目的 对比分析自动弹力线痔疮套扎术(RPH)与外剥内扎术联合治疗及吻合器痔上黏膜环切术(PPH)单独治疗重度混合痔的临床疗效。方法 选取2017年5月—2018年5月我院收治的100例重度混合痔患者,将其随机分为研究组(50例)与对照组(50例)。对照组患者采取PPH治疗,研究组患者采取RPH联合外剥内扎术治疗,对比两组患者治疗效果、手术相关指标,并观察术后肛门功能评分差异。结果 研究组患者的临床疗效高于对照组(P<0.05);手术时间及术中出血量、住院时间两组患者比较,研究组低于对照组(P<0.05)。研究组患者术后干便、气体、稀便、生活方式发生变化、需衬垫等肛门功能评分低于对照组(P<0.05)。结论 RPH与外剥内扎术联合治疗重度混合痔效果优于单独应用PPH治疗,值得临床推广。

Objective To study the efficacy and its influence on anal function of RPH combined with external ligation and internal ligation in the treatment of severe mixed hemorrhoids. Methods 100 patients with severe mixed hemorrhoids admitted to our hospital from May 2017 to May 2018 were selected as research subjects. They were randomly divided into the study group and the control group, 50 cases in each group. The control group was treated with PPH, and the study group was treated with RPH combined with external stripping and internal ligation. The therapeutic effect and operation related indexes of the two groups were compared, and the postoperative anal function scores were observed. Results The clinical efficacy of the study group was higher than that of the control group (P<0.05), and the intraoperative bleeding volume, operation time and hospitalization time of the study group were lower than that of the control group (P<0.05). The anal function scores such as dry stool, gas, dilution, lifestyle changes and padding requirement in the study group were lower than those in the control group (P<0.05). Conclusion RPH combined with external stripping and internal ligation is better than PPH alone in the treatment of severe mixed hemorrhoids.

目的 研究罗哌卡因阻滞用于胸腹腔镜联合食管癌根治术后镇痛的临床效果。方法 胸腹腔镜联合食管癌根治术患者60例,分为: 观察组(n=30),缝合切口时用0.25%盐酸罗哌卡因10 mL于切口局部浸润;对照组(n=30) 不做局部浸润麻醉处理;记录二组术后2 h、6 h、12 h、24 h、48 h的疼痛视觉模拟评分(VAS)及血浆皮质醇浓度。结果 观察组术后2 h、6 h、12 h VAS评分优于对照组,术后12 h观察组血浆皮质醇浓度低于对照组。结论 罗哌卡因术终阻滞术后12 h内镇痛效果明显。

Objective To evaluate the efficiency of postoperative analgesia with ropivacaine block after thoracoscopic-lapacoscopic esophagectomy (TLE). Methods Totally 60 patients with esophageal cancer underwent TLE were divided into two groups: observation group(n=30)with 0.25% ropivacaine hydrochloride solution 10 mL injection around incision before end of the operation; control group(n=30)without the treatment. The VAS and the plasma Cortisol concentration at 2 h、6 h、12 h、24 h、48 h after surgery were recorded. Results The VAS at 2 h、6 h、12 h after surgery in observation group was higher than that of the control group,but not at 24 h、48 h after surgery. The plasma Cortisol concentration in the observation group was higher than that of in the control at 12 hours postoperatively. Conclusion Ropivacaine block of incision is helpful to have analgesic effect within 12 hours after TLE.

目的 分析远红外穴位敷贴辅助蒙脱石口服液治疗小儿腹泻的疗效。方法 选择2014年9月—2016年9月我院门诊收治的腹泻患儿190例,按照随机数字表法分为对照组(n=95)和观察组(n=95),对照组患儿给予蒙脱石散口服液,观察组患儿在对照组治疗基础上给予远红外穴位敷贴治疗,比较2组患儿治疗效果、大便次数恢复正常时间、大便性状恢复正常时间、平均治愈时间及不良反应。结果 观察组患儿治疗有效率94.74%高于对照组85.26%(P<0.05);观察组患儿大便次数恢复正常时间、大便性状恢复正常时间、平均治愈时间均较对照组少(P<0.05);观察组与对照组患儿均无明显不良反应发生。结论 远红外穴位敷贴辅助蒙脱石口服液治疗小儿腹泻疗效显著,安全性较高。

