目的 调查老年脆性骨折患者术前衰弱现况,并分析影响因素。方法 采用便利抽样法, 2024年11月—2025年3月, 选取于广州市某三甲医院骨科住院的207例老年脆性骨折患者, 使用一般资料调查表、简易衰弱评估量表、简版流调中心抑郁量表、广泛性焦虑量表和营养风险筛查量表2002开展问卷调查。采用有序分类Logistic回归, 分析老年脆性骨折患者术前衰弱的影响因素。结果 207例老年脆性骨折患者的术前衰弱前期占48.3%, 衰弱发生率为23.2%。有序分类Logistic 回归分析结果显示年龄（OR=1.131）、睡眠差（OR=2.557）、合并3种及以上慢性病（OR=3.990）、抑郁（OR=3.296）、营养不良风险（OR=4.005）为老年脆性骨折患者术前衰弱的危险因素,BMI正常（OR=0.206）是保护因素（均P<0.05）。结论 老年脆性骨折患者年龄, 睡眠情况, 多种共病,抑郁, 存在营养不良风险及BMI影响其术前衰弱水平, 重视衰弱的筛查及早期干预, 提升患者治疗效果和生活质量。

       Objective To explore the preoperative frailty status and influencing factors in elderly patients with osteoporotic fractures．Methods Using convenience sampling, 207 elderly patients with osteoporotic fractures admitted to the orthopedic department of a tertiary hospital in Guangzhou from November 2024 to March 2025 were selected．Data were collected using a general information questionnaire, the Frail Scale, the 10-item Center for Epidemiologic Studies Depression Scale（CES-D-10）, the Generalized Anxiety Disorder Scale（GAD-7）, and the Nutritional Risk Screening 2002（NRS-2002）．Logistic regression was used to analyze factors influencing preoperative frailty．Results Among 207 elderly patients with osteoporotic fractures, the incidence of early stages of frailty was 48.3%, and the incidence of frailty was 23.2%．Logistic regression analysis revealed the following risk factors for preoperative frailty：age（OR=1.131）, poor sleep quality（OR=2.557）, multiple chronic comorbidities（OR=3.990）, depression（OR=3.296）, nutritional risk（OR=4.005）．Normal body mass index（OR=0.206）was a protective factor．Conclusions Advanced age,poor sleep quality, multiple chronic comorbidities, depression, nutritional risk and body mass index are associated with frailty in elderly osteoporotic fracture patients．Health care providers should pay attention to frailty screening and early intervention, which can reverse or delay the progression of frailty and improve the treatment effect and quality of life of patients．

      生物化学是临床医学专业的一门重要基础课程，其教学质量可直接影响临床医学生物的培养目标。文章探讨了“新医科”背景下生物化学课程的教学改革，从思政元素融入课堂、教学手段的改革、开放实验平台的搭建和课程考核的改革等方面入手，着力培养学生自主学习的能力，解决临床问题的能力和提升科研素养。

      For students who majored in clinical medicine，biochemistry is a crucial foundation course，and the teaching quality of which directly influence the educational objectives of clinical medicine students．In this study，we explored the teaching reformation methods of biochemistry course under the background of New Medicine．We integrated ideological elements into classroom teaching，and used various teaching methods in the classroom，built an open experiment platform and innovated course assessment mode，for trying to improve the students’ ability of self-study，clinical problems resolving and scientific literacy．

