药物递送系统对于各类疾病意义非凡,但传统药物载体面临细胞毒性强、组织相容性低、半衰期短和靶向性弱等诸多挑战。血小板及其相关衍生物作为新型药物载体具有更为显著的优势。由于血小板自身的生理特点,以及在肿瘤、心血管疾病、血栓性疾病、感染等多种疾病中发挥的病理生理作用,血小板能够弥补传统药物载体的缺陷,具有极大的临床转化意义。该文总结了血小板相关药物递送系统目前的研究进展,以期为新型药物载体研究提供参考。

Drug delivery systems are important for various diseases,but conventional therapeutic drug have many shortcomings,such as high cytotoxicity,low histocompatibility,short half-life and weak targeting．Platelets and their derivatives have more significant advantages as novel drug carriers．Platelets play an important role in the pathophysiology of a wide range of diseases including oncology,cardiovascular diseases,thrombosis and infection．In this paper,we summarized the current research progress of platelet-related drug delivery systems to provide a reference for the research of novel drug delivery systems．

价值医疗下公立医院需转变运营管理模式,建设专门运营管理部门对满足外部政策要求和改善内部运营管理十分必要。通过梳理公立医院开展运营管理的主要任务,确定公立医院专门运营管理部门的职责,设计与承担职责相适应的组织架构,保证专门运营管理部门的职能充分发挥。

Public hospitals need to change the operation management mode under value-based healthcare．It is necessary to build a special operation management department to meet the requirements of external policies and improve internal operation management．By sorting out the operation and management tasks of public hospitals,the responsibilities of the operation management department are determined,and the organizational structure suitable for the responsibilities is designed,so that the construction of specialized operation management department can be effectively implemented．

目的 分析PDCA管理法在医院药事管理中的应用效果。方法 将我院2 000批药品设置为研究对象,样本纳入的起始、截止时间分别为2022年1月、2022年12月,依据时间对纳入样本开展组别划分,将2022年1月—6月1 000批药品设置为PDCA管理前研究对象,期间接受常规药品管理;将2022年7月—12月1 000批药品设置为PDCA循环法管理后研究对象。对比PDCA管理前后药品不良事件发生率及药事管理质量评分。结果 PDCA循环法管理后药学差错事件发生率低于PDCA循环法管理前,分别为0.30%、1.90%,对比差异有统计学意义（P<0.05）;PDCA循环法管理后建立药品质量监控体系、药品调剂制度、抗肿瘤药物分级管理方案和处方管理、临床药师参与四个维度评分较PDCA循环法管理前均有明显提升,分别为18.15±1.83、18.15±1.64、18.22±1.67、18.07±1.84,管理前后评分对比差异具有统计学意义（P<0.05）。结论 医院药事管理采用PDCA管理法可提升药事管理质量,降低药品不良事件发生率,值得应用。

Objective To analyze the application effect of PDCA cycle method in hospital pharmaceutical management．Methods A total of 2 000 batches of drugs in our hospital were included as research objects,the inclusion start and end of samples were January 2022 and December 2022．The included samples were divided into groups according to the time,1 000 batches of drugs from January 2022 to June 2022 were included as research objects before PDCA management,during which they were subjected to routine drug management．1 000 batches of drugs from July 2022 to December 2022 were included as the research objects under management by PDCA cycle method．The incidence of adverse drug events and the quality score of drug administration before and after PDCA administration were compared．Results The incidence of pharmaceutical error events after PDCA cycle management was lower than that before PDCA cycle management,which were 0.30% and 1.90%,respectively,and the differences were statistically significant（P<0.05）．After PDCA cycle management,the scores of establishment of drug quality control system（18.15±1.83）,drug dispensing system（18.15±1.64）,anti-tumor drug grading management scheme and prescription management（18.22±1.67）,clinical pharmacist participation（18.07±1.84）were significantly improved compared with those before PDCA cycle management,and the difference between scores before and after PDCA cycle management was statistically significant（P<0.05）．Conclusions PDCA cycle can improve the quality of pharmaceutical management and reduce the incidence of adverse drug events,which is worthy of application．

