目的 探讨头位分娩评分法在孕妇分娩过程中的应用价值。方法 选取2020年1月—2022年12月于郑州市妇幼保健院进行建档住院的4 000例待产分娩孕妇作为研究对象,所有孕妇在宫口已开时都给予头位分娩评分,观察与记录所有孕妇的分娩方式与头位分娩评分法状况,记录新生儿出生1 min与出生5 min的Apgar评分,记录所有孕妇的产后并发症发生情况。结果 在4 000例孕妇中,Apgar评分≤8分者156例、9~10分者894例、≥11分者2 950例。不同头位分娩评分法孕妇的年龄、孕周、孕次、产次对比差异无统计学意义（P>0.05）。≤8分者的剖宫产率为100.0%,9~10分者、≥11分者分别为35.3%、5.7%,对比差异有统计学意义（P<0.05）。≤8分者、9~10分者、≥11分者的新生儿出生1 min与出生5 min的Apgar评分对比差异无统计学意义（P>0.05）。≤8分者、9~10分者、≥11分者的产后发热、产后出血、产后血肿、产后尿潴留等并发症发生率为分别为13.5%、2.0%、0.2%,对比差异有统计学意义（P<0.05）。结论 头位分娩评分法在产科中处理头位分娩时具有指导价值,值得推广应用。

Objective To explore and analyze the application values of the head position delivery scoring method in the delivery process of 4 000 pregnant women．Methods Selected 4 000 cases of pregnant women as the study object,all pregnant women gave head delivery score,observed and recorded the delivery mode and head delivery scoring method,recorded the Apgar score of 1 min and 5 min,and recorded the occurrence of postpartum complications of all pregnant women．Results Among the 4 000 pregnant women,156 scored ≤8,894 scored 9-10,and 2 950 scored ≥11．There was no significant difference in the age,gestational age,pregnancy time and delivery status of pregnant women in different head delivery scoring methods（P>0.05）．The cesarean section of patients with ≤8 score was 100.0%,those with 9-10 score and those with ≥11 score were 35.3% and 5.7%,respectively,and there were significant differences（P<0.05）．There was no significant difference in Apgar score between newborns with ≤8 scores,9-10 scores and ≥11 scores at 1 min and 5 min after birth（P>0.05）．The incidence rates of puerperal fever,postpartum hemorrhage,postpartum hematoma and postpartum urinary retention were 13.5%,2.0% and 0.2% in patients with ≤8 score,9~10 score and ≥11 score,respectively,and there were significant differences（P<0.05）．Conclusions The head delivery scoring method has guiding value in handling head delivery in obstetrics and is worth promoting and applying．

目的 探讨计划-实施-检查-处理（PDCA）循环法及根本原因分析法在持续正压通气治疗重症肺炎患儿中的应用效果。方法 选取2021年1月—2023年1月医院收治并接受鼻塞式持续正压通气治疗的重症肺炎患儿80例,基于随机数字表法分为两组,每组各40例。对照组接受常规护理,观察组采用PDCA循环法联合根本原因分析法护理干预。比较两组临床症状改善时间、血气指标[动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）]、肺功能指标[第1秒用力呼气容积（FEV₁）、潮气量（VT）]、炎症免疫指标[单核细胞趋化蛋白-1（MCP-1）、可溶性髓系细胞触发受体-1（sTREM-1）、可溶性细胞间黏附分子-1（sICAM-1）]水平变化,比较两组患儿家属满意度情况。结果 观察组患儿咳嗽、气促、哮鸣音、心率恢复及紫绀等症状改善用时均低于对照组,比较差异有统计学意义（P<0.05）。干预前,两组患儿PaO₂、SaO₂、PaCO₂、FEV₁、VT、MCP-1、sTREM-1、sICAM-1水平比较差异均无统计学意义（P>0.05）;干预后,两组患儿上述指标水平均有不同程度变化（P<0.05）,观察组PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）、SaO₂（93.58±3.82% vs 86.30±4.21%）、FEV₁（2.66±0.46 L vs 1.97±0.34 L）、VT（11.92±1.89% vs 9.83±1.10%）水平均高于对照组,观察组PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）、MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）、sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）、sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）水平低于对照组,差异均有统计学意义（P<0.05）。观察组患儿家属满意度整体优于对照组（P<0.05）;观察组总满意率（97.5% vs 77.5%）高于对照组,差异有统计学意义（P<0.05）。结论 PDCA循环法及根本原因分析法应用于接受持续正压通气治疗的重症肺炎患儿,能够有效促进患儿临床症状改善,有利于血气及肺功能恢复,且可降低炎症反应,患儿家属满意度较高。

