目的 探讨危急重症多学科模拟演练在助产专科培训中的应用及其效果.方法 选取2019年10月-2020年6月在我院参加产科危急重症多学科模拟培训的116名助产士为研究对象,采用助产士核心胜任力量表、一般自我效能量表和满意度调查问卷对模拟培训效果进行评价.结果 经培训后,助产士的团队能力、核心胜任力、自我效能感、理论及临床实践考核成绩较培训前显著改善(P＜0.05),且满意度较高.结论 危急重症多学科模拟培训提升了助产士快速反应团队的团结协作能力和核心胜任力.

目的 探讨基于雨课堂的混合式教学模式在孕妇学校教学中的应用效果.方法 选择2018年6月至2019年3月在郑州大学第三附属医院孕妇学校建立母子健康手册的180名孕产妇,随机分为对照组和实验组,对照组采用传统的孕妇学校团体授课模式;实验组在对照组基础上实施基于雨课堂的混合式教学模式.采用教学效果评价问卷、孕期保健质量问卷和满意度评价问卷比较两组教学效果.结果 实验组孕产妇的教学效果评价问卷评分、孕期保健质量问卷及满意度评价问卷得分均高于对照组.结论 基于雨课堂的混合式教学模式能有效提高孕产妇的孕期保健质量和满意度,提升教学效果,值得在临床教学中应用.

目的 对公立医院的临床助产工作者对会阴切开术的知识、态度和行为开展调查,探索降低会阴切开在产程中的不规范使用.方法 采用便利抽样法,在河南省32所三级医院、47所二级医院、11所一级医院的医生和助产士进行问卷调查.结果 900名临床助产工作者参与了问卷调查.关于过度使用会阴切开术的并发症知识得分情况较好;对初产妇会阴切开术的使用频率与医院等级和工作年限相关,即二级医院使用会阴切开术的频率比三级医院高,差异有统计学意义(P＜0.05);年资高的助产士个人会阴切开率较高,差异有统计学意义(P＜0.05);仍有42.11％的临床助产工作者认为目前的会阴切开率(45％)正常或过低;产科医生(83.94％)和助产士(79.69％)操作会阴切开术的主要原因是为减少三度或四度会阴裂伤;产科医生(80.29％)和助产士(82.57％)都认为减少会阴切开术最主要的障碍是缺乏"减少会阴裂伤或维持会阴完整性"的培训.结论 当前会阴侧切率仍与WHO的推荐存在差异,迫切需要落实相关临床指南,而基层医院和年长的临床助产工作者是需要转变知识和态度的重点培训对象.

Objective:To construct a scientific and reasonable early warning evaluation index system for high-risk pregnancy during childbirth, so as to provide a content framework for the establishment of an information management platform.Methods:Convenience sampling was used to select 15 experts from 2 colleges and universities, 5 ClassⅢ Grade A general hospitals and 2 ClassⅢ Grade A maternal and child health hospitals in Henan Province as the subject of consultation. The early warning evaluation indicators of high-risk pregnancy during childbirth were determined through literature research, group discussion, and Delphi expert consultation method. Convenience sampling method was adopted to select 288 pregnant women admitted to the hospital for delivery from February to April 2020 in a ClassⅢ Grade A hospital in Henan Province as the research object. The early warning evaluation index system for high-risk pregnancy during childbirth was used to evaluate pregnant women.Results:The final early warning evaluation index system for high-risk pregnancy during childbirth included 7 first-level indicators and 27 second-level indicators. The expert authority coefficients of the two rounds of consultation were 0.91 and 0.93, respectively, and the Kendall harmony coefficients were 0.241 and 0.385, respectively ( P<0.001) . The area under the ROC curve predicted by the early warning evaluation index system for high-risk pregnancy during childbirth was> 0.85, and the best cut-off point was 9.98. Conclusions:The constructed early warning evaluation index system for high-risk pregnancy during childbirth has comprehensive content and high reliability, which will help midwives to identify high-risk pregnancy during childbirth.

自由体位分娩是目前临床产科发展的一个趋势,其对加快产程进展,促进自然分娩,影响分娩结局起到十分重要的作用.本文结合近年来相关文献资料,对国内自由体位分娩的临床研究进展进行综述,为临床分娩研究提供一定理论依据.

