目的 分析不同年龄、不同季节河源市源城区呼吸道感染的病原学情况,指导临床用药。方法 回顾性研究2020年3月—2022年2月2 468例呼吸道感染的住院患儿,取咽部分泌物送广州达安临床检验中心进行呼吸道核酸六项检测并分析结果。包括：肺炎链球菌（Sp）、呼吸道合胞病毒（RSV）、卡他莫拉菌（MC）、流感嗜血杆菌（Hi）、肺炎支原体（LP）、腺病毒（ADV）。结果 （1）2 468例患儿的标本中阳性率52.8%,其中RSV最高,其他依次为Sp、Hi、MC、MP、ADV。而混合感染仅次于RSV。（2）婴儿组和幼儿组以RSV感染为主,在学龄前组和学龄组儿童中,以Sp感染为主,各病原体的混合感染组合很多,一种细菌合并一种病毒多见。（3）秋冬季是河源市源城区呼吸道感染的高发季节,RSV是秋冬季呼吸道感染最主要的病原体。结论 秋冬季节为河源市源城区呼吸道感染的高发季节,RSV为该季节的主要病原体。RSV也是婴幼儿组感染的主要致病菌,随着年龄增大,细菌感染导致的呼吸道疾病逐渐占优势。混合感染在各年龄组中均占比较高,值得临床诊疗的重视。

Objective To analyze the etiology of respiratory tract infection in Yuancheng District of Heyuan City ,which was in different ages and seasons,and to provide guidance of clinical drug usage．Methods Cases of 2 468 hospitalized children with respiratory tract infection from March 2020 to February 2022 were analyzed．The secretion from pharynx was collected and sent to Guangzhou Da’an Clinical Examination Center for six respiratory nucleic acid tests and then the results were analyzed,including Streptococcus pneumoniae（Sp）,respiratory syncytial virus（RSV）,Moraxella catarrhalis（MC）,Haemophilus influenzae（Hi）,Mycoplasma pneumonia（MP）,adenovirus（ADV）．Results The positive rate of 2 468 hospitalized children with respiratory tract infection was 52.8%,of which the highest was RSV,followed by Sp,Hi,MC,MP,ADV．Meanwhile the mixed infection rate was second to RSV．RSV infection was the main infection in infant group and early-aged children group,while in preschool group and school-aged group,Sp infection was the main infection．There were many mixed infection of pathogen,and one bacteria combined with one virus was more common．Respiratory tract infection had high incidence in autumn and winter in Yuancheng District of Heyuan City,RSV was the major pathogen．Conclusions Autumn and winter were the seasons with high respiratory tract infection incidence in Yuancheng District of Heyuan City,and RSV was the main pathogen in these two seasons．RSV was also the main pathogen of infant group infection．But with the increase of children’s age,bacterial infection became the main reason of respiratory tract diseases．Mixed infection accounts for a high proportion in all age groups,which should be valued in clinical diagnosis and treatment．

