目的 探索使用血浆中溶血磷脂酸 LPA作为老年糖尿病患者发生缺血性心脑血管病早期预警指标。方法 在公共卫生项目开展的基础上,将老年糖尿病患者随机分为观察组和对照组。对照组实施糖尿病规范管理,观察组在对照组的基础上进行血浆LPA 的水平定期检测,对LPA 明显升高者,予降脂、抗纤溶、抗血小板凝集等干预措施,比较两组间缺血性心脑血管病发生率和病情严重程度。结果 观察组缺血性脑血管发病率高于对照组,差异有统计学意义（P<0.05）。中、重型缺血性脑血管病患者的血浆LPA高于轻型组（P<0.05）,且重型组高于中型组（P<0.05）结论 血浆LPA值可作为老年糖尿病患者发生缺血性心脑血管病的预警因子,值得在基层老年糖尿病患者规范化管理中常规应用。

Objective To explore the early warning index of ischemic cardiocerebrovascular disease in elderly diabetic patients with plasma LPA. Methods On the basis of public health project,elderly diabetic patients were randomly divided into observation group and control group. Control group adopted diabetes management implementation,while observation group adopted periodic testing of the levels of plasma LPA on the basis of the control group,implementing fall fat,resisting fibrinolytic,antiplatelet aggregation and other interventions if LPA significantly increased. We compared the ischemic cardio-cerebrovascular disease incidence and disease severity between the two groups. Results The incidence of cerebral ischemia in the observation group was higher than that in the control group,and the difference was statistically significant （P<0.05）. Medium and heavy plasma LPA is higher than the light of ischemic cerebrovascular disease group （P < 0.05）,and heavy above medium group （P < 0.05） Conclusion The plasma LPA values can be used as early warning factor in elderly patients with diabetes occuring ischemic cardio-cerebrovascular disease and promote its application.

目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

代谢综合征(MS)是临床上多个症候群构成的代谢紊乱聚合体。近几十年来,MS的发病率和患病率一直呈上升趋势。笔者整理近5年关于老年代谢综合征研究的相关文献,分析老年人群代谢综合征患病情况、特点及影响因素等,并对老年代谢综合征的防治提出一些建议。

目的 探究不同类型职业病危害因素对暴露工人生命质量的影响。方法 在某市电子制造业、灯饰制造业、金属冶炼业等能够接触到粉尘、铅、苯以及噪声的6家企业中,采用整群随机抽样法,共计抽取742人为研究对象,对上述企业2015—2017年的职业病危害因素检测报告进行回顾性分析,主要对各企业的职业病危害因素以及暴露水平实施分析,并对企业员工的生命质量情况实施调查。结果 三种不同行业之间的有机溶剂检测合格率比较差异均有统计学意义(P＜0.05),其中有机溶剂检测合格率最低的是金属冶炼业;三种不同行业的粉尘检测合格率差异以及噪声检测合格率比较差异无统计学意义(P＞0.05),其中灯饰制造业的噪声及粉尘检测合格率最低;各行业工作人员的生理、社会功能,心理、情感职能,精神健康,身体疼痛、活力以及总计健康评分差异有统计学意义(P＜0.05),电子制造企业的各项评分均高于金属冶炼业以及灯饰制造业。多重线性回归分析结果发现,电子制造企业的生理与心理健康维度得分均高于灯饰制造业、金属冶炼业,差异有统计学意义(P＜0.05),且主要与运动锻炼以及所从事的行业有较大关联。结论 不同类型的职业病危害因素暴露水平存在一定差异,企业职工的生命质量也会因此受到不同程度的影响,应对存在噪声、粉尘以及大量使用有机溶剂等职业病危害因素企业作为健康监护的重点。

目的 探究血清外泌体对小鼠烫伤伤口愈合的促进作用及机制。方法 选取我院60只NIH小鼠作为研究对象,对其血清中的外泌体进行提取和分离,建立起皮肤烫伤模型。采用血清外泌体进行治疗,评估治疗的效果,观察皮肤组织的病理变化,检测小鼠成纤维细胞增殖和表皮HaCat细胞迁移使用血清外泌体受到的影响。结果 空白对照组和血清外泌体小鼠烫伤创口愈合时间比较,差异有统计学意义(P＜0.05);血清外泌体作用24 h后,不同剂量OD值差异有统计学意义(P＜0.05);10 μL Exo组和PBS组内部不同时间点OD值差异均有统计学意义(P＜0.05);外泌体组和PBS组24 h的HaCat细胞迁移率相比较,差异有统计学意义(P＜0.05)。结论 血清外泌体可以促进小鼠烫伤伤口的愈合,对成纤维细胞的增殖和表皮HaCat细胞的迁移作用也比较显著,可能成为临床治疗烫伤的新手段。

