目的 探究儿童抗NMDA受体脑炎临床特点、诊治及预后。方法 回顾性分析16例儿童抗NMDA受体脑炎的临床表现、辅助检查、治疗与预后。结果 16例患儿中,意识障碍16例, 语言障碍15例,运动障碍13例,11例惊厥发作。9例脑脊液NMDA受体抗体阳性,14例血清NMDA受体抗体阳性。16例患儿脑电图均出现背景中高波幅慢活动,头颅磁共振检查未见异常。所有患儿均接受丙种球蛋白联合激素冲击治疗,14例症状缓解,2例需加用利妥昔单抗治疗,症状缓解。结论 识别儿童抗NMDA受体脑炎多样临床表现,筛查NMDA受体抗体有助于早期诊断及治疗儿童抗NMDA受体脑炎。

Objective To investigate clinical features, diagnosis, treatment and prognosis of the patient with anti-NMDA receptor encephalitis in children. Methods The data of clinical feature,auxiliary examination of 16 cases with anti-NMDA receptor encephalitis in children were reviewed and analyzed. Results Of all 16 cases, there were 16 cases with decreased consciousness, 15 cases developed speech alteration, 13 cases developed movements disorder and 11 cases with seizure. Cerebrospinal fluid NMDA antibody were positive in 9 cases and serum NMDA antibody were positive in 14 cases. The EEG of 16 patients showed high-amplitude slow activity in the background. There were no significant abnormalities in head magnetic resonance imaging (MRI) of all children. After all children received gamma globulin combined hormone therapy, 14 cases had boen improved and another 2 cases need to be further treated combined with Rituximab. Conclusion Pediatric patients had diverse clinical manifestations. Screening of NMDA receptor antibody may help early diagnosis of anti-NMDA receptor encephalitis. And timely treatment may yield a favorable prognosis.

目的 比较不同浓度罗哌卡因横纹肌阻滞应用于剖宫产术后镇痛的临床效果。方法 选取2015年3月—2016年3月于我院剖宫产的孕妇300例,随机分为A组、B组、C组,每组100例,A组产妇给予质量浓度为1.5 g/L的罗哌卡因1.5 mg/kg,B组产妇给予质量浓度为2 g/L的罗哌卡因1.5 mg/kg,C组产妇给予质量浓度为2.5 g/L的罗哌卡因1.5 mg/kg,同时给予所有产妇镇痛泵辅助镇痛。记录观察所有产妇术后6 h、12 h、24 h、36 h、48 h的疼痛视觉模拟评分(VAS)、镇痛泵按压次数、产妇对镇痛效果的满意程度以及腹横肌平面阻滞(TAP)不良反应发生情况。结果 B、C组产妇的VAS评分均低于A组产妇(P＜0.05),24 h后C组产妇的VAS评分低于B组产妇(P＜0.05);与B、C组产妇相比,A组产妇的镇痛泵按压次数更多,镇痛效果满意度较低(P＜0.05),同时B组产妇的镇痛泵按压次数多于C组产妇(P＜0.05);3组产妇均未出现术后不良反应。结论 使用质量浓度为2.5 g/L的罗哌卡因横纹肌阻滞进行剖宫产术后镇痛,效果显著、安全性较高,临床中可推广使用。

Objective To compare the clinical effects of different concentrations of ropivacaine for postoperative analgesia after cesarean section. Methods 300 cases of pregnant women undergoing cesarean section in our hospital from March 2015 to March 2016 were selected and were randomly divided into group A, group B and group C with 100 cases in each group. The patients in group A were given 0.15% ropivacaine 1.5 mg/kg, 0.20% ropivacaine 1.5 mg/kg in group B and 0.25% ropivacaine 1.5 mg/kg in group C, and at the same time all the pregnant women were given analgesic pump assisting analgesia. The pain visual analogue scales (VAS) of the pregnant women were recorded at 6 hours, 12 hours, 24 hours and 36 hours after cesarean section and the number of times of analgesia pressing pump were also recorded. The satisfaction degree of analgesic effect and the TAP occurrence of adverse reactions of the patients were also recorded. Results The VAS scores of group B and group C were lower than that of group A(P<0.05). 24 hours after cesarean section, the VAS score of group C was lower than that of group B (P<0.05). Compared with group B and C, the number of times of analgesia pressing pump in group A were more but the analgesic effect of satisfaction was lower (P<0.05), and at the same time the number of times of analgesia pressing pump in group B were more than those in group C (P<0.05). No adverse reactions were found in the three groups. Conclusion The treatment of using of 0.25% of ropivacaine for muscle block for postoperative analgesia after cesarean section is effective and safe, which may be widely used in clinical practice.

