药物递送系统对于各类疾病意义非凡,但传统药物载体面临细胞毒性强、组织相容性低、半衰期短和靶向性弱等诸多挑战。血小板及其相关衍生物作为新型药物载体具有更为显著的优势。由于血小板自身的生理特点,以及在肿瘤、心血管疾病、血栓性疾病、感染等多种疾病中发挥的病理生理作用,血小板能够弥补传统药物载体的缺陷,具有极大的临床转化意义。该文总结了血小板相关药物递送系统目前的研究进展,以期为新型药物载体研究提供参考。

Drug delivery systems are important for various diseases,but conventional therapeutic drug have many shortcomings,such as high cytotoxicity,low histocompatibility,short half-life and weak targeting．Platelets and their derivatives have more significant advantages as novel drug carriers．Platelets play an important role in the pathophysiology of a wide range of diseases including oncology,cardiovascular diseases,thrombosis and infection．In this paper,we summarized the current research progress of platelet-related drug delivery systems to provide a reference for the research of novel drug delivery systems．

肝癌患者因食欲降低、进食减少导致不同程度的营养不良,引发厌食症,甚至恶病质,严重影响患者生存质量。食欲评估是降低营养风险的基础,医护人员可通过食欲症状的评估调整患者饮食及营养指导措施,以改善患者营养状态,提高生存质量。该文对食欲的评估工具、方法及干预在肝癌营养不良患者中的应用现状进行阐述,为肝癌患者的食欲干预提供科学依据。

Hepatocellular carcinoma patients suffer from different degrees of malnutrition due to decreased appetite and eating,which triggers anorexia and even cachexia,seriously affecting the quality of patient survival．Appetite assessment is the basis for reducing nutritional risk,and healthcare professionals can adjust patients’ diet and nutritional guidance measures through the assessment of appetite symptoms in order to improve patients’ nutritional status and survival quality．In this paper,the current status of the assessment tools,methods and interventions of appetite in malnutrition patients with hepatocellular carcinoma are described to provide a scientific basis for appetite interventions．

目的 探讨综合呼吸康复训练对老年慢性阻塞性肺疾病急性期（AECOPD）患者的临床症状、生活质量、活动能力、肺功能、肺康复依从性的影响。方法 纳入70 例AECOPD 患者,随机数字分为对照组（n=35）和干预组（n=35）,对照组在常规治疗基础上予缩唇腹式呼吸功能锻炼,干预组在常规治疗基础上进行综合呼吸康复训练,干预前后采用慢性阻塞性肺疾病评估测试（CAT）调查问卷、改良版英国医学研究委员会呼吸问卷（mMRC）、肺功能第一秒用力呼气容积（FEV1）预计值进行评估。结果 对照组呼吸康复训练前后CAT评分、mMRC量表呼吸困难评级比较差异均有统计学意义（t=16.781,t=8.103,均P<0.001）;干预组呼吸康复训练前后CAT评分、mMRC呼吸困难评级比较差异也均有统计学意义（t=24.035,t=15.938,均P<0.001）;干预组患者的CAT评分、mMRC量表呼吸困难评级较对照组下降明显。结论 综合呼吸康复训练能有效改善 AECOPD 患者临床症状、增强患者活动能力、提高生活质量、提高肺康复依从性。

Objective To investigate the effects of comprehensive respiratory rehabilitation training on clinical symptoms,quality of life,activity ability,lung function and compliance of elderly patients with acute exacerbation of obstructive pulmonary disease（AECOPD）．Methods Seventy patients with AECOPD were included and randomly divided into control group（n=35）and intervention group（n=35）．The control group was given routine treatment and respiratory muscle function exercise．The intervention group was given routine treatment and comprehensive respiratory rehabilitation training．COPD Assessment Test（CAT）,modified Medical Research Council Scale（mMRC）and FEV1 predicted value of lung function were used to evaluate before and after intervention．Results In the control group,differences of CAT score and mMRC score were significant（t=16.781,t=8.103,P<0.001）before and after respiratory rehabilitation training．In the intervention group,the CAT score before and after respiratory rehabilitation training showed a 0.01 level of significance（t=24.035,P<0.001）,and the mMRC score before and after training showed a 0.01 level of significance（t=15.938,P<0.001）．There were significant differences between control group and intervention group（P<0.01）．Compared with the control group,CAT score and mMRC score were significantly lower in the intervention group．Conclusions Comprehensive respiratory rehabilitation training can effectively improve the clinical symptoms of AECOPD patients,enhance the activity ability of patients,improve the quality of life,and improve the compliance of patients to perform pulmonary rehabilitation．

