目的 探究孕产妇参与以家庭为中心的群组式围生期保健模式的真实体验,促进围生期护理质量.方法 对44例孕妇行群组式围生期保健干预,干预时间从孕妇入组时(孕周26±3周)至产后3个月.采用半结构式访谈法分别于产后2 d和2年内对其中的15例产妇进行2次访谈,使用Colaizzi七步分析法分析访谈资料.结果 提炼出3个主题:有助于以家庭为中心的积极准备;全程链式专业照护使孕产妇安心;有效延续同伴支持功能.结论 群组式围生期保健通过助产士赋予服务对象权利、一对一咨询服务、互联网远程答疑、衔接产前教育内容与分娩阶段需求、产后群组聚会等措施增强孕产妇在孕期、分娩阶段及产后的安全感,但实施过程仍有待改进之处.

1 病史摘要 患者,男,37岁,因"发现乙型肝炎阳性20 年,肝硬化5 年,腹胀1 个月"于2017年12月20日入院.患者20年前体检发现乙型肝炎表面抗原阳性.5 年前B超提示肝硬化.1 年前,口服抗病毒药富马酸替诺福韦二吡呋酯片300 mg,qd.1 个月前患者突发腹胀、尿黄,在某省级医院就诊,经过相关检查确诊为原发性肝癌、肝硬化失代偿期,予TACE术、脾栓塞术.

目的:分析实施治未病理念与"互联网+"智慧中医健康管理的效果及对生活质量、中医健康管理服务满意率的影响效果.方法:选择2019年6月～2020年6月医院的慢性病、手术恢复期、亚健康、体质偏颇等患者380例为研究对象,随机均分为对照组与观察组各190例,对照组实施常规健康管理,观察组实施治未病理念与"互联网+"中医健康管理,比较两组患者的管理效果.结果:管理后两组患者的中医护理管理质量评价量表评分、生活质量测定简表WHOQOL-BREF评分,均显著高于管理前(P＜0.05).管理后观察组患者的中医护理管理质量评价量表评分、生活质量测定简表WHOQOL-BREF评分,显著高于对照组(P＜0.05).观察组患者对中医健康管理服务满意率,显著高于对照组(P＜0.05).结论:实施治未病理念与"互联网+"中医健康管理的效果更佳,能够更有效提升健康管理质量、中医健康管理服务满意率,改善患者的生活质量.

坏死梭杆菌(Fusobacterium necrophorum)是严格厌氧的革兰阴性多形态杆菌,广泛分布于人和动物的口腔、胃肠道和泌尿生殖道 [1].该菌是条件致病菌,除了能引起动物的腐蹄病[2]、肝脓肿[3],还能引起人的急性咽炎综合征[4].

溃疡性结肠炎(ulcerative colitis,UC)是一种慢性非特异性肠道疾病,其病变主要累及粘膜层和粘膜下层,呈弥漫性、连续性分布.临床表现为腹泻、黏液脓血便、腹痛以及不同程度的全身反应和肠外表现,严重影响患者生活质量.UC发病可能与自身免疫、家族遗传、环境和肠道微生物等因素有关[1],但其机制尚不明确.现代医学治疗UC多使用5-氨基水杨酸制剂(5-ASA)、糖皮质激素、免疫抑制剂以及生物制剂,虽能有效缓解症状,改善生活质量,但均存在局限性.近年来,线粒体自噬已成为各个领域的研究热点,不同通路介导的线粒体自噬参与不同种系、不同组织细胞内的线粒体降解过程,在肿瘤、自身免疫性疾病和心脏病等常见疾病的发生发展中起关键调节作用[2-4].研究表明,线粒体自噬可以对抗UC的炎症反应,控制UC发作[5].探讨线粒体自噬与UC发生之间的关系,寻找介导UC线粒体自噬信号通路的药物来治疗UC是一个具有潜在价值的研究方向.

