目的:探讨鱼骨图分析法护理干预对行冠状动脉造影冠心病合并糖尿病患者的影响.方法:选取 2019 年 5 月 1 日～2021 年 6 月 30 日收治的 120 例行冠状动脉造影冠心病合并糖尿病患者,按照随机数字表法分为对照组和观察组各 60 例,对照组给予常规护理,观察组在常规护理基础上实施鱼骨图分析法护理干预;比较两组护理前后依从性、空腹血糖、收缩压、舒张压及负性情绪[采用焦虑自评量表(SAS)、抑郁自评量表(SDS)],统计两组患者及家属护理满意度.结果:护理后,观察组用餐时间、用餐量、锻炼方面依从性均高于对照组(P<0.01);护理后,观察组空腹血糖、收缩压、舒张压水平均优于对照组(P<0.01);护理后,观察组SAS、SDS评分均低于对照组(P<0.01);观察组护理满意度高于对照组(P<0.05).结论:冠状动脉造影可针对性检测患者病变程度,准确度较高,但患者常因疾病本身及对手术的担心产生焦虑或抑郁情绪,本研究通过使用鱼骨图分析法对行冠状动脉造影冠心病合并糖尿病患者实施干预,可缓解患者焦虑、抑郁等负性情绪,提升生活质量.

目的:探讨维持性控制护理结合4R危机风险管理在高血压合并脑出血非急性期患者中的应用效果.方法:将2019年6月1日～2021年1月30日收治的78例高血压合并脑出血患者,采用奇偶法将患者分为研究组和对照组各39例,对照组采用常规护理干预,研究组在常规基础上采用维持性控制护理结合4R危机风险管理护理;比较两组护理前后生活能力[采用日常生活能力评定量表(BI)]、神经功能[采用美国国立卫生研究院脑卒中量表(NIHSS)]、生活质量[采用健康调查简表(SF-36)]和自我管理能力.结果:护理后,两组BI、NIHSS、SF-36评分均优于护理前(P<0.05);且研究组均优于对照组(P<0.05);研究组自我管理能力评分高于对照组(P<0.05).结论:维持性控制护理结合4R危机风险管理有助于改善高血压合并脑出血患者的神经功能、自我管理能力和生活质量,值得临床推广应用.

Objective:To investigate the diagnostic value of rapid on-site evaluation (ROSE) technique in the mucosal biopsy under respiratory endoscopy in children with active tuberculosis.Methods:Clinical data of 40 patients with active tuberculosis diagnosed in Department of Respiratory Intervention, Qilu Children′s Hospital, Shandong University from June 2017 to January 2020 were retrospectively analyzed.Results:(1) There were 33 cases of tracheobronchial tuberculosis and 7 cases of tuberculous pleurisy in the 40 cases, among them 9 cases were difficult to diagnose.(2)Among 33 cases of tracheobronchial tuberculosis, 24 cases (72.7%) of caseous necrosis breaking into the lumen, and 9 cases (27.3%) of mucosal swelling and external pressure.Cytological ROSE (C-ROSE) showed granuloma, epithelioid cells and lymphocytic infiltration with all bronchial mucosal biopsies.Different positives results of microbiological ROSE (M-ROSE) in different biopsy parts: positive results were found 6 times at caseous necrosis (13.6%, 6/44 times), 4 times at granulation hyperplasia (12.5%, 4/32 times), 2 times at hyperemia and edema (22.2%, 2/18 times), 0 time at yellow-white necrosis, and 54 times at the junction between lesions and normal mucosa (81.8%, 54/66 times). The mucosal pathology showed granuloma, exudation and necrosis, including 22 cases with tuberculous granuloma, 5 cases with characteristic tuberculous nodules, and 11 cases with positive acid-fast staining.(3)Seven cases of tuberculous pleurisy, serious pleural adhesion, pleural hyperemia and edema were observed under thoracoscopy.After clearing the adhesive tape, scattered caseous miliary nodules were found in pleura in 4 cases with a difficult clinical diagnosis.The C-ROSE of smear on thoracoscopic biopsy were characterized by necrotic and histopathic cell, with multinucleated giant cells, but granuloma was rare.M-ROSE in different parts: 8 times positive for millet nodules (80.0%), 0 time positive for adhesion band, 2 times positive for congestion oedema (14.3%); biopsy pathology showed granuloma and necrosis, with 3 cases characteristic tuberculosis nodules and 2 cases positive for anti-acid staining.(4)Pathogenic microorganisms were detected in 19 children using next generation sequencing (NGS) and Mycobacterium tuberculosis/Rifampicin resistance real-time nucleic acid amplification detection technology (Xpert MTB/RIF), including 7 positive for NGS (36.8%), 8 positive (42.1%) and 5 positive for both NGS and Xpert MTB/RIF (26.3%).Conclusions:Respiratory endoscopy combined with ROSE technique has important clinical significance in early diagnosis of active tuberculosis in children, and it is worth of promotion and applying.

