目的 评价Turbohawk定向斑块切除系统联合药物涂层球囊在下肢动脉硬化闭塞症中临床应用价值。方法 对于术前超声以及下肢动脉CTA检查诊断为下肢动脉硬化闭塞症的8例患者,行Turbohawk斑块旋切以及药物涂层球囊治疗,术后行常规抗凝治疗,定期行彩超复查。结果 8例患者下肢动脉均全部再通成功,技术成功率为100%,术后缺血症状明显改善,术后平均踝肱指数为0.78±0.06,高于术前的0.31±0.12(P<0.05)。住院期间无并发症发生,随访3～18个月,患者保肢均获得成功。结论 Turbohawk定向机械旋切系统联合药物涂层球囊治疗下肢动脉硬化闭塞症,具有创伤小、疗效好以及安全性高等优点,值得临床推广使用。

Objective To evaluate clinical application of using Turbohawk atherectomy device in combination with drug-coated balloon in treatment of atreriosclerosis obliterans in lower extremity. Methods Turbohawk atherectomy device and DCB was performed in 8 patiments with atreriosclerosis obliterans in lower extremity. All patients were diagnosed by ultrasound and CTA. Routine anticoagulation drugs were used after the operation. Follow-up was carried out with color Doppler ultrasound. Results Revascularization was gained in 8 patients. The technically successful rate was 100% and ischemic symptoms relieved significantly immediately after the operation. The post-operative ankle brachinal index(ABI) was 0.78±0.06,which was higher than that of before operation(0.31±0.12). No obvious complications occurred after operation. The follow-up range was 3~18 months and limbs were salvaged successfully. Conclusion With minimal invasive, safe and few complications, Turbohawk atherectomy device in combination with drug-coated balloon is proved to be a very effective treatment atreriosclerosis obliterans in lower extremity and it is worth to popularize.

目的 探讨分阶段延续护理对改善留置输尿管支架管老年农民患者并发症的效果。方法 按时间顺序将106例患者分为对照组52例和观察组54例,对照组给予常规电话随访,观察组实施三个阶段的延续护理。30天后测评患者并发症持续时间和发生率、自我管理能力。结果 观察组腰痛、血尿、膀胱刺激征持续时间缩短,尿路感染、支架管移位和滞留的发生率下降,自我管理能力各维度评分升高,与对照组比较差异均有统计学意义(P＜0.01)。结论 分阶段延续护理能提高留置输尿管支架管老年农民患者的自我管理能力,增强依从性,减少并发症的发生,促进早日康复。

Objective To investigate the effect of staged continuous nursing on complications in elderly agricultural-workerpatients with indwelling ureteral stent. Methods According to the chronological order, 106 patients were divided into control group (52 cases) and observation group (54 cases). The control group received routine telephone follow-up, and the observation group received three stages of continuous care. 30 days later, the complications' duration, incidence and self-management ability were assessed. Results In the observation group, pain, hematuria and bladder irritation were obviously shorten. Urinary tract infection and the incidence of stent displacement and retention were decreased. Scores in all dimensions of self management ability were increased. Comparing with the control group, it had significant difference (P<0.01). Conclusion The phased continuous nursing may improve the self-management ability of the elderly agricultural-worker with indwelling ureteral stents, strengthen the compliance, reduce the occurrence of complications and promote early rehabilitation.

目的 探讨Graf法超声在6个月以内婴儿发育性髋关节异常筛查及随访中的应用价值。方法 选取我院2014年1月—2017年6月2 000例0～6个月婴儿(4 000个髋关节)为标本,采用Graf法超声检查进行筛查,检测发病率,并对部分髋关节异常的婴儿进行随访。结果 Ⅰ型髋关节3 572例(89.3%),Ⅱ型336例(8.4%),Ⅲ型92例(2.3%)。随访的272例发育性髋关节异常婴儿中,86例Ⅱ型转化为Ⅰ型,42例Ⅲ型转化为Ⅰ型,46例Ⅱa型转化为Ⅱb型,98例Ⅱ型无转化。结论 Graf法超声检查在婴儿髋关节异常筛查以及随访中有较高的使用价值。Graf法超声检查安全性好、有效率高,有助于发育性髋关节异常疾病的早期诊断及早期治疗。

