目的 分析探讨案例式教学法在超声科教学中的应用效果.方法 对我院超声科2020年1—10月所开展的超声科教学质量开展回顾性分析,所有见习医师的一般资料均齐全,对本次研究知情.两组均选用人民卫生出版社《医学影像学》第6版教材,均讲授临床常见疾病的超声诊断知识.其中观察组的25名见习医师接受案例式教学法,教学手段以多媒体为主,对照组的25名见习医师接受常规教学法,对两组见习医师教学后的理论成绩、实践操作成绩及教学满意度加以比较.结果 观察组理论成绩与实践操作成绩高于对照组(t1=6.963,t2=9.109,P<0.05);观察组教学满意度高于对照组(χ2=12.500,P<0.05),所有指标比较差异有统计学意义(P<0.05).结论 案例式教学法在超声科教学中效果显著,可显著提升见习医师的理论成绩与实践操作能力,且可以得到见习医师的认可,激发其学习积极性与主观能动性.因此,值得将案例式教学法推广应用至超声科带教中.

课程思政是将思想政治教育的元素有机融入专业课教育教学全过程的一种综合教育理念,是实施德育的重要途径.经调查发现,农村订单定向医学生自愿服务基层的意识不强,服务期满后继续服务基层率低.通过从教师思想政治素养、教师榜样的引领作用、课程思政示范课的建立、课程思政评价体系的构建和校院支持等方面研究,探讨新时代背景下农村订单定向医学生课程思政建设的路径,引导农村订单定向医学生树立正确的人生观、价值观,提高其自愿服务基层的意识,培养"下得去、留得住、用的上"的基层卫生人才,以助力"健康中国"建设.

目的 探讨肌骨超声规范化培训教学的相关模式的教学效果.方法 纳入2018年1月—2020年1月期间实习生60名,按照随机数字表法分为观察组及对照组各30名,给予对照组常规培训教学,观察组为CBL教学法结合workshop,观察两组实习生对对自己肌骨超声诊断水平提高效果的满意度.结果 观察组的肌骨超声扫查方法、超声解剖正确率、常见疾病的超声诊断准确率以及总正确率均高于对照组,差异有统计学意义(P<0.05).观察组的肌骨超声教学的综合满意度评分高于对照组,差异有统计学意义(P<0.05).观察组对自己肌骨超声诊断水平提高效果的满意度高于对照组,差异有统计学意义(P<0.05).结论 通过CBL教学法结合workshop的实施,确保了实习生迅速了解肌肉以及骨骼的超声解剖理论知识,提高了其对常见肌肉骨骼系统疾病的独立诊断能力,明显提高了肌骨超声培训的教学效果,实习生感到更加满意,因此该教学模式值得推广应用.

患者女性,29岁,孕1产0,自然受孕,未服用过合成激素类药物,孕24周4天,外院检查诊断为胎儿左侧多囊性发育不良肾,转诊至滨州医学院烟台附属医院检查.常规超声检查所见:右侧肾大小及位置正常.胎儿左侧肾窝未探及正常肾回声反射,可见一多囊样厚壁无回声团块,壁厚1～3 mm,内透声良好,其中两个较大的无回声区之间借不完全分隔互相联通,范围约22.7 mm×14.9 mm,上述较大无回声区内侧可见数个孤立互不相通的小无回声区(大者约5.3 mm×4.4 mm;图 1).

目的 探讨采用多元化教学法联合"专业学习共同体"在肌骨超声教学的应用效果.方法 选取2017年6月—2019年10月在医院超声科学习的96名医生,按照随机数字表法分为对照组及观察组,每组48名.对照组人员接受"专业学习共同体"教学法,观察组人员在此基础上联合多元化教学法,教学结束后比较两组教学效果.结果 教学结束后,观察组自我评价得分显著高于对照组(P<0.05);观察组理论知识考核及技能考核成绩均显著高于对照组(P<0.05);观察组教学满意度显著高于对照组(P<0.05).结论 多元化教学法联合"专业学习共同体"在肌骨超声教学的应用效果更佳,有助于提高教学效果和教学满意度.

