目的 探讨老年髋部骨折（GHF）患者围术期隐性失血的影响因素及护理措施。方法 回顾性分析2020年3月—2023年3月我院收治的86例老年GHF患者,所有患者均采取手术治疗,计算所有患者围术期失血量,并收集所有患者的一般资料及围术期相关治疗情况,分析不同一般资料患者围术期隐性失血情况,不同手术方式及麻醉方式围术期隐性失血情况,不同术后处理方式围术期隐性失血情况,随后采取Logistic回归分析老年GHF患者围术期隐性失血的影响因素,最后针对结果制定老年GHF隐性失血的护理措施。结果 不同性别和是否合并冠状动脉粥样硬化、高血压患者围术期隐性失血量比较差异无统计学意义（P>0.05）,不同年龄、合并糖尿病、骨折类型患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同手术方式、麻醉方式患者围术期隐性失血量比较差异有统计学意义（P<0.05）;不同术后引流、使用肝素情况患者围术期隐性失血量比较差异有统计学意义（P<0.05）;Logistic回归分析结果表明：年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素都是造成GHF老年患者围术期隐性失血的影响因素（P<0.05）。患者经相关护理后,恢复较佳。结论 老年GHF患者围术期会存在大量隐性失血情况,同时年龄、合并糖尿病、手术方式、麻醉方式、术后引流、使用肝素与围术期隐性失血量密切相关,临床上可采取针对性措施减少GHF患者隐性失血。

Objective To explore the influencing factors and nursing measures of perioperative hidden blood loss in elderly patients with geriatric hip fractures（GHF）．Methods From March 2020 to March 2023,86 elderly patients with GHF admitted to our hospital were selected as the study objects for retrospective analysis．All patients were treated with surgery．The perioperative blood loss of all patients was calculated,general information and perioperative treatment status of all patients were collected,the hidden blood loss of patients with different general information,different surgical and anesthesia methods and different postoperative treatment methods were analyzed．Logistic regression analysis was used to analyze the influencing factors of hidden blood loss of elderly GHF patients during the perioperative period．Nursing measures for hidden blood loss in elderly hip fractures were developed based on the results．Results There was no statistical difference in the amount of perioperative hidden blood loss among patients with different gender,complicated with coronary heart disease and hypertension or not（P>0.05）,but there was statistical difference in the amount of perioperative hidden blood loss among patients with different ages,complicated with diabetes and fracture types（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different surgical and anesthesia methods（P<0.05）．There was statistically significant difference in the amount of hidden blood loss during the perioperative period among patients with different postoperative drainage and use of heparin（P<0.05）．The results of Logistic regression analysis showed that age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use were independent risk factors for perioperative hidden blood loss in elderly patients with GHF（P<0.05）．Conclusions There will be a lot of hidden blood loss in the perioperative period of elderly patients with GHF．At the same time,age,complicated with diabetes,operation methods,anesthesia methods,postoperative drainage and heparin use are closely related to the amount of hidden blood loss in the perioperative period．Targeted measures can be taken clinically to reduce the hidden blood loss in patients with GHF．

目的 了解越秀区助产机构医务人员对艾滋病母婴阻断知识及患者相关权益知识掌握情况,为更好地贯彻落实消除艾滋病母婴传播工作提供下一步工作策略和措施依据。方法 于2022年7月—8月,对广州市越秀区5家助产机构妇产科、保健科和医务科的医务人员进行艾滋病母婴阻断知识政策及HIV感染孕产妇相关权益知识的问卷调查。结果 465名医务人员对个别艾滋病母婴阻断政策了解不足,包括“人类免疫缺陷病毒（HIV）感染孕产妇到定点医疗机构终止妊娠或住院分娩时可以获得一定的减免”（知晓率79.78%）、“HIV感染孕产妇的宝宝可以免费领取一定数量的奶粉”（知晓率66.88%）;医务人员对HIV感染孕产妇的生育相关权益认识严重不足,对HIV感染孕产妇生育权益认识正确的仅有45.59%。临床护士群体对上述艾滋病母婴阻断政策及HIV感染孕产妇相关权益的知晓率低于临床医生及其他医务人员,组间比较差异有统计学意义（P<0.05）。结论 越秀区助产机构医务人员对艾滋病母婴阻断知识有一定的了解,但掌握不够完整、全面,对HIV感染患者的生育权认识严重不足,应进一步加强对助产机构医务人员、尤其是护士群体关于艾滋病母婴阻断政策知识及患者相关权益的培训,以更好地贯彻落实消除艾滋病母婴传播工作,保障HIV感染患者的权益。

