目的 了解晚期非小细胞肺癌患者接受程序性死亡受体1(programmed cell death 1,PD-1)抑制剂治疗相关不良反应的发生率和影响因素.方法 采用一般资料调查问卷对广东省人民医院的261例晚期非小细胞肺癌患者进行横断面调查,利用不良反应事件评价标准(Common Terminology Criteria for Adverse Events,CTCAE)5.0 版进行判别,同时分析患者发生免疫相关不良反应的影响因素.结果 261 例患者中有 139 例(53.3%)出现相关不良反应,常见为乏力、恶心、皮疹、瘙痒症、肺炎.Logistic回归分析结果显示:吸烟史[比值比(odds ratio,OR)=2.75,95%可信区间(confidence interval,CI)1.59～4.75,P<0.001]、免疫抑制剂治疗为2个周期(OR=6.84,95%CI 2.47～18.95,P<0.001),3个周期及以上(OR=4.51,95%CI 1.71～11.89,P=0.002)、PD-1抑制剂合并靶向治疗(OR=34.11,95%CI 4.21～276.18,P=0.001)是晚期非小细胞肺癌患者发生免疫治疗相关不良反应的危险因素.结论 晚期非小细胞肺癌患者接受免疫抑制剂治疗时不良反应的发生率较高,医护人员应加强对有吸烟史、免疫抑制剂的治疗周期为2个周期且合并其他治疗患者的关注,提供有针对性的观察和预防处理,以减少不良反应的发生.

目的:探讨NNN-链接护理模式在肺癌部分切除手术患者中的应用效果.方法:将2020年9月1日～12月31日收治的100例肺癌部分切除手术患者作为研究对象,按随机数字表法分为观察组和对照组各50例,对照组围术期给予常规护理措施,观察组采用NNN-链接护理模式进行干预;比较两组干预效果.结果:干预3个月后,观察组第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC均高于干预前(P<0.05),且观察组高于对照组(P<0.05);观察组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分低于干预前(P<0.05),且观察组低于对照组(P<0.05);观察组自我护理能力测定量表(ESCA)、肺癌生活质量测定量表(FACT-L)评分均高于干预前(P<0.05),且观察组高于对照组(P<0.05).结论:将NNN-链接护理模式应用于肺癌部分切除手术患者中,有助于肺癌部分切除手术患者术后肺功能恢复,缓解患者不良情绪,同时能对患者自护能力和生活质量水平的提升产生积极影响.

目的一线医护人员在COVID-19（coronavirus disease 2019）疫情期间的SARS-CoV-2（severe acuterespiratory syndrome coronavirus 2）的血清学特征仍然不明确。尚不清楚他们是否已建立保护性免疫。方法我们对一家COVID-19定点收治医院肿瘤中心的所有医护人员进行了SARS-CoV-2抗体检测及咽拭子核酸检测。所有医护人员均按照医院要求配备了相应的个人防护设备。使用两种胶体金法的抗体检测试剂盒（Wondfo,Innovita）进行抗体检测。结果受试者的工作场所包括隔离病房（n=18,6.40%）,发热门诊（n=11,3.9%）,普通病房（n=221,78.9%）以及行政和后勤部门（n=30,10.7%）。两种抗体检测的结果在大多数受试者中（n=278,99.2%）呈阴性。一名员工（0.36%）的Ig G/Ig M（Wondfo）呈弱阳性,而IgG/IgM（Innovita）呈阴性。另一名员工（0.36%）的IgM（Innovita）呈弱阳性,而Ig G（Innovita）和IgG/Ig M（Wondfo）呈阴性。两人随后的动态血清学检测结果均为阴性。所有受试者的核酸检测结果也均呈阴性。结论该中心的个人防护装备分级措施可有效保护人员免受COVID-19侵害。即使员工处于高风险环境中并与曾与感染患者密切接触,他们也没有受到感染,但同时也没有建立保护性免疫。因此,医护人员仍然容易受到COVID-19伤害,应严格保持个人防护。

