联合护理在腹腔镜食管裂孔疝修补中的应用效果分析

目的探讨预见性护理与快速康复护理理念(简称联合护理)在腹腔镜食管裂孔疝修补中的应用效果。方法前瞻性选取2019年1月至2021年1月于空军军医大学第二附属医院急诊科入院实施腹腔镜食管裂孔疝修补术的90例患者,按照随机数字表法分为预见性护理组、快速康复护理理念组和联合组(每组30例)。所有患者均给予常规护理,在此基础上,预见性护理组采用预见性护理模式;快速康复护理理念组采用快速康复护理理念护理模式;联合组采用预见性护理联合快速康复护理理念的护理模式。比较3组患者住院时间、肛门排气时间、疼痛持续时间、拔除胃管时间、护理前后抑郁自评量表(SDS)和焦虑自评量表(SAS)评分、以及术后并发症发生率和满意度,以观察护理干预效果。结果联合组患者术后住院时间、肛门排气时间、疼痛持续时间、拔除胃管时间、护理后SDS评分和SAS评分、并发症发生率均显著低于预见性护理组、快速康复护理理念组,差异均有统计学意义(P<0.05);联合组满意率显著高于预见性护理组、快速康复护理理念组,差异有统计学意义(P<0.05)。结论预见性护理联合快速康复护理理念的护理模式可有效缩短腹腔镜食管裂孔疝修补术患者住院时间、降低并发症发生率并提高患者满意度,有利于患者术后康复,且其效果优于二者的单独使用。

High-resolution crustal velocity structure in the Shanxi rift zone and its tectonic implications

The Shanxi rift zone,located in the Trans-North China Orogen(TNCO)of the North China Craton(NCC),is wellknown for hosting large intraplate earthquakes in continental China.The TNCO is a suture zone formed by the amalgamation of the eastern and the western blocks of the NCC.After its formation,it was reactived and deformed by later tectonic activities,which result in complex lithospheric heterogeneities.Thus,the detailed crustal structure of the Shanxi rift zone is critical for understanding the tectonics and seismogenic mechanism in this area,which will shed new lights on the formation and dynamic evolution of the NCC.In this study,we applied ambient noise tomography based on 18 months continuous records from 108 seismic stations located in Shanxi and its surroundings,in order to constrain its detailed crustal structure.We measured 4437 Rayleigh wave phase velocity dispersion curves in the period of 5–45 s from the cross-correlation functions.Next,a surface wave direct inversion algorithm based on surface-wave ray tracing was used to resolve a 3-D S-wave velocity model in the upper 60 km with lateral resolution of~50–80 km.The tomographic images show that the sedimentary thickness of the Taiyuan Basin is less than 5 km.At depth of 0–10 km,we observe a good correlation between the imaged structural variations with geological and topographic features at the surface.For example,the center of rift shows low-velocity anomalies and the uplifting areas on both sides are characterized by high velocity anomalies.The western and eastern boundaries of the slow materials coincide with the faults that control the basin.The slow material extends from the shallow surface to depth of about 15 km but it getting smaller in shape at deeper depth.For the Taiyuan Basin,Linfen Basin,and Yuncheng Basin in the central and southern parts,the structure is dominant by slow materials in the upper crust but changes to strong high-velocity anomalies in the lower crust and the uppermost mantle at depth deeper than 25 km.We interprete these high-velocity anomalies to be associated with the cold remnant of the underplated basalt in the lower crust that were formed in early Tertiary before the basin was stretched.We also observe the low-velocity anomaly beneath the Datong volcanic area,which extends from the uppermost mantle to a depth of 20 km vertically and migrates from west to east laterally.It may reflect the upwelling channel of the magmatic material in Datong.Moreover,the strong low-velocity anomalies presented north of 38°N could be related to the heated crustal materials with paritial melting as a result of the intensive magmatic activities of the Datong Volcano since the Cenozoic.In our study region,seismicity mainly concentrates in the depth range of 5–20 km and we find that most earthquakes appear to occur in places where velocity changes from high to low rapidly,with slight higher concentration in the faster material areas.In summary,our high-resolution 3-D crustal velocity model provides important seismological constraints to understand the tectonic evolution and seismicity across the Shanxi rift zone.