目的 探讨在早期早产儿配方奶(PF)喂养失败下,更换母乳(HM)或深度水解奶(eHF)对极低出生体质量儿喂养不耐受(FI)的改善情况。方法 选择2016年1月—2018年1月在广州市妇女儿童医疗中心出生、生后PF喂养失败、出现FI的极低出生体质量儿84例,根据家长HM喂养意愿及条件,分为HM喂养组38例和eHF喂养组46例,比较2组患儿更换喂养配方后FI消失时间、FI改善率、达全肠内喂养时间及体质量增长情况等喂养结局。结果 相对于eHF喂养组,HM喂养组FI消失时间更快,FI改善率更高,达全肠内喂养时间更快,差异有统计学意义。HM喂养组平均每日体质量增长量、出院时体质量均明显大于eHF喂养组,住院时间更短,出院时宫外发育迟缓(EUGR)发生率更低,差异有统计学意义。2组患儿坏死性小肠结肠炎、胆汁淤积症、院内感染发生率比较无统计学差异。结论 当极低出生体质量儿PF喂养失败、出现FI时,选择HM或eHF均可改善FI,但HM效果更好,达全肠内喂养时间更快且体质量增长更理想,出院时EUGR发生率较低。

Objective To investigate the improvement of feeding intolerance (FI) by changing human milk (HM) or extensively hydrolyzed formula(eHF) after failure of preterm formula (PF) feeding in very low birth weight (VLBW) infants. Methods Eighty-four VLBW infants who were born in Guangzhou Women and Children's Medical Center from January 2016 to January 2018 with PF feeding failure and FI were divided into HM feeding group (n=38) and eHF feeding group (n=46) according to their parents' HM feeding willingness and conditions.The time of FI disappearance, FI improvement rate, total enteral feeding time and weight gain were compared between the two groups after changing feeding formula. Results Compared with the eHF feeding group, the disappearance time of FI, the time of getting total intestinal feeding in the HM feeding group were shorter, and the improvement rate of FI was higher,the differences were statistically significant.The average daily weight increase and discharge weight of the HM feeding group were significantly more than those of the eHF feeding group, and the length of hospital stay, the incidence of extrauterine growth retardation(EUGR) at discharge were lower, the differences were statistically significant.There was no significant difference in the incidence of necrotizing enterocolitis, cholestasis and nosocomial infection between the two groups. Conclusions In the case of failure of PF feeding and FI in VLBW infants, both HM and eHF could ameliorate FI, but HM had a better effect, with a shorter time of getting total intestinal feeding, better weight gain and a lower incidence of EUGR at discharge.

目的 探究空心加压螺钉(CCS)和股骨颈系统(FNS)两种不同的内固定方法治疗60岁以下患者股骨颈骨折的疗效。方法 回顾性研究2018年1月—2019年9月期间在我院接受内固定手术治疗的100例股骨颈骨折患者,根据内固定方式不同,分为FNS组(观察组)和CCS组(对照组),比较2组患者的术后并发症、围手术期特征;并在手术前和手术后1年使用Harris髋关节评分(HHS)评估关节功能。结果 2组患者中,观察组的手术时间和围手术期出血量均大于对照组(P<0.05);术后观察组的骨愈合时间低于对照组,且观察组股骨颈短缩程度也低于对照组(P<0.05);观察组螺钉切除发生率以及术后并发症总发生率均低于对照组(P<0.05)。结论 年龄小于60岁的股骨颈骨折患者通过CCS或FNS治疗可以获得满意的临床效果。 FNS 具有优异的生物力学性能,并显示出更高的整体结构稳定性。

