目的 促進醫學生化檢驗課程理論與實驗的結合，提高學生學習實驗興趣，增強學生臨床對話的能力。 方法 通過創建問題情景和病例，在醫學檢驗專業本科班中應用以問題為導向教學法（PBL），結合病例教學方法進行臨床生化檢驗實驗教學改革。 結果 問卷調查顯示，學生在教學內容掌握、學習的主動性、綜合分析能力、創新能力、團隊協作等方面均得到明顯提高。92.6%的學生認為PBL結合病例教學法優于傳統實驗教學法。 結論 PBL結合病例教學法值得在生化檢驗實驗教學中加以推廣。
ObjectiveTo investigate the therapeutic effect, safety and effectiveness of multiple valvular surgery through right anterolateral intercostal thoracotomy, as well as the mid-term follow-up results and surgeon's learning curve.MethodsThe clinical data of 154 patients with multiple valvular disease were performed minimally invasive cardiac surgery in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University, from 2015 to 2019 were retrospectively analyzed. There were 103 males and 51 females, aged 23-68 years. Closed cardiopulmonary bypass was established through femoral artery and femoral vein, and the thoracic cavity was entered through a 6 cm transverse incision in the fourth intercostal space on the right side of sternum. Baseline and perioperative characteristics and postoperative outcomes were reviewed.ResultsThere was no perioperative death. The average cardiopulmonary bypass time was 159.3±39.4 min, and the aortic clamping time was 102.3±20.3 min. One patient underwent thoracotomy during the operation, and two patients underwent second thoracotomy for hemostasis. During the follow-up period of 10-55 months, 1 patient died, 2 patients developed mild perivalvular regurgitation, 6 patients developed moderate tricuspid regurgitation, and no serious cardiovascular events occurred in the rest of the patients.ConclusionOur findings demonstrate that multiple valvular surgery through right anterolateral intercostal thoracotomy is safe, and in an acceptable risk of complication. The early and middle follow-up results are satisfactory. The minimally invasive cardiac surgery can also meet the requirements of cosmetology, and is conducive to the recovery of patients' mental and physical health. This method is worthy of application in medical centers with rich experience in routine cardiac surgery.