目的 评价急性心肌梗塞患者转往有条件医院行PCI治疗前应用替罗非班(血小板Ⅱb/Ⅲa受体拮抗剂)的临床疗效与安全性。方法 选取从2013年1月—2014年9月诊断为急性心肌梗塞行PCI治疗的患者共66例。随机分为观察组(确定转院行PCI治疗前在我院应用替罗非班) 34例、对照组(转运到花都区人民医院心内科行PCI治疗后应用替罗非班) 32例。观察比较两组患者首次造影的冠脉血流情况与术后的冠脉血流情况、PCI时心电图抬高的ST回落情况与心肌标志物峰值前移情况、住院期间与随访30天期间不良心血管事件(MAGC)的发生情况(支架内血栓与二次血运重建发生率、再梗塞率、心绞痛、死亡率)以及两组的不良反应。结果 观察组首次造影的冠脉血流优于对照组;术后的冠脉血流观察组优于对照组(P<0.05);PCI时心电图ST回落≥1/2的情况与TNI、CK-MB峰值前移情况优于对照组(P<0.05);不良心血管事件发生率较对照组少(P<0.05);不良反应发生率差异无统计学意义(P>0.05)。结论 急性心梗转院PCI患者,转院前应用替罗非班比转院后应用获益更大,安全性尚可。这类病人,在确定转院之时即时应用替罗非班是合理时机。

目的 分析研究阿奇霉素治疗急性肠炎的临床疗效。方法 选取我院2012年5月—2014年6月期间收治急性肠炎患者52例,分成研究组和对照组各26例,研究组应用阿奇霉素治疗,对照组患者应用培氟沙星治疗,比较两组患者临床疗效、退热时间、止泻时间、症状体征好转时间、症状体征消失时间、治疗费用等指标。结果 研究结果显示,研究组患者临床疗效、退热时长、止泻时长、症状体征好转时间长、症状体征消失时间长、医疗费用等指标均优于对照组,差异有统计学意义(P<0.05)。结论 应用阿奇霉素治疗急性肠炎患者,临床效果显著,治疗时间短、安全,降低患者治疗费用。

目的 探讨血清降钙素原(PCT)与中性粒细胞淋巴细胞比率(NLR)对预测急性胰腺炎(AP)继发急性肺损伤(ALI)的临床适用性。方法 回顾性分析60个AP病例,对合并ALI的实验组和没有合并ALI的对照组治疗前后血清PCT和NLR进行均数比较、相关性分析、ROC分析等统计分析。结果 两组间治疗前NLR(P=0.019)与治疗期间血清PCT平均值(P<0.001)有统计学差异,ROC分析:治疗前NLR、治疗期间血清PCT平均值对于预测ALI的灵敏度、特异度、约登指数分别为0.778、0.889;0.690、0.881;0.468、0.77,两者的差异有统计学意义(P=0.0134)。结论 急性胰腺炎早期治疗前,NLR对于预测ALI有一定的参考价值,而在急性胰腺炎后期,治疗期间的血清PCT平均值对于预测ALI有着良好的灵敏度和特异度,具有一定的临床适用性。

Objective To investigate the clinical applicability of serum procalcitonin levels and neutrophil-to-lymphocyte ratio (NLR) in predicting acute lung injury(ALI) secondary to acute pancreatitis(AP). Methods Sixty cases of AP were recruited to explore their serum-PCT and NLR before/after treatment. Means comparison, correlation analysis, ROC analysis were carried out. Results The NLR before treatment (P=0.019)and serum-PCT after treatment(P<0.001)were statistical significance of two groups(ALI、NON-ALI). In ROC analysis, the sensitivity, specificity, Jorden index of above two index were 0.778、0.889;0.690、0.881;0.468、0.77 respectively. There were statistically significant differences between them(P=0.0134). Conclusion In the early phase before treatment in AP, NLR has certain reference value in predicting ALI. On the other hand, in the later phase after treatment in AP, serum-PCT has great sensitivity, specificity and clinical applicability.

