目的 探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法 将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组,给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗,观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果 观察组手术时间、术后血尿以及住院时间均短于对照组,观察组术中出血量少于对照组,观察组结石清除率高于对照组（P<0.05）;术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P<0.05）;两组肾动脉收缩期血流速度（V_s）以及舒张末期血流速度（V_d）对比差异无统计学意义（P>0.05）;观察组并发症发生率（4.16%）低于对照组（19.15%）（P<0.05）。结论 无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况,减轻患者肾脏损伤,提高结石清除率,不影响肾脏血流,且并发症更少。

Objective To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy,PCNL）in the treatment of impacted upper ureteral stones．Methods A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL）,48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions,serological indicators,renal hemodynamics and complications of the two groups were observed．Results The operation time,postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume of the observation group was less than that of the control group,and the stone free rate of the observation group was higher than that of the control group（P<0.05）．One day after surgery,the levels of kidney injury molecule-1（KIM-1）,lipocalin（NGAL）and cystatin C（Cys-C）in the observation group were lower than those in the control group（P<0.05）;the renal artery systolic blood flow velocity（V_s）and end-diastolic blood flow velocity（V_d）had no statistical significance（P>0.05）;the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P<0.05）．Conclusions Tubeless minimally invasive PCNL can improve the general conditions of surgery,reduce kidney damage,increase stone free rate,does not affect renal blood flow,and has fewer complications．

目的 探讨单克隆免疫球蛋白血症患者M蛋白质量浓度检测的临床意义。方法 选取2018年6月—2023年6月龙岩人民医院收治的88例单克隆免疫球蛋白血症患者为研究对象,其中意义未明单克隆免疫球蛋白血症（MGUS）21例,具有肾脏意义单克隆免疫球蛋白血症（MGRS）50例,血液系统恶性肿瘤17例。对比其M蛋白质量浓度及临床实验室相关指标表达水平,采用Spearman相关分析法分析临床实验室相关指标的与M蛋白的相关性,对所有患者进行半年随访,以预后情况作为因变量,纳入Logistics回归模型分析M蛋白质量浓度对单克隆免疫球蛋白血症预后的预测价值。结果 不同病种M蛋白水平分别为（2.42±0.55）（2.57±0.64）（4.36±0.64）g/L、24 h尿蛋白分别为（1.45±0.16）（2.98±0.68）（2.43±0.44）g/24 h、血清白蛋白质量浓度分别为（31.01±3.06）（35.03±5.04）（39.05±7.08）g/L、总胆固醇水平分别为（3.42±1.25）（3.87±0.64）、（4.16±0.64）mmol/L、血肌酐水平分别为（114.35±23.23）（81.18±12.12）（146.36±21.12）μmol/L、血红蛋白质量浓度分别为（148.12±15.26）（141.69±12.15）（133.34±15.31）g/L,组间对比差异均有统计学意义（F分别为23.890,19.700,12.044,25.767,36.572,10.267,P<0.05）。MGUS患者24h尿蛋白与M蛋白有相关性（r=-0.384,P=0.033）,24 h尿蛋白、血清白蛋白、总胆固醇、血肌酐与MGRS患者M蛋白有相关性（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,血清白蛋白、总胆固醇、血红蛋白与血液系统恶性肿瘤患者M蛋白有相关性（r=0.374,P=0.029;r=-0.617,P=0.001;r=-0.414,P=0.024）;年龄、M蛋白为单克隆免疫球蛋白血症患者预后的影响因素（P<0.05）。结论 不同单克隆免疫球蛋白血症患者M蛋白水平存在差异,其中血液系统恶性肿瘤患者的M蛋白水平最高,且M蛋白为单克隆免疫球蛋白血症预后的独立影响因素。

