晚期癌痛所带来的疼痛症状是持久且严重的，这十分影响患者的生活质量与身心健康，并阻碍肿瘤治疗方案的顺利实施，进而影响患者治疗效果。阿片类药物是治疗中重度癌痛的主要方式，具有明确的镇痛效果，但是，吗啡、芬太尼等具有代表性的传统阿片类药物也存在一定的应用局限性，其主要通过激活μ-阿片受体下游的G蛋白信号通路以发挥镇痛作用，这会在一定程度上激活β-arrestin通路，进而增加呼吸抑制、严重便秘、过度镇静等副作用的发生情况，因此，该类药物不具有临床广泛应用性[1-2]。在此背景下，奥赛利定作为新型阿片类药物应运而生，其可选择性激活G蛋白通路，且不会显著激动β-arrestin通路效应，能够在实现强效镇痛的同时，还可降低由β-arrestin通路激活所介导的不良反应发生率，这十分适合应用在无法耐受传统阿片镇痛药物副作用的患者群体之中[3-4]。基于此，本研究进一步探究奥赛利定注射液治疗晚期癌痛的临床疗效与安全性，如下。

目的：对比季德胜蛇药片不同用药方式分别与阿昔洛韦结合，在带状疱疹治疗中的价值。方法： 将74例于我院诊治带状疱疹患者随机分为外涂组（37例，季德胜蛇药片外涂结合阿昔洛韦治疗）与口服组（37例，季德胜蛇药片口服结合阿昔洛韦治疗）。对治疗7天后两组的症状程度、病情转归时间、整体疗效及用药安全性展开对比。结果：治疗后，外涂组VAS评分、皮损评分均低于口服组（P＜0.05）；治疗后，外涂组止疱时间、疼痛减轻时间、结痂时间均短于口服组（P＜0.05）；外涂组97.30%的总有效率较口服组的83.78%高（P＜0.05）；外涂组5.41%的药物副反应发生率较口服组的21.62%低（P＜0.05）。结论：在带状疱疹治疗中，季德胜蛇药片外涂结合阿昔洛韦治疗，相比于季德胜蛇药片口服结合阿昔洛韦治疗，可获得更好整体疗效，患者症状改善更明显，病情转归更快，用药安全性更高。

目的：对比季德胜蛇药片不同用药方式分别与阿昔洛韦结合，在带状疱疹治疗中的价值。方法： 将74例于我院诊治带状疱疹患者随机分为外涂组（37例，季德胜蛇药片外涂结合阿昔洛韦治疗）与口服组（37例，季德胜蛇药片口服结合阿昔洛韦治疗）。对治疗7天后两组的症状程度、病情转归时间、整体疗效及用药安全性展开对比。结果：治疗后，外涂组VAS评分、皮损评分均低于口服组（P＜0.05）；治疗后，外涂组止疱时间、疼痛减轻时间、结痂时间均短于口服组（P＜0.05）；外涂组97.30%的总有效率较口服组的83.78%高（P＜0.05）；外涂组5.41%的药物副反应发生率较口服组的21.62%低（P＜0.05）。结论：在带状疱疹治疗中，季德胜蛇药片外涂结合阿昔洛韦治疗，相比于季德胜蛇药片口服结合阿昔洛韦治疗，可获得更好整体疗效，患者症状改善更明显，病情转归更快，用药安全性更高。

