目的 对出生缺陷知信行健康教育模式效果进行策略分析与探讨,为进一步完善围产期保健服务及健康教育工作提供合理化建议。方法 采用《孕期妇女出生缺陷基本知识知晓率专题测评问卷》并结合实际情况设定有关信念、行为方面的7个问题,对2011年1月—2013年6月期间在中心孕妇学校参加健康教育活动课堂的孕妇进行调查,并应用决策树模型对中心现有的出生缺陷知信行健康教育模式效果进行探讨。结果 预防出生缺陷知识方面,对初高中及中专文化程度的孕期妇女加强出生缺陷预防知识健康教育的预期收益合计达到51.2%,可作为重点目标人群;预防出生缺陷信念方面,主要决定因素是户籍类型和年龄,加大对本地户籍及25岁以上流动妇女人群的健康教育,促进孕期妇女树立预防出生缺陷信念的预期收益累计达95.9%;预防出生缺陷行为方面,主要影响因素是产检医生的嘱咐,受到嘱咐的孕期妇女预期收益为62.3%。结论 为了达到出生缺陷防治目标与健康教育整体效果的提高,应将预防出生缺陷的健康教育工作重点放在初高中及中专文化程度人群,本地户籍孕期妇女和25岁以上流动性孕期妇女又是需要树立预防出生缺陷信念的重点人群,强化产检医生的嘱托义务是提高孕期妇女出生缺陷知信行健康教育模式效果的有力保证。

Objective To identify factors related to the knowledge, attitude and practice KAP of birth defects prevention among pregnant women, and provide reasonable suggestions to improve perinatal health services and health education. Methods Using cluster sampling method, 5500 participants from pregnant women school were enrolled. Information on “awareness of basic knowledge of birth defects” and 7 questions about attitudes and practice to participant actual situation was gathered through personal interviews using a structured questionnaire. The related factors were analyzed by classification tree model of SPSS 19.0. Results As to birth defects related knowledge, prospective return was more than 50% in the pregnant women with junior, senior high school and technical secondary school education level. As to birth defects prevention faith, the main determinant was census register types; prospective return of pregnant women who were local permanent residents and floating population aged ≥25 years was 95.9%. The main influencing factor of practice was prenatal doctor's education; prospected return was 62.3% after strengthening the health education of prenatal doctor. Conclusion In order to improve birth defects education effect, pregnant women who have junior, senior high school and technical secondary school education level and are local permanent residents or floating population aged ≥25 years should be key targeted population. Prenatal doctor's health education will be a powerful guarantee.

目的 研究比较低流量异氟烷与七氟烷麻醉在小儿腹腔镜手术中的麻醉效果。方法 选取在我院进行腹腔镜手术治疗的小儿患者120例作为研究对象,随机分为异氟烷和七氟烷两组,每组各60例,分别采用低流量异氟烷和七氟烷进行麻醉,比较两组患儿的相关麻醉参数,以及入睡、苏醒、拔管时间和不良反应情况。结果 两组患儿的不同时期脉搏氧饱和度、心率、呼气末二氧化碳浓度比较无差异(P＞0.05);七氟烷组患儿的不同时期的平均动脉压具有较强的稳定性,而异氟烷组患儿在诱导期间、手术过程中平均动脉压降低,差异有统计学意义(P＜0.05)。结论 在小儿腹腔镜手术过程,采用低流量七氟烷进行麻醉,可以使手术过程中血流动力学更加稳定,缩短术后拔管时间,减少术后不良反应发生,更易满足小儿腹腔镜手术的麻醉要求。

Objective To investigate efficacy between low flow isoflurane and sevoflurane in pediatric laparoscopic surgery. Methods 120 cases of children underwent laparoscopic surgery in our hospital were randomly divided into two groups. 60 patients in isoflurane group were given low-flow isoflurane anesthesia; 60 patients in sevoflurane group were given low-flow isoflurane anesthesia. Heart rate (HR), mean arterial blood pressure (MAP), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) at different period, sleep and awakening time, extubation time, and adverse reactions of two groups were observed. Results Heart rate (HR), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) of two groups at different period had no significantly difference (P>0.05). Mean arterial blood pressure (MAP) of two groups at different period had significantly difference (P<0.05). The sleep time and recovery time of two groups had no significant difference (P>0.05). The extubation time of sevoflurane was significantly lower than isoflurane group (P<0.05). The adverse reaction rate of sevoflurane was significantly lower than isoflurane group (P<0.05). Conclusion Low flow isoflurane and sevoflurane can be used in pediatric laparoscopic surgery, and the efficacy of sevoflurane is better.

