目的 研究基于儿童早期预警评分（PEWS）的分级干预模式促进重症肺炎患儿康复进程及对呼吸功能的影响。方法 回顾性分析2021年4月—2023年4月我院收治的100例重症肺炎患儿临床资料。将其按照干预方式的差异分为研究组（n=50）及对照组（n=50）。对照组选用常规干预,研究组则于对照组基础上增加基于PEWS的分级干预。对比两组康复进程（相关指标涵盖症状持续时长及住院天数）、呼吸功能（涵盖通气流速、每分钟最大通气量、肺活量、用力肺活量及深吸气量）、并发症发生情况（涵盖呼吸机相关性肺炎、肺大疱及胸膜炎）、患儿家属满意度。结果 研究组各项症状持续时长及住院天数均短于对照组（均P<0.05）。研究组各项呼吸功能指标水平均高于对照组（均P<0.05）。两组各项并发症发生率对比差异无统计学意义（P>0.05）。研究组患儿家属满意度高于对照组（96.00% vs 82.00%,P<0.05）。结论 基于PEWS的分级干预模式促进重症肺炎患儿康复进程的效果较佳,且能改善呼吸功能,提高患儿家属满意度。

Objective To study the effect of graded intervention mode based on Pediatric Early Warning Score（PEWS）on the recovery process and respiratory function of children with severe pneumonia．Methods The clinical data of 100 children with severe pneumonia treated in our hospital from April 2021 to April 2023 were retrospectively analyzed．Those children were divided into study group（n=50）and control group（n=50）according to the difference of intervention methods．Conventional intervention was used in the two groups,and PEWS-based graded intervention was added to the study group．The two groups were compared with each other in terms of recovery process（including duration of symptoms and length of stay）,respiratory function（including ventilation velocity,maximum volume per minute,vital capacity,forced vital capacity and deep inspiratory capacity）,complications（including ventilators associated pneumonia,bullosa and pleurisy）,and family member satisfaction．Results The duration of symptoms and hospitalization days in the study group were shorter than those in the control group（all P<0.05）．The levels of respiratory function indexes in study group were higher than those in control group（all P<0.05）．There was no significant difference in the incidence of complications between the two groups（P>0.05）．The satisfaction of family member in the study group was higher than that in the control group（96.00% vs 82.00%）（P<0.05）．Conclusions The PEWS based graded intervention model has a good effect on promoting the rehabilitation process of children with severe pneumonia,and can improve respiratory function,and increase the satisfaction of family member of children with severe pneumonia．

目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组（n=53）与对照组（n=53）。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表（WHOQOL-100）及癌因性疲乏程度（PFS）,最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表（VAS）评分、术后住院时间均优于对照组（P<0.05）;观察组并发症发生率低于对照组（P<0.05）;干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组（P<0.05）;观察组护理满意度高于对照组（P<0.05）。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。

Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection．Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group（n=53）and a control group（n=53）using a random number table method．All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care．The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared．Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale（VAS）score and postoperative hospital stay compared to the control group（P<0.05）．The incidence of complications in the observation group was lower than that in the control group（P<0.05）．After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group．The PFS score decreased,and the observation group was lower than the control group（P<0.05）．The nursing satisfaction of the observation group was significantly higher than that of the control group（P<0.05）．Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction．

目的 研究甲泼尼龙琥珀酸钠对重症支原体肺炎（SMPP）患儿的治疗效果及安全性。方法 采用随机数表法将南华大学附属长沙中心医院2021年1月—2022年12月收治的108例SMPP患儿分为两组,对照组（54例）采用常规治疗,研究组（54例）采用常规治疗联合甲泼尼龙琥珀酸钠治疗,比较2组临床疗效。结果 治疗后研究组炎症因子水平低于对照组,肺功能指标、健康状况评分均高于对照组,发热、咳嗽、肺啰音及肺阴影消失时间均短于对照组（P<0.05）;两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 应用甲泼尼龙琥珀酸钠治疗可加快患儿症状缓解,改善机体炎症反应及肺功能,且安全性较高。

