目的 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系, 并应用于临床,为急诊脑出血患者护理质量管理、监测与评价提供客观、科学的参考依据。方法 通过文献查阅、筛查与评价, 提取可行性资料, 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系的框架, 并采用德尔菲法完成两轮专家函询,确定最终的指标体系。选择2021年1月—2024年1月本院收治的230例急诊脑出血患者为研究对象, 将2021年1月—2022年6月作为干预前监测节点,该阶段的165例患者为传统组, 实施常规的护理质量管理;将2022年7月—2024年1月作为干预后监测节点,该阶段的165例患者为观察组, 实施以急诊脑出血患者护理质量评价指标进行护理质量监测管理。结果 两轮函询中专家积极系数分别为95%和100%, 意见提出率分别为56.25%和35.54%; 两轮函询专家权威系数为0.945、0.893; 第1轮函询中各项指标变异系数（CV）均值为0~0.136, Kendall’s W协调系数为0.065; 第2轮函询中变异系数（CV）均值为0~0.110, Kendall’s W协调系数为0.186。最终形成的急诊脑出血患者护理质量评价体系共涵盖一级指标3个、二级指标11个、三级指标55个。观察组入院-用药时间合格率、吞咽障碍患者动态评估率、气道管理合格率、早期被动/主动活动落实率高于传统组,差异具有统计学意义（χ²=14.850、12.261、8.183、37.420, P<0.05）, 观察组患者满意度明显高于传统组（χ²=14.049, P<0.001）。结论 本研究构建的急诊脑出血患者护理质量评价体系具有一定的科学性、可靠性和实用性, 可作为临床实现护理质量持续改进的重要评价工具。

Objective Based on the Donabedian model,the nursing quality evaluation system of emergency cerebral hemorrhage patients was constructed, and applied to clinical practice, providing an objective and scientific reference basis for realizing the nursing quality management, monitoring and evaluation of emergency cerebral hemorrhage patients．Methods Through literature review, screening and evaluation, the feasibility data was extracted, and the framework of the nursing quality evaluation system for patients with emergency cerebral hemorrhage was constructed based on the Donabedian model, and the Delphi method was adopted to complete two rounds of expert letter inquiry to determine the final index system．The study selected 230 patients with acute cerebral hemorrhage admitted to our hospital from January 2021 to January 2024 as the research subjects．The period from January 2021 to June 2022 was used as the pre-intervention monitoring period, during which 165 patients were in the traditional group, receiving routine nursing quality management．The period from July 2022 to January 2024 was used as the post-intervention monitoring period, during which 165 patients were in the observation group,implementing nursing quality monitoring and management based on evaluation indicators for the care of patients with acute cerebral hemorrhage．Results In the two rounds of letter inquiry, the positive coefficient of experts was 95% and 100%, respectively, and the rate of suggestions was 56.25% and 35.54%, respectively; the authority coefficient of experts in the two rounds of letter inquiry was 0.945 and 0.893．In the first round the mean value of coefficient of variation（CV）of each index was 0~0.136, and the coordination coefficient of Kendall’s W was 0.065; in the second round the mean value of variation coefficient（CV）was 0-0.110, and the coordination coefficient of Kendall's W was 0.186．The final nursing quality evaluation system for emergency cerebral hemorrhage patients covers 11 first-level indicators, 11 second-level indicators and 55 third-level indicators．The results showed that the pass rate of admission-medication time, dynamic assessment rate of dysphagia patients, airway management rate, and early passive / active activity implementation rate of the observation group were statistically significant different from those in the traditional group（χ²=14.850,12.261, 8.183, 37.420, P<0.05）, and the patient satisfaction in the observation group was significantly higher than that in the traditional group（χ²=14.049, P<0.001）．Conclusions The nursing quality evaluation system for emergency cerebral hemorrhage patients constructed in this study is scientific,reliable and practical, and can be used as an important evaluation tool to achieve continuous improvement of nursing quality in clinical practice．

