目的 分析单核细胞-淋巴细胞比率（MLR）联合游离三碘甲腺原氨酸（FT₃）对乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者生存状况的预测效果。方法 纳入我院在2019年1月—2022年1月期间收治的HBV-ACLF患者共187例进行研究,随访患者90 d的生存状况,其中69例死亡患者设为死亡组,其余118存活患者设为存活组。对2组患者的各项资料进行单因素分析,对差异有统计学意义的因素行Logistic多因素分析,分析HBV-ACLF患者死亡的危险因素,并分析MLR联合FT3对HBV-ACLF死亡的预测效果。结果 死亡组患者的年龄、肝硬化发生率、原发性腹膜炎发生率、肝肾综合征发生率、电解质紊乱发生率、终末期肝病模型、MLR、中性粒细胞与淋巴细胞计数比值、国际标准化比值、肌酐、白细胞计数、总胆红素水平均高于B组,血钠、FT₃、总血清胆固醇水平均低于存活组,差异有统计学意义（P<0.05）。MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）。MLR、FT₃、MLR+FT₃对HBV-ACLF患者死亡均有一定的预测价值,但MLR+FT3的预测价值高于其他单项预测。结论 MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）,且二者联合应用对HBV-ACLF患者死亡有较佳的预测价值。

Objective To analyze the predictive effect of mononuclear-lymphocyte ratio（MLR）combined with free triiodothyronine（FT₃）on the survival of patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）．Methods In the study,187 patients with HBV-ACLF from January 2019 to January 2022 in our hospital were included,and the survival status of the patients was followed up for 90 days．Among them,69 patients were included in the death group and the rest 118 patients were included in the survival group．The data of the two groups of patients were analyzed by univariate analysis,and the statistically significant factors were analyzed by Logistic multifactor analysis．The risk factors of death in patients with HBV-ACLF were analyzed,and the predictive effect of MLR combined with FT₃ on the death of HBV-ACLF was analyzed．Results The age,incidence of cirrhosis,primary peritonitis,hepatorenal syndrome,electrolyte disturbance,ratio of neutrophil to lymphocyte count,international standardized ratio,model for end stage liver disease,MLR,creatinine,white blood cell count and total bilirubin of the patients in the death group were higher than those in survival group,and the levels of serum sodium,FT₃ and total cholesterol were lower than those in survival group,the differences were significant（P<0.05）．The results showed that MLR≥0.60,FT₃≤2.50 pmol/L were risk factors for death of HBV-ACLF patients（P<0.05）．MLR,FT₃,MLR+FT₃ had certain predictive value for the death of HBV-ACLF patients,but the predictive value of MLR+FT₃ was higher than other single prediction．Conclusions MLR≥0.60 and FT₃≤2.50 pmol/L are risk factors for death of patients with HBV-ACLF（P<0.05）,and the combination of the two has a better predictive value for death of patients with HBV-ACLF．

目的 探讨外周血CD34阳性（CD34⁺）细胞计数对普乐沙福自体干细胞动员效果的预测价值。方法 回顾性分析2021年5月—2023年7月中山大学附属第七医院使用人粒细胞集落刺激因子（G-CSF）联合普乐沙福进行自体干细胞动员的13例患者临床资料,分析普乐沙福动员前后外周血CD34⁺细胞计数的变化及干细胞采集情况。结果 共有13例患者纳入研究,包括淋巴瘤10例和多发性骨髓瘤3例。多发性骨髓瘤患者中1例为新诊断,另2例为复发患者;淋巴瘤患者中3例为套细胞淋巴瘤,6例为弥漫大B细胞淋巴瘤（包括1例复发）,1例为B细胞淋巴瘤（不能明确类型）。本研究纳入的患者均使用G-CSF动员,在使用普乐沙福后CD34⁺细胞计数均升高,使用普乐沙福前中位CD34⁺细胞计数为13.3（2.5~76.1）/μL,使用普乐沙福后中位CD34⁺细胞计数为73.6（10.4~208.70）/μL,升高4.18（1.99~13.60）倍。13例患者中有2例患者在使用普乐沙福前外周血CD34⁺细胞计数<5 /μL,均动员失败。Spearman相关分析结果显示,使用普乐沙福后CD34⁺细胞计数与使用普乐沙福前CD34⁺细胞数呈正相关（r_s=0.769,P=0.003）。多元线性回归分析显示,使用普乐沙福后CD34⁺细胞计数能较好地预测采集结果（P=0.004）。结论 监测外周血CD34⁺细胞计数可预测普乐沙福自体干细胞动员效果,使用普乐沙福后CD34⁺细胞计数越多,CD34⁺细胞采集量越大。

