BackgroundNecrotizing enterocolitis (NEC) is the most common severe gastrointestinal emergency in neonates. We designed this study to identify the pathogenic microorganisms of NEC in the microbiota of the small intestine of neonates.MethodsUsing the 16S ribosomal DNA (rDNA) sequencing method, we compared and analyzed the structure and diversity of microbiotas in the intestinal feces of different groups of neonates: patients undergoing jejunostomy to treat NEC (NP group), neonates undergoing jejunostomy to treat other conditions (NN group), and neonates with NEC undergoing conservative treatment (NC group). We took intestinal feces and saliva samples from patients at different time points.ResultsThe beta diversities of the NP, NN, and NC groups were all similar. When comparing the beta diversities between different time points in the NP group, we found similar beta diversities at time points E1 to E3 but significant differences between the E2-E3 and E4 time points: the abundances of Klebsiella and Enterococcus (Proteobacteria) were higher at the E1-E3 time points; the abundance of Escherichia-Shigella (Proteobacteria) increased at the E2 time point, and the abundance of Klebsiella decreased significantly, whereas that of Streptococcus increased significantly at the E4 time point.ConclusionsOur results suggest that the pathological changes of intestinal necrosis in the small intestine of infants with NEC are not directly caused by excessive proliferation of pathogenic bacteria in the small intestine. The sources of microbiota in the small intestine of neonates, especially in premature infants, may be affected by multiple factors.

Objective To investigate the status and influencing factors of pain in 1 063 officers and soldiers.Methods A total of 1 063 officers and soldiers from a certain area were investigated with general data questionnaire, pain assessment scale, pain status questionnaire.Results A total of 732 officers and soldiers had different degrees of pain.The incidence rate was 68.86%,and the incidence rate of chronic pain was 30.39%.The pain site was more common in the waist and neck, and the nature of the pain was often soreness and distending pain.Logistic regression analysis showed that time of enlistment, smoking, injury and daily training intensity were the influencing factors of pain.Conclusion The incidence of pain in officers and soldiers is universal and influenced by many factors.Early screening and intervention should be strengthened to reduce the incidence of pain and improve the combat effectiveness.

目的 探讨基于达标理论的护理干预方案对肠造口患儿及照顾者的影响.方法 便利抽样选取北京市某儿童医院肠造口患儿及照顾者206例纳入研究,分为对照组102例和干预组104例.对照组给予常规护理,干预组在常规护理基础上给予达标理论干预方案护理,比较两组出院准备度、照顾者照护能力、非计划再次入院率与并发症发生情况.结果 干预组的患儿照顾者出院准备度各维度得分和总分高于对照组(P<0.01),照顾者照护能力各维度得分和总分高于对照组(P<0.01).干预组非计划再入院率明显低于对照组,并发症总发生率低于对照组(P<0.05).结论 基于达标理论的护理干预方案可提高肠造口患儿及照顾者的出院准备度,提升照顾者照护能力,减少非计划的再次入院和并发症的发生,为做好出院准备提供实践基础.

Postoperative intussusception (POI) in preterm infants is very rare; intussusception at the distal end of the stoma is not seen. A 13-day-old premature infant was referred from peripheral hospital with history of necrotizing enterocolitis(NEC), which after the surgery of enterostomy. No typical symptoms appeared during treatment. Distal intestinal intussusception found during closed enterostomy. The patient recovered well after excision of the intussusception and intestinal anastomosis.

