糖尿病赋权有面对面赋权和远程赋权两种,两种方式联合使用对提高患者的赋权能力有积极意义,国内外糖尿病赋权的测量工具内容较为单一,进一步研发针对糖尿病患者的整体赋权量表可全面评估患者的赋权能力和影响因素.基于此,本文通过回顾国内外糖尿病患者赋权相关文献,对糖尿病患者的赋权概念、赋权实施方案和赋权效果进行综述,讨论糖尿病患者赋权过程中所遇到的问题和实施赋权的有效方式.

Objective:To analyze the bacteriological distribution and drug resistance of nasopharynx in patients with adenoid hypertrophy complicated with secretory otitis media, and to clarify the distribution of pathogenic bacteria, so as to provide guidance and basis for antibiotic use in clinical treatment. Methods:A retrospective analysis was performed on 311 patients with adenoid hypertrophy and secretory otitis media who underwent surgical treatment in the department of otolaryngology head and neck surgery, Affiliated Hospital of Qingdao University from February 2013 to January 2020. They were divided into 3 groups by age: Group A（0-5 years old）, Group B（6-10 years old）, and Group C（11-16 years old）. The secretions from deep adenoid near the eustachian tube of the affected ear were collected during the surgery for bacterial culture and drug resistance analysis. Results:One hundred and forty-two strains of pathogenic bacteria were isolated and cultured, with a detection rate of 45.66%. Staphylococcus aureus （63 strains）, streptococcus pneumoniae （15 strains） ,streptococcus pyogenes （13 strains） and moraxella cachinella（28 strains）was the main strain.Staphylococcus aureus had high drug resistance rate to penicillin, erythromycin and clindamycin.Streptococcus pneumoniae and Streptococcus pyogenic had high resistance rates to erythromycin,clindamycin and tetracycline. The resistance rate of Moraxella catarrhalis to ampicillin and co-trimoxazole was higher. Conclusion:The main pathogens detected in patients with adenoid hypertrophy complicated with secretory otitis media are staphylococcus aureus, streptococcus pneumoniae, streptococcus pyogenes and moraxella catarrhalis. Drug resistance of different pathogens is quite different. So it is recommended to carry out extensive bacteriological detection, and select antibiotics according to the principle of rational drug use and the results of drug resistance test, so as to achieve good therapeutic effect.

目的 研究分析利用最佳证据规范气管切开非机械通气患者的湿化方式选择.方法 选取128例于2018年4月～2020年1月在本院接受气管切开术的喉癌患者.应用数字随机排序法将患者平均分为对照组(64例,行间断滴注护理)与研究组(64例,行持续湿化护理),对比两组患者护理后痰液浓稠度与酸碱度.结果 经各采取不同的护理方式后,研究组患者痰液浓稠度为Ⅰ度的患者明显多于对照组,且在酸碱度方面,研究组患者较对照组患者更偏向于正常值,以上数据对比,差异有统计学意义(P<0.05).结论 在喉癌患者完成气管切开术后,采用持续性湿化护理,能够有效改善其痰液状态与体质酸碱性,进而能够使患者呼吸功能得到改善,预防肺部感染等并发症的发生,提升气道管理水平.

异位甲状腺(ETG)是较常见的甲状腺发育不全类型之一,临床上存在误诊误治的情况,若胚胎发育过程中始基出现下降障碍或弥散现象,使得甲状腺不能下降到气管前方的正常解剖位置,则形成ETG.从发育程度上,可分为迷走甲状腺和副甲状腺.从形态学上,可分为真性异位、假性异位和完全异位.从异位部位上,可分为下降不良、颈中部异位、颈外侧异位和远处异位.超声学检查是诊断ETG的首选方法,甲状腺功能检查是诊断ETG功能状态的必要检查,核医学检查是定位、定性诊断ETG的最佳检查方法,对肿物进行病理学检查是诊断ETG的金标准.对于无临床症状、甲状腺功能正常的ETG,可以不进行特别的临床干预.若合并甲状腺功能减退,可使用外源性甲状腺激素以改善甲状腺功能.若ETG发生的位置影响机体的正常功能或合并良恶性肿瘤时,则建议行手术治疗.

