目的 分析在临床治疗腰椎间盘突出症过程中采取脊柱微创手术的价值。方法 回顾研究2019年2月-2021年2月本院的102例腰椎间盘突出症患者,按照电脑排序将患者分为参照组51例与研究组51例。其中,接受传统手术治疗的为参照组,接受脊柱微创手术治疗的为研究组,将不同方案下的效果进行对比。结果 研究组切口长度指标更低于参照组,术中出血量指标比较差异有统计学意义少于对照组,手术时间更短于参照组,比较差异有统计学意义（P<0.05）。研究组术后引流量指标均更低于参照组,术后活动时间及住院时间指标均更低于参照组,比较差异有统计学意义（P<0.05）。两组患者接受治疗前疼痛程度评分对比,无比较差异有统计学意义差异性（P>0.05）,治疗后研究组患者疼痛评分均更低于参照组,比较差异有统计学意义（P<0.05）。研究组治疗后并发症发生概率5.88%更低于参照组的21.57%,比较统计差异比较差异有统计学意义（P<0.05）。结论 在临床治疗腰椎间盘突出症过程中采取脊柱微创手术效果良好,比较差异有统计学意义地降低患者手术损伤,缓解了患者手术疼痛感,促进患者尽快术后康复,防止并发症的发生,适合于临床中应用。

目的 探析化疗联合调强放疗（IMRT）治疗老年（≥65岁）局部晚期鼻咽癌的临床效果。方法 选取2018年1月—2019年1月我院诊治的90例老年局部晚期鼻咽癌患者为研究对象,使用随机数表法将此90例患者分为观察组及对照组,各45例。观察组行IMRT,对照组行化疗联合IMRT,对比2组的效果。结果 2组的治疗总有效率均为100%,组间差异不显著（P<0.05）。观察组的生活质量改善率（93.33%）高于对照组（77.78%）（P<0.05）。对照组出现3~4级白细胞减少、呕吐、黏膜炎人数明显高于观察组（P<0.05）,两者其他毒副反应比较无显著差异（P>0.05）。观察组的1年总体生存率（91.11%）及3年总体生存率（75.56%）均高于对照组（86.67%、68.89%）（P<0.05）。结论 对于老年局部晚期鼻咽癌,化疗联合IMRT相比单纯IMRT降低了远期生存率,增加了毒副反应并影响疗后生活质量的改善,不宜常规应用,单纯IMRT可能是更合适的治疗选择。

Objective To explore the clinical effect of chemotherapy combined with intensity modulated radiation therapy（IMRT）in the treatment of elderly（≥65 years old）locally advanced nasopharyngeal carcinoma．Methods The study was carried out from January 2018 to January 2019．During this period,90 elderly patients with locally advanced nasopharyngeal carcinoma who were diagnosed and treated in our hospital were selected as the research objects．The random number table method was used to divide the 90 patients into observation groups,and the control group,each with 45 cases．The observation group was treated with IMRT,and the control group was treated with chemotherapy combined with IMRT．The effects of the two groups were compared．Results The total effective rate of the two groups was 100%,and there was no significant difference between the two groups（P<0.05）．The improvement rate of quality of life in the observation group（93.33%）was higher than that in the control group（77.78%,P<0.05）．The number of grade 3-4 leukopenia,vomiting and mucositis in the control group was significantly higher than that in the observation group（P<0.05）,and there was no significant difference in other side effects between the two groups（P>0.05）．The 1-year overall survival rate（91.11%）and 3-year overall survival rate（75.56%）of the observation group were higher than those of the control group（86.67%,68.89%,P<0.05）．Conclusions For locally advanced nasopharyngeal carcinoma in the elderly,chemotherapy combined with IMRT reduces the long-term survival rate,increases the toxic and side effects and affects the improvement of the quality of life after treatment．It is not suitable for routine application,and IMRT alone may be a more appropriate treatment choice.

