目的：探究对老年腹腔镜结直肠癌根治术中患者实施环泊酚联合瑞芬太尼后对其的苏醒质量、认知功能影响。方法：选取2025年1月-10月在我院接受腹腔镜结直肠癌根治术的50例老年患者作为研究对象，并采用随机数字表法将其分为两组。对照组25例患者，实施丙泊酚联合瑞芬太尼麻醉；观察组25例患者，采用环泊酚联合瑞芬太尼进行麻醉。对两组患者的苏醒质量（睁眼时间、拔管时间、定向力恢复、Steward评分）、术后认知功能（MMSE、MOCA.POCD发生率、MOAA/S评分）、炎症反应（IL-6, TNF-a, CRP, S100B, NSE）、疼痛控制（VAS评分、镇痛药用量）、不良反应（呼吸抑制、PONV、低血压、寒战等）与术中血流动力学（血压、心率、Sp0z、PaCO2、氧合指数）进行比较分析。结果：观察组的睁眼时间（10.55±2.11 min）、拔管时间（16.44±1.55 min）、定向力恢复时间（34.55±5.33 min）短于对照组，Steward苏醒评分（5.44±0.33 min）高于对照组（P＜0.05）。观察组术后的MMSE评分（27.44±1.22 分）、MoCA评分（28.44±1.66 分）、MOAA/S评分（3.22±0.44 分）均高于对照组，POCD发生率（16.00%）低于对照组（P＜0.05）。观察组术后IL-6（100.22±10.22 pg/mL）、TNF-α（30.22±4.44 pg/mL）、CRP（80.44±5.22 mg/L）、S100B（0.15±0.02 μg/L）、NSE水平（13.66±3.22 μg/L）均低于对照组（P＜0.05）。两组的术后VAS评分比较，统计学无差异，P＞0.05；观察组24h镇痛药物用量（80.23±20.44 mg）少于对照组（P＜0.05）。观察组术中血压、心率、Sp0z、PaCO2、氧合指数比对照组更稳定（P＜0.05）。观察组呼吸抑制、PONV、低血压、寒战的不良反应发生率（16.00%）低于对照组（44.00%）（P＜0.05）。结论：环泊酚联合瑞芬太尼麻醉方案可提高老年腹腔镜结直肠癌根治术患者的苏醒质量方面，利于患者的术后认知功能恢复，减轻其神经炎症反应，维持患者血流动力学稳定，并降低镇痛药物用量与不良反应发生率。

目的 探讨养血清脑颗粒联合银杏叶提取物注射液对脑梗死（CI）恢复期患者神经功能及认知功能的影响。方法 选取我院2024年7月-2025年11月收治的CI恢复期患者120例，按随机数字表法分2组，各组均60例；对照组予银杏叶提取物注射液治疗，治疗组基于对照组予养血清脑颗粒治疗，治疗周期均2周；对比2组疗效、神经功能、脑动脉血流速度、炎症指标、血液流变学指标、认知功能及不良反应。结果 治疗组总治疗有效率（95.00%）较对照组（81.67%）高，治疗后美国国立卫生研究院卒中量表（NIHSS）评分较对照组低（P＜0.05）；治疗组治疗后脑动脉平均血流速度（Vm）较对照组高，搏动指数（PI）、阻力指数（RI）、C反应蛋白（CRP）、同型半胱氨酸（Hcy）水平、血浆黏度、纤维蛋白原（FIB）水平、血小板最大聚集率水平较对照组低（P＜0.05）；治疗组治疗后简明精神状态检查量表（MMSE）评分较对照组高（P＜0.05）；组间不良反应相比无统计学差异（P＞0.05）。结论 养血清脑颗粒联合银杏叶提取物注射液治疗CI恢复期患者效果较好，可减轻神经功能缺损，提高脑动脉血流速度，降低炎症反应，调节血液流变学，改善认知功能。

