目的 观察阶梯式呼吸管理策略在改善感染性休克伴急性肺损伤（ALI）患者中的价值。方法 纳入我院2019年1月—2020年12月收治的感染性休克伴ALI患者共146例为研究对象,数字表法随机分为观察组（73例）与对照组（73例）。对照组常规护理方案,观察组阶梯式呼吸管理,对比干预前后患者心肺功能的差异。结果 观察组平均动脉压、PaCO₂水平低于对照组,心脏指数、中心静脉压、血管外肺水指数、PaO₂与氧合指数高于对照组（P<0.05）;观察组复苏成功率与临床总有效率高于对照组,复苏时间与呼吸平稳时间低于对照组（P<0.05）;观察组气管切开率、有创呼吸机使用率及呼吸机相关性肺炎与气道并发症发生率均低于对照组（P<0.05）。结论 感染性休克并急性肺损伤患者建立阶梯化呼吸管理策略能够显著改善患者的心肺功能,提高临床复苏效果,降低相关并发症风险。

Objective To observe the value of stepwise respiratory management strategy in improving patients with septic shock and acute lung injury（ALI）．Methods A total of 146 patients with septic shock and ALI treated in our hospital from January 2019 to December 2020 were included as the research objects．They were randomly divided into observation group（73 cases）and control group（73 cases）by digital table method．The control group received routine nursing plan,and the observation group received stepwise respiratory management．The differences of cardiopulmonary function before and after the intervention were compared．Results The levels of mean arterial pressure,PaCO₂ in the observation group were significantly lower than those in the control group,cardiac index,central venous pressure,extravascular lung water index,PaO₂ and oxygenation index in the observation group were significantly higher than those in the control group（P<0.05）．The success rate of resuscitation and total clinical effective rate in the observation group were significantly higher than those in the control group,and the resuscitation time and respiratory stability time in the observation group were significantly shorter than those in the control group（P<0.05）．The tracheotomy rate,the rate of using invasive ventilator and the incidence of ventilator associated pneumonia and airway complications in the observation group were lower than those in the control group（P<0.05）．Conclusions The establishment of stepwise respiratory management strategy in patients with septic shock and ALI can significantly improve their cardiopulmonary function,improve the effect of clinical resuscitation and reduce the risk of related complications.

目的 研究CXC趋化因子配体4（CXCL4）、基质金属蛋白酶-9（MMP-9）、微小RNA-24（miR-24）对急性脑梗死（ACI）早期神经功能恶化（END）的预测价值。方法 分别选择2020年1月—2021年6月我院收治的30例ACI早期END患者（ACI+END组）,30例单纯ACI患者（ACI组）,同时期30例健康人群作为对照组,检测受试者CXCL4、MMP-9、miR-24表达情况及存在的相关性,分析血清CXCL4、MMP-9、miR-24表达情况与ACI早期发生END的关系。结果 CXCL4、MMP-9水平在对照组、ACI组、ACI+END组中依次升高,miR-24相对表达量依次降低（P<0.05）。血清CXCL4、MMP-9、miR-24水平在轻度、重度患者中呈升高趋势,miR-24相对表达呈降低趋势（P<0.05）。Logistic回归分析血清CXCL4、MMP-9、miR-24表达异常与ACI早期发生END独立相关（P<0.05）。经Pearson相关性分析发现,CXCL4与MMP-9之间呈正相关（r=0.584,P=0.001）;CXCL4、miR-24之间呈负相关（r=-0.569,P=0.001）,MMP-9、miR-24之间呈负相关（r=-0.567,P=0.001）。ROC曲线显示,与CXCL4、MMP-9、miR-24单项预测相比,三项联合对ACI的关系及对早期END的预测价值较高（P<0.05）。结论 CXCL4、MMP-9、miR-24在ACI发生END时出现异常表达,检测CXCL4、MMP-9、miR-24水平对ACI早期END具有一定预测价值,可尽早制定相关措施干预,提高治疗效率。

