目的 探讨光棒引导与传统喉镜气管插管在不稳定型颈椎骨折患者中的应用效果。方法 不稳定型颈椎骨折患者80例,按照随机数字表法随机分成光棒引导组和传统喉镜组各40例,记录两组患者的插管时间、插管总成功率,入室安静后(T0)、诱导后插管前(T1)、气管插管后即刻(T2)、气管插管后3 min(T3)时的收缩压(SBP)、舒张压(DBP)、心率(HR)、血浆去甲肾上腺素(NE)、肾上腺素(E) 和血管紧张素Ⅱ(ATⅡ)的变化和插管时气道并发症。结果 两组间插管时间(光棒组29.63±11.04s vs.喉镜组62.41±19.49 s)有统计学意义(P<0.001)。两组插管总成功率无统计学意义(P=0.305)。光棒组T2、T3时刻SBP、DBP、HR 、NE、E和ATⅡ均低于喉镜组(P<0.001)。光棒组气道并发症低于喉镜组无统计学意义(P>0.05)。结论 光棒引导气管插管较传统喉镜气管内插管插管时间短,对血流动力学和应激激素水平影响较轻。

目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。

Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.

目的 探讨基于品管圈活动构建健康体检重要异常结果的追踪管理模式对提高电话随访率的影响。方法 选取2022年5月—2023年4月在中山大学孙逸仙纪念医院健康管理中心体检重要异常结果的328例受检者作为研究对象。成立品管圈活动小组,实施追踪管理模式。干预后时间段为2022年11月—2023年4月,期间针对不同样本分别实施了干预措施一至四及全面实施措施,分析随访1个月后成功随访人数。比较干预前后圈员综合能力变化及患者对健康管理中心的满意度。结果 电话随访率在干预措施一实施后为85.02%,干预措施二实施后为88.59%,干预措施三实施后为90.23%,干预措施四实施后为95.27%,全面实施干预措施一至干预措施四后为95.80%,均较干预措施实施前电话随访率（75.91%）有所增长;干预成功随访人数中,复诊率为84.34%（210/249）,全面实施措施后成功随访人数中复诊率为94.74%（216/228）。相较于干预前,干预后,圈员解决问题能力、责任心、沟通协调、团队凝聚力、积极性、品管手法、自信心、和谐感分值均升高（P<0.05）。干预前患者满意度为85.37%,干预后患者满意度为87.80%,干预后满意度有所升高,差异具有统计学意义（P<0.05）。结论 通过开展品管圈活动,使重要异常结果电话随访率明显提高,有利于提升体检机构的服务质量和服务能力,有利于疾病的早发现、早干预。

Objective Exploring the impact of establishing a tracking and management model for important abnormal results of health check ups based on quality control circle activities on improving telephone follow-up rates. Methods A total of 328 subjects with important abnormal results in Health Management Center of Sun Yat-sen Memorial Hospital of Sun Yat sen University from May 2022 to April 2023 were selected. The quality control circle activity group was set and the tracking management mode was carried out. The post intervention period was from November 2022 to April 2023, during which intervention measures 1-4 and comprehensive implementation measures were implemented for different samples. The number of successful follow-up after 1 month of follow-up was analyzed. Changes in the comprehensive ability of the circle staff before and after the intervention and the patients’ satisfaction with the health management center were compared. Results The telephone follow-up rate after intervention 1 was 85. 02%, 88. 59% after intervention 2,90. 23% after intervention 3,95. 27% after intervention 4 and 95. 80% after all intervention,which was higher than 75. 91% before intervention implementation. Among the single intervention individuals, the re-visit rate was 84. 34%（210/249）, and after the comprehensive implementation of measures, the re-visit rate among the successfully intervened individuals was 94. 74%（216/228）. After the intervention,the problem solving ability,responsibility, communication and coordination,team cohesion, enthusiasm,quality control techniques,self-confidence,and sense of harmony all significantly increased（P<0. 05）. The patient satisfaction rate before intervention was 85. 37%, and after intervention it was 87. 80%. The satisfaction rate increased after intervention, and the difference was statistically significant（P<0. 05）. Conclusions Through the quality control circle activities, the telephone follow-up rate of important abnormal results is significantly improved,which is conducive to improving the service quality and service capacity of physical examination institutions,is conducive to the early detection and early intervention of diseases.

