目的 研究伤口护理中延续性护理的应用效果。方法 选取2017年12月—2018年8月为研究阶段,抽取我院收治的130例皮肤擦伤和存在深部皮肤损伤患者作为研究对象,采用均衡分组法分为参照组和研究组,各65例。参照组采用常规伤口护理,研究组采用延续性护理干预。护理1个月后观察效果,包括并发症发生情况、创面愈合时间、疼痛评分及舒适度评分,进一步观察患者护理前后焦虑、抑郁评分变化。结果 研究组并发症发生率1.54%,参照组并发症发生率13.85%,对比有统计学意义(P＜0.05)。研究组创面愈合时间与参照组相比要短,疼痛评分与参照组相比要低,舒适度评分与参照组相比要高,对比差异有统计学意义(P＜0.05)。护理后,研究组患者焦虑、抑郁评分低于参照组及护理前,对比差异有统计学意义(P＜0.05)。结论 伤口护理中延续性护理的应用效果显著,可有效降低并发症发生风险,使其疼痛感及负性心理得到缓解的同时促使其创面恢复时间缩短,具有较高临床推广价值。

目的 探讨TBL教学法在物理治疗学教学资源库建设中的应用效果。方法 选取我校康复治疗学专业2013级和2014级各60名学生为研究对象,分别作为传统教学组和试验教学组,传统教学组采用传统教学方法,试验教学组在传统教学方法的基础上,采用TBL教学法参与教学资源库建设的方式来完成教学。学期结束对学生进行实践技能、理论考试及问卷调查评估。结果 在牵引疗法的考核中,两组实践技能成绩无差异(P＞0.05),其它项目试验教学组实践技能成绩均高于传统教学组(p＜0.05)。试验教学组理论考试成绩高于传统教学组,对教学的满意度也更高。结论 采用TBL教学法建设物理治疗学教学资源库,不仅能提高教学效果,而且有助于加快实践教学资源库的建设。

Objective To explore the application effect of TBL teaching method in the construction of physiotherapy teaching resources library. Methods We selected 60 students from the 2013 and 2014 grades of rehabilitation therapy in our school respectively, who were used the traditional teaching method group and the experimental teaching method group. The traditional teaching method group adopted the traditional teaching method. The experimental teaching method group was based on the traditional teaching methods, and used TBL to participate in the construction of a teaching resource library. At the end of the semester, students will be assessed on practical skills, theoretical examinations, and questionnaire surveys. Results In the assessment of traction therapy, there was no significant difference in the performance of the two groups (P>0.05). The other experimental skills of the experimental teaching group were better than those of the traditional teaching group (p<0.05). Theoretical test scores of experimental teaching group are higher than the traditional one, and satisfaction with teaching is also higher than the latter. Conclusion Using TBL teaching method to build a library of physiotherapy teaching resources may not only improve the teaching effect, but also help to speed up the construction of practical teaching resources.

目的 探讨TBL(Team-Based Learning)教学在临床实践教学中的应用效果。方法 将2015年外科实习学生分为应用传统教学的对照组与应用TBL教学的实验组,教学效果采用出科考核成绩、实习效果调查和TBL教学法可行性调查问卷进行评估。结果 两组学生出科考核成绩无明显差异, TBL有助于提高学生解决临床问题的综合能力、课堂参与度、自觉知识掌握度、实习满意度。结论 TBL可以增强学生主动思考学习、团队协作能力,在临床实践教学中切实可行。

Objective To explore the application effect of TBL (Teaching Team-Based Learning) in clinical practice teaching. Methods The surgical internship students of the year 2015 were divided into the control group with traditional teaching and the experimental group with TBL teaching. The teaching effect was evaluated by the examination results, the internship effect survey and the TBL pedagogical feasibility questionnaire. Results There was no significant difference between the two groups in their test scores. TBL helped to improve students' comprehensive ability to solve clinical problems, classroom participation, degree of self-knowledge and internship satisfaction. Conclusion TBL may enhance students' ability of active thinking and learning, teamwork and practicing in clinical practice teaching.

