在“健康中国2030”战略框架下，医工融合已成为推动医疗技术创新与复合型医学人才培养的关键路径。“三维协同”教育体系：课程维度打造“基础模块—交叉课程—项目实训”渐进式矩阵；实践维度建立校企共建实验室与临床转化基地的产教融合平台；师资维度创新“临床医师+工程师+科研导师”三师型导师协同机制。基于广州医科大学等高校的实证分析，该模式显著提升了学生跨学科创新能力与工程实践转化能力。研究进一步提出“政产学研用”五螺旋发展模型，倡导通过建立医工融合特区、构建智能医疗科研共享平台、完善学科交叉质量评价体系等策略，为“新医科”建设提供理论范式与实践路径。本研究为医学教育改革提供了系统化、可复制的解决方案，对推进健康中国战略实施具有重要理论与实践意义。

      Under the framework of the “Healthy China 2030” strategy，the integration of medicine and engineering has become a key path to promoting medical technological innovation and the cultivation of interdisciplinary medical talents．This study has constructed a “three-dimensional synergy” education system：in the curriculum dimension，a progressive matrix of “basic modules - cross-disciplinary courses - project training” is created；in the practical dimension，a platform for industry-education integration is established through the joint construction of university-enterprise laboratories and clinical transformation bases；in the faculty dimension，an innovative “Clinician + Engineer + Research mentor” tripartite mentorship collaboration mechanism is developed．Based on empirical analysis from universities such as Guangzhou Medical University，this model has significantly enhanced students’ cross-disciplinary innovation capabilities and engineering practice transformation abilities．The study further proposes a “government-industry-academia-research-application” five-spiral development model，advocating strategies such as establishing special zones for medicine-engineering integration，building intelligent medical research sharing platforms，and improving the quality evaluation system for interdisciplinary studies，to provide theoretical paradigms and practical paths for the construction of “new medicine”．This research offers a systematic and replicable solution for medical education reform and holds significant theoretical and practical significance for the implementation of the Healthy China strategy．

       本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题，IMB模型通过向患者提供科学的疾病知识，改变其疾病认知与态度，最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示，IMB模型可显著降低患者术后疼痛发生率，并提高患者参与治疗决策的程度，为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考，以便后期实施相关个性化干预措施，并提供相关理论依据。

       This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy．The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge，and ultimately promotes their adoption and maintenance of healthy behaviors．It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy，the research background of this study，the current research status at home and abroad，as well as the future development trends and challenges．The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making．This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model，so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis．

       目的 探讨低浓度罗哌卡因行超声引导下髋关节囊周围神经（PENG）阻滞联合椎管内麻醉对衰弱患者髋关节手术的应用优势。方法 选择行髋关节手术的衰弱患者76例，随机分为两组，A 组（38例）行PENG阻滞联合椎管内麻醉，C 组（38例）行椎管内麻醉。比较两组入室（T0）、摆放体位时（T1）、术后6 h（T2）、术后12 h（T3）、术后24 h（T4）静息和活动状态的数字等级评定量表（NRS）疼痛评分；术后非甾体抗炎药及阿片类药物补救次数；术后 6 h、24 h患侧股四头肌徒手肌力分级（MMT）；首次下床活动时间、住院时间。结果 A组T1～T4时刻静息状态NRS疼痛评分分别为2（1，3）分、1（1，2）分、2（1，2）分、3（2，4）分均低于C组的5（4，7）分、4（3，5）分、5（3，6）分、4（2，6）分，比较差异有统计学意义（均P＜0.001）；A组T1～T4时刻活动状态NRS疼痛评分分别为5（4，7）分、3（2，4）分、4（3，5）分、6（4，7）分均低于C组的10（9，10）分、8（6，9）分、8（7，9）分、9（8，10）分，比较差异有统计学意义（均P＜0.001）。A组在T1～T4时的静息状态NRS疼痛评分低于T0时的（均P＜0.01）；C组在T1～T4时的静息状态NRS疼痛评分低于T0时的（均P＜0.05）；A组在T1～T4时的活动状态NRS疼痛评分均低于T0时的（均P＜0.001）；C组在T1、T2时的活动状态NRS疼痛评分均低于T0时的（均P＜0.01）。A组术后非甾体抗炎药及额外阿片类药物补救次数为4（0，8）、2（0，3）次，均低于C组的15（7，19）、5（3，7）次，比较差异有统计学意义（均P＜0.001）。两组术后 6 h和24 h患侧股四头肌MMT分级、首次下床活动时间和住院时间比较差异无统计学意义（P＞0.05）。结论 低浓度罗哌卡因PENG阻滞可以有效减轻衰弱患者髋关节手术术后疼痛，不影响其术后下肢肌力。

