目的 研究内托生肌法治疗肉芽肿性乳腺炎溃后期的临床疗效。方法 63例符合肉芽肿性乳腺炎溃后期的患者,分为西药组31例和中药组32例。西医药组予常规激素、抗生素等治疗,中药组予内托生肌法,加减组方,两组治疗时间为6个月。比较两组患者的疾病转归、乳房外形评价、临床症状观察评分等指标。结果 中药组6个月治愈率高于西药组,中药组临床治愈18例（56.2%）、痊愈11例（34.4%）,相较于西药组临床治愈11例（35.5%）和痊愈9例（29%）;治疗后中药组乳房外形评价优于西药组,中药组临床症状评分较低,组间比较差异具有统计学意义。两组患者治疗前后免疫球蛋白IgA、IgG、IgM水平比较差异均未见统计学意义。中药组相较于西药组不良反应更少,患者依从性更高。结论 内托生肌法治疗肉芽肿性乳腺炎溃后期能促进肉芽肿创面愈合,加快肉芽组织新生,改善破溃流脓症状以及在恢复乳房外观方面具有明显的优势。

Objective To study the clinical efficacy of endotropic muscle-generating therapy in treating late-stage ulcerative granulomatous mastitis．Methods Sixty-three eligible patients were included in the western medicine group（31 cases）and the traditional Chinese medicine group（32 cases）．The western medicine group received conventional hormones and antibiotics,while the traditional Chinese medicine group received the endotropic muscle-generating method with adjustments．The treatment duration for both groups was six months．Disease regression,breast shape evaluation,clinical symptom observation scores,and other relevant indices of both groups were compared．Results The study found that the six-month cure rate in the traditional Chinese medicine group（56.2% clinically cured,34.4% cured）exceeded that of the western medicine group（35.5% clinically cured,29% cured）．Breast appearance evaluation in the traditional Chinese medicine group significantly better that of the western medicine group post-treatment,and clinical symptom scores were lower,demonstrating a statistically significant difference．Before and after treatment,there was no significant difference in the levels of immunoglobulins A,G,and M observed between the two groups．The traditional Chinese medicine group exhibited fewer side effects and higher patient compliance compared to the western medicine group．Conclusions The endotropic muscle-generating method,when employed to treat granulomatous mastitis in the late ulcerative stage,proves effective in promoting granulomatous wound healing,accelerating the generation of new granulation tissue,and improving ulceration and pus flow symptoms．Additionally,it contributes to the restoration of breast appearance．

目的 评估多种气道湿化方法对喉癌患者术后气道湿化的效果。方法 检索PubMed、Cochrane、Embase、Web of Science、Ovid、中国知网、万方、CBM、Google Scholar等数据库和网站,检索时限为建库至2023年2月。搜集关于喉癌患者术后不同气道湿化方法的随机对照试验,采用JBI2016年随机对照试验RCT评价标准评价文献质量。使用ADDIS1.16.5软件进行网状Meta分析。结果 纳入18篇研究,共1 596例患者。结果显示,镇痛泵持续泵入与注射器间断滴入、喷雾瓶间断喷雾在痰痂形成方面比较差异有统计学意义[OR（95%CI）=537.70（4.18,124 511.88）、0（0,0.52）,P<0.05];湿化满意度方面,注射器间断滴入与喷雾瓶间断喷雾比较差异有统计学意义[OR（95%CI）=8.55（1.40,73.35）,P<0.05];其余比较差异无统计学意义（P>0.05）。概率排序显示,降低肺部感染、黏膜出血和痰痂形成、痰液黏稠度、咳嗽和湿化不满意的发生,最优方法分别为湿化泵持续泵入、镇痛泵持续泵入、MR400湿化器和输液器持续泵入。结论 综合网状Meta分析及概率排序结果,考虑到喉癌患者术后早期下床活动,推荐便携式持续湿化方法。

