伴随着对医疗领域人才水平要求的逐步提高,医院人力资源管理尤其是医院人才引进工作正在由规模化发展向精细化发展转变。当前医院人才引进过程中存在缺乏人力资源发展规划、高层次人才引进方法有待完善、人才管理能力亟须提高、科室用人需求脱离实际、忽视对于岗位胜任力的分析等问题。人力资源成熟度模型（People Capability Maturity Model,P-CMM）作为一种系统的管理理论,其具备很强的实践性,文章对人力资源成熟度模型在医院人才引进工作中的本土化应用进行相关讨论与研究,将P-CMM不同成熟度等级、过程域目标与医院人才引进工作相结合,并提出可操作性指导,具有一定的理论与实践价值。

With the gradual improvement of the requirements for talents in the medical field,hospital human resource management,especially the introduction of talents in hospitals,is changing from large-scale development to refined development．At present,there are some problems in the process of hospital talent introduction,such as lack of human resource development plan,improvement of high-level talent introduction method,improvement of talent management ability,separation of department employment demand from reality,neglect of post competency analysis,etc．People Capability Maturity Model（P-CMM）,as a systematic management idea,has strong practicality．This study discusses and studies the localization application of human resource maturity model in hospital talent introduction,combines different maturity levels and process area objectives of P-CMM with hospital talent introduction,and puts forward operational guidance It has certain theoretical and practical value．

目的 探讨时机理论的护理干预在三叉神经痛微血管减压术中的应用效果。方法 选取2020年7月—2023年6月厦门大学附属第一医院神经外科三叉神经痛患者85例,均实施微血管减压术治疗,通过奇偶数抽签的方式分组,即对照组（n=43,予以常规护理）与观察组（n=42,实施常规护理基础上给予基于时机理论的护理干预）,通过专业调查表对两组患者疼痛、负面情绪及生活质量进行全面评估。结果 观察组出院时数字分级评分表（NRS）、抑郁自评量表（SDS）、焦虑自评量表（SAS）评分分别为（2.13±0.57）（42.45±3.17）（42.45±3.17）分,低于对照组的（3.23±0.78）（52.34±4.45）（48.23±3.23）分（P<0.05）;观察组术后1个月简明健康状况调查表（SF-36）生理功能、生理职能、躯体功能、活力、社会功能、情感职能、心理健康及总体健康状态等维度评分分别为（38.12±8.27）（42.22±9.12）（52.34±8.23）（64.11±8.92）（70.12±9.03）（34.46±6.18）（71.34±8.17）（75.24±8.46）分,高于对照组的（35.23±8.13）（38.56±9.23）（45.03±8.11）（60.57±8.23）（65.23±8.78）（30.14±6.13）（66.23±8.08）（72.12±8.35）分（P<0.05）。结论 三叉神经痛患者实施微血管减压术治疗的同时,采取基于时机理论的护理干预不仅可减轻其疼痛程度,改善其负面情绪,还可全面提高其生活品质。

Objective To explore the application effect of timing theory nursing intervention in microvascular decompression surgery for trigeminal neuralgia．Methods The research period was from July 2020 to June 2023．The study subjects were 85 patients with trigeminal neuralgia selected from the Neurosurgery Department of the First Affiliated Hospital of Xiamen University,all of whom underwent microvascular decompression surgery．They were divided into a control group（n=43,receiving routine care）and an observation group（n=42,receiving timing based nursing intervention on the basis of routine care）through odd and even number drawing．A preliminary assessment of pain,negative emotions,and quality of life for two groups of patients were conducted through a professional questionnaire．Results The scores of NRS,SDS and SAS in the observation group at discharge were（2.13±0.57）,（42.45±3.17）and（42.45±3.17）respectively,which were significantly lower than those in the control group（3.23±0.78）, （52.34±4.45）and（48.23±3.23）．The scores of physiological function,physiological function,physical function,vitality,social function,emotional function,mental health and general health status in the observation group one month after operation were（38.12±8.27）,（42.22±9.12）,（52.34±8.23）, （64.11±8.92）, （70.12±9.03）, （34.46±6.18）, （71.34±8.17） and（75.24±8.46）, which were significantly higher than those of the control group（35.23±8.13）, （38.56±9.23）, （45.03±8.11）, （60.57±8.23）, （65.23±8.78）, （30.14±6.13）, （66.23±8.08）and（72.12±8.35）（P<0.05）．Conclusions While implementing microvascular decompression surgery for patients with trigeminal neuralgia,nursing interventions based on timing theory can not only alleviate their pain,improve their negative emotions,but also comprehensively improve their quality of life．

