SNOT-22中文版
比较两种不同内镜下鼻窦手术在难治性慢性鼻-鼻窦炎的临床疗效
HEILONGJIANG MEDICAL JOURNAL Vol.45No.7Apr.2021736比较两种不同内镜下鼻窦手术在难治性慢性鼻-鼻窦炎的临床疗效张萃，罗启贤，谷雨，丁景菊，吴应玲，王胜六盘水市人民医院耳鼻喉科，贵州六盘水553001摘要目的：比较轮廓化鼻内镜手术（RRS）和功能性内镜下鼻窦手术（FESS）在治疗难治性慢性鼻-鼻窦炎的临床效果。
方法:选取2219年1月一2022年5月在六盘水市人民医院接受手术治疗的难治性慢性鼻-鼻窦炎患者80例，随机分为观察组和实验组，每组各40例。
观察组给予轮廓化鼻内镜手术进行治疗，对照组给予功能性内镜下鼻窦手术进行治疗。
利用SPSS22.4统计软件对治疗效果的数据进行统计分析。
结果：两组患者在治疗前，SNOT-22评分和Lund-Kennedy 评分无显著差异（P>0.05）;治疗后，SNOT-20评分和Lunn-Kennedy评分均显著下降，差异有统计学意义（Pv0.05）;观察组的评分明显低于对照组的评分，差异有统计学意义（PV0.05）;术后复发率随着时间推移而增长，研究组的复发率明显低于实验组，两组差异统计学意义（PV0.05）。
结论：在治疗难治性慢性鼻-鼻窦炎中，轮廓化鼻内镜手术（RRS）明显优于功能性内镜下鼻窦手术（FESS），具有临床推广价值。
关键词轮廓化鼻内镜手术；功能性内镜下鼻窦手术；慢性鼻-鼻窦炎；临床疗效doi10.3969/j.issn.l004-5775.202907.023学科分类代码362.01中图分类号R755.0文献标识码BComparison of the Clinical Effects of Two Different Endoscopic Sinus Surgery in the Treatment of Refractory Chronic Rhinosinusihs/ZHANG Cus,LUO Qs-xian,GU Yu,eh al.//DepartmenS of Otolaryneoloey,LiupansOus Peeple's HospitC,Liupanshui,Guizhou,553001,ChinaAbstract Objective:To compare the clinical effects of RRS and FESS in the trentment of refractory chronis rhinosinusitis. Method/:80patients with refrcctory chrornc rhinosinusitis who unUeroeni snryery in the hospital from January2019to Mcy2022 were racnomly yivinen into the observatioo eroup(zi=44)and the experimentci eroup(二40).The onservation eroup wcs treaten withnasal ennoscopic snryery,anO the eroop wcs treaten with functionci ennosccpic sinus suryery.The Oata of0x0 meni effect were statistically analyzed by SPSS22.0statisticcl software.Respite:There wcs no sivnificant(^^亡比附亡in SNOT-22 score anO Luny-KenneOysccre between the two eroops before00X06x1(P>0.05),but the SNOT-20score anO Luny-Kennenysccre Oecreasen sisnificanCy aftev treatment,c U the scores in theevop were^迄山五閃^.lowev than t hose in the conWoi ehrnp((<0.05).The postoperative recuirence rate increasen with the passaye of Cme,anU the recuirence rate in theeroop wcs sisnificanCy lowev than thct in the cxperimcnmi eroop(P<0.05),ann the dimerencc between the two eroups wcs statisti-caty sisnificant((<0.05).Conclusion:In the treatment of refrcctory cUrouic rhinosinpsitis,enOosccpic sinps suryery (RRS)is snpeCfr to funcUopcl0x0030010simis snrcery(FESS).Key word/RSS;FESS;Chrouic rhinosmpsitis;Clinical effect慢性鼻一鼻窦炎（CRS）是一种慢性上呼吸道炎症性疾病，是鼻黏膜对各种变态反应源和传染源的炎性应答［1］o导致该病的病因多样且复杂，且极易复发，对于药物治疗无效的慢性鼻一鼻窦炎，通常归类为难治性慢性鼻—鼻窦炎［2,一般需要进行手术治疗，临床上通常选择轮廓化鼻内镜手术（radical sinps surgery，RRS）和功能性内镜下鼻窦手术（£11001100^enposcopic sinps screeryjPESS）两种手术方式［3］o本研究通过比较两种手术在难治性慢性鼻-鼻窦炎的临床疗效患者术后效果，为临床治疗难治性慢性鼻一鼻窦炎提供参考，现报告如下。
中文版鼻腔鼻窦结局测试22条对青少年慢性鼻-鼻窦炎患者健康相关生
·临床论著·中文版鼻腔鼻窦结局测试22条对青少年慢性鼻-鼻窦炎患者健康相关生活质量的评价余爵波程泽星【摘要】目的（1）评价中文版鼻腔鼻窦结局测试22条（SNOT-22）用于评价青少年慢性鼻-鼻窦炎（CRS）的信度及效度；（2）探讨SNOT-22调查表是否可以作为一种较好的评价手段对青少年CRS患者治疗前后健康相关生存质量（HRQOL）状况及疗效进行评价。
方法（1）采用中文版SNOT-22对2014年1月至2015年6月住院接受鼻内镜手术（ESS）的61例患者和60名健康志愿者进行HRQOL调查；用重测信度、内部一致性、结构效度和内容效度等指标对中文版SNOT-22量表进行评判；（2）用中文版SNOT-22量表、鼻窦CT Lund-MacKay评分及Lund-Kennedy鼻内镜黏膜形态评分对61例青少年CRS患者分别进行ESS术前及术后6～12个月的生活质量评价及ESS手术后生活质量改善情况及疗效的评价。
结果（1）中文版SNOT-22作为评价青少年CRS生活质量调查量表的可行性、信度、内部一致性及效度等性质均通过考核。
（2）中文版SNOT-22总分、各个维度得分及各条目得分术后均较术前明显下降，青少年CRS患者的生活质量改善明显。
青少年CRS患者术前鼻窦CT Lund-MacKay评分及Lund-Kennedy鼻内镜黏膜形态评分与中文版SNOT-22量表评分之间均呈正相关性（P＜0.000 1），而术后只有Lund-Kennedy鼻内镜黏膜形态评分与中文版SNOT-22量表评分之间呈正相关性（P＜0.000 1）。
结论（1）中文版SNOT22具有良好的信度和效度，适用于青少年CRS患者生活质量的评价；（2）中文版SNOT-22有助于监测临床干预治疗措施对青少年CRS患者的疗效。
【关键词】青少年；慢性鼻-鼻窦炎；健康相关生活质量；鼻腔鼻窦结局测试-22；鼻内镜手术Chinese version of the sino-nasal outcome test (SNOT)-22: the evaluation of health-related quality oflife for chronic rhinosinusitis in adolescent Yu Juebo, Cheng Zexing. Department of Otolaryngology,the First People's Hospital of Yangzhou, Yangzhou 225001, ChinaCorresponding author: Yu Juebo, Email: yujuebo2004@【Abstract】Objective One of the objective of the study was to evaluate the reliability andvalidity of Chinese version of the sino-nasal outcome test-22 (SNOT-22) which was made forhealth-related quality of life (HRQOL) in adolescent with chronic rhinosinusitis. The other was to explorewhether SNOT-22 could be used as a valid instrument on chronic rhinosinusitis in adolescent HRQOLbefore and after surgery. Methods First, sixty-one adolescent parents were interviewed with SNOT-22questionnaire and the questionnaire was assessed by retest reliability, internal consistency, split-halfreliability, construct validity and content validity. Second, SNOT-22, Lund-Mackay scoring system andLund-Kennedy scoring system were used to evaluate the HRQOL of 61 teenage parents 6-12 months afterendoscopic sinus surgery (ESS). Results The feasibility, reliability, validity and responsibility of Chineseversion of SNOT-22 questionnaire for adolescent CRS all passed the test. Test-retest evaluation wasaccepted in 61 patients. Cronbach's alpha was 0.923 and 0.967 at test and retest, respectively, suggestingDOI:10.3877/cma.j.issn.1674-0785.2017.06.011作者单位：225001 江苏省，扬州市第一人民医院耳鼻咽喉-头颈外科通信作者：余爵波，Email: yujuebo2004@good internal consistency. Pearson's correlation coefficient was 0.99 (P<0.001), revealing good correlation between initial and retest scores. All domains and items Cronbach's alpha coefficients>0.8. Construct validity and content validity were satisfactory. 61 CRS patients underwent surgical treatment. Postoperative SNOT-22 total scores, every domain and item score were significantly lower than preoperative (P<0.000 1) while the magnitude of surgery effect was considered high. The preoperative and postoperative SNOT-22 total score had a statistically significant correlation with Lund-Kennedy score (P<0.000 1). The preoperative SNOT-22 total score had a statistically significant correlation with Lund-Mackay score (P<0.000 1), but postoperative had not correlation (P>0.05). Conclusions The Chinese version of the 22-item sino-nasal outcome test has better good internal consistency, reliability, reproducibility, validity and responsiveness; and it is a useful measurement of general health-related quality of life with sensitivity to clinical change in adolescent chronic rhinosinusitis that support its use for monitoring those patient outcomes.【Key words】Adolescent; Chronic rhinosinusitis; Health-related quality of life; SNOT-22; Endoscopic sinus surgery慢性鼻-鼻窦炎（chronic rhinosinusitis，CRS）是耳鼻咽喉科临床工作中最常见的慢性疾病之一，有文献报道，在英国多达11%～15%的成年人受到CRS影响，CRS也是少年儿童的常见病和多发病，而且病程长、易复发，使患者的日常生活受到极大困扰，导致受损的生活质量[1]。
