Objective:To analyze the injury factors and prognosis of children with traumatic brain injury (TBI), and to explore the risk factors affecting its severity, so as to provide evidence for the prevention and intervention of TBI in children.Methods:A total of 6 040 children with TBI who were admitted to the Department of Neurosurgery of Children's Hospital of Soochow University from January 1, 2011 to December 31, 2020 were selected. The injury factors and prognosis were retrospectively analyzed. Univariate and multivariate Logistic regression analysis was used to analyze the factors affecting the severity of TBI in children.Results:Of the 6 040 children, 3 681 were males and 2 359 were females. The patients aged 1 to 3 years accounted for the highest proportion (34.0%, 2 056/6 040), and most of them were mild injuries (93.2%, 5 631/6 040). The main injury sites of children with TBI were road (35.9%, 2 167/6 040) and home (31.1%, 1 881/6 040), and the main causes of injury were falling from height (34.9%, 2 107/6 040) and falling (34.5%, 2 085/6 040). Children aged 1 to 3 years were most likely to be injured at home(41.9%, 861/2 056), mainly due to falling from height, while children aged 4 to 6 years were most likely to be injured on the road(43.8%, 828/1 891), mainly due to falling. Logistic regression analysis showed that children's residence, the presence of multiple injuries and the location of brain injury were independent influencing factors for the severity of TBI in children ( χ2=6.58, 138.15, 4.25, all P <0.05). Conclusions:TBI in children aged 1 to 3 years mainly occurred at home, and in children aged 4 to 6 years mainly occurred on the road. Falling from height and falling are the main causes of TBI in children. The society, schools and families should take targeted prevention education and intervention measures according to different age groups. Children who live in rural areas, have multiple injuries, and have multiple brain injury sites are more severely injured. In the process of treating children with TBI, the severity can be quickly predicted based on this, and the treatment efficiency of children with TBI can be improved.

目的:探讨管道护理联合协同护理在脑积水行脑室-腹腔分流术患儿中的应用方法及效果.方法:将60例脑积水患儿按住院编号奇偶数分为对照组和研究组各30例,对照组在围术期常规护理基础上给予管道护理,研究组在对照组基础上联合协同护理,比较两组护理效果.结果:两组患儿置管次数、住院时间、并发症发生率比较差异有统计学意义(P<0.05,P<0.01);研究组家属护理满意度高于对照组(P<0.01);两组家属干预后汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评分低于干预前(P<0.05),研究组家属干预后HAMA、HAMD评分低于对照组(P<0.01).结论:管道护理联合协同护理可降低脑积水行脑室-腹腔分流术患儿术后并发症发生率,减少置管次数,缩短住院时间,缓解家属焦虑、抑郁情绪,提高护理满意度.

目的:探讨小儿脑积水分流术后精细化护理的方法及效果.方法:选取2015年1月1日～2020年4月1日收治的60例脑积水分流术患儿为研究对象,采用随机数字表法分为对照组和观察组各30例;对照组给予常规护理,观察组给予精细化护理;比较两组术后并发症发生情况,干预前后两组智力发育情况[采用Gesell婴幼儿发展量表(GDS)]、肌张力水平[采用改良Tardieu量表(MTS)],干预后两组护理质量(采用护理服务质量评价量表).结果:观察组分流管阻塞、消化道症状发生率低于对照组(P＜0.05);干预后,两组GDS得分均高于干预前(P＜0.05),且观察组高于对照组(P＜0.05);干预后,两组MTS得分均高于干预前(P ＜0.05),且观察组高于对照组(P＜0.05);观察组护理质量评分高于对照组(P＜0.05).结论:小儿脑积水分流术后实施精细化护理,有助于降低术后并发症发生率,促进患儿智力发育,增加肌张力水平,提升护理质量.

