目的 探讨急性胆囊炎患者术后胆管损伤发生的诊治及影响因素分析。方法 随机选取2019年3月—2020年6月经腹腔镜胆囊切除术后发生胆管损伤的86例急性胆囊炎患者作为观察组,另选同期腹腔镜胆囊切除术治疗未发生胆管损伤的56例患者作为对照组,观察2组患者的影响因素将其进行对比分析。结果 2组患者病历资料中的胆囊壁厚度≥ 4 mm、Calot三角充血、Calot三角水肿经统计学分析有差异(P＜0.01);手术情况中比较发现,胆囊三角区的解剖变异、术中操作不当、术中经验不足情况,经统计学分析有差异(P＜0.05);胆囊壁厚度≥ 4 mm、Calot三角充血、Calot三角水肿、胆囊三角区的解剖变异、术中操作不当、术中经验不足均为急性胆囊炎术后胆管损伤的独立影响因素(P＜0.05)。结论 急性胆囊炎患者术后发生胆管损伤的影响因素较多,应制定精准化的手术方案,在最大程度上减少胆管损伤的发病率,从而确保手术的安全性。

目的 考察灯盏花素辅助阿替普酶治疗溶栓时间窗外急性脑梗死的疗效。方法 选取82例溶栓时间窗外急性脑梗死患者,随机分成实验组(40例)和对照组(42例)。对照组给予阿替普酶治疗,实验组在对照组基础上给予灯盏花素治疗。比较治疗前及治疗2周后,2组患者的神经功能缺损程度[国立卫生研究院卒中量表(NIHSS)]、脑梗死区域组织灌注情况[相对脑血容量(rCBV)、脑血流量水平(CBF)]、血流变学指标[高切全血黏度(HSBV)、低切全血黏度(LSBV)、血浆黏度(PV)、红细胞比容(HCT)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]。结果 治疗2周后,2组NIHSS评分及HSBV、LSBV、PV、HCT、MDA水平皆低于治疗前,且实验组低于同一时间对照组(P＜0.05);2组rCBV、CBF、SOD水平皆高于治疗前,且实验组高于同一时间对照组(P＜0.05)。结论 灯盏花素辅助阿替普酶治疗溶栓时间窗外急性脑梗死的治疗效果较好,有利于逆转患者神经功能缺损程度,增加梗死区域灌注量,改善患者血流情况,对其预后康复有利。

Objective To investigate the efficacy of breviscapine combined with alteplase in the treatment of acute cerebral infarction beyond thrombolytic time window. Methods A total of 82 patients with acute cerebral infarction beyond thrombolytic time window were randomly divided into experimental group (40 cases) and control group (42 cases). The control group was treated with alteplase, and the experimental group was treated with breviscapine on the basis of the control group. Before and 2 weeks after treatment, the degree of neurological deficit [National Institutes of Health Stroke Scale (NIHSS)], regional tissue perfusion of cerebral infarction [relative cerebral blood volume (rCBV), cerebral blood flow (CBF)], hemorheological indexes [high shear whole blood viscosity (HSBV), low shear whole blood viscosity (LSBV), plasma viscosity (PV), hematocrit (HCT)], the indexes of oxidative stress [malondialdehyde (MDA) and superoxide dismutase (SOD)] were compared between the two groups. Results After 2 weeks of treatment, NIHSS score, HBSV, LSBV, PV, HCT and MDA levels of the two groups were significantly lower than those before treatment, and those of the experimental group were significantly lower than the control group at the same time (P＜0.05). The rCBV, CBF and SOD levels of the two groups were significantly higher than those before treatment, while those of the experimental group was significantly higher than the control group (P＜0.05). Conclusions Breviscapine combined with alteplase in the treatment of acute cerebral infarction beyond thrombolytic time window had good therapeutic effect, which was beneficial to improve the degree of neurological deficit, increase the perfusion volume of infarcted area, improve the cerebral blood flow of patients, and was beneficial to the prognosis and rehabilitation.

