目的 观察环泊酚在老年患者无痛胃肠镜检查中的麻醉效果和不良反应。方法 选择80例65岁以上行无痛胃肠镜检查的老年患者,将患者随机分为环泊酚组（C组）40例和丙泊酚组（P组）40例。每例患者均静脉注射舒芬太尼0.08 μg/kg,30 s后C组给予环泊酚0.3 mg/kg、P组给予丙泊酚1.5 mg/kg。记录2组患者麻醉前（T₀）、睫毛反射消失时（T₁）、置入胃镜后即刻（T₂）和操作结束时（T₃）的心率（HR）和平均动脉压（MAP）;记录2组患者检查操作时间、清醒时间、追加药物次数及静脉注射痛、呼吸抑制、呛咳、体动等不良反应发生情况。结果 2组患者行胃肠镜检查操作时间、麻醉清醒时间和追加药物次数比较差异无统计学意义（P>0.05）。与T₀时间点（102.6±14.1 mmHg）比较,P组患者的MAP在T₁（86.0±12.5 mmHg）、T₂（86.1±13.2 mmHg）、T₃（92.8±12.6 mmHg）时间点明显下降,差异有统计学意义（P<0.05）;与C组T₁（95.9±10.8 mmHg）、T₂（96.3±9.6 mmHg）时间点比较,P组的MAP在T₁（86.0±12.5 mmHg）、T₂（86.1±13.2 mmHg）时均明显降低（P<0.05）。C组患者静脉注射痛、呼吸抑制的发生率明显低于P组（P<0.05）;2组体动和呛咳的发生率比较差异无统计学意义（P>0.05）。结论 环泊酚0.3 mg/kg在老年患者胃肠镜检查中能提供和丙泊酚1.5 mg/kg相似的麻醉效果,环泊酚组的老年患者发生注射痛、血压下降、呼吸抑制的比例更低。

Objective To observe the effect of ciprofol and propofol in painless gastroenteroscopy in elderly patients．Methods A total of 80 elderly patients aged 65 or above who underwent painless gastroenteroscopy were randomly divided into a group of 40 patients receiving ciprofol（Group C）and a group of 40 patients receiving propofol（Group P）．All patients were given sufentanil 0.08 μg/kg,and group C was given ciprofol 0.3 mg/kg,group P was given propofol 1.5 mg/kg after 30 seconds．The heart rate（HR）and mean arterial pressure（MAP）of two groups of patients before anesthesia（T₀）,at the disappearance of eyelash reflex（T₁）,after gastroscopy insertion（T₂）,and at the end of the procedure（T₃）were recorded．The operating time,anesthesia awakening time,number of additional medications and the adverse reactions such as injection pain,respiratory depression,cough,body movements were also recorded．Results There were no significant differences（P>0.05）in the gastroenteroscopy operating time,recovery time and number of additional medications between the two groups．Compared with T₀ time point（102.6±14.1 mmHg）,the MAP of group P patients significantly decreased at T₁（86.0±12.5 mmHg）,T₂（86.1±13.2 mmHg）and T₃（92.8±12.6 mmHg）time points（P<0.05）．Compared with Group C at T₁（95.9±10.8 mmHg）,T₂（96.3±9.6 mmHg）time points,the MAP of Group P decreased significantly at T₁（86.0±12.5 mmHg）and T₂（86.1±13.2 mmHg）time points（P<0.05）．The incidences of injection pain and respiratory depression in group C were significantly lower than those in group P（P<0.05）．There was no statistically significant difference in the incidences of body movements and cough between the two groups（P>0.05）．Conclusions Ciprofol 0.3 mg/kg combined with sufentanil can provide anesthesia effect similar to that of propofol 1.5 mg/kg combined with sufentanil in gastroenteroscopy of elderly patients．The proportions of injection pain,blood pressure decreasing and respiratory depression in elderly patients in the ciprofol group were lower．