       目的   评价血塞通联合右美托咪定对脑缺血再灌注损伤大鼠的脑保护效果。方法   选择老龄雄性Wistar大鼠50只，随机分为假手术（C）组、脑缺血再灌注（R）组、血塞通（P）组、右美托咪定（D）组，血塞通联合右美托咪定（PD）组，每组各10只。根据组别给予不同药物，行神经行为学测试；于第3、7天，测量脑梗死面积、脑水含量，以及超氧化物歧化酶（Superoxide dismutase，SOD）、谷胱甘肽过氧化酶（Glutathione peroxidase，GSH-PX）活性测定。结果   给药后第3、5、7天，与P、D组相比，PD组神经行为学评分改善更加显著（P＜0.001）；给药后第3、7天，与P组相比，PD组脑梗死面积、脑水含量均降低（P=0.01，P=0.002），SOD、GSH-PX活性升高显著（P=0.03，P=0.001）；与D组相比，PD组脑梗死面积、脑水含量也显著降低（P＜0.01，P=0.008）；SOD、GSH-PX活性升高显著（P=0.009，P＜0.001）。结论   血塞通联合右美托咪定较单独应用药物，能显著减轻缺血再灌注损伤造成的脑损害，具有脑保护作用。

       Objective  To explore the effects of Xuesaitong combined with dexmedetomidine on cerebral ischemia-reperfusion in elderly rats．Methods  Fifty elderly male Wistar rats were randomly divided into 5 groups：sham operation（C）group，cerebral ischemia-reperfusion（R）group，Xuesaitong（P）group，dexmedetomidine（D）group，Xuesaitong combined with dexmedetomidine（PD）group．Xuesaitong was given in group P，dexmedetomidine was given in group D，and normal saline was given in group C and group R，continuously for 7 days．After 3- and 7-day treatment，the brain of rats was dissected out to assay the area of cerebral infarction，degree of cerebral edema，superoxide dismutase（SOD） and glutathione peroxidase（GSH-PX） activity．Results  When compared PD group with P and D group，neurobehavioral score was lower at 3，5，7 day（P＜0.001）；area of cerebral infarction，degree of cerebral edema were less（P=0.01，P=0.002），activity of SOD and GSH-PX were higher at 3，7 days（P=0.03，P=0.001）respectively．When compared PD group with D group，area of cerebral infarction，degree of cerebral edema were less（P＜0.01，P=0.008），activity of SOD and GSH-PX were higher at 3，7 days（P=0.009，P＜0.001）respectively．Conclusions  The combination of Xuesaitong and dexmedetomidine can obviously reduce the damage by cerebral ischemia-reperfusion in elderly rats and has brain protective effects．

       目的   分析贝伐珠单抗与化疗对晚期结直肠癌患者4种错配修复蛋白（MSH2、MLHI、MSH6、PMS2）水平影响。方法   选择2022年1月—2024年1月江苏省宿迁市中医院肿瘤科102例晚期结直肠癌患者，按抽签法分成两组，即化疗组及联合组，各51例。化疗组应用FOLFOX（亚叶酸钙+奥沙利铂+氟尿嘧啶）方案进行化疗，联合组采取贝伐珠单抗联合FOLFOX方案治疗。对比其肿瘤控制效果、免疫功能及MSH2、MLHI、MSH6和PMS2水平变化，并对比组间不良反应发生率。结果   联合组客观缓解率、疾病控制率高于化疗组（P＜0.05）；治疗后联合组患者CD4⁺ 、CD3⁺ 、CD8⁺ 、和CD4⁺ /CD8⁺数值高于化疗组，且两组治疗后均低于治疗前（P＜0.05）；治疗后两组患者MSH2、MLHI、MSH6和PMS2缺失率对比无统计学意义（P＞0.05），但其阳性、阴性表达情况对比差异有统计学意义，联合组MSH2、MLHI、MSH6和PMS2阳性率低于化疗组（P＜0.05）；两组不良反应发生率对比差异无统计学意义（P＞0.05）。结论   对晚期结直肠癌在化疗基础上增加贝伐珠单抗抗肿瘤效果显著，改善其免疫功能，虽无法改善患者错配修复蛋白缺损，但可辅助降低其阳性率，且不影响安全性。

