目的 探讨术前静注艾司氯胺酮在腹腔镜结直肠癌根治术患者中的应用效果。方法 前瞻性分析2024年1月—2025年4月在厦门市中医院行腹腔镜结直肠癌根治术患者的临床资料，根据随机数字表法将患者分为两组：对照组40例，术前5 min予5 mL生理盐水；观察组40例，术前5 min予以0.25 mg/kg艾司氯胺酮（以生理盐水配置成5 mL）。比较围术期指标、炎症因子、负性情绪、疼痛情况、不良反应。结果 观察组的手术时间、麻醉时间、术中出血量分别为（213.54±64.22）min、（240.67±81.26）min、（141.31±45.03）mL，与对照组的（210.43±65.71）min、（244.25±81.33）min、（137.64±42.75）mL比较，差异均无统计学意义（t=0.214、0.197、0.374，P均＞0.05），而观察组丙泊酚、瑞芬太尼用量分别为（1 075.52±134.37）mg、（1 267.18±242.26）μg，虽然低于对照组的（1?126.64±150.21）mg、（1 352.50±295.14）μg，但差异也无统计学意义（t=1.604、1.413，P均＞0.05）；观察组在术后24 h的肿瘤坏死因子-α、白介素-6、C反应蛋白水平分别为（54.52±9.64）pg/mL、（40.08±7.75）pg/mL、（30.38±6.93）mg/L，均低于对照组的（77.31±10.86）pg/mL、（56.35±9.47）pg/mL、（43.73±7.61）mg/L（t=9.926、8.409、8.203，P均＜0.05）；术后1 d的焦虑、抑郁自评量表评分及术后1 h、6 h、12 h、24 h咳嗽时的疼痛视觉模拟量表评分分别为（51.92±4.41）分、（53.96±4.47）分、（3.59±1.14）分、（3.06±1.01）分、（2.89±0.91）分、（2.57±0.76）分，均低于对照组的（55.06±5.12）分、（57.21±5.19）分、（4.27±1.36）分、（3.68±1.18）分、（3.41±1.06）分、（2.96±0.92）分（t=2.939、3.001、2.423、2.525、2.329、2.067，P均＜0.05），但两组术后48 h咳嗽时疼痛视觉模拟量表评分比较差异无统计学意义（P＞0.05）；两组术后不良反应发生率也无显著差异（P＜0.05）。结论 在腹腔镜结直肠癌根治术术前静注艾司氯胺酮可有效降低术后炎症反应水平，减轻术后疼痛，缓解术后负性情绪，且不会增加患者术后不良反应发生率。

Objective To explore the application effect of preoperative intravenous injection of esketamine in patients undergoing laproscopic radical resection of colorectal cancer．Methods The clinical data of patient who underwent laparoscopic radical resection of colorectal cancer in Xiamen Hospital of Traditional Chinese Medicine from January 2024 to April 2025 were retrospectively analyzed．The patients were divided into two groups according to the random number table method：40 cases in the control group were given 5 mL saline，five minutes before operation，40 cases in the observation group were treated with 0.25 mg / kg esketamine（in 5 mL saline）five minutes before operation．The perioperative indicators，inflammatory factors，negative emotions，pain and adverse reactions were compared between two groups．Results The operation time，anesthesia time and intraoperative blood loss of the observation group were（213.54±64.22）min，（240.67±81.26）min and（141.31±45.03）mL，respectively，which were not significantly different from those of the control group（210.43±65.71）min，（244.25±81.33）min and（137.64±42.75）mL（t=0.214，0.197，0.374，all P＞0.05）．The dosage of propofol and remifentanil in the observation group were（1 075.52±134.37）mg and（1 267.18±242.26）μg，respectively，which were lower than those in the control group of （1126.64±150.21）mg and（1352.50±295.14）μg，but the difference was not statistically significant（t=1.604，1.413，P＞0.05）．The levels of tumor necrosis factor-α，interleukin-6 and C-reactive protein in the observation group at 24 h after operation were（54.52±9.64）pg / mL，（40.08±7.75）pg / mL and（30.38±6.93）mg / L，respectively，which were lower than those in the control group of （77.31±10.86）pg / ml，（56.35±9.47）pg / mL and 43.73±7.61）mg / L（t=9.926，8.409，8.203，all P＜0.05）．The scores of Anxiety and Depression Self-Rating Scale at 1 day after operation and the scores of pain visual analogue scale at 1 h，6 h，12 h and 24 h after operation were（51.92±4.41），（53.96±4.47），（3.59±1.14），（3.06±1.01），（2.89±0.91） and（2.57±0.76），respectively，which were lower than those of the control group（55.06±5.12），（57.21±5.19），（4.27±1.36），（3.68±1.18），（3.41±1.06） and（2.96±0.92）（t=2.939，3.001，2.423，2.525，2.329，2.067，P＜0.05）．However，no significant difference was observed in cough-related VAS scores between the groups at 48 h postoperatively（P＞0.05）．Adverse event rates showed no significance in two groups（P＞0.05）．Conclusions Preoperative administration of esketamine in laparoscopic colorectal cancer surgery can attenuate postoperative inflammation，decrease pain，mitigate negative emotions，without increasing the incidence of postoperative adverse reactions．

