类风湿关节炎(rheumatoid arthritis,RA)是以滑膜炎为主要特征的慢性自身免疫性疾病,可导致关节畸形及功能障碍.RA动物模型能很好地模拟疾病发生发展的病理生理过程,广泛用于RA实验研究.多模态超声技术可以定性、定量诊断RA,监测病情变化,评估药物疗效,引导局部给药及靶向治疗,为RA动物模型研究提供精准方法.该文综述了多模态超声在RA动物模型诊疗中的应用情况.

Objective:To evaluate the application value of left ventricular pressure-strain loop (PSL) in patients with rheumatoid arthritis (RA) by the PSL.Methods:From April 2020 to June 2021, 75 RA patients(case group) and 35 healthy physical examination person(control group) were selected from the Affiliated Hospital of Inner Mongolia Medical University.According to the disease activity scores 28(DAS28) joint disease range of activity score, the patients were divided into low range of activity group (16 cases), medium range of activity group (35 cases) and high range of activity group (24 cases). Echocardiographic examinations were performed on all patients, conventional ultrasound data were collected and the left ventricular PSL technology was used to analyze the myocardial work parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW) and global work efficiency (GWE). The mean values of myocardial work index (MWI), constructive work (CW), waste work (WW) and work efficiency (WE) were calculated. The differences of myocardial work parameters between the case groups and the control group were compared, and the correlation analysis of myocardial work parameters with global longitudinal strain of left ventricle(LVGLS), left ventricular ejection fraction(LVEF) and DAS28 scores were conducted.Results:①There were no statistically significant differences of clinical data between each case group and the control group (all P>0.05). ②Compared with the control group and low disease activity group, the LVGLS of medium and high disease activity groups decreased obviously (all P<0.05). ③The GWI and GCW of the medium and high disease activity groups were significantly lower than those of the control group (all P<0.05), and there were no statistically significant differences of GWW and GWE between the case groups and the control group (all P>0.05). The mid-segment MWI, apical MWI and CW of the medium and high disease activity case groups, and the mid-segment CW of the medium disease activity case group were lower than those of the control group (all P<0.05). ④In the case group, GWI, GCW and LVEF were significantly and positively correlated ( rs1=0.253, P=0.008; rs2=0.261, P=0.024), and were significantly negatively correlated with LVGLS ( rs1=-0.525, P<0.001; rs2=0.455, P<0.001). There were no significant correlations between myocardial work parameters and DAS28 score (all P>0.05). Conclusions:PSL can early reflect to the impaired cardiac function of RA patients with moderate and high disease activity, and provide a new imaging method for clinical evaluation of the cardiac function of patients.

经导管动脉化疗栓塞术(TACE)是治疗肝细胞癌的一种合理有效的方法 .在不能切除的肝细胞癌的临床治疗中,其价值已得到肯定.与全身化疗不同,TACE能有效阻断肿瘤的血液供应,切断癌细胞的营养来源.此外,药物可直接作用于肝动脉和肿瘤组织,提高局部药物浓度,长期发挥抗肿瘤作用.然而,由于肝癌血供丰富,在接受TACE治疗后,癌细胞很难被完全杀死,癌细胞转移的可能性很高.因此,单纯TACE治疗肝癌的效果并不理想.为了延长晚期肝癌患者的生存周期,TACE联合其他综合治疗策略在原发性肝癌的治疗中是必要的.不同的治疗方法 相互配合,相辅相成,可以显著提高治疗效果,减少术后并发症,为肝癌的临床治疗提供新的思路.

类风湿性关节炎(RA)是一种病因不明的全身性自身免疫疾病,以慢性、对称性、侵蚀性关节炎为主要表现,致残率极高.RA最重要的病理表现为滑膜增生和其内新生血管形成.目前能很好地显示RA滑膜增生的方法主要有超声、PET/CT和MRI,PET/CT可实现滑膜新生血管的定量靶向显影,对比增强超声也能实现同样的定量显像,这对于RA早期诊断、筛选新的治疗药物及开发靶向治疗意义重大.本文总结目前评价RA滑膜增生的影像学方法,并分析其优缺点,展望超声靶向微泡在RA诊断与治疗中的应用前景.