       Objective  To analyze the effects of bevacizumab and chemotherapy on the levels of four mismatch  repair proteins（MSH2，MLHI，MSH6，PMS2）in patients with advanced colorectal cancer．Methods  A total of 102 patients with advanced colorectal cancer from the Oncology Department of Suqian Traditional Chinese Medicine Hospital in  Jiangsu Province from January 2022 to January 2024 were selected，and were divided into two groups according to the drawing method，namely the chemotherapy group and the combination group，with 51 patients in each group．The chemotherapy group received FOLFOX（calcium folinate+oxaliplatin+fluorouracil）regimen for chemotherapy，while the combination group received bevacizumab combined with FOLFOX regimen for treatment．Tumor control effect，immune function，and changes in MSH2，MLHI，MSH6，and PMS2 levels，and its incidence of adverse reactions were compared．Results  The objective remission rate and disease control rate of the combined group were higher than those of the chemotherapy group（P＜0.05）．After treatment，the CD4⁺ ，CD3⁺ ，CD8⁺ and CD4⁺ /CD8⁺ values in the combination group were higher than those in the chemotherapy group，and those after treatment were lower than those before treatment in both groups（P＜0.05）．After treatment，there were no significant differences in the deletion  rates of MSH2，MLHI，MSH6，and PMS2 between the two groups of patients（P＞0.05），but there was a significant difference in their positive and negative expression．The positive rates of MSH2，MLHI，MSH6，and PMS2 in the combination group were lower than those in the chemotherapy group（P＜0.05）．There was no significant difference in the incidence of adverse  reactions between the two groups（P＞0.05）．Conclusions  Adding bevacizumab on the basis of chemotherapy has a significant anti-tumor effect on advanced colorectal cancer，improving its immune function．Although it cannot improve the mismatch  repair protein defect in patients，it can assist in reducing its positivity rate and has high safety．

       目的   探讨免疫治疗联合化学治疗（化疗）对晚期非小细胞肺癌（NSCLC）患者淋巴免疫及生活质量的影响，为临床进一步治疗提供参考。方法  选择2021年6月—2023年6月天津市滨海新区大港医院收治的晚期NSCLC患者120例进行研究，按抽签法分为干预组及对照组，每组60例，对照组采取单纯化疗方案，干预组采取免疫联合化疗方案，对比两组临床疗效、药物不良反应，治疗前后免疫功能（CD3⁺ 、CD4⁺ 、CD8⁺ ）、糖类抗原199（CA199）、糖类抗原 125（CA125）、血清癌胚抗原（CEA）水平及健康状态调查表（QOL）评分。结果  干预组患者治疗总有效率高于对照组（68.33%＞41.67%，P＜0.05）；治疗后干预组患者CD3⁺ 、CD4⁺ 比例高于治疗前及对照组治疗后，CD8⁺ 比例低于治疗前及对照组治疗后（P＜0.05）；治疗后干预组血清CA199、CA125、CEA水平均低于治疗前及对照组治疗后（P＜0.05）；干预组药物不良反应发生率为16.67％，对照组为36.67％，干预组低于对照组（P＜0.05）；治疗后干预组QOL各维度评分高于对照组及治疗前（P＜0.05）。结论  与单纯化疗相比，免疫联合化疗治疗晚期NSCLC患者，能有效降低肿瘤标志物水平，改善患者免疫指标，减轻药物不良反应，提高患者疗效及生活质量。