目的 分析后循环脑梗死（PCCI）患者椎基底动脉狭窄和血清生化指标的相关性。方法 对100例PCCI患者的临床资料进行回顾性分析,依照椎基底动脉狭窄程度将患者分为不稳定斑块组（n=35）、稳定斑块组（n=36）和无斑块组（n=29）。对比3组患者临床一般情况,血清神经细胞因子水平,血清炎症因子水平,并分析PCCI患者椎基底动脉狭窄和血清生化指标的相关性。结果 3组患者再次发病情况与NIHSS评分对比差异有统计学意义,不稳定斑块组高于其他2组（P<0.05）,但稳定斑块组与无斑块组比较差异无统计学意义（P>0.05）;3组患者脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S100β）水平对比差异有统计学意义,不稳定斑块组BDNF低于稳定斑块组与无斑块组,不稳定斑块组NSE、S100β高于稳定斑块组与无斑块组（P<0.05）,但稳定斑块组与无斑块组对比无差异（P>0.05）;3组患者血清C反应蛋白（CRP）、白细胞介素-37（IL-37）、肿瘤坏死因子（TNF-α）、血管细胞黏附分子-1（VCAM-1）、细胞间黏附分子-1（ICAM-1）、人软骨糖蛋白40（YKL-40）水平对比有差异,不稳定斑块组高于其它2组（P<0.05）,但稳定斑块组与无斑块组比较差异无统计学意义（P>0.05）;Pearson直线相关分析显示,椎基底动脉狭窄与BDNF呈负相关,与NSE、S100β、CRP、IL-37、TNF-α、VCAM-1、ICAM-1、YKL-40呈正相关（P<0.05）;多因素 Logistic 回归分析结果显示,BDNF、NSE、ICAM-1、YKL-40是椎基底动脉狭窄的独立危险因素（P<0.05）。结论 PCCI患者椎基底动脉狭窄程度越严重,再次发病率越高,对患者的神经功能影响越严重。同时血清相关神经细胞因子水平和炎症因子水平与椎基底动脉狭窄严重程度具有明显相关性,其中BDNF、NSE、ICAM-1、YKL-40可作为PCCI患者椎基底动脉狭窄预测的重要指标,因此临床上可以通过监测患者的血清相关生化指标为临床诊断及预后判断提供参考依据。

Objective To investigate the correlation between vertebrobasilar artery stenosis and serum biochemical indexes in patients with posterior circulation cerebral infarction（PCCI）．Methods One hundred patients with PCCI admitted to our hospital were selected as the study objects,and the clinical data of all patients were retrospectively analyzed．The patients were divided into unstable plaque group（n=35）,stable plaque group（n=36）and no plaque group（n=29）according to the degree of vertebrobasilar artery stenosis．The general clinical conditions,serum levels of neurocytokines and inflammatory factors of the patients were compared,the correlation between vertebrobasilar artery stenosis and serum biochemical indicators in patients with PCCI was analyzed．Results The recurrence and NIHSS score of the 3 groups were significantly different,the unstable plaque group was significantly higher than the other 2 groups（P<0.05）,but there was no significant difference between the stable plaque group and the no plaque group（P>0.05）．The levels of brain-derived neurotrophic factor（BDNF）,neuron-specific enolase（NSE）and central nerve specific protein（S100β）in the three groups were significantly different．BDNF in unstable plaque group was lower than that in stable plaque group and no plaque group,while NSE and S100β in unstable plaque group were higher than that in stable plaque group and no plaque group（P<0.05）．There was no significant difference between stable plaque group and no plaque group（P>0.05）．The levels of serum C-reactive protein（CRP）,interleukin-37（IL-37）,tumor necrosis factor-α（TNF-α）,vascular cell adhesion molecule-1（VCAM-1）,intercellular adhesion molecule-1（ICAM-1）and human cartilage glycoprotein 40（YKL-40）in 3 groups were significantly different．The unstable plaque group was higher than the other two groups（P<0.05）,but there was no significant difference between the stable plaque group and the no plaque group（P>0.05）．Pearson Line correlation analysis showed that vertebrobasilar artery stenosis was negatively correlated with BDNF,and positively correlated with NSE,S100β,CRP,IL-37,TNF-α,VCAM-1,ICAM-1,YKL-40（P<0.05）．Multivariate Logistic regression analysis showed that BDNF,NSE,ICAM-1 and YKL-40 were independent risk factors for vertebrobasilar artery stenosis（P<0.05）．Conclusions The more severe degree of vertebrobasilar artery stenosis in patients with PCCI,the higher recurrence rate and more serious the impact on the neurological function of patients．At the same time,the levels of serum related neurocytokines and inflammatory factors were significantly related to the severity of vertebrobasilar artery stenosis．BDNF,NSE,ICAM-1 and YKL-40 can be used as important indicators to predict the severity of vertebrobasilar artery stenosis in patients with PCCI．Therefore,monitoring the patient’s serum biochemical indicators of angiography can provide reference for clinical diagnosis and prognosis judgment．

