目的 运用传统中医药理论,用中西医结合的方法,探讨简便中药结合肠内营养(EN)的支持方式对胃肠道肿瘤术后营养状况和炎性反应的影响,及改善胃肠道功能的作用。方法 胃肠道肿瘤术后患者随机分为黄陈枳术汤结合肠内营养组(观察组)和单纯肠内营养组(对照组)作对比研究,观察两组病人营养支持前后营养指标视黄醇结合蛋白(RBP),血清白蛋白(ALB)及炎性指标C反应蛋白(CRP)的改善情况,观察两组病人恶心、呕吐、腹胀、腹泻等胃肠道症状发生情况。结果 营养支持后RBP,ALB均有升高,观察组病人营养支持后第7、14天RBP和ALB水平均高于对照组,CRP低于对照组,差异有统计学意义(P＜0.05)。两种病人均有胃肠道不良反应,但观察组胃肠道并发症发生率较低,差异有统计学意义(P＜0.05)。结论 黄陈枳术汤结合肠内营养的中西医结合营养支持方法能纠正胃肠道功能紊乱,提高营养支持疗效,对胃肠道肿瘤术后患者的RBP和ALB有提高作用,能降低CRP,减少炎性反应,促进患者快速康复,缩短住院时间。

Objective Using a combination of Chinese and western medicine, to explore the effect of Huang Chen Zhisu decoction combined with enteral nutrition on RBP/ALB/CRP of gastrointestinal tumor patients after surgery,and improve gastrointestinal disorders. Methods Postoperative patients of gastrointestinal tumor were randomized into Huangchen Zhisu decoction combined with enteral nutrition group(observation group)and enteral nutrition group(control group). The retinol-binding protein(RBP),albumin(ALB),C-reactive protein (CRP),gastrointestinal symptoms, adverse reaction were observed and recorded. Results After nutrition support, the level of ALB and RBP were both increased. The ALB and RBP of the observation group on the 7th and 14th day after nutrition support were higher than those of the control group.The CRP of the observation group on the 7th and 14th day after nutrition support were lower than the control group, (P<0.05).The rate of postoperative gastrointestinal disorder of the observation group was obviously lower (P<0.05). Conclusion Huangchen Zhisu decoction combined with enteral nutrition has remarkable effect,can enhance the ALB and RPB, reduce CRP. The effect was better than enteral nutrition only. It improves the nutritional status and immune function,helps to promote the resumption on of gastrointestinal function,and helps postoperative patient for a quicker recovery.

目的 分析石河子地区2型糖尿病(T2DM)合并消化道恶性肿瘤患者的临床特征,探讨T2DM合并消化道恶性肿瘤的影响因素。方法 ①纳入我院2015年至今消化道恶性肿瘤患者为研究对象。根据OGTT结果或既往有无T2DM病史分为三组:健康对照组(A组),消化道恶性肿瘤组(B组),T2DM合并消化道恶性肿瘤组(C组)。②全自动生化分析仪测定血清中糖脂代谢指标,化学发光法测定血清甲胎蛋白(AFP)等肿瘤标志物,分析其临床特征,进行组间比较,并探讨其影响因素。采用SPSS 22.0软件处理数据,并进行方差分析;影响因素采用Logistic回归分析;假设检验水准α＝0.05,双侧检验P<0.05差异有统计学意义。结果 ①基线资料比较显示:A组310例(男女比138/172),年龄(52.96±10.98)岁;B组513例(男女比343/170),胃癌患者居多(26.90%),年龄(62.26±12.34)岁;C组134例(男女比80/54),肝癌患者较多(26.12%),年龄(66.78±10.47)岁;与A组相比,B组与C组男性患者较多,年龄较大。②组间基线资料比较显示:三组的性别、年龄存在统计学差异(P<0.001)。③协方差分析消除影响因素后:与A组相比,B组及C组的TG、 TC、HDL-c降低(P<0.001);FPG、AFP、CEA、CA12-5、CA15-3、CA19-9、CA72-4升高(P<0.01)。④Logistic回归分析后结果显示:FPG为消化道恶性肿瘤发生的独立危险因素(OR=1.204);年龄是消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的危险因素(OR=1.072,1.105),HDL-c为消化道恶性肿瘤及T2DM合并消化道恶性肿瘤发生的保护因素(OR=0.200,0.111);结论 老年男性T2DM患者易发生消化道恶性肿瘤。因此,对于高龄男性T2DM患者,尤其是HDL-c降低的情况下,应进行相关筛查,以早期防治消化道恶性肿瘤的发生发展。

