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 基于计划行为理论探讨妊娠期糖尿病（GDM）孕妇自我管理行为意向,为促进其孕期良好的自我管理提供依据。方法 运用质性研究中的现象学研究方法,对12例GDM孕妇进行深度半结构式访谈,并用Colaizzi七步内容分析法对主题进行归纳。结果 根据计划行为理论对主题进行归纳,共提炼出3种类别：①行为态度：认知不足,积极态度,消极态度;②主观规范：家庭影响,医护压力,人际压力;③知觉行为控制：知识技能获取受限,客观条件束缚共8个主题。结论 GDM患者在自我管理过程中存在对疾病认知不足的问题GDM,自我管理行为受到家庭、医护人员、人际关系等外界压力对自我管理态度的影响,且存在知识技能欠缺,客观条件制约多方面阻碍。医护人员应加强对GDM孕妇的自我管理教育,适时提供支持,提高其自我管理效率。

Objective To explore the self-management behavior intention of pregnant women with gestational diabetes mellitus（GDM）based on the theory of planned behavior,and to provide a basis for promoting good self-management during pregnancy. Methods Using the phenomenological research method in qualitative research,12 pregnant women with GDM were interviewed in an in-depth semi-structured interview,and then the themes were summarized by Colaizzi's seven-step content analysis. Results According to the theory of planned behavior,the themes were summarized into three categories and eight themes including（1）Behavioral Attitudes：cognition deficiency,positive attitude,and negative attitude,（2）Subjective norms：family influence,medical pressure,interpersonal pressure,and（3）Perceptual behavior control：self-management knowledge acquisition limitations,self-management Objective conditions constraint. Conclusions Most of the respondents have insufficient awareness of self-management of gestational diabetes,different patients have different attitudes towards self-management,and self-management behavior is affected by external pressures such as family,medical staff,and interpersonal relationships,and there are many obstacles due to a lack of knowledge and skills,Objective conditions．Medical staff should strengthen the self-management education of pregnant women with gestational diabetes,provide timely support,and improve their self-management efficiency．

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．

目的 探讨术前血清肌酐（sCr）、估测肾小球滤过率（eGFR）对急性A型夹层术后急性肾损伤3级（AKI 3级）及连续性肾脏替代治疗（CRRT）的影响。方法 回顾性分析广州市第一人民医院2017年1月—2022年12月6年间收治的143例行Bentall或升主动脉置换+Sun’s手术的急性Stanford A型夹层患者术前sCr及eGFR、术后24 h及48 h sCr、尿量、术后AKI及CRRT情况。应用ROC曲线（受试者特征曲线）分析术前sCr、eGFR对术后AKI 3级及CRRT的影响。结果 术后AKI 3级27例（18.9%）,CRRT 14例（9.8%）。发生AKI 3级及CRRT的患者术前sCr水平升高（AKI3级与AKI0-2级组间比较t’=-2.722,P=0.011,CRRT与非CRRT组间比较t’=-2.184,P=0.048）、eGFR降低（AKI3级与AKI0-2级组间比较t=4.585,P<0.001,CRRT与非CRRT组间比较t=4.932,P<0.001）。ROC曲线分析提示术前sCr可有效预测术后AKI 3级（AUC 0.768,临界点123 μmol/L,灵敏度67%,特异度85%）及CRRT（AUC 0.848,临界点137.5 μmol/L,灵敏度71%,特异度88%）。eGFR可预测AKI 3级[AUC 0.761,临界点56.25 mL/（min·1.73 m²）,灵敏度67%,特异度83%]及CRRT[AUC 0.855,临界点47.6 mL/（min·1.73 m²）,灵敏度71%,特异度87%]。手术合并低心排血量等肾灌注不良时,eGFR低于75.9 mL/（min·1.73 m²）,术后CRRT发生率增加。结论 急性A型夹层术前sCr及eGFR影响术后AKI 3级及CRRT的发生。sCr>123 μmol/L、eGFR低于58.25 mL/（min·1.73 m²）的患者术后AKI 3级发生率增加。sCr>137.5 μmol/L、eGFR低于47.6 mL/（min·1.73 m²）,或合并肾灌注不良的患者术后CRRT发生率增加。