目的 探讨山莨菪碱联合黄体酮治疗高原地区急性肾绞痛的临床疗效。方法 将2016年9月—2017年6月收治的60例急性肾绞痛患者随机分成2组,试验组和对照组各30人,试验组应用黄体酮注射液40 mg肌肉注射,山莨菪碱10 mg加入质量浓度为50 g/L的葡萄糖注射液250 mL静脉滴注;对照组仅用山莨菪碱10 mg加入质量浓度为50 g/L的葡萄糖注射液250 mL静脉滴注。给药前、后15min、30min、1 h及4 h对患者疼痛采用视觉模拟评分(VAS)评价其疗效,并观察其起效时间和不良反应。结果 治疗组和对照组总有效率分别为 93.3%和70.0%,2组比较差异有统计学意义( P<0.05);2组药物起效时间比较有差异(P<0.05);给药后15min至4 h,试验组VAS评分均低于对照组(P<0.05)。结论 山莨菪碱联合黄体酮治疗高原急性肾绞痛安全有效,联用明显优于只采用山莨菪碱。

Objective To study the effect and efficacy of Anisodamine combined with Progesterone in the treatment of acute renal colic in plateau area. Methods From September 2016 to June 2017, 60 cases of acute renal colic patients were randomly divided into experimental group or control group. Both groups are 30 cases. The test group applied the injection of progesterone injection 40 mg by muscle injection and Anisodamine 10mg to the concentration of 5% of glucose injection in 250 mL by intravenous drip. In the control group, only using 10 mg of Anisodamine was added to the 250 mL intravenous drip of 5% glucose injection. The visual Analogue Scale/Score(VAS) was used to evaluate the efficacy of the patients before dosing, after dosing of 15min, 30min, 1 h and 4 h, and we observed their effective time and adverse reactions. Results The total effective rate of treatment group and control group was 93.3 % and 70.0 % respectively. There was a statistically significant difference between the two groups (P<0.05). The VAS score of the experimental group was lower than that in the control group (P<0.05). Conclusion Anisodamine combined with Progesterone is safe and effective in the treatment of plateau acute renal coli, and is obviously better than only using Anisodamine.

目的 探讨治疗青年原发性高血压,联合使用硝苯地平控释片(CCB)与厄贝沙坦(ARB)对降压效果、肾功能及不良反应的影响。方法 2012年1月—2015年1月到我院就诊的青年原发性高血压患者共计180例。将患者按照首次就诊顺序编号,分为A、B两组各90例。A组患者CCB治疗,B组患者CCB联合ARB治疗。两周后比较两组患者降压效果、肾功能及不良反应发生率。结果 两组患者治疗前的收缩压、舒张压无差异(P>0.05); 治疗两周后,收缩压、舒张压均有下降,与治疗前相比,差异有统计学意义(P<0.05)。 B组患者血压下降幅度更大。两组患者间治疗后收缩压、舒张压的比较,差异具有统计学意义(P<0.05)。 两组患者治疗前24 h尿蛋白、24h尿白蛋白无显著性差异(P>0.05), 经两周治疗后,两项指标均有下降,与治疗前相比,差异有统计学意义(P<0.05)。 B组患者下降幅度更大。两组患者治疗后24 h尿蛋白、24 h尿白蛋白比较,差异有统计学意义(P<0.05)。 两组患者各项不良反应发生率均相当(P>0.05)。结论 在青年原发性高血压治疗中,联合使用CCB与ARB,能提高降压效果,改善肾功能,不增加不良反应,值得临床推广。

目的 了解番禺区市桥街居民卫生服务利用和卫生服务需求现况,为城市社区卫生服务发展指明方向。方法 采用自行编制的社区居民健康需求调查问卷,通过7个社区卫生服务机构的义诊活动进行一对一问卷调查。结果 被调查的居民以女性为主,占67.2%;35岁以上居民占71.4%;初中以下文化程度占22.6%; 医疗保险覆盖率为91.2%;两周社区就诊率39.0%;患病后首选社区卫生服务机构占51.6%;调查居民的生活行为和方式总体状况较好,但健康危险因素仍普遍存在。总体对疾病预防、饮食及心脑血管的系统疾病的健康知识需求以及对社区应提供的六种基本服务需求较高。结论 针对健康服务的需求次序,合理配置卫生服务资源,促使居民合理利用社区卫生资源。

