目的 筛选结直肠癌（CRC）差异性表达的长链非编码RNA（lncRNA）,并进行临床标本验证,研究其对结肠癌细胞HCT116功能的作用。方法 利用lncRNA PCR芯片对3对CRC组织和癌旁对照组织筛选差异性表达的lncRNA,确定候选研究lncRNA GAPLINC,RT-qPCR对21例临床样本进行验证其表达的差异性;同时构建GAPLINC表达质粒及其沉默体siRNA转染HCT116细胞,研究其对细胞凋亡、迁移及侵袭能力的影响。结果 lncRNA芯片实验结果提示CRC组织中存在大量的差异性表达的lncRNA,其中GAPLINC在CRC组织表达稳定增加,21例临床样本进一步验证了其在肿瘤组织中表达增加（P<0.05）;转染GAPLINC表达质粒后,HCT116细胞凋亡被抑制,同时其迁移及侵袭能力增强,转染siRNA抑制GAPLINC的表达后,则出现相反的结果。结论 利用lncRNA芯片可对CRC差异性表达lncRNA进行批量筛选,GAPLINC在CRC组织中表达稳定增加,具有促癌作用,在CRC发生发展中可能起着重要作用。

Objective To screen the differentiational expression of lncRNA in CRC tissue,confirm it in large simple of clinical specimens,and study its effects on human colorectal cells HCT116 cell line. Methods We screened the lncRNA which expressed differently in 3 CRC tissues and their pair-non carcinour tissues by lncRNA arrays;chose the over expressed lncRNA which played the potential role of oncogene for further researching,and tested the difference in 21 clinical specimens by RT-qPCR. We cultured the HCT166 cells,and then constructed expressed plasmids pcCDNA3.1-GAPLINC and synthesized GAPLINC siRNA,transfected the plasmids and siRNA into HCT116 cells;to study the changes of HCT116 cells behavior,the transwell assays were carried on;the changes of apoptosis of HCT116 cells were tested by flow cytometry. Results There existed many lncRNA which expressed differently between CRC tissues and normal control tissues by lncRNA arrays,there were 21 lncRNA down expressed,and 3 lncRNA up expressed;among these lncRNA,GAPLINC over expressed stably,and its high level of expression was approved in 21 clinical specimens by the test of RT-qPCR. We constructed the expressed plasmids pcCDNA3.1-GAPLINC and synthesizing GAPLINC siRNA successfully;after transfecting pcCDNA3.1-GAPLINC into HCT116 cells,the over expression of GAPLINC increased the migration and invasion of the HCT166 cells （P<0.05）,decreased the proportion of cell apoptosis （P <0.05）;by contraries,knocked down the expression of GAPLINC inhibited invasion and migration of HCT116 cells （P<0.05）,and promoted the apoptosis of the HCT116 cells （P <0.05）. Conclusion It could screen the different expression of lncRNA in large quantities by lncRNA arrays,and GAPLINC expressed highly and stably in CRC tissues. GAPLINC played a role of oncogene,which promoted the proliferation and invasion of CRC cells,and inhibited the apoptosis of CRC cells,which meant playing an important role in the carcinoma and development of CRC.

目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

目的 观察并比较注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（益塞普）剂量递减方案与标准剂量维持方案治疗强直性脊柱炎（AS）的疗效及安全性。方法 选择2015年1月—2016年6月共18个月在我院治疗的80例AS患者为研究对象,随机分为两组,A组40例,给予益塞普递减方案治疗,B组40例,给予益塞普标准剂量维持方案治疗,比较两组的用药疗效及安全性。结果 治疗后,两组的BASDAI、BASFI评分,腰背痛VAS评分,血清CRP、ESR水平均低于治疗前（P<0.05）,但两组组间比较未见统计学意义（P>0.05）;在治疗期间,A组与B组的不良反应发生率（32.50%、55.00%）及复发率（27.50%、22.50%）比较均无统计学意义（P>0.05）;经统计,A组的年平均药物费用为（47 391±4 830）元,少于B组（82 038±5 127）元（P<0.05）。结论 采用益塞普剂量递减方案治疗AS安全有效,能在短时间内控制疾病活动及改善临床症状,且花费更低,患者接受度更高。

Objective To observe and compare the clinical effect and safety of dose reduction scheme for recombinant human tumor necrosis factor receptor antibody fusion protein （hTNFR：Fc,etanercept） for injection and standard dose maintenance scheme in treatment of ankylosing spondylitis （AS）. Methods 80 cases of patients with AS and who were treated in our hospital from January 2015 to June 2016 for 18 months were selected as the research objects,and were randomly divided into two groups.The group A of 40 cases were treated with etanercept of degressive scheme therapy,while the group B of 40 cases were treated with etanercept of standard dose maintenance therapy. Then,the clinical effect and safety of drug use of two groups were compared. Results The BASDAI,BASFI score,VAS score of low back pain,serum CRP and ESR levels of two groups after treatment were lower than those before the treatment （P < 0.05）,but there was no statistical significance between the two groups （P > 0.05）. During the treatment,there was no significant difference in the incidence of adverse reactions （32.50%,55%） and recurrence rate （27.50%,22.50%） between group A and group B （P > 0.05）. By statistics,the average annual drug cost in group A was RMB （47 391±4 830） yuan,which was less than that in group B of RMB （82 038±5 127） yuan （P < 0.05）. Conclusion The etanercept of degressive scheme therapy in treatment of AS are safe and effective,which may control disease activity and improve clinical symptoms in a short time,and low costs. The patient will receive higher degree of acceptance.

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.

