目的 探讨天麻止痫汤分别联合托吡酯和卡马西平治疗对癫痫患者记忆能力及甘丙肽、铁调节转运体1（IREG1）的影响。方法 选择我院2019年6月—2022年6月收治的85例癫痫患者,其中21例予天麻止痫汤联合托吡酯治疗（A组）,23例予天麻止痫汤联合卡马西平治疗（B组）,22例予托吡酯治疗（C组）,19例予卡马西平治疗（D组）。评价4组的治疗效果、记忆能力、甘丙肽和IREG1水平等指标,并进行统计比较。结果 4组治疗总有效率和完全控制率比较差异均无统计学意义（P>0.05）。两两比较,A组总有效率高于C组和D组（P<0.05）,B组总有效率高于C组和D组（P<0.05）,A组和B组总有效率比较差异无统计学意义（P>0.05）;A组患者治疗后中医症候积分、癫痫发作次数及发作持续时间均少于其他3组（P<0.05）;A组患者治疗后视觉再认、图片回忆、视觉再生、联想学习、理解、顺背和倒背数字和记忆商数（MQ）均较治疗前升高,且高于其他3组（P<0.05）;4组治疗后甘丙肽水平升高（P<0.05）,IREG1蛋白表达量降低（P<0.05）,A组治疗后甘丙肽水平高于其他3组,IREG1蛋白表达量低于其他3组（P<0.05）;4组不良反应发生率比较差异无统计学意义（P>0.05）。结论 天麻止痫汤联合托吡酯或卡马西平治疗癫痫的总有效率、安全性均较好,且对患者记忆能力影响较小;而天麻止痫汤在改善癫痫症状、减少癫痫发作次数及发作持续时间、抑制甘丙肽和IREG1异常表达方面更具优势。

Objective To investigate the effects of Tianma Zhixian Decoction combined with topiramate and carbamazepine on memory ability and galanin and iron exporter ferroportin 1（IREG1）in patients with epilepsy．Methods A total of 85 patients with epilepsy were admitted to our hospital from June 2019 to June 2022,including 21 patients treated with Tianma Zhixian Decoction combined with topiramate（Group A）,23 patients treated with Tianma Zhixian Decoction combined with carbamazepine（Group B）,22 patients treated with topiramate（Group C）,and 19 patients treated with carbamazepine（Group D）．The therapeutic effect,memory ability,galanin and IREG1 levels were compared among the four groups．Results There were no significant differences in the total treatment response rate and complete control rate between the four groups（P>0.05）．By pairwise comparison,the total response rate in Group A was significantly higher than those in Group C and Group D（P<0.05）,the rate in Group B was significantly higher than those in Group C and Group D（P<0.05）,there was no significant difference in the total response rate between group A and B（P>0.05）．In group A,the TCM syndrome score,seizure attacks and duration of seizure were significantly less than those of the other three groups（P<0.05）．In Group A,visual re-recognition,picture recall,visual regeneration,associative learning,understanding,numbers recitation forward or backward and MQ values were all significantly improved compared with those before treatment,which was significantly higher than that in the other three groups（P<0.05）．Galanin levels significantly increased in the four groups（P<0.05）after treatment,while IREG 1 protein expression decreased（P<0.05）．Galanin level in group A was significantly higher than the other three groups,IREG 1 protein expression was significantly lower than that in the other three groups（P<0.05）．There was no significant difference in the incidence of adverse reactions among the four groups（P>0.05）．Conclusions Tianma Zhixian Decoction combined with topiramate or carbamazepine is effective and safe in the treatment of epilepsy,with little effect on the memory ability of patients．Tianma Zhixian Decoction has more advantages in improving the complete control rate of epilepsy,improving epilepsy symptoms,reducing the number and duration of seizures,and inhibiting the abnormal expression of galanin and IREG1．

