目的 研究温肾利水汤联合贝前列素钠对老年原发性肾病综合征（PNS）患者T淋巴细胞亚群及肾功能的影响。方法 回顾性收集我院106例老年PNS患者临床资料（2024年4月-2026年1月），按照不同治疗方法分为研究组（n=55，温肾利水汤联合贝前列素钠）、对照组（n=51，贝前列素钠治疗）。比较两组治疗效果、中医证候积分、治疗前后肾功能[血尿素氮（BUN）、白蛋白（ABL）、血肌酐（SCR）]、T淋巴细胞亚群[CD4+、辅助性T细胞17（Th17）、CD3+]、不良反应。结果 治疗3个月后，研究组总有效率（92.73%）高于对照组（P<0.05）；治疗3个月后，研究组主证积分、次证积分均低于对照组（P<0.05）；治疗3个月后，研究组血清BUN、SCR水平低于对照组，ABL水平高于对照组（P<0.05）；治疗3个月后，研究组CD4+、CD3+高于对照组，Th17低于对照组（P<0.05）；两组不良反应发生率（5.45% VS 9.80%）相比，差异无统计学意义（P>0.05）。结论 温肾利水汤联合贝前列素钠治疗老年PNS患者能提高治疗效果，改善T淋巴细胞亚群水平，促进肾功能恢复。

背景：经动脉穿刺行冠状动脉介入治疗（PCI）是心血管疾病常见的诊疗手段，但术后常并发术侧上肢肿胀、血肿等并发症，影响患者康复进程。传统护理方法如硫酸镁湿敷效果有限，探索安全有效的中医外治方案具有重要临床意义。目的：探讨芒硝与大黄中药热奄包对经动脉介入术后肿胀的临床疗效及护理要点。方法：总结芒硝与大黄的药理作用，阐述热奄包的制备方法、应用时机、操作流程及注意事项，结合63例PCI术后患者的临床观察数据进行分析。结果：中药热奄包干预组在术后肿胀消退时间、疼痛评分（VAS）、臂围变化及患者舒适度（GCQ）方面均显著优于常规护理组（P<0.05）。结论：芒硝与大黄中药热奄包能有效促进经动脉介入术后肿胀消退，减轻疼痛，提高患者舒适度，操作简便安全，值得临床推广使用。

[摘要] 目的 验证医院在用冷藏药品库（以下简称冷库）相关设施、设备的性能是否符合规定的设计标准和使用要求，为药品冷链管理提供依据，保证药品质量安全。方法 以《药品经营质量管理规范》《医药产品冷链物流温控设施设备验证性能确认技术规范》为指导，于2021年10月26日-10月30日对冷库进行温度分布特性测试、自动温湿度监测系统准确度测试，开门测试及断电测试，记录、分析测试数据。结果 测试数据显示，冷库各测试点的温度均在2~8 ℃范围内波动，温度均匀度、温度波动度及温度偏差均不高于±3℃；开门7min后，冷库达到温度警戒值，开门后冷库温度恢复时间分别为17min和13min；两次断电测试中，分别于106min和92min后冷库到达温度警戒值。结论：冷库运作正常，制冷设备参数设置合理，温度均匀度、波动度能满足冷藏药品的存储要求；建议开门作业时间不能超过7min，断电时最大应急时间为90min。

