目的 探讨精细护理在颈椎神经鞘瘤术后脑脊液漏患者护理中的应用效果.方法 纳入2020年4月至2022年4月于郑州大学第一附属医院接受手术治疗的颈椎神经鞘瘤术后脑脊液漏患者,将患者随机均分为研究组和对照组,每组30例.其中对照组接受常规护理干预,而研究组在对照组基础上实施精细护理.比较2组患者的治疗效果和不良反应发生情况.结果 术后12个月,研究组健康状态、心理状态、睡眠质量、功能恢复评分均优于对照组,差异均有统计学意义(t=12.966,P＜0.001;t=21.826,P＜0.001;t=19.945,P＜0.001;t=10.531,P＜0.001).研究组不良反应总发生率低于对照组,差异有统计学意义(x2=19.200,P＜0.001).结论 采用精细护理对颈椎神经鞘瘤术后并发脑脊液漏患者进行干预,能够改善患者健康状况和恢复情况,降低不良反应发生风险.

目的 探讨基于预见性理论的风险评估护理方案在缺血性脑卒中行脑血管造影术患者中的效果.方法 选择2021 年 4 月至 2022 年 4 月郑州大学附属郑州中心医院收治的缺血性脑卒中行脑血管造影术患者 150 例,根据随机数表法将其分为对照组(N=75)和干预组(N=75).予以对照组患者常规护理干预,干预组实施基于预见性理论的风险评估护理,观察两组患者并发症发生情况、焦虑情绪、抑郁情绪、护理质量及营养状况.结果 干预组脑血管造影术后并发症发生率低于对照组,差异有统计学意义(P＜0.05).两组干预后焦虑自评量表与抑郁自评量表评分低于干预前,且干预组分值低于对照组,差异有统计学意义(P＜0.05);干预组护理质量评估量表各项评分均高于对照组,差异有统计学意义(P＜0.05);干预后两组血清标本总蛋白(TP)、白蛋白(ALB)及血红蛋白(Hb)水平均高于干预前,且干预组高于对照组,差异有统计学意义(P＜0.05).结论 基于预见性理论的风险评估护理方案应用于脑血管造影术缺血性脑卒中患者可降低并发症发生率,有助于缓解其负面情绪,并可提高整体护理质量,帮助患者改善机体营养状况.

目的 探讨全膝关节置换术患者实施家属同步教育的延续性护理的价值及对患者情绪的改善效果.方法 选取2019年5月～2021年5月内我院诊治的全膝关节置换术患者92例,根据随机数字表法分2组,实施常规护理46例(对照组),实施家属同步教育的延续性护理46例(观察组).比较两组患者的心理及情绪状态、康复锻炼治疗依从性、膝关节功能评分(纽约特种外科医院(Hospital for Special Surgery,HSS)膝关节评分)、生活质量评分.结果 与对照组相比,观察组患者康复锻炼依从率明显高,膝关节功能HSS评分显著高,生活质量SF-36评分均更高(P＜0.05);且观察组干预后焦虑自评量表(Self-Rating Anxiety Scale,SAS)评分、抑郁自评量表(Self-rating depression scale,SDS)评分较对照组显著低(P＜0.05).结论 实施家属同步教育的延续性护理,有利于改善全膝关节置换术患者的不良情绪,增加其康复锻炼依从性,更有利于患者膝关节的功能康复.

目的 探讨快速康复护理在脊柱转移瘤患者中的应用及其对患者快速康复和护理满意度的影响.方法 入组2018年3月至2020年10月郑州大学第一附属医院收治的经病理学确诊的脊柱转移瘤患者60例,采用随机数字表法分为2组,每组30例,即应用快速康复护理的观察组和常规康复护理的对照组.治疗过程中及术后随访时,采用疼痛视觉评分、自制调查量表进行术后患者状态及护理满意度评价.结果 观察组功能恢复总有效率93.33％,高于对照组的73.33％,差异统计学意义(χ2=4.320,P=0.038).观察组患者住院时间为(10.42±0.78)d,短于对照组的(12.55±1.09)分,差异有统计学意义(t=4.875,P=0.029).观察组患者术后6个月VAS评分为(2.06±0.37)分,低于对照组的(4.59±0.72)分,差异有统计学意义(t=7.824,P=0.016).观察组并发症总发生率为3.33％,低于对照组的26.67％,差异有统计学意义(χ2=6.405,P=0.011).观察组患者护理满意度为96.67％,高于对照组的73.33％,差异有统计学意义(χ2=6.405,P=0.011).结论 快速康复护理可有效帮助脊柱转移瘤患者实现早期活动与快速康复,提高患者护理满意度,改善患者预后.

