目的 通过超声造影成像技术( CEUS)观察颈动脉斑块内新生血管的情况,探讨颈动脉斑块的厚度与新生血管的关系。方法 选择颈动脉粥样硬化患者40例,经常规超声确诊存在斑块,共64个,应用CEUS成像技术检测斑块内新生血管情况。结果 不同厚度的颈动脉斑块的增强强度与斑块厚度成正相关(r=0.897 6,P=0.000 0)。结论 超声造影成像技术可以在常规超声的基础上通过检测斑块内的新生血管,进而判断斑块的性质,提供更多有用的信息进一步评估颈动脉斑块内新生血管增强强度与斑块厚度存在线性正相关性。

Objective To evaluate the neovascularization in carotid plaques by gray-scale harmonic contrast echocardiography (CEUS), and to investigate the relationship between the thickness of carotid artery plaque and the neovascularization.Methods 40 patients with carotid atherosclerosis were selected, and 64 plaques were diagnosed by regular ultrasound. The neovascularization in plaques was detected by CEUS imaging technique.Results The enhanced strength of carotid plaques with different thickness was positively correlated with plaque thickness (r=0.8976,P=0.0000).Conclusion Ultrasound contrast imaging can detect angiogenesis within the plaque based on conventional ultrasound, and then determine the nature of the plaque. More useful information is provided to further evaluate the linear positive correlation between the intensity of neovascularization and the thickness of plaque in carotid plaque.

目的 探讨应用三维斑点追踪技术(3D-STI)评价冠心病患者左前降支冠状动脉支架置入(PCI)术前、术后左室局部收缩功能。方法 对30例接受左前降支PCl术的患者分别于术前、术后3～5天,术后3个月进行常规及三维超声心动图检查,获得患者左前降支冠状动脉供血的7个心肌节段(即前壁基底段、前间隔基底段、前壁中间段、前间隔中间段、前壁心尖段、前间隔心尖段及心尖帽)的收缩期纵向应变、径向应变、圆周应变及面积应变,分析冠状动脉支架植入术前、后各参数的变化规律。结果 PCI术后3～5天5/7节段纵向应变(前壁基底段、前壁中间段、前间隔基底段、前间隔中间段、前壁心尖段)、3/7节段面积应变(前壁基底段、前壁中间段、前间隔中间段)、3/7节段圆周应变(前壁基底段、前间隔基底段、前壁中间段)及2/7节段径向应变(前间隔基底段、前壁中间段)较术前相应心肌节段升高,差异有统计学意义(P＜0.05),PCI术后3个月左前降支供血各心肌节段纵向、圆周、径向及面积应变较术前、术后3～5天均升高,差异有统计学意义(P＜0.05)。结论 3D-STI能够早期评价冠心病患者左前降支冠状动脉PCI治疗前后左室局部收缩功能的改善,为临床早期评价PCI疗效及后续治疗提供诊断依据。

Objective To evaluate the left ventricular regional systolic function before and after left anterior descending coronary artery stent implantation (PCI) using three-dimensional speckle tracking imaging (3D-STI) in patients with coronary artery disease. Methods 30 patients who received left anterior descending PCl were underwent routine and three-dimensional echocardiography before and after 3~5 days, 3 months to obtain longitudinal strain(LS), radial strain(RS), circumferential strain(CS)and area strain(AS) of the seven myocardial segments(BA,BAS,MA,MAS,AA,AS,A ),which accepted blood from the left anterior descending coronary artery. We analyzed the changes of the parameters before and after the coronary stent implantation. Results The 5/7 segment of the longitudinal strain(BA,MA,BAS,MAS,AA), 3/7 segment of area strain(BA,MA,MAS), 3/7 segment of circumferential strain (BA,BAS,MA)and 2/7 segment of radial strain (BAS,MAS)at 3~5 days after PCI were higher than that before the operation. The difference was statistically significant (P＜ 0.05). The longitudinal, circumferential, radial and area strain of the left anterior descending branch at 3 months after the operation were higher than that before and 3~5 days after the operation. The difference was statistically significant (P＜ 0.05). Conclusion 3D-STI may early evaluate the improvement of left ventricular regional systolic function before and after coronary artery PCI treatment in patients with coronary heart disease, and provide a basis for early clinical evaluation of PCI effect and follow-up treatment.

