目的 探究尿毒症继发性甲状旁腺功能亢进经甲状旁腺切除术治疗效果及安全性分析。方法 选取2017年6月—2019年5月于我院就诊的90例尿毒症继发性甲状旁腺功能亢进患者为研究对象,随机分为对照组与观察组,两组各45例。均采取同一药物治疗,对照组行次全切除治疗,观察组行甲状旁腺全切除术+前臂移植术。对比分析两组治疗效果、血生化指标及并发症。结果 观察组疗效优于对照组(P<0.05);观察组术后1周、1个月钙、iPTH、磷、钙磷乘积及ALP水平均低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论 甲状旁腺全切除+前臂移植治疗尿毒症继发性甲状旁腺功能亢进疗效显著,并发症风险低,值得推广。

目的 探讨骨髓间充质干细胞源性微泡(BMSC-MV)修复大鼠早发性卵巢功能不全的自噬机制。方法 大鼠骨髓分离培养骨髓间充质干细胞;超速离心法从骨髓间充质干细胞培养液中分离微泡;腹腔注射顺铂溶液制备早发性卵巢功能不全(POI)模型,制备后3 d尾静脉取血ELISA检测血清雌二醇(E2)及卵泡刺激素(FSH);尾静脉注射BMSC-MV移植治疗POI大鼠模型,移植后28 d尾静脉取血ELISA检测E2、FSH及抗苗勒管激素(AMH),同时取卵巢组织检测自噬相关蛋白LC3及P62。结果 模型对照组及微泡移植组在模型制备后3 d的E2 含量低于正常对照组,FSH 含量高于正常对照组(P<0.001);微泡移植组在移植后28 d的E2、AMH含量高于模型对照组(P<0.001),FSH含量低于模型对照组(P<0.001);微泡移植组的LC3较模型对照组表达升高,而P62表达降低(P<0.001)。结论 BMSC-MV介导自噬修复大鼠早发性卵巢功能不全。

Objective To investigate the autophagy mechanism of bone marrow mesenchymal stem cell-derived microvesicle (BMSC-MV) in repairing premature ovarian dysfunction in rats. Methods The whole bone marrow adherence method was used to isolate,culture and identify BMSCs of SD rats. Microvesicles were isolated from bone marrow mesenchymal stem cell by ultracentrifugation. Premature ovarian insufficiency (POI) model was prepared by intraperitoneal injection of cisplatin solution,and serum estradiol (E2) and follicular stimulating hormone (FSH) were detected by ELISA from tail vein 3 days after preparation. Rat model of POI was treated with BMSC-MV transplantation by tail vein. Blood from tail vein was collected 28 days after transplantation to detect E2,FSH and AMH by ELISA. Meanwhile,ovarian tissues were collected to detect autophagy-related proteins LC3 and P62. Results The E2 content of the model control group and the microvesicle transplantation group was lower than that of the normal control group,and the FSH content was higher than that of the normal control group (P<0.001). The content of E2 and AMH in the microvesicle transplantation group at 28 days after transplantation was higher than that in the model control group (P<0.001),and the content of FSH was lower than that in the model control group (P<0.001). Compared with the model control group,LC3 expression in the microvesicle transplantation group was increased,while P62 expression was decreased (P<0.001). Conclusion BMSC -MV mediate autophagy to repair premature ovarian insufficiency in rats.

目的 探讨循证护理干预在肺功能检查中对检查准确性的影响。方法 选取行肺功能检查患者80例,随机分为2组,分别记录为观察组40例和对照组40例,分别实施循证护理干预和常规护理干预,比较两组患者肺功能检查时间、肺功能检查结果及护理满意度。结果 观察组患者平均肺功能检查时间短于对照组(P<0.05);观察组患者肺功能检查正常率高于对照组;且观察组患者对护理服务的满意度高于对照组,组间对比差异有统计学意义(P<0.05)。结论 对行肺功能检查的患者实施循证护理干预效果显著,有利于缩短患者肺功能检查时间,并可提高检查的准确率,且有利于改善护患关系,值得在临床上推广应用。