目的 探讨俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果。方法 选取泉州市儿童医院2020年9月—2023年9月收治的72例脓毒症合并急性肺损伤患儿,应用抽签法将其分为观察组与对照组,均为36例。对照组患儿实施常规仰卧位机械通气与对应护理,观察组患儿在常规护理基础上增加俯卧位通气与对应护理。对比两组患儿机械通气时间,干预前和干预3 d后气道平台压和心率水平,动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）,并计算动脉血氧分压与吸入气中的氧浓度分数比值（PaO₂/FiO₂）,评价两组患儿预后及不良事件发生情况。结果 观察组机械通气时间明显低于对照组（P<0.05）,干预后两组患儿气道平台压、心率均降低,且观察组低于对照组（P<0.05）;干预后两组患儿PaO₂/FiO₂、PaO₂水平升高,观察组高于对照组,PaCO₂降低,观察组低于对照组（P<0.05）;干预后两组患儿全身性感染相关性器官功能衰竭评分（SOFA）、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）评分均降低,观察组低于对照组（P<0.05）;两组患儿呼吸机管路折管、管路滑脱、压力性损伤等不良事件发生率对比差异无统计学意义（P>0.05）。结论 俯卧位通气在脓毒症合并急性肺损伤患儿的应用效果显著,可降低患儿气道平台压及心率,缩短机械通气时间,改善患儿通气功能,有助提升预后水平。

Objective To explore the application effect of prone position ventilation in children with sepsis complicated with acute lung injury．Methods From September 2020 to September 2023,72 children with sepsis and acute lung injury admitted to Quanzhou Children's Hospital were selected and divided into observation group and control group by drawing lots,both with 36 cases．The children in the control group received routine supine mechanical ventilation and corresponding nursing,and the children in the observation group added prone ventilation and corresponding nursing on the basis of routine nursing．By comparing the duration of mechanical ventilation,airway plateau pressure and heart rate level,PaCO₂,PaO₂,PaO₂/FiO₂,the prognosis and occurrence of adverse events in the two groups were evaluated．Results The mechanical ventilation time in the observation group was significantly shorter than that in the control group（P<0.05）．After intervention,the airway plateau pressure and heart rate levels of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．After the intervention,the levels of PaO₂/FiO₂ and PaO₂ in the two groups of children increased,with the observation group higher than the control group,while the level of PaCO₂ was lower,with the observation group lower than the control group（P<0.05）．After the intervention,the SOFA and APACHE II scores of the two groups of children decreased,and the observation group was lower than the control group（P<0.05）．There was no difference in the incidence of adverse events such as ventilator tube folding,tube slip and pressure injury between the two groups（P>0.05）．Conclusions The application of prone position ventilation in children with sepsis combined with acute lung injury has a significant effect,which can reduce airway plateau pressure,lower heart rate,shorten mechanical ventilation time,improve ventilation function,and assist in improving prognosis．

目的 探讨个体化肠内营养支持在胃肠术后早期应用的可行性及安全性。方法 选取2022年1月—12月安徽省亳州市中医院普通外科收治的胃肠手术患者100例。使用随机数字表法将患者随机为观察组和对照组,每组各50例。观察组在常规治疗基础上实施个体化肠内营养,持续7 d。对照组则接受术后常规处理。术后第7天测定实验室指标,并比较两组胃肠功能的恢复情况。结果 观察组术后肛门首次排气时间短于对照组[（55.41±19.63）h vs （81.46±19.39） h],前白蛋白水平高于对照组[（241.14±65.73）g/L vs（217.35±51.63）g/L],组间比较差异有统计学意义（P<0.05）。血清总蛋白水平[（70.55±18.89）g/L vs （68.16±20.05）g/L]、血清白蛋白水平[（53.22±17.76）g/L vs（50.76±18.54）g/L]、淋巴细胞计数[（1.60±0.54）×10⁹/L vs （1.56±0.55）×10⁹/L]以及肛门排便时间[（89.67±22.31）h vs （97.77±21.27）h ]在组间比较差异无统计学意义（P>0.05）。结论 根据个体情况在胃肠术后早期实施个体化的肠内营养支持是安全可行的,能够促进胃肠功能的快速恢复,从而改善患者的营养状况。

