目的 基于计划行为理论探讨妊娠期糖尿病（GDM）孕妇自我管理行为意向,为促进其孕期良好的自我管理提供依据。方法 运用质性研究中的现象学研究方法,对12例GDM孕妇进行深度半结构式访谈,并用Colaizzi七步内容分析法对主题进行归纳。结果 根据计划行为理论对主题进行归纳,共提炼出3种类别：①行为态度：认知不足,积极态度,消极态度;②主观规范：家庭影响,医护压力,人际压力;③知觉行为控制：知识技能获取受限,客观条件束缚共8个主题。结论 GDM患者在自我管理过程中存在对疾病认知不足的问题GDM,自我管理行为受到家庭、医护人员、人际关系等外界压力对自我管理态度的影响,且存在知识技能欠缺,客观条件制约多方面阻碍。医护人员应加强对GDM孕妇的自我管理教育,适时提供支持,提高其自我管理效率。

Objective To explore the self-management behavior intention of pregnant women with gestational diabetes mellitus（GDM）based on the theory of planned behavior,and to provide a basis for promoting good self-management during pregnancy. Methods Using the phenomenological research method in qualitative research,12 pregnant women with GDM were interviewed in an in-depth semi-structured interview,and then the themes were summarized by Colaizzi's seven-step content analysis. Results According to the theory of planned behavior,the themes were summarized into three categories and eight themes including（1）Behavioral Attitudes：cognition deficiency,positive attitude,and negative attitude,（2）Subjective norms：family influence,medical pressure,interpersonal pressure,and（3）Perceptual behavior control：self-management knowledge acquisition limitations,self-management Objective conditions constraint. Conclusions Most of the respondents have insufficient awareness of self-management of gestational diabetes,different patients have different attitudes towards self-management,and self-management behavior is affected by external pressures such as family,medical staff,and interpersonal relationships,and there are many obstacles due to a lack of knowledge and skills,Objective conditions．Medical staff should strengthen the self-management education of pregnant women with gestational diabetes,provide timely support,and improve their self-management efficiency．

目的 探讨标准化沟通（SBAR）模式交接班联合护理质量指标管理在胆管结石患者中的应用效果及护理质量、不良事件及并发症影响。方法 选取天津市人民医院2021年1月—2022年12月收治的80例胆管结石患者,应用抽签法分为观察组与对照组,每组各40例。所有患者均采取手术治疗,其中对照组患者实施常规护理,观察组患者在对照组基础上增加SBAR沟通模式交接班联合护理质量指标管理。对比两组患者的护理质量、护理不良事件发生率、护理满意度及术后并发症发生率。结果 观察组基础护理、护理态度、护理责任心、风险识别能力、风险防范能力护理质量评分高于对照组（P<0.05）;两组注射、口服给药差错、换药、抽血差错、病例书写错误以及执行医嘱不及时等护理不良事件发生率对比差异无统计学意义（P>0.05）,观察组患者护理满意度高于对照组（P<0.05）;观察组患者压疮、感染、静脉血栓等并发症发生率均低于对照组（P<0.05）。结论 SBAR沟通模式交接班联合护理质量指标管理针对胆管结石患者应用效果显著,可改善临床护理质量,同时患者护理满意度较高,进一步降低患者术后并发症发生率。

Objective To investigate the application effect of SBAR communication mode shift combined with the management of care quality indicators on patients with bile duct stones and their influence on postoperative complications. Methods Eighty patients with bile duct stones admitted to our hospital from January 2021 to December 2022 were selected,and divided into observation group and control group by drawing lots,40 cases each．All the patients were treated by surgery,and the control group patients received routine care,and the observation group patients added the SBAR communication mode．The quality of care,incidence of adverse events,satisfaction with care and incidence of postoperative complications of the two groups were compared. Results The quality of care values of basic care,nursing care,nursing responsibility,risk identification and risk prevention in the observation group were significantly higher than in the control group（P<0.05）．There was no difference in the incidence of nursing side effects such as injection and oral administration errors,dressing changes,blood sampling errors,case clerk errors and delayed execution of medical orders between the two groups（P>0.05）．Patient satisfaction in the observation group was significantly higher than that in the control group（P<0.05）．The incidence of complications such as pressure ulcers,infections and venous thrombosis in the observation group was significantly lower than that in the control group（P<0.05）. Conclusions SBAR communication mode and combined nursing quality index management for patients with bile duct stones,which can improve the quality of clinical nursing and patient nursing satisfaction,and further reduce the incidence of postoperative complications in patients．

