剪切波成像对乳腺BI-RADS 4类肿块分类影响的研究

目的:探讨剪切波成像（shear wave elastography，SWE）对乳腺BI-RADS 4类肿块分类影响。方法:收集2017年9月至2019 年3月就诊于我院肿瘤科且常规超声定为BI-RADS 4类的乳腺肿瘤患者139例，共 157个病灶，在手术或穿刺活检前均进行SWE检查，以病理结果作为金标准，评估常规超声及SWE对乳腺肿块诊断的敏感度、特异度和准确性。结果:常规超声诊断4a类73个，4b类35个，4c类49个，常规超声诊断乳腺肿块的敏感性86.1%，特异性74.1%，准确性76.9%；SWE参数最大杨氏模量值（Emax）诊断乳腺良恶性病灶的临界值为94.15 kPa，以该值为诊断良恶性肿块的依据，SWE校正BI-RADS分类后诊断的敏感性87.5%，特异性90.6%，准确性90.4%。结论:SWE通过硬度信息评估，在常规超声的基础上矫正BI-RADS 4类肿块的亚分类，降低了误诊率，提高了诊断的准确性，有一定临床应用价值。     

精细化护理干预在腹腔镜食管裂孔疝修补术护理配合中的作用

ObjectiveTo explore the role of fine nursing in laparoscopic repair of hiatal hernia. Methods the clinical data of 300 patients who underwent laparoscopic esophageal hiatus repair in the operating room of people's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were retrospectively analyzed. Methods150 cases of patients with laparoscopic hiatal hernia repair from January to December 2018 were selected as the control group, and 150 cases from January to December 2019 were selected as the experimental group. The operation nursing cooperation of the experimental group was treated with fine nursing, while the control group was treated with conventional management methods. The occurrence of intraoperative complications, operating room efficiency, patient satisfaction and physician satisfaction of the two groups before and after the implementation were compared It's a matter of intention. The measurement data were expressed as mean ± standard deviation (±s) by t test, and the count data were expressed as percentage (%) by chi square test. Resultsthe incidence of intraoperative pressure injury, hypothermia, deep venous thrombosis and other complications in the experimental group was lower than that in the control group, and the difference was statistically significant (χ²=4.147, 4.253, 4.124; P＜0.05). The turnover time, preparation time and operation time of the experimental group were shorter than those of the control group (F=69.437, 48.394; P＜0.05). The difference of satisfaction between the two groups was statistically significant (χ²=4.353, P＜0.05). There was a significant difference in the satisfaction of the two groups (χ²=0.605, P＜0.05). Conclusionthe application of fine nursing intervention in laparoscopic hiatal hernia repair has obvious effect, which is worthy of promotion.     

超声诊断胰管内蛔虫1例

患者男，45岁。因上腹阵发性疼痛5h就诊。使用仪器为Alocka-1400,探头频率为3.5MHz。检查所见：胆囊形态及胆总管走行均未见异常。胆总管下段腔内见直径约0.4cm管状回声，未见明显蠕动。胰腺形态大小尚可，实质回声尚均质，主胰管内见直径约0.4cm管状回声（图1），与胆总管下段内管状回声相延续。超声诊断：胆总管及主胰管内蛔虫。后经手术证实。     

彩超诊断外伤性下肢假性动脉瘤1例

患者,男,37岁。7个月前因胫腓骨开放性骨折, 行清创+骨外固定架固定术后,有一枚钉孔时有渗血, 加压包扎后好转出院。时有周期性出血,间隔5～7天, 每次量约70ml;每一次小腿剧烈活动,此钉孔亦有少 量渗血,均经加压包扎后好转。同时发现患侧小腿增 粗,遂入院。行彩超检查:于右胫骨外侧距皮肤表面 1.05cm处探及大小为7.8cm×4.5cm ×6.8cm梭形 包块回声,边界清,有包膜,以液性暗区为主,见密 集点状强回声,呈漩涡状。CDFI显示内部血流信号, 其外上有一破口,宽约0.8cm,破口处血流呈涡流状, PW呈双相血流频谱,收缩期流速较高,高达5m/s,近 侧腘动脉血流信号未见异常。足背动脉信号较弱,压 迫近侧腘动脉后,PW测破口处血流速度明显下降(彩 图12见Ⅳ页)。     

