目的 分析早期活动康复对机械通气患儿肌力的影响,探讨影响肌力的相关因素。方法 采取回顾性研究,选择2021年4月—2023年4月医院收治的104例机械通气患儿临床资料,根据康复方法分为两组,其中采取常规康复训练的52例患儿为对照组,采取早期活动康复的52例患儿为观察组。两组均连续干预至出院,比较两组患儿的机械通气、住ICU、总住院时间、不同时点（转出ICU时、出院时、出院1个月）的肌力及Barthel日常生活能力（Barthel）评分;参照《中国重症肌无力诊断和治疗指南（2015年简版）》中诊断标准,评估机械通气患儿获得性肌无力（AW）发生情况。统计并比较两组基线资料,采用二元Logistic回归分析机械通气患儿AW发生的影响因素。结果 观察组的机械通气、住ICU及总住院时间[（7.28±2.47）d、（15.27±3.64）d、（27.08±5.68）d]均短于对照组[（10.64±3.39）d、（17.74±3.55）d、（32.57±6.14）d]（P<0.05）;与转出ICU时、出院时相比,两组出院1个月时英国医学研究委员会（MRC）肌力评定法评分升高,且观察组转出ICU时、出院时MRC评分[（53.57±5.13）分、（56.84±2.16）分]均高于对照组[（50.13±4.57）分、（53.67±2.42）分],两组组间·时点交互比较差异有统计学意义（P<0.05）;与转出ICU时、出院时相比,两组出院1个月时Barthel评分升高,且观察组转出ICU时、出院时Barthel评分[（65.03±12.47）分、（90.58±7.59）分]均高于对照组[（55.25±11.12）分、（84.13±9.62）分],两组组间·时点交互比较差异有统计学意义（P<0.05）;住院期间104例机械通气患儿发生AW 31例,发生率29.81%,AW组机械通气时间、营养风险筛查量表2002（NRS）评分[（11.84±4.19）d、（3.07±1.04）分]高于非AW组[（8.18±2.26）d、（1.61±0.75）分],且有创机械通气模式、使用罗库溴铵患儿[77.42%（24/31）、32.26%（10/31）]占比均高于非AW组[53.42%（39/73）、13.70%（10/73）]（P<0.05）;二元Logistic回归分析结果显示,机械通气时间长、有创机械通气模式、使用罗库溴铵、NRS评分高是机械通气患儿AW发生的危险因素（OR>1,P<0.05）。结论 早期活动康复能够有效缩短机械通气患儿患儿通气时间及住院时间,改善肌力,提高生活自理能力,同时机械通气时间、创机械通气模式、使用罗库溴铵、NRS评分与机械通气患儿肌力下降有关。

