目的 观察腹横肌平面阻滞复合七氟醚诱导喉罩全身麻醉在高危产妇剖宫产手术中的应用效果。方法 在2016年12月-2017年12月间,选取我院收治的80例高危产妇作为观察对象,均择期行剖宫产手术,依照随机数字表法分为观察组、对照组,每组产妇各40例。剖宫产手术的麻醉方式为,观察组采取双侧腹横肌平面阻滞后,七氟醚吸入诱导插入喉罩,对照组采取腰硬联合麻醉。观察比较两组的生命体征、手术持续时间、麻醉并发症发生率、新生儿Apgar 评分。结果 ①观察组T1~T3时段的平均动脉压、心率均低于对照组,（P<0.05）,有统计学意义。②观察组手术持续时间、麻醉并发症发生率、新生儿Apgar 评分与对照组比较,无差异,（P>0.05）。结论 腹横肌平面阻滞复合七氟醚诱导喉罩全身麻醉在高危产妇剖宫产手术中的应用效果较好,对产妇和胎儿影响小,麻醉平稳、苏醒快,麻醉风险低,值得应用。

目的 探讨p27^Kip1蛋白的表达与梅州地区客家人食管鳞癌的关系。方法 收集我院病理科2003年1月—2008年12月的61例经手术切除的中国梅州地区客家人食管鳞癌组织及32例食管良性肿瘤组织为研究对象并包埋成蜡块。采用免疫组织化学技术检测组织中p27^Kip1蛋白的表达,结合患者的临床病理资料和随访资料,进行回顾性分析,并作出评价。结果 P27^Kip1蛋白在食管鳞癌细胞核和/或细胞浆都有表达。胞核表达阳性率为27.87%,低于食管良性肿瘤组织胞核表达（50.0%）（P<0.05）;而胞浆表达阳性率为49.18%,高于食管良性肿瘤组织胞浆表达（12.5%）（P<0.05）。无淋巴结转移的食管鳞癌p27^Kip1蛋白胞核表达阳性率为42.41%,高于有淋巴结转移者的阳性率（10.7%）,差异有统计学意义（P<0.05）;而无淋巴结转移的食管鳞癌p27^Kip1蛋白胞浆表达阳性率为42.4%,比有淋巴结转移者（57.12%）的阳性率有降低的趋势（P>0.05）。Ⅱ期（ⅡA+ⅡB）和Ⅲ期p27Kip1蛋白胞核表达阳性率分别为42.41%和10.71%,差异有统计学意义（P<0.05）;p27^Kip1蛋白胞浆表达阳性率有随着TNM分期的增高而增高的趋势（P>0.05）。结论 P27^Kip1蛋白作为肿瘤抑制因子,其在食管鳞癌的胞核和胞浆表达阳性呈相反趋势,随食管鳞癌TNM分期越高,胞核阳性率越低,胞浆阳性率越高,其可作为食管肿瘤恶性程度及进展的预测指标。

目的 分析无创产前基因检测(NIPT)在胎儿染色体非整倍体疾病诊断中的检出效率及临床应用价值。方法 选取2016年4月—2018年3月在我院接受无创产前基因检测的3 759例孕妇作为研究对象,利用二代测序AR550平台结合生物信息学进行无创产前基因检测,NIPT 的检测范围包括21、18、13 及性染色体非整倍体。对 NIPT 高风险的孕妇,建议行羊水或脐血穿刺染色体核型分析,比较两者结果的一致性,并随访妊娠结局。结果 3759例孕妇中NIPT提示高风险27例,阳性率为0.71%。其中24例孕妇行染色体核型分析,确诊为 21-三体14例、18-三体1例、13-三体1例和性染色体数目异常4例,阳性预测值分别为100%、50%、100%和66.7%。其中NT增厚中无创孕妇99例,检出高风险为5例,检出率为5.05%（5/99）,明显高于总体检出率。结论 NIPT 对 21-三体和 18-三体具有较高的敏感性和特异性,能提高产前筛查和诊断效率,具有较好的临床应用价值.