   Objective To explore the application advantages of low-concentration ropivacaine for ultrasound-guided pericapsular nerve group（PENG）block combined with spinal-epidural anesthesia in hip joint surgery for frail patients．Methods Seventy-six frail patients undergoing hip surgery were randomly divided into two groups：Group A（38 cases）received PENG block combined with intraspinal anesthesia，while Group C（38 cases）received only intraspinal anesthesia．The numerical rating scale（NRS）pain scores of resting and active states were compared between the two groups at the time of entering the room（T0），placing the position（T1），6 hours after surgery（T2），12 hours after surgery（T3），and 24 hours after surgery（T4）．Postoperative non-steroidal drugs and opioids remedy times，muscle strength grading（MMT）of quadriceps femoris at 6 hours and 24 hours after operation，and the first time out of bed activity time，hospitalization time were also compared．Results The resting NRS pain scores at T1-T4 in Group A were 2（1，3），1（1，2），2（1，2）and 3（2，4），respectively，which were lower than 5（4，7），4（3，5），5（3，6）and 4（2，6）in Group C，and the difference was statistically significant（all P＜0.001）．The NRS pain scores at T1-T4 in Group A were 5（4，7），3（2，4），4（3，5）and 6（4，7），respectively，which were lower than 10（9，10），8（6，9），8（7，9）and 9（8，10）in Group C，and the difference was statistically significant（all P＜0.001）．The resting NRS pain score of Group A at T1-T4 was lower than that at T0（all P＜0.01）；the resting NRS pain score of Group C at T1-T4 was lower than that at T0（all P＜0.05）．The NRS pain scores at T1-T4 in Group A were lower than those at T0（all P＜0.001）；the NRS pain scores at T1 and T2 in Group C were lower than those at T0（all P＜0.01）．The number of postoperative non-steroidal drugs and additional opioids in group A（4［0，8］，2［0，3］）was lower than that in Group C（15［7，19］，5［3，7］），and the difference was statistically significant（all P＞0.001）．There was no significant difference in the MMT grade of the affected quadriceps femoris at 6 h and 24 h after operation，the first time of getting out of bed and the number of days of hospitalization between the two groups（P＞0.05）．Conclusions Low concentration ropivacaine PENG block can effectively reduce the postoperative pain of hip joint surgery in frail patients without affecting the postoperative lower extremity muscle strength．

       目的 探讨血浆细胞周期依赖性激酶9（CDK9）水平与大动脉粥样硬化（LAA）型脑梗死病情进展及预后的相关性，评估其作为疾病风险分层及预后评估生物标志物的临床价值。方法 选取2020年1月—2024年12月期间于本院就诊的400例急性LAA型脑梗死患者作为观察组，并同期纳入100名健康体检者作为对照组。发病90 d后，采用改良Rankin量表（mRS）对所有患者进行预后评估。根据评估结果，将观察组进一步划分为预后不良组（152例）与预后良好组（248例）。检测患者血浆CDK9水平并收集临床资料。分析CDK9水平与美国国立卫生研究院卒中量表（NIHSS）评分、梗死灶体积的相关性；分析预后不良的影响因素。结果 观察组CDK9水平高于对照组［（185.6±42.3） pg/mL vs （62.4±18.5） pg/mL，P＜0.001］，且与梗死体积（r=0.586）、NIHSS评分（r=0.628）、高敏C反应蛋白（r=0.452）及白介素6（r=0.418）呈正相关（均P＜0.001）。多因素Logistic回归分析显示，CDK9升高是90天预后不良的独立危险因素。受试者工作特征曲线（ROC）曲线分析显示，CDK9预测预后不良的曲线下面积（AUC）为0.854（最佳截断值为198.6 pg/mL，灵敏度为78.3%，特异度为82.5%），联合NIHSS评分及梗死体积后AUC提升至0.912（P＜0.001）。结论 血浆CDK9水平可作为急性LAA型脑梗死病情进展及预后的独立预测标志物，联合传统指标可提高预后评估效能。

