疗保障水平,促进口腔医疗服务健康发展,现就有关工作通知如下. 1 深刻认识做好口腔医疗服务和保障工作的重要意义 口腔健康是反映公众健康水平的重要标志.
Objective To explore the application effect of rapid rehabilitation surgery nursing combined with exercise in patients undergoing gastrointestinal tumor surgery.Methods A total of 80 patients with gastrointestinal tumors admitted to the Second Hospital of Longyan,Fujian Province from January 1,2020 to December 31,2022 were randomly divided into a control group and an observation group,with 40 patients in each group.All patients underwent surgical treatment.The control group received rapid rehabilitation surgical nursing,while the observation group received rapid rehabilitation surgical nursing combined with exercise.Compare the recovery,complications,satisfaction degree,as well as anxiety and depression before and after intervention between the two groups.Results The observation group had significantly better exhaust time,bowel sound recovery time,defecation time,eating recovery time,hospitalization time,ambulation time,as well as urinary tract infection,incision infection,lower limb venous thrombosis,and abdominal infection compared to the control group(P<0.05).After treatment,the depression and anxiety scores of the observation group were significantly lower than those of the control group(P<0.05).The overall satisfaction of the observation group was significantly higher than that of the control group(P<0.05).Conclusion The application of rapid rehabilitation surgical nursing combined with exercise for patients undergoing gastrointestinal tumor surgery has a good effect,which can effectively promote postoperative recovery,improve negative emotions,reduce the occurrence of complications,and improve satisfaction.
Objective To analyze the effects of acupoint application combined with swallowing function training on swallowing function and quality of life of stroke patients with swallowing disorder.Methods Clinical data of 70 patients with stroke combined with dysphagia in our hospital from January 2021 to December 2022 were analyzed.Thirty-five patients receiving dysphagia function training were included in the control group,and 35 patients receiving dysphagia function training combined with traditional Chinese medical acupoint application were included in the combined group.Both groups were treated for 1 month.The effects of intervention,swallowing function,nutritional status and quality of life of the two groups were compared.Results The effective rate of the combined group was significantly higher than that of the control group,and the scores of food residue,intake,aspiration and laryngeal rise after 1 month of intervention were significantly higher than those of the control group(P<0.05).The serum albumin(ALB),hemoglobin(Hb),magnesium,phosphorus and vitamin C in the combined group were significantly higher than those in the control group after one month of intervention,and the nutritional risk screening 2002(NRS2002)score was significantly lower than that in the control group(P<0.05).The swallowing quality of life(SWAL-QOL)score of the combined group was significantly higher than that of the control group after one month of intervention(P<0.05).Conclusion The application of traditional Chinese medical acupoint application combined with swallowing function training in patients with dysphagia in stroke can effectively improve the patients'swallowing function and nutritional status,and enhance the quality of life.
Objective To study the application effect of information-motivation-behavior skills(information-motivation-behavioral,IMB)based intervention model in patients undergoing esophageal cancer surgery.Methods Eighty-two patients with esophageal cancer who underwent surgical treatment in our hospital from November 2020 to October 2022 were retrospectively analyzed.They were divided into two groups according to the random number table method.The control group(40 cases)received routine intervention,and the research group(42 cases)received the IMB-based intervention model on the basis of routine intervention.The postoperative rehabilitation,nutritional status,negative psychology,coping style and complications were compared between the two groups.Results Compared with the control group,the first exhaust time,eating time,bowel sounds recovery,ambulation time and hospitalization time in the study group were significantly shorter(P<0.05).Seven days after operation,the levels of prealbumin(PA),albumin(ALB),transferrin(TRF),hemoglobin(HB),total protein(TP),red blood cell(RBC),globulin and vitamin D in both groups increased significantly,especially in the study group(P<0.05).After the intervention,the scores of SAS,SDS,avoidance and yield in the two groups were significantly decreased,and the study group had lower SAS,SDS,avoidance and yield scores than control group.The facing scores were significantly increased after intervention,and the study group had higher facing score than control group(P<0.05).The incidence of complications in the observation group was 7.14%,which was significantly lower than the 25.00%of the control group(P<0.05).Conclusion The intervention model based on IMB model can effectively improve the nutritional status of patients undergoing esophageal cancer surgery,shorten the postoperative rehabilitation time,relieve negative psychology,improve coping style and reduce complications.
Objective To explore the clinical effect of rehabilitation training combined with percutaneous neuromuscular electrical stimulation on patients with dysphagia after stroke.Methods A total of 120 stroke patients with dysphagia admitted to Panjin Central Hospital from May 2022 to April 2023 were randomly divided into a control group of 61 cases and an observation group of 59 cases.The control group received comprehensive rehabilitation training such as medication treatment,eating training,and oral muscle exercise.The observation group received percutaneous neuromuscular electrical stimulation on the basis of the control group's treatment plan.Observe and compare the treatment efficacy,incidence of aspiration pneumonia,and swallowing function before and after treatment between the two groups.Results The total effective rate of the observation group was 91.52%,which was significantly higher than 75.41%of the control group(P<0.05).The incidence of aspiration pneumonia in the observation group was 10.17%,and significantly lower than the control group's 24.59%(P<0.05).After treatment,the swallowing function of both groups improved compared to before treatment,and the swallowing function of the observation group was significantly better than that of the control group after treatment(P<0.05).Conclusion The combination of percutaneous neuromuscular electrical stimulation and rehabilitation training for the treatment of dysphagia after stroke can further improve the symptoms of dysphagia in patients and reduce the incidence of aspiration pneumonia,which is worth promoting and using.