目的：探讨维生素B2（VB2）联合蓝光照射对新生儿黄疸康复进程及肝脏功能的影响。方法：选取2024年5月—2025年10月收治的150例黄疸患儿，应用随机数字表法分为常规组和试验组，每组75例。常规组接受蓝光照射治疗，试验组在常规组基础上口服VB2治疗。比较两组患儿的氧化应激反应[谷胱甘肽过氧化物酶（GSH-Px），8羟基脱氧鸟苷（8-OHdG）、晚期蛋白氧化产物（AOPP）、超氧阴离子（O2-）]、肝脏微循环[血管性血友病因子（vWF）、可溶性血栓调节蛋白（sTM）、肝动脉阻力指数（HA-RI）、门静脉血流速度（PVV）]、胆红素排泄[总胆红素（TBil）、间接胆红素（IBil）]、肝脏功能[丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）]、康复进程[光疗时间、胆红素恢复正常时间、黄疸消退时间、住院康复时间]及治疗安全性。结果：治疗后，试验组的GSH-Px高于常规组，8-OHdG、AOPP、O2-均低于常规组（P＜0.05）；试验组的vWF、sTM、HA-RI均低于常规组，PVV高于常规组（P＜0.05）。试验组的TBil、IBil、ALT、AST分别为（80.52±5.47）μmol/L、（68.52±5.49）μmol/L、（30.25±5.48）U/L、（32.14±5.22）U/L，均低于常规组[（85.19±6.44）μmol/L、（74.37±6.52）μmol/L、（35.29±6.17）U/L、（38.55±6.48）U/L]，差异有统计学意义（P＜0.05）。试验组的光疗时间、胆红素恢复正常时间、黄疸消退时间、住院康复时间分别为（3.05±0.33）d、（4.22±1.39）d、（5.41±1.27）d、（5.12±0.49）d，均低于常规组[（3.68±0.36）d、（5.36±1.45）d、（6.28±1.33）d、（6.51±0.54）d]，差异有统计学意义（P＜0.05）。试验组的不良反应发生率与常规组比较，差异无统计学意义（P＞0.05）。结论：VB2联合蓝光照射可减轻黄疸患儿的氧化应激反应并改善肝脏微循环，对促进胆红素排泄、改善肝脏功能均有积极影响，在促进患儿康复同时未显著增加治疗风险。其安全性较高，可进一步推广。

