目的 构建适宜北京市血液透析室的医院感染质量控制体系,评估北京市血液透析室医院感染防控关键点的薄弱环节,为进一步完善质量控制中心医院感染质量控制能力与水平提供帮助.方法 在肾内科专家、医院感染控制专家及医政管理专家共同参与下,根据国家卫生管理部门制定的医院感染管理规范及血液透析标准操作规程,确定调查内容与环节并形成现场医院感染质量控制体系,其核心内容包括8个关键维度:机构与人员资质;透析室布局与结构;管理制度;职业防护及手卫生规范;重点血液传播性疾病的管理;感染控制措施的落实;各功能区感染防控管理;安全复用,共计43个感染控制检查专项,其中包含91个感染控制风险行为(点),采用调阅档案、现场考试与现场观察相结合的方法,于2017年11月～2018年1月对北京市辖区内血液透析室进行调查与分析.结果 ①共调查北京市辖区内122家血液透析室,总体医院感染检查得分为94.6分,其中三级医疗机构中的血液透析室得分为95.0分;二级医疗机构中的血液透析室得分为93.4分;一级医疗机构中的血液透析室得分为90.8分.②在上述8个维度中得分排名较低的3位分别为:透析室布局与结构(89.3分)、感染控制措施的落实(91.3分)、机构与人员资质(92.8分).③医院感染防控最薄弱环节的检出率前3位为:消毒隔离的风险行为(点)(29.5％)、基础设施不完善的风险行为(点)(26.2％)、治疗准备室区域的风险行为(点)(26.2％).结论 血液透析室的布局与结构、感染控制措施的落实、各功能区域感染防控管理等3个维度是北京市血液透析室中医院感染风险行为(点)的高发环节,血液净化质量控制中心在未来质量控制以及各血液透析室日常管理过程中应强化这3个维度的督导与管理.

目的 通过分析北京市适龄妇女免费乳腺癌筛查中确诊为乳腺原位癌和浸润癌妇女的筛查情况,评价乳腺超声和乳腺X射线摄影检查在乳腺癌筛查中的应用效果,为提高乳腺癌筛查工作质量提供参考依据.方法 采用2011-01-01-2018-12-31北京市乳腺癌筛查的数据,选择病理确诊为乳腺原位癌和浸润癌的1339名妇女作为研究对象,回顾性分析确诊妇女乳腺超声检查和X射线摄影检查的乳腺影像报告和数据系统(BI-RADS)分类结果与病理确诊结果的符合情况.结果 病理确诊为乳腺原位癌和浸润癌的妇女中,共有1264名妇女在指定筛查和转诊机构接受了全部检查,其中1209名妇女检出原位癌或浸润癌,漏诊率为4.35％.2017-2018年,漏诊率下降到2.79％.接受超声检查的1337名妇女中,697人检查结果为BI-RADS分类≥4类,符合率为52.13％,159人超声筛查结果为1或2类,超声漏诊率为11.89％.接受乳腺X射线摄影检查的1166名妇女中,909人检查结果为≥4类,符合率为77.96％,257人检查结果为1或2类,乳腺X射线摄影检查漏诊率为7.20％.乳腺癌筛查工作开展以来,乳腺超声检查和乳腺X射线摄影检查的漏诊率均呈下降趋势.2017-2018年,乳腺超声漏诊率为8.33％,乳腺X射线摄影检查漏诊率为4.81％.结论 乳腺超声及X射线摄影检查作为中国女性乳腺癌筛查常规的影像学检查方式具有诊断符合率稳定、漏诊率低的优点,应进一步加强对筛查人员的技术培训,规范检查技术,加强质量控制,重点提高对于乳腺恶性病变的识别能力.

