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中国实用医刊
中国实用医刊

秦省

半月刊

1674-4756

zgsyyk@163.com

0371-65920096

450003

河南省郑州市经三路七号

中国实用医刊/Journal Chinese Journal of Practical Medicine
查看更多>>1974年1月创刊，中华人民共和国卫生部主管，中华医学会主办。本刊原名《中原医刊》，中国期刊全文数据库全文收录期刊、中国学术期刊综合评价数据库统计刊源期刊、中国核心期刊（遴选）数据库收录期刊、万方数据-数字化期刊群收录期刊。重点报道内、外、妇、儿等学科进展，以及新理论、新成果等。设有论著、临床实践、经验交流、临床研究、药物与临床、综述、误诊分析等栏目。
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    高流量鼻导管给氧与传统面罩给氧在重体质量COPD患者中的应用效果比较

    王秋颖孙瑜霞刘小敏
    41-44页
    查看更多>>摘要：目的 比较高流量鼻导管给氧与传统面罩给氧在重体质量慢性阻塞性肺疾病(COPD)患者治疗中的应用效果。 方法 前瞻性队列研究。抽取2020年6月至2023年3月河南科技大学第一附属医院收治的重体质量COPD患者76例作为研究对象，按照随机数字表法将患者分为面罩组与鼻导管组，每组38例。面罩组应用传统面罩给氧，鼻导管组应用高流量鼻导管给氧。比较两组的血氧指标、治疗效果及并发症发生率。 结果 治疗后，鼻导管组动脉血氧饱和度、动脉血氧分压、氧合指数均高于面罩组(P均<0.05)，鼻导管组动脉血二氧化碳分压低于面罩组(P<0.05)。鼻导管组总有效率(97.37%，37/38)高于面罩组(81.58%，31/38)，P<0.05。鼻导管组并发症发生率(10.53%，4/38)低于面罩组(28.95%，11/38)，P<0.05。 结论 重体质量COPD患者治疗中应用高流量鼻导管给氧治疗的有效性和安全性均高于传统面罩给氧，可促进患者血氧恢复正常。 Objective To compare the clinical effects of high-flow nasal cannula oxygen delivery and conventional mask oxygenation in the treatment of chronic obstructive pulmonary disease (COPD) patients with heavy body mass. Methods This study was a prospective cohort study. Seventy-six COPD patients with heavy body mass admitted to the First Affiliated Hospital of Henan University of Science and Technology from June 2020 to March 2023 were selected as the study subjects. They were divided into the mask group and the nasal catheter group using a random number table method, with 38 cases in each group. The mask group was given conventional mask oxygenation, while the nasal catheter group was given high-flow nasal cannula oxygen delivery. The blood oxygen indexes, therapeutic effects and incidence of complications of the two groups were compared. Results After treatment, the arterial oxygen saturation, arterial partial pressure of oxygen and oxygenation index of the nasal catheter group were higher than those of the mask group (all P<0.05) while arterial partial pressure of carbon dioxide of the the nasal catheter group was lower than that of the mask group (P<0.05). The total effective rate in the nasal catheter group was 97.37% (37/38), higher than the 81.58% (31/38) in the mask group (P<0.05). The incidence of complications in the nasal catheter group (10.53%, 4/38) was lower than that in the mask group (28.95%, 11/38),P<0.05. Conclusions Application of high-flow nasal cannula oxygen therapy in the treatment of COPD patients with heavy body mass is more effective and safer compared with traditional mask oxygenation. It can promote the normalization of blood oxygenation.