目的 探讨妊娠期高血压疾病患者血尿酸、淀粉酶水平的变化的临床意义。方法 选择2020年2月—2023年2月期间焦作市第二人民医院收治的150例合并妊娠期高血压疾病孕妇作为观察组,另选择同期接收的50例正常妊娠孕妇作为对照组,测定两组孕妇孕早期、孕中期、孕晚期的血尿酸、淀粉酶水平,比较两组检测结果,并采取受试者工作特征曲线分析（ROC）血尿酸、淀粉酶水平筛查妊娠期高血压疾病的诊断效能,比较观察组妊娠期高血压、子痫前期、子痫孕妇的检测结果。结果 观察组孕妇在孕早期、孕中期、孕晚期的血尿酸水平高于对照组,淀粉酶水平低于对照组（P<0.05）;孕早期与孕中期的血尿酸、淀粉酶水平比较,两组孕妇比较差异均无统计学意义（P>0.05）;孕晚期两组孕妇的血尿酸水平升高,淀粉酶水平降低,与孕早期、孕中期比较差异有统计学意义（P<0.05）。ROC曲线分析显示,妊娠期高血压疾病的筛查中血尿酸灵敏度为58.15%、特异度为88.72%,淀粉酶灵敏度为56.47%、特异度为92.24%,血尿酸联合淀粉酶灵敏度为82.24%、特异度为98.57%。子痫、重度子痫前期、轻度子痫前期、妊娠期高血压孕妇的血尿酸、淀粉酶水平比较差异均有统计学意义（P<0.05）。结论 与正常妊娠孕妇相比,合并妊娠期高血压疾病孕妇的血尿酸水平升高、淀粉酶水平降低,二者联合可实现对妊娠期高血压疾病的准确筛查,而且可评估病情进展。

目的 探讨茵栀黄口服液、还原型谷胱甘肽联合光疗对新生儿黄疸的临床疗效。方法 以2020年2月—2023年3月河南省驻马店市中医院收治的100例黄疸患儿为研究对象。按照随机数字表法分为A组和B组,每组各50例。A组和B组患儿均接受蓝光治疗,B组予以还原型谷胱甘肽治疗,A组在B组的基础上联合茵栀黄口服液。观察A组和B组患儿临床疗效、黄疸消退时间、胆红素水平、T淋巴细胞亚群以及不良反应发生情况。结果 A组总有效率高于B组（96.00% vs 82.00%）（P<0.05）;治疗7 d后,A组和B组患儿组总胆红素、间接胆红素、直接胆红素水平均低于治疗前,且A组低于B组（P<0.05）;A组和B组患儿组CD3⁺、CD4⁺、CD4⁺/CD8⁺均高于治疗前且A组高于B组,A组和B组CD8⁺低于治疗前且A组低于B组（P<0.05）;A组皮疹、腹泻等不良反应的总发生率和B组组间对比差异无统计学意义（10.00% vs 6.00%,P>0.05）。结论 茵栀黄口服液联合还原型谷胱甘肽和光疗用于新生儿黄疸的治疗中可加快总胆红素水平的降低,改善T淋巴细胞亚群,进而提高临床疗效且不增加不良反应。

目的 检验婴儿孤独症观察量表中文版（AOSI）临床应用的灵敏度与特异度,评价其临床应用效果。方法 随机抽取1岁时曾在清远市妇幼保健院行AOSI评估,于2~3岁时诊断为孤独症谱系障碍（ASD）的48例患儿为ASD组,诊断为正常发展的46例幼儿作为对照组。比较两组患儿的18个条目得分和总分,采用受试者操作特征（ROC）曲线计算AOSI的特异度、灵敏度、阳性预测值与阴性预测值,并判断AOSI的最佳诊断（阳性）分界值;分析AOSI评估结果与《精神障碍诊断与统计手册（第5版）》（DSM-5）中ASD诊断标准的一致性。结果 两组研究对象性别、年龄比较差异无统计学意义（P>0.05）。ASD组各条目得分和总分均高于对照组,且差异具有统计学意义（P<0.01）。AOSI的曲线下面积（AUC）为1.00（P<0.01）,95%置信区间为（1.00,1.00）。不同阳性分界线的灵敏度、特异度、阳性预测值、阴性预测值及一致性相比较,当约登指数等于1.00时AOSI的最佳诊断（阳性截断值）界线为9分时,其上述值均为1.00。AOSI评估结果与DSM-5中ASD的诊断标准完全相一致（Kappa=1,P<0.01）。结论 AOSI应用于评估1岁的婴儿,当取9分为诊断界值时,具有高度的灵敏度与特异度,能较好地预测该婴儿在2~3岁时是否患ASD;AOSI是婴儿期ASD筛查的重要工具,其评估结果可作为ASD高危儿早期干预的证据和ASD的辅助诊断工具,适合于临床推广应用。