目的 探讨连续性肾脏替代治疗(CRRT)在治疗重症急性胰腺炎(SAP)中的临床意义。方法 回顾分析2018年1月—2019年1月在我院接受救治的SAP患者64例,根据治疗方案的不同分为观察组和对照组, 每组各搜集32例,2组患者基线水平一致。对照组为采用常规内科方案治疗的病例, 观察组为对照组治疗方案基础上联合CRRT的病例,分析对比2组治疗后的各项疗效指标。结果 2组患者治疗后5~7 d内APACHE Ⅱ评分[(11.02±3.14)vs(13.98±3.27)分]、甘油三脂[(4.02±1.05)vs(5.62±1.11)mmol/L]、C反应蛋白[(88.25±6.73)vs(104.41±10.28)ng/L]、降钙素原[(13.12±4.33)vs(18.55±3.96)ng/mL、血尿素氮[(7.33±1.72) vs (11.24±2.76) mmol/L]、血肌酐[(69.51±15.03) vs(91.12±19.17)mmol/L]相较治疗前均降低,观察组患者上述指标水平下降幅度超过对照组,结果分析差异有统计学意义(t=3.693, 5.924, 7.440, 9.362, 5.235, 6.801, 5.018,P均＜0.001)。观察组患者治疗期间疾病症状缓解时间[(3.15±1.26)vs (5.22±1.51) d]、体征指标稳定时间[(2.52±1.38) vs (4.39±1.50) d]、胃肠功能恢复时间[(4.48±1.27) vs (6.21±1.55) d]以及ICU住院时间[(15.03±2.21) vs (18.44±3.27) d]均低于对照组,结果分析差异有统计学意义(t=5.954, 5.190, 4.884,4.888,P均＜0.05)。结论 与常规内科治疗相比,联合CRRT治疗SAP能够显著改善各项炎症指标,有助患者快速脱离重症危险状态,具有积极的临床价值。

Objective To explore the clinical significance of continuous renal replacement therapy (CRRT) in the treatment of severe acute pancreatitis (SAP). Methods Retrospective analysis of 64 patients with SAP in our hospital from January 2018 to January 2019 was carried out. The patients were divided into the observation group and the control group according to different treatment regimens, with 32 cases in each group, and the baseline levels of the two groups were consistent. Patients in the control group were treated with conventional medical treatment, and the patients in the observation group were treated with CRRT on the basis of the control group, and the efficacy of the two groups were analyzed and compared. Results The APACHE II scores [(11.02±3.14) vs (13.98±3.27)]、triglyceride[(4.02±1.05) vs (5.62±1.11) mmol/L], C-reactive protein[(88.25±6.73) vs (104.41±10.28) ng/L], procalcitonin[(13.12±4.33) vs (18.55±3.96) ng/mL], blood urea nitrogen[(7.33±1.72) vs (11.24±2.76) mmol/L], serum creatinine[(69.51±15.03)vs(91.12±19.17)mmol/L] of patients in both groups were significantly decreased within 5-7 days after treatment compared with those before treatment, and the decrease of the above indicators in the observation group was significantly greater than that in the control group, P<0.05. The remission time of symptoms[(3.15±1.26) vs (5.22±1.51) d], the stabilization time of signs[(2.52±1.38) vs (4.39±1.50) d], the recovery time of gastrointestinal function[(4.48±1.27) vs (6.21±1.55) d] and the length of ICU stay[(15.03±2.21) vs (18.44±3.27) d] in the observation group were lower than those in the control group, and the analysis of the results was statistically significant (t=5.954, 5.190, 4.884,4.888,all P＜0.05). Conclusions Compared with conventional medical treatment, additional CRRT treatment can significantly improve the inflammatory indicators of SAP, help patients survive from critical state of SAP, which has positive clinical value.

目的 分析中山市博爱医院妊娠合并哮喘急性发作患者相关危险因素。方法 选取2019年7月—2021年2月中山市博爱医院收治100例的妊娠合并哮喘患者作为研究对象,将100例妊娠合并患者分为哮喘急性发作组(n=46)与未发作组(n=54),采用多因素Logistic回归分析进行调查分析。结果 100例患者中发作人数为46例,占46.0%。Logistic回归分析显示孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的危险因素(P<0.05)。发作组剖宫产率发生率、住院时间以及并发症发生率均高于未发作组,差异有统计学意义(P<0.05)。结论 孕周、哮喘药物的使用、焦虑、IL-17是妊娠合并支气管哮喘急性发作的独立危险因素,应对此类患者给予高度重视。

