目的 探讨标准化病人(standardized patient,SP)结合基于问题学习(problem-based learning,PBL)教学法在疼痛科临床教学中的应用效果.方法 选择2018年8月—2019年8月在滨州医学院附属医院疼痛科实习的48名麻醉学专业本科生为研究对象,将其随机分为试验组和对照组,分别采用SP结合PBL教学法和传统教学模式进行实习带教教学.实习结束后,对两组学生进行理论与实践考核,比较两组实习生的考核成绩,并对教学满意度进行问卷调查.结果 试验组的理论考核、临床实践考核成绩分别为(35.97±2.64)分及(57.32±3.14)分,明显高于对照组(33.73±2.78)分及(50.86±3.95)分,差异有统计学意义(P<0.01);试验组在激发学习兴趣、自主学习能力、临床思维能力、医患沟通能力、团队协作能力、提高学习效率等方面,明显优于对照组(P<0.05),试验组的教学满意度明显高于对照组(P<0.05).结论 在疼痛科临床教学中应用SP结合PBL教学法,有利于提高学生的学习主动性,提升临床思维能力和医患沟通能力,显著提高教学质量.

Objective:To evaluate the clinical efficacy of stellate ganglion block combined with linear polarized light irradiation in treatment of patients with shouder-hand syndrome.Methods:Sixty patients with shouder-hand syndrome in Department of Pain Medicine, Binzhou Medical University Hospital, no gender and age limitation, from August 2015 to August 2019, were enrolled and randomly divided into conventional rehabilitation group and combined treatment group, with 30 cases in each group. Patients were treated with routine rehabilitation treatment in the conventional rehabilitation group, while patients were treated with stellate ganglion block combined with linear polarized light irradiation based on routine rehabilitation treatment in the combined treatment group. Both groups were treated once a day for 2 courses with 10 days in a course (20 days). Visual analogue scale (VAS), upper limb simplification Fugl-Meyer assessment (FMA), and the effective improvement rate of palm circumference were used to evaluate the degree of pain, upper limbs function and edema before and after the treatment. The total effective rate of the two groups was evaluated at the end of the treatment according to the VAS.Results:There was no significant difference in general data between the two groups (all P>0.05). Before the treatment, there were no significant differences of VAS and FMA score between the two groups (all P>0.05). At the end of the treatment, VAS and FMA score were (2.3±1.8) and (56.8±5.3) in the combined treatment group, while (4.6±2.5) and (40.2±5.1) in the conventional rehabilitation group, respectively. The curative effect was significantly better in the combined treatment group than that in the conventional rehabilitation group (all P<0.05). The number of VAS 0-3 patients was much more in the combined treatment group than that in the conventional rehabilitation group (23 cases vs. 11 cases, P=0.002). The effective improvement rate of palm circumference was significantly higher in the combined treatment group (86.7%) than that in the conventional rehabilitation group (56.7%, P=0.010). The total effective rate was 93.3% in the combined treatment group, which was significantly higher than that in the conventional rehabilitation group 63.3% ( P=0.005). The incidence of adverse reactions was significantly lower in the combined treatment group than that in the conventional rehabilitation group ( χ 2=4.04, P<0.05). Conclusion:Both stellate ganglion block combined with linear polarized light irradiation and routine rehabilitation treatment can improve the clinical symptoms and upper limb function in patients with shouder-hand syndrome, but the efficacy of the combined treatment is better.

目的 探讨活血化瘀汤联合双氯芬酸钠对慢性肌肉骨骼疼痛患者的临床疗效.方法 100例患者随机分为对照组和观察组,每组50例,对照组给予双氯芬酸钠,观察组在对照组基础上加用活血化瘀汤,疗程12周.检测中医病证疗效、血清炎性因子(Hs-CRP、TNF-α、IL-6)、VAS评分、SF-36评分变化.结果 观察组总有效率高于对照组(P<0.05).治疗后,2组Hs-CRP、TNF-α、IL-6、VAS评分降低(P<0.05),SF-36评分更高(P<0.05),以观察组更明显(P<0.05).结论 活血化瘀汤联合双氯芬酸钠可控制慢性肌肉骨骼疼痛患者炎性因子水平,降低疼痛阈值,改善生活质量.

目的:探讨临床路径在疼痛科临床教学中的应用效果.方法:将70名麻醉学实习生随机分为实验组和对照组,分别采用临床路径教学法和传统临床教学法进行教学.实习结束后,比较两组学生的出科考试成绩和教学满意度.结果:实验组出科考试成绩和教学满意度明显高于对照组(P＜0.05).结论:在疼痛科临床教学中应用临床路径可以显著提高教学效果.

目的:观察腰交感神经连续阻滞对下肢动脉硬化闭塞症的临床疗效.方法:选择下肢动脉硬化闭塞症引起下肢疼痛的患者24例,在CT引导下行腰交感神经阻滞及置管术,术后行腰交感神经连续阻滞治疗,采用数字评分法(NRS)对下肢疼痛症状进行评价.结果:20例患者下肢疼痛症状明显减轻或消失,下肢皮肤温度升高,NRS评分显著降低(p＜0.05),有效率达83.3%,且术后未出现明显并发症.结论:腰交感神经连续阻滞治疗下肢动脉硬化闭塞症是一种安全、有效的方法.