目的 探讨新冠疫情期间对于血液透析患者应用健康教育宣教记录单进行疫情防控的效果评价.方法 全层抽取某三甲综合医院2020年2月1日-2020年6月30日血液净化中心维持性血液透析患者120人,疫情期间对患者采用以健康宣教记录单为标准对患者进行健康教育,记录患者居家管理情况、透析情况以及心理干预情况.于2020年2月1日及2020年6月30日分别对患者进行焦虑量表、健康调查简表及患者满意度评价.结果 应用健康教育记录单后患者焦虑评分为35.11±2.40分,与应用健康教育记录单前49.25±3.65分有明显降低,P=0.001具有统计学意义.应用健康教育记录单后患者生理职能、情感职能、社会职能、生理功能、躯体疼痛、活力、精神健康以及总体健康等健康调查简表中生活质量各项评分均显著好于应用前.患者满意度由90％提升至98％,差异具有统计学意义,P=0.035.结论 在新冠疫情期间,通过健康教育宣教记录单的应用,对维持性血液透析患者进行针对性健康宣教,对抗疫治疗和提升生活质量均有积极意义.

目的 对拟参与北京市适龄女性免费子宫颈癌筛查的人乳头瘤病毒(HPV)检测试剂与实验室进行评估.方法 2016年11月至2017年5月期间对自愿参与北京市适龄女性免费子宫颈癌筛查的HPV检测试剂与实验室进行资料审核、实验室质控及样本检测.结果 8种试剂检测HR-HPV、HPV16和18的Kappa值均达到了0.800以上,一致性较好;检测CIN2+的敏感度、特异度、阳性预测值和阴性预测值各组之间相比均无统计学差异(P＞0.05).63.1％的实验室通过了室间质评.8种试剂与6家实验室组合具备参与北京市适龄女性免费子宫颈癌筛查的资质.结论 通过评估分析参与北京市免费子宫颈癌筛查的各种HPV检测方法的临床准确性,掌握了HPV实验室的服务能力,初步筛选出了8种HPV检测试剂和6家PCR实验室承担北京市宫颈癌筛查工作,为完善适龄女性免费子宫颈癌筛查方案提供依据.

目的 了解北京地区门诊收集的青少年女性流产情况,为制定北京市青少年综合保健服务内容以及针对在校青少年的宣传策略提供理论依据.方法 利用自行设计的调查登记表,对2017年10月1日至12月30日在北京市3个区的计划生育技术服务机构,对孕10周内人工流产的所有妇女的情况进行登记.结果 共收集流产个案信息2 895例,其中14～24岁青少年女性531例,占总流产人数的18.4％.北京地区≤17岁流产的青春期女性例数很少,从18岁开始,随年龄增加流产例数逐渐增加,24岁最多.门诊流产青少年学历以高中、中专及职高为主(37.1％).青少年既往有过流产史的共215例,占40.5％;最多的流产5次,3次及以上高危流产史的30例,占5.7％.青少年中有分娩史的109例,占20.5％.在采用避孕方法方面,青少年未避孕的比例较高,为34.7％;采用现代高效避孕方法的比例仅为42.9％.青少年流产原因中无妊娠意愿、未避孕的比例较高,为57.8％.结论 建议学校及相关机构在高中阶段前对青少年进行性与生殖健康的全面教育,同时整合学校、社区和妇幼保健资源,建立关爱青少年生殖健康的服务网络.

目的 探讨自制固定式冰袋在肌肉活组织检查术后的应用效果.方法 于2016年8月—2017年7月,选取首都医科大学宣武医院神经内科收治的神经肌肉病患者96例.根据患者入院顺序予以编号,按照随机数字表将患者分为观察组(n=48)、对照组(n=48).两组患者均采用相同的神经肌肉活检术,对照组患者术后予以常规护理和治疗,观察组患者在对照组基础上采用自制固定式冰袋进行冰敷.比较两组患者在活检术后伤口疼痛、出血及改善肿胀之间的差异.结果 观察组患者在术后2、6、12 h敷料血迹面积、疼痛评分小于对照组,差异具有统计学意义(P<0.05);观察组术后24、48、72 h切口下3 cm处的周径与术前肢体对应部位周径的差值小于对照组,差异具有统计学意义(P<0.05).结论 自制固定式冰袋冰敷在肌肉活组织检查术后患者中应用效果良好,能减轻术后疼痛、改善肢体肿胀情况、降低活检术后并发症的发生.

