目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.

目的 探究肺表面活性物质联合高频振荡通气治疗新生儿呼吸窘迫综合征的有效性及安全性。方法 选取我院新生儿科2016年2月—2018年7月收治的120例呼吸窘迫综合征新生患儿作为研究对象,随机将其分为常规组和试验组,每组各60例。常规组实施肺表面活性物质联合常频振荡通气治疗,试验组采取肺表面活性物质联合高频振荡通气治疗,比较两组治疗前后的肺氧合功能和并发症发生情况。结果 PaO₂、OI、a/A PO₂等指标在治疗前两组差异无统计学意义(P＞0.05),治疗后试验组均要优于常规组,差异有统计学意义(P＜0.05);常规组的并发症发生率为35.0%(21/60),试验组的并发症发生率为18.3%(11/60),试验组低于常规组,差异有统计学意义(P＜0.05)。结论 新生儿呼吸窘迫综合征采用肺表面活性物质联合高频振荡通气治疗效果显著,并发症少,安全性高。

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 了解广州市海珠区肺结核患者登记情况及流行特征,为进一步做好海珠区肺结核防治提供依据。方法 收集2008—2017年海珠区结核病信息管理系统中按现住址登记的肺结核患者资料,采用描述性流行病学方法和相关统计方法对肺结核患者登记资料进行分析。结果 2008—2017年海珠区共报告登记肺结核患者 14 384 例,年报告发病率由2008年的105.3/10万下降到2017年的73.1/10万,呈下降趋势(χ²=164.973,P<0.001);男女发病相对比为2:1;各个年龄组均有发病,其中25～34岁年龄组发病人数最多,占总发病数的21.61%;职业分布方面,家务及待业人群最多,占总发病率34.48%,其次分别是其他(不固定职业),占17.29%,退休人群,占15.12%,学校学生占比5.52%。地区分布方面,各街道年平均发病率相差较大,最高为131.23/10万,最低的为66.40/10万,差异有统计学意义(χ² =164.973,P<0.001)。结论 广州市海珠区肺结核疫情呈逐年下降趋势,但部分街道肺结核发病率仍达100/10万以上。男性人群、25~34岁年龄组和低收入人群(家务及待业、不固定职业、退休人群)是防控的主要人群,学生肺结核发病人数多,要加强学校结核病防控和筛查工作。

Objective To understand the registration situation and epidemic characteristics of tuberculosis patients in Haizhu district of guangzhou, and to provide a basis for further prevention and treatment of tuberculosis in Haizhu district. Methods The data of tuberculosis patients registered at present address in the TB information management system of Haizhu district from 2008 to 2017 were collected, and the registration data of tuberculosis patients were analyzed using descriptive epidemiological methods and relevant statistical methods. Results From 2008 to 2017, 14 384 cases of tuberculosis patients were reported in Haizhu district. The annual reported incidence rate decreased from 105.3/100,000 in 2008 to 73.1/100,000 in 2017, showing a down ward trend (χ² = 164.973, P<0.001). The relative incidence of male and female was 2:1; all age groups had morbidity, of which 25~34 years old group had the largest number of cases, accounting for 21.61% of the total number of cases; in occupational distribution, household chores and unemployed were the most, accounting for 34.48 %, followed by other (non-fixed occupations), accounting for 17.29%, retired people, accounting for 15.12%, and school students accounting for 5.52%. In terms of regional distribution, the average annual incidence rate of each street varied greatly, with the highest being 131.23/100,000 and the lowest being 66.40/100,000. The difference is statistically significant(χ²=164.973,P<0.001). Conclusion The incidence of tuberculosis in Haizhu district of Guangzhou has been decreasing year by year, but the incidence of tuberculosis in some streets is still more than 100/100,000. Male population, 25~34 years old group and low-income population (domestic and underemployed, irregular occupation, retired population) are the main population for prevention and control. Students have a large number of cases of tuberculosis, so we need to strengthen prevention, control and screening of tuberculosis in schools.

