目的 研究以尼尔·诺丁斯关怀理论为基础的全程护理在病毒性脑炎（VE）患儿中的干预效果。方法 选取我院2020年4月—2022年4月收治的VE患儿88例,以随机抽签法分为对照组（44例）、观察组（44例）,对照组采用常规护理,观察组在此基础上实施以尼尔·诺丁斯关怀理论为基础的全程护理。比较2组治疗依从性、恢复情况、儿童抑郁障碍自评量表（DSRSC）、儿童焦虑性情绪障碍筛查表（SCARED）、生存质量[儿童生存质量普适性核心量表（PedsQLTM4.0）]及家属护理满意度。结果 观察组治疗依从性100.00%（44/44）高于对照组86.36%（38/44）（P<0.05）;干预后,观察组DSRSC、SCARED评分低于对照组,PedsQLTM4.0评分高于对照组（P<0.05）;干预后,观察组FMA、MMSE评分较对照组升高（P<0.05）;观察组家属护理满意度97.93%（43/44）高于对照组81.82%（36/44）（P<0.05）。结论 以尼尔·诺丁斯关怀理论为基础的全程护理可改善VE患儿心理状态,提高治疗依从性,促进身体康复,进而提高患儿生存质量及家属护理满意度。

目的 探讨K点刺激联合吞咽-摄食管理下颅脑外伤术后吞咽障碍患者康复的影响因素。方法 采用回顾性分析法,收集K点刺激联合吞咽-摄食管理下的516例颅脑外伤术后吞咽障碍患者临床资料,根据吞咽障碍疗效分为有效组和无效组,采用Logistic回归分析其影响因素。结果 516例患者中,有效者479例,占92.93%;无效者37例,占7.17%。2组在性别、年龄、文化程度、有无慢性病、有无留置鼻饲管、鼻饲管留置天数方面比较差异无统计学意义（P>0.05）;在吞咽障碍分级、有无并发症、管理依从性和知识掌握程度比较差异有统计学意义（P<0.001）。Logistic回归分析结果显示,吞咽障碍分级、有无并发症、管理依从性和知识掌握程度是影响康复效果的独立危险因素（OR分别为6.455、0.011、1.074、0.084,P<0.001）。结论 吞咽障碍分级、有无并发症、管理依从性和知识掌握程度是K点刺激联合吞咽-摄食管理下颅脑外伤术后吞咽障碍患者吞咽功能康复的影响因素,神经外科医护人员应根据上述因素制定干预措施,以进一步提高干预效果,改善患者生活质量。

目的 通过静脉输液批次决策的自动化、标准化以及个体化,实现静脉用药调配中心（PIVAS）工作同质化和高效化,进而促进临床安全合理用药。方法 根据药物使用的时辰药理学,调查分析人工决策输液批次存在的问题,建立批次时间划分表和制定批次决策规则,基于医院信息系统构建自动输液批次决策系统。由药师维护自动输液批次决策系统,针对该系统的应用效果评价分析。结果 应用自动批次决策软件后,PIVAS 批次不合格率下降,输液时间合理性提高。审方药师用于决策输液批次的时间减少,大幅度提高 PIVAS 和病区护士工作效率,同时降低 PIVAS输液配送出错频率。结论 自动输液批次决策系统构建完成之后,用药时间更合理,提高药物治疗效果;PIVAS工作效率明显提高,工作质量显著提升,输液批次不合格率降低,患者输液批次真正做到编排一致性,提高用药时间合理性,进而使临床用药更合理、更安全,实现个体化治疗。