目的 分析本院静脉用药调配中心(PIVAS)退药情况及相关因素.方法 调取本院PIVAS 2019年1月至2019年12月退药数据,包括退药时间、退药病区、退药原因、药品名称、规格、批号、有效期、数量、性状变化情况、质量合格与否.统计2019年每月退药张数、全年退药原因、退药病区.结果 2019年全年本院PIVAS接受全院输液处方599214份,退药46737份,占处方总数的7.80％.每月平均退药处方3895张,3月、4月、7月退药处方数较多.排在前三位的退药病区分别是重症医学科10520次(22.51％)、血液科9296次(19.89％)和普外科8562次(18.32％).未及时暂停医嘱(25.99％)、更改方案(22.16％)、不良反应(15.21％)为排在前三位的退药原因.结论 PIVAS退药情况受到医师、患者、药品、医保等因素的影响,应针对各个因素进行针对性的提升,以降低退药率.

弥漫性内生性脑桥胶质瘤( diffuse intrinsic pontine glio-mas,DIPGs)是发生在脑干的高度侵袭性神经胶质瘤,占所有儿童脑干胶质瘤的60％ ～80％,好发于5 ～10 岁的儿童,一般以亚急性起病[1]. 由于肿瘤位于重要神经核团和纤维集中位置,无法手术切除,且放、化疗效果均不明显,也缺少有效的靶向药物,导致其预后极差,中位生存期仅9 ～12 个月,2年生存率10％ ～25％,5 年生存率不足1％ [2]. 儿童安宁疗护是利用全人照顾的理念为终末期患儿提供身、心、社、灵的全方位照顾,在我国儿童安宁疗护仍处于探索阶段. 为更好地推广儿童安宁疗护工作,笔者总结了1例弥漫性内生性脑桥胶质瘤患儿的居家安宁疗护实践经验,以期为晚期癌症儿童居家护理提供借鉴.

目的 探讨舒缓疗护对白血病患儿生存质量的影响.方法 将82例初次确诊为白血病的患儿分为干预组36例和对照组46例,对照组给予常规治疗护理,干预组由舒缓疗护团队介入干预,12周后使用PedsQLTM癌症模块量表(3.0中文版)家长问卷对患儿家属进行问卷调查.结果 干预组与对照组白血病患儿在疼痛或受伤、恶心、操作过程焦虑、治疗焦虑、担忧和交流问题等6个维度的差异有统计学意义(P＜0.05).结论 舒缓疗护对提高白血病患儿的生存质量有积极作用.

目的 观察在神经外科气管切开患者康复护理中辅以品管圈活动对其疗效的影响.方法 选取苏州大学附属第二医院神经外科2016年3月至2017年5月收治的48例行气管切开患者,采用随机数字分组法分为干预组和对照组,每组24例.两组患者均给予常规治疗护理及康复措施,干预组患者在此基础上辅以品管圈活动,比较两组患者的气管套管拔除率、临床肺部感染评分(CPIS)、日常生活活动能力(ADL)评分及住院时间和住院费用等.结果 两组患者治疗后CPIS均低于治疗前,差异有统计学意义(P<0.05).干预组气管套管拔除率[70.83％(17/24)]、CPIS[(3.54±1.99)分]、ADL评分[(45.00±5.66)分]、住院时间[(16.83±4.37)d]及住院费用[(7.52±0.83)万元]均优于对照组[分别为37.50％(9/24)、(4.91±1.84)分、(37.75±5.02)分、(21.63±5.89)d、(8.48±1.92)万元],差异均有统计学意义(P<0.05).结论 在神经外科气管切开患者康复护理中配合品管圈活动,可提高患者气管套管拔除率,改善ADL,降低肺部感染率,缩短住院时间及降低住院费用,值得在临床推广.

[目的]探讨V-P引流术后裂隙脑室综合征的患儿的观察与护理.[方法]总结分析2013年7月-2016年7月12例分流术后诊断为裂隙脑室综合征行可调压分流阀更换术患儿的护理体会,包括病情观察、分流管护理、心理护理、疼痛护理、并发症的观察与护理等内容.[结果]患儿术后症状得到明显缓解,均顺利康复出院,术后未发生并发症.[结论]专业的病情观察和护理,有利于促进裂隙脑室综合征患儿术后的康复.