Objective To analyze the effect of early mobilization and rehabilitation on muscle strength in children with mechanical ventilation and to explore the risk factors affecting muscle strength．Methods A retrospective study was conducted on 104 children with mechanical ventilation admitted to the hospital from April 2021 to April 2023．According to the rehabilitation methods,they were divided into two groups．The clinical data of children with routine rehabilitation training were included in the control group（52 cases）,and the clinical data of children with early mobilization and rehabilitation were included in the observation group（52 cases）．Both groups were continuously intervened until discharged．The mechanical ventilation time,ICU stay and total hospital stay were compared between the two groups．Muscle strength and self-care ability at different time points（transfer out of ICU,discharge,1 month after discharge）,the incidence of acquired weakness（AW）in children with mechanical ventilation were evaluated according to the diagnostic criteria in the Chinese Guidelines for the Diagnosis and Treatment of Myasthenia Gravis． Baseline data was collected and compared between the two groups．Binary logistic regression was used to analyze the risk factors of AW in children with mechanical ventilation．Results The mechanical ventilation time,ICU and total hospitalization time in the observation group[（7.28±2.47）d,（15.27±3.64）d,（27.08±5.68）d] were shorter than those in the control group[（10.64±3.39）d,（17.74±3.55）d,（32.57±6.14）d]（P<0.05）．Compared with those at the time of transfer out of ICU and discharge,the Medical Research Council（MRC）scores of the two groups increased at 1 month after discharge,and the MRC scores of the observation group at the time of transfer out of ICU and discharge[（53.57±5.13）,（56.84±2.16）] were higher than those of the control group[（50.13±4.57）,（53.67±2.42）]．There were significant differences between the two groups,time points and between groups · time points（P<0.05）．Compared with those at the time of transferring out of ICU and at discharge,the Barthel scores of the two groups increased at 1 month after discharge,and the Barthel scores of the observation group at the time of transferring out of ICU and at discharge[（65.03±12.47）,（90.58±7.59）] were higher than those of the control group[（55.25±11.12）,（84.13±9.62）]．There were significant differences in Barthel scores between the two groups,time points and groups · time points（P<0.05）．AW occurred in 31 of 104 children with mechanical ventilation during hospitalization,with an incidence of 29.81%．The mechanical ventilation time and Nutritional Risk Screening（NRS）score in the AW group[（11.84±4.19）d,（3.07±1.04）] were higher than those in the non-AW group[（8.18±2.26）d,（1.61±0.75）]．The proportion of children with invasive mechanical ventilation mode and the use of rocuronium[77.42%（24/31）,32.26%（10/31）] were higher than those in the non-AW group[53.42%（39/73）,13.70%（10/73）]（P<0.05）．Binary logistic regression analysis showed that long mechanical ventilation time,invasive mechanical ventilation,use of rocuronium and high NRS score were risk factors for AW in children with mechanical ventilation（OR>1,P<0.05）．Conclusions Early mobilization and rehabilitation can effectively shorten the ventilation time and hospitalization time of patients with mechanical ventilation,improve muscle strength and improve the ability of self-reliance．At the same time,mechanical ventilation time,mechanical ventilation mode,use of rocuronium and NRS score are related to the decrease of muscle strength in children with mechanical ventilation．

目的 研究磁共振成像（MRI）、经直肠超声（TRUS）结合血清前列腺特异性抗原（PSA）诊断前列腺癌诊断的应用价值。方法 收集2020年1月—2023年1月前在武穴市第一人民医院检查的疑似前列腺癌患者140例,均给予MRI、TRUS检查,并进行血清PSA水平检测,以患者手术病理结果为金标准,观察单一MRI、TRUS、血清PSA及联合诊断时漏诊、误诊情况,进行一致性分析,计算各项单一诊断及联合诊断的诊断灵敏度、特异度、准确率。结果 经手术病理结果证实为前列腺癌81例,非前列腺癌59例,前列腺癌患者血清PSA水平高于非前列腺癌患者（P<0.05）;单一MRI、TRUS或PSA诊断前列腺癌与手术病理结果的一致性一般（Kappa=0.641、0.624、0.536,均P<0.001）,联合诊断与手术病理结果的一致性较好（Kappa=0.906,P<0.001）;联合诊断的灵敏度、特异度、准确率为高于单一MRI、TRUS、血清PSA及各诊断方式两两联合（P<α,α=0.007）。结论 前列腺癌诊断中单一MRI、TRUS、血清PSA诊断均存在漏诊、误诊风险,联合诊断可弥补单一诊断的不足,提高前列腺癌患者的诊断准确率。

