目的 探讨无创血流动力学监测(non-invasive cardiac output monitoring,NICOM)在儿童脓毒性休克早期液体复苏的临床应用评价。方法 选取2019年1月—2020年6月期间在我院PICU患儿诊断为儿童脓毒性休克61例,随机分为对照组(未接受NICOM监测29例)和干预组(接受NICOM监测32例),记录液体复苏后6、12、24小时血气分析(pH值、剩余碱、乳酸)、尿量以及病死率、NICOM监测(CO、CI、SVR、SV、SVRI、HR、MAP)等结果。结果 液体复苏6 小时后两组HR、MAP、乳酸、剩余碱、尿量比较无统计学差异 (P>0.05),液体复苏12 h后干预组乳酸较对照组降低,差异有统计学意义(P<0.05);液体复苏24 h后两组HR、MAP、乳酸、剩余碱及尿量比较,差异均有统计学意义 (P<0.05)。干预组治疗后12 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05),干预组治疗后24 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05)。结论 NICOM具有敏感度及准确率高,且操作简单,可有效用于指导脓毒性休克早期液体复苏,针对个体化治疗提供客观依据,正确指导容量管理,具有科学实用价值,值得推广。

Objective To evaluate the clinical application of non-invasive cardiac output monitoring (NICOM) for early fluid resuscitation in children with septic shock. Methods 61 children diagnosed with septic shock in the PICU at our hospital between January 2019 and June 2020 were randomly divided into a control group (29 without NICOM monitoring) and an intervention group (32 with NICOM monitoring), and the results of blood gas analysis (pH,lactate and residual base), urine volume, and mortality, and NICOM monitoring (CO, CI, SVR, SVRI, HR, and MAP) were recorded at 6, 12, and 24 h after fluid resuscitation. Results There was no statistically significant difference in HR, MAP, lactic acid, residual base and urine volume between the two groups after 6 h of fluid resuscitation (P>0.05), and lactic acid was lower in the intervention group than that in the control group after 12 h of fluid resuscitation (P<0.05); the differences in HR, MAP, lactic acid, residual base and urine volume between the two groups after 24 h of fluid resuscitation were all statistically significant (P<0.05). The differences were statistically significant (P<0.05) in CO, CI, SVR, SVI, HR, and MAP at 12 h and at 24 h after treatment in the intervention group compared with that of the pre-treatment (P<0.05). Conclusion NICOM has high sensitivity and accuracy and it can be operated in simple processes. It may be effectively applied to guide the early fluid resuscitation of septic shock. It also provides Objective evidence for individualized treatment and correctly guides volume management. Its scientific and practical value makes it worth promoting.

目的 探讨微量喂养对早产儿早期喂养不耐受喂养结局的影响。方法 选择我院2019年1月—2020年6月胎龄≤34周、出生后1周内反复出现喂养不耐受的早产儿78例,采用随机数字表法分为微量喂养组(38例)和中断喂养组(40例),比较两组患儿喂养不耐受的改善及喂养结局的差异性。结果 相对于直接中断喂养,微量喂养3～5天的患儿喂养不耐受改善率更高、体质量增长速度更快、更早达完全肠内喂养时间、静脉营养时间和住院时间也缩短了。而且胆汁淤积症发生率也低于中断喂养组,差异具有统计学意义,两组坏死性小肠结肠炎发生率比较无差异。结论 对于胎龄≤34周、生后1周内反复出现喂养不耐受的早产儿,在排除了外科或败血症早期表现的情况下,相对于中断喂养,选择微量喂养可改善患儿的喂养结局,而且不会增加坏死性小肠结肠炎的发生。

Objective To investigate the effect of minimal feeding on the outcome of early feeding intolerance in premature infants. Methods Seventy-eight premature infants with gestational age＜34 weeks and recurrent feeding intolerance within 1 week after birth in our hospital from January 2019 to June 2020 were selected. They were randomly divided into minimal feeding group (38 cases) and interrupted feeding group (40 cases) to compare the improvement of feeding intolerance and the difference of feeding outcome between the two groups. Results Compared with discontinuation of feeding, the rates of feeding intolerance improvement were higher in children who were given minimal feeding for 3-5 days,and they had faster weight gainand, the time to complete enteral feeding got earlier, intravenous nutrition time and hospitalization time were also shortened. Moreover, the incidence of cholestasis was also lower than that of the interrupted feeding group, and the difference was statistically significant. There was no difference in the incidence of necrotizing enterocolitis between the two groups. Conclusion For premature infants with gestational age＜34 weeks and feeding intolerance happened within 1 week after birth, excluding the early manifestation of surgery or sepsis, minimal feeding can improve the feeding outcome of the infants compared with discontinuation of feeding, without increasing the incidence of necrotizing enterocolitis.

