目的 探讨基于加速康复外科(ERAS)理念联合人文关怀护理在内镜黏膜切除术(EMR)患者中的应用效果.方法 选取医院2021年1月—2022年1月收治的103例行EMR治疗的患者为研究对象,依据患者基本资料具有可比性的原则分为对照组42例和观察组61例.对照组采用常规人文关怀护理,观察组在对照组基础上接受ERAS理念护理模式.比较两组患者一般临床指标、干预前后焦虑自评量表(SAS)、抑郁自评量表(SDS)、世界卫生组织生活质量测定量表简表(WHOQOL-BREF)评分及患者对护理满意程度.结果 护理干预后,观察组置管时间、首次进食时间、术后排便时间、首次下床时间、平均住院时间短于对照组,NRS评分低于对照组,组间比较差异有统计学意义(P<0.05);护理干预后,两组患者WHOQOL-BREF量表各项评分均明显上升且观察组高于对照组,组间比较差异有统计学意义(P<0.05);两组患者SAS、SDS量表评分均下降且观察组低于对照组,组间比较差异有统计学意义(P<0.05).护理干预后,观察组患者对护理满意程度高于对照组,组间比较差异有统计学意义(P<0.05).结论 将ERAS理念联合人文关怀护理应用在EMR患者中效果理想,能够明显提高患者术后生存质量、改善不良情绪,提高护理满意水平.

Background: Iodiene-131 (I-131) treatment is the primary therapeutic approach for imaging I-131-avid pulmonary metastases. The response to radioiodine (RAI) treatment is an important prognostic factor in patients with pulmonary metastases from differentiated thyroid cancer (DTC). Patients who achieve an excellent response (ER) to I-131 treatment show significantly reduced disease-related mortality. This study aimed to retrospectively analyse the clinical data and therapeutic effects of I-131 treatment in patients with DTC and pulmonary metastases and to screen out the clinical factors affecting ER. Materials and methods: The study included a total of 75 patients with exclusively Iodine-131 avid (I-131-avid) pulmonary metastases who underwent I-131 treatment. Relevant clinical data for these patients were collected. Following treatment, the status of DTC metastatic lesions was categorized as follows: excellent response (ER), biochemical incomplete response (BIR), structural incomplete response (SIR), or indeterminate response (IDR). Gender, age at diagnosis, pathological type, stages (TNM), stimulated thyroglobulin (sTg) value before initial I-131 treatment, metastatic nodule size, and type of post-treatment whole body scan (Rx-WBS) were recorded. Mono-factor analysis and binary logistic regression analyses were used to identify the factors that might affect the ER in DTC pulmonary metastases. The receiver operating characteristic (ROC) curve of the sTg value was used to predict the ER of I-131 treatment. Results: All 75 patients with exclusively I-131-avid pulmonary metastases received I-131 treatment and underwent follow-up. Out of the 75 patients, 26 achieved ER, resulting in an excellent response rate of 34.7 % (26/75). Among them, 25 (25/26, 96.2 %) achieved an ER after undergoing two rounds of I-131 treatment. Binary logistic regression analysis showed that the factors influencing DTC pulmonary metastases excellent response were lower sTg levels [odds ratio (OR) = 0.998, P < 0.001], micronodular metastases (OR = 0.349, P = 0.001) and focal distribution on Rx-WBS imaging (OR = 0.113, P = 0.001). The area under the ROC curve for sTg value predicting ER was 0.876, and the cut-off value was 26.84 ng/mL, with a sensitivity and specificity of 87.9 % and 80.3 %, respectively. Conclusions: I-131 treatment is effective for I-131-avid pulmonary metastases of DTC. Some patients who underwent I-131 treatment achieved ER. Most patients with ER were obtained after two rounds of I-131 treatments. Patients with sTg values before initial I-131 treatment lower than 26.84 ng/mL, micronodular metastases, and focal distribution on Rx-WBS imaging were more likely to achieve ER.