Objective:To study the early predictors of Mycoplasma pneumoniae necrotizing pneumonia in children.Methods:Clinical data of 291 children with lobar pneumonia caused by Mycoplasma pneumoniae who were hospitalized in Department of Respiratory Intervention, Qilu Children′s Hospital of Shandong University from August 2016 to September 2018, were retrospectively analyzed.The patients were divided into necrotizing pneumonia group (154 cases) and non-necrotizing pneumonia group (137 cases). After comparing clinical characteristics, laboratory tests, and bronchoscopy findings, multivariate logistic regression analysis was carried out on the indicators with statistical significance to obtain the independent predictive indicators of Mycoplasma pneumoniae necrotizing pneumonia, and then the cutoff value with the maximum diagnostic value of each indicator was found through receiver operating characteristic (ROC) curve analysis.Results:There were no significant differences in gender and age distribution, duration before admission, and platelet count between the 2 groups(all P>0.05). Necrotizing pneumonia group manifested with 11.0(8.3-14.4)×10 9/L of white blood cell count, 0.740±0.115 of neutrophil, 44.2(21.2-72.0) mg/L of C-reactive protein(CRP), 55(35-80) mm/1 h of erythrocyte sedimentation rate, 0.19(0.08-0.60) ng/L of procalcitonin, 2.63(1.62-3.79) mg/L of plasma D-dimer, 456(340-665) U/L of serum lactate dehydrogenase, (35.6±4.3) g/L of serum albumin, 121 cases(78.6%)of bronchoscopic mucosal erosion, 75 cases(48.7%)of purulent lavage, 119 cases(77.3%)of massive secretions embolism; non-necrotizing pneumonia group manifested with 8.7(6.9-11.6)×10 9/L of white blood cell count, 0.660±0.127 of neutrophil percentage, 15.9(7.5-34.3) mg/L of CRP, 45(30-60) mm/1 h of erythrocyte sedimentation rate, 0.10(0.06-0.20) ng/L of procalcitonin, 0.69(0.46-1.24) mg/L of plasma D-dimer, 314(250-419) U/L of serum lactate dehydrogenase, (38.9±3.7) g/L of serum albumin, 53 cases(38.7%)of bronchoscopic mucosal erosion, 20 cases(14.6%)of purulent lavage, and 76 cases(55.5%)of massive secretions embolism.All the above indicators had statistical differences between the 2 groups.Erythrocyte sedimentation rate, serum lactate dehydrogenase, D-dimer, and bronchoscopic mucosal erosion were independent predictors of Mycoplasma necrotizing pneumonia.The area under the ROC curve were 0.643, 0.749, 0.858 and 0.699, respectively, with the cut off point of 53 mm/1 h, 335 U/L, and 1.36 mg/L, respectively. Conclusions:Erythrocyte sedimentation rate≥53 mm/1 h, serum lactate dehydrogenase≥335 U/L, D-dimer≥1.36 mg/L, and bronchoscopic mucosal erosion are early independent predictors of Mycoplasma necrotizing pneumonia in children, among which D-dimer has the highest value.

