目的 探讨血浆置换联合泼尼松（PDN）联合环磷酰胺（CTX）治疗抗黑色素瘤分化相关基因5（MDA5）抗体阳性皮肌炎（DM）伴肺间质纤维化（ILD）患者疗效及安全性。方法 回顾性分析2014年6月—2023年6月普洱市人民医院诊断的MDA5阳性DM伴ILD患者40例,其中治疗组20例,采用血浆置换联合PDN 1 mg/kg每日1次口服,4周后减量,每周减总量10%,CTX 1 g每月1次静脉滴注,共6次治疗;另20例设为对照组,采用PDN 1 mg/kg每日1次口服,4周后减量,每周减总量10%,CTX 1 g每月1次静脉滴注,共6次治疗,分别于治疗后3月、6月检测一氧化碳弥散量（DLCO）、第1秒用力呼气量（FEV₁）,血清铁蛋白（SF）、C-反应蛋白（CRP）、涎液化糖链抗原（KL-6）、MDA5转阴率行疗效评估。结果 在治疗3个月和6个月时,两组患者的DLCO、FEV1、SF、CRP、KL-6、MDA5转阴率等指标的完全缓解率不一致。其中,3个月时,治疗组上述指标的完全缓解率依次为95%、85%、90%、90%、90%、85%,对照组依次为15%、20%、20%、15%、0%、0%。两组患者在治疗3个月的DLCO、FEV1、SF、CRP、KL-6水平和MDA5转阴数均有所不同。其中治疗组的DLCO、KL-6、CRP水平均较对照组降低（P<0.01）,治疗组FEV₁水平较对照组升高（P<0.01）,治疗组SF水平较对照组降低（P<0.05）,两组治疗6个月时,治疗组上述指标缓解率依次为95%、85%、90%、90%、90%、85%,对照组依次为20%、25%、20%、20%、20%、5%。两组患者在DLCO、FEV₁、SF、CRP、KL-6水平以及MDA5转阴数和死亡例数方面比较差异均有统计学意义,其中治疗组的DLCO、KL-6和CRP水平均较对照组降低（P<0.01）,治疗组FEV₁水平较对照组升高（P<0.01）,SF水平治疗组较对照组降低（P<0.05）。结论 在MDA5抗体阳性DM伴ILD患者治疗中,给予血浆置换联合PDN、CTX治疗,可以提高疗效,降低病死率。

Objective To explore the effect of plasmapheresis combined with prednisone（PDN）plus cytoxan（CTX）on patients with anti-melanoma differentiation-associated gene 5（MDA 5）antibody-positive dermatomyositis（DM）with interstitial lung disease（ILD）. Methods The data of 40 patients with MDA 5 positive DM and ILD diagnosed in the People's Hospital of Pu'er City from June 2014 to June 2023 were retrospectively was analyzed．Twenty patients of the treatment group were treated with plasmapheresis combined with PDN 1mg / kg once daily,which was reduced by 10% per week after 4 weeks．The other 20 patients of the control group were treated with PDN 1mg / kg once daily,which was reduced after 4 weeks by 10% per week,and CTX 1g once per month．diffusing capacity of the lungs for carbon monoxide（DLCO）,forced expiratory volume in the first second（FEV₁）,serum ferritin（SF）,C-reactive protein（CRP）,Krebs Von den Lungen-6（KL-6）and MDA5 negative conversion rate were measured at 3 and 6 months after treatment,respectively. Results At 3 and 6 months of treatment,complete remission rates of DLCO,FEV₁,SF,CRP,KL-6,MDA 5 conversion and other indicators were inconsistent．Among them,at 3 months,the complete response rate of the above indicators in the treatment group was successively：95%,85%,90%,90%,90% and 85%．The control group was 15%,20%,20%,15%,and 0%,0%．Statistical analysis showed that the levels of DLCO,FEV₁,SF,CRP,KL-6 and MDA 5 significantly varied at 3 months of treatment．Pairwise comparison of LSD found that the DLCO,KL-6 and CRP levels in the treatment group were significantly lower than the control group（P<0.01）,the FEV₁ level in the treatment group was significantly higher（P<0.01）,and the SF level in the treatment group was significantly lower（P<0.05）．After 6 month of treatment,the complete response rate of the above indicators in the treatment group were 95%,85%,90%,90%,90% and 85%,and the complete response rate of the above indicators in the control group was 20%,25%,20%,20%,20% and 5%．Statistical analysis showed the levels of DLCO,FEV₁,SF,CRP,KL-6 for the amount of MDA 5 and the number of deaths between two groups were significantly different．Further pairwise comparison of LSD showed that the DLCO,KL-6 and CRP levels in the treatment group were significantly lower compared with the control group（P<0.01）,the FEV₁ level was significantly increased compared with the control group（P<0.01）,and the SF treatment group was significantly decreased compared with the control group（P<0.05）. Conclusions In the treatment of patients with MDA 5 antibody positive DM with ILD,the treatment of plasmapheresis combined with PDN and CTX can significantly improve the efficacy and reduce the mortality rate．

