摘要 目的：针对混合痔日间手术后静脉镇痛泵无法带回家的临床困境，探索骶管内注射长效镇痛药联合长强、承山穴位埋线作为替代镇痛方案的有效性与安全性。 方法：回顾性纳入2023年6月至2025年9月行混合痔外剥内扎术的患者60例，根据术后镇痛方案分为两组：治疗组（骶管注射+穴位埋线，30例）和对照组（静脉镇痛泵，30例）。比较两组术后2、8、24、48 h的疼痛视觉模拟评分（VAS）及不良反应。 结果：治疗组术后2 h、8 h、24 h的VAS评分均显著低于对照组（均P<0.05）；48 h两组差异无统计学意义。治疗组尿失禁、尿潴留、排便困难各1例，对照组恶心呕吐4例、嗜睡5例、尿潴留4例，组间差异无统计学意义。 结论：骶管注射联合穴位埋线可有效缓解混合痔日间术后早期疼痛，避免了静脉镇痛泵无法家庭使用的限制，为日间手术提供了一种可行的镇痛替代方案。

Abstract Objective：To address the clinical challenge that intravenous patient-controlled analgesia (PCA) pumps cannot be taken home after ambulatory surgery for mixed hemorrhoids, and to evaluate the efficacy and safety of intrasacral canal injection of a long-acting analgesic combined with acupoint catgut embedding at Changqiang (GV1) and Chengshan (BL57) as an alternative analgesic regimen. Methods：A retrospective cohort study was conducted. Sixty patients who underwent Milligan-Morgan hemorrhoidectomy for mixed hemorrhoids between June 2023 and September 2025 were enrolled and divided into two groups according to the postoperative analgesic regimen: a treatment group (intrasacral injection + catgut embedding, n=30) and a control group (intravenous PCA pump, n=30). Pain intensity assessed by Visual Analogue Scale (VAS) and adverse reactions were compared between the two groups at 2, 8, 24, and 48 hours postoperatively. Results：The VAS scores in the treatment group were significantly lower than those in the control group at 2, 8, and 24 hours after surgery (all P < 0.05). No significant difference was observed at 48 hours. One case each of urinary incontinence, urinary retention and defecation difficulty occurred in the treatment group, while the control group had 4 cases of nausea/vomiting, 5 of drowsiness, and 4 of urinary retention, with no statistically significant differences between groups. Conclusion：Intrasacral canal injection combined with acupoint catgut embedding can effectively relieve early postoperative pain in ambulatory surgery for mixed hemorrhoids, circumventing the limitation that intravenous PCA pumps cannot be used at home, thus providing a feasible alternative analgesic strategy for ambulatory surgery.

目的 探讨清咳平喘颗粒联合乙酰半胱氨酸对痰热闭肺型大叶性肺炎（LP）患儿的治疗效果。方法 回顾性选取我院收治的118例痰热闭肺型LP患儿（选例时间：2023年1月~2025年11月）为研究对象，根据治疗方案分为参照组（59例，采用乙酰半胱氨酸治疗）、联合组（59例，采用清咳平喘颗粒联合乙酰半胱氨酸治疗）。对比两组临床疗效、不良反应及治疗前、后肺功能［潮气量（VT）、达峰时间比（TPTEF/TE）、吸呼比（Ti/Te）、达峰容积比（VPEF/VE）］、中医证候、免疫功能、炎症因子［白细胞介素-8（IL-8）、趋化因子配体3（CCL3）、肿瘤坏死因子-α（TNF-α）、高迁移率族蛋白B1（HMGB1）］水平。结果 联合组总有效率为96.61%，高于参照组的83.05%（P＜0.05）；与参照组相比，治疗后联合组各中医证候积分均较低（P＜0.05）；联合组治疗后VT、TPTEF/TE、Ti/Te、VPEF/VE水平均较参照组高（P＜0.05）；联合组治疗后CD8+水平较参照组低，CD3+、CD4+、CD4+/CD8+水平较参照组高（P＜0.05）；治疗后联合组血清IL-8、CCL3、TNF-α、HMGB1水平均较参照组低（P＜0.05）；不良反应发生情况组间比较，无明显差异（P＞0.05）。结论 清咳平喘颗粒联合乙酰半胱氨酸可提高痰热闭肺型LP患儿治疗效果，减轻临床症状，改善肺功能、免疫功能，降低机体炎症反应程度。

