Objective:To explore the effect of comprehensive accusation intervention on the use of antibacterial drugs and the writing of medical records in elderly patients with closed fracture.Methods:A total of 120 elderly patients (aged ≥60 years) with fracture were enrolled from January 2017 to June 2019 in the department of orthopaedics and traumatology of the Second Hospital of Tangshan University and the Affiliated Hospital of North China University of Technology. According to random number table method, 120 patients were divided into intervention group (61 cases) and non intervention group (59 cases) by computer random number method. The patients in the intervention group received pharmaceutical care and quality control management intervention during the perioperative period; The patients in the non intervention group were routinely treated with antibiotics and wrote medical records. The use effect of antibiotics, the cost of antibiotics and the effect of standardized writing of medical documents were compared between the two groups. Independent sample t-test was used for comparison between measurement data groups with normal distribution, and χ 2 test was used for comparison between counting data groups. Results:Compared with the non-intervention group, the rate of perioperative use of antibiotics (49.2% (30/61)), the rate of drug use without indication (4.9% (3/61)), the rate of irrational drug selection (6.6% (4/61)), the rate of irrational drug use (6.6% (4/61)), and the proportion of irrational combined use of antibiotics (3.3% (2/61)) were significantly lower than that in the non-intervention group (81.4% (48/59), 16.9%(10/59), 22.0% (13/59), 20.3% (12/59), 18.6% (11/59)), the difference was statistically significant (χ 2 values were 13.65, 4.49, 5.91, 4.93 and 7.33, respectively; P values were <0.001, 0.034, 0.015, 0.026 and 0.007,respectively). The cost of antibiotics in the intervention group ((283.86±59.86) yuan) was lower than that in the non intervention group ((820.45±136.27) yuan), and the difference was statistically significant ( t=27.478, P<0.001). The eligible rate of the pre-operative informed consent document signing was 100% (61/61) in the intervention group, and the eligible rate of the operative record completion time was 100% (61/61) higher than that in the non-intervention group (84.7% (50/59), 79.7% (47/59)), the difference was statistically significant (χ 2 values were 7.98 and 13.79; P values were 0.005 and <0.001). The loss rate of preoperative alternative therapy (0) and postoperative communication (0) were significantly lower than those of non-intervention group (11.9% (7/59), 10.2% (6/59)) (χ 2 values were 5.68 and 4.56; P values were 0.017 and 0.033). Conclusion:The implementation of comprehensive quality control intervention mode reduced the application of unreasonable antibiotics and standardized the writing of inpatient medical records. It is of great significance for the rational use of antibiotics and the standardization of medical record writing in the elderly patients with closed fracture.

目的 分析唐山市某院中国临床疾病诊断规范术语集(CCDT)规范选择对疾病诊断相关分组(DRGs)合格病案率及相关医疗服务绩效影响.方法 利用该院2019年4月至9月出院患者病案共26297份,分为培训前(2019年4月至6月)13069份和培训后(2019年7月至9月)13228份,分别评估CCDT规范选择质量,分析CCDT规范选择培训前后DRGs合格病案率及相关绩效指标变化.结果 CCDT规范选择培训前,CCDT选择填写错误病案3184份,占24.34％,错误类型中的诊断重复录入、主要诊断与主要操作不符占比较高,分别为48.12％、42.31％.CCDT规范选择培训前后DRGs合格病案率分别为55.27％和76.40％,差异有统计学意义(x2=1306.13,P＜0.01).CCDT规范选择培训后,医院入组病案DRGs总权重增加,DRGs组数增加,费用消耗指数减少,时间消耗指数减少,中低风险及低风险组病例减少.结论 CCDT规范选择质量直接影响DRGs合格病案率和相关医疗服务绩效评价,影响程度受CCDT选择错误类型、专科类别、疾病类别等因素影响,临床科室应充分重视住院病案首页CCDT规范选择质量控制.

目的 认识锁骨上神经的解剖分布及其功能,同时注意在锁骨骨折手术治疗过程中对锁骨上神经的游离和保护.方法 收集我院2012年10月至2013年7月共15例锁骨骨折患者,术中均行锁骨上神经分离保护,术后随访3.0 ～8.0个月,平均(6.5±0.3)个月.结果 14例未出现锁骨上神经损伤的症状体征(锁骨上神经损伤的症状有:胸壁有不同程度皮肤的感觉过敏或是感觉迟钝,同时有不同程度的皮肤干燥角化).1例术后1个月内皮肤感觉迟钝麻木,3个月后胸前皮肤感觉逐渐正常,考虑术中可能有过度牵拉造成的神经挫伤.结论 锁骨上神经从胸锁乳突肌中点处穿出筋膜,支配颈部皮肤.锁骨上神经斜行穿越锁骨,位于颈阔肌的浅面,手术暴露时应注意辨别和保护,防止发生上胸壁的感觉过敏或感觉迟钝等并发症.