目的 探讨多指标联合监测在冠心病(CHD)早期诊断中的应用。方法 选择2018年6月—2018年12月在我院就诊的患者180例,其中动脉硬化中低危人群60例(低危组),动脉硬化中高危人群60例(高危组),确诊的冠心病患者(CHD组),另选取健康体检者60例为对照组。分析血浆游离脂肪酸、高敏C反应蛋白、尿β-2微球蛋白、血清25羟维生素D及血脂水平与冠心病之间的关系。结果 低危组、高危组和CHD组患者FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平均高于对照组,血清25羟维生素D₃、HDL-C水平均低于对照组,差异均有统计学意义(P＜0.05);低危组、高危组和CHD组患者的血清FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平逐渐升高,血清25羟维生素D₃、HDL-C逐渐降低,以CHD组最为显著。冠心病患者血清HDL-C的敏感度高于其他各指标(P＜0.05);血清FFA、hs-CRP的特异度高于其他各指标(P＜0.05)。结论 多指标联合检测对于早期诊断冠心病患者有一定意义。

Objective To explore the application of multi-index combined monitoring in early diagnosis of coronary heart disease (CHD). Methods 180 patients were selected from June 2018 to December 2018 in our hospital. Among them, 60 patients with middle and low risk of atherosclerosis (low risk group), 60 patients with middle and high risk of atherosclerosis (high risk group), 60 patients with confirmed coronary heart disease (CHD group), and 60 healthy people were selected as control group. The relationship between plasma free fatty acid, high sensitivity C-reactive protein, urinary β-2 microglobulin, serum 25-hydroxyvitamin D and blood lipid levels and coronary heart disease was analyzed. Results The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group were higher than those in control group, and serum levels of 25-hydroxyvitamin D3 and HDL-C were lower than those in control group (P<0.05). The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group increased gradually, while serum levels of 25-hydroxyvitamin D3, H-MG, TC, TG and LDL-C increased gradually. DL-C decreased gradually, especially in CHD group. The sensitivity of serum HDL-C in patients with coronary heart disease was higher than that of other indicators (P<0.05), and the specificity of serum FFA and hs-CR P was higher than that of other indicators (P<0.05). Conclusion The combined detection of multiple indicators has certain significance for the early diagnosis of coronary heart disease.

目的 探讨血浆BNP预测急性肺栓塞患者发生心血管疾病的临床价值。方法 选择2017年1月—2017年12月在我院诊断为急性肺血栓栓塞患者97例为研究对象,根据有无出现心血管并发症分为观察组(21例)和对照组(76例)。比较两组间实验室指标的差异性和相关性,并采用ROC曲线分析BNP预测急性肺栓塞患者发生心血管疾病的临床价值。结果 观察组共出现21例心血管并发症,占21.65%。观察组中BNP、Hs-CRP 、TnI 、AST、CK和DD的浓度分别为(413.01±33.09)(pg/mL)、(20.49±2.88)mg/L、(0.154±0.103)μg/L、(131.23±27.05)U/L、(421.64±50.70)U/L和(1.95±0.18)mg/L,高于对照组(P<0.05)。Spearman相关性分析,血浆BNP水平与Hs-CRP 、TnI 、AST、CK和DD水平呈正相关(r=0.802、0.718、0.683、0.705、0.753,P<0.05)。ROC曲线分析,BNP的AUC面积最高,为0.834(95%CI:0.795~0.935),敏感度和特异度分别为90.5%和87.5%,联合诊断的AUC面积为0.892(95%CI:0.811~0.976),敏感度和特异度分别为84.6%和91.3%。结论 血浆BNP对于预测急性肺栓塞患者发生心血管疾病具有极高临床价值,采取多指标联合检查可以更加有效发现心血管疾病的发生。

