目的 分析0～14岁儿童颅脑肿瘤行为问题检出率,研究0～14岁颅脑肿瘤患儿心理行为的影响因素.方法 选取温州医科大学附属第二医院育英儿童医院2016年1月—2019年12月接收的110例颅脑肿瘤患儿作为研究对象.采用Rutter行为问题问卷调查法结合临床观察和深入访谈等方法调查患儿行为问题分布情况,然后通过多因素Logistic分析患儿心理行为问题的影响因素.结果 110例颅脑肿瘤患儿中,男童占65.45％,女童占34.55％,儿童颅脑肿瘤发病集中于4个月～10岁,占总调查人群的80.00％;儿童颅脑肿瘤发病位置以小脑幕下为主,占61.82％,小脑幕上占38.18％;儿童颅脑肿瘤以髓母细胞瘤、星型细胞瘤、颅咽管瘤和间变型室管膜瘤为主,分别占31.82％、24.55％、9.09％和6.36％;颅脑肿瘤患儿临床症状主要表现为呕吐、头痛、步态不稳及共济失调、颈抵抗、颅神经受累、视力下降和肢体活动障碍,分别占63.64％、60.00％、39.09％、26.36％、14.55％、13.64％和12.73％;110例颅脑肿瘤患儿A型行为、N型行为和M型行为检出率分别为17.27％、16.36％和14.55％,4个年龄段检出率从低到高依次为2.73％、10.00％、12.73％和22.73％,总检出率为48.18％;单因素分析显示,主要照护者选择、教养方式、家庭关系、患病后儿童及父母应对方式对患儿心理行为问题检出率有明显影响(P＜0.05);多因素Logistic分析结果显示,祖辈照护、专制型教养、溺爱型教养、忽视型教养、家庭关系不和睦、患病后儿童消极应对和父母消极应对是颅脑肿瘤患儿心理行为问题的独立影响因素.结论 0～14岁颅脑肿瘤患儿行为问题检出率较高,临床医护人员应基于心理行为问题的独立影响因素进行针对性心理干预、矫正并预防不良心理行为,以保障颅脑肿瘤儿童的身心健康.

目的 探讨观察预见性护理联合血栓弹力图在妇科术后预防下肢静脉血栓中的应用效果.方法 选取2020年7月～2021年7月滨州医学院附属医院收治的68例妇科良性疾病且行腹部手术治疗患者为研究对象,按照住院时间的单双月将患者分为对照组和观察组,每组34例.对照组采用常规护理及血栓弹力图;观察组采用血栓弹力图联合预见性护理.比较两组患者的凝血功能指标(纤维蛋白原、D-二聚体)、血栓弹力图指标(凝血反应时间、凝固角、血凝块最大强度、综合凝血指数)、舒适状况、下肢静脉血栓发生率.结果 术后6 h、3 d观察组纤维蛋白

目的:探讨小儿疝气术后疼痛护理中运用人性化护理的效果.方法:2017年3月-2019年8月收治小儿疝气患者60例,随机分为两组,各30例.对照组给予常规护理;观察组在常规护理基础上增加人性化护理.比较两组护理效果.结果:观察组护理后疼痛评分及睡眠质量评分均低于对照组,差异有统计学意义(P<0.05).观察组住院时间低于对照组,生活质量评分及家属满意度评分均高于对照组,差异有统计学意义(P<0.05).结论:小儿疝气术后疼痛护理中,运用人性化护理的效果显著.

2020年1月12日,WHO将湖北省卫生健康委员会首次公布的一组原因不明的肺炎病例中发现的病毒命名为2019新型冠状病毒[1-2].新冠肺炎疫情持续蔓延,家族聚集性发病提示它有人传人的能力,全国乃至全球各地也相继发现了此类病例[3].2020年1月20日,国家疾病预防控制中心宣布将该病纳入国家乙类传染病,采取甲类传染病防控措施[4].2020年1月30日,WHO宣布将新冠肺炎疫情列为国际关注的突发公共卫生事件,引起了国际社会的广泛关注[5].截止2020年2月2日24时,全国共有17205例确诊病例,21558例疑似病例[6].目前国内已有儿童感染确诊病例,最小患儿年龄仅3个多月,尚不能确定是否存在母-婴传播[7].

目的 有关上肢骨折患者外固定并发关节僵硬的出现原因和康复护理措施进行探讨.方法 选取2019年1—12月接诊的上肢骨折患者80例作为该文观察对象,所选上肢骨折患者全部产生外固定并发关节僵硬表现,利用随机数字表法将所选上肢骨折患者加以分组,给予其中40例上肢骨折患者临床常规护理服务,将其纳入对照组,给予剩余40例上肢骨折患者常规护理基础之上强化康复护理服务,将其纳入研究组,对比两组上肢骨折患者接受各自护理措施之后的关节恢复情况和治疗效果.结果 研究组与对照组上肢骨折患者接受各自护理措施之后的关节恢复效果对比差异明显;研究组与对照组上肢骨折患者接受各自护理服务之后的临床优良率对比差异明显.结论 临床中强化对上肢骨折外固定并发关节僵硬患者的康复护理措施,能够加快上肢骨折患者患肢功能恢复速度,提高疾病治疗效果,应该给予大力的推广与应用.

