目的 探讨密室逃脱教学法运用于急诊护理教学查房的效果。方法 选取2024年6月—2025年6月在本院急诊科的新入职护士76人作为研究对象,按随机数字表法将所有护士分为对照组和观察组（n均=38）。对照组采用传统模式护理教学查房,观察组采用密室逃脱教学法教学查房。培训后对两组护士采用理论及操作技能考核、批判性思维能力量表-中文版进行考核，并调查两组护士对两种教学模式的满意度。结果 与对照组比较，观察组的理论知识成绩及操作技能成绩明显提升（P＜0.05）；另外，观察组的批判性思维能力量表-中文版得分比对照组明显提升（P＜0.05）。观察组的非常满意、比较满意例数（率）及总满意度均比对照组明显增加（P＜0.05）。结论 密室逃脱教学法可有效提高急诊护理教学查房效果，值得在临床教学实践中进一步推广。
Objective: To investigate the effectiveness of the escape room teaching method in emergency nursing teaching rounds. Methods: A total of 76 newly hired nurses in the Emergency Department of our hospital between June 2024 and June 2025 were selected as study subjects. Using a random number table, all nurses were divided into a control group and an observation group (n = 38 each). The control group underwent traditional nursing teaching rounds, while the observation group participated in teaching rounds using the escape room teaching method. After training, both groups were assessed using theoretical and practical skill examinations, as well as the Critical Thinking Skills Scale (Chinese Version), and their satisfaction with the two teaching models was surveyed. Results: Compared with the control group, the observation group showed significant improvements in theoretical knowledge and practical skill scores (P < 0.05); Additionally, the scores on the Critical Thinking Skills Scale (Chinese Version) in the observation group were significantly higher than those in the control group (P < 0.05). The number (and rate) of nurses in the observation group who reported being “very satisfied” or “fairly satisfied,” as well as the overall satisfaction rate, were significantly higher than those in the control group (P < 0.05). Conclusion: The escape room teaching method can effectively enhance the effectiveness of emergency nursing teaching rounds and is worthy of further promotion in clinical teaching practice.
目的：初步探索羧基麦芽糖铁（FCM）治疗非透析慢性肾脏病（ND-CKD）贫血患者的有效性与安全性，为FCM在我国ND-CKD贫血患者中的临床应用提供参考。方法：本研究为单中心、前瞻性、单臂研究，纳入25例ND-CKD贫血患者，给予FCM 500 mg或1000 mg单次静脉输注，分别于基线和 FCM治疗的1周后、1月后采集患者外周血，检测血红蛋白、血清铁蛋白、转铁蛋白饱和度，同时观察、记录不良事件发生情况。结果：（1）患者经FCM单次输注后，1周后及1月后的血红蛋白、血清铁蛋白、转铁蛋白饱和度均显著升高（P<0.05）。与FCM治疗1周后相比，1月后的血红蛋白显著升高（P<0.05），血清铁蛋白、转铁蛋白饱和度均显著降低（P<0.05）。（2）2例患者发生低磷血症，1例患者出现过敏性皮疹，1例患者出现输注侧上肢酸胀不适。结论：FCM作为新型快速补铁制剂，可有效改善ND-CKD患者的贫血及铁代谢，短期安全性整体可控。
Objective: To preliminarily explore the efficacy and safety of ferric carboxymaltose (FCM) in the treatment of anemia in patients with non-dialysis chronic kidney disease (ND-CKD), and to provide a reference for the clinical application of FCM in Chinese ND-CKD patients with anemia. Methods: This was a single-center, prospective, single-arm study. A total of 25 ND-CKD patients with anemia were enrolled and received a single intravenous infusion of FCM at a dose of 500 mg or 1000 mg. Peripheral blood samples were collected from the patients at baseline, 1 week, and 1 month after FCM treatment to measure hemoglobin, serum ferritin, and transferrin saturation. Meanwhile, adverse events were observed and recorded. Results: (1) After a single infusion of FCM, the levels of hemoglobin, serum ferritin, and transferrin saturation were significantly increased at one week and one month post-treatment (P<0.05). Compared with the values at one week after FCM treatment, hemoglobin levels at one month were significantly higher (P<0.05), while serum ferritin and transferrin saturation levels were significantly lower (P<0.05). (2) Two patients developed hypophosphatemia, one patient experienced an allergic rash, and one patient reported soreness and discomfort in the upper limb on the infusion side. Conclusion: As a novel and rapid iron supplement preparation, FCM can effectively improve anemia and iron metabolism in patients with ND-CKD, with overall manageable short-term safety.
