目的 探讨以护士为主导的MDT模式在防范患者VTE风险中的临床实践效果.方法 选取2018年12月-2019年7月的患者为对照组,采用常规护理模式;选取2019年8月-2020年1月的患者为试验组,实施以护士为主导的MDT模式.比较两组住院患者VTE风险评估率、VTE风险评估准确率、预防VTE护理措施落实率.结果 试验组VTE风险评估率、VTE风险评估准确率、预防VTE护理措施落实率均高于对照组,差异均有统计学意义(P＜0.05).结论 实施以护士为主导的MDT模式,正确使用VTE评估量表和流程,实施防范VTE的精准护理,提高了住院患者VTE的规范评估率,降低了VTE发生率,达到了深化护理专业内涵、提升整体护理服务水平的目标.

目的:探讨隧道式经外周静脉穿刺中心静脉置管(peripherally inserted central venous catheters,PICC)在妇科恶性肿瘤化疗患者中的临床应用效果.方法:随机选取2020-01-01～12-31妇科收治的卵巢癌化疗患者36例,在超声引导联合腔内心电图定位下采用隧道式PICC置管.观察其穿刺成功率、带管期间并发症发生情况等.结果:在超声引导下联合腔内心电图定位采用隧道式PICC置管的36例患者均一针完成穿刺,带管期间未见并发症发生.结论:采用隧道式PICC置管穿刺成功率高,未见导管脱出、血栓形成等非计划拔管,可推广应用于妇科恶性肿瘤患者的化疗治疗.

目的:探讨互联网联合多元化延续性护理在妇科肿瘤患者经外周静脉穿刺中心静脉置管(peripherally inserted central catheters,PICC)居家护理中的应用效果.方法:选取我院2020-02-01～10-30采用互联网联合多元化延续护理进行PICC居家护理的143例PICC置管并带出院的妇科肿瘤患者为实验组;另选取我院2019-03-01～2020-01-31常规居家护理的PICC置管并带出院的妇科肿瘤患者132例为对照组.干预3个月后,比较两组PICC置管后的并发症发生率、患者满意度.结果:实验组PICC并发症发生率低于对照组,患者满意度明显高于对照组(均P＜0.01).结论:通过运用互联网联合多元化延续性护理对妇科肿瘤PICC患者进行居家护理,显著降低了其并发症的发生率,提高了患者满意度.

目的:探讨腔内心电图定位在卵巢癌患者手臂输液港植入过程中导管尖端定位的准确性.方法:随机选取2019-01-01～12-31我院收治的卵巢癌化疗患者80例,手臂输液港植入过程中,采用腔内心电图定位,并通过X线评价手臂输液港导管尖端是否到达正确位置.结果:80例患者采用超声引导下联合腔内心电图定位植入手臂输液港,79例患者胸部X线证实手臂输液港导管尖端均在正确位置,一次性置港成功率达98.75％.结论:采用腔内心电图定位手臂输液港导管尖端的成功率高,并发症少,在卵巢癌化疗患者治疗中值得推广.

目的 探讨腹腔镜子宫肌瘤剥除术的临床应用价值.方法 分析我院2014年1月至2016年6月采取腹腔镜子宫肌瘤剥除术治疗的121例子宫肌瘤患者的临床资料,观察其治疗效果.结果 121例患者均在腹腔镜下完成手术,除1例患者因术中发现系子宫腺肌瘤而行腹腔镜全子宫切除术,其余120例均行肌瘤剥除术.肌瘤剥除术后患者均月经正常,术后3个月B超检查,子宫恢复正常大小,肌层无明显异常回声.结论 在微创理念贯穿的外科时代,腹腔镜子宫肌瘤剥除术是一种安全可行、临床效果佳的微创术式,值得推广应用.