Objective To explore the curative effect of two different internal fixation methods, cannulated compression screw (CCS) and femoral neck system (FNS), in the treatment of femoral neck fractures in patients under 60 years old. Methods Retrospectively studied 100 patients with femoral neck fractures who underwent internal fixation surgery in our hospital from January 2018 to September 2019. According to different internal fixation methods, they were divided into FNS group (observation group) and CCS group (control group). The postoperative complications and perioperative characteristics of the two groups of patients were compared, and the Harris Hip Score (HHS) was used to assess joint function before and 1 year after the operation. Results In the two groups of patients, the operation time and perioperative blood loss of the observation group were more than those of the control group (P<0.05); the bone healing time of the observation group was shorter than that of the control group, and the degree of femoral neck shortening in the observation group was also lower than the control group (P<0.05); the incidence of screw resection and the total incidence of postoperative complications in the observation group were lower than those in the control group (P<0.05). Conclusions Patients with femoral neck fractures under 60 years old could obtain satisfactory clinical results through CCS or FNS treatment. FNS had excellent biomechanical properties and showed significantly higher overall structural stability.

目的 探讨应用56孔冷盐水(STSF)压力导管高功率消融模式治疗老年阵发性房颤患者的有效性和围手术期安全性。方法 回顾性分析广州市第一人民医院2019年1月—2021年6月使用STSF导管高功率消融模式行射频治疗的老年阵发性房颤患者68例(STSF组),匹配同期年龄、性别、左房直径、左室射血分数无差异且使用6孔冷盐水 (ST)压力导管常规功率消融的老年房颤患者71例(ST组),比较2组患者之间的即刻环肺静脉隔离成功率、单圈隔离成功率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。结果 2组患者都成功完成环肺静脉电隔离,STSF组单圈隔离成功率与ST组无差异(左侧肺静脉92.6% vs 90.1%,P>0.05;右侧肺静脉83.8% vs 87.3%,P>0.05),与ST组比较,STSF组手术及消融时间缩短[(70.9±10.0)min vs (79.1±14.2)min,P<0.001;(25.4±4.5)min vs(30.5±6.3)min,P<0.001],灌注量更低[(406.5±46.3)mL vs (729.2±106.1)mL;P<0.001],X线透视时间相近[(6.5±2.5)min vs(7.3±2.6)min;P=0.056]。2组围手术期并发症率均较低(2.9% vs 3.9%;P=0.39),STSF组2例术中发生气体爆破,但未引起心包填塞,ST组有2例术后出现心衰,利尿后好转,1例出现持续性胸痛,胃镜提示食道糜烂,予流质饮食及质子泵抑制剂治疗后恢复。结论 应用STSF导管高功率消融模式在老年阵发性房颤患者行肺静脉大环隔离可提高消融效率,减少术中液体负荷,且不增加围手术期风险。

Objective To investigate the effectiveness and perioperative safety of ThermoCool SmartTouch SurroundFlow (STSF) catheter high-power ablation mode in the treatment of elderly patients with paroxysmal atrial fibrillation. Methods A total of 68 elderly patients with paroxysmal atrial fibrillation who used STSF catheter high-power ablation mode (STSF group) in Guangzhou First People's Hospital from January 2019 to June 2021 were analyzed retrospectively. There were 71 elderly patients with atrial fibrillation who had no significant difference in age, sex, left atrial diameter and left ventricular ejection fraction, used ThermoCool SmartTouch (ST) catheters for conventional power ablation (ST group) at the same time. The success rate of immediate circumferential pulmonary vein isolation, single lap isolation, operation time, X-ray fluoroscopy time, ablation time, intraoperative saline perfusion volume and the incidence of complications were compared between the two groups. Results Both groups of patients successfully completed circular pulmonary vein electrical isolation. There was no significant difference in the success rate of single-circle isolation between STSF group and ST group (left pulmonary vein 92.6% vs 90.1%, P>0.05; right pulmonary vein 83.8% vs 87.3%, P>0.05). Compared with ST group, STSF group had shorter operation and ablation time [(70.9±10.0) min vs (79.1±14.2) min, P<0.001; (25.4±4.5) min vs (30.5±6.3) min, P<0.001], lower perfusion volume [(406.5±46.3)mL vs (729.2±106.1)mL, P<0.001], similar X-ray fluoroscopy time [(6.5±2.5)min vs (7.3±2.6)min, P=0.056 ]. The perioperative complication rate of the two groups was low (2.9% vs 3.9%, P=0.39). Two cases of STSF group had steam pops during operation but did not cause pericardial tamponade, and 2 cases of ST group had postoperative heart failure occurred and improved after diuresis. One case developed persistent chest pain, which gastroscope indicated esophageal erosion, and recovered after liquid diet and PPI treatment. Conclusions Using STSF catheter high-power ablation mode to perform pulmonary vein isolation in elderly patients with paroxysmal atrial fibrillation could improve ablation efficiency, reduce intraoperative fluid load, and without increasing perioperative risk.

