2020 Vol. 18, No. 11

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Thoughts on the combination of medicine and nursing for the elderly based on the concept of general practice in the new situation
HU Xiao-lei, WANG Hao-xiang, WANG Jia-ji
2020, 18(11): 1797-1800,1896. doi: 10.16766/j.cnki.issn.1674-4152.001622
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General practice(GP) is oriented to communities and families. It is a comprehensive medical discipline that integrates clinical medicine, preventive medicine, rehabilitation medicine, and humanities and society. The main purpose of general practice is to emphasize long-term responsible care that is people-centered, family-based, and oriented toward the maintenance and promotion of overall health, focusing on both individual health and group health. Since the 70 th anniversary of the founding of the People's Republic of China, general practice has experienced vigorous development in our country. In the face of the new situation of chronic non-communicable diseases and emerging infectious diseases that continue to threaten people's health, disease prevention and health care, health management and emergency response to public health emergencies based on the concept of general practice have played a huge role in China's primary health system. With the aging of the social population, the ever-increasing demand for elderly care services has also provided more perspectives and space for the development of general practice. From the perspective of general practice, integration the resources of families, hospitals, communities and pension institutions, promotion the comprehensive construction of "family type" "community type" and "integrated" mode of medical care and nursing through the link of general practitioners, so as to improve the quality of life of the elderly, reduce the pressure of social pension, cultivate a general professional team with the concept and skills of general practice, and do a good job in guarding the whole life cycle nursing, are not only the development trend of China's medical and pension reform, but also the necessary way to achieve the goal of "healthy China".
YANG Hui-min, LI Zhi-jun
2020, 18(11): 1801-1802.
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Correlation of hs-C R P,MMP-9 and Lp-PLA2 with neurological deficit,cerebral infarction volume and carotid plaque properties in patients with acute cerebral infarction
HAO Ze-lin, WU Jian-yue, TENG Zhen-fei, HUANG Zhi-hui, CHENG Jun
2020, 18(11): 1803-1806. doi: 10.16766/j.cnki.issn.1674-4152.001623
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Objective To investigate the correlation of plasma High-sensitivity C-reactive protein(hs-CRP), matrix metalloproteinase-9(MMP-9) and lipoprotein-related phospholipase A2(Lp-PLA2) levels with neurological impairment, cerebral infarction volume and carotid artery plaque stability in patients with acute cerebral infarction(ACI). Methods A total of 120 ACI in patients(ACI group) who were admitted in the Affiliated Hospital of Hangzhou Normal University from June 2017 to February 2020 were selected, and 60 healthy people for physical examination during the same period were selected as health control group. The levels of hs-CRP, MMP-9 and Lp-PLA2 in different groups were compared, and the Spearman Method was used to analyze the correlation. Results The levels of hs-CRP, MMP-9 and Lp-PLA2 in the ACI group were significantly higher than those in the healthy control group(t=20.364, 22.115, 14.163, all P<0.05); the levels of hs-CRP, MMP-9 and Lp-PLA2 in the mild, moderate, and severe neurological deficit groups increased sequentially, with significant differences(F=171.283, 82.137, 278.610, all P<0.05); the levels of hs-CRP, MMP-9 and Lp-PLA2 in the small, moderate, and severe infarct focus group increased sequentially, with significant differences(F=100.672, 59.707, 134.199, all P<0.05); the levels of hs-CRP, MMP-9 and Lp-PLA2 in the non-, stable, and unstable plaque groups increased sequentially, with significant differences(F=50.120, 34.056, 67.255, all P<0.05). The levels of MMP-9, hs-CRP and Lp-PLA2 in ACI patients were positively correlated with neurological deficits, cerebral infarction volume, and carotid plaque Carotid stability(all P<0.05). Conclusion The more unstable the plaque nature, the larger the cerebral infarction volume and the higher the neurological function defect degree were, the higher the serum HS-CRP, MMP-9 and LP-PLA2 levels were.
Analysis of influencing factor of CT-guided dorsal root ganglion radiofrequency thermocoagulation for treating postherpetic neuralgia in thorax and abdomen
LIU Song-lei, YAO Ming, XU Long-sheng, NI Hua-dong, HUANG Bing, LIU Qian-ying, HE Qiu-li
2020, 18(11): 1807-1810. doi: 10.16766/j.cnki.issn.1674-4152.001624
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Objective To analyze the influencing factors of CT-guided radiofrequency thermocoagulation for treating postherpetic neuralgia(PHN) in thorax and abdomen, and to construct a nomogram efficacy prediction model. Methods Total 109 patients with PHN in thorax and abdomen, who accepted CT-guided radiofrequency thermocoagulation on dorsal root ganglion(DRG) in pain management department of Affiliated Hospital of Jiaxing College from June 2013 to September 2018 were selected. The efficacy was evaluated by numerical rating scales(NRS). The effective standard was that NRS decreased more than 50% compared with baseline before operation, and the observation point was 1 year after operation. Univariate analysis and multivariate logistic regression were used to identify independent influencing factors. The nomogram was constructed by R software and validated to predict the efficacy. Results The number of valid patients were 68 while the invalid were 41 at one year after the operation. The univariate analysis showed that age >65 years, disease course >3 months, whether had nerve treatment, and radiofrequency mode were correlated with the efficacy of radiofrequency thermocoagulation(all P<0.05). The multivariate logistic regression revealed that age >65 years(OR=0.234, 95%CI:0.078-0.703), disease course >3 months(OR=0.382, 95%CI: 0.016-0.908) and bipolar radiofrequency(OR=5.727, 95%CI:1.437-22.827) were independent factors. For validation of the nomogram, area under receiver operating curve was 0.725 and Hosmer-Lemeshow test was P=0.937, which demonstrated that the model had good accuracy. Conclusion For patients of old age( >65 years) and long duration(course >3 months) with PHN in thorax and abdomen, the effect of radiofrequency thermocoagulation may be poor. We should evaluate carefully before treating. Bipolar radiofrequency may be more effective.
Expression and clinical significance of autophagy-related genes in peripheral blood mononuclear cells of systemic sclerosis
ZHENG Jian-xiong, QIN Qian, TAN Min, HUANG Yu-qin, XIONG Qin, ZHOU Wen-jun, ZHANG Quan-bo, QING Yu-feng
2020, 18(11): 1811-1814. doi: 10.16766/j.cnki.issn.1674-4152.001625
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Objective To investigate the expression and clinical significance of autophagy-related genes LC-3 mRNA, Beclin-1 mRNA, Agt-3 mRNA, Agt-5 mRNA, Agt-12 mRNA and Agt-16 L1 mRNA in peripheral blood mononuclear cell(PBMC) of systemic sclerosis(SSc). Methods Twenty-nine cases of SSc and 29 cases of normal control were received from the Affiliated Hospital of North Sichuan Medical College, and autophagy-related genes were detected by RT-PCR. SPSS 19.0 statistical software was used to compare the expression of autophagy-related genes between groups and analyze the relationship between autophagy-related genes and clinical data, P<0.05 was considered statistically significant. Results (1)LC-3, Beclin-1, and Agt-3 were highly expressed in SSc compared with normal control [LC-3:0.77(0.51,1.00)×10-3 vs. 0.46(0.37,0.63)×10-3; Beclin-1: 6.13(5.01,7.88) ×10-3 vs. 4.76(3.43,5.34)×10-3;Agt-3:15.67(11.52,23.66)×10-3 vs. 8.65(7.44,11.23)×10-3], however Agt-5, Agt-12 and Agt-16 L1 of autophagy-related genes were not statistically significant.(2)LC-3 high expressed in SSc with the positive of anti-nucleosome antibody and the positive of anti-SSA/Ro antibody.(3)LC-3 was positively correlated with Age and ESR, and the values of r were 0.662, 0.428(all P<0.05). Conclusion Autophagy-related genes were increased in PBMC of SSc, and were correlated with age, ESR and autoantibody, suggested that autophagy is a key feature in the pathogenesis of systemic sclerosis.
Transcription factor IRF4 regulates the expression of miR-133b in esophageal squamous cell carcinoma
CENG Wei, LIU Yi, LI Wen-ting, ZHU Jin-feng
2020, 18(11): 1815-1818,1833. doi: 10.16766/j.cnki.issn.1674-4152.001626
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Objective To research the upstream regulation mechanism of miR-133 b in esophageal squamous cell carcinoma. Methods The upstream transcription factors involved in the regulation of miR-133 b expression were predicted by bioinformatics analysis. The effects of IRF4 overexpression plasmid on the expression of IRF4 and miR-133 b were verified by qRT-PCR and Western blotting. The mechanisms of IRF4 regulating miR-133 b expression were verified by chromatin immunoprecipitation(ChIP) and dual-luciferase reporter assay. Results ConTra V3 predicted that the transcription factor IRF4 could bind to miR-133 b. The transfection of IRF4 overexpression plasmid could significantly up-regulate the expression of IRF4 at mRNA(t=-18.950, P=0.010) and protein(t=-4.061, P=0.042) levels, and promote the expression of miR-133 b(t=-8.681, P=0.005). ChIP( primer 1: t=-17.391, P=0.003; primer 2: t=-14.421, P=0.004) and dual-luciferase reporter assay(t=-22.112, P=0.010) confirmed that the transcription factor IRF4 could directly target miR-133 b. Conclusion IRF4 can directly target miR-133 b, which is helpful to construct the signal regulatory network of miR-133 b and provide a new target for the diagnosis and treatment of esophageal squamous cell carcinoma.
Application of multiple-gene stool DNA test in screening for early colorectal cancer
SHAO Shu-xian, SHEN Zhong, ZHANG Xiu-feng, WANG Dong, WANG Hou-dong
2020, 18(11): 1819-1822. doi: 10.16766/j.cnki.issn.1674-4152.001627
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Objective To study the application of joint detection of feces sFRP2, Vimentin and HPP1 gene methylation in screening for early colorectal cancer. Methods Sixty patients with colorectal cancer admitted to the Third People's Hospital of Hangzhou were recruited in the colorectal cancer group. A non-colorectal cancer group(90 cases) was composed of 60 patients with adenomatous polyps and 30 normal healthy people. The stool samples were collected in early morning to extract stool DNA, And DNA was then modified with bisulfite, methylation-specific PCR was performed to detect the methylation status of sFRP2, Vimentin and HPP1 genes, and their relationship with the clinicopathological features of colorectal cancer was analyzed, and the diagnostic sensitivity and specificity of the three genes combined detection was compared. Results Among colorectal cancer patients, in the test of single gene methylation the sensitivity for sFRP2, Vimentin and HPP1 were 46.7%, 43.3%, 53.3%,respectively; and the specificity for sFRP2, Vimentin and HPP1 was 73.3%, 75.6%, 76.7% respectively; the combined test group had 3 genes One of the genes was positive for methylation expression. The sensitivity was 83.3% and the specificity was 46.7% which was higher than that of sFRP2, Vimentin and single gene test alone. The methylation status of the three genes was not related to the gender, age, tumor site, lymph node metastasis and TNM stage of colorectal cancer patients(all P>0.05). Conclusion The incidence of abnormal methylation of sFRP2, Vimentin and HPP1 genes in fecal DNA of colorectal cancer patients is significantly higher than that of non-colorectal cancer patients. The combined test of stool DNA in screening for colorectal cancer is superior to single gene test in early stage of colorectal cancer It is of great significance in screening applications.