目的 探讨紫芪补肾汤联合达格列净治疗脾肾阳虚型糖尿病肾病（DKD）患者的临床疗效，并分析其对糖代谢、肾功能的影响。方法 选取2024年9月～2025年9月于本院就诊的106例DKD患者为研究对象，按照随机数字表法将其分为对照组、研究组，各53例。对照组予以达格列净治疗，研究组予以紫芪补肾汤联合达格列净治疗，连续治疗2个月。统计对比两组临床疗效、不良反应及治疗前后中医证候积分、血糖及糖代谢指标[空腹血糖（FPG）、餐后2 h血糖（2 h PG）、糖化血红蛋白（HbA1c）、糖原合酶激酶-3β（GSK-3β）、缺氧诱导因子-1α（HIF-1α）]、肾功能相关指标[血尿素氮（BUN）、血肌酐（SCr）、尿微量白蛋白排泄率（UAER）、估算的肾小球滤过率（eGFR）、同型半胱氨酸（Hcy）、胱抑素C（CysC）、碳水化合物反应元件结合蛋白（ChREBP）]、炎症因子[肿瘤坏死因子-α（TNF-α）、白细胞介素-1β（IL-1β）、肿瘤坏死因子1型受体（TNFR1）、趋化因子配体9（CXCL9）]、血管内皮功能[血管生成抑制蛋白-1（VASH-1）、血管内皮生长因子（VEGF）、内皮素-1（ET-1）、一氧化氮（NO）、血栓素B2（TXB2）]。结果 研究组总有效率为90.57%，明显高于对照组的73.58%（P＜0.05）；研究组治疗后中医证候积分低于对照组（P＜0.05）；研究组治疗后FPG、2 h PG、HbA1c、GSK-3β、HIF-1α水平低于对照组（P＜0.05）；研究组治疗后BUN、SCr、UAER、Hcy、CysC、ChREBP水平低于对照组，eGFR高于对照组（P＜0.05）；研究组治疗后血清TNF-α、IL-1β、TNFR1、CXCL9水平低于对照组（P＜0.05）；研究组治疗后VASH-1、NO水平高于对照组，VEGF、ET-1、TXB2水平低于对照组（P＜0.05）；两组不良反应比较无明显差异（P＞0.05）。结论 紫芪补肾汤联合达格列净治疗DKD患者的疗效显著，可降低血糖水平，改善肾功能，抑制炎症反应，减轻血管内皮损伤，且具有一定安全性。

目的 比较白内障超声乳化吸除术（Phaco）+房角分离术与Phaco+小梁切除术治疗急性原发性闭角型青光眼（APACG）合并白内障的临床价值。方法 回顾性分析2022年1月至2025年1月我院200例APACG合并白内障患者临床资料，根据手术方式分为小梁切除组（Phaco+小梁切除术）与房角分离组（Phaco+房角分离术），每组100例（200眼）。比较两组眼压、视力[最佳矫正视力（BCVA）]、中央前房深度、视盘血流密度[整体视盘血流密度（wiVD）、视盘内血流密度（diVD）]、生活质量[视功能相关生活质量量表-25（NEI-VFQ-25）]及并发症情况。结论 术后1周、1个月、3个月，房角分离组眼压低于小梁切除组，BCVA、中央前房深度大于小梁切除组，wiVD、diVD高于小梁切除组（P＜0.05）；术后1个月，房角分离组NEI-VFQ-25评分高于小梁切除组（P＜0.05），术后3月两组NEI-VFQ-25评分比较无显著差异（P＞0.05）；房角分离组并发症总发生率（6.50%）低于小梁切除组（13.00%）（P＜0.05）。结论 与Phaco+小梁切除术相比，Phaco+房角分离术治疗APACG合并白内障患者能有效控制眼压，增加前房深度，改善视盘血流循环，恢复患者视力，提高生活质量，减少并发症发生率。