       Objective  To explore the effect of immunotherapy combined with chemotherapy on lymphatic immunity and quality of life of patients with advanced non-small cell lung cancer（NSCLC），and to provide reference for further clinical treatment．Methods  A total of 120 patients with NSCLC from June 2021 to June 2023 were selected and divided into observation group and control group evenly according to the method of drawing lots，control group was treated with chemotherapy，the observation group was treated with immunotherapy combined with chemotherapy，and the clinical efficacy and adverse drug reactions were compared between the two groups．Before and after treatment，immune function（CD3⁺ ，CD4⁺ ，CD8⁺ ），carbohydrate antigen 199（CA199），carbohydrate antigen 125（CA125），serum carcinoembryonic antigen（CEA）levels and health status questionnaire（QOL-RRB- scores）were measured．Results The total effective  rate in the observation group was significantly higher than that in the control group（68.33%＞41.67%，P＜0.05）．After treatment，the ratios of CD3⁺  and CD4⁺  in the observation group were significantly higher than those before treatment and control group after treatment，and the ratio of CD8⁺  was significantly lower than that before and after treatment in the control group（P＜0.05）．After treatment，the serum levels of CA199，CA125 and CEA in the observation group were lower than those before and after treatment in the control group（P＜0.05）．The incidence of adverse drug  reactions was 16.67% in the observation group and 36.67% in the control group，which was significantly lower in the observation group than in the control group（P＜0.05）．After treatment，the QOL scores in the observation group were significantly higher than those in the control group and before treatment（P＜0.05）．Conclusions  Compared with chemotherapy alone，immunotherapy combined with chemotherapy can effectively reduce the levels of tumor markers，improve the immune indexes of patients，reduce the adverse drug reactions，and improve the efficacy and quality of life of patients with advanced NSCLC．

       目的   探讨免疫及靶向药物联合肝动脉灌注化学治疗（化疗）治疗晚期肝癌的临床疗效。方法   选取甘肃省武威市人民医院2021年1月—2024年1月收治的78例晚期肝癌患者进行回顾性分析，其中20例患者采取单纯肝动脉灌注化疗（HAIC）治疗为单化疗组，30例患者采取HAIC联合程序性细胞死亡受体-1（PD-1）抗体治疗为免疫组，28例患者采取HAIC联合PD-1抗体免疫治疗与甲磺酸仑伐替尼胶囊靶向治疗为联合组。对比三组临床疗效、治疗前后胚抗原（CEA）、糖类抗原125（CA125）、甲胎蛋白（AFP）表达水平，不良反应发生率，并采用Piper疲乏修正量表（PFS-R）、世界卫生组织生存质量量表简表（WHOQOL-BREF）对两组癌因性疲乏程度及生存质量进行评价。结果   单纯化疗组、免疫组、联合组客观缓解率分别为15.00%、40.00%、64.29%，疾病控制率为30.00%、66.67%、82.14%，联合组高于单纯化疗组与免疫组（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001）；治疗后三组患者CEA、CA125、AFP水平均降低，且联合组［CEA：（13.62±4.24）ng/mL、CA125：（31.62±13.66）U/mL、AFP：（35.21±5.93）ng/mL］低于免疫组［（17.85±3.32）ng/mL、（59.26±9.35）U/mL、（42.12±4.12）ng/mL］及单纯化疗组［（23.73±4.79）ng/mL、（64.57±5.23）U/mL、（47.46±5.32）ng/mL］，对比差异有统计学意义（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）；所有患者均无5级不良反应及严重肝功能损害出现，且三组血小板减少、白细胞减少、腹痛、呕吐、消化道出血、厌食等不良反应发生率对比差异无统计学意义（P＞0.05）；治疗后三组患者PFS-R评分均降低，联合组（3.85±1.13）分低于免疫组（5.39±1.25）分及单纯化疗组（6.33±1.26）分，WHOQOL-BREF评分均升高，联合组（348.58±66.12）分高于免疫组（297.24±72.21）分及单纯化疗组（256.35±41.67）分，对比差异有统计学意义（F=2.526，P=0.014；F=2.167，P=0.033）。结论   免疫及靶向药物联合肝动脉灌注化疗治疗晚期肝癌疗效显著，可有效控制疾病进展的同时，降低机体肿瘤标志物水平，安全性可控，同时可改善患者生存质量，减轻癌因性疲乏程度。

