目的 探讨基于括约肌保护的置管中药冲洗对高位复杂性肛瘘术后中早期肛门功能恢复与生活质量改善的临床效果。方法 采用回顾性研究方法，收集2025年1月-2025年12月太原市中医院肛肠科收治的85例高位复杂性肛瘘患者，按治疗方式分为研究组（42例，括约肌保护置管+中药冲洗术）和对照组（43例，括约肌保护置管+复方黄柏液）。比较两组患者术前1天（T0）及术后3天（T1）、1周（T2）、2周（T3）、3周（T4）的肛门括约肌功能（Wexner量表）、创面愈合质量（REEDA量表、创面愈合时间）、生活质量（SF-36量表），并统计术后3周内并发症发生率及术后3个月（T5）肛瘘复发情况。结果 术前两组各项评估指标差异均无统计学意义（P>0.05）；术后各时间点，研究组Wexner量表评分、REEDA量表评分均显著低于对照组，SF-36量表评分显著高于对照组，创面愈合时间显著短于对照组，差异均有统计学意义（P<0.05）；术后3周内研究组总并发症发生率（7.14%）低于对照组（16.28%）P>0.05），随访3个月，研究组肛瘘复发率、mVSS、肛门坠胀VAS评分、肠液渗漏分级低于对照组，差异有统计学意义（P<0.05）。结论 基于括约肌保护的置管中药冲洗可有效改善高位复杂性肛瘘患者术后中早期肛门括约肌功能，缩短创面愈合时间、提升创面愈合质量，改善患者生活质量，且安全性良好。
目的 分析对肺癌化学治疗（化疗）患者采取个性化营养干预联合分级步行运动方案的应用价值。方法 将郑州大学附属郑州中心医院2023年7月—2024年7月符合标准的198例肺癌化疗患者作为研究对象，通过随机数字表法分为观察组和对照组各99例。对照组仅采用个性化营养干预方案，观察组则联合分级步行运动方案，两组患者均在同一时间内入组并接受持续干预3个月。对两组干预前后癌因性疲乏［Piper疲乏修订量表（PFS-R）］、营养状况、睡眠质量［匹茨堡睡眠质量指数（PSQI）］、生活质量［生活质量评估量表（SF-36）］水平予以比较。结果 相较于对照组，干预后观察组PFS-R、PSQI评分较低，白蛋白、前白蛋白、血红蛋白、铁转蛋白水平和SF-36评分较高（P＜0.05）。结论 对肺癌化疗患者采取个性化营养干预联合分级步行运动方案，有利于促进其癌因性疲乏的减轻和营养状态、睡眠质量及生活质量水平的提高。
Objective To analyze the effects of personalized nutritional intervention combined with graded walking exercise treatment on cancer-related fatigue and quality of life in lung cancer patients during chemotherapy．Methods A total of 198 lung cancer patients undergoing chemotherapy who met the criteria in our hospital from July 2023 to July 2024 were selected as the research subjects．They were divided into an observation group and a control group，with 99 cases in each group，by the random number table method．The control group only received individualized nutritional intervention，while the observation group received graded walking exercise additionally．Both groups of patients were enrolled at the same time and received continuous intervention for three months．Cancer-related fatigue（Piper’s Fatigue Scale-Revised［PFS-R］），nutritional status，sleep quality（Pittsburgh Sleep Quality Index［PSQI］），and quality of life（Quality of Life Scale［SF-36］） before and after the intervention were compared between the two groups．Results Compared with the control group，the observation group had lower PFS-R and PSQI scores and higher albumin，prealbumin，hemoglobin，transferrin levels and SF-36 scores after the intervention（P＜0.05）．Conclusions Adopting personalized nutritional intervention combined with graded walking exercise for lung cancer patients during chemotherapy is beneficial to promote the reduction of cancer-caused fatigue and the improvement of their nutritional status，sleep quality and quality of life．
目的 探讨医院药房外包代煎代送服务的质量管理。方法 成立中药代煎质量控制管理小组，研究给出完善质量控制体系的策略，涉及建立标准化操作流程、加强人员培训、优化信息化管理系统以及健全监督评估机制。结果 通过对中药库房的采购、入库验收、在库管理、调剂环节的审方、调剂、煎药质量管理以及物流、发药人员全流程管理，提高了患者的满意度，更多的患者选择了中药代煎服务。结论 实施有效的质量控制措施可提高代煎代送服务的质量，为医院药房提升服务质量给予理论依据与实践指导。
Objective To explore quality management of outsourced decoction preparation and delivery services in hospital pharmacies．Methods A quality control management team for traditional Chinese medicine（TCM）decoction preparation was established to develop strategies for improving the quality control system．These strategies involved establishing standardized operating procedures，strengthening personnel training，optimizing the information management system，and improving the supervision and evaluation mechanism．Results Through comprehensive process management，covering procurement，warehouse acceptance，inventory management，prescription review in the dispensing stage，dispensing itself，quality control of decoction preparation，logistics，and management of dispensing personnel，patient satisfaction was enhanced，leading more patients to opt for the TCM decoction service．Conclusions Implementing effective quality control measures can improve the quality of decoction preparation and delivery services，providing a theoretical basis and practical guidance for hospital pharmacies to enhance their service quality．