Objective To explore the predictive value of peripheral blood CD34⁺ cell count for the stem cell mobilization effect of plerixafor．Methods The clinical data of 13 patients who used granulocyte colony-stimulating factor + plerixafor for stem cell mobilization in the Seventh Affiliated Hospital of Sun Yat-sen University from May 2021 to July 2023 were retrospectively analyzed．The changes of peripheral blood CD34⁺ cell count in all patients before and after the mobilization of plerixafor were analyzed．Results In 13 enrolled patients,there were 10 lymphoma patients and 3 multiple myeloma（MM）patients．One patient was newly diagnosed with MM,and the other two were recurrent patients．The lymphoma cases included 3 mantle cell lymphoma,6 diffuse large B cell lymphoma and 1 B cell non-Hodgkin's lymphoma（type cannot be specified）．The CD34⁺ cell counts were increased in all patients when mobilized with granulocyte colony-stimulating factor before plerixafor．The CD34⁺ cell count was 13.3（2.5~76.1）/μL and 73.6（10.4~208.70）/μL before and after the use of plerixafor,between which the difference was statistically significant（Z=0.578,P<0.05）,and the median increased of 4.18（1.99~13.6）times．There were 2 patients failed in mobilizing whose CD34⁺ cell count was less than 5 /μL before using plerixafor．Spearman analysis showed that there was a positive correlation in peripheral blood CD34⁺ cell count before and after the use of plerixafor（r_s=0.80,P=0.032）．The CD34⁺ cell count after using plerixafor was a good predictor of the collection results（P=0.002）．Conclusions Monitoring the CD34⁺ cell count in peripheral blood has a certain predictive value for the stem cell mobilization effect of plerixafor．The higher of CD34⁺ cell count after the use of plerixafor,the higher of CD34⁺ collection．

目的 探讨CT混合征和岛征及其联合征象对脑出血早期血肿扩大的临床预测价值。方法 将2018年12月—2020年12月河南宏力医院收治的脑出血患者86例作为研究对象,按照有无血肿扩大分为早期血肿扩大组(38例)和血肿未扩大组(48例)。分析CT平扫的岛征、混合征及联合征象对早期血肿扩大的影响,使用ROC曲线及曲线下面积(area under the curve,AUC)比较混合征、岛征及联合征对脑出血后血肿扩大的诊断效能。结果 混合征、岛征、联合征象诊断血肿扩大的灵敏度分别为65.79%、50.00%、84.21%,特异度分别为72.92%、83.33%、93.75%,阳性预测值分别为65.79%、70.37%、91.43%,阴性预测值分别为72.92%、67.80%、88.24%。不同影像学征象诊断血肿扩大的灵敏度、特异度、阳性预测值和阴性预测值差异均具有统计学意义(P<0.05)。ROC曲线分析中,混合征、岛征、联合征象诊断血肿扩大的AUC分别为0.690、0.656和0.811,P均小于0.05,其中联合征象的AUC最大。结论 CT征象中的混合征和岛征分别对脑出血早期血肿扩大的患者进行有效的预测,但相较于单独征象而言,二者的联合征象的诊断效能更高,对患者早期是否出现血肿扩大的现象诊断效能更具有科学性、高效性,为临床后期的治疗提供指导意义,同时也对患者疾病的恢复及预后起到积极作用。

目的 探讨老年吸入性肺炎的危险因素,建立风险预测模型,以期降低老年吸入性肺炎的发病率。方法 选取2017年8月28日—2020年 10月30日广州市第一人民医院老年病科住院治疗的老年肺炎患者205例,按照是否发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,对比2组患者的各项指标,分析老年吸入性肺炎的危险因素,建立风险预测模型,采用ROC曲线对模型进行预测效果检验。结果 多因素Logistic回归分析结果显示,脑梗塞、帕金森、留置胃管、长期卧床为老年吸入性肺炎的危险因素(P<0.05)。模型公式为Logit(P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀。该模型ROC曲线下面积为0.894。结论 本研究中的模型预测效果良好,可为医护人员预测老年患者发生吸入性肺炎的概率,及时采取相应的预见性护理及干预性治疗。

