目的 探讨流程化(CICARE)沟通模式在中下段尿路结石患者中的应用价值。方法 回顾性分析2018年8月—2019年11月我院80例中下段尿路结石患者,均行输尿管镜下钬激光碎石术,2018年8月—2019年5月的37例患者作为对照组,采用常规沟通流程,2019年6月—2019年11月的43例患者作为研究组,采用CICARE沟通模式。对比两组手术时间、沟通满意度及干预前后手术室注意事项知晓程度、贝克焦虑量表(BAI)、贝克抑郁量表21项版(BDI-21)评分。结果 研究组手术时间较对照组短(P＜0.05);干预后,研究组手术室注意事项知晓程度较对照组高(P＜0.05);干预后,研究组BAI、BDI-21评分较对照组低(P＜0.05);研究组沟通满意度95.35%(41/43)较对照组81.08%(30/37)高(P＜0.05)。结论 CICARE沟通模式应用于中下段尿路结石患者,可提高患者手术室注意事项知晓程度,减轻负性情绪,缩短手术时间,且具有较高沟通满意度。

Objective To explore the application value of CICARE communication model in patients with middle and lower urinary calculi. Methods From August 2018 to November 2019, eighty patients with middle and lower urinary calculi in our hospital were analyzed retrospectively. All patients underwent ureteroscopic holmium laser lithotripsy.Thirty-seven patients from August 2018 to May 2019 served as a control group, using a routine communication process, forty-three patients from June 2019 to November 2019 served as the study group and adopted the CICARE communication model. The two groups were compared in surgical time, communication satisfaction, awareness of operating room precautions before and after intervention, Baker Anxiety Scale (BAI), and Baker Depression Scale 21 item (BDI-21)scores. Results The operation time in the study group was shorter than that in the control group (P＜0.05). After the intervention, the awareness degree of the operating room precautions in the study group was higher than that in the control group (P<0.05). After the intervention, the BAI and BDI-21 scores in the study group were lower than those in the control group (P<0.05). The communication satisfaction of the study group was 95.35% (41/43),higher than the control group of 81.08% (30/37)(P<0.05). Conclusion The application of CICARE communication mode in patients with middle and lower urinary calculi may improve patient's awareness of precautions in the operating room. It may reduce negative emotions, shorten the operation time, and has higher communication satisfaction.

目的 运用传统中医药理论,用中西医结合的方法,探讨简便中药结合肠内营养(EN)的支持方式对胃肠道肿瘤术后营养状况和炎性反应的影响,及改善胃肠道功能的作用。方法 胃肠道肿瘤术后患者随机分为黄陈枳术汤结合肠内营养组(观察组)和单纯肠内营养组(对照组)作对比研究,观察两组病人营养支持前后营养指标视黄醇结合蛋白(RBP),血清白蛋白(ALB)及炎性指标C反应蛋白(CRP)的改善情况,观察两组病人恶心、呕吐、腹胀、腹泻等胃肠道症状发生情况。结果 营养支持后RBP,ALB均有升高,观察组病人营养支持后第7、14天RBP和ALB水平均高于对照组,CRP低于对照组,差异有统计学意义(P＜0.05)。两种病人均有胃肠道不良反应,但观察组胃肠道并发症发生率较低,差异有统计学意义(P＜0.05)。结论 黄陈枳术汤结合肠内营养的中西医结合营养支持方法能纠正胃肠道功能紊乱,提高营养支持疗效,对胃肠道肿瘤术后患者的RBP和ALB有提高作用,能降低CRP,减少炎性反应,促进患者快速康复,缩短住院时间。

Objective Using a combination of Chinese and western medicine, to explore the effect of Huang Chen Zhisu decoction combined with enteral nutrition on RBP/ALB/CRP of gastrointestinal tumor patients after surgery,and improve gastrointestinal disorders. Methods Postoperative patients of gastrointestinal tumor were randomized into Huangchen Zhisu decoction combined with enteral nutrition group(observation group)and enteral nutrition group(control group). The retinol-binding protein(RBP),albumin(ALB),C-reactive protein (CRP),gastrointestinal symptoms, adverse reaction were observed and recorded. Results After nutrition support, the level of ALB and RBP were both increased. The ALB and RBP of the observation group on the 7th and 14th day after nutrition support were higher than those of the control group.The CRP of the observation group on the 7th and 14th day after nutrition support were lower than the control group, (P<0.05).The rate of postoperative gastrointestinal disorder of the observation group was obviously lower (P<0.05). Conclusion Huangchen Zhisu decoction combined with enteral nutrition has remarkable effect,can enhance the ALB and RPB, reduce CRP. The effect was better than enteral nutrition only. It improves the nutritional status and immune function,helps to promote the resumption on of gastrointestinal function,and helps postoperative patient for a quicker recovery.

