目的 分析中药穴位贴敷、沙库巴曲缬沙坦联合治疗在慢性心力衰竭（CHF）中的应用效果。方法 选取我院CHF患者90例（2024-08—2026-01），依据随机数字表分成两组，每组45例。对照组接受沙库巴曲缬沙坦治疗，研究组接受中药穴位贴敷联合沙库巴曲缬沙坦治疗。观察两组疗效、6min步行距离、中医证候积分、心功能[心脏指数（CI）、每搏输出量（SV）、左室射血分数（LVEF）]、心肌指标[脑钠肽（BNP）、肌钙蛋白Ⅰ（cTnⅠ）]、安全性。结果 研究组治疗效果优于对照组（P＜0.05）；治疗后，研究组中医证候积分、BNP、cTnⅠ低于对照组，6min步行距离、LVEF、CI、SV高于对照组（P＜0.05）；两组治疗期间不良反应无显著差异（P＞0.05）。结论 中药穴位贴敷联合沙库巴曲缬沙坦治疗CHF效果显著，可减轻临床症状，改善心功能，减少心肌损伤。

Objective To analyze the clinical efficacy of combined therapy with traditional Chinese medicine acupoint application and sacubitril/valsartan in patients with chronic heart failure (CHF). Methods A total of 90 patients with CHF admitted to our Hospital from August 2024 to January 2026 were selected, and divided into two groups by random number table, with 45 cases in each group. The control group was treated with sacubitril/valsartan, while the study group received combined therapy of traditional Chinese medicine acupoint application and sacubitril/valsartan. The therapeutic efficacy, 6-minute walking distance, TCM syndrome score, cardiac function indexes [cardiac index (CI), stroke volume (SV), left ventricular ejection fraction (LVEF)], myocardial indicators [brain natriuretic peptide (BNP), cardiac troponin Ⅰ (cTnⅠ)] and safety were observed in both groups. Results The therapeutic efficacy of the study group was better than that of the control group (P<0.05). After treatment, the TCM syndrome scores, BNP and cTnⅠ levels in the observation group were lower, while the 6-minute walking distance, LVEF, CI and SV were higher compared with the control group (P<0.05). No significant between-group difference was found in adverse reactions during treatment (P>0.05). Conclusion Traditional Chinese medicine acupoint application combined with sacubitril/valsartan achieves remarkable efficacy in the treatment of CHF. It can relieve clinical symptoms, improve cardiac function and alleviate myocardial injury.

对比微创拔牙与传统拔牙在下颌阻生智齿治疗中的效果及并发症概率。方法：自2023年1月至2025年9月，选取110名下颌阻生智齿患者，采用随机数字列表法，将对象均衡地分为实验组（55人）与对照组（55人）。观察组行微创拔牙术（高速涡轮手机分牙+微创牙挺），对照组行传统拔牙术（骨凿劈冠+锤击增隙）。对比两组手术时间、术后疼痛程度、张口度及术中及术后并发症发生率。结果： 观察组施行手术的时间明显短于对照组[（25.38±5.47）min vs （31.65±6.83）min，P<0.001]；术后24h及7d的VAS评分均低于对照组[（3.52±1.21）分 vs （5.87±1.56）分，（0.89±0.65）分 vs （1.95±0.91）分，均P<0.001]，张口度大于对照组（均P<0.001）。观察组术中并发症总发生率（1.82%）显著低于对照组（14.55%）（P=0.009），术后并发症总发生率（3.64%）亦显著低于对照组（20.00%）（P=0.022）。结论：相较于常规拔牙方式，下颌阻生智齿的微创手术能显著减少治疗时间，减轻术后疼痛与张口受限，并显著降低术中及术后并发症风险，疗效与安全性俱佳，具备临床推广价值。