目的 探讨正念干预对青少年特发性脊柱侧凸手术患者呼吸训练依从性和肺功能的影响.方法 采用便利抽样法,选取2018年12月—2020年2月于河南省某三级甲等医院骨科诊疗78例青少年特发性脊柱侧凸患者为研究对象,采用随机数字表法将患者分为观察组(n=39)和对照组(n=39).对照组患者接受常规护理和呼吸训练指导,观察组在此基础上给予正念干预.比较2组患者围术期呼吸训练依从率及干预前、干预后肺功能指标情况.结果 干预后,观察组患者呼吸训练依从率、用力肺活量占预计值百分比、第1秒用力呼气量占预计值百分比均优于对照组,差异均具有统计学意义(P<0.05).结论 正念干预能够提高青少年特发性脊柱侧凸手术患者呼吸训练依从率,改善患者肺功能.

目的 探讨并总结3D打印技术在脊柱肿瘤患者护理中的应用与方法.方法 选择2018年1月至2020年12月于郑州大学第一附属医院骨科应用3D打印植入物进行治疗的脊柱肿瘤患者26例,其中应用3D打印植入物治疗患者13例纳入观察组,应用常规植入物(钛笼)治疗患者13例纳入对照组.在脊柱肿瘤常规护理基础上,对观察组加强3 D打印模型的指导与并发症的观察、护理,比较2组患者视觉模拟评分法(VAS)评分、护理满意度及并发症情况.结果 观察组患者住院时间(10.68±0.95)d,明显短于对照组的(12.47±1.12)d(t=4.965,P=0.028).观察组患者术后6个月时VAS评分(2.76±1.17)分,明显低于对照组的(4.37±0.59)分(t=7.624,P=0.017).观察组患者护理满意度评分(9.57±0.41)分,明显高于对照组的(7.96±0.55)分(t=5.346,P=0.023).2组术后6个月均未见复发.观察组并发症发生率15.38％,低于对照组的30.76％,但差异无统计学意义(χ2=0.503,P=0.478).结论 通过对脊柱肿瘤患者加强3D打印模型的术前宣教与并发症的观察与护理,可有效帮助患者改善术后疼痛及预后,提高患者的满意度.

综述颈椎前路手术后病人吞咽困难特异性评估工具和非特异性评估工具的基本特点、应用情况及发展现状,旨在为临床护理人员选择评估工具提供借鉴,为术后病人吞咽困难症状管理提供参考.

目的 了解青少年特发性脊柱侧凸(AIS)手术患儿照顾者的真实感受,分析其在照顾过程中的负性、正性体验及需求,以期为临床护理提供参考.方法 采用目的抽样法,选取16名AIS手术患儿照顾者进行半结构式访谈,运用主题分析法对资料进行整理分析.结果 AIS手术患儿照顾者反应可归纳为5个主题:负性情绪明显、照顾压力沉重、疾病不确定感、疾病获益感、支持系统薄弱.结论 AIS手术患儿照顾者负性与正性体验并存,期待得到更多的关注和支持.临床医务人员应重视其照顾体验和需求,帮助其提高照护能力和改善应对方式,从而提升患儿和照顾者的生活质量.

目的:观察围术期整体护理对颈动脉内膜斑块切除血管成形术患者心理状态及并发症的影响.方法:选取100例行颈动脉内膜斑块切除血管成形术患者为研究对象,按照随机数字表法分为观察组与对照组各50例.两组均行颈动脉内膜斑块切除血管成形术治疗,对照组采用常规护理,观察组实施围术期整体护理.比较两组焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、并发症发生率和护理满意度.结果:护理后,观察组SAS评分和SDS评分均明显低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.00％,明显低于对照组的22.00％,差异有统计学意义(P<0.05);观察组护理满意度明显高于对照组,差异有统计学意义(P<0.05).结论:围术期整体护理可降低颈动脉内膜斑块切除血管成形术患者SAS评分、SDS评分和发症发生率,以及提高护理满意度,效果优于常规护理效果.