1 临床资料 患者,马某某,女,43 岁,因"声嘶半年余"就诊,门诊行电子喉镜检查示:右侧声带近前联合处暗红色新生物,肿物表面光滑,声带活动良好. 于2018年5月2 日以"声带息肉"收入青岛大学附属医院耳鼻咽喉科. 入院后采集病史告知哮喘病史,未规律服药治疗. 查体:肥胖体型,颈粗,下颌短小. 相关辅助检查无明显异常. 于2018 年5月4日行全麻下支撑喉镜下声带息肉切除术. 手术过程顺利,撤镜时发现右侧腭舌弓下方轻度撕裂,给予压迫止血,血止术毕.

目的 探讨不同剂量的外源性白细胞介素17A(IL-17A)干预对变应性鼻炎小鼠气道炎症的影响.方法 将48只小鼠采用随机数字表法分为A、B、C、D、E、F组,每组8只.分别于第0、7、14天将溶于50μL生理盐水的20μg卵清蛋白(OVA)加2 mg铝佐剂腹腔注射处理D、E及F组小鼠,间隔7 d,于第22天开始鼻腔激发,每天每侧鼻孔各滴入OVA 10μL,连续7 d.D、E及F组小鼠于每次OVA鼻腔激发前1 h分别给予生理盐水、IL-17A蛋白100 ng、IL-17A蛋白500 ng滴鼻,A、B及C组小鼠于相同时点予等量生理盐水腹腔注射并滴鼻,B、C组小鼠于每次生理盐水鼻腔激发前1 h分别给予IL-17A蛋白100 ng、IL-17A蛋白500 ng滴鼻.所有小鼠于最后一次激发后评估鼻部症状学变化,Diff-Quik染色观察鼻腔灌洗液(NLF)中嗜酸性粒细胞浸润情况,ELISA法检测血清及NLF中IL-6、IL-10水平,鼻黏膜组织行甲苯胺蓝染色观察肥大细胞数.结果 4周末D组所有小鼠症状学评分均>5分,造模成功.A、B、C、D、E及F组症状学评分分别为1.5(1.0～2.8)、2.0(1.0～3.0)、2.5(2.0～3.0)、7.0(6.3～8.0)、3.0(2.3～3.8)及8.0(7.0～8.8)分.E组小鼠挠鼻及喷嚏次数少于D组(H=21.375,P=0.033;H=20.250,P=0.049).D组小鼠血清及NLF中IL-6水平高于A组(H=25.750,P=0.004;H=20.688,P=0.047),IL-10水平低于A组(H=22.875,P=0.016;H=20.625,P=0.048).E组小鼠血清及NLF中IL-6水平与A组相比差异无统计学意义(H=19.875,P=0.068;H=8.125,P>0.999).E组小鼠血清中IL-10水平高于D组(H=27.062,P=0.002).F组小鼠血清及NLF中IL-6水平高于A组(H=22.250,P=0.008;H=28.688,P=0.001).F组小鼠血清及NLF中IL-10水平与D组相比差异无统计学意义(H=13.062,P=0.930;H=0.500,P>0.999).C组小鼠NLF中嗜酸性粒细胞数高于A组(H=20.688,P=0.047).E组小鼠NLF中嗜酸性粒细胞数低于D组(H=21.188,P=0.037).F组小鼠NLF中嗜酸性粒细胞数与D组相比差异无统计学意义(H=2.875,P>0.999).D组小鼠鼻黏膜组织中肥大细胞数与A组相比增多(H=27.188,P=0.002).E组小鼠鼻黏膜组织中肥大细胞数少于D组(H=20.938,P=0.042).F组小鼠鼻黏膜组织中肥大细胞数与D相比差异无统计学意义(H=1.188,P>0.999).结论 500 ng的外源性IL-17A能促使小鼠鼻腔嗜酸性粒细胞募集,100 ng的外源性IL-17A对变应性鼻炎小鼠模型气道炎症有保护作用.