目的 探究骨质疏松性椎体压缩骨折治疗中3D打印技术的应用及其效果。方法 选取我院2016年1月—2018年10月收治的90例行经皮椎体成形术治疗的骨质疏松性椎体压缩骨折患者作为研究对象,随机分为常规组45例和实验组45例。常规组采用MR+常规穿刺方法,通过MR引导,注入骨水泥;实验组采用CT+3D打印技术,在应用CT的基础上,借助制作模型的引导,实施精准定位并实施手术治疗,对两组各项围术期治疗指标(手术时间、射线暴露次数、后凸Cobb角改善)和治疗前后的VAS评分、ODI评分以及骨水泥渗漏情况。结果 在手术时间、射线暴露次数、后凸Cobb角改善等围术期治疗指标方面,实验组均要优于常规组,差异有统计学意义(P<0.05)。在骨水泥渗漏发生率方面,常规组为17.78%(8/45),实验组为4.44%(2/45),实验组低于常规组,差异有统计学意义(P<0.05)。在VAS评分、ODI评分方面,常规组和实验组治疗前、治疗后相比差异均无统计学意义(P>0.05)。结论 骨质疏松性椎体压缩骨折经皮椎体成形术治疗中,配合3D打印技术能够有效提升治疗的有效性,促进患者的健康恢复,值得推广应用。

目的 探讨多指标联合监测在冠心病(CHD)早期诊断中的应用。方法 选择2018年6月—2018年12月在我院就诊的患者180例,其中动脉硬化中低危人群60例(低危组),动脉硬化中高危人群60例(高危组),确诊的冠心病患者(CHD组),另选取健康体检者60例为对照组。分析血浆游离脂肪酸、高敏C反应蛋白、尿β-2微球蛋白、血清25羟维生素D及血脂水平与冠心病之间的关系。结果 低危组、高危组和CHD组患者FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平均高于对照组,血清25羟维生素D₃、HDL-C水平均低于对照组,差异均有统计学意义(P＜0.05);低危组、高危组和CHD组患者的血清FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平逐渐升高,血清25羟维生素D₃、HDL-C逐渐降低,以CHD组最为显著。冠心病患者血清HDL-C的敏感度高于其他各指标(P＜0.05);血清FFA、hs-CRP的特异度高于其他各指标(P＜0.05)。结论 多指标联合检测对于早期诊断冠心病患者有一定意义。

Objective To explore the application of multi-index combined monitoring in early diagnosis of coronary heart disease (CHD). Methods 180 patients were selected from June 2018 to December 2018 in our hospital. Among them, 60 patients with middle and low risk of atherosclerosis (low risk group), 60 patients with middle and high risk of atherosclerosis (high risk group), 60 patients with confirmed coronary heart disease (CHD group), and 60 healthy people were selected as control group. The relationship between plasma free fatty acid, high sensitivity C-reactive protein, urinary β-2 microglobulin, serum 25-hydroxyvitamin D and blood lipid levels and coronary heart disease was analyzed. Results The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group were higher than those in control group, and serum levels of 25-hydroxyvitamin D3 and HDL-C were lower than those in control group (P<0.05). The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group increased gradually, while serum levels of 25-hydroxyvitamin D3, H-MG, TC, TG and LDL-C increased gradually. DL-C decreased gradually, especially in CHD group. The sensitivity of serum HDL-C in patients with coronary heart disease was higher than that of other indicators (P<0.05), and the specificity of serum FFA and hs-CR P was higher than that of other indicators (P<0.05). Conclusion The combined detection of multiple indicators has certain significance for the early diagnosis of coronary heart disease.

目的 初步探讨D-二聚体对判断女性恶性肿瘤病情和疗效观察的应用价值与诊断效能。方法 选取2016年3月—2017年12月间在佛山第一人民医院乳腺肿瘤内科住院治疗的女性恶性肿瘤患者149例,早期术后患者(术后组)58例,晚期复发转移患者(晚期组)91例,测定其接受化疗前后的血浆D-二聚体水平(分别记作D1、D2),分析D-二聚体浓度变化(ΔD=D2-D1)与疗效的相关性。D-二聚体浓度(ng/mL)用中位数(四分位间距)表示,治疗前后配对样本比较用Wilcoxon秩和检验,两组间独立+样本比较用Mann-Whitney U检验,以Spearman法分析两组资料的相关性是否有统计学意义。结果 术后组患者化疗后D-二聚体水平低于化疗前(ΔD=-184.8,P<0.0001),D1、D2均与年龄正相关(P<0.01),r²分别为0.356,0.389。晚期组患者中,化疗后有33例出现病情进展(progressive disease, PD组),58例获得疾病缓解或稳定(非PD组)。PD组化疗前基线水平高于非PD组(1 586 vs 754.2,P<0.01),接受化疗后PD组D-二聚体较基线水平升高(ΔD=1 124,P<0.0001),非PD组较基线水平下降(ΔD=-153.3,P=0.004 5),PD组化疗后D-二聚体水平高于非PD组(2 511 vs 525.8,P<0.01)。以ΔD、D1、D2诊断是否PD分别进行受试者工作特征曲线(receiver operating characteristic curve,ROC)分析,结果显示ROC曲线下面积分别为0.8 603(95% CI:0.768 5~0.952 0)、0.674 0(95% CI:0.558 2~0.759 7)、0.895 6(95%CI:0.829 1~0.962 1),对诊断PD有一定准确性。当ΔD＜-145.4 ng/mL、D1>1 375 ng/mL、D2>1 033 ng/mL时,Youden指数最大,诊断PD的准确性较高。结论 血浆D-二聚体的变化与肿瘤负荷密切相关,有助于女性恶性肿瘤病情的判断和疗效观察及评价预后,对辅助判断病情进展上的具有较高的诊断效能。

