目的 探讨依奇珠单抗对中重度斑块型银屑病的治疗效果。方法 选取厦门大学附属第一医院2022年1月—2023年8月收治的75例中重度斑块型银屑病患者,应用抽签法进行分组,分为试验组（n=35）与对照组（n=40）。对照组采取常规外用药物治疗,试验组采取依奇珠单抗治疗。对比两组临床疗效,治疗前后外周血调节性T细胞（Treg）和辅助性T细胞17（Th17/Treg）细胞水平变化,并对所有患者进行6个月门诊复查随访,对比复发率及不良反应。结果 试验组总有效率88.57%,高于对照组的67.50%（χ²=4.730,P=0.028）;治疗后两组患者Treg细胞升高,试验组（5.59±1.24）%高于对照组（4.12±1.13）%,对比差异有统计学意义（t=5.371,P<0.001）,Th17细胞、Th17/Treg细胞降低,试验组[（1.06±0.14）%、0.19±0.05]低于对照组[（1.71±0.28）%、0.42±0.14],对比差异有统计学意义（t=12.434、9.212,P<0.001）;试验组停药后6个月复发率低于对照组（5.71% vs 27.50%,χ²=6.180,P=0.013）;试验组不良反应发生率略高于对照组,组间对比差异无统计学意义（14.29% vs 5.00%,χ²=1.900,P=0.168）。结论 依奇珠单抗治疗中重度斑块型银屑病疗效显著,可调节Th17/Treg平衡,降低停药后复发率,且安全性较高。

Objective To explore the therapeutic effect of Ixekizumab on moderate to severe plaque psoriasis. Methods Seventy-five patients with moderate to severe plaque psoriasis who were admitted to the First Affiliated Hospital of Xiamen University from January 2022 to August 2023 were selected and allocated by lottery into an experimental group（n=35）and a control group（n=40）．The control group received routine external medication while the experimental group received Ixekizumab treatment．The clinical efficacy of two groups,changes in Th17/Treg cell values before and after treatment were compared,and a 6-month outpatient follow-up for all patients was conducted to compare recurrence rates and incidence of adverse reactions. Results The total response rate in the experimental group was 88.57%,which was higher than the 67.50% in the control group（χ²=4.730,P=0.028）．After treatment,the level of Treg cell in the two groups was significantly higher,and the level of Treg cell experimental in the group was higher than that in the control group[（5.59±1.24）% vs （4.12±1.13）%,t=5.371,P<0.001]．After treatment,the level of Th17 and Th17/Treg cell in the two groups were lower,and the level of Th17 cell and Th17/Treg in the experimental group[（1.06±0.14）%,0.19±0.05] were significantly lower than those in the control group[（1.71±0.28）%,0.42±0.14],which was statistically significant（t=12.434、9.212,P<0.001）．The relapse rate at 6 months after drug withdrawal in the experimental group was significantly lower than that in the control group（5.71% vs 27.50,χ²=6.180,P=0.013）．The incidence of adverse reactions in the experimental group was higher than that in the control group,but with no statistical significance（14.29% vs 5.00%,χ²=1.900,P=0.168）. Conclusions Ixekizumab has a significant therapeutic effect on moderate to severe plaque psoriasis．It can regulate the Th17/Treg balance and reduce the recurrence rate after discontinuation,and with high safety．

目的 探讨基于失效模式与效应分析法（FMEA）风险管理模式的在消化内镜诊疗护理中的应用价值。方法 选取2021年7月—2022年12月在河南省人民医院接受无痛消化内镜诊疗的368例患者为研究对象,根据入组时间顺序,2022年3月及其之前入组患者为对照组（n=171）,实施常规护理管理;2022年3月之后入组的患者为观察组（n=197）,在对照组基础上,增加基于FMEA的护理风险管理模式,对比两组患者的护理质量。结果 观察组各环节风险优先级（RPN）值较干预前明显好转,RPN总分由1 044分降至336分,观察组不良事件发生率低于对照组（17.3% vs 33.3%,P<0.05）,观察组患者对医护人员满意度高于对照组（92.9% vs 85.4%,P<0.05）,观察组患者所需的等待时间低于对照组[（35.68±7.29）min vs （44.27±8.65）分min,P<0.05]。结论 FMEA风险管理模式能有效提高无痛消化内镜诊疗中的护理质量。