目的 分析神经系统副肿瘤综合征（PNS）的临床特点以提高对该病的早期诊断和治疗效果。方法 回顾性分析惠州市第一人民医院和惠州市中心人民医院神经内科2019年10月—2022年10月收治的21例PNS患者的临床表现、实验室检查结果和治疗效果,并作文献回顾。结果 21例患者中出现了10种副肿瘤综合征,其中经典综合征占比28.6%（6/21）,最多见的是边缘叶脑炎;20例在血液或脑脊液中发现检测到抗神经元抗体,非特征性抗体阳性率最高（12/20）,其中以半定量脑组织切片TBA检测阳性率最高（7/20）;有特征性抗体的8例以抗Yo抗体阳性率最高（6/8）。21例患者均随访至2023年3月,8例发现原发肿瘤,其中4例在神经系统病变之后。69.25%（9/13）的患者使用糖皮质激素治疗和（或）丙种球蛋白治疗有效。结论 21例PNS患者中以非经典综合征占比较多,经典与非经典副肿瘤综合征均应进行肿瘤筛查,未发现肿瘤者应密切随访。非特征性抗体阳性率最高,提示PNS可能仍有许多相关抗体未明确,临床工作中也应对非特征性抗体阳性予以重视。

Objective To analyze the clinical features of paraneoplastic neurological syndrome（PNS）to improve the early diagnosis and treatment of this disease. Methods The clinical manifestations,laboratory results and treatment effects of 21 patients with PNS admitted to Huizhou First People's Hospital and Huizhou Central People's Hospital from October 2019 to October 2022 were retrospectively analyzed,and literature review was performed. Results There were 10 paraneoplastic syndromes in 21 patients,of which classical syndrome accounted for 28.6%（6/21）,the most common was limbic lobe encephalitis．Anti-neuronal antibodies were detected in blood or cerebrospinal fluid in 20 cases,with the highest positive rate of non-characteristic antibodies（12/20）,among which the positive rate of TBA detection by semi-quantitative brain tissue sections was the highest（7/20）;Eight cases with characteristic antibodies had the highest positive rate of anti-Yo antibody（6/8）．All 21 patients have been followed up so far,and 8 cases have found primary tumors,4 of which were after neurological lesions．There was 69.25%（9/13）of patients responded to hormone therapy or（and）gamma globulin therapy. Conclusions Non-classical syndrome accounts for more patients with PNS,and both classical and non-classical paraneoplastic syndromes should be screened for tumors,and those who have not found tumors should be closely followed．The positive rate of non-characteristic antibodies is the highest,indicating that there may still be many related antibodies in PNS that are not clear,and the positive of non-characteristic antibodies should also be paid attention to in clinical work．

目的 探讨Nolla分期对青少年拔牙正畸患者下颌第三磨牙倾斜角的影响。方法 选择2018年10月—2022年10月收治的100例拔牙正畸青少年患者。100例患者均拔除了4颗前磨牙,共有100颗下颌第三磨牙,通过Nolla分期,可将100例患者分成四组,每组25例。Ⅰ组：牙冠正在形成,Ⅱ组：牙冠基本形成,Ⅲ组：牙根形成在1/2以下,Ⅳ组：牙根形成在1/2以上。在治疗前后,测量下颌第三磨牙倾斜角,对角度α的变化进行分析。结果 第三磨牙牙胚倾斜角、MP-SN、MP-FH在不同组间比较差异无统计学意义（F=0.256,P=0.857;F=0.033,P=0.992;F=0.028,P=0.994）;治疗前组间下颌第三磨牙角度比较差异无统计学意义（P>0.05）,治疗后不同组间下颌第三磨牙角比较差异有统计学意义（F=13.376,P<0.001）,治疗前后Ⅰ组、Ⅱ组、Ⅳ组第三磨牙的角度无差异（t=0.757,P=0.453;t=0.224,P=0.824;t=0.852,P=0.399）,Ⅲ组治疗后角度变化减少（t=3.697,P<0.001）。结论 青少年正畸拔牙后,下颌第三磨牙处于牙根形成阶段的一半以下可能会导致第三磨牙近中倾斜加重。当下颌第三磨牙处于牙冠形成阶段,牙冠形成超过一半时,第三磨牙角度变化较小。在治疗前应根据Nolla分期评估下颌第三磨牙的预后情况,并及时制定相应的干预策略。