目的 探讨终末期肾病患者血液透析中实施基于依从性曲线变化规律的阶段性护理的效果。方法 选择2022年1月—2023年10月濮阳市人民医院收治的接受血液透析治疗的86例终末期肾病患者,将其通过单双号抽签的方式分组,即对照组与观察组,各43例,前者实施常规护理,后者在此基础上实施基于依从性曲线变化规律的阶段性护理,对比两组患者护理前后心理状态评分情况、生活质量评分情况及治疗依从性。结果 两组患者护理前后正性负性情绪量表（PANAS评分有一定差距,其中负性情绪显著降低,正性情绪显著提升,而护理后观察组负性情绪评分为（11.67±2.55）分,低于对照组的（16.11±3.02）分,正性情绪为（25.07±5.28）,高于对照组的（20.11±5.23）分（t=7.366、4.376,P<0.05）;护理后观察组生活质量综合评定量表（GQOLI-74）躯体、心理、社会及物质生活等维度评分分别为（82.17±7.11）分、（82.02±7.45）分、（81.11±7.78）分及（81.11±7.42）分,高于对照组的（71.22±7.23）分、（72.12±7.56）分、（71.23±7.45）分及（70.23±7.33）分（t=7.081、6.116、6.015、6.840,P<0.05）;观察组（95.35%）与对照组（76.74%）的治疗依从性比较,前者更高（χ²=6.198,P<0.05）。结论 基于依从性曲线变化规律的阶段性护理对于接受血液透析治疗的终末期肾病患者,不仅有助于调整其心理状态,还有助于提高其治疗依从性,使其生活质量也得以全面提高。

Objective To explore the effect of implementing phased nursing based on compliance curve changes in hemodialysis for end-stage renal disease patients. Methods The research deadline was from January,2022 to October,2023．The research object was 86 patients with end-stage renal disease who received hemodialysis treatment in Puyang People's Hospital,and they were divided into control group and observation group with 43 patients in each group by odd and even numbers．The former was given routine care,while the latter was given stage nursing based on the change of compliance curve．The psychological state score,quality of life score and treatment compliance of the two groups were compared before and after care. Results There was a certain difference in the Positive and Negative Affect Scale（PANAS）scores between the two groups before and after nursing,in which the negative emotion was significantly reduced and the positive emotion was significantly improved．After nursing,the negative emotion score of the observation group was（11.67±2.55）,which was significantly lower than that of the control group（16.11±3.02）,and the positive emotion score was（25.07±5.28）,which was significantly higher than that of the control group（20.11±5.23）（t=7.366,4.376,P<0.05）．After nursing,the scores of Generic Quality of Life Inventory-74（GQOLI-74）in the observation group were（82.17±7.11）,（82.02±7.45）,（81.11±7.78）and（81.11±7.42）,which were significantly higher than those in the control group（71.22±7.23）,（72.12±7.56）,（71.23±7.45）and（70.23±7.33）（t=7.081,6.116,6.015,6.840,P<0.05）．The treatment compliance of the observation group（95.35%）was higher than that of the control group（76.74%）（χ²=6.198,P<0.05）. Conclusions Choosing stage nursing based on the variation pattern of compliance curve for end-stage renal disease patients undergoing hemodialysis not only helps to adjust their psychological state,but also improves their treatment compliance,leading to a comprehensive improvement in their quality of life．

目的 对比纳布啡联合环泊酚、纳布啡联合丙泊酚应用于老年患者无痛胃镜中的效果。方法 选取厦门市中医院2021年10月至2022年10月收治的180例老年患者（均行无痛胃肠镜检查）为研究对象,按照随机数表法分组,其中A组90例患者给予纳布啡联合环泊酚,B组90例患者给予纳布啡联合丙泊酚,对比两组患者麻醉相关指标、血流动力学、围术期不良反应。结果 两组患者诱导量、诱导时间、追加次数、总追加量、苏醒时间、恢复室停留时间对比差异均无统计学意义（t=1.486、0.830、1.157、0.941、0.906、1.403,均P>0.05）;重复测量方差分析结果显示,分组因素间收缩压（SBP）（F=30.019,P<0.001）、心率（HR）（F=282.057,P<0.001）、SpO₂（F=64.518,P<0.001）、;时间因素SBP（F=21.780,P<0.001）、HR（F=345.118,P<0.001）、SpO₂（F=41.762,P<0.001）;分组与时间交互时间因素SBP（F=12.941,P<0.001）、HR（F=193.295,P<0.001）、SpO₂（F=13.546,P<0.001）,差异均有统计学意义。折线图直观显示,A组患者SBP、HR、SpO₂、较B组低。;A组患者围术期不良反应发生率（20.00%）低于B组患者（56.67%）（χ²=25.593,P<0.001）。结论 两种麻醉方案应用于老年无痛胃肠镜,麻醉效果相近,环泊酚复合纳布啡血流动力学更稳定,且围术期不良反应的发生率较低。

