目的 探讨支气管镜灌洗用于儿童重症肺部感染合并肺实变的治疗效果及对CT特征、肺功能的影响。方法 选取2022年5月—2024年5月铜仁市人民医院收治的100例重症肺部感染合并肺实变患儿开展前瞻性研究,应用随机数表法分为对照组和观察组,每组各50例。对照组患儿采取常规治疗,观察组则采取常规治疗加支气管镜灌洗治疗。对比其临床疗效,治疗前后炎症因子、CT特征及肺功能变化。结果 观察组治疗总有效率高于对照组（P<0.05）;治疗后观察组患儿白细胞计数（10.36±2.52）×10⁹/L、白细胞介素-6（20.57±5.05）ng/L、C反应蛋白（13.12±2.64）mg/L、降钙素原（101.62±12.16）pg/L均低于对照组白细胞计数（13.25±3.32）×10⁹/L、白细胞介素-6（31.69±4.11）ng/L、C反应蛋白（16.16±4.44）mg/L、降钙素原（113.46±18.11）pg/L（P<0.05）;治疗后两组患儿胸腔积液、支气管壁增厚、空气支气管征、肺部实变、磨玻璃影等相关CT影像特征占比下降,且观察组低于对照组（P<0.05）;治疗后两组患儿呼气流量峰值水平均升高,观察组（90.67±18.45）L/s高于对照组（81.27±17.69）L/s,用力肺活量水平均更高,观察组（3.33±0.68）L高于对照组（2.68±0.25）L（P<0.05）。结论 针对儿童重症肺部感染合并肺实变,在常规治疗基础上增加支气管镜灌洗可提升临床疗效,减轻机体炎症反应,改善胸部CT各种表现及肺功能。

Objective To explore the therapeutic effects of bronchoalveolar lavage in children with severe pulmonary infection complicated by lung consolidation and its impact on CT features and pulmonary function．Methods A prospective study was conducted on 100 children with severe pulmonary infection complicated with pulmonary consolidation in a hospital from May 2022 to May 2024．They were randomly divided into observation group and control group using a random number table method,50 cases in each group．The control group of children received routine treatment,and the observation group received conventional treatment plus bronchoalveolar lavage．Clinical efficacy,inflammatory factors,CT features,and alterations in pulmonary function before and after therapy were compared．Results The total effective rate of the observation group was higher than that of the control group（P<0.05）．After treatment,the white blood cell count（10.36±2.52）×10⁹/L,interleukin-6（20.57±5.05）ng/L,C-reactive protein（13.12±2.64）mg/L,and procalcitonin（101.62±12.16）pg/L in the observation group were all lower than those in the control group（13.25±3.32）×10⁹/L,interleukin-6（31.69±4.11）ng/L,C-reactive protein（16.16±4.44）mg/L,and procalcitonin（113.46±18.11）pg/L（P<0.05）．After treatment,the proportion of CT imaging features such as pleural effusion,bronchial wall thickening,air bronchogram sign,lung consolidation,ground glass opacities,decreased in both groups of children,and the observation group was lower than the control group（P<0.05）．After treatment,the peak levels of expiratory flow in both groups of children increased,with the observation group（90.67±18.45）L/s higher than the control group（81.27±17.69）L/s．The forced vital capacity levels were also higher,with the observation group（3.33±0.68）L higher than the control group（2.68±0.25）L（P<0.05）．Conclusions Adding bronchoalveolar lavage to routine treatment for children with severe pulmonary infection complicated with pulmonary consolidation can improve their clinical efficacy,alleviate inflammatory reactions,and improve various chest CT manifestations and lung function．

