目的 探讨关节镜下外侧韧带增强固定修复术治疗慢性踝关节不稳定的护理和康复方案。方法 回顾性分析2023年1月–2023年8月广州市正骨医院收治的31例采用关节镜下外侧韧带增强固定修复术治疗的慢性踝关节不稳定患者的围术期护理措施和康复指导措施。结果 31例患者均随访无脱落,于术后3、6、12个月返院复查随访,患者手术后患足美国矫形外科足踝协会（AOFAS）踝-后足评分均较前次随访评分提高（均P<0.05）。患者术后3个月Zung焦虑评分和Zung抑郁评分较术前均明显下降（均P<0.05）。31例患者术后无1例发生踝关节不稳定复发、腓肠神经损伤和感染等并发症。结论 关节镜下外侧韧带增强固定修复术的方法治疗慢性踝关节不稳定患者,加强术前术后的护理措施、康复指导,对恢复踝关节稳定性和灵活性有重要作用,有利于提高患者生活质量和满意度。

Objective To investigate the nursing and rehabilitation of chronic ankle instability with reinforcement fixation and repair of lateral ligament under arthroscopy．Methods The perioperative nursing measures and rehabilitation guidance of 31 patients with chronic ankle instability treated with lateral ligament reinforcement fixation under arthroscopy from January 2023 to August 2023 were analyzed retrospectively．Results None of the 31 patients was disassociated during follow-up．The American Orthopaedic Foot and Ankle Society（AOFAS）scores of the patients were significantly higher and higher at 3,6 and 12 months after surgery（all P<0.05）．The Zung anxiety score and Zung depression score at 3 months after operation were significantly lower than those before operation（all P<0.05）．None of the 31 patients had postoperative complications such as ankle instability recurrence,sural nerve injury,peroneal tendinitis and infection．Conclusions In arthroscopic reinforcement fixation of lateral ligament in the treatment of patients with chronic ankle instability,strengthening the perioperative nursing measures and rehabilitation guidance,plays an important role in restoring the stability and flexibility of the ankle,and is conducive to improving the quality of life and satisfaction of patients．

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．

目的 探讨血清胱抑素C（Cys-C）联合β₂-微球蛋白（β₂-MG）早期诊断糖尿病肾病的应用价值。方法 选择2021年4月—2023年4月医院接收的100例糖尿病患者为对象,根据其有无合并肾脏疾病,将其分为糖尿病组及糖尿病肾病组,各50例,同比例选取同期到我院体检的健康人群50名进行对照研究,检测比较其Cys-C及β₂-MG水平,对比其Cys-C阳性率、β2-MG阳性率及联合检测阳性率,并对比不同疾病分期糖尿病肾病患者的Cys-C、β₂-MG水平。结果 糖尿病肾病患者Cys-C、β₂-MG水平高于糖尿病患者与健康者（P<0.05）。糖尿病患者Cys-C、β₂-MG水平高于健康者（P<0.05）。糖尿病肾病患者Cys-C阳性率64.00%、β₂-MG阳性率72.00%、Cys-C+β₂-MG联合检测阳性率96.00%高于糖尿病6.00%、10.00%、12.00%及健康者0.00%、0.00%、0.00%（P<0.05）;糖尿病Cys-C+β₂-MG联合检测阳性率12.00%高于健康者0.00%（P<0.05）;糖尿病肾病中Cys-C+β₂-MG联合检测阳性率96.00%高于CysC 64.00%、β₂-MG 72.00%（P<0.05）。糖尿病肾病不同分期患者Cys-C、β₂-MG水平比较,Ⅳ期>Ⅲ期>Ⅰ~Ⅱ期（P<0.05）。结论 糖尿病肾病患者Cys-C、β₂-MG水平明显升高,Cys-C、β₂-MG联合诊断更具有优势,而且肾损害越严重,Cys-C、β₂-MG异常程度越高,作为临床诊治的参考依据的价值较高。