目的 探讨80例局部宫颈癌根治性同步放化疗的临床疗效及预后影响因素。方法 选取鹤壁市妇幼保健院2018年1月—2021年1月收治的80例宫颈癌患者进行回顾性分析,患者依照其病变程度均采取积极的手术与同步放化疗,其中40例患者采取单纯化疗,将其分为化疗组,40例患者采取同步放化疗,将其分为同步放化疗组,分析其近远期临床疗效与不良反应发生率。对所有患者进行3年随访,将患者分为两个亚组,即预后不良组（n=20）和预后良好组（n=60）,对比两组患者一般临床特征,应用Logistic回归模型分析局部宫颈癌根治性同步放化疗的预后影响因素。结果 同步放化疗组ORR、DCR高与化疗组（P<0.05）,对照组中位无进展生存期为5.4（2.38~14.52）个月。观察组中位无进展生存期为6.66（2~20.1）个月,观察组高于对照组（χ²=4.536,P=0.041）;同步放化疗组盆腔积液、阴道炎症、泌尿生殖道反应、直肠反应、骨髓抑制、胃肠道反应发生率略高于化疗组,但两组对比差异无统计学意义（P>0.05）;预后良好组与预后不良组患者年龄、是否绝经、病理类型、肿瘤大小对比差异无统计学意义（P>0.05）,预后良好组与预后不良组患者临床分期、组织分化程度、淋巴结转移、是否同步放化疗、治疗前血红蛋白水平对比差异有统计学意义（P<0.05）;组织分化程度低、未同步放化疗、治疗前血红蛋白水平低为局部宫颈癌的预后不良影响因素（P<0.05）。结论 对局部宫颈癌患者采取根治性同步放化疗与单一化疗相比可提升其临床疗效与远期生存率,同时安全性较高。组织分化程度低、未同步放化疗、治疗前血红蛋白水平低为宫颈癌预后不良影响因素。

Objective To explore the clinical efficacy and prognostic factors of 80 cases of local cervical cancer treated with radical synchronous radiotherapy and chemotherapy．Methods A retrospective analysis was conducted on 80 cervical cancer patients admitted to Hebi Maternal and Child Health Hospital from January 2018 to January 2021．Patients underwent surgery and synchronous radiotherapy and chemotherapy according to their degree of lesion．Among them,40 patients received simple chemotherapy and were divided into a chemotherapy group,while 40 patients received synchronous radiotherapy and chemotherapy and were divided into a synchronous radiotherapy and chemotherapy group．The short-term and long-term clinical efficacy and incidence of adverse reactions were analyzed．A 3-year follow-up was conducted on all patients,and patients were divided into two subgroups,namely the poor prognosis group（n=20）and the good prognosis group（n=60）．The general clinical characteristics of the two groups of patients were compared,and a Logistic regression model was used to analyze the prognostic factors of local cervical cancer radical synchronous radiotherapy and chemotherapy．Results The objective relief rate and disease control rate of the synchronous radiotherapy and chemotherapy group were significantly higher than those of the chemotherapy group（P<0.05）,and the median progression free survival of the control group was 5.4（2.38-14.52）months．The median progression free survival of the observation group was 6.66（2-20.1）months,which was higher than that of the control group（χ²=4.536,P=0.041）．The incidence of pelvic fluid accumulation,vaginitis,urogenital reactions,rectal reactions,bone marrow suppression,and gastrointestinal reactions in the synchronous radiotherapy and chemotherapy group was slightly higher than that in the chemotherapy group,but there was no statistically significant difference between the two groups（P>0.05）．There was no statistically significant difference in age,menopause,pathological type,and tumor size between the patients with good prognosis and those with poor prognosis（P>0.05）．However,there was a statistically significant difference in clinical stage,tissue differentiation,lymph node metastasis,synchronous radiotherapy and chemotherapy,and pre-treatment hemoglobin levels between the patients with good prognosis and those with poor prognosis（P<0.05）．Low degree of tissue differentiation,lack of synchronous radiotherapy and chemotherapy,and low hemoglobin levels before treatment were adverse prognostic factors for local cervical cancer（P<0.05）．Conclusion sCompared with single radiotherapy,radical synchronous radiotherapy and chemotherapy can improve the clinical efficacy and long-term survival rate of patients with local cervical cancer,with higher safety．The severe tissue differentiation,unsynchronized chemoradiotherapy and hemoglobin before treatment were the adverse prognostic factors of cervical cancer．

