痤疮对男女大学生心理人格倾向及生活质量影响比较

目的：比较痤疮对男女大学生患者心理人格倾向和生活质量的影响程度和相关因素。方法：采用专题讲座、现场医疗咨询,问卷式调查（UPI、APSEA量表）的形式对广州七所高校的男女大学生痤疮患者进行调研。结果：分别回收UPI有效问卷773份,其中男286份,女487份;APSEA有效问卷1356份,其中男577份,女779份。结果UPI总分≥25者,男生占24．1％,女生占25．5％;APSEA评分〉80者,男生占8．8％,女生占9．2％,经穿检验,男女差异无统计学意义（X^2分别为0．17、0．07,P值均〉0．05）。使用Spearman秩相关法检验APSEA总评分〉80与痤疮的严重程度的关系,结果r男生〉r女生〉0,表明痤疮越严重,APSEA总评分〉80的发生率越高,而且男生组关联性比女生组强。男女生患者的心理问题均表现为焦虑、抑郁、社交障碍和缺乏自信,女生患病后比男生更容易情绪失控（男69．3％,女79．7％）、对自己的外貌不满意（男48．9％,女62．3％）和不愿与外界接触（男45．4％,女58．9％）,差异均有统计学意义（P值均〈0．05）。结论：痤疮对男女大学生患者的心理健康、人格倾向都有较大程度的影响,痤疮越严重,受影响的程度越高。患有严重痤疮的男生发生心理异常的可能性更高。     

天津市0～6岁儿童特应性皮炎患病率调查

目的了解天津市城市和农村0～6岁儿童特应性皮炎（AD）的患病率及患病因素。方法采取整群抽样方法，依据儿童哮喘和过敏国际研究协作组问卷，对天津市城市和农村0～6岁儿童进行问卷调查。结果本次调查涉及天津市城市和农村，收回问卷3749份，有效问卷3708份，有41份因填写不规范而未被录入数据库进行统计学分析。城市应答率为84．9％，农村应答率为79．3％，总应答率为82．7％。所调查人群的年龄在不同性别间及城市和农村问分布均衡。经过对调查资料的分析，儿童AD的患病率为2．9％，其中城市为3．5％，农村为2．4％，城市AD患病率高于农村（矿=3．98，P〈0．05）。结论天津市AD的患病率为2．9％，城市AD患病率为3．5％，农村AD的患病率为2．4％。     

高温高强度训练条件下睡眠状况调查

目的探讨阅兵武警战士在高温、高心理压力、高训练强度的阅兵训练下的心理状态、睡眠情况及其与应对方式的关系。方法参加阅兵的220名战士,均男性,年龄（20＋3）（18～22）岁,军龄2～3年,接受采用阿森斯（Athens）失眠量表、简易应对方式问卷和症状自评量表（SCL-90）进行的问卷调查。结果收有效问卷199份,有效率90．45％。这些战士中失眠组62人（31．15％）、疑似失眠组47人（23．62％）、非失眠组90人（45．23％）。SCL-90测评示,失眠组和疑似失眠组各因子的评分均显著高于非失眠组（均P〈0．01）。疑似失眠组的总分和躯体化评分均显著大于失眠组（P〈0．05）,其他各因子的评分在两组间均不存在差异（均P〉0．05）。三组间,积极应对维度得分两两对比均不存在显著差异（均P〉0．05）。失眠组和疑似失眠组的消极应对秩次显著高于非失眠组（均P〈0．05）。结论武警阅兵战士在高温、高心理压力、高训练强度的阅兵训练下,普遍发生失眠情况,且多数失眠战士存在焦虑、抑郁、敌对等心理问题。而这部分战士在应对生活事件时多采取消极、不成熟的应对方式,这可能与失眠存在联系。     

口腔卫生习惯对高强度训练条件下武警战士牙周健康的影响

目的了解武警战士在高强度训练时口腔卫生情况及卫生教育前后牙周健康状况的变化。方法采用调查问卷及专科检查牙龈指数和牙结石指数。采用随机分为口腔教育组和对照组，4月后再行口腔检查，调查卫生教育对口腔卫生的影响。结果在高强度训练组中牙龈炎和牙结石发病率的检出率高于对照组（P〈0．05），口腔教育可以显著降低牙龈炎和牙结石的检出率（P〈0．05）。结论口腔卫生教育可以显著改善战士的牙周健康。     