Objective To study the application value of magnetic resonance imaging（MRI）,transrectal ultrasound（TRUS）combined with serum prostate-specific antigen（PSA）in the diagnosis of prostate cancer．Methods A total of 140 patients with suspected prostate cancer who were examined at Wuxue First People's Hospital from January 2020 to January 2023 were enrolled．MRI and TRUS examinations were performed,and serum PSA levels were tested．The surgical pathology results of the patients were used as the gold standard．The missed diagnosis and misdiagnosis in single MRI,TRUS,serum PSA and combined diagnosis were observed,consistency was analyzed,and the diagnostic sensitivity,specificity,and accuracy of each single diagnosis and combined diagnosis were calculated．Results There were 81 cases of prostate cancer and 59 cases of non-prostate cancer confirmed by surgical pathology results．The serum PSA level of prostate cancer patients was higher than that of non-prostate cancer patients（P<0.05）．The difference between the diagnosis of prostate cancer by single MRI,TRUS or PSA and the results of surgical pathology was with general consistency（Kappa=0.641,0.624,0.536,all P<0.001）,and the consistency of combined diagnosis and surgical pathology results was good（Kappa=0.906,P<0.001）．The sensitivity,specificity,and accuracy of combined diagnosis were higher than single MRI,TRUS,serum PSA and the combination of two diagnostic methods（P<α,α=0.007）．Conclusions In the diagnosis of prostate cancer,single MRI,TRUS and serum PSA diagnosis all have risks of missed diagnosis and misdiagnosis．Combined diagnosis can make up for the shortcomings of single diagnosis and improve the diagnostic accuracy of prostate cancer．

目的 检验婴儿孤独症观察量表中文版（AOSI）临床应用的灵敏度与特异度,评价其临床应用效果。方法 随机抽取1岁时曾在清远市妇幼保健院行AOSI评估,于2~3岁时诊断为孤独症谱系障碍（ASD）的48例患儿为ASD组,诊断为正常发展的46例幼儿作为对照组。比较两组患儿的18个条目得分和总分,采用受试者操作特征（ROC）曲线计算AOSI的特异度、灵敏度、阳性预测值与阴性预测值,并判断AOSI的最佳诊断（阳性）分界值;分析AOSI评估结果与《精神障碍诊断与统计手册（第5版）》（DSM-5）中ASD诊断标准的一致性。结果 两组研究对象性别、年龄比较差异无统计学意义（P>0.05）。ASD组各条目得分和总分均高于对照组,且差异具有统计学意义（P<0.01）。AOSI的曲线下面积（AUC）为1.00（P<0.01）,95%置信区间为（1.00,1.00）。不同阳性分界线的灵敏度、特异度、阳性预测值、阴性预测值及一致性相比较,当约登指数等于1.00时AOSI的最佳诊断（阳性截断值）界线为9分时,其上述值均为1.00。AOSI评估结果与DSM-5中ASD的诊断标准完全相一致（Kappa=1,P<0.01）。结论 AOSI应用于评估1岁的婴儿,当取9分为诊断界值时,具有高度的灵敏度与特异度,能较好地预测该婴儿在2~3岁时是否患ASD;AOSI是婴儿期ASD筛查的重要工具,其评估结果可作为ASD高危儿早期干预的证据和ASD的辅助诊断工具,适合于临床推广应用。

Objective To test the sensitivity and specificity of the Chinese version of the Autism Observation Scale for Infants（AOSI）in clinical application and evaluate its clinical application effect．Methods Forty-eight children with autism spectrum disorder（ASD）diagnosed at the age of 2 to 3 years who had undergone AOSI evaluation in Qingyuan Maternal and Child Health Hospital at the age of 1 year（2021）were randomly selected as the ASD group,and 46 children with normal development were randomly selected as the control group．The scores of 18 items and total scores of the two groups of subjects were compared．The specificity,sensitivity,positive predictive value and negative predictive value of AOSI were calculated using the receiver operating characteristic curve（ROC）,and the best diagnostic（positive）cut-off value of AOSI was confirmed．The consistency of AOSI evaluation results with the ASD diagnostic criteria in DSM-5 were compared．Results There was no statistically significant difference in genders or age between two groups（P>0.05）．The scores of each item and total scores in the ASD group were significantly higher than those in the control group,and the difference was statistically significant（P<0.01）．The area under the curve of AOSI（AUC=1.00,P<0.01）had a 95% confidence interval of（1.00,1.00）．Comparing the sensitivity,specificity,positive predictive value,negative predictive value and consistency of different positive boundary points,when the Youden index was equal to 1.00,the optimal diagnostic（positive cut-off value）boundary for AOSI was 9 points,and all of the above values were 1.00． The AOSI evaluation results were completely consistent with the diagnostic criteria for ASD in DSM-5（Kappa=1,P<0.01）．Conclusions AOSI has high sensitivity and specificity when it is used to evaluate the 1-year-old infant．When “9 points” is taken as the diagnostic threshold,it can better predict whether the infant has ASD at the age of 2~3 years．AOSI is an important tool for screening ASD in infancy．Its evaluation results can be used as evidence for early intervention of high-risk infants with ASD and as a assisting tool to diagnosis ASD,which is suitable for clinical application．