Objective To study the therapeutic effect and safety of methylprednisolone sodium succinate on children with severe Mycoplasma pneumoniae pneumonia（SMPP）．Methods A total of 108 children with SMPP admitted to Changsha Central Hospital from January 2021 to December 2022 were divided into two groups by random number table method．The control group（54 cases）was treated with conventional therapy,and the study group（54 cases）was treated with conventional therapy combined with methylprednisolone sodium succinate．The clinical effects of the two groups were compared．Results After treatment,the levels of inflammatory factors in the study group were lower than those in the control group,and lung function indicators and health status scores were higher than those in the control group．The disappearance time of fever,cough,lung rales and lung shadows was shorter than that in the control group（P<0.05）．There was no statistically significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions The application of methylprednisolone sodium succinate treatment can accelerate the relief of symptoms in children,improve the body's inflammatory response and lung function,and has high safety．

目的 探讨慢性阻塞性肺疾病（COPD）住院患者口腔功能状态现状及影响因素。方法 采用便利抽样法,选择2022年9月—2023年7月在深圳市龙岗区某三甲医院呼吸内科、胸外科的老年COPD住院患者191例作为研究对象。使用一般资料调查表、日常生活自理能力评估量表（BADL）、反复唾液吞咽试验（RSST）、改良版呼吸困难量表（mMRC）、改良版Beck口腔评分量表进行调查及评估。采用单因素分析老年COPD住院患者口腔功能状态的影响因素,采用Logistic回归分析老年COPD住院患者口腔功能状态的影响因素。结果 191例老年COPD患者中,入院时、住院第3天（D3）、住院第5天（D5）、出院的Beck口腔评分分别为（10.79±2.51）,（10.91±2.82）,（11.21±2.30）,（10.83±2.55）分,比较差异无统计学意义（P>0.05）。单因素分析结果显示,COPD患者在D3、D5、出院时,Beck口腔功能状态的影响因素有：年龄、性别、婚姻状况、牙齿缺失情况、抽烟史以及生活自理能力影响,差异具有统计学意义（P<0.05）。二元Logistic回归分析结果显示,年龄、吸烟状况、牙齿缺失数量、生活自理能力是COPD住院患者口腔功能状态的影响因素（P<0.05）。结论 老年COPD患者口腔卫生状况较差,且受到年龄、吸烟情况、牙齿缺失、生活自理能力的影响,应采取针对性预防和干预策略,改善老年COPD住院患者的口腔卫生状况,以降低COPD患者发生并发症的风险。

Objective To investigate the status quo and influencing factors of oral function in hospitalized patients of chronic obstructive pulmonary disease（COPD）．Methods A total of 191 patients with COPD who were hospitalized in the Respiratory Department and Thoracic Surgery Department of a hospital in Longgang,Shenzhen from September 2022 to July 2023 were selected by convenience sampling．The general data questionnaire,the Barthel index of activity of daily living（BADL） the repetitive saliva swallowing test（RSST）,modified Medical Research Council Dyspnea Scale（mMRC）,the Modified Beck Oral Assessment Scale（BOAS）were used for investigation and evaluation．Single factor analysis was used to analyze the influencing factors of oral function status in elderly COPD patients,and logistic regression was used to analyze the independent risk factors affecting oral function status in elderly COPD patients．Results Among 191 elderly patients with COPD,the BOAS scores were（10.79±2.51）,（10.91±2.82）,（11.21±2.30）,（10.83±2.55）at admission,the 3rd day,the 5th day and discharged day,respectively,with no statistical significance．The results of univariate analysis indicated that the independent risk factors of Beck oral function status in COPD patients at D3,D5 and discharge were gender,age,marital status,tooth loss,smoking history and Barthel index score,and the differences were statistically significant（P <0.05）．Binary logistic regression analysis indicated that age,smoking status,tooth loss and Barthel index score were independent risk factors for oral function status in hospitalized patients with COPD（P<0.05）．Conclusions Elderly patients with COPD have poor oral health status,which is affected by patient's age,smoking history,tooth loss and self-care ability．Targeted prevention and intervention strategies should be adopted to improve the oral health status of hospitalized patients with COPD,so as to reduce the COPD patient's risk of complications．

