目的 探究麦默通（Mammotome）微创旋切术加置引流对乳腺良性肿物患者术后疼痛、炎性应激指标及并发症的影响。方法 选取本院2020年1月—2022年1月收治的100例乳腺良性肿物患者,简单随机法进行分组,每位患者赋予1位随机数,1~51号为实验组,采用Mammotome微创旋切术加置引流,52~100号为对照组,实施Mammotome微创旋切术。对比2组治疗效果、围术期指标、术前及术后1 d、3 d疼痛程度（NRS评分）、术前及术后3 d炎性应激指标及并发症情况。结果 2组病灶清除率（100.00%、97.96%）、并发症发生率（3.92%、16.32%）间无差异（P>0.05）;相较于对照组,实验组手术时间较长,残腔积液较少,住院时间较短（P<0.05）;术后1 d、3 d实验组NRS评分低于对照组（P<0.05）;术后3 d 2组C反应蛋白、白介素-6、白介素-1β、降钙素原水平较术前上升,且实验组上升幅度小于对照组（P<0.05）。结论 Mammotome微创旋切术加置引流治疗乳腺良性肿物能减少残腔积液,降低炎症反应程度,有助于术后切口愈合,缓解术后疼痛,且不增加并发症风险。

Objective To investigate the effect of Mammotome minimally invasive excision with drainage on postoperative pain,inflammatory stress indexes and complications in patients with benign breast tumors．Methods A total of 100 patients with benign breast tumors admitted to our hospital from January 2020 to January 2022 were selected and grouped by simple random method,each patient was assigned a random number．Patients No.1 to No.51 were included in the experimental group,treated with Mammotome minimally invasive excision with drainage．Patients No.52 to No.100 were included in the control group,treated with Mammotome minimally invasive excision．The treatment effect,perioperative indicators,pain level（NRS score）and inflammatory stress indexes before and 1st and 3rd days after operation and complications were compared between the two groups．Results There were no significant differences in the lesion clearance rate（100.00% vs 97.96%）and the complication rate（3.92% vs 16.32%）between the two groups（P>0.05）．Compared with the control group,the experimental group had longer operation time,less residual cavity liquid and shorter hospital stay（P<0.05）．The NRS score of the experimental group was lower than that of the control group at 1st and 3rd days after operation（P<0.05）．On the third day after operation,the levels of C-reactive protein,interleukin- 6,interleukin-1β and procalcitonin in the two groups were increased compared with those before operation,and the increase in the experimental group was smaller than that in the observation group（P<0.05）．Conclusions Mammotome minimally invasive excision with drainage in the treatment of benign breast tumors can reduce residual cavity fluid accumulation,reduce the degree of inflammatory response,help postoperative incision healing,relieve postoperative pain,and without increasing the risk of complications．

目的 探讨术前控制营养状态评分在老年胃癌患者术后短期并发症中的应用价值。方法 回顾分析统计2015年1月—2020年12月在江苏大学附属医院接受治疗的确诊胃癌患者,根据纳入标准和排除标准,选择入组患者,收集纳入研究患者一般资料、术前实验室检测数据和术后并发症情况,计算控制营养状况（CONUT）评分,统计分析CONUT营养评分在老年胃癌患者接受胃癌D2根治术术后短期并发症的价值。结果 共223例患者纳入研究,CONUT评分的截断值为2.5,肿瘤直径的截断值为2.75 cm。CONUT评分>2.5组的平均年龄高于CONUT评分<2.5组（P=0.005 3）,且2组性别构成存在差异,男性患者多于女性（P=0.037 0）。CONUT评分>2.5组患者的肿瘤直径较大（P=0.039 4）。在术后并发症方面,CONUT评分>2.5组的术后并发症多于CONUT评分<2.5组（P=0.008 3）。单因素Logistic回归分析,年龄（OR=1.127;95%CI：1.028~1.236;P=0.011）、CONUT评分（OR=0.339;95%CI：0.151~0.764;P=0.009）是患者发生短期并发症的危险因素。多因素Logistic回归分析显示年龄（OR=1.115;95%CI：1.008~1.233;P=0.035）、CONUT评分（OR=0.414;95%CI：0.175~0.982;P=0.045）是患者发生短期并发症的危险因素。结论 CONUT评分作为老年胃癌患者术前营养评估项目可以有效预测患者术后短期并发症,进而提前进行营养干预,降低术后并发症发生率。

