探索 PDCA循环模式应用于麻精药品规范化管理的效果。方法：选取2023年6月至2025年7月该院所辖各科室 100例麻精药品管理全过程作为研究样本，随机分为实施 PDCA前（50例）与实施 PDCA后（50例），以 PDCA循环法对该类药物从购进到使用各个环节进行标准化管理，比较两组管理前后相关质控指标的变化情况。结果：实施后，我院麻精药品管理质量显著提升：库存周转率由 2.15次/月提升至 3.52次/月，提高63.72%；处方合格率由 87.50% 提升至?96.80%；空安瓿批号准确率由 84.30% 提升至?98.50%。同时，处方质量评分从73.41±7.85 升至 96.93±1.62分P<0.001；审核规范性得分从20.16±3.97分增长到25.85±3.18分（P=0.001）；登记完整性和及时性得分分别从22.33±4.15分和20.15±4.21分增加到26.87±3.38分和23.85±3.62分P<0.001；用药合理性得分从19.25±4.13分增至22.07±3.34分P=0.003。此外，处方医师知晓WHO治疗方案的比例增加。 医务人员对麻精药品专业知识掌握程度大幅提升，总体得分由74.00±3.43分涨至92.60±2.58分P<0.001，其中WHO治疗方案知识掌握度增加幅度最大，达78.7%（P=0.001）。结论：PDCA循环管理模式可有效地促进麻精药品管理工作的开展，最大限度地保障患者的安全并简化操作程序，并且能够使医护人员的知识水平以及专业素养得到有效提升，为医疗卫生机构麻精药品的规范化管理工作提供切实可行的方法。

To explore the effectiveness of applying the PDCA cycle model in standardized management of anesthetic and psychotropic drugs. Method: A total of 100 cases from all departments under the hospital's jurisdiction were selected as research samples covering the entire process of psychotropic and anesthetic drug management from June 2023 to July 2025. These cases were randomly divided into two groups: 50 before implementing the PDCA cycle (pre-implementation) and 50 after implementation. The PDCA cycle method was applied to standardize drug management from procurement to usage, with comparative analysis of quality control indicators before and after implementation. Results:Following the implementation, our hospital's quality management of anesthetic and psychotropic drugs has shown significant improvements: Inventory turnover rate increased from 2.15 times/month to 3.52 times/month, representing a 63.72% improvement; prescription qualification rate rose from 87.50% to 96.80%; accuracy rate of empty ampoule batch numbers improved from 84.30% to 98.50%. Concurrently, prescription quality scores jumped from 73.41±7.85 to 96.93±1.62 points (P<0.001); audit standardization scores grew from 20.16±3.97 to 25.85±3.18 points (P=0.001); registration completeness and timeliness scores increased from 22.33±4.15 and 20.15±4.21 points respectively to 26.87±3.38 and 23.85±3.62 points (P<0.001); medication rationality scores rose from 19.25±4.13 to 22.07±3.34 points (P=0.003). Additionally, the proportion of prescribing physicians familiar with WHO treatment protocols saw notable growth. Medical staff's expertise in anesthetic and psychotropic drug knowledge improved substantially, with overall scores rising from 74.00±3.43 to 92.60±2.58 points (P<0.001), particularly marked by a 78.7% increase in WHO protocol knowledge mastery (P=0.001).Conclusion: The PDCA cycle management mode can effectively promote the development of narcotic drug management, maximize the safety of patients and simplify the operation procedures, and can effectively improve the knowledge level and professional quality of medical staff, providing a feasible method for the standardized management of narcotic drugs in medical and health institutions.

