目的 对本院老年重症肺炎患者的临床资料进行回顾性分析,为老年重症肺炎多药耐药菌感染的临床诊疗提供参考。方法 回顾性分析本院医院76例老年重症肺炎患者的病例信息,将患者随机分为研究组和对照组,每组38例,研究组患者在对照组基础上(头孢哌酮／舒巴坦)联合胸腺肽α1治疗。研究2组患者的痰液致病菌分布及其临床特点,通过对比2组患者治疗前后免疫功能指标T淋巴细胞CD4⁺及炎症因子超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白介素-6(interleukin-6, IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α, TNF-α)水平变化,对头孢哌酮/舒巴坦联合胸腺肽α1治疗老年重症肺炎的临床效果进行分析。结果 76例老年重症肺炎患者中,共检出143株病原菌,以不动杆菌属为主的革兰氏阴性菌(89株)为主要致病菌株,占比64.3%,革兰氏阳性菌(54株)以葡萄球菌属为主,占比35.7%;排名前3位的主要致病菌为:铜绿假单胞菌(33.6%)、金黄色葡萄球菌(22.4%)和大肠埃希菌(14.7%)。痰液分离出的致病菌出现了普遍的严重耐药性,主要以多药耐药铜绿假单胞菌为主。2组治疗前 T 淋巴细胞CD4⁺、hs-CRP、IL-6、TNF-α水平对比无差异(P＞0.05),治疗后观察组CD4⁺水平更高,而 CRP、TNF-α、IL-6水平更低,与对照组有差异(P＜0.05)。结论 老年重症肺炎多药耐药菌重症肺炎检出病原菌主要以铜绿假单胞菌为主,治疗上联合使用胸腺肽α1,能够有效改善患者的免疫抑制状态、减轻老年患者机体炎症反应,对于提高老年患者临床治疗效果及改善患者预后有着重要的临床意义,值得广泛推广。

目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果。方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌Kegel运动,并在产后42天开始行盆底康复治疗仪治疗6周,统计临床疗效,2组均在产后42天、3个月、6个月统计2组盆底功能检测、盆底器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incorrtinence,SUI)发生情况。结果 观察组和对照组一般资料,2组在年龄、分娩孕周、新生儿平均体重无统计学差异(P＞0.05),2组盆底功能进行检测比较,产后42天观察组阴道收缩持续时间、Ⅱ类肌纤维强度(85.24±22.19 cmH₂O)高于对照组(74.14±19.94 cmH₂O),差异具有统计学意义(P＜0.05),产后3月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(76.41±16.42 cmH₂O;4.35±1.78 s;94.15±18.25 cmH₂O)高于对照组(62.45±17.55 cmH₂O;3.89±1.52 s;88.55±18.36 cmH₂O),差异具有统计学意义(P＜0.05),产后6月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(79.56±15.78 cmH₂O;5.46±2.01 s;99.78±23.47 cmH₂O)明显高于对照组(67.63±14.45 cmH₂O;4.13±1.45 s;90.16±18.75 cmH₂O),差异具有统计学意义(P＜0.05)。对比2组POP和SUI发生率情况,产后42天观察组SUI发生率(28.24%)低于对照组(35.14%),差异具有统计学意义(P＜0.05);产后3月观察组POP和SUI发生率(18.32%;13.74%)低于对照组(22.70%;17.83%),差异具有统计学意义(P＜0.05),产后6月观察组POP和SUI发生率(0.00%;0.07%)明显低于对照组(8.10%;11.89%),差异具有统计学意义(P＜0.05)。 结论 孕期行盆底肌锻炼联合产后盆底功能康复治疗能明显改善产后盆底功能状态,显著降低产后盆底功能障碍性疾病的发生率。