Objective To test the sensitivity and specificity of the Chinese version of the Autism Observation Scale for Infants（AOSI）in clinical application and evaluate its clinical application effect．Methods Forty-eight children with autism spectrum disorder（ASD）diagnosed at the age of 2 to 3 years who had undergone AOSI evaluation in Qingyuan Maternal and Child Health Hospital at the age of 1 year（2021）were randomly selected as the ASD group,and 46 children with normal development were randomly selected as the control group．The scores of 18 items and total scores of the two groups of subjects were compared．The specificity,sensitivity,positive predictive value and negative predictive value of AOSI were calculated using the receiver operating characteristic curve（ROC）,and the best diagnostic（positive）cut-off value of AOSI was confirmed．The consistency of AOSI evaluation results with the ASD diagnostic criteria in DSM-5 were compared．Results There was no statistically significant difference in genders or age between two groups（P>0.05）．The scores of each item and total scores in the ASD group were significantly higher than those in the control group,and the difference was statistically significant（P<0.01）．The area under the curve of AOSI（AUC=1.00,P<0.01）had a 95% confidence interval of（1.00,1.00）．Comparing the sensitivity,specificity,positive predictive value,negative predictive value and consistency of different positive boundary points,when the Youden index was equal to 1.00,the optimal diagnostic（positive cut-off value）boundary for AOSI was 9 points,and all of the above values were 1.00． The AOSI evaluation results were completely consistent with the diagnostic criteria for ASD in DSM-5（Kappa=1,P<0.01）．Conclusions AOSI has high sensitivity and specificity when it is used to evaluate the 1-year-old infant．When “9 points” is taken as the diagnostic threshold,it can better predict whether the infant has ASD at the age of 2~3 years．AOSI is an important tool for screening ASD in infancy．Its evaluation results can be used as evidence for early intervention of high-risk infants with ASD and as a assisting tool to diagnosis ASD,which is suitable for clinical application．

脑卒中是临床常见的急性脑血管疾病,常有偏瘫、肩手综合征、下肢深静脉血栓等后遗症,严重影响患者的生活质量。温针疗法是中医传统的特色疗法,近年来,应用以温针为主的相关疗法治疗脑卒中后遗症的报道越来越多,在临床上得到广泛应用。本文归纳分析了近10年来温针疗法治疗脑卒中后肩手综合征、偏瘫、下肢深静脉血栓三大主要疾病的案例及研究,以期为相关研究与应用提供参考。

Stroke is a common acute cerebrovascular disease in clinical practice,which frequently leaves sequelae like hemiplegia,shoulder-hand syndrome and deep vein thrombosis of the lower extremities,and vastly reduces the quality of life of patients．Warm needling is a characteristic therapy of traditional Chinese medicine．In recent years,there have been more and more reports of warm needling-based related therapies for the treatment of stroke sequelae,and it has been widely used in clinical practice．This article summarizes and analyzes the cases and studies of warm needing therapy in the treatment of shoulder-hand syndrome,hemiplegia and deep vein thrombosis of the lower extremities after stroke in the past 10 years,so as to provide reference for related research and application．

