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 分析恶性梗阻性黄疸患者实施经皮肝穿刺胆道引流术后出院准备度情况,探究此类患者出院准备度的影响因素。方法 选择2020年9月—2023年4月于天津市人民医院消化内科接受经皮肝穿刺胆道引流术的80例恶性梗阻性黄疸患者,选择院内系统对入组患者的性别、年龄等资料进行统计,并使用出院准备度量表评估患者出院准备度,应用出院指导质量量表评估患者出院指导质量,选择Pearson相关性分析的措施对影响患者出院准备度和出院指导质量的关联进行分析,并分析患者出院准备度影响因素。结果 合并慢性疾病以及居住方式方面,不同亚组患者间出院准备度得分比较差异具有统计学意义（P<0.05）;Pearson相关性分析显示出院准备度量表各维度得分与出院指导质量得分呈正相关（均P<0.05）;Logistic回归分析显示,居住方式得分为出院准备度量表得分的独立影响因素（P<0.05）。结论 经皮肝穿刺胆道引流术恶性梗阻性黄疸患者出院准备度得分较低,通过改变患者居住方式、提高患者出院指导质量,将有助于提高患者出院准备度。

Objective To analyze the discharge readiness of patients with malignant obstructive jaundice after percutaneous transhepatic biliary drainage,and explore the influencing factors of discharge readiness of such patients．Methods A total of 80 patients with malignant obstructive jaundice who underwent percutaneous transhepatic biliary drainage in Tianjin People's Hospital from September 2020 to April 2023 were selected as the research objects．The data such as sex and age of the patients were statistically analyzed in the hospital system,and the discharge readiness scale was used to evaluate the discharge readiness of the patients．The discharge guidance quality scale was used to evaluate the discharge guidance quality of patients．Pearson correlation analysis was selected to analyze the relationship between the discharge readiness and the discharge guidance quality,analyze factors influencing patient discharge readiness．Results There was a statistically significant difference（P<0.05）in the comparison of discharge readiness scores between different subgroups of patients with combined chronic diseases and living habits．Pearson correlation analysis showed that the scores of each dimension of the discharge readiness measurement table were positively correlated with the scores of discharge guidance quality（all P<0.05）．Logistic regression analysis showed that the residential style score was an independent influencing factor（P<0.05）for the discharge readiness scale score．Conclusions The discharge readiness score of patients with malignant obstructive jaundice undergoing percutaneous liver puncture biliary drainage was low．By changing the patient's living style and improving the quality of discharge guidance,will help to improve the patient's discharge readiness．

目的 探讨乳腺癌术后疼痛综合征（PMPS）的发生率及影响因素。方法 选择2021年1月—2023年2月医院收治的82例乳腺癌患者为研究对象,采取手术治疗,统计PMPS发生率,分析PMPS的特征,比较PMPS患者和非PMPS患者的临床资料,采用 Logistic 逐步回归分析。结果 82例中有20例患者术后发生PMPS,发生率为24.39%,其中患侧腋窝45.00%、麻木样疼痛35.00%、中度疼痛60.00%、术后即刻疼痛50.00%、每日发作疼痛50.00%占比较高。PMPS患者和非PMPS患者的体质指数、教育程度、病理分期、肿瘤占位、手术方式、术前使用非甾体抗炎药、术前化学治疗、术后化学治疗比较差异均无统计学意义（P>0.05）。PMPS患者年龄低于非PMPS患者,负性情绪率30.00%高于非PMPS患者8.06%,清扫腋窝淋巴结率95.00%高于非PMPS患者72.58%,术后放射治疗率30.00%高于非PMPS患者6.45%（P<0.05）。年龄、负性情绪、清扫腋窝淋巴结、术后放射疗为PMPS发生的危险因素（P<0.05）。结论 乳腺癌术后较容易发生PMPS,主要表现为术后即刻腋窝疼痛、麻木,发作频率较高,疼痛较重,其中年龄小、术前焦虑、清扫腋窝淋巴结、术后放疗为引发PMPS的危险因素,需加强监测和针对性处理,研究价值较高。