目的 探讨急性卒中合并医院获得性肺炎患者的病原学特点及药物敏感性情况。方法 回顾性分析116例急性卒中合并医院获得性肺炎患者临床资料,记录其病原菌分布特点;分析检出率最高的三种病原菌耐药情况。结果 ①此次入组的116例受试患者呼吸道分泌物样本中共分离出160株病原菌,其中革兰阳性菌50株(31.3%),革兰阴性菌88株(55.0%),真菌22株(13.8%);肺炎克雷伯菌、绿铜假单胞菌及金黄色葡萄球菌为分布构成比最大的前三位病原菌,构成比分别为17.5%、15.6%和12.5%;②三种常见病原菌均对万古霉素及利奈唑胺药物敏感性较高,可达100.0%;左氧氟沙星对金黄色葡萄球菌敏感性较高,但肺炎克雷伯菌及绿铜假单胞菌等革兰阴性菌对其耐药性较强;头孢唑林对肺炎克雷伯菌及绿铜假单胞菌敏感性较高。结论 急性卒中合并医院获得性肺炎患者多以革兰阴性菌为常见病原菌,肺炎克雷伯杆菌、铜绿假单胞菌及金黄色葡萄球菌最多见;病原菌对常见抗菌药物存在不同程度耐药性,需引起临床重视,根据病原学分析结果科学合理使用抗菌药物以提升治疗效果。

目的 探讨红细胞分布宽度(RDW)与老年重症社区获得性肺炎(CAP)患者病情严重程度及预后的相关性。方法 将103例老年重症CAP患者按照近期预后分为存活组(n=83例)及死亡组(n=20例),按照RDW的水平分为RDW≥14.5%组(n=83例)和RDW＜14.5%组(n=20例);记录患者的一般临床资料及相关实验室检查指标,比较各组之间的差异,并利用Logistic回归模型分析老年重症CAP患者近期死亡的危险因素。结果 死亡组中的患者入院APACHEⅡ评分、CRP、PCT、RDW水平均高于存活组,差异有统计学意义(P＜0.05)。RDW 异常率随着PSI 级别的增高而增高,RDW 异常率分别为PSIⅠ-Ⅱ级7.32%(3/41、 PSI Ⅲ级16.67%(6/36)、PSI Ⅳ级39.13%(9/23)、PSIⅤ级 66.67%(2/3),差异有统计学意义(P＜0.05)。Spearsman相关性分析显示:RDW与APACHEⅡ评分、CRP、PCT、PSI评分呈正相关(r_s分别为=0.353,0.363,0.432,0.362,P均＜0.05)。多因素Logistic回归分析显示: RDW(OR=2.024,P＜0.05)是老年重症CAP患者近期死亡的独立危险因素。结论 RDW水平随着老年重症CAP患者病情严重程度的增加而增加,RDW增高亦是患者近期死亡的高危因素。

目的 探讨原发性脾脏肿瘤的诊断与治疗。方法 选取2006年1月—2014年12月期间收治的58例原发脾脏肿瘤患者进行临床观察。结果 脾脏良性肿瘤45例,其中脾血管瘤21例,脾囊肿11例,脾淋巴管瘤8例,脾脏窦岸细胞血管瘤3例,脾错构瘤1例,脾脏硬化性血管瘤样结节性转化1例;脾脏恶性肿瘤13例,其中脾脏B细胞淋巴瘤11例,脾脏霍奇金淋巴瘤及脾脏血管肉瘤各1例。B超和CT是主要的检查方法。全组行脾切除术51例,其中开腹脾切除术23例,腹腔镜脾切除术28例;部分脾切除术5例;脾切除+胰腺体尾部切除术2例。所有病例无手术并发症。术后随访9个月~9年,平均随访时间(43.8±21.3)个月,41例脾脏良性肿瘤患者预后良好,无复发和转移;11例脾脏恶性肿瘤患者的1、3、5年生存率分别为81.8%、63.6%和27.2%。结论 原发性脾脏肿瘤的诊断主要依靠临床表现和影像学检查。手术切除不仅是脾脏肿瘤一种有效的治疗手段,也是重要的确诊方法。脾脏局限性良性肿瘤可选择部分脾切除术以保留脾脏功能。早期手术及术后联合放化疗可改善脾脏恶性肿瘤的预后。