Objective To understand the knowledge of medical staff of midwifery institutions in Yuexiu District about AIDS prevention of mother-to-children transmission（PMTCT）and patients' rights and interests,in order to provide the basis for the following work strategy and measures for better implementation of the elimination of mother-to-child transmission of HIV．Methods From July to August in 2022,a questionnaire survey about knowledge and policies of AIDS PMTCT and rights of HIV infected pregnant women was conducted among the medical staff of obstetrics and gynecology department,health care department and medical department in five midwifery institutions in Yuexiu District of Guangzhou City．Results A total of 465 medical workers had insufficient understanding of some policies on PMTCT of AIDS,including HIV-infected pregnant women can obtain certain fee waiver when they go to designated medical institutions to terminate pregnancy or hospitalized deliver（awareness rate of 79.78%）,HIV-infected pregnant women's babies can receive a certain amount of free milk powder（awareness rate of 66.88%）．There was a serious lack of awareness of reproductive rights of HIV-infected pregnant women among medical staff,and only 45.59% of them had correct understanding．The awareness rate of the PMTCT and the rights and interests of HIV-infected pregnant women among clinical nurses was significantly lower than that among clinicians and other medical staff．Conclusions The medical staff of midwifery institutions in Yuexiu District have some knowledge about the PMTCT of AIDS,but their knowledge is not complete and comprehensive,and their understanding of the reproductive rights of HIV-infected patients is seriously inadequate,so it is necessary to further strengthen the training of medical staff in midwifery institutions,especially nurses,on the policy knowledge of PMTCT of AIDS and the related rights and interests of patients,in order to better implement the elimination of mother-to-child transmission of AIDS and protect the rights and interests of infected patients．

目的 通过关注追踪中老年人口腔健康问题对生活质量的影响,系统梳理中老年人口腔健康的相关影响因素及其关系,为此类人群的口腔健康及其相关生活质量的活动开展提供调研依据。方法 随机抽取2022年10月—2023年5月之间的266名中老年人参与调查,按照“病因链”收集该类人群的社会学特征、日常口腔保健行为、身体健康状况,分析评价中老年人口腔健康相关生活质量。结果 266名中老年人口腔健康常识和行为得分平均为（30.69±8.98）分,口腔健康评估平均为（8.59±3.68）分,口腔健康相关生活质量GOHAI总分为（25.65±8.10）分。单因素分析显示,人口学特征与一般身体健康状况、口腔健康常识和行为以及口腔健康情况与中老年人的口腔健康相关生活质量的GOHAI得分密切相关（P<0.05）。多因素分析显示,女性、年龄>45岁、患慢性病、日常生活习惯是影响中老年口腔健康和生活质量的独立危险因素（P<0.05或P<0.01）。结论 口腔健康作为全身健康的基础,其影响因素多种多样,通过控制干预主要影响因素来提高社区口腔健康和相关生活质量,以改善社区居民生活幸福值。

Objective By focusing on and tracking the impact of oral health problems of middle-aged and elderly people on the quality of life,the relevant influencing factors and relationships of oral health were systematically sorted out to provide a research basis for the development of oral health and related quality of life of such people．Methods A total of 266 middle-aged and elderly people were randomly selected from October 2022 to May 2023 to participate in the survey,and the sociological characteristics,daily oral health care behaviors and physical health status of this population were collected according to the “etiological chain”,so as to analyze and evaluate the quality of life related to the oral health of middle-aged and elderly people．Results The 266 middle-aged and elderly people had a mean score of（30.69±8.98）for general knowledge and behavioral scores of oral health,a mean score of（8.59±3.68）for oral health assessment,a total score of（25.65±8.10）for oral health-related quality of life GOHAI．The univariate analysis showed that demographic characteristics,general body health state,oral health cognition and behavior and oral health state were closely associated with the GOHAI score related to the oral health associated quality of life in the middle-aged and elderly people（P<0.05）．The multivariate analysis indicated that female,age >45 years old,presence of chronic diseases and daily living habits were indepdent risk factors of the oral health and quality of life of the middle-aged and elderly（P<0.05）．Conclusions Oral health,as the basis of systemic health,has various influencing factors,by controlling the main influencing factors can improve the community oral health and related quality of life,and improve the happiness of community residents．

