目的 探究改良Miccoli手术治疗单侧甲状腺癌（TC）患者的效果及其对机体创伤应激反应的影响。方法 选取新密市中医院200例单侧TC患者（2021年3月—2023年3月）,按随机数字表法分两组。A组100例接受改良Miccoli手术治疗,B组100例接受开放根治术（OT）治疗。对比两组围术期指标、喉返神经损伤发生情况、美学效果、手术前后肿瘤指标[细胞角蛋白19片段抗原（Cyfra21.1）、半乳糖凝集素3（Gal-3）、可溶性白细胞介素-2受体（sIL-2R）]、创伤应激反应指标[去甲肾上腺素（NE）、肾上腺素（E）、皮质醇（Cor）]水平。结果 A组切口长度为（2.05±0.13）cm,短于B组的（7.11±0.49）cm,住院及手术用时分别为（3.12±0.44）d、（53.48±7.52）min,均短于B组的（5.22±0.81）d、（76.81±11.39）min,术中失血量、引流量分别为（19.24±2.66）mL、（21.47±3.41）mL,均少于B组的（45.08±5.75）mL、（64.82±7.24）mL,组间比较差异有统计学意义（P<0.05）;A组喉返神经损伤总发生率为2.00%（2/100）,低于B组的12.00%（12/100）,组间比较差异有统计学意义（P<0.05）;A组美容总满意度为97.00%（97/100）,高于B组的73.00%（73/100）,差异有统计学意义（P<0.05）;A组术后3个月血清Cyfra21.1、Gal-3水平分别为（1.78±0.26）ng/mL、（6.14±1.64）ng/mL,均高于B组的（1.55±0.21）ng/mL、（5.39±1.28）ng/mL,血清sIL-2R水平为（375.36±20.12）μg/mL,低于B组的（427.13±23.18）μg/mL,组间比较差异有统计学意义（P<0.05）;A组术后1 d血清NE、E、Cor水平分别为（0.73±0.17）mmol/L、（0.49±0.10）mmol/L、（185.46±22.95）μg/L,均低于B组的（0.96±0.19）mmol/L、（0.81±0.22）mmol/L、（272.53±32.41）μg/L,组间比较差异有统计学意义（P<0.05）。结论 相较于OT治疗单侧TC患者,经改良Miccoli手术治疗更有助于提升美学效果,减少喉返神经损伤,优化围术期指标,抑制肿瘤进展,且机体产生的创伤应激反应更轻微。

Objective To investigate the effect of modified Miccoli surgery on patients with unilateral thyroid cancer（TC）and its impact on the body’s traumatic stress response．Methods The data of 200 patients with unilateral TC in Xinmi City Hospital of Traditional Chinese Medicine from March 2021 to March 2023 were retrospectively collected and divided into two groups according to different surgical protocols．A hundred patients treated with modified Miccoli surgery were classified as group A and 100 patients treated with open radical surgery（OT）were classified as group B．The perioperative indicators,incidence of recurrent laryngeal nerve injury,aesthetic effect,as well as tumor indicators [cytokeratin 19 fragment antigen（Cyfra21.1）,galectin-3（Gal-3）,soluble interleukin -2 receptor（sIL-2R）] and trauma stress response indicators [norepinephrine（NE）,epinephrine（E）,and cortisol（Cor）] before and after surgery were compared between the two groups．Results The incision length of group A was（2.05±0.13）cm,which was shorter than that of group B [（7.11±0.49）cm]．The duration of hospitalization and operation of group A were（3.12±0.44）d and（53.48±7.52）min,respectively,which were shorter than those of group B [（5.22±0.81）d and（76.81±11.39）min]．The intraoperative blood loss and drainage volume were（19.24±2.66）mL and（21.47±3.41）mL,respectively,which were lower than those in group B [（45.08±5.75）mL and（64.82±7.24）mL],and the difference was statistically significant（P<0.05）．The total incidence of recurrent laryngeal nerve injury in group A was 2.00%（2/100）,lower than that in group B [12.00%（12/100）],and the difference was statistically significant（P<0.05）．The total satisfaction of group A was 97.00%（97/100）,higher than that of group B [73.00%（73/100）],and the difference was statistically significant（P<0.05）．Serum Cyfra21.1 and Gal-3 levels in group A were（1.78±0.26）ng/mL and（6.14±1.64）ng/mL,respectively,higher than those in group B [（1.55±0.21）ng/mL and（5.39±1.28）ng/mL]．Serum sIL-2R level was（375.36±20.12）μg/mL,lower than that of group B [（427.13±23.18）μg/mL],and the difference was statistically significant（P<0.05）．The serum levels of NE,E and Cor in group A were（0.73±0.17）mmol/L,（0.49±0.10）mmol/L and（185.46±22.95）μg/L,respectively．They were lower than（0.96±0.19）mmol/L,（0.81±0.22）mmol/L and（272.53±32.41）μg/L in group B,and the differences were statistically significant（P<0.05）．Conclusions Compared to OT treatment for unilateral TC patients,the modified Miccoli surgery is more helpful in improving aesthetic effects,reducing damage to the recurrent laryngeal nerve,optimizing perioperative indicators,inhibiting tumor progression,and producing less traumatic stress response to the body．