Objective To investigate the clinical value of plasma BNP in predicting cardiovascular disease in patients with acute pulmonary embolism. Methods 97 cases of acute pulmonary thromboembolism diagnosed in our hospital from January to December 2017 were selected.The patients were divided into the observation group (21 cases) and control group (76 cases) according to whether there were cardiovascular complications.The differences and correlations of laboratory indexes between the two groups were compared, and the ROC curve was used to analyze the clinical value of BNP in predicting the occurrence of cardiovascular disease in patients with acute pulmonary embolism. Results 21 cases of cardiovascular complications occurred in the observation group, accounting for 21.65%.The concentration of BNP, Hs-CRP, TnI, AST, CK and DD in the observation group were (413.01±33.09) (pg/mL), (20.49±2.88) mg/L, (0.154±0.103) μg/L, (131.23±27.05) U/L, (421.64±50.70) U/L and (1.95±0.18) mg/L, which were higher than those of the control group(P<0.05). Spearman correlation analysis showed that plasma BNP levels were positively correlated with the levels of Hs-CRP, TnI, AST, CK and DD (r=0.802,0.718,0.683,0.705,0.753,P<0.05). The ROC curve analysis showed that the area of AUC of BNP was 0.834 (95%CI:0.795~0.935) of the highest, the sensitivity and specificity were 90.5% and 87.5% respectively. The area of combined diagnosis of AUC was 0.892 (95%CI:0.811~0.976),the sensitivity and specificity were 84.6% and 91.3%, respectively. Conclusion Plasma BNP is of high clinical value for predicting the incidence of cardiovascular disease in patients with acute pulmonary embolism. Multi-index combined examination may be more effective to detect the occurrence of cardiovascular disease.

目的 了解医院感染及抗菌药物使用现状,进一步制定有效的预防控制措施。方法 采用横断面调查方法,应用SPSS 17.0行统计分析。结果 3次调查实查率100%。其中社区感染255例,现患率31.14%;高发科室为儿科;感染部位以下呼吸道为主(62.75%);感染病原以革兰氏阳性菌(G⁺)为主。医院内感染6例、现患率0.73%;高发科室为妇产科、外科;感染部位以浅表切口为主(50%);感染病原以革兰氏阴性菌(G^-)为主(66.6%)。三年内医院抗菌药物平均使用率32.23%。结论 调查结果反映了医院感染及抗菌药物使用现状。依此制定干预措施,防控多重耐药菌感染,减少医院感染发生。

Objective To investigate the trends of nosocomial infections and use of antimicrobial agents,in order to effectively prevent and control program of hospital infection. Methods Cross-sectional survey method was adopted,the SPSS17.0 were used to statistical analysis. Results The check real rate was 100％.Among them 255 cases were community infection, the infection rate was 31.14%; the high frequent incidence was in the pediatric department; lower respiratory tract infection was the primary infection sites(62.75%);gram-positive bacteria (G +) was the main pathogenic bacteria. 6 cases were nosocomial infection, the infection rate was 0.73%; the obstetrics and gynecology /surgery were the primary incidence; superficial incisional wound infection was the primary infection sites(50%);gram-negative bacteria (G-) was the main pathogenic bacteria(66.6%).The antimicrobial drug utilization rate averaged 32.23% in the three years. Conclusion The investigation reflects the nosocomial infection rates and the present situation of the use of antibacterial drugs. intervention measures were formulated based on the results of the survey. multiple drug-resistant bacteria infection should be prevented and controlled to reduce the incidence of hospital infection.

目的 分析本科医学生对临床技能学培训课程的满意度,探索可提高临床技能学课程的改进措施。方法 抽取2015级不同专业医学生参加临床技能学课程的学生,通过问卷调查学生对培训课程的满意度。结果 临床技能学体系改革后,学生对临床技能学课程设置和老师的满意度都很高,对课程设置非常满意有18.31%,满意有58.03%,基本满意有21.69%,不满意的只有1.41%;对老师非常满意有36.9%,满意有49.86%,基本满意有12.68%,不太满意只有0.56%。结论 临床技能学可提高学生的临床综合能力和思维能力,可以持续的开展。

Objective To Through the analysis of the satisfaction surveys of clinical skills course, we aimed to make improvements on the teaching of clinical skills course. Methods With the method of stratified sampling, we chose medical students of different majors in the grade 2015 who attended the clinical skills course, and carried out the surveys of their satisfaction on the course. Results Students were satisfied with the design and the teaching of clinical skills course after the reform of clinical skills teaching. With the design of clinical skills course, 18.31% students were very satisfied, 58.03% were satisfied, 21.69% were basically satisfied, and just 1.41% were unsatisfied; With the teachers of clinical skills, 36.9% students were very satisfied, 49.83% were satisfied, 12.68% were basically satisfied, and just 0.56% were unsatisfied. Conclusion Clinical skills course may improve students' clinical comprehensive abilities and clinical thinking. It should be carried out continuously.

目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。