目的：探讨利多卡因复合艾司氯胺酮对肺部手术患者苏醒质量及认知功能的影响。方法：选取2023年7月至2025年6月本院收治的100例拟行肺部手术患者，按随机数字表法分为观察组和对照组，各50例。对照组采用常规麻醉方案维持麻醉，观察组在常规麻醉基础上复合利多卡因及艾司氯胺酮辅助麻醉。比较两组患者苏醒质量[拔管后30min Riker镇静躁动评分（SAS）、苏醒时间、拔管时间]、认知功能[术前及术后1d、3d简易精神状态检查表评分（MMSE）]、围术期血流动力学指标[麻醉药物输注前（T0）、气管插管时（T1）、拔管后5min（T2）平均动脉压（MAP）、心率（HR）]及术后72h不良反应发生率。结果：观察组拔管后30min SAS评分、术后1d、3d的MMSE评分高于对照组，苏醒时间、拔管时间低于对照组；观察组T0、T1、T2各时间点MAP、HR无显著差异（P>0.05）；对照组T1、T2时MAP、HR高于T0（P<0.05）；两组不良反应发生率无显著差异（P>0.05）。结论：利多卡因复合艾司氯胺酮应用于肺部手术，可提升患者苏醒质量、保护术后认知功能，维持围术期血流动力学稳定，且安全性良好。

Objective : To investigate the effect of lidocaine combined with esketamine on recovery quality and cognitive function in patients undergoing lung surgery. Methods : A total of 100 patients receiving pulmonary resection at our hospital between July 2023 and December 2025 were enrolled and randomized via a random number table into two equal arms (n=50 per group): observation and control. The control group was treated with routine anesthesia to maintain anesthesia, and the observation group was treated with lidocaine and esketamine on the basis of routine anesthesia. The recovery quality [ Riker sedation agitation score ( SAS ) at 30 min after extubation, recovery time, extubation time ], cognitive function [ simple mental state examination score ( MMSE ) before operation and 1 d, 3 d after operation ], perioperative hemodynamic indexes [ mean arterial pressure ( MAP ), heart rate ( HR ) before anesthesia drug infusion ( T0 ), tracheal intubation ( T1 ), 5 min after extubation ( T2 ) ] and the incidence of adverse reactions at 72 h after operation were compared between the two groups. Results : In the observation group, the SAS score measured 30 minutes post-extubation and the MMSE scores at 1 day and 3 days post-operation were significantly higher than those in the control group. Conversely, both recovery and extubation times were shorter in the observation group compared to the control group. No significant differences in MAP and HR were observed at T0, T1, and T2 within the observation group (P > 0.05). In contrast, within the control group, MAP and HR at T1 and T2 were notably elevated compared to T0, with the differences being statistically significant (P < 0.05). Conclusion : The application of lidocaine combined with esketamine in lung surgery can improve the quality of recovery, protect postoperative cognitive function, maintain perioperative hemodynamic stability, and has good safety.

       脑卒中后认知障碍（PSCI）是脑卒中患者常见的并发症，严重影响患者的生活质量和社会功能。近年来，随着认知储备理论的发展和早期干预理念的普及，PSCI的早期干预模式逐渐成为研究热点。文章综述了PSCI早期干预模式的研究现状与进展，包括干预的理论基础、具体措施及未来发展方向，以期为临床实践和科研提供参考。

       Post-stroke cognitive impairment（PSCI）is a common complication among stroke patients．It seriously affects the patients’ quality of life and social functions．In recent years，with the development of the cognitive  reserve theory and the popularization of the concept of early intervention，the early intervention model for PSCI has gradually become a research hotspot．This article reviews the current research status and progress of the early intervention model for PSCI，including the theoretical basis of the intervention，specific measures，and future development directions，aiming to provide  references for clinical practice and scientific research．

