随着医疗信息化建设的不断完善,医疗数据资源的不断积累,基于真实世界数据的研究受到广泛关注.作为数据处理的高效工具,机器学习被应用于病理诊断、临床决策及风险预警等多个方面,其在护理领域中的应用也越来越广泛.本文从机器学习在护理不良事件和并发症、康复护理、慢病管理、护理管理、心理护理及中医护理等方面进行系统综述,为开展基于机器学习的护理实践提供参考,以促进学科间的交叉融合发展.

目的 分析老年慢性阻塞性肺疾病患者生活质量现状及ADOPT护理体会.方法 选取于2019年4月到2021年3月在我院就诊的118例慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)老年患者为研究对象,随机分组为对照组与试验组,每组59例.对比两组生活质量.结果 与出院时相比,各组的生活质量评分均明显上升(P<0.05),其中以试验组更为显著(P<0.05).结论 ADOPT护理干预模式可有效提高老年COPD患者的生活质量,值得推广应用.

目的 了解多学科团队协作模式的筛查-评估-计划-治疗营养干预对慢性阻塞性肺病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者营养状态及住院时间的影响.方法 采用便利抽样的方法,选取2019年6月至2020年6月在本院呼吸与危重症医学科收治的AECOPD患者为研究对象.根据入院时间先后次序,将2019年6月至12月入院治疗的AECOPD患者52例设为对照组,采用常规营养干预模式;将2020年1月至6月入院治疗的AECOPD患者52例设为试验组,实施多学科团队协作模式的筛查-评估-计划-治疗营养干预,比较入院时和出院时两组患者总蛋白、白蛋白及血红蛋白值的差异及住院时间的差异.结果 两组患者入院时总蛋白、白蛋白及血红蛋白值的比较,差异无统计学意义(均P>0.05).两组患者出院时总蛋白值、白蛋白值比较,差异有统计学意义(均P<0.05),而血红蛋白值比较,差异无统计学意义(P>0.05).试验组患者住院时间(11.8±3.7)d,对照组(13.9±3.9)d,两组比较,差异有统计学意义(t=-2.897,P=0.005).结论 多学科团队协作模式的筛查-评估-计划-治疗营养干预可改善AECOPD患者营养状态,促进疾病康复,从而缩短住院时间.

目的 探讨丹红注射液辅助米力农注射液治疗慢性肺心病呼吸衰竭患者的临床效果及安全性.方法 前瞻性选取2017年3月至2019年5月四川省人民医院诊治的120例慢性肺心病呼吸衰竭患者,采用随机数字表法分为研究组和对照组,各60例.2组患者均给予米力农注射液等基础药物治疗、同时给予无创正压通气治疗,研究组患者同时给予丹红注射液治疗.比较2组患者的临床疗效.比较2组患者治疗前、治疗2周后的血气指标、血清一氧化氮(NO )、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-a(TNF-a)、内皮素-1( ET -1 )、血小板聚集率.比较2组患者不良反应发生情况.结果 治疗2周后,研究组患者的临床效果(显效70.00％、有效28.33％、无效1.67％ )优于对照组(显效51.67％、有效43.33％、无效5.00％ ),差异有统计学意义(P ＜0.05 ).治疗前,2组患者的Pa02、PaCO2、pH值、Sa02测定值差异无统计学意义(P ＞0.05 );治疗2周后,研究组患者的Pa02、pH值、Sa02测定值为( 85.3 ±7.4 )mmHg、7.36 ±0.06、( 94.2 ±3.0 )％,显著高于对照组[( 81.0 ±7.2 )mmHg、7.33 ±0.05、( 91.0 ±3.6 )％ ],PaC02测定值[( 38.9±4.8)mmHg]显著低于对照组[(42.4±5.2)mmHg],差异有统计学意义(P ＜0.05).治疗前,2组患者的NO、hs-CRP、TNF-α、ET-1、血小板聚集率测定值差异无统计学意义(P ＞0.05 );治疗2周后,研究组患者的NO测定值[( 57.2±5.8 )μmol/L]高于对照组[( 52.8 ±6.1 μ,mol/L ],hs - CRP、TNF - a、ET - 1、血小板聚集测定值为(:3.2 ±1.1 )mg/L、( 38.2 ±11.0 )pg/mL、( 48.3 ±9.0 )ng/L、( 34.8 ±5.1 )％,显著低于对照组[( 4.5 ± 1.4 )mg/L、( 44.1 ± 13.2 )pg/mL、( 57.0 ±10.0 )ng/L、( 39.5 ±7.3 )％],差异有统计学意义(P ＜0.05).2组不良反应发生率比较( 5.0％ vs.11.7％),差异无统计学意义(P ＞0.05 ).结论 丹红注射液辅助米力农注射液治疗慢性肺心病呼吸衰竭患者能显著的改善患者血气水平、降低炎性反应及血小板聚集率,从而提高临床效果,同时安全性高.