Experimental study on proliferation and apoptosis effect of triacetyl resveratrol on HL-60 cells in vitro
ZHENG Nan, XU Xiu-cai
2020, 18(11): 1823-1826. doi: 10.16766/j.cnki.issn.1674-4152.001628
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Objective To explore the effect of triacetyl resveratrol(TRES) on apoptosis of human promyelocytic leukemia HL-60 cells. Methods After treatment with TRES in different concentrations(5, 12.5, 25, 50, 75 μmol/L) for indicated times(12, 24, 48 h), the proliferation of HL-60 cells were analyzed by Alamar blue assay. Annexin V-FITC/PI staining were conducted to detect apoptosis induced by TRES(5, 25, 50 μmol/L) for different times(12, 24 h). The expression of STAT3, pSTAT3, Bcl-2, Bax and Cleaved caspase-3 in HL-60 treated by TRES(5, 25, 50 μmol/L) for 24 h were detected by Western blotting. Results The results of Alamar blue showed that TRES had inhibitory effect on HL-60. The Annexin V-FITC/PI double staining showed that TRES induced apoptosis of HL-60 cells. With the increase of TRES concentration, the expression of STAT3 and Bax did not change significantly, the expression of pSTAT3 was significantly down regulated, the expression of Bcl-2 and Cleaved caspase-3 was significantly up-regulated, and the ratio of Bcl-2/Bax was down regulated, which eventually led to apoptosis. Conclusion TRES inhibits HL-60 cell proliferation, and induces apoptosis of HL-60 cells through STAT3-Bcl-2/Bax-caspase-3 pathway.
Role of Red blood cell distribution width in evaluating the prognosis of patients with sepsis caused by pulmonary infection
YANG Jian-qiu, BI Jian-zhou
2020, 18(11): 1827-1829,1915. doi: 10.16766/j.cnki.issn.1674-4152.001629
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Objective To discuss the role of red blood cell distribution(RDW) in evaluating the prognosis of patients with sepsis caused by pulmonary infection. Methods Eighty patients with sepsis caused by pulmonary infection in the Affiliated Hospital of Hangzhou Normal University from January 2018 to December 2018 were retrospectively analyzed. They were divided into sepsis group and septic shock group according to the severity of the disease. The score of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) and RDW of the two groups were compared, the Pearson correlation coefficient is used to measure the strength of a linear association between between APACHE Ⅱ score and RDW. Multivariate logistic regression model was used to analyze the independent risk factors affecting the prognosis of sepsis. ROC curve was used to analyze the predictive value. Results APACHE Ⅱ score and RDW in the septic shock group were significantly higher than those in sepsis group(all P<0.05). There was a significant positive correlation between RDW and APACHE Ⅱ score(r=0.015, P<0.001). Logistic regression analysis of multiple prognostic factors in patients with sepsis showed that the levels of APACHE Ⅱ, SOFA, PCT and RDW were all important risk factors affecting the prognosis of patients with sepsis. The ROC curves of PCT, APACHE Ⅱ, SOFA and RDW to predict the prognosis of septic patients showed that the AUC of these four indexes were 0.922, 0.878, 0.888 and 0.935, respectively, and there was no significant difference among APACHE Ⅱ score, SOFA score and AUC of PCT(all P>0.05). The critical value of RDW diagnosis was 14.92% the critical value of APACHE Ⅱ score was 16 points, the critical value of SOFA score diagnosis was 6 points, and the critical value of PCT diagnosis was 24.02 ng/mL. Conclusion The higher the level of RDW, the more serious the sepsis condition, and the worse the prognosis of patients, which has certain evaluation value for the prognosis of sepsis patients.
The effect of foot acupuncture hot medicated compress on immune function and gastrointestinal function in patients with colorectal cancer after general anesthesia
CHEN Shu-hua, SU Qin
2020, 18(11): 1830-1833. doi: 10.16766/j.cnki.issn.1674-4152.001630
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Objective General anesthesia may cause poor immune function and gastrointestinal dysfunction after the operation. The aim of this study is to explore the effect of foot acupoint hot medicated compress on postoperative immune function and gastrointestinal function among colorectal cancer patients after general anesthesia. Methods From January 2016 to June 2017, 74 patients with colorectal cancer who underwent surgical therapy under general anesthesia in the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, were included in this study. The patients were randomly divided into study group and control group, 37 cases in each group. In the control group, routine perioperative nursing measures were adopted. In the study group, on the basis of the nursing of the control group, the foot Chongyang point and Yongquan point were given hot medicated compress nursing with moxa and salt bag. The levels of serum immunoglobulins(IgG, IgA, IgM) and T lymphocyte subsets(CD3+, CD4+, CD8+, CD4+/CD8+) were measured by flow cytometry before and 7 days after operation, and the time of first anal exhaust, first defecation, gastric tube retention and bowel sound recovery were recorded. Results The serum levels of IgG, IgA and IgM of the study group 7 days after the operation were significantly higher than those in the control group and before the operation(all P<0.05). The levels of CD3+, CD4+, CD4+/CD8+ of the study group 7 days after the operation were significantly higher than those in the control group and before operation(all P<0.05), and the levels of CD8+ were significantly lower than control group and before treatment(P<0.05). The time of first anal exhaust, first defecation, gastric tube indwelling and recovery of bowel sounds in the study group were significantly shorter than those in the control group(all P<0.05). Conclusion Foot acupuncture hot medicated compress can improve the immune function of colorectal cancer patients after general anesthesia, and effectively promote the recovery of gastrointestinal function.
A study of the effect of dexmedetomidine on the inflammatory response of rats with mechanical ventilation lung injury based on miR-223-3p/NLRP3 axis
LI Ai-mei, TIAN Hai-tao, YIN Qiu-wen, LIU Su-juan, REN Guang-min
2020, 18(11): 1834-1837,1888. doi: 10.16766/j.cnki.issn.1674-4152.001631
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Objective The ventilator-induced lung injury(VILI) rat model was established in this study to explore the influence of DEX on its inflammatory response and the axis of microRNA-223-3 p/nucleotide binding oligomeric domain-like protein 3(miR-223-3 p/NLRP3). Methods The adult healthy 6-week-old Specific pathogen-free(SPF) grade male SD rats of were randomly divided into 5 groups using the random number table: control group(NC group), model group(M group), low dose DEX group(L-DEX group), medium dose DEX group(M-DEX group), high dose(H-DEX group) DEX group, 12 rats in each group; the rats were given 0.5, 2.5 and 5.0 μg/(kg·h) DEX intravenously in L-DEX group, M-DEX group and H-DEX group respectively. At the end of 4 h, the rats were sacrificed and the lung permeability index(LPI) and the ratio of lung tissue wet weight to dry weight(W/D), miR-223-3 p, NLRP3 mRNA and protein, caspase-1 protein expression and IL-1β and IL-18 levels in lung homogenate were measured. Results Compared with group M, the LPI, W/D ratio, NLRP3 mRNA(4.04±0.38, 2.12±0.32, 1.98±0.25) and NLRP3 protein(0.92±0.11, 0.58±0.06, 0.39±0.02), caspase-1 protein, IL-1β, IL-18 levels in L-DEX group, M-DEX group and H-DEX group decreased in turn, while NLRP3 mRNA in group M was 5.47±062, and NLRP3 protein was 1.31±0.27), and the level of miR-223-3 p increased in turn in the L-DEX group, M-DEX group, H-DEX group(P<0.05). Conclusion DEX may up-regulate the expression of miR-223-3 p, down-regulate the expression of NLRP3, caspase-1 and downstream inflammatory factors, which is closely related to the miR-223-3 p/NLRP3 axis, so as to reduce the VILI and inflammatory response in rats.
Changes and significance of related serum indices levels in patients with severe pulmonary infection
CHENG Wei-ling, WANG Lei, LIN Le-qing
2020, 18(11): 1838-1841. doi: 10.16766/j.cnki.issn.1674-4152.001632
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Objective To explore changes and significance of levels of serum C-reactive protein(CRP), procalcitonin(PCT), interleukin-6(IL-6) and brain natriuretic peptide(BNP) in patients with severe pulmonary infection. Methods A total of 467 patients with severe pulmonary infection who were admitted to Intensive Care Unit(ICU) of the Affiliated Hospital of Hangzhou Normal University from December 2015 to August 2019 were enrolled. According to age, patients were divided into 18-35 years group(172 cases), 36-60 years group(141 cases) and >60 years group(154 cases). According to survival within 30 d after admission in ICU, they were divided into survival group(349 cases) and death group(118 cases). Levels of serum CRP, PCT, IL-6 and BNP were measured. Pearson correlation analysis was applied to analyze correlation between age and CRP, PCT, IL-6, BNP. ROC curves were applied to analyze predictive value of CRP, PCT, IL-6 and BNP for prognosis of severe pulmonary infection patents at different age. Results The levels of serum CRP, PCT, IL-6 and BNP were significantly correlated with age(all P<0.05). The levels of CRP, PCT, IL-6 and BNP in the all survival group were significantly lower than those in the death group(all P<0.05). AUC of serum CRP, PCT, IL-6, BNP and their combination for predicting prognosis in 18-35 years group, 36-60 years group and >60 years group were(0.759, 0.729, 0.690, 0.798, 0.889),(0.813, 0.797, 0.713, 0.804, 0.927) and(0.644, 0.697, 0.696, 0.703, 0.847), respectively. Conclusion The levels of serum CRP, PCT, IL-6 and BNP are significantly correlated with age. The combined detection is of relatively higher predictive value for prognosis of patients with severe pulmonary infection at different age.
