围手术期对于儿童来说可能是一段充满不安和紧张的时期,这对其情感状态和康复产生潜在负面影响.小丑照护作为一种创新的医疗实践,旨在通过欢笑、互动和情感支持来改善患儿的情感状态、减轻疼痛感和提高医疗体验.文章将研究医疗小丑在儿童围手术期中的应用,探讨了其组织、管理、效果和潜在益处.研究表明,医疗小丑的互动可以显著减轻儿童的疼痛感和焦虑,提高情感状态,促进康复.此外,医疗小丑有助于改善儿童与医疗团队的互动,增强治疗的合作性.这项研究结果显示通过有效的组织与管理,小丑照护可以在儿科医疗中发挥关键作用,为儿童患者提供更加温馨、愉悦和有效的治疗效果提供了新的途径.

目的:探讨基于循证护理证据构建的右半肝切除术后呼吸功能锻炼流程的应用效果.方法:分析2017年1月—2021年1月于南京医科大学附属淮安第一医院肝胆外科行右半肝切除术的146例病人临床资料,按随机数字表法分为对照组和观察组,每组73例,其中对照组实行术后常规护理,观察组实施依据循证证据构建的呼吸功能锻炼流程,比较两组病人术后氧合指数、一秒用力呼气量/用力肺活量(FEV1％)、呼吸困难程度(Borg评分量表)以及术后胸腔积液、肺不张、肺部感染等并发症情况.结果:术后两组病人在氧合指数、FEV1％、呼吸困难程度(Borg评分量表)及术后胸腔积液、肺不张、肺部感染等方面情况比较差异均有统计学意义(P均<0.05).结论:依据循证护理证据构建的右半肝切除术后呼吸功能锻炼流程能有效提高病人的肺功能状态、减少肺部并发症,从而改善病人恢复质量.

目的 探讨胰十二指肠切除术后发生谵妄的危险因素,为制定临床护理干预方法提供参考依据.方法 选取2014年1月—2021年7月于南京医科大学附属淮安第一医院行胰十二指肠手术的269例患者为调查对象,将其中19例诊断为谵妄的患者作为病例组(谵妄组),250例非谵妄患者为对照组(非谵妄组).采用单因素分析及二元Logistic回归模型分析术后谵妄发生的相关危险因素.结果 单因素分析结果显示,年龄、术前睡眠障碍、手术时间、术中出血量、术后机械通气、术后血红蛋白、术后白蛋白、术后中度及以上疼痛、术后发热是影响胰十二指肠切除术后发生谵妄的相关因素(P<0.05);多因素Logistic回归分析结果显示,年龄、术前睡眠障碍、手术时间、术后白蛋白、术后中度及以上疼痛是影响胰十二指肠切除术后发生谵妄的危险因素(P<0.05).谵妄患者与非谵妄患者在术后并发症、术后住院时间、住院总费用、治疗满意度方面比较,差异有统计学意义(P<0.05).结论 对手术时间较长的高龄患者改善术前睡眠障碍、增加术后营养及术后有效镇痛是预防胰十二指肠切除术后发生谵妄的关键,应根据患者具体情况,选择个体化、综合性的护理预防措施.

目的 探讨个性化护理在急性心肌梗死患者院前急诊护理中的应用效果.方法 选取2016年1月-2017年3月急性心肌梗死患者80例以数字表法分组.对照组进行常规的院前护理,实验组开展院前个性化护理.比较两组急性心肌梗死患者抢救效果;接到急救电话至出诊时间、入院平均时间、急救时间;护理前后患者SAS评分;纠纷发生率.结果 实验组急性心肌梗死患者抢救效果高于对照组,P＜0.05;实验组接到急救电话至出诊时间、入院平均时间、急救时间优于对照组,P＜0.05;护理前两组SAS评分相近,P＞0.05;护理后实验组SAS评分优于对照组, P＜0.05.实验组纠纷发生率低于对照组,P＜0.05.结论 院前个性化护理在急性心肌梗死护理中的应用效果确切,可有效缩短出诊时间,提高抢救成功率,稳定患者心理状态,降低纠纷.

Objective:To evaluate the diagnostic value of 18 F - FDG dual head gamma - camera coincidence ( DHC)imaging in the local recurrence of postoperative rectal cancer. Methods:DHC was studied between November 2013 and April 2015 on 27 patients(9 women,18 men,mean age:55. 6 years old)highly suspected recurrence. DHC imaging and contrast-enhanced computed tomography( CT)findings were compared with histopathological findings and/or clinical follow-up data as the"gold standard". Results:The positive predictive value and accuracy of DHC imaging(93. 3%,92. 6%)was higher than CT(86. 7%,88. 9%). While the negative predictive value between the two imaging had no significant difference. All of the 27 cases were performed CEA measurement,9 cases of 15 CEA positive patients and 3 cases of the 12 CEA negative patients had FDG metabolism,confirmed by pathology and follow-up. Conclusion:18 F-FDG dual head gamma-camera coincidence( DHC)imaging is a sensitive and effective method in the local recurrence diagnosis of postoperative rectal carcinoma,and has broad clinical application pros-pects.

