目的 了解行角膜胶原交联术患者围术期的体验感受,为角膜胶原交联术的顺利进行及术后康复提供参考依据。方法 采用目的抽样法,于2023年8月—2023年10月在中山大学中山眼科中心选取12例行角膜交联术的患者进行半结构式访谈,采取Colaizzi七步法进行整理分析资料。结果 通过分析得出患者在围手术期的5种感受：焦虑、疼痛、恐惧、紧张、盲目乐观。结论 分析角膜交联手术患者在围术期不同感受,做好围术期护理,希望有利于提高手术效果。

Objective To understand the perioperative experience of patients undergoing corneal collagen cross-linking surgery,and provide reference for the smooth progress of corneal collagen cross-linking surgery and postoperative rehabilitation．Methods Using purposive sampling method,12 patients who underwent corneal cross-linking surgery were selected from the Sun Yat-sen Ophthalmology Center of Sun Yat-sen University from August 2023 to October 2023 for semi-structured interviews．The data were analyzed using the Colaizzi seven step method．Results Through analysis,five feelings of patients during the perioperative period were identified：anxiety,pain,fear,tension and blind optimism．Conclusion sAnalyzing the different feelings of patients undergoing corneal cross-linking surgery during the perioperative period and providing good perioperative care can help achieve satisfactory results in the surgery．

慢性萎缩性胃炎是常见的胃癌前病变,不仅治疗过程漫长,治疗难度大,而且患者依从性欠佳。不仅会对患者的生理、心理健康和生活质量造成严重不良的影响,还会给患者家属造成负担,成为临床上不可忽视的难题。但是本病发病机制目前尚未完全明确,临床治疗还未达成共识。文章综述了近10年基于Hedgehog信号通路的中医药干预慢性萎缩性胃炎的研究概况。中医药调控Hedgehog信号通路辨证论治是治疗慢性萎缩性胃炎的一种独具特色的疗法,近年来有关基于Hedgehog信号通路的中医药干预治疗慢性萎缩性胃炎的报道越来越多。文章主要通过遵循疾病本虚标实的病性,以脾胃虚弱为本,瘀血、气滞、湿热、痰浊等为标,探讨选方治疗对慢性萎缩性胃炎的影响,认为中医药联合Hedgehog信号通路实行现代化发展能够有效干预治疗慢性萎缩性胃炎,以期为进一步临床研究与应用提供参考。

Chronic atrophic gastritis,a common precancerous lesion of gastric cancer,requires a long-term treatment and is difficult to cure．Therefore,it usually leads to decreased patient compliance．It will not only have a serious adverse impact on the patient’s physical and mental health and quality of life,but also cause a burden to the patient’s family,which has become a difficult problem that can not be ignored clinically．However,the pathogenesis has not yet been totally clarified,not to mention a consensus on the clinical treatment．This paper reviews the research revolving around Chinese medicine intervention in chronic atrophic gastritis based on the Hedgehog signaling pathway in the last decade．It’s creative therapy of chronic atrophic gastritis that utilizing Traditional Chinese Medicine to regulate and control Hedgehog signaling pathway,which has been increasingly reported in recent years．This paper is based on “deficiency in origin” and “excess in superficiality” principle．Concretely,spleen-stomach vacuity is characterized by deficiency in origin,and excess in superficiality manifests blood stasis,qi stagnation,dampness-heat and phlegm turbidity as excess in superficiality．By this way,the paper explores the effect of prescription selection on chronic atrophic gastritis．It is believed that the modern therapy that combines traditional Chinese medicine with Hedgehog signaling pathway can tackle chronic atrophic gastritis,thus providing a reference for further clinical trials and practices．