目的 探究抗-M抗体影响血型鉴定及对临床输血的影响,分析不规则抗体筛查必要性,以期进一步提升临床输血的安全性及有效性。方法 分析2020年1月—2023年4月于蚌埠医学院第二附属医院输血科检查的100例O型红细胞对照管凝集患者样本资料,使用全自动血型仪微柱凝胶卡、反定型试管法对样本进行血型鉴定和抗体检查,使用抗人球蛋白实验检测抗体类型及特异性,并分析抗-M抗体在不同环境温度下的效性。结果 血型仪微柱凝胶法显示100例标本中存在正反定型不符89.00%,正反定型相符11.00%;反定型试管法复核显示100例标本A、B、O细胞管均为阳性,对照管均为阴性。对89例正反定型不符的样本予以分析,抗-M是最主要影响抗体,占比56.18%;IgM、IgG是最主要影响抗体类型;13例未鉴定出抗体特异性,占比14.61%。89例正反定型不符的样本中男25例、女64例;71例存在妊娠史或输血史,占比79.78%,其中的11例合并妊娠史和输血史。50例抗-M抗体标本在不同气温下呈现不同效价,在4 ℃、22 ℃下会出现凝集梯度;在37 ℃下,50例样本中反应强烈31例,占比62.00%,阴性19例,占比38.00%。结论 抗-M类不规则抗体是影响血型鉴定、威胁输血安全的主要因素,临床需加强输血前血型鉴定,明确抗-M抗体临床检测的意义,通过多种途径提升鉴定准确性,对合并高危险因素的患者更需要着重关注,保障输血安全。

目的 检测微小RNA（miR）在人黑色素瘤中的表达情况,研究miR-412通过抑制性别确定区Y框转录因子6（SOX6）的表达影响黑色素瘤细胞增殖及侵袭能力的变化。方法 癌症基因组图谱（TCGA）数据库分析发现miR-412在黑色素瘤中异常表达,为研究其表达与肿瘤的相关性,采用Transwell小室,非锚定独立生长实验分析miR-412对黑色素瘤细胞增殖及侵袭能力的影响。软件预测SOX6可能为其靶向基因,采用荧光素酶报告分析及Western blot实验检测SOX6与miR-412的靶向调节情况。结果 TCGA数据库分析黑色素瘤组织中miR-412表达水平高于正常对照组,表达越高,生存时间越短。Transwell小室,非锚定独立生长实验显示miR-412过表达后促进细胞增殖及侵袭能力,而下调miR-412后抑制黑色素瘤细胞增殖及侵袭能力;通过靶点预测miR-412结合SOX6基因3’-非翻译区（UTR）,导致SOX6蛋白因miR-412表达增高而下调;同时在miR-412下调的细胞中抑制SOX6表达可恢复黑色素瘤细胞的增殖及侵袭能力。结论 miR-412过表达后促进黑色素瘤细胞增殖及侵袭能力,反之则抑制黑色素瘤细胞增殖及侵袭能力。 miR-412通过靶向调控SOX6影响黑色素瘤细胞增殖及侵袭,提示miR-412在黑色素瘤的发病过程中起重要作用,是潜在的治疗靶点。

