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．

摘要：目的 探讨心力衰竭患者住院期间容量管理成效及影响因素。方法 选取2024年1月—2025年12月我院收治的666例心力衰竭患者为调查对象，根据其成效将其分为有效组（n=612）和无效组（n=54）。统计两组患者临床资料及监测指标，采用单/多因素Logistic分析心力衰竭患者住院期间容量管理成效的影响因素。结果 本研究中，心力衰竭患者住院期间容量管理的有效率为91.89%（612/666）。两组年龄、病程、心功能分级及下肢水肿发生率比较（P＜0.05）；性别、体重指数、文化程度、吸烟史、饮酒史、基础疾病比较无明显差异（P＞0.05）。干预前及干预后，两组左室射血时间、左心室做功指数、左心室做功、每搏输出量、心脏指数、心输出量及脑钠肽比较（P＜0.05）。自变量设置为一般资料中对比有差异的指标包括年龄、病程、心功能分级及下肢水肿发生率、左室射血时间、左心室做功指数、左心室做功、每搏输出量、心脏指数、心输出量及脑钠肽，因变量为心力衰竭患者住院期间容量管理成效，进行单因素Logistic回归分析，结果显示，心力衰竭患者住院期间容量管理成效的影响因素是年龄、心功能分级及下肢水肿发生率、左室射血时间、左心室做功指数、左心室做功、每搏输出量、心脏指数、心输出量及脑钠肽。校正年龄、性别等混杂因子，将单因素方差中对比有差异的数据纳入多因素Logistic回归分析，结果显示，心力衰竭患者住院期间容量管理成效的影响因素是年龄、心功能分级及下肢水肿发生率、左室射血时间、左心室做功指数、左心室做功、心输出量及脑钠肽。结论 心力衰竭患者住院期间容量管理成效较好，心力衰竭患者住院期间容量管理成效的影响因素为年龄、心功能分级及下肢水肿发生率、左室射血时间、左心室做功指数、左心室做功、心输出量及脑钠肽。

目的 基于生物—心理—社会模式分析精神专科住院患者负荷现状及其关联因素。 方法 选取某三级精神专科医院住院患者为研究对象，构建涵盖住院天数、费用、护理风险、联合用药、危机干预及出院准备难度的住院负荷综合评分，采用多元线性回归和Logistic回归分析影响因素。 结果 患者住院负荷评分为57.16±15.36分，高负荷患者约占三分之一；生物、心理、社会因素联合模型可解释68.4%的负荷变异；明显睡眠问题、既往住院次数≥3次、治疗依从性差、家庭支持低、社会功能重度受损及缺乏社区衔接资源等为高住院负荷危险因素。 结论 精神专科住院负荷具有复合性和多因素累积特征，应建立多维评估与分层干预机制，以优化资源配置和连续照护。

Objective To analyze the current status of inpatient burden and its associated factors among psychiatric inpatients based on the biopsychosocial model. Methods Inpatients from a tertiary psychiatric hospital were selected as study subjects. A comprehensive inpatient burden score was developed, incorporating length of stay, cost, nursing risk, polypharmacy, crisis intervention, and difficulty in discharge preparation. Multivariate linear regression and logistic regression analyses were used to identify influencing factors. Results The mean inpatient burden score was 57.16 ± 15.36 points, with approximately one-third of patients experiencing high burden. The combined model of biological, psychological, and social factors explained 68.4% of the variance in burden. Significant sleep problems, prior hospitalizations ≥3 times, poor treatment adherence, low family support, severe impairment in social functioning, and lack of community follow-up resources were identified as risk factors for high inpatient burden. Conclusion Psychiatric inpatient burden is complex and characterized by cumulative multifactorial influences; therefore, a multidimensional assessment and tiered intervention system should be established to optimize resource allocation and ensure continuous care.

【摘要】 目的 评价基于智慧教室的PBL教学法在肾内科临床教学中的应用效果，并探讨该模式对提升临床科室带教同质化水平的潜在价值。方法 选取2023年9月—2024年10月在江苏大学附属医院肾内科轮转的临床医学专业学生及住院医师规范化培训学员共80名为研究对象，采用区组随机化方法分为实验组和对照组，每组40名。实验组在智慧教室环境中实施PBL教学，对照组采用传统讲授法。两组课堂学时完全一致（每周2次，每次2学时，共16学时），但实验组课前预习与课后拓展为自愿完成，未对课外学习时间进行量化记录。通过理论考核、临床技能评估、模拟临床演练评估及问卷调查评价教学效果。结果 Mini-CEX评估显示，实验组在临床判断（7.65±0.78 vs 6.82±0.85，P<0.001）和沟通技能（7.80±0.72 vs 6.95±0.88，P<0.001）维度改善最为明显，均从达标水平（4~6分）跨越至优秀水平（7~9分）；临床技能考核中腹膜透析置管术成绩实验组（45.82±1.45分）高于对照组（42.15±2.03分）（t=9.24，P<0.001，Cohen's d=2.08）。实验组理论考核成绩（89.45±3.12）分高于对照组（84.23±4.56）分（t=5.89，P<0.001, Cohen's d=1.32），临床技能考核成绩（45.82±1.45）分高于对照组（42.15±2.03）分（t=9.24, P<0.001, Cohen's d=2.08）。实验组在学习动机、课堂互动性和学习效率方面自评优于对照组（P<0.05），但团队合作能力培养两组差异无统计学意义（62.5% vs 52.5%, P=0.340）。结论 该联合模式能有效促进规培生临床核心胜任力的转化，可为临床科室高仿真技能带教提供实操路径。