Objective To analyze the risk factors of pregnancy complicated with acute attack of asthma in Zhongshan Bo'ai Hospital.Methods A total of 100 patients with pregnancy complicated with asthma treated in Zhongshan Bo'ai Hospital from July 2019 to February 2021 were selected as the research objects.Patients were divided into acute attack group (n=46) and no attack group (n=54).Multivariate logistic regression analysis was used for investigation and analysis.Results The patient number of attack was 46,accounting for 46.0%. The incidence of cesarean section,length of hospital stay and complications in the attack group were higher than those in the no attack group,and the difference was statistically significant (P<0.05).Conclusions Gestational age,use of asthma drugs,anxiety and IL-17 level were independent risk factors for pregnancy complicated with acute attack of asthma.Great attention should be paid to these patients.

目的 探讨沙丁胺醇与M胆碱受体阻断剂应用于支气管哮喘患儿对其症状改善及肺功能的影响。方法 选择我院2018年9月—2019年9月收治的88例支气管哮喘患儿,采用随机数表法分为观察组(n=44)和对照组(n=44)。在对症治疗基础上,对照组给予沙丁胺醇治疗,在对照组基础上,观察组加入M胆碱受体阻断剂(异丙托溴铵气雾剂)治疗。比较两组患儿治疗效果、症状表现、肺功能指标、生活质量及不良反应发生率。结果 与对照组总有效率77.27%(34/44)相比,观察组93.18%(41/44)较高,差异有统计学意义(P＜0.05);治疗7 d后,观察组咳嗽消失时间(5.12±1.88)d、憋喘消失时间(1.88±0.95)d、肺啰音消失时间(5.45±1.21)d均较对照组[(8.03±1.22)d、(3.65±1.04)d、(7.02±1.62)d]短,差异有统计学意义(P＜0.05);治疗7 d后,观察组FVC、FEV₁、PEF水平[(3.38±0.42)、(2.13±0.48)、(435.79±40.75)L/min]均高于对照组[(2.67±0.46)、(1.75±0.43)、(388.94±35.93)L/min],差异有统计学意义(P＜0.05)。治疗7 d后,观察组SGRQ评分(34.11±4.25)分低于对照组(42.52±4.48)分,差异有统计学意义(P＜0.05)。两组不良反应发生率比较[13.64%(6/44),9.09%(4/44)],差异无统计学意义(P＞0.05)。结论 沙丁胺醇与M胆碱受体阻断剂应用于支气管哮喘患儿,可提高其治疗效果,可缩短咳嗽消失、憋喘消失及肺啰音消失时间,改善其肺功能,提高生活质量,降低不良反应发生率,值得临床推广应用。

目的 探讨血常规、血沉、C-反应蛋白水平对小儿急性肺炎的诊断价值。方法 选取2014年1月—2019年12月我院收治的小儿急性肺炎100例作为研究组,同时根据有无发生感染将其分为感染组(26例)与非感染组(74例),另外选择同期在我院检查的健康儿童100例作为对照组。比较感染组与非感染组血常规、血沉、C-反应蛋白水平、感染组与对照组血常规、血沉、C-反应蛋白水平、非感染组与对照组血常规、血沉、C-反应蛋白水平。结果 感染组中性粒细胞百分比、白细胞计数、C-反应蛋白高于非感染组(P＜0.05),两组血沉对比,无明显差异(P＞0.05);感染组中性粒细胞百分比、白细胞计数、C-反应蛋白、血沉高于对照组(P＜0.05);两组中性粒细胞百分比、C-反应蛋白水平相比,无明显差异(P＞0.05),非感染组白细胞计数、血沉高于对照组(P＜0.05)。结论 小儿急性肺炎的诊断中,对小儿的血常规、血沉、C-反应蛋白水平进行检测对诊断疾病非常重要,值得临床使用。