目的 应用中国膳食平衡指数(DBI-07)对活动期溃疡性结肠炎(Ulcerative Colitis,UC)患者进行膳食质量评价,并分析其与营养指标、活动度等的关系,为UC患者制订科学的营养干预措施提供依据。方法 选取我院符合纳入标准的82例UC患者进行研究,用食物频率法对患者进行膳食调查,应用膳食平衡指数DBI-07评分系统进行评价,同时进行人体测量及营养指标测定。数据用SPSS 17.0软件进行处理分析。结果 本研究中68.3%的UC患者体质量近半年有不同程度降低,40.2%的患者存低白蛋白血症,34.1%的合并贫血。UC患者TS平均值-20.02±7.97; LBS平均值-22.15±6.78, 其中54.9%存在轻度膳食摄入不足、37.8%存在中度摄入不足;DQD平均值24.27±6.21,其中轻、中度失衡分别占80.5%、17.1%。LBS绝对值与体质量减轻程度呈正相关,P<0.05,与血清白蛋白负相关,P<0.01;DQD与白蛋白呈负相关,P<0.01;4 UC患者LBS绝对值与UC活动度呈正相关,P<0.01;DQD值与UC活动度负相关,P<0.01。结论 以中国膳食平衡指数DBI-07评价UC患者膳食质量,92.7%的患者存在低、中度摄入不足,97.6%的UC患者存在膳食失衡,均明显高于健康人群。摄入不足是UC患者营养不良的重要原因,应对UC患者进行营养补充或营养支持。

Objective To survey the diet quality of UC patients using Chinese diet balance index(DBI-07) and explore their relationship with nutritional index and activity of disease, thereby to provide evidences of nutritional therapy for UC patients. Methods 82 adult UC patients who met the inclusion criteria were included in our study. They were investigated with food frequency questionnaires(FFQ) and diet quality was assessed with DBI-07. Anthropometric measurement and blood examinations were done. Data were analyzed with SPSS 17 software. Results 68.3% of the UC patients loss their weight during the recent 6 months. 40.2% of the patients were found hypoalbuminemia and 34.1% were complicated with anemia. The mean TS,LBS and DQD were -20.02±7.97, -22.15±6.78 and 24.27±6.21 respectively. Percentage of patients in slightly or moderately deficit of food intake were 54.9% and 37.8%. Percentage of the UC patients in slightly or moderately dietary imbalance were 80.5% and 17.1%.The absolute value of LBS and DQD were negatively correlated with serum albumin respectively, and both of them were positively correlated with activity of UC. Conclusion Evaluating the quality of UC with DBI-07,92.7% of UC patients were in slightly or moderately deficit of food intake,97.6% were in slightly or moderately dietary imbalance. These percentages were higher than that of healthy people. It indicated that deficit of food intake is an important reason resulting in malnutrition. Nutrition therapy is essential for UC patients.

目的 观察社区综合防治健康管理模式对社区高血压患者血压控制疗效及药物经济学的影响。方法 收集2012年7月—2013年7月广州参与研究的三级医院及社区卫生服务中心收治的原发性高血压病患者2 383例,病例入组后随机分为综合管理组和常规治疗组。记录及随访两组高血压患者基线血压值、降压药物使用方案、是否更换药物、血压控制疗效及药物经济学相关费用情况。结果 与常规治疗组相比,综合管理组患者血压治疗效果较好,显效率及总有效率提高[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001];高血压治疗及管理的药物费用虽有升高(t=16.186,P＜0.001),但相关的门诊费用、住院费用、护理费用及总费用降低(t=25.647, t=35.785, t=22.274,t=73.710,P＜0.001);在降压方案方面,从减少抗高血压药物使用,减少费用考虑,单独用药方式适合单纯性轻度高血压患者,从费用效果分析上,成本效果比以单药组最低,联用药组逐渐增大;增量成本-效果比:二药联用降压方案优于其他降压联合方案,因而两药联用降压为兼顾疗效和成本的降压较佳组合。结论 应用社区综合防治模式对高血压患者进行干预,效果满意,能够有效降低成本-效果比,值得临床推广应用。

Objective To investigate the effects of comprehensive prevention and control measures on the therapeutic efficient and pharmacoeconomics in community hypertension patients. Methods 2383 cases of hypertension were collected from July 2012 to July 2013 in the tertiary and community hospitals in Guangzhou, which were randomly divided into general therapy group, in which the patients were treated by general administration of drugs, and comprehensive management group that the patients were visited regularly. The sources of drugs, drugs use and changes in drugs were investigated. Results Compared with the general therapy group, better treatment effects were achieved in the comprehensive group. The apparent efficiency and total efficiency were both increased in the comprehensive group[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001]. Although the therapy and pharmacy fees were slightly increased in the comprehensive group as compared to the control group (t=16.186, P＜0.001), the outpatient expenses,hospitalization expenses, nursing expenses and the total expenses were decreased(t=25.647; t=35.785; t=22.274;t=73.710;P＜0.001). Considering reducing the use of drugs and decreasing the cost, the method of using single drug is beneficial to the patients of low-risk mild hypertension. The method of using calcium antagonist is the most economical and reasonable way. Conclusion Standardizing management of hypertension in community is effective in improving hypertension treatment and decreasing the cost, which is thus worth popularizing.