Objective To explore the impaction and significance of radiation therapy on repair of skull base defect with nasal septum mucosa flap with pedicle in rabbit models. Methods Ten fresh white rabbit bodies served for the anatomy research of blood supply of nasal septum mucosa flap. Twenty New Zealand white rabbits were induced into models of skull base defect and cerebrospinal fluid rhinorrhea. Nasal septum mucosa flap with pedicle was employed to reconstruct the defect and repair the leakage. Seven days and 10 days after the operation,wound healing and leakage were observed by nasal endoscopy. Twenty-one days after the operation,10 rabbits which accepted the surgical treatment as the experimental group were randomly drew to get radiation therapy,the other 10 as the control group. One day and 14 days after the radiation therapy,repair area of the experiment and the control groups were respectively observed by nasal endoscopy. Results Seven blood supplies of the nasal septum mucosa flap come from behind and below the nasal septum,2 blood supplies come from behind the nasal septum 1cm away,and 1 did not show obvious blood supply. Twenty rabbits models of skull base defect and cerebrospinal fluid rhinorrhea and the nasal septum mucosa flap with pedicle was employed to reconstruct the defect and repair the leakage were successfully established and survived without any complication as continuous rhinorrhea of cerebrospinal fluid,local tissue eminence and neurological function defect. Ten rabbits of the experiment group which accepted radiation therapy and 10 rabbits of the control group were all survived,but the speed of wound healing of the rabbits of the experiment group was fairly slower. Conclusion Repair of skull base defect with the nasal septum mucosa flap with pedicle in rabbit models is feasible,and radiation therapy can delay the speed of healing of the nasal septum mucosa flap with pedicle.

目的 通过研究低温等离子消融术与下鼻甲成形术术后患者鼻塞改善情况和对鼻腔黏膜纤毛功能的影响,探讨治疗慢性鼻炎更有效的方法.方法 选取慢性鼻炎患者40例,随机分为两组,分别行等离子消融术(A组)与下鼻甲成形术(B组).术前,术后1周、1个月、3个月分别用VAS评分评价患者鼻腔症状.糖精试验评价术前及术后3个月患者鼻腔黏膜纤毛传送功能.结果 等离子组术中出血、手术时间较下鼻甲成形组明显减少,且术后并发症较少;术后3个月两组患者鼻塞均有明显改善;两种手术方式对鼻腔黏膜纤毛功能无影响.结论 对单纯黏膜肥厚的慢性鼻炎,等离子消融疗效显著;对鼻甲骨质肥厚或形态异常的慢性鼻炎,下鼻甲成形术效果好.

目的:探讨系统性出院指导对腭裂整复术患儿语音治疗依从性的影响。方法:将110例腭裂整复术患儿按手术时间分为对照组50例和实验组60例,对照组给予常规出院指导,实验组患儿及家属给予系统性出院指导,语音治疗6个月后,比较两组语音治疗依从性和效果。结果:实验组语音治疗依从性高于对照组(P<0.01),实验组语音治疗效果优于对照组(P<0.01)。结论:系统性出院指导可增强腭裂整复术患儿及家属对疾病知识的理解,提高语音治疗依从性,明显改善腭裂患儿的语音功能。

在大学英语精读教学中,教师应注重语言中文化意识的培养,将语言与文化的教学内容结合起来,充分提高学生综合运用语言的能力.本文作者从语言和文化的关系,以及文化意识的必要性入手,提出了一些建设性的文化培养的策略和方法.

<正>血管瘤是口腔颌面外科治疗的一种常见病,多发于儿童,其发病率为8%～12%,其中60%的血管瘤发生于面部[1],随着生长发育逐渐增大,如不及时治疗可影响美观及引起功能障碍。虽然传统的治疗方法很多,但各有其局限性。因此笔

自身免疫性溶血性贫血是由于机体免疫功能调节紊乱,自身抗体吸附于红细胞表面而引起的一种溶血性贫血.部分病人溶血严重,输同型血配型困难,不能及时输血而引起一系列严重的并发症甚至危及生命.2004年6月～2005年10月,我院对6例配同型血困难而病情危重的病人输注异型血,均无不良反应.现报告如下.

本文通过对任务型语言教学的理论依据、概念、特点极其对教师的要求等方面的简要陈述,创造性地阐述了任务型语言教学的具体设计,并见解性地提出了其应在教学实践中注意的问题,从而使英语教师对有效的任务型教学有一个更加深刻的认识和理解。

2003年1月～2004年12月,我院共收治口腔颌面部感染合并糖尿病15例,经精心治疗与护理,效果满意.现报告如下.

静脉穿刺输液是临床常用的抢救和治疗的重要措施之一,文献[1,2]对头皮针针尖刺入皮下后如何进入静脉,以及持针手法无明确规定,临床上也不一致,有的持针柄的上下面,有的则持针柄的前后面.为了比较不同持针手法患者疼痛的程度,我们进行了观察对比,现将结果报告如下.

随着护理改革的深入开展,我们对唇裂、腭裂患者采取了综合序列治疗和护理;不仅解决了面部畸形的整复,而且通过鼻咽镜、语音测试等帮助患者正确发音.现将对唇裂、腭裂的有关健康教育体会报告如下.