目的 探讨达格列净在行经皮冠状动脉介入治疗（Percutaneous Coronary Intervention，PCI）后2型糖尿病（Type 2 Diabetes Mellitus,T2DM）伴不稳定型心绞痛（Unstable Angina，UA）患者中的应用价值及短期心功能改善效果。方法 本研究为单中心、随机对照试验，纳入90例PCI术后2型糖尿病合并不稳定型心绞痛患者，随机分为达格列净组（n=43）和二甲双胍组（n=47），规范调整降糖药物保证降糖强度一致。治疗期间及治疗后6-12个月通过心脏彩超测量左心室射血分数（Left Ventricular Ejection Fraction，LVEF）、左室舒张末期内径（Left Ventricular End-Diastolic Diameter，LVEDD），并采集静脉血样检测N端B型利钠肽前体（N-terminalpro-Brain Natriuretic Peptide，NT-proBNP）水平，以评估心功能变化。 结果 PCI治疗后的6-12个月随访中，观察组NT-proBNP（P<0.01）显著降低，左心室射血分数LVEF（P<0.01）显著提升。与对照组相比：观察组NT-ProBNP水平明显下降（P<0.01），且低于对照组。结论 在PCI术后合并不稳定型心绞痛的T2DM患者中，加用达格列净治疗可显著改善NT-proBNP和LVEF等心功能替代指标，且安全性良好。
Objective:To explore the application value of dapagliflozin and its short-term cardiac function improvement effect in patients with type 2 diabetes mellitus (T2DM) combined with unstable angina (UA) after percutaneous coronary intervention (PCI). Methods: This was a single-center, randomized controlled trial. A total of 90 patients with type 2 diabetes mellitus (T2DM) complicated with unstable angina (UA) after percutaneous coronary intervention (PCI) were enrolled and randomly assigned to a dapagliflozin group (n=43) and a metformin group (n=47). Hypoglycemic agents were adjusted routinely to ensure consistent glycemic control intensity between the two groups. During treatment and at 6–12 months after treatment, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were measured by echocardiography, and venous blood samples were collected to determine the level of N-terminal pro-Brain Natriuretic Peptide (NT-proBNP) for the evaluation of cardiac function changes. Results: During the 6-month follow-up after PCI treatment, the N-terminal pro-brain natriuretic peptide (NT-proBNP) level in the observation group decreased significantly (P<0.01), and the left ventricular ejection fraction (LVEF) increased significantly (P<0.01).Compared with the control group, the NT-proBNP level in the observation group was notably lower (P<0.01) and also remained below that of the control group. Conclusion: For type 2 diabetes mellitus (T2DM) patients complicated with unstable angina pectoris after PCI, adjuvant treatment with dapagliflozin for 6 months can significantly improve cardiac function surrogate markers such as NT-proBNP and LVEF, with favorable safety profile.