目的 研究基于儿童早期预警评分（PEWS）的分级干预模式促进重症肺炎患儿康复进程及对呼吸功能的影响。方法 回顾性分析2021年4月—2023年4月我院收治的100例重症肺炎患儿临床资料。将其按照干预方式的差异分为研究组（n=50）及对照组（n=50）。对照组选用常规干预,研究组则于对照组基础上增加基于PEWS的分级干预。对比两组康复进程（相关指标涵盖症状持续时长及住院天数）、呼吸功能（涵盖通气流速、每分钟最大通气量、肺活量、用力肺活量及深吸气量）、并发症发生情况（涵盖呼吸机相关性肺炎、肺大疱及胸膜炎）、患儿家属满意度。结果 研究组各项症状持续时长及住院天数均短于对照组（均P<0.05）。研究组各项呼吸功能指标水平均高于对照组（均P<0.05）。两组各项并发症发生率对比差异无统计学意义（P>0.05）。研究组患儿家属满意度高于对照组（96.00% vs 82.00%,P<0.05）。结论 基于PEWS的分级干预模式促进重症肺炎患儿康复进程的效果较佳,且能改善呼吸功能,提高患儿家属满意度。

Objective To study the effect of graded intervention mode based on Pediatric Early Warning Score（PEWS）on the recovery process and respiratory function of children with severe pneumonia．Methods The clinical data of 100 children with severe pneumonia treated in our hospital from April 2021 to April 2023 were retrospectively analyzed．Those children were divided into study group（n=50）and control group（n=50）according to the difference of intervention methods．Conventional intervention was used in the two groups,and PEWS-based graded intervention was added to the study group．The two groups were compared with each other in terms of recovery process（including duration of symptoms and length of stay）,respiratory function（including ventilation velocity,maximum volume per minute,vital capacity,forced vital capacity and deep inspiratory capacity）,complications（including ventilators associated pneumonia,bullosa and pleurisy）,and family member satisfaction．Results The duration of symptoms and hospitalization days in the study group were shorter than those in the control group（all P<0.05）．The levels of respiratory function indexes in study group were higher than those in control group（all P<0.05）．There was no significant difference in the incidence of complications between the two groups（P>0.05）．The satisfaction of family member in the study group was higher than that in the control group（96.00% vs 82.00%）（P<0.05）．Conclusions The PEWS based graded intervention model has a good effect on promoting the rehabilitation process of children with severe pneumonia,and can improve respiratory function,and increase the satisfaction of family member of children with severe pneumonia．

