Objective:To retrieve and analyze the relevant guidelines for the second and third stages of normal delivery, and summarize the evidence of high-quality guidelines so as to provide references for the formulation of clinical practice programs.Methods:We took Johns Hopkins evidence-based nursing practice model as theoretical guidance and set up an evidence-based team.We systematically searched major guideline publication websites, electronic resource databases, related academic groups and guideline networks at home and abroad, evaluated guidelines and summarized the best evidence, and the search time limit was up to June 1, 2019. The literature quality evaluation and evidence extraction were carried out independently by four researchers with evidence-based training.Results:This study included two guidelines, summarizing the 20 best evidences in 9 aspects of humanistic support, delivery companion, delivery position, fetal monitoring, delayed exertion, perineal protection, fundus compression, prevention of postpartum hemorrhage, and delayed umbilical cord clamping.Conclusions:Based on the existing evidence, it integrates the best evidence of nursing measures for the second and third stages of normal delivery. It is recommended that maternal and child institutions promote the transformation of the best evidence based on their actual conditions.

对全球新生儿皮肤接触相关研究进展、存在问题进行回顾和整理,为我国新生儿皮肤接触开展提供参考和借鉴.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:比较手术治疗的肺部良性肿瘤与早期、中期肺癌患者的焦虑及抑郁症状的检出比率,探讨其影响因素。方法:研究对象为就诊于某三级综合医院的283例接受手术的肺部肿瘤患者,其中肺部良性肿瘤或病变患者107例,早期肺癌患者58例,中期肺癌患者118例。采用自编调查表收集社会人口学及临床相关信息,使用抑郁自评量表（SDS）和焦虑自评量表（SAS）分别评价肿瘤患者抑郁和焦虑症状,SDS标准分&gt;53分记为有抑郁症状,SAS标准分&gt;50分记为有焦虑症状。结果:肺部良性肿瘤或病变患者无明显焦虑及抑郁症状,早期和中期肺癌患者中53.40%存在焦虑症状,43.44%存在抑郁症状,差异有统计学意义（P&lt;0.001）。多重线性回归分析显示,中期肺癌（β=29.70,P&lt;0.001）及年龄65岁以上（β=2.58,P=0.018）是发生抑郁症状的危险因素,相对于良性肿瘤及早期肺癌患者,中期肺癌患者焦虑症状更重（β=27.22,P&lt;0.001）。结论:中期肺癌较良性肿瘤及早期肺癌更加容易导致患者出现焦虑和抑郁等负面心理应激;且老年肿瘤患者更容易出现抑郁症状。</span>

总结了3例采用子宫下段环形缝扎法治疗中央型前置胎盘伴胎盘植入成功保留子宫产妇的围手术期护理。护理要点包括：术前做好充分的准备；术中严密监测病情变化；术后预防各种并发症的发生。3例产妇经过精心的护理，产后恢复良好，顺利出院。认为对采用子宫下段环形缝扎法治疗中央型前置胎盘伴胎盘植入的患者进行精心的围手术期护理可以促进其康复。

Objective: To explore the effect of quality control activities on decreasing urine retention rate after natural labour. Methods: The authors set up a quality control circle, followed the steps of quality control activities with professional quality management tools to solve the existing problems in preventing postpartum urine retention. Urine retention rate was compared before and after the activities. Results: The urine retention rate decreased from 18.80% to 7.29%, and the difference was statistically signiifcant (P<0.01). Conclusion: The application of the quality control circle activities could decrease the postpartum urine retention rate and improve care quality. It also could increase the quality management capacities of staff nurses.