To compare the efficacy and complication rates of minimally invasive tooth extraction versus traditional extraction in treating impacted lower wisdom teeth. Methods: From January 2023 to September 2025,110 patients with impacted lower wisdom teeth were randomly assigned to an experimental group (55 cases) and a control group (55 cases) using a random number table. The experimental group underwent minimally invasive extraction (high-speed rotary mobile phone tooth splitting + minimally invasive tooth elevator), while the control group received traditional extraction (bone chisel splitting + hammer gap widening). The study compared operative time, postoperative pain (VAS score), mouth opening degree, and intraoperative/operative complications between the two groups. Results: The experimental group showed significantly shorter operative time [(25.38±5.47) min vs (31.65±6.83) min, P<0.001]. Postoperative VAS scores at 24h and 7d were significantly lower in the experimental group [(3.52±1.21) vs (5.87±1.56) points, (0.89±0.65) vs (1.95±0.91) points, both P<0.001], with greater mouth opening degree (P<0.001). The total intraoperative complication rate (1.82%) in the experimental group was significantly lower than the control group (14.55%) (P=0.009), and the postoperative complication rate (3.64%) was also significantly lower than the control group (20.00%) (P=0.022). Conclusion: Compared with traditional tooth extraction, minimally invasive tooth extraction can effectively shorten the operation time, reduce postoperative pain and limited mouth opening, and significantly reduce the risk of intraoperative and postoperative complications. The efficacy and safety are excellent, and it has the value of clinical promotion.

目的 基于Logistic多因素回归分析探讨糖尿病肾病（DKD）患者发生贫血的独立影响因素，并构建诊断模型。方法 回顾性选取2020年1月—2025年8月我院收治的200例DKD患者，依据贫血发生情况，将患者分为贫血组（80例）与非贫血组（120例）。比较2组临床资料，采用Logistic多因素回归分析DKD患者发生贫血的影响因素，并构建DKD患者发生贫血的联合诊断模型。结果 贫血组糖尿病病程、肾病分期G3~G4患者占比、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）、甘油三酯（TG）水平高于非贫血组，免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、白蛋白（ALB）、低密度脂蛋白胆固醇（LDL-C）水平低于非贫血组，差异有统计学意义（P＜0.05）；糖尿病病程（OR=1.723，95%CI：1.317~2.254）、肾病分期（OR=5.202，95%CI：2.338~11.573）、TNF-α（OR=2.861，95%CI：1.636~5.001）、hs-CRP（OR=2.073，95%CI：1.440~2.985）、IgM（OR=0.470，95%CI：0.331~0.667）、ALB（OR=0.533，95%CI：0.378~0.753）、TG（OR=3.016，95%CI：1.833~4.962）均为DKD患者发生贫血的影响因素，差异有统计学意义（P＜0.05）；基于Logistic回归分析构建联合诊断模型：Logit（P）=-0.218+0.544×糖尿病病程+1.649×肾病分期+1.051×TNF-α+0.729×hs-CRP+（-0.756）×IgM+（-0.629）×ALB+1.104×TG，经校准曲线和决策曲线检验显示，该模型诊断结果与实际预测结果具有较高一致性，且具有较高净获益。结论 糖尿病病程、肾病分期、TNF-α、hs-CRP、IgM、ALB、TG水平是DKD患者发生贫血的影响因素，临床应关注上述影响因素，以早期预防患者贫血的发生。

目的：评估血细胞分离机单采制备自体富血小板血浆（PRP）治疗雄激素性脱发（AGA）的疗效及安全性。方法：纳入31例AGA患者，采用单采技术制备血小板浓度803~1669×10?/L的自体PRP，激活后行头皮注射治疗3次（间隔1个月）。于基线（T1）及每次治疗后1、2、3个月（T2~T4）评估毛发密度与不良反应。结果：患者均为男性。毛发密度由T1的（111.77±12.00）根/cm2升至T4的（133.74±16.34）根/cm2（均P＜0.001）。医师评估有效率80.6%，患者满意率74.2%。主要不良反应为注射部位出血、肿痛及灼热感，均自行缓解；1例出现额部及眼睑明显水肿，5 d后消退。结论：单采自体PRP治疗AGA疗效确切且安全。规范控制PRP制备质量及血小板浓度有助于优化疗效。

