目的 探究高龄患者植入静脉输液港并发感染相关影响因素分析。方法 随机抽取我院2015年5月—2018年8月期间收入高龄患者总计72例,对并发感染患者数量进行统计,采取Logistic回归方程进行计算,分析高龄患者植入静脉输液港并发感染相关因素。结果 共计纳入植入静脉输液港并发感染患者总计72例,其中并发感染患者为23例,占比31.94%,对比两组一般资料,发现两组患者在穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量上存在差异,数据对比差异有统计学意义(P＜0.05),将上述有差异资料带入Logistic回归方程计算,发现穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量均为导致高龄患者植入静脉输液港并发感染影响因素。结论 对高龄患者而言,植入静脉输液港并发感染各项因素中,包括穿刺部位、疾病种类、使用时间及频率、是否有糖尿病史、体质量,患者需加强关注,可控制输液港相关感染。

Objective To explore the influencing factors of infection in elderly patients with intravenous infusion port. Methods 72 elderly patients from May 2015 to August 2018 were randomly selected in our hospital. After counting the number of patients with complicated infection,the relative factors of infection in elderly patients were analyzed by using the Logistic regression equation. Results A total of 72 patients were included in the intravenous infusion port with concurrent infection,of which 23 were accompanied with infection,accounting for 31.94%.By comparing the general data,two groups in puncture sites,types of diseases,application times and frequencies,histories of diabetes and body masses had statistically difference(P<0.05). It was found all the above factors were the concomitant factors leading to the implantation of intravenous infusion port in elderly patients by putting the difference data into the Logistic regression equation. Conclusion To control infusion port related infection,the elderly patients should focus more on the infection factors of the implantation in intravenous infusion port which included puncture sites,types of diseases,application times and frequencies,histories of diabetes and body masses.

目的 探讨以肺间质改变为主的不典型肺结核的CT特征。方法 收集2018 年1月—2018 年12月期间44例经我院临床及实验室确诊的以肺间质改变为主的不典型肺结核的CT影像学资料,进行归纳总结,分析其影像特点。结果 44例以肺间质改变为主的不典型肺结核其中14例患者在肺叶的分布呈局限性分布,其中主要分布于右肺上叶占13例;30例呈弥漫性分布;以间质改变为主的局限性分布及弥漫性分布的不典型肺结核均以细网织影、微结节、细支气管壁增厚、小叶间隔增厚为主要表现,树芽征、磨玻璃影在弥漫性分布中相对常见,其合并空洞、支气管扩张、纵膈淋巴结肿大钙化、胸膜炎、肺大疱的比例高于局限性分布患者;以肺间质改变为主的不典型肺结核呈局限性分布(14例)的患者预后良好,13例呈显著吸收,1例吸收良好;弥漫性分布(30例)的患者中,18例显著吸收,其中6例未吸收或吸收欠佳。结论 以肺间质为改变为主的非典型肺结核具有其特征性,了解其CT特点有助于提高临床诊断及更好的评价治疗预后。

Objective To discuss value of the CT features of atypical pulmonary tuberculosis with pulmonary interstitial changes and improve the early diagnosis of pulmonary tubeculosis. Methods The CT imaging data of 44 patients with atypical pulmonary tuberculosis with interstitial changes was collected from January 2018 to December 2018,and the imaging characteristics were analyzed. Results In 44 cases of atypical pulmonary tuberculosis,14 cases of atypical pulmonary tubeculosis were the localized distribution,13 cases were mainly in the right upper lobe,and 30 cases were diffuse distribution. The atypical pulmonary tuberculosis of the localized and diffuse distribution mainly with interstitial changes was characterized by tine reticular shadow,micnodule,thickening of bronchiole wall and thickening of interlobular Septa. Tree-bud sign and ground-glass shadow were common in diffuse distribution,and the proportions of cavity,bronchiectasis,mediastinal lymphadenopathy calcification,pleurisy and bullae were higher than that in localized distribution. The atypical pulmonary tuberculosis patients with localized pulmonary interstitial changes (14 cases) have a favourable prognosis,13 cases with significant absorption,1 case with favourable absorption,and 18 cases with the atypical pulmonary tuberculosis patients with diffuse pulmonary interstitial changes (30 cases) with significant absorption,6 cases with no absorption or poor absorption. Conclusion The atypical pulmonary tuberculosis with interstitial changes has its characteristics,and the CT features is helpful to improve the clinical diagnosis and better evaluation of treatment prognosis.