Objective To assess the expression of miR-412 in human melanoma and investigate how miR-412 modulates melanoma cell proliferation and invasive capacity by inhibiting SRY-Box Transcription Factor 6,（SOX6） expression．Methods Analysis of the TCGA（The Cancer Genome Atlas）database identified aberrant miR-412 expression in melanoma．To explore its relevance to tumorigenesis,we conducted Transwell chamber and non-adherent independent growth assays to examine the effects of miR-412 on melanoma cell proliferation and invasion．Software predictions highlighted SOX6 as a potential target gene．We performed luciferase reporter assays and Western blot experiments to elucidate the regulatory interactions between SOX6 and miR-412．Results TCGA database analysis revealed significantly elevated miR-412 expression levels in melanoma tissues compared to the normal control group．Moreover,higher miR-412 expression correlated with shorter survival times．Functional assays using Transwell chambers and non-adherent independent growth assays demonstrated that overexpressing miR-412 enhanced cell proliferation and invasive capabilities．Conversely,reducing miR-412 expression restrained these attributes in melanoma cells． Target prediction analysis indicated that miR-412 binds to the 3’-UTR region of SOX6,resulting in decreased SOX6 protein levels due to increased miR-412 expression．Intriguingly,inhibiting SOX6 expression concurrently amplified the proliferation and invasive potential of melanoma cells,which was initially dampened by miR-412 downregulation．Conclusions Elevated miR-412 expression augments melanoma cell proliferation and invasive capabilities,while its suppression diminishes these traits．Through its targeted regulation of SOX6,miR-412 exerts a significant influence on melanoma cell proliferation and invasion．These findings underscore the pivotal role of miR-412 in melanoma pathogenesis and underscore its potential as a promising therapeutic target．

目的 通过分析奥氮平的群体药代动力学研究,探讨影响奥氮平药动学参数的因素,为临床制定个体化给药方案提供依据。方法 在中国知网、万方、维普、迈特思创、PubMed和Embase等中英文数据库,以“奥氮平”“群体药代动力学”“模型”“非线性混合效应模型”及“olanzapine pamoate”“olanzapine”“population pharmacokinetic”“pharmacokinetic model”“nonlinear mixed effect”“NONMEM”为检索策略,检索建库至2023年5月所有关于奥氮平群体药代动力学的研究。结果 共纳入14篇奥氮平的群体药代动力学研究,大多数研究将奥氮平的药代动力学描述为一个单室模型。成人群体药代动力学模型群体典型值吸收速率常数：（0.3~2.85）/h;表观分布清除率：（10.4~25.4）L/h;表观分布容积：（223~2 390）L。儿童青少年模型群体典型值吸收速率常数：（0.142~0.758）/h;表观分布清除率：（13.6~16.8）L/h;表观分布容积：（322~899）L。年龄、体质量、性别、种族、吸烟状况、合并用药是影响奥氮平药动学参数的显著协变量。结论 奥氮平药动学参数估计值存在差异且有不同程度的个体间变异,未来应侧重于对特殊人群的研究。有必要对先前发表的模型进行外部验证,以便更准地的描述模型的适用性。

Objective By analyzing the population pharmacokinetics of olanzapine,the factors affecting the pharmacokinetic parameters of olanzapine were discussed,so as to provide a basis for the clinical formulation of individualized dosing regimens．Methods In Chinese and English databases such as CNKI,Wanfang,Wipro database,FMRS,PubMed and Embase,all studies on population pharmacokinetics of olanzapine from the establishment of the database to May 2023 were searched with “olanzapine pamoate”“olanzapine”,“population pharmacokinetics”,“pharmacokinetic model”,“nonlinear mixed-effect” and “NONMEM” as key words．Results A total of 14 population pharmacokinetic studies of olanzapine were included．Most studies described the pharmacokinetics of olanzapine as a single-chamber model．Adult pharmacokinetic model population typical values absorption rate constant was（0.3-2.85）/h;apparent distribution clearance was（10.4-25.4）L/h;apparent volume of distribution was（223-2390）L．absorption rate constants of the population of children and adolescents was（0.142-0.758）/h,apparent distribution clearance was（13.6-16.8）L/h,apparent volume of distribution was（322-899）L．Age,weight,gender,ethnicity,smoking status and concomitant medication were significant covariates affecting the pharmacokinetic parameters of olanzapine．Conclusions Estimates of pharmacokinetic parameters of olanzapine vary and have varying degrees of inter-individual variation．In the future,research should focus on special populations．Externally validation of previously published models should also be performed to more accurately describe the applicability of the models．

本文探讨临床药师对口服靶向药物的非小细胞肺癌患者开展药学服务的要点,以案例为依据,通过查阅药品说明书、指南及文献等,分析药学服务的内容和方向。临床药师在安全性评估、剂量调整、个体化治疗方案选择、用药教育和健康宣教等方面为患者和临床医生提供专业、全面的药学服务。临床药师通过全程参与患者的治疗过程,指导患者正确用药、优化治疗方案,利用专业优势解决临床实际问题,提升药学服务质量的同时体现了药师的职业价值。

