目的   探讨口服水合氯醛与鼻内给予右美托咪定中深度镇静下行泪道探通术治疗婴幼儿先天性泪道阻塞的疗效、并发症及安全性。方法   随机选择2021年2月—2023年6月在广州医科大学附属妇女儿童医疗中心就诊的先天性泪道阻塞患儿，将其分为观察组和对照组，观察组行中深度镇静后进行泪道探通术，对照组进行表麻下泪道探通术，对比两组的治愈率及并发症发生率。结果   观察组共76例（97眼），总治愈率98.97%，分为3组，6~12月龄组41例（53眼），12~18月龄组14例（15眼），18~36月龄组21例（29眼），对照组共84例（116眼），总治愈率93.10%，6~12月龄组55例（70眼），12~18月龄组15例（24眼），18~36月龄14例（22眼），观察组泪道探通术治愈率高于对照组，差异有统计学意义（χ ² =4.49，P＜0.05）。观察组一次探通的成功率为92.78%，高于对照组61.21%，差异有统计学意义（χ ² =26.86，P＜0.05）。观察组二次探通的成功率为85.71%，高于对照组44.44%，差异有统计学意义（χ ² =4.13，P＜0.05）。发生的并发症主要是出血、皮下水肿、感染、假道形成，观察组并发症的发生率4.12%，低于对照组15.52%，差异有统计学意义（χ ² =7.40，P＜0.05）。观察组中2例患儿口服水合氯醛出现恶心呕吐，改为右美托咪定滴鼻。3例患儿右美托咪定滴鼻后出现口唇苍白，持续10～15 min即可缓解。其余均未有不良反应。结论   中深度镇静下给予婴幼儿泪道阻塞患儿行泪道探通术相比传统表麻下泪道探通术疗效更好，并发症较少，对孩子的心理创伤小，安全且经济实惠。

       Objective  To explore the efficacy，complications and safety of moderate and deep  sedation  under oral administration of chloral hydrate and intranasal administration of dexmedetomidine for the treatment of congenital nasolacrimal duct obstruction（CNLDO） in infants and young children．Methods  Children with CNLDO who visited our hospital from February 2021 to June 2023 were randomly selected and divided into the observation group and the control group．The observation group was performed with lacrimal duct probing after moderate and deep sedation，while the control group was performed with lacrimal duct probing under surface anesthesia．The cure rate and incidence of complications were compared between the two groups．Adverse reactions after using sedatives were observed．Results  The observation group consisted of 76 cases（97 eyes），with a total cure rate of 98.97%．They were divided into three groups：41 cases（53 eyes）in the aged 6-12 months group，14 cases（15 eyes）in the aged 12-18 months group，and 21 cases（29 eyes）in the aged 18-36 months group．The control group consisted of 84 cases（116 eyes），with a total cure rate of 93.10%．There were 55 cases（70 eyes）in the aged 6-12 months group，15 cases（24 eyes）in the aged 12-18 months group，and 14 cases（22 eyes）in the aged 18-36 months group．The cure rate of lacrimal duct probing in the observation group was significantly higher than that in the control group（χ ² =4.49，P＜0.05）．The success  rate of the first probing in the observation group was 92.78%，significantly higher than that in the control group of 61.21%（χ ² =26.86，P＜0.05）．The success rate of the second probing in the observation group was 85.71%，significantly higher than that in the control group of 44.44%（χ ² =4.13，P＜0.05）．The incidence of complications mainly were bleeding，subcutaneous edema，infection，and false passage formation．The incidence of complications in the observation group was 4.12%，lower than that in the control group 15.52%，and the difference was statistically significant（χ ² =7.40，P＜0.05）．Two cases in the observation group experienced nausea and vomiting after taking chloral hydrate orally，and were replaced with dexmedetomidine nasal drops．Three cases of pediatric patients showed pale lips after nasal administration of dexmedetomidine，which lasted for 10-15 minutes and could be relieved．No other adverse reactions were observed．Conclusions  Under moderate and deep sedation，lacrimal duct probing treatment for infants and young children with CNLDO showed better therapeutic effects，fewer complications，less psychological trauma to these patients，which is safe and cost-effective，and is suitable for promotion compared to under traditional surface anesthesia．