目的 研究慢性非特异性腰痛患者腰椎正侧位X线中腰椎侧弯、L1-5棘突偏歪和椎体滑脱情况,总结规律,为慢性非特异性腰痛患者治疗提供依据。方法 选取164例慢性非特异性腰痛患者,观察并记录每例患者腰椎正侧位X线中腰椎侧弯、L1~L5棘突偏歪和椎体滑脱情况。用统计学软件分析腰椎侧弯、棘突偏歪和椎体滑脱情况。结果 共有59例发生腰椎侧弯,占35.98%,其中Cobb角5°~10 °有47例,占28.66%;Cobb角>10°有12例,占7.32%。腰椎侧弯发病以L4为下端椎为主。以L3为下端椎有12例患者,占20.34%;以L4为下端椎有37例患者,占62.71%;以L5为发椎有10例患者,占16.95%。共119例发生棘突偏歪,占总例数的72.56%。L5棘突偏歪最常见,发生率为57.93%;L4次之,发生率为48.17%。L5棘突偏歪率与L1~L3棘突偏歪率比较差异均有统计学意义（χ²分别为14.580,11.771,7.484,P分别为<0.001,0.001,0.006）,但与L4棘突偏歪率比较差异无统计学意义（χ²=3.124,P=0.077）。共30例患者存在椎体滑脱,占18.29%。L5最常发生滑脱,发生率为8.54%;L4次之,发生率为7.93%。L4与L5椎体滑脱率比较差异无统计学意义（χ²=0.040,P=0.841）;L4分别与L1,L2,L3以及L5分别与L1,L2,L3椎体滑脱率差异均有统计学意义（L5与L1、L2、L3：χ²分别为14.580、11.771、7.484,P分别为<0.001、<0.001、<0.006;L4与L1、L2、L3：χ²分别为13.495、10.712、6.550,P分别为<0.001、<0.001、<0.010）。结论 慢性非特异性腰痛患者较常发生腰椎侧弯,侧弯以L4为下端椎为主;慢性非特异性腰痛患者较常发生棘突偏歪,L5棘突偏歪最常见,L4次之;L5和L4是慢性非特异性腰痛患者最常发生滑脱的椎体。在治疗慢性非特异性腰痛患者时,与L5和L4相关的肌肉、筋膜等软组织损伤以及关节退行性变或紊乱应引起重点关注。

Objective To study the lumbar scoliosis,L1-5 spinous process deviation and spondylolisthesis in spine X-ray of patients with chronic non-specific low back pain（CNLBP）,and summarizing the existing rules,so as to provide imaging theoretical support for the treatment of CNLBP．Methods A total of 164 patients with CNLBP were selected．The lumbar scoliosis,L1-5 spinous process deviation and spondylolisthesis were observed and recorded in the anteroposterior and lateral X-ray films of each patient．The lumbar scoliosis,spinous process deviation and spondylolisthesis were statistically analyzed by statistical software．Results A total of 59 people had lumbar scoliosis,accounting for 35.98%．There were 47 patients with 5°-10°Cobb angle,accounting for 28.66%．There were 12 patients with Cobb angle >10°,accounting for 7.32%．L4 was the main lower apical vertebra of lumbar scoliosis．There were 12 patients with L3 as the lower apical vertebra,accounting for 20.34%;37 patients with L4 as the lower apical vertebra,accounting for 62.71%;10 patients with L5 as the lower apical vertebra,accounting for 16.95%．A total of 119 people appeared spinous process deviation,accounting for 72.56%．L5 spinous process deviation was the most common,with proportion of 57.93%,and L4 was the second,with proportion of 48.17%．The results of chi-square test showed that there were significant differences between L5 and L1-L3 spinous process deviation（χ² were 14.580,11.771,7.484,and P values were <0.001,0.001,0.006 respectively）,but no significant difference between L5 and L4 spinous process（χ²=3.124,P=0.077）．A total of 30 patients had spondylolisthesis,accounting for 18.29%．L5 was the most common of spondylolisthesis,with an occurrence rate of 8.54%．L4 was the second,with an occurrence rate of 7.93%．There was no significant difference in spondylolisthesis rate between L4 and L5（χ²=0.040,P=0.841）．The spondylolisthesis rates of L4 and L5 were significantly different from those of L1,L2 and L3（L5 and L1,L2,L3：χ² were 14.580,11.771,7.484,and P values were <0.001,0.001,0.006 respectively;L4 and L1,L2,L3：χ² was 13.495,10.712,6.550,P values was <0.001,0.001,0.010 respectively）．Conclusions Lumbar scoliosis is more common in patients with CNLBP,and L4 is the main lower apical vertebra of lumbar scoliosis．Patients with CNLBP often have spinous process deviation,and the most common is L5 spinous process deviation,followed by L4．L5 and L4 are the most common vertebrae with spondylolisthesis in patients with CNLBP．The soft injury and joint degeneration or disorder related to L5 and L4 should be paid more attention in the treatment of patients with CNLBP．