老年性皮肤病

20140923吕梁市老年性黑子现状调查及防治对策／董建光（山西吕梁市卫校附院皮肤科）∥皮肤病与性病．-2013,35（4）．-218～219 采用问卷调查方式取得326名各种不同环境人群的临床资料,对他们的性别、皮损发生年龄、皮损部位、防治情况及合并症进行统计分析。结果：男性患病率为89．37％,女性为80．67％,两组比较差异有统计学意义（P〈0．05）;市民中老年性黑子患病率82．07％,农民为91．54％,两组比较差异有统计学意义（P〈0．05）。表2参5（杨帆）     

可视喉镜在排痰受限患者气道护理中的应用

目的探讨可视喉镜下吸痰在排痰受限患者中的应用价值。方法对2013年1月-2013年12月人住ICU的排痰受限患者351例,随机分为可视喉镜组（A组）,口咽通气道组（B组）,常规吸痰组（C组）,分别给予可视喉镜下普通吸痰管吸痰,口咽通气管吸痰,常规方法吸痰。观察三组患者入院7d内肺部感染率,人工开放气道率（气管插管或气切）,口鼻咽出血并发症发生率,人工开放气道前吸痰率等指标。结果三组均为117例,三组7d肺部感染率、人工气道开放率、人工开放气道前吸痰频率依次A组〈B组〈C组,且组间比较,P〈0．05）,差异有统计学意义;C组口鼻咽出血并发症发生率最高,A、B组与之比较,P〈0．05,差异有统计学意义。结论可视喉镜在对排痰受限患者气道护理中痰液清除效率较常规吸痰及口咽通气管辅助吸痰方法更有效。     

Vidas CHL法在女性宫颈和尿液标本中检测沙眼衣原体的应用

目的：为研究能否用Vidas衣原体试验（CHL）检测女性尿液中沙眼衣原体。方法：采用Vidas CHL法检测126例有症状和220例无症状女性患者宫颈拭子及尿沉渣中沙眼衣原体。结果：与宫颈拭子沙眼衣原体细胞培养相比，Vidas CHL法检测有症状女性患者宫颈拭子、尿沉渣中沙眼衣原体敏感性分别为95．8％（P＞0．05）、87．5％（P＞0．05），特异性分别为98．0％（P＞0．05）、99．0％（P＞0．05）；检测无症状女性患者宫颈拭子、尿沉渣中沙眼衣原体敏感性分别为92．9％（P＞0．05）、50．0％（P＜0．05），特异性分别为97．9％（P＞0．05）、99．0％（P＞0．05）。结论：Vidas CHL法具有高度敏感性和特异性，可用来检测有症状女性患者尿沉渣中沙眼衣原体，但不能用来检测无症状女性患者尿沉渣中沙眼衣原体。     

724例广东籍女性生殖道支原体感染及耐药情况分析

为了解广东籍女性支原体感染及其耐药情况，选取我院皮肤科门诊2002年10月-2003年9月与2004年10月-2005年9月724例广东籍女性患者进行了支原体及药敏检测。结果：单一解脲脲原体（Uu）感染率分别为41．09％、48．93％（x^2=4．490，P〈0．05），UU和人型支原体（MH）合并感染率分别为10．63％、6．38％（x^2=4．229，P〈0．05）；支原体对罗红霉素、交沙霉素、阿奇霉素、克拉霉素、左氧氟沙星及司帕沙星，耐药性增强（P〈0．05）；而对四环素、多西环素、米诺环素及大观霉素，耐药性减弱（P〈0．05）。治疗女性生殖道支原体感染可考虑使用四环素类及氨基糖甙类抗生素。     