Objective To observe the effects of gonadotropin releasing hormone agonists combined with Mirena on ovarian function and sex hormone levels in patients with adenomyosis.Methods A total of 98 patients with adenomyosis who underwent treatment at Quanzhou Licheng Wanxiang Minimally Invasive Hospital from June 2019 to June 2021 were selected and divided into a control group of 48 cases and an observation group of 50 cases according to the order of admission.The control group was treated with Mirena,while the observation group was treated with Gonadotropin Releasing Hormone Agonist combined with Mirena.Compare the ovarian function,estrogen levels,degree of dysmenorrhea pain,menstrual volume,and incidence of adverse reactions during treatment between the two groups before and after treatment.Results After treatment,the levels of anti-Mullerian hormone in both groups increased and the levels of follicle stimulating hormone,luteinizing hormone,and estradiol decreased compared to before treatment(P<0.05).After treatment,the levels of anti-Mullerian hormone in the observation group were significantly higher than those in the control group,while the levels of follicle stimulating hormone,luteinizing hormone,and estradiol were significantly lower than those in the control group(P<0.05).The visual simulation pain scores and menstrual volume and menstrual bleeding map scores of the observation group after 3 and 6 months of treatment were significantly lower than those of the control group(P<0.05).The total incidence of adverse reactions in the observation group was 6.00%,significantly lower than the control group's 20.83%(P<0.05).Conclusion The combination of gonadotropin releasing hormone agonists and Mirena can effectively improve ovarian function and estrogen levels in patients with adenomyosis,and is worth promoting and using.
特发性膜性肾病是成人肾病综合征的常见类型,其发病机理至今仍不明确,但大多数学者认为与自体免疫密切相关.一般认为是借助细胞免疫和体液免疫路径起作用,临床上病理特征为肾小球基膜上皮细胞下方堆积免疫复合物、肾小球基膜弥散增厚和补体介导引起大量蛋白尿.治疗特发性膜性肾病药品较多,但最常采取的是免疫抑制剂,包括皮质类固醇、烷化剂、钙调磷酸酶抑制剂、拮抗代谢类制剂、单抗制剂等.本文介绍各类免疫抑制剂的作用机理、作用靶点、治疗效果和毒副反应,以期为临床用药的选择提供依据.
为落实《中共中央国务院关于优化生育政策促进人口长期均衡发展的决定》和《中国妇女发展纲要(2021—2030年)》《中国儿童发展纲要(2021—2030年)》要求,进一步完善出生缺陷防治网络,提升出生缺陷防治能力,改善优生优育服务水平,我委决定2023—2027年在全国组织实施出生缺陷防治能力提升计划.
麻黄附子细辛汤最早出处为张仲景所著的《伤寒论》,从方名可以看出,该方具有外解太阳之表和内散少阴之寒之功效.临床上,麻黄附子细辛汤作为经典验方,在各系统疾病的治疗的均有着广泛的临床共识,然而,如何在经典验方上进行加减,以满足不同病情患者的需求更能体现中医的魅力.为此,本文在肺病范畴内介绍麻黄附子细辛汤的证机方药,并且结合两例病例(一例为过敏性鼻炎伴荨麻疹;另一例为慢性阻塞性肺疾病伴肺源性心脏病)介绍相关用药心得体会,以供医学界同仁参考借鉴.
子宫颈机能不全(cervical incompetence,CIC)是指子宫颈解剖结构或功能异常,导致在妊娠足月前出现进行性、无痛性子宫颈缩短或扩张,从而无法继续维持妊娠.它是复发性中晚期妊娠流产及早产的重要原因,及时明确诊断非常重要.目前,该病没有统一的诊断标准,其诊断的关键是通过病史、典型临床表现及超声检查子宫颈长度和形态的变化.本文对CIC的不同诊断方法和标准的研究进展进行综述.
Objective To observe the effect of sequential management of airway tubes on reducing tracheotomy rate in patients with severe neurological diseases.Methods A retrospective study was conducted on 100 patients with severe neurological diseases admitted to Department of Neurosurgery,Dongguan Shipai Hospital,from June 2020 to December 2022.Among them,50 patients admitted from June 2020 to June 2021 were included in the control group,which was intervened with traditional management methods,and the other 50 patients admitted from July 2021 to December 2022 were included in the observation group,which was intervened with sequential management of airway tubes.The tracheotomy rate,incidence of airway safety events(airway obstruction and asphyxia,pulmonary infection,ventilator associated pneumonia),recovery time of oral swallowing,retention time of tracheal intubation,and incidence of late airway stenosis were compared between the two groups.Results The tracheotomy rate and late airway stenosis rate in the observation group were 16.00%and 0,respectively,which were significantly lower than those in the control group(74.00%and 10.00%,P<0.05).The incidences of airway obstruction and asphyxia,pulmonary infection,and ventilator associated pneumonia in the observation group were 2.00%,70.00%,and 60.00%,respectively,which were not significantly different with 0,78.00%,and 72.00%in the control group(P>0.05).There was no significant difference in airway safety between the observation group and the control group(P>0.05).The recovery time of oral swallowing(2.12±0.45)months and the retention time of tracheal intubation(1.02±0.23)months in the observation group were significantly shorter than those in the control group[(7.23±1.12)months and(9.74±1.47)months](P<0.05).Conclusion The sequential management method of airway tubes can reduce the tracheotomy rate of critically ill patients in neurosurgery,ensure airway safety,reduce long-term tracheal stenosis rate,shorten airway intubation retention time,and promote the recovery of swallowing function and early oral feeding.
当代少年儿童是实现第二个百年奋斗目标,建设社会主义现代化强国的生力军.当前,我国儿童青少年近视呈早发、高发态势,已经成为影响儿童健康和全面发展的突出问题.近视可防可控不可逆,要做到早预防、早发现、早干预.