Objective To analyze the clinical characteristics of patients with type 2 diabetes mellitus (T2DM)complicated with gastrointestinal malignancy in Shihezi area, and investigate the influencing factors of T2DM complicated with gastrointestinal malignancy. Methods ①Patients with malignant tumors of the digestive tract in our hospital from 2015 to the present have been included in the study. They were divided into three groups based on OGTT results or previous history of T2DM: healthy control group (group A), gastrointestinal malignant tumor group (group B), and T2DM combined gastrointestinal malignant tumor group (group C). ②Automatic biochemical analyzer measured serum glucose and lipid metabolism indicators, chemiluminescence method was used to measure serum alpha-fetoprotein (AFP)and other tumor markers, to analyze its clinical characteristics, make a comparaison between groups, and explore its influencing factors. The data was processed with SPSS 22.0 software and analysis of variance was performed; the influencing factors were analyzed by logistic reg-ression; hypothesis test level = 0.05, and the two-sided test P <0.05 was statistically significant. Results ①Comparison of baseline data showed that 310 cases (male/female 138/172)in group A were (52.96±10.98)years old. In group B, 513 patients (male/female 343/170)were diagnosed with gastric cancer (26.90%), aged (62.26±12.34)years. There were 134 cases in group C (male/female 80/54), with more liver cancer patients (26.12%), and the age was (66.78±10.47)years. Compared with group A, group B and group C had more male patients and were older. ②Comparison of baseline data among groups showed there were statistical differences in gender and age among the three groups (P<0.001). ③After covariance analysis eliminated influencing factors: compared with group A, TG, TC and HDL-c were decreased in group B and group C (P<0.001). FPG, AFP, CEA, CA12-5, CA15-3, CA19-9, and CA72-4 increased (P<0.01). ④Logistic regression analysis results: FPG was an independent risk factor for gastrointestinal malignancy (OR=1.204). Age wss a risk factor for gastrointestinal malignancy and T2DM complicated with gastrointestinal malignancy (OR=1.072, 1.105), HDL-c was the protective factor (OR=0.200, 0.111). Conclusion Elderly male T2DM patients are prone to gastrointestinal malignancies. Therefore, for elderly men with T2DM, especially when HDL-c is reduced, relevant screening should be performed to prevent and control the occurrence and development of gastrointestinal malignant tumors in the early stage.

目的 探讨二氢丹参酮Ⅰ在胃癌细胞中的抗癌作用。方法 采用 3-(4,5-二甲基噻唑-2)-2,5-二苯基四氮唑溴盐法(MTT法)测定细胞活力。流式细胞术检测细胞内活性氧(ROS)水平。荧光法测定Caspase活性。裸鼠胃癌模型验证DHTS的抗癌活性。结果 MTT实验结果表明,DHTS对HCG27和AGS细胞活力具有明显的剂量依赖性和时间依赖性。在DHTS处理的HCG27和AGS细胞中,细胞内ROS水平升高,凋亡细胞增多。 在DHTS处理的HCG27和AGS细胞中发现caspase-3和caspase-8活性增高,caspase-9活性不变。用N -乙酰半胱氨酸阻断ROS生成可显著逆转DHTS诱导的细胞凋亡。DHTS显著抑制小鼠肿瘤瘤体体积的增加。结论 所有的研究结果都有力的说明,DHTS可以在HCG27和AGS人胃癌细胞中启动活性氧生成,诱导氧化应激和细胞凋亡,值得作为抗癌药物进一步开发。

Objective To evaluate the anticancer actions of dihydrotanshinone Ⅰ(DHTS)in gastric cancer cells. Methods Cell viability was determined using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT)assay. Intracellular reactive oxygen species (ROS)levels were determined using flow cytometry. Caspase activities were measured with fluorometric assay. The anticancer activity of DHTS in nude mouse gastric cancer model was verified. Results MTT assay showed that DHTS greatly inhibited HCG27 or AGS cell viability in dose- and time-dependent manners. Elevated intracellular ROS levels and increased apoptotic cells were observed in DHTS-treated HCG27 or AGS cells. In addition, activation of caspase-3 and caspase-8, rather than caspase-9, were noticed in DHTS-treated HCG27 or AGS cells. Furthermore, blocking ROS generation with N-acetylcysteine markedly reversed DHTS-induced cell apoptosis. DHTS inhibited the increase of tumor volume in mice. Conclusion All the findings strongly suggest that DHTS may initiate ROS generation and induce oxidative stress and cell apoptosis in HCG27 or AGS human gastric cancer cells, which deserves to be further developed as an anticancer agent.

