三种不同经外周置入中心静脉导管固定方法临床效果的比较

目的 比较3种不同的经外周静脉置人中心静脉导管(PICC)固定方法对导管固定的临床效果.方法 将120例留置PICC导管患者采用便利抽样的方法分为3组,每组各40例,分别采用缝合固定(A组)、免缝胶带交叉固定(B组)和思乐扣免缝导管固定装置固定(C组).观察并比较3组患者置管后留置期间导管固定的牢固性、并发症发生率、固定部位皮肤损伤情况及患者的满意度.结果 B组导管移位的发生率(57.5%)明显高于A组(12.5%,P=0.000)和C组(7.5%,P=0.000),导管脱出的发生率(15.0%)亦明显高于A组(0,P=0.034)和C组(0,P=0.034).导管留置期间静脉炎的发生率在B组(25.0%)明显高于A组(7.5%,P=0.034)和C组(5.0%,P=0.012);在A组中并发穿刺部位蜂窝织炎的发生率明显高于C组(20.0%比2.5%,P=0.034).A组患者出现固定翼下的皮肤压痕的发生率(37.5%)明显高于B组(5.0%,P=0.000)和C组(5.O%,P=0.000),且A组患者皮肤破损的发生率(22.5%)也高于B组(5.0%,P=0.023)和C组(0,P=0.005);各种原因所致的皮肤刺激痛在A组(52.5%)中明显增加,高于B组(0,P=0.000)和C组(2.5%,P=0.000).患者对3组不同导管固定法的满意度在A组(12.0%)显著低于B组(62.5%,P=0.000)和C组(90.0%,P=0.000),且C组满意度最高,明显高于B组(P=0.004).结论 思乐扣免缝导管固定装置固定法可以作为胶带和缝合固定的替代,具有等同于缝合法对导管的固定作用,预防了导管移位、脱出等导管相关并发症,同时也避免了缝合固定造成的皮肤损伤.

Abstract：

Objecfive To compare the clinical effectiveness of three different fixation methods for peripherally inserted central catheter(PICC).Methods Totally 120 patients requiting PICCs were randomized into suture securement group(group A),tape securement group(group B),and sutureless adhesive-hacked device (StatIock)securement group(group C),with 40 patients in each group.Patients were followed up throughout their entire catheter course,and the securement effectiveness,catheter-related complications,risk of skin injury,and patients'satisfaction were observed.Results The rate of catheter migration without function loss in group B (57.5%)was significantly higherthan in group A(12.5%,P=0.000)and in group C(7.5%,P=0.000).Catheter dislodgment rate in group B(15.0%)was also significantly higher than group A(0,P=0.034)and group C(0,JP=0.034).Phlebitis documented during their catheter course in group B(25.0%)were more than in group A(7.5%,P=0.034)and in group C(5.0%,P=0.012).In addition,the rate of cellulitis in group A was significantly higher than group C(20.0%vs.2.5%,P=0.034).The rate of skin injury in group A 0.005).Nearly half of patients in group A (52.5%)complained irritation and/or pain at the sucure site,which was significantly higher than in other two groups ( both P = 0.000 ).The patients' satisfaction rate was significantly lower in group A (12.0% ) than in the other two groups ( both P = 0.000), documented highest in group C (90.0%) (group C vs.group B, P = 0.004).Conclusions The availability of sutureless adhesive-backed de vice StatLock provides an alternative for securement of PICCs.It performs as well as suture securement in catheterfixing.Meanwhile, it can prevent catheter-related complications such as migration and dislodgment Furthermore, it avoids skin injuries during catheter fixation or securement.     