      目的   基于决策树构建老年患者吞咽障碍预警模型。方法  采用便利取样法对宁夏银川市宁夏回族自治区人民医院老年科住院的200例老年患者进行调查。结果  200例老年患者中，吞咽障碍发生率为40.5%。依据是否发生吞咽障碍将其患者分为两组，两组患者在性别、年龄、文化程度、职业、医保类型、家庭年收入、日常生活能力、衰弱、抑郁、营养、体质指数（BMI）比较（χ ² 值分别为13.321、4.064、31.944、36.695、18.230、19.681、52.509、10.253、20.456、9.070、9.483），差异均有统计学意义（均P＜0.05）。决策树模型筛选出老年患者吞咽障碍的影响因素主要有自理能力、职业、文化程度和抑郁，决策树模型受试者工作特征曲线下面积为0.862，灵敏度为79.8%，特异度为79.0%，P＜0.001。结论  基于自理能力、职业、文化程度和抑郁构建的决策树模型，能有效预测老年患者吞咽障碍风险。

       Objective  To construct a swallowing disorder warning model for elderly patients based on decision tree．Methods  Convenience  sampling was  used to  study  200  elderly  patients  admitted to the  geriatric  department  of  a tertiary comprehensive hospital in Yinchuan，Ningxia．Results  Among 200 elderly patients，the incidence of swallowing disorders was 40.5%．The two groups of patients were compared in terms of gender，age，education level，occupation，medical insurance type，annual family income，daily living ability，frailty，depression，nutrition，and BMI（χ ²  values were 13.321，4.064，31.944，36.695，18.230，19.681，52.509，10.253，20.456，9.070，9.483，respectively），and the  differences were  statistically significant（all P＜0.05）．The decision tree model identified the main influencing factors of swallowing disorders in elderly patients as self-care ability，occupation，education level，and depression．The Receiver Operating Characteristic curve of the decision tree model had an area under the curve of 0.862，sensitivity of 79.8%，and specificity of 79.0%，P＜0.001．Conclusions  A decision tree model based on self-care ability，occupation，education level，and depression can effectively predict the  risk of swallowing disorders in elderly patients．

       目的   调查老年人照护服务需求现状并分析其影响因素，为构建基于需求为导向的老年照护服务体系提供参考依据。方法  采用便利抽样法，选取广州市某三甲医院212名老年人作为调查对象，采用日常生活能力量表、Fried衰弱评估量表及自行编制的老年人需求评估问卷进行调查。结果   老年人对运动与营养（1.96±0.90分）、心理慰藉（2.63±0.85分）、安宁服务（2.73±1.07分）的需求水平较高。多因素线性回归分析结果显示养老方式、日常生活活动能力、爱好数量、性别、衰弱等级、有无主要照顾者是照护服务需求的影响因素（P均＜0.05），可解释61.5%的变异量。结论   老年人的照护服务需求受多种因素的影响。应根据老年人的不同特征，构建供需匹配的多元化，多层次照护体系。

       Objective  To investigate the status quo of care service needs of the elderly and analyze its influencing factors，so as to provide a reference for the construction of a needs-oriented care service system for the elderly．Methods  A total of 212 elderly people from a tertiary hospital in Guangzhou were selected by convenience sampling method and investigated with the Activity of Daily Living scale，Fried frailty scale and the self-designed elderly needs assessment questionnaire．Results  Elderly patients had higher demands for exercise，nutrition，psychological comfort and hospice services．The results of multivariate analysis showed that the influencing factors of care service demand included pension style，activities of daily living，number of hobbies，gender，frailty level，and having main caregivers（all P＜0.05），which could explain 61.5% of the variation．Conclusions  The care needs of elderly patients are affected by many factors．A diversified and multi-level care system with matching supply and demand should be constructed according to the different characteristics of the elderly．