目的 探讨急性阑尾炎(acute appendicitis, AA)及急性感染性肠炎(acute infectious enteritis, AIE)患儿的阑尾高频超声影像特点及其显像敏感性。方法 回顾性分析临床确诊为急性阑尾炎患儿120例,急性感染性肠炎患儿160例,并对其行高频超声检查,另设120例正常儿童为对照组。分析高频超声阑尾显示率,阑尾外径,阑尾周围系膜炎性变化以及阑尾的位置等情况。结果 AA组、AIE组、对照组阑尾的显示率分别为96.7%、80.6%、68.3%,差异有统计学意义(P<0.05)。三组超声显示的阑尾外径分别为(8.5±2.2)mm、(4.3±0.8)mm、(3.5±0.7)mm,相互间差异亦均有统计学意义(P<0.05)。AA组所有的阑尾周围系膜炎症改变均可探及,但AIE组的阑尾周围系膜无变化。结论 小儿急性阑尾炎高频超声显像敏感性高,旨在为临床对AA早期诊断、早期治疗提供较准确全面的影像学依据。

Objective Use high-frequency ultrasound to determine the frequency of visualization and image feature of the appendix in children with acute appendicitis (acute appendicitis, AA) and with acute infectious enteritis (acute infectious enteritis, AIE). Methods The ultrasonic features of 120 children with AA, 160 children with AIE, and 120 randomly selected asymptomatic children were analyzed retrospectively. And their visualization rate, outer appendiceal diameter, presence or absence of inflamed periphery appendiceal mesenterium, and location of the appendix were recorded. Results The visualization rates of the appendix were 96.7%, 80.6%, and 68.3% for AA groups, AIE groups, and the control, respectively(P<0.05). The outer appendiceal diameters for the 3 groups were (8.5±2.2)mm, (4.3±0.8)mm, and (3.5±0.7)mm. Difference among the 3 groups was statistically significant also. Periphery appendiceal inflamed mesenterium was detected in all AA cases, but in none of the AIE cases. Conclusion High ultrasound imaging sensitivity of puerile acute appendicitis provided relatively accurate comprehensive imaging basis for clinical early diagnosis and early treatment.

目的 分析丁苯酞软胶囊联合疏血通治疗急性脑梗死的临床效果。方法 随机抽取我院近几年来收治的急性脑梗死患者87例,按照患者治疗方式分为两组,两组患者均予以常规治疗,对照组43例在此基础上以疏血通治疗,治疗组44例患者在此基础上以丁苯酞软胶囊联合疏血通治疗,对比两组患者治疗效果。结果 治疗组临床疗效总有效率较对照组临床疗效总有效率提高18.8%,两组患者治疗后NIHSS评分较治疗前降低,治疗组治疗后NIHSS评分较对照组低,心理健康、社会功能、精神功能及日常能力较对照组相比,P<0.05。两组患者治疗前后未发生肝肾功能异常情况,无出血等不良反应。结论 丁苯酞软胶囊联合疏血通治疗急性脑梗死具有效果,可改善患者神经功能缺损,临床价值确切。

目的 评估灯盏花素联合自血穴位注射疗法治疗慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效。方法 对照组使用常规治疗方法,治疗组加用灯盏花素联合自血穴位注射疗法。所有入组患者在入院和出院当天进行圣乔治呼吸问卷(SGRQ)评分和COPD评估测试(CAT)评分,使用统计软件比较两组的SGRQ总评分、CAT评分和住院天数。结果 SGRQ总评分、CAT评分和住院天数有正相关关系;和对照组相比较,治疗组SGRQ总评分在治疗前后没有差异, CAT评分在治疗前后有差异,治疗组的住院天数减少。结论 SGRQ总评分、CAT评分能够反映AECOPD病情,CAT评分更加适合评估AECOPD短期病情变化,灯盏花素联合自血穴位注射疗法治疗AECOPD具有临床疗效。

Objective It was evaluated the clinical effect of the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with Breviscapine combined with self-blood acupoint injection therapy. Methods Routine treatment methods were used in the controlled group. Breviscapine and the self-blood acupoint injection therapy were added into the treatment group. St George's respiratory questionnaire (SGRQ) and chronic obstructive pulmonary disease assessment test (CAT) were done in all enrolled patients. And the total score of SGRQ, the score of CAT and the length of stay in hospital were assessed. Results There were positive relationships between the total score of SGRQ, the score of CAT and the length of stay in hospital.compared with the controlled group, before and after the treatment, significant difference was not observed with the overall score of SGRQ in the treatment group, but was observed with the score of CAT in the treatment group, and stay time in hospital in the treatment group was declined obviously. Conclusion The total score of SGRQ and the score of CAT could reflect the conditions of AECOPD, and the latter was more suitable for the evaluation of the condition change in short period. The clinical effects were obvious in the treatment of AECOPD with Breviscapine combined with self-blood acupoint injection therapy.