Objective To explore the clinical significance of detecting M protein concentration in patients with monoclonal gammopathy．Methods From June 2018 to June 2023,88 patients with monoclonal gammopathy admitted to the hospital were selected as the study subjects．Among them,21 cases of monoclonal gammopathy with undetermined significance（MGUS）,50 cases of monoclonal gammopathy with renal significance（MGRS）,and 17 cases of hematological malignancies were selected． Concentration of M protein and the expression levels of clinical laboratory related indicators were compared,Spearman correlation analysis was used to analyze the correlation between clinical laboratory related indicators and M protein．All patients were followed up for six months,with prognosis as the dependent variable,included in the logistic regression model to analyze the predictive value of M protein concentration on the prognosis of monoclonal gammopathy．Results There were significant differences in the expression levels of M protein（[2.42±0.55],[2.57±0.64],[4.36±0.64]）g/L,24-hour urine protein（[1.45±0.16],[2.98±0.68],[2.43±0.44]）g/24 h,serum albumin（[31.01±3.06],[35.03±5.04],[39.05±7.08]）g/L,total cholesterol（[3.42±1.25],[3.87±0.64],[4.16±0.64]）mmol/L,blood creatinine（[114.35±23.23],[81.18±12.12],[146.36±21.12]）μmol/L,and hemoglobin（[148.12±15.26],[141.69±12.15],[133.34±15.31]）g/L among different diseases（F=23.890,19.700,12.044,25.767,36.572,10.267;P<0.05）．There was a significant correlation between 24 h urinary protein and M protein in MGUS patients（r=-0.384,P=0.033）．Urinary protein,serum albumin,serum cholesterol and blood creatinine were significantly associated with M protein in MGRS patients（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,Serum albumin,total cholesterol,and hemoglobin were significantly associated with M protein in patients with hematological malignancies（r=0.374,P=0.029;r=- 0.617,P=0.001;r=-0.414,P=0.024;P<0.05）．Age and M protein were independent risk factors for the prognosis of patients with monoclonal gammopathy（P<0.05）．Conclusions There are significant differences in the concentration of M protein among patients with different levels of monoclonal gammopathy,with the highest level observed in patients with hematological malignancies．M protein is an independent prognostic factor for monoclonal gammopathy．

通过筛查和早期发现,可以降低结直肠癌（CRC）的发病率,有效切除肿瘤病变可以降低CRC的病死率。虽然对CRC的危险因素、发病机制和前体病变的了解已经取得进展,但最近年轻人群CRC发病率升高,原因尚不清楚。在过去十年中,出现了多种侵入性、半侵入性和非侵入性筛查方式。目前对结肠镜检查质量的重视提高了筛查的有效性,人工智能等影像新技术在肿瘤检测中的作用正在迅速显现。而且,CRC有效干预措施,如保肛治疗新术式、靶向治疗及免疫治疗领域的新进展,被证明可以提高CRC患者的生存率。该文旨在总结目前国内外CRC筛查方式和指南的证据,并综述CRC治疗领域的进展。

The incidence of colorectal cancer（CRC）can be reduced through screening and early detection．Effective resection of tumor lesions reduces mortality from CRC．Although progress has been made in understanding the risk factors,pathogenesis and precursor lesions of CRC,the reasons for the recent increase in the incidence of CRC in young adults are largely unknown．A variety of invasive,semi-invasive and non-invasive screening modalities have emerged in the last decade．The current emphasis on the quality of colonoscopy has improved the effectiveness of screening,and the role of new imaging technologies such as artificial intelligence in tumor detection is rapidly emerging．Moreover,there are effective interventions for CRC,such as new surgical modalities for anal preservation therapy,and new advances in the field of targeted therapy and immunotherapy,which have been shown to improve the survival rate of CRC．The aim of this article is to summarize the current evidence on CRC screening modalities and guidelines both nationally and internationally,and to provide an overview of advances in the field of CRC treatment．

目的 探讨复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中的疗效。方法 选择2019年6月—2023年1月在河南省许昌中医院诊治的79例缺血性脑卒中患者,按照入院就诊顺序采用奇偶法把患者分为联合组40例与传统组39例。传统组给予阿替普酶静脉溶栓治疗,联合组给予复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗,评价与记录联合组与传统组的疗效与安全性及治疗前、治疗14 d后Fugl-Meyer评定量表（FMA）与改良版Banhel评价指数（MBI）、血清β-内啡肽、前列腺素E2（PGE2）水平变化。结果 治疗14 d后联合组的总有效率更高（97.5% vs 82.1%,P<0.05）,并发症发生率更低（5.0% vs 20.5%,P<0.05）。联合组与传统组治疗14 d后的FMA与MBI评分高于治疗前（P<0.05）,联合组治疗14 d后的FMA评分、MBI评分比传统组提高（P<0.05）。联合组与传统组治疗14 d后的血清β-内啡肽、PGE2水平低于治疗前（P<0.05）,联合组治疗14 d后的血清β-内啡肽、PGE2水平低于传统组（P<0.05）。结论 复方脑肽节苷脂注射液联合阿替普酶静脉溶栓治疗急性缺血性脑卒中能提高效果,降低患者的肺部感染、尿路感染、静脉血栓、褥疮等并发症发生率,改善患者的运动与日常生活功能,还可降低患者血清β-内啡肽、PGE2水平。