目的 探究Harris-Benedict(HB)公式用于估算机械通气的危重症患者能量代谢的准确性,以及不同BMI分组对其影响。方法 使用间接能量测定法测量患者的静息能量(ICREE),通过HB公式计算其静息能量代谢估算值(HBREE)。将80例患者按BMI分为4组,并通过配对样本t检验对ICREE与HBREE进行比较,Pearson分析用于分析ICREE与HBREE的相关性。结果 共纳入80例机械通气的危重症患者。除肥胖组外的其余各组病人,ICREE均高于HBREE(均P＜0.01),HB公式的准确率为23.75%。ICREE与HBREE相关性差(r=0.331,P＜0.01)。当各组使用校正系数对HB公式进行调整后,ICREE与HBREE差异无统计学意义,准确率提高至38.8%。结论 使用HB公式不能很好地反应危重症患者的实际能量代谢。BMI可能是影响HB公式准确性的重要因素。依据不同BMI分组,使用相应校正系数可提高HB公式的准确性。

Objective To explore the accuracy of the Harris-Benedict (HB) formula used to estimate the energy metabolism in critically ill patients undergoing mechanical ventilation and the effects of different BMI groups on it. Methods Indirect calorimetry was used to measure the resting energy of the patient,and the estimated resting energy metabolism was calculated by the HB formula. 80 patients were divided into four groups according to BMI. ICREE and HBREE were compared by paired sample t test. Pearson analysis was used to analyze the correlation between ICREE and HBREE. Results This study included 80 critically ill patients undergoing mechanical ventilation.Except for the obese group,ICREEE was higher than HBREE in all patients and the remaining groups of patients. The accuracy rate of the HB formula was 23.75%. The correlation between ICREE and HBREE is poor(r=0.331,P＜0.01). There was no statistical difference between ICREEE and HBREE and the accuracy rate increased to 38.8% after the Harris-Benedict equation was adjusted by using the correction factor. Conclusion Using the HB formula can not reflect the actual energy metabolism of critically ill patients well. BMI may be an important factor affecting the accuracy of HB formula. The accuracy of the HB equation can be improved by using different correction factors according to different BMI groupings.

目的 分析彩色多普勒超声在小儿阴囊急症诊断中的应用价值。方法 于2019年1月—2019年12月选取院内收治的100例以阴囊急症就诊的患儿作为研究对象,使用彩色多普勒超声对所有患儿进行诊断,分析患儿的超声影像学特点,并对彩色多普勒超声的诊断结果与手术和病理结果进行对比。结果 急性睾丸扭转患儿的影像学形态以睾丸肿胀(90.63%)、阴囊壁水肿(75.00%)、鞘膜积液(68.75%)、睾丸实质回声异常(59.38%)和附睾增大(53.13%)为主,其中睾丸肿胀和睾丸实质回声异常的患儿例数明显高于其他疾病类型(P＜0.05);急性睾丸附件扭转患儿的影像学形态以睾丸外结节(96.30%)、附睾增大(74.07%%)、阴囊壁水肿(70.37%)和鞘膜积液(51.85%)为主,其中睾丸外结节的患儿例数高于其他疾病类型(P＜0.05);急性附睾炎患儿的影像学形态以阴囊壁水肿(82.61%)、附睾增大(73.91%)和鞘膜积液(52.17%)为主;急性睾丸炎患儿的影像学形态也以阴囊壁水肿(83.33%)、附睾增大(83.33%)、和鞘膜积液(55.56%)为主,急性附睾炎和急性睾丸炎患儿的影像学形态相比差异无统计学意义(P＞0.05);急性睾丸扭转患儿的睾丸内血流分布主要为减少或消失和精索扭转,与其他疾病类型患儿相比差异有统计学意义(P＜0.05);急性睾丸附件扭转患儿的睾丸内血流分布主要为正常,与其他疾病类型患儿相比差异有统计学意义(P＜0.05);急性附睾炎和睾丸炎患儿的睾丸内血流分布主要为增加,与其他疾病类型患儿相比差异有统计学意义(P＜0.05),急性附睾炎和急性睾丸炎患儿的睾丸内血流分布情况相比差异无统计学意义(P＞0.05);彩色多普勒超声在阴囊急症中的总诊断率为97%,与手术病理结果相比无差异(P＞0.05),在急性睾丸扭转中的诊断符合率为96.88%,在急性睾丸附件扭转中的诊断率为96.30%,在急性附睾炎中的诊断符合率为95.65%,在急性睾丸炎中的诊断率为100.00%,不同疾病类型阴囊急症患儿中的诊断率与手术病理结果相比均无差异(P＞0.05)。结论 彩色多普勒超声在小儿阴囊急症的诊断中发挥出了较好的临床诊断效果,在不同疾病类型阴囊急症中的诊断符合率均相对较高,应当作为小儿阴囊急症早期筛查的主要影像学方法,值得广泛应用及推广。