Objective To explore the therapeutic efficacy of Qingke Pingchuan granules combined with acetylcysteine on children with lobar pneumonia (LP) of phlegm-heat obstructing lung type. Methods A total of 118 children with LP of phlegm-heat obstructing lung type admitted to our hospital from January 2023 to November 2025 were retrospectively selected as the research subjects. According to different treatment regimens, they were divided into the control group (59 cases, treated with acetylcysteine) and the combined group (59 cases, treated with Qingke Pingchuan granules combined with acetylcysteine). The clinical efficacy, adverse reactions, as well as the levels of pulmonary function indicators [tidal volume (VT), time to peak tidal expiratory flow ratio (TPTEF/TE), inspiration-expiration ratio (Ti/Te), volume to peak tidal expiratory flow ratio (VPEF/VE)], traditional Chinese medicine (TCM) syndrome scores, immune function and inflammatory factors [interleukin-8 (IL-8), C-C motif chemokine ligand 3 (CCL3), tumor necrosis factor-α (TNF-α), high mobility group box 1 protein (HMGB1)] before and after treatment were compared between the two groups. Results The total effective rate of the combined group was 96.61%, which was higher than 83.05% of the control group (P<0.05). After treatment, the TCM syndrome scores of the combined group were lower than those of the control group (P<0.05). The levels of VT, TPTEF/TE, Ti/Te and VPEF/VE in the combined group were higher than those in the control group after treatment (P<0.05). After treatment, the level of CD8? in the combined group was lower, while the levels of CD3?, CD4? and CD4?/CD8? were higher than those in the control group (P<0.05). The serum levels of IL-8, CCL3, TNF-α and HMGB1 in the combined group were significantly lower than those in the control group after treatment (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of Qingke Pingchuan granules and acetylcysteine can enhance the therapeutic efficacy on children with LP of phlegm-heat obstructing lung type, relieve clinical symptoms, improve pulmonary function and immune function, and reduce systemic inflammatory response.

目的：探讨填髓益精法联合环孢素A治疗再生障碍性贫血（AA）的临床疗效，及其对骨髓造血功能、免疫功能及生活质量的影响。方法：选取2021年1月—2026年1月收治的AA患者65例，随机分为对照组（21例）、中药组（23例）、综合组（21例）。对照组予环孢素A口服；中药组在对照组基础上加用填髓益精方口服；综合组在中药组基础上联合督灸、艾灸、耳针治疗。连续治疗24周，观察三组临床疗效、血常规、免疫指标、生活质量及不良反应。结果：对照组、中药组、综合组总有效率分别为76.19%、86.96%、85.71%，中药组与综合组均显著高于对照组（P<0.05）。治疗后，三组红细胞、血红蛋白、血小板均较治疗前升高（P<0.05），IL?2水平下降，CD3?、CD4?、CD4?/CD8?升高，中药组与综合组改善优于对照组（P<0.05）。生活质量评分综合组改善最优，三组不良反应发生率差异无统计学意义（P>0.05）。结论：填髓益精法联合环孢素A可有效提高AA临床疗效，改善骨髓造血与免疫功能，提升生活质量，安全性良好，值得临床推广。

Objective To investigate the clinical efficacy of traditional Chinese medicine (TCM) method of tonifying marrow and nourishing essence combined with cyclosporine A in the treatment of aplastic anemia (AA)， and its effects on bone marrow hematopoiesis， immune function and quality of life. Methods A total of 65 patients with AA admitted from July 2014 to January 2024 were randomly divided into control group (21 cases)， TCM group (23 cases) and comprehensive group (21 cases). The control group was treated with oral cyclosporine A; the TCM group was additionally given Tonifying Marrow and Nourishing Essence Decoction; the comprehensive group was further combined with governor vessel moxibustion， moxibustion and ear acupuncture on the basis of the TCM group. All patients were treated for 24 weeks. The clinical efficacy， blood routine， immune indexes， quality of life and adverse reactions were observed. Results The total effective rates of the control group， TCM group and comprehensive group were 76.19%， 86.96% and 85.71%， respectively. The TCM group and comprehensive group were significantly higher than the control group (P<0.05). After treatment， red blood cells， hemoglobin and platelets in the three groups were increased compared with those before treatment (P<0.05)， the levels of IL?2 were decreased， and CD3?， CD4? and CD4?/CD8? were increased. The improvements in the TCM group and comprehensive group were better than those in the control group (P<0.05). The quality of life score of the comprehensive group was the best， and there was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion TCM method of tonifying marrow and nourishing essence combined with cyclosporine A can effectively improve the clinical efficacy of AA， ameliorate bone marrow hematopoiesis and immune function， and improve quality of life with good safety， which is worthy of clinical promotion.

