目的 研究临床实习生技能培训中"产出导向法(production-oriented approach,POA)+混合式教学法"的应用效果.方法 选取 2021 年 7 月—2022 年 3 月于大庆油田总医院进行临床实习的 58 名实习生,按随机数字表法分为对照组(29 名)与试验组(29 名),两组均以教学计划为依据实施教学,对照组采用传统教学模式,试验组采用POA+混合式教学法,对比两组教学满意度、理论知识考核成绩、技能操作考核成绩、评判性思维能力、自我导向学习能力及职业成熟度.结果 试验组(96.55％)教学总满意率高于对照组(68.97％),差异有统计学意义(P＜0.05);与对照组比较,试验组理论知识、技能操作考核成绩均更高,差异有统计学意义(P＜0.05);与对照组比较,试验组学习行为、人际关系技能、学习评价、学习策略及学习意识评分均更高,差异有统计学意义(P＜0.05);与对照组比较,试验组寻找真相、求知欲、认知成熟度、评判自信心、系统化能力、分析能力及开放思想评分均更高,差异有统计学意义(P＜0.05);与对照组比较,试验组职业参照、职业自信、职业目标、职业自主、亲友依赖及职业价值均更高,差异有统计学意义(P＜0.05).结论 临床实习生技能培训中应用"POA+混合式教学法",可促进教学满意度提高,提高实习生自我导向学习能力,并提高实习生评判性思维能力及职业成熟度.

目的 分析启发式教学在临床医学本科生实习前集中技能培训的效果.方法 选取2022年6月—2022年9月大庆油田总医院临床专业的58名实习生为观察组,应用启发式教学在实习前集中开展技能培训,另选取2021年6月—2022年9月本院临床专业的58名实习生为对照组,采用常规教学方法在实习前集中开展技能培训,统计分析两组实习生培训前后的考核成绩、培训教学满意度情况以及本次培训学习的自我评分和教学老师对学生的表现评分.结果 两组实习生教学后的理论考核评分、操作技能考核评分均高于教学前,且观察组高于对照组,差异有统计学意义(P<0.05).观察组的自我评价评分、教学老师对学生的表现评分及教学满意度评分均显著高于对照组,差异有统计学意义(P<0.05).结论 启发式教学在临床医学本科生实习前集中技能培训中具有良好的效果,可显著提升医学本科生在实习前临床技能的理论和实践能力.

目的 探讨血管内皮生长因子(VEGF)在正常皮肤、瘢痕、瘢痕疙瘩中的表达及意义,VEGF在瘢痕疙瘩不同部位中的表达与意义.方法 采用免疫组化法检测VEGF在不同组织中表达及强度.结果 VEGF在瘢痕疙瘩组中的阳性表达率与正常皮肤组、瘢痕组相比具有显著性差异,在瘢痕疙瘩边缘部的表达强度与中央部相比具有显著差异.结论 VEGF的过量表达与瘢痕疙瘩的形成过程及瘢痕疙瘩的浸润性生长具有相关性.

目的 探讨下睑凹陷畸形的修复方法.方法 自2014年3月至2018年2月以来,应用脂肪注射、局部皮瓣、植皮等修复方法修复下睑凹陷畸形16例.术后随访时间3-12个月.结果 术后效果良好.结论 根据患者病例特点合理选择术式

目的 分析眼底激光治疗、羟苯磺酸钙胶囊(口服)联用对糖尿病视网膜病变的治疗效果.方法 选择2017年8月—2018年8月于我院就诊的糖尿病视网膜病变患者,共100例,按入院编号随机分为两组,每组50例.对照组仅开展眼底激光治疗,观察组又加用羟苯磺酸钙胶囊治疗,对比两组患者的具体治疗情况.结果 观察组的总有效率为96.00％,对照组仅为70.00％,且不良反应少,P<0.05,具有统计学意义.结论 关于糖尿病视网膜病变的治疗,口服羟苯磺酸钙胶囊加眼底激光治疗,效果显著,在临床上具有很高的应用价值,安全可靠,值得大力推广.