Objective Toinvestigatetheeffectsofmindfulnesstrainingonfunctionalrecoveryinelderlypatientsofhip fractureafterfixation.Methods SixtyclosedhipfracturepatientshavinghadopenreductioninSecondHospitalofTangshan from June 2011 to December 2012 and internal fixation and scored 71-100 points of rehabilitation exercise(RE)safety assess-ment were divided randomly into groups control,study,30 in each. Control group had early RE,study group had mindfulness training based on RE,90 min/time,once/week,for 12 weeks,12 times altogether. The scores of hip joint function( Harris scores),activities of daily living( Barthel index),profile of mood status( POmS),mindfulness level were carried out in 2 groupsbeforeandaftertreatment.Results Onepatienthadbreakofinternalfixation,1haddeepveinthrombosisincontrol group,and 1 had break of internal fixation in study group. The above-mentioned 3 cases were excluded,the others included into statistical analysis. There was no significant difference in Harris score,Barthel indexes between 2 groups before treatment (P﹥0. 05),but higher in study group than in control group after treatment(P ﹤0. 05),higher after treatment than before treatment in 2 groups(P﹤0. 05). No difference was noted in scores of POmS scales or mindfulness level between 2 groups be-fore treatment(P﹥0. 05). The scores of tension-anxiety,depression-dispiritment,somasthemia-sluggishness were lower, those of vitality-hyperactivity higher in study group than in control group after treatment(P﹤0. 05). The scores of tension-anxiety,depression-dispiritment were lower after treatment than before in control group(P﹤0. 05),and the scores of tension -anxiety,depression-dispiritment,somasthemia-sluggishness were lower,those of vitality-hyperactivity,mindfulness level higheraftertreatmentthanbeforeinstudygroup(P﹤0.05).Conclusion mindfulnesstrainingcanenhancerehabilitationex-ercises,help recover the function of elderly patients after internal fixation and improve daily living skills and mood status.

Objective To investigate the effects of mindfulness behavior training on emotional disorder and immunological function in elderly patients after hip fracture fixation surgery.Methods Sixty elderly patients with fixed hip fracture by operation were randomly divided into a training group and a control group with 30 cases in each group.The training group received mindfulness behavior training in addition to routine rehabilitation training,while the control group only received routine rehabilitation training.The mindfulness behavior training was administered 90 min for once a week,lasting for 5 weeks.The emotional disorder was assessed with the profile of mood states (POMS),and the immune system function were evaluated by the number of CD3 + 、CD4 + 、CD8 + in T cell subgroup before and after 5 weeks of training.Results Before training,there was no significant difference in scores of POMS and the cells number of CD3 +,CD4 +,CD8 + (P ＞ 0.05) between the two groups.After treatment,scores of POMS including tension-anxiety (13.14 ± 3.36 vs 15.90 ± 4.28),depression-dejection (18.10 ± 6.24 vs 20.06 ± 5.42),fatigue-inertia (16.53 ± 3.50 vs 18.98 ± 4.88),vgor-activity (26.68 ± 5.22 vs 22.43 ± 5.20) (P ＜ 0.05),the level of mindfulness practice(58.00 ± 4.78 vs 54.00 ± 4.89) and the cells number of CD3 +,CD4 +,CD8 + (75.75 ± 5.40vs 69.91 ± 4.42 ;39.54 ± 3.29 vs 34.44 ± 4.21 ; 39.82 ± 3.55 vs 36.82 ± 3.55) in experimental group improved more than those in control group (P ＜ 0.05).Conclusion Mindfulness behavior training can improve the patients' mood state and have positive promotion on immunological function.

患者女性,35岁,政府职员,主因发热咳嗽、咳痰、呼吸困难2周就诊于某院.患者入院前2周前无诱因出现发热,体温最高达 39.5 ℃,发热时伴寒战、畏寒,伴咳嗽、咳痰、咳黄色粘痰,呼吸困难,遂就诊于当地医院给予"抗炎、化痰、平喘、间断给予解热镇痛药物治疗"(具体用药及剂量不详)治疗4 d,效果不佳.仍有咳嗽咳痰,呼吸困难及发热.