Objective To explore and analysis the efficacy and safety of compound brain peptide ganglioside injection combined with alteplase intravenous thrombolysis in the treatment of acute ischemic stroke. Methods From June 2019 to January 2023,79 patients with ischemic stroke who were diagnosed and treated at Henan Xuchang Traditional Chinese Medicine Hospital were selected as the research subjects．According to the order of admission,the patients were divided into the combination group of 40 cases and the traditional group of 39 cases．The traditional group received intravenous thrombolytic therapy with alteplase,while the combination group received treatment with compound brain peptide ganglioside injection on the basis of the traditional group．The efficacy and safety and changes of the Fugl-Meyer rating Scale（FMA）and modified Banhel Evaluation Index（MBI）,serum β-endorphin,and PGE 2 levels in the combined and traditional groups were evaluated and recorded. Results After 14 days of treatment,the combined group had a higher overall response rate（97.5% vs 82.1%,P<0.05）and a lower complication rate（5.0% vs 20.5%,P<0.05）．FMA scores and MBI scores of the two groups after 14 days of treatment were higher than those before treatment（P<0.05）,and FMA scores and MBI scores of the combined group after 14 days of treatment were higher than those of the traditional group（P<0.05）．The contents of β-endorphin and prostaglandin E2 in two groups after 14 days of treatment were lower than those before treatment（P<0.05）,and the contents of β-endorphin and prostaglandin E2 in combination group after 14 days of treatment were lower than those in traditional group（P<0.05）. Conclusions The combination of compound brain peptide ganglioside injection and alteplase intravenous thrombolysis in the treatment of acute ischemic stroke can improve the treatment effect,reduce the incidence of complications such as pulmonary infections,urinary tract infections,venous thrombosis and bedsores in patients,improve patients' motor and daily life functions,and also reduce patients' serum levels of β-endorphins and prostaglandin E2．

胶质瘤是颅内最常见的原发性恶性肿瘤,其分级对患者治疗方式的选择和预后至关重要。尽管目前组织病理学仍是其最为可靠的分级手段,但需通过有创性手术以获取组织样本,存在一定的风险。相较之下,磁共振成像（MRI）作为一种非侵入性影像诊断工具,在胶质瘤分级中发挥着不可或缺的作用。然而,传统MRI评估受限于医师个体主观性强和可重复性差的问题,一定程度上影响了准确的分级结果。近年来,影像组学技术的崭露头角为解决上述难题开辟了新视角,通过高通量提取影像数据特征捕捉并量化肿瘤的影像学表现,避免因主观因素而导致的不确定性,协助医师更准确地评估肿瘤的恶性程度。本文对近五年来MRI影像组学在胶质瘤术前分级预测方面的相关研究进行了简要综述,旨在为相关领域研究者提供有益的参考和借鉴,以推动MRI影像组学在临床实践中的应用。

Glioma is the most common primary malignant brain tumor,and its grading is crucial for treatment decisions and prognosis．Currently,histopathology remains the gold standard for grading,but it requires invasive procedures and carries inherent risks．In contrast,magnetic resonance imaging（MRI）,a non-invasive diagnostic tool,plays an indispensable role in glioma grading．However,traditional MRI assessment is hampered by interobserver subjectivity and limited repeatability,which compromise grading accuracy．In recent years,radiomics,a burgeoning field,has offered a promising solution to address these challenges．By extracting high-dimensional imaging data features,radiomics enables the quantification of tumor radiological characteristics and elimination of subjectivity-related discrepancies．This technology assists clinicians in more precisely assessing the malignancy of gliomas．This article summarizes relevant studies in the past five years on the application of MRI radiomics in preoperative glioma grading,aiming to provide valuable insights and guidance to researchers in the field and promote the clinician implementation of MRI radiomics．

目的 探讨特发性间质性肺炎（IIPs）[非特发性肺间质性纤维化（IPF）型]合并弥漫性肺部出血综合征患者治疗方案以及应用价值。方法 报道1例IIPs（非IPF型）合并弥漫性肺部出血综合征患者的治疗经过以及结果,结合文献分析治疗IIPs（非IPF型）合并弥漫性肺部出血综合症临床应用价值。结果 该文报道 l 例特发性肺间质肺炎（非IPF型）伴弥漫性肺泡出血综合征的老年男性患者,合并呼吸、循环衰竭,启用静脉-静脉体外膜肺氧合（VV-ECMO）抢救并成功撤机,病情好转出院。结论 IIPs作为病因以及发病机制未明、临床表现多样的一类肺间质性疾病,需临床多学科协作,及早诊断、治疗,才能成功挽救患者。