ObjectiveThrough the automation, standardization and individualization of intravenous（IV）fluid batch decision-making, to realize the homogenization and high efficiency of Pharmacy Intravenous Admixture Services（PIVAS）, to promot safe and rational clinical drug use．Methods According to the pharmacology of drug use, the problems existing in manual IV fluid batch decision were investigated and analyzed, and an automatic IV fluid batch decision system was constructed based on hospital information system．Batch time division table and batch decision rules were established, automatic IV fluid batch decision system was maintained by pharmacists, the application effect of the system were evaluated and analyzed．Results The unqualified rate of PIVAS batch decreased, and the rationality of IV transfusion time increased．The time for prescription checking pharmacists to make IV fluid batch decisions was shortened, which greatly improved the work efficiency of PIVAS and nurses, and reduced the error frequency of PIVAS IV fluid distribution．Conclusions After the completion of the automatic IV fluid batch decision system, the medication time is more reasonable and the drug treatment effect is improved．The work efficiency and quality of PIVAS are significantly improved, and the unqualified rate of IV fluid batches is reduced．The IV fluid batches of patients are really arranged in a consistent way, and the rationality of medication time is improved, so that clinical medication is more reasonable and safer, and individualized treatment is realized．

目的 探索基于患者居家护理服务需求且以三甲医院为实施主体的“互联网+护理服务”模式,以期为“互联网+护理服务”的开展提供借鉴。方法 成立“互联网+护理服务”小组,基于患者需求进行平台建设,组建“互联网+护理服务”团队,经过同质化培训持证上岗,提供专科护理、母婴护理以及基础护理共25项服务内容。服务结束后,调查患者对“互联网+护理服务”的满意度。结果 截至2022年10月,该平台注册护士438名,注册患者1 000人。共开展“互联网+护理服务”居家护理服务841人次,排名前三位的服务项目是母婴护理、留置/更换鼻饲管护理、留置/更换尿管护理。患者居家服务好评率为100％,对护理服务的整体满意度为（4.86±0.22）分。患者对护士指导居家护理知识的满意度最高,为（4.89±0.33）分,对平台收费的满意度最低,为（4.12±0.78）分。结论 “互联网+护理服务”为居家护理提供了更加方便快捷的渠道,使资源利用更有效,患者认可度高。

Objective To explore the“Internet + Nursing Service”model based on the needs of patients' home care, which the grade A class 3 hospital hospital was the main institution of implementation, and to provide the reference for implementing “Internet + Nursing Service”．Methods We set up a working group, built a platform according to needs, and set up the “Internet + Nursing service”team, who worked with the certificate after homogenization training．The program provided 25 kinds of services, including specialist nursing, maternal and child care, basic nursing, provides high-quality and convenient home care services．After the service, the patients' satisfaction was investigated．Results By October 2021, the platform had 438 registered nurses and 1000 registered patients．A total of 841 people were provided with “Internet + Nursing service”home care services, and the top three services were maternal and infant care, nasal feeding tube care with indentation/replacement, and urinary tube care with indentation/replacement．The favorable rate of home service was 100%, and the overall satisfaction with nursing services was（4.86±0.22）points．Patients had the highest level of satisfaction with nurses' guidance on home nursing knowledge, which was（4.89±0.33）points, and the lowest level of satisfaction with platform fees, which was（4.12±0.78）points．Conclusions “Internet + Nursing Service”provides a more convenient and fast access for home nursing, making resource utilization more effective and with high patient recognition．

目的 探讨苏黄止咳胶囊联合多索茶碱对慢性持续期支气管哮喘的疗效及对肺功能、呼出气一氧化氮（FeNO）的影响。方法 选择2020年3月—2022年3月70例慢性持续期支气管哮喘患者,随机分为2组各35例,对照组仅予以多索茶碱治疗,研究组在对照组基础上加服苏黄止咳胶囊治疗。治疗3个月,采用哮喘控制测试（ACT）对患者进行评估,记录哮喘急性加重、急救药物使用情况及急诊入院情况,测定肺功能和呼出FeNO。结果 2组治疗1月的ACT评分比较无统计学意义（P>0.05）,治疗2、3个月时研究组的ACT评分高于对照组（P<0.05）。研究组哮喘急性加重次数、急救药物使用次数均少于对照组（P<0.05）,而2组急诊入院次数比较差异无统计学意义（P>0.05）。与基线值相比,2组治疗3个月时的肺功能指标无改变（P>0.05）且组间比较差异亦无统计学意义（P>0.05）;2组治疗3个月时的FeNO无改变（P>0.05）,而研究组的FeNO低于对照组（P<0.05）。结论 苏黄止咳胶囊联合多索茶碱治疗慢性持续期支气管哮喘可降低FeNO,提高哮喘控制水平。