目的 分析肺肝样腺癌(HAL)的临床病理特征、诊断、免疫表型、基因检测及治疗预后等。方法 对1例HAL临床及影像学、组织学形态、免疫组化及基因检测结果等进行观察,并结合相关文献综合分析。结果 患者为48岁吸烟男性,镜下肿瘤具有肝细胞样和腺样分化特征,血清AFP升高。免疫组化: Hepatocyte,AFP, Arginase-1均阳性,ARMS-PCR法均未检测到EGFR,ALK/ROS1,KRAS及BRAF突变。结合相关文献分析: HAL常见于有吸烟史的男性,血清AFP值升高也是该肿瘤的一个特点。肿物多见于肺上叶,体积较大,易发生淋巴结和远处转移,预后相对较差。结论 HAL非常少见,易误诊,其诊断需结合形态学特点、临床病理特征及免疫组化结果等。

Objective To explore the clinicopathologic characteristics, diagnosis, immunophenotype, gene detection and prognosis of primary hepatoid adenocarcinoma of the lung (HAL). Methods A case of hepatoid adenocarcinoma of the lung was analyzed with clinical manifestations, histology, immunohistochemical staining and gene detection, and relevant literatures were reviewed. Results The patient was a 48-years-old man with smoking history. Microscopically, the tumor has the characteristics of hepatocellular carcinoma and adenoid differentiation, also serum AFP was elevated. The immunohistochemical results showed that Hepatocyte, AFP and Arginase-1were positive. No mutations were detected for EGFR, ALK/ROS1, KRAS and BRAF by ARMS-PCR. Combining with literature analysis, HAL is common in males and most patients with this tumor are smokers. Serum AFP in very high levels has been a distinguishing feature of this tumor. HAL usually presents as a large bulky solitary mass in the upper lobe. Lymph nodes and distant metastases are prone to occur. Therefore, the prognosis is very poor. Conclusion HAL is a rare malignant tumor and easy to be misdiagnosed. The diagnosis of primary hepatoid adenocarcinoma of the lung should be combined with morphological features, clinicopathological features and immunohistochemical findings.

目的 了解我院肺炎链球菌的临床分布及耐药情况,为临床合理应用抗菌药物提供依据。方法 采用WHONET 5.6软件对我院2012年—2016年培养、分离和鉴定出的肺炎链球菌的临床分布及药敏试验结果进行分析。结果 2012年—2016年共检出肺炎链球菌519株(不含重复菌株),每年秋冬和初春季节检出率最高。五年检出的肺炎链球菌对各类抗生素的耐药率变化不大。从8个科室和病区分离出此菌,以呼吸科为主,分离出313株,占60.3%。痰液中共分离出488株,占94.03%,其次从血液中分离出32株,占4.24%。对抗生素耐药率大于60%的有:复方新诺明、四环素、克林霉素和红霉素;未出现耐药的抗生素有厄他培南、莫西沙星、利奈唑胺和万古霉素;其余抗生素的耐药率均小于30%,其中肺炎链球菌对青霉素的耐药率为2%、中介率为20%。结论 青霉素仍可以作为治疗肺炎链球菌感染的首先药物;三代头孢菌素可用于青霉素非敏感的肺炎链球菌(PNSSP)治疗;未发现万古霉素非敏感菌株;红霉素、克林霉素的耐药率极高,不适合肺炎链球菌的治疗。临床应当根据培养药敏结果合理使用抗菌药物,减少细菌耐药率的发生。

目的 探讨分析莫西沙星对2型糖尿病合并肺部感染患者内皮素及降钙素基因相关肽的影响。方法 回顾性分析2015年1月—2016年1月来我院就诊并确诊为2型糖尿病合并肺部感染的84例患者的临床资料,根据治疗方案将其分为对照组和观察组,每组各42例。对照组患者给予常规治疗,观察组患者在对照组的治疗基础上予以莫西沙星治疗。观察两组患者治疗后内皮素以及降钙素基因相关肽的变化。结果 ①观察组总有效率(92.86%)优于对照组(78.57%),两组患者间总有效率的比较有统计学意义(P<0.05);②两组患者治疗前ET、CGRP水平无差异(P>0.05)。治疗后,观察组ET水平低于对照组,CGRP水平高于对照组(P<0.05)。结论 临床应用莫西沙星治疗2型糖尿病合并肺部感染具有明显的临床疗效,值得临床推广应用。