       目的   探讨脓毒性休克患者肿瘤坏死因子相关受体6 （TRAF6）、胆碱酯酶（ChE）及急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）对预后不良的预测价值。方法   回顾分析2023年2月—2024年3月于某院ICU病区收治的226例脓毒性休克患者的临床资料，基于患者预后情况分为预后良好组（n=151）以及预后不良组（n=75）。回顾226例脓毒性休克患者入院时及治疗后的TRAF6、ChE表达变化，并记录患者APACHEⅡ评分和序贯器官功能衰竭评估（SOFA）评分动态变化；比较并分析两组患者详尽的临床资料，探讨TRAF6、ChE联合APACHE Ⅱ评分之间的关联性以及上述指标对脓毒性休克患者预后情况的临床评估价值。采用Logistic回归来分析对脓毒性休克患者生存状况产生影响的潜在因素。结果   多因素Logistic回归分析，年龄、APACHE Ⅱ评分、SOFA评分、机械通气时间、TRAF6与ChE表达水平均是影响患者预后的独立危险因素（P＜0.05）；受试者操作特征曲线分析显示，年龄、APACHE Ⅱ评分、机械通气时间、SOFA评分、TRAF6、ChE表达水平联合预测脓毒性休克患者预后不良的曲线下面积为0.925，高于单独检测的0.689、0.783、0.794、0.781、0.708、0.827。结论   临床需要及时识别高龄、长时间机械通气时间、高APACHE Ⅱ与SOFA评分、高TRAF6和ChE表达水平的高风险患者，TRAF6、ChE表达水平、SOFA评分、APACHE Ⅱ评分可作为评估脓毒性休克患者预后情况的临床指标，联合应用能进一步提升临床价值。

      Objective  To explore the predictive value of tumor necrosis factor receptor associated factor 6（TRAF6），cholinesterase（ChE）and Acute Physiology and Chronic Health Evaluation II scove（APACHE II）for adverse prognosis in patients with septic shock．Methods  The clinical data of 226 patients with septic shock admitted to the Intensive Care Unit（ICU） of a hospital from February 2023 to March 2024 were retrospectively analyzed，and the patients were divided into a good prognosis group（n=151）and an adverse prognosis group（n=75）based on their prognosis．The expression of TRAF6 and ChE in 226 patients with septic shock was reviewed at admission and after treatment，while the dynamic changes of APACHE  II score and Sequential Organ Failure Assessment（SOFA）score were recorded．Detailed clinical data of the two groups were compared and analyzed to explore the correlation between TRAF6，ChE，APACHE II scores and the clinical evaluation value of the above indexes in the prognosis of patients with septic shock．Logistic regression was used to analyze the potential factors affecting the survival of septic shock patients．Results  Multiple Logistic regression analysis revealed that age，APACHE II score，SOFA score，mechanical ventilation time，TRAF6 and ChE expression levels were independent risk factors for prognosis（P＜0.05）．Receiver Operating Characteristic（ROC）curve analysis showed that the area under curve（AUC）was 0.925，which was higher than single index prediction（0.689，0.783，0.794，0.781，0.708 and 0.827）．Conclusions  High-risk patients with advanced age，prolonged mechanical ventilation，high APACHE II and SOFA scores，and high TRAF6 and ChE expression levels need to be identified in time．TRAF6，ChE expression levels，SOFA scores，and APACHE  II scores can be used as clinical indicators to evaluate the prognosis of septic shock patients．The combined application of those four indicators can further improve the clinical value．

       目的   探讨优化护理路径在急性缺血性脑卒中介入手术中的应用及效果。方法   采用随机对照研究，纳入2024年1月—2025年1月收治的112例急性缺血性脑卒中取栓患者，观察组（56例）实施优化介入护理路径，对照组（56例）采用常规护理。结果   观察组患者的满意度评分、医护满意度评分均优于对照组（P＜0.05）；观察组的术前等待时间、患者自进入介入室至股动脉穿刺时间、手术时间、住院费用、并发症发生率、差错事故发生率也优于对照组（P＜0.05）。结论   通过标准化术前准备、术中多学科协作及术后康复衔接，优化护理路径可显著提升急性缺血性脑卒中治疗时效性（缩短急性脑卒中患者从进入医院到开始静脉溶栓给药的时间至黄金时间窗内），改善患者神经功能预后。

