摘要：目的 分析2022—2024年深圳市福田区危重症孕产妇不同亚组（不同并发症/合并症）的流行病学特征、病因构成及相关因素，为优化区域孕产妇健康管理提供依据。方法 基于福田区危重症孕产妇监测网络，对2022年1月1日至2024年12月31日期间107921例孕产妇个案资料进行回顾性描述性分析，采用描述性流行病学方法及卡方检验分析不同因素与危重症主要并发症的关联。结果 深圳市福田区3年间危重症孕产妇共729例，总体发生率为6.75‰。各年度发生率分别为2022年6.67‰、2023年7.38‰和2024年6.33‰。危重症孕产妇中，≥35岁者占33.7%，本科及以上学历者占53.8%。初检妊娠风险评级为黄色者占比最高（41.98%），高危者占21.9%。最常见并发症为产后出血（43.89%），其次为宫缩乏力（17.28%）、前置胎盘（16.59%）、子痫/子痫前期（14.67%）和胎盘植入（13.99%）。血液系统疾病为最常见合并症（57.75%），内分泌系统疾病次之（24.42%）。单因素分析显示，产后出血的发生与高龄、产检次数不足5次、经产妇身份存在统计学关联（均P<0.05）；前置胎盘的发生与高龄、低学历、非汉族、初检高危评级、产检不足5次、经产存在统计学关联（均P<0.05）。结论 深圳市福田区危重症孕产妇发生率约为6.75‰，产后出血和前置胎盘为主要并发症。单因素分析显示，高龄、产检不足、初检高危分级及经产与上述主要并发症的发生相关。应加强动态妊娠风险管理和多学科协作，完善产科早期预警体系，以降低危重症孕产妇发生率，提高母婴安全水平。
Abstract: Objective To analyze the epidemiological characteristics, etiology composition, and related factors of critically ill pregnant women in Futian District, Shenzhen, from 2022 to 2024. Methods Based on the surveillance network, a retrospective descriptive analysis was conducted on 107,921 pregnant women. Chi-square tests were used to analyze the association between different factors and major complications. Results A total of 729 critically ill pregnant women were identified (overall incidence 6.75‰).??The most common complication was postpartum hemorrhage (43.89%), followed by uterine atony (17.28%), placenta previa (16.59%), eclampsia/preeclampsia (14.67%), and placenta accreta (13.99%). Univariate analysis showed that postpartum hemorrhage was statistically associated with advanced age, <5 antenatal visits, and multiparity (all P<0.05). Placenta previa was statistically associated with advanced age, low education level, non-Han ethnicity, high-risk initial assessment, <5 antenatal visits, and multiparity (all P<0.05). Conclusion The incidence of critically ill pregnant women in Futian District is approximately 6.75‰. Univariate analysis suggested that advanced age, insufficient antenatal visits, high-risk classification, and multiparity were associated with the main complications. Dynamic risk management and multidisciplinary collaboration should be strengthened.
探讨将 Root Cause Analysis（RCA）质量管理模式与心理资本理论相结合应用于手术核查团队，对改善沟通中断、提升沟通执行质量与团队协作能力的效果。方法 选取 2025年 1 月至 2025 年12 月某三级医院手术室手术团队成员 80 名，按手术间编号分为对照组与实验组，各 40 名。对照组实施常规手术核查流程；实验组在此基础上实施基于 RCA 的流程诊断与基于心理资本理论的综合沟通能力提升干预。干预结束后，比较两组沟通中断发生率、核查流程执行质量、沟通效率，以及心理资本量表（PCQ-24）和团队协作量表（T-TPQ）得分。结果 实验组沟通中断发生率显著低于对照组（P＜0.05），核查流程执行质量和沟通效率均显著优于对照组（P＜0.001）。实验组 PCQ-24 各维度及总分、T-TPQ 各维度及总分均显著高于对照组（均 P＜0.001）。结论 将 RCA 流程分析与心理资本理论干预相结合，可通过流程规范化与心理动力增强双路径同步改善手术团队沟通质量与协作水平，具有良好的临床应用价值与推广潜力。
To evaluate the effectiveness of an intervention combining Root Cause Analysis (RCA)–based quality management and Psychological Capital (PsyCap) theory in reducing communication interruptions and improving communication quality and teamwork in surgical safety check teams. Methods: Eighty surgical team members from a tertiary hospital (January 2025 - December 2025.) were assigned to a control group or an intervention group according to operating room allocation (40 per group). The control group followed routine surgical safety check procedures, whereas the intervention group additionally received an RCA-guided workflow analysis and a PsyCap-based communication enhancement program. Post-intervention outcomes included communication interruption rate, execution quality and efficiency of safety checks, Psychological Capital Questionnaire (PCQ-24) scores, and TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) scores. Results: The intervention group demonstrated a significantly lower communication interruption rate compared with the control group (P＜0.05). Execution quality and communication efficiency were significantly improved in the intervention group (P＜0.001). PCQ-24 total and subscale scores were significantly higher in the intervention group than in the control group (P＜0.001), as were T-TPQ total and subscale scores (P＜0.001). Conclusion: Integrating RCA-based workflow optimization with PsyCap-oriented psychological and behavioral training can effectively enhance communication quality, reduce interruptions, and strengthen teamwork in surgical safety check teams. The combined model has strong applicability and potential for wider clinical promotion.
