目的 探讨对于重症肺部感染患者采用药物+纤维支气管镜肺泡灌洗吸痰术治疗的效果。方法 选取2021年9月—2023年5月在郑州市第一人民医院ICU中94例肺部感染患者,分为观察组、对照组,对照组进行常规治疗,观察组采用药物+纤维支气管镜肺泡灌洗吸痰术治疗,对比两组患者的疗效、症状的缓解时间、炎性因子、实验室相关指标以及不良反应。结果 治疗后,观察组患者的治疗有效率91.49%高于对照组76.60%（χ²=3.887,P<0.05）,观察组患者的发热、肺部湿啰音、咳嗽以及咳痰等症状的缓解时间分别为（3.09±1.25）（4.17±2.24）（3.95±1.53）（4.05±1.77）d,均低于对照组（5.14±2.43）（7.03±3.23）（6.40±2.62）（6.32±1.81）d（t=5.143、4.988、5.536、6.147,P<0.05）,观察组的 C 反应性蛋白（C-reactive protein,CRP）、白细胞介素-6（Interleukin-6,IL-6）以及Toll样受体4（Toll-like receptor 4,TLR-4）水平分别为（3.64±0.87）mg/L、（54.59±10.65）ng/mL、（7.94±1.57）%,均低于对照组（7.51±1.43）mg/L、（87.66±11.17）ng/mL、（12.11±2.48）%（t=15.850、14.690、9.740,P<0.05）,观察组的气道压力、动脉血二氧化碳分压（partial pressure of carbon dioxide in artery,PaCO₂）水平分别为（6.92±3.60）cmH₂O、（43.19±6.29）mmHg,低于对照组（8.68±2.98）cmH₂O、（55.43±5.95）mmHg,观察组动脉氧分压（Partial arterial oxygen pressure,PaO₂）（86.06±5.31）mmHg、血氧饱和度（oxyhemoglobin saturation,SpO₂）（98.03±6.63）%高于对照组（68.04±5.19）mmHg、（90.22±5.51）%要高（t=2.582、9.692、16.638、6.221,P<0.05）,观察组中的不良反应发生率为2.13%与对照组10.64%比较差异无统计学意义（χ²=2.849,P>0.05）。结论 对处于ICU中的肺部感染患者治疗时,使用药物+纤维支气管镜肺泡灌洗吸痰术能够改善患者症状,降低炎性因子水平。

Objective To investigate the efficacy of medication combined with bronchoscopic alveolar lavage and sputum aspiration in ICU patients with severe pulmonary infection. Methods Ninety-four patients with pulmonary infection in the ICU of Zhengzhou First People's Hospital from September 2021 to May 2023 were selected and divided into observation group and control group．The control group received routine treatment,and the observation group was treated with medication and bronchoscopic alveolar lavage and sputum aspiration．The efficacy,duration of symptom remission,inflammatory factors,laboratory-related indicators and adverse reactions were compared between the two groups. Results After treatment,the effective rate of 91.49% in observation group was significantly higher than 76.60% in control group（χ²=3．887,P<0.05）．The relief time of fever,pulmonary rale,cough and sputum in observation group was（3.09±1.25）d,（4.17±2.24）d,（3.95±1.53）d,and（4.05±1.77）d,respectively,which were significantly lower than the control group[（5.14±2.43）d,（7.03±3.23）d,（6.40±2.62）d and（6.32±1.81）d]（t=5.143,4.988,5.536,6.147,P<0.05）．The levels of CRP,IL-6 and TLR-4 in the observation group were（3.64±0.87）mg/L,（54.59±10.65）ng/mL and（7.94±1.57）%,respectively．They were significantly lower than（7.51±1.43）mg/L,（87.66±11.17）ng/mL and（12.11±2.48）% in the control group（t=15.850,14.690,9.740,P<0.05）．The airway pressure and PaCO₂ levels of the observation group were（6.92±3.60）cmH₂O and（43.19±6.29）mmHg,respectively,which were significantly lower than those of the control group[（8.68±2.98）cmH₂O and（55.43±5.95）mmHg]．The levels of PaO₂[（86.06±5.31）mmHg] and SpO₂[（98.03±6.63）%] in the observation group were higher than those in the control group[（68.04±5.19）mmHg and（90.22±5.51）%],and there were statistically significant differences（t=2.582,9.692,16.638,6.221,P<0.05）．The adverse reactions of 2.13% in the observation group were lower than 10.64% in the control group,and there was no statistically significant difference（χ²=2.849,P>0.05）. Conclusions In ICU patients with severe lung infection,the treatment of drugs combined with alveolar lavage and fiberoptic bronchoscopic aspiration is better,and can significantly improve the symptoms and inflammatory factor levels of patients．

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 探讨无痛消化内镜下高频电刀治疗对胃癌前病变的应用效果及复发率的影响。方法 选取甘肃医学院附属医院2017年1月—2020年1月收治的120例胃癌前病变患者进行回顾性分析,依照其手术治疗方案将其分为两组,各60例。对照组采取常规内镜黏膜下剥离术,观察组患者采取无痛消化内镜下高频电刀剥离治疗。对比两组的切除速度、切除面积、治愈性切除率、完全及整块切除率,对患者进行3年随访,记录其复发情况,并对比两组患者并发症情况。结果 两组的切除面积、治愈性切除率、完全切除率及整块切除率对比差异无统计学意义（P>0.05）,观察组切除速度为（27.34±8.58）mm²/min,高于对照组的（15.54±4.52）mm²/min,差异有统计学意义（P<0.05）。两组患者术后3年的总复发率（28.33% vs 30.00%）对比差异无统计学意义（P>0.05）。观察组感染、穿孔等相关并发症发生率为3.33%,低于对照组的15.00%（P<0.05）。结论 无痛消化内镜下高频电刀与常规内镜黏膜下剥离术治疗胃癌前病变相比具有显著疗效。但无痛消化内镜下高频电刀治疗可提升切除速度,降低并发症发生率。