Objective To explore the application effect of Plan-Do-Check-Action（PDCA）circulation method and root cause analysis method in the treatment of children with severe pneumonia with continuous positive pressure ventilation．Methods From January 2021 to January 2023,80 children with severe pneumonia who were admitted to hospital and received nasal plug continuous positive pressure ventilation treatment were enrolled in this study．Based on the random number table method,they were divided into two groups,with 40 cases in each group．The control group received routine nursing,while the observation group received PDCA circulation method combined with root cause analysis nursing intervention．The improvement time of clinical symptoms,changes in blood gas indicators[arterial partial oxygen pressure（PaO₂）,arterial oxygen saturation（SaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）],lung function indicators [（forced expiratory volume in 1 second,FEV₁）,tidal volume（VT）],and inflammatory immune indicators [monocyte chemotactic protein-1（MCP-1）,soluble myeloid cell trigger receptor-1（sTREM-1）,soluble intercellular adhesion molecule-1（sICAM-1）] levels between the two groups were compared,and the family members’ satisfaction of the two groups was also compared．Results The improvement time for symptoms such as cough,shortness of breath,wheezing,heart rate recovery and cyanosis in the observation group was lower than that in the control group,and the difference was statistically significant（P<0.05）．Before intervention,there was no statistically significant difference in the levels of PaO₂,SaO₂,PaCO₂,FEV₁,VT,MCP-1,sTREM-1 and sICAM-1 between the two groups of children（P>0.05）．After intervention,the levels of the above indicators in both groups of children showed varying degrees of change（P<0.05）．The levels of PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）,SaO₂（93.58±3.82% vs 86.30±4.21%）,FEV₁（2.66±0.46 L vs 1.97±0.34 L）,VT（11.92±1.89% vs 9.83±1.10%）in the observation group were higher than those in the control group．The levels of PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）,MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）,sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）and sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）in the observation group were lower than those of the control group,with statistically significant differences（P<0.05）．The overall satisfaction of the observation group was better than that of the control group（P<0.05）,the total family members’ satisfaction rate of the observation group was higher than that of the control group（97.5% vs 77.5%）,with a statistically significant difference（P<0.05）．Conclusions PDCA circulation method and root cause analysis method applied to children with severe pneumonia who receive continuous positive pressure ventilation treatment,can effectively promote the improvement of clinical symptoms,be conducive to the recovery of blood gas and lung function,and reduce inflammatory reaction,with high family members’ satisfaction．

目的 观察利伐沙班对心力衰竭（HF）合并心房颤动（AF）患者凝血因子及预后情况的影响。方法 采用前瞻性研究,纳入平顶山市第二人民医院2021年1月—2022年4月期间收治的123例HF合并AF患者,以数字随机表法将入组患者分为常规组（61例）和试验组（62）例,两组均行起搏器植入术（CRTD）治疗,常规组予以常规抗凝治疗辅助CRTD,试验组予以利伐沙班辅助CRTD,所有患者术后均开展一年随访,比较两组患者治疗前后的抗Xa凝血因子、心肌损伤标志物、心功能指标变化情况,以及术后血栓栓塞、心血管死亡事件发生情况。结果 治疗前,两组患者的Xa凝血因子,心肌损伤标志物,心功能指标比较差异无统计学意义（P>0.05）;在不同抗凝方案下,观察组治疗1 d后的抗Xa凝血因子为（130.44±20.18）IU/mg,治疗3 d后的抗Xa凝血因子为（115.36±20.77）IU/mg,治疗7 d的抗Xa凝血因子为（90.25±20.44）IU/mg,均低于常规组[（145.33±20.19）IU/mg、（128.45±20.16）IU/mg、（103.34±20.17）IU/mg],差异有统计学意义（P<0.05）。治疗后,试验组的肌酸激酶同工酶为（7.52±2.16）U/L,心肌肌钙蛋白Ⅰ为（0.52±0.12）ng/mL,乳酸脱氢酶为（126.41±20.45）U/L,均低于常规组[（8.44±2.28）U/L、（0.94±0.31）ng/mL、（140.33±20.25）U/L],差异有统计学意义（P<0.05）。治疗后,观察组的左室射血分数为（56.12±10.41）%,高于常规组（50.24±10.33）%,左室舒张末期内径为（47.11±10.25）mm,左室舒张末期容积为（36.72±10.43）mL,均低于常规组（53.28±10.14）mm、（42.77±10.36）mL,差异有统计学意义（P<0.05）。随访期间,试验组的血栓栓塞事件发生率为4.84%（3/62）,心血管死亡事件发生率为3.23%（2/62）,均低于常规组[19.67%（12/61）、14.75%（9/61）],差异有统计学意义（P<0.05）。结论 利伐沙班辅助CRTD能有效增强HF合并AF患者的抗Xa凝血因子活性,对减轻心肌损伤、改善心功能并降低血栓栓塞或心血管死亡风险均有积极意义。