目的 探索使用血浆中溶血磷脂酸 LPA作为老年糖尿病患者发生缺血性心脑血管病早期预警指标。方法 在公共卫生项目开展的基础上,将老年糖尿病患者随机分为观察组和对照组。对照组实施糖尿病规范管理,观察组在对照组的基础上进行血浆LPA 的水平定期检测,对LPA 明显升高者,予降脂、抗纤溶、抗血小板凝集等干预措施,比较两组间缺血性心脑血管病发生率和病情严重程度。结果 观察组缺血性脑血管发病率高于对照组,差异有统计学意义（P<0.05）。中、重型缺血性脑血管病患者的血浆LPA高于轻型组（P<0.05）,且重型组高于中型组（P<0.05）结论 血浆LPA值可作为老年糖尿病患者发生缺血性心脑血管病的预警因子,值得在基层老年糖尿病患者规范化管理中常规应用。

Objective To explore the early warning index of ischemic cardiocerebrovascular disease in elderly diabetic patients with plasma LPA. Methods On the basis of public health project,elderly diabetic patients were randomly divided into observation group and control group. Control group adopted diabetes management implementation,while observation group adopted periodic testing of the levels of plasma LPA on the basis of the control group,implementing fall fat,resisting fibrinolytic,antiplatelet aggregation and other interventions if LPA significantly increased. We compared the ischemic cardio-cerebrovascular disease incidence and disease severity between the two groups. Results The incidence of cerebral ischemia in the observation group was higher than that in the control group,and the difference was statistically significant （P<0.05）. Medium and heavy plasma LPA is higher than the light of ischemic cerebrovascular disease group （P < 0.05）,and heavy above medium group （P < 0.05） Conclusion The plasma LPA values can be used as early warning factor in elderly patients with diabetes occuring ischemic cardio-cerebrovascular disease and promote its application.

目的 应用NRS2002、MNA-SF两种营养筛查方法评估住院老年冠心病患者营养风险,观察营养风险与营养指标及心功能的关系。方法 选取2017年8月-2018年6月在我院全科医学科住院的老年冠心病患者129例,使用两种方法分别进行营养筛查,分成存在营养风险组和不存在营养风险组,完善血常规、生化、心功能检查,统计两组各项指标之间的关系,及两种营养筛查方法与各项指标的相关性。结果 NRS2002筛查出营养风险发生率为38.76%,MNA-SF筛查出营养风险发生率75.97%。与不存在营养风险组比较,存在营养风险组的BMI、HB、ALB下降,且NRS-2002评分中存在营养风险组pro-BNP较不存在营养风险组明显升高。两种营养筛查方法与HB、PA、ALB、pro-BNP均有相关性。结论 运用两种营养筛查方法,结合各项指标能更好对老年冠心病患者进行营养风险评估。

Objective To analyze the preoperative nutritional screening results of the nutritional risk screening 2002（NRS2002） and the Mini Nutritional Assessment Short Form（MNA-SF） in 129 elderly patients with coronary heart disease and their relationships with some nutritional indicators and heart function. Methods NRS2002 and MNA-SF were used to evaluate the nutritional risk of 129 elderly patients with coronary heart disease. We divided the patients into nutritional risk group and non- nutritional risk group. The relationships between two groups with the nutritional indicators and the heart function were analyzed,and the value of the two nutritional screening tools was compared. Results The incidence rate of malnutrition by using NRS2002 was 38.76% and that of MNA-SF was 75.97% among 129 CHD patients. The nutritional risk group had lower BMI,HB and ALB. Nutritional risk group that was screened by NRS2002 had higher pro-BNP. And the two nutritional risk texts were related to HB,PA,ALB and pro-BNP. Conclusion It would be better to use two methods and some indicators to analyze the nutritional risk in elderly CHD patients in the hospital.

目的 研究加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎的临床疗效。方法 将100例慢性萎缩性胃炎患者随机分为对照组和观察组各50例,对照组患者给予三联疗法而观察组在对照组基础上辨证使用加减香砂六君子汤加减进行治疗。对临床疗效进行评估,观察两组患者临床症状并测定血清中超氧化物歧化酶（SOD）、丙二醛（MDA）水平的变化,统计两组的幽门螺杆菌（Hp）转阴率及复发率、根除率。结果 治疗以后统计有效率,观察组为92%,而对照组仅有76%,胃胀、胃痛、痞满、反酸、饮食减少等症状均缓解,各症状的积分治疗后均降低,两组相比其差异有统计学意义,观察组的Hp转阴率为92.0%,对照组Hp转阴率为68.0% ,两组Hp转阴率比较,差异有统计学意义。两组SOD水平均较治疗前上升,MDA水平均较治疗前下降,SOD水平高于对照组,MDA水平低于对照组,差异均有统计学意义（P<0.05）。结论 加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎可显著改善患者的临床症状,有良好的应用前景。

Objective To observe the clinical effect of Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis. Methods We selected 100 cases of patients with chronic atrophic gastritis of intertwined,and divided them into the control group and the observation group randomly with 50 cases in each group. The control group was given triple therapy for treatment,while the observation group was additionally given Jiajianxiangshaliujunzi decoction based on the syndrome differentiation for treatment. We observed the changes of clinical symptoms and levels of superoxide dismutase（SOD） and malondialdehyde（MDA） in serum of both groups. The negative conversion rate,recurrence rate and eradication rate of Helicobacter pylori （Hp） in 2 groups were statistically analyzed,in both groups and the clinical effect. Results After treatment,the total effective rates were counted: the observation group was 92%,and the control group was only 76%. The symptoms such as stomach distention,stomachache,distention and fullness,acid reflux,and diet reduction were reduced after the treatment. The difference between the two groups had statistical significance. In the two groups of stomachache,fullness and boredom,low appetite and acid regurgitation scores were all lower than those before treatment,and the differences were statistically significant. The negative rate of Hp in the observation group was 92%,while the negative rate of Hp in the control group was 68%. There was difference between the two groups in the negative rate of Hp. The levels of SOD in both groups were higher than those before treatment,and the levels of MDA were lower than those before treatment,differences being significant（P< 0.05）;the level of SOD in the observation group was higher than that in the control group,and the level of MDA was lower than that in the control group. Difference was statistically significant. （P< 0.05）. Conclusion Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis may improve clinical symptoms of patients,and promote the negative rate of Hp as well as the clinical effect.