目的 儿童流感相关坏死性脑病(influenza-associated necrotizing encephalopathy,IANE)是一种严重的流感并发症,目前缺乏早期诊断预警指标,本文探讨血生化和脑脊液检测在儿童IANE早期预警中的作用,为IANE早期诊断提供预测参考。 方法 回顾分析2016年1月—2020年12月在我院接受诊治的确诊流感并发神经系统并发症的患儿。40例流感相关性脑病(influenza-associated encephalopathy,IAE)和32例IANE患儿纳入研究。采用受试者工作特征曲线(ROC)分析来确定所选变量的预警价值。 结果 与IAE组相比,IANE组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐激酶(CK)、乳酸脱氢酶(LDH)、脑脊液乳酸脱氢酶(CSF LDH)、脑脊液蛋白(CSF PRO)均升高,两组差别有统计学意义(P<0.05)。用于区分IAE和IANE的LDH、CSF LDH和CSF PRO的曲线下面积(AUC)分别为0.876、0.853和0.831。LDH>535 U/L预测IANE的敏感度为89.7%,特异度为86.5%。CSF LDH>67 U/L预测IANE的敏感度为82.8%,特异度为73.3%。CSF PRO>0.49 g/L预测IANE的敏感度为73.7%,特异度为76.6%。IANE患儿死亡10例(43.3%),IAE患儿死亡0例(P<0.05)。 结论 IANE组LDH、CSF LDH和CSF PRO明显升高,可作为IANE的早期预警指标。对此类患儿要密切评估,早期预测及干预,减少后遗症及病死率,改善预后。

Objective Influenza-associated necrotizing encephalopathy (IANE) in children is a serious complication of influenza. At present, there is a lack of indicators for early diagnosis and early warning. In this paper, the role of blood biochemical and cerebrospinal fluid detection in early warning of IANE in children is discussed, so as to provide a predictive reference for early diagnosis of IANE. Methods A retrospective analysis was conducted on children diagnosed with influenza and with neurological complications who were treated in our hospital from January 2016 to December 2020. Forty children with influenza-associated encephalopathy (IAE) and 32 children with IANE were included. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive value of the selected variables. Results Compared with IAE group, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine kinase (CK), lactate dehydrogenase (LDH), cerebrospinal fluid lactate dehydrogenase (CSF LDH) and cerebrospinal fluid protein (CSF PRO) were all increased in IANE group, and the differences between the two groups were statistically significant (P<0.05). The area under curve (AUC) of LDH, CSF LDH and CSF PRO used to distinguish IAE from IANE were 0.876, 0.853 and 0.831, respectively. The sensitivity and specificity of LDH>535 U/L for predicting IANE were 89.7% and 86.5% respectively. The sensitivity and specificity of CSF LDH>67 U/L for predicting IANE were 82.8% and 73.3% respectively. The sensitivity and specificity of CSF PRO＞0.49 g/L in predicting IANE were 73.7% and 76.6%. There were 10 deaths of IANE (43.3%) and 0 death of IAE (P<0.05). Conclusion The levels of LDH, CSF LDH and CSF PRO were significantly increased in IANE group, which could be used as early warning indicators for IANE. For such children, close evaluation, early prediction and intervention should be made to reduce sequelae and fatality rate and to improve prognosis.

目的 研究妊娠早期低血压对子宫动脉血流的影响。方法 前瞻性连续收集2020年9月—2021年3月在广州市妇女儿童医疗中心行产前检查的早孕期正常单胎妊娠孕妇,分为两组:低血压组(43人)及正常血压组(73人),分别监测两组孕妇的双侧子宫动脉血流搏动指数 (pulse index,PI)及收缩期峰值 (peak systolic velocity,PSV),并比较两组间PI及PSV是否有统计学差异。结果 双侧子宫动脉血流PI与平均动脉压呈线性正相关关系(P＜0.05)。低血压组双侧子宫动脉PI低于正常血压组,差异有统计学意义(P＜0.05),低血压组右侧子宫动脉PSV低于正常血压组,差异有统计学意义(P＜0.05),左侧子宫动脉PSV两组间无差异(P＞0.05)。结论 低血压孕妇子宫动脉血流动力学参数异常降低,临床应重视妊娠期低血压孕妇子宫动脉血流动力学异常者的围产期管理。