Objective To explore the application analysis of failure mode and effect analysis（FMEA）risk management model in digestive endoscopy diagnosis treatment and nursing．Methods A total of 368 patients who underwent painless endoscopic diagnosis and treatment at Henan Provincial People’s Hospital from July 2021 to December 2022 were selected．According to the order of enrollment,patients enrolled in March 2022 and before were selected as the control group（n=171）,and routine nursing management was implemented．The patients enrolled after March 2022 were in the observation group（n=197）．In addition to the control group,a nursing risk management model based on FMEA was added to compare the nursing quality of the two groups of patients．Results The risk priority number（RPN）values of each link in the observation group showed a significant improvement compared to that before intervention．The total RPN score decreased from 1 044 points to 336 points,and the incidence of adverse events in the observation group was lower than that in the control group（17.3% vs 33.3%,P<0.05）．The satisfaction of the observation group with medical staff was higher than that in the control group（92.9% vs 85.4%,P<0.05）．The waiting time required by the observation group was lower than that in the control group[（35.68±7.29）min vs（44.27±8.65）min,P<0.05]．Conclusion sThe FMEA risk management model can effectively improve the nursing quality in painless endoscopic diagnosis and treatment．

目的 探讨风险防范护理干预对颅内动脉瘤介入术后患者血管并发症的应用。方法 选取天津市人民医院2020年6月—2023年10月收治的80例颅内动脉瘤患者,应用随机数字表法将其分为观察组与对照组,各40例。所有患者均采取血管内介入栓塞术治疗,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风险防范护理干预。对比两组患者干预前后负面情绪变化、术后并发症发生率、干预前后生活质量变化以及护理满意度。结果 干预后,两组焦虑、抑郁评分降低,观察组分别为（39.78±1.80）（44.73±3.78）分,低于对照组的（54.63±3.91）（49.23±4.14）分,对比差异有统计学意义（t=21.823、5.078,P<0.05）;观察组术后并发症发生率低于对照组（7.50% vs 27.50%,χ²=5.541,P=0.019）;干预后两组中文版明尼苏达心功能不全生命质量（MLHFQ）相关维度评分均升高,且观察组分别为（30.73±3.82]（21.13±2.70）（27.08±4.28）分,高于对照组的（26.20±3.50）（17.20±2.79）（23.20±2.35）分,对比差异有统计学意义（t=5.530、6.389、5.021,P<0.05）;观察组护理满意度高于对照组（92.50% vs 72.50%,χ²=5.541,P=0.019）。结论 颅内动脉瘤介入术后采取风险防范护理干预可改善患者焦虑、抑郁情绪,降低术后并发症,改善患者术后生活质量,患者护理满意度较高。

Objective To investigate the application effect of risk prevention nursing intervention on vascular complications in patients with intracranial aneurysms after interventional surgery．Methods Eighty patients with intracranial aneurysm admitted in Tianjin People’s Hospital from June 2020 to October 2023 were selected and divided into observation group and control group with 40 cases each．All the patients were treated with endovascular interventional embolization,the control group patients underwent routine care,and the observation group patients added risk prevention nursing intervention on the basis of the control group．The negative mood changes before and after the intervention,the incidence of postoperative complications,the quality of life before and after the intervention,and nursing satisfaction were compared between the two groups．Results After the intervention,the anxiety and depression scores in both groups decreased,and the observation group[（39.78±1.80）and （44.73±3.78）] scores were lower than the control group[（54.63±3.91）and（49.23±4.14）] scores,significantly（t=21.823,5.078,P<0.05）．The postoperative complication rate was significantly lower than the control group（7.50% vs 27.50%,χ²=5.541,P=0.019）．After the intervention,MLHFQ related dimension scores were increased in both groups,and the observation group（30.73±3.82,21.13±2.70 and 27.08±4.28）scores were higher than the control group（26.20±2.50,17.20±2.79 and 23.20±2.35）scores,statistically significant（t=5.530,6.389,5.021,P<0.05）．The nursing satisfaction was higher than the control group（92.50% vs 72.50%,χ²=5.541,P=0.019）．Conclusion sRisk prevention nursing intervention after intracranial aneurysm intervention can improve patient anxiety and depression,assist in reducing the incidence of postoperative complications,improve patient quality of life,and increase patient satisfaction with nursing．