腹腔镜联合胃镜单孔免气腹治疗胃间质瘤的手术配合及护理

回顾性分析8例病人的腹腔镜联合胃镜单孔免气腹切除胃间质瘤手术的手术配合及护理措施,即术前做好充分准备,术中巡回护士、器械护士密切配合,同时术中、术后给予精心的护理。结果8例病人手术均获得成功,随访时间6个月至1年,均未出现复发。认为充分术前准备与密切的术中配合及有效的护理是保证腹腔镜联合胃镜单孔免气腹手术顺利完成的关键。     

彩超在诊断腹主动脉夹层动脉瘤的应用价值

目的应用彩色多普勒超声诊断腹主动脉夹层动脉瘤。方法应用彩超测量腹主动脉内径,观察腹主动脉及其分支内膜的部位和范围,以及间鉴别真假腔。结果内膜分离是本病最可靠的诊断依据。血流分隔现象、动脉扩张和管腔内血栓等具有重要的辅助诊断价值。彩超能很好地鉴别真假腔和诊断夹层动脉瘤破裂。结论彩超能正确地评价本病受累血管,是诊断腹主动脉支动脉瘤的一种较为可靠的影像检查方法。     

护士人文关怀品质与儿童重症监护室患儿家属信任度的相关性

目的:探究护士人文关怀品质与儿童重症监护室(PICU)患儿家属信任度的相关性。方法:选择医院PICU 2020年1月—2021年3月收治的200名患儿家属为研究对象,采用护士人文关怀品质测评量表、护患关系信任度量表对其实施评价,借助单因素分析、多因素分析筛选PICU患儿家属信任度的影响因素,并采用Pearson相关性分析明确护士人文关怀品质与PICU患儿家属信任度的相关性。结果:患儿家属信任度评分为(34.59±5.28)分,护士人文关怀品质评分为(114.59±11.94)分。单因素分析显示,PICU患儿家属信任度影响因素有患儿PICU入住时间、患儿治疗效果、家属文化水平、家属疾病认知水平、家属社会支持现况、家属疾病不确定感、护士工作年限、护士职称、护士学历、护士规范化培训、护理服务态度(P<0.05)。Pearson相关性分析显示,护士人文关怀品质评分与PICU患儿家属信任度评分呈正相关(r=0.853,P=0.031)。多元线性回归分析显示,PICU患儿家属信任度独立影响因素有患儿治疗效果、家属疾病认知水平、家属疾病不确定感、护士职称、护士规范化培训、护理服务态度、护士人文关怀品质(P<0.05)。结论:PICU患儿家属信任度影响因素复杂,且与护士人文关怀品质呈正相关。临床中应全面提升护士人文关怀品质,强化健康教育,以增强PICU患儿家属信任度。     

144例X线引导下经皮肺穿刺活检术的护理体会

X线引导下经皮肺穿刺活检术对明确肺部及胸膜占位性病变的病理、指导治疗、诊断疾病及预后等有重要意义 ,做好经皮肺穿刺活检术的护理工作与提高经皮肺穿刺活检术的成功率及预防并发症具有重要意义 ,我院于 2 0 0 1年 8月至 2 0 0 2年8月共行 X线引导下经皮肺穿刺活检术 14 4例均获得成功 ,未出现严重并发症 ,现将护理体会报告如下。1　临床资料患者 14 4例 ,其中男 89例 ,女 5 5例 ,年龄 2 3～ 6 9岁 ,平均年龄 4 6岁 ,病程 1个月至 6 a不等 ,诊断为肺癌 131例占 91% ,肺脓肿 9例占 6 .2 5 % ,肺结核 4例占 2 .75 %。2　护理体会2 .1　术…