目的:探讨在小儿外科临床护理教学中为护理学生们开展情境模拟教学法的应用价值,分析护生们的教学效果.方法:从2021年6月到2022年2月期间某校临床护理学专业的学生中筛选出60名学生作为本次的研究对象,将2021年6月到2021年12月采取传统教学法期间纳入对照组,将2022年1月到2022年6月采取情境模拟教学法期间纳入研究组,对比教学效果、考核成绩以及教学满意度.结果:两组间比较,研究组学生教学效果评分中各项评分均更高;研究组学生考核成绩评分均更高;研究组学生对教学满意度评价更高,P ＜ 0.05.结

Objective: To explore the nursing difficulties and Countermeasures of central venous catheterization in the prevention of infection in 129 patients with AIDS. Methods: using retrospective case data, 129 AIDS patients treated in Beijing You''an Hospital from January 2011 to December 2020 were collected and indwelling central venous catheter. Standard prevention was implemented in strict accordance with the requirements of nosocomial infection, and nursing intervention was taken in the aspects of infection source management, transmission route management and susceptible patient management. Adopt protective isolation for all AIDS patients.; Results: none of 129 AIDS patients had nosocomial cross infection during indwelling central venous catheter. Conclusion: it is effective to take intervention measures in the prevention of infection for AIDS patients with indwelling central venous catheter. In view of the four nursing difficulties existing in AIDS patients with indwelling central venous catheter, the implementation of timely, correct and effective nursing intervention measures for nursing difficulties can effectively cut off the path of cross infection in AIDS patients with indwelling central venous catheter, so that AIDS patients do not have cross infection during indwelling central venous catheter, Finally, reduce the hospitalization expenses and hospitalization days of patients.

目的 分析帕金森病(PD)患者血清血管紧张素(Ang)Ⅱ、Ang(1-7)、骨桥蛋白(OPN)表达水平及与患者抑郁、焦虑症状的关系.方法 选择该院2020年1月至2021年12月收治的80例PD患者作为观察组,50例体检健康者作为对照组;检测受试者血清AngⅡ、Ang(1-7)、OPN水平,采用汉密尔顿焦虑量表(HA-MA)和17项汉密尔顿抑郁量表(HAMD-17)评估患者焦虑及抑郁情况;采用多因素Logistic回归分析探讨患者血清AngⅡ、OPN、Ang(1-7)表达水平与PD患者抑郁、焦虑症状的关系.结果 观察组血清AngⅡ、Ang(1-7)和OPN水平均低于对照组(P<0.05).伴随焦虑和抑郁症状的PD患者血清AngⅡ、OPN、Ang(1-7)表达水平低于无焦虑和抑郁症状的PD患者(P<0.05).多因素Logistic回归分析显示,血清低水平AngⅡ、OPN、Ang(1-7)是影响PD患者焦虑和抑郁症状的独立危险因素(P<0.05).结论 PD患者血清AngⅡ、OPN、Ang(1-7)呈明显低表达状态,也是影响PD患者抑郁、焦虑症状的独立危险因素.

目的:总结先天性腹裂患儿应用免缝腹裂袋(silo袋)治疗的护理经验,为今后先天性腹裂患儿治疗后的护理提供帮助.方法:总结自2008-2015年以来,我院应用silo袋进行分期腹壁修补治疗的11例先天性腹裂患儿的护理病例资料.结果:11例患儿中8例治愈出院,3例因合并其他严重疾病,放弃治疗后死亡.结论:手术是治愈新生儿腹裂的有效唯一方法,应用silo袋在治疗新生儿腹裂方面效果显著,针对xxx(该病护理要点)的观察与护理,先天性腹壁裂患儿的存活率已有了很大提高.