Objective To explore the influences of preoperative serum creatinine（sCr）and estimated glomerular filtration rate（eGFR）on postoperative stage 3 acute kidney injury（AKI）or continuous renal replacement treatment（CRRT）in patients with acute Stanford type A aortic dissection（ATAAD）．Methods From July 2017 to December 2022,143 ATAAD patients who underwent Bentall or ascending aortic replacement and total arch replacement and stented elephant trunk were retrospective analyzed．Data included preoperative sCr and eGFR,postoperative sCr,eGFR,urine volume,AKI and CRRT at 24 h and 48 h．Receiver operating characteristic（ROC）curve were used to analyze the influences of preoperative sCr and eGFR on stage 3 AKI and CRRT．Results Stage 3 AKI occurred in 27（18.9%）patients,including 14 patients who required CRRT．sCr was significantly higher in stage 3 AKI or CRRT group（AKI 3 vs AKI 0-2 group：t’=-2.722,P=0.011,CRRT vs non-CRRT group：t’=-2.184,P=0.048）,and eGFR was significantly lower（AKI 3 vs AKI 0-2 group：t=4.585,P<0.001,CRRT vs non-CRRT group：t=4.932,P<0.001）．Preoperative sCr could effectively predict postoperative stage 3 AKI（AUC 0.768,the best cut-off value was 123 μmol/L,sensitivity 67%,specificity 85%）and CRRT（AUC 0.848,the best cut-off value was 137.5 μmol/L,sensitivity 71%,specificity 88%）．Preoperative eGFR could predict postoperative stage 3 AKI（AUC 0.761,the best cut-off value was 56.25mL/（min·1.73 m²）,sensitivity 67%,specificity 83%）and CRRT（AUC 0.855,the best cut-off value was 47.6 mL/（min·1.73 m²）,sensitivity 71%,specificity 87%）．CRRT requirement significantly increased in patients with eGFR lower than 75.9 mL/（min·1.73 m²） who complicated with peripheral malperfusion．Conclusion sPreoperative sCr and eGFR have significant influences on incidence of postoperative stage 3 AKI and CRRT．Postoperative stage 3 AKI significantly increase in patients with sCr more than 123 μmol/L or eGFR lower than 56.25mL/（min·1.73 m²）．Postoperative CRRT significantly increase in patients with sCr more than 137.5 μmol/L,eGFR lower than 47.6mL/（min·1.73 m²）,or peripheral malperfusion．

目的 了解行角膜胶原交联术患者围术期的体验感受,为角膜胶原交联术的顺利进行及术后康复提供参考依据。方法 采用目的抽样法,于2023年8月—2023年10月在中山大学中山眼科中心选取12例行角膜交联术的患者进行半结构式访谈,采取Colaizzi七步法进行整理分析资料。结果 通过分析得出患者在围手术期的5种感受：焦虑、疼痛、恐惧、紧张、盲目乐观。结论 分析角膜交联手术患者在围术期不同感受,做好围术期护理,希望有利于提高手术效果。

Objective To understand the perioperative experience of patients undergoing corneal collagen cross-linking surgery,and provide reference for the smooth progress of corneal collagen cross-linking surgery and postoperative rehabilitation．Methods Using purposive sampling method,12 patients who underwent corneal cross-linking surgery were selected from the Sun Yat-sen Ophthalmology Center of Sun Yat-sen University from August 2023 to October 2023 for semi-structured interviews．The data were analyzed using the Colaizzi seven step method．Results Through analysis,five feelings of patients during the perioperative period were identified：anxiety,pain,fear,tension and blind optimism．Conclusion sAnalyzing the different feelings of patients undergoing corneal cross-linking surgery during the perioperative period and providing good perioperative care can help achieve satisfactory results in the surgery．

慢性萎缩性胃炎是常见的胃癌前病变,不仅治疗过程漫长,治疗难度大,而且患者依从性欠佳。不仅会对患者的生理、心理健康和生活质量造成严重不良的影响,还会给患者家属造成负担,成为临床上不可忽视的难题。但是本病发病机制目前尚未完全明确,临床治疗还未达成共识。文章综述了近10年基于Hedgehog信号通路的中医药干预慢性萎缩性胃炎的研究概况。中医药调控Hedgehog信号通路辨证论治是治疗慢性萎缩性胃炎的一种独具特色的疗法,近年来有关基于Hedgehog信号通路的中医药干预治疗慢性萎缩性胃炎的报道越来越多。文章主要通过遵循疾病本虚标实的病性,以脾胃虚弱为本,瘀血、气滞、湿热、痰浊等为标,探讨选方治疗对慢性萎缩性胃炎的影响,认为中医药联合Hedgehog信号通路实行现代化发展能够有效干预治疗慢性萎缩性胃炎,以期为进一步临床研究与应用提供参考。

