目的 研究米氮平和文拉法辛二药连用治疗抑郁症的临床疗效和安全性,以及对患者认知功能及生活质量的影响。方法 选取125例抑郁症患者随机分为三组,A组42例给予文拉法辛,B组41例给予米氮平,C组42例给予米氮平及文拉法辛,疗程均为8周。采用HAMD-17、GQOLI-74集WMS-RC量表作为评价指标。结果 用药8周后总有效率比较,C组>B组>A组,同时,C组与其他两组比较有差异(P<0.05)。治疗前,三组患者WMS-RC各项评分比较无差异(P>0.05),治疗8周后,三组患者各项认知功能均有改善;其中,联合用药的改善效果最为显著。相较于治疗前,三组患者GQOLI-74评分均有不同程度上升,但C组患者上升幅度更大(P<0.05)。结论 联合应用来治疗难治性抑郁症疗效显著,且能帮助恢复患者的认知能力,研究过程中未发现较明显不良反应,故提倡临床推广。

Objective To study on the clinical efficacy and safety of mirtazapine and venlafaxine in the treatment of refractory depression, as well as to improve cognitive function and quality of life in patients. Methods 125 patients were randomly assigned to three groups, including group A: 42 cases with venlafaxine, group B: 41 cases with mirtazapine, group C 42 cases with mirtazapine and venlafaxine, 8 weeks for a course. Results After the treatment, total effective rate: group C>group B>group A. There's no difference between WMS-RC among three groups. After treatment for 8 weeks, cognitive function of three groups was enhanced, and group C was the most significant. GQOLI-74 scores of the three groups were increased, but group C of patients increased even more sharply (P<0.05). Conclusion Mirtazapine and venlafaxine may effectively improve the quality of life and cognitive function of patients with depression. It's high safety and worthy of clinical promotion and application.

目的 探讨儿童不明原因肝功能异常的临床特点、病因及预后,为临床及时对因治疗提供帮助。方法 回顾性分析本院2016年1月—2017年12月期间205例以不明原因肝功能异常住院患者的临床资料,并对其临床特点、病因及预后进行分析。结果 在205例不明原因肝功能异常患者中,其中166例(80.97%)得到明确诊断,涉及多种疾病。其中分别为非嗜肝病毒所致感染性肝损104例(50.73%),遗传代谢疾病38例(18.54%),药物性肝损11例(5.37%),全身性疾病如川崎病6例(2.93%)、血液肿瘤疾病4例(1.95%)、营养不良3例(1.46%)等,原因未明 39例(19.02%)。结论 引起肝功能异常病因多且复杂。婴幼儿肝功能异常以非嗜肝病毒所致感染性肝损为主,感染主要为巨细胞病毒及EB病毒;遗传代谢性疾病、药物性肝损、全身性疾病也是造成肝功能异常的重要原因。

Objective To investigate the clinical features, etiology and prognosis of children patients with unexplained liver dysfunction. Methods The clinical data of 205 inpatients with unexplained liver dysfunction from January 2016 to December 2017 were analyzed retrospectively. The clinical characteristics, etiology and prognosis were analyzed. Results Of 205 patients with unexplained abnormal liver function, 166 patients with liver dysfunction (80.97%) were clearly diagnosed and involved in a variety of diseases. Among them, 104 cases were infected liver damage caused by non-hepatophilic virus, 38 cases were related to genetic metabolic diseases, 11 cases were drug-induced liver damage, 6 cases were Kawasaki disease, 4 cases were hematologic tumor diseases, 3 cases were malnutrition. The cause of abnormal liver function was not clear in 39 cases. Conclusion There are many and complicated causes of abnormal liver function, and part of the causes are unknown. Infantile liver dysfunction was mainly caused by non-hepatophilic virus, the first was cytomegalovirus, the second was Epstein-Barr virus; genetic metabolic disease, drug-induced liver damage, systemic disease are also an important cause of liver dysfunction.