目的 探讨优质护理服务对促进心胸外科患者恢复和提高患者护理满意度的效果。方法 将478例患者按时段分为按常规护理的对照组和实施优质护理的实验组,观察患者住院天数、拔除胸腔引流管时间、早期离床活动时间、护患纠纷发生率及满意度。结果 实验组患者住院天数、拔除胸腔引流管时间、早期离床活动时间、护患纠纷发生率明显缩短/降低,满意度显著提高,与对照组比较均差异有统计学意义(P＜0.01)。结论 优质护理服务有利于心胸外科患者术后恢复、减少护患纠纷和提高护理满意度,值得推广。

目的 探讨老年患者在手部静脉输液后用手握塑料输液瓶固定法的效果及患者手部的舒适度。方法 将160例次手部静脉输液患者随即分为试验组和对照组,试验组在静脉穿刺成功固定后再采用手握塑料输液瓶固定法固定手部,对照组在静脉穿刺成功固定后后再采用传统夹板固定法固定手部。结果 试验组患者在静脉输液中手握输液瓶固定的效果和舒适度高于对照组(P<0.05)。结论 手握塑料输液瓶固定法能减少针头移动或滑脱,减少老年患者在长时间输液时的疲劳感,增加舒适感,满意的固定效果有效地保证静脉输液顺利进行,减少重复穿刺,提高患者满意度。

目的 探讨快速康复外科理念在手术室护理中应用效果。方法 选取2012年2月—2014年10月我院手术室普外科择期手术治疗140例患者随机分为康复组和常规组,分别采用快速康复外科理念护理和常规护理,比较两组患者胃肠功能恢复时间、下床活动时间、住院时间及并发症发生情况。结果 康复组胃肠功能恢复时间、下床活动时间及住院时间均短于常规组,两组间各值比较有统计学意义(P＜0.05);康复组并发症总发生率为4.29%,低于常规组20.00%发生率,两组比较差异有统计学差异(P＜0.05)。结论 快速康复外科理念应用于手术室护理可缩短患者康复时间,降低并发症发生,有较高应用价值,值得在临床中推广应用。

目的 探讨连续护理在提高乳腺癌保乳患者生存质量中的应用效果,号召我院为病人提供持续性、连续性护理开展APN排班。方法 随机抽取2011年1月—2014年1月我院收治的117例乳腺癌患者的临床资料。观察两组患者术后生存质量、焦虑情况、抑郁情况、术后上肢水肿情况。结果 两组患者术后1周生存质量比较,差异无统计学意义(P＞0.05);观察组术后1个月、3个月、6个月、1年生存质量高于对照组,差异有统计学意义(P＜0.05)。两组患者术后1周焦虑情况比较,差异无统计学意义(P＞0.05);观察组术后1个月、3个月、6个月、1年忧郁情况优于对照组,差异有统计学意义(P＜0.05)。观察组患者术后上肢水肿情况优于对照组,差异有统计学意义(P＜0.05)。结论 连续护理在提高乳腺癌保乳患者生存质量中的应用效果较好,能够改善患者术后生存质量、焦虑抑郁情况、术后上肢水肿情况,值得临床推广。