目的 探讨作业疗法结合经皮神经电刺激对脑卒中后肩痛的疗效。方法 选取2020年6月—2023年6月在肇庆市第一人民医院治疗的60例脑卒中后肩痛患者为研究对象,随机分为观察组和对照组各30例。其中,观察组进行作业疗法结合经皮神经电刺激;对照组单纯进行作业疗法。记录患者治疗前及治疗4周后的视觉模拟疼痛评分（VAS）,改良Barthel指数（MBI）和汉密顿抑郁量表评分（HAMD）,并对记录进行检验和t检验。结果 观察组和对照组的治疗效果比较差异有统计学意义（P=0.019）,观察组治疗有效率（93.33%）高于对照组（63.33%）;治疗前两组患者的VAS（P=0.536）和HAMD（P=0.558）分值比较差异无统计学意义,治疗后其VAS（P=0.049）及HAMD（P=0.023）分值均较治疗前下降,且观察组下降幅度分别为（2.23±1.14）分和（4.47±3.06）分,均高于对照组的（1.27±0.98）和（1.33±1.35）,组间比较差异有统计学意义;治疗前两组患者的MBI分值比较差异无统计学意义（P=0.216）,治疗后其MBI分值均较治疗前提高,且观察组提高幅度（21.87±10.25）较对照组（12.00±13.58）更显著,组间比较差异有统计学意义（P=0.003）。结论 作业疗法结合经皮神经电刺激可缓解脑卒中肩痛,改善患者日常生活能力和心理精神状态,减少抑郁的发生。

Objective To explore the therapeutic effect of occupational therapy combined with transcutaneous electrical nerve stimulation（TENS） on shoulder pain after stroke．Methods Sixty patients with post-stroke shoulder pain who were treated in the First People’s Hospital of Zhaoqing from June 2020 to June 2023 were selected as the study subjects and randomly divided into an observation group and a control group,with 30 cases in each group．Among them,the observation group received occupational therapy combined with TENS,while the control group received occupational therapy alone．This study recorded the Visual Analogue Scale（VAS）,modified Barthel Index（MBI）,and Hamilton Depression Rating Scale（HAMD）of patients before and after 4 weeks of treatment,and conducted the and t-test analysis．Results The test analysis showed a significant difference in treatment effectiveness between the observation group and the control group（P=0.019）,with the observation group having a significantly higher treatment effectiveness rate（93.33%）than the control group（63.33%）;t-test analysis showed that there was no statistically significant difference in VAS（P=0.536）and HAMD（P=0.558）indicators between the two groups of patients before treatment．However,after treatment,the VAS（P=0.049）and HAMD（P=0.023）indicators decreased compared to before treatment．The observation group had decreased（2.23±1.14）and（4.47±3.06）,respectively,which were significantly higher than the control group’s（1.27±0.98）and（1.33±1.35）,and the inter group differences were statistically significant;before treatment,there was no statistically significant difference in MBI indicators between the two groups of patients（P=0.216）．After treatment,their MBI indicators increased compared to before treatment,and the observation group（21.87±10.25）showed a more significant improvement compared to the control group（12.00±13.58）．The difference between the groups was statistically significant（P=0.003）．Conclusions Occupational therapy combined with TENS can significantly alleviate shoulder pain after stroke,improve daily living ability and psychological state of patients,and reduce the occurrence of depression．

目的 探究伏诺拉生三联疗法根除幽门螺杆菌（Hp）的疗效。方法 入组2022年5月—12月经¹³C尿素呼气试验确诊的Hp现症感染者200例,分为观察组和对照组,每组100例。观察组方案为阿莫西林、呋喃唑酮、伏诺拉生三联疗法,对照组方案为阿莫西林、呋喃唑酮、艾司奥美拉唑镁、枸橼酸铋钾四联疗法;疗程均为14 d。在治疗停药后1个月复查¹³C尿素呼气试验判定是否Hp根除成功,并观察药物不良反应发生率。结果 观察组Hp根除率为96.97%,高于对照组的89.80%,差异有统计学意义（P<0.05）;观察组不良反应发生率和对照组比较差异无统计学意义（P>0.05）。结论 伏诺拉生、阿莫西林、呋喃唑酮三联疗法的Hp根除率较高且安全性良好,可作为Hp感染的治疗方案之一。