Objective: To evaluate the clinical efficacy and safety of autologous platelet-rich plasma (PRP) prepared via apheresis using a blood cell separator for the treatment of androgenetic alopecia (AGA). Methods: A total of 31 patients with AGA who completed the study were enrolled. Autologous PRP with a platelet concentration of 803-1669×10?/L was prepared using apheresis technology. After activation, the PRP was administered via intralesional scalp injections for a total of 3 sessions at 1-month intervals. Hair density changes and adverse reactions were evaluated at baseline (T1) and at 1, 2, and 3 months after the initial treatment (T2-T4). Results: All included patients were male. Hair density significantly increased from (111.77±12.00) hairs/cm2 at baseline to (133.74±16.34) hairs/cm2 at T4 (all P<0.001). The clinician-evaluated effective rate was 80.6%, and the patient satisfaction rate was 74.2%. The primary adverse reactions included hemorrhage, swelling, burning sensation, and transient pain at the injection site, all of which resolved spontaneously. Notably, 1 patient developed marked edema in the forehead and eyelids, which subsided spontaneously after approximately 5 days. Conclusion: Autologous PRP prepared via apheresis is effective and safe for the treatment of AGA. Standardized quality control of PRP preparation and platelet concentration may contribute to further optimizing the therapeutic outcomes.

肛周脓肿术后防瘘是临床的关注点，本文基于“治未病”思想，提出覆盖肛周脓肿术后防瘘全周期的防治策略，包括未病调体质、调摄饮食、优化手术、加强创面管理降低风险，既发截断病势、辨证防治并发症及局部干预防蔓延，康复期整体调养与随访促愈防复，为中医药在肛周脓肿术后防瘘的临床实践应用方面提供参考。

Prevention of fistula formation after perianal abscess surgery is a clinical concern. Based on the concept of "treating disease before it arises," this paper proposes a comprehensive prevention and treatment strategy covering the entire cycle of fistula prevention after perianal abscess surgery, including regulating constitution before disease onset, adjusting diet, optimizing surgery, strengthening wound management to reduce risk, interrupting disease progression after onset, treating complications based on syndrome differentiation, and local intervention to prevent spread. During the rehabilitation period, holistic recuperation and follow-up are emphasized to promote healing and prevent recurrence, providing a reference for the clinical application of traditional Chinese medicine in preventing fistula after perianal abscess surgery.

目的 探讨入院时血清淀粉样蛋白A（SAA）、载脂蛋白A1（ApoA1）、C反应蛋白（CRP）水平联合检测对老年急性脑梗死（ACI）患者规范治疗后3个月内发生预后不良的早期预测效能。方法 前瞻性选取2023年1月～2025年1月于焦作市第五人民医院就诊的108例老年ACI患者作为ACI组，另选取同期健康志愿者108例作为对照组。比较两组血清SAA、ApoA1、CRP水平。老年ACI患者予以规范治疗，根据治疗后3个月内预后情况将其分为预后不良（46例）和预后良好（62例）亚组，比较不同预后ACI患者患者临床资料及入院时血清SAA、ApoA1、CRP水平；Logistic回归分析入院时血清SAA、ApoA1、CRP水平是否为老年ACI患者规范治疗后3个月内发生预后不良的独立影响因素；ROC曲线分析入院时血清SAA、ApoA1、CRP水平联合检测对ACI患者预后不良的预测效能。结果 ACI组入院时血清SAA、CRP水平高于对照组，血清ApoA1水平低于对照组（P＜0.05）；预后不良亚组高血压占比、入院NIHSS评分、梗死体积、入院时血清SAA、CRP水平高于预后良好亚组，血清ApoA1水平低于预后良好亚组（P＜0.05）；剔除存在多重共线性指标高血压、入院NIHSS评分、梗死体积后，入院时血清SAA、ApoA1、CRP水平仍是老年ACI患者规范治疗后3个月内发生预后不良的独立影响因素（P＜0.05）；入院时血清SAA、ApoA1、CRP水平联合预测ACI患者预后不良的AUC值为0.873，显高于各指标单独预测值0.738、0.768、0.749（P＜0.05）。结论 入院时血清SAA、ApoA1、CRP水平是老年ACI患者预后不良的独立影响因素，联合检测对预后不良具有较高的预测效能，可将其作为ACI患者血清敏感指标，协助临床医师早期制定针对性干预措施，减少ACI患者预后不良的发生。

