目的 探讨以跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床应用效果。方法 将2020年1月—10月重症医学科收治的100例ARDS患者随机分为对照组和观察组各50例,对照组采用小潮气量辅助控制通气治疗,观察组以跨肺压(transpulmonary pressure,Ptp)为导向选择最佳呼气末正压(positive end-expiratory pressure,PEEP)进行机械通气治疗,观察比较两组患者治疗前和治疗48 h的呼吸动力学指标、血气分析指标,随访28 d病死率。结果 治疗48 h,潮气量、PEEP、肺静态顺应性、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂观察组明显高于对照组(P＜0.05);随访28 d病死率观察组和对照组比较差异无统计学意义(P＞0.05)。结论 以Ptp为导向选择最佳PEEP的机械通气治疗ARDS可以有效改善患者的呼吸动力学指标和血气分析指标,不增加ARDS的病死率,值得临床推广应用。

Objective To investigate the clinical effect of positive end-expiratory pressure(PEEP) ventilation guided by transpulmonary pressure (Ptp) in acute respiratory distress syndrome (ARDS). Methods Between January and October 2020, 100 cases of ARDS treated in intensive care unit were randomly divided into control group and observation group with 50 cases each. Control group used auxiliary control small tidal volume ventilation therapy, and observation group used the best PEEP mechanical ventilation therapy with the guiding of Ptp. The respiratory dynamics index, blood gas analysis results, follow-up of 28d case fatality rate before and 48h after treatment between the two groups were compared. Results After 48h of treatment, tidal volume、PEEP、pulmonary static compliance、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂ of the observation group were all higher than those of the control group (P<0.05). There was no statistically significant difference in mortality between the two groups at 28d follow-up (P＞0.05). Conclusion Mechanical ventilation with the best PEEP guided by Ptp could effectively improve the respiratory dynamic index and blood gas analysis results of patients with ARDS, without increasing the mortality of ARDS, which is worthy of clinical application.

目的 探究硼替佐米、地塞米松联合环磷酰胺治疗骨髓瘤的疗效及对患者不良反应发生的影响。方法 研究对象为我院2016年1月—2020年12月收治的60例骨髓瘤患者,将其随机分为研究1组(n=20)、研究2组(n=20)与对照组(n=20)。对照组给予硼替佐米联合沙利度胺及地塞米松化疗,研究1组给予硼替佐米联合环磷酰胺及地塞米松化疗,研究2组给予硼替佐米联合来那度胺及地塞米松化疗。对比三组治疗效果、免疫功能变化情况、相关血清因子水平以及骨代谢因子水平变化情况。结果 对照组治疗有效率85.0%比研究1组95.0%、研究2组90.0%低(P＜0.05);三组治疗前的免疫对比无较大差异(P＞0.05),对照组经治疗后的免疫功能比研究组差(P＜0.05);三组治疗前的相关血清因子水平比较无较大差异(P＞0.05),对照组经治疗后的相关血清因子水平比研究1组、研究2组高(P＜0.05);对照组经治疗后的骨代谢因子水平变化比研究1组、研究2组差(P＜0.05)。结论 硼替佐米、地塞米松联合环磷酰胺治疗骨髓瘤效果理想,药物不良反应发生率下降,患者生活质量得到改善,可在临床推广应用。

Objective To investigate the clinical efficacy of bortezomib,dexamethasone combined with cyclophosphamide in the treatment of myeloma and the effect on the occurrence of adverse reactions in patients. Methods The subjects were 60 myeloma patients admitted to our hospital from January 2016 to December 2020, and they were randomly divided into study group 1 (n=20), study group 2 (n=20) and control group (n=20). The control group received bortezomib combined with thalidomide and dexamethasone chemotherapy, the study group 1 received bortezomib combined with cyclophosphamide and dexamethasone chemotherapy, and the study group 2 received bortezomib combined with lenalidomide and dexamethasone chemotherapy. The therapeutic efficacy, the changes of immune function,serum factors and bone metabolism factors were compared among the three groups. Results The effective rate of control group was 85.0%, which was lower than those of study group 1 and study group 2 (P＜0.05). There was no significant difference of immune function among the three groups before treatment (P＞0.05), which of the control group after treatment was worse than that of the study groups (P＜0.05). There were no significant differences in the levels of related serum factors among the three groups before treatment (P＞0.05),which in the control group after treatment was higher than those in the study group 1 and study group 2 (P＜0.05). After treatment, the changes of bone metabolic factors in control group were worse than those in study group 1 and study group 2 (P＜0.05). Conclusion Bortezomib, dexamethasone combined with cyclophosphamide in the treatment of myeloma had ideal effect, and the incidence of adverse drug reaction was reduced, the quality of life of patients was improved, which can be popularized in clinical application.