      Objective To investigate the correlation between plasma cyclin-dependent kinase 9（CDK9）level and disease progression and prognosis in patients with acute large artery atherosclerosis（LAA）cerebral infarction，and to evaluate its clinical value as a biomarker for disease risk stratification and prognostic assessment．Methods This study enrolled 400 patients with acute LAA-type cerebral infarction who visited our hospital between January 2020 and December 2024 as the observation group，along with 100 healthy individuals as the control group during the same period．After 90 days of symptom onset，all patients were assessed using the modified Rankin Scale（mRS）for prognostic evaluation．Based on the assessment results，the observation group was further divided into two subgroups：the poor prognosis group（152 cases）and the good prognosis group（248 cases）．Plasma CDK9 levels were measured，and clinical data were collected．The correlation between CDK9 level and National Institutes of Health Stroke Scale（NIHSS）score and infarct volume，and the factors affecting poor prognosis were analyzed．Results Plasma CDK9 levels in the observation group were higher than those in the control group（［185.6±42.3］ pg/mL vs ［62.4±18.5］ pg/mL，P＜0.001），and were positively correlated with infarct volume（r=0.586），NIHSS score（r=0.628），high-sensitivity C-reactive protein（r=0.452），and interleukin-6（r=0.418）（all P＜0.001）．Multivariate Logistic regression analysis showed that elevated CDK9 level was an independent risk factor for poor prognosis at 90 d．Receiver Operating Characteristic（ROC）curve analysis revealed that the area under the curve（AUC）of CDK9 for predicting poor prognosis was 0.854（optimal cut-off value：198.6 pg/mL，sensitivity：78.3%，specificity：82.5%），and the AUC increased to 0.912 when combined with NIHSS score and infarct volume（P＜0.001）．Conclusions Plasma CDK9 level may serve as an independent predictive biomarker for disease progression and prognosis in acute LAA cerebral infarction，and combining it with traditional indicators can improve the efficacy of prognostic assessment．

      目的 调查住院老年患者因经外周静脉置入中心静脉导管（PICC）而引发的血栓情况，并分析其影响因素，为老年患者置入PICC产生的相关性血栓（PICC-CRT）和症状性血栓的评估与干预提供借鉴。方法 在2023年1月—2023年12月期间，选取广州市第一人民医院接受PICC置管的317例住院老年患者。采用包括患者一般情况调查表、运动功能评定、肌力检测、 Barthel指数评定、Padua评分等多种工具进行综合评估。采用多因素 Logistic 回归构建 PICC-CRT 及症状性血栓的预测模型，并应用逐步回归法优化变量筛选过程。模型性能通过 ROC 曲线进行评估。结果 去除临床资料不完整的患者40例，最终纳入277例患者的完整资料，其中123例患者出现了PICC-CRT，发生率为44.40%（123/277）。血栓分级中，I级78例，Ⅱ级37例，Ⅲ级8例。无症状血栓83例，占67.48%，发生率29.96%（83/277）；症状性血栓40例，占32.52 %，发生率14.44%（40/277）。单因素分析联合多因素Logistic回归显示，卒中史、凝血酶原时间（PT）、导管留置时间是住院老年患者PICC-CRT的关键因素（P＜0.05），预测模型ROC曲线下面积为0.719；置管史、恶性肿瘤史、导管留置时间、置管后并发症数量是住院老年患者PICC症状性血栓的独立影响因素（P＜0.05），预测模型ROC曲线下面积为0.812。结论 文章总结了PICC-CRT和症状性血栓独特的影响因素，基于关键因素构建了预测模型预测其发生，为护理人员预防PICC-CRT和症状性血栓的发生提供了参考。