目的 探讨医护合作护理程序教育模式在轻度认知功能障碍血透患者中的应用效果。方法 对65例患者实施医护合作护理程序教育模式,2个月后对患者的健康教育知识掌握程度、自体动静脉内瘘自我护理能力、维持性透析依从性、满意度进行测评。结果 医护合作护理程序教育模式后患者的健康教育知识掌握程度为92.31%、自体动静脉内瘘自我护理能力为27.11±3.26、维持性透析依从性是48.22±4.67、护理满意度是92.31%,均比护理程序教育前提高,护理程序教育前后比较差异均有统计学意义(P＜0.01)。结论 医护合作护理程序教育模式能提高患者的认知能力、自我护理能力和满意度,减少并发症,利于患者生活质量的提高。

Objective To explore the effect of the application of nursing process education model under doctor-nurse cooperation in hemodialysis patients with mild cognitive impairment.Methods 65 patients received nursing process education model under doctor-nurse cooperation. After 2 months, these patients were assessed in terms of the level of knowledge about health education, autologous arteriovenous fistula self-care ability, compliance of maintenance dialysis and satisfaction.Results After the nursing process education model under doctor-nurse cooperation, the percentage of patients who became proficient at knowledge about health education was 92.31%, that of patients who showed autologous arteriovenous fistula self-care ability was 27.11±3.26, that of the patients who became compliant to maintenance dialysis was 48.22±4.67, and nursing satisfaction was 92.31%. These performances improved significantly, comparing to those before the nursing process education model under doctor-nurse cooperation. The differences between before and after the model have statistical significance (P<0.01).Conclusion The nursing process education model under doctor-nurse cooperation may improve patients' cognitive ability, self-care ability and satisfaction. It also reduces complications and helps patients to increase the quality of life.

目的 探究聚乙二醇筛查法在高泌乳血症诊断中的临床意义。方法 选取260例HP患者作为观察组以及80例健康体检者作为对照组。应用雅培I2000全自动化学发光检测仪对两组标本进行PRL浓度测定,并将标本进行PEG筛查法沉淀后再次进行PRL浓度测定,将所得数据进行对比。结果 观察组检出MP67例,检出率25.77%,对照组检出MP3例,检出率3.75%,二者差异有统计学意义(P＜0.05);HP组、MP组和对照组之间PEG沉淀前PRL浓度差异有统计学意义(P＜0.05),沉淀后HP组和MP组以及对照组差异有统计学意义(P＜0.05),MP组和对照组差异无统计学意义(P＞0.05);MP在HP引起的各种临床疾病中检出情况差异无统计学意义(P＞0.05)。结论 应用聚乙二醇筛查法对于排除MPRL对HP诊断的干扰具有可行性,对降低HP的误诊率有着重要的意义。

Objective To explore the clinical signification of polyethylene glycol screening method on the diagnosis of hyperprolactinemiat.Methods We selected 260 patients with hyperprolactinemia as observation group and 80 healthy individuals as control group. The two groups were measured with Abbott laboratories I2000 automatic chemiluminescence detector about the concentration of PRL. Then the groups were measured again after they were precipitated by the polyethylene glycol and the result data were analyzed.Results 78 cases of MP were checked out from the observation group and 3 cases were checked out from the control group. The proportion was 25.77% and 3.75% respectively, and the differences were statistically significant (P＜0.05). The difference of the concentration of PRL before precipitated by PEG among the HP group, the MP group and the control group were statistically significant (P＜0.05). After precipitating, the difference of the concentration of PRL between the HP group and the MP group were statistically significant (P＜0.05), as well as the HP group and the control group. However, there was no difference between the MP group and the control group (P＞0.05). The checking conditions of MP in some diseases caused by HP had no difference(P＞0.05).Conclusion The use of polyethylene glycol screening method is a practicable method to eliminate the interference of MPRL on the diagnosis in HP. It has significance reducing misdiagnosis rate of HP.

