目的 研究脊柱经皮内镜椎间孔入路和椎板间入路治疗腰椎间盘突出的临床应用效果。方法 本次选取的研究对象为2016年1月—2017年12月期间在我院进行治疗的腰椎间盘突出患者,将60例患者根据红蓝球分组法分为两组,30例/组。将实施脊柱经皮内镜椎间孔入路椎间盘切除术的患者纳入PETD组,将采用椎板间入路椎间盘切除术的患者设为PEID组。将两组腰椎间盘突出患者的手术相关指标、治疗优良率、ODI评分、VAS评分进行比对。结果 观察组腰椎间盘突出患者的手术时间、C型臂透视次数同对照组相比存在差异(P＜0.05);术后卧床时间和住院时间、治疗优良率组间对比无统计学意义;两组术后三个月时的ODI评分、VAS评分均较术前更优(P<0.05)。结论 在腰椎间盘突出治疗中脊柱经皮内镜椎间孔入路、椎板间入路的效果相当,临床上需患者的实际情况和解剖特点选择适合的入路方式和手术方法。

目的 探讨拔岗晋级结合激励机制在护士岗位管理的实践和体会。方法 在护士岗位管理中运用拔岗晋级结合激励机制,收集实施岗位管理前后1年护士满意度、患者满意度、护士职业获益感、护士职业投入、离职率资料,进行统计学分析。结果 实施后护士满意度、患者满意度、护士职业获益感、护士职业投入较实施前提高(P<0.05),离职率下降(P<0.05),差异有统计学意义。结论 建立在拔岗晋级及激励机制上的护士岗位管理能提高护士满意度,降低护士离职率,稳定护士队伍,能够提高护士职业获益感、护士职业投入,从而提高护士工作的主观能动性和工作积极性,为高质量护理服务和优质护理服务长效机制的建立奠定了基础,促进优质护理服务的可持续发展,提高护理管理效能。

Objective To explore the application and experience of job promotion combing with excitation mechanism in nurses position management. Methods We used job promotion combing with excitation mechanism in nurses position management to compare the satisfaction rate, perceived career benefit, work engagement and separation rate of nurses. Results After the application, the satisfaction rate, perceived career benefit and work engagement of nurses were increased, while separation rate of nurses was decreased(P<0.05), the difference has statistical significance. Conclusion The application may increase the satisfaction rate, perceived career benefit and work engagement of nurses, and decrease the separation rate of nurses, elevate the subjective initiative and work enthusiasm. Nursing quality is improved continuously. The management efficacy is promoted.

目的 探讨临床全程导师制结合OSCE考试法对实习护生评判性思维的影响。方法 将176名在我院实习的本科实习护生随机分为两组,每组88人。对照组采用传统的临床带教和考核方式进行带教,实验组采用临床全程导师制结合OSCE考试法进行带教。记录两组理论考试成绩、实践技能成绩及护理病历成绩,比较两组实习护生教学前后评判性思维能力,比较两组实习护生干预后对临床带教模式的整体评价。结果 实验组理论考试成绩、实践技能成绩、护理病历成绩得分均高于对照组（P<0.05）。开展教学后两组评判性思维能力量表（CTDI-CV）各维度评分及总分均升高,实验组各维度评分及总分均高于对照组（P<0.05）。开展教学后实验组对临床带教模式的整体评价均高于对照组（P<0.05）。结论 临床全程导师制结合OSCE考试法,有助于提高本科实习护生的评判性思维能力。

Objective To explore the application and influence of the whole course mentor system combined with OSCE on the critical thinking ability of undergraduate clinical student nurses. Methods 176 undergraduate clinical student nurses were divided to control group and experimental group,88 for a group respectively. Control group used traditional clinical teaching method while the experimental group used whole course mentor system combined with OSCE. The theory and practice assessment scores ,medical record writing scores and critical thinking scores of clinical student nurses before and after the implementation of the two teaching modes were compared. Results The theory and practice assessment scores and medical record writing scores of the students in the experimental group were better than those of students in the control group（P<0.05）. The score of CTDI-CV was increased in both two groups after intervention. The score of all dimensions in CTDI-CV was better improved in the experimental group than that of controls （P<0.05）. And the evaluation of teaching mode of the experimental group was better than the control group（P<0.05）. Conclusion The teaching method of the whole course mentor system combined with OSCE is helpful to improve undergraduate clinical student nurses'ability of critical thinking.