Objective To explore the treatment plan and application value of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome．Methods A case of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was reported．The clinical application value of treatment of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was analyzed combined with the literature．Results A case of idiopathic interstitial pneumonia（non IPF type）with diffuse alveolar hemorrhage syndrome was reported in this paper． Combined with respiratory and circulatory failure,veno-venous extracorporeal membrane oxygenation was used to rescue and successfully wean,and the condition improved and discharged．Conclusions Through the curative effect evaluation of this patient,it is believed that idiopathic interstitial pneumonia,as a kind of pulmonary interstitial disease with unknown etiology and pathogenesis and diverse clinical manifestations,need clinical multidisciplinary cooperation,early diagnosis and treatment,in order to successfully save the patient．

目的 分析恩格列净对2型心肾综合征（CRS）患者的治疗效果。方法 研究于2021年10月—2023年10月进行,随机抽取88例2型CRS患者,经计算机程序随机分成对照组（44例,给予常规治疗）、实验组（44例,在常规治疗的同时加用恩格列净）,通过对比两组患者心、肾功能指标来评估疗效,并记录两组患者治疗过程中发生的不良反应。结果 治疗后,实验组LAD、LVED低于对照组,而LVEF高于对照组;实验组血清肌酐、尿酸等肾功能指标水平均低于对照组（均P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 对于2型CRS患者,恩格列净可促进其心、肾功能的改善,且无过多不良反应,安全性理想,治疗效果可观,值得推广。

Objective To analyze the therapeutic effect of empagliflozin on patients with type 2 cardiorenal syndrome（CRS）．Methods The study was conducted from October 2021 to October 2023,and 88 patients with type 2 CRS were randomly selected and divided into control group（44 cases,receiving conventional treatment）and experimental group（44 cases,receiving conventional treatment combined with englaglitzin）by computer program．The efficacy was evaluated by comparing cardiac and renal function indexes and adverse reactions．Results After treatment,the LAD and LVED of the experimental group were lower than those of the control group,while LVEF was higher than that of the control group．The levels of serum creatinine,uric acid and other renal function indexes in the experimental group were lower than those in the control group after treatment（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions For patients with type 2 CRS,empagliflozin can promote the improvement of cardiac and renal function without many side effects,with ideal safety and considerable therapeutic effect,which is worthy of promotion．

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 探讨住院儿童甲型流感病毒肺炎合并其他病原菌感染的临床特征。方法 通过回顾性研究方法,分析2021年6月—2023年6月广州市妇女儿童医疗中心住院治疗的153例甲型流感病毒肺炎患儿的临床资料,针对有无合并其他病原菌感染,分为混合感染组及非混合感染组两组,分别为98例及55例,分析并对比两组的临床特征。结果 甲型流感病毒肺炎患儿以发热、咳嗽、呕吐/腹泻等症状为主,其中混合感染组患儿呕吐/腹泻症状占比高于非混合感染组（P<0.05）;两组患儿其他症状及并发症对比差异无统计学意义（P>0.05）;儿童甲型流感病毒肺炎患儿检出合并细菌感染的患儿65例（29.41%）,合并肺炎支原体感染的患儿33例（21.57%）;合并病毒感染的患儿20例（13.07%）。与非混合感染组比较,混合感染组患儿乳酸脱氢酶水平更高,白细胞计数<4×10⁹/L的人数占比更少（P<0.05）;其他实验室指标对比差异无统计学意义（P>0.05）;经过抗病毒及对症治疗后,150例（98.04%）患儿痊愈出院,3例出现严重并发症,其均伴有其他病原菌感染。与非混合感染组比较,混合感染组患儿住院天数更长、住院费用更高（P<0.05）;其他预后指标对比差异无统计学意义（P>0.05）。结论 甲型流感病毒肺炎患儿易感染其他的病原菌,导致疾病治疗难度加大,因此临床要提高警惕,以防混合感染情况发生,尽早采取有效的诊治措施,提高疾病早期治愈率。

