目的 探讨妊娠期自主凯格尔运动对初产妇产后早期盆底结构及功能的影响.方法 前瞻性研究.募集拟于北京大学深圳医院产检及分娩的初产妇中收集基线资料,对符合入排标准的研究对象通过宣教后配对分组为运动组(妊娠期凯格尔运动组)、对照组.对照组孕妇按照一般诊疗常规进行,无特殊干预措施;运动组孕妇从妊娠期28周起至分娩前在专科医师指导下进行盆底肌肉锻炼,余均同对照组.建立运动组微信群组并实时监督指导运动组进行规范化盆底肌锻炼.(1)比较两组产妇的年龄、孕前孕后BMI、分娩方式概率差异;(2)比较两组产妇产前及产后6周时盆底肌障碍早期症状发生率;(3)比较两组产妇孕前及产后6周时逼尿肌厚度、会阴体长度和厚度、肛提肌裂口面积差异;比较Valsalva状态下两组产妇产后6周时盆底超声测量指标的差异;(4)比较两组产妇产后6周时电生理差异.结果 (1)两组产妇年龄、产前产后BMI、孕期、新生儿体重、顺产率的差异均无统计学意义(P值均大于0.05).(2)61例产妇中存在性欲降低共14例(22.9％),两组比较有统计学意义(P<0.05).(3)产前基线期两组逼尿肌厚度、会阴体长度、会阴体厚度、肛提肌裂口面积差异均无统计学意义(P>0.05);产后6周时测量两组产妇逼尿肌厚度、会阴体长度差异存在统计学意义(P<0.05).产后6周时在Valsalva状态下测量两组产妇膀胱移动度、尿道旋转角差异存在统计学意义(P<0.05);膀胱后角差异无统计学意义(P>0.05),但对照组膀胱移动度、尿道旋转角、膀胱后角平均值均大于实验组.(4)两组产妇电生理参数比较,对照组盆底肌Ⅱ类肌纤维最大肌力平均值小于实验组,且差异存在统计学意义(P<0.05);测量Ⅰ类、Ⅱ类肌纤维肌力时腹肌参与度平均值对照组均大于实验组,且差异存在统计学意义(P<0.05).结论 妊娠期经专科医师指导后自主盆底肌锻炼降低妊娠期及分娩时对盆底肌肌纤维损伤程度可能;在掌握盆底肌康复动作要领后,对Ⅱ类肌纤维保护效果更明显.

Objective: To explore the common factors affecting the success rate of clinical pregnancy after embryo transfer from frozen embryos. Methods: A retrospective analysis was performed on 590 patients who received frozen embryo thawed transplantation in Shenzhen Hospital of Peking University from January to June 2021. Relevant clinical data were collected and the parameters of transvaginal uterus, bilateral adnexa and pelvic color Doppler ultrasonography were included before transplantation. Logistic regression was used to analyze the related factors affecting the success rate of clinical pregnancy after frozen embryo transplantation. Results: Univariate analysis showed that age, number of pregnancies, number of births, number of ectopic pregnancy（EP） and transplantation（ET）, hydrosalpinx and pelvic effusion≥20 mm may affect the clinical pregnancy outcome after thawed embryo transplantation. Multivariate Logistic regression analysis showed that age, previous EP and ET times, hydrosalpinx were risk factors for clinical pregnancy success after frozen embryo transplantation, and pelvic effusion was protective factor for clinical pregnancy success in frozen embryo transplantation. Conclusion: The age, EP, ET and depth of tubal effusion and pelvic effusion greater≥20 mm are important factors affecting the success rate of clinical pregnancy in patients with frozen embryo thawed transplantation.

目的 探讨细化护理方案在缺血性肠病介入治疗术后的可行性及满意度.方法 2012年1月至2020年4月介入治疗术后缺血性肠病患者60例,其中2012年1月至2016年9月30例患者采用常规护理方案(对照组),2016年10月至2020年4月30例患者采用细化护理方案(观察组).比较2种护理方案在患者及医生中的满意度.结果 对照组30例患者满意度调查量表得分为(94.5±2.79)分,观察组30例患者满意度调查量表得分为(97.8±1.39)分,差异有统计学意义(P＜0.05).医生对护士满意度调查结果显示,观察组得分均高于对照组,差异有统计学意义(P＜0.05).结论 对比常规护理方案,细化护理方案可以优化护理时间分配及护理工作满意度.