Objective To explore the prevention and treatment effect of pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy on postpartum pelvic floor dysfunction in women. Methods From January 2019 to June 2020, women in our hospital's obstetrics outpatient department for regular obstetric checkups were selected, which ultrasound confirmed it was a singleton full-term delivery. The cases of stillbirth, fetal malformation and placenta previa were excluded. A total of 316 cases met the inclusion criteria and were randomly divided into the observation group and the control group, with 131 cases in the observation group and 185 cases in the control group. Observation group started regular pelvic floor muscle Kegel exercises from 12 weeks of gestation,and accepted pelvic floor rehabilitation therapeutic treatment from 42 days to six weeks postpartum. We summerized the pelvic floor function tests results, pelvic organ prolapse (POP) and stress urinary incontinence (SUI) situation of both groups in 42 days, 3 months and 6 months postpartum. Results The general information of the observation group and the control group showed that there were no statistical differences in age, gestational age of delivery and average weight of newborn (P>0.05). The pelvic floor function 42 days after delivery of the two groups was tested and compared, duration of vaginal contraction and class Ⅱ muscle fiber strength of the observation group [(85.24±22.19) cmH₂O] was significantly higher than that of the control group [(74.14±19.94) cmH₂O], and the difference was statistically significant (P＜0.05). Class I muscle fiber strength, duration of vaginal contraction and class Ⅱ muscle fiber strength were observed at 3 months postpartum, those of observation group[(76.41±16.42) cmH₂O; (4.35±1.78) s; (94.15±18.25) cmH₂O] were significantly higher than that in the control group [(62.45± 17.55) cmH₂O; (3.89±1.52) s; (88.55±18.36) cmH₂O], and the difference were statistically significant (P<0.05). At 6 months postpartum, class I muscle fiber strength, vaginal contraction duration and class Ⅱ muscle fiber strength in observation group [(79.56±15.78) cmH₂O; (5.46±2.01) s; (99.78±23.47) cmH₂O] were significantly higher than that of the control group [(67.63±14.45) cmH₂O; (4.13± 1.45) s; (90.16±18.75) cmH₂O], and the difference were statistically significant (P<0.05). Comparison of the incidence of POP and SUI between the two groups showed that the incidence of SUI in the observation group at 42 days postpartum (28.24%) was significantly lower than that in the control group (35.14%), the difference was statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 3 months postpartum (18.32%; 13.74%) were significantly lower than that of the control group (22.70%; 17.83%), the difference were statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 6 months postpartum (0.00%; 0.07%) were significantly lower than that of the control group (8.10%; 11.89%), the difference were statistically significant (P＜0.05). Conclusion Pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy can significantly improve postpartum pelvic floor function and significantly reduce the incidence of postpartum pelvic floor dysfunction diseases.

目的 探讨肠道菌群多样性及丰度在抗结核治疗强化期的变化。方法 收集广州市胸科医院20例初治菌阳肺结核患者使用强化方案治疗1周及强化期结束的粪便标本,所有标本进行16S rDNA测序,进行生物信息学分析。结果 强化期结束治疗组的Alpha多样性指标Chao1和observed_otus指数分别为(97.8±28.3)和(97.6±28.2),高于治疗1周组的(81±34.7)和(81±34.7),差异有统计学意义(P=0.04;P=0.038)。基于加权和未加权Unifrac距离的PCoA分析显示两组整体菌群结构无明显差异。在相对丰度较高的菌科中,强化期结束治疗组的拟杆菌科、肠球菌科、肠杆菌科、丹毒菌科、卟啉单胞菌科、双歧杆菌科等相对丰度下降,毛螺菌科、梭杆菌科、普氏菌科、瘤胃球菌科、韦氏菌科等相对丰度增加。通过线性判别分析效应量LEfse分析两组数据,发现在属水平上,厚壁菌门的瘤胃球菌、乳杆菌及放线菌门的柯林氏菌为组间显著差异菌种。结论 强化期治疗结束与治疗1周相比,肠道菌群多样性增加,但肠道菌群结构无明显差异。肠道拟杆菌科丰度减少,毛螺菌科丰度增加。