目的 探讨医护一体化管理对神经外科住院患者深静脉血栓(DVT)发生率及护士专科考核成绩的影响.方法 选择我院神经外科住院者146例,按照护理管理模式,分为对照组(70例,实施常规护理管理)和观察组(76例,实施医护一体化管理);比较两组患者DVT发生率、护士专科考核成绩.结果 实施医护一体化管理后,观察组患者DVT发生率显著低于对照组,18名护理人员的理论考核成绩及实际操作技能合格率高于实施前,差异有统计学意义(p＜0.05).结论 医护一体化管理能有效降低神经外科住院患者DVT发生率,提高护士护理考核成绩和服务水平,临床应用及推广价值较高.

目的:分析神经外科重症监护室护士存在的压力,提出相关的解决措施.方法:采用问卷形式,对神经外科重症监护室护士的压力情况进行调查.结果:神经外科重症监护室的护士普遍压力较大,压力主要来自患者家属要求高、监护病房设备性能差、护士自身的监护能力不足、护士心理素质较差、工作制度不合适等.结论:神经外科重症监护室护士工作压力较大,影响了工作质量,易引发不良护理事件,应加强培训,提升护理服务水平,营造良好的工作环境,关心护士,加强沟通,优化对重症监护室的护理服务质量.

有研究指出[1],在颅脑损伤围手术期予以有效护理,有助于患者远期恢复效果. 本研究我们在患者围手术期给予精细化护理干预, 旨在探讨精细化护理对颅脑损伤患者的护理效果,对生活质量、日常生活能力的影响,为临床提供参考,报告如下.

目的:了解护士完美主义倾向与工作投入的现状,并分析两者间相关性,为护理管理者实施管理提供依据.方法:采用便利抽样法对3所三级甲等医院281名护士进行问卷调查.结果:护士完美主义倾向总分为(112.86±17.38)分,工作投入总分为(24.39±6.25)分,Pearson相关分析两者之间相关系数为6.192(P＜0.01).其中学历、婚姻状况以及“完美主义倾向”中“高标准”、“秩序”、“差异性”为护士工作投入的主要影响因素(P＜0.05).结论:护士完美主义倾向与工作投入相关.

随着我国进入老龄化社会,养老机构的入住率逐渐升高,意味着老年人在医院治疗后返回养老机构继续进行延续性护理的需求量逐步增大.而针对这个特殊群体,延续性护理的优质、高效和便捷显得尤为重要.本文旨在阐述建立健全医院与养老机构护理沟通网络平台的构想,并分析其优缺点和可行性,以期提高老年人群的诊疗效果和生活质量.

Objective To explore the threshold of 4 m-walking speed for predicting falls in patients with stroke and to evaluate its clinical significance. Methods A total of 1 079 cases of stroke patients in Neurology Surgery Department and Neurology Medicine Department of the Second Affiliated Hospital of Wenzhou Medical University from July 2015 to May 2017 were selected as the research subjects by convenience sampling method. Data of physical examination, body composition measurement, blood biochemistry, muscle strength and 4 m-walking speed were collected by questionnaire. According to the results of 4 m-walking speed test, the receiver operating characteristic curve (ROC) of subjects was drawn to determine the critical value of 4 m-walking speed for stroke patients, and the predictive value of the critical value of 4 m-walking speed for the risk of falling was analyzed by logistic regression. Results The incidence of falls was 37.5% in stroke patients. The 4 m-walking speed for male and female with stroke was (0.75±0.02) m/s and (0.82±0.06) m/s respectively. ROC curve showed that, in male patients, the critical value of 4 m-walking speed was 0.84 m/s, the area under curve (AUC) was 0.71 (0.65, 0.75), the sensitivity was 87.5%, and the specificity was 65.9%. In female, the critical value of 4 m-walking speed was 0.79 m/s, the AUC was 0.68 (0.62, 0.73), the sensitivity was 75.3%, and the specificity was 78.6%. Logistic regression analysis showed that after adjusting for age, BMI, smoking, alcohol consumption, exercise and disease history, compared with the elderly population below 4 m-walking speed threshold, the OR values of falls in male and female stroke patients above the 4 m-walking speed threshold were 2.97 (1.94, 4.56) and 2.25 (1.40, 3.60) respectively. Conclusions The incidence of fall is high in stroke patients. The threshold of 4 m-walking speed to predict the fall risk of male and female patients with stroke was 0.84 m/s and 0.79 m/s respectively. The determination of the threshold of 4 m-walking speed can provide reference for the prevention of falls in stroke patients and is worthy of clinical popularization and application.