目的 探讨阴道B超引导下减胎术治疗ART术后宫内妊娠合并宫角妊娠(CHP)的效果.方法 回顾性分析2015年1月至2021年4月在我院生殖中心行体外受精-胚胎移植(IVF-ET)及冻融胚胎移植(FET)治疗后获得妊娠并经B超检查确诊为CHP的7例患者的临床资料,记录患者的年龄、不孕年限、孕产次、输卵管情况、移植胚胎情况及B超检查情况等,分析7例患者的治疗方案和预后情况.结果 2015年1月至2021年4月我院生殖中心助孕妊娠患者中C H P发生率为0.072％.7例患者均行减胎术治疗,其中2例采用腹腔镜监控下经阴道B超引导宫角异位妊娠减胎术,5例直接采用经阴道B超引导下选择性宫角妊娠减胎术.7例患者均1次减胎成功,无术中大出血症状,其中6例孕足月行剖宫产,1例孕36 W因胎膜早破行剖宫产,新生儿出生情况均良好,Apgar评分8～10分.结论 采用经阴道B超引导下抽吸减胎术治疗CHP可以有效终止宫角妊娠和保留宫内妊娠,且具有手术时间短、创伤小、恢复快等优点,可作为CHP治疗的可选术式之一.

目的:观察拮抗剂方案中应用不同扳机药物对体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)患者妊娠结局的影响.方法:回顾性分析2017年1月至2020年6月行IVF/IC-SI-ET助孕患者的临床资料,根据拮抗剂方案中扳机用药不同分为促性腺激素释放激素激动剂(Gn-RH-a,0.1 mg)+绒促性素(HCG,2000 U)组和HCG组(10000 U),经1∶1倾向性匹配评分后,两组各79例.比较两组扳机日激素水平[雌二醇(E2)、孕酮(P)、促黄体生成素(LH)]、卵泡直径、卵泡微环境[胰岛素样生长因子Ⅰ(IGF-Ⅰ)、胰岛素样生长因子结合蛋白Ⅰ(IGFBP-Ⅰ)]、促排卵助孕及妊娠结局,并评价不同卵巢储备功能的妊娠结局.结果:①两组扳机日E2、P、LH水平及直径≥18 mm卵泡数比较,差异无统计学意义(P＞0.05);②GnRH-a+HCG组取卵日血清及卵泡液IGF-1、IGFBP-1水平均较HCG组明显升高(P＜0.05).③GnRH-a+ HCG组成熟卵数、可利用胚胎数、优质胚胎数、受精率、卵子利用率、优质胚胎率均较HCG组升高(P＜0.05);GnRH-a+ HCG组卵巢过度刺激综合征(OHSS)发生率(1.27％)较HCG组(11.39％)明显下降(P＜0.05);但两组生化妊娠率、临床妊娠率、流产率及活产率比较,差异均无统计学意义(P＞0.05).④卵巢储备功能正常(106例)患者中,GnRH-a+ HCG组成熟卵数、可利用胚胎数、优质胚胎数、受精率、卵子利用率、优质胚胎率均较HCG组升高(P＜0.05),OHSS发生率较HCG组下降(P＜0.05);DOR(52例)患者中,GnRH-a+ HCG组成熟卵数、可利用胚胎数、优质胚胎数、优质胚胎率、活产率均较HCG组升高(P＜0.05).结论:IVF/ICSI-ET患者采取GnRH-a联合HCG扳机可更好改善卵泡微环境,有利于提高胚胎质量、减少OHSS风险,且无论患者卵巢储备功能正常与否,均能从GnRH-a联合HCG扳机中获得一定收益.

