本文概述了传统日间腹腔镜胆囊切除术患者术后早期康复质量存在的问题，IMB模型通过向患者提供科学的疾病知识，改变其疾病认知与态度，最终促使其采纳并维持健康行为。本文还介绍了IMB模型在日间腹腔镜胆囊切除术后患者早期康复质量中应用涉及的相关概念、研究背景和国内外的研究现状以及未来发展趋势与挑战。研究结果显示，IMB模型可显著降低患者术后疼痛发生率，并提高患者参与治疗决策的程度，为后期关于IMB模型在日间腹腔镜胆囊切除术患者术后早期康复质量的相关研究提供借鉴与参考，以便后期实施相关个性化干预措施，并提供相关理论依据。

       This paper summarizes the problems existing in the early postoperative rehabilitation quality of patients undergoing traditional ambulatory laparoscopic cholecystectomy．The IMB model changes patients’ disease cognition and attitude by providing them with scientific disease knowledge，and ultimately promotes their adoption and maintenance of healthy behaviors．It also introduces the relevant concepts involved in the application of the IMB model in the early postoperative rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy，the research background of this study，the current research status at home and abroad，as well as the future development trends and challenges．The research results show that the IMB model can significantly reduce the incidence of postoperative severe pain in patients and the degree of patient participation in treatment decision-making．This provides reference and guidance for subsequent studies on the early rehabilitation quality of patients undergoing ambulatory laparoscopic cholecystectomy using the IMB model，so as to implement relevant personalized intervention measures in the future and provide relevant theoretical basis．

      目的 调查住院老年患者因经外周静脉置入中心静脉导管（PICC）而引发的血栓情况，并分析其影响因素，为老年患者置入PICC产生的相关性血栓（PICC-CRT）和症状性血栓的评估与干预提供借鉴。方法 在2023年1月—2023年12月期间，选取广州市第一人民医院接受PICC置管的317例住院老年患者。采用包括患者一般情况调查表、运动功能评定、肌力检测、 Barthel指数评定、Padua评分等多种工具进行综合评估。采用多因素 Logistic 回归构建 PICC-CRT 及症状性血栓的预测模型，并应用逐步回归法优化变量筛选过程。模型性能通过 ROC 曲线进行评估。结果 去除临床资料不完整的患者40例，最终纳入277例患者的完整资料，其中123例患者出现了PICC-CRT，发生率为44.40%（123/277）。血栓分级中，I级78例，Ⅱ级37例，Ⅲ级8例。无症状血栓83例，占67.48%，发生率29.96%（83/277）；症状性血栓40例，占32.52 %，发生率14.44%（40/277）。单因素分析联合多因素Logistic回归显示，卒中史、凝血酶原时间（PT）、导管留置时间是住院老年患者PICC-CRT的关键因素（P＜0.05），预测模型ROC曲线下面积为0.719；置管史、恶性肿瘤史、导管留置时间、置管后并发症数量是住院老年患者PICC症状性血栓的独立影响因素（P＜0.05），预测模型ROC曲线下面积为0.812。结论 文章总结了PICC-CRT和症状性血栓独特的影响因素，基于关键因素构建了预测模型预测其发生，为护理人员预防PICC-CRT和症状性血栓的发生提供了参考。

   Objective To explore the incidence of thrombosis associated with peripherally inserted central catheter（PICC）placement in hospitalized elderly patients and to analyze its influencing factors，in order to provide a reference for the assessment and prevention of PICC-catheter related thrombosis（PICC-CRT）and symptomatic thrombosis in this population．Methods A total of 317 elderly inpatients who underwent PICC placement at a tertiary hospital in Guangzhou between January and December 2023 were enrolled．Comprehensive assessments were conducted using general patient information forms，motor function evaluation，muscle strength testing，Barthel Index，and Padua score．Multivariate Logistic regression analysis was used to construct predictive models for PICC-CRT and symptomatic thrombosis，with variable selection optimized via stepwise regression．Model performance was evaluated using receiver operating characteristic（ROC）curve analysis．Results After excluding 40 patients with incomplete clinical data，277 cases were included in the final analysis．Among them，123 patients developed PICC-CRT，with an incidence rate of 44.40%（123/277）．Thrombosis was graded as Grade I in 78 cases，Grade II in 37 cases，and Grade III in 8 cases．Asymptomatic thrombosis occurred in 83 cases（29.96%），accounting for 67.48% of PICC-CRT；symptomatic thrombosis occurred in 40 cases（14.44%），accounting for 32.52%．Univariate and multivariate Logistic regression analyses identified history of stroke，prothrombin time（PT），and catheter dwell time as key risk factors for PICC-CRT（P＜0.05），with the area under the curve（AUC）of 0.719．History of catheterization，malignancy，catheter dwell time，and number of post-catheterization complications were independent predictors of symptomatic thrombosis（P＜0.05），with an AUC of 0.812．Conclusions This study identified distinct risk factors for PICC-CRT and symptomatic thrombosis in elderly inpatients．Predictive models based on key variables may provide useful references for clinical staff in preventing the occurrence of PICC-related and symptomatic thrombosis．