Objective To explore the effect of vonoprazan triple therapy on Helicobacter pylori（Hp）．Methods A total of 200 patients with Hp infection confirmed by ¹³C urea breath test from May-December 2022 were selected and divided into observation group and control group with 100 patients in each group．The observation group was treated with triple therapy of amoxicillin,furazolidone and vonoprazan,while the control group was treated with quadruple therapy of amoxicillin,furazolidone,esomeprazole magnesium and bismuth potassium citrate．The treatment course was 14 days．The ¹³C urea breath test was reviewed one month after treatment withdrawal to determine whether Hp eradication was successful,and the incidence of adverse drug reactions was observed．Results The eradication rate of Hp in the observation group was 96.97%,higher than 89.80% in the control group,and the difference was statistically significant（P<0.05）．There was no significant difference in the incidence of adverse reactions between the observation group and the control group（P>0.05）．Conclusions The triple therapy of vonoprazan,amoxicillin and furazolidone has a very high eradication rate and good safety,which can be used as one of the treatment options for Hp．

目的 探讨选择输尿管软镜下钬激光碎石术治疗肾结石（直径≤3 cm）的效果。方法 回顾性选择2021年1月—2023年1月广州市增城区新塘医院接收的180例肾结石（直径≤3 cm）患者为研究对象,按照手术方式分为对照组（n=90,给予经皮肾镜碎石术治疗）与观察组（n=90,给予输尿管软镜下钬激光碎石术治疗）,比较两组的结石清除效果、并发症、手术治疗情况、炎症反应、肾功能指标。结果 观察组结石清除89例、清除率98.89%,与对照组85例、清除率94.44%比较差异无统计学意义（χ²=2.758,P=0.096）;观察组发生并发症1例、发生率1.11%,比对照组8例、发生率8.89%更低（χ²=5.731,P=0.016）。与对照组（58.45±10.62）min、（32.26±4.49）mL、（10.42±2.27）g/L、（4.25±0.86）min比较,观察组手术操作时长（70.05±15.24）min更高,术中失血量（10.22±2.28）mL更少、术后血红蛋白（Hb）下降值（3.94±1.05）g/L更低,视觉模拟评分法（VAS）（2.22±0.42）分更低（t分别为5.924、41.521、24.579、20.121,P<0.05）。术后两组白细胞计数（WBC）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、降钙素原（PCT）明显升高,而观察组（7.62±1.15）×10⁹/L、（14.25±2.24）mg/L、（1.65±0.34）mg/mL、（17.22±1.45）ng/ml明显低于对照组（8.82±1.41）×10⁹/L、（22.26±3.63）mg/L、（2.56±0.44）mg/mL、（20.64±2.87）ng/mL（t分别为6.256、17.814、15.525,10.090,P<0.05）。术后两组各指标明显升高,血肌酐（Scr）、胱抑素-C（Cys-C）、血尿素氮（BUN）组间比较差异无统计学意义（P>0.05）;而观察组、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）（4.95±0.84）μg/L明显低于对照组（6.45±1.15）μg/L（t=9.992,P<0.05）。结论 输尿管软镜引导下置入钬激光进行碎石可有效治疗直径≤3 cm肾结石,取得与经皮肾镜相当的疗效,可进一步减轻疼痛,减少出血,控制炎症反应,避免肾功能损伤,安全性更高。