目的 探讨真武汤联合八段锦在老年冠状动脉粥样硬化性心脏病（冠心病）患者中的应用效果。方法 将96例75岁以上冠心病患者按照随机数字表法分为对照组与干预组,每组各48例。在12周的临床研究期间,对照组用规范的冠心病二级预防药物治疗;干预组在规范的冠心病二级预防药物治疗基础上,增加真武汤以及八段锦运动处方。结果 治疗后干预组中医临床疗效（P=0.023）和中医证候积分（P<0.001）均优于对照组。两组患者的心肺运动试验指标均有改善,且干预组在升高峰值摄氧量（Peak VO₂,P=0.005）、最大摄氧量（VO₂max,P=0.001）、氧脉搏（VO₂/HR,P=0.002）和无氧阈值时最大代谢当量（MET,P=0.001）,以及降低无氧阈值（AT,P<0.001）和二氧化碳通气当量（VE/VCO₂,P=0.020）方面比对照组更明显。两组患者在36项简明健康状态调查表（SF-36）评分的8个维度中评分均有所升高,其中在生理机能（P=0.001）、生理职能（P<0.001）、一般健康状况（P=0.018）、精力（P=0.007）、社会职能（P=0.010）、精神健康（P=0.004）方面,干预组效果优于对照组;而在躯体疼痛、情感职能维度改善方面,两组间结果相近,差异无统计学意义（P>0.05）。两组患者的匹兹堡睡眠质量指数（PSQI）均有所改善,且干预组效果优于对照组（P<0.001）。结论 真武汤联合八段锦能够进一步增强老年冠心病患者中医证候疗效,改善心肺运动试验Peak VO₂、VO₂max、VO₂/HR、MET、AT、VE/VCO₂等指标,并提高SF-36评分多个维度的生活质量及睡眠质量。

Objective To explore the therapeutic effects of Zhenwu Decoction combined with Baduanjin Qigong in older adults with coronary heart disease（CHD）．Methods Ninety-six patients with CHD aged ≥75 years were randomly divided into a treatment group and a control group,with 48 patients in each group．Within the 12-week period,the control group received standard secondary prevention therapy for CHD,while the treatment group received Zhenwu Decoction and Baduanjin Qigong prescription,in addition to the standard treatment．Results After treatment,both groups showed improvement in the traditional Chinese medicine（TCM）clinical efficacy,TCM syndrome,SF-36 scores and Pittsburgh Sleep Quality Index（PSQI）scores;increase in Peak VO₂,VO₂max,VO₂/HR,and metabolic equivalent（MET）;and decrease in AT and VE/VCO₂．However,the treatment group had a more pronounced improvement in the TCM clinical efficacy（P=0.023）,TCM syndrome（P<0.001）,PSQI scores（P<0.001）,and cardiopulmonary exercise testing（CPET）indicators including Peak VO₂（P=0.005）,VO₂max（P=0.001）,VO₂/HR（P=0.002）,MET（P=0.001）,AT（P<0.001）and VE/VCO₂（P=0.020）,compared to their control counterparts． For the SF-36 scores,in comparison to the control group,the treatment group presented better outcomes in enhancing physical functioning（P=0.001）,role limitations due to physical health（P<0.001）,general health（P=0.018）,vitality（P=0.007）,social functioning（P=0.010）and mental health（P=0.004）,but not in pain or role limitations due to emotional problems．Conclusions The Zhenwu Decoction combined with Baduanjin Qigong can enhance the TCM syndrome,improve various CPET indicators such as Peak VO₂、VO₂max、VO₂/HR、MET、AT and VE/VCO₂,and elevate both quality of life and sleep quality among older adults with CHD．

