目的 探究互动达标模式康复训练对胫骨平台骨折患者膝关节功能恢复及康复积极性的影响.方法 选择胫骨平台骨折患者96例,随机分成对照组和观察组各48例.对照组采用常规干预,观察组采用互动达标模式康复训练,两组均干预6个月.比较两组干预后膝关节功能、Lysholm评分、关节活动度(ROM)、康复积极性、并发症发生率、患者的护理满意度,比较两组干预前后的焦虑(HAMA)、抑郁(HAMD)评分.结果 干预后,观察组的膝关节功能优良率为93.75％,高于对照组的75.00％,差异有统计学意义(χ2=6.40,P<0.05);干预后,观察组的Lysholm评分、ROM及康复积极性均高于对照组,差异均有统计学意义(t分别=13.04、5.43、5.48,P均<0.05);干预后观察组HAMA及HAMD评分均低于对照组,差异有统计学意义(t分别=7.53、13.67,P均<0.05);干预后,观察组的并发症发生率为4.17％,低于对照组的18.75％,差异均有统计学意义(χ2=5.03,P<0.05);干预后,观察组的专业知识、护理技术、护理态度、出院指导评分均高于对照组,差异有统计学意义(t分别=6.54、4.66、3.95、11.29,P均<0.05).结论 采用互动达标模式康复训练对胫骨平台骨折患者进行干预能够有效提高患者康复积极性,改善其不良情绪,降低并发症的发生,有助于患者膝关节功能恢复,护理满意度更高.

目的 调查脊髓损伤患者致病性大肠埃希菌分子分型、流行病学和毒力特征.方法 选取2017年1月-2019年12月入院治疗的脊髓损伤合并泌尿系感染患者86例,共分离、鉴定出致病性大肠埃希菌56株,进行多位点序列分型和药敏试验,采用多重聚合酶链反应(PCR)方法检测毒力因子基因和超广谱β-内酰胺酶(ESBLs)情况.结果 86例脊髓损伤合并泌尿系感染患者共检出病原菌105株,前3位分别为大肠埃希菌53.33％、肺炎克雷伯菌16.19％、铜绿假单胞菌8.57％.大肠埃希菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星、亚胺培南及美罗培南耐药性较低,均<15％,但对头孢他啶、头孢呋辛、头孢唑林、哌拉西林、环丙沙星、氨苄西林、氨苄西林/舒巴坦及磺胺甲噁唑/甲氧苄啶耐药性较高,均>50％.56株致病性大肠埃希菌共鉴定出24个ST分子分型,其中前5位ST型分别为ST131、ST1193、ST405、ST38、ST648;毒力因子基因dsdA、tonB、fimH、degP、ompR检出率较高,均>80％,而ireA、neuC、fliC在致病性大肠埃希菌中检出率较低,均<25％;大肠埃希菌中产ESBLs菌株检出44株,检出率为78.57％,其中仅携带有1种基因型有40株(90.91％),以blaCTX-M-14检出率最高(54.55％).结论 脊髓损伤患者致病性大肠埃希菌以ST131分子分型流行,具有较强的耐药性,且携带有多种毒力因子基因,临床应加强医院感染监测与隔离防护措施,阻碍耐药性大肠埃希菌的传播.

Objective:To investigate the relationship between serum fibroblast growth factor 21/23 level, trauma severity and prognosis in middle-aged and older adult patients with traumatic fracture.Methods:A total of 126 middle-aged and older adult patients with traumatic facture who received treatment in the Second People's Hospital of Lishui, China between June 2017 and June 2019 were included in the study group. Fifty healthy controls who concurrently received physical examination in the Second People's Hospital of Lishui were included in the control group. The study group was divided into five subgroups according to relevant criteria: mild, moderate, severe, poor prognosis and good prognosis. The levels of C-reactive protein (CRP), procalcitonin (PCT), FGF21 and FGF23 were measured.Results:On admission, serum CRP, PCT, FGF23, FGF2 levels in the study group were (19.18 ± 5.66) mg/L, (0.71 ± 0.20) μg/L, (79.75 ± 18.62)μg/L,(52.10 ± 16.34) μg/L, respectively, and they were significantly higher than those in the control group [ (7.60 ± 2.61) mg/L, (0.30 ± 0.11) μg/L, (40.18 ± 10.33) μg/L, (30.11 ± 10.19) μg/L, t = 18.888, 17.750, 18.336, 11.032, all P < 0.001). On admission, serum CRP, PCT, FGF23, FGF2 levels in the study group were (19.18 ± 5.66) mg/L, (0.71 ± 0.20) μg/L, (79.75 ± 18.62) μg/L, (52.10 ± 16.34) μg/L, respectively, and they were significantly increased at 1 day [(21.59 ± 4.53) mg/L, (0.79 ± 0.22) μg/L, (83.85 ± 19.07) μg/L, (55.18 ± 16.55) μg/L, t = 3.72, 3.29, 1.56, 1.56, P < 0.05, P < 0.05, P = 0.122, P = 0.122] and 3 days after surgery [(23.15 ± 3.16) mg/L, (0.80 ± 0.24) μg/L, (88.11 ± 19.80) μg/L, (59.70 ± 16.07) μg/L, t = 6.65, 3.12, 3.59, 3.77, all P < 0.05] , and significantly decreased at 7 days after surgery [(14.35 ± 4.02) mg/L, (0.52 ± 0.16) μg/L, (50.06 ± 15.50) μg/L, (32.18 ± 12.52) μg/L, t = 8.31, 8.58, 13.77, 11.11, all P < 0.001]. On admission, there were significant differences in serum CRP, PCT, FGF23, FGF21 levels between mild, moderate and severe groups ( F = 25.087, 15.851, 15.831 and 12.645, all P < 0.001). On admission, serum CRP, PCT, FGF23, FGF21 levels in the poor prognosis group were significantly higher than those in the good prognosis group ( t = 5.757, 4.984, 3.189 and 4.006, all P < 0.001). The receiver operating characteristic curve (ROC) analysis results showed that serum CRP, PCT, FGF23, FGF21 levels in patients with traumatic fracture on admission had a certain value in the prediction of poor prognosis. Combined detection of these four indexes had the highest value, with AUC (0.95 CI) of 0.877 (0.783-0.982). Conclusion:Serum FGF21 and FGF23 levels have a certain value in the prediction of severity and prognosis of traumatic fracture in middle-aged and older adult patients.