       目的 探究肺泡灌洗液靶向高通量测序（tNGS）在鹦鹉热衣原体肺炎中应用效果。方法 选取2021年5月—2025年3月我院收治的35例鹦鹉热衣原体肺炎患者进行研究，患者均接受肺泡灌洗液tNGS检测、肺泡灌洗液常规病原检测，以病原学为金标准，分析肺泡灌洗液tNGS对鹦鹉热衣原体肺炎的诊断效能。结果 金标准对鹦鹉热衣原体阳性检出35例，检出率100.00%，肺泡灌洗液tNGS阳性检出率高于传统病原检测，检测结果回报耗时短于肺泡灌洗液传统病原检测（P＜0.05）。结论 鹦鹉热衣原体肺炎临床症状缺乏特异性，容易转为重症肺炎，肺泡灌洗液tNGS可提高鹦鹉热衣原体肺炎检出率且结果回报较快，采用四环素类、喹诺酮类抗生素有助于改善患者预后。

     Objective To investigate the application effect of targeted next-generation sequencing（tNGS）of bronchoalveolar lavage fluid（BALF）in Chlamydia psittaci pneumonia．Methods Thirty-five patients with Chlamydia psittaci pneumonia admitted to our hospital from May 2021 to March 2025 were selected for the study．All patients underwent BALF tNGS and conventional BALF pathogen detection．With etiology as the gold standard，the diagnostic efficacy of BALF tNGS for Chlamydia psittaci pneumonia was analyzed．Results The gold standard detected 35 cases of Chlamydia psittaci positive，with a detection rate of 100.00%．The positive detection rate of tNGS in alveolar lavage fluid was higher than that of traditional pathogen detection，and the results report time of tNGS was shorter than that of traditional pathogen detection（P＜0.05）．Conclusions Chlamydia psittaci pneumonia lacks specificity in clinical symptoms and is easy to turn into severe pneumonia，bronchoalveolar lavage fluid tNGS can improve the detection rate of Chlamydia psittaci pneumonia and the results return quickly，and the use of tetracyclines and quinolones antibiotics can help improve the prognosis of patients．

       目的 构建首发脑出血患者并发卒中相关性肺炎的风险预测模型并验证模型的预测性能。方法 回顾性分析2012年1月—2022年12月广州市第一人民医院治的419例首发脑出血患者的临床资料，按照7︰3比例随机化分为训练列（293例）和验证队列（126例）。统计基于开发队列数据，采用Logistic回归模型分析首发脑出血患者并发卒中相关性肺炎的影响因素，并构建风险预测模型。基于开发队列和验证队列数据，采用校准曲线、受试者操作特征（ROC）曲线下面积和决策曲线分析模型的预测性能。结果 419例首发脑出血患者中有113例发生卒中相关性肺炎，发生率为26.97%。美国国立卫生研究院卒中量表（NIHSS）评分、吞咽困难、初始血肿体积、中性粒细胞百分比与白蛋白比值（NPAR）、中性粒细胞计数与淋巴细胞计数比值（NLR）、手术治疗、气管插管、留置胃管均是首发脑出血患者并发卒中相关性肺炎的影响因素（P＜0.05）。基于上述影响因素构建了首发脑出血患者并发卒中相关性肺炎的风险预警模型，校准曲线显示模型在开发队列和验证队列中预测卒中相关性肺炎发生率均与实际发生率相近；ROC曲线显示此模型在开发队列、验证队列中预测的曲线下面积分别为0.906（95%CI：0.867~0.937）、0.884（95%CI：0.815~0.934）；决策曲线分析显示当开发队列阈概率在3%~80%内、验证队列阈概率在2%~76%内使用此模型干预比全/无干预更有临床价值。结论 基于NIHSS评分、吞咽困难、初始血肿体积、NPAR、NLR、手术治疗、气管插管、留置胃管构建的首发脑出血患者并发卒中相关性肺炎的风险预测模型具有良好预测性能和临床应用价值。