目的 研究经皮肾镜碎石术围手术期尿路感染应用磷霉素氨丁三醇治疗的临床效果。方法 纳入2019年1月—2021年1月我院收治的80例经皮肾镜碎石术围手术期尿路感染的患者为研究对象,按照随机数表法分为2组,各40例,术毕对照组静脉滴注左氧氟沙星氯化钠,观察组口服磷酸素氨丁三醇。观察2组干预后临床疗效,治疗后尿细菌培养转阴率,2组血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、单核细胞趋化蛋白-1(MCP-1)、血红素加氧酶-1(HO-1)、降钙素原(PCT)等炎性因子水平及细菌学疗效,并分析干预期间不良反应发生情况。结果 观察组总有效率为87.50%,高于对照组的65.00%(P＜0.05)。观察组尿细菌培养转阴率为97.5%,高于对照组的80.0%(P＜0.05)。治疗后,2组血清hs-CRP、IL-6、MCP-1、HO-1及PCT水平均较治疗前下降,且观察组低于对照组(P＜0.05)。2组粪肠球菌清、金黄色葡萄球菌清除率比较差异无统计学意义(P＞0.05),观察组大肠埃希菌清除率为86.97%,高于对照组的61.54%(P＜0.05)。干预期间,观察组不良反应总发生率为10.00%,与对照组的12.5%比较,差异无统计学意义(P＞0.05)。结论 相比于左氧氟沙星氯化钠注射液,采用磷霉素氨丁三醇可有效提高经皮肾镜碎石术患者围手术期尿路感染临床控制效果,改善患者的炎症因子水平,安全性较高。

目的 本文主要探讨信迪利单抗联合化疗治疗复发转移食管癌的临床有效性和安全性。方法 选取2018年1月—2020年1月我院收治的复发转移食管癌患者共98例纳入研究。按照随机数字表法将患者分为对照组(49例)和观察组(49例),对照组给予多西他赛75 mg/m²+顺铂75 mg/m²治疗,观察组在对照组的基础上给予信迪利单抗(200 mg)治疗,分析比较2组临床疗效及不良反应,主要评估指标是随访期间患者中位生存时间。结果 观察组临床治疗有效率高于对照组(P<0.05);与治疗前比较,2组治疗后血清糖类抗原-199(CA-199)、癌胚抗原(CEA)及肿瘤特异生长因子(TSGF)水平均降低(P<0.05);与对照组比较,观察组治疗后血清CA-199 、CEA及TSGF水平降低(P<0.05);2组临床不良反应主要以恶心呕吐、皮疹等为主,观察组免疫相关不良事件发生率高于对照组(P<0.05),但总不良反应发生率比较无差异(P>0.05);随访至2020年10月,观察组中位OS为16个月(5～27个月),对照组中位总生存期(OS)为9个月(3～23个月),观察组中位OS长于对照组(P<0.001)。结论 信迪利单抗联合化疗可提高复发转移食管癌的临床治疗效果,降低肿瘤抗原水平,延长患者生存时间,且临床较为安全。

