目的 评价心理关怀联合健康宣教在反复发作念珠菌外阴阴道炎患者中的作用.方法 选取2017年12月至2019年3月深圳市龙华区人民医院诊治的70例反复发作念珠菌外阴阴道炎患者作为研究对象.按数字随机表法分为对照组(n=35),施以常规宣教,观察组(n=35),施以心理关怀联合健康宣教.比较两组患者管理效果.结果 观察组患者干预后自我效能感、自我管理能力均高于对照患者组,差异具有统计学意义(P<0.05);观察组患者干预后阴道健康状态(11.34±2.15)分高于对照组患者的(8.21±1.82)分,差异具有统计学意义(t=6.574,P=0.000).结论 对反复发作念珠菌外阴阴道炎患者采取心理关怀联合健康宣教,能够提高患者自我管理能力,临床价值高,值得推广.

目的 分析BISAP(Bedside index for severity in AP)评分系统在急性胰腺炎(AP)患者护理中的应用.方法 选取深圳市龙华区人民医院2017年2月—2018年6月间急性胰腺炎患者208例,随机分为对照组和观察组,每组104例.对照组采用常规护理,观察组在常规护理基础上进行BISAP评分系统指导护理,对比分析两组患者恢复情况、心理状态及护理满意度.结果 观察组恢复情况高于对照组,差异有统计学意义(P<0.05);观察组护理后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分低于对照组,差异有统计学意义(P<0.05);观察组护理满意度(96.15％)高于对照组(85.58％),差异有统计学意义(P<0.05).结论 BISAP评分系统应用于AP患者护理中,患者恢复情况得到提高,改善不良心理状态,提高护理满意度,值得借鉴,临床上值得推广应用.

目的 探究重症急性胰腺炎应用BISAP评分(Bedside Index for Severity in AP,BISAP)的预后价值.方法 此次实验对象全部选自2016年7月-2018年10月期间接收的198例重症急性胰腺炎患者,用BISAP评分对其胸膜渗出、血尿素氮、全身炎症反应综合征、意识障碍以及年龄五项指标进行综合评估,并对比该评分和APACHE Ⅱ评分对预测胰腺坏死、机体脏器功能衰竭、死亡的价值,以及对预后的影响.结果 198例患者中,34.34％器官功能衰竭,胰腺坏死为48.99％.对器官功能衰竭、胰腺坏死患者的BISAP评分、APACHE Ⅱ评分进行AUC预测,以3分为最佳截点,BISAP评分的阴性预测值、阳性预测值、敏感性、特异性均优于APACHE Ⅱ评分,差异有统计学意义(P＜0.05).BISAP评分的预计死亡率为12.12％,实际死亡率为11.62％,差异无统计学意义(P＞0.05);APACHE Ⅱ评分的预计死亡率为9.09％,实际死亡率为11.62％,差异有统计学意义(P＜0.05);BISAP评分的预计死亡率和APACHE Ⅱ评分差异有统计学意义(P＜0.05).结论 对重症急性胰腺炎患者应用BISAP评分进行评估的效果显著优于APACHE Ⅱ评分,能够有效预测胰腺坏死和器官功能衰竭现象,可对患者预后进行有效评估,其临床应用价值较高.

目的 探究重症感染合并血小板减少症的危险因素.方法 选择2011年6月至2016年6月我院重症医学科收治的重症感染合并血小板减少症患者58例作为观察组,选择同期在我院接受治疗的58例重症感染患者作为对照组.比较两组患者的临床资料,应用Logistic回归分析重症感染合并血小板减少症的危险因素.结果 观察组患者的年龄、中性粒细胞、白细胞、革兰阴性菌感染、呼吸道感染以及多系统感染比例均明显高于对照组,血小板计数显著低于对照组,差异均有统计学意义(P<0.05);Logistic回归性分析结果显示,年龄、中性粒细胞、白细胞、革兰阴性菌感染、呼吸道感染以及多系统感染是重症感染合并血小板减少症的危险因素;重症感染合并血小板减少症患者的临床表现中以发热、合并贫血、白细胞正常为主,白细胞减少等次之.结论 重症感染合并血小板减少症患者中年龄偏大,而中性粒细胞、白细胞水平高以及革兰阴性菌感染、呼吸道感染、多系统感染比例大,临床上应根据这些危险因素进行及早干预、治疗,保证治疗效果.

