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医学教育

BOPPPS 模式下模块化教学结合模拟演练在创伤急救培训中的应用

Application of modular teaching combined with simulation exercise in trauma first aid training under BOPPPS model

:422-428
 
       目的   探讨BOPPPS[(导引(B),目标(O),课前测试(P),参与式学习(P),课后测试(P),总结(S)]模式下模块化教学结合模拟演练在创伤急救培训中的应用效果。方法   选取福建省泉州市正骨医院急诊科2022年8月—2024年2月90名护士,随机分为对照组和干预组,每组45名护士。对照组采用传统授课模式进行教学培训;干预组采用BOPPPS模式下模块化教学结合模拟演练进行教学培训。培训结束对两组学员的创伤急救综合理论及单项技能、创伤急救救护综合能力、培训效果满意度进行统计分析。结果   干预组的综合理论成绩为(80.74±6.87)分、单项技能成绩为(92.13±2.26)分,相较于对照组均提高(P<0.05)。干预组对创伤急救课程的总体满意度:非常同意23例、同意20例,比例均高于对照组(P<0.05)。干预组的创伤急救救护综合能力如病情评估预判能力,优秀26例、良好15例;护理计划分析实施能力,优秀25例、良好13例;团队协作与资源管理能力,优秀27例、良好15例;情景感知与应变能力,优秀30例、良好11例;综合救护能力,优秀36例、良好5例。显著优于对照组(P<0.05)。结论  BOPPPS模式下模块化教学结合模拟演练能够提高急诊科护士的综合创伤救护能力,且取得了较高的满意度,值得进一步推广应用。
       Objective  To explore the application effect of modular teaching combined with simulation exercise in trauma 
first aid training under BOPPPS model.Methods  A total of 90 nurses in the emergency department from August 2022 to February 2024 were randomly divided into control group(n=45) and intervention group(n=45).The control group was trained  by traditional teaching mode.The intervention group was trained by BOPPPS modular teaching combined with simulation exercise.After the training,the comprehensive theory of trauma first aid,individual skills,comprehensive ability of trauma first aid and satisfaction degree of training effect of the two groups of nurses were statistically analyzed.Results  The comprehensive theoretical scores and single skill scores of the intervention group were significantly improved compared with the control group(P<0.05).The satisfaction degree of trauma first aid training in the intervention group was significantly higher than that in the control group(P<0.05).The comprehensive ability of trauma first aid in the intervention group was significantly better than that in the control group(P<0.05).Conclusions  The combination of modular teaching and  simulation exercise in BOPPPS model can improve the comprehensive trauma rescue ability of nurses in emergencydepartment,and has obtained a high degree of satisfaction,which is worthy of further popularization and application.
医学教育

住院医师规范化培训师资教学能力提升效果评价

Evaluation on the improvement of resident standardization training teachers’ teaching ability

:416-421
 
       目的   对该培训基地师资2021—2023年教学能力进行评价,了解和分析“1+3+n”的院级督导推行前的2021年、“1+3+n”的院级督导推行后的 2022年、2023年师资的教学能力变化。方法   采用问卷调查法收集评价数据,采用SPSS.27.0对教学评价资料进行统计分析,采用净推荐值计算教学口碑,对多年度结果进行纵向比较分析。结果  2021—2023年教学评价次数共5 483次;2021—2023年对师资教学设计能力评价由实施前的8.8提高到9.6、教学实施能力由实施前的9.0提高到9.5、教学热情由实施前的9.0提高到10.0、时间投入由实施前的9.3提高到10.0,不同年份组间比较的差异均有统计学意义(P<0.001);课程净推荐值由实施前的60.5%提高到81.3%,师资课程推荐者占比由实施前的65.5%提高到83.2%,贬损者占比由实施前的5.0%降低到1.9%,差异有统计学意义(χ 2 =175.4,P<0.001)。结论   “1+3+n院级督导模式的相关举措,对师资教学能力的提高具有促进作用,且该促进作用持续存在,师资教学能力逐年递增。
    Objective  To evaluate the teaching ability change of teachers  from 2021 to 2023,including of teachers’ teaching ability in 2021 before the implementation of "1+3+n" college-level supervision,and in  2022  and  2023  after the implementation of "1+3+n" college-level supervision.Methods  Questionnaire survey was used to collect evaluation data,SPSS.27.0 was used to make statistical analysis of teaching evaluation data,and NPS(Net Promoter Score)was used to evaluate teaching quality.Results  From 2021 to 2023,there were 5483 teaching evaluations.From 2021 to 2023,teaching design ability evaluation score increased from 8.8 before the implementation to 9.6,teaching implementation ability evaluation score increased from 9.0 before the implementation to 9.5,teaching enthusiasm evaluation score increased from 9.0 before the implementation to 10.0,time investment evaluation score increased from 9.3 before the implementation to 10.0,and the differences between different years were statistically significant(P<0.001).The courses quality increased from 60.5% before the implementation to 81.3%,and the proportion of teachers' course recommenders has increased from 65.5% before the implementation to 83.2%,while the proportion of detractors has decreased from 5.0% before the implementation to 1.9%,with statistical significance(χ 2 =175.4,P<0.001).Conclusions  The measures of "1+3+n" college-level supervision mode promote the improvement of teachers’ teaching ability,the promotion effect persists,and the teaching ability increases year by year.
论著