Objective To analyze the efficacy of far infrared acupoint application assisted montmorillonite oral liquid on infantile diarrhea. Methods 190 cases of children with diarrhea treated in outpatient clinic of our hospital from September 2014 to September 2016 were selected for the study and divided into control group (n=95) and observation group (n=95) according to the random number table method. The control group was given the montmorillonite powder oral liquid, and the observation group was treated with far infrared acupoint application on the basis of treatment in the control group. The treatment effect, the recovery normal time of defecation frequency, the recovery normal time of stool property, the average cure time and adverse reactions were compared between the two groups. Results The effective rate of the observation group was higher than that of the control group (94.74% vs. 85.26%) (P<0.05). The recovery normal time of defecation frequency, the recovery normal time of stool property, the average cure time in the observation group were less than those of the control group (P<0.05). There were no significant adverse reactions between the observation group and the control group. Conclusion Far infrared acupoint application assisted montmorillonite oral liquid may have a significant efficacy and high safety in the treatment of infantile diarrhea.

目的 观察重组牛碱性成纤维细胞生长因子应用于治疗浅Ⅱ度烧伤创面的临床效果。方法 选取90例小面积浅Ⅱ度烧伤患者,随机平均分为2组:应用重组牛碱性成纤维细胞生长因子治疗的患者为治疗组,使用碘伏油纱治疗的患者为对照组,观察创面愈合时间、患者疼痛程度及远期色素沉着、瘢痕增生几率情况。结果 重组牛碱性成纤维细胞生长因子治疗组效果优于对照组,治疗组创面愈合时间(8.56±2.51)d短于对照组(12.42±2.13)d(P﹤0.05),平均愈合时间较提前3~5 d;患者疼痛度减轻[VAS评分分别是:(1.66±0.05)和(3.25±0.12),P﹤0.05];部分患者一年后随访发现治疗组远期色素沉着较轻,疤痕增生几率低。结论 应用重组牛碱性成纤维细胞生长因子治疗小面积浅度烧伤能够缩短创面愈合时间,在有效促进烧伤创面愈合同时,可减轻换药时疼痛,减轻远期色素沉着,降低瘢痕增生率。

Objective To observe effect of the recombinant bovine basic fibroblast growth factor in the treatment of superficial Ⅱ degree burn wounds. Methods Ninety cases of small area of superficial Ⅱ degree burn wounds were randomly divided into 2 groups: recombinant bovine basic fibroblast growth factor group(rb-bFGF) and control group (Iodophor gauze group). The wound healing time,patient pain, long-term hyperpigmentation and scar chance of proliferation were observed. Results The effect of rb-bFGF treatment group was better than that of control group. The healing time of the treatment group was (8.56 ± 2.51)d, it was shorter than that of the control group (12.42±2.13)d(P<0.01). The average healing time was 3~5 days, it was ahead of the control group; Compared to the control group, the rb-bFGF group had less pain (VAS scores were: 1.66±0.05 and 3.25±0.12,P<0.01); Some patients were followed up a year later, we found that the treatment group long-term pigmentation was lighter, scar chance of proliferation was lower. Conclusion Application of rb-bFGF in the treatment of small area of shallow Ⅱ degree of burns may shorten the wound healing time. As effective promotion of burn wound healing, it may reduce the pain when dressing, reduce long-term pigmentation and scarring rate.

目的 探讨生脉注射液联合环磷腺苷治疗慢性心力衰竭的临床疗效及对其心功能的影响。方法 选择本院2016年3月—2017年4月收治的90例慢性心力衰竭患者,随机将其分为2组,各45例。对照组采用环磷腺苷静脉滴注治疗,在此基础上观察组加用生脉注射液治疗,比较两组临床疗效、心功能及药物不良反应。结果 2个疗程后,观察组总有效率、LVEF、CI及CO水平均较对照组高,差异有统计学意义(P＜0.05);两组治疗期间药物不良反应率相比,差异无统计学意义(P＞0.05)。结论 生脉注射液联合环磷腺苷可提高慢性心力衰竭临床疗效,改善心功能,且用药安全性较高。