目的 分析石河子地区2型糖尿病(T2DM)合并消化道恶性肿瘤患者的临床特征,探讨T2DM合并消化道恶性肿瘤的影响因素。方法 ①纳入我院2015年至今消化道恶性肿瘤患者为研究对象。根据OGTT结果或既往有无T2DM病史分为三组:健康对照组(A组),消化道恶性肿瘤组(B组),T2DM合并消化道恶性肿瘤组(C组)。②全自动生化分析仪测定血清中糖脂代谢指标,化学发光法测定血清甲胎蛋白(AFP)等肿瘤标志物,分析其临床特征,进行组间比较,并探讨其影响因素。采用SPSS 22.0软件处理数据,并进行方差分析;影响因素采用Logistic回归分析;假设检验水准α＝0.05,双侧检验P<0.05差异有统计学意义。结果 ①基线资料比较显示:A组310例(男女比138/172),年龄(52.96±10.98)岁;B组513例(男女比343/170),胃癌患者居多(26.90%),年龄(62.26±12.34)岁;C组134例(男女比80/54),肝癌患者较多(26.12%),年龄(66.78±10.47)岁;与A组相比,B组与C组男性患者较多,年龄较大。②组间基线资料比较显示:三组的性别、年龄存在统计学差异(P<0.001)。③协方差分析消除影响因素后:与A组相比,B组及C组的TG、 TC、HDL-c降低(P<0.001);FPG、AFP、CEA、CA12-5、CA15-3、CA19-9、CA72-4升高(P<0.01)。④Logistic回归分析后结果显示:FPG为消化道恶性肿瘤发生的独立危险因素(OR=1.204);年龄是消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的危险因素(OR=1.072,1.105),HDL-c为消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的保护因素(OR=0.200,0.111);结论 老年男性T2DM患者易发生消化道恶性肿瘤。因此,对于高龄男性T2DM患者,尤其是HDL-c降低的情况下,应进行相关筛查,以早期防治消化道恶性肿瘤的发生发展。

Objective To analyze the clinical characteristics of patients with type 2 diabetes mellitus (T2DM)complicated with gastrointestinal malignancy in Shihezi area, and investigate the influencing factors of T2DM complicated with gastrointestinal malignancy. Methods ①Patients with malignant tumors of the digestive tract in our hospital from 2015 to the present have been included in the study. They were divided into three groups based on OGTT results or previous history of T2DM: healthy control group (group A), gastrointestinal malignant tumor group (group B), and T2DM combined gastrointestinal malignant tumor group (group C). ②Automatic biochemical analyzer measured serum glucose and lipid metabolism indicators, chemiluminescence method was used to measure serum alpha-fetoprotein (AFP)and other tumor markers, to analyze its clinical characteristics, make a comparaison between groups, and explore its influencing factors. The data was processed with SPSS 22.0 software and analysis of variance was performed; the influencing factors were analyzed by logistic reg-ression; hypothesis test level = 0.05, and the two-sided test P <0.05 was statistically significant. Results ①Comparison of baseline data showed that 310 cases (male/female 138/172)in group A were (52.96±10.98)years old. In group B, 513 patients (male/female 343/170)were diagnosed with gastric cancer (26.90%), aged (62.26±12.34)years. There were 134 cases in group C (male/female 80/54), with more liver cancer patients (26.12%), and the age was (66.78±10.47)years. Compared with group A, group B and group C had more male patients and were older. ②Comparison of baseline data among groups showed there were statistical differences in gender and age among the three groups (P<0.001). ③After covariance analysis eliminated influencing factors: compared with group A, TG, TC and HDL-c were decreased in group B and group C (P<0.001). FPG, AFP, CEA, CA12-5, CA15-3, CA19-9, and CA72-4 increased (P<0.01). ④Logistic regression analysis results: FPG was an independent risk factor for gastrointestinal malignancy (OR=1.204). Age wss a risk factor for gastrointestinal malignancy and T2DM complicated with gastrointestinal malignancy (OR=1.072, 1.105), HDL-c was the protective factor (OR=0.200, 0.111). Conclusion Elderly male T2DM patients are prone to gastrointestinal malignancies. Therefore, for elderly men with T2DM, especially when HDL-c is reduced, relevant screening should be performed to prevent and control the occurrence and development of gastrointestinal malignant tumors in the early stage.

