目的 分析在中耳胆脂瘤患者中耳内窥镜的价值。方法 回顾性分析61例单侧中耳胆脂瘤患者的临床资料,均接受手术治疗,其中有31例实施耳内窥镜下手术,记为A组;有30例实施常规鼓室成形术,记为B组。对比2组术前和术后1个月气骨导差和气道听阈变化,临床效果和术后并发症。结果 术后1个月A组气骨导差和气道听阈分别为(8.5±1.5)dB、(21.2±2.4)dB,均较术前下降(t=38.195,P<0.001;t=27.739,P<0.001),B组分别为(13.4±2.3)dB、(25.6±2.7)dB,均较术前下降(t=23.510,P<0.001;t=21.575,P<0.001),且术后1个月A组气骨导差和气道听阈均低于B组(t=9.888,P<0.001;t=6.732,P<0.001);A组与B组临床效果分布对比差异有统计学意义(Z=6.102,P=0.014),且A组总有效率为100.00%,高于B组的83.33%(χ²=5.628,P=0.018);A组总并发症发生率为3.23%,低于B组的20.00%(χ²=4.223,P=0.040)。结论 在中耳胆脂瘤患者手术中应用耳内窥镜治疗能够显著改善气骨导差和气道听阈,较常规鼓室成形术效果更佳,安全性更高。

Objective To analyze the value of middle ear endoscopy in patients with middle ear cholesteatoma. Methods The clinical data of 61 patients with unilateral middle ear cholesteatoma were retrospectively analyzed. All of them underwent surgery. Among them, 31 underwent otoendoscopic surgery, which was recorded as group A; 30 underwent conventional tympanoplasty, which was recorded as group B. The changes of air-bone conduction, airway auditory threshold, clinical effect and complications were compared between the two groups before and 1 month after operation. Results One month after operation, the difference of air-bone conduction and airway auditory threshold in group A were (8.5±1.5) dB and (21.2 ±2.4) dB, were lower than those before operation (t=38.195, P<0.001;t= 27.739,P<0.001), group B were (13.4±2.3) dB and (25.6±2.7) dB, respectively, lower than those before operation (t= 23.510,P<0.001;t=21.575,P<0.001), one month later, the air-bone conduction and airway hearing threshold in group A were lower than those in group B (t=9.888,P=0.000;t=6.732,P<0.001); The difference was statistically significant in clinical effect distribution between group A and group B (Z=6.102,P= 0.014), and the total effective rate of group A was 100.00%, which was higher than that of group B 83.33% (χ²= 5.628,P=0.018); the total incidence of complications in group A was 3.23%, lower than that in group B 20.00% (χ²= 4.223,P=0.040). Conclusion Endoscopic ear surgery may improve the air-bone conduction and airway auditory threshold in patients with middle ear cholesteatoma, which is more effective and safe than conventional tympanoplasty.

目的 分析比较经皮微创椎弓根钉内固定和传统开放式手术治疗脊椎骨折的优劣差异。方法 本研究选择我院2015年2月—2016年6月收治的脊椎骨折患者72例,按照治疗方法的不同将全部患者分成对照组(36例)和实验组(36例),两组患者分别给予传统开放式手术治疗和经皮微创椎弓根钉内固定治疗,对两组患者的临床疗效进行观察分析。结果 在手术时间、手术出血量、切口长度以及住院时间方面,实验组患者均优于对照组(P＜0.05);实验组患者术后的血清肌酸激酶活性低于对照组患者(P＜0.05);治疗后两组患者椎体前缘高度、Cobb's角均优于治疗前(P＜0.05),但是组间比较差异无统计学意义(P＞0.05)。术后两组患者均没有发生椎间隙感染、神经损伤、切口感染等并发症。结论 在对脊椎骨折患者进行治疗时,经皮微创椎弓根钉内固定治疗和传统开放式手术治疗的临床疗效比较类似,但是和传统开放式手术相比较,经皮微创椎弓根钉内固定治疗对患者的损伤更加轻微,术后恢复时间更短。

目的 探讨医护合作护理程序教育模式在轻度认知功能障碍血透患者中的应用效果。方法 对65例患者实施医护合作护理程序教育模式,2个月后对患者的健康教育知识掌握程度、自体动静脉内瘘自我护理能力、维持性透析依从性、满意度进行测评。结果 医护合作护理程序教育模式后患者的健康教育知识掌握程度为92.31%、自体动静脉内瘘自我护理能力为27.11±3.26、维持性透析依从性是48.22±4.67、护理满意度是92.31%,均比护理程序教育前提高,护理程序教育前后比较差异均有统计学意义(P＜0.01)。结论 医护合作护理程序教育模式能提高患者的认知能力、自我护理能力和满意度,减少并发症,利于患者生活质量的提高。

Objective To explore the effect of the application of nursing process education model under doctor-nurse cooperation in hemodialysis patients with mild cognitive impairment.Methods 65 patients received nursing process education model under doctor-nurse cooperation. After 2 months, these patients were assessed in terms of the level of knowledge about health education, autologous arteriovenous fistula self-care ability, compliance of maintenance dialysis and satisfaction.Results After the nursing process education model under doctor-nurse cooperation, the percentage of patients who became proficient at knowledge about health education was 92.31%, that of patients who showed autologous arteriovenous fistula self-care ability was 27.11±3.26, that of the patients who became compliant to maintenance dialysis was 48.22±4.67, and nursing satisfaction was 92.31%. These performances improved significantly, comparing to those before the nursing process education model under doctor-nurse cooperation. The differences between before and after the model have statistical significance (P<0.01).Conclusion The nursing process education model under doctor-nurse cooperation may improve patients' cognitive ability, self-care ability and satisfaction. It also reduces complications and helps patients to increase the quality of life.