Objective To investigate the application value of serum cystatin C（Cys-C）combined with β₂-microglobulin（β₂-MG）in the early diagnosis of diabetic nephropathy．Methods A total of 100 diabetic patients admitted to our hospital from April 2021 to April 2023 were selected as subjects,and divided into diabetes group and diabetic nephropathy group according to whether they have renal diseases or not,with 50 cases in each group．Then,50 healthy people who came to our hospital for physical examination in the same period were selected for comparative study,and their Cys-C and β₂-MG levels were detected and compared,and their Cys-C positive rate,β₂-MG positive rate and combined detection positive rate were compared．Results The levels of Cys-C and β₂-MG in patients with diabetic nephropathy were higher than those in patients with diabetes and healthy controls（P<0.05）．The levels of Cys-C and β₂-MG in diabetic patients were higher than those in healthy controls（P<0.05）．The positive rates of Cys-C（64.00%）,β₂-MG（72.00%）and Cys-C+β₂-MG（96.00%）in patients with diabetic nephropathy were higher than those in patients with diabetes（6.00%,10.00%,12.00%）and healthy subjects（0.00%,0.00%,0.00%）（P<0.05）．The positive rate of combined detection of Cys-C and β₂-MG in diabetic patients（12.00%）was higher than that in healthy subjects（0.00%）（P<0.05）．The positive rate of Cys-C combined with β₂-MG in diabetic nephropathy was 96.00%,which was higher than that of Cys-C 64.00% and β₂-MG 72.00%（P<0.05）．The levels of Cys-C and β₂-MG in patients with stage Ⅳ diabetic nephropathy were higher than those in patients with stage Ⅲ and Ⅰ-Ⅱ diabetic nephropathy（P<0.05）．The levels of Cys-C and β₂-MG in stage Ⅲ patients were higher than those in stage Ⅰ-Ⅱ patients（P<0.05）．Conclusions The levels of Cys-C and β₂-MG are significantly increased in patients with diabetic nephropathy,and the combination of Cys-C and β₂-MG has more advantages．The greater serious renal damage,the greater abnormal degree of Cys-C and β₂-MG,which has a higher value as a reference for clinical diagnosis and treatment．

目的 研究单核细胞/高密度脂蛋白比值（MHR）对免疫球蛋白A肾病（IgAN）患者肾小球硬化严重程度的预测价值。方法 回顾性分析2016年1月—2022年6月龙岩人民医院收治的296例IgAN患者的临床和肾脏病理资料,参照牛津分型将患者分为无肾小球节段性硬化组（S0组）、有肾小球节段性硬化组（S1组）及球性硬化组;根据Katafuchi肾小球积分将患者分为低三分位组、中三分位组及高三分位组。比较不同肾小球硬化程度和不同Katafuchi肾小球积分患者的MHR水平,对MHR与Katafuchi肾小球积分的关系进行相关性分析,绘制受试者操作特征（ROC）曲线分析MHR对肾小球硬化程度的预测效能。结果 S1组和球性硬化组的单核细胞计数分别为（0.41±0.11）×10⁹ /L、（0.45±0.10）×10⁹ /L,均高于S0组的（0.30±0.06）×10⁹ /L,对比差异有统计学意义（t₁=10.381,P₁<0.001;t₂=12.169,P₂<0.001）,球性硬化组的HDL水平为（1.14±0.16）mmoL/L,低于S0组（1.26±0.24）mmoL/L（t₂=2.992,P₂=0.003）。S1组和球性硬化组的MHR为（0.36±0.04）、（0.44±0.05）,大于S0组的（0.24±0.02）,对比差异有统计学意义（t₁=37.852,P₁<0.001;t₂=42.037,P₂<0.001）,球性硬化组的MHR大于S1组（t₃=9.673,P₃<0.001）。中三分位组和高三分位组的单核细胞计数为（0.34±0.06）×10⁹ /L、（0.48±0.10）×10⁹ /L,高于低三分位组的（0.27±0.05）×10⁹ /L,对比差异有统计学意义（t₁=9.017,P₁<0.001;t₂=20.080,P₂<0.001）,高三分位组的单核细胞计数高于中三分位组（t₃=8.855,P₃<0.001）。高三分位组的HDL水平为（0.96±0.12）mmoL/L,低于低三分位组的（1.23±0.21）mmoL/L和中三分位组的（1.19±0.16）mmoL/L,对比差异有统计学意义（t₂=8.132,P₂<0.001;t₃=7.954,P₃<0.001）。高三分位组的MHR为（0.49±0.07）,大于低三分位组的（0.25±0.03）和中三分位组（0.26±0.08）,对比差异有统计学意义（t₂=35.382,P₂<0.001;t₃=15.146,P₃<0.001）。相关性分析显示,单核细胞与Katafuchi肾小球积分呈正相关（r=0.58,P<0.05）,HDL与Katafuchi肾小球积分呈负相关（r=-0.52,P<0.05）,MHR与Katafuchi肾小球积分呈正相关（r=0.66,P<0.05）。MHR预测肾小球节段性硬化的曲线下面积（AUC）为0.609（95%CI：0.325~0.917）,此时截断值为0.29,灵敏度为68.42%,特异度为65.45%。MHR预测球性硬化的AUC为0.735（95%CI：0.527~1.001）,此时截断值为0.40,灵敏度为73.08%,特异度为66.14%。结论 MHR在预测IgAN患者肾小球硬化程度方面具有潜能。