目的 构建并验证主动脉夹层B型（TBAD）患者急性期预后的列线图预测模型,帮助临床医生在急性期内更准确地评估TBAD患者的死亡风险,并制定更合适的治疗策略。方法 回顾性分析从重症监护医学信息数据库v2.2 中提取的399例 TBAD患者的人口学资料和临床资料,结局为TBAD患者急性期（≤14 d）内死亡。先采用最小绝对收缩选择算法回归筛选特征变量,再采用多因素分析确定独立预后因素,并据此构建预测模型。通过受试者工作特征曲线、校准曲线、决策曲线分析（DCA）评价列线图预测模型的性能和临床适用性。结果 APS Ⅲ评分、二氧化碳总量、红细胞分布宽度为TBAD患者14 d内死亡的独立预测因素。列线图预测模型在内部验证中的受试者工作特征曲线下面积为0.776（95% CI：0.691 ~ 0.860）,Hosmer-Lemeshow 检验P=0.604,校准曲线和标准曲线高度重合,表明该模型具有良好的区分度和校准度。同时,DCA曲线显示,预测模型在大部分的阈值概率范围内提供了显著的净收益。结论 本研究基于APS Ⅲ评分、二氧化碳总量、红细胞分布宽度构建的列线图预测模型可以较准确地预测TBAD患者14 d内的死亡风险,有助于临床医生制定更合适的个体化治疗策略。

Objective To develop and verify a nomogram for predicting acute phase outcomes in patients with type B aortic dissection（TBAD）,enabling clinicians to more precisely evaluate mortality risk in TBAD patients during the acute stage and to devise better treatment plans．Methods This retrospective study analyzed demographic and clinical data of 399 TBAD patients from the Medical Information Mart for Intensive Care IV v2.2,focusing on mortality within 14 days of the acute phase in TBAD patients． Initially,the Least Absolute Shrinkage and Selection Operator regression was employed for feature variable selection,and then multivariate analysis was used to identify independent prognostic factors for constructing the predictive model．The nomogram predictive model's effectiveness and clinical applicability were assessed via the Receiver Operating Characteristic curve,calibration curve,and Decision Curve Analysis（DCA）．Results Acute Physidogy Score Ⅲ score,total carbon dioxide,and red blood cell distribution width emerged as independent predictors of 14-day mortality in TBAD patients．The internal validation of the nomogram predictive model showed an area under the curve of 0.776（95%CI：0.691-0.860）,with a Hosmer-Lemeshow test P-value of 0.604． The close alignment of the calibration and standard curves suggested the model's strong discriminative power and calibration． Furthermore,the DCA curve revealed that the predictive model offered substantial net benefits within a wide range of threshold probabilities．Conclusions This study's nomogram,developed using APS Ⅲ score,total carbon dioxide,and red blood cell distribution width,accurately predicts the 14-day mortality risk in TBAD patients,assisting clinicians in creating better personalized treatment plans．