目的：描述发病48 h内急性缺血性卒中（acute ischemic stroke，AIS）患者依达拉奉右莰醇真实世界用药特征，探讨48 h内不同启动时间与住院期间神经功能改善及短期预后的关系。方法：回顾性连续筛选2023年12月1日至2026年4月30日本院诊断为AIS并使用依达拉奉右莰醇的住院患者，药学部基于药学信息系统、住院医嘱及病历记录提取资料。初筛147例，排除35例，纳入112例发病至首次用药时间（onset-to-treatment time，OTT）≤48 h者；按预设24 h界值分为24 h内用药组（n=67）和24～48 h用药组（n=45）。主要结局为住院期间美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）变化值（ΔNIHSS=入院NIHSS评分－出院前NIHSS评分）；次要结局包括出院前NIHSS评分、出院改良Rankin量表（modified Rankin Scale，mRS）评分、显著神经功能改善、住院时间、出院去向及安全性事件。采用多因素线性回归分析24 h内用药与ΔNIHSS的相关性，并行简化模型、排除再灌注治疗患者、完整疗程人群、进一步调整大血管闭塞及OTT连续变量模型等敏感性分析。结果：总体OTT为19.65（14.97，34.68）h，疗程12.00（11.00，13.00）d，完成相对完整疗程比例89.3%。两组入院NIHSS评分差异无统计学意义［8.00（6.00，9.00）分 vs 8.00（6.00，10.00）分，P=0.447］；24 h内用药组出院前NIHSS评分更低［5.00（4.00，6.50）分 vs 6.00（5.00，8.00）分，P=0.025］，ΔNIHSS更高［3.00（2.00，3.00）分 vs 2.00（1.00，2.00）分，P＜0.001］，显著神经功能改善率更高（77.6% vs 60.0%，P=0.045）。多因素校正后，24 h内用药仍与更大的ΔNIHSS相关（β=0.768，95%CI：0.377～1.159，P＜0.001）；Logistic探索性分析显示其与显著神经功能改善发生可能性较高相关（OR=2.475，95%CI：1.047～5.853，P=0.039）。两组出血转化、症状性颅内出血、药物相关不良反应及院内死亡差异均无统计学意义。结论：本单中心真实世界队列中，发病48 h内依达拉奉右莰醇治疗疗程完成比例较高、短期安全性事件发生率低；24 h内启动治疗与住院期间NIHSS改善幅度较大及显著神经功能改善率较高相关。由于为回顾性观察性研究，结果应解释为关联性证据，需前瞻性、多中心研究及长期功能结局验证。

Objective: To describe real-world treatment characteristics of edaravone dexborneol in acute ischemic stroke (AIS) patients treated within 48 hours of onset and to explore the association between initiation time and short-term in-hospital outcomes. Methods: This single-center retrospective real-world study screened hospitalized AIS patients with edaravone dexborneol records from December 1, 2023 to April 30, 2026. Medication data were extracted from the pharmacy information system, inpatient orders, and medical records. After 35 exclusions, 112 of 147 patients with onset-to-treatment time (OTT) ≤48 h were included and classified by a prespecified 24-hour cutoff into a within-24-hour group (n=67) and a 24-48-hour group (n=45). The primary outcome was in-hospital National Institutes of Health Stroke Scale (NIHSS) change (ΔNIHSS=admission NIHSS minus pre-discharge NIHSS); secondary outcomes included pre-discharge NIHSS, discharge modified Rankin Scale (mRS), marked neurological improvement, length of stay, discharge destination, and safety events. Multivariable linear regression assessed the association between within-24-hour treatment and ΔNIHSS, with sensitivity analyses using simplified adjustment, exclusion of reperfusion-treated patients, the complete-course population, additional adjustment for large-vessel occlusion, and continuous OTT modeling. Results: Median OTT was 19.65 (14.97, 34.68) h, treatment duration was 12.00 (11.00, 13.00) days, and 89.3% completed a relatively complete course. Baseline NIHSS was comparable [8.00 (6.00, 9.00) vs 8.00 (6.00, 10.00), P=0.447]. The within-24-hour group had lower pre-discharge NIHSS [5.00 (4.00, 6.50) vs 6.00 (5.00, 8.00), P=0.025], greater ΔNIHSS [3.00 (2.00, 3.00) vs 2.00 (1.00, 2.00), P<0.001], and a higher marked improvement rate (77.6% vs 60.0%, P=0.045). After adjustment for age, admission NIHSS, reperfusion therapy, and atrial fibrillation, within-24-hour treatment remained associated with greater ΔNIHSS (β=0.768, 95% CI: 0.377-1.159, P<0.001). Exploratory logistic regression showed a higher likelihood of marked improvement (OR=2.475, 95% CI: 1.047-5.853, P=0.039). Hemorrhagic transformation, symptomatic intracranial hemorrhage, drug-related adverse reactions, and in-hospital death did not differ significantly. Conclusion: In this real-world cohort, edaravone dexborneol within 48 h of AIS onset showed a high complete-course proportion and low short-term safety event incidence. Initiation within 24 h was associated with greater in-hospital NIHSS improvement and a higher marked improvement rate than initiation at 24-48 h. These findings are associative and need prospective multicenter validation with long-term functional outcomes.