Objective To investigate the feasibility and safety of personalized enteral nutrition support during the early postoperative period of gastrointestinal surgery．Methods A total of 100 patients who underwent gastrointestinal surgery at the Department of General Surgery,Bozhou Hospital of Traditional Chinese Medicine,who were enrolled in this study during January 2022 to December 2022．Patients were randomly allocated into either the observational or control group,with 50 patients in each group．The randomization was performed using a random number table．The observational group received personalized enteral nutrition support in addition to routine treatment for 7 days．The control group received standard postoperative care．Laboratory indicators were measured on the 7th postoperative day to compare recovery of gastrointestinal function between the two groups．Results The observational group exhibited a significantly shorter time to the first passage of flatus from the anus compared to the control group（55.41±19.63 h vs 81.46±19.39 h,P<0.05）,as well as higher prealbumin levels（241.14±65.73 g/L vs 217.35±51.63 g/L,P<0.05）．However,there were no significant differences between the two groups in terms of serum total protein levels（70.55±18.89 g/L vs 68.16±20.05 g/L）,serum albumin levels（53.22±17.76 g/L vs 50.76±18.54 g/L）,lymphocyte counts[（1.60±0.54）×10⁹/L vs （1.56±0.55）×10⁹/L],and time to the first defecation from the anus（89.67±22.31 h vs 97.77±21.27 h）（all P>0.05）．Conclusions Personalized enteral nutrition support based on individual conditions is safe and feasible in the early postoperative period of gastrointestinal surgery．It can promote the rapid recovery of gastrointestinal function and improve patients' nutritional status．

目的 探讨快速康复理念联合腹腔镜手术治疗对小儿腹股沟疝疗效观察。方法 选取焦作市妇幼保健院2021年1月—2023年1月收治的86例腹股沟疝患儿进行分析与研究,应用随机数字表法将其分为观察组与对照组,各组均为43例。所有患儿均采取腹腔镜手术治疗,对照组采取常规护理,观察组采取快速康复理念护理。对比两组围术期恢复情况,术后4、12、24、48 h疼痛程度,并发症及护理满意度情况。结果 观察组首次下床时间、首次肛门排气时间、进食时间、住院时间短于对照组（P<0.05）;两组患儿术后4、12、24、48 h视觉模拟量表（VAS）评分逐渐降低,观察组低于对照组（P<0.05）;两组恶心呕吐、尿潴留、腹胀腹痛、感染并发症发生率对比差异无统计学意义（P>0.05）;观察组患儿及家长健康教育、住院环境、专科护理、检查指导、病情观察相关护理满意度评分高于对照组（P<0.05）。结论 快速康复理念联合腹腔镜手术治疗小儿腹股沟疝效果显著,可进一步促进患儿早日康复,缩短住院时间,术后疼痛水平低,同时可提升患儿及家长护理满意度。