目的 探讨丙戊酸钠联合奥卡西平治疗癫痫的疗效及其对患者炎性因子的影响。方法 选择2022年1月—2023年1月医院接收的100例癫痫患者进行研究,电脑随机编号奇偶数分为两组各50例,对照组采取丙戊酸钠治疗,观察组采取丙戊酸钠联合奥卡西平治疗,评价并比较两组治疗效果、神经因子、炎症因子、免疫功能、认知功能及生活质量,观察不良反应发生率。结果 观察组和对照组的治疗有效分别为47例（94.00%）、39例（78.00%）,观察组治疗有效率高于对照组（χ²=5.315,P=0.02）。治疗后,观察组的脑源性神经营养因子（195.33±18.29）pg/mL、神经生长因子（594.69±54.45）ng/mL水平高,肿瘤坏死因子-α（4.12±1.07）pg/mL、IL-1β（3.48±0.79）pg/mL、IL-6（53.44±3.63）pg/mL水平比对照组（150.68±15.27）pg/mL、（542.46±45.56）ng/mL、（6.35±1.27）pg/mL、（4.35±0.93）pg/mL、（63.02±3.81）pg/mL低（t=13.250、5.201、9.495、5.041、12.872,P<0.05）。治疗后,观察组的IgM（1.02±0.12）g/L、IgG（10.02±1.22）g/L、IgA（2.10±0.22）g/L比对照组（1.13±0.14）g/L、（11.68±1.57）g/L、（2.65±0.31）g/L更高（t=4.218、5.903、10.230,P<0.05）。治疗后,观察组的蒙特利尔认知量表（27.78±2.15）分、日常生活活动量表（71.88±6.45）分、癫痫患者生活质量评定量表-31（82.65±8.25）分比对照组（25.33±2.01）分、（65.65±5.54）分、（74.05±7.37）分更高（t=5.886、5.181、5.497,P<0.05）。观察组、对照组发生不良反应组间比较差异无统计学意义（χ²=1.010,0.343,1.010,1.010,1.010,P均>0.05）。结论 丙戊酸钠联合奥卡西平治疗癫痫患者可取得良好的疗效,控制癫痫症状,改善神经因子、认知功能,增强免疫功能,控制炎症因子,而且不良反应少,利于生活质量提高。

Objective To investigate the effect of sodium valproate combined with oxcarbazepine in the treatment of epilepsy and its influence on inflammatory factors．Methods From January 2022 to January 2023,100 patients with epilepsy admitted to our hospital were selected and randomly divided into two groups,50 cases in each group．The control group was treated with sodium valproate,and the observation group was treated with sodium valproate combined with oxcarbazepine．The therapeutic effect,neurological factors,inflammatory factors,immune function,cognitive function and quality of life were evaluated and compared between the two groups,and the incidence of adverse reactions was observed．Results The effective rate of the observation group and the control group were 94.00%（47 cases）and 78.00%（39 cases）,respectively．The effective rate of the observation group was higher than that of the control group（χ²=5.315,P=0.02）．After treatment,the levels of brain-derived neurotrophic factor（195.33±18.29）pg/mL and nerve growth factor（594.69±54.45）ng/mL in the observation group were higher than those in the control group．The levels of tumor necrosis factor-α（4.12±1.07）pg/mL,IL-1β（3.48±0.79）pg/mL,IL-6（53.44±3.63）pg/mL in the control group were（150.68±15.27）pg/mL,（542.46±45.56）ng/mL,（6.35±1.27）pg/mL,（4.35±0.93）pg/mL,（63.02±3.81）pg/mL（t=13.250,5.201,9.495,5.041,12.872,P<0.05）． After treatment,the IgM（1.02±0.12）g/L,IgG（10.02±1.22）g/L,IgA（2.10±0.22）g/L were higher than those in the control group（1.13±0.14）g/L,（11.68±1.57）g/L,（2.65±0.31）g/L（t=4.218,5.903,10.230,P<0.05）．After treatment,the scores of Montreal Cognitive Scale（27.78±2.15）,Activities of Daily Living Scale（71.88±6.45）and Quality of Life in Epilepsy Scale 31（82.65±8.25）in the observation group were higher than those in the control group（25.33±2.01）,（65.65±5.54）and（74.05±7.37）（t=5.886,5.181,5.497,P<0.05）．There was no significant difference in adverse reactions between the observation group and the control group（χ²=1.010,0.343,1.010,1.010,1.010,all P>0.05）．Conclusions Sodium valproate combined with oxcarbazepine in the treatment of patients with epilepsy can achieve good curative effect,control epilepsy symptoms,improve neurological factors,cognitive function,enhance immune function,control inflammatory factors,with less adverse reactions,conducive to improve the quality of life．