目的:观察熊胆粉对肝纤维化大鼠CD4+、CD8+淋巴细胞的影响.方法:按随机数字表随机分为对照组、肝纤维化模型组和熊胆粉治疗组.对照组:注射用生理盐水连续腹腔内注射,同时用生理盐水灌胃;肝纤维化模型组:10g/L二甲基亚硝胺(DMN)(生理盐水稀释)连续腹腔内注射,同时用生理盐水灌胃;熊胆粉治疗组:10g/L DMN腹腔内注射的同时用熊胆粉灌胃.在第2周末和第4周末,采用流式细胞术检测CD4+、CD8+淋巴细胞比例及CD4+/CD8+的比值.结果:肝纤维化大鼠肝细胞中CD4+阳性细胞比例及CD4+/CD8+比值较正常组显著降低,CD8+阳性细胞比例显著升高,而熊胆粉对肝纤维化大鼠肝细胞中CD4+阳性细胞降低、CD8+阳性细胞比例的升高及CD4+/CD8+比值降低有显著的负调控作用.结论:熊胆粉能有效改善DMN诱发大鼠肝纤维化免疫功能.

目的 探讨参与以家庭为中心的群组式孕期保健活动对孕妇的影响,为在国内推广该孕期保健模式提供理论依据.方法 构建以家庭为中心的群组式孕期保健模式,便利选取60名孕妇参与该模式下的群组活动.运用质性研究法,对参与该孕期保健活动的16名孕妇进行半结构式访谈,使用Colaizzi分析法,对获取的资料进行分析、总结、归纳.结果 提炼出孕妇参与以家庭为中心的群组式孕期保健活动体验的3个主题(整体化自护管理、参与式健康教育和多元化社会支持),以及“契合现存和潜在的孕期需求”这一反映孕妇综合体验的核心主题.结论 与传统的孕期保健模式相比,以家庭为中心的群组式孕期保健模式促进了孕妇及其家属对孕期专业支持的寻求,提高了孕妇孕期的自我管理能力,满足了孕妇所需的同伴支持和家庭支持,有助于提高孕期保健的利用率和有效性.

Objective? To explore the effects of the midwife-centered antenatal care model attended by pregnant women on reducing cesarean delivery rates and properly controlling neonatal weight. Methods? Totally 120 pregnant women who established medical records and attended antenatal care regularly in Hangzhou First People's Hospital from February 2017 to January 2018 were selected by on-site recruiting and divided into the treatment group (n=60) and the control group (n=60) according to the random number table. Pregnant women in the control group received conventional antenatal care, while pregnant women in the treatment group received the midwife-centered antenatal care in family groups. The cesarean delivery rate, postpartum hemorrhage rate, neonatal weight, incidence rate of fetal macrosomia and incidence rate of low birth weight infant were compared between the two groups. Results? The cesarean delivery rate of the treatment rate was 8.3%, while that of the control group was 35.0% (χ2=12.570, P＜0.01); the neonatal weight of the treatment group was (3.22±0.39) kg, while that of the control group was (3.51±0.47) kg (t=-3.70,P＜0.01). Conclusions? The midwife-centered antenatal care in family groups can reduce cesarean delivery rates and properly control neonatal weight, which is of significance in nursing research and clinical nursing work.

目的 探讨农村老年人对死亡的态度.方法 采用目的抽样法,对16名农村老年人进行面对面半结构式访谈,了解其对死亡的态度,对所得资料采用内容分析法分析.结果 通过分析、整理和提炼,老年人的死亡态度可归纳为6个方面:对死亡的思考;对死亡的谈论;对死亡的看法;对死亡的设想;对死后世界的想法;对生命的看法.结论 农村老年人对死亡多持逃避的态度,希望能够开心地生活.应主动关注老年人的内心感受,正确引导他们面对死亡及生命.

目的 了解初产妇参与助产士主导的家庭群组式孕期保健模式的体验,为推广该孕期保健模式提供参考.方法 运用质性研究方法,对符合纳入标准的16例初产妇进行深度访谈,使用内容分析法分析访谈资料.结果 初产妇对该孕期保健模式的体验主要有4个主题:获得同伴支持,获得家庭支持,群组活动的优势,促进行为改变.结论 以助产士主导的家庭群组式孕期保健模式能够帮助孕产妇同时获得来自助产士、家属和同伴的全面支持,从而更好地应对围生期出现的问题.