目的 探讨与分析全面护理联合细节干预在创伤骨科手术质量及康复中应用价值。方法 选择2022年1月—2023年1月在福建省立医院骨科进行创伤骨科手术患者120例为研究对象,用随机数字表法分组,分为常规组、联合组,各纳入60例患者。前者进行常规护理,后者在前者基础上开展全面护理联合细节干预,对两组患者术后恢复情况进行观察比较。结果 在围术期指标方面,联合组手术时间、术中出血量、术后首次下床活动时间、术后住院时间与常规组相比减少（P<0.05）。联合组术后1 d、术后3 d、术后7 d、术后14 d的疼痛VAS评分与常规组相比减少（P<0.05）。联合组术后14 d的护理总满意度为100.00%,常规组为83.33%,联合组与常规组相比明显提高（P<0.05）。联合组术后14 d的社会关系、心理关系、生理关系等生活质量评分均高于常规组（P<0.05）。结论 全面护理联合细节干预在创伤骨科手术患者的应用促进患者康复,能持续缓解患者的疼痛状况,提高患者的护理满意度与生活质量。

Objective To explore and analyze the application value of comprehensive nursing combined with detailed intervention in the quality and rehabilitation of orthopedic trauma surgery．Methods From January 2022 to January 2023,120 cases of patients who underwent trauma orthopedic surgery in the Department of Orthopedic Surgery of Fujian Provincial Hospital were selected as the research subjects．And the randomized numerical table method was taken to operate in groups,which were divided into the conventional group and the combined group,and 60 patients were included in each group．The former group recieved conventional nursing care,and the latter group recieved comprehensive nursing care combined with detail intervention on its basis to observe and compare the postoperative recovery of patients in the two groups．Results In terms of perioperative indicators,the operation time,intraoperative bleeding,time to first postoperative bed movement and postoperative hospitalization time were significantly reduced in the combined group compared with the conventional group（P<0.05）．The pain VAS scores of the combination group were significantly reduced compared to the conventional group at 1 day,3 days,7 days and 14 days after surgery（P<0.05）．The total satisfaction rate of postoperative care in the combination group at 14 days was 100.00%,while in the conventional group it was 83.33%．The combination group showed there were significant improvements compared to the conventional group（P<0.05）．The social,psychological and physiological quality of life scores of the combination group were significantly higher than those of the conventional group 14 days after surgery（P<0.05）．Conclusions The application of comprehensive nursing combined with detailed intervention in orthopedic trauma surgery patients can promote their recovery,continuously alleviate their pain status and improve their nursing satisfaction and quality of life．

目的 运用数据挖掘的方法检测奥马珠单抗上市后的不良反应信号,为临床安全合理用药提供参考。方法 本研究采用报告比值比法（ROR）和贝叶斯判别可信区间递进神经网络法（BCPNN）对美国FDA不良事件报告系统（FAERS）中2004年第1季度至2023年第2季度的奥马珠单抗相关不良事件（ADE）报告进行数据挖掘和信号检测。结果 通过数据挖掘和信号检测,涉及奥马珠单抗的ADE报告中提取了186,353份报告,涉及45,383例患者。在这些报告中,女性（65.31%）比例远高于男性（24.97%）。主要报告国家为美国（64.93%）和加拿大（11.96%）。报告者中以消费者（41.35%）和医师（36.97%）为主要群体。研究发现了621个ADE阳性信号,涉及25个系统器官分类（SOC）,主要包括呼吸系统、胸部和纵隔疾病（21.29%）以及感染和侵染类疾病（10.91%）。其中,183个信号被评定为高风险信号,其中包括57个新的高风险信号,如血压升高、易醒型失眠和心律失常等。这些发现有助于更全面地了解奥马珠单抗的安全性和潜在风险。结论 在奥马珠单抗的临床应用过程中,除了要注意药品说明中提到的已知不良反应外,还需特别警惕潜在的不良药物事件,如血压升高、心率升高、中间易醒型失眠、体位性心动过速综合征等。