Objective To analyze the efficiency and clinical value of noninvasive prenatal gene test (NIPT) in the diagnosis of fetal chromosomal aneuploidy. Methods From April 2016 to March 2018, 3 759 pregnant women who underwent noninvasive prenatal gene testing in our hospital were selected as subjects. The second generation sequencing AR550 platform combined with bioinformatics was used for noninvasive prenatal gene testing. The NIPT detection ranged from 21, 18, 13 to sex chromosome aneuploidy. For pregnant women at high risk of NIPT, amniotic fluid or umbilical cord blood puncture karyotype analysis was recommended to compare the consistency of the two results, and follow-up pregnancy outcomes. Results Among 3 759 pregnant women, NIPT showed 27 cases of high risk, with a positive rate of 0.71%. Twenty-four pregnant women were diagnosed as 21-trisomy in 14 cases, 18-trisomy in 1 case, 13-trisomy in 1 case and abnormal sex chromosome number in 4 cases. The positive predictive values were 100%, 50%, 100% and 66.7% respectively. Among them, 99 cases were non-invasive pregnant women with NT thickening, and 5 cases were at high risk of detection. The detection rate was 5.05% (5/99), which was higher than the overall detection rate. Conclusion NIPT has high sensitivity and specificity to 21-trisomy and 18-trisomy, can improve the efficiency of prenatal screening and diagnosis, and has good clinical application value.

目的 研究新辅助化疗联合保肢手术治疗骨肉瘤的临床效果。方法 根据既往治疗骨肉瘤方法的不同,将56例患者分为对传统保肢组（A组）和现代保肢组（B组）,各28例。A组用采用传统保肢方案,即保肢手术+术后化疗方案进行;B组采用现代保肢方案,即新辅助化疗+保肢手术+术后化疗方案进行。化疗方案均采用CTX + VCR +MTX+ ADM方案,比较两组转移/复发率、术后1 年、2年及 3 年生存率、肢体功能、临床疗效情况。结果 比较两组的转移/复发率及3年后的死亡率,B组低于A组(P<0.05);肢体功能优良率及临床疗效,B组高于A组(P<0.05)。结论 新辅助化疗联合保肢手术能够降低骨肉瘤患者转移/复发率、死亡率,改善肢体功能,提高临床疗效。

Objective To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma. Methods Based on the previous methods of treating osteosarcoma, 56 patients were divided into the traditional limb salvage group (A group) and the modern limb salvage group (B group), 28 cases for each. The traditional limb salvage surgery + postoperative chemotherapy regimen were used in group A, and modern limb salvage regimen was performed in group B, ie neoadjuvant chemotherapy + limb salvage surgery + postoperative chemotherapy. The CTX + VCR +MTX+ ADM protocol was used in the chemotherapy regimens. The metastasis/recurrence rate, the 1-year, 2-year and 3-year survival rates, limb function, and clinical efficacy were compared between the two groups. Results The metastasis/recurrence rate and the mortality rate after 3 years in the two groups were compared. The B group was lower than that of the group A (P<0.05). The excellent rate of limb function and clinical efficacy were higher in the B group than that of in the group A (P<0.05). Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery may reduce the metastasis/recurrence rate and mortality of osteosarcoma patients, improve limb function and increase clinical efficacy.

目的 分析针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的临床效果。方法 选择我院收治的乳腺肿物患者200例进行观察（2012年1月—2017年12月）,针对200例乳腺肿物患者存在的305个乳腺不可触及肿物进行活检检查,采用随机分组的方式将其分成两组后针对常规组100例乳腺肿物患者实施传统手术治疗,针对治疗组100例乳腺肿物患者实施超声引导下微创旋切活检术治疗,对比两组的治疗效果。结果 两组乳腺肿物患者之间对比的术中出血量、术后愈合时间、术后并发症发生率、治疗显效率存在差异（P<0.05）,统计学有意义;且超声引导下微创旋切活检术对于乳腺癌的诊断检出率较高。结论 针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的疗效显著,促进患者预后。