Objective To investigate the incidence and influencing factors of post-mastectomy pain syndrome（PMPS）in breast cancer patients．Methods A total of 82 patients with breast cancer admitted to our hospital from January 2021 to February 2023 were selected as the research objects,and underwent surgical treatment．The incidence of PMPS was counted,the characteristics of PMPS were analyzed,and the clinical data of PMPS patients and non-PMPS patients were compared．Results Among the 82 patients,20 patients had PMPS after surgery,with an incidence of 24.39%．Among them,the affected axilla accounted for 45.00%,numbness pain 35.00%,moderate pain 60.00%,immediate postoperative pain 50.00%,and daily pain 50.00%．There were no significant differences in body mass index,education level,pathological stage of disease,tumor location,surgical method,preoperative use of non-steroid anti-inflammatory drugs,preoperative chemotherapy and postoperative chemotherapy between PMPS patients and non-PMPS patients（P>0.05）．The age of PMPS patients was significantly higher than that of non-PMPS patients,the rate of negative emotion was 30.00%,the rate of axillary lymph node dissection was 95.00%,and the rate of postoperative radiotherapy was 30.00%,which was significantly higher than that of non-PMPS patients（P<0.05）．Age,negative emotion,axillary lymph node dissection and postoperative radiotherapy were independent risk factors for PMPS（P<0.05）．Conclusions PMPS is prone to occur after breast cancer surgery,mainly characterized by immediate postoperative axillary pain and numbness,with a high frequency and severe pain．Young age,preoperative anxiety,axillary lymph node dissection,and postoperative radiotherapy are independent risk factors for PMPS,which need to be strengthened monitoring and targeted treatment．

目的 探讨微RNA-29b（miR-29b）对子宫内膜癌细胞增殖、迁移和侵袭的影响。方法 子宫内膜癌HEC-1-B细胞分为miR-29b模拟物组（MM组）、miR-29b阻遏物组（MR组）和阴性对照物组（MNC组）,分别转染miR-29b拟似物、miR-29b阻遏物和miR-29b阴性对照物,每组设置6个复孔。以实时定量逆转录PCR检测miR-29b表达,以水溶性四氮唑（WST-1）检测miR-29b对HEC-1-B子宫内膜癌细胞增殖的影响,以Transwell小室检测HEC-1-B子宫内膜癌细胞迁移和侵袭的影响,以Western blot法检测磷酸酶张力蛋白同源物（PTEN）-蛋白激酶 B（AKT）通路蛋白表达水平。结果 MNC组、MM组、MR组miR-29b相对表达量分别为（2 032.1±873.4）、（19 272.8±2 087.9）、（472.7±105.6）,组间比较差异有统计学意义（P<0.05）。MM组0、3、5、7 d时OD值分别为（0.32±0.06）、（0.53±0.08）、（1.13±0.12）和（1.92±0.14）,MNC组0、3、5、7 d时OD值分别为（0.34±0.09）、（0.71±0.08）、（1.67±0.21）和（3.49±0.24）,MR组0、3、5、7 d时OD值分别为（0.38±0.09）、（0.84±0.18）、（2.43±0.24）和（5.67±0.15）,3组0 d时OD值比较差异无统计学意义（P=0.216）,三组3 d、5 d、7 d时OD值比较差异存在统计学意义（P<0.001）。MNC组、MM组和MR组迁移细胞数分别为（403.9±23.8）（102.6±15.7）和（685.7±46.8）个,上述3组侵袭细胞数分别为（82.1±12.7）（38.2±10.6）和（124.6±21.6）个,MM组和MNC组上述指标比较差异均有统计学意义（P<0.05）,MR组和MM组上述指标比较差异均有统计学意义（P<0.05）。MNC组、MM组、MR组PTEN蛋白相对表达量分别为（0.25±0.08）、（0.69±0.11）、（0.11±0.05）,上述3组p-AKT蛋白相对表达量分别为（0.58±0.10）、（0.13±0.06）和（0.79±0.08）,上述3组AKT蛋白相对表达量分别为（0.38±0.09）、（0.37±0.11）和（0.37±0.08）,MM组与MNC组PTEN、p-AKT水平比较差异有统计学意义（P<0.05）,AKT水平比较差异无统计学意义（P>0.05）;MR组与MNC组、MM组PTEN、p-AKT水平比较差异有统计学意义（P<0.05）,AKT水平比较差异无统计学意义（P>0.05）。结论 过表达miR-29b对子宫内膜癌细胞增殖、迁移和侵袭具有抑制作用,靶向PTEN-AKT可能是其重要作用途径。