Objective To investigate the clinical significance and diagnostic value of plasma D-dimer measurement in response evaluation of female patients with tumor. Methods 149 female cancer patients were enrolled, in which there were 58 post-operative early staged cases(post-operative group), 91 metastatic cases(metastatic group). D-dimer levels before chemotherapy (D1) and after the last cycle of chemotherapy (D2) were assessed and analyzed to examine whether they are correlated to response of therapy. D-dimer levels were presented as median(25^th percentile,75^th percentile) and compared using Wilcoxon signed-rank test(for paired samples) and Mann-Whitney U test(for independent samples). Spearman rank tests were conducted to show the correlation of two variables. Results In post-operative group,D2 was lower than D1(ΔD=-184.8,P<0.0001),and both of D1 and D2 were positively correlated with age(r²= 0.356,0.389,respectively,P<0.01). In metastatic group, after chemotherapy,33 cases had progressive diseases(PD group), while 58 cases gained response or stable diseases(non-PD group). Baseline D-dimer level of PD group was higher than that of non-PD group(1586 vs 754.2,P<0.01),and after chemotherapy the case was similar(2511 vs 525.8,P<0.01). After chemotherapy, D-dimer level increased in PD group(ΔD=1124,P<0.0001), and decreased in non-PD group(ΔD=-153.3,P=0.0045).We compared the abilities of the ΔD(ΔD=D2-D1), D1and D2 to discriminate between responders and non-responders using receiver operating characteristic curves(ROC). The areas under the curve (AUC) of the ΔD, D1and D2, were 0.8603(95%CI:0.7685-0.9520)、0.6740(95%CI:0.5582-0.7597)、0.8956(95%CI:0.8291-0.9621), respectively. The appropriate cut-off values with biggest Youden index of D-dimer for non-responders were as follows: ΔD＜-145.4 ng/mL,D1>1375ng/mL,D2>1033ng/mL. Conclusion Plasma D-dimer level is strongly associated with tumor burden. D-dimer could be used to predict prognosis and treatment response in female patients with tumor.

目的 探讨集束化护理模式在AECOPD并呼吸衰竭患者初次无创通气中的作用。方法 选我院2016年10月—2018年12月收治AECOPD并呼吸衰竭需初次无创通气的患者为研究对象,随机分为对照组和观察组,对照组予传统护理,观察组予集束化护理,各30例;分别记录两组患者每日无创通气时间、总住院时间、循环呼吸指标(HR、RR)、指尖血氧饱和度、血气分析、并发症、患者满意度和护理质量。结果 观察组患者的每日无创通气时间,指尖血氧饱和度、pH值、氧分压和二氧化碳分压改善均优于对照组,并发症发生率和住院时间低于对照组,满意度和护理质量较高(P<0.01)。结论 集束化护理可以提高AECOPD并呼吸衰竭患者无创通气的疗效,减少并发症、缩短住院天数,改善预后。

目的 探讨中药竹罐结合体感音乐疗法在筋伤腰痛患者中的应用效果。方法 将128例患者按入院顺序分为实验组(68例)和对照组(60例),对照组采用中药竹罐疗法,实验组采用中药竹罐结合体感音乐疗法,4周后对两组患者的疗效、VAS 评分及满意度进行测评。结果 治疗后实验组患者疗效优于对照组(P＜0.01);治疗后实验组、对照组VAS 评分较治疗前降低,但实验组VAS 评分下降更明显(P＜0.01);治疗后实验组、对照组对治疗效果满意度较治疗前提高,而实验组对治疗效果满意度更高(P＜0.01)。结论 筋伤腰痛患者采取中药竹罐结合体感音乐疗法能起到缓解肌肉痉挛,身心放松,活血化瘀,温筋祛寒的作用。

