ObjectiveTo investigate the applicability of a modified verbal learning test redesigned from the memory subtest of the Syndrom Kurztest (SKT) in perioperative cognitive evaluation.MethodsPatients receiving elective herniorrhaphy and their accompanying family members (set as normal controls), 55–75 years old, were randomly divided into two groups. The two groups received the self-made objects memory test derived from the SKT (SMOT) SMOT or a traditional auditory verbal learning test (AVLT). The cognitive evaluation was administered at the bedside on the day before surgery and the second day after surgery.ResultsThe SMOT test was administered to 121 subjects, while 107 patients received the AVLT test. After confirming that there was no significant difference in cognitive function between patients and their family members, the results of the SMOT and AVLT tests were compared. The results showed that the “low-score” ratio of the SMOT was significantly lower than that of the AVLT test (P < 0.05), and the influencing factors of the SMOT were less than those of the AVLT test. However, the learning effect of the SMOT was more significant (P < 0.05).ConclusionThis study preliminarily confirms that the SMOT has better applicability to elderly Chinese individuals than AVLT in perioperative cognitive evaluation, but its learning effect should be noted.

目的 探讨术中积极保温措施在预防剖宫产患者术后手术源性低体温中的作用.方法 回顾性分析本院 2022 年 1 月至2022 年 12 月 98 例行剖宫产者临床资料,其中 49 例患者于术中实施常规保温者为对照组;49例于术中积极实施保温措施者为观察组.比较两组患者不同时间节点时体温状况;比较两组患者手术期间血压(收缩压、舒张压)和心率水平.比较两组患者术后状况;比较两组手术期间寒颤发生率.结果 观察组患者产后 10 min、30 min、60 min时体温分别为(35.17±1.35)℃、(36.21±0.53)℃、(37.07±0.31)℃,较对照组产后相应时间点时体温(34.02±1.08)℃、(35.23±0.32)℃、(36.12±0.36)℃高,P＜0.05.观察组手术期间收缩压、舒张压、心率水平均明显低于对照组,P＜0.05.观察组患者手术期间寒颤发生率明显低于对照组,P＜0.05.观察组产后出血量明显少于对照组,首次下床活动时间和首次肛门排气时间以及住院时间明显短于对照组,P＜0.05.结论 术中积极采取保温措施不仅可降低剖宫产患者寒颤发生率,有助于维持患者体温的稳定性,降低应激反应发生,促进患者康复.

Objective:To analyze the effect of different lithotomy positions on hemodynamics in patients undergoing laparoscopic total hysterectomy.Methods:A total of 50 patients who underwent laparoscopic total hysterectomy at Zhoushan Women and Children's Hospital between January 2020 and June 2021 were included in this study. The patients were randomly divided into a control group and an observation group using a random number table method, with 25 patients in each group. The control group underwent conventional lithotomy position total laparoscopic hysterectomy, while the observation group underwent high and low lithotomy position total laparoscopic hysterectomy. The general surgical indicators, respiratory function indicators, blood gas analysis indicators, hemodynamic levels, incidence of complications, and clinical efficacy were compared between the two groups.Results:The general surgical indicators and airway peak pressure indicators in the observation group were significantly lower than those in the control group (both P < 0.05). There was no statistically significant difference in partial pressure of end-tidal carbon dioxide (PCO 2) and arterial carbon dioxide partial pressure (PaCO 2) between the two groups (both P < 0.05). At 15 minutes after pneumoperitoneum, the PaCO 2 level increased in each group, and the PaCO 2 level in the observation group was significantly higher than that in the control group (all P < 0.05). At the same time, the HCO 3- level decreased in each group, and the HCO 3- level in the observation group was significantly lower than that in the control group (all P < 0.05). At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (76.52 ± 8.61) beats/minute, (113.52 ± 5.36) mmHg (1 mmHg = 0.133 kPa), and (86.91 ± 4.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (89.52 ± 8.61) beats/minute, (106.85 ± 5.63) mmHg, and (80.96 ± 3.65) mmHg, respectively. At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (76.36 ± 8.61) beats/minute, (112.79 ± 5.28) mmHg, and (86.89 ± 4.54) mmHg. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (75.63 ± 6.86) beats/minute, (111.99 ± 5.51) mmHg, and (85.06 ± 3.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate in the control group was increased and that in the observation group was decreased compared with heart rate measured at 5 minutes before recovery of body position. At 5 minutes after recovery of body position, heart rate in the observation group was significantly lower than that in the control group. Diastolic blood pressure and systolic blood pressure decreased in each group, and the amplitudes of reductions in diastolic blood pressure and systolic blood pressure in the observation group were significantly lower than those in the control group. ( t = 6.04, 3.26, 4.22, all P < 0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups ( P > 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( P < 0.05). Conclusion:Compared with conventional lithotomy position total laparoscopic hysteretsotomy, high and low lithotomy position total laparoscopic hysterectomy takes a shorter duration for total laparoscopic hysterectomy, leads to a shorter length of hospital stay, results in less blood loss, causes fewer postoperative infections, and results in more stable hemodynamics and a lower incidence of complications.