Objective To explore the risk factors of aspiration pneumonia in the elderly and establish the risk prediction model, in order to reduce the incidence of aspiration pneumonia in the elderly. Methods A total of 205 elderly patients with pneumonia who were hospitalized in the department of geriatrics, Guangzhou First People's Hospital from August 28, 2017 to October 30, 2020, were divided into aspiration pneumonia group and non-aspiration pneumonia group according to whether aspiration pneumonia occurred. The indicators of the two groups of patients were compared, the risk factors of aspiration pneumonia in the elderly were analyzed, the risk prediction model was established, and the prediction effect of the model was tested by receiver operating characteristic curve. Results Multivariate Logistic regression analysis showed that cerebral infarction, Parkinson's disease, indwelling nasogastric tube, and being bedridden were risk factors for aspiration pneumonia in elderly patients (P<0.05). The model formula was Logit (P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀. The area under receiver operating characteristic curve of this model was 0.894. Conclusion The prediction effect of the model in this study was good, which could predict the probability of aspiration pneumonia in elderly patients for medical staff, and to timely take the corresponding predictive care and interventional treatment.

目的 使用金标免疫层析法检测儿童腹泻粪便标本,将其轮状病毒的结果进行分析汇总。方法 选取本院2020年1月—2021年1月收治的86例儿童腹泻者,根据金标免疫层析法的检测方式,将检测结果为阳性者的轮状病毒粪便标本进行回顾性分析。将86例阳性者的轮状病毒粪便标本送往我市疾控中心,采用逆转录-聚合酶链式反应(RT-PCR)进行检测,分析对比检测情况。结果 86例儿童腹泻感染经金标免疫检测为阳性者80例,阳性率为93.02%,同时将86例粪便标本送往本市疾控中心采用RT-PCR检测验证70例阳性,轮状病毒阳性率为81.39%,两种检测方法相比,金标免疫检测结果其准确度更高;80例阳性者中,1岁以下的婴幼儿为31例,占38.75%,较为多见,其次为1岁、2岁的儿童,各占23.75%、25.00%。季节性以秋季和冬季为轮状病毒的高发期,11-12月份36例,占45.00%,1-2月、9-10月18例、16例,占22.50%、20.00%;男女性别比中2组阳性率比较,经统计学分析无明显差异性(χ²=2.500,P＞0.05)。结论 轮状病毒多以5岁以下的婴幼儿为主,秋冬季节较为常见,采取金标免疫层析法的检测方式,来检测儿童的粪便标本,其操作简单,可快速准确地检测出轮状病毒,且该方法具有一定的临床诊断价值,值得推广应用。

目的 探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ²检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果 单因素分析,术前超声指标:胆囊大小>50 cm²、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论 手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。

Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ² test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm², gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.

目的 探究血清降钙素原(PCT)联合阴离子隙(AG)检测在脓毒症患者预后中预测价值。方法 选取2019年1月—2021年1月于我院治疗117例毒症患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(78例)和死亡组(39例),对比2组患者一般资料,采用多因素分析其高危因素,应用ROC曲线确定曲线下面积,评估血清PCT联合AG检测对该类患者预后的预测价值。结果 2组患者一般资料对比,年龄、中性粒细胞计数、血清C反应蛋白(CRP)、PCT、AG、APACHEⅡ评分差异有统计学意义(P<0.05);年龄、CRP、PCT、AG水平是该类死亡的危险因素;ROC曲线分析结果显示,血清PCT曲线下面积为0.737,最佳截断值为9.595;AG曲线下面积为0.791,最佳截断值为21.695;血清PCT联合AG检测曲线下面积为0.933,最佳截断值为1.3442。结论 血清PCT联合AG检测对脓毒症患者预后具有较高的预测价值。