   Objective To explore the incidence of thrombosis associated with peripherally inserted central catheter（PICC）placement in hospitalized elderly patients and to analyze its influencing factors，in order to provide a reference for the assessment and prevention of PICC-catheter related thrombosis（PICC-CRT）and symptomatic thrombosis in this population．Methods A total of 317 elderly inpatients who underwent PICC placement at a tertiary hospital in Guangzhou between January and December 2023 were enrolled．Comprehensive assessments were conducted using general patient information forms，motor function evaluation，muscle strength testing，Barthel Index，and Padua score．Multivariate Logistic regression analysis was used to construct predictive models for PICC-CRT and symptomatic thrombosis，with variable selection optimized via stepwise regression．Model performance was evaluated using receiver operating characteristic（ROC）curve analysis．Results After excluding 40 patients with incomplete clinical data，277 cases were included in the final analysis．Among them，123 patients developed PICC-CRT，with an incidence rate of 44.40%（123/277）．Thrombosis was graded as Grade I in 78 cases，Grade II in 37 cases，and Grade III in 8 cases．Asymptomatic thrombosis occurred in 83 cases（29.96%），accounting for 67.48% of PICC-CRT；symptomatic thrombosis occurred in 40 cases（14.44%），accounting for 32.52%．Univariate and multivariate Logistic regression analyses identified history of stroke，prothrombin time（PT），and catheter dwell time as key risk factors for PICC-CRT（P＜0.05），with the area under the curve（AUC）of 0.719．History of catheterization，malignancy，catheter dwell time，and number of post-catheterization complications were independent predictors of symptomatic thrombosis（P＜0.05），with an AUC of 0.812．Conclusions This study identified distinct risk factors for PICC-CRT and symptomatic thrombosis in elderly inpatients．Predictive models based on key variables may provide useful references for clinical staff in preventing the occurrence of PICC-related and symptomatic thrombosis．

      目的 探讨术前静注艾司氯胺酮在腹腔镜结直肠癌根治术患者中的应用效果。方法 前瞻性分析2024年1月—2025年4月在厦门市中医院行腹腔镜结直肠癌根治术患者的临床资料，根据随机数字表法将患者分为两组：对照组40例，术前5 min予5 mL生理盐水；观察组40例，术前5 min予以0.25 mg/kg艾司氯胺酮（以生理盐水配置成5 mL）。比较围术期指标、炎症因子、负性情绪、疼痛情况、不良反应。结果 观察组的手术时间、麻醉时间、术中出血量分别为（213.54±64.22）min、（240.67±81.26）min、（141.31±45.03）mL，与对照组的（210.43±65.71）min、（244.25±81.33）min、（137.64±42.75）mL比较，差异均无统计学意义（t=0.214、0.197、0.374，P均＞0.05），而观察组丙泊酚、瑞芬太尼用量分别为（1 075.52±134.37）mg、（1 267.18±242.26）μg，虽然低于对照组的（1?126.64±150.21）mg、（1 352.50±295.14）μg，但差异也无统计学意义（t=1.604、1.413，P均＞0.05）；观察组在术后24 h的肿瘤坏死因子-α、白介素-6、C反应蛋白水平分别为（54.52±9.64）pg/mL、（40.08±7.75）pg/mL、（30.38±6.93）mg/L，均低于对照组的（77.31±10.86）pg/mL、（56.35±9.47）pg/mL、（43.73±7.61）mg/L（t=9.926、8.409、8.203，P均＜0.05）；术后1 d的焦虑、抑郁自评量表评分及术后1 h、6 h、12 h、24 h咳嗽时的疼痛视觉模拟量表评分分别为（51.92±4.41）分、（53.96±4.47）分、（3.59±1.14）分、（3.06±1.01）分、（2.89±0.91）分、（2.57±0.76）分，均低于对照组的（55.06±5.12）分、（57.21±5.19）分、（4.27±1.36）分、（3.68±1.18）分、（3.41±1.06）分、（2.96±0.92）分（t=2.939、3.001、2.423、2.525、2.329、2.067，P均＜0.05），但两组术后48 h咳嗽时疼痛视觉模拟量表评分比较差异无统计学意义（P＞0.05）；两组术后不良反应发生率也无显著差异（P＜0.05）。结论 在腹腔镜结直肠癌根治术术前静注艾司氯胺酮可有效降低术后炎症反应水平，减轻术后疼痛，缓解术后负性情绪，且不会增加患者术后不良反应发生率。