针对大规模、高频次能量流和信息流在多元用户传输与交互过程中存在的安全问题,提出一种基于用户偏好的电力资源去中心化配置方法.首先,将电力市场中的节点区分为能源节点和能源区块代理路由器两类主体;随后,对能源供需中的偏好按照历史供能习惯划分为环境友好型、输电资源节约型和经济高效型三类;进而提出一类能量信息匹配算法及综合评估函数,用于满足多用户环境下的最优电力资源配置.仿真实验表明,该方法可提高清洁能源在市场交易中的消费占比,促进能量就近消纳,提高电网的资源配置能力.

目的:观察鞘内注射右美托咪定对神经病理性疼痛大鼠背根神经节(dorsal root gangli-on,DRG)神经元GABAA受体激活电流的影响.方法:鞘内置管成功的雄性SD大鼠36只,体重180～220 g,采用随机数字表法随机分为3组(n=12):假手术组(S组)、神经病理性疼痛组(CCI组)、右美托咪定+神经病理性疼痛组(D组).S组和CCI组鞘内注射生理盐水每日10μl/次,D组鞘内注射右美托咪定2μg/kg,生理盐水稀释至10μl,每日1次,持续至术后14 d.各组于术前1 d(T0),术后3、5、7、10、14 d(T1-5)时测试热缩足潜伏期(thermal withdrawal latency,TWL).于术后T5时测试完TWL后处死大鼠,在急性分离的DRG细胞上,运用全细胞膜片钳技术,记录不同浓度药物作用下各组背根神经节细胞GABAA受体激活电流的变化.结果:(1)与S组比较,CCI组和D组T1-5时TWL均缩短(P<0.05);与D组比较,CCI组T1-5时TWL均缩短(P<0.05).(2)GABA(0.1～1000.0μmol/L)可以使85.7％(102/119)的DRG神经元产生浓度依赖性的内向电流,而且这种内向电流能被GABAA受体选择性拮抗剂荷包牡丹碱(100μmol/L)所阻断.(3)CCI组在不同浓度(0.1～1000.0μmol/L)GABA激活电流幅值均小于S组和D组(P<0.05);D组在不同浓度(0.1～1000.0μmol/L)GABA激活电流幅度小于S组(P<0.05).结论:右美托咪定通过增强GABAA受体介导的突触前抑制作用,可能是其缓解神经病理性疼痛的机制之一.

目的 调查河南省妇幼保健机构护士长岗位胜任力现状及影响因素.方法 2018年5月-6月采用多阶段分层抽样法,使用一般资料调查表、护士长岗位胜任力量表、中文版Wallace自我概念量表、职业认同感量表、学习型组织量表对河南省妇幼联盟医联体内12所医院的263名护士长进行调查.结果 护士长的岗位胜任力总均分为(4.20土0.63)分,医院级别、是否参加培训、自我概念、职业认同感、学习型组织是影响护士长的岗位胜任力水平的影响因素(P＜0.001).结论 河南省妇幼保健机构护士长岗位胜任力处于较高水平,但仍有改善的空间,管理者可以从培训、自我概念、职业认同感、学习型组织为切入点,进一步提高护士长的岗位胜任力.

在分布式能源系统的区块链应用中,存在异构区块链间互信困难、并网可扩展性差等不足.针对以上问题,该文提出一种异构能源区块链的多能互补安全交易模型.首先给出异构能源区块链网络的形式化模型,进而引入一种跨链互信交易方法ET-Relay,构造了一种多能互补安全交易模型,通过构建能源索引交易中继链和能源平行链,融合多种能源上链并网,并安全地完成跨链能源协同调度.仿真实验表明,在利用区块链特性确保交易数据安全性的前提下,该模型较好地解决了能源交易系统中分布式能源的多能互补和整合调度的问题.

目的 探讨一对一导师制在助产士临床实践培训中的应用效果.方法 采用目的抽样法选取2016年9月-2017年9月在河南省某三级医院参加培训的54名助产士为研究对象,采用一对一导师制进行临床实践培训,经3个月培训后,比较助产士核心胜任力和一般自我效能感.结果 培训后,助产士核心胜任力的总均分为(4.14±0.33)分,助产士一般自我效能感总分为(29.19±5.74)分,均高于培训前(P＜0.01).结论 对助产士采用一对一导师制临床实践培训,能有效提高其核心胜任力和自我效能感.

针对分布式能源在交易认证中的数据安全问题,提出一类基于联盟链的分布式能源交易认证模型,通过区块链权益证明、数据加密、时间戳和分布式共识的方法优化了传统能源的交易模式,以分布式共享账本的方式解决了交易数据过于中心化的问题,并运用数据分离的方法在一定程度上保护了交易各方的私有数据,提高了分布式能源交易数据安全性、信息透明度和自动化认证水平.仿真实验验证了模型的有效性.

