目的 探讨将 Root Cause Analysis（RCA）质量管理模式与心理资本理论相结合应用于手术核查团队，对改善沟通中断、提升沟通执行质量与团队协作能力的效果。方法 选取 2025年 1 月至 2025 年12 月某三级医院手术室手术团队成员 80 名，按手术间编号分为对照组与实验组，各 40 名。对照组实施常规手术核查流程；实验组在此基础上实施基于 RCA 的流程诊断与基于心理资本理论的综合沟通能力提升干预。干预结束后，比较两组沟通中断发生率、核查流程执行质量、沟通效率，以及心理资本量表（PCQ-24）和团队协作量表（T-TPQ）得分。结果 实验组沟通中断发生率显著低于对照组（P＜0.05），核查流程执行质量和沟通效率均显著优于对照组（P＜0.001）。实验组 PCQ-24 各维度及总分、T-TPQ 各维度及总分均显著高于对照组（均 P＜0.001）。结论 将 RCA 流程分析与心理资本理论干预相结合，可通过流程规范化与心理动力增强双路径同步改善手术团队沟通质量与协作水平，具有良好的临床应用价值与推广潜力。

目的 探讨将 Root Cause Analysis（RCA）质量管理模式与心理资本理论相结合应用于手术核查团队，对改善沟通中断、提升沟通执行质量与团队协作能力的效果。方法 选取 2025年 1 月至 2025 年12 月某三级医院手术室手术团队成员 80 名，按手术间编号分为对照组与实验组，各 40 名。对照组实施常规手术核查流程；实验组在此基础上实施基于 RCA 的流程诊断与基于心理资本理论的综合沟通能力提升干预。干预结束后，比较两组沟通中断发生率、核查流程执行质量、沟通效率，以及心理资本量表（PCQ-24）和团队协作量表（T-TPQ）得分。结果 实验组沟通中断发生率显著低于对照组（P＜0.05），核查流程执行质量和沟通效率均显著优于对照组（P＜0.001）。实验组 PCQ-24 各维度及总分、T-TPQ 各维度及总分均显著高于对照组（均 P＜0.001）。结论 将 RCA 流程分析与心理资本理论干预相结合，可通过流程规范化与心理动力增强双路径同步改善手术团队沟通质量与协作水平，具有良好的临床应用价值与推广潜力。

Operating Room, Qidong People's Hospital, Jiangsu Province, Qidong 226200, Jiangsu, China Objective: To evaluate the effectiveness of an intervention combining Root Cause Analysis (RCA)–based quality management and Psychological Capital (PsyCap) theory in reducing communication interruptions and improving communication quality and teamwork in surgical safety check teams. Methods: Eighty surgical team members from a tertiary hospital (January 2025 - December 2025.) were assigned to a control group or an intervention group according to operating room allocation (40 per group). The control group followed routine surgical safety check procedures, whereas the intervention group additionally received an RCA-guided workflow analysis and a PsyCap-based communication enhancement program. Post-intervention outcomes included communication interruption rate, execution quality and efficiency of safety checks, Psychological Capital Questionnaire (PCQ-24) scores, and TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) scores. Results: The intervention group demonstrated a significantly lower communication interruption rate compared with the control group (P＜0.05). Execution quality and communication efficiency were significantly improved in the intervention group (P＜0.001). PCQ-24 total and subscale scores were significantly higher in the intervention group than in the control group (P＜0.001), as were T-TPQ total and subscale scores (P＜0.001). Conclusion: Integrating RCA-based workflow optimization with PsyCap-oriented psychological and behavioral training can effectively enhance communication quality, reduce interruptions, and strengthen teamwork in surgical safety check teams. The combined model has strong applicability and potential for wider clinical promotion.

目的 探讨将 Root Cause Analysis（RCA）质量管理模式与心理资本理论相结合应用于手术核查团队，对改善沟通中断、提升沟通执行质量与团队协作能力的效果。方法 选取 2025年 1 月至 2025 年12 月某三级医院手术室手术团队成员 80 名，按手术间编号分为对照组与实验组，各 40 名。对照组实施常规手术核查流程；实验组在此基础上实施基于 RCA 的流程诊断与基于心理资本理论的综合沟通能力提升干预。干预结束后，比较两组沟通中断发生率、核查流程执行质量、沟通效率，以及心理资本量表（PCQ-24）和团队协作量表（T-TPQ）得分。结果 实验组沟通中断发生率显著低于对照组（P＜0.05），核查流程执行质量和沟通效率均显著优于对照组（P＜0.001）。实验组 PCQ-24 各维度及总分、T-TPQ 各维度及总分均显著高于对照组（均 P＜0.001）。结论 将 RCA 流程分析与心理资本理论干预相结合，可通过流程规范化与心理动力增强双路径同步改善手术团队沟通质量与协作水平，具有良好的临床应用价值与推广潜力。