Objective To explore the value of controlling nutritional status score in short-term postoperative complications of elderly patients with gastric cancer．Methods The data of patients who confirmed gastric cancer and treated in the Affiliated Hospital of Jiangsu University from January 2015 to December 2020 were reviewed and analyzed．Patients were selected according to the inclusion criteria and exclusion criteria,the general data,preoperative laboratory test data and postoperative complications of the included patients were collected,and the controlling nutritional status（CONUT）score was calculated．The value of CONUT score in the short-term complications of elderly gastric cancer patients undergoing D2 radical gastrectomy for gastric cancer was evaluated．Results A total of 223 patients were included in this study．The cut-off value of CONUT score was 2.5 and the cut-off value of tumor diameter was 2.75 centimeter．The average age of the group with CONUT score > 2.5 was significantly higher than that of the group with CONUT score < 2.5（P=0.005 3）．Moreover,there was significant difference between the sex ratio of the two groups,with male more than female（P=0.037 0）．The tumor diameter was significantly larger in the group with CONUT score > 2.5（P=0.039 4）．In terms of postoperative complications,there was significantly more postoperative complications in the group with CONUT score > 2.5 than in the group with CONUT score < 2.5（P=0.008 3）．Univariate logistic regression analysis showed that age（OR=1.127;95% CI：1.028-1.236;P=0.011）and CONUT score（OR=0.339;95% CI：0.151-0.764;P=0.009）were the risk factors for short-term complications．Multivariate logistic regression analysis showed that age（OR=1.115;95% CI：1.008-1.233;P=0.035）and CONUT score（OR=0.414;95% CI：0.175-0.982;P=0.045）were the risk factors for short-term complications．Conclusions As a preoperative nutritional evaluation item for elderly patients with gastric cancer,CONUT score can effectively predict the short-term postoperative complications of patients,and then carry out nutritional intervention in advance to reduce the incidence of postoperative complications．

目的 探讨超声引导下外周静脉置入中心静脉导管(PICC)老年患者常见并发症的预防与护理措施。方法 回顾性分析本院2019年12月—2021年1月间收治的116例PICC置管老年患者,根据是否实施超声引导下PICC置管并发症专项预防护理(后简称专项护理)将入选患者分配为实施组及对照组各58例,对比2组患者穿刺效果、并发症发生情况,评估2组患者护理前后的心理状态变化情况,调查患者满意度。结果 实施组一次穿刺成功、头端到位率、头端最佳率均高于对照组,平均穿刺次数、操作时间均少于对照组,差异均有统计学意义(P<0.05);实施组各种并发症总发生率为18.97%,对照组为46.55%,2组差异有统计学意义(P<0.05);置管后2组患者焦虑自评量表、抑郁自评量表评分均低于置管前,且实施组均低于对照组,差异均有统计学意义(P<0.05);实施组患者总满意率为96.55%,对照组为77.59%,实施组高于对照组,差异有统计学意义(P<0.05)。结论 专项预防护理措施能够提高老年患者超声引导下外周静脉置入中心导管的穿刺准确性,降低置管相关并发症发生风险,缓解患者心理压力,提高患者满意度。

Objective To explore the preventing and nursing measures of common complications in elderly patients with ultrasound-guided peripherally inserted central catheter (PICC). Methods The data of 116 elderly patients with PICC catheterization in our hospital from December 2019 to January 2021 were retrospectively analyzed.Patients were divided into implementation group and control group (58 cases each) according to whether they received special preventive nursing for complications of ultrasound-guided PICC catheterization (specialized nursing). The catheterization outcomes and complications of the two groups were compared, the changes in the psychological state were evaluated, and satisfaction rate of the patients was investigated. Results The success rate of the first catheterization, the head-end in place, and ideal placement of the head-end in implementation group were higher than those of the control group, the average number of catheterization and operation time were less than those of the control group, and the differences were statistically significant (P<0.05). The total incidence of various complications in the implementation group was 18.97%, while that in the control group was 46.55%, the difference between two groups was statistically significant (P<0.05). The scores of Self-Rating Anxiety Scale and Self-Rating Depression Scale of the two groups after PICC catheterization were lower than those before catheterization, and the implementation group was lower than the control group, the differences were statistically significant (P<0.05). The total satisfaction rate of patients in the implementation group was 96.55%, and that in the control group was 77.59%, which difference was statistically significant (P<0.05). Conclusion Special preventive nursing measures could improve the catheterization accuracy of ultrasound-guided PICC for elderly patients, reduce the risk of catheter-related complications, relieve the psychological pressure of patients, and improve patients’ satisfaction.

