目的 探讨分析白带涂片多功能染色技术(BTR 法)在妇科疾病患者中的临床应用价值。方法 选取300 例有明显感染症状的妇科疾病患者取白带,采用BTR 法、盐水法和巴氏染色法进行检测。结果 BTR 法病原体阳性率:滴虫42%、霉菌36.7%、线索细胞17.3%、纤毛菌12%、淋球菌6.7%、球杆菌86%、核异质细胞6.3%和癌细胞2.7%,阴道清洁度95%;阳性率高于盐水法和巴氏染色法,差异有统计学意义(P<0.01);而且BTR法操作简单,耗时少,检出率高,成本低,优于盐水法和巴氏染色法,差异有统计学意义(P<0.01)。结论 BTR 法可在几分钟内检出滴虫性或霉菌性或细菌性阴道炎、宫颈炎、宫颈癌、卵巢癌等异常情况,可提高妇科疾病病原体的检出率,为诊断和治疗提供可靠依据,适用于大型妇科普查和癌症筛查,值得在基层医院推广应用。

Objective To explore and analysis the application of leucorrhea smear multi-function BTR staining techniques(method) in gynecological disease. Methods Leucorrhea were taken in 300 gynecological disease patients with obvious infection symptoms, BTR, saline smear, pap staining were performed at the same sample. Results Pathogene positive rate ofBTR method of trichomonad, mould, clue cell, leptotrichia, gonococci, coccobacillus, dyskaryotic cell, cancer cell and vaginal cleanliness detection rate is 42%,36.7%,17.3%,12%,6.7%,86%,6.3%,2.7% and 95% respectively. The pathogens detection rate of BTR was higher than saline smear, pap staining. It showed statistical difference(P<0.01). BTR method operated simply, timely, low cost, positively than saline smear, pap staining,it showed statistical difference(P<0.01). Conclusion BTR method can detect bacterial vaginitis, colpitis mycotica, cervicitis, cervical carcinoma and ovarian cancer. It can provide reliable evidence for gynecological disease diagnosis and treatment. It can be applied in big gynecological and cancer screening. BTR method is deserved to popularize and apply in primary hospital.

目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.

目的 探讨纵隔髓外造血(EMH)的临床特点,从而为其诊断、治疗提供参考意见。方法 总结分析我科收治的1例双侧后纵隔骨髓外造血组织多发瘤样增生,并对近10年来国内相关文献报道的27例病例进行回顾性分析。结果 患者需行手术活检取得病理诊断,确诊髓外造血。结论 纵隔髓外造血瘤样增生是一种罕见特殊的良性病变, 预后良好。但因其临床表现和影像学均缺乏特异性,当临床中遇到发生在后纵隔脊柱旁的占位性病变,同时患有贫血的患者应考虑EMH 的可能性,给予经皮穿刺或者胸腔镜下活检来取得细胞学诊断,从而避免不必要的手术治疗。

Objective To probe into the clinical features of mediastinal extramedullary hematopoiesis (EMH), for providing a reference for clinical diagnosis and treatment. Methods The clinical data was studied in a case of mediastinal EMH from our department, and 27 case reports from domestic published literatures over the last decade were analyzed retrospectively. Results Of the 27 patients, 15 received surgical excision, while the other 12 underwent needle biopsy. In our patient, the diagnosis of EMH was made by mini thoracotomy and open biopsy. Conclusion Mediastinal EMH is a rare disease and its prognosis is well. Because there is no obvious specific clinical symptoms and imaging appearances, the possibility of EMH should be considered when a patient with a mediastinal tumor associated with anemia is encountered. Diagnosis can be achieved by needle biopsy or video-assisted thoracic surgery (VATS) in order to prevent unnecessary surgical procedures.

目的 目前对于生物反馈发挥治疗作用的机理还未完全研究清楚,该实验借助近似熵(ApEn)这一新型的非线性研究方法,研究在生物反馈过程中心电的变化,从而希望发现生物反馈对心脏功能的潜在影响。方法 总数30人的健康正常受试者纳入研究,其中20人为生物反馈实验组,10人为正常对照组。该实验采用肌电生物反馈作为反馈方法,同时记录心电的变化。实验所得数据采用非线性动力学参数—近似熵(ApEn)进行研究。结果 实验组的平均心率在最后两个生物反馈阶段高于对照组。随着实验进展,实验组的心率标准差逐渐缩小,而心率和心电ApEn明显增高。结论 该实验发现生物反馈能够影响心电生理系统,使得心脏系统变得更加健康,展现出更强的抗应激能力,从而揭示了生物反馈潜在的治疗机理。