Objective: To compare the visual quality of the Symfony extended range of vision intraocular lensand the Tecnis ZMBOO multifocal intraocular lens, which can provide a theoretical basis for clinical promotionand application. Method: This was a retrospective case control analysis. One hundred thirteen patients (113 eyes) with cataract, who underwent phacoemulsification and IOL implantation, were divided into two groups: 63 patients (63 eyes) who were prescribed Symfony extended range of vision intraocular lenses and 50 patients (50 eyes) who were prescribed Tecnis ZMBOO multifocal intraocular lenses. Far, intermediate, and near distance vision were tested at postoperative 3 months. A binocular defocus curve was plotted, contrast sensitivity wave front aberrations were measured and patients answered a questionnaire. Data from the two groups were statistically analyzed by t test. Results: There was no significant difference invisual acuity between the two groups at 3 months postoperatively. Near vision (33 cm) in the ZMBOO group was superior to the Symfony group, and the difference was statistically significant (t=6.641, P=0.002). The intermediate-distance visual acuity (60 cm, 80 cm) of the Symfony group was superior to that of the ZMBOO group, and the difference was statistically significant (t=3.942, P=0.020; t=4.247; P=0.011). Three months after surgery, the defocus curve of the two groups showed that the Symfony group tended to be stable between +0.5 D and -2.5 D, and vision was above 0.3 LogMAR, forming a platform stage, and was more consistently superior to that of the ZMBOO group. The ZMBOO group showed a double peak, with a peak value of 0 D and -3.5 D. There were no statistically significant differences in spatial frequency contrast sensitivity between the two groups under visual acuity conditionsand visual acuity with glare three months after surgery. Under dark conditions, the contrast sensitivities for the spatial frequencies of the Symfony group were better than that of ZMBOO group at 3.0 c·d-1, 6.0 c·d-1, and 12.0 c·d-1, and the differences were statistically significant (t=8.246, P=0.013; t=10.831, P=0.006; t=6.246, P=0.027). Three months after surgery, the total aberrations, higher-order aberrations, and coma aberrations of the Symfony group were lower than that of the ZMBOO group, and the differences were statistically significant (t=3.302, P=0.035;t=9.495, P=0.010; t=5.310, P=0.018; t=4.259, P=0.024). There was no significant difference in total lower order aberrations, spherical aberrations and second-order astigmatism in the two groups. Conclusion:Symfony extended range of vision intraocular lenses can provide patients with good visual quality and continuous range of vision, while Tecnis ZMBOO multi-focus IOL is more suitable for near vision.

目的 探讨应用微型骨锚钉结合克氏针急诊一期修复指间关节侧副韧带断裂的临床效果.方法 2015年1月——2017年5月,我科对11例指间关节侧副韧带断裂的患者进行一期急诊手术治疗.术中应用微型带线骨锚钉重建断裂的指间关节侧副韧带的起点或止点,应用一枚克氏针固定受损的指间关节.克氏针术后3周拔除,逐渐进行功能锻炼.结果 术后11名患者创口Ⅰ期愈合,无血肿、感染、皮肤坏死,植入物外露等并发症发生,11名患者随访时间1个月到18个月,平均8个月.定期拍片检查,无关节脱位及植入物脱位,松动,断裂等并发症发生.再采用seatta功能评定标准评估疗效.评价优良率达到82％.结论 应用微型骨锚钉结合克氏针治疗急诊指间关节侧副韧带断裂技术容易掌握,疗效可靠,值得临床推广.

目的 探讨EX-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼的临床疗效.方法 选取我院65例78眼新生血管性青光眼患者,随机分为观察组33例(40只眼)及对照组32例(38只眼).对照组单纯给予Ex-Press引流器植入术,观察组给予雷珠单抗注射联合Ex-Press引流器植入术.观察两组治疗前和治疗后1、4周时,两组患者的患眼视力情况和眼压.比较两组患者治疗成功率及并发症发生率.结果 两组患者手术均获得成功,术后视力均高于治疗前视力(P<0.05).但观察组治疗后1、4周眼压的眼压明显低于对照组(P<0.05).两组治疗前视力分布情况比较,差异无统计学意义(P>0.05);治疗后对照组视力升高情况优于对照组,两组视力分布比较差异有统计学意义(Z=5.179,P<0.05).观察组患者的成功率为97.50%,明显高于对照组的86.84%(P<0.05).观察组患者的并发症总发生率为15.00%,明显低于对照组的26.32%(P<0.05).结论 EX-Press植入联合雷珠单抗玻璃体内注射治疗新生血管性青光眼临床疗效确切,可以明显提高视力,降低眼压.