目的：探讨沙库巴曲缬沙坦钠对慢性心力衰竭（CHF）患者心电稳定性及心脏负荷的改善作用。方法：病例纳入2023年10月~2025年5月收治的102例CHF患者为研究对象，依据就诊时间段及治疗方案不同，将2023年3月~2024年6月沿用缬沙坦+螺内酯+比索洛尔治疗的51例患者列为常规组，将2024年7月~2025年9月采用沙库巴曲缬沙坦+螺内酯+比索洛尔治疗的51例患者列为试验组，比较两组患者的心肌纤维化，心电稳定性，心脏负荷及治疗安全性。所有患者均接受为期半年随访，比较两组患者的预后情况。结果：治疗后，试验组的基质金属蛋白酶-2（MMP-2）、基质金属蛋白酶-9（MMP-9）、半乳糖凝集素-3（Gal-3）、可溶性生长刺激表达基因2蛋白（sST2）均低于常规组（t=5.045，2.889，4.115，4.582；P＜0.05）。试验组的校正QT间期（QTc）、QT离散度（QTd）、T波峰-末间期（Tp-e）、室性早搏次数分别为（405.39±40.26）ms、（45.25±5.33）ms、（90.33±5.28）ms、（80.36±5.39）次/24h，均低于常规组[（450.22±42.19）ms、（50.37±6.15）ms、（95.29±6.44）ms、（85.27±6.18）次/24h]（t=5.490，4.493，4.253，4.276；P＜0.05）。试验组的收缩期肺动脉压（sPAP）、三尖瓣反流峰值速度（TRVmax）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD）分别为（20.48±5.26）mmHg、（2.13±0.25）m/s、（45.29±5.62）mm、（30.61±5.33）mm，均低于常规组[（25.35±6.29）mmHg、（3.22±0.47）m/s、（50.45±6.15）mm、（35.49±6.27）mm]（t=4.242，14.622，4.423，4.235；P＜0.05）。试验组的药物相关副反应发生率与常规组比较，差异无统计学意义（P＞0.05）。截至随访结束时，试验组的不良预后发生率9.80%（5/51）低于常规组27.45%（14/51）（x2=5.239；P＜0.05）。结论：沙库巴曲缬沙坦钠能延缓CHF患者的心肌纤维化进程并改善心电稳定性，在有效改善心电稳定性并降低不良预后发生风险同时未显著增加治疗风险。