目的 评价布加综合征(BCS)合并下腔静脉(IVC)血栓的个体化治疗方案及长期随访结果.方法 回顾性分析108例BCS合并IVC血栓患者的临床资料,根据血栓性质、大小、范围及机化程度对患者进行个体化治疗.使用卡普兰-迈耶(Kaplan-Meier)曲线计算一期及二期IVC通畅率,对复发因素和生存率进行Cox回归分析.结果 腔内治疗成功率99.1％(107/108),并发症发生率7.4％(8/108).103例完成随访,随访时间3～140月,平均(61.7±39.3)月.复发17例,其中15例再次治疗成功.1年、2年、5年及10年IVC一期通畅率为91％、88％、79％、79％;二期通畅率为100％、100％、97％、97％.随访期间死亡15例,累计1年、5年及10年生存率为95％、86％、81％.多因素分析,血清白蛋白和总胆红素是患者生存的独立危险因素.结论 根据血栓性质、大小、范围及机化程度进行个体化治疗BCS合并IVC血栓安全有效,并发症发生率低,长期疗效满意.

目的 探讨放松训练联合心理干预对手术麻醉患者的应激反应、负面情绪的影响.方法 将2017年1月～2018年6月期间来我院就诊的117例手术麻醉患者随机分为对照组58例及观察组59例,两组患者均给予常规围术期干预,对照组患者增加心理干预,观察组患者在对照组基础上应用放松训练,观察患者术后相关指标、手术前后焦虑抑郁情绪变化、免疫功能、睡眠质量及血压心率变化,并对比术后生活质量.结果 两组患者手术时间、麻醉苏醒时间、术中出血量及手术成功率无明显差异(P＞0.05);干预后,观察组心率、舒张压、收缩压、CD8+水平及AIS、SAS、SDS评分低于对照组,CD3+、CD4+水平及QLQ-c30评分高于对照组(P＜0.05).结论 放松训练联合心理干预能够有效改善手术麻醉患者负面情绪、免疫功能及应激反应,提升睡眠质量及术后生活质量.

Objective? To explore the application effect of six-step standard communication process in nursing communication with elderly patients with lung cancer. Methods? A six-step standard communication process training was conducted for 38 nurses in the Thoracic Surgery Department of the First Affiliated Hospital of Zhengzhou University from January to June 2017 selected by purposive sampling. Nurses＇ Clinical Communication Competence Scale (NCCCS) was used to evaluate the changes of nurses＇ communication ability with patients before and after training. A total of 38 elderly patients with newly diagnosed lung cancer in Thoracic Surgery Department from January to December 2016 were enrolled as the control group, and during their in-hospital period of time, the nurses had not received the training and their communication was in the conventional way; a total of 35 elderly patients with newly diagnosed lung cancer in Thoracic Surgery Department from July 2017 to June 2018 were enrolled as the observation group, and during their in-hospital period of time, the nurses had already completed the training and their communication mode was based on the six-step standard communication process. The two groups were compared in terms of their scores in Profile of Mood States-Short Form(POMS) 24 hours after getting newly diagnosed (before intervention), 24 hours before operation(after intervention), and their nursing satisfaction degree upon discharge. Results? After training, nurses＇ communication ability in difficult situations, emotional perception ability, emotional support ability, basic language communication ability and basic non-verbal communication ability were significantly improved with statistical differences (P＜ 0.05). There was no statistical difference in each dimensional scores in POMS between the two groups before intervention(P＞0.05);after intervention, the observation group had lower scores in dimensions of"depression-dejection", "tension-anxiety","anger-hostility", "confusion-bewilderment", and "fatigue-inertia" than the control group with statistical differences(P＜ 0.05). The observation group had higher nursing satisfaction degree upon discharge than the control group with statistical differences(P＜0.05). Conclusions? For elderly patients with lung cancer in Thoracic Surgery Department, the application of six-step standard communication process can effectively improve the nursing communication efficacy,improve patient＇s bad mood and improve nursing satisfaction.