目的 调查护理人员对预防跌倒知识掌握的情况,以提高其对防跌倒相关知识的认知水平,减少住院患者跌倒的发生。方法 用自编住院患者跌倒相关知识掌握量表对护理人员进行问卷调查。结果 护理人员对跌倒知识的掌握正确率最高为跌倒分级64.04%、最低为跌倒后干预措施17.10%。外科护理人员对患者跌倒风险评估时机的把握为88.69%,妇儿科护理人员的正确率（71.11%）高（χ²=21.319,P=0.003）,住院患者发生跌倒后的处理正确率急诊为76.67%,高于门诊的42.67%（χ²=27.651,P<0.001）;在把握患者跌倒风险评估的时机方面工作年限<5年的护理人员为 89.81%,比工作年限>20年的护理人员（64.15%）更容易把握患者跌倒风险评估的时机（χ²=18.921,P<0.001）,工作年限11~20年的护理人员对住院患者预防跌倒的干预措施正确率为24.66%,比工作年限<5年的护理人员（11.46%）高（χ²=9.678,P=0.022）;工作年限>20年的护理人员对住院患者发生跌倒后的处理正确率为58.49%比工作年限<20年以下的护理人员（34.25%）高（χ²=12.787,P=0.005）。结论 护理人员跌倒预防相关知识掌握度总体较低,应加强对护理人员关于患者跌倒预防知识的系统培训,减少住院患者跌倒的发生。

Objective To investigate the mastery of falls prevention knowledge among nursing staffs,in order to improve their cognitive level of falls prevention related knowledge and reduce the occurrence of falls in hospitalized patients．Methods A questionnaire survey was conducted among nursing staffs with a self-designed questionnaire on the mastery of falls related knowledge among hospitalized patients．Results The highest accuracy rate of nursing staffs' mastery of falls knowledge was 64.04% for falling classification,and the lowest was 17.10% for falls intervention measures．Nursing staffs' accuracy of the timing of patient fall risk assessment was 88.69% in surgery,which was higher than 71.11% in nursing staff in obstetrics,gynecology,and pediatrics（χ²=21.319,P=0.003）．The accuracy of emergency treatment for hospitalized patients after falls was 76.67%,which was higher than 42.67% in outpatient treatment（χ²=27.651,P<0.001）．The accuracy of the timing of patient fall risk assessment in nursing staffs with less than 5 years of work experience was 89.81%,which was better than nursing staff with more than 20 years of work experience（64.15%）（χ²=18.921,P<0.001）．Nursing staff with 11-20 years of work experience had a correct intervention rate for preventing falls in hospitalized patients of 24.66%,which was higher than nursing staffs with less than 5 years of work experience（11.46%）（χ²=9.678,P=0.022）．The accuracy rate of handling falls in hospitalized patients by nursing staffs with more than 20 years of work experience was 58.49%,which was higher than that of nursing staff with less than 20 years of work experience,which is 34.25%（χ²=12.787,P=0.005）．Conclusions Overall,nursing staff had a low level of falls prevention knowledge,and systematic training on patient fall prevention should be strengthened to reduce the occurrence of falls in hospitalized patients．

目的 探讨多原发恶性肿瘤(MPMN)的临床特点,提高该类型肿瘤的认识,为临床诊断及治疗提供一定的经验。方法 分析2021年12月广州市第一人民医院呼吸与危重症学科二区收治的1例乳腺、甲状腺及肺三重多原发恶性肿瘤的临床特点及诊治经过,并结合相关文献进行回顾分析。结果 该例首患乳腺导管内癌并予手术切除,9年后再同时患肺癌及甲状腺癌,最终确诊为三重多原发恶性肿瘤。结论 通过对多原发恶性肿瘤的临床特点的分析研究,可一定程度提高临床医生对MPMN的认知以及早期临床鉴别的能力,亦为肿瘤患者早期诊断、早期治疗提供更好的时机,改善患者生活质量。

Objective To explore the clinical characteristics of multiple primary malignant neoplasms (MPMN), to improve the understanding of this type of tumors, and to provide some experience for clinical diagnosis and treatment. Methods The clinical characteristics, diagnosis and treatment of a case with triple MPMN of breast, thyroid and lung treated in the Respiratory and Critical Care Department (Area 2) of Guangzhou First People's Hospital in December 2021 were analyzed retrospectively. Results The breast intraductal carcinoma was the first tumor of that case and had been resected, and 9 years later, lung cancer and thyroid cancer occured at the same time, which were diagnosed as triple MPMN. Conclusions The analysis and study of the clinical characteristics of MPMN can improve the clinicians' cognition and the ability of early clinical differentiation, and provide a better opportunity for early diagnosis and early treatment of tumor patients, and improve their quality of life.