目的 探讨导航护士主导的三级质控在胸腔镜肺癌切除术患者加速康复中的应用效果。方法 选取2020年6月—2023年6月周口市中心医院收治的106例肺癌患者,应用随机数字表法分为观察组（n=53）与对照组（n=53）。患者均采取胸腔镜肺癌切除术治疗,对照组实施常规的术前、术中及术后相关围术期护理,观察组在常规围术期护理基础上增加导航护士主导的三级质控护理。对比两组住院时间、术后并发症和护理前后世界卫生组织生活质量-100量表（WHOQOL-100）及癌因性疲乏程度（PFS）,最后对比两组的护理满意度。结果 观察组首次排气时间、首次下床时间、术后疼痛视觉模拟量表（VAS）评分、术后住院时间均优于对照组（P<0.05）;观察组并发症发生率低于对照组（P<0.05）;干预后两组WHOQOL-100评分升高、PFS评分降低,观察组均优于对照组（P<0.05）;观察组护理满意度高于对照组（P<0.05）。结论 对胸腔镜肺癌切除术患者,采取导航护士主导的三级质控管理的加速康复护理,可促进患者术后肠胃功能恢复,缩短住院时间,减轻术后疼痛感与减少并发症,在改善患者癌因性症状的同时,提升其生活质量,提高患者护理满意度。

Objective To explore the application effect of three-level quality control led by navigation nurses in accelerating rehabilitation of patients undergoing thoracoscopic lung cancer resection．Methods A total of 106 lung cancer patients admitted to our hospital from June 2020 to June 2023 were selected and randomly divided into an observation group（n=53）and a control group（n=53）using a random number table method．All patients were treated with thoracoscopic lung cancer resection,while the control group received routine preoperative,intraoperative and postoperative perioperative care,the observation group received a three-level quality control nursing led by navigation nurses in addition to routine perioperative care．The length of hospitalization,postoperative complications,WHOQOL-100 and PFS before and after care,and the nursing satisfaction of the two groups were compared．Results The observation group had significantly shorter first exhaust time,first time out of bed,postoperative visual analogue scale（VAS）score and postoperative hospital stay compared to the control group（P<0.05）．The incidence of complications in the observation group was lower than that in the control group（P<0.05）．After intervention,the WHOQOL-100 scores of both groups increased,and the observation group was higher than the control group．The PFS score decreased,and the observation group was lower than the control group（P<0.05）．The nursing satisfaction of the observation group was significantly higher than that of the control group（P<0.05）．Conclusions Adopting a three-level quality control management led by navigation nurses to accelerate rehabilitation care for patients undergoing thoracoscopic lung cancer resection can promote postoperative recovery of gastrointestinal function,reduce hospitalization time,reduce postoperative pain and complications,improve cancer related symptoms,improve their quality of life and increase patients nursing satisfaction．

目的 了解危重产妇代理决策者的决策困境现状及其影响因素。方法 选择2022年10月—2023年10月许昌市中心医院产科及ICU的262例危重产妇及其代理决策者作为研究对象。应用一般资料问卷、母婴健康素养问卷、决策困境量表、决策参与期待量表进行调查。结果 决策困境量表总分为（39.38±14.58）分,其中信息提供和价值观明确总分为（13.91±7.16）分、社会支持和决策有效性总分为（20.41±8.25）分、不确定性总分为（5.06±1.96）分。多元线性回归分析发现,性别、学历、决策时间和脑卒中防治知识总分对危重产妇代理决策者决策困境均有影响（P<0.05）。结论 危重产妇代理决策者存在决策困境,医护人员需要根据代理决策者的人口学特征、疾病防治知识以及患者疾病特征进行决策辅助,减轻其决策困境,提升决策质量。