目的 探讨骨肉瘤（OS）和软组织肉瘤（STS）的关键核心基因（Hub基因）及其潜在作用,为肿瘤诊断和预后提供新依据。方法 从基因表达综合数据库（GEO）获得OS数据集GSE16088及STS数据集GSE21122,采用GEO2R在线工具筛选GSE16088和GSE21122数据集的差异表达基因（DEGs）。通过韦恩图获得2个数据集共同DEGs。选取2个数据集中差异表达最显著的上调和下调基因各20个,分别绘制聚类热图。通过使用注释、可视化和综合发现数据库（DAVID）对2个数据集的共同DEGs进行功能（GO）和通路（KEGG）富集分析。构建蛋白互作网络并使用最大中心度（MCC）算法筛选排名最前的10个基因作为潜在的关键Hub基因。采用受试者工作特征（ROC）曲线探讨关键Hub基因对肉瘤患者的诊断价值。通过Kaplan-Meier Plotter进行生存期分析。通过实时荧光定量PCR技术对得分靠前的5个Hub基因进行验证。结果 GSE16088数据集筛选出5 210个DEGs,其中上调和下调的DEGs分别为1 028、4 182个;GSE21122数据集共筛选出1 224个DEGs,其中上调和下调的DEGs分别为451、773个;2个数据集共获得498个共同DEGs。共同DEGs参与到多个生物学过程和信号通路。基于PPI网络和MCC算法最终获得10个关键Hub基因,ROC曲线验证结果符合预期,且生存期分析10个关键Hub基因与肉瘤预后显著相关（P<0.05）。Hub基因在mRNA表达水平和生物信息学分析结果一致（P<0.05）。结论 10个关键Hub基因可用于肉瘤的诊断和预后,为后续免疫治疗提供新视野。

Objective To explore the Hub genes of osteosarcoma（OS）and soft tissue sarcoma（STS）and their potential roles,and to provide evidence for tumor diagnosis and prognosis．Methods The GSE16088 dataset and the GSE21122 dataset were screened in the Gene Expression Omnibus database of the National Center for Biotechnology Information in the United States．The online editing tool GEO2R was used to screen the DEGs of the GSE16088 dataset and the GSE21122 dataset and the Veen map was drawn to find the common DEGs of the GSE16088 dataset and the GSE21122 dataset．20 up-regulated and 20 down-regulated genes with the most significant differential expression were selected from 2 datasets,and heatmaps were drawn for each．The Database for Annotation,Visualization and Integrated Discovery was used to perform GO function enrichment analysis and KEGG pathway enrichment analysis on DEGs of GSE16088 dataset and GSE21122 dataset．PPI network of DEGs was constructed by STRING．PPI sub-modules and Hub genes with high connectivity were screened．Maximal clique centrality（MCC）score was used to select the Hub genes in the protein interaction network．The predictive value of 10 Hub genes in sarcoma patients was analyzed by receiver operating characteristic（ROC）curve．Survival analysis was performed by means of the Kaplan-Meier Plotter．The top five core genes were verified by real-time fluorescence quantitative PCR．Results A total of 5 210 genes were screened in GSE16088 dataset,including 1 028 and 4 182 genes with upregulated and downregulated expression．A total of 1 224 genes were selected from the GSE21122 dataset,including 451 and 773 genes with upregulated and downregulated expression．The cluster heatmap was used to show the top 20 DEGs with high and low expression in GSE16088 and GSE21122 datasets．By differential analysis of gene expression between the two datasets,498 co-DEGs were obtained．GO and KEGG enrichment showed that common DEGs were associated．Ten Hub genes were obtained by PPI and MCC algorithm,the ROC curve verification results were as expected．Survival analysis showed that 10 Hub genes were significantly associated with the prognosis of sarcoma（P<0.05）．The mRNA expression level of Hub genes was the same as the results of bioinformatics analysis（P<0.05）．Conclusions The 10 Hub genes can be used for the diagnosis and prognosis of osteosarcoma,and provide a new vision for subsequent immunotherapy．