Objective To compare the clinical efficacy of phacoemulsification (Phaco) combined with goniosynechialysis and phacoemulsification combined with trabeculectomy in the treatment of acute primary angle-closure glaucoma (APACG) complicated with cataract. Methods The clinical data of 200 patients with APACG complicated with cataract treated in our hospital from January 2022 to January 2025 were retrospectively analyzed. According to surgical procedures, the patients were divided into trabeculectomy group (Phaco combined with trabeculectomy) and goniosynechialysis group (Phaco combined with goniosynechialysis), with 100 patients (200 eyes) in each group. Intraocular pressure, visual acuity [best corrected visual acuity (BCVA)], central anterior chamber depth, optic disc vessel density [whole-image optic disc vessel density (wiVD), disc-inside vessel density (diVD)], quality of life [25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25)] and complications were compared between the two groups. Results At 1 week, 1 month and 3 months after surgery, the goniosynechialysis group had lower intraocular pressure, better BCVA, deeper central anterior chamber depth, and higher wiVD and diVD than the trabeculectomy group (P<0.05). One month postoperatively, the NEI-VFQ-25 score of the goniosynechialysis group was significantly higher than that of the trabeculectomy group (P<0.05), while no significant difference was observed between the two groups at 3 months after surgery (P>0.05). The overall incidence of complications in the goniosynechialysis group was 6.50%, which was lower than 13.00% in the trabeculectomy group (P<0.05). Conclusion Compared with phacoemulsification combined with trabeculectomy, phacoemulsification combined with goniosynechialysis can effectively control intraocular pressure, increase anterior chamber depth, improve optic disc blood circulation, restore visual acuity, enhance quality of life and reduce the incidence of complications in patients with APACG complicated with cataract.

目的:探讨早期康复治疗对中青年脑卒中患者肢体运动功能恢复等影响。方法：从我院选取中青年脑卒中患者90例作为实验对象，分为实验组和观察组各45例，两组同时接受相同常规治疗并给予早期康复介入，并对其进行患侧上肢和下肢功能评定量表（ Fugl-Meyer, FMMS），以及患者日常生活活动能力（Modified Barthel Index,MBI）评定。实验组给予进一步强化康复运动治疗，以加速提高患者康复速率；2周结束时对实验组和观察组再次进行评估，比较2组患者治疗前后组内和组间治疗疗效。结果：早期康复2周后，实验组FMMS量表上肢评分为(29.82±15.43)分，观察组上肢评分为(21.33±11.98)分，组间存在统计学差异（P=0.005）。实验组FMMS量表下肢评分为(21.18±8.97)分，观察组下肢评分为(15.40±7.40)分，实验组得分高于观察组且两组间存在显著统计学差异（P=0.002）；随访1个月后实验组上下肢功能呈持续改善趋势，且两组间差异具有显著统计学意义。实验组MBI量表评分为(35.56±18.93)分，高于对照组（28.56±14.68）分，但未见统计学意义；1个月后两组间差异具有显著统计学意义（P＜0.001）。结论：研究表明，早期康复治疗对改善中青年脑卒中患者肢体功能和日常生活活动能力具有显著康复效果。

Objective:Exploring the impact of early rehabilitation therapy on the recovery of limb motor function and other aspects in young and middle-aged stroke patients. Methods: Ninety young and middle-aged stroke patients were selected from our hospital as experimental subjects and divided into two groups, namely the experimental group and the observation group, with 45 cases in each group. Both groups received the same conventional treatment and early rehabilitation intervention simultaneously, and were evaluated using the Fugl-Meyer Motor Scale (FMMS) for the affected upper and lower limbs, as well as the Modified Barthel Index (MBI) for activities of daily living. The experimental group received further intensive rehabilitation exercise therapy to accelerate the rehabilitation rate. At the end of 2 weeks, both groups were reassessed, and the therapeutic effects within and between the two groups before and after treatment were compared. Results: After 2 weeks of early rehabilitation, the FMMS upper limb score in the experimental group was (29.36±15.27) points, while that in the observation group was (25.18±11.99) points, with no statistically significant difference observed between the groups. The FMMS lower limb score in the experimental group was (20.93±8.93) points, higher than that in the observation group (15.40±7.40) points, with a significant statistical difference between the two groups (P=0.002). The MBI score in the experimental group was (33.22±15.96) points, higher than that in the control group (28.56±14.68) points, but no statistical significance was observed. Conclusions: Our study indicates that early rehabilitation therapy has certain effects on upper limb function and activities of daily living in patients, particularly demonstrating significant rehabilitation effects in improving lower limb functional recovery in young and middle-aged stroke patients.