    慢性阻塞性肺疾病高流量鼻导管给氧传统面罩给氧重体质量

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    瑞芬太尼靶控输注与舒芬太尼靶控输注在老年胃癌患者腹腔镜胃癌根治术中的麻醉效果比较

    温泉张军叶园园马文娟...
    45-48页
    查看更多>>摘要：目的 比较瑞芬太尼靶控输注与舒芬太尼靶控输注在老年胃癌患者腹腔镜胃癌根治术(LRG)中的麻醉效果。 方法 随机对照研究。抽取2017年5月至2020年4月于南阳市中心医院行LRG的老年胃癌患者96例，按照随机数字表法分为对照组与观察组，每组48例。对照组采用瑞芬太尼靶控输注麻醉，观察组采用舒芬太尼靶控输注麻醉。比较两组麻醉恢复情况，比较两组麻醉前(T0)、麻醉诱导后(T1)、麻醉结束时(T2)及麻醉后24 h(T3)的血流动力学指标[心率、平均动脉压(MAP)]、应激反应指标[皮质醇(COR)、谷氨酰胺(GLU)]，比较两组不良反应发生率。 结果 观察组苏醒时间、拔管时间短于对照组(P<0.05)。T1、T2时，观察组心率低于对照组、MAP水平高于对照组，且观察组心率、MAP水平变化幅度小于对照组(P<0.05)。T1、T2、T3时，观察组COR、GLU水平低于对照组，且COR、GLU水平变化幅度小于对照组(P<0.05)。观察组不良反应发生率(4.17%，2/48)低于对照组(18.75%，9/48)，P<0.05。 结论 与瑞芬太尼相比，舒芬太尼靶控输注在老年胃癌患者LRG中的效果更好，能缩短患者苏醒时间和拔管时间，稳定血流动力学，且不会使患者产生明显的应激反应，用药安全性较高。 Objective To compare the anesthesia effects of target-controlled infusion of remifentanil and target-controlled infusion of sufentanil in laparoscopic radical gastrectomy (LRG) for gastric cancer in elderly patients. Methods A total of 96 elderly gastric cancer patients who underwent LRG in Nanyang Central Hospital from May 2017 to April 2020 were selected for the randomized controlled study. And they were divided into a control group and an observation group using a random number table method, with 48 cases in each group. The control group received target-controlled infusion of remifentanil for anesthesia, and the observation group received target-controlled infusion of sufentanil for anesthesia. The recovery of anesthesia of the two groups were compared. The hemodynamic indexes, including heart rate and mean arterial pressure (MAP), stress response indexes, including cortisol (COR) and glutamine (GLU), before anesthesia (T0), after anesthesia induction (T1), at the end of anesthesia (T2) and 24 hours after anesthesia (T3) were compared between the two groups. The incidence of adverse reactions of the two groups were compared. Results The recovery time and extubation time of the observation group were shorter than those of the control group (P<0.05). At T1 and T2, the observation group had lower heart rate and higher level of MAP, compared with the control group (P<0.05) while the amplitude of changes in heart rate and MAP level in the observation group were smaller than those in the control group (P<0.05). At T1, T2, and T3, the observation group had lower levels of COR and GLU compared with the control group, and the changes in levels of COR and GLU in the observation group at T1, T2 and T3 were smaller than those in the control group (P<0.05). The incidence of adverse reactions in the observation group (4.17%, 2/48) was lower than that in the control group (18.75%, 9/48),P<0.05. Conclusions Compared with remifentanil, target-controlled infusion of sufentanil has a better anesthesia effect in LRG for gastric cancer in elderly patients. It can shorten the recovery time and extubation time, stabilize hemodynamics, and do not cause significant stress response in patients, with higher safety.

    舒芬太尼瑞芬太尼胃癌根治术靶控输注

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    iRoot SP配合单尖法根管充填治疗牙体牙髓病的临床观察