摘要：目的：分析西双版纳傣族自治州地中海贫血髓外造血组织瘤样增生与胸部髓脂肪瘤的临床与CT影像学特征，筛选出可鉴别地中海贫血胸部髓外造血组织瘤样增生与胸部髓脂肪瘤的独立性影响因素。方法：选择2020年1月至2024年12月我院接诊的40例地中海贫血胸部髓外造血组织瘤样增生患者为病例组，选择同期就诊的40例胸部髓脂肪瘤患者为对照组进行回顾性分析。收集并比较两组患者一般资料及CT影像学特征，以多因素Logisitc回归筛选出独立性影响因素。结果：病例组与对照组性别、年龄、BMI、病灶最大径差异均无统计学意义（P>0.05），两组病灶部位、病灶数量、病灶形态、密度、强化情况差异均具有统计学意义（P<0.05）。多因素Logistic回归分析结果显示：病灶数量（OR=4.526，95%CI=1.258~16.281）、病灶形态（OR=0.310，95%CI=0.104~0.927）、密度（OR=6.704，95%CI=1.145~39.256）、强化情况（OR=4.062，95%CI=1.078~15.308）为地中海贫血髓外造血组织瘤样增生的鉴别两种疾病的独立性影响因素（P<0.05）。结论：病灶数量、病灶形态、密度等CT影像学特征可用于鉴别地中海贫血胸部髓外造血组织瘤样增生与胸部髓脂肪瘤。
目的 探究复方玄驹胶囊与西地那非联合治疗对轻中度勃起功能障碍（ED）的临床疗效及安全性的影响。方法 前瞻性选取2023-04至2025-04我院98例轻中度ED患者，随机分为2组，各49例。对照组予以西地那非治疗，联合组在对照组基础上予以复方玄驹胶囊，治疗时间均为12周。比较2组临床疗效、治疗前与治疗12周后勃起功能指标[国际勃起功能评分表-5（IIEF-5评分）、勃起硬度量表（EHS评分）、勃起质量量表（QEQ评分）]、阴茎血流动力学[收缩期峰值流速（PSV）、舒张末期流速（EDV）、阻力指数（RI）]、血管内皮功能[一氧化氮（NO）、内皮素（ET）、血管内皮生长因子（VEGF）]及安全性。结果 与对照组相比，联合组有效率较高（P＜0.05）；治疗12周后，与对照组相比，联合组IIEF-5、EHS、QEQ评分较高（P＜0.05）；治疗12周后，与对照组相比，联合组PSV、RI较高，EDV较低（P＜0.05）；治疗12周后，与对照组相比，联合组NO、VEGF水平较高，ET水平较低（P＜0.05）；2组治疗期间不良反应无显著差异（P＞0.05）。结论 复方玄驹胶囊联合西地那非治疗能提高轻中度ED患者疗效，改善血管内皮功能与阴茎血流动力学，恢复勃起功能，且具有一定安全性。
目的 探讨非重型肺源性急性呼吸窘迫综合征（ARDS）患者发生肺纤维化的影响因素，并构建Logistic回归模型，以筛选高危患者，指导临床制定针对性干预方案。方法 前瞻性选取2022年1月～2024年12月于本院诊治的134例非重型肺源性ARDS患者为研究对象，依据发病后30 d内是否发生肺纤维化将其分为发生组58例、未发生组76例。比较两组临床资料，并通过多因素Logistic回归分析肺纤维化发生的影响因素。构建Logistic回归模型，并分析该模型对肺纤维化发生的预测价值。结果 多因素Logistic回归分析显示病程中出现休克、脓毒症、吸烟史、肺动脉高压及血清白细胞介素-8（IL-8）、低氧诱导因子-1α（HIF-1α）、Clara细胞分泌蛋白16（CC-16）、成纤维细胞生长因子（FGF-2）水平为肺纤维化发生的独立危险因素（P＜0.05）；Logistic回归模型预测肺纤维化发生的AUC值为0.871，敏感度、特异度分别为77.59%、84.21%，Hosmer-Lemeshow检验该模型与观测值拟合度良好，且Bootstrap检验显示该模型具有良好的区分度。结论 病程中出现休克、脓毒症、吸烟史、肺动脉高压及血清IL-8、HIF-1α、CC-16、FGF-2水平为非重型肺源性ARDS患者发生肺纤维化的独立危险因素，基于上述危险因素构建Logistic回归模型，该模型预测肺纤维化发生具有良好的预测效能，临床可依据上述因素采取针对性干预方案，以降低肺纤维化发生率。
目的 探讨不同剂量左甲状腺素钠联合二甲双胍治疗妊娠期糖尿病（GDM）并发甲状腺功能减退症（简称“甲减”）患者的临床疗效，并分析其对甲状腺激素水平、妊娠结局的影响。方法 选取2023年1月～2025年1月于本院诊治的92例GDM并发甲减患者为研究对象，依据治疗方案不同将其分为2组，对照组采用左甲状腺素钠、二甲双胍治疗，观察组采用维生素D联合左甲状腺素钠、二甲双胍治疗。比较2组临床疗效及治疗前后甲状腺激素[促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）]、糖脂代谢指标[空腹血糖、胰岛素抵抗指数（HOMA-IR）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）]、血管内皮功能[一氧化氮（NO）、内皮素-1（ET-1）、一氧化氮合酶（NOS）、非对称性二甲基精氨酸（ADMA）]、病情进展相关指标[成纤维细胞生长因子-21（FGF-21）、视黄醇结合蛋白4（RBP4）、脂蛋白相关磷脂酶A2（Lp-PLA2）]。比较2组妊娠结局。结果 观察组总有效率高于对照组（P＜0.05）；观察组治疗后TSH水平低于对照组，FT3、FT4水平高于对照组（P＜0.05）；观察组治疗后空腹血糖水平、TC、TG、LDL-C水平及HOMA-IR低于对照组（P＜0.05）；观察组治疗后NO、NOS水平高于对照组，ET-1、ADMA水平低于对照组（P＜0.05）；观察组治疗后血清FGF-21、RBP4、Lp-PLA2水平低于对照组（P＜0.05）；2组流产、胎盘早剥、新生儿窒息发生率比较无明显差异（P＞0.05），观察组早产发生率低于对照组（P＜0.05）。结论 维生素D联合左甲状腺素钠、二甲双胍治疗GDM并发甲减患者的效果显著，可更好地维持甲状腺功能正常，纠正糖脂代谢，改善血管内皮功能，控制疾病进展，并可在一定程度上改善妊娠结局。