目的 探讨数字减影血管造影（DSA）在冠状动脉病变诊断中的应用价值，并评估血清学参数相对于DSA金标准的诊断效能。方法 本研究纳入100名确诊为冠心病的患者。病例组为100例DSA确诊的冠心病患者，对照组按1:1比例匹配100例同期接受DSA检查排除冠心病的患者。应用DSA技术分别评估冠心病的狭窄程度及部位等指征。回顾性收集并对比分析两组患者的各项血清学参数（cTnI、CK-MB、hs-CRP、LDL-C、TC），计算血清学指标诊断冠心病的效能，并进一步探究以上评估于入组患者性别亚组间的统计学差异。结果 病例组与对照组在性别、年龄、BMI等基线资料上均衡可比（P > 0.05）。以DSA为金标准，cTnI诊断冠心病的灵敏度为82.0%，特异度为85.0%；hs-CRP的灵敏度为85.0%，特异度为75.0%。 cTnI、hs-CRP水平随冠状动脉狭窄程度加重而显著升高（P < 0.05）。且以上冠心病评价指征于患者性别亚组间均无统计学差异（ P <0.05）。结论 DSA技术可用于冠状动脉病变发生的部位、形态、数目等指征的明确评估，且于不同性别亚组间无统计学差异。血清学参数，尤其是cTnI和hs-CRP，对冠心病具有良好的辅助诊断价值，其水平与病变严重程度相关，可作为DSA检查前的有效筛查工具，为后续的治疗提供重要的参考依据。

Objective: To investigate the clinical value of digital subtraction angiography (DSA) in the diagnosis of coronary artery disease (CAD) and to evaluate the diagnostic performance of serological parameters relative to the DSA gold standard. Methods: A total of 100 patients with confirmed CAD were included in this study. The case group comprised 100 patients with CAD confirmed by DSA, while the control group consisted of 100 age- and sex-matched individuals who underwent DSA during the same period and were excluded from CAD. DSA was employed to assess the degree and location of coronary artery stenosis. Retrospective collection and comparative analysis of serological parameters (cTnI, CK-MB, hs-CRP, LDL-C, TC) were performed between the two groups. The diagnostic efficacy of these serological indicators for CAD was calculated, and subgroup analyses were conducted to explore potential sex-related differences. Results: The case and control groups were comparable in baseline characteristics such as sex, age, and BMI (P > 0.05). Using DSA as the gold standard, the sensitivity and specificity of cTnI for diagnosing CAD were 82.0% and 85.0%, respectively; hs-CRP demonstrated a sensitivity of 85.0% and specificity of 75.0%. Levels of cTnI and hs-CRP increased significantly with the severity of coronary stenosis (P < 0.05). No statistically significant differences were observed between male and female subgroups (P > 0.05). Conclusion: DSA provides definitive assessment of lesion location, morphology, and number in coronary artery disease, with no significant sex-related differences. Serological markers, particularly cTnI and hs-CRP, demonstrate good auxiliary diagnostic value for CAD. Their levels correlate with disease severity and may serve as effective screening tools prior to DSA, offering important reference value for subsequent clinical management.

【摘要】目的：探讨安全-行为双维度管理模式在儿童全麻舒适化口腔治疗中的应用效果。方法：选取2025年4月至2025年12月在本院接受全麻舒适化口腔治疗的80例患儿作为研究对象，根据围术期不同管理方式分为观察组和对照组，每组40例。对照组实施常规围术期管理，观察组实施安全-行为双维度管理模式。对比两组患儿牙科恐惧程度、治疗依从性、苏醒期躁动发生率及家属满意度。结果：术前检查、麻醉诱导、出院时观察组CFSS-DS评分均比对照组低（P＜0.05），FCS评分均比对照组高（P＜0.05）。与对照组苏醒期躁动发生率20.00%对比，观察组5.00%显著降低（P＜0.05）。与对照组家属满意度75.00%对比，观察组95.00%显著升高（P＜0.05）。结论：在儿童全麻舒适化口腔治疗中应用安全-行为双维度管理模式干预，可有效减轻患儿牙科恐惧程度，提高治疗依从性，减少苏醒期躁动发生，提升家属满意度，值得临床推广应用。