目的 探讨ADOPT护理实施对改善老年慢性阻塞性肺疾病急性加重期(Acute Exacerbation of Chronic Obstructive Pulmonary Disease,AECOPD)患者自护能力及生活质量的影响.方法 选取2019年4月～2021年3月在我院治疗的老年AECOPD患者90例,分为常规组(常规护理)和试验组(ADOPT护理).对比两组患者的自护能力及生活质量.结果 两组患者出院前的自护能力及生活质量评分对比无差异(P>0.05);两组患者出院3、6个月后,试验组自护能力及生活质量评分均高于常规组(P<0.05).结论 实施ADOPT护理更能够改善老年AECOPD患者的自护能力及生活质量.

蛋氨酸限制(Methionine restriction,MetR)作为饮食限制的方法之一,能够改善多种无脊椎动物、啮齿类动物及包括人类灵长类动物的衰老及其相关疾病.但MetR对衰老的具体调节作用机制尚未完全明确,目前除了与饮食限制的共有机制以外,越来越多的研究表明内源性硫化氢(Endogenous hydrogen sulfide,H2S)可能是其发挥效应的主要机制.硫化氢作为水溶性和脂溶性的小分子气体,在延缓衰老进程和改善衰老相关疾病中具有重要意义.本文阐述了MetR通过提高内源性H2S的活性延缓衰老的机制及相关研究.

Aim To clarify the association of serum kisspeptin levels in women with polycystic ovary syndrome (PCOS) by meta-analysis. Methods Two English databases and two Chinese databases were searched for the relationship between kisspeptin and PCOS published from 2009. After the studies screening according to specific principles, we used STATA 12.0 for meta-analysis. Standardized mean difference (SMD) and its 95% confidence intervals (95% CIs) were used as the effect size and STATA 12.0 software was performed by this meta-analysis. Results Nine articles were included in the end, with a total of 1282 participants (699 patients and 583 controls). Heterogeneity between studies was statistically significant. Therefore, the random effects model was used to combine the effects. Meta-analysis showed statistically significant differences in serum kisspeptin levels between the PCOS patients and controls (SMD = 0.57, 95% CI [0.32, 0.82]), which indicated that there is a strong association between serum kisspeptin levels and PCOS. The source of high heterogeneity between the inclusion studies (I-2 = 73.2%) might be due to the small sample size. The larger variation of kisspeptin concentration might be caused by different diagnosis criteria of PCOS and short half-time period of kisspeptin combined with nonstandard testing process. Conclusion Serum kisspeptin levels in PCOS patients were higher than non-PCOS patients. It is a hint to indicate us that kisspeptin might be an independent biomarker of PCOS patients.

目的 探讨以问题为基础的教学法(PBL)结合以授课为基础的教学法(LBL)在老年科护理教学中的应用效果.方法 选取2017年8月—2018年8月在我院老年科学习的实习护生共计84例,将实习护生按照随机法分为研究组与对照组,各42例,研究组采用PBL结合LBL教学方法,对照组采用单纯的传统LBL教学法.观察并对比两组实习护生的教学效果.结果 研究组实习护生的理论考核成绩以及实践操作成绩均高于对照组,研究组实习护生对课程的满意度及学习积极性明显优于对照组,差异有统计学意义(P<0.05).结论 PBL结合LBL在老年科护理教学中具有良好的教学效果,能够显著提高实习护生的理论考核成绩及实践操作成绩.

