目的 着重分析和探究普外科护士结直肠手术快速康复外科(FTS)护理知识的知晓和掌握情况.方法 按照随机的方法有针对性的选取2017年3月～2018年3月在我院任职的护士50例作为研究对象,采用我们医院自行设计和制定的调查问卷,针对护士的结直肠手术快速康复外科护理知识的基本掌握和应用情况进行调查和总结.结果 普外科护士在对于FTS护理知识的知晓情况和应用情况的得分是10分,针对FTS护理知识的学习态度所呈现出的得分是67分,FTS护理行为质量所呈现出的得分为是54.13分,普外科护士与ICU病房护士进行有针对性的对比,在FTS相关知识的知晓情况,参加专业培训情况等相关方面都要有十分明显的降低,组间比较,差异有统计学意义(P<0.05).结论 经过相对应的调查和研究,可以很明显的看出,我院普外科护士针对结直肠手术FTS护理知识在知晓和应用掌握情况都比较不理想,在学习态度方面相对比较积极,在FTS培训方面比较欠缺.为了在最大程度上有效推进FTS在临床上的应用和推广,要进一步加强宣传的力度,着重针对普外科护士开展相关方面的专业培训,与相关部门进行密切的合作.

目的 有针对性的分析和研究腹腔镜结直肠癌根治术围手术期快速康复外科护理的应用效果.方法 着重选取在2017年3月～2018年3月这个时间段,我们医院所收治的100例腹腔镜结直肠癌患者进行相应的分析和研究,并针对所有患者随机分成对照组和观察组,两组各50例患者,对照组是常规的护理方法,观察组在对照组常规护理基础上在再实施加速康复外科护理,针对两个组别患者在临床效果、护理满意度、住院时间、费用和并发症发生情况等一系列相关方面进行有针对性的分析和比较.结果 通过相关的研究和分析,可以很明显的看出,在临床效果和护理满意程度方面,观察组患者要比对照组患者有十分明显的提升,在住院时间、住院费用以及并发症的发生几率方面,观察组十分显著的低于对照组,两者对比的差异有统计学意义(P<0.05).结论 对于腹腔镜结直肠癌患者来说,切实有效的对其采取加速康复外科护理措施,能够在很大程度上有效提升患者的护理满意程度和临床效果,对于住院时间、住院费用和相应的并发症发生几率等方面,都有极大的降低作用,这种方法所呈现的临床效果十分显著,值得临床应用和推广.

目的 有针对性的分析和探究快速康复外科护理措施在结直肠癌患者围术期的应用效果.方法 着重选取在2016年4月～2018年4月这个时间范围内,我们医院所收治的100例结直肠癌患者作为这次研究的研究对象,按照随机的方法分成两个组别,分别是对照组和观察组,两组各有50例患者.其中针对对照组患者所采取的是常规的护理方法,而针对观察组患者所采取的是在常规护理方法的基础上进一步实行快速康复外科护理措施,针对两个组别患者的住院时间、住院费用以及手术之后的并发症发生几率等相关情况,进行相对应的分析和对比.结果 观察组患者在平均住院时间、住院费用以及并发症的发生几率等相关方面要比对照组患者有十分明显的降低,两者比较的差异具备统计学意义(P<0.05).结论 对结直肠癌的患者采取切实有效的快速康复外科护理措施,能够在很大程度上有效降低患者术后的恢复时间以及住院费用,使其并发症的发生几率也得到根本上的降低,其临床效果十分显著,值得在临床应用和推广.

多感官刺激疗法是以灯光效果、真实的触感、冥想音乐和令人放松的香气为媒介,为患者提供以视觉、听觉、触觉、味觉和嗅觉为主的感官刺激的治疗方法[1].多感官刺激疗法起源于20世纪70年代的荷兰,最初命名为Snoezelen,传至英国后,英国人根据其含义将其命名为"多感官环境"(multi-sensory environment).临床研究将其称为"Snoezelen"或"多感官刺激疗法(multi-sensory stimulation, MSS)"或"多感官环境刺激疗法(multi-sensory stimulation environments,MSSE)".多感官刺激疗法作为一种刺激或放松的方式,为患者提供了一种无压力、娱乐的环境.因其具有智力要求低、适用范围广、时间安排灵活等特点,被国外学者广泛应用于老年痴呆、神经发育障碍、慢性疼痛及教育学等领域.但在国内,多感官刺激疗法尚仅应用于教学领域,且缺乏较为严谨的随机对照类的干预性研究.大量文献及研究[2-4]表明,多感官刺激疗法在改善不适性行为、促进患者身心健康方面有着重要作用.本文就其在相关领域的研究进展作一综述,以期为我国学者进行相关研究提供借鉴和参考,现介绍如下.

