目的 探讨胸部良性疾病非计划二次手术的原因,降低非计划二次手术率,研究防止措施。方法 回顾性分析2006年5月—2016年5月间胸部良性疾病患者行外科手术治疗的临床资料574例,其中16例术后因各种原因行非计划二次手术,总结胸部良性疾病外科治疗后非计划二次手术的临床特点、治疗经过及原因,对可能的影响因素进行单因素分析和多因素分析。结果 本组患者行非计划二次手术,无死亡病例,二次手术手术时间为30～215(135.6±47.4) min。术中出血量50～650 (313.6±93.1)mL。术后住院时间7～30(15.7±6.8)d。二次手术原因包括术后出血 (10例)、术后肺持续漏气(4例)、切口感染(2例)。单因素分析首次手术疾病分类,首次手术时间,首次手术方式与胸部良性疾病非计划二次手术相关性有统计学意义(P<0.05),多因素分析结果显示首次手术疾病分类,首次手术时间,首次手术方式是胸部良性疾病非计划二次手术的独立危险因素(P<0.05)。结论 根据胸部良性疾病的不同疾病类别来估计和预防可能出现的并发症,特别是胸部炎症性病变,术前充分准备、术中仔细操作、术后并发症的早期积极处理,能降低胸部良性疾病非计划二次手术的发生率。

Objective To investigate the causes of benign thoracic disease unplanned reoperation,improve the level of diagnosis and treatment and reduce the rate of unplanned reoperation. Methods From May 2006 to May 2016,594 cases of benign thoracic disease were performed thoracic surgery,including 16 patients underwent the unplanned reoperation due to various reasons. The clinical characteristics, therapy course and results of benign thoracic disease unplanned reoperation were analyzed retrospectively. Results The patients underwent the unplanned reoperation were no deaths. The operative time 30～215(135.6±47.4)min, intraoperative blood loss 50～650 (313.6±93.1)mL,postoperation hospitalization duration 7～30(15.7±6.8)d. The causes of benign thoracic disease unplanned reoperation were as follows: postoperative bleeding (10 cases), prolonged air leaks (4 cases),incision infection (2 cases). Univariate analysis showed first-time classification of diseases, operative time and operation method were statistically significant (P<0.05), Multivariate Logistic regression analysis revealed first-time classification of diseases, operative time and operation method were independent factors associated with benign thoracic disease unplanned reoperation. Conclusion According to the different classification of benign thoracic disease to estimate and prevent possible complications, we need to have sufficient preoperative preparation, intraoperative careful operation. Early active processing can be taken in postoperative complications.It can reduce the incidence of unplanned reoperation in benign thoracic disease,especially the chest inflammatory diseases.

目的 探讨健康成人颈段气管的体外高频超声影像特点,为开展体外超声在检测颈段气管病变应用作前期研究。方法 应用体外高频超声观察120例健康成人颈段气管结构的声像表现,并对气管环T1-T4的内外横径、气管环厚度、相邻气管环间距进行测量和统计学分析。结果 120例志愿者均获得了颈段气管前、侧壁声像图,以及气管环T1-T4内外横径、气管环厚度、相邻气管环间距测值。结论 体外高频超声可以清晰显示气管形态和细微支撑结构,并进行部分径线测量,有望成为评估颈段气管病变的一种有价值的辅助手段。

Objective We investigated features of the healthy adult cervical tracheas in order to studying cervical tracheal lesions by extracorporeal high-frequency ultrasound EHFUS. Methods EHFUS examination of the trachea was performed in 120 asymptomatic adult volunteers. We observed imaging features of the healthy adult cervical tracheas, and measured TRID, TRED, TRTh and TRAS to analysis. Results The cervical tracheal anterior and side wall ultrasonograms, and measurements were obtained in all subjects. Conclusion The cervical tracheal shape and the fine structure of support can be seen in EHFUS, and partly of diameter measurements were obtained. Thus EHFUS may be a valuable assistant method to assess cervical tracheal lesions of support structure.