目的 血清同型半胱氨酸（Hcy）水平与慢性肾脏病（CKD）的进展相关,但中年人群的非线性关联研究较少,本研究旨在寻找慢性肾脏病危险因素。方法 本研究基于NHANES 1996—2006年数据,纳入5 361例45~65岁参与者,以估算肾小球滤过率（eGFR）<60 mL/（min·1.73 m²）和尿白蛋白/肌酐比值（uACR）≥30 mg/g评估肾功能下降。结果 通过逻辑回归及平滑曲线拟合分析发现,Hcy每升高1 µmol/L,eGFR降低的风险增加8%（OR=1.08,95%CI：1.06~1.10）,uACR升高的风险增加2%（OR=1.02,95%CI：1.00~1.04）。非线性分析显示,Hcy对eGFR的阈值效应拐点为13.4 µmol/L（拐点左侧OR=1.59,95%CI：1.49~1.70;右侧无显著关联）。亚组分析表明,性别、高血压、糖尿病等协变量无交互作用,然而,在敏感性分析中,糖尿病患者中Hcy与eGFR降低的关联更强（交互P=0.015 8）。结论 本研究提示,控制Hcy水平或可延缓美国中年人群（尤其是糖尿病患者）的肾功能衰退。

Objective Elevated serum homocysteine（Hcy）levels are linked to chronic kidney disease（CKD）progression,yet the nonlinear relationship in middle-aged populations remains underexplored．Methods This study analyzed data from 5 361 participants aged 45-65 years in the NHANES 1996-2006 cohort．Renal dysfunction was defined as an estimated glomerular filtration rate（eGFR）<60 mL/min/1.73 m² and urinary albumin-to-creatinine ratio（uACR）≥30 mg/g．Results Logistic regression and smoothed curve fitting revealed that each 1 µmol/L increase in Hcy elevated the risk of reduced eGFR by 8%（OR=1.08,95% CI：1.06-1.10）and uACR by 2%（OR=1.02,95% CI：1.00-1.04）．A nonlinear threshold effect was identified at 13.4 µmol/L,with a stronger association below this threshold（OR=1.59,95% CI：1.49-1.70）and no significant effect above it．Subgroup analyses showed no interactions with gender or hypertension,but a stronger Hcy-eGFR association was observed in diabetics（interaction P=0.0158）．Conclusions These findings suggest that controlling Hcy levels may mitigate renal decline,particularly in diabetic populations,warranting further causal investigations．

随着中西医结合的不断深入,医学工作者在临床工作中发现,西药因囿于西医体系,很难在中医药理论体系指导下的临床诊疗上发挥作用,极有必要走西药中药化之路,以弥补这一方面的不足。本文以阿司匹林为主要范例,从推测西药的中药性质入手,总结归纳几种研究方法及注意事项,并大致总结目前研究西药中药化上的诸多不足,同时收集汇总目前相关文献中提到的西药的中药性质,以抛砖引玉,供后续研究者参考。

With the continuous deepening of Chinese medicalization of western medicine,it is not difficult to find that western medicine is limited to the western medicine system,which is hard to play a role in clinical diagnosis and treatment under the guidance of traditional Chinese medicine（TCM）system．It is extremely necessary to take the road of TCM of western medicines to make up for the deficiencies．In this paper,we take aspirin as the main example,start from the speculation of the nature of western medicines,summarize several research methods and notes,and generally summarize the many shortcomings of the current research on the Chinese medicalization of western medicines,and at the same time,collect and summarize the TLM nature of western medicines mentioned in the relevant literature,to provide a reference for the subsequent researchers．

腹腔镜手术后除躯体创伤疼痛,部分患者还可能经历痛苦的术后内脏痛,不仅使患者术后体验不佳,疼痛应激甚至可能加重机体的内环境紊乱,不利于患者的术后康复。内脏痛是来源于内脏器官和组织的疼痛,其产生与脏器的平滑肌痉挛、扩张、缺血、化学炎症刺激等密切相关。在这个过程中,许多离子通道和受体在调节内脏伤害性刺激信号的传导上发挥作用。目前,临床上术后镇痛治疗方案多样,但如何针对性地控制术后内脏痛是临床医生需要面对和解决的问题。为此,该文对腹腔镜术后内脏痛发生的相关机制、内脏感觉的神经传导及临床特征、治疗进展进行综述。