人口避孕节育服务综合干预效果分析

目的：了解对流动人口避孕节育服务的综合干预效果,为形成更加适宜于流动人口推广避孕节育技术的服务新方式提供参考。方法：以自填式问卷,对年龄15—49岁、非深圳户籍、未采取长效避孕措施、有过性生活且到我中心接受服务的流动人口进行调查,分阶段进行2个月的基本干预和2个月全面干预后,再次进行调查,了解干预效果。结果：知识水平：在女性干预组干预后知识水平均有所提高,全面干预后提高更明显（P〈0．05）。咨询：干预后咨询人数有显著提高,全面干预后提高更显著（P〈0．05）。意愿：干预后,流动人口愿意使用提供的药具、愿意将信息告诉同伴和在有需求时愿意再来中心就诊。行为：调查对象采取避孕措施比例在98％以上,干预后比例有显著提高,全面干预后增加更显著（P〈0．05）,但仍有30％左右的人没有坚持使用。满意度：不同性别对11项相关服务干预前后满意度平均分有差别。服务质量全面干预后较基本干预和干预前的差别有统计学意义。结论：南山区计生服务中心充分发挥自身优势,将流动人口做为重点服务人群,开展了一系列宣传教育、技术服务、药具发放、信息咨询、人员培训、生殖保健等综合干预活动,引导流动人口在避孕节育认知、信念、态度和行为方面发生改变,取得了较好的效果。     

深圳市已婚育龄夫妇性生活现状调查

目的：了解深圳市已婚育龄夫妇性生活状况及影响性功能的生活、职业、环境因素。方法：利用深圳市人口和计划生育局的育龄夫妇信息系统,使用随机抽样法,抽取已婚育龄夫妇424对为研究对象,培训社区调查员后对研究对象进行入户调查,采用Epidata 3．0软件建立数据库并录入问卷,使用SPSS13．0对数据进行统计分析。结果：1）被调查的已婚育龄夫妇中夫妻双方至少一方存在性生活问题的有149对,占总体的41．6％;而至少存在一个性生活问题的女性有136人（36．1％）,高于男性的72人（19．4％）;2）女性（8．3％）比男性（2．4％）更容易出现性交痛（P〈0．05）。在性高潮障碍方面,女性（11．3％）比男性（5．8％）也更不容易达到性高潮（P〈0．05）;3）被调查的影响夫妻双方性生活因素中,年龄是最主要的因素,随着年龄增大,性生活更容易出现问题,夫妻双方的教育程度越高,性生活满意度越高,而家庭收入对性生活影响不显著;4）当性生活遇到问题时,极少数女性（3．1％）和男性（4．0％）会寻求医疗帮助和心理帮助。结论：已婚育龄夫妇性生活状况较差,约有41．6％夫妻至少一方出现了性生活问题,女性比男性更容易出现性生活问题;年龄和教育程度是影响性生活的重要因素,家庭收入则对性生活影响较小。     

肺复张操作联合震动排痰对重症监护室机械通气患者吸痰影响的临床研究

目的研究联合应用肺复张操作与震动排痰对重症监护室（ICU）内行机械通气患者的吸痰效果和相关并发症的影响及意义。方法选择建立人工气道行机械通气的ICU患者176例,随机平均分为研究组和对照组。研究组吸痰时联合应用肺复张操作与震动排痰法,对照组采用普通吸痰法。观察2组患者吸痰前后血压、心率、心律、血氧饱和度、肺功能各参数指标的变化,以及吸痰时患者症状、体征及相关并发症的发生率。结果对照组舒张压吸痰前为（78.45±1.68）mmHg,与吸痰后[（78.45±1.62）mmHg]无显著差异（P〉0.05）。研究组舒张压吸痰后为前为（70.88±1.62）mmHg,显著低于吸痰前[（75.88±1.62）mmHg,P〈0.05）]。对照组吸痰后呼吸功为（2.22±0.188）J／L,与吸痰前无显著差异[（2.22±0.178）J／L,P〉0.05]研究组呼吸功吸痰后为（1.90±0.16）J／L,显著低于吸痰前[（2.28±0.16）J／L,P〈0.05]。研究组舒张压、体表脉搏氧饱和度（SpO2）、潮气量、气道阻力、气道压力均低于对照组,而肺顺应性高于对照组（P〈0.05,P〈0.01）。研究组的吸痰次数、SpO2≥95％例数、一次吸净例数均显著多于对照组（均P〈0.05）,咳嗽反应、气急、痰鸣音、蒸汽吸入、黏膜损伤例数均显著少于对照组（均P〈0.05）。结论对ICU内机械通气患者联合应用肺复张与震动排痰后吸痰法效果优于普通吸痰法。值得临床推广应用。     