目的 观察体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)反复种植失败患者宫腔镜检查情况及子宫内膜CD138表达情况,探讨子宫内膜CD138阳性表达联合宫腔镜检查对IVF-ET反复种植失败患者合并慢性子宫内膜炎的诊断价值.方法 行IVF-ET的患者147例,其中反复种植失败患者81例为失败组,一次移植成功患者66例为成功组,2组患者均行宫腔镜检查及子宫内膜组织病理检查,观察慢性子宫内膜炎发生情况;2组均行子宫内膜组织免疫组织化学检查,观察子宫内膜组织CD138阳性表达情况.比较不同临床病理特征的IVF-ET反复种植失败患者子宫内膜组织CD138阳性表达率;绘制ROC曲线,评估子宫内膜组织CD138阳性表达、宫腔镜检查对IVF-ET反复种植失败患者合并慢性子宫内膜炎的诊断效能.结果 失败组患者宫腔镜检查慢性子宫内膜炎检出率(60.49％)、子宫内膜组织病理检查慢性子宫内膜炎检出率(39.51％)、子宫内膜组织CD138阳性表达率(60.49％)均高于成功组(24.24％、10.61％、37.88％) (P＜0.05).有经期延长、慢性子宫内膜炎、输卵管阻塞、移植次数＞3次的IVF-ET反复种植失败患者子宫内膜组织CD138阳性表达率(88.24％、92.31％、66.18％、87.50％)分别高于无经期延长、无子宫内膜炎、无输卵管阻塞、移植次数2～3次者(53.13％、3.45％、30.77％、53.85％)(P＜0.05),不同年龄、体质量指数、月经周期、不孕时间及有无孕产史、既往流产史、宫颈衣原体感染、阴道炎史、宫颈支原体感染、盆腔炎的IVF-ET反复种植失败患者子宫内膜组织CD138阳性表达率比较差异均无统计学意义(P＞0.05).子宫内膜组织CD138阳性表达和宫腔镜检查诊断IVF-ET反复种植失败患者合并慢性子宫内膜炎的AUC分别为0.620(95％CI:0.496～0.744,P=0.069)、0.568(95％CI:0.441～0.696,P=0.301),灵敏度分别为75.0％、68.75％,特异度分别为48.98％、44.90％;二者联合诊断IVF-ET反复种植失败患者合并慢性子宫内膜炎的AUC[0.785(95％CI:0.685～0.886,P＜0.001)]大于单独检测(Z=3.823,P＜0.001;Z=4.528,P＜0.001),灵敏度为93.75％,特异度为63.27％.结论 有经期延长、慢性子宫内膜炎、输卵管阻塞、移植次数＞3次的IVF-ET反复种植失败患者子宫内膜组织CD138阳性表达率增高;子宫内膜组织CD138阳性表达联合宫腔镜检查可提高对IVF-ET反复种植失败患者合并慢性子宫内膜炎诊断率.

目的 观察不同容量0.08％罗哌卡因复合0.3 μg/mL舒芬太尼用于程控硬膜外间歇脉冲注入分娩镇痛的效果.方法 选择行硬膜外分娩镇痛的产妇150例,随机分为3组,每组50例.记录所有产妇镇痛前(T0)、镇痛后30 min(T1)、镇痛后1 h(T2)、镇痛后2h(T3)、镇痛后3h(T4)、镇痛后4h(T5)、镇痛后5 h(T6)、镇痛后6 h(T7)的疼痛视觉模拟评分(VAS)、最高感觉消失平面以及下肢运动神经阻滞程度(Bromage)评分.记录新生儿出生后1 min和5 min的Apgar评分.记录产妇分娩镇痛期间恶心呕吐、低血压、尿潴留、皮肤瘙痒和发热的发生率以及镇痛结束后产妇满意度评分.结果 与6mL组相比,T3-T7时刻8mL组VAS评分明显降低,T2～T7时刻10mL组VAS评分明显降低(P＜0.05).三组最高感觉消失平面比较:10 mL组感觉消失平面最高,8 mL组居中,6 mL组最低.10 mL组分娩镇痛用药量大于6 mL组和8 mL组;6 mL组镇痛泵按压次数明显高于8 mL和10 mL组;三组产妇满意度评分均较满意;三组新生儿1 min及5 min的Apgar评分比较差异无统计学意义.三组产妇的恶心呕吐、低血压、尿潴留、皮肤瘙痒和发热等不良反应差异无统计学意义.结论 每40 min脉冲式输注0.08％罗哌卡因复合0.3 μg/mL舒芬太尼8 mL可有效实施分娩镇痛,同时麻醉用药总量更少,产妇感觉消失平面更低,对母婴影响更小.