Objective: To investigate the clinical practice status of the Clinical Practice Standards for Arterial Blood Gas Analysis published in 2017, and to provide reference for further standardizing clinical practice for arterial blood gas analysis in adults. Methods: From April 12 to May 31, 2022, a self-designed questionnaire was used to investigate the practice status of adult arterial blood gas analysis among medical staff from 134 medical institutions in China by convenience sampling. Results: A total of 500 valid questionnaires were collected, and 28.2% respondents preferred 2% chlorhexidine gluconate ethanol solution as skin disinfectant. In clinical arterial blood gas sampling, 90.4% of the preferred site were radial artery, and the needle entry angles were slightly different. Only 15.0% removed three times the dead space volume of mixture blood; 73.8% correctly mixed the specimens after blood collection; 76.2% could complete the test within 30 minutes. There were 8.6% of the respondents who suffered needle injuries due to arterial blood collection operation. Conclusion: There are differences in the disinfection methods of arterial blood gas analysis, puncture sites for blood collection, and needle entry angles among medical staff. The quality control of arterial blood gas sample collection, transportation, and preservation needs to be optimized. The training and examination related to arterial blood gas analysis are insufficient, and the awareness of occupational protection is weak. The success rate of arterial blood collection can be improved by strengthening the training of adult arterial blood gas analysis operation knowledge and skills, and the quality control of the collection process, to ensure the accuracy of test results.

通过介绍BOPPPS模式和虚拟仿真实验及其适用性,再以"片剂"为例,设计BOPPPS模式与虚拟仿真实验相结合的教学方案,以期为中药药剂学课程提供新型教学模式,提高学生学习积极性,培养学生的实际应用能力,培养应用型人才.

目前禁毒外交已成为我国外交的重要内容之一.如何在新时代认识好、开展好禁毒外交,并进一步丰富禁毒外交的理论是摆在我们面前的重要课题.追溯中国禁毒外交的起源,总结历史经验教训,对更好地开展禁毒外交有所裨益.本文对中国禁毒外交起源进行初步探索,梳理了鸦片战争前后清政府禁毒外交的开展过程,解析了对清末禁毒外交产生影响的多方力量,并对20世纪初中英达成禁烟合作的外交过程予以阐述和分析,以期对禁毒外交研究有所帮助.

目的 探讨以神经功能恢复为核心的术后护理模式在急性缺血性脑卒中(acute ischemic stroke,AIS)机械取栓患者中的护理效果.方法 2016年1月～2019年6月我们将神经功能恢复为核心的术后护理模式应用于机械取栓治疗36例AIS,评价指标为美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)和改良Rankin量表(modified Rankin Scale,mRS).结果 31例(86.1％)经急诊机械取栓手术成功获得血管再通.术前NIHSS评分(12.6±4.7)分,出院时(5.3±1.5)分,差异有显著性(P<0.05).5例死亡:2例机械取栓术后24 h出现症状性脑出血死亡;2例颈内动脉近端急性闭塞,血栓负荷量大,分别于术后1、4.5 h出现恶性脑水肿、脑疝死亡;1例术后第5天突发大量蛛网膜下腔出血死亡.出院时mRS评分:0分14例,1分11例,2分5例,3分1例.23例术后90 d门诊随访,由医生进行mRS评分:0分9例,1分9例,2分5例,均为预后良好.结论 对于AIS机械取栓患者,以神经功能恢复为核心的术后护理模式能有效降低神经系统并发症发生率,促进患者神经功能康复.

急性髓系白血病( acute myelocytic leukemia,AML)是成年人最常见的急性白血病,目前治疗以化疗为主.化疗后,患者由于机体免疫功能下降,粒细胞减少,容易出现张口受限、吞咽困难、局部红肿、皮温升高等口腔颌面部间隙感染表现,严重者可出现局部肿胀累及气道,从而导致呼吸困难甚至死亡[1].及时恰当的护理措施,能够提高患者的生存质量.本科于2019年11月4日收治1例急性髓系白血病化疗后并发口腔颌面部间隙感染的患者,经积极治疗护理,患者病情得到控制,为后续康复治疗创造了条件,现将护理经验报告如下.

目的 探讨盆腔区域子宫静脉内平滑肌瘤病(IVL)的超声特征,以提高对该病的超声诊断水平.方法 回顾性分析2016年2月至2020年12月本院收治的4例经手术证实的盆腔区域IVL患者临床、超声及病理资料.结果 患者平均年龄44岁,2例有子宫肌瘤剔除术病史.3例超声提示子宫及附件区实性"蠕虫样"占位,术前提示IVL.1例漏诊病例,超声仅提示子宫肌瘤.术中瘤体呈条索状分布,沿子宫血管生长,与超声所见相符.结论 盆腔区域IVL的超声声像图表现具有一定特征性,对比历史检查如发现"蠕虫样"实性结节可提示IVL可能;超声能显示病变大小、累及范围、内部回声及血流等情况,可作为IVL术前诊断及术后随访的首选影像学方法 .

