随着影像诊断技术的快速发展,造影剂应用的频率越来越高.为了达到更好的成像效果,提高诊断准确率,临床上CT增强扫描均使用高压注射器将造影剂快速注入受检者静脉内,由于压力大、速度快、黏度高、浅静脉壁薄等因素,极易导致造影剂外渗,引起剧烈疼痛、皮肤软组织损伤甚至坏死[1-2],临床处理一般使用50％硫酸镁湿敷,但起效较慢,而且对于中重度外渗的治疗效果不理想.通过查阅大量的相关文献发现,针刺减压应用在骨筋膜室症早期的疗效良好,但尚未有针刺减压应用在造影剂外渗方面的报道.该文主要探讨针刺减压联合硫酸镁湿敷治疗CT增强扫描造影剂外渗的效果,现报道如下.

Objective:To analyze the medical knowledge map of lifestyle medicine based on Web of Science database.Methods:“Lifestyle medicine” “lifestyle intervention” “lifestyle medicine strategy” and “lifestyle factor” were used as Mesh terms to search the core collections of Web of Science database. The time span was from January 1st, 2000 to December 31st, 2021. The statistical function of Web of Science database was used for bibliometric analysis, and VOS Viewer software was used for co-occurrence analysis of authors, countries, institutions, keywords, and cited literature, then the visual knowledge maps were drawn.Results:A total of 5 717 articles were included, and the number of published articles from 2000 to 2021 showed an increasing trend. The top 10 authors were from the United States (nine authors) and Finland (one author); high producing countries included the United States (2 882 papers), the United Kingdom (1 254 papers) and Australia (781 papers), and China ranked sixth (499 papers). The most productive institutions were the Union of European Research Universities (946 articles), Harvard University (677 articles), University of California (313 articles), etc. The papers are mainly published in Diabetes, Circulation, BMC Public Health, Obesity, PLoS One, Med Sci Sports Exerc, etc. Five clusters were obtained by co-occurrence of key words, which were “health status” “lifestyle intervention” “lifestyle risk factors” “exercise and weight” and “chronic disease research”. The national cooperation network involves 67 countries. Conclusions:Recently, the research on lifestyle medicine shows a rapid growth trend. The current research interests include behavioral sciences, psychology, nutrition, endocrinology and metabolism, healthcare services, internal medicine, public health, pathology, cardiovascular medicine and geriatrics. Research hotspots include chronic disease and disease burden, whole life-cycle health, nutrition and exercise intervention and behavior change.

With the change of medical model from "Disease-centered" to "Health-centered" value medical system, the rise and development of Lifestyle Medicine (LM) has become inevitable. With the intervention of disease risk and individualized diagnosis and treatment of etiology, LM is expected to be the first-line tools for chronic disease prevention and treatment. The textbook Lifestyle Medicine, edited by Professor James M. Rippe, who is the founder of LM, is the first one of LM textbook in the United States. The third edition, revised in 2019, consists of 20 Parts, collecting the theories of behavioral science, psychology, nutrition and other disciplines and the latest clinical research results. It has far-reaching influence by building the theoretical framework and the foundation of LM education.The textbook advocates the integration of lifestyle medicine into daily clinical practice and adheres to the goal of patient-centered, value-based and results-oriented discipline development, thus to promote the human health. This article introduces the subject definition, education certification and professional requirements of lifestyle medicine, and introduces the structure, content and research topics of the textbook as a reference for domestic peers.

ICU集中医院危重患者、先进仪器及经验丰富的护士,重症监护护理记录单具有评估内容多、专科性强、记录全面、随时记录等特点,既往普遍采用手工记录方式,不仅易出错,部分护士的字迹潦草可能导致识别困难,影响护理安全及护理文书质量,同时减少护士床旁护理时间,增加纸张浪费.2018年8月本院重症医学科医护人员联合信息科、护理部、设备科自主研发出一套数字化护理文书系统,将其应用于临床,在应用过程中不断优化、完善,取得良好效果,现报道如下.

在我国优质医疗资源总量不足、结构不合理、分布不均衡,特别是基层优秀人才缺乏的背景下,医共体建设应运而生.建立责权清晰、管理科学、运行高效、监督有力的现代医院管理制度有利于推进医共体建设工作的顺利开展.笔者总结了绍兴市中心医院医共体法人治理结构、人力资源管理制度、一体化管理以及错位发展经验,为医共体建设提供思路.