目的 探讨华南地区自身免疫性肝炎-原发性胆汁性胆管炎重叠综合征(AIH-PBC OS)临床特点,提高对该病的认识。方法 回顾性总结2010年1月—2020年1月期间收治的居住在华南地区AIH-PBC OS患者37 例,对患者的临床表现、血清学、影像学和病理学特点,伴发肝外自身免疫性疾病等情况进行分析。结果 37例AIH-PBC OS以女性(94.6%)为主,平均发病年龄(48.3±10.3)岁,确诊年龄(50.4±9.2)岁,病程(2.7±2.5)年。83.8%患者存在临床症状,以乏力纳差,身目黄染、尿黄及瘙痒最为常见。在所有患者中,诊断为慢性肝炎为45.9%,代偿性肝硬化为18.9%,失代偿性肝硬化为35.1%,合并肝外自身免疫性疾病占35.1%,以自身免疫性甲状腺疾病和干燥综合征最常见。血清谷丙转氨酶、谷草转氨酶、谷氨酰转肽酶、碱性磷酸酶、总胆红素、总胆固醇、低密度脂蛋白胆固醇水平均升高,失代偿肝硬化期患者血红蛋白和白蛋白下降(P<0.05)。近一半患者血清免疫球蛋白G、免疫球蛋白M和免疫球蛋白A水平升高,失代偿肝硬化期患者免疫球蛋白G升高最为明显(P<0.05)。自身抗体包括抗核抗体阳性率、抗线粒体抗体和(或)抗线粒体抗体M2型抗体阳性率、抗平滑肌抗体阳性率、抗核点蛋白抗体阳性率、抗核包膜蛋白抗体阳性率分别为92%、67.6%、10.8%、11.1%、13.8%。病理学提示AIH-PBC OS患者可见汇管区淋巴细胞和浆细胞浸润,肝小叶界面炎,并伴有不同程度小胆管病变,70.2%同时伴有AIH-PBC特征。肝脏影像学显示在所有患者中,29.7%存在肝硬化,18.9%存在门静脉高压,62.2%存在脾大,18.9%存在腹腔积液。结论 AIH-PBC OS同时具有AIH及PBC疾病的临床特点,病情较复杂、发病较隐蔽;同时伴有血脂代谢障碍,且容易并发肝外自身免疫性疾病。

目的 探讨美多巴联合盐酸司来吉兰治疗帕金森患者的临床效果及对不良反应情况的影响。方法 选取我院2018年1月—2020年12月收治的96例帕金森患者,通过单双号抽签法将96例患者分为2组,分别为对照组、观察组(每组48例)。对照组给予美多巴治疗,观察组在美多巴联合盐酸司来吉兰进行治疗。然后对比2组患者治疗前后的临床疗效,采用帕金森统一评分量表计算精神状态 、运动功能和日常活动评分并记录不良反应的发生率。结果 对比2组患者治疗前后临床疗效,观察组患者临床总有效率高于对照组(87.50% vs 66.66%),差异有统计学意义(χ²=5.897,P=0.015);治疗后2组患者精神状态 、运动功能和日常活动评分低于治疗前(P<0.05),且观察组患者各项评分低于对照组,差异有统计学意义(t=8.250,P<0.001;t=4.388,P=<0.001;t=3.207,P=0.002);对比2组患者不良反应发生率,对照组与观察组不良反应发生率比较无差异(10.41% vs 12.50%,χ²=0.103,P=0.749),2组患者治疗后的不良反应均为一过性,停药或休息后可自行缓解。结论 美多巴联合盐酸司来吉兰治疗帕金森患者的临床疗效良好,能让患者精神状态、运动功能和日常生活得到显著改善,且不良反应较少。