目的 探讨痰涂片找抗酸杆菌、痰利福平耐药实时荧光定量核酸扩增检测技术（Xpert MTB/RIF）、分枝杆菌菌种鉴定、痰抗酸杆菌培养和血γ-干扰素释放检测技术（TB-IGRA）5种检测技术在尘肺合并肺结核临床诊断中的应用价值。方法 纳入2016年7月—2021年5月在厦门大学附属第一医院住院治疗的尘肺合并肺结核患者,按照尘肺患者是否合并肺结核,将患者分为尘肺组（156例）和尘肺合并肺结核组（111例）;比较两组患者的性别、年龄、接尘时间等一般资料,以及患者痰涂片、Xpert MTB/RIF、分枝杆菌菌种鉴定、痰培养和TB-IGRA的检测结果,分析尘肺合并肺结核患者5种检测技术阳性检出率的差异及其诊断价值。结果 在尘肺合并肺结核组中,TB-IGRA检测方法的阳性检出率最高（81.1%）,高于其他4种检测方法（P<0.01）;两两联合检测,以Xpert MTB/RIF+TB-IGRA组合的检测方式检出率最高（96.4%）,高于其他9种组合（P<0.01）。结论 TB-IGRA检测方法对尘肺合并肺结核患者的阳性检出率较高,联合Xpert MTB/RIF检测后可进一步提高诊断效率,对早期诊断尘肺是否合并结核具有重要的临床诊断价值。

Objective To investigate the value of five testing techniques in the clinical diagnosis of pneumoconiosis combined pulmonary tuberculosis,including sputum smear,Xpert Mycobacterium tuberculosis/rifampicin（Xpert MTB/RIF）,identification of Mycobacterium species,sputum acid-fast bacilli culture and tuberculosis-interferon-gamma release assays（TB-IGRA）．Methods Patients with pneumoconiosis combined with tuberculosis who were hospitalized in the First Hospital of Xiamen University from July 2016 to May 2021 were included in the study．The patients were divided into the pneumoconiosis group（156 cases）and pneumoconiosis combined with tuberculosis group（111 cases）according to whether the pneumoconiosis patients were combined with tuberculosis or not．The general data of the patients in the two groups were compared with respect to gender,age,and dust exposure time,and the results of sputum smears,Xpert MTB/RIF,identification of Mycobacterium species,sputum acid-fast bacilli culture and TB-IGRA were collected to analyze the differences and the diagnostic value in the five testing techniques of the positivity rates for patients who have pneumoconiosis combined with pulmonary tuberculosis．Results In the group with pneumoconiosis combined with tuberculosis,the positive detection rate of TB-IGRA was the highest（81.1%）,which was higher than other 4 testing methods（P<0.01）．Combined testing in pairs suggested that the testing method of Xpert MTB/RIF and TB-IGRA combination was the highest（96.4%）,significantly higher than the other 9 combinations（P<0.01）．Conclusions TB-IGRA has higher positive detection rate for patients with pneumoconiosis combined with tuberculosis,and diagnostic efficiency can be further improved by combining Xpert MTB/RIF assay testing,which is of great clinical diagnostic value for the early diagnosis of pneumoconiosis combined with tuberculosis．