Objective To understand the current situation and influencing factors of decision-making difficulties among surrogate decision-makers for critically ill puerpera．Methods A total of 262 critically ill puerpera and their surrogate decision-makers from the obstetrics and ICU of Xuchang Central Hospital from October 2022 to October 2023 were selected．A survey was conducted using the General Information Questionnaire,Maternal and Child Health Literacy Questionnaire,Decision Dilemma Scale,and Decision Participation Expectancy Scale．Results The total score of the Decision Dilemma Scale was（39.38±14.58）,with a total score of（13.91±7.16）for information provision and clear values,（20.41±8.25）for social support and decision effectiveness,and（5.06±1.96）for uncertainty．Multiple linear regression analysis found that gender,education level,decision time and total score of stroke prevention and control knowledge all have an impact on the decision-making difficulties of surrogate decision-makers in critically ill puerpera（P<0.05）．Conclusions There is a decision-making dilemma for the surrogate decision-makers of critically ill puerpera．Medical staff need to provide decision-making assistance based on the demographic characteristics,disease prevention and control knowledge,and patient disease characteristics of the surrogate decision-makers,in order to alleviate their decision-making difficulties and improve the quality of decision-making．

目的 研究靶向NKG2A抑制剂抗头颈部鳞状细胞癌（HNSCC）的作用。方法 应用GEO和TCGA数据库分析NKG2A及其配体HLA-E单细胞表达情况、与患者预后以及免疫微环境的相关性。构建HNSCC皮下抑制瘤模型,流式细胞技术检测化学治疗（化疗）对免疫检测点NKG2A表达的影响。动物实验验证NKG2A抑制剂以及NKG2A抑制剂联合多西他赛化疗的抗肿瘤作用。结果 NKG2A（KLRC1）主要表达在NK细胞,少量表达在T淋巴细胞。HNSCC肿瘤高表达NKG2A/HLA-E（P<0.01）,与患者不良预后密切相关;肿瘤微环境中NKG2A/HLA-E与多个免疫细胞浸润以及免疫检测点表达密切相关（P<0.01）。动物实验显示化疗能上调T、B淋巴细胞表达免疫检查点NKG2A的表达水平（P<0.01）;化疗的基础上联合NKG2A抑制剂能更有效地介导抗肿瘤作用（P=0.013）。结论 化疗基础上联合NKG2A抑制剂能更有效地介导抗肿瘤作用,为探索HNSCC临床新策略提供实验和理论基础。

Objective To investigate the anti-tumor effects of NKG2A inhibitor on head and neck squamous cell carcinoma（HNSCC）．Methods The single-cell expression of NKG2A ,its ligand HLA-E and their correlations with patient prognosis and immune microenvironment were analyzed in GEO and TCGA databases．The subcutaneous tumor model of HNSCC was constructed,and the effects of chemotherapy on the expression of NKG2A on T and B lymphocytes were detected by flow cytometry．Animal experiments were used to confirmed the anti-tumor effects of NKG2A inhibitor and NKG2A inhibitors combined with docetaxel．Results NKG2A（KLRC1）was mainly expressed in NK cells,and a small amount was expressed in T lymphocytes．The high expression of NKG2A/HLA-E in HNSCC tumors（P<0.01）were closely related to poor prognosis．NKG2A/HLA-E in tumor microenvironment were closely related to the infiltration of multiple immune cells and the expression of immune checkpoints（P<0.01）．Animal experiments showed that chemotherapy could up-regulate the expression of NKG2A in T and B lymphocytes（P<0.01）．Chemotherapy in combination with NKG2A inhibitor could mediate more effective antitumor effects in HNSCC（P=0.013）．Conclusions Combined with NKG2A inhibitor on the basis of chemotherapy can mediate more effective anti-tumor effects,and this study may provide experimental and theoretical basis for exploring new clinical strategies of HNSCC．

目的 研究影响新生儿低血糖的相关危险因素。方法 回顾性分析新生儿科570例新生儿的临床资料,其中新生儿低血糖组190例,正常血糖组新生儿380例,采用Logistic回归分析新生儿低血糖相关危险因素。结果 单因素Logistic回归分析显示,新生儿体质量减轻、早产、新生儿呼吸衰竭、新生儿呼吸窘迫、新生儿感染、母亲分娩年龄增大、经产妇、剖宫产、双胎、妊娠期糖尿病、妊娠期高血压疾病是新生儿低血糖发生的危险因素（均P<0.05）;多因素Logistic回归分析显示,早产（OR=2.115,95%CI：1.186~3.772）、剖宫产（OR=6.92,95%CI：4.202~11.397）是新生儿低血糖发生的危险因素（均P<0.05）。结论 早产、剖宫产是新生儿低血糖发生的危险因素,应根据危险因素及时识别和治疗新生儿低血糖,为新生儿提供及时产后护理指导,以降低新生儿低血糖发生率。