Chronic atrophic gastritis,a common precancerous lesion of gastric cancer,requires a long-term treatment and is difficult to cure．Therefore,it usually leads to decreased patient compliance．It will not only have a serious adverse impact on the patient’s physical and mental health and quality of life,but also cause a burden to the patient’s family,which has become a difficult problem that can not be ignored clinically．However,the pathogenesis has not yet been totally clarified,not to mention a consensus on the clinical treatment．This paper reviews the research revolving around Chinese medicine intervention in chronic atrophic gastritis based on the Hedgehog signaling pathway in the last decade．It’s creative therapy of chronic atrophic gastritis that utilizing Traditional Chinese Medicine to regulate and control Hedgehog signaling pathway,which has been increasingly reported in recent years．This paper is based on “deficiency in origin” and “excess in superficiality” principle．Concretely,spleen-stomach vacuity is characterized by deficiency in origin,and excess in superficiality manifests blood stasis,qi stagnation,dampness-heat and phlegm turbidity as excess in superficiality．By this way,the paper explores the effect of prescription selection on chronic atrophic gastritis．It is believed that the modern therapy that combines traditional Chinese medicine with Hedgehog signaling pathway can tackle chronic atrophic gastritis,thus providing a reference for further clinical trials and practices．

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 调查护理人员对预防跌倒知识掌握的情况,以提高其对防跌倒相关知识的认知水平,减少住院患者跌倒的发生。方法 用自编住院患者跌倒相关知识掌握量表对护理人员进行问卷调查。结果 护理人员对跌倒知识的掌握正确率最高为跌倒分级64.04%、最低为跌倒后干预措施17.10%。外科护理人员对患者跌倒风险评估时机的把握为88.69%,妇儿科护理人员的正确率（71.11%）高（χ²=21.319,P=0.003）,住院患者发生跌倒后的处理正确率急诊为76.67%,高于门诊的42.67%（χ²=27.651,P<0.001）;在把握患者跌倒风险评估的时机方面工作年限<5年的护理人员为 89.81%,比工作年限>20年的护理人员（64.15%）更容易把握患者跌倒风险评估的时机（χ²=18.921,P<0.001）,工作年限11~20年的护理人员对住院患者预防跌倒的干预措施正确率为24.66%,比工作年限<5年的护理人员（11.46%）高（χ²=9.678,P=0.022）;工作年限>20年的护理人员对住院患者发生跌倒后的处理正确率为58.49%比工作年限<20年以下的护理人员（34.25%）高（χ²=12.787,P=0.005）。结论 护理人员跌倒预防相关知识掌握度总体较低,应加强对护理人员关于患者跌倒预防知识的系统培训,减少住院患者跌倒的发生。

Objective To investigate the mastery of falls prevention knowledge among nursing staffs,in order to improve their cognitive level of falls prevention related knowledge and reduce the occurrence of falls in hospitalized patients．Methods A questionnaire survey was conducted among nursing staffs with a self-designed questionnaire on the mastery of falls related knowledge among hospitalized patients．Results The highest accuracy rate of nursing staffs' mastery of falls knowledge was 64.04% for falling classification,and the lowest was 17.10% for falls intervention measures．Nursing staffs' accuracy of the timing of patient fall risk assessment was 88.69% in surgery,which was higher than 71.11% in nursing staff in obstetrics,gynecology,and pediatrics（χ²=21.319,P=0.003）．The accuracy of emergency treatment for hospitalized patients after falls was 76.67%,which was higher than 42.67% in outpatient treatment（χ²=27.651,P<0.001）．The accuracy of the timing of patient fall risk assessment in nursing staffs with less than 5 years of work experience was 89.81%,which was better than nursing staff with more than 20 years of work experience（64.15%）（χ²=18.921,P<0.001）．Nursing staff with 11-20 years of work experience had a correct intervention rate for preventing falls in hospitalized patients of 24.66%,which was higher than nursing staffs with less than 5 years of work experience（11.46%）（χ²=9.678,P=0.022）．The accuracy rate of handling falls in hospitalized patients by nursing staffs with more than 20 years of work experience was 58.49%,which was higher than that of nursing staff with less than 20 years of work experience,which is 34.25%（χ²=12.787,P=0.005）．Conclusions Overall,nursing staff had a low level of falls prevention knowledge,and systematic training on patient fall prevention should be strengthened to reduce the occurrence of falls in hospitalized patients．