剖宫产后再次分娩阴道试产失败的影响因素

The influencing factors of failed vaginal trial delivery after cesarean section

:410-415
 
       目的   探讨剖宫产后再次分娩阴道试产失败的影响因素。方法   选取2021年5月—2024年5月在枣庄市妇幼保健院分娩的138例有剖宫产手术史的足月妊娠产妇进行回顾性分析。所有产妇依照其阴道试产结果将成功阴道分娩的35例产妇分为成功组,将阴道试产失败中转剖宫产的103例产妇分为失败组。对比两组产妇的妊娠结局、孕期情况及围产期情况,最后采用多因素Logistic回归分析法分析剖宫产后再次分娩阴道试产失败的影响因素。结果   两组产妇子宫破裂、胎儿窘迫、产褥感染及产后出血等妊娠不良结局总发生率对比差异无统计学意义(11.43% vs 6.80%,χ 2 =0.760,P=0.382 >0.05);通过对比两组产妇孕期情况发现,失败组与成功组孕妇年龄、孕次、身高、孕前体质量、妊娠期合并症、分娩前体质量指数(BMI)比较差异无统计学意义(P>0.05),失败组与成功组孕妇孕期体质量增长[(4.56±2.56)kg vs(12.45±3.24)kg]、分娩孕周[(39.46±1.25)周 vs(37.95±1.37)周]、阴道分娩史(8.57% vs 26.21%)、妊娠间隔时间[(2.74±0.35)年 vs(3.37±0.57)年]及瘢痕厚度[(4.51±0.56)mm vs(5.42±0.38)mm],对比差异有统计学意义(t=3.497,P<0.001;t=5.755,P<0.001;χ 2 =4.780,P=0.029;t=6.148,P<0.001;t=10.764,P<0.001);通过对比两组产妇围产期情况发现,失败组与成功组新生儿性别、是否镇痛比例比较差异无统计学意义(P>0.05),失败组与成功组孕妇产前新生儿估重[(3352.31±153.67)g vs(3046.25±141.68)g]、是否引产[60.00% vs 52.43%]、胎膜早破[11.43% vs 35.92%]、入院时是否临产[857% vs 27.18%],对比差异有统计学意义(t=10.805,P<0.001;χ 2 =7.330,P=0.007;χ 2 =7.500,P=0.006;χ 2 =5.200,P=0.023);以阴道试产情况作为因变量(失败=1,成功=0)纳入Logistic回归模型,结果显示,分娩孕周过晚、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的影响因素P<0.05)。结论   分娩孕周过高、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的独立影响因素,需针对分娩孕周、产前新生儿估重过高的剖宫产后再次分娩阴道试产产妇给予高度关注并采取相应措施进行干预,同时自然临产能够降低阴道试产失败风险,但针对具有引产指征的产妇,依然需要及时引产。
       Objective   To explore the influencing factors of vaginal trial delivery failure after cesarean section.Methods   A retrospective analysis was conducted on 138 full-term pregnant women with a history of cesarean section who gave birth in our hospital from May 2021 to May 2024.All women were divided into two groups according to the  results of their vaginal trial delivery.Based on their vaginal trial results,35 parturients who successfully delivered were divided into the successful group,and 103 parturients who failed vaginal trial delivery and transitioned to cesarean section were divided into the failed group.The pregnancy outcomes of postpartum women and the pregnancy and perinatal conditions were compared between the two groups,and multivariate Logistic  regression analysis was used to analyze the independent influencing factors of vaginal trial delivery failure after cesarean section.Results   There was no significant difference in the total incidence of adverse pregnancy outcomes such as uterine rupture,fetal distress,postpartum infection,and postpartum hemorrhage between the two groups of parturients (P>0.05).By comparing the pregnancy status of two groups of  pregnant women,it was found that there was no difference (P>0.05).The average weight gain during pregnancy of failure and successful group,gestational age,cases with vaginal delivery history,intervalbetween pregnancy and scar thickness,the contrast difference was significant (all P<0.05) .By comparing the perinatal situation of the two groups,there was no difference in the sex of fetus and analgesia receiving of parturients between the failed group and the successful group (P>0.05),while there is difference in weight estimation,whether induced labour,premature  rupture of fetal membrane,whether admitted to hospital (all P<0.05).Vaginal trial delivery was set as the dependent variable (failure=1,success=0) and it was incorporated into the Logistic regression model.The results showed that high gestational age during delivery,high estimated weight of fetus before delivery,induction of labor,and non-labor upon admission were independent influencing factors for vaginal trial delivery failure after cesarean section (P<0.05).Conclusions  Excessive gestational age,high estimated weight of fetus before delivery,induced labor,and non-labor upon admission were independent influencing factors for the failure of vaginal trial delivery after cesarean section.It is necessary to pay high attention and take corresponding measures to intervene in women who have undergone vaginal trial delivery after cesarean section due to excessive gestational age and high estimated weight of fetus before delivery.At the same time,spontaneous labour can reduce the risk of vaginal trial delivery failure.However,for women with indications for induced labor,timely induction is still necessary.
论著