目的:观察高压氧(HBO)联合常规物理因子治疗对Perthes病患儿髋关节血流的影响，为临床治疗小儿股骨头缺血坏死提供参考资料。方法:采用随机数字表法将48例Perthes病患儿分为HBO组及对照组，每组24例。2组患儿均给予常规物理因子治疗(包括蜡疗、中频电疗、磁疗、红外偏振光疗等)，观察组患儿在此基础上辅以HBO治疗。2组患儿均每天治疗1次，治疗10 d为1个疗程，均治疗2个疗程。于治疗前、治疗后分别采用彩色多普勒超声检测2组患儿股骨头外侧颈升动脉血流收缩期峰值流速(PSV)及阻力指数(RI)，并行髋关节彩色多普勒血流显像(CDFI)评级(其结果分为0～Ⅲ级)。结果:治疗后发现HBO组及对照组患儿PSV[分别为(25.27±5.23)cm/s和(22.18±4.39)cm/s]、RI[分别为(0.55±0.05)和(0.58±0.04)]及CDFI评级均较治疗前明显改善( P<0.05)；并且观察组上述指标改善幅度均显著优于对照组水平，组间差异均具有统计学意义( P<0.05)。 结论:常规物理因子联合HBO治疗能进一步改善Perthes病患儿髋关节血流情况，对缓解患儿病情具有重要临床意义。

目的 探讨体外受精-胚胎移植(IVF-ET)后应用来曲唑联合加尼瑞克预防早发型卵巢过度刺激综合征(OHSS)的临床效果.方法 选取2019年3月至2021年3月于郑州大学第二附属医院接受IVF-ET的85例患者,随机分为对照组(n=42)与研究组(n=43);取卵后,对照组使用来曲唑预防,研究组使用来曲唑联合加尼瑞克,均用药3 d.比较两组患者早发型OHSS总发生率和严重程度、助孕情况[平均获卵数、受精率、卵裂率];比较用药3d后两组患者B超监测情况[卵巢最大直径、腹水];比较两组患者用药前和用药3d后血清性激素水平[卵泡刺激素(FSH)、雌二醇(E2)、促黄体生成素(LH)].结果 研究组早发型OHSS总发生率(11.63％,5/43)低于对照组(28.57％,12/42),差异有统计学意义(χ2=4.525,P=0.033);研究组早发型OHSS严重程度显著小于对照组(P<0.05);两组患者平均获卵数、受精率、卵裂率比较差异未见统计学意义(P>0.05);用药3 d后,研究组患者卵巢最大长径、腹水水平均明显小于对照组(P<0.05);用药3 d后两组患者E2、FSH和LH水平均较用药前显著降低,且研究组显著低于同一时间对照组(P<0.05).结论 来曲唑联合加尼瑞克用于IVF-ET可有效预防早发型OHSS发生,降低其性激素水平且不影响助孕结局.

Objective:To observe the effects of vaginal administration of different doses of femoston on endometrial receptivity in patients with moderate-to-severe intrauterine adhesions (IUA).Methods:Totally 94 patients with intrauterine adhesions admitted to the Second Affiliated Hospital of Zhengzhou University from May 2019 to May 2020 were selected as the research subjects, and they were randomly divided into observation group and control group, with 47 cases in each group. Patients in control group were treated with vaginal administration of conventional dose of femoston, and patients in observation group were given vaginal administration of high dose of femoston. The endometrial receptivity score (Salle score), endometrial thickness and levels of serum sex hormones including estradiol (E2), follicle stimulating hormone (FSH), luteinizing hormone (LH) before treatment and after 12 weeks of treatment and menstruation and uterine cavity re-adhesion after 12 weeks of treatment were compared between the two groups, and the occurrence of adverse drug reactions were record in the two groups within 12 weeks of treatment.Results:After 12 weeks of treatment, the endometrial thickness, Salle score and serum E2 level in the two groups were significantly increased compared with those before treatment, and the indexes in observation group were higher than those in control group at the same time point ( P<0.05). The levels of FSH and LH were decreased compared with those before treatment, and the levels in observation group were lower than those in control group at the same time point ( P<0.05). The proportion of cases with menstrual improvement in observation group was higher than that in control group, and the proportion of cases with intrauterine adhesions was significantly less than that in control group ( P<0.05) .There was no significant difference in the incidence rates of adverse drug reactions between the two groups during treatment ( P>0.05). Conclusions:Vaginal administration of high dose of femoston is more effective in improving endometrial receptivity and levels of serum sex hormones in patients with moderate-to-severe IUA, and there are no other obvious adverse drug reactions.

