目的 促进医学生化检验课程理论与实验的结合，提高学生学习实验兴趣，增强学生临床对话的能力。 方法 通过创建问题情景和病例，在医学检验专业本科班中应用以问题为导向教学法（PBL），结合病例教学方法进行临床生化检验实验教学改革。 结果 问卷调查显示，学生在教学内容掌握、学习的主动性、综合分析能力、创新能力、团队协作等方面均得到明显提高。92.6%的学生认为PBL结合病例教学法优于传统实验教学法。 结论 PBL结合病例教学法值得在生化检验实验教学中加以推广。
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.