Objective: To analyze the etiology, clinical manifestations, treatment and prognosis of chronic diarrhea in children. MethodsThe clinical data of 134 children with chronic diarrhea hospitalized in our hospital from June 2017 to May 2021 were retrospectively analyzed. ResultsThe main causes included food allergy in 75 cases (55.9％), infection in 30 cases (22.3％);Lactose intolerance was found in 11 cases (8.2％), intestinal flora imbalance in 3 cases (2.2％), and tumor in 2 cases (1.4％); There were 4 cases of Crohn''s disease (2.9％), 1 case of ulcerative colitis (0.7％), 1 case of celiac disease (0.7％), 7 cases of unclear etiology (5.2％). Some cases were caused by multiple factors. The treatment mainly includes supplementing water and electrolyte, correcting acid-base imbalance, etiological treatment, enteral and parenteral nutrition and symptomatic treatment. Antibiotics were used in 11 cases (8.2％). All the children were cured or improved without death. ConclusionThe causes of chronic diarrhea in children are complex and diverse. We should strengthen the understanding of non sensitive factors, especially food allergy, avoid allergic foodanduse of antibiotics. We should strive to remove the cause of disease, combine enteral and parenteral nutrition, symptomatic support and other treatment, reduce complications, improve the cure rate, and improve the prognosis.

目的 分析980例儿童消化道异物的临床特征、并发症危险因素及治疗方法.方法 回顾性分析我院2007年1月～2017年12月收治的980例消化道异物患儿的临床资料.结果 980例消化道异物患儿以男性为主(63.7％),年龄(3.1±1.7)岁;仅359例(36.6％)患儿吞入消化道异物后有临床表现,主要为吞咽不适(22.1％)和呕吐(9.7％);消化道异物主要位于食管(40.6％)和胃(53.6％);异物类型主要为钝性异物(58.1％)和尖锐异物(32.3％),少数为腐蚀性纽扣电池(8.7％)及磁性异物(0.9％).558例(56.9％)发生了异物相关并发症(黏膜损伤、糜烂及溃疡、消化道梗阻、消化道穿孔),非钝性异物(OR=5.696,95％ CI 4.252 ～7.630)和食管异物(OR=1.764,95％ CI1.356 ～ 2.293)是发生异物相关并发症的危险因素.本组患儿315例(32.1％)异物自行排出,655例(66.8％)异物经上消化道内镜取出,10例(1.0％)接受手术取出.结论 儿童消化道异物的好发年龄为6岁以下,以钝性异物为主,硬币最常见,主要位于上消化道,多数患儿无明显临床症状;异物相关并发症的危险因素为非钝性异物及食管异物;全麻下上消化道内镜取出是其主要治疗方式.

目的 探讨多潘立酮辅助治疗对儿童功能性消化不良的疗效.方法 本研究纳入病例96例,分为对照组(健胃消食口服液)及观察组(健胃消食口服液联合多潘立酮),比较两组患儿症状积分.结果 观察组上腹痛、餐后饱胀、厌食、反酸、恶心呕吐及总积分均低于对照组的,差异有统计学意义(P<0.05).结论 对功能性消化不良患儿采取多潘立酮辅助治疗,能够改善患儿症状,值得推广.

目的 明确成都地区儿童幽门螺杆菌根除治疗成功率,分析可能导致儿童根除失败的主要因素.方法 收集2012年1月至2019年6月成都市妇女儿童中心医院经碳13尿素酶呼气试验和胃镜检查确诊幽门螺杆菌感染且需要根除治疗的患儿临床数据,包括疾病人口学数据、根除方案、可能导致根除失败的原因等进行统计分析.结果 共纳入974例确诊幽门螺杆菌感染且需根除治疗的患儿(男性514例,女性460例,<6岁402例,6～9岁371例,≥10岁201例).所有患儿根除成功率69.82%(680/974),首次根除成功率64.99%(633/974);失败后家长同意继续根除治疗116例,最终成功率40.52%(47/116);因溃疡行根除治疗成功率72.00%(18/25).共完成1135次根除,成功率59.91%(680/1135),6种治疗方案的治疗成功率差异无统计学意义(χ2=7.070,P=0.07).2012至2015年成都地区儿童根除以含甲硝唑根除方案为主,根除成功率63.49%;2015年中国儿童幽门螺杆菌诊治专家共识出版后,2016至2019年首选克拉霉素方案,根除成功率提高至73.83%,差异有统计学意义(χ2=11.72,P=0.001).幽门螺杆菌感染家族史是影响儿童根除率的主要因素[优势比=3.921,95%CI(1.249～12.305),P=0.019].结论 成都地区儿童幽门螺杆菌感染总体根除成功率尚未达到80%,初次根除选择克拉霉素三联方案能够提高成功率;有幽门螺杆菌感染家族史是影响成功的主要环境因素.