空鼻综合征的研究进展
- 173 -①成都中医药大学 四川 成都 610075②成都市中西医结合医院通信作者：白云丹空鼻综合征的研究进展 李天星① 白云丹② 【摘要】 空鼻综合征（简称为空鼻症）是一种衰弱性疾病，目前认为主要由于鼻甲组织过度切除而引发的。
其主要特征是“矛盾性鼻塞”，即尽管鼻腔有足够的通气空间，但患者时常感到鼻塞。
此外空鼻症还表现为鼻腔干燥、嗅觉减退或消失、鼻涕量少或形成结痂、容易出血，而且超过半数的空鼻症患者都有不同程度的焦虑、抑郁等心理问题，严重影响其工作和生活。
近几年国内外学者对于空鼻症的研究越发深入，但对于空鼻症的定义、发病机制、诊断及治疗一直都是备受争议的话题。
笔者结合空鼻症最新的研究成果，围绕空鼻症的发病机制、诊断、鉴别诊断及治疗进行综述。
【关键词】 空鼻综合征 心理问题 三叉神经 棉花试验 黏膜下植入 doi：10.14033/ki.cfmr.2024.01.044 文献标识码 A 文章编号 1674-6805（2024）01-0173-04 Research Progress of Empty Nose Syndrome/LI Tianxing, BAI Yundan. //Chinese and Foreign Medical Research, 2024, 22(1): 173-176 [Abstract] Empty nose syndrome is a debilitating disorder currently believed to be caused primarily by excessive removal of turbinate tissue. Its main feature is "contradictory nasal congestion", that is, although the nasal cavity has enough space for ventilation, but patients often feel nasal congestion. In addition, empty nose syndrome is also manifested as dry nasal cavity, reduced or disappeared sense of smell, less nasal discharge or formation of scab, easy to bleed, and more than half of patients with empty nose syndrome have different degrees of anxiety, depression and other psychological problems, seriously affecting their work and life. In recent years, scholars at home and abroad have more and more in-depth research on empty nose syndrome, but the definition, pathogenesis, diagnosis and treatment of empty nose syndrome have always been a controversial topic. The author summarized the pathogenesis, diagnosis, differential diagnosis and treatment of empty nose syndrome based on the latest research results. [Key words] Empty nose syndrome Psychological problems Trigeminal nerve Cotton experiment Submucosal implantation First-author's address: Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China 空鼻综合征（ENS）简称为空鼻症，最早由Eugene 和Stenkvis 于1994年提出的，用于描述有部分或全部下/中鼻甲切除史的患者在鼻腔影像学上的表现[1]。
OS-MINI22系列微型红外温度传感器产品说明书
Miniature Infrared Temperature Sensorfor High Temperature Targets and MetalsOS-MINI22 SeriesU S hort WavelengthMeasurement for Low-Emissivity Targets Such as Steel Rollers and Other Metal Surfaces U R anges from 100°C to 2000°C (212 to 3632°F) U 4 to 20 mA or RS485 Modbus ® Output Models U M iniature Sensing Head to Fit Most Applications with Configurable Electronics Package U O ptional Touch Screen Display for Temperature Indication and Configuration U B right Red Alarm Screen U A djustable Emissivity on All Models U D ata Logging SD Card (Optional) on All Touch Screen Models U M AX/MIN/AVG and Instantaneous Read Modes, Peak or Valley Hold, Reflected energy Compensation U S ensing Head Sealed to IP65 (NEMA 4)U R esistant to Errors Due to Moving Cables as on Robotic Armsrequirements. The optional backlit touch screen interface mounted in the electronics module,provides an easy-to-read large, bright display of the measured Temperature, as well as controls allowing full configuration of the sensor. The graph viewallows viewing the history of the measured temperature.In alarm condition, the display turns bright red to provide an immediate and obvious alarm indication. The alarm levels and modes can be configured from the touch screen.SpecificationsMin/Max Adjustable Span (D-MA Model): 100°C (212°F)/up to 1550°C (2822°F) within the full rangeOutput: 4 to 20 mA or RS485 Modbus (up to 247 sensors may be installed on a single Modbus network)Field of View: See To Order chart on next pageAccuracy: ±2°C or 1% reading, whichever is greaterRepeatability: ±0.5°C or 0.5% reading, whichever is greaterThe OS-MINI has miniature sensing head to fit mostapplications and configurable electronics package. They use short wavelength measurement for low-emissivity targets such as steel rollers and other metal surfaces. Field of views from 15:1 to 75:1 plus a close focus model are designed to fill most industrialEmissivity Setting Range: 0.10 to 1.00Emissivity Setting Method:-MA Models: T wo rotary switches in electronics packageC4 and /D-C4 Models: RS485 D-MA/D-C4 Models: Touch screen Response Time, t 90: ≥240 mS (90% response)Spectral Range: 2.0 to 2.6 μm Supply Voltage: 24 Vdc ±5%Maximum Current Draw: 100 mA Maximum Loop Impedance(4 to 20 mA Output Models): 900Ω“D-” Models Alarm Relays:2 x Single Pole alarm relays 24 Vdc, 1A, 500 Vdc isolationMECHANICALSensing Head: Material: 316 SSDimensions: 18 dia. x 45 mm (see diagram above)Mounting: M16 x 1 mm thread, nut includedElectronics Module:Material: Cast aluminumDimensions: 98 L x 64 W x 36 mm D (3.9 x 2.5 x 1.4")OS-MINI22-SN151-D-MA-MT miniature sensor with display, shown smaller than actual size.ENVIRONMENTAL Environmental Sealing:NEMA 4 (IP65)Ambient Range: 0 to 70°C(32 to 158°F)Relative Humidity: 95% non-condensingElectronics Module: Environmental Sealing: NEMA 4 (IP65) models with touch screen Ambient Range: 0 to 60°C(32 to 140°F)Relative Humidity:95% non-condensing Electromagnetic Standards:EMC Directive: EN61326-1:2006 Immunity: IEC 61000-4-2,IEC 61000-4-3, IEC 61000-4-4, IEC 61000-4-5, IEC 61000-4-6, EN 55022A, EN 55022B Data Logging (Models withDisplay Data Logging Interval):1 to 86,400 sec (1-day)MicroSD Card: 2 GB max capacity(not included)Internal Clock Battery: 1 x BR12253V (not included)Variables Logged: Target temp,Sensing head temp, electronicsmodule temp, max, min, average,emissivity setting, reflected energycompensation, alarm eventsFile Format: .csvConfigurable Parameters: Sampleperiod, number of samples, scheduledstart date and timeTOUCH SCREEN DISPLAYDisplay Format: 72 mm (2.83")resistive touch TFT, 320 x 240 pixels,backlitConfigurable Parameters:Temperature range, temperatureunits, emissivity setting, reflectedenergy compensation, alarms, signalprocessing, Modbus address (D-C4models), date, time, data loggingTemperature Units: °C, °FTemperature Resolution: 0.1°Alarm Configuration: Two alarmswith adjustable levels, individuallyconfigurable as HI or LO; Alarm 2can be set to target temperature orsensing head internal temperatureSignal Processing: Average, peakhold, valley hold, minimum, maximum24 Vdc 100 mA 24 Vdc 100 mATP+TP-TH+GND OP+OP-PWR-PWR+TP+TP-TH+GND OP+OP-PWR-PWR+Emissivityswitches on -MA models onlyMA and D-MA modelsC4 and D-C4 modelsA 24 Vdc 100 mA 4 to 20 Modbus GND 24 Vdc 100 mATP+TP-TH+GNDOP+OP-PWR-PWR+TP+TP-TH+GNDOP+OP-PWR-PWR+Emissivityswitches on -MA models onlyOrdering Example: OS-MINI22-SN251-D-MA-MT, OS-MINI with 2.2 μm spectral range, 25:1 field of view, touch screen display, 4 to 20 mA output and 2 alarm relays, and 250 to 1000°C (482 to 1832°F) temperature range.。
