目的 探讨多学科护理团队协作模式在老年围手术期患者中的应用效果.方法 选取笔者所在科室2018年1—12月就诊并行手术治疗的65岁以上老年患者50例为对照组,选取2019年1—12月就诊行手术治疗的65岁以上老年患者50例为观察组.对照组给予老年科常规围手术期护理,观察组在对照组基础上给予多学科护理团队协作模式进行干预,比较2组患者术后并发症、护理不良事件发生率及平均住院天数.结果 观察组术后并发症及护理不良事件发生率均低于对照组(χ2=5.086,P=0.024;χ2=4.396,P=0.036);平均住院天数短于对照组(t=5.913,P=0.016).结论 多学科护理团队协作模式可以降低老年患者术后并发症的发生率,缩短平均住院时间.

新型冠状病毒肺炎作为突发的疾病,有较强的传染性,而且人类对此疾病的认识也有一定的局限性,所有的医护人员在面对一个从来没有接触过此疾病的工作过程中对他们的身心产生了巨大的压力.该文旨在分析产生心理压力的原因,探讨对策,使医护人员更有效地工作.

目的:分析功能性胃肠病(FGIDs)患者发生抑郁、焦虑状态与胃肠道症状分级之间的联系,进而针对性采取正确有效的预防措施.方法:选取60例FGIDs患者(均于2019年1月-2019年12月期间我院接受诊疗)作为观察组,选出同期60例健康体检人群作为对照组.比较两组患者抑郁、焦虑发生率,进行胃肠道症状严重程度测评,并对二者间的相关性进行分析.结果:观察组其组间抑郁、焦虑的发生率比较无显著性差异(P>0.05),但相较对照组均明显较高,且差异具统计学意义(P<0.05).观察组患者抑郁、焦虑症状越严重,则患者胃肠道症状分级越高,呈正相关,且不同程度抑郁、焦虑症状患者的胃肠道症状分级相比较具统计学意义(P<0.05).结论:功能性胃肠病患者的胃肠道症状严重程度随着其抑郁、焦虑发生率增高而加重.

目的 探讨超声引导下富血小板血浆注射治疗肩袖损伤的临床疗效.方法 选取2014年1月至2015年1月期间在我科治疗的60例肩袖损伤患者作为研究对象,采用随机数字表法将其分为观察组及对照组,每组30例患者.观察组给予富血小板血浆注射治疗,对照组给予玻璃酸钠注射治疗.于治疗前、治疗后2周、12周及24周时分别采用上肢Fugl-Meyer量表(FMA)及视觉模拟评分法(VAS)对2组患者上肢功能及疼痛病情进行评定,同时记录治疗过程中2组患者不良反应发生情况,于治疗后24周时采用超声观察肩袖修复情况.结果 治疗前2组患者上肢FMA评分及疼痛VAS评分组间差异均无统计学意义(P＞0.05);注射治疗后2周、12周及24周时2组患者上肢FMA评分、疼痛VAS评分均较治疗前明显改善(P＜0.05);并且上述时间点观察组患者上肢FMA评分及疼痛VAS评分均显著优于对照组水平(P＜0.05);注射治疗后24周时观察组总有效率为96.6％,注射后未发现明显不良反应;对照组总有效率为63.3％,注射后有2例出现疼痛加重现象,不良反应发生率为6.7％,组间差异均具有统计学意义(P＜0.05).结论 超声引导下富血小板血浆注射治疗肩袖损伤操作简单且疗效确切,能显著缓解患者肩关节疼痛,加速组织修复并改善关节功能.

目的:探讨分化型甲状腺癌患者围术期内应用临床护理路径的作用.方法:选择2017年1月至2018年3月收治的84例分化型甲状腺癌患者作为研究对象,随机平均将患者分为两组:为对照组患者实施常规护理干预,为观察组患者实施临床路径护理.对比两组护理效果.结果:观察组患者发生并发症的几率低于对照组,患者对护理服务的满意度高于对照组,住院时间短于对照组;SAS和SDS量表结果显示干预后观察组患者的焦虑、抑郁情绪明显改善,情绪状态好于对照组,各项数据在统计学中对比均得到P<0.05.结论:临床护理路径在分化型甲状腺癌病人围术期护理中的应用效果良好.