目的 研究子宫内膜异位症生育指数（EFI）评分对子宫内膜异位症（EMT）患者腹腔镜术后生育指导的应用价值。方法 对2015年3月—2017年4月于我院进行腹腔镜手术治疗的76例EMT患者进行EFI评分,并依据其结果施加相应生育指导,随访2年观察患者术后妊娠情况。结果 随访2年结果显示,76例患者共出现68例妊娠,且其妊娠率及自然妊娠率随EFI评分减少而降低,组间均有性差异（P<0.05）;68例妊娠患者足月分娩率为76.47%,同时不同EFI评分患者不良妊娠结局比较,组间均无显著性差异（P>0.05）。结论 腹腔镜手术能够提高EMT患者妊娠率及自然分娩率,同时可根据EFI评分,综合评估患者的生育状况,对于指导术后处理的选择以及指导后续治疗均有重要参考意义。

Objective To study the application value of uterine endometriosis index （EFI） on the postoperative reproductive guidance of patients with endometriosis （EMT）. Methods From March 2015 to April 2017,76 EMT patients in our hospital underwent laparoscopic surgery for EFI score. On the basis of corresponding guidance,the patients were followed up and observed for 2 years for results in postoperative pregnancies. Results The two-year follow-up period showed that there were 68 cases of pregnancy in 76 cases. Pregnancy rate and natural pregnancy rate decreased with the decrease of EFI score. There was a difference between the groups （P<0.05）. The monthly delivery rate of 68 cases was 76.47%. At the same time,there were no significant differences between the groups in the pregnancy outcomes of patients with different EFI scores （P>0.05）. Conclusion Laparoscopic surgery can improve pregnancy rate and natural delivery rate of EMT patients. At the same time,according to the EFI score,comprehensive assessment of the patient's reproductive status is important for guiding the selection of postoperative treatment and for guiding follow-up treatment.

目的 探究全程护理干预在门诊鼻咽喉部疾病检查中的应用效果,为纤维鼻咽喉镜应用的临床护理方式提供理论依据。方法 选择2015年7月—2016年6月在本院行纤维鼻咽喉镜检测的患者458例为研究组,同时选择2014年7月—2015年6月行纤维鼻咽喉镜检测的患者400为对照组例。对照组患者行常规护理模式,研究组患者行全程护理干预模式。对比两组患者护理效果、并发症率以及患者满意度。结果 研究组患者的呼吸频率、心率、舒张压以及收缩压均低于对照组患者指标,且两组数据对比差异有统计学意义(P＜0.05)。研究组患者的总并发症率为4.58%,对照组患者的总并发症率为24.00%,两组数据对比差异有统计学意义(P＜0.05)。研究组患者的总并发症率为4.58%,对照组患者的总并发症率为24.00%,两组数据对比差异有统计学意义(P＜0.05)。结论 在对老年患者行纤维鼻咽喉镜检查时,相对于常规护理模式,采用全程护理干预措施,可以提升患者的护理效果,降低并发症机率,同时可以提升患者的满意度,具有较高的临床应用和推广价值。

目的 探讨行动导向法在原位新膀胱患者康复中的应用效果。方法 选取36例新膀胱术后回归社区的患者,自出院当天起按“提出任务、计划制订、计划实施、自我反馈”4个完整的行动进行健康教育,6个月后评价患者尿失禁或尿潴留的发生率、新膀胱控尿效果、健康知识知晓率。结果 干预后患者尿失禁的发生率为2.78%、尿潴留为8.33%,新膀胱控尿效果和健康知识知晓率均为100%,与干预前比较差异均有统计学意义(P<0.05 )。结论 行动导向法对原位新膀胱患者进行健康教育,有利于提高患者学习积极性和依从性,促进理想自主排尿早日恢复。