目的 探讨回馈教学对养老机构脑卒中患者功能锻炼依从性的影响.方法 选择温州地区养老机构符合标准的脑卒中患者143例,随机分成实验组69例和对照组74例,分别通过回馈教学和传统宣教对患者进行功能锻炼指导.结果 进行调查比较,接受回馈教学的脑卒中患者12周后的功能锻炼依从率是(60.00±13.00)%,而接受传统宣教的脑卒中患者12周后的功能锻炼依从率是(47.00±9.00)%,通过回馈教学的远期效果优于传统宣教(P<0.05).结论 回馈教学有利于提高养老机构脑卒中患者功能锻炼依从性,是一种有效的健康教育方式.

Objective To investigate the relationship between Treg cells,Th17 cells,their specific transcription factor Foxp3 and ROR-γt mRNA levels,related cytokines,and the immune mechanism of serofast syphilis.Methods The data of 60 patients who suffered from peripheral blood with serofast syphilis were collected and 60 healthy patients were collected as control group.The PBMCs were isolated and the proportion of the Th17 and Treg cells was detected with flow cytometry.Meanwhile the total RNA was extracted to detect the expression levels of the Foxp3 and ROR-γt mRNA with QRT-PCR.The expression levels of IL-17 and TGF-β were detected in the supematants of PBMCs with ELISA.Results The proportion of Treg cells [(9.68±1.54)％],Foxp3 mRNA [(2.85±0.16)％] and TGF-β [(275.15420.89)pg/ml] in the observation group were higher than those of the control group[(5.96± 1.27)％,(1.96±0.14)％,(156.33±41.49)pg/ml].The expression levels of Thl7 cells [(1.13±0.31)％],ROR-γt mRNA [(0.98±0.16)％] and IL-17 [(12.21±4.73)pg/ml] in the observation groups were lower than those of the control group[(1.98±0.17)％,(1.85±0.15)％,(18.98±6.89)pg/ml],the difference was statistically significant(P ＜ 0.05).Conclusion The changes of Th17 and Treg cells'proportion,the mRNA expression levels of ROR-γt and Foxp3 are related to the immune mechanism of syphilis serofast.Meanwhile there may be imbalance of Th17 and Treg cells in patients with syphilis serofast which is drifted to Treg cells.

OBJECTIVE To investigate the influence of anti‐syphilis treatment to serofast pregnant women on gesta‐tion and infant serum so as to provide reference for clinical diagnosis and treatment .METHODS Totally 54 cases of pregnant women with syphilis serofast from Jan .2011 to Jan .2013 were selected and divided into treatment group and non‐treated group with 27 cases each according to whether received anti‐syphilis treatments .Meanwhile ,50 healthy pregnant women were chosen as control group .The pregnancy outcome ,newborn prognosis and infant se‐rum indicators were compared among the three groups .RESULTS The first detection found that distribution ratio of RPR titers of the treatment group were 1∶1 ,1∶2 ,and 1∶4 and compared with the non‐treated group ,the differences were not significant .The result showed that in the three groups ,rate of premature delivery ,abortion , stillbirth ,adverse neonatal outcome were similar ,and the differences had no significance;in the treatment group , newborn RPR titers distribution ratio were 1∶1 ,1∶2 ,1∶4 ,no significant difference was found between two groups .After birth ,RPR were all negative in 6 months ,and TPPA were all negative in 12 months ,no significant differences showed .CONCLUSION Anti‐syphilitic treatment during pregnancy had no significant effect on the preg‐nancy outcome in patients with syphilis serum fixed and the serological indexes of newborns .

2007年1月～2008年3月,我们收治78例未婚宫外孕患者,并根据患者病情实施健康教育,效果满意.现将健康教育体会报告如下. 1 资料与方法 1.1临床资料本组未婚宫外孕患者78例,17～28岁,其中20岁以下13例;以宫外孕破裂入院者6例.

医院担负着医疗、教学、科研、康复和预防保健等工作,作为一所教学医院,已有多年的临床教学经验,并取得了良好的社会信誉,为了能使临床护理教学工作做得更好,让实习护生学到更多的知识,笔者就2005年的实习护生用发放问卷的方式,了解其实习要求,以指导临床带教工作,报道如下.

1病例资料 病人,女,46岁,3年前无明显透因出现下腹坠痛不适,遂在当地医院检查并经B超证实为"子宫肌瘤",月经量增多,但未予系统治疗,后月经恢复正常.3年来经常下腹部疼痛伴阴阜阴道处不适,每次下腹痛或不适时有咳嗽溢尿.月经周期、经期均规律.近3～4个月开始出现尿频,尿急,无大便干结,无经间期阴道流血、痛经及白带增多.妇科检查:4h不排尿,咳嗽后未见尿液溢出.