目的 为寻找治疗盆腔炎性疾病（PID）的有效治疗方案,对比分析头孢哌酮舒巴坦钠+吗啉硝唑、康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑两种用药方案治疗PID的效果差异,期望为今后临床中合理选择PID药物治疗方案提供参考依据。方法 选取2019年1月—12月期间在我院接受治疗的104例急性PID患者（湿毒壅盛证）作为研究对象,用随机信封分为参照组、研究组,各52例。予以参照组患者头孢哌酮舒巴坦钠+吗啉硝唑静脉滴注治疗,研究组患者在参照组基础上口服康妇炎胶囊,均持续治疗14 d。观察2组患者近期疗效、炎性因子、盆腔炎性疾病包块、远期复发率（6个月、1年）、远期生活质量,综合评价两种用药方案应用效果。结果 治疗14 d后,研究组总有效率96.00%,高于参照组的80.39%,差异显著（P<0.05）;WBC、CRP、IL-2、TNF-α四项炎性因子水平均低于参照组,差异显著（P<0.05）;腔包块直径、疼痛评分均低于参照组,差异显著（P<0.05）。随访6个月、1年,研究组患者PID复发率分别为4.00%、10.00%,均低于参照组的15.69%、29.41%,差异显著（P<0.05）。结论 以康妇炎胶囊联合头孢哌酮舒巴坦钠及吗啉硝唑治疗PID,能够提升患者的近期治疗效果,改善炎性反应、盆腔炎性疾病包块,降低远期复发风险,改善远期生活质量,而且能够保证用药安全性,具有推广使用价值。

Objective To find an effective treatment for pelvic inflammatory disease（PID）,and to compare and analyze the difference of efficacy of cefoperazone and sulbactam sodium + molinidazole,Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,in order to provide reference for rational selection of PID drug treatment in future clinical practice．Methods A total of 104 patients with acute PID（excessive wet toxin accumulation syndrome）who received treatment in our hospital from January to December 2019 were selected as the research objects．They were randomly divided into the control group and the research group with 52 cases in each group．Patients in the control group were given intravenous infusion of cefoperazone and sulbactam sodium + morinidazole,and patients in the research group were given Kangfuyan capsule orally on the basis of the control group,all treated for 14 days．The short-term efficacy,inflammatory factors,pelvic inflammatory mass and pain improvement,adverse reactions,long-term recurrence rate（6 months,1 year）,long-term quality of life in two groups were observed,and the application effect of the two drug regimens was comprehensively evaluated．Results After 14 days of treatment,the total effective rate of the research group was 96.00%,which was higher than that of the control group（80.39%）,with significant difference（P<0.05）．After treatment,the levels of WBC,CRP,IL-2 and TNF-α were lower than those of the control group,and the differences were significant（P<0.05）．After treatment,lumen mass diameter and pain score were lower than the control group,the differences were significant（P<0.05）．After 6 months and 1 year follow-up,the PID recurrence rate of the research group was 4.00% and 10.00% respectively,both lower than that of the control group（15.69% and 29.41%）,with significant difference（P<0.05）．Conclusions Using Kangfuyan capsule combined with cefoperazone and sulbactam sodium + molinidazole in the treatment of PID,can improve the patient's recent treatment effect,improve the inflammatory reaction,pelvic inflammation mass, lower long-term risk of recurrence,improve the long-term quality of life,and can ensure medication safety,with promotion value.

目的 观察帕立骨化醇治疗维持性血液透析并发继发性甲状旁腺功能亢进（SHPT）患者6个月的疗效。方法 选取40例血液透析合并 SHPT的患者,分成观察组和对照组,分别使用帕立骨化醇和骨化三醇治疗6个月,监测治疗前、治疗后血清全段甲状旁腺素（iPTH）、血钙、血磷水平。比较2组患者治疗6个月后iPTH、血钙、血磷变化情况。结果 治疗6个月后,观察组iPTH水平较对照组下降,观察组血钙水平较对照组上升幅度小,观察组血磷水平较对照组下降。结论 帕立骨化醇治疗6个月能显著降低血透并发SHPT患者的iPTH水平,治疗效果显著,且不会增加高钙、高磷血症风险,药物安全性好。

Objective To observe the effectiveness of paricalcitol in the 6-month treatment of maintenance hemodialysis patients with secondary hyperparathyroidism（SHPT）．Methods Forty maintenance hemodialysis patients with SHPT were selected and divided into observation group and control group．They were treated with paricalcitol or calcitriol for 6 months,respectively．Serum levels of intact parathyroid hormone（iPTH）,calcium and phosphorus were monitored before and after treatment．The changes of iPTH,calcium and phosphorus were compared between the two groups after 6 months of treatment．Results After 6 months of treatment,the level of iPTH in the observation group decreased significantly compared with the control group,the level of calcium in the observation group increased slightly compared with the control group,and the level of phosphorus in the observation group decreased significantly compared with the control group．Conclusions This observational study shows that paricalcitol can significantly reduce the iPTH level in hemodialysis patients with SHPT after treatment for 6 months,without increasing the risk of hypercalcemia and hyperphosphatemia.