Objective To access the effects of multiple airway humidification methods for postoperative patients with laryngeal cancer．Methods PubMed,Cochrane Library,EMbase,Web of Science,Ovid,China National Knowledge Infrastructure,Wanfang database,CBM and Google Scholar were searched systematically from establishment to February 2023,respectively．Related randomized controlled trials on airway humidification for postoperative patients with laryngeal cancer was analyzed and the quality of the literature was assessed using the JBI 2016 RCT evaluation．The network Meta analysis was performed using ADDIS 1.16.5 softwares．Results A total of 18 articles and 1596 patients were inciuded．The results showed that the analgesia pump continued to pump into the airway compared with the syringe intermittently drip and the spray bottle intermittent spray was statistically different in the formation of sputum[OR（95%CI）=537.70（4.18,124 511.88）,0（0,0.52）,P<0.05]．In terms of satisfaction of wetness,the difference between the intermittent drop of the syringe and the intermittent spray of the spray bottle was statistically different[OR（95%CI）=8.55（1.40,73.35）,P<0.05],the others were not statistically different（P>0.05）．Probability ranking table shows that the optimal methods were the humidification pump continues to pump into the airway,the analgesia pump continued to pump into the airway,the MR400 humidifier and the infusion set continuously pumped into the airway,which were beneficial to the reduction in pulmonary infection,tracheal mucosal hemorrhage and formation of phlegm callus,the degree of sputum viscosity,cough and unsatisfactory wetness．Conclusions Based on the comprehensive mesh meta-analysis and probability ranking results,a portable continuous humidification method is recommended considering the early post-operative activities of laryngeal cancer patients．

目的 探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法 将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组,给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗,观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果 观察组手术时间、术后血尿以及住院时间均短于对照组,观察组术中出血量少于对照组,观察组结石清除率高于对照组（P<0.05）;术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P<0.05）;两组肾动脉收缩期血流速度（V_s）以及舒张末期血流速度（V_d）对比差异无统计学意义（P>0.05）;观察组并发症发生率（4.16%）低于对照组（19.15%）（P<0.05）。结论 无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况,减轻患者肾脏损伤,提高结石清除率,不影响肾脏血流,且并发症更少。

Objective To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy,PCNL）in the treatment of impacted upper ureteral stones．Methods A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL）,48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions,serological indicators,renal hemodynamics and complications of the two groups were observed．Results The operation time,postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume of the observation group was less than that of the control group,and the stone free rate of the observation group was higher than that of the control group（P<0.05）．One day after surgery,the levels of kidney injury molecule-1（KIM-1）,lipocalin（NGAL）and cystatin C（Cys-C）in the observation group were lower than those in the control group（P<0.05）;the renal artery systolic blood flow velocity（V_s）and end-diastolic blood flow velocity（V_d）had no statistical significance（P>0.05）;the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P<0.05）．Conclusions Tubeless minimally invasive PCNL can improve the general conditions of surgery,reduce kidney damage,increase stone free rate,does not affect renal blood flow,and has fewer complications．

目的 探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法 对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析,将其分为观察组,另选取82例肺部良性肿瘤患者作为对照组,收集其术前CT增强延迟扫描结果,以术后病理诊断结果为金标准,分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值,采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征（12.50% vs 53.57%）、内部空泡征数量（6.25% vs 39.29%）低于对照组（χ²=26.560、24.680,P<0.05）,观察组患者边缘毛刺（56.25% vs 17.86%）、胸部凹陷征（59.38% vs 14.29%）、高于对照组（χ²=43.330、64.600,P<0.05）;82例非小细胞肺癌通过CT增强延迟扫描共确诊79例,CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%（79/82）,与病理诊断结果100.00%对比差异无统计学意义（χ²=3.060,P=0.080）;82例非小细胞肺癌平均CT增强值为（39.14±7.31）,不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义（P>0.05）,不同病理类型[腺癌（43.75±7.15）vs 鳞癌（34.74±6.12）]、细胞分化程度[中、低分化（45.71±7.21）vs 高分化（32.81±5.11）]、临床分期[Ⅰ期（31.03±2.12）vs Ⅱ期（36.61±3.13）vs Ⅲa期（46.32±6.83）]患者、淋巴结转移[是（42.75±4.21）vs 否（35.77±8.13）]CT增强值对比差异有统计学意义（t/F=5.243、8.804、84.828、4.378,P<0.05）;Spearman相关分析结果显示：病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008,P<0.05）。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值,其诊断准确率与病理诊断并无显著差异,且可通过CT增强延迟扫描技术确定患者CT增强值,从而为非小细胞肺癌患者术后病理特征判断提供参考。

Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer（NSCLC）．Methods A retrospective analysis was conducted on 82 patients with NSCLC who underwent surgical treatment in a hospital from May 2021 to May 2024．They were included into an observation group and another 82 patients with benign lung tumors were included in the control group．The preoperative CT enhanced delayed scanning results were collected,and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC．And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared,and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC．Results CT enhanced delayed scanning showed that the number of lobular（12.50% vs 53.57%）and internal vacuolar signs（6.25% vs 39.29%）in the observation group was significantly lower than that in the control group（χ²=26.560,24.680,P<0.05）,while the edge spicules（56.25% vs 17.86%）and chest depression signs（59.38% vs 14.29%）in the observation group were significantly higher than that in the control group（χ²=43.330,64.600,P<0.05）．A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan,and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%（79/82）,with no significant difference from the pathological diagnosis result of 100.00%（χ²=3.060,P=0.080）．The average CT enhancement value of 82 NSCLC cases was（39.14±7.31）．There was no significant difference in CT enhancement values among patients of different genders,ages,maximum tumor diameter,and lymph node infiltration（P>0.05）．Patients with different pathological types [adenocarcinoma（43.75±7.15）vs squamous cell carcinoma（34.74±6.12）],degree of cell differentiation [moderate,and low differentiation（45.7±7.21）vs high differentiation（32.81±5.11）],clinical stage [I（31.03±2.12）vs II（36.61±3.13）vs IIIa（46.32±6.83）] and lymph node metastasis [yes（42.75±4.21）,vs no（35.77±8.13）] CT enhancement had significant difference（t/F=5.243,8.804,84.828,4.378,P<0.05）．The Spearman correlation analysis results showed that pathological type,degree of cell differentiation,clinical stage,lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients（r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008）．Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC．Its diagnostic accuracy is not significantly different from pathological diagnosis,and the CT enhanced value of patients can be determined through CT enhanced delayed scanning,providing reference for postoperative pathological feature judgment of NSCLC patients．

目的 探究经鼻间歇正压通气（NIPPV）和经鼻持续正压通气（NCPAP）作为早产儿呼吸窘迫综合征气管插管机械通气拔管后无创呼吸支持过渡的临床效果的差异。方法 纳入2021年1月—2023年6月在广东省吴川市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征早产儿66例,用随机数字表法将患儿分为NIPPV组（33例）和NCPAP组（33例）。NIPPV组患儿予经鼻间歇正压通气作为过渡期无创呼吸支持,NCPAP组患儿则予以经鼻持续正压通气作为过渡期无创呼吸支持。对比两组患儿治疗前后血气分析结果、脱机失败率、无创呼吸支持时间、无创后吸氧时间、总给氧时间等指标。结果 接受无创呼吸支持12 h后,NIPPV组患儿的PaO₂升至（76.46±1.10）mmHg,高于NCPAP组患儿的（75.51±2.15）mmHg（t=2.249,P=0.028）。此外,NIPPV组患儿的SaO₂升至（96.36±0.52）%,也高于NCPAP组患儿的（96.07±0.59）%（t=2.138,P=0.034）。而NIPPV组患儿的PaCO₂则降至（41.39±0.74）mmHg,较NCPAP组患儿的（41.87±0.95 ）mmHg低（t=-2.230,P=0.025）。NIPPV组无创呼吸支持时间为（3.09±0.52）d,短于NCPAP组的（3.45±0.62）d,且该差异有统计学意义（t=2.584,P=0.012）。同样的,NIPPV组总给氧时间（9.52±0.76）天较NCPAP组的（10.00±0.79）天短,且该差异有统计学意义（t=-2.548,P=0.013）。而两组在脱机失败率、无创呼吸支持后吸氧时间、不良反应发生率等方面比较差异无统计学意义（均P>0.05）。结论 与NCPAP模式相比,早产儿拔管后应用NIPPV模式进行无创呼吸支持取得的临床效果更优。

