目的 比较早产胎膜早破(PPROM)≥34周的肥胖孕妇与非肥胖孕妇的早产儿住院结局。方法 回顾性分析2016年1月—2020年12月在本院出生并入住新生儿科的所有出生胎龄≥34周的PPROM早产儿。根据孕妇分娩时体质量指数(BMI),分为肥胖组(BMI≥30 kg/m²)和非肥胖组(BMI＜30 kg/m²),比较2组间的一般情况、妊娠结局及所生晚期早产儿的住院结局,组间比较采用两独立样本t检验及χ²检验。结果 与非肥胖孕妇相比,肥胖孕妇的晚期早产儿分娩后呼吸道并发症发病率高,主要表现为新生儿呼吸窘迫综合征,辅助通气、吸氧和表面活性物质的使用、败血症、感染性肺炎发病率高,母亲妊娠期糖尿病发病率增高,差异均具有统计学意义(P＜0.05),其余新生儿高胆红素血症、新生儿坏死性小肠结肠炎、脑室内出血、早产儿支气管肺发育不良等并发症比较无统计学意义(P＞0.05)。结论 PPROM≥34周的肥胖孕妇与非肥胖孕妇相比,所生晚期早产儿呼吸道并发症和败血症等不良结局的发生率增加。

Objective To compare the hospitalization outcomes of 34 weeks or over preterm infants with preterm premature rupture of membranes (PPROM) in obese and non-obese pregnant women. Methods A retrospective analysis of PPROM preterm infants born in our hospital and admitted to the neonatology department from January 2016 to December 2020 with a gestational age of 34 weeks or over was carried out. According to the pregnant women's body mass index (BMI) at delivery, they were divided into obese group (BMI≥30 kg/m²) and non-obese group (BMI<30 kg/m²). The general conditions, pregnancy outcomes and late premature infants hospitalization outcomes between the two groups were compared using two independent samples t test and χ² test. Results Compared with non-obese pregnant women, the incidence of respiratory complications after delivery in late preterm infants of obese pregnant women was higher, mainly manifested as high incidence of neonatal respiratory distress syndrome, assisted ventilation, oxygen inhalation and the use of surfactants, sepsis, and pneumonia, also maternal gestational diabetes incidence was increased, and the differences were statistically significant (P<0.05); other complications of neonatal hyperbilirubinemia, necrotizing enterocolitis, intraventricular hemorrhage, bronchopulmonary dysplasia were not statistically significant (P>0.05). Conclusions Compared with non-obese pregnant women with 34 weeks or over PPROM, obese pregnant women had an increased incidence of adverse outcomes in late preterm infants such as respiratory complications and sepsis.

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．

目的 探讨度普利尤单抗对瘙痒性皮肤病的效果及对嗜酸粒细胞（EOS）恢复和生活质量的影响。方法 选取2021年2月—2022年1月期间,我院收治的瘙痒性皮肤病患者96例。根据治疗方式不同分为对照组（48例）和观察组（48例）。对照组给予传统激素治疗,观察组给予度普利尤单抗治疗。比较治疗前后2组血清炎症因子、免疫球蛋白水平情况;比较治疗前后2组症状积分下降指数（SSRI 评分）、神经激肽/速激肽受体1（NK1R）及EOS情况。观察2组疗效情况。采用皮肤病生活质量问卷（DLQI）对2组生活质量进行评价,并观察2组复发率情况。结果 治疗后,2组血清IFN-γ（干扰素-γ）、IL-2（白介素2）、IgA、IgG、IgM、NK1R、EOS水平升高,IL-4、IL-13、IgE水平及SSRI 评分降低,且观察组更明显（P<0.05）。观察组治疗有效率高于对照组（P<0.05）。随访6个月,观察组DLQI评分及复发率低于对照组（P<0.05）。结论 度普利尤单抗可减轻瘙痒性皮肤病患者瘙痒症状,增强机体防御力,促进嗜酸粒细胞恢复,提高其生活质量,值得临床推广应用。

Objective To investigate the effect of Dupilumab on pruritic dermatosis,eosinophil（EOS）recovery and quality of life．Methods From February 2021 to January 2022,96 patients with pruritic dermatosis were selected．According to different treatment methods,they were divided into control group（48 cases）and observation group（48 cases）．The control group was treated with traditional hormone,and the observation group was treated with Dupilumab．The levels of serum inflammatory factors and immunoglobulin in the two groups were compared before and after treatment．The symptom score reduce index（SSRI score）,neurokinin/tachykinin receptor 1（NK1R）and EOS were compared between the two groups before and after treatment．The curative effect of the two groups was observed．The quality of life of the two groups was evaluated with Dermatology Quality of Life Questionnaire（DLQI）,and the recurrence rate of the two groups was observed．Results After treatment,levels of serum IFN-γ,IL-2,IgA,IgG,IgM,NK1R and EOS of two groups increased,while the levels of IL-4,IL-13,IgE and SSRI scores decreased,especially in the observation group（P<0.05）．The effective rate of the observation group was higher than that of the control group（P<0.05）．The DLQI score and recurrence rate in the observation group were lower than those in the control group（P<0.05）in 6 months follow-up．Conclusions Dupilumab can alleviate the itching symptoms of patients with pruritic dermatosis,enhance the body's defense,promote eosinophil recovery,and improve their quality of life,which is worthy of clinical application．