目的 分析单核细胞-淋巴细胞比率（MLR）联合游离三碘甲腺原氨酸（FT₃）对乙型肝炎病毒（HBV）相关慢加急性肝衰竭（ACLF）患者生存状况的预测效果。方法 纳入我院在2019年1月—2022年1月期间收治的HBV-ACLF患者共187例进行研究,随访患者90 d的生存状况,其中69例死亡患者设为死亡组,其余118存活患者设为存活组。对2组患者的各项资料进行单因素分析,对差异有统计学意义的因素行Logistic多因素分析,分析HBV-ACLF患者死亡的危险因素,并分析MLR联合FT3对HBV-ACLF死亡的预测效果。结果 死亡组患者的年龄、肝硬化发生率、原发性腹膜炎发生率、肝肾综合征发生率、电解质紊乱发生率、终末期肝病模型、MLR、中性粒细胞与淋巴细胞计数比值、国际标准化比值、肌酐、白细胞计数、总胆红素水平均高于B组,血钠、FT₃、总血清胆固醇水平均低于存活组,差异有统计学意义（P<0.05）。MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）。MLR、FT₃、MLR+FT₃对HBV-ACLF患者死亡均有一定的预测价值,但MLR+FT3的预测价值高于其他单项预测。结论 MLR≥0.60、FT₃≤2.50 pmol/L均为HBV-ACLF患者死亡的危险因素（P<0.05）,且二者联合应用对HBV-ACLF患者死亡有较佳的预测价值。

Objective To analyze the predictive effect of mononuclear-lymphocyte ratio（MLR）combined with free triiodothyronine（FT₃）on the survival of patients with hepatitis B virus-related acute-on-chronic liver failure（HBV-ACLF）．Methods In the study,187 patients with HBV-ACLF from January 2019 to January 2022 in our hospital were included,and the survival status of the patients was followed up for 90 days．Among them,69 patients were included in the death group and the rest 118 patients were included in the survival group．The data of the two groups of patients were analyzed by univariate analysis,and the statistically significant factors were analyzed by Logistic multifactor analysis．The risk factors of death in patients with HBV-ACLF were analyzed,and the predictive effect of MLR combined with FT₃ on the death of HBV-ACLF was analyzed．Results The age,incidence of cirrhosis,primary peritonitis,hepatorenal syndrome,electrolyte disturbance,ratio of neutrophil to lymphocyte count,international standardized ratio,model for end stage liver disease,MLR,creatinine,white blood cell count and total bilirubin of the patients in the death group were higher than those in survival group,and the levels of serum sodium,FT₃ and total cholesterol were lower than those in survival group,the differences were significant（P<0.05）．The results showed that MLR≥0.60,FT₃≤2.50 pmol/L were risk factors for death of HBV-ACLF patients（P<0.05）．MLR,FT₃,MLR+FT₃ had certain predictive value for the death of HBV-ACLF patients,but the predictive value of MLR+FT₃ was higher than other single prediction．Conclusions MLR≥0.60 and FT₃≤2.50 pmol/L are risk factors for death of patients with HBV-ACLF（P<0.05）,and the combination of the two has a better predictive value for death of patients with HBV-ACLF．