Objective To explore the effect of Nolla staging on the inclination angle of mandibular third molars in adolescent orthodontic patients undergoing tooth extraction. Methods A total of 100 adolescent patients who underwent tooth extraction orthodontic treatment from October 2018 to October 2022 were included．All 100 patients had 4 premolars extracted,with a total of 100 mandibular third molars．According to Nolla staging,the 100 patients can be divided into 4 groups,with 25 cases in each group．Group I：The crown was forming,Group II：The crown was basically formed,Group III：The root formation was below 1/2,Group IV：The root formation was above 1/2．The inclination angle of the mandibular third molar was measured before and after treatment,and the angle α changes will be analyzed. Results There was no difference in the inclination angle,MP-SN,and MP-FH of the third molar tooth germ among different groups（F=0.256,P=0.857;F=0.033,P=0.992;F=0.028,P=0.994）．There was no difference in the angle of mandibular third molar teeth between groups before treatment（P>0.05）,the contrast of mandibular third molar angles between different groups after treatment was signifiant（F=13.376,P<0.001）,while the angles in Group I,Group and Group Ⅳ were not slgnificantly different（t=0.757,P=0.453;t=0.224,P=0.824;t=0.852,P=0.399）,and the angle change decreased after treatment in Group Ⅲ（t=3.697,P<0.001）. Conclusions After orthodontic extraction in adolescents,if the mandibular third molar is less than half of the root formation stage,it may lead to increased mesial inclination of the third molar．However,when the mandibular third molar is in the stage of crown formation and the crown is more than half formed,the angle change of the third molar is relatively small．Therefore,in clinical practice,Nolla staging should be evaluated in the prognosis of mandibular third molars before treatment and develop corresponding intervention strategies in a timely manner．

目的 探讨终末期肾病患者血液透析中实施基于依从性曲线变化规律的阶段性护理的效果。方法 选择2022年1月—2023年10月濮阳市人民医院收治的接受血液透析治疗的86例终末期肾病患者,将其通过单双号抽签的方式分组,即对照组与观察组,各43例,前者实施常规护理,后者在此基础上实施基于依从性曲线变化规律的阶段性护理,对比两组患者护理前后心理状态评分情况、生活质量评分情况及治疗依从性。结果 两组患者护理前后正性负性情绪量表（PANAS评分有一定差距,其中负性情绪显著降低,正性情绪显著提升,而护理后观察组负性情绪评分为（11.67±2.55）分,低于对照组的（16.11±3.02）分,正性情绪为（25.07±5.28）,高于对照组的（20.11±5.23）分（t=7.366、4.376,P<0.05）;护理后观察组生活质量综合评定量表（GQOLI-74）躯体、心理、社会及物质生活等维度评分分别为（82.17±7.11）分、（82.02±7.45）分、（81.11±7.78）分及（81.11±7.42）分,高于对照组的（71.22±7.23）分、（72.12±7.56）分、（71.23±7.45）分及（70.23±7.33）分（t=7.081、6.116、6.015、6.840,P<0.05）;观察组（95.35%）与对照组（76.74%）的治疗依从性比较,前者更高（χ²=6.198,P<0.05）。结论 基于依从性曲线变化规律的阶段性护理对于接受血液透析治疗的终末期肾病患者,不仅有助于调整其心理状态,还有助于提高其治疗依从性,使其生活质量也得以全面提高。

Objective To explore the effect of implementing phased nursing based on compliance curve changes in hemodialysis for end-stage renal disease patients. Methods The research deadline was from January,2022 to October,2023．The research object was 86 patients with end-stage renal disease who received hemodialysis treatment in Puyang People's Hospital,and they were divided into control group and observation group with 43 patients in each group by odd and even numbers．The former was given routine care,while the latter was given stage nursing based on the change of compliance curve．The psychological state score,quality of life score and treatment compliance of the two groups were compared before and after care. Results There was a certain difference in the Positive and Negative Affect Scale（PANAS）scores between the two groups before and after nursing,in which the negative emotion was significantly reduced and the positive emotion was significantly improved．After nursing,the negative emotion score of the observation group was（11.67±2.55）,which was significantly lower than that of the control group（16.11±3.02）,and the positive emotion score was（25.07±5.28）,which was significantly higher than that of the control group（20.11±5.23）（t=7.366,4.376,P<0.05）．After nursing,the scores of Generic Quality of Life Inventory-74（GQOLI-74）in the observation group were（82.17±7.11）,（82.02±7.45）,（81.11±7.78）and（81.11±7.42）,which were significantly higher than those in the control group（71.22±7.23）,（72.12±7.56）,（71.23±7.45）and（70.23±7.33）（t=7.081,6.116,6.015,6.840,P<0.05）．The treatment compliance of the observation group（95.35%）was higher than that of the control group（76.74%）（χ²=6.198,P<0.05）. Conclusions Choosing stage nursing based on the variation pattern of compliance curve for end-stage renal disease patients undergoing hemodialysis not only helps to adjust their psychological state,but also improves their treatment compliance,leading to a comprehensive improvement in their quality of life．