脑卒中是临床常见的急性脑血管疾病,常有偏瘫、肩手综合征、下肢深静脉血栓等后遗症,严重影响患者的生活质量。温针疗法是中医传统的特色疗法,近年来,应用以温针为主的相关疗法治疗脑卒中后遗症的报道越来越多,在临床上得到广泛应用。本文归纳分析了近10年来温针疗法治疗脑卒中后肩手综合征、偏瘫、下肢深静脉血栓三大主要疾病的案例及研究,以期为相关研究与应用提供参考。

Stroke is a common acute cerebrovascular disease in clinical practice,which frequently leaves sequelae like hemiplegia,shoulder-hand syndrome and deep vein thrombosis of the lower extremities,and vastly reduces the quality of life of patients．Warm needling is a characteristic therapy of traditional Chinese medicine．In recent years,there have been more and more reports of warm needling-based related therapies for the treatment of stroke sequelae,and it has been widely used in clinical practice．This article summarizes and analyzes the cases and studies of warm needing therapy in the treatment of shoulder-hand syndrome,hemiplegia and deep vein thrombosis of the lower extremities after stroke in the past 10 years,so as to provide reference for related research and application．

血友病是一种由于X染色体上凝血因子基因突变所致的遗传性出血性疾病,目前主要的治疗方法是凝血因子替代疗法。但长期频繁的注射用药往往导致患者依从性差,容易产生抑制性抗体,从而影响治疗效果。虽然现在延长半衰期的新型凝血因子药物、人源化双特异性抗体以及抗组织因子途径抑制剂单克隆抗体等用于疾病治疗,在给药方式和作用持续时间上已有很大进步,但它们仍无法治愈血友病。因此,以疾病根治为重要目标的基因治疗被设计出来,近年来受到了广泛的关注。该文介绍了血友病基因治疗的原理、基因治疗载体的选择、基因治疗预处理方案,总结了现阶段基因治疗临床应用的安全性和有效性;最后讨论基因治疗目前存在的问题以及未来发展方向。

Hemophilia is a genetic bleeding disorder resulting from mutations in coagulation factor genes on the X chromosome．The mainstay of current treatment is coagulation factor replacement therapy．However,frequent and long-term injections often lead to poor patient compliance,easy inhibitor development,and compromised therapeutic efficacy．Despite advancements in delivery methods and prolonged action of novel agents such as extended half-life coagulation factor concentrates,humanized bispecific antibodies,and anti-tissue factor pathway inhibitor monoclonal antibodies,these approaches still fall short of curing hemophilia．Consequently,gene therapy,aiming for disease eradication,has garnered significant attention in recent years．This review delves into the principles of gene therapy,the selection of gene therapy vectors,and gene therapy preconditioning regimens．It summarizes the safety and efficacy of gene therapy in current clinical applications and discusses challenges and future directions in this field．

