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 观察父亲参与的早期母婴皮肤接触(SSC)对顺产初产妇的新生儿应激反应及生命体征的影响,为进一步优化“新生儿早期基本保健(EENC)”技术的临床实施建议提供实验依据。方法 使用随机数字表选取2017年2月—2021年5月期间,在深圳市福田区妇幼保健院产科分娩的1 986例顺产初产妇及新生儿作为研究对象。其中638例新生儿(共同参与组)实施了父亲参与的早期SSC,467例新生儿(SSC组)实施了早期母婴SSC,881例新生儿(对照组)实施了常规新生儿处理。观察3组新生儿的唾液皮质醇水平、体温和低温发生率、心率以及啼哭时间的差异,探讨父亲参与的早期母婴SSC在临床实施的可行性。结果 ① 3组新生儿出生30 min、60 min、90 min、180 min时,任意2组唾液皮质醇水平比较,差异均有统计学意义(均P<0.01);出生120 min时,共同参与组与对照组、SSC组与对照组比较,差异均有统计学意义(均P<0.01)。② 3组新生儿出生30 min、60 min时,共同参与组与对照组,SSC组与对照组的体温、低温发生率比较,差异均有统计学意义(均P<0.01);出生90 min时,任意2组体温比较,差异均有统计学意义(均P<0.01),共同参与组与对照组,SSC组与对照组的低温发生率比较,差异均有统计学意义(均P<0.01);出生120 min、180 min时,任意2组的体温与低温发生率比较,差异均有统计学意义(均P<0.01)。③ 3组新生儿出生30 min、60 min、90 min时,共同参与组与对照组,SSC组与对照组的心率比较,差异均有统计学意义(均P<0.01)。出生120 min、180 min时,任意2组比较,差异均有统计学意义(均P<0.01)。④ 3组新生儿出生0～30 min、30～60 min、60～90 min时间段,共同参与组与对照组,SSC组与对照组的啼哭时间比较,差异均有统计学意义(均P<0.01)。出生90～120 min、120～180 min时间段:任意2组的啼哭时间比较,差异均有统计学意义(均P<0.01)。结论 早期母婴SSC和父亲参与的早期母婴SSC均能降低顺产初产妇的新生儿唾液皮质醇水平,维持恒定的体温和心率,减少低温发生率和啼哭时间。相比较而言,父亲参与的早期母婴SSC是一种更科学、更有利于降低新生儿应激反应及维护其生命体征的护理模式。

Objective To observe the effect of father's participation in early maternal skin to skin contact (SSC) on primiparas' neonatal stress response and vital signs, so as to provide experimental basis for further optimizing the clinical implementation of “early essential newborn care (EENC)” technology. Methods The random number table was used to select 1 986 primiparas with their newborns who gave birth in Shenzhen Futian District Maternity and Child Healthcare Hospital from February 2017 to may 2021. Among them, 638 newborns (co-participation group) implemented early SSC with father participation, 467 newborns (SSC group) implemented early maternal and infant SSC, 881 newborns (control group) were treated with routine neonatal treatment. To observe the differences of salivary cortisol level, mean body temperature, incidence of hypothermia, heart rate and crying time among the newborns of three groups and to explore the feasibility of early mother and infant SSC with father participation in clinical implementation. Results ①There were significant differences in newborn salivary cortisol levels between any two groups at 30 min, 60 min, 90 min and 180 min after birth (all P<0.01). At 120 min after birth, there were significant differences between the co-participation group and the control group, SSC group and the control group (all P<0.01). ②At 30 min and 60 min after birth, there were significant differences in body temperature and the incidence of hypothermia between the co-participation group and the control group, SSC group and the control group (all P<0.01). At 90 min after birth, there were significant differences in body temperature between any two groups (all P<0.01). There were significant differences in the incidence of hypothermia between the co-participation group and the control group, SSC group and the control group (all P<0.01). There were significant differences in body temperature and the incidence of hypothermia between any two groups at 120 min and 180 min (all P<0.01). ③At 30 min, 60 min and 90 min after birth, there were significant differences in heart rate between the co-participation group and the control group, SSC group and the control group (all P<0.01). At 120 min and 180 min after birth, there were significant differences between any two groups (all P<0.01). ④There were significant differences in the crying time of newborns in the three groups at 0-30 min, 30-60 min and 60-90 min, between the co-participation group and the control group, and between the SSC group and control group (all P<0.01). There were significant differences in crying time between any two groups at 90-120 min and 120-180 min after birth (all P<0.01). Conclusions Early maternal and infant SSC and early maternal and infant SSC participated by father could reduce the salivary cortisol level of primipara newborn, maintain constant body temperature and heart rate,also reduce the incidence of hypothermia and crying time. In comparison, the early maternal and infant SSC with father participation was a more scientific and conducive nursing model to reduce neonatal stress response and maintain their vital signs.

目的 检索和分析新生儿医用粘胶相关性皮肤损伤(MARSI)预防及管理的相关证据,并对最佳证据进行总结,为临床提供参考,以预防住院新生儿MARSI的发生。方法 利用PIPOST公式,对新生儿MARSI的预防和管理构建循证问题并进行计算机检索。检索时限为建库至2020年3月31日。由2名已接受过系统循证培训的研究者对纳入的证据文献进行独立评价,从符合标准的文献中提取证据,并由临床审查小组对证据进行FAME论证,最终总结出最佳证据。结果 最终纳入文献2篇,包括一篇专家共识和一篇系统评价,汇总了17条证据,经过FAME论证后最终总结出11条最佳证据,包括患者评估、MARSI预防和MARSI处理三个方面。结论 新生儿MARSI的发生与诸多内外因素相关,临床主要以预防为主,建议医疗机构根据实际情况制定住院新生儿MARSI的预防和管理规范,加强医护人员培训,提升新生儿照护质量。

Objective To retrieve,appraise and summarize the best evidence of the prevention of medical adhesive related skin injury(MARSI) in neonates, and provide references for clinical practice. Methods We systematically searched for evidence on prevention of neonatal MARSI. The retrieval period was from the inception of databases to March 31,2020. Two researchers independently evaluated the quality of the literature and extracted evidence. Results Two literatures were included, including an expert consensus and a systematic review. Three categories (patient evaluation, MARSI prevention and MARSI management) and totally 11 items of best evidence were summarized. Conclusion The occurrence of neonatal MARSI is related to many internal and external factors, and prevention is the most important. Medical institutions should establish principles and practice guidelines of the management of neonatal MARSI, strengthen the training of medical staffs, and improve the quality of newborn care.