Objective To explore the difference of clinical effect of nasal intermittent positive pressure ventilation（NIPPV）and nasal continuous positive pressure ventilation（NCPAP）as non-invasive respiratory support mode after extubation in preterm infants with endotracheal intubation．Methods Sixty-six cases of preterm infants with neonatal respiratory distress syndrome treated in our hospital from January 2021 to June 2023 were included．All the subjects were randomly divided into NIPPV group（n=33）and NCPAP group（n=33）．The blood gas analysis results,weaning failure rate,non-invasive respiratory support time,oxygen inhalation time after noninvasive ventilation,total oxygen administration time．were compared between the two groups．Results After 12 hours of noninvasive respiratory support,PaO₂ in the NIPPV group increased to（76.46±1.10）mmHg,which was significantly higher than that（75.51±2.15）mmHg in the NCPAP group（t=2.249,P=0.028）．In addition,SaO₂ in the NIPPV group increased to （96.36±0.52）%,which was also significantly higher than that（96.07±0.59）% in the NCPAP group（t=2.138,P=0.034）．The PaCO₂ in the NIPPV group decreased to （41.39±0.74）mmHg,which was lower than that（41.87±0.95）mmHg in the NCPAP group（t=-2.230,P=0.025）．The duration of non-invasive respiratory support in the NIPPV group（3.09±0.52） days was shorter than that（3.45±0.62）days in the NCPAP group,and the difference was statistically significant（t=2.584,P=0.012）．Similarly,the total duration of oxygen administration in the NIPPV group（9.52±0.76）days was shorter than that（10.00±0.79）days in the NCPAP group,and the difference was statistically significant（t=-2.548,P=0.013）．There were no significant differences in weaning failure rate,oxygen inhalation time after noninvasive respiratory support,and incidence of adverse reactions between the two groups（P>0.05）．Conclusions Compared with NCPAP mode,NIPPV mode for non-invasive respiratory support in preterm infants after extubating has better clinical effect,and it is worthy of clinical application．

目的 评估医院-社区-家庭一体化康复护理模式对慢性创面患者生活质量及创面愈合的潜在影响。方法 选择2023年1月—2024年6月在广州市第一人民医院接受治疗的慢性创面患者80例作为研究对象,所有患者在住院期间均接受基于溃疡面积、深度及是否合并感染等因素的综合治疗,包括彻底清创、创缘处理、负压治疗、感染控制等治疗,并接受常规护理。出院前,通过随机数字表法将患者分为两组,每组40例。两组患者在住院期间均接受常规护理,出院后,对照组接受延续护理并定期复查。干预组40例患者在出院后接受医院-社区-家庭一体化康复护理模式。入组时及护理3个月后,使用生活质量调查表（SF-36）对患者生活质量和创面愈合率进行评估。结果 干预组创面愈合率为（32.61±4.26）%,高于对照组（11.48±1.04）%,差异具有统计学意义（t=19.473,P<0.05）。两组患者在护理3个月后的数字评定量表评分和创面疼痛频率评分均较入组时降低（P<0.05）。其中干预组护理3个月后的创面VAS评分为（1.82±0.17）分,创面疼痛频率评分为（1.28±0.25）分;而对照组分别为（3.91±0.22）分和（2.63±0.37）分,干预组低于对照组（P<0.05）。此外,干预组在护理后3个月的总体健康、生理功能、生理职能、精神健康、情感功能、社会功能评分均高于对照组（P<0.05）。在居家3个月期间,干预组的感染发生率为5.00%,而对照组为17.50%,干预组感染发生率低于对照组（χ²=3.781,P<0.05）。结论 本研究表明,医院-社区-家庭一体化康复护理模式干预能够促进慢性创面患者的创面愈合,降低居家期间感染的风险,并提升患者的生活质量。