Objective To investigate the effect of Suhuang Zhike capsule combined with doxofylline on chronic persistent bronchial asthma, pulmonary function and exhaled nitric oxide（FeNO）．Methods Seventy patients with chronic persistent bronchial asthma from March 2020 to March 2022 were randomly divided into two groups, 35 cases in each group．The control group was only treated with doxofylline, and the study group was treated with Suhuang Zhike capsule additionally．After 3 months of treatment, the patients were evaluated by asthma control test（ACT）, the acute exacerbation of asthma was recorded, and the pulmonary function and exhaled FeNO were measured．Results There was no statistical significance in the ACT score of the two groups after one month of treatment（P>0.05）．The ACT scores of the study group after two months and three months of treatment were significantly higher than those of the control group（P<0.05）．The times of acute exacerbation of asthma and the use of emergency drugs in the study group were less than those in the control group（P<0.05）, but there was no significant difference in the number of emergency hospitalizations between the two groups（P>0.05）．Compared with the baseline value, there was no significant change in lung function indexes in the two groups after 3 months of treatment（P>0.05）．Compared with the baseline value, there was no significant change in FeNO in the two groups after 3 months of treatment（P<0.05）, while FeNO in the study group was lower than that in the control group（P<0.05）．Conclusions Suhuang Zhike capsule combined with doxofylline in the treatment of chronic persistent bronchial asthma can reduce FeNO and improve the level of asthma control．

目的 探讨与分析推拿联合补肾祛瘀针刺法治疗慢性腰肌劳损恢复期患者对腰部疼痛及表面肌电图的影响。方法 选择2019年9月—2022年4月我院收治的72例慢性腰肌劳损恢复期患者为研究对象,根据随机1∶1数字表法,分为联合组与对照组各36例。对照组给予推拿治疗,联合组在此基础上,给予补肾祛瘀针刺法治疗,2组均治疗并观察4周,评价腰部疼痛及表面肌电图变化情况。结果 治疗后联合组与对照组的总有效率分别为97.2%和75%,联合组高于对照组（P<0.05）;治疗前,2组患者的视觉类比疼痛评分法（VAPS）和下腰痛失能问卷（OPDG）评分比较差异无统计学意义,治疗后,2组患者的VAPS和OPDG评分均降低,且联合组低于对照组（P<0.05）;2组治疗后的腰椎前屈力度都高于治疗前（P<0.05）,且联合组更高（P<0.05）;2组治疗后的表面肌电图神经根振幅和潜伏期均低于治疗前（P<0.05）,且联合组更低（P<0.05）。联合组与对照组治疗后的血清5-HT含量均高于治疗前（P<0.05）,联合组更高（P<0.05）。结论 推拿联合补肾祛瘀针刺法在慢性腰肌劳损恢复期患者中的应用具有良好的安全性,有效改善患者的腰椎功能,缓解患者疼痛,提高整体治疗效果,也能改善患者的表面肌电图状况,促进血清5-HT的释放。

Objective To explore and analyze the effects of massage combined with kidney tonifying and blood stasis removing acupuncture on lumbar pain and surface electromyography in patients with chronic lumbar muscle strain in the recovery period．Methods From September 2019 to April 2022, 72 cases of patients in the recovery period of chronic lumbar muscle strain treated in our hospital were selected as the research objects, and were divided into the combined group and the control group with 36 cases in each group by the random 1∶1 number table method．The control group were given massage therapy, and the combination group were given kidney tonifying and stasis removing acupuncture additionally．Results After treatment, the total effective rates of combined group and control group were 97.2% and 75%, respectively, and the combined group was significantly higher than the control group（P<0.05）．Before treatment, there was no significant difference in the visual analogue pain scale（VAPS）and Oswestry low pain & disability questionnaire（OPDG）scores between the two groups, but after treatment, the scores of the two groups were significantly decreased, and the combined group was significantly lower than the control group（P<0.05）．The lumbar flexion intensity after treatment was significantly higher in both groups than before treatment（P<0.05）, and higher in combination group（P<0.05）．The amplitude and latency of surface electromyogram nerve roots after treatment were significantly lower in both groups than before treatment（P<0.05）, and even lower in combination group（P<0.05）．The serum 5-HT content in combination group and control group after treatment was significantly higher than that before treatment（P<0.05）, and that in combination group was higher（P<0.05）．Conclusions The application of massage combined with kidney tonifying and blood stasis removing acupuncture in patients recovering from chronic lumbar muscle strain has good safety, which can improve the lumbar function of patients, relieve the pain of patients, improve the overall therapeutic effect, improve the surface electromyography of patients and promote the release of serum 5-HT．