Objective To analysis of the clinical effect of ultrasound guided minimally invasive rotary biopsy for untouchable breast masses. Methods A total of 200 patients with breast masses were selected for observation （January 2012 to December 2017）, and 305 untouchable breast masses in 200 patients were examined by biopsy. It was divided into two groups randomly and then treated with traditional surgical treatment for 100 patients with breast masses in the routine group and 100 patients with breast masses in the treatment group with minimally invasive biopsy under the guidance of ultrasound. The therapeutic effects of the two groups were compared. Results There were differences between the two groups in the amount of intraoperative bleeding, postoperative healing time, the incidence of postoperative complications and the effective rate of treatment （P < 0.05）, and the differences were statistically significant （P < 0.05）. The diagnostic rate of breast cancer was higher with minimally invasive rotary biopsy guided by ultrasound. Conclusion The effect of ultrasound-guided minimally invasive rotary biopsy on untouchable breast masses is significant and promotes the prognosis of the patients.

目的 分析15例腹腔妊娠患者的临床病例特点,为临床工作提供参考依据,进一步减少漏诊及误诊的情况。方法 收集我院2002年1月—2018年6月期间住院治疗的腹腔妊娠患者的临床病例资料。回顾性分析并总结患者的临床诊治特点。通过t检验,进一步比较腹腔镜与腹式手术患者围手术期情况是否存在统计学差异。结果 1例B超检查提示大网膜妊娠可能;另1例入院前外院B超提示腹腔妊娠,孕8⁺周单活胎;其余13例患者术前B超提示宫内未见孕囊,子宫旁有包块,提示异位妊娠可能,术前未能明确腹腔妊娠。14例患者行手术治疗,另1例行介入穿刺保守治疗。术中探查发现腹腔妊娠病灶种植部位：位于大网膜5例,位于盆腔9例（膀胱区右下方盆壁1例,子宫直肠窝右侧直肠表面1例,右侧宫骶韧带2例,子宫下段前壁瘢痕处右缘1例,偏左侧肠管与子宫粘连之间1例、右侧盆壁1例、子宫直肠窝1例、子宫左侧圆韧带起始端1例）,位于腹腔1例（腰3椎体前方、腹主动脉与下腔静脉之间）。结论 腹腔妊娠的异位妊娠病灶种植部位非常广泛,超声检查需进一步扩大检查范围。必要时可选择MRI或CT检查准确定位,减少漏诊及误诊的情况。

Objective To analysis and summary clinical characteristics of 15 patients who were diagnosed with abdominal pregnancy,which supply reference for clinical work. Methods 15 cases who were diagnosed with abdominal pregnancy and admitted to Guangdong Women and Children hospital between January 2002 and June 2018 were identified. Retrospective analysis was used to summarize the clinical characteristics of diagnosis and treatment in 15 patients. Test statistics used Student's t test to find if there was statistical difference between laparoscopic and abdominal surgery patients in perioperative period. Results One case was likely diagnosed with greater omentum pregnancy by type B ultrasound. Another one patient was diagnosed with abdominal pregnancy which has 8+ weeks pregnant single live fetus by type B ultrasound in other hospital prior to hospitalization.The B ultrasound tests of the other 13 patients showed there were no sac in uterus and enclosed mass beside uterus which were diagnosed with ectopic pregnancy, but not positive diagnosis with abdominal pregnancy.Surgery was performed for 14 patients.We found more different sites where gestational sacs plant in abdominal pregnancy patients in operation, 5 cases sacs planted in greater omentum, 9 cases sacs planted in pelvic cavity including 1 case sac planted in pelvic wall bottom-right bladder,1 case sac planted in rectum outside right-hand of Douglas pouch,2 cases sacs planted in right utero-sacral ligament,1 case sac planted in right-side of scar in lower uterus segment,1 case sac planted in adhesive tissue between the lift intestinal canal and uterus,1 case sac planted in right pelvic cavity,1 case sac planted in Douglas pouch,1 case sac planted in initiating terminal of the lift round ligament of uterus. The inteventional puncture with medical treatment was supply for only 1 patient,CT test showed the sac planted in abdominal: ahead of third lumbar vertebra between abdominal aorta and inferior vena cava. Conclusion There are more sites where gestational sacs can plant in abdominal pregnancy patients. Ultrasound is first choice for patient who was considered ectopic pregnancy and better to expansion the inspection range. MRI or CT may find sacs plant site who was considered abdominal pregnancy which may reduce missed diagnosis and misdiagnosis. Surgery is first performed who was diagnosed with abdominal pregnancy. Medical treatment for patients who vital signs are stable.