目的 探讨恙虫病患者血清乳酸脱氢酶（LDH）水平在检查中的临床价值及LDH与血小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。方法 选取2016年3月—2018年2月在我院就诊的60例恙虫病患者,其中男25例,女35例。记录患者的基本情况,血常规、肝肾功能等实验室检测指标;并检测患者血清中乳酸脱氢酶水平。并分析患者乳酸脱氢酶与小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。结果 多数患者出现发烧、头痛、腹痛、咳嗽咳痰等症状,少数患者出现腰痛、意识障碍、皮肤黏膜出血等症状;60例恙虫病患者中,52名患者血清乳酸脱氢酶含量高于正常值,15例患者血小板数量低于正常值;55名患者丙氨酸氨基转移酶高于正常值,53名患者天冬氨酸氨基转移酶高于正常值;患者血清LDH与血小板数目（r=-0.929,P<0.01）呈负相关,与丙氨酸氨基转移酶（r=0.957,P<0.01）,天冬氨酸氨基转移酶（r=0.947,P<0.01）呈正相关。结论 乳酸脱氢酶水平可以作为患者恙虫病的早期诊断标志。

Objective To investigate the clinical value of serum LDH levels in tsutsugamushi patients. Methods We selected 60 patients with tsutsugamushi disease who were enrolled in our hospital from September 2016 to February 2018,including 25 males and 35 females. We recorded the patients' basic conditions,blood tests,liver and kidney function and other laboratory testing indicators;and we detected serum lactate dehydrogenase levels in patients. The correlations in lactate dehydrogenase and platelet number,alanine aminotransferase,and aspartate aminotransferase were analyzed. Results Most patients developed fever,headache,abdominal pain,cough,sputum,and other symptoms. A small number of patients suffered low back pain,disturbance of consciousness,skin mucosal bleeding,and other symptoms;among the 60 patients with tsutsugamushi disease,the contents of serum amblytic dehydrogenase were higher than normal in 52 patients,and the numbers of platelets in 15 patients were lower than normal. The value of alanine aminotransferase was higher than normal in 55 patients,and the value of aspartate aminotransferase was higher than normal in 53 patients;serum LDH and platelet counts （r=-0.929,P<0.01）,alanine aminotransferase （r=0.957,P<0.01） and aspartate aminotransferase （r=0.947,P<0.01） showed positive correlation. Conclusion Lactate dehydrogenase level may be used as an early diagnostic marker for patients with tsutsugamushi disease.

目的 分析促红细胞生成素（EPO）及促红细胞生成素受体（EPOR）在肝细胞癌（NCC）以及正常组织中的表达规律,以及它们和肝细胞癌微血管密度（MVD）之间的关系。方法 选取我院手术切除的肝细胞肝癌的标本30例,取肿瘤边缘2.0 cm的肝组织作为对照,同时取正常肝脏组织10例做为阴性对照。利用酶联免疫吸附实验（ELISA）检测各组织中EPO及EPOR表达水平,利用免疫组织化学方法染色检测微血管密度（MVD）。对比癌组织和癌旁组织EPO、EPOR及MVD差异,分析NCC中EPO、EPOR、MVD与肿瘤病理特征的关系,分析EPO、EPOR表达水平与MVD之间的关系。结果 HCC组织中,EPR、EPOR、MVD均高于癌旁组织和正常组织,差异有统计学意义（P<0.001）,EPR、EPOR、MVD在癌旁组织和正常组织中,差异无统计学意义（P>0.05）。肿瘤大小>5 cm、存在包膜侵犯、存在远处转移以及高中分化的HCC中,EPR、EPOR、MVD水平高于肿瘤大小≤5 cm、无包膜侵犯、无远处转移以及低分化的水平,差异有统计学意义（P<0.05）。Person相关分析结果显示,EPO表达水平与MVD的相关系数r=0.651（P<0.001）,EPOR表达水平与MVD的相关系数r=0.620（P<0.001）。结论 EPO、EPOR、MVD在HCC中呈现高水平,且与肿瘤大小、局部侵犯、远处转移及分化程度有关,其机制可能与EPO、EPOR增加MVD有关。

Objective To analyze the expression of erythropoietin （EPO） and erythropoietin receptor （EPOR） in hepatocellular carcinoma （NCC） and normal tissues,and their relationship with hepatocyte microvessel density （MVD）. Methods Thirty specimens of hepatocellular carcinoma hepatectomy were selected from our hospital. The liver tissue at the edge of the tumor was taken as a control,and 10 cases of normal liver tissue were used as a negative control. The expression levels of EPO and EPOR in each tissues were detected by enzyme-linked immunosorbent assay （ELISA）,and microvessel density （MVD） was detected by immunohistochemistry. The differences of EPO,EPOR and MVD between each tissues were compared. The relationship between EPO,EPOR,MVD and tumor pathological features in NCC was analyzed. The relationship between EPO and EPOR expression levels and MVD was analyzed. Results In HCC tissues,EPR,EPOR and MVD were higher than those in adjacent tissues and normal tissues. The difference was statistical difference （P<0.001）. EPR,EPOR and MVD were not statistically significant in adjacent tissues and normal tissues. P>0.05）. The levels of EPR,EPOR,and MVD in tumors with tumor size >5 cm,invasion of the capsule,distant metastasis,and high-differentiation were higher than those of tumor size ≤ 5 cm,no capsule invasion,no distant metastasis,and poor differentiation. The difference was statistical difference （P < 0.05）. Person correlation analysis showed that the correlation coefficient between EPO expression level and MVD was r=0.651 （P<0.001）,and the correlation coefficient between EPOR expression level and MVD was r=0.620 （P<0.001）. Conclusion EPO,EPOR and MVD are highly expressed in HCC,and are related to tumor size,local invasion,distant metastasis and differentiation. The mechanism may be related to EPO and EPOR increasing MVD.