目的 对线上联合超声体模线下教学模式在超声介入教学中的应用价值进行分析.方法 选取本院2019年1月—2020年1月期间的12名超声介入实习生为本次研究对象,应用数字随机表对实习生进行分组,即对照组与实验组各6名.对照组运用超声体膜线下教学模式,实验组运用线上联合超声体膜线下教学模式分别开展教学工作,对比教学效果.结果 与对照组比较,实验组在临床思维能力、病情观察评估能力、专业知识点掌握能力、规范动手能力、表达沟通能力、应变处理能力和人文关怀及素质方面得分均较高,差异均有统计学意义(P<0.05);同时,实验组实习生对课程安排、授课方式及带教教师的评分均更高(P<0.05).结论 线上联合超声体模线下教学模式在超声介入教学中发挥着重要价值,可有效提高实习生临床工作能力,为临床输送更多优秀人才,应用前景广阔.

目的 分析探讨问题-讨论-指导教学法在本科消化专科护理教学中的应用价值与效果.方法 将我校2019级本科护士5班作为对照组,2019级本科护士6班作为观察组,均有学生58名.对照组接受常规教学模式,理论课程30学时,临床实习8学时,观察组接受问题-讨论-指导教学法,自我训练8学时,临床见习16学时,启发讨论10学时,定期小结3学时,进而对两组测试成绩、对教学效果认可度及对教学方法的满意度加以比较.结果 观察组的理论知识评分、操作技能评分均高于对照组,比较差异均有统计学意义(P<0.05),对教学效果认可度及对教学方法的满意度均高于对照组,所有指标比较差异均有统计学意义(P<0.05).结论 问题-讨论-指导教学法在本科消化专科护理教学中有良好的应用效果,可以提升护理教学质量,得到学生的认可,教学效果显著.因此可以考虑将讨论式教学法进一步推广应用至本科消化专业护理教学中.

目的 探究剪切波弹性成像在酒精性周围神经病变中的诊断价值.方法 选取98例慢性酒精中毒患者,根据是否伴有酒精性周围神经病变分为病变组(观察组)49例以及无病变组(对照组)49例,另选同期体检的健康人群49例为健康对照组.采用神经肌电图检测、超声检查以及剪切波弹性成像对患者进行神经功能的检测诊断,比较三组患者的神经功能等指标的差异,比较不同检测手段的灵敏度等.结果 三组患者在维生素B12 (B12)和叶酸(FA)比较上,对照组以及健康对照组均高于观察组,差异有统计学意义(P＜0.05).观察组的运动传导速度(MCV)及感觉传导速度(SCV)明显低于对照组以及健康对照组(P＜0.05),观察组的CSA以及杨氏模量值明显高于对照组以及健康对照组(P＜0.05).Spearson相关性分析显示,杨氏模量值与性别、年龄、BMI无明显相关性(P＞0.05),与饮酒时间、MCV、SCV以及CSA存在显著相关(P＜0.05).神经肌电图联合剪切波弹性成像分析具有最高的灵敏度(94.32％)、特异度(91.82％),神经肌电图联合剪切波弹性成像曲线下面积明显高于其余两组,差异具有统计学意义(P＜0.05).结论 酒精性周围神经病变患者的神经功能下降,采用神经肌电图联合剪切波弹性成像检测具有较高的灵敏度和特异度,在诊断中具有一定的应用价值.