Objective To investigate the influence of evidence-based nursing intervention on the accuracy of the examination in pulmonary function test. Methods 80 cases of patients with lung function examination, were randomly divided into 2 groups, were recorded in 40 cases of observation group and control group 40 cases, respectively. The implementation of evidence-based nursing intervention and routine nursing intervention were taken, to compare times of patients with pulmonary function test, pulmonary function test results and nursing satisfaction in two groups. Results In the observation group the average lung function examination time was shorter than that of the control group (P<0.05); normal pulmonary function tests was higher than that of the control group; satisfaction with nursing service was higher than the control group, there was statistical significance the differences between the two groups (P<0.05). Conclusion The pulmonary function test for patients with the implementation of evidence-based nursing intervention has significant effect. It can shorten the time in patients with pulmonary function examination, improve the inspection accuracy, and improve the relationship between nurses and patients, it is worthy of clinical application.

目的 运用网络药理学方法预测生白术活性成分、作用靶点及生物学意义,探讨其防治便秘的作用机制,并结合导师临床应用取得的疗效进行进一步的验证。方法 借助TCMSP在线数据库查找白术的药效成份并选择其生物利用度(OB)>30%且类药性(DL)>0.18的化合物,并查询每种成分所对应的靶标。通过Gene Cards、OMIM共2个疾病相关靶点的数据库检索便秘相关靶点信息。将二者靶基因相映射获得交集靶点。借助 cytoscape 3.7.1 软件对查询结果进行可视化。所得到的基因通过相互作用数据库(STRING)进行相互作用蛋白查询并构建蛋白质相互作用(PPI)网络。使用R语言对关键靶点行GO和KEGG富集分析,以构建“成分-靶点-信号通路”的网络。结果 共得到白术人源靶蛋白7个,便秘相关的人源基因2 859个。发现其主要通过干预PGR、CHRM3、CHRM1、ACHE、CHRM2五个基因并参与胆碱能突触、钙信号通路、肌动蛋白细胞骨架的调控、神经活性配体-受体相互作用、cAMP信号通路、PI3K-AKT信号通路共6条信号通路以达到防治便秘的效果。结论 应用网络药理学方法分析预测得到重用生白术防治便秘的潜在药效成分、作用靶点及其信号通路,为临床应用提供了理论依据。

Objective To predict the active ingredients, targets and biological significance of Atractylodes macrocephala by network pharmacology, to explore the mechanism of its prevention and treatment of constipation, and to further verify its efficacy in combination with the clinical application of tutors. Methods The constituents of Atractylodes macrocephala were searched by TCMSP database and the compounds with bioavailability (OB) > 30% and drug-like property (DL) > 0.18 were screened, and the corresponding targets of each constituent were queried. Constipation-related target information was retrieved from two disease-related target databases of GeneCards and OMIM, mapping the two target genes to obtain intersecting targets, by visualization of query results with cytoscape 3.7.1. The resulting genes were queried by the interaction database (STRING) and the protein interaction (PPI) network was constructed. GO and KEGG enrichment analysis of key targets was carried out by R language in order to construct the network of “component-target-signal pathway”. Results Seven human target proteins and 2 859 constipation related human genes were obtained from Atractylodes macrocephala. It was found that the effect of prevention and treatment of constipation was mainly achieved by interfering with five genes of PGR, CHRM3, CHRM1, ACHE and CHRM2 and participating in six signaling pathways: cholinergic synapse, calcium signaling pathway, regulation of actin cytoskeleton, neuroactive ligand-receptor interaction, cAMP signaling pathway and PI3K-AKT signaling pathway. Conclusion The potential pharmacodynamic components, targets and signaling pathways of reuse Rhizoma atractylodis macrocephalae in the prevention and treatment of constipation can be predicted by network pharmacological method, which provides a theoretical basis for clinical application.

