目的 探讨重症急性胰腺炎诊治特点。方法 回顾性分析13例重症急性胰腺炎患者临床资料,包括一般资料、生化检测及影像资料、治疗措施与预后结果,纳入标准为急性胰腺炎合并器官衰竭＞48 h(改良Marshall评分≥2分)。结果 重症急性胰腺炎患者一般资料中普遍突出存在心率增快(121.07±28.09)次/分、APACHE II评分偏高(18.92±7.34),病因排序则是高脂血症(38.5%)＞胆石症(30.8%)＞酒精性(23.1%),SAP合并ARDS发生率可达46.2%,合并AKI则高达69.2%;WBC(12.60±5.57)×10⁹/L、CRP(138.16±67.06)mg/L及PCT(15.76±27.33)ng/L等炎症指标升高提示SAP普遍存在炎症反应,影像学中69.2%患者合并发生肺炎及腹腔积液则提示多处感染部位,其他脏器指标异常升高也提示SAP患者心肺肝肾均存在不同程度的受损;接受CRRT治疗及呼吸支持可分别达46.2%及76.9%,7天内死亡例数为1例(7.7%),28天内死亡例数为4例(30.8%),ICU及总住院时间为(10.77±7.38)及(19.61±13.40)天。结论 重症急性胰腺炎是全身及局部性的炎症反应累及全身各个脏器的急性复杂病变,以合并发生ARDS及AKI为临床特征,需要多器官功能保护与替代、外科干预等多学科综合协作治疗。

Objective To evaluate characteristics of diagnosis and treatment on severe acute pancreatitis. Methods To respective analysis clinical data of 13 patients with severe acute pancreatitis. The data included baseline characteristics, biochemical tests and imaging data, treatment and prognosis, inclusion criteria for acute pancreatitis with organ failure > 48 h (modified Marshall score > 2). Results Higher heart rate(121.07±28.09) times/min and APACHEII scores(18.92±7.34) were universally found in SAP, which primary disease contained hyperlipidemia (38.5%) > cholelith disease (30.8%) > alcohol (23.1%) with incidence of ARDS and AKI being 46.2% and 69.2%; Higher inflammatory biomarkers including WBC(12.60±5.57)×10⁹/L, CRP(138.16±67.06)mg/L and PCT(15.76±27.33)ng/L indicated widespread inflammation with many infection sites revealing by 69.2% pneumonia and peritoneal effusion on imaging; Other abnormally biochemical index prompted some injury of viscera including heart, lungs, kidney and liver; 1 case suffered death within 7 days and 4 cases also did within 28 days, ICU and total length of hospital stay was (10.77±7.38) and (19.61±13.40) days, CRRT treatment and respiratory support respectively reached 46.2% and 46.2%. Conclusion Severe acute pancreatitis is a acute complex pathological changes on various organs induced by acute systemic and local inflammation with feature of mergence with the ARDS and AKI, which need the multidisciplinary integrated collaborative treatment on organ function protection and sustain and surgical intervention.

目的 探讨内科治疗的高血压基底节区出血的疗效及预后相关的因素。方法 回顾性分析2005年4月—2014年12月贵阳市第二人民医院神经外科收治的174例高血压脑出血患者的临床资料,所有患者均采用内科保守治疗,对疗效及影响患者预后的因素进行分析。结果 174例患者中,死亡50例,持续植物生存状态4例,对124例存活患者进行随访,随访时间2~117个月,随访ADL分级Ⅰ级43例,Ⅱ级53例,Ⅲ级21例,Ⅳ级3例,Ⅴ级4例,预后较好者(ADL分级Ⅰ~Ⅱ级)96例,预后不良者(ADL分级Ⅲ~Ⅴ级)28例。χ²检验显示入院 GCS评分和出血量是影响患者预后的因素。结论 影响高血压基底节区脑出血患者的预后因素较多,GCS评分较高、出血量少的患者可采用内科治疗,多数患者预后较好。

Objective To investigate treatment efficacy and the factors influencing prognosis of conservative treatment of hypertensive intracerebral hemorrhage in basal ganglia. Methods A retrospective analysis was conducted on the clinical data of 174 patients with hypertensive intracerebral hemorrhage in basal ganglia who were admitted to our hospital during the period from April 2005 to December 2014. All the patients were given internal medicine conservative treatment and followed up to observe the clinical curative effect to analyze the prognosis. Results Of the 174 patients, 50 patients died and 4 patients were persistent vegetative state. 124 patients were followed up for 2-117 months and they were classified according to ability of daily life(ADL) prognosis scale: 43 cases were in I grade, 53 cases in II grade, 21 cases in III grade, 3 cases in IV grade, 4 cases in V grade. 96 cases achieved favourable outcomes and 28 cases got poor outcomes.The results of Chi square test revealed that GCS scale and intracerebral hemorrhage volume were the factors influencing prognostic of hypertensive intracerebral hemorrhage in basal ganglia. Conclusion There were many prognosis factors related with hypertensive intracerebral hemorrhage. The curative effect and prognosis in patients with conservative treatment is obvious in these patients with high GCS scale and less intracerebral hemorrhage volume.