To explore the key points of pharmaceutical care for non-small cell lung cancer patients with oral targeted drugs．Based on clinical cases,the content and direction of pharmaceutical care were analyzed with drug instructions,guidelines and literature．Clinical pharmacists provided professional and comprehensive pharmaceutical services for patients and clinicians in safety assessment,dose adjustment,individualized treatment plan selection,medication education and health education．Clinical pharmacists participate in the whole treatment process,guide patients to use drugs correctly,optimize treatment plans,use professional advantages to solve clinical practical problems,improve the quality of pharmaceutical care and reflect the professional value of pharmacists．

目的 探讨唐氏综合征血清学筛查风险值异常孕妇选择接受无创产前基因检测（NIPT）的影响因素,为临床制定对应策略提供参考依据。方法 选取2022年1月—2022年12月唐氏综合征血清学筛查风险值异常孕妇229例,根据是否接受NIPT分为接受组（195例）与不接受组（34例）。收集两组临床资料,采用Lasso-Logistic回归分析唐氏综合征血清学筛查风险值异常孕妇接受NIPT的影响因素。结果 单因素分析显示,年龄、文化水平、居住地、家庭平均月收入、孕前优生优育检查、孕前合并生殖相关疾病、受孕方式、不良孕产史、家族史、补充叶酸、配偶意愿、NIPT认知水平、血清学风险等级是血清学筛查异常孕妇接受NIPT的影响因素（P<0.05）;Lasso回归分析筛选出7个变量,分别为年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级;Logistic回归分析,年龄（OR=6.269,95%CI：2.413~16.285）、文化水平（OR=4.119,95%CI：1.627~10.430）、家庭平均月收入（OR=5.102,95%CI：2.067~12.594）、不良孕产史（OR=5.247,95%CI：1.833~15.021）、家族史（OR=7.416,95%CI：2.952~18.629）、NIPT认知水平（OR=5.751,95%CI：2.338~14.146）、血清学风险等级（OR=7.866,95%CI：3.057~20.238）是血清学筛查异常孕妇接受NIPT的影响因素（P<0.05）。结论 唐氏综合征血清学筛查风险值异常孕妇选择接受NIPT的影响因素较多,包括年龄、文化水平、家庭平均月收入、不良孕产史、家族史、NIPT认知水平、血清学风险等级,能为临床提高NIPT接受度提供指导信息。

Objective To explore the influencing factors of noninvasive prenatal testing（NIPT）for pregnant women with abnormal risk value of serological screening for Down syndrome,and to provide reference for clinical development of corresponding strategies．Methods A total of 229 pregnant women with abnormal serological screening risk values for Down syndrome from January 2022 to December 2022 were selected and divided into acceptance group（195 cases）and non-acceptance group（34 cases）according to whether they received NIPT．The clinical data of the two groups were collected and Lasso-Logistic regression was used to analyze the factors influencing the acceptance of NIPT in pregnant women with abnormal serological screening risk value for Down syndrome．Results In single factor analysis,age,education level,place of residence,average monthly family income,pre-pregnancy and childbearing examination,pre-pregnancy combined with reproductive diseases,conception method,adverse pregnancy history,family history,folic acid supplementation,spouse intention,NIPT cognition level and serological risk grade were the influencing factors for the acceptance of NIPT in pregnant women with abnormal serological screening（P<0.05）．Seven variables were selected by Lasso regression analysis,which were age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level and serological risk level．Logistic regression analysis showed that age（OR=6.269,95%CI：2.413-16.285）,education level（OR=4.119,95%CI：1.627-10.430）,average monthly family income（OR=5.102,95%CI：2.067-12.594）,adverse pregnancy history（OR=5.247,95%CI：1.833-15.021）,family history（OR=7.416,95%CI：2.952-18.629）,NIPT cognitive level（OR=5.751,95%CI：2.338-14.146）and serological risk level（OR=7.866,95%CI：3.057-20.238）were independent influencing factors for NIPT acceptance in pregnant women with abnormal serological screening（P<0.05）．Conclusions There are many influencing factors for pregnant women with abnormal serological screening risk value to accept NIPT,including age,education level,average monthly family income,adverse pregnancy history,family history,NIPT cognition level,serological risk grade,etc．,which can provide guidance information for clinical improvement of NIPT acceptance．