目的 探讨以滋养层血流作为早期宫内妊娠(IUP)的诊断标志在临床中的应用.方法 对120例意外妊娠患者进行阴道彩色多普勒超声检查,将二维图像、血流分布及频谱特征进行回顾性分析并将105例宫内妊娠与105例非妊娠育龄期妇女比较,将意外妊娠患者超声检查结果与手术病理结果或临床随访结果进行对照分析并对宫内液性暗区旁双向血流频谱的峰值流速(PSV)、舒张期末速度(EDV)、最大收缩期速度(S)与舒张期末速度(D)的比值(S/D)、阻力指数(RI)构建ROC曲线.结果 宫内妊娠妇女滋养层血流的PSV(10.37±4.35)cm/s,EDV(5.48±2.32) cm/s,S/D 1.92±0.23,RI 0.47±0.06与子宫螺旋动脉的PSV(16.0±4.03) cm/s,EDV(6.47±1.82) cm/s,S/D 2.53±0.31,RI 0.60±0.05相比,差异均具有统计学意义(均P＜0.05),滋养层血流频谱形态不同于子宫螺旋动脉.以宫内液性暗区旁双向血流频谱PSV、EDV、RI、S/D构建的ROC曲线下面积分别为0.856、0.65、0.981、0.978.结论 滋养层血流频谱形态不同于子宫螺旋动脉,可以作为诊断早期IUP的标志,并且可以将诊断早期宫内妊娠的时间提前到卵黄囊出现之前,具有重要的临床应用价值.

Objective To evaluate the cardiac structure and ventricular function in elderly patients with persistent atrial fibrillation( PAF) by two?dimensional and real time three?dimensional echocardiography. Methods From January 2015 to December 2016,50 patients with PAF more than 15 years in the Second Affiliated Hospital of Dalian Medical University were enrolled as experimental group;50 healthy subjects in the same period were selected as control group. The parameters of the conventional two?dimensional echocardiography were obtained respectively for experimental group and control group:the area of left atrial end?diastolic( LAA);the area of right atrial end?diastolic ( RAA);left ventricular end?diastolic dimension ( LVDd );left ventricular end?systolic dimension ( LVDs );end?diastolic thickness of ventricular septum (IVSTd);end?diastolic thickness of LV posterior wall(LVPWd);mitral regurgitation(MR);right ventricular end?diastolic dimension( RVDd );tricuspid regurgitation( TR);the rate change of inferior vena cava(ΔIVC);diastolic flow velocity of mitral valve diastolic and tricuspid valve were measured by spectral Doppler, and diastolic velocity of mitral and tricuspid annular plane by tissue Doppler imaging, then E/E ' were calculated. The parameters of the three?dimensional echocardiography parameters were obtained for experimental group and control group:end?systolic volume ( ESV );end?diastolic volume ( EDV );ejection fractions of Simpson ( EF ) . Results Conventional parameters:there were no significant differences between experimental group and control group of LVDd,LVDs,IVSTd and LVPWd(all P>0. 05);The LAA, MR,RAA,RVDd ,E/E' ,TR of experimental group were significantly higher than those in the control group (all P< 0. 05),TheΔIVC of experimental group was decreased significantly than those in the control group (P<0. 05 or P<0. 01). Three?dimensional parameters:the RVEDV,RVESV were significantly higher and RT?RVEF significantly lower in the experimental group than in the control group(all P<0. 05). LVEDV, LVESV were higher than control groups, and LVEF was lower than control groups, but without statistical significance(all P>0. 05). Conclusions Real?time Three?Dimensional echocardiography is independent of the ventricular geometry and can accurately evaluate left ventricular volume and ejection fraction. In elderly patients with atrial fibrillation and long?term poorly controlled ventricular rate, double atrium and right ventricle are enlarged and heart function,especially right ventricular function decreased.