       Objective  To explore the clinical efficacy of immune and targeted drugs combined with hepatic artery infusion chemotherapy（HAIC）in the treatment of advanced liver cancer．Methods  A retrospective analysis was conducted on 78 patients with advanced liver cancer admitted to our hospital from January 2021 to January 2024．Among them，20 patients were treated with simple HAIC and divided into a single chemotherapy group．Thirty patients were treated with HAIC combined with PD-1 antibody，and divided into an immune group．Twenty-eight patients were treated with HAIC combined with PD-1 antibody immunotherapy and lenvatinib mesylate capsule targeted therapy，and divided into a combination group．The clinical efficacy of three groups，the expressionlevels of CEA，CA125，AFP，and incidence of adverse reactions before and after treatment were compared．Piper Fatigue Correction Scale（PFS-R）and the WHO QOL-BREF were used to assess cancer-related fatigue in both groups．The degree of fatigue and quality of life were assessed．Results  The objective response rates of the simple chemotherapy group，the immune group，and the combination group were 15.00%，40.00% and 64.29%，respectively．The disease control  rates were 30.00%，66.67% and 82.14%，respectively．The indicators above of the combination group was significantly higher than those in the simple chemotherapy group and the immune group（χ ² =11.720，P=0.003；χ ² =13.890，P＜0.001；P＜0.05）．After treatment，the levels of CEA，CA125 and AFP were all decreased in the three groups，and those in the combined group （CEA［13.62±4.24］ng/mL，CA125［31.62±13.66］U/mL，AFP：Ng/mL［35.21±5.93］）were lower than those in the immune group（17.85±3.32 ng/mL，59.26±9.35 U/mL，/ 42.12±4.12 ng/mL）and single chemotherapy group（23.73±4.79 ng/mL，64.57±5.23 U/mL47.46±5.32］ng/mL），the differences were statistically significant（F=7.698，P＜0.001；F=11.480，P＜0.001；F=14.952，P＜0.001；P＜0.05）．All patients had no grade 5 adverse reactions or severe liver function damage，and there was no statistically significant difference in the incidence adverse reactions such as thrombocytopenia，leukopenia，abdominal pain，vomiting，gastrointestinal bleeding，and anorexia among the three groups（P＞0.05）．After treatment，the PFS-R score of the three groups was decreased，and the combined group（3.85±1.13）score was lower than that of the immune group（5.39±1.25）and the chemotherapy group（6.33±1.26）．While the WHOQOL-BREF score was increased，the score of combination group（348.58±66.12）was higher than that of immune group（297.24±72.21）and chemotherapy group（256.35±41.67），and the difference was statistically significant（F=2.526，P=0.014；F=2.167，P=0.033；P＜0.05）．Conclusions  The combination of immune and targeted drugs with hepatic artery infusion chemotherapy has a significant therapeutic effect on advanced liver cancer．It can effectively control disease progression，reduce tumor marker levels in the body，improve patient quality of life，and alleviate cancer-related fatigue，with controllable safety

       目的   探讨影响急性脑梗死患者接受重组组织型纤溶酶原激活剂（rt-PA）静脉溶栓治疗决策延迟的因素，并提出减少溶栓决策时间的建议。方法   采用回顾性分析方法，对泉州市第一医院2023年通过急诊收治的120例急性脑梗死患者及其家属的资料进行分析。根据溶栓决策时间，以5 min为界限，将患者分为非延迟组（62例）和延迟组（58例），并对两组资料进行比较分析。采用SPSS 23.0统计软件分析数据，运用t检验（针对连续变量）和χ ² 检验（针对分类变量）比较组间的差异。此外，通过Logistic回归分析，确定影响急性脑梗死患者静脉溶栓治疗决策的危险因素。结果   对比两组患者数据后发现，籍贯地区、冠心病史、外院转入、发病到入院时间以及决策家属数量比较差异具有统计学意义（P＜0.05）。多因素Logistic回归分析进一步揭示，非泉州籍贯地区［OR（95%CI）：9.29（2.21~38.97），P=0.002］、决策家属人数≥2人［OR（95%CI）：18.73（5.96~58.80），P＜0.001］、从外院转入［OR（95%CI）：10.26（2.09~50.42），P=0.004］以及发病到入院时间3.0~4.5 h［OR（95%CI）：4.09（1.45~11.48），P=0.008］是导致治疗决策延迟的独立危险因素。结论   患者非泉州籍贯地区、外院转入、溶栓决策家属人员≥2个、发病到入院时间3~4.5 h是溶栓决策延误的影响因素，提出优化卒中急诊抢救流程以及通过卒中宣教以缩短溶栓决策时间的建议。