Objective To explore the application effect of traditional Chinese medicine bamboo jar combined with somatosensory music in patients with tendon injury and low back pain. Methods 128 patients were divided into experimental group (68 cases) and control group (60 cases) according to the order of admission. The control group was treated with traditional Chinese medicine bamboo pot therapy. The experimental group was treated with traditional Chinese medicine bamboo pot combined with somatosensory music therapy. After 4 weeks, the curative effect, VAS score and satisfaction of the two groups were evaluated. Results After treatment, the curative effect of the experimental group was better than that of the control group (P<0.01); the VAS score of the experimental group and the control group was lower than that before treatment, but the VAS score of the experimental group was lower (P<0.01); the satisfaction of the experimental group and the control group was higher than that before treatment, while the satisfaction of the experimental group was more satisfactory (P<0.01). Conclusion The traditional Chinese medicine bamboo pot combined with somatosensory music therapy may alleviate muscle spasm, relax body and mind, promote blood circulation and remove blood stasis, warm tendons and dispel cold.

目的 评价Turbohawk定向斑块切除系统联合药物涂层球囊在下肢动脉硬化闭塞症中临床应用价值。方法 对于术前超声以及下肢动脉CTA检查诊断为下肢动脉硬化闭塞症的8例患者,行Turbohawk斑块旋切以及药物涂层球囊治疗,术后行常规抗凝治疗,定期行彩超复查。结果 8例患者下肢动脉均全部再通成功,技术成功率为100%,术后缺血症状明显改善,术后平均踝肱指数为0.78±0.06,高于术前的0.31±0.12(P<0.05)。住院期间无并发症发生,随访3～18个月,患者保肢均获得成功。结论 Turbohawk定向机械旋切系统联合药物涂层球囊治疗下肢动脉硬化闭塞症,具有创伤小、疗效好以及安全性高等优点,值得临床推广使用。

Objective To evaluate clinical application of using Turbohawk atherectomy device in combination with drug-coated balloon in treatment of atreriosclerosis obliterans in lower extremity. Methods Turbohawk atherectomy device and DCB was performed in 8 patiments with atreriosclerosis obliterans in lower extremity. All patients were diagnosed by ultrasound and CTA. Routine anticoagulation drugs were used after the operation. Follow-up was carried out with color Doppler ultrasound. Results Revascularization was gained in 8 patients. The technically successful rate was 100% and ischemic symptoms relieved significantly immediately after the operation. The post-operative ankle brachinal index(ABI) was 0.78±0.06,which was higher than that of before operation(0.31±0.12). No obvious complications occurred after operation. The follow-up range was 3~18 months and limbs were salvaged successfully. Conclusion With minimal invasive, safe and few complications, Turbohawk atherectomy device in combination with drug-coated balloon is proved to be a very effective treatment atreriosclerosis obliterans in lower extremity and it is worth to popularize.

目的 探讨分阶段延续护理对改善留置输尿管支架管老年农民患者并发症的效果。方法 按时间顺序将106例患者分为对照组52例和观察组54例,对照组给予常规电话随访,观察组实施三个阶段的延续护理。30天后测评患者并发症持续时间和发生率、自我管理能力。结果 观察组腰痛、血尿、膀胱刺激征持续时间缩短,尿路感染、支架管移位和滞留的发生率下降,自我管理能力各维度评分升高,与对照组比较差异均有统计学意义(P＜0.01)。结论 分阶段延续护理能提高留置输尿管支架管老年农民患者的自我管理能力,增强依从性,减少并发症的发生,促进早日康复。

Objective To investigate the effect of staged continuous nursing on complications in elderly agricultural-workerpatients with indwelling ureteral stent. Methods According to the chronological order, 106 patients were divided into control group (52 cases) and observation group (54 cases). The control group received routine telephone follow-up, and the observation group received three stages of continuous care. 30 days later, the complications' duration, incidence and self-management ability were assessed. Results In the observation group, pain, hematuria and bladder irritation were obviously shorten. Urinary tract infection and the incidence of stent displacement and retention were decreased. Scores in all dimensions of self management ability were increased. Comparing with the control group, it had significant difference (P<0.01). Conclusion The phased continuous nursing may improve the self-management ability of the elderly agricultural-worker with indwelling ureteral stents, strengthen the compliance, reduce the occurrence of complications and promote early rehabilitation.