目的 通过皮肤点刺筛查慢性荨麻疹的变应原,为临床治疗提供依据。方法 采用“阿罗格”点刺液对2 974例临床确诊慢性荨麻疹患者行皮肤点刺试验进行29种变应原的检测,并设阳性(0.1%组胺)及阴性(生理盐水)对照,记录阳性反应的变应原和反应强度。结果 2 974名受试者中,呈阳性反应人数有1 052人,阳性率为35.37%;阳性反应结果中,受试者对蟑螂、粉尘螨、屋尘螨最为敏感,阳性率分别为78.80%、78.04%和73.76%;不同性别、月份、年龄组的阳性反应种数与反应强度无统计学上的差异:不同变应原的反应强度秩和检验(χ²=9 741.284,P<0.001)差异有统计学意义,受试者对蟑螂、粉尘螨、屋尘螨、杂草、虾和霉菌Ⅰ等的过敏强度较大。结论 皮肤点刺作为慢性荨麻疹筛查变应原的方法之一,能筛选出阳性反应强度最大的前几个变应原,临床能为患者进行行为干预规避过敏原或进一步脱敏治疗提供参考依据。

目的 研究孟鲁斯特治疗哮喘的临床疗效及其对患者Th1/Th2细胞免疫平衡和相关炎症因子水平的影响。方法 选取哮喘患者68例随机分为对照组31例及观察组37例,对照组予以常规糖皮质激素吸入治疗,观察组在此基础上加服孟鲁斯特。用药3个月后流式细胞仪检测两组患者外周血Th1、Th2数量变化,ELISA定量外周血IL-4及IFN-γ含量变化并作临床效果评定。结果 两组患者经治疗后,外周血Th1/Th2比例均升高,IL-4/IFN-γ细胞因子水平下降,但观察组较对照组变化更为明显,差异有统计学意义(P＜0.01)。疗效方面,观察组总有效率94.59%,高于对照组的74.19%,差异具有统计学意义(P＜0.01),同时两组均未见明显不良反应。结论 哮喘患者加用孟鲁斯特具有明显免疫调节功能,使Th1/Th2水平趋于平衡,作为哮喘辅助治疗药物疗效确切。

目的 探讨白癜风初诊患者外周血细胞因子水平与临床分型、皮损面积的相关性。方法 收集我院2009年7月—2013年7月4年间收治的初诊白癜风患者78例及健康志愿者37例,用ELISA检测外周血血清IL-6、IL-2, IFN-γ、TNF-α浓度并判断其与白癜风分型、皮损程度的相关性。结果 与对照组相比,白癜风各分型组的IL-6、IL-2水平均升高,其中,散在性的升高幅度最为明显。IL-6及IL-2与皮损面积呈正相关,其相关系数分别为0.664及0.483,P值分别为0.021及0.014。结论 IL-2及IL-6在白癜风的发病过程中起重要作用,且在不同的分型中的表达存在差异,并与皮损面积呈正相关。

Objective To evaluate the correlation of cytokine level of peripheral blood cells, clinical classification and skin lesion in preliminary diagnosis of vitiligo. Methods A total of 78 patients with vitiligo of preliminary diagnosis and 37 health volunteers were collected from July 2009 to July 2013. The peripheral blood were collected for ELISA measurement of IL-6, IL-2, IFN-γand TNF-α, and evaluated whether the cytokines concentration was correlated to clinical classification and skin lesion. Results Compared to control group, IL-6 and IL-2 in all of classification of vitiligo was higher, and the most increase was observed in scattered group. Both IL-6 and IL-2 showed the positive correlation with skin lesion (CI: 0.664 and 0.483, P=0.021 and 0.014). Conclusion IL-2 and IL-6 maybe play a key role in vitiligo etiology, and showed different level in different classification of vitiligo. Besides, they showed a positive correlation with skin lesion.

目的 探讨用捏脊联合中药外洗治疗脾胃气虚型儿童功能性消化不良的效果。方法 随机选取脾胃气虚型功能性消化不良的儿童120例,分为联合组、捏脊组、外洗组、对照组4个组,每组30例,分别采用捏脊、中药外洗、捏脊联合中药外洗、吗丁啉进行治疗,两周后观察4组治疗效果及唾液淀粉酶活性比值、D-木糖排泄率的变化,进行分析。结果 联合组的有效率优于捏脊组、外洗组、对照组,差异有统计学意义(P<0.05)。治疗后联合组的唾液淀粉酶活性比值比捏脊组、外洗组、对照组提高,差异有统计学意义(P<0.05)。治疗后D-木糖排泄率均较治疗前有增加,两两比较,联合组与对照组比较差异有统计学意义(P<0.05)。结论 捏脊联合中药外洗可改善脾胃气虚型儿童功能性消化不良,疗效良好,其机理同改善唾液淀粉酶活性有关。

       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%（χ ² =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（χ ² =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（χ ² =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（χ ² =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（χ ² =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（χ ² =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．