Objective The mechanism about biofeedback is not complete clear. Our aim was to study changes of cardiac function (electrophysiology) during biofeedback with the help of approximate entropy (ApEn), and a potential new mechanism about neurofeedback may be detected. Methods A total of 30 healthy volunteers participated in this study which consisted of the neurofeedback group(n=20) and the control group (n=10). We applied electromyogram neurofeedback as the feedback method, and simultaneously recorded electroencephalogram(EEG) and electrocardiogram(ECG). We applied the nonlinear analysis ApEn assess obtained data. Results In the biofeedback group the average of heart rate was higher than that of control group in the last two sessions. As the biofeedback experiment sessions were progressed, the standard deviation of heart rate gradually reduced and the ApEn of ECG increased with statistic significance in the biofeedback group. Conclusion We found that biofeedback can influence cardiac electrophysiological system and make cardiac systems progress healthily and achieve greater ability of anti-stress.

目的 分析药源性双硫仑样反应医疗损害责任纠纷的规律及特点,为规避用药风险、促进合理用药提供参考。方法 以“双硫仑”为关键词,检索中国裁判文书网,时间截至2025年3月25日,将通过筛选的裁判文书基本情况、双硫仑样反应药物关联情况、症状表现、转归、赔偿情况等信息提取录入Excel表,建立评价数据库。结果 共检索得裁判文书81份,纳入裁判文书18例,涉及医疗机构为三级医院3例、二级医院5例、卫生院/卫生室7例、民营医院2例、诊所1例;性别构成中,男15例,女3例;怀疑引起双硫仑样反应的药物有头孢哌酮、头孢呋辛、替硝唑、头孢噻肟、甲硝唑、左氧氟沙星、头孢曲松钠、头孢替安和头孢米诺;患者饮酒和用药间隔多为1~3 d;症状表现有呼吸困难/呼吸骤停、昏迷/意识丧失/休克、面色紫绀/局部发紫/指甲发紫、抽搐/发抖、出汗、不能说话/说话不清楚等;转归结果中,15例结局为死亡,1例为神经症,1例为一级伤残（植物人）,1例为二级伤残（缺氧缺血性脑病后遗四肢功能障碍）;7例患者死亡案例因未尸检影响了结果鉴定;判决情况中,1例和解,1例未公布三审判决结果,余16例医疗机构承担了10%~70%的医疗赔偿责任,赔偿金额43 092.4~1 616 354元;医方存在的过失主要有未认真采集饮酒史、违反诊疗常规用药、违反合理注意义务、未履行知情告知义务等。结论 药源性双硫仑样反应危害大,误诊率高,发病急骤凶险,基层医疗机构对其鉴别和处置能力亟需提高;应重视饮酒史的采集和记录;合理合规处方抗生素;加强对患者的高度注意义务、知情告知义务等履行;医院药学人员应积极参与安全用药工作,做好用药教育。

      Objective  To analyze the regularity and characteristics of the medical damage liability dispute with drug-induced disulfiram-like reaction, to avoid the risk of medication and provide reference for clinical rational drug use. Methods  China Judgements Online had been searched using the keywords of “disulfiram” from inception to March 25,2025. The evaluation table database was established with the excel table to conduct statistical analysis on the basic information of judgements, drug association, clinical performance,outcome of disease and the compensation. Results A total of 81 cases of judgements documents were retrieved,and 18 cases were enrolled. There were 3 tertiary hospitals, 5 second-class hospitals, 7 health-centers, 2 private hospitals,1 clinic among the medical establishments. Fifteen cases were male and 3 cases were female. The drugs suspected causing disulfiram-like reaction were cefoperazone, cefuroxime, tinidazole, cefotaxime, metronidazole, levofloxacin, ceftriaxone, cefotiam, cefminox. The interval between drinking and medication was usually 1-3 days. The symptoms were as follows：dyspnea/respiratory arrest, coma/loss of consciousness/shock, cyanosis /purple nails, convulsion/trembling, sweatiness, inability to speak/lack of clarity, etc. Fifteen cases ended in death, 1 was neurosis, 1 was first-degree disability (vegetative state), 1 was secondary disability (limb dysfunction after hypoxic encephalopathy). The identification of 7 cases of death was affected by the lack of autopsy. One case was settled and the outcome of the third trial was not announced in another case. The remaining 16 medical institutions took 10%-70% of the medical compensation liability, with the compensation amount ranging from 43 092. 4 yuan to 1 615 354 yuan. The main faults of the medical institutions were undetailed drinking history, irregular medication, breaches of duty of reasonable care, failure to fulfill the obligation of informed notification,etc. Conclusions Drug-induced disulfiram-like reaction has the characteristics of graveness of harm and rapid progress. Primary medical institutions need to improve their identification and disposal capacity urgently. Attention should be paid to collecting and recording of drinking history. Antibiotics should be used in a reasonable and compliant manner. Obligation of high attention to patients, information and other obligations should be fulfilled. Hospital pharmacy staff should ensure drug use safety through participating in drug education actively.