目的 探讨结直肠癌肝转移瘤的CT 成像特点及规律分析。方法 回顾性分析我院2016 年3 月—2018年3 月的84 例结直肠癌肝转移瘤患者的CT 动态增强图像及临床资料记录并统计其不同血流汇入情况下、不同增强时期的CT 成像结果,根据原发灶部位,将患者分为左半结肠组和右半结肠组,左半结肠组再按照血管重建情况分组。结果 原发灶在左半结肠时,转移瘤的左、右叶分布无差异（P>0.05）,而原发灶在右半结肠时,转移瘤的右叶优势分布多于左叶优势（P<0.001）;左半结肠组内比较,甲组转移瘤的左叶优势分布多于右叶,分布差异有统计学意义（P<0.001）,其左右叶构成比约为4∶1;乙组转移瘤的左、右叶分布差异不具有统计学意义（P>0.05）;丙组转移瘤的右叶优势分布多于左叶优势（P<0.001）;84 例患者中,共发现338 个肝转移灶。平扫中,低密度灶多于高密度灶,最少是等密度灶;动态CT 增强扫描中,环状强化灶多于结节状强化灶,其他不典型强化灶最少,且门脉期时强化灶显示最为清晰。结论 结直肠癌肝转移患者的CT 肝扫描图像特点有一定规律,可以为诊断结直肠癌原发灶及结直肠癌的早期转移提供一定理论依据。

Objective To investigate the characteristics and regularity of CT imaging of colorectal cancer liver metas tases. Methods A retrospective analysis of 84 cases of colorectal cancer liver metastases from March 2016 to March 2018 in our hospital. CT dynamic imaging images and clinical data were recorded and statistically analyzed for different blood flow in flows and different enhancement periods. For the CT imaging results, the patients were divided into the left colon group and the right colon group according to the primary tumor site, and the left colon group was grouped according to the blood vessel reconstruction. Results There was no statistic difference in the distribution of left and right lobe between the primary tumor and the left colon in the left colon （P>0.05） . However, in the right colon, the dominant distribution of the right lobe in the metastatic tumor was more than that in the left lobe. The advantage （P=0.00） in the left colon group, the left leaf dom inant distribution of the metastatic tumor of group A was more than that of the right lobe, and the difference was statistically significant （P=0.00）, and the ratio of left and right lobe was about 4∶1;There was no statistic difference in the distribu tion of left and right leaves between group B metastases （P>0.05） . The right leaf dominant distribution of group C metasta ses was more than that of left lobe （P=0.00） . Among 84 patients, a total of 338 liver metastases were found. In the plain scan, the low-density foci were more than the high-density foci, and at least the iso-density foci;in the dynamic CT-en-hanced scan, the annular intensified foci were more than the nodular intensive foci, and the other atypical intensive foci were the least, and the portal vein period enhanced stove display is the clearest. Conclusion The characteristics of CT liver scan in patients with liver metastases from colorectal cancer do have certain regularity, which may provide a theoretical basis for the diagnosis of primary colorectal cancer and early metastasis of colorectal cancer.

目的 探讨哮喘患者的气道炎症表型分布及肺功能指标情况。方法 选择226 例哮喘患者为研究对象,其中50 例为重症哮喘,76 例为普通哮喘,对比哮喘患者的气道炎症表型分布情况及患者肺功能指标情况。结果 226 例哮喘患者中,嗜酸性粒细胞型最为常见,占36.73%,之后为中性粒细胞型（31.86%）、混合细胞型（22.12%）、寡细胞型（9.29%）;重度哮喘患者中,中性粒细胞型患者肺功能相关指标均低于其它类型的重症患者（P<0.05）。结论 在哮喘气道炎症表型中,最常见的表型为嗜酸性粒细胞型,其中中性粒细胞型的哮喘患者的肺功能最差。