目的 探究来曲唑联合绒毛膜促性腺激素(HCG)治疗对多囊卵巢综合征(PCOS)不孕患者性激素水平、胰岛素抵抗指数(HOMA-IR)、临床妊娠率及妊娠结局的影响.方法 回顾性分析2014年1月-2018年10月郑州大学第二附属医院行来曲唑+HCG治疗(观察组)及枸橼酸氯米芬+HCG治疗(对照组)的PCOS不孕患者各68例临床资料.比较两组治疗前(月经周期第5d)及治疗后(排卵后6～8d)性激素[雌二醇(E2)、孕酮(P)]水平、HOMA-IR及血浆皮质醇(Cor)水平差异,并记录两组卵巢过度刺激综合征(OHSS)发生情况、临床妊娠率及妊娠结局(早期流产情况)差异.结果 治疗后,两组性激素(E2)水平均较治疗前升高(P＜0.05),且对照组高于观察组(P＜0.05);两组性激素(P)水平也均较治疗前升高(P＜0.05),而观察组高于对照组(P＜0.05);两组HOMA-IR水平均较治疗前降低(P＜0.05),血浆Cor水平则较治疗前升高,且观察组变化幅度大于对照组(P＜0.05).观察组OHSS发生率明显低于对照组(P＜0.05),临床妊娠率则高于对照组(P＜0.05).两组早期流产率比较,差异无统计学意义(P＞0.05).结论 来曲唑联合HCG治疗可促进PCOS不孕患者性激素水平稳定,也能调节患者血脂代谢紊乱状态,减少OHSS发生,还能提高其妊娠率,于改善患者妊娠结局有积极意义.

目的:探讨腹腔镜术后麻醉苏醒期病人躁动防控措施的应用效果.方法:采用便利抽样法将2019年7月—2020年7月462例腹腔镜术后麻醉苏醒期病人分为对照组与观察组各231例,对照组实施临床常规护理,观察组在临床常规护理基础上采用睡眠集束化管理与纳布啡静脉自控镇痛相关防控措施.比较两组病人躁动率,分别于术后第2天、第5天、第7天采用视觉模拟评分法(VAS)评定两组病人疼痛程度,干预前后采用生活质量量表(SF-36)评定两组病人生活质量.结果:干预后观察组病人躁动率低于对照组(P<0.05);观察组病人术后第5天、第7天VAS疼痛评分低于对照组(P<0.05);观察组病人生活质量评分高于对照组(P<0.05).结论:对腹腔镜术后麻醉苏醒期病人实施睡眠集束化管理与纳布啡静脉自控镇痛后可有效减轻其疼痛与躁动程度,提高病人生活质量.

目的:评价改良鼻咽通气道用于全麻术后拔管患者呼气末二氧化碳分压(PetCO2)监测的效果.方法:将120例全麻术后拔管患者分为鼻咽通气道组(P组)和鼻氧管组(N组),每组60例.吸入氧流量为0 L/min时,采集两组患者的PetCO2和动脉血二氧化碳分压(PaCO2)数据,进行相关性和一致性分析.调节吸入氧流量至2、4、6 L/min,采集两组患者不同氧流量下的PetCO2数据.结果:氧流量为0 L/min时,两组患者PetCO2和PaCO2均呈正相关(P组:r=0.846,P<0.001;N组:r=0.794,P<0.001);P组PaCO2和PetCO2差值为(0.89±0.31)kPa,95％一致性界限为0.29～1.49 kPa;N组PaCO2和PetCO2差值为(0.95±0.33)kPa,95％一致性界限为0.30～1.60 kPa.两组差值比较,差异无统计学意义(P=0.308).随着氧流量由0 L/min增至6 L/min,P组PetCO2无变化,N组PetCO2逐渐降低(P<0.001).结论:改良鼻咽通气道用于全麻术后拔管患者PetCO2监测,有较好的准确性和稳定性.