目的 观察LACE风险模型下的护理干预策略在心脏瓣膜置换术后患者中的应用效果。方法 选取我院2021年3月—2022年3月心脏瓣膜置换术后患者82例作为研究对象,以患者入院顺序编号分为对照组、观察组,各41例。对照组予以常规护理,观察组予以LACE风险模型下的护理干预。比较2组出院时、干预后的自我管理能力及负性情绪;干预期间的术后并发症发生率、再入院率、用药依从性。结果 干预后观察组自我管理环境、自我管理行为、自我管理认知评分高于对照组（P<0.05）;观察组术后并发症发生率7.32%（3/41）、再入院率4.88%（2/41）均低于对照组24.39%（10/41）、21.95%（9/41,P<0.05）;观察组用药依从率97.56%（40/41）高于对照组78.05%（32/41,P<0.05）;干预后观察组汉密尔顿抑郁量表评分、汉密尔顿焦虑量表评分低于对照组（P<0.05）。结论 心脏瓣膜置换术后患者进行LACE风险模型下的护理干预后,患者的自我管理能力及用药依从性明显改善,同时其并发症发生率和再入院率有效降低,焦虑、抑郁等负性情绪得到缓解,具有良好护理效果。

Objective To observe the effect of nursing intervention strategy under LACE risk model in patients after heart valve replacement．Methods From March 2021 to March 2022,82 patients with heart valve replacement were enrolled as the study objects．The patients were divided into control group and observation group according to the order of admission,with 41 patients in each group．The control group was given routine nursing,and the observation group was given nursing intervention under LACE risk model．The self-management ability and negative emotions at discharge and after intervention were compared between the two groups．The incidence of postoperative complications,readmission rate and medication compliance during the intervention period were also compared．Results After intervention,the scores of self-management environment,self-management behavior and self-management cognition in the observation group were higher than those in the control group（P<0.05）．The postoperative complication rate of 7.32%（3/41）and readmission rate of 4.88%（2/41）in the observation group were lower than those of 24.39%（10/41）and 21.95%（9/41）in the control group（P<0.05）．The compliance rate of the observation group（97.56%）was higher than that of the control group（78.05%,P<0.05）．After intervention,the scores of Hamilton Depression Scale and Hamilton Anxiety Scale in the observation group were lower than those in the control group（P<0.05）．Conclusions After nursing intervention under LACE risk model for patients after heart valve replacement,the self-management ability and medication compliance of patients have been significantly improved,the incidence of complications and readmission rate have been effectively reduced,and negative emotions such as anxiety and depression have been alleviated,which has good nursing effect．

目的 明确上海市闵行区社区老人轻度认知功能障碍（MCI）发生现状,分析MCI发生的影响因素间的交互作用关系。方法 采用横断面研究方法,应用AD-8与CSI-D对该区2021年65岁以上老人MCI发生现状进行双量表评估。应用SPSS 26.0 软件,先后采用χ²检验分析受检老人吸烟、饮酒、慢性病等因素在不同检出情况的构成、二分类非条件Logistic回归分析MCI发生的影响因素,再将各因素依次纳入双因素交互作用分析模型,分析各变量对MCI发生的交互作用。结果 应用AD8与CSI-D双量表评估法具有较高的灵敏度,评估闵行区社区老人MCI阳性率为26.6%,高于其他研究,低年龄（OR=1.09,95%CI：1.04~1.14）、良好的健康心态（OR=1.67,95%CI：1.15~2.42）是减少老人MCI的保护因素,职业类型（OR=1.19,95%CI：1.04~1.38）、照料者类型（OR=1.56,95%CI：1.09~2.22）与老人MCI的发生存在相关关系。家庭月总收入与照料者类型之间、是否饮酒与照料者类型之间对老人MCI的发生存在交互作用（P均<0.05）。结论 保持良好的心态可以降低老人MCI发生风险,不同职业类型、照料者类型与老人MCI的发生具有相关关系,照料者选择保姆可能会增加老人MCI风险。