新疆地区两种循证医学教学方案效果的对比研究

Objective We compared the new teaching curriculum of evidence-based medicine (EBM) with the traditional one to explore a more effective one of EBM and provide reference for the popularization of EBM in Xinjiang.Methods From the fourteen regions in Xinjiang,we selected randomly four regions,and the trainees of the four regions were allocated randomly to the experimental group (169) and the control group (167).The new teaching curriculum was used in the experimental group and the raditional one in the control group.After training,we investigated all the trainees with questionnaires and compared the differences of the two groups.Results Compared with the control group,trainees of the experimental group were significantly enhanced in the abilities of cognition (χ2 =6.870,P=0.009),literature retrieval (χ2 =22.670,P=0.000),communication (χ2 =6.288,P =0.012)and scientific research (χ2=4.667,P = 0.031).However,the difference in the ability of diagnosis and treatment (χ2 =0.663,P=0.426) was not significant.On the other hand,the total examinational scores and the scores for the chapters of general introduction,etiological factor,diagnosis and system review of the experimental group were significantly higher than those of the control group,but there was not significant difference between the two groups in terms of the scores for the chapters of treatment and prognosis.Conclusion The new teaching curriculum of EBM is beneficial in developing the abilities of cognition,literature retrieval,communication,scientific research and apprehension of EBM theory and is more applicable for the popularization of EBM in Xinjiang.     

新疆地区两种循证医学教学方案效果的对比研究

Objective We compared the new teaching curriculum of evidence-based medicine (EBM) with the traditional one to explore a more effective one of EBM and provide reference for the popularization of EBM in Xinjiang.Methods From the fourteen regions in Xinjiang,we selected randomly four regions,and the trainees of the four regions were allocated randomly to the experimental group (169) and the control group (167).The new teaching curriculum was used in the experimental group and the raditional one in the control group.After training,we investigated all the trainees with questionnaires and compared the differences of the two groups.Results Compared with the control group,trainees of the experimental group were significantly enhanced in the abilities of cognition (χ2 =6.870,P=0.009),literature retrieval (χ2 =22.670,P=0.000),communication (χ2 =6.288,P =0.012)and scientific research (χ2=4.667,P = 0.031).However,the difference in the ability of diagnosis and treatment (χ2 =0.663,P=0.426) was not significant.On the other hand,the total examinational scores and the scores for the chapters of general introduction,etiological factor,diagnosis and system review of the experimental group were significantly higher than those of the control group,but there was not significant difference between the two groups in terms of the scores for the chapters of treatment and prognosis.Conclusion The new teaching curriculum of EBM is beneficial in developing the abilities of cognition,literature retrieval,communication,scientific research and apprehension of EBM theory and is more applicable for the popularization of EBM in Xinjiang.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

自我管理教育对经外周静脉置入中心静脉导管置管患者的影响

目的 探讨自我管理教育对经外周静脉置人中心静脉导管(PICC)患者的自我管理能力和自我效能的影响.方法 60例PICC置管患者按随机数字表随机分配进入自我管理教育组(n=32)与常规护理组(n=28),分别进行6个月的自我管理教育及常规的置管后护理,比较两组患者在体现自我管理能力的自我管理行为、健康状况、导管功能、卫生服务利用率方面及自我效能水平的差别.结果 与常规护理组相比较,自我管理教育组患者自我管理能力中除与护士交流评分(P=0.618)、健康状况总分(P=0.083)及疼痛评分(P=0.069)外,其余各项指标差异均有统计学意义(P均<0.05),且并发症发生率明显降低(P=0.038),自我效能水平明显提高(P=0.012).结论 自我管理教育可以提高PICC置管患者的自我管理能力和自我效能,从而降低并发症的发生率,是导管有效利用、改善患者健康状况的有效方法.

Abstract：

Objective To investigate the influence of self-management education(SME)on the selfmanagement ability and self-efficacy of patients with peripherally inserted central catheters(PICC).Methods Sixty patients with PICC were randomly divided into SME group(n=32)and control group(n=28).Patients in the SME group took SME and the control group received routine nursing;both lasted six months.The self-management ability(including self-management action,health status,catheter function,utility of health service)and selfefficacy were compared between these two groups.Results Except the scores of communication with the nurse (P=0.618),health status(P=0.083),and pain(P=0.069),the other indicators of self-management ability in the SME group had significantly higher scores than those in control group(all P<0.05).The incidence of complications was significantly lower(P=0.038)and the self-efficacy was significantly higher in SME group(P=0.012).Conclusion SME can improve the self-management ability and self-efficacy and prevent the catheter-related complications in patients with PICC.     