目的 探讨两性霉素B联合氟康唑对获得性免疫缺陷综合征(AIDS)合并新生隐球菌性脑膜炎患者细胞免疫功能的影响.方法 选取2018年12月至2020年12月首都医科大学附属北京佑安医院收治的AIDS合并新生隐球菌性脑膜炎患者50例,应用随机数字表法分为对照组和观察组,各25例.对照组给予两性霉素B普通输液留置针静脉滴注治疗,观察组给予两性霉素B中心静脉导管置管联合氟康唑治疗.治疗2周为1个疗程,2组均治疗3个疗程.比较2组治疗前后细胞免疫功能和颅内压,临床疗效、置管并发症和不良反应发生率.结果 治疗前,2组CD3+、CD4+、CD8+ T淋巴细胞计数和颅内压比较差异均无统计学意义(均P＞0.05);治疗后,观察组CD3+、CD4+、CD8+ T淋巴细胞计数均高于治疗前且高于对照组[(1383±398)爪/μl比(1147±375)个/μl、(846±261)个/μl比(688 ±232)个/μl、(881±218)个/μl比(598±221)个/μl],2组颅内压均低于治疗前,且观察组低于对照组[(135 ±33)mmH2O(1 mmH2O =0.098 kPa)比(194 ±47) mmH2O](均P＜0.05).治疗3个疗程后,观察组总有效率高于对照组[96.0％(24/25)比76.0％ (19/25)](P=0.042).观察组置管渗液渗血和穿刺异常发生率均低于对照组(均P＜0.05),2组不良反应发生率比较差异无统计学意义(P=0.157).结论 两性霉素B联合氟康唑治疗可改善AIDS合并新生隐球菌性脑膜炎患者细胞免疫功能、降低颅内压、提高疗效,且安全性较好.

目的 探讨进口某品牌TEG5000型血栓弹力图(TEG)仪及原装进口试剂与国产某品牌相应产品检测结果的相关性、一致性及临床可替代性.方法 选取30例临床血浆标本,用进口某品牌和国产某品牌TEG仪以及两家公司生产的试剂进行平行和交叉检测,即分别用进口TEG仪+进口试剂(TEG组)、国产TEG仪+国产试剂(DR组)、进口TEG仪+国产试剂(TD组)进行检测,分析3组间凝血反应时间(R)、凝血形成时间(K)、凝固角(Angle)、最大振幅(MA)4个参数的相关性和一致性.结果 R、K、Angle、MA 4个参数在TEG组、DR组、TD组间均具有高度相关性(r>0.9,P<0.05);且TEG组、DR组、TD组间的检测结果有良好的一致性,相差幅度为临床可接受;进口TEG5000型TEG仪采用国产试剂进行检测,与生物参考区间的符合率≥90％.结论 进口TEG5000型TEG仪可以采用国产试剂替代进口仪器试剂进行TEG检测,能为临床诊疗提供可靠、准确、有价值的数据.

目的:分析脑肿瘤患儿父母心理弹性状态及其影响因素,为开展有针对性的心理护理提供借鉴.方法:采用方便抽样法,对某儿童医院2018年10月至2021年2月神经外科收治的200名脑肿瘤患儿父母采用简易心理弹性量表、抑郁-焦虑-压力量表中文精简版、社会支持评定量表进行调查.结果:脑肿瘤患儿父母弹性心理得分低于国内常模,差异具有统计学意义(P<0.05);患儿父母的抑郁、焦虑、压力得分与其心理弹性得分呈负相关;社会支持得分与其心理弹性得分呈正相关;患儿父母的性别、年龄、居住地、抑郁得分及社会支持总分是影响其心理弹性的因素(调整后R2=0.664).结论:护士需要关注脑肿瘤患儿父母的心理状态,全面评估患儿父母的社会支持情况,调动其有效的社会支持力量,改善其心理弹性状态,从而为患儿的后期治疗和提高患儿的生存率奠定基础.