目的:通过实施日间手术服务模式,改善患者就医难、住院难的问题,根据眼科疾病的特点,挑选适合的病种,以确保护理安全和护理质量.方法:依据医院的医疗特点和眼科患者诊疗需要创建眼科日间手术并实病房并实施.结果:住院患者由往年的1580例增加到3128例.年平均住院时间普遍缩短,床位周转和床位使用率均达标.通过日间手术的具体实施,取得良好效果.结论:眼科日间手术服务模式的创建与实施,很大程度上解决了眼科患者就医难、住院难和床位周转慢等问题.在实施护理过程中注重护理人员管理、流程管理、安全管理是确保日间手术顺利进行、提高患者满意度、确保护理质量的关键.

目的 通过研究OPN与TGF-β1在正常皮肤、扁平瘢痕及瘢痕疙瘩三组中的表达规律,探讨两者在瘢痕疙瘩形成中的意义.方法 应用免疫组化法 (SP法)结合计算机病理图像分析检测三组患者中OPN与TGF-β1的表达.分析OPN与TGF-β1在各组中的表达水平差异.结果 OPN与TGF-β1在瘢痕疙瘩组中的阳性表达率及IOD值与其他两组相比差异有统计学意义(P<0.05).OPN与TGF-β1在瘢痕疙瘩中的表达具有正相关.结论 OPN与TGF-β1在瘢痕疙瘩中的表达呈正相关,与瘢痕疙瘩的发生发展具有相关性.

Objective To analyze early secondary glaucoma types in eye trauma patients, and to investigate effective treatment scheme. Methods A total of 108 (108 eyes) eye trauma patients with early secondary glaucoma were divided by different clinical manifestations into intraocular hemorrhage group (34 cases), adhesion proliferation group (29 cases), chamber angle contusion group (26 cases) and crystalline lens-related group (19 cases). They all received drug and operation treatment in accordance with specific condition. Comparison was made on intraocular pressure changes and clinical effects before and after treatment in all four groups. Results All groups had obviously lower intraocular pressure after treatment than those before treatment (P<0.05). Clinical effective rates in ntraocular hemorrhage group, adhesion proliferation group, chamber angle contusion group and crystalline lens-related group were respectively 94.1%, 82.8%, 84.6% and 84.2%. Conclusion Rational classification and symptomatic treatment in accordance with multiple factors shows precisely curative effect for early secondary glaucoma types in eye trauma, and this method is worth promoting.

目的：OPN 在纤维化疾病中呈高表达，参与肿瘤的发生发展，本文探讨 OPN 在瘢痕疙瘩形成中的作用。方法就与瘢痕疙瘩的发生的因素：成纤维细胞、血管生成、细胞外基质沉积、细胞凋亡等分别探讨 OPN 与瘢痕疙瘩的关系。结果OPN 的过量表达与瘢痕疙瘩的形成过程相关。

The degeneration of retinal pigment epithelium (RPE) cells in the sub retinal pigment epithelial space and choroid is an initial pathological characteristic for the age-related macular degeneration which is the leading cause of severe vision loss in old people. Moreover, oxidative stress is implicated as a major inducer of RPE cell death. Here, we assessed the correlation between the H2O2-induced RPE cell death and glutamine metabolism. We found under low glutamine supply (20 %), the ARPE-19 cells were more susceptive to H2O2-induced apoptosis. Moreover, the glutamine uptake and the glutaminase (GLS) were suppressed by H2O2 treatments. Moreover, we observed miR-23a was upregulated by H2O2 treatments and overexpression of miR-23a significantly sensitized ARPE-19 cells to H2O2. Importantly, Western blotting and luciferase assay demonstrated GLS1 is a direct target of miR-23a in RPE cells. Inhibition of the H2O2-induced miR-23a by antagomiR protected the RPE cells from the oxidative stress-induced cell death. In addition, recovery of GLS1 expression in miR-23a overexpressed RPE cells rescued the H2O2-induced cell death. This study illustrated a mechanism for the protection of the oxidative-induced RPE cell death through the recovery of glutamine metabolism by inhibition of miR-23a, contributing to the discovery of novel targets and the developments of therapeutic strategies for the prevention of RPE cells from oxidative stress.

