目的:探讨戒烟门诊干预后戒烟者的戒烟效果和影响因素,提出戒烟干预改进措施.方法:采用前瞻性干预研究设计,对2021年1月至2022年1月在广州市胸科医院戒烟门诊咨询的吸烟者采用强化戒烟干预,明确提出戒烟建议,然后顺序进行1周、1个月、3个月、6个月的规范化随访.把未戒烟者和戒烟＜7 d者记为戒烟失败组,把戒烟≥7 d(包括戒烟7 d后复吸)者记为7 d戒烟成功组.完成6个月随访后分析吸烟者的戒烟行为、戒烟结局、复吸情况并探讨戒烟成败影响因素.结果:共79名吸烟者完成6个月随访,7 d戒烟成功者为23名,未戒烟者为15名,复吸者为41名.各随访期均有复吸发生,但大部分复吸发生在戒烟后第一周内,占48.8％(20/41).7日戒烟成功率为55.7％(44/79),比较戒烟失败组和戒烟成功组两组的基线情况,戒烟成功组的日平均吸烟量[(17.43+4.95)支]明显低于戒烟失败组[(21.43+7.43)支],差异有统计学意义(t=-2.859,P=0.005);烟草依赖评分[(5.43±1.11)分]明显低于戒烟失败组[(6.14±0.97)分],差异有统计学意义(t=-2.987,P=0.004).多因素logistic回归分析显示,日平均吸烟量≥20支是戒烟成败的独立影响因素[OR(95％CI):4.441(1.652～11.940),P=0.003].结论:吸烟者经戒烟门诊强化干预后,可取得较好的戒烟效果;日平均吸烟量是影响戒烟的主要因素.

目的 分析结核病患者诊断延误情况及其影响因素,为区域性结核病控制措施的持续改进提供科学依据.方法 从"中国疾病预防控制信息系统"子系统"结核病管理信息系统"中导出广东省英德市2010-2020年新发肺结核患者网报资料,回顾性分析该地区11年的肺结核患者诊断延误(从症状发生到肺结核确诊时间>28d者)总体情况、年间变化趋势以及性别、年龄、居住地域及就诊医疗机构等因素的可能影响.结果 (1)英德市11年间共报告新发肺结核病11973例,其中3189例患者(26.63%)存在诊断延误;以第29天开始计算诊断延误时间,其诊断延误时间中位数为17 d.(2)11年间诊断延误率除2010、2011和2020年高达约30%外,其他年份均在22.35%～26.65%的较窄范围内波动;2010-2014年诊断延误时间中位数呈逐年上升趋势,2014年达33d峰值,其后的6年呈现总体下降趋势,2018年为9d最低值.(4)≥60岁患者组诊断延误率为22.61%,低于其他年龄组(P = 0.000);慢性病防治院就诊患者诊断延误率为62.89%,远高于其他就诊医疗单位(P = 0.000);市区、郊区、农村等不同居住地域患者诊断延误率依次升高,且差异显著(P = 0.000).男女性别间则差异无统计学意义(P = 0.462).(4)不同分类组别的诊断延误时间中位数分别为:男、女患者17、16 d;<18岁、18～44岁、45～59岁和≥60岁各年龄组患者10、13、18、20 d;郊区、农村、市区患者19、17、16 d;综合医疗机构、镇卫生院、监狱医院、慢性病防治院报告患者20、15、12、8 d.结论 近年来该地区结核病患者诊断延误总体情况不断向好,但患者年龄、居住地域、就诊医疗机构为诊断延误重要影响因素,必须相宜施策.