Objective To analyze the pathogenic bacteria and their drug resistance in patients with severe infection diseases,and provide an important reference for clinical diagnosis and treatment. Methods The data of patients with severe infection diseases in ICU of People' s Hospital of Longhua District of Shenzhen City was analyzed. Bacteria isolation and drug sensitivity tests were done ,and the bacterial strains and their drug resistance were statistically tested. Results There were 152 strains (33.78%) of gram-negative bacteria (G-) in 450 strains of pathogenic microorganisms, 128 strains of gram-positive bacteria (28.44%), 170 strains of fungi, accounting for 37.78%;drug resistance test showed that gram negative bacteria were highly resistant to the first generation, the second generation cephalosporin, piperacillin and ampicillin, and highly sensitive to imipenem; Gram positive bacteria have high resistance to penicillin, erythromycin and oxacillin, and have high sensitivity to vancomycin; fungi have higher resistance to azole antibiotics. Conclusions The main pathogens that caused severe infection in longhua district were gram-negative bacteria, gram-positive bacteria and fungi. All strains had different degrees of resistance to different antibiotics.

Objective To investigate the changes of B-type brain natriuretic peptide (BNP), high-sensitivity C-reactive protein (hs-CRP), troponin (cTnI) in peripheral blood of children with heart failure and their correlation with disease and prognosis. Methods A total of 103 cases of hospitalized children with heart failure, who admitted to De-partment of Pediatrics in our hospital from January 2014 to September 2016, were selected and divided into the mild group (n=24), moderate group (n=41) and severe group (n=38) according to modified Ross score. The peripheral blood BNP, hs-CRP, cTnI levels were detected immediately on admission and after 5 d of the treatment. Using the improved Ross score as a reference, Pearson correlation analysis was used to analyze its correlation with disease severity. Of the 103 children, 92 were alive, 11 were dead, and the correlation of the BNP, hs-CRP, cTnI to prognosis were analyzed by Pearson correlation analysis. Results There was significant difference between the mild, moderate, and severe group in the levels of BNP, hs-CRP and cTnI on admission (P<0.05). At the fifth day of treatment, the levels of BNP, hs-CRP and cTnI in the severe group were significantly higher than those in mild group and moderate group;the level of BNP in the moderate group was significant higher than that in the mild group (P<0.05);there was no significant difference between the mild and moderate group in the levels of hs-CRP and cTnI (P>0.05). The survival rate of the children in the mild group was 100.00%, 90.24% in the moderate group, 81.58% in the severe group, and the difference in survival rates were statistically significant (P<0.05). At the fifth day of treatment, the levels of BNP, the hs-CRP, and cTnI in the dead children of the severe group were significantly higher than those in the children who were alive (P<0.05);there was no significant difference between the dead children of the mild, moderate and servere group in the levels of BNP, hs-CRP, and cTnI (P>0.05). The levels of BNP, hs-CRP and cTnI in patients with heart failure were positively correlated with the severity of the disease (r=0.747, 0.562, 0.381), and negatively correlated with prognosis (r=-0.817,-0.741,-0.776). Conclusion The levels of peripheral blood BNP, hs-CRP, cTnI were positively correlated with the severity of the dis-ease in children with heart failure, and negatively correlated with the prognosis, which can be used as a secondary indica-tor for diagnosis and treatment.

Objective To observe the variation of interleukin-8 (IL-8) and cyclophilin A (CyPA) in pa-tients without lung disease duration mechanical ventilation ( MV) with different tidal volumes. Methods 20 patients with cerebral stroke were randomly divided into two groups. The group A received 10 ml/kg of mechanical ventila-tion, and the group B received 6ml/kg of mechanical ventilation. All patients were given an oxygen inspiratory frac-tion ( FiO2 ) of 40% and set breath frequency to keep PaCO2 35-40% with positive end-expiratory pressure ( PEEP) of 5 cmH2 O during 24 hours after admission. IL-8 and CyPA concentrations were measured in the serum and in the bronchoalveolar lavage fluid ( BALF) at admission and 24 hours after the treatment. Results There was no signifi-cant difference in serum IL-8 and CyPA between the two groups before and after the treatment (P>0. 05). The lev-els of IL-8 and CyPA in BALF were stable in the low VT group (P>0. 05), but they increased in the high VT group (P<0. 05). After 24 hours, the levels of IL-8 and CyPA were higher in the high VT group than in the low VT group (P<0. 05). Conclusion The application of higher tidal volumes may induce pulmonary inflammation and the use of lower tidal volumes may limit pulmonary inflammation in mechanically ventilated patients even without lung injury.

1病例资料1.1主诉患者，男性，27岁，因“发热1周，腹胀4天，鼻衄1天”入院。