目的 探讨以多媒体教学法、标准患者教学法、案例教学法、手术观摩教学法等多种教学方法相结合的多样化教学,在小儿外科临床见习的教学实施效果评价。方法 以2022年、2023年参加小儿外科临床见习的儿科学生为研究对象,随机分为试验组和对照组,每组分别45人。试验组采用多样化教学进行临床带教,对照组采用传统教学法进行带教。对比两组儿科学生的理论知识分数、技能操作分数、临床知识评分及总成绩,师生满意度及家属对儿科学生的满意度。结果 试验组的理论知识分数（85.69±4.59）、技能操作分数（86.36±4.35）、临床知识评分（87.71±4.01）及总成绩（86.59±2.85）均高于对照组,差异有统计学意义（P<0.05）。在满意度评价中,试验组在教学方式、学习兴趣、自我评价、团队协作能力及对小儿外科的专业认可度分别为（4.84±0.37）（4.87±0.34）（4.89±0.32）（4.84±0.37）（4.91±0.29）,均高于对照组,差异有统计学意义（P<0.01）;而试验组及对照组对带教教师的理论知识水平分别为（4.80±0.46）（4.64±0.53）,带教教师的积极性评分分别为（4.89±0.32、4.75±0.43）,比较差异无统计学意义（P>0.05）;带教教师在试验组专业知识掌握情况、临床实践操作能力、学生学习积极性及团队协作能力评分分别为（4.82±0.39）（4.87±0.34）（4.91±0.29）（4.93±0.25）,均高于对照组,差异有统计学意义（P>0.05）。患儿家属对试验组在医师尊重孩子、医师非常关注孩子及医师鼓励孩子提问并积极解决问题方面评分分别为（4.91±0.29）（4.93±0.25）（4.91±0.29）,均高于对照组,差异有统计学意义（P<0.05）。结论 在小儿外科临床见习采用多样化教学不仅能提高儿科学生的理论、技能、临床知识水平,还能提高师生满意度及儿科学生对小儿外科的专业认可度。

Objective To assess the impact of multimedia teaching methods,standard patient teaching methods,case teaching methods,and surgical observation teaching methods on clinical probation in pediatric surgery．Methods Pediatric students participating in clinical probation in pediatric surgery in 2022 and 2023 were randomly assigned to either the experimental group or the control group,with 45 students in each group．The experimental group received diversified teaching methods,while the control group received traditional teaching methods．A comparison was made between the two groups regarding theoretical knowledge scores,skill operation scores,clinical knowledge scores,total scores,teacher-student satisfaction levels,and family satisfaction levels of pediatric students．Results The experimental group demonstrated significantly higher theoretical knowledge scores（P<0.05）,skill operation scores（P<0.05）,clinical knowledge scores（P<0.05）,and total scores compared to the control group．In terms of satisfaction evaluation criteria such as teaching style,learning interest,self-evaluation ability,teamwork skills and professional recognition of pediatric surgery（P<0.01）,the experimental group showed significantly higher levels than the control group．There was no significant difference between the two groups regarding teachers’ theoretical knowledge level and enthusiasm score（P>0.05）．However,the teachers in the experimental group scored significantly higher than those in the control group when it came to professional knowledge mastery,clinical practice ability,student learning enthusiasm,and teamwork skills（P>0.05）．Conclusions Implementing diversified teaching approaches during pediatric surgery clinical probation not only enhances theoretical understanding,skills development,and clinical expertise among pediatric students,but also improves overall satisfaction levels for both teachers and students as well as enhances professional recognition of pediatric surgery students．

目的 了解深圳市助产士培训的现况,为今后进一步加强助产士培训工作提供参考依据。方法 利用方便整群抽样法选取2022年在深圳市助产医疗机构工作的助产士,通过问卷调查及数据分析,了解他们在2009—2020年间参加助产士培训的情况以及对临床实操技能掌握的自评现况。结果 本研究共调查481名助产士,大部分来自三级医院,平均拥有9（5,15）年的助产工作经验,根据其工作年限和经验分别参加初级、中级和（或）高级培训,以参加一次初级或中级培训居多。助产士未参加培训的主要原因为医院人员不足和新入职。临床实操技能掌握自评现况分析显示,助产士初、中级母儿急救实操技能亟待加强,中级培训的助产士带教能力需提升。不同职称助产士的实操技能自评分数比较差异有统计学意义（Z=9.23,P=0.026）。结论 深圳市助产士对于初级培训和中级培训的参与度较高,但对部分临床实操技能的掌握仍存在不足,有必要进一步强化助产士临床实操技能培养,以全面满足孕产妇的健康需求。