Objective:To explore the main influencing factors of tuberculosis students analyzing visit delay and diagnosis delay of students with pulmonary tuberculosis.Methods:The relevant information including symptom onset times, initial visit times, and disease diagnosis times of the hospitalized students with pulmonary tuberculosis from 2019 to 2021 was obtained, which were abstracted from the electronic medical records of the "Hospital Statistical Medical Record System" searching the terms "discharge time", "occupation", and "international classification code of main diagnoses of diseases". The intervals between symptom onset time and initial visit time and between the interval between initial visit time and disease diagnosis time were the visit time and the diagnosis time, respectively; the times ≥ 15 days were defined as visit delay and diagnosis delay accordingly. The two kinds of delays of different groups were described, inferred, and analyzed statistically; they were grouped according to gender (male / female), student levels (primary school student / junior high schools tudent / high school student / undergraduate / postgraduate), case finding methods (seeking medical attention in tuberculosis control agency / referral from general hospital / recommendation by medical staff of primary health care institutions / physical examination), and symptom onset month (from January to February / from March to June / from July to August / from September to December). The χ2, Mann-Whitney U, and Kruskal-Wallis rank sum tests were applied. Results:There were 723 hospitalized students with pulmonary tuberculosis during the three years; their visit time was 0-92 days, and 406 cases (56.16%) had visit delay of 15-92 days (median 25 days); their diagnosis time was 1-95 days ,and 503 cases (69.57%) had diagnosis delay of 15-95 days (median 24 days). There was a statistical difference in the incidence of visit delay between the groups of case finding method ( χ2=33.288, P?0.001); there were statistical differences in the incidence of diagnosis delay between the groups of gender and symptom onset month ( χ2=10.029, P=0.002; χ2=18.187, P?0.001) by χ2 test. There were statistical differences in visit delay time betweeb the groups of student level and symptom onset month ( χ2=33.000, P?0.001; χ2=12.750, P=0.005) and was in diagnosis delay time between the groups of symptom onset month ( χ2=15.987, P=0.001) by Mann- Whitney U test (comparison between two groups) or Kruskal-Wallis rank-sum test (comparison between ≥3 groups). Conclusions:There are high incidences of visit delay and diagnosis delay in students with pulmonary tuberculosis. And the degree of delay is closely related to gender, student level, case finding methods, and symptom onset month.

目的 评价家庭支持方法对吸烟者戒烟的有效性.方法 采用前瞻性干预研究设计,选择符合纳入标准的80例戒烟门诊患者,每例患者首诊时进行标准的基线问卷评估,并在首诊后1、3、6个月进行随访,由经过培训的医师对每例患者进行面对面心理干预和戒烟方法辅导,并将其按首诊时是否有家属陪同分为对照组(43例)和家庭支持组(37例),对照组仅给予心理干预,家庭支持组在心理干预的基础上,给予家庭内戒烟支持和监督.比较两组患者治疗的7天时点戒烟率、已戒烟患者的复吸率,以及干预结束时尼古丁依赖程度的差异.结果 随访1、3、6个月时,家庭支持组的7天时点戒烟率[分别为83.3％(30/36)、68.6％(24/35)和48.6％(17/35)]均明显高于对照组[分别为58.5％(24/41)、37.5％(15/40)和17.5％(7/40)],差异均有统计学意义(x2=5.627,P=0.018;x2 =8.142,P=0.017;x2=10.174,P=0.006).随访3个月时,家庭支持组的复吸率[20.0％(6/30)]低于对照组[37.5％(9/24)],但两组间差异无统计学意义(x2=2.035,P=0.154);随访6个月时,家庭支持组的复吸率[43.3％(13/30)]明显低于对照组[70.8％(17/24)],差异有统计学意义(x2=4.084,P=0.043).干预结束时,尼古丁依赖评分为重度的患者,家庭支持组所占比例[28.6％(10/35)]明显少于对照组[52.5％ (21/40)],差异有统计学意义(x2=4.408,P=0.036).结论 在对吸烟者的戒烟干预中,运用家庭支持方法可有效提高戒烟率,降低复吸率,促进未戒烟者减少吸烟依赖程度.

目的 探讨健康体检路径在提升体检中心优质护理服务工作效率及满意度的价值.方法 选取广州市市胸科医院体检中心2014年6月～2016年6月收治的810例体检者模式,比较两组的效果.结果 观察组护理满意度显著优于对照组;观察组体检效率、受检时间、体检可信度等指标均优于对照组(P＜0.05).结论 采取健康体检路径,可提高体检效率,提高护理满意度,促进护理服务质量提升,值得在临床进一步探讨和推广.

Objective To understand the physical health of college faculty,to explore the major risk factors affecting their health,and to provide some references for preventive health care in colleges.Methods The examination results of the faculties of a university in Guangzhou were retrospectively analyzed from 2012 to 2013.Results The top ten diseases with highest detection rates (abnormal indicators) were hyperlipidemia,high uric acid,ECG abnormalities,hypertension,overweight and obesity,fatty liver,gallstones,high blood sugar,pneumonia / tuberculosis,and elevated transaminases.Five out of ten associated with obesity-related diseases—— hyperlipidemia,high uric acid,high blood pressure,overweight and obesity,and fatty liver.290 people were detected in 2012,with a detection rate of 82.86％; 391 people were detected in 2013,with a detection rate of 72.27％,which dropped by 10％ comparing to the previous year.In hyperlipidemia,hyperuricaemia,hypertension,overweight and obesity,and fatty liver,the detection rates of the male were distinctly higher than those of the female,with statistical differences (P ＜0.01); while detection rates of ECG abnormalities,gallstones,high blood sugar,pneumonia / tuberculosis,and elevated transaminases had no statistical differences between men and women (P ＞ 0.05).Conclusions Both results showed that the physical conditions of the college faculties are alarming.Universities should pay attention to the physical condition of the faculty members.Health education should be given to improve the faculties' awareness of self-care.