目的 对3例儿童Rotor综合征的临床特点及SLCO1B1和SLCO1B3基因突变分析,提高儿科医生对Rotor综合征的认识。方法 收集广州市妇女儿童医疗中心2018年—2019年确诊的3例Rotor综合征患儿的临床资料,对患儿及其家系成员肝脏常见遗传代谢性疾病二代测序筛查并家系验证结果进行分析。结果 患儿主要临床表现为反复或持续巩膜和(或)皮肤轻度黄染,实验室检查提示高直接胆红素血症。二代测序发现3例患儿均为SLCO1B1基因c.1738C＞T纯合突变和SLCO1B3基因5号内含子区域大片段插入纯合突变。SLCO1B1基因和SLCO1B3基因2处纯合突变均进行了家系验证。文献报道的SLCO1B1基因c.1738C＞T突变是无义突变,可以造成蛋白功能缺失;SLCO1B3基因的大片段插入突变虽暂未有文献收录或报道,但大片段的插入突变可引起移码突变而造成编码蛋白功能丧失。结论 由于基因检测技术的不断进步,Rotor综合征不断被儿科医生所认识。SLCO1B1和SLCO1B3双基因纯合或复合杂合突变是3例Rotor综合征患儿的分子遗传基础。

Objective To better understand Rotor syndrome(RS)in children,the clinical features and SLCO1B1 and SLC01B3 gene mutations were analyzed. Methods The clinical data of the 3 pediatric cases diagnosed in Guangzhou Women and Children's Medical Center between 2018 and 2019 was collected. Genomic DNA was extracted from the children and their family members, and subjected for second-generation sequencing to screen the known genes for liver genetic metabolic diseases. Then the detected mutations were confirmed by Sanger sequencing analysis. Results The main clinical manifestations were recurrent or persistent mild yellowish sclera and/or skin. Laboratory examinations showed hyperbilirubinemia with direct bilirubin elevating. Second generation sequencing showed that all 3 children were c.1738c＞Thomozygous mutations of SLCO1B1 gene and homozygous mutations of large fragment insertion in SLCO1B3 gene intron 5. Two homozygous mutations in SLCO1B1 gene and SLCO1B3 gene were verified in families.SLCO1B1 gene c.1738C＞T mutation,a nonsense mutation reported in references,could lead to protein function loss.A large insertion mutation of SLCO1B3 gene could cause frame-shift mutation which might lead to protein function loss even though it was neither reported in the references nor recorded in SNP database. Conclusion Due to the progress in the clinical application of gene detection technology, RS has been recognized gradually by pediatricians. Homozygous mutations or compound heterozygous mutations simultaneously occurred in SLCO1B1 and SLCO1B3 gene were the molecular genetics base in these cases of RS.

目的 探讨婴儿过敏性直肠结肠炎的临床特点及肠镜、肠黏膜病理特点。方法 回顾性分析2016年1月—2018年12月我院收治的110例婴儿过敏性直肠结肠炎的临床资料及其结肠镜、肠黏膜病理结果、食物过敏原特异度IgG、血常规、粪常规、血清总IgE检测及治疗情况。结果 110例过敏性直肠结肠炎中男67例,女43例,< 6月龄98例;单纯母乳喂养26例,单纯牛奶喂养19例,混合喂养65例;临床表现均有腹泻,大部分患儿伴有血便(93例),部分患儿伴湿疹(23例)、排便哭闹(67例)、夜眠不安稳(61例)、呕吐(8例)、营养不良(6例);血嗜酸性粒细胞升高63例;血清总IgE升高21例;食物过敏原特异度IgG检测结果,牛奶103例,鸡蛋62例;内镜下病变均累及降结肠、乙状结肠、直肠,累及横结肠76例、升结肠47例、回盲部18例;最常表现为疱疹样改变(106例)、糜烂(97例)、溃疡(13例),组织病理学表现为肠黏膜嗜酸性粒细胞浸润91例,隐窝炎、隐窝增生21例,淋巴滤泡形成18例、浅表溃疡形成4例;18例经母亲规避饮食后好转,8例经先换用氨基酸奶粉喂养1周、再逐渐引入母乳后好转;19例换用深度水解或氨基酸奶粉喂养后好转;65例经换用深度水解或氨基酸配方奶粉喂养、同时母亲规避饮食后好转。结论 婴儿过敏性直肠结肠炎缺乏特异度表现,多数临床经过良好,仅少数并发营养不良;牛奶是最主要的过敏原;腹泻、便血病史、血嗜酸细胞升高、肠镜疱疹样改变、肠黏膜嗜酸细胞浸润,提示过敏性直肠结肠炎可能性大;母亲规避饮食或换用氨基酸或深度水解奶粉治疗有效,也是确诊的标准。