目的 探讨产科监护室妊娠期糖尿病产妇泌乳启动延迟及影响因素,以期作为预防泌乳启动延迟的参考依据。方法 选择2021年1月—2023年5月期间医院产科监护室接收的妊娠期糖尿病产妇80例为研究对象,采用单因素和多因素分析产妇的年龄、体质指数、产次、定期复查血糖、妊娠期高血压、分娩方式、开奶时间、新生儿体质量、产后焦虑、产后抑郁、产后疲乏、吸吮次数等对泌乳启动延迟的影响。结果 妊娠期糖尿病产妇泌乳启动延迟33例,发生率41.25%;泌乳启动延迟产妇的年龄≥35岁者占51.52%、未定期复查血糖者占39.39%、合并妊娠期高血压者占54.55%、开奶时间≥6 h者占57.58%、产后焦虑者占30.0%、产后抑郁者占36.36%、产后疲乏者占36.36%、吸吮次数<6次者占60.61%,与非泌乳启动延迟产妇比较差异均有统计学意义（P<0.05）。两组孕前体质指数、产次、分娩方式、新生儿出生体质量比较差异无统计学意义（P>0.05）。年龄≥35岁、未定期复查血糖、合并妊娠期高血压、开奶时间≥6 h、产后焦虑、产后抑郁、产后疲乏、吸吮次数<6次为妊娠期糖尿病产妇泌乳启动延迟的危险因素（P<0.05）。结论 产科监护室妊娠期糖尿病产妇泌乳启动延迟发生率较高,主要受到年龄、未定期复查血糖、合并妊娠期高血压、开奶时间、产后心理状态、吸吮次数等因素影响,应重视健康教育和早期辅助干预,降低泌乳启动延迟发生率。

Objective To explore the delayed lactation initiation and its influencing factors of pregnant women with diabetes in the obstetric care unit,so as to provide a reference for preventing delayed lactation initiation．Methods A total of 80 pregnant women with diabetes who were received by the hospital obstetric care unit from January 2021 to May 2023 were selected as the research objects．The age,body mass index,parity,regular blood glucose recheck,pregnancy hypertension,delivery mode,starting time,neonatal weight,postpartum anxiety,postpartum depression,postpartum fatigue,sucking times and other factors that led to the delay of lactation initiation were analyzed by single factor and multi factor analysis．Results The onset of lactation was delayed in 33 pregnant women with diabetes,with an incidence of 41.25%．The age of postpartum women with delayed lactation initiation over 35 years old accounted for 51.52%,blood sugar was not regularly rechecked accounted for 39.39%,pregnancy induced hypertension accounted for 54.55%,lactation time over 6 hours accounted for 57.58%,postpartum anxiety accounted for 30.0%,postpartum depression accounted for 36.36%,postpartum fatigue accounted for 36.36%,and sucking frequency <6 times accounted for 60.61%,which were higher than that of non-delayed lactation initiation women（P<0.05）．There was no statistically significant difference between the two groups in terms of pre pre-pregnancy body mass index,parity,delivery method and newborn birth weight（P>0.05）．The risk factors of delayed lactation initiation in pregnant women with diabetes were age ≥ 35 years,no regular blood glucose review,hypertension during pregnancy,≥ 6 h of first milk expression time,postpartum anxiety,postpartum depression,postpartum fatigue and sucking times<6（P<0.05）．Conclusions The incidence of delayed lactation initiation in pregnant women with diabetes in the obstetric care unit is high,which is mainly affected by age,pregnancy induced hypertension,time of starting breast feeding,postpartum psychological state and sucking times．Health education and early auxiliary intervention should be emphasized to reduce the incidence of delayed lactation initiation．

