目的 探讨免疫治疗联合化学治疗（化疗）对晚期非小细胞肺癌（NSCLC）患者淋巴免疫及生活质量的影响,为临床进一步治疗提供参考。方法 选择2021年6月—2023年6月天津市滨海新区大港医院收治的晚期NSCLC患者120例进行研究,按抽签法分为干预组及对照组,每组60例,对照组采取单纯化疗方案,干预组采取免疫联合化疗方案,对比两组临床疗效、药物不良反应,治疗前后免疫功能（CD3⁺、CD4⁺、CD8⁺）、糖类抗原199（CA199）、糖类抗原 125（CA125）、血清癌胚抗原（CEA）水平及健康状态调查表（QOL）评分。结果 干预组患者治疗总有效率高于对照组（68.33%>41.67%,P<0.05）;治疗后干预组患者CD3⁺、CD4⁺比例高于治疗前及对照组治疗后,CD8⁺比例低于治疗前及对照组治疗后（P<0.05）;治疗后干预组血清CA199、CA125、CEA水平均低于治疗前及对照组治疗后（P<0.05）;干预组药物不良反应发生率为16.67％,对照组为36.67％,干预组低于对照组（P<0.05）;治疗后干预组QOL各维度评分高于对照组及治疗前（P<0.05）。结论 与单纯化疗相比,免疫联合化疗治疗晚期NSCLC患者,能有效降低肿瘤标志物水平,改善患者免疫指标,减轻药物不良反应,提高患者疗效及生活质量。

Objective To explore the effect of immunotherapy combined with chemotherapy on lymphatic immunity and quality of life of patients with advanced non-small cell lung cancer（NSCLC）,and to provide reference for further clinical treatment. Methods A total of 120 patients with NSCLC from June 2021 to June 2023 were selected and divided into observation group and control group evenly according to the method of drawing lots,control group was treated with chemotherapy,the observation group was treated with immunotherapy combined with chemotherapy,and the clinical efficacy and adverse drug reactions were compared between the two groups．Before and after treatment,immune function（CD3⁺,CD4⁺,CD8⁺）,carbohydrate antigen 199（CA199）,carbohydrate antigen 125（CA125）,serum carcinoembryonic antigen（CEA）levels and health status questionnaire（QOL-RRB- scores）were measured．Results The total effective rate in the observation group was significantly higher than that in the control group（68.33%>41.67%,P<0.05）．After treatment,the ratios of CD3⁺ and CD4⁺ in the observation group were significantly higher than those before treatment and control group after treatment,and the ratio of CD8⁺ was significantly lower than that before and after treatment in the control group（P<0.05）．After treatment,the serum levels of CA199,CA125 and CEA in the observation group were lower than those before and after treatment in the control group（P<0.05）．The incidence of adverse drug reactions was 16.67% in the observation group and 36.67% in the control group,which was significantly lower in the observation group than in the control group（P<0.05）．After treatment,the QOL scores in the observation group were significantly higher than those in the control group and before treatment（P<0.05）．Conclusions Compared with chemotherapy alone,immunotherapy combined with chemotherapy can effectively reduce the levels of tumor markers,improve the immune indexes of patients,reduce the adverse drug reactions,and improve the efficacy and quality of life of patients with advanced NSCLC．

目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组（P<0.05）;术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组（P>0.05）;但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组（P<0.05）;联合组的麻醉相关不良反应发生率略高于全麻组（P>0.05）;随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组（P<0.05）。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。

Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects．The patients were divided into groups by drawing lots．Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group．Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation．The changes of physical signs and the quality of recovery were compared between the two groups．Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group（P<0.05）．After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group（P>0.05）．However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group（P<0.05）．The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group（P>0.05）．During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group（P<0.05）. Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe．

目的 探讨重复经颅磁刺激应用于帕金森病失眠患者中的效果及对睡眠质量的影响。方法 选取2021年1月—2022年3月南阳南石医院神经内科收治的帕金森病失眠患者100例,按照随机数字表法均分为参照组（n=50）和研究组（n=50）,参照组采用常规西药治疗,研究组在参照组基础上采用重复经颅磁刺激治疗,对比两组治疗效果、神经递质指标水平、帕金森症状表现及睡眠质量评分的差异。结果 研究组治疗总有效率98.00%（49/50）高于参照组82.00%（41/50）,对比差异有统计学意义（P<0.05）。治疗后,研究组神经递质多巴胺及5-羟色胺水平分别为（6.84±0.62）、（22.75±0.59）,均高于参照组,对比差异均有统计学意义（P<0.05）。治疗后,研究组帕金森病症状表现及睡眠质量总评分均低于参照组,对比差异均有统计学意义（P<0.05）。结论 重复经颅磁刺激应用到帕金森病失眠患者的治疗中,能提升疗效,明显改善患者睡眠质量和帕金森病症状。