目的:研究特异性富AT序列结合蛋白1(SATB1)在非小细胞肺癌(NSCLC)和正常肺组织中的差异性表达及其与临床、病理特征和预后之间的关系.方法:2008年8月至2009年12月间于我科接受手术治疗的60例NSCLC患者的60对NSCLC和癌旁正常肺组织标本,以实时定量RNA反转录聚合酶链式反应(real-time RT-PCR)验证SATB1在肺癌和正常肺组织间是否存在差异性表达.按SATB1基因表达量是否高于均值而将患者分为SATB1高、低表达两组,分析SATB1表达程度高低与NSCLC的病理类型、pTNM分期、无瘤生存时间(DFS)、总生存时间(OS)之间的关系.结果:SATB1 基因在NSCLC中的表达高于癌旁正常肺组织(P＜0.001).该基因的表达程度与肺癌患者性别 (P=0.155)、病理类型(P=0.809)、肿瘤分化程度(P=0.937)以及病理分期(P=0.704)之间无明显相关性.2例患者失访,余58例患者中位随访时间44个月(4-58个月).SATB1高、低表达组患者的3年无瘤生存率分别为33.7%和42.9%;中位DFS分别为18个月和28个月;3年总生存率分别为38.8%和71.4%,高表达组中位OS 21个月,低表达组中位OS未达到.结论:SATB1在肺癌组织中的表达高于正常肺组织,肺癌组织中SATB1高表达组患者的预后较低表达组为差.

This paper introduces the nursing care of a case of 20-day delayed delivery in twin pregnancy complicated with gestational diabetes.Before the delivery,nursing care focused on basic nursing,psychological nursing,prevention of infections,control of uterine contraction,monitoring of blood sugar and fetus situation.During the delivery,monitoring of birth process and preparations for rescuing the neonate were emphasized.After the delivery,the key points in nursing were prevention of postpartum hemorrhage and infection,as well as health education.The patient was discharged 7 days after the labor and the second twin was discharged 59 days after the delivery.

Pulmonary glomus tumors are extremely rare, with only 19 cases having been reported worldwide. The glomus body is considered to be related to the regulation of body temperature, but the reported cases were not associated with hyperpyrexia. Here, we describe a 28-year-old man with hyperpyrexia and anemia complicated with a coin lesion of the right lung. After resection of the upper lobe of the right lung by video-assisted thoracoscopic surgery, all of the patient's symptoms disappeared. The pathologic analysis reported a rare pulmonary glomus tumor. The disease had not recurred by 1 year after operation. (Ann Thorac Surg 2013;95:e29-31) (c) 2013 by The Society of Thoracic Surgeons

患者女,36岁,于1998年4月因宫内孕39周、胎膜早破收入北京大学第一医院待产.待产时出现突发咳嗽,面部青紫,深长呼吸,四肢痉挛抽搐,立即测血压80/50 mm Hg(1 mm Hg=0.133 kPa),脉搏摸不到,3 min后再次测量血压消失,双侧瞳孔等大,直径3 mm,对光反射存在,角膜反射未引出,呼吸、心搏骤停,子宫不迟缓,考虑羊水栓塞,立即开放静脉,给予解痉、扩血管、抗过敏、预防弥散性血管内凝血(DIC)的抢救治疗,此时胎心音消失,加压吸氧,请麻醉科行气管插管及胸外按压,头枕冰帽,给予罂粟碱60 mg,地塞米松20 mg,肾上腺素1 mg气管内给药,碳酸氢钠40 ml,抽静脉血不凝,此时心跳、呼吸停止已15 min,产妇仍无心率及自主呼吸,心电图呈直线,给予同步电除颤2次,心内科、麻醉科、心血管内科、呼吸内科和妇产科多科协作积极抢救,产妇呼吸、心搏骤停长达20 min后心肺复苏成功,但意识始终没有恢复,在心内科及神经内科会诊期间,产妇双手、双足不自主抽动约1 min后好转,30 s后再次抽动约1 min,此时角膜刺激无反应,压眶不皱眉,5 min内抽搐5次,给予20％的甘露醇250ml.