Objective:To investigate the prevalence of congenital heart disease (CHD) in children aged 3-6 years in the central regions of Inner Mongolia by echocardiography, to provide reference data for national prevention and control of CHD.Methods:From March 2016 to December 2020, 4264 children aged 3 to 6 years from 16 kindergartens in eight districts and counties, including Hohhot, Wuchuan County, Liangcheng County, Siziwang Banner, Chahar Right-right Middle Banner, Erlianhot City, Sunite Left Banner and Baimiaozi Township of Hohhot City, were selected for free CHD screening. The results of echocardiography were used as the criteria for the diagnosis of CHD.Results:A total of 4264 children were screened, of whom 36 (8.4‰) had CHD. There was no significant difference in the positive rate of screening between genders (P＞0.05). The prevalence of CHD in different regions was 2.9‰ in Hohhot, 14.9‰ in Wuchuan County, 11.2‰ in Liangcheng County, 3.4‰ in Siziwang Banner, 8.2‰ in Chayou Central Banner, 3.5‰ in Erlianhot City, 16.7‰ in Sunite Left Banner and 19.1‰ in Bamiaozi Township. There was no statistical significance in the positive rate of CHD screening among the eight different counties and cities (P＞0.05). The types of CHD included patent ductus arteriosus (PDA) in 16 (44.4%) cases, atrial septal defect (ASD) in 13 (36.1%), ventricular septal defect in 6 (16.7%), and pulmonary stenosis (PS) in 1 (2.78%). The rates of PDA and ASD were significantly higher than that of PS (P＜0.001 for both). Among the 36 children, 1 case of PDA and 1 case of ASD received interventional occlusion therapy, and both children recovered well after surgery. The other children received regular follow-up visits.Conclusion:The prevalence of CHD in children aged 3 to 6 years in Central Inner Mongolia is higher than the national level, and the composition of CHD is primarily PDA and ASD.

目的 探讨建构主义教学理论在消化内科护理教学中的应用效果.方法 选取2018年1-12月期间在该院消化内科实习的90名护生当作研究对象.按照入科时间的不同,将90名护生分为研究组、对照组2组,各45例.2018年1-6月期间入科的研究组采取建构主义教学理论指导下的护理带教,2018年7-12月期间入科的对照组采取传统带教模式.观察并比较2组的护理带教效果.结果 研究组的理论考核成绩(95.36±4.14)分、实际操作成绩(94.13±5.28)分明显高于对照组的理论考核成绩(81.22±8.68)分、实际操作成绩(80.64±8.42)分,差异有统计学意义(t=6.221、6.125,P=0.025、0.024).结论 在消化内科护理教学中应用建构主义教学理论指导,可提高护生的理论知识与操作技能,值得推广.

目的 探讨临床护理路径对急性胰腺炎患者心理状态的影响.方法 方便选取2018年2月-2019年2月期间的86例急性胰腺炎患者当作研究对象.根据护理模式的不同,将86例急性胰腺炎患者分为两组,各43例.对照组采取常规护理模式,研究组采取临床护理路径模式.观察并比较两组护理前后的心理状态变化情况.结果 护理后,研究组的SCL-90评分[躯体化(20.35±3.21)分,强迫症状(13.25±2.18)分,人际关系敏感(16.55±2.25)分,抑郁(21.35±3.23)分,焦虑(12.34±2.17)分,敌对(8.56±1.12)分,恐怖(10.25±1.23)分,偏执(6.24±1.16)分,精神病性(15.14±2.25)分]明显低于对照组的SCL-90评分[躯体化(21.89±5.34)分,强迫症状(18.05±3.23)分,人际关系敏感(22.02±3.35)分,抑郁(27.03±3.37)分,焦虑(20.96±3.25)分,敌对(11.06±1.45)分,恐怖(13.79±1.41)分,偏执(8.68±1.21)分,精神病性(21.78±2.27)分],差异有统计学意义(t=5.285、5.635、5.228、5.482、5.128、5.663、5.318、5.689、5.342,P=0.035、0.024、0.037、0.029、0.041、0.022、0.034、0.021、0.032);研究组的护理满意度97.67％明显高于对照组的护理满意度74.42％,差异有统计学意义(x2=6.521,P=0.005).结论 临床护理路径可有效改善急性胰腺炎患者的心理状态,有利于提高急性胰腺炎患者的满意度,值得推广.

目的 探讨消化内科带教中循证护理与PBL结合的教学模式应用效果.方法 选取2017年1月—2018年12月期间在该院消化内科实习的70名护生当作研究对象.按照入科时间的不同,将70名护生分为两组,各35名.2017年1—12月期间的对照组采取传统带教模式,2018年1—12月期间的研究组采取循证护理与PBL结合的教学模式.观察并比较2组的带教效果.结果 带教后,研究组的理论成绩(96.24±3.25)分、操作成绩(95.14±4.22)分明显高于对照组的理论成绩(82.21±5.34)分、操作成绩(80.36±5.69)分,差异有统计学意义(t=6.243、5.647,P=0.025、0.029);研究组的学习兴趣提高率82.86％、学习负担降低率88.57％、自主学习能力加强率85.71％、问题解决能力加强率91.43％、语言表达能力提高率88.57％明显高于对照组的学习兴趣提高率62.86％、学习负担降低率65.71％、自主学习能力加强率57.14％、问题解决能力加强率71.43％、语言表达能力提高率62.86％,差异有统计学意义(χ2=6.127、7.145、6.582、6.225、6.841,P=0.024、0.017、0.022、0.025、0.019).结论 消化内科带教中循证护理与PBL结合的教学模式有着理想的应用效果,值得推广.