目的 探讨男性人乳头瘤病毒（HPV）基因分型感染情况。方法 收集采用聚合酶链式反应反向斑点杂交法进行28种HPV基因分型检测的1 137例男性检查结果,进行回顾性分析。结果 1 137例男性患者中阳性441例,阳性率为38.79%,感染率居前5位的亚型依次为HPV6（11.35%）、HPV11（7.92%）、HPV16（5.10%）、HPV52（3.52%）、HPV43（2.64%）;就诊人群以20~39岁为主,感染人数也最多,各年龄组间阳性率比较差异无统计学意义（P>0.05）,≥50岁组HPV52型阳性率高于20~29岁组（P<0.05）和30~39岁组（P<0.05）。单一感染占67.35%,多重感染占32.65%,单一感染中低危型占比最多（41.27%）,多重感染中,二重感染占比最多（19.50%）,高低危混合感染为各种类型感染之首（15.87%）。结论 1 137例样本中HPV阳性率为38.79%,感染亚型以HPV6、HPV11、HPV16、HPV52、HPV43为主,单一低危型感染较为常见,各年龄组间阳性率相近。

Objective To investigate the genotypes of human papillomavirus（HPV）infection．Methods A total of 1 137 male patients’ diagnoses were collected and analyzed retrospectively,which came from the detections using polymerase chain reaction reverse dot blot hybridization to genotype 28 HPV．Results Among 1 137 male patients,441 were HPV positive,with a positive rate of 38.79%,the infections of top five HPV types were HPV6（11.35%）,HPV11（7.92%）,HPV16（5.10%）,HPV52（3.52%）,HPV43（2.64%）．The majority of the patients were the 20-39 age group,and the number of infections was also the highest．There was no statistical significance on the difference in the positive rate among different age groups（P>0.05）．The positive rate of HPV52 in ≥50 years old group was higher than the groups of aged 20~29（P<0.05）and 30~39（P<0.05）．The single and multiple infections accounted for 67.35% and 32.65%．The low-risk HPV accounted for the highest proportion（41.27%）in single infections,while in patients with multiple infections,the proportion of dual infections was the largest（19.50%）and the high- and low-risk HPV mixed infections was the maximum of the infection types（15.87%）．Conclusions The detection rate of positive HPV in 1 137 male patients was 38.79%,mainly were type 6,type 11,type 16,type 52 and type 43,and the single low-risk HPV infected was common．Positive rates were similar among different age groups．

目的 分析恩格列净对2型心肾综合征（CRS）患者的治疗效果。方法 研究于2021年10月—2023年10月进行,随机抽取88例2型CRS患者,经计算机程序随机分成对照组（44例,给予常规治疗）、实验组（44例,在常规治疗的同时加用恩格列净）,通过对比两组患者心、肾功能指标来评估疗效,并记录两组患者治疗过程中发生的不良反应。结果 治疗后,实验组LAD、LVED低于对照组,而LVEF高于对照组;实验组血清肌酐、尿酸等肾功能指标水平均低于对照组（均P<0.05）。两组不良反应发生率比较差异无统计学意义（P>0.05）。结论 对于2型CRS患者,恩格列净可促进其心、肾功能的改善,且无过多不良反应,安全性理想,治疗效果可观,值得推广。

Objective To analyze the therapeutic effect of empagliflozin on patients with type 2 cardiorenal syndrome（CRS）．Methods The study was conducted from October 2021 to October 2023,and 88 patients with type 2 CRS were randomly selected and divided into control group（44 cases,receiving conventional treatment）and experimental group（44 cases,receiving conventional treatment combined with englaglitzin）by computer program．The efficacy was evaluated by comparing cardiac and renal function indexes and adverse reactions．Results After treatment,the LAD and LVED of the experimental group were lower than those of the control group,while LVEF was higher than that of the control group．The levels of serum creatinine,uric acid and other renal function indexes in the experimental group were lower than those in the control group after treatment（P<0.05）．There was no significant difference in the incidence of adverse reactions between the two groups（P>0.05）．Conclusions For patients with type 2 CRS,empagliflozin can promote the improvement of cardiac and renal function without many side effects,with ideal safety and considerable therapeutic effect,which is worthy of promotion．