目的 观察经鼻高流量氧疗治疗慢性阻塞性肺疾病急性加重期（AECOPD）伴Ⅱ型呼吸衰竭对患者肺功能、血气分析指标的影响。方法 收集2020年3月—2022年3月我院收治的AECOPD伴Ⅱ型呼吸衰竭患者92例,随机分为常规通气组（46例,无创正压通气）、经鼻氧疗组（46例,经鼻高流量氧疗）,测量记录治疗前及治疗后2组患者心率及呼吸频率、血气分析指标、肺功能指标,评估患者舒适度及呼吸困难情况,记录治疗期间并发症。结果 治疗后经鼻氧疗组心率、呼吸频率低于常规通气组（P<0.05）;治疗后经鼻氧疗组二氧化碳分压（PaCO₂）低于常规通气组,动脉血氧分压（PaO₂）高于常规通气组（P<0.05）;治疗后经鼻氧疗组第1秒用力呼出气容积（FEV₁）、用力呼气容积（FVC）高于常规通气组（P<0.05）;治疗后经鼻氧疗组Borg评分低于常规通气组,舒适率高于常规通气组（P<0.05）;经鼻氧疗组并发症发生率低于常规通气组（P<0.05）。结论 给予AECOPD伴Ⅱ型呼吸衰竭患者经鼻高流量氧疗可改善患者肺功能、血气分析指标,促进呼吸困难症状缓解,且可提高患者舒适度,降低并发症发生率。

Objective To observe the effect of nasal high-flow oxygen therapy on pulmonary function and blood gas analysis indexes in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）with type Ⅱ respiratory failure．Methods From March 2020 to March 2022,92 patients with AECOPD complicated with type Ⅱ respiratory failure who were treated in our hospital were enrolled and randomly divided into conventional ventilation group（46 cases,non-invasive positive pressure ventilation）and nasal oxygen therapy group（46 cases,nasal high-flow oxygen therapy）．The heart rate and respiratory rate,blood gas analysis indexes,pulmonary function indexes of the two groups of patients before and after treatment were measured and recorded,the comfort level and dyspnea situation of the patients were evaluated,and the complications during the treatment were recorded．Results After treatment,the heart rate and respiratory rate in the nasal oxygen therapy group were significantly lower than those in the conventional ventilation group（P<0.05）．The partial pressure of carbon dioxide（PaCO₂）in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group,partial pressure of oxygen（PaO₂）was significantly higher than the conventional ventilation group（P<0.05）．The nasal oxygen therapy group forced expiratory volume in one second,（FEV₁）,forced vital capacity（FVC）were significantly higher than the conventional ventilation group（P<0.05）．The Borg score of nasal oxygen therapy group was significantly lower than the conventional ventilation group,the comfort level was significantly higher than the conventional ventilation group（P<0.05）．The incidence of complications in the nasal oxygen therapy group was significantly lower than that in the conventional ventilation group（P<0.05）．Conclusions Nasal high-flow oxygen therapy for AECOPD patients with type Ⅱ respiratory failure can significantly improve the pulmonary function and blood gas analysis indicators,promote the relief of dyspnea symptoms,improve the comfort level of patients,and reduce the incidence of complications．

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 评估全身免疫炎症指数（SII）、中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）在区分急性缺血性卒中（AIS）伴发卵圆孔未闭（PFO）与非伴发PFO患者的价值。方法 回顾性分析100例AIS患者的血液和血清指标,计算SII、NLR和PLR,使用Logistic回归及受试者操作特征（ROC）曲线分析3项指标在鉴别AIS伴发PFO与非伴发PFO中的价值。结果 伴发PFO的AIS患者SII、NLR、PLR高于非伴发PFO的AIS患者,其中以SII最为明显（P均<0.05）。单因素Logistic回归显示,中性粒细胞计数、淋巴细胞计数、PLR、NLR、SII与AIS伴发PFO有关（P<0.05）。ROC曲线分析结果,SII、NLR、PLR鉴别AIS伴PFO与非伴PFO患者,最佳阈值分别为476.4、1.99、115.3,曲线下面积分别为0.777、0.767、0.708。结论 SII、NLR和PLR可作为鉴别AIS患者是否伴发PFO的生物标志物,具有潜在临床应用价值。