      Objective To construct a risk prediction model for stroke associated pneumonia in patients with initial cerebral hemorrhage（ICH）and validate the predictive performance of the model．Methods A retrospective analysis was conducted on the clinical data of 419 patients with ICH admitted to our hospital from January 2012 to December 2022．They were randomly divided into a development cohort（293 cases）and a validation cohort（126 cases）according to a 7∶3 ratio．The Logistic regression model was used to analyze the influencing factors of stroke related pneumonia in patients with ICH based on the development cohort data，and a risk prediction model was constructed．Based on the development cohort data and validation cohort data，the predictive performance of the model was analyzed using calibration curves，receiver operating characteristic（ROC）curve，and decision curve analysis．Results Among 419 patients，113 developed stroke associated pneumonia，with a rate of 26.97%．The National Institutes of Health Stroke Scale（NIHSS）score，swallowing difficulties，initial hematoma volume，neutrophil percentage to albumin ratio（NPAR），neutrophil count to lymphocyte count ratio（NLR），surgical treatment，endotracheal intubation，and indwelling gastric tube were all independent influencing factors for stroke associated pneumonia in patients with ICH（P＜0.05）．Based on the above influencing factors，a risk prediction model for stroke associated pneumonia in patients with ICH was constructed．The calibration curve showed that the predicted incidence of stroke associated pneumonia by the model in both the development and validation cohorts was close to the actual incidence．The ROC curve showed that the predicted area under the curve for this model in the development cohort and validation cohort was 0.906（95%CI：0.867-0.937）and 0.884（95%CI：0.815-0.934），respectively．The decision curve analysis showed that when the threshold probability of the development cohort was between 3%-80%，and the threshold probability of the validation cohort was between 2%-76%，the intervention using this model was more clinically valuable than all/no intervention．

Conclusions The risk prediction model for stroke associated pneumonia in patients with ICH based on NIHSS score，swallowing difficulties，initial hematoma volume，NPAR，NLR，surgical treatment，tracheal intubation，and indwelling gastric tube has good predictive performance and clinical application value．

      目的 调查消化系统恶性肿瘤患者营养风险、营养知识-态度-行为（知信行）水平的现状，探究各因素是否对患者的营养风险、营养知信行水平具有影响，并分析两者之间的相关性。方法 选取中山大学附属第八医院（深圳福田）2024年2月—10月的244例消化系统恶性肿瘤患者为研究对象，采用一般资料调查表、营养风险筛查NRS2002量表以及消化系统肿瘤患者营养知信行问卷进行调查，数据收集后进行统计分析，从而研究消化系统恶性肿瘤患者营养筛查风险与营养知信行水平的现状、影响因素及两者间的相关性。结果 69.3%的消化系统恶性肿瘤患者存在营养风险，营养风险评分为（2.72±1.42）分。消化系统恶性肿瘤患者营养知识水平得分为（12.30±5.26）分、营养态度水平得分为（14.80±2.68）分、营养行为水平得分为（22.82±4.55）分、营养知信行水平总分为（49.96±9.50）分。家庭经济收入是患者营养风险水平的核心影响因素（P＜0.05），学历水平是患者营养知信行水平的核心影响因素（P＜0.05）。消化系统恶性肿瘤患者营养风险水平与营养知信行的总体水平呈负相关（r=-0.143，P＜0.05）。结论 消化系统恶性肿瘤患者的营养知信行水平总体处于中等水平，但普遍存在营养风险较高的情况。在患者治疗期间实施个性化营养健康宣教至关重要，这将有助于提升患者的营养知识水平，从而整体性改善其营养知信行素养并降低其营养风险，但在进行营养宣教和制定个性化营养方案时应充分考虑患者的家庭经济收入及学历水平。