Objective: To investigate the effects of vitamin B2 (VB2) combined with blue light irradiation on the recovery process and liver function of neonatal jaundice. Method: 150 children with jaundice admitted from May 2024 to October 2025 were selected and randomly divided into a control group and an experimental group using a random number table method, with 75 cases in each group. The conventional group received blue light irradiation treatment, while the experimental group received oral VB2 treatment on the basis of the conventional group. Compare the oxidative stress response of two groups of children [glutathione peroxidase (GSH Px) higher than the control group, 8-hydroxydeoxyguanosine (8-OHdG), advanced protein oxidation products (AOPP), superoxide anion (O2-)], liver microcirculation [von Willebrand factor (vWF), soluble thrombomodulin (sTM), hepatic artery resistance index (HA-RI), portal vein blood flow velocity (PVV)], bilirubin excretion [total bilirubin (TBil), indirect bilirubin (IBil)], liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST)], rehabilitation process [phototherapy time, bilirubin recovery time to normal, jaundice regression time]. Hospitalization rehabilitation time and treatment safety. Result: After treatment, the GSH Px levels in the experimental group were higher than those in the control group, while 8-OHdG, AOPP, and O2- levels were lower than those in the control group (P<0.05); The vWF, sTM, and HA-RI of the experimental group were lower than those of the control group, while PVV was higher than that of the control group (P<0.05). The TBil, IBil, ALT, and AST of the experimental group were (80.52 ± 5.47) μ mol/L, (68.52 ± 5.49) μ mol/L, (30.25 ± 5.48) U/L, and (32.14 ± 5.22) U/L, respectively, which were lower than those of the conventional group [(85.19 ± 6.44) μ mol/L, (74.37 ± 6.52) μ mol/L, (35.29 ± 6.17) U/L, (38.55 ± 6.48) U/L], and the difference was statistically significant (P<0.05). The phototherapy time, bilirubin recovery time, jaundice resolution time, and hospital rehabilitation time of the experimental group were (3.05 ± 0.33) days, (4.22 ± 1.39) days, (5.41 ± 1.27) days, and (5.12 ± 0.49) days, respectively, which were lower than those of the conventional group [(3.68 ± 0.36) days, (5.36 ± 1.45) days, (6.28 ± 1.33) days, and (6.51 ± 0.54) days], and the difference was statistically significant (P<0.05). The incidence of adverse reactions in the experimental group was not significantly different from that in the control group (P>0.05). Conclusion: VB2 combined with blue light irradiation can alleviate oxidative stress response and improve liver microcirculation in children with jaundice. It has a positive effect on promoting bilirubin excretion and improving liver function, and does not significantly increase treatment risk while promoting the recovery of children. It has high safety and can be further promoted.

目的：探讨利多卡因复合艾司氯胺酮对肺部手术患者苏醒质量及认知功能的影响。方法：选取2023年7月至2025年6月本院收治的100例拟行肺部手术患者，按随机数字表法分为观察组和对照组，各50例。对照组采用常规麻醉方案维持麻醉，观察组在常规麻醉基础上复合利多卡因及艾司氯胺酮辅助麻醉。比较两组患者苏醒质量[拔管后30min Riker镇静躁动评分（SAS）、苏醒时间、拔管时间]、认知功能[术前及术后1d、3d简易精神状态检查表评分（MMSE）]、围术期血流动力学指标[麻醉药物输注前（T0）、气管插管时（T1）、拔管后5min（T2）平均动脉压（MAP）、心率（HR）]及术后72h不良反应发生率。结果：观察组拔管后30min SAS评分、术后1d、3d的MMSE评分高于对照组，苏醒时间、拔管时间低于对照组；观察组T0、T1、T2各时间点MAP、HR无显著差异（P>0.05）；对照组T1、T2时MAP、HR高于T0（P<0.05）；两组不良反应发生率无显著差异（P>0.05）。结论：利多卡因复合艾司氯胺酮应用于肺部手术，可提升患者苏醒质量、保护术后认知功能，维持围术期血流动力学稳定，且安全性良好。