目的 比较压力控制通气(PCV)中不同吸气流速对单肺通气(OLV)患者呼吸功能及炎症因子的影响。方法 本研究为2018—2019年对75例单肺通气患者的前瞻性研究。患者在麻醉和单肺通气(OLV)后随机分为吸气流量30 L/min(A组)、50 L/min(B组)或70 L/min(C组)。比较OLV前(T₀)、OLV后30 min(T₁)、60 min(T₂)和120 min(T₃)的呼吸力学、呼吸功能、血流动力学和血气分析,中心静脉血检测分析IL- 6、IL-8、TNF-α和sICAM-1,观察术后3天肺部并发症和ARDS的发生情况。结果 三组一般情况、血流动力学指标差异均无统计学意义(P＞0.05);B组、C组PaCO₂较A组降低(P<0.05);与T₀时比较,T₁-T₃时三组PaO_2、SVO₂均降低(P<0.05);三组PH、SO₂和HB差异均无统计学意义(P>0.05)。与A组比较,B组、C组ΔVT增大(P<0.05);三组Ppeak差异无统计学意义;与A组比较,B组、C组PEEP均增大(P<0.05);与A组比较,T₁-T₃时B组、C组V_D/V_T减少(P>0.05);与T₀比较,T₁-T₃时三组Qs/Qt增加(P<0.05);与A组比较,T₁-T₃时B组、C组Cdyn增大(P<0.05);与T₀相比,T₁-T₃时三组PaO₂/FiO₂降低(P<0.05);与T₀相比,T₁-T₃时三组IL-6、IL-8、TNF-α和sICAM-1的浓度增多(P<0.05),但A组、B组低于C组(P<0.05)。三组患者发生术后肺部并发症和ARDS差异均无统计学意义。结论 在PCV模式下通过增加吸气流速能增加VT,减少死腔率,促进 CO₂的交换,并且改善肺动态顺应性,但并不能很好的改善氧合及肺内分流。吸气流速50 mL/L在较小炎症反应的情况下达到上述改善呼吸功能和呼吸力学,可推荐应用于进行OLV患者。

Objective The effects of different inspiratory velocity PCV on respiratory function and inflammatory factors in patients with one-lung ventilation OLV were compared. Methods This was a prospective study of 75 patients with one-lung ventilation in 2018-2019. The subjects were randomized to the inspiratory velocity 30(group A),50(group B)or 70(group C)L/min after anesthesia and one-lung ventilation OLV. Respiratory mechanics,respiratory function,hemodynamics and blood gas parameters were compared between the three groups pre-OLV(T₀)and after 30 (T₁), 60 (T₂), and 120 (T₃)minutes of OLV.Center venous blood was collected to measure interleukin (IL)-6, IL-8,tumor necrosis factor (TNF)-α,andsoluble intercellular adhesion molecule-1 levels.Observation of pulmonary complications and occurrence of ARDS 3 days after operation were made. Results Hemodynamic and general patient status were similar between the three groups (all P>0.05). PaCO₂was lower in the group B and group C compared with the group A (P<0.05). Compared with T₀, PaO₂ and SVO₂were lower at T₁-T₃of the three groups(P<0.05). PH, SO2 and HB were similar between the three groups (all P>0.05).ΔVT was higher in the group B and group C compared with the group A (P<0.05);Ppeak were similar between the three groups (all P>0.05). PEEP was higher in the group B and group C compared with the group A (P<0.05); V_D/V_T decreased in the group B and group C compared with the group A (P<0.05).Compared with T₀,Qs/Qt increased at T₁-T₃ of the three groups (all P<0.05). Cdyn increased at T₁-T₃ of the group B and group C(all P<0.05). PaO₂/FiO₂ decreased at T₁-T₃ of the three groups(all P<0.05).Compared with T₀, the concentrations of Il-6, Il-8, TNF-α and sICAM-1 increased at T₁-T₃of three groups (P<0.05), and in group A and group B were lower than those in group C (P<0.05).The number of patients who had postoperative pulmonary complications PPCS or acute respiratory distress syndrome(ARDS)were similar between the three groups (all P>0.05). Conclusion In PCV mode, it can increase VT by increasing the inspiratory velocity, reduce the V_D/V_T, promote the exchange of CO₂, and increase the Cdyn, but it cannot improve the oxygenation and Qs/Qt.Inspiratory velocity of 50 mL/L to achieve the above improvement in respiratory function and respiratory mechanics in the case of a smaller inflammatory response. It may be recommended for use in patients undergoing OLV.