依托咪酯与普鲁泊福在困难气管纤维支气管镜引导插管时安全性比较

Objective To investigate the risk factors and anticoagulation parameters in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with deep venous thrombosis (DVT). Methods All of 110 AECOPD patients were divided into two groups according to Doppler examination of lower extremities: DVT group and non-DVT group. The risk factors and anticoagulation parameters were compared. Results Twelve cases (10.9%) were in DVT group,of whom 2 cases (1.8%)had pulmonary embolism. The rate of lying in bed > 3 d, smoke, mechanical ventilation, hospital stays and the levels of PaCO2 were significantly higher in DVT group than those in non-DVT group (P < 0.01 or <0.05 ). In DVT group, the activity of antithrombin Ⅲ and the level of protein S decreased (P < 0.05 ), and the level of D-Dimer increased (P < 0.05). Conclusions Long-term bed, smoke and mechanical ventilation requirement are the main risk factors of DVT in patients with AECOPD. Respiratory failure (type Ⅱ ) is easier to combine with DVT. Abnormality of coagulation and fibrinolytic system exists in AECOPD with DVT.     

慢性阻塞性肺疾病急性加重期合并深静脉血栓形成危险因素及抗凝因子检测

Objective To investigate the risk factors and anticoagulation parameters in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with deep venous thrombosis (DVT). Methods All of 110 AECOPD patients were divided into two groups according to Doppler examination of lower extremities: DVT group and non-DVT group. The risk factors and anticoagulation parameters were compared. Results Twelve cases (10.9%) were in DVT group,of whom 2 cases (1.8%)had pulmonary embolism. The rate of lying in bed > 3 d, smoke, mechanical ventilation, hospital stays and the levels of PaCO2 were significantly higher in DVT group than those in non-DVT group (P < 0.01 or <0.05 ). In DVT group, the activity of antithrombin Ⅲ and the level of protein S decreased (P < 0.05 ), and the level of D-Dimer increased (P < 0.05). Conclusions Long-term bed, smoke and mechanical ventilation requirement are the main risk factors of DVT in patients with AECOPD. Respiratory failure (type Ⅱ ) is easier to combine with DVT. Abnormality of coagulation and fibrinolytic system exists in AECOPD with DVT.     

经静脉和动脉不同途径新辅助化疗治疗局部晚期宫颈癌的疗效对比分析

目的 对比分析静脉和动脉不同给药途径新辅助化疗治疗局部晚期宫颈癌(LACC)的临床疗效和不良反应.方法 对宫颈肿瘤直径≥4 cm、国际妇产科联盟(FIGO)分期Ⅰ B～ⅡB期的LACC患者分别采用静脉途径化疗(静脉组,36例)和动脉途径化疗(动脉组,34例),观察并比较其化疗效果、不良反应等.结果 两组患者54例获得近期部分缓解,总有效率为77.1%(54/70),其中静脉组为72.2%(26/36),动脉组为82.4%(28/34),两组比较差异无统计学意义(P＞0.05).静脉组发生的胃肠道反应、骨髓抑制的总疗程数(43、32个)明显多于动脉组(23、17个)(P＜0.01).结论 不同途径新辅助化疗治疗LACC的近期疗效相当,静脉给药操作简单,但不良反应相对较大,有条件时以选择动脉途径新辅助化疗治疗为好.

Abstract：

Objective To compare the efficacy and toxicity of neoadjuvant chemotherapy with venous and arterial way in patients with locally advanced cervical cancer( LACC ). Methods A retrospective study was carried out on 70 patients suffering from tumor diameter≥4 cm and FIGO stage Ⅰ B- Ⅱ B disease of LACC. Among 70 patients, 36 were given venous chemotherapy ( venous group ) and 34 were given arterial interventional chemotherapy(arterial group). All patients received platinum-based neoadjuvant chemotherapy.The therapeutic toxic and adverse effects of the two groups were analyzed and compared. Results Clinical response to neoadjuvant chemotherapy occurred in 54 patients with a total effective rate of 77.1% (54/70),that of venous group was 72.2% (26/36) and that of arterial group was 82.4% (28/34),there was no significant difference between two groups (P ＞ 0.05 ). The number of the occurrence of gastrointestinal tract reaction and bone marrow depression in venous group (43,32 pieces) was more than that in arterial group (23,17 pieces)(P ＜ 0.01 ). Conclusion The results suggest that the therapeutic effects of venous and arterial interventional chemotherapy be similar,but the adverse effects of venous chemotherapy is more serious than that of arterial interventional chemotherapy.     