Objective To explore the application effect and recurrence rate of painless endoscopic high-frequency electrocautery on gastric precancerous lesions．Methods A total of 120 patients with precancerous gastric cancer admitted to the Affiliated Hospital of Gansu Medical College from January 2017 to January 2020 were selected for retrospective analysis and divided into two groups according to their surgical treatment plan,with 60 patients in each group．The control group underwent conventional endoscopic submucosal dissection,and the patients in the observation group received painless digestive endoscopic high-frequency electric knife dissection．The resection speed,resection area,curative resection rate,complete and bulk resection rate were compared of the two groups,the patients were followed up for 3 years to record the recurrence rate,and the complications of the two groups of patients were also compared．Results There were no differences in resection area,curative resection rate,complete resection rate and total resection rate between the two groups（P>0.05）．The resection speed in the observation group was（27.34±8.58）mm²/min,which was higher than that in the control group（15.54±4.52）mm²/min（P<0.05）．There was no difference in the total recurrence rate（28.33% vs 30.00%）at 3 years after surgery between the two groups（P>0.05）．The incidence of infection,perforation and other related complications in the observation group was 3.33%,lower than that in the control group（15.00%）（P<0.05）．Conclusion sCompared with conventional endoscopic submucosal dissection,high-frequency electric knife under painless digestive endoscopy has significant efficacy in the treatment of gastric precancerous lesions．However,painless endoscopic high-frequency electrosurgical treatment can improve the resection speed and reduce the incidence of complications such as infection,perforation and bleeding．

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 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．

目的 了解行角膜胶原交联术患者围术期的体验感受,为角膜胶原交联术的顺利进行及术后康复提供参考依据。方法 采用目的抽样法,于2023年8月—2023年10月在中山大学中山眼科中心选取12例行角膜交联术的患者进行半结构式访谈,采取Colaizzi七步法进行整理分析资料。结果 通过分析得出患者在围手术期的5种感受：焦虑、疼痛、恐惧、紧张、盲目乐观。结论 分析角膜交联手术患者在围术期不同感受,做好围术期护理,希望有利于提高手术效果。

Objective To understand the perioperative experience of patients undergoing corneal collagen cross-linking surgery,and provide reference for the smooth progress of corneal collagen cross-linking surgery and postoperative rehabilitation．Methods Using purposive sampling method,12 patients who underwent corneal cross-linking surgery were selected from the Sun Yat-sen Ophthalmology Center of Sun Yat-sen University from August 2023 to October 2023 for semi-structured interviews．The data were analyzed using the Colaizzi seven step method．Results Through analysis,five feelings of patients during the perioperative period were identified：anxiety,pain,fear,tension and blind optimism．Conclusion sAnalyzing the different feelings of patients undergoing corneal cross-linking surgery during the perioperative period and providing good perioperative care can help achieve satisfactory results in the surgery．

目的 分析基于叙事护理理论的心理干预在突发创伤下肢骨折患者中的应用价值。方法 选择南方医科大学深圳医院2023年4月—2023年10月收治的100例突发创伤下肢骨折患者,根据随机数字表法将患者分为研究组和对照组,各50例。对照组提供常规心理护理和健康教育,研究组在对照组的基础上增加基于叙事护理理论的心理干预。对比两情绪压力量表和创伤后成长情况、康复依从性。结果 研究组的情绪压力评分维度中抑郁和焦虑及压力评分明显低于对照组（P<0.05）;研究组的创伤相关评分维度中与他人的关系、新的可能性和个人力量、生活的欣赏和精神变化评分高于对照组,康复依从性高于对照组（P<0.05）。结论 基于叙事护理理论的心理干预,可缓解突发创伤下肢骨折患者的心理压力,提高康复依从性,促进早日康复。

Objective To analyze the application value of psychological intervention based on narrative nursing theory in patients with sudden traumatic lower extremity fracture．Methods A total of 100 patients with sudden traumatic lower extremity fracture admitted to Shenzhen Hospital of Southern Medical University from April 2023 to October 2023 were selected and divided into study group and control group with 50 cases in each group by random number table method．The control group received routine psychological nursing and health education,and the study group was added psychological intervention based on narrative nursing theory．The two emotional stress scales were compared with post-traumatic growth and rehabilitation compliance．Results The scores of depression,anxiety and stress in the study group were significantly lower than those in the control group（P<0.05）．The trauma-related scores of the study group were significantly higher than those of the control group in relation to others,new possibilities and personal strength,appreciation of life and spiritual changes,and the rehabilitation compliance was significantly higher than that of the control group（P<0.05）．Conclusions Psychological intervention based on narrative nursing theory can relieve psychological pressure of patients with sudden traumatic lower extremity fracture,improve rehabilitation compliance,and promote early recovery．