目的 探讨快速康复理念联合腹腔镜手术治疗对小儿腹股沟疝疗效观察。方法 选取焦作市妇幼保健院2021年1月—2023年1月收治的86例腹股沟疝患儿进行分析与研究,应用随机数字表法将其分为观察组与对照组,各组均为43例。所有患儿均采取腹腔镜手术治疗,对照组采取常规护理,观察组采取快速康复理念护理。对比两组围术期恢复情况,术后4、12、24、48 h疼痛程度,并发症及护理满意度情况。结果 观察组首次下床时间、首次肛门排气时间、进食时间、住院时间短于对照组（P<0.05）;两组患儿术后4、12、24、48 h视觉模拟量表（VAS）评分逐渐降低,观察组低于对照组（P<0.05）;两组恶心呕吐、尿潴留、腹胀腹痛、感染并发症发生率对比差异无统计学意义（P>0.05）;观察组患儿及家长健康教育、住院环境、专科护理、检查指导、病情观察相关护理满意度评分高于对照组（P<0.05）。结论 快速康复理念联合腹腔镜手术治疗小儿腹股沟疝效果显著,可进一步促进患儿早日康复,缩短住院时间,术后疼痛水平低,同时可提升患儿及家长护理满意度。

Objective To explore the therapeutic effect of rapid rehabilitation concept combined with laparoscopic surgery on pediatric inguinal hernia．Methods A total of 86 children with inguinal hernia admitted to Jiaozuo Maternal and Child Health Care Hospital from January 2021 to January 2023 were selected for analysis and study,and divided into observation group and control group by random number table method,with 43 cases in each group．All patients were treated with laparoscopic surgery,while the control group received routine care,while the observation group received rapid recovery concept care．The perioperative recovery,pain level,complications,and nursing satisfaction at 4,12,24,and 48 hours after surgery were compared．Results The first discharge time,first anal exhaust time,feeding time,and hospitalization time were shorter than the control group（P<0.05）．The VAS scores decreased after 4 h,12 h,24 h and 48 h,and the observation group was lower than the control group（P<0.05）．The incidences of nausea and vomiting,urinary retention,abdominal distension,abdominal pain and infectious complications between the two groups were significantly insignificant（P>0.05）．The health education,inpatient environment,specialized care,nursing examination guidance and condition observation were significantly higher than that of the observation group（P<0.05）．Conclusions The combination of rapid recovery concept and laparoscopic surgery for the treatment of inguinal hernia in children has a significant effect,which can further promote early recovery,shorten hospital stay,lower postoperative pain levels．At the same time,it can improve the nursing satisfaction of children and parents．

目的 探讨依奇珠单抗对中重度斑块型银屑病的治疗效果。方法 选取厦门大学附属第一医院2022年1月—2023年8月收治的75例中重度斑块型银屑病患者,应用抽签法进行分组,分为试验组（n=35）与对照组（n=40）。对照组采取常规外用药物治疗,试验组采取依奇珠单抗治疗。对比两组临床疗效,治疗前后外周血调节性T细胞（Treg）和辅助性T细胞17（Th17/Treg）细胞水平变化,并对所有患者进行6个月门诊复查随访,对比复发率及不良反应。结果 试验组总有效率88.57%,高于对照组的67.50%（χ²=4.730,P=0.028）;治疗后两组患者Treg细胞升高,试验组（5.59±1.24）%高于对照组（4.12±1.13）%,对比差异有统计学意义（t=5.371,P<0.001）,Th17细胞、Th17/Treg细胞降低,试验组[（1.06±0.14）%、0.19±0.05]低于对照组[（1.71±0.28）%、0.42±0.14],对比差异有统计学意义（t=12.434、9.212,P<0.001）;试验组停药后6个月复发率低于对照组（5.71% vs 27.50%,χ²=6.180,P=0.013）;试验组不良反应发生率略高于对照组,组间对比差异无统计学意义（14.29% vs 5.00%,χ²=1.900,P=0.168）。结论 依奇珠单抗治疗中重度斑块型银屑病疗效显著,可调节Th17/Treg平衡,降低停药后复发率,且安全性较高。