Objective:To construct an information management system of follow-up data and investigate the influence of the system on the diagnostic efficiency of ultrasonic physicians.Methods:A total of 8951 cases at Peking University Shenzhen Hospital from July 2016 to December 2018 were analyzed retrospectively. All the cases were confirmed by pathology. An information management system of follow-up data was built by hierarchical diagnosis. Diagnostic grade (grades 1-3; each diagnostic grade was further divided into diagnostic conformity and non-conformity) and diagnostic weighted score were used in all cases. The efficiency of follow-up (the personnel and time required to follow every 100 valid cases) was calculated. The diagnostic efficiency of ultrasonic physicians was evaluated by diagnostic grade, diagnostic coincidence rate, and diagnostic weighted score. The differences of diagnostic grade and diagnostic coincidence rate of ultrasonic physicians before and after the use of the information management system of follow-up data were analyzed by the Chi-square test, and diagnostic weighted score was analyzed by t-test.Results:The cost of follow-up was reduced from 5.2 man-hours/100 cases to 3.1 man-hours/100 cases. The diagnostic grade after the use of the information management system of follow-up data was higher than that before the use (grade 1/grade 2/grade 3: 21.0%/21.0%/58.0% vs 17.3%/23.9%/58.8%; χ2=23.708, P＜0.001). The proportion of cases (grade 2+grade 3) that were judged as benign or malignant lesions increased (82.7% vs 79.0%). After the system was used, the diagnostic coincidence rate of grade 1 and grade 3 cases was significantly improved compared with that before the use of the system (83.8% vs 66.6%, χ2=361.453, P＜0.001; 87.8% vs 85.7%, χ2=5.573, P=0.020). There was no statistically significant difference in the diagnostic coincidence rate of grade 2 cases (P＞0.05). The mean weighted score of ultrasonic physicians' diagnosis increased from 3.93 points to 4.51 points, which was statistically different (t=-14.816, P＜0.001).Conclusion:The use of the information management system of follow-up data can improve the efficiency of follow-up, and evaluate the diagnostic efficiency of ultrasonic physicians quantitatively. And the diagnostic efficiency of ultrasonic physicians can be improved through the feedback and correction in the system.

爱国卫生运动在应对突发性公共卫生事件和社会日常卫生倡导等方面发挥着重要作用.从1978年的16字方针到1989年的24字方针,再到2017年"以人民健康为中心,政府主导,跨部门协作,全社会动员,预防为主,群防群控,依法科学治理,全民共建共享"的42字方针,爱国卫生运动的内容不断深化和丰富,不同时期呈现不同特点.针对此次暴发的新冠肺炎疫情,我们应吸取经验教训,并将卫生防疫工作提升到政治任务的层面加以重视.

颈动脉支架成形术( carotid artery stenting ,CAS)治疗颈动脉重度狭窄引起的缺血性脑卒中已广泛开展. CAS 术后可出现脑高灌注综合征 ( hyper perfusion syndrome,HPS),是最危险的并发症之一, CAS术后1 .1％～6 .8％的患者可发生脑组织高灌注损伤,造成脑肿胀甚至脑出血[1]. 存在颈动脉极重度狭窄、对侧颈动脉重度狭窄或闭塞、侧支循环代偿差、合并难控性高血压等高危因素的患者,HPS发生率可高达14 .1％～56％[ 2 ]. HPS往往起病隐匿,如不及时发现及纠正,致残率和致死率均很高,如何降低有HPS高危因素患者术后HPS的发生风险是目前临床亟待解决的热点问题. 2015 年1 月 ～2018年6月我科对36例有HPS高危风险的颈内动脉狭窄行CAS ,现将围手术期的护理报道如下.