Objective To explore predictive value of the monocyte / high-density lipoprotein ratio（MHR）on the severity of glomerulosclerosis in patients with immunoglobulin A nephropathy（IgAN）．Methods The clinical and renal pathological data of 296 IgAN patients admitted to Longyan People's Hospital from January 2016 to June 2022 were analyzed retrospectively,and the patients were divided into no segmental sclerosis group（S0）,segment sclerosis group（S1）and glomerular sclerosis group according to Oxford classification;the patients were divided into low group,middle group and high group according to Katafuchi score．MHR levels in patients with different degrees of glomerular sclerosis and different Katafuchi score were compared,the relationship between MHR and Katafuchi glomerular integration was analyzed,and ROC curves were drawn to analyze the predictive efficacy of MHR on the degree of glomerular sclerosis．Results Monocyte counts in the S1 and glomerular sclerosis groups [（0.41±0.11）10⁹ /L,（0.45±0.10）10⁹ /L] were all significantly higher than the S0 group（0.30±0.06）10⁹ /L,with statistically significant difference（t₁=10.381,P₁<0.001,t₂=12.169,P₂<0.001）．The HDL level（1.14±0.16）mmoL / L was significantly lower than that in the S0 group（1.26±0.24）mmoL / L（t₂=2.992,P₂=0.003）．The MHR in S1 and glomerular sclerosis group[（0.36±0.04）,（0.44±0.05）] were significantly greater than S0（0.24±0.02）（t₁=37.852,P₁<0.001,t₂=42.037,P₂<0.001）,and the MHR in glomerular sclerosis group was significantly greater than that of S1（t₃=9.673,P₃<0.001）．The monocyte counts of middle and high group[（0.34±0.06）10⁹ /L,（0.48±0.10）10⁹ /L] were significantly higher than the low group（0.27±0.05）10⁹ /L（t₁=9.017,P₁<0.001;t₂=20.080,P₂<0.001）and high group was significantly higher than middle group（t₃=8.855,P₃<0.001）．The HDL level of high group（0.96±0.12）mmoL/L was significantly lower than the low group（1.23±0.21）mmoL/L and middle group（1.19±0.16）mmoL/L,with statistically significance（t₂=8.132,P₂<0.001,t₃=7.954,P₃<0.001）．The MHR（0.49±0.07）in the high group was significantly greater than the low group（0.25±0.03）and middle group（0.26±0.08）,with statistically significance（t₂=35.382,P₂<0.001,t₃=15.146,P₃<0.001）．Correlation analysis showed that monocytes were positively correlated with Katafuchi score（r=0.58,P<0.05）,HDL negatively with Katafuchi score（r=-0.52,P<0.05）,and MHR positively with Katafuchi score（r=0.66,P<0.05）．The AUC of MHR predicting segmental sclerosis was 0.609（95%CI：0.325~0.917）,when the cut-off was 0.29,sensitivity was 68.42% and specificity of 65.45%．The AUC of MHR predicting glomerulosclerosis was 0.735（95%CI：0.527~1.001）,when the cut-off was 0.40,sensitivity was 73.08% and specificity was 66.14%．Conclusions MHR has the potential in predicting the degree of glomerulosclerosis in IgAN patients．