目的 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系, 并应用于临床,为急诊脑出血患者护理质量管理、监测与评价提供客观、科学的参考依据。方法 通过文献查阅、筛查与评价, 提取可行性资料, 基于Donabedian环节模型构建急诊脑出血患者护理质量评价体系的框架, 并采用德尔菲法完成两轮专家函询,确定最终的指标体系。选择2021年1月—2024年1月本院收治的230例急诊脑出血患者为研究对象, 将2021年1月—2022年6月作为干预前监测节点,该阶段的165例患者为传统组, 实施常规的护理质量管理;将2022年7月—2024年1月作为干预后监测节点,该阶段的165例患者为观察组, 实施以急诊脑出血患者护理质量评价指标进行护理质量监测管理。结果 两轮函询中专家积极系数分别为95%和100%, 意见提出率分别为56.25%和35.54%; 两轮函询专家权威系数为0.945、0.893; 第1轮函询中各项指标变异系数（CV）均值为0~0.136, Kendall’s W协调系数为0.065; 第2轮函询中变异系数（CV）均值为0~0.110, Kendall’s W协调系数为0.186。最终形成的急诊脑出血患者护理质量评价体系共涵盖一级指标3个、二级指标11个、三级指标55个。观察组入院-用药时间合格率、吞咽障碍患者动态评估率、气道管理合格率、早期被动/主动活动落实率高于传统组,差异具有统计学意义（χ2=14.850、12.261、8.183、37.420, P<0.05）, 观察组患者满意度明显高于传统组（χ2=14.049, P<0.001）。结论 本研究构建的急诊脑出血患者护理质量评价体系具有一定的科学性、可靠性和实用性, 可作为临床实现护理质量持续改进的重要评价工具。
Objective Based on the Donabedian model,the nursing quality evaluation system of emergency cerebral hemorrhage patients was constructed, and applied to clinical practice, providing an objective and scientific reference basis for realizing the nursing quality management, monitoring and evaluation of emergency cerebral hemorrhage patients．Methods Through literature review, screening and evaluation, the feasibility data was extracted, and the framework of the nursing quality evaluation system for patients with emergency cerebral hemorrhage was constructed based on the Donabedian model, and the Delphi method was adopted to complete two rounds of expert letter inquiry to determine the final index system．The study selected 230 patients with acute cerebral hemorrhage admitted to our hospital from January 2021 to January 2024 as the research subjects．The period from January 2021 to June 2022 was used as the pre-intervention monitoring period, during which 165 patients were in the traditional group, receiving routine nursing quality management．The period from July 2022 to January 2024 was used as the post-intervention monitoring period, during which 165 patients were in the observation group,implementing nursing quality monitoring and management based on evaluation indicators for the care of patients with acute cerebral hemorrhage．Results In the two rounds of letter inquiry, the positive coefficient of experts was 95% and 100%, respectively, and the rate of suggestions was 56.25% and 35.54%, respectively; the authority coefficient of experts in the two rounds of letter inquiry was 0.945 and 0.893．In the first round the mean value of coefficient of variation（CV）of each index was 0~0.136, and the coordination coefficient of Kendall’s W was 0.065; in the second round the mean value of variation coefficient（CV）was 0-0.110, and the coordination coefficient of Kendall's W was 0.186．The final nursing quality evaluation system for emergency cerebral hemorrhage patients covers 11 first-level indicators, 11 second-level indicators and 55 third-level indicators．