    段珂崔璐王贝马艳丽...
    49-52页
    查看更多>>摘要：目的 探讨iRoot SP配合单尖法根管充填治疗牙体牙髓病的临床效果。 方法 抽取2021年5月至2022年11月郑州大学第一附属医院收治的牙体牙髓病患者94例，依据随机数字表法分为对照组和观察组，每组47例。对照组采用iRoot SP配合冷侧压法根管充填治疗，观察组采用iRoot SP配合单尖法根管充填治疗。比较两组治疗效果、治疗后牙周指标[探诊深度(PD)、探诊出血指数(PBI)、菌斑指数(PLI)]、龈沟液炎症因子[肿瘤坏死因子－α(TNF－α)、C反应蛋白(CRP)、白细胞介素－1β(IL－1β)]水平、视觉模拟评分法(VAS)评分。 结果 观察组总有效率(97.87%，46/47)高于对照组(80.85%，38/47)，差异有统计学意义(P<0.05)。治疗后，观察组PD、PBI、PLI低于对照组，TNF－α、CRP、IL－1β水平低于对照组，VAS评分低于对照组，差异有统计学意义(P<0.05)。 结论 牙体牙髓病应用iRoot SP配合单尖法根管充填治疗效果显著，能改善牙周指标，减轻龈沟液炎症，缓解疼痛症状。 Objective To observe the clinical effect of iRoot SP combined with single cone obturation in the treatment of endodontic diseases. Methods A total of 94 patients with endodontic disease admitted to the First Affiliated Hospital of Zhengzhou University from May 2021 to November 2022 were selected, and they were divided into control group and observation group by random number table method, with 47 cases in each group. The control group was treated by iRoot SP combined with cold lateral pressure root canal filling, and the observation group was treated by iRoot SP combined with single cone obturation. The treatment effect, postoperative periodontal indexes, including probing depth (PD), probing bleeding index (PBI) and plaque index (PLI), levels of inflammatory factors in gingival crevicular fluid, including tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and interleukin-1β (IL-1β), and visual analogue scale (VAS) score were compared between the two groups. Results The total effective rate of the observation group (97.87%, 46/47) was higher than that of the control group (80.85%, 38/47), and the difference was statistically significant (P<0.05). After treatment, the observation group had lower levels of PD, PBI, PLI, TNF-α, CRP and IL-1β compared with the control group (P<0.05), and the VAS score in the observation group was lower (P<0.05). Conclusions iRoot SP combined with single cone obturation has obvious effects in the treatment of endodontics, which can improve periodontal indexes, reduce levels of inflammation factors in gingival crevicular fluid, and relieve pain symptoms.

    牙体牙髓病根管充填单尖法牙周指标

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    老年股骨转子间骨折患者围术期低钠血症发生现状及影响因素分析