Objective To explore the therapeutic effect of rapid rehabilitation concept combined with laparoscopic surgery on pediatric inguinal hernia．Methods A total of 86 children with inguinal hernia admitted to Jiaozuo Maternal and Child Health Care Hospital from January 2021 to January 2023 were selected for analysis and study,and divided into observation group and control group by random number table method,with 43 cases in each group．All patients were treated with laparoscopic surgery,while the control group received routine care,while the observation group received rapid recovery concept care．The perioperative recovery,pain level,complications,and nursing satisfaction at 4,12,24,and 48 hours after surgery were compared．Results The first discharge time,first anal exhaust time,feeding time,and hospitalization time were shorter than the control group（P<0.05）．The VAS scores decreased after 4 h,12 h,24 h and 48 h,and the observation group was lower than the control group（P<0.05）．The incidences of nausea and vomiting,urinary retention,abdominal distension,abdominal pain and infectious complications between the two groups were significantly insignificant（P>0.05）．The health education,inpatient environment,specialized care,nursing examination guidance and condition observation were significantly higher than that of the observation group（P<0.05）．Conclusions The combination of rapid recovery concept and laparoscopic surgery for the treatment of inguinal hernia in children has a significant effect,which can further promote early recovery,shorten hospital stay,lower postoperative pain levels．At the same time,it can improve the nursing satisfaction of children and parents．

目的 比较喀什地区和广州地区健康体检儿童维生素D3水平和缺乏率。方法 纳入2019年1月—2020年12月喀什地区第一人民医院、广州市番禺区中心医院健康体检儿童,比较汉族儿童不同地区间以及比较喀什儿童不同民族间的维生素D3水平和缺乏率,分析了性别、年龄和季节对血清维生素D3水平的影响。结果 喀什汉族儿童维生素D3低于广州汉族儿童,缺乏率更高（均P<0.05）。喀什维族儿童的维生素D3水平低于喀什汉族儿童,缺乏率更高（均P<0.05）。同一地区、同一民族不同年龄段儿童间维生素D3缺乏率和水平比较差异均有统计学意义（均P<0.05）,维生素D3缺乏率随年龄增加而升高,水平则显著下降。同一地区、同一民族儿童不同季节间维生素D3缺乏率和水平比较差异均有统计学意义（均P<0.05）,冬季的缺乏率最高、水平最低。同一地区、同一民族儿童不同性别间维生素D3缺乏率和水平比较差异均无统计学意义（P>0.05）。结论 健康体检儿童血清维生素D3水平,喀什维族低于喀什汉族,喀什汉族低于广州汉族,缺乏率间差异明显。健康体检儿童血清维生素D3水平和缺乏率与年龄、季节有关,与性别无关。

目的 探讨不同高血压分级血压变异性与空腹甘油三酯血糖指数及内皮功能的相关性。方法 选取天津市第一医院2020年10月—2023年10月收治的150例高血压患者作为研究对象,将患者分为：1级组（n=50）,即140~159 mmHg和（或）舒张压90~99 mmHg,2级组（n=60）,即收缩压160~179 mmHg和（或）舒张压100~109 mmHg,3级组（n=40）,即收缩压≥180 mmHg和（或）舒张压≥110 mmHg。测量所有患者收缩压加权标准差（SBP_wSD）和舒张压加权标准差（DBP_wSD）评价血压变异性,检测空腹血糖、空腹甘油三酯水平,计算空腹甘油三酯血糖指数（TyG）,以及记录丙二醛（MDA）、一氧化氮（NO）、内皮素-1（ET-1）、超氧化物歧化酶（SOD）水平对内皮功能进行评价。采用Spearman相关分析法分析血压变异性与空腹TyG及内皮功能的相关性。结果 1级组DBP_wSD、SBP_wSD低于2级组和3级组（P<0.05）;1级组空腹血糖、空腹甘油三酯、TyG低于2级组和3级组（P<0.05）;1级组MDA、ET-1低于2级组和3级组,NO、SOD高于2级组和3级组（P<0.05）; DBPwSD、SBPwSD与空腹血糖、空腹甘油三酯无关（P>0.05）,DBP_wSD、SBP_wSD与NO、SOD水平呈负相关,与TyG、MDA、ET-1呈正相关（P<0.05）。结论 不同血压分级的高血压患者血压变异性、TyG及血管内皮功能具有明显差异,且高血压患者血压变异性与TyG和血管内皮功能具有明显相关性。