目的 探讨成人全身麻醉（全麻）腹腔镜下腹股沟疝修补日间手术的可行性及安全性。方法 回顾性分析2021年1月—2023年12月广州市第一人民医院收治的进行全麻腹腔镜下疝修补手术治疗的成人患者病历资料,根据患者住院手术模式分为日间手术组、传统手术组。日间手术组采用日间手术模式下全麻腹腔镜腹股沟疝修补术,传统手术组采用传统入院模式下择期全麻腹腔镜下腹股沟疝修补术,对比分析两组可行性（住院时间、住院费用、患者满意度）、安全性（手术时间、手术的出血量、手术并发症的发生率）等。结果 最终纳入199例病例,日间手术组52例（26.1%）,传统手术组147例（73.9%）。与传统手术组相比较,日间手术组住院时间、术前住院时间、术后住院时间缩短,满意度评分升高,差异具有统计学意义（P<0.05）。在手术费用、住院总费用、术后24 h疼痛评分、手术时间、手术的出血量、手术并发症的发生率方面,组间比较差异均无统计学意义（P>0.05）。结论 成人全麻腹腔镜下腹股沟疝修补日间手术,能够缩短患者的住院时间,提高患者的住院满意程度,不增加手术风险和并发症发生率,是安全、有效的。

Objective To explore and analyze the feasibility and safety of laparoscopic inguinal hernia repair surgery under general anesthesia in adults．Methods A retrospective analysis was conducted on the medical records of patients admitted to a hospital from January 2021 to December 2023 who underwent laparoscopic hernia repair surgery under general anesthesia．The patients were divided into day surgery group and traditional surgery group based on their hospitalization surgery mode．The daytime surgery group underwent laparoscopic inguinal hernia repair under general anesthesia in the daytime surgery mode,while the traditional surgery group underwent elective laparoscopic inguinal hernia repair under general anesthesia in the traditional admission mode．The feasibility（hospitalization duration,hospitalization cost,patient satisfaction）and safety（surgery duration,surgical bleeding volume,incidence of surgical complications）of the two groups were compared and analyzed．Results A total of 199 cases were enrolled,with 52 cases（26.1%）in the day surgery group and 147 cases（73.9%）in the traditional surgery group．Compared with the traditional surgery group,the daytime surgery group showed a decrease in length of hospital stay,preoperative hospital stay,and postoperative hospital stay,while the satisfaction score increased,and the difference was statistically significant（P<0.05）．There was no difference（P>0.05）between the two groups in terms of surgical costs,total hospitalization costs,postoperative 24-hour pain scores,surgical time,surgical bleeding volume,and incidence of surgical complications．Conclusion sLaparoscopic inguinal hernia repair under general anesthesia during the day for adults is safe and effective．

目的 探讨本体感觉训练联合等速肌力训练对早期膝骨关节炎（KOA）患者的应用效果。方法 选择郑州市骨科医院2022年5月—2023年5月收治的120例早期膝骨关节炎患者为研究对象,将所有对象进行编号,采用简单随机方法分成研究组和对照组,每组各60例,两组均接受常规治疗,对照组在此基础上接受等速肌力训练,研究组在对照组基础上联合应用本体感觉训练,比较两组治疗前和治疗6周后疼痛视觉模拟量表（VAS）评分、膝关节伸屈肌群峰力矩（PT）、关节功能以及本体感觉。结果 治疗后研究组VAS评分为（1.33±0.31）分,对照组为（2.05±0.34）分,研究组低于对照组（t=12.121,P<0.05）;治疗后两组膝关节伸、屈肌群PT均较治疗前明显增加（P<0.05）,研究组大于对照组（t₁=2.696,t₂=3.360,P<0.05）;治疗后研究组WOMAC评分为（24.58±5.14）分,对照组为（26.85±5.11）分,研究组低于对照组（t=2.426,P<0.001）,研究组Lequesne指数为（6.55±1.21）分,对照组为（7.02±1.25）分,研究组低于对照组（t=2.093,P<0.001）;治疗后研究组平均轨迹误差为（21.35±5.96）%,对照组为（24.06±5.88）%,研究组改善程度优于对照组（t=2.507,P<0.001）,研究组平均负重力量差为（0.77±0.22）kg,对照组为（1.01±0.24）kg,研究组改善程度明显优于对照组（t=5.710,P<0.001）。结论 本体感觉训练联合等速肌力训练可以显著提升早期膝骨关节炎患者肌力,改善关节功能和本体感觉作用明显,适合推广。