    田月玲孙海东闫莹莹魏旭洋...
    53-56页
    查看更多>>摘要：目的 探讨老年股骨转子间骨折患者围术期低钠血症的发生现状及影响因素。 方法 前瞻性队列研究。抽取2021年2月至2023年2月郑州大学附属郑州中心医院骨科接受手术治疗的老年股骨转子间骨折120例患者作为研究对象，围术期监测所有患者血钠浓度，术前、术后根据患者的血钠浓度判定其低钠血症发生情况，血钠浓度<135 mmol/L视为低钠血症，将发生低钠血症者纳入发生组，未发生者纳入未发生组。自制资料调查问卷，调查患者基本情况，记录实验室相关检查重要指标(为术前检查结果)，分析围术期老年股骨转子间骨折患者发生低钠血症的影响因素。 结果 120例老年股骨转子间骨折患者术前血钠浓度均>135 mmol/L，接受手术治疗后发生低钠血症者30例(25.00%，30/120)；初步经卡方与独立样本t检验比较发生与未发生低钠血症患者的资料与实验室指标，结果显示，发生组与未发生组术前白蛋白、血尿素氮、血清肌酐水平和氯离子浓度比较差异有统计学意义(P<0.05)，组间其他资料比较差异有统计学意义(P>0.05)；Logistic回归分结果显示，老年股骨转子间骨折患者术前白蛋白水平、血尿素氮、血清肌酐水平异常过表达是围术期低钠血症发生的影响因素，其中白蛋白异常升高是其保护因素(OR<1，P<0.05)，血尿素氮、血清肌酐水平异常过表达是其危险因素(OR>1，P<0.05)。 结论 老年股骨转子间骨折患者围术期间低钠血症发生风险较高，且多在术后发生，可能与患者术前白蛋白、血尿素氮、血清肌酐水平有关。 Objective To investigate the current status and influencing factors of perioperative hyponatremia in elderly patients with intertrochanteric fractures of the femur. Methods This study was prospective cohort trail. A tota of 120 elderly patients with intertrochanteric fractures of the femur who received surgical treatment in the Department of Orthopaedics of Zhengzhou Central Hospital Affiliated to Zhengzhou University from February 2021 to February 2023 were selected as the research objects. The serum sodium concentration of the patients was monitored during the perioperative period. The occurrence of hyponatremia was determined according to the serum sodium concentration before and after the operation. The patients with serum sodium concentration<135 mmol/L were diagnosed with hyponatremia, which were included in the occurrence group, and patients without hyponatremia were included in the non-occurrence group. A self-made data survey questionnaire was designed to investigate the basic situation of patients and record important laboratory examination indicators (preoperative examination results). The influencing factors of hyponatremia in elderly patients with intertrochanteric fractures of the femur during the perioperative period were analyzed. Results The preoperative level of serum sodium concentration in the 120 elderly patients with intertrochanteric fractures of the femur were all >135 mmol/L. Thirty patients (25.00%, 30/120) developed hyponatremia after surgery. The results of preliminarily chi square and independent sample t test for comparison of the data and laboratory indicators between patients with and without hyponatremia showed that there were significant differences in preoperative levels of albumin, blood urea nitrogen, serum creatinine and chloride ion concentration between the occurrence group and the non-occurrence group (P<0.05), and there were no differences in other data between the two groups (P>0.05). Results of logistic regression analysis showed that the abnormal overexpressions of albumin, blood urea nitrogen and serum creatinine in elderly patients with intertrochanteric fracture of the femur before operation were the influencing factors of the occurrence of perioperative hyponatremia, of which the abnormal overexpression of albumin was the protective factor (OR<1,P<0.05), and of which the abnormal overexpression of blood urea nitrogen and serum creatinine were the risk factors (OR>1,P<0.05). Conclusions The risk of hyponatremia in elderly patients with intertrochanteric fracture of the femur during perioperative period is high. Moreover, the disease mostly occurs after surgery, which may be related to the preoperative levels of albumin, blood urea nitrogen, and serum creatinine.

    股骨股骨转子间骨折老年患者低钠血症

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    低频脉冲治疗仪联合下颏抗阻力训练在缺血性脑卒中后吞咽障碍患者中的应用

    宁淼淼谢作文李灿灿秦秀宝...
    57-60页
    查看更多>>摘要：目的 探讨低频脉冲治疗仪联合下颏抗阻力训练(CTAR)在缺血性脑卒中后吞咽障碍患者中的应用效果。 方法 随机对照研究。抽取2021年1月至2023年6月河南省人民医院收治的缺血性脑卒中后吞咽障碍患者124例，按照随机数表法分为对照组(62例)与观察组(62例)。对照组采用常规吞咽训练联合低频脉冲治疗仪治疗，观察组采用低频脉冲治疗仪联合CTAR治疗。比较两组治疗后吞咽功能、口咽部形态、生活质量及并发症发生情况。 结果 治疗后，两组洼田饮水试验加权评分、标准吞咽功能评分低于治疗前，且观察组低于对照组，差异有统计学意义(P<0.05)。治疗后，两组腭后距离、舌后距离长于治疗前，软腭长度短于治疗前，观察组腭后距离、舌后距离长于对照组，观察组软腭长度短于对照组，差异有统计学意义(P<0.05)。治疗后，两组生活质量及吞咽症状评分高于治疗前，且观察组高于对照组，差异有统计学意义(P<0.05)。观察组并发症发生率(0.00%，0/62)与对照组(3.23%，2/62)比较差异未见统计学意义(P>0.05)。 结论 低频脉冲治疗仪联合CTAR在缺血性脑卒中吞咽障碍患者中的应用效果较好，可有效改善吞咽功能，纠正口咽部形态，提高患者生活质量。 Objective To investigate the application effect of low-frequency pulse therapy combined with chin tuck against resistance exercise (CTAR) on patients with swallowing disorders after ischemic stroke. Methods This study was a randomized controlled study. A total of 124 patients with swallowing disorders after ischemic stroke admitted to Henan Provincial People’s Hospital from January 2021 to June 2023 were selected. And they were divided into control group (62 cases) and observation group (62 cases) using a random number table method. The control group was treated by routine swallowing training combined with low-frequency pulse therapy, while the observation group was treated by low-frequency pulse therapy combined with CTAR. The swallowing function, oropharyngeal morphology, quality of life, and incidence of complications were compared between the two groups. Results After treatment, the weighted score of the water swallow test and standardized swallowing assessment score in the two groups were lower than those before treatment, moreover, these scores in the observation group were lower than those in the control group (P<0.05). After treatment, the post-palatal distance and retrolingual distance of the two groups were longer than those before treatment, the soft palate length of the two groups were shorter than those before treatment (P<0.05). After treatment, the post-palatal distance and retrolingual distance of the observation group were longer than those of the control group, and the soft palate length of the observation group was shorter than that of the control group (P<0.05). After treatment, the scores of quality of life and swallowing symptoms in the two groups were higher than those before treatment, and the scores of quality of life and swallowing symptoms in the observation group were higher than those in the control group (P<0.05). There was no significant difference in the incidence of complications between the the observation group (0.00%, 0/62) and the control group (3.23%, 2/62),P>0.05. Conclusions Low-frequency pulse therapy combined with CTAR has an ideal effect on patients with swallowing disorders after ischemic stroke, which can effectively improve swallowing function, correct oropharyngeal morphology, and improve the quality of life of patients.