目的 探讨临床全程导师制结合OSCE考试法对实习护生评判性思维的影响。方法 将176名在我院实习的本科实习护生随机分为两组,每组88人。对照组采用传统的临床带教和考核方式进行带教,实验组采用临床全程导师制结合OSCE考试法进行带教。记录两组理论考试成绩、实践技能成绩及护理病历成绩,比较两组实习护生教学前后评判性思维能力,比较两组实习护生干预后对临床带教模式的整体评价。结果 实验组理论考试成绩、实践技能成绩、护理病历成绩得分均高于对照组（P<0.05）。开展教学后两组评判性思维能力量表（CTDI-CV）各维度评分及总分均升高,实验组各维度评分及总分均高于对照组（P<0.05）。开展教学后实验组对临床带教模式的整体评价均高于对照组（P<0.05）。结论 临床全程导师制结合OSCE考试法,有助于提高本科实习护生的评判性思维能力。

Objective To explore the application and influence of the whole course mentor system combined with OSCE on the critical thinking ability of undergraduate clinical student nurses. Methods 176 undergraduate clinical student nurses were divided to control group and experimental group,88 for a group respectively. Control group used traditional clinical teaching method while the experimental group used whole course mentor system combined with OSCE. The theory and practice assessment scores ,medical record writing scores and critical thinking scores of clinical student nurses before and after the implementation of the two teaching modes were compared. Results The theory and practice assessment scores and medical record writing scores of the students in the experimental group were better than those of students in the control group（P<0.05）. The score of CTDI-CV was increased in both two groups after intervention. The score of all dimensions in CTDI-CV was better improved in the experimental group than that of controls （P<0.05）. And the evaluation of teaching mode of the experimental group was better than the control group（P<0.05）. Conclusion The teaching method of the whole course mentor system combined with OSCE is helpful to improve undergraduate clinical student nurses'ability of critical thinking.

目的 探讨运用巴林特沟通模式对老年住院患者满意度的影响。方法 选取我院2016年1月—2016年12月老年科收治的120名患者作为对照组,实施常规护理;另选取2017年1月—2017年12月间老年科接收的120名患者作为观察组,在对照组的护理基础上运用巴林特沟通模式,对比两组患者满意度评价。结果 运用巴林特培训后临床护士的沟通能力（包括困难情景沟通能力、情感感知能力、情感支持能力、基本语言沟通能力、基本非语言沟通能力、团队沟通能力）得分较培训前有提高,且观察组患者对护理人员的工作态度、疑问解答、业务指导以及沟通反馈等方面的满意度评价均优于对照组,差异有统计学意义（P<0.05）。结论 运用巴林特沟通模式不仅能够显著提升老年患者对住院医疗服务的满意度评价,同时能够提高护士的沟通能力,为提升医院医疗服务水平和良好的社会形象奠定有利基础,值得推广。

Objective To study Communication mode of Balint group in elderly inpatient's satisfaction. Methods 120 patients undergoing the conventional nursing care from January 2016 to December 2016 in our geriatric department were selected as control group;120 patients undergoing the conventional nursing care plus Balint communication mode from January 2017 to December 2017 were selected as observation group. The clinical satisfaction was evaluated. Results After the Balint training,the communication abilities including communication ability at the difficult scenes,emotional perception ability,emotional support ability,basic verbal communication ability,basic non-verbal communication ability,team communication ability were higher than before;the clinical satisfaction on the nurse's working attitude,frequently asked question,professional guidance,and communication and feedbacks in the observation group was higher than that of control group （P<0.05）. Conclusion The Balint communication mode may remarkably improve the patient's satisfaction on the nursing services and the nurse's communication abilities. It is of great importance to increase the hospital's medical service and establish a good social image. It is worthy of promotion.