目的 探究以助产士主导的家庭群组式孕期保健服务模式对孕妇的干预效果.方法 将109例初产妇随机分为干预组(54例)和对照组(55例).对照组参加孕期检查、孕妇学校教育和孕妇学校微信群;干预组实施以助产士主导的家庭群组式孕期保健服务的实践,即参加孕期检查、群组活动教育和群组微信群.比较两组孕晚期增重、分娩结局、新生儿体质量等.结果 干预组孕妇分娩前体质量、孕晚期每周增重显著低于对照组(均P＜0.01);干预组自然分娩率显著高于对照组;两组新生儿体质量比较,差异有统计学意义(P＜0.05);两组妊娠期并发症发生率、巨大儿发生率差异无统计学意义(均P＞0.05).结论 以助产士主导的家庭群组式孕期保健服务模式能有效管理孕妇孕期体质量,改善分娩结局.

Objective:To investigate the status quo of the death attitude of rural elderly in Hangzhou city,and to analyze its influencing factors,in order to provide a basis for the development of targeted death education.Methods:The convenient sampling method,the General information Questionnaire and Chinese version of Death Attitude Profile-Revised (DAP-R)were used to investigate 250 rural elderly in 4 districts of Hangzhou city.Results:Among the 250 rural elderly,a total of 235 questionnaires were retrieved,and 211 were valid.The total score of death attitude was (75.88±7.61),the highest score was Neutral Acceptance dimension(16.95±3.10)points,followed by Death Avoidance dimension,scoring (15.29 ± 2.95),Fear of Death dimension scored lowest (14.45± 3.43).Whether had a serious illness,the current psychological condition and the participation times of funeral in the past two years were the major influencing factors of the death attitude of the elderly in rural areas (P＜0.05).Conclusions:The death attitude of the rural elderly was mainly towards Neutral Acceptance,while there were nearly tending of the rural elderly tending to a negative death attitude.The main influencing factors included the current psychological condition,whether had a serious illness,and participation times of funeral in the past two years.

Objective] To explore the correlation between the TCM syndromes distribution of mild chronic hepatitis B(CHB) and liver tissue pathology . [Methods] 494 CHB patients(among whom 407 patients are mild CHB) are chosen as objects in the retrospective survey ,mainly studying their liver pathology grading,staging and TCM syndrome.In accordance with TCM syndrome,patients are divided into five groups,including syndrome of liver-qi stagnation and spleen-qi deficiency,syndrome of damp-heat stagnation,syndrome of static blood blocking collaterals,syndrome of yin deficiency of liver and kidney and syndrome of yang deficiency of spleen and kidney.It also analyzes the features of TCM syndrome distribution in mild CHB patients and skin and histopathology with the statistical method of testing.[Results] It turns out that among the 494 CHB patients,the TCM syndrome distribution is syndrome of liver-qi stagnation and spleen-qi deficiency﹥syndrome of damp-heat stagnation﹥syndrome of static blood blocking collaterals﹥syndrome of yin deficiency of liver and kidney﹥syndrome of yang deficiency of spleen and kidney,and the distribution of the 407 cases with mild chronic hepatitis B inflammation and fibrosis from light to heavy is as follows:syndrome of liver-qi stagnation and spleen-qi deficiency,syndrome of damp-heat stagnation,syndrome of static blood blocking collaterals,syndrome of yin deficiency of liver and kidney,syndrome of yang deficiency of spleen and kidney.There are significant statistical differences between the inflammation and fibrosis of the five syndromes;According to inflammation: syndromes of liver-qi stagnation and spleen-qi deficiency are significantly different compared with syndromes of static blood blocking collaterals ,syndrome of yin deficiency of liver and kidney and syndrome of yang deficiency of spleen and kidney respectively(χ2=11.310,P<0.005;χ2=16.565,P<0.001;χ2=16.013,P<0.001); According to inflammation and fibrosis: syndrome of liver-qi stagnation and spleen-qi deficiency are significantly different compared with syndrome of static blood blocking collaterals,syndrome of yin deficiency of liver and kidney and syndrome of yang deficiency of spleen and kidney respectively(χ2=18.798,P<0.001;χ2=18.313,P<0.001;χ2=23.076,P<0.001); syndrome of damp-heat stagnation also has remarkable statistical differences from syndrome of static blood blocking collaterals,syndrome of yin deficiency of liver and kidney and syndrome of yang deficiency of spleen and kidney(χ2=18.798,P<0.001;χ2=18.313,P<0.001;χ2=23.076,P<0.001);However,there is no statistical difference between syndrome of liver-qi stagnation and spleen-qi deficiency and syndrome of damp-heat stagnation.The TCM syndrome in patients with mild chronic hepatitis B is highly correlated with the degree of liver histopathological inflammation and fibrosis ,mainly syndrome of liver-qi stagnation and spleen-qi deficiency and syndrome of damp-heat stagnation,which belongs to the early pathological changes,but there is still a quarter of patients who need to receive antiretroviral therapy.Syndrome of static blood blocking collaterals,syndrome of yin deficiency of liver and kidney and syndrome of yang deficiency of spleen and kidney belong to the late or advanced stage pathological changes.These patients also need antiviral treatment. [Conclusion] The TCM syndrome in patients with mild chronic hepatitis B provides scientific basis for the anti-hepatitis B therapy.The patients who can’t accept the liver biopsy could choose a reasonable antiviral treatment according to the TCM syndrome.