Objective To explore the effects of continuous nursing intervention on the quality of life for breast cancer patients after breast conserving therapy. Methods 117 cases of patients with breast cancer were randomly divided into observation group(59 cases) and control group(58 cases). The control group were cared by routine postoperative care, including health education. On the basis of the control group, the observation group were cared by continuous nursing intervention, including cognitive intervention, psychological intervention, social support, life care, functional exercise, the prevention of complications and discharge instruction. The quality of life, anxiety situation, depression amd upper limb edema were compared in the two groups. Results There has no significant difference on the quality of life after 1 week in the two groups(P＞0.05); The quality of life after 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). There has no significant difference on the anxiety situation after 1 week in the two groups(P＞0.05); The anxiety situation after 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). The depression situation after 1 week, 1 month, 3 months, 6 months, 1 year for the observation group were higher than the control group(P＜0.05). The upper limb edema situation for the observation group were better than the control group(P＜0.05). Conclusion The effects of continuous nursing intervention on the quality of life for breast cancer patients after breast conserving therapy is good. It can improve the quality of life, situations of anxiety, depression and upper limb edema. It is worthy of clinical promotion.

目的 探讨对注意缺陷多动障碍（ADHD）患儿联合应用维生素D与盐酸托莫西汀的效果及对其行为功能障碍和神经功能损伤的影响。方法 选择于我院接受治疗的105例ADHD患儿,纳入时间为2023年7月—2024年3月,按照计算机分组法分为对照组52例给予盐酸托莫西汀治疗,观察组53例给予维生素D联合盐酸托莫西汀治疗,比较两组临床疗效、神经与行为功能、不良反应。结果 观察组总有效率（96.23%）高于对照组（78.85%）（P<0.05）。治疗后,与对照组比较,观察组神经元特异性烯醇化酶水平与行为、学习、躯体、冲动多动、焦虑及多动指数评分更低（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 对于ADHD患儿,使用维生素D联合盐酸托莫西汀显示出更为显著的疗效,能有效缓解行为功能障碍,减少神经功能损伤,且具有良好的安全性。

Objective To explore the effect of combined use of vitamin D and atomoxetine hydrochloride on children with attention deficit hyperactivity disorder（ADHD）and its impact on their behavioral dysfunction and neurological damage. Methods A total of 105 children with ADHD treated in the hospital were included from July 2023 to March 2024. They were divided into control group with 52 cases treated with atomoxetine hydrochloride, and observation group with 53 cases treated with vitamin D combined with atomoxetine hydrochloride using a computerized grouping method. The clinical efficacy, neurological function, behavioral function, and adverse reactions were observed in both groups. Results The total effective rate of the observation group（96. 23%）was higher than that of the control group（78. 85%）（P<0. 05）. After treatment, compared with the control group, the levels of neuron-specific enolase in the observation group were significantly lower in terms of behavior, learning, physical fitness, impulsivity hyperactivity, anxiety and hyperactivity index scores（P<0. 05）. The comparison of the incidence of adverse effects between the two groups was not significant（P>0. 05）. Conclusions The combined use of vitamin D and atomoxetine hydrochloride has a more significant therapeutic effect on children with ADHD, which can effectively alleviate behavioral dysfunction, reduce neurological damage, and has good safety.

      目的   探讨基于迷你临床演练评估（Mini-CEX）的可视化思维导图联合案例教学在全科住院医师规范化培训中的应用效果。方法   选取参加全科住院医师规范化培训的52例学员并分为试验组（n=26）和对照组（n=26）。对照组采取以案例讲授为主的传统教学模式，试验组采取基于Mini-CEX的可视化思维导图联合案例教学模式。对比两组Mini-CEX评分、考核成绩及教学满意度。结果   试验组Mini-CEX测评的问诊技巧、体格检查、临床判断、诊治能力、技能操作及整体表现得分均高于对照组（P＜0.05）。试验组理论知识［（86.89±4.75）分 vs （82.96±4.87分）］、专业技能［（84.20±3.46）分 vs （70.18±4.93）分］及病历书写成绩［（80.64±5.26）分 vs （75.58±5.94）分］均高于对照组（t分别为2.678、13.685、2.764，P分别为0.009、＜0.001、0.007）。试验组住院医师教学满意度高于对照组（P＜0.05）。结论   基于Mini-CEX的可视化思维导图联合案例教学模式用于全科住院医师规范化培训，有助于提高教学效果及教学满意度。

