目的 本文主要探讨信迪利单抗联合化疗治疗复发转移食管癌的临床有效性和安全性。方法 选取2018年1月—2020年1月我院收治的复发转移食管癌患者共98例纳入研究。按照随机数字表法将患者分为对照组(49例)和观察组(49例),对照组给予多西他赛75 mg/m²+顺铂75 mg/m²治疗,观察组在对照组的基础上给予信迪利单抗(200 mg)治疗,分析比较2组临床疗效及不良反应,主要评估指标是随访期间患者中位生存时间。结果 观察组临床治疗有效率高于对照组(P<0.05);与治疗前比较,2组治疗后血清糖类抗原-199(CA-199)、癌胚抗原(CEA)及肿瘤特异生长因子(TSGF)水平均降低(P<0.05);与对照组比较,观察组治疗后血清CA-199 、CEA及TSGF水平降低(P<0.05);2组临床不良反应主要以恶心呕吐、皮疹等为主,观察组免疫相关不良事件发生率高于对照组(P<0.05),但总不良反应发生率比较无差异(P>0.05);随访至2020年10月,观察组中位OS为16个月(5～27个月),对照组中位总生存期(OS)为9个月(3～23个月),观察组中位OS长于对照组(P<0.001)。结论 信迪利单抗联合化疗可提高复发转移食管癌的临床治疗效果,降低肿瘤抗原水平,延长患者生存时间,且临床较为安全。

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 比较来曲唑和氯米芬治疗极严重少精子症的治疗效果。方法 选取2020—2021年在本生殖中心门诊50例极严重少精子症病例,分为2组,A组(来曲唑,研究组n=26)、B组(氯米芬,对照组n=24)。结果 来曲唑和氯米芬治疗后1月、3月,A组精子浓度明显提高,优于B组[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]。通过卵胞浆内单精子注射/体外受精胚胎移植治疗,A组妊娠16例(61.5%),B组妊娠11例(45%)。2组治疗后的血清卵泡刺激素、黄体生成素、睾酮升高[(5.9±3.8) vs (20.3±2.6);(3.6±2.8) vs (9.5±5.7);(13.6±10.5) vs (25.3±10.8),P<0.05],A组雌二醇水平降低[(36.8±20.6) vs (7.6±2.5),P<0.05]。结论 来曲唑治疗极严重少精子症有较理想的临床治疗效果,明显优于氯米芬。

Objective To explore and compare the therapeutic effects of letrozole and clomiphene in the treatment of extremely severe oligospermia. Methods A tatal of 50 cases of extremely severe oligosperospermia in the reproductive center from 2020 to 2021 were selected and divided into two groups, group A (letrozole, study group n=26) and B (clomiphene, control group n=24). Results After letrizole and clomiphene treated for 1 and 3 months, sperm concentration in group A was significantly better than group B[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]. With ICSI/IVF, 16 cases (61.5%) succeed in encyesis in group A, 11 cases (45%) in group B. Serum follicle stimulating hormone, luteinizing hormone and testosterone levels were significantly increased after treatment [(5.9±3.8) vs (20.3±2.6), (3.6±2.8) vs (9.5±5.7), (13.6±10.5) vs (25.3±10.8), P<0.05]. The level of estradiol in group A decreased [(36.8±20.6) vs (7.6±2.5), P<0.05]. Conclusions Letrozole has ideal clinical treatment effect, which is obviously superior to clommiphene.

目的 探讨重组人干扰素α2b喷雾剂治疗儿童流行性感冒的疗效及安全性。方法 选取我院2017年1月—2020年2月所收治的80例儿童流行性感冒患者,按1:1随机分为实验组及对照组,每组患儿40例,对照组患者给予奥司他韦治疗,实验组患者在对照组治疗基础上联合重组人干扰素α2b喷雾剂治疗,对比2组患者的疗效及安全性。结果 实验组患儿咽痛症状消失时间(2.01±0.23)d、体温恢复正常时间(2.18±0.30)d、咳嗽症状消失时间(1.68±0.52)d、治疗时间(5.41±0.36)d均短于对照组(t=26.001、9.766、19.277、28.089,P＜0.05);实验组患儿治疗有效率95.0%高于对照组治疗有效率(χ²=4.114,P＜0.05);实验组患儿的不良反应发生率低于对照组(χ²=4.021,P＜0.05)。结论 重组人干扰素α2b喷雾剂治疗儿童流行性感冒的方案可获取较为理想的治疗效果,保证患儿用药安全性,尽快缓解患儿的临床症状,促使患儿病情康复,促进患儿健康生长,该治疗方案可在临床中推广应用。