Objective To explore the application effect of proprioceptive training combined with isokinetic muscle strength training on early knee osteoarthritis（KOA）patients．Methods A total of 120 patients with early knee osteoarthritis admitted to a hospital from May 2022 to May 2023 were selected as the study subjects．All subjects were numbered and randomly divided into an experimental group and a control group,with 60 cases in each group．Both groups received routine treatment,while the control group received isokinetic muscle strength training additionally．The experimental group received proprioceptive training in addition to the control group treatment．After 6 weeks of treatment,compare the pain situation,peak torque（PT）of knee extensor and flexor muscles,joint function,and proprioception before and after treatment between two groups were compared．Results After treatment,the VAS scores of both groups were lower than those before treatment（P<0.05）,and the experimental group was lower than the control group（t=12.121,P<0.05）．After treatment,the PT of the knee joint extensor and flexor muscle groups in both groups significantly increased compared to before treatment（P<0.05）,and the experimental group was significantly larger than the control group（P<0.05）．After treatment,the WOMAC score and Lequesne index of the two groups significantly decreased compared to those before treatment（P<0.05）,and the experimental group was smaller than the control group（P<0.05）．After treatment,the average trajectory error and average weight difference between the two groups were significantly smaller than those before treatment（P<0.05）,while the experimental group was smaller than the control group（P<0.05）．Conclusion sThe combination of proprioceptive training and isokinetic muscle strength training can significantly improve muscle strength,joint function,and proprioceptive sensation in patients with early knee osteoarthritis,making it suitable for promotion．

目的 探究应用高频振荡通气（HFOV）模式下早期肺表面活性物质干预对呼吸窘迫综合征致重度呼吸衰竭患儿转归的影响。方法 选取南阳医学高等专科学校第一附属医院2020年6月—2022年12月收治的120例呼吸窘迫综合征致重度呼吸衰竭患儿作为研究对象,按照随机数字表法将其分为对照组与研究组各60例,对照组行常规通气联合早期肺表面活性物质干预,研究组行HFOV联合早期肺表面活性物质干预,对比两组患儿临床症状、血气指标、肺功能指标、患儿转归分析、并发症以及临床疗效。结果 研究组患儿症状消失时间为（31.28±10.24）h、呼吸机辅助通气时间为（50.13±15.81）h以及住院天数为（12.47±5.48）d,对照组患儿症状消失时间为（59.91±11.56）h,呼吸机辅助通气时间为（91.17±25.47）h及住院天数为（20.11±9.45）d,研究组低于对照组（P<0.05）;治疗后,研究组患儿PaO₂为（77.89±9.10）mmHg,PaCO₂为（41.09±8.25）mmHg,氧合指数为（432.18±37.81）mmHg,对照组患儿PaO₂为（65.28±8.16）mmHg,PaCO₂为（49.71±8.91）mmHg,氧合指数为（258.64±56.74）mmHg,研究组PaO₂、氧合指数高于对照组,且PaCO₂低于对照组（P<0.05）;治疗后,研究组患儿体重潮气量（TV）为（7.68±2.16）mL/kg,达峰容积比（TPEF/TE）为（34.19±4.06）%,达峰时间比（VPEF/VE）为（33.47±3.42）%,对照组患儿TV为（6.64±2.01）mL/kg,TPEF/TE为（28.66±3.81）%,VPEF/VE为（28.95±3.10）%,研究组高于对照组（P<0.05）;研究组患儿支气管肺发育不良（BPD）为11.66%,对照组为13.33%,两组患儿BPD发生率比较差异无统计学意义（P>0.05）;研究组IVH为3.33%、ROP为5.00,对照组脑室内出血（IVH）为8.33%,早产儿视网膜病（ROP）为11.66%,研究组低于对照组（P<0.05）;研究组患儿并发症发生率为6.66%,对照组患儿并发症发生率为20.00%,研究组低于对照组（P<0.05）;研究组患儿总有效率为96.66%,对照组患儿总有效率为83.33%,研究组高于对照组（P<0.05）。结论 HFOV模式下早期肺表面活性物质干预呼吸窘迫综合征致重度呼吸衰竭患儿效果显著,改善患儿呼吸功能与血气指标,并发症较少。