The economic impact of pressure ulcers among patients in intensive care units. A systematic review

BackgroundThe incidence and prevalence of pressure ulcers in critically ill patients in intensive care units (ICUs) remain high, despite the wealth of knowledge on appropriate prevention strategies currently available.MethodsThe primary objective of this systematic review was to examine the economic impact of pressure ulcers (PU) among adult intensive care patients. A systematic review was undertaken, and the following databases were searched; Medline, Embase, CINAHL, and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was used to formulate the review. Quality appraisal was undertaken using the Consensus on Health Economic Criteria (CHEC)-list. Data were extracted using a pre-designed extraction tool, and a narrative analysis was undertaken.ResultsSeven studies met the inclusion criteria. Five reported costs associated with the prevention of pressure ulcers and three explored costs of treatment strategies. Four main PU prevention cost items were identified: support surfaces, dressing materials, staff costs, and costs associated with mobilisation. Seven main PU treatment cost items were reported: dressing materials, support surfaces, drugs, surgery, lab tests, imaging, additional stays and nursing care. The overall validities of the studies varied between 37 and 79%, meaning that there is potential for bias within all the included studies.ConclusionThere was a significant difference in the cost of PU prevention and treatment strategies between studies. This is problematic as it becomes difficult to accurately evaluate costs from the existing literature, thereby inhibiting the usefulness of the data to inform practice. Given the methodological heterogeneity among studies, future studies in this area are needed and these should use specific methodological guidelines to generate high-quality health economic studies.     

芬太尼为基础的镇静方案对机械通气患者镇静效果的影响

目的 探讨以芬太尼为基础的镇静对重症病房机械通气患者镇静效果的影响。方法40例需机械通气的内科患者随机分为咪达唑仑组（M组）和芬太尼＋咪达唑仑组（F＋M组）,每组20例。以肌肉活动评分法（MAAS）评分3分、ATICE人机顺应性评分≥3分为镇静目标。记录镇静前的血压、心率、呼吸频率、脉搏氧饱和度、气道峰压、吸入氧浓度、动脉氧分压、MAAS评分、ATICE意识评分和人机顺应性评分。镇静开始M组以咪达唑仑0．05mg／kg（静脉推注1次／5min）,并进行镇静评估至达镇静目标。F＋M组以芬太尼0．25μg／kg（静脉推滓1次／5min）,并进行镇静评估至达镇静目标。然后M组开始以眯达唑仑0．1mg·kg·h^-1。持续泵入;F＋M组开始以芬太尼1．0μg·kg^-1·h^-1持续泵人。每隔2h进行一次镇静评估,调整药物输注速率维持镇静目标,记录呼吸、循环及镇静指标,当芬太尼输注速度达到2μg·kg^-1·h^-1仍未达镇静目标时加用咪达唑仑静脉泵入。镇静中12h和24h各监测一次血气分析,计算氧合指数。镇静达24h时停止药物输注,每30min评估一次镇静深度,记录恢复时间（停药至MAAS评分≥3分的时间）。计算镇静药物费用、药物调整次数、镇静满意程度和人机顺应性满意程度。结果镇静过程中两组患者的血压及药物调整次数比较差异均无统计学意义（P〉0．05）。F＋M组的心率、气道压力、呼吸频率、药物费用均明显低于M组（P＜0．05）;F＋M组的脉搏氧饱和度、氧合指数高于M组（P〈0．05）。F＋M组的镇静满意程度、人机顺应性满意程度和意识评分明显高于M组,恢复时间较短（P〈0．05）。结论对机械通气的内科患者以芬太尼为基础的镇静能提高镇静效果,减轻患者经济负手担。     