目的 探讨症状性颅内动脉重度狭窄（sICAS）患者接受自膨式支架成形术后预后不良的相关因素，并构建预测模型。方法 回顾性连续纳入2023年1月至2025年6月于本院脑血管病科行自膨式支架联合经皮腔内血管成形支架置入术（PTAS）的重度sICAS患者96例。收集患者一般临床资料、影像学特征、手术相关资料及随访结局。以术后1年内发生主要终点事件（包括缺血性卒中复发、颅内出血、死亡或症状性支架内再狭窄）定义为预后不良。采用单因素及多因素Logistic回归分析筛选独立危险因素，并构建列线图预测模型。通过受试者工作特征曲线（ROC）及校准曲线评估模型效能。结果 96例患者中，术后1年共发生预后不良事件22例（22.9%），其中缺血性卒中复发12例（12.5%），症状性支架内再狭窄8例（8.3%），颅内出血2例（2.1%）。多因素Logistic回归分析显示，糖尿病（OR = 3.21，95% CI：1.28～8.05，P = 0.013）、术前狭窄长度≥10 mm（OR = 2.89，95% CI：1.15～7.28，P = 0.024）、Mori C型病变（OR = 4.12，95% CI：1.52～11.16，P = 0.005）及术后即刻残余狭窄率≥20%（OR = 2.67，95% CI：1.06～6.72，P = 0.037）是预后不良的独立危险因素。基于上述因素构建的预测模型AUC为0.84（95% CI：0.76～0.92），校准曲线显示模型一致性良好。结论 糖尿病、长病变、复杂Mori分型及术后残余狭窄率高是自膨式支架成形术后预后不良的独立预测因素，所构建的预测模型具有较好的区分度与校准度，可用于个体化风险评估。

目的 探讨将 Root Cause Analysis（RCA）质量管理模式与心理资本理论相结合应用于手术核查团队，对改善沟通中断、提升沟通执行质量与团队协作能力的效果。方法 选取 2025年 1 月至 2025 年12 月某三级医院手术室手术团队成员 80 名，按手术间编号分为对照组与实验组，各 40 名。对照组实施常规手术核查流程；实验组在此基础上实施基于 RCA 的流程诊断与基于心理资本理论的综合沟通能力提升干预。干预结束后，比较两组沟通中断发生率、核查流程执行质量、沟通效率，以及心理资本量表（PCQ-24）和团队协作量表（T-TPQ）得分。结果 实验组沟通中断发生率显著低于对照组（P＜0.05），核查流程执行质量和沟通效率均显著优于对照组（P＜0.001）。实验组 PCQ-24 各维度及总分、T-TPQ 各维度及总分均显著高于对照组（均 P＜0.001）。结论 将 RCA 流程分析与心理资本理论干预相结合，可通过流程规范化与心理动力增强双路径同步改善手术团队沟通质量与协作水平，具有良好的临床应用价值与推广潜力。