       目的   了解育龄期乳腺癌患者对子代健康和遗传风险担忧现状及其对癌症诊断前后生育意愿改变的影响。方法   于2019年11月—2020年9月，采用中文版癌症后生育忧虑量表（RCAC）-子女健康亚量表对广州市某三甲医院的230例育龄期乳腺癌患者进行调查，应用SPSS 26.0及PSM插件对结果进行统计分析。在进行子女健康亚量表得分低分组和中高分组患者的生育意愿改变率的比较时，应用倾向性评分匹配法控制混杂因素。结果   育龄期乳腺癌患者对子代健康和遗传风险担忧得分为（11.40±2.99）分；匹配前后不同子女健康亚量表得分分组的患者在癌症诊断前后生育意愿改变率的差异均不具有统计学意义（P＞0.05）。结论   育龄期乳腺癌患者对子代健康和遗传风险的担忧虽然没有显著影响其生育意愿的改变，但其对子代健康和遗传风险担忧处于较高水平，临床医护人员应提高对这一现象的重视，可通过多渠道科普相关知识，开展遗传咨询服务以减轻患者的担忧。

      Objective  To explore the current status of childbearing age breast cancer patients’  concerns  about their children’s health and genetic risk and its influence on the change of fertility intention before and after cancer diagnosis．Methods  From November 2019 to September 2020，the Chinese version of the Reproductive Concern After Cancer Scale（RCAC）- Children’s Health Sub-scale was used to interview 230 patients with breast cancer of childbearing age in a tertiary hospital in Guangzhou，and SPSS 26.0 and PSM plug-in were used to analyze the results statistically．The  propensity  score matching method was used to control confounding factors when comparing the change  rate of fertility intention of patients with low scores and those with medium and high scores in the children health subscale．Results  The score of concern for the health and genetic risk of children in breast cancer patients of childbearing age was（11.40±2.99）．There was no statistically significant difference in the change  rate of fertility intention before and after cancer diagnosis among patients with different subscale scores of children’s health．Conclusions   Despite not significantly impacting fertility intentions，the notably high level of concern regarding children’s health and genetic risks among childbearing-age breast cancer patients necessitates increased clinical awareness．It is recommended that healthcare professionals address this through multi-channel education and genetically focused counseling within a collaborative model to mitigate patient distress．

       目的   探究认知行为疗法联合治疗性沟通在对内镜黏膜下剥离（ESD）术患者心理及治疗依从性的效果。方法   前瞻性选取2023年3月至2025年3月鹰潭市一八四医院收治的122例行ESD术的患者作为研究对象，采用随机数字表法将患者分为A、B组，B组56例患者采取治疗性沟通干预，A组66例患者采用认知行为疗法联合治疗性沟通干预，两组均连续干预2个月。比较两组患者干预前后焦虑自评量表（SAS）、抑郁自评量表（SDS）评分、心理弹性量表（CD-RISC）评分、Herth希望指数量表（HHI）评分差异，对比两组干预依从性。结果   干预后，两组SAS、SDS评分均下降且A组低于B组（t分别为12.096、10.326，P＜0.05）；干预后，两组CD-RISC量表各项评分均提高且A组高于B组（t分别为18.483、12.060、13.622，P＜0.05）；干预后，两组HHI量表各项评分均上升且A组高于B组（t分别为1.289、11.568、12.527、13.794，P＜0.05）；A组患者总依从率96.97%（64/66）高于B组80.36%（45/56）（χ ² =8.782，P＜0.05）。结论   认知行为疗法联合治疗性沟通在ESD术患者中干预效果理想，能够明显改善患者负性情绪，提高心理弹性及对疾病康复的希望水平，有效提升依从性。