目的 探究缬沙坦(valsartan)抑制大鼠颈动脉球囊损伤后血管内膜增生的作用机制.方法 选取40只6周龄SPF级SD大鼠体,体质量(200±30)g,制作大鼠颈动脉球囊损伤模型并分为4组:空白对照组、模型组、低浓度缬沙坦组[10mg/(g· d)]、高浓度缬沙坦组[20mg/(g· d)],14 d后取损伤血管段并测定内膜增生情况;使用放射免疫分析血浆内皮素1(ET1)、血栓素B2 (TXB)、6-酮-前列腺素1α(6-keto-PGF1α)含量;使用免疫组织化学法检测血管壁增殖细胞核抗原(PCNA)的表达情况,使用Western blot检测碱性成纤维细胞因子(b-FGF)、转化生长因子(TGF-β1)和血小板源性生长因子(PDGF-BB)的表达情况.结果 相比空白对照组,模型组内膜面积、内膜/中膜比值、内膜厚度、ET1、TXB2含量、PCNA阳性指数、b-FGF、TGF-β1和PDGF-BB蛋白表达量显著升高,管腔面积、6-keto-PGF1α含量显著降低,差异有统计学意义(P＜0.01);相比模型组,低浓度缬沙坦组和高浓度缬沙坦组,内膜面积、内膜/中膜比值、内膜厚度、ET1、TXB2含量、管腔狭窄度、PCNA阳性指数、b-FGF、TGF-β1和PDGF-BB蛋白表达量显著降低,且高浓度缬沙坦组显著低于低浓度缬沙坦组,差异有统计学意义(P＜0.01);相比模型组,低浓度缬沙坦组和高浓度缬沙坦组大鼠管腔面积、6-keto-PGF1α含量显著升高,高浓度缬沙坦组显著高于低浓度缬沙坦组,差异有统计学意义(P＜0.01).结论 缬沙坦可以抑制大鼠颈动脉球囊损伤后血管内膜增生,其作用机制与抑制相关生长因子和血管内膜平滑肌的增殖有关,且在一定范围内呈浓度依赖.

新型冠状病毒肺炎,是指2019新型冠状病毒感染导致的肺炎.新型冠状病毒肺炎U07.100x001适用于新型冠状病毒肺炎的确诊患者;新型冠状病毒肺炎临床确诊病例U07.100x003适用于第五版诊疗方案中湖北等地的临床诊断病例;新型冠状病毒感染U07.100x002适用于新型冠状病毒无症状感染者.不忽视新型冠状病毒肺炎疑似病例作为其它诊断代码的作用.明确新冠肺炎临床分型,细读病案,准确完整地编码出该病案的其它诊断、手术和相关操作.编码员应重视新型传染病ICD编码工作,了解编码的分类原则,结合临床诊疗方案,仔细阅读病案相关内容,明确临床诊断和临床分型,提高编码准确性.

帕金森运动障碍是一组有关运动系统基础功能不同程度受损性质的运动障碍.患者出现患侧上肢肩胛带和手关节疼痛、活动受限及血管运动改变等症状,并可伴有皮肤及肌肉的萎缩,该综合征的发生时间多集中在病后的3 个月内[1?2].主动呼吸节律调节主要依靠自主节律呼吸系统以及延髓的随意呼吸调节系统,此外还包括肺牵张反射、快适应激惹等感受器的神经反射共同作用.而运动康复护理则是多数慢性病患者在急性期过后预后恢复的首要干预措施[3] ,心理干预则起到辅助的作用[4] ,帮助患者从主观上顺利完成对疾病接受态度的过渡,从心理层面形成疾病预后的保护因素.运动康复护理中的体力活动或有氧运动的学习过程本身就是一种简便、有效的认识过程,对患者的手足协调性、平衡能力、注意力集中和分配、记忆力及执行能力均有一定的维持和促进作用.

目的 探讨从团队为基础(TBL)+从问题为中心(PBL)+以案例为基础(CBL)融合式教学法结合ISO15189相关要素在血栓与止血检验临床见习带教中的效果.方法 选择首都医科大学2014级临床医学专业五年制学生63例,七年制学生49例为研究对象,随机分为传统教学组和实验教学组.传统教学组采用讲授式教学模式(LBL),实验教学组采用TBL+ PBL+ CBL教学方法并结合ISO15189进行授课.观察教学效果及学生对教学方法的满意度.结果 实验组理论知识、操作技能和检验综合分析能力得分均高于传统组,差异有统计学意义(P＜0.05).实验组专业知识掌握程度、学习兴趣、团队协作、表达沟通能力、动手能力、ISO15189融入见习认可度等均高于传统组,差异有统计学意义(P＜0.05).结论 在血栓与止血检验见习带教中,融合式教学法结合ISO15189有利于提高教学效果,值得在实验诊断学的临床见习中推广.