意识障碍（Disorders of Consciousness, DoC）是颅脑损伤、脑卒中、缺血缺氧性脑病等严重脑损伤后的常见并发症，其康复治疗是神经科学领域的重大挑战。重复经颅磁刺激（Repetitive Transcranial Magnetic Stimulation, rTMS）作为一种无创神经调控技术，通过调节皮层兴奋性、促进神经可塑性及改善脑血流灌注，在DoC治疗中展现出独特优势。本文系统梳理近年研究，从作用机制、临床证据及未来方向等方面进行综述，旨在为临床精准治疗提供理论依据。

目的：描述发病48 h内急性缺血性卒中（acute ischemic stroke，AIS）患者依达拉奉右莰醇真实世界用药特征，探讨48 h内不同启动时间与住院期间神经功能改善及短期预后的关系。方法：回顾性连续筛选2023年12月1日至2026年4月30日本院诊断为AIS并使用依达拉奉右莰醇的住院患者，药学部基于药学信息系统、住院医嘱及病历记录提取资料。初筛147例，排除35例，纳入112例发病至首次用药时间（onset-to-treatment time，OTT）≤48 h者；按预设24 h界值分为24 h内用药组（n=67）和24～48 h用药组（n=45）。主要结局为住院期间美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）变化值（ΔNIHSS=入院NIHSS评分－出院前NIHSS评分）；次要结局包括出院前NIHSS评分、出院改良Rankin量表（modified Rankin Scale，mRS）评分、显著神经功能改善、住院时间、出院去向及安全性事件。采用多因素线性回归分析24 h内用药与ΔNIHSS的相关性，并行简化模型、排除再灌注治疗患者、完整疗程人群、进一步调整大血管闭塞及OTT连续变量模型等敏感性分析。结果：总体OTT为19.65（14.97，34.68）h，疗程12.00（11.00，13.00）d，完成相对完整疗程比例89.3%。两组入院NIHSS评分差异无统计学意义［8.00（6.00，9.00）分 vs 8.00（6.00，10.00）分，P=0.447］；24 h内用药组出院前NIHSS评分更低［5.00（4.00，6.50）分 vs 6.00（5.00，8.00）分，P=0.025］，ΔNIHSS更高［3.00（2.00，3.00）分 vs 2.00（1.00，2.00）分，P＜0.001］，显著神经功能改善率更高（77.6% vs 60.0%，P=0.045）。多因素校正后，24 h内用药仍与更大的ΔNIHSS相关（β=0.768，95%CI：0.377～1.159，P＜0.001）；Logistic探索性分析显示其与显著神经功能改善发生可能性较高相关（OR=2.475，95%CI：1.047～5.853，P=0.039）。两组出血转化、症状性颅内出血、药物相关不良反应及院内死亡差异均无统计学意义。结论：本单中心真实世界队列中，发病48 h内依达拉奉右莰醇治疗疗程完成比例较高、短期安全性事件发生率低；24 h内启动治疗与住院期间NIHSS改善幅度较大及显著神经功能改善率较高相关。由于为回顾性观察性研究，结果应解释为关联性证据，需前瞻性、多中心研究及长期功能结局验证。

Objective: To describe real-world treatment characteristics of edaravone dexborneol in acute ischemic stroke (AIS) patients treated within 48 hours of onset and to explore the association between initiation time and short-term in-hospital outcomes. Methods: This single-center retrospective real-world study screened hospitalized AIS patients with edaravone dexborneol records from December 1, 2023 to April 30, 2026. Medication data were extracted from the pharmacy information system, inpatient orders, and medical records. After 35 exclusions, 112 of 147 patients with onset-to-treatment time (OTT) ≤48 h were included and classified by a prespecified 24-hour cutoff into a within-24-hour group (n=67) and a 24-48-hour group (n=45). The primary outcome was in-hospital National Institutes of Health Stroke Scale (NIHSS) change (ΔNIHSS=admission NIHSS minus pre-discharge NIHSS); secondary outcomes included pre-discharge NIHSS, discharge modified Rankin Scale (mRS), marked neurological improvement, length of stay, discharge destination, and safety events. Multivariable linear regression assessed the association between within-24-hour treatment and ΔNIHSS, with sensitivity analyses using simplified adjustment, exclusion of reperfusion-treated patients, the complete-course population, additional adjustment for large-vessel occlusion, and continuous OTT modeling. Results: Median OTT was 19.65 (14.97, 34.68) h, treatment duration was 12.00 (11.00, 13.00) days, and 89.3% completed a relatively complete course. Baseline NIHSS was comparable [8.00 (6.00, 9.00) vs 8.00 (6.00, 10.00), P=0.447]. The within-24-hour group had lower pre-discharge NIHSS [5.00 (4.00, 6.50) vs 6.00 (5.00, 8.00), P=0.025], greater ΔNIHSS [3.00 (2.00, 3.00) vs 2.00 (1.00, 2.00), P<0.001], and a higher marked improvement rate (77.6% vs 60.0%, P=0.045). After adjustment for age, admission NIHSS, reperfusion therapy, and atrial fibrillation, within-24-hour treatment remained associated with greater ΔNIHSS (β=0.768, 95% CI: 0.377-1.159, P<0.001). Exploratory logistic regression showed a higher likelihood of marked improvement (OR=2.475, 95% CI: 1.047-5.853, P=0.039). Hemorrhagic transformation, symptomatic intracranial hemorrhage, drug-related adverse reactions, and in-hospital death did not differ significantly. Conclusion: In this real-world cohort, edaravone dexborneol within 48 h of AIS onset showed a high complete-course proportion and low short-term safety event incidence. Initiation within 24 h was associated with greater in-hospital NIHSS improvement and a higher marked improvement rate than initiation at 24-48 h. These findings are associative and need prospective multicenter validation with long-term functional outcomes.

