目的 分析病灶切除术治疗局限性子宫腺肌症的疗效及术后复发的高危因素.方法 选取2017年10月至2019年10月蚌埠医学院第一附属医院收治的局限性子宫腺肌症患者120例作为研究对象,对患者进行病灶切除术,观察患者的手术时间、术中出血量、术后排气时间及术后住院时间,手术前后指标变化,复发情况及影响因素.结果 患者手术平均时间(100.70±34.00)min,术中平均出血(172.61±9550)ml,术后平均排气时间(22.14±8.68)h,术后平均住院时间(5.02±1.01)d.与手术前相比,手术后患者子宫体积缩小、痛经评分、月经量评分降低、血红蛋白表达水平升高,血清CA125表达水平降低(P＜0.05),对所有进行病灶切除术的120例患者进行随访,复发率为25.00％(30/120).单因素分析显示,病灶切除术后复发影响因素与痛经评分、术前子宫体积、合并子宫内膜异位症相关,痛经评分较高、术前子宫体积较大、患有合并子宫内膜异位症的患者术后复发率较高,差异具有统计学意义(P＜0.05).Logistic回归分析显示,痛经评分、术前子宫体积、合并子宫内膜异位症为患者术后复发的影响因素(P＜0.05).结论 病灶切除术具有良好的治疗效果,可改善患者月经疼痛程度,并减少月经量.

目的 比较经脐单孔腹腔镜与多孔腹腔镜在子宫肌瘤剔除术中的临床疗效.方法 选取2020年4月至2021年4月在蚌埠医学院第一附属医院行子宫肌瘤剔除术的患者150例,进行回顾性分析,分为单孔组(行单孔腹腔镜手术患者)61例、多孔组(行多孔腹腔镜手术患者)89例,比较两组患者手术时间、术中出血量、肛门排气时间、住院天数,随访术后恢复情况,采用体象量表(BIS)、切口美观满意度(CS)评分比较患者满意度和切口美观度.结果 单孔组手术时间少于多孔组(t=-0.830,P=0.001),单孔组术中出血量少于多孔组(t=-2.269,P=0.025),单孔组住院时间少于多孔组(t=-2.113,P=0.036),差异有统计学意义(P<0.05).术后随访比较,单孔组无复发,多孔组10例复发;单孔组与多孔组均无切口疝发生;单孔组BIS评分为(7.72±1.08)分,高于多孔组的(6.80±1.01)分;单孔组CS评分为(4.36±0.61)分,高于多孔组的(3.83±0.61)分,差异有统计学意义(P<0.05).结论 子宫肌瘤患者行单孔腹腔镜手术,其手术时间、住院时间均少于多孔组,出血量更少,无切口疝发生,且术后恢复快,手术切口更美观,可以在临床推广使用.

Autologous costal cartilage is the best material for auricle reconstruction due to its superior biomechanical properties and histocompatibility. However, costal cartilage harvest will inevitably damage the donor site. By conducting a comprehensive search for relevant literatures, this author reviewed the donor site complications of autologous costal cartilage ear reconstruction, including thoracic deformity, pneumothorax, scar and pain, as well as the corresponding prevention and treatment methods, hoping to provide reference for the clinical application of autologous costal cartilage ear reconstruction.

目的 分析探讨多元智能理论在妇产科临床实习教学中的应用.方法 将2017年8月—2019年6月期间至医院妇产科临床实习的100名实习医生作为研究主体,按照不同教学模式分组,观察组(50名)接受多元智能理论指导下临床教学,对照组(50名)接受传统教学模式教学,评价对比教学效果.结果 观察组理论知识得分、妇科诊疗技能得分、妇科专业治疗技能成绩与对照组相较均明显较高(P<0.05);观察组实习医生急救动手能力、病情观察判断能力、应急配合能力得分均明显高于对照组(P<0.05);观察组实习医生对实习教学模式各评价项目的 满意人数占比均明显高于对照组,数据对比有统计学意义(P<0.05).结论 多元智能理论指导下的妇产科实习教学模式可明显的提升实习医生的应急能力、应急配合技能与对教学模式各评价项目的 满意度.