目的 探讨鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿的临床疗效。方法 选择2014年8月-2017年8月我院收治的60例鼻前庭囊肿患者为研究对象,根据手术方式不同分为两组,每组各30例。对照组采用传统唇龈沟径路鼻前庭囊肿切除术进行治疗,观察组采用鼻内镜鼻前庭囊肿揭盖术治疗;评价两组手术情况、术后疼痛程度及并发症发生情况,术后随访1年,观察两组患者的复发情况。结果 对照组手术时间、术中出血量、术后住院时间分别为（44.78±8.13）min、（37.09±7.11）mL、（7.27±1.45）d均高于观察组的（17.91±4.26）min、（8.85±3.12）mL、（5.02±1.06）d,差异有统计学意义（P<0.05）;对照组术后24 h、48 h、72 h的VAS评分分别为（3.53±1.07）分、（2.84±1.12）分、（2.34±0.69）分均高于观察组的（2.92±1.14）分、（2.21±1.00）分、（1.73±0.76）分,差异有统计学意义（P<0.05）;对照组术后并发症发生率为26.67%,复发率为20.00%,高于观察组的6.67%、0.00%,差异有统计学意义（P<0.05）。结论 鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿疗效显著,具有手术时间短、出血量少的优点,可减轻患者术后疼痛,减少术后并发症的发生,利于加速患者恢复,预后较好。

Objective To investigate the clinical efficacy of nasal endoscopic nasal vestibular cyst uncovering for nasal vestibular cyst. Methods Sixty patients with nasal vestibular cysts admitted to our hospital from August 2014 to August 2017 were enrolled in the study. They were divided into two groups according to different surgical methods,30 in each group. The control group was treated with traditional sacral sulcus cystectomy. The observation group was treated with nasal endoscopic nasal vestibular cyst uncovering for nasal vestibular cyst. The operation status,postoperative pain degree and complications were evaluated. After one year,the recurrence of the two groups of patients was observed. Results The operation time,intraoperative blood loss and postoperative hospital stay were （44.78±8.13） min,（37.09±7.11） mL,and （7.27±1.45）d,respectively,which were higher than the observation group （17.91±4.26） min. （8.85±3.12） mL,（5.02±1.06） d,the differences were statistically significant （P<0.05）;the VAS scores of the control group at 24h,48h,72h were （3.53±1.07） points,（2.84±1.12）. The scores of （2.34±0.69） were higher than those of the observation group （2.92±1.14）,（2.21±1.00）,and （1.73±0.76）,the differences were statistically significant （P<0.05）. The postoperative complication rate was 26.67%,and the recurrence rate was 20.00%,which was higher than that of the observation group （6.67%,0.00%）. The differences were statistically significant （P<0.05）. Conclusion Endoscopic nasal vestibular cyst is a significant treatment for nasal vestibular cyst. It has the advantages of short operation time and less bleeding. It may reduce postoperative pain,reduce postoperative complications,and accelerate the recovery of patients. It is good at prognosis.

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 观察腹腔镜下胆总管切开取石术中胆管一期缝合治疗胆总管结石的临床效果。方法 研究对象选取我院2016年3月—2017年3月术前诊断为胆总管结石且符合纳入标准的患者92例,采用随机法,将其分为一期缝合术组和T管引流术组各46例,两组患者均行腹腔镜下胆总管切开取石术,一期缝合术组行术中胆管一期缝合,T管引流术组行术中胆管T管引流。比较两组手术相关指标,住院时间,住院费用,术后并发症的发生率。结果 一期缝合术组在减少手术出血量、促进切口恢复、预防切口感染的发生率上优于T管引流术组（P < 0.05）;在住院时间、住院费用以及术后并发症的发生率上低于T管引流术组（P < 0.05）。结论 本次研究结果表明腹腔镜下胆总管切开取石术中胆管一期缝合的临床效果优于T管引流,可有效减少手术并发症,缩短病人的住院时间,是治疗胆总管结石理想的选择。

Objective To observe the clinical effect of primary suture in the treatment of common bile duct stones under laparoscopic common bile duct incision. Methods The subjects were enrolled in our hospital from March 2017 to March 2018. 92 patients with choledocholithiasis and met the inclusion criteria, were randomly divided into one-stage suture group and T-tube drainage group. Surgery-related indicators,length of hospital stay,hospitalization costs,and incidence of postoperative complications were compared. Results In the first-stage suture group,the incidence of surgical bleeding reduction,postoperative incision recovery,and prevention of wound infection were better than those in the T-tube drainage group （P < 0.05）. The incidence of hospitalization,hospitalization,and postoperative complications were lower in the first-stage suture group than in the T-tube drainage group（P < 0.05）. Conclusion The clinical effect of one-stage suture in laparoscopic common bile duct incision and stone removal is better than T-tube drainage,which may effectively reduce surgical complications and shorten the hospitalization time of patients. It is an ideal choice for the treatment of common bile duct stones.

目的 探讨内镜活检Crohn病（CD）的临床病理特征,为临床提供更可靠的诊断。方法 回顾性分析内镜活检12例CD的临床表现、内窥镜特征,采用HE染色及免疫组化EnVision二步法。结果 显微镜下CD的组织学形态主要特征是非干酪样坏死性肉芽肿、裂隙状溃疡、黏膜及黏膜下层不均匀分布的重度炎症,淋巴管扩张和纤维组织增生,免疫组化染色CD68、D2-40、S-100均表达。结论 CD是一肿少见的炎症性肠病,回盲部及末段回肠是最好发部位,主要表现反复腹泻、血便等症状,内镜下见多灶溃疡,不连续性病变等特征,组织学见裂隙性溃疡,黏膜及黏膜下层的重度炎症且不均匀分布,位于生发中心的非干酪结节病样肉芽肿、淋巴管扩张和纤维组织增生等非特异性特征,可靠的病理诊断要结合临床、内镜、影像等检查及多部位多次活检。

Objective To investigate the clinical and pathological features of endoscopic biopsy tissue of Crohn disease （CD） and further to provide more reliable evidence for clinic. Methods A retrospective analysis of 12 cases of endoscopic biopsy tissue about CD’s clinical manifestations and endoscopic features,by HE staining and immunohistochemistry EnVision two-step method. Results The morphology of CD specimen is characterized by non-caseous necrotizing granuloma,ulceration,mucosal and submucosal uneven distribution of severe inflammation,dilated lymph vessels and fibrous hyperplasia. Immunohistochemical staining , all of cases express CD68,D2-40 and S-100. Conclusion CD is a rare inflammatory bowel disease. The majority of CD arises in ileocecal and terminal ileum. The main symptoms show repeated diarrhea,bloody stool and others. Endoscopic examination revealed multifocal ulcers,discontinuous lesions and other characteristics. Histological examination showed that there were nonspecific features such as fissure ulcer,severe inflammation in mucosa and submucosa with uneven distribution,non-caseous sarcoid-like granuloma in the germinal center,lymphangiectasis and fibrous tissue hyperplasia. An reliable pathological diagnosis is made that depends on many examinations including clinical,endoscope,radiology and multiple biopsy.

