目的 分析恶性肿瘤患儿行静脉输液港植入后发生不良事件的影响因素,并探讨相应的护理策略.方法 选取2020年1月至2021年12月于徐州医科大学附属医院行静脉输液港植入的150例恶性肿瘤患儿作为研究对象.采集患儿的一般资料(如性别和恶性肿瘤类型等),以及静脉输液港植入相关资料(如置管位置和手术时间等),并统计患儿行静脉输液港植入的相关不良事件发生率.先采用单因素分析探究患儿行静脉输液港植入后相关不良事件的影响因素,再采用Logistic多因素回归分析独立危险因素.结果 150例恶性肿瘤患儿行静脉输液港植入后,16例发生静脉输液港植入相关不良事件,发生率为10.67％,其中,局部感染5例、导管相关性血流感染3例,药物外渗4例、导管堵塞4例.单因素分析结果显示,2组患儿在年龄、肿瘤类型和血白蛋白水平上相比,差异均有统计学意义(P均＜0.05).Logistic多因素回归分析结果显示,年龄＜5岁、血液系统恶性肿瘤和白蛋白水平＜35 g/L均是患儿行静脉输液港植入后发生相关不良事件的独立危险因素(P均＜0.05).结论 恶性肿瘤患儿行静脉输液港植入后发生相关不良事件的危险因素包括年龄偏小、血液系统恶性肿瘤和血白蛋白水平偏低,临床应采用相应的护理干预措施以降低相关不良事件的发生率.

目的 探讨脑转移瘤放疗后放射性脑坏死发病的风险因素.方法 研究脑转移瘤放疗后放射性脑坏死的风险因素.从2014年12月至2018年12月,应用加速器治疗的脑转移瘤患者36例(68个靶点).治疗后运用核磁影像学来复查,由三位核磁诊断医生根据患者病史及影像学表现来诊断放射性脑坏死.采用Logistic回归分析糖尿病、心脑血管病、计划靶区体积、分割次数、分割剂量,是否有脑部放疗史,是否联合全脑照射、生物效应剂量与放射性脑坏死的关系;采用ROC曲线测定所有影响因素对放射性脑坏死的预测价值.结果 共有4个靶点(11.54％)发生放射性脑坏死.回归分析显示计划靶区体积的大小是放射性脑坏死发病的风险因素.ROC曲线显示曲线下面积为0.737.结论 计划靶区体积的大小是脑转移瘤放疗后放射性脑坏死的风险因素.

Objective To investigate the effect of clinical psychological nursing program on the social ability and intelligence development of children with autism. Methods 40 cases of autistic children in our hospital were observed from July 20, 2020 to July 21, 20

目的:探讨集束化护理在大叶性肺炎纤维支气管镜灌洗术患儿中的应用效果.方法:选取2018年1月—2019年12月医院收治的168例大叶性肺炎纤维支气管镜灌洗术患儿为研究对象,按照治疗先后顺序将其分为对照组和观察组各84例.对照组患儿给予常规护理,观察组患儿在常规护理的基础上给予集束化护理干预,比较两组患儿干预前后临床疗效及不良反应发生率.结果:观察组患儿咳嗽症状缓解时间、白细胞(WBC)恢复正常值时间、CT结果无异常时间、C反应蛋白(CRP)恢复正常值时间、发热症状消退时间及肺部啰音消失时间均短于对照组(P<0.05),观察组患儿不良反应总发生率低于对照组(P<0.05).结论:对大叶性肺炎纤维支气管镜灌洗术患儿实施集束化护理干预,能提升临床治疗效果,降低不良反应发生率.