目的 分析80例子宫内膜不典型增生患者的临床特征,观察患者合并子宫内膜癌情况,探讨子宫内膜不典型增生合并子宫内膜癌的临床特征及可能的危险因素.方法 选取2015年9月-2018年9月陕西省人民医院因子宫内膜不典型增生接受全子宫切除术治疗的80例患者为研究对象,回顾性分析其临床资料,采用临床资料收集问卷记录患者相关临床资料,包括年龄、身高、体质量、婚育史、内科合并疾病、术前子宫内膜厚度、术前相关血清学指标表达情况等.根据患者术后病理诊断结果将合并子宫内膜癌者纳入研究组,其他单纯子宫内膜不典型增生者纳入对照组,观察并记录子宫内膜不典型增生患者子宫内膜癌合并情况,对比两组患者临床特征,分析子宫内膜不典型增生患者合并子宫内膜癌的危险因素.结果 80例接受全子宫切除术的子宫内膜不典型增生患者中有25例合并子宫内膜癌,患病率为31.25％ (25/80);25例子宫内膜不典型增生合并子宫内膜癌患者接受全子宫切除术后病理结果证实多为高分化者,且Ⅰ期患者占主要比重,多为浅肌层浸润,且多为子宫内膜样腺癌.多因素Logistic回归分析结果显示,高龄、绝经、术前内膜病理结果重度是子宫内膜不典型增生患者合并子宫内膜癌的危险因素(OR＞1,均P＜0.05).结论 子宫内膜不典型增生患者合并子宫内膜癌风险高,多表现为高分化的Ⅰ期子宫内膜腺样癌,可能受年龄、绝经、子宫内膜病理结果等因素影响,应引起临床重视.

目的 探讨肥胖多囊卵巢综合征患者实施营养运动联合炔雌醇环丙孕酮治疗的临床效果.方法 将本科室2015年1月至2017年3月收治的110例肥胖多囊卵巢综合征患者按随机数字表法分为药物组(n=55,炔雌醇环丙孕酮)和联合组(n=55,营养运动联合炔雌醇环丙孕酮),比较两组的治疗效果.结果 治疗后,联合组患者体质量指数、临床症状评分均明显低于药物组(P<0.05).治疗后,联合组患者血清睾酮、黄体生成素、促卵泡生成素水平均明显低于药物组(P<0.05).治疗后,联合组患者血清胰岛素、胰岛素抵抗指数、瘦素水平明显低于药物组,脂联素水平均明显高于药物组(P<0.05).联合组中存在妊娠需求患者1年排卵成功率、1年妊娠率均明显高于药物组(P<0.05).结论 肥胖多囊卵巢综合征患者采用营养运动联合炔雌醇环丙孕酮治疗可达到良好的治疗效果.

目的:探讨V-Loc TM180可吸收缝合线在腹腔镜子宫肌瘤剔除术中的应用价值.方法:74例子宫肌瘤患者分为试验组(n=30)和对照组(n=43),试验组术中应用V-Loc TM180可吸收线缝合,对照组术中应用2-0号薇乔可吸收缝线缝合;比较2组患者手术平均时间、术中平均出血量、术中血红蛋白(hb)下降数值及盆腔引流时间,比较2组患者术后最高体温、体温恢复时间、下床时间、住院时间及术后中转开腹例数、术后发热例数及肛门排气时间.结果:与对照组比较,试验组术中指标手术平均时间、术中出血量、Hb下降数值、盆腔引流时间明显降低(P＜0.05),术后2组患者最高体温、体温恢复时间、下床时间及术后住院时间比较,差异无统计学意义(P＞0.05);术后两组患者术后中转开腹及术后发热例数,肛门排气时间比较,差异无统计学意义(P＞0.05).结论:V-Loc TM180可吸收缝合线适合腹腔镜子宫肌瘤剔除术,效果优于薇乔可吸收缝缝合线.

