本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题，IMB模型通过向患者提供科学的疾病知识，改变其疾病认知与态度，最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示，IMB模型可显著降低患者术后疼痛发生率，并提高患者参与治疗决策的程度，为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考，以便后期实施相关个性化干预措施，并提供相关理论依据。

       This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy．The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge，and ultimately promotes their adoption and maintenance of healthy behaviors．It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy，the research background of this study，the current research status at home and abroad，as well as the future development trends and challenges．The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making．This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model，so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis．

《广州医药》杂志创刊于1970年，是国家新闻出版总署批准，由广州市卫生健康委员会主管、广州市第一人民医院主办并出版的综合性医学学术期刊。由钟南山院士、宋尔卫院士、黄达德教授担任名誉主编，消化病学专家曹杰教授担任主编。获评广东省期刊协会“第六届广东省优秀期刊提名奖”、广东省科技期刊编辑学会“第八届广东省特色科技期刊”等荣誉称号；被武汉大学中国科学评价研究中心评选为“中国应用型期刊”。

目的 分析以信息-动机-行为技巧（IMB）模型为基础延续护理平台在帕金森病患者中的应用效果。方法 纳入河南省人民医院在2019年1月至2022年1月期收治的帕金森病患者96例进行研究,将其依据随机数表法分为对照组和观察组,均为48例,对照组均给予常规护理干预,观察组均给予以IMB模型为基础延续护理平台干预。比较两组主要照顾者干预前24 h（T0）和完成干预24 h（T1）内的心理状态评分、自我效能、希望水平、运动能力、肌张力、认知功能,并评估T1时刻的Barthel指数。结果 观察组患者T1时的汉密尔顿焦虑量表（HAMA）（16.64±2.57）分、汉密尔顿抑郁量表（HAMD）（16.38±1.69）分均低于对照组（20.65±1.68）（19.57±2.65）分（t=10.116、5.407,P<0.001）,观察组患者T1时的自我效能（7.24±1.48）分、希望水平（44.51±4.07分）均高于对照组（6.02±1.74）（38.95±4.54）分（t=3.357、3.311,P<0.001）,观察组患者T1时的运动能力评分（43.62±4.01）分高于对照组（39.17±5.25）分（t=4.715,P<0.001）,肌张力评分（0.72±0.21）分低于对照组（1.13±0.52）分（t=5.118,P<0.001）,观察组患者T1时刻的Barthel指数评估依靠帮助完成率（6.25%）、部分完成率（10.42%）低于对照组（25.00%）、（27.08%）（χ²=6.353、5.263,P<0.05）,观察组患者T1时刻的命名能力（3.46±0.51）、延迟回忆（3.78±0.21）分、语言能力（3.29±0.48）分、注意力评分（3.95±0.10）分均高于对照组（2.91±0.98 ）（3.21±0.96）（2.87±0.82）（3.76±0.05）分（t=3.698、3.675、3.846、4.305,P<0.001）。结论 以IMB模型为基础延续护理平台干预能够改善帕金森病患者的负性情绪,提升自我效能、希望水平,改善运动能力、肌张力、日常生活能力、认知水平。