Objective To evaluate the value of systemic immune-inflammatory index（SII）,neutrophil/lymphocyte ratio（NLR）and platelet/lymphocyte ratio（PLR）in distinguishing acute ischemic stroke（AIS）patients with patent foramen ovale（PFO）and without PFO．Methods A retrospective analysis of blood and serum indicators in 100 AIS patients was conducted,and SII,NLR and PLR indices were calculated．Logistic regression and ROC curve analyses were performed．Results SII,NLR and PLR were significantly higher in PFO patients than in non-PFO patients,with SII being the most significant．Univariate logistic regression showed that Neu,Lym,PLR,NLR,and SII variables were significantly associated with AIS combined with PFO（P<0.05）．ROC curve analysis revealed that the optimal cut-off values for SII,NLR and PLR in distinguishing AIS patients with PFO from those without PFO were 476.4,1.99 and 115.3,respectively,with area under the curve of 0.777,0.767 and 0.708．Conclusions SII,NLR and PLR can serve as biomarkers for identifying AIS patients with PFO,offering potential clinical application value．

目的 探讨基于心肺运动试验（CPET）的康复运动应用于维持性血液透析（MHD）患者免疫功能及疲劳程度的影响。方法 选取2020年1月—2022年6月我院200例MHD患者作为研究对象,随机将其分入研究组（n=100）和对照组（n=100）。对照组患者采用常规运动模式进行管理,研究组患者采用基于CPET的康复运动。比较2组的疲劳程度、炎症反应、免疫功能以及心功能。结果 干预3个月后,2组患者透析后的疲劳程度均优于干预前,且研究组优于对照组（均P<0.05）。干预3个月后,2组C-反应蛋白均低于干预前,且研究组低于对照组,免疫球蛋白G（IgG）、IgA、IgM、CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺均高于干预前,且研究组高于对照组（均P<0.05）。干预3个月后,2组左室射血分数、6 min步行距离均高于干预前,且研究组高于对照组（均P<0.05）。干预3个月后,2组左室舒张末期内径、左室收缩末期内径比较差异均无统计学意义（均P>0.05）。结论 基于CPET的康复运动应用于MHD患者中可缓解炎症反应及透析后疲劳程度,提升免疫功能及心功能。

目的 探讨血清外泌体中糖蛋白 Ib 血小板亚基α（GP1BA）的表达水平与动脉粥样硬化的相关性。方法 选取福州市第二医院2022年1月—2023年1月收治的30例心电图提示ST-T改变及冠状动脉造影显示有AS斑块的患者为动脉粥样硬化组;30名健康志愿者为对照组。实时荧光定量（RT-qPCR）法和蛋白质印迹（WB）检测受试人员血清外泌体中GP1BA的表达量,ELISA法检测血清中肿瘤坏死因子α（TNF-α）、白细胞介素-1β（IL-1β）、干扰素-γ（IFN-γ）、高敏心肌肌钙蛋白（hs-cTnT）、血管性血友病因子（vWF）含量。采用Pearson相关系数分析血清外泌体中GP1BA的表达水平与TNF-α、IL-1β、IFN-γ、hs-cTnT、vWF的相关性。结果 动脉粥样硬化组血清外泌体中GP1BA的表达水平高于对照组,血清中TNF-α、IL-1β、IFN-γ、hs-cTnT、vWF含量升高（均P<0.05）。相关性分析发现GP1BA的表达水平与TNF-α、IL-1β、IFN-γ、hs-cTnT、vWF含量均呈较强正相关关系（均P<0.05）。结论 血清外泌体中GP1BA的表达水平与AS存在相关性,并可作为AS的潜在标志物。