Objective To analyze the value of color Doppler ultrasound in the diagnosis of scrotal emergency in children. Methods From January 2019 to December 2019,100 children admitted to the hospital with scrotal emergency were selected as the research objects. All patients were diagnosed by color Doppler ultrasound and the characteristics of ultrasound imaging were analyzed. The diagnostic results of color Doppler ultrasound were compared with surgical and pathological results. Results The imaging morphology of children with acute testicular torsion was testicular swelling (90.63%),scrotal wall edema (75.00%),hydrocele (68.75%),abnormal testicular parenchymal echo (59.38%),and enlarged epididymis (53.13%) mainly. The numbers of children with testicular swelling and abnormal testicular parenchymal echo were higher than other disease types (P<0.05); the imaging morphology of children with acute testicular attachment reversal was extratesticular nodules (96.30%) and enlarged epididymis (74.07 %%),scrotal wall edema (70.37%),and hydrocele (51.85%) were predominant,and the numbers of children with extra testicular nodules were higher than other disease types (P<0.05); acute epididymis morphology of scrotal wall edema (82.61%),enlarged epididymis (73.91%),and hydrocele (52.17%) in children with inflammation are mainly; the morphology of scrotal wall edema in children with acute orchitis (83.33%) also,epididymis enlargement (83.33%),and hydrocele (55.56%) were the main factors. There was no significant difference in imaging morphology between children with acute epididymitis and acute orchitis (P> 0.05); Testicular blood flow distribution in children with acute testicular torsion was mainly reduced or disappeared and spermatic cord twisted,the difference was statistically significant compared with children with other disease types (P<0.05); blood distribution in the testis of children with acute testicular accessory torsion was mainly normal,compared with children with other disease types. The difference was statistically significant (P<0.05); the distribution of blood flow in the testis of children with acute epididymitis and orchitis was mainly increased,and the difference was statistically significant compared with children with other disease types (P<0.05). There was no significant difference in testicular blood flow distribution between children with inflammation and acute orchitis (P> 0.05);The overall diagnosis rate of color Doppler ultrasound in scrotal emergency was 97%,and there was no significant difference compared with the surgical pathological results (P> 0.05). The diagnostic coincidence rate in acute testicular torsion was 96.88%,and in acute testis, the diagnostic rate of attachment reversal was 96.30%,the diagnostic coincidence rate in acute epididymitis was 95.65%,the diagnostic rate in acute orchitis was 100.00%. Compared with the diagnosis rates and surgical pathology results in children with scrotal emergency of different disease types,there were no significant differences (P> 0.05). Conclusion Color Doppler ultrasound has a good clinical diagnosis effect in the diagnosis of scrotal emergencies in children,and the diagnostic coincidence rate in different types of scrotal emergencies is relatively high. It should be used as the main early screening for scrotal emergencies. The imaging method is worthy of wide application and promotion.