目的 探讨针对性护理模式在激光治疗黄褐斑患者中的应用价值.方法 以2019年6月～2020年6月我院收治的180例接受激光治疗的黄褐斑患者为研究对象.按照随机数字表法分为对照组与观察组.对照采用常规护理,观察采用针对性护理.对比两组有效率和护理满意度.结果 观察组总有效率为98.89％(89/90),高于对照组(73.33％(66/90),P<0.05).观察组护理满意度为98.9％(89/90),高于对照组(75.55％(68/90),P<0.05).观察组躯体、角色、情感、社会功能评分均高于对照组(P<0.05).结论 给予接受激光治疗的黄褐斑患者针对性护理,可增强治疗疗效,获得更好的护理满意度.

Objective:To study the effect of intensive early training in limb rehabilitation nursing of stroke patients with severe hemiplegia.Results:Using the convenient sampling method, a total of 68 stroke patients with severe hemiplegia who were admitted to the First Affiliated Hospital of Zhengzhou University from February 2017 to February 2018 were selected as the routine group, while 69 stroke patients with severe hemiplegia who were admitted to the hospital from March 2018 to March 2019 were selected as the intensive group. The routine group adopted routine rehabilitation care, while the intensive group adopts intensive early training on the basis of routine rehabilitation care. Canadian Neurological Scale (CNS) and Fugl-Meyer Motor Assessment Scale (M-FMA) were used to compare the neurological function and motor function of patients of the two groups before the intervention, after the intervention, 6 months after the intervention and 12 months after the intervention. Finally, 62 patients were enrolled in the routine group and 63 patients in the intensive group.Results:The results of repeated measures analysis of variance showed that the total CNS scores of patients of the two groups had time effects, inter-group effects, time and inter-group interaction effects ( Ftime=125.451, Finter-group=14.355, Finteraction=13.562; P<0.01) . There were time effects, inter-group effects, time and inter-group interaction effects in the total score of M-FMA of patients of the two groups ( Ftime=105.329, Finter-group=13.302, Finteraction=12.245; P<0.05) . The total scores of CNS and M-FMA in the two groups increased with time, and the total scores of CNS and M-FMA in the intensive group were higher than those in the control group. Conclusions:Intensive early training in limb rehabilitation nursing of stroke patients with severe hemiplegia can improve long-term neurological function and motor function of patients.

宫内妊娠合并剖宫产瘢痕妊娠( heterotopic cesarean scar pregnancy, HCSP)在自然妊娠时极其罕见.随着我国剖宫产率的增加、"二孩"政策的实施以及辅助生殖技术的发展,HCSP时有发生,多数为个案报道[1-2].瘢痕妊娠本身就是高危妊娠,是剖宫产后的远期并发症,发生率为0. 045％,处理不及时可能导致瘢痕处破裂大出血危及生命.当合并宫内妊娠时,更是威胁到宫内胚胎的安危,如何选择安全有效的方法,既能终止瘢痕妊娠,又能保留宫内妊娠,对妇产科医生来说是很大的挑战.我院采用经阴道B超引导下选择性减胎术成功治疗1例宫内妊娠合并剖宫产瘢痕妊娠,宫内妊娠继续并足月剖宫产一女婴,现报道如下,并结合文献进行分析,旨在为临床提供参考.