Objective To explore the clinical effect of medopa combined with selegiline hydrochloride in the treatment of patients with Parkinson's disease and its impact on adverse reactions. Methods A total of 96 Parkinson's disease patients from January 2018 to December 2020 were selected and divided into two groups by the odd and even number drawing method, 48 cases each. The control group was treated with medopa, and the observation group was treated with selegiline hydrochloride on the basis of the control group. Then the clinical efficacy of the two groups were compared, and the Unified Parkinson's Disease Rating Scale was used to access the mental state, motor function and daily activity scores of the patients, and the incidence of adverse reactions was recorded. Results The total effective rate of the observation group was higher than that of the control group (87.50% vs 66.66%), with statistical significance(χ²=5.897,P=0.015). After treatment, the scores of mental state, motor function and daily activities were lower (P<0.05), and the scores of the observation group were significantly lower than those of the control group (t=8.250, P<0.001; t=4.388, P=<0.001; t=3.207, P=0.002);the incidence of adverse reactions had no differences (10.41% vs 12.50%, χ²=0.103, P=0.749). The adverse reactions were transient, which could be alleviated by drug withdrawal or rest. Conclusions Madopa combined with selegiline hydrochloride had a good clinical effect in the treatment of patients with Parkinson's disease. It could significantly improve the mental state, motor function and daily life of patients, with less adverse reaction, which is worthy of promotion.

目的 分析76例工业区来源的结核性胸膜炎患者的患病相关因素及临床特征。方法 回顾性收集2018年1月—2020年12月于深圳市中西医结合医院住院的76例工业区来源的结核性胸膜炎患者(观察组)的病历资料和57例同期同区域来源的健康体检者(对照组)的病历资料。运用统计学分析工业区结核性胸膜炎的患病相关因素及临床特征。结果 2组的比较当中,年龄、白蛋白水平、身高、体质量、体质量指数之间的差异具有统计学意义(P<0.05);而多因素Logistic回归分析结果显示,年龄及白蛋白水平则是工业区结核性胸膜炎的独立保护因素(P<0.001,OR=0.728,95% CI:0.634～0.836以及P<0.001,OR=0.908,95% CI:0.874～0.944);工业区结核性胸膜炎的临床症状为咳嗽(71.05%)、发热(48.68%)、胸痛(47.37%),发病季节以春秋季节(27.63%和32.90%)为主。结论 工业区结核性胸膜炎的独立影响因素是年龄及白蛋白水平,临床症状主要为咳嗽、发热、胸痛,好发于春秋季节。

Objective To analyze the relative factors and clinical characteristics of 76 patients with tuberculous pleurisy from industrial area. Methods The medical records of 76 patients with tuberculous pleurisy from industrial areas (observation group) and 57 healthy subjects from the same period and region (control group) who were hospitalized in Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine from January 2018 to December 2020 were retrospectively collected. The correlative factors and clinical characteristics of tuberculous pleurisy in industrial area were analyzed by statistics. Results There were statistically significant differences in age, albumin level, height, weight and body mass index between the two groups (P<0.05). Multivariate logistic regression analysis showed that age and albumin level were independent protective factors for tuberculous pleurisy in industrial areas (P<0.001, OR=0.728, 95% CI: 0.634~0.836 and P<0.001, OR=0.908, 95% CI: 0.874~0.944). The clinical symptoms of tuberculous pleuritis in industrial areas were cough (71.05%), fever (48.68%) and chest pain (47.37%), and the onset season was mainly in spring and autumn (27.63% and 32.90%). Conclusions The independent influencing factors of tuberculous pleuritis in industrial area are age and albumin level. The main clinical symptoms are cough, fever and chest pain, which usually occur in spring and autumn.

