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多系统萎缩高血压伴直立性低血压患者的护理

目的　总结多系统萎缩高血压伴直立性低血压患者的护理干预措施。 方法　对2009年5月－2012年5月收治的20例多系统萎缩高血压伴直立性低血压患者，根据临床特点分别从用药指导、安全管理、并发症预防等多方面予以针对性护理干预。 结果　20例患者头晕等不适症状得到不同程度缓解，且无跌伤坠床等意外事件、呼吸道、泌尿道感染和压疮等并发症发生。 结论　积极的综合措施及个体化的护理对策，可提高患者的生存质量。

帕金森病合并痛风致关节溃疡护理一例

神经棘红细胞增多症患者护理一例

肺部结节管理策略研究进展

以眼底病变为首发症状的Revesz综合征1例

Effects of Cardioselective Beta-Blockers on Respiratory Function in COPD Patients:A Meta-Analysis

Objective To evaluate the effects of cardioselective beta-blockers on respiratory function in patients with chronic obstructive pulmonary disease ( COPD) . Methods We used computer to search the Cochrane Controlled Trials Register database, Medline, Netherlands EMBASE/Excerpta Medica,EBSCO database, China Academic Journal and the Chinese Biomedical Literature Database, as well as respiratory magazines and conference abstracts, without language restrictions. The information was retrieved until December 2011. We collected all the randomized, blinded, controlled clinical trails ( RCTs ) of cardioselective beta-blockers on respiratory function in patients with COPD. Then two evaluators evaluated the quality of RCTs according to the Cochrane Review Manual 4. 2 independently. Meta-analysis was performed using statistical software Stata 11. 0. X2 test was used to analyze their heterogeneity. Standardizedmean difference ( SMD) was used to describe continuous variables. Relative risk degree ( RR) was used to describe categorical variables, and 95% CI was used to describe treatment effect. Results 22 trails met the selection criteria. Meta-analysis showed no change of FEV1 in COPD patients after taking single dose of cardioselective beta-blockers [ SMD - 0. 367, 95% CI( - 0. 786, 0. 052) ] and no respiratory symptoms aggravation [ RR1. 000, 95% CI( 0. 848, 1. 179) ] . Meta-analysis also showed no change of FEV1 in COPD patients who received long-term cardioselective beta-blockers treatment [ SMD - 0. 236, 95% CI( - 0. 523,0.051) ] , and no respiratory symptoms aggravation [ RR 1. 000, 95% CI ( 0. 830, 1. 205) ] . Inhaled beta-2 agonists showed no effect on FEV1 in COPD patients after either long-term administration [ SMD - 0. 200,95% CI( - 0. 586, 0. 187) ] or single dose administration of cardioselective beta-blockers [ SMD - 0. 078,95% CI( - 0. 654, 0. 497) ] . Conclusion Cardioselective beta-blockers, given to patients with COPD in conditions such as heart failure, coronary artery disease and hypertension in the identified studies did not produce adverse respiratory effects.

Establishing Long-term Mechanism of Cross-inspection to Promote Continuous Quality Improvement of Hospital-acquired Infection Management

ObjectiveTo explore the supervision and inspection mechanism of hospital-acquired infection management at hospital-level in order to promote continuous quality improvement of hospital-acquired infection control. MethodsInstead of inspecting hospital departments only by hospital infection control professionals, the clinical hospital infection control nurses were also involved in the two cross-inspections carried out respectively in September and December, 2013, which shared the same contents, methods, and the inspectors. According to standard procedures, on-site view and inquiry methods were adopted to check the implementation of the system and measures and the infection control knowledge among medical staff. Inspection results were written down to feed back to each department with a unified form. The problems found during the two inspections were classified to be analyzed and solved. The results of the two inspections were compared to understand whether the effect of continuous quality improvement can be achieved through cross-inspections and subsequent work. ResultsThe excellent rate of department and overall accuracy rate of the second inspection increased with statistical significance compared to that of the first inspection (χ2=619.902, P=0.000; χ2=40.347, P=0.000). Meanwhile, the correct rate of each module and infection control knowledge among all kinds of medical staff also increased compared with the first inspection with statistically significant differences (P<0.05). ConclusionLong-term mechanism of cross-inspection involving hospital infection control nurses should be established to facilitate the continuous quality improvement of hospital-acquired infection management.