目的 评价银杏二萜内酯葡胺注射液（DGMI）联合依达拉奉右崁对急性缺血性脑卒中（AIS）的治疗效果。方法 回顾性分析我院2021年3月—2022年6月收治的86例AIS患者,根据治疗方法不同,分为单药组和联合组,每组43例,2组均予以DGMI治疗,联合组加用依达拉奉右崁醇。对比2组的治疗效果。结果 治疗后,联合组美国国立卫生研究院卒中量表（NIHSS）评分低于单药组（P<0.05）,简易智能精神状态检查量表（MMSE）和Barthel指数（BI）得分高于单药组（P<0.05）;联合组治疗后脑血流动力学指标（Q_min和V_min）高于单药组（P<0.05）,而全血还原黏度、血浆黏度和血小板聚集指数低于单药组（P<0.05）;联合组治疗后血清丙二醛（MDA）、超敏C-反应蛋白（hsCRP）和白细胞介素-6（IL-6）低于单药组（P<0.05）,而超氧化物歧化酶（SOD）高于单药组（P<0.05）;联合组治疗总有效率88.37%,高于单药组的67.44%（P<0.05）,且2组不良反应总发生率比较差异无统计学意义（P>0.05）。结论 DGMI联合依达拉奉右崁醇可有效提高AIS患者的神经功能、认知功能及日常生活能力,降低血液高凝状态,改善脑部血流,缓解机体氧化应激及炎症反应,且不良反应发生率较低,安全性良好。

Objective To evaluate the clinical efficacy of diterpene ginkgolides meglumine injection（DGMI）combined with edaravone dextracanthol in the treatment of acute ischemic stroke（AIS）．Methods A total of 86 patients with AIS admitted to our hospital from March 2021 to June 2022 were divided into single drug group and combination group according to different treatment methods,with 43 patients in each group．Both groups were treated with DGMI,and the combination group was added with edaravone dextracanthol．The therapeutic effect,neurological function and adverse reactions of the two groups were compared．Results After treatment,compared with the single drug group,the NIH Stroke Scale（NIHSS）score of the combination group was significantly lower（P<0.05）,and the Mini-Mental State Examination（MMSE）and Barthel index（BI）scores were significantly higher（P<0.05）．After treatment,the cerebral hemodynamic indexes（Q_min and V_min）in the combination group were significantly higher（P<0.05）,while the whole blood reducing viscosity,plasma viscosity and platelet aggregation index were significantly lower（P<0.05）．After treatment,compared with the single drug group,the serum malondialdehyde（MDA）,high sensitive C-reactive protein（hsCRP）and interleukin- 6（IL-6）levels in the combination group were significantly lower（P<0.05）,while the level of superoxide dismutase（SOD）was significantly higher（P<0.05）．The total effective rate of the combination group was 88.37%,which was significantly higher than 67.44% of the single drug group（P<0.05）．The incidence of adverse reaction between two groups was not significant（P>0.05）．Conclusions DGMI combined with edaravone dextracanthol can effectively improve the neurological function,cognitive function and daily living ability of patients with AIS,reduce blood hypercoagulability,improve cerebral blood flow,alleviate oxidative stress and inflammatory reaction,improve the therapeutic effect,without increasing the incidence of adverse reactions,which has good safety．

目的 探讨与观察思维导图教育模式对肠造口患者生活质量与心理情绪的影响。方法 选择2021年5月—2022年4月本院胃肠外科收治的低位直肠癌术后患者80例为研究对象,按入院顺序随机编号,对应随机数字为偶数的分到思维导图组（n=40）,奇数的分到传统组（n=40）。传统组给予常规健康教育干预,思维导图组在传统组护理的基础上给予思维导图教育模式干预,思维导图组与传统组护理观察时间为3个月。结果 思维导图组护理期间的造口感染、坏死、水肿、出血、旁疝等并发症发生率与传统组相比都降低（P<0.05）。思维导图组与传统组护理后的焦虑与抑郁评分与护理前相比降低（P<0.05）,护理后思维导图组评分与传统组相比降低（P<0.05）。思维导图组的术后住院时间、术后排气时间、术后下床活动时间与传统组相比均减少（P<0.05）。思维导图组护理后的副作用、共性症状、尿路症状、特异躯体症状、特异心理、性功能、尿袋问题等生活质量评分与传统组相比都减少（P<0.05）。结论 思维导图教育模式在肠造口患者的应用能促进缓解心理负面情绪,促进患者康复,提高患者的生活质量,减少术后造口并发症的发生。