目的 探讨细胞毒素-1(Cytotoxin-1,CTX-1)对人卵巢癌SKOV-3细胞增殖凋亡的影响。方法 利用0、4、8、12 μg/mL浓度 CTX-1处理SKOV-3细胞6、12、24 h,MTS法检测细胞活性,8 μg/mL CTX-1处理SKOV-3细胞24、48 h,Hoechst-33258荧光染色观察细胞核染色质形态。取处理 6、12 h 后细胞,利用流式细胞仪检测SKOV-3细胞的凋亡率。结果 4、8、12 μg/mL的CTX-1可抑制SKOV-3细胞活性及增殖,呈时间-剂量依赖。Hoechst-33258染色观察可见细胞染色质呈固缩或碎裂状、染色质着色不均、核形态各异,随时间增加而更趋明显。8 μg/mL CTX-1处理细胞,6 h细胞坏死率为(1.90±0. 27)%,晚期凋亡率为(10.96±1. 56)%,而早期凋亡率为(1.52±0.39)%;12 h细胞坏死率为(10.62±0.96)%,晚期凋亡率(15.07±1.23)%,而早期凋亡率为(1.88±0.17)%,与对照组比较,差异有统计学意义 (P<0.0 1)。结论 CTX-1可以抑制人卵巢癌细胞活性、抑制其体外增殖、诱导其发生凋亡,该作用呈剂量依赖和时间依赖,主要引起细胞晚期凋亡和坏死。

Objective To investigate the effect of cytotoxin-1 (CTX-1)on the proliferation and apoptosis of ovarian cancer SKOV-3 cells. Methods SKOV-3 cells were treated with CTX-1 at concentrations of 0, 4, 8, 12 μg/mL for 6, 12, and 24 hours respectively. Cell viability was measured by MTS method. SKOV-3 cells were treated with 8 μg/mL CTX-1 for 24 and 48 hours, by Hoechst-33258 fluorescence staining to observe the morphology of nuclear chromatin. The apoptotic rate of SKOV-3 cells was detected by flow cytometry after 6 and 12 hours of treatment. Results CTX-1 at 4, 8, and 12 μg/mL inhibited the activity and proliferation of SKOV-3 cells in a time-dose-dependent manner. Hoechst-33258 staining observation showed that the apoptotic cell chromatin was condensed or fragmented chromatin, the chromatin was unevenly colored, and the nuclear morphology was different. It became more obvious with time. 8 μg/mL CTX-1 treated cells, the 6 h cell necrosis rate was (1.90±0.27)%, the late apoptosis rate was (10.96±1.56)%, and the early apoptosis rate was (1.52±0.39)%; 12 hours cell necrosis rate was (10.62±0.96)%, late apoptosis rate was (15.07±1.23)%, and early apoptosis rate was (1.88±0.17)%, compared with the control group, the difference was statistically significant (P<0.01). Conclusion CTX-1 may inhibit the activity of human ovarian cancer cells, inhibit its proliferation in vitro, and induce its apoptosis. The effect is dose-dependent and time-dependent. Mainly it causes late apoptosis and necrosis of cells.

目的 探讨早期康复训练对高龄股骨骨折内固定患者术后康复的影响研究。方法 抽选我院2015年3月—2017年7月收治的98例高龄股骨骨折患者,均以防旋股骨近端髓内钉（PFMA）内固定治疗,根据患者自愿及实际自身状态原则分为对照组（n=45例,仅开展常规术后康复护理）和观察组（n=53例,在内固定治疗期给予早期康复训练）,比较术前及术后3、6个月髋关节运动功能（Harisr评分）及日常生活活动能力（Barthel指数）,观察6个月内并发症发生情况。结果 观察组干预3、6个月后Harisr髋关节活动评分、Barthel指数均高于对照组（P<0.05）。观察组锻炼6月后,髋关节运动功能恢复优良率高于对照组（P<0.05）。观察组发生骨延迟愈合、压疮、切口感染、肺炎、泌尿系感染等并发症的概率低于对照组（P<0.05）。结论 高龄股骨骨折患者PFMA内固定术后开展早期康复训练,可促进患者骨关节功能恢复,改善运动功能,降低并发症发生率,值得临床推广。