Objective To investigate the effect of thymosin α1 therapy on the function of CD4 + CD25 + CD127dim/-regulatory T (Treg)cells in chronic hepatitis B (CHB) patients.Methods A total of 67 CHB patients who were admitted to Department of Infectious Diseases in Shaanxi Provincial People's Hospital from December 2016 to July 2017 were enrolled,among whom 38 patients received entecavir antiviral therapy (control group) and 29 received entecavir combined with thymosin c1 for injection (treatment group).Peripheral blood mononucleated cells were isolated before and after treatment,and flow cytometry was used to measure the percentage of CD4 + CD25 + CD127dim/-Treg cells.CD4 + CD25 + CD127dim/-Treg cells were purified and co-cultured with autologous CD4 + CD25-T cells.CCK-8 assay was used to measure cell proliferation,and ELISA was used to measure the levels of cytokines.The t-test was used for comparison of related indices between the two groups,the chi-square test was used for comparison of categorical data.Results In the control group,the percentage of CD4 + CD25 + CD127dim/-Treg cells was significantly reduced from 12.32％ ± 1.22％ at baseline to 8.85％ ±2.18％ after 12 weeks of treatment (t =4.579,P =0.0005),while in the treatment group,this value was significantly reduced from 13.71％ ± 2.32％ at baseline to 9.26％ ± 2.30％ after 12 weeks of treatment (t =4.803,P =0.0003).The measurement of cytokines was performed for 17 patients in the control group and 21 in the treatment group.After 12 weeks of treatment,the control group showed no significant changes in cell proliferation and levels of cytokines in the co-culture system of Treg and CD4 + CD25-T cells;the treatment group had a significant increase in cell count in the co-culture system [(3.66 ± 0.95) × 106 vs (2.07 ± 0.51) × 106,t =5.709,P ＜ 0.0001],as well as significant reductions in the levels of inhibitory cytokines interleukin-10 (41.40 ± 11.89 pg/ml vs 56.53 ± 27.85 pg/ml,t =2.639,P =0.019) and interleukin35 (122.9 ± 9.98 pg/ml vs 130.0 ± 15.98 pg/ml,t =2.459,P =0.028) and significant increases in the levels of antiviral cytokines interferon-α (297.5 ± 83.56 pg/ml vs 235.6 ± 67.72 pg/ml,t =2.603,P =0.017) and interferon-γ(5.83 ± 0.85 pg/ml vs 4.39 ± 0.95 pg/ml,t =4.659,P =0.0004).Conclusion Thymosin α1 can inhibit the level and immunosuppressive function of CD4 + CD25 + CD127dim/-Treg cells in CHB patients and improve their immune function.

Objective To observe the effect of strict designed form for chewing gum on the first anus exhaust and defecation after laparoscopic surgery,and the actual compliance of chewing gum was investigate.Methods Totally 106 patients with abdominal operation in gynaecology department of Shaanxi Provincial People's Hospital from August to December 2016 were classified into chewing gum group and control group according to stratified random sampling.Chewing gum group had 53 cases,and the principle and requirement of chewing gum in patients and relatives were explained before operation.The xylitol chewing gum was chosed and chewed 2 to 3 gums in the 2 hours after operation,chewed about 30 times every minute and last for 15 to 20 minutes each time.From 7∶00 to 22∶00 the interval was 2 hours, and the interval at the rest time must not exceed 3 hours until exhaust.Fifty-three cases in control group received routine nursing,and started to drink a small amount of water 6 hours after operation,and gradually started to eat.Other dietary guidance and medical care measures were identical in both groups.Compared the first anus exhaust time,defecation time,abdominal distension and postoperative hospitalization time in two groups,and the actual compliance of chewing gum was investigated.Results The first anus exhaust time and the first defecation time of chewing gum group were (19.60±7.59) hours and (36.77±17.16) hours respectively,while those of the control group were (33.79±10.54)hours and (53.25±16.92) hours,and the differences were statistically significant(P<0.05).No abdominal distension occurred in chewing gum group,8 cases (15.1%) in control group had abdominal distension,the difference was statistically significant(P<0.05).The postoperative hospitalization time of chewing gum group and control group were (3.94±1.87) days and (4.42±1.26)days respectively,and the difference was statistically significant(P>0.05).The actual compliance investigation of chewing gum was selected in 53 cases with the actual completion of 48 cases(90.6%).The averaged actual chewing number was (4.39±1.35) times,the averaged actual chewing time in each duration was (16.16±2.05) minutes,the average actual chewing interval was (2.38±0.26) hours.Conclusion The well designed form of chewing gum postoperative can shorten the postoperative anus exhaust and defecation time, and it can reduce postoperative abdominal distention.