Objective To clarify the current situation of mild cognitive impairment（MCI）in the community elderly in Minhang District,Shanghai,and analyze the interaction relationship between the influencing factors of MCI．Methods A cross-sectional study method was used,and AD8 and CSI-D were used to evaluate the current situation of MCI in the elderly over 65 years old in this district in 2021．SPSS 26.0 software,chi-square test and binary unconditional Logistic regression model were used to analyze the composition of smoking,drinking,chronic diseases and other factors in different detected conditions and the influencing factors of MCI occurrence in the elderly．A factor interaction analysis model was used to analyze the interaction of each variable on the occurrence of MCI．Results The AD8 and CSI-D double-scale evaluation method had high sensitivity．The positive rate of MCI in the community elderly in Minhang District was 26.6%,which was higher than other studies．Younger age（OR=1.09,95%CI：1.04~1.14）,good health mentality（OR=1.67,95%CI：1.15~2.42）were protective factors for reducing MCI in the elderly,occupation type（OR=1.19,95%CI：1.04~1.38）,caregiver type（OR=1.56,95%CI：1.09~2.22）were correlated with the occurrence of MCI in the elderly．There were interaction effects between the total monthly household income and the type of caregivers,whether drinking or not and the type of caregivers on the occurrence of MCI in the elderly（all P<0.05）．Conclusions Maintaining a good attitude can reduce the risk of MCI in the elderly．Different occupational types and types of caregivers are related to the occurrence of MCI in the elderly．Caregivers choosing nanny may increase the risk of MCI in the elderly．

目的 以单中心法研究心房颤动患者住院病死率的影响因素。方法 纳入2019年3月—2022年3月于我院住院治疗的338例心房颤动患者作为研究对象,统计住院病死率,并以单因素Logistic回归分析法,分析对患者病死率产生影响的风险因素。结果 统计结果显示,在338例患者中,住院死亡人数为13例,死亡率3.85%;经单因素分析发现,患者的年龄高龄、有慢性肾病病史以及机体贫血均是导致患者住院病死的主要影响因素;脂代谢异常、左房内径稍大、左室射血分数较高则是降低患者住院病死率的重要影响因素。结论 贫血、慢性肾病以及高龄均会提升房颤患者住院期间的病死率,而心功能较强的患者住院死亡率则明显降低,临床治疗期间需高度关注上述因素。

目的 了解门诊老年患者补充与替代医学（CAM）使用现状及影响因素。方法 采用便利抽样法,选取2020年11月—2021年2月广东省某三甲医院老年科门诊就诊的老年患者作为研究对象,调查方法采用一般资料调查表和CAM使用情况调查表进行横断面调查。应用二元Logistics回归分析探讨门诊老年患者使用CAM的影响因素。结果 参与调查的123例老年患者中,有75例（61.0%）老年患者使用CAM,使用CAM的项目主要为中草药、药膳等中国传统医学项目。支付方式是门诊老年患者是否使用CAM的影响因素,使用医保支付的患者较公费、自费患者更愿意使用CAM（OR=5.054,95%CI：1.452~17.590,P<0.05）。结论 CAM在门诊应用广泛,我们应充分发挥我国传统医学优势,为老年人疾病防治提供更多的思路。政府层面也可进一步提高医保覆盖范围,让更多的患者有经济能力可以接受安全、有效的治疗。

Objective To investigate the current status of complementary and alternative medicine（CAM）use and the influencing factors of elderly patients in outpatient clinic．Methods Using the convenience sampling method,the elderly patients treated in the geriatric outpatient department of a Class A tertiary Hospital in Guangdong from November 2020 to February 2021 were selected．General data and the CAM usage questionnaire were collected．Binary logistics regression analysis was used to explore the factors influencing CAM use in elderly patients．Results Seventy-five（61.0%）of 123 elderly patients used CAM．Chinese herbal medicine and medicinal diet were the most common CAM．Payment method was a factor affecting whether elderly outpatient patients use CAM．Insured patients were more willing to use CAM than self-funded patients（OR=5.054,95%CI：1.452-17.590,P<0.05）．Conclusions CAM is widely used in outpatient clinics．We should make full use of our country’s traditional medicine,to provide different thoughts of diseases prevention and treatment in elderly patients．The government can also further enlarge the coverage of health insurance,so that more patients can afford safe and effective treatment．