    吞咽障碍缺血性脑卒中低频脉冲治疗仪下颏抗阻力训练吞咽功能

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    高血压脑出血术后患者继发肺部感染的病原学特点及风险因素分析

    谢红兵张利通罗文凯马文娟...
    61-64页
    查看更多>>摘要：目的 探讨高血压脑出血术后继发肺部感染的病原学特点并分析其风险因素。 方法 回顾性分析。抽取2020年2月至2022年6月安阳市人民医院收治的高血压脑出血患者92例，所有患者在入院后均行颅内血肿清除术，并依据术后是否发生肺部感染分为肺部感染组(39例)与非肺部感染组(53例)。术后采集感染组患者的呼吸道分泌物进行病原菌的分离与鉴定；收集感染组与非感染组患者的一般资料、吸烟史、糖尿病病史、发病后是否呕吐、术前格拉斯哥昏迷评分法(GCS)评分、气管插管时间与术后是否气管切开等临床资料，并进行单因素与多因素Logistic回归分析。 结果 病原菌分析结果显示，39例感染组患者呼吸道分泌物中共分离出病原菌59株，其中革兰阳性菌32株(54.24%)，革兰阴性菌27株(45.76%)。单因素分析结果显示，吸烟史(P＝0.015)、糖尿病病史(P＝0.002)、发病后呕吐史(P<0.001)、术前GCS评分(P＝0.017)、气管插管时间(P＝0.009)以及术后是否气管切开(P<0.001)为高血压脑出血患者术后感染的影响因素。多因素Logistic回归分析结果显示，吸烟史(P＝0.019)、糖尿病病史(P＝0.027)、发病后呕吐(P＝0.012)、术前GCS评分低(P＝0.023)、气管插管时间延长(P＝0.006)以及术后气管切开(P＝0.028)是高血压脑出血术后并发肺部感染的独立危险因素。 结论 高血压脑出血术后并发肺部感染的患者中发生革兰阳性菌感染的患者比例更高；吸烟史、糖尿病病史、发病后呕吐、术前GCS评分低、气管插管时间延长以及术后气管切开是高血压脑出血患者术后并发肺部感染的独立危险因素。 Objective To investigate the microbiological characteristics and risk factors of postoperative secondary pulmonary infection after surgery for hypertensive cerebral hemorrhage. Methods A total of 92 patients with hypertensive cerebral hemorrhage admitted to Anyang People’s Hospital from February 2020 to June 2022 were selected for the retrospective analysis study. All the patients underwent intracranial hematoma removal surgery after admission, and were divided into the pulmonary infection group (39 cases) and the non-pulmonary infection group (53 cases) according to the occurrence of pulmonary infection after surgery. Respiratory secretions of patients in the infection group were collected for pathogen isolation and identification. The general data, smoking history, history of diabetes, vomiting after onset, preoperative Glasgow coma scale (GCS) score, time of tracheal intubation, tracheotomy after operation of the pulmonary infection group and the non-pulmonary infection group were collected. Univariate and multivariate logistic regression analysis were performed. Results Results of microbiological characteristics analysis showed that a total of 59 strains of pathogens were isolated from the respiratory secretions from the 39 infected patients, including 32 strains (54.24%) of Gram positive bacteria and 27 strains (45.76%) of Gram negative bacteria. The results of univariate analysis showed that the history of smoking (P=0.015), history of diabetes (P=0.002), vomiting history after onset (P<0.001), preoperative GCS score (P=0.017), time of tracheal intubation (P=0.009) and performance of postoperative tracheotomy (P<0.001) were the influencing factors of postoperative infection in patients with hypertensive cerebral hemorrhage. Results of multivariate logistic regression analysis showed that the history of smoking (P=0.019), history of diabetes (P=0.027), vomiting after onset (P=0.012), low preoperative GCS score (P=0.023), prolonged tracheal intubation time (P=0.006) and postoperative tracheotomy (P=0.028) were independent risk factors for pulmonary infection after hypertensive cerebral hemorrhage surgery. Conclusions The proportion of patient infected by Gram-positive bacteria is higher among patients with secondary pulmonary infection after hypertensive cerebral hemorrhage surgery. History of smoking, history of diabetes, vomiting after onset, low preoperative GCS score, prolonged tracheal intubation time and postoperative tracheotomy are independent risk factors for postoperative pulmonary infection in patients after surgery for hypertensive cerebral hemorrhage.