目的 比较羟考酮与舒芬太尼用于可视可塑型光纤喉镜(SOS)引导经口清醒气管插管的效果.方法 预期困难气道择期拟行SOS引导下经口清醒气管插管的全身麻醉患者40例,分为羟考酮组(Q组)和舒芬太尼(S组),每组20例.Q组静脉注射羟考酮0.2 mg/kg,S组靶控输注舒芬太尼,血浆靶浓度0.4 ng/mL,Q组静脉注射结束 、S组达血浆靶控浓度时进行气管插管.气管插管期间评价气管插管条件和患者对气管插管的耐受性,记录气管插管时间 、气管插管成功率 、气管插管后第1个呼吸末二氧化碳(PetCO2)等临床指标;分别于表面麻醉前(T0)、麻醉诱导完成(T1),气管插管后即刻(T2),气管插管后1、3 min(T3、T4)时记录灌注指数(PI)和Ramsay镇静评分.结果 与S组比较,Q组呼吸频率降低 、低氧血症的发生率,气管插管后第1个Pet-CO2降低(P<0.05).两组患者平均动脉压(M AP)和心率(HR)的变化率>30％ 、RPP>12000的发生率 、气管插管条件 、插管的耐受性 、插管时间 、PI、Ramsay镇静评分,咽喉疼痛 、声音嘶哑的发生率比较,差异无统计学意义(P>0.05).结论 羟考酮用于SOS引导经口清醒气管插管时呼吸抑制率低,能提供更安全的插管条件.

In the current way of generating block data, the scenarios of micro trading are easy to encounter the efficiency bottleneck. In order to solve the problem of long waiting time for micro trading in blockchain, a novel strategy called real-time micro trading strategy with blockchain (RMTSB) was proposed in this paper. Firstly, a delay control Petri net model(DCPN) was constructed to describe, analyze and control the system that has delay information. Secondly, in order to record and evaluate the transaction process, a transaction data block structure with personal credit index and a personal credit evaluation method for micro trading were proposed. Then, on the basis of credit analysis and DCPN model, the paper presented the RMTSB strategy. Finally, the real-time micro trading strategy with blockchain is established from both the full node and SPV. To verify the validity of the proposed strategy, three kinds of transaction process were simulated, namely the conventional blockchain transaction process, the trading process under RMTSB strategy and the trading process under RMTSB strategy with network delay variables. The contingency of a single experiment was eliminated by the delay accumulation of multi-round transactions. The simulation results demonstrated that, compared with the conventional blockchain trading models, the RMTSB strategy improved the efficiency of transaction verification,Specifically, the transaction delay can be reduced by 50%~75%. Therefore, this strategy can simplify the certification process to a certain extent, and thus improve the payment speed of micro trading in blockchain, making blockchain really become a supporting technology in micro trading application scenarios.

Objective To investigate the core competency of midwives in grassroots hospitals in Henan province and to analysis the relationship between the general self-efficacy and learning organization as well as the core competency.Methods Using the Midwife Core Competency Scale and the General Self-Efficacy Scale and the Dimensions of the Learning Organization Questionnaire,245 midwives of 34 grassroots hospitals were investigated in Henan province.Results Most of the Midwives were the primary title,and the initial degree was low.Only 17 (6.9％) people took undergraduate course.The total score of core midwifery competency was (4.02 ± 0.53).The scores of pro-gestational care,neonatal health care,public health care were relatively lower.The scores of their core competency in each dimension were no statistically significant difference in training time and the highest degree (P ＞ 0.05).The scores of core competence in each dimension,general self-efficacy and nursing learning organization were positively correlated (P ＜ 0.01).Conclusion The initial degree,the level of professional titles and the core competence are limited,and the service consciousness is not strong in the whole process of the pregnant women,and the general clinical continuing education effect is not significant.So during the midwife standardization training,more attention should be paid to refresher training and make sure of their important role in dealing with the baby boom.

Block chain is a new decentralized framework and a distributed computing paradigm,which integrates and innovates a variety of computer technologies.Virtual power plant is an important branch of the energy intemet.It plays an important role in the convergence of distributed power generation resources and the establishment of virtual power resource transactions.In this paper,it proposed a kind of energy block chain network model and a virtual power plant operation and scheduling of the improved model to solve the existing problems in the VPP model.The simulation results show that the proposed model can reflect the real-time information of the demand,conducive to the virtual power plant environmental friendly and transparent stable scheduling,and improve the data and storage security.