目的 探讨特发性间质性肺炎（IIPs）[非特发性肺间质性纤维化（IPF）型]合并弥漫性肺部出血综合征患者治疗方案以及应用价值。方法 报道1例IIPs（非IPF型）合并弥漫性肺部出血综合征患者的治疗经过以及结果,结合文献分析治疗IIPs（非IPF型）合并弥漫性肺部出血综合症临床应用价值。结果 该文报道 l 例特发性肺间质肺炎（非IPF型）伴弥漫性肺泡出血综合征的老年男性患者,合并呼吸、循环衰竭,启用静脉-静脉体外膜肺氧合（VV-ECMO）抢救并成功撤机,病情好转出院。结论 IIPs作为病因以及发病机制未明、临床表现多样的一类肺间质性疾病,需临床多学科协作,及早诊断、治疗,才能成功挽救患者。

Objective To explore the treatment plan and application value of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome．Methods A case of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was reported．The clinical application value of treatment of idiopathic interstitial pneumonia（non IPF）complicated with diffuse alveolar hemorrhage syndrome was analyzed combined with the literature．Results A case of idiopathic interstitial pneumonia（non IPF type）with diffuse alveolar hemorrhage syndrome was reported in this paper． Combined with respiratory and circulatory failure,veno-venous extracorporeal membrane oxygenation was used to rescue and successfully wean,and the condition improved and discharged．Conclusions Through the curative effect evaluation of this patient,it is believed that idiopathic interstitial pneumonia,as a kind of pulmonary interstitial disease with unknown etiology and pathogenesis and diverse clinical manifestations,need clinical multidisciplinary cooperation,early diagnosis and treatment,in order to successfully save the patient．

目的 调查与探讨高龄髋部骨折患者术后谵妄（POD）的发生因素,并提出相关处理对策。方法 选取2019年8月—2022年12月择在南阳市中医院独山院区进行手术治疗的高龄髋部骨折患者82例为研究对象,所有患者在术前1 d进行机械痛阈评定,在术后7 d判定患者的POD发生情况,进行POD与术前痛阈水平的相关性分析,并提出相关的处理对策。结果 术后7 d,82例患者中发生POD 12例（谵妄组）,占比14.6%,未发生POD 70例（非谵妄组）,占比85.37%。谵妄组的性别、体质指数、骨折类型、骨折至手术时间与非谵妄组对比差异无统计学意义（P>0.05）,谵妄组的年龄、术前血红蛋白水平、术前白蛋白水平与非谵妄组对比差异有统计学意义（P<0.05）。谵妄组的术前1 d的痛阈水平低于非谵妄组（P<0.05）。Spearman分析显示,POD与术前痛阈、年龄、术前血红蛋白、术前白蛋白均存在相关性（P<0.05）。Logistic回归分析显示,术前痛阈、年龄、术前血红蛋白、术前白蛋白等都为导致POD发生的影响因素（P<0.05）,要积极加强预防性护理干预。结论 高龄髋部骨折患者POD的发生率较高,患者的术前痛阈、年龄、术前血红蛋白、术前白蛋白等均为导致POD发生的影响因素,要积极加强预防性护理干预。

Objective To investigate and explore the factors leading to postoperative delirium（POD）in elderly patients with hip fractures,and to propose relevant handling measures．Methods From August 2019 to December 2022,82 cases of elderly patients with hip fractures who underwent surgical treatment in Nanyang Hospital of Traditional Chinese Medicine Dushan District were selected as the research subjects．All patients underwent mechanical pain threshold assessment 1 day before surgery,and their postoperative delirium were determined 7 days after surgery,followed by correlation analysis,and relevant handling measures were proposed．Results Seven days after surgery,there were 12 patients（delirium group）of POD,accounted for 14.6%,and 70 patients（non delirium group）without POD,accounted or 85.37%．There was no significant difference in genders,body mass index,fracture types and fracture to surgery time compared between the delirium group and the non delirium group（P>0.05）． However,there were significant differences in ages,preoperative hemoglobin levels and preoperative albumin levels compared between the delirium group and the non delirium group（P<0.05）．The pain threshold level of the delirium group on the first day before surgery was significantly lower than that of the non delirium group（P<0.05）．Spearman analysis showed that POD was associated with preoperative pain threshold,ages,preoperative hemoglobin and preoperative albumin levels（P<0.05）．Logistic regression analysis showed that the preoperative pain threshold level,ages,preoperative hemoglobin and preoperative albumin levels were all independent risk factors for the development of POD（P<0.05）,preventive nursing intervention should be actively strengthened．Conclusions The incidence of POD is high in elderly patients with hip fractures．Preoperative pain threshold level,age,preoperative hemoglobin and preoperative albumin levels are all factors that contribute to the occurrence of POD．It is necessary to actively strengthen preventive nursing interventions．