目的 观察健康促进诊疗管理模式对社区慢性病的干预效果。方法 选取社区的慢性病患者268例,对他们实施慢性病健康促进诊疗管理,主要的方向有健康干预、诊疗管理、随访管理等。结果 干预后患者的体质指数、血压、血糖、血脂的达标率、健康知识、用药依从率等都比干预前有所提升。组间比较差异具有统计学意义(P＜0.05)。干预治疗后患者的满意度为87.3%,治疗有效率为85.8%,显著高于干预治疗前的70.1%和59.0%。结论 对社区慢性病患者采取健康促进诊疗管理模式进行干预,能够提高社区慢性病的综合防治效果,对提高患者的生活质量具有一定的促进作用。

目的 对切开复位与撬拨复位内固定术治疗SandersⅡ型跟骨骨折临床疗效进行比较。方法 回顾分析2014年10月—2016年6月陕西中医药大学附属医院收治的58例SandersⅡ型跟骨骨折患者临床资料,切开组29例,其中男24例、女5例,平均年龄(37.10±3.45)a;闭合组29例,其中男26例、女3例,平均年龄(36.60±3.15)a。采用Maryland及AOFAS评分系统评定临床功能。结果 X线显示两组患者术后Bohler角及Gissane角均恢复,比较差异没有统计学意义(P>0.05)。撬拨复位组术中出血量、住院天数及手术时间均明显少于切开复位组(P<0.05)。撬拨组出现2例针孔感染,换药后感染消失。切开组出现2例切口感染,1例切口裂开,2例刀口皮缘坏死,长期换药后全部好转;1例腓肠神经损伤。两组并发症发生率比较差异有统计学意义(P<0.05)。结论 对于治疗SandersⅡ型跟骨骨折,两组术式均能取得良好疗效,经皮撬拨复位克氏针内固定较切开复位钢板内固定具有时间成本小、创伤小、痛苦少、并发症少等优点。

目的 探讨替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病的临床疗效及安全性。方法 前瞻性选取本院2012年4月—2015年10月收治的80例急性冠脉综合征合并妊娠糖尿病患者,按随机数字表法分为对照组、实验组,每组40例,实验组采用替罗非班辅助低分子肝素治疗,对照组使用单独低分子肝素治疗方案,比较两组治疗后血浆蛋白-A(PAPP-A)以及超敏C反应蛋白(hs-CRP)水平;比较两组内出血情况以及血小板计数的变化。结果 两组治疗后PAPP-A以及hs-CRP水平均有所下降,实验组下降幅度高于对照组,对比差异有统计学意义(P＜0.05);两组内出血发生率分别为10.0%、40.0%,均无严重出血情况发生,实验组轻度出血3例,中度出血1例,对照组轻度出血10例,中度出血6例,实验组轻中度出血率低于对照组(P＜0.05);两组治疗前血小板计数对比差异无统计学意义(P＞0.05),治疗后实验组血小板计数下降明显,对照组血小板计数无明显变化,两组不同时间点血小板计数差异无统计学意义(P＞0.05)。结论 替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病患者具有一定的效果,且用药安全性较高。

目的 观察自拟中药方内服外洗结合冲击波治疗足底筋膜炎的临床疗效。方法 收集在我院门诊就诊的符合条件足底筋膜炎患者50例,采用自拟四物四藤汤内服外洗结合冲击波治疗,运用VAS评分法及疼痛减轻百分数评定治疗前与治疗后1周、2周、1月的疗效比较。结果 治疗前后VAS评分比较(P<0.05),组间比较有统计学意义,且前两周效果更明显,总有效率为94.00%,患者满意度为96.00%。结论 本治疗方法对足底筋膜炎是有明显疗效的,可以在临床上进一步推广验证。

Objective To observe clinical curative effect of TCM oral use and external wash combined with application of shock wave in the treatment of plantar fasciitis. Methods To collect 50 cases of patients with plantar fasciitis in our hospital clinic,use Siwusiteng medical herbal decoction combined with shock wave treatments, elevate VAS score and the percentage of pain relief before and after treatment at 1 week, 2 weeks, and 1 month. Results VAS score before and after treatment was statistically significant(P<0.05), and the effect of the first two weeks is more obvious. The total effective rate was 94.00%,patient satisfaction was 96.00%. Conclusion This treatment has obvious curative effect on plantar fasciitis, and it could be further promoted in clinical verification.