Simultaneous thoracoscopic bilateral pneumonectomy of multiple pulmonary nodules by with 40 cases
XU Bo, CHEN Xian-guo, WANG Ye-ping, LOU Yang, LI Xian-shuai, ZHANG Xiao-ling
2020, 18(11): 1842-1844,1965. doi: 10.16766/j.cnki.issn.1674-4152.001633
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Objective To summarize the clinical experience of simultaneous thoracoscopic bilateral pneumonectomy in the treatment of bilateral pulmonary nodules. Methods A retrospective analysis of the clinical data of 40 patients with multiple lung nodules underwent bilateral thoracoscopic pneumonectomy from January 2017 to November 2019. All patients were examined by CT, ECG and pulmonary function before operation to locate double pulmonary nodules and evaluate the pulmonary function reserve. According to the examination, the operation plan was made and sub lobectomy was performed. Operation related indicators(operation time, lesion diameter, intraoperative blood loss, number of lymph nodes) and perioperative related indicators(postoperative drainage time, hospital stay, postoperative pulmonary function index FEV1), operation mode and intraoperative and postoperative complications; pathological results, clinical efficacy, surgical related complications and The correlation of surgical procedures was analyzed. Results A total of 118 nodules were resected from 40 patients, of which 86(72.88%) were malignant tumors and precancerous lesions, which were distributed in 33 patients. Among them, 4 cases were precancerous lesions, 26 cases were primary lung cancer, 3 cases were other malignant lung tumors. TNM stage of primary lung cancer: 7 cases were stage 0, 14 cases were stage Ⅰ, 4 cases were stage Ⅱ, 1 case was stage Ⅲ, 0 case was stage Ⅳ. Among the primary lung cancer, 5 cases had lymph node metastasis, 4 cases had N1 metastasis, 1 case had N2 metastasis. All patients recovered smoothly. There were no deaths during the hospitalization. The operation time was(139.80±33.12) min, the intraoperative bleeding volume was(150.00±23.63) mL, and the postoperative hospitalization time was(5.42±4.23) d. The postoperative complications included pulmonary infection in 2 cases, arrhythmia in 2 cases, and respiratory failure in 1 case. Surgical related complications mainly occurred in patients with lobectomy(complication rate was 100.0%) and segmental pulmonary segment(complication rate was 50.0%). At the time of discharge, the short-term curative effect was evaluated. Among the patients who underwent wedge resection of lung lobe, there were some invalid cases(2/30, 6.67%). Conclusion Patients with multiple pulmonary nodules screened by preoperative evaluation and undergoing simultaneous bilateral thoracoscopic pneumonectomy are safe and effective. For different pathological types of patients, preoperative comprehensive evaluation is needed to determine the best operation method, to obtain better short-term efficacy and low complications.
Comparison of clinical efficacy of laparoscopic and open hepatectomy for primary hepatocellular carcinoma
ZHU Er-chang, LU Zheng, XU Jian-zhong, ZHOU Kai, MO Guang-ju, ZHANG Deng-yong, WANG Dong-dong
2020, 18(11): 1845-1847,1973. doi: 10.16766/j.cnki.issn.1674-4152.001634
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Objective To compare and analyze the clinical efficacy of laparoscopic and open hepatectomy in the treatment of primary hepatocellular carcinoma(HCC), so as to provide certain theoretical reference for clinical practice and improve the treatment level of HCC. Methods A total of 86 patients with HCC admitted to our hospital from January 2014 to January 2017 were selected and divided into control group and observation group by numerical random table method, with 43 cases each group. The control group underwent open hepatectomy, while the observation group underwent laparoscopic hepatectomy. The levels of intercellular adhesion molecules-1(ICAM-1), matrix metalloproteinases-13(MMP-13), procalcitonin(PCT), interleukin-6(IL-6), and the incidence of postoperative complications in the two groups were compared. Results The operative time, intraoperative blood loss, incision length, postoperative visual analogue pain(VAS) score, and length of postoperative hospital stay in the observation group were all lower than those in the control group(all P<0.05). Before treatment, the levels of ICAM-1, MMP-13, PCT and IL-6 in the two groups were not significantly different(all P>0.05). After treatment, the levels of ICAM-1, MMP-13, PCT and IL-6 in the observation group were(7.48±2.69) ng/mL,(121.03±23.61) ng/mL,(6.83±1.97) μg/mL and(13.58±4.29) pg/mL, respectively, which were all lower than those in the control group(13.07±3.86) ng/mL,(168.52±30.27) ng/mL,(8.32±2.67) μg/mL and(16.40±5.38) pg/mL(all P<0.05). The complication rate in the observation group was 6.99%, lower than 23.27% in the control group(P<0.05). Conclusion Both laparoscopic and open hepatectomy are common surgical treatment methods for primary HCC. Compared with open surgery, laparoscope-guided surgery is more effective, has the advantages of less trauma, faster postoperative recovery, less impact on inflammatory response, high safety.
The effect of sacubitril/valsartan on myocardial injury and inflammatory factors in ischemic cardiomyopathy with reduced ejection fraction
PAN Chun-qi, JIAN Ying, NI Bin, LIU Shan-xin
2020, 18(11): 1848-1850,1945. doi: 10.16766/j.cnki.issn.1674-4152.001635
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Objective To explore the effect of sacubitril/valsartan on myocardial injury and inflammatory indexes in patients with ischemic cardiomyopathy with reduced ejection fraction, so as to provide evidence for the treatment of heart failure caused by ischemia. Methods Eighty-four patients with ischemic cardiomyopathy complicated with heart failure who were hospitalized in the Affiliated Hospital of Hangzhou Normal University from January 2019 to December 2019 were selected as the research object. They were divided into observation group(42 cases) and control group(42 cases) by random number table method. The observation group was treated with sacubitril/valsartan, and the control group was treated with valsartan. Myocardial injury and inflammation indexes were compared between the two groups after 4 weeks of treatment. Results After 4 weeks of treatment, the average level of N-terminal prohormone of brain natriuretic peptide(NT-proBNP) in the observation group was(1 726.36±492.37) pg/mL, the average level of cardiac troponin I(cTnI) was(19.27±4.38) ng/L, and the above indexes in the control group were(2 833.37±503.44) pg/mL,(22.39±5.02) ng/L, respectively, the difference was statistically significant(t=10.188 and 3.035, all P<0.05). In the observation group, the high-sensitivity C-reactive protein(hs-CRP) level was(5.48±1.28) mg/L, IL-6 level was(18.36±3.38) pg/mL, TNF-α level was(5.32±1.27) pg/mL, and IFN-γ level was(6.67±1.17) pg/mL, the above indexes of the control group were(6.85±1.37) mg/L,(21.29±3.22) pg/mL,(8.34±1.87) pg/mL,(9.30±1.20) pg/mL, respectively. The level of inflammatory factors in the observation group were lower than those in the control group(all P<0.05). Conclusion sacubitril/valsartan can repair myocardial injury in patients with ischemic cardiomyopathy and reduce inflammation in heart failure in a short time.
Effect of CYP1A2 gene polymorphism on plasma concentration of olanzapine in schizophrenic patients
YAN Pan, SONG Ming-fen, WANG Sheng-dong, LI Jing, WANG Shu-qi, WANG Cheng-peng, LIU Jian, LI Xin, SHI Jian-fei
2020, 18(11): 1851-1853,1939. doi: 10.16766/j.cnki.issn.1674-4152.001636
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Objective To investigate the effect of cytochrome P450 1 A2(CYP1 A2) gene polymorphism on plasma concentration of olanzapine in schizophrenic patients, and to provide reference for the individualized administration of olanzapine. Methods A total of 226 schizophrenic patients treated with olanzapine in Hangzhou Seventh People's Hospital from June 2017 to December 2018 were selected as subjects in the study. The plasma concentration of olanzapine was determined by ultra-high-performance liquid chromatography-tandem mass spectrometry. The gene polymorphisms of CYP1 A2*1 C and CYP1 A2*1 F were detected by improved multiple ligase detection reaction, and the CYP1 A2 genotypes were classified into high activity genotype(HA) and low activity genotype(LA) based on these two gene polymorphism sites. Then the difference in plasma concentration of olanzapine among different genotypes were compared. Results The plasma concentrations of olanzapine in the genotypes of GG/AA, GG/CA and GA/AA were obviously lower than that in the wild GG/CC genotype [(2.17±0.79)ng/(mL·mg),(2.53±1.10)ng/(mL·mg),(2.44±0.79)ng/(mL·mg) vs.(2.99±1.00)ng/(mL·mg),F=3.312,P<0.05]. However, there was no significant difference in the genotypes of GG/CC,GA/CA and AA/AA or in the genotypes of GG/AA,GG/CA and GA/AA(P>0.05).The plasma concentration of olanzapine in high activity genotype was obviously lower than that in low activity genotype [(2.43±0.96)ng/(mL·mg) vs.(2.91±1.06)ng/(mL·mg),t=3.561,P<0.05], and the activity of CYP1 A2 was negatively correlated with the plasma concentration of olanzapine(r=-0.232, P<0.05). Conclusion CYP1 A2 gene polymorphism could affect the plasma concentration of olanzapine. The CYP1 A2 genotypes of GG/AA, GG/CA and GA/AA had low plasma concentrations of olanzapine, and clinicians should pay appropriate attention to it when using olanzapine.
Association of preoperative serum alanine aminotransferase and asparagine aminotransferase ratio and prognosis in patients with gastric cancer
WU Jia, LI Zhong-sheng, YAO Han-hui
2020, 18(11): 1854-1856,1932. doi: 10.16766/j.cnki.issn.1674-4152.001637
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Objective To analyze the effect of preoperative serum alanine aminotransferase(ALT) and asparagine aminotransferase(AST) ratio(LSR) on long-term prognosis in patients with gastric cancer undergoing radical gastrectomy. Methods Clinical data of 106 patients with gastric cancer in our hospital from January 2014 to December 2018 were analyzed. Patients were divided into two groups according to the level of LSR. The relationship between preoperative LSR and clinic pathological factors were analyze. The influence of preoperative LSR on long-term prognosis of gastric cancer patients was analyzed by Cox regression. Results The best cut-off point of LSR in ROC curve was 1.48, and 81 cases in LSR<1.48 group, 25 cases in LSR ≥ 1.48 group. Single factor results showed that the LSR was higher in patients with smoking, higher TNM staging and combined visceral resection(all P<0.05). A total of 98 patients(92.45%) were followed up for 22-86(median 43) months, and the 5-year survival rate was 39.80%. The 5-year survival rate of patients with LSR<1.48 was 44.44%, and patients with LSR ≥ 1.48 was 12.0%, with statistically significant difference(P<0.05). Multivariate Cox regression analysis showed that tumor size, TNM staging and LSR were independent factors affecting the prognosis of patients with gastric cancer(all P<0.05). Conclusion Preoperative LSR may be an independent factor to predict the prognosis of patients with gastric cancer. Therefore, the prognosis and survival time of patients with gastric cancer can be improved by restoring and improving their liver function.