Objective To evaluate the ventricular function in patients with lone Atrial Fibrillation (LAF) by quantitative Tissue Velocity Imaging (QTVI), mitral annular displacement (MAD)and tricuspid annular plane systolic excursion (TAPSE). Methods Thirty-six patients with LAF served as experimental group.Thirty normal volunteers served as control group.The values of right ventricle (RV) and left ventricle (LV), MAD and TAPSE were evaluated by M-mode ultrasound. Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) were calculated by Simpson's method. Mitral inflow velocity and tricuspid inflow velocity (E) were measured by Doppler echocardiography. QTVI derived systolic mitral annular velocity, systolic tricuspid annular velocity (Vs), diastolic mitral annular velocity, diastolic tricuspid annular velocity (Ve), and the ratio of diastolic mitral inflow velocity to Ve and diastolic tricuspid inflow velocity to Ve (E/Ve) were calculated. Results Compared with the values in control group, the E, E/Ve of LV were significantly higher and the Ve, Vs and MAD of LV were significantly lower in LAF group (all P 0.05). Conclusions Both LV and RV functions are impaired in patients with LAF. Key words: Echocardiography; Atrial fibrillation; Ventricular function

Objective To evaluate the structure and function of right atrium (RA) in patients with hypertension atrial fibrillation (HAF) and lone atrial fibrillation (LAF) by AVT. Methods Sixty patients with atrial fibrillation were divided into LAF group (n=36) and HAF group (n=24). Thirty normal volunteers served as control group. Interventricular septum thickness at end diastole (IVSTd), left ventricular posterior wall thickness at end diastolic(LVPWTd), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension(LVESD), right ventricular end-diastolic dimension(RVEDD)were evaluated by M-mode ultrasound. Left ventricular ejection fraction (LVEF) was calculated by Teich method. Echocardiographic evaluations included RA major dimension (RAD1), RA minor dimension (RAD2), LA diameter (LAD1), LA major dimension (LAD2) and LA minor dimension (LAD3). RA maximal area (RAAmax), RA maximal volume(RAVmax), RA minimal volume (RAVmin), systolic RA filling rate (dv/dtS) and early diastolic RA emptying rate (dv/dtE) were derived using AVTM. Then the RA emptying fraction (RAEF) was calculated. Results Compared with the values in control group, the RAD1, RAD2, RAAmax, RAVmax, RAVmin and dv/dtE, LAD1, LAD2, LAD3 were significantly higher and RAEF, dv/dtS were significantly lower in atrial fibrillation group (all P 0.05). RAD1, RAD2, RAAmax, RAVmax, RAVmin, dv/dtE were significantly higher and LAD1, LAD2, LAD3, RAEF, dv/dtS significantly lower in LAF group compared with HAF group (all P<0.05). Conclusions Compared with HAF patients, RA function is significantly impaired in patients with LAF. AVT can evaluate RA function accurately and simply. Key words: Atrial fibrillation; Echocardiography; Right atrial emptying fraction; Atrial volume tracking

目的 应用超声心动图技术评价高血压性心房颤动(hypertension atrial fibrillation,HAF)及孤立性心房颤动(lone atrial fibrillation,LAF)患者的左心室收缩、舒张功能.方法 将50例心房颤动患者,分为孤立性房颤组,高血压性房颤组,分别采集房颤患者的心室率、左房左室结构参数、二尖瓣血流频谱、彩色M型及二尖瓣环的组织多普勒运动曲线上的参数,并与正常对照组比较.结果 较正常对照组,房颤组心室率、左房结构参数、二尖瓣血流频谱及彩色M型、二尖瓣环组织多普勒运动曲线上的参数差异有统计学意义(P＜0.05),较孤立性房颤组,高血压性房颤组彩色M型、二尖瓣环组织多普勒运动曲线上的参数差异有统计学意义(P＜0.05).结论 (1)房颤组患者在左室结构未改变时,左房增大,其左室收缩、舒张功能已受损；高血压房颤组较孤立性房颤组左室功能损害更明显；(2)组织速度成像、彩色M型能敏感、快速、准确地定量分析房颤患者的心功能.