目的 探讨二件式造口袋预热装置在婴幼儿造口护理中的应用效果.方法 采用方便抽样法选取我院2019年7月1日-2021年6月30日儿科医学部肠造口 89例患儿为研究对象,按入院时间先后分为对照组44例(2019年7月1日-2020年6月30日)与观察组45例(2020年7月1日-2021年6月30日).对照组实施造口常规护理;观察组佩戴造口袋前采用二件式造口袋预热装置预热.比较2组患儿造口潮湿相关性皮炎发生率、造口周围皮肤受损程度、造口袋留置时间、造口相关总费用以及照顾者满意度.结果 观察组患儿第1、第2周造口潮湿相关性皮炎发生率以及总发生率均低于对照组(P＜0.05);观察组造口周围皮肤受损程度低于对照组.造口袋留置时间长于对照组,照顾者满意度高于对照组,造口相关总费用低于对照组,差异均有统计学意义(P＜0.05).结论 婴幼儿造口护理时使用二件式造口袋预热装置对造口袋进行预热,可有效降低造口潮湿相关性皮炎发生率,减轻皮肤受损严重程度,为照顾者减轻经济负担.

目的 调查高位小肠造口婴幼儿营养不良现状及危险因素并探讨相应管理措施.方法 选取高位小肠造口婴幼儿201例为研究对象,采用一般资料调查表和疾病相关资料调查表进行调查,并评估其营养状况.结果 高位小肠造口婴幼儿营养不良发生率为47.26％.Logistic回归分析显示,造口部位、造口近端小肠长度、喂养方式、高排量腹泻是高位小肠造口婴幼儿营养不良的影响因素.结论 高位小肠造口婴幼儿是营养不良的高发人群,应采取针对性措施进行早干预,尽可能保留近端小肠长度,加强经口喂养、减少高排量腹泻、改善营养不良.

Objective:The objective of this study is to investigate the operation timing, methods, and outcome of pulmonary metastases of hepatoblastoma (HB) in children. Methods:The clinical and follow-up data of 53 children with pulmonary metastases of HB that were admitted to our hospital from January 2012 to December 2018 were retrospectively analyzed. The pediatric patients, 36 male and 17 female, aged 13-124 months with the median age of 41 months, and all underwent routine thoracotomy. Results:In the 53 cases, 77 lung metastatic tumors were resected. Further, 37 patients received only one operation, 10 received two operations, 4 received 3 operations, and 2 received 4 operations. Based on Kaplan-Meier analysis, the accumulative overall survival (OS) rates at 1, 3, and 5 years were 86.8%, 69.0%, and 57.0%, respectively (median OS time: 60 months; 95% CI: 50.675-69.709 months), and accumulative EFS (vent-free survival) rates at 1, 3, and 5 years were 86.8%, 67.0%, and 55.4%, respectively (median EFS time: 59 months; 95% CI: 49.519-68.578 months). According to univariate analysis, OS was significantly altered for patients with no more than 5 nodules (p = 0.023), lung metastases without extrapulmonary metastases (p = 0.000), and laterality (p = 0.029). Gender and age (less than three years) were not significantly related to survival. According to univariate analysis, lung metastases with extrapulmonary metastases could be considered as individual factor contributing to poorer prognosis. Conclusion:In this pediatric group, patients with residual nodules after chemotherapy of HB could benefit from surgical treatment, but the appropriate surgical indication of metastasectomy needs to be further investigated.

目的 通过检索、总结,系统评价智慧化养老背景下失能老人居家接受远程照护的最佳证据,为有效实施医养结合远程智慧化照护提供参考.方法 计算机检索Up To Date(中文版)、BMJ Best Practice、JBI Evidence Summary、苏格兰学院间指南网、美国远程医疗协会、Cochrane Library、Ovid、PubMed、Elsevier Science Direct、中国生物医学文献数据库、CNKI、万方数据知识服务平台等关于失能老人远程智慧化照护的相关证据,包括指南、专家共识、证据总结、系统评价、原始研究等.检索时限为建库至2022年4月30日.由两名研究员对文献质量进行独立评价,并结合专业判断,提取符合标准的文献.结果 共纳入文献14篇,其中指南3篇,系统评价9篇,随机对照试验2篇,提取了6个方面共37条证据.结论 失能老人智慧化养老远程照护须基于评估开展,由多专业照护团队借助远程医疗设备从营养、药物、活动等多方面提供专业照护,提倡全程、连续照护,以确保失能老人居家期间照护服务质量.