目的 分析超声检查前准备质量评价对超声检查效果的影响。方法 对进行泌尿科B超检查150例患者按数字表法随机分为对照组和实验组各75例,两组患者发放超声检查须知,按检查准备要求按预约时间前来完成超声检查;实验组在检查前对患者准备效果进行评价,及时落实检查须知事项。结果 检查前准备知识知晓、检查前准备质量、按时检查率对照组低于实验组(P＜0.05);检查前准备依从性、服务满意度对照组低于实验组(P＜0.05)。结论 开展检查前准备质量评价能促进患者落实超声检查前准备,提高准备依从性和准备知识知晓率,缩短检查等候时间,提高检查前准备质量和患者服务满意度。

Objective To analyze the influence of pre-preparation quality evaluation on the effect of ultrasound examination. Methods According to the digital table method, 150 patients were randomly divided into the control group and the experimental group, 75 cases in the control group and the experimental group each. The two groups were taken the ultrasound examination, and the ultrasound examination was completed according to the preparation requirements. The patients in the experimental group were evaluated before the examination, and the inspection notes were timely implemented. Results Knowledge of pre preparation, preparation quality before examination, and rate of check on time were lower in the control group than that in the experimental group(P<0.05). The control group was lower than the experimental group(P<0.05). Conclusion The preparation quality evaluation before examination may promote the patient's preparation before the ultrasonic examination, improve the preparation compliance and knowledge awareness, shorten the waiting time, and improve the quality of preparation and the satisfaction of patient service.

目的 探究纽扣钢板内固定方法治疗新鲜Rockwood Ⅲ型以上肩锁关节脱位的效果。方法 选取2013年1月—2017年12月在我院诊断并治疗的肩锁关节脱位(Rockwood Ⅲ型以上)60例,随机分为观察组(30例)与对照组(30例),观察组采用纽扣钢板内固定方法,对照组采用锁骨钩钢板方法。对比两组治疗前后肩功能指标(Constant-Murley)、手术的治疗疗效指标(Karlsson)的优良率,以及手术时间和术中出血量。结果 治疗前两组的Constant-Murley评分无差异(P＞0.05),治疗后两组评分均提高(P＜0.05),其中观察组高于对照组(P＜0.05);观察组的Karlsson评分优良率、术中出血量均优于对照组(P＜0.05),观察组的手术时间高于对照组(P＜0.05)。结论 纽扣钢板内固定能够有效恢复患者正常肩部功能,具有良好的治疗效果,同时对患者造成的创伤较小。

Objective To observe the effect of button plates in treatment of Rockwood Ⅲ and greater acromioclavicular dislocation. Methods From January 2013 to December 2017, 60 Rockwood Ⅲ and greater acromioclavicular dislocation patients in our hospital were randomly divided into observe group(30 cases)and control group (30 cases), the observe group received button plates treatment, the control group received clavicula hook plate treatment. The shoulder function(Constant-Murley)of two groups before and after treatment were compared, and the effect of operation(the good rate of Karlsson), surgical time and intraoperative bleeding of two groups were also compared. Results There were no difference in shoulder function between two groups before treatment(P＞0.05). The indices were increased after treatment(P<0.05), and the indices in the observe group were higher than that of control group(P＜0.05), The good rate of Karlsson index, intraoperative bleeding of observe group were better than that of control group(P＜0.05).The surgical time of observe group were better than that of control group(P＜0.05). Conclusion Button plate's internal fixation nay better improve the shoulder function; it has better therapeutic effect, and smaller trauma to patient.