Objective To investigate the effects of microRNA-29b on proliferation,migration and invasion of endometrial cancer cells．Methods The endometrial cancer HEC-1-B cells were divided into micro29b mimetic group（MM group）,micro29b repressor group（MR group）and negative control group（MNC group）,and the micro29b mimetic,micro29b repressor and micro29b negative control were transfected into each group,six compound holes with each group．The real-time quantitative reverse transcription polymerase chain reaction（RT-PCR）was used to detect the expression of mi29b,WST-1 was used to detect the effect of mi29b on the proliferation of HEC-1-B endometrial cancer cells,Transwell chamber was used to detect the migration and invasion of HEC-1-B endometrial cancer cells,and Western blot was used to detect the expression level of PTEN-AKT pathway protein．Results The relative expression levels of microRNA-29b in MNC group,MM group and MR group were（2 032.1±873.4）,（19 272.8±2 087.9）and（472.7±105.6）,respectively,and there were significant differences between groups（P<0.05）．OD values of MM group at 0 d,3 d,5 d and 7 d were（0.32±0.06）,（0.53±0.08）,（1.13±0.12）and（1.92±0.14）respectively．The OD values of MNC group at 0,3,5 and 7 days were（0.34±0.09）,（0.71±0.08）,（1.67±0.21）and（3.49±0.24）respectively．The OD values of MR group at 0 d,3 d,5 d and 7 d were（0.38±0.09）,（0.84±0.18）,（2.43±0.24）and（5.67±0.15）respectively．There was no significant difference in OD value between the three groups on day 0 （P=0.216）．There were significant differences in OD value between the three groups on day 3,day 5 and day 7（P<0.001）．The number of migrating cells in MNC group,MM group and MR group were（403.9±23.8）cells,（102.6±15.7）cells and（685.7±46.8）cells,respectively．The number of invasive cells in the above three groups were（82.1±12.7）cells,（38.2±10.6）cells and（124.6±21.6）cells．There were significant differences in the above indexes between MM group and MNC group（P<0.05）,also between MR group and MM group（P<0.05）．The relative expression levels of PTEN protein in MNC group,MM group and MR group were（0.25±0.08）,（0.69±0.11）and（0.11±0.05）．The relative expression levels of p-AKT protein in the above three groups were（0.58±0.10）,（0.13±0.06）and（0.79±0.08）．The relative expression levels of AKT protein in the above three groups were（0.38±0.09）,（0.37±0.11）and（0.37±0.08）,respectively．Compared with MNC group,the levels of PTEN and p-AKT in MM group had statistical significance（P<0.05）,but there was no statistical difference in AKT level（P>0.05）．Compared with MNC group and MM group,the levels of PTEN and p-AKT in MR group had statistical significance（P<0.05）,and there was no statistical difference in AKT level（P>0.05）．Conclusions Overexpression of microRNA-29b can inhibit the proliferation,migration and invasion of endometrial cancer cells,and targeting PTEN-AKT may be an important pathway．