目的 探讨表皮生长因子受体酪氨酸酶抑制剂（EGFR-TKIs）一线治疗耐药后,二线化学治疗（化疗）联合程序性死亡蛋白1及其配体（PD-1/L1）免疫检查点抑制剂方案对晚期非小细胞肺癌（NSCLC）的疗效。方法 选取2018年 6月—2022年10月期间就诊于南通大学附属肿瘤医院院的80例有完整临床资料、应用EGFR-TKIs耐药后晚期NSCLC患者进行回顾性分析,依照不同治疗方式将患者分为观察组与对照组,均为40例。对照组一线EGFR-TKIs治疗耐药后进行二线化疗,观察组一线EGFR-TKIs治疗耐药后进行二线化疗联合PD-1/L1免疫检查点抑制剂治疗。对比两组临床疗效及无进展生存期（PFS）,化疗前后血清中人细胞角蛋白21-1片段（Cyfra21-1）、糖类抗原125（CA125）、碱性成纤维细胞生长因子（bFGF）、血管内皮生长因子（VEGF）水平变化,不良反应发生率及生存质量。结果 观察组客观缓解率与疾病控制率高于对照组（P<0.05）,对照组PFS为10（2.38,24.13）个月,观察组PFS为14（5.27~,5.27）个月,观察组高于对照组（χ²=4.536,P=0.041）;化疗后两组bFGF、VEGF,CA125、Cyfra21-1肿瘤标志物水平均比化疗前降低,且观察组[（17.85±3.32）ng/L、（310.51±88.37）ng/L、（51.62±13.66）U/mL、（10.26±3.37）ng/mL]低于对照组[（19.62±3.24）ng/L、（366.26±49.42）ng/L、（59.26±9.35）U/mL、（12.62±2.73）ng/mL],对比差异有统计学意义（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）;两组不良反应发生率对比差异无统计学意义（P>0.05）;化疗后两组世界卫生组织生存质量量表简表评分均升高,观察组[（98.62±8.24）、（101.53±12.62）、（95.28±11.15）、（97.79±10.47）分]高于对照组[（84.25±7.32）、（93.58±15.75）、（82.24±9.34）、（83.47±8.38）]分,对比差异有统计学意义（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）。结论 对EGFR-TKIs耐药后晚期非小细胞肺癌患者采取二线化疗联合PD-1/L1免疫检查点抑制剂可提升其临床疗效及生存期,改善血清相关肿瘤标志物表达水平,提升患者生存质量。

