目的 调查I-IIa期宫颈鳞状细胞癌患者术后随诊和复发情况,并探索随诊和复发的相关因素。方法 分析2011年1月—2012年6月中山市妇幼保健院收治的128例宫颈鳞状细胞癌患者的临床资料,分析他们的术后随诊情况及其影响因素。将有液基薄层细胞学(TCT)及盆腔检查者视为有效随诊的患者,分析肿瘤复发情况及其影响因素。结果 128例患者中,有效随诊104例(占总人数的81.25%)。年龄组越小,随诊率越高(P=0.034);城市患者较农村患者,随诊率高(P=0.028);文化程度越高,随诊率越高(P=0.028);职业为公务员、教师、公司职员或自由职业、个体,随诊率比职业为家庭妇女和工人更高(P=0.030)。在104例随诊者中,2年复发8例(占7.7%)。临床分期较晚,肿瘤直径>4cm,病理类型,脉管内瘤栓阳性,淋巴结转移阳性是影响患者2年复发的危险因素(P<0.05)。结论 临床分期,肿瘤直径,脉管内瘤栓阳性,淋巴结转移等临床病理特征与患者复发密切相关。应针对宫颈癌患者社会人口学特点制定措施,提高随诊率。

Objective To investigate the follow-up rate after surgical treatment and the recurrence rate among patients with cervical squamous cell carcinoma in I-IIa stage, and identify associated factors. Methods The clinical data of 128 cases of cervical squamous cell carcinoma from January 2011 to June 2012 in Zhongshan maternal and child health hospital was collected. Follow up record of these cases was analyzed and factors associated with follow up were identified. Patients having taken thinprep liquid-based cytology test (TCT) and pelvioscopy were treated as cases being followed effectively, and their recurrence and associated factors were analyzed. Results Among the 128 patients, 104(81.25%) were effectively followed. Patients with younger age(P=0.034), living in city (P=0.028), with higher education level(P=0.028) had higher follow-up rate. Civil servants, teachers and freelancers had higher follow-up rate than housewives and workers (P=0.030).Eight of the 104 effectively followed cases recurred within two years after surgery, accounting for 7.7%. The associated factors of recurrence included clinical stage, tumor diameter, larger than 4cm, the depth of myometrial invasion, deeper than 2/3, vascular tumor thrombus positive, and lymph node metastasis positive (P<0.05). Conclusion Clinical stage, tumor size, vascular tumor thrombus positive, lymph node metastasis positive were associated with recurrence. Tailored strategies should be developed to improve the follow up rate based on the social and demographic characteristics of patients.

目的 探讨优质护理对于提高白内障手术患者术后恢复的影响。方法 选取本院自2014年1月—2014年6月收治的56例实施白内障手术的患者,将患者平均分配为对照组和实验组,对照组实行常规护理服务,观察组实施优质护理服务,建立完善的护理人员工作机制,提高护理人员素质;加强对患者的健康教育和心理护理,及时给患者进行检查。统计两组患者的治疗效果,分析优质护理服务的效果。结果 在术后接受优质护理服务的实验组患者的恢复效果好于对照组患者,术后的不良事件发生率较对照组低,患者的疼痛程度低,二组数据差异具有统计学意义。结论 给白内障术后的患者以优质护理服务能提高护理质量,缩短患者恢复时间,提高患者恢复效果。

目的 通过对比观察常规西药和当归芍药散加减治疗哺乳期子宫上环术后子宫异常出血的临床效果,探讨其安全有效的治疗方法。方法 选取在哺乳期行子宫上环术的妇女96例,随机分为两组,西药组采用常规西药治疗,中药组采用当归芍药散加减方剂治疗。观察术前、术后及治疗后月经量的变化,并对实验结果进行分析和评价。结果 所有96例患者在行子宫上环术后均出现月经量较术前增多(P<0.05),在经过药物治疗后,所有患者月经量较治疗前减少(P<0.05),并治疗后月经量与术前月经量相比波动较小,差异无统计学意义(P>0.05)。中药组与西药组比较,治疗后月经量稍增多,差异无统计学意义(P>0.05)。西药组有5例患者出现头痛、头晕、恶心、呕吐等不适,对症处理或减量后好转,中药组无不良反应病例。结论 西药及中药治疗哺乳期子宫上环术后子宫异常出血效果相当,当归芍药散加减方剂副作用小,具有较高的可靠性和安全性,值得借鉴与推广。