Objective To explore the correlation between blood pressure variability and fasting triglyceride blood glucose index and endothelial function in different hypertension grades．Methods A total of 150 hypertensive patients admitted to our hospital from October 2020 to October 2023 were selected as study participants．Patients were classified into group level 1 （n=50）,with systolic blood pressure 140~159 mmHg and/or diastolic blood pressure 90~99 mmHg,group level 2（n=60）,with systolic blood pressure 160~179 mmHg and/or diastolic blood pressure 100~109 mmHg,and group level 3（n=40）,with systolic blood pressure ≥180 mmHg and/or diastolic blood pressure ≥110 mmHg．SBPwSD and DBP_wSD of all patients were measured to assess their blood pressure variability．Fasting blood glucose and fasting triglyceride levels were measured to calculate TyG．MDA,NO,ET-1 and SOD were used to evaluate endothelial function．The correlation between blood pressure variability and glycemic index and endothelial function was analysed using Spearman correlation analysis．Results The DBP_wSD and SBP_wSD of the group level 1 were significantly lower than those of the groups level 2 and 3（P<0.05）．The fasting blood glucose,fasting triglycerides and TyG in the group level 1 were significantly lower than those in the groups level 2 and 3（P<0.05）．MDA and ET-1 values in the group level 1 were significantly lower than in the groups level 2 and 3,while NO and SOD values in the group level 1 were significantly higher than those in the other two groups（P<0.05）．DBP_wSD and SBP_wSD did not correlate significantly with fasting blood glucose and fasting triglycerides（P>0.05）,while DBP_wSD and SBP_wSD correlated negatively with NO and SOD values and correlated positively with TyG,MDA and ET-1（P<0.05）．Conclusions There are significant differences in blood pressure variability,TyG,and endothelial function among hypertensive patients with different grades,and there is a significant correlation between blood pressure variability and TyG and endothelial function in hypertensive patients．

目的 分析流行性感冒（流感）患儿的流行病学特征及病原学分布。方法 纳入2020年3月—2023年2月在开封市祥符区第一人民医院确诊为流感的394例1~10岁患儿的咽拭子标本,通过实时荧光定量聚合酶链式反应完成流感病毒检测,分析此394例流感患儿感染的病毒类型及年龄、季节、性别、年份等分布情况。结果 甲型H1N1流感病毒为本次研究检出占比最高的流感病毒,占36.04%;男女患儿之间的甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异无统计学意义（P>0.05）;春季及冬季流感患儿占比最多,分别为41.12%、35.53%,且不同季节之间的甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异有统计学意义（P<0.05）;7~10岁流感患儿占比最高,为42.13%,不同年龄段患儿之间的甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异无统计学意义（P>0.05）;2020年流感患儿占比最高,为43.40%,后续依次为2022年的29.70%,2021年的26.90%;不同年份的冬季流感患儿占比比较差异有统计学意义（P<0.05）;不同年份的各年龄段流感患儿占比比较差异无统计学意义（P>0.05）;各年甲型H3、甲型H1N1、乙型BV、乙型BY流感病毒占比比较差异无统计学意义（P>0.05）。结论 年龄7~10岁的患儿为流感高危群体,且甲型流感为患儿主要感染类型,而甲型流感病毒多见于春、冬季,新型冠状病毒肺炎疫情期间防控政策变化对流感流行有影响,应加强春、冬季7~10岁年龄段患儿的甲流预防工作。