Analysis of serum uric acid and fasting blood glucose level in female patients with common rheumatic immune diseases
YUAN Guo-long, WANG Qian-qian, ZHANG Feng-chun, XU Sheng-qian
2020, 18(11): 1857-1859,1868. doi: 10.16766/j.cnki.issn.1674-4152.001638
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Objective To detect the serum uric acid level and fasting blood glucose level in women with common rheumatism immune disease, and to compare and analyze the relative indexes with those of normal women, so as to understand the metabolic status of patients and provide some references for clinical treatment. Methods The clinical data of 300 female patients in Fuyang People's hospital from September 2017 and September 2019 were selected, including systemic lupus erythematosus(SLE) 50 cases, lupus nephritis(LN) 50 cases, primary Sj9 gren's syndrome(pSS) 50 cases, rheumatoid arthritis(RA) 50 cases, spinal arthritis(SpA) 50 cases, and inflammatory myopathy(IIM) 50 cases. Another 50 cases of healthy women in the same period of physical examination in our hospital were randomly selected as the control group. The blood uric acid and fasting glucose level were detected. Results There were significant differences in the serum uric acid levels among 6 groups of female patients with different categories of rheumatic diseases(F=1.789, P=0.044). The LSD-t results showed that the serum uric acid level was significantly increased in LN patients compared with that in normal women(t=4.622, P<0.001), the serum uric acid level of SpA patients was lower than that of normal women(t=-2.796, P=0.006). There was no statistically significant difference in fasting glucose level between the 6 groups compared with that of the normal women(F=1.112, P=0.712). Conclusion The serum uric acid level of female LN patients is higher than that of normal women. The serum uric acid levels in female SpA patients is lower than those in normal women. There is no significant difference between the fasting blood glucose levels of women with different rheumatism and that of healthy women. Follow up should be paid attention to in LN women and the appearance of renal injury should be vigilant.
Risk factors of liver damage associated with obstructive sleep apnea hypopnea syndrome
ZHOU Zuo-ling, CHEN Xi-sheng
2020, 18(11): 1860-1863. doi: 10.16766/j.cnki.issn.1674-4152.001639
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Objective To investigate the risk factors of elevated liver enzymes and nonalcoholic fatty liver disease(NAFLD) in patients with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods A total of 162 OSAHS patients admitted to Beijing Shunyi District Hospital affiliated to Capital Medical University from July 2017 to July 2019 were selected and divided into a group of 68 patients with elevated liver enzymes and a group of 94 patients with normal liver enzymes. Patients with or without NAFLD were divided into a NAFLD group of 56 patients and a non-NAFLD group of 106 patients. The risk factors affecting OSAHS liver injury were analyze. Results In the elevated liver enzymes group, the AHI, ODI, CT90, BMI, ESS score, ALT, GGT total apnea time were significantly higher than those in the normal liver enzymes group(all P<0.05), and the LSaO2 was significantly lower than that in the normal liver enzymes group(P<0.01). The sleep apnea hypopnea index(AHI), oxygen loss index(ODI), duration of blood oxygen saturation below 90%(CT90), body mass index(BMI), ESS score, and total apnea duration in the NAFLD group were significantly higher than those in the non-NAFLD group(all P<0.05), and the minimum oxygen saturation(LSaO2) was significantly lower than that in the non-NAFLD group(P<0.01). The ODI and LSaO2 were independent risk factors for liver enzyme elevation(ORODI=1.184; ORLSaO2=1.091; all P<0.001). The BMI, ODI and CT90 were independent risk factors for OSAHS associated NAFLD(ORBMI=1.395; ORODI=1.274; ORCT90=1.295; all P<0.001). Conclusion The ODI and LSaO2 are independent risk factors for liver enzyme elevation in OSAHS patients, while the BMI, ODI and CT90 are independent risk factors for OSAHS patients with NAFLD.
Screening of risk factors and prevention strategies for the decrease of oxygen saturation during the intra-hospital transport of critically ill children
ZHANG Min, SHEN Guo-lian, QIAN Fei-yang
2020, 18(11): 1864-1868. doi: 10.16766/j.cnki.issn.1674-4152.001640
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Objective To analyze the incidence of blood oxygen saturation(SpO2) decrease influencing factors during the intra-hospital transport of pediatric critically ill children by using a prospective cross-sectional survey, and provide a reference for clinical optimization of the intra-hospital transport plan for critically ill children. Methods Two hundred and four critically ill children who met the research conditions in Hangzhou First People's Hospital Affiliated to Medical School of Zhejiang University from September 2019 to November 2019 were selected as the study subjects. They were divided into observation group and control group. An investigation scheme was developed for various factors that may affect SpO2 reduction during the transportation of children. All possible influencing factors were recorded and analyzed statistically. Results (1) The incidence of SpO2 decrease was 60.29% in the process of intra-hospital transport of critical children, and the time of SpO2 decrease was mainly within 5 minutes of the beginning of the transfer;(2) The factors that may affect the decrease of SpO2 during the transport in critically ill children were: age, body mass index(BMI), basic disease, pediatric early warning score(PEWS), blood pressure, respiratory rate, age of transfer nurse, assistance of attending doctor in the process of transfer, transfer path, transfer distance, accident in the process of transfer, transfer time(P<0.05);(3) Risk factors of SpO2 decrease during the intra-hospital transportation of critically ill children: multivariate logistic analysis showed that the risk factors of SpO2 reduction decrease during the intra-hospital transportation of critically ill children were the low age( 0-6 years old), respiratory and/or nervous system diseases, one or more items in PEWS score is 3 points, the experience of the transfer nurse was less than 3 years, transportation path, transportation process accidents the high risk factors of SpO2 reduction intra-hospital transport of critically ill children. Conclusion The incidence of SpO2 decrease is high during the intra-hospital transportation of critically ill children. The main risk factors are the serious condition of the children, the low efficiency of the transportation process and the improper protective measures. The optimization of the transportation process, the strengthening of the training of the transportation personnel and the careful assessment of the risk of intra-hospital transportation of critically ill children, raise the transportation efficiency and the protective effect, and can improve the safety of the critically ill children.
Analysis of distribution characteristics of refractive error in preschoolers with low vision
SUO Qian, ZHANG De-yong, CAI Wen-qian, SUN Li, ZHANG Bo, YAN Xiao-ling, GUO Bao
2020, 18(11): 1869-1871. doi: 10.16766/j.cnki.issn.1674-4152.001641
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Objective To analyze the distribution of refractive error in preschool children with low vision. Methods Total 100 preschoolers diagnosed with low visual acuity and excluded from organic eye disease in Xuzhou Children's Hospital from April 2017 to October 2019 were selected as research objects. The distribution characteristics of their refractive error were analyzed. Results (1)Age distribution of refractive error: a total of 85 cases were detected in 100 preschoolers with low vision, including 50 cases in the 3-year-old group(58.82%), 20 cases in the 4-year-old group(23.53%), 10 cases in the 5-year-old group(11.76%), and 5 cases in the 6-year-old group(5.88%). The detection rates of refractive error, farsightedness and myopia in different age groups were statistically significant(all P<0.05), but there was no significant difference in the detection rate of mixed astigmatism among different age groups(P>0.05).(2)Distribution characteristics of amblyopia: a total of 50(50.00%) amblyopia children were detected in 100 cases of preschoolers with low vision, including 22 cases of amblyopia, 18 cases of anisometropic amblyopia, and 10 cases of strabismus amblyopia. There was a significant difference in the detection rate of amblyopia among different age groups(all P<0.05).(3)Refractive type distribution: among the 85 children with ametropia, 52(61.18%) had hyperopia, 22(25.88%) had myopic ametropia, and 11(12.94%) had mixed astigmatism.(4)Refractive degree distribution: among the 85 children with ametropia, 60(70.59%) had mild ametropia, 21(24.71%) had moderate ametropia, and 4(4.71%) had severe ametropia. Conclusion The refractive error of preschool children with low vision mainly occurs in young children. With the increase of age, the incidence of refractive error gradually decreases. The type of refractive error is mainly hyperopia, and the degree of refractive error is mainly mild. The refractive examination is essential for preschool children with low vision.
Application of serum amyloid A and high sensitivity C-reactive protein in early diagnosis of respiratory tract infection in children
CHEN Jie, WU Su-ling
2020, 18(11): 1872-1874. doi: 10.16766/j.cnki.issn.1674-4152.001642
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Objective To analyze the expression levels of serum amyloid A(SAA) and high-sensitivity C-reactive protein(hs-CRP) in children with respiratory tract infection and their application value in early diagnosis. Methods Total 70 children with respiratory tract infection diagnosed and treated in our hospital from March 2019 to March 2020 were selected and included in the study group. According to the results of etiological examination, they were divided into group A(bacterial infection group) and group B(viral infection group), and 35 healthy children who received routine physical examination in our hospital at the same time were selected and included in the control group. The venous blood of upper limbs was collected on an empty stomach in the study group at the beginning of admission(acute stage) and recovery period, while the control group was collected once. SAA and hs-CRP were detected. The application value of SAA and hs-CRP in early diagnosis of respiratory tract infection in children was analyzed. Results The levels of SAA and hs-CRP in the group A and B at the beginning of admission were higher than those in the control group(all P<0.05). The levels of SAA and hs-CRP in the group A at the beginning of admission and in the recovery period were higher than those in the group B(all P<0.05). The levels of SAA and hs-CRP in the recovery period in the group A and B were lower than those in the beginning of admission(all P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value of SAA combined with hs-CRP(97.14%, 97.14%, 97.14%, 94.28%) were higher than those of SAA alone(87.14%, 80.00%, 89.71%, 75.68%) and hs-CRP alone(45.71%, 68.57%, 74.42%, 38.71%), all P<0.05. Conclusion SAA combined with hs-CRP detection has high application value in the early diagnosis of respiratory tract infection in children, which can provide important reference for clinical diagnosis and is worth carrying out.
Analysis on the advantages of“General practice+”medical community mode in the prevention and control of COVID-19
DU Qing-feng, XU Ya-fei, ZHANG Peng, WANG Pei-xi, MAO Chen, CHEN Min-sheng
2020, 18(11): 1875-1878,1883. doi: 10.16766/j.cnki.issn.1674-4152.001643
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The outbreak of COVID-19 in early 2020 is a major public health emergency with the fastest spread, the widest range of infection and the most difficult prevention and control since the founding of the People's Republic of China. The whole country has been vigorously carrying out epidemic prevention and control work. Lishui Town located in the northeast of Nanhai District, Foshan City, Guangdong Province, is close to Guangzhou, with an area of 148.28 square kilometers. Although the administrative division is only a town, the Lishui is located in the Pearl River Delta, and is an important industrial town. There are many small and medium-sized enterprises and floating population in the area, with more than 20 000 people from Hubei province. With the end of the Spring Festival, many enterprises employees returned to work and production, and many migrants personnel returned to Lishui and gather in real estate, factories, enterprises and other places, which putted great pressure on epidemic prevention and control. However, there were only 10 imported COVID-19 cases and no local COVID cases in Lishui Town as of March 5, 2020. The success in blocking the spread of the virus in the community was benefited from the long-term layout of regional grid management mode based on the "general medicine +" medical community, which was based on the support and resource allocation of the Southern Medical University and the local government through developing general medicine, coordinating the forces of the society and industry according to "medical prevention integration", aiming to provide community residents with a full range of health services throughout the life cycle. During this epidemic period, a full coverage community prevention and control system for new coronavirus pneumonia was constructed in Lishui Town, which giving full plays to the positive role of basic-level general practitioners, orderly and effectively carries out community epidemic prevention and control, actively and efficiently strengthens the management of key populations, reduces the pressure of government prevention and control, improves the efficiency of epidemic prevention and control, and provides necessary medical and health protection for the normal operation of regional economy. It is worthy of popularization and application.