Objective To explore the application of comprehensive rehabilitation therapy in elbow joint dysfunction resulted from traumatic elbow fracture.Methods Sixty-eight patients with elbow dysfunction after fractures were treated in our hospital between June 2014 and June 2015.The patients were randomly divided into the comprehensive treatment group and control group with 34 patients each.Patients in the comprehensive treatment group underwent the comprehensive rehabilitation therapy (traditional Chinese herbal fumigation+fine-tuning static drawing limp+arthrosis mobilization+active training).Patients in the control group were treated with arthrosis mobilization only.Visual analogue scale (VAS) pain score and Mayo elbow performance score were assessed before and 2,6 and 12 weeks after the treatment,respectively.Results After 2,6 and 12 weeks of treatment,VAS pain score and Mayo elbow performance score were improved in patients of both groups compared with pre-treatment.The differences were statistically significant (P＜0.05).The scores of the comprehensive treatment group were all significantly higher than scores of the control group (P＜0.05).Conclusion Comprehensive rehabilitation therapy can not only improve the function of the elbow,but also greatly improve the efficacy of rehabilitation,which is worth to be popularized and applied clinically.

Biliary atresia (BA) is the most common cause of persistent jaundice in infant,it can rapidly advance to biliary cirrhosis and death.Surgical treatment in time can decrease mortality,so it is essential to be differentiated from other diseases as early as possible.Main diagnosis methods of BA include clinical feature of patients,liver biopsy,and high-frequen cy ultrasonography,MR cholangiopancreatography (MRCP),hepatobiliary scintigraphy.High-frequency ultrasonography is superior to other methods with high diagnostic specificity and sensitivity.The progresses of ultrasonography in diagnosis of BA were reviewed in this article.

Objective:To study the correlation between the features of ultrasonography,histopathology and ultrastructural pathologic changes in children with non-biliary atresia (BA) cholestatic diseases.Methods:26 children with non-biliary atresia (BA) cholestatic diseases were received liver biopsy guided by ultrasonography.The children were scanned by ultrasound before the biopsy,and the tissues obtained by biopsy were send for pathology or gene examination.Results:Ultrasonography of 26 children showed hyperechoic liver parenchyma in 8 cases,Glisson system wall thickening in 4 cases,coarse parenchyma in 3 cases,hepatomegaly in 5 cases,and no special changes in other 6 cases.Ordinary pathologic reports included 18 cases of inflammatory cell infiltration,14 hepatocyte hydropic degeneration,13 cholestasis,and others included hepatocyte swelling,fatty degeneration and fiber tissues proliferation.Ultrastructural pathologic changes showed 20 cases of hepatocyte cholestasis,17 dilation of cholangiole and 15 increased glycogen.Other findings were as follows:fatty degeneration,fibrous tissues proliferation and inflammatory cell infiltration.Conclusion:US features can reflect the liver pathological state,and these can guide clinical diagnosis and estimate prognosis.The diagnosis of hereditary metabolic disorders could be made by liver biopsy,especially the ultrastructure pathology.

Objective To compare the medical quality among hospitals of different ownerships,and to explore its reference value for policy-making.Methods The paper summarized the relevant empirical literatures at home and abroad.Results The current studies didn't reach a conclusive result on medical quality among hospitals of different ownerships.Conclusion Chinese government should create a mechanism and a fair environment for running hospitals by nongovernmental capital,formulate unified quality standards,and strengthen the supervision.

Objective To evaluate the differential diagnostic value and superior of biliary atresia(BA)in the infants with cholestatic hepatopathy by high-frequency ultrasonography (HUS).Methods After 4 hours fasting,124 infants with cholestatic hepatopathy were scanned with high-frequency US.The data of hepatic size and parenchyma,gallbladder,triangular cord (TC) sign,bile duct,right hepatic artery (RHA)and portal vein (PV) were observed and measured.Meanwhile,the other data were collected,which included the clinical diagnosis,blood biochemical tests,the MRCP and dynamic duodenal liquid color check finding,the pathological results after liver puncture biopsy and so on.Results In 124 infants with cholestatic hepatopathy,BA was found in 61 infants and ruled out in 63.TC thickness,RHA diameter,and gallbladder length and width exhibited significant differences between the group with BA and the group non-BA(all P ＜0.001).The correctness for the diagnosis of BA was 90.3％ by the combination of TC sign and abnormal gallbladder morphology,and 83.1 ％ by stool color,81.5 ％ by γ-GT,47.5 ％ by MRCP,83.3 ％ by dynamic duodenal liquid color check,95.2％ by the pathology after liver puncture biopsy,respectively.Conclusions HUS is superior to other diagnostic methods in BA with higher accuracy rate,noninvasion,simplicity and economy.