目的 探讨接受冠状动脉造影患者的中性粒细胞-淋巴细胞比值（NLR）、血小板-淋巴细胞比值（PLR）和单核细胞-淋巴细胞比值（MLR）与冠状动脉疾病（CAD）严重程度的关系。方法 收集2021年1月—2021年12月在六安市人民医院接受冠状动脉造影的150例急性冠脉综合征（ACS）患者。CAD的严重程度通过Gensini评分进行评估,150例ACS患者根据评分被分为轻度病变组（≤14分,41例）、中度病变组（15~47分,69例）和重度病变组（≥48分,40例）。比较3组的临床指标,采用相关统计学分析NLR、PLR、MLR与CAD严重性（Gensini评分）的相关性。结果 纳入研究的150例患者的平均年龄为（66.49±11.43）岁,男性占67.3%。在重度病变组,NLR和PLR值高于其他两组。在Pearson相关性检验中,Gensini评分与NLR呈正相关（r=0.319,P<0.001）,然而,Gensini评分与MLR、PLR之间无相关性（P>0.05）。在Logistic回归分析中,NLR（OR：1.306,95%CI：0.107~0.427）是CAD的独立危险因素。在ROC曲线分析中,发现NLR的曲线下面积最高,为0.723（95%CI：0.629~0.817,P<0.001）,NLR≥0.25为识别CAD存在的最佳临界值,灵敏度为78.49%,特异度为60.26%。结论 根据Gensini评分,NLR与CAD的严重程度呈正相关,而研究中未观察到MLR、PLR与CAD严重程度之间的关联。

Objective To explore the correlation of neutrophil-to-lymphocyte ratio（NLR）,platelet-to-lymphocyte ratio（PLR）,monocyte-to-lymphocyte ratio（MLR）with coronary artery disease（CAD）severity in patients undergoing coronary angiography．Methods A total of 150 patients with acute coronary syndrome（ACS）who underwent coronary angiography in Lu'an People's Hospital from January 2021 to December 2021 were enrolled．The severity of CAD was assessed by Gensini score,according to the score,150 patients with ACS were divided into mild disease group（≤14 points,41 cases）,moderate disease group（15-47 points,69 cases）and severe disease group（≥48 points,40 cases）．Clinical indicators of the three groups were compared,and related statistics were used to analyze the correlation between NLR,PLR,MLR and the severity of coronary artery lesions（Gensini score）．Results The average age of selected 150 patients was（66.49±11.43）,67.3% were male．In the severe disease group,NLR,PLR values were higher than the other two groups．A positive significant correlation was found between Gensini score and NLR（r=0.319,P<0.001）by Pearson's correlation test．However,no correlation was found between Gensini score and MLR and PLR（P>0.05）．In the Logistic regression analysis,NLR（OR：1.306,95% CI：0.107-0.427）was the independent risk factor of CAD．In receiver operating characteristic curve analysis,NLR was found to have highest area under the curve at 0.723（95% CI：0.629-0.817,P<0.001）,with an optimal cut-off value of 0.25,predicting the severe coronary lesion with a sensitivity of 60.26% and specificity of 78.49%．Conclusions The NLR is positively correlated with the severity of CAD．No correlation between MLR,PLR and severity of CAD in the cohort were observed．

目的 探讨与分析高频超声联合超微血流成像对肱三头肌肌腱断裂伴骨化性肌炎的诊断价值。方法 选择2020年7月—2022年5月在本院诊治的84例肱三头肌肌腱断裂患者作为研究对象,所有患者均行关节镜及超声检查,超声检查包括高频超声、超微血流成像,记录超声特征并判断诊断价值,根据关节镜检查结果分为骨化性肌炎组和非骨化性肌炎组。结果 84例患者中,经关节镜检查判断为合并骨化性肌炎24例（骨化性肌炎组）,占比28.6%。骨化性肌炎组超声表现为肱三头肌肌腱纤维呈连续性中断,含稍强回声的非均质等回声,近侧断端肌腱有回缩并增厚。非骨化性肌炎组（60例）超声表现为肱三头肌肌腱纤维呈连续性中断,局限性边界清晰非均质性稍低回声,两断端中间呈不均质低回声。骨化性肌炎组的骨质破坏、软组织肿胀与关节积液等占比分别为75.0%、79.2%、79.2%,均高于非骨化性肌炎组的20.0%、25.0%、35.0%（P<0.05）。骨化性肌炎组的肌腱面积、肌腱厚度、血管条数均比非骨化性肌炎组更高（P<0.05）。84例患者中,高频超声、超微血流成像与两者联合诊断为肱三头肌肌腱断裂伴骨化性肌炎分别为18例、23例、24例,高频超声、超微血流成像与两者联合诊断肱三头肌肌腱断裂伴骨化性肌炎的灵敏度为70.8%（17/24）、91.7%（22/24）、100.0%（24/24）,特异度为98.3%（59/60）、98.3%（59/60）、100.0%（60/60）。结论 肱三头肌肌腱断裂伴骨化性肌炎比较常见,高频超声联合超微血流成像在肱三头肌肌腱断裂伴骨化性肌炎的应用可有效反映病灶形态特征与血流特征,在诊断上具有很高的灵敏度与特异度。