目的 对比不同血管通路运用于血液透析中的透析充分性及并发症发生率分析。方法 选取我院2018年5月—2020年10月收治的其中60例血液透析患者作为研究对象,根据患者不同血管通路分为3组,甲组30例,采取自体动静脉内瘘为通路方式,乙组15例,采取聚四氟乙烯移植血管内瘘为通路方式;丙组15例,采取带隧道和涤纶套的透析导管为通路方式。观察并记录3组患者透析后的血红蛋白、高密度脂蛋白、总胆固醇、C反应蛋白、血浆清蛋白、低密度脂蛋白、尿素清除指数、甘油三酯、尿素降低率水平,并对患者随访10个月,观察3组患者血管通路并发症(感染及血栓栓塞)的发生情况。结果 透析后3组患者血红蛋白、总胆固醇、高密度脂蛋白、甘油三酯、血浆清蛋白、C反应蛋白、低密度脂蛋白、尿素清除指数、尿素清除率比较,差异无统计学意义(P>0.05)。甲组的感染和血栓栓塞发生率低于乙组和丙组,而乙组的感染率又低于丙组,差异有统计学意义(P<0.05)。结论 自体动静脉内瘘可以做为血液透析治疗中血管通路的首选方式,若患者自体血管条件有限,可考虑建立移植血管内瘘来保证透析的充分性,降低并发症发生率,提高患者透析安全性及生活质量。

Objective To compare the dialysis adequacy and complication incidence of different vascular access in hemodialysis. Methods A total of 60 hemodialysis patients treated in our hospital from May 2018 to October 2020 were selected as the research objects. They were divided into three groups according to different vascular access. Thirty patients in group A took autologous arteriovenous fistula (AVF) as the access, and 15 patients in group B took polytetrafluoroethylene graft (arteriovenous grafts,AVG) as the access, 15 cases in group C were treated with dialysis catheter with tunnel and polyester sleeve (tunnel-cuffed catheter,TCC). The levels of hemoglobin, high density lipoprotein, total cholesterol, C-reactive protein, plasma albumin, low density lipoprotein, urea clearance index, triglyceride and urea reduction ratio (URR) were observed and recorded. The patients were followed up for 10 months to observe the incidence of vascular access complications (infection and thromboembolism) in the three groups. Results There was no significant difference in hemoglobin, total cholesterol, high density lipoprotein, triglyceride, plasma albumin, C-reactive protein, low density lipoprotein, urea clearance index and URR among the three groups after dialysis (P>0.05). The incidence of infection and thromboembolism in group A was lower than that in group B and group C, while the infection rate in group B was lower than that in group C, the differences were statistically significant (P<0.05). Conclusions AVF can be used as the preferred way of vascular access in hemodialysis treatment. If the patient's autologous vascular conditions are limited, it can be considered to establish transplanted vascular fistula (AVG) to ensure the adequacy of dialysis, reduce the incidence of complications and improve the dialysis safety and quality of life of patients.

目的 分析高压氧治疗对面部填充术后血管并发症的疗效。方法 将62例面部填充剂注射后并发症患者根据高压氧介入时机分为A组和B组,A组在在常规治疗的基础上,48小时内进行高压氧治疗,B组在在常规治疗的基础上,48小时后进行高压氧治疗,在治疗结束后对两组患者进行疗效分析。结果 A组患者的治疗疗效较B组患者治疗疗效好,差异有统计学意义(P<0.05)。结论 高压氧治疗对面部填充剂注射后并发症疗效是肯定的,且高压氧介入时间越早效果越好。

Objective To analysie effect of hyperbaric oxygen therapy on vascular complications after facial filling. Methods 62 patients with complications after injection of facial filler according to the timing of hyperbaric oxygen intervention were divided into group A and group B.Group A was treated with hyperbaric oxygen within 48 hours on the basis of conventional treatment.Group B was treated with hyperbaric oxygen 48 hours later on the basis of conventional treatment to analysie the efficacy of the two groups of patients after the end of treatment. Results The efficacy of group A patients was better than that of group B, the difference was statistically significant P<0.05. Conclusion Hyperbaric oxygen therapy is effective in the treatment of complications after facial filler injection, and the earlier the hyperbaric oxygen intervention time is taken, the better the effect is.