Objective To investigate whether ultrasound(US) irradiation combined with nano/microbubble(NMB) can enhance the inhibiting effects of adriamycin on H22 hepatocarcinoma in mice.Methods 50 models of transplanted subcutaneously tumors in female KM mice were randomly divided into five groups,ten mice in every group:the control group,ADM group,ADM+NMB group,ADM+US group and ADM+NMB+US group.The mice were treated every other day for five times.The growth of the tumor was monitored by ultrasound,the necrosis area and the microvascular density of the extracted tumor were obtained,the remained mice were fed as usual to observe the survival time.Results Compared with the control group,treatment group tumors grew slowly,the lifespan lengthened,the tumor's necrosis area increased,the microvascular density decreased(P＜0.05),and the difference of the ADM+NMB+US group is more significant compared with the other experience groups(P＜0.05).Conclusions Ultrasound combined with nano/microbubbles can enhance the inhibiting effect of adriamycin on H22 hepatocarcinoma in mice.

目的 对冠心病患者接受综合护理干预后其生活质量的改善情况进行观察和评价.方法 选取2015年3月~2016年3月我院收治的冠心病患者90例为研究对象,随机分为对照组与观察组,观察组接受综合性护理干预,对照组接受常规护理干预.对比干预后两组患者的生活质量变化情况.结果 干预后,观察组患者的健康情况明显好转,问卷结果 显示患者的生理功能、生理职能以及心理情绪状况均发生了大幅度的好转,与对照组比较,差异有统计学意义(P<0.05).结论 冠心病患者接受综合护理干预后,其生活质量水平得到明显的改善,该种护理理念和措施极具应用于推广价值.

Objective To investigate whether ultrasound mediated nano/microbubbles(NMB) could reduce the dosage and cardiotoxicity of adriamycin(ADM) on the treatment of H22 transplanted mice model.Methods Thrity models of transplanted subcutaneously tumors in female KM mice were randomly divided into 5 groups(n =6):the control group,ADM 1.0 mg/kg,1.5 mg/kg,2.5 mg/kg groups and 1.0 mg/kg ADM + NMB + US group.The mice were treated every other day for five times.After treatment the mice were sacrificed and the growth of the tumor was monitored by ultrasound and drawn tumor growth curve diagram.The tumor was extracted for HE staining,CD34 and ki67 immumohistochemical staining to observe and count the necrosis area,the microvascular density and the proliferation of tumor cells.The myocardial enzymes (AST,CK,LDH) were assayed to evaluate the cardiac toxicity of each treatment in mice.Results Compared with the control group,the all experiment groups were with a tumor growth slowly,necrosis area enlargement,microvascular density and the tumor cell proliferating phase decreased (P＜0.05).The tumor's volume,microvascular density and the tumor cell proliferating phase in the 1.0 mg/kg ADM+ NMB+ US group were less than those in other groups(P ＜0.05) expect for 2.5 mg/kg ADM group(P ＞0.05).The values of AST,CK and LDH in 1.0 mg/kg ADM + NMB + US group were less than those in 2.5 mg/kg ADM group(P ＜0.05).The CK in 1.0 mg/kg ADM + NMB + US group was less than that in 1.5 mg/kg ADM group(P =0.002).Conclusions Ultrasound irradiation combined with nano/microbubbles can keep the therapeutic effect of adriamycin but decrease its dose and toxicity on H22 transplanted mice.