Objective To explore the therapeutic effect of Ixekizumab on moderate to severe plaque psoriasis. Methods Seventy-five patients with moderate to severe plaque psoriasis who were admitted to the First Affiliated Hospital of Xiamen University from January 2022 to August 2023 were selected and allocated by lottery into an experimental group（n=35）and a control group（n=40）．The control group received routine external medication while the experimental group received Ixekizumab treatment．The clinical efficacy of two groups,changes in Th17/Treg cell values before and after treatment were compared,and a 6-month outpatient follow-up for all patients was conducted to compare recurrence rates and incidence of adverse reactions. Results The total response rate in the experimental group was 88.57%,which was higher than the 67.50% in the control group（χ²=4.730,P=0.028）．After treatment,the level of Treg cell in the two groups was significantly higher,and the level of Treg cell experimental in the group was higher than that in the control group[（5.59±1.24）% vs （4.12±1.13）%,t=5.371,P<0.001]．After treatment,the level of Th17 and Th17/Treg cell in the two groups were lower,and the level of Th17 cell and Th17/Treg in the experimental group[（1.06±0.14）%,0.19±0.05] were significantly lower than those in the control group[（1.71±0.28）%,0.42±0.14],which was statistically significant（t=12.434、9.212,P<0.001）．The relapse rate at 6 months after drug withdrawal in the experimental group was significantly lower than that in the control group（5.71% vs 27.50,χ²=6.180,P=0.013）．The incidence of adverse reactions in the experimental group was higher than that in the control group,but with no statistical significance（14.29% vs 5.00%,χ²=1.900,P=0.168）. Conclusions Ixekizumab has a significant therapeutic effect on moderate to severe plaque psoriasis．It can regulate the Th17/Treg balance and reduce the recurrence rate after discontinuation,and with high safety．

目的 探究炔雌醇环丙孕酮联合胰岛素增敏剂治疗多囊卵巢综合征疗效。方法 选取广东省第一荣军医院妇科2018年8月—2020年8月收治的100例多囊卵巢综合征患者作为研究对象,采用随机数字表法将患者分为对照组(n=50)和观察组(n=50),2组患者均给予炔雌醇环丙孕酮治疗,观察组此外联合胰岛素增敏剂治疗,比较2组患者治疗前、治疗30 d后血清性激素、抗缪勒管激素(AMH)水平、代谢指标水平以及临床疗效(包括排卵、妊娠等)。结果 治疗前,2组患者血清性激素、AMH水平比较,差异不具有统计学意义(P>0.05),治疗后,2组患者AMH、血清性激素水平均有所下降,且观察组低于对照组(P<0.05)。治疗前,2组患者代谢指标比较,差异不具有统计学意义(P>0.05),治疗后2组患者代谢指标水平均有所下降,且观察组低于对照组(P<0.05)。观察组治疗有效率高于对照组(P<0.05)。结论 使用单一药物治疗具有局限性,将炔雌醇环丙孕酮与胰岛素增敏剂相联合治疗能够有效降低患者胰岛素代谢指标水平以及性激素水平,提高患者受孕几率,具有良好的治疗效果。

Objective To explore the efficacy of ethinylestradiol and cyproterone combined with insulin sensitizer in the treatment of polycystic ovary syndrome. Methods A total of 100 patients with polycystic ovary syndrome treated in the Department of Gynecology of the First Invalids Hospital of Guangdong Province from August 2018 to August 2020 were selected as the research object. The patients were divided into control group (n=50) and observation group (n=50). The patients in both groups were given ethinylestradiol cyproterone. In addition, the observation group was treated with insulin sensitizer. The levels of serum sex hormone, anti-Müllerian hormone (AMH), metabolic index level and clinical efficacy (including ovulation, pregnancy, etc.) before treatment and 30 days after treatment were compared. Results Before treatment, the levels of serum sex hormone and AMH had no significant difference between two groups (P>0.05). After treatment, the levels of AMH and serum sex hormone both decreased in two groups, and those in observation group were lower than those in control group (P<0.05). Before treatment, it had no significant difference in metabolic indexes (P>0.05). After treatment, the levels of metabolic indexes in the two groups decreased, and those in observation group were lower than those in control group (P<0.05). The effective rate of the observation group was higher than the control group (P<0.05). Conclusions Using single drug treatment has limitations. The combination of ethinylestradiol cyproterone and insulin sensitizer can reduce insulin metabolism and sex hormone levels, improve the probability of pregnancy, which have a good therapeutic effect.