目的:了解北京市大学生不安全性行为的现状及相关危险因素,为制定有针对性的干预措施提供依据.方法:在“北京市关爱青少年生殖健康综合防治项目”的4个试点区采用方便抽样的方法调查未婚大学生1069名.采用自行设计的问卷调查大学生的性行为、避孕方法等情况,分析不安全性行为的相关因素.结果:大学生婚前性行为发生率为13.2％.非意愿首次性行为发生率为10.9％.首次性行为不避孕者占31.9％,采用低效避孕措施者占18.3％.最近一次性行为不避孕者占11.6％,采用低效避孕措施占18.8％.多性伴行为发生率为25.7％.多因素分析显示,在首次性行为和近期性行为中,年龄较小的大学生发生避孕措施不当的风险较高(OR =3.631,95％CI 1.600～8.240;OR=2.807,95％CI 1.146～6.879).女大学生发生非意愿首次性行为的风险高于男性(OR=3.596,95％CI1.045～12.379).结论:大学生不安全性行为问题形势严峻,应加强对年龄偏低的大学生及女大学生的关注.

Abstract Objective:To explore the effect of homebased cognitive training on improving cognitive function in patients with mild cognitive impairment.Methods:A total of 58 patients with mild cognitive impairment were randomly divided into control group and observation group,29 cases in each group.The patients in control group received routine discharge guidance and followup.The patients in observation group conducted homebased cognitive training on the basis in control group.The patient′s cognitive function was evaluated at the time of discharge and 6 months after discharge using the MiniMental State Examination(MMSE),the Montreal Cognitive Assessment Scale (MoCA),and the Barthel Index(BI).Results:The MMSE score and MoCA score in observation group were higher than those in control group after 6 months of discharge (P<0.05),but there was no significant change in Barthel score(P>0.05).Conclusions:Through the implementation of homebased cognitive training for patients with mild cognitive impairment,the cognitive function of patients could significantly be improved,and the progress of cognitive impairment could be delayed.

目的:研究阶段变化护理干预对血液透析患者自护能力及疾病管理能力的影响.方法:选取维持性血液透析患者82例,采用随机数字表法分为观察组(41例)、对照组(41例).对照组采用常规护理方法,观察组在常规护理的基础上实施了阶段变化的护理干预措施,对两组护理结果进行对比.结果:通过阶段性护理干预,患者护理的效果得到明显改善,观察组护理中的依从率为97.56％,对照组的依从率为85.37％,观察组效果明显(P<0.05).结论:针对维持性血液透析患者,给予阶段变化护理干预能够有效改善患者自我护理能力,优化疾病管理能力,提高患者依从性,提升患者护理的满意度.

目的 探索建立宫颈癌筛查宫颈细胞学机构事前质控评估方法,并用该方法对参与北京市宫颈癌免费筛查的宫颈细胞学检查机构进行事前质控评估,掌握机构服务现况及存在问题,筛选出宫颈细胞学产品、制片、阅片质量良好的机构,参与北京市宫颈癌免费筛查,提高筛查质量.方法 采用资料审核、现场评价两种方法对影响细胞学检查质量的机构资质、硬件条件、制度、保存液质量、制片操作流程、人员能力等进行综合评价,筛选出宫颈细胞学产品、制片、阅片质量良好的机构.结果 16家机构参与了事前质控.通过专家组统一对资料进行审核剔除资料不全、字迹模糊、无相关资质、不符合技术要求的机构,最终6家机构5种产品进入现场评价阶段.保存液质量评估发现1家机构的产品不合格;2家机构的保存液取材后应在1周内尽快制片;2家机构的保存液可以4周内完成制片.现场评价基本具备承担筛查的硬件条件,但细胞学检查机构制度不健全,5家机构制订了质控方案,5家机构未对可疑病例进行追访;检查机构间人员的阅片能力有差异,人员阅片考核的平均分为64.6分;细胞学检查机构阅片质量复核符合率为95％,制片的操作流程欠规范.结论 通过事前质控评估方法,筛选出了合格的细胞学检查机构及产品,要求各区从评估合格的机构中择优选择承担本区宫颈癌免费筛查中宫颈细胞学检测工作.同时通过评估发现宫颈细胞学检查机构管理及操作欠规范,阅片人员的技能需加强.下一步将针对存在问题,组织统一培训,规范服务流程,加强对筛选合格机构的日常监管和内部质控,不断提高筛查质量和技术水平.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的分析采用不同模式对北京市适龄妇女进行宫颈癌免费筛查结果。方法在2014年12月—2015年3月北京市接受宫颈癌免费筛查的182 119例35～64岁妇女中,采用整群随机抽样法,分别采用联合筛查、高危型人乳头瘤病毒（HPV）初筛以及细胞学初筛方法筛查宫颈癌,使用SPSS 11.0软件对数据进行描述性分析和X²检验。结果在35～64岁妇女中进行的免费宫颈癌筛查结果显示,联合筛查癌及癌前病变检出率最高,为505.9/10万,高于HPV初筛的334.6/10万及细胞学初筛的246.3/10万,不同模式宫颈癌检出率和早诊率差异无统计学意义。联合筛查的初筛阳性率为8.5%,显著高于HPV初筛及细胞学初筛。高危型HPV检出阳性率为7.4%,其中HPV16型检出率为0.53%,HPV18型检出率为0.15%。结论初筛手段中增加HPV检测具有可行性。</span>