    高血压脑出血术后肺部感染病原学危险因素

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    阶梯式肺康复运动在慢性阻塞性肺疾病急性加重住院患者中的应用效果

    吴晓缺黄艳耿前芳马文娟...
    65-68页
    查看更多>>摘要：目的 探讨阶梯式肺康复运动对慢性阻塞性肺疾病急性加重(AECOPD)住院患者的康复效果。 方法 随机对照研究。抽取2020年1月至2022年1月河南中医药大学第三附属医院收治的80例AECOPD住院患者为研究对象，按照随机数字表法分为对照组与研究组，每组40例。对照组给予常规肺康复训练干预，研究组给予阶梯式肺康复运动干预。比较两组患者的康复运动依从性、肺功能、呼吸情况、运动能力及生活质量评分。 结果 研究组康复运动依从性(77.50%，31/40)高于对照组(55.00%，22/40)，差异有统计学意义(χ2＝4.53，P＝0.033)。干预后，两组各项肺功能指标比较差异均未见统计学意义(P均>0.05)；两组慢性阻塞性肺疾病评估测试评分、6 min步行距离和Borg评分均较干预前明显改善(P<0.05)，且研究组优于对照组(P<0.05)。 结论 合理、有序的阶梯式肺康复运动训练，能改善AECOPD患者的呼吸困难状况，提高患者的生活质量及运动耐受性。 Objective To investigate the effect of stepwise pulmonary rehabilitation exercise on hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This study was a randomized controlled trial. A total of 80 patients with AECOPD admitted to the Third Affiliated Hospital of Henan University of Traditional Chinese Medicine from January 2020 to January 2022 were selected as the study subjects. According to the random number table method, they were divided into a control group and a study group, with 40 cases in each group. The control group was given routine pulmonary rehabilitation training intervention, and the study group was given stepwise pulmonary rehabilitation exercise intervention. The compliance of rehabilitation exercise, lung function, respiration condition, exercise ability and activity of daily life scores of the two groups were compared. Results The compliance of rehabilitation exercise in the study group (77.50%, 31/40) was higher than that in the control group (55.00%, 22/40), and the difference was statistically significant (χ2=4.53, P=0.033). After intervention, there was no statistically significant difference in any lung function indicator between the two groups (all P>0.05). After intervention, the score of chronic obstructive pulmonary disease assessment test, 6-minute walking distance, and Borg score of the two groups were significantly improved compared with indexes before intervention (P<0.05) and the above indexes in the study group were better than those in the control group (P<0.05). Conclusions Reasonable and orderly stepwise pulmonary rehabilitation exercise can improve the respiratory status of AECOPD patients, and enhance activity of daily life and complianc of exercise.