Objective : To investigate the effect of lidocaine combined with esketamine on recovery quality and cognitive function in patients undergoing lung surgery. Methods : A total of 100 patients receiving pulmonary resection at our hospital between July 2023 and December 2025 were enrolled and randomized via a random number table into two equal arms (n=50 per group): observation and control. The control group was treated with routine anesthesia to maintain anesthesia, and the observation group was treated with lidocaine and esketamine on the basis of routine anesthesia. The recovery quality [ Riker sedation agitation score ( SAS ) at 30 min after extubation, recovery time, extubation time ], cognitive function [ simple mental state examination score ( MMSE ) before operation and 1 d, 3 d after operation ], perioperative hemodynamic indexes [ mean arterial pressure ( MAP ), heart rate ( HR ) before anesthesia drug infusion ( T0 ), tracheal intubation ( T1 ), 5 min after extubation ( T2 ) ] and the incidence of adverse reactions at 72 h after operation were compared between the two groups. Results : In the observation group, the SAS score measured 30 minutes post-extubation and the MMSE scores at 1 day and 3 days post-operation were significantly higher than those in the control group. Conversely, both recovery and extubation times were shorter in the observation group compared to the control group. No significant differences in MAP and HR were observed at T0, T1, and T2 within the observation group (P > 0.05). In contrast, within the control group, MAP and HR at T1 and T2 were notably elevated compared to T0, with the differences being statistically significant (P < 0.05). Conclusion : The application of lidocaine combined with esketamine in lung surgery can improve the quality of recovery, protect postoperative cognitive function, maintain perioperative hemodynamic stability, and has good safety.

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 探究25-羟维生素D[25-（OH）D]水平预测糖尿病周围神经病变发生的相关性。方法 选取2021年6月—2021年12月间在上海市静安区南京西路社区卫生服务中心就诊的200例2型糖尿病患者为研究对象,根据体格检查、血液生化、神经症状评分、肌电图等方法分为无周围神经病变组（n=153）和周围神经病变组（n=47）,对比两组患者的一般资料及血清基线25-（OH）D水平,分析25-（OH）D与糖尿病周围神经病变的相关性,采用Logistic回归分析25-（OH）D对糖尿病周围神经病变的预测价值。结果 两组患者基线25-（OH）D水平、空腹血糖、糖化血红蛋白（HbA_1c）、收缩压对比差异有统计学意义（P<0.001）,而年龄、性别、BMI、腰围、餐后血糖值、谷草转氨酶、空腹C肽、总胆固醇、高密度脂蛋白胆固醇、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、血肌酐、血尿酸、舒张压对比无明显差异（P>0.05）;基线25-（OH）D水平与密歇根糖尿病周围神经病变评分（MDNS）呈负相关（r=-0.583,P<0.001）,空腹血糖与MDNS评分呈正相关（r=0.303,P<0.001）;Logistic回归分析提示,25-（OH）D每增加一个单位,糖尿病周围神经病变风险下降25%,校正性别、年龄、HbA_1c、LDL后,相关性依然存在。结论 25-（OH）D水平与糖尿病周围神经病变呈负相关,与该病的发生及发展密切相关,血清25-（OH）D水平可作为预测尿病周围神经病变发生、发展的重要指标。

Objective To explore the correlation of 25-hydroxyvitamin D[25-（OH）D] level in predicting the occurrence of diabetic peripheral neuropathy．Methods A total of 200 patients with type 2 diabetes mellitus（T2DM）who were admitted to Community Health Service Center of West Nanjing Road,Jing’an District,Shanghai from June 2021 and December 2021 were selected as the study subjects．According to physical examination,blood biochemistry,neurological symptom score and electromyography,the patients were divided into two groups：no peripheral neuropathy group（n=153）and peripheral neuropathy group（n=47）．The general data and serum baseline 25-（OH）D levels of the two groups were compared to analyze the correlation between 25-（OH）D and diabetic peripheral neuropathy．The predictive value of 25-（OH）D in diabetic peripheral neuropathy was analyzed by Logistic regression．Results There were significant differences in baseline 25-（OH）D level,fasting blood glucose（FBG）,HbA_1c and SBP between two groups（P<0.001）,but no significant differences in age,sex,BMI,waist circumference,postprandial plasma glucose,AST,C-peptid total cholesterol,HDL-C,triglyceride,LDL-C,Scr,UA and DBP between two groups（P>0.05）．Baseline 25-（OH）D level was negatively correlated with MDNS score（r=-0.583,P<0.001）,and FBG was positively correlated with MDNS score（r=0.303,P<0.001）．Logistic regression analysis showed that the DPN risk decreased by 25% for every unit increase of 25-（OH）D,and the correlation remained after timely adjustment for sex,age,HbA_1c,and LDL-C．Conclusion sThe level of 25-（OH）D is negatively correlated with the occurrence and development of diabetic peripheral neuropathy,and the detection of serum 25-（OH）D level can be used as an important indicator to predict the occurrence and development of urinary peripheral neuropathy．