目的：探讨闭合复位弹性髓内钉固定术（CR-ESIN）对股骨骨折患儿康复进程及关节功能的影响。方法：回顾性选取2024年4月~2025年6月至我院行内固定术治疗的102例股骨骨折患儿为研究对象，依据手术方案不同，将行CR-ESIN治疗的51例患儿列为CR-ESIN组，将剩余51例行传统切开复位接骨板内固定术（ORIF）治疗的患儿列为ORIF组，比较两组患儿的治疗情况、康复进程，手术并发症发生情况，关节功能恢复情况及内固定物取出阶段负担。结果：在不同手术方案下，CR-ESIN组的手术耗时、术中出血量、术后住院时间、支具使用时间、完全负重时间分别为（60.29±5.44）min、（50.52±5.49）mL、（6.22±1.34）d、（4.15±1.33）周、（6.81±1.34）周，均低于ORIF组[（76.33±8.29）min、（190.48±20.51）mL、（8.17±1.65）d、（6.32±1.48）周、（7.82±2.17）周]（t=11.552，47.076，6.552，8.322，2.828；P＜0.05）。CR-ESIN组的手术并发症发生率5.88%（3/51）低于ORIF组19.61%（10/51）（x2=4.320；P＜0.05）。CR-ESIN组的髋关节前屈活动度、后伸活动度、儿童下肢功能量表（PODCI）评分分别为（132.44±22.52）°、（20.39±4.47）°、（75.14±6.29）分，均高于ORIF组[（120.28±20.37）°、（17.55±3.12）°、（70.31±5.36）分]，术后双侧股骨长度差（1.52±0.39）cm低于ORIF组（3.08±0.44）cm（t=2.860，3.721，4.174，18.948；P＜0.05）。CR-ESIN组的取出手术切口长度、取出手术耗时、取出手术出血量、再骨折率均低于ORIF组（t/x2=31.706，8.298，38.448，4.883；P＜0.05）。结论：CR-ESIN能提高股骨骨折患儿手术效率并降低出血风险，与传统ORIF相比，此术式有利于加快患儿康复进程、降低术后并发症发生率、促进关节功能恢复并减轻内固定物取出阶段负担。

Objective:To explore the effects of closed reduction elastic intramedullary nail fixation (CR-ESIN) on the rehabilitation process and joint function of children with femoral fractures.Methods:A retrospective study was conducted on 102 children with femoral fractures who underwent internal fixation surgery in our hospital from April 2024 to June 2025. Based on different surgical plans, 51 children who underwent CR-ESIN treatment were included in the CR-ESIN group, and the remaining 51 children who underwent traditional open reduction plate internal fixation (ORIF) treatment were included in the ORIF group. The treatment status, rehabilitation process, incidence of surgical complications, joint function recovery, and burden during the removal of internal fixation materials were compared between the two groups of children.Results:Under different surgical plans, the surgical time, intraoperative blood loss, postoperative hospitalization time, brace use time, and complete weight-bearing time of the CR-ESIN group were (60.29 ± 5.44) min, (50.52 ± 5.49) mL, (6.22 ± 1.34) d, (4.15 ± 1.33) weeks, and (6.81 ± 1.34) weeks, lower than the ORIF group [(76.33 ± 8.29) min, (190.48 ± 20.51) mL, (8.17 ± 1.65) d, (6.32 ± 1.48) weeks, and (7.82 ± 2.17) weeks] (t=11.552，47.076，6.552，8.322，2.828; P<0.05). The incidence of surgical complications in the CR-ESIN group was 5.88% (3/51) lower than the ORIF group 19.61% (10/51) (x2=4.320; P<0.05). The hip flexion range of motion, extension range of motion, and PODCI scores of the CR-ESIN group were (132.44 ± 22.52) °, (20.39 ± 4.47) °, and (75.14 ± 6.29) points, higher than the ORIF group [(120.28 ± 20.37) °, (17.55 ± 3.12) °, and (70.31 ± 5.36) points]. The length difference between the bilateral femurs was (1.52 ± 0.39) cm, which was lower than the ORIF group (3.08 ± 0.44) cm (t=2.860，3.721，4.174，18.948; P<0.05). The length of the surgical incision, the duration of the extraction surgery, the amount of bleeding during the extraction surgery, and the rate of re fracture in the CR-ESIN group were all lower than the ORIF group (t/x2=31.706，8.298，38.448，4.883; P<0.05).Conclusion:CR-ESIN can improve the surgical efficiency and reduce the risk of bleeding in children with femoral fractures. Compared with traditional ORIF, this procedure is beneficial for accelerating the recovery process of children, reducing the incidence of postoperative complications, promoting joint function recovery, and reducing the burden of internal fixation removal stage.