目的 探讨以多媒体教学法、标准患者教学法、案例教学法、手术观摩教学法等多种教学方法相结合的多样化教学,在小儿外科临床见习的教学实施效果评价。方法 以2022年、2023年参加小儿外科临床见习的儿科学生为研究对象,随机分为试验组和对照组,每组分别45人。试验组采用多样化教学进行临床带教,对照组采用传统教学法进行带教。对比两组儿科学生的理论知识分数、技能操作分数、临床知识评分及总成绩,师生满意度及家属对儿科学生的满意度。结果 试验组的理论知识分数（85.69±4.59）、技能操作分数（86.36±4.35）、临床知识评分（87.71±4.01）及总成绩（86.59±2.85）均高于对照组,差异有统计学意义（P<0.05）。在满意度评价中,试验组在教学方式、学习兴趣、自我评价、团队协作能力及对小儿外科的专业认可度分别为（4.84±0.37）（4.87±0.34）（4.89±0.32）（4.84±0.37）（4.91±0.29）,均高于对照组,差异有统计学意义（P<0.01）;而试验组及对照组对带教教师的理论知识水平分别为（4.80±0.46）（4.64±0.53）,带教教师的积极性评分分别为（4.89±0.32、4.75±0.43）,比较差异无统计学意义（P>0.05）;带教教师在试验组专业知识掌握情况、临床实践操作能力、学生学习积极性及团队协作能力评分分别为（4.82±0.39）（4.87±0.34）（4.91±0.29）（4.93±0.25）,均高于对照组,差异有统计学意义（P>0.05）。患儿家属对试验组在医师尊重孩子、医师非常关注孩子及医师鼓励孩子提问并积极解决问题方面评分分别为（4.91±0.29）（4.93±0.25）（4.91±0.29）,均高于对照组,差异有统计学意义（P<0.05）。结论 在小儿外科临床见习采用多样化教学不仅能提高儿科学生的理论、技能、临床知识水平,还能提高师生满意度及儿科学生对小儿外科的专业认可度。

Objective To assess the impact of multimedia teaching methods,standard patient teaching methods,case teaching methods,and surgical observation teaching methods on clinical probation in pediatric surgery．Methods Pediatric students participating in clinical probation in pediatric surgery in 2022 and 2023 were randomly assigned to either the experimental group or the control group,with 45 students in each group．The experimental group received diversified teaching methods,while the control group received traditional teaching methods．A comparison was made between the two groups regarding theoretical knowledge scores,skill operation scores,clinical knowledge scores,total scores,teacher-student satisfaction levels,and family satisfaction levels of pediatric students．Results The experimental group demonstrated significantly higher theoretical knowledge scores（P<0.05）,skill operation scores（P<0.05）,clinical knowledge scores（P<0.05）,and total scores compared to the control group．In terms of satisfaction evaluation criteria such as teaching style,learning interest,self-evaluation ability,teamwork skills and professional recognition of pediatric surgery（P<0.01）,the experimental group showed significantly higher levels than the control group．There was no significant difference between the two groups regarding teachers’ theoretical knowledge level and enthusiasm score（P>0.05）．However,the teachers in the experimental group scored significantly higher than those in the control group when it came to professional knowledge mastery,clinical practice ability,student learning enthusiasm,and teamwork skills（P>0.05）．Conclusions Implementing diversified teaching approaches during pediatric surgery clinical probation not only enhances theoretical understanding,skills development,and clinical expertise among pediatric students,but also improves overall satisfaction levels for both teachers and students as well as enhances professional recognition of pediatric surgery students．

目的 了解深圳市助产士培训的现况,为今后进一步加强助产士培训工作提供参考依据。方法 利用方便整群抽样法选取2022年在深圳市助产医疗机构工作的助产士,通过问卷调查及数据分析,了解他们在2009—2020年间参加助产士培训的情况以及对临床实操技能掌握的自评现况。结果 本研究共调查481名助产士,大部分来自三级医院,平均拥有9（5,15）年的助产工作经验,根据其工作年限和经验分别参加初级、中级和（或）高级培训,以参加一次初级或中级培训居多。助产士未参加培训的主要原因为医院人员不足和新入职。临床实操技能掌握自评现况分析显示,助产士初、中级母儿急救实操技能亟待加强,中级培训的助产士带教能力需提升。不同职称助产士的实操技能自评分数比较差异有统计学意义（Z=9.23,P=0.026）。结论 深圳市助产士对于初级培训和中级培训的参与度较高,但对部分临床实操技能的掌握仍存在不足,有必要进一步强化助产士临床实操技能培养,以全面满足孕产妇的健康需求。