目的 探究新斯的明拮抗顺阿曲库铵的时机对患者腹腔镜结直肠癌根治术后肌松残留和早期肺功能的影响。方法 选取于2021年2月—2022年9月在我院行结肠癌根治手术的194例患者为研究对象,以随机数字表法将患者分为空白对照组和试验组,然后结合给予新斯的明治疗时所体现的4个成串刺激（TOF）比值将试验组患者分为试验组A（TOF≤0.1）、试验组B（0.10.8）。对比组间肌松残余情况以及肺功能情况。结果 插管前,试验组A患者TOF比值低于其他组（P<0.01）,空白对照组患者TOF比值高于其他组（P<0.01）;空白对照组分别与试验组A~E在复苏室接受观察的时间比较,差异无统计学意义（P>0.01）;试验组A患者肌松恢复指数低于其他组（P<0.01）,空白对照组患者肌松恢复指数高于其他组（P<0.01）。插管前、拔管0.5 h以及拔管24 h时,组间1秒用力呼气容积（FEV1）、用力肺活量（FVC）和FEV1/FVC比较差异无统计学意义（P>0.05）。结论 结直肠癌根治术后给予新斯的明,有助于加快肌松恢复,但不会影响复苏室停留时间与肺功能水平。

Objective To investigate the effect of timing of neostigmine antagonizing cisatracurium on residual muscle relaxation and early lung function in patients underwent laparoscopic radical resection of colorectal cancer．Methods February 2021 to September 2022,194 patients who underwent radical colon cancer surgery in our hospital were selected as the research subjects．The patients were randomly divided into a blank control group and an experimental group using a random number table method．Then,combined with the train-of-four（TOF）ratios observed during neostigmine treatment,the experimental group patients were divided into experimental group A（TOF≤0.1）,experimental group B（0.10.8）．The residual muscle relaxation and lung function between groups were compared．Results Before intubation,the TOF ratio of patients in experimental group A was lower than that of other groups（P<0.01）,while the TOF ratio of patients in the blank control group was higher than that of other groups（P<0.01）．There was no significant difference in the observation time between the blank control group and the experimental group A~E in the postanesthesia care unit（P>0.01）．The muscle relaxation recovery index of patients in experimental group A was lower than that of other groups（P<0.01）,while the muscle relaxation recovery index of patients in the blank control group was higher than that of other groups（P<0.01）．There were no significant differences in force expiratory volume in one second（FEV1）,forced Vital capacity（FVC）and FEV1/FVC between groups before intubation,0.5 h after extubation and 24 h after extubation（P>0.05）．Conclusions Administration of neostigmine after radical surgery for colorectal cancer can accelerate muscle relaxation recovery,but it will not affect the residence time of the postanesthesia care unit and lung function levels．

糖尿病已成为全球最严重的健康问题之一。需要白内障手术的糖尿病患者也日益增多,虽然糖尿病的眼表并发症很常见,但由于糖尿病患者全身和眼部疾病十分复杂,使得眼前段如角结膜和泪腺的糖尿病并发症往往被忽视。糖尿病患者白内障超声乳化术有引发或加重眼前节疾病的风险,包括干眼病（DED）、角膜上皮糜烂、上皮缺损迁延不愈,甚至威胁视力的角膜溃疡。这些风险里最为常见的是DED,并且可能因白内障超声乳化手术而加重。眼科医生需要在手术前预先评估已存在的DED是否需要术前治疗,并且需要注意在已存在 DED 的情况下,各项术前检查数据测量的准确性会降低,以及尽可能减少对眼表造成损害的各种手术因素;并考虑通过管理减少术后 DED。本综述就评估白内障超声乳化术对合并糖尿病的老年性白内障患者的眼表术中的影响因素进行分析。

Diabetes mellitus(DM)has become one of the most serious health problems in the world. The number of diabetic patients requiring cataract surgery is also increasing. Although ocular surface complications of DM are common,the complexity of systemic and ocular disease in diabetic patients makes diabetic complications in the anterior segment,such as the cornea and lacrimal gland,often be overlooked. Phacoemulsification in diabetic patients carries the risk of triggering or exacerbating ocular segment disease,including dry eye disease,corneal epithelial erosion,persistent epithelial defects and even vision-threatening corneal ulcers. The most common of these risks is dry eye disease,and it can be exacerbated by cataract phacoemulsification. Ophthalmologists need to preemptively assess the need for preoperative treatment of pre-existing dry eye disease(DED),be aware of the reduced accuracy of preoperative data measurements in the presence of DED,and minimize surgical factors that can damage the ocular surface;and consider management to reduce postoperative DED. In this review,we analyze the factors that influence phacoemulsification in ocular surface surgery for senile cataract patients with diabetes.