目的 比较早产胎膜早破(PPROM)≥34周的肥胖孕妇与非肥胖孕妇的早产儿住院结局。方法 回顾性分析2016年1月—2020年12月在本院出生并入住新生儿科的所有出生胎龄≥34周的PPROM早产儿。根据孕妇分娩时体质量指数(BMI),分为肥胖组(BMI≥30 kg/m²)和非肥胖组(BMI＜30 kg/m²),比较2组间的一般情况、妊娠结局及所生晚期早产儿的住院结局,组间比较采用两独立样本t检验及χ²检验。结果 与非肥胖孕妇相比,肥胖孕妇的晚期早产儿分娩后呼吸道并发症发病率高,主要表现为新生儿呼吸窘迫综合征,辅助通气、吸氧和表面活性物质的使用、败血症、感染性肺炎发病率高,母亲妊娠期糖尿病发病率增高,差异均具有统计学意义(P＜0.05),其余新生儿高胆红素血症、新生儿坏死性小肠结肠炎、脑室内出血、早产儿支气管肺发育不良等并发症比较无统计学意义(P＞0.05)。结论 PPROM≥34周的肥胖孕妇与非肥胖孕妇相比,所生晚期早产儿呼吸道并发症和败血症等不良结局的发生率增加。

Objective To compare the hospitalization outcomes of 34 weeks or over preterm infants with preterm premature rupture of membranes (PPROM) in obese and non-obese pregnant women. Methods A retrospective analysis of PPROM preterm infants born in our hospital and admitted to the neonatology department from January 2016 to December 2020 with a gestational age of 34 weeks or over was carried out. According to the pregnant women's body mass index (BMI) at delivery, they were divided into obese group (BMI≥30 kg/m²) and non-obese group (BMI<30 kg/m²). The general conditions, pregnancy outcomes and late premature infants hospitalization outcomes between the two groups were compared using two independent samples t test and χ² test. Results Compared with non-obese pregnant women, the incidence of respiratory complications after delivery in late preterm infants of obese pregnant women was higher, mainly manifested as high incidence of neonatal respiratory distress syndrome, assisted ventilation, oxygen inhalation and the use of surfactants, sepsis, and pneumonia, also maternal gestational diabetes incidence was increased, and the differences were statistically significant (P<0.05); other complications of neonatal hyperbilirubinemia, necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia were not statistically significant (P>0.05). Conclusions Compared with non-obese pregnant women with 34 weeks or over PPROM, obese pregnant women had an increased incidence of adverse outcomes in late preterm infants such as respiratory complications and sepsis.

目的 了解并分析白云区不同年龄段男性精液质量现状。方法 选取2020年1月—2021年12月在我中心就诊的已婚孕前体检男性为研究对象,开展常规精液检测,采集精液标本进行分析。结果 白云区育龄男性精液各项指标均在正常范围仅有3 176例（占比57.52%）,随年龄的增加,精液指标总活力、存活率和精子前向运动指标逐渐降低（P<0.05）。结论 26~30岁年龄段男性的精液质量各项指标正常率较其他年龄组更好（P<0.05）,是男性生育的黄金年龄。

Objective To understand and analyze the status of semen quality in men of different ages in Baiyun District of Guangzhou. Methods From January 2020 to December 2021,married men who received pre-pregnant physical examination in our center were selected as the research subjects．Routine semen testing was conducted,and samples were collected for semen analysis. Results Only 3176 cases（57.52%）of male semen data of childbearing age in Baiyun District were within the normal range．With the increase of age,total semen motility,survival rate and sperm forward motility decreased gradually（P < 0.05）. Conclusions Men in the age group of 26-30 years had higher normal rates of all indicators of semen quality than other age groups（P < 0.05）,which is the golden age of male fertility.