目的 评估重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（rhTNRF：Fc）治疗难治性慢性痛风性关节炎的临床疗效及安全性。方法 选取2022年1月一2023年12月广州中医药大学顺德医院风湿科门诊收治的46例难治性痛风性关节炎患者,分为观察组和对照组两组,对照组规范使用降尿酸药物治疗,观察组在对照组治疗的基础上联合使用rhTNRF：Fc至少12周,在0、12、24、48周观察两组的血尿酸（sUA）、肿瘤坏死因子-α（TNF-α）、关节肌肉骨骼超声变化、痛风发作例数、肝肾功能等指标。结果 观察组与对照组sUA无明显差别（P>0.05）,TNF-α水平明显下降（P<0.05）,滑膜炎、关节积液影像表现减少（P<0.05）,痛风发作例数明显减少（P<0.05）,观察期间肝肾功能正常,无患者因不良反应退出研究。结论 rhTNRF：Fc对难治性慢性痛风性关节炎安全有效。

Objective To explore the efficacy and safety of recombinant human type II tumor necrosis factor receptor-antibody fusion protein（rhTNRF：Fc）in refractory chronic gouty arthritis. Methods From January 2022 to December 2023, 46 cases of refractory chronic gouty arthritis in the Rheumatology Outpatient Department,Shunde Hospital Guangzhou University of Chinese Medicine were selected and divided into an observation group and a control group. The control group received routine treatment,while the observation group received rhTNRF：Fc treatment additionally for at least 12 weeks, two groups of indicators such as serum urine acid（sUA）, TNF-α, changes in musculoskeletal ultrasound,number of gout attacks,hepatic and renal function at 0, 12, 24, and 48 weeks were observed. Results There was no significant difference in sUA between the observation group and the control group（P>0. 05）, TNF-α significantly decreased（P<0. 05）, synovitis and joint effusion imaging manifestations reduced（P<0. 05）, number of gout attacks decreased（P<0. 05）. During the observation period, liver and kidney function were normal, and no patients withdrew from the study due to adverse reactions. Conclusions Using rhTNRF：Fc is safe and effective in treating refractory chronic gouty arthritis.

目的 探讨肝癌根治术后恶心呕吐现状及影响因素。方法 选取2022年5月—2024年5月天津市第二人民医院收治的70例肝癌患者进行回顾性分析,所有患者均行肝癌根治术,分析其术后恶心呕吐情况。并依照恶心呕吐发生情况进行分组,将30例术后发生恶心呕吐的患者分为观察组,其余40例患者为对照组。对比两组患者临床病理特征及围术期指标。并建立Logistic回归模型以术后恶心呕吐为因变量分析肝癌患者手术切除术后恶心呕吐的影响因素。结果 肝癌患者手术切除术后恶心呕吐发生率为42.86%（30/70）,其中Ⅰ度14例（20.00%）、Ⅱ度10例（14.29%）、Ⅲ度4例（5.71%）、Ⅳ度2例（2.86%）;观察组与对照组性别、体质量指数（BMI）、病理类型、临床分期、术前禁食时间对比差异无统计学意义（P>0.05）,观察组与对照组年龄及是否化疗情况对比差异有统计学意义（P<0.05）;观察组与对照组手术时间、术后VAS评分、麻醉方式、术后合并其他并发症情况对比差异无统计学意义（P>0.05）,观察组与对照组肝门阻断时间、术中失血量及术后腹胀情况对比差异有统计学意义（P<0.05）;年龄、是否化学治疗、术中失血量、术后腹胀情况为肝癌患者手术切除术后恶心呕吐的影响因素（P<0.05）。结论 肝癌患者手术切除术后恶心呕吐发生率较高,且年龄、是否化疗、术中失血量及术后腹胀情况可能为恶心呕吐发生的影响因素,针对此类患者高风险患者需及时采取相关措施进行干预,预防患者术后恶心呕吐情况及减轻严重程度。