目的 调查分析病案首页疾病诊断存在的问题,以提出针对性的干预对策。方法 由病案科编码员根据《卫生部关于修订下发住院病案首页的通知》相关规定,对抽取的4200份病案首页的疾病诊断进行检查,对疾病诊断问题分类记录,同时对其发生原因进行问卷调查,建立相应数据库,应用Excel统计工具进行统计分析。结果 共748份的疾病诊断存在问题,发生率高达17.8%,包括疾病诊断中主要诊断选择错误8.3%、疾病诊断的名称不规范7.6%,以及漏诊问题1.8%。疾病诊断存在问题发生率较高的临床科室为内分泌科38.0%,骨科科32.8%,肿瘤科31.6%。在读研究生最容易出现疾病诊断问题,发生率高达48.0%。结论 对疾病诊断存在问题的高发临床医师群体和临床科室进行针对性干预对策,有望降低病案首页疾病诊断问题的发生率。

Objective To investigate the defects analysis and targeted intervention on the diseases diagnosis in the home pages of medical records. Methods To conduct an inspection analysis on the four thousand and two hundred medical records according to the related requirements of “Notification on Standard writing in Home Pages of Hospitalization Medical Records announced by the Ministry of Health” by professional medical records staff.They found out and classified the defects on the diseases diagnosis in the home pages of medical records,at the same time,questionnaire survey were carried on to investigate the related causes,and the corresponding database establish ed.Excel statistical tools were applied for statistical analysis. Results There were defects on the diseases diagnosis in a total of seven hundred and forty-eight cases,the incidence of which was 17.8%,including 8.3% of mistakes of main diagnosis,7.6% of lack of standardization in diagnosis names,1.8% of missed diagnosis respectively.Defects on the diseases diagnosis occurred in a higher rate in the clinical departments,such as department of endocrine with 38.0%,department of orthopedics with 32.8%,and department of oncology with 31.6%.Graduate students most prone to make mistakes with defects on the diseases diagnosis,the incidence of which was 48.0%. Conclusion Targeted interventions to clinician groups and clinical departments with high incidence of defects on the diseases diagnosis,is expected to reduce the incidence of which in the home pages of medical records.

目的 研究低视力儿童“学校-社区-家庭”三位一体综合康复干预工作的具体效果。方法 2013年1月,选择广州市盲人学校新入学80名低视力儿童,随机分为两组,为期二年的跟踪研究。其中A组执行“学校-社区-家庭”三位一体综合康复干预,B组执行传统康复干预。就知识积累、心理健康、生活能力三个方面对两组儿童的具体数据收集,研究“学校-社区-家庭”三位一体综合康复干预与传统干预方式之间的区别。结果 A组低视力儿童较B组儿童的文化知识积累与生活能力训练成绩均有提高,两者差距在正常分布带内,A组低视力儿童的心理素质优于B组低视力儿童。A组低视力儿童的综合评价效果高于B组儿童。结论 低视力儿童“学校-社区-家庭”三位一体综合康复干预工作的具体效果优于传统康复干预方式。

目的 总结分析青光眼术后前房形成延缓的原因与处理措施。方法 选取2010年12月—2013年12月在我院行青光眼滤过术的84例患者(112眼),回顾性分析术后发生浅前房的原因及相应处理措施。结果 术后出现浅前房为26眼,占23.2%;其中高滤过泡引流过畅18眼(69.2%),结膜伤口渗漏5眼(19.2%),脉络膜脱离2眼(7.6%),恶性青光眼1眼(3.8%),大多数浅前房均经保守治疗恢复,1例需行再次手术。结论 青光眼术后前房延缓形成发生率较高,主要原因是脉络膜脱离、滤过作用强、结膜伤口渗漏、恶性青光眼等,及时发现并采取相应处理是浅前房恢复正常的关键。