Objective To use data mining method to detect the adverse reaction signal of omalizumab after marketing,and to provide reference for clinical safety and rational drug use．Methods In this study,the report odds ratio method（ROR）and Bayesian confidence propagation neural network（BCPNN）were used to conduct data mining and signal detection for omalizumab-related adverse event（ADE）reports from the FDA Adverse Event Reporting System（FAERS）from the first quarter of 2004 to the second quarter of 2023．Results Through data mining and signal detection,186,353 reports of ADE involving omalizumab were extracted,involving 45,383 patients．Among these reports,the proportion of women（65.31%）was much higher than that of men（24.97%）．The main reporting countries were the United States（64.93%）and Canada（11.96%）．consumers（41.35%）and doctors（36.97%）were the main groups of reporters．The study identified 621 ADE positive signals across 25 system organ classes（SOCs）,including respiratory,chest,and mediastinal diseases（21.29%）and infectious and infectious diseases（10.91%）．Of these,183 signals were assessed as high risk,including 57 new high-risk signals．These findings contribute to a more complete understanding of the safety and potential risks of omalizumab．Conclusions In the clinical application of omalizumab,in addition to the known adverse reactions mentioned in the drug description,special attention should be paid to potential adverse drug events,such as elevated blood pressure,elevated heart rate,intermediate insomnia,and postatic tachycardia syndrome．

目的 分析广州某三甲医院脑梗死患者住院费用的变化以及影响因素,为有效减轻患者疾病经济负担提供参考依据。方法 提取广州某三甲医院2015—2022年出院诊断ICD-10前三位编码为I63的病案首页数据,并采用IBM SPSS 20.0软件对费用结构进行描述性统计分析,以多重线性回归分析患者住院费用的影响因素。结果 2015—2022年脑梗死患者的平均住院费用年均增长率为2.86%;费用结构以药品费为主,占比逐年下降,至2022年占比为27.74%,技术劳务性费用占比逐年增加,至2022年占比为47.41%;住院费用主要受医院感染情况、住院天数以及支付方式等因素影响（F=990.10,P<0.001）。结论 脑梗死患者的住院费用结构显著优化,但患者的疾病经济负担仍然较重,且费用受多种因素的综合影响。建议通过提高医疗质量与服务效能,并严格落实临床路径管理,减少不必要的检查以及耗材使用,以期最大程度地减轻患者的负担。

Objective To analyze the structural changes and influencing factors of the hospitalization expenses for patients with cerebral infarction in a tertiary general hospital in Guangzhou,and provide a scientific basis for reducing economic burden of the patients．Methods The front page data of medical records with the main diagnosis of I63 were collected in the sample hospital．Descriptive statistics analysis of hospitalization expenses structure and multiple linear regression analysis of the influencing factors were carried out by SPSS 20.0．Results The annual growth rate of average hospitalization expenses of cerebral infarction patients from 2015 to 2022 in the sample hospital was 2.86% per year．The highest proportion of hospitalization expenses was medicine fee,the proportion of which declined year by year with a minimum 27.74% in 2022．The proportion of technical labor costs accelerated year by year with a maximum 47.41% in 2022．This study revealed the main factors influencing hospitalization expenses were hospital internal infection or not,length of stay,payment method and so on（F=990.10,P<0.001）．Conclusions The structure of hospitalization expenses for cerebral infarction patients was significantly optimized,but the economic burden of patients was still heavy affected by a combination of factors．In order to minimize the burden of patients,hospitals should improve medical quality and service efficiency and implement clinical pathway management strictly,to reduce unnecessary inspections and consumables．

目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组（n=53）与对照组（n=53）。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表（WHOQOL-100）及癌因性疲乏程度（PFS）,最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表（VAS）评分、术后住院时间均优于对照组（P<0.05）;观察组并发症发生率低于对照组（P<0.05）;干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组（P<0.05）;观察组护理满意度高于对照组（P<0.05）。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。

Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection．Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group（n=53）and a control group（n=53）using a random number table method．All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care．The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared．Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale（VAS）score and postoperative hospital stay compared to the control group（P<0.05）．The incidence of complications in the observation group was lower than that in the control group（P<0.05）．After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group．The PFS score decreased,and the observation group was lower than the control group（P<0.05）．The nursing satisfaction of the observation group was significantly higher than that of the control group（P<0.05）．Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction．

全膝关节置换术（TKA）是目前治疗终末期膝关节疾病的首选方法,它能够缓解疼痛、改善畸形、恢复力线、增加膝关节活动度及提高患者生活质量。目前,关于胫骨假体旋转对线的方法很多,主要包括胫骨结节、胫骨前后轴、胫骨前皮质、自我形合技术、计算机辅助导航技术、个性化截骨技术等,它们各有优缺点,但在临床上并没有达成共识。该文主要对胫骨近端的解剖学特点和TKA中胫骨假体旋转定位的方法等方面进行综述。旨在为临床骨科医生在行TKA时,选择合适的胫骨假体旋转对线方法提供一些参考。