Objective To explore and analyze the diagnostic values of high-frequency ultrasound combined with superb microvascular imaging（SMI）in triceps brachii tendon rupture with ossifying myositis．Methods From July 2020 to May 2022,84 cases of patients with triceps brachii tendon rupture who were diagnosed and treated in our hospital were selected as research subjects．All patients underwent arthroscopy and ultrasonography,ultrasonography including high-frequency ultrasound and SMI,to record ultrasound characteristics and determine diagnostic value,and patients were divided into ossifying myositis group and non-ossifying myositis group according to the results of the arthroscopic examination．Results In 84 patients,there were 24 patients（28.6%）diagnosed as ossifying myositis by arthroscopy（ossifying myositis group）．The ultrasound findings of the ossifying myositis group were interruption of the triceps brachii muscle tendon fibers with slightly strong echogenicity and heterogeneous isoechogenicity．The proximal severed tendon had retraction and thickening．In the non-ossifying myositis group（n=60）,the ultrasound findings showed a interruption of the triceps brachii muscle tendon fibers,with clear localized boundaries and slightly heterogeneous hypoechogenicity,and there was an uneven hypoechogenicity between the two broken ends．The proportions of bone destruction,soft tissue swelling and joint effusion in the myositis group were 75.0%,79.2% and 79.2%,which were significantly increased compared to 20.0%,25.0% and 35.0% in the non-ossifying myositis group（P<0.05）．The tendon area,tendon thickness and vascular number in the ossifying myositis group were significantly higher than those in the non-ossifying myositis group（P<0.05）．In the 84 patients,there were 18 cases,23 cases and 24 cases diagnosed of triceps tendon rupture with ossifying myositis by high-frequency ultrasound,SMI and their combination．The sensitivity of high-frequency ultrasound,SMI and their combination in the diagnosis of triceps tendon rupture with ossifying myositis were 70.8%（17/24）,91.7%（22/24） and 100.0%（24/24）,with specificity of 98.3%（59/60）,98.3%（59/60） and 100.0%（60/60）．Conclusions Triceps brachii tendon rupture with ossifying myositis is relatively common．The application of high-frequency ultrasound combined with SMI in triceps brachii tendon rupture with ossifying myositis can effectively reflect the morphological and blood flow characteristics of the lesion,with high sensitivity and specificity in diagnosis．

目的 探讨多参数磁共振成像对T₁高信号间隔与非T₁高信号间隔的原发性鼻腔鼻窦黑色素瘤（PSM）的鉴别价值。方法 回顾性分析经病理证实的 PSM 44例,术前均接受常规,DWI 和DCE-MRI检查。通过单因素和多因素Logistic分析评估T₁高信号间隔与非T₁高信号间隔PSM各MRI参数的差异。结果 44例PSMs 中,T₁高信号间隔PSMs 25例,非T₁高信号间隔PSMs 19例。两者在多参数MRI中,仅T₂低信号间隔,ADC值、达峰时间（Tp）及最大相对增强率（MRER）在单变量分析中差异存在统计学意义（均P<0.05）,在多因素Logistic分析中差异均无统计学意义（P均>0.05）。结论 多参数MRI对区分T₁高信号间隔与非T₁高信号间隔的PSM具有一定的指导价值,但并不能作为区分两者的独立预测指标。