目的 探讨低中心静脉压(LCVP)对肝癌肝切除术的影响及意义。方法 选择我院2010年3月—2012年3月期间拟行肝切除术的原发性肝癌患者60例,随机分为LCVP组(30例)和NCVP(30例)。LCVP组术中采用相关技术控制CVP<0.5 kPa;NCVP组术中CVP和血压控制在基础值10%上下范围内。两组的麻醉方法、切口、切肝方法、输血指征均一致。分别记录:心率、血压、CVP值和血常规;手术时间、手术切除肝组织范围、手术期间各阶段出血量、输注血制品的数量;术后第1、3、7天的肝肾功能以及凝血功能,所需补充的外源性白蛋白量;术后并发症的发生率、住院时间和费用。结果 ①2组术前一般临床资料比较均无差异(均P>0 05)。②LCVP组手术时间、手术总出血量、肝离断时出血量、RBC输注量均低于NCVP组(P<0.05);③2组术后肝功能、肾功能指标比较无差异(P>0.05),LCVP组患者术后白蛋白补充量比NCVP组减少(P<0.05);④2组患者术后肝功能衰竭、膈下积液、胆瘘、大量腹水、肺部感染、空气栓塞、死亡的发生率比较,均无差异(P>0.05);⑤LCVP患者住院天数、住院总费用均比NCVP组减少(P<0.05)。结论 术中应用LCVP可减少肝癌肝切除术中出血量,缩短住院时间和住院费用,有利于患者的术后恢复。

Objective To evaluate the effect of LCVP applied during the operation of hepatectomy.Methods Sixty patients underwent hepatectomy were enrolled in the study from March 2010 to March 2012 in our hospital which were randomized into LCVP group and normal CVP (NCVP) group by the sealed envelope method. CVP was kept<0.5 kPa during entire procedure of hepatectomy in LCVP group, and the value of CVP and blood pressure were controlled within 10% of the baseline. The same anesthesia, incision and hepatectomy technique and indications of blood transfusion in LCVP group were undertaken as those in NCVP group. Intraoperative CVP, blood pressure, HR and blood routine were recorded. The time of operation, the amount of bleeding, the extent of removed hepatic tissue, the amount of transfused blood products,liver and renal function index, and coagulation function index were detected on the 1st, 3rd and 7th day after operation. Also the supplement of albumin, the rate of postoperation complications and the length of hospital stay and the expense in hospital were recorded.Results ① The general clinical data of patients were similar in the two group (P>0.05). ② The operation time, total bleeding volume, bleeding volume and RBC infusion volume in LCVP group were significantly lower than those in group NCVP (P<0.05). ③ There were no significant difference of postoperative liver and renal function index between the two groups (P>0.05). But the supplement of albumin in LCVP group after operation was significant less than that in NCVP group (P<0.05). ④ There were no significant difference of the postoperative complication, the length of hospital stay and the expense in hospital between the two groups (P>0.05).Conclusions The application of LCVP in hepatectomy cause less blood loss, shorten the length of hospital stay and decrease the expense in hospital, which is beneficial for the postoperative recovery.

目的 探讨声触诊组织定量(virtual touch tissue quantification,VTQ)技术在肾上腺肿瘤诊断中的应用价值。方法 对50例患者共50个肾上腺肿瘤及同侧肾皮质进行VTQ检查,获取肾上腺肿瘤及同侧肾皮质剪切波速度(shear wave velocity,SWV)值,比较肾上腺肿瘤与同侧肾皮质及肾上腺肿瘤各类型之间SWV值,全部病例均经手术后病理证实。结果 病理证实恶性肿瘤5个,良性肿瘤45个。良、恶性肿瘤之间SWV值的差异无统计学意义。肿瘤与同侧肾皮质之间SWV值的差异有统计学意义。髓样脂肪瘤、神经鞘瘤、皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间,除皮质腺瘤、皮质腺癌及嗜铬细胞瘤之间SWV值的差异无统计学意义外,其余任两组之间SWV值的差异有统计学意义。结论 VTQ技术可以提供肾上腺肿瘤的硬度及弹性信息,在肾上腺肿瘤的诊断中具有一定应用价值。