Objective To explore the application effect of preoperative intravenous injection of esketamine in patients undergoing laproscopic radical resection of colorectal cancer．Methods The clinical data of patient who underwent laparoscopic radical resection of colorectal cancer in Xiamen Hospital of Traditional Chinese Medicine from January 2024 to April 2025 were retrospectively analyzed．The patients were divided into two groups according to the random number table method：40 cases in the control group were given 5 mL saline，five minutes before operation，40 cases in the observation group were treated with 0.25 mg / kg esketamine（in 5 mL saline）five minutes before operation．The perioperative indicators，inflammatory factors，negative emotions，pain and adverse reactions were compared between two groups．Results The operation time，anesthesia time and intraoperative blood loss of the observation group were（213.54±64.22）min，（240.67±81.26）min and（141.31±45.03）mL，respectively，which were not significantly different from those of the control group（210.43±65.71）min，（244.25±81.33）min and（137.64±42.75）mL（t=0.214，0.197，0.374，all P＞0.05）．The dosage of propofol and remifentanil in the observation group were（1 075.52±134.37）mg and（1 267.18±242.26）μg，respectively，which were lower than those in the control group of （1126.64±150.21）mg and（1352.50±295.14）μg，but the difference was not statistically significant（t=1.604，1.413，P＞0.05）．The levels of tumor necrosis factor-α，interleukin-6 and C-reactive protein in the observation group at 24 h after operation were（54.52±9.64）pg / mL，（40.08±7.75）pg / mL and（30.38±6.93）mg / L，respectively，which were lower than those in the control group of （77.31±10.86）pg / ml，（56.35±9.47）pg / mL and 43.73±7.61）mg / L（t=9.926，8.409，8.203，all P＜0.05）．The scores of Anxiety and Depression Self-Rating Scale at 1 day after operation and the scores of pain visual analogue scale at 1 h，6 h，12 h and 24 h after operation were（51.92±4.41），（53.96±4.47），（3.59±1.14），（3.06±1.01），（2.89±0.91） and（2.57±0.76），respectively，which were lower than those of the control group（55.06±5.12），（57.21±5.19），（4.27±1.36），（3.68±1.18），（3.41±1.06） and（2.96±0.92）（t=2.939，3.001，2.423，2.525，2.329，2.067，P＜0.05）．However，no significant difference was observed in cough-related VAS scores between the groups at 48 h postoperatively（P＞0.05）．Adverse event rates showed no significance in two groups（P＞0.05）．Conclusions Preoperative administration of esketamine in laparoscopic colorectal cancer surgery can attenuate postoperative inflammation，decrease pain，mitigate negative emotions，without increasing the incidence of postoperative adverse reactions．

       目的 探讨基于肺康复的阻抗训练联合营养支持对老年慢性阻塞性肺疾病（COPD）衰弱患者肌少症及运动耐量的影响。方法 将2024年1月—2025年5月收治的80例老年COPD衰弱合并肌少症患者，分为对照组、观察组，各40例。所有患者均采取常规药物治疗，对照组予以营养支持，观察组在对照组基础上增加基于肺康复的阻抗训练。比较两组治疗前、治疗3个月后肌少症改善情况，运动耐量，肺功能指标，衰弱状态及生活质量。结果 治疗3个月后，观察组骨骼肌指数、握力、股四头肌肌厚度均较治疗前提高，且与对照组相比，观察组更高（P＜0.05）；治疗3个月后，两组6 min步行距离、日常活动代谢当量均较治疗前提高，Borg量表评分降低，且与对照组相比，观察组改善幅度更大（P＜0.05）；治疗3个月后，两组第一秒用力呼气容积（FEV1）、FEV1/用力肺活量（FVC）、最大通气量（MVV）均较治疗前改善，且与对照组相比，观察组更优（P＜0.05）；治疗3个月后，两组Fried衰弱表型评分、COPD评估测试（CAT）总分、圣乔治呼吸问卷（SGRQ）总分均较治疗前降低，且与对照组相比，观察组更低（P＜0.05）。结论 老年COPD衰弱合并肌少症患者采取基于肺康复的阻抗训练联合营养支持可改善其肌少症情况，提升运动耐量，并且提升患者肺功能水平，改善衰弱状态，提升生活质量。