目的 探讨自体心包膜组织对急性心肌梗死大鼠心脏功能的影响。方法 筛选合格的模型动物随机分为三组:心包去除组:仅去除心包膜;心梗组:前降支结扎法建立大鼠心肌梗死模型3周后仅开胸;移植组:前降支结扎法建立大鼠心肌梗死模型,3周后将心包膜移植于心肌梗死及周边区。实验4周后,通过心动图评价实验动物心脏功能,使用Masson染色检测动物心肌梗死大小,通过免疫荧光评价动物心肌存活率、观察血管新生状况,Western blot检测Caspase-3蛋白/Bcl-2基因表达情况。结果 4周后,心包去除组大鼠的心电图监测结果未见有室性颤动;而心梗组、心梗+移植组均有非致死性室性颤动。相比心梗组,心梗+移植组改善了心功能,降低了心肌凋亡指数,免疫Bcl-2蛋白表达升高,而Caspase-3蛋白表达降低。结论 提示自体心包膜移植不会导致恶性室性心律失常,相对有较高的安全性;并能促进心肌梗死细胞恢复心功能,其改善机制可能与通过修补心室重构途径同时抑制缺血区域细胞凋亡有关。

Objective To explore the effect of autologous pericardial transplantation for treating the myocardial infarction (MI) in experimental rats. Methods 30 SD rats were randomly divided in to three equal parts: Pericardial removal group (PR group): only pericardium tissue was removed; Myocardial infarction group (MI group): the anterior descending branch ligation method established a rat model of myocardial infarction and only opened the chest after 3 weeks. Autologous pericardium transplantation (APT group): After established the MI model of SD rats, 3 weeks later, the autologous pericardial patch was harvested and transplanted to infarcted zone. Four weeks after the surgery, the cardiac function and serum biochemistry were analyzed for all the experimental rats. The cardiac function was evaluated by echocardiography, which the size of the infarction were examined by Masson staining, the survival time of transplanted autologous pericardial and angiogenesis were measured by immunohistochemistry, the protein expressions of Caspase and the gene expressions of Bcl were examined by Western blot analysis. Results 4 week after the 2^nd operation, no ventricular fibrillation was detected in the ECG of PR group. Fatal ventricular fibrillation wasn't detected in the ECG of MI group and APT group. Compared with MI group, APT group improved cardiac function and decreased myocardial apoptosis index(P<0.05),which similar to PR group. APT group has the higher density of angiogenesis at infracted area to MI group but less than that of PR group. PT group had decreased protein expressions of Caspase-3 and the expressions of Bcl-2 were decreased. Conclusion Autologous pericardial transplantation could recover myocardial infarction cells, which will improve the cardiac function in experimental rats with MI.

目的 探讨腹腔镜手术与传统开腹手术对右半结肠癌患者免疫功能指标及临床疗效的影响。方法 选取80例右半结肠癌患者,随机分成两组,各40例分别行腹腔镜手术及传统开腹手术,分别比较两组患者手术前后免疫功能指标及相关临床疗效的差异。结果 腹腔镜组及开腹组术后免疫指标CD3⁺、CD4⁺、CD8⁺均出现不同程度下降,但腹腔镜组免疫指标CD3⁺、CD4⁺均优于开腹组(P＜0.05);腹腔镜组术中出血量、术后胃肠排气功能恢复时间、住院时间均优于开腹组(P＜0.05);两组手术时间及淋巴结清扫个数方面无显著差异(P＞0.05)。结论 腹腔镜手术治疗右半结肠癌不仅对患者免疫功能损害较低,还较开腹术具有术中出血量少、术后恢复快等优点,值得临床推广。

目的 探讨吸烟对稳定期COPD患者炎症反应和肺功能的影响。方法 选取2013年8月—2016年9月我院门诊收治的稳定期COPD患者70例为研究对象,其中吸烟35例(X1组)、不吸烟35例(X2组),另选取同期入院的不吸烟健康志愿者35例纳入健康组,采用酶联免疫吸附试验(ELISA)测定血清白介素-6(IL-6)、白细胞介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平,以肺功能检测仪测定三组一秒用力呼气容积(FEV1)、一秒用力呼气容积/用力肺活量比值(FEV1/FVC)、FEV1占预计值百分比(FEV1％),并采用自拟症状评分表及简明健康调查简表(SF-36)评价呼吸困难程度及生活质量。结果 X1组IL-6、IL-8及TNF-α依次为(135.27±1.24)pg/mL、(189.45±1.14)pg/mL、(39.39±1.14)pg/mL,明显高于X2组、健康组(P均<0.05);X1组FEV1(0.75±0.14)L、FEV1/FVC(3.65±1.87)％、FEV1％(3.45±0.12)％低于X2组、健康组(P均<0.05);X1组症状积分(10.17±1.02)分较X2组、健康对照组高(P<0.05),而其SF-36评分(54.27±1.46)分明显低于X2及健康组(P<0.05);X2组上述指标与健康组比较亦有统计学意义(P均<0.05)。结论 吸烟可明显增加稳定期COPD患者IL-6、IL-8、TNF-α等炎症因子水平,同时降低肺功能,临床应采取措施进行有效干预,防止患者病情恶化。