The results showed that the pass rate of admission-medication time, dynamic assessment rate of dysphagia patients, airway management rate, and early passive / active activity implementation rate of the observation group were statistically significant different from those in the traditional group（χ2=14.850,12.261, 8.183, 37.420, P<0.05）, and the patient satisfaction in the observation group was significantly higher than that in the traditional group（χ2=14.049, P<0.001）．Conclusions The nursing quality evaluation system for emergency cerebral hemorrhage patients constructed in this study is scientific,reliable and practical, and can be used as an important evaluation tool to achieve continuous improvement of nursing quality in clinical practice．
目的 探讨与分析全面护理联合细节干预在创伤骨科手术质量及康复中应用价值。方法 选择2022年1月—2023年1月在福建省立医院骨科进行创伤骨科手术患者120例为研究对象,用随机数字表法分组,分为常规组、联合组,各纳入60例患者。前者进行常规护理,后者在前者基础上开展全面护理联合细节干预,对两组患者术后恢复情况进行观察比较。结果 在围术期指标方面,联合组手术时间、术中出血量、术后首次下床活动时间、术后住院时间与常规组相比减少（P<0.05）。联合组术后1 d、术后3 d、术后7 d、术后14 d的疼痛VAS评分与常规组相比减少（P<0.05）。联合组术后14 d的护理总满意度为100.00%,常规组为83.33%,联合组与常规组相比明显提高（P<0.05）。联合组术后14 d的社会关系、心理关系、生理关系等生活质量评分均高于常规组（P<0.05）。结论 全面护理联合细节干预在创伤骨科手术患者的应用促进患者康复,能持续缓解患者的疼痛状况,提高患者的护理满意度与生活质量。
Objective To explore and analyze the application value of comprehensive nursing combined with detailed intervention in the quality and rehabilitation of orthopedic trauma surgery．Methods From January 2022 to January 2023,120 cases of patients who underwent trauma orthopedic surgery in the Department of Orthopedic Surgery of Fujian Provincial Hospital were selected as the research subjects．And the randomized numerical table method was taken to operate in groups,which were divided into the conventional group and the combined group,and 60 patients were included in each group．The former group recieved conventional nursing care,and the latter group recieved comprehensive nursing care combined with detail intervention on its basis to observe and compare the postoperative recovery of patients in the two groups．Results In terms of perioperative indicators,the operation time,intraoperative bleeding,time to first postoperative bed movement and postoperative hospitalization time were significantly reduced in the combined group compared with the conventional group（P<0.05）．The pain VAS scores of the combination group were significantly reduced compared to the conventional group at 1 day,3 days,7 days and 14 days after surgery（P<0.05）．The total satisfaction rate of postoperative care in the combination group at 14 days was 100.00%,while in the conventional group it was 83.33%．The combination group showed there were significant improvements compared to the conventional group（P<0.05）．The social,psychological and physiological quality of life scores of the combination group were significantly higher than those of the conventional group 14 days after surgery（P<0.05）．Conclusions The application of comprehensive nursing combined with detailed intervention in orthopedic trauma surgery patients can promote their recovery,continuously alleviate their pain status and improve their nursing satisfaction and quality of life．
1994年中国引进患者自控镇痛（PCA）,经过国人改造升级如今已取得了令人瞩目的成绩：2007年《术后患者自控镇痛临床研究与推广应用》获教育部科学技术进步奖二等奖和中华医学科技奖三等奖;2011年具有中国自主专利产权和创新数字医疗的智能化患者自控镇痛（Ai-PCA）诞生,2019年《智能化术后患者自控镇痛管理关键技术及其临床应用》获得中国抗癌协会科技奖二等奖;2023年《中国分娩镇痛规范及推广应用》获得华夏医学科技奖二等奖。笔者撰写述评,提出努力推进Ai-PCA高水平高质量发展的措施,呼吁国内学者重视引领数智镇痛医疗规范化,于2024年在《中华疼痛学杂志》刊出由余守章教授牵头制定的《患者自控镇痛临床应用规范专家共识》,助力中国数智镇痛医疗技术向智慧化前行,为人民群众切实享受到舒适镇痛提供更优质的服务。