       Objective  To explore the effect of cognitive behavioral therapy combined with therapeutic communication on psychological  health and therapy compliance of patients undergoing endoscopic submucosal dissection（ESD）．Methods  Prospectively，122 patients who underwent ESD at Yingtan 184 Hospital from March 2023 to March 2025 were selected as the research subjects．These patients were randomly divided into Group A and Group B using the random number table method，and 56 patients in group B were treated with therapeutic communication，66 patients in group A were treated with cognitive behavioral therapy combined with therapeutic communication，and both groups were continuously intervened for 2 months．The  scores of Self-Rating Anxiety Scale（SAS），Self-Rating Depression Scale（SDS），Connor-Davidson Resilience Scale（CD-RISC）and Herth Hope Index（HHI）were compared between the two groups before and after treatment．Therapy compliance between the two groups was compared．Results  After treatment，the SAS and SDS scores of the two groups were decreased，and the scores of group A was lower than that of group B（t=12.096，10.326，P＜0.05）after the intervention，the scores of the CD-RISC scale of the two groups were improved，and the score of group A was higher than that of group B（t=18.483，12.060，13.622，P＜0.05）．After intervention，the scores of HHI scale in both groups increased and score of group A was higher than that ofgroup B（t=11.289，11.568，12.527，13.794，P＜0.05）．The total compliance rate of patients in group A was 96.97%（64/66），which was significantly higher than 80.36%（45/56）in group B（χ ² =8.782，P＜0.05）．Conclusions  Cognitive-behavioral therapy combined with therapeutic communication has an ideal effect in ESD patients，which can significantly improve patients’ negative emotions，psychological resilience and hope for disease recovery，and also therapy compliance．

目的 探讨载脂蛋白E（ApoE）基因多态性与卒中后认知障碍的相关性,即大动脉粥样硬化型脑梗塞的严重程度。方法 采用病例——对照研究的方法,收集九江学院附属医院神经内科的100例急性缺血性脑卒中且病因分型为大动脉粥样硬化型患者（脑梗死组）和50例性别、年龄匹配的非缺血性脑卒中患者（对照组）。检测患者的 ApoE 基因型、血脂、美国国立卫生院卒中量表（NIHSS）、卒中后6个月简易智力状态检查量表（MMSE）等,采用多因素方差分析等统计学方法分析他们之间的关联性。结果 ApoE 3/4基因型频率与Ɛ3、Ɛ4等位基因频率,在脑梗死组别中高于对照组（P<0.05）。同时,携带Ɛ3等位基因患者的低密度脂蛋白水平高于携带Ɛ2、Ɛ4等位基因的患者;进一步分析发现含Ɛ3等位基因的脑梗死患者NIHSS评分更高、卒中后认知障碍更严重（P<0.05）。结论 ApoE基因型为Ɛ3/4、等位基因Ɛ3、Ɛ4更易罹患大动脉粥样硬化型脑梗死,提示该基因型是脑梗死的易感基因,脑梗死后认知障碍患者Ɛ3等位基因的频率较高,可能是卒中后认知障碍的易感因素。

Objective To explore the relationship between ApoE gene polymorphisms and post-stroke cognitive impairment,the severity of large artery atherosclerotic cerebral infarction．Methods A case-control research study was conducted,gathering data from 100 individuals diagnosed with large artery atherosclerotic cerebral infarction according to the TOAST classification,who admitted to the Neurology Department of the Affiliated Hospital of Jiujiang University．Additionally,50 non-ischemic stroke patients,matched for gender and age,were included as the control group．The patients were assessed for ApoE genotype,blood lipid,NIHSS,and MMSE scale at 6 months post-stroke,and statistical methods were used to analyze their associations．Results Significant differences were observed in the ApoE 3/4 genotype frequency and Ɛ3、Ɛ4 allele frequency between patients with cerebral infarction and the control group,with a notably higher incidence of cerebral infarction in the former．Furthermore,patients carrying the Ɛ3 allele exhibited significantly higher LDL levels than those carrying Ɛ2 or Ɛ4．The analysis also revealed that patients with the Ɛ4 allele experienced higher NIHSS and severer post-stroke cognitive impairment．Conclusions The findings suggest that the ApoE genotype Ɛ3/4 and allele Ɛ3、Ɛ4 may predispose individuals to develop large atherosclerotic cerebral infarction,indicating a susceptibility gene for cerebral infarction．Additionally,the Ɛ3 allele was associated with a higher frequency of cognitive deficits after cerebral infarction,implying that it may be a predisposing factor for post-stroke cognitive impairment．