       Objective To explore the effects of impedance training based on pulmonary rehabilitation combined with nutritional support on sarcopenia and exercise tolerance in elderly patients with chronic obstructive pulmonary disease（COPD）and frailty．Methods Eighty elderly patients with COPD and frailty complicated by sarcopenia，admitted from January 2024 to May 2025，were selected as the study subjects and divided into a control group and an observation group，with 40 patients in each group．All patients received conventional drug therapy．The control group received nutritional support，while the observation group received additional impedance training based on pulmonary rehabilitation on top of the matched group’s treatment．The improvement of sarcopenia，exercise tolerance，pulmonary function index，weakness status and quality of life before and 3 months after treatment were compared between the two groups．Results After 3 months of treatment，the skeletal muscle index，grip strength and quadriceps thickness of the observation group increased compared with that before treatment，and compared with the control group，the observation group was higher（P＜0.05）．After 3 months of treatment，the 6 min walking distance and daily activity metabolic equivalent of both groups increased compared with that before treatment，and the Borg Scale score decreased．Compared with the control group，the improvement of the observation group was better（P＜0.05）．After 3 months of treatment，Forced Expiratory Volume in one second（FEV1），FEV1/Forced Vital Capacity（FVC）and Maximal Voluntary Ventilation（MVV）of both groups improved compared with that before treatment，and the observation group  was better than that of the control group（P＜0.05）．After 3 months of treatment，the Fried weakness phenotype score，COPD Assessment Test（CAT）total score and St. George’s Respiratory Questionnaire（SGRQ）total score of both groups were lower than that before treatment，and the observation group  was lower than that of the control group（P＜0.05）．Conclusions Impedance training based on pulmonary rehabilitation combined with nutritional support can improve sarcopenia，enhance exercise tolerance，and improve pulmonary function levels，frailty status，and quality of life in elderly patients with COPD and frailty complicated by sarcopenia．

       目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料，按照7︰3比例随机化分为训练列（293例）和验证队列（126例）。统计基于开发队列数据，采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素，并构建风险预测模型。基于开发队列和验证队列数据，采用校准曲线、受试者操作特征（ROC）曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎，发生率为26.97%。美国国立卫生研究院卒中量表（NIHSS）评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞计数与淋巴细胞计数比值（NLR）、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素（P＜0.05）。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型，校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近；ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906（95%CI：0.867~0.937）、0.884（95%CI：0.815~0.934）；决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。

      Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage（ICH）and validate the predictive performance of the model．Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022．They were randomly divided into a development cohort（293 cases）and a validation cohort（126 cases）according to a 7∶3 ratio．The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data，and a risk prediction model was constructed．Based on the development cohort data and validation cohort data，the predictive performance of the model was analyzed using calibration curves，receiver operating characteristic（ROC）curve，and decision curve analysis．Results Among 419 patients，113 developed stroke associated pneumonia，with a rate of 26.97%．The National Institutes of Health Stroke Scale（NIHSS）score，swallowing difficulties，initial hematoma volume，neutrophil percentage to albumin ratio（NPAR），neutrophil count to lymphocyte count ratio（NLR），surgical treatment，endotracheal intubation，and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH（P＜0.05）．Based on the above influencing factors，a risk prediction model for stroke associated pneumonia in patients with ICH was constructed．The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence．The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906（95%CI：0.867-0.937）and 0.884（95%CI：0.815-0.934），respectively．The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%，and the threshold probability of the validation cohort was between 2%-76%，the intervention using this model was more clinically valuable than all/no intervention．

Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score，swallowing difficulties，initial hematoma volume，NPAR，NLR，surgical treatment，tracheal intubation，and indwelling gastric tube has good predictive performance and clinical application value．