目的 分析阿莫西林克拉维酸钾与第三代头孢类抗菌药联合应用于新生儿肺炎患儿的应用效果及其对患儿肠道菌群的影响。方法 选择在2021年2月—2022年11月期间于我院新生儿科接受相关治疗的100例新生儿肺炎患儿,依照简单随机化法将患儿分为研究组（n=50）及参照组（n=50）。给予参照组常规新生儿肺炎治疗,在此基础上给予研究组患者阿莫西林克拉维酸钾与第三代头孢类抗菌药的联合治疗。治疗结束后对比两组患儿的血清因子水平、肠道菌落情况、临床疗效以及不良反应发生情况。结果 治疗前,两组患儿的血清因子水平、肠道内菌群数量比较差异无统计学意义（P>0.05）,治疗后两组患儿的降钙素原（procalcitonin,PCT）、C-反应蛋白（C-reactive protein,CRP）、白细胞计数（white blood cell count,WBC）、肠球菌、肠杆菌、双歧杆菌以及乳酸杆菌水平均有改善（P<0.05）,其中研究组的PCT、CRP、WBC、肠球菌、双歧杆菌以及乳酸杆菌数量低于参照组,而研究组的肠杆菌数量高于参照组;同时研究组的临床有效率（94.00%）与参照组的临床有效率（86.00%）比较差异无统计学意义（P>0.05）;两组患儿的不良反应发生率比较差异无统计学意义（P>0.05）,但其中研究组腹泻的发生率高于参照组（P<0.05）。结论 在对新生儿肺炎患儿进行治疗时采取阿莫西林克拉维酸钾单纯治疗与阿莫西林克拉维酸钾+第三代头孢类抗菌药（头孢他啶）的临床疗效相当,联合用药虽能更为显著地减少患儿机体的细菌数量,改善血清因子水平,但更易发生腹泻的并发症,且为了减少耐药性,应适当采用单独用药。

Objective To analyze the application effect of amoxicillin clavulanate potassium combined with third-generation cephalosporin antibiotics in children with neonatal pneumonia and its impact on the intestinal microbiota．Methods From February 2021 to November 2022,100 newborns with pneumonia who received relevant treatment in the Department of Neonatology at the First People’s Hospital of Shangqiu City were randomly divided into a study group（n=50）and a reference group（n=50）using a simple randomization method．Routine treatment was provided for neonatal pneumonia in the reference group,and on this basis,a combination treatment of amoxicillin,clavulanate potassium,and third-generation cephalosporin antibiotics was applied on the study group patients．After treatment,the serum factor levels,intestinal colony status,clinical efficacy,and incidence of adverse reactions were compared between the two groups of children．Results Before treatment,there were no statistically significant differences in serum factor levels and intestinal microbiota between the two groups of children（P>0.05）．After treatment,the levels of procalcitonin（PCT）,C-reactive protein（CRP）,white blood cell count（WBC）,Enterococcus,Enterobacter,Bifidobacterium,and Lactobacillus in the two groups of children improved（P<0.05）,with the levels of PCT,CRP,WBC,the number of Enterococcus,Bifidobacterium,and Lactobacillus in the study group was lower than that in the reference group,while the number of Enterobacter in the study group was higher．There was no statistically significant difference（P>0.05）in the clinical response rate between the study group（94.00%）and the reference group（86.00%）．There was no statistically significant difference in the incidence of adverse reactions between the two groups of children（P>0.05）,but the incidence of diarrhea in the study group was higher than that in the reference group（P<0.05）．Conclusions The clinical efficacy of amoxicillin clavulanate potassium alone and amoxicillin clavulanate potassium+third-generation cephalosporin antibiotics（ceftazidime）in the treatment of newborns with pneumonia is comparable．Although the combination therapy can significantly reduce the number of bacteria in the body of children and improve serum factor levels,it is more prone to complications of diarrhea．In order to reduce drug resistance,separate medication should be appropriately used．