Objective:To observe the effect of orally administered dietary fiber (DF)on anal aerofluxus,defeca-tion and abdominal distension prevention after laparoscopic surgery,and to collect data on relevant side effects. Methods:A total of 78 patients with laparoscopic surgery from gynecology department of Shaanxi Provincial People's hospital (201609 to 201612)were recruited in this study.Patients were evenly divided into two groups by stratified random sampling,39 cases in each.Patients of the two groups started to drink water at 6 h after surgery,liquid diet after anal aerofluxus and common food after defecation.DF group took half package of vilof (7.5 g,dissolved in 200ml warm water,9 o'clock on the next day after surgery)in 10 to 20 minutes,and another half package was given to the patients with no anal aerofluxus more than 12 h;DF group and control group shared the same medical treatment;the first anal aerofluxus time,defecation time,postoperative hospitali-zation date and incident rate of abdominal distension were compared,meanwhile,close observation was conduc-ted among DF patients to discover side effects.Results:There were 25 cases (64.1%)who took first anal aer-ofluxus within 24 h after surgery in DF group and 4 cases (10.3%)in control group.12 cases (30.8%)in DF group and 20 cases (51.2%)in control group between 2448 h.2 cases (5.1%)in DF group and 20 cases (51.2%) in control group over 48 h.The differences were statistically significant (P<0.01).There were 20 cases (51.2%)in DF group and 7 cases (17.9%)in control group took the first defecation within 48 h;13 cases (33.3%)in DF group and 17 cases (43.6%)in control group between 4872 h;6 cases (15.4%)in DF group and 15 cases (38.5%)in control group over 72 h;the differences were statistically significant(P<0.01).The postoperative hospitalization stay of DF group was (4.64±1.40)days,and (4.38±1.07)days in the control group;there was no significant difference between the two groups (P>0.05).There were no patients with abdominal distension, nausea,and vomiting discovered in DF group,while 8 cases were reported in control group,and the difference was statistically significant (P<0.01).Conclusions:Orally taken DF after laparoscopic surgery could remark-ably shorten the time of anal aerofluxus and defecation,lower the incidence of abdominal distension and recover the postoperative gastrointestinal function.It was safe and no side effects as diarrhea,abdominal pain,nausea or vomiting were observed.

Objective:To study the expression of the miR‐99b before and after neo adjuvant chemotherapy of cervical cancer .Methods :Through micRNA extraction ,reverse transcription ,timing quantitative PCR detection the expression of miR‐99b in the tumor tissue respectively before and after neoadjuvant chemotherapy in the patients with cervical cancer .Results :After neoadjuvant chemotherapy the cervical cancer miR‐99b expression was signifi‐cantly higher(P<0 .05) .Conclusion:Neoadjuvant chemotherapy can inhibition of cervical cancer through raising the expression of the miR‐99b .

目的：探讨绿原酸药理作用的研究进展。方法：分别从绿原酸的药动学、药效学研究等方面进行文献综述。结论：绿原酸具有抗糖尿病、保护心脑血管肝脏、抑制血小板聚集、抗炎、抑制免疫等多方面的药理作用。

目的:研究乙酰肝素酶(heparanase,Hpa)在子宫内膜癌中的表达,并探讨其临床意义.方法:采用免疫组织化学SP法检测48例子宫内膜癌组织中Hpa蛋白的表达情况.结果:Hpa蛋白在子宫内膜癌中阳性率显著高于正常子宫内膜、子宫内膜增生症(P＞0.05).单因素分析表明浸润不超过内1/2肌层者的Hpa蛋白阳性率显著低于浸润达到外1/2肌层者(P＞0.05).有淋巴转移组的Hpa蛋白阳性率显著高于无淋巴转移组(P＞0.05).Ⅰ-Ⅱ期组的Hpa蛋白阳性率显著低于Ⅲ-Ⅳ期组(P＞0.05).弥漫型内膜癌中Hpa蛋白阳性率高于局限性(P＞0.05).中、低分化内膜癌中Hpa表达与细胞分化无关(P＞0.05).多因素Logistic回归分析结果表明Hpa蛋白表达只与淋巴转移、临床分级及肌层浸润显著相关(P＜0.05).结论:Hpa在子宫内膜癌的阳性率显著高于正常子宫内膜、子宫内膜增生症.Hpa表达与转移、临床分期显著相关.

Objective To investigate the complication rate of gynecological laparoscopies of benign diseases.Methods One thousand three hundred and forty laparoscopic surgeries were carried out from march 2004 through june 2009,included 990 cystectomies and salpingectomies,153 adnexectomies,110 myomectomies,and 87 total hysterectomies.Results Complications occurred in 25 cases,the over complication rate was 1.87%(25/1 340).Complication rate was 0.30%,3.27%,7.27% and 10.34% in cystectomies and salpingectomies,adnexectomies,myomectomies and total hysterectomies repectively.9(36.00%)complications related to puncture and pneumoperitoneum.2(8.00%)introaperative complications occurred during the laparoscopic surgery.14(56.00%)complications occurred during postoperative stage.Conclusion Operative gynecologic laparoscopy is associated with acceptable morbidity rate,but can not be overlooked.Complications seems related to difficulty of the operation.

采用肌肉注射氯甲喋呤配伍口服米非司酮治疗异位妊娠21例,成功19例.成功的关键在于早诊断,掌握好适应症,严密观察.该方法简单,安全有效,毒副作用少,疗效短.