目的:探讨保留卵巢功能的宫颈癌根治术对宫颈癌病人预后的影响.方法:选取手术治疗的宫颈癌病人358例,按照手术方式分为观察组83例,行保留卵巢的宫颈癌根治术;对照组275例,行不保留卵巢的宫颈癌根治术.术后3、6个月,分别进行血清学性激素水平测定;术后6个月,采用改良Kupperman评分法进行生活质量问卷调查.结果:术后6个月,观察组病人改良Kupperman评分明显低于对照组(P<0.01).术后3、6个月,观察组FSH、LH、E2水平均在正常值范围,3例出现卵巢衰竭表现;对照组术后3、6个月FSH、LH均明显高于观察组(P<0.01),E2水平明显低于观察组(P<0.01).观察组病人术后随访,其中2例卵巢转移,4例出现卵巢脓肿,1例有残留卵巢综合征,3例保留卵巢的病人出现移植部位疼痛.结论:宫颈癌符合保留卵巢功能的病人术中给予保留单/双侧卵巢是可行的,保留卵巢功能使宫颈癌病人获益,提高病人术后生活质量,且术中保留卵巢是安全的,极少病人出现卵巢转移.

糖化血红蛋白(Hemoglobin A1c,HbA1c)能否成为糖尿病诊断标准这一问题愈来愈受到人们的关注,与空腹血糖(fasting blood glucose,FBG)及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)相比,HbA1c稳定性较高,HbA1c≥6.5％作为糖尿病诊断切点被认为具有较好的敏感性与特异性.糖尿病相关的慢性并发症主要发病基础为其血管病变,其中慢性高血糖是导致其血管病变的主要因素,而HbA1c是反映近2-3个月平均血糖控制情况的主要指标.现针对HbA1c诊断糖尿病的准确性、敏感性、特异性及HbA1c与糖尿病血管并发症的关系等方面做一综述.

目的:探讨术中局部使用泰陵联合大环内酯类药物预防食管癌根治术术后淋巴液渗出,以达到减少渗出量及缩短渗出时间的临床效果.方法:采取随机分组的方法,将收治的193例准备行根治性手术的食管癌患者随机分成术中局部使用泰陵联合大环内酯类药物预防食管癌根治术术后淋巴液渗出的观察组(103例)和对照组(90例)进行比较研究.2组患者除了在手术过程中观察组采用术中局部使用泰陵联合大环内酯类药物预防食管癌根治术术后淋巴液渗出及缩短渗出时间的方法外,其余相同.结果:观察组103例中,第1,2,3天平均引流量为275,162,94 mL,1周大于或者等于50 mL引流液的例数为12例;对照组第1,2,3天为428,340,255 mL,1周大于或者等于50 mL引流量的例数为37例.第1,2,3天的平均积液量差异有统计学意义(P<0.05),1周大于或者等于50 mL积液的例数2组比较差异有统计学意义(P<0.05).结论:术中局部使用泰陵联合大环内酯类药物的治疗方法能够很好的预防食管癌根治术后淋巴液渗出引起的胸腔积液,缩短胸腔积液的持续时间.

Objective To analyze the risk factors and clinicopathological features of patients with triple-negative breast cancer.Methods Total 180 cases of breast cancer in our hospital between February,2013 and June,2016 were enrolled into this study.The expression of ER,PR and HRE-2 was detected by immunohistochemical method.The 60 patients with triple-negative breast cancer were chosen as observation group,and the other 120 patients with non-triple-negative breast cancer were chosen as control group.The Age,smoking and drinking history,body mass index(BMI),family history,place of residence,educational background,age of menarche,lactation status,use of contraceptive drugs,parity,age at primiparity,abortion history,menopausal time of the two groups were compared.The indexes with significant differences were screened out for multivariate logistic regression analyses.The risk factors and clinicopathological features of patients with triple-negative breast cancer were analyzed.Results Statistically significant differences (P ＜ 0.05) were found in age,body mass index(BMI),lactation status,use of contraceptive drugs,parity,and menopausal time between the patients in the two groups,but not in smoking and drinking history,family history,place of residence,educational background,age of menarche,age at primiparity,abortion history (P ＞ 0.05).Multivariate logistic regression analyses showed that the ORs of under the age of 60,twice or more than twice of parity,menopausal time were 2.384,1.213 and 3.324,respectively.The corresponding P values were all greater than 0.05,and there was no statistical significance.The ORs of body mass index,lactation status,use of contraceptive drugs were 5.789,5.672 and 8.932,respectively.The corresponding P values were all less than 0.05,and there was statistical significance.BMI ≥25 kg/m2,suppression of lactation and the use of contraceptive drugs were risk factors of triple-negative breast cancer.The main pathological type of triple-negative breast cancer was invasive ductal carcinoma,with higher incidence of lymph node metastasis.The tumor staging and grading of triplenegative breast cancer were advanced.Conclusion The malignant degree of triple-negative breast cancer is higher than that of non-triple-negative breast cancer.Obesity,suppression of lactation and the use of contraceptive drugs is risk factors of triple-negative breast cancer.