目的 分析烟雾病患者在血管重建术并发脑高灌注综合征的危险因素,为指导预防血管重建术后并发症提供参考依据。方法 选择2022年9月—2023年9月期间医院接收的148例烟雾病患者为研究对象,采用血管重建术治疗,统计术后高灌注综合征发生率,单因素分析术后并发高灌注综合征与性别、年龄、既往史、类型、铃木分期、灌注分期、手术侧别、入院改良Rankin 量表（mRS）评分、术后脑血流量（CBF）等因素的关系,并采取非条件Logistic多因素回归分析烟雾病患者血管重建术后并发高灌注综合征的危险因素。结果 148例患者血管重建术后,共42例并发脑高灌注综合征,发生率为28.38%。其中术后并发脑高灌注综合征与无并发脑高灌注综合征患者的性别、总胆固醇、甘油三酯、空腹血糖、入院mRS评分及基础疾病类型、手术侧别和手术时间比较差异无统计学意义（P>0.05）。烟雾病血管重建术后并发脑高灌注综合征患者年龄、是否合并高血压、铃木分期、灌注分期、收缩压、舒张压、术后CBF与无脑高灌注综合征患者比较差异有统计学意义（P<0.05）。年龄、收缩压、舒张压、铃木分期、灌注分期、CBF为烟雾病血管重建术后并发脑高灌注综合征的影响因素（P<0.05）。结论 烟雾病患者血管重建术后并发高灌注综合征的危险因素主要为高龄、收缩压升高、舒张压升高、铃木分期中晚期、灌注分期高、CBF降低,对此类患者需引起重视,做好针对性干预。

目的 观察营养指导联合预防护理在小儿癫痫意外预防中作用。方法 抽取焦作市妇幼保健院2021年1月—2023年1月收治的116例小儿癫痫患儿,按照护理方法分为两组,每组各58例。对照组行常规护理,联合组患儿在常规护理基础上给予营养指导联合预防护理干预,对比两组家属满意度、患儿依从率、蒙特利尔认知评估量表（MoCA）评分。结果 经过护理干预,联合组家属满意率98.28%,依从率96.55%,比对照组87.93%、82.76%高（P<0.05）;住院至出院居家三个月内,相较于对照组,联合组患儿外伤发生次数、发病持续时间、癫痫发作次数较少（P<0.05）;护理后,联合组MoCA评分高于对照组（P<0.05）。结论 在小儿癫痫意外预防中联合应用营养指导和预防护理可改善患儿遵医行为,优化小儿癫痫意外预防效果,减少患儿外伤、癫痫发生次数,缩短患儿发病持续时间,提升患儿生活质量和家属满意度。

Objective To observe the effect of nutritional guidance combined with preventive nursing on the prevention of epilepsy accidents in children．Methods A total of 116 cases of pediatric epilepsy admitted in Jiaozuo Maternal and Child Health Care Hospital from January 2021 to January 2023 were selected．They were divided into two groups according to the nursing method,with 58 cases in each group．The control group was given usual care,while the combined group was given nutritional guidance combined preventive nursing intervention．The satisfaction,the compliance rate and MoCA score were compared between two groups．Results After nursing intervention,the satisfaction rate of the combined group was 98.28%,and the compliance rate of the combined group was 96.55%,which were higher than 87.93% and 82.76% in the control group（P<0.05）．Within three months from hospitalization to discharge,compared with the control group,number of injuries,duration and frequency of seizures were less in the combined group（P<0.05）．After nursing,the MoCA score of the combined group was higher than that of the control group（P<0.05）．Conclusions The combined application of nutritional guidance and preventive nursing in the prevention of pediatric epileptic accidents can improve the compliance behavior of children,optimize the prevention effect of pediatric epileptic accidents,reduce the incidence of trauma and epilepsy in children,shorten the duration of illness,and improve the quality of life of children and family satisfaction．

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．

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 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．