Objective To understand the current state of midwifery training in Shenzhen,providing insights for the enhancement of future midwifery training programs．Methods Using a convenience cluster sampling method,midwives working in obstetric medical institutions in Shenzhen in 2022 were selected．Through questionnaire surveys and data analysis,the participation in midwifery training from 2009 to 2020 was examined along with their self-assessment of mastery over clinical practical skills．Results A total of 481 midwives,mostly from tertiary hospitals,with an average of 9（5,15）years of midwifery experience,were surveyed in this study and participated in primary,intermediate and/or advanced training according to their years of experience and years of work,with the majority participating in primary or intermediate training once．The main reasons for midwives not attending training were insufficient hospital staff and new recruits．The analysis of the self-assessment of the mastery of clinical practical skills showed that the practical skills of midwives in maternal and pediatric emergencies at the primary and intermediate levels needed to be strengthened,and the teaching ability of midwives with intermediate training needed to be improved．There was a difference in the self-rating of practical skills among midwives of different titles（Z=9.23,P=0.026）．Conclusions Though participation in primary and intermediate midwifery training in Shenzhen City is high,there remains a deficiency in mastering specific clinical practical skills．This research suggests that there’s a pressing need to further enhance the practical clinical skill training for midwives to comprehensively meet the health needs of pregnant and postnatal women．

目的 探讨唐氏综合征血清学筛查风险值异常孕妇选择接受无创产前基因检测（NIPT）的影响因素,为临床制定对应策略提供参考依据。方法 选取2022年1月—2022年12月唐氏综合征血清学筛查风险值异常孕妇229例,根据是否接受NIPT分为接受组（195例）与不接受组（34例）。收集两组临床资料,采用Lasso-Logistic回归分析唐氏综合征血清学筛查风险值异常孕妇接受NIPT的影响因素。结果 单因素分析显示,年龄、文化水平、居住地、家庭平均月收入、孕前优生优育检查、孕前合并生殖相关疾病、受孕方式、不良孕产史、家族史、补充叶酸、配偶意愿、NIPT认知水平、血清学风险等级是血清学筛查异常孕妇接受NIPT的影响因素（P<0.05）;Lasso回归分析筛选出7个变量,分别为年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级;Logistic回归分析,年龄（OR=6.269,95%CI：2.413~16.285）、文化水平（OR=4.119,95%CI：1.627~10.430）、家庭平均月收入（OR=5.102,95%CI：2.067~12.594）、不良孕产史（OR=5.247,95%CI：1.833~15.021）、家族史（OR=7.416,95%CI：2.952~18.629）、NIPT认知水平（OR=5.751,95%CI：2.338~14.146）、血清学风险等级（OR=7.866,95%CI：3.057~20.238）是血清学筛查异常孕妇接受NIPT的影响因素（P<0.05）。结论 唐氏综合征血清学筛查风险值异常孕妇选择接受NIPT的影响因素较多,包括年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级,能为临床提高NIPT接受度提供指导信息。