Objective To evaluate the application value of virtual touch tissue quantification (VTQ) technique in the diagnosis of adrenal tumors.Methods VTQ was performed in 50 patients with 50 adrenal tumors and ipsilateral renal cortex, to obtain the shear wave velocity(SWV) of adrenal tumors and ipsilateral renal cortex, the comparison between adrenal tumor and ipsilateral renal cortex and adrenal tumors of various types of SWV. All cases were pathologically confirmed after operation.Results 5 malignant tumors and 45 benign tumors were confirmed by pathology. The difference of SWV between benign and malignant tumors was not statistically significant. The difference of SWV between tumor and ipsilateral renal cortex was statistically significant. Among myelolipoma, schwannoma, adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma in addition to differences in adrenocortical adenoma, pheochromocytoma and adrenocortical carcinoma, SWV value was not statistically significant; it was statistically significant difference between the two groups in any other SWV.Conclusion VTQ technology may provide hardness and elasticity of the adrenal tumors; it has certain application value in the diagnosis of adrenal tumors.

目的 评估AMA-M2、SP100和GP210三种自身抗体在诊断原发性胆汁性肝硬化(primary biliary cirrhosis,PBC)中的应用价值。方法 收集我院近3年就诊患者的AMA-M2、SP100、GP210、ALP和GGT检测数据,其中PBC患者50例,非PBC肝胆疾病或自身免疫病患者226例,正常对照290例。分析这些检测指标对PBC诊断的敏感度和特异度。结果 AMA-M2、SP100和GP210诊断原发性胆汁性肝硬化的敏感度分别为96.00%、36.00%、8.00%,特异度分别为98.26%、97.87%、99.03%。PBC组病人的ALP和GGT检测结果高于非PBC病人组。结论 AMA-M2、SP100和GP210对PBC的临床诊断特异度较高;AMA-M2的敏感度高,但SP100和GP210敏感度低。

Objective To evaluate the diagnostic accuracy of AMA-M2, SP100 and GP210 for the primary biliary cirrhosis (PBC).Methods A total of 50 patients with PBC and 226 patients with other liver diseases or autoimmune diseases were enrolled in this study and 290 healthy individuals were included as normal controls. The data of AMA-M2, SP100, GP210, ALP and GGT were collected and analyzed for sensitivity and specificity in the diagnosis of PBC.Results The sensitivity and specificity of AMA-M2, SP100 and GP210 in the diagnosis of PBC were 96.00%, 36.00%, 8.00% and 98.26%, 97.87%, 99.03%, respectively. Compared to PBC group, the concentrations of ALP and GGT in non-PBC patients and controls were low.Conclusion AMA-M2 is quite accurate with high specificity and sensitivity in the diagnosis of PBC. However, SP100 and GP210 have high sensitivity but low sensitivity.

目的 探讨FORCE CT实时迭代ADMIRE重建技术在肝脏CT扫描中的应用价值。方法 临床疑肝病患者50例,行FORCE CT肝脏平扫后,分别采用FBP重建和ADMIRE-1~5级重建,比较6组图像的平均CT值、噪声、SNR、CNR及图像质量的主观评分及诊断效能等。结果 比较6组图像显示,肝实质平均CT值无统计学差异(P>0.05);噪声、SNR、CNR及主观评分间均有差异(P<0.05),ADMIRE-5重建噪声最小、SNR、CNR最大。图像主观评分ADMIRE-1和ADMIRE-5图像评分低于FBP,ADMIRE-2~4高于FBP,绝对评分最高为ADMIRE-3重建,但六种重建图像对病变诊断效能一致。结论 肝脏CT平扫结合FORCE CT 实时迭代ADMIRE重建技术能有效降低图像噪声及提高图像质量,具有潜在降低扫描剂量的作用。