目的 探讨群组管理对老年前列腺术后患者下肢活动依从性的效果。方法 将60例患者分为干预组和对照组,对照组按常规护理,干预组实施1周的群组管理活动。结果 干预后干预组患者对预防DVT发生的知晓度、进行下肢主动活动的依从性高于对照组,双下肢皮肤温度、颜色、胀痛等改变显著小于对照组,比较差异均有统计学意义(P＜ 0. 01)。结论 群组管理是一种有效的管理模式,可增强患者的自我效能,提高患者下肢活动的依从性,达到预防DVT发生的作用。

Objective To explore the influence of group management on compliance of lower extremities of elderly patients who underwent prostatectomy. Methods 60 patients were divided into the intervention group and the control group. While the control group was accepted normal nursing, the intervention group was accepted one-week group management. Results The intervention group performed better than the control group in awareness on the prevention of DVT and compliance of activities of lower extremities, and experienced less changes than the control group in skin temperatures, colors and ache of both lower extremities. These changes had statistical significant (P＜0.01). Conclusion Group management is an effective management mode, and improves parents' self-efficacy and compliance of lower extremities, is helping prevent DVT.

目的 通过比较利伐沙班、依若肝素和非抗凝治疗对全膝关节表面置换术后的疗效,分析全膝关节置换术后抗凝治疗的必要性、有效性及安全性。方法 选取2010年1月—2013年8月我科收治的全膝关节表面置换术的患者154例,按治疗方式分成利伐沙班组(A组)、依若肝素钠组(B组)及非抗凝组(C组)。观察各组术后静脉血栓栓塞发生率;术前及用药后凝血功能指标的变化;术后总失血量、显性失血量、隐性失血量;伤口情况;膝关节功能HSS评分。结果 A组与B组术后无静脉栓塞症发生,C组出现静脉栓塞症3例;A、B、C三组术前与术后凝血功能指标差异均无统计学意义(P>0.05);B组术后显性失血量高于A组(P<0.05);三组患者术前及术后各回访时间点膝关节功能HSS评分差异无统计学意义(P>0.05)。结论 抗凝药物预防全膝关节置换术后静脉血栓栓塞症的效果确切,利伐沙班与依若肝素疗效相当;抗凝治疗不会增加术后失血量及伤口并发症的发生率,且对术后膝关节中期功能恢复无影响。全膝关节表面置换术后使用抗凝治疗效果良好,安全性可。

Objective To compare the influence of anticoagulant therapy on the curative effect after total knee arthroplasty and evaluate the necessity, effectiveness and safety of anticoagulant therapy. Methods 154 patients after total knee arthroplastyfrom January 2010 to August 2013 in our department were divided into the rivaroxaban group (group A), the enoxaparin group (B group) and non anticoagulation group (group C) according to the treatments. It was observed that the postoperative venous thromboembolism incidence; changes of blood coagulation indexes before and after the operation; the total blood loss、dominant blood loss and hidden hemorrhage; the wound; the HSS score of knee function. Results None of postoperative venous thromboembolism occurred in group A and B, three cases of venous thromboembolism in group C;The differences of between preoperative and postoperative coagulation indexes in three groups had no statistical significance (P>0.05); Dominant blood loss in group B was significantly higher than that of group A (P<0.05); No statistical significance in the HSS scores of knee function of three group (P>0.05). Conclusion The effect of anticoagulant drugs on the prevention of venous thromboembolism after total knee arthroplasty is effective, same efficacy in the treatment with rivaroxaban or enoxaparin; anticoagulant therapy does not significantly increase the postoperative blood loss and the incidence of wound complications, does not influence the recovery of postoperative mid-term knee function. The use of anticoagulation therapy after total knee arthroplasty has good effect and be safety.