目的 分析融合功能训练在大龄人群行斜视矫正术后建立双眼三级视功能及巩固术后效果的可能性。方法 回顾性研究2008年10月—2016年12月在广州爱尔眼科医院被诊断为共同性斜视并进行手术矫正的患者174例,术后进行融合功能训练。根据术前诊断斜视的类型分成共同性内斜视组、共同性外斜视组、间歇性外斜视组,根据两眼最佳矫正视力差别分为＞2行、≤2行组,训练时对单眼抑制及交叉抑制者先采用脱抑制训练再扩大融合功能训练,具有较小融合范围的矫正术后的患者直接从扩大融合功能开始训练,对比观察斜视手术矫正前和矫正后进行融合训练后融合功能及双眼视情况。结果 斜视矫正术后128例建立了正常的融合范围,随访1年斜视无复发,无视疲劳症状发生。其中共同性外斜视组、共同性内斜视组、间歇性外斜视组进行训练后治疗的有效率分别为32.35%、28.57%、100%,两眼最佳矫正视力相差＞2行和≤2行的有效率分别为11.54%、100%。结论 大龄斜视患者尤其是间歇性外斜视或双眼最佳矫正视力相差在2行以内的患者,经过融合训练均获得良好的双眼视,视疲劳得到改善,斜视手术效果得到巩固。

Objective To analyze the possibility of fusion function training to establish binocular tertiary vision function and consolidate the effect of postoperative strabismus correction in elderly people. Methods Conduct a retrospective study about 174 patients who were diagnosed with common strabismus and had corrective surgery at Guangzhou Aier Eye Hospital from October 2008 to December 2016, and those patients was performed after the fusion function training. According to the type of preoperative diagnosis of strabismus, they were divided into common esotropia group, common exotropia group, intermittent exotropia group. According to the difference of the best corrected visual acuity between the two eyes, they were divided into>2 lines group and ≤2 lines group. Monocular-suppression and cross-suppression patients firstly used de-inhibition training and then expand the fusion-range training. Patients with a smaller fusion range started training directly by expanding the fusion function. We compared and observed the fusion function and binocular condition between before and after strabismus surgery. Results The normal fusion range was established in 128 cases after strabismus correction, and there was no recurrence of strabismus and visual fatigue symptoms after 1 year of follow-up. Among them, the effective treatment rates of the common exotropia group, the common esotropia group, and the intermittent exotropia group after training are 32.35%, 28.57%, and 100%, respectively. The two groups which are divided into>2 lines group and ≤2 lines group are 11.54% and 100%, respectively. Conclusion Elderly patients with strabismus, especially those with intermittent exotropia or within two lines of best corrected visual acuity, have achieved good binocular vision after fusion training, have been improved visual fatigue, and the effect of strabismus surgery is consolidated.

目的 对首发短暂性脑缺血发作(TIA)及缺血性轻型卒中的患者进行认知功能分析,评估其认知损害程度及常见的认知损害领域,以便制定早期的认知功能康复计划,减少痴呆的发生。方法 纳入起病10天内的首发TIA及缺血性轻型卒中患者,完善MMSE和MoCA评分,把MMSE评分正常者划分为MoCA正常组和MoCA异常者,比较两组的认知功能损害程度及损害领域。结果 纳入142例患者,MMSE正常者113例,其中MoCA正常组83例,MoCA异常组30例。两组的认知功能比较,在视空间/执行功能、命名、注意力、计算、延迟记忆、定向力等方面的差异有统计学意义(P＜0.05),在言语流畅、抽象思维方面的差异无统计学意义(P＞0.05)。结论 TIA/轻型卒中患者存在多方面不同程度的认知功能损害,临床上需重视对该类患者的认知筛查,及时了解患者认知功能的变化,以便给予及时的诊断和治疗。

Objective To analyze the cognitive impairment among the paitents with TIA and minor ischemic stroke for the first attack. Making a recovery plan in early time by eveluating the degree and domains of the cognitive impairment, so as to reduce the prevelance of dimentia. Methods Patients with TIA and minor ischemic stroke for the first attack in 10 days were included. MMSE and MoCA were completed, we sorted out the normal MMSE patients and divided them into MoCA normal group and MoCA abnormal group, compared the cognitive function between the two groups. Results 142 patients were included. Among them 113 patients' MMSE were normal, in which MoCA normal group were with 83 patients and MoCA abnormal group with 30 patients. There were significant differences between them in visuospatial and executive function, naming, attention, caculation, delay memory and orientation(P＜0.05), while no significant difference in language fluency and abstraction(P＞0.05). Conclusion Cognitive impairment of TIA/minor ischemic stroke patients was in different degree, so we should pay more attention to their cognitive function and give them an in-time diagnosis and treatment.