目的 比较单纯康复训练和在此基础上结合苍龟探穴针法对脑卒中后肩手综合征I期的临床疗效差异。方法 选择响水县人民医院疼痛康复科收治的卒中后出现肩手综合征I期患者60例,按随机数字表法分为治疗组（n=30）和对照组（n=30）。治疗组患者行与苍龟探穴中医针法结合康复训练,先由具备针灸专业主治资格的临床医师对所选取的部分穴位使用苍龟探穴中医传统针法实施治疗后,再由具有5年以上工作经历的康复治疗师实施治疗,而其他患者则单纯接受康复训练,并观察2组患者在治疗前和治疗后的视觉模拟评分（VAS）、肿胀程度、简式上肢运动功能（Fugl-Meyer）评估以及临床疗效。结果 本次研究临床治疗进程中,2组无不良反应情况出现,因疫情和不能配合治疗而出现5例脱落病例（治疗组2例,对照组3例）。①治疗后,2组患者的VAS和肿胀程度评分低于治疗前（P<0.01）,治疗组患者2项评分高于治疗前（P<0.05）;②治疗后,2组患者的Fugl-Meyer评分高于治疗前（P<0.01）,治疗组患者评分高于对照组（P<0.01）;③治疗组的有效率高于对照组,组间比较差异有统计学意义（P<0.05）。结论 苍龟探穴中医传统针法结合康复训练可减少患者水肿和酸痛情况,明显改善患者上肢运动能力,有良好的临床效果。

Objective To compare the clinical efficacy of rehabilitation training alone and the combination of Cangguitanxue acupuncture on post-stroke stage I shoulder-hand syndrome．Methods A total of 60 patients from the Department of Rehabilitation Medicine of Xiangshui County People's Hospital who met the diagnosis（stroke followed by stage I shoulder-hand syndrome）were selected, and they were randomly divided into treatment group（n=30）and control group（n=30）according to the random number table method．Patients in the treatment group underwent a combination of rehabilitation training with the Cangguitanxue acupuncture Chinese medicine acupuncture method, and were first treated by a clinician qualified in acupuncture using the Cangguitanxue acupuncture Chinese medicine traditional acupuncture method on selected acupoints, and then by a rehabilitation therapist with more than five years of experience, while other patients received rehabilitation treatment alone．Results In the clinical treatment process of this study, there were no adverse reactions in the two groups, but there were five cases of dropout due to the epidemic and the inability to cooperate with the treatment（two cases in the treatment group and three cases in the control group）．After treatment, the visual analogue scale（VAS）and swelling degree scores of the two groups were significantly lower than those before treatment（P<0.01）, and the performance of the patients in the treatment group was better than that before treatment（P<0.05）．After treatment, the score of simplified upper limb motor control function（Fugl-Meyer）score in the two groups was significantly higher than that before treatment（P<0.01）, and the score of patients in the treatment group was higher than that of the control group（P<0.01）．The effective rate of the control group was inferior to that of the treatment group, and the difference was statistically significant（P<0.05）．Conclusions The traditional acupuncture method combined with rehabilitation training can significantly reduce edema and soreness in patients, significantly improve upper limb motor ability, and have good clinical effects．