Objective To explore the effect of action oriented method in the rehabilitation of patients with orthotopic neobladder. Methods Select 36 cases of patients who return to the community after the new bladder surgery, from the day of discharge, according to“ the objective, plan making, plan implementation, self feedback” these 4 complete actions to implement health education. After 6 months the evaluation for the patients with urinary incontinence or urinary retention including the incidence of new bladder continence, awareness of health knowledge were taken. Results The incidence of urinary incontinence was 2.78% and urinary retention was about 8.33%. The awareness rate of urinary continence and health knowledge was 100%, and the difference was statistically significant (P<0.05). Conclusion It is helpful to improve the learning interesting and compliance of the patients with bladder cancer, and to promote the early recovery of the ideal autonomous urination.

目的 探讨标准化沟通模式在重症孕产妇院前转运前评估与交接环节中的应用效果。方法 设计转运前标准化沟通信息登记表,用以标准化转运前评估与交接环节,护士按照登记表中的项目逐条交接,对方未交代的项目护士进行主动评估,并将结果登记并汇报接诊医生。结果 运用标准化沟通模式后,有效缩短了转诊的通话时间和抵院后的处理时间,护士评估信息的错漏率由13.84%降低至4.23%,交接不清导致的不良事件发生率由7.41%降至1.21%,并在改善母婴结局等方面均取得较好效果。结论 SBAR 沟通模式在重症孕产妇孕前转运的评估和交接环节中保证了重要信息的准确传递,为重症孕产妇的救治争取宝贵时间,值得临床上推广应用。

Objective To explore the application effects of SBAR (situation, background, assessment and recommendation) communication mode in the transfer of critically ill obstetric women. Methods A transfer from based on SBAR communication mode was designed and used to assess the psychological status and illness condition of critically ill obstetric women. Results After the application of SBAR communication transfer model, the communication time and hospital action time were both shortened and the occurrence of transfer problems decreased,while the pregnancy outcomes were improved (P＜0.05). Conclusion Applying SBAR communication mode in the transfer of critically ill obstetric women is helpful to reduce the transfer time and the occurrence of transfer problems,and improve the quality of patient handover.

目的 探讨精神科急救培训用护士作为标准化病人的培养方法。方法 2013年9月挑选了4名精神科护士参加标准化病人系统培训,考核合格后成为护士标准化病人在2013年10月—11月对30名新护士自缢、噎食急救培训和考核中使用。结果 对急救培训中使用护士标准化病人,30名新护士中认为“新颖,第一次接触”19人(63%)、“满意”的26人(87%);4名作为标准化病人的护士都认为“非常有意义”。结论 精神科急救培训应用护士标准化病人丰富了培训的形式和内涵,得到了绝大部分参与人员的肯定。

Objective To explore the methods of training nurses as standardized patients for psychiatric first aid. Methods 4 nurses were selected to participate in the psychiatric standardized patient training program and all passed the examination. Using these nurse standardized patients to train the 30 new nurses for psychiatric first aid. Results After the first aid training, 19 of the 30 new nurses(63%) felt that it was “novelty and interesting”. 26 nurses(87%) felt “being satisfied”. And those 4 standardized patients felt “very meaningful”. Conclusion Training and application of nurses as standardized patients for psychiatric first aid may enrich the form and content of training program, and gains most of the participants affirmation.