    慢性阻塞性肺疾病急性加重期阶梯式康复运动肺康复运动

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    手工清洗与超声波清洗对腔镜手术器械的清洗消毒效果比较

    刘颖苏毅帖茜花瑞芳...
    69-71页
    查看更多>>摘要：目的 比较手工清洗与超声波清洗对腔镜手术器械的清洗消毒效果。 方法 随机对照研究。抽取2022年10月至2023年10月于郑州大学第一附属医院清洗消毒的124批次中124件腔镜手术器械，按照清洗的时间顺序分成参照组与研究组，每组62件。参照组采取手工清洗，研究组采用超声波清洗机清洗。比较两组清洗时长及成本、消毒时长及成本、清洗合格率、器械破损率、患者术后感染率。 结果 研究组器械清洗时长和消毒时长均短于参照组，清洗成本和消毒成本均低于参照组，差异有统计学意义(P<0.05)。目测法及三磷酸腺苷生物荧光检测法结果显示，研究组器械清洗合格率均高于参照组(P<0.05)。研究组器械破损率(1.61%，1/62)与参照组(3.23%，2/62)比较差异未见统计学意义(P>0.05)。研究组患者术后感染率(0.00%，0/62)低于参照组(6.45%，4/62)，P<0.05。 结论 应用超声波清洗机清洗腔镜手术器械，清洗和消毒时间更短，成本更低，清洗合格率更高，患者术后感染率更低。 Objective To compare the effect of manual cleaning and ultrasonic cleaning in cleaning and disinfection of laparoscopic surgical instruments. Methods A randomized controlled trail was conducted on a total of 124 endoscopic surgical instruments selected from 124 batches which were cleaned and disinfected in the First Affiliated Hospital of Zhengzhou University from October 2022 to October 2023. These instruments were divided into the reference group and the study group according to order of cleaning, with 62 instruments in each group. The instruments in the reference group were cleaned by hand, and the instruments in the study group were cleaned by ultrasonic cleaning machine. The time and cost of cleaning and disinfection, cleaning qualified rate, instrument breakage rate, postoperative infection rate of patients were compared between the two groups. Results Compared with the reference group, the cleaning time and disinfection time of instruments in the study group were significantly shorter, and the cleaning cost and disinfection cost in the study group were significantly lower (P<0.05). The qualified rate of instrument cleaning detected by visual inspection and adenosine triphosphate method in the study group were significantly higher than those in the reference group (P<0.05). There was no statistically significant difference in the breakage rate of instruments between the study group (1.61%, 1/62) and the reference group (3.23%, 2/62),P>0.05. The postoperative infection rate of patients in the study group (0.00%, 0/62) was lower than that in the reference group (6.45%, 4/62),P<0.05. Conclusions Ultrasonic cleaning can shorten the cleaning and disinfection time, reduce the cost, increase the cleaning qualified rate, and reduce the postoperative infection rate of patients.