Total knee replacement（TKA） is currently the preferred treatment for end-stage knee disease,and it can relieve pain,improve deformity,restore strength lines,increase knee range of motion,and improve patients’ quality of life．At present,there are many methods for the rotation of alignment of tibial prosthesis,mainly including tibial tubercles,tibial anteroposterior axes,anterior tibial cortex,self-morphing technology,computer-aided navigation technology,personalized osteotomy technology,etc．Each of the methods above has its advantages and disadvantages,but there is no clinical consensus at present．This article mainly reviews the anatomical characteristics of the proximal tibia and the method of rotational positioning of tibial prosthesis in TKA,which aims to provide some reference for clinical orthopedic surgeons to select the appropriate tibial prosthesis rotation alignment method when performing TKA．

1994年中国引进患者自控镇痛（PCA）,经过国人改造升级如今已取得了令人瞩目的成绩：2007年《术后患者自控镇痛临床研究与推广应用》获教育部科学技术进步奖二等奖和中华医学科技奖三等奖;2011年具有中国自主专利产权和创新数字医疗的智能化患者自控镇痛（Ai-PCA）诞生,2019年《智能化术后患者自控镇痛管理关键技术及其临床应用》获得中国抗癌协会科技奖二等奖;2023年《中国分娩镇痛规范及推广应用》获得华夏医学科技奖二等奖。笔者撰写述评,提出努力推进Ai-PCA高水平高质量发展的措施,呼吁国内学者重视引领数智镇痛医疗规范化,于2024年在《中华疼痛学杂志》刊出由余守章教授牵头制定的《患者自控镇痛临床应用规范专家共识》,助力中国数智镇痛医疗技术向智慧化前行,为人民群众切实享受到舒适镇痛提供更优质的服务。

Since the introduction of Patient-Controlled Analgesia（PCA）in China in 1994,the domain has witnessed its substantial advancements．The project,Clinical Research and Promotion of Postoperative Patient-Controlled Analgesia,achieved the Ministry of Education’s Second Prize for Scientific and Technological Progress and the Chinese Medical Association’s Third Prize in 2007．The innovation continued in 2011 with the development of an intelligent PCA system（Ai-PCA）endowed with Chinese independent patent rights and innovative digital medical technology．In 2019,the Key Technologies and Clinical Application of Intelligent Postoperative Patient-Controlled Analgesia Management was honored with the second-class Science and Technology Award by the Chinese Anti-Cancer Association．Furthering this trend．In 2023,the Standards and Promotion of Labor Analgesia in China secured the second-class prize in Medical Science and Technology from Huaxia Medical Science and Technology．This commentary suggest strategies for the qualitative enhancement of Ai-PCA and urge domestic scholars to spearhead the standardization of Ai-PCA．Expert Consensus on Clinical Application Standards for Patient-Controlled Analgesia leaded and edited by Pro．She has published,in 2024,which fervently supports the advancement of China’s Ai-PCA technology towards a more intelligent future,to provide the public with higher quality and more comfortable pain management services．

Wnt/β-catenin信号通路是一种在胚胎发育,细胞增殖分化、迁移,干细胞更新等中起关键作用的蛋白质家族。Wnt/β-catenin信号通路的失调常常会导致各种严重的疾病,例如肿瘤、心脏疾病、肺部疾病、肝脏疾病、骨骼疾病、神经疾病等。大量研究表明,Wnt/β-catenin信号通路在心肌纤维化发病机制中起重要作用,本文结合最新研究成果,从心肌纤维化相关疾病的角度对Wnt/β-catenin通路进行综述,为预防心肌纤维化提供新的思路,进一步达到防治心血管疾病的目的。