目的 探究曲美他嗪对慢性心力衰竭患者血清炎症因子水平及心功能的影响。方法 选择2015年4月—2016年3月我院收治的慢性心力衰竭患者94例,根据随机数表法分为两组,每组47例。对照组实施阿托伐他汀治疗,观察组在此基础上予以曲美他嗪治疗。比较两组患者治疗6个月后血清炎症因子和脑利钠肽(BNP)、心功能以及临床疗效。结果 观察组血清C-反应蛋白(CRP)、BNP、肿瘤坏死因子-α(TNF-α)水平均低于对照组,差异有统计学意义(P＜0.05);观察组左收缩末期内径(LVESD)、左室舒张末期内径(LVEDd)水平较对照组明显降低,而左室射血分数(LVEF)高于对照组,差异有统计学意义(P＜0.05);观察组患者治疗有效率与对照组相比明显提高,差异有统计学意义(P＜0.05)。结论 对慢性心力衰竭患者实施曲美他嗪治疗,能有效提高患者临床疗效,降低患者血清炎症因子,改善心功能,值得临床推广与应用。

Objective To investigate the effect of Trimetazidine on serum inflammatory factors levels and cardiac function in patients with chronic heart failure (CHF). Methods 94 CHF patients admitted into our hospital from April 2015 to March 2016 were divided into two groups randomly, 47 cases in each. Control group took Atorvastatin, and on this basis observation group was given Trimetazidine. The serum inflammatory factors levels, brain natriuretic peptide (BNP), cardiac function and clinical efficacy of two groups after treatment for 6 months were compared. Results The serum C-reactive protein (CRP), BNP, Tumor necrosis factor-α (TNF-α) levels of observation group were lower than control group (P<0.05); The left ventricular end-systolic diameter (LVESD), Left ventricular end-diastolic diameter (LVEDd) levels of observation group significantly decreased compared with control group, but left ventricular ejection fraction (LVEF) was higher than control group (P<0.05); The curative effective rate of observation group significantly increased compared with control group (P<0.05). Conclusion Trimetazidine for treating CHF patients may effectively increase clinical efficacy, decrease serum inflammatory factors and improve cardiac function, which is worthy of clinical promotion and application.

目的 探讨慢性阻塞性肺疾病急性期加重期(AECOPD)患者血清降钙素原(PCT)、白介素6(IL-6)、超敏C反应蛋白(hs-CRP)水平变化及与肺功能的相关性。方法 选择121例COPD急性加重期患者为实验组研究对象,选取同期体检的80例稳定期COPD患者为对照组,比较两组患者血清PCT、IL-6、hs-CRP的差别,并对三者与COPD患者肺功能的相关性进行探讨。结果 实验组患者IL-6、hs-CRP水平显著高于对照组(P＜0.05)。实验组FEV1值、FEV1%显著低于对照组(P＜0.05)。Pearson分析显示,实验组hs-CRP与肺功能指标FEV1%呈负相关关系(r=-1.51,P=0.048)。结论 AECOPD患者的血清炎症因子水平明显高于COPD稳定期患者,血清炎症因子与慢阻肺患者肺功能损伤密切相关。

目的 探讨追踪护理模式对中青年保留神经宫颈癌根治术后膀胱功能恢复的影响效果。方法 按住院先后顺序将82例患者分为对照组40例、实验组42例,对照组给予常规护理,实验组实施追踪护理模式,3个月后对两组患者的尿失禁、尿潴留发生率,膀胱功能恢复情况及尿失禁严重程度进行测评。结果 实验组尿失禁、尿潴留的发生率分别为2%、4% ,膀胱功能Ⅰ级、Ⅱ级达100%,68%患者无尿失禁,与对照组比较差异均有统计学意义(P>0.05)。结论 对中青年保留神经宫颈癌根治术实施追踪护理模式,可提高患者膀胱功能锻炼的有效性,促进膀胱功能的早日恢复,改善其生活质量。