Objective To investigate the predictive value of serum procalcitonin (PCT) combined with anion gap (AG) detection on the prognosis of patients with sepsis. Methods One hundred and seventeen patients with sepsis treated in our hospital from January 2019 to January 2021 were selected as study subjects and divided into survival group (78 patients) and death group (39 patients) according to their prognosis at 28 d of admission. The general data of the two groups was compared, multi-factor Logistic analysis of high-risk factors of sepsis patients was performed, area under the ROC curve was applied to assess the predictive value of serum PCT combined AG detection on the prognosis of sepsis patients. Results After comparing the general data of the two groups, the differences in age, neutrophil count, C-reactive protein (CRP), PCT, AG and APACHE II scores were statistically significant (P<0.05); multi-factor Logistic regression analysis showed that age, CRP, PCT and AG levels were risk factors for death in sepsis patients; the results of ROC curve analysis showed that the area under the curve of serum PCT was 0.737, with an optimal cut-off value of 9.595; the area under the AG curve was 0.791, with an optimal cut-off value of 21.695;the area under the curve of serum PCT combined with AG was 0.933, and the optimal cut-off value was 1.3442. Conclusions Serum PCT combined with AG assay had a high predictive value for the prognosis of patients with sepsis.

目的 研究应用手机软件(Goniometer Pro,G-pro)进行测量髋关节活动度(range of motion,ROM)的测量的信度和效度。方法 用量角器和苹果手机软件G-pro来测量髋关节ROM,共有12名受试者参加本次试验。测量者A应用量角器和G-pro来测量髋关节的屈曲角度,同时测量者B应用G-pro进行再次测量髋关节屈曲角度,24 h后测量者A在相同条件下应用G-pro再次测试髋关节屈曲角度。通过分析量角器与G-pro测量结果进行效度分析,通过比较测量者A与B,测量者A前后两次测量进行组间和组内信度研究。结果 在同一测量者量角器与G-pro测量值之间无显著性差异(P >0.05),测量者A用G-pro前后24 h前后测量受试者得出的差值也无显著性差异(P>0.05),测量者A、B用G-pro测量髋关节活动度的测量值无显著性差异(P>0.05)。结论 G-pro对于测量髋关节屈曲具有良好的信度和效度。

Objective To study the reliability and validity of measuring hip joint range of motion(ROM) with mobile APP (Goniometer Pro,G-pro). Methods The hip joint ROM was measured with a protractor and iPhone APP (G-pro), 12 subjects participated in this trial. Tester A used a protractor and iPhone APP (G-pro) to measure the flexion angle of the hip joint. Tester B used the mobile APP to measure the hip flexion angle again. Twenty-four hours later, tester A used the mobile APP to measure the hip flexion angle again under the same conditions. The validity was evaluated by analyzing the measurement results of protractor and mobile APP. The inter group and intra group reliability was studied by comparing the two measurements of tester A and tester B, and twice measurements of tester A. Results There was no significant difference between the measurements of protractor and iPhone APP by the same tester (P＞0.05). There was no significant difference in the twice measurements of tester A using iPhone APP (P＞0.05), and there was no significant difference in measurements of tester A and tester B using iPhone APP (P＞0.05). Conclusions The iPhone APP (Goniometer Pro) has good reliability and validity in measuring hip ROM.

目的 建立HPLC法测定人血浆中亚胺培南浓度,并基于稳定性试验结果建立临床标本采样流程。方法 以0.01 mol·L^-1乙酸铵缓冲液(pH 6.8)-乙腈(95∶5,V∶V)为流动相,用Agilent Zorbax SB-AQ(4.6 mm×250 mm,5 μm)色谱柱,进样量30 μL,柱温30 ℃,流速1.0 mL·L^-1,紫外检测波长298 nm,分别考察了在不同温度,加入稳定剂等条件下亚胺培南的稳定性。结果 亚胺培南在3.30～105.60 μg·mL^-1线性关系良好(R²=0.999 1),定量下限为0.41 μg·mL^-1,批内回收率在97.83%～103.54%,批间回收率在99.43%～104.24%,日内、日间RSD＜15.0%;在稳定性血浆中,亚胺培南在低温、室温条件下可分别稳定72 h和18 h,在非稳定性血浆中,分别为24 h和6 h。结论 本方法简便、快速、准确,可用于监测亚胺培南浓度,且基于稳定性试验建立临床标本采样流程,能确保血药浓度监测结果准确性。