Objective To investigate the clinical features of infantile allergic proctocolitis and its endoscopic lesions and pathological features. Methods A retrospective analysis of 110 cases of infantile allergic proctocolitis admitted to our hospital from January 2016 to December 2018 and its colonoscopy and pathological results, food allergen-specific IgG, blood routine, fecal routine, serum total IgE detection and treatment. Results Among 110 patients with allergic proctocolitis, 67 were male and 43 were female, 98 were < 6 months old; 26 were breastfed exclusively, 19 were fed milk alone, and 65 were mixed feeding. The clinical manifestations were diarrhea, most of children with bloody stools (93 cases), some children with eczema (23 cases), defecation and crying (67 cases), restless sleep (61 cases), vomiting (8 cases), malnutrition (6 cases); blood eosinophils increased in 63 cases,serum total IgE increased in 21 cases. Food allergen-specific IgG test results:103 cases of milk, 62 cases of eggs. Endoscopic lesions involved the descending colon, sigmoid colon, rectum, 76 cases of transverse colon, 47 cases of ascending colon and 18 cases of ileocecal. Most common manifested as herpes-like changes (106 cases), erosion (97 cases), ulcers (13 cases). Histopathology showed 91 cases of intestinal mucosal eosinophil infiltration, 21 cases of cryptitis and crypt hyperplasia, 18 cases of lymphoid follicle formation and 4 cases of superficial ulcer formation. 18 cases were improved after the mother evaded diet. 8 cases were improved by feding with amino acid milk powder for one week, and then breast milk was gradually introduced; 19 cases were improved after switching to deep hydrolysis or amino acid milk powder. 65 cases were improved after switching to deep hydrolysis or amino acid milk powder and simultaneously the mother evaded diet. Conclusion Infantile allergic proctocolitis lack of insufficient specific manifestations, most of the clinical cases are good, only a few are complicated by malnutrition. Milk is the most important allergen. Diarrhea, history of blood in the stool, elevated blood eosinophils, intestinal herpes-like changes, bowel mucosal eosinophil infiltration, are suggesting a high possibility of allergic proctocolitis. Mothers avoiding diet or switching to amino acids or deep hydrolyzed milk powder treatment is also effective, and this is also the standard of diagnosis of proctocolitis.

目的 探究客观结构化临床考试(objective structured clinical examination,OSCE)对夜班护士准入培训效果的影响,并总结经验。方法 选取2017年5月—2018年5月期间首次获得执业注册并接受夜班准入培训的护士62名作为研究对象,采用随机数字法划分为观察组和对照组各31例。夜班准入培训时,对照组采用传统的培训考核模式,观察组采用以客观结构化临床考试为理论框架的培训考核模式,考试内容按教学目标设置,并由临床经验丰富的副高级以上导师围绕专业知识、技能、综合能力等对考点进行设计。培训结束后,两组护士均进行客观结构化临床考试、填写教学满意度量表、分析两组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力得分的差异。结果 观察组对培训效果的满意度为83.87%,对照组的满意度为54.84%,差异有统计学意义 (P＜0.05);与对照组比较,观察组护士护理评估能力、健康教育能力、人文关怀、沟通与协调能力、临床思维能力及总分上分值明显更高,差异有统计学意义(P＜0.05);6个站点得分中,观察组的平均成绩要高于对照组,对实际临床操作、护理诊断和临床判断方面更具优势,差异有统计学意义(P＜0.05)。结论 客观结构化临床考试培训模式应用在护士夜班准入培训中,有效提高其临床能力及综合能力,提升了护士对培训课程的满意度。