Objective To explore the therapeutic effect of second-line chemotherapy combined with PD-1/L1 immune checkpoint inhibitor regimen on advanced non-small cell lung cancer（NSCLC） after epidermal growth factor receptor-tyrosine kinase inhibitors（EGFR-TKIs）resistance in first-line chemotherapy．Methods Retrospectively selected 80 patients with advanced NSCLC EGFR TKIs resistance,who were admitted to the Affiliated Cancer Hospital of Nantong University from June 2018 to October 2022．Patients were divided into an observation group and a control group according to different treatment methods,with 40 cases in each group．The control group received second-line chemotherapy after first-line EGFR-TKIs therapy resistance,while the observation group received second-line chemotherapy and PD-1/L1 inhibitor after first-line EGFR-TKIs therapy reactions and quality of live．Clinical efficacy and PFS,changes in serum levels of human Cyfra21-1,CA125,bFGF,VEGF,incidence of adverse chemotherapy of two groups were compared．Results The ORR and DCR of the observation group were significantly higher than those of the control group（P<0.05）．The mean PFS of the control group was 10（2.38-24.13）months,while the mean PFS of the observation group was 14（5.27-35.27）months．The observation group was higher than the control group（χ²=4.536,P=0.041）．After chemotherapy,levels of bFGF,VEGF,CA125 and Cyfra21-1 tumor markers decreased in both groups,and the observation group [（17.85±3.32）ng/L,（310.51±88.37）ng/L,（51.62±13.66）U/mL,（10.26±3.37）ng/mL] was lower than the control group [（19.62±3.24）ng/L,（366.26±49.42）ng/L,（59.26±9.35）U/mL,（12.62±2.73）ng/mL],which showed statistically significant difference in the comparison（t₁=2.413,P₁=0.018;t₂=3.482,P₂<0.001;t₃=2.919,P₃=0.005;t₄=3.442,P₄<0.001）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．After treatment,the WHO QOL-BREF scores increased in both patient groups and the observation group scores[（98.62±8.24）,（101.53±12.62）,（95.28±11.15）,（97.79±10.47）] were higher than the control group scores[（84.25±7.32）,（93.58±15.75）,（82.24±9.34）,（83.47±8.38）],which showed statistically significant difference．（t₁=8.246,P₁<0.001;t₂=2.491,P₂=0.015;t₃=5.670,P₃<0.001;t₄=6.753,P₄<0.001）．Conclusions The combination of second-line chemotherapy with PD-1/L1 immune checkpoint inhibitors can improve the clinical efficacy and survival of advanced NSCLC patients who are resistant to EGFR-TKIs,improve the expression levels of serum related tumor markers,and enhance the quality of life of patients．

目的 探讨透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者的效果。方法 收集2019年7月—2021年7月在本院就诊的膝骨关节炎患者120例,采用随机数字表法分组,即对照组、观察组,均60例。对照组患者注入富含血小板的血浆(4 mL),观察组患者注射透明质酸钠(2 mL)联合富含血小板的血浆(3.5 mL),1次/周,3次为1个疗程,共2～3疗程。统计2组患者膝关节功能、临床疗效及并发症发生率。结果 ①组内比较:治疗后2月、3月及6月平均Lysholm膝关节评分均升高,P<0.05;②组间比较:治疗前及治疗后2月,2组患者平均Lysholm膝关节评分比较,P>0.05,治疗后3月、6月,2组平均Lysholm膝关节评分比较,P<0.05。2组患者Lysholm膝关节评分均较治疗前有所改善,P<0.05;观察组疼痛评分(18.92±4.11、17.61±3.83)分、肿胀度评分(10.64±2.82、9.66±1.21)分均高于对照组疼痛评分(14.02±3.52、13.54±3.21)分、肿胀度评分(9.62±2.63、8.71±1.93)分(P<0.05)。观察组临床总有效率98.33%高于对照组临床总有效率88.33%(χ²=4.821,P=0.028)。经过6个月的随访后,2组均1例出现局部肿胀,未发生其他并发症。结论 透明质酸钠注射联合富含血小板的血浆治疗膝骨关节炎患者,可以有效改善患者膝关节功能,减轻患者疼痛及肿胀程度等,安全性高,值得推广应用。

Objective To investigate the effect of sodium hyaluronate injection combined with platelet-rich plasma in the treatment of patients with knee osteoarthritis. Methods A total of 120 patients with knee osteoarthritis who were treated in our hospital from July 2019 to July 2021 were collected and randomly divided into control group and observation group,60 cases each.The patients in the control group were injected with platelet-rich plasma(4 mL),and the patients in the observation group were injected with sodium hyaluronate(2 mL)combined with platelet-rich plasma(3.5 mL),once a week,3 times as a course of treatment,total 2-3 courses of treatment.The knee joint function,clinical efficacy and complication rates of the two groups were compared. Results ①Intra-group comparison:the average Lysholm knee joint scores were significantly increased in 2 months,3 months and 6 months after treatment,P<0.05. ②Comparison between groups:before and 2 months after treatment,the average Lysholm knee joint scores of the two groups were significantly increased (P<0.05). After 3 months and 6 months treatment,the comparison of the average Lysholm knee score between the two groups were statistic significant (P<0.05).The Lysholm knee joint scores in both groups were improved compared with those before treatment (P<0.05). Three months after treatment,the pain score(18.92±4.11, 17.61±3.83)and swelling score(10.64±2.82, 9.66±1.21)in the observation group were significantly higher than those in the control group(14.02±3.52, 13.54±3.21, 9.62±2.63, 8.71±1.93, P<0.05).The total clinical effective rate of the observation group was 98.33%,which was significantly higher than that of the control group (88.33%, χ²=4.821,P=0.028).After 6-month follow-up,local swelling occurred in 1 case in both groups,and no other complications occurred. Conclusions Sodium hyaluronate injection combined with platelet-rich plasma in the treatment of patients with knee osteoarthritis can effectively improve the knee joint function and reduce the pain and swelling of the patients.It is safe and worthy of popularization and application.