目的 探究雾化吸入布地奈德对急性支气管炎患者疗效及相关指标的影响。方法 选取2016年7月—2018年6月在我院接受治疗的120例急性支气管炎患者作为研究对象,随机分为两组：常规组（60例）和综合组（60例）。常规组实施常规治疗,综合组在常规治疗基础上实施雾化吸入布地奈德治疗,比较两组的整体治疗效果。结果 综合组的治疗总有效率为95.0%,常规组的治疗总有效率为83.3%,综合组要高于常规组,差异有统计学意义（P<0.05）;在PEF、FVC、FEV1等肺功能指标的比较中,综合组和常规组治疗前不存在差异（P>0.05）,治疗后综合组要高于常规组,差异有统计学意义（P<0.05）。结论 急性支气管炎患者实施雾化吸入布地奈德治疗,疗效显著,有利于改善肺功能。

目的 观察康柏西普玻璃体腔注射治疗湿性老年性黄斑变性病变对于视网膜神经纤维厚度的影响。方法 对2016年10月—2017年10月在汕头大学附属韶关市粤北人民医院采用康柏西普玻璃体腔注射治疗湿性老年性黄斑变性35例38眼中符合标准的患者18例（18眼）的临床资料进行回顾性分析,患者行最佳矫正视力、眼压（NCT）检查、OCT、荧光眼底血管造影（FFA）检查后,均接受0.05 mL康柏西普玻璃体腔注射,分别注射后1和2月观察患者最佳矫正视力 （BCVA）、视网膜神经纤维厚度（RNFL）变化。结果 18眼共接受康柏西普玻璃体腔注射54次,所有患眼均注射3次。注射3个月后,OCT检查结果显示有18眼视力有提高,CRT厚度有下降。第1次注射时和注射后1个月、2个月的BCVA分别为0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）,总体比较差异有统计学意义（χ²=13.880,P<0.001）;第1次注射时和注射后1个月、2个月的CRT（μm） 319.50（269.50,390.50）, 271.00（219.00,296.25） 和234.50（182.75,273.25）总体比较差异有统计学意义（χ²=11.978,P<0.05）,第1次注射时和注射后1个月、2个月后的 ARNFL（μm）86.00（76.25,98.00） 83.00（76.00,95.50）和 83.00（76.25,94.75） 总体比较差异无统计学意义（χ²=11.978,P>0.05）,第1次注射时和注射后1个月、2个月眼压（kPa）2.27（1.97,2.44）,16.0（13.7,17.0）,和 2.00（1.84,2.31） 总体比较差异无统计学意义（χ²=1.604,P>0.05）。结论 玻璃体腔注射康柏西普治疗湿性老年性黄斑变性对视网膜神经纤维厚度无明显的损害,安全且有效,但仍需要大样本量及长期随访观察。

Objective To observe the effect on the thickness of retinal nerve fibers in the patients with wet age-related macular degeneration by adopted intravitreal injection with Conbercept. Methods We analyzed 18 cases （18 eyes） that conform to the standard from 35 cases（38 eyes） retrospectively,who were treated with wet age-related macular degeneration by adopted intravitreal injection with Conbercept in Shaoguan Yuebei People's Hospital Affiliated to Shantou University from October in 2016 to October in 2017.After undergoing best corrected visual acuity （BCVA）,intraocular pressure （IOP） and fluorescein angiography （FFA）,all of them were adopted intravitreal injection with 0.05mL Conbercept. We observed the changes of best corrected visual acuity （BCVA） and retinal nerve fiber thickness （RNFL） after 1 and 2 months of adopted intravitreal injection with 0.05 mL Conbercept. Results 18 eyes were adopted intravitreal injection Conbercept 54 times totally. All the eyes were injected three times. After 3 months of injection,OCT showed that the visual acuity of 18 eyes improved and the thickness of CRT decreased. The BCVA values at the first injection,after the first injection and after the second injection were 0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）respectively. The overall difference was statistically significant （χ²=13.880,P< 0.001）. CRT（μm）values at the first injection,after the first injection and after the second injection were 319.50（269.50,390.50）,271.00（219.00,296.25） and 234.50（182.75,273.25）respectively. The overall difference was statistically significant （χ²=11.978,P< 0.05）. ARNFL（μm）values at the first injection,after the first injection and after the second injection were 86.00（76.25,98.00）,83.00（76.00,95.50） and 83.00（76.25,94.75）respectively. There was no significant difference （χ²=11.978,P> 0.05）. The IOP（mmHg）values at the first injection,after the first injection and after the second injection were 17.0（14.8,18.3）,16.0（13.7,17.0）,和 15.0（13.8,17.3）respectively. There was no significant difference（χ²=1.604,P>0.05）. Conclusion There was no obvious damage to the retinal nerve fiber by adopted intravitreal injection with Conbercept to treat the patients with wet age-related macular degeneration. That’s safe and effective,but need a large sample to follow-up for a longtime.