目的 探讨子午流注开穴法对薄型子宫内膜患者妊娠结局的影响。方法 将同期在门诊行B超监测排卵、指导受孕的薄型子宫内膜患者80例随机分为两组,每组各40例,观察组采用子午流注开穴法及药物治疗,对照组则单纯给予药物治疗。比较两组治疗前后的子宫内膜厚度、子宫内膜形态、子宫内膜血流搏动指数(PI)、血流阻力指数(RI)及临床妊娠率(PR)。结果 两组治疗后子宫内膜厚度与同组治疗前均有不同程度的改善(P<0.05),治疗后子宫内膜厚度两组间比较差异有统计学意义(P<0.05)。观察组治疗后A型子宫内膜的比例较治疗前增加,差异有统计学意义(P<0.05);与对照组比较,差异有统计学意义(P<0.05)。观察组临床妊娠率为27.5%,对照组临床妊娠率为10%,两组相比较差异有统计学意义(P<0.05)。结论 子午流注开穴法在薄型子宫内膜患者中的应用有效促进子宫内膜容受性的建立,从而改善其妊娠结局。

Objective To explore the effects of selection points by earth meridian ebb-flowing rule on infertile women suffering from thin endometrium. Methods 80 patients with thin endometrium who were monitored ovulation and guided pregnancy under B-mode ultrasound were randomly divided to two groups: the observation group and the control group, 40 patients for each group. The observation group was treated with selection points by earth meridian ebb-flowing rule and medication, while the control group was treated with medication only. The endometrial thickness, endometrial morphology, endometrial blood flow Pulsation Index (PI), Resistance Index (RI) and Clinical Pregnancy Rate (PR) before and after treatment were compared between the two groups. Results After treatment, the endometrial thickness was improved in both groups, which was statistical significant between the two groups(P<0.05). The proportion of type A endometrium in the observation group was increased compared with that before treatment and the control group, the difference was statistical significant(P<0.05). The clinical pregnancy rate was 27.5% in the observation group and 10% in the control group, and the difference between the two groups was statistically significant(P<0.05). Conclusion The application of selection points by earth meridian ebb-flowing rule in patients with thin endometrium may effectively promote the establishment of endometrial receptivity and improve the pregnancy outcome.

目的 研究富血小板血浆联合强骨胶囊对大鼠骨质疏松性骨折骨愈合的影响。方法 80只未交配、3月龄雌性健康SD大鼠作为研究对象,将以上大鼠分为空白组(K组)、PRP组(P组)、强骨胶囊组(Q组),联合组(L组),每组大鼠20例,分析四组大鼠的骨痂显微形态、组织形态学以及生物力学指标之间的差异。结果 经过两两比较,联合用药组患者的骨小梁体积、数量、厚度、连接密度高于单独用药组,分离度、表面积体积比低于对照组(P＜0.05);联合用药组患者的最大载荷、结构能量吸收、材料最大应力、材料能量吸收高于单独用药组;经过两两比较,联合用药组患者的骨架面积及软骨或骨性骨痂面积比高于单独用药组。结论 富血小板血浆联合强骨胶囊通过对骨折部位骨质密度以及骨质强度的增强,大鼠骨质疏松性骨折骨愈合情况良好。

Objective To study the effect of platelet rich plasma combined with Qianggu capsule on osteoporotic fracture healing in rats. Methods 80 unmatched and 3-month-old female healthy SD rats were divided into blank group (group K),PrP group (group P),Qianggu capsule group (group Q),combined group (group L) and 20 rats in each group. The differences of callus morphology,histomorphology and biomechanical indexes among the four groups were analyzed. Results After comparing the two groups,the volume,quantity,thickness and connection density of trabecula in the combined group were higher than those in the single drug group,and the separation and surface area volume ratio were lower than those in the control group (P< 0.05); the maximum load,structural energy absorption,material maximum stress and material energy absorption in the combined group were higher than those in the single group; after comparing the two groups,in the combined group,skeleton area and area ratio of cartilage or osteotylus in the treatment group were higher than that in single-drug group. Conclusion Platelet rich plasma combined with Qianggu capsule may enhance the bone density and bone strength of the fracture site,and the osteoporotic fracture healing in rats is good.