Objective To investigate the effect of early intervention with pulmonary surfactant under HFOV mode on the outcome of severe respiratory failure in children with respiratory distress syndrome．Methods A total of 120 children with severe respiratory failure caused by respiratory distress syndrome admitted to our hospital from June 2020 to December 2022 were selected as the study subjects．They were randomly divided into a control group and a study group of 60 cases each using a random number table method．The control group received routine ventilation combined with early pulmonary surfactant intervention,while the study group received HFOV combined with early pulmonary surfactant intervention．Symptom disappearance,ventilator-assisted ventilation,hospital stay,blood gas indicators,lung function indicators,analysis of pediatric outcomes,complications,and clinical efficacy were compared between the two groups．Results The time of symptom disappearance was（31.28±10.24）h,the duration of ventilator assisted ventilation was（50.13±15.81）h and the number of days in hospital was（12.47±5.48）d in the study group,while the time of symptom disappearance was（59.91±11.56）h,the duration of ventilator assisted ventilation was（91.17±25.47）h and the number of days in hospital was（20.11±9.45）d in the control group,which were higher than those in the study group（P<0.05）．After treatment,PaO₂ was （77.89±9.10）mmHg,PaCO₂ was （41.09±8.25）mmHg and oxygenation index was （432.18±37.81）mmHg in the study group,while PaO₂ was （65.28±8.16）mmHg,PaCO₂ was （49.71±8.91）mmHg and oxygenation index was （258.64±56.74）mmHg in the control group．The PaO₂ and oxygenation index of the study group were higher than those of the control group,and the PaCO₂ was lower than that of the control group（P<0.05）．After treatment,TV in the study group was （7.68±2.16）mL/kg,TPEF/TE was （34.19±4.06）%,VPEF/VE was （33.47±3.42）%,and TV in the control group was （6.64±2.01）mL/kg,TPEF/TE was （28.66±3.81）%,VPEF/VE was （28.95±3.10）%．The study group was higher than the control group（P<0.05）．BPD was 11.66% in the study group and 13.33% in the control group．There was no significant difference in the incidence of BPD between the two groups（P>0.05）．The IVH and ROP of the study group were 3.33% and 5.00 respectively,while those of the control group were 8.33% and 11.66% respectively,which were lower in the study group（P<0.05）．The incidence of complications was 6.66% in the study group and 20.00% in the control group,which was lower in the control group（P<0.05）．The total effective rate was 96.66% in the study group and 83.33% in the control group,which was higher in the control group（P<0.05）．Conclusion sEarly intervention of pulmonary surfactant in children with severe respiratory failure caused by respiratory distress syndrome under HFOV mode has a significant effect,improving respiratory function and blood gas indicators,and reducing complications．

目的 构建并验证机械通气患儿肠内营养支持发生误吸的风险预测模型。方法 回顾性分析中山市博爱医院2021年3月—2023年3月儿童重症监护病房330例行机械通气并进行肠内营养的患儿临床资料,通过二元Logistic回归,获取机械通气患儿肠内营养支持发生误吸的预测因素,绘制列线图模型,并进行模型评价及验证。结果 330例机械通气患儿中,104例患儿发生误吸、226例未发生误吸。两组患儿在意识状态、机械通气方式、管饲量、胃残留量、胃管置入深度、促胃动力药、镇静剂等方面对比差异具有统计学意义（P<0.05）。二元Logistic结果显示,胃残留量、机械通气方式、管饲量、意识状态、胃管置入深度、促胃动力药、镇静剂是机械通气患儿肠内营养支持发生误吸的影响因素（P<0.05）。建模组AUC为0.810（95%CI：0.760~0.860）,Hosmer-Lemesh结果显示,χ²=3.245,P=0.846;外部验证组AUC为0.873（95%CI：0.831~0.914）,Hosmer-Lemesh结果显示,χ²=3.567,P=0.875。建模组和训练组DCA曲线大部分落于Y=0上方。建模组与外部验证组校准曲线均与参考曲线高度贴合,预测概率与实际概率接近,校准度良好。结论 基于胃残留量、机械通气方式、管饲量、意识状态、胃管置入深度、促胃动力药、镇静剂等7项指标构建的风险预测模型具有一定的临床价值,可作为医护人员识别肠内营养机械通气误吸高危患儿的工具。