目的 观察及探讨电子纤维喉镜抽吸法结合保守疗法治疗成年人分泌性中耳炎与单纯保守疗法治疗成年人分泌性中耳炎的疗效对比。 方法 86例成年人分泌性中耳炎患者按就诊先后顺序分成电子纤维喉镜抽吸法结合保守疗法治疗组及单纯保守疗法对照组两组,治疗6个月后, 统计分析临床治疗情况。 结果 电子纤维喉镜抽吸法结合保守疗法治疗组的临床疗效明显优于单纯保守疗法对照组 (P<0.05)。结论 电子纤维喉镜抽吸法结合保守疗法是一种高效、副作用小的治疗成年人分泌性中耳炎的方法,明显改善患者的症状、体征,提高疗效,缩短疗程,降低鼓膜穿刺及中耳手术概率。

Objective To observe and explore the difference on the treatment of secretory otitis media between the effect of electronic fiber laryngoscope suction combined with conservative therapy and the effect of the simple conservative therapy only. Methods The 86 adult patients with secretory otitis media were divided into two groups according to the order of treatment, One group used the electronic fiber laryngoscope suction combined with conservative therapy and the other used simple conservative therapy. After 6 months of treatment, the clinical treatment was statistically analyzed. Results The group used the electronic fiber laryngoscope suction combined with conservative therapy has a better effect(P<0.05). Conclusion The treatment of secretory otitis media electronic fiber laryngoscope suction combined with conservative therapy is a high efficiency and less side effect. What more, it improves the patient's symptoms, improves the curative effect and shortens the course of treatment and reduce the probability of tympanic membrane puncture and surgery.

目的 研究探讨复合式小梁切除术治疗原发性闭角型青光眼(primary angel closure glaucoma,PACG)的疗效。方法 选取2017年6月—2019年5月我院眼科收治的PACG患者86例(98眼),所有患者入院前均确诊,按照随机数字表法分为对照组和研究组各43例。对照组以传统小梁切除术、研究组以复合式小梁切除术治疗,对比滤过泡情况、中央前房深度(CACD)、眼压(IOP)及并发症发生率。结果 研究组术后1个月、6个月Ⅰ~Ⅱ型滤过泡形成率均高于对照组,(P＜0.05)。术前,两组CACD、IOP对比差异无统计学意义(P＞0.05);术后1 d、1个月,研究组CACD均高于对照组,研究组IOP均低于对照组,(P＜0.05);术后6个月,两组IOP比较无统计学意义(P＞0.05);两组并发症比较,对照组并发症发生率38.00%,研究组6.25%,研究组低于对照组(P＜0.05)。结论 以复合式小梁切除术治疗PACG,能够促进功能性滤过泡形成、前房及IOP恢复,并能够减少并发症,临床效果优于传统小梁切除术。

目的 本研究旨在探讨颈椎手法治疗对颞下颌关节紊乱症患者的疗效,为其临床应用及推广提供依据。方法 将符合入组条件的40例诊断为颞下颌关节紊乱症的患者随机分为实验组(20例)和对照组(20例)。对照组给予物理治疗,包括超声波及超短波治疗。实验组除与对照组一样的物理治疗外,还给予手法治疗,包括椎旁软组织放松按摩,颈椎复位及枕后肌群抑制技术。两组的治疗均持续2周,每周5次,总共10次。两组患者分别在治疗前和治疗后评估其咬肌的压痛阈值、最大张口度、咀嚼肌(咬肌和颞肌)在静息状态下表面肌电平均电位、咀嚼肌在最大用力状态下表面肌电峰值均值,并计算咀嚼肌不对称性指数、总体活动不对称性指数。结果 组内前后比较:对照组患者治疗后仅部分咀嚼肌的静息电位、最大张口度和咬肌压痛阈值的改变有统计学意义(P<0.05);实验组治疗后所有的指标的改变均有统计学意义(P<0.05)。组间比较:通过比较两组治疗前后的差值,结果显示所有指标改变都有统计学意义(P<0.05)。实验组的静息电位和咀嚼肌不对称性指数下降更多(P<0.05),而最大张口度和咬肌压痛阈值增加得更多(P<0.05)。结论 相比单纯运用理疗的方式,采用颈椎手法治疗联合物理治疗对颞下颌关节紊乱患者,其疗效更加明显。