       Objective  To investigate the factors influencing delays in decision-making for intravenous thrombolysis with recombinant tissue plasminogen activator（rt-PA）in patients with acute cerebral infarction and to propose  recommendations for reducing thrombolysis decision-making time．Methods  A  retrospective analysis was conducted on data from 120 patients with acute cerebral infarction admitted to the emergency department at Quanzhou First Hospital in 2023，including information from their families．Patients were divided into non-delay group （62 cases） and delay group （58 cases） based on a 5-minute threshold for thrombolysis decision-making time．Comparative analysis between the two groups was performed using SPSS 23.0 statistical software，with t-tests for continuous variables and χ ²  tests for categorical variables．Logistic  regression analysis was employed to identify  risk factors affecting decision-making for intravenous thrombolysis in these patients．Results  Statistical analysis  revealed significant differences between the two groups in terms of native region，history of coronary heart disease，transfer from other hospitals，time from onset to hospital admission，and number of family members involved in decision-making（P＜0.05）．Multivariate Logistic regression identified independent risk factors for delayed treatment decisions：non-Quanzhou native region （OR［95%CI］：9.29［2.21-38.97］，P=0.002），having two or more decision-making family members （OR［95%CI］：18.73［5.96-58.80］，P＜0.001），transfer from other hospitals （OR［95%CI］：10.26［2.09-50.42］，P=0.004），and a time from onset to hospital admission of 3-4.5 hours （OR［95%CI］：4.09［1.45-11.48］，P=0.008）．Conclusions  Factors  such as non-Quanzhou native region，transfer from other hospitals，having two or more family members involved in decision-making，and a time from onset to hospital admission of 3-4.5 hours are associated with delays in thrombolysis decision-making．Optimizing the emergency  rescue process for stroke and shortening the thrombolytic decision-making time through stroke education are suggested．

       目的   对该培训基地师资2021—2023年教学能力进行评价，了解和分析“1+3+n”的院级督导推行前的2021年、“1+3+n”的院级督导推行后的 2022年、2023年师资的教学能力变化。方法   采用问卷调查法收集评价数据，采用SPSS.27.0对教学评价资料进行统计分析，采用净推荐值计算教学口碑，对多年度结果进行纵向比较分析。结果  2021—2023年教学评价次数共5 483次；2021—2023年对师资教学设计能力评价由实施前的8.8提高到9.6、教学实施能力由实施前的9.0提高到9.5、教学热情由实施前的9.0提高到10.0、时间投入由实施前的9.3提高到10.0，不同年份组间比较的差异均有统计学意义（P＜0.001）；课程净推荐值由实施前的60.5%提高到81.3%，师资课程推荐者占比由实施前的65.5%提高到83.2%，贬损者占比由实施前的5.0%降低到1.9%，差异有统计学意义（χ ² =175.4，P＜0.001）。结论   “1+3+n”院级督导模式的相关举措，对师资教学能力的提高具有促进作用，且该促进作用持续存在，师资教学能力逐年递增。

    Objective  To evaluate the teaching ability change of teachers  from 2021 to 2023，including of teachers’ teaching ability in 2021 before the implementation of "1+3+n" college-level supervision，and in  2022  and  2023  after the implementation of "1+3+n" college-level supervision．Methods  Questionnaire survey was used to collect evaluation data，SPSS.27.0 was used to make statistical analysis of teaching evaluation data，and NPS（Net Promoter Score）was used to evaluate teaching quality．Results  From 2021 to 2023，there were 5483 teaching evaluations．From 2021 to 2023，teaching design ability evaluation score increased from 8.8 before the implementation to 9.6，teaching implementation ability evaluation score increased from 9.0 before the implementation to 9.5，teaching enthusiasm evaluation score increased from 9.0 before the implementation to 10.0，time investment evaluation score increased from 9.3 before the implementation to 10.0，and the differences between different years were statistically significant（P＜0.001）．The courses quality increased from 60.5% before the implementation to 81.3%，and the proportion of teachers' course recommenders has increased from 65.5% before the implementation to 83.2%，while the proportion of detractors has decreased from 5.0% before the implementation to 1.9%，with statistical significance（χ ² =175.4，P＜0.001）．Conclusions  The measures of "1+3+n" college-level supervision mode promote the improvement of teachers’ teaching ability，the promotion effect persists，and the teaching ability increases year by year．