目的 分析胃热壅盛证急性非静脉曲张性上消化道出血（Acute Non-variceal Upper Gastrointestinal Bleeding，ANVUGIB）患者应用生地泻心汤联合矛头蝮蛇血凝酶治疗的效果。方法 收集2022-02—2025-09我院确诊的ANVUGIB患者98例为研究对象，按照治疗方案分为研究组与对照组，其中接受矛头蝮蛇血凝酶治疗的49例患者作为对照组，接受生地泻心汤、矛头蝮蛇血凝酶联合治疗的49例作为研究组。观察两组疗效、再出血率、止血效果、中医证候积分、安全性、凝血功能指标[全血活化部分凝血活酶时间（Activated Partial Thromboplastin Time，APTT）、凝血酶原时间（Prothrombin Time，PT）、血浆D-二聚体（D-Dimer，D-D）、纤维蛋白原（Fibrinogen，FIB）水平]、全血血红蛋白（Hemoglobin，Hb）、红细胞压积（Hematocrit，HCT）、红细胞计数（Red Blood Cell Count，RBC）以及血清尿素氮（Blood Urea Nitrogen，BUN）水平。结果 研究组治疗有效率93.88%比对照组77.55%高（P＜0.05）；与对照组相比，治疗12h、24h、48h研究组有效止血率较高，出血停止时间较短（P＜0.05）；治疗1周后，研究组中医证候积分低于对照组（P＜0.05）；研究组再出血率低于对照组（P＜0.05）；治疗1周后，研究组PT、APTT短于对照组，血浆D-D、FIB水平低于对照组（P＜0.05）；治疗1周后，研究组全血RBC、Hb、HCT水平高于对照组，血清BUN水平低于对照组（P＜0.05）；两组治疗期间未发生不良反应。结论 胃热壅盛证ANVUGIB患者应用生地泻心汤联合矛头蝮蛇血凝酶治疗效果确切，可缩短出血时间，减轻临床症状，改善凝血功能与循环血容量，且未见不良反应。

摘要：目的 探讨重症急性胰腺炎患者在CRRT治疗期间液体平衡管理的体验与需求，为优化临床液体管理及护理支持策略提供依据。方法 采用描述性质性研究方法，运用目的抽样法选取2024年5月—2025年12月在我院重症医学科接受CRRT治疗的13例重症急性胰腺炎患者进行半结构式深入访谈。采用Colaizzi七步分析法对访谈资料进行整理、编码、归类与主题提炼。结果 本研究最终提炼出4个主题、11个亚主题，分别为：①强烈而持续的身体不适体验（强烈的口渴感、身体肿胀与沉重、治疗期间寒冷与束缚）；②液体管理限制下的认知行为冲突（对限液医嘱情绪复杂、出入量监测引发的复杂感受、配合行为背后的动力与障碍）；③治疗过程中的负性情绪与心理调适（治疗初期的强烈恐惧与不确定感、无助感与自主权被削弱、在病痛中重建希望与韧性）；④对疾病信息与多维照护支持的迫切需求（信息缺乏引发困惑与焦虑、照护支持需求）。结论 重症急性胰腺炎患者在CRRT治疗期间，临床护理不仅应关注液体出入量等客观指标，还应重视患者的口渴等主观不适、限液过程中的认知行为冲突、治疗相关情绪反应及信息支持需求。