目的 探讨复方甘草酸苷联合卡泊三醇乳膏治疗寻常型银屑病的效果观察。方法 选取辽健集团阜新矿总医院2019年12月—2022年12月收治的96例寻常型银屑病患者,分为联合组与对照组,每组48例。对照组使用卡泊三醇乳膏治疗,联合组在对照组基础上联用复方甘草酸苷治疗,对比临床疗效,以皮质含量、经表皮水分流失（TEWL）、角质层水含量变化评价患者的皮肤屏障功能,并对比两组患者治疗前后T细胞相关炎症因子表达水平。结果 联合组治疗总有效率较对照组高[93.75% vs 77.08%,χ²=5.352,P=0.021];治疗后两组皮质含量、角质层水含量升高,联合组高于对照组,TEWL降低,联合组低于对照组[皮质含量：（73.59±7.24）μg/cm² vs（110.12±13.64）μg/cm²,t=16.389,P<0.001;角质层水含量：（25.28±3.25）% vs（16.24±2.14）%,t=16.095,P<0.001;TEWL：（8.06±1.44）g/（h·m²）vs（11.71±2.68）g/（h·m²）,t=8.312,P<0.001];治疗后两组患者白细胞介素-2（IL-2）、白细胞介素-6（IL-6）、γ干扰素（IFN-γ）表达水平均降低,且联合组低于对照组[IL-2：（22.25±3.32）vs（26.62±3.24）pg/mL,t=6.661,P<0.001;IL-6：（80.46±5.11）vs（112.62±12.16）pg/mL,t=16.892,P<0.001;IFN-γ：（68.62±10.73）vs（51.26±6.37）ng/L,t=9.639,P<0.001]。结论 复方甘草酸苷联合卡泊三醇乳膏可改善寻常型银屑病皮肤屏障功能,降低炎症因子,改善Th1/Th2细胞因子失衡情况。

Objective To investigate the effect of compound glycyrrhizin and caspotriol cream in psoriasis vulgaris. Methods The 96 psoriasis patients admitted to Fuxin Mine General Hospital from December 2019 to December 2022 were selected and divided into combined group and control group,with 48 patients in each group．The control group was treated with caspotriol cream,the combined group treated with compound glycyrrhizin treatment,the clinical efficacy was compared,and the skin barrier function of patients was evaluated by cortical content,transepidermal water loss（TEWL）,and changes in stratum corneum water content．The expression levels of T cell related inflammatory factors before and after treatment were compared between the two groups. Results The overall effective treatment rate in the combined group was higher than in the control group[93.75% vs 77.08%,χ²=5.352,P=0.021]．After treatment,cortical and stratum corneum water levels increased in both groups,with the combined group being higher than the control group．TEWL decreased and the combined group was lower than the control group[cortical content：（73.59±7.24）μg/cm² vs（110.12±13.64）μg/cm²,t=16.389,P<0.001;water content in the stratum corneum：（25.28±3.25）% vs（16.24±2.14）%,t=16.095,P<0.001;TEWL：（8.06±1.44）g/（h·m²）vs（11.71±2.68）g/（h·m²）,t=8.312,P<0.001]．After treatment,two groups of patients were treated with interleukin-2（IL-2）,interleukin-6（IL-6） and interferon（IFN）-γ,and the combined group was lower than the control group[IL-2：（22.25±3.32）pg/mL vs（26.62±3.24）pg/mL,t=6.661,P<0.001;IL-6：（80.46±5.11）pg/mL vs（112.62±12.16）pg/mL,t=16.892,P<0.001;IFN-γ：（68.62±10.73）ng/L vs（51.26±6.37）ng/L,t=9.639,P<0.001]. Conclusions The combination of compound glycyrrhizin and carpotriol cream can improve the skin barrier function of psoriasis vulgaris,reduce inflammatory factors,and improve the imbalance of Th1/Th2 cytokines．