Objective To explore the clinical characteristics of hospitalized children with influenza A virus pneumonia complicated with other pathogens．Methods The clinical data of 153 children with influenza A virus pneumonia hospitalized in Guangzhou Women and Children Medical Center in the past two years（June 2021 ~ June 2023）were analyzed retrospectively． According to whether they were infected with other pathogens,they were divided into mixed infection group and non-mixed infection group,with 98 cases and 55 cases respectively．The clinical characteristics of the two groups were analyzed and compared．Results Fever,cough,vomiting and diarrhea were the main symptoms in children with influenza A virus pneumonia,and the proportion of vomiting and diarrhea in children with mixed infection group was higher than that in children without mixed infection group（P<0.05）．There was no significant difference in other symptoms and complications between the two groups（P>0.05）．There were 65 children（29.41%）with influenza A virus pneumonia and 33 children（21.57%）with mycoplasma pneumonia,20 children（13.07%）with virus infection．Compared with non-mixed infection group,the level of lactate dehydrogenase in children with mixed infection group was higher,and the proportion of children with white blood cell count<4×10⁹/L was less（P<0.05）．There was no significant difference in other laboratory indexes（P>0.05）．After antiviral and symptomatic treatment,150 cases（98.04%）were cured and discharged,and 3 cases had serious complications,all of which were accompanied by other pathogens．Compared with non-mixed infection group,children in mixed infection group had longer hospitalization days and higher hospitalization expenses（P<0.05）．There was no significant difference in other prognostic indicators（P>0.05）．Conclusions Children with influenza A virus pneumonia are easily infected with other pathogens,which makes it more difficult to treat the disease．Therefore,we should be vigilant in clinic to prevent mixed infection and take effective diagnosis and treatment measures as soon as possible to improve the early cure rate of the disease．

目的 探讨责任制助产护理模式配合体位管理对高龄产妇分娩方式及产程的影响。方法 选择2023年6月—12月医院接收的高龄产妇68例进行研究，按照护理方式分为两组各34例，对照组为常规助产护理，观察组为责任制助产护理模式配合体位管理，比较两组分娩方式、产程、疼痛程度及护理满意度。结果 观察组阴道分娩率为76.47%（26例），高于对照组52.94%（18例），剖宫产率为8.82%（3例），低于对照组29.41%（10例）（χ2分别为4.121、4.660，均P＜0.05）。观察组第一产程（6.25±0.50）h、第二产程（0.79±0.21）h、总产程（7.15±0.63）h、宫口开大3 cm、10 cm时的疼痛程度（4.12±1.08）分、（6.29±1.25）分明显低于对照组（7.01±0.62）h、（0.96±0.30）h、（8.11±1.07）h、（7.84±1.45）分、（9.09±0.74）分（t分别为5.563、2.706、4.508、11.997、11.239，均P＜0.05）。观察组的护理满意度为97.06%（33例），比对照组的76.47%（26例）高（χ2=4.610，P=0.031）。结论 高龄产妇展开责任制助产护理模式配合体位管理可促进自然分娩，并缩短产程，减轻产时疼痛程度，降低剖宫产率，提高护理满意度。

Objective To explore the effect of responsibility midwifery nursing model combined with position management on delivery mode and labor process of elderly parturient．Methods A total of 68 cases of elderly pregnant women admitted to the hospital from June to December 2023 were selected,and they were divided into two groups according to the nursing mode,34 cases in each group．The control group was given routine midwifery nursing,and the observation group was given responsible midwifery nursing mode combined with position management．The methods of delivery,labor process,pain degree and nursing satisfaction of the two groups were compared．Results The vaginal delivery rate was 76.47%（26 cases）in the observation group,which was higher than 52.94%（18 cases）in the control group,and the cesarean section rate was 8.82%（3 cases）in the observation group,which was lower than 29.41%（10 cases）in the control group（χ²=4.121 and 4.660,P=0.042 and 0.030）．The pain degree of the first stage of labor（6.25±0.50）h,the second stage of labor（0.79±0.21）h,the total stage of labor（7.15±0.63）h,the pain degree of the cervical dilation 3 cm,10 cm in the observation group were significantly lower than those in the control group[（7.01±0.62）h,（4.12±1.08）points,（6.29±1.25）points vs （0.96±0.30）h,（8.11±1.07）h,（7.84±1.45）score,（9.09±0.74）score（t=5.563,2.706,4.508,11.997,11.239,P<0.05）．The nursing satisfaction of the observation group was 97.06%（33 cases）,which was higher than 76.47%（26 cases）of the control group（χ²=4.610,P=0.031）．Conclusion sResponsibility midwifery nursing mode combined with position management can promote natural childbirth,shorten the labor process,reduce the pain during labor,reduce the rate of cesarean section,and improve nursing satisfaction in elderly women,which is worthy of promotion．