目的 探讨锌剂辅助治疗对病毒性腹泻婴幼儿胃肠道功能恢复的影响.方法 将成都市妇女儿童中心医院收治的180例轮状病毒性腹泻患儿分为对照组和观察组,每组90例,对照组患儿接受蒙脱石散十双歧杆菌三联活菌治疗,观察组在对照组基础上给予甘草锌治疗.观察比较两组患儿的临床疗效和恢复时间,以及胃肠道屏障、运动和消化吸收等功能相关指标.结果 治疗后7d,观察组总有效率显著高于对照组(P＜0.05),观察组的腹痛消失时间、大便次数恢复时间、大便性状恢复时间和住院时间均显著短于对照组(P＜0.05),观察组的血锌和IgA水平均显著高于对照组(P＜0.05),观察组的肿瘤坏死因子-α(TNF-α)、内毒素、二胺氧化酶(DAO)、D-乳酸、胃泌素(GAS)、胃动素(MOT)水平和胃排空率(GER)显著低于对照组(P＜0.05),观察组的双歧杆菌和乳酸杆菌数量更高,而大肠埃希菌数量更低(P＜0.05).结论 锌剂可增加轮状病毒性腹泻的治疗有效率,缩短恢复时间.

目的:探讨小剂量西甲硅油在无痛儿童胃镜胃体胃底清晰度观察中的应用价值.方法:对需行胃镜检查的儿童随机分为三组,A组151例,采用2m l西甲硅油+3m l生理盐水治疗;B组179例,采用2m l西甲硅油治疗;C组185例,采用3m l西甲硅油治疗.3组浓度西甲硅油,均于术前15分钟口服,观察西甲硅油去除胃内泡沫状黏液(特别是胃体、胃底部泡沫),提高内镜清晰度、减少操作时间的效果.结果:胃底、胃体祛泡率比较:A组>C组>B组,差异有统计学意义(χ2=9.937,P<0.01);内镜操作时间:A组<C组<B组,差异有统计学意义(χ2=27.91,P<0.01).结论:40％浓度西甲硅油对胃内汽泡消除率高于100％浓度2m l及3m l西甲硅油用量,其清晰度对内镜的操作时长亦存在影响.应用小剂量西甲硅油可显著提高儿童胃镜视野清晰度,尤其对胃体胃底观察具有重要价值,同时减少术前大剂量口服药后检查时可能出现的反流风险,值得临床推广应用.

目的 探讨糖尿病(DM)合并细菌性肝脓肿的病原菌特征及耐药性,为合并细菌性肝脓肿患者的临床诊治提供依据.方法 2016年1月至2018年4月我科确诊的70例DM合并细菌性肝脓肿患者,收集其临床相关资料,分析并发细菌性肝脓肿的原因,并进行病原菌培养与药敏分析.结果 70例合并细菌性肝脓肿的DM患者发病原因依次为胆管疾病(45.71％)、呼吸道感染(28.57％)及隐匿性感染(25.71％).本次共检出病原菌70株,以革兰阴性菌为主(81.43％),包括肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、铜绿假单胞菌;革兰阳性菌较少(18.57％),包括金黄色葡萄球菌、粪肠球菌、草绿色链球菌等.主要革兰阴性菌肺炎克雷伯菌、大肠埃希菌对亚胺培南、阿米卡星均较敏感,耐药率均低于20％;而对氨苄西林、环丙沙星不敏感,耐药率较高,均超过85％,对其他抗菌药物敏感性一般.主要革兰阳性菌金黄色葡萄球菌对万古霉素敏感,耐药率为0;而对青霉素、头孢唑林不敏感,耐药率超过85％.结论 胆管疾病、呼吸道感染、隐匿性感染均可导致DM患者发生细菌性肝脓肿,此并发症病原菌以革兰阴性菌为主,应根据病原菌特征和耐药性合理选择抗菌药物治疗.