运动干预联合治疗性聆听对孤独症谱系障碍儿童社会交往功能的影响

The effect of exercise intervention combined with therapeutic listening on social communication function inchildren with autism spectrum disorder

:403-409
 
       目的   探讨运动干预联合治疗性聆听对孤独症谱系障碍儿童社会交往功能的影响。方法   选取黄河三门峡医院2020年1月—2023年10月收治的100例孤独症患儿,应用随机数字表法分为两组,各50例。对照组患儿实施常规护理,观察组在对照组基础上增加运动干预联合治疗性聆听。分别在干预前及干预6个月后采用孤独症治疗评价量表(ATEC)、儿童感觉统合发展评定量表、格塞尔发育量表(GDS)及中国韦氏儿童智力量表(WISC-R)评价两组患儿社会交往能力、感觉统合发展水平、神经发育水平及智力水平变化。结果   干预后两组患儿的ATEC各部分评分,包括健康/生理/行为、感知/认知能力、社交能力、语言表达/沟通能力及ATEC总分均降低,观察组低于对照组(P<0.05);干预后两组患儿学习能力发展、本体感觉、触觉防御、前庭功能及儿童感觉统合发展评定量表总分均升高,观察组高于对照组P<0.05);干预后两组患儿动作能、应物能、言语能、应人能相关神经发育情况评分均升高,观察组高于对照组(P<0.05);干预后两组患儿言语智商、操作智商、总智商相关WISC-R评分均升高,观察组高于对照组(P<0.05)。  运动干预联合治疗性聆听对孤独症谱系障碍儿童应用效果显著,可提升其社会交往能力,促进感觉统合发展,进而促进其神经发育及智力水平提升。
       Objective  To  explore the  effect  of  exercise intervention  combined with therapeutic listening  on  social communication function in children with autism spectrum disorder.Methods  A total of 100 autistic children who were admitted to our hospital from January 2020 to October 2023 were selected and divided into two groups by random number table method,with 50 children each.The control group received routine care,while the observation group  received exercise intervention combined with therapeutic listening in addition to routine care.The Autism Treatment Evaluation Scale (ATEC),Children’s Sensory Integration Development Scale,Gesell Development Scale,and Wechsler Intelligence Scale for Children-Revised by China (WISC-R)were used before and 6 months after the intervention to evaluate the social communication ability,sensory integration development level,neural development level,and intellectual level changes of the two groups of children.Results  After intervention,the score of every dimension in ATEC including the health/physiology/behavior,perception/cognitive ability,social ability,language expression/communication ability,and total ATEC score of the two groups of children decreased,and the observation group was lower than the control group (P<0.05).After intervention,the total scores of the learning ability development insufficient,proprioceptive dysfunction,excessive tactile defense,vestibular dysfunction,and children’s sensory integration development assessment scale in both groups of children increased,with the observation group being higher than the control group (P<0.05).After intervention,the neurological development scores related to motor,adapt,language,and social ability in both groups of children increased,and the observation group was higher than the control group (P<0.05).After intervention,the WISC-R scores related to verbal intelligence,operational intelligence,and total intelligence in both groups of children increased,and the observation group was higher than the control group (P<0.05).Conclusions  The combination of exercise intervention and therapeutic listening has asignificant effect on children with autism spectrum disorder,which can enhance their social communication ability,promote sensory integration development,and ultimately promote their neural development and intellectual level improvement.
论著