目的 系统检索、评价和总结肠衰竭儿童营养支持的相关证据,为临床提供参考.方法 系统检索Up To Date、苏格兰学院间指南网、Cochrane Library、OVID、PubMed、Elsevier Science Direct、循证卫生保健中心数据库、欧洲临床营养与代谢协会官网、美国肠外肠内营养学会官网、万方数据库、中国知网关于肠衰竭儿童营养支持的所有证据.采用JBI证据预分级及推荐级别划分.检索时限为建库至2021年11月27日.结果 纳入文献共16篇,其中指南10篇、专家共识1篇、系统评价2篇、证据总结2篇、推荐实践1篇.分别为营养筛查及营养评估、肠内营养支持及监测观察、肠外营养支持及输注方案、严重并发症预防策略、多学科团队管理5个方面共30个证据.结论 该研究总结了肠衰竭儿童的营养支持最佳证据,通过合理营养支持策略为医护人员临床开展营养支持提供循证依据,降低并发症发生率,提高肠衰竭儿童存活率.

目的 加强新生儿病房感染防控管理,为新生儿提供安全的医疗环境.方法 针对保洁感染防控管理的薄弱环节,建立可视化标准作业程序,从可视化标准作业程序的制订、人员的培训、实施、效果评价进行规范管理,分析实施管理前后质量指标及满意度指标并进行比较.结果 各项保洁过程评价指标得分提高、保洁效果监测指标得分提高、医护人员对保洁的满意度提高,各评价指标进行比较,差异具有统计学意义(P<0.01).结论 对新生儿病房保洁感染防控实施可视化标准作业程序规范管理,提升了保洁质量,提高了医护人员对保洁员的满意度,增强了保洁工作的系统性、规范性、科学性,对提高新生儿病房保洁管理水平和减少医院感染的发生有重要的作用和意义.

目的 探讨儿童环状胰腺手术后复发性胰腺炎的治疗策略.方法 回顾性分析中国人民解放军总医院第七医学中心附属八一儿童医院收治的2例行环状胰腺十二指肠菱形吻合术后3年余,出现复发性胰腺炎患者的临床资料,并对相关文献进行分析.结果 2例经保守治疗7d后胰腺炎症状消失,于气管插管全身麻醉下行内镜诊治,实施经内镜胰胆管造影术(endoscopic cholangiopancre-atography,ERCP),后置入胰管支架,术后1年、3年均未见胰腺炎复发,未更换或取出胰管支架管.对2篇儿童环状胰腺手术后复发性胰腺炎的英文文献进行分析,共纳入7例患者,年龄21个月至10岁;采用ERCP治疗成功4例,失败1例;最终常规手术治疗6例,放弃治疗1例;随访11～54个月,均未见胰腺炎复发.结论 儿童环状胰腺十二指肠旁路手术后出现复发性胰腺炎需明确是否伴发胰胆管畸形,依据随访结果采取不同的治疗策略.

目的 探讨新型冠状病毒肺炎疫情期间保洁工作应急管理策略.方法 运用PDCA循环对保洁工作实施应急管理,通过应知应会理论知识培训、应用SOP流程可视化指导、建立分级质控管理体系、细化考核指标跟进督查等措施加强保洁管理,分析比较管理措施实施前、后各评价指标.结果 保洁员理论知识掌握情况及各项监测指标均得到提升,差异有统计学意义.结论 新冠疫情期间,运用PDCA循环对保洁实施可视化应急管理策略,提高了保洁员知识与技能的掌握,提升了保洁质量和医护人员对保洁工作的满意度,有助于医院感染防控.

Surgical therapy and nursing of a rare case of semi-conjoined deformed twins was summarized. To relieve life threaten, correct deformity and retain function, surgical therapy was performed. Afterwards, patient received nursing strategies including preventing elevation of abdominal pressure, incision care of hemipelvectomy, pelvic fixation, prevention of pressure sores, multi-canal nursing, nutrition support and infection control. Survival of patient was prolonged through a comprehensive therapy and nursing, and the patient was successfully discharged.