Objective To compare the effects of nalbuphine combined with ciprofol and nalbuphine combined with propofol on painless gastroscopy in elderly patients. Methods A total of 180 elderly patients（all underwent painless gastroscopy）admitted to Xiamen Traditional Chinese Medicine Hospital from October 2021 to October 2022 were selected as the study subjects．They were randomly divided into groups using a random number table method．Among them,90 patients in Group A were given a combination of nalbuphine and ciprofol,while 90 patients in Group B were given a combination of nalbuphine and propofol．Anesthesia related indicators,hemodynamics,and perioperative adverse reactions were compared between the two groups．There was no statistically significant difference in the induction amount,induction time,number of additional times,total additional amount,awakening time,and recovery room stay time between the two groups of patients（t=1.486,0.830,1.157,0.941,0.906,1.403,all P>0.05）．The results of repeated measures analysis of variance showed that there were statistically significant differences among the grouping factors,including SBP（F=30.019,P<0.001）,HR（F=282.057,P<0.001）,SpO₂（F=64.518,P<0.001）,time factors SBP（F=21.780,P<0.001）,HR（F=345．118,P<0.001）,SpO₂（F=41.762,P<0.001）,and interaction factors SBP（F=12.941,P<0.001）,HR（F=193.295,P<0.001）,and SpO₂（F=13.546,P<0.001）．The line chart visually shows that the SBP,HR,SpO₂ of Group A patients were lower than those of Group B．The incidence of perioperative adverse reactions in Group A patients（20.00%）was lower than that in Group B patients（56.67%）（χ²=25.593,P<0.001）. Conclusions The two anesthesia regimens used for elderly painless gastroscopy have similar anesthesia effects,with more stable hemodynamics of ciprofol combined with nalbuphine,and a lower incidence of perioperative adverse reactions．

目的 初步探讨无创产前基因检测（NIPT）筛查胎儿患猫叫综合征临床性能。方法 收集2018年4月—2019年3月行NIPT提示胎儿患猫叫综合征高风险的孕妇,并收集其羊水细胞培养染色体核型分析或微阵列芯片检测结果,分析NIPT与羊水产前诊断结果的符合率。结果 NIPT提示猫叫综合征病例11例,孕妇均接受了羊水穿刺,染色体核型分析或微阵列芯片检测出胎儿染色体异常6例,符合率为54.5%。结论 NIPT对胎儿猫叫综合征的筛查具有临床价值,当提示高风险时必须行有创性产前诊断。

Objective To investigate the value of non-invasive prenatal testing（NIPT）for the screening of fetal Cri du Chat Syndrome（CdCS）. Methods Pregnant women who accepted NIPT with the results with high risk of fetal CdCS were selected in the study from April 2018 to March 2019．They were also accepted prenatal genetic counseling and the chromosome karyotype analysis or CMA detection of amniotic fluid cell culture．The coincidence rate of NIPT with chromosome karyotype and microarray analysis results were conducted. Results There were 11 cases with high risk of fetal CdCS in NIPT．All of them had received amniocentesis chromosome karyotype or microarray analysis,6（54.5%）cases were confirmed. Conclusions NIPT has some clinical value in screening fetal CdCS from maternal blood．Therefore,it was suggested to perform the invasive chromosomal karyotyping and CMA for high risk of fetal CdCS．

前人总结的用药禁忌十八反未必是绝对禁忌,笔者从广东省名中医陈国成主任独创星夏止痛膏外治中得到反药“乌头-半夏”的配伍启示。本文简要叙述反药配伍的源流及应用,重点对陈国成使用乌头配半夏外用的经验及思路进行论述,认为乌头与半夏配伍可通过多种方式减毒增效,为临床安全使用该配伍药物提供新的思路。

The eighteen antagonisms summarized by predecessors may not be absolute contraindications．The author obtained the inspiration of the antagonism medicinals “aconite-pinellia” from the external treatment of Xingxia painkiller ointment created by Chen Guocheng．The present paper provides a concise overview of the origin and application of anti-drug compatibility,with a specific focus on Chen Guocheng's expertise and insights regarding the external use of aconite combined with pinellia．It is postulated that diverse approaches can be employed to modulate the compatibility between aconite and pinellia,thereby offering novel perspectives for ensuring the safe utilization of this drug combination in clinical practice．