目的 探讨超声监测导向下早期肠内营养（EEN）在重症脓毒血症（SS）有创通气（IV）患者中的应用效果。方法 选取2021年2月—2023年11月连州市人民医院收入的115例SS-IV患者,依据随机数字表法分为对照组（n=57）、超声监测组（n=58）。所有患者均予重症监护病房（ICU）综合治疗,在此基础上对照组实施临床经验的传统肠内营养（EN）干预,超声监测组实施超声监测导向下EEN干预,均监测至治疗结束。统计两组IV时间、ICU停留时间、EN达标时间、EN不耐受发生率、相关并发症发生率,比较干预前、EN结束时营养状况[白蛋白（ALB）、总蛋白（TP）、前白蛋白（PA）]、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。结果 对照组剔除放弃治疗1例,死亡2例,纳入54例;超声监测组剔除放弃治疗1例,死亡1例,纳入56例。超声监测组EN达标时间[（40.18±8.46）h]、IV时间[（7.12±1.44）d]、ICU停留时间[（9.21±1.63）d]短于对照组[（46.03±10.15）h、（8.02±1.62）d、（10.18±1.54）d]（t=3.288、3.082、3.206,均P<0.05）。EN结束时超声监测组SS-IV患者血清ALB[（32.05±3.13）g/L]、TP[（65.36±3.62）g/L]、PA[（0.24±0.06）g/L]高于对照组[（30.28±2.24）g/L、（63.28±4.24）g/L、（0.21±0.05）g/L]（t=3.400、2.770、2.843,均P<0.05）。EN结束时超声监测组APACHEⅡ评分[（15.85±1.93）分]、SOFA评分[（7.42±1.64）分]低于对照组[（17.02±2.04）分、（8.35±2.03）分]（t=3.091、2.648,均P<0.05）。超声监测组EN不耐受发生率[12.50%（7/56）]低于对照组[29.63%（16/54）],超声监测组相关并发症发生率[8.93%（5/56）]低于对照组[24.07%（13/54）]（χ²=4.878、4.608,均P<0.05）。结论 超声监测导向下EEN干预应用于SS-IV患者,可改善患者病情与营养状况,降低EN不耐受及相关并发症发生风险,缩短恢复时间。