Objective To investigate the effect of repetitive transcranial magnetic stimulation（rTMS）on Parkinson's insomnia and its influence on sleep quality．Methods A total of 100 Parkinson's patients with insomnia admitted to the Department of Neurology,Nanyang Nanshi Hospital from January 2021 to March 2022 were selected and divided into the reference group（n=50）and the study group（n=50）according to random number table method．The reference group was treated with conventional western medicine,and the study group was treated with rTMS on the basis of the reference group．The levels of neurotransmitters,symptoms of Parkinson's disease and sleep quality were compared．Results The effective rate of the study group was 98.00%（49/50）,which was higher than 82.00%（41/50）of the reference group,with statistical significance（P<0.05）．After treatment,the levels of dopamine and 5-hydroxytryptamine in the study group,（6.84±0.62）and（22.75±0.59）,were higher than those in the reference group,and the comparison was statistically significant（P<0.05）．After treatment,the total score of Parkinson's symptom and sleep quality in the study group were lower than those in the reference group,with statistical significance（P<0.05）．Conclusions The application of rTMS in the treatment of Parkinson's patients with insomnia can improve the curative effect,significantly improve the sleep quality and symptoms of Parkinson's disease,and is worthy of further application and promotion．

目的 探讨与分析基于信息-动机-行为（IMB）模型的护理干预对造口患者并发症及生活质量的影响。方法 选择2021年5月—2023年4月本院进行结直肠癌行肠造口患者84例作为研究对象,根据1∶1随机电脑抽签分配原则把患者分为IMB组42例与常规组42例。常规组给予常规护理干预,IMB组在常规组护理的基础上给予基于IMB模型的护理干预,IMB组与常规组护理观察时间为3个月,观察与记录IMB组与常规组患者并发症、生活质量、心理状况、自我管理能力评分变化情况。结果 IMB组护理3个月期间的腹腔脓肿、肠梗阻、肺部感染、造口感染等并发症发生率为4.8%,与常规组的19.0%相比降低更多（P<0.05）。IMB组护理3个月期间的遵医依从性为100.0%,与常规组的90.5%相比提高更多（P<0.05）。护理3个月后IMB组的症状识别、症状处理、处理后评价等自我管理能力评分与常规组相比提高更多（P<0.05）。IMB组与常规组护理3个月后的焦虑评分与抑郁评分与护理前相比都有统计学意义的降低（P<0.05）,护理3个月后IMB组的焦虑评分、抑郁评分与常规组对比降低（P<0.05）。护理3个月后IMB组的总生活质量量表、症状子量表、症状量表、功能量表评分都与常规组相比提高（P<0.05）。结论 基于IMB模型的护理干预在造口患者的应用能提高遵医依从性,缓解焦虑与抑郁情绪,提高患者自我管理能力,从而可有效减少患者并发症的发生,促进提高患者的预后生活质量。

Objective To explore and analysis the effects of nursing intervention based on Information-Motivation-Behavioral（IMB）model on complications and quality of life of patients with stoma. Methods Eighty-four cases of patients with colorectal cancer undergoing enterostomy in our hospital from May 2021 to Aprilt 2023 were selected as the study subjects．According to the principle of 1∶1 random computer lottery,the patients were divided into IMB group（42 cases）and traditional group（42 cases）．The traditional group were given routine nursing intervention,and the IMB group were given nursing intervention based on the IMB model on the basis of the traditional group．The nursing observation time of the traditional group and IMB group were 3 months,the changes in complications,quality of life,psychological status,and self-management ability scores of patients were observed and recorded. Results The incidence of complications such as abdominal abscess,intestinal obstruction,pulmonary infection and stoma infection in IMB group during nursing were 4.8%,which were significantly lower than 19.0% in the traditional group（P<0.05）．The compliance of IMB group during nursing were 100.0%,which were significantly higher than 90.5% in the traditional group（P<0.05）．After nursing of 3 months,the scores of self-management ability such as symptom recognition,symptom treatment and post-treatment evaluation in IMB group were significantly higher than those in the traditional group（P<0.05）．The scores of anxiety and depression in the traditional group and IMB group after nursing of 3 months were significantly lower than those before nursing（P<0.05）,and the scores of anxiety and depression in the IMB group after nursing of 3 months were also significantly lower than those in the traditional group（P<0.05）．After nursing of 3 months,the scores of IMB group on function scale,symptom scale,symptom subscale and total quality of life scale were significantly higher than those of the traditional group（P<0.05）. Conclusions The application of nursing intervention based on the IMB model in patients with stoma can improve the compliance with medical treatment,reduce the occurrence of complications,improve the self-management ability of patients,relieve anxiety and depression,and continue to improve the prognosis and quality of life of patients．

