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一体化单分支型主动脉支架腔内修复Stanford B型主动脉夹层的疗效体会

目的 总结Stanford B型主动脉夹层使用一体化单分支型主动脉支架行腔内隔绝治疗的疗效。方法 2019年10月至2021年10月期间河西学院附属张掖人民医院血管外科对10例破口距离左锁骨下动脉开口 ＜2 cm的Stanford B型主动脉夹层使用一体化单分支型主动脉支架（上海微创CastorTM）行单纯腔内修复手术，对比支架置入前后数字减影血管造影（digital subtraction angiography，DSA）结果以及术后2个月和12个月主动脉全程CT成像结果，以手术即时成功率、术后相关存活率、分支通畅率、是否截瘫、有无内漏、支架移位及破损作为评价指标。结果 10例患者术中支架均成功释放，手术即时成功率为100%，手术时间100～140 min、中位数118 min，围手术期无不良事件发生。术后所有患者均遵医嘱复查，无一例死亡，无截瘫发生，无明显内漏发生，支架主体形态及位置良好，分支支架通畅率为100%，夹层假腔均出现血栓化，假腔直径缩小9.0～12.5 mm、中位数10.2 mm（肺动脉分叉平面)。结论 对于部分破口距左锁骨下动脉开口 ＜2 cm或夹层逆撕至左锁骨下动脉根部的Stanford B型主动脉夹层经一体化单分支型主动脉支架行腔内隔绝治疗可取得较满意的疗效。

Artificial intelligence in thoracic surgery

As an emerging technology, artificial intelligence (AI) uses human theory and technology for robots to study, develop, learn and identify human technologies. Thoracic surgeons should be aware of new opportunities that may affect their daily practice by the direct use of AI technology, or indirect use in the relevant medical fields (radiology, pathology, and respiratory medicine). The purpose of this paper is to review the application status and future development of AI associated with thoracic surgery, diagnosis of AI-related lung cancer, prognosis-assisted decision-making programs and robotic surgery. While AI technology has made rapid progress in many areas, the medical industry only accounts for a small part of AI use, and AI technology is gradually becoming widespread in the diagnosis, treatment, rehabilitation, and care of diseases. The future of AI is bright and full of innovative perspectives. The field of thoracic surgery has conducted valuable exploration and practice on AI, and will receive more and more influence and promotion from AI.

Effectiveness evaluation of systematic clinical management for femoral pseudoaneurysm after interventional treatment under doctor-nurse integration mode

Objective To carry out the systematic clinical management to reduce the incidence of femoral pseudoaneurysm after interventional treatment. Methods A historical controlled study was used to compare the management effect before (from October 2012 to October 2013) and after (from March 2014 to March 2015) the application of doctor-nurse integrated systematic clinical management mode. This work mode enhanced cooperation between doctors and nurses, formed the clinical path for nursing workflows and contingency plans, and strengthened specialized education and training for nurses. Results After the implementation of systematic clinical management, the incidence of femoral pseudoaneurysm was significantly lower than before (1.0% vs. 2.7%), and the difference was statistically significant (P<0.05). Conclusions The systematic clinical management, carrying out in the doctor-nurse integration mode, can improve the quality of nursing and reduce the incidence of femoral pseudoaneurysm. And the management model has achieved remarkable results. So it is worth to be applied in the clinical practices.

Clinical Application of Doctor-nurse Collaboration Model for Patients Undergoing Day Surgery of Laparoscopic Cholecystectomy

ObjectiveTo investigate the application and effect of doctor-nurse collaboration model for patients undergoing day surgery of laparoscopic cholecystectomy. MethodsFrom April 2010 to October 2013, we established the day-case laparoscopic cholecystectomy rapid rehabilitation team by day-surgery ward nurses, anesthesiologists, and surgeons. Collaboration was practiced through preoperative health education for the 1 902 patients, perioperative nursing cooperation, postoperative early activity and feeding of the patients, and follow-up. ResultsAfter the operation, there were 8 cases of incision bleeding, 1 case of bile leakage, 8 cases of shoulder and back pain, and 12 cases of nausea and vomiting. All the patients' postoperitive complications were controlled after treatment. ConclusionThe doctor-nurse collaboration model can significantly ensure the medical quality and safety of day surgery and improve the patients' medical experience. All the Patients, hospital and society will benefit from the model.

Investigation on the Management Methods of Drug Repercussion in Burn and Plastic Surgery Department and Evaluation of the Effect of These Methods

ObjectiveTo investigate the management methods of drug repercussion and its intervention measures in the Burn and Plastic Surgery Department by analyzing the reasons for drug repercussion. MethodBased on the drug repercussion data provided by the computer information center, we analyzed the common reasons and the status quo of drug repercussion. Active intervention measures were carried out, and real-time supervision and feedback of drug repercussion management were also performed. We compared such repercussion indexes before intervention (between May and September 2013) and after intervention (between October 2013 and February 2014):number of drug repercussion patients, times of drug repercussion, amount of money involved in drug repercussion, ratio of drug repercussion and dispensing and comprehensive ranking of the drug repercussion in the whole hospital. ResultsAfter intervention, the ranking of the causes of drug repercussion changed obviously. Changing orders casually dropped to the 3rd of the rank, and changing the department based on necessity rose from the 4th to the 2nd. All the indexes (including the times, number, and amount of money of drug of repercussion, and the ratio of repercussion and dispensing and compreheasive rank) reduced significantly (P<0.05). ConclusionsActualizing active intervention measures redounds to reducing drug repercussion, standardizing clinical use of drugs, insuring safety, and advancing the satisfaction of patients and quality of medical nursing.