Objective To explore the effect of objective structured clinical examination (OSCE) on the admission training of night shift nurses and to summarize the experience. Methods A total of 62 nurses who received the practice registration and night shift admission training from May 2017 to May 18, 2017 for the first time were selected as the study subjects. They were randomly divided into observation group and control group. For night shift admission training, the control group adopted the traditional training assessment mode, and the observation group adopted the training assessment mode with objective structured clinical examination as the theoretical framework. The examination content was set according to the teaching objectives, and was designed by clinically experienced supervisors at deputy senior level or above revolving the knowledge points of professional knowledge, skills, comprehensive ability. At the end of the trainings, nurses in the two groups took objective structured clinical examinations and filled out the teaching satisfaction scale. The differences in scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability in the two groups were analyzed. Results The satisfaction rate in the observation group was 83.87%, higher than that in the control group, which was 54.84%, and the difference was statistically significant (P<0.05). The scores of nursing assessment ability, health education ability, humanistic care, communication and coordination ability, and clinical thinking ability and the total scores in the observation group were higher than those in the control group, and the difference was statistically significant (P<0.05). The average score of knowledge points in the observation group was higher than that in the control group, with the former group boasting more advantages in actual clinical operation, nursing diagnosis and clinical judgment, with statistically significant difference between the two groups (P<0.05). Conclusion The application of objective structured clinical examination in nurse's night shift admission training may help improve their clinical ability and comprehensive ability, as well as their satisfaction to training courses.

目的 运用DRG分析临床路径管理对患者住院费用的影响。方法 采用BJ-DRGs分组器,选取2016年广州某三级综合医院的出院患者病案首页信息及DRG分组信息,对比是否实施临床路径管理对患者的总体住院费用影响及各DRG组的住院费用差异。结果 路径组中位住院费用为9 239.41元,低于对照组的12 358.06元,差异有统计学意义(P<0.001)。费用构成分析发现,路径组的治疗费、检查费、药品费、手术费和其他费低于对照组,而材料费用相对较高。比较的14个DRG组中,6个DRG组的路径组住院费用低于对照组。结论 实行临床路径管理可降低患者住院费用、改变费用构成。结合DRG积极推进临床路径精细化管理,可有效控制病种成本,遏制医疗费用的不合理增长。

Objective Using DRG to analyze the impacts on inpatient costs of a hospital in Guangzhou as incurred by clinical pathway management. Methods As performed by BJ-DRGs, we selected DRG grouping information and medical record homepage information of the inpatients discharged from a tertiary hospital in Guangzhou in 2016. Then we compared the impacts of clinical pathway management on overall inpatients costs and the difference of inpatient costs for the DRG group. Results The median of inpatient costs in the clinical pathway group was 9239.41 yuan, was lower than that of control group which was 12358.06 yuan, and the difference was statistical difference (P<0.001). Cost composition analysis found that the costs of treatment, examination, medicine, surgery and the others in the clinical pathway group were much lower than that of the control group, while the cost of materials was relatively high. Among the 14 DRG group study, there were 6 DRG groups which the inpatient costs of the clinical path group was obviously lower than the control group. Conclusion The implementation of clinical pathway management may reduce the inpatient costs and change the makeup of costs. Therefore, combining with DRG, we actively promote the refined management of clinical pathway, which may effectively control the costs of diseases and the unreasonable growth of medical expenses.

目的 盾叶冠心宁片与复方丹参滴丸治疗冠心病稳定型心绞痛临床疗效比较。方法 选取于2017年10月—2018年10月至延安大学附属医院诊治的120例冠心病稳定型心绞痛患者。随机将所有患者分为2组,观察组患者在常规西药治疗基础上加服盾叶冠心宁片,对照组患者在常规西药治疗基础上加服复方丹参滴丸,比较两组患者治疗6个月后的临床疗效。结果 经过6个月治疗后,观察组患者的治疗有效率为66.7%,对照组患者的治疗有效率为40.0%。观察组与对照组治疗效果相比,差异有统计学意义(P＜0.05)。盾叶冠心宁片治疗冠心病稳定型心绞痛的综合疗效优于复方丹参滴丸。结论 冠心病稳定型心绞痛患者在常规西药治疗不变的基础上加用盾叶冠心宁片,不仅能改善临床心绞痛症状,还能调节血脂异常及降低同型半胱氨酸水平,以及缓解患者情绪及睡眠问题,且安全性高,有较高临床应用价值。