Objective To investigate the optimal ultrasound exposure parameter on H22 neoplasms of mice meditated by ultrasound exposure combined with self‐made nanobubbles ,and then observe their therapeutic effect combined with cisplatin and their possible mechanism of anti‐tumor . Methods Thirty mice engrafts models with subcutaneous H22 neoplasms were established and divided into 6 groups randomly ,which received ultrasound exposure at different intensity and exposure time . The contrast enhanced ultrasound imaging ( CEUS ) was performed in every group at the four time points of before treatment and at 0 h ,24 h ,72 h after treatment . To obtain the optimal ultrasound parameters ,the tumor inhibitory effect was assessed by enhanced intensity ( EI) and microvascular density ( MVD) . The H22 tumor were treated by ultrasound exposure nanobubbles combined with cisplatin to observe their tumor growth inhibition rate ,and the microvessels density and nuclear associated antigen Ki‐67 proliferation index were measured by immunohistochemical staining . Results There was a statistically difference in enhanced intensity (EI) between the experimental groups and control group ( P < 0 .05) . With the increasing of ultrasound intensity and exposure time ,the tumor inhibitory effect was more obvious ,with an increasing side reactions . Except the simple ultrasound group ,there was a statistical difference in tumor inhibition ,the mean MVD and the tumor cell proliferation index (KI‐67) between control group and the other ultrasound therapy groups ( P<0 .05) . The tumor inhibitory rate was the highest ( tumor inhibition rate 70 .0% ) and the mean MVD and KI‐67 expression were the lowest ( P <0 .05) in the combination group comparing with the others . Conclusions The ideal ultrasound exposure parameter of tumor inhibition showed that exposure intensity chose 1 W/cm2 and exposure time chose 1 min or 3 min intermittence . The ultrasound exposure self‐made nanobubbles combined with cisplatin could enhance the tumor inhibitory effect .Its mechanism may be related to the decrease of microvascular density ,the inbition of tumor cell proliferation and the increase of tumor cell necrosis .

目的 对胃癌手术患者接受优质护理的具体护理效果进行观察和评价.方法 选取2014年3月~2016年3月我院胃癌手术且接受优质护理干预患者40例作为研究对象,作为观察组,另外抽取胃癌手术行常规护理的患者35例作为对照组.比较两组在护理效果方面存在的差异.结果 观察组术后肛门首次排气时间、平均住院时间、术后疼痛均优于对照组,差异有统计学意义(P<0.05);观察组护理满意度为97.5%(39/40),对照组护理满意度为74.29%(26/35),差异有统计学意义(P<0.05).结论 胃癌手术患者接受优质护理干预具有良好的护理效果,极具临床推广价值.

医疗服务质量改进和医院服务效率的提高是改善医院绩效的经典话题，在深化医药卫生体制改革阶段，开展对医疗服务质量与效率持续改进的讨论具有切实的实践意义与理论价值。为了促进卫生决策与医院管理实践及理论研究的互动与融合，为了加强国内医院院长之间的交流与合作，同时为了更好地发挥高校医院管理研究机构的引领作用，华中科技大学同济医学院医院管理与发展研究中心于2015年3月18日在武汉市主办了为期2天的“第一届医疗服务质量与效率改进院长论坛”。

分析化疗患者静脉炎发生的原因分析及干预方法。

Objective To explore the scope of basic medical services at primary health organizations in China and offer references for making corresponding lists of such basic services.Methods The investigation covered 541 primary health organizations in six provinces and cities in China,and the diseases of basic medical services were rounded up with the disease integrated values.Results The survey found 41 common diseases for both outpatient/emergency departments at primary health organizations in 2010,covering 82％ of the total outpatients.And there were 24 common diseases in inpatient environment at primary health organizations in 2010,covering 82.53％ of the total inpatients,and accounting for 79.20％ of the total inpatient costs.Conclusion Primary health institutions are critical medical service providers which guarantee basic medical care services in rural and urban areas in China.The integrated value for single diseases may be used to identify common diseases within basic medical services.This will provide references for rounding up the scope of basic medical services of such organizations.

医院等级评审作为医院规范化管理的途径,对民营医院的健康发展具有重要导向意义.自201 1年第二周期医院等级评审启动以来,我国民营医院评审认证日益活跃.文章在回顾总结我国民营医院评审认证经验的基础上,分析了我国民营医院的发展以及医院评审的相关内容,并对民营医院评审提出建议.

静脉留置针输液现已广泛用于临床，其操作简单，套管在静脉内留置时间长，且不易穿破血管，从而减轻患者痛苦，提高护士工作效率，便于临床用药。影响留置针留置时间的因素较多，如血管及留置针的选择、护理人员的操作技术、固定方法、封管液的选择与封管技术、药物因素等等。在临床工作中，我科针对相关因素，采取了相应护理对策，从而延长了留置时间，保护了血管，提高了护理质量。