Objective To assess the potential impact of the integrated hospital-community-home rehabilitation nursing model on the quality of life and wound healing in patients with chronic wounds．Methods A total of 80 patients with chronic wounds treated at the Guangzhou First People’s Hospital from January 2023 to June 2024 were selected as the study subjects．All patients received comprehensive treatment during their hospital stay,including thorough debridement,edge treatment,vacuum therapy,infection control and routine nursing care．Prior to discharge,the patients were randomly divided into two groups using a random number table,with 40 patients in each group．Both groups received routine nursing care during their hospital stay,and the control group received continuing nursing care and regular follow-up after discharge．Forty patients in the intervention group received the integrated hospital-community-home rehabilitation nursing model after discharge．Quality of life（QoL）and wound healing rates were assessed using the Short Form 36（SF-36）questionnaire at the time of enrollment and 3 months after nursing．Results The wound healing rate in the intervention group was significantly higher than that in the control group （[32.61±4.26]% vs [11.48±1.04]%）,with a statistical difference（t=19.473,P<0.05）．The numerical rating scale（NRS）scores and frequency of wound pain scores decreased in both groups 3 months after nursing compared to the enrollment period（P<0.05）．Specifically,the VAS score for wound pain in the intervention group 3 months after nursing was（1.82±0.17）,and the frequency of wound pain was（1.28±0.25）,in the control group,these scores were（3.91±0.22）and（2.63±0.37）,respectively,with the intervention group scoring significantly lower than the control group（P<0.05）．Furthermore,the scores for overall health,physical function,role physical,mental health,emotional function,and social function in the intervention group were higher than those in the control group 3 months after nursing（P<0.05）．During the 3-month home recovery period,the incidence of infection in the intervention group was 5.00%,whereas it was 17.50% in the control group,with the intervention group showing a lower incidence of infection（χ²=3.781,P<0.05）．Conclusions This study demonstrates that the hospital-community-home integrated rehabilitation care model intervention can promote wound healing in chronic wound patients,reduce the risk of infection during home care,and significantly improve patients’ quality of life．

目的 探讨单克隆免疫球蛋白血症患者M蛋白质量浓度检测的临床意义。方法 选取2018年6月—2023年6月龙岩人民医院收治的88例单克隆免疫球蛋白血症患者为研究对象,其中意义未明单克隆免疫球蛋白血症（MGUS）21例,具有肾脏意义单克隆免疫球蛋白血症（MGRS）50例,血液系统恶性肿瘤17例。对比其M蛋白质量浓度及临床实验室相关指标表达水平,采用Spearman相关分析法分析临床实验室相关指标的与M蛋白的相关性,对所有患者进行半年随访,以预后情况作为因变量,纳入Logistics回归模型分析M蛋白质量浓度对单克隆免疫球蛋白血症预后的预测价值。结果 不同病种M蛋白水平分别为（2.42±0.55）（2.57±0.64）（4.36±0.64）g/L、24 h尿蛋白分别为（1.45±0.16）（2.98±0.68）（2.43±0.44）g/24 h、血清白蛋白质量浓度分别为（31.01±3.06）（35.03±5.04）（39.05±7.08）g/L、总胆固醇水平分别为（3.42±1.25）（3.87±0.64）、（4.16±0.64）mmol/L、血肌酐水平分别为（114.35±23.23）（81.18±12.12）（146.36±21.12）μmol/L、血红蛋白质量浓度分别为（148.12±15.26）（141.69±12.15）（133.34±15.31）g/L,组间对比差异均有统计学意义（F分别为23.890,19.700,12.044,25.767,36.572,10.267,P<0.05）。MGUS患者24h尿蛋白与M蛋白有相关性（r=-0.384,P=0.033）,24 h尿蛋白、血清白蛋白、总胆固醇、血肌酐与MGRS患者M蛋白有相关性（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,血清白蛋白、总胆固醇、血红蛋白与血液系统恶性肿瘤患者M蛋白有相关性（r=0.374,P=0.029;r=-0.617,P=0.001;r=-0.414,P=0.024）;年龄、M蛋白为单克隆免疫球蛋白血症患者预后的影响因素（P<0.05）。结论 不同单克隆免疫球蛋白血症患者M蛋白水平存在差异,其中血液系统恶性肿瘤患者的M蛋白水平最高,且M蛋白为单克隆免疫球蛋白血症预后的独立影响因素。