OBJECTIVE:To evaluate technique aspects of video-assisted thoracoscopic lobectomy for benign diseases.METHODS:Retrospective review of 24 patients with benign pulmonary disease underwent thoracoscopic lobectomy from September 2006 to September 2008. One patient had bilateral bronchiectasis received concurrent bilateral lobectomy. The patients included 11 males and 13 females with mean age of 49.0 years. Fifteen cases were diagnosed as benign diseases preoperatively consisted 10 bronchiectasis as the primary indication. The other 9 cases were pulmonary nodules pathologic diagnosed intra-operatively. Inflammation changes including dense plural adhesions, pulmonary artery adhesions and calcified lymph nodes were managed endoscopically.RESULTS:All 25 thoracoscopic procedures were completely with no conversion to thoracotomy. The mean operation time was (163 +/- 52) min, blood loss was (163 +/- 130) ml. There was no hospital death or major morbidity. Postoperative drainage was (5.8 +/- 2.8) d. No long-term complications were noticed during a mean follow-up of 7.3 months.CONCLUSION:Chronic inflammation induced adhesions is the key limiting factor for thoracoscopic lobectomy for benign diseases.

BACKGROUND:Melanoma antigen genes (MAGE) are tumor specific genes. The aim of this study is to explore the feasibility of MAGE genes detection as a diagnostic method for malignant pleural effusion.METHODS:The expression of MAGE-1, -2, -3 and -4 mRNA was detected in 18 benign and 22 malignant pleural effusion samples by RT-PCR.RESULTS:No MAGE gene expressed in the 18 cases of benign pleural effusion. Out of the 22 cases of malignant pleural effusion, 8 cases were positive by cytological examination, who all showed positive expression of MAGA genes; in the other 14 patients who were positive by pleural biopsy but negative by cytological examination, 11 cases showed positive expression of MAGE genes in both the pleural effusion and pleura samples, while the other 3 cases showed negative MAGE expression in both the pleural effusion and pleura samples.CONCLUSIONS:Detection of MAGE genes in pleural effusion may be an effective method in the differential diagnosis of benign and malignant pleural effusion.

OBJECTIVE:To evaluate the application of lung biopsy in the diagnosis of diffuse pulmonary interstitial disease (DPID).METHODS:The data of lung biopsy from 17 cases with uncertain DPID obtained during the period of July 1997 and December 2002 were retrospectively analysed.RESULTS:All the cases were diagnosed by pathology. Three of them were diagnosed as sarcoidosis. Two were pulmonary alveolar proteinosis. One with usual interstitial pneumonia (UIP), one with bronchiolitis obliterans and organizing pneumonia, one with nonspecific pneumonia, one with Castleman's disease, one with pulmonary lymph angio-leiomyomatosis, two with bronchioalveolar carcinoma, one as rheumatoid pulmonary fibrosis complicated with pulmonary squamous cancer and locally metastasis in lungs, two as pulmonary lymphangitic carcinomatosis, one as lung squamous cancer with pulmonary lymphangitic metastasis, and one with primary pulmonary paraganglioma.CONCLUSION:Harvest of lung tissue directly by biopsy could be the most useful diagnostic method for DPID, and it is a highly valuable diagnostic tool for those patients whose diagnosis is uncertain with routine chest film and high resolution computed tomography.

OBJECTIVE:To evaluate the effect of electronic fiberesophagoscopy in video-assisted thoracoscopic surgery for benign esophageal diseases. METHODS:We determined the position of lesion, separated the lesion from the esophageal wall, resected the lesion and protected the esophageal mucosa during the process of video-assisted thoracoscopic surgery for benign esophageal diseases. RESULTS:Thirty-six patients with benign esophageal disease underwent the operation successfully and recovered uneventfully. There was no operative death or severe perioperative complications such as esophago pleural fistula. Two patients were changed to undergo thoracotomy. CONCLUSIONS:Electronic fiberesophagoscopy is an essential equipment in video-assisted thoracoscopic surgery for benign esophageal diseases. It should be adopted as a routine equipment to ensure the accuracy, safety, reliability and convenience of this kind of operations.