Objective To explore the efficacy and safety of recombinant human interferon α2b spray in the treatment of influenza in children. Methods Eighty children with influenza who were admitted to our hospital from January 2017 to February 2020 were randomly divided into experimental group and control group evenly, with 40 children in each group. Oseltamivir treatment was given to the control group, the experimental group was treated with recombinant human interferon α2b spray on the basis of oseltamivir, and the efficacy and safety of the two groups were compared. Results In the experimental group, the time for the disappearance of sore throat was (2.01±0.23) d, the time for the body temperature returned to normal was (2.18±0.30) d, the time for the cough to disappear was (1.68±0.52) d, and the treatment time was (5.41±0.36) d, which were all shorter than the control group (t=26.001, 9.766, 19.277, 28.089, P<0.05). The treatment effective rate of children in the experimental group was 95.0%, which was significantly higher than that in the control group (χ²=4.114, P<0.05); the incidence of adverse reactions in experimental group was significantly lower than that in the control group (χ²= 4.021, P<0.05). Conclusions The recombinant human interferon α2b spray for the treatment of influenza in children could obtain a more ideal therapeutic effect, ensure the safety of the children's medication, relieve the clinical symptoms as soon as possible, promote the improvement of the children's condition, and promote the healthy growth of the children. The treatment plan can be promoted and applied in clinical practice.

目的 探讨在COVID-19流行期间血库资源紧张状态下输血时机对儿童输血效果及临床预后的影响。方法 本回顾性队列研究纳入2020年1月—2020年12月在广州市妇女儿童医疗中心儿科急诊就诊并申请输血的患儿的临床预后。结果 共566例发起红细胞和血小板的非手术输血申请的患儿纳入研究,包括 260 例的红细胞申请和306例血小板申请。260份红细胞申请中:209 例及时输血,40 例延时输血,11 例未输血;及时组和延时组的输血有效率分别为37.8%和35.0%(P=0.737);1名不良预后的死亡病例出现在及时组中,余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.886)。306份血小板申请中:195 例及时输血,108 例延时输血,3例未输血;1名不良预后的死亡病例出现在及时组中(0.51%),3名不良预后的死亡病例出现在延时组中(2.78%),余病例临床预后均良好,3组的临床结局无统计学差异(组间P=0.131)。结论 符合红细胞与血小板输血指征的非急诊手术用血的急诊患儿中,及时组、延时组和未输血组之间的临床结局没有差异。输血时机进一步需要大样本的循证研究加以确定。

Objective To investigate the influence of blood transfusion timing on blood transfusion efficacy and clinical prognosis in children under the strain of blood bank resources during COVID-19 pandemic. Methods This retrospective cohort study included clinical outcomes of pediatric emergency patients who applied for blood transfusion in Guangzhou Women and Children's Hospital from January 2020 to December 2020. Results A total of 566 children applicated blood transfusion for red blood cells and platelets for non-emergency surgical use were enrolled, including 260 red blood cells cases and 306 platelets cases. Among the 260 applications for red blood cells, 209 cases received timely transfusion, 40 cases received delayed transfusion, and 11 cases did not receive transfusion.The effective rate of transfusion for red blood cells was 37.8% in the timely group and 35.0% in the delayed group (P=0.737). One death case with poor prognosis was found in the timely transfusion group, and the clinical prognosis of the rest cases was good. There was no statistical difference in the clinical outcomes among the three groups (P=0.886). Among 306 applications for platelet, 195 cases had timely transfusion, 108 cases had delayed transfusion, and 13 cases did not had transfusion.One case with poor prognosis died in the timely transfusion group (0.51%), and three with poor prognosis died in the delayed transfusion group (2.78%). The rest of the cases had good clinical prognosis, and there was no statistical difference in clinical outcomes among the three groups (P=0.131). Conclusions There were no significant differences in clinical outcomes among the timely transfusion group, the delayed transfusion group, and the non-transfusion group for red blood cell and platelet transfusion respectively. The timing of transfusion may need to be determined by evidence-based studies with large samples.