Objective:To explore the improvement effect of sacubitril valsartan sodium on electrocardiogram stability and cardiac load in patients with CHF.Methods:A total of 102 CHF patients admitted from October 2023 to May 2025 were included in the study. Based on the treatment period and regimen, 51 patients treated with valsartan, spironolactone, and bisoprolol from March 2023 to June 2024 were classified as the conventional group, while 51 patients treated with sacubitril/valsartan, spironolactone, and bisoprolol from July 2024 to September 2025 were designated as the experimental group. The myocardial fibrosis, electrocardiographic stability, cardiac workload, and treatment safety were compared between the two groups. All patients underwent a six-month follow-up to assess their prognosis.Results:After treatment, the levels of MMP-2, MMP-9, Gal-3, and sST2 in the experimental group were lower than the control group (t=5.045，2.889，4.115，4.582; P<0.05). The QTc, QTd, Tp-e, and number of ventricular premature beats in the experimental group were (405.39 ± 40.26) ms, (45.25 ± 5.33) ms, (90.33 ± 5.28) ms, and (80.36 ± 5.39) beats per 24 hours, lower than the control group [(450.22 ± 42.19) ms, (50.37 ± 6.15) ms, (95.29 ± 6.44) ms, and (85.27 ± 6.18) beats per 24 hours] (t=5.490，4.493，4.253，4.276; P<0.05). The sPAP, TRVmax, LVEDD, and LVESD of the experimental group were (20.48 ± 5.26) mmHg, (2.13 ± 0.25) m/s, (45.29 ± 5.62) mm, and (30.61 ± 5.33) mm, lower than the conventional group [(25.35 ± 6.29) mmHg, (3.22 ± 0.47) m/s, (50.45 ± 6.15) mm, and (35.49 ± 6.27) mm] (t=4.242，14.622，4.423，4.235; P<0.05). The incidence of drug-related side effects in the experimental group was not significantly different from that in the control group (P>0.05). As of the end of follow-up, the incidence of poor prognosis in the experimental group was 9.80% (5/51) lower than that in the conventional group 27.45% (14/51) (x2=5.239; P<0.05).Conclusion:Sacubitril valsartan sodium can delay the progression of myocardial fibrosis and improve electrocardiogram stability in CHF patients, effectively improving electrocardiogram stability and reducing the risk of adverse prognosis without significantly increasing treatment risk.

目的：分析冠状动脉CT血管成像（CTA）联合动态心电图（DCG）与冠心病患者冠脉狭窄程度及预后情况的关联。方法：研究对象选择我院2024年1月~2025年3月收治的210例冠心病患者及同期接受检查的210例非冠心病患者，分别列为病例组和对照组，比较两组CTA参数、DCG参数间差异。依据入院测得（Gensini）评分不同，将入组患者分别列为轻度组（60例，Gensini评分≤30分）、中度组（75例，Gensini评分＞30分、≤60分）和重度组（75例，Gensini评分＞60分），比较三组CTA参数、DCG参数间差异，分析CTA参数、DCG参数与Gensini评分的相关性。统计入组患者不良预后发生情况，比较不同预后患者CTA参数、DCG参数间差异，归纳冠心病患者预后影响因素，检验CTA参数、DCG参数对患者不良预后的预测效能。结果：病例组的最小管腔直径（MLD）、最小管腔面积（MLA）、血流储备分数（FFR）、正常窦性间期的标准差（SDNN）、每5min平均RR间期的标准差（SDANN）、相邻RR间期差值的均方根（RMSSD）均低于对照组，斑块总体积（TPV）、低频/高频比值（LF/HF）均高于对照组（t=24.128，25.811，15.613，37.636，26.858，9.195，59.862，29.389；P＜0.05）。重度组的MLD、MLA、FFR、SDNN、SDANN、RMSSD均低于中度组，轻度组，TPV、LF-HF均高于中度组，轻度组（F=190.291，51.562，186.482，42.084，44.413，22.541，56.503，109.983；P＜0.05）。MLD、MLA、FFR、SDNN、SDANN、RMSSD均与Gensini评分负相关，TPV、LF-HF均与Gensini评分正相关（r=-0.352，-0.377，-0.445，-0.472，-0.332，-0.356，0.401，0.355；P＜0.05）。经统计，210例冠心病患者的不良预后发生率为38.10%（80/210）。预后不良组的MLD、MLA、FFR、SDNN、SDANN、RMSSD均低于预后良好组，TPV、LF-HF均高于预后良好组（t=6.827，12.219，19.313，6.097，7.097，5.027，7.088，12.465；P＜0.05）。MLA、FFR、SDNN升高为冠心病不良预后的保护因素，LF/HF升高为冠心病不良预后的危险因素。FFR、SDNN联合检测预测不良预后的 AUC 值优于两项指标单独检测（Delong检验，P＜0.05）。结论：CTA、DCG能客观评估冠心病患者冠脉狭窄程度，联合检测FFR、SDNN可作为预测冠心病不良预后的重要辅助手段。