目的 探讨吲哚布芬联合智能抗阻训练对急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后血小板功能及心功能的影响。方法 选取2024年1月至2025年12月在本院接受PCI支架植入术的60例ACS患者，随机分为观察组和对照组，每组30例。对照组给予常规治疗联合氯吡格雷75 mg/d治疗，观察组给予常规治疗联合吲哚布芬（100mg/次，2次/d）+智能抗阻训练干预，两组均连续干预3个月。比较两组患者干预前、干预1个月、3个月时花生四烯酸（AA）诱导和二磷酸腺苷（ADP）诱导的血小板聚集率，随访3个月不良心血管事件（MACE）发生率，以及干预前后心功能指标[左心室射血分数（LVEF）、左心室舒张末期内径（LVEDD）]。结果 干预前两组血小板聚集率、LVEF、LVEDD比较差异无统计学意义（P＞0.05）；干预1个月、3个月时，观察组AA诱导和ADP诱导的血小板聚集率降低幅度均显著大于对照组（P＜0.05）；干预3个月后，观察组LVEF显著高于对照组，LVEDD显著低于对照组（P＜0.05）；随访3个月，两组MACE发生率比较差异无统计学意义（P＞0.05）。结论 吲哚布芬联合智能抗阻训练可更显著地抑制ACS患者PCI术后血小板聚集，更有效地改善心功能指标，且安全性良好。
Objective To explore the effect of indobufen combined with intelligent resistance training on platelet function and cardiac function in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods A total of 60 ACS patients who underwent PCI stent implantation in our hospital from January 2024 to December 2025 were selected and randomly divided into an observation group and a control group, with 30 patients in each group. The control group was given conventional treatment combined with clopidogrel 75 mg/d, while the observation group was given conventional treatment combined with indobufen (100 mg/time, twice a day) + intelligent resistance training intervention. Both groups received continuous intervention for 3 months. The arachidonic acid (AA)-induced and adenosine diphosphate (ADP)-induced platelet aggregation rates were compared between the two groups before intervention, 1 month and 3 months after intervention. The incidence of major adverse cardiovascular events (MACE) was followed up for 3 months, and the cardiac function indexes [left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD)] were compared before and after intervention. Results Before intervention, there were no significant differences in platelet aggregation rates, LVEF and LVEDD between the two groups (P > 0.05); at 1 month and 3 months after intervention, the reduction amplitudes of AA-induced and ADP-induced platelet aggregation rates in the observation group were significantly greater than those in the control group (P < 0.05); after 3 months of intervention, LVEF in the observation group was significantly higher than that in the control group, and LVEDD was significantly lower than that in the control group (P < 0.05); after 3 months of follow-up, there was no significant difference in the incidence of MACE between the two groups (P > 0.05). Conclusion Indobufen combined with intelligent resistance training can more significantly inhibit platelet aggregation, more effectively improve cardiac function indexes in ACS patients after PCI, and has good safety.