Objective: To explore the effect of perioperative pain intervention on postoperative rehabilitation of patients who underwent thoracoscopic partial resection of lung cancer. Methods: From January 2021 to May 2021, 100 patients with primary lung cancer who underwent thoracoscopic partial lung resection in Cardiopulmonary Department II of Cancer Center in our hospital were selected. They were divided into observation group and control group by random number table. Routine nursing after surgery was used in both groups, the observation group was given perioperative pain intervention nursing on the basis of routine nursing, and the postoperative pain (6 h, 12 h, 24 h, 48 h after operation), the rate of out-of-bed activity within 24 h after operation, lien chest tube time, the incidence of postoperative complications, the influence of pain on daily life, the satisfaction of patients with pain control methods and pain education and the satisfaction of discharged patients were observed and recorded. Results: There was no significant difference in general data (age, sex, educational level, course of disease, TNM stage of lung cancer, maximum diameter of tumor (CM), surgical site) between the two groups (P > 0.05); the NRS scores of the observation group at 6, 12, 24 and 48 hours after operation were all lower than those in the control group, and the difference was statistically significant (P h out-of-bed activity in the observation group was higher than that in the control group, the lien chest tube time was shorter than the control group, and the incidence of postoperative complications was lower than that in the control group, the difference was statistically significant (P as higher than that in the control group, with statistical significance (P Conclusion: Perioperative pain intervention can effectively relieve postoperative pain state of patients, promote patients’ early out of bed and conducive to lung expansion, shorten the time of lien chest tube, reduce postoperative complications and the impact of pain on daily life, help patients recover as soon as possible, and improve the satisfaction of patients for medical treatment.

Aim To evaluate the incidence and risk factors for hypoglycemia in patients with hepatocellular carcinoma (HCC). Methods We collected and analyzed the clinical data of patients with HCC in our cancer center between April 2020 and June 2021. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with hypoglycemia. Results The incidence rate of hypoglycemia in patients with HCC was 28.9% (67/232). Multivariate logistic regression analysis showed a significant association between hypoglycemia and Child-Pugh grade C (odds ratio [OR]=7.3, 95% confidence interval [CI] 2.28–23.31, p=0.001), alpha-fetoprotein (AFP) level (OR=1.000035, 95% CI 1.000007–1.000063, p=0.015), and glycated hemoglobin (HbA1c) level (OR=0.46, 95% CI 0.29–0.73, p=0.001). Conclusion Child-Pugh stage and HbA1c and AFP levels were associated with hypoglycemia in patients with HCC. Our study suggests that these three factors should be comprehensively considered when estimating the risk of hypoglycemia in these patients, and the diagnosis, treatment, and nursing plan should be adjusted in time to reduce the incidence of hypoglycemia.

Objective:To explore the squeeze method of PTCD tube to maintain smooth drainage of the tube and promote postoperative recovery.Methods:A total of 120 patients with PTCD tube placed after cholangiography were selected, and the patients were divided into three groups A, B, and C according to the randomized controlled single-blind principle, with 40 cases in each group. Group A adopts the rapid squeeze method; Group B adopts the winding finger method; Group C adopts the progressive V-shape method.Results:The pain rate and bleeding rate of the three squeezing methods were compared, and the differences were statistically significant (P < 0.05). Among them, the pain rate and bleeding rate of the finger-wound method were the highest; the comparison of the single squeeze times of the three methods showed that the difference was significant. Statistical significance (F = 36.069, P < 0.001); comparison of the patency rates of the three methods before and after extrusion, the difference in patency rates of group C before and after extrusion was statistically significant (χ2 = 6.725, P < 0.05), suggesting the progressive V method The squeeze has the best effect.Conclusions:The progressive V-shaped method has a moderate number of single squeezing, the drainage tube has the best patency effect, and there are fewer pain and bleeding complications after squeezing. It does not affect the comfort of the patient and does not increase the burden on the operator. It is more suitable for PTCD tube squeezing. The preferred method of compression.

目的:探讨联用洛铂、表柔比星和丝裂霉素对原发性肝癌患者进行介入治疗的效果.方法:选择2014年1月至2018年12月期间广东省英德市人民医院收治的100例原发性肝癌患者作为研究对象.根据治疗方案的不同将其分为Oxaliplatin组(50例)和Lobaplatin组(50例).为Oxaliplatin组患者联用奥沙利铂、表柔比星和丝裂霉素进行介入治疗,为Lobaplatin组患者联用洛铂、表柔比星和丝裂霉素进行介入治疗.然后对比两组患者的治疗效果.结果:Lobaplatin组患者治疗的总有效率高于Oxaliplatin组患者,P<0.05.在治疗期间,Lobaplatin组患者不良反应的发生率低于Oxaliplatin组患者,P<0.05.结论:联用洛铂、表柔比星和丝裂霉素对原发性肝癌患者进行介入治疗的效果较为理想,且安全性较高.