目的:分析手术室教学中应用模拟训练对教学成果的影响.方法:选取2018 年1 月至2020 年6月手术室40名护生为对照组(采用传统教学法),选取2020 年7 月至2022 年1 月手术室40 名护生为实验组(采用模拟教学融合渐进式教学方法).比较两组护生借鉴客观结构化考试(OSCE)成绩.结果:相比于对照组,实验组的OSCE成绩较高(P<0.05).结论:情景模拟训练用于手术室护生带教中明显提高了实践技能.

目的 探讨产后认知功能的改变情况并分析其相关影响因素.方法 采用神经心理测验组合进行认知功能评估并用Z计分法进行产后认知功能减退(PPCD)的诊断,并记录认知功能相关影响因素.结果 共纳入119例健康孕产妇,产后1周PPCD的发生率为15.53％,主要表现为记忆力、视觉空间能力及执行力的降低;产后6周PPCD发生率为15.21％,认知功能降低表现与产后1周类似;PPCD孕妇生活中看电视比例、生活习惯数量及食用肉类与海鲜比例均减少.此外,6例(42.9％)在产后6周发生PPCD的产妇在产后1周已出现PPCD,该比例显著高于产后6周无认知功能减退组.结论 产后认知功能减退具有较高发生率,且主要表现为记忆力、视觉空间能力及执行力的降低;教育水平、围产期疼痛程度、生活与饮食习惯是其可能影响因素.

目的 分析人形改良截石位在凶险型前置胎盘中的应用效果,为临床提供参考依据.方法 筛选出2020年2月至12月本院收治的80例前置胎盘患者,按照手术体位改良前后分为对照组与研究组,每组40例.对照组采取常规平卧位下行剖宫产术,研究组采取人形改良截石位下行剖宫产术,对比两组的手术时间与术中出血量、经阴道辅助操作时所需时间、术后并发症(外周神经损伤、压力性皮肤损伤)以及医生满意度.结果 研究组的手术时间、术中出血量(64.5±18.9分钟、307.0±55.3ml)均少于对照组(75.8±19.3分钟、346.5±61.5ml),P<0.05;对照组经阴道辅助操作20例,研究组19例,研究组的经阴道辅助操作时所需时间(2.9±1.9分钟)少于对照组(10.7±1.3分钟),P<0.05;两组术后均无外周神经损伤和压力性皮肤损伤发生;研究组的医生满意度(92.9％)高于对照组(40.0％),P<0.05.结论 凶险型前置胎盘剖宫产术中采取人形改良截石位,可缩短手术时间与经阴道辅助操作时所需时间,且能减少术中出血量,医生满意度高,值得推行.