目的 系统评价产前超声筛查发现胆囊未显示胎儿(NVFGB)各种结局的发生率.方法 计算机检索PubMed、The Cochrane Library、Elsevier、ClinicalKey、CBM、CNKI和WanFang Data数据库,搜集关于产前超声筛查发现NVFGB胎儿不同围产期结局的相关性研究,检索时限均从1990年1月到2019年3月.由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R 3.5.2软件进行Meta分析.结果 共纳入9个研究.Meta分析结果显示:NVFGB胆道闭锁的发生率为1.0％,其中孤立性NVFGB胆道闭锁的发生率为2.0％,非孤立性NVFGB胆道闭锁的发生率为3.0％.囊性纤维化的发生率为6.0％,其中孤立性NVFGB囊性纤维化的发生率为2.0％,非孤立性NVFGB囊性纤维化的发生率为9.0％.染色体异常发生率为5.0％,其中非孤立性NVFGB染色体异常发生率为31.0％.其他畸形率为13.0％,其中非孤立性NVFGB其他畸形的发生率为44.0％.胆囊发育不良或缺如的发生率为22.0％,孤立性NVFGB胆囊发育不良或缺如的发生率为28.0％.胆囊最终显示且胎儿正常的发生率为53.0％,其中孤立性NVFGB最终胆囊显示且胎儿正常率为63.0％.结论 当前证据显示,单次筛查为NVFGB大多数于妊娠期后期或新生儿期行超声复查可发现胆囊的存在.对于超声明确诊断为孤立性NVFGB发生胆囊缺如或胆囊发育不良的可能性较高,而非孤立性NVFGB发生胆道闭锁、囊性纤维化(尤其在胎儿肠管回声增强的情况下)、染色体异常(尤其是染色体非整倍体)的可能性较高.

预防教育是解决毒品问题的治本之策,禁毒宣传教育在禁毒工作中具有重要地位和作用,做好禁毒宣传教育工作,需要以史为鉴.本文梳理了中国禁毒宣传教育史的相关研究,将中国禁毒宣传教育的历史发展分为兴起、初步发展、发展成熟、发展高潮、全面发展五个阶段,总结了中国禁毒宣传教育历史发展的经验教训.中国禁毒宣传教育史研究已取得了一定成果,但是系统性专门性的中国禁毒宣传教育史研究还相对欠缺.中国禁毒宣传教育的发展历史有待更系统、更具体、更深入的研究.

目的 运用超声测量并建立不同孕周胎儿子宫前后径的正常值范围,探讨胎儿子宫前后径与孕周的相关性.方法 常规产前超声检查的1 818例24～38周孕妇中选取符合条件的样本库,对其胎儿进行子宫前后径的测量,按孕周分组,进行统计学分析.结果 总共1 745例进行最后的统计分析,子宫前后径与孕周呈正相关,相关系数为r=0.990 (P＜0.001).以孕周为自变量,胎儿子宫前后径为因变量,直线回归分析得出自变量与因变量之间存在的直线关系,将所得方程进行简化,得出简易公式:子宫前后径(mm)=孕周×0.5-8.结论 成功建立了孕24～38周胎儿子宫前后径的直线回归方程,为胎儿外生殖器异常及子宫发育异常的诊断提供有价值的信息.

This article briefly reviewed the development of nursing-sensitive quality indicators. On this basis, it expounded the connotation and clinical application of nursing-sensitive quality indicators for critical care. Problems that exposed during building and implementing these indicators were also discussed. The main purpose of this literature review is to provide evidence for improving nursing quality assessment in ICU settings.

A health nursing work environment can improve nurses' working satisfaction and job retention, which is an important indicator reflecting the quality of nursing care and patient safety. This article expounds the connotation of nursing working environment,reviews the research status and extracts the improvement strategies for the future.

中国性学会性人文专委会在2017年、2018年连续两年以“性/性别与社会”为题召开了学术讨论会.两次讨论会收到的论文涉及的内容非常广泛.呈现出以下特点,一是主题多元,涉及“性行为与性观念的变迁” “性别平等与和谐家庭建设” “青少年(大学生)的性行为与婚恋观念”等;二是多学科视角,从社会学视角下的家庭变革与改造到哲学视角下性快乐本质的思考;三是时间跨度大,从古代的女性观到当代酷儿理论视角下的性别身份;四是中外兼有,从中国的性学研究到马来西亚的舞女历史.

总结造血干细胞移植术后弥漫性肺泡出血患者的护理经验.分析2014年3月~2015年11月本院重症医学科收治的19例造血干细胞移植术后弥漫性肺泡出血患者的临床资料,对护理进行回顾性总结.在这19例患者中,死亡6人,转回病患当地医院继续治疗4人,转回病房继续治疗9人.认为造血干细胞移植术后弥漫性肺泡出血患者死亡率很高,辅助有效的护理是患者救治成功的重要保证.

Objective To evaluate the mesh implants following minimally invasive abdominal sacrocolpopexy using three-dimensional ultrasound with OmniView and volume contrast imaging.Methods Sixteen patients underwent the mesh implant were examined from the 6 months to 1 0 months after sacrocolpopexy retrospectively by 3D OmniView combining with VCI to view the mesh at rest and on Valsalva.Results Nine cases appeared straight flat and 7 cases appeared folded or shrinkage among the 16 cases mesh implants.3D Omniview combining with VCI could image all the cases of mesh in any planes. The imaging rate was 100%.Conclusions 3D OmniView combining VCI can well image the mesh implants appeared shrinkage or folded.