目的 探讨个体化肠内营养联合电动起立床训练对老年脑卒中卧床患者器官功能的影响。方法 严格执行纳排标准后前瞻性选取2021年7月—2022年9月期间我院收治的97例老年脑卒中卧床患者作为研究对象,按照随机数字表法分为单一组48例给予脑卒中基础干预,联合组49例给予个体化肠内营养联合电动起立床训练干预,观察2组患者营养状况、肺功能指标以及心功能指标。结果 干预4周后,2组血清前蛋白、血清白蛋白、血红蛋白水平均上升且联合组高于单一组（P<0.05）;2组用力肺活量（FVC）、第1秒用力呼吸容积（FEV₁）、FEV₁/FVC均上升且联合组高于单一组（P<0.05）;联合组左心室收缩期内径、左室舒张末期内径低于单一组,联合组左心室射血分数高于单一组（P<0.05）。结论 个体化肠内营养联合电动起立床训练干预可有效改善老年脑卒中卧床患者营养状况及心肺功能,促进其机体功能的恢复。

目的 分析早、中期肝细胞癌（HCC）切除术后早期（≤2年）复发的危险因素并探讨术前系统免疫炎症指数（SII）对早、中期HCC术后早期复发的预测价值。方法 回顾性研究2017年10月—2020年10月于我院接受肝癌根治性切除术的238例早中期HCC患者,收集基线资料,通过1∶1倾向性评分匹配（PSM）均衡组间协变量获取早期复发组及未复发组各69例;单因素和多因素Logistic回归分析影响术后早期HCC复发的相关因素,构建列线图模型,临床决策曲线（DCA）评估列线图预测模型在临床的应用效果;受试者操作特征（ROC）曲线评价预测效能,根据最高约登指数确定截断点。结果 单因素及多因素Logistic回归分析结果均提示微血管侵犯（MVI）及术前系统免疫炎症指数（SII）高水平是术后早期复发的独立危险因素;列线图模型有较好的预测效能;ROC曲线计算出SII最佳临界值为696.85×10⁹／L。结论 术前高水平SII可能对预测HCC患者术后早期复发具有潜在价值。

目的 探讨精细化管理模式对消毒供应中心风险事件发生率的影响。方法 选取2020年6月—2022年5月为研究阶段,抽取本院消毒供应室1 000件医疗器械作为研究对象,随机分为对照组和研究组,各500件。对照组采用常规管理模式,研究组采用精细化管理模式,对比2组医疗器械不良事件发生率,观察30名工作人员分别在不同管理模式下发生职业风险暴露人数的变化,并进一步比较工作效率的不同。结果 研究组发生数量不等、物品过期、标签错误、型号错误、零部件差错等不良事件发生率均低于对照组（P<0.05）。研究组工作人员利器损伤和血制品污染者发生率低于对照组（P<0.05）,研究组工作人员工作效率评分高于对照组（P<0.05）。结论 精细化管理模式可有效减少消毒供应室医疗器械不良事件,降低工作人员职业暴露风险事件发生率,提高工作人员工作效率,改善管理工作质量。

Objective To explore the influence of refined management mode on the incidence of risk events in disinfection supply center. Methods From June 2020 to May 2022,1 000 pieces of medical devices were selected from the disinfection supply room of our hospital as the research object,and were randomly divided into control group and research group,with 500 pieces in each group. The control group adopted the conventional management mode,while the research group adopted the refined management mode. The incidence of adverse medical device events in the two groups was compared,and the changes in the number of 30 staff exposed to occupational risks under different management modes were observed,and the differences in work efficiency were further compared. Results The incidences of adverse events involving unequal quantities,expired items,mislabeling,modeling errors and parts errors were lower in the study group than in the control group(P<0. 05). The number of sharps injuries and blood product contamination among the staff in the study group was significantly lower than that in the control group(P<0. 05),and the staff efficiency scores of the study group were higher than those of the control group(P<0. 05). Conclusions Refined management mode can effectively reduce the adverse events of medical devices in disinfection supply room,reduce the number of occupational exposure risk events of staff,improve the work efficiency of staff and improve the quality of management.