目的 探讨计划-实施-检查-处理（PDCA）循环法及根本原因分析法在持续正压通气治疗重症肺炎患儿中的应用效果。方法 选取2021年1月—2023年1月医院收治并接受鼻塞式持续正压通气治疗的重症肺炎患儿80例,基于随机数字表法分为两组,每组各40例。对照组接受常规护理,观察组采用PDCA循环法联合根本原因分析法护理干预。比较两组临床症状改善时间、血气指标[动脉血氧分压（PaO₂）、动脉血氧饱和度（SaO₂）、动脉血二氧化碳分压（PaCO₂）]、肺功能指标[第1秒用力呼气容积（FEV₁）、潮气量（VT）]、炎症免疫指标[单核细胞趋化蛋白-1（MCP-1）、可溶性髓系细胞触发受体-1（sTREM-1）、可溶性细胞间黏附分子-1（sICAM-1）]水平变化,比较两组患儿家属满意度情况。结果 观察组患儿咳嗽、气促、哮鸣音、心率恢复及紫绀等症状改善用时均低于对照组,比较差异有统计学意义（P<0.05）。干预前,两组患儿PaO₂、SaO₂、PaCO₂、FEV₁、VT、MCP-1、sTREM-1、sICAM-1水平比较差异均无统计学意义（P>0.05）;干预后,两组患儿上述指标水平均有不同程度变化（P<0.05）,观察组PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）、SaO₂（93.58±3.82% vs 86.30±4.21%）、FEV₁（2.66±0.46 L vs 1.97±0.34 L）、VT（11.92±1.89% vs 9.83±1.10%）水平均高于对照组,观察组PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）、MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）、sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）、sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）水平低于对照组,差异均有统计学意义（P<0.05）。观察组患儿家属满意度整体优于对照组（P<0.05）;观察组总满意率（97.5% vs 77.5%）高于对照组,差异有统计学意义（P<0.05）。结论 PDCA循环法及根本原因分析法应用于接受持续正压通气治疗的重症肺炎患儿,能够有效促进患儿临床症状改善,有利于血气及肺功能恢复,且可降低炎症反应,患儿家属满意度较高。

Objective To explore the application effect of Plan-Do-Check-Action（PDCA）circulation method and root cause analysis method in the treatment of children with severe pneumonia with continuous positive pressure ventilation．Methods From January 2021 to January 2023,80 children with severe pneumonia who were admitted to hospital and received nasal plug continuous positive pressure ventilation treatment were enrolled in this study．Based on the random number table method,they were divided into two groups,with 40 cases in each group．The control group received routine nursing,while the observation group received PDCA circulation method combined with root cause analysis nursing intervention．The improvement time of clinical symptoms,changes in blood gas indicators[arterial partial oxygen pressure（PaO₂）,arterial oxygen saturation（SaO₂）,arterial partial pressure of carbon dioxide（PaCO₂）],lung function indicators [（forced expiratory volume in 1 second,FEV₁）,tidal volume（VT）],and inflammatory immune indicators [monocyte chemotactic protein-1（MCP-1）,soluble myeloid cell trigger receptor-1（sTREM-1）,soluble intercellular adhesion molecule-1（sICAM-1）] levels between the two groups were compared,and the family members’ satisfaction of the two groups was also compared．Results The improvement time for symptoms such as cough,shortness of breath,wheezing,heart rate recovery and cyanosis in the observation group was lower than that in the control group,and the difference was statistically significant（P<0.05）．Before intervention,there was no statistically significant difference in the levels of PaO₂,SaO₂,PaCO₂,FEV₁,VT,MCP-1,sTREM-1 and sICAM-1 between the two groups of children（P>0.05）．After intervention,the levels of the above indicators in both groups of children showed varying degrees of change（P<0.05）．The levels of PaO₂（97.18±7.90 mmHg vs 90.30±7.12 mmHg）,SaO₂（93.58±3.82% vs 86.30±4.21%）,FEV₁（2.66±0.46 L vs 1.97±0.34 L）,VT（11.92±1.89% vs 9.83±1.10%）in the observation group were higher than those in the control group．The levels of PaCO₂（36.70±3.97 mmHg vs 40.65±3.79 mmHg）,MCP-1（58.45±11.94 ng/L vs 74.46±16.69 ng/L）,sTREM-1（36.25±8.30 ng/L vs 51.57±9.51 ng/L）and sICAM-1（187.52±31.22 mg/L vs 243.73±46.79 mg/L）in the observation group were lower than those of the control group,with statistically significant differences（P<0.05）．The overall satisfaction of the observation group was better than that of the control group（P<0.05）,the total family members’ satisfaction rate of the observation group was higher than that of the control group（97.5% vs 77.5%）,with a statistically significant difference（P<0.05）．Conclusions PDCA circulation method and root cause analysis method applied to children with severe pneumonia who receive continuous positive pressure ventilation treatment,can effectively promote the improvement of clinical symptoms,be conducive to the recovery of blood gas and lung function,and reduce inflammatory reaction,with high family members’ satisfaction．