Modicon Premium自动化平台-TSXCAY22运动控制模块说明书
i s c l a i m er : T h i s d o c u m e n t a t i o n i s n o t i n t e n d e d a s a s u b s t i t u t e f o r a n d i s n o t t o b e u s e d f o r d e t e r m i n i n g s u i t a b i l i t y o r r e l i a b i l i t y o f t h e s e p r o d u c t s f o r s p e c i f i c u s e r a p p l i c a t i o n sProduct data sheetCharacteristicsTSXCAY22motion control modules - for servomotors - 8ms..10 s - 2 axisProduct availability : Stock - Normally stocked in distribution facilityPrice* : 5340.60 USDMainRange of productModicon Premium Automation platform Product or component type Motion control modules Product specific application For servo motorsServo loop type Proportional to overshoot compensation and gain switching 2 ms ChecksConsistency of commandsEncoder coupling, servo drive present, emergency stop Proper execution of movement Sensor power supply Validity of parametersPresence of voltage/sensor feedback counter inputComplementarySpeed profile path Trapezoidal or parabolic Resolution <= 1000 position units per point >= 0.5 position units per point Length of axis 256...32000000 P Acquisition speed >= 54000 points/mn <= 270000 points/mn Acceleration time 8 ms...10 s Operating modeDirect drive mode OFF ManualFOLLOWER AutomaticType of axisFollowing axis dynamic ratio Infinite axis Limited axisFunction of module Cut on the flyServo drive offset correction I/O modularity2 axesInput compatibility Absolute encoder SSI output 12...25 bitsIncremental encoder 10...30 V totem poleIncremental encoder 5 V DC RS422With 2-wire/3-wire sensor (24 DC) auxiliary inputAbsolute encoder parallel output ABE7CPA11Clock frequency200 kHz SSI absolute encoderIncremental encoder frequency x1500 kHzIncremental encoder frequency x 41000 kHz in counting250 kHz in inputPower dissipation in W7.2...11.5 WInput type Current sink auxiliary input conforming to EN/IEC 1131 Type 2Resistive counter inputResistive servo drive control input conforming to EN/IEC 1131 Type 1 Input logic PositiveInput voltage24 V 8 mA auxiliary input24 V 8 mA servo drive control input5 V 18 mA counter inputInput voltage limits<= 5.5 V counter input19...30 V auxiliary input19...30 V servo drive control inputVoltage state 1 guaranteed>= 11 V auxiliary input>= 11 V servo drive control input>= 2.4 V counter inputCurrent state 1 guaranteed>= 3.5 mA servo drive control input>= 3.7 mA counter input>= 6 mA auxiliary inputVoltage state 0 guaranteed<= 1.2 V counter input<= 5 V auxiliary input<= 5 V servo drive control inputCurrent state 0 guaranteed<= 1 mA counter input<= 1.5 mA servo drive control input<= 2 mA auxiliary inputInput impedance270 Ohm counter input3000 Ohm auxiliary input3000 Ohm servo drive control inputNumber of outputs 2 analogue output static2 reflex output static conforming to EN/IEC 611312 servo drive validation output relayAnalogue output range+/- 10...24 VAnalogue output resolution13 bits + signLSB value 1.25 mV analogue outputOutput voltage24 V DC reflex output24 V DC servo drive validation outputOutput voltage limits19...30 V reflex output5...30 V servo drive validation outputNominal output current0.5 A reflex outputMaximum output current 1.5 mA analogue output200 mA servo drive validation output625 mA reflex outputMinimum load 1 mA 1 VVoltage drop< 1 V at state on reflex outputLeakage current< 0.3 mA reflex outputSwitching time< 5 ms for servo drive validation< 500 µs for reflex outputOutput compatibility Positive logic DC inputs (resistance <= 15 kOhm) reflexShort-circuit protection Current limiter reflex outputThermal tripping reflex outputOutput overload protection Current limiter reflex outputThermal tripping reflex outputOutput overvoltage protection Zener diode between outputs and 24 DC reflex outputReverse polarity protection Reverse diode on supply reflex outputLocal signalling 2 LEDs green axis diagnostics available1 LED green module operating (RUN)1 LED red external fault (I/O)1 LED red internal fault, module failure (ERR)Electrical connection1 connector HE-10 20 pins for aux inputs, reflex output, for external sensor and preactuator power supply1 connector HE-10 20 pins for servo drive ctrl inputs + for ext power supply of servo drive inputs/outputs1 connector SUB-D 9 for an analogue output (speed reference)2 connectors SUB-D 15 for an incremental or absolute encoder Current consumption1100 mA 5 V DC 15 mA 24 V DC11...20 mA 24 V DC on 10/30 V absolute encoder module Module format StandardProduct weight1.06 lb(US) (0.48 kg)EnvironmentProtective treatmentTCAmbient air temperature for operation 32...140 °F (0...60 °C)Ambient air temperature for storage -13...158 °F (-25...70 °C)Relative humidity 5...95 % without condensation Operating altitude<= 6561.68 ft (2000 m)Ordering and shipping detailsCategory22558 - TSX PREMIUM, ATRIUM & PL7 PRO Discount Schedule PC22GTIN00785901123675Nbr. of units in pkg.1Package weight(Lbs) 2.21Returnability N Country of originFROffer SustainabilitySustainable offer status Not Green Premium productRoHS (date code: YYWW)Compliant - since 0806 - Schneider Electric declaration of conformity Schneider Electric declaration of conformity REAChReference not containing SVHC above the threshold Reference not containing SVHC above the threshold Product end of life instructionsNeed no specific recycling operationsContractual warrantyWarranty period18 monthsDimensions DrawingsStandard and Extendable Racks for Modules MountingDimensions of Modules and Racks(1) With screw terminal block modules.