现代人面临更大的工作与生活压力,每天的生活节奏较快,因此经常出现饮食不规律、饮食结构不合理等现象,这样就增加了肠胃疾病的发生率。胃肠道间质瘤（GIST）以人体胃肠道最为常见的肿瘤疾病,该病患者占全部胃肠道间叶性肿瘤患者人数的80%以上。GIST根据疾病进展、间质瘤体积等不同因素又能够分为不同的疾病类型,需采取对应的诊断措施与治疗措施。本文将针对胃小间质瘤的流行病学、临床症状、临床诊断以及治疗措施等进行研究与分析,以供参考。

Modern people are facing greater pressure in work and life,and the pace of daily life is fast．Therefore,irregular diet and unreasonable diet structure often occur,which increases the incidence of gastrointestinal diseases．Gastrointestinal stromal tumor（GIST）is the most common tumor disease in human gastrointestinal tract,accounting for over 80% of all patients with gastrointestinal mesenchymal tumors．GIST can be divided into different types according to different factors such as disease progression and stromal tumor volume,thus corresponding diagnostic and therapeutic measures should be taken．This paper studied and analyzed the epidemiology,clinical symptoms,clinical diagnosis and treatment of gastric small stromal tumors for reference．

目的 探讨消肿化瘀膏治疗骨性关节炎的临床疗效。方法 选择2017年5月—2022年1月在本院诊治的骨性关节炎患者124例作为研究对象,根据简单分配原则把患者分为消肿化瘀膏组与传统药物组各62例。传统药物组给予传统药物治疗,消肿化瘀膏组给予消肿化瘀膏治疗,判定2组患者治疗总显效率、疼痛评分、关节评分、血清中炎症因子水平变化。结果 消肿化瘀膏组治疗后的总显效率为98.4%,高于传统药物组的83.9%（P<0.05）。治疗后,2组的疼痛评分都低于治疗前（P<0.05）,且消肿化瘀膏组低于传统药物组（P<0.05）。2组治疗后的关节评分都高于治疗前（P<0.05）,且消肿化瘀膏组与传统药物组相比升高（P<0.05）。2组治疗后的血清白介素-1β、白介素-6水平都低于治疗前（P<0.05）,且消肿化瘀膏组较传统药物组降低更多（P<0.05）。结论 消肿化瘀膏治疗骨性关节炎能有效抑制血清炎症因子的表达,缓解疼痛,改善关节功能,提高患者的总体治疗效果。

Objective To explore the clinical efficacy of Xiaozhonghuayu ointment in the treatment of osteoarthritis．Methods From May 2017 to January 2022,124 patients with osteoarthritis who diagnosed and treated in our hospital were selected as the research subjects．According to the simple allocation principle,the patients were divided into the Xiaozhonghuayu ointment group and the traditional medicine group with 62 cases each．The traditional medicine group was treated with traditional medicine,and the Xiaozhonghuayu ointment group was treated with Xiaozhonghuayu ointment．The total therapeutic efficiency,pain score,joint score,and the changes of serum inflammatory factors were compared in the two groups．Results The total efficiency of Xiaozhonghuayu ointment group after treatment were 98.4%,which were higher than 83.9% in the traditional medicine group（P<0.05）．The pain scores in both groups after treatment were lower than those before treatment（P<0.05）,and that in the Xiaozhonghuayu ointment group were lower than the traditional medicine group（P<0.05）．The joint scores of the two groups after treatment were higher than those before treatment（P<0.05）,and that in the Xiaozhonghuayu ointment group were higher than the traditional medicine group（P<0.05）．After treatment,the levels of serum interleukin-1β and interleukin-6 in the two groups were significantly lower than those before treatment（P<0.05）,compared with the traditional medicine group,those levels in the Xiaozhonghuayu ointment group also decreased significantly after treatment（P<0.05）．Conclusions Xiaozhonghuayu ointment in the treatment of osteoarthritis can effectively inhibit the expressions of serum inflammatory factors,promote pain relief,improve joint function,and improve the overall therapeutic effect of patients．