Objective To investigate the changes in the diversity and abundance of intestinal flora during the intensive period of anti-tuberculosis treatment. Methods Stool specimens from 20 patients with newly treated bacteria-positive pulmonary tuberculosis in Guangzhou Chest Hospital, which were treated with the intensive treatment for 1 week and whole intensive treatment, were collected. All the specimens were subjected to 16S rDNA sequencing and bioinformatics analysis. Results The Alpha diversity index Chao1 and observed_otus index of the treatment group with whole process were (97.8±28.3) and (97.6±28.2) respectively, which were higher than (81±34.7) and (81±34.7) of the 1-week treatment group, which had statistical differences (P=0.04;P=0.038). PCoA analysis based on weighted and unweighted Unifrac distance showed that there was no significant difference in the overall flora community structure between the two groups. Among the bacteria families with higher relative abundance, the relative abundance of Bacteroidaceae,Enterococcaceae,Enterobacteriaceae,Erysipelotrichaceae,Porphyromonadaceae and Bifidobacteriaceae in the treatment group with whole process decreased, the relative abundance content of Lachnodoiraceae,Fusobacteriaceae,Prevotellaceae, Rumincoccaceae, and Veillonellaceae increased. By using linear discriminant analysis effect size (LEfse) to analyze the two sets of data, it was found that at the genus level,Rumincoccaceae of Firmicutes and Lactobacillus;Collinsella of Actinobacteria were significantly different species between the groups. Conclusion Compared with 1 week of treatment, the diversity of intestinal flora increased at the end of intensive treatment, but there was no significant difference in the community structure of intestinal flora. The abundance of intestinal Bacteroidaceae decreased, and the abundance of Lachnodoiraceae increased.

目的 分析CT+MRI在原发性肝癌诊断与介入治疗预后评估中的临床意义。方法 选定本院2019年1月—2021年1月住院治疗的150例原发性肝癌患者,入院后均接受介入治疗,分别予以CT、MRI检查,将手术病理检查结果作为本次研究的金标准,比较CT、MRI、CT+MRI诊断效能,Kappa检验CT、MRI、CT+MRI与金标准的一致性,比较CT、MRI、CT+MRI介入术后病灶检出率。结果 CT+MRI诊断准确率(98.67%)、特异度(75.00%)、灵敏度(99.32%)均高于CT(86.00%、25.00%、87.67%)、MRI(90.67%、91.78%、50.00%),P＜0.05(差异均有统计学意义),CT+MRI与金标准的一致性较好(Kappa值为0.779),CT、MRI与金标准的一致性一般(Kappa值为0.527、0.596)。CT+MRI介入术后病灶总检出率(12.00%)高于CT(2.00%)、MRI(4.00%),P＜0.05(差异有统计学意义)。结论 CT+MRI可提高原发性肝癌患者介入术后病灶检出率,弥补了单一CT、MRI检查的不足。

Objective To evaluate the clinical significance of CT + MRI scans in diagnosis of primary liver cancer and prognosis evaluation after interventional therapy. Methods A total of 150 cases of patients with primary liver cancer admitted to our hospital from January 2019 to January 2021 were selected. They all received interventional treatment, and were examined by CT and MRI. The results of pathological examination were taken as the gold standard in this study to compare the diagnostic efficacy of CT, MRI and CT+MRI.Kappa value was used to compare the consistency of CT, MRI, CT+MRI scans with gold standard, and compared the detection rate of lesions after CT, MRI and CT+MRI interventional surgery. Results The diagnostic accuracy (98.67%), specificity (75.00%) and sensitivity (99.32%) of CT + MRI scans were higher than those of CT (86.00%, 25.00%, 87.67%) and MRI scans (90.67%, 91.78%, 50.00%),P<0.05 (which differences were statistically significant). The consistency of CT + MRI scans with gold standard was good (kappa value was 0.779), but the consistency of CT/MRI scans with gold standard were not satisfying (kappa value were 0.527, 0.596). The total detection rate of lesions after CT + MRI interventional surgery (12.00%) was higher than that of CT (2.00%) and MRI (4.00%, which P<0.05). Conclusion CT + MRI scans can improve the detection rate of lesions in patients with primary liver cancer after interventional therapy, and make up for the deficiency of only CT or MRI scans.