目的 探讨医院消毒供应中心清洗全程质量控制用于院内感染风险预防价值。方法 选取2019年1月—2021年6月期间医院消毒供应中心待清洗消毒的1 000件手术器械（观察组）,采用全程质量控制;另选取1 000件手术器械（对照组）,常规流程清洗;比较2组患者器械清洗质量,统计清洗后因术中器械的院内感染率。结果 观察组清洗消毒后器械血渍、污垢、锈斑总发生率0.20%,低于对照组的1.50%,器械清洗、消毒、灭菌合格率高于对照组（P<0.05）。观察组器械操作流程与标准、科室管理、安全管理、综合质量管理高于对照组,院内感染率0.10%低于对照组的1.00%,医护人员满意度95.00%高于对照组的75.00%（P<0.05）。结论 医院消毒供应中心清洗质量控制,可增加手术器械清洗质量,减少院内感染的发生。

Objective To explore the value of whole process cleaning quality control in hospital disinfection supply center for risk prevention of hospital infection．Methods From January 2019 to June 2021,1000 surgical instruments to be cleaned and disinfected in the hospital disinfection supply center（observation group）were selected,and the whole process quality control was applied;another 1000 surgical instruments（control group）were selected for routine cleaning．The quality of instrument cleaning in the two groups was compared,and the hospital infection rate after the application of cleaned instrument was calculated．Results After cleaning and disinfecting instruments,the total incidence of blood stains,dirt and rust was 0.20% in the observation group,lower than that in the control group,which was 1.50%,and the qualified rate of instrument cleaning,disinfecting and sterilizing was higher than that in the control group（P<0.05）．The equipment operation procedures and standards,department management,safety management,and comprehensive quality management of the observation group were higher than those of the control group,the hospital infection rate was 0.10%,lower than that of the control group（1.00%）,and the satisfaction rate of medical staff was 95.00% in the observation group,higher than that of the control group（75.00%,P<0.05）．Conclusions The cleaning quality control of hospital disinfection supply center can improve the cleaning quality of surgical instruments and reduce the occurrence of hospital infection.

目的 利用品管圈工具提高某三甲医院住院病案首页主要诊断编码正确率。方法 成立品管圈小组,选取2022年11月出院日期前200份住院病案首页作为开展品管圈前的对照组,按照出院科室分层抽取2021年8月1日—2022年3月31日的2 007份首页作为开展品管圈后的研究对象,对上述首页的主要诊断填写及疾病分类编码进行核对、检查、汇总统计。针对主要诊断编码错误率高的现象,从人、法、测3个维度进行分析,根据找出的原因制定对策并执行。根据具体情况使用χ²检验或者四格表资料的Fisher确切概率法检验比较品管圈前后主要诊断编码正确、错误份数的差异。结果 开展一系列改进措施后医生主要诊断填写正确率从95.00%上升到98.01%,编码员主要诊断编码正确率从97.50%上升至99.55%,住院病案首页主要诊断编码正确率从93.50%提高到97.56%,临床医师的书写质量、编码员的编码质量均有改善。品管圈开展前后主要诊断编码正确、错误份数差异有统计学意义。通过开展品管圈,标准化了一个院级规范、多个院级编码共识、两个科级工作工具和机制以及一个科级绩效分配方案。结论 品管圈质量改进工具能有效提高病案首页主要诊断编码正确率,后期应持续开展。