The Wnt/β-catenin signaling pathway is a family of proteins that play a key role in embryonic development,cell proliferation and differentiation,migration,stem cell renewal,etc．Dysfunctions of Wnt/β-catenin signaling pathway often lead to various serious diseases,such as tumor,heart,lung,liver,bone and neurological diseases,etc．Numerous studies have shown that the Wnt/β-catenin signaling pathway plays an important role in the pathogenesis of cardiac fibrosis．This article,in combination with the latest research findings,presents a review of the Wnt/β-catenin pathway from the perspective of myocardial fibrosis-related diseases,in order to provide new ideas for preventing myocardial fibrosis and achieving the goal of combating cardiovascular disease．

如何降低急性胰腺炎的病死率是一项意义重大的课题。日本2021版诊疗指南提出了对急性胰腺炎患者的“集束化管理措施”,在此指导下,日本急性胰腺炎总体病死率下降至2.6%,重症急性胰腺炎病死率下降至6.1%,远低于全球各国报道的病死率。本文对该指南之诊疗方案进行分析,并与我国现行指南进行对比,以期对AP患者的临床诊治提供指导意义,并期待日后有更多更深入的该领域相关研究。

It is a significant problem that how to reduce the mortality rate of acute pancreatitis．However,under the guidance of the Pancreatitis Bundles from the 2021 Edition of the Japanese Guidelines for Acute Pancreatitis of patients with acute pancreatitis,the overall fatality rate of acute pancreatitis in Japan has decreased to 2.6%,and the fatality rate of severe acute pancreatitis has decreased to 6.1%,which is much lower than the fatality rate reported around the world．We analyze the diagnosis and treatment methods of this guideline and compare it with the current guideline in China,in order to have more relevant studies in the future．

目的 探讨多学科整合护理路径联合手术室优质护理对下肢骨折的应用效果及对术后下肢静脉血栓发生率的影响。方法 选择2021年1月—2022年10月我院收治的70例下肢骨折患者,随机分为联合组与常规组,每组各35例。常规组患者实施常规护理,联合组患者实施多学科整合护理路径联合手术室优质护理,对比两组患者护理效果。结果 联合组患者首次下床活动时间、术后视觉模拟量表（VAS）评分低于常规组（P<0.05）,二者住院时间以及引流管拔除时间比较差异无统计学意义（P>0.05）;经过护理干预后,两组的凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）均延长,血浆纤维蛋白原（FIB）降低,联合组优于常规组（P<0.05）,且联合组下肢静脉血栓发生率低于常规组（0% vs 17.14%,P<0.05）;联合组患者护理满意度更高（P<0.05）;术后1个月两组患者日常生活活动能力（ADL）评分、Fugl-Meyer评分均升高,联合组高于常规组（P<0.05）。结论 多学科整合护理路径联合手术室优质护理可改善下肢骨折患者围术期指标和血液高凝状态,降低患者下肢静脉血栓发生率,提升护理满意度及患者远期日常生活能力、肢体运动功能。

Objective To explore the application effect of multidisciplinary integrated nursing path combined with high-quality nursing in operating room on patients with lower limb fracture and the effect on postoperative lower limb venous thrombosis．Methods From January 2021 to October 2022,70 patients with lower limb fracture admitted to our hospital were randomly divided into combination group and conventional group,with 35 cases in each group．Patients in the conventional group received routine nursing,and patients in the combined group received multidisciplinary integrated nursing path combined with high-quality nursing in the operating room．The nursing effect of the two groups was compared．Results The first time of getting out of bed in the combined group was earlier and postoperative VAS score was lower than those in the conventional group（P<0.05）,and the length of hospital stay and drainage tube removal time were not significantly different between the two groups（P>0.05）．After nursing intervention,the prothrombin time（PT）and activated partial thromboplastin time（APTT）of the two groups were prolonged,and the plasma fibrinogen（FIB）decreased,and the change range of the combined group was greater（P<0.05）．The incidence of venous thrombosis in the combined group was significantly lower than that in the conventional group（0.00% vs 17.14%,P<0.05）．The nursing satisfaction of patients in combination group was higher（P<0.05）．The activities of daily living score and Fugl-Meyer score of both groups increased one month after surgery,and the combined group was higher than the conventional group（P<0.05）．Conclusions Multidisciplinary integrated nursing path combined with high-quality nursing in operating room can improve perioperative indicators and blood hypercoagulability of patients with lower limb fractures,reduce the incidence of lower limb venous thrombosis,improve nursing satisfaction,long-term daily living ability and limb motor function of patients．