目的 探讨2型糖尿病合并多发性骨髓瘤患者预后的影响因素.方法 选取2018年2月至2019年5月本院收治的2型糖尿病合并多发性骨髓瘤患者88例.采集患者清晨空腹外周静脉血4 ml,取其中2 ml进行血常规检测,记录白细胞/淋巴细胞、白细胞/单核细胞、淋巴细胞/单核细胞水平;取另外2 ml室温静置凝固后离心收集血清,测定血清白蛋白、β2微球蛋白、肌酐、胱抑素C、钙离子、乳酸脱氢酶水平.进行为期3年的随访,记录患者的生存情况和生存时间,根据随访结果将患者分为生存组和死亡组,分析影响因素.结果 88例2型糖尿病合并多发性骨髓瘤患者平均生存时间为(33.19±1.85)个月;3年生存63例(71.59％,生存组),死亡25例(28.41％,死亡组).死亡组患者白细胞、肌酐、胱抑素、钙离子、乳酸脱氢酶、白细胞/淋巴细胞、白细胞/单核细胞水平明显高于生存组,差异均有统计学意义(均P＜0.05);血红蛋白、血小板、白蛋白、β2微球蛋白、淋巴细胞/单核细胞、空腹血糖、糖化血红蛋白在两组间比较差异均无统计学意义(均P＞0.05).多因素logistic回归分析显示,钙离子、白细胞/淋巴细胞、白细胞/单核细胞是2型糖尿病合并多发性骨髓瘤患者生存的独立影响因素(均P＜0.05).ROC曲线分析显示,钙离子、白细胞/淋巴细胞、白细胞/单核细胞单独和联合检测对2型糖尿病合并多发性骨髓瘤患者预后均具有较高的诊断价值(P＜0.05);其中钙离子、白细胞/淋巴细胞、白细胞/单核细胞联合检测的诊断价值最高(AUC=0.882),灵敏度明显高于各指标单独检测.结论 钙离子、白细胞/淋巴细胞、白细胞/单核细胞是2型糖尿病合并多发性骨髓瘤患者预后的影响因素,联合检测具有较高的预测价值.

Objective To analyze the application effcet of individualized exercise rehabilitation nursing care under multi-disciplinary mode after implantation of artificial cardiac permanent pacemaker（PPM）.Methods A total of 35 patients who received routine care after PPM implantation in the First People’s Hospital of Shangqiu from May 2020 to May 2021 were included in the control group, while another 35 patients who received individualized exercise rehabilitation care under the multidisciplinary model after PPM implantation from June 2021 to June 2022 were included in the observation group. Patients in the two groups received continuous intervention until they were discharged from hospital. The recovery after operation, cardiac function, psychological status, shoulder function and quality of life after care of patients in the two groups were compared.Results After nursing, the observation group had shorter ambulation and hospitalization time than the control group and six-minute walking test（6MWT） distance was longer than the control group（P＜0.05）. After care, left ventricular ejection fraction（LVEF）, left ventricular end diastolic diameter（LVEDD）, left ventricular end systolic diameter（LVESD）, heart rate（HR） of the two groups were higher than those before care, and those in the observation group were higher than those in the control group（P＜0.05）. After nursing, the self-rating anxiety scale（SAS）, self-rating depression scale（SDS） scores of the two groups were lower than those before nursing, and the scores in the observation group were lower than those in the control group（P＜0.05）. After nursing, the daily living ability, pain, shoulder joint activity function and total score of the two groups were higher than those before nursing, and the observation group was higher than the control group（P＜0.05）. The total scores of postoperative physical function, psychological function, social function, general cognition and quality of life in the observation group were higher than those in the control group（P＜0.05）.Conclusion Individualized exercise rehabilitation nursing under multi-disciplinary mode can effectively alleviate the psychological pressure of patients with PPM implantation, improve the quality of life, cardiac function and shoulder function, and promote postoperative rehabilitation.

目的 探讨枸橼酸咖啡因联合维生素A在新生儿呼吸窘迫综合征(NRDS)中的应用效果.方法 96例NRDS患儿随机分为两组各48例,对照组采用枸橼酸咖啡因治疗,观察组采用枸橼酸咖啡因联合维生素A治疗,比较两组的临床疗效、血气指标(PO2、PCO2、pH).结果 观察组的治疗总有效率为93.75％,显著高于对照组的79.17％(P<0.05).治疗1周后,两组的PO2、pH均升高,PCO2均降低,且观察组的PO2、pH显著高于对照组,PCO2显著低于对照组(P<0.05).结论 枸橼酸咖啡因联合维生素A治疗NRDS效果显著,可改善患儿的血气指标.

目的 探讨心力衰竭患者出院后再入院的相关影响因素,为临床防治提供参考.方法 回顾性分析2019年1月至2020年1月我院接诊的98例心力衰竭患者临床资料,分析再入院的相关影响因素.结果 98例患者中出院后再入院46例(46.94％),未再入院52例(53.06％);Logistic回归分析显示,年龄＞70岁、心功能分级Ⅳ级、NT-proBNP≥3.24 pmol/L、小学及以下文化、高盐饮食、心肌梗死病史、合并高血压、合并感染为心力衰竭患者出院后再入院的独立危险因素(P＜0.05且OR≥1).结论 心力衰竭患者出院后再入院是多种因素共同作用所致,临床需针对各危险因素加强干预,以降低心力衰竭患者出院后再入院比例.

目的 探讨老年心力衰竭合并肺部感染的相关危险因素.方法 回顾性分析2018年1月至2020年3月我院接诊的76例老年心力衰竭患者临床资料,分析老年心力衰竭合并肺部感染的相关危险因素.结果 76例患者中出现肺部感染37例(48.68％);Logistic回归分析:年龄≥80岁、吸烟、高血压史、糖尿病史、慢性阻塞性肺疾病史、抗生素滥用、长期卧床是老年心力衰竭合并肺部感染的独立危险因素(P＜0.05且OR≥1).结论 老年心力衰竭合并肺部感染是由吸烟、高血压、抗生素滥用等多种因素共同作用结果,临床需针对各项危险因素实施相应措施,以减少肺部感染发生,改善患者预后.

目的 探讨影响冠心病患者服药依从性的相关因素及其干预措施.方法 选取2018年1月至2020年1月我院门诊确诊的94例冠心病患者作为研究对象,收集患者临床资料,分析影响冠心病患者服药依从性的相关因素.结果 94例患者中服药依从性好者42例(44.68％),服药依从性欠佳者52例(55.32％);Logistic回归分析显示,使用药物种类＞3种、受家庭和社会关心程度较差、对医务人员信任程度较差、对疾病了解和重视程度较差、获取医药健康知识积极性较差是冠心病患者服药依从性差的独立危险因素(P＜0.05且OR≥1).结论 冠心病患者服药依从性相对较差,影响因素复杂多样,可经加强医患沟通、发展临床药物工作、开展用药宣教、提升药师业务水平等措施提高患者服药依从性,提升其生命质量.