Objective To understand the status of insomnia,anxiety and depression and the correlation with sleep quality in the community.Method Insomnia patients over 65 years old who went to 7 community health service stations in a tertiary hospital from May 2021 to January 2022 were selected.Face-to-face questionnaire survey was adopted to collect the general situation of insomnia elderly in the community and Pittsburgh sleep quality index(PSQI),self-rating anxiety scale(SAS),and self-rating depression scale(SDS)filled by insomnia elderly were evaluated.Result There were 120 elderly patients with simple insomnia(simple insomnia group)and 26 patients with anxiety and depression(insomnia combined with anxiety and depression group).Compared with the insomnia group,the PSQI score,the proportion of female,the proportion of chronic diseases,the proportion of combined medication were higher,and the satisfaction of social relationship and the proportion of exercise were lower,with significant differences(P＜0.05).The incidence of anxiety and depression were 14.4%(21 cases)and 12.3%(18 cases),respectively.The incidence of anxiety,depression and SAS,SDS and PSQI scores of elderly women with insomnia in community were higher than those of men,and the difference was significant(P＜0.05).Spearman correlation analysis showed that PSQI total score was positively correlated with SAS(r=0.515,P＜0.001)and SDS(r=0.586,P＜0.001)scores.PSQI sleep quality,sleep time,sleep time,sleep efficiency,sleep disorders,hypnotic drugs,daytime dysfunction and other dimensions were positively correlated with SAS and SDS scores,among which sleep quality was strongly correlated with SAS scores(r=0.480,P＜0.001)and SDS scores(r=0.540,P＜0.001).Sleep disorders and SAS(r=0.514,P＜0.001),SDS(r=0.512,P＜0.001)scores.Conclusion The proportion of anxiety and depression in the community insomnia old people is high.The anxiety and depression of the community insomnia old people are related to the sleep quality.
目的 评估牙周护理指导对慢性牙周炎患者维护期的菌斑控制效果及口腔卫生状况的影响.方法 选取2021年6月至2022年6月就诊于首都医科大学附属北京天坛医院牙周护理门诊的慢性牙周炎患者96例,采用随机数字表法分为观察组和对照组,每组各48例,在牙周治疗维护后对照组患者进行常规口腔卫生宣教,观察组患者在对照组基础上,每月于牙周护理门诊进行口腔护理指导.于基线及治疗后3个月复查时对患者进行口腔检查,包括全口Quigley-Hein菌斑指数(plaque index,PLI)、软垢指数(debris index,DI)、牙龈指数(gingival index,GI)、出血指数(bleeding index,BI)、探诊后出血(bleeding on probing,BOP),并通过问卷调查患者在牙周治疗维护后3个月内的口腔卫生习惯及就诊满意度调查.结果 基线时两组的PLI、DI、GI、BI、BOP比较差异均无显著性(P＞0.05);在治疗后3个月复查时,观察组的PLI、DI、GI、BI及BOP与基线时比较差异无显著性(P＞0.05),而对照组上述指标均较基线时有所升高,且高于观察组,差异均有显著性(P＜0.05).两组基线时刷牙次数、刷牙时长、牙线使用次数、牙间隙刷使用次数及使用Bass刷牙法刷牙比例比较,差异均无显著性(P＞0.05);治疗后3个月复查时,两组使用Bass刷牙法刷牙比例、刷牙次数、刷牙时长、牙线使用次数、牙间隙刷使用次数均较基线时显著增多,且观察组上述指标均显著高于对照组,差异有显著性(P＜0.05).就诊满意度评价中,两组患者对护理人员语气态度的满意度得分比较差异无显著性(P＞0.05);而观察组在主动告知检查流程、耐心解答问题及健康宣教、通过宣教增加口腔知识、操作及技术熟练程度、护理服务整体评价等方面的满意度得分高于对照组,差异均有显著性(P＜0.05).结论 牙周护理门诊的护理干预可以有效提高患者菌斑控制及口腔卫生状况,减轻牙龈炎症,对控制牙周炎症及预防疾病复发具有显著作用,牙周护理门诊在临床实践中值得应用.