Objective To explore the clinical significance of detecting M protein concentration in patients with monoclonal gammopathy．Methods From June 2018 to June 2023,88 patients with monoclonal gammopathy admitted to the hospital were selected as the study subjects．Among them,21 cases of monoclonal gammopathy with undetermined significance（MGUS）,50 cases of monoclonal gammopathy with renal significance（MGRS）,and 17 cases of hematological malignancies were selected． Concentration of M protein and the expression levels of clinical laboratory related indicators were compared,Spearman correlation analysis was used to analyze the correlation between clinical laboratory related indicators and M protein．All patients were followed up for six months,with prognosis as the dependent variable,included in the logistic regression model to analyze the predictive value of M protein concentration on the prognosis of monoclonal gammopathy．Results There were significant differences in the expression levels of M protein（[2.42±0.55],[2.57±0.64],[4.36±0.64]）g/L,24-hour urine protein（[1.45±0.16],[2.98±0.68],[2.43±0.44]）g/24 h,serum albumin（[31.01±3.06],[35.03±5.04],[39.05±7.08]）g/L,total cholesterol（[3.42±1.25],[3.87±0.64],[4.16±0.64]）mmol/L,blood creatinine（[114.35±23.23],[81.18±12.12],[146.36±21.12]）μmol/L,and hemoglobin（[148.12±15.26],[141.69±12.15],[133.34±15.31]）g/L among different diseases（F=23.890,19.700,12.044,25.767,36.572,10.267;P<0.05）．There was a significant correlation between 24 h urinary protein and M protein in MGUS patients（r=-0.384,P=0.033）．Urinary protein,serum albumin,serum cholesterol and blood creatinine were significantly associated with M protein in MGRS patients（r=-0.586,P=0.006;r=0.431,P=0.018;r=-0.457,P=0.020;r=0.523,P=0.009）,Serum albumin,total cholesterol,and hemoglobin were significantly associated with M protein in patients with hematological malignancies（r=0.374,P=0.029;r=- 0.617,P=0.001;r=-0.414,P=0.024;P<0.05）．Age and M protein were independent risk factors for the prognosis of patients with monoclonal gammopathy（P<0.05）．Conclusions There are significant differences in the concentration of M protein among patients with different levels of monoclonal gammopathy,with the highest level observed in patients with hematological malignancies．M protein is an independent prognostic factor for monoclonal gammopathy．

目的本文聚焦DeepSeek这一国产人工智能技术,结合护理临床实践,系统探讨其在护理场景中的应用潜力、现存问题及应对策略。方法检索国内外相关文献,与现有通用人工智能技术对比,进行综述,并提出思考和建议。结果预计DeepSeek在护理文书自动化、个性化护理方案生成、临床决策支持、护理质控及教育培训等提供适配应用路径,针对性的服务和解决方案等。结论DeepSeek可通过多模态技术整合与跨平台互补策略,推动护理服务向智能化、精准化方向发展,为缓解护理人力短缺、优化资源分配提供新思路。

ObjectiveThis study focuses on DeepSeek,a domestic artificial intelligence technology,systematically exploring its application potential,existing issues,and targeted strategies in nursing clinical scenarios through integration with practical nursing care contexts．MethodsRelevant literatures from both domestic and international sources were collected,compared with existing Artificial General Intelligence（AGI）technologies,to conduct a review,and propose reflections and recommendations．ResultsThrough literature review and technical comparisons,the results proposed specific application paths for DeepSeek in scenarios such as automated nursing documentation,personalized care plan generation,clinical decision support,quality control,and education．It further addressed issues including data privacy,ethical risks,and technical limitations．ConclusionsThe findings suggest that DeepSeek can integrate multimodal technologies and cross-platform complementary strategies to promote intelligent and precise nursing services,offering innovative solutions to alleviate nursing shortages and optimize resource allocation．

目的 探讨不同清洗方法对聚甲基丙烯酸甲酯（PMMA）骨水泥附着的骨科外来医疗器械清洗效果。方法 以河源地区某三级医院消毒供应中心2023年7—12月同型号PMMA骨水泥术后附着的215件骨科外来医疗器械为研究对象,所有器械均为不锈钢材质,表面光滑,无明显磨损,利用随机数字表将其分为对照组与观察组。对照组（107件）采用常规预处理后清洗消毒器清洗,观察组（108件）预处理采用95%乙醇浸泡15 min后联合快干增亮剂清洗消毒器清洗。比较两种不同清洗方法的清洗效果。结果 观察组的器械清洗消毒后更加光滑且清洁,对照组的器械表面有部分磨损且仍存在一定程度的残留物。采用10倍光源放大镜清洁度检查,对照组清洗合格100件,清洗合格率为93.5%;观察组清洗合格108件,清洗合格率为100%。采用杰力试纸法检测,观察组清洗合格率为100%,对照组清洗合格率为94.4%,采用快速检测三磷酸腺苷（ATP）生物荧光法检查,观察组清洗合格率为99.1%,对照组清洗合格率为93.5%,观察组的清洗合格率高于对照组,差异有统计学意义（P<0.05）。结论 PMMA骨水泥附着的骨科外来医疗器械采用95%乙醇浸泡15 min后联合快干增亮剂和清洗消毒器可以提高清洗合格率以及外来器械再处理技术的安全性,为安全质量管理提供了有利依据。该技术适合推广使用,能有效排除医疗隐患,确保医疗安全。