Objective To investigate serum Ig Gamma-3 Chain C Region (IGHG3) and Haptoglobin (HPT) levels in patients with pulmonary tuberculosis(TB).Methods Serum IGHG3 and HPT levels were tested by enzyme linked immunosorbent assay (ELISA) in 50 TB patients and 36 healthy subjects.Plasma fibrinogen (FIB),prothrombin time (PT),activated partial thromboplastin time (APTT),thromboplastin time (TT),blood glucose,C reaction protein (CRP),triglyceride(TG) were measured.Results Serum IGHG3) and HPT levels in TB patients were significant higher than those in healthy controls (P＜0.0001 and P =0.0037).There were significant differences in plasma FIB,APTT and CRP levels between TB patients and healthy controls (P =0.04,P =0.004,P =0.0001,respectively).Serum IGHG3 level was significantly correlated with serum CRP(r=0.372,P=0.014),and the serum HPT level was significantly correlated with the existence of tuberculosis cavity (r=0.28,P=0.04).A protein model consisting of IGHG3 and HPT was established by logistic regression analysis,and the sensitivity,specificity,and area under curve (AUC) of the model was 90.90％,80.80％,and 0.866,respectively.Conclusion IGHG3 and HPT may be potential biomarkers for TB patients.

Objective To explore the scanning of tuberculosis biomarkers. Methods The enzyme-linked immunosorbent assays aimed on proteins related with the inflammatory state were performed. Result Alpha-1-antichymotrypsin(AACT),clusterin(CLU),and Ig alpha-1 chain C region(IGHA1) showed significantly reduced levels in cured pulmonary tuberculosis(TB) patients than untreated ones. Furthermore,the decision model established by these three proteins reached a sensitivity of 79.59％,and a specificity of 77.36％. Conclusion It is suggested that AACT,CLU, IGHA1 may be served as potential biomarkers for curing TB.

疼痛是临床骨科患者术后最常见的症状之一。术后疼痛刺激可通过脊髓介质，交感神经反射而引起肌肉、血管收缩致切口呈缺血状态，影响切口愈合，疼痛还可导致机体免疫球蛋白下降，降低机体免疫力，影响术后康复[1]。目前，骨科术后应用自控镇痛泵在临床越来越普遍。本次研究总结骨科术后应用自控镇痛泵的止痛效果、安全性及护理要点，现报道如下。

模拟病人网络平台(Human Patient Simulation Network,HPSN)是目前全球最大的医学模拟教育培训和交流平台,始于1997年,由美国佛罗里达州24名护理和健康教育工作者自发组织,旨在分享护理模拟医学教学经验,如今已发展成一个在模拟医学教育方面最具影响力的国际性学术交流团体.

Objective To observe the clinical efficacy and safety of the elderly patients with hyperlipidemia and hypertension treated w ith different doses of simvastatin. Methods 96 elderly patients w ith hypertension and hyperlipidemia w ere randomly divided into tw o groups using the envelope w ay,48 cases in each group. Observation group w as treated w ith simvastatin 40 mg / d,qnpo,control group w as treated w ith simvastatin,20 mg / d qn po. The patients in the tw o groups w ere given health guidance,parallel low-fat diet,and no longer use any other lipids or lipid-low ering drugs during the treatment. The blood pressure and blood lipids situation of all the patients before and after treatment w ere recorded and w hether the patients had cardiac events and other adverse reactions during the treatment w as closely observed. Results The lipid levels of the tw o groups had no significant differences before treatment,the TC,TG,LDL-C levels of the observation group w ere significantly low er and HDL-C level w as significantly higher than those of the control group after treatment,there w ere significant differences betw een the tw o groups( P 0. 05). The total effective rate of pressure release of the observation group and control group w ere 95. 83% and 83. 33%,there w as significant difference betw een the tw o groups( P 0. 05). The total effective rate of blood pressure of the observation group and control group w ere 93. 75% and 89. 58%,there w as no significant difference betw een the tw o groups( P 0. 05).The tw o groups of patients had no cardiac events w ith no urine routine,liver and kidney dysfunction during the treatment,6 cases( 12. 50%) in observation group had adverse reactions,4 cases( 8. 33%) in control group had adverse reactions,the difference of the adverse reactions betw een the tw o groups w as not significant( P 0. 05). Conclusion Elderly patients w ith hyperlipidemia and hypertension treated w ith high-dose( 40 mg / d) of simvastatin treatment compared to smaller doses( 20 mg / d),the efficacy of regulation is better,does not increase the incidence of adverse reactions,it is safe and reliable.

总结160例严重多发伤整体化急救策略的护理配合体会.在医院多发伤救治小组领导下,护士密切配合各科医生及医技人员,做好患者的初步救治,配合医生准确评估伤情,伤情应急救护中做好呼吸和循环支持、密切观察病情、做好损伤控制的护理配合,急救后安全转运患者.抢救成功139例(86.9%),死亡21例(13.1%),死因为不可逆转的失血性休克、心脏破裂、血气胸和严重颅脑损伤等.