(2) Maximum depth for all types of modules and their associated connectors.Connection of Speed Reference Signals Connector PinoutConnection of Counting SignalsConnectors PinoutsConnection of Sensors/Pre-actuators and Encoder Power Supply, without Variable Speed ControllerHE10 Connector PinoutThe auxiliary inputs/outputs are allocated the following functions:●I0 = cam reference point input,●I1 =emergency stop input (stop if there is no current in the input),●I2 = adjusting input,●I3 = adjustment input,●Q0 = reflex output (static output),●0 V = shared auxiliary inputs and reflex outputs.Connection of the Variable Speed Controller Signals Connector PinoutThe axis command modules implement basic management of the signals necessary for correct operation of the variable speed controllers. Thereis only one connector, regardless of the number of axis command module channels.COMx – VALVARx: potential free contact to validate variable speed controller OK_VARx: variable speed controller input check 24 V – 0 V sensor power supplyNOTE: Each channel uses a potential free closing contact.。
基于PubMed数据库病人报告结局研究热点的共词聚类分析
基于P u b M e d 数据库病人报告结局研究热点的共词聚类分析邹丽萍,宁向东,徐淑君,尹 婷,孙美艳,吴 飞摘要 目的:分析P u b M e d 数据库中病人报告结局的研究热点,了解该领域研究现状及发展方向㊂方法:以P u b M e d 收录的病人报告结局相关文献为研究对象,使用B i c o m b2.0㊁S P S S25.0软件对主题词+副主题词进行词频分析和共词聚类分析㊂结果:共纳入3652篇文献,获得高频主题词+副主题词77个,占总频次累计百分比为20.23%㊂通过共词聚类分析总结出病人报告结局研究的11个热点㊂战略坐标图中,第Ⅰ象限1个类团;第Ⅱ象限4个类团;第Ⅲ象限3个类团;第Ⅳ象限3个类团㊂结论:病人报告结局研究热点分析有助于了解该领域的研究现状及发展趋势㊂癌症治疗及幸存者的心理㊁脊柱手术术后并发症及病人满意度㊁骨关节手术术后疼痛评估方式㊁膝关节手术的不良反应等类团主题是未来病人报告结局研究的热点㊂关键词 病人报告结局;聚类分析;战略坐标;类团K e y w o r d s p a t i e n t -r e p o r t e do u t c o m e s ;c l u s t e r a n a l y s i s ;s t r a t e g i c c o o r d i n a t e s ;c l a s s g r o u p d o i :10.12104/j.i s s n .1674-4748.2023.22.008 病人报告结局(p a t i e n t -r e po r t e d o u t c o m e s ,P R O s)是一种在没有医生或他人影响下,直接由病人对自身健康状况进行测量报告[1]㊂P R O s 在治疗效果的评价㊁治疗不良反应的检测㊁病人健康状况的监测㊁症状严重程度的判断及病人治疗依从性和医疗服务质量的评估方面都有应用[2]㊂P R O s 可有效提高病人疾病体验,促进医/护患沟通和病人在临床决策中的参与,降低病人门诊及二次入院次数,最终提升病人整体生活质量和照护质量[3]㊂病人报告结局工具(pa t i e n t -r e po r t e do u t c o m e m e a s u r e s ,P R OM s )是用来测量P R O s 的一种工具[4],是一种标准化的问卷或量表㊂G r a m -H a n s s e n 等[5]认为P R OM s 一般可以分为通用㊁特定疾病㊁特定领域3种类型,通用P R OM s 用来评估病人一般症状或体征;特定疾病P R OM s 用于某种特定疾病或状况的评估㊂由于疾病种类繁多,需要通过聚类分析了解当前P R O s 领域的研究热点,明确研究方向和发展趋势㊂1 资料与方法1.1 资料来源通过查询美国国立生物技术信息中心(N a t i o n a lC e n t e r f o rB i o t e c h n o l o g y In f o r m a t i o n ,N C B I )网站的基金项目 湖南省卫生健康委2020年度卫生科研课题立项项目,编号:D 202314027633㊂作者简介 邹丽萍,主管护师,本科,单位:421001,南华大学附属第二医院;宁向东㊁徐淑君㊁尹婷㊁孙美艳单位:421001,南华大学附属第二医院;吴飞(通讯作者)单位:421001,南华大学护理学院㊂引用信息 邹丽萍,宁向东,徐淑君,等.基于P u b M e d 数据库病人报告结局研究热点的共词聚类分析[J ].全科护理,2023,21(22):3061-3065.医学主题词(M e d i c a lS u b j e c tH e a d i n gs ,M e S H )数据库,确定主题词为 P a t i e n tR e p o r t e dO u t c o m eM e a s u r e s ㊂检索P u b M e d 数据库,检索时间2019年5月29日2021年5月29日,共检索到相关文献3669篇㊂通过N o t e E x p r e s s 软件去重后,剩余3652篇文献㊂将剩余文献题录以x m l 格式导入书目共现分析系统(B i b l i o g r a ph i c I t e m C o o c c u r r e n c eM a t r i xB u i l d e r ,B I C OM B )[6],包括文献题目㊁作者㊁所在期刊㊁主题词㊁摘要等基本信息㊂1.2 研究方法1.2.1 系统聚类分析在B I C OM B2.0软件提取的主题词+副主题词列表中,将 P a t i e n tR e p o r t e d O u t c o m e s 以及同义词删除,将剩余主题词+副主题词按出现频次降序排列,形成主题词+副主题词次序和频次对照表,通过h 指数㊁高低频次分界公式T =1/2ˑ(-1+1+8I 1)㊁普赖斯公式m =0.749ˑn m a x 和二八定律4种方法确定高频主题词+副主题词的结果,选择最佳频次和累计百分比,记录序号㊁关键字段㊁出现频次㊁出现百分比和累计百分比㊂高频主题词+副主题词计算确定后,利用B i c o m b2.0软件构建高频主题词+副主题词词篇矩阵,并将词篇矩阵(t x t )数据导入S P S S25.0软件进行系统聚类分析,选择谱系图,聚类方法选择组内联接,词篇矩阵为二值(0,1)矩阵,选择落合(o c h i a i )系数,主题词+副主题词的聚类分析结果以树状图形式呈现㊂1.2.2 战略坐标图分析战略坐标图是一个二维坐标轴,是类团分析的主要方法,X 轴为向心度,表示类团主题间相互作用的强度,一个学科主题同其他学科主题联系的强度越大,说明这个类团主题在整个学科研究中趋于中心地位;Y㊃1603㊃全科护理2023年8月第21卷第22期Copyright ©博看网. All Rights Reserved.轴为密度,表示类团主题内的联系强度,是该类维持自己和发展自己的能力,密度越大表示该类团主题发展得越成熟[7]㊂从B i c o m b2.0软件导出共现矩阵数据,根据词篇矩阵的聚类分析结果对高频主题词+副主题词进行分类,并计算高频主题词+副主题词的总链接数㊁类内链接数㊁类外链接数㊁类内主题词数㊁类外主题词数㊁类内链接平均数和类外链接平均数,然后根据上述数据计算各类团的类内链接平均值㊁类间链接平均值㊁总计平均值,再计算各类团的向心度X和密度Y,并绘制战略坐标图[8]㊂2结果2.1高频主题词+副主题词聚类分析2.1.1高频主题词+副主题词统计分析通过B i c o m b2.0软件共提取9377个P R O s的主要主题词+副主题词,根据h指数原则确定高频词阈值为24,累计百分比只有11.55%,占比较小,不适合;根据高低频词分界公式计算的T值为77.85,只有1个主题词+副主题词符合,不适合;根据普赖斯公式计算出的m值为9.5,高频词阈值确定为10,有113对主要主题词+副主题词,数量较大;根据二八定律自主确定,高频词阈值为12时,累计百分比达到20.23%,有77对主要主题词+副主题词,更为适合进行聚类分析㊂2.1.2高频主题词+副主题词聚类分析在B i c o m b2.0软件设置频次阈值ȡ12,ɤ161,生成词篇矩阵㊂将B i c o m b2.0软件词篇矩阵(t x t)数据导入S P S S25.0软件进行系统聚类分析,生成谱系图㊂谱系图横坐标聚类标定距离表示2个主题词之间的平均距离,反映二者之间的亲密关系,距离越小,主题词内涵越接近,在同一篇文献中出现次数越多,反映的主题越一致㊂以聚类谱系图为参考,结合专业知识,共总结了11个主题类团,其中第1类团~第3类团最具代表性,主题词亲密关系梯度更加明显,聚类分析结果见图1㊂图1 P R O s高频主题词+副主题词第1类团~第3类团聚类分析谱系图2.2战略坐标图绘制根据各主题类团的向心度和密度计算结果绘制P R O s主题战略坐标,见图2㊂㊃2603㊃C H I N E S EG E N E R A LP R A C T I C E N U R S I N G A u g u s t2023V o l.21N o.22Copyright©博看网. All Rights Reserved.图2 P R O s主题类团战略坐标3讨论3.1聚类分析P R O s主题类团热点分析P R O s高频主题词+副主题词聚类分析形成的11个类团热点可以划分为鼻炎病人生活质量㊁类风湿关节炎病人生活质量㊁癌症病人心理㊁骨关节手术病人生活质量和术后疼痛5个方面㊂3.1.1鼻炎病人生活质量第1类团为鼻炎手术治疗对病人生活质量及心理的影响,该热点说明鼻炎对病人健康相关生活质量有显著负面影响,需借助P R O s进行报告,22项鼻腔结局测量工具(22-i t e m S i n o N a s a lO u t c o m eT e s t,S N O T-22)属于鼻炎这种特定疾病的P R OM s,H u s a i n等[9]通过S N O T-22来评价过敏性鼻炎病人的生活质量和症状控制,B a c h e r t等[10]通过S N O T-22评价慢性鼻窦炎合并鼻息肉病人的健康相关生活质量㊂3.1.2类风湿关节炎病人生活质量第2类团为单克隆抗体在类风湿性关节炎(r h e u m a t o i da r t h r i t i s,R A)治疗中的应用,该热点关注的是类风湿性关节炎,该疾病造成病人关节疼痛和日常活动困难,单次就诊判断病人的情况可能会导致医生和病人对疾病的评估不一致,将P R O s作为主要结果是类风湿性关节炎临床研究的重大转变之一[11],但尚缺乏类风湿性关节炎特异性的P R OM s㊂3.1.3癌症病人心理第3类团和第4类团涉及的热点均与癌症病人的心理有关,因为抗肿瘤药物治疗会导致病人出现疲劳㊁恶心㊁血小板减少㊁头痛等一系列不良反应,病人的心理负担更重㊂P R O s可用于评估癌症病人化疗的效果,C o n t e等[12]比较乳腺癌病人术后2种化疗方法的效果,使用欧洲癌症研究治疗组织的生活质量问卷-核心30(Q u a l i t y o fL i f e Q u e s t i o n n a i r e-C o r e30,Q L Q-C30)和生活质量问卷乳腺癌模块(Q L Q-B R23)测量癌症特异性和乳腺癌特异性生活质量结果;K a r g o等[13]对P R OM s在卵巢癌幸存者中的前瞻性应用进行系统综述,表明P R OM s可以识别其他未观察到的症状,提出未来的研究应评估使用P R OM s是否能促进更个性化和更有效的随访计划,以适应卵巢癌病人的需求和偏好㊂3.1.4骨关节手术病人生活质量第5类团涉及的热点是脊柱手术,F a r a j等[14]对成人脊柱畸形手术的病人报告结果进行系统综述,评估各种P R OM s的优点㊁缺点和不足,结果显示脊柱侧凸研究会-22(S c o l i o s i sR e s e a r c hS o c i e t y,S R S-22)问卷的评估质量最高㊂第7类团和第10类团涉及的热点是膝关节手术,K a n e k o等[15]通过美国膝关节协会评分(K n e e S o c i e t y S c o r e,K S S)㊁西部安大略省和麦克马斯特大学骨关节炎指数评分(W e s t e r n O n t a r i oa n d M c M a s t e rU n i v e r s i t i e sA r t h r i t i s I n d e x,WOMA C)等4个P R OM s评估膝关节置换术后1.5年病人的满意度㊁生理功能㊁股四头肌肌力等多个方面的状况,及时评价膝关节手术术后病人存在的不良反应;前交叉韧带(A n t e r i o r c r u c i a t e l i g a m e n t,A C L)损伤是临床上一种较为常见的运动创伤,S a r r a j等[16]的研究结果表明前交叉韧带重建(A n t e r i o r c r u c i a t e l i g a m e n t r e c o n s t r u c t i o n, A C L R)联合半月板切除的病人随访2年的症状较A C L R联合半月板修复的病人更好;G r a s s i等[17]对A C L R病人随访10年,通过膝关节损伤和骨关节炎评分表㊁L y s h o l m评分表和疼痛视觉模拟评分表评价病人主观的临床结果㊂第8类团和第9类团涉及的热点是髋关节手术,髋关节置换前症状持续时间可能影响㊃3603㊃全科护理2023年8月第21卷第22期Copyright©博看网. All Rights Reserved.