       Objective  To evaluate the effect of visual mind mapping combined with case teaching based on mini-clinical evaluation exercise（Mini-CEX）for standardized training of general practitioners．Methods  A total of 52 students who participated the standardized training of general practitioners were selected and divided into an experimental group（n=26）and a control group（n=26）．The control group adopted the traditional teaching mode based on case teaching and the experimental group adopted the visual mind mapping combined with case teaching based on Mini-CEX．The Mini-CEX score，assessment  results and teaching satisfaction of two groups were compared．Results  The interrogation skills，physical examination，clinical judgment，diagnosis and treatment ability，skill operation and overall performance of Mini-CEX in experimental group were higher than control group（P＜0.05）．Theoretical knowledge score（［86.89±4.75］ vs ［82.96±4.87］），professional skills score（［84.20±3.46］ vs［70.18±4.93］）and medical record writing score（［80.64±5.26］ vs ［75.58±5.94］）of experimental groups were higher than control group（t=2.678，13.685，2.764，P=0.009，＜0.001，0.007）．The teaching satisfaction of residents in experimental group was higher than control group（P＜0.05）．Conclusions  The visual mind mapping combined with case teaching based on Mini-CEX for standardized training of general practitioners is helpful to improve teaching effect and teaching satisfaction．

     目的   探讨综合康复训练对脑卒中后轻度认知障碍患者的应用效果及认知功能影响。方法   选取2022年2月—2023年2月暨南大学附属广州红十字会医院收治的80例脑卒中后轻度认知障碍患者展开前瞻性研究，应用抽签法将其分为综合康复组与常规组，各40例。常规组实施常规干预，综合康复组在常规组基础上增加综合康复训练，对比其认知功能，简易智能精神状态检查量表（MMSE）、美国国立卫生院卒中量表（NIHSS）评分变化，运动功能与平衡功能，日常生活能力与生活质量。结果   干预后综合康复组患者洛文斯顿作业疗法认知量表评分注意力为（3.36±0.42）分、思维运动为（17.34±2.31）分、定向力为（13.19±1.24）分，均高于常规组，且两组干预后高于干预前（P＜0.05）；干预后综合康复组患者MMSE评分为（25.58±4.12）分高于常规组，且两组干预后高于干预前，NIHSS评分为（14.53±2.62）分，低于常规组，且两组干预后低于干预前（P＜0.05）；干预后综合康复组患者Fugl-Meyer运动功能评定量表评分为（14.51±3.23）分、手臂动作调查测试表评分为（26.86±5.25）分、平衡量表评分为（43.06±5.13）分，高于常规组，且两组干预后高于干预前（P＜0.05）；干预后综合康复组患者日常生活活动能力量表评分为（53.02±4.43）分、脑卒中专用生活质量量表评分为（97.11±12.23）分，高于常规组，且两组干预后高于干预前（P＜0.05）。结论   针对脑卒中后轻度认知障碍患者采取综合康复训练可促进患者认知功能恢复，提升患者运动功能及机体平衡功能，改善患者智力水平与神经功能，进一步提升患者日常生活能力与生活质量。

        Objective  To explore the effect of comprehensive  rehabilitation training on cognitive function in patients with mild cognitive impairment after stroke．Methods  A  prospective  study was conducted on  80  patients with mild cognitive impairment after stroke，who admitted to the hospital from February 2022 to February 2023．They were divided into a comprehensive rehabilitation group and a control group using a lottery method，with 40 patients in each group．The control group  received  routine intervention，while the comprehensive  rehabilitation group  received additional comprehensive  rehabilitation training on the basis of the control group．Their cognitive function，Mini Mental State Examination Scale（MMSE），National  Institutes of Health Stroke Scale in the United States（NIHSS）score changes，motor function and balance function，daily living ability and quality of life were compared．Results  After intervention，the Lowenstein Occupational Therapy Cognitive Scale scores of attention（3.36±0.42），thinking and motor（17.34±2.31），and orientation（13.19±1.24）in the comprehensive  rehabilitation group were higher than those in the control group，and both groups had higher scores after intervention than before（P＜0.05）．After intervention，the MMSE score（25.58±4.12）of patients in the comprehensive rehabilitation group was higher than that of the control group，and both groups had higher scores after intervention compared to those before intervention．The NIHSS score（14.53±2.62）was lower than that of the control group，and both groups had lower scores after intervention compared to those before intervention（P＜0.05）．After intervention，the Fugl Meyer Assessment score（14.51±3.23），Arm Movement Survey Test Form score（26.86±5.25），and Balance Scale score（43.06±5.13）in the comprehensive rehabilitation group were higher than those in the control group，and both groups had higher scores after intervention than before（P＜0.05）．After intervention，the Basic Activity of Daily Living score（53.02±4.43）and stroke specific quality of life score（97.11±12.23）in the comprehensive  rehabilitation group were higher than those in the control group，and both groups had higher scores after intervention than before（P＜0.05）．Conclusions  Comprehensive  rehabilitation training for patients with mild cognitive impairment after stroke can promote cognitive function recovery，improve motor function and balance function，enhance intelligence and neurological function，and further improve daily living ability and quality of life．