Objective To study the predictive value of CXC chemokine ligand 4（CXCL4）,matrix metalloproteinase-9（MMP-9）,microRNA-24（miR-24）in early neurological deterioration（END）of acute cerebral infarction（ACI）．Methods A total of 30 patients with ACI early END（ACI+END group）and 30 patients with ACI only（ACI group）who were admitted to our hospital from January 2020 to June 2021 were selected,and 30 healthy people（control group）who underwent physical examination in our hospital during the same period were selected．Expressions of CXCL4,MMP-9,and miR-24 were detected and their correlations were analyzed,and the relationship between the expressions of serum CXCL4,MMP-9,miR-24 and the early occurrence of END in ACI were analyzed．Results The levels of CXCL4 and MMP-9 were increased in the control group,ACI group and ACI+END group in turn,and the relative expression of miR-24 was decreased in turn,and the differences among the groups were statistically significant（P<0.05）．The levels of serum CXCL4,MMP-9,and miR-24 increased in mild and severe patients,while the relative expression of miR-24 decreased,and the differences between groups were statistically significant（P<0.05）．Logistic regression analysis showed that abnormal expressions of serum CXCL4,MMP-9 and miR-24 were independently correlated with the early occurrence of END in ACI（P<0.05）．After Pearson correlation analysis,it was found that there was a positive correlation between CXCL4 and MMP-9（r=0.584,P=0.001）,a negative correlation between CXCL4 and miR-24（r=-0.569,P=0.001）;a negative correlation between MMP-9 and miR-24（r=-0.567,P=0.001）．The ROC curve showed that compared with the single prediction of CXCL4,MMP-9 and miR-24,the predictive value of the combined prediction on ACI and early END were higher（P<0.05）．Conclusions CXCL4,MMP-9,and miR-24 are abnormally expressed in ACI when END occurs．Detection of CXCL4,MMP-9,and miR-24 levels has certain predictive value for early END of ACI,and relevant measures can be formulated as soon as possible to improve treatment efficiency．

目的 探讨尿液前列腺特异性抗原（u-PSA）预测老年良性前列腺增生（BPH）发生急性尿潴留（AUR）的价值。方法 选取东莞市中医院100例老年BPH患者（2020年1月—2021年4月）进行回顾性研究,均口服盐酸坦索罗辛+非那雄胺片治疗,随访1年,记录AUR发生情况,据此分为AUR组、非AUR组。比较2组一般资料,Logistic回归模型分析老年BPH发生AUR的危险因素,受试者工作特征（ROC）分析前列腺体积（PV）、u-PSA对老年BPH发生AUR的预测价值。结果 100例老年BPH患者AUR发生率为26%;AUR组u-PSA水平高于非AUR组,PV大于非AUR组（P<0.05）;Logistic回归模型分析,u-PSA水平及PV增高是老年BPH患者发生AUR的独立危险因素（P<0.05）;ROC曲线分析,u-PSA预测AUR的AUC=0.897,高于AUC_PV（P<0.05）。结论 u-PSA可作为老年BPH继发AUR的量化评估指标,有利于临床早期筛查、诊断,采取针对性干预措施,改善预后。

Objective To investigate the value of urinary prostate-specific antigen（u-PSA）in predicting acute urinary retention（AUR）in elderly patients with benign prostatic hyperplasia（BPH）．Methods A total of 100 elderly patients with BPH in our hospital（from January 2020 to April 2021）were selected for a retrospective study,all of whom were treated with oral tamsulosin hydrochloride + finasteride tablets,followed up for 1 year,and the occurrence of AUR was recorded．The patients were divided into AUR group and non-AUR group．The general data of the two groups were compared．Logistic regression model was used to analyze the risk factors of AUR in elderly BPH patients,and receiver operating characteristic（ROC）was used to analyze the predictive value of prostate volume（PV）and u-PSA for AUR occurrence．Results The incidence of AUR in 100 elderly patients with BPH was 26%;the level of u-PSA in the AUR group was higher than that in the non-AUR group,and the PV was greater than that in the non-AUR group（P<0.05）．Increased PV was an independent risk factor for AUR in elderly patients with BPH（P<0.05）．ROC curve analysis showed that the AUC of u-PSA for predicting AUR was 0.897,which was higher than that of PV（P<0.05）．Conclusions u-PSA can be used as a quantitative evaluation index for AUR secondary to BPH in the elderly,which is conducive to early clinical screening and diagnosing,and taking targeted intervention measures to improve prognosis.