术后获得的生活质量,L a u等[18]通过欧洲五维健康量表(E Q-5D)和牛津髋关节评分表(O x f o r d H i p S c o r e, O H S)评估病人术前症状持续时间与术后结局之间的关系,结果表明髋关节置换术前病人的症状持续时间增加,术后生活质量㊁功能状态则较差;M a r t i n等[19]通过12项国际髋关节评估工具(12-i t e mI n t e r n a t i o n a l H i p O u t c o m eT o o l,i HO T-12)评估髋关节镜手术后2年内实质性的临床受益和病人可接受症状状态,并通过术后视觉模拟满意度量表评估病人对手术的满意度㊂3.1.5术后疼痛第6类团和第11类团涉及的研究热点为术后疼痛,传统评估疼痛的量表有多种,P R OM s的响应能力关系到P R O s报告结果的质量,C h e n等[20]通过3组临床试验比较病人报告结局测量信息系统疼痛干扰量表(P a t i e n t-R e p o r t e dO u t c o m e sM e a s u r e s I n f o r m a t i o n S y s t e m P a i n I n t e r f e r e n c e,P R OM I S-P I)与健康调查简表(S F-36)身体疼痛分量表㊁罗兰-莫里斯伤残问卷㊁简明疼痛清单㊁疼痛量表等传统疼痛测量工具的响应能力,结果P R OM I S-P I的响应能力更高㊂慢性疼痛病人的用药频率与P R OM s结果测量的相关性尚不清楚,瑞典的K a l l m a n等[21]通过医院焦虑抑郁量表(H o s p i t a lA n x i e t y a n dD e p r e s s i o nS c a l e,HA D S)㊁多维疼痛清单(M u l t i d i m e n s i o n a lP a i nI n v e n t o r y)㊁欧洲生活质量仪器(E u r o p e a nQ u a l i t y o fL i f e I n s t r u m e n t, E Q-5D)等多个量表评估阿片类药物治疗与P R O s的关系,结果表明阿片类药物的使用与疼痛严重程度㊁干扰㊁健康相关生活质量㊁活动参与度和社会生活满意度呈显著负相关㊂3.2聚类分析P R O M s主题类团核心度与成熟度分析第Ⅰ象限为核心㊁成熟的类团,只有第10类团在第Ⅰ象限,密度高,而向心度较低,表示此类团内部主题之间联系较紧密,研究已经成熟,具备相当的规模,但是与外部各类主题联系不是特别密切,中心地位不够㊂第Ⅱ象限为核心㊁不成熟的类团,第4类团~第7类团主题向心度较高,特别是第6类,但密度较低,表示主题的内部结构比较松散,但与其他类之间联系紧密,处于核心地位,在P R OM s研究领域中比较活跃,未来有很大的发展空间,随着研究的深入会日渐成熟㊂第Ⅲ象限为周边㊁成熟的类团,第1类团㊁第2类团㊁第9类团密度较高,但是向心度最低,表示此类内部主题集聚程度较高,但与外部各类的联系程度很低,说明此类主题的研究虽然已经形成相当的研究规模,但是特异性较强,核心地位低㊂第Ⅳ象限为周边㊁不成熟的类团,第3类团㊁第8类团㊁第11类团的向心度和密度均较低,表示此类主题尚不成熟,且外部各类的紧密程度尚较低,说明这几类研究的关注度不高,处于边缘研究领域㊂4小结聚类的11个类团中只有1个类团处在第Ⅰ象限,说明成熟又具有一定核心性的类团很少;第Ⅱ象限的癌症治疗及幸存者的心理㊁脊柱手术术后并发症及病人满意度㊁骨关节手术术后疼痛评估方式㊁膝关节手术的不良反应4个类团具有较高的核心性,但是发展得不成熟,可以作为未来研究的热点,继续推进相关研究㊂对于既不成熟也不核心的类团要关注其特异性以及临床的研究价值㊂我国对P R O s及P R OM s在临床中的应用研究处于起步阶段,通过本研究有助于国内研究者把握P R O s领域的研究热点,推动相关领域研究进一步深化,在借鉴国外相关领域研究成果的同时,鼓励研究者开发适合我国病人生理㊁精神和社会状态评估的P R OM s,真正做到以病人为中心㊂参考文献:[1] U.S.D e p a r t m e n t o fH e a l t ha n d H u m a nS e r v i c e sF D A C e n t e r f o rD r u gE v a l u a t i o na n d R e s e a r c h,U.S.D e p a r t m e n to f H e a l t ha n dH u m a n S e r v i c e s F D A C e n t e r f o r B i o l o g i c s E v a l u a t i o n a n dR e s e a r c h,U.S.D e p a r t m e n to f H e a l t ha n d H u m a nS e r v i c e sF D AC e n t e r f o rD e v i c e s a n dR a d i o l o g i c a lH e a l t h.G u i d a n c e f o r i n d u s t r y:p a t i e n t-r e p o r t e d o u t c o m e m e a s u r e s:u s e i n m e d i c a l p r o d u c td e v e l o p m e n t t o s u p p o r t l a b e l i n g c l a i m s:d r a f t g u i d a n c e[J].H e a l t hQ u a l L i f eO u t c o m e s,2006,4:79.[2]安凤英,韩吉淑,玄银河,等.国外慢性静脉疾病特异性患者报告结局工具的研究进展[J].解放军护理杂志,2019,36(12):75-78.[3] L A V A L L E E DC,C H E N O K K E,L O V E R M,e ta l.I n c o r p o r a t i n gp a t i e n t-r e p o r t e do u t c o m e s i n t oh e a l t hc a r e t oe n g a g e p a t i e n t s a n de n h a n c e c a r e[J].H e a l t hAf f a i r s,2016,35(4):575-582.[4]J O K S T A D A.P a t i e n t-r e p o r t e do u t c o m e s(P R O s)v e r s u s p a t i e n t-r e p o r t e do u t c o m em e a s u r e s(P R OM s)-I s t h e r ead i f f e r e n c e?[J].C l i n i c a l a n dE x p e r i m e n t a lD e n t a lR e s e a r c h,2018,4(3):61-62.[5] G R A M-H A N S S E N A,J E S S E N M L,C H R I S T O P H E R S E N C,e t a l.T r e n d si nt h eu s eo f p a t i e n t-r e p o r t e do u t c o m em e a s u r e s f o r i n g u i n a lh e r n i a r e p a i r:a q u a n t i t a t i v e s y s t e m a t i c r e v i e w[J].H e r n i a,2021,25(5):1111-1120.[6]崔雷,刘伟,闫雷,等.文献数据库中书目信息共现挖掘系统的开发[J].现代图书情报技术,2008(8):70-75.[7]李永忠,陈静,谢隆腾.共词分析法中战略坐标图的改进研究[J].情报理论与实践,2019,42(1):65-69.[8] C A L L O N M,C O U R T I A L J P,L A V I L L EF.C o-w o r d a n a l y s i s a s at o o l f o r d e s c r i b i n g t h en e t w o r ko f i n t e r a c t i o n sb e t w e e nb a s i ca n d t e c h n o l o g i c a l r e s e a r c h:t h e c a s e o f p o l y m e r c h e m s i t r y[J].S c i e n t o m e t r i c s,1991,22(1):155-205.[9] HU S A I N Q,H O E H L E L,P H I L L I P S K,e t a l.T h e22-i t e ms i n o n a s a l o u t c o m e t e s t a sa t o o l f o r t h ea s s e s s m e n to f q u a l i t y o f l i f e a n d s y m p t o mc o n t r o l i na l l e r g i c r h i n i t i s[J].A m e r i c a nJ o u r n a l o fR h i n o l o g y&A l l e r g y,2020,34(2):209-216.[10] B A C H E R TC,H E L L I N G SP W,MU L L O LJ,e ta l.D u p i l u m a bi m p r o v e sh e a l t h-r e l a t e d q u a l i t y o f l i f ei n p a t i e n t s w i t hc h r o n i c㊃4603㊃C H I N E S EG E N E R A LP R A C T I C E N U R S I N G A u g u s t2023V o l.21N o.22Copyright©博看网. All Rights Reserved.r h i n o s i n u s i t i sw i t hn a s a l p o l y p o s i s [J ].A l l e r g y,2020,75(1):148-157.[11] C HOSK ,S U N G Y K.A p a r a d i gm s h i f ti ns t u d i e sb a s e d o n r h e u m a t o i da r t h r i t i s c l i n i c a l r e g i s t r i e s [J ].T h eK o r e a nJ o u r n a l o f I n t e r n a lM e d i c i n e ,2019,34(5):974-981.[12] C O N T EP ,S C H N E E W E I S SA ,L O I B LS ,e ta l .P a t i e n t -r e po r t e d o u t c o m e sf r o m K A T H E R I N E :a p h a s e 3s t u d y o f a d ju v a n t t r a s t u z u m a b e m t a n s i n e v e r s u s t r a s t u z u m a b i n p a t i e n t s w i t h r e s i d u a l i n v a s i v ed i s e a s ea f t e rn e o a d j u v a n tt h e r a p y fo rh u m a n e p i d e r m a l g r o w t hf a c t o rr e c e p t o r2-po s i t i v eb r e a s tc a n c e r [J ].C a n c e r ,2020,126(13):3132-3139.[13] K A R G O AS ,C O U L T E R A ,J E N S E N P T ,e ta l .P r o a c t i v eu s eo f P R OM s i no v a r i a nc a n c e 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t a l .A n t e r i o rc r u c i a t e l i ga m e n t r e c o n s t r u c t i o n w i t h c o n c o m i t a n t m e n i s c a l s u r g e r y :as y s t e m a t i c r e v i e wa n d m e t a -a n a l y s i so f o u t c o m e s [J ].K n e e S u r g e r y ,S p o r t sT r a u m a t o l o g y ,A r t h r o s c o p y ,2019,27(11):3441-3452.