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目的探讨基因多态性对先天性心脏病儿童心脏介入手术中舒芬太尼（SUF）药代动力学的影响。方法选择年龄6~72月，ASA分级Ⅱ级并拟行心脏介入手术的患儿168例。使用丙泊酚2 mg·kg-1、SUF 0.3 μg·kg-1及苯磺顺阿曲库铵0.2 mg·kg-1行麻醉诱导，丙泊酚8 mg·kg-1·h-1维持麻醉。采用稀释采样法收集给予SUF后5、10、20、30、45、60、75、90 min的血液标本。使用UHPLC-MS/MS法测定血浆中SUF的药物浓度，并用Phoenix WinNonlinTM软件计算药代动力学参数。基因型检测采用基质辅助激光解析电离飞行时间质谱进行检测。应用SNPStats对基因型数据和药代动力学数据进行分析，选择赤池信息量准则数值最小的模型为最优模型。结果共纳入可能影响SUF药代动力学和药效学相关的靶点、代谢酶、转运体及通路相关的9个基因中30个单核苷酸多态性位点。发现基因ABCG2 rs2054576和OPRM1 rs4870266与SUF药物暴露量相关（P OPRM1 rs2236257与SUF表观分布容积相关（PCYP3A4 rs2246709和OPRM1 rs2236257，rs4870266与SUF药物清除率相关（PABCG2 rs2054576，CYP3A4 rs2246709和OPRM1 rs2236257，rs4870266的基因多态性可显著地影响SUF的药代动力学变化。

近年来，随着全球经济快速发展和城镇化加速，城市能耗及排放持续增长，面临严峻的资源短缺和环境污染问题。为满足城市居民多样化的能源需求，以及能源系统安全高效、清洁低碳的转型要求，城市能源系统应运而生，并迅速成为能源领域的研究热点。针对城市能源系统的规划设计及能耗分析，各国研究学者已经开发了一系列相关工具，然而各类工具的开发目的及开发者专业背景存在差异，其适用场景不尽相同，且模型的时间和空间颗粒度也存在较大差异。通过聚焦城市能源系统的规划设计及能耗分析工具，分别选取对比典型商用工具的功能和特性，并结合应用案例对工具的适用性进行分析，为相关工具的后续开发及应用提供参考。

Objective To investigate the effect of f fine nursing management for patients undergoing simultaneous bilateral lobectomy. Methods Totally 52 patients under simultaneous bilateral lobectomy were randomly divided into the control group and observation group, with 26 cases in each group. The control group received routine nursing interventions during perioperative period. The observation group was given fine nursing management. The indwelling time of catheter, length of postoperative hospital stay, hospitalization costs and postoperative complications were recorded. Results The indwelling time of drainage tube and length of postoperative hospital stay in the observation group were shorter than those in the control group(P＜0. 05). There was a case of pneumothorax, 1 case of stage I pressure injury, 5 cases of arrhythmia, 2 cases of breathing difficulties and 2 cases of incision infection in the observation group. There was a case of pneumothorax, 3 cases of stage I pressure injury, 5 cases of arrhythmia, 1 case of breathing difficulties, 5 cases of incision infection and 1 case of death in the control group. Conclusion Implementation of fine nursing management is effective to shorten indwelling time of drainage tube and length of postoperative hospital stay of patients undergoing simultaneous bilateral lobectomy. (目的 探讨同期双侧肺叶切除围手术期实施精细化护理干预的效果。方法 选取2015年1月—2021年12月医院收治的行同期双侧肺叶切除患者52例, 随机分为对照组和观察组, 各26例。对照组围手术期采取常规护理, 观察组围术期采取精细化护理干预。记录和分析两组患者引流管留置时间、术后平均住院日、住院费用和术后并发症。结果 观察组患者引流管留置时间、术后平均住院日较对照组缩短, 差异有统计学意义(P＜0. 05)。观察组术后发生气胸1例, I期压疮1例, 心律失常5例, 呼吸困难2例, 切口感染2例; 对照组术后气胸1例, I期压疮3例, 心律失常5例, 呼吸困难1例, 切口感染5例, 死亡1例。结论 同期双侧肺叶切除围手术期实施精细化护理干预, 能缩短患者引流管留置时间和术后平均住院日, 对促进患者术后康复具有积极意义。)

Objective To investigate the effect of hierarchical nursing based on fall risk assessment for prevention of falls in elderly patients with Parkinson's disease (PD). Methods Totally 200 PD patients were randomly divided into the control group and observation group, with 100 cases in each group. The control group received routine fall prevention and management, while the observation group received hierarchical nursing based on fall risk assessment. The self-made Knowledge-Attitude-Practice (KAP) questionnaire was used to assess the patients’ fall prevention awareness. The Client Satisfaction Questionnaire(CSQ) was used to assess patients’ satisfaction with nursing service. The incidence of falls in a one-year follow-up was observed. Results Total score of KAP and dimension scores of knowledge, attitude and practice were increased in both two groups after interventions, and total score of KAP in the observation group was higher than that in the control group (P＜0. 01). The overall satisfaction rate of the observation group was higher than that of the control group (P＜0. 05). The incidence of falls of the observation group was lower than that of the control group after a one-year follow-up (P＜0. 05). Conclusion The hierarchical nursing based on fall risk assessment for prevention of falls is effective to enhance the knowledge, attitude and practice skills of PD patients, improve the quality of falls prevention and management, and reduce the incidence of falls. (目的 探讨基于跌倒风险评估的分层护理干预对老年帕金森病(PD)患者知信行水平的影响及预防跌倒的效果。方法 选取医院神经内科2018年3月—2020年3月收治的200例老年PD患者作研究对象, 随机分成对照组和观察组, 各100例。对照组实施常规预防跌倒护理干预, 观察组在对照组基础上实施基于跌倒风险评估的分层护理干预。运用自制知信行量表(KAP)问卷评估患者知信行水平, 运用顾客满意度量表(CSQ)评价患者对护理服务的满意度, 记录随访1年期间跌倒发生情况。结果 实施护理干预后, 两组知识、信念、行为维度得分和KAP问卷总分均较干预前提高, 且观察组知识、信念、行为维度得分和KAP问卷总分高于对照组, 差异有统计学意义(P＜0. 01)。观察组总满意度高于对照组(P＜0. 05)。随访1年时观察组总跌倒发生率低于对照组(P＜0. 01)。结论 基于跌倒风险评估的分层护理干预能提升PD患者的护理效果, 提高患者知信行水平, 降低跌倒发生率。)