血液灌流结合连续性静脉-静脉血液滤过对急性百草枯中毒疗效的研究

目的 探讨血液灌流(hemoperfusion,HP)结合连续性静脉-静脉血液滤过(continuous venovenous hemofiltration,CVVH)对于急性百草枯中毒患者的疗效.方法 急性百草枯中毒患者91例随机分成HP组(49例)和HP后给予CVVH治疗组(HP-CVVH组,42例),比较两组患者的病死率、存活时间和死亡原因.结果 HP组病死率为59.2%(29/49),HP-CVVH组为61.9%(26/42),两组比较,差异无统计学意义(χ2=0.070,P=0.791).HP-CVVH组患者中毒至死亡时间为(4.9±3.1)d,明显长于HP组[(3.5±2.0)d],差异有统计学意义(t=2.026,P=0.049).HP组和HP-CVVH组中毒后4 d内死亡构成比分别为62.1%(18/29)和30.8%(8/26),HP组和HP-CVVH组中毒至死亡＞4 d的构成比分别为37.9%(11/29)和69.2%(18/26),差异有统计学意义(χ2=5.388,P=0.020).HP-CVVH组患者出现中毒至低氧血症时间为(4.3±2.5)d,明显长于HP组[(3.2±1.9)d],差异有统计学意义(t=2.033,P=0.047).HP组呼吸衰竭导致死亡的发生率为20.4%(10/49),明显低于HP-CVVH组(40.5%,17/42),差异有统计学意义(χ2=4.365,P=0.037);HP组患者急性肾衰竭的发生率为63.3%(31/49),明显高于HP-CVVH组(40.5%,17/42),差异有统计学意义(χ2=4.712,P=0.030).结论 HP结合CVVH可减少急性百草枯中毒的早期死亡,延长病死患者的存活时间,降低急性肾衰竭的发生率,但无法降低总体病死率.

Abstract：

Objective To explore the therapic effects of hemoperfusion (HP) with continuous venovenous hemofiltration (CVVH) on the patients with acute paraquat poisoning. Methods Nighty-one patients with acute paraquat poisoning were randomly divided into HP group (49 cases) and HP-CVVH group(42 cases). The mortality, survival duration and the death causes between the two groups were compared and analyzed. Results There were no significant differences in mortality (59.2% versus 61.9%) between the two groups. The mean time between poisoning and death in HP-CVVH group was (4.9±3.1) days, which was significantly longer than that (3.5 ±2.0) days in HP group (P＜0.05).The death proportion on 4th day after poisoning in HP group was 62.1%(18/29), which was significantly higher than that (30.8%, 8/26) in HPCVVH group (P＜0.05). The hypoxia appeared in 4.3±2.5 days after poisoning in HP-CVVH group, which was significantly longer than that (3.2±1.9) days in HP group (P＜0.05). The mortality due to respiratory failure in HP group was 20.4%(10/49),which was significantly lower than that (40.5%, 17/42) in HP-CVVH group (P＜0.05). The incidence of acute renal failure in HP group was 63.3%(31/49), which was significantly higher than that (40.5%,17/42) in HP-CVYH group (P＜0.05). Conclusion The combined therapy of HP and CVVH can prevent the patients with acute paraquat poisoning from early death and prolong the survival duration, but can not reduce mortality for the patients with acute paraquat poisoning.     