    手术器械腔镜手工清洗超声波清洗

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    脑卒中吞咽障碍患者并发隐性误吸的危险因素分析

    高国珍吕小兰赵迎春马艳丽...
    72-74页
    查看更多>>摘要：目的 探讨脑卒中吞咽障碍患者隐性误吸的危险因素。 方法 回顾性抽取2021年2年至2023年3月商丘市第一人民医院收治的脑卒中吞咽障碍患者136例，其中显性误吸3例，隐性误吸60例(误吸组)，无误吸73例(未误吸组)。收集并比较两组患者临床资料，应用多因素Logistic回归分析脑卒中吞咽障碍患者隐性误吸的危险因素。 结果 两组患者年龄、性别、梗死部位、义齿、合并慢性支气管炎、吸烟史、自主进食、进食体位构成比比较差异有统计学意义(P<0.05)，两组饮酒史构成比比较差异未见统计学意义(P>0.05)。多因素Logistic回归分析结果显示，男性、年龄≥70岁、双侧梗死、义齿、合并慢性支气管炎、吸烟史、进食体位(头/颈伸直、仰卧)是卒中后吞咽障碍患者隐性误吸的独立危险因素(OR>1，P<0.05)，自主进食是保护因素(OR<1，P<0.05)。 结论 男性、年龄≥70岁、双侧梗死、义齿、合并慢性支气管炎、吸烟史以及采用头/颈伸直或仰卧的进食体位是卒中后吞咽障碍患者隐性误吸的独立危险因素，自主进食可能降低卒中后吞咽障碍患者的误吸风险。 Objective To investigate the risk factors of silent aspiration in stroke patients with swallowing disorders. Methods A total of 136 stroke patients with swallowing disorders admitted to the First Hospital of Shangqiu from February 2021 to March 2023 were retrospectively selected, involving 3 cases of overt aspiration, 60 cases of silent aspiration (aspiration group) and 73 cases without aspiration (non-aspiration group). The clinical data of the two groups were selected and compared. The multivariate logistic regression analysis was used to analyze the influencing factors of silent aspiration. Results The difference was significant in the proportion of age, gender, infarct site, presence of dentures, chronic bronchitis, smoking history, autonomous eating, and eating posture between the two groups (P<0.05). There was no significant in the proportion of drinking history between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that male, age≥70 years, bilateral infarction, presence of dentures, chronic bronchitis, smoking history, and food ingestion posture (head/neck extension, supine position) were independent risk factors for silent aspiration in patients with swallowing disorders after stroke (OR>1,P<0.05) while autonomous eating was a protective factor (OR<1,P<0.05). Conclusions Male, age≥70 years, bilateral infarction, presence of dentures, chronic bronchitis, smoking history, and food ingestion in head/neck extension or supine position are independent risk factors for silent aspiration in patients with swallowing disorders after stroke. Being able to eat independently may be reduce the risk of aspiration in patients with swallowing disorders after stroke.

    脑卒中吞咽障碍隐性误吸危险因素

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    早期目标导向活动方案在ICU呼吸衰竭机械通气患者中的应用效果

    王丹常阳阳徐飞马艳丽...
    75-78页
    查看更多>>摘要：目的 探讨早期目标导向活动(EGDM)方案在重症监护病房(ICU)呼吸衰竭机械通气患者中的应用效果。 方法 回顾性抽取2020年10月至2022年10月于河南大学淮河医院ICU行机械通气的呼吸衰竭患者76例，依据入院时间分为观察组(38例)和对照组(38例)。对照组给予ICU常规干预，观察组在对照组基础上实施EGDM方案干预。比较两组机械通气时间、入住ICU时间、住院时间、呼吸力学指标[肺顺应性(CL)、气道阻力(Raw)、内源性呼气末正压(PEEPi)]、医学研究委员会(MRC)评分、Barthel指数(BI)评分、睡眠质量参数及ICU获得性衰弱(ICU－AW)发生率。 结果 观察组机械通气时间、入住ICU时间、住院时间短于对照组，差异有统计学意义(P<0.05)。干预7 d后，观察组CL、MRC评分、BI评分、睡眠效率高于对照组，Raw、PEEPi低于对照组，睡眠总时间长于对照组，差异有统计学意义(P<0.05)。干预7 d后，观察组ICU－AW发生率(10.53%，4/38)低于对照组(31.58%，12/38)，差异有统计学意义(P<0.05)。 结论 EGDM方案干预可缩短ICU呼吸衰竭机械通气患者入住ICU时间、机械通气时间、住院时间，改善呼吸力学指标，改善睡眠障碍，并可减少ICU－AW发生。

    呼吸衰竭早期目标导向活动重症监护病房机械通气

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