Objective To investigate the effect of ultrasound monitoring guided early enteral nutrition（EEN）in patients with severe sepsis（SS）and invasive mechanical ventilation（IV）．Methods A total of 115 SS-IV patients admitted to Lianzhou People's Hospital from February 2021 to November 2023 were randomly divided into control group（n=57）and ultrasound monitoring group（n=58）．All patients were given comprehensive treatment in intensive care unit（ICU）．On this basis,traditional enteral nutrition（EN）intervention with clinical experience was implemented in control group,and EEN intervention guided by ultrasonic monitoring was implemented in ultrasound monitoring group．All patients were monitored until the end of treatment．IV time,ICU stay time,EN compliance time,incidence of EN intolerance,and incidence of related complications were analyzed in the 2 groups．Nutritional status [albumin（ALB）,total protein（TP）,prealbumin（PA）],sequential organ failure assessment（SOFA）,acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）were compared before intervention and at the end of EN．Results In control group,1 cases gave up,2 cases died,and 54 cases were included．In ultrasound monitoring group,1 case gave up,1 case died,and 56 cases were included．The EN compliance time [（40.18±8.46）h],IV time [（7.12±1.44）d] and ICU stay time [（9.21±1.63）d] of ultrasound monitoring group were shorter than those of control group [（46.03±10.15）h,（8.02±1.62）d,（10.18±1.54）d]（t=3.288,3.082,3.206,all P<0.05）．At the end of EN,serum ALB[（32.05±3.13）g/L],TP[（65.36±3.62）g/L],PA[（0.24±0.06）g/L] of SS-IV patients in ultrasound monitoring group were higher than those in control group [（30.28±2.24）g/L,（63.28±4.24）g/L,（0.21±0.05）g/L]（t=3.400,2.770,2.843,all P<0.05）．At the end of EN,APACHEⅡ scores [（15.85±1.93）points] and SOFA scores [（7.42±1.64）points] of ultrasound monitoring group were lower than those of control group [（17.02±2.04）points and（8.35±2.03）points]（t=3.091,2.648,all P<0.05）．The incidence of EN intolerance in ultrasound monitoring group [12.50%（7/56）] was lower than that in control group [29.63%（16/54）],and the incidence of related complications in ultrasound monitoring group [8.93%（5/56）] was lower than that in control group [24.07%（13/54）]（χ²=4.878,4.608,all P<0.05）．Conclusions EEN intervention guided by ultrasonic monitoring in SS-IV patients can improve the nutritional status of patients,reduce the risk of EN intolerance and related complications,shorten the recovery time,and reduce the progression of patients' disease．

目的 探讨真武汤联合八段锦在老年冠状动脉粥样硬化性心脏病（冠心病）患者中的应用效果。方法 将96例75岁以上冠心病患者按照随机数字表法分为对照组与干预组,每组各48例。在12周的临床研究期间,对照组用规范的冠心病二级预防药物治疗;干预组在规范的冠心病二级预防药物治疗基础上,增加真武汤以及八段锦运动处方。结果 治疗后干预组中医临床疗效（P=0.023）和中医证候积分（P<0.001）均优于对照组。两组患者的心肺运动试验指标均有改善,且干预组在升高峰值摄氧量（Peak VO₂,P=0.005）、最大摄氧量（VO₂max,P=0.001）、氧脉搏（VO₂/HR,P=0.002）和无氧阈值时最大代谢当量（MET,P=0.001）,以及降低无氧阈值（AT,P<0.001）和二氧化碳通气当量（VE/VCO₂,P=0.020）方面比对照组更明显。两组患者在36项简明健康状态调查表（SF-36）评分的8个维度中评分均有所升高,其中在生理机能（P=0.001）、生理职能（P<0.001）、一般健康状况（P=0.018）、精力（P=0.007）、社会职能（P=0.010）、精神健康（P=0.004）方面,干预组效果优于对照组;而在躯体疼痛、情感职能维度改善方面,两组间结果相近,差异无统计学意义（P>0.05）。两组患者的匹兹堡睡眠质量指数（PSQI）均有所改善,且干预组效果优于对照组（P<0.001）。结论 真武汤联合八段锦能够进一步增强老年冠心病患者中医证候疗效,改善心肺运动试验Peak VO₂、VO₂max、VO₂/HR、MET、AT、VE/VCO₂等指标,并提高SF-36评分多个维度的生活质量及睡眠质量。