Objective To investigate the clinical significance of combined detection of serum IFN-γ,OPN and IL-18 in patients with pulmonary tuberculosis .Methods From September 2013 to November 2016 ,55 patients with pulmonary tuberculosis in the hospital were selected as the tuberculosis group ,at the same time ,60 healthy persons were selected as control group .The levels of IFN-γ,OPN and IL-18 in serum of patients with pulmonary tuberculosis and control group ,sputum positive and negative pulmonary tuberculosis and different pathological groups were compared .Results The levels of IFN-γ,OPN and IL-18 in tuberculosis group were higher than those in control group ,the difference was statistically significant (P<0 .05) .The levels of IFN-γ,OPN and IL-18 in serum of sputum positive pulmonary tuberculosis patients were higher than those of sputum negative pulmonary tuberculosis pa-tients ,the difference was statistically significant (P< 0 .05) .Serum IFN-γ,OPN and IL-18 of miliary tuberculosis patients were higher than that of cavitary pulmonary ,tuberculous pleurisy and invasive ,the cavitary pulmonary tuberculosis in patients with IFN-γ,OPN and IL-18 were higher than that of tuberculous pleurisy and invasive ,the differences were statistically significant (P<0 .05) .Conclusion The levels of serum IFN-γ,OPN and IL-18 in patients with pulmonary tuberculosis are high ,which can be used as a sensitive index to evaluate the progress and severity of pulmonary tuberculosis .

[目的]了解我国病人家属疾病不确定感的研究现状及存在的问题。[方法]采用文献分析法,检索万方数据库、中国期刊全文数据库、维普数据库自建库以来至2016年12月公开发表的关于家属疾病不确定感的研究文献,并对文献进行整理分析。[结果]共纳入文献49篇,第一作者主要来源于东部地区(24篇,49.0%)和中部地区(21篇,42.9%),文献类型以调查性研究为主(42篇,85.7%),研究内容多为重症监护室病人家属(17篇,34.7%)。[结论]我国病人家属疾病不确定感的研究逐渐增多,但涉及面较窄,今后需扩大研究对象,并在理论研究的基础上进一步开展干预性研究。

目的 了解护理人员使用手持无线终端(PDA)的规范情况,并探讨PDA的质量控制管理方法及其效果.方法 选择42名在岗执业护士为质控对象,由科室护理质控专职人员对PDA执行医嘱情况进行为期1周的专项检查,了解使用PDA执行医嘱情况,分析PDA使用不规范的原因并提出整改措施,3个月后再进行为期1周的专项检查.比较质控前后PDA使用的规范率.结果 质控前执行不规范的医嘱占65.29%(837/1282),PDA使用不规范的主要原因有护理人员对PDA的作用及使用功能认识不够(46.12%,386/837)、硬件及软件问题(35.13%,294/837)、患者依从性差(6.21%,52/837)、PDA数量不够(12.54%,105/837).质控后PDA使用规范率为99.50%(1 578/1 586),高于质控前的34.71%(445/1 282)(P<0.05).结论 护理人员对PDA的认识不够及PDA硬件及软件问题是造成不规范使用PDA的主要原因,针对原因采取有效的质量控制管理可以改善PDA使用的规范性.

Objective:To investigate the anxiety and depression of patients with advanced primary lung cancer,and give mental nursing according to the causes of anxiety and depression.Methods:We analyzed retrospectively the anxiety and depression and the proper nursing processes of 100 cases of patients with advanced primary lung cancer.We grouped 50 cases of patients with mental nursing into the observation group and 50 cases of patients with conventional nursing into the control group.We compared the scores of anxiety and depression of the patients in two groups before treatment and the improvement of life quality before and after the nursing.Results:The score of anxiety (SAS)after nursing in the observation group was significantly lower than that in the control group (t =-12.4388,P ＜0.001),the score of depression(SDS)in the observation group was significantly lower than that in the control group (t =-11.2744,P ＜ 0.001).The scores of the life quality in spirit,pain,sleep quality,emotional communication,daily activities were significantly lower than those in the control group (t =-9.1040,-18.2787,-12.7545,-15.6229,-11.1533;P ＜0.001).Conclusion:Pain,mentality and other factors lead to a serious anxiety and depression of patients with advanced primary lung cancer.The mental nursing is effective to relieve patients' negative emotions and improve the life quality though ameliorating sleep and mood of the patients.