目的 探讨乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗慢性阻塞性肺疾病疗效及对患者肺功能的影响。方法 以2020年4月—2022月4月在本院诊治的84例慢性阻塞性肺疾病患者作为研究对象,根据1∶1简单分配原则把患者分为联合组与对照组各42例。对照组行传统治疗,联合组在对照组治疗的基础上,再给予乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗,联合组与对照组都治疗观察4周。检测患者的疗效、肺功能与血清超敏C反应蛋白（hs-CRP）与降钙素原（PCT）含量变化情况。结果 联合组治疗后的总有效率与对照组相比有提高（P<0.05）。治疗后,联合组与对照组的第一秒用力呼气容积占用力肺活量百分比（FEV₁/FVC）、第一秒用力呼气容积占预计值百分比（FEV₁%）更高（P<0.05）,且联合组与对照组对比有提高（P<0.05）。联合组治疗后的疾病影响、活动能力、症状部分等SGRQ生活质量评分与对照组相比降低（P<0.05）。联合组与对照组治疗后的血清 hs-CRP与 PCT含量低于治疗前（P<0.05）,联合组与对照组相比也降低（P<0.05）。结论 乙酰半胱氨酸泡腾片联合布地格福气雾剂治疗慢性阻塞性肺疾病能有效抑制hs-CRP、PCT的表达,能促进改善患者的肺功能,提高治疗效果与生活质量。

Objective To investigate the efficacy of acetylcysteine effervescent tablets combined with budigraf aerosol in the treatment of chronic obstructive pulmonary disease（COPD）and its effect on the pulmonary function of patients．Methods From April 2020 to April 2022,a total of 84 patients with COPD diagnosed and treated in our hospital were selected as the research objects,and the patients were divided into the combination group and the control group with 42 cases in each group,according to the 1∶1 simple allocation principle．The control group were given traditional treatment,and the combination group were given acetylcysteine effervescent tablets combined with budigraf aerosol additionally．Both the combined group and the control group were observed for 4 weeks．The efficacy of patients,lung function and serum hypersensitive C-reactive protein（hs-CRP）and procalcitonin（PCT）levels were detected．Results The total effective rates after treatment in the combination group were higher than the control group（P<0.05）．After treatment,The forced expiratory volume in 1 second/forced vital capacity（FEV₁/FVC）,FEV₁% value of the two groups were higher（P<0.05）,and the combination group had greater improvement（P<0.05）．The SGRQ quality of life scores,such as disease impact,activity ability,and symptom in the combination group were lower（P<0.05）．After treatment,the serum high-sensitivity C-reactive protein（hs-CRP）and procalcitonin（PCT）levels in the two groups were significantly lower（P<0.05）,and the combined group decreased more（P<0.05）．Conclusions Acetylcysteine effervescent tablets combined with budigraf aerosol in the treatment of COPD can effectively inhibit the expression of hs-CRP,PCT,promote the improvement of lung function,improve the treatment effect and quality of life．

目的 探讨影响宫腔修复的因素,为不全流产妇女选择期待治疗提供理论依据。方法 2021年1月—12月在香港大学深圳医院招募早孕药流不全的患者534例,记录其人口学特征以及从排胎到流产后3周到月经复潮后的相关情况,通过多因素Logistic回归分析影响不全流产者宫腔修复的因素。结果 534例药流不全患者中,月经复潮后宫腔残留240例,残留率为44.9%;多因素Logistic回归分析显示,BMI（OR=0.888,95%CI：0.808~0.975）、子宫位置（OR=1.836,95%CI：1.139~2.958）、人工流产次数（OR=2.258,95%CI：1.078~4.728）、阴道流血时长（OR=0.344,95%CI：0.141~0.837）、残留物最大径线（OR=1.061,95%CI：1.031~1.092）、残留物血流信号2级/3级（OR=3.636,95%CI：1.790~7.394;OR=4.001,95%CI：1.561~10.256）是宫腔残留的影响因素。结论 宫腔残留的高危因素有子宫后位、残留物最大径线、1次以上的人工流产、2级及以上的残留物血流信号,且血流信号等级影响最大。BMI和阴道流血时长>3周是宫腔残留的保护因素。

Objective To investigate the factors affecting uterine cavity repair and to provide a theoretical basis for the choice of expectant treatment for women with incomplete abortion．Methods From January to December 2021,534 patients with incomplete abortions were recruited at University of Hong Kong-Shenzhen Hospital,and their demographic characteristics and correlations from expulsion of the gestational sac to 3 weeks after medication abortion and after menstrual resumption were recorded,and the factors affecting uterine cavity repair in incomplete abortions were analyzed by multifactorial logistic regression．Results In 534 women,there were 240 cases of uterine cavity remnants after menstrual return,with a remnant rate of 44.9%;the results of multifactorial logistic regression analysis showed that BMI（OR=0.888,95% CI：0.808-0.975）,uterine position（OR=1.836,95% CI：1.139-2.958）,number of abortions（OR=2.258,95% CI：1.078-4.728）,length of vaginal bleeding（OR=0.344,95% CI：0.141-0.837）,maximum diameter of residuals（OR=1.061,95% CI：1.031-1.092）,and residual blood flow signal grade 2/3（OR=3.636,95% CI：1.790-7.394;OR=4.001,95%CI：1.561-10.256）were influential factors for uterine residuals．Conclusions High-risk factors for uterine residuals are posterior uterus,the maximum diameter of residuals,more than one abortion,grade 2 or higher residual blood flow signal,and the grade of blood flow signal had the greatest effect．BMI and duration of vaginal bleeding >3 weeks are protective factors for uterine residuals．