Objective To understand residents' awareness and satisfaction of family doctor service and two-way referral through investigating their situation of visiting family doctors and demand for family doctor services in two pilot towns in Shaanxi Province.Methods Using the convenience sampling,local residents from Shengshui Town and Huangguan Town in Hanzhong City of Shaanxi Province were recruited according to the locations of investigators.Residents were interviewed face to face with a self-designed questionnaire from July to August of the year 2016.The main contents of the questionnaire were the baseline characteristics of residents,residents' awareness of family doctor service and two-way referral,residents' demand for family doctor services,ways they get information about family doctor services,residents' situation of visiting family doctors and asking for the two-way referral,residents' satisfaction of family doctor services,and residents' evaluation of the two-way referral.A total of 300 questionnaires were distributed and 225 effective questionnaires were collected.The effective recovery rate was 75.0％.Results There were 91.1％ (205/225) of the residents who knew the family doctor services and two-way referral.Top three service projects with the highest awareness rate were annual free medical examination [83.6％ (188/225)],the establishment and management of health records [56.0％ (126/225)] and reimbursement ratio of two-way referral [53.8％ (121/225)].There were significant differences among residents with different age,occupation and self-health status in residents' awareness rate of the family doctor services and two-way referral (P ＜ 0.05).And 72.9％ (164/225) of residents believed that the current service projects of family doctors could meet their basic needs.The service project with the highest demand rate [81.3％ (183/225)] was regular medical examination,and the main way the residents got information about family doctor services [36.0％ (81/225)] was the introduction of medical staff.In addition,89.3％ (201/225) of the residents were in favor of initial diagnosis in primary health care institutions,and 86.2％ (194/225) of the residents preferred to visit doctors in primary health care institutions.The most satisfying service project was service attitude.Moreover,18.2％ (41 /225) of the residents were satisfied with the service attitude very much,and 66.2％ (149/225) of the residents were satisfied with the service attitude.The residents who thought the referral to superior hospitals from the primary health care institutions was carried out in a more timely manner accounted for 21.3％ (48/225),and 70.7％ (159/225) of the residents thought the referral to superior hospitals was carried out in time.The residents who thought the superior hospitals took more timely action on the referral accounted for 22.7％ (51/225),and 62.6％ (141/225) of the residents thought the superior hospitals took action on the referral timely.Conclusion The residents' awareness and satisfaction of the family doctor services and two-way referral are both in a high level.Family doctor services and two-way referral plays an important role in increasing the initial diagnosis rate in primary health care institutions and relieving the treatment pressure of large hospitals,which makes it deserve to be promoted in the future.

目前,全球约有2430万老年痴呆患者,且每年新发病例达460万以上〔1〕. 我国大约有(600~700)万老年痴呆患者,占世界老年痴呆患者数量的25%, 65 岁以上人口痴呆发病率为5% ~7% 〔2〕. 老年痴呆主要临床表现是认知功能受损和行为精神症状,研究发现,在老年痴呆疾病两大主要临床表现中,与照顾者负担密切相关的是行为精神症状〔3〕. 受传统"孝"文化、社会保障体系以及养老体系不健全等多方面因素的影响,我国老年痴呆患者主要照顾者是家庭成员. 老年痴呆不仅严重影响患者的生活质量,同时也给照顾者带来了繁重的负担.本文将从生理、心理、社会经济三方面对因老年痴呆患者行为精神症状而带来的主要的家庭照顾者负担及引起相应照顾者某一具体负担的精神行为症状进行阐述.

据统计全球每年新增460万例老年痴呆患者,患病人数增长最多的地区是中国及其周围南亚国家[1].老年痴呆是导致老年人发生残疾并依赖他人的主要原因,其社会成本几乎等同于癌症、心脏病和中风三种疾病的社会成本之和[2].目前临床主要应用药物和非药物管理两种方法治疗老年痴呆.2012年美国食品和药物管理局及欧洲药品管理局对痴呆患者药物的使用发出警告,强调传统抗精神病药物和非典型抗精神病药物均可增加患者发生缺血性脑血管病及全因死亡的风险[3],故提倡将非药物治疗作为老年痴呆患者的首选治疗方法.

Objective To investigate the status and influencing factors of self-efficacy of caregivers of cer-vical cancer patients.Methods By convenience sampling,348 caregivers of cervical cancer patients were se-lected and investigated by using general information questionnaire and general self-efficacy scale.Results The average total score of caregivers'self-efficacy was (2.77±0.61),which was below the norm.The pa-tient's occupation,education level,current life status and caregiver's gender,occupation,education level, family residence,number of alternative caregivers were the main influencing factors of caregivers'self-effi-cacy (all P<0.05),which could explain 20.3% of the total variance.Conclusion The level of self-efficacy of caregivers in patients with cervical cancer is low,and there are many factors affect the self-efficacy of care-givers.The medical staff should take targeted interventions based on the demographic characteristics of car-egivers,to improve the level of caregivers'self-efficacy and help caregivers deal with problems related to diseases effectively which can also improve the life quality of patients and caregivers.