目的 为寻找治疗盆腔炎性疾病（PID）的有效治疗方案,对比分析头孢哌酮舒巴坦钠+吗啉硝唑、康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑两种用药方案治疗PID的效果差异,期望为今后临床中合理选择PID药物治疗方案提供参考依据。方法 选取2019年1月—12月期间在我院接受治疗的104例急性PID患者（湿毒壅盛证）作为研究对象,用随机信封分为参照组、研究组,各52例。予以参照组患者头孢哌酮舒巴坦钠+吗啉硝唑静脉滴注治疗,研究组患者在参照组基础上口服康妇炎胶囊,均持续治疗14 d。观察2组患者近期疗效、炎性因子、盆腔炎性疾病包块、远期复发率（6个月、1年）、远期生活质量,综合评价两种用药方案应用效果。结果 治疗14 d后,研究组总有效率96.00%,高于参照组的80.39%,差异显著（P<0.05）;WBC、CRP、IL-2、TNF-α四项炎性因子水平均低于参照组,差异显著（P<0.05）;腔包块直径、疼痛评分均低于参照组,差异显著（P<0.05）。随访6个月、1年,研究组患者PID复发率分别为4.00%、10.00%,均低于参照组的15.69%、29.41%,差异显著（P<0.05）。结论 以康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑治疗PID,能够提升患者的近期治疗效果,改善炎性反应、盆腔炎性疾病包块,降低远期复发风险,改善远期生活质量,而且能够保证用药安全性,具有推广使用价值。

Objective To find an effective treatment for pelvic inflammatory disease（PID）,and to compare and analyze the difference of efficacy of cefoperazone and sulbactam sodium + molinidazole,Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,in order to provide reference for rational selection of PID drug treatment in future clinical practice．Methods A total of 104 patients with acute PID（excessive wet toxin accumulation syndrome）who received treatment in our hospital from January to December 2019 were selected as the research objects．They were randomly divided into the control group and the research group with 52 cases in each group．Patients in the control group were given intravenous infusion of cefoperazone and sulbactam sodium + morinidazole,and patients in the research group were given Kangfuyan capsule orally on the basis of the control group,all treated for 14 days．The short-term efficacy,inflammatory factors,pelvic inflammatory mass and pain improvement,adverse reactions,long-term recurrence rate（6 months,1 year）,long-term quality of life in two groups were observed,and the application effect of the two drug regimens was comprehensively evaluated．Results After 14 days of treatment,the total effective rate of the research group was 96.00%,which was higher than that of the control group（80.39%）,with significant difference（P<0.05）．After treatment,the levels of WBC,CRP,IL-2 and TNF-α were lower than those of the control group,and the differences were significant（P<0.05）．After treatment,lumen mass diameter and pain score were lower than the control group,the differences were significant（P<0.05）．After 6 months and 1 year follow-up,the PID recurrence rate of the research group was 4.00% and 10.00% respectively,both lower than that of the control group（15.69% and 29.41%）,with significant difference（P<0.05）．Conclusions Using Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,can improve the patient's recent treatment effect,improve the inflammatory reaction,pelvic inflammation mass, lower long-term risk of recurrence,improve the long-term quality of life,and can ensure medication safety,with promotion value.

肿瘤相关巨噬细胞（TAMs）是肿瘤微环境中最丰富的免疫细胞之一,M2-TAMs在肿瘤发生、发展、转移和治疗过程中发挥重要作用,被认为是肿瘤治疗中的重要靶点。已有的研究表明,通过将促肿瘤的M2-TAMs重编程为促炎的M1-TAMs可实现抑制肿瘤生长和转移。本综述在介绍TAMs与肿瘤治疗相关背景的基础上,重点关注纳米药物重编程TAMs增强抗肿瘤的研究进展。本文将从TAMs靶向递送各种活性物质进行重编程TAMs和纳米药物介导的异常肿瘤微环境调节的间接重编程TAMs两种方式,综述近年来基于纳米药物递送系统的调控策略及典型例子。