目的 分析评价呋喃唑酮与阿莫西林三联疗法联用对幽门螺杆菌感染胃溃疡患者的临床疗效与安全性.方法 方便选取该院于2017年10月-2018年10月接收诊治的幽门螺杆菌感染胃溃疡患者80例作为研究对象,随机分成两组:对观察组(40例)患者采用呋喃唑酮与阿莫西林三联疗法联用治疗,对对照组(40例)患者采用阿莫西林三联疗法治疗,治疗8周后,观察比较两组治疗效果及不良反应情况.结果 与对照组的治疗总有效率62.50％相比,观察组92.50％明显更高,差异有统计学意义(χ2=6.971,P<0.05).与对照组的不良反应发生率30.00％相比,观察组10.00％明显更低,差异有统计学意义(χ2=5.167,P<0.05).结论 采用呋喃唑酮与阿莫西林三联疗法联用治疗幽门螺杆菌感染胃溃疡,不但临床疗效显著,并且安全性较高,值得在临床上广泛应用和推广.

声学造影即在常规超声心动图的基础上,将含微泡的液体通过各种途径进入心血管系统,产生造影效果,进一步达到诊断目的的方法称为对比超声心动图或造影超声心动图,简称声学造影.根据声学造影的研究部位不同,可分为右心声学造影、左心声学造影(left ventricular opacification,LVO)、心肌声学造影(myocardial contrast echocardiograghy,MCE).虽然常规超声心动图已经在临床当中广泛应用,但在定性和定量分析某些疾病时仍有一定局限性.心脏声学造影技术显著提高了心脏疾病诊断的准确性,从而被广泛运用于临床当中.本文主要阐述了左心腔声学造影、心肌声学造影的临床应用进展.

乙型病毒性肝炎（ HBV）发病率逐年增加，目前我国乙型肝炎病毒感染率达7％左右。亚洲尤其是乙型肝炎流行的高发区，人群HBV携带率8％~15％，乙型肝炎是严重危害人类健康的传染病。供应室是医院工作的重点部门，承担着全院医疗用品的回收、清洗、包装等工作，是控制医院感染工作的关键科室［1］。供应室工作人员经常回收、清洗、包装患者用过的医疗器械、敷料，稍有不慎就可能发生乙型肝炎职业损害，如乙型肝炎患者用过的带血的针头、器械在清洗的过程划伤工作人员的皮肤等，由于手上的伤口接触临床用过的医疗用品后，感染乙型肝炎病毒的几率高达3％［2］。因此，供应室工作人员是职业暴露乙型肝炎的高危人群。现分析供应室护士职业暴露乙型肝炎病毒的常见原因并提出相应的防护对策。

糖尿病是发达国家四大优先考虑疾病之一，目前随着人类社会的快速进步，糖尿病的发病率随之呈逐年上升趋势，容易引发糖尿病患者机体其他重要器官的严重并发症。因此，增强患者自身对疾病相关知识的了解，提高医疗护理人员的治疗护理水平，是糖尿病合并肾病患者生命健康延续的重要基础，已成为当下医学研究者重点关注的热点课题。提高临床护理疗效是改善患者生活质量，为患者生命提供安全保障的重要因素。本研究主要针对糖尿病合并肾病患者的临床护理进展结果进行详细研究分析，了解当下糖尿病合并肾病的护理要点及趋势，总结护理经验为日后改病症患者临床护理提供价值指导。

产后湿疹属于湿疹的一种，是由内外因引发的过敏性皮肤病变，其本身没有传染性，但湿疹所引发患处的水肿、红斑是滋生细菌、引发感染的温床，尤其当产妇患上乳房湿疹时，会严重影响日常哺乳。在产褥期，母体的状态极为敏感，产后湿疹会加剧体内物质的消耗，可能引发多种危害，会给患者以后的生活和工作带来诸多不便。因此，科学合理的治疗和护理，对于疾病的早日康复、防止并发症的发生及提高生活质量等都具有十分重要的意义。

腹膜透析是治疗尿毒症的重要方法之一,在治疗过程中,尤其是居家腹膜透析后,如能尽早实施有效的护理,可有效预防腹膜透析造成的腹膜炎等并发症的发生.体会如下.

对维持性血液透析1例观察护理体会如下. 1 病历摘要 女,11岁.原发性疾病:肾病综合征,建立血管通路为临时血管通路,颈内静脉插管,同时行前臂桡动脉与头静脉吻合术形成内瘘,内瘘成熟后应用.