目的 基于随机森林方法构建甲状腺功能减退（简称甲减）患病风险预测模型。方法 从MIMIC-IV数据库纳入5 735名甲减患者为病例组,4 803名非甲减患者为对照组,基于随机森林模型进行建模。同时利用逻辑回归、贝叶斯正则化神经网络、XGBoost作为比较模型。最后用准确率、F1分数、精确率、召回率、特异性以及AUC值评价四个机器学习模型性能。结果 随机森林模型准确率为0.85,F1分数为0.84,精确率为0.84,召回率为0.84,特异性为0.86,AUC值为0.91。在该模型中,促甲状腺激素、年龄、绝对淋巴细胞计数、血液中红细胞数、中性白细胞、性别、碱性磷酸酶、丙氨酸氨基转移酶、嗜酸性粒细胞绝对计数、尿素氮为甲减患者诊断重要性排前10的指标。结论 采用随机森林方法构建的甲减患病预测模型为甲减的早期诊断有潜在应用价值。

Objective To construct a risk prediction model for hypothyroidism based on the random forest model．Methods A total of 5 735 hypothyroidism patients were included from the MIMIC-IV database as the case group, and 4 803 non-hypothyroidism patients were included as the control group．Random forest models were constructed for both groups, and logistic regression, Bayesian regularized neural network, and XGBoost were used as comparative models．The performance of the four machine learning models was evaluated using accuracy, F1 score, precision, recall, specificity, and AUC value．Results The random forest model had an accuracy of 0.85, an F1 score of 0.84, a precision of 0.84, a recall of 0.84, a specificity of 0.86, and an AUC value of 0.91．In this model, thyroid-stimulating hormone, age, absolute lymphocyte count, red blood cell count in blood, neutrophil, gender, alkaline phosphatase, aspartate aminotransferase, absolute eosinophil count, and blood urea nitrogen were the top 10 indicators for diagnosing hypothyroidism patients．Conclusions The hypothyroidism disease prediction model constructed using the random forest method has potential application value for the early diagnosis of hypothyroidism．

目的 明确上海市闵行区社区老人轻度认知功能障碍（MCI）发生现状,分析MCI发生的影响因素间的交互作用关系。方法 采用横断面研究方法,应用AD-8与CSI-D对该区2021年65岁以上老人MCI发生现状进行双量表评估。应用SPSS 26.0 软件,先后采用χ²检验分析受检老人吸烟、饮酒、慢性病等因素在不同检出情况的构成、二分类非条件Logistic回归分析MCI发生的影响因素,再将各因素依次纳入双因素交互作用分析模型,分析各变量对MCI发生的交互作用。结果 应用AD8与CSI-D双量表评估法具有较高的灵敏度,评估闵行区社区老人MCI阳性率为26.6%,高于其他研究,低年龄（OR=1.09,95%CI：1.04~1.14）、良好的健康心态（OR=1.67,95%CI：1.15~2.42）是减少老人MCI的保护因素,职业类型（OR=1.19,95%CI：1.04~1.38）、照料者类型（OR=1.56,95%CI：1.09~2.22）与老人MCI的发生存在相关关系。家庭月总收入与照料者类型之间、是否饮酒与照料者类型之间对老人MCI的发生存在交互作用（P均<0.05）。结论 保持良好的心态可以降低老人MCI发生风险,不同职业类型、照料者类型与老人MCI的发生具有相关关系,照料者选择保姆可能会增加老人MCI风险。

Objective To clarify the current situation of mild cognitive impairment（MCI）in the community elderly in Minhang District,Shanghai,and analyze the interaction relationship between the influencing factors of MCI．Methods A cross-sectional study method was used,and AD8 and CSI-D were used to evaluate the current situation of MCI in the elderly over 65 years old in this district in 2021．SPSS 26.0 software,chi-square test and binary unconditional Logistic regression model were used to analyze the composition of smoking,drinking,chronic diseases and other factors in different detected conditions and the influencing factors of MCI occurrence in the elderly．A factor interaction analysis model was used to analyze the interaction of each variable on the occurrence of MCI．Results The AD8 and CSI-D double-scale evaluation method had high sensitivity．The positive rate of MCI in the community elderly in Minhang District was 26.6%,which was higher than other studies．Younger age（OR=1.09,95%CI：1.04~1.14）,good health mentality（OR=1.67,95%CI：1.15~2.42）were protective factors for reducing MCI in the elderly,occupation type（OR=1.19,95%CI：1.04~1.38）,caregiver type（OR=1.56,95%CI：1.09~2.22）were correlated with the occurrence of MCI in the elderly．There were interaction effects between the total monthly household income and the type of caregivers,whether drinking or not and the type of caregivers on the occurrence of MCI in the elderly（all P<0.05）．Conclusions Maintaining a good attitude can reduce the risk of MCI in the elderly．Different occupational types and types of caregivers are related to the occurrence of MCI in the elderly．Caregivers choosing nanny may increase the risk of MCI in the elderly．