目的 评价银杏二萜内酯葡胺注射液（DGMI）联合依达拉奉右崁对急性缺血性脑卒中（AIS）的治疗效果。方法 回顾性分析我院2021年3月—2022年6月收治的86例AIS患者,根据治疗方法不同,分为单药组和联合组,每组43例,2组均予以DGMI治疗,联合组加用依达拉奉右崁醇。对比2组的治疗效果。结果 治疗后,联合组美国国立卫生研究院卒中量表（NIHSS）评分低于单药组（P<0.05）,简易智能精神状态检查量表（MMSE）和Barthel指数（BI）得分高于单药组（P<0.05）;联合组治疗后脑血流动力学指标（Q_min和V_min）高于单药组（P<0.05）,而全血还原黏度、血浆黏度和血小板聚集指数低于单药组（P<0.05）;联合组治疗后血清丙二醛（MDA）、超敏C-反应蛋白（hsCRP）和白细胞介素-6（IL-6）低于单药组（P<0.05）,而超氧化物歧化酶（SOD）高于单药组（P<0.05）;联合组治疗总有效率88.37%,高于单药组的67.44%（P<0.05）,且2组不良反应总发生率比较差异无统计学意义（P>0.05）。结论 DGMI联合依达拉奉右崁醇可有效提高AIS患者的神经功能、认知功能及日常生活能力,降低血液高凝状态,改善脑部血流,缓解机体氧化应激及炎症反应,且不良反应发生率较低,安全性良好。

Objective To evaluate the clinical efficacy of diterpene ginkgolides meglumine injection（DGMI）combined with edaravone dextracanthol in the treatment of acute ischemic stroke（AIS）．Methods A total of 86 patients with AIS admitted to our hospital from March 2021 to June 2022 were divided into single drug group and combination group according to different treatment methods,with 43 patients in each group．Both groups were treated with DGMI,and the combination group was added with edaravone dextracanthol．The therapeutic effect,neurological function and adverse reactions of the two groups were compared．Results After treatment,compared with the single drug group,the NIH Stroke Scale（NIHSS）score of the combination group was significantly lower（P<0.05）,and the Mini-Mental State Examination（MMSE）and Barthel index（BI）scores were significantly higher（P<0.05）．After treatment,the cerebral hemodynamic indexes（Q_min and V_min）in the combination group were significantly higher（P<0.05）,while the whole blood reducing viscosity,plasma viscosity and platelet aggregation index were significantly lower（P<0.05）．After treatment,compared with the single drug group,the serum malondialdehyde（MDA）,high sensitive C-reactive protein（hsCRP）and interleukin- 6（IL-6）levels in the combination group were significantly lower（P<0.05）,while the level of superoxide dismutase（SOD）was significantly higher（P<0.05）．The total effective rate of the combination group was 88.37%,which was significantly higher than 67.44% of the single drug group（P<0.05）．The incidence of adverse reaction between two groups was not significant（P>0.05）．Conclusions DGMI combined with edaravone dextracanthol can effectively improve the neurological function,cognitive function and daily living ability of patients with AIS,reduce blood hypercoagulability,improve cerebral blood flow,alleviate oxidative stress and inflammatory reaction,improve the therapeutic effect,without increasing the incidence of adverse reactions,which has good safety．

目的 探讨无乳链球菌感染性心内膜炎的临床特点和治疗效果。方法 回顾性分析我院收治的1例无乳链球菌感染性心内膜炎合并急性肝衰竭患者的临床表现、诊疗经过及预后。结果 经过积极抗感染、血浆置换和体外循环下赘生物清除、瓣膜置换手术治疗,术后继续予抗感染、抗凝等治疗,患者脏器功能恢复良好,取得了良好的治疗效果,并顺利出院。结论 无乳链球菌感染性心内膜炎可引起急性心力衰竭、急性肝衰竭、急性肾衰竭等多脏器功能不全,合理把握手术时机和准确评估围术期风险有助于提高急危重症感染性心内膜炎患者的救治率。

Objective To explore the clinical characteristics and treatment of infective endocarditis caused by Streptococcus agalactiae．Methods Clinical data and treatment details of a patient with Streptococcus agalactiae endocarditis and acute liver failure admitted to our hospital was analyzed retrospectively．Results After strict anti-biotic therapy and plasmapheresis,the patient received the vegetative removal and valve replacement and finally successfully recovered．Conclusions The diagnosis and treatment of this case suggests that Streptococcus agalactiae infective endocarditis can cause multiple organ dysfunction such as acute heart,liver and renal failure．Optimal timing of surgery and accurate benefits-risk assessment is helpful to improve the prognosis of patients with acute and severe infective endocarditis．