Analysis on psychological and sleep state of general practitioners involved in epidemic prevention and control during the novel coronavirus pneumonia epidemic
CHENG Yan-li, CHEN Dong, XIAO Ju-jiao, LI Jian-yi, SUN Zhi-yi, DU Qing-feng
2020, 18(11): 1879-1883. doi: 10.16766/j.cnki.issn.1674-4152.001644
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Objective To explore psychological and sleep state of general practitioners involved in epidemic prevention and control during the novel coronavirus pneumonia epidemic, and to provide theoretical basis for the targeted intervention. Methods Using the convenient sampling method, the general practitioners who participated in the epidemic prevention and control work during February 13 to March 10, 2020 were selected as the observation group, and the general doctors who did not participate in the epidemic prevention and control work were selected as the control group. The general data, the generalized anxiety disorder self-assessment scale(GAD-7), the patient health questionnaire(PHQ-9), and the Pittsburgh sleep quality index(PSQI) were investigated using examination stars. The results were statistically analyzed. Results There was no significant difference in age, gender, marriage, working years and education between the two groups(all P>0.05). The observation group had higher scores of anxiety than those of the control group(P=0.010). The observation group had higher scores of depression than those of the control group(P=0.001). The sleep score of general practitioners(7.76±3.85) was slightly higher than that of general doctors(6.13±2.91), but the sleep score of doctors in the two groups was not statistically significant(P=0.062). The general practitioner's daytime dysfunction scores were higher than that of the general doctor(P=0.001). The sleep score of the two groups was significantly higher than that of the Chinese norm sleep total score(3.41±3.57), all P<0.001. General practitioners were more anxious and depressed than general doctors(P<0.001). Conclusion During the outbreak of novel coronary pneumonia, the general practitioners involved in the prevention and control of the epidemic have anxiety, depression and sleep disorders, which need targeted intervention.
Research on the emergency management of the grid management of medical personnel in the medical community during the COVID-19 epidemic based on Wuli-Shili-Renli methodology
WEI Xiao-xue, XU Ya-fei, WANG Chen-long, DENG Yu-bing, FU Yun, DU Qing-feng
2020, 18(11): 1884-1888. doi: 10.16766/j.cnki.issn.1674-4152.001645
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Grid management is a modern management idea that the management objects are divided into several grid units according to certain standards. By using the modern information technology and the coordination mechanism among the grid units, the information exchange between each grid can be effectively carried out, the organizational resources can be shared, and the management efficiency can be improved. Grid management can provide a set of new thinking and new methods for solving some complicated management problems. As a methodology for complex systems, Wuli-Shili-Renli(WSR) methodology is not only a methodology, but also a tool for solving complex problems. Our hospital set a grid management system of medical personnel in the medical community based on the WSR methodology during the COVID-19 epidemic. An epidemic emergency management is established, mainly including personnel hidden danger investigation and early warning mechanism, emergency information transmission and sharing mechanism, and emergency management coordination and linkage mechanism. It can fully and effectively grasp personal information of employees, understand the health and epidemiology history, and achieve information sharing, foresight and comprehensive management, which plays an important role in the prevention and control of epidemic situation in the COVID-19 epidemic prevention and control period. Grid management system is currently widely used in hospital management and other fields. In the face of major public emergencies and other events, it can be promoted in the functional communities in the region, such as schools, factories, enterprises, which is conducive to timely, effective and comprehensive grasp of everyone's information. It is a very important part of the prevention and control work, and plays an important role in the emergency management.
Exploration and practice of improving the community prevention and control ability of infectious diseases of general practitioners of residential training:Research on the project-based learning model based on the COVID-19
XIAO Ju-jiao, CHEN Dong, LI Jian-yi, XIE Xiao, LI Qi, TANG Si-yu, XU Hua-ying, LI Han-lin, DU Qing-feng
2020, 18(11): 1889-1892,1978. doi: 10.16766/j.cnki.issn.1674-4152.001646
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Objective To explore a project-based learning model, inspire students' internal learning motivation, and improve the infectious disease community prevention and control capabilities of general practitioners of residential training. Methods Total 36 general practitioners of residential training in our hospital from February 2020 to May 2020 were selected as training subjects. All general practitioners of residential training were included in the four sub-project groups of home medical observation, centralized medical observation, popular science publicity, and online consultation for practical exploration, and senior practitioners with experience in infectious disease prevention and control evaluated their practical results. After the project was over, all students evaluated the satisfaction of this project-based learning activity. Results All general practitioners of residential training completed the project practice, and scored above 40 in each group. The problems existing in the process can be sorted out through various channels of information and can be clearly expressed. The overall satisfaction of the students with this study was 4.94±0.25, the knowledge score of the prevention and control of infectious diseases before training was 1.39±0.49, the recognition of project-based learning is 4.87±0.34, and the recognition of teacher guidance is 3.94±0.44, the willingness to participate in project-based learning again was 4.97±0.18. Conclusion Through project-based learning, the students' community prevention and control capabilities have been improved to a certain extent, and this learning method is very recognized. This research can provide a reference for the training of other skills for doctors living in the stage of resident physician training, and has a certain significance for promoting the teaching reform after graduation.
Effects of Orem self-care model on mental symptoms,social function and recurrence rate of female patients with schizophrenia
WU Gui-hong, MA Ling-ya, SHEN Ou-ying, PAN Xi-ping, LI Jie-qiong
2020, 18(11): 1893-1896. doi: 10.16766/j.cnki.issn.1674-4152.001647
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Objective To explore the effect of Orem self-care model on female patients with schizophrenia. Methods From July 2018 to July 2019, 85 female schizophrenic patients treated in the mental health center of Seventh People's Hospital of Shaoxing were selected as the research object, and were divided into observation group(43 cases) and control group(42 cases) by random number table method. The control group adopted the conventional management model. The observation group combined the Orem self-care model on the basis of the control group and both were followed up for 6 months to compare the two groups of mental symptoms(positive and negative syndrome scale,PANSS), social function [social disability screening schedule(SDSS) and activities of daily living(ADL)] and relapse rate. Results There were no statistical difference between the two groups before treatment in terms of population characteristics and various scales(P>0.05). After 6 months, the observation group's PANSS negative scale, general psychopathology scale and total score were(9.27±1.20),(20.84±3.40), and(39.44±4.35), which were lower than those of the control group, the difference was statistically significant(t=12.152, 13.832, 17.265, P<0.05). There was no statistical difference between the two groups of positive scales(t=0.922, P>0.05). The SDSS and ADL of the observation group were(3.27±1.13) and(4.68±1.27) respectively, and the above scales of the control group were(29.84±3.10) points and(23.40±2.77) points, respectively. The differences were statistically significant(t=5.411, 10.091, respectively, P<0.05). The cumulative recurrence rate in the observation group at 6 months was 16.28%(7/43) and that in the control group was 35.71%(15/42), the difference was statistically significant(χ2=4.184, P=0.041). Conclusion The Orem self-care model reduces mental symptoms, improves social ability, and reduces rehospitalization or recurrence by strengthening the self-care ability of female schizophrenia.
Effects of IKAP mode health education on improving treatment compliance and quality of life in patients undergoing blood purification after vascular access establishment
WANG Rui-min, MIAO Jin-hong, YUE Xiao-hong
2020, 18(11): 1897-1900,1928. doi: 10.16766/j.cnki.issn.1674-4152.001648
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Objective To observe clinical effects of information-knowledge-attitude-practice(IKAP) mode health education on improving treatment compliance and quality of life in patients undergoing blood purification after vascular access establishment. Methods Total 120 patients who underwent regular blood purification in the hospital from May 2018 to February 2019 were divided into IKAP group(78 cases) and control group(42 cases) according to different health education methods. The control group underwent routine health education. On this basis, IKAP group underwent IKAP mode health education. After intervention, self-designed questionnaire, exercise of self-care agency scale(ESCA) and short-form-36 health survey(SF-36) were applied to assess treatment compliance, self-care ability and quality of life. The incidence of complications was statistically analyzed. Results After intervention, the cooperation degree of treatment compliance such as self-warming, no weight-bearing and no oppression, complying with treatment regimen, regular hand care exercises, timed blood pressure measuring and protecting vascular access of the IKAP group was better than that of the control group, and the scores of self-concept, self-care responsibility, self-care skills and health knowledge level of ESCA in the IKAP group were significantly higher than those in the control group(all P<0.05). Within 6 months after intervention, the incidence of complications in the IKAP group was significantly lower than that in the control group(8.97% vs. 23.81%). At 6 months after intervention, the scores of physiological function, physical pain, vitality, social function, emotional function and mental health in SF-36 questionnaire in the IKAP group were significantly higher than those in the control group(all P<0.05). Conclusion For patients undergoing blood purification, IKAP mode health education can effectively improve treatment compliance after vascular access establishment, improve self-care ability, reduce incidence of complications and improve quality of life.
Multi slice spiral CT findings and differential diagnosis of AIDS complicated with Pneumocystis carinii pneumonia
ZHANG Jian, CHEN Ping, SONG Qin-xia, WANG An-sheng
2020, 18(11): 1901-1903. doi: 10.16766/j.cnki.issn.1674-4152.001649
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Objective To analyze the multi slice spiral CT(MSCT) features of Pneumocystis carinii pneumonia(PCP) in patients with acquired immunodeficiency syndrome(AIDS), and to improve the cognition on the disease. Methods A retrospective analysis was conducted on the lung MSCT findings of PCP in 24 patients with AIDS diagnosed clinically by Anqing Hospital Affiliated to Anhui Medical University from December 2016 to August 2019. The ground glass opacity, pulmonary balloon, interstitial changes and mediastinal or lung hilar enlarged lymph nodes, pneumothorax, and pleural effusion were observed and counted. The features of the lesions such as the configuration, density and range of its distribution were summarizing. Results Among the 24 cases, 18 cases(75.0%) showed diffusing symmetrical lesions in both lungs, mainly in bilateral lung hilar, middle and lower lung fields. Among them, 7 cases(29.2%) had lesions of exudate and fused into patchy consolidation shadow, 10 cases(41.7%) had interstitial changes, presenting as thickens of interlobular septum, subpleural lines or reticulation, paving stone sign and fibrosis of interstitium, 6 cases(25.0%) had pulmonary balloon, 4 cases(16.7%) had "lunar arch sign". Extrapulmonary manifestations included 1(4.2%) pneumothorax, 1(4.2%) pleural effusion, 2(8.4%) pericardial effusion, and 2(8.4%) or lung hilar enlarged lymph nodes. Conclusion The MSCT manifestations of PCP in patients with AIDS have certain characteristics. When AIDS patients have fever, dry cough, dyspnea and other symptoms, combined with typical MSCT imaging manifestations, the diagnosis of AIDS combined with PCP can be considered.