Objective To analyze the application effect of the information motivation behavioral skills（IMB）model as a continuous care platform in Parkinson's patients. Methods A study was conducted on 96 Parkinson's patients enrolled in our hospital from January 2019 to January 2022．They were divided into a control group and an observation group based on a random number table method,with 48 patients in each group．The control group received routine nursing intervention,while the observation group received continuous nursing platform intervention based on the IMB model．The psychological state scores,self-efficacy,hope level,motor ability,muscle tone,cognitive function of the two main caregivers 24 hours before intervention（T0）and 24 hours after completion of intervention（T1）,and evaluate the Barthel index at T1 time were compared. Results The Hamilton Anxiety Scale（HAMA）[（16.64±2.57）points] and Hamilton Depression Scale（HAMD）[（16.38±1.69 points）scores] of patients in the observation group at T1 were lower than those in the control group [（20.65±1.68）points,（19.57±2.65）points]（t=10.116,5.407,P<0.001）．The self-efficacy of patients in the observation group at T1 was（7.24±1.48）points．The hope level [（44.51±4.07）points] was higher than that of the control group [（6.02±1.74）points,（38.95±4.54）points]（t=3.357,3.311,P<0.001）．The motor ability score at T1 time in the observation group [（43.62±4.01）points] was higher than that in the control group [（39.17±5.25）points]（t=4.715,P<0.001）,and the muscle tone score [（0.72±0.21）points] was lower than that in the control group [（1.13±0.52）points]（t=5.118,P<0.001）．The Barthel index evaluation of patients in the observation group at T1 time relied on help completion rate（6.25%）and partial completion rate（10.42%）,which were lower than those in the control group（25.00%）and（27.08%）（χ²=6.353,5.263,P=0.012,0.022）．The naming ability [（3.46±0.51）points],delayed recall [（3.78±0.21）points],language ability [（3.29±0.48）points],attention scores [（3.95±0.10）points] were higher than the control group [（2.91±0.98）points,（3.21±0.96）points,（2.87±0.82）points,（3.76±0.05）points]（t=3.698,3.675,3.846,4.305,P=<0.001,<0.001,<0.001）. Conclusions Continuing nursing platform intervention based on the IMB model can improve the negative emotions,self-efficacy,hope level,motor ability,muscle tone,daily living ability,and cognitive level of Parkinson's patients．

目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表（VAS）评分低于常规组（P<0.05）,二者住院时间以及引流管拔除时间比较差异无统计学意义（P>0.05）;经过护理干预后,两组的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）均延长,血浆纤维蛋白原（FIB）降低,联合组优于常规组（P<0.05）,且联合组下肢静脉血栓发生率低于常规组（0% vs 17.14%,P<0.05）;联合组患者护理满意度更高（P<0.05）;术后1个月两组患者日常生活活动能力（ADL）评分、Fugl-Meyer评分均升高,联合组高于常规组（P<0.05）。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。

Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis．Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group．Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room．The nursing effect of the two groups was compared．Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group（P<0.05）,and the length of hospital stay and drainage tube removal time were not significantly different between the two groups（P>0.05）．After nursing intervention,the prothrombin time（PT）and activated partial thromboplastin time（APTT）of the two groups were prolonged,and the plasma fibrinogen（FIB）decreased,and the change range of the combined group was greater（P<0.05）．The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group（0.00% vs 17.14%,P<0.05）．The nursing satisfaction of patients in combination group was higher（P<0.05）．The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group（P<0.05）．Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients．

目的 探讨丙酸睾酮注射液联合乌司他丁对脓毒症患者免疫失衡的调节作用。方法 选取我院2019年10月—2020年1月收治的88例脓毒症患者,随机分成观察组和对照组各44例,对照组采用乌司他丁配合常规治疗,观察组在此基础上联合丙酸睾酮注射液对患者治疗,比较治疗1周2组临床疗效差异,观察治疗前及治疗1周,2组炎症因子水平[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞介素-1β(IL-1β)]、睾酮(T)、白蛋白(Alb)水平及疾病危重程度(APACHEⅡ评分)、器官衰竭程度(SOFA评分)变化,分析治疗1周内2组患者药物不良反应发生情况差异。结果 治疗1周,观察组总有效率高于对照组(P＜0.05);2组患者IL-6、IL-1β水平及APACHEⅡ、SOFA评分均降低,且观察组较对照组更低(P＜0.05);2组患者IL-10、T、Alb水平均升高,且观察组较对照组更高(P＜0.05);2组药物不良反应总发生率比较无统计学意义(P>0.05)。结论 丙酸睾酮注射液联合乌司他丁治疗脓毒症可取得良好临床疗效,可有效改善病情及预后,对患者免疫失衡调节有积极意义。