目的 研究颅内压(ICP)监测联合浮动骨瓣减压术在治疗颅脑损伤中对颅内压及脑血流指标的影响。方法 选取我院2019年3月—2021年3月收治的拟行骨瓣减压术的颅脑损伤患者106例作为研究对象,按照手术方法不同分为对照组(n＝53)、观察组(n＝53)。对照组采用传统去骨瓣减压术(DC)治疗,观察组采用ICP监测联合浮动骨瓣减压术治疗。对比2组ICP、脑血流指标[平均流速(Vm)、收缩期血流速度(Vs)、血管搏动指数(PI)]及并发症发生情况。结果 术后1、3、7 d观察组ICP、PI低于对照组,Vm、Vs高于对照组(P＜0.05);术后观察组并发症总发生率9.43%低于对照组37.74%(P＜0.05)。结论 采用ICP监测联合浮动骨瓣减压术治疗颅脑损伤能降低患者ICP,改善脑血流状态,降低术后并发症,避免二次手术,减轻患者经济负担。

Objective To study the effect of intracranial pressure (ICP) monitoring combined with floating bone flap decompression on intracranial pressure and cerebral blood flow index in the treatment of craniocerebral injury. Methods A total of 106 patients admitted to our hospital from March 2019 to March 2021 were selected as study subjects and divided into control group (n=53) and observation group (n=53).The control group was treated with traditional decompressed craniectomy (DC), and the observation group was treated with ICP monitoring combined with floating bone flap decompression.The ICP, cerebral blood flow index [mean flow velocity (Vm), systolic flow velocity (Vs), vascular pulsatility index (PI)] and complications were compared between the two groups. Results ICP and PI were lower in observation groups on 1,3 and 7 d, Vm and Vs were higher (P <0.05); the incidences of complications in observation group (9.43%), such as electrolyte disorder, pulmonary infection, abnormal renal function and incisional hernia, were lower in the control group (37.74%, P<0.05). Conclusions ICP monitoring combined with floating bone flap decompression could reduce ICP, improve cerebral blood flow, reduce postoperative complications, avoid secondary surgery and reduce economic burden.

目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。

Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.

目的 探讨乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗慢性阻塞性肺疾病疗效及对患者肺功能的影响。方法 以2020年4月—2022月4月在本院诊治的84例慢性阻塞性肺疾病患者作为研究对象,根据1∶1简单分配原则把患者分为联合组与对照组各42例。对照组行传统治疗,联合组在对照组治疗的基础上,再给予乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗,联合组与对照组都治疗观察4周。检测患者的疗效、肺功能与血清超敏C反应蛋白（hs-CRP）与降钙素原（PCT）含量变化情况。结果 联合组治疗后的总有效率与对照组相比有提高（P<0.05）。治疗后,联合组与对照组的第一秒用力呼气容积占用力肺活量百分比（FEV₁/FVC）、第一秒用力呼气容积占预计值百分比（FEV₁%）更高（P<0.05）,且联合组与对照组对比有提高（P<0.05）。联合组治疗后的疾病影响、活动能力、症状部分等SGRQ生活质量评分与对照组相比降低（P<0.05）。联合组与对照组治疗后的血清 hs-CRP与 PCT含量低于治疗前（P<0.05）,联合组与对照组相比也降低（P<0.05）。结论 乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗慢性阻塞性肺疾病能有效抑制hs-CRP、PCT的表达,能促进改善患者的肺功能,提高治疗效果与生活质量。