Objective To investigate the diagnosis and treatment of primary splenic tumor. Methods The clinical data of 58 patients with primary splenic tumor from January 2006 to December 2014 were retrospectively analyzed. Results 45 cases were benign splenic tumor, including 21 hemangioma, 11 splenic cyst, 8 lymphangioma, 3 littoral cell angioma, 1 hamartoma and 1 sclerosing angiomatoid nodular transformation of spleen. 13 cases were malignant splenic tumor, including 12 lymphoma and 1 angiosarcoma. Ultrasound and CT were the main diagnostic methods. 51 cases underwent splenectomy, including 23 open splenectomy and 28 laparoscopic splenectomy. 5 cases underwent partial splenectomy and 2 splenectomy combined distal pancreatectomy. There had no postoperative complications. The follow-up period was 9 months to 9 years. 41 cases with benign splenic tumor had no recurrence or metastasis. The 1-, 3-, 5-years survival rate were 81.8%, 63.6% and 27.2% respectively of 11 patients with malignant splenic tumor. Conclusion The diagnostic of primary splenic tumor mostly rely on clinical features and imagic examination. Surgical resection is not only an effective treatment, but also a confirmed diagnosis method for primary splenic tumor. Partial splenectomy is a reasonable procedure for local benign splenic tumor. Early surgery, combined adjuvant chemotherapy and radiotherapy are important for improving the prognosis of malignant splenic tumor.

目的 提高对精索静脉曲张合并同侧腹股沟隐匿性斜疝的认识。方法 2009年1月—2013年9月,3例左侧精索静脉曲张合并同侧腹股沟隐匿性斜疝患者经我科诊治,合并的隐匿性腹股沟斜疝术前均未能发现,其中2例患者在行经腹股沟精索静脉高位结扎时发现合并的隐匿性疝,同时行疝修补手术;另1例术后第2天发现再次行疝修补术,疝修补手术采用Bassini术式。结果 术后6个月电话随访,3例患者腹股沟疝无复发、无睾丸萎缩、鞘膜积液并发症。结论 精索静脉曲张合并腹股沟隐匿性疝少见,但临床工作中还是会遇到,需要提高对该疾病的认识,治疗方式存在一定争议。

Objective To improve the realization of the varicocele combined with ipsilateral concealed indirect hernia. Methods Three cases of the varicocele combined with ipsilateral concealed indirect hernia were treated in our department from January 2009 to September 2013. Combined ipsilateral concealed indirect hernia were not diagnosed before operation, 2 were found during the operation of spermatic vein ligation through the groin and received Bassini's hernia repair simultaneous, another found 2 days after operation and then received Bassini's hernia repair. Results No recurrence of hernia, testicular atrophy and hydrocele observed in the follow-up by phone 6 after months. Conclusion Varicocele combined with ipsilateral concealed indirect hernia is rare, we need to improve the understanding of this disease and the therapy is controversial.

目的 探讨年轻恶性肿瘤化疗女性的发病情况及保留生育功能和卵巢功能的意义。方法 回顾性分析和总结在我院行化疗的17～40岁年轻恶性肿瘤女性患者的年龄、肿瘤类别、构成等临床资料。结果 5年间在我院化疗的1261例女性恶性肿瘤患者中,年龄15～40岁者共786例(占62.3％),其中乳腺癌355例、大肠癌89例、白血病80例、宫颈癌67例、卵巢癌46例、恶性淋巴瘤39例,胃癌38例,肺癌30例,肝癌18例。15～25岁年龄段的女性恶性肿瘤化疗以白血病和卵巢癌为主。随年龄增长,大部分女性恶性肿瘤化疗的发生率增高。结论 15～40岁年轻恶性肿瘤化疗女性中乳腺癌占首位,其次为大肠癌、白血病和宫颈癌。保留年轻患者卵巢功能和生育功能的保守治疗具有重要意义。

Objective To analyze the clinical characteristics of malignant tumor in young women receiving chemotherapy aged from 15 to 40 and investigate the role of conservative treatment. Methods The clinical data of female aged from15 to 40 years old who were received chemotherapy in our hospital between 2010 and 2014 were retrospectively analyzed. Results 786 cases were identified from 1261 cases of malignant tumor receiving chemotherapy. Including 355 cases of breast cancer,89 cases of colorectal cancer,80 cases of leukemia,67 cases of cervical carcinoma,46 cases of ovarian cancer,39 cases of lymphoma,38 cases of gastric cancer,30 cases of lung cancer and 18 cases of liver cancer. Leukemia and ovarian cancer is the most common malignant tumor in young female between 15 to 25 years old. The cases of malignant tumor receiving chemotherapy increased with increasing age. Conclusion Breast cancer is the most common malignant tumor in young female receiving chemotherapy, followed by colorectal cancer, leukemia, and cervical carcinoma. It is very important to conserve young women's ovary function and fertility function.