Objective To compare the clinical efficacy of Dunye Guanxinning tablets and Compound Danshen dropping pills in the treatment of stable angina pectoris caused by coronary heart disease. Methods 120 patients with stable angina pectoris were selected from the affiliated hospital of Yan'an University from October 2017 to October 2018.All patients were randomly divided into two groups. The observation group was treated with Dunye Guanxinning tablets on the basis of conventional western medicine, while the control group was treated with Compound Danshen dropping pills on the basis of conventional western medicine. The clinical efficacy of the two groups was compared after 6 months of treatment. Results After 6 months of treatment, the effective rate was 66.7% in the observation group and 40.0% in the control group. The treatment effect of the observation group was statistical different from that of the control group (P<0.05). The comprehensive curative effect of Dunye Guanxinning tablets in treating stable angina pectoris of coronary heart disease is better than that of Compound Danshen dropping pills. Conclusion The use of Dunye Guanxinning tablets in patients with stable angina pectoris after conventional western medicine treatment may not only improve the symptoms of clinical angina pectoris, but also regulate dyslipidemia and reduce homocysteine level, as well as alleviate the patients' emotional and sleep problems. It has high safety and high clinical application value.

目的 回顾分析2017—2018年汕头中心医院50例腹泻儿童鼠伤寒沙门菌的标本信息及药敏结果, 得出汕头地区这两年鼠伤寒沙门菌感染特性及指导临床合理用药。方法 从腹泻儿童粪便标本中分离沙门氏菌, 采用纸片扩散法检测其对抗菌药物的敏感性, 采用血清学凝集试验沙门氏菌血清型, 记录鉴定为鼠伤寒沙门菌的标本数据进行分析。结果 50例腹泻儿童鼠伤寒沙门氏菌中,易感时间多为夏秋季节;0～1岁为易感人群;感染后多出现发热、腹泻症状,可出现血便症状,较少出现呕吐;鼠伤寒沙门菌对亚胺培南、替加环素、厄他培南有100%的敏感率,对呱啦西林/他唑巴坦、头孢呱酮/舒巴坦有96%和92.68%的敏感率,队阿莫西林/克拉维酸有80.48%的敏感率,对阿米卡星、头孢呋辛酯、头孢呋辛、头孢西丁都为100%耐药,对其他抗生素有不同程度的敏感性及耐药性。结论 在夏秋季节,0～1岁儿童应加强对鼠伤寒沙门菌感染的预防,若出现发热、腹泻症状需及时就医,医生需向鼠伤寒沙门菌的方向考虑治疗,鼠伤寒沙门菌对多抗生素产生耐药性,临床上需根据药敏结果合理使用抗生素。

Objective To retrospectively analyze information and drug susceptibility of 50 cases of Salmonella typhimurium isolated from children with diarrhea in Shantou Central Hospital from 2017 to 2018, and to obtain the characteristics of Salmonella typhimurium infection in Shantou area in the past two years and to guide rational drug use in clinic. Methods Salmonella was isolated from fecal specimens of children with diarrhea. The susceptibility of Salmonella to antimicrobial agents was detected by disk diffusion method. Serological agglutination test was used to determine the serotype of salmonella. Sample data identified as Salmonella typhimurium were recorded and analyzed. Results Among the 50 children with diarrhea, the susceptibility time of Salmonella typhimurium was summer and autumn; the age of 0～1 was susceptible population; fever and diarrhea were common after infection, and hematochezia and vomiting were rare; Salmonella typhimurium had 100% susceptibility to imipenem, tegacycline and ertapenem, 96% and 92.68% to guacillin/tazobactam, cefotaxone/sulbactam. The sensitivity rate of amoxicillin/clavulanic acid was 80.48%. It was 100% resistant to amikacin, cefuroxime axetil, cefuroxime and cefoxitin. It had different sensitivity and resistance to other antibiotics. Conclusion In summer and autumn, children aged 0～1 should strengthen prevention of Salmonella typhimurium infection. If symptoms of fever and diarrhea occur, doctors should consider the direction of Salmonella typhimurium treatment. Salmonella typhimurium is resistant to multi-antibiotics, and rational use of antibiotics in clinic should be based on the results of drug sensitivity.