目的 分析促红细胞生成素（EPO）及促红细胞生成素受体（EPOR）在肝细胞癌（NCC）以及正常组织中的表达规律,以及它们和肝细胞癌微血管密度（MVD）之间的关系。方法 选取我院手术切除的肝细胞肝癌的标本30例,取肿瘤边缘2.0 cm的肝组织作为对照,同时取正常肝脏组织10例做为阴性对照。利用酶联免疫吸附实验（ELISA）检测各组织中EPO及EPOR表达水平,利用免疫组织化学方法染色检测微血管密度（MVD）。对比癌组织和癌旁组织EPO、EPOR及MVD差异,分析NCC中EPO、EPOR、MVD与肿瘤病理特征的关系,分析EPO、EPOR表达水平与MVD之间的关系。结果 HCC组织中,EPR、EPOR、MVD均高于癌旁组织和正常组织,差异有统计学意义（P<0.001）,EPR、EPOR、MVD在癌旁组织和正常组织中,差异无统计学意义（P>0.05）。肿瘤大小>5 cm、存在包膜侵犯、存在远处转移以及高中分化的HCC中,EPR、EPOR、MVD水平高于肿瘤大小≤5 cm、无包膜侵犯、无远处转移以及低分化的水平,差异有统计学意义（P<0.05）。Person相关分析结果显示,EPO表达水平与MVD的相关系数r=0.651（P<0.001）,EPOR表达水平与MVD的相关系数r=0.620（P<0.001）。结论 EPO、EPOR、MVD在HCC中呈现高水平,且与肿瘤大小、局部侵犯、远处转移及分化程度有关,其机制可能与EPO、EPOR增加MVD有关。

Objective To analyze the expression of erythropoietin （EPO） and erythropoietin receptor （EPOR） in hepatocellular carcinoma （NCC） and normal tissues,and their relationship with hepatocyte microvessel density （MVD）. Methods Thirty specimens of hepatocellular carcinoma hepatectomy were selected from our hospital. The liver tissue at the edge of the tumor was taken as a control,and 10 cases of normal liver tissue were used as a negative control. The expression levels of EPO and EPOR in each tissues were detected by enzyme-linked immunosorbent assay （ELISA）,and microvessel density （MVD） was detected by immunohistochemistry. The differences of EPO,EPOR and MVD between each tissues were compared. The relationship between EPO,EPOR,MVD and tumor pathological features in NCC was analyzed. The relationship between EPO and EPOR expression levels and MVD was analyzed. Results In HCC tissues,EPR,EPOR and MVD were higher than those in adjacent tissues and normal tissues. The difference was statistical difference （P<0.001）. EPR,EPOR and MVD were not statistically significant in adjacent tissues and normal tissues. P>0.05）. The levels of EPR,EPOR,and MVD in tumors with tumor size >5 cm,invasion of the capsule,distant metastasis,and high-differentiation were higher than those of tumor size ≤ 5 cm,no capsule invasion,no distant metastasis,and poor differentiation. The difference was statistical difference （P < 0.05）. Person correlation analysis showed that the correlation coefficient between EPO expression level and MVD was r=0.651 （P<0.001）,and the correlation coefficient between EPOR expression level and MVD was r=0.620 （P<0.001）. Conclusion EPO,EPOR and MVD are highly expressed in HCC,and are related to tumor size,local invasion,distant metastasis and differentiation. The mechanism may be related to EPO and EPOR increasing MVD.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.