近年来，随着人口老龄化以及对视近需求的不断增加，老视问题受到越来越大的关注。老龄患者近距离工作时出现视物模糊、眼胀、眼痛、异物感、头疼等视觉疲劳症状，被称为眼疲劳综合征〔1〕。本研究旨在探讨七叶洋地黄双苷对眼调节幅度的影响，为改善老视、推迟佩戴花镜时间寻找有效的药物，为临床治疗提供理论依据。

目的：探讨化学性眼外伤患者急救治疗方法和疗效。方法选择24例化学性眼外伤患者，对酸性烧伤、碱性烧伤治疗方法进行分析。结果经积极干预治疗，24例化学性眼外伤患者均恢复良好，其中治愈15例，好转8例，无效1例，总有效率95.8%。治疗效果满意。结论对于化学性眼外伤，应去除残留化学物质，防止坏死病变的进一步扩散，恢复伤区组织的营养，防止感染，减少并发症和后遗症。

目的讨论准分子激光屈光性角膜切削术。方法 对患者进行手术治疗。结论 去除角膜上皮后，用准分子激光对角膜中央区前弹力层和浅层基质进行切削，直接改变角膜中央部前表面的曲率。

目的探讨Tecnis ZMA00+4D衍射型多焦点人工晶体的临床应用效果.方法选取2010年1月-2012年1月,在我院行白内障超声乳化吸出联合TecnisZMA00+4D衍射型多焦点人工晶体植入术患者32例(50眼).术后3d观察术眼的屈光状态(裸眼远、近视力);术后1个月观察术眼的屈光状态(裸眼远、近视力,最佳矫正远、近视力)、患者生活质量问卷调查及脱镜率.结果术后均有良好的远、中、近视力,术后1个月裸眼远视力≥4.8占96.0%,裸眼近视力≥4.8为82.0%,看远脱镜率为96.0%,看近脱镜率为86.0%,问卷调查无或眩光不明显的患者为42眼(90.0%).结论 Tecnis ZMA00+4D衍射型多焦点人工晶体植入后能提供良好的远近视力,提高患者调节力,改善白内障患者术后的视觉质量,提高患者生存质量.

Objective To evsluate the use of the kite flap for the repair of the post-traumatic partial defect of the eyebrow.Methods To repair defective eyebrow,the choice of metheds would be based on character,scope of defective eyebrow.Since 2009,kite flaps had been used to repair defective eyebrows in 16 cases with 17 pieces fo eyebrow.Followed-up for 3 to 12 months.Results All flaps survived with primary healing.The colour and quality of the flap was similar with eyebrow.The scar was hard to find and there were no eyebrow overstafled.All cases had achieved satisfactory cosmetic effects without secondary deformity.Conclusion It is a simple,safe,and reliable method to use kite flap for the repair of post-traumatic partial defect of the eyebrow.

目的探讨Tecnis ZMA00+4D衍射型多焦点人工晶体的临床应用效果。方法选取2010年1月-2012年1月,在我院行白内障超声乳化吸出联合TecnisZMA00+4D衍射型多焦点人工晶体植入术患者32例(50眼)。术后3d观察术眼的屈光状态(裸眼远、近视力);术后1个月观察术眼的屈光状态(裸眼远、近视力,最佳矫正远、近视力)、患者生活质量问卷调查及脱镜率。结果术后均有良好的远、中、近视力,术后1个月裸眼远视力≥4.8占96.0%,裸眼近视力≥4.8为82.0%,看远脱镜率为96.0%,看近脱镜率为86.0%,问卷调查无或眩光不明显的患者为42眼(90.0%)。结论 Tecnis ZMA00+4D衍射型多焦点人工晶体植入后能提供良好的远近视力,提高患者调节力,改善白内障患者术后的视觉质量,提高患者生存质量。

目的:观察环孢霉素眼药水治疗带状疱疹病毒性角膜炎的临床疗效。方法:60例(60只眼)患有带状疱疹后引起角膜炎的患者随机分为2组,A组局部应用环孢霉素A滴眼液滴眼及更昔洛韦眼凝胶,B组局部应用皮质类固醇滴眼液(普楠扑林滴眼液)及更昔洛韦眼凝胶,随诊观察12~24个月,平均18个月。结果:2组比较治愈率A组与B组无显著性差异,但治愈时间缩短存在显著性差异,且A组的复发率低于B组,有显著性差异。结论:对于带状疱疹引起角膜炎的患者使用环胞霉素A滴眼液能够缩短病程,且减少复发,并达到治愈效果较佳。