目的:探讨中医情志疗法联合耳穴压豆对心脾两虚型失眠症乳腺癌患的影响.方法:采取方便抽样法,选取 2022 年 4月1 日～2023 年4 月30 日在山东省立第三医院、山东第一医科大学附属省立医院住院的200 例心脾两虚型失眠症乳腺癌患者为研究对象,采用两因素两水平的析因设计,根据随机数字表法分为对照组、中医情志疗法组、耳穴压豆组、联合组各 50 例.对照组给予外科术后失眠常规护理,中医情志疗法组在对照组基础上实施中医情志疗法干预,耳穴压豆组在对照组基础上实施耳穴压豆干预,联合组在对照组基础上实施中医情志疗法和耳穴压豆干预,干预时间为 4 周,3 例患者中途退出,最终对照组 50 例,中医情志疗法组 48 例、耳穴压豆组 49 例、联合组 50 例患者完成研究;比较四组干预前后睡眠质量[采用匹兹堡睡眠质量指数量表(PSQI)]、中医证候(采用中医证候量表)、心理状态[采用正负性情绪量表(PANAS)].结果:干预后,中医情志疗法组、耳穴压豆组、联合组PSQI、中医证候、PANAS评分均优于干预前(P<0.01),四组比较差异有统计学意义(P<0.01).结论:中医情志疗法联合耳穴压豆能有效改善心脾两虚型失眠症乳腺癌患者睡眠质量,可以提高患者正性情绪,降低其负性情绪,从而缓解患者中医症状.

Objective:To explore the effects of online supportive disclosure therapy on the self-expression level, professional identity, dimission intention, and turnover rate of pre-dimission nurses, in order to provide a reference for nursing managers to stabilize the nursing team.Methods:A quasi experimental research method was used, and a convenient sampling method was used to select 192 pre resigned nurses from Shandong Provincial Third Hospital, the First Affiliated Hospital of Shandong First Medical University, and Shandong First Medical University Affiliated Provincial Hospital from October 2021 to December 2022 as the research subjects. They were divided into a control group and an experimental group by random number table method, with 96 nurses in each group. The control group received routine exit interviews, while the experimental group received online supportive disclosure therapy intervention based on this. The self-expression level, professional identity, dimission intention, and turnover rate of two groups of nurses before and 1, 2 months after the intervention were evaluated.Results:Finally, 94 nurses in the control group and 92 nurses in the experimental group completed the study. There were no significant differences in the self-expression level, professional identity, dimission intention before the intervention between the two groups ( P>0.05). After 1 and 2 months of the intervention, the scores of the Pain Self Disclosure Index, Nurse Professional Identity Rating Scale, and Resignation Intention Scale of the experimental group were 36.33 ± 5.13, 73.88 ± 8.72, 14.18 ± 1.12 and 34.22 ± 6.78, 98.26 ± 11.29, 6.16 ± 1.19, respectively,and the control group were 28.06 ± 8.23, 64.72 ± 10.39, 17.82 ± 1.37 and 44.26 ± 7.62, 79.82 ± 8.66, 9.18 ± 1.06, there were statistically significant differences between the two groups ( t values were -13.54 to -2.11, all P<0.05); there were statistically significant differences in the inter group effects, time effects, and interaction effects of the scores on the Pain Self Disclosure Index, Professional Identity Rating Scale, and Resignation Intention Scale between the two groups ( F values were 5.12 to 14.82, all P<0.05). The turnover rate of nurses in the experimental group was 1.09% (1/92), lower than 8.51% (8/94) in the control group, and the difference between the two groups was statistically significant ( χ2=1.59, P<0.05). Conclusions:Online supportive disclosure therapy can improve the self-expression level and professional identity of pre-dimission nurses, and reduce their willingness to resign and turnover rate.