目的 探讨标准化沟通（SBAR）模式交接班联合护理质量指标管理在胆管结石患者中的应用效果及护理质量、不良事件及并发症影响。方法 选取天津市人民医院2021年1月—2022年12月收治的80例胆管结石患者,应用抽签法分为观察组与对照组,每组各40例。所有患者均采取手术治疗,其中对照组患者实施常规护理,观察组患者在对照组基础上增加SBAR沟通模式交接班联合护理质量指标管理。对比两组患者的护理质量、护理不良事件发生率、护理满意度及术后并发症发生率。结果 观察组基础护理、护理态度、护理责任心、风险识别能力、风险防范能力护理质量评分高于对照组（P<0.05）;两组注射、口服给药差错、换药、抽血差错、病例书写错误以及执行医嘱不及时等护理不良事件发生率对比差异无统计学意义（P>0.05）,观察组患者护理满意度高于对照组（P<0.05）;观察组患者压疮、感染、静脉血栓等并发症发生率均低于对照组（P<0.05）。结论 SBAR沟通模式交接班联合护理质量指标管理针对胆管结石患者应用效果显著,可改善临床护理质量,同时患者护理满意度较高,进一步降低患者术后并发症发生率。

Objective To investigate the application effect of SBAR communication mode shift combined with the management of care quality indicators on patients with bile duct stones and their influence on postoperative complications. Methods Eighty patients with bile duct stones admitted to our hospital from January 2021 to December 2022 were selected,and divided into observation group and control group by drawing lots,40 cases each．All the patients were treated by surgery,and the control group patients received routine care,and the observation group patients added the SBAR communication mode．The quality of care,incidence of adverse events,satisfaction with care and incidence of postoperative complications of the two groups were compared. Results The quality of care values of basic care,nursing care,nursing responsibility,risk identification and risk prevention in the observation group were significantly higher than in the control group（P<0.05）．There was no difference in the incidence of nursing side effects such as injection and oral administration errors,dressing changes,blood sampling errors,case clerk errors and delayed execution of medical orders between the two groups（P>0.05）．Patient satisfaction in the observation group was significantly higher than that in the control group（P<0.05）．The incidence of complications such as pressure ulcers,infections and venous thrombosis in the observation group was significantly lower than that in the control group（P<0.05）. Conclusions SBAR communication mode and combined nursing quality index management for patients with bile duct stones,which can improve the quality of clinical nursing and patient nursing satisfaction,and further reduce the incidence of postoperative complications in patients．

随着新医改全面深化、医保基金支付方式改革、国家公立医院绩效考核持续推进等新业态,医院靠粗放式规模扩张的收入模式不再适应新时期的发展。大多数基层公立医院不重视运营管理,存在收不抵支的财务风险与压力,导致医院面临巨大的良性运营挑战。探究基层公立医院的运营管理现状,普遍存在运营定位不清晰、运营组织体系不完善、运营意识薄弱、业财融合理念不强、专业人才少、信息系统功能不完善等诸多问题。如何有效应对潜在运营风险,推动转变管理模式并向高质量发展成为基层公立医院面临的重要课题。为此,基层公立医院迫切需要加强运营管理,对人、财、物、技术、空间等核心资源进行评估和流程管理,多管齐下,提高运营效率和社会经济效益,实现向管理要效益,解决收不抵支问题,推动医院可持续和高质量发展。