Objective To explore the phenotype distribution and lung function indicators of airway inflammation in asthmatic patients. Methods 226 cases of asthma patients were chosen as the research objects,in which 50 cases of severe asthma,76 cases of asthma,to compare asthma airway inflammation phenotype distribution and lung function index. Results Among 226 asthma patients,eosinophilic granulocytes were the most common,accounting for 36.73%,followed by neutrophilic granulocytes （31.86%）,mixed cell types （22.12%） and oligocytes （9.29%）. Among patients with severe asthma, the lung function of neutrophil patients was lower than that of other severe patients（P < 0.05）. Conclusion Among asthmatic airway inflammatory phenotypes, the most common phenotype is eosinophilic granulocyte type, among which neutrophil asthmatic patients have the worst lung function.

目的 研究加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎的临床疗效。方法 将100例慢性萎缩性胃炎患者随机分为对照组和观察组各50例,对照组患者给予三联疗法而观察组在对照组基础上辨证使用加减香砂六君子汤加减进行治疗。对临床疗效进行评估,观察两组患者临床症状并测定血清中超氧化物歧化酶（SOD）、丙二醛（MDA）水平的变化,统计两组的幽门螺杆菌（Hp）转阴率及复发率、根除率。结果 治疗以后统计有效率,观察组为92%,而对照组仅有76%,胃胀、胃痛、痞满、反酸、饮食减少等症状均缓解,各症状的积分治疗后均降低,两组相比其差异有统计学意义,观察组的Hp转阴率为92.0%,对照组Hp转阴率为68.0% ,两组Hp转阴率比较,差异有统计学意义。两组SOD水平均较治疗前上升,MDA水平均较治疗前下降,SOD水平高于对照组,MDA水平低于对照组,差异均有统计学意义（P<0.05）。结论 加减香砂六君子汤联合三联疗法治疗慢性萎缩性胃炎可显著改善患者的临床症状,有良好的应用前景。

Objective To observe the clinical effect of Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis. Methods We selected 100 cases of patients with chronic atrophic gastritis of intertwined,and divided them into the control group and the observation group randomly with 50 cases in each group. The control group was given triple therapy for treatment,while the observation group was additionally given Jiajianxiangshaliujunzi decoction based on the syndrome differentiation for treatment. We observed the changes of clinical symptoms and levels of superoxide dismutase（SOD） and malondialdehyde（MDA） in serum of both groups. The negative conversion rate,recurrence rate and eradication rate of Helicobacter pylori （Hp） in 2 groups were statistically analyzed,in both groups and the clinical effect. Results After treatment,the total effective rates were counted: the observation group was 92%,and the control group was only 76%. The symptoms such as stomach distention,stomachache,distention and fullness,acid reflux,and diet reduction were reduced after the treatment. The difference between the two groups had statistical significance. In the two groups of stomachache,fullness and boredom,low appetite and acid regurgitation scores were all lower than those before treatment,and the differences were statistically significant. The negative rate of Hp in the observation group was 92%,while the negative rate of Hp in the control group was 68%. There was difference between the two groups in the negative rate of Hp. The levels of SOD in both groups were higher than those before treatment,and the levels of MDA were lower than those before treatment,differences being significant（P< 0.05）;the level of SOD in the observation group was higher than that in the control group,and the level of MDA was lower than that in the control group. Difference was statistically significant. （P< 0.05）. Conclusion Jiajianxiangshaliujunzi decoction combined with triple therapy for chronic atrophic gastritis may improve clinical symptoms of patients,and promote the negative rate of Hp as well as the clinical effect.

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 研究在去骨瓣减压术中以神经补片隔离颞肌与硬脑膜对后期颅骨修补术的帮助。方法 回顾分析 23 例去骨瓣大骨瓣减压术后行颅骨修补术的临床资料,随机分为对照组13例,以神经补片隔离颞肌与硬脑膜;观察组10例,不隔离颞肌与硬脑膜。对比颅骨修补术中剥离肌皮瓣时间、术中出血量、术后引流量、术中硬脑膜破损、术后皮下积液、满意度。结果 治疗组的剥离肌皮瓣时间(28.69±9.78)min、术中出血量(36.54±10.59)mL、术后引流量(108.92±29.34)mL几个方面优于对照组,至于术中脑膜破损及术后积液,因例数不够,无统计意义,但由原理及经验判断,治疗组应优于对照组。而治疗组术后外观满意度(77%)高于对照组(40%)。结论 在去骨瓣减压术中以神经补片隔离颞肌与硬脑膜对后期颅骨修补术有明显的帮助。