    Objective To explore the nutritional risk and nutritional knowledge-attitude-behavior status of patients with digestive system malignant tumors，to analyze the influencing factors of nutritional risk，nutritional knowledge-attitude-behavior，and explore the correlation between them．Methods From February 2024 to October 2024，244 patients with digestive system malignant tumors at the Eighth Affiliated Hospital of Sun Yat-sen University were selected as the research subjects．A general information questionnaire，Nutritional Risk Screening 2002，and digestive system tumor patient nutrition knowledge-attitude-behavior questionnaire were used to study the influencing factors and correlations between the nutritional screening risk and nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors．Results There were 69.3% of the patients with digestive system malignant tumors had nutritional risk score ≥3，and the overall score was（2.72±1.42）．The scores of nutritional knowledge，attitude，behavior and total score of digestive system malignant tumors patients were（12.30±5.26），（14.80±2.68），（22.82±4.55）and（49.96±9.50），respectively．Family economic income was the core influencing factors of nutritional risk in patients with digestive system malignant tumors，while educational level was the core influencing factor of nutritional knowledge-attitude-behavior in patients with digestive system malignant tumors．The nutritional risk level of patients with malignant tumors of the digestive system was significantly negatively correlated with the overall level of nutritional knowledge-attitude-behavior．Conclusions The nutritional knowledge-attitude-behavior level of patients with malignant tumors of the digestive system is generally at a medium level，but there is a widespread situation of relatively high nutritional risk．It is extremely important and necessary to conduct personalized nutrition knowledge education for patients during their treatment period，which will help enhance patients’ nutritional knowledge level，thereby comprehensively improving their nutritional knowledge-attitude-behavior literacy and reducing their nutritional risks．However，when conducting nutrition education and formulating personalized nutrition plans，the patient’s family economic income，medical payment methods and educational level should be fully considered．

       目的 分析药品集中带量采购（集采）政策下医院药品供应保障实况，提出优化政策及保障的对策建议。方法 通过提取重庆市渝北区人民医院2023年1月—2024年12月集采药品供应采购数据，描述性统计分析集采药品供应情况。结果 采购的416个中标药品中，69个在购销合同期内短缺，短缺率16.59%。短缺原因与企业生产能力、季节性需求波动相关，季节性强，以慢性病药和抗感染药为主。结论 建议建立监测平台、完善报告制度、制定应急预案、评估供货能力，保障供应。

   Objective To analyzes the current situation of hospital drug supply guarantee under the policy of centralized and volume-based procurement（hereinafter referred to as “central procurement”），and proposes optimization strategies and suggestions for the policy and guarantee．Methods By extracting the procurement data of drugs supplied through centralized procurement at Yubei District People’s Hospital in Chongqing from January 2023 to December 2024，descriptive statistical analysis of the drug supply situation through centralized procurement was conducted．Results Among the 416 selected drugs purchased，69 were in short supply during the contract period，with a shortage rate of 16.59%．The reasons for the shortage were related to the production capacity of the enterprise，seasonal demand fluctuations，strong seasonality，and mainly chronic diseases and anti-infective．Conclusions It is suggested to build a monitoring platform，improve the reporting system，formulate emergency plans，and evaluate the supply capacity to ensure supply．

目的 修订肺癌患者联合药物治疗间歇期症状评估问卷，并评价其信效度。方法 以中文版安德森症状评估量表及肺癌特异性模块为基础，经文献分析、专家会议和认知性访谈形成测试版问卷。于2023年10-12月便利选取福州、莆田2所三级甲等医院278例肺癌患者进行调查，评价其信效度及偏倚风险。结果 修订后问卷含7个症状系统、60个条目，跳转式作答后实际作答21个条目。总问卷Cronbach's α系数为0.856，各维度为0.639～0.747；内容效度指数为0.81。验证性因子分析显示模型拟合尚可（χ2/df=2.366，RMSEA=0.070，CFI=0.858），各维度因子载荷、组合信度及平均方差提取量均达到可接受标准，区分效度良好。COSMIN-RoB评价结果为良好。结论 该问卷信效度良好，可用于评估肺癌患者联合药物治疗间歇期症状严重程度。