新型冠状病毒(COVID-19)主要通过呼吸道飞沫和密切接触传播,可经人与人传播,人群普遍易感,随着感染病例的不断增加,参与新型冠状病毒肺炎患者救治的医务人员存在较大的医院内交叉感染风险.因此,采取适当的医院感染防控措施对有效预防院内感染十分重要.该文总结了介入病房临时改造的感染病房在抗击新型冠状病毒中的感染防控策略,涉及病区结构、人员培训、消毒隔离制度和工作流程等方面,实现了医务人员零感染,可为其他隔离病房的感染管理工作提供参考.

研究护士是随着临床试验行业发展而产生的一种职业,目前大多数的医院没有专人全程管理临床试验项目,导致临床试验质量无法得到保证。作为国内最早借鉴国外先进经验启用研究护士及落实相关研究护士制度的医院之一,本文总结十几年来研究护士参与临床试验全程管理实践及取得成效,供同行参考。

目的 总结该院在新型冠状病毒肺炎流行期间药物临床试验受试者随访经验,为国内医院药物临床试验受试者随访管理提供参考.方法 秉持受试者及临床试验从业人员安全第一的理念,严格遵守伦理原则及药物临床试验管理规范,迅速制定工作指引,利用信息化手段加强各部门协调沟通、人员培训,针对不同项目随访及受试者特点,改革随访方式,优化随访流程,落实随访细节,及时收集真实、准确的临床数据保障临床试验顺利开展.结果 受试者及临床试验从业人员无新型冠状病毒感染,口罩佩戴率、流行病史筛查率、环境及医疗用品消毒率均为100％,受试者超出随访窗口期58例,失访6例,失访率为1.4％,用药依从性为98.5％.结论 新型冠状病毒肺炎流行期间系统化、精细化、个性化的随访管理策略切实保障了药物临床试验质量.突发疫情对药物临床试验部门应对突发事件的能力及相关应急预案的制订和实施提出了更高的要求.

目的 减少全麻胸腔镜下肺楔形切除术后麻醉苏醒期导尿管所致的患者躁动.方法 将182例全麻胸腔镜下肺楔形切除手术患者按照数字随机表法分为观察组(不留置导尿管)和对照组(留置导尿管),每组各91例.比较两组术后麻醉苏醒期躁动例数、患者术后恢复原有排尿型态时间、膀胱刺激征发生率、尿潴留发生率等情况.结果 观察组术后恢复原有排尿型态时间显著短于对照组(P＜0.01),苏醒期躁动、膀胱刺激征发生率显著低于对照组(P＜0.05,P＜0.01).两组术后尿潴留发生率比较,差异无统计学意义(P≮0.05).结论 全麻胸腔镜下肺楔形切除手术不留置导尿管没有增加患者术后尿潴留发生率,不仅有利于患者尽快恢复正常排尿,还能显著降低患者麻醉苏醒期躁动和膀胱刺激征发生率,减轻患者痛苦.

目的 评价开展术前访谈在介入手术患者中的应用价值.方法 纳入符合研究标准的介入手术患者246例,观察组患者采取术前访谈的方式进行术前宣教,对照组采取常规的术前宣教方法,比较两组患者对介入手术相关知识的知晓情况.采用自制的介入病房护士专科知识摸底考核问卷对科室17名护士进行专科知识摸底调查及培训后的考核,比较培训前后护士对专科知识的掌握情况.结果 两组患者对介入相关知识的知晓情况差异有统计学意义(术前的相关注意事项χ2=16.814,P<0.001;术后的相关注意事项χ2=13.624,P<0.001;术后的相关饮食知识χ2=23.111,P<0.001).培训前后护士的介入手术相关知识的考核平均分从66.65分提高到75.12分.结论 实施术前访谈的宣教方式的患者观察组,无论是患者对介入相关知识知晓率,还是对科室总体满意度,都明显优于患者对照组;根据访谈表内容对介入病房护士进行介入手术相关知识的培训,可全面提高护士的介入专科知识水平.