目的 探讨载脂蛋白E基因多态性在COPD患者合并AD中的意义。方法 通过病例资料进行回顾性研究,收集慢性阻塞性肺疾病70例,阿尔茨海默病81例,健康对照人群566例,进行统计分析。结果 “AD组”和“COPD合并AD组”的LDL水平高于“COPD未合并AD组”;“COPD组”的ApoE水平高于“AD组”,且在“COPD组”中,未合并AD者的ApoE水平明显高于合并AD者;“COPD组”的ε3/ε4基因型均少于“AD组”,且“COPD未合并AD组”的ε3/ε4基因型明显少于“COPD合并AD组”;“AD组”及“COPD合并AD组”的ε4等位基因频率多于“COPD组”及“COPD未合并AD组”;“COPD合并AD组”的ε3/ε3基因型少于“健康对照组”,而ε2/ε4基因型则多于“健康对照组”;“COPD组”的ε3/ε4基因型多于“健康体检组”;“COPD合并AD组”的ε3/ε4基因型多于“健康体检组”;“COPD合并AD组”的ε4等位基因频率高于“健康对照组”。结论 ApoE基因多态性不但参与COPD患者认知功能受损甚至合并AD,而且可能通过影响脂质代谢,参与COPD的发生发展;ApoE的ε4等位基因可能是COPD和AD患病的共同危险因素。

目的 探讨HHIP基因单核苷酸多态性与新疆蒙古族慢性阻塞性肺疾病易感性之间的关系。方法 以259例蒙古族吸烟慢性阻塞性肺疾病患者为病例组,245例蒙古族吸烟健康体检者为对照组,提取外周血标本 DNA,运用Taqman分型技术检测HHIP基因rs13118928、rs13141461位点多态性。结果 HHIP基因rs13118928、rs13141461位点基因型与等位基因在病例组和对照组之间的频率分布,结果显示差异有统计学意义(P<0.05)。rs13118928位点基因型AG、GG,等位基因G在病例组与对照组分布差异有统计学意义(P<0.001),且OR<1,可能降低发生COPD的风险。rs13141461位点基因型TC在病例组与对照组分布差异无统计学意义(P>0.05),rs13141461位点基因型CC, 等位基因C在病例组与对照组分布差异有统计学意义(P<0.05),且OR>1,可能增加发生慢阻肺的风险。rs13118928、rs13141461位点基因型与肺功能 FEV1%预计值比较差异有统计学意义(P<0.05)。结论 HHIP基rs13118928、rs13141461位点多态性可能与新疆蒙古族人群慢阻肺的发生有关。

Objective To explore the relationship between HHIP gene single nucleotide polymorphism and the susceptibility of Mongolian chronic obstructive pulmonary disease.Methods DNAs were extracted from the peripheral blood of 259 patients with COPD (case group) and 245 healthy controls (control group) from Xinjiang Mongolian population. Polymorphisms of HHIP rs13118928 and rs13141461 were determined by the Taqman PCR method.Results The frequency of HHIP rs13118928 and rs13141461 genotypes and alleles in the case group and the control group showed significant difference (P<0.05). HHIP rs13118928 genotype, AG, GG and allele G were significantly different between case group and control group (P<0.001), and OR<1. It could reduce the risk of COPD. There was no significant difference in HHIP rs13141461 genotype TC between the case group and the control group (P>0.05). HHIP rs13141461 genotype CC and allele C were significantly different between the case group and the control group (P<0.05), and OR>1. It may increase the risk of COPD. The difference of HHIP rs13118928, rs13141461 and FEV1% predicted value was statistically significant(P<0.05).Conclusion The polymorphism of HHIP rs13118928 and rs13141461 may be related to the occurrence of COPD in Xinjiang Mongolian population.