肺炎链球菌(Streptococcus pneumoniae,Spn)是近年来人们所重视的超级细菌之一,于1881年首次由美国陆军医师乔治·斯特恩伯格和法国化学家路易斯·巴斯德尔从患者痰液中分离获得.作为一种有荚膜的革兰阳性双球菌,肺炎链球菌是引起脓毒症、肺炎、脑膜炎、鼻窦炎的主要病原体.现有针对Spn感染的肺炎球菌多糖疫苗(Pneumococcal polysaccharide vaccine,PPV)和肺炎链球菌结合疫苗(Pneumococcal conjugate vaccine,PCV),但具有生产成本高、血清覆盖率有限等局限性.近年来疫苗的研发方向开始逐步转向改变疫苗的有效成分的方向,并因此出现了以蛋白质疫苗、全细胞疫苗、DNA疫苗为代表的新型肺炎球菌疫苗.本文对肺炎链球菌疫苗发展至今的研究进展进行总结,以期为未来的疫苗研制事业提供灵感与方向.

目的 探讨2型糖尿病伴冠心病患者医院感染的病原学特点.方法 选择我院于2017年2月至2018年4月期间收治的2型糖尿病冠心病患者421例,分析2型糖尿病冠心病医院感染情况,医院感染病原菌分布及耐药情况.结果 2型糖尿病冠心病421例发生医院感染47例,感染率11.16％.以呼吸道为主,其次为尿路和胃肠道.医院感染47例患者共分离培养病原菌58株,主要为革兰阴性菌,其中铜绿假单胞菌、肺炎克雷伯菌和大肠埃希菌,分别占18.97％、15.52％和13.79％;革兰阳性菌中以金黄色葡萄球菌和表皮葡萄球菌为主,分别占13.79％和12.07％.革兰阴性菌中铜绿假单胞菌对头孢他啶及头孢呋辛耐药率高,分别为81.82％、72.73％;肺炎克雷伯菌对头孢曲松及头孢西丁钠耐药率高,为88.89％、77.78％;大肠埃希菌对头孢他啶及头孢曲松耐药率高,为87.50％、75.00％.革兰阳性菌中金黄色葡萄球菌和表皮葡萄球菌均对红霉素和青霉素G耐药率较高,均为100.00％.结论 2型糖尿病伴冠心病患者医院感染病原菌以革兰阴性菌为主,主要对头孢类耐药率较高;而革兰阳性菌主要对青霉素和红霉素耐药率较高.

目的 对2型老年糖尿病患者采用延续性护理干预的效果进行分析探讨.方法 选取78例2015年1月—2016年6月在我院治疗的2型老年糖尿病患者作为临床观察对象,随机分成观察组和对照组,每组39例患者,给予对照组患者出院常规指导,给予观察组患者延续性护理干预,对两组患者出院后的血糖控制水平进行总结.结果 观察组患者的护理满意度高于对照组,出院时两组患者的血糖水平对比,差异无统计学意义(P>0.05).在患者出院第18个月观察组的血糖水平低于对照组,差异有统计学意义(P<0.05).结论 通过对该病患者实施的延续性护理干预使其遵医行为得到有效改善,血糖得到更好控制,降低发生并发症的风险,有效改善预后.

目的 研究预后营养指数和ST段抬高型心肌梗死(STEMI)患者疾病严重程度的相关性.方法 回顾性纳入2014年1月至2016年8月在我院急诊入院的STEMI且行急诊经皮冠状动脉支架植入术(PCI)术的患者共544例作为研究对象,收集临床资料,利用人院时血浆白蛋白和淋巴细胞计数计算预后营养指数(PNI),并依据PNI将患者分为PNI0分组(PNI原始分数≥45分,n=232)和PNI1分组(PNI原始分数＜45分,n=312).同时计算反映STEMI患者严重程度的Gensini积分和全球急性冠状动脉事件注册评分(GRACE评分),Pearson相关分析PNI原始分数与Gensini积分和GRACE评分的相关性,利用多因素线性回归分析PNI(原始分数≥45分、原始分数＜45分,分别赋值为0、1)对Gensini积分、GRACE评分与的影响.结果 PNI1分组患者比PNI0分组患者有更高的年龄、心率、白细胞计数、三酰甘油、心肌肌钙蛋白T、肌酸激酶同工酶(CK-MB)、LVEF,两组间差异有统计学意义(P均＜0.05).PNI1分组Gensini积分和GRACE评分高于PNI0分组[(88±41)分VS.(66±27)分,(115±27)分vs.(121±23)分,P均＜0.05],差异有统计学意义.PNI原始分数与Gensini积分(r=-0.253,P=0.003)、GRACE评分(r=-0.361,P=0.015)均呈低度负相关.多因素线性回归显示,PNI是Gensini积分和GRACE评分的独立影响因素.结论 PNI是STEMI患者疾病严重程度的独立影响因素,但能否作为STEMI患者早期危险评估的有效工具仍需要更多验证.