目的 比较压力控制通气(PCV)中不同吸气流速对单肺通气(OLV)患者呼吸功能及炎症因子的影响。方法 本研究为2018—2019年对75例单肺通气患者的前瞻性研究。患者在麻醉和单肺通气(OLV)后随机分为吸气流量30 L/min(A组)、50 L/min(B组)或70 L/min(C组)。比较OLV前(T₀)、OLV后30 min(T₁)、60 min(T₂)和120 min(T₃)的呼吸力学、呼吸功能、血流动力学和血气分析,中心静脉血检测分析IL- 6、IL-8、TNF-α和sICAM-1,观察术后3天肺部并发症和ARDS的发生情况。结果 三组一般情况、血流动力学指标差异均无统计学意义(P＞0.05);B组、C组PaCO₂较A组降低(P<0.05);与T₀时比较,T₁-T₃时三组PaO_2、SVO₂均降低(P<0.05);三组PH、SO₂和HB差异均无统计学意义(P>0.05)。与A组比较,B组、C组ΔVT增大(P<0.05);三组Ppeak差异无统计学意义;与A组比较,B组、C组PEEP均增大(P<0.05);与A组比较,T₁-T₃时B组、C组V_D/V_T减少(P>0.05);与T₀比较,T₁-T₃时三组Qs/Qt增加(P<0.05);与A组比较,T₁-T₃时B组、C组Cdyn增大(P<0.05);与T₀相比,T₁-T₃时三组PaO₂/FiO₂降低(P<0.05);与T₀相比,T₁-T₃时三组IL-6、IL-8、TNF-α和sICAM-1的浓度增多(P<0.05),但A组、B组低于C组(P<0.05)。三组患者发生术后肺部并发症和ARDS差异均无统计学意义。结论 在PCV模式下通过增加吸气流速能增加VT,减少死腔率,促进 CO₂的交换,并且改善肺动态顺应性,但并不能很好的改善氧合及肺内分流。吸气流速50 mL/L在较小炎症反应的情况下达到上述改善呼吸功能和呼吸力学,可推荐应用于进行OLV患者。

Objective The effects of different inspiratory velocity PCV on respiratory function and inflammatory factors in patients with one-lung ventilation OLV were compared. Methods This was a prospective study of 75 patients with one-lung ventilation in 2018-2019. The subjects were randomized to the inspiratory velocity 30(group A),50(group B)or 70(group C)L/min after anesthesia and one-lung ventilation OLV. Respiratory mechanics,respiratory function,hemodynamics and blood gas parameters were compared between the three groups pre-OLV(T₀)and after 30 (T₁), 60 (T₂), and 120 (T₃)minutes of OLV.Center venous blood was collected to measure interleukin (IL)-6, IL-8,tumor necrosis factor (TNF)-α,andsoluble intercellular adhesion molecule-1 levels.Observation of pulmonary complications and occurrence of ARDS 3 days after operation were made. Results Hemodynamic and general patient status were similar between the three groups (all P>0.05). PaCO₂was lower in the group B and group C compared with the group A (P<0.05). Compared with T₀, PaO₂ and SVO₂were lower at T₁-T₃of the three groups(P<0.05). PH, SO2 and HB were similar between the three groups (all P>0.05).ΔVT was higher in the group B and group C compared with the group A (P<0.05);Ppeak were similar between the three groups (all P>0.05). PEEP was higher in the group B and group C compared with the group A (P<0.05); V_D/V_T decreased in the group B and group C compared with the group A (P<0.05).Compared with T₀,Qs/Qt increased at T₁-T₃ of the three groups (all P<0.05). Cdyn increased at T₁-T₃ of the group B and group C(all P<0.05). PaO₂/FiO₂ decreased at T₁-T₃ of the three groups(all P<0.05).Compared with T₀, the concentrations of Il-6, Il-8, TNF-α and sICAM-1 increased at T₁-T₃of three groups (P<0.05), and in group A and group B were lower than those in group C (P<0.05).The number of patients who had postoperative pulmonary complications PPCS or acute respiratory distress syndrome(ARDS)were similar between the three groups (all P>0.05). Conclusion In PCV mode, it can increase VT by increasing the inspiratory velocity, reduce the V_D/V_T, promote the exchange of CO₂, and increase the Cdyn, but it cannot improve the oxygenation and Qs/Qt.Inspiratory velocity of 50 mL/L to achieve the above improvement in respiratory function and respiratory mechanics in the case of a smaller inflammatory response. It may be recommended for use in patients undergoing OLV.