随着对TNFLs和TNFRs在免疫系统及非淋巴组织中调节细胞凋亡、坏死作用越来越广泛的研究,LT及其受体作为肿瘤坏死因子超家族(TNFSF)的一员被越来越多的提及.淋巴毒素α(LTα)是一种淋巴细胞受丝裂原及特殊抗原刺激后反应性产生的细胞毒性物质,LTα能与相应受体结合,从而引起肿瘤细胞凋亡及坏死,而激动性抗LTβ受体抗体和LTαβ生理性作用相同,同样能够产生抑制瘤细胞生长、减少瘤细胞淋巴结转移、增强化疗效果的作用.本文就淋巴毒素及其受体的研究进展进行综述.

目的 :调查某医院神经外科患儿家长对健康类手机应用程序(APP)使用及需求情况,为开发适合神经外科患儿家长的健康类APP,促进患儿康复,实现延续护理提供依据.方法 :采用自设调查问卷对某医院神经外科病房的150名患儿家长进行调查.结果 :患儿家长的手机使用经验值为(48.37±7.62)分,处于中等水平.93.3％ 患儿家长愿意安装新开发的健康类APP;患儿家长对健康类APP的使用信心得分中位数为39.0分,具有较高使用信心.不同年龄、文化程度、居住地的患儿家长健康类APP的使用信心值差异有统计学意义(P<0.05).结论 :应针对患儿家长的期待和需求开发具有针对性和实用性的健康类APP,为延续护理服务提供补充.

目的 采用不同方法检测急性脑梗死患者血浆中蛋白C抗凝活性,并评价2种方法的相关性、一致性及临床可替代性.方法 收集294例临床血浆样本,用发色底物法和凝固法同时测定血浆中蛋白C抗凝活性,比较2组数据的相关性和一致性.结果 2种方法检测急性脑梗死患者蛋白C抗凝活性结果差异无统计学意义(P>0.05),具有良好的相关性,但二者一致性检验较差.结论 实验室在比较不同方法检测一致性时应采取多种方法从不同角度进行联合评价,以避免某一方法评价中局限性的影响,使评价结论更合理、客观.

目的 研究餐后不同时间抗凝血酶Ⅲ(ATⅢ)、蛋白C(PC)、蛋白S(PS)活性测定结果的差异.方法 选择30名健康志愿者,分别检测其空腹、餐后2h、餐后4hATⅢ、PC、PS水平,对测得的结果分别进行比较.结果 与空腹相比,餐后2h、餐后4h血浆ATⅢ、PC、PS水平均降低,差异有统计学意义(P＜0.05);而餐后4h三种抗凝蛋白的活性比餐后2h有所升高,但其差异不显著(P＞0.05).结论 进食是ATⅢ、PC、PS活性水平的重要影响因素,为保证检测结果的准确性,应严格要求空腹采集标本.

Objective?To analyze the literature about the research situation and developmental trend of swallowing dysfunction nursing in China and to provide reference for further swallowing dysfunction nursing practice. Methods?Using blibiometric method and NoteExpress 2.0 soft-ware, we searched China National Knowledge Infrastructure (CNKI) database and Wan Fang database for swallowing dysfunction nursing related publications in China (from January 2000 to December 2016). Results?A total of 1 330 publications published have been searched out. The number of articles increased every year, and 814 (61.20%) articles were published in recent 5 years. The articles were mainly clinical trial research literature, accounting for 50.83%, followed by experience introduction and case report literature, accounting for 44.28%. These articles mainly focused on rehabilitation nursing and rehabilitation training. 96 articles were cited over 10 times, accounting for 7.22%, and the highest was cited for 135 times. 35 articles (2.63%) were funded by grants. Conclusions?Swallowing dysfunction nursing related articles have been increasing yearly, however, the contents and the objects needs to be expended. There is great space for the improvement in research depth, breadth and quality.