Objective To establish and verify the risk prediction model of enteral nutritional aspiration in children with mechanical ventilation．Methods The clinical data of 330 children who underwent mechanical ventilation and enteral nutrition in the PICU of Zhongshan Boai Hospital from March 2021 to March 2023 were retrospectively analyzed．The independent predictive factors of enteral nutrition support aspiration in children with mechanical ventilation were obtained by binary Logistic regression,and the nomographic model was drawn,and the model was evaluated and verified. Results Among 330 children with mechanical ventilation,104 had aspiration and 226 did not．There were statistically significant differences between the two groups in consciousness state,mechanical ventilation mode,tube feeding amount,gastric residual amount,gastric tube insertion depth,gastric motivity drugs,sedatives,etc.（P<0.05）．Binary Logistic results showed that gastric residual amount,mechanical ventilation mode,tube feeding amount,state of consciousness,depth of gastric tube insertion,gastric motonics and sedatives were the influential factors of enteral nutritional aspiration in children with mechanical ventilation（P<0.05）．The AUC of the modeling group was 0.810（95%CI：0.760-0.860）,and the Hosmer-Lemesh result showed that χ²=3.245,P=0.846．The AUC of the external verification group was 0.873（95%CI：0.831-0.914）,and the Hosmer-Lemesh result showed that χ²=3.567,P=0.875．The DCA curves of modeling group and training group mostly were above Y=0．The calibration curves of the modeling group and the external verification group are highly fit to the reference curves,and the prediction probability was close to the actual probability,and the calibration degree was good．Conclusion sThe risk prediction model based on 7 indexes,including stomach residual amount,mechanical ventilation mode,tube feeding amount,state of consciousness,depth of gastric tube insertion,gastric motivity drug and sedative,with certain clinical value,and can be used as a tool for medical staff to identify children at high risk of enteral nutritional mechanical aspiration．

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 调查良性前列腺增生（BPH）患者对前列腺手术的接受意愿,并分析其影响因素。方法 采用问卷调查法,于2021年3月—2022年10月选取中山大学附属第一院惠亚医院收治的133例BPH患者为研究对象。由调查者床边发放问卷,并当场收回。结果 调查共发放问卷133份,回收有效问卷130份,有效率为97.74%。单因素分析结果显示,经济负担、医保报销、BPH程度、住院陪护、了解BPH对自身的危害等因素与患者接受手术意愿相关（P<0.05）。Logistic多因素回归分析显示,患者的经济负担、医保报销及已存在BPH并发症是影响患者接受手术意愿的因素（P<0.05）。结论 本区域BPH患者由于经济、医保及已存在BPH并发症的问题,直接影响了接受前列腺手术的意愿,不仅影响患者的生理健康,也影响生活质量及家庭和睦关系,应加大疾病认知宣传力度,组建患者互助团体,促进居民对BPH疾病及手术的了解,提高该类患者的生活质量。

Objective To investigate the willingness of patients with benign prostatic hyperplasia（BPH）to accept prostate surgery and analyze its influencing factors．Methods A questionnaire survey method was used to select 133 patients with BPH admitted to a hospital from March 2021 to October 2022．The questionnaires were distributed and collects by the investigator at the bedside．Results A total of 133 questionnaires were distributed during the survey and 130 valid questionnaires were collected,with an effective rate of 97.74%．The results of single factor analysis showed that factors such as financial burden,medical insurance reimbursement,degree of BPH,hospitalization accompaniment,and understanding of the harm of prostate hyperplasia were significantly related to patients’ willingness to receive surgery,with statistical significance（P<0.05）．Logistic multifactor regression analysis showed that the patient’s financial burden,medical insurance reimbursement,and existing BPH complications were factors that affected the patient’s willingness to receive surgery．Conclusion sBPH patients in local region have financial burden,medical insurance and existing complications of BPH,which directly affect their willingness to undergo prostate surgery．Those factors not only affect the patients’ physical health but also affect the quality of theirlife and harmonious thier family relationships． Awareness of the disease should be increased to promote publicity,and patient mutual aid groups should be started to improve residents’ understanding of BPH disease and surgery and improve the quality of patients’life．