目的:探讨早产低体重儿喂养不耐受的相关因素分析及其护理干预.方法:选取本院喂养不耐受的早产低体重儿70例为研究对象.收集统计早产低体重儿基本资料、临床资料及喂养不耐受情况,通过单因素分析早产低体重儿喂养不耐受的相关影响因素,通过多因素Logistic回归分析早产低体重儿喂养不耐受的独立影响因素.结果:本研究调查结果显示,70例早产低体重儿中,发生喂养不耐受情况29例,未发生喂养不耐受情况41例.其中呕吐3例,奶量不增5例,胃潴留13例,呕吐+奶量不增1例,呕吐+胃潴留1例,奶量不增+胃潴留4例,呕吐+奶量不增+胃潴留2例.单因素分析结果显示,胎龄、出生体重、开奶时间、首次喂养时间、胎儿窘迫、肺炎、坏死性小肠结肠炎及使用氨茶碱为早产低体重儿喂养不耐受的相关影响因素(P<0.05).多因素分析结果显示,胎龄、开奶时间、胎儿窘迫及使用氨茶碱为影响早产低体重儿喂养不耐受的独立影响因素(OR>1,P<0.05).结论:本研究选取早产低体重儿喂养不耐受发生率为41.43％,显示发生率偏高.多因素分析结果显示,胎龄、开奶时间、胎儿窘迫及使用氨茶碱为影响早产低体重儿喂养不耐受的独立影响因素,通过间歇性胃管喂养、尽早安排开奶及严格控制氨茶碱的规范使用为降低早产低体重儿喂养不耐受发生率的有效方式.

目的 对新生儿窒息脑损伤病人进行磁敏感加权成像(SWI)检查,并检测血清脑源性神经营养因子(BDNF)、水通道蛋白-4(AQP-4)水平,评估联合检查对新生儿窒息脑损伤的诊断价值.方法 选取2017年5月至2019年5月在新乡医学院第一附属医院出生的新生儿窒息脑损伤病人(观察组)123例作为研究对象,同期出生的健康新生儿(对照组)125例作为对照.对两组新生儿进行SWI检查;采集两组新生儿清晨外周血提取血清,利用酶联免疫吸附法(ELISA)检测血清中BDNF、AQP-4表达水平;采用四格表分析评估SWI检查对新生儿窒息脑损伤的诊断价值;采用受试者工作特征(ROC)曲线评估血清BDNF、AQP-4表达水平对新生儿窒息脑损伤的诊断价值.结果 观察组采用SWI检查的患病检出率(86.2％)、血清AQP-4水平(148.73±48.74)ng/mL高于对照组[(35.2％)、(98.56±30.93)ng/mL](P<0.05);血清BDNF水平(1.35±0.30)ng/mL明显低于对照组(1.79±0.54)ng/mL(P<0.05).SWI检测新生儿窒息脑损伤的灵敏度为86.2％,特异性为64.8％,准确度为75.4％;BDNF灵敏度为86.2％,特异性为64.0％,准确度为75.0％;AQP-4灵敏度为75.6％,特异性为75.2％,准确度为75.4％.SWI联合血清BDNF、AQP-4水平检测新生儿窒息脑损伤的灵敏度为95.1％,特异性为89.6％,准确度为92.3％,误诊率为10.4％,漏诊率为4.9％,约登指数为84.7％,阳性预测值为90.0％,阴性预测值为94.9％;与单独检测相比,三者联合检测诊断新生儿窒息脑损伤的灵敏度、特异性和准确度均明显升高(P<0.05).结论 新生儿窒息脑损伤病人采用SWI检查的患病检出率高于健康对照组,血清AQP-4水平明显升高,血清BDNF水平明显降低,SWI检查、血清BDNF、AQP-4水平对新生儿窒息脑损伤均有一定诊断价值,三者联合检测对新生儿窒息脑损伤的诊断价值更高,可用于临床借鉴.

目的 探讨个体化健康教育在急性白血病护理中的应用效果.方法 选择2018年1月至2019年12月我院收治的急性白血病患者80例,按随机数字表法分为两组,各40例.对照组实施常规护理,观察组实施个体化健康教育,对比两组健康知识掌握情况与心理状况.结果 观察组干预后健康知识掌握合格率高于对照组,焦虑(SAS)、抑郁评分(SDS)评分均低于对照组,差异有统计学意义(P<0.05).结论 健康教育能够提高急性白血病患者的健康知识掌握程度,改善其心理状况.

目的 探讨新生儿护理干预中应用静脉留置针的实用性与安全性.方法 选取2014年2月~2015年3月我院收治的286例新生儿为研究对象,将286例新生儿分为观察组和对照组,观察组146例,对照组140例,在护理干预中对照组行常规静脉注射,观察组行静脉留置针,观察比较两组新生儿的护理效果.结果 与对照组相比,观察组新生儿的一次性穿刺成功率和家属的护理满意度均明显更高(P<0.05);阻塞发生率和并发症发生率均明显更低(P<0.05).结论 新生儿护理干预中应用静脉留置针,减轻了对新生儿血管的伤害,提高穿刺成功率,且操作简单、置留时间较长,提高新生儿的护理质量,具有显著的实用性和安全性.