目的 对颞下颌关节紊乱病患者的心理健康状况进行分类别的评估分析。方法 随机选择口腔科门诊就诊的颞下颌关节紊乱病患者88例为病例组,健康正常人92例为对照组,心理科抑郁患者92例及焦虑患者90例为心理疾病组,采用症状自评量表(SCL-90)量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克人格问卷(EPQ)进行问卷调查,将量表调查结果分别归类整理后,使用统计软件SPSS13.0进行统计学分析。结果 TMD患者与正常对照组相比,在SCL-90、SAS、SDS评分中多项有统计学意义,在病例组中,多次患病和初次患病相比、高学历与低学历患者相比,在焦虑和抑郁上有统计学意义。颞下颌关节紊乱病患者与心理疾病患者相比,心理疾病患者在焦虑和抑郁上得分高于颞下颌关节紊乱病患者。结论 颞下颌关节紊乱病患者存在着不同程度的心理障碍,但远未达到心理疾病的程度,且颞下颌关节紊乱病患者中的不同群体心理状况也有所不同,这对于TMD患者心理上的疏导提供了一定的依据。

Objective To explore the research and analysis of temporomandibular disorder(TMD)patients' psychological states. Methods People diagnosed in the dental clinic were identified as target population.Totally, 88 patients with TMD were recruited as case control,whereas 92 normal people,92 patients with mental depression and 90 patients with dysphoria disorders were collected as control group.Questionnaire survey was carried out based on Symptom Checklist(SCL-90),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)and Eysenck Personality Questionnaire(EPQ). Correlations between TMD and psychological factors were assessed using the statistical methods. Results Compared with normal people,patients with TMD showed statistically significant diversity in SCL-90,SAS and SDS.In subgroup analysis of patients with TMD,patients with repeated disease history or advanced education degree presented significant variation in terms of depression and anxiety when compared with those with first diagnosed or lower education degree.Compared with patients with mental illnesses,patients with TMD showed significant lower score in depression and anxiety. Conclusion In TMD treatment we should not only adapt traditional physical therapy,medical therapy,corrective therapy and surgical treatment but also pay attention to psychological treatment to correct the patients' negative emotions,which may improve the symptoms and actively terminate disease process.

目的 回顾分析椎体成形术(PVP)对于治疗骨质疏松性新鲜椎体压缩骨折(OVCF)患者的疗效。方法 收集2011年1月—2012年6月新鲜OVCF患者伤后两周内行PVP术治疗共34例(51个椎体)。于术前1天、术后3天、1个月、3个月、6个月、12个月予VAS、ODI评分,并行X线检查以测量病椎前、中、后缘的高度和病椎cobb角。结果 纳入研究的34个病例中,患者术后各时间点随访中VAS和ODI评分均较术前1天明显改善(P<0.05)。术后各时间点随访中行X线检查时,术后各次随访中椎体前缘、中段、病椎cobb角均较术前有较为明显的矫正(P<0.05)。结论 应用PVP治疗新鲜OVCF疗效满意,可快速缓解疼痛、改善生活质量和矫正病椎后凸畸形。

Objective To study the efficiency and safety of percutaneous Vertebroplasty(PVP) for the fresh osteoporotic vertebral compression fractures(OVCF). Methods 34 patients (30 females and 4 males), mean age 75.8 years old(75.79±9.32, range 60 to 93 years old) hospitalized between January 2011 to June 2012 were reviewed retrospectively in this study. Evaluation at follow-up time point(1 day before PVP, 3rd day, 1st, 3rd, 6th, 12th month after PVP) included the pain score with VAS, mobility improvement with ODI and the measurement of anterior, middle and posterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra with X-ray image. Results For the 34 patients by followed up 1 year, the mean VAS score and ODI decreased significantly after PVP at any follow-up time compared with the 1 day before operation. Anterior and middle body height and the focal kyphotic angle at any follow-up time after PVP was improved statistically significant compared with the preoperative value(P<0.05). Conclusion Percutaneous vertebroplasty results in prompt pain relief, rapid rehabilitation and kyposis reduction, it is a safe and effective procedure for treating fresh osteoporotic vertebral compression fractures.