Objective To investigate the efficacy of acetylcysteine effervescent tablets combined with budigraf aerosol in the treatment of chronic obstructive pulmonary disease（COPD）and its effect on the pulmonary function of patients．Methods From April 2020 to April 2022,a total of 84 patients with COPD diagnosed and treated in our hospital were selected as the research objects,and the patients were divided into the combination group and the control group with 42 cases in each group,according to the 1∶1 simple allocation principle．The control group were given traditional treatment,and the combination group were given acetylcysteine effervescent tablets combined with budigraf aerosol additionally．Both the combined group and the control group were observed for 4 weeks．The efficacy of patients,lung function and serum hypersensitive C-reactive protein（hs-CRP）and procalcitonin（PCT）levels were detected．Results The total effective rates after treatment in the combination group were higher than the control group（P<0.05）．After treatment,The forced expiratory volume in 1 second/forced vital capacity（FEV₁/FVC）,FEV₁% value of the two groups were higher（P<0.05）,and the combination group had greater improvement（P<0.05）．The SGRQ quality of life scores,such as disease impact,activity ability,and symptom in the combination group were lower（P<0.05）．After treatment,the serum high-sensitivity C-reactive protein（hs-CRP）and procalcitonin（PCT）levels in the two groups were significantly lower（P<0.05）,and the combined group decreased more（P<0.05）．Conclusions Acetylcysteine effervescent tablets combined with budigraf aerosol in the treatment of COPD can effectively inhibit the expression of hs-CRP,PCT,promote the improvement of lung function,improve the treatment effect and quality of life．

目的 探讨基于中药熏蒸配合穴位按摩的健康管理对稳定期肺肾气虚型慢阻肺的疗效。方法 选取2020年1月—2021年1月在我院接受治疗的稳定期肺肾气虚型慢阻肺患者120例为研究对象,随机分为对照组和干预组。对照组采用西医常规干预,干预组在此基础上实施为期1年的中药熏蒸配合穴位按摩的健康管理,比较干预前后2组患者肺功能、血氧指标以及生活质量的差异。结果 干预前,2组患者第1秒用力肺活量（FEV₁）、第1秒用力肺活量占预计值百分比（FEV₁%）、用力肺活量（FVC）、第1秒用力肺活量占用力肺活量的比值（FEV₁/FVC%）等指标比较差异无统计学意义（P>0.05）,干预后,2组患者的FEV₁、FEV₁%、FVC、FEV₁/FVC%明显上升,且干预组患者优于对照组（P<0.05）;实施相关干预前,干预组和对照组患者的血氧指标比较差异无统计学意义（P>0.05）,干预后,2组患者的PaO₂、和SpO₂上升,PaCO₂下降,且干预组的变化幅度大于对照组（P<0.05）;干预前2组患者在圣乔治问卷（SGRQ）生活质量评分比较差异无统计学意义（P>0.05）,干预后2组患者的SGRQ生活质量评分降低,且干预组患者的SGRQ生活质量指标评分更低（P<0.05）。结论 中药熏蒸配合穴位按摩应用于稳定期肺肾气虚型慢阻肺患者中,能够提高患者的肺功能,改善血氧指标,提高患者的生活质量。

Objective To explore the effect of health management based on traditional Chinese medicine fumigation combined with acupoint massage on stable chronic obstructive pulmonary disease（COPD）with lung-kidney deficiency．Methods A total of 120 patients with stable COPD and lung-kidney deficiency who received treatment in our hospital from January 2020 to January 2021 were selected as the study objects and randomly divided into control group and intervention group．The control group received conventional Western medicine intervention,and the intervention group received 1-year traditional Chinese medicine fumigation combined with acupoint massage on the basis of Western management．The differences of lung function,blood oxygen index and quality of life between the two groups were compared before and after intervention．Results Before intervention,there were no significant differences in forced expiratory volume in one second（FEV₁）,the first second forced vital capacity percentage of expected value（FEV₁%）,forced vital capacity（FVC）,the ratio of the first second forced vital capacity of forced vital capacity（FEV₁/FVC%）between the two groups（P>0.05）,but after intervention,the FEV₁,FEV₁%,FVC,FEV₁/FVC% of the two groups increased significantly,and those in the intervention group were better（P<0.05）．Before the implementation of relevant intervention,there was no difference in blood oxygen index between the two groups（P>0.05）．After the intervention,PaO₂ and SpO₂ of the two groups were significantly increased,while PaCO₂ was significantly decreased,and the change in the intervention group was significantly greater（P<0.05）．Before intervention,there were no significant differences in the quality of life scores of St George’s Respiratory Questionnaire（SGRQ）between the two groups（P>0.05）．After intervention,the scores of SGRQ of the two groups were significantly decreased,and the scores of the intervention group were significantly lower（P<0.05）．Conclusions Traditional Chinese medicine fumigation combined with acupoint massage can significantly improve lung function,blood oxygen index and life quality of stable COPD patients with lung-kidney deficiency．