Objective:To analyze the correlation between CTA combined with DCG and the degree of coronary stenosis and prognosis in patients with coronary heart disease.Methods:The research subjects selected were 210 patients with coronary heart disease admitted to our hospital from January 2024 to March 2025, as well as 210 non coronary heart disease patients who underwent examinations during the same period. They were divided into a case group and a control group. The differences in CTA parameters and DCG parameters between the two groups were compared. According to the different Gensini scores obtained upon admission, the enrolled patients were divided into mild group (60 cases, Gensini score ≤ 30 points), moderate group (75 cases, Gensini score>30 points, ≤ 60 points), and severe group (75 cases, Gensini score>60 points). The differences in CTA parameters and DCG parameters among the three groups were compared, and the correlation between CTA parameters, DCG parameters, and Gensini score was analyzed. Statistically analyze the occurrence of poor prognosis in enrolled patients, compare the differences in CTA and DCG parameters among patients with different prognoses, summarize the factors affecting the prognosis of coronary heart disease patients, and test the predictive power of CTA and DCG parameters for poor prognosis in patients.Results:The MLD, MLA, FFR, SDNN, SDANN, and RMSSD in the case group were all lower than the control group, while the TPV and LF/HF were higher than the control group (t=24.128，25.811，15.613，37.636，26.858，9.195，59.862，29.389; P<0.05). The MLD, MLA, FFR, SDNN, SDANN, and RMSSD of the severe group were lower than the moderate group, mild group, while the TPV and LF-HF of the mild group were higher than the moderate group, mild group (F=190.291，51.562，186.482，42.084，44.413，22.541，56.503，109.983; P<0.05). MLD, MLA, FFR, SDNN, SDANN, and RMSSD are all negatively correlated with Gensini score, while TPV and LF-HF are positively correlated with Gensini score (r=-0.352，-0.377，-0.445，-0.472，-0.332，-0.356，0.401，0.355; P<0.05). According to statistics, the incidence of poor prognosis in 210 patients with coronary heart disease was 38.10% (80/210). The MLD, MLA, FFR, SDNN, SDANN, and RMSSD of the poor prognosis group were lower than the good prognosis group, while TPV and LF-HF were higher than the good prognosis group (t=6.827，12.219，19.313，6.097，7.097，5.027，7.088，12.465; P<0.05). High MLA, FFR, and SDNN are protective factors for poor prognosis of coronary heart disease, while higher values than LF/HF are risk factors for poor prognosis of coronary heart disease. The combined detection of FFR and SDNN has a better AUC value for predicting poor prognosis of coronary heart disease than the detection of FFR and SDNN alone (Delong test, P<0.05）.Conclusion:CTA and DCG can objectively evaluate the degree of coronary stenosis in patients with coronary heart disease, and combined detection of FFR and SDNN can be an important auxiliary tool for predicting poor prognosis of coronary heart disease.

【摘要】目的：探讨器械护士术中分区精细化器械管理对心脏瓣膜置换术（HVR）手术效率及安全性的影响。方法：研究对象包括2024年6月~2026年5月至我院行HVR治疗的110例心脏瓣膜病（VHD）患者，以及同期参与手术的22名器械护士，采用随机数字表法将入组患者及护士分别列为常规组（55例患者、11名护士）、试验组（55例患者、11名护士），常规组内护士术中实施常规器械管理，试验组内护士术中实施分区精细化器械管理。比较两组患者的手术效率、围手术期安全事件，以及两组护士所参与手术的工作效率、术中器械管理情况。结果：在不同器械管理模式下，试验组内患者的主动脉阻断时间、体外循环时间、术中非必要等待时间、手术总耗时均低于常规组（t=8.817，5.730，20.609，9.632；P＜0.05）。试验组内患者的围手术期安全事件发生率9.09%（5/55）低于常规组25.45%（14/55）（x2=5.153；P＜0.05）。试验组内护士的器械摆台时间、器械传递反应时间、手术中断次数、器械整理时间、器械移交时间均低于常规组（t=3.347，6.505，5.971，3.795，5.838；P＜0.05）。试验组内护士的器械管理差错率低于常规组（x2=5.238；P＜0.05）。结论：器械护士术中分区精细化器械管理能提高HVR患者的手术效率并降低围手术期安全事件发生风险，对提高器械护士的器械管理质量、预防器械管理差错有积极影响