In addition to physical trauma,patients undergoing laparoscopic surgery may also experience postoperative visceral pain．This pain not only impacts the patient's postoperative experience,but can also worsen the body's internal environment and hinder recovery．Visceral pain originates from internal organs and tissues．It is closely related to smooth muscle spasms,dilations,ischemia,and chemical inflammatory stimulation of organs．In this process,numerous ion channels and receptors regulate the transmission of visceral nociceptive stimulus signals．At present,there are multiple clinical treatment options available for postoperative pain management．However,clinicians must overcome the challenge of controlling postoperative visceral pain．This article provides a review of the relevant mechanisms of visceral pain following laparoscopic surgery,the neural conduction of visceral sensation,clinical characteristics and treatment advancements．

目的 探讨院外延续性护理联合院内心理指导对重症烧伤患者创伤应激的影响。方法 选取2020年6月—2022年6月南开大学附属医院（天津市第四医院）重症烧伤科收治的86例重度烧伤患者为研究对象,应用随机数字表法将患者分为观察组与对照组,每组各43例。对照组采取常规护理,观察组在常规护理基础上增加院外延续性护理联合院内心理指导,评估患者的创伤应激指标[血清肿瘤坏死因子α（TNF-α）、白细胞介素6（IL-6）、β-内啡肽（β-ep）]、心理韧性程度、应对行为、创伤后成长水平,并分析患者创伤应激与心理韧性的相关性。结果 干预前,两组的TNF-α、IL-6、β-ep水平比较差异无统计学意义（P>0.05）;干预后,两组创伤应激相关指标水平均下降,且观察组降低幅度更大（P<0.05）。干预后,两组患者乐观性、力量性、坚韧性相关中文版创伤后成长评定量表（C-PTGI）评分均升高,且观察组更高（P<0.05）;Pearson相关性分析显示,TNF-α、IL-6、β-ep等创伤应激指标水平与心理韧性水平呈负相关（P<0.05）;干预后,两组患者积极应对特质应对方式问卷（TCSQ）评分均升高,观察组高于对照组,人消极应对评分均降低,观察组低于对照组（P<0.05）;干预后,两组患者人际关系、精神变化、生活欣赏、个人力量、新的可能相关C-PTGI评分分量表得分均升高,观察组高于对照组（P<0.05）。结论 对重度烧伤患者采取院外延续性护理联合院内心理指导能够降低患者的创伤后应激水平、消极应对评分,提升患者心理韧性程度、创伤后成长水平以及积极应对评分,且创伤后应激水平与心理韧性水平呈负相关。

Objective To explore the effect of out-hospital continuous nursing combined with in-hospital psychological guidance on traumatic stress in severe burn patients．Methods A total of 86 patients with severe burn treated in the Affiliated Hospital of Nankai University（Tianjin Fourth Hospital）from June 2020 to June 2022 were selected as the research objects．The patients were divided into observation group and control group by random number table method,with 43 cases in each group．The control group received routine care,and the observation group was supplemented with out-hospital continuous nursing and in-hospital psychological guidance on the basis of routine care．The traumatic stress indexes [serum tumor necrosis factor-α（TNF-α）,interleukin-6（IL-6）,β-endorphin（β-ep）],psychological toughness,coping behavior and post-traumatic growth level of the patients were evaluated．The correlation between traumatic stress and mental toughness was analyzed．Results Before intervention,the levels of TNF-α,IL-6 and β-ep were not significantly different between the two groups（P>0.05）．After intervention,the levels of traumatic stress-related indicators were decreased between the two groups,and the reduction was greater in the observation group（P<0.05）．After intervention,C-PTGI scores related to optimism,strength and fortitude were increased in both groups,which were higher in observation group（P<0.05）．Pearson correlation analysis showed that the levels of TNF-α,IL-6,β-ep and other traumatic stress indexes were significantly negatively correlated with the levels of mental toughness（P<0.05）．After intervention,the positive coping TCSQ scores of both groups were increased,the observation group was higher,and the negative coping scores were decreased,while the observation group was lower（P<0.05）．After the intervention,the scores of interpersonal relationships,mental changes,life appreciation,personal strength,and new possibly relevant C-PTGI score subscale were increased in both groups,and higher in the observation group（P<0.05）．Conclusions The combination of out-hospital continuous nursing and in-hospital psychological guidance for severe burn patients can reduce the level of post-traumatic stress and negative response score of patients,and improve the level of mental toughness,post-traumatic growth and positive score of patients,and the level of post-traumatic stress is significantly negatively correlated with the level of mental toughness．