Objective To understand the current state of midwifery training in Shenzhen,providing insights for the enhancement of future midwifery training programs．Methods Using a convenience cluster sampling method,midwives working in obstetric medical institutions in Shenzhen in 2022 were selected．Through questionnaire surveys and data analysis,the participation in midwifery training from 2009 to 2020 was examined along with their self-assessment of mastery over clinical practical skills．Results A total of 481 midwives,mostly from tertiary hospitals,with an average of 9（5,15）years of midwifery experience,were surveyed in this study and participated in primary,intermediate and/or advanced training according to their years of experience and years of work,with the majority participating in primary or intermediate training once．The main reasons for midwives not attending training were insufficient hospital staff and new recruits．The analysis of the self-assessment of the mastery of clinical practical skills showed that the practical skills of midwives in maternal and pediatric emergencies at the primary and intermediate levels needed to be strengthened,and the teaching ability of midwives with intermediate training needed to be improved．There was a difference in the self-rating of practical skills among midwives of different titles（Z=9.23,P=0.026）．Conclusions Though participation in primary and intermediate midwifery training in Shenzhen City is high,there remains a deficiency in mastering specific clinical practical skills．This research suggests that there’s a pressing need to further enhance the practical clinical skill training for midwives to comprehensively meet the health needs of pregnant and postnatal women．

目的 探讨间歇经口至食管管饲法与自创吞咽功能训练联合应用于脑卒中吞咽障碍患者的效果。方法 选取河南大学淮河医院2022年1月—2023年12月收治的50例脑卒中吞咽障碍患者,应用随机数字表法将其分为两组,每组各25例。对照组采取持续留置鼻饲的同时应用自创吞咽功能训练进行训练,观察组采取间歇经口至食管管饲的同时应用自创吞咽功能训练进行训练。对比两组吞咽障碍改善情况、干预前后营养状况指标及生活质量变化,比较两组并发症发生率。结果 观察组总有效率高于对照组（P<0.05）。干预后两组血清总蛋白、白蛋白和血红蛋白水平和体质量指数均升高,观察组高于对照组（P<0.05）。干预后两组生活质量综合评定量表评分升高,观察组高于对照组（P<0.05）。观察组并发症发生率低于对照组（P<0.05）。结论 对脑卒中吞咽功能障碍患者采取间歇经口至食管管饲法与自创吞咽功能训练,能够更有效改善患者吞咽功能,提升其生活质量,且可降低留置饲管营养支持过程中的并发症发生率。

Objective To explore the application effect of intermittent oral to esophageal feeding combined with self created swallowing function training exercises in stroke patients with swallowing disorders．Methods Fifty stroke patients with swallowing disorders admitted to our hospital from January 2022 to December 2023 were selected and divided into two groups by random number table method,both with 25 cases．Control group patients received continuous nasogastric feeding while using solf created swallowing function training exercises for training,while observation group patients received intermittent oral to oesophageal tube feeding and using solf created swallowing function training exercises for training．The improvement of swallowing disorders,changes in nutritional status indicators and quality of life before and after the intervention were compared,and also the frequency of complications．Results The observation group was generally more effective than the control group（P<0.05）．After intervention,the serum total protein,albumin hemoglobin,and BMI levels of both groups of patients increased,with the observation group being higher than the control group（P<0.05）．After the intervention,GQOLI-74 score increased in both groups,and the observation group was higher than the control group（P<0.05）．The complication rate was lower in the observation group（P<0.05）．Conclusions The intervention method of intermittent oral to esophageal tube feeding combined with self created swallowing function training exercises can further improve the swallowing function of stroke patients with swallowing dysfunction,improve their quality of life,and reduce the occurrence of complications during the nutritional support process of feeding tubes．