[17] G R A S S IA ,MA C C H I A R O L A L ,L U C I D IG A ,e ta l .T e n -ye a r s u r v i v o r s h i p ,p a t i e n t -r e po r t e d o u t c o m e m e a s u r e s ,a n d p a t i e n t a c c e p t a b l e s y m p t o m s t a t ea f t e ro v e r -t h e -t o p h a m s t r i n g an t e r i o r c r u c i a t el i ga m e n tr e c o n s t r u c t i o n w i t h al a t e r a le x t r a -a r t i c u l a r r e c o n s t r u c t i o n :a n a l y s i s o f 267c o n s e c u t i v e c a s e s [J ].T h e A m e r i c a n J o u r n a l o f S po r t sM e d i c i n e ,2021,49(2):374-383.[18] L A U YS ,H A R R I S O N M ,S U T T O N M.A s s o c i a t i o n b e t w e e ns y m p t o m d u r a t i o n a n d p a t i e n t -r e po r t e d o u t c o m e s b e f o r e a n d a f t e rh i p r e p l a c e m e n ts u r g e r y [J ].A r t h r i t i sC a r e &R e s e a r c h ,2020,72(3):423-431.[19] MA R T I N RL ,K I V L A N B R ,C H R I S T O F O R E T T IJJ ,e ta l .D e f i n i n g v a r i a t i o n s i n o u t c o m e s o f h i p a r t h r o s c o p y f o r f e m o r o a c e t a b u l a r i m p i n g e m e n tu s i n g th e12-i t e m i n t e r n a t i o n a l h i p o u t c o m e t o o l (i H O T -12)[J ].T h eA m e r i c a nJ o u r n a l o f S p o r t s M e d i c i n e ,2020,48(5):1175-1180.[20] C H E NCX ,K R O E N K E K ,S T UM P T ,e t a l .C o m p a r a t i v e r e s po n s i v e n e s so ft h e P R OM I S p a i ni n t e r f e r e n c es h o r tf o r m s w i t h l e g a c yp a i nm e a s u r e s :r e s u l t s f r o mt h r e e r a n d o m i z e d c l i n i c a l t r i a l s [J ].T h e J o u r n a l o f P a i n ,2019,20(6):664-675.[21] K A L L MA N TF ,B ÄC K R Y D E .P r e v a l e n c eo fa n a l ge s i cu s ei n p a t i e n t sw i t hc h r o n i c p a i nr ef e r r e dt oa m u l t i d i s c i p l i n a r y pa i n c e n t r e a n d i t s c o r r e l a t i o n w i t h p a t i e n t -r e po r t e d o u t c o m e m e a s u r e s :ac r o s s -s e c t i o n a l ,r e g i s t r y -b a s e ds t u d y [J ].J o u r n a lo f R e h a b i l i t a t i o n M e d i c i n e ,2020,52(11):jr m 00126.(收稿日期:2023-03-23;修回日期:2023-08-05)(本文编辑李进鹏)护理本科 五维一体 发展性评价体系的信效度分析及应用聂玉翠,卢玉林,史书毓,王肖芹,饶 梦摘要 目的:检验护理本科 五维一体 发展性评价体系的信效度,并结合实际应用情况不断完善该评价体系㊂方法:以前期构建的评价指标体系内容为依据,转化编制为调查问卷,采用便利抽样法和整群抽样法,于2022年12月 2023年1月在云南省某医科大学选取符合纳入标准的473名护理本科生进行问卷调查,分析该体系的信效度及初步应用情况㊂结果:体系问卷的C r o n b a c h 's α系数为0.987;总体系的内容效度(S -C V I )为0.93,各指标条目水平的内容效度(I -C V I )为0.75~1.00;该评价体系79个条目的KMO值为0.968,B a r t l e t t 球形检验显著性为0.000,通过探索性因子分析共提取出7个公因子,累计贡献率为81.204%,经最大方差正交旋转后的因子载荷矩阵中,各条目的载荷值均>0.4;再通过2次探索性因子分析,对应本研究的5个维度㊂结论:护理本科 五维一体 发展性评价体系具有良好的信效度,且初步应用情况良好,可为客观评价护理本科生综合素质的梯度水平提供一定借鉴㊂关键词 护理本科;五维一体;评价体系;信度;效度K e y w o r d s b a c h e l o r d e g r e e i nn u r s i n g ;f i v e d i m e n s i o n a l i n t e g r a t i o n ;e v a l u a t i o n s y s t e m ;r e l i a b i l i t y ;v a l i d i t y d o i :10.12104/j.i s s n .1674-4748.2023.22.009基金项目 云南省哲学社会科学规划项目,编号:Y B 2021052;昆明医科大学2022年度发展改革研究项目立项课题项目,编号:2022-F G -Z D -02㊂作者简介 聂玉翠,护师,本科,单位:650500,昆明医科大学护理学院;卢玉林(通讯作者)㊁史书毓㊁王肖芹㊁饶梦单位:650500,昆明医科大学护理学院㊂引用信息 聂玉翠,卢玉林,史书毓,等.护理本科 五维一体 发展性评价体系的信效度分析及应用[J ].全科护理,2023,21(22):3065-3069.㊃5603㊃全科护理2023年8月第21卷第22期Copyright ©博看网. All Rights Reserved.。
Snort中文手册
<< Back to Snort 中文手册摘要snort有三种工作模式：嗅探器、数据包记录器、网络入侵检测系统。
嗅探器模式仅仅是从网络上读取数据包并作为连续不断的流显示在终端上。
数据包记录器模式把数据包记录到硬盘上。
网路入侵检测模式是最复杂的，而且是可配置的。
我们可以让snort分析网络数据流以匹配用户定义的一些规则，并根据检测结果采取一定的动作。
(2003-12-11 16:39:12) Snort 用户手册第一章 snort简介snort有三种工作模式：嗅探器、数据包记录器、网络入侵检测系统。
嗅探器模式仅仅是从网络上读取数据包并作为连续不断的流显示在终端上。
数据包记录器模式把数据包记录到硬盘上。
网路入侵检测模式是最复杂的，而且是可配置的。
我们可以让snort分析网络数据流以匹配用户定义的一些规则，并根据检测结果采取一定的动作。
嗅探器所谓的嗅探器模式就是snort从网络上读出数据包然后显示在你的控制台上。
首先，我们从最基本的用法入手。
如果你只要把TCP/IP包头信息打印在屏幕上，只需要输入下面的命令： ./snort -v使用这个命令将使snort只输出IP和TCP/UDP/ICMP的包头信息。
如果你要看到应用层的数据，可以使用：./snort -vd这条命令使snort在输出包头信息的同时显示包的数据信息。
如果你还要显示数据链路层的信息，就使用下面的命令：./snort -vde注意这些选项开关还可以分开写或者任意结合在一块。
例如：下面的命令就和上面最后的一条命令等价：./snort -d -v –e数据包记录器如果要把所有的包记录到硬盘上，你需要指定一个日志目录，snort就会自动记录数据包： ./snort -dev -l ./log当然，./log目录必须存在，否则snort就会报告错误信息并退出。
当snort在这种模式下运行，它会记录所有看到的包将其放到一个目录中，这个目录以数据包目的主机的IP地址命名，例如：192.168.10.1如果你只指定了-l命令开关，而没有设置目录名，snort有时会使用远程主机的IP地址作为目录，有时会使用本地主机IP地址作为目录名。
OPTO 22 SNAP-SCM-CAN2B 模块数据手册说明书
PAGE 1 SNAP-SCM-CAN2B MODULEFeaturesTransmits and receives data packets on a Controller AreaNetworkCan be configured to encode data as ASCII Hex with framedelimitingStandard top-mounted connector for easy wiringBaud rates to 1 MbpsUp to eight SNAP-SCM-CAN2B modules per rackPAC Project integration kit available30-month warrantyUL approvedDESCRIPTIONThe SNAP-SCM-CAN2B serial communications module can transmit and receive data on a Controller Area Network (CAN).When transmit functionality is enabled, all transmit and receive data passed between the module and the SNAP PAC brain or controller over Ethernet is ASCII encoded and frame delimited for robust communications.The SNAP-SCM-CAN2B module is designed for use with Opto22’s SNAP PAC R-series controllers and SNAP PAC EB-series brains, both the standard wired models and the Wired+Wireless™ models. The brain or controller processes the data from the module and can communicate the data to other parts of an Opto 22 SNAP PAC System™ or to another system (such as a Modbus® system or an OPC client).NOTE: The R-series controller or EB-series brain must have firmware version 9.2a or newer. This module does not work with legacy brains or controllers. The SNAP-SCM-CAN2B module snaps into Opto22 SNAP PAC mounting racks, right beside other SNAP I/O modules, to provide the mix of analog, digital, and serial channels you need at any location. It uses the standard SNAP removable top-mounted connector for easy wiring. LEDs indicate CAN bus activity on the port, as well as power and operation status.SNAP racks have a retention rail locking system. Use two 4-40 by½-inch standard machine screws to hold each module securely in position on the SNAP rack.ConfigurationConfiguration of the SNAP-SCM-CAN2B module to transmit and receive data is normally done in PAC Control using sample subroutines from the Opto22 CAN RX/TX Integration Kit for PAC Project™ (part number PAC-INT-CAN-RXTX, a free download from our website).Using PAC Control, you add the integration kit’s sample subroutines into your PAC Control strategy. By modifying the samples as necessary, your Opto22 SNAP PAC System (equipped with one or more SNAP-SCM-CAN2B modules) can transmit data from a CAN network and receive data with encoding and frame delimiting.For information on using the integration kit, see form 2151, the CAN RX/TX Integration Kit for PAC Project Technical Note.If you wish, you can also use PAC Manager for configuration.For information on installing and configuring the module in PAC Manager, see form 1191, Serial Communications Module User’s Guide. PAC Project Basic (including PAC Control and PAC Manager) comes on a CD with every SNAP PAC brain and controller. Both PAC Project and the integration kit are also available for download from the Product section of our website, .