早期干预是预防和减少早产儿神经系统损伤的有效措施,可以促进早产儿的正常发育并减轻神经系统伤残的发生,对提高儿童综合素质和家庭幸福都至关重要。在早产儿早期干预过程中存在与医学伦理原则不相适应的方面,如医疗设施不足、医疗措施不当、专业人员不足,早产儿干预预后的不确定性,治疗时机与家长经济及遵医行为之间的冲突,家长知情选择和知情同意不足等,本文结合医学伦理学的观点对0~3岁早产儿在早期干预中存在的问题进行分析并提出相应的建议。

Early intervention is an effective measure to prevent and reduce the nervous system injury in preterm infants,It can promote the normal development of preterm infants and reduce the occurrence of the nervous system disability.It is vital to improve the comprehensive quality of children and family quality of life. In the stage of premature infant intervention,there are some aspects that are incompatible with the medical ethics principle,i.e. inadequate medical facilities,improper medical measures,lack of professionals,premature infants intervention prognosis uncertainty,the conflict between the timing of treatment and the parents' economic and compliance behaviors,parents' informed choice and informed consent. etc. This paper analyzes the problems in early intervention of 0~3 year old preterm infants and puts forward corresponding suggestions according to the viewpoint of medical ethics.

目的 观察家庭式康复教育结合模式对脑瘫儿童发育情况的影响。方法 采用随机数字表法将38例脑瘫患儿分为实验组及对照组。2组患儿均给予常规日常康复,康复治疗师、引导式教师、特殊教育教师组成的团队共同对实验组内儿童功能情况进行评估,设计引导式教育课程,对无康复教育知识背景的专职护理人员进行课程培训,完成培训的护理员具体执行引导式教育课程,每天2次,每次60min,每周介入6日,持续半年。于治疗前、治疗后采用Gesell发展量表进行评测。结果 治疗前,两组患儿适应性行为、大运动、精细动作、语言、个人-社会行为5个领域指标组间差异无统计学意义（P>0.05）;经介入半年后,两组患儿的适应性行为、大运动、精细动作、语言、个人-社会行为5个领域评分均优于组内治疗前水平（P <0.05）,且实验组优于对照组（P <0.05）。结论 家庭式康复教育结合模式,对改善脑瘫患儿的多方面功能发展有重要意义,值得在专业人才资源缺乏的机构和社会中推广、应用。

Objective To observe the effect of the model of family rehabilitation education on the development of children with cerebral palsy. Methods 38 children with cerebral palsy were divided into experimental group and control group by random digital table method. Two groups of children were given routine daily rehabilitation. A team of rehabilitation therapists,guided teachers and special education teachers assessed the children's function in the experimental group,and designed guiding education course. The team offered curriculum training for full-time nurses without background knowledge of rehabilitation education,and the trained nurses implemented the guiding education course twice each day,60 minutes each time,6 days per week. The training lasted for six months. The Gesell development scale was used for evaluation before and after treatment. Results Before treatment,there was no statistically difference between 2 groups of children in 5 areas of adaptive behavior,exercise,fine motor,language and personal social behavior （P >0.05）. After six months' intervention,2 groups of children were better than the pre-treatment level （P <0.05）. The experimental group was superior to the control group （P <0.05）. Conclusion The model of family rehabilitation education is of great significance to the improvement of the multifaceted function of children with cerebral palsy. It is worthy of popularization and application in institutions and societies which are lack of professional talent resources.