目的 探讨芪苈强心胶囊治疗慢性充血性心力衰竭（cCHF）的临床疗效及安全性，并分析其对中医证候积分、心功能、心室重塑的影响。方法 选取2024年3月～2025年3月于本院就诊的106例cCHF患者分为对照组、研究组，各53例。对照组采取常规西药治疗，研究组采取芪苈强心胶囊联合常规西药治疗，连续治疗4周。比较两组临床疗效及治疗前后中医证候积分、心功能、心室重塑、炎症因子[肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、淀粉样蛋白A（SAA）]、血管内皮功能[血管紧张素Ⅱ（AngⅡ）、内皮素-1（ET-1）、一氧化氮（NO）、血管内皮生长因子（VEGF）]。观察两组不良反应。结果 研究组总有效率高于对照组（P＜0.05）；治疗后，研究组中医证候积分较对照组明显降低（P＜0.05）；治疗后，研究组CO、LVFS、LVEF、较对照组明显升高，LVEDD、IVST、LVPWT、LVMI较对照组明显降低（P＜0.05）；治疗后，研究组血清TNF-α、IL-6、SAA水平较对照组明显降低（P＜0.05）；治疗后，研究组AngⅡ、ET-1水平较对照组明显降低，NO、VEGF水平较对照组明显升高（P＜0.05）；两组治疗后均无新发症状及明显不良反应。结论 芪苈强心胶囊联合常规西药治疗cCHF患者的疗效显著，可增强心功能，延缓心室重塑，并可减轻炎症反应，改善血管内皮功能。

目的：分析血脑屏障标志物闭合蛋白（Occludin，OCLN）、密封蛋白-5（Claudin-5，CLDN5）与帕金森病（PD）患者神经功能损伤程度及不良预后的关联。方法：研究对象选择2024年6月~2025年6月就诊于我院的180例PD患者，及同期接受检查的180例健康志愿者，将其分别列为病例组、对照组，比较两组OCLN、CLDN5间差异。依据病情严重程度不同，将PD患者分别列为早期组（50例）、中期组（65例）和晚期组（65例），比较三组患者OCLN、CLDN5，神经损伤标志物间差异，分析晚期组患者OCLN、CLDN5与神经损伤标志物的相关性。统计入组患者不良预后发生情况，比较不同预后患者OCLN、CLDN5及神经损伤标志物间差异，分析PD患者预后影响因素，验证OCLN、CLDN5对PD患者不良预后的预测效能。结果：病例组的外周血OCLN、CLDN5均高于对照组（t=50.450，51.670；P＜0.05）。晚期组外周血OCLN、CLDN5、神经元特异性烯醇化酶（NSE）、泛素羧基末端水解酶L1（UCH-L1）、神经丝轻链蛋白（NfL）、胶质纤维酸性蛋白（GFAP）均高于中期组、早期组（F=280.611，378.453，82.254，122.413，185.272，257.733；P＜0.05）。晚期组的OCLN、CLDN5均与NSE、UCH-L1、NfL、GFAP正相关（r=0.411，0.457，0.505，0.494，0.465，0.425，0.491，0.503；P＜0.05）。180例PD患者的不良预后发生率为28.89%（52/180）。预后不良组的外周血OCLN、CLDN5、NSE、UCH-L1、NfL、GFAP均高于预后良好组（t=17.096，14.405，7.632，6.903，11.695，10.702；P＜0.05）。Logistic多因素回归分析结果显示，外周血OCLN、CLDN5、NfL、GFAP高表达为PD患者发生不良预后的危险因素。经ROC检验，外周血OCLN、CLDN5联合检测对于PD不良预后的预测AUC高于外周血OCLN、CLDN5单独检测（DeLong检验，P＜0.05）。结论：外周血OCLN、CLDN5可随PD患者神经损伤程度加剧而不断升高，联合检测外周血OCLN、CLDN5或可作为预测患者不良预后的重要辅助手段。