目的 对比中成药镇痛活络酊和非甾体抗炎药(Nonsteroidal Anti-inflammatory Drugs,NSAIDs)治疗肱骨外上髁炎(lateral epicondylitis,LE)的短期临床疗效差异。方法 筛选后符合纳入标准的LE患者60例,随机分为镇痛活络酊组(n=30)和NSAIDs组(n=30)。镇痛活络酊组外用镇痛活络酊,NSAIDs组外用法斯通凝胶(酮洛芬),两组均连续用药3周,3次/d。用药后3 周、6 周和12 周连续随访,主要观测指标包括视觉模拟评分(visual analog scale,VAS);肩、肘和手的功能评分(Disabilities of the arm, Shoulder And Hand,DASH);无痛握力(Pain-free grip strength,PFGS)。VAS评分分别测量患者1周前用力活动时的VAS评分和正常休息时的VAS评分,记为VAS(活动时)和VAS(休息时)。运用统计学方法对比分析两组患者在VAS评分(活动时)、VAS评分(休息时)、DASH评分和PFGS上的差异。结果 两组患者在VAS评分(活动时)、VAS评分(休息时)和DASH评分上均未见组间差异(P>0.05)。两组患者在用药前、用药后3周、用药后6周的PGFS对比同样无组间差异(P=0.91,P=0.42,P=0.13)。但是,在用药后12周,镇痛活络酊组的PFGS高于NSAIDs组(P=0.02)。结论 镇痛活络酊缓解LE疼痛的效果与外用NSAIDs相当,对提升伸肌力效果则更优。

Objective To compare the short-term clinical effects difference between analgesic tincture and topical nonsteroidal anti-inflammatory drugs (NSAIDs) in the treatment of lateral epicondylitis (LE). Methods 60 cases of LE patients were randomly divided into an analgesic tincture group (n=30) and a NSAIDs group (n=30). Analgesic tincture was chosen for the analgesic tincture group and topical ketoprofen gel for the NSAIDs group to treat LE. Two groups were treated continuously for 3w, 3 times/day. Clinical results of each drug were followed-up at the time point of 3w, 6w and 12w after usage. Observational indexes included the visual analogue scale (VAS), disabilities of the arm, shoulder and hand questionnaire (DASH) and pain-free grip strength (PFGS). The inter-group difference of VAS (at activity), VAS (at rest), DASH score and PFGS were compared subsequently. Results No difference of the VAS (at activity), VAS (at rest), DASH score were ascertained (P> 0.05) between groups. Inter-group difference of PGFS was also not discerned at the time points of pre-treatment and 3 weeks and 6 weeks (P=0.91, P=0.42, P=0.13) post-treatment. However, PFGS of the analgesic tincture group was found to be higher than that of the NSAIDs group (P=0.02) after 12 weeks post-treatment. Conclusion Effect of analgesic tincture in releasing pain is almost the same to that of tropical NSAIDs, but a better effect in improving muscle strength.

目的 探讨循证护理干预在肺功能检查中对检查准确性的影响。方法 选取行肺功能检查患者80例,随机分为2组,分别记录为观察组40例和对照组40例,分别实施循证护理干预和常规护理干预,比较两组患者肺功能检查时间、肺功能检查结果及护理满意度。结果 观察组患者平均肺功能检查时间短于对照组(P<0.05);观察组患者肺功能检查正常率高于对照组;且观察组患者对护理服务的满意度高于对照组,组间对比差异有统计学意义(P<0.05)。结论 对行肺功能检查的患者实施循证护理干预效果显著,有利于缩短患者肺功能检查时间,并可提高检查的准确率,且有利于改善护患关系,值得在临床上推广应用。

Objective To investigate the influence of evidence-based nursing intervention on the accuracy of the examination in pulmonary function test. Methods 80 cases of patients with lung function examination, were randomly divided into 2 groups, were recorded in 40 cases of observation group and control group 40 cases, respectively. The implementation of evidence-based nursing intervention and routine nursing intervention were taken, to compare times of patients with pulmonary function test, pulmonary function test results and nursing satisfaction in two groups. Results In the observation group the average lung function examination time was shorter than that of the control group (P<0.05); normal pulmonary function tests was higher than that of the control group; satisfaction with nursing service was higher than the control group, there was statistical significance the differences between the two groups (P<0.05). Conclusion The pulmonary function test for patients with the implementation of evidence-based nursing intervention has significant effect. It can shorten the time in patients with pulmonary function examination, improve the inspection accuracy, and improve the relationship between nurses and patients, it is worthy of clinical application.