【摘要】目的：探讨安全-行为双维度管理模式在儿童全麻舒适化口腔治疗中的应用效果。方法：选取2025年4月至2025年12月在本院接受全麻舒适化口腔治疗的80例患儿作为研究对象，根据围术期不同管理方式分为观察组和对照组，每组40例。对照组实施常规围术期管理，观察组实施安全-行为双维度管理模式。对比两组患儿牙科恐惧程度、治疗依从性、苏醒期躁动发生率及家属满意度。结果：术前检查、麻醉诱导、出院时观察组CFSS-DS评分均比对照组低（P＜0.05），FCS评分均比对照组高（P＜0.05）。与对照组苏醒期躁动发生率20.00%对比，观察组5.00%显著降低（P＜0.05）。与对照组家属满意度75.00%对比，观察组95.00%显著升高（P＜0.05）。结论：在儿童全麻舒适化口腔治疗中应用安全-行为双维度管理模式干预，可有效减轻患儿牙科恐惧程度，提高治疗依从性，减少苏醒期躁动发生，提升家属满意度，值得临床推广应用。

[摘要]目的：探讨基于肾虚冲任失养理论指导下补肾调冲汤治疗围绝经期综合征的临床疗效。方法：选取2023年1月至2026年1月期间在本院接受治疗的114例围绝经期综合征（PMS）患者为研究对象，根据入院顺序编号后随机分为对照组（常规西医治疗）、观察组（常规西医+肾虚冲任失养理论指导下补肾调冲汤治疗）各57例。对比两组临床疗效及治疗前后雌激素水平、中医证候积分、改良Kupperman评分及生活质量水平。结果：与对照组治疗后临床疗效总有效率78.95%对比，观察组94.74%显著升高（P＜0.05）。治疗后观察组雌二醇（E2）水平比对照组高，卵泡刺激素（FSH）、黄体生成素（LH）水平均比对照组低（P＜0.05）。治疗后观察组烘热汗出、心烦不宁、腰膝酸软、手足心热、口干便坚症状的中医证候积分均比对照组低（P＜0.05）。治疗后观察组改良Kupperman评分、围绝经期综合征生存质量量表（MENQOL）评分均比对照组低（P＜0.05）。结论：基于肾虚冲任失养理论指导的补肾调冲汤治疗围绝经期综合征，能够显著提升疗效，调节性激素水平，降低中医证候积分，改善临床症状与生活质量，值得临床推广。

分析经开窗减压+二期刮治术治疗巨大型颌骨囊肿的效果。方法：回顾性采集100例巨大型颌骨囊肿的临床资料（2020年1月至2024年12月），按手术方法分组（传统刮治组、开窗减压+二期刮治术组），各50例，观察两组治疗有效率、炎症因子水平、并发症、华盛顿大学生活质量问卷（UW-QOL）评分及疾病复发情况。结果：总有效率比较，开窗减压+二期刮治术组（96.00%）比传统刮治组（82.00%）高（P＜0.05）；与传统刮治组比较，术后1周开窗减压+二期刮治术组白介素-6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）水平更低（P＜0.05）；开窗减压+二期刮治术组并发症总发生率为 6.00%，低于传统刮治组的22.00%（P＜0.05）；UW-QOL各维度（情绪、外貌、疼痛、咀嚼、味觉、唾液）评分比较，术后6个月开窗减压+二期刮治术组比传统刮治组高（P＜0.05）；开窗减压+二期刮治术组复发率（2.00%）比传统刮治组（16.00%）低（P＜0.05）。结论：对巨大型颌骨囊肿患者开展开窗减压+二期刮治术，有利于抑制炎症反应，改善临床结局，提升生活质量。