目的：探讨综合护理干预在新生儿黄疸患儿中的应用效果。方法：将90例新生儿黄疸患儿采用随机数字表法分为观察组和对照组各45例，均给予蓝光照射治疗，对照组采取常规护理，观察组在此基础上实施综合护理干预；比较两组疗效。结果：观察组治疗3 d、5 d后黄疸指数均高于对照组（P<0.05），新生儿首次排便时间和胎粪转黄时间均少于对照组（P<0.05），每日睡眠时间多于对照组（P<0.05），皮肤损伤、呕吐、闷热综合征和过度换气等不良反应的发生率均低于对照组（P<0.05）。结论：联合护理干预蓝光照射治疗，可有效减轻新生儿黄疸患儿黄疸程度，降低不良反应的发生率，具有较好的临床应用价值。

目的：探讨派瑞松软膏联合局部照灯治疗新生儿尿布皮炎疗效观察。方法65例新生儿尿布皮炎患儿随机分为对照组（ n＝35例）和观察组（ n＝30例），对照组给予常规护理，观察组在常规护理基础上使用派瑞松软膏联合局部照灯，比较两组总有效率。结果观察组总有效率为90．0％，对照组总有效率为65．7％。两者差异有统计学意义（χ2＝5．367，P＝0．021）。结论派瑞松软膏联合局部照灯治疗新生儿尿布皮炎疗效显著。

The aim of this study was to obtain geometric data of in vivo patellar ligament (PL) and anterior cruciate ligament (ACL) by MRI and to analyze the correlation of the two with body weight, height and gender. A total of 157 cases with normal sagittal images of bilateral PL and ACL were enrolled. The PL and ACL lengths in the images were measured using the Radworks 5.1 application. The intraclass correlation coefficient for the data measured independently by three doctors was 0.997-1.000. In individuals aged 15-24 years, the values of PL and ACL length and the PL to ACL ratio were 43.95±4.25 mm, 38.45±4.62 mm and 1.15±1.09 in males and 42.03±0.94 mm, 36.00±1.06 mm and 1.18±0.1 in females, respectively. In individuals aged 25-64 years, the values in males were 40.99±4.45 mm, 36.06±3.74 mm and 1.14±0.09 and in females were 39.84±0.64 mm, 36.50±0.81 mm and 1.11±0.02, respectively. In individuals aged ≥65 years, the values in males were 41.43±3.08 mm, 36.62±3.44 mm and 1.15±0.09 and in females were 38.94±0.79 mm, 34.36±0.85 mm and 1.13±0.07, respectively. There was a significant difference between PL and ACL length on the same side (P<0.01). The data obtained was stable and repeatable. The present study established a database of PL and ACL length and the ratio of the two measured by MRI.

Objective To explore clinical value of magnetic resonance imaging(MRI) in diagnosis of knee injuries.Methods Clinical and imaging data of 55 cases of knee injuries were analyzed retrospectively.Patients were subjected to computed radiography and 16-slice spiral CT scan firstly,and then MRI examination.Results Among 55 patients,32 of them were diagnosed as meniscus injuries by MRI,with accuracy of 87.3%(48/55),sensitivity of 93.1%(27/29),specificity of 80.8%(21/26),false positive rate of 19.2%(5/26) and false negative rate of 6.9%(2/29).Accuracy,sensitivity,specificity,false positive rate and false negative rate of MRI in diagnosis of bone injuries were 65.5%(36/55),38.5%(10/26),89.7%(26/29),10.3%(3/29) and 61.5%(16/26),respectively,and those were 72.7%(40/55),87.1%(27/31),54.2%(13/24),45.8%(11/24) and 12.9%(4/31),respectively,for MRI in diagnosis of ligament injuries.Conclusion MRI possesses a high diagnostic accuracy for a variety of knee injuries,and can provide reliable imaging evidence for clinical treatment and prognosis.