安全注射的现状及管理对策

注射是医疗、预防、保健服务中最常使用的技术手段，而不安全注射已成为严重的公共卫生安全问题，在发展中国家尤为突出。不安全注射主要与缺乏安全注射的意识和知识、缺乏有效的方法和设备、经济利益趋势导致注射滥用以及缺乏安全注射监管体系等密切相关。安全注射不仅是医院感染防控和医务人员职业安全保障的基本措施，也体现了医疗卫生保健机构的整体管理水平和医疗质量。安全注射的管理是系统工程，涉及到国家政策和法规、教育培训、产品和技术改进及监督管理等方面，应积极采取有效措施推动和促进我国安全注射质量的持续改进，保障注射安全。

Research on Application of PDCA Cycle in Standardized Medical Waste Management

ObjectiveTo explore medical waste management method in a large hospital and strengthen the standardized management of medical waste. MethodsBetween July 2012 and December 2014, according to the PDCA cycle working procedures, existing problems were found in medical waste management through survey, the cause of which was analyzed to formulate and implement a new system of medical waste management, to help carry out employee training and cross examination, and give feedback to clinical departments to make improvements. Then, we analyzed the awareness rate of medical waste-related knowledge among medical staff, accuracy rate of medical waste disposal, average daily medical waste amount before and after the application of PDCA cycle to evaluate the effect of the measures taken. ResultsAwareness rate of medical waste-related knowledge among medical staff (2012:55.59%, 2013:62.89%, 2014:94.43%) increased with statistical significance (χ2=410.871, P<0.001). Accuracy rate of medical waste disposal (2012:69.83%, 2013:87.29%, 2014:94.91%) increased with statistical significance (χ2=197.449, P<0.001). Rank correlation analysis showed that average daily medical waste amount declined as average daily inpatients number increased (rs=?0.590, P<0.001). ConclusionUsing PDCA cycle can improve the awareness rate of medical waste-related knowledge and accuracy among medical staff to achieve continuous quality improvement of medical waste management.

原发性肺肉瘤30例临床分析

目的研究原发性肺肉瘤的临床表现、影像学诊断、病理学诊断和治疗,提高临床医生对肺肉瘤的诊治水平。 方法分析我院2005年3月至2015年1月间经病理诊断的30例肺肉瘤患者,其中男18例,女12例;平均年龄(55.6±10.2)岁,发病年龄40~75岁;初诊症状为咳嗽、咳痰10例, 咯血2例,胸痛9例,胸闷、气促8例,体检意外发现1例。 结果30例患者均表现为孤立性占位病变。其中,28例行手术治疗,2例行非手术治疗。手术治疗的28例中,右肺上叶切除12例,右肺中、下叶切除2例,右肺下叶切除4例,左肺上叶切除5例,左肺上叶部分切除2例,左肺下叶切除2例, 左胸膜全肺切除1例。免疫组织化学检查结果为波形蛋白阳性24例,结蛋白阳性20例。病理类型:恶性纤维组织细胞瘤9例,滑膜肉瘤7例,脂肪肉瘤5例,平滑肌肉瘤3例,横纹肌肉瘤3例,软骨肉瘤2例,胸膜肺母细胞瘤1例。2例平滑肌肉瘤及1例横纹肌肉瘤患者存活超过5年。全组患者1年生存率为40%,5年生存率为10%。 结论原发性肺肉瘤主要表现为孤立性占位病变,其波形蛋白、结蛋白免疫组织化学检查可呈阳性。外科治疗为首选治疗方式,但预后差。其预后与肿瘤组织学类型、大小和位置有关。