[Abstract]Objective:To explore the impact of refined intraoperative instrument management by operating room nurses on the efficiency and safety of HVR surgery.Methods:The study subjects included 110 patients with VHD who underwent HVR treatment at our hospital from June 2024 to May 2026, along with 22 instrument nurses who participated in the surgeries synchronously. Using the random number table method, the enrolled patients and nurses were divided into a control group (55 patients, 11 nurses) and an experimental group (55 patients, 11 nurses). Nurses in the conventional group implemented routine instrument management during surgery, while nurses in the experimental group implemented zoned and refined instrument management during surgery. The surgical efficiency, perioperative safety events of the two groups of patients, as well as the work efficiency and intraoperative instrument management of the surgeries participated by the nurses in the two groups were compared.Results:Under different instrument management modes, the aortic occlusion time, extracorporeal circulation time, intraoperative non-essential waiting time, and total surgical time of patients in the experimental group were all lower than the control group (t=8.817，5.730，20.609，9.632; P<0.05). The incidence of perioperative safety events in the experimental group was 9.09% (5/55) lower than that in the control group 25.45% (14/55) (x2=5.153; P<0.05). The instrument placement time, instrument delivery response time, number of surgical interruptions, instrument sorting time, and instrument handover time of nurses in the experimental group were lower than those in the control group (t=3.347，6.505，5.971，3.795，5.838; P<0.05). The error rate of nurses in the experimental group was lower than the control group (x2=5.238; P < 0.05).Conclusion:Refined intraoperative zone-specific instrument management by instrument nurses enhances surgical efficiency for HVR patients and reduces the risk of perioperative safety incidents, thereby positively impacting the quality of instrument care provided by nurses and preventing instrument-related adverse events.

目的 探讨冠心病（CHD）患者经皮冠状动脉介入（PCI）术后冠脉微循环损伤（CMI）发生的影响因素及构建的Logistic风险预测模型对CMI发生的预测效能，以指导临床制定针对性的干预措施。方法 选取2023年4月至2025年4月于本院接受PCI治疗的143例CHD患者为研究对象，依据PCI术后1 d是否发生CMI，将其分为发生CMI组（86例）和未发生CMI组（57例）。比较两组临床资料；分析CHD患者PCI术后发生CMI的影响因素，构建Logistic风险预测模型，分析其对PCI术后CMI发生的预测效能。结果 发生CMI组心肌梗死病史、糖尿病史、吸烟史、NYHA心功能分级为Ⅲ级、多支冠脉病变、伴有冠脉中重度钙化、症状出现至PCI时间＞6 h占比及冠脉狭窄率、预扩张次数、预扩张时间高于未发生CMI组，最大扩张压力、术后即刻TIMI血流分级为3级占比低于未发生CMI组，PCI术前血清ANGPTL3、EMMPRIN水平及hs-CRP/PA高于未发生CMI组（P＜0.05）；Logistic多因素分析结果显示，糖尿病史、冠脉狭窄率、预扩张次数、NYHA心功能分级、冠脉中重度钙化、症状出现至PCI时间及ANGPTL3、EMMPRIN、hs-CRP/PA为CHD患者PCI术后发生CMI的独立危险因素，最大扩张压力为其独立保护因素（P＜0.05）；构建的Logistic风险预测模型预测PCI术后CMI发生风险的AUC值为0.901（95%CI：0.840～0.945），敏感度、特异度分别为82.56%、80.70%，且该模型与观测值拟合度良好，具有良好的区分度、校准度和临床适用性。结论 依据CHD患者PCI术后发生CMI的影响因素构建的Logistic风险预测模型对CMI发生具有较高的预测效能，可指导临床制定针对性干预措施，以减少PCI术后CMI发生，改善CHD患者预后。