Objective To explore the effects of continuous nursing in the home care of colostomy patients. Methods A total of 96 patients who received colostomy between January and December 2014 were randomly divided into observation group (48 cases) and control group (48 cases). Patients in control group were received routine care, while patients in observation group were provided continuous nursing. The complications, patients′ satisfactions, correct nursing of colostomy and self care ability were evaluated after intervention. Results The incidence rate of complications including fecal dermatitis and parastomal hernia in observation group was significantly lower than that in control group (P <0. 05). The score of patients′ satisfaction in observation group was higher than that in control group [(98. 4 ± 1. 6) vs. (91. 3 ± 1. 7)]. Furthermore, the percentage of correct nursing of colostomy in observation group and control group were 89. 6% and 64. 6%. The difference between two groups was statistically significant (t/χ2 =21. 07,16. 34;P<0. 05). The scores of self care ability in self care skills, self-responsibility, self-concept and health knowledges in observation group were higher than those in control group. The differences between two groups were statistically significant ( t=9. 42, 4. 31,5. 86,6. 05 and 5. 41;P<0. 05). Conclusions Continuous nursing can significantly increase patients′satisfaction and self care ability, reduce complications, and improve home care quality of colostomy patients.

Objective To explore the diagnostic value of 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging in early diagnosis of diabetes-induced myocardial damage. Methods 32 patients with diabetes and 26 healthy volunteers received 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging for assessing myocardial ischemia, viability status, and cardiac function. Results Myocardial perfusion abnormalitieswere observed in 47 regions on myocardial perfusion imagingin 21 of 32 (65.6%)patients with diabetes, showing perfusion/metabolism mismatched and suggesting viable myocardium. All the volunteers were normal on DISA. As compared with the normal control group, the positive rate of DISA in diabetic patients was significantly higher (P < 0.01). Left ventricular ejection fraction (LVEF) was (54.3 ± 7.2%) and (67.3±4.9%) respectively, the difference was statistically significant (P < 0.05). Conclusions 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging can assess myocardial ischemia ,viability and cardiac function in diabetic patients, and it is helpful for the early diagnosis of cardiac damage in patients with diabetes mellitus.

Objective To practice the distance nursing and healthcare through mobile care clinic, and to provide a higher quality of specialist care to colostomy patients. Methods 76 colostomy patients who were operated during August 2015 to January 2016 were investigated and randomly divided into the intervention group ( n=40) and the control group ( n=36 ) . Based on the conventional nursing care, the intervention group received additional continuing care including the subsequent visit and telephone follow-up with the help of mobile care clinic. After one month of intervention, patients′satisfaction level and their awareness of health knowledge were surveyed using an autonomous questionnaire. Results The intervention group had much higher level of satisfaction compared to the control group [ ( 98. 4 ± 1. 6 ) vs ( 91. 3 ± 1. 7 ); t=18. 75, P<0. 05 ] . They also performed better wound care and knowledge awareness compared to the control group ( 92. 5% vs 69. 4%;82. 50% vs 58.33%; χ2=6.70, 5.38; P<0.05). Furthermore, the intervention group had significantly fewer cases of fecal dermatitis than the control group (2 vs 11; χ2=8.73,P<0.05).Conclusions With the help of home health care platform and mobile care clinic, more professional nursing guidelines can be provided in time. It can also improve the nursing satisfaction and reduce related compliances.

目的 应用Meta分析系统评价黑色素皮质激素第四受体基因(melanocortin-4 receptor gene,MC4R)rs17782313与儿童肥胖易感性的关系,以得到更有说服力的结论.方法 利用计算机检索数据库PubMed,中国知网、万方等,手工检索纳入文献的参考文献.采用STATA 11.0软件进行Meta分析.利用随机效应模型或固定效应模型计算其合并比值比(OR)和95％可信区间(95％ CD,以及合并加权均数差(WMD)的值.结果 共有12个研究纳入研究,其中在纯合子模型(OR=1.84,95％CI:1.44～2.36,Phet=0.001)、杂合子模型(OR=1.48,95％CI:1.29～1.70,Phet=0.756)、显性模型(OR=1.67,95％CI:1.39～1.99,Phet=0.082)和隐性模型(OR=1.35,95％CI:1.19～1.55,Phet=0.000),差异均有统计学意义.在基因型与体质指数(body mass index,BMI) Z-score定量关联性分析中,发现rs17782313T＞C的突变会影响儿童的BMI Z-score(WMD=0.14,95％CI:0.06～0.23,CC vs TT).结论 Meta分析研究结果证实了MC4Rrs17782313与儿童肥胖的关系.

Objective To evaluate the value of 99mTc-MIBI SPECT positive tumor imaging and MRI in the diagnosis of recurrence and postoperative residual of glioma. Methods Of 30 cases of glioma, 21 cases were residual or recurrent of glioma, while 9 cases were not, confirmed by pathology or follow-up. 99mTc-MIBI SPECT positive tumor imaging and MRI were performed on all patients. Results The sensitivity of 99mTc-MIBI SPECT positive tumor imaging (80.1%)was lower than that of MRI (90.5%) (χ2 = 0.006 4,P = 0.035), while the specificity of 99mTc-MIBI SPECT(88.9%) was much higher than that MRI(77.8%)(χ2= 3.827,P = 0.006). The accuracy in diagnosing residual or recurrent glioma between the two imaging has no significant difference. The sensitivity, specificity and accuracy were 95.2%, 100% and 93.3% when the two imaging methods were combined. Conclusions 99mTc-MIBI SPECT positive tumor imaging has higher specificity in the diagnosis of recurrence and postoperative residual of glioma. The combination of 99mTc-MIBI SPECT positive tumor imaging and MRI has great clinical significance.