目的 探究分析基于互联网平台的健康管理模式对2型糖尿病患者血糖管理的效果及其临床价值。方法 选择2018年3月—2019年3月期间到我院进行治疗的120例2型糖尿病患者作为研究对象,用电脑随机法分为对照组和实验组各60例,对照组患者对其进行常规的护理干预,实验组患者给予基于互联网平台的健康管理模式,测试他们接受护理管理前后的血糖情况,邀请所有患者填写焦虑、抑郁自评量表评分并比较两组患者的心理状态评分,比较两组患者的生活质量和护理满意度。分析它们的护理要点及其结果。结果 实验组患者的护理后的血糖低于对照组;实验组患者焦虑自评量表(SAS)、抑郁自评量(SDS)表得分分别为(45.2±4.3)分和(42.8±6.3)分,这两个表均低于对照组的(56.3±7.5)分、(58.1±3.9)分;实验组患者的生活质量高于对照组;护理满意度高于对照组,差异有统计学意义(P＜0.05)。结论 应用基于互联网平台的健康管理模式有利于提高糖尿病患者血糖控制效果,对改善患者负面情绪、提高其生活质量及维持良好的护患关系也具有积极意义。

Objective To explore the effect and clinical value of health management model based on internet platform on blood glucose management in patients with type 2 diabetes(T2DM). Methods 120 patients with T2DM who came to our hospital for treatment from March 2018 to March 2019 were selected and they were randomly divided into the control group and the experimental group with 60 cases each. The patients in the control group were given routine nursing intervention. The patients in the experimental group were given health management mode based on the internet platform to test their blood glucose before and after receiving nursing management. All patients were invited to filled in the self-rating anxiety scale (SAS) and self-rating depression scale (SDS).The blood glucose level, the psychological state, the self-rating scales and nursing points in the two groups were investigated and compared after intervention. Results The blood glucose of the experimental group was lower than that of the control group, the scores of SAS and SDS were (45.2 ± 4.3) (42.8 ± 6.3) respectively, both of which were lower than those of the control group (56.3 ± 7.5) and (58.1 ± 3.9); the quality of life of patients in the experimental group was higher than that in the control group; nursing satisfaction was higher than that in the control group, the difference was statistically significant (P<0.05). Conclusion The application of health management model based on internet platform is conducive to improving the effect of blood glucose control in diabetes patients, relieving their negative emotions, improving their quality of life and maintaining a good nurse-patient relationship.

目的 探讨实习前护理知识技能评价与实习教学目标相结合的临床护理实习培训效果。方法 选择2018年在我科实习的护理本科实习生40名为对照组,采取传统的带班实习带教方法进行临床带教;2019年在我科实习的40名护理本科实习生为实验组,对实习生在实习前进行护理知识和护理操作能力评估,根据实习生专业知识与护理技术的评估结果,结合实习教学目标进行针对性的临床带教;实习结束对两组同学掌握的护理理论知识、护理操作技术、服务满意度进行评价。结果 实验组掌握的护理知识、护理操作技术得分均高于对照组,两组结果比较差异有统计学意义(P<0.001);服务满意度评价实验组高于对照组,两组结果比较差异有统计学意义(P<0.05);结论 开展实习前护理专业能力评价与教学目标相结合的护理临床实习培训模式管理,有助于带教老师掌握实习生存在的护理知识缺乏和护理技术薄弱问题,利于带教老师制定合理的实习带教计划和带教重点,提高学生临床实习效果和老师的带教质量。

Objective To explore the effect of clinical nursing practice training combined with the evaluation of nursing knowledge and skills and teaching objectives before practice. Methods 40 nursing undergraduates who practiced in our department in 2018 were selected as the control group, and the traditional method of clinical teaching was adopted; 40 nursing undergraduates who practiced in 2019 were selected as the experimental group to evaluate the nursing knowledge and nursing operation ability of the interns before the practice, according to the evaluation results of professional knowledge and nursing technology of the interns, combined with the practice teaching at the end of the internship. The students in the two groups were evaluated on their theoretical knowledge, nursing operation technology and service satisfaction. Results The scores of nursing knowledge and nursing operation technology in the experimental group were higher than those in the control group, and the results of the two groups were statistically significance (P<0.001); the evaluation of service satisfaction in the experimental group was higher than that in the control group, and the results of the two groups were statistically significance (P<0.05); Conclusion To carry out the management of nursing clinical practice training mode combining the evaluation of nursing professional ability with teaching objectives before practice is helpful for the teachers to find out problems of lack of nursing knowledge and weak nursing technology existing in the interns. It helps the teachers to formulate reasonable practice teaching plan and key points, and improves the effect of students' clinical practice and the quality of teaching.