Objective:To investigate the type and diagnosis value of diastematomyelia on MRI.Methods:To analyze clinical and MRI resources of 39 cases with diastematomyelia.Results:Accord Pang’s type,there were 28 patients with TypeⅠand 11 patients were TypeⅡof the 39 patients.According to the area of diastematomyelia,18 cases were complet slit and 21 were section slit.Conclusion:MRI can diagnose diastematomyelia and it’s complication accurately and completely.According to the area of diastematomyelia,it can be classified with complet slit and section slit.

Objective To compare the value of 64-and 320-slice spiral CT in displaying coronary artery stents and diagnosing in-stent restenosis.Methods Data of 64(64-slice spiral CT group,including 20cases with 38stents) and 320(320slice spiral CT group,including 42cases with 64stents) slice spiral CT coronary angiography of 62patients after coronary artery stent implantation were retrospectively analyzed.The image quality,patients'heart rate and effective radiation dose(ED) of the two groups were compared.Moreover,the diagnostic ability for in-stent restenosis of 64-and 320-slice spiral CT were evaluated with CAG results as gold standards.Results There was no significant difference in image quality(P 0.05) between two groups.Statistical differences were found in patients'heart rate and ED(both P0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of 64-slice spiral CT was 100%(5 / 5),92.31%(24 / 26),71.43%(5 / 7),100%(24 / 24) and 93.55%(29 / 31),respectively,that in 320-slice spiral CT group was 100%(11 / 11),95.65%(44 / 46),84.62%(11 / 13),100%(44 / 44),96.49%(55 / 57),respectively.No significant difference of above diagnostic indexes was found(all P0.05).Conclusion Both 64-and 320-slice spiral CT can be used to follow-up after percutaneous coronary intervention,but 320-slice spiral CT have fewer requirements of patients'heart rate and less radiation.

目的 研究腋静脉穿刺置管在低出生体重儿中的临床应用效果.方法 选择新生儿重症监护病房低出生体重儿181例,分为腋静脉组96例和其他外周静脉组85例,分别进行静脉穿刺置管,考察其临床应用效果.结果 腋静脉组一次穿刺成功率显著高于其他外周静脉组(P＜0.01);腋静脉组的并发症(静脉炎、液体外渗、脱管、折管等)也显著低于其他外周静脉组(P＜0.05或P<0.01);但2组拔管时细菌培养阳性率无显著性差异(P＞0.05).腋静脉组穿刺针留置天数显著长于其他外周静脉组(P＜0.01).结论 腋静脉穿刺置管简便,容易掌握,安全性高,能满足较长时间治疗的需要,值得在新生儿科推广.

Pharmacotherapy and cognitive-behavioral therapy (CBT) are currently the most effective interventions for treating obsessive-compulsive disorder (OCD). These treatments, however, are time consuming and in some cases the patients do not show significant improvement. In all, 30%-60% of OCD patients do not respond adequately to pharmacotherapy and 20%-40% of OCD patients who complete CBT do not improve significantly, suggesting a more efficacious approach is needed. The objectives of this study are to demonstrate an efficacious pharmacotherapy plus psychotherapy, named cognitive-coping therapy (CCT), for OCD and to investigate the efficacy of this approach in a larger sample size. Therefore, a total of 108 patients with OCD were randomly allocated into three groups: pharmacotherapy (N = 38), pharmacotherapy plus CBT (PCBT, N = 34), and pharmacotherapy plus CCT (PCCT, N = 36). The severity of symptoms and the patients' functioning were assessed pretreatment and after 7, 14, 21 days, and 1-, 3-, 6-, and 12-month treatment using the Yale-Brown Obsessive Compulsive Scale and Global Assessment of Functioning (GAF). Compared with the pharmacotherapy and PCBT groups, the severity of OCD symptoms was significantly reduced (P < 0.001), the rates of response (100%) and remission (85.0%) were significantly higher (P < 0.001), and relapse rate was lower (P = 0.017) in PCCT group during the 1- year follow-up. In addition, the GAF score was significantly higher in the PCCT group than in the other two groups (P < 0.001). Our preliminary data suggest that PCCT is a more efficacious psychotherapy for OCD patients than pharmacotherapy or PCBT.