A case report introduced the doctor-nurse integration management of one patient,who was infected by Scedosporium apiospermum at lumbar vertebra after drowning in accident.The key problem of nursing was analyzed and an individual nursing plan was made for the patient.The key point included provision of humanistic concerns,individually psychological nursing,monitoring of the drug usage,paying attention to the nutrient support,avoiding to the complication from keeping in bed for a long time,and making plans for the movement of the patient by multidisciplinary collaboration.The patient recovered by the interventions as above after 62 days.

Objective To evaluate the clinical application and therapeutic effect of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of congenital esophageal atresia (CEA) and preliminary explore the influencing factors associated with repeated gastroscopic bougie dilatations.Methods A total of 25 cases of infants who received gastroscopic bougie dilatation treatment in Chengdu Women′s and Children′s Central Hospital due to anastomotic stricture after surgical repair of CEA were chosen as research subjects.They were divided into group A (n=11, dilatation times≤2 times) and group B (n=14, dilatation times>2 times) according to the times of gastroscopic bougie dilatation.The influencing factors associated with repeated gastroscopic bougie dilatations were analyzed between two groups by statistical methods.Follow-up of survival children were conducted after the last dilatation including diet condition and nutrition status and the follow-up deadline was September 2015.The follow-up results of two groups were statistically analyzed.This study was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Women′s and Children′s Central Hospital.All the parents of the infants signed informed consents.There were no statistically significant differences between two groups in the age, gender ratio and the other basic clinical data (P>0.05).Results ①As to the 25 children with anastomotic stricture after surgical repair of CEA, the ages of initial gastroscopic bougie dilatation were 27-575 days.All the children received 76 times of successful gastroscopic bougie dilatations and each received an average of 3 times of dilatation.And 2 children had complications including esophageal fistula and esophageal edema, respectively.②The value of structure index (SI) before the last gastroscopic bougie dilatation in group A was higher than that in group B, while the largest diameter of bougie was lower than that in group B, and both the differences were statistically significant (t=3.829, P=0.002;t=4.263, P<0.001).③One case of child died with esophageal fistula after the last gastroscopic bougie dilatation.So 24 survival children were enrolled in the follow-up, the longest follow-up time was 42 months and the mean time was 7.4 months.The growth and development of 91.2％ (22/24) children were in normal range.Esophageal edema and gastroesophageal reflux were occurred in two children, respectively.All children had no obvious dysphagia and food obstruction symptoms and none of the children received gastroscopic bougie dilatation again at end of follow-up.Conclusions Gastroscopic bougie dilatation is effective and safe for the treatment of anastomotic stricture after surgical repair of CEA.Repeated gastroscopic bougie dilatations lead to bigger diameter of esophageal and improvement of dysphagia.As the sample size in this study is relatively small, more large sample, multi-center, randomized controlled clinical trials are required to explore the causes of repeated gastroscopic bougie dilatations in treatment of anastomotic stricture after surgical repair of CEA, and to confirm the exact therapeutic effect of gastroscopic bougie dilatation in treatment of anastomotic stricture after surgical repair of CEA.

皮肤缺损是临床常见的急性损伤之一。污染较重，面积较大和部分复合组织缺损严重的患者无法Ⅰ期行皮瓣和植皮修复，可为Ⅱ期手术治疗创造条件[1]。近日我科应用封闭式负压引流（vacuum-assisted closure, VAC）技术治疗1例皮肤大面积缺损伴重度软组织感染的患者，并配合有效的护理措施，取得良好的疗效，报道如下。