Objective To discuss the diagnosis,curative effect evaluation of infantile subglottic hemangioma through bronchoscopy,and oral Propranolol curative effect.Methods Twenty-four cases of subglottic hemangioma were retrospectively analyzed from April 2012 to March 2015 in Shandong University Qilu Children's Hospital,all cases were diagnosised by neck enhanced CT or magnetic resonance,receiving oral Propranolol treatment.Starting dose was 0.5 mg/(kg · d),3 times per day,monitored in terms of blood pressure,blood sugar and heart rate,etc.with no bad reaction after 3 days of dosage,increased to 2.0 mg/(kg · d),6 days later to maintain the dose for at least 6 months,with bronchoscopy follow-up visit on a regular basis.All the children received 3 to 15 months of follow-up.Results Clear diagnosis of subglottic hemangioma was made in 24 cases who received oral Propranolol treatment,and after 5-7 days symptoms such as laryngeal stridor and dyspnea were relieved to different extent.Under the bronchoscope tumors could be observed to shrink.After 6 months of oral Propranolol,11 cases of tumors had completely faded,13 cases of tumors had significantly reduced,laryngeal stridor and breathing difficulties were relieved.One patient with parotid gland hemangioma was also improved,3 cases had mild bradycardia during hospital treatment,but during hospitalization and after discharge low blood pressure,hypoglycemia and other side effects were not observed.Conclusions Bronchoscopy in the diagnosis and treatment of infantile subglottic hemangioma plays an important role in the judgment of curative effect as it is both safe and reliable.Taking oral Propranolol can help to shrink tumors in a short period of time,improve the symptoms of respiratory tract obstruction,with distinct curative effect and little side effect.

OBJECTIVE To detect and analyze the drug resistance of Escherichia coli,Pneumonia crayresearch and Acinetobacter baumannii strains and the resistance genes situation of quinolone-resistant strains,to provide the scientific basis for guiding rational clinical application of antibacterial drugs,effective preventing and controlling drug-resistant bacterial infections. METHODS The bacteria stains were separated in clinic and identified by BD Phoenix100 full-automatic Microbiology System.We conducted the drug sensitive test by Kirby-Bauer.Extended spectrum β-Lactamase strains were identified by antimicrobial susceptibility guesswork.Polymerase Chain Reaction(PCR) was takento detect two sorts of Quinolone drug-resistant genes: parC、gyrA in drug resistant strains to Quinolone drugs.On antimicrobial susceptibility test and genetic test were analyzed comprehensively. RESULTS Three kinds of bacteria were obviously drug-resistant phenomenon.According to quinolone drug resistance they were E.coli,Pneumonia crayresearch bacteria and A.baumannii.Between Qingdao and Juxian area the positive rate of quinolone drug-resistant genes gyrA of E.coli clinical separation strains(42.9% and 5.36%) was significantly different,parC(42.9% and 25.0%) wasn't different.The positive rate of quinolone drug-resistant genes gyrA(20.0% and 17.6%)and parC(40.0% and 47.1%) of Pneumonia crayresearch bacteria and A.baumannii with genes gyrA(10.3% and 11.1%)and parC(10.3% and 22.2%)in Qingdao and Juxian area also was no different.The positive rate of resistant genes gyrA and parC in ESBLs-producing E.coli(30.0% and 14.0%)and Pneumonia crayresearch(50.0% and 28.6%)weren't obviously different compared with no ESBLs-producing E.coli(25.0% and 10.0%)and Pneumonia crayresearch(38.9% and 11.1%). CONCLUSION The drug resistance of three kinds of bacteria strains from ICU and clinical departments critical patients is serious and is multiple drug-resistant;carrying quinolone resistance genes is quinolone resistance of reason,besides there might be other quinolone drug resistant mechanism existing.