Objective To explore the therapeutic effects of Zhenwu Decoction combined with Baduanjin Qigong in older adults with coronary heart disease（CHD）．Methods Ninety-six patients with CHD aged ≥75 years were randomly divided into a treatment group and a control group,with 48 patients in each group．Within the 12-week period,the control group received standard secondary prevention therapy for CHD,while the treatment group received Zhenwu Decoction and Baduanjin Qigong prescription,in addition to the standard treatment．Results After treatment,both groups showed improvement in the traditional Chinese medicine（TCM）clinical efficacy,TCM syndrome,SF-36 scores and Pittsburgh Sleep Quality Index（PSQI）scores;increase in Peak VO₂,VO₂max,VO₂/HR,and metabolic equivalent（MET）;and decrease in AT and VE/VCO₂．However,the treatment group had a more pronounced improvement in the TCM clinical efficacy（P=0.023）,TCM syndrome（P<0.001）,PSQI scores（P<0.001）,and cardiopulmonary exercise testing（CPET）indicators including Peak VO₂（P=0.005）,VO₂max（P=0.001）,VO₂/HR（P=0.002）,MET（P=0.001）,AT（P<0.001）and VE/VCO₂（P=0.020）,compared to their control counterparts． For the SF-36 scores,in comparison to the control group,the treatment group presented better outcomes in enhancing physical functioning（P=0.001）,role limitations due to physical health（P<0.001）,general health（P=0.018）,vitality（P=0.007）,social functioning（P=0.010）and mental health（P=0.004）,but not in pain or role limitations due to emotional problems．Conclusions The Zhenwu Decoction combined with Baduanjin Qigong can enhance the TCM syndrome,improve various CPET indicators such as Peak VO₂、VO₂max、VO₂/HR、MET、AT and VE/VCO₂,and elevate both quality of life and sleep quality among older adults with CHD．

目的 探讨脊柱外科围术期康复指导方案的临床疗效。方法 选取毕节市第三人民医院脊柱外科184例行择期手术治疗的患者,对照组继续脊柱外科原康复方案行术前及术后管理,观察组使用新的康复行为规范方案,即系统行术前预康复指导和术后规范管理。对患者的术后起床活动、在院时间、住院费用、疼痛恢复情况、满意调查情况进行对比。结果 术前,患者的性别、年龄、病种分布对比差异无统计学意义（P>0.05）。术后,观察组的术后下床活动时间（3.09±1.02）d、住院时间（10.73±3.96）d、住院费用（17 388±5 217）元、术后2天VAS评分（3.04±1.19）分、出院时VAS评分（2.36±1.25）分、住院患者满意度（89.80±8.20）分,均优于对照组的术后起床活动时间（4.44±1.58）d、住院时间（13.38±2.73）d、住院费用（23 242±7 971）元、术后2天VAS评分（4.01±1.44）分、出院时VAS评分（3.39±1.38）分、住院满意度（80.27±11.45）分。新的康复指导方案在脊柱外科患者中较对照组减轻术后疼痛、减少患者卧床时间及缩短住院时间（P<0.05）。结论 围手术期加快患者术后康复及提高术后恢复优良率,提高患者就医满意度,使医患关系更加融洽。

Objective To investigate the clinical effect of the rehabilitation guidance protocol of spinal surgery in perioperative period．Methods A total of 184 patients undergoing selective surgery in the spine surgery department of the Third People's Hospital of Bijie City were selected．The conventional rehabilitation group was the control group,which preoperative and postoperative management was continued with the original rehabilitation program of spine surgery;the rehabilitation guidance group was the observation group：the new rehabilitation behavior code program was used to provide systematic preoperative pre-rehabilitation guidance and postoperative standardized management．The patients' activities of getting up after surgery,days in hospital,economic use,pain recovery and satisfaction survey were compared．Results Before surgical treatment,the gender,age and disease distribution of patients were compared（P>0.05）．After surgical treatment,observation group：Postoperative time of getting out of bed（3.09±1.02）d,length of hospitalization（10.73±3.96）d,hospitalization expenses（17 388±5 217）yuan,VAS score of 2 days after surgery（3.04±1.19）,VAS score of discharge（2.36±1.25）,inpatient satisfaction（89.80±8.12）,were significantly better than the control group：Postoperative activity time（4.44±1.58）d,length of hospitalization（13.38±2.73）d,hospitalization expenses（23 242±7 971）yuan,VAS score（4.01±1.44）,VAS score at discharge（3.39±1.38）,hospitalization satisfaction（80.27±11.45）．Compared with the control group,the new rehabilitation guidelines significantly reduced postoperative pain,bed time and hospital days in spinal surgery patients（P<0.05）．Conclusions Speeding up the postoperative rehabilitation of patients and improving the rate of postoperative recovery,improving patients' sense of access to medical treatment,can make the doctor-patient relationship more harmonious．

