目的 探讨基于失效模式与效应分析法（FMEA）风险管理模式的在消化内镜诊疗护理中的应用价值。方法 选取2021年7月—2022年12月在河南省人民医院接受无痛消化内镜诊疗的368例患者为研究对象,根据入组时间顺序,2022年3月及其之前入组患者为对照组（n=171）,实施常规护理管理;2022年3月之后入组的患者为观察组（n=197）,在对照组基础上,增加基于FMEA的护理风险管理模式,对比两组患者的护理质量。结果 观察组各环节风险优先级（RPN）值较干预前明显好转,RPN总分由1 044分降至336分,观察组不良事件发生率低于对照组（17.3% vs 33.3%,P<0.05）,观察组患者对医护人员满意度高于对照组（92.9% vs 85.4%,P<0.05）,观察组患者所需的等待时间低于对照组[（35.68±7.29）min vs （44.27±8.65）分min,P<0.05]。结论 FMEA风险管理模式能有效提高无痛消化内镜诊疗中的护理质量。

Objective To explore the application analysis of failure mode and effect analysis（FMEA）risk management model in digestive endoscopy diagnosis treatment and nursing．Methods A total of 368 patients who underwent painless endoscopic diagnosis and treatment at Henan Provincial People’s Hospital from July 2021 to December 2022 were selected．According to the order of enrollment,patients enrolled in March 2022 and before were selected as the control group（n=171）,and routine nursing management was implemented．The patients enrolled after March 2022 were in the observation group（n=197）．In addition to the control group,a nursing risk management model based on FMEA was added to compare the nursing quality of the two groups of patients．Results The risk priority number（RPN）values of each link in the observation group showed a significant improvement compared to that before intervention．The total RPN score decreased from 1 044 points to 336 points,and the incidence of adverse events in the observation group was lower than that in the control group（17.3% vs 33.3%,P<0.05）．The satisfaction of the observation group with medical staff was higher than that in the control group（92.9% vs 85.4%,P<0.05）．The waiting time required by the observation group was lower than that in the control group[（35.68±7.29）min vs（44.27±8.65）min,P<0.05]．Conclusion sThe FMEA risk management model can effectively improve the nursing quality in painless endoscopic diagnosis and treatment．

目的 探讨血必净注射液对SAP大鼠TLR4信号通路介导肠黏膜屏障功能障碍的影响。方法 24只SD大鼠随机分成空白组(n=8)、对照组(n=8)和治疗组(n=8)。对照组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射制备SAP模型,空白组采用等量生理盐水逆行注射。治疗组在造模3 h后经鼠尾静脉注射血必净注射液(3 mL/kg)。三组大鼠造模后观察24 h,然后处死取胰腺和小肠组织送病理检查,采用荧光RT-PCR技术检测TLR4和NF-κB表达水平,采用ELSIA法检测血清TNF-α、IL-6、淀粉酶(AMS)及二胺氧化酶(DAO)水平,比较三组大鼠各项指标。结果 对照组和治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平均高于空白组(P>0.05),治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平低于对照组(P＜0.05)。结论 血必净注射液通过干预SAP大鼠TLR4信号通路,降低小肠组织TLR4和NF-κB的表达,减轻小肠组织的炎症反应,对肠黏膜屏障具有一定的保护作用。

Objective To investigate the effect on intestinal mucosal barrier dysfunction (IBF) of Xuebijing injection mediated by Toll-like receptor 4 (TLR4) signal pathway in rats of severe acute pancreatitis (SAP). Methods 24 Sprague Dawley (SD) rats were randomly divided into Sham group (n=8), control group (n=8) and treatment group (n=8). The SAP model was established by retrograde injection of 4.5% sodium taurocholate into the biliopancreatic duct in control group and treatment group, while control group was injected with the same amount of saline. In treatment group, Xuebijing injection (3 mL/kg) was injected via tail vein after 3h of modeling. All rats were monitored and sacrificed after 24 hours of modeling. Samples of pancreas and intestine were collected for pathologic determination. A fluorescent RT-PCR was used to determine the expression of TLR4 and NF-κB of small intestine. The serum levels of TNF-α, IL-6, amylase (AMS) and diamine oxidase (DAO) were measured by using ELISA. All parameters of three groups were compared. Results The expression of TLR4 and NF-κB of small intestine in control group and treatment group were higher than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). The expression of TLR4 and NF-κB of small intestine in treatment group were lower than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). Conclusion Xuebijing injection may not only reduce the expression of TLR4 and NF-κB of small intestine, but also alleviate the inflammation reaction of small intestine by interfering with TLR4 signal pathway, which may have a protective effect on intestinal mucosal barrier in SAP rats.