目的:探究风险管理在维持性血液透析护理管理中的作用及效果.方法:选取维持性血液透析患者100例,采用随机数字表法分为试验组60例和对照组40例.观察组在常规护理基础上实施风险管理,对照组实施常规护理,对两组患者的护理效果观察比较.结果:观察组风险事件的发生率为3.3％,显著要低于对照组15％(P<0.05),护理满意度与健康知识掌握有所增加但无统计学意义(P>0.05).结论:对维持性血液透析患者进行风险管理,能够有效预防风险发生,有效的提升护理质量,保证了患者的安全.

患者徐女士今年47岁.不久前出现了上腹部和背部针扎样疼痛,在此之前出现双下肢乏力、麻木,很快发展至大腿和臀部无力,不能自行排尿,不能行走.日前,徐女士被北京友谊医院神经内科收治入院.由于病情持续进展,躯干及双下肢瘫痪,下肢自主运动消失,完全瘫痪在床上,排便费力,肚脐以下针刺感觉完全消失,甚至先后曾出现视神经炎、延髓最后区综合征、急性脊髓炎等表现.经过一系列辅助检查后,徐女士被确诊为视神经脊髓炎谱系疾病.该种疾病如不及时诊治,致残率、死亡率极高,且预后差.病情危重随时可出现呼吸循环骤停并危及生命.

Objective To understand the effect and problems of cervical cancer screening by cytology as the primary screening method in Beijing from 2008 to 2014,in order to further improve cervical cancer screening strategy.Methods A Three-cycle-data of cervical cancer screening of Beijing in years of 2008-2009,2011-2012 and 2013-2014 was collected from the Beijing cervical and breast cancer screening information system,which was reported annually from 18 districts and counties of Beijing.The data was analyzed retrospectively.Results Coverage rate of the first,second and third cycle was 19.2％ (728 704/3 787 748),18.8％(495 814/2 630 818) and 15A％(467 863/3 032 690),respectively.Cervical cytology positive detection rate of the three cycles were 2.3％ (16 587/728 704),2.0％ (10 095/495 814) and 2.2％ (10 073/467 863),respectively.The detection rate of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesion (HSIL) gradually increased.Cervical lesion detection rate rising from 70.4/100 000 (513/72 870) of the first cycle increased to 224.2/100 000 (1 049/467 863) in the third cycle,which had risen by 218.5％.Rate of early diagnosis was 92.0％(552/602) of the first cycle,increased to 97.1％(1 061/1 093) in the third cycle,which increased by 5.5％.The detection rate of cervical cancer was fluctuated,the highest was in the first cycle,which was 12.2/100 000(89/728 704),while it declined to 9.4/100 000(44/467 863) in the third cycle.Conclusions Beijing cervical cancer screening program has shown great progress.The detection rate of cervical lesions and the rate of early diagnosis gradually increased which was due to improving screening technology of health care institutions in the grassroots level.Meanwhile,issues on the low screening coverage and low cervical cytology detection rate should be paid more attention to.