Imaging examination and clinical significance of 48 cases of parapharyngeal space tumors
LIU Shi-xian, HAN Yue-feng, XIE Zong-yu, WANG Xiao-min, LI Hui, MA Shi-yin
2020, 18(11): 1904-1907. doi: 10.16766/j.cnki.issn.1674-4152.001650
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Objective To improve the diagnostic accuracy of parapharyngeal space tumor by analyzing the imaging features of 48 cases in our hospital, and further guide the choice of treatment plan and surgical approach. Methods Total 48 patients with parapharyngeal space tumor were diagnosed by pathology in Department of Imaging and Otorhinolaryngology and Head and Neck Surgery from January 2016 to April 2020. Preoperative CT examination was performed in 36 patients(8 alone, 28 CT and MRI), and MRI in 40 patients(12 alone, 28 CT and MRI). According to the characteristics of imaging, the source of tumor was identified, and its nature was judged according to the characteristics of tumor imaging, and the coincidence rate with postoperative gross pathology was counted. Results CT and MRI examination could help to judge the source, location, size, boundary and relationship with the important anatomical structures around the tumor. The coincidence rate of CT combined with MRI was higher than that of CT alone(χ2=7.365, P=0.007), and the coincidence rate of CT combined with MRI was higher than that of MRI alone(χ2=6.160, P=0.013). Conclusion CT or(and) MRI examination can preliminarily identify the nature, location and source of the tumor. CT combined MRI examination of parapharyngeal space tumor is more important than the application of CT or MRI alone examination. Imaging, as a non-invasive examination, plays an important role in the diagnosis and differential diagnosis of parapharyngeal tumors, and has clinical guiding value in the selection of treatment plan and surgical approach.
Quantitative analysis of the degree of inflammatory lesions in rabbit rheumatoid arthritis model by contrast-enhanced ultrasound
LI Yang, DU Huan, JIN Peng
2020, 18(11): 1908-1910. doi: 10.16766/j.cnki.issn.1674-4152.001651
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Objective To quantitatively analyze the degree of inflammatory lesions in rabbit rheumatoid arthritis models using contrast-enhanced ultrasonography. Methods Total 32 rabbits, purchased from the Animal Experiment Center of Bengbu Medical College, were randomly divided into model group and control group according to the random number table, 16 cases in each group. The model group were induced by injecting ovalbumin into the knee joint cavity. Conventional ultrasound examination and contrast-enhanced ultrasonography were performed at 4 weeks after the last injection. The experimental rabbits were euthanized after the ultrasound examination, and synovium specimens were harvested for histological staining of haematoxylin-eosin to calculate the pathological synovitis score, and for histological staining of CD31 to obtain the density of neovascularization. Pearson correlation was used to assess the association between enhancement intensity and synovitis pathological score, and histological neovascularization density. Results The maximum thickness of knee synovium in the model group was significantly greater than that of the control group [(3.53±0.49) mm vs.(0.89±0.15) mm, P<0.001]. The synovium of the model group was significantly enhanced [(12.06±2.40) dB], while the synovium of the control group was not enhanced. The pathological synovitis score in the model group was [(5.19±1.47) points], and the density of synovial neovascularization was [(23.00±4.05) microvessels per 200 × magnification microscopic field]. There were good correlation between contrast-enhanced ultrasound intensity and synovitis pathological score(r=0.758, P=0.001) and synovial neovascularization density(r=0.761, P=0.001). There was a certain correlation between the maximum thickness of knee joint synovium and pathological score of synovitis in model group(r=0.513, P=0.042). Conclusion The contrast-enhanced ultrasonography can not only quantitatively evaluate the neovascularization of rheumatoid arthritis synovium, but also sensitively and effectively evaluate the degree of synovial inflammatory lesions.
Comparison of the effectiveness of differential diagnosis on renal space occupying lesions between and contrast-enhanced ultrasonography and contrast-enhanced CT
LIU Xue, GAO Yin, YANG Chong-yi, CHEN Jian-ke, HU Zeng-gang, YANG Feng-qiang
2020, 18(11): 1911-1915. doi: 10.16766/j.cnki.issn.1674-4152.001652
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Objective To analyze the effect of contrast-enhanced ultrasonography, enhanced CT and combined examination in the qualitative differential diagnosis of renal space occupying lesions. Methods Total 126 cases of renal space occupying lesions whom were treated in Ninghai First Hospital Medicare and Health Group from February 2017 to February 2020 were studied. All patients were examined by contrast-enhanced ultrasonography and contrast-enhanced CT respectively. The sensitivity, specificity and accuracy of contrast-enhanced ultrasonography, contrast-enhanced CT and combined examination in the differential diagnosis of benign and malignant renal space occupying lesions with different pathological types and different lesions sizes were compared. Results In the differential diagnosis of different pathological types of renal space occupying lesions, the sensitivity(96.47%) and accuracy(93.65%) of combined examination were significantly higher than those of contrast-enhanced CT(78.82% and 74.60%)(all P<0.017), while there was no significant difference in sensitivity(88.24% vs. 84.92%) and accuracy(84.92% vs. 74.60%) between contrast-enhanced ultrasonography, enhanced CT alone(P>0.017). In the differential diagnosis of benign and malignant renal lesions with a diameter ≥ 3 cm, there was no significant difference in sensitivity, specificity and accuracy of the three examinations(all P>0.017). In the differential diagnosis of benign and malignant renal lesions with a diameter<3 cm, the sensitivity(94.34%) and accuracy(91.78%) of combined examination were significantly higher than those of contrast-enhanced CT alone(67.92% and 64.86%)(all P<0.017), and the sensitivity(88.68%) and accuracy and(85.14%) of contrast-enhanced ultrasound were significantly higher than those of contrast-enhanced CT(67.92% and 64.86%)(all P<0.017). Conclusion Contrast-enhanced ultrasound and contrast-enhanced CT have higher qualitative diagnostic value for renal space occupying lesions. Contrast-enhanced ultrasound is slightly better than contrast-enhanced CT in the qualitative diagnosis of small renal space occupying lesions. The combined diagnosis can improve the differential diagnosis efficiency of benign and malignant renal space occupying lesions.
Domestic research progress of intravenous thrombolysis and intravascular treatment of acute cerebral infarction
ZHANG Ran, TIAN Hao-lin, WANG Li-ting, HUANG Chao-lian, GAO Yin-tong, ZHANG Chen-hao, CHEN Xiao-jie, LI Xiao-tao, LIANG Chun-ling, LIU Zu-fa
2020, 18(11): 1916-1920. doi: 10.16766/j.cnki.issn.1674-4152.001653
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Acute cerebral infarction, also known as acute ischemic stroke, refers to the neurologic deficit syndrome caused by the ischemia and anoxic state in brain tissue. As a serious nervous system disease with high disability rate, high mortality rate and high incidence of complications, acute cerebral infarction brings heavy burden to our family and society. The key point of treatment is to open the occluded vessels and restore the blood flow as early as possible to save the ischemic penumbra. At present, the most effective treatments for hyperacute cerebral infarction mainly includes intravenous thrombolysis and intravascular intervention. Intravenous thrombolysis is the first choice and recommended by domestic and international guidelines. Most of the thrombolytic drugs are fibrinolytic enzyme activators, which can directly or indirectly activate fibrinolytic enzyme and degrade fibrin, so as to achieve the goal of thrombolysis. However, the recanalization rate of intravenous thrombolysis is low in patients with large vessel occlusive cerebral infarction. Intravascular therapy can directly observe thrombolysis and recanalization, improve recanalization rate and improve clinical prognosis, such as arterial thrombolysis, mechanical thrombectomy and so on. In recent years, domestic researchers have done a lot of exploration. The clinical research of intravenous thrombolysis and intravascular therapy is increasing gradually. This article makes a brief review of this, in order to find better clinical evidence and improve the quality of clinical medical practice. At the same time, it is found that there are still many problems, which limits the reference value of the results, such as the large differences in research methodology, the lack of clinical research on new thrombolytic drugs, the lack of unified specifications of mechanical thrombectomy technology, etc. We are looking forward to the further improvement.
Association of soluble CD36 with type 2 diabetes and its complications
WANG Sheng-han, YANG Ju-hong, ZHENG Miao-yan, KONG Yan, WANG Shan-shan, DAN Chun-yan
2020, 18(11): 1921-1924. doi: 10.16766/j.cnki.issn.1674-4152.001654
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There are 415 million people with diabetes in the world, and it is estimated that 193 million patients are undiagnosed with diabetes, of which type 2 diabetes accounts for more than 90 percent of diabetics. China has the largest number of diabetics in the world. With the significant increase in the prevalence of diabetes in recent years. The early intervention, detection and prognosis evaluation of diabetes have become a hot research direction in recent years. We usually confirm it by measuring fasting blood glucose or HbA1 c concentration or oral glucose tolerance test. HbA1 c can play an important role in the diagnosis of diabetes, its relationship with average blood glucose, its relationship with the risk of diabetic complications and guiding the adjustment of treatment. However, children(< 18 years old), pregnant women or patients with hemoglobin disorders(such as anemia) cannot rely on HbA1 c diagnosis, so we need to find another biomarker. As one of the most widely studied scavenger receptors, CD36 is not widely expressed, but it exists in a variety of mammalian cell types, including hematopoietic cells(platelets, monocytes, macrophages), endothelial cells, specialized epithelial cells in the breast and eyes, taste bud cells, intestinal cells and insulin-responsive cells(such as fat cells), as well as heart and skeletal muscle cells, It is involved in inflammatory reaction, atherosclerotic disease, intestinal fat absorption, lipid storage in adipose tissue, lipid utilization in heart and skeletal muscle, and glucose metabolism disorder, and is associated with the incidence of type 2 diabetes mellitus(type 2 diabetes mellitus, T2 DM). Serum soluble CD36(soluble CD36, sCD36), as a non-cellular binding cycle of CD36, can reflect the expression of CD36 in tissues, and is described as associated with metabolic syndrome for the first time in a small number of subjects. Subsequent studies have shown that the level of sCD36 in peripheral blood is associated with glucose and lipid metabolism, insulin resistance and diabetic complications in patients with type 2 diabetes, suggesting that it may be a potential biomarker for predicting diabetes and its complications.