Objectives To investigate the evaluation of the medical service performance of the hospital based the diagnosis related group (DRGs) in technique for order preference by similarity to an ideal solution statistics method. Methods The front page information of patients from a hospital in Beijing were analyzed by the Beijing edition of the diagnosis related group (BJ-DRGs), then the DRGS related information of patients were obtained. The TOPSIS statistics method was applied to analyze the medical service performance of hospital. Results The hospital treated disease categories (MDC) was 23 groups, DRGs group was 522, case mix index (CMI) was 0.95, which was close to the average level of medical technology difficulty in Beijing; cost index, time consumption index were 1.09, 1.11, which were cower than the average level of the service efficiency. The department of most widely used in the treatment of disease was the department of general surgery, the DRGS group was about 130 group, The difficulty of treatment was the department of Cardiology, CCU and department of Neurosurgery, the case mix index was 1.39. The time and pay consumption index of department of urology surgery was the lowest, but the longest was obstetrics and gynecology department. The result of TOPSIS showed the department with best medical service performance were department of cardiology, department of orthopedics, department of general surgery, department of infectious disease, department of oncology, respectively as top 5, the medical service performance of the department of renal medicine, obstetrics, gynecology, of endocrinology, department of urology were lowest respectively. Conclusion The TOPSIS evaluation method based on the DRGs utilized comprehensively the width and difficulty of the medical service, the medical service efficiency index, the evaluation result was objective and reliable, it provided a reasonable and feasible method for the hospital medical performance evaluation.

Objective: To compare and analyze the usage of oral hypoglycemic drugs in our hospital during 2012~2013.Methods: Sales amount of oral hypoglycemic drugs, DDDs (DDDs) and defined daily cost (DDC) were retrospectively analyzed of inpatients in our hospital during 2012~2013. Analyze the use of oral hypoglycemic drugs according to the DDDs order and sum order.Results: Oral hypoglycemic agents in our hospital drug usage showed a rising trend year by year, 2012~2013 patients using the DDDs of oral hypoglycemic drugs three are acarbose, metformin, Gliquidone, conforms to the trends in clinical medicine and treatment principles. Conclusions:The use of oral hypoglycemic drugs in our hospital during 2012~2013 was basically reasonable.

Objective: To compare and analyze the usage of lipid-lowing agents in our hospital during 2014~2015.Methods: Sales amount of lipid-lowing agents, DDDs (DDDs) and defined daily cost (DDC) were retrospectively analyzed of inpatients in our hospital during 2014~2015. Analyze the use of lipid-lowing agents according to the DDDs order and sum order.Results: The use of lipid-lowing agents in our hospital showed a rising trend year by year. Statins was the top of lipid-lowing agents by the DDDs order, which conformed to the clinical medication trend and treatment principles.Conclusions:The use of lipid-lowing agents in our hospital during 2014~2015 was basically reasonable.

目的 探讨基于疾病诊断相关组(DRGs)对医疗服务绩效进行秩和比法(RSR)评价.方法 利用北京市某三甲医院2015年上半年出院患者的首页信息,通过“北京版诊断相关组(BJ-DRGs)”的病例组合系统分析获取出院患者的DRGs相关信息,运用RSR评价方法对各科室医疗服务进行综合绩效评价.结果 1)全院收治疾病大类(MDC)组数为23组,DRGs组数为479组,病例组合指数(CMI)为0.96,接近北京市医疗技术难度的平均水平;费用消耗指数、时间消耗指数分别为1.06、1.07,高于北京市服务效率的平均水平.2)治疗疾病范围最广的是传染科,DRGs组数71个;技术难度最高的为危重症内科部ICU,CMI指数为3.17;泌尿外科的住院时间消耗最短、费用消耗最低;妇产科的住院时间消耗最长、费用消耗最大(1.28,1.46).3)RSR综合评价显示,最优档为传染科、神经内科、泌尿外科、中西医结合科、ICU;最差档为妇产科、儿科.结论 基于DRGs的RSR评价方法,综合了医疗服务广度及难度、医疗服务效率指标,评价结果客观,为医院绩效评价提供了一种可行的方法.