Objective To explore and observe the effects of mind map education mode on the quality of life and psychological emotions of patients with enterostomy．Methods From May 2021 to April 2022, 80 cases of patients with postoperative low rectal cancer who were admitted to the Gastrointestinal Surgery Department of our hospital were selected as the research subjects, and all the cases were numbered according to the random admission sequence, and those with even random numbers were assigned to the mind map group（n=40）, and odd numbers were assigned to the traditional group（n=40）．The traditional group was given routine health education intervention, the mind map group was given mind map education mode intervention additionally, and the nursing observation time of both groups was 3 months．Results The incidences of complications such as stoma bleeding, parastomal hernia, stoma necrosis, stoma edema and stoma infection during nursing in the mind map group were lower than that in the traditional group（P<0.05）．The anxiety and depression scores in both groups after nursing were significantly lower than those before nursing（P<0.05）, and the scores in the mind map group after nursing were also significantly lower than those in the traditional group（P<0.05）．The postoperative hospital stay, postoperative exhaust time, and postoperative ambulation time of the mind map group were significantly shorter than those of the traditional group（P<0.05）．The quality of life scores of common symptoms, side effects, urinary tract symptoms, specific somatic symptoms, specific psychology, urine bag problems and sexual function in the mind map group after nursing were significantly lower than those in the traditional group（P<0.05）．Conclusions The application of mind map education model in patients with enterostomy can promote the relief of psychological negative emotions, promote the recovery of patients, reduce the occurrence of postoperative complications, and improve the quality of life of patients．

目的 探讨小于4 cm的胃神经鞘瘤（GS）的CT误诊与漏诊原因,从而加深影像科医师对GS的认识,提高其CT检出率及诊断准确率。方法 回顾性分析2019年3月—2022年10月经手术切除及病理证实的10例小于4 cm的GS患者的临床、CT及病理资料。在CT图像上评估肿瘤的位置、大小、形态、密度、强化特点及周围淋巴结等情况。结果 术前CT误诊7例,漏诊2例,仅1例正确诊断;10例病灶均起源于胃黏膜下;9例为圆形或类圆形;7例发生于胃体;平扫密度均低于肌肉组织,均呈渐进性强化。结论 小于4 cm的GS术前误诊率很高,且可发生漏诊。当CT检查提示胃体部黏膜下圆形或类圆形占位病变,平扫呈均匀稍低密度,增强呈渐进性强化时应考虑GS的可能,最终确诊需病理及免疫组化检查。

Objective To investigate the causes of CT misdiagnosis and missed diagnosis of gastric schwannomas（GS）smaller than 4 cm in size,and to improve radiologists’ awareness of GS and increase the detection rate and diagnostic accuracy．Methods Clinical,pathological and CT data of ten surgically and pathologically confirmed GS patients were retrospectively reviewed between March 2019 and October 2022．The location,size,shape,attenuation,enhancement features and surrounding lymph nodes of each tumor on CT were analyzed．Results Of the 10 patients,7 cases were misdiagnosed in preoperative CT examination,two cases were missed diagnosed and only one case was correctly diagnosed．All tumors originated from the submucosa in ten cases,and nine cases showed a round or oval shape．Seven lesions were located in the gastric body,and all tumors had homogeneous low attenuation compared to muscle on plain CT images．All cases displayed mild-moderate to obvious enhancement．Conclusions GS smaller than 4 cm have a high rate of misdiagnosis and missed diagnosis preoperatively．When CT examination indicates a submucosa tumor with a round-like shape in the gastric body and homogeneous mild hypoattenuation on plain CT,the possibility of GS should be raised．Pathological and immunohistochemical examinations are necessary to confirm the final diagnosis．

目的 分析互联网+联合分段式心理干预对结肠癌患者生活质量及希望水平的影响。方法 采用随机数字表法对照试验,于2019年12月—2022年12月选取本院收治的100例结肠癌患者,分为参照组（50例,给予常规心理护理）与试验组（50例,给予互联网+联合分段式心理护理）,比较2组患者在护理前后的精神状态、生活质量、希望水平及护理满意度。结果 护理后,2组患者的简明精神病评定量表（BPRS）评分均降低,且试验组评分优于参照组（P<0.05）;2组患者的简明健康状况调查表（SF-36）各维度评分均升高,并且试验组评分更高（P<0.05）;2组患者的Herth希望量表（HHI）各维度评分均升高,且试验组评分高于参照组（P<0.05）;试验组患者（96.00%）护理满意度高于参照组（80.00%）（P<0.05）。结论 结肠癌患者采用互联网+联合分段式心理干预可改善患者精神状态,提高结肠癌患者生活质量、希望水平。