无管化微创 PCNL 治疗嵌顿性输尿管上段结石的效果

The effect of tubeless minimally invasive PCNL in the treatment of incarcerated upper ureteral calculi

:398-402
 
       目的   探讨无管化微创PCNL(经皮肾镜取石术)治疗嵌顿性输尿管上段结石的效果。方法   将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组,给予对照组47例患者经尿道输尿管镜碎石术(TURL)治疗、观察组48例患者无管化微创PCNL治疗,观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果   观察组手术时间、术后血尿以及住院时间均短于对照组,观察组术中出血量少于对照组,观察组结石清除率高于对照组(P<0.05);术后1 d观察组肾损伤分子-1(KIM-1)、中性粒细胞明胶相关脂脂质运载蛋白(NGAL)以及胱抑素C(Cys-C)水平低于对照组(P<0.05);两组肾动脉收缩期血流速度(Vs)以及舒张末期血流速度(Vd)对比差异无统计学意义(P>0.05);观察组并发症发生率(4.16%)低于对照组(19.15%)P<0.05)。结论   无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况,减轻患者肾脏损伤,提高结石清除率,不影响肾脏血流,且并发症更少。
       Objective  To explore the effect of tubeless minimally invasive(percutaneous nephrolithotomy,PCNL)in the treatment of impacted upper ureteral stones.Methods  A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method.Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy(TURL),48 patients in the observation group were given tubeless minimally invasive PCNL treatment.The general surgical conditions,serological indicators,renal hemodynamics and complications of the two groups were observed.Results  The operation time,postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume of the observation group was less than that of the control group,and the stone free rate of the observation group was higher than that of the control group(P<0.05).One day after surgery,the levels of kidney injury molecule-1(KIM-1),lipocalin(NGAL)and cystatin C(Cys-C)in the observation groupwere lower than those in the control group(P<0.05);the renal artery systolic blood flow velocity(Vs)and end-diastolic blood flow velocity(Vd)had no statistical significance(P>0.05);the incidence of complications in the observation group(4.16%)was lower than that in the control group(19.15%)(P<0.05).Conclusions  Tubeless minimally invasive PCNL can improve the general conditions of surgery,reduce kidney damage,increase stone free rate,does not affect renal blood flow,and has fewer complications.
论著

非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发危险因素分析

Risk factors for relapse after primary transurethral resection on non-muscular invasive bladder cancer