Objective To observe the effect of rivaroxaban on coagulation factors and prognosis in patients of heart failure（HF）with atrial fibrillation（AF）．Methods This is a prospective study．The patients were included from January 2021 to April 2022 in Pingdingshan Second People’s Hospital．The study subjects were 123 patients with HF and AF．The enrolled patients were divided into the conventional group（61 cases）and the experimental group（62 cases）by the method of digital random table．Both groups were treated with cardiac resynchronization therapy with defibrillator（CRTD）．The conventional group was treated with conventional anticoagulation therapy to assist CRTD,and the experimental group was treated with rivaroxaban to assist CRTD．All patients were followed up for one year after surgery,the changes in anti-Xa coagulation factors,myocardial injury markers,cardiac function indicators,as well as the incidence of postoperative thromboembolism and cardiovascular death events between the two groups of patients before and after treatment were compared．Results Before treatment,there were no statistically significant differences in Xa coagulation factor,myocardial injury markers and cardiac function indicators between the two groups of patients（P>0.05）．Under different anticoagulation regimens,the anti-Xa coagulation factor levels in the observation group were（130.44±20.18）IU/mg after 1 day of treatment,（115.36±20.77）IU/mg after 3 days of treatment,and（90.25±20.44）IU/mg after 7 days of treatment,which were lower than that in the conventional group [（145.33±20.19）IU/mg,（128.45±20.16）IU/mg,（103.34±20.17）IU/mg]（P<0.05）．After treatment,the CK-MB level of the experimental group was（7.52±2.16）U/L,cTnI was（0.52±0.12）ng/mL,and LDH was（126.41±20.45）U/L,which were lower than that of the conventional group [（8.44±2.28）U/L,（0.94±0.31）ng/mL,（140.33±20.25）U/L]（P<0.05）．After treatment,the left ventricular ejection fraction of the observation group was（56.12±10.41）%,which was higher than the conventional group（50.24±10.33）%,left ventricular diameter was（47.11±10.25）mm,left ventricular end disastolic volume was（36.72±10.43）mL,which were lower than the conventional group（53.28±10.14）mm,（42.77±10.36）mL（P<0.05）．During the follow-up period,the incidence of thromboembolism events in the experimental group was 4.84%（3/62）,and the incidence of cardiovascular death events was 3.23%（2/62）,which was lower than the conventional group [19.67%（12/61）,14.75%（9/61）]（P<0.05）．Conclusions Rivaroxaban assisted CRTD can effectively enhance the activity of anti-Xa coagulation factors in patients with HF and AF,which has positive significance in reducing myocardial injury,improving cardiac function and reducing the risk of thromboembolism or cardiovascular death．