       Objective  To explore the application and efficacy of an optimized nursing pathway in endovascular therapy for acute ischemic stroke（AIS）．Methods  A randomized controlled trial was conducted，enrolling 112 AIS patients undergoing mechanical thrombectomy from January 2024 to January 2025．Patients were randomly assigned to either the observation group（n=56），which received the optimized interventional nursing pathway，or the control group（n=56），which  received  routine nursing care．Results  Patient satisfaction score，medical staff satisfaction score，and postoperative favorable  recovery  rate in observation group were better than those of control group（P＜0.05）．Additionally，the observation group  showed  significant improvements in preoperative waiting time，time from entering the operation room to femoral artery puncture，surgical duration，hospitalization costs，complication incidence rate，and medical error incidence rate（P＜0.05）．Conclusions  By standardizing preoperative preparations，implementing intraoperative multidisciplinary collaboration，and enhancing postoperative  rehabilitation coordination，the optimized nursing pathway significantly improved the timeliness of thrombectomy treatment（shortening door-to-needle time to reach the golden time window）and enhanced neurological functional prognosis in AIS patients，demonstrating substantial clinical applicability．

       目的   探讨营养评估及炎症因子水平对非霍奇金淋巴瘤（NHL）患者化学治疗（化疗）后感染及平均住院日的影响。方法   回顾性分析接受R-CHOP治疗的NHL患者95例。通过受试者工作特征（ROC）曲线确定患者主观整体营养评估（PG-SGA）预测患者化疗后感染的界值。将患者分为PG-SGA＜4组与PG-SGA≥4组，比较两组间营养及炎症相关指标的差异。采用单因素与多因素回归分析NHL患者化疗后感染及平均住院日延长的危险因素。结果  ROC曲线显示PG-SGA为3.5时，约登指数最大，预测NHL患者化疗后感染灵敏度为92%，特异度为11.1%。PG-SGA≥4组患者平均年龄、国际预后指数（IPI）及Ann arbor Ⅲ~Ⅳ期比例均高于PG-SGA＜4组（P＜0.05）。与PG-SGA＜4组相比，PG-SGA≥4组患者白介素6（IL-6）及中性粒细胞与淋巴细胞比值（NLR）明显升高，且化疗后感染率及平均住院日≥5 d比例高于对照组（P＜0.05）；与对照组相比，PG-SGA＜4组患者前白蛋白、白蛋白和血红蛋白水平升高（P均＜0.05）。多因素回归分析显示，PG-SGA≥4及合并糖尿病是NHL患者化疗后感染率的独立危险因素（P均＜0.05）。白蛋白低于35 g/L及合并化疗后感染是NHL患者平均住院日延长的独立危险因素（P均＜0.05）。结论   基于PG-SGA的营养评估及炎症因子分析对NHL患者化疗后感染及平均住院日的预测具有临床指导意义。

       Objective  To explore the effects of nutritional assessment and inflammatory factor levels on post-chemotherapy infections and length of hospital stay in patients with non-Hodgkin’s lymphoma（NHL）．Methods  A total of 95 NHL patients treated with the R-CHOP regimen were retrospectively analyzed．The  cut-off  value  of  Patient-Generated  Subjective Global Assessment （PG-SGA） for post-chemotherapy infection in NHL patients was evaluated by Receiver Operating Characteristic（ROC）curves．Patients were categorized into PG-SGA＜4 and PG-SGA≥4 groups and compared for differences of nutritional and inflammation-related factors．Univariate and multivariate logistic regression were used to analyze the risk factors for post-chemotherapy infection and length of hospital stay（LHS）．Results  The ROC curve showed that the Youden index was largest at PG-SGA of 3.5，which predicted post-chemotherapy infection in NHL patients with a sensitivity of 92% and a specificity of 11.1%．The mean age，International Prognostic Index（IPI），and Ann Arbor stage Ⅲ~IV proportion in patients with PG-SGA≥4 were higher compared with the control（P＜0.05）．Patients with PG-SGA≥4 had significantly higher interleukin-6 and neutrophil-to-lymphocyte ratio（NLR），and the infection rate and the proportion of LHS≥5 days after chemotherapy were higher than those in the control group（P＜0.05）．Patients in the PG-SGA＜4 group had significantly higher prealbumin，albumin，and hemoglobin levels compared to the PG-SGA≥4 group（P＜0.05）．Multifactorial logistic regression analysis revealed that PG-SGA≥4 and combined diabetes mellitus were independent risk factors for post-chemotherapy infection rate in NHL patients（both P＜0.05）．Albumin less than 35 g/L and combined post-chemotherapy infection were independent risk factors for prolonged LHS in NHL patients（both P＜0.05）．Conclusions  PG-SGA nutritional assessment and inflammatory factor analysis are clinically instructive in predicting post-chemotherapy infections and LHS in NHL patients．