目的 探讨二维斑点追踪成像技术（Two-dimensional speckle tracking imaging,2D-STI）检测心肌肥厚患者左心室短轴收缩功能变化的效果。方法 选择2016年1月—2018年6月我院接诊的心肌肥厚100例为观察组,选取同期在我院行健康体检的健康者100例,均接受2D-STI检查,比较两组左心室短轴收缩期圆周应变与最大径向应变参数。结果 观察组前侧壁、前壁、下壁、后侧壁、前间隔、后间隔左心室短轴收缩期最大圆周应变均低于对照组,差异有统计学意义（P<0.05）;观察组前侧壁、前壁、下壁、后侧壁、前间隔、后间隔左心室短轴收缩期最大径向应变均低于对照组,差异有统计学意义（P<0.05）。结论 2D-STI可测量心机肥厚患者左心室短轴收缩功能,准确评价其心室局部运动,值得临床推广。

Objective To investigate the effect of two-dimensional speckle tracking imaging （2D-STI） on the changes of left ventricular short-axis systolic function in patients with cardiac hypertrophy. Methods 100 cases of cardiac hypertrophy received from our hospital from January 2016 to June 2018 were selected as observation group. 100 healthy subjects who underwent physical examination in our hospital during the same period were examined by 2D-STI. The left ventricle was compared between the two groups. Short-axis systolic circumferential strain and maximum radial strain parameters were compared . Results The maximum circumferential strain of the anterior wall of the anterior wall, anterior wall, inferior wall, posterior wall, anterior septum and posterior septum of the left ventricle was lower than that of the control group, and the difference was statistically significant （P<0.05）. The maximum radial strain of the anterior wall, anterior wall, inferior wall, posterior wall, anterior septum and posterior septal left ventricle was lower than the control group, and the difference was statistically significant （P<0.05）. Conclusion 2D-STI can measure the left ventricular short-axis systolic function in patients with cardiac hypertrophy and accurately evaluate the local ventricular motion, which is worthy of clinical promotion.

目的 探讨哮喘患者的气道炎症表型分布及肺功能指标情况。方法 选择226 例哮喘患者为研究对象,其中50 例为重症哮喘,76 例为普通哮喘,对比哮喘患者的气道炎症表型分布情况及患者肺功能指标情况。结果 226 例哮喘患者中,嗜酸性粒细胞型最为常见,占36.73%,之后为中性粒细胞型（31.86%）、混合细胞型（22.12%）、寡细胞型（9.29%）;重度哮喘患者中,中性粒细胞型患者肺功能相关指标均低于其它类型的重症患者（P<0.05）。结论 在哮喘气道炎症表型中,最常见的表型为嗜酸性粒细胞型,其中中性粒细胞型的哮喘患者的肺功能最差。

Objective To explore the phenotype distribution and lung function indicators of airway inflammation in asthmatic patients. Methods 226 cases of asthma patients were chosen as the research objects,in which 50 cases of severe asthma,76 cases of asthma,to compare asthma airway inflammation phenotype distribution and lung function index. Results Among 226 asthma patients,eosinophilic granulocytes were the most common,accounting for 36.73%,followed by neutrophilic granulocytes （31.86%）,mixed cell types （22.12%） and oligocytes （9.29%）. Among patients with severe asthma, the lung function of neutrophil patients was lower than that of other severe patients（P < 0.05）. Conclusion Among asthmatic airway inflammatory phenotypes, the most common phenotype is eosinophilic granulocyte type, among which neutrophil asthmatic patients have the worst lung function.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.