Tumor associated macrophages（TAMs）is one of the most abundant immune cells in the tumor microenvironment．M2-TAMs play an important role in tumor genesis,progression,metastasis and treatment,and is additionally a very important target in tumor therapy．Previous studies have shown that inhibition of tumor growth and metastasis can be achieved by reprogramming M2-TAMs to M1-TAMs．On the basis,this review focuses on the analysis progress of nano-drug reprogramming TAMs to boost anti-tumor．In this paper,we reviewed two methods of reprogramming TAMs for targeted delivery of various active substances and indirect reprogramming TAMs for abnormal tumor microenvironment regulation mediated by nanomedicine．The regulatory strategies and typical samples of nanomedicine delivery systems in recent years were summarized.

目的 分析艾司氯胺酮对剖宫产术后镇痛及肾素-血管紧张素-醛固酮系统（RAAS）、产后抑郁情况发生的影响。方法 研究对象为2020年5月—2021年6月在我院行剖宫产的96例孕产妇,根据麻醉药物的不同分为研究组50例和对照组46例,2组孕产妇均给予腰硬联合麻醉行剖宫产术,研究组于手术切皮前5 min静脉注射艾司氯胺酮0.2 mg/kg,对照组静脉注射等量生理盐水。比较2组孕产妇术后疼痛评分（VAS评分）、肾素活性（PRA）、血管紧张素-II（AT-II）、醛固酮（ALD）、爱丁堡产后抑郁量表（EPDS）、不良反应的发生情况。结果 与对照组比较,术后各时间点研究组孕产妇VAS评分均明显较低,差异具有统计学意义（P<0.01）。2组T1、T2、T3各时间点RAAS各指标均明显低于T0时间点（P<0.05）;研究组在T1、T2时间点RAAS各指标均明显低于对照组,差异具有统计学意义（P<0.05）。研究组术后3 d、术后6周EPDS评分均明显低于对照组（P<0.01）。2组不良反应总发生率比较无差异（P>0.05）。结论 艾司氯胺酮用于剖宫产术后镇痛效果显著,对产妇RAAS影响较小,并可缓解产妇抑郁症状,且不良反应发生率较低。

Objective To analyze the effect of esketamine on analgesia and renin angiotensin aldosterone system（RAAS）and the occurrence of postpartum depression after cesarean delivery．Methods The subjects were 96 pregnant women who underwent cesarean section in our hospital from May 2020 to June 2021,they were divided into 50 cases in the study group and 46 cases in the control group．Both groups of pregnant women were given combined spinal epidural anesthesia for cesarean section．The patients in study group were injected with esmketamine 0.2 mg/kg intravenously 5 minutes before skin incision,and those in control group were injected with the same amount of saline intravenously．The postoperative pain scores（VAS score）,plasma renin activity（PRA）,angiotensin-II（AT-II）,aldosterone（ALD）,Edinburgh Postpartum Depression Scale（EPDS）,and the occurrence of adverse effects were compared between the two groups．Results Compared with the control group,maternal VAS scores were significantly lower in the study group at all postoperative time points,and the differences were statistically significant（P<0.01）．The indexes of RAAS were significantly lower in both groups at T1,T2 and T3 time points than at T0 time point（P<0.05）;the indexes of RAAS were significantly lower in the study group at T1 and T2 time points than in the control group,and the differences were statistically significant（P<0.05）．The postoperative EPDS scores in the study group were significantly lower than those in the control group at 3 d and 6 weeks（P<0.01）．There was no difference in the overall incidence of adverse reactions between the two groups（P>0.05）．Conclusions Esketamine is effective for postoperative analgesia after cesarean section,with less effect on maternal RAAS,and can relieve maternal depressive symptoms,and has a low incidence of adverse reactions．