目的 研究探讨全面触发工具（GTT）在新生儿医源性皮肤损伤（ISI）不良事件监测中的应用,检验其有效性与适用性。方法 根据GTT白皮书中推荐的护理模块触发器,结合江西省妇幼保健院医院新生儿科ISI发生的特点和实际情况,建立科室审查团队,回顾性分析我院新生儿科重症监护室（NICU）2021年1月—2021年9月168例新生儿的病历。初级审查员负责审查病历;高级审查员负责对确定的ISI和伤害分级作最终决策,对ISI不良事件发生率进行综合的分析,制定符合科室的不良事件触发器,评价GTT在提高新生儿医源性不良事件检出率的优势。结果 168份病历中,设计的14项触发器中14项显示为阳性,触发器阳性检测率为100.00%,触发器阳性总频次为66次,阳性检出频次12例,阳性预测值为18.18%;168份病历GTT检出不良事件频次12次,涉及患儿8例,GTT检出率4.76%;GTT检出E级5例（2.98%）,F级3例（1.79%）;自愿上报E级3例（1.79%）,F级2例（1.19%）,均未发生G级、H级、I级事件;自愿上报事件5例,上报率为（2.98%）。结论 建立新生儿ISI不良事件触发器,并规范皮肤管理、规范和监督ISI医疗护理工作,可以最大限度保证患儿安全,提高新生儿综合救治能力,提升医疗护理服务水平。

目的 探讨¹³¹I治疗儿童及青年格雷夫斯病（GD）的疗效及其影响因素。方法 回顾性分析2013年—2022年在简阳市人民医院核医学科院接受¹³¹I治疗且年龄≤22岁的儿童及青年GD患者的临床资料。采用个体计算剂量法,每克甲状腺组织的计划用量为80~140 μCi,依据甲状腺吸碘率及甲状腺质量,确定¹³¹I的用量。依据¹³¹I治疗后3~6个月的甲状腺功能指标,进行疗效评价,甲状腺功能恢复正常或发生甲减视为治愈。统计分析治愈组与非治愈组间的临床疾病特征参数,评估可能影响疗效的因素。结果 纳入患者71例：男23例、女48例,年龄11~22岁。患儿甲状腺质量4.8~60.0 g,均值22.1 g。¹³¹I的用量在6~24 mCi,均值11.3 mCi。49例（69%）患者获得治愈,22例（31%）未获治愈。单因素分析显示年龄、性别、促甲状腺激素受体抗体的滴度、甲状腺吸碘率、甲状腺质量及¹³¹I用量等,治愈组与非治愈组间比较差异均无统计学意义（均P>0.05）。结论 以每克甲状腺组织80~140 μCi的计划用量,确定¹³¹I用量治疗儿童青年GD的疗效可达69%。

Objective To investigate the effect of ¹³¹I on Graves' disease（GD）in children and young adults and its influencing factors．Methods The clinical data of GD patients aged ≤22 who received ¹³¹I treatment in Nuclear Medicine Department of Jianyang People's Hospital from 2013 to 2022 were retrospectively analyzed．The planned dosage of ¹³¹I was 80~140 μCi per gram of thyroid tissue,and the dosage of ¹³¹I was determined according to the iodine uptake rate and thyroid mass．According to the thyroid function indicators of 3 to 6 months after ¹³¹I treatment,the curative effect was evaluated,and the thyroid function returned to normal or hypothyroidism occurred were considered as cured．The clinical characteristic parameters of the cured group and the non-cured group were analyzed to evaluate the factors that might affect the curative effect．Results Seventy-one patients were included：23 males and 48 females,aged 11-22．The thyroid mass of the children ranged from 4.8 to 60.0 g,with an average of 22.1 g．The dosage of ¹³¹I ranges from 6 to 24 mCi,with an average of 11.3 mCi．Forty-nine patients（69%）were cured and 22（31%）were not cured．Univariate analysis showed that there were no significant differences in age,sex,titer of thyrotropin receptor antibody,thyroid iodine uptake rate,thyroid mass and ¹³¹I dosage between the cured group and the non-cured group（all P>0.05）．Conclusions With the planned dosage of 80~140 μCi per gram of thyroid tissue,the efficacy of ¹³¹I in the treatment of GD in children and young adults can reach 69%．