目的:分析神经妥乐注射剂治疗慢性疼痛性疾病临床机制.方法:选取2018年2月至2019年3月在我院接受治疗的慢性疼痛性疾病患者120例纳入研究,按照随机数表将所有患者均分成2组,参考组(60例)和一般组(60例).一般组实施常规治疗,参考组实施神经妥乐注射剂治疗,观察两组患者临床效果以及不良反应发生率.结果:经护理后,较一般组,参考组的临床效果更佳,不良反应显著更小,组间数据对比具有明显的差异,具备统计学意义(P<0.05).结论:因此可看出,神经妥乐注射剂治疗慢性疼痛性疾病临床效果显著,总体副作用少,可在临床实践应用推广.

OBJECTIVE To observe the correlation between blood inflammatory markers and illness condition of pa‐tients with sepsis bacterial infection .METHODS A total of 100 patients with sepsis who were treated in hospitals from Jul 2013 to Jan 2016 were enrolled in the study and were divided into the sepsis group with 36 cases ,the se‐vere sepsis group with 34 cases ,and the septic shock group with 30 cases according to the severity of illness .The incidence of bacterial infection in the sepsis patients was analyzed ,the levels of blood inflammatory markers (LPS , CRP ,PCT ,IL‐6 ,WBC) and acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score were com‐pared among the three groups of sepsis patients ;the correlation between the levels of blood inflammatory markers and the APACHE‐Ⅱ score was observed .RESULTS Escherichiacoli ,Klebsiella pneumoniae ,coagulase‐negative Staphylococcus ,and Staphylococcus aureus were the predominant species of pathogens causing the bacterial infec‐tion in the sepsis patients ,followed by Acinetobacter baumannii and Enterobacter cloacae .The levels of LPS , CRP ,PCT ,IL‐6 ,and WBC of the sepsis group were respectively (28 .75 ± 5 .69)ng/L ,(68 .54 ± 12 .73)mg/L , (0 .84 ± 0 .21)μg/L ,(29 .85 ± 6 .47)ng/L ,and WBC (9 .81 ± 2 .54) × 109/L ,lower than (37 .18 ± 7 .24)ng/L ,&nbsp;(129 .20 ± 17 .62)mg/L ,(8 .41 ± 0 .81)μg/L ,(53 .22 ± 11 .41)ng/L ,and (11 .35 ± 3 .06) × 109/L of the severe sepsis group and (44 .79 ± 8 .25)ng/L ,(153 .24 ± 21 .38)mg/L ,(11 .37 ± 1 .05)μg/L ,(85 .60 ± 16 .28)ng/L ,and (14 .79 ± 3 .54)× 109/L of the septic shock group ,and there was significant difference (P<0 .05) .The APACHE‐Ⅱ score of the sepsis group was (12 .16 ± 3 .51)points ,lower than (21 .12 ± 4 .93)points of the severe sepsis group and (26 .29 ± 5 .63)points of the septic shock group ,and there was significant difference (P<0 .05) .The levels of blood LPS ,CRP ,PCT ,IL‐6 ,and WBC of the sepsis patients were positively correlated with the APACHE‐Ⅱ score ,and there was significant difference (P<0 .05) .CONCLUSION The levels of blood inflamma‐tory markers of the sepsis patients with bacterial infection are positively correlated with the severity of illness , which can be used as reliable clinical indicators for evaluation of illness condition and prognosis of the patients .

目的 本研究旨在探讨应用超声造影三维成像对脑梗死患者颈动脉低回声斑块内新生血管进行定量评价的临床意义.方法 61例存在颈动脉低回声斑块患者根据是否存在脑梗死分为两组:脑梗死组27例,34例无脑梗死患者作为对照组,对低回声斑块行超声造影三维成像,并对三维图像按照统一的标准进行处理,计算并记录斑块的体积和斑块内新生血管的条数,计算血管指数,所有参数进行两组间的对比分析. 结果脑梗死组颈动脉低回声斑块的血管指数明显高于对照组,差异有统计学意义(P＜0.05).而两组间的斑块体积、最大厚度、横截面积狭窄率差异无统计学意义(P＞0.05).结论 超声造影三维成像不仅能显示颈动脉低回声斑块内的新生血管的空间立体分布,还可以通过血管指数对斑块内新生血管进行定量评价,这为进一步研究斑块内微血管灌注提供了一个新方法.

Objective To investigate the clinical value of contrast-enhanced three-dimensional ultrasound in assessing neovascularization within carotid soft plaques. Methods Thirty-six cases with 42 soft plaques were examined with contrast-enhanced two dimensional ultrasound and contrast-enhanced three dimensional ultrasound. Soft plaques were divided into four grades according to distribution and shape of contrast media:grade Ⅰ (there was no enhancement in plaque) , grade Ⅱ (plaque was enhanced with sparse spots pattern or enhanced in small range locally), grade Ⅲ (plaque was enhanced with sparse spots and short-line pattern ),grade Ⅳ (plaque was enhanced with line and grid pattern). Results The results of contrast-enhanced two-dimensional ultrasound were as followed: 4.8% grade Ⅰ , 35.7% grade Ⅱ , 52.4% grade Ⅲ and 7.1% grade Ⅳ. The results of contrast-enhanced three-dimensional ultrasound were as followed:9.5% grade Ⅱ , 47.6% grade Ⅲ and 42.9% grade Ⅳ. Conclusions Spatial distribution of neovascularization within carotid soft plaques could be reflected comprehensively by contrast-enhanced three dimensional ultrasound, and it might be a new mothod to investigate spatial structure and microvascular perfusion of soft plaques furtherly.