Objective To sum up the treatment methods of asphyxia due to massive hemoptysis,and to explore how to improve the successful life-saving rate of asphyxia due to massive hemoptysis.MethodsA retrospective analysis of the successful life-saving cases of asphyxia due to massive hemoptysis,the life-saving methods were as follows:using oxygen saturation finger monitor Biometric Monitors to monitor oxygen saturation finger monitor,high-pressure oxygen balloon artificial ventilation,bedside bronchoscopy,mechanical ventilation and so on.First of all,we ensured re-supply of oxygen to remove blood clots airway,and to compare with the traditional methods such as postural drainage,bleeding with aspirator suction block.ResultsThe successful rate of the traditional methods were between 47% and 81%,but it was successful to rescue 18 cases pulmonary tuberculosis asphyxia due to massive hemoptysis by using these devices such as oxygen monitor,artificial ventilation balloon,bronchoscopy,mechanical ventilation.ConclusionThe key to the success of the rescue of asphyxia due to massive hemoptysis are that ensure the brain's oxygen supply within the first 4~6 minutes of as asphyxia,monitoring of oxygen saturation,using the devices such as artificial ventilation balloon,bronchoscopy,mechanical ventilation can markedly improved the survival rate of suffocation.

【Objective】To study the clinical value of bronchofibroscope in the diagnosis of secondary pulmonary aspergilloma.【Method】123 cases appeared the symptom of cough and sputum,spite blood after regulations anti-tubercle and were doubted secondary pulmonary aspergilloma and got a pathology to confirm by bronchofibroscope.【Results】123 cases,108 were confirmed secondary aspergilloma infection,5 complicated nontuberculous mycobac-teria infection,3 were confirmed pulmonary actinomycosis,there was blood cavities in 5,pulmonary tuberculosis re-occurred in 7.【Conclusions】Cavities of pulmonary tuberculosis more easy complicated aspergilloma infection,a check of bronchofibroscope can get accurate diagnosis in time.

肺血栓栓塞症(PTE)在国外有较高的发病率,美国每年约有新发PET患者60万例[1],法国PTE的年发病数超过10万例,英国、意大利每年也有较多PTE发病患者[2].

目的探讨几种肺部疾病患者中血浆D-二聚体的临床意义。方法对内科住院患者的血浆D-二聚体浓度进行测定。结果肺结核、结核性胸膜炎、肺炎、慢性阻塞性肺疾病、肺血栓栓塞症(肺栓塞)、肺癌6种肺部疾病患者血浆D-二聚体浓度均值与正常值比较,差异有显著性(P<0.05)。其中D-二聚体的升高阳性率以肺栓塞、结核性胸膜炎两种疾病最为明显。肺栓塞组与结核性胸膜炎组血浆D-二聚体浓度比较差异无显著性(P>0.05),肺栓塞组、结核性胸膜炎组分别与其他各组的血浆D-二聚体浓度比较差异有显著性(P<0.05)。其他各组的血浆D-二聚体浓度两两比较差异无显著性(P>0.05)。结论肺部多种疾病如结核、细菌感染、肿瘤、肺血栓栓塞等均可致血浆D-二聚体水平升高。D-二聚体的检测和D-二聚体水平升高对肺栓塞并不是特异的,D-二聚体检测在肺栓塞诊断的临床价值在于其阴性结果。

目的分析支气管扩张剂雾化吸入辅助治疗初治涂阳肺结核的临床疗效。方法雾化组与对照组同样采用规则抗结核治疗的基础上,雾化组加用支气管扩张剂雾化吸入,对比观察两组治疗后痰涂片阴转率及呼吸道症状、体征的变化。结果两组治疗后痰菌疗效近似,分别为92%和88%(P>0.05);雾化组治疗后咳嗽、咯痰、湿音、哮鸣音的消失率(80%,72%,84%,76%)明显高于对照组(40%,35%,44%,36%)(P均<0.01)。结论支气管扩张剂雾化吸入辅助治疗初治涂阳肺结核对痰涂阴转率没有明显影响,但可明显改善呼吸道症状、体征。