Objective To explore the influencing factors of noninvasive prenatal testing（NIPT）for pregnant women with abnormal risk value of serological screening for Down syndrome,and to provide reference for clinical development of corresponding strategies．Methods A total of 229 pregnant women with abnormal serological screening risk values for Down syndrome from January 2022 to December 2022 were selected and divided into acceptance group（195 cases）and non-acceptance group（34 cases）according to whether they received NIPT．The clinical data of the two groups were collected and Lasso-Logistic regression was used to analyze the factors influencing the acceptance of NIPT in pregnant women with abnormal serological screening risk value for Down syndrome．Results In single factor analysis,age,education level,place of residence,average monthly family income,pre-pregnancy and childbearing examination,pre-pregnancy combined with reproductive diseases,conception method,adverse pregnancy history,family history,folic acid supplementation,spouse intention,NIPT cognition level and serological risk grade were the influencing factors for the acceptance of NIPT in pregnant women with abnormal serological screening（P<0.05）．Seven variables were selected by Lasso regression analysis,which were age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level and serological risk level．Logistic regression analysis showed that age（OR=6.269,95%CI：2.413-16.285）,education level（OR=4.119,95%CI：1.627-10.430）,average monthly family income（OR=5.102,95%CI：2.067-12.594）,adverse pregnancy history（OR=5.247,95%CI：1.833-15.021）,family history（OR=7.416,95%CI：2.952-18.629）,NIPT cognitive level（OR=5.751,95%CI：2.338-14.146）and serological risk level（OR=7.866,95%CI：3.057-20.238）were independent influencing factors for NIPT acceptance in pregnant women with abnormal serological screening（P<0.05）．Conclusions There are many influencing factors for pregnant women with abnormal serological screening risk value to accept NIPT,including age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level,serological risk grade,etc．,which can provide guidance information for clinical improvement of NIPT acceptance．

本文探讨临床药师对口服靶向药物的非小细胞肺癌患者开展药学服务的要点,以案例为依据,通过查阅药品说明书、指南及文献等,分析药学服务的内容和方向。临床药师在安全性评估、剂量调整、个体化治疗方案选择、用药教育和健康宣教等方面为患者和临床医生提供专业、全面的药学服务。临床药师通过全程参与患者的治疗过程,指导患者正确用药、优化治疗方案,利用专业优势解决临床实际问题,提升药学服务质量的同时体现了药师的职业价值。

To explore the key points of pharmaceutical care for non-small cell lung cancer patients with oral targeted drugs．Based on clinical cases,the content and direction of pharmaceutical care were analyzed with drug instructions,guidelines and literature．Clinical pharmacists provided professional and comprehensive pharmaceutical services for patients and clinicians in safety assessment,dose adjustment,individualized treatment plan selection,medication education and health education．Clinical pharmacists participate in the whole treatment process,guide patients to use drugs correctly,optimize treatment plans,use professional advantages to solve clinical practical problems,improve the quality of pharmaceutical care and reflect the professional value of pharmacists．

目的 探究抗-M抗体影响血型鉴定及对临床输血的影响,分析不规则抗体筛查必要性,以期进一步提升临床输血的安全性及有效性。方法 分析2020年1月—2023年4月于蚌埠医学院第二附属医院输血科检查的100例O型红细胞对照管凝集患者样本资料,使用全自动血型仪微柱凝胶卡、反定型试管法对样本进行血型鉴定和抗体检查,使用抗人球蛋白实验检测抗体类型及特异性,并分析抗-M抗体在不同环境温度下的效性。结果 血型仪微柱凝胶法显示100例标本中存在正反定型不符89.00%,正反定型相符11.00%;反定型试管法复核显示100例标本A、B、O细胞管均为阳性,对照管均为阴性。对89例正反定型不符的样本予以分析,抗-M是最主要影响抗体,占比56.18%;IgM、IgG是最主要影响抗体类型;13例未鉴定出抗体特异性,占比14.61%。89例正反定型不符的样本中男25例、女64例;71例存在妊娠史或输血史,占比79.78%,其中的11例合并妊娠史和输血史。50例抗-M抗体标本在不同气温下呈现不同效价,在4 ℃、22 ℃下会出现凝集梯度;在37 ℃下,50例样本中反应强烈31例,占比62.00%,阴性19例,占比38.00%。结论 抗-M类不规则抗体是影响血型鉴定、威胁输血安全的主要因素,临床需加强输血前血型鉴定,明确抗-M抗体临床检测的意义,通过多种途径提升鉴定准确性,对合并高危险因素的患者更需要着重关注,保障输血安全。