Objective To analyze the epidemiological characteristics and etiological distribution of children with influenza（flu）．Methods The throat swab specimens of 394 children aged 1 to 10 years old who were diagnosed with influenza at the First People's Hospital of Xiangfu District,Kaifeng City from March 2020 to February 2023 were included．The samples were analyzed by real-time fluorescence quantitative polymerase chain reaction to complete influenza virus detection and analyze the virus types and distribution of age,season,gender,year,etc．among these 394 children with influenza were analyzed．Results Influenza A H1N1 virus was the influenza virus with the highest proportion detected in this study,accounting for 36.04%;there were differences in the proportions of influenza A H3,A H1N1,BV,and B BY influenza viruses between male and female children,with no statistical significance（P>0.05）;the proportion of children with influenza is the largest in spring and winter,41.12% and 35.53% respectively,and proportions of influenza A H3,A H1N1,B BV,and B BY influenza in different seasons were significantly different（P<0.05）．Children aged 7 to 10 accounted for the highest proportion of influenza patients,42.13%．Among children of different ages,the proportion of influenza A H3,A H1N1,B BV,B BY had no statistically significant difference（P>0.05）．The proportion of children with influenza in 2020 was the highest at 43.40%,followed by 29.70% in 2022 and 26.90% in 21;in different years there is a statistically significant difference in the proportion of children with influenza in winter（P<0.05）．There is no statistically significant difference in the proportion of children with influenza of all ages in different years（P>0.05）．The preportions of influenza A H3 and A H1N1,B BV and B BY viruses in each year,had no statistically significant difference（P>0.05）．Conclusions Children aged 7 to 10 years old are a high-risk group for influenza,and influenza A is the main type of infection in children．Influenza A viruses are more common in spring and winter．Changes in prevention and control policies during the new coronavirus pneumonia epidemic have an impact on the epidemic of influenza．Therefore,prevention of influenza A for children aged 7 to 10 years old in spring and winter should be strengthened．

目的 探讨在分化型甲状腺癌（DTC）患者的治疗中,采用早期积极心理进行干预,对患者负性情绪和癌因性疲乏的影响。方法 抽取2021年6月—2023年1月平煤神马医疗集团总医院收治的160例DTC癌患者,随机分为对照组（常规护理）和研究组（常规护理+早期积极心理干预）,每组各80例,评估患者干预前后的心理状态、癌因性疲乏、生活质量、护理工作满意度。结果 护理干预1~4周后,两组患者汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分均降低,并且研究组患者评分更低（P<0.05）;干预后,两组患者的癌因性疲乏评分均升高,但是研究组患者的以上指标升高幅度小于对照组（P<0.05）;此外,两组患者的护士观察量表（NOSIE）评分均明显改善,并且研究组变化幅度大于对照组（P<0.05）;研究组患者的护理满意度高于对照组（95.00% vs 82.50%,P<0.05）。结论 对DTC患者开展早期积极心理干预,能够帮助患者改善负性情绪,减轻癌因性疲乏,提高患者的生活质量和护理满意度。

Objective To investigate the effect of early positive psychological intervention on negative emotions and cancer-related fatigue in the treatment of differentiated thyroid cancer（DTC） patients．Methods From June 2021 to January 2023,160 patients with DTC admitted to General Hospital of Pingmei Shenma Group were randomly divided into the control group（routine nursing）and the research group（routine nursing + early positive psychological intervention）,with 80 patients in each group．The psychological state,cancer-related fatigue,quality of life and nursing satisfaction of patients before and after intervention were evaluated．Results After 1~4 weeks of intervention,the scores of Hamilton Depression Scale（HAMD）and Hamilton Anxiety Scale（HAMA）were decreased in both groups,and the scores of research group were lower（P<0.05）．After intervention,the cancer-related fatigue scores of both groups were increased,but the increase of research group were less than that of control group（P<0.05）．Moreover,NOSIE scores of both groups were significantly improved,and the change range of research group was greater than that of control group（P<0.05）．The nursing satisfaction of research group was higher than that of control group（95.00% vs 82.50%,P<0.05）．Conclusions Early positive psychological intervention for patients with DTC can effectively improve negative emotions,reduce cancer-related fatigue,and improve nursing satisfaction of patients．