Objective To study the relationship between early pregnancy hypotension and uterine artery blood flow. Methods We prospectively and consecutively selected pregnant women with normal singleton pregnancy in early pregnancy for this study from September 2020 to March 2021 in Guangzhou Women and Children's Medical Center. According to the blood pressure, they were divided into hypotension group (n=43) and normal blood pressure group (n=73). We monitored the pulse index (PI) and peak systolic velocity (PSV) of bilateral uterine artery blood flow, then compared the PI and PSV between the two groups. Results There was a positive linear correlation between PI and mean arterial pressure (P＜0.05). The PI of bilateral uterine arteries in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of right uterine artery in hypotension group was lower than that in normal blood pressure group (P＜0.05). PSV of left uterine artery in hypotension group was not different from that in normal blood pressure group (P＞0.05). Conclusion Uterine artery hemodynamic parameters of hypotensive pregnant women decreased abnormally, so attention should be paid to the perinatal management of pregnant women with abnormal uterine artery hemodynamics.

目的 观察早期经鼻肠内营养(ENEN)对中-重度急性胰腺炎(MSAP+SAP)患者的治疗效果。方法 回顾性分析2014年9月—2019年5月期间,广东药科大学附属第一医院消化内科收治的50例MSAP及SAP患者临床资料,根据患者营养支持治疗方式不同,将患者分为观察组(n=25)和对照组(n=25)。观察组患者采用ENEN治疗,对照组采用肠外肠内营养联合(PNEN)治疗。对比两组患者治疗后血清白蛋白(ALB)、血清前白蛋白(PA)、C-反应蛋白(CRP)、急性生理与慢性健康(APACHE Ⅱ)评分、序贯器官功能衰竭(SOFA)评分及多器官功能障碍综合征(MODS)发生率。结果 经过治疗后,观察组患者ALB水平、PA水平高于对照组,CRP水平低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者APACHE Ⅱ评分、SOFA评分低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者MODS发生率低于对照组,差异有统计学意义(P＜0.05)。结论 ENEN治疗MSAP及SAP患者可有效改善患者营养状态和健康状况,降低机体炎症反应,减少MODS发生率。

Objective To observe the effect of early nasal enteral nutrition(ENEN) on patients with moderate to severe acute pancreatitis(MSAP+SAP). Methods A retrospective analysis of the clinical data of 58 patients with(MSAP+SAP) admitted to the department of gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2014 to May 2019, according to the different nutritional support treatment methods, the patients were divided into observation groups(n=25) and control group(n=25). Patients in the observation group were treated with ENEN, and the control group was treated with Parenteral nutrition and enteral nutrition(PNEN). Serum albumin(ALB), serum prealbumin(PA), C-reactive protein(CRP), acute physiology and chronic health evaluation(APACHE II) score, sequential organ failure assessment(SOFA) score, and incidence of multiple organ dysfunction syndrome(MODS) were compared between the two groups. Results After treatment, the ALB and PA level of the observation group were higher than those of the control group, and the CRP level was lower than that of the control group, the difference was statistically significant(P<0.05). After treatment, the APACHE II score and SOFA score of the observation group were lower than those of the control group, and the difference was statistically significant(P<0.05). After treatment, the incidence of MODS in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion ENEN treatment of MSAP and SAP may effectively improve the nutritional status and health of patients, reduce the body's inflammatory response and reduce the incidence of MODS.

目的 分析应用蓝激光成像技术(BLI)联合内镜智能分光比色技术(FICE)诊断早期食管癌的临床意义。方法 收集本院及下级医院2016年1月—2018年6月在普通内镜下发现的108例食管可疑病变患者,分别给予白光、FICE和BLI不同模式进行观察诊断,再结合放大模式对病变部位的上皮乳头内毛细血管袢(IPCL)进行观察、分型、判断性质。最后取活检送病理学检查。内镜数据和病理数据采用Kappa一致性检验方法、Spearman相关性分析,统计每种内镜检查模式诊断的准确性,分析各方法下IPCL分型与病理诊断之间的相关性。结果 Kappa一致性检验显示,白光内镜、FICE、BLI以及FICE+BLI等模式诊断早期食管癌的准确度、敏感度、特异度、阳性预测、阴性预测及Kappa值呈逐步升高;Spearman相关性分析显示,FICE、BLI以及BLI与FICE联合诊断时,IPCL分型与早期食管癌的诊断均呈正相关,且BLI联合FICE的相关性强于BLI或FICE单独诊断。结论 BLI联合FICE可显著提高早期食管癌的诊断率,结合放大内镜下IPCL分型可判断早期食管癌病理分型。