目的 探究和分析本组腹主动脉瘤腔内治疗病例并发症发生的原因及预防、处理策略。方法 对本团队在2014年1月—2017年12月实施的37例腹主动脉瘤腔内修复手术病例进行回顾性分析。结果 共有11例发生并发症,其中3例为术中I型内漏、1例术后支架移位致Ⅰ型内漏、1例术后Ⅲ型内漏、1例术中Ⅳ型内漏,全部经处理后内漏消失;术后髂动脉支架内血栓1例,经取栓后血流恢复;术后股动脉狭窄闭塞1例,经取栓并行股动脉人工血管置换后血流恢复;术后移植物反应1例,对症处理后症状消失出院;2例双侧髂内动脉栓塞致术后盆腔疼痛,随访疼痛消失,无跛行。结论 腹主动脉瘤腔内修复治疗本身存在内漏、血栓、血管入路损伤、移植物反应等相关并发症。术前正确评估并严格掌握适应症以及具有成熟的操作经验,是减少并发症发生的关键。

Objective To discuss and analyze the occurrence causes, prevention and treatment methods of complications in the endovascular repair of patients with abdominal aortic aneurysm. Methods Totally 37 cases of patients with abdominal aortic aneurysm underwent endovascular repair in our hospital from January 2014 to December 2017 were retrospectively analyzed. Results The complications were occurred in 11 cases, which including intra-operative typeⅠendoleak in 3 cases, postoperative typeⅠendoleak caused by stent displacement in 1 case; intra-operative type Ⅲ endoleak in 1 case; postoperative type Ⅳ endoleak in 1 case. all of the endoleak events disappeared after dealing. There was postoperative iliac artery stent thrombosis in 1 case, the blood flow was restored after thrombectomy; postoperative femoral artery stenosis or occlusion in 1 case, the blood flow was restored after thrombectomy and femoral artery artificial vascular replacement; postoperative host versus graft reaction in 1 case, no stent infection was found; and postoperative bilateral pelvic pain caused by internal iliac artery embolization in 2 cases, the pain disappeared during the follow-up visit, and the patients were free from lameness. Conclusion The complications related to endoleak, thrombosis, vascular approach injury and host versus graft reaction are existing with the endovascular repair itself of abdominal aortic aneurysm. The correct preoperative evaluation as well as strict control of indications and mature operational experience are the key to reduce the occurrence of complications.

目的 探讨在小剂量催产素基础上分别联合普贝生和COOK宫颈扩张球囊对足月妊娠引产的临床效果。方法 抽取110例足月妊娠孕妇住院资料,根据引产方式不同分为两组,各55例。A组采用小剂量催产素引产,B组在A组基础上加用COOK球囊引产,比较两组促宫颈成熟效果、母婴结局以及不良并发症情况。结果 两组孕妇引产前后Bishop 评分相比,差异显著（P<0.01）,此外,与A组相比,B组引产后Bishop 评分升高（P<0.01）。A组促宫颈成熟效果有效人数为48例,新生儿Apgar 评分为9.12±2.11,产后出血量（210.7±55.44）mL,阴道分娩人数为40例,而B组引产过程中各指标均显著改善。此外,B组未出现宫内感染和胎盘早剥,而胎儿窘迫和其他并发症降低（P<0.01）。结论 催产素联合COOK球囊对足月妊娠孕妇促宫颈成熟效果显著,降低剖腹产,母婴状态良好,减少不良并发症发生。

目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。

Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.