目的 探讨基于心肺运动试验（CPET）的康复运动应用于维持性血液透析（MHD）患者免疫功能及疲劳程度的影响。方法 选取2020年1月—2022年6月我院200例MHD患者作为研究对象,随机将其分入研究组（n=100）和对照组（n=100）。对照组患者采用常规运动模式进行管理,研究组患者采用基于CPET的康复运动。比较2组的疲劳程度、炎症反应、免疫功能以及心功能。结果 干预3个月后,2组患者透析后的疲劳程度均优于干预前,且研究组优于对照组（均P<0.05）。干预3个月后,2组C-反应蛋白均低于干预前,且研究组低于对照组,免疫球蛋白G（IgG）、IgA、IgM、CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺均高于干预前,且研究组高于对照组（均P<0.05）。干预3个月后,2组左室射血分数、6 min步行距离均高于干预前,且研究组高于对照组（均P<0.05）。干预3个月后,2组左室舒张末期内径、左室收缩末期内径比较差异均无统计学意义（均P>0.05）。结论 基于CPET的康复运动应用于MHD患者中可缓解炎症反应及透析后疲劳程度,提升免疫功能及心功能。

目的 探讨个体化肠内营养联合电动起立床训练对老年脑卒中卧床患者器官功能的影响。方法 严格执行纳排标准后前瞻性选取2021年7月—2022年9月期间我院收治的97例老年脑卒中卧床患者作为研究对象,按照随机数字表法分为单一组48例给予脑卒中基础干预,联合组49例给予个体化肠内营养联合电动起立床训练干预,观察2组患者营养状况、肺功能指标以及心功能指标。结果 干预4周后,2组血清前蛋白、血清白蛋白、血红蛋白水平均上升且联合组高于单一组（P<0.05）;2组用力肺活量（FVC）、第1秒用力呼吸容积（FEV₁）、FEV₁/FVC均上升且联合组高于单一组（P<0.05）;联合组左心室收缩期内径、左室舒张末期内径低于单一组,联合组左心室射血分数高于单一组（P<0.05）。结论 个体化肠内营养联合电动起立床训练干预可有效改善老年脑卒中卧床患者营养状况及心肺功能,促进其机体功能的恢复。

目的 分析互联网+联合分段式心理干预对结肠癌患者生活质量及希望水平的影响。方法 采用随机数字表法对照试验,于2019年12月—2022年12月选取本院收治的100例结肠癌患者,分为参照组（50例,给予常规心理护理）与试验组（50例,给予互联网+联合分段式心理护理）,比较2组患者在护理前后的精神状态、生活质量、希望水平及护理满意度。结果 护理后,2组患者的简明精神病评定量表（BPRS）评分均降低,且试验组评分优于参照组（P<0.05）;2组患者的简明健康状况调查表（SF-36）各维度评分均升高,并且试验组评分更高（P<0.05）;2组患者的Herth希望量表（HHI）各维度评分均升高,且试验组评分高于参照组（P<0.05）;试验组患者（96.00%）护理满意度高于参照组（80.00%）（P<0.05）。结论 结肠癌患者采用互联网+联合分段式心理干预可改善患者精神状态,提高结肠癌患者生活质量、希望水平。

Objective To analyze the effect of internet combined with segmented psychological intervention on the quality of life and hope level of colon cancer patients. Methods In a randomized controlled trial,100 patients with colon cancer admitted to our hospital from December 2019 to December 2022 were selected as the subjects of this study. According to the nursing methods,they were divided into control group(50 cases,given conventional psychological nursing intervention)and experimental group(50 cases,given internet combined segmented psychological intervention). The mental status,quality of life,hope level and nursing satisfaction of the patients in the two groups were compared. Results After nursing,the score of Brief Psychiatric Rating Scale was decreased in both groups,and the score of experimental group was better(P<0. 05). The scores of all dimensions of the concise Health Survey Questionnaire increased in both groups,and the scores of the experimental group were higher(P<0. 05). The scores of Herth Hope index were increased in both groups,and the scores of experimental group were higher(P<0. 05). The nursing satisfaction of experimental group(96. 00%)was higher than that of control group(80. 00%,P<0. 05). Conclusions The use of internet combined segmental psychological intervention in colon cancer patients can improve the mental state,improve the quality of life and hope level,with promotion value.