目的 探讨基于5A模式对急性心肌梗死经皮冠状动脉介入治疗（PCI）术后患者早期心脏康复的应用效果。方法 根据随机数字表法将2021年1月—2022年6月来我院接受治疗的80例急性心肌梗死PCI术后患者分为对照组40例与干预组40例。对照组患者在常规护理模式下进行早期心脏康复,干预组患者在基于5A模式下进行早期心脏康复。对比2组患者的心功能与运动能力情况、自我管理能力以及护理依从性。结果 干预2个月后2组患者的左室射血分数、6分钟步行试验距离水平高于干预前,且干预组高于对照组（P<0.05）;左室收缩末期内径水平低于干预前,且干预组低于对照组（P<0.05）;2组患者干预2个月后的日常生活、疾病管理、情绪控制以及自我管理总分均高于干预前,且干预组高于对照组（P<0.05）;干预组的护理总依从率高于对照组（P<0.05）。结论 对急性心肌梗死PCI术后患者给予基于5A模式进行的早期心脏康复可改善其心功能,提升预后自我管理能力,增强护理干预依从性。

目的 分析医院急诊患者24小时诊疗数据与临床路径标准的差异,以此探讨现行诊疗路径存在的问题及提升策略。方法 统计和分析本院2021年1月—2021年12月间收治的218例急性消化道出血和82例急性脑出血患者急诊治疗相关诊疗数据,并与相关疾病诊疗指南进行对比,分析实际诊疗数据与临床路径标准的差异,探究问题出现的原因并探讨针对性改良方案。结果 急性消化道出血临床路径诊疗标准规定检查项目为13项,急性消化道出血患者的应用率为100%,其中有11项符合率>50%,占比84.62%;急性脑出血临床路径诊疗标准规定检查项目为14项,急性脑出血患者的应用率为100%,其中有10项符合率>50%,占比71.43%;急性消化道出血患者中,超出临床路径检查标准项目9项,且检查率均在50%以上;急性脑出血患者中,超出临床路径检查标准项目4项,其中2项检查率在50%以上;在治疗措施方面,急性消化道出血、急性脑出血的实际治疗与临床路径标准基本相符,在针对不同病情时会采用不同治疗方法,会存在一定差异。结论 医院临床实际疾病诊疗情况与临床路径诊疗标准间尚存在一定差异,医院必须对问题进行分析,不断优化诊疗路径,进一步提升临床路径实用性、可行性、规范性以及科学性,为居民提供更优质的医疗服务,同时减轻患者医疗经济负担。

目的 探讨3种根管冲洗剂应用于根管治疗急性牙髓炎患者的效果。方法 按照计算机分组法将我院2020年12月—2022年7月期间收治的121例急性牙髓炎患者分为3组,3组均采用一次性根管治疗,A组40例在超声引导下采用3%过氧化氢（H₂O₂）溶液荡洗,B组40例在超声引导下采用1%聚维酮碘溶液荡洗,C组41例在超声引导下采用0.5%次氯酸钠（NaClO）溶液荡洗,观察两组临床疗效、致病菌检出量以及不良反应发生率。结果 3组总有效率对比差异无统计学意义（P>0.05）;3组粪肠球菌、具核梭杆菌、牙髓卟啉单胞菌均降低,A组、B组对比差异无统计学意义（P>0.05）,C组均较A、B组低（P<0.05）;3组不良反应发生率对比差异无统计学意义（P>0.05）。结论 3% H₂O₂、0.5% NaClO与1%聚维酮碘均具有良好的治疗效果,且安全性较好,但相较而言,0.5% NaClO在降低患者术后致病菌检出量方面效果更佳。

目的 探讨血清心型脂肪酸结合蛋白（H-FABP）、血管生成素-1（Ang-1）在急性大血管闭塞性卒中（AIS-LVO）静脉溶栓桥接支架取栓患者预后中的评估价值。方法 选择2019年1月—2021年5月80例AIS-LVO患者作为研究对象,均接受静脉溶栓桥接支架取栓治疗,检测术前血清H-FABP、Ang-1水平,术后随访90 d将患者分为预后良好组（n=57）与预后不良组（n=23）。结果 两组在高血压、冠心病、心房颤动、急性卒中治疗低分子肝素试验（TOAST）分型、侧支循环、术前H-FABP、术前Ang-1方面存在差异（P<0.05）。多因素 Logistic 回归分析结果显示,高血压、心房颤动、心源性梗死型、侧支循环为0 ~1 级、术前H-FABP≥10.0 ng/L、术前Ang-1<5.25 ng/mL是AIS-LVO静脉溶栓桥接支架取栓患者预后不良的危险因素。术前血清H-FABP预测术后90 d预后不良的AUC为0.728（95%CI：0.368~0.918）,灵敏度、特异度分别为66.68%、58.92%。术前血清Ang-1预测术后90 d预后不良的AUC为0.773（95%CI：0.592~1.129）,灵敏度、特异度分别为70.35%、63.92%。H-FABP联合Ang-1预测术后90 d预后不良的AUC为0.854（95%CI：0.652~0.957）,灵敏度、特异度分别为77.18%、71.82%。结论 静脉溶栓桥接支架取栓治疗AIS-LVO患者的预后受到多种危险因素的影响,其中术前血清H-FABP和Ang-1是具有前景的预后预测因子。