脊柱结核是脊柱感染性疾病中最为常见的类型。本文综述了脊柱结核外科治疗的现状及最新进展。在早期治疗阶段,规范化的抗结核药物治疗能够有效缓解疼痛,改善患者生活质量。但对于中后期,特别是椎旁脓肿较大,椎体骨质破坏较大而导致脊柱不稳定的患者,手术治疗往往是必要且必需的辅助手段,手术可以最大限度清除病变的椎间盘、椎体和脓肿,也应该最大限度保留健康的骨质。其主要原则包括病灶彻底清除、脊髓充分减压、脊柱稳定性重建等步骤。在手术治疗中,一期前路手术作为经典入路已经得到广泛应用,而单纯后路手术治疗也逐渐受到重视。近年来,随着微创手术技术的发展,其在脊柱结核治疗中的应用越来越广泛。微创手术的优势在于术中创伤更小、恢复更快,为患者带来了更好的治疗体验和临床效果。然而,对于手术的选择,临床医师需要综合考虑患者的个体差异性、临床表现及特征、影像学资料和手术适应证等多种因素,以确定最合适的治疗方案。只有充分考虑各种治疗手段的优劣,采取个性化、综合性的治疗方案,才能更好地提高患者的生活质量和治疗效果。

Spinal tuberculosis is the most common types of infectious diseases affecting the spine．This article reviews the current status and progress of surgical treatment for spinal tuberculosis．In the early and initial stages,standardized anti-tuberculosis drug therapy can effectively alleviate pain and improve patients' quality of life．However,for more complex cases in the middle and late stages,surgical treatment is needed,including thorough lesion clearance,adequate spinal cord decompression,and reconstruction of spinal stability．In surgical treatment,anterior approach surgery,as a classical method,has been widely applied,and posterior approach surgery alone has gradually gained attention．In recent years,with the development of minimally invasive surgical techniques,their application in the treatment of spinal tuberculosis has become increasingly widespread．The advantages of minimally invasive surgery lie in smaller intraoperative trauma and faster recovery,providing patients with better treatment experience and clinical outcomes．However,for the selection of surgery,clinicians need to consider multiple factors such as individual differences,clinical manifestations and characteristics,imaging data and surgical indications to determine the most suitable treatment plan．Only by fully considering the advantages and disadvantages of various treatment modalities and adopting personalized,comprehensive treatment plans can the quality of life and treatment outcomes of patients be effectively improved．

目的 探讨学生实验室安全知识盲区,以提高高校实验室安全管理工作的成效。方法 考试人数192人,共计235次考试,根据考试系统的统计分析结果,观察各题目错误率和各选项构成比;结合统计描述和χ²检验,探讨影响学生实验室安全考试成绩的原因和所存在的知识盲区。结果 41%的考生身份为在读硕士研究生,59%的考生为在读本科生,男生占48%,女生占52%,且比较不同身份的性别构成比,差异无统计学意义;题目被归纳分为“行为规范”“应急自救技能”和“事故防范能力”三大部分,比较“行为规范”和“应急自救技能”类题目的错误率,差异存在统计学意义（χ²=7.570,P=0.006）,“应急自救技能”类题目的错误率为3.14%,高于其余两类。结论 高校学生对应急自救技能类可能存在较多的知识盲区,应以之作为实验室安全管理工作关键控制点,加强应急自救技能培训可以极大地降低事故的严重程度。