目的 探究脐动脉血流动力学指标、血脂、促甲状腺激素(TSH)对妊娠期糖尿病患者分娩结局的影响研究。方法 选取我院2021年1月—2021年11月收治的妊娠期糖尿病患者138例,采用随机数字表法分为对照组和研究组,每组各69例。比较2组患者体内脐动脉血流动力学指标、血脂指标及TSH相关指标表达水平差异及妊娠结局,并通过多元线性回归分析探究脐动脉血流动力学指标、血脂指标、TSH等相关指标与妊娠期糖尿病患者不良妊娠结局的相关性。结果 研究组孕妇脐动脉峰值流速/舒张末期流速(S/D)、阻力指数(RI)、三酰甘油(TG)、低密度脂蛋白(LDL)、TSH水平高于对照组,游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平低于对照组(P<0.05);研究组孕妇巨大儿、剖宫产、新生儿低血糖发生率及新生儿体质量均高于对照组(P<0.05);多元线性回归方程显示:S/D、RI、TG、LDL、TSH水平变化均与不良妊娠结局存在相关性(R²=0.224,调整R²=0.201;F=9.504,P<0. 05),且影响顺序由大到小依次为 TG、TSH、RI、S/D、LDL。结论 妊娠期糖尿病孕妇体内的S/D、RI、TG、LDL、TSH水平异常可能会影响妊娠结局,临床可通过监测上述指标的变化,及时采取干预措施。

Objective To investigate the effects of umbilical artery hemodynamic indexes, blood lipids and thyroid stimulating hormone (TSH) on delivery outcomes in patients with gestational diabetes mellitus. Methods A total of 138 patients with gestational diabetes mellitus who were admitted to our hospital from January 2021 to November 2021 were selected and divided into a control group and a study group by random digital table, with 69 cases in each group. The differences in umbilical artery hemodynamic indexes, blood lipid indexes and TSH-related indexes and pregnancy outcomes were compared between the two groups, and multiple linear regression analysis was used to explore the relationship between umbilical artery hemodynamic indexes, blood lipid indexes, TSH, other related indexes and adverse pregnancy outcomes in patients with gestational diabetes mellitus. Results The systolic and diastolic peak volume ratio (S/D), resistive index (RI) of umbilical artery, triglyceride (TG), low density lipoprotein (LDL) and TSH in the study group were higher than those in the control group, while the levels of free triiodothyronine (FT3) and free thyroxine (FT4) were lower than those in the control group (P<0.05). The incidences of macrosomia, cesarean section, neonatal hypoglycemia and neonatal weight in study group were significantly higher than those in the control group (P<0.05). The multiple linear regression equation showed that the adverse pregnancy outcomes were correlated with changes of TG, TSH, RI, S/D, LDL levels (R²=0.224, adjusted R²=0.201; F=9.504, P<0.05), in descending order. Conclusions Abnormal levels of S/D, RI, TG, LDL, TSH and FT4 in pregnant women with gestational diabetes mellitus may affect the pregnancy outcomes. Clinical intervention measures can be taken by monitoring the changes of the above indicators.

目的 探讨多原发恶性肿瘤(MPMN)的临床特点,提高该类型肿瘤的认识,为临床诊断及治疗提供一定的经验。方法 分析2021年12月广州市第一人民医院呼吸与危重症学科二区收治的1例乳腺、甲状腺及肺三重多原发恶性肿瘤的临床特点及诊治经过,并结合相关文献进行回顾分析。结果 该例首患乳腺导管内癌并予手术切除,9年后再同时患肺癌及甲状腺癌,最终确诊为三重多原发恶性肿瘤。结论 通过对多原发恶性肿瘤的临床特点的分析研究,可一定程度提高临床医生对MPMN的认知以及早期临床鉴别的能力,亦为肿瘤患者早期诊断、早期治疗提供更好的时机,改善患者生活质量。

Objective To explore the clinical characteristics of multiple primary malignant neoplasms (MPMN), to improve the understanding of this type of tumors, and to provide some experience for clinical diagnosis and treatment. Methods The clinical characteristics, diagnosis and treatment of a case with triple MPMN of breast, thyroid and lung treated in the Respiratory and Critical Care Department (Area 2) of Guangzhou First People's Hospital in December 2021 were analyzed retrospectively. Results The breast intraductal carcinoma was the first tumor of that case and had been resected, and 9 years later, lung cancer and thyroid cancer occured at the same time, which were diagnosed as triple MPMN. Conclusions The analysis and study of the clinical characteristics of MPMN can improve the clinicians' cognition and the ability of early clinical differentiation, and provide a better opportunity for early diagnosis and early treatment of tumor patients, and improve their quality of life.