Objective:To analysis of the association between blood-brain barrier markers Occludin (OCLN), Claudin-5 (CLDN5) and the degree of neurological damage and poor prognosis in PD patients.Methods:The research subjects selected 180 PD patients who visited our hospital from June 2024 to June 2025, as well as 180 healthy volunteers who underwent examinations during the same period. They were divided into a case group and a control group, and the differences between the two groups in terms of OPLN and CLDN5 were compared. According to the severity of the disease, PD patients were divided into early group (50 cases), middle group (65 cases), and late group (65 cases). The differences in OCLN, CLDN5, and nerve injury markers among the three groups of patients were compared, and the correlation between OCLN, CLDN5, and nerve injury markers in the late group of patients was analyzed. Statistically analyze the occurrence of poor prognosis in enrolled patients, compare the differences in OCLN, CLDN5, and nerve injury markers among patients with different prognoses, analyze the factors affecting the prognosis of PD patients, and verify the predictive power of OCLN and CLDN5 for poor prognosis in PD patients.Results:The peripheral blood levels of OCLN and CLDN5 in the case group were higher than the control group (t=50.450，51.670; P<0.05). The levels of OCLN, CLDN5 NSE,UCH-L1,NfL, and GFAP in peripheral blood of the late stage group were higher than those of the mid stage and early stage groups (F=280.611，378.453，82.254，122.413，185.272，257.733; P<0.05). The OCLN and CLDN5 in the late stage group were positively correlated with NSE, UCH-L1, NfL, and GFAP (r=0.411，0.457，0.505，0.494，0.465，0.425，0.491，0.503; P<0.05). The incidence of poor prognosis in 180 PD patients was 28.89% (52/180). The peripheral blood levels of OCLN, CLDN5, NSE, UCH-L1, NfL, and GFAP in the poor prognosis group were higher than those in the good prognosis group (t=17.096，14.405，7.632，6.903，11.695，10.702; P<0.05). The results of logistic multiple regression analysis showed that high expression of peripheral blood OCLN, CLDN5, NfL, and GFAP were risk factors for poor prognosis in PD patients. According to ROC test, the combined detection of peripheral blood OCLN and CLDN5 has a higher AUC for predicting poor prognosis of PD than the detection of peripheral blood OCLN and CLDN5 alone (DeLong test, P<0.05).Conclusion:Peripheral blood OCLN and CLDN5 can exacerbate and continuously increase the degree of nerve damage in PD patients. Combined detection of peripheral blood OCLN and CLDN5 may serve as an important auxiliary tool for predicting poor prognosis in patients.

目的 探讨密室逃脱教学法运用于急诊护理教学查房的效果。方法 选取2024年6月—2025年6月在本院急诊科的新入职护士76人作为研究对象,按随机数字表法将所有护士分为对照组和观察组（n均=38）。对照组采用传统模式护理教学查房,观察组采用密室逃脱教学法教学查房。培训后对两组护士采用理论及操作技能考核、批判性思维能力量表-中文版进行考核，并调查两组护士对两种教学模式的满意度。结果 与对照组比较，观察组的理论知识成绩及操作技能成绩明显提升（P＜0.05）；另外，观察组的批判性思维能力量表-中文版得分比对照组明显提升（P＜0.05）。观察组的非常满意、比较满意例数（率）及总满意度均比对照组明显增加（P＜0.05）。结论 密室逃脱教学法可有效提高急诊护理教学查房效果，值得在临床教学实践中进一步推广。

目的 探讨密室逃脱教学法运用于急诊护理教学查房的效果。方法 选取2024年6月—2025年6月在本院急诊科的新入职护士76人作为研究对象,按随机数字表法将所有护士分为对照组和观察组（n均=38）。对照组采用传统模式护理教学查房,观察组采用密室逃脱教学法教学查房。培训后对两组护士采用理论及操作技能考核、批判性思维能力量表-中文版进行考核，并调查两组护士对两种教学模式的满意度。结果 与对照组比较，观察组的理论知识成绩及操作技能成绩明显提升（P＜0.05）；另外，观察组的批判性思维能力量表-中文版得分比对照组明显提升（P＜0.05）。观察组的非常满意、比较满意例数（率）及总满意度均比对照组明显增加（P＜0.05）。结论 密室逃脱教学法可有效提高急诊护理教学查房效果，值得在临床教学实践中进一步推广。

Objective: To investigate the effectiveness of the escape room teaching method in emergency nursing teaching rounds. Methods: A total of 76 newly hired nurses in the Emergency Department of our hospital between June 2024 and June 2025 were selected as study subjects. Using a random number table, all nurses were divided into a control group and an observation group (n = 38 each). The control group underwent traditional nursing teaching rounds, while the observation group participated in teaching rounds using the escape room teaching method. After training, both groups were assessed using theoretical and practical skill examinations, as well as the Critical Thinking Skills Scale (Chinese Version), and their satisfaction with the two teaching models was surveyed. Results: Compared with the control group, the observation group showed significant improvements in theoretical knowledge and practical skill scores (P < 0.05); Additionally, the scores on the Critical Thinking Skills Scale (Chinese Version) in the observation group were significantly higher than those in the control group (P < 0.05). The number (and rate) of nurses in the observation group who reported being “very satisfied” or “fairly satisfied,” as well as the overall satisfaction rate, were significantly higher than those in the control group (P < 0.05). Conclusion: The escape room teaching method can effectively enhance the effectiveness of emergency nursing teaching rounds and is worthy of further promotion in clinical teaching practice.