Objective To compare the cleaning effects of different methods on external orthopedic medical devices contaminated with PMMA bone cement. Methods A total of 215 external orthopedic medical devices contaminated with PMMA bone cement were selected from the disinfection supply center of a tertiary hospital in Heyuan from July to December 2023．All devices were made of stainless steel,with smooth surfaces and no significant abrasion．The devices were randomly divided into control group and observation group using a random number table．The control group（107 devices）was cleaned using conventional pre-treatment followed by a cleaning and disinfection machine．The observation group（108 devices）was pre-treated by soaking in 95% medical ethanol for 15 minutes,followed by cleaning with a quick-drying brightener and a cleaning and disinfection machine．The cleaning effects of the two methods were compared．Results The study showed that the devices in the observation group were smoother and cleaner after cleaning and disinfection,while the devices in the control group had some abrasion and residual contaminants．Using a 10 x magnifying glass to check cleanliness,the control group had 107 devices passed the cleaning test,with a pass rate of 93.5%,while the observation group had 108 devices passed,with a pass rate of 100%．Using the Geri test paper method,the observation group had a cleaning pass rate of 100%,and the control group had a pass rate of 94.4%．Using the ATP bioluminescence method,the observation group had a cleaning pass rate of 99.1%,and the control group had a pass rate of 93.5%．The cleaning pass rate of the observation group was higher than that of the control group,with a statistically significant difference（P<0.05）．Conclusions Soaking external orthopedic medical devices contaminated with PMMA bone cement in 95% medical ethanol for 15 minutes,followed by cleaning with a quick-drying brightener and a cleaning and disinfection machine,can improve the cleaning pass rate and enhance the safety of reprocessing external devices．This technique provides a strong basis for safety and quality management,is suitable for widespread use,which effectively eliminates medical hazards,and ensures medical safety．

目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者,依据随机数字表法进行分组处理。对照组60例给予常规扩皮法,观察组60例给予钝性分离扩皮法,对比两组患者扩皮结果。结果 观察组患者满意度为96.67%,对照组患者满意度为86.67%（χ²=3.927,P=0.048）;观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm²、1 d后（4.89±0.94）cm²以及3 d后（0.21±0.05）cm²,均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²,对比差异有统计学意义（t=22.444、17.243、13.704,P<0.05）;观察组患者一次性送鞘成功率为98.33%,对照组患者一次性送鞘成功率为88.33%,观察组高于对照组（χ²=4.821,P=0.028）;扩皮前两组患者的VAS评分无差异（P>0.05）,扩皮后两组患者的VAS评分均降低,且观察组（1.75±0.54）分低于对照组（3.89±1.22）分,对比差异有统计学意义（t=12.425,P<0.001）;观察组患者不良事件发生率为5.00%,对照组患者不良事件发生率为16.67%,观察组患者不良事件发生率低于对照组（χ²=4.227,P<0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率,提高一次性送鞘成功率,减轻患者疼痛感,提高患者满意度。

Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery. Methods From April 2022 to April 2024,120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion,and 60 patients in the observation group received blunt separation skin expansion,which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group,86.67% in the control group（χ²=3.927,P=0.048,P<0.05）．In the observation group,the blood immersion area after catheterization,after 1 d and 3 d were（0.87±0.14）,（4.89±0.94）,（0.21±0.05）cm²,lower than those of the control group [（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²],the comparative difference was statistically significant（t=22.444,17.243,13.704,P<0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%,which was higher than 88.33% in the control group（χ²=4.821,P=0.028<0.05）．There was no difference in VAS scores between the two groups before the intervention（P>0.05）,VAS scores decreased in both groups after the intervention,the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22）,the difference was statistically significant（t=12.425,P<0.001）．The incidence of adverse events in the observation group was 5.00%,and in the control group was 16.67%,which difference was significant（χ²=4.227,P<0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events,improve the success rate of disposable sheath delivery,reduce patient pain,improve patient satisfaction,and have significant clinical application value．