目的:探讨膝关节置换合并慢性深静脉血栓形成(DVT)患者的围术期护理效果,为其标准化流程的建立及临床围术期护理提供依据.方法:对2015年1月～2016年12月我院22例膝关节置换合并慢性DVT患者采取围术期干预措施,术前准确评估,术后鼓励患者早期活动,加强健康教育,提高患者抗凝治疗及康复锻炼依从性,鼓励患者参与疾病管理,提高其自护能力.结果:22例患者均顺利出院,住院时间(12.92±1.21)d,术后随访6～10个月,均无远期并发症发生.结论:通过准确评估血栓风险、鼓励患者早期活动、互动式参与患者安全管理模式、药物与物理预防相结合,能够有效预防患者DVT复发和新发血栓的形成.

Objective To examine the expression of Krüppel-like factor-6 (KLF6) in human hepatocellular carcinoma (HCC) and adjacent non-cancerous tissues (ANCT),and further explore the effects and molecular mechanisms of KLF6 on proliferation and invasion of HCC cells.Methods The expression of KLF6 in 50 cases of HCC and corresponding ANCT was detected by immunohistochemical assay.In vitro human HCC SMCC-7721 cells were stably transfected with lentivirus-mediated KLF6 overexpression vector,and the expression levels of proliferating cell nuclear antigen (PCNA) and metalloproteinase-9 (MMP-9) were detected by Western blotting assay.The proliferative activity and invasive capability of HCC cells were detected by MTT and Transwell assays.Results The expression level of KLF6 protein was significantly downregulated in 50％ (25/50) of HCC tissues compared with than in 72％ (36/50) of ANCT.Western blotting results showed that the expression of PCNA and MMP-9 protein in KLF6 group were reduced by 81.5％ and 58.2％,respectively (P ＜ 0.01);MTT assay showed that cell proliferation activity significantly decreased in KLF6 group (P ＜ 0.01);Transwell assay results showed that invasion and metastasis cell number in KLF6 group was significantly reduced [(58.33 ±6.45) cells vs.(98.50±11.33) cells;(58.33 ±6.45) cells vs.(103.25 ±12.17) cells,P＜ 0.01).Conclusion KLF6 is lowly expressed in HCC,and KLF6 overexpression can suppresses HCC cell proliferation and invasion,which mechanism is related to down regulating the expression of PCNA and MMP-9.

Aim:To investigate the clinical value of intraoperative magnetic resonance imaging ( iMRI) combined with motor functional neuronavigation in resection of intracranial lesions .Methods: A total of 138 cases ( 75 males and 63 fe-males, aged from 5 to 83 years with mean of 43.2 years) underwent surgical operation with the assistance of 3.0T iMRI combined with motor functional neuronavigation .All cases were adjacent to or involved motor area or corticospinal tract . Blood oxygen level dependent functional MRI and diffusion tensor imaging data analysis could be analyzed in real -time using the software directly installed on the MR , and the result visualization was possible during scanning .Results:3D brain sur-face visualization was considered useful for precise localization of 41 cases situated at the brain convexity .Eventually , out of 138 cases, 81(58.7%) benefited from further resection after iMRI scans;104 achieved gross total resection (GRT) and the GRT rate improved from 29.7%to 75.4%.All 138 cases accomplished more than 6 months follow-up postoperatively. No new permanent postoperative motor deficit was observed in 127 cases(92.0%),among which, improved motor function was observed in 34 cases,unchanged neurological findings in 83 cases,and transient motor deficit in 10 cases.New perma-nent motor deficit was present in 11 cases(8.0%) until 6 months after surgery.Conclusion:iMRI combined with function-al neuronavigation can help to maximize tumor removal and minimize neurological deficit , which has great value in impro-ving operation efficiency and prognosis of patients with intracranial lesions .

Objective]To discuss the surgical indications and the treatment results of traumatic diaphragmatic hernia(TDH)and traumatic diaphragmatic injury (TDI)treated by abdominal operation[.Methods]Retrospective analy‐sis of 16 patients with treatment of TDH and TDI underwent abdominal surgery was conducted in terms of causes , clinical manifestation ,preoperative examination ,surgical approach selection and the result of surgical treatment .[Re‐sults]Sixteen cases were included in the group :14 males ,2 females ;13 left ,1 right ,2 double;all cases combined with united injury ,11 cases combined with traumatic shock .8 cases examined by X‐ray ,5 diagnosed ;16 cases examined by computed tomography ,135 diagnosed ;2 cases examined by thoracoscopy ,both with diaphragm injury ;16 cases were treated by abdominal diaphragm repair ,15 cases cured ,3 cases with complications ,2 cases with incision infection ,1 case with inflammatory intestinal obstruction and 1 case died of multiple organ failure[.Conclusion]Most of TDI and TDH could be repaired by abdominal operation so as to treat bleeding of the abdominal organs timely ,and the double side of diaphragm could be examined to avoid the misdiagnosis and missed diagnosis .Meanwhile the abdominal opera‐tion could reduce the effect of respiratory and circulatory system caused by open chest operation ,and will be benefit to postoperative discharge of phlegm and rehabilitation .