目的 探讨血清心型脂肪酸结合蛋白（H-FABP）、血管生成素-1（Ang-1）在急性大血管闭塞性卒中（AIS-LVO）静脉溶栓桥接支架取栓患者预后中的评估价值。方法 选择2019年1月—2021年5月80例AIS-LVO患者作为研究对象,均接受静脉溶栓桥接支架取栓治疗,检测术前血清H-FABP、Ang-1水平,术后随访90 d将患者分为预后良好组（n=57）与预后不良组（n=23）。结果 两组在高血压、冠心病、心房颤动、急性卒中治疗低分子肝素试验（TOAST）分型、侧支循环、术前H-FABP、术前Ang-1方面存在差异（P<0.05）。多因素 Logistic 回归分析结果显示,高血压、心房颤动、心源性梗死型、侧支循环为0 ~1 级、术前H-FABP≥10.0 ng/L、术前Ang-1<5.25 ng/mL是AIS-LVO静脉溶栓桥接支架取栓患者预后不良的危险因素。术前血清H-FABP预测术后90 d预后不良的AUC为0.728（95%CI：0.368~0.918）,灵敏度、特异度分别为66.68%、58.92%。术前血清Ang-1预测术后90 d预后不良的AUC为0.773（95%CI：0.592~1.129）,灵敏度、特异度分别为70.35%、63.92%。H-FABP联合Ang-1预测术后90 d预后不良的AUC为0.854（95%CI：0.652~0.957）,灵敏度、特异度分别为77.18%、71.82%。结论 静脉溶栓桥接支架取栓治疗AIS-LVO患者的预后受到多种危险因素的影响,其中术前血清H-FABP和Ang-1是具有前景的预后预测因子。

Objective To investigate the prognostic value of serum heart-type fatty acid binding protein（H-FABP）and angiopoietin-1（Ang-1）in patients with acute ischemic stroke-large vessel occlusion（ALS-LVO）undergoing venous thrombolytic bridging stent thrombectomy．Methods A total of 80 patients with ALS-LVO from January 2019 to May 2021 were selected as the study subjects,treated with intravenous thrombolytic bridging stent thrombectomy,and their serum H-FABP and Ang-1 levels were measured before operation．After 90 days of follow-up,the patients were divided into good prognosis group（n=57）and poor prognosis group（n=23）．Results There were significant differences between the two groups in hypertension,coronary heart disease,atrial fibrillation,TOAST classification,collateral circulation,preoperative H-FABP,and preoperative Ang-1（P<0.05）．Multivariate logistic regression analysis showed that hypertension,atrial fibrillation,cardiogenic infarction type,collateral circulation of 0~1 grade,preoperative H-FABP≥10.0 ng/L,preoperative Ang-1<5.25 ng/mL were independent risk factors for poor prognosis of ALS-LVO patients treated with venous thrombolytic bridging stents．The AUC of preoperative serum H-FABP predicting poor prognosis 90 days after operation was 0.728（95%CI：0.368~0.918）,with sensitivity and specificity of 66.68% and 58.92% respectively．The AUC of preoperative serum Ang-1 predicting poor prognosis 90 days after surgery was 0.773（95%CI：0.592~1.129）,with sensitivity and specificity of 70.35% and 63.92% respectively．The AUC predicted by H-FABP combined with Ang-1 for poor prognosis 90 days after operation was 0.854（95%CI：0.652~0.957）,and the sensitivity and specificity were 77.18% and 71.82% respectively．Conclusions The prognosis of patients with ALS-LVO treated with intravenous thrombectomy bridging stent thrombectomy is affected by many risk factors,among which preoperative serum H-FABP and Ang-1 are promising prognostic factors．