目的 探讨术中精准穿刺套针辅助CT引导经皮穿刺定位法在周围型肺部微小结节术前定位中的作用.方法 对2016年9月至2019年2月低剂量螺旋CT显示需行术前CT定位的肺小结节患者,分为精准穿刺套件+传统胸腔穿刺针组(试验组)和传统胸腔穿刺针组(对照组),比较两组患者小结节穿刺的首次进针成功率、气胸发生率和术前定位成功率.结果 试验组与对照组首次进针成功率为78.73％vs.48.94％(x2=9.034,P=0.002),无症状气胸发生率为0％vs.8.51％(x2=4.178,P=0.041),术前肺结节定位成功率为95.74％vs.93.62％(x2=0.211,P=0.646).结论 术中精准穿刺套针联合传统胸腔穿刺针辅助CT定位提高了穿刺定位的首次进针成功率,减少了气胸的发生率,值得临床运用.

目的 对心理痛苦温度计用于肺癌患者心理痛苦影响因素进行深入研究.方法 选取我院于2019年5～7月收治的120名肺癌患者,对其进行问卷调查.结果 本次总共发放120份调查问卷,回收112份有效调查问卷,患者家庭情况、患者个人情绪、患者躯体与肺癌患者心理痛苦指数呈正相关.其中,呼吸状况、知识缺乏、焦虑、睡眠状况、疲乏、经济问题、担心复发等是肺癌患者引发心理痛苦的主要影响因素.结论 通过使用心理痛苦温度计对其进行筛查,可以对肺癌患者心理变化进行及时了解,以便对患者进行及时有效的护理干预.

目的 以低相对分子质量肝素钠(LMWH-Na)联合戒烟健康教育干预,探讨其对下肢动脉硬化闭塞血栓形成及患者生活质量的影响.方法 于2015年3月-2017年3月采用随机抽样的方法抽取我院的下肢动脉硬化闭塞症患者70例(观察组及对照组各35例),本研究采用临床随机对照试验的设计方案,所有选入研究队列的受试者均行下肢动脉硬化闭塞症的常规保守治疗,观察组在常规治疗的基础上添加LMWH-Na联合戒烟教育干预,对照组则不添加任何额外干预,对比两组患者住院期间的治疗结果 .结果观察组在干预前后"NRS评分"、"畏寒评分"、"肢端麻木评分"、"肌肉痉挛评分"、"易疲劳评分"、"躯体功能评分"、"情绪功能评分"、"社会功能评分"项目得分有所提升,对照组在干预前后"NRS评分"、"畏寒评分"、"肢端麻木评分"、"躯体功能评分"、"社会功能评分"项目得分有所提升,观察组与对照组相比"NRS评分"、"肢端麻木评分"、"躯体功能评分"、"社会功能评分"项目得分提升更加明显(P均>0.05).结论 LMWH-Na联合戒烟教育干预预防患者下肢血栓形成获得了比常规治疗更好的效果,对患者躯体和社会功能的改善尤为显著.

目的:探讨肝动脉栓塞术后术侧肢体制动时间及影响因素.方法:选取广东省人民医院2016年2月至2016年8月88例肝动脉栓塞术后的患者资料.根据患者的凝血指标异常与否分为观察组和对照组各44例.两组术后实施不同的护理措施,最后对两组术侧肢体制动时间进行比较.结果:经护理后,对照组患者的卧床时间优于观察组,两组数据比较,差异具有统计学意义(P＜ 0.05).结论:在临床上,肝动脉栓塞术后,凝血指标正常的患者4h内可下床活动,凝血指标异常的患者卧床时间应大于6h,而且可以减少并发症,提高患者的舒适度.