目的 探究与分析化脓性阑尾炎抗生素治疗后不同时机腹腔镜阑尾切除术的疗效及预后。方法 研究于2019年1月—2021年1月进行,我院收治的96例化脓性阑尾炎患者为此研究的参与对象,接受抗生素治疗≤72 h后手术的患者为观察组(n=38),>72 h的患者为对照组(n=38)。对比2组患者的指标。结果 2组的手术时间等相较均无差异(P>0.05);观察组的住院时间及住院费用均短于或少于对照组(P<0.05)。观察组术前中性粒细胞比例及白细胞计数高于对照组(P<0.05);术后2组患者组间无差异(P>0.05)。观察组的腹腔渗液阳性率低于对照组(P<0.05)。2组并发症发生率比较,组间无差异(P<0.05)。结论 化脓性阑尾炎患者经抗生素治疗后续尽早接受手术治疗。

目的 探究青少年首发抑郁症患者治疗中联合应用艾司西酞普兰与重复经颅磁刺激(rTMS)的总疗效及应用价值。方法 选取东莞市第七人民医院2020年5月—2021年10月80例青少年首发抑郁症患者,参考“数字双盲法”,分为对照组和观察组(各40例)2组,对照组接受伪rTMS+艾司西酞普兰治疗,观察组接受rTMS+艾司西酞普兰治疗。评价指标:临床总疗效、抑郁评分(17项汉密尔顿抑郁量表,HAMD-17)、认知功能评分(威斯康星卡片分类测验,WCST)、生活质量(SF-36评分),不良反应发生率(副反应量表,TESS)。结果 观察组患者总有效率95.00%较对照组80.00%明显高(P＜0.05);且2组不良反应率比较(P＞0.05)。观察组治疗1周、2周、4周HAMD-17评分均较对照组低,同时治疗4周后WCST项目中完成分类评分较对照组更高(P＜0.05)。观察组SF-36(角色、社会、躯体、认知)评分均较对照组高(P＜0.05)。结论 青少年首发抑郁症患者,在艾司西酞普兰用药基础上联合rTMS,可获取更为显著的治疗效果,控制病情进展,减轻抑郁症状,同时对认知功能无影响,促进生活质量大幅度提高,且用药安全性有保障。

Objective To explore the total efficacy and application value of escitalopram combined with repetitive transcranial magnetic stimulation (rTMS) in the treatment of adolescent patients with first-episode depression.Methods A total of 80 adolescent patients with first-episode depression in Dongguan Seventh People's Hospital from May 2020 to October 2021 were selected.Referring to the “digital double-blind method”,they were divided into control group and observation group (40 cases each).The control group was treated with pseudo rTMS and escitalopram,and the observation group was treated with rTMS and escitalopram.Evaluation indexes: total clinical efficacy,depression score (17-item Hamilton Depression Scale,HAMD-17),cognitive function score (Wisconsin Card Sorting Test,WCST),quality of life (SF-36 score),adverse reaction rate (Treatment Emergent Symptom Scale,TESS).Results The total effective rate of 95.00% in the observation group was significantly higher than 80.00% in the control group (P<0.05); the incidence of adverse reactions was compared between the two groups (P>0.05).The HAMD-17 scores of the observation group at 1 week,2 weeks and 4 weeks were significantly lower than those of the control group.At the same time,the classification scores of WCST items after 4 weeks of treatment were higher in observation group (P<0.05).The SF-36 (role,society,body and cognition) scores in the observation group were higher than those in the control group (P<0.05).Conclusions Adolescent patients with first-episode depression treated with rTMS on the basis of escitalopram can obtain more significant therapeutic effect,control the progress of the disease,reduce depressive symptoms,have no effect on cognitive function,greatly improve the quality of life,and ensure the safety of medication.

目的 观察聚乙二醇化重组人粒细胞刺激因子(PEG-rhG-CSF)与重组人粒细胞刺激因子(rhG-CSF)在造血干细胞移植后促进造血恢复的疗效对比。方法 回顾分析2016年1月—2020年12月以来在深圳市第二人民医院血液科进行造血干细胞移植的恶性血液疾病患者共 100例,随机分为2组,分别在造血干细胞回输后给与聚乙二醇化重组人粒细胞刺激因子与重组人粒细胞刺激因子。结果 PEG-rhG-CSF组与rhG-CSF组中性粒细胞植入时间分别为(18.7±3.4)天、(18.0±3.1)天,P=0.281,无统计学差异。粒细胞缺乏伴发热在PEG-rhG-CSF组与rhG-CSF组分别发生26例、29例,发生率分别为53.06%、56.86%,P=0.89,无差异。用药次数分别为2.6次(2~5次)、18.1次(11~31次),P<0.05,差异有统计学意义。不良反应主要为骨痛、肌肉疼痛。结论 PEG-rhG-CSF组与rhG-CSF组结果相似,PEG-rhG-CSF具有用药次数少的优势。