目的 探讨围手术期并发肺栓塞患者临床特征.方法选择围手术期并发肺栓塞患者102例,所及患者一般资料及临床资料,分析其临床特征.结果 围手术期高龄(≥60岁)人群并发肺栓塞者占54.9%.呼吸困难发生率分别为98.0%,明显高于心前区闷痛、胸痛、晕厥症状及紫绀、P2亢进及双下肢不对称性水肿体征发生率;合并外伤者及合并内科疾病肺栓塞发生率分别为71.1%及60.2%.结论 对于高龄、合并外伤或者内科基础疾病的围手术期患者,一旦出现呼吸困难症状,临床医师需要高度警惕是否存在肺栓塞,应给予患者相关检查明确诊断.

Objective To investigate the effects of mindfulness behavior training on mood states and quality of life in old patients post fixation for hip fracture. Methods Patients were randomly divided into experiment group (n=30) and control group (n=30). The control group received routine rehabilitation, while the experiment group received mindfulness practice therapy in addition. They were evaluated with Profile of Mood States (POMS), Short Form of Health Survey (SF-36), and Mindful Attention Awareness Scale (MAAS) before and 5 weeks after treatment. Results There was no difference in the scores of POMS, MAAS and SF-36 before treatment (P>0.05). The scores of MAAS and SF-36, the subscores of tension-anxiety, depression-dejection, fatigue-inertia and vigor-activity of POMS improved more in the experiment group than in the control group (P<0.05). Conclusion Mindfulness behavior training can improve the mood state and quality of life of old patients post fixation for hip fracture.

目的 探讨自体游离腓骨段结合自体髂骨移植治疗感染性胫骨骨缺损的方法和疗效.方法 胫骨开放性粉碎性骨折(Gustilo C3型)经过平均3.6次手术后,形成骨缺损型感染性骨不连15例,平均骨缺损6.5 cm,采用健侧游离的腓骨段结合自体髂骨移植治疗.结果 15例均获得平均12.4(9～18)个月随访.术后7个月所有骨折获得骨性愈合.疗效按Wohner-Wruhs评分标准评定:优9例,良6例.结论 自体游离腓骨段结合髂骨移植是治疗感染性胫骨骨缺损的有效方法.

目的 探讨交通伤所致肺动脉栓塞(PTE)的临床特征.方法选择我院经CT肺动脉造影 (CTPA)确诊的交通伤所致PTE的病例71人,所有患者同时行下肢螺旋CT静脉造影 (CTV)检查,收集患者临床资料,分析患者临床特征.结果 入组的71例PTE患者中,DVT发生率100%,其中41例为双下肢DVT(57.7%);单一下肢DVT患者30例(42.3%).发生交通伤至出现PTE 症状的时间半个月～6个月.多在用力大便或开始功能练习过程中发生,主要表现为呼吸困难(59/71例,83.1%)、胸痛(46/71 例,64.8%)、咯血(19/71 例,26.8%)、晕厥(5/71 例,7.0%).呼吸困难、胸痛、咯血三联症者24例,占33.8%.29例(40.8%)同时并存糖尿病、支气管哮喘、高脂血症、高血压或者冠心病之一病史,4例(19.0%)女性有口服避孕药史.结论当交通伤患者出现呼吸困难、胸痛等症状,尤其是合并多个临床危险因素时,需要临床医师要高度重视交通伤患者可能并发肺栓塞.

①目的探讨不同剂量硫酸镁对局灶性脑缺血再灌注损伤的影响。②方法将远交群(SD)大鼠分为正常组、脑缺血再灌注组和硫酸镁干预组(干预组);干预组又分为硫酸镁I组(100mg/kg)和硫酸镁II组(300mg/kg)。采用线栓法制备大脑中动脉缺血再灌注模型;缺血2小时再灌注24小时,采用化学比色法检测各组脑组织一氧化氮(NO)浓度。③结果缺血再灌注组脑组织NO浓度升高;与缺血再灌注组比较,干预组NO浓度明显降低;硫酸镁II组比I组NO浓度有所降低(P<0.05)。④结论脑缺血早期应用硫酸镁可有效减轻脑组织的损害程度,减轻脑组织的炎症反应,而且大剂量组的保护作用更加明显;硫酸镁能减少自由基的生成,提高抗自由基的能力,且与硫酸镁剂量有明显的依赖关系。