目的 探讨富血小板血浆(platelet-rich plasma, PRP)联合髓芯减压治疗早期膝关节自发性骨坏死(spontaneous osteonecrosis of the knee, SONK)的临床疗效。方法 回顾性分析我院2015年6月—2020年6月收治Koshino分期为Ⅰ、Ⅱ期的SONK患者,按治疗方法不同分为单纯髓芯减压组(对照组 21例)和PRP注射+髓芯减压组(PRP组 22例),比较2组患者治疗前、后1月、3月、6月、12月的VAS评分、WOMAC评分,评估术前和随访时膝关节功能,并观察记录有无并发症。结果 43例患者术后随访12～62个月,2组患者治疗后均无切口感染、关节感染、深静脉血栓等并发症。2组患者术前VAS评分、WOMAC评分比较无统计学意义(P>0.05);VAS评分、WOMAC评分在术后1、3、6 、12月较术前比较差异均有统计学意义(P<0.05);与对照组相比,PRP组术后3、6、12月的VAS评分降低(P＜0.05),PRP组在术后6、12月的WOMAC评分改善(P＜0.05)。PRP组、对照组的总体有效率分别为90.48%(19/21)、77.27%(17/22),差异有统计学意义(P＜0.05)。在完成治疗12个月后至今的随访中,对照组共有6例患者、PRP组仅2例患者行单髁置换。结论 富血小板血浆联合髓芯减压治疗早期SONK,安全有效,临床疗效优于单纯髓芯减压术。

Objective To investigate the clinical effect of platelet-rich plasma(PRP) combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee(SONK). Methods A retrospective analysis of SONK patients with Koshino stage I and Ⅱ admitted to our hospital from June 2015 to June 2020 was carried out. According to the different treatment methods, patients were divided into core decompression group (control group, 21 patients), and knee joint cavity PRP injection combined with core decompression group (PRP group, 22 patients). The VAS scores and WOMAC scores before treatment, 1, 3, 6 and 12 months after surgery were compared between the two groups to assess the knee joint function, and observed whether there were complications. Results Forty-three patients were followed up for 12 to 62 months after the operation. After treatment, the two groups had no complications such as wound infection, joint infection, or deep vein thrombosis. The preoperative VAS score and WOMAC score of the two groups were not significantly different (P>0.05);compared with those before the operation, VAS score and WOMAC score were significantly different at 1, 3, 6, and 12 months after the operation (P<0.05); compared with the control group, the VAS score of the PRP group was significantly reduced at 3, 6, and 12 months after surgery (P<0.05), and the WOMAC score of the PRP group was significantly improved at 6 and 12 months after surgery (P<0.05). The overall effective rates of the PRP group and the control group were 90.48% (19/21) and 77.27% (17/22) respectively, and the difference between the two groups was statistically significant (P<0.05). In the follow-up 12 months after the completion of the treatment, 6 patients in the control group and 2 patients in the PRP group underwent unicondylar replacement. Conclusion The combination of platelet-rich plasma and core decompression in the treatment of early SONK was safe and effective, and the clinical effect was better than that of core decompression only.