目的 调查分析ICU转出患者的陪床家属即照顾者的准备度对其迁移应激的影响作用。方法 纳入2020年1月—2022年12月在焦作市第二人民医院ICU住院治疗的患者家属106人为研究对象,以问卷调查法对患者及家属一般资料、家属准备度水平以及迁移应激水平进行数据分析。结果 ICU转出患者家属的照顾者准备度测试总分为（14.92±3.86）分,为中等水平,迁移应激总分为（57.21±5.88）分,为中度应激水平,照顾准备度与迁移应激呈负相关。结论 ICU转出患者家属的照顾者准备度水平不足,且与迁移应激水平呈负相关。

Objective To investigate and analyze the effect of readiness of accompanying family members,i.e．caregivers,on migration stress in patients transferred out of the ICU．Methods From January 2020 to December 2022,106 patients hospitalized in ICU were included in the study,general data of patients and their caregives,preparation level and migration stress level of caregives were investigated and analyzed by questionnaire survey．Results The caregivers of patients transferred out of the ICU had a total readiness test score of（14.92±3.86）,which was moderate level,and the total score of migration stress was（57.21±5.88）,which was moderate stress level,and was negatively correlated with readiness．Conclusions The readiness level of the caregivers of patients transferred out of the ICU is insufficient and negatively correlated with the migration stress level．

目的 探讨头位分娩评分法在孕妇分娩过程中的应用价值。方法 选取2020年1月—2022年12月于郑州市妇幼保健院进行建档住院的4 000例待产分娩孕妇作为研究对象,所有孕妇在宫口已开时都给予头位分娩评分,观察与记录所有孕妇的分娩方式与头位分娩评分法状况,记录新生儿出生1 min与出生5 min的Apgar评分,记录所有孕妇的产后并发症发生情况。结果 在4 000例孕妇中,Apgar评分≤8分者156例、9~10分者894例、≥11分者2 950例。不同头位分娩评分法孕妇的年龄、孕周、孕次、产次对比差异无统计学意义（P>0.05）。≤8分者的剖宫产率为100.0%,9~10分者、≥11分者分别为35.3%、5.7%,对比差异有统计学意义（P<0.05）。≤8分者、9~10分者、≥11分者的新生儿出生1 min与出生5 min的Apgar评分对比差异无统计学意义（P>0.05）。≤8分者、9~10分者、≥11分者的产后发热、产后出血、产后血肿、产后尿潴留等并发症发生率为分别为13.5%、2.0%、0.2%,对比差异有统计学意义（P<0.05）。结论 头位分娩评分法在产科中处理头位分娩时具有指导价值,值得推广应用。

Objective To explore and analyze the application values of the head position delivery scoring method in the delivery process of 4 000 pregnant women．Methods Selected 4 000 cases of pregnant women as the study object,all pregnant women gave head delivery score,observed and recorded the delivery mode and head delivery scoring method,recorded the Apgar score of 1 min and 5 min,and recorded the occurrence of postpartum complications of all pregnant women．Results Among the 4 000 pregnant women,156 scored ≤8,894 scored 9-10,and 2 950 scored ≥11．There was no significant difference in the age,gestational age,pregnancy time and delivery status of pregnant women in different head delivery scoring methods（P>0.05）．The cesarean section of patients with ≤8 score was 100.0%,those with 9-10 score and those with ≥11 score were 35.3% and 5.7%,respectively,and there were significant differences（P<0.05）．There was no significant difference in Apgar score between newborns with ≤8 scores,9-10 scores and ≥11 scores at 1 min and 5 min after birth（P>0.05）．The incidence rates of puerperal fever,postpartum hemorrhage,postpartum hematoma and postpartum urinary retention were 13.5%,2.0% and 0.2% in patients with ≤8 score,9~10 score and ≥11 score,respectively,and there were significant differences（P<0.05）．Conclusions The head delivery scoring method has guiding value in handling head delivery in obstetrics and is worth promoting and applying．