Objective To observe the serum vitamin D level and different cognitive domains in patients with Parkinson''s disease (PD),and to assess the associations between the serum vitamin D level and specific cognitive domains.Methods Serum 25-hydroxyvitamin D level were examined for 77 PD patients and 34 healthy controls.Set of cognitive function scales were completed on them, motor function and degree of depression were administered on PD patients.Results Serum vitamin D levels of PD patients were significant lower than those of healthy controls (t=-3.154,P=0.002).MMSE score and Montreal cognitive assessment score of PD patients in demented and non-demented subsets were significantly lower than those of the health controls (all P<0.05).Compared with health controls, PD demented subset and PD non-demented subset both have significant differences in many scores of differernt cognitive domains (all P<0.05).Serum vitamin D levels had a significant negative correlation with disease duration and Hoehn-Yahr stage period in all PD patients(r1=-0.372,P1=0.002;r2=-0.292,P2=0.010).Significant positive associations were specifically found between vitamin D level and immediate memory, short delay memory and long delay memory of auditory verbal memory test(P1=0.005;P2=0.007;P3=0.014) in the non-demented subset of the PD patients.Conclusions The serum vitamin D levels in patients with PD are significantly lower than healthy controls.Serum vitamin D levels have a significant negative correlation with disease duration and severity in PD patients, and have a significant positive correlation with memory function in non-demented subset, serum vitamin D levels have an impact on memory function in non-demented PD patients.

目的:探讨老年人上消化道出血的病因及临床特点。方法:回顾性分析上消化道出血老年患者120例,并与同期成年患者132例比较。结果:老年人上消化道出血病因主要为消化性溃疡,其中胃溃疡居多,其次为上消化道肿瘤,且急性胃黏膜病变患者比例高。老年人上消化道出血前临床症状不典型,合并症多。结论:消化性溃疡、胃肿瘤、急性胃黏膜病变是老年人上消化道出血的主要病因,全身性慢性疾病多、症状不典型是其临床特点。

Objective Evaluating the diagnostic value on pronton magnetic resonance spectroscopy(1H-MRS)in Parkinson disease(PD).Methods Proton magnetic resonance spectroscopy localized to the lentiform nucleus and clinical evaluation by unified PD rating scale(UPDRS)were carried out in 19 patients with PD and 12 healthy age-matched controls,to evaluate whether there was a specific correlation between metabolic changes and the clinical findings.Results The N-acetylaspartate/creatine(NAA/Cr)peak ratio in the lentiform nucleus in PD group was significantly reduced as compared to that of control group,1.441±0.138 vs 1.551±0.837(P0.05);no significant difference was found in choline/creatine(Cho/Cr)ratio in PD group compared to control.There were no significant differences in ratios between the ipsilateral and contralateral to the worst affected side.The metabolic changes in the lentiform nucleus did not correlate well with the severity of PD.Conclusion 1H-MRS is a noninvasive technique that can help to understand the pathogenesis of PD but may be not a useful indicator correlated with the severity of clinical findings in PD.

支架内血栓形成是经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后的严重并发症之一,随着高压球囊及强效抗血小板药物的广泛应用,其发生率降低至1%左右[1].目前认为支架内血栓形成与多种因素有关,现将我院19例发生支架内血栓患者的临床及造影特点总结分析如下.

Objective To investigate cognitive dysfunction and its correlated factors in maintenance hemodialysis patients. Methods We administered the Mini Mental State Examination (MMSE) for assessing cognitive function to 49 patients undergone outpatient hemodialysis and compared with that the normal controls. Results We found that 14.3% (7/49) of subjects had mild mental impairment (MMSE 18～23) and that 6.12% (13/49) had moderate to severe mental impairment (MMSE 0～17) before dialysis. Cognitive capacity in hemodialysis patients was still lower than that in the controls after dialysis. Multivariant stepwise regression analysis showed that MMSE score was significantly associated with increased number of co-morbid conditions, lower hemoglobin concentration and Albumin. Conclusion Cognitive capacity decline in hemodialysis patients is associated with number of co-morbid conditions, lower hemoglobin concentration and Albumin etc.

本文综述了透析患者常见躯体障碍的研究现状及对生活质量的影响.