目的 观察关节镜下清理术联合中药熏洗治疗痛风性膝关节炎的临床疗效。方法 收集2013年7月—2016年7月期间收治于我院骨科的痛风性膝关节炎患者,根据纳入及排除标准,获得44例患者,共44个膝关节。根据术后是否采用中药熏洗治疗,将其分为治疗组25例及对照组19例。观察内容:术后1周及术后3月的WBC、BUA、ESR、CRP、膝关节疼痛VAS、Lysholm关节功能评分;2组患者术后6月、12月随访时的膝关节疼痛VAS、Lysholm关节功能评分。结果 ①2组患者术前与术后1周的膝关节疼痛VAS、 Lysholm关节功能评分组内比较差异有统计学意义(P＜0.05),术后1周的膝关节疼痛VAS、 Lysholm关节功能评分组间比较差异无统计学意义(P＞0.05)。②2组患者术前与术后3月随访的WBC、BUA、ESR、CRP组内比较差异有统计学意义(P＜0.05),术后3月随访的WBC、BUA、ESR、CRP组间比较差异无统计学意义(P＞0.05)。③2组患者术后3月、6月、12月随访的膝关节疼痛VAS、Lysholm关节功能评分组间比较,差异有统计学意义(P＜0.05)。结论 关节镜下清理术结合中药治疗痛风性膝关节炎能有效减轻患者膝关节疼痛,值得临床使用。

Objective Retrospective evaluation of the curative effect of the arthroscopic debridement combined with Chinese medicine fumes in the treatment of the gouty arthritis of knee joint.Methods We analyzed 44 patients (from July 2013 to July 2016 in the orthopaedic department of the Sichuan Second T.C.M.Hospital)with gouty arthritis of knee joint. The all 44 patients were divided into treatment group and control group according to postoperative management that whether or not to apply Chinese medicine fumes.The treatment group,25 patients, were all treated by arthroscopic debridement combined with Chinese medicine fumes,and the control group,19 patients, were all treated by arthroscopic debridement only.The observation targets were as follows: VAS、Lysholm、WBC、BUA、ESR、CRP of postoperative after 1 week, 3 months,and VAS、Lysholm. postoperative VAS、Lysholm after 6months、12months.Results Compared the preoperative contents with postoperative contents after1 week,there was statistically significant difference in VAS、Lysholm of both groups(P＜0.05).There was no statistically significant difference in VAS、Lysholm in postoperative 1 week between two groups (P＞0.05). Compared the preoperative contents with postoperative contents after 3 month,there was statistically significant difference in WBC、BUA、ESR、CRP of both groups(P＜0.05).There was no statistically significant difference in WBC、BUA、ESR、CRP of postoperative 3 months between two groups(P＞0.05). There was statistically significant difference in VAS、Lysholm of postoperative 3 months and 6 months between two groups(P＜0.05).Conclusion Arthroscopic debridement combined with Chinese medicine fumes may improve the quality of life in the treatment of gouty arthritis of knee joint,and it is worthy of wide clinical application.

目的 观察脑血管球囊成形支架置入术治疗急性脑梗死的疗效。方法 选取我院和珠江医院2015年1月—2017年7月收治的急性脑梗死患者40例,根据随机数表法分为观察组及对照组,各20例。对照组单纯施以药物治疗,观察组在对照组基础上加以脑血管球囊成形支架置入术治疗,对比两组治疗前后凝血功能指标水平变化情况及疗效。结果 治疗后,观察组APTT、PT、TT、INR水平高于对照组,Fbg水平低于对照组,治疗总有效率高于对照组,差异有统计学意义(P＜0.05)。结论 脑血管球囊成形支架置入术治疗急性脑梗死疗效确切,患者临床症状得到更好更快的改善,可改善患者凝血功能,对急性脑梗死的早期救治有着极为重要的应用价值。

目的 分析与比较不同血运重建策略对急性心肌梗死合并多支血管病变患者的疗效,以探讨其临床价值。方法 选取本院在2012年8月—2015年8月期间收治的急性心肌梗死合并多支血管病变患者,对每个患者均成功行PCI后,按随机数字表法分为实验组与对照组,实验组于发病后7～10天行预防性急诊PCI,并对非梗死相关血管病变进行干预;对照组则根据患者的缺血情况对非梗死相关血管病变行急诊PCI。随访2年,并记录2组患者主要心脏不良事件、其它心血管事件以及再次急诊PCI情况。结果 共有450例患者完成2年的随访,实验组患者有226例,对照组患者有224例。2组患者的全因病死率(χ²=7.040,P=0.008)、心脏不良事件(P均>0.05)以及心力衰竭发生率(χ²=1. 527,P=0.217)均无统计学差异。与对照组相比,实验组再发心绞痛(χ²=21.092,P<0.001)、心因性再住院(χ²=22.893,P<0.001)和再次支架治疗(χ²=17.835,P<0.001)的发生率均明显较低,而其相关血管血运重建率较高。且实验组随访2年时,β受体阻滞剂(χ²=7.040,P=0.008)和硝酸酯类药物(χ²=63.889,P<0.001)服用率均明显较高。结论 急性心肌梗死合并多支血管病变患者在成功行急诊干预梗死相关血管后,且预防性干预非梗死相关血管,可使再发心绞痛、再次支架治疗以及心因性再住院的发生率显著降低。