       目的   探讨单次根管疏通填充对牙体牙髓病患者的填充效果及龈沟液炎症指标的影响。方法   选择2023年8月—2024年2月天津市人民医院接收的牙体牙髓病患者84例进行研究，采用随机数字表法分为两组，各42例。对照组采取多次根管疏通填充，观察组采取单次根管疏通填充，比较2组填充效果、治疗效果、龈沟液炎症指标、口腔健康和功能指标、并发症情况。结果 观察组欠填、恰填、超填比例与对照组比较无统计学意义（χ ² 分别为0.262、1.615、0.512，P分别为0.608、0.203、0.474）。观察组的总有效率为97.62%，高于对照组80.95%（χ ² =6.098，P=0.014）。治疗后，观察组龈沟液白细胞介素IL-1β、IL-17A、IL-35、肿瘤坏死因子-α水平低于对照组（t分别为3.271、3.028、2.699、2.968，P分别为0.002、0.003、0.008、0.004）。治疗后，观察组龈沟出血指数、牙龈指数低于对照组，咬合力、咀嚼效率高于对照组（t分别为2.311、2.686、2.262、2.776，P分别为0.023、0.009、0.026、0.007）。观察组并发症发生率4.76%低于对照组21.43%（χ ² =5.126，P=0.024）。结论   牙体牙髓病采取单次根管疏通填充治疗可保证恰当的填充效果，取得良好的治疗效果，而且减轻龈沟液炎症反应，促进口腔健康和功能改善，并发症较少，安全性高，值得推广。

       Objective  To explore the effects of one-time  root canal dredging and filling on the filling effect and gingival crevicular fluid inflammation indexes in patients with endodontic disease．Methods  A total of 84 cases of endodontic patients admitted to the Tianjin People’s Hospital from August 2023 to February 2024 were chosen and separated into the control group（n=42，multiple-time root canal dredging and filling）and the observation group（n=42，one-time root canal dredging and filling）by random number table method．The filling effect，therapeutic effect，gingival creval fluid inflammation indicators，oral health and function indicators，and complications were compared．Results  The underfilling，accurate filling and overfilling showed no significant difference between the two groups（χ ² =0.262，1.615，0.512，P=0.608，0.203，0.474）．The total effective  rate of observation group was 97.62%，higher than that of control group 80.95%（χ ² =6.098，P=0.014）．After treatment，levels of interleukin（IL）-1β，IL-17A，IL-35 and tumor necrosis factor-α in gingival crevicular fluid of observation group were lower（t=3.271、3.028、2.699、2.968，P=0.002、0.003、0.008、0.004）．After treatment，the sulcus bleeding index and gingival index of the observation group were lower，and the biting force and mastication efficiency were higher（t=2.311、2.686、2.262、2.776，P=0.023、0.009、0.026、0.007）．The complication rate in the observation group was 4.76%，lower than that in the control group 21.43%（χ ² =5.126，P=0.024）．Conclusions  A one-time  root canal dredging and filling treatment for endodontic diseases can ensure proper filling effect，achieve good therapeutic effect，reduce gingival crevicular fluid inflammation，promote oral health and function improvement，with fewer complications，high safety，which is worthy of promotion．