目的:研究不同中医证型的慢性乙型肝炎(CHB)轻度患者肝组织病理特点,并探讨其临床意义.方法:将310例CHB轻度患者进行中医辨证分型,采用Menshini法1秒钟经皮肝穿取肝组织进行炎症和纤维化程度判断,并与车祸死亡正常人作对照,同时荧光定量PCR法检测患者血清HBV DNA水平.结果:①肝组织炎症≥G2、肝纤维化≥S2等级的患者年龄明显高于肝组织炎症＜G2、肝纤维化＜S2等级的年龄;②各中医证型患者肝组织炎症级别≥G2的比率明显高于正常组,但证型间比较差异均无显著性意义;③各中医证型患者肝组织纤维化程度≥S2的比率明显高于正常组,但证型间比较仅肝肾阴虚和脾肾阳虚两型明显高于肝郁脾虚和湿热中阻型;④各中医证型间HBV DNA水平比较,肝肾阴虚和脾肾阳虚两证型明显低于肝郁脾虚型,其他证型之间差异无显著性意义.结论:CHB轻度患者至少有1/3的患者需要抗病毒治疗,而且年龄越大越有必要;在控制肝脏炎症方面,辨证治疗应多加倡导,在抗纤维化治疗方面应重视补肾法研究.

[Objective]Analysis of chronic hepatitis B(hereinafter referred to as b) distribution in liver tissue pathology and TCM syndrome type, provide the objective material to determine the chronic hepatitis B fibrosis degree of TCM use. [Method] From 2011 November to 2013 March in Zhejiang Chinese Medicine University First Affiliated Hospital and Lishui People's Hospital hospital infection 310 cases of patients with chronic hepatitis B, monitoring the liver biopsy and liver fibrosis indexes, to investigate the relationship between the above indexes and the TCM syndrome types. [Results] 310 cases of chronic hepatitis B with liver stagnation and spleen deficiency type, are fol owed by the damp heat type, liver kidney yin deficiency, spleen kidney yang deficiency, blood stasis type. And liver stagnation and spleen deficiency type, damp heat type, liver kidney yin deficiency, spleen kidney yang deficiency type are of mainly stage S2 fibrosis, blood stasis blocking col ateral type in fibrosis stage S4; 212 cases of mild chronic hepatitis B patients with liver qi stagnation and spleen deficiency, damp heat group relatively flat and vitrinite in fibrosis≥S2 have differences, with statistical significance. [Conclusion] Pathology and TCM syndrome type distribution in liver tissue of patients with chronic hepatitis B have some regularity; TCM syndrome type has correlation with the pathologic change of liver tissue objective.

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