Objective By analyzing and comparing the effects of different revascularization strategies on patients with acute myocardial infarction complicated with multi-vessel disease, to explore its clinical value.Methods Selecting the patients with acute myocardial infarction complicated with multi-vessel disease from August, 2012 to August, 2015 in our hospital (Zhaoqing No.2 People's Hospital), after each patient was successfully treated with PCI, divided them into experimental group and control group by random number table method, the experimental groups were treated with preventive emergency PCI after the onset 7-10 days, and the intervention of non-infarct-related vascular diseases were done;the control groups were treated with emergency PCI for the non-infarct-related vascular diseases according to the patient's lack of blood. Visiting them randomly for 2 years, the main cardiac adverse events, other cardiovascular events and one more emergency PCI situation in the two groups were recorded.Results A total of 450 patients completed two years of follow-up, with 226 patients in the experimental group and 224 patients in the control group. All-cause mortality (χ2=7.040,P=0.008), cardiac adverse events (P> 0.05)and incidence of heart failure (χ2=1. 527,P=0.217) were no statistically significant difference between the two groups. Compared with the control group, the incidence of angina pectoris (χ2=21.092,P<0.001), cardiologic rehospitalization (χ2=22.893,P<0.001)and one more stent treatment (χ2=17.835,P<0.001) of the experimental group was significantly lower, but the revascularization rate was higher of their related blood vessels. And when the experimental group was followed up for 2 years, the taking rate of β-blockers (χ2=7.040,P=0.008) and nitrates (χ2=63.889,P<0.001) was significantly higher.Conclusion After the patients with acute myocardial infarction complicated with multi-vessel disease were successfully treated with emergency PCI to intervene the infarct-related blood vessels, and at the same time the intervention of the non-infarct-related blood vessels were done, the recurrence of angina pectoris, stent treatment and cardiopulmonary rehospitalization was significantly reduced.

目的 探讨复合声及心理辅导联合耳后注射利多卡因与甲强龙综合治疗特发性耳鸣的临床疗效。方法 选择符合纳入标准的耳鸣患者60例,随机分为耳后注射利多卡因与甲强龙组(A组)20例、心理辅导联合复合声组(B组)20例、耳后注射利多卡因与甲强龙联合心理辅导及复合声组(C组)20例,分别于治疗后1月、3月,通过耳鸣严重程度评估指标及评分标准评估三种治疗方式的疗效。结果 3组患者治疗3个月后A组总有效率为50 %, B组45%, C组90%,且组间有差异(P＜0.05)。另外,除A组与B组之间无差异外,C组与A组(P=0.0058)、B组(P=0.0024)之间均有差异。结论 实验结果表明复合声及心理辅导联合利多卡因与甲强龙综合治疗特发性耳鸣能有效治疗耳鸣,提高患者生存质量,在耳鸣临床治疗中明显具有积极作用,临床应用前景广阔。

目的 观察⁹⁹锝-亚甲基二膦酸盐对前列腺癌骨转移患者骨痛、骨质疏松的治疗效果。方法 对76例前列腺癌骨转移患者给予⁹⁹锝-亚甲基二膦酸盐治疗1年(每疗程15 d,每天静滴22 mg,15 d为一个疗程,共12个疗程),比较治疗前及治疗1年后患者骨密度(BMD)值及血清钙、磷、碱性磷酸酶、骨钙素、I型胶原交联羧基末端肽、1,25二羟维生素D3等指标的变化。结果 云克治疗后腰椎(L1-4)及左股骨颈、大转子及小转子骨密度(BMD)值均较治疗前增加(P＜0.05);云克治疗后AKP、ICTP均较治疗前明显下降(P＜0.01)。OC云克治疗后较治疗前增加(P＜0.05)。血钙、血磷、1,25-二羟维生素D3云克治疗后与云克治疗前相比无明显变化,P<0.05。前列腺癌骨转移轻度骨痛组及中度骨痛组治疗1年后骨痛VAS评分明显降低,差异有统计学意义,P＜0.05。重度骨痛组云克治疗前、治疗后VAS评分比较,差异无统计学意义,P<0.05。结论 ⁹⁹锝-亚甲基二膦酸盐在治疗前列腺癌骨转移的骨痛、骨质疏松方面,具有缓解骨痛,促进骨增殖,抑制骨吸收,提高骨密度,防治骨质疏松的作用。