目的 分析围绝经期女性糖脂代谢水平与卵巢储备功能减退（DOR）的相关性，并探讨绝经激素治疗的应用价值。方法 回顾性选取2024年2月至2026年2月就诊于本院的194例围绝经期女性为研究对象，根据其卵巢储备功能将其分为DOR组（n=103）与卵巢储备功能正常组（NOR，n=91）。比较2组临床资料，采用Logistic回归分析围绝经期女性DOR的危险因素，绘制ROC曲线分析其预测效能，并利用Spearman相关系数分析指标相关性。同时予以所有患者绝经激素治疗（MHT），比较治疗前后的性激素指标、糖代谢指标、超声指标及安全性指标。结果 Logistic多因素结果显示：年龄、FSH、HbA1c、TG是围绝经期女性DOR的重要影响因素（P＜0.05）。ROC结果显示：联合预测的AUC=0.982，95%CI为0.964~1.000，灵敏度为0.990，特异度为0.923，校准曲线拟合性好。卵巢储备功能与年龄、FSH、HbA1c、TG均呈显著正相关（P均<0.05）。与治疗前相比，FSH、LH、HbA1c、TG、LDL-C水平有明显下降（P＜0.05），子宫内膜厚度略有增加（P＜0.05）；AMH、卵巢体积无显著变化（P＞0.05）。MHT治疗后不良反应发生率为4.64%。结论 糖脂代谢异常与围绝经期女性DOR密切相关，是其重要危险因素。规范MHT干预可有效改善内分泌代谢紊乱，且安全性可靠。

Objective To analyze the correlation between glycolipid metabolism levels and diminished ovarian reserve (DOR) in perimenopausal women, and to explore the application value of menopausal hormone therapy.Methods A total of 194 perimenopausal women admitted to our hospital from February 2024 to February 2026 were retrospectively enrolled. They were divided into the DOR group (n=103) and the normal ovarian reserve (NOR) group (n=91) according to ovarian reserve function. Clinical data were compared between the two groups. Logistic regression analysis was used to identify risk factors for DOR. Receiver operating characteristic (ROC) curves were plotted to evaluate predictive efficacy, and Spearman correlation analysis was performed to assess indicator correlations. All patients received menopausal hormone therapy (MHT). Sex hormone indicators, glycolipid metabolic indicators, ultrasonographic indicators and safety indicators were compared before and after treatment.Results Multivariate Logistic regression showed that age, folliclestimulating hormone (FSH), glycated hemoglobin A1c (HbA1c) and triglyceride (TG) were independent risk factors for DOR in perimenopausal women (P＜0.05). ROC analysis revealed that the combined prediction yielded an AUC of 0.982 (95%CI: 0.964–1.000), with a sensitivity of 0.990 and a specificity of 0.923, and good calibration curve fitting. Ovarian reserve was significantly positively correlated with age, FSH, HbA1c and TG (all P＜0.05). After treatment, levels of FSH, luteinizing hormone (LH), HbA1c, TG and lowdensity lipoproteincholesterol (LDLC) decreased significantly (P＜0.05), and endometrial thickness increased slightly (P＜0.05). No significant changes were observed in antiMüllerian hormone (AMH) and ovarian volume (P＞0.05). The incidence of adverse reactions after MHT was 4.64%.Conclusion Abnormal glycolipid metabolism is closely associated with DOR and serves as a critical risk factor in perimenopausal women. Standardized MHT can effectively improve endocrinemetabolic disorders with satisfactory safety.

目的：评价在特发性黄斑裂孔（Idiopathic macular hole，IMH）患者的治疗中采用内界膜翻转覆盖术联合空气填充干预的实际价值；方法：选取2022年9月至2025年8月在我院接受手术治疗的42例裂孔直径在400~700μm的IMH患者，以随机数字表法分组，各21例。对照组采取内界膜剥离术联合空气填充进行干预，观察组采取内界膜翻转覆盖术联合空气填充进行干预，比较两组的裂孔闭合情况、最佳矫正视力（Best corrected vision，BCVA）及并发症发生情况；结果：两组患者在裂孔闭合情况率上差异无统计学意义（P＞0.05）。但术后3个月观察组的外界膜（External membrane，ELM）及椭圆体带（Ellipsoid zone，EZ）缺损直径均略低于对照组，表明两组在外层视网膜愈合情况上差异有统计学意义（P＜0.05）。术后1个月及3个月观察组的BCVA均低于对照组（P<0.05）。两组术后并发症发生率基本一致（P＞0.05）；结论：对IMH患者采取内界膜翻转覆盖术联合空气填充进行治疗，能够促进黄斑裂孔愈合并改善患者视力，且安全性良好，可广泛应用。