目的 分析围绝经期女性糖脂代谢水平与卵巢储备功能减退（DOR）的相关性，并探讨绝经激素治疗的应用价值。方法 回顾性选取2024年2月至2026年2月就诊于本院的194例围绝经期女性为研究对象，根据其卵巢储备功能将其分为DOR组（n=103）与卵巢储备功能正常组（NOR，n=91）。比较2组临床资料，采用Logistic回归分析围绝经期女性DOR的危险因素，绘制ROC曲线分析其预测效能，并利用Spearman相关系数分析指标相关性。同时予以所有患者绝经激素治疗（MHT），比较治疗前后的性激素指标、糖代谢指标、超声指标及安全性指标。结果 Logistic多因素结果显示：年龄、FSH、HbA1c、TG是围绝经期女性DOR的重要影响因素（P＜0.05）。ROC结果显示：联合预测的AUC=0.982，95%CI为0.964~1.000，灵敏度为0.990，特异度为0.923，校准曲线拟合性好。卵巢储备功能与年龄、FSH、HbA1c、TG均呈显著正相关（P均<0.05）。与治疗前相比，FSH、LH、HbA1c、TG、LDL-C水平有明显下降（P＜0.05），子宫内膜厚度略有增加（P＜0.05）；AMH、卵巢体积无显著变化（P＞0.05）。MHT治疗后不良反应发生率为4.64%。结论 糖脂代谢异常与围绝经期女性DOR密切相关，是其重要危险因素。规范MHT干预可有效改善内分泌 代谢紊乱，且安全性可靠。
Objective To analyze the correlation between glycolipid metabolism levels and diminished ovarian reserve (DOR) in perimenopausal women, and to explore the application value of menopausal hormone therapy.Methods A total of 194 perimenopausal women admitted to our hospital from February 2024 to February 2026 were retrospectively enrolled. They were divided into the DOR group (n=103) and the normal ovarian reserve (NOR) group (n=91) according to ovarian reserve function. Clinical data were compared between the two groups. Logistic regression analysis was used to identify risk factors for DOR. Receiver operating characteristic (ROC) curves were plotted to evaluate predictive efficacy, and Spearman correlation analysis was performed to assess indicator correlations. All patients received menopausal hormone therapy (MHT). Sex hormone indicators, glycolipid metabolic indicators, ultrasonographic indicators and safety indicators were compared before and after treatment.Results Multivariate Logistic regression showed that age, follicle stimulating hormone (FSH), glycated hemoglobin A1c (HbA1c) and triglyceride (TG) were independent risk factors for DOR in perimenopausal women (P＜0.05). ROC analysis revealed that the combined prediction yielded an AUC of 0.982 (95%CI: 0.964–1.000), with a sensitivity of 0.990 and a specificity of 0.923, and good calibration curve fitting. Ovarian reserve was significantly positively correlated with age, FSH, HbA1c and TG (all P＜0.05). After treatment, levels of FSH, luteinizing hormone (LH), HbA1c, TG and low density lipoprotein cholesterol (LDL C) decreased significantly (P＜0.05), and endometrial thickness increased slightly (P＜0.05). No significant changes were observed in anti Müllerian hormone (AMH) and ovarian volume (P＞0.05). The incidence of adverse reactions after MHT was 4.64%.Conclusion Abnormal glycolipid metabolism is closely associated with DOR and serves as a critical risk factor in perimenopausal women. Standardized MHT can effectively improve endocrine metabolic disorders with satisfactory safety.