目的 了解广州市某净水公司职工脂肪肝检出情况,并分析影响因素。方法 选取2023年广州市某净水公司参加职业健康检查的职工为研究对象,收集研究对象的一般情况、个人史、职业史、身体质量指数（BMI）、血压、血生化指标、肝脏彩超等资料。对该人群脂肪肝的患病情况进行描述性分析,对脂肪肝的影响因素进行单因素及多因素Logistic回归分析。结果 共收集研究对象1 217人,检出脂肪肝543例,检出率为44.62%。单因素分析结果表明,脂肪肝的发生与性别、年龄、体质量指数、高血压相关（P<0.05）。接触硫化氢、氨的职工脂肪肝检出率高于非接触者（P<0.05）,且职工工龄越长,脂肪肝检出率越高（P<0.05）。患脂肪肝职工的肝功能、脂代谢、血糖及尿酸水平高于非脂肪肝者（P<0.05）。多因素Logistic回归分析提示,年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸是脂肪肝的影响因素（P<0.05）。结论 广州市某净水公司职工的脂肪肝检出率较高,脂肪肝的发生主要与年龄、体质量指数、肝功能异常、脂代谢异常、高血糖、高尿酸等因素相关。

Objective To investigate the prevalence of fatty liver disease and influencing factors among employees of a water purification company in Guangzhou．Methods Employees of a water purification company in Guangzhou who participated in occupational health examinations in 2023 were selected as the study subjects．The subjects' general conditions,personal history,occupational history,BMI,blood pressure,blood biochemical indicators,and liver ultrasound images were collected．Descriptive analysis was used to analyze the prevalence of fatty liver disease in this population．The influencing factors of fatty liver were analyzed by single factor and multiple factor Logistic regression．Results A total of 1 217 subjects were included in this study,and 543 were diagnosed as fatty liver disease,with a detection rate of 44.62%．The results of single factor analysis showed that the occurrence of fatty liver was closely related to gender,age,BMI and hypertension（P<0.05）．The analysis of occupational hazard factors showed that,the detection rate of fatty liver disease was higher in people exposed to hydrogen sulfide and ammonia compared to non-exposed individuals（P<0.05）．The longer the working years,the higher the detection rate of fatty liver（P<0.05）．The levels of liver function,lipid metabolism,blood glucose and uric acid in workers with fatty liver were higher than those in workers without fatty liver（P<0.05）．Multivariate Logistic regression analysis showed that age,BMI,abnormal liver function,abnormal lipid metabolism,high blood glucose levels and hyperuricemia were independent influencing factors for fatty liver disease（P<0.05）．Conclusions The detection rate of fatty liver disease among employees of a water purification company in Guangzhou is high,and the occurrence of fatty liver disease is mainly related to factors such as age,BMI,abnormal liver function,abnormal lipid metabolism,high sugar levels and hyperuricemia．

目的 探讨动态对比增强磁共振成像（DCE-MRI）多参数定量特征对乳腺癌腋窝淋巴结转移（ALNM）风险的预测价值。方法 回顾性收集2020年3月—2022年11月在佛山市高明区人民医院经手术病理确诊的155例乳腺癌患者临床资料,根据患者是否发生ALNM分为ALNM 组（n=39）和无ALNM 组（n=116）。采用单因素分析和多因素Logistic回归分析乳腺癌发生ALNM的影响因素。结果 ALNM组和无ALNM 组患者的肿块质地、肿块直径、肿块部位、肿块形状、肿块内部强化特征等指标比较差异无统计学意义（t/χ²=2.249、0.977、1.369、0.524、2.158,P>0.05）。两组患者肿块表观扩散系数（ADC）值、腋窝淋巴结（ALN）短径、肿块边缘、动态增强时间-信号强度曲线（TIC）曲线等指标比较,差异有统计学意义（t/χ²=6.573、9.873、29.441、2.031,P<0.05）。二元Logistic回归模型结果显示,肿块ADC值、ALN 短径（≥5 mm）、TIC曲线（流出型）为乳腺癌ALNM发生的危险因素（OR=0.251、0.106、0.002,P<0.05）。结论 DCE-MRI多参数定量特征中,乳腺癌患者的肿块ADC值低、ALN 短径（≥5 mm）、TIC曲线（流出型）为乳腺癌ALNM发生的危险因素。