Objective :To investigate the clinical effects of treatment of traumatic rupture by laparoscopic and open surgery .Methods :84 cases of patients with traumatic rupture admitted to emergency department in our hospital were selected from May 2010 to June 2013 .All cases were randomly divided into conventional surgery group and laparoscopic group .Cases in conventional surgery group underwent open splenectomy ,and in laparoscopic group underwent laparoscopic splenectomy .The operative time ,blood loss ,postoperative recovery time of gastrointestinal function ,postoperative pain medication usage ,and length of hospital stay and postoperative complications of the two groups were compared .And the satisfactions of the patients for the effect of surgery were investigated .Results :The surgery time ,gastrointestinal function recovery time and hospital stay in laparoscopic group were shorter than con ‐ventional surgery group ,the differences were all statistically significant (P< 0 .05) .The blood loss in laparoscopic group was less than conventional surgery group ,the difference was statistically significant (P< 0 .05) .The postop‐erative analgesia utilization rate in laparoscopic group was 14 .3% ,which was further below the 66 .7% in the con‐ventional surgery group ,the difference was statistically significant (P< 0 .05) .The satisfaction with the treatment for the patients in laparoscopic group was 92 .9% ,which was higher than that in the conventional surgery group (P< 0 .05) .The postoperative complications rate in laparoscopic group was 11 .9% ,which was further below than 33 . 3% of the conventional surgery group ,the difference was statistically significant (P < 0 .05) .Conclusions : The effect of laparoscopic treatment for traumatic rupture is better than open surgery .It had the advantage of less trau‐ma ,less bleeding ,less pain ,fewer complications ,faster recovery ,etc .And it helped to increase the satisfaction of patient for surgery .

目的：总结表面麻醉喉内镜成像电视监视系统下声带良性病变手术的效果。方法对我科2012年1月至2013年12月收治的声带良性病变在表面麻醉喉内镜成像电视监视系统下手术的患者进行效果分析。结果所有患者均一次性手术成功，术后无明显并发症。结论表面麻醉喉内镜成像电视监视系统下手术治疗声带良性病变，患者容易接受，手术安全、创伤小、费用低廉，操作有一定难度，需要一定手术技巧。

Objective: To explore the effects of clinical pathway teaching mode in new nurses' standardized training. Methods: In 2011, new nurses in pilot department of clinical pathway were trained according to the clinical pathway teaching mode. Results: Compared with the traditional model of teaching, new nurses mastered the specialized nursing knowledge in a shorter time; comprehensive evaluation results of new nurses had been improved signiifcantly; the satisfaction of new nurses and the clinical teachers with the clinical teaching mode was also improved (P<0.05). Conclusion: The purpose of quick and standardized training has been achieved. In this way, the teaching quality, enthusiasm and satisfaction of both teachers and new nurses have been improved signiifcantly.

OBJECTIVE To evaluate the effect of forced‐air warming on hypothermia and surgical site infection in brain tumor craniotomy patients ,so as to provide evidence for clinical treatment .METHODS From Feb .to Jul . 2014 ,245 patients underwent brain tumor craniotomy were randomly divided into a control group (n=117)and a observation group(n= 128) .Patients in the control group were covered by quilts .Patients in the observation group were covered by quilts combine forced‐air warming .The temperature ,shivering rate ,hypothermia rate ,re‐covery time ,intra operative liquid volume ,blood loss volume ,SSI rate and adverse event rate were compared . SPSS 19 .0 was adopted for a statistical analysis .RESULTS Three hours ,twelve hours and twenty four hours after operation ,the blood loss volume of the observation group were significantly less than the control group ( P<0 .05) .The SSI incidence was 3 .9% in the observation group ,11 .9% in the control group ,so significant differ‐ence noted between the groups (P<0 .05) .CONCLUSION Using forced‐air warming on brain tumor craniotomy patients can effectively maintain body temperature ,and reduce SSI .