Objective To explore the effect of follow-up nursing on the recovery of bladder function in young and middle-aged patients with cervical cancer after radical operation. Methods 82 patients were divided into control group (n = 40) and experimental group (n=42). The control group was given routine nursing care, experimental group to implement the follow-up nursing model. After 3 months, the incidence of urinary incontinence and urinary retention were observed in the two groups, including bladder function recovery and severity of urinary incontinence. Results The incidence of urinary incontinence and urinary retention in the experimental group were 2% and 4%, respectively. Bladder function level I and II reached 100%. There was no urinary incontinence in 68% patients. Compared with the control group, the difference was statistically significant (P>0.05). Conclusion It may improve the effectiveness of bladder function training, promote the early recovery of bladder function and improve the quality of life of young and middle-aged patients with cervical cancer.

目的 探讨康复护理路径早期功能训练对桡骨远端骨折LCP(锁定加压接骨板locking compression plate, LCP)内固定术后患者腕关节功能康复的影响。方法 对2014年5月—2016年6月住院80例桡骨远端骨折LCP 内固定术后患者分为对照组和观察组,每组各40例,对照组按桡骨远端LCP内固定术后护理措施进行护理,观察组患者在此护理基础上,制定术后功能康复护理路径,按功能康复护理路径对术后患者实施早期功能康复训练,随访评价两组患者患肢的组织肿胀、疼痛、骨折复位和腕关节功能康复效果。结果 疼痛评分:对照组在术后第3天~14天疼痛评分均高于观察组(P＜0.005);肿胀程度评分:对照组在术后第3天~7天肿胀程度评分均高于观察组,消肿速度比观察组慢(P＜0.001);腕关节的屈伸活动范围、握力和捏力比较观察组优于对照组(P＜0.001);腕关节复位优良率观察组95%高于对照组87.5%(P＜0.001)。结论 应用康复护理路径对桡骨远端骨折的LCP内固定术后患者进行早期腕关节功能康复训练,能减轻患者疼痛和局部软组织肿胀,减少并发症,提高术后患者康复质量。

Objective To investigate the early functional training of rehabilitation nursing path to the effects of distal radius fracture LCP (locking compression plate LCP) in patients after internal fixation of wrist joint function rehabilitation. Methods From May 2014 to June 2016, 80 patients with distal radius fractures were divided into control group and observation group(n=LCP), each with 40 cases. The control group was treated with nursing care of patients with distal radius LCP internal fixation. On the basis of nursing, the patients in the observation group were given rehabilitation nursing pathway, and the patients were followed up according to the rehabilitation path including evaluation of two groups of patients with fracture limb swelling, pain, fracture reduction and wrist joint function rehabilitation. Results Pain score: in the third days to fourteenth days pain score of the control group was higher than the observation group (P<0.005); Swelling degree score: swelling scores of the control group for the third days to seventh days after were higher than those in the observation group, the swelling reduced slowly (P<0.001); The wrist flexion range, grip and pinch strength compared to the observation group was better than the control group (P<0.001); The good rate of wrist joint reduction in the observation group (95%) was higher than that in the control group[(87.5%) (P<0.001)]. Conclusion The application of rehabilitation nursing path for patients with distal radius fracture after LCP internal fixation for early rehabilitation of wrist function may reduce the pain and local soft tissue swelling, reduce complications and improve the quality of postoperative rehabilitation.

目的 本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法 选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果 本研究患者的平均年龄(84.23±4.92)a,按eGFR<60 mL·min^-1·1.73 m^-2定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 ①肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。②年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people's hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of (84.23±4.92),had being divided into two groups according to eGFR< 60 ml·min^-1·1.73 m^-2:renal insufficiency group (n=52) and normal renal function group (n=51).There were statistical significance in the number of lacunar lesions,score of white-matter hyperintensity,mixed lesions between groups(P<0.05). Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is positively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI,and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.