目的 观察肌内效贴技术对桡骨远端骨折内固定术后手功能的影响,并与对照组进行比较。方法 随机选取36例桡骨远端不稳定骨折内固定术后患者,随机分为治疗组与对照组,治疗组18例患者采用肌内效贴扎及腕关节主动活动康复训练,对照组18例采用腕关节主动活动康复训练。所有患者在治疗前及治疗后1周、2周均采用Gartland-Werley进行腕关节功能评价;容积法测量腕关节远端肿胀程度、视觉模拟疼痛评分(visual analog scale,VAS)进行疼痛评价。结果 治疗后1周,后2周治疗组的腕关节功能Gartland-Werley评定,腕关节远端肿胀程度和VAS优于对照组,差异有统计学意义(P＜0.05)。结论 肌内效贴技术对改善桡骨远端骨折术后肿胀,促进患者手功能恢复,改善患肢疼痛方面疗效显著,值得推广。

Objective To observe the effect of Kinesio taping on hand function after internal fixation of distal radius fracture, comparing to the control group. Methods Using randomized controlled methods, 36 cases of unstable distal radius fracture after internal fixation were randomly divided into two groups, 18 cases in the treatment group were treated by Kinesio taping and wrist active rehabilitation training. The control group (18 cases) only got wrist active rehabilitation training. All patients were evaluated before and after treatment in 1 week and 2 weeks, including the function assessment of wrist joint by Gartland-Werley, swelling measurement of distal wrist joint by volumetric method, pain evaluation by visual analogue scale (visual analog scale, VAS). Results In the twice evaluation after treatment, Gartland-Werley assessment of wrist joint, distal swelling degree and VAS of the treatment group were superior to that of the control group, the difference had statistical significance(P<0.05). Conclusion Kinesio taping can improve the distal radius fracture postoperative swelling, promote the recovery of hand function in patients, and improve the curative effect of limb pain significantly. It's worthy of promotion.

目的 探讨生长抑素对腹部手术后早期肠内营养支持顺应性的影响。方法 选择在本院接受中等以上腹部手术的住院病人60例,随机分成实验组和对照组各30例,手术后12 h开始给予早期肠内营养支持,连续5 d,实验组按常规使用生长抑素5 d,而对照组未使用生长抑素;比较两组在术后5 d内胃肠道不适的发生与否,胃肠减压的引流量,肠蠕动功能恢复情况,以及术后7 d的血液常规、肝、肾功能及血糖等血液生化指标。结果 与对照组比较,实验组在手术后胃肠道不适的发生,鼻胃管(胃肠减压)引流量,肠蠕动功能恢复时间等差异有统计学意义;术后7 d的血液常规、肝、肾功能及血糖等指标比较差异无统计学意义。结论 生长抑素有助于机体对腹部手术后肠内营养支持的顺应性,并安全可行。

Objective To study the clinical effects of somatostatin on compliance of early enteral nutrition after abdominal surgery. Methods 60 cases who accepted above medium abdominal operations were randomized into two groups including 30 cases of treatment group with somatostatin on the bases of early enteral nutrition and 30 cases of control group with early enteral nutrition, continued for 5 days after abdominal surgery. The promotion of clinical manifestations and signs, gastrointestinal decompression, blood routine examination, liver and renal function, blood glucose and so on were compared between the two groups. Results As for clinical manifestations and signs promotion, there were statistically significance in the alleviation of pain and distension of the abdominal and the average volume gastrointestinal decompression and the time of recovering peristalsis and passing flatus (P<0.05).As for blood routine examination, liver and renal function, blood glucose there were no statistically significance between the two groups. Conclusion Somatostatin can effected on compliance of early enteral nutrition after abdominal surgery.