Objective To enhance the efficiency of laboratory safety management in colleges,we analyzed the insufficiency of students in the knowledge about laboratory safety. Methods A total of 192 college students had attended the education tests of laboratory safety and totally 235 tests had been successfully recorded．According to the statistical analysis results,we observed the error ratio and the and the composition of the options for each question in the tests．With statistical description and Chi-square test,the impact of the test scores and the main insufficiency in the knowledge about laboratory safety were discussed. Results 41% of the students were pursuing master's degree,59% of them were pursuing bachelor's degree,48% are males and 52% are females,there was no significant difference in gender composition among different identities．All the questions had been categorized into three types,which were principle for conduct in laboratory,the skills of self rescue and the capability to prevent accidence．There was statistical significance between types of questions on principle for conduct in laboratory and the skills of self rescue（χ²=7.570,P=0.006）,the error ratio of the question type of skills of self rescue was 3.14%,which was higher than the other types. Conclusions The insufficiency in the knowledge of skills of self rescue might probably be the critical control point in laboratory safety management,which should set as the key point of lab security,improve the self rescue skill of students may decrease thu severity accidence．

目的 探讨理论授课后续以问题为基础的学习（PBL）的阶梯教学法在临床技能混合教学中的效果。方法 选择福建医科大学附属南平第一医院2019级临床医学专业58名见习生为研究对象,将其通过单双号抽签的方式分为两组,即研究组与对照组各29例,研究组基于理论授课后续PBL的阶梯教学法,以“一对一”方式进行线上线下混合教学,对照组开展常规线下教学,对两组见习生教学效果进行比较。结果 研究组见习生参与消毒铺巾、气管插管、胸腔穿刺、腰椎穿刺及小儿腰椎穿刺等5项临床技能考核分别为（95.23±3.18）（95.19±3.26）（95.15±3.35）（95.28±3.17）（95.11±3.45）分,优于对照组（88.23±4.01）（87.89±4.59）（86.23±3.78）（87.22±3.89）（86.23±3.67）分（t=7.366、6.983、9.510、8.650、9.494,P<0.05）;研究组见习生综合能力提升情况优于对照组（χ²=6.444,5.497、5.497、6.444、7.733,P<0.05）;从教师培训态度（7项）、培训方法（15项）、培训时间（3项）、培训效果（11项）等方面进行评价,研究组临床技能培训教学效果各项评分及总分分别为（6.67±0.35）（12.23±2.23）（2.44±0.29）（9.23±2.56）（30.34±4.45）分,高于对照组的（4.12±1.45）（10.12±2.17）（9.23±2.56）（1.68±0.56）（7.23±2.12）分（24.34±3.45）分,（t=9.206、3.652、6.490、3.240、5.738,P<0.05）。结论 基于理论授课后续PBL的阶梯教学法,以“一对一”线上线下混合教学建立医学生临床技能的培训方法,见习生的综合能力明显提升,教学效果更好。

Objective To explore the effect of Problen-Based Learning（PBL）step-by-step teaching method in the online and offline mixed teaching of clinical skills for medical students. Methods Fifty-eight interns majoring in clinical medicine of grade 2019 in Nanping First Hospital affiliated to Fujian Medical University were selected as the research object,they were divided into two groups by drawing lots with even and odd numbers,namely,the study group and the control group,with 29 cases in each group．The study group conducted online and offline mixed teaching in a “one-on-one” way based on the step-by-step PBL teaching method after theoretical teaching,while the control group received regular offline teaching,and the teaching effects of the two groups were compared. Results The students of the study group participated in 5 clinical skills assessment,including disinfection towel（95.23±3.18）,tracheal intubation（95.19±3.26）,chest puncture（95.15±3.35）,lumbar puncture（95.28±3.17）and pediatric lumbar puncture（95.11±3.45）,were significantly better than those of control group（88.23±4.01）,（87.89±4.59）,（86.23±3.78）,（87.22±3.89）,（86.23±3.67）（t=7.366,6.983,9.510,8.650,9.494,P<0.05）．The comprehensive ability improvement of students in study group was better than that in control group（χ²=6.444,5.497,5.497,6.444,7.733,P<0.05）．The evaluation was made from the aspects of teacher training attitude（7 items）,training method（15 items）,training time（3 items）and training effect（11 items）．The clinical skill training teaching effect scores of study group（6.67±0.35）,（12.23±2.23）,（2.44±0.29）,（9.23±2.56）,（30.34±4.45）were significantly higher than those of control group（4.12±1.45）,（10.12±2.17）,（9.23±2.56）,（1.68±0.56）,（7.23±2.12）,（24.34±3.45）（t=9.206,3.652,6.490,3.240,5.738,P<0.05）. Conclusions Based on PBL step-by-step teaching method after theoretical teaching,the training method of clinical skills for medical students is established by “one-to-one” online and offline mixed teaching,can improve the clinical skills and comprehensive ability of interns and get high evaluation from students．