目的 探讨内镜下逆行胰胆管造影( ERCP) 治疗胆总管结石患者的临床疗效及其相关并发症。方法 严格筛选纳入从2012年1月—2015年1月在我院行ERCP治疗的胆总管结石患者,归纳评估ERCP手术对胆总管结石治疗的有效性及安全性。结果 359例胆总管结石患者,其中行ERCP治疗共347例,其中9例因一般情况差无法耐受手术或无法配合而未予以实施ERCP治疗,其中3例因术中穿孔转为开放手术治疗。 1次性取净结石者311例(89.6%),结石2次以上(含2次)取净者27例(7.8%),放置胆道支架者9 例(2.6%)。ERCP 术后总胆红素(61.7±103.8) μmol/L; 直接胆红素(34.7±59.6) μmol/L; 谷丙转氨酶(62.8±74.2) U/L; 谷草转氨酶(48.3±61) U/L。术后 2 h血淀粉酶(115±162) U/L,无统计学差异(P＞0.05) ,24 h血淀粉酶(124.7±215.8)U/L,与术前相比差异有统计学意义(P＜0.05) 。术后寒战、发热、腹痛、黄疸等症状均有不同程度的减轻;肝功能术后明显好转(P＜ 0.05);术后平均住院天数4～6 d;出现并发症患者16例,其中急性胰腺炎占6例,急性胆管炎占5例,出血占3例,穿孔占2例,经对症支持治疗后均治愈出院。结论 ERCP 治疗胆总管结石安全、有效,临床疗效显著,是胆胰疾病重要的诊治手段。

Objective To investigate the clinical efficacy and complications of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of common bile duct stones. Methods Cases received ERCP therapy from January 2012 to January 2015 were studied retrospectively,and evaluated the safety and efficacy of therapeutic ERCP in patients with common bile duct calculi. Results 359 Cases of patients with common bile duct stones treated successfully with 347 cases,among them 9 cases unable to implementation of ERCP because of bad surgery tolerance,3 cases of intraoperative perforation to have surgical operation treatment. The stones were removed completely one time in 311 cases(89.6%). More than two times removing net calculi in 27 cases(7.8%). 9 cases were placed biliary stent (2.6%). Postoperative total bilirubin ERCP:61.7 ±103.8 μmol / l; Postoperative bilirubin direct: 34.7±59.6 μmol/l; Postoperative ALT:62.8±74.2 U/L; Postoperative AST: 48.3±61 U/L; Postoperative 2 h blood amylase was 115±162 U/L. It showed no significant difference (P＞0.05).24 h blood amylase was 124.7±215.8 U/L,there was significant difference compared with before operation(P＜0.05). Postoperative chills,fever, pain,jaundice have different degrees of ease. Postoperative liver function was improved significantly(P＜0.05). The postoperative average length of stay in common bile duct stones was 4～ 6 days. Complications occurred in 16 cases,including 6 cases of acute pancreatitis,5 cases of acute cholangitis,3 cases of bleeding,perforation in 2 cases. After treatment they were cured and discharged. Conclusion ERCP is safe,effective in treatment of common bile duct stones. It is an important means in treatment in bile duct diseases

      目的   探讨在冠状动脉造影术后患者中应用风险防范护理干预对血管并发症的控制效果。方法   选择2022年1月—2023年6月于我院接受治疗的85例冠状动脉造影术后患者。按照随机数字表法分组，其中对照组42例给予常规护理干预，观察组43例给予风险防范护理干预，比较两组干预前后的心理状态、治疗依从性、血管并发症。结果   干预后，观察组正性情绪（PA）评分高于对照组PA评分（t=3.821，P＜0.001），观察组负性情绪（NA）评分低于对照组NA评分（t=5.380，P＜0.001）。与对照组比，观察组治疗依从性更好（Z=2.268，P=0.023）。观察组血管并发症总发生率低于对照组（9.30% vs 30.95%，χ ² =6.224，P=0.013）。结论   采用风险防范护理干预，能够改善冠状动脉造影术后患者的心理状态，提高治疗依从性，并降低血管并发症总发生率。

       Objective  To explore the effect of  risk prevention nursing intervention on controlling vascular complications in patients after coronary angiography．Methods  Eighty-five patients after coronary angiography in our hospital were selected from January 2022 to June 2023．They were grouped according to the random number table．And 42 cases were divided into the control group for routine nursing intervention，and 43 cases in the observation group were given risk prevention nursing intervention．Psychological status，treatment compliance and vascular complications of the two groups were observed．Results  After the intervention，the postive affect score of the observation group was higher than that of the control group（t=3.821，P＜0.001），and the negative affect score of the observation group（21.25±3.31）was lower than the score of the control group（25.35±3.70）（t=5.380，P＜0.001）．Compared with the control group the compliance of observation group was higher（Z=2.268，P=0.023）．The overall incidence of vascular complications in the observation group was lower than that in the control group（9.30% vs 30.95%，χ2=6.224，P=0.013）．Conclusions  Risk prevention nursing intervention can improve the psychological status of patients after coronary angiography，improve treatment compliance，and reduce the overall incidence of vascular complications．