目的 探讨老年高血压住院患者的心理健康状况和治疗依从性.方法 将2012年5月至2014年5月我院收治的200例老年高血压住院患者分为空巢老人组、丧偶老人组、五保户老人组及常规老人组,使用症状自评量表( SCL-90),纽芬兰纪念大学幸福度量表(MUNSH),社会支持评定量表(SSRS),治疗依从性问卷对所有老年患者进行调查并分析.结果老人偏执、焦虑、抑郁、人际关系敏感及躯体化症状五因子差异有统计学意义(P<0.05);不同分组患者MUNSH量表中总分、NE、PE、NA及PA评分差异有统计学意义(P<0.05);不同分组患者其客观支持及主观支持间差异有统计学意义(P<0.05).Logistic分析结果显示,年龄及患者主动性是患者治疗依从性的影响因素( P<0.05).结论 通过研究不同人群的住院老年高血压患者的心理状况,及时给予干预和影响,提高治疗依从性,为临床医护用药和治疗提供科学合理的依据.

Objectives To investigate the clinical efficacy of health education intervention on chronic gastritis nursing. Methods A total of 142 patients with chronic gastritis in our hospital were recruited from February 2016 to June 2017. All patients were randomly assigned into two groups. The control group received conventional therapy and routine nursing, whereas the case group was offered with extra health education based on control group. Then related disease knowledge, nursing efficiency, nursing satisfaction, and nursing quality were compared. Results A total of 71 patients were in the case group, while 71 patients in the control group. Compared with the control group, the case group achieved better related disease knowledge, nursing satisfaction, total nursing efficiency, psychological status, sleep quality, exercise training, and daily diet (all P value＜0.05). Conclusions Health education intervention not only can enhance disease knowledge of patients with chronic gastritis but also improve nursing quality, clinical effects and nursing satisfaction. Thus, it is worthy of further popularization in clinics.

目的 探究预防跌倒护理在老年心血管疾病患者中的临床应用效果.方法 选取四川省人民医院2013年6月至2014年5月收治的心血管疾病老年患者92例作为对照组;2014年6月至2015年5月收治的心血管疾病老年患者92例作为试验组.对照组采用常规护理;试验组采用预防跌倒护理模式,比较两组患者的跌倒发生率、跌倒损伤程度及患者护理满意度,并进行统计学分析.结果 试验组患者的跌倒发生率及跌倒损伤情况发生率均低于对照组;患者对护理工作的满意度高于对照组,差异有统计学意义(P＜0.05).结论 预防跌倒护理明显减少心血管疾病老年患者跌倒发生率,保证了老年患者的住院安全,值得在临床护理工作中推广应用.

目的:分析延续性护理干预在预防老年高血压患者跌倒中的应用效果.方法:以我院老年心血管内科2015年4月~2016年4月期间治疗出院的114例老年高血压患者为研究对象,分组采取随机信封法进行,分为参照组与干预组,参照组出院后不给予护理干预措施,干预组给予延续性护理干预,两组均定期进行随访,对比两组患者的跌倒事故的发生率以及跌伤严重程度.结果:干预组患者发生跌倒事件的概率为7.02%,跌倒后骨折的概率为0.00%、跌倒后软组织损伤的概率为3.51%,参照组患者发生跌倒事件的概率为26.32%,跌倒后骨折的概率为10.53%,跌倒后软组织损伤的概率为14.04%,两组上述事件的发生率的对比,表现出明显的差异性,具有统计学意义(P<0.05).结论:在老年高血压患者出院后,给予延续性护理干预,可有效降低患者跌倒事件的发生概率,并显著减轻跌倒后的损伤程度,值得推广应用.

Objective To investigate the cadres' demand for health warning inspection and explore the scientific and effective mode of health warning inspection.Methods The self-made scale was used to conduct the questionnaire anonymously from January of 2013 to November of 2013 among the 46 cadres appointed by Sichuan Cadre Health Committee.Results The in-service cadres and the retired cadres had significant differences in the demand for the inspection time,site and content of pamphlets (P <0.05),while all of them could accept the ways of presenting the medical knowledge by text messages.Conclusion The individualized inspection mode should be offered according to the cadres'demands for the health warning and the comprehensive health information of cadres should be collected and recorded according to their demands in order to improve the cadres'health records and the inspection efficiency.