Objective: To discuss the value of ADMIRE reconstruction technique in the liver plain CT scan by the comparison of displays to the liver separately by ADMIRE and traditional FBP reconstructions after DSCT scan. Methods: 48 patients who were clinically doubted to have hepatic lesions were scanned by DSCT in liver, then six groups of images for FBP and ADMIRE 1-5 on the average CT value, noise, signal to noise ratio ( SNR ), contrast to noise ratio (CNR) and subjective scoring on image quality were compared. Results: 6 groups of images were compared,and the average CT value of liver parenchyma has no statistical differences (P>0.05);The differences were statistically significant (P<0.05)on noise, SNR, CNR and subjective scoring,ADMIRE5 reconstruction has the least noise and the largest SNR and CNR.For the images of ADMIRE1 and ADMIRE5, the image subjective scoring is lower than that by FBP; for the images of ADMIRE2 and ADMIRE4, the image subjective scoring is higher than that by FBP; and ADMIRE-3 has the highest score.But for the rate of lesion detection, all the images were the same. Conclusion: ADMIRE reconstruction strength 3 makes the best image quality.ADMIRE reconstruction can decrease noise and improve SNR and CNR,as well as have a potential effect decreasing the scan dose.

目的 探究磁敏感加权成像(SWI)对帕金森病(PD)与血管性帕金森综合征(VPS)的鉴别诊断价值。方法 回顾性分析我院2013年1月—2016年12月收治的30例PD患者(PD组)和30例VPS患者(VPS)组SWI分析结果,比较两组患者的脑椎体外系各核团的相位值差异,同时将两组患者的测量值与来我院行常规体检的正常者作为对照组进行测量比较。结果 PD组患者的黑质致密带(SNc)、苍白球(GP)、壳核(PUT)相位值较VPS组、对照组更低,组间数据对比有差异(P<0.05);而对照组的SNc、GP、PUT的相位值与VPS组相比无差异(P>0.05);三组对象的红核(RN)、尾状核(CN)测量值无差异(P>0.05);采用Hoehn&Yahr对PD患者和VPS进行分级后发现,各级PD患者SNc相位值之间差异均有统计学意义(P＜0.05),VPS组Ⅰ~Ⅱ级、III级与IV级患者相比,SNc、PUT、尾状核(CN)有统计学差异(P<0.05),而RN相位值无差异(P>0.05)。结论 采用磁敏感加权成像对PD患者和VPS患者的椎体外系各核团的相位值进行测量,能对两者的鉴别起到较大的参考价值。

Objective To explore the value of magnetic susceptibility weighted imaging (SWI) in the differential diagnosis of Parkinson's disease (PD) and vascularized Parkinson's syndrome (VPS). Methods The results of SWI analysis of 30 patients with PD (PD) and 30 patients with VPS (VPS) from January 2013 to December 2016 were retrospectively analyzed. The results were compared between the two groups. Of the phase value of the difference between the two groups of patients with the measured values and routine examination of our hospital as a control group for comparison. Results The phase values of the substantia nigra (SNc), globus pallidus (GP) and crustal nucleus (PUT) were significantly lower in the PD group than in the VPS group and the control group (P <0.05).There was no significant difference in the GP and PUT values between the control group and the VPS group (P> 0.05).There was no significant difference in the red nuclei (RN) between the three groups (P> 0.05).There was significant difference in SNc phase values between PD patients at all levels (P <0.05). Compared with patients with grade IV, grade I and II were higher than those of patients with grade IV (P <0.05), and the difference was statistically significant (P <0.05) between PD patients and VPS. (P <0.05), but there was no significant difference (P> 0.05) between the PUT and the caudate nucleus (CN). Conclusion The phase value of the nucleus of the vertebral body in PD patients and VPS patients was measured by magnetic susceptibility weighted imaging, which could be used as a reference for the identification of the two.