【摘要】目的：探讨超声骨刀与高速涡轮手机在颌骨囊肿患者外科手术中的应用效果及安全性。方法：研究选择2024年1月~2025年6月至我院行囊肿刮治术治疗的100例颌骨囊肿患者，通过隐藏信封法将入组患者随机列为常规组、试验组，每组50例。常规组术中应用高速涡轮手机去骨，试验组术中应用超声骨刀去骨，比较两组患者的手术情况，术后疼痛肿胀情况及住院期间并发症发生情况。术毕随访半年，比较两组患者神经损伤情况及骨愈合情况。结果：试验组的术中出血量、术后24h引流量、切骨精度偏差分别为（30.59±5.24）mL、（20.55±5.28）mL、（0.18±0.05）mm，均低于常规组[（40.19±7.33）mL、（30.46±6.45）mL、（0.59±0.12）mm]（t=7.534，8.407，22.301；P＜0.05）；手术耗时与常规组比较，差异无统计学意义（P＞0.05）。试验组术后24h、48h、72h的视觉模拟疼痛量表（VAS）评分，肿胀评分均低于常规组（t=4.403，3.354，12.986，4.610，2.911，14.888；P＜0.05）。试验组住院期间的并发症发生率4.00%（2/50）低于常规组18.00%（9/50）（x2=5.005；P＜0.05）。试验组随访第1个月、第3个月、第6个月的神经传导速度（NCV）均高于常规组，两点辨别觉（TPD）均低于常规组（t=4.598，5.784，6.322，3.194，3.595，3.501；P＜0.05）。截至随访结束时，试验组的成骨率分别为（75.27±8.14）%高于常规组（68.18±5.27）%]，骨缺损面积、创面愈合时间、骨吸收量分别为（55.29±5.42）%、（3.22±0.47）月、（1.25±0.36）mm，均低于常规组[（62.44±7.51）%、（5.08±1.33）月、（2.49±0.32）mm]（t=5.170，5.459，9.324，18.204；P＜0.05）。结论：与高速涡轮手机相比，超声骨刀可降低颌骨囊肿患者术中出血风险并实现精准去骨，在减轻术后疼痛、肿胀程度同时能一定程度减轻术后神经损伤，对促进患者骨愈合也有积极影响。

[Abstract]Objective:To explore the application effect and safety of ultrasound bone scalpel and high-speed turbine mobile phone in surgical procedures for patients with jaw cysts.Methods:A total of 100 patients with maxillary cysts who underwent curettage surgery in our hospital from January 2024 to June 2025 were selected for the study. The enrolled patients were randomly divided into a control group and an experimental group using the hidden envelope method, with 50 patients in each group. The conventional group used high-speed turbine mobile phones for bone removal during surgery, while the experimental group used ultrasonic bone knives for bone removal during surgery. The surgical conditions, postoperative pain and swelling, and incidence of complications during hospitalization were compared between the two groups of patients. Follow up for six months after surgery to compare the nerve damage and bone healing between the two groups of patients.Results:The intraoperative bleeding volume, postoperative 24-hour drainage volume, and bone cutting accuracy deviation of the experimental group were (30.59 ± 5.24) mL, (20.55 ± 5.28) mL, and (0.18 ± 0.05) mm, respectively, all lower than those of the control group [(40.19 ± 7.33) mL, (30.46 ± 6.45) mL, and (0.59 ± 0.12) mm] (t=7.534，8.407，22.301; P<0.05); The surgical time of the experimental group was similar to the control group (P>0.05). The VAS scores and swelling scores of the experimental group at 24, 48, and 72 hours after surgery were lower than the control group (t=4.403，3.354，12.986，4.610，2.911，14.888；; P<0.05). The incidence of complications during hospitalization in the experimental group was 4.00% (2/50) lower than the control group 18.00% (9/50) (x2=5.005; P<0.05).The NCV of the experimental group was higher than the control group at the1,3,6 months of follow-up, and TPD was lower than the control group (t=4.598，5.784，6.322，3.194，3.595，3.501; P<0.05). As of the end of follow-up, the osteogenic rate of the experimental group was (75.27 ± 8.14)% higher than the control group (68.18 ± 5.27)%. The bone defect area, wound healing time, and bone resorption were (55.29 ± 5.42)%, (3.22 ± 0.47) months, and (1.25 ± 0.36) mm, lower than the control group [(62.44 ± 7.51)%, (5.08 ± 1.33) months, and (2.49 ± 0.32) mm] (t=5.170，5.459，9.324，18.204; P<0.05).Conclusion:Compared with high-speed turbo phones, ultrasonic bone scalpel can reduce the risk of intraoperative bleeding in patients with jaw cysts and achieve precise bone removal. It can alleviate postoperative pain and swelling while greatly avoiding postoperative nerve damage, and has a positive impact on promoting bone healing in patients.

目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者,依据随机数字表法进行分组处理。对照组60例给予常规扩皮法,观察组60例给予钝性分离扩皮法,对比两组患者扩皮结果。结果 观察组患者满意度为96.67%,对照组患者满意度为86.67%（χ²=3.927,P=0.048）;观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm²、1 d后（4.89±0.94）cm²以及3 d后（0.21±0.05）cm²,均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²,对比差异有统计学意义（t=22.444、17.243、13.704,P<0.05）;观察组患者一次性送鞘成功率为98.33%,对照组患者一次性送鞘成功率为88.33%,观察组高于对照组（χ²=4.821,P=0.028）;扩皮前两组患者的VAS评分无差异（P>0.05）,扩皮后两组患者的VAS评分均降低,且观察组（1.75±0.54）分低于对照组（3.89±1.22）分,对比差异有统计学意义（t=12.425,P<0.001）;观察组患者不良事件发生率为5.00%,对照组患者不良事件发生率为16.67%,观察组患者不良事件发生率低于对照组（χ²=4.227,P<0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率,提高一次性送鞘成功率,减轻患者疼痛感,提高患者满意度。

Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery. Methods From April 2022 to April 2024,120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion,and 60 patients in the observation group received blunt separation skin expansion,which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group,86.67% in the control group（χ²=3.927,P=0.048,P<0.05）．In the observation group,the blood immersion area after catheterization,after 1 d and 3 d were（0.87±0.14）,（4.89±0.94）,（0.21±0.05）cm²,lower than those of the control group [（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²],the comparative difference was statistically significant（t=22.444,17.243,13.704,P<0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%,which was higher than 88.33% in the control group（χ²=4.821,P=0.028<0.05）．There was no difference in VAS scores between the two groups before the intervention（P>0.05）,VAS scores decreased in both groups after the intervention,the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22）,the difference was statistically significant（t=12.425,P<0.001）．The incidence of adverse events in the observation group was 5.00%,and in the control group was 16.67%,which difference was significant（χ²=4.227,P<0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events,improve the success rate of disposable sheath delivery,reduce patient pain,improve patient satisfaction,and have significant clinical application value．

目的 探讨支气管镜灌洗用于儿童重症肺部感染合并肺实变的治疗效果及对CT特征、肺功能的影响。方法 选取2022年5月—2024年5月铜仁市人民医院收治的100例重症肺部感染合并肺实变患儿开展前瞻性研究,应用随机数表法分为对照组和观察组,每组各50例。对照组患儿采取常规治疗,观察组则采取常规治疗加支气管镜灌洗治疗。对比其临床疗效,治疗前后炎症因子、CT特征及肺功能变化。结果 观察组治疗总有效率高于对照组（P<0.05）;治疗后观察组患儿白细胞计数（10.36±2.52）×10⁹/L、白细胞介素-6（20.57±5.05）ng/L、C反应蛋白（13.12±2.64）mg/L、降钙素原（101.62±12.16）pg/L均低于对照组白细胞计数（13.25±3.32）×10⁹/L、白细胞介素-6（31.69±4.11）ng/L、C反应蛋白（16.16±4.44）mg/L、降钙素原（113.46±18.11）pg/L（P<0.05）;治疗后两组患儿胸腔积液、支气管壁增厚、空气支气管征、肺部实变、磨玻璃影等相关CT影像特征占比下降,且观察组低于对照组（P<0.05）;治疗后两组患儿呼气流量峰值水平均升高,观察组（90.67±18.45）L/s高于对照组（81.27±17.69）L/s,用力肺活量水平均更高,观察组（3.33±0.68）L高于对照组（2.68±0.25）L（P<0.05）。结论 针对儿童重症肺部感染合并肺实变,在常规治疗基础上增加支气管镜灌洗可提升临床疗效,减轻机体炎症反应,改善胸部CT各种表现及肺功能。

Objective To explore the therapeutic effects of bronchoalveolar lavage in children with severe pulmonary infection complicated by lung consolidation and its impact on CT features and pulmonary function．Methods A prospective study was conducted on 100 children with severe pulmonary infection complicated with pulmonary consolidation in a hospital from May 2022 to May 2024．They were randomly divided into observation group and control group using a random number table method,50 cases in each group．The control group of children received routine treatment,and the observation group received conventional treatment plus bronchoalveolar lavage．Clinical efficacy,inflammatory factors,CT features,and alterations in pulmonary function before and after therapy were compared．Results The total effective rate of the observation group was higher than that of the control group（P<0.05）．After treatment,the white blood cell count（10.36±2.52）×10⁹/L,interleukin-6（20.57±5.05）ng/L,C-reactive protein（13.12±2.64）mg/L,and procalcitonin（101.62±12.16）pg/L in the observation group were all lower than those in the control group（13.25±3.32）×10⁹/L,interleukin-6（31.69±4.11）ng/L,C-reactive protein（16.16±4.44）mg/L,and procalcitonin（113.46±18.11）pg/L（P<0.05）．After treatment,the proportion of CT imaging features such as pleural effusion,bronchial wall thickening,air bronchogram sign,lung consolidation,ground glass opacities,decreased in both groups of children,and the observation group was lower than the control group（P<0.05）．After treatment,the peak levels of expiratory flow in both groups of children increased,with the observation group（90.67±18.45）L/s higher than the control group（81.27±17.69）L/s．The forced vital capacity levels were also higher,with the observation group（3.33±0.68）L higher than the control group（2.68±0.25）L（P<0.05）．Conclusions Adding bronchoalveolar lavage to routine treatment for children with severe pulmonary infection complicated with pulmonary consolidation can improve their clinical efficacy,alleviate inflammatory reactions,and improve various chest CT manifestations and lung function．