目的 观察康柏西普玻璃体腔注射治疗湿性老年性黄斑变性病变对于视网膜神经纤维厚度的影响。方法 对2016年10月—2017年10月在汕头大学附属韶关市粤北人民医院采用康柏西普玻璃体腔注射治疗湿性老年性黄斑变性35例38眼中符合标准的患者18例（18眼）的临床资料进行回顾性分析,患者行最佳矫正视力、眼压（NCT）检查、OCT、荧光眼底血管造影（FFA）检查后,均接受0.05 mL康柏西普玻璃体腔注射,分别注射后1和2月观察患者最佳矫正视力 （BCVA）、视网膜神经纤维厚度（RNFL）变化。结果 18眼共接受康柏西普玻璃体腔注射54次,所有患眼均注射3次。注射3个月后,OCT检查结果显示有18眼视力有提高,CRT厚度有下降。第1次注射时和注射后1个月、2个月的BCVA分别为0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）,总体比较差异有统计学意义（χ²=13.880,P<0.001）;第1次注射时和注射后1个月、2个月的CRT（μm） 319.50（269.50,390.50）, 271.00（219.00,296.25） 和234.50（182.75,273.25）总体比较差异有统计学意义（χ²=11.978,P<0.05）,第1次注射时和注射后1个月、2个月后的 ARNFL（μm）86.00（76.25,98.00） 83.00（76.00,95.50）和 83.00（76.25,94.75） 总体比较差异无统计学意义（χ²=11.978,P>0.05）,第1次注射时和注射后1个月、2个月眼压（kPa）2.27（1.97,2.44）,16.0（13.7,17.0）,和 2.00（1.84,2.31） 总体比较差异无统计学意义（χ²=1.604,P>0.05）。结论 玻璃体腔注射康柏西普治疗湿性老年性黄斑变性对视网膜神经纤维厚度无明显的损害,安全且有效,但仍需要大样本量及长期随访观察。

Objective To observe the effect on the thickness of retinal nerve fibers in the patients with wet age-related macular degeneration by adopted intravitreal injection with Conbercept. Methods We analyzed 18 cases （18 eyes） that conform to the standard from 35 cases（38 eyes） retrospectively,who were treated with wet age-related macular degeneration by adopted intravitreal injection with Conbercept in Shaoguan Yuebei People's Hospital Affiliated to Shantou University from October in 2016 to October in 2017.After undergoing best corrected visual acuity （BCVA）,intraocular pressure （IOP） and fluorescein angiography （FFA）,all of them were adopted intravitreal injection with 0.05mL Conbercept. We observed the changes of best corrected visual acuity （BCVA） and retinal nerve fiber thickness （RNFL） after 1 and 2 months of adopted intravitreal injection with 0.05 mL Conbercept. Results 18 eyes were adopted intravitreal injection Conbercept 54 times totally. All the eyes were injected three times. After 3 months of injection,OCT showed that the visual acuity of 18 eyes improved and the thickness of CRT decreased. The BCVA values at the first injection,after the first injection and after the second injection were 0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）respectively. The overall difference was statistically significant （χ²=13.880,P< 0.001）. CRT（μm）values at the first injection,after the first injection and after the second injection were 319.50（269.50,390.50）,271.00（219.00,296.25） and 234.50（182.75,273.25）respectively. The overall difference was statistically significant （χ²=11.978,P< 0.05）. ARNFL（μm）values at the first injection,after the first injection and after the second injection were 86.00（76.25,98.00）,83.00（76.00,95.50） and 83.00（76.25,94.75）respectively. There was no significant difference （χ²=11.978,P> 0.05）. The IOP（mmHg）values at the first injection,after the first injection and after the second injection were 17.0（14.8,18.3）,16.0（13.7,17.0）,和 15.0（13.8,17.3）respectively. There was no significant difference（χ²=1.604,P>0.05）. Conclusion There was no obvious damage to the retinal nerve fiber by adopted intravitreal injection with Conbercept to treat the patients with wet age-related macular degeneration. That’s safe and effective,but need a large sample to follow-up for a longtime.

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 探讨结直肠癌肝转移瘤的CT 成像特点及规律分析。方法 回顾性分析我院2016 年3 月—2018年3 月的84 例结直肠癌肝转移瘤患者的CT 动态增强图像及临床资料记录并统计其不同血流汇入情况下、不同增强时期的CT 成像结果,根据原发灶部位,将患者分为左半结肠组和右半结肠组,左半结肠组再按照血管重建情况分组。结果 原发灶在左半结肠时,转移瘤的左、右叶分布无差异（P>0.05）,而原发灶在右半结肠时,转移瘤的右叶优势分布多于左叶优势（P<0.001）;左半结肠组内比较,甲组转移瘤的左叶优势分布多于右叶,分布差异有统计学意义（P<0.001）,其左右叶构成比约为4∶1;乙组转移瘤的左、右叶分布差异不具有统计学意义（P>0.05）;丙组转移瘤的右叶优势分布多于左叶优势（P<0.001）;84 例患者中,共发现338 个肝转移灶。平扫中,低密度灶多于高密度灶,最少是等密度灶;动态CT 增强扫描中,环状强化灶多于结节状强化灶,其他不典型强化灶最少,且门脉期时强化灶显示最为清晰。结论 结直肠癌肝转移患者的CT 肝扫描图像特点有一定规律,可以为诊断结直肠癌原发灶及结直肠癌的早期转移提供一定理论依据。

