This study investigated the prevalence of falls in maintenance hemodialysis (MHD) patients, and established a nomogram model for evaluating the fall risk of MHD patients. This study enrolled 303 MHD patients from the dialysis department of a tertiary hospital in July 2021. The general data of the participants, as well as the scores on the FRAIL scale, Sarcopenia Screening Questionnaire (SARC-F), Short Physical Performance Battery (SPPB) Scale, and of anxiety and depression, and the occurrence of falls were recorded. Using R language, data were assigned to the training set (n = 212) and test set (n = 91), and a logistic regression model was established. The regression model was verified by the receiver operating characteristic (ROC) curve, area under the curve (AUC), and the calibration curve. As a result, the prevalence of falls in MHD patients was 20.46%. Risk factors for falls in the optimal multivariate logistic regression model included hearing impairment, the depression score, and the SPPB score, of which a higher depression score (odds ratio (OR): 1.28, 95% confidence interval (CI): 1.09-1.49, p = 0.002) and SPPB <= 6 (OR (vs) (SPPB9-12): 3.69, 95% CI: 1.04-13.14, p = 0.043) conferred independent risk for falls. AUC of the nomogram in the training was 0.773, which in the test group was 0.663. The calibration and standard curves were fitted closely, indicated that the evaluation ability of the model was good. Thus, a higher depression score and SPPB <= 6 are independent risk factors for falls in MHD patients, and the nomogram with good accuracy and discrimination that was established in this study has clinical application value.

目的:构建分级肺康复护理方案,预防ICU患者卒中相关性肺炎的发生.方法:在文献研究和半结构访谈的基础上,构建预防ICU患者卒中相关性肺炎的分级肺康复护理草案.采用德尔菲法进行2轮专家函询,按照专家意见对条目进行修改.结果:最终形成预防ICU患者卒中相关性肺炎的分级肺康复护理方案包括基础肺康复策略、一级肺康复策略、二级肺康复策略3项一级指标、15项二级指标、39项三级指标.结论:构建的预防ICU患者卒中相关性肺炎分级肺康复护理方案科学可靠,可以为开展神经科ICU康复护理研究及实践提供借鉴.

目的:探讨分级肺康复护理方案在预防脑卒中相关性肺炎中的应用效果。方法:方便抽取2022年8月—10月陕西省某三级甲等医院神经内科重症监护室（ICU）的80例病人作为研究对象，随机分为对照组和干预组各40例，对照组实施神经内科ICU常规护理，试验组在常规护理的基础上实施分级肺康复护理方案，干预2周后比较两组病人脑卒中相关性肺炎发生率、临床肺部感染评分、标准吞咽功能评估量表评分、上肢运动功能量表（Fugl-Meyer）评分、氧分压（PaO2）、二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）和ICU住院时间。结果:干预组脑卒中相关性肺炎发生率、临床肺部感染评分、标准吞咽功能评分、PaCO2值及ICU住院时间均显著低于对照组，PaO2值、PaO2/FiO2值、Fugl-Meyer评分均显著高于对照组，差异均有统计学意义（P<0.05）。结论:分级肺康复护理方案可有效降低神经内科ICU病人脑卒中相关性肺炎的发生率，减轻肺部感染的严重程度，改善病人呼吸功能、吞咽功能、上肢运动情况，缩短ICU住院时间。

Objective:To investigate the development and influencing factors of frailty in elderly patients on maintenance hemodialysis.Methods:A cross-sectional survey involved 146 elderly patients on maintenance hemodialysis at the blood purification department of the First Affiliated Hospital of Xi'an Jiaotong University.A self-designed demographic questionnaire was used to collect general information of patients, the Simple Physical Performance Scale(SPPB)was used to assess physical function, the 5-item SARC-F was used as a tool for rapid screening of sarcopenia, and the Hospital Anxiety and Depression Scale(HADS)was used for screening of anxiety and depression.The FRAIL scale was used for frailty assessment and participants were divided into a no frailty group, a pre-frailty group and a frailty group according to different frailty scores.Relevant influencing factors of frailty were analyzed.Results:Among 146 hemodialysis patients, 33(22.6%)were in the non-frailty group, 86(58.9%)in the pre-frailty group, and 27(18.5%)in the frailty group.Univariate analysis showed that there were statistically significant differences in sex( χ2=6.220, P=0.045), age( F=5.197, P=0.007), body type( χ2=31.927, P<0.001), SARC-F score( χ2=24.283, P<0.001)and SPPB score( χ2=26.773, P<0.001)between different groups.There were 3 patients(9.4%)at high risk for sarcopenia in the no frailty group, 13 patients(40.6%)at high risk for sarcopenia in the pre-frailty group, and 16 patients(50%)at high risk for sarcopenia in the frailty group, and differences in the occurrence of sarcopenia between the different subgroups of frailty were statistically significant( χ2=27.496, P<0.001). Multifactorial Logistic regression analysis showed that age, ( OR=1.04, 95% CI: 0.99-1.08, P=0.049), sex( OR=0.39, 95% CI: 0.17-0.87, P=0.021), body size( OR=0.07, 95% CI: 0.01-0.50, P=0.008), SARC-F( OR=0.14, 95% CI: 0.05-0.38, P<0.001)were independent influencing factors of frailty in elderly maintenance hemodialysis patients( P<0.05). Conclusions:The incidence of frailty is high in elderly patients on maintenance hemodialysis, and the development of frailty is affected by age, body mass index and sarcopenia.

回顾性分析湖南省人民医院收治的5例IgG4相关硬化性胆管炎行手术治疗患者的临床和随访资料，从临床及影像学角度分析其临床诊治特点。术前1例诊断为肝门胆管癌Ⅳ型，4例诊断为胆总管下段癌；3例行胰十二指肠切除术，2例行胆肠内引流术；术后病例均诊断为IgG4相关硬化性胆管炎。笔者认为IgG4相关硬化性胆管炎缺乏典型的临床表现、无特殊生化检查以及影像学结果，常常误诊为其他疾病，明确诊断通常依赖于临床、影像学、组织学、血清学、治疗及预后的综合分析。

目的 探讨维持性血液透析患者衰弱发生情况及与肌少症、躯体功能的关系,为衰弱预防及管理提供参考.方法 便利抽样法选取303例维持性血液透析患者,采用FRAIL衰弱量表、简易五项评分问卷、简易机体功能评估,进行衰弱、肌少症及躯体功能评估.结果 303例维持性血液透析患者中,无衰弱占27.1％、衰弱前期占60.7％、衰弱占12.2％.肌少症高危者占11.2％,躯体功能下降者占44.9％.多因素logistic回归分析显示,年龄＜60岁、体型标准及超重、躯体功能正常、肌少症低危是衰弱的保护因素(P＜0.05,P＜0.01).结论 维持性血液透析患者衰弱及衰弱前期占比较高,衰弱的发生受年龄、体型的影响,并与肌少症、躯体功能密切相关.