目的 研究与分析放大内镜在内镜下黏膜剥离术（ESD）治疗食管早期癌及癌前病变中的作用。方法 选取2020年1月—2022年7月我院收治的明确诊断为食管癌的患者为观察对象,研究者为其一级亲属40岁以上经普通内镜发现食管异常病灶同时行放大内镜检查者。据疑病处食管黏膜上皮乳头内毛细血管袢（IPCL）变化,判断病变性质估计侵犯深度。疑早期食管癌及癌前病变者行ESD治疗,疑进展期食管癌者行外科手术治疗,送整体标本病理检查。结果 食管癌一级亲属40岁以上患者经普通内镜发现食管异常病灶同时行放大内镜检查者共128例,其中行ESD和外科手术取得整体病理标本102例。对比放大胃镜术前判断和术后整体病理标本,判断性质方面放大内镜对食管早期病变诊断的总体准确率为87.3%,诊断食管早期鳞癌的灵敏度为97.8%,特异度为15.4%,阳性预测值88.8%,阴性预测值50%。判断浸润层次方面,放大内镜对食管早期鳞癌深度诊断的总体准确率为69%,B1型血管对浸润深度正确诊断率为90.6%,灵敏度为70.6%,B2型血管对浸润深度正确诊断为32.2%,灵敏度为76.9%,B3型血管对浸润深度正确诊断为66.7%,灵敏度为33.3%。结论 放大内镜在ESD下治疗食管早期鳞癌及癌前病变患者,可对食管病变性质准确判断,提升病变检出率,实践价值较高。

Objective To investigate and analyze the role of magnifying endoscopy in endoscopic submucosal dissection（ESD）in the treatment of early esophageal cancer and precancerous lesions．Methods Esophageal cancer patients in our hospital from January 2020 to July 2022 were selected as the observation objects,the investigator was a first-degree relative over 40 years old who found abnormal esophageal lesions through ordinary endoscopy,and underwent magnifying endoscopy,according to suspected esophageal mucosal epithelial nipple capillary loop（IPCL）changes,defined the nature of the lesion to estimate the invasion depth．Patients with suspected early esophageal cancer and precancerous lesions were given ESD treatment,and those with suspected progressive esophageal cancer underwent surgical treatment,and were sent to the whole specimen for pathological examination．Results A total of 128 patients with first-degree relatives of esophageal cancer over 40 years old were found to have simultaneous enlarged endoscopy simultaneously through common endoscopy,among which 102 patients had obtained overall pathological specimens by ESD and surgery．Comparing the preoperative diagnosis of magnifying gastroscopy and the postoperative overall pathological specimens,the overall accuracy of magnifying endoscopy for the diagnosis of early esophageal lesions was 87.3%,the sensitivity of detecting early esophageal squamous cell carcinoma was 97.8%,specificity was 15.4%,the positive predictive value was 88.8%,and the negative predictive value was 50%．In terms of invasion level,the overall accuracy of magnifying endoscopy for the depth diagnosis of early esophageal squamous cell carcinoma was 69%,90.6% accuracy and 70.6% sensitivity of B1 vessels,32.2% and 76.9% of B2 vessels,66.7% and 33.3% of B3 vessels．Conclusions The magnifying endoscopic treatment of patients with early esophageal cancer and precancerous lesions under ESD can accurately diagnosis the nature of esophageal lesions,improve the detection rate of lesions,and has high practical value．

目的 探究维持性血液透析（MHD）患者的病耻感现状,并对其影响因素进行分析。方法 根据便利抽样法,选取2020年2月—2022月10月在河南省郑州市第三人民医院血液净化中心进行MHD治疗的236例患者作为研究对象,并采用一般资料调查问卷、领悟社会支持量表（PSSS）以及社会影响量表（SIS）进行调查。根据SIS得分情况进行分组,采用Logistic回归分析行MHD患者病耻感的影响因素。结果 MHD患者病耻感得分为（65.03±10.68）分,其中病程较短、社会支持度低、家庭平均收入低、文化水平较低以及未参加肾友会的患者病耻感得分较高,病程较长、家庭平均收入高、社会支持度高、参加肾友会以及文化水平较高者病耻感得分较低（P<0.05）。多因素Logistic回归分析结果显示,患者文化水平、家庭平均收入、是否参加肾友会、病程以及社会支持情况是患者病耻感的影响因素（P<0.05）。结论 MHD患者病耻感得分处于中高等水平。指导患者正确认识疾病,多关注家庭收入较低患者,鼓励患者积极参与肾友会,为患者提供良好的社会支持,均有助于降低其病耻感程度。