全球老龄化影响着世界上每一个国家〔1〕,2008 年世界人口前景估计指出全球老龄化将持续到2050年. 全球老龄化的日益加剧将会导致养老服务需求增加. 目前我国家庭结构核心化、小型化,老人空巢化、高龄化,传统的家庭养老观念日渐减弱,养老机构床位总体不足〔2〕等多方面问题的出现,以前的养老模式已经不适合现在的生活模式〔3〕,集传统家庭养老、机构养老二者优势的社区居家养老由此产生. 我国社区居家养老服务刚刚开展,与发达国家存在差距.

阿尔茨海默病（ AD）行为精神症状（ BPSD）是AD的常见临床表现之一，可出现在患病后的任意时期。国际老年精神病学会将其定义为“痴呆患者经常出现的知觉、思维内容、心境或行为等症状的紊乱”〔1〕。但是目前关于BPSD相关因素的综述并不多，本文就AD患者行为精神症状相关因素的研究进展作一综述。

目的 探讨长春市某3所三甲医院老年良性前列腺增生(BPH)患者睡眠障碍的影响因素.方法 根据匹兹堡睡眠质量指数量表(PSQI)得分,对PSQI>7分的老年BPH患者应用自行设计的一般资料调查表、国际前列腺症状评分表(IPSS)和焦虑自评量表(SAS)进行问卷调查.结果 存在睡眠障碍的老年良性前列腺增生患者PSQI总分为(12.00±2.58)分,IPSS得分为(20.63±4.86)分,SAS标准分为(53.45±10.40)分,PSQI总分与IPSS得分、SAS标准分均呈正相关(P<0.01);下尿路症状分级、商业、锻炼时间、正常饮食、离婚、教师、其他职业、医务人员、自己独居、性生活次数、吸烟、完全公费、疾病了解程度进入多元逐步回归方程.结论 长春市某3所三甲医院老年BPH患者睡眠障碍发生率较高,应采取针对性的措施改善其睡眠质量,消除焦虑情绪,减少睡眠障碍的发生,促进老年患者身心健康,提高生活质量.

目的：探讨视频互动宣教对肺癌患者宣教效果，降低术后并发症发生率的影响。方法：将278名患者按非同期队列对照研究方法分为对照组132例和观察组146例。对照组采用常规教育方法，观察组实施视频互动宣教方案。比较两组患者的健康教育知识掌握情况及术后并发症发生率。结果：干预后，观察组患者对健康教育相关知识中疾病知识、手术知识、术后护理、康复知识掌握均优于对照组，差异有统计学意义（P ＜0.05），观察组患者术后并发症发生率低于对照组，差异有统计学意义（P ＜0.01）。结论：视频互动宣教有利于患者掌握健康教育相关知识，降低患者肺癌术后并发症发生率。

目的:探讨勒-雪氏病(Letterer-S iwe D isease,LS)临床病理特点。方法:采用组织病理学方法对1990~2005年间收集的LS患儿进行分析。结果:4例中,男性2例,女性2例。发病年龄最小2个月,最大9个月,平均4.75个月,3例在出生后9个月内发病。4例患者临床症状及病理结果均典型。结论:LS为朗格罕斯组织细胞增生症的一种类型,较少见,预后差,以多形性皮疹及早期出现系统损害为其特征。0

目的:探讨乳房Paget病(Mammary Paget's D isease,MPD)临床病理特征,以提高诊断水平。方法:对1989~2005年间的15例女性乳房Paget病进行回顾性分析,重阅其病理学特征。结果:15例均为单侧发病。诊断时年龄为38~82岁,平均年龄为58岁。病程约0.5~3年。2例(13.33%)自觉瘙痒,4例(26.67%)乳头回缩,10例(66.67%)为绝经后发病,7例(46.67%)同侧淋巴结肿大。15例患者临床特征及组织病理均符合乳房Paget病,镜下Paget细胞单个或成簇甚至成片浸润,分布以棘层及基底层为主。结论:乳房Paget病临床表现为湿疹样变化,临床上极易误诊,诊断主要靠组织病理。此病转移较晚,预后较好。

角化棘皮瘤(keratoacanthoma,KA),是一种比较少见的可以自愈的皮肤假性肿瘤,好发于老年人.该病的临床及病理表现变化多样,易与其他皮肤肿瘤相混淆.为此,本文对15例KA的临床表现及组织学资料进行回顾性分析,并结合文献进行讨论.