目的 探讨真武汤联合八段锦在老年冠状动脉粥样硬化性心脏病（冠心病）患者中的应用效果。方法 将96例75岁以上冠心病患者按照随机数字表法分为对照组与干预组,每组各48例。在12周的临床研究期间,对照组用规范的冠心病二级预防药物治疗;干预组在规范的冠心病二级预防药物治疗基础上,增加真武汤以及八段锦运动处方。结果 治疗后干预组中医临床疗效（P=0.023）和中医证候积分（P<0.001）均优于对照组。两组患者的心肺运动试验指标均有改善,且干预组在升高峰值摄氧量（Peak VO₂,P=0.005）、最大摄氧量（VO₂max,P=0.001）、氧脉搏（VO₂/HR,P=0.002）和无氧阈值时最大代谢当量（MET,P=0.001）,以及降低无氧阈值（AT,P<0.001）和二氧化碳通气当量（VE/VCO₂,P=0.020）方面比对照组更明显。两组患者在36项简明健康状态调查表（SF-36）评分的8个维度中评分均有所升高,其中在生理机能（P=0.001）、生理职能（P<0.001）、一般健康状况（P=0.018）、精力（P=0.007）、社会职能（P=0.010）、精神健康（P=0.004）方面,干预组效果优于对照组;而在躯体疼痛、情感职能维度改善方面,两组间结果相近,差异无统计学意义（P>0.05）。两组患者的匹兹堡睡眠质量指数（PSQI）均有所改善,且干预组效果优于对照组（P<0.001）。结论 真武汤联合八段锦能够进一步增强老年冠心病患者中医证候疗效,改善心肺运动试验Peak VO₂、VO₂max、VO₂/HR、MET、AT、VE/VCO₂等指标,并提高SF-36评分多个维度的生活质量及睡眠质量。

Objective To explore the therapeutic effects of Zhenwu Decoction combined with Baduanjin Qigong in older adults with coronary heart disease（CHD）．Methods Ninety-six patients with CHD aged ≥75 years were randomly divided into a treatment group and a control group,with 48 patients in each group．Within the 12-week period,the control group received standard secondary prevention therapy for CHD,while the treatment group received Zhenwu Decoction and Baduanjin Qigong prescription,in addition to the standard treatment．Results After treatment,both groups showed improvement in the traditional Chinese medicine（TCM）clinical efficacy,TCM syndrome,SF-36 scores and Pittsburgh Sleep Quality Index（PSQI）scores;increase in Peak VO₂,VO₂max,VO₂/HR,and metabolic equivalent（MET）;and decrease in AT and VE/VCO₂．However,the treatment group had a more pronounced improvement in the TCM clinical efficacy（P=0.023）,TCM syndrome（P<0.001）,PSQI scores（P<0.001）,and cardiopulmonary exercise testing（CPET）indicators including Peak VO₂（P=0.005）,VO₂max（P=0.001）,VO₂/HR（P=0.002）,MET（P=0.001）,AT（P<0.001）and VE/VCO₂（P=0.020）,compared to their control counterparts． For the SF-36 scores,in comparison to the control group,the treatment group presented better outcomes in enhancing physical functioning（P=0.001）,role limitations due to physical health（P<0.001）,general health（P=0.018）,vitality（P=0.007）,social functioning（P=0.010）and mental health（P=0.004）,but not in pain or role limitations due to emotional problems．Conclusions The Zhenwu Decoction combined with Baduanjin Qigong can enhance the TCM syndrome,improve various CPET indicators such as Peak VO₂、VO₂max、VO₂/HR、MET、AT and VE/VCO₂,and elevate both quality of life and sleep quality among older adults with CHD．

目的 了解并分析白云区不同年龄段男性精液质量现状。方法 选取2020年1月—2021年12月在我中心就诊的已婚孕前体检男性为研究对象,开展常规精液检测,采集精液标本进行分析。结果 白云区育龄男性精液各项指标均在正常范围仅有3 176例（占比57.52%）,随年龄的增加,精液指标总活力、存活率和精子前向运动指标逐渐降低（P<0.05）。结论 26~30岁年龄段男性的精液质量各项指标正常率较其他年龄组更好（P<0.05）,是男性生育的黄金年龄。

Objective To understand and analyze the status of semen quality in men of different ages in Baiyun District of Guangzhou. Methods From January 2020 to December 2021,married men who received pre-pregnant physical examination in our center were selected as the research subjects．Routine semen testing was conducted,and samples were collected for semen analysis. Results Only 3176 cases（57.52%）of male semen data of childbearing age in Baiyun District were within the normal range．With the increase of age,total semen motility,survival rate and sperm forward motility decreased gradually（P < 0.05）. Conclusions Men in the age group of 26-30 years had higher normal rates of all indicators of semen quality than other age groups（P < 0.05）,which is the golden age of male fertility.