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 探讨俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果。方法 选取泉州市儿童医院2020年9月—2023年9月收治的72例脓毒症合并急性肺损伤患儿,应用抽签法将其分为观察组与对照组,均为36例。对照组患儿实施常规仰卧位机械通气与对应护理,观察组患儿在常规护理基础上增加俯卧位通气与对应护理。对比两组患儿机械通气时间,干预前和干预3 d后气道平台压和心率水平,动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）,并计算动脉血氧分压与吸入气中的氧浓度分数比值（PaO₂/FiO₂）,评价两组患儿预后及不良事件发生情况。结果 观察组机械通气时间明显低于对照组（P<0.05）,干预后两组患儿气道平台压、心率均降低,且观察组低于对照组（P<0.05）;干预后两组患儿PaO₂/FiO₂、PaO₂水平升高,观察组高于对照组,PaCO₂降低,观察组低于对照组（P<0.05）;干预后两组患儿全身性感染相关性器官功能衰竭评分（SOFA）、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）评分均降低,观察组低于对照组（P<0.05）;两组患儿呼吸机管路折管、管路滑脱、压力性损伤等不良事件发生率对比差异无统计学意义（P>0.05）。结论 俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果显著,可降低患儿气道平台压及心率,缩短机械通气时间,改善患儿通气功能,有助提升预后水平。

Objective To explore the application effect of prone position ventilation in children with sepsis complicated with acute lung injury．Methods From September 2020 to September 2023,72 children with sepsis and acute lung injury admitted to Quanzhou Children's Hospital were selected and divided into observation group and control group by drawing lots,both with 36 cases．The children in the control group received routine supine mechanical ventilation and corresponding nursing,and the children in the observation group added prone ventilation and corresponding nursing on the basis of routine nursing．By comparing the duration of mechanical ventilation,airway plateau pressure and heart rate level,PaCO₂,PaO₂,PaO₂/FiO₂,the prognosis and occurrence of adverse events in the two groups were evaluated．Results The mechanical ventilation time in the observation group was significantly shorter than that in the control group（P<0.05）．After intervention,the airway plateau pressure and heart rate levels of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．After the intervention,the levels of PaO₂/FiO₂ and PaO₂ in the two groups of children increased,with the observation group higher than the control group,while the level of PaCO₂ was lower,with the observation group lower than the control group（P<0.05）．After the intervention,the SOFA and APACHE II scores of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．There was no difference in the incidence of adverse events such as ventilator tube folding,tube slip and pressure injury between the two groups（P>0.05）．Conclusions The application of prone position ventilation in children with sepsis combined with acute lung injury has a significant effect,which can reduce airway plateau pressure,lower heart rate,shorten mechanical ventilation time,improve ventilation function,and assist in improving prognosis．

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 对比纳布啡联合环泊酚、纳布啡联合丙泊酚应用于老年患者无痛胃镜中的效果。方法 选取厦门市中医院2021年10月至2022年10月收治的180例老年患者（均行无痛胃肠镜检查）为研究对象,按照随机数表法分组,其中A组90例患者给予纳布啡联合环泊酚,B组90例患者给予纳布啡联合丙泊酚,对比两组患者麻醉相关指标、血流动力学、围术期不良反应。结果 两组患者诱导量、诱导时间、追加次数、总追加量、苏醒时间、恢复室停留时间对比差异均无统计学意义（t=1.486、0.830、1.157、0.941、0.906、1.403,均P>0.05）;重复测量方差分析结果显示,分组因素间收缩压（SBP）（F=30.019,P<0.001）、心率（HR）（F=282.057,P<0.001）、SpO₂（F=64.518,P<0.001）、;时间因素SBP（F=21.780,P<0.001）、HR（F=345.118,P<0.001）、SpO₂（F=41.762,P<0.001）;分组与时间交互时间因素SBP（F=12.941,P<0.001）、HR（F=193.295,P<0.001）、SpO₂（F=13.546,P<0.001）,差异均有统计学意义。折线图直观显示,A组患者SBP、HR、SpO₂、较B组低。;A组患者围术期不良反应发生率（20.00%）低于B组患者（56.67%）（χ²=25.593,P<0.001）。结论 两种麻醉方案应用于老年无痛胃肠镜,麻醉效果相近,环泊酚复合纳布啡血流动力学更稳定,且围术期不良反应的发生率较低。