目的 探讨6野切线射野方式调强放疗(6F-IMRT)用于左侧乳腺癌根治术后放疗的临床价值。方法 纳入我院70例左侧乳腺癌根治术患者为研究对象,进行模拟CT增强扫描,三维重建后勾画大体靶区,分别对每个患者靶区设计4F-IMRT、5F-IMRT、6F-IMRT三种治疗计划,规定计划靶区(PTV)达到95%的处方剂量前提下,分析三种治疗计划PTV所受照射的平均剂量、最大剂量、最小剂量,95%、100%等剂量线包绕的靶区体积(V₉₅、V₁₀₀),适形度指数(CI)及剂量不均匀指数(HI),并比较三种计划下心脏、双肺、右乳受照射剂量。结果 各治疗计划靶区最大剂量、最小剂量、平均剂量比较无统计学意义(P＞0.05)。6F-IMRT的V₉₅、V₁₀₀均高于4F-IMRT、5F-IMRT,差异有统计意义(P＜0.05)。4F-IMRT、5F-IMRT、6F-IMRT的CI呈递增趋势,HI呈递减趋势,各组间比较差异有统计学意义(P＜0.05)。三种放疗计划中心脏的平均剂量、V₃₀,双肺的平均剂量、V₂₀、右乳平均剂量比较无显著差异(P＞0.05)。三种放疗计划中,4F-IMRT右乳V₁₀显著低于5F-IMRT、6F-IMRT,差异有统计学意义(P＜0.05),但均在最大耐受剂量范围内。结论 与4F-IMRT、5F-IMRT相比,6F-IMRT用于左侧乳腺癌根治术后放疗有明显剂量学优势,可提高靶区照射剂量,靶区适形程度及剂量均匀性均较好,而且并不会增加周围正常器官照射剂量。

目的 探讨重组人表皮生长因子滴眼液联合玻璃酸钠治疗白内障术后干眼症的随机对照情况。方法 选取2017年度在本院实施白内障术后发生干眼症患者120例,采取随机分组方法分成观察组、对照组各60例,观察组给予重组人表皮生长因子滴眼液联合玻璃酸钠治疗,对照组给予玻璃酸钠滴眼液治疗,比较两组患者的临床疗效情况。结果 观察组有效率90%高于对照组73.33%,有差异;两组患者治疗前FL、BUT、SIT比较均无差异,P>0.05;治疗后,两组FL、BUT、SIT比较有差异,P<0.05; 两组患者治疗前视力评价比较均无差异,P>0.05;治疗后,两组视力评价比较有差异,P<0.05。结论 给予白内障术后干眼症患者采取重组人表皮生长因子滴眼液联合玻璃酸钠治疗,可提高临床疗效,对于改善相关临床体征、视力指标均具有重要临床价值。

目的 探讨血管介入治疗糖尿病足的疗效以及术后血管再狭窄的影响因素。方法 选取2013年2月—2015年3月在我院接受治疗的糖尿病足患者96例,采用随机数表法将患者分为观察组和对照组两个各48例,观察组患者给予血管微创手术介入治疗,对照组患者给予常规治疗,比较两组患者治疗后的临床疗效、住院费用、住院天数、Wagner分级以及患者观察组患者术后血管再狭窄的影响因素。结果 治疗后,观察组患者的总有效率为93.75%高于对照组72.91%,两组比较差异有统计学意义(P<0.05);将观察组患者术后发生发生血管再狭窄的22例患者作为A组,未出现血管再狭窄的26例患者作为B组。A、B两组患者病程、TG、LDL-C、MDA含量、HbA以及BMI比较差异无统计学意义(P>0.05);术后,A组患者的TC明显高于B组,两组比较差异有统计学意义(P<0.05),由此可见,TC是导致患者术后出现血管再狭窄的危险因素;观察组患者的住院费用以及住院天数低于对照组,两组比较差异显著(P<0.05)。结论 采用血管介入治疗糖尿病足患者疗效显著,高TC是患者术后血管再次发生狭窄的影响因素。