Objective To explore the current status of shame in maintenance hemodialysis（MHD）patients and analyze its influencing factors．Methods Based on the convenience sampling method,236 patients who underwent MHD treatment at the Blood Purification Center of the Third People’s Hospital of Zhengzhou City,Henan Province from February 2020 to October 2022 were selected as the research subjects．A general information survey questionnaire,Perceived Social Support Scale（PSSS）,and Social Impact Scale（SIS）were used for the survey．Grouping based on SIS scores,logistic regression analysis was used to analyze the influencing factors of shame in MHD patients．Results MHD patients had a shame score of（65.03±10.68）,among which patients with shorter disease course,lower social support,lower average family income,lower education level,and those who did not participate in kidney friend associations had higher shame scores．Patients with longer disease course,higher average family income,higher social support,participation in kidney self-help group,and higher education level had lower shame scores（P<0.05）．The results of multivariate logistic regression analysis showed that the patient’s educational level,average family income,participation in a kidney self-help group,course of illness,and social support were the influencing factors for the patient’s sense of shame（P<0.05）．Conclusions The shame score of MHD patients is at a moderate high level．Guiding patients to have a correct understanding of the disease,paying more attention to patients with lower family income,encouraging them to actively participate in kidney self-help group,and providing good social support to patients can all help reduce their sense of shame．

目的 探讨近端和远端结直肠无蒂锯齿状病变在临床和内镜特征上的区别。方法 回顾性分析103例结直肠无蒂锯齿状病变患者的临床内镜资料,对近端和远端结直肠无蒂锯齿状病变患者在性别、年龄、内镜特征（息肉大小、山田分型、内镜NICE分型、蛇形微血管、黏液帽）等方面进行比较。结果 与远端结直肠无蒂锯齿状病变相比,近端结肠无蒂锯齿状病变发病年龄更早（P=0.014）,内镜下山田1型息肉更为常见（P=0.050）,黏液帽也是近端结肠无蒂锯齿状病变的重要内镜特征（P<0.001）。结论 近端无蒂锯齿状病变内镜下扁平隐匿,容易漏诊,掌握其内镜特征有助于提高该病的检出率。

Objective To explore the differences in clinical and endoscopic characteristics of sessile serrated lesions in the proximal and distal colorectum．Methods The clinical endoscopic data of 103 patients with sessile serrated lesions of the colorectum were retrospectively analyzed．The gender,age and endoscopic features（polyp size,Yamada classification,NICE classification,dilate vessels and the mucus cap）of patients with proximal and distal colorectal sessile serrated lesions were compared retrospectively．Results Compared with distal colorectal sessile serrated lesions,the age of onset of proximal colon sessile serrated lesions was earlier（P=0.014）,endoscopic Yamada type 1 polyps were more common（P=0.050）,and mucus cap was also an important endoscopic feature of proximal colon sessile serrated lesions（P<0.001）．Conclusions The proximal sessile serrated lesions are flat and hidden under endoscopic examination which are easily missed．Understanding their endoscopic characteristics can help improve the detection rate of the disease．

目的 探索机械通气患者发生呼吸机相关性肺炎（VAP）的危险因素,为医疗机构降低VAP的发生率提供参考依据。方法 采用回顾性病例对照的方法,收集2020年1月—2021年4月入住重症医学科（ICU）接受机械通气>48 h、年龄>18岁的患者资料。根据诊断标准确定20例VAP患者作为病例组,在同期住院患者筛选性别、年龄与病例匹配的20例未发生VAP患者为对照组,并对两组间各项临床指标进行统计分析。结果 两组患者在接受机械通气前入院诊断情况、是否手术和合并慢性阻塞性肺炎、APACHEⅡ评分、置管地点比较差异均无统计学意义（P>0.05）;机械通气时白细胞、C反应蛋白、降钙素原比较差异无统计学意义（P>0.05）。与对照组相比,病例组住院总日数、住ICU天数、机械通气时间、吸痰护理次数、抗生素使用天数明显增加（均P<0.05）。其中ICU中VAP以耐碳青霉烯类鲍曼不动杆菌（占比70%）感染为主;环境卫生学监测发现,患者周围环境、护士站及使用后的消毒物品均检出鲍曼不动杆菌,说明医务人员手卫生依从性差及环境消毒不彻底也是导致院内VAP发生的原因之一。病例组住院总费用中位数为145 207元,对照组为60 745.48元,VAP造成的平均经济损失为84 461.52元/例。病例组各项医疗费用均高于对照组,比较差异有统计学意义（P<0.05）。结论 机械通气期间不适当的诊治、环境消毒不到位、手卫生依从性差可能是造成医疗机构VAP发生的主要原因。