Objective To investigate the predictive value of multi-parameter quantitative features of dynamic contrast-enhanced magnetic resonance imaging（DCE-MRI）in the risk of axillary lymph node metastasis（ALNM）in breast cancer．Methods Clinical data of 155 patients with breast cancer diagnosed by surgery and pathology in Foshan Gaoming District People's hospital from March 2020 to November 2022 were retrospectively collected．According to whether the patients had ALNM,they were divided into ALNM group（n=39）and non-ALNM group（n=116）．Univariate analysis and multiple Logistic regression models were used to explore the influencing factors of ALNM in breast cancer．Results There was no significant difference in mass texture,mass diameter,mass location,mass shape and internal enhancement between the ALNM group and the non-ALNM group（t/χ²=2.249,0.977,1.369,0.524,2.158,P>0.05）．There were significant differences in ADC value,ALN short diameter,tumor margin and TIC curve between the two groups（t/χ²=6.573,9.873,29.441,2.031,P<0.05）．Binary Logistic regression model showed that ADC value,ALN short diameter（≥5 mm）and tumor margin（blur）were risk factors for the occurrence of breast cancer ALNM（OR=0.251,0.106,0.002,P<0.05）．Conclusions Among the multi-parameter quantitative features of DCE-MRI,the ADC value of breast cancer,the short diameter of ALN（≥5 mm）,and the edge of the tumor（blur）are the risk factors for the occurrence of ALNM in breast cancer．

目的 探讨高频超声对小儿梅克尔憩室所致肠梗阻的诊断价值。方法 选取广州市妇女儿童医疗中心2018年1月—2023年12月经手术证实的由梅克尔憩室引起的肠梗阻患儿41例作为研究对象,回顾性分析患儿临床资料及超声表现,并与术中所见和病理结果进行对照。结果 41例患儿,发病平均年龄为（3.97±3.69）岁,其中男32例、女9例。术前超声诊断肠梗阻38例,诊断符合率为92.7%;诊断梅克尔憩室所致肠梗阻9例,诊断符合率为21.9%。术中诊断梅克尔憩室索带卡压肠管24例,腹内疝8例,肠扭转1例;肠套叠10例;梅克尔憩室炎症、粘连6例,粘连穿孔1例;憩室内异物并穿孔1例。结论 高频超声对小儿肠梗阻有重要的诊断价值,仔细探查可以明显提高梅克尔憩室所致肠梗阻的临床诊断率,为临床尽早手术提供重要依据。

Objective To investigate the diagnostic value of high frequency ultrasound for intestinal obstruction caused by Meckel's diverticulum in children．Methods From January 2018 to December 2023,41 children with intestinal obstruction caused by Meckel's diverticulum were selected as the study objects．The clinical data and ultrasound images of the children were analyzed retrospectively,and compared with the intraoperative and pathological results．Results In 41 patients,the average age of onset was（3.97±3.69）years ,including 32 males and 9 females．Preoperative ultrasonic diagnosis of intestinal obstruction in 38 cases,diagnosis coincidence rate was 92.7%．Intestinal obstruction caused by Meckel's diverticulum was diagnosed in 9 cases,the diagnosis coincidence rate was 21.9%．During the operation,24 cases of Meckel's diverticulum intestinal compression were diagnosed,8 cases of abdominal hernia,1 case of intestinal torsion,and intussusception of 10 cases．Meckel's diverticulum had inflammation and adhesion in 6 cases and adhesion perforation in 1 case．A case of foreign body in diverticulum with perforation．Conclusions High-frequency ultrasound has an important diagnostic value for intestinal obstruction in children．Careful exploration can significantly improve the clinical diagnosis rate of intestinal obstruction caused by Meckel's diverticulum,and provide an important basis for early clinical operation．