目的 探讨医院消毒供应中心清洗全程质量控制用于院内感染风险预防价值。方法 选取2019年1月—2021年6月期间医院消毒供应中心待清洗消毒的1 000件手术器械（观察组）,采用全程质量控制;另选取1 000件手术器械（对照组）,常规流程清洗;比较2组患者器械清洗质量,统计清洗后因术中器械的院内感染率。结果 观察组清洗消毒后器械血渍、污垢、锈斑总发生率0.20%,低于对照组的1.50%,器械清洗、消毒、灭菌合格率高于对照组（P<0.05）。观察组器械操作流程与标准、科室管理、安全管理、综合质量管理高于对照组,院内感染率0.10%低于对照组的1.00%,医护人员满意度95.00%高于对照组的75.00%（P<0.05）。结论 医院消毒供应中心清洗质量控制,可增加手术器械清洗质量,减少院内感染的发生。

Objective To explore the value of whole process cleaning quality control in hospital disinfection supply center for risk prevention of hospital infection．Methods From January 2019 to June 2021,1000 surgical instruments to be cleaned and disinfected in the hospital disinfection supply center（observation group）were selected,and the whole process quality control was applied;another 1000 surgical instruments（control group）were selected for routine cleaning．The quality of instrument cleaning in the two groups was compared,and the hospital infection rate after the application of cleaned instrument was calculated．Results After cleaning and disinfecting instruments,the total incidence of blood stains,dirt and rust was 0.20% in the observation group,lower than that in the control group,which was 1.50%,and the qualified rate of instrument cleaning,disinfecting and sterilizing was higher than that in the control group（P<0.05）．The equipment operation procedures and standards,department management,safety management,and comprehensive quality management of the observation group were higher than those of the control group,the hospital infection rate was 0.10%,lower than that of the control group（1.00%）,and the satisfaction rate of medical staff was 95.00% in the observation group,higher than that of the control group（75.00%,P<0.05）．Conclusions The cleaning quality control of hospital disinfection supply center can improve the cleaning quality of surgical instruments and reduce the occurrence of hospital infection.

目的 利用品管圈工具提高某三甲医院住院病案首页主要诊断编码正确率。方法 成立品管圈小组,选取2022年11月出院日期前200份住院病案首页作为开展品管圈前的对照组,按照出院科室分层抽取2021年8月1日—2022年3月31日的2 007份首页作为开展品管圈后的研究对象,对上述首页的主要诊断填写及疾病分类编码进行核对、检查、汇总统计。针对主要诊断编码错误率高的现象,从人、法、测3个维度进行分析,根据找出的原因制定对策并执行。根据具体情况使用χ²检验或者四格表资料的Fisher确切概率法检验比较品管圈前后主要诊断编码正确、错误份数的差异。结果 开展一系列改进措施后医生主要诊断填写正确率从95.00%上升到98.01%,编码员主要诊断编码正确率从97.50%上升至99.55%,住院病案首页主要诊断编码正确率从93.50%提高到97.56%,临床医师的书写质量、编码员的编码质量均有改善。品管圈开展前后主要诊断编码正确、错误份数差异有统计学意义。通过开展品管圈,标准化了一个院级规范、多个院级编码共识、两个科级工作工具和机制以及一个科级绩效分配方案。结论 品管圈质量改进工具能有效提高病案首页主要诊断编码正确率,后期应持续开展。

Objective To improve the accuracy of main diagnostic codes on the home page of inpatient medical records in a Class III Grade A Hospital by using the quality control circle．Methods The Medical Record Department set up a quality control circle group．A total of 200 inpatient medical records' home pages were selected as the control group before the quality control circle carried out,which patients were discharged in November 2022．Home pages of 2 007 inpatient medical records from August 1,2021 to March 31,2022 were selected according the discharge department as the research objects after the quality control circle carried out．The main diagnosis filling and disease classification codes on those home pages of the above medical records were checked and summarized．We analyzed the reason of the high error rate of the main diagnostic codes from three dimensions of people,law and test．Countermeasures were formulated and implemented according to the identified causes．Fisher exact probability method of four grid data or χ² test were used to compare the correct copies of main diagnostic codes before and after the quality control circle according to the specific situation．Results The writing quality of clinicians and the coding quality of coders were improved after a series of improvement measures were carried out．The correct rate of doctors' main diagnostic codes increased from 95.00% to 98.01%,the correct rate of coders' main diagnostic codes increased from 97.50% to 99.55%,and the correct rate of main diagnostic codes on the home page of inpatient medical records increased from 93.50% to 97.56%．The number of correct copies of main diagnostic codes before and after the development of the quality control circle was statistically significant．Through the development of the quality control circle,one institute level specification,multiple institute level coding consensus,two department level work tools and mechanisms,and one department level performance allocation scheme have been standardized．Conclusions The application of the quality control circle tool can effectively improve the accuracy of the main diagnostic codes on the home page of the inpatient medical record,which should be continued in the later period．