Objective To study the relevant risk factors of neonatal hypoglycemia．Methods A retrospective analysis was conducted on the clinical data of 570 newborns in neonatal pediatrics,including 190 cases in the neonatal hypoglycemia group and 380 cases in the normal blood glucose group．Logistic regression analysis was used to analyze the risk factors related to neonatal hypoglycemia．Results Single factor Logistic regression analysis showed that neonatal weight loss,premature,neonatal respiratory failure,neonatal respiratory distress,neonatal infection,the mother’s age of delivery,multipara,cesarean section,twins,pregnancy diabetes,pregnancy hypertension were the risk factors for neonatal hypoglycemia,all of which had statistical significance（all P<0.05）．In multivariate Logistic regression analysis,premature（OR=2.115,95% CI：1.186-3.772）and cesarean section（OR=6.92,95% CI：4.202-11.397）were risk factors for neonatal hypoglycemia（both P<0.05）．Conclusions Premature and cesarean section are risk factors for the occurrence of neonatal hypoglycemia in the local area．Timely identification and treatment of neonatal hypoglycemia based on risk factors,providing timely postpartum nursing guidance for newborns,can reduce the occurrence of neonatal hypoglycemia．

目的 研究高尿酸（UA）和肥胖的交互作用对非酒精性脂肪肝病（NAFLD）患病率的影响。方法 采用病例对照的研究法,选取2021年1月至2021年12月兰州市某医院健康体检中心进行常规健康体检的504人为研究对象,按照诊断标准分为NAFLD组187人和非NAFLD 组317人。采用Logistic 回归模型、相乘、相加交互模型探讨非酒精性脂肪肝病患病风险的影响因素及因素间的交互作用。结果 多因素条件Logistic回归分析可知,肥胖（OR=4.87,95%CI：3.01~7.89）,糖尿病患者（OR=3.40,95%CI：1.51~7.68）,幽门螺杆菌（Hp）携带者（OR=1.62,95%CI：1.03~2.57）,高尿酸血症的NAFLD患病风险增加,分别是正常者、非糖尿病患者、非Hp携带者,非高尿酸血症的4.87倍,3.40倍,1.62倍,2.28倍,在调整混杂因素后交互作用结果显示,高尿酸血症和肥胖对NAFLD患病率有相乘交互作用（OR=0.30,95%CI：0.10~0.88,P=0.029）、但无相加交互作用（相对超额危险度比=3.15、归因比=0.24、协同指数=1.34）。结论 BMI、糖尿病、Hp是NAFLD患病的独立危险因素,其中高尿酸血症和超重与肥胖对NAFLD患病有相乘交互作用,无相加交互作用。

Objective To explore the influence of the interaction of high uric acid（UA）and obesity on the prevalence of non-alcoholic fatty liver disease（NAFLD）．Methods Using a case-control study method,504 people who underwent routine health checkups at the health checkup centre of a hospital in Lanzhou City from January 2021 to December 2021 were enrolled in the study,and 187 people were included in the NAFLD group and 317 people in the non-NAFLD group according to the diagnostic criteria．Logistic regression models,multiplicative and additive interaction models were used to investigate the factors affecting the risk factors of NAFLD and the interaction between the factors．Results Multifactorial conditional logistic regression analysis showed that the risk of NAFLD was increased in obese（OR=4.87,95% CI：3.01-7.89）,diabetic patients（OR=3.40,95% CI：1.51-7.68）,Helicobacter pylori（Hp）carriers（OR=1.62,95% CI：1.03-2.57）;the increased risk of NAFLD prevalence in hyperuricaemia patients was 4.87,3.40,1.62,and 2.28 times higher than that of normal,non-diabetic,non-Hp carriers,and non-hyperuricemic individuals,respectively．And the adjusted interaction showed a multiplicative interaction of hyperuricaemia and obesity on the prevalence of NAFLD after controlling for the confounders（OR=0.30,95% CI：0.10-0.88,P=0.029）,but no additive interaction （relative excess risk due to interaction=3.15,attributable proportion due to interaction=0.24,and synergy index=1.34） interactions．Conclusions BMI,diabetes mellitus,and Hp were independent risk factors for the prevalence of NAFLD,with hyperuricaemia and overweight and obesity having multiplicative interaction and no additive interaction．