目的降低静脉输液并发症的发生率,完善护理管理措施,提升护理人员技术水平。方法成立专业团队,通过对静脉输液并发症的现况进行原因分析,提出解决对策。结果留置针并发症由14.44%下降到6.16%,CVC并发症由8.9%下降到4.35%。完成了一系列标准化成果,目标达成率106.7%,进步率56.82%。结论该管理措施有效降低了静脉输液并发症发生率,调动了护理人员工作积极性,提升了护理水平和管理质量。

多元文化护理理论由美国护理学者Madeleine Leininger提出，认为文化照顾是护理工作的本质和中心，是护理实践的原动力［1，2］。该理论在我国已得到推广应用，逐渐成为护理学科发展的新趋势之一［3，4］。绍兴县以“中国轻纺城”而享誉海内外，吸引来众多国家和地区的外籍人士，外籍患者就医数量也持续增长，相应的护理需求日益突出。本调查旨在了解不同文化背景的外籍患者对护理的需求，为开展优质护理服务提供理论依据。

中国医科大学绍兴医院积极推进新医改试点工作,施行医院管理新举措,实现了资源管理信息化、服务管理人性化、质量管理制度化、绩效考核精细化,各方面工作取得初步成效,为经济发达地区县级公立医院如何加强自身建设,实现政府考核目标,体现公益性积累了经验.

我院为绍兴县地区唯一的一家三级综合性医院,医疗任务繁重.近年来,我院护理队伍一直存在着人员紧缺、学历低、年轻化、不稳定等问题.为提高护理人员素质,整合护理人力资源,我院自2010年起实施了小组责任制护理管理模式,并在此基础上以临床技能实训基地为依托,推行了临床护理能级培训方案.实行两年来,效果显著,现报告如下. 1 资料与方法 1.1护士能级定义 我院护理人员500余名,中级以上职称仅占19％.临床护理工作模式实施责任制和小组负责制,由责任护士或责任组负责实施住院病人所有的护理工作.护理部按临床工作年限,将护理人员分为N0到N4共五个级别,N0:1年内;N1:临床工作2到3年;N2:临床工作4到7年;N3:临床工作8年以上;N4:临床工作8年以上并担任责任组长或带教负责人3年以上.

为深化医药卫生体制改革,积极响应卫生部号召,我院陆续开展了“优质护理服务示范工程”系列活动.2010年5月到11月,医院引进了品管圈管理手段,在12个病区开展了以“以患者为中心,提供优质护理服务,创建温馨病房”为主题的活动,采取由下而上的管理方式,推动一线护理人员积极参与温馨病房创建活动,成效显著,现报告如下:

总结以品管圈为载体创建优质护理服务示范病房的体会。由10名护士长组成团队,针对目前医院护理现况,运用品管工具,进行持续质量改进。通过品管圈活动,促进了优质护理服务示范工程的开展,使病房环境改善、基础护理落实、护理服务质量提高、护士仪表行为规范、患者整体满意度提高。

策略共识营是指采用共识策略法,通过形式活泼、气氛热烈的表演、小游戏等结构性活动的设计,打破人与人之间的心理隔阂,增进团队的水平垂直沟通能力,有助于团队情感的凝聚及彼此信任的建立,从而达成共识[1].策略共识营活动较多应用于企业及商界.在医疗机构开展策略共识营活动,是让员工思考过去、专注现在、放眼未来,通过核心成员的讨论以及涵盖全院各部门的问卷调查,了解医院经营管理的优势、劣势、机会及威胁,形成战略方针,再运用脑力激荡方式凝聚全员共识,寻求最佳的应对策略,以确认未来全院资源分配的优先顺序。

[Objective]To raise the stool sampling rate of diarrhea clinic.[Method]The 5 procedures of 6 - sigma including defining,measuring,analyzing,improving and controlling were applied in the service for the outpatients in diarrhea clinic.Find out the main factors which influenced the sampling rate and improve them.[Result]After the application of the 6 - sigma management, the stool sampling rate increased from 95.3%to 100%which has a statistical significance.[Conclusion]6-sigma management contributed to the increase of sampling rate in diarrhea clinic.

Objective To investigate the disease spectrum of foreigner in local area and offer the basis for the disease prevention and health education. Methods 1901 cases of foreign patients of our hospital in the year of 2009 were selected. Results Of all the cases, 1402 patients aged from 21 to 40 years, accounted for 73.75% , the male patients were the majority, there were 1329 cases(69.91%). 733 patients suffered from respiratory system disease, accounted for 40.66%, mainly in upper respiratory tract infection (34.41%, 226/773); 227 patients suffered from digestive system disease, accounted for 11.9%, of which gastritis for 27.75% (63/227); 191 patients suffered from skin and subcutaneous tissue disease(10.04% ); 132 cases suffered from eyes and (or) ear diseases(6.94%); 111 patients suffered from urogenital system diseases, accounted for 5.84%, of which the urinary tract infection for 48.65% (54/111). Conclusions Most of the foreign patients are young males, and the main diseases are respiratory system and digestive system infection. We should pay much attention to the health education and behavior intervention for the young foreigners, so as to control the diseases effectively.