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 调查与分析儿童结直肠息肉的临床特征及腹腔镜联合结肠镜下手术对其的治疗效果。方法 选择2019年2月—2021年10月在郑州大学附属儿童医院诊治的98例结直肠息肉患儿,记录患儿的临床特征,根据患儿的手术方法分为腹腔镜组（腹腔镜联合结肠镜下手术治疗,n=40）与结肠镜组（采用结肠镜手术治疗,n=58）,对比不同手术方法的治疗效果、并发症发生率、疼痛视觉模拟评分法（VAS）评分、息肉复发与再手术率。结果 98例患儿中,息肉部位为直肠44例、横直肠38例、其他16例;息肉最大直径（1.65±0.24）cm;息肉单发83例、多发15例。腹腔镜组的围手术期指标比结肠镜组改善（P<0.05）。腹腔镜组术后7 d的感染、出血、肠穿孔、肠梗阻等并发症发生率为5.00%,低于结肠镜组的17.24%（P<0.05）。腹腔镜组术后1个月的总有效率为97.50%,高于结肠镜组的82.76%（P<0.05）。腹腔镜组术后1、3、7 d的疼痛VAS评分低于结肠镜组（P<0.05）。所有患儿术后随访1年,联合的息肉复发率与再次手术率为5.00%、2.50%,均低于结肠镜组的18.97%、13.79%（P<0.05）。结论 儿童结直肠息肉主要位于直肠、横直肠,多为单发,腹腔镜联合结肠镜下手术治疗能促进患儿康复,提高总体治疗效果,也能缓解患儿疼痛,减少并发症的发生,降低随访息肉复发率与再次手术率。

Objective To investigate and analyze the clinical features of children with colorectal polyps and the efficacy of laparoscopic surgery combined with colonoscopy. Methods A total of 98 children with colorectal polyps diagnosed and treated in our hospital from February 2019 to October 2021 were selected as subjects of this study. The clinical characteristics of all children were recorded,and they were divided into the laparoscopic group(laparoscopic surgery combined with colonoscopy,n=40)and the colonoscopy group(colonoscopy,n=58)according to the differences in surgical methods. The therapeutic effect,complication rate,VAS pain score,polyp recurrence and reoperation rate of different surgical methods were compared. Results Among the 98 children,the polyps of 44 cases were in rectum,38 cases in transverse rectum and 16 cases in other sites. The maximum diameter of polyp was(1. 65±0. 24)cm. Polyps were solitary in 83 cases and multiple in 15 cases. The perioperative indexes in the laparoscopic group were significantly improved compared with those in the colonoscopy group(P<0. 05). The incidence of postoperative complications such as infection,bleeding,intestinal perforation and intestinal obstruction was 5. 00% in the laparoscopy group,which was significantly lower than 17. 24% in the colonoscopy group(P<0. 05). The total effective rate of laparoscopic group was 97. 50% one month after operation,which was significantly higher than that of colonoscopy group(82. 76%,P<0. 05). The VAS pain score of the laparoscopic surgery group was significantly lower than that of the colonoscopy group at 1,3 and 7 days after surgery(P<0. 05). After 1 year of follow-up,the combined polyp recurrence rate and reoperation rate were 5. 00% and 2. 50%,which were significantly reduced compared with 18. 97% and 13. 79% in colonoscopy group(P<0. 05). Conclusions The main sites of colorectal polyps in children are rectum and transverse rectum,and most of them are solitary. Laparoscopic and colonoscopic surgery for colorectal polyps in children can promote the recovery of children,improve the overall treatment effect of patients,relieve the pain of children,reduce the occurrence of complications,and reduce the recurrence rate and reoperation rate of follow-up polyps in children.