肉芽肿性小叶性乳腺炎（GLM）是一种临床较为难治的、慢性、炎症性的疾病,虽不会影响患者的生命,但是对患者的生理、心理造成了一定程度的影响,近年来该病的发病率有逐年上升的趋势。“治未病”是中医的基本思想之一,在疾病的预防、诊治方面具有重要意义。该文尝试将中医“治未病”思想应用于GLM的预防和治疗中,试图构建独特的中医预防GLM质量管理模式,以期为GLM防治提供新的思路。

Granulomatous lobular mastitis（GLM）is a chronic,inflammatory disease that is difficult to treat．Although it does not affect the patient's life,it has a certain degree of physiological and psychological impact on the patient,and in recent years the incidence of this disease has been increasing year by year．“Treating Disease Before Its Onset” is one of the basic ideas of Chinese medicine,which is of great significance in the prevention,diagnosis and treatment of diseases．In this paper,we try to apply the idea of “Treating Disease Before Its Onset” in Chinese medicine to the prevention and treatment of GLM,and attempt to construct a unique quality management model of Chinese medicine for the prevention of GLM,with a view to providing new ideas for the prevention and treatment of GLM．

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 探讨高分辨率低剂量CT（HRLDCT）在无症状健康体检者筛查肺部疾病和肺外病变的应用价值。方法 回顾性分析于2011年1月—2021年12月在广州市第一人民医院行胸部HRLDCT检查的1 940例无症状健康体检者的影像学资料,由两位研究者分别评估和记录所有受检者的每一个阳性CT病征征象,分析各个阳性CT征象在总受检人群中的检出情况、各个阳性CT征象在性别、年龄分层中的分布情况,以及肺外阳性CT征象检出情况。比较肺癌和肺良性结节在不同性别、不同年龄段分布中的检出情况。结果 共有1 831例受检者存在阳性CT征象,总检出率为94.38%,共检出3 339个阳性CT征象。检出率最高的阳性CT征象是肺部良性结节（1 630例,84.02%）。在973例男性受检者中,检出肺癌22例（2.26%）,肺良性结节 815例（83.73%）;在967例女性受检者中,检出肺癌19例（1.96%）,肺良性结节815例（84.28%）,肺癌与肺良性结节在不同性别间的检出率比较差异无统计学意义（P=0.64,χ²=0.214）。肺部阳性CT征象的检出率随年龄的增长而升高,肺癌与肺良性结节最多见于51~60岁受检人群中,两者在51~60岁和61~70岁中的检出率比较差异有统计学意义（P=0.038,χ²=4.32）。此外,检出最多的肺外其他阳性CT征象为脂肪肝,共497例（25.62%）,其次是冠状动脉钙化173例（8.90%）。结论 HRLDCT在胸部的健康体检中可同时用于肺部疾病的筛查及发现肺外异常征象,具有较高的临床应用价值。

Objective To investigate the application value of high-resolution low-dose CT（HRLDCT）in screening for lung diseases and extra-pulmonary lesions in asymptomatic healthy individuals．Methods A retrospective analysis was performed on the images of 1 940 asymptomatic healthy individuals who underwent chest HRLDCT examination in our hospital from January 2011 to December 2021．Two investigators conducted independent evaluations and recordings of each positive CT sign in all individuals．An analysis of the detection rates of positive CT signs in the entire population,examining their distribution across various gender and age groups was involved in this study．The detection of positive CT signs outside the lung was also investigated．Additionally,the comparative analysis of lung cancer and benign pulmonary nodules detection across various genders and age cohorts were performed．Results A comprehensive count of 1831 individuals exhibited positive CT signs,resulting in an overall detection rate of 94．38%,with identifying a total of 3339 positive CT signs．The positive CT sign with the highest detection rate was benign pulmonary nodule（1 630 cases,84.02%）．In 973 male participants,22 cases of lung cancer were detected（2.26%）,and 815 cases of benign lung nodules were found（83.73%）．In 967 female participants,19 cases of lung cancer were detected（1.96%）,and 815 cases of benign lung nodules were identified（84.28%）．Statistical analysis revealed no significant difference in the detection rates of lung cancer and benign lung nodules between genders（P=0.64,χ²=0.214）．The prevalence of positive CT signs in the lungs demonstrates an upward trend with advancing age．Notably,individuals aged 51-60 exhibit a higher incidence of lung cancer and benign lung nodules．A statistically significant disparity in the detection rates of these conditions is observed between the 51-60 and 61-70 age cohorts（P=0.038,χ²=4.32）．In addition,the most frequently detected extrapulmonary positive CT findings were fatty liver,with a total of 497 cases（25.62%）,followed by coronary artery calcification with 173 cases（8.90%）．Conclusion sHRLDCT can be effectively employed in the screening of pulmonary conditions and identification of extra-pulmonary abnormalities during thoracic health assessments,demonstrating considerable clinical significance．

目的 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．