目的 探究本体感觉神经肌肉促进疗法（PNF）技术与居家远程康复治疗对缺血性脑卒中患者凝血功能、平衡状态的影响。方法 选择2023年1月—2024年1月在宁乡市中医医院择期治疗的60例缺血性脑卒中患者为研究对象。按照患者选择的治疗方案进行分组, 观察组接受PNF技术联合居家远程康复指导治疗, 对照组接受常规居家远程康复指导治疗。记录疗效、凝血功能、神经功能缺损症状。结果 凝血功能方面,观察组治疗后活化部分凝血酶时间（APTT）、凝血酶原时间（PT）高于治疗前, 二聚体（D-D）、纤维蛋白原（FIB）低于治疗前,组间比较差异有统计学意义（P<0.05）。与对照组相比, 观察组的APTT、PT、D-D、FIB指标相近,组间比较差异无统计意义（P>0.05）。治疗后, 观察组平衡功能（BBS）评分比治疗前高, 组间比较差异有统计学意义（P<0.05）。观察组BBS评分、FMA评分、肌力等级更高, 组间比较差异有统计学意义（P<0.05）。结论 PNF技术+居家远程康复指导治疗可作为缺血性脑卒中患者治疗的有效手段。联合治疗后凝血功能、平衡状态、肢体功能状况、肌力明显改善, 可见联合治疗对于减轻患者病情尤为明显。

Objective To explore the effects of proprioceptive neuromuscular facilitation（PNF）and home-based remote rehabilitation on coagulation function and balance function in patients with ischemic stroke．Methods From January 2023 to January 2024, 60 patients with ischemic stroke were selected from our hospital．The patients were divided into two groups according to the treatment plan chosen by themselves．The patients in the observation group received PNF technology combined with home-based remote rehabilitation guidance, while the patients in the control group received routine home-based remote rehabilitation guidance．The curative effect, coagulation function and neurological deficit were recorded．Results After treatment, activated partial thrombin time（APTT）and prothrombin time（PT）were significantly higher, D-dimer（D-D）and fibrinogen（FIB）were significantly lower in the observation group than those before treatment（P<0.05）．Compared with the control group, the APTT, PT, D-D and FIB of the observation group were similar, and there was no significant difference between the two groups（P>0.05）．After treatment, the Berg Balance Scale score of the observation group was higher than that before treatment, and there was significant difference between the two groups（P<0.05）．The Berg Balance Scale score, Fugl-Meyer Assessment score and muscle strength grade of observation group were higher than those of control group（P<0.05）．Conclusions PNF combined with home-based remote rehabilitation can be used as an effective method for the treatment of patients with ischemic stroke．The coagulation function, balance, extremity function and muscle strength were significantly improved after combined treatment, which indicated that the combined treatment was especially effective in relieving the patients’ symptoms．