目的 探讨胸部良性疾病非计划二次手术的原因,降低非计划二次手术率,研究防止措施。方法 回顾性分析2006年5月—2016年5月间胸部良性疾病患者行外科手术治疗的临床资料574例,其中16例术后因各种原因行非计划二次手术,总结胸部良性疾病外科治疗后非计划二次手术的临床特点、治疗经过及原因,对可能的影响因素进行单因素分析和多因素分析。结果 本组患者行非计划二次手术,无死亡病例,二次手术手术时间为30～215(135.6±47.4) min。术中出血量50～650 (313.6±93.1)mL。术后住院时间7～30(15.7±6.8)d。二次手术原因包括术后出血 (10例)、术后肺持续漏气(4例)、切口感染(2例)。单因素分析首次手术疾病分类,首次手术时间,首次手术方式与胸部良性疾病非计划二次手术相关性有统计学意义(P<0.05),多因素分析结果显示首次手术疾病分类,首次手术时间,首次手术方式是胸部良性疾病非计划二次手术的独立危险因素(P<0.05)。结论 根据胸部良性疾病的不同疾病类别来估计和预防可能出现的并发症,特别是胸部炎症性病变,术前充分准备、术中仔细操作、术后并发症的早期积极处理,能降低胸部良性疾病非计划二次手术的发生率。

Objective To investigate the causes of benign thoracic disease unplanned reoperation,improve the level of diagnosis and treatment and reduce the rate of unplanned reoperation. Methods From May 2006 to May 2016,594 cases of benign thoracic disease were performed thoracic surgery,including 16 patients underwent the unplanned reoperation due to various reasons. The clinical characteristics, therapy course and results of benign thoracic disease unplanned reoperation were analyzed retrospectively. Results The patients underwent the unplanned reoperation were no deaths. The operative time 30～215(135.6±47.4)min, intraoperative blood loss 50～650 (313.6±93.1)mL,postoperation hospitalization duration 7～30(15.7±6.8)d. The causes of benign thoracic disease unplanned reoperation were as follows: postoperative bleeding (10 cases), prolonged air leaks (4 cases),incision infection (2 cases). Univariate analysis showed first-time classification of diseases, operative time and operation method were statistically significant (P<0.05), Multivariate Logistic regression analysis revealed first-time classification of diseases, operative time and operation method were independent factors associated with benign thoracic disease unplanned reoperation. Conclusion According to the different classification of benign thoracic disease to estimate and prevent possible complications, we need to have sufficient preoperative preparation, intraoperative careful operation. Early active processing can be taken in postoperative complications.It can reduce the incidence of unplanned reoperation in benign thoracic disease,especially the chest inflammatory diseases.

目的 探讨加味骨洗方外治法用于治疗类风湿关节炎的疗效以及类风湿因子等临床指标的变化。方法 选取100例类风湿关节炎患者,随机分为治疗组和对照组各50例。治疗组给予加味骨洗方及TDP特定电磁疗灯导入的外治,对照组给予TDP特定电磁疗灯磁疗。结果 在缓解症状和恢复功能方面治疗组总有效率为84%,对照组总有效率为58%,治疗组各临床指标与对照组相比均有差异(P<0.05)。结论 加味骨洗方治疗类风湿关节炎疗效显著,能有效降低类风湿因子等炎性指标,值得临床推广。

Objective To discuss curative effects of rheumatoid arthritis treatment and clinical indicators transformation including rheumatoid factor by additional Guxi prescription external therapy. Methods We selected 100 patients who were suffered from rheumatoid arthritis, divided randomly into two groups. 50 patients for the treatment group and another 50 for the control group. The treatment group was treated by the additional Guxi prescription external therapy. While the control group was treated by the infrared magnetic therapy. Results The effective proportion of the treatment group was 84%, while the control group total was 58% in the aspect of relieve the symptoms and recovery of functions. Besides, all clinical indicators of the treatment group were inferior to the control group(P<0.05). Conclusion There are effects for treating rheumatoid arthritis by utilizing additional Guxi prescription external therapy. This therapy which can effectively reduce the inflammatory indexes of the rheumatoid factor is worth promoting clinically.

目的 研究低视力儿童“学校-社区-家庭”三位一体综合康复干预工作的具体效果。方法 2013年1月,选择广州市盲人学校新入学80名低视力儿童,随机分为两组,为期二年的跟踪研究。其中A组执行“学校-社区-家庭”三位一体综合康复干预,B组执行传统康复干预。就知识积累、心理健康、生活能力三个方面对两组儿童的具体数据收集,研究“学校-社区-家庭”三位一体综合康复干预与传统干预方式之间的区别。结果 A组低视力儿童较B组儿童的文化知识积累与生活能力训练成绩均有提高,两者差距在正常分布带内,A组低视力儿童的心理素质优于B组低视力儿童。A组低视力儿童的综合评价效果高于B组儿童。结论 低视力儿童“学校-社区-家庭”三位一体综合康复干预工作的具体效果优于传统康复干预方式。