Objective To discuss the care coordination and comfort perioperative care in patients undergoing the dental implantation operation,improve the success rate of the treatment.Method The clinical data of 92 patients receiving the dental implantation operation by the Bicon implant system from April 2007 to April 2012 were analyzed.The appropriate comfort perioperative care was carried out according to the operation and feature of the patients.Result The proper care coordination and comfort perioperative care were performed successfully.We earned patients' trust,strengthen their confidence,kept their joyous mood and ensured the success of the operation.Conclusion The good care coordination and efficient comfort perioperative care can decrease the pain and anxiety of patients,increase the success rate of dental implantation operation.

Practice is the sole criterion for testing truth;practice is the essential important link for the clinical internship in department of Stomatology to serve the people.Adhere to practice hardly,ensure no child left behind in the teaching mode conversion,to ask,only work hard,can learn the real knowledge,and become the good doctor that people welcome.This article elaborated from many aspects and practical activities in the Department of stomatology in the clinical practice of the importance of oral medicine,combined with the present situation and development prospect of Department of stomatology in clinical practice,pointed out the common problems and deficiencies,and practice theory as a guide,the analysis of the causes and consequences,constructive put forward practical feasibility study method,in order to help the oral medical students perform better medical practice,to guide the clinical practice to success.

Objective To explore the application of the evidence-based care for esophageal cancer patients receiving radiotherapy.Methods According to evidence-based method to retrieve relevant documents,then to evaluate the authenticity,the reliability and clinical utility of the evidence,the final adoption of evidence-based care strategies,the objects of these works above are to release the psychological pressure and to reduce the patient radiation reactions and complications.Results Request for certificate of care for patients with esophageal cancer,it was found that the apparent effects accounted for 80.3%,88.6% effective,invalid(11.4%),death(0%),and therefore through the application of evidence-based care in patients with esophageal carcinoma,taking effective care measures can ease the patient's psychological pressure,reduce the incidence of radiation side effects and complications,and thereby improving patient outcomes.Conclusion To patients treated with radiotherapy for esophageal cancer,evidence-based care can be effective in reducing the incidence of radiation side effects and complications,reducing the psychological pressure,and ensuring that patients with the successful completion of radiation therapy,it was recommended that the request for certificate should care be promoted in patients with esophageal carcinoma.

Objective: To discuss the effect of PDCA cycle management in the cleaning and disinfection quality in the department of stomatology.Methods: PDCA cycle management(planning,implement,checking and manipulation) was adopted to analyze the problems existing in the cleaning and disinfection room of the stomatology department,and the effects were evaluated.Results: After the application of PDCA cycle management,the cleaning and disinfection quality in the stomatology department was significantly improved;the conformity rate of the apparatus's cleaning,packing and sterilization reached 100.00%,which was significantly higher than before(P <0.05 to P <0.01).Conclusions: PDCA cycle management is effective in improving the cleaning and disinfection quality in the sterilizing room.

目的将武警湖北总队医院不同临床来源分布的153株铜绿假单胞菌进行抗生素耐药性实验,了解该菌的院内感染及耐药情况,为临床使用抗菌药物及院内感染防护提供依据。方法收集不同来源的PAE菌,采用法国梅里埃公司生产的ATB Expression细菌自动分析鉴定系统鉴定,采用纸片扩散法(K-B法)进行15种抗生素药敏试验。结果 153株铜绿假单胞菌主要来自痰液(71.9%);临床病区分布以重症监护室(33.1%)、呼吸科(25.6%)为主;药敏结果显示,该细菌对妥布霉素、阿米卡星、亚胺培南较为敏感。结论铜绿假单胞菌感染在该院呈广泛分布,其中以呼吸道感染为主,且对多种抗菌药物耐药。

Objective To explore the management methods of cleaning and disinfection room of outpatient department of stomatology,improve the qualified rate of sterile articles.Methods According to Ministry of Health issued the industry standard,seriously implement the management system of hospital infection,gradually improved the standardized cleaning disinfection and sterilization processes of the oral professional equipments and monitoring of quality of disinfection and sterilization,responsibilities,the occupation protection systems,and implemented them,and evaluated effectivenesss of management.Results In accordance with industry standards management,after standardized management of each operation flow on recyling,cleaning,packing,sterilization,storage and distribution.sterile 100% pass rate,compared with prior to the standardized management(96.14%),there was significant(P0.05).Conclusion Standardized management was a scientific method to ensure that the health industry standards,standardized cleaning disinfection and sterilization process,the management system ware implement.It was effective methods to improve the qualifed rate of sterilization,and also the key to improve the quality of of cleaning and disinfection room.