目的 探讨超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中的应用价值。方法 我院52例经皮肺穿刺活检的病例,术前均采用高效抗逆转录病毒治疗,依据CD4⁺T淋巴细胞确定是否手术,术中规范手术方式,做好防护措施,27例行超声引导穿刺,25例行CT引导穿刺,术后应用抗生素预防机会性感染等。结果 所有患者穿刺成功率100%,超声组肺结核13例,真菌感染67例,细菌感染4例,肺腺样囊性癌2例、卡波西肉瘤1例。CT组肺结核11例,真菌感染7例,细菌感染5例,肺腺样囊性癌1例。术后并发症:超声组5例病灶少量气胸,2例周围少量出血,咯血4例;CT组8例病灶少量气胸,4例周围少量出血,咯血7例。结论 经过术前控制患者计数及预防感染治疗,超声引导下经皮肺穿刺活检术在艾滋病周围型肺部病变中应用更为安全、有效、可行的,值得临床应用及推广。

Objective Objective to investigate the value of ultrasound-guided percutaneous lung biopsy in the diagnosis of peripheral lung lesions in AIDS patients. Methods 52 cases in our hospital of percutaneous pulmonary biopsy cases, preoperative highly active antiretroviral therapy was used, basis of CD4⁺T lymphocytes count determined whether the operation were performed, standard operation mode in the operation. It must to take good protective measures. 27 cases underwent ultrasound guided puncture, 25 cases underwent CT guided puncture and had postoperative application of antibiotics to prevent opportunistic infections. Results The successful rate of puncture was 100% in all patients. Tuberculosis in the ultrasound group was 13 cases, fungal infection was 67 cases, bacterial infection was 4 cases, pulmonary adenoid cystic carcinoma was 2 cases, and Posey's sarcoma was 1 cases. There were 11 cases of pulmonary tuberculosis in CT group, 7 cases in fungal infection, 5 cases in bacterial infection, and 1 cases in adenoid cystic carcinoma of the lung. Postoperative complications included: 5 cases of small pneumothorax in the ultrasound group, a small amount of bleeding around the surrounding, hemoptysis in 4 cases, CT group of patients with 8 cases of a small amount of pneumothorax in the lesions, 4 cases of a small amount of bleeding around the case, 7 cases of hemoptysis. Conclusion After preoperative control count and prevention of infection in patients with treatment, ultrasound guided percutaneous lung biopsy in peripheral pulmonary lesions of AIDS is more safe and effective, worthy of clinical application and promotion.

目的 探究一次性带冲洗球囊胃管的临床应用。方法 收集来我院进行腹部外科手术的患者共200例,随机分为研究组与对照组,每组100例,其中研究组患者采用一次性带球囊胃管治疗,对照组则应用传统胃管进行治疗。观察对比2组患者进行引流的通畅情况、治愈时间、胃管滑脱及胃管相关并发症等情况。结果 研究组患者的一次置管成功率高于对照组(P＜0.05),置管停顿率和自行拔管率均低于对照组(P＜0.05);研究组低于对照组(P＜0.05);研究组患者的不良反应发生率低于对照组(P＜0.05),差异均有统计学意义。结论 一次性带冲洗球囊胃管治疗可持续冲洗胃腔及灌注药物,保证引流通畅,明显提高胃肠减压效果,促进胃黏膜的炎症水肿、糜烂出血等病症的修复愈合,并且能够提高置管效果,减少置管时间,同时避免不良反应的发生,值得临床进一步推广。

Objective To investigate the clinical value of disposable balloon catheter with irrigation. Methods In our hospital for abdominal surgery patients with a total of 200 cases were randomly divided into study group and control group, 100 cases in each group. The study group was treated by disposable balloon intubation, the control group used conventional gastric tube. Observation and comparison of two groups were taken with drainage patency, cure time, gastric tube slippage and gastric tube related complications. Results The study group of patients with a success rate of catheterization was higher than that of the control group (P<0.05), catheter pause rate and self extubation rate were lower than that of the control group (P<0.05); the study group was significantly lower than that of the control group (P<0.05); the adverse reaction of patients in the study group was significantly lower than that of the control group (P<0.05), the differences were statistically significant. Conclusion Disposable flushing balloon intubation treatment of gastric cavity perfusion and sustainable irrigation, to ensure smooth drainage, may improve the effect of gastrointestinal decompression, promote the repair of gastric mucosal inflammation and edema, erosion, bleeding and other symptoms and improve the effect of catheterization, reduce the intubation time, and avoid the occurrence of adverse reactions. It is worthy of further promotion.