目的 探索干预因素对4~12岁孤独症谱系障碍（ASD）患儿社交反应的影响,为开展ASD患儿的早期干预提供参考。方法 选取于2020年1月—2023年3月在清远市妇幼保健院儿童神经与发育中心康复干预的ASD患儿,采用社交反应量表（SRS）对患儿进行社交行为评估,采用自编一般情况问卷对家长进行问卷调查,调查内容包括患儿的基本情况（性别、共患病情况、干预时长、上学情况等）。结果 202例ASD患儿中,男性患儿162例（80.2%）,女性40例（19.8%）,性别对社交反应的影响比较差异无统计学意义（t=2.969,P>0.05）。共患病方面,无共患病的ASD患儿与共患智力发育障碍及注意缺陷多动障碍的患儿相比,其SRS得分差异有统计学意义（F=6.920,P<0.05）。在上学情况方面,普通学校就读的患儿与特殊学校及未上学的患儿相比,其SRS得分差异有统计学意义（F=3.823,P<0.05）,但在特殊学校就读的患儿与未上学的患儿相比,差异无统计学意义（P>0.05）。在干预时长方面,干预≥1年与干预<1年及未干预的患儿比较,其SRS得分更低,差异有统计学意义（F=4.477,P<0.05）,但干预<1年与未干预患儿相比,两者差异无统计学意义（P>0.05）。结论 ASD患儿中,是否患有其他无共患病、上学情况、干预时长会影响其社交反应;存在共患疾病的ASD患儿社交反应表现更差;相较于就读特殊教育机构和未上学的患儿,就读于普通学校的ASD患儿社交障碍程度更轻;干预时间越长,其社交障碍程度也越轻。

Objective To explore the impact of intervention factors on social response in children with autism spectrum disorder（ASD）aged 4—12,and to provide reference for early intervention in children with ASD. Methods Children with ASD who underwent rehabilitation intervention at the Children's Neurology and Development Center of Qingyuan Maternal and Child Health Hospital from January 2020 to March 2023 were selected．The social behavior of the children was evaluated using the Social Response Scale（SRS）,and the parents were surveyed using a self-made general situation questionnaire．The survey content included the basic information of the children（gender,comorbidity,intervention duration,and school attendance,etc．）. Results Among the 202 cases of ASD,162 were male（80.2%）and 40 were female（19.8%）．There was no statistically significant difference in the impact of gender on social response（t=2.969,P>0.05）．In terms of comorbidities,there was a statistically significant difference in SRS scores between ASD children without comorbidities and those with comorbidities such as intellectual development disorder and attention deficit hyperactivity disorder（F=6.920,P<0.05）．In terms of school attendance,there was a statistically significant difference in SRS scores between children enrolled in regular schools and those who attended special schools and those who did not attend school（F=3.823,P<0.05）,but there was no statistically significant difference between children enrolled in special schools and those who did not attend school（P>0.05）．In terms of intervention duration,compared with children with intervention≥1 year and those with intervention<1 year and no intervention,the SRS score was lower and the difference was statistically significant（F=4.477,P<0.05）．However,compared with children with intervention<1 year and those without intervention,the difference was not statistically significant（P>0.05）. Conclusions No comorbidities,attending regular schools,and intervention duration≥1 year are positive factors that affect social response．Children with ASD who have comorbidities have poorer social response performance;compared to children who attend special education institutions and those who do not attend school,children with ASD who attend regular schools have lower levels of social impairment;the longer the intervention time,the lighter the degree of social impairment．

目的 探讨依奇珠单抗对中重度斑块型银屑病的治疗效果。方法 选取厦门大学附属第一医院2022年1月—2023年8月收治的75例中重度斑块型银屑病患者,应用抽签法进行分组,分为试验组（n=35）与对照组（n=40）。对照组采取常规外用药物治疗,试验组采取依奇珠单抗治疗。对比两组临床疗效,治疗前后外周血调节性T细胞（Treg）和辅助性T细胞17（Th17/Treg）细胞水平变化,并对所有患者进行6个月门诊复查随访,对比复发率及不良反应。结果 试验组总有效率88.57%,高于对照组的67.50%（χ²=4.730,P=0.028）;治疗后两组患者Treg细胞升高,试验组（5.59±1.24）%高于对照组（4.12±1.13）%,对比差异有统计学意义（t=5.371,P<0.001）,Th17细胞、Th17/Treg细胞降低,试验组[（1.06±0.14）%、0.19±0.05]低于对照组[（1.71±0.28）%、0.42±0.14],对比差异有统计学意义（t=12.434、9.212,P<0.001）;试验组停药后6个月复发率低于对照组（5.71% vs 27.50%,χ²=6.180,P=0.013）;试验组不良反应发生率略高于对照组,组间对比差异无统计学意义（14.29% vs 5.00%,χ²=1.900,P=0.168）。结论 依奇珠单抗治疗中重度斑块型银屑病疗效显著,可调节Th17/Treg平衡,降低停药后复发率,且安全性较高。