目的 探讨老年鲍曼不动杆菌感染患者的集束化护理措施.方法 选取2008年1月-2010年10月干部病房16例老年患者,均为鲍曼不动杆菌感染者,对其实施集束化护理.集束化护理是集合一系列有循证基础的治疗及护理对策,处理某种难治的临床疾患.本文集束化护理对策包括严格消毒隔离制度,加强手卫生和职业防护,加强病区环境管理,做好分泌物的处理,严格把握抗菌药物的给药时间.严格执行集束化护理,通过病原学追踪检查,观察老年鲍曼不动杆菌感染的情况.结果 16例患者经治疗及集束化护理痊愈13例,死亡3例,治愈率81.3％.结论 对感染鲍曼不动杆菌的老年患者采取集束化护理措施,加强消毒隔离管理能有效降低鲍曼不动杆菌的感染率,有利于院内感染的控制.

Objective:To compare the clinical effects of the minimally invasive method with hammer chisel crown method in the extraction of mandible impacted wisdom tooth.Methods:Two hundred and sixty-nine cases with mandibular impacted wisdom tooth were randomly divided into the observation group(138 cases) and the control group(131 cases).The observation and control group were treated with minimally invasive extraction method and hammer chisel crown method,respectively.The operation time,the intraoperative and postoperative complications of two groups were observed and compared.Results:The operation time of the observation group was significantly shorter than that of the control group(P0.01).The intraoperative and postoperative complications of the observation group were significantly less than that of the control group(P0.05 to P0.01).Conclusions:The minimally invasive extraction method in the treatment of mandibular impacted wisdom tooth is short operation time and few intraoperative and postoperative complications,which has worth using in clinic.

目的探讨干部病房老年患者院内感染的危险因素以及护理对策。方法采用回顾性调查的方式。以2009年1月-2010年4月干部病房老年院内感染患者35例为感染组,设同一时期住院的老年非院内感染患者40例为未感染组,分析老年患者院内感染的危险因素。结果老年患者院内感染中以呼吸道感染居首位,单因素分析显示住院期间侵入性操作、抗生素使用情况、住院天数、免疫抑制剂和激素的使用情况均是发生感染的危险因素。多因素Logistic回归分析显示住院期间侵入性操作、抗生素使用情况是老年患者发生院内感染的独立危险因素。结论老年患者院内感染是多种因素共同导致的结果;针对其危险因素制定综合的护理对策,才能有效控制院内感染。

Objective:To evaluate a new psychological nursing therapy happy factor stimulation in elevating the quality of life of the elderly patients who had retired from work.Methods:A total of 50 elderly patients with an age of over 80 in the gerontology department of our hospital were enrolled in the study.The happy factors we collected were their achievements in their early life.We stimulated their pride and joy by chatting with them about them.Their physiological and psychological reactions were observed before and after the therapy,and their quality of life was evaluated.Results:There was a significant difference in appraisal score before and after the happy factor-stimulation therapy (P<0.01).Conclusions:Happy factor stimulation therapy is simple and effective in elevating the life quality of the elderly patients who have retired from work

Objective To observe the effect of the nursing intervention on elderly patients with the dysphagia owing to acute stroke.Methods 65 elderly patients with dysphagia owing to acute stroke were divided into nursing group and control group randomly.The patients from nursing group not only received conventional therapy,but also obtained nursing intervention in early stage.The extent of dysphagia was compared between two groups on 30th day after onset.Results The extend of dysphagia in those patients from nursing intervention group was improved significantly compares to those from control group(P<0.01).Conclusions The implementation of nursing intervention can alleviate the dysphagia state in elderly patients with the stroke,thereby,improve these patients' quality of life.

目的:探讨少儿前恒牙脱位再植的特点.方法:总结分析69颗少儿恒牙脱位再植的过程及随访结果.结果:随访3年存活61颗.其中50颗为牙周膜愈合,并有24颗恢复牙髓活力.伴有牙槽骨骨折者易发生牙根吸收.结论:少儿前恒牙脱位率高,再植效果好.脱位时间及损伤程度是影响再植牙成功的主要因素.根尖诱导成形术可提高死髓牙的存活时间.