Since the introduction of Patient-Controlled Analgesia（PCA）in China in 1994,the domain has witnessed its substantial advancements．The project,Clinical Research and Promotion of Postoperative Patient-Controlled Analgesia,achieved the Ministry of Education’s Second Prize for Scientific and Technological Progress and the Chinese Medical Association’s Third Prize in 2007．The innovation continued in 2011 with the development of an intelligent PCA system（Ai-PCA）endowed with Chinese independent patent rights and innovative digital medical technology．In 2019,the Key Technologies and Clinical Application of Intelligent Postoperative Patient-Controlled Analgesia Management was honored with the second-class Science and Technology Award by the Chinese Anti-Cancer Association．Furthering this trend．In 2023,the Standards and Promotion of Labor Analgesia in China secured the second-class prize in Medical Science and Technology from Huaxia Medical Science and Technology．This commentary suggest strategies for the qualitative enhancement of Ai-PCA and urge domestic scholars to spearhead the standardization of Ai-PCA．Expert Consensus on Clinical Application Standards for Patient-Controlled Analgesia leaded and edited by Pro．She has published,in 2024,which fervently supports the advancement of China’s Ai-PCA technology towards a more intelligent future,to provide the public with higher quality and more comfortable pain management services．
目的 开发适合中国肾癌患者的生命质量测定量表的特异模块。方法 采用议题小组和核心小组的程序化决策方式,提出条目池,形成初步量表,采用医生及患者重要性评分法、相关系数法、变异度法、因子分析法和克朗巴赫系数α对20例肾癌患者和20名医护人员进行的数据进行统计分析。结果 经过上述方法进行筛检,结合专家小组的建议,最终得到含有11个条目的肾癌生命质量测定量表的特异模块。结论 肾癌的生命质量测定量表特异模块严格按照程序执行,具有较好的内容效度。
Objective To develop the specific module of the quality of life instruments for patients with renal cancer（QLICP-RE）．Methods With the structured group（nominal group and focus group）methods,the item pool was put forward and a preliminary instrument was formed．The data from 20 renal cancer patients and 20 doctors/nurses were analyzed by statistical procedures．Doctors and patients' importance rating procedure,correlation analysis,method of coefficient of variation,factor analysis,and Cronbach's α．Results By above statistical procedures and advises of expert panel,11-items of the specific module were formed finally．Conclusions The specific module of QLICP-RE developed on the strict procedures has good content validity and representativeness．
目的 评估医院-社区-家庭一体化康复护理模式对慢性创面患者生活质量及创面愈合的潜在影响。方法 选择2023年1月—2024年6月在广州市第一人民医院接受治疗的慢性创面患者80例作为研究对象,所有患者在住院期间均接受基于溃疡面积、深度及是否合并感染等因素的综合治疗,包括彻底清创、创缘处理、负压治疗、感染控制等治疗,并接受常规护理。出院前,通过随机数字表法将患者分为两组,每组40例。两组患者在住院期间均接受常规护理,出院后,对照组接受延续护理并定期复查。干预组40例患者在出院后接受医院-社区-家庭一体化康复护理模式。入组时及护理3个月后,使用生活质量调查表（SF-36）对患者生活质量和创面愈合率进行评估。结果 干预组创面愈合率为（32.61±4.26）%,高于对照组（11.48±1.04）%,差异具有统计学意义（t=19.473,P<0.05）。两组患者在护理3个月后的数字评定量表评分和创面疼痛频率评分均较入组时降低（P<0.05）。其中干预组护理3个月后的创面VAS评分为（1.82±0.17）分,创面疼痛频率评分为（1.28±0.25）分;而对照组分别为（3.91±0.22）分和（2.63±0.37）分,干预组低于对照组（P<0.05）。此外,干预组在护理后3个月的总体健康、生理功能、生理职能、精神健康、情感功能、社会功能评分均高于对照组（P<0.05）。在居家3个月期间,干预组的感染发生率为5.00%,而对照组为17.50%,干预组感染发生率低于对照组（χ2=3.781,P<0.05）。结论 本研究表明,医院-社区-家庭一体化康复护理模式干预能够促进慢性创面患者的创面愈合,降低居家期间感染的风险,并提升患者的生活质量。