目的:研究五苓散辅助罗格列酮治疗糖尿病肾病的临床疗效.方法:选取我院2012年2月至2014年8月68例糖尿病肾病患者为研究对象,将患者随机分为观察组和对照组,每组34例,观察组采用五苓散辅助罗格列酮,对照组采用单纯西药罗格列酮,比较两组的临床疗效,血糖、血脂指标,尿蛋白、肾功能指标以及不良反应.结果:观察组的治疗总有效率为94.1％,显著高于对照组的76.5％,观察组治疗后的空腹血糖、餐后2小时血糖、三酰甘油酯、24h尿微量白蛋白排泄率、血肌酐、血尿素氮分别为(5.48±2.66) mmol/L、(8.16±2.37) mmol/L、(2.04±0.85) mmol/L、(39.52±11.16) μ~min、(77.26±12.31) μmol/L、(7.16±2.57)mmol/L,显著低于对照组的(7.35±1.64) mmol/L、(10.42±3.41) mmol/L、(2.86±1.12) mmol/L、(45.35±11.52) μg/min、(86.48± 12.09) μmol/L、(8.72 ±.2.61) mmol/L.观察组的不良反应率为17.6％略高于对照组的14.7％,但差异不显著.结论:五苓散可辅助治疗糖尿病肾病,控制患者的血糖、血脂水平,改善患者肾功能.

Objective To explore the influence of psychological nursing intervention on the adverse emotion and mental state of patients with acute myocardial infarction(AMI),and to provide practical basis for the nursing work of AMI patients.Meth-ods 160 cases of patients with AMI selected from our hospital from May 2013 to May 2015 were randomly divided into experimen-tal group(n=80)and control group(n=80). The control group was treated with regular nursing,on the basis of which psychologi-cal nursing intervention was added to comprise experimental treatment.The clinical treatment effect,psychological status,quality of life,anxiety and depression degree of the two groups were compared by doing follow-up after 1 month treatment.Results After 1 month nursing with different methods,the incidence of arrhythmia,angina pectoris and heart failure in the experimental group was significantly lower than those in the control group(P<0.05),and the average length of stay in the experimental group was signifi-cantly lower than that in the control group(P<0.01).The indexes of somatization,compulsion,interpersonal sensitivity,depres-sion,anxiety,hostility,terror,paranoia and psychosis were lower in the experimental group than those in the control group(P<0.05).Compared with the control group,the quality of life score of patients in the experimental group was significantly higher than (t=41.898,P<0.01)while there was no difference in quality of life score between two groups before the nursing(t=0.726,P>0.05).The SAS and SDS scores of experimental group after nursing were significantly lower than those in the control group[SAS (t=11.700,P<0.01),SDS(t=10.816,P<0.01)].However,there were no difference in the SAS and SDS score between two groups before nursing[SAS(t=0.312,P>0.05),SDS(t=0.867,P>0.05)].Conclusion Careful psychological nursing inter-vention on AMI patients could significantly alleviate the patients'adverse emotions like anxiety and depression,shorten hospitaliza-tion time,improve psychological status of patients,promote the quality of life of patients,and enhance patients' self-confidence to promote treatment compliance,which deserves to be spread.

Objective To evaluated the efficacy of induced sputum in elderly patients with pneumonia by different atomization.Methods 108 cases of elderly patients with pneumonia were selected as the study object,who were randomized into three groups. The efficacy of oxygen atomization,pressure atomization and ultrasonic atomization was compared.ResultsThere was no significant difference in heart rate,respiratory rate and oxygen saturation among the three groups(P>0.05). The number of FEV1 / predicted % decrease>15% in oxygen atomization group less than in pressure atomization group and ultrasonic atomization group(P<0.05). The amount of expectoration in oxygen atomization group and pressure atomization group was better than that in ultrasonic atomization group(P<0.05). Adverse reactions were less in the oxygen atomization group (P<0.05).Conclusion Compared among the three kinds of atomization,induced sputum in elderly patients with pneumonia by oxygen atomization have a better effect,safety and comfort,which should be preferred.