>>>>>>>>Part NumbersPart DescriptionSNAP-SCM-CAN2B Serial communication module for transmitting and receiving CAN packetsPAC-INT-CAN-RXTX CAN RX/TX Integration Kit for PACProjectSNAP-SCM-CAN2B ModuleOPTO 22PAGE 2OPTO 22•800-321-6786•1-951-695-3000••****************DATA SHEETForm 1537-221026Backward CompatibilityThe SNAP-SCM-CAN2B was originally issued as a receive-only module but as of May 2015 includes transmit capability as well. Default behavior is still receive only; to also transmit you just need to configure the module in PAC Control or PAC Manager.To add transmit capability to a module with older firmware, update the module’s firmware to version R2.0b or higher. The new SNAP-SCM-CAN2B firmware is available on the Opto 22 website (follow the link or click the Support tab, choose Downloads, and filter by Firmware). For steps to update firmware, see the PAC Manager User’s Guide .PINS FOR EACH PORTPins 1-4 are in parallel to pins 5-8. V+ is not used by the module. See diagram on page 4 for location of pin 1.For complete installation information, see form 1191, the SNAP Serial Communication Modules User’s Guide .BUFFERSThe SNAP-SCM-CAN2B has two buffers, transmit and receive, that are 8192 bytes each, regardless of the mode (transmit and receive or receive only). If transmit is enabled (which implies ASCII Hex encoding and frame delimiting) then packet sizes range from 9–29 bytes, which translates to a buffer storing 282 to 910 CAN packets. In receive-only mode packet sizes are from 6–13 bytes and a buffer can store 613 to 1365 CAN packets. If the buffer is full and a new packet is received, the oldest packet will be dropped from the buffer.Modules now sold with transmit capability built in are backwards compatible with older module firmware version R1.0d. If you are using a new module in a PAC Control strategy designed for the older module, you should not need to change your strategy unless you want to use the transmit capability.Integration kits. There are two integration kits:•PAC-INT-CAN-RXTX is the new integration kit that includes sample subroutines and charts for transmitting and receiving CAN data. Use this integration kit for modules with firmware version R2.0b or higher.•PAC-INT-CAN-RX (formerly PAC-INT-CAN) is the older kit that includes sample charts only for receiving CAN data. Use this kit only for modules with firmware R1.0d and lower.SPECIFICATIONSPin Use 1,5V +2,6CAN +3,7CAN –4,8GNDBaud rates10–1000 Kbps*Logic supply voltage 5.0 VDC Logic supply current 250 mA DC Number of ports per module 1Max. number of modules per rack**8Processor compatibility SNAP PAC R-series controllers and SNAP PAC EB brains, both standard wired and Wired+Wireless models, with firm-ware 9.2a or newer.Operating temperature -20 to 70 °C Storage temperature -30 to 85 °CTorque, hold-down screws Not to exceed 1 in-lb (0.11 N-m)Torque, connector screws 5.22 in-lb (0.59 N-m)Agency Approvals UL, CE, FM, RoHS, DFARS Warranty30 months from date of manufacture* Module performance is limited by the number of serial modules on the SNAP rack. Each rack backplane pro-vides approximately 2.5 Mbps of bandwidth.** Maximum number of modules per rack assumes a 4A power supply (for example, SNAP-PS5).OPTO 22•800-321-6786•1-951-695-3000••****************PAGE 3DATA SHEETForm 1537-221026LEDsError LED Operation. The #4 LED indicates an error on the CAN bus. Error codes include:To clear the error, you can use PAC Manager or PAC Control to read the CAN module configuration from the memory map. (For the memory map addresses required to access the error codes, see form 1465, OptoMMP Protocol Guide , Appendix A: SNAP-SCM-CAN2B Serial Module Configuration-Read/Write.)If your device has SNAP-SCM-CAN2B Firmware R2.0b or higher , the Error LED also illuminates when any bits are set in either the CAN bus error flags register or the CAN transport error flags register. For information on error flags, see form 2151, the CAN RX/TX Integration Kit for PAC Project Technical Note , “CAN Module Status Reply.”In addition to clearing the error by reading from the memory map, with firmware R2.0b, you can also clear the error by issuing an “S” command from the O22Can2BModuleCtrlStat subroutine (in the CAN Integration Kit for PAC Project ). For more information, see form 2151, the CAN RX/TX Integration Kit for PAC Project Technical Note, “PAC Control Sample Subroutines.”LED Type Indicates1CAN Bus ActivityCommunication activity with the CAN module. This LED illuminates while the mod-ule is being configured and when CAN data is received.2STATUS 2 blinks: SNAP-SCM-CAN2B firmware has started.5 blinks: firmware error 8 blinks: CAN module error 3POWER Power is applied to the module.4ERRORError on the CAN bus. (For details, see next section.)Error CodesDescription0Error—Active State. The SNAP-SCM-CAN2B has received less than 96 errors.-1Error—Active State. The SNAP-SCM-CAN2B has received 96 or more errors but less than 128 errors.-2Receiver Overflow. A CAN packet was dropped. This happens when theSNAP-SCM-CAN2B can't keep up with the traffic on the CAN bus. This means the internal buffer on the CAN2B module is full. This can happen if the strategy isn't reading the data fast enough, or too many serial modules are on the rack. To resolve it, you can:• Configure the Data Masks and Filters to receive fewer CAN packets.