The effect of Shujin Huoxue Decoction combined with massage on the recovery of ankle function in elderly patients with ankle fracture after operation
YU Wang-fen, TANG Yang-hua, YUE Zhen-shuang
2020, 18(11): 1925-1928. doi: 10.16766/j.cnki.issn.1674-4152.001655
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Objective Based on the theory of traditional Chinese medicine, it is very helpful to treat the elderly ankle fracture with Shujin Huoxue Decoction and massage, but there are few reports about the combination of them. Therefore, this paper will explore the effect of Shujin Huoxue Decoction on the angle displacement, radian displacement and movement obstacle of ankle joint after operation in the way of comparative study, so as to open up a more effective treatment way for the clinical treatment of this disease. Methods A total of 140 elderly patients with ankle fracture admitted to the Department of Orthopaedics, Jiangnan Hospital affiliated to Zhejiang University of Traditional Chinese Medicine, from January 2017 to January 2019, were selected for prospective study. They were randomly divided into group A and group B, with 70 cases in each group. Group A was treated with Shujin Huoxue Decoction alone, while group B was treated with massage on the basis of group A. All the clinical data of all subjects were included in SPSS 21.0 statistical software. Baird-Jackson, American Orthopaedic Foot & Ankle Society(AOFAS) scoring system and joint swelling score were used to evaluate the recovery of joint function, and the angular displacement, radian displacement and dyskinesia of the two groups before and after treatment were evaluated. Results After 1 year follow-up, the excellent and good rate of Baird Jackson scoring system in group A(84.06%) was lower than that in group B(95.38%), the excellent and good rate of AOFAS ankle hind foot scoring system in group A(82.61%) was lower than that in group B(93.85%). There was no significant difference in joint swelling scores of all patients in group B before treatment(1.73±0.31 vs. 1.78±0.29, P>0.05), but the scores of above joint swelling in group A were significantly lower than those in group B after treatment(0.59±0.17 vs. 0.71±0.24, P<0.05). Conclusion In the clinical treatment of elderly patients with ankle fracture, scientific and reasonable Shujin Huoxue Decoction combined with massage is of great help to improve ankle function, with good effect and good clinical application and popularization value.
Effect of Duhuo Jisheng Decoction on residual low back pain after spinal endoscopic surgery for disc herniation
WEI Jin-zhong, LING Yi-long, SHEN Xing-chao
2020, 18(11): 1929-1932. doi: 10.16766/j.cnki.issn.1674-4152.001656
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Objective To investigate the effect of Duhuo Jisheng Decoction on postoperative lumbago of patients with intervertebral disc herniation. Methods From January 2017 to January 2019, 64 patients with residual lumbago after spinal endoscopic surgery for disc herniation were selected and divided into two groups according to different treatment methods. The control group received early rehabilitation training, and the research group received early rehabilitation combined with Duhuo Jisheng Decoction. Results The effective rate of 100.00% in the study group was higher than that in the control group(43.75%, χ2=25.043,P=0.000). The scores of physical life status, physical function, role function and social work in the study group were(84.00±4.40, 75.88±3.34, 85.00±4.08, 81.60±3.29) points, respectively, higher than those in the control group(75.83±5.06, 52.42±3.15, 76.00±3.19, 74.28±2.85) points(all P<0.05 respectively). VAS, ODI and ADL scores(0.83±0.64, 3.00±0.64, 3.00±0.58) in the study group were all lower than those in the control group(1.60±0.81, 3.83±0.69, 4.00±0.63), all P<0.05. Conclusion The application of Duhuo Jisheng Decoction in the treatment of residual lumbago after spinal endoscopy can promote the clinical recovery of the body function of patients, improve their quality of life, has an ideal therapeutic effect, and is worthy of application.
Application of case-based teaching method combined with multi-modality imaging intelligent system in neurosurgery regulatory education
ZHENG Xia-lin, SHI Shi-kui, JIANG Zhi-quan, HAN Yi, SUN Tao, XU De-cai
2020, 18(11): 1933-1935. doi: 10.16766/j.cnki.issn.1674-4152.001657
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Objective The case-based teaching method is widely used in clinical teaching, but there are still some deficiencies in the teaching of neurosurgery. Therefore, this study intends to use multimodal imaging intelligent system combined with case-based learning(CBL) to explore its application value, advantages and disadvantages. Methods From January 2015 to October 2019, a total of 42 neurosurgery regular students from the First Affiliated Hospital of Bengbu Medical College were selected. The students were all from the Bengbu Medical College. They were randomly divided into the observation group(n=22) and the control group(n=20). The CBL was used as the control group, and the multimodal imaging intelligent system combined with CBL was used as the observation group. There were five steps in the simple CBL teaching method(designing cases and problems, preparing cases in advance, division of labor among members of the group, discussion, and summary). The teaching method of the observation group was to use the multi-modal imaging intelligent system(based on the information department and imaging department of our hospital. The image HISS system was the real-time image transmission reading system) throughout the first three steps of the simple CBL five steps. There were two teachers, both qualified as lecturers and experienced in CBL teaching. The teaching time was one week. The differences between the two groups were compared through the examination. Results After the training, the average score of the control group was 78.6±0.8, and that of the observation group was 82.3±1.5, with statistical significance(t=10.513, P<0.001). Conclusion The multi-modal imaging intelligent system can provide three-dimensional and intuitive images for neurosurgery discipline students. Combined with CBL, it can significantly improve the teaching quality of neurosurgery discipline students compared with the previous teaching methods, and it is worthy of further promotion to neurosurgery discipline training and other directions.
Prognosis of acute ischemic stroke patients by crisis management combined with seamless integrated first aid model
LUO Guo-ying, CHEN Xiu-fang
2020, 18(11): 1936-1939. doi: 10.16766/j.cnki.issn.1674-4152.001658
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Objective To analyze the crisis management combined with integrated first aid model for the prognosis of patients with acute ischemic stroke. Methods A total of 65 patients with acute ischemic stroke admitted to our hospital from January 2018 to July 2018 were selected as the control group by the convenience sampling method, and 82 patients with acute ischemic stroke admitted to our hospital from October 2018 to April 2019 were selected as the observation group. The patients in the control group were treated with the conventional mode, and the observation group were with the crisis management and seamless first-aid mode. Retrospective analysis of the time used in the first aid of 2 groups, the neurological function and daily living ability of the patients were evaluated according to stroke scale(NIHSS) and daily living ability scale(BI index), and the nursing satisfaction of the patients in the 2 groups was calculated. Results The time from admission to CT examination, from the end of CT examination to the beginning of thrombolysis and DNT time(time from visit to intravenous thrombolytic drugs) in the observation group were shorter than those in the control group, with statistically significant differences(all P<0.05). At discharge, NIHSS of patients in the observation group was lower than the control, and BI index was higher than the control, with statistically significant differences(all P<0.05). The nursing satisfaction of patients in the observation group was 97.6%(80/82), higher than 89.2%(58/65) in the control, the difference was statistically significant(P<0.05). Conclusion Crisis management combined with seamless first-aid mode can shorten the treatment time of patients with acute ischemic stroke, improve their neurological function and daily life ability, and improve nursing satisfaction, which is worthy of clinical application.
Effect of social network-based interventions on self-management and others of patients with chronic obstructive pulmonary disease:a systematic review
WU Shi-shi, LIU Yu, YANG Kai-lian, LU Feng-ling, OU Meng-xian
2020, 18(11): 1940-1945. doi: 10.16766/j.cnki.issn.1674-4152.001659
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Objective To evaluate the effect of social network-based interventions on self-management and quality of life of patients with chronic obstructive pulmonary disease(COPD). Methods We searched Chinese database(such as CNKI, Wanfang Data, CBM, VIP) and English database(The Cochrane Library, PubMed, Embase, Web of science, Proquest) for randomized clinical trials(RCTs) of social network interventions in patients with COPD. Search time was from database establishment to December 2019. Two researchers screened literature according to inclusion and exclusion criteria, extracted data and assessed the risk of bias. Then, meta-analysis and/or descriptive analysis was conduct with RevMan 5.3 software. Results A total of 10 RCTs were included in this study with enrolling 967 participants. Meta-analysis showed that the score of self-management in intervention group was higher than control group [SMD=1.89, 95% CI(0.24, 3.54), P=0.020], and the score of quality of life in control group was lower than intervention group [MD=-8.43,95% CI(-11.10,-2.77), P<0.001]. Conclusion The present evidences suggest that social network-based interventions have a positive effect on improving the self-management ability of COPD patients, as well as on improving their quality of life. Due to the limitations of study design and samples, more large sample studies are needed to make the effect more clearly.
The application of project management in nutrition management of spinal surgery patients
QU Jun-hong, NING Ning, CHEN Jia-li, LI Ye, LI Pei-fang, PU Xing-cui
2020, 18(11): 1946-1949. doi: 10.16766/j.cnki.issn.1674-4152.001660
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Objective To investigate the application and effect of the project management in nutrition management of spinal surgery patients. Methods The project management in nutrition management was applied in 120 cases of spinal surgery patients in a third hospital in Sichuan province who were selected as the study subjects from January 2017 to March 2017 by taking the convenience sampling method. Specific methods included: analyzing the current situation of nutrition management and retrieving relevant documentary evidence; setting up an interdisciplinary nutrition management project team and constructing the organizational structure of nutrition management; defining the nutrition management responsibilities of the core members of the project team; creating an atmosphere for the training of nutrition management; refining the nutrition management plan of spinal surgery; control of nutrition process; the management and other series of the management of the spinal surgery nutrition management after discharge. The incidence of daily hunger stress, the nutrition management service experience and satisfaction, the evaluation rate of nutrition risk and the rate of the nutrition path of the patients were compared. Results By applying the project management to spinal surgery nutrition management, the incidence of daily hunger in spine surgery patients decreased from 45% to 11%. The nutrition management service experience and satisfaction of hospitalized patients was increased from 90% before the application project management to 97% of the application project management. The rate of nutritional risk screening was also increased from 16% to 93%. All the patients with spinal surgery included in the ERAS were given nutritious meals on time, and the implementation rate of the ERAS nutrition path was 100%. Conclusion Project management used in spine surgery nutrition management which help reduce stress, improve patient outcomes and patient satisfaction, at the same time change nutrition management become passive to active. It's an advanced and scientific management methods.