Objective To explore the therapeutic effect of Ixekizumab on moderate to severe plaque psoriasis. Methods Seventy-five patients with moderate to severe plaque psoriasis who were admitted to the First Affiliated Hospital of Xiamen University from January 2022 to August 2023 were selected and allocated by lottery into an experimental group（n=35）and a control group（n=40）．The control group received routine external medication while the experimental group received Ixekizumab treatment．The clinical efficacy of two groups,changes in Th17/Treg cell values before and after treatment were compared,and a 6-month outpatient follow-up for all patients was conducted to compare recurrence rates and incidence of adverse reactions. Results The total response rate in the experimental group was 88.57%,which was higher than the 67.50% in the control group（χ²=4.730,P=0.028）．After treatment,the level of Treg cell in the two groups was significantly higher,and the level of Treg cell experimental in the group was higher than that in the control group[（5.59±1.24）% vs （4.12±1.13）%,t=5.371,P<0.001]．After treatment,the level of Th17 and Th17/Treg cell in the two groups were lower,and the level of Th17 cell and Th17/Treg in the experimental group[（1.06±0.14）%,0.19±0.05] were significantly lower than those in the control group[（1.71±0.28）%,0.42±0.14],which was statistically significant（t=12.434、9.212,P<0.001）．The relapse rate at 6 months after drug withdrawal in the experimental group was significantly lower than that in the control group（5.71% vs 27.50,χ²=6.180,P=0.013）．The incidence of adverse reactions in the experimental group was higher than that in the control group,but with no statistical significance（14.29% vs 5.00%,χ²=1.900,P=0.168）. Conclusions Ixekizumab has a significant therapeutic effect on moderate to severe plaque psoriasis．It can regulate the Th17/Treg balance and reduce the recurrence rate after discontinuation,and with high safety．

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．

目的 探讨基于失效模式与效应分析法（FMEA）风险管理模式的在消化内镜诊疗护理中的应用价值。方法 选取2021年7月—2022年12月在河南省人民医院接受无痛消化内镜诊疗的368例患者为研究对象,根据入组时间顺序,2022年3月及其之前入组患者为对照组（n=171）,实施常规护理管理;2022年3月之后入组的患者为观察组（n=197）,在对照组基础上,增加基于FMEA的护理风险管理模式,对比两组患者的护理质量。结果 观察组各环节风险优先级（RPN）值较干预前明显好转,RPN总分由1 044分降至336分,观察组不良事件发生率低于对照组（17.3% vs 33.3%,P<0.05）,观察组患者对医护人员满意度高于对照组（92.9% vs 85.4%,P<0.05）,观察组患者所需的等待时间低于对照组[（35.68±7.29）min vs （44.27±8.65）分min,P<0.05]。结论 FMEA风险管理模式能有效提高无痛消化内镜诊疗中的护理质量。

Objective To explore the application analysis of failure mode and effect analysis（FMEA）risk management model in digestive endoscopy diagnosis treatment and nursing．Methods A total of 368 patients who underwent painless endoscopic diagnosis and treatment at Henan Provincial People’s Hospital from July 2021 to December 2022 were selected．According to the order of enrollment,patients enrolled in March 2022 and before were selected as the control group（n=171）,and routine nursing management was implemented．The patients enrolled after March 2022 were in the observation group（n=197）．In addition to the control group,a nursing risk management model based on FMEA was added to compare the nursing quality of the two groups of patients．Results The risk priority number（RPN）values of each link in the observation group showed a significant improvement compared to that before intervention．The total RPN score decreased from 1 044 points to 336 points,and the incidence of adverse events in the observation group was lower than that in the control group（17.3% vs 33.3%,P<0.05）．The satisfaction of the observation group with medical staff was higher than that in the control group（92.9% vs 85.4%,P<0.05）．The waiting time required by the observation group was lower than that in the control group[（35.68±7.29）min vs（44.27±8.65）min,P<0.05]．Conclusion sThe FMEA risk management model can effectively improve the nursing quality in painless endoscopic diagnosis and treatment．