Objective To investigate the prognostic value of serum heart-type fatty acid binding protein（H-FABP）and angiopoietin-1（Ang-1）in patients with acute ischemic stroke-large vessel occlusion（ALS-LVO）undergoing venous thrombolytic bridging stent thrombectomy．Methods A total of 80 patients with ALS-LVO from January 2019 to May 2021 were selected as the study subjects,treated with intravenous thrombolytic bridging stent thrombectomy,and their serum H-FABP and Ang-1 levels were measured before operation．After 90 days of follow-up,the patients were divided into good prognosis group（n=57）and poor prognosis group（n=23）．Results There were significant differences between the two groups in hypertension,coronary heart disease,atrial fibrillation,TOAST classification,collateral circulation,preoperative H-FABP,and preoperative Ang-1（P<0.05）．Multivariate logistic regression analysis showed that hypertension,atrial fibrillation,cardiogenic infarction type,collateral circulation of 0~1 grade,preoperative H-FABP≥10.0 ng/L,preoperative Ang-1<5.25 ng/mL were independent risk factors for poor prognosis of ALS-LVO patients treated with venous thrombolytic bridging stents．The AUC of preoperative serum H-FABP predicting poor prognosis 90 days after operation was 0.728（95%CI：0.368~0.918）,with sensitivity and specificity of 66.68% and 58.92% respectively．The AUC of preoperative serum Ang-1 predicting poor prognosis 90 days after surgery was 0.773（95%CI：0.592~1.129）,with sensitivity and specificity of 70.35% and 63.92% respectively．The AUC predicted by H-FABP combined with Ang-1 for poor prognosis 90 days after operation was 0.854（95%CI：0.652~0.957）,and the sensitivity and specificity were 77.18% and 71.82% respectively．Conclusions The prognosis of patients with ALS-LVO treated with intravenous thrombectomy bridging stent thrombectomy is affected by many risk factors,among which preoperative serum H-FABP and Ang-1 are promising prognostic factors．

目的 评估全身免疫炎症指数（SII）、中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）在区分急性缺血性卒中（AIS）伴发卵圆孔未闭（PFO）与非伴发PFO患者的价值。方法 回顾性分析100例AIS患者的血液和血清指标,计算SII、NLR和PLR,使用Logistic回归及受试者操作特征（ROC）曲线分析3项指标在鉴别AIS伴发PFO与非伴发PFO中的价值。结果 伴发PFO的AIS患者SII、NLR、PLR高于非伴发PFO的AIS患者,其中以SII最为明显（P均<0.05）。单因素Logistic回归显示,中性粒细胞计数、淋巴细胞计数、PLR、NLR、SII与AIS伴发PFO有关（P<0.05）。ROC曲线分析结果,SII、NLR、PLR鉴别AIS伴PFO与非伴PFO患者,最佳阈值分别为476.4、1.99、115.3,曲线下面积分别为0.777、0.767、0.708。结论 SII、NLR和PLR可作为鉴别AIS患者是否伴发PFO的生物标志物,具有潜在临床应用价值。

Objective To evaluate the value of systemic immune-inflammatory index（SII）,neutrophil/lymphocyte ratio（NLR）and platelet/lymphocyte ratio（PLR）in distinguishing acute ischemic stroke（AIS）patients with patent foramen ovale（PFO）and without PFO．Methods A retrospective analysis of blood and serum indicators in 100 AIS patients was conducted,and SII,NLR and PLR indices were calculated．Logistic regression and ROC curve analyses were performed．Results SII,NLR and PLR were significantly higher in PFO patients than in non-PFO patients,with SII being the most significant．Univariate logistic regression showed that Neu,Lym,PLR,NLR,and SII variables were significantly associated with AIS combined with PFO（P<0.05）．ROC curve analysis revealed that the optimal cut-off values for SII,NLR and PLR in distinguishing AIS patients with PFO from those without PFO were 476.4,1.99 and 115.3,respectively,with area under the curve of 0.777,0.767 and 0.708．Conclusions SII,NLR and PLR can serve as biomarkers for identifying AIS patients with PFO,offering potential clinical application value．