目的 探讨增生期糖尿病视网膜病变患者经全视网膜激光光凝治疗的临床效果。方法 选取2016年2月—2019年3月我院收治的增生期糖尿病视网膜病变患者97例,使用随机数表法分为观察组(49例)与对照组(48例)。对照组患者接受黄斑格栅样光凝治疗,观察组患者则接受全视网膜激光光凝治疗。收集2组患者手术前后视力、黄斑中心凹容积、乳头周边视网膜神经纤维层厚度及视网膜厚度变化情况等数据进行分析,并对比生活质量评分。结果 治疗前,2组患者视乳头旁视网膜神经纤维层厚度、黄斑中心凹容积以及视网膜厚度之间差异无统计学意义(P＞0.05),具有可比性。接受不同治疗后,观察组患者上述3项指标均优于对照组患者(P＜0.05)。观察组患者治疗总有效率为79.59%,高于对照组患者治疗总有效率59.18%(P＜0.05)。此外,观察组患者在精细动作、调节能力、日常生活及远视力、光感和移动4个维度评分均高于对照组患者(P＜0.05)。结论 与黄斑格栅样光凝治疗相比,增生期糖尿病视网膜病变患者接受全视网膜激光光凝治疗有助于改善其乳头周边视网膜神经纤维层厚度和黄斑区视网膜厚度,能够显著促进视力恢复,提升患者生活质量,疗效确切。

Objective To investigate the clinical effect of panretinal laser photocoagulation for proliferative diabetic retinopathy. Methods 97 cases of proliferative diabetic retinopathy in our hospital from Feb 2016 to Mar 2019 were enrolled in the study, and were divided into 2 groups randomly. The control group received treatment of macular grid photocoagulation, while the observation group received whole retina laser photocoagulation. Data of visual acuity, macular fovea volume, retinal nerve fiber layer thickness around nipple and retinal thickness before and after operation were collected and analyzed, and quality of life scores were compared. Results Before treatment, there was no significant difference in retinal nerve fiber layer thickness, macular fovea volume and retinal thickness between the two groups (P>0.05), which was comparable. After different treatments, the three indexes mentioned above in the observation group were better than those in the control group (P<0.05). The total effective rate of the observation group was 79.59%, which was higher than that of the control group (59.18%, P<0.05). In addition, the scores of fine motion, accommodation ability, daily life and distant vision, light perception and movement in the observation group were higher than those in the control group (P<0.05). Conclusion Compared with macular grid-like photocoagulation, panretinal laser photocoagulation may improve the retinal nerve fiber layer thickness around the nipple and macular retinal thickness in patients with proliferative diabetic retinopathy. It promotes the recovery of visual acuity, improves the quality of life of patients, and has definite curative effect.

目的 探讨不同甲状腺结节手术治疗方案的合理性及临床效果。方法 选取本院2018年1月—2019年1月收治的120例患有甲状腺结节患者为研究对象,将其随机分为A组和B组各60例,A组患者未进行甲状腺细针抽吸细胞学检查直接进行甲状腺结节切除手术,B组患者接受超声负压引导甲状腺细针抽吸细胞学检查后给予手术治疗方案,比较两组患者手术前、后良恶性结节患者变化、术后复发率、并发症发生率及手术疗效。结果 术后A组残余恶性结节患者比例高于B组(P=0.001),A组健康无结节病变患者占比低于B组(P=0.002),A组患者恶性结节复发率高于B组患者(P<0.05);两组术后并发症发生率无差异(P>0.05),A组手术治疗总有效率低于B组(P<0.05)。结论 甲状腺结节患者术前有效超声穿刺诊断、术中超声引导手术及术后抗癌化疗治疗方案可以提高甲状腺结节患者手术有效率,B组方案具有重要临床推广价值。

Objective To investigate the rationality and clinical effect of different thyroid nodules surgical treatment. Methods A total of 120 patients with thyroid nodules admitted to our hospital from January 2018 to January 2019 were randomly divided into group A and group B, respectively. Group A patients did not undergo fine needle extraction. Aspiration cytology was performed directly for thyroid nodule resection. Group B patients underwent ultrasound negative pressure guided thyroid fine needle aspiration cytology and were given surgical treatment. The changes of benign and malignant nodules before and after surgery were compared between the two groups including postoperative recurrence rate, complication rate and surgical outcome. Results The proportion of patients with residual malignant nodules in group A was higher than that in group B (P=0.001). The proportion of patients with healthy no-nodular lesions in group A was lower than that in group B (P=0.002). The recurred rate of malignant nodules in group A was higher than that of group B (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). The total effective rate of group A was lower than that of group B (P<0.05). Conclusion Preoperative effective ultrasound puncture diagnosis, intraoperative ultrasound guided surgery and postoperative anticancer chemotherapy treatment may improve the efficiency of thyroid nodules in patients with thyroid nodules. Group B has important clinical value.