目的 探索机械通气患者发生呼吸机相关性肺炎（VAP）的危险因素,为医疗机构降低VAP的发生率提供参考依据。方法 采用回顾性病例对照的方法,收集2020年1月—2021年4月入住重症医学科（ICU）接受机械通气>48 h、年龄>18岁的患者资料。根据诊断标准确定20例VAP患者作为病例组,在同期住院患者筛选性别、年龄与病例匹配的20例未发生VAP患者为对照组,并对两组间各项临床指标进行统计分析。结果 两组患者在接受机械通气前入院诊断情况、是否手术和合并慢性阻塞性肺炎、APACHEⅡ评分、置管地点比较差异均无统计学意义（P>0.05）;机械通气时白细胞、C反应蛋白、降钙素原比较差异无统计学意义（P>0.05）。与对照组相比,病例组住院总日数、住ICU天数、机械通气时间、吸痰护理次数、抗生素使用天数明显增加（均P<0.05）。其中ICU中VAP以耐碳青霉烯类鲍曼不动杆菌（占比70%）感染为主;环境卫生学监测发现,患者周围环境、护士站及使用后的消毒物品均检出鲍曼不动杆菌,说明医务人员手卫生依从性差及环境消毒不彻底也是导致院内VAP发生的原因之一。病例组住院总费用中位数为145 207元,对照组为60 745.48元,VAP造成的平均经济损失为84 461.52元/例。病例组各项医疗费用均高于对照组,比较差异有统计学意义（P<0.05）。结论 机械通气期间不适当的诊治、环境消毒不到位、手卫生依从性差可能是造成医疗机构VAP发生的主要原因。

Objective To explore the risk factors of ventilator-associated pneumonia（VAP）in patients with mechanical ventilation,and provide a reference basis for medical institutions to reduce the occurrence of VAP．Methods A retrospective case-control method was used to collect data of patients who hospitalized in intensive care unit（ICU）from January 2020 to April 2021,received mechanical ventilation > 48 h and were >18 years old．According to the diagnostic criteria,20 patients with VAP infection were enrolled as the case group．During the same period,20 non-infected patients who matched sex,age with case group patients were enrolled as the control group,and the clinical indicators between the two groups were statistically analyzed．Results There were no significant differences between the two groups in terms of admission diagnosis,surgery and chronic obstructive pulmonary disease,APACHEII score and place of intubation before mechanical ventilation（P>0.05）．There were no significant differences in white blood cell,C-reactive protein and procalctionin,CRP and PCT during the mechanical ventilation period（P>0.05）．Compared with the control group,the length of stay in hospital,the length of stay in ICU,the time of mechanical ventilation,number of sputum suction nursing,and the days of antibiotic use increased significantly（all P<0.05）．Among them,Acinetobacter baumannii resistant to carbapenem in ICU（accounting for 70%）was the main cause of VAP infection．The environmental hygiene monitoring found that Acinetobacter baumannii was detected in the patient’s surrounding environment,the nurse station and the disinfected items after use,indicating that the low hand hygiene compliance of medical staff and the incomplete disinfection of the environment were also the causes of VAP infection in the hospital．The median of total cost of hospitalization in the case group was 145 207 yuan,while that in the control group was 60 745.48 yuan．The average economic loss caused by VAP infection was 84 461.52 yuan each case．The medical expenses of the case group were higher than those of the control group,with a statistically significant difference（P<0.05）．Conclusions Improper diagnosis and treatment during the mechanical ventilation period,poor environmental disinfection,low hand hygiene compliance of medical staff are probably the main reasons for the occurrence of VAP in this institution．