目的 探讨自制尿量记录单和健康教育对普通病房患者尿量监测的作用.方法 选择2015年2月-7月住院患者110例.根据时间段将110例记尿量患者分为对照组(42例)和试验组(68例).对照组使用常规的尿量记录单及健康教育.试验组在此基础上,使用自制24 h尿量记录单及健康知识单,并由责任护士对患者做尿量相关知识的专科健康教育.使用尿量相关知识问卷对两组进行调查,分析数据并比较两组的知识知晓情况.结果 试验组尿量专科知识知晓情况及尿量记录执行情况在各个方面都优于对照组(P＜0.05).在对照组中,不同性别的患者在记录小便的目的及意义方面知晓情况比较差异有统计学意义(P＜0.05),男性患者优于女性患者;且不同学历的患者在记录小便的目的及意义方面知晓情况比较差异有统计学意义(P＜0.05),大专及以上学历的患者知识知晓情况最好,小学及以下学历的患者知识知晓情况最差.结论 使用自制尿量记录单及健康知识单并加强专科知识健康教育可提高患者及其家属对专科知识的知晓率,改善患者的尿量监测的效果,培养患者自我护理的意识,促进患者预后.

临床资料 患者,女,49岁.3+年前因“吞咽梗阻”入院,胃镜示食管上段“管腔狭窄,可见长条形黏膜隆起,表面光滑,考虑外压性病变”,食管超声内镜提示“病灶处食管壁5层结构正常”,食管造影示“食管上段实性占位,脂肪密度”(图1),初步考虑食管上段良性占位,于全身麻醉下行经胸食管占位切除术,术后病理检查示“脂肪瘤”.患者术后恢复可,但出院后未遵医嘱定期门诊复查.

目的建立胸外科患者门诊-入院-出院一体化的工作模式,提高患者就医体验的满意度,持续改进护理质量。方法制定胸外门诊-入院-出院一体化工作流程,比较2010年、2011年的门诊人次、出院人次,术前等待时间、平均住院时间;并自行设计护理服务满意度调查表,对2010年1月-2011年12月入住的患者,每月随机调查10例,共计240例次,分析就医体验等数据。结果门诊人次上升11.2%;出院人次上升4.91%;术前等待时间下降7.20%;平均住院日下降0.66%;患者就诊体验满意度由90.83%提高到97.67%(P<0.01)。结论择期手术患者部分术前检查前移至门诊,缩短术前等待时间;护理评估、健康教育从门诊开始,实施一体化连续的健康教育,能提高患者对护理工作的认可度;出院后为患者提供良好的随访服务,解除患者的后顾之忧。

目的探讨系统呼吸训练在食管癌患者围术期应用的意义。方法将2009年6月收治的73例行食管癌切除术的患者作为对照组,在围术期行常规健康教育;将2010年6月收治的59例行食管癌切除术的患者作为试验组,在围术期行常规健康教育的同时,采用集体健康教育的方法进行系统呼吸训练。结果试验组术后肺部并发症的发生率(27.11%)低于对照组(43.83%),差异有统计学意义(P<0.05);试验组平均住院日15.75 d,低于对照组平均住院日16.87 d;试验组健康教育满意度达到99.49%,高于对照组的95.01%,差异有统计学意义(P<0.05)。结论在食管癌患者围术期应用系统呼吸训练能降低肺部并发症,缩短平均住院日;同时,系统呼吸训练的开展,整合了护士的人力资源、提高工作效率,促进了护士自身素质的提高,也提高了患者对护士健康教育的满意度。

目的总结胸外术后患者意外拔管的原因,积极完善护理管理措施。方法回顾性分析2010年1月2010年12月术后发生的48例患者意外拔管事件的相关因素及处理措施。结果拔管者主要为60岁以上老年患者,夜间为意外拔管高发时段,拔管时间主要发生在术后3d,多数患者因疼痛不适导致自行拔管,导管固定欠妥仅6例,占12.5%。结论增加夜间薄弱环节护士人手,加强巡视;充分镇痛,改善患者的疼痛度;妥善固定管道等护理措施,可以保证患者的护理安全,提高护理质量。

目的分析患者非计划取消手术的原因,研究其应对办法。方法对2008年10月2010年8月期间临时取消的350例手术原因进行归类分析,从中寻求解决措施。结果 350例非计划取消手术中,生命体征异常占10.3%,检查结果不完善及结果异常的占39.4%,患者及家属意见不统一占27.4%,血库缺血占6%,女患者月经来潮占2%,其他占15.1%。结论术前详细评估患者具体情况,做好护患沟通及心理护理,完善和强化术前各项准备措施,可保障手术按计划顺利进行。