目的 探讨氟哌噻吨美利曲辛联合帕罗西汀对重度抑郁障碍（MDD）患者躯体化症状、睡眠和认知功能的影响分析以及临床应用效果。方法 回顾性分析2020年8月—2023年2月在南昌市某医院接受治疗的120例MDD患者相关资料,按照其治疗方案不同分为帕罗西汀治疗组（常规组,n=55）和氟哌噻吨美利曲辛联合帕罗西汀治疗组（联合组,n=65）。两组患者治疗周期均为4周,比较两组患者治疗前和治疗第2、4周的汉密尔顿抑郁量表（HAMD-17）评分、躯体化症状自评量表（SSS）评分、睡眠质量评分（PSQI）、神经心理状态评定量表（RBANS）;且治疗后对患者进行1个月的随访比较两组患者治疗后总体疗效及不良反应发生情况。结果 经治疗第2、4周联合组RBANS评分高于常规组（P<0.05）,而PSQI评分、SSS评分、HAMD-17评分均低于常规组（P<0.05）。治疗后1个月随访资料显示,两组患者不良反应总发生率比较,差异无统计学意义（P>0.05）,且总有效率高于常规组（P<0.05）。结论 氟哌噻吨美利曲辛联合帕罗西汀对MDD患者临床应用疗效确切,还可以帮助患者减轻躯体化症状,改善患者睡眠质量,并且提高患者认知功能。

Objective To investigate the effect of haloperitoxine melitraxine combined with paroxetine on somatic symptoms,sleep and cognitive function in patients with major depressive disorder（MDD）and its clinical application effects．Methods A retrospective analysis was performed on the relevant data of 120 patients with MDD who received treatment in our hospital from August 2020 to February 2023,and divided into conventional group（treated with paroxetine,55 cases）and combined group（haloperitoxetex melitraxine combined with paroxetine,65 cases）according to their different treatment regimens．The treatment duration of the two groups was 4 weeks,and the Hamilton Rating Scale for Depression（HAMD-17）score,Somatized Symptom Self-rating Scale（SSS）score,Sleep Quality Score（PSQI） and Neuropsychological State Rating Scale（RBANS）scores were compared before treatment and at the 2nd and 4th week of treatment．After treatment,the patients were followed up for 1 month,and the total efficacy and adverse reactions of the two groups of patients after treatment were compared．Results After 2 and 4 weeks of treatment,the combined group showed significantly higher RBANS scores compared to the control group（P<0.05）,while PSQI scores,SSS scores and HAMD-17 scores were significantly lower in the combined group compared to the control group（P<0.05）．One month after treatment,follow-up data showed that there was no statistically significant difference in the overall incidence of adverse reactions between the two groups（P>0.05）．Additionally,the total effective rate was significantly higher in the combined group compared to the control group（P<0.05）．Conclusions Haloperitoxine melitrexine combined with paroxetine has a definite clinical effect in patients with MDD,and can also help patients reduce somatization symptoms,improve patients' sleep quality,and improve patients' cognitive function．

目的 调查眼科患者对荧光素眼底血管造影认知情况及健康教育需求,为眼底造影医护人员实施高效、个性化健康教育提供依据。方法 采用自制眼底造影认知及健康教育需求问卷,对本院2021年6月—8月的123例眼底血管造影患者进行问卷调查,使用Spearman相关性分析、非参数秩和检验及多元线性逐步回归分析患者眼底血管造影认知的影响因素。结果 患者荧光素眼底血管造影认知得分为（33.77±8.09）分,其中,患者对于检查中的相关知识认知最低,相对得分为0.59;患者健康教育需求的得分为（43.95±7.63）分,其中,检查后的相关知识需求度最高,相对得分为0.77;不同年龄、文化程度、主要照顾者、眼造影检查次数及是否合并全身病的患者的认知水平差异有统计学意义（P<0.05）。多元线性逐步回归分析表明,眼造影检查史是患者眼底血管造影认知的独立影响因素。结论 眼科患者对荧光素眼底血管造影认知水平较低,健康教育需求高,医护人员应重视健康教育的实施,结合FFA操作流程及患者特点,制定标准化健康教育流程,探索有效的线上+线下的健康教育模式,以提高造影患者认知水平,保障患者安全。