Objective To explore the risk factors of ventilator-associated pneumonia（VAP）in patients with mechanical ventilation,and provide a reference basis for medical institutions to reduce the occurrence of VAP．Methods A retrospective case-control method was used to collect data of patients who hospitalized in intensive care unit（ICU）from January 2020 to April 2021,received mechanical ventilation > 48 h and were >18 years old．According to the diagnostic criteria,20 patients with VAP infection were enrolled as the case group．During the same period,20 non-infected patients who matched sex,age with case group patients were enrolled as the control group,and the clinical indicators between the two groups were statistically analyzed．Results There were no significant differences between the two groups in terms of admission diagnosis,surgery and chronic obstructive pulmonary disease,APACHEII score and place of intubation before mechanical ventilation（P>0.05）．There were no significant differences in white blood cell,C-reactive protein and procalctionin,CRP and PCT during the mechanical ventilation period（P>0.05）．Compared with the control group,the length of stay in hospital,the length of stay in ICU,the time of mechanical ventilation,number of sputum suction nursing,and the days of antibiotic use increased significantly（all P<0.05）．Among them,Acinetobacter baumannii resistant to carbapenem in ICU（accounting for 70%）was the main cause of VAP infection．The environmental hygiene monitoring found that Acinetobacter baumannii was detected in the patient’s surrounding environment,the nurse station and the disinfected items after use,indicating that the low hand hygiene compliance of medical staff and the incomplete disinfection of the environment were also the causes of VAP infection in the hospital．The median of total cost of hospitalization in the case group was 145 207 yuan,while that in the control group was 60 745.48 yuan．The average economic loss caused by VAP infection was 84 461.52 yuan each case．The medical expenses of the case group were higher than those of the control group,with a statistically significant difference（P<0.05）．Conclusions Improper diagnosis and treatment during the mechanical ventilation period,poor environmental disinfection,low hand hygiene compliance of medical staff are probably the main reasons for the occurrence of VAP in this institution．

目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA_1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA_1c水平。

Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA_1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA_1c level in the third trimester．

目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组（P<0.05）;术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组（P>0.05）;但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组（P<0.05）;联合组的麻醉相关不良反应发生率略高于全麻组（P>0.05）;随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组（P<0.05）。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。

Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects．The patients were divided into groups by drawing lots．Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group．Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation．The changes of physical signs and the quality of recovery were compared between the two groups．Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group（P<0.05）．After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group（P>0.05）．However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group（P<0.05）．The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group（P>0.05）．During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group（P<0.05）. Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe．

目的 探讨耳内镜下超薄耳屏软骨-软骨膜修补鼓膜大穿孔的效果。方法 回顾性分析31例应用超薄耳屏软骨-软骨膜行耳内镜下夹层法鼓膜修补术的患者资料,随访6个月,分析术后鼓膜愈合率、听力恢复情况。结果 30例鼓膜愈合,成功率96.8％,无移植物外移、内陷、钝角愈合;术前平均气导听阈为（38.3±3.3）dB HL,骨气导差为（23.5±3.1）dB HL,术后平均气导听阈为（22.3±1.6）dB HL,骨气导差为（6.3±2.5）dB HL,听力较术前提高（P<0.001）。结论 超薄耳屏软骨-软骨膜在耳内镜下鼓膜大穿孔修补术中效果较好,并发症少,是可靠的修复材料,值得临床推广应用。

Objective To investigate the clinical efficacy of endoscopic ultrathin tragus cartilage-perichondrium as graft material for treatment of large tympanic membrane perforations. Methods A total of 31 cases（31 ears）which were diagnosed as chronic suppurative otitis with large tympanic membrane perforation were performed endoscopic myringoplasty with ultrathin tragus cartilage-perichondrium by sandwich technique．The pure tone threshold average（PTA）of speech frequency and the air-bone gap were assessed at 6 month safter surgery. Results Successful closure without reperforation was obtained in 30 of 31 patients（96.8%）．There was no graft lateralization,anterior blunting ．Average postoperative air conduction and bone-air conduction gap were（22.3±1.6）dB HL and（6.3±2.5）dBHL compared with（38.3±3.3）dB HL and（23.5±3.1）dB HL preoperatively（P<0.001）. Conclusions The ultrathin tragus cartilage-perichondrium is liable repair material for large tympanic membrane perforation with excellent graft take and significant improvement of hearing,which is worthy of clinical promotion．