目的 探讨卵巢癌化学治疗（化疗）耐药与焦孔素E（GSDME）基因的甲基化是否有关, 以及地西他滨是否可以通过去甲基化使GSDME蛋白表达水平升高从而逆转卵巢癌化疗耐药。方法 顺铂逆浓度梯度构建SKOV-3卵巢癌耐顺铂细胞株（SKOV-3/DDP）; CCK8法检测耐药前后细胞株的半抑制浓度（IC₅₀）; 实时荧光定量甲基化特异性PCR法检测两组细胞中GSDME基因的甲基化水平; Wetern Blot检测两组细胞中GSDME的表达水平。将耐药细胞株用不同质量浓度的地西他滨处理,重复上述实验, 检测地西他滨处理前后细胞的IC₅₀、GSDME基因的甲基化水平及GSDME蛋白的表达程度。结果 与SKOV-3细胞相比, SKOV-3/DDP中GSDME基因的甲基化水平升高（P<0.01）, 同时GSDME蛋白的表达水平降低（P<0.001）; 随着地西他滨作用浓度的升高, 耐药细胞中GSDME基因的甲基化程度逐渐降低, 蛋白的表达水平逐渐升高, 细胞的IC₅₀逐渐降低：在用0.5 μg/mL地西他滨处理耐药细胞后GSDME基因的甲基化水平虽然降低（P<0.01）, 但是此时蛋白的表达水平及耐药细胞的IC₅₀均无明显改变（P>0.05）; 当地西他滨的浓度增加到1.0 μg/mL时蛋白的表达水平才明显升高（P<0.05）, 而此时细胞的IC₅₀仍未见明显降低（P>0.05）; 待药物浓度达到1.5 μg/mL时, 细胞的IC₅₀才表现出明显的下降趋势（P<0.05）。结论 GSDME的表达与卵巢癌的化疗耐药密切相关, GSDME的高甲基化水平致使其低表达可促进卵巢癌的化疗耐药。但地西他滨可以通过去甲基化使卵巢癌耐药细胞中GSDME的表达水平升高, 从而增加卵巢癌细胞对化疗药物的敏感性, 进而逆转卵巢癌化疗耐药。

Objective To explore whether drug resistance in ovarian cancer is associated with gasdermin E（GSDME） methylation, and to explore whether decitabine can reverse ovarian cancer chemoresistance by increasing GSDME protein expression levels through demethylation．Methods The cisplatin-resistant cell line（SKOV-3/DDP）was constructed by inverse concentration gradient of cisplatin．Semi-inhibitory concentration（IC₅₀）of cell lines after drug resistance was detected using the CCK8 assay．Real-time fluorescence quantitative methylation-specific PCR was used to detect the methylation level of GSDME gene in the two groups of cells．Wetern Blot was used to detect the expression level of GSDME in the two groups of cells．Drug-resistant cell lines were treated with different concentrations of the demethylating drug decitabine．Experiments above were repeated to detect the methylation degree of IC₅₀ and GSDME genes and the expression level of GSDME protein in drug-resistant cells before and after decitabine treatment．Results Compared with SKOV-3 cells, the methylation level of GSDME gene in SKOV-3/DDP was significantly increased（P<0.01）, while the expression level of GSDME protein was significantly decreased（P<0.001）．With the increase of decitabine concentration, the methylation degree of GSDME gene in drug-resistant cells was gradually decreased, the expression level of protein was gradually increased, and the IC₅₀ of cells was gradually decreased：the methylation level of GSDME gene was decreased after 0.05 μg/mL decitabine treatment（P<0.01）, but there were no significant changes in protein expression level and IC₅₀ of drug-resistant cells（P>0.05）．The protein expression level was significantly increased when the concentration of local citabine was increased to 0.10 μg/mL（P<0.05）, while the IC50 of the cells was not significantly decreased（P>0.05）．When the drug concentration reached 0.15 μg/mL, he IC₅₀ of the cells showed a significant downward trend（P<0.05）．Conclusions The expression of GSDME is closely related to chemoresistance in ovarian cancer, and the low expression of GSDME due to its high methylation level can promote chemoresistance in ovarian cancer．However, decitabine can increase the expression level of GSDME in drug-resistant ovarian cancer cells through demethylation,thereby increasing the sensitivity of ovarian cancer cells to chemotherapeutic drugs, and then reversing the chemoresistance of ovarian cancer．

值班和交接班制度是医疗质量安全管理核心制度之一,是医院 “8 h”以外医疗质量安全连续性的重要保障。华西天府医院以往依托纸质排班进行医师值班工作管理,容易造成值班信息不透明、手工报送信息繁琐等弊端。利用值班排班系统对医师值班工作进行科学管理,不仅使值班排班及值班费报送工作便捷、及时、规范,还有利于提升临床医师和行政管理人员的工作效率和满意度。