本文综述近10年中医传统疗法中通过穴位刺激预防与治疗老年患者骨折术后谵妄的研究概况。术后谵妄是老年患者骨折术后常见的并发症,不仅延长患者住院时间、增加经济负担,同时与骨折术后死亡并发症的发生密切相关。但是本病机制尚未明确,在临床治疗上难以达成共识。针灸等穴位刺激是中医药治疗脑病的独具特色的疗法,近年来有关穴位刺激防治老年骨折术后谵妄的报道越来越多,本文主要探讨不同的穴位刺激方法干预对骨折术后谵妄发生率的影响,包括传统刺激方式如毫针、电针、穴位注射、穴位敷贴和新针疗法如耳针、头针等,认为穴位刺激能够较好预防骨折术后谵妄发生,在治疗上也有较好疗效。以期为进一步临床研究与应用提供参考。

This article summarized the research of acupoint stimulation in preventing delirium after fracture surgery in elderly patients in recent 10 years．Postoperative delirium is a common complication in elderly patients after fracture surgery, which affects life extremely and increases economic burden．However, the mechanism of this disease haven't been revealed, and it is difficult to reach consensus on clinical treatment．Acupoint stimulation, like acupuncture, is a unique treatment of encephalopathy with traditional Chinese medicine．In recent years, there are more and more reports on acupoint stimulation therapy to prevent and treat delirium after fracture surgery in the elderly．This article mainly study the influence of different acupoint stimulation therapy on treatment of delirium after fracture surgery, including electroacupuncture, auriculotherapy, scalp acupuncture, acupoint injection and acupoint application, etc．It is believed that acupoint stimulation can prevent delirium after fracture surgery, so as to provide reference for further clinical research and application．

我国结直肠癌的发病率与死亡率逐年增加,约10%~30%新发结直肠癌患者可表现为急性肠梗阻,其中梗阻发生率较高的主要部位是左半结肠。急性梗阻性左半结肠癌患者的主要治疗方式仍是急诊手术（ES）,但术后并发症发生率及围手术期死亡率较高,自膨式金属支架（SEMS）被一些指南推荐为梗阻性结肠癌的初始治疗选择,SEMS可将部分ES转变为择期手术,支架置入后择期手术（SBTS）与ES相比不仅可改善患者的短期生存结局,且支架置入后新辅助化疗为梗阻性结肠癌的治疗提供了新的途径;就长期生存结果而言,选择SBTS还是ES存在一定的争议。对于支架置入后手术时机的选择尚未达成共识,有指南表明大约两周的短桥接间隔可使患者最大程度获益,因而可有效指导临床工作。肠道支架置入术目前看来是一种简单、有效的临时性或永久性的治疗手段。

In recent years, the incidence and mortality of colorectal cancer in our country have been increasing year by year．Around 10% to 30% of newly diagnosed colorectal cancer patients showed acute intestinal obstruction, which the left colon cancer has higher incidence．Emergency surgery（ES）is still the main treatment for patients with acute obstructive left colon cancer, but the incidence of postoperative complications and perioperative mortality are high．Self-expanding metallic stents（SEMS）can convert some emergency procedures into stent as bridge to surgery（SBTS）, which is recommended by some guidelines as the initial treatment option for obstructive colon cancer．SBTS can not only improve the short-term survival outcome of patients compared with ES, but also provide a new approach for the treatment of obstructive colon cancer with neoadjuvant chemotherapy after intestinal obstruction stent placement．The choice of SBTS versus ES is somewhat controversial in terms of long-term survival outcomes．There is no consensus on the timing of surgery after stenting, and current guidelines suggest that bridging intervals of approximately two weeks strike a balance between potential adverse events and long-term outcomes．At present, intestinal stenting is still a simple, feasible and effective temporary or palliative permanent treatment with few complications．