目的:调查中老年患者脑出血后急性期深静脉血栓形成(DVT)的发病率,并探讨DVT的影响因素.方法:选择2019年9月至2021年5月在温州医科大学附属第一医院就诊且发病24 h内住院的脑出血患者245例,在患者脑出血后10～14 d内进行双下肢静脉超声检查,得出脑出血后急性期DVT发病率.通过单因素分析和二元Logistic回归分析中老年患者脑出血后并发DVT的影响因素.结果:245例中老年脑出血患者中79例患者发生DVT,发病率为32.24％,其中39例(49.37％)无DVT的临床症状.二元Logistic回归分析显示,年龄≥70岁(OR=1.73,95％CI=1.12～2.98)、下肢美国国立卫生研究院卒中量表评分≥3分(OR=4.13,95％CI=2.15～8.97)、连续卧床时间≥3 d(OR=4.73,95％CI=2.25～9.78)、Wells评分≥2分(OR=3.54,95％CI=1.62～6.67)、入院时D-二聚体高(OR=3.06,95％CI=1.01～3.49)是脑出血后急性期DVT发生的独立危险因素,早期康复治疗是DVT发生的保护因素(OR=0.55,95％CI=0.28～0.96).结论:中老年人脑出血后DVT发生率较高,接近一半的患者无DVT临床症状.中老年急性期卒中患者发生DVT的独立危险因素较多,建议及时对存在危险因素的患者进行DVT监测和干预,并结合脑出血早期康复治疗以减少DVT的发生.

功能性消化不良(FD)是世界范围内发病率较高的消化道疾病之一.关于FD的发病因素尚不明确,认为由多种因素共同参与,目前已有许多与FD病因相关的基因和病理生理机制研究.这些研究有助于增强对FD的了解并为其治疗提供帮助.迄今为止,全球FD的治疗大多以改善症状为目的,并未有有效的治疗方法.由于缺乏FD标准的治疗方法,临床治疗药物以质子泵抑制剂和促胃肠动力药物等为主,但是这些药物疗效有限.因此,明确FD的病理机制,为FD提供有效的药物治疗具有重要的临床意义.未来研究者们需深入研究,寻找更精准的机制及治疗手段.

Objective To explore the clinical effect of evidence-based nursing in ventilator-associated pneumonia (VAP).Methods One hundred and sixty patients with mechanical ventilation in our ICU from January 2011 to June 2013 were randomly divided into the observation group and the control group.The control group received the traditional nursing,and the observation group received evidence-based nursing on the basis of the routine nursing.The time of invasive ventilation,the duration of ventilation,the off-line time,the occurrence time of VAP,and the incidence and mortality rates of VAP were compared between two groups.Results The time of invasive ventilation,the duration of ventilation,the off-line time,the occurrence time of VAP in the observation group were respectively (3.3 ± 0.6),(10.3 ± 3.8),(2.6 ± 4.3),(9.2 ± 2.8) d,and were significantly lower or later than (5.6 ± 3.1),(13.1 ± 3.4),(6.5 ± 4.8),(4.8 ± 2.7) d in the control group,and the differences were statistically significant (t =2.58,2.63,2.86,2.79,respectively; P ＜0.05).The incidence and mortality rates of VAP in the observation group were respectively 16.9％ and 10.4％,and were significantly lower than 48.1％ and 34.9％ in the control group,and the differences were statistically significant (x2 =5.36,4.93,respectively; P ＜ 0.01).Conclusions Evidence-based nursing can significantly shorten the time of invasive ventilation,the duration of ventilation and the off-line time; and can also effectively delay and reduce the occurrence of VAP.