       目的 探讨营养风险管理结合分期饮食指导对溃疡性结肠炎（UC）患者营养状况的影响。方法 选择郑州市大肠肛门病医院收治的90例UC患者，纳入时间为2024年1月—2025年1月，按照计算机分组法分为对照组（45例），给予分期饮食指导，观察组（45例），在对照组的基础上增加营养风险管理，观察两组患者症状改善情况、营养状况、生活质量。结果 干预后，观察组Mayo评分（4.30±1.14）分、主观整体营养状况评价表（PG-SGA）评分（1.74±0.38）分低于对照组（5.48±1.33、2.28±0.43）分（P＜0.05）；观察组血红蛋白（HB）、前白蛋白（PA）、白蛋白（ALB）水平高于对照组（P＜0.05），IBDQ各维度评分及总分更高（P＜0.05）。结论 对UC患者应用营养风险管理结合分期饮食指导，能够减轻临床症状，改善营养状况，促进生活质量的提升。

       Objective To explore the influence of nutritional risk management combined with staged dietary guidance on the nutritional status of ulcerative colitis（UC）patients．Methods A total of 90 UC patients admitted to our hospital were selected and included from January 2024 to January 2025．According to the computer grouping method，45 cases were divided into control group with staged dietary guidance，and 45 cases were divided into observation group with nutritional risk management．The symptoms improvement，nutritional status，and quality of life of the two groups were observed．Results After intervention，the observation group had lower Mayo score（4.30±1.14）and Patient?Generated Subjective Global Assessment（PG-SGA）score（1.74±0.38）than the control group（5.48±1.33 and 2.28±0.43，respectively）（P＜0.05）；the observation group had higher levels of hemoglobin（HB），prealbumin（PA），and albumin（ALB）than the control group（P＜0.05），and also had higher scores in all dimensions and total score of the Inflammatory Bowel Disease Questionnaire（IBDQ）（P＜0.05）．Conclusions The application of nutrition risk management combined with staged dietary guidance in UC patients can reduce clinical symptoms，improve nutritional status，promote the improvement of life quality．

       目的 构建与验证回肠造口术后造口周围皮炎发生的列线图预测模型。方法 回顾性分析广州市中山大学附属第六医院2022年7月—2023年7月收治的441例回肠造口术患者资料。通过单因素Logistic回归确定影响因素，基于训练队列建立列线图模型，并采用受试者操作特征（ROC）曲线和校准曲线分别评估模型的区分度与校准能力，同时通过决策曲线分析（DCA）评估临床实用性。在内部验证队列进行模型性能验证。结果 单因素Logistic回归确定6个危险因素，最终选取其中5个（是否糖尿病、造口定位、是否接受造口护理宣教、造口皮肤凹陷、性别）构建预测模型。训练队列中，模型校准曲线显示良好拟合优度（Hosmer and Lemeshow检验P = 0.976），ROC曲线下面积为0.672；决策曲线证实模型具有临床应用价值，预测模型在验证集上有类似结果。结论 本研究建立的5参数列线图模型具有良好的区分度、校准能力和临床实用价值，可为造口周围皮炎的预测提供量化工具。

       Objective To establish a predictive nomogram for peristomal dermatitis after ileostomy．Methods This study analyzed 441 patients who underwent ileostomy at a third-class premium hospital．The risk factors of peristomal dermatitis were determined by univariate binary Logistics regression．Then a predictive nomogram was established with the risk factors in the training cohort．The discrimination and calibration ability of the nomogram was demonstrated by receiver operating characteristic curves and calibration curves，respectively．Besides，a testing cohort was utilized to validate the nomogram model．To reflect the clinical utility of the model，we also performed decision curve analysis．Results A total of six parameters was determined as the risk factors of peristomal dermatitis．Finally，five of them（whether diabetes，stoma location，whether to receive stoma care education，stoma skin depression，gender）were chosen to establish the nomogram．The calibration curve showed favorable calibration ability in the training cohort with a Hosmer and Lemeshow goodness of fit test P-value of 0.976 and the area under the curve of the nomogram is 0.672．The decision curve showed nomogram had potential clinical utility．These results were consistent with the testing cohort．Conclusions The nomogram established by five parameters was capable of predicting the occurrence of peristomal dermatitis with favorable discrimination and calibration ability and shows potential clinical utility．