目的 探讨超声引导双侧眶下神经阻滞对鼻中隔偏曲矫正术患者术后镇痛效果、麻醉苏醒质量的影响。方法 回顾性选取2021年8月至2025年8月我院收治的行鼻中隔偏曲矫正术治疗的患者120例，按麻醉方案不同，分为全麻组和眶下神经阻滞组，各60例。全麻组进行气管插管全身麻醉和术后镇痛泵镇痛，眶下神经阻滞组在全麻基础上进行超声引导双侧眶下神经阻滞+术后镇痛泵镇痛。比较两组麻醉前、拔管即刻、拔管后5 min血流动力学（心率、平均动脉压）水平、术后麻醉苏醒质量（苏醒时间、苏醒期躁动发生情况）、术后24 h按压镇痛泵次数、术后3 h、6 h、12 h、24 h镇痛效果[数字分级评分（NRS）]及麻醉前、拔管后5 min时血清应激指标水平及不良反应发生情况。结果 拔管即刻、拔管后5 min，眶下神经阻滞组平均动脉压、心率均低于全麻组（P＜0.05）；眶下神经阻滞组躁动发生率、术后24 h按压镇痛泵次数低于全麻组（P＜0.05）；术后3 h、6 h、12 h，眶下神经阻滞组NRS评分均低于全麻组（P＜0.05）；拔管后5 min，眶下神经阻滞组血清皮质醇（Cor）、去甲肾上腺素（NE）水平低于全麻组（P＜0.05）；两组麻醉相关不良反应总发生率比较，差异无统计学意义（P＞0.05）。结论 超声引导双侧眶下神经阻滞可有效减轻患者鼻中隔矫正术后循环波动、术后疼痛及应激反应，减少麻醉药物用量，降低躁动发生率。
目的: 探讨RNF213基因敲除对hCMEC/D3细胞分泌的外泌体circRNAs表达谱的影响。方法: 采用尺寸排阻法分别从RNF213-/- hCMEC/D3细胞（KO组）和野生型细胞（WT组）培养上清中提取外泌体，用Illumina Novaseq 6000 平台检测外泌体circRNAs表达谱，并用生物信息学方法进行分析。结果: 两组细胞存在134种差异表达的外泌体circRNAs，其中116种上调，18种下调。GO分析结果中，cellular nitrogen compound metabolic process (BP), intracellular anatomical structure (CC), heterocyclic compound binding (MF)和organic cyclic compound binding (MF)是最丰富的术语。Polycomb repressive complex通路是KEGG分析最显著富集的通路。circHIPK3可能通过ceRNA机制和/或与RNA结合蛋白相互作用参与烟雾病的发生发展，并成功构建circRNA-miRNA-mRNA通路。结论: 本研究确定了RNF213-/- hCMEC/D3细胞与野生型细胞外泌体circRNAs的差异表达谱，从外泌体的视角，为烟雾病的发病分子机制提供了新的见解。
自2019年2月国务院发布《粤港澳大湾区规划纲要》以来，明确提出推动粤港澳大湾区医疗合作，促进优质医疗卫生资源跨境共享。2020年10月提出并实施港澳药械通工作方案，2021年4月首个试点单位首批药械顺利内地使用，截至2025年12月，港澳药械通指定医疗机构已拓展至71家，实现湾区9地市覆盖，引进使用港澳药品、医疗器械149个品种，惠及患者近2万人次，并获得广东省立法保障。本文以粤港澳三地医疗协同发展背景下，回顾其发展历程，总结部分经验，从实践和执行者的视角透析港澳药械通这一举措的创新性和融合性，实践中的启示，为我国医疗模式的国际接轨，国家医疗改革的相关政策制定，未来国际医疗的“中国服务”提供参考。
目的：评价在特发性黄斑裂孔（Idiopathic macular hole，IMH）患者的治疗中采用内界膜翻转覆盖术联合空气填充干预的实际价值；方法：选取2022年9月至2025年8月在我院接受手术治疗的42例裂孔直径在400~700μm的IMH患者，以随机数字表法分组，各21例。对照组采取内界膜剥离术联合空气填充进行干预，观察组采取内界膜翻转覆盖术联合空气填充进行干预，比较两组的裂孔闭合情况、最佳矫正视力（Best corrected vision，BCVA）及并发症发生情况；结果：两组患者在裂孔闭合情况率上差异无统计学意义（P＞0.05）。但术后3个月观察组的外界膜（External membrane，ELM）及椭圆体带（Ellipsoid zone，EZ）缺损直径均略低于对照组，表明两组在外层视网膜愈合情况上差异有统计学意义（P＜0.05）。术后1个月及3个月观察组的BCVA均低于对照组（P<0.05）。两组术后并发症发生率基本一致（P＞0.05）；结论：对IMH患者采取内界膜翻转覆盖术联合空气填充进行治疗，能够促进黄斑裂孔愈合并改善患者视力，且安全性良好，可广泛应用。