Objective To assess the potential impact of the integrated hospital-community-home rehabilitation nursing model on the quality of life and wound healing in patients with chronic wounds．Methods A total of 80 patients with chronic wounds treated at the Guangzhou First People’s Hospital from January 2023 to June 2024 were selected as the study subjects．All patients received comprehensive treatment during their hospital stay,including thorough debridement,edge treatment,vacuum therapy,infection control and routine nursing care．Prior to discharge,the patients were randomly divided into two groups using a random number table,with 40 patients in each group．Both groups received routine nursing care during their hospital stay,and the control group received continuing nursing care and regular follow-up after discharge．Forty patients in the intervention group received the integrated hospital-community-home rehabilitation nursing model after discharge．Quality of life（QoL）and wound healing rates were assessed using the Short Form 36（SF-36）questionnaire at the time of enrollment and 3 months after nursing．Results The wound healing rate in the intervention group was significantly higher than that in the control group （[32.61±4.26]% vs [11.48±1.04]%）,with a statistical difference（t=19.473,P<0.05）．The numerical rating scale（NRS）scores and frequency of wound pain scores decreased in both groups 3 months after nursing compared to the enrollment period（P<0.05）．Specifically,the VAS score for wound pain in the intervention group 3 months after nursing was（1.82±0.17）,and the frequency of wound pain was（1.28±0.25）,in the control group,these scores were（3.91±0.22）and（2.63±0.37）,respectively,with the intervention group scoring significantly lower than the control group（P<0.05）．Furthermore,the scores for overall health,physical function,role physical,mental health,emotional function,and social function in the intervention group were higher than those in the control group 3 months after nursing（P<0.05）．During the 3-month home recovery period,the incidence of infection in the intervention group was 5.00%,whereas it was 17.50% in the control group,with the intervention group showing a lower incidence of infection（χ2=3.781,P<0.05）．Conclusions This study demonstrates that the hospital-community-home integrated rehabilitation care model intervention can promote wound healing in chronic wound patients,reduce the risk of infection during home care,and significantly improve patients’ quality of life．
目的 探讨单克隆免疫球蛋白血症患者M蛋白质量浓度检测的临床意义。方法 选取2018年6月—2023年6月龙岩人民医院收治的88例单克隆免疫球蛋白血症患者为研究对象,其中意义未明单克隆免疫球蛋白血症（MGUS）21例,具有肾脏意义单克隆免疫球蛋白血症（MGRS）50例,血液系统恶性肿瘤17例。对比其M蛋白质量浓度及临床实验室相关指标表达水平,采用Spearman相关分析法分析临床实验室相关指标的与M蛋白的相关性,对所有患者进行半年随访,以预后情况作为因变量,纳入Logistics回归模型分析M蛋白质量浓度对单克隆免疫球蛋白血症预后的预测价值。结果 不同病种M蛋白水平分别为（2.42±0.55）（2.57±0.64）（4.36±0.64）g/L、24 h尿蛋白分别为（1.45±0.16）（2.98±0.68）（2.43±0.44）g/24 h、血清白蛋白质量浓度分别为（31.01±3.06）（35.03±5.04）（39.05±7.08）g/L、总胆固醇水平分别为（3.42±1.25）（3.87±0.64）、（4.16±0.64）mmol/L、血肌酐水平分别为（114.35±23.23）（81.18±12.12）（146.36±21.12）μmol/L、血红蛋白质量浓度分别为（148.12±15.26）（141.69±12.15）（133.34±15.31）g/L,组间对比差异均有统计学意义（F分别为23.890,19.700,12.044,25.767,36.572,10.267,P<0.05）。MGUS患者24h尿蛋白与M蛋白有相关性（r=-0.384,P=0.033）,24 h尿蛋白、血清白蛋白、总胆固醇、血肌酐与MGRS患者M蛋白有相关性（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,血清白蛋白、总胆固醇、血红蛋白与血液系统恶性肿瘤患者M蛋白有相关性（r=0.374,P=0.029;r=-0.617,P=0.001;r=-0.414,P=0.024）;年龄、M蛋白为单克隆免疫球蛋白血症患者预后的影响因素（P<0.05）。结论 不同单克隆免疫球蛋白血症患者M蛋白水平存在差异,其中血液系统恶性肿瘤患者的M蛋白水平最高,且M蛋白为单克隆免疫球蛋白血症预后的独立影响因素。