Objective To compare the effects of nalbuphine combined with ciprofol and nalbuphine combined with propofol on painless gastroscopy in elderly patients. Methods A total of 180 elderly patients（all underwent painless gastroscopy）admitted to Xiamen Traditional Chinese Medicine Hospital from October 2021 to October 2022 were selected as the study subjects．They were randomly divided into groups using a random number table method．Among them,90 patients in Group A were given a combination of nalbuphine and ciprofol,while 90 patients in Group B were given a combination of nalbuphine and propofol．Anesthesia related indicators,hemodynamics,and perioperative adverse reactions were compared between the two groups．There was no statistically significant difference in the induction amount,induction time,number of additional times,total additional amount,awakening time,and recovery room stay time between the two groups of patients（t=1.486,0.830,1.157,0.941,0.906,1.403,all P>0.05）．The results of repeated measures analysis of variance showed that there were statistically significant differences among the grouping factors,including SBP（F=30.019,P<0.001）,HR（F=282.057,P<0.001）,SpO₂（F=64.518,P<0.001）,time factors SBP（F=21.780,P<0.001）,HR（F=345．118,P<0.001）,SpO₂（F=41.762,P<0.001）,and interaction factors SBP（F=12.941,P<0.001）,HR（F=193.295,P<0.001）,and SpO₂（F=13.546,P<0.001）．The line chart visually shows that the SBP,HR,SpO₂ of Group A patients were lower than those of Group B．The incidence of perioperative adverse reactions in Group A patients（20.00%）was lower than that in Group B patients（56.67%）（χ²=25.593,P<0.001）. Conclusions The two anesthesia regimens used for elderly painless gastroscopy have similar anesthesia effects,with more stable hemodynamics of ciprofol combined with nalbuphine,and a lower incidence of perioperative adverse reactions．

目的 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．

目的 探究质控预警系统在重症患儿连续性血液净化治疗的应用效果。方法 随机选取于2020年1月—2021年12月在我院进行连续性血液净化治疗的共80例重症患儿作为本次研究对象,将80例患儿随机分成研究组和对照组,对照组进行常规护理,研究组则在常规护理的基础上行预警系统质量控制,对比2组患儿连续性血液净化治疗时长及报警频次、2组患儿在不同治疗时间段内滤器凝血发生率、2组非计划下机发生情况及2组患儿家属的护理满意度。结果 研究组平均报警频次为(8.60±3.35),低于对照组(16.52±7.41)的报警频次。而研究组的治疗时长(32.54±6.73 h)较对照组(21.38±5.61 h)延长,研究组患儿在进行连续性血液净化治疗的过程中,在8小时至24小时之间及大于24小时滤器的凝血发生率低于对照组,研究组和对照组护理满意度分别为92.50%和75.00%,对比差异显著。结论 在对重症患儿进行连续性血液净化治疗过程中应用质控预警系统具有较高的临床使用价值,不仅可以有效降低报警频次及滤器凝血发生率,而且对延长治疗时间有显著的促进作用,值得在今后的治疗过程中大力推广。

Objective To explore the application effect of quality control early warning system in continuous blood purification treatment of critically ill children.Methods A total of 80 critically ill children who underwent continuous blood purification treatment in our hospital from January 2020 to December 2021 were randomly selected as the research object, and were randomly divided into observation group and control group.The control group received routine nursing,and the observation group received early warning system quality control on the basis of routine nursing.The duration and alarm frequency of continuous blood purification treatment,the incidence of filter coagulation in different treatment periods,the occurrence of unplanned quitting and nursing satisfaction of the two groups were compared.Results The average alarm frequency of the observation group was (8.60±3.35),which was significantly lower than that of the control group (16.52±7.41).However,the treatment duration of the observation group (32.54±6.73 h) was significantly longer than that of the control group (21.38±5.61 h).During continuous blood purification treatment,the incidence of blood coagulation in the observation group was lower than that of the control group,and the nursing satisfaction of the observation group and the control group were 92.50% and 75.00% respectively,with significant differences.Conclusions The application of quality control early warning system in the continuous blood purification treatment of critically ill children has a high clinical value,which can not only effectively reduce the alarm frequency and the incidence of filter coagulation,but also significantly prolong the treatment time,and it is worth promoting in the future treatment process.