Background To explore the feasibility, indication and method of surgical treatment of central-type lung cancer by lobar replantation. Methods A retrospective study on the radical resection of 6 patients with stage III central-type lung cancer of the upper lobe by lobar replantation was made. Two patients underwent double-sleeve right upper and middle lobectomy, firstly. Since the length of resected bronchus or pulmonary artery involved by tumor was too long to perform tension-free anastomosis, we had to transplant the inferior pulmonary vein to the proximal stump of the supperior pulmonary vein, so the lower lobe was preserved. Another four patients underwent radical pneumonectomy, because the tumor had extended through the oblique fissure to the margin of the lower lobe. Subsequently, the lower lobe was isolated from the resected lungs and perfused with heparin solution ( 12 500 U/ 500 ml normal saline) for later replantation. After a radical systematic en-bloc mediastinal lymphadenectomy was performed, the preserved lower lobewas replanted. Results Followed up to Dec 2000, 3 patients had been alive for 43, 12 and 8 months separately with a good living quality. One case had tumor recurrence at 19th month and died at 23rd month postoperatively. One case died of tension pneumothorax caused by bronchopleural fistula on the 19th postoperative day. Another case received resection of the replanted lung for pulmonary arteriobroncho-pleural fistula on the 42nd day and died of respiratory failure caused by pulmonary infection on 14th month postoperatively. Conclusions Lobar replantation is an alternative procedure of parenchyma-sparing in patients with stage III central lung cancer of the upper lobe whose cardiopulmonary function is too poor to undergo pneumonectomy.

目的 探讨对支气管哮喘患者并发肺癌进行联合手术治疗的可行性。 方法 在根治性切除肺部肿瘤的同时 ,采用肺门神经彻底切断术治疗支气管哮喘。 1例右上叶周围型肺癌 ,行右上肺叶切除、淋巴结清扫的同时作同侧肺门迷走神经和交感神经的彻底切断。另 1例左上肺巨大中心型肺癌 ,行全肺切除后 ,摘出可保留的左下肺叶 ,采用自体肺移植技术将其重植于原左肺上叶位置。 结果 随访至 1999年 11月底 ,2例已分别存活 6年 8个月及 17个月。术后辅助通气分别为 4h及18h。术后哮喘发作频率减少、程度减轻 ,动脉血气分析和肺功能测定各项参数有轻度或明显改善 ,生活质量明显提高。 结论 对支气管哮喘引起肺功能差的肺癌患者不应一律视为手术禁忌症 ,行肺癌根治术的同时行肺门自主神经彻底切断术可获得二病同治的良好效果

目的 探讨局限性胸膜、肺病灶切除术治疗肺癌伴癌性胸水的可行性。 方法 １９９４年１ 月～１９９７ 年１２ 月采用局限性肺切除、胸膜转移灶切除、心包转移灶切除、胸膜微小转移灶电灼及纵隔淋巴结清扫，治疗肺癌伴癌性胸水１４ 例。 结果 所有病历均得到随访，已死亡８ 例，仍存活６例，存活期７～３０ 个月。中位生存期１６－５ 个月。所有病例均未见胸水复发，胸闷、呼吸困难、胸痛及上腹痛症状明显缓解。 结论 此术式操作简单、创伤小、术后恢复快而平稳，控制胸水疗效肯定，其术后生存期明显长于仅做姑息性癌灶切除和内科治疗者，并可缓解胸膜转移所致胸腹部疼痛

病人男,40岁.四肢无力、运动受限4个月、伴视物模糊2个月.曾诊为四肢供血不足,治疗月余无好转且症状渐加重.查体:双上肢近端肌力Ⅲ级,远端肌力Ⅳ级,双下肢近、远端肌力Ⅳ级.二头肌、三头肌、膝腱、跟腱反射均减弱.肌电图示右腓肠肌重收缩运动单位电位为低波幅混合相.X线胸片示左上肺不张.