Objective To revise the Symptom Assessment Questionnaire for Lung Cancer Patients During Combined Drug Therapy Intervals and evaluate its reliability and validity. Methods Based on the Chinese version of the M. D. Anderson Symptom Inventory and its lung cancer-specific module, a preliminary questionnaire was developed through literature review, expert panel discussions, and cognitive interviews. From October to December 2023, a convenience sample of 278 lung cancer patients was recruited from two tertiary hospitals in Fuzhou and Putian, China. Reliability, validity, and risk of bias were evaluated. Results The revised questionnaire comprised seven symptom-system domains and 60 items, with 21 items completed through a skip-logic design. The overall Cronbach's α coefficient was 0.856, and the coefficients for each domain ranged from 0.639 to 0.747. The content validity index of the questionnaire was 0.81. Confirmatory factor analysis demonstrated an acceptable model fit (χ2/df = 2.366, RMSEA = 0.070, CFI = 0.858). Factor loadings, composite reliability, and average variance extracted of all domains met acceptable standards, indicating good discriminant validity. The overall risk of bias was rated as good according to the COSMIN Risk of Bias checklist. Conclusion The revised questionnaire demonstrated satisfactory reliability and validity and can be used to assess symptom severity in lung cancer patients during combined drug therapy intervals.

目的 编制适用于老年人群的衰弱综合征中医评估量表并检验其信度与效度。方法 通过文献研究及《中华医典》检索构建条目池，采用4轮德尔菲专家咨询及预调查筛选条目形成初量表；便利抽取300例老年患者行横断面调查，以Fried表型衰弱量表为校标，进行项目分析、Cronbach’s α系数、探索性因子分析及ROC曲线分析。 结果 经条目筛选最终形成含5个核心症状条目（表A）及38个证候条目（表B）的量表。表A校标关联效度r=0.929（P＜0.05），AUC=0.957，灵敏度0.949，特异度0.859；表A+B校标关联效度r=0.648（P＜0.05），AUC=0.827，灵敏度0.606，特异度0.911；总量表Cronbach's α=0.872。结论 所研制的衰弱综合征中医量表信效度良好，可用于老年人衰弱状态筛查及中医证型判别。

Objective: To develop a Traditional Chinese Medicine (TCM) assessment scale for frailty syndrome in the elderly and to evaluate its reliability and validity. Methods: An item pool was constructed through literature review and searches of the *Chinese Medical Canon*. A preliminary scale was developed through four rounds of Delphi expert consultation and a pilot survey. A cross-sectional survey was conducted using a convenience sample of 300 elderly patients. Using the Fried Phenotypic Frailty Scale as the gold standard, item analysis, Cronbach’s α coefficient, exploratory factor analysis, and ROC curve analysis were performed. Results: After item screening, the final scale comprised 5 core symptom items (Table A) and 38 syndrome items (Table B). For Table A, the criterion-related validity was r = 0.929 (P < 0.05), AUC = 0.957, sensitivity = 0.949, and specificity = 0.859; Table A+B showed a test-retest reliability of r = 0.648 (P < 0.05), an AUC of 0.827, a sensitivity of 0.606, and a specificity of 0.911; the total scale had a Cronbach’s α of 0.872. Conclusion: The developed Traditional Chinese Medicine (TCM) frailty syndrome scale demonstrates good reliability and validity and can be used for screening frailty in the elderly and for distinguishing TCM syndrome patterns.

随着公立医院免陪照护试点推进，家属由床旁陪伴转为院外等待，信息不对称、分离焦虑及信任弱化等问题日益凸显。本文围绕国际免陪照护实践，梳理家属数字化参与从虚拟探视、信息共享到共同决策的演进路径，并总结住院门户、电子日记、代理访问等工具在维系家庭支持、提升照护透明度中的作用。在此基础上，提出我国应依托智慧病房构建医护患属闭环沟通机制，完善授权分级、隐私保护、数字公平与人文支持制度，推动免陪照护兼具效率与温度。

With the advancement of pilot programs for accompaniment-free care in public hospitals, family members have shifted from bedside companionship to waiting outside the ward, giving rise to increasingly prominent problems such as information asymmetry, separation anxiety and weakened trust. Focusing on international practices of accompaniment-free care, this paper reviews the evolutionary path of digital family participation from virtual visits and information sharing to shared decision-making, and summarizes the role of tools such as inpatient portals, electronic diaries and proxy access in maintaining family support and improving care transparency. On this basis, it proposes that hospitals in China should rely on smart ward construction to establish a closed-loop communication mechanism integrating healthcare professionals, patients and family members, and improve institutional arrangements for hierarchical authorization, privacy protection, digital equity and humanistic support, so as to promote accompaniment-free care that combines efficiency with warmth.

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.