目的 探讨黄芪枳术汤结合肠内营养的对颅脑术后患者ALB/PA/TP的影响。方法 将60例颅脑术后患者随机分为观察组(n=30)和对照组(n=30)。观察组给予中药黄芪枳术汤和整蛋白肠内营养液,对照组仅给予整蛋白肠内营养液。通过观察两组病人营养支持前后各项营养指标的变化和胃肠道的并发症,对两种治疗方式的疗效进行比较。结果 观察组病人营养支持后第7,14 天各项营养指标总蛋白(TP),白蛋白(ALB),前白蛋白(PA),血红蛋白(HGb)水平均高于对照组,差异有意义(P均＜0.05),观察组的胃肠道症状的发生率较对照组少。结论 黄芪枳术汤能加强肠内营养疗效,促进胃肠功能恢复及减少术后并发症,黄芪枳术汤结合肠内营养能增加颅脑术后患者的摄入量,提高血清蛋白水平,改善机体的营养状况,促进患者的早日康复。

目的 对经皮冠状动脉介入(PCI)治疗术前高敏C反应蛋白(hs-CRP)水平进行测定,探究其与患者术后发生造影剂肾病相关性。方法 选取2011年4月—2013年5月在我院进行PCI手术疗的患者120例为实验对象。根据术前hs-CRP值分为3组:A组(hs-CRP<1 mg/L,n=56),B组(hs-CRP 1～3 mg/L,n=40)和C组(hs-CRP>3 mg/L,n=24)。观察各组术后造影剂肾病的发生情况以及探究其两者之间的相关性。结果 A、B、C组患者术后CIN的发生率分别为8.93%、22.5%和50.0%,经过统计学比较,差异有统计学意义(P<0.05)。患者术前hs-CRP水平年龄在75岁以上、男性、糖尿病、贫血、水化治疗均与CIN显著独立相关。C组MACE发生率均高于A组、B组(P<0.05)。结论 接受PCI手术治疗的患者,其术前hs-CRP水平与其术后CIN的发生具有一定的相关性,患者术前hs-CRP水平越高,术后更可能发生CIN,hs-CRP的水平可作为辅助CIN诊断的指标。

目的 观察动静平衡康复训练对胫骨平台骨折术后患者平衡和行走功能的影响。方法 将2012年7月—2014年12月100例胫骨平台骨折患者,随机分为两组,每组50例。对照组术后展开常规康复训练,观察组实施动静平衡康复训练,观察两组膝关节功能、康复效果以及肌力恢复情况。结果 观察组患者的膝关节功能优良率为98.0%,高于对照组的60.0%,差异有统计学意义(P＜0.05)。观察组患者的Lysholm评分,高于对照组(P＜0.05)。观察组患者的肌力恢复情况,优于对照组(P＜0.05)。结论 基于“动静平衡”理念针对胫骨平台骨折患者实施术后康复指导与训练,有利于促进患者关节功能以及肌力恢复,巩固康复疗效,在训练过程中实现动态平衡,具有积极的临床意义。

Objective To investigate the static and dynamic balance rehabilitation training on the tibial plateau fracture patients balance and walking functions. Methods 100 cases of patients with tibial plateau fractures from July 2012 to December 2014, were randomly divided into two groups, 50 cases of each group. The control group was launched conventional rehabilitation, observation group received static and dynamic balance rehabilitation training. The knee function, rehabilitation and muscle recovery of the two groups were observed and statistically analyzed. Results The knee function excellent rate of observation group was 98.0%, significantly higher than control group 60.0%, there was statistical significance(P＜0.05). Lysholm score of observation group was higher than control group(P＜0.05). Muscle recovery of observation group was better than control group(P＜0.05). Conclusion Based on the “static and dynamic balance” concept for tibial plateau fractures postoperative rehabilitation for patients with guidance and training, and it will be promoting joint function in patients with muscle recovery and consolidate the recovery effect, to achieve dynamic equilibrium in the training process, with positive clinical significance.