Objective To improve the accuracy of main diagnostic codes on the home page of inpatient medical records in a Class III Grade A Hospital by using the quality control circle．Methods The Medical Record Department set up a quality control circle group．A total of 200 inpatient medical records' home pages were selected as the control group before the quality control circle carried out,which patients were discharged in November 2022．Home pages of 2 007 inpatient medical records from August 1,2021 to March 31,2022 were selected according the discharge department as the research objects after the quality control circle carried out．The main diagnosis filling and disease classification codes on those home pages of the above medical records were checked and summarized．We analyzed the reason of the high error rate of the main diagnostic codes from three dimensions of people,law and test．Countermeasures were formulated and implemented according to the identified causes．Fisher exact probability method of four grid data or χ² test were used to compare the correct copies of main diagnostic codes before and after the quality control circle according to the specific situation．Results The writing quality of clinicians and the coding quality of coders were improved after a series of improvement measures were carried out．The correct rate of doctors' main diagnostic codes increased from 95.00% to 98.01%,the correct rate of coders' main diagnostic codes increased from 97.50% to 99.55%,and the correct rate of main diagnostic codes on the home page of inpatient medical records increased from 93.50% to 97.56%．The number of correct copies of main diagnostic codes before and after the development of the quality control circle was statistically significant．Through the development of the quality control circle,one institute level specification,multiple institute level coding consensus,two department level work tools and mechanisms,and one department level performance allocation scheme have been standardized．Conclusions The application of the quality control circle tool can effectively improve the accuracy of the main diagnostic codes on the home page of the inpatient medical record,which should be continued in the later period．

目的 探讨度普利尤单抗对瘙痒性皮肤病的效果及对嗜酸粒细胞（EOS）恢复和生活质量的影响。方法 选取2021年2月—2022年1月期间,我院收治的瘙痒性皮肤病患者96例。根据治疗方式不同分为对照组（48例）和观察组（48例）。对照组给予传统激素治疗,观察组给予度普利尤单抗治疗。比较治疗前后2组血清炎症因子、免疫球蛋白水平情况;比较治疗前后2组症状积分下降指数（SSRI 评分）、神经激肽/速激肽受体1（NK1R）及EOS情况。观察2组疗效情况。采用皮肤病生活质量问卷（DLQI）对2组生活质量进行评价,并观察2组复发率情况。结果 治疗后,2组血清IFN-γ（干扰素-γ）、IL-2（白介素2）、IgA、IgG、IgM、NK1R、EOS水平升高,IL-4、IL-13、IgE水平及SSRI 评分降低,且观察组更明显（P<0.05）。观察组治疗有效率高于对照组（P<0.05）。随访6个月,观察组DLQI评分及复发率低于对照组（P<0.05）。结论 度普利尤单抗可减轻瘙痒性皮肤病患者瘙痒症状,增强机体防御力,促进嗜酸粒细胞恢复,提高其生活质量,值得临床推广应用。

Objective To investigate the effect of Dupilumab on pruritic dermatosis,eosinophil（EOS）recovery and quality of life．Methods From February 2021 to January 2022,96 patients with pruritic dermatosis were selected．According to different treatment methods,they were divided into control group（48 cases）and observation group（48 cases）．The control group was treated with traditional hormone,and the observation group was treated with Dupilumab．The levels of serum inflammatory factors and immunoglobulin in the two groups were compared before and after treatment．The symptom score reduce index（SSRI score）,neurokinin/tachykinin receptor 1（NK1R）and EOS were compared between the two groups before and after treatment．The curative effect of the two groups was observed．The quality of life of the two groups was evaluated with Dermatology Quality of Life Questionnaire（DLQI）,and the recurrence rate of the two groups was observed．Results After treatment,levels of serum IFN-γ,IL-2,IgA,IgG,IgM,NK1R and EOS of two groups increased,while the levels of IL-4,IL-13,IgE and SSRI scores decreased,especially in the observation group（P<0.05）．The effective rate of the observation group was higher than that of the control group（P<0.05）．The DLQI score and recurrence rate in the observation group were lower than those in the control group（P<0.05）in 6 months follow-up．Conclusions Dupilumab can alleviate the itching symptoms of patients with pruritic dermatosis,enhance the body's defense,promote eosinophil recovery,and improve their quality of life,which is worthy of clinical application．