•Reduce the number of serial modules on the rack.•Increase how frequently the strategy reads the module.-3Error—Passive State. The SNAP-SCM-CAN2B has received 128 or more errors but less than 255 errors.PAGE 4OPTO 22•800-321-6786•1-951-695-3000••****************DATA SHEETForm 1537-221026DIMENSIONSPin 1OPTO 22 • SALES •****************SUPPORT •******************43044 Business Park Dr. Temecula, CA 92590-3614800-321-6786 • 1-951-695-3000800-835-6786 • 1-951-695-3080More about Opto 22Form 1335-220705PRODUCTSOpto 22 develops and manufactures reliable, easy-to-use, open standards-based hardware and software products. Industrial automation, process control, remote monitoring, data acquisition, and industrial internet of things (IIoT) applications worldwide all rely on Opto 22.groov RIO ®groov RIO edge I/O offers a single, compact, PoE-powered industrial package with web-based configuration and IIoT software built in, support for multiple OT and IT protocols, and security features like a device firewall, data encryption, and user account control.Standing alone, groov RIO connects to sensors, equipment, and legacy systems, collecting and securely publishing data from field to cloud. Choose a universal I/O model with thousands of possible field I/O configurations, with or without Ignition from Inductive Automation®, or a RIO EMU energy monitoring unit that reports 64 energy data values from 3-phase loads up to 600 VAC, Delta or Wye.You can also use groov RIO with a Modbus/TCP master or as remote I/O for a groov EPIC system.groov EPIC ® SystemOpto 22’s groov Edge Programmable Industrial Controller (EPIC) system gives you industrially hardened control with a flexible Linux®-based processor with gateway functions, guaranteed-for-life I/O, and software for your automation and IIoT applications.groov EPIC ProcessorThe heart of the system is the groov EPIC processor. It handles a wide range of digital, analog, and serial functions for data collection, remote monitoring, process control, and discrete and hybrid manufacturing.In addition, the EPIC provides secure data communications among physical assets, control systems, software applications, and online services, both on premises and in the cloud. No industrial PC needed.Configuring and troubleshooting I/O and networking is easier with the EPIC’s integrated high-resolution color touchscreen. Authorized users can manage the system locally on the touchscreen, on a monitor connected via the HDMI or USB ports, or on a PC or mobile device with a web browser.groov EPIC I/Ogroov I/O connects locally to sensors and equipment. Modules have a spring-clamp terminal strip, integrated wireway, swing-away cover, and LEDs indicating module health and discrete channel status. groov I/O is hot swappable, UL Hazardous Locations approved, and ATEX compliant.groov EPIC SoftwareThe groov EPIC processor comes ready to run the software you need:•Programming: Choose flowchart-based PAC Control, CODESYS Development System for IEC61131-3 compliantprograms, or secure shell access (SSH) to the Linux OS for custom applications •Node-RED for creating simple IIoT logic flows from pre-built nodes•Efficient MQTT data communications with string or Sparkplug data formats •Multiple OPC UA server options•HMI: groov View to build your own HMI viewable on touchscreen, PCs, and mobile devices; PAC Display for aWindows HMI; Node-RED dashboard UI•Ignition or Ignition Edge® from Inductive Automation (requires license purchase) with OPC-UA drivers to Allen-Bradley®,Siemens®, and other control systems, and MQTT communicationsOlder productsFrom solid state relays, to world-famous G4 and SNAP I/O, to SNAP PAC controllers, older Opto 22 products are still supported andworking hard at thousands of installations worldwide. You can count on us for the reliability and service you expect, now and in the future.QUALITYFounded in 1974, Opto 22 has established a worldwide reputation for high-quality products. All are made in the U.S.A. at our manufacturing facility in Temecula, California.Because we test each product twice before it leaves our factory rather than testing a sample of each batch, we can afford to guarantee most solid-state relays and optically isolated I/O modules for life.FREE PRODUCT SUPPORTOpto 22’s California-based Product Support Group offers freetechnical support for Opto 22 products from engineers with decades of training and experience. Support is available in English and Spanish by phone or email, Monday–Friday, 7a.m. to 5 p.m. PST.Support is always available on our website, including free online training at OptoU, how-to videos , user’s guides , the Opto 22 KnowledgeBase, and OptoForums .PURCHASING OPTO 22 PRODUCTSOpto 22 products are sold directly and through a worldwide network of distributors, partners, and system integrators. For more information, contact Opto 22 headquarters at 800-321-6786 (toll-free in the U.S. and Canada) or +1-951-695-3000, or visit our website at .。
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16.睡醒后觉得累
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鼻腔鼻窦结局测试22(SNOT-22)中文版
编号：姓名：性别：年龄：评分：
下面您将看到一系列鼻窦炎导致的症状以及社会或情绪方面的影响，我们想深入了解这些问题，请您尽自己最大的能力回答每一个问题。回答无所谓对与错，只有您才能为我们提供这种信息．您所有的回答，必须与自己的鼻窦炎有一定联系．请根据您最近2周经历的情况，对下列问题做出选择．谢谢您的参与．如有疑虑，请直接询问我们医务人员。
5
17疲倦
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18.工作效率下降
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19.注意力不集中
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20.沮丧、焦躁、易怒
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21.忧虑
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22.感觉不安或难堪
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总分
列出您认为最困扰的五项：
一、根据您问题发生的严重程度和无轻中重最频率大小．请在每个问题后面的数字上，对准困扰程度打钩．因为鼻窦炎，您…→
无任何困扰
很轻度的困扰
轻度的困扰
中度的困扰
重度的困扰
极重度的困扰
1.需要擤鼻涕
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2.打喷嚏
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3.流清鼻涕
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4.咳嗽
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5.鼻涕倒流（咽喉）
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