Objective To determine the concentration of imipenem in human plasma by HPLC method, and establish the sampling process of clinical specimens based on stability investigation result. Methods The mobile phase was consisted of 0.01 mol·L^-1 ammonium acetate buffer(pH 6.8)-acetonitrile(95∶5, V∶V), and using Agilent Zorbax SB-AQ column(4.6 mm×250 mm,5 μm)to investigat the stability of imipenem under different temperature and with or without stabilizer. The injection volume was 30 μL, the colum temperature was 30℃, the flow rate was 1.0 mL·L^-1 and the detection wavelength was 298 nm. Results Imipenem had a good correlation coefficient(R²=0.999 1)at concentration of 3.30-105.60 μg·mL^-1. The lower limit of quantification was 0.41 μg·mL^-1, the intra-batch and inter-batch recovery rate were 97.83%-103.54% and 99.43%-104.24%, the intra-day and inter-day RSD were less than 15.0%. In stabilized plasma, imipenem could maintain stable at low temperature for 72 h and room temperature for 18 h, in non-stabilized plasma for 24 h and 6 h respectively. Conclusions This method was simple, rapid and accurate, which was suitable for the imipenem therapeutic drug monitoring, and establishing the sampling process of clinical specimen based on stability test could ensure the accuracy of plasma concentration monitoring.

目的 观察失效模式与效应分析(FMEA)在医务人员血源性职业暴露监测分析及防护的应用。方法 采用FMEA回顾性分析2018年1月—2019年6月我院医务人员血源性职业暴露高危因素,计算风险指数(RPN),优先处理最高风险因素,制定改进措施,且于2019年7月—2020年12月采用改进后方案,对照分析方案实施前后失效模式RPN值、血源性职业暴露情况、医院安全氛围量表中文版。结果 采用FMEA后,RPN、权重系数(W_i)均降低,且RPN实施前为2 633分,实施后为853分,降幅为67.60%,W_i实施前为0.729 9,实施后为0.268 0,降幅为63.28%,均达到预定目标。采用FMEA前,血源性职业暴露率为28.74%,采用FMEA后,血源性职业暴露率为4.65%。实施整改方案后的安全工作阻碍(11.99±2.16)分、清洁度和整洁度(11.48±1.89)分、管理与支持(28.58±3.24)分、冲突与沟通(22.54±2.83)分、反馈和培训(13.82±2.55)分均高于实施前(10.67±2.68)分、(10.06±2.36)分、(26.80±3.86)分、(20.85±2.62)分、(12.52±1.19)分,P<0.05。结论 在医务人员血源性职业暴露管理中采用FMEA,可以细化高风险环节,提高改进措施的针对性,减少职业暴露。

Objective To observe the application of failure mode and effect analysis (FMEA) in monitoring analysis and protection countermeasures of blood-borne occupational exposure of medical personnel. Methods FMEA was used to retrospectively analyze the high risk factors of blood-borne occupational exposure of medical staff in our hospital from January 2018 to June 2019, to calculate the risk priority number (RPN), to give priority to the highest risk factor, to formulate improvement measures. The improved scheme was adopted from July 2019 to December 2020. The RPN value of failure mode, blood-borne occupational exposure and Chinese Hospital Safety Atmosphere Scale (C-HSCS) before and after the implementating of the scheme were compared and analyzed. Results After implementating FMEA, RPN and weight coefficient (W_i) decreased, and the RPN scores were 2 633 and 853 before and after implementation, with a decrease of 67.60%, W_i was 0.729 9 before implementation and 0.268 0 after implementation, with a decrease of 63.28%. Before FMEA, the blood-borne occupational exposure rate was 28.74%, and after FMEA, the rate was 4.65%. After the implementation, the scores of safety work obstruction was (11.99±2.16), cleanliness and tidiness was (11.48±1.89), management and support was (28.58±3.24), conflict and communication was (22.54±2.83), feedback and training was (13.82±2.55), which were higher than those before the implementation: (10.67±2.68), (10.06±2.36), (26.80±3.86), (20.85±2.62), (12.52±1.19), P<0.05. Conclusions Using FMEA in the management of blood-borne occupational exposure of medical personnel could refine high-risk steps, improve the pertinence of improvement measures and reduce occupational exposure.