Objective To evaluate left ventricular global and regional systolic function by two-dimensional speckle tracking imaging in patients with left anterior descending artery(LAD) single vessel disease. Methods A total of 75 patients underwent coronary angiography were enrolled.Of those 27 with normal coronary angiogram as control group,25 patients with LAD single vessel lesion between 50% and 75% stenosis as group A,and 23 with LAD single vessel lesion more than 75% stenosis as group B.High frame rate two-dimensional images were recorded from the apical two-chamber view,long-axis view of the left ventricle and the left ventricular short-axis views at the levels of mitral va1ve and apex by Echocardiography.longitudinal Strain(LS) of the segments supplied by LAD,the peak basal and apical rotation(Rot-base,Rot-apex) in basal and apical plane and peak LV-tor were calculated using Echo PAC software.Left ventricular wall motion amplitude,left ventricular ejection fraction(LVEF) and fractional shortening(FS) were measured by M-mode ultrasound under resting state. Results No significant difference was found for LS and LV-tor between group A and control group(P>0.05).Compared to control group and group A,LS of the segments supplied by LAD(-24.2±1.8 vs.25.2±1.8 and 25.1±1.4,both P=0.037) and LV-tor(16.4±1.2 vs.17.2±1.1 and 16.7±1.1,both P=0.041) was significantly decreased in group B.LVEF and FS were similar among three groups(P>0.05). Conclusions LS and LV-tor decreased suggests left ventricular regional and global systolic function are affected in patients with LAD single vessel disease with ≥75% stenosis.

Objective To evaluate the changes of left atrial(LA) function in patients with hypertensive atrial fibrillation and lone atrial fibrillation using left atrial volume tracking(LAVT) method.Methods Fifty patients with atrial fibrillation were divided into lone atrial fibrillation group(n=24) and hypertensive atrial fibrillation group(n=26).Twenty-five normal volunteers served as control group.Left ventricular end-diastolic dimension(LVEDD),left ventricular end-systolic dimension(LVESD),interventricular septum thickness at end diastole(IVSTd),left ventricular posterior wall thickness at end diastolic(LVPWTd)were evaluated by M-mode ultrasound.Left ventricular ejection fraction(LVEF) were calculated by Teich method.Echocardiographic evaluations included LA diameter(LAD1),LA major dimension(LAD2),LA minor dimension(LAD3),RA major dimension(RAD1),RA minor dimension(RAD2).LA maximal area(LAAmax),LA maximal volume(LAVmax),LA minimal volume(LAVmin),systolic LA filling rate(dv/dtS),early diastolic LA emptying rate(dv/dtE) and late diastolic emptying rate(dv/dtA) were derived using LAVT.Then calculated the LA emptying fraction(LAEF).Results Compared with control group,the LAD1,LAD2,LAD3,RAD1,RAD2,LAAmax,LAVmax,LAVmin and dv/dtE were significantly increased and the LAEF,dv/dtS,dv/dtA significantly decreased in lone atrial fibrillation group.There were no significant differences in LVEDD,LVESD,IVSTd,LVPWTd,LVEF between lone atrial fibrillation group and contral group(all P>0.05).Compared with control group,the LAD1,LAD2,LAD3,RAD1,RAD2,LAAmax,LAVmax,LAVmin and dv/dtE were significantly increased and the LAEF,dv/dtS,dv/dtA significantly decreased in hypertensive atrial fibrillation group.There were no significant differences in LVEDD,LVESD,IVSTd,LVPWTd,LVEF between hypertension atrial fibrillation group and control group(P>0.05).The LAAmax,LAVmax,LAVmin were significantly higher and the LAEF,dv/dtS,dv/dtE,dv/dtA significantly lower in hypertensive atrial fibrillation group compared with lone atrial fibrillation group(all P<0.05).There were no significant differences in LAD1,LVEDD,LVESD,IVSTd,LVPWTd,LVEF,LAD2,LAD3,RAD1,RAD2,between hypertensive atrial fibrillation group and lone atrial fibrillation group(all P>0.05).Conclusions Left atrial function of atrial fibrillation patients is impaired.Compared with LAF patients,LA function is significantly impaired in patients with HAF.LAVT can evaluate left artial size and function in patients with atrial fibrillation accurately and rapidly.