目的 探讨神经导航辅助神经内镜经鼻蝶入路切除垂体瘤的疗效。方法 将2014年10月—2018年4月我院接诊的20例垂体瘤患者纳入本研究,按照随机数字表法均分为观察组和对照组各10例,对照组患者行常规神经内镜下经鼻蝶入路垂体瘤切除术,观察组患者行神经导航辅助神经内镜下经鼻蝶入路垂体瘤切除术,比较两组患者手术及术后住院情况(包括手术时间、术中出血量及术后住院时间)、手术效果(包括显效率和总有效率)、手术前后血清内分泌指标变化情况(包括GH、PRL水平)以及术后并发症情况(即术后并发症发生率)。结果 观察组患者手术时间、术中出血量及术后住院时间均低于对照组,差异有统计学意义(P＜0.05);观察组显效率和总有效率均略高于对照组,但两组间手术效果并差异无统计学意义(P＞0.05);观察组患者治疗后血清生长激素(GH)、催乳素(PRL)水平均低于对照组,差异有统计学意义(P＜0.05);两组患者术后并发症发生率无统计学差异。结论 神经导航辅助神经内镜经鼻蝶入路切除垂体瘤疗效显著,手术时间短、术中出血少、术后恢复快,可明显改善患者内分泌指标,值得临床推荐。

Objective To evaluate the efficacy of resection for pituitary tumors through transsphenoidal approach with endoscopic neuronavigation assisted. Methods From October 2014 to April 2018, 10 patients with pituitary tumor were operated in our hospital with neuronavigation, which were set as the observation group. Meanwhile, 10 patients with pituitary tumor underwent surgical treating through transsphenoidal approach without neuronavigation were set as the control group. SPSS 19.0 were used for statistical analysis to compare the difference between the two groups, including the operation time, blood loss, hospitalization time, hormone level, clinical total efficiency, and complications in the two groups. Results The operation time, blood loss and hospitalization time of the observation group were less than that of the control group, and there was statistical significance (P<0.05). The efficiency rate and overall efficiency rate of the observation group were a little more than that of the control group, but there was no statistical significance (P＞0.05). The level of growth hormone (GH) and prolactin (PRL) of the observation group were less than that of the control group, and there was statistical significance (P<0.05). And there was no statistical significance between the incidence rate of postoperative complications of the two groups. Conclusion The efficacy of resection for pituitary tumors through transsphenoidal approach with endoscopic neuronavigation is significant, which may shorten the course, reduce the blood loss, quicken recovery of a patient from operation, and improve the hormone level. It is worthy to be recommended to clinical application.

目的 探讨醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效。方法 选取我院2014年6月—2016年6月收治的76例脓毒症相关性脑病患者作为研究对象,按照随机数字表法将其分成两组,每组38例。观察组给予醒脑静联合连续肾脏替代疗法治疗,对照组给予连续肾脏替代疗法治疗,比较两组患者的临床疗效,治疗前后格拉斯哥昏迷(Glasgow coma scale,GCS)评分、神经元特异性烯醇化酶(neuron-specifie enolase,NSE)含量、C-反应蛋白(C-reactive protein,CRP)含量及治疗后退热时间、恢复意识时间的长短。结果 观察组总有效率为89.47%,相对于对照组明显上升(P<0.05);观察组治疗后GCS评分较对照组明显升高,NSE含量、CRP含量较对照组明显降低,差异均有统计学意义(P<0.01);观察组治疗后的退热时间、恢复意识时间较对照组明显降低(P<0.01)。结论 醒脑静联合连续肾脏替代疗法对脓毒症相关性脑病的疗效显著,可有效缩短退热及恢复意识时间,降低患者痛苦,值得临床推广应用。

Objective To investigate the curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy. Methods 76 cases of sepsis associated encephalopathy in our hospital from June 2014 to June 2016 were selected as the research objects, and they were divided into two groups according to the random number table method, 38 cases in each group. The observation group were treated with Xingnaojing combined with continuous renal replacement therapy. The control group was given continuous renal replacement therapy. The clinical efficacy of two groups were compared before and after treatment about the Glasgow coma (Glasgow coma scale, GCS) score, neuron specific enolase (neuron-specifie enolase, NSE) content, C- reactive protein (C-reactive protein, CRP)content, and the length of the consciousness recovery time and pyretolysis time. Results In the observation group, the total effective rate was 89.47%. Compared with the control group. it increased significantly (P<0.05); After treatment the GCS score in the observation group was significantly higher than the control group, the content of NSE and CRP were significantly lower than the control group, the differences were statistically significant (P<0.01); In the observation group, after treatment the pyretolysis time, consciousness recovery time was significantly lower than the control group(P<0.01). Conclusion The curative effect of Xingnaojing combined with continuous renal replacement therapy on sepsis associated encephalopathy is significant and may effectively shorten the pyretolysis and the recovery of consciousness time, which is worthy of clinical application.