目的 探讨剖宫产围术期患者采用布托啡诺治疗寒战的最佳剂量。方法 选取2019年10月—2020年11月期间于本院分娩的150例剖宫产妇女作为研究对象,按照随机数字表法分为A组、B组、C组,各组50例。A组给予0.01 mg/kg布托啡诺静脉注射,B组给予0.02 mg/kg,C组给予0.03 mg/kg。比较3组临床疗效、血流动力学、镇静(Ramesay)评分、不良反应、新生儿Apgar评分。结果 3组治疗有效率、 血流动力学、T₁、T₂时间段Ramesay评分及1 min、5 min、10 min 新生儿Apgar评分比较,差异无统计学意义(P＞0.05);C组不良反应发生率高于B组与A组(P＜0.05);T₃时间段Ramesay评分C组＜B组＜A组(P＜0.05)。结论 0.02 mg/kg剂量布托啡诺治疗剖宫产围术期寒战效果最为理想,产妇围术期血流动力学稳定,不良反应较轻,且对新生儿无明显影响。

Objective To investigate the optimal dose of butorphanol in the treatment of shivering in patients underwent cesarean section. Methods A total of 150 women with cesarean section in our hospital from October 2019 to November 2020 were selected as the research objects, and were divided into group A, group B and group C according to random number table method, with 50 cases in each group. Group A was given 0.01 mg/kg butorphanol intravenously, group B was given 0.02 mg/kg, and group C was given 0.03 mg/kg. Clinical efficacy, hemodynamics, sedation (Ramesay) scores, adverse drug reactions (ADR) and neonatal Apgar scores were compared among the three groups. Results There were no significant differences in effective rate, hemodynamics, Ramesay scores at T₁ and T₂ time periods and Apgar scores of neonates at 1 min, 5 min and 10 min among the three groups (P>0.05). The incidence of ADR in group C was higher than that in group B and A (P<0.05). Ramesay score at time of T₃ of group C was lower than group B and group A (P<0.05). Conclusion The 0.02 mg/kg dose of butorphanol in the treatment of perioperative shivering in cesarean section was the most ideal dose, perioperative hemodynamics of puerpera was stable, adverse reactions were mild, and there was no obvious influence on neonates.

目的 分析厄贝沙坦+美托洛尔治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床效果及对患者心功能影响。方法 选取本院2018年12月—2020年12月住院治疗的200例慢性CHF患者,根据不同的治疗方法分组,参照组100例患者采用厄贝沙坦治疗,治疗组100例患者采用厄贝沙坦+美托洛尔治疗,比较2组临床疗效、心功能指标、血清炎性因子、血清N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)水平、不良反应发生率。结果 治疗组临床总有效率(97.00%)高于参照组(87.00%),治疗组治疗后左室射血分数(left ventricular ejection fraction,LVEF)高于参照组,治疗组治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室收缩末期内径(left ventricular end systolic diameter,LVESd)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、NT-proBNP、Hcy水平均低于参照组,差异均具有统计学意义(P＜0.05)。治疗组不良反应发生率(4.00%)与参照组(5.00%)比较,P>0.05。结论 厄贝沙坦+美托洛尔可有效改善慢性CHF患者心功能,减轻炎症反应,抑制NT-proBNP、Hcy释放,且不良反应较少。

Objective To analyze the clinical effect of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure (CHF) and its influence on cardiac function. Methods A total of 200 patients with chronic CHF in our hospital from December 2018 to December 2020 were selected and divided into two groups according to different treatment methods. One handred patients in the control group were treated with irbesartan, and 100 patients in the treatment group were treated with irbesartan + metoprolol. The clinical efficacy, cardiac function indexes, serum inflammatory factors, serum NT-proBNP, Hcy levels and adverse reactions of the two groups were compared. Results The total effective rate of the treatment group (97.00%) was higher than that of the control group (87.00%), LVEF of the treatment group was higher than that of the control group, LVEDd, LVESd, serum TNF-α, hs-CRP, IL-6, NT-proBNP, Hcy levels of the treatment group were lower than those of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the treatment group (4.00%) was higher than that in the control group (5.00%),P>0.05. Conclusion Irbesartan + metoprolol could effectively improve cardiac function, reduce inflammatory reaction, inhibit the release of NT-proBNP and Hcy in patients with chronic CHF, with less adverse reactions.