目的 通过公共数据库筛选急性肺损伤（ALI）及急性呼吸窘迫综合征（ARDS）相关分子标志物,并探索其临床意义。方法 利用基因表达综合数据库（GEO）中有关ALI/ARDS基因表达芯片研究的两个数据集GSE76293和GSE10474,通过STRING网站和Cytoscape软件对差异基因进行蛋白互作网络分析并筛选ALI/ARDS相关关键基因。采用A549细胞构建ALI模型,并通过转录组测序验证关键基因在细胞中的表达差异情况。结果 2个GEO数据集中共筛选出共同上调基因27个,共同下调基因26个。主要参与抗原加工和外源抗原递呈、免疫受体活性调节、内质网膜构成等生物学功能,且与抗原加工、细胞分化等信号通路有关。蛋白互作网络分析共筛选出10个ALI/ARDS相关关键基因,分别为CD4、HLA-DQB1、CD74、HLA-DRA、FCGR2B、TOR1A、RELA、NME8、RNF19B、RHOB。细胞转录组测序结果显示,关键基因的上调或下调特征及表达差异情况与GEO数据集分析结果一致。结论 CD4等关键基因可能参与ALI/ARDS发生、发展的生物学过程,是ALI/ARDS临床诊断及预后预测的潜在个体化分子标志物。

Objective To identify molecular biomarkers associated with acute lung injury（ALI）/ acute respiratory distress syndrome（ARDS）and to explore their clinical significance with public databases. Methods Two datasets GSE76293 and GSE10474 in Gene Expression Omnibus（GEO）database for ALI/ARDS gene expression chip study were used to screen genes with significant differences in both datasets．The protein-protein interaction（PPI）analysis of co-expression genes was performed based on the STRING website and Cytoscape software,and then key genes related to ALI/ARDS were identified with cytoHubba method．The ALI model was constructed using A549 cells cultured in vitro,and the expression differences of key genes in the cells were verified by RNA sequencing. Results A total of 27 up-regulated genes and 26 down-regulated genes were screened in both the two GEO datasets with Venn Diagramm．These co-expression genes were mainly involved in biological functions such as antigen processing and presentation of exogenous peptide antigen,immune receptor activity,integral component of lumenal side of endoplasmic reticulum membrane and were related to signal pathways such as antigen processing and cell differentiation．A total of 10 key genes（CD4,HLA-DQB1,CD74,HLA-DRA,FCGR2B,TOR1A,RELA,NME8,RNF19B,RHOB）related to ALI/ARDS were identified． The results of cell RNA sequencing showed that the up-regulated or down-regulated characteristics and expression differences of key genes were consistent with the results of GEO datasets. Conclusions Several key genes identified in this study may be involved in the biological process of ALI/ARDS development,and may be potential individualized molecular markers for clinical diagnosis and prognosis prediction of ALI/ARDS．

目的 探讨特发性间质性肺炎（IIPs）[非特发性肺间质性纤维化（IPF）型]合并弥漫性肺部出血综合征患者治疗方案以及应用价值。方法 报道1例IIPs（非IPF型）合并弥漫性肺部出血综合征患者的治疗经过以及结果,结合文献分析治疗IIPs（非IPF型）合并弥漫性肺部出血综合症临床应用价值。结果 该文报道 l 例特发性肺间质肺炎（非IPF型）伴弥漫性肺泡出血综合征的老年男性患者,合并呼吸、循环衰竭,启用静脉-静脉体外膜肺氧合（VV-ECMO）抢救并成功撤机,病情好转出院。结论 IIPs作为病因以及发病机制未明、临床表现多样的一类肺间质性疾病,需临床多学科协作,及早诊断、治疗,才能成功挽救患者。

Objective To explore the treatment plan and application value of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome．Methods A case of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was reported．The clinical application value of treatment of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was analyzed combined with the literature．Results A case of idiopathic interstitial pneumonia（non IPF type）with diffuse alveolar hemorrhage syndrome was reported in this paper． Combined with respiratory and circulatory failure,veno-venous extracorporeal membrane oxygenation was used to rescue and successfully wean,and the condition improved and discharged．Conclusions Through the curative effect evaluation of this patient,it is believed that idiopathic interstitial pneumonia,as a kind of pulmonary interstitial disease with unknown etiology and pathogenesis and diverse clinical manifestations,need clinical multidisciplinary cooperation,early diagnosis and treatment,in order to successfully save the patient．