目的 探讨手术室环境对人工股骨头置换术患者等待期应激反应的影响。方法 回顾性选取2021年1月1日—2023年7月31日入院的84例患者,患者均需要接受人工股骨头置换术治疗。根据患者接受治疗时手术室的环境将患者分为两组,对照组42例患者,其接受手术治疗时手术室环境未改造升级;观察组42例患者,其接受手术治疗时手术室环境已改造升级。对比两组应激反应（肾上腺素、皮质醇水平）、情绪状态[汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分]、血压（收缩压、舒张压、心率）、生活质量评分、患者对手术室环境的满意度。结果 T₁时刻,两组肾上腺素、皮质醇水平均升高,但对照组升高幅度[（43.48±4.59）pg/L、（268.48±13.55）ng/L]大于观察组[（38.15±5.28）pg/L、（240.15±12.48）ng/L],对比差异有统计学意义（t=4.937、9.967,P<0.05）。T₁时刻,两组HAMD、HAMA评分均升高,对照组水平[（22.84±3.26）（24.03±3.47）分]大于观察组[（19.75±3.73）（20.76±3.36）分],对比差异有统计学意义（t=4.042、4.387,P<0.05）。T₁时刻,两组收缩压、舒张压、心率水平均显著升高,但对照组升高幅度[（129.34±7.25）mmHg、（94.25±6.62）mmHg、（88.58±3.27）次/分]大于观察组[（117.62±8.13）mmHg、（85.63±5.38）mmHg、（82.16±3.66）次/分],对比有统计学意义（t=6.973、6.549,8.477,P<0.05）。术后5 d,两组各维度评分均显著升高,观察组各维度评分高于对照组（P<0.05）。观察组患者对手术室环境的满意率高于对照组（97.62% vs 85.71%,χ²=3.896,P=0.048）。结论 手术室环境改造升级对人工股骨头置换术患者具有积极作用,可有效降低患者等待期应激反应,减轻患者等待期焦虑、抑郁情绪,降低患者等待期血压、心率上升幅度,有利于提升患者术后生活质量,提高患者对手术室环境的满意度。

Objective To investigate the effect of operating room environment on stress response during the waiting period in patients with artificial femoral head replacement．Methods Eighty-four patients admitted between January 1,2021 to July 31,2023 required artificial femoral head replacement．According to the operating room environment during treatment,the patients were divided into two groups．Forty-two patients in the control group received the surgical treatment in the original operating room environment and 42 patients received surgical treatment in upgraded environment．Comparing two groups of stress response（adrenaline,cortisol）,emotional status[HAMD score,HAMA score],blood pressure（systolic blood pressure,diastolic blood pressure,heart rate）,quality of life,patient satisfaction with the operating room environment of two groups were compared．Results At time T₁,epinephrine and cortisol levels were significantly increased in the two groups,but the control group increased[（43.48±4.59）pg/L,（268.48±13.55）ng/L] greater than the observation group[（38.15±5.28）pg/L,（240.15±12.48）ng/L],which were statistically significant（t=4.937,9.967,P<0.05）．At time T₁,the HAMD and HAMA scores were significantly higher in both groups,but the increase[（22.84±3.26）and（24.03±3.47）] was greater than the observation group[（19.75±3.73）and（20.76±3.36）],which showed statistical significance（t=4.042,4.387,P<0.05）． At time T₁,SBP,DBP and heart rate increased significantly in both groups,but the control group increased[（129.34±7.25）mmHg,（94.25±6.62）mmHg,（88.58±3.27）][（117.62±8.13）mmHg,（85.63±5.38）mmHg,（82.16±3.66）/min] grater than the observation group（t=6.973,6.549,8.477,P<0.05）．Five days after surgery,the scores of each dimension increased significantly in both groups,but the observation group increased more than the control group（P<0.05）．The observation group patients showed a higher satisfaction rate of the operating room environment than the control group（97.62% vs 85.71%,χ²=3.896,P=0.048）．Conclusion sThe transformation and upgrading of the operating room environment has a positive effect on the patients with artificial femoral head replacement,which can effectively reduce the stress response of patients during the waiting period,reduce the anxiety and depression of patients during the waiting period,and reduce the rise in blood pressure and heart rate of patients during the waiting period,which is conducive to improving the quality of life of patients after surgery and improving the satisfaction of patients with the operating room environment．