Objective To investigate fundus fluorescein angiography（FFA）cognition and health education needs in ophthalmic patients,and to provide basis for efficient and personalized health education for FFA medical staff．Methods A self-made questionnaire was used in a survey of 123 patients from June to August 2021．The influencing factors of FFA cognition were analyzed by Spearman correlation analysis,non parametric rank sum test and multiple linear stepwise regression．Results The score of FFA cognition was（33.77 ± 8.09）．Patients had the lowest cognition of relevant knowledge during the examination,with a relative score of 0.59．The score of patient's health education needs was（43.95 ± 7.63）,while the score of relevant knowledge needs after examination was the highest,with a relative score of 0.77．There were significant differences in cognitive level among patients with different ages,educational levels,main caregivers,angiographic times,and complication of systemic diseases（P<0.05）．Multiple linear stepwise regression analysis showed that the number of ocular angiography was an independent factor affecting the cognition of FFA．Conclusions Patients with FFA have low cognitive level and high demand for health education．Medical staff should pay attention to the implementation of health education,formulate a standardized health education process with the combination of operation process and patient characteristics,and explore an effective online-to-offline health education mode,so as to improve the cognitive level of angiography patients and ensure the safety of patients．

目的 明确上海市闵行区社区老人轻度认知功能障碍（MCI）发生现状,分析MCI发生的影响因素间的交互作用关系。方法 采用横断面研究方法,应用AD-8与CSI-D对该区2021年65岁以上老人MCI发生现状进行双量表评估。应用SPSS 26.0 软件,先后采用χ²检验分析受检老人吸烟、饮酒、慢性病等因素在不同检出情况的构成、二分类非条件Logistic回归分析MCI发生的影响因素,再将各因素依次纳入双因素交互作用分析模型,分析各变量对MCI发生的交互作用。结果 应用AD8与CSI-D双量表评估法具有较高的灵敏度,评估闵行区社区老人MCI阳性率为26.6%,高于其他研究,低年龄（OR=1.09,95%CI：1.04~1.14）、良好的健康心态（OR=1.67,95%CI：1.15~2.42）是减少老人MCI的保护因素,职业类型（OR=1.19,95%CI：1.04~1.38）、照料者类型（OR=1.56,95%CI：1.09~2.22）与老人MCI的发生存在相关关系。家庭月总收入与照料者类型之间、是否饮酒与照料者类型之间对老人MCI的发生存在交互作用（P均<0.05）。结论 保持良好的心态可以降低老人MCI发生风险,不同职业类型、照料者类型与老人MCI的发生具有相关关系,照料者选择保姆可能会增加老人MCI风险。

Objective To clarify the current situation of mild cognitive impairment（MCI）in the community elderly in Minhang District,Shanghai,and analyze the interaction relationship between the influencing factors of MCI．Methods A cross-sectional study method was used,and AD8 and CSI-D were used to evaluate the current situation of MCI in the elderly over 65 years old in this district in 2021．SPSS 26.0 software,chi-square test and binary unconditional Logistic regression model were used to analyze the composition of smoking,drinking,chronic diseases and other factors in different detected conditions and the influencing factors of MCI occurrence in the elderly．A factor interaction analysis model was used to analyze the interaction of each variable on the occurrence of MCI．Results The AD8 and CSI-D double-scale evaluation method had high sensitivity．The positive rate of MCI in the community elderly in Minhang District was 26.6%,which was higher than other studies．Younger age（OR=1.09,95%CI：1.04~1.14）,good health mentality（OR=1.67,95%CI：1.15~2.42）were protective factors for reducing MCI in the elderly,occupation type（OR=1.19,95%CI：1.04~1.38）,caregiver type（OR=1.56,95%CI：1.09~2.22）were correlated with the occurrence of MCI in the elderly．There were interaction effects between the total monthly household income and the type of caregivers,whether drinking or not and the type of caregivers on the occurrence of MCI in the elderly（all P<0.05）．Conclusions Maintaining a good attitude can reduce the risk of MCI in the elderly．Different occupational types and types of caregivers are related to the occurrence of MCI in the elderly．Caregivers choosing nanny may increase the risk of MCI in the elderly．