The doctor duty arrangements system is one of the core systems of medical quality and safety management．It is an important guarantee for the continuity of medical quality and safety beyond “eight hours”．In the past,a tertiary hospital relied on paper scheduling to manage doctors’ on-duty work,which was easy to cause defects such as opaque on-duty information and complicated manual information submission．The scientific management of doctors’ on-duty work by using the on-duty scheduling system not only makes the on-duty scheduling and on-duty fee reporting to be convenient,timely and standard,but also helps to improve the work efficiency and satisfaction of clinicians and administrative staffs．

目的 探讨广州市越秀区青少年近视特点和危险因素,为降低青少年近视发病率提供参考依据。方法 本项目采用分层随机整群抽样的研究方法,抽取分布于广州市越秀区2 774名青少年作为研究对象,根据近视检查情况将其分为近视组（n=1 657）与非近视组（n=1 117）,通过问卷调查的方式,分析青少年近视整体现况、流行病学特征以及影响青少年近视发生、发展的相关行为和因素。结果 2 774名青少年中,1 657名近视,检出率为59.73%;其中女生为872名,多于男生的785名;幼儿园、小学生、初中生、高中生近视人数分别为20名、446名、484名、707名,呈升高趋势。学段、校内用眼环境、校外用眼环境、读写姿势、电子屏幕使用情况、近距离用眼情况、户外活动及睡眠情况、近视检查及矫治情况是广州市越秀区青少年近视的影响因素（P<0.05）。广州市越秀区青少年近视程度均与学段、校外用眼环境、电子屏幕使用情况、户外活动及睡眠情况、近距离用眼情况呈正相关（P<0.05）,与校内用眼环境、读写姿势、近视检查及矫治情况呈负相关（P<0.05）。对不同预后组间存在统计学差异的因素进行Logistic多因素分析后得到,学段、校内用眼环境、校外用眼环境、读写姿势、电子屏幕使用情况、近距离用眼情况、户外活动及睡眠情况、近视检查及矫治情况是广州市越秀区青少年近视的相关影响因素（P<0.05）。结论 广州市越秀区青少年近视发生人群呈现高龄化,学段、校内用眼环境、校外用眼环境、读写姿势、电子屏幕使用情况、近距离用眼情况、户外活动及睡眠情况、近视检查及矫治情况是青少年近视的相关影响因素,建议加强组织学生到户外进行多种课间户外体育活动,同时鼓励家长在校外从自身做起,树立爱眼护眼好榜样,与学校共同保护孩子的视力。

Objective To explore the characteristics and risk factors of myopia among adolescents in Yuexiu District,Guangzhou,and to provide reference for reducing the incidence of myopia among adolescents．Methods This project adopted stratified random cluster sampling to select 2 774 adolescents distributed in Yuexu District,Guangzhou as the research objects,which were divided into myopia group（n=1 657）and non-myopia group（n=1 117）according to the myopic examination．Through questionnaire survey,the overall situation and epidemiological characteristics of myopia among adolescents in our district were comprehensively known,in order to explore the related behaviors and factors affecting the occurrence and development of myopia among adolescents in our district,explore reasonable intervention measures,and put forward scientific and effective myopia prevention and control technical means and strategies．Results Among 2 774 adolescents,1 657 were nearsighted（59.73%）．Among them,872 were female and 785 were male．The number of myopia in kindergarten,primary school,middle school and high school students were 20,446,484 and 707 respectively,showing an increasing trend．School period,eyes use environment in school and outside school,reading and writing posture,situations of electronic screen use,close distance eye use,outdoor activities and sleep,myopia examination and correction were the relevant influencing factors on myopia of adolescents in Yuexui District of Guangzhou（P<0.05）．The myopia degree of adolescents in Yuexiu District of Guangzhou was positively correlated with school period,out-of-school eyes use environment,electronic screen use,outdoor activities and sleep conditions,and close distance eyes use（P<0.05）,and negatively correlated with in-school eyes use environment,reading and writing posture,myopia examination and correction conditions（P<0.05）．After Logistic multivariate analysis of the factors with statistical difference between different prognostic groups,school period,eyes use environment in school and outside school,reading and writing posture,electronic screen use,close distance eyes use,outdoor activities and sleep conditions,myopia examination and correction were the relevant influencing factors on myopia of adolescents in Yuexui District of Guangzhou（P<0.05）．Conclusions In Yuexiu District,Guangzhou,the population with myopia is gradually moving to a younger age．School period,eyes use environment in school and outside school,reading and writing posture,electronic screen use,close distance eyes use,outdoor activities and sleep condition,myopia examination and correction are the relevant influencing factors．It is recommended to strengthen the organization of students to go outdoors for a variety of outdoor sports activities between classes,while encouraging parents to set a good example of eye care outside the school and work with the school to protect their children’s eyesight．