Objective:To investigate the expression of seven in absentia homologues 2 (SIAH2) and Annexin A2 in the carcinogenesis of primary liver carcinoma (PLC) and their relationship with the clinicopathological features of PLC.Methods:A total of 26 cases of normal liver tissue specimens, 43 cases of liver cirrhosis tissue specimens and 85 cases of PLC tissue specimens confirmed pathologically were collected from Linyi People’s Hospital, Affiliated Hospital of Shandong Medical College and the Third Hospital of Shandong Province from January 2018 to November 2022. The expression of SIAH2 and Annexin A2 in the above tissues was detected by immunohistochemistry, and the relationship between the expression of SIAH2 and Annexin A2 and the clinicopathological features of PLC was analyzed by chi-square test combined with clinical data.Results:The positive expression rates of SIAH2 in normal liver tissues, liver cirrhosis tissues and PLC tissues were 15.39% (4/26), 41.86% (18/43) and 74.12% (63/85), and the differences among them were statistically significant (respectively, χ2=12.787, 28.705, 5.230, P<0.05). The expression level of SIAH2 was significantly correlated with tumor size, tumor node metastasis (TNM) stage and vascular invasion (respectively, χ2=6.182, 6.910, 6.618, P<0.05), but not with gender, differentiation degree of cancer cells, age and pathological type of PLC (respectively, χ2=0.014, 0.037, 0.497, 0.002, P>0.05). The positive expression rates of Annexin A2 in normal liver tissues, liver cirrhosis tissues and PLC tissues were 7.69% (2/26), 18.60% (8/43) and 48.24% (41/85), and the differences among them were statistically significant (respectively, χ2=4.864, 13.790, 4.094, P<0.05). The expression level of Annexin A2 was significantly correlated with vascular invasion, tumor size, differentiation degree of cancer cells and TNM stage of PLC (respectively, χ2=4.637, 8.090, 0.497, 7.636, P<0.05), but not with the gender, age and pathological type of PLC (respectively, χ2=0.042, 0.009, 0.007, P>0.05). Conclusion:The expression of SIAH2 and Annexin A2 is up-regulated in PLC tissues, and the expression of SIAH2 and Annexin A2 may be related to the occurrence, progression, poor clinicopathological features and prognosis of PLC.

目的:了解下肢截肢患者幻肢痛的身心体验,探讨其幻肢痛的影响因素,为采取有效干预措施提供理论依据.方法:采用质性研究方法,对15例下肢截肢患者采取半结构式深入访谈,采用Colaizzi 7步分析法整理分析资料.结果:下肢截肢患者幻肢痛的影响因素可归纳为术前患肢痛、术中伤害刺激、残肢痛与残肢觉、心理障碍、伤残接受度5个方面.结论:医护人员应加强围术期镇痛护理,帮助患者采取有效应对方式解除其幻肢痛影响因素,从而降低幻肢痛的发生率,提高其适应能力,促进其身心康复.

目的:探讨接纳与承诺疗法(ACT)在截肢术后患者中的应用效果.方法:将2020年9月1日～2021年2月28日100例截肢术后患者随机分为对照组和实验组各50例,最终对照组48例、实验组47例完成研究.对照组采用常规护理干预,实验组在此基础上实施接纳与承诺疗法干预.干预前、干预后3个月和6个月分别对两组患者心理灵活性[采用接纳与行动问卷第二版(AAQ-Ⅱ)]、病耻感[采用中文版社会影响量表(SIS)]、伤残接受度[采用伤残接受度量表(ADS-R)]进行评价.结果:干预后,实验组AAQ-Ⅱ、SIS评分均低于对照组(P<0.05),ADS-R评分高于对照组(P<0.05);两组ADS-R、AAQ-Ⅱ、SIS评分时间效应比较差异有统计学意义(P<0.01,P<0.05).结论:接纳与承诺疗法可提高截肢术后患者的心理灵活性及伤残接受度,降低其病耻感.

目的:探讨肺癌患者创伤后应激障碍与睡眠质量的现状及正负性情绪在其之间的中介效应.方法:2020年3月1日～2021年4月30日,采用便利抽样法选取3所三级甲等医院的住院肺癌患者作为研究对象,采用匹兹堡睡眠质量指数量表、正性负性情绪量表和创伤后应激障碍自评量表,对纳入研究的549例肺癌患者进行横断面调查.结果:肺癌患者睡眠质量指数总分为(10.34±4.93)分,正性情绪总分为(16.18±4.89)分,负性情绪总分为(19.19±4.71)分,创伤后应激障碍总分为(48.24±12.84)分.肺癌患者睡眠质量指数总分与正性情绪呈负相关(P<0.05),与负性情绪呈正相关(P<0.05),与创伤后应激障碍呈正相关(P<0.05).路径分析表明,创伤后应激障碍可直接正向预测睡眠质量,也可通过正负性情绪的中介效应作用于睡眠质量,其中介作用分别占总效应的16.61％、36.46％.结论:我国肺癌患者睡眠质量普遍较差,创伤后应激障碍症状突出,临床工作者应给予患者针对性心理干预,降低患者创伤后应激程度,鼓励患者维持积极正性情绪,缓解负性情绪,以改善睡眠质量,促进患者康复.

目的:探讨手术室精准护理在宫颈癌患者中的应用效果.方法:选择2020年11月1日～2021年2月1日收治的80例宫颈癌手术患者为研究对象,采用随机抽样法分为对照组和观察组各40例;对照组采用常规护理,观察组采用手术室精准护理干预;比较两组手术时间和术中出血量.结果:观察组手术时间短于对照组(P<0.05),术中出血量少于对照组(P<0.05).结论:手术室精准护理能缩短宫颈癌患者手术时间,减少术中出血量,值得临床推广.