目的 体外构建胶原—壳聚糖复合支架材料,分析其物理化学性质及生物相容性,探讨其应用于组织工程支架材料的可行性。方法 利用冷冻干燥的方法构建三维多孔的胶原支架材料,通过甲醛交联以及添加壳聚糖的方法改善其物理化学性能。通过体外降解实验以及电镜扫描的方法检测材料的各项物理化学指标;通过细胞接种的方法研究材料的生物相容性。结果 胶原—壳聚糖复合材料通过冷冻干燥的方法,能够获得稳定的三维多孔结构,电镜显示孔隙贯通,体外降解速度降低,并且能够支持细胞生长。理化性质分析显示该结构适合细胞生长,具有良好的生物相容性。结论 本课题体外构建胶原—壳聚糖复合支架材料,满足组织工程生物材料的理化以及生物相容性要求,为其应用于组织工程支架材料提供重要的依据。

Objective We build up the Collagen-Chitosan compound scaffold in vitro,and study the physical,chemical and biological properties,to analyze the feasibility in tissue engineering. Methods The three-dimensional porous scaffold was obtained by freezing-drying method,and optimized by using formaldehyde and Chitosan.We used hydrolysis in vitro and SEM scanning to investigate its physical and chemical properties.The biocompatibility of scaffold was analyzed in MEF cells. Results Collagen-Chitosan compound scaffold we obtained by freezing-drying method was a kind of stable 3D vesicular structure.The scaffold degenerated in decreased velocity in vitro.The physical and chemical properties showed that it was suitable for the cells grow in it,which suggested that it has a good biocompatibility. Conclusion This kind of Collagen-Chitosan compound scaffold is constructed.It's qualified by the physical and chemical properties,and biocompatibility which the biomaterials require.The evidence are important for its application in tissue engineering.

目的 评价阿奇霉素序贯疗法治疗小儿支原体肺炎的临床疗效及药物经济学效果。方法 将我院儿科于2011年3月—2013年8月收治的522例支原体肺炎患儿随机分为静滴组(n=265)和序贯组(n=287),两组均给予阿奇霉素进行疗程为5 d的治疗,静滴组采用静脉滴注的给药方法进行治疗,序贯组采用静脉滴注2 d后口服序贯给药3 d的方法进行治疗,运用药物经济学原理对两种给药方案进行成本－效果分析。结果 静滴组和序贯组的总有效率分别为94.0%(249/265)和92.7%(266/287),两组比较差异无统计学意义(P>0.05),但静滴组的成本高于序贯组(P<0.01);静滴组和序贯组的不良反应发生率分别为34.7%(92/265)和26.9%(76/287),两组比较差异有统计学意义(P<0.05)。结论 采用序贯疗法治疗小儿支原体肺炎符合安全、有效、经济的临床用药原则,值得临床广泛推荐。

Objective To evaluate the clinical efficacy and pharmacoeconomic effect of sequential therapy of azithroycin on treatment of community mycoplasmal pneumonia(MP)in chindren. Methods 522 cases with MP from March 2011 to August 2013 in pediatrics department of our hospital were randomly divided into intravenous-drip group(n=265)and sequential-therapy group(n=287),and both two groups were treated by azithromycin for 5 days.The intravenous-drip group was treated with intravenous drip of azithromycin,and the sequential-therapy group was treated with azithromycin in the way of intravenous drip for 2 days and oral-taken for 3 days.The two treatments were cost-effectiveness analyzed by pharmacoeconomic theory. Results The total efficiency of the sequential-therapy group and intravenous-drip group were 94.0%(249/265)and 92.7%(266/287),respectively.There was no different between the sequential-therapy group and the intravenous-drip group(P<0.05).But the cost in intravenous-drip group was higher than that in sequential-therapy group(P<0.01).The incidence of adverse reaction of the sequential-therapy group and intravenous-drip group were 94.0% 34.7%(92/265)and 26.9%(76/287),respectively.And it was significant different between the two groups(P<0.05). Conclusions The treatment of sequential therapy of azithromycin is safety,effective and economical.And it is worthy to be widely recommended in clinical.

目的 了解老年患者医院感染的发生情况及相关因素,为有效降低医院感染提供临床依据。方法 对我院2010年6月—2014年6月452例60岁以上的老年患者医院感染情况进行回顾性分析,调查并分析其年龄、住院天数、医院感染部位及相关因素。结果 老年患者医院感染的发生与年龄增长、住院天数延长、感染部位、基础病及抗生素不合理应用等因素密切相关。结论 根据医院感染的相关因素,对老年人加强病房管理及基础护理,不仅改善治疗操作中易感染的环节,减少感染途径,还可以降低医院感染发生率。