       目的   探讨营养评估及炎症因子水平对非霍奇金淋巴瘤（NHL）患者化学治疗（化疗）后感染及平均住院日的影响。方法   回顾性分析接受R-CHOP治疗的NHL患者95例。通过受试者工作特征（ROC）曲线确定患者主观整体营养评估（PG-SGA）预测患者化疗后感染的界值。将患者分为PG-SGA＜4组与PG-SGA≥4组，比较两组间营养及炎症相关指标的差异。采用单因素与多因素回归分析NHL患者化疗后感染及平均住院日延长的危险因素。结果  ROC曲线显示PG-SGA为3.5时，约登指数最大，预测NHL患者化疗后感染灵敏度为92%，特异度为11.1%。PG-SGA≥4组患者平均年龄、国际预后指数（IPI）及Ann arbor Ⅲ~Ⅳ期比例均高于PG-SGA＜4组（P＜0.05）。与PG-SGA＜4组相比，PG-SGA≥4组患者白介素6（IL-6）及中性粒细胞与淋巴细胞比值（NLR）明显升高，且化疗后感染率及平均住院日≥5 d比例高于对照组（P＜0.05）；与对照组相比，PG-SGA＜4组患者前白蛋白、白蛋白和血红蛋白水平升高（P均＜0.05）。多因素回归分析显示，PG-SGA≥4及合并糖尿病是NHL患者化疗后感染率的独立危险因素（P均＜0.05）。白蛋白低于35 g/L及合并化疗后感染是NHL患者平均住院日延长的独立危险因素（P均＜0.05）。结论   基于PG-SGA的营养评估及炎症因子分析对NHL患者化疗后感染及平均住院日的预测具有临床指导意义。

       Objective  To explore the effects of nutritional assessment and inflammatory factor levels on post-chemotherapy infections and length of hospital stay in patients with non-Hodgkin’s lymphoma（NHL）．Methods  A total of 95 NHL patients treated with the R-CHOP regimen were retrospectively analyzed．The  cut-off  value  of  Patient-Generated  Subjective Global Assessment （PG-SGA） for post-chemotherapy infection in NHL patients was evaluated by Receiver Operating Characteristic（ROC）curves．Patients were categorized into PG-SGA＜4 and PG-SGA≥4 groups and compared for differences of nutritional and inflammation-related factors．Univariate and multivariate logistic regression were used to analyze the risk factors for post-chemotherapy infection and length of hospital stay（LHS）．Results  The ROC curve showed that the Youden index was largest at PG-SGA of 3.5，which predicted post-chemotherapy infection in NHL patients with a sensitivity of 92% and a specificity of 11.1%．The mean age，International Prognostic Index（IPI），and Ann Arbor stage Ⅲ~IV proportion in patients with PG-SGA≥4 were higher compared with the control（P＜0.05）．Patients with PG-SGA≥4 had significantly higher interleukin-6 and neutrophil-to-lymphocyte ratio（NLR），and the infection rate and the proportion of LHS≥5 days after chemotherapy were higher than those in the control group（P＜0.05）．Patients in the PG-SGA＜4 group had significantly higher prealbumin，albumin，and hemoglobin levels compared to the PG-SGA≥4 group（P＜0.05）．Multifactorial logistic regression analysis revealed that PG-SGA≥4 and combined diabetes mellitus were independent risk factors for post-chemotherapy infection rate in NHL patients（both P＜0.05）．Albumin less than 35 g/L and combined post-chemotherapy infection were independent risk factors for prolonged LHS in NHL patients（both P＜0.05）．Conclusions  PG-SGA nutritional assessment and inflammatory factor analysis are clinically instructive in predicting post-chemotherapy infections and LHS in NHL patients．

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 探讨基于迷你临床演练评估（Mini-CEX）的可视化思维导图联合案例教学在全科住院医师规范化培训中的应用效果。方法 选取参加全科住院医师规范化培训的52例学员并分为试验组（n=26）和对照组（n=26）。对照组采取以案例讲授为主的传统教学模式,试验组采取基于Mini-CEX的可视化思维导图联合案例教学模式。对比两组Mini-CEX评分、考核成绩及教学满意度。结果 试验组Mini-CEX测评的问诊技巧、体格检查、临床判断、诊治能力、技能操作及整体表现得分均高于对照组（P<0.05）。试验组理论知识[（86.89±4.75）分 vs （82.96±4.87分）]、专业技能[（84.20±3.46）分 vs （70.18±4.93）分]及病历书写成绩[（80.64±5.26）分 vs （75.58±5.94）分]均高于对照组（t分别为2.678、13.685、2.764,P分别为0.009、<0.001、0.007）。试验组住院医师教学满意度高于对照组（P<0.05）。结论 基于Mini-CEX的可视化思维导图联合案例教学模式用于全科住院医师规范化培训,有助于提高教学效果及教学满意度。