目的 探讨追踪护理模式对中青年保留神经宫颈癌根治术后膀胱功能恢复的影响效果。方法 按住院先后顺序将82例患者分为对照组40例、实验组42例,对照组给予常规护理,实验组实施追踪护理模式,3个月后对两组患者的尿失禁、尿潴留发生率,膀胱功能恢复情况及尿失禁严重程度进行测评。结果 实验组尿失禁、尿潴留的发生率分别为2%、4% ,膀胱功能Ⅰ级、Ⅱ级达100%,68%患者无尿失禁,与对照组比较差异均有统计学意义(P>0.05)。结论 对中青年保留神经宫颈癌根治术实施追踪护理模式,可提高患者膀胱功能锻炼的有效性,促进膀胱功能的早日恢复,改善其生活质量。

Objective To explore the effect of follow-up nursing on the recovery of bladder function in young and middle-aged patients with cervical cancer after radical operation. Methods 82 patients were divided into control group (n = 40) and experimental group (n=42). The control group was given routine nursing care, experimental group to implement the follow-up nursing model. After 3 months, the incidence of urinary incontinence and urinary retention were observed in the two groups, including bladder function recovery and severity of urinary incontinence. Results The incidence of urinary incontinence and urinary retention in the experimental group were 2% and 4%, respectively. Bladder function level I and II reached 100%. There was no urinary incontinence in 68% patients. Compared with the control group, the difference was statistically significant (P>0.05). Conclusion It may improve the effectiveness of bladder function training, promote the early recovery of bladder function and improve the quality of life of young and middle-aged patients with cervical cancer.

目的 研究鳞癌抗原(SCC-Ag)的表达对宫颈癌手术治疗后临床转归的预测价值。方法 选取我院2014年4月—2015年9月实施宫颈癌手术的患者52例,分别于手术前后分析所有患者的鳞癌抗原表达,对患者进行1年的随访,以发生癌细胞转移、复发或死亡为研究终点,比较预后良好的患者与预后差的患者鳞癌抗原的表达的不同。结果 Ia、Ib1、Ib2、IIa、IIb期宫颈癌患者术后SCC-Ag水平较手术前均显著降低(P＜0.05);纳入本次研究的患者宫颈癌术后复发或转移发生率为15.38%,转归良好的患者为84.62%,预后良好的患者术后SCC-Ag水平(0.91±0.27)ng/mL较发生复发或转移的患者(1.37±0.57)ng/ml显著较较低(P＜0.05)。结论 宫颈癌患者术后血清SCC-Ag水平与肿瘤的应答之间具有关联性,术后SCC-Ag水平高的患者复发与转移发生率显著高于SCC-Ag水平低的患者,鳞癌抗原的表达对宫颈癌手术后患者的转归情况具有预测价值,临床应予以重视。

目的 探讨医护合作客观结构化临床考试(OSGE)培训对手术室低年资护士应急能力的影响效果。方法 对36名手术室低年资护士进行医护合作OSGE培训,于培训前和培训后3个月对低年资护士进行手术意外事件应对能力、实际参与应对手术意外事件能力以及对手术配合满意度的测评。结果 培训后低年资护士在医护配合、抢救仪器准备、抢救能力、病情评估、应对能力的得分显著提高,在护士抢救到位时间、抢救仪器到位时间、静脉穿刺成功时间明显缩短,医护对手术配合满意度明显提升,与培训前比较差异均有统计学意义(P＜0.05)。结论 对手术室低年资护士进行医护合作OSGE培训,可提高其对手术意外事件应对能力和实际参与应对手术意外事件能力,提高医护人员对手术配合的满意度,降低手术风险。

Objective To explore the effect of Objective structured clinical examination (OSGE) training on theemergency ability of nurses in the operation room. Methods Medical cooperation OSGE training was taken for 36 junior nurses in operation room. We evaluated their undergo operation contingency ability, participation contingency ability and operation cooperation in 3 months before and after training. Results After the training, the junior nurses in medical care cooperation, rescue ability, equipment preparation, condition assessment, coping ability were significantly higher. Nurses′s in-place time, equipments in place time, puncture time were shortened. Cooperation satisfaction was improved significantly. Compared with that before training, the differences were statistically significant (P<0.05). Conclusion Medical cooperation OSGE training for junior nurses in operation room may improve undergo operation contingency ability, coping contingency ability and operation cooperation, reduce the risk of surgery.

目的 探讨快速康复外科(enhanced recovery after surgery, ERAS)理念在膀胱癌根治加回肠膀胱术后护理的有效性和安全性。方法 分析我院2012年1月—2016年12月行膀胱癌根治加回肠膀胱术的患者共98例,其中ERAS组47例,传统组51例。比较两组术后伤口感染率、出血率、吻合口瘘率、肺部感染率及术后住院日等指标。结果 两组患者的伤口感染率、出血率、吻合口瘘率无差异,ERAS组的肺部感染率4.26%低于传统组21.57%,差异有统计学意义(P＜0.05)。ERAS组的术后住院日短于对照组[(8.53±1.82)vs (13.21±2.16)],差异有统计学意义(P＜0.05)。ERAS组的30天内再入院率6.38%低于传统组19.61%,差异有统计学意义(P＜0.05)。两组的非计划再次手术率无统计学差异。结论 快速康复外科理念应用在膀胱癌根治加回肠膀胱术后护理是有效和安全的,ERAS能减少术后并发症及缩短术后住院日。