目的 分析ABCB1基因G2677T、C3435T位点在我国汉族血脂异常人群的分布特征;探讨ABCB1基因G2677T和C3435T多态性与阿托伐他汀降脂疗效之间的关系。方法 依据中国成人血脂异常防治指南判断标准,在中国汉族人群中收集205例受试者,抽取其外周血液样本,利用聚合酶链式反应-限制性片段长度多态分析(PCR-RFLP)技术对受试者ABCB1进行基因分型,同时在阿托伐他汀治疗3个月前后检测总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)血脂水平,将205例患者治疗后4项指标恢复正常分为A组,治疗后4项指标仍有一项及一项以上异常分为B组,来分析G2677T和C3435T基因多态性与阿托伐他汀降脂疗效的关系,以及G2677T和C3435T等位基因的分布特征。结果 205例患者中G2677T位点GG型、GT型、TT型基因频率分别为19.51%、42.44%、38.05%;C3435T位点CC型、CT型、TT型基因频率分别为34.63%、49.76%、15.61%。G2677T位点A组与B组等位基因突变率为58.46%与60.67%,A组GG型、GT型、TT型基因频率分别为23.08%、36.92%、40.00%,B组GG型、GT型、TT型基因频率分别为13.33%、52.00%、34.67%;C3435T位点A组与B组等位基因突变率为40.77%和40.00%,A组CC型、CT型、TT型基因频率分别为34.62%、 49.23%、16.15%,B组CC型、CT型、TT型基因频率分别为34.67%、50.67%、14.66%;ABCB1 基因G2677T、C3435T位点基因型在A组和B组中分布相同,无差异(P＞0.05)。205例患者中,用药前ABCB1基因G2677T位点TT型血浆TC、LDL-C水平高于GT型(P＜0.05)。用药后ABCB1基因G2677T位点GT型血浆TC、HDL-C、LDL-C水平低于GG型与TT型(P＜0.05);用药后ABCB1基因C3435T位点TT型血浆TC水平低于CC与CT型(P＜0.05),而CC型血浆LDL-C水平高于TT型(P＜0.05)。结论 ABCB1基因G2677T、C3435T位点多态性与血浆血脂水平有关,但ABCB1基因G2677T、C3435T位点多态性可能与阿托伐他汀3个月降脂疗效无关。

目的 分析献血者献血后血肿(瘀斑)应用不同治疗方法的效果。方法 随机选取147例在广州血液中心献血后出现血肿(瘀斑)的献血者,根据其采用处理方式的差异分为甲组(n=66)、乙组(n=48)、丙组(n=33),为甲组献血者实施冷热敷法,为乙组献血者实施马铃薯片贴敷法,为丙组献血者实施喜辽妥(多磺酸粘多糖)软膏外敷法。结果 乙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=4.63,P＜0.05),丙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=13.99,P＜0.05),丙组献血者临床总有效率高于乙组献血者,2组差异有统计学意义(χ²=3.99,P＜0.05)。结论 献血者献血后血肿应用喜疗妥软膏外敷法疗效确切,可使其身心健康得到改善。

Objective To analyze the effects of different treatment methods on blood donors with haematoma(or bruise) after blood donation. Methods 147 blood donors with haematoma(or bruise) after blood donation in our blood station were randomly selected. According to the difference of treatment methods, they were divided into group A (n=66), group B (n=48) and group C (n=33), for the group A of blood donors to carry out cold and hot compress method, for the group B blood donors to implement the potato slice application method, for the group C blood donors to implement the hi-treatment ointment external application method. Results The total effective rate of group B blood donors was higher than that of group A blood donors. The difference was statistically significant (χ²=4.63,P＜0.05). The total clinical effective rate of group C blood donors was higher than that of group A blood donors. There is statistical significance (χ²=13.99,P＜0.05). The total effective rate of donors in group C was higher than that in group B. The difference between the two groups was statistically significant (χ²=3.99,P＜0.05). Conclusion The effect of external application of Hirudoid(Mucopolysaccharide Polysulfate Cream) on blood donors after blood donation is effective, which may improve their physical and mental health.