目的 应用FRAX^®工具评估广州社区中老年人发生骨质疏松性骨折的风险。方法 回顾性研究1 140例广州社区中老年人的临床资料,应用FRAX^®工具计算未来10年发生主要骨质疏松性骨折及髋部骨折的风险,分析不同危险因素与骨折风险的关系。结果 广州社区中老年人群10年内发生主要骨质疏松性骨折概率为(4.2±3.6)%,髋部骨折概率为(1.3±2.4)%。主要骨质疏松性骨折风险及髋部骨折风险、OSTA值均随着年龄增长而增加。多因素回归分析结果显示: 年龄、性别、既往骨折、继发性骨质疏松、股骨颈T值、跌倒对主要部位骨折及髋部骨折风险具有独立性预测意义。结论 FRAX^®工具可用于评估广州社区中老年人骨质疏松性骨折风险,建议在社区中老年人健康体检时应用FRAX^®工具进行骨折风险评估。

Objective To predict the osteoporotic fracture risk in senile people in Guangzhou communities by FRAX,the fracture risk assessment tool published by WHO. Methods Clinical data of 1140 cases were collected for the retrospective analysis. The FRAX tool was uesed to calculate the 10-year probability of a major osteoporotic and hip fracture.The relationship between different risk factors and the fracture risk predicted by FRAX was analyzed. Results The 10-year probability of major osteoporotic fractures was (4.2±3.6)%, and the 10-year probability of hip fractures was (1.3±2.4)%.The 10-year probability of the major osteoporotic and hip fracture increased with age.Multivariate regression analysis showed that age,gender,previous fracture,secondary osteoporosis,T-score of femoral neck BMD and fall were independent predictors of the 10-year probability of major osteoporotic fracture and hip fracture. Conclusion The FRAX tool may be effectively applied to assess the fracture risk of senile population in Guangzhou communities.We recommedated that FRAX-tool should be included in routine health check-up.

目的 分析感恩拓延-建构理论在血友病患儿家庭护理中的应用效果。方法 对2021年1月—2022年1月期间在河南省儿童医院治疗的116例血友病患儿进行随机数表法分组,两组各58例。对照组给予常规临床干预,观察组给予感恩拓延-建构理论干预。比较两组患儿的负性情绪评分、家庭功能评分、自我意识评分、功能独立性评分、感恩问卷评分。结果 干预后观察组的焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）评分、各项家庭功能评分均低于对照组,干预后观察组的各项自我意识评分、各项功能独立性评分、感恩问卷评分均高于对照组,差异统计学有意义（P<0.05）。结论 感恩拓延-建构理论干预能够在一定程度上改善血友病患儿的负性情绪、家庭功能、自我意识、独立性及感恩水平。

Objective To analyze the application effect of gratitude extension-construction theory in family nursing of children with haemophilia．Methods A total of 116 children with haemophilia from January 2021 to January 2022 were randomly divided into two groups,58 children in each group．The control group received routine clinical intervention,while the observation group received gratitude extension-construction theory intervention．The negative emotional scores,family function scores,self-awareness scores,functional independence scores and gratitude questionnaire scores between the two groups were compared．Results After intervention,the SCARED,DSRSC,and family function scores of the observation group were lower than those of the control group．The self-awareness score,functional independence score,and gratitude questionnaire score of the observation group were higher than those of the control group,and the differences were significant（P<0.05）．Conclusions Gratitude extension-construction theory intervention can improve the negative emotion,family function,self-consciousness,independence and gratitude level of children with haemophilia to a certain extent．