Objective To investigate the characteristics and regularity of CT imaging of colorectal cancer liver metas tases. Methods A retrospective analysis of 84 cases of colorectal cancer liver metastases from March 2016 to March 2018 in our hospital. CT dynamic imaging images and clinical data were recorded and statistically analyzed for different blood flow in flows and different enhancement periods. For the CT imaging results, the patients were divided into the left colon group and the right colon group according to the primary tumor site, and the left colon group was grouped according to the blood vessel reconstruction. Results There was no statistic difference in the distribution of left and right lobe between the primary tumor and the left colon in the left colon （P>0.05） . However, in the right colon, the dominant distribution of the right lobe in the metastatic tumor was more than that in the left lobe. The advantage （P=0.00） in the left colon group, the left leaf dom inant distribution of the metastatic tumor of group A was more than that of the right lobe, and the difference was statistically significant （P=0.00）, and the ratio of left and right lobe was about 4∶1;There was no statistic difference in the distribu tion of left and right leaves between group B metastases （P>0.05） . The right leaf dominant distribution of group C metasta ses was more than that of left lobe （P=0.00） . Among 84 patients, a total of 338 liver metastases were found. In the plain scan, the low-density foci were more than the high-density foci, and at least the iso-density foci;in the dynamic CT-en-hanced scan, the annular intensified foci were more than the nodular intensive foci, and the other atypical intensive foci were the least, and the portal vein period enhanced stove display is the clearest. Conclusion The characteristics of CT liver scan in patients with liver metastases from colorectal cancer do have certain regularity, which may provide a theoretical basis for the diagnosis of primary colorectal cancer and early metastasis of colorectal cancer.

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 观察重组人血管内皮抑素注射液（恩度） 联合化疗治非小细胞肺癌（NSCLC）的近期疗效和安全性。方法 对2015年3月—2017年10月经病理组织学或细胞学检查确诊的Ⅲ-Ⅳ期NSCLC74例患者,采用随机数字法把受试者随机分为联合治疗组（n=35）和对照组（n=39）,联合治疗组接受恩度联合化疗的方案治疗;对照组单纯行常规化疗治疗。近期疗效评价采用RECIST标准,生活质量（QOL）采用Karnofsky评分（KPS）,抗癌药物急性与亚急性毒性反应分度标准分0~Ⅳ度。比较两组患者的近期疗效指标（疾病完全缓解（CR）、疾病稳定（ SD）、疾病进展（ PD）、客观有效率（RR）、疾病控制率（DCR ）;QOL评分及毒副反应情况。结果 联合治疗组近期疗效指标RR及DCR高于对照组（P < 0.05）;联合治疗组KPS评分高于对照组（P < 0.05）;两组间的毒副作用包括恶心/呕吐、腹泻、疲乏、脱发、血小板下降及白细胞下降等,两组间毒副反应出现数量比较,差异无统计学意义（P > 0.05）。结论 恩度与化疗药物联合使用可以提高NSCLC疗效和改善患者生活质量,未增加患者不良反应发生率。

Objective To observe the curative effect and the side effects of recombinant human vascular endostatin （Endostar） combined with the chemotherapy on nonsmall cell lung cancer（NSCLC）. Methods Seventy-four NSCLC patients confirmed by histopathology or cytopathology were randomly distributed to combined therapy group （n=35, with Endostar combined with chemotherapy） and control group （n=39, with conventional chemotherapy）. The recent efficacy of drug was evaluated according to the RECIST criteria. The quality of life （QOL） was assessed by usingto the Karnofsky scores, and the safety of drug was evaluated according to WHO side effects criteria. Results The therapeutic effectiveness was better in the combined therapy group than that in the control group（P<0.01）. The KPS was better in co-therapy group than that in the control group（P<0.05）. The common adverse reactions in both groups included neutropenia, thrombocytopenia, nausea/vomiting, diarrhea, lassitude, alopecia, thrombocytopenia and leukocytopenia. However, the incidence rates of adverse reactions between the two group was not significant （P>0.05）. Conclusion Endostar combined with the related chemotherapy may improve the curative effect and QOL of NSCLC.

目的 探讨替罗非班联合丁苯酞应用于进展性脑梗死的疗效与安全性。方法 选取2016年1月—2018年1月广州医科大学附属第三医院神经内科收治的进展性脑梗死患者98例。对照组采用硫酸氢氯吡格雷加阿司匹林（双抗）治疗,观察组采用替罗非班（静脉治疗48 h）联合丁苯酞序贯双抗治疗。结果 替罗非班联合丁苯酞序贯双抗治疗组的神经功能缺损（NIHSS）评分、日常生活能力评定量表（Barthel指数）、改良 Rankin 量表评分优于对照组,血浆凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）与凝血酶时间（TT）水平高于对照组,两组有差异。两组患者药物不良反应发生率无差异。结论 替罗非班联合丁苯酞序贯双抗治疗可明显改善进展性脑梗死的神经功能,为时间窗外的进展性脑梗死提供了治疗方法,疗效显著。

Objective To observe the effect and safety of triofiban combined with butylphthalide in treatment of progressive cerebral infarction. Methods A total of 98 patients with progressive cerebral infarction in the department of neurology from January 2016 to January 2018.The control group was treated with clopidogrel hydrogen sulfate plus aspirin（dual antiplatelet）. The observer group was treated with Tirofiban（48 h intravenous treatment） combined with butylphthalide on the basis of the treatment of the control group. Results The score of National Institutes of Health Stroke、 Barthel Index and mRS in the triofiban combined with butylphthalide group were better than that of the control group. There were statistical differences between the two groups. PT,APTT and TT were higher than that in the control group .There was no significant difference in drug adverse reactions between the two groups. Conclusion Triofiban combined with butylphthalide may improve the neurologic function of progressive cerebral infarction and provide treatment for progressive cerebral infarction outside the time window.