目的 比较锝[???Tc]甲氧基异丁基异腈单光子发射计算机断层扫描/计算机断层扫描（???Tc-MIBI SPECT/CT）双时相显像与颈部超声在继发性甲状旁腺功能亢进症（SHPT）患者术前定位中的诊断价值。方法 回顾性纳入2025年5月至2026年4月于黔东南苗族侗族自治州人民医院行两种影像学检查的疑似SHPT患者54例。以手术病理结果为金标准，计算超声与SPECT/CT在区域层面（共216个区域）的敏感性、特异性、准确性，并比较不同解剖区域的病灶检出率。结果 54例中确诊SHPT 45例（83.33%）。超声诊断敏感性、特异性、准确性分别为70.89%（112/158）、86.21%（50/58）、75.00%（162/216）；SPECT/CT分别为92.41%（146/158）、94.83%（55/58）、93.06%（201/216）。SPECT/CT的敏感性和准确性均高于超声（P均<0.001）。SPECT/CT在左上、左下、右上三个区域的检出率均高于超声（P<0.05）。结论 99mTc-MIBI SPECT/CT双时相显像在SHPT术前定位中的敏感性和准确性优于颈部超声，尤其对左上、左下、右上区域病灶检出优势明显，可作为SHPT患者术前定位的重要补充或首选影像学方法。
Objective?To compare the diagnostic value of technetium-99m methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) dual-phase imaging and cervical ultrasound in preoperative localization of secondary hyperparathyroidism (SHPT).?Methods?A total of 54 patients with suspected SHPT who underwent both imaging examinations at Qiandongnan Miao and Dong Autonomous Prefecture People's Hospital from May 2025 to April 2026 were retrospectively enrolled. Using surgical pathology as the gold standard, the sensitivity, specificity, and accuracy of ultrasound and SPECT/CT were calculated at the regional level (216 regions in total), and the detection rates in different anatomical regions were compared.?Results?Among the 54 patients, 45 (83.33%) were confirmed with SHPT. The sensitivity, specificity, and accuracy of ultrasound were 70.89% (112/158), 86.21% (50/58), and 75.00% (162/216), respectively; while those of SPECT/CT were 92.41% (146/158), 94.83% (55/58), and 93.06% (201/216), respectively. The sensitivity and accuracy of SPECT/CT were significantly higher than those of ultrasound (both?P<0.001). The detection rates of SPECT/CT in the upper-left, lower-left, and upper-right regions were significantly higher than those of ultrasound (P<0.05).?Conclusion?99mTc-MIBI SPECT/CT dual-phase imaging demonstrates superior sensitivity and accuracy compared with cervical ultrasound in preoperative localization of SHPT, especially showing significant advantages in detecting lesions in the upper-left, lower-left, and upper-right regions. It can serve as an important supplement or the first-choice imaging modality for preoperative localization in SHPT patients.