Objective Usinghigh-risk HPV test as primary cervical cancer screening,to detect the situation of high-risk HPV infection in 35 to 64 years old women inruralareas of Beijingand the effect of this methodology. Methods Data of 20 076 women among 35~64 years lived in in five rural areasof Beijing including Haidian District,Changping District,Shunyi District,Tongzhou District and Miyun County under went cervial cancer screening by using high-risk HPV test as primary screening in 2014. Results Total high-risk HPV infection rate was 7.6% of the 20 076 cases,of which the top five high-risk subtypes of single infectioni case was HPV16(219/20 076,14.3%),HPV52(146/20 076,9.5%),HPV58(101/20 076,6.9%),HPV18(84/20 076,5.5%),and HPV51(66 /20 076,4.3%).Co-infection rate of highrisk HPV infection was 7.6%(116 /20 076),the most serious infection was four types of high-risk HPV subtypes are detected in one woman. High-risk HPV infection rates of 35~40 years old,41~45 years old,46~50 years old,51~55 years old,56~60 years old,and 61~64 years old were 50.0 %(192/384),38.9%(330/848),33.0%(388/1 177),6.3%(298/4 757),3.4%(251/7 438)and 1.4%(76/5 472),respectively.In addition,cytology positive rate was 13.0%among high-risk HPV infections except HPV16/18. 461 cases accepted colposcopy,which was 2.3%;among these,CIN2 was 27 cases,CIN3 was 39 cases,microinvasive carcinoma was 2 cases,and 1 case of invasive cancer. Detection rate of precancerous lesion was 343.7/100 000 and detection rate of cervical cancer was 14.9/100 000,early diagnosis rate of cervical cancer was 98.6%. For HSIL and cervical cancers,HPV16/18 subtype infection accounted for 71.0%.Conclusion Major high-risk HPV infection of 35~64 years old women in rural Beijing was HPV16,52 and 58. The highest high-risk HPV detection rate was found among 35~40 years old women,HPV16/18 infections are major cause of HSIL and cervical cancer. Started with high-risk HPV detection cervical cancer screening,detection rate of screening positive results has increased while significantly reducing the workload of cytologists.

Objective To analyze the data of cervical cytology quality control among women accepted free cervical cancer screening in Beijing in 2013.Methods Collected 286 781 cervical cytology smears information of free cervical cancer screening in medical screening units of 1 6 districts and counties in Beijing in 2013.Use probability random sampling method to get 9 907 cervical cytology smears for quality control analysis.Took the pathologists′diagnosis as golden standards.Detection positive rate,various indicators of quality control and unsatisfactory rate of smears were compared statistically between traditional Pap smear and liquid-based cervical cytology smear.Results ① The total detection positive rate and the detection positive rate of low-grade squamous intraepithelial lesion (LSIL)and high-grade squamous intraepithelial lesion(HSIL)of liquid-based cytology smear were higher than those of traditional Pap smear,and the differences were statistically significant(2.41% vs 2.05%,χ2 =39.885,P =0.000;0.58% vs 0.31%,χ2 =1 13.772,P = 0.000;0.14% vs 0.1 1%,χ2 = 4.464,P = 0.035 ).② There were no significant differences between Pap smears and liquid-based cytology smears in false negative rate,specificity and coincidence rate (P >0.05).The false positive rate of Pap smears was lower than that of liquid- based cytology smears, while the sensitivity rate were higher,and the differences were statistically significant(0 vs 0.55%,χ2 =18.342,P =0.000;100.00% vs 75.00%,χ2 =98.980,P =0.000).③The dissatisfaction rate of smears was 4.1 7%(413/9 907)among 9 907 cervical cytology smears,and the primary reason was lighter dyeing and (or)unclear structure of cell (54.24%),followed by the lack of cell mass(43.09%).The dissatisfaction rate of Pap smears caused by lack of cell mass was higher than that of liquid-based cytology smears(2.45% vs 1.44%),while the dissatisfaction rate of liquid-based cytology smears caused by lighter dyeing and (or) unclear structure of cell was higher than that of Pap smears (3.34% vs 0.26%),and the differences were statistically significant(χ2 = 12.452,93.31 1;P =0.000).Conclusions Cervical cytology detection positive rate of free cervical cancer screening in Beijing need to be further improved.And it is necessary to establish a quality control evaluation system on cervical cytology,focusing on improvement of cells collection,cytology smear producing and drum dyeing,to improve satisfaction rate and quality of cervical cytology smears.