Objective To analyze the clinical significance of blue laser imaging (BLI)technology combined with Fuji intelligent chromo endoscopy (FICE)in the diagnosis of early esophageal cancer. Methods 108 cases of patients with esophageal suspicious lesions admitted to our hospital from January 2016 to June 2018 were enrolled in the study. They were given different modes of white light, FICE and BLI for observation and diagnosis, and the magnifying endoscopy model was combined to observe the intraepithelial papillary capillary loop (IPCL)at lesions sites for IPCL typing. After complete endoscopic examinations, the lesions were taken for pathological examination. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of each method were tested by Kappa consistency test. Spearman correlation analysis was used to analyze the correlation between IPCL classification and pathological diagnosis under each method. Results Kappa consistency test showed that the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of white light endoscopy, FICE, BLI and FICE+BLI were increased in the diagnosis of early esophageal cancer. IPCL classification under combined magnifying endoscopy showed that type IV was mainly early esophageal cancer, and types I-III were mainly precancerous lesions. Spearman correlation analysis showed that through FICE, BLI and BLI combined with FICE for diagnosis, IPCL classification was positively correlated with early esophageal cancer, and the correlation of BLI combined with FICE was stronger than that of BLI or FICE. Conclusions BLI combined with FICE can greatly improve the diagnosis rate of early esophageal cancer. Combined with magnifying endoscopy, IPCL classification can judge the pathological types of early esophageal cancer.

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 探讨恙虫病患者血清乳酸脱氢酶（LDH）水平在检查中的临床价值及LDH与血小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。方法 选取2016年3月—2018年2月在我院就诊的60例恙虫病患者,其中男25例,女35例。记录患者的基本情况,血常规、肝肾功能等实验室检测指标;并检测患者血清中乳酸脱氢酶水平。并分析患者乳酸脱氢酶与小板数目、丙氨酸氨基转移酶和天冬氨酸氨基转移酶的相关性。结果 多数患者出现发烧、头痛、腹痛、咳嗽咳痰等症状,少数患者出现腰痛、意识障碍、皮肤黏膜出血等症状;60例恙虫病患者中,52名患者血清乳酸脱氢酶含量高于正常值,15例患者血小板数量低于正常值;55名患者丙氨酸氨基转移酶高于正常值,53名患者天冬氨酸氨基转移酶高于正常值;患者血清LDH与血小板数目（r=-0.929,P<0.01）呈负相关,与丙氨酸氨基转移酶（r=0.957,P<0.01）,天冬氨酸氨基转移酶（r=0.947,P<0.01）呈正相关。结论 乳酸脱氢酶水平可以作为患者恙虫病的早期诊断标志。

Objective To investigate the clinical value of serum LDH levels in tsutsugamushi patients. Methods We selected 60 patients with tsutsugamushi disease who were enrolled in our hospital from September 2016 to February 2018,including 25 males and 35 females. We recorded the patients' basic conditions,blood tests,liver and kidney function and other laboratory testing indicators;and we detected serum lactate dehydrogenase levels in patients. The correlations in lactate dehydrogenase and platelet number,alanine aminotransferase,and aspartate aminotransferase were analyzed. Results Most patients developed fever,headache,abdominal pain,cough,sputum,and other symptoms. A small number of patients suffered low back pain,disturbance of consciousness,skin mucosal bleeding,and other symptoms;among the 60 patients with tsutsugamushi disease,the contents of serum amblytic dehydrogenase were higher than normal in 52 patients,and the numbers of platelets in 15 patients were lower than normal. The value of alanine aminotransferase was higher than normal in 55 patients,and the value of aspartate aminotransferase was higher than normal in 53 patients;serum LDH and platelet counts （r=-0.929,P<0.01）,alanine aminotransferase （r=0.957,P<0.01） and aspartate aminotransferase （r=0.947,P<0.01） showed positive correlation. Conclusion Lactate dehydrogenase level may be used as an early diagnostic marker for patients with tsutsugamushi disease.