Objective To evaluate the effect of visual mind mapping combined with case teaching based on mini-clinical evaluation exercise（Mini-CEX）for standardized training of general practitioners．Methods A total of 52 students who participated the standardized training of general practitioners were selected and divided into an experimental group（n=26）and a control group（n=26）．The control group adopted the traditional teaching mode based on case teaching and the experimental group adopted the visual mind mapping combined with case teaching based on Mini-CEX．The Mini-CEX score,assessment results and teaching satisfaction of two groups were compared．Results The interrogation skills,physical examination,clinical judgment,diagnosis and treatment ability,skill operation and overall performance of Mini-CEX in experimental group were higher than control group（P<0.05）．Theoretical knowledge score（[86.89±4.75] vs [82.96±4.87]）,professional skills score（[84.20±3.46] vs [70.18±4.93]）and medical record writing score（[80.64±5.26] vs [75.58±5.94]）of experimental groups were higher than control group（t=2.678,13.685,2.764,P=0.009,<0.001,0.007）．The teaching satisfaction of residents in experimental group was higher than control group（P<0.05）．Conclusions The visual mind mapping combined with case teaching based on Mini-CEX for standardized training of general practitioners is helpful to improve teaching effect and teaching satisfaction．

目的 探讨住院儿童甲型流感病毒肺炎合并其他病原菌感染的临床特征。方法 通过回顾性研究方法,分析2021年6月—2023年6月广州市妇女儿童医疗中心住院治疗的153例甲型流感病毒肺炎患儿的临床资料,针对有无合并其他病原菌感染,分为混合感染组及非混合感染组两组,分别为98例及55例,分析并对比两组的临床特征。结果 甲型流感病毒肺炎患儿以发热、咳嗽、呕吐/腹泻等症状为主,其中混合感染组患儿呕吐/腹泻症状占比高于非混合感染组（P<0.05）;两组患儿其他症状及并发症对比差异无统计学意义（P>0.05）;儿童甲型流感病毒肺炎患儿检出合并细菌感染的患儿65例（29.41%）,合并肺炎支原体感染的患儿33例（21.57%）;合并病毒感染的患儿20例（13.07%）。与非混合感染组比较,混合感染组患儿乳酸脱氢酶水平更高,白细胞计数<4×10⁹/L的人数占比更少（P<0.05）;其他实验室指标对比差异无统计学意义（P>0.05）;经过抗病毒及对症治疗后,150例（98.04%）患儿痊愈出院,3例出现严重并发症,其均伴有其他病原菌感染。与非混合感染组比较,混合感染组患儿住院天数更长、住院费用更高（P<0.05）;其他预后指标对比差异无统计学意义（P>0.05）。结论 甲型流感病毒肺炎患儿易感染其他的病原菌,导致疾病治疗难度加大,因此临床要提高警惕,以防混合感染情况发生,尽早采取有效的诊治措施,提高疾病早期治愈率。

Objective To explore the clinical characteristics of hospitalized children with influenza A virus pneumonia complicated with other pathogens．Methods The clinical data of 153 children with influenza A virus pneumonia hospitalized in Guangzhou Women and Children Medical Center in the past two years（June 2021 ~ June 2023）were analyzed retrospectively． According to whether they were infected with other pathogens,they were divided into mixed infection group and non-mixed infection group,with 98 cases and 55 cases respectively．The clinical characteristics of the two groups were analyzed and compared．Results Fever,cough,vomiting and diarrhea were the main symptoms in children with influenza A virus pneumonia,and the proportion of vomiting and diarrhea in children with mixed infection group was higher than that in children without mixed infection group（P<0.05）．There was no significant difference in other symptoms and complications between the two groups（P>0.05）．There were 65 children（29.41%）with influenza A virus pneumonia and 33 children（21.57%）with mycoplasma pneumonia,20 children（13.07%）with virus infection．Compared with non-mixed infection group,the level of lactate dehydrogenase in children with mixed infection group was higher,and the proportion of children with white blood cell count<4×10⁹/L was less（P<0.05）．There was no significant difference in other laboratory indexes（P>0.05）．After antiviral and symptomatic treatment,150 cases（98.04%）were cured and discharged,and 3 cases had serious complications,all of which were accompanied by other pathogens．Compared with non-mixed infection group,children in mixed infection group had longer hospitalization days and higher hospitalization expenses（P<0.05）．There was no significant difference in other prognostic indicators（P>0.05）．Conclusions Children with influenza A virus pneumonia are easily infected with other pathogens,which makes it more difficult to treat the disease．Therefore,we should be vigilant in clinic to prevent mixed infection and take effective diagnosis and treatment measures as soon as possible to improve the early cure rate of the disease．