骨牵引和DHS治疗老年股骨粗隆骨间骨折的临床比较研究

Objective The purpose of this study is to observe the difference of the six-month mortality,complications and function recovery between the skeletal traction group and DHS group.Methods This retrospective study was undergone in the department of orthopaedics of Longhua hospital.According to the methods of tareatment,87 cases were divided into two groups:skeletal traction group and DHS group.To comapare the rate of six-month moaality,general complications(which include pulmonary infeetion,bed-sore,minary infection and deep venous thrombosis)and coxa yams between the two groups,while the Harris hip score in the third month and sixth month after injury were also compared.Reuslt ①About the rate of six-month momdity,there was one case(2.27%) in the skeletal traction group,and one ease also(2.33%) in the DHS group,there was no difference between the two groups.(P=1.0) ②About the rate of general complications,there were 15 cases(34.09%) in the skeletal traction group,and 14 cases(32.56%) in the DHS group,there was no difference between the two groups.(P=0.879) ③About the rate of coxa varus,there were seven eases (16.28%) in the skeletal traction group,and one ease(2.38%)in the DHS group,there was no difference between the two groups.(P=0.068).But for the unstable intertrochantefic fractures,there were seven cases out of 29(24.14%)in the skeletal traction group,and one case out of 31 (3.23%),these showed that the rate of coxa yams is higher in the skeletal traction group than in the DHS group.(P=0.045) ④In the third month after injury,the Harris hip score was 52.99±4.86 in the skeletal traction group,and 65.87±3.39 in the DHS group,these showed that the Harris hip score is higher in the DHS group than in the skeletal traction group(P<0.0001).While in the sixth month after injury,the Harris hip score was 84.44±5.79 in the skeletal traction group,and 85.69±4.07 in the DHS group,these showed that there was no difference between the two groups(P=0.254).Conclusion ① A low mortality and complications morbidity could be found in the treatment of intearochanteric fractures in aged patients by the skeletal traction associated with careful nursing.②For the unstable fratures,compared to the DHS fLxation the conservative method may get higher rate of the coxa varus.③Although the operative fixation is the first choice for the treatment of the intertreehanterie fractures in aged patients,the skeletal traction method are not to be out of date thoroughly.     

对医院护理管理队伍建设的几点思考

文章分析了当前医院护理管理队伍存在的主要问题：知识结构不合理；专业思想不纯正；接受继续教育不足：工作效能低下。提出了建设高素质护理管理人才队伍的思路：严格标准，搞好选才；加强思想教育和引导；加大培养力度；建立科学考评和激励机制；完善人才合理流动措施；合理编制，突出效率。     

医学科技成果信息资源网络开放利用的原则探析

医学科技成果信息资源网络开放利用，为资源的开放共享创造了良好条件，它使医学科技信息得到了高效传播和最大利用。网络开放利用医学科技成果信息资源，利用的主体和核心是其信息内容。信息内容是网络用户从中提取知识和所需资料的主要来源，同时也是信息破坏者发动攻击的主要目标之一，因而，信息内容的安全是信息安全的基本问题，主要包括信息内容的规范性、完整性与真实性、知识产权保护与利用的合理性等。要做好这些工作，应该遵循相应的原则和要求。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

转基因食品产业化的风险防范及制度构建

风险防范机制的缺失是阻碍转基因食品产业发展的因素之一。基于转基因食品产业对人类健康、物种进化和生态环境的负面影响，及时有效地构建风险防范机制十分必要。我国既有的转基因食品产业风险防范机制存在诸多缺陷：未形成转基因食品全程跟踪制度及安全事故应急处理制度，在安全性评价制度及法律责任体系等方面也有待进一步完善。     

中医药干预治疗不同程度产后抑郁临床研究

目的 观察中药干预不同程度产后抑郁症患者的临床疗效.方法 选择90例产后抑郁症患者,随机平均分为干预组和对照组,每组中又平均各自分为轻度、中度、重度3组.干预组在基础治疗上加中药干预治疗,对照组只进行基础治疗.结果 两组轻度产后抑郁症患者均100％痊愈;中度产后抑郁症患者,痊愈率和有效率差异无统计学意义(P＞0.05);重度产后抑郁症患者中,干预组的痊愈率和有效率均显著高于对照组(P＜0.05).结论 中药干预重度产后抑郁症患者具有一定的疗效.