目的 对冠心病治疗过程中出现迷走神经反射的原因进行分析探讨,并进行高效防治措施的总结。方法 本研究采用现况研究进行调查。本研究以在本院2021年1月—2021年3月就诊并临床诊断为冠心病的患者作为研究对象,经过纳入、排除标准筛选,共挑选出240名患者作为研究对象。根据文献分析得知拔鞘管可能是影响冠心病介入治疗过程中出现迷走神经反射的重要原因,因此将研究对象分为2组,实验组130人,对照组110人。对2组患者进行冠状动脉腔内血管成形术+支架置入术。实验组在患者进行鞘管拔出时进行局部麻醉;对照组则按照常规方法对鞘管进行拔出,分析2组患者迷走神经发生反射的几率,运用统计学软件进行数据分析对比。结果 根据数据分析结果可知,2组患者出现迷走神经反射的几率并不相同,通过差异性分析可知2组数据的差异具有统计学意义,且观察组发生率低于对照组(P<0.05)。结论 建议在临床上对冠心病进行介入治疗时,拔除鞘管的过程应该加入合理的干预,以减少患者出现迷走神经反射的几率,增强患者预后。

目的 本文主要对接受两种不同的甲氨蝶呤治疗方式与腹腔镜保守治疗输卵管妊娠患者治疗效果进行比较,了解不同治疗方案所具有的优势。方法 选择参与者为收治的输卵管妊娠患者200例(时间选择:2018年1月—2020年12月),以治疗方案进行分组(共2组,各100例)。对照组进行腹腔镜下输卵管线性切开术治疗,术中应用甲氨蝶呤治疗;研究组在术前进行甲氨蝶呤肌注,48小时后进行腹腔镜输卵管线性切开术治疗;比较治疗结果。结果 2组输卵管通畅率、术后持续异位妊娠率比较有差异,2组比对有统计学意义(P<0.05)。 2组手术指标(手术时长、术中出血量、β-hCG恢复至正常时间)比较有差异,2组比对有统计学意义(P<0.05)。结论 输卵管妊娠患者选择腹腔镜下输卵管线性切开术治疗时联合术前肌注甲氨蝶呤或术中应用甲氨蝶呤治疗,均可有助于输卵管妊娠症状的进一步缓解。但在此次治疗中患者术前接受甲氨蝶呤肌注+腹腔镜输卵管线性切开术联合治疗取得的疗效比常规的术中应用甲氨蝶呤更具有治疗优势,患者手术时长明显缩短,术中出血量明显降低,有效的避免反复电凝止血造成对输卵管造成的伤害,对输卵管功能进行有效保护,可推广。

目的 探讨慢性扁桃体炎扁桃体切除术后患者咽部疼痛采用紫银荷冰汤治疗的临床疗效。方法 选取本院2018年2月—2021年2月收治的320例慢性扁桃体炎扁桃体切除术的患者,将其根据数字随机法分为对照组与研究组各160例。其中对照组采用生理盐水漱口,研究组采用紫银荷冰汤漱口。观察2组患者用药后的疼痛程度,采用视觉模拟量表(VAS)评分进行评估。结果 2组患者咽痛术后第1～3天VAS评分比较,经统计学分析无差异(P＞0.05);咽痛术后第4～7天VAS评分比较,研究组评分优于对照组,经统计学分析有差异(P＜0.05)。研究组术后第1~3天其疗效优于对照组(P＜0.05);术后第4、6天研究组显效例数也高于对照组,但经统计学表现无差异。 经统计学分析,2组患者术后12 h、术后1天平均服用止痛药物数量无差异(P＞0.05);但术后3天、术后5天平均服用止痛药物数量经统计学分析,研究组优于对照组,有差异(P＜0.05)。结论 紫银荷冰汤具有缓解术后伤口疼痛,减轻组织炎性反应之功效,对治疗慢性扁桃体炎扁桃体切除术后患者咽部疼痛疗效显著,能有效减少止痛药物的使用数量,值得推广应用。