目的 分析不同黄芪剂量补阳还五汤治疗大鼠慢性难愈性创面的疗效。方法 选择SPF级健康雄性SD大鼠78只作为本次研究材料,在其背部实施造模创建皮肤缺损性创面,并随机分为不同剂量（15 g、30 g、60 g、120 g）黄芪组,观察并对比各组大鼠创面愈合率及愈合时间。结果 对照组创面愈合率比造模后第3天、7 天、11 天高,差异有统计学意义（P<0.05）;不同剂量黄芪组（排除黄芪组15 g第11天）创面愈合率比模型组高,差异有统计学意义（P<0.05）;第3 d对照组创面愈合率比黄芪组30 g、120 g低,差异有统计学意义（P<0.05）;黄芪15 g组各时间点创面愈合均比黄芪120 g组低,差异有统计学意义（P<0.05）;对照组创面愈合时间较模型组延长,差异有统计学意义（P<0.05）;对照组创面愈合时间较黄芪组延长,差异有统计学意义（P<0.05）;黄芪15 g组创面愈合时间较黄芪组120 g延长,差异有统计学意义（P<0.05）;黄芪30 g、60 g创面愈合时间较黄芪组120 g组延长,差异有统计学意义（P<0.05）。结论 不同黄芪剂量补阳还五汤均具有促进慢性难愈性创面愈合效果,利于缩短创面愈合时间,其中以黄芪30 g、60 g、120 g效果较为显著。

目的 通过探讨分析14例手术治疗肱骨小头骨折的方法和疗效。方法 自2009年1月—2016年12月用开放手术治疗肱骨小头台骨折14例。男10例,女4例;年龄13~65岁;平均年龄35.3岁。按照实用骨科学的分型：I型8例,Ⅱ型6例。其中10例采用螺钉固定骨折块,4例采用骨折碎片切除术。术后根据X线拍片,患肘关节功能进行伸曲功能评估。结果 14例病人中,有6例未能在第一次就诊时未明确诊断,经二次或三次就诊时才能确诊。经6~20个月的随诊,术后根据 Borberg-Morrey肘关节功能评分标准进行疗效评价,优6例,良6例,一般2例,差0例,优良率86%。所有用螺钉内固定的病例均骨性愈合,4例肱骨小头骨碎片切除的病例,有3例于术后1年内出现患肘关节不同程度的疼痛,经注射关节腔注射玻璃酸钠后缓解。结论 肱骨小头骨折容易漏诊、误诊,早期正确诊断明确,解剖复位,坚强内固定,必要时做碎片切除,早期的肘关节伸曲功能锻炼可获得满意的疗效。

目的 探究雾化吸入布地奈德对急性支气管炎患者疗效及相关指标的影响。方法 选取2016年7月—2018年6月在我院接受治疗的120例急性支气管炎患者作为研究对象,随机分为两组：常规组（60例）和综合组（60例）。常规组实施常规治疗,综合组在常规治疗基础上实施雾化吸入布地奈德治疗,比较两组的整体治疗效果。结果 综合组的治疗总有效率为95.0%,常规组的治疗总有效率为83.3%,综合组要高于常规组,差异有统计学意义（P<0.05）;在PEF、FVC、FEV1等肺功能指标的比较中,综合组和常规组治疗前不存在差异（P>0.05）,治疗后综合组要高于常规组,差异有统计学意义（P<0.05）。结论 急性支气管炎患者实施雾化吸入布地奈德治疗,疗效显著,有利于改善肺功能。

目的 分析难治性痛风的治疗效果及经验总结。方法 收集30例难治性痛风性关节炎患者分长病程及短病程组,对比各组基线指标及治疗后的血尿酸水平,肾功能情况及受累部位关节超声变化,及患者VAS评分比较,最后统计分析组间差异及探讨难治性痛风预后与降尿酸控制水平、炎症指标、血肌酐变化的相关性。结果 30例痛风患者治疗前后对比,短病程组患者VAS评分从5.6±3.3下降至3.2±1.1,血沉从59.3±12.4下降至20.6±6.9,受累关节滑膜厚度从（3.57±0.63）mm下降至（1.96±0.65）mm,血尿酸从（589.3±146.2）μmol/L下降至（403.8±96.4）μmol/L,P<0.05;短病程组及并发症少的患者改善更明显,血尿酸控制更低的患者相关指标下降更明显,P<0.01;患者的血尿酸下降趋势跟关节滑膜厚度与炎症指标（ESR）、血肌酐的变化趋势符合,通过回归分析有相关性意义,P<0.05。结论 难治性痛风的处理核心还是有效的控制尿酸,但需要对影响预后的因素,包括感染、肾功能不全、消化性溃疡等并发症进行风险管理,降低相关风险及合并症治疗对难治性痛风的有效治疗管理非常重要。

目的 探讨医务人员血源性职业暴露情况,并且制定有效的防护对策,以保证医护人员的生命健康。方法 回归性分析2013年3月—2017年5月出现的51例出现血源性职业暴露的医务人员为研究对象,对医务人员的基本情况、职业暴露病种及类型、锐器致伤类型、暴露后预防用药及随访监测结果进行分析。结果 血源性职业暴露中,发生率最高的是护士,占62.75%;职业暴露来源上,主要来自外科科室,占50.98%;职业暴露病种以乙型肝炎最常见,暴露类型主要为锐器伤;锐器伤最主要原因为输血器针头;给予职业暴露者预防用药,随访监测职业暴露者的实际情况均得到有效改善。结论 医务人员在实际工作中,多种因素会引起职业暴露情况,因此需加强医务人员的培训教育,规范医护人员操作流程及完善暴露后的处理及干预,以降低职业暴露风险发生率。

目的 探讨急性脑出血并发高钠血症的原因及预后情况。方法 选择2017年1月—2018年8月就诊于我院的急性脑出血并发高钠血症60例为观察组[根据血清钠离子浓度分为重度组37例（血清钠离子浓度>170 mmol/L）,中度组12例（钠离子浓度161~170 mmol/L）,轻度组11例（钠离子浓度145~160 mmol/L）],选择同期就诊于我院不伴高钠血症的脑出血患者60例为对照组。比较两组意识障碍程度、出血部位、死亡率,并分析急性脑出血并发高钠血症患者中不同血清钠离子浓度患者预后情况。结果 观察组GCS评分≤8分比例、丘脑出血比例、死亡率高于对照组,差异有统计学意义（P<0.05）;观察组基底节区、脑干小脑、脑叶出血比例与对照组比较,差异无统计学意义（P>0.05）;血清钠离子浓度越高则患者的预后越差,差异有统计学意义（P<0.05）。结论 与急性脑出血患者相比,急性脑出血患者并发高钠血症患者的死亡率较高,且预后情况与血清钠离子浓度密切相关;丘脑部出血与急性脑出血患者并发高钠血症密切相关,临床应加以重视。