目的：探究对老年腹腔镜结直肠癌根治术中患者实施环泊酚联合瑞芬太尼后对其的苏醒质量、认知功能影响。方法：选取2025年1月-10月在我院接受腹腔镜结直肠癌根治术的50例老年患者作为研究对象，并采用随机数字表法将其分为两组。对照组25例患者，实施丙泊酚联合瑞芬太尼麻醉；观察组25例患者，采用环泊酚联合瑞芬太尼进行麻醉。对两组患者的苏醒质量（睁眼时间、拔管时间、定向力恢复、Steward评分）、术后认知功能（MMSE、MOCA.POCD发生率、MOAA/S评分）、炎症反应（IL-6, TNF-a, CRP, S100B, NSE）、疼痛控制（VAS评分、镇痛药用量）、不良反应（呼吸抑制、PONV、低血压、寒战等）与术中血流动力学（血压、心率、Sp0z、PaCO2、氧合指数）进行比较分析。结果：观察组的睁眼时间（10.55±2.11 min）、拔管时间（16.44±1.55 min）、定向力恢复时间（34.55±5.33 min）短于对照组，Steward苏醒评分（5.44±0.33 min）高于对照组（P＜0.05）。观察组术后的MMSE评分（27.44±1.22 分）、MoCA评分（28.44±1.66 分）、MOAA/S评分（3.22±0.44 分）均高于对照组，POCD发生率（16.00%）低于对照组（P＜0.05）。观察组术后IL-6（100.22±10.22 pg/mL）、TNF-α（30.22±4.44 pg/mL）、CRP（80.44±5.22 mg/L）、S100B（0.15±0.02 μg/L）、NSE水平（13.66±3.22 μg/L）均低于对照组（P＜0.05）。两组的术后VAS评分比较，统计学无差异，P＞0.05；观察组24h镇痛药物用量（80.23±20.44 mg）少于对照组（P＜0.05）。观察组术中血压、心率、Sp0z、PaCO2、氧合指数比对照组更稳定（P＜0.05）。观察组呼吸抑制、PONV、低血压、寒战的不良反应发生率（16.00%）低于对照组（44.00%）（P＜0.05）。结论：环泊酚联合瑞芬太尼麻醉方案可提高老年腹腔镜结直肠癌根治术患者的苏醒质量方面，利于患者的术后认知功能恢复，减轻其神经炎症反应，维持患者血流动力学稳定，并降低镇痛药物用量与不良反应发生率。

心肌纤维化是心力衰竭等心血管疾病演化过程中的关键性病理改变，该病的进展机制依赖巨噬细胞与成纤维细胞的相互调控。现有现代医学研究证实巨噬细胞可凭借M1、M2表型极化行为介导炎症反应与组织修复过程，成纤维细胞能够分化形成肌成纤维细胞并推动细胞外基质异常沉积，两类细胞可依托TGF-β/Smad、CSF-1/CSF-1R等信号通路构建相互调控的作用网络并介导心肌纤维化恶化。中医痰瘀互结病机理论指出痰浊与瘀血可相互滋生、交织阻滞，是各类慢性迁延性疾病的关键发病基础。本文以中医痰瘀互结理论为研究切入点，剖析该病机理论与巨噬细胞、成纤维细胞交互作用的内在关联，整合现代医学关于两种细胞交互作用的现有研究成果，深入分析细胞互作在心肌纤维化发病过程中的协同机制与病理关联，旨在为心肌纤维化的中西医协同防治提供理论依据，为相关动物实验及临床应用研究筑牢研究基础。

Myocardial fibrosis is a key pathological change in the progression of cardiovascular diseases such as heart failure. The progression mechanism of this disease relies on the reciprocal regulation between macrophages and fibroblasts. Current modern medical research has confirmed that macrophages can mediate inflammatory responses and tissue repair processes through M1 and M2 phenotypic polarization behaviors, and fibroblasts can differentiate into myofibroblasts and promote abnormal extracellular matrix deposition. The two types of cells can construct a reciprocal regulatory network through signaling pathways such as TGF-β/Smad and CSF-1/CSF-1R, thereby mediating the deterioration of myocardial fibrosis. The theory of phlegm and blood stasis intermingling in traditional Chinese medicine suggests that phlegm turbidity and blood stasis can mutually generate and interweave to cause obstruction, serving as a key pathological basis for various chronic and persistent diseases. This article takes the traditional Chinese medicine theory of phlegmblood stasis intermingling as a research entry point, analyzes the intrinsic relationship between this pathological theory and the interaction of macrophages and fibroblasts, integrates existing modern medical research findings on the interaction between the two cell types, and deeply analyzes the synergistic mechanisms and pathological correlations of cellcell interactions in the pathogenesis of myocardial fibrosis. The aim is to provide a theoretical basis for the integrated traditional Chinese and Western medicine prevention and treatment of myocardial fibrosis, and also to lay a solid research foundation for related animal experiments and clinical application studies.