Objective To investigate the regulatory effect of testosterone propionate injection combined with ulinastatin on immune imbalance in patients with sepsis.Methods A total of 88 patients with sepsis treated in our hospital from October 2019 to January 2020 were randomly divided into observation group and control group,with 44 cases each.The control group was treated with ulinastatin combined with routine treatment,while the observation group was treated with testosterone propionate injection additionally.The clinical efficacy difference between the two groups were compared after treating 1 week.The levels of inflammatory factors [interleukin-6 (IL-6),interleukin-10 (IL-10),interleukin-1 β (IL-1β)],testosterone (T),albumin (Alb),the severity of disease (APACHE II score) and the degree of organ failure (SOFA score) in the two groups were observed before and 1 week after treatment.The differences of adverse drug reactions between the two groups within 1 week of treatment were analyzed.Results The total effective rate of the observation group was higher than that of the control group (P＜0.05).IL-6 and IL-1β levels and APACHE II and SOFA scores decreased after treatment,while those of the observation group were lower than the control group (P＜0.05).The levels of IL-10,T and Alb in the two groups were increased,while those in the observation group were higher than the control group (P ＜ 0.05); the total incidence of adverse drug reactions in the two groups was not statistically significant (P>0.05).Conclusions Testosterone propionate injection combined with ulinastatin had good clinical efficacy in the treatment of sepsis,effectively improved the condition and prognosis,and had positive significance in the regulation of immune imbalance.

目的 研究新辅助化疗联合保肢手术治疗骨肉瘤的临床效果。方法 根据既往治疗骨肉瘤方法的不同,将56例患者分为对传统保肢组（A组）和现代保肢组（B组）,各28例。A组用采用传统保肢方案,即保肢手术+术后化疗方案进行;B组采用现代保肢方案,即新辅助化疗+保肢手术+术后化疗方案进行。化疗方案均采用CTX + VCR +MTX+ ADM方案,比较两组转移/复发率、术后1 年、2年及 3 年生存率、肢体功能、临床疗效情况。结果 比较两组的转移/复发率及3年后的死亡率,B组低于A组(P<0.05);肢体功能优良率及临床疗效,B组高于A组(P<0.05)。结论 新辅助化疗联合保肢手术能够降低骨肉瘤患者转移/复发率、死亡率,改善肢体功能,提高临床疗效。

Objective To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma. Methods Based on the previous methods of treating osteosarcoma, 56 patients were divided into the traditional limb salvage group (A group) and the modern limb salvage group (B group), 28 cases for each. The traditional limb salvage surgery + postoperative chemotherapy regimen were used in group A, and modern limb salvage regimen was performed in group B, ie neoadjuvant chemotherapy + limb salvage surgery + postoperative chemotherapy. The CTX + VCR +MTX+ ADM protocol was used in the chemotherapy regimens. The metastasis/recurrence rate, the 1-year, 2-year and 3-year survival rates, limb function, and clinical efficacy were compared between the two groups. Results The metastasis/recurrence rate and the mortality rate after 3 years in the two groups were compared. The B group was lower than that of the group A (P<0.05). The excellent rate of limb function and clinical efficacy were higher in the B group than that of in the group A (P<0.05). Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery may reduce the metastasis/recurrence rate and mortality of osteosarcoma patients, improve limb function and increase clinical efficacy.

目的 探讨快速康复外科理念对降低子宫全切术后患者下肢深静脉血栓形成的应用效果。方法 采用方便抽样的方法,将185例子宫全切术后患者分为观察组(95例)和对照组(90例)。观察组实施快速康复外科护理路径,对照组实施常规护理路径。结果 两组患者术后的下肢深静脉血栓发生率、D-二聚体水平、日常生活活动能力评分的比较差异均有统计学意义(P<0.05);观察组下肢深静脉血栓形成的发生率和D-二聚体水平低于对照组(P<0. 01),观察组日常生活活动能力评分低于对照组(P<0.05)。结论 快速康复外科理念应用于子宫全切术后患者,可降低患者下肢深静脉血栓的发生率,提高患者自理能力,使患者尽快恢复健康水平。

Objective To explore the effect of fast-track surgery on the treatment of lower extremity deep venous thrombosis in patients after total hysterectomy. Methods A total of 185 patients with hysterectomy were divided into observation group(n=95) and control group (n=90) randomly. The observation group implemented a rapid rehabilitation surgical care path, and the control group implemented routine nursing path. Results There were significant differences in the incidence of deep venous thrombosis, D-dimer level and daily living activity score between the two groups (P<0.05). The incidence of deep venous thrombosis and the level of D-dimer in the lower extremity of the observation group were significantly lower than those in the control group (P<0.01). The score of the daily living activity was lower in the observation group than that of control group (P<0.05). Conclusion Fast-track surgery for patients after total hysterectomy could reduce the incidence of postoperative deep venous thrombosis and improve the self-care abilities of patients, so that patients may return to health as soon as possible.