目的 探讨经皮雌二醇凝胶联合口服芬吗通在重度宫腔粘连术后治疗中的应用.方法 选择2019年5月至2020年10月在我院生殖医学部经宫腔镜确诊为重度宫腔粘连并实施宫腔粘连分离术的不孕患者60例为研究对象,按照随机数字表及1:1匹配分为研究组(30例,口服芬吗通联合经皮雌二醇凝胶给药)和对照组(30例,单纯口服芬吗通).比较两组患者给药2个人工周期后血清E2水平、宫腔形态恢复情况、内膜厚度、不良反应发生情况及满意度评分.结果 两组患者治疗前血清E2水平及子宫内膜厚度比较均无显著性差异(P>0.05);两组患者治疗后血清E2水平及子宫内膜厚度均显著高于治疗前(P=0.000).两组患者间治疗后血清E2水平、内膜厚度比较均无显著性差异(P>0.05);治疗后两组患者的月经量恢复情况、宫腔形态恢复情况比较亦无显著性差异(P>0.05);研究组患者治疗过程中不良反应发生率显著低于对照组(P<0.05),满意度评分则显著高于对照组(P<0.05).两组患者满意度评分与不良反应发生率均存在显著负相关关系(P<0.05).结论 经皮雌二醇凝胶联合口服芬吗通用于重度宫腔粘连术后治疗临床效果满意,可作为宫腔粘连术后应用雌激素的给药策略之一.

Objective:To investigate the effect of applying waterproof film combined with non-woven tape fixation of endotracheal tube in cleft lip and palate operation.Methods:From July 2018 to December 2018, 72 cases of cleft palate and cleft lip were selected from the operating room of the First Affiliated Hospital of Zhengzhou University The cases were randomly divided into the control group (suture and thread fixation method) and the experimental group (medical waterproof lamination combined with non-woven cloth), with 36 cases in each group. The duration of catheter fixation, intraoperative catheter fixation and postoperative catheter-related complications were compared between the two groups.Results:There were statistically significant differences between the experimental group and the control group in the duration of catheter fixation, surgeon satisfaction score and incidence of needle stab injury and needle stab bleeding: (1.15±0.63) min, (4.50±0.56), 0 case, 0 case in the experimental group, and those in the control group were (2.36±0.56) min, (3.83±1.13), 6 cases, 6 cases ( t values were 0.000, 14.435, χ2 values were 72.000, 6.545, P<0.01 or 0.05). Compared with the control group, there were no statistically significant differences in operation time, intraoperative oxygen saturation, catheter fixation direction, incidence of tube tearing, and incidence of postoperative scar ( P>0.05) in the experimental group. Conclusions:Medical waterproof film combined with non-woven tape fixed endotracheal intubation can obviously shorten the preoperative endotracheal intubation fixing time, improve the surgeon satisfaction. At the same time, it is effective in preventing postoperative complications caused by fixation with needle and silk thread.

Objective To explore the application of limbs and fingers movement combined with moxibustion in patients with PICC catheterization. Methods A total of 346 PICC catheterized patients treated from August 2014 to July 2017 were randomly divided into control group (173 cases) and observation group (173 cases) according to random number table method. The control group was given local hot-wet compression at 3-4 cm of puncture point after 24 h of catheterization, and the observation group was given preventive moxibustion with the direction of the punctured vein at the same site in the control group, and then was given limbs and fingers movement. The levels of serum monocyte chemoattractant protein- 1 (MCP- 1), tumor necrosis factor- α (TNF- α) and interleukin- 8 (IL- 8), hemorheological parameters [rate of high and low shear whole blood viscosity (RBV), rate of plasma specific viscosity (RPV), hematocrit (HCT)] and the incidence rates of mechanical phlebitis and venous thrombosis were compared between the two groups after intervention. Results The levels of MCP-1, TNF-αand IL-8 were (53.03±7.86), (85.93±10.72), (54.65±9.23) ng/L in the observation group, (60.27± 8.45), (94.74±11.36), (63.08±10.07) ng/L in the control group, and there were significant differences (t=8.252, 7.419, 8.117, all P<0.05). The levels of high shear RBV, low shear RBV, RPV and HCT were (3.94 ± 0.85) mPa · s, (6.55 ± 1.22) mPa · s, (1.70 ± 0.54) mPa · s and (43.71 ± 4.82)％ respectively in the observation group, (4.18±0.74) mPa·s, (6.97±1.25) mPa·s, (1.92±0.59) mPa·s and (45.13±4.65)％in the control group, and there were significant differences (t=2.789-3.618, P<0.05). The incidence rates of venous thrombosis and phlebitis were 1.16％(2/173) and 5.78％(10/173) respectively in the observation group, 5.78％(10/173) and 13.29％(23/173) in the control group, there were significant differences (χ2=4.230, 5.661, P<0.05). Conclusions Limbs and fingers movement combined with moxibustion can effectively improve the blood flow status, and reduce the occurrence of mechanical phlebitis and venous thrombosis in patients with PICC catheterization.