隐球菌病是新型隐球菌引起的一种亚急性或慢性真菌病.最常见的是中枢神经系统隐球菌病,胆道系统受累者十分罕见[1-3].国内文献报道的胆道隐球菌病仅有9例[4-12],且确诊前无一例诊断正确者.笔者现报道1例,并复习相关文献,以期提高其临床诊断水平.

Objective To evaluate the therapeutic effect of transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) and TACE combined with psychro-circulation percutaneous microwave coagulation therapy in the treatment of primary hepatocellular carcinoma (HCC).Methods Fifty patients with HCC underwent TACE and RFA with Tyko Radinics CooltipTM systerm,while 60 patients underwent TACE and psychro-circulation percutaneous microwave coagulation therapy with ECO-100 system.One month after the treatment,dynamic enhanced CT scanning was performed.Results One month after the treatment,the local control rate of the tumor for TACE combined with RFA or ECO-100 psychro-circulation percutaneous microwave coagulation therapy was 70.00% and 87.67%,respectively.Statistically significant difference existed in the rate of complete tumor necrosis between the two groups (P0.05).Conclusion Both TACE combine with RFA and TACE combined with ECO-100 psychro-circulation percutaneous microwave coagulation therapy are effective for HCC,the latter can be regarded as an ideal alternative for patients who failed to respond to TACE alone.

Objective To study the clinical value of magnetic resonance imaging( MRI) and human leucocyte antigen B27( HLA-B27) in diagnosing early ankylosing spondylitis( AS) . Methods The changes of MRI and HLA-B27 of sixty-six patients with AS were retrospectively analyzed,and the clinical value was summarized. Results Among sixty-six patients of AS,MRI showed that sixty-three patients with synovial cartilage abnormalities,fifty-six patients with bone marrow edema,forty-six patients with bone erosion,and thirty-nine patients with fatty deposition. Sixty patients presented HLA-B27( + ) . Fifty-two patients were correctly diagnosed by combining of HLA-B27 ( + ) and MRI. Fourteen patients were missed diagnosis or misdiagnosed,among them,six patients presented HLA-B27( ) ,but with radiological changes; Five patients presented HLA-B27( + ) ,but with atypical radiological changes HLA-B27 ( + ) . Three patients presented HLA-B27 ( + ) . Conclusion The manifests of MRI and HLA-B27 of sacroiliac joint can provide valuable evidence for diagnosing the early AS; Patients without typical symptoms and images of MRI were needed to multi-analysis and identify fully to other diseases with the similar symptoms,and periodic check and follow-up examination should be carried out so as to reduce the rate of diagnostic errors and missed diagnosis.

Objective:To study the value of contrast-enhanced MR angiography(CE-MRA) with 3D time-resolved imaging of contrast kinetics(3D TRICKS MRA) in the diagnosis of carotid atherosclerotic stenosis.Methods:43 cases with clinically suspected carotid atherosclerotic stenosis underwent 3D TRICKS MRA and 2D time-of-flight(TOF) MRA.31 of these 43 cases underwent digital subtract angiography(DSA) within a week.The percentage of stenosis was calculated with common carotid artery method(CC).Results:There were occlusion(n=2),severe stenosis(n=10),moderate stenosis(n=31),mild stenosis of carotid artery(n=25) and normal carotid artery(n=18).Comparing the findings of 3D TRICKS MRA and 2D TOF MRA with DSA,all of the positions of carotid artery stenosis were in agreement;but there were overestimation of the stenotic degree by 2D TOF MRA(n= 6),only one was overestimated by 3D TRICKS MRA.Taking the diagnosis of DSA as the standard,the sensitivity,specificity and accuracy for evaluating carotid atherosclerotic stenosis by 2D TOF MRA was 91.6%,85.7%,90.3% respectively(Kappa=0.737);by 3D TRICKS MRA was 97.9%,100%,98.4% respectively(Kappa=0.955),with significant statistical differences(P0.05).Conclusion:3D TRICKS MRA in the evaluation of carotid atherosclerosis stenosis was in excellent agreement with DSA(Kappa=0.955),which was obviously superior to that of 2D TOF MRA(Kappa=0.737)(P0.05).3D TRICKS MRA is the technique of choice in the screening,preoperative evaluation and postoperative follow-up of carotid atherosclerosis stenosis,and might be the substitution of DSA in the future.