目的 探讨经皮穴位电刺激对脑卒中偏瘫患者上肢运动功能的影响。方法 37例脑卒中患者随机分为TAES组(n=19)和安慰刺激组(n=18)。两组常规治疗相同。TAES组采用KD-2A型经皮神经电刺激治疗仪治疗,刺激部位选择患侧上肢的4个穴位(肩髃、曲池、外关、合谷),频率100 Hz,脉宽0.2 ms,强度以患者最大耐受强度为限;每天治疗1次,每次60 min,连续3周共15次;安慰刺激组接受治疗的部位、时间和疗程与TAES组相同,但每次治疗时没有电流输出。治疗前、治疗第2周、治疗第3周分别用上肢Fugl-Meyer评分和改良Barthel指数评分(MBI)评定上肢运动功能及日常生活活动能力。结果 治疗前,两组患者间的一般情况、FMA-UE 评分和MBI评分的比较差异无统计学意义(P>0.05)。经过治疗,两组患者的FMA-UE和MBI评分与治疗前比较均有改善(P<0.05);TAES组FMA-UE和MBI评分的改善较安慰刺激组明显(P<0.05)。结论 TAES治疗能够提高脑卒中患者上肢运动功能,提高生活自理能力。

Objective To investigate the effect of transcutaneous accupoint electrical stimulation (TAES) in enhancing upper limb function in subjects with stroke. Methods 37 subjects with first stroke were randomly assigned into 2 groups:TAES group(n=19) and placebo stimulation group(n=18). All subjects received the same standard rehabilitation. In the TAES group, Model KD-2A stimulator was applied with 0.2 ms pulses, at 100 Hz within the subject's tolerance level on the 4 acupuncture points (LI15, L I11, LI4, and SJ5) in the affected upper limb for 60 min, 5 days a week for 3 weeks; The time and the course of treatment of the placebo stimulation group were as well as the TAES group's, but no current output for each treatment. All subjects in the 2 groups received standard rehabilitation program. Measurements including Fugl-Meyer motor assessment (FMA-UE) and modified Barthel index(MBI) on affected side were recorded before treatment after 2 and 3 weeks' treatments. Results After 3 weeks treatments,the function scores on affected side of the two groups were improved significantly(P<0.05). And function scores of the TAES group were significantly improved than those of the placebo group (P<0.05). Conclusion Transcutaneous accupoint electrical stimulation significantly may improve the recovery of upper limb function.

目的 探讨二维超声联合三维超声检测不同孕期胎儿肢体畸形的临床价值。方法 回顾性分析我科2013年1月—2015年1月超声筛查的1352名孕15~34周的孕妇,运用二维及三维超声,采用连续顺序追踪超声法检测胎儿四肢,将产前诊断结果与引产或引产结果对照。结果 1352名孕妇胎儿畸形46例(3.40%,46/1352),总涉及肢体73处(近端肢体畸形65处,远端肢体畸形8处),其中四肢短小9例(骨发育不全2例,单纯四肢短小畸形5例,成骨发育不全2例),漏诊2例;足畸形16例34处,漏诊1例,残肢畸形15例;手畸形6例,漏诊1例。结论 孕中期二维连续顺序追踪超声法联合三维超声胎儿肢体畸形检出率高,对及早发现胎儿肢体畸形有一定的诊断价值。