目的 探讨基于FloTrac/Vigileo系统对胸科手术中不同年龄组患者血流动力学监测的有效指标.方法 选取全麻下行胸腔镜肺癌根治术30例的患者,分为老年组(60～79岁)15例和中年组(40～59岁)15例.观察并记录2组患者在麻醉诱导后5 min(T 0)、侧卧位后5 min(T 1)、单肺通气(OLV)5 min(T 2)、OLV 15 min(T 3)、OLV 30 min(T 4)、恢复双肺通气(TLV)5 min(T 5)、恢复TLV 15 min(T 6)、转平卧位后5 min(T 7)的FloTrac/Vigileo系统的血流动力学指标,心输血量(CO)、每搏量(SV)、每搏量变异率(SVV)和心率(HR)、平均动脉压(MAP)及中心静脉压(CVP)的变化.结果 2组患者无显著人口统计学差异(P>0.05).2组患者其他时间点的HR、MAP及CO、SV与T 0时比较,差异无统计学意义(P>0.05).中年组患者其他时间点的CVP和SVV与T 0时比较差异无统计学意义(P>0.05).老年组患者的T 1、T 4时的CVP、SVV与T 6、T 0时的差异有统计学意义(P<0.05).T 4、T 6时2组患者的CVP和SVV差异有统计学意义(P<0.05),而其他时间点比较差异无统计学意义(P>0.05).老年组患者的CVP和SVV呈正相关(r=0.61,P<0.01).结论 基于FloTrac/Vigileo系统的血流动力学监测,老年组和中年组比较发现,SVV在老年组胸腔镜肺癌根治术中更有监测意义.

Objective To investigate the effects of different fluid therapies on postoperative outcomes in patients undergoing thoracoscopic lobectomy and to evaluate the advantages of intraoperative goaldirected fluid therapy when compared with restrictive fluid therapy.Methods Fifty-four patients,aged 18-64 yr,with body mass index of 18.5-24.9 kg/m2,of American Society of Anesthesiologists physical status Ⅰ-Ⅲ,scheduled for elective thoracoscopic lobectomy under general anesthesia,were divided into goal-directed fluid therapy group (group G) and restrictive fluid therapy group (group R) using a random number table method,with 27 patients in each group.In group G,fluid management was guided by an oesophageal Doppler monitoring,Ringer's solution was continuously infused at a rate of 4 ml · kg-1 · h-1,with corrected flow time (FTc) ≥350 ms and change in stroke volume (SV) ＜ 10％ of the pre-rehydration level as the goal.In group R,restrictive fluid management was performed,and blood loss was replaced with hydroxyethyl starch 130/0.4 at a 1 ∶ 1 ratio.Compound sodium chloride injection was continuously infused at a rate of 4 ml · kg-1 · h-1 until the end of surgery in both groups.Mean arterial pressure,heart rate,SpO2,FTc,SV and cardiac index were recorded at 5 min before intubation,immediately after lateral position,at the start of one-lung ventilation,at the end of one-lung ventilation and at the end of surgery.The amount of fluid intake and output during surgery was recorded.The complications on 1st,3rd,5th and 8th days after surgery were evaluated using POMS scale.The length of hospital stay,admission to intensive care unit and in-hospital death were also recorded.Results Compared with group R,FTc,SV and cardiac index were significantly increased at the end of one-lung ventilation and at the end of surgery in group G (P＜0.05).There were no significant differences in the incidence of postoperative complications or length of hospital stay between two groups (P＞0.05).No patients were admitted to intensive care unit after surgery,and no in-hospital death occurred in two groups.Conclusion GDFT and restrictive fluid therapy applied during surgery produce similar postoperative outcomes in patients undergoing thoracoscopic lobectomy.