Objective To explore the status and influencing factors of nausea and vomiting after radical resection of liver cancer. Methods A retrospective analysis was conducted on 70 liver cancer patients admitted to the Second People’s Hospital of Tianjin from May 2022 to May 2024. All patients underwent radical surgery for liver cancer,and their postoperative nausea and vomiting conditions were analyzed. According to the occurrence of nausea and vomiting, 30 patients who experienced nausea and vomiting after surgery were divided into an observation group, and the remaining 40 patients were divided into a control group. The clinical and pathological characteristics as well as perioperative indicators between two groups of patients were compared. A logistic regression model was established to analyze the influencing factors of postoperative nausea and vomiting in liver cancer patients after surgical resection,with postoperative nausea and vomiting as the dependent variable. Results The incidence of postoperative nausea and vomiting in liver cancer patients was 42. 86%（30/70）, including 14 cases of grade I, accounting for 20. 00%, 10 cases of grade II, accounting for 14. 29%, four cases of grade III,accounting for 5. 71%, and two cases of grade IV,accounting for 2. 86%. There were no significant differences in gender,body mass index（BMI）, pathological type,clinical stage,and preoperative fasting time between the observation group and the control group（P>0. 05）. However, there were significant differences in age and chemotherapy status between the observation group and the control group（P<0. 05）. There were no significant differences in the operation time,postoperative VAS score,anesthesia method and postoperative complications between the observation group and the control group（P>0. 05）, but with differences in the portal block time,intraoperative blood loss and postoperative abdominal distension between the observation group and the control group（P<0. 05）. Age, chemotherapy, intraoperative blood loss, and postoperative abdominal distension were independent influencing factors for postoperative nausea and vomiting in liver cancer patients undergoing surgical resection（P<0. 05）. Conclusions The incidence of nausea and vomiting after surgical resection in liver cancer patients is relatively high, with age, chemotherapy, intraoperative blood loss, and postoperative abdominal distension may be influencing factors for nausea and vomiting. Therefore, relevant measures should be taken in a timely manner to intervene in high-risk patients to prevent postoperative nausea and vomiting and reduce its severity.

目的 建立大鼠急性心肌梗死缺血再灌注后无复流模型,并初步验证细胞焦亡在其中的发生情况。方法 选用20只标准成年雄性Sprague Dawley大鼠（体质量260~320 g）,随机分为对照组（n=5）和手术组（n=15）。对照组仅穿线冠状动脉,未行结扎;手术组结扎左前降支0.5 h后解除,进行再灌注4 h,以建立无复流模型。通过Evens blue和硫磺素S染色,评估心肌的正常供血区、再灌注区及无复流区,并对两组大鼠心肌组织进行病理分析。结果 对照组大鼠全部存活,未出现无复流现象,心肌组织中未见细胞焦亡。手术组存活13只,形成明确的正常供血区（n=13）、再灌注区（n=13）和无复流区（n=10）。在无复流区的心肌细胞中均观察到细胞焦亡（n=10）,而正常供血区未见（n=0）,再灌注区部分出现（n=4）,差异具有统计学意义（P<0.05）。结论 细胞焦亡现象主要存在于大鼠急性心肌梗死缺血再灌注后无复流区域中,细胞焦亡可能作为一种区域特异性程序性死亡方式,在心肌无复流的发生与发展中发挥重要作用。

Objective To establish a rat model of myocardial no-reflow after acute myocardial infarction with ischemia-reperfusion injury and to preliminarily explore the occurrence of pyroptosis in the affected myocardium. Methods Twenty adult male Sprague-Dawley rats（260-320 g）were randomly divided into a control group（n=5）and a surgical group（n=15）. In the control group,the coronary artery was encircled with suture but not ligated. In the surgical group,the left anterior descending artery was ligated for 30 minutes, followed by 4 hours of reperfusion to induce the no-reflow model. Evans blue and thioflavin S staining were used to evaluate the normal perfusion area,reperfusion area,and no-reflow area of the myocardium. Histopathological analysis was conducted on myocardial tissues from both groups. Results All rats in the control group survived without evidence of no-reflow or pyroptosis in myocardial tissue. In the surgical group, 13 rats survived and showed distinct regions of normal perfusion, 13 with reperfusion, and 10 with no-reflow. Pyroptosis was observed in all no-reflow areas（n=10）, absent in the normal perfusion zones（n=0）, and partially present in the reperfusion zones（n=4）. The differences were statistically significant（P<0. 05）. Conclusions Pyroptosis predominantly occurs in the no-reflow zones following acute myocardial infarction and ischemia-reperfusion injury in rats. As a region-specific form of programmed cell death, pyroptosis may play an important role in the development of myocardial no-reflow.