Objective To evaluate the diagnostic value of multi-parameter MRI in differential diagnosis of primary sinonasal melanoma（PSM）with high- and non-high-T₁ signal septa．Methods Forty-four patients pathologically confirmed with PSMs underwent conventional,DWI and DCE-MRI examinations before operation．Univariate and multivariate Logistic analyses were used to evaluate the differences of MRI parameters between high- and non-high-T₁ signal septa in PSMs．Results Among 44 PSMs,25 cases had high T₁ signal septa and 19 cases had non-T₁ high signal septa．In multi-parameter MRI,only T₂ low signal septa,the value of ADC,peak time（TP）and maximum relative enhancement rate（MRER）were significantly different in univariate analysis（P<0.05）,but not in multivariate Logistic analysis（P>0.05）．Conclusions Multi-parameter MRI has some value in differentiating PSM with high-T₁ and non-high-T₁ signal septa,but it can not be used as an independent predictor to distinguish them．

受试者招募工作关乎临床研究质量与进度。无法按计划招募到合适的受试者,一直是研究者发起的临床研究（IIT）开展过程中面临的主要挑战之一。本文分析影响IIT项目受试者招募进度的常见因素,并借鉴国内外经验,从提高受试者认知度与信任度、拓宽招募渠道、加强人文关怀、建立多中心伦理协作审查机制等方面探讨推进受试者招募的具体措施,以期为IIT研究者及科研管理部门提供参考。

Recruitment of subjects is crucial to the quality and progress of clinical research．However,the inability to recruit suitable subjects according to the plan has been one of the major challenges faced by investigators in the process of conducting investigator-initiated trial（IIT）．This article analyzes the common factors that affect the recruitment progress of IIT projects,draws on domestic and international experiences,and explores specific measures to promote subject recruitment,including improving subject awareness and trust,expanding recruitment channels,enhancing humanistic care and establishing a multi-center ethical collaboration review mechanism,in order to provide reference for IIT researchers and research management departments．

嵌合基因是指由两个或多个原本不连续的基因片段重组而成的新基因,它们可以通过基因组重排、转录诱导等机制产生。嵌合基因在正常生理和发育过程中具有重要的功能和调控作用。嵌合基因可以改变原有基因的表达水平、编码蛋白质的结构和功能、信号通路的激活和抑制等,从而促进肿瘤细胞的增殖、侵袭、转移和耐药性。近年来,随着高通量测序技术的发展和应用,越来越多的嵌合基因被发现和鉴定,它们在不同类型的肿瘤中具有不同的表达模式和功能作用,为肿瘤的分子诊断、预后评估和靶向治疗提供了新的机会和挑战。本文旨在对嵌合基因产生的机制、检测方法和在肿瘤中的功能和应用等方面进行综述,为进一步认识嵌合基因在肿瘤进展中的功能机制及其精准化治疗提供参考。

Chimeric genes refer to novel genes formed by the recombination of two or more originally non-contiguous gene fragments through mechanisms like genomic rearrangement and transcriptional induction．They play important roles in physiological and developmental regulation．Chimeric genes can alter the expression,structure and function of original genes,modulate signaling pathway activation and inhibition,and thereby promote tumor cell proliferation,invasion,metastasis and drug resistance．In recent years,with the development and application of high-throughput sequencing technologies,increasing numbers of chimeric genes have been discovered and identified．They demonstrate different expression patterns and functional roles in various tumor types,providing new opportunities and challenges for molecular diagnosis,prognostic assessment and targeted therapy of cancers．This review summarizes the mechanisms of chimeric gene formation,detection methods and their functions and applications in tumors,to provide insights into the functional mechanisms of chimeric genes in tumor progression and their implications for precision treatment．