Objective The efficacy of pegylated recombinant human granulocyte stimulating factor (PEG-rhG-CSF) and recombinant human granulocyte stimulating factor(rhG-CSF) in promoting hematopoiesis recovery after hematopoietic stem cell transplantation.Methods The data of 100 patients with malignant blood diseases who underwent hematopoietic stem cell transplantation in the Hematology Department of Shenzhen Second People's Hospital from January 2016 to December 2020 were retrospectively analyzed.They were randomly assigned to two groups,which accepted PEG-rhG-CSF and rhG-CSF respectively after hematopoietic stem cell transfusion.Results The time of neutrophil implantation in PEG-rhG-CSF group and rhG-CSF group were (18.7±3.4) days and (18.0±3.1) days respectively,P=0.281,showing no statistical difference.There were 26 cases of neutropenia with fever in PEG-rhG-CSF group and 29 cases in rhG-CSF group,with incidence of 53.06% and 56.86% (P=0.89),showing no statistical difference.The times of medication were 2.6 times (2-5 times) and 18.1 times (11-31 times),P<0.05,with significant statistical difference.The main adverse reactions were bone pain and muscle pain.Conclusions The outcomes of PEG-rhG-CSF group and rhG-CSF group were similar,PEG-rhG-CSF had the advantage of fewer times of medication.

目的 探究支气管镜下肺泡灌洗并局部使用阿米卡星治疗老年支气管扩张合并感染患者的疗效及对血清炎性因子水平的影响。方法 选取我院2018年3月—2019年5月确诊支气管扩张症、合并感染的符合纳入标准的患者共64例,按照1:1比例抽签分为2组,32例纳入观察组,应用支气管镜下肺泡灌洗阿米卡星治疗;32例纳入对照组,以单纯的支气管镜下肺泡灌洗治疗。观察并比较2组患者的治疗效果、血清炎性因子水平、肺功能情况等。结果 疗效比较显示观察组的96.9%总有效率高于对照组的75.0%(P＜0.05);血清炎性因子水平在患者用药前检测无差异(P＞0.05),经过治疗后,观察组水平均优于对照组P＜0.05;经治疗后,观察组静态肺活量、补呼气量、补吸气量、用力肺活量均优于对照组,差异具有统计学意义(P＜0.05)。结论 对老年支气管扩张合并感染患者应用支气管镜下肺泡灌洗阿米卡星治疗,促进临床效果改善,患者的症状、炎症及肺功能等指标均得到明显改善,值得推广。

Objective To investigate the efficacy of bronchoscopic alveolar lavage and local application of amikacin in the treatment of elderly patients with bronchiectasis complicated with infection and its effect on the level of serum inflammatory factors.Methods A total of 64 patients with bronchiectasis complicated with infection diagnosed in our hospital from March 2018 to May 2019 were selected.They were divided into two groups evenly by proportional drawing. Thirty-two cases were included in the observation group that were treated with bronchoscopic alveolar lavage with amikacin.The other 32 cases were included in the control group that were treated with the bronchoscopic alveolar lavage only.The therapeutic effect,serum inflammatory factor level and pulmonary function of the two groups were observed and compared.Results The total effective rate of 96.9% in observation group was higher than 75.0% in control group (P<0.05).There was no difference in the levels of serum inflammatory factors before treatment (P>0.05).After treatment,the levels of the observation group were better than those of the control group (P<0.05).After treatment,the slow vital capacity,expiratory reserve volume,inspiratory reserve volume and forced vital capacity of the patients in the observation group were better than those in the control group (P<0.05).Conclusions Bronchoscopic alveolar lavage of amikacin in elderly patients with bronchiectasis complicated with infection could improve the clinical effect.The symptoms of the patients,the serum inflammatory factors and lung function of the patients were significantly improved.The treatment is worthy of promotion.

目的 探究词联导航训练法结合针灸、环喉按摩对脑卒中构音功能障碍的疗效。方法 将我院收治的200例脑卒中伴有构音障碍患者按照随机数字表法平均分为干预组与对照组。两组患者均接受临床基础治疗、常规PT、0T、理疗和中医药治疗,在此基础上干预组给予词联导航训练法结合针灸、环喉按摩等综合的康复方案进行康复护理和治疗,观察疗效以及不良反应发生情况。结果 干预组(90%)的临床疗效优于对照组(76%),差异有统计学意义(P＜0.05);生活质量评价干预组高于对照组,差异有统计学意义(P＜0.05);不良反应发生情况干预组(6%)与对照组(7%)接近,差异没有统计学意义(P＞0.05)。结论 词联导航训练法结合针灸、环喉按摩对脑卒中构音功能障碍方法安全、疗效显著,可以提升患者的生活质量。