目的 利用可视化软件CiteSpace分析近20年儿童注意缺陷多动障碍（ADHD）及其共患病的相关文献,得出该领域的研究现状和发展趋势,为儿童注意缺陷多动障碍及其共患病的研究和诊疗提供参考。方法 检索2004—2024年发表在中国知网、维普、万方数据库关于儿童注意缺陷多动障碍及其共患病的相关文献,运用CiteSpace软件对纳入文献进行可视化分析,对来源、机构、发文量、作者、关键词绘制科学知识图谱。结果 共纳入383个机构、500个作者、235种期刊、577篇有效文献。自2012年发文量总体上呈波动上升趋势;在发文来源中,《中国儿童保健杂志》以47篇居首;研究机构以北京大学精神卫生研究所为代表;王玉凤作者发文21篇为最多;ADHD患儿的主要共患病为抽动障碍、癫痫、对立违抗障碍、学习障碍;主要治疗药物为托莫西汀;主要影响患儿的执行功能。ADHD患儿共患病研究分为3个阶段,第一阶段为2004—2009年,研究对象主要为品行障碍、对立违抗障碍、学习障碍、焦虑障碍,主要研究内容为患儿的脑损伤与基因;第二阶段为2009—2017年,重视研究患儿的心理问题,如焦虑、抑郁,也重视患儿的生活及家庭环境;第三阶段为2017—2024年,重点研究托莫西汀、阿立哌唑等药物,并重视ADHD共患癫痫的研究。结论 目前对ADHD共患病的研究仍较为局限,主要集中研究共患抽动障碍、对立违抗障碍、癫痫,未来应重视研究其他共患病,进一步探索更好的诊治方法。

Objective To analyze the literature on attention deficit hyperactivity disorder（ADHD）and its comorbidities in children in the past 20 years by using the visualization software CiteSpace, and to obtain the research status and development trend of this field, so as to provide reference for the research, diagnosis and treatment of ADHD and its comorbidities in children. Methods The relevant literature on ADHD and its comorbidities in children published in CNKI, VIP and Wanfang data bases from 2004 to 2024 was searched, and the included literature was visually analyzed by CiteSpace 6. 2R6 software, and the scientific knowledge graph was drawn by the source, institution, number of publications, authors and keywords. Results A total of 383 institutions, 500 authors, 235 journals, and 577 valid articles were included. Since 2012, the number of published documents has fluctuated and increased. Among the sources of publication, the Chinese Journal of Child Health ranked first with 47 articles. The research institutions were represented by the Institute of Mental Health of Peking University. Wang Yufeng was the most prolific author with 21 articles. The main comorbidities of ADHD children were tic disorder, epilepsy, oppositional defiant disorder and learning disorder. The main treatment drug was tomoxetine. It mainly affects the executive function of the children. The study on comorbidity in children with ADHD was divided into three stages. The first stage was from 2004 to 2009. The research objects mainly included conduct disorder, oppositional defiant disorder, learning disorder and anxiety disorder, and the main research content was brain injury and genes in children. The second stage, from 2009 to 2017, focused on the psychological problems of children, such as anxiety and depression, and also paid attention to the life and family environment of children. The third stage was 2017-2024, focusing on tomoxetine, aripiprazole and other drugs, and paying attention to the study of ADHD co-induced epilepsy. Conclusions The current research on ADHD and its comorbidities is still limited, and its pathogenesis should be explored in the future, so as to quickly and accurately identify comorbidities and further study better treatments.

       目的   构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型，帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险，并制定更合适的治疗策略。方法   回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料，结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量，再采用多因素分析确定独立预后因素，并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果  APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860），Hosmer-Lemeshow 检验P=0.604，校准曲线和标准曲线高度重合，表明该模型具有良好的区分度和校准度。同时，DCA曲线显示，预测模型在大部分的阈值概率范围内提供了显著的净收益。结论   本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险，有助于临床医生制定更合适的个体化治疗策略。

       Objective  To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD），enabling clinicians to more precisely evaluate mortality  risk in TBAD patients during the acute stage and to devise better treatment plans．Methods  This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2，focusing on mortality within 14 days of the acute phase in TBAD patients．Initially，the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection，and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model’s effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve，calibration curve，and Decision Curve Analysis（DCA）．Results  Acute Physidogy Score Ⅲ score，total carbon dioxide，and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860），with a Hosmer-Lemeshow test P-value of 0.604．The close alignment of the calibration and standard curves suggested the model’s strong discriminative power and calibration．Furthermore，the DCA curve  revealed that the predictive model offered substantial net benefits within a wide  range of threshold probabilities．Conclusions  This study's nomogram，developed using APS Ⅲ score，total carbon dioxide，and  red blood cell distribution width，accurately predicts the 14-day mortality risk in TBAD patients，assisting clinicians in creating better personalized treatment plans．