:393-397
 
       目的   探讨非肌层浸润性膀胱癌患者初次经尿道膀胱肿瘤电切术的复发情况及危险因素。方法   以93例非肌层浸润性膀胱癌患者进行研究,2018年1月至2022年1月西藏自治区人民政府驻成都办事处医院泌尿外科医院收治采取经尿道膀胱肿瘤电切术,术后随访24个月,复发22例,未复发71例,比较复发与未复发基础情况、不同肿瘤直径、不同肿瘤分期、分级、数量、是否带蒂、灌注化疗方式等特征患者的复发情况,对具有统计学意义的因素,采取非条件Logistic多因素回归分析,明确术后复发的危险因素。结果   肿瘤分期T1期者的复发率为32.08%,高于Ta期者15.50%,肿瘤分级为高级别者的复发率为53.33%,高于低级别者17.95%,肿瘤多发者的复发率为35.71%,高于单发者的13.73%,肿瘤不带蒂者的复发率为38.71%,高于肿瘤带蒂者的16.13%,常规灌注化疗患者的复发率为29.85%,高于术后即刻+灌注化疗患者的7.69%,比较差异均有统计学意义(χ 2 分别为6.648、4.836、6.872、6.166、5.834、5.902,P分别为0.010、0.027、0.008、0.013、0.015、0.024)。肿瘤分期T1期、肿瘤分级为高级别、肿瘤多发、常规灌注化疗为非肌层浸润性膀胱癌行初次经尿道膀胱肿瘤电切术的术后复发的危险因素(P<0.05)。结论   非肌层浸润性膀胱癌患者初次采取经尿道膀胱肿瘤电切术容易因为临床分期为T1期、肿瘤分级为高级别、肿瘤多发及常规灌注等出现复发,应采取针对性干预措施,改进灌注化疗方式,降低复发率。
       Objective  To investigate the  relapse and  risk factors of non-muscular invasive bladder cancer after primary transurethral resection.Methods  A total of 93 patients with non-muscular invasive bladder cancer were selected for study.They were received by the hospital from January 2018 to January 2022 and underwent transurethral resection.After 24 months of follow-up,22 patients recurred,and 71 patients did not recur.The recurrence of patients with different tumor diameter,tumor stage,grade,numbers,pedicel or not,and infusion chemotherapy methods were compared.For the statistically significant factors,unconditional logistic regression analysis was used to determine the independent risk factors for recurrence.Results  The recurrence rate in T1 stage of tumor was 32.08% higher than that in Ta stage,which was 15.50%.The recurrence rate in high stage was 53.33% higher than that in low stage,which was 17.95%.The recurrence rate in multiple tumor patients was 35.71% higher than that in single tumor patients,which was 13.73%.The no-pedicle tumor recurrence rate was 38.71% higher than that with pedicle,which was 16.13%.The recurrence rate in patients receiving conventional infusion chemotherapy was 29.85% higher than that in patients receiving immediate postoperative infusion chemotherapy,which was 7.69%.The differences were statistically significantχ 2 =6.648、4.836、6.872、6.166、5.834、5.902,P=0.010、0.027、0.008、0.013、0.015、0.024).The independent  risk factors of recurrence after primary transurethral resection were tumor stage T1,high grade tumors,multiple tumors,routine perfusion chemotherapy as non-muscular invasive bladder cancer(P<0.05).Conclusions  The  patients with  non-muscular invasive bladder cancer taking transurethral resection for the first time are prone to recurrence because of the clinical stage of T1,tumor grade of high grade,multiple tumors and routine perfusion.Targeted intervention measures  should be taken to improve the perfusion chemotherapy method to reduce the recurrence rate.
论著

ALBI 联合 NLR 预测肝硬化合并食管胃底静脉曲张破裂出血的作用

The role of ALBI combined with NLR in predicting liver cirrhosis complicated with esophageal and gastric varices bleeding

:387-392
 
       目的   探讨白蛋白-胆红素(ALBI)联合中性粒细胞与淋巴细胞比值(NLR)预测肝硬化合并食管胃底静脉曲张破裂出血(EGVB)的临床价值。方法   回顾性分析2021年1月—2022年12月肇庆市第一人民医院消化内科收治的80例肝硬化合并EGVB患者的临床资料,通过电话及门诊、再入院对其进行为期1年的随访,根据随访结果,将其分为2组,即存活组(n=69)与死亡组(n=11),分析导致患者死亡的危险因素,并评估ALBI联合NLR预测肝硬化合并EGVB患者死亡的临床价值。结果   死亡组的年龄60岁以上、腹水和肝性脑病者占比,总胆红素(TBiL)、NLR、凝血酶原时间(PT)、谷丙转氨酶(ALT)水平及ALBI评分均高于存活组(均P<0.05),而血红蛋白(HGB)、白蛋白(ALB)及血钠水平均低于存活组(均P<0.05);Logtisic回归分析显示,年龄60岁以上、腹水、肝性脑病和TBiL、NLR水平升高及ALBI分级为3级是肝硬化合并EGVB患者死亡的危险因素(均P<0.05);ALBI联合NLR预测肝硬化合并EGVB患者预后的准确率及灵敏度高于单一诊断,漏诊率低于单一诊断(P<0.05)。结论   肝硬化合并EGVB患者可见ALBI评分及NLR水平升高,而以上两种指标是患者死亡的危险因素,将其联合检测可评估患者预后,预测其死亡风险。
       Objective  To investigate the clinical value of albumin-bilirubin(ALBI)combined with neutrophil lymphocyte ratio(NLR)in predicting liver cirrhosis complicated with esophageal  and gastric varices bleeding(EGVB).Methods The clinical data of 80 patients with liver cirrhosis complicated with EGVB admitted to the Department of Gastroenterology of the First People’s Hospital of Zhaoqing from January 2021 to December 2022 were retrospectively analyzed.They were followed up for one year by telephone,outpatient service and readmission.According to the follow-up results,they were divided into the survival group(n=69)and the death group(n=11).The risk factors leading to the death of patients were analyzed and evaluated.Results  The proportion of age over 60,ascites and hepatic encephalopathy,the levels of TBiL,NLR,PT,ALT and ALBI in the death group were higher(P<0.05),while the levels of HGB,ALB and blood sodium were lower(P<0.05).Logistics analysis showed that age over 60,ascites,hepatic encephalopathy,NLR and ALBI grade 3 were independent risk factors for the death(P<0.05).The accuracy and sensitivity of ALBI combined with NLR in predicting their prognosis were significantly higher than that of single diagnosis,and the missed diagnosis rate was lower(P<0.05).Conclusions  ALBI scores and NLR levels significantly increase in patients with liver cirrhosis complicated with EGVB,and the above two indexes are risk factors for the death,and the combination of them can evaluate the prognosis of patients and predict the death risk.
论著