目的 探讨富血小板血浆（PRP）联合关节镜治疗Ⅲ度半月板损伤患者的临床疗效,及其对膝关节功能恢复时间的影响。方法 选取2021年2月—2022年2月南方医科大学南方医院增城院区骨科收治的Ⅲ度半月板损伤患者45例,采用随机数字法分为观察组22例与对照组23例,对照组患者在关节镜下行半月板成形术,观察组在对照组基础上给予PRP治疗。观察两组患者术后恢复时间、治疗效果及并发症发生情况;比较两组治疗前和治疗后1、3、6个月膝关节功能、疼痛情况。结果 利用观察组患者自体全血制备的PRP,其血小板的回收率、红细胞留存率、白细胞留存率分别为（91.00±9.27）%、（0.29±0.12）%、（29.98±6.68）%,PRP制备质量稳定、可控。观察组联合PRP治疗术与关节镜手术治疗后恢复时间均短于对照组,观察组治疗有效率高于对照组（P<0.05）。经重复方差测量分析,两组美国特种外科医院膝关节评分系统（HSS）评分、西安大略大学和麦克马斯特大学骨关节炎指数（WOMAC）评分、视觉模拟疼痛评分法（VAS）交互（F_交互=1.869、F_交互=1.482、F_交互=2.193）比较差异均有统计学意义（P<0.05）;与对照组治疗后1、3、6个月比较,观察组HSS评分升高,WOMAC评分、VAS评分下降（P<0.05）;观察组并发症总发生率4.55%低于对照组30.43%（χ²=5.156、P=0.023）。结论 对于Ⅲ度半月板损伤患者,采用PRP联合关节镜手术治疗可帮助患者消炎止痛、加快疗效、加快膝关节功能的恢复,缩短其恢复的时间,效果良好,且安全性较高。

Objective To investigate the clinical effect of platelet rich plasma（PRP）combined with arthroscopy treatment on patients with third degree meniscus injury,and its impact on the recovery time of knee joint function．Methods From February 2021 to February 2022,45 patients with III-degree meniscal injuries admitted to the Department of Orthopedics,Zengcheng district,Nanfang Hospital of Southern Medical University were selected and divided into an observation group of 22 cases and a control group of 23 cases using the random number method．Patients in the control group received menisplasty under arthroscopy,and the observation group was given PRP treatment on the basis of the control group．The postoperative recovery time,treatment effects and complications of the two groups of patients were observed;the knee joint function and pain of the two groups before treatment and 1,3,and 6 months after treatment were compared．Results The platelet recovery rate,red blood cell retention rate,and white blood cell retention rate of PRP prepared from the autologous whole blood of patients in the observation group were（91.00±9.27）%,（0.29±0.12）%,and（29.98±6.68）% respectively．The PRP preparation quality is stable and controllable．The recovery time after combined PRP treatment and arthroscopic surgery in the observation group was shorter than that in the control group,and the treatment effectiveness of the observation group was higher than that of the control group（P<0.05）．After repeated measures of variance analysis,the comparison of American Hospital for Special Surgery（HSS）Knee Scoring System,Western Ontario and McMaster Universities Osteoarthritis Index（WOMAC）,and visual analogue pain scales（VAS）interacted(F_Interaction=1.869,F_interaction=1.482,F_interaction=2.193),the differences were statistically significant（P<0.05）．Compared with the control group 1,3,and 6 months after treatment,the HSS score of the observation group increased,and the WOMAC score,VAS score decreased（P<0.05）;the total incidence of complications in the observation group was 4.55%,lower than that in the control group（30.43%,χ²=5.156,P=0.023）．Conclusions For patients with III-degree meniscal injuries,PRP combined with arthroscopic surgery can help reduce inflammation and pain,speed up the curative effect,accelerate the recovery of knee joint function,and shorten the recovery time．It has good effects and is relatively safe．