目的 探讨预后营养指数（PNI）对脓毒症合并心力衰竭患者发生谵妄的预测价值，并评估其在指导护理风险分层中的作用。方法 采用回顾性队列研究，纳入2022年2月—2024年9月广东省第二中医院收治的162例脓毒症合并心力衰竭患者。通过ROC曲线确定PNI预测谵妄的最佳截断值，并以此将患者分为高低PNI组。比较两组基线特征，采用Kaplan-Meier曲线分析谵妄累积发生率和28天院内死亡率，通过Cox比例风险模型评估PNI与谵妄及预后的独立关联，并利用ROC曲线评价其预测性能。最后利用亚组分析技术进一步评估PNI预测价值的普适性。结果 低PNI（≤35.72）是谵妄发生的独立危险因素。竞争风险模型显示，低PNI组10 d谵妄累积发生率达37.8%，高于高PNI组的10.0%。多因素分析表明，PNI每降低一个单位，谵妄风险增加约17.2%。限制性立方样条分析提示PNI与谵妄风险呈线性负相关。ROC曲线分析显示PNI预测谵妄的AUC为0.721，其预测效能优于白蛋白和SOFA评分。亚组分析进一步证实PNI的保护效应在不同临床特征患者中具有一致性。结论 PNI是脓毒症合并心力衰竭患者谵妄风险的独立预测指标，其预测效能优于传统单一指标。基于PNI的风险分层有助于早期识别谵妄高危患者，为实现精准护理干预提供重要依据。

      Objective To explore the predictive value of the prognostic nutritional index（PNI）for delirium in patients with sepsis complicated by heart failure，and to evaluate its role in guiding nursing risk stratification．Methods A retrospective cohort study was conducted，including 162 patients with sepsis and heart failure admitted to Guangdong Provincial Second Hospital of Traditional Chinese Medicine between February 2022 and September 2024．The optimal PNI cut-off value for predicting delirium was determined using ROC curve analysis，and patients were divided into high and low PNI groups accordingly．Baseline characteristics of the two groups were compared．Kaplan-Meier curves were used to analyze the cumulative incidence of delirium and 28-day in-hospital mortality．Cox proportional hazards models were employed to assess the independent association between PNI and delirium as well as prognosis，and ROC curves were used to evaluate its predictive performance．Subgroup analysis was further utilized to assess the generalizability of PNI’s predictive value．Results A low PNI（≤35.72）is an independent risk factor for delirium．The competing risk model showed that the cumulative incidence of delirium in the low PNI group was 37.8% at 10 days，significantly higher than the 10.0% in the high PNI group．Multivariate analysis indicated that for each unit decrease in PNI，the risk of delirium increased by 17.2% approximately．Restricted cubic spline analysis suggested a linear negative correlation between PNI and delirium risk．ROC curve analysis demonstrated that the AUC of PNI for predicting delirium was 0.721，with its predictive performance surpassing that of albumin and SOFA score．Subgroup analysis further confirmed that the protective effect of PNI was consistent across patients with different clinical characteristics．Conclusions PNI is an independent predictor of delirium risk in patients with sepsis and heart failure，with superior predictive performance compared to traditional single indicators．Risk stratification based on PNI aids in the early identification of patients at high risk for delirium，providing an important basis for precise nursing interventions．

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．

本文综述近10年中医传统疗法中通过穴位刺激预防与治疗老年患者骨折术后谵妄的研究概况。术后谵妄是老年患者骨折术后常见的并发症,不仅延长患者住院时间、增加经济负担,同时与骨折术后死亡并发症的发生密切相关。但是本病机制尚未明确,在临床治疗上难以达成共识。针灸等穴位刺激是中医药治疗脑病的独具特色的疗法,近年来有关穴位刺激防治老年骨折术后谵妄的报道越来越多,本文主要探讨不同的穴位刺激方法干预对骨折术后谵妄发生率的影响,包括传统刺激方式如毫针、电针、穴位注射、穴位敷贴和新针疗法如耳针、头针等,认为穴位刺激能够较好预防骨折术后谵妄发生,在治疗上也有较好疗效。以期为进一步临床研究与应用提供参考。

This article summarized the research of acupoint stimulation in preventing delirium after fracture surgery in elderly patients in recent 10 years．Postoperative delirium is a common complication in elderly patients after fracture surgery, which affects life extremely and increases economic burden．However, the mechanism of this disease haven't been revealed, and it is difficult to reach consensus on clinical treatment．Acupoint stimulation, like acupuncture, is a unique treatment of encephalopathy with traditional Chinese medicine．In recent years, there are more and more reports on acupoint stimulation therapy to prevent and treat delirium after fracture surgery in the elderly．This article mainly study the influence of different acupoint stimulation therapy on treatment of delirium after fracture surgery, including electroacupuncture, auriculotherapy, scalp acupuncture, acupoint injection and acupoint application, etc．It is believed that acupoint stimulation can prevent delirium after fracture surgery, so as to provide reference for further clinical research and application．