Development of intelligent monitoring system based on Internet of Things and wearable technology and exploration of its clinical application mode

Wearable monitoring, which has the advantages of continuous monitoring for a long time with low physiological and psychological load, represents a future development direction of monitoring technology. Based on wearable physiological monitoring technology, combined with Internet of Things (IoT) and artificial intelligence technology, this paper has developed an intelligent monitoring system, including wearable hardware, ward Internet of Things platform, continuous physiological data analysis algorithm and software. We explored the clinical value of continuous physiological data using this system through a lot of clinical practices. And four value points were given, namely, real-time monitoring, disease assessment, prediction and early warning, and rehabilitation training. Depending on the real clinical environment, we explored the mode of applying wearable technology in general ward monitoring, cardiopulmonary rehabilitation, and integrated monitoring inside and outside the hospital. The research results show that this monitoring system can be effectively used for monitoring of patients in hospital, evaluation and training of patients’ cardiopulmonary function, and management of patients outside hospital.

医护一体化模式教学法在重症医学科心肺复苏培训中的效果

目的 探讨在重症医学科心肺复苏培训中应用医护一体化模式教学法的教学效果。 方法 2015 年 1 月—6 月在四川大学华西医院重症医学科采用医护一体化模式教学法进行心肺复苏培训，评价培训前后心肺复苏理论和操作考核成绩，同时采用问卷调查方式评价教学效果。 结果 培训前后医护人员的理论知识成绩分别为（91.66±4.60）、（97.62±3.87）分，操作成绩分别为（90.34±5.73）、（97.39±4.73）分，心肺复苏护理文书成绩分别为（92.27±3.71）、（98.44±3.79）分，差异均有统计学意义（P<0.05）。 结论 医护一体化模式教学法有利于提高重症医学科心肺复苏培训效果。

主髂动脉一体化支架及股股动脉搭桥技术修复合并巨大腹主动脉瘤的肾移植术后患者一例

医护一体化无痛管理在胆道结石患者围手术期的应用及效果

目的 探讨医护一体化无痛管理在胆道结石患者围手术期疼痛控制中的实施及其效果。 方法 选取 2016 年 3 月 1 日— 8 月 31 日四川大学华西医院胆道外科收治的 479 例胆道结石患者，按其入院时间的不同，将 2016 年 3 月 1 日—5 月 31 日入院的 241 例胆道结石患者围手术期疼痛采用传统的疼痛管理（对照组），2016 年 6 月 1 日—8 月 31 日入院的 238 例胆道结石患者围手术期疼痛采用医护一体化无痛管理（观察组）。比较两组患者的疼痛评分、疼痛控制满意度、术后康复指标（下床活动时间、肛门排气时间、术后住院时间）、采用疼痛解救情况的差异。 结果 观察组患者术后当日睡前～术后 3 d、出院前疼痛评分均较对照组低，疼痛控制满意率（99.16%）明显高于对照组（60.17%），术后下床活动时间[（36.27±9.20）h]、肛门排气时间[（50.28±10.50）h]、术后住院时间[（4.68±1.26）d]均短于对照组[（56.57±12.03）h、（74.88±10.22）h、（6.55±1.76）d]，采用疼痛解救者[21 例（8.82%）]亦低于对照组[241例（ 100.00%）]，差异均有统计学意义（P<0.05）。 结论 医护一体化无痛管理在胆道结石患者围手术期的应用能有效减轻患者术后的疼痛程度，使其能早期下床活动，不仅促进了患者胃肠功能的恢复，缩短了住院时间，提高了患者对疼痛控制的满意度，也促进了患者康复；另外，医护一体化疼痛管理也明显减少了对疼痛爆发的解救次数，从而降低了医护人员的应急工作量。

Construction of the ability system of general practice tutors in grass-roots community training bases under the background of hospital-community teaching integration

ObjectiveTo construct the general practice tutors’ ability system in community training bases under the background of hospital-community integrated teaching of general practice.Methods From January to April 2021, literature analysis, expert group consultation, in-depth interview and questionnaire survey were conducted to construct the grass-roots general practice tutors’ ability system, and exploratory factor analysis method was applied, using main component analysis to extract the competency elements. Results There were 4 first level indicators and 20 second level indicators in the system, among which the first level indicators were personal characteristics and professionalism, teaching and research ability, basic level clinical practice ability, and base organization management ability. Conclusion This research enriches the indicators and connotations of the general practice tutors in community training base of general practice, and provides empirical research basis for the selection, ability training and performance evaluation of tutors in community practice bases of general practice medicine.