清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后

Effect of conscious sedation in the application of endovascular treatment and prognosis of acute ischemic stroke

:382-386
 
       目的   探讨清醒镇静应用在急性缺血性脑卒中血管内治疗中的效果。方法   选择2020年1月—2023年3月医院接收的急性缺血性脑卒中患者82例进行研究,按随机数表法分为2组,每组各41例,两组采取溶栓与取栓治疗,对照组采取全身麻醉方式,观察组采取清醒镇静方式,记录两组治疗相关参数,比较两组近期疗效、并发症发生情况及预后。结果   观察组入院到腹股沟穿刺时间(95.52±3.63)min、穿刺至血管再通时间(72.25±5.58)min低于对照组(112.25±4.18)min、(102.45±10.63)min(t=19.349,P<0.05);观察组ICU时间(7.81±2.63)d、住院时间(13.75±3.64)d,与对照组(8.05±2.81)d、(14.52±4.07)d比较差异无统计学意义(t分别为0.524、0.399、0.902,P分别为0.601、0.690、0.369)。观察组近期总有效39例(95.12%)与对照组37例(90.24%)比较差异无统计学意义χ 2 =0.719,P=0.396)。观察组症状性颅内出血3例(7.32%)与对照组6例(14.63%)比较差异无统计学意义(χ 2 =1.123,P=0.289);观察组脑水肿4例(9.76%)、坠积性肺炎12例(29.27%),低于对照组7例(17.07%)、18例(43.90%)(χ 2分别为4.969、6.962,P分别为0.025、0.008)。观察组预后良好21例(51.22%)高于对照组10例(24.39%)(χ 2 =6.275,P=0.012)。结论   急性缺血性脑卒中患者溶栓与取栓治疗中采取清醒镇静方式可获得与全身麻醉相近的疗效,而且可进一步缩短治疗时间,促进血管快速再通,减少相关并发症,使患者获得更好的预后。
       Objective  To investigate the conscious sedation effect of endovascular treatment in acute ischemic stroke.Methods  A total of 82 patients with acute ischemic stroke admitted to the hospital from January 2020 to March 2023 were selected and divided into two groups according to the random number table method,with 41 cases in each group.The two groups were treated with thrombolysis and thrombectomy,the control group was treated with general anesthesia,and the observation group was treated with conscious sedation.The short-term efficacy,complications and prognosis were compared between the two groups.Results  The time from admission to groin puncture [(95.52±3.63)min] and time from puncture to vascular  recanalization [(72.25±5.58)min] in the observation group were significantly lower than those in the control group [(112.25±4.18)min,(102.45±10.63)min](t=19.349,P<0.05).Observation group ICU time,length of hospital stay(7.81+2.63)d(13.75+3.64)d,and the control group(8.05+2.81)d,(14.52-4.07)d  had  no  statistically  significant  difference in comparison(t were 0.524,0.399,0.902,P were 0.601,0.690,0.369).Recent total effective cases observation in group was 39(95.12%)and control group was 37(90.24%),there was no statistically significant difference comparing(χ 2 =0.719,P=0.396).Observation group had symptomatic intracranial hemorrhage in three patients(7.32%)and control group had six cases(14.63%),there was no statistically significant difference(χ 2 =1.123,P=0.289).There were four cases(9.76%)of brain edema and 12 cases(29.27%)of hypostatic pneumonia in the observation group,which were significantly lower than seven cases(17.07%)and 18 cases(43.90%)in the control group(χ 2 =4.969,6.962,P=0.025,0.008).The number of patients with good prognosis in the observation group(21 cases,51.22%)was significantly higher than that in the control group(10 cases,24.39%)χ 2 =6.275,P=0.012).Conclusions In the treatment of acute ischemic stroke patients with thrombolysis and thrombectomy,conscious sedation can achieve the same efficacy as general anesthesia,and can further shorten the treatment time,promote  rapid recanalization of blood vessels and reduce related complications,so that patients can get a better prognosis.
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