Analysis of the effect of the whole process quality control management in disinfection management of supply room on the prevention and control of hospital infection
HAN Song-hua, JIANG Li-qian, YU Xu-liang, YU Zhi-fen, WU Li-zhen, ZHANG Jun
2020, 18(11): 1950-1952,1960. doi: 10.16766/j.cnki.issn.1674-4152.001661
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Objective To explore the effect of whole process quality control management in disinfection management of supply room and its effect on hospital infection control. Methods The supply room of Quzhou Hospital of traditional Chinese Medicine began to implement the whole process quality control management in disinfection management from July 2016. A total of 25 012 cleaning, disinfection and sterilization articles in the supply room before the implementation of the whole process quality control(from July in 2014 to June in 2016) and 27 885 cleaning, disinfection and sterilization articles in the supply room after the implementation(from July 2016 to June 2018) were statistically analyzed. The qualification rate and nosocomial infection rate of sterilized articles in the supply room were compared before implementation and after implementation. Results Before the implementation of the whole process quality control management, the qualified rate of disinfection, sterilization, aseptic packaging and aseptic distribution were 83.0%, 86.0%, 86.0% and 85.0% respectively. After the implementation of the whole process quality control management, the qualified rate of disinfection, sterilization, aseptic packaging and aseptic distribution were 97.5%, 100.0%, 100.0% and 100.0% respectively. After the implementation, the qualified rates of sterilization, aseptic packaging and aseptic distribution were all increased(χ2=3 269.004, 4 181.060, 4 181.060, 4 502.324; all P<0.05). The total incidence of nosocomial infection(3.25% vs. 1.76%) decreased after the implementation of the whole process quality control management(χ2=120.451, P<0.05). There were significant differences in the infection rate of the surgical site/incision(1.57% vs. 0.27%) and the respiratory system(1.14% vs. 0.93%) before and after the implementation of the whole process quality control management(χ2=255.925, 5.956, all P<0.05). Conclusion The whole process quality control management in disinfection management of the supply room can improve the qualified rate of sterilization articles and reduce the incidence of hospital infection.
Analysis of current situation and influencing factors of compassion fatigue in junior nurses
ZHANG Hai-yan, YANG Xiao-min, HUANG Jin, WANG Zhi-yi
2020, 18(11): 1953-1956. doi: 10.16766/j.cnki.issn.1674-4152.001662
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Objective To understand the current situation of compassion fatigue in junior nurses, and analyze its influencing factors. Methods Total 348 junior nurses from 4 third-grade class-A hospitals in Wenzhou city were selected as the research subjects using the convenience sampling from March to April 2020. The general data questionnaire, the Chinese meaning in life questionnaire, Connor-Davidson resilience scale and the health care workers' compassion fatigue scale were used. Results The total score of the meaning in life was(45.77±6.82) points. The total score of psychological resilience was(78.74±16.84) points. The score of junior nurses' compassion fatigue was(109.74±14.59) points. Univariate analysis showed that there were statistically significant differences in the scores of compassion fatigue among nurses with different ages, educational background, professional title, nursing age, night shift, and satisfaction with salary(all P<0.05). Pearson correlation analysis showed that meaning in life, psychological resilience and each dimension scores were negatively correlated with the junior nurses' compassion fatigue(all P<0.01). Multiple linear regression analysis showed that junior nurses' title, meaning in life, psychological resilience, night duty were the main influence factors of junior nurses' compassion fatigue(all P<0.05). Conclusion Junior nurses' compassion fatigue degree is higher. The title, meaning in life, psychological resilience, night duty all can affect the compassion fatigue level. Nursing managers should formulate fair and equitable professional title promotion and assessment rules, standardize the shift system, take targeted measures to improve the meaning of life and psychological resilience, alleviate the compassion fatigue of junior nurses, and improve the quality of clinical nursing service.
Effect of early prone position ventilation on children with sepsis complicated with ARDS and nursing experience
YU Min-min, ZHONG Jian-feng, GONG Xiao-li, XU Zhen
2020, 18(11): 1957-1960. doi: 10.16766/j.cnki.issn.1674-4152.001663
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Objective To explore the effect of early prone position ventilation on children with sepsis and acute respiratory distress syndrome(ARDS). Methods Forty-two children with sepsis and ARDS who were admitted to the Pediatrics Department of Huzhou Central Hospital from January 2017 to December 2019 were selected, and they were randomly divided into observation group and control group, 21 cases of each. The two groups of children on the basis of conventional tracheal intubation and mechanical ventilation, the prone position ventilation strategy for both groups were adopted. The children of control group received prone ventilation within 24 hours and later of starting MV, while the children in the observation group performed prone ventilation within 6 hours of starting MV. The related indicators and complications were compared between the two groups. Results Compared with the control group, the observation group could stabilize heart rate faster [(96.3±6.4)beats/min vs.(109.6±10.1)beats/min], reduce airway platform pressure [(17.5±5.5)cm H2O vs.(24.65±4.1)cm H2O], increase arterial oxygen partial pressure significantly [(109.8±24.7)mm Hg vs.(67.5±22.8)mm Hg] and better improve the oxygenation index(114.2±20.6 vs. 89.1±17.2), as well as obviously shorten that mechanical ventilation time of tracheal intubation of children [(7.0±0.8)d vs.(11.6±1.8)d], improve the cure rate(95.23% vs. 66.67%), the differences were statistically significant(all P<0.05). However, the incidence of related complications in the two groups no statistically significant differences(all P>0.05). Conclusion The early prone position ventilation can significantly improve oxygenation index of septic children complicated with ARDS, stabilize heart rate faster, reduce airway platform pressure, shorten mechanical ventilation time of tracheal intubation and improve cure rate, but has no significant increase in which is worthy of clinical promotion.
Application of cognitive behavioral intervention based on IMB model in patients with chronic heart failure
GUO Li-li, XU Yan, YANG Xiu-mu
2020, 18(11): 1961-1965. doi: 10.16766/j.cnki.issn.1674-4152.001664
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Objective To explore the scientific methods to effectively improve the quality of life, cardiac function, negative emotions and self-care ability of patients with chronic heart failure, so as to provide basis for clinical nursing. Methods A total of 72 patients with chronic heart failure admitted to the Department of Cardiology of Suixi County Hospital, from January 2019 to March 2020, were randomly divided into control group and observation group, 36 cases in each group. The control group received routine nursing. The observation group received cognitive behavioral intervention based on information-motivation-behavioral skills(IMB) model on the basis of routine nursing. ZUNG self-rating anxiety scale(SAS), self-rating depression scale(SDS), minnesota living with heart failure questionnaire(MLWHFQ), exercise of self-care agency scale(ESCA), and 6-minute walking test were used to measure the levels of anxiety and depression, quality of life, self-care ability and heart function. Results Before the intervention, there were no significant difference in anxiety and depression score, quality of life score, self-care ability score and 6-minute walking distance between the two groups(all P>0.05). The scores of anxiety and depression in the intervention group,(36.84±6.57) and(38.00±4.66), were significantly lower than those in the control group,(43.65±7.93) and(47.10±6.39). The scores of quality of life in the intervention group(47.66±7.87)were significantly lower than those in the control group(59.39±7.63), with statistically significant significance(P<0.05). After intervention, the self-care ability score(109.53±12.29)of the observation group was higher than that of the control group( 99.41±12.51), and the 6-minute walking distance[(287.47±51.68) m] of the observation group was higher than that of the control group[(235.78±49.54)m], the difference was statistically significant(all P<0.05). Conclusion Using cognitive behavioral intervention based on IMP model can significantly improve the heart function and negative emotions of patients with chronic heart failure, improve self-care ability and quality of life, which is worthy of clinical application and family nursing promotion.
Effects of evidence-based nursing on neurological function and self-nursing ability of patients with acute cerebral infarction complicated with hypertension
ZHAO Qiu-e, LU Zhen-chan, SHEN Yi-qian, XU Jin-fen
2020, 18(11): 1966-1969. doi: 10.16766/j.cnki.issn.1674-4152.001665
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Objective Through the evidence-based method, the patients with acute cerebral infarction complicated with hypertension were given effective, scientific nursing intervention, to explore its impact on the patient's neurological function and self-care ability, and provide a feasible plan for clinical nursing. Methods A total of 104 patients with acute cerebral infarction complicated with hypertension admitted to Huzhou Central Hospital from May 2018 to October 2019 were selected as the study subjects. According to the random number table method, they were divided into control group and observation group with 52 cases respectively. Patients in the control group were given routine nursing, and patients in the observation group were given evidence-based nursing intervention on the basis of the control group. The scores of neurological function, motor function and self-care ability before and after nursing intervention were compared between the two groups, and the nursing satisfaction of the two groups was counted. Results Before nursing intervention, there was no statistically significant difference in the scores of mini-mental state examination(MMSE), activities of daily living(ADL) and exercise of self-care agency scale(ESCA) between the two groups(all P>0.05). After nursing intervention, the scores of MMSE and ADL in the observation group were(26.27±2.87) points and(62.37±4.60) points, respectively, which were higher than those in the control group [(21.45±3.41) points,(54.77±4.16) points, all P<0.05]. The nursing satisfaction of patients in the observation group was 100.0%(52/52), higher than that of the control group [84.6%(44/52), P<0.05]. Conclusion On the basis of routine treatment, evidence-based nursing can effectively improve the neurological function and motor function of patients with acute cerebral infarction complicated with hypertension, improve the self-nursing ability of patients, and improve the nursing satisfaction.
The application of risk nursing in the management of severe operation in Department of neurosurgery and its influence on the complications
CHEN Pei-fei, MOU Chao-hui, LI Yu-ling
2020, 18(11): 1970-1973. doi: 10.16766/j.cnki.issn.1674-4152.001666
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Objective To explore the effect of risk nursing in the treatment of severe craniocerebral injury by controlled step intracranial decompression. Methods A total of 92 patients with severe craniocerebral injury from March 2018 to March 2019 were randomly divided into two groups. The control group received routine nursing and the observation group received risk nursing based on the control group. The incidence of risk events, prognosis after 6 months, surgical results, complications, intracranial pressure, delirium rating scale(DRS) and NIH stroke scale(NIHSS) scores were compared between the two groups. Results The incidence of postoperative risk events in the observation group was 10.4%(5/48), which was lower than that in the control group(33.3%, 16/48), χ2=7.375, P<0.05. The good prognosis rate in the observation group was 81.3%(39/48), which was better than that in the control group(62.5%, 30/48), χ2=4.174, P<0.05. The operation time, hospitalization days and bleeding volume in the observation group were lower than those in the control group(all P<0.05). The complication rate was 6.3%(3/48), which was lower than that of the control group(20.8%, 10/48), χ2=4.360, P<0.05. The intracranial pressure, DRS and NIHSS scores of the observation group were lower than those of the control group(all P<0.05). Conclusion For patients with severe craniocerebral injury, risk nursing can reduce the incidence of risk events and complications and improve the safety of treatment. Meanwhile, intracranial pressure can be improved, DRS and NIHSS scores can be reduced, prognosis of patients can be improved, and recovery of patients can be accelerated.
LIAO Ying, GAO Yang-xu, ZHANG Qing-you, LIU Xue-qin, YAO Yong, DU Jun-bao
2020, 18(11): 1974-1978. doi: 10.16766/j.cnki.issn.1674-4152.001667
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