早期适时呼吸支持策略在急性中毒呼吸衰竭中的应用

目的探讨早期适时呼吸支持在急性中毒所致急性呼吸衰竭救治中的临床应用价值。方法对26例急性重症中毒所致急性呼吸衰竭患者采用早期适时呼吸支持策略，观察治疗模式选择、通气指标、血压、心率、血气指标、APACHEⅡ评分的动态变化以及病情转归。结果呼吸支持模式分别为SIMV＋PSV＋PEEP 16例，BiPAP＋PSV＋PEEP 6例，CPAP＋PSV 4例，所有患者上机时间1-11d，平均（3．40±2．05）d，其中6例在72h后行气管切开人工机械通气。治愈出院23例，死亡3例，治愈者均一次成功撤机。全部患者在给予人工呼吸支持前APACHEⅡ评分11-35，平均为16．53±4．89；动态APACHEⅡ评分在治愈者第1-3天有明显下降。结论实施早期适时呼吸支持策略将有助于提高急性重症中毒伴呼吸衰竭患者的抢救成功率，改善患者预后。     

急诊护理人员职业倦怠心理的影响因素分析及建议

目的分析急诊护理人员职业倦怠心理的影响因素，方法用“Maslach氏倦怠量表-服务行业版”结合相关因素，对2005～2008年瑞安市医院急诊护士80人进行职业倦怠和敬业度情况的调查研究和相关分析。结果职业倦怠阳性率为46％。职业倦怠与情感衰竭得分上升和个人成就感得分下降相关。结论情感衰竭与个人成就感降低是造成职业倦怠的主要因素。     

The incidence of hydroxyethyl starch-associated pruritus

BACKGROUND: Pruritus due to hydroxyethyl starch (HES) is reported with a very variable frequency but appears to be relatively uncommon in the U.K. compared with other European countries. OBJECTIVES: To determine the frequency of HES-related pruritus in patients discharged from intensive care units (ICUs) in two U.K. hospitals. METHODS: A questionnaire survey was given to 253 patients after discharge from ICU. Questions were designed to exclude pre-existing skin disease and other causes of pruritus. RESULTS: One hundred and fifty-nine completed questionnaires were suitable for analysis. Seventeen of 135 (12.6%) subjects who had received HES reported itch, as did one of 24 who had not received HES. There was no apparent relationship between the occurrence of HES-related pruritus and either the surgical indication or the brand or volume of HES infused. CONCLUSIONS: HES-related pruritus is a problem that dermatologists need to recognize; however, its frequency in the U.K., when other causes of itch are excluded, appears to be lower than suggested in some previous reported studies.     

Improvised technique for measuring tracheal tube cuff pressure

We agree with the editorial published by Feng et al concerning the insufficient routine monitoring of tracheal tube cuff pressure (TTCP) by anesthesiologists, and propose an improvised technique that can facilitate and promote such routine monitoring by intensive care staff who attend to patients receiving mechanical ventilation. Insufficient monitoring of tracheal cuff pressure has also been documented for intensive care unit nurses. Measurements of cuff pressure are beneficial when used in management of air leakage around an endotracheal tube, and can be easily obtained with the aid of a personalized and simple technique performed using materials that are readily available in all hospitals. Other investigators have previously demonstrated the usefulness of employing an improvised technique. We considered that possible disadvantages are similar to those encountered when using standardized equipment. With our improvised technique, we seek to promote among the nursing staff the determination of the TTCP in intubated patients to reduce the risk of related medical complications.     

Barriers to the implementation of clinical guidelines

Clinical guidelines in wound care have recently been formulated at the national and international level, reflecting a shift from locally derived guidelines common during the 1990s. There remains considerable uncertainty regarding the extent of implementation and monitoring of these new guidelines. This paper presents the results of a survey of members of the Tissue Viability Society that sought their views upon the guidelines in place within their workplace--how were these guidelines developed, was the impact of guidelines monitored and how and finally what barriers limited their full implementation. Of the 1500 members, 476 returned completed questionnaires (34.0% response rate). Most (n = 422, 88.4%) worked within environments that implemented clinical guidelines in some aspect of wound care, with guidance upon pressure ulcer prevention being most commonly reported (n = 351). The use of national guidelines (either in their original format or locally modified to reflect local circumstances) was relatively common--reported by 307 of the 476 respondents. Few reported that guidelines were fully implemented (n = 77; 18.3%) with lack of resources, lack of awareness of the content of the guidelines and, when aware, lack of acceptance of their recommendations being the most commonly cited reasons for the failure to implement. However, it should be noted that only 34.0% of the surveyed population responded--this may question how far the results can be considered to reflect the current status of guideline implementation in the UK given the unreported views of 66% of all those surveyed.