目的 观察伊伐布雷定对冠状动脉粥样硬化性心脏病（CHD,以下简称：冠心病）合并心律失常患者心率变异性（HRV）的影响,及对心房颤动（AF）的防治效果。方法 本文为前瞻性研究,病例纳入时间为2021年1月—2023年1月,研究对象为焦作市第二人民医院收治的125例CHD合并心律失常患者,采用随机数字表法对入组患者进行分组,分别列为常规组（62例）和联合组（63例）,常规组予常规药物治疗,联合组在常规药物治疗基础上联合伊伐布雷定治疗,比较2组患者治疗前后的HRV指标、血管内皮功能指标、心功能指标改善情况、心房颤动发生率及用药安全性。结果 治疗后,联合组24 h窦性心律RR间期标准差为（88.25±10.36）ms,24 h相邻正常RR间期差值均方根为（50.25±10.61）ms,24 h相邻正常RR间期差值>50 ms百分比为（12.04±3.41）%,均高于常规组[（81.44±10.77）ms、（43.28±10.71）ms、（10.77±3.08）%],组间比较差异具有统计学意义（P<0.05）。治疗后,联合组的血流介导下血管扩张程度为（12.33±3.27）%,硝酸甘油介导下血管内皮舒张程度为（9.83±2.21）%,均高于常规组[（10.25±3.23）%、（8.14±2.03）%]。AF发生率为4.76%（3/63）,低于常规组16.13%（10/62）,差异具有统计学意义（P<0.05）。治疗后,联合组的左室射血分数为（55.35±10.27）%,高于常规组（48.45±10.61）%,左室舒张末期内径为（40.24±10.37）mm,左室后壁厚度为（9.22±2.06）mm,均低于常规组[（46.33±10.28）mm、（10.88±2.46）mm],差异具有统计学意义（P<0.05）。治疗后,联合组的药物相关不良反应发生率为7.94%（5/63）,略高于常规组6.45%（4/62）,组间比较差异无统计学意义（P>0.05）。结论 伊伐布雷定联合常规药物治疗CHD合并心律失常能有效改善患者HRV指标、血管内皮功能及心功能,降低AF发生率,且未增加药物不良反应发生风险。

Objective To observe the effect of ivabradine on heart rate variability（HRV）in coronary heart disease（CHD）patients with arrhythmia and its preventive and therapeutic effects on atrial fibrillation（AF）．Methods This is a prospective cohort study．The 125 CHD patients with arrhythmia were included from January 2021 to January 2023 and divided into the conventional group（62 cases）and the combined group（63 cases）by random number table．The conventional group was treated with conventional drugs,and the combined group was treated with ivabradine additionally．The HRV index,vascular endothelial function index,improvement of cardiac function indicators,incidence of AF and medication safety were compared．Results After treatment,the standard deviation of normal RR intervals in 24 h of the combination group was（88.25±10.36）ms,root mean square of successive RR interval differences in 24 h was（50.25±10.61）ms,and successive RR interval differences>50 ms was（12.04±3.41）%．Compared with the conventional group [（81.44±10.77）ms,（43.28±10.71）ms and（10.77±3.08）%],the above indicators were all higher（P<0.05）．After treatment,the flow-mediated dilation and nitrite-mediated dilation of the combination group were（12.33±3.27）% and（9.83±2.21）%,respectively．Compared with the conventional group（10.25±3.23）% and（8.14±2.03）%）,the above indicators were higher．The incidence of AF was 4.76%（3/63）,which was lower（P<0.05）than the conventional group of 16.13%（10/62）．After treatment,the left ventricular ejection fraction of the combination group was（55.35±10.27）%,which was higher than that of the conventional group（48.45±10.61）%．The left ventricular diastolic diameter was（40.24±10.37）mm and the left ventricular posterior wall thickness was（9.22±2.06）mm．Compared with the conventional group [（46.33±10.28）mm,（10.88±2.46）mm],the above indicators were all lower（P<0.05）．After treatment,the incidence of drug-related side effects in the combination group was 7.94%（5/63）,which was similar to 6.45%（4/62）in the conventional group（P>0.05）．Conclusions The combination of ivabradine and conventional drugs in the treatment of CHD complicated with arrhythmia can effectively improve HRV indicators in patients,promote the recovery of vascular endothelial cell function and cardiac function,reduce the incidence of AF,and do not significantly increase the risk of drug side effects．