目的 探讨维生素D对维生素D缺乏患者ACCF术后钛网下沉及临床疗效的影响。方法 70例行ACCF术治疗的维生素D缺乏患者,按随机数字表法将患者分为对照组及观察组,每组35例。观察组患者术后即刻及出院后每月给予肌肉注射10万U维生素D₃,持续6个月,对照组患者则给予肌肉注射1 mL生理盐水。比较两组颈椎融合时间、钛网下沉率、术后1年颈椎JOA评分、NDI评分。结果 观察组术后1年颈椎JOA评分、NDI评分均优于对照组(均P＜0.05);观察组钛网下沉率低于对照组,颈椎融合时间短于对照组(均P＜0.05)。结论 补充维生素D可以缩短维生素D缺乏患者的ACCF术后融合时间、减少钛网下沉、改善临床疗效。

Objective To investigate the effect of vitamin D on titanium mesh subsidence and clinical efficacy in patients with vitamin D deficiency after ACCF. Methods Seventy patients with vitamin D deficiency treated by ACCF were divided into control group and observation group according to random number table method, 35 cases in each group. Patients in the observation group were given intramuscular injection of 100 000 U of vitamin D₃ immediately after operation and after discharge for 6 months, while patients in the control group were given intramuscular injection of 1 mL of normal saline. The time of cervical fusion, the subsidence rate of titanium mesh, the JOA score and NDI score of cervical spine 1 year after operation were compared between the two groups. Results The JOA score and NDI score of cervical vertebra in the observation group were better than those in the control group one year after operation(P<0.05);the subsidence rate of titanium mesh in the observation group was lower than that in the control group, and the fusion time of cervical vertebra was shorter than that in the control group(P<0.05). Conclusion Vitamin D supplementation may shorten the fusion time of patients with vitamin D deficiency after ACCF, reduce the sinking of titanium mesh and improve the clinical efficacy.

目的 探讨广州地区老年人维生素D水平及其与骨密度、甲状旁腺激素的相关性。方法 收集2016年6月—12月在广州市第一人民医院老年病科就诊的患者。检测25-羟维生素D、甲状旁腺激素、Ⅰ型前胶原氨基端前肽、β-Ⅰ型胶原C端肽、腰椎和髋部骨密度。将患者分为维生素D缺乏组(≤20 ng/mL)、维生素D不足组(20～30 ng/mL)、维生素D充足组(≥30 ng/mL)。结果 ①426例研究对象的平均年龄是(79.77±7.69)岁,25羟维生素D平均值是(20.38±8.20)ng/mL。维生素D缺乏、不足、充足者比例分别是53%(226/426)、34.3%(146/426)、12.7%(54/426)。②25羟维生素D水平随年龄增加而降低。25羟维生素D与股骨颈和全髋骨密度呈正相关(r=0.18,P＜0.001),与甲状旁腺激素呈负相关(r=-2.05,P＜0.001)。结论 广州地区老年人维生素D不足及缺乏十分普遍。维生素D与股骨颈、髋部骨密度呈正相关,与甲状旁腺激素呈负相关。

Objective To investigate the vitamin D level of elder people in Guangzhou and the relationship in vitamin D, bone mineral density and parathyroid hormone. Methods To screening elderly patients in the geriatric department of Guangzhou First peoples Hospital from June to December 2016.Serum 25-hydroxy vitamin D,parathyroid hormone,procollagen typeⅠN-terminal propeptide,β-crosslaps of C-telopeptide of typeⅠcollagen,bone mineral density were measured.Three groups were divided according to the serum 25(OH)D level,including deficiency group(≤20 ng/mL),insufficiency group(20-30 ng/mL) and sufficiency group(≥30 ng/mL). Results The mean age of the 426 subjects was 79.77±7.69 years old. The average level of 25(OH)D was 20.38±8.20 ng/mL. The proportion of vitamin D deficiency, insufficient and sufficient persons were 53% (226/426), 34.3% (146/426), and 12.7% (54/426). The level of 25 hydroxy vitamin D was decreased with age.Correlation analysis showed that 25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density(r=0.18,P＜0.001),was negatively correlated with parathyroid hormone(r=-2.05,P＜0.001). Conclusion Vitamin D deficiency or insufficiency is highly prevalent in elderly men in Guangzhou.25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density, negatively correlated with parathyroid hormone.