       目的   探讨清醒镇静应用在急性缺血性脑卒中血管内治疗中的效果。方法   选择2020年1月—2023年3月医院接收的急性缺血性脑卒中患者82例进行研究，按随机数表法分为2组，每组各41例，两组采取溶栓与取栓治疗，对照组采取全身麻醉方式，观察组采取清醒镇静方式，记录两组治疗相关参数，比较两组近期疗效、并发症发生情况及预后。结果   观察组入院到腹股沟穿刺时间（95.52±3.63）min、穿刺至血管再通时间（72.25±5.58）min低于对照组（112.25±4.18）min、（102.45±10.63）min（t=19.349，P＜0.05）；观察组ICU时间（7.81±2.63）d、住院时间（13.75±3.64）d，与对照组（8.05±2.81）d、（14.52±4.07）d比较差异无统计学意义（t分别为0.524、0.399、0.902，P分别为0.601、0.690、0.369）。观察组近期总有效39例（95.12%）与对照组37例（90.24%）比较差异无统计学意义（χ ² =0.719，P=0.396）。观察组症状性颅内出血3例（7.32%）与对照组6例（14.63%）比较差异无统计学意义（χ ² =1.123，P=0.289）；观察组脑水肿4例（9.76%）、坠积性肺炎12例（29.27%），低于对照组7例（17.07%）、18例（43.90%）（χ 2分别为4.969、6.962，P分别为0.025、0.008）。观察组预后良好21例（51.22%）高于对照组10例（24.39%）（χ ² =6.275，P=0.012）。结论   急性缺血性脑卒中患者溶栓与取栓治疗中采取清醒镇静方式可获得与全身麻醉相近的疗效，而且可进一步缩短治疗时间，促进血管快速再通，减少相关并发症，使患者获得更好的预后。

       Objective  To investigate the conscious sedation effect of endovascular treatment in acute ischemic stroke．Methods  A total of 82 patients with acute ischemic stroke admitted to the hospital from January 2020 to March 2023 were selected and divided into two groups according to the random number table method，with 41 cases in each group．The two groups were treated with thrombolysis and thrombectomy，the control group was treated with general anesthesia，and the observation group was treated with conscious sedation．The short-term efficacy，complications and prognosis were compared between the two groups．Results  The time from admission to groin puncture ［（95.52±3.63）min］ and time from puncture to vascular  recanalization ［（72.25±5.58）min］ in the observation group were significantly lower than those in the control group ［（112.25±4.18）min，（102.45±10.63）min］（t=19.349，P＜0.05）．Observation group ICU time，length of hospital stay（7.81+2.63）d（13.75+3.64）d，and the control group（8.05+2.81）d，（14.52-4.07）d  had  no  statistically  significant  difference in comparison（t were 0.524，0.399，0.902，P were 0.601，0.690，0.369）．Recent total effective cases observation in group was 39（95.12%）and control group was 37（90.24%），there was no statistically significant difference comparing（χ ² =0.719，P=0.396）．Observation group had symptomatic intracranial hemorrhage in three patients（7.32%）and control group had six cases（14.63%），there was no statistically significant difference（χ ² =1.123，P=0.289）．There were four cases（9.76%）of brain edema and 12 cases（29.27%）of hypostatic pneumonia in the observation group，which were significantly lower than seven cases（17.07%）and 18 cases（43.90%）in the control group（χ ² =4.969，6.962，P=0.025，0.008）．The number of patients with good prognosis in the observation group（21 cases，51.22%）was significantly higher than that in the control group（10 cases，24.39%）（χ ² =6.275，P=0.012）．Conclusions In the treatment of acute ischemic stroke patients with thrombolysis and thrombectomy，conscious sedation can achieve the same efficacy as general anesthesia，and can further shorten the treatment time，promote  rapid recanalization of blood vessels and reduce related complications，so that patients can get a better prognosis．