Objective To explore the clinical significance of detecting M protein concentration in patients with monoclonal gammopathy．Methods From June 2018 to June 2023,88 patients with monoclonal gammopathy admitted to the hospital were selected as the study subjects．Among them,21 cases of monoclonal gammopathy with undetermined significance（MGUS）,50 cases of monoclonal gammopathy with renal significance（MGRS）,and 17 cases of hematological malignancies were selected． Concentration of M protein and the expression levels of clinical laboratory related indicators were compared,Spearman correlation analysis was used to analyze the correlation between clinical laboratory related indicators and M protein．All patients were followed up for six months,with prognosis as the dependent variable,included in the logistic regression model to analyze the predictive value of M protein concentration on the prognosis of monoclonal gammopathy．Results There were significant differences in the expression levels of M protein（[2.42±0.55],[2.57±0.64],[4.36±0.64]）g/L,24-hour urine protein（[1.45±0.16],[2.98±0.68],[2.43±0.44]）g/24 h,serum albumin（[31.01±3.06],[35.03±5.04],[39.05±7.08]）g/L,total cholesterol（[3.42±1.25],[3.87±0.64],[4.16±0.64]）mmol/L,blood creatinine（[114.35±23.23],[81.18±12.12],[146.36±21.12]）μmol/L,and hemoglobin（[148.12±15.26],[141.69±12.15],[133.34±15.31]）g/L among different diseases（F=23.890,19.700,12.044,25.767,36.572,10.267;P<0.05）．There was a significant correlation between 24 h urinary protein and M protein in MGUS patients（r=-0.384,P=0.033）．Urinary protein,serum albumin,serum cholesterol and blood creatinine were significantly associated with M protein in MGRS patients（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,Serum albumin,total cholesterol,and hemoglobin were significantly associated with M protein in patients with hematological malignancies（r=0.374,P=0.029;r=- 0.617,P=0.001;r=-0.414,P=0.024;P<0.05）．Age and M protein were independent risk factors for the prognosis of patients with monoclonal gammopathy（P<0.05）．Conclusions There are significant differences in the concentration of M protein among patients with different levels of monoclonal gammopathy,with the highest level observed in patients with hematological malignancies．M protein is an independent prognostic factor for monoclonal gammopathy．
传统的结肠镜检查质量评估方式具有主观性强、费时费力等缺点。近年来,人工智能（AI）技术在结肠镜检查质量控制方面展现出客观性、即时性、全面性等优势,具有广阔的应用前景。文章全面探讨了AI在结肠镜检查质量控制中的多个应用场景,包括评估肠道准备质量、记录退镜时间、息肉识别和分类、预测早期结直肠癌浸润深度等方面,并通过具体的研究案例和数据分析了AI技术的有效性和优势。AI技术有望在提升结肠镜检查质量、促进结直肠癌的早诊早治方面发挥更加重要的作用,但面对技术、伦理及法规等多方面的挑战,未来需要持续努力,不断优化算法,加强跨学科合作,推动AI技术在医疗领域的健康、快速发展。
Traditional colonoscopy quality assessment methods have strong subjectivity and are time-consuming．In recent years,artificial intelligence technology has shown objectivity,timeliness,and comprehensiveness in colonoscopy quality control,with broad application prospects．This article comprehensively explores multiple application scenarios of AI in colonoscopy quality control,encompassing assessments of bowel preparation quality,recording of withdrawal times,polyp identification and classification,and prediction of early colorectal cancer invasion depth．Through specific research cases and data analysis,the effectiveness and advantages of AI technology are elucidated．AI technology is expected to play an increasingly significant role in enhancing the quality of colonoscopy and promoting early diagnosis and treatment of colorectal cancer．However,facing challenges from technology,ethics,regulations,and other aspects,continued efforts are needed in the future to continuously optimize algorithms,strengthen interdisciplinary collaboration,and promote the healthy and rapid development of AI technology in the medical field．