Objective To investigate the effect of different doses of dexmedetomidine on optic nerve sheath diameter(ONSD)in patients undergoing laparoscopic radical resection of colorectal cancer.Method 90 patients undergoing laparoscopic radical resection of colorectal cancer treated in Fuyang People's Hospital from June 2020 to December 2021 were selected as the study objects.They were divided into group A(given 0.4µg/(kg·h)dexmedetomidine),group B(given 0.6µg/(kg·h)dexmedetomidine)and group C(given 0.4µg/(kg·h)normal saline)by random number table method,with 30 cases in each group.Surgical related indexes,and HR,MAP,ONSD before anesthesia(T0),during pneumoperitoneum establishment(T1),10min after pneumoperitoneum establishment(T2),30min after pneumoperitoneum establishment(T3),60min after pneumoperitoneum establishment(T4),5min after pneumoperitoneum closure(T5),and perioperative adverse reactions of the three groups were compared and analyzed.Result There were no significant differences in operation time,Trendelenburg position time,blood loss and fluid replenishment among three groups(P＞0.05).Compared with T0,HR and MAP in three groups at T1,T2,T3,T4,T5 were significantly decreased(P＜0.05).At T2,T3,HR in group A and group B was significantly lower than that in group C(P＜0.05),but there was no significant difference between group A and group B(P＞0.05).Compared with T0,ONSD in three groups at T2,T3,T4,T5 were significantly increased(P＜0.05).At T2,T3,T4,T5,ONSD in group A and group B was significantly lower than that in group C(P＜0.05),but there was no significant difference between group A and group B(P＞0.05).The incidence of perioperative delirium in group A and group B was significantly lower than that in group C(P＜0.05),but there was no significant difference between group A and group B(P＞0.05).Conclusion The application of 0.4µg/(kg·h)and 0.6µg/(kg·h)dexmedetomidine in laparoscopic radical resection of colorectal cancer can effectively reduce the ONSD of patients,and significantly reduce the occurrence of perioperative delirium.
目的 探讨外周血中性粒细胞与淋巴细胞比值(neutrophil-lymphocyte ratio,NLR)预测股腘动脉支架植入术后再狭窄的临床价值.方法 回顾性分析2018年9月至2021年9月于北京市海淀医院接受股腘动脉支架植入治疗的82例患者,根据术后1年内是否发生支架内再狭窄分为再狭窄组(12例)和未狭窄组(70例),采用单因素及多因素logistic回归分析股腘动脉支架植入术后再狭窄的影响因素,并通过受试者工作特征(receiver operating characteristic,ROC)曲线探讨各影响因素对股腘动脉支架植入术后再狭窄的预测价值.结果 两组患者的性别、年龄、吸烟史、饮酒史、高血压史、糖尿病史、心脏病史、总胆固醇、低密度脂蛋白、甘油三酯、中性粒细胞、红细胞、血红蛋白、血小板、谷丙转氨酶、血肌酐、C反应蛋白、病变长度、术前Rutherford分级比较差异无显著性(P＞0.05),而再狭窄组的白细胞和淋巴细胞计数明显低于未狭窄组,NLR明显高于未狭窄组,差异有显著性(P＜0.05).单因素logistic回归分析显示白细胞计数、淋巴细胞计数、NLR是股腘动脉支架植入术后再狭窄的影响因素(P＜0.05),多因素logistic回归分析显示淋巴细胞计数和NLR是股腘动脉支架植入术后再狭窄的独立影响因素(P＜0.05).淋巴细胞计数和NLR预测股腘动脉支架植入术后再狭窄的ROC曲线下面积分别为0.074、0.905,NLR预测股腘动脉支架植入术后再狭窄的敏感度和特异度分别为91.7%和90.0%.结论 NLR对股腘动脉支架植入术后再狭窄具有一定的预测价值.
目的 探讨将医学职业素养融入妇产科案例分析教学方法在临床见习中的效果.方法 选取2022年1月至2022年12月于首都医科大学附属复兴医院妇产科见习的临床医学5年制学生60名,采用随机数字表法分为观察组和对照组,每组30名.观察组采用医学职业素养与妇产科案例分析相融合的临床见习方法,对照组采用传统的临床见习方法.妇产科见习时间为6周,见习结束后进行见习课程评价的调查问卷,并比较两组学生的出科考核成绩.结果 见习结束后,见习课程评价的调查问卷结果显示,观察组学生在见习课程总体评价、临床思维培养、提高对妇产科学学习兴趣及自学能力培养上得分高于对照组,差异均有显著性(P＜0.05);而两组在巩固基础理论知识、临床基本技能培养方面比较差异均无显著性(P＞0.05).两组出科考核成绩比较,在问诊、回答相关问题及出科考核成绩总分上,观察组的得分高于对照组,差异均有显著性(P＜0.05),而两组在体格检查、辅助检查的判读及病历的书写方面比较差异均无显著性(P＞0.05).结论 将医学职业素养融入妇产科案例分析临床见习方法有利于调动学生妇产科学的学习积极主动性,提高学习兴趣,有助于其自学能力的提高,而且有助于培养医学生的人文素养,有助于培养全面发展的高素质医学人才.