目的 探讨与分析基于信息-动机-行为（IMB）模型的护理干预对造口患者并发症及生活质量的影响。方法 选择2021年5月—2023年4月本院进行结直肠癌行肠造口患者84例作为研究对象,根据1∶1随机电脑抽签分配原则把患者分为IMB组42例与常规组42例。常规组给予常规护理干预,IMB组在常规组护理的基础上给予基于IMB模型的护理干预,IMB组与常规组护理观察时间为3个月,观察与记录IMB组与常规组患者并发症、生活质量、心理状况、自我管理能力评分变化情况。结果 IMB组护理3个月期间的腹腔脓肿、肠梗阻、肺部感染、造口感染等并发症发生率为4.8%,与常规组的19.0%相比降低更多（P<0.05）。IMB组护理3个月期间的遵医依从性为100.0%,与常规组的90.5%相比提高更多（P<0.05）。护理3个月后IMB组的症状识别、症状处理、处理后评价等自我管理能力评分与常规组相比提高更多（P<0.05）。IMB组与常规组护理3个月后的焦虑评分与抑郁评分与护理前相比都有统计学意义的降低（P<0.05）,护理3个月后IMB组的焦虑评分、抑郁评分与常规组对比降低（P<0.05）。护理3个月后IMB组的总生活质量量表、症状子量表、症状量表、功能量表评分都与常规组相比提高（P<0.05）。结论 基于IMB模型的护理干预在造口患者的应用能提高遵医依从性,缓解焦虑与抑郁情绪,提高患者自我管理能力,从而可有效减少患者并发症的发生,促进提高患者的预后生活质量。

Objective To explore and analysis the effects of nursing intervention based on Information-Motivation-Behavioral（IMB）model on complications and quality of life of patients with stoma. Methods Eighty-four cases of patients with colorectal cancer undergoing enterostomy in our hospital from May 2021 to Aprilt 2023 were selected as the study subjects．According to the principle of 1∶1 random computer lottery,the patients were divided into IMB group（42 cases）and traditional group（42 cases）．The traditional group were given routine nursing intervention,and the IMB group were given nursing intervention based on the IMB model on the basis of the traditional group．The nursing observation time of the traditional group and IMB group were 3 months,the changes in complications,quality of life,psychological status,and self-management ability scores of patients were observed and recorded. Results The incidence of complications such as abdominal abscess,intestinal obstruction,pulmonary infection and stoma infection in IMB group during nursing were 4.8%,which were significantly lower than 19.0% in the traditional group（P<0.05）．The compliance of IMB group during nursing were 100.0%,which were significantly higher than 90.5% in the traditional group（P<0.05）．After nursing of 3 months,the scores of self-management ability such as symptom recognition,symptom treatment and post-treatment evaluation in IMB group were significantly higher than those in the traditional group（P<0.05）．The scores of anxiety and depression in the traditional group and IMB group after nursing of 3 months were significantly lower than those before nursing（P<0.05）,and the scores of anxiety and depression in the IMB group after nursing of 3 months were also significantly lower than those in the traditional group（P<0.05）．After nursing of 3 months,the scores of IMB group on function scale,symptom scale,symptom subscale and total quality of life scale were significantly higher than those of the traditional group（P<0.05）. Conclusions The application of nursing intervention based on the IMB model in patients with stoma can improve the compliance with medical treatment,reduce the occurrence of complications,improve the self-management ability of patients,relieve anxiety and depression,and continue to improve the prognosis and quality of life of patients．