目的 探讨颈性眩晕应用针刺解结法治疗的临床疗效。方法 选取广东省中医院进修期间2016年3月—2016年9月收治的60例颈性眩晕患者,按照随机数字表法均分为两组。对照组:予以常规针刺治疗;观察组:在此基础上,行针刺解结法治疗。记录比较两组治疗前后基底动脉(BA)、左侧椎动脉(LVA)、右侧椎动脉(RVA)等部位的血流速度,改良颈性眩晕症状与功能评估量表(ESCV)总评分,临床疗效。结果 两组治疗后BA、LVA及RVA部位的血流速度,均明显高于治疗前(P<0.05);与对照组治疗后比较,观察组TCD检测参数改善幅度更为显著(P<0.01);与治疗前相比,两组治疗后改良ESCV总评分均显著更高(P<0.01);且观察组改善情况显著优于对照组(P<0.01);观察组总有效率为96.7%较对照组的76.7%相比,明显更高(P<0.05)。结论 颈性眩晕应用针刺解结法治疗更能有效改善脑部血液循环,缓解临床症状,提高生活质量,疗效显著,具有较高临床推广价值。

Objective To analyze the clinical effect of curing cervical vertigo with acupuncture thrawing method. Methods To select 60 patients with cervical vertigo in Cantonese Chinese Medicine Hospital from March 2016 to September 2016 as the research objects. According to the random number table method, they were randomly divided into the control group and the study group. The control group: treated with normal acupuncture; The observation group: plus with acupuncture thrawing method. We recorded and compared the blood flow velocity in the basilar artery(BA), the left vertebral artery(LVA) and the right vertebral artery(RVA), the overall score of the improved cervical Evaluation Scale for Cervical Vertigo(ESCV), and the clinical therapeutic effect of the two groups. Results After treatment, the blood flow velocity of the two groups in the basilar artery(BA), the left vertebral artery(LVA) and the right vertebral artery(RVA) was obviously higher than before treatment (P<0.05). Compared with the control group, the improvement level of TCD verifying arguments in the observation group was more significant (P<0.01). Compared with before treatment, the overall score of the improved ESCV in the two groups after treatment was significantly higher (P<0.01). And the improved conditions in the observation group were better than in the control group. The total effective rate 96.7% in the observation group was apparently higher than that of 76.7% in the control group (P<0.05). Conclusion Curing cervical vertigo with acupuncture thrawing method may improve the brain blood circulation, relieve clinical symptoms, enhance the living quality, which is a good way with evident clinic efficacy and higher clinical popularization value.

目的 分析雷替曲塞致药品不良反应(ADR)的特点及相关因素影响,为临床用药提供参考依据。方法 以“雷替曲塞”、“不良反应”、“raltitrexed”等为检索词,在中国期刊网全文数据库(CNKI)、维普中文期刊数据库等检索近5年的文献,共纳入符合标准文献28篇进行整理,分析雷替曲塞所致ADR类型及在不同给药剂量、联合化疗或同步放疗及老年患者、特殊给药途径下ADR发生的特点。结果 雷替曲塞常见的ADR包括消化系统症状、中性粒细胞减少和转氨酶升高,而中性粒细胞减少和转氨酶升高对临床治疗影响较大。给药剂量对ADR影响较小,而联合放疗会增加骨髓抑制的风险;在两药联合化疗时,雷替曲塞与长春瑞滨联合致中性粒细胞减少的风险增加;雷替曲塞引起的转氨酶升高多为Ⅰ~Ⅱ级,高龄(≥70 a)、肝转移对转氨酶升高影响不大。结论 雷替曲塞在不同治疗方案中的ADR发生存在差异,临床应用时应注意监测,防范严重和罕见ADR的发生。

Objective To Summarize the literature on adverse drug reactions(ADR) of Raltitrexed,in order to provide reference for the rational use of the drug in clinic. Methods Raltitrexed and adverse reaction were both used as key words to retrieve articles in CNKI and VIP database, 28literatures which met the inclusion and exclusion criteria were collected and analyzed. The characteristics of ADR were analyzed indifferent dosage, combined chemotherapy or radiotherapy, elderly patients and using with special administration. Results The main adverse reactions of Raltitrexed in the treatment included digestive system symptoms, neutropenia and elevation of aminotransferase, and the latter two had a great influence on the clinical treatment.Combination with radiotherapy increased the risk of myelosuppression. Incidence of neutropenia in combination Raltitrexed with Vinorelbine was higher. Transaminase elevations were generally Ⅰ-Ⅱ grades. Age(≥70 a) and liver metastasis had little effected on transaminase increase. Conclusion There were differences in the occurrence of ADR in different therapeutic schemes. Attention should be paid to ADRs of Raltitrexed especially to monitoring and reporting rare and severe ADRs in clinic.