       目的   分析以信息-动机-行为技巧（IMB）模型为基础延续护理平台在帕金森病患者中的应用效果。方法   纳入河南省人民医院在2019年1月至2022年1月期收治的帕金森病患者96例进行研究，将其依据随机数表法分为对照组和观察组，均为48例，对照组均给予常规护理干预，观察组均给予以IMB模型为基础延续护理平台干预。比较两组主要照顾者干预前24 h（T0）和完成干预24 h（T1）内的心理状态评分、自我效能、希望水平、运动能力、肌张力、认知功能，并评估T1时刻的Barthel指数。结果   观察组患者T1时的汉密尔顿焦虑量表（HAMA）（16.64±2.57）分、汉密尔顿抑郁量表（HAMD）（16.38±1.69）分均低于对照组（20.65±1.68）（19.57±2.65）分（t=10.116、5.407，P＜0.001），观察组患者T1时的自我效能（7.24±1.48）分、希望水平（44.51±4.07分）均高于对照组（6.02±1.74）（38.95±4.54）分（t=3.357、3.311，P＜0.001），观察组患者T1时的运动能力评分（43.62±4.01）分高于对照组（39.17±5.25）分（t=4.715，P＜0.001），肌张力评分（0.72±0.21）分低于对照组（1.13±0.52）分（t=5.118，P＜0.001），观察组患者T1时刻的Barthel指数评估依靠帮助完成率（6.25%）、部分完成率（10.42%）低于对照组（25.00%）、（27.08%）（χ ² =6.353、5.263，P＜0.05），观察组患者T1时刻的命名能力（3.46±0.51）、延迟回忆（3.78±0.21）分、语言能力（3.29±0.48）分、注意力评分（3.95±0.10）分均高于对照组（2.91±0.98 ）（3.21±0.96）（2.87±0.82）（3.76±0.05）分（t=3.698、3.675、3.846、4.305，P＜0.001）。结论   以IMB模型为基础延续护理平台干预能够改善帕金森病患者的负性情绪，提升自我效能、希望水平，改善运动能力、肌张力、日常生活能力、认知水平。

       Objective  To analyze the application effect of the information motivation behavioral skills（IMB）model as a continuous care platform in Parkinson’s patients．Methods  A study was conducted on 96 Parkinson’s patients enrolled in our hospital from January 2019 to January 2022．They were divided into a control group and an observation group based on a  random number table method，with 48 patients in each group．The control group received routine nursing intervention，while the observation group received continuous nursing platform intervention based on the IMB model．The psychological state scores，self-efficacy，hope level，motor ability，muscle tone，cognitive function of the two main caregivers 24 hours before intervention（T0）and 24 hours after completion of intervention（T1），and evaluate the Barthel index at T1 time were compared．Results  The Hamilton Anxiety Scale（HAMA）［（16.64±2.57）points］ and Hamilton Depression Scale（HAMD）［（16.38±1.69 points）scores］of patients in the observation group at T1 were lower than those in the control group ［（20.65±1.68）points，（19.57±2.65）points］（t=10.116，5.407，P＜0.001）．The self-efficacy of patients in the observation group at T1 was（7.24±1.48）points．The hope level ［（44.51±4.07）points］ was higher than that of the control group ［（6.02±1.74）points，（38.95±4.54）points］（t=3.357，3.311，P＜0.001）．The motor ability score at T1 time in the observation group ［（43.62±4.01）points］ was higher than that in the control group ［（39.17±5.25）points］（t=4.715，P＜0.001），and the muscle tone score ［（0.72±0.21）points］ was lower than that in the control group ［（1.13±0.52）points］（t=5.118，P＜0.001）．The Barthel index evaluation of patients in the observation group at T1 time relied on help completion rate（6.25%）and partial completion rate（10.42%），which were lower than those in the control group（25.00%）and（27.08%）（χ ² =6.353，5.263，P=0.012，0.022）．The naming ability ［（3.46±0.51）points］，delayed recall ［（3.78±0.21）points］，language ability ［（3.29±0.48）points］，attention scores ［（3.95±0.10）points］ were higher than the control group ［（2.91±0.98）points，（3.21±0.96）points，（2.87±0.82）points，（3.76±0.05）points］（t=3.698，3.675，3.846，4.305，P=＜0.001，＜0.001，＜0.001）．Conclusions  Continuing nursing platform intervention based on the IMB model can improve the negative emotions，self-efficacy，hope level，motor ability，muscle tone，daily living ability，and cognitive level of Parkinson’s patients．