Objective To investigate the diagnostic value of blood routine, erythrocyte sedimentation rate and C-reactive protein level in children with acute pneumonia. Methods A total of 100 cases of acute pneumonia in children admitted to our hospital from January 2014 to December 2019 were selected as the study group. At the same time, they were divided into an infected group (26 cases) and a non-infected group (74 cases) according to the presence or absence of infection. In addition, 100 healthy children examined in our hospital during the same period were selected as the control group. Blood routine examination, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level were compared between infected and non-infected group; in infection and control group blood routine examination, ESR, C-reactive protein level were compared; in non-infection and control group blood routine examination, ESR, C-reactive protein level were compared. Results The percentage of neutrophils, white blood cell count and C-reactive protein in the infected group were higher than those in the non-infected group (P<0.05). There was no significant difference in erythrocyte sedimentation rate between the two groups (P> 0.05). The percentage of neutrophils, leukocyte count, C-reactive protein and erythrocyte sedimentation rate in the infected group were higher than those in the control group (P<0.05). There was no significant difference in the percentage of neutrophils and C-reactive protein levels between the two groups (P> 0.05), and the white blood cell count and erythrocyte sedimentation rate in the non-infected group were higher than those in the control group (P<0.05). Conclusion In the diagnosis of acute pneumonia in children, it is very important to detect the blood routine, erythrocyte sedimentation rate and C-reactive protein level in children, and it is worthy of clinical use.

目的 探讨急性脑梗死采用丹红联合曲克芦丁脑蛋白水解物治疗的效果。方法 本文将2019年7月—2020年9月我院收治的88例急性脑梗死患者作为研究对象,应用简单数字表达法将患者随机分为两组,44例对照组和44例实验组,对照组患者应用丹红注射液治疗,实验组患者则在对照组基础上联合曲克芦丁脑蛋白水解物进行治疗,1个疗程后,统计分析用药后有效率、治疗前后NIHSS评分、血液流变学指标。结果 两组之间治疗后NIHSS评分、血液流变学指标相比,实验组较对照组低;用药后有效率相比,实验组较对照组高,P＜0.05。结论 采用丹红注射液治疗急性脑梗死的基础上给予曲克芦丁脑蛋白水解物治疗可提升疗效,改善患者神经功能缺损状态与血液循环,改善患者预后,促进患者早日康复。

Objective To investigate the effect of Danhong combined with troxerutin brain protein hydrolysate in the treatment of acute cerebral infarction. Methods 88 patients with acute cerebral infarction in our hospital from July 2019 to September 2020 were randomly divided into two groups, 44 cases in the control group and 44 cases in the experimental group. The effective rate, NIHSS score and hemorheology indexes before and after treatment were statistically analyzed after one course of treatment. Results After treatment, NIHSS score and hemorheology indexes of the experimental group were lower than those of the control group; the effective rate of the experimental group was higher than that of the control group, P<0.05. Conclusion On the basis of Danhong injection in the treatment of acute cerebral infarction, troxerutin cerebroprotein hydrolysate can improve the curative effect, improve the neurological deficit and blood circulation, improve the prognosis of patients, and promote the early recovery of patients.

目的 探讨老年急性缺血性脑卒中并发肺部感染患者的临床特征和相关危险因素。方法 采用回顾性研究方法,选择2017年7月— 2019年10月深圳市第二人民医院神经内科收治的1 113例老年急性缺血性脑卒中患者,其中卒中并发肺部感染患者(108 例)纳入感染组,未并发肺部感染患者(1 005例)纳入对照组。以单因素对比分析两组患者的临床资料,采用 Logistic多因素回归分析方法分析合并肺部感染的高危因素。结果 单因素分析提示两组年龄(尤其是高龄患者)、住院天数、房颤、脑梗死史、慢性肺疾病、吞咽困难、言语不清、意识障碍差异有统计学意义(P <0.05)。多因素 Logistics 回归分析显示,高龄(≥80岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍与老年急性缺血性脑卒中并发肺部感染密切相关。结论 老年急性缺血性脑卒中并发肺部感染的独立危险因素主要是高龄(≥80 岁)、住院天数、脑梗死史、吞咽困难、言语不清、意识障碍,临床应高度重视。