目的 探讨<34周早产儿发生晚发型败血症的危险因素及其病原分布,为防控及治疗用药提供依据。方法 选择2015年1月—2017年12月本院收治的<34周早产儿,根据是否发生晚发型败血症分为感染组及对照组,回顾性分析两组临床资料,对其可能的危险因素采用多因素Logistic回归分析。分析感染组患儿所感染的病原菌及其药敏情况。结果 感染组27例,对照组73例,单因素分析显示感染组患儿出生体重低于对照组,出生窒息、机械通气、使用H₂受体阻滞剂、多种抗生素使用、经外周中心静脉置管（PICC）及PICC留置≥14天比例均高于对照组,差异有统计学意义（P<0.05）。多因素logistic回归分析显示出生体质量、PICC留置是<34周早产儿发生晚发型败血症的独立危险因素。感染组中血培养阳性20例,真菌培养阳性11例（55.0%）,G⁺菌5例（25.0%）,G^-菌4例（20.0%）。药敏结果中两性霉素B和氟康唑敏感性高。结论 早期早产儿发生晚发型败血症受多重因素影响,真菌已成为主要致病菌,应针对高危因素加强感染防控,根据血培养及药敏结果合理使用抗菌药物。

目的 针对以问题为导向教学法（PBL教学法）联合以案例为基础教学法（CM教学法）在手术室实习生带教中的应用进行探讨。方法 选取我院2016年9月—2017年6月期间手术室实习生100名,根据双盲分组法分为联合组和常规组,常规组实习生实施传统教学模式,联合组实习生实施PBL联合CM教学法,对比分析两组实习生的考核成绩、教学评估效果及带教满意度。结果 在考核成绩对比中,联合组实习生在理论成绩和实践成绩等考核成绩均高于常规组,组间对比有差异（P<0.05）;在教学评估效果对比中,联合组实习生在自主学习、护理知识掌握、主动参与、团队合作、临床护理实践等教学评估效果中均优于常规组（P<0.05）;在带教满意度对比中,联合组实习生总满意率高于常规组,经统计学对比分析有意义（P<0.05）。结论 PBL联合CM教学法能够有效提高手术室实习生的学习效果和临床护理实践能力,应在临床护理工作中予以推广并应用。

目的 探讨临床路径带教模式在胸外科带教中的应用价值。方法 选取2017年1月—2018年1月于我院胸外科进行规范化培训的学员84人,根据培训时间分为两组,其中2017年1月—2017年6月的42名学员为对照组,采用常规带教模式,2017年7月—2018年1月的42名学员为观察组,采用临床路径带教模式。两组带教时间均为3个月,分别在带教前、带教期满时采用《简易临床评估实习量表（Min-CEX）》评价两组学员的临床工作能力,采用《评判性思维能力测量表（CTDI-CV）评价学员的评判性思维能力。结果 观察组带教后反射检查、组织效能、沟通技能、定位诊断、专业态度、临床胜任能力、处理建议、感觉系统检查、运动系统检查、定性诊断评分及总分高于对照组,差异有统计学意义（P<0.05）。观察组带教后寻求真相、分析能力、评判性思维的自信心、认知成熟度、开放思想、系统化能力评分及总分高于对照组,差异有统计学意义（P<0.05）。结论 临床路径带教模式能提高培训学员的临床工作能力与评判性思维能力,在胸外科带教中的应用价值较高。

新的形势对预防医学专业人才提出了更高的要求,为了提高预防医学专业学生综合素质和培养创新思维能力,我院近年来开展了多种形式的“第二课堂”教学,取得了积极的作用。

目的 调查临床医学生医患沟通能力的现状,分析其影响因素。方法 采用《医患沟通技能评价表（SEGUE量表）》对广州市某三甲医院的155名临床医学生进行调查。结果 临床医学生沟通技能总成绩得分率只有58.9%,在5个维度中,沟通结束方面得分率最高,为82.9%,而理解病人方面得分率最低,只有45.5%。性别、接受医患沟通相关培训次数不同的临床医学生,其沟通能力差异有统计学意义（P﹤0.05）。结论 临床医学生的医患沟通能力总体水平有待提高,特别是在理解病人方面。性别和参加医患沟通培训次数是临床医学生沟通能力的影响因素,应加强对医学生在共情能力、情感支持、移情等方面能力的培训,以提高医患沟通能力。

Objective To investigate the status of medical students' doctor-patient communication skill and analyze the influencing factors. Methods An investigation on 155 clinical medical students in a level 3 hospital in Guangzhou was conducted using the Doctor-patient Communication Skills Evaluation Scale （also called SEGUE Scale）. Results The clinical medical students’ scoring rate of communication skill was only 58.9%. Among the five dimensions, the scoring rate of communication skill end was the highest, which was 82.9%, while the scoring rate of understanding patients was the lowest, which was only 45.5%. The difference in communication skill between clinical medical students with different gender and the training times related to doctor-patient communication was statistically significant （P<0.005）. Conclusion The overall level of doctor-patient communication skill among clinical medical students was needed to be improved, especially on understanding patients. Gender and training times on doctor-patient communication training were the influencing factors of communication skills of medical students. Medical students’skills include empathy and doctor-patient communication skills, etc.

目的 探讨早期康复训练对高龄股骨骨折内固定患者术后康复的影响研究。方法 抽选我院2015年3月—2017年7月收治的98例高龄股骨骨折患者,均以防旋股骨近端髓内钉（PFMA）内固定治疗,根据患者自愿及实际自身状态原则分为对照组（n=45例,仅开展常规术后康复护理）和观察组（n=53例,在内固定治疗期给予早期康复训练）,比较术前及术后3、6个月髋关节运动功能（Harisr评分）及日常生活活动能力（Barthel指数）,观察6个月内并发症发生情况。结果 观察组干预3、6个月后Harisr髋关节活动评分、Barthel指数均高于对照组（P<0.05）。观察组锻炼6月后,髋关节运动功能恢复优良率高于对照组（P<0.05）。观察组发生骨延迟愈合、压疮、切口感染、肺炎、泌尿系感染等并发症的概率低于对照组（P<0.05）。结论 高龄股骨骨折患者PFMA内固定术后开展早期康复训练,可促进患者骨关节功能恢复,改善运动功能,降低并发症发生率,值得临床推广。