目的 分析阿莫西林克拉维酸钾与第三代头孢类抗菌药联合应用于新生儿肺炎患儿的应用效果及其对患儿肠道菌群的影响。方法 选择在2021年2月—2022年11月期间于我院新生儿科接受相关治疗的100例新生儿肺炎患儿,依照简单随机化法将患儿分为研究组（n=50）及参照组（n=50）。给予参照组常规新生儿肺炎治疗,在此基础上给予研究组患者阿莫西林克拉维酸钾与第三代头孢类抗菌药的联合治疗。治疗结束后对比两组患儿的血清因子水平、肠道菌落情况、临床疗效以及不良反应发生情况。结果 治疗前,两组患儿的血清因子水平、肠道内菌群数量比较差异无统计学意义（P>0.05）,治疗后两组患儿的降钙素原（procalcitonin,PCT）、C-反应蛋白（C-reactive protein,CRP）、白细胞计数（white blood cell count,WBC）、肠球菌、肠杆菌、双歧杆菌以及乳酸杆菌水平均有改善（P<0.05）,其中研究组的PCT、CRP、WBC、肠球菌、双歧杆菌以及乳酸杆菌数量低于参照组,而研究组的肠杆菌数量高于参照组;同时研究组的临床有效率（94.00%）与参照组的临床有效率（86.00%）比较差异无统计学意义（P>0.05）;两组患儿的不良反应发生率比较差异无统计学意义（P>0.05）,但其中研究组腹泻的发生率高于参照组（P<0.05）。结论 在对新生儿肺炎患儿进行治疗时采取阿莫西林克拉维酸钾单纯治疗与阿莫西林克拉维酸钾+第三代头孢类抗菌药（头孢他啶）的临床疗效相当,联合用药虽能更为显著地减少患儿机体的细菌数量,改善血清因子水平,但更易发生腹泻的并发症,且为了减少耐药性,应适当采用单独用药。

Objective To analyze the application effect of amoxicillin clavulanate potassium combined with third-generation cephalosporin antibiotics in children with neonatal pneumonia and its impact on the intestinal microbiota．Methods From February 2021 to November 2022,100 newborns with pneumonia who received relevant treatment in the Department of Neonatology at the First People’s Hospital of Shangqiu City were randomly divided into a study group（n=50）and a reference group（n=50）using a simple randomization method．Routine treatment was provided for neonatal pneumonia in the reference group,and on this basis,a combination treatment of amoxicillin,clavulanate potassium,and third-generation cephalosporin antibiotics was applied on the study group patients．After treatment,the serum factor levels,intestinal colony status,clinical efficacy,and incidence of adverse reactions were compared between the two groups of children．Results Before treatment,there were no statistically significant differences in serum factor levels and intestinal microbiota between the two groups of children（P>0.05）．After treatment,the levels of procalcitonin（PCT）,C-reactive protein（CRP）,white blood cell count（WBC）,Enterococcus,Enterobacter,Bifidobacterium,and Lactobacillus in the two groups of children improved（P<0.05）,with the levels of PCT,CRP,WBC,the number of Enterococcus,Bifidobacterium,and Lactobacillus in the study group was lower than that in the reference group,while the number of Enterobacter in the study group was higher．There was no statistically significant difference（P>0.05）in the clinical response rate between the study group（94.00%）and the reference group（86.00%）．There was no statistically significant difference in the incidence of adverse reactions between the two groups of children（P>0.05）,but the incidence of diarrhea in the study group was higher than that in the reference group（P<0.05）．Conclusions The clinical efficacy of amoxicillin clavulanate potassium alone and amoxicillin clavulanate potassium+third-generation cephalosporin antibiotics（ceftazidime）in the treatment of newborns with pneumonia is comparable．Although the combination therapy can significantly reduce the number of bacteria in the body of children and improve serum factor levels,it is more prone to complications of diarrhea．In order to reduce drug resistance,separate medication should be appropriately used．