Objective To investigate the current situation of radiation protection capability and personal protection in the clinical practice of interventional radiology in grade-Ⅲ hospital.Methods A total of 108 medical staffs including physicians,technicians and nurses,who worked in interventional room,CT/ MR room,interventional catheterization room,radiotherapy department or radiology department in a grade-Ⅲ hospital of Guangdong province during the period from June 2014 to November 2015,were enrolled in this questionnaire investigation.The contents of self-mnade questionnaire included general demographic data,personal radiation exposure and protection.By using self-made questionnaire about the radiation protection capability of interventional work (both I-CVI and S-CVI being 0.9) the interventional radiation protection capability of the hospital was evaluated.Results In a certain grade-Ⅲ hospital of Guangdong province,the protection capability in shielding facilities,operating time and distance protection was quite strong,but the health-care leave system was lack,the occupational hazard detection was insufficient,and the protection and training system was poorly executed.In aspect of personal protection,the usage rate of lead apron in interventional procedures was only 72.2％,moreover,the rate of not wearing a radiation detector was up to 4.6％,and 9.3％ of medical staff didn't know the correct wearing position of a radiation detector.Conclusion The medical institution is lack of enough attention to the personal radiation protection as well as to the occupational health of interventional medical staff.In part of the medical staff,the consciousness of radiation protection is weak and the protection knowledge is insufficient,they are lack of adequate attention to occupational protection.All these issues need to be further improved.

目的:分析水胶体敷料对化疗患者静脉炎护理的临床价值,对其应用效果进行比较.方法:将我科接收的2015年9月~2016年3月静疗患者中随机选取158例随机分为观察组和对照组各79例,观察组在化疗前沿穿刺血管贴水胶体敷料,对照组在静疗沿穿刺血管不贴水胶体敷料,比较两组静脉炎发生率和护理满意度等.结果:观察组护理满意度显著高于对照组(P<0.05),观察组静脉炎发生率显著低于对照组(P<0.05).结论:水胶体敷料对静疗患者静脉炎护理效果显著,可提高患者的护理满意度,其临床应用价值高.

Objective To explore the clinical effect of psychological nursing pathway for patients with hepatocellular carcinoma (HCC) who are receiving 125I particle implantation therapy.Methods A total of 130 HCC patients,who were scheduled to receive 125I particle implantation therapy,were randomly and equally divided into the study group and the control group with 65 patients in each group.Traditional routine psychological nursing method was conducted for patients of the control group,while routine psychological nursing that was based on psychological nursing pathway was carried out for patients of the study group.The patient's conditions of both groups were evaluated by using self-rating anxiety scale (SAS),trait coping style questionnaire (TCSQ) and the quality of life assessment scale (SF-36).The results were statistically analyzed with t test.Results After nursing intervention,SAS scores of the study group and the control group were (43.76±6.25) and (46.16±7.19) points respectively,the difference between the two groups was statistically significant (t=-3.92,P＜0.001).The PC and NC values of the TCSQ score in the study group were (41.61±4.82) points and (20.53±5.88) points respectively,while those in the control group were (37.32±4.62) and (22.80±6.93) respectively,the differences between the two groups were statistically significant (t=5.944 and t=-3.316 respectively,P＜0.01).One month after discharge,the mental health scores of the study group and the control group were (74.58±8.68) points and (71.53±8.16) points respectively,the emotion function scores were (79.46±10.05) points and (75.13±15.09) points respectively,and the differences in both mental health score and emotion function score between the two groups were statistically significant (P＜0.05).Conclusion Standardized psychological nursing pathway can make nurses more clear about the content of psychological nursing work and enable nurses to actively plan and complete psychological nursing care measures,so that patients can get prospective,individual and comprehensive psychological care to alleviate his or her negative emotion,and to improve the quality of life.

目的 评价专科护理指标在治疗下肢深静脉血栓的应用效果.方法 选择2015年1月至2017年4月我院住院治疗的患者82例,采用尿激酶联合低分子肝素治疗,并配合优质的护理措施.比较治疗前后NRS评分、大腿围、小腿围周径差,比较治疗前后血小板(PLT)凝血酶原时间(PT)活化部分凝血活酶时间(aPTT)值,统计治疗有效率.结果 治疗有效率为91.67%;患者治疗后的NRS评分(3.06±0.33)、大腿围周径差(3.97±0.14)、小腿围周径差(2.85±0.67)显著低于治疗前的NRS评分(7.04±1.37)、大腿围周径差(4.05±0.19)、小腿围周径差(3.17±0.54);凝血指标aPTT(34.09±5.31)、PT(13.22±1.91)显著低于治疗前的aPTT(36.92±8.77)、PT(14.01±1.86),PLT(225.16±13.42)显著高于治疗前PLT(211.43±11.85),P<0.05,差异有统计学意义.结论 专科护理指标能够能为临床治疗提供客观的数据支持,改善患者的生活质量,提高治愈率.