Objective To analyze the effect of internet combined with segmented psychological intervention on the quality of life and hope level of colon cancer patients. Methods In a randomized controlled trial,100 patients with colon cancer admitted to our hospital from December 2019 to December 2022 were selected as the subjects of this study. According to the nursing methods,they were divided into control group(50 cases,given conventional psychological nursing intervention)and experimental group(50 cases,given internet combined segmented psychological intervention). The mental status,quality of life,hope level and nursing satisfaction of the patients in the two groups were compared. Results After nursing,the score of Brief Psychiatric Rating Scale was decreased in both groups,and the score of experimental group was better(P<0. 05). The scores of all dimensions of the concise Health Survey Questionnaire increased in both groups,and the scores of the experimental group were higher(P<0. 05). The scores of Herth Hope index were increased in both groups,and the scores of experimental group were higher(P<0. 05). The nursing satisfaction of experimental group(96. 00%)was higher than that of control group(80. 00%,P<0. 05). Conclusions The use of internet combined segmental psychological intervention in colon cancer patients can improve the mental state,improve the quality of life and hope level,with promotion value.

目的 探讨与研究白介素-33（IL-33）、白介素-37（IL-37）、亮氨酸富集的核苷酸结合寡聚结构域-3（NLRP-3）及自然杀伤（NK）细胞/树突状细胞（DC）比值与慢性乙型肝炎（CHB）患者病情的相关性。方法 研究时间为2020年2月—2022年9月,选择在本院诊治的86例CHB患者作为肝炎组,同期选择86名体格检查健康者作为对照组。检测2组血清IL-37、IL-33、NLRP3含量,并计算NK/DC比值。对所有入选者的血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBIL）含量进行检测并实施相关性分析。结果 与对照组相比,肝炎组的血清ALT、TBIL、AST有的增高趋势（P<0.05）,肝炎组的血清IL-33、IL-37、NLRP3含量更高（P<0.05）,NK/DC比值下降（P<0.05）。在肝炎组中,Pearson分析显示IL-33、IL-37、NLRP3、NK/DC比值与ALT、TBIL、AST均存在相关性（P<0.05）。在肝炎组中,ROC曲线分析显示IL-33、IL-37、NLRP3、NK/DC比值预测CHB病情的曲线下面积为0.705（95%CI：0.404~1.123）、0.690（95%CI：0.372~1.057）、0.670（95%CI：0.378~1.043）、0.685（95%CI：0.415~1.107）,联合检测预测病情的曲线下面积为0.895（95%CI：0.532~1.216）,与单独检测相比,联合检测具有更高的特异度与灵敏度。结论 CHB患者多伴随有血清IL-33、IL-37、NLRP3的高表达,并且NK/DC比值会降低,IL-33、IL-37、NLRP3及NK/DC比值与CHB患者病情存在相关性,联合检测对患者病情具有一定的预测性。

Objective To explore and study the correlation between interleukin-33(IL-33),interleukin-37(IL-37),leucine-enriched nucleotide-binding oligomeric domain(NLRP)- 3,the ratio of natural killer(NK)cells/dendritic cells(DC)and the conditions of patients with chronic hepatitis B(CHB). Methods From February 2020 to September 2022,86 patients with CHB treated in our hospital were selected as hepatitis group,and 86 healthy patients were selected as control group during the same period. The contents of IL-37,IL-33 and NLRP3 in serum of the two groups were detected,and NK/DC ratio was calculated. Serum alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL)of all the selected subjects were detected and correlation analysis was carried out. Results Compared with the control group,the serum ALT,TBIL and AST in hepatitis group were significantly increased(P<0. 05),the contents of IL-33,IL-37 and NLRP3 were higher(P<0. 05),and the NK/DC ratio was significantly decreased(P<0. 05). In the hepatitis group,Pearson analysis showed that IL-33,IL-37,NLRP3 and NK/DC ratios were correlated with ALT,TBIL and AST(P<0. 05). In the hepatitis group,ROC curve analysis showed that the maximum areas under the curve of IL-33,IL-37,NLRP3 and NK/DC ratios were 0. 705(95%CI：0. 404-1. 123),0. 690(95%CI：0. 372-1. 057),0. 670(95%CI：0. 378-1. 043)and 0. 685(95%CI：0. 415-1. 107),and the maximum area under the curve of combined detection was 0. 895(95%CI：0. 532-1. 216). Compared with single detection,combined detection had higher specificity and sensitivity. Conclusions The patients with CHB are often accompanied by the high expression of serum IL-33,IL-37 and NLRP3,and the NK/DC ratio will be significantly reduced. IL-33,IL-37,NLRP3 and NK/DC ratio are correlated with the condition of patients with CHB,and can also predict the condition of patients.