心肌纤维化是心力衰竭等心血管疾病演化过程中的关键性病理改变，该病的进展机制依赖巨噬细胞与成纤维细胞的相互调控。现有现代医学研究证实巨噬细胞可凭借M1、M2表型极化行为介导炎症反应与组织修复过程，成纤维细胞能够分化形成肌成纤维细胞并推动细胞外基质异常沉积，两类细胞可依托TGF-β/Smad、CSF-1/CSF-1R等信号通路构建相互调控的作用网络并介导心肌纤维化恶化。中医痰瘀互结病机理论指出痰浊与瘀血可相互滋生、交织阻滞，是各类慢性迁延性疾病的关键发病基础。本文以中医痰瘀互结理论为研究切入点，剖析该病机理论与巨噬细胞、成纤维细胞交互作用的内在关联，整合现代医学关于两种细胞交互作用的现有研究成果，深入分析细胞互作在心肌纤维化发病过程中的协同机制与病理关联，旨在为心肌纤维化的中西医协同防治提供理论依据，为相关动物实验及临床应用研究筑牢研究基础。

Myocardial fibrosis is a key pathological change in the progression of cardiovascular diseases such as heart failure. The progression mechanism of this disease relies on the reciprocal regulation between macrophages and fibroblasts. Current modern medical research has confirmed that macrophages can mediate inflammatory responses and tissue repair processes through M1 and M2 phenotypic polarization behaviors, and fibroblasts can differentiate into myofibroblasts and promote abnormal extracellular matrix deposition. The two types of cells can construct a reciprocal regulatory network through signaling pathways such as TGF-β/Smad and CSF-1/CSF-1R, thereby mediating the deterioration of myocardial fibrosis. The theory of phlegm and blood stasis intermingling in traditional Chinese medicine suggests that phlegm turbidity and blood stasis can mutually generate and interweave to cause obstruction, serving as a key pathological basis for various chronic and persistent diseases. This article takes the traditional Chinese medicine theory of phlegmblood stasis intermingling as a research entry point, analyzes the intrinsic relationship between this pathological theory and the interaction of macrophages and fibroblasts, integrates existing modern medical research findings on the interaction between the two cell types, and deeply analyzes the synergistic mechanisms and pathological correlations of cellcell interactions in the pathogenesis of myocardial fibrosis. The aim is to provide a theoretical basis for the integrated traditional Chinese and Western medicine prevention and treatment of myocardial fibrosis, and also to lay a solid research foundation for related animal experiments and clinical application studies.

目的 分析布地格福吸入、无创正压通气（NIPPV）联合治疗慢性阻塞性肺疾病急性加重（AECOPD）合并呼吸衰竭的效果。方法 本研究采用回顾性对照研究。选取2024-06—2025-05我院96例AECOPD合并呼吸衰竭者，根据治疗方案不同分组，每组48例。对照组接受NIPPV治疗，研究组接布地格福吸入、NIPPV联合治疗，持续治疗1周。观察并对比两组疗效、病情程度、血气指标[动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）]、肺功能[最大呼气压（MEP）、一秒率（FEV1/FVC）]、炎性因子指标[C反应蛋白（CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）]、氧化应激指标[超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）、过氧化脂质（LPO）]及不良反应。结果 研究组治疗有效率为91.67%（44/48），高于对照组75.00%（36/48）（P＜0.05）；治疗1周后与对照组相比，研究组mMRC分值、CAT分值均较低（P＜0.05）；治疗1周后，与对照组相比，研究组MEP、FEV1/FVC、PaO2较高，PaCO2较低（P＜0.05）；治疗1周后与对照组相比，研究组CRP、TNF-α、IL-6较低（P＜0.05）；治疗1周后与对照组相比，研究组SOD、GSH-Px较高，LPO较低（P＜0.05）；两组不良反应无明显差异（P＞0.05）。结论 布地格福吸入、NIPPV联合治疗AECOPD合并呼吸衰竭，可明显减轻症状，改善血气指标与肺功能，抑制炎症反应，调节氧化应激，且保障安全性。