Objective To investigate the service status of genital tract infection in medical institutes level II and under in Beijing, and to study the prevention knowledge, attitude and behavior ( KAB) of women, so as to provide evidence for further prevention and control of genital tract infection. Methods A questionnaire survey was conducted in 36 medical institutes in Beijing, and 360 women with genital tract infection were enrolled in the survey randomly. Results Testing of clean degree, trichomonas, candida, BV and syphilis were available in all involved hospitals, and hospitals in each functional area of Beijing could identify diplococcus, HIV, mycoplasma, chlamydia and HPV. Cervical physical therapy, colposcopy and LEEP were also available in these hospitals. There were no significant differences among them (all P>0. 05). Among doctors working in obstetrics and gynecology department, 95. 48% had college degree or above, and 33. 33% of them could answer all of the questions on professional knowledge about diagnosis and treatment of genital tract infections. There were 98. 89% female patients willing to learn knowledge about genital tract infection. In various propaganda ways, the most acceptable one was individual explanation or consulting of doctors. Conclusion The equipments and staff for diagnosis and treatment of genital tract infection in Beijing are funded well, but the doctors show lack of professional knowledge. The diagnosis and treatment ability of doctors are needed to standardize and improve to meet the needs of patients on knowledge about genital tract infection.

多囊卵巢综合征(polycystic ovary syndrome,PCOS)是育龄妇女常见的一种复杂的内分泌及代谢紊乱性疾病,是具有发病多因性、临床表现多态性的内分泌综合征.PCOS好发于青春期,多以月经稀发或继发性闭经等月经异常,及多毛、痤疮、肥胖等高雄激素表现为临床特征;进入育龄期后往往以无排卵性不孕为近期并发症影响患者的生育功能;在围绝经期及中老年期由于持续的胰岛素抵抗、高雄激素血症、血脂和血糖异常及月经紊乱,易导致PCOS患者发生糖尿病、高血压、心血管疾病及雌激素依赖性子宫内膜癌等一系列远期并发症.

2008年北京市政府在全国率先启动户籍适龄妇女免费两癌筛查试点工作,并于2009年在北京市逐步推开,2011年形成了以两年为一周期的长效机制[1].为确保两癌筛查工作的科学性和权威性,保证筛查质量,政府制定了统一质控方案,对筛查全程把关.本文就谈谈我们在此项工作中的一些做法和体会。

目的:了解北京市18个区县适龄妇女生殖健康状况。方法:2008～2009年对25～65岁户籍妇女进行妇科及宫颈细胞学检查,同时对40～60岁户籍妇女进行乳腺癌筛查,并记录个人基本信息及个人病史。结果:本次宫颈癌筛查728 704例,宫颈癌筛查平均年龄47.39岁。乳腺癌筛查568 000例,乳腺癌筛查平均年龄49.71岁。宫颈癌筛查检出宫颈上皮内瘤变(C INⅠ、C INⅡ、C INⅢ)及以上病变968例,检出率132.84/10万,其中宫颈癌及癌前病变(C INⅡ、C INⅢ)602例,检出率为82.61/10万(602/728 704),其中宫颈癌89例,检出率为12.21/10万。乳腺癌筛查检出乳腺癌266例,乳腺癌检出率为46.83/10万。结论:适龄妇女生殖健康状况不容忽视,应定期开展宫颈癌、乳腺癌筛查,早期发现并治疗癌前病变,提高妇女健康水平。