目的 探讨作业疗法结合经皮神经电刺激对脑卒中后肩痛的疗效。方法 选取2020年6月—2023年6月在肇庆市第一人民医院治疗的60例脑卒中后肩痛患者为研究对象,随机分为观察组和对照组各30例。其中,观察组进行作业疗法结合经皮神经电刺激;对照组单纯进行作业疗法。记录患者治疗前及治疗4周后的视觉模拟疼痛评分（VAS）,改良Barthel指数（MBI）和汉密顿抑郁量表评分（HAMD）,并对记录进行检验和t检验。结果 观察组和对照组的治疗效果比较差异有统计学意义（P=0.019）,观察组治疗有效率（93.33%）高于对照组（63.33%）;治疗前两组患者的VAS（P=0.536）和HAMD（P=0.558）分值比较差异无统计学意义,治疗后其VAS（P=0.049）及HAMD（P=0.023）分值均较治疗前下降,且观察组下降幅度分别为（2.23±1.14）分和（4.47±3.06）分,均高于对照组的（1.27±0.98）和（1.33±1.35）,组间比较差异有统计学意义;治疗前两组患者的MBI分值比较差异无统计学意义（P=0.216）,治疗后其MBI分值均较治疗前提高,且观察组提高幅度（21.87±10.25）较对照组（12.00±13.58）更显著,组间比较差异有统计学意义（P=0.003）。结论 作业疗法结合经皮神经电刺激可缓解脑卒中肩痛,改善患者日常生活能力和心理精神状态,减少抑郁的发生。

Objective To explore the therapeutic effect of occupational therapy combined with transcutaneous electrical nerve stimulation（TENS） on shoulder pain after stroke．Methods Sixty patients with post-stroke shoulder pain who were treated in the First People’s Hospital of Zhaoqing from June 2020 to June 2023 were selected as the study subjects and randomly divided into an observation group and a control group,with 30 cases in each group．Among them,the observation group received occupational therapy combined with TENS,while the control group received occupational therapy alone．This study recorded the Visual Analogue Scale（VAS）,modified Barthel Index（MBI）,and Hamilton Depression Rating Scale（HAMD）of patients before and after 4 weeks of treatment,and conducted the and t-test analysis．Results The test analysis showed a significant difference in treatment effectiveness between the observation group and the control group（P=0.019）,with the observation group having a significantly higher treatment effectiveness rate（93.33%）than the control group（63.33%）;t-test analysis showed that there was no statistically significant difference in VAS（P=0.536）and HAMD（P=0.558）indicators between the two groups of patients before treatment．However,after treatment,the VAS（P=0.049）and HAMD（P=0.023）indicators decreased compared to before treatment．The observation group had decreased（2.23±1.14）and（4.47±3.06）,respectively,which were significantly higher than the control group’s（1.27±0.98）and（1.33±1.35）,and the inter group differences were statistically significant;before treatment,there was no statistically significant difference in MBI indicators between the two groups of patients（P=0.216）．After treatment,their MBI indicators increased compared to before treatment,and the observation group（21.87±10.25）showed a more significant improvement compared to the control group（12.00±13.58）．The difference between the groups was statistically significant（P=0.003）．Conclusions Occupational therapy combined with TENS can significantly alleviate shoulder pain after stroke,improve daily living ability and psychological state of patients,and reduce the occurrence of depression．