目的 探讨FLT3及C-kit基因突变在急性髓细胞白血病(AML)中的临床意义。方法 回顾性分析南方医院2010年1月—2013年12月期间初诊AML患者的临床资料,PCR分析FLT3及C-kit基因突变情况。结果 248例初诊AML患者中, FLT3-ITD突变率为16.9%,TKD突变率为3.2%,C-kit8号外显子突变率为1%,17号外显子突变率为5.2%;FLT3-ITD突变更倾向发生于正常染色体核型的AML患者;FLT3突变阳性组及C-kit突变阳性组患者的外周血白细胞数高于基因突变阴性组,染色体核型正常患者的无病生存时间较阴性组缩短(P<0.05)。但是对血红蛋白、血小板及完全缓解率(CR率)并无影响(P>0.05)。结论 FLT3及C-kit突变的AML患者有较差的临床预后。

Objective This study was to investigate the prognostic value of FLT3 and C-kit gene mutations in patients with acute myeloid leukemia (AML). Methods We retrospect and analyzed the data of the 248patients with newly diagnosed AML from January 2013 to December 2010. FLT3 and C-kit gene mutations was detected by Polymerase chain reaction (PCR). Results Among these 248 subjects, the FLT3-ITD mutation rate was 16.9%, FLT3-TKD was 3.2%, C-kit 8 exon mutation rate was 1% and 17exon mutationwas 5.2%. FLT3-ITD mutation likely occurred in AML patients with normal karyotype. The patients with FLT3-ITD mutation or C-kit mutation had significantly higher PWBC and shorter DFS than patients without gene mutations (P< 0.05), but there was no significantly differences in sex, age, Hb, PLT and CR rate of the first course induction chemotherapy among groups (P>0.05). Conclusion Among patients with AML,FLT3-ITD and C-kit mutations were associated with worse prognosis.

目的 观察有创-无创序贯通气治疗慢性阻塞性疾病(COPD)急性加重并呼吸衰竭的疗效。方法 选取2013年3月—2015年3月在兴宁市人民医院呼吸科收治的COPD急性加重并II型呼吸衰竭、需行机械通气的患者80例,随机进行有创-无创序贯通气治疗组A和单一有创通气治疗组B,两组除了机械通气的方式不同之外,其他的常规治疗均相同,主要观察两组患者进行相关机械通气方式前后的呼吸、循环及血气指标的变化情况以及进行机械通气的总时间和住院时间及呼吸机相关肺炎(VAP)的发生例数。结果 治疗组患者的血气、呼吸及循环内的各项生化指标改善程度均与对照组无统计学意义(P>0.05),同时治疗组患者的VAP的发生率,总的住院时间,进行机械通气的总时间少于对照组患者,有统计学意义(P<0.05)。结论 采用有创-无创序贯通气治疗慢性阻塞性疾病(COPD)急性加重并呼吸衰竭综合治疗效果要好于采用单一有创通气治疗,值得临床推广应用。

目的 通过建立急性心力衰竭（AHF）患者服药依从性预测模型,提高AHF患者的服药依从性和临床管理效果。方法 纳入2021年1月—2023年12月在广州市番禺区何贤纪念医院住院治疗的580例AHF患者,通过收集患者的一般人口学资料、疾病相关资料及出院后6个月的服药依从性数据,应用Logistic回归模型分析患者服药依从性的影响因素,并基于影响因素建立预测模型。结果 患者服药依从性总体良好（75%）。依从性良好组与依从性差组的年龄、独居情况、合并基础病、服药种类、疾病了解评分、治疗信心评分和自我控制信心评分比较差异有统计学意义（P<0.05）。Logistic 回归分析显示危险因素包括年龄≥60岁（OR=1.774）、独居（OR=1.871）、合并基础病≥2种（OR=1.719）和服药种类≥7种（OR=1.456）。而疾病了解评分（OR=0.923）、治疗信心评分（OR=0.946）和自我控制信心评分（OR=0.901）是保护因素（P<0.05）。基于上述因素建立的预测模型,通过ROC曲线验证,曲线下面积为0.815（95%CI：0.780~0.850）,提示所构建的模型具有良好的区分度。对该模型的校准度进行评价,P=0.528,提示该预测模型拟合度良好。此外,该预测模型的一致性指数为0.738,说明模型的预测性能良好。绘制的决策曲线中,曲线位于极端线之上,当阈概率取值在9%~59%时,对应的净获益率为0~27%,提示建立的模型具有优秀的临床有效性。结论 AHF患者的服药依从性受到多种因素的影响,包括年龄、居住状态、合并基础病种类及服药种类等。