目的 探讨多指标联合监测在冠心病(CHD)早期诊断中的应用。方法 选择2018年6月—2018年12月在我院就诊的患者180例,其中动脉硬化中低危人群60例(低危组),动脉硬化中高危人群60例(高危组),确诊的冠心病患者(CHD组),另选取健康体检者60例为对照组。分析血浆游离脂肪酸、高敏C反应蛋白、尿β-2微球蛋白、血清25羟维生素D及血脂水平与冠心病之间的关系。结果 低危组、高危组和CHD组患者FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平均高于对照组,血清25羟维生素D₃、HDL-C水平均低于对照组,差异均有统计学意义(P＜0.05);低危组、高危组和CHD组患者的血清FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平逐渐升高,血清25羟维生素D₃、HDL-C逐渐降低,以CHD组最为显著。冠心病患者血清HDL-C的敏感度高于其他各指标(P＜0.05);血清FFA、hs-CRP的特异度高于其他各指标(P＜0.05)。结论 多指标联合检测对于早期诊断冠心病患者有一定意义。

Objective To explore the application of multi-index combined monitoring in early diagnosis of coronary heart disease (CHD). Methods 180 patients were selected from June 2018 to December 2018 in our hospital. Among them, 60 patients with middle and low risk of atherosclerosis (low risk group), 60 patients with middle and high risk of atherosclerosis (high risk group), 60 patients with confirmed coronary heart disease (CHD group), and 60 healthy people were selected as control group. The relationship between plasma free fatty acid, high sensitivity C-reactive protein, urinary β-2 microglobulin, serum 25-hydroxyvitamin D and blood lipid levels and coronary heart disease was analyzed. Results The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group were higher than those in control group, and serum levels of 25-hydroxyvitamin D3 and HDL-C were lower than those in control group (P<0.05). The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group increased gradually, while serum levels of 25-hydroxyvitamin D3, H-MG, TC, TG and LDL-C increased gradually. DL-C decreased gradually, especially in CHD group. The sensitivity of serum HDL-C in patients with coronary heart disease was higher than that of other indicators (P<0.05), and the specificity of serum FFA and hs-CR P was higher than that of other indicators (P<0.05). Conclusion The combined detection of multiple indicators has certain significance for the early diagnosis of coronary heart disease.

目的 探讨后稳定型全膝关节置换术患者术后股骨后髁偏距变化对早期功能的影响。方法 选取2013年1月—2016年1月我院收治的121例骨关节炎接受单侧后稳定型膝关节置换患者,记录所有患者术前与术后股骨后髁偏距,根据股骨后髁偏距变化情况分为A组(股骨后髁偏距不变或增加)与B组(股骨后髁偏距减小)。对两组患者进行至少12个月的随访,比较其骨关节炎指数评分(WOMAC)、美国膝关节协会评分(KS)、美国膝关节外科学会评分系统(HSS)及膝关节功能之间的差异。结果 术后,2组患者在前髁偏距变化、股骨假体屈曲角、胫骨后倾角、胫骨角方面差异无统计学意义(P＞0.05)。但术后1年A组患者在WOMAC评分、HSS评分和负重主动屈曲范围方面改善优于B组患者,差异有统计学意义(P＜0.05)。结论 重建股骨后髁偏距能够改善后稳定型全膝关节置换术患者术后早期的骨关节炎症状,并提升患者负重位主动屈曲范围,有一定临床价值。

Objective To explore the stabilized total knee arthroplasty effects on early functional changes of condylar offset. Methods 121 cases of posterior stabilized total knee arthroplasty in our hospital from Jan.2013 to Jan.2016 were enrolled in the study. All patients with preoperative and postoperative posterior condylar offset records, according to the changes of femoral condylar offset were divided into A group and B group. The patients in the two groups were followed for at least 12 months, and the differences in the Osteoarthritis Index score (WOMAC), the American Knee association score (KS), HSS score and knee function were compared. Results After surgery, two patients in the anterior condylar offset changes, femoral prosthesis flexion angle, tibial angle, tibial angle difference was not statistically significant (P > 0.05). But after 1 years, the improvement of WOMAC score, HSS score and weight-bearing active flexion range in group A was better than that in group B, the difference was statistically significant (P < 0.05). Conclusions The reconstruction of the posterior condylar offset can improve the stability after total knee arthroplasty in patients with early osteoarthritis symptoms, and enhance the active flexion range of patients with weight-bearing, which has some clinical value.