目的 分析人类疱疹病毒(EBV)致传染性单核细胞增多症(IM)患儿病毒量与临床特征的关系。方法 选取我院2016年1月—2021年1月收治的EBV定量阳性的IM患儿128例,按照患儿EBV含量分为低病毒量组(n=64)和高病毒量组(n=64)。比较不同病毒含量组患儿的症状体征、实验室检查及临床特征,并分析具有统计学差异的指标与病毒量之间的相关性。结果 高EBV含量组患儿丙氨酸氨基转移酶、乳酸脱氢酶、血沉、外周血白细胞计数指标水平均高于低EBV含量组(P<0.05)。患儿的退热时间、淋巴结缩小时间、肝脾肿大消退时间及住院时间均随着EBV含量的增加而延长(P<0.05)。EBV含量与退热时间、淋巴结缩小时间、肝脾肿大消退时间及住院时间成正相关(r=0.453,0.458,0.402,0.415,P<0.05)。结论 EBV含量越高,IM患儿住院时间及临床指标恢复时间越长,因此临床治疗IM患儿时可以根据EBV含量的高低进行病情评估。

Objective To analyze the relationship between viral load and clinical characteristics in children with infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV). Methods A total of 128 children with IM who tested positive for EBV and admitted to our hospital from January 2016 to January 2021 were selected and divided into low virus group (n=64) and high virus group (n=64) according to their EBV level. The symptoms and signs, laboratory examinations and clinical characteristics of two groups were compared, and the correlation between the statistically different indicators and the amount of virus were analyzed. Results In children with high EBV level, the levels of alanine aminotransferase, lactate dehydrogenase, erythrocyte sedimentation rate, and peripheral blood white blood cell count were higher than low EBV level group (P<0.05). The time of fever, lymph node shrinkage, hepatosplenomegaly to subside, and hospitalization time of the children were all prolonged with the increase of EBV level (P<0.05). The level of EBV was positively correlated with the time to allay fever, the time to shrink the lymph nodes, the time to improve hepatosplenomegaly, and the length of hospital stay (r=0.453, 0.458, 0.402, 0.415,P<0.05). Conclusions The higher EBV level, the longer hospitalization time and recovery time of clinical indicators in children with IM. Therefore, the disease assessment of children with IM can be based on EBV level.

目的 探讨肠道病毒相关性脑炎患儿的临床特点;以期能为临床医师对该病的认识提供一定的帮助。方法 回顾性分析2018年1月—2019年12月广州市妇女儿童医疗中心感染科收治的37例肠道病毒相关性脑炎患儿的临床相关资料。结果 37例患儿男28例,女9例,男女比例3.11:1。主要临床症状体征发热(97.30%)、口腔疱疹和(或)皮疹(54.05%);常见神经系统症状呕吐(56.76%)、头痛(56.76%)、惊厥(29.72%),其中惊厥及呕吐头痛症状≤1岁组与其他年龄组差异有统计学意义;脑脊液检查白细胞升高为主;所有患儿均康复出院且无神经系统后遗症。结论 儿童肠道病毒相关性脑炎近一半患儿临床无咽部疱疹或皮疹表现,1岁以内患儿主要以发热及惊厥为主要表现,大于1岁尤其学龄前期及学龄期患者以发热呕吐伴头疼为主要表现;早期诊治预后良好。

Objective To explore the clinical characteristics of children with enterovirus associated encephalitis, in order to provide some help for clinicians to understand the disease. Methods The clinical data of 37 children with enterovirus related encephalitis treated in the infection department of Guangzhou Women and Children's Medical Center from January 2018 to December 2019 were analyzed retrospectively. Results There were 28 males and 9 females, with a male to female ratio of 3.11:1. The main clinical symptoms and signs were fever (97.30%), oral herpes and/or rash (54.05%); the common nervous system symptoms were vomiting (56.76%), headache (56.76%) and convulsion (29.72%). There were significant differences in convulsion, vomiting and headache symptoms between ≤ 1 year old group and other age groups. The leukocytes level in cerebrospinal fluid was elevated. All children recovered and discharged without neurological sequelae. Conclusions Nearly half of children with enterovirus associated encephalitis had no clinical manifestations of pharyngeal herpes or rash. The main manifestations of children under 1 year old were fever and convulsion. The main manifestations of children over 1 year old, especially preschool and school-age patients, were fever and vomiting with headache. Early diagnosis and treatment had good prognosis.