Objective To establish a predictive model for medication compliance among acute heart failure（AHF）patients in order to enhance their therapeutic compliance and optimize clinical outcomes. Methods A total of 580 AHF inpatients at He Xian Memorial Hospital in Panyu District, Guangzhou between January 2021 and December 2023 were enrolled. Demographic information, disease-specific data,as well as post-discharge medication compliance records within six-month were collected by investigators. Utilizing logistic regression analysis revealed several influential determinants affecting medication compliance which formed the basis for constructing our predictive model. Results Generally,patient compliance was good（75%）. The comparison between the good compliance group and the poor compliance group showed that there were significant differences in age, living alone,combined with underlying diseases, types of medication, disease understanding score, treatment confidence score and self-control confidence score（P<0. 05）. Logistic regression analysis showed that independent risk indicators including individuals aged ≥60 years（odds ratio[OR]=1. 774）, those living alone（OR=1. 871）, presence of two or more underlying diseases（OR=1. 719）, along with consumption of seven or more medications daily（OR=1. 456）. Conversely,disease awareness score（OR=0. 923）, treatment confidence score（OR=0. 946）, and self-control confidence score（OR=0. 901）were identified as independent protective factors. Validation using receiver operating characteristic curves demonstrated robust predictive performance with an area under curve value of 0. 815（95%CI：0. 780-0. 850）, affirming its efficacy. The calibration of the model was evaluated, with a P-value of 0. 528, indicating good fit of the predictive model. Additionally, the concordance index（C-index）of the model was 0. 738, suggesting its excellent predictive performance. The decision curve analysis revealed that the curve was above the extreme lines, with a net benefit rate ranging from 0 to 27% when the threshold probability falls between. Conclusions The medication compliance of AHF patients is influenced by various factors, including age, living arrangement, the number of underlying diseases, and the number of medications taken. Targeted interventions such as enhancing patient education, simplifying treatment regimens, and improving social support can effectively improve the medication compliance of AHF patients. The predictive model established in this study provides a scientific basis for clinicians to develop more precise and effective individualized intervention measures,thereby improving the prognosis and quality of life.

目的 建立大鼠急性心肌梗死缺血再灌注后无复流模型,并初步验证细胞焦亡在其中的发生情况。方法 选用20只标准成年雄性Sprague Dawley大鼠（体质量260~320 g）,随机分为对照组（n=5）和手术组（n=15）。对照组仅穿线冠状动脉,未行结扎;手术组结扎左前降支0.5 h后解除,进行再灌注4 h,以建立无复流模型。通过Evens blue和硫磺素S染色,评估心肌的正常供血区、再灌注区及无复流区,并对两组大鼠心肌组织进行病理分析。结果 对照组大鼠全部存活,未出现无复流现象,心肌组织中未见细胞焦亡。手术组存活13只,形成明确的正常供血区（n=13）、再灌注区（n=13）和无复流区（n=10）。在无复流区的心肌细胞中均观察到细胞焦亡（n=10）,而正常供血区未见（n=0）,再灌注区部分出现（n=4）,差异具有统计学意义（P<0.05）。结论 细胞焦亡现象主要存在于大鼠急性心肌梗死缺血再灌注后无复流区域中,细胞焦亡可能作为一种区域特异性程序性死亡方式,在心肌无复流的发生与发展中发挥重要作用。

Objective To establish a rat model of myocardial no-reflow after acute myocardial infarction with ischemia-reperfusion injury and to preliminarily explore the occurrence of pyroptosis in the affected myocardium. Methods Twenty adult male Sprague-Dawley rats（260-320 g）were randomly divided into a control group（n=5）and a surgical group（n=15）. In the control group,the coronary artery was encircled with suture but not ligated. In the surgical group,the left anterior descending artery was ligated for 30 minutes, followed by 4 hours of reperfusion to induce the no-reflow model. Evans blue and thioflavin S staining were used to evaluate the normal perfusion area,reperfusion area,and no-reflow area of the myocardium. Histopathological analysis was conducted on myocardial tissues from both groups. Results All rats in the control group survived without evidence of no-reflow or pyroptosis in myocardial tissue. In the surgical group, 13 rats survived and showed distinct regions of normal perfusion, 13 with reperfusion, and 10 with no-reflow. Pyroptosis was observed in all no-reflow areas（n=10）, absent in the normal perfusion zones（n=0）, and partially present in the reperfusion zones（n=4）. The differences were statistically significant（P<0. 05）. Conclusions Pyroptosis predominantly occurs in the no-reflow zones following acute myocardial infarction and ischemia-reperfusion injury in rats. As a region-specific form of programmed cell death, pyroptosis may play an important role in the development of myocardial no-reflow.