目的 总结儿童嗜酸细胞性胃肠炎（EG）的临床表现、内镜检查和病理学特点、治疗和预后。方法 回顾性分析2019年1月—2022年12月滨州医学院附属医院儿科确诊的48例EG患儿临床资料,包括临床症状、实验室检查、影像学检查、内镜和病理学检查、治疗和随访情况。结果 48例患儿中,男26例（54.17%）,女22例（45.83%）,中位年龄7.8岁,20例（41.67%）患儿有过敏史或家族史,临床症状主要有腹痛（34例,70.83%）、腹泻（18例,37.5%）和腹胀（12例,25%）。外周血嗜酸性粒细胞（EOS）升高36例（75%）,血清总IgE升高14例（29.17%）。48例行胃镜检查,最常见的表现是黏膜充血水肿（32例,66.67%）、点状红斑（28例,58.33%）和糜烂（22例,45.83%）,28例行结肠镜检查,表现为黏膜充血水肿（18例,64.29%）、点状红斑（15例,53.57%）和结节样隆起（12例,42.86%）。黏膜组织病理表现为大量EOS浸润,主要累及十二指肠降部、胃窦和回肠末端。所有患儿均采用饮食干预的治疗,6例（12.5%）单纯饮食干预治疗后好转,16例（33.33%）孟鲁司特钠、酮替芬、奥美拉唑治疗后好转,26例（54.17%）联合泼尼松治疗后好转,随访10个月~3年,8例（16.67%）停药后复发,再次治疗后好转。结论 儿童EG临床症状和内镜表现多样化、缺乏特异性,内镜下黏膜组织病理检查有助于确诊。大多数患儿外周血EOS升高,饮食干预和糖皮质激素治疗效果显著,但存在复发的可能,需长期维持治疗和随访。

Objective To summarize the clinical manifestations,endoscopic and pathological features,treatment and prognosis of eosinophilic gastroenteritis（EG）in children．Methods A retrospective analysis was carried out on clinical data of 48 patients with EG diagnosed at the Department of Pediatrics of Binzhou Medical University Hospital from January 2019 to December 2022,including clinical symptoms,laboratory examination,imaging examination,endoscopic and pathological examination,treatment and follow-up．Results A total of 48 patients were included in the analysis,including 26 males（54.17%）and 22 females（45.83%）,with the median age of 7.8 years（7 months to 13 years）．Twenty patients（41.67%）had a history or family history of allergy．The most clinical symptoms were abdominal pain（34 cases,70.83%）,diarrhea（18 cases,37.5%）and abdominal distension（12 cases,25%）．Peripheral blood eosinophils（EOS）increased in 36 cases（75%）,and the serum total IgE increased in 14 cases（29.17%）．48 cases underwent gastroscopy,the most common manifestations were mucosal hyperemia and edema（32 cases,66.67%）,punctate erythema（28 cases,58.33%）and erosion（22 cases,45.83%）．Twenty-eight cases underwent colonoscopy,the manifestations were mucosal hyperemia and edema（18 cases,64.29%）,spotted erythema（15 cases,53.57%）and nodular eminence（12 cases,42.86%）．Mucosal histopathology showed a large number of EOS infiltration,mainly involving the descending duodenum,gastric antrum and terminal ileum．All children were treated with dietary intervention,6 cases（12.5%）were improved after simple diet intervention,16 cases（33.33%）were improved after treatment with montelukast,ketotifen,omeprazole,26 cases（54.17%）were improved after combined treatment with prednisone acetate．Followed up for 10 months to 3 years,8 cases（16.67%）relapsed after drug withdrawal and improved after retreatment．Conclusions The clinical symptoms and endoscopic manifestations of EG in children are diverse and lack of specificity,endoscopic mucosal histopathological examination is helpful for diagnosis．The EOS in peripheral blood of most children increased,diet intervention and glucocorticoid therapy are effective,but there is a possibility of recurrence,which need long-term maintenance treatment and follow-up．

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 探讨住院儿童甲型流感病毒肺炎合并其他病原菌感染的临床特征。方法 通过回顾性研究方法,分析2021年6月—2023年6月广州市妇女儿童医疗中心住院治疗的153例甲型流感病毒肺炎患儿的临床资料,针对有无合并其他病原菌感染,分为混合感染组及非混合感染组两组,分别为98例及55例,分析并对比两组的临床特征。结果 甲型流感病毒肺炎患儿以发热、咳嗽、呕吐/腹泻等症状为主,其中混合感染组患儿呕吐/腹泻症状占比高于非混合感染组（P<0.05）;两组患儿其他症状及并发症对比差异无统计学意义（P>0.05）;儿童甲型流感病毒肺炎患儿检出合并细菌感染的患儿65例（29.41%）,合并肺炎支原体感染的患儿33例（21.57%）;合并病毒感染的患儿20例（13.07%）。与非混合感染组比较,混合感染组患儿乳酸脱氢酶水平更高,白细胞计数<4×10⁹/L的人数占比更少（P<0.05）;其他实验室指标对比差异无统计学意义（P>0.05）;经过抗病毒及对症治疗后,150例（98.04%）患儿痊愈出院,3例出现严重并发症,其均伴有其他病原菌感染。与非混合感染组比较,混合感染组患儿住院天数更长、住院费用更高（P<0.05）;其他预后指标对比差异无统计学意义（P>0.05）。结论 甲型流感病毒肺炎患儿易感染其他的病原菌,导致疾病治疗难度加大,因此临床要提高警惕,以防混合感染情况发生,尽早采取有效的诊治措施,提高疾病早期治愈率。

Objective To explore the clinical characteristics of hospitalized children with influenza A virus pneumonia complicated with other pathogens．Methods The clinical data of 153 children with influenza A virus pneumonia hospitalized in Guangzhou Women and Children Medical Center in the past two years（June 2021 ~ June 2023）were analyzed retrospectively． According to whether they were infected with other pathogens,they were divided into mixed infection group and non-mixed infection group,with 98 cases and 55 cases respectively．The clinical characteristics of the two groups were analyzed and compared．Results Fever,cough,vomiting and diarrhea were the main symptoms in children with influenza A virus pneumonia,and the proportion of vomiting and diarrhea in children with mixed infection group was higher than that in children without mixed infection group（P<0.05）．There was no significant difference in other symptoms and complications between the two groups（P>0.05）．There were 65 children（29.41%）with influenza A virus pneumonia and 33 children（21.57%）with mycoplasma pneumonia,20 children（13.07%）with virus infection．Compared with non-mixed infection group,the level of lactate dehydrogenase in children with mixed infection group was higher,and the proportion of children with white blood cell count<4×10⁹/L was less（P<0.05）．There was no significant difference in other laboratory indexes（P>0.05）．After antiviral and symptomatic treatment,150 cases（98.04%）were cured and discharged,and 3 cases had serious complications,all of which were accompanied by other pathogens．Compared with non-mixed infection group,children in mixed infection group had longer hospitalization days and higher hospitalization expenses（P<0.05）．There was no significant difference in other prognostic indicators（P>0.05）．Conclusions Children with influenza A virus pneumonia are easily infected with other pathogens,which makes it more difficult to treat the disease．Therefore,we should be vigilant in clinic to prevent mixed infection and take effective diagnosis and treatment measures as soon as possible to improve the early cure rate of the disease．

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．

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．