To analyze the effect of fenestrated decompression + two-stage curettage in the treatment of giant mandibular cysts. Methods: The clinical data of 100 cases of giant jaw cysts (from January 2020 to December 2024) were retrospectively collected and divided into groups according to surgical methods (traditional curettage group, fenestrated decompression + two-stage curettage group), 50 cases in each group, and the treatment effectiveness, inflammatory factor levels, complications, University of Washington Quality of Life Questionnaire (UW-QOL) scores and disease recurrence were observed in the two groups. Results: Comparing the total effective rate, the window decompression + second-stage curettage group (96.00%) was higher than the traditional curettage group (82.00%) (P<0.05); compared with the traditional curettage group, the window decompression + second-stage curettage group 1 week after surgery The levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) in the surgery group were lower (P<0.05); the total incidence of complications in the window decompression + second-stage curettage group was 6.00%, lower than 22.00% in the traditional scaling group (P<0.05); comparison of UW-QOL scores in each dimension (emotion, appearance, pain, chewing, taste, saliva), window opening 6 months after surgery The decompression + two-stage curettage group was higher than the traditional curettage group (P<0.05); the recurrence rate of the window decompression + two-stage curettage group (2.00%) was lower than the traditional curettage group (16.00%) (P<0.05). Conclusion: Carrying out fenestration decompression + two-stage curettage for patients with giant jaw cysts can help suppress the inflammatory reaction, improve clinical outcomes, and enhance the quality of life.

目的：运用网络药理学和分子对接技术研究黄芪甲苷（AstragalosideIV，AS-IV）治疗突发性聋的作用机制及潜在靶点，并进行体外实验验证。方法：通过中药药理学分析平台（TCMSP）获取到AS-IV活性成分，从Genecard获得AS-IV对应的靶点及与突发性聋相关的靶点。疾病靶点蛋白和蛋白之间的交互数据是通过检索String数据库得到的。使用 Cytoscape3.7.1 构建成分-靶点-疾病网络，用 R4.0.3，安装ClusterProfiler 包，然后进行 GO 分析和 KEGG 路径分析。利用 Pymol 软件来优化靶点，利用 AutoDockTools 进行加氢和电荷处理，将关键靶点作为受体，其对应的有效成分作为配体，再利用 Pyrx 软件内部的 Vina 进行分子对接，计算结合能量。建议听觉细胞HEI-OC1的结果：利用软件Venny 2.1，得到89个共有靶点，通路分析排名前七的关键靶点是ALB、AKT1、CTNNB1、IL-6、VEGFA，EGFR，CASP3。分子对接结合活性由高到低分别是IL-6、Caspase3、AKT1、MAPK1、ALB。体外实验qPCR结果显示AS-IV干预前后mRNA存在差异。结论：初步揭示了黄芪甲苷通过多成分、靶点、通路起到了激活自噬抑制凋亡等作用，为突发性聋的临床治疗提供了新的思路。

目的 探讨TAPP“画双眉”修补术在男性巨大腹股沟斜疝治疗中的临床应用价值。方法 回顾性分析 2016年 2月至 2024年 12 月期间，本院采用TAPP‘“画双眉”修补术治疗的 75 例男性巨大腹股沟斜疝患者的临床资料，其中巨大疝定义为疝囊最大径≥10cm ，或疝内容物包含部分腹腔脏器（如小肠、大网膜）且难以手法完全回纳，即使环纳后包块又迅速出现。手术时间、术中出血量、手术后下床活动时间、住院天数、术后并发症（阴囊积液及血肿、切口疼痛、补片移位、感染、疝复发）发生情况，并通过手术后 1年、3年、5年的随访评估远期疗效。结果 75例患者均顺利完成TAPP“画双眉”修补手术，无中转开放手术病例。手术时间为60分钟左右，术中出血量为5mL—15mL，手术后下床活动时间为6小时—12小时，平均8小时。住院天数为4天—7天，平均5天。术后连续随访 3年，有 2例患者出现阴囊少量积液，没有作任何处理，分别在15天—1 个月左右自行吸收；无切口疼痛、补片移位、感染及疝复发病例。结论 TAPP“画双眉”修补术治疗男性巨大腹股沟斜疝，具有操作简单、容掌握、手术时间短、创伤小、出血少、术后恢复快、并发症发生率低、复发率低等特点，特别是对于在基层医院开展TAPP手术更适合本手术方式，是一种安全有效的手术方式，值得临床广泛推广应用。