Objective Objective To investigate the clinical characteristics and risk factors of elderly patients with acute ischemic stroke complicated with pulmonary infection. Methods A retrospective study was conducted on 1 113 elderly patients with acute ischemic stroke admitted to the department of neurology, Shenzhen Second People's Hospital from July 2017 to October 2019. Among them, 108 patients with stroke complicated with pulmonary infection were included in the infection group and 1 005 patients without concurrent pulmonary infection were included in the control group. The clinical data of the two groups were analyzed by single factor comparison, and the risk factors for pulmonary infection were analyzed by logistic multiple factor regression analysis. Results Single factor analysis showed there were statistically significant differences between the two groups in age (especially elderly patients), length of stay in hospital, atrial fibrillation, history of cerebral infarction, chronic pulmonary disease, dysphagia, slurred speech, and disturbance of consciousness (P <0.05). Multi-factor logistic regression analysis showed that old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech, and disturbance of consciousness were closely related to pulmonary infection in elderly patients with acute ischemic stroke. Conclusion The independent risk factors of acute ischemic stroke complicated with pulmonary infection in the elderly mainly include old age (≥80 years old), length of stay in hospital, history of cerebral infarction, dysphagia, slurred speech and disturbance of consciousness, which should be paid more attention to clinically.

目的 探讨中性粒细胞及淋巴细胞比值与急性冠状动脉综合征、冠状动脉狭窄程度的相关性。方法 选取2019年2月—2020年2月我院收治的急性冠状动脉综合征患者90例作为研究对象,根据检查结果将患者分为两组,分别为不稳定心绞痛组(51例)、急性心肌梗死组(39例),同时选取同期在我院检查且没有明显狭窄的患者52例作为对照组。对三组人群的中性粒细胞-淋巴细胞比值进行测定。比较三组人群中性粒细胞-淋巴细胞比值(NLR)、冠状动脉病变(Gensini)评分、不同冠状动脉病变狭窄患者NLR、Gensini评分、分析中性粒细胞-淋巴细胞比值与急性冠状动脉综合征、冠状动脉狭窄程度的相关性。结果 急性心肌梗死组NLR值大于不稳定心绞痛组、对照组(P＜0.05),急性心肌梗死组Gensini评分高于不稳定心绞痛组、对照组(P＜0.05);重度冠状动脉病变狭窄组NLR值大于中度狭窄组、轻度狭窄组(P＜0.05),重度冠状动脉病变狭窄患者Gensini评分高于中度狭窄组、轻度狭窄组(P＜0.05);NLR与急性冠状动脉综合征、冠状动脉狭窄程度呈正相关(r=0.236,P＜0.05;r=0.214,P＜0.05)。结论 中性粒细胞-淋巴细胞比值与急性冠状动脉综合征有明显的关系,且可以对患者的冠状动脉狭窄程度进行判断。

目的 探讨D-二聚体在急诊胸痛中心早期鉴别诊断急性主动脉综合征(AAS)的重要性,以及讨论如何结合D-二聚体检测优化现有胸痛中心的急救流程。方法 收集近1年来我院胸痛中心收治的50例以胸痛为主诉的患者资料,其中25例最终确诊AAS的患者作为AAS组,以同一时期诊治的25例进行了急诊经皮冠状动脉介入治疗(PCI)确诊的急性非ST抬高型心肌梗死(NSTEMI)患者作为对照组。所有患者在首诊时检测血D-二聚体,通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),分析D-二聚体对AAS与NSTEMI的鉴别诊断价值,并探讨其优化胸痛中心救治流程的实际意义。结果 AAS组D-二聚体水平明显高于NSTEMI组,差异具有统计学意义(P<0.001),且在D-二聚体为89 500 μg/L时取得最佳截止点。结论 对于胸痛患者早期鉴别诊断,D-二聚体具有重要参考价值。

Objective To explore the importance of D-dimer in early differential diagnosis of acute aortic syndrome (AAS) in the emergency chest pain center. And to discuss how to combine D-dimer detection with optimizing the first aid process of existing chest pain centers. Methods The data of 50 patients who complained of chest pain in the chest pain center of our hospital in the past 1 year was collected, including 25 patients who were finally diagnosed as AAS group. Other 25 patients with acute non-ST elevation myocardial infarction (NSTEMI) diagnosed by emergency percutaneous coronary intervention (PCI) were included as control group. Blood D-dimer was detected in all patients at the first visit. By drawing receiver operating characteristic curve (ROC), the value of D-dimer in differential diagnosis between AAS and NSTEMI was analyzed, and the practical significance of optimizing the treatment process of chest pain center was discussed. Results The level of D-dimer in AAS group was significantly higher than that in NSTEMI group (P<0.001), and the best cutoff point was obtained when D-dimer was 895.00 μg/L. Conclusion D-dimer has reference significance for early differential diagnosis of patients with chest pain.