目的 探讨医院-社区-家庭一体化管理在精神分裂症患者中的应用效果。方法 选择我院2018年6月—2019年6月期间收治的精神分裂症患者86例,按随机数字表法分为两组,每组43例。对照组采取常规护理管理,研究组实施医院-社区-家庭一体化管理,观察6个月。比较两组精神症状、生活质量及肇事肇祸率。结果 两组管理前阳性与阴性症状量表(PANSS)评分、WHOQOL-100评分比较,差异无统计学意义(P＞0.05);两组管理后PANSS评分均低于管理前,生存质量测定量表简表(QOL-BREF)评分高于管理前,差异有统计学意义(P＜0.05);研究组管理后PANSS评分为(43.23±8.11)分,低于对照组的(49.48±8.26)分,WHOQOL-100评分为(83.69±8.87)分,高于对照组的(77.25±8.54)分,差异有统计学意义(P＜0.05);研究组肇事肇祸率为9.30%,低于对照组的25.58%,差异有统计学意义(P＜0.05)。结论 医院-社区-家庭一体化管理的实施能够减轻精神分裂症患者精神症状,提升生活质量,降低肇事肇祸率。

Objective To explore the applications of hospital community family integrated management on the quality of life and accident rate of schizophrenics. Methods 86 schizophrenics admitted to our hospital from June 2018 to June 2019 were divided into two groups according to the method of random number table, 43 cases in each group. Routine nursing management was adopted in the control group and hospital community family integrated management was implemented in the study group for 6 months. The mental symptoms, quality of life and accident rate were compared between the two groups. ResultsThere was no statistical significance in PANSS score and WHOQOL-100 score between the two groups before management (P>0.05); PANSS score of the two groups after management was lower than that before management, QOL-BREF score was higher than that before management, and the difference was statistically significant (P<0.05); PANSS score of the study group after management was (43.23±8.11), lower than that of the control group (49.48±8.26), WHOQOL-100 score was (83.69±8.87), higher than the control group (77.25±8.54), the difference was statistically significant (P<0.05); the study groupls accident rate was 9.30%, lower than that of the control group 25.58%, the difference was statistically significant (P<0.05). Conclusion The implementation of hospital community family integrated management reduces the mental symptoms of schizophrenics, improve the quality of life, and reduce the accident rate.

目的 分析应用蓝激光成像技术(BLI)联合内镜智能分光比色技术(FICE)诊断早期食管癌的临床意义。方法 收集本院及下级医院2016年1月—2018年6月在普通内镜下发现的108例食管可疑病变患者,分别给予白光、FICE和BLI不同模式进行观察诊断,再结合放大模式对病变部位的上皮乳头内毛细血管袢(IPCL)进行观察、分型、判断性质。最后取活检送病理学检查。内镜数据和病理数据采用Kappa一致性检验方法、Spearman相关性分析,统计每种内镜检查模式诊断的准确性,分析各方法下IPCL分型与病理诊断之间的相关性。结果 Kappa一致性检验显示,白光内镜、FICE、BLI以及FICE+BLI等模式诊断早期食管癌的准确度、敏感度、特异度、阳性预测、阴性预测及Kappa值呈逐步升高;Spearman相关性分析显示,FICE、BLI以及BLI与FICE联合诊断时,IPCL分型与早期食管癌的诊断均呈正相关,且BLI联合FICE的相关性强于BLI或FICE单独诊断。结论 BLI联合FICE可显著提高早期食管癌的诊断率,结合放大内镜下IPCL分型可判断早期食管癌病理分型。

Objective To analyze the clinical significance of blue laser imaging (BLI)technology combined with Fuji intelligent chromo endoscopy (FICE)in the diagnosis of early esophageal cancer. Methods 108 cases of patients with esophageal suspicious lesions admitted to our hospital from January 2016 to June 2018 were enrolled in the study. They were given different modes of white light, FICE and BLI for observation and diagnosis, and the magnifying endoscopy model was combined to observe the intraepithelial papillary capillary loop (IPCL)at lesions sites for IPCL typing. After complete endoscopic examinations, the lesions were taken for pathological examination. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of each method were tested by Kappa consistency test. Spearman correlation analysis was used to analyze the correlation between IPCL classification and pathological diagnosis under each method. Results Kappa consistency test showed that the accuracy, sensitivity, specificity, positive predictive value, negative predictive value and Kappa value of white light endoscopy, FICE, BLI and FICE+BLI were increased in the diagnosis of early esophageal cancer. IPCL classification under combined magnifying endoscopy showed that type IV was mainly early esophageal cancer, and types I-III were mainly precancerous lesions. Spearman correlation analysis showed that through FICE, BLI and BLI combined with FICE for diagnosis, IPCL classification was positively correlated with early esophageal cancer, and the correlation of BLI combined with FICE was stronger than that of BLI or FICE. Conclusions BLI combined with FICE can greatly improve the diagnosis rate of early esophageal cancer. Combined with magnifying endoscopy, IPCL classification can judge the pathological types of early esophageal cancer.

目的 观察康柏西普玻璃体腔注射治疗湿性老年性黄斑变性病变对于视网膜神经纤维厚度的影响。方法 对2016年10月—2017年10月在汕头大学附属韶关市粤北人民医院采用康柏西普玻璃体腔注射治疗湿性老年性黄斑变性35例38眼中符合标准的患者18例（18眼）的临床资料进行回顾性分析,患者行最佳矫正视力、眼压（NCT）检查、OCT、荧光眼底血管造影（FFA）检查后,均接受0.05 mL康柏西普玻璃体腔注射,分别注射后1和2月观察患者最佳矫正视力 （BCVA）、视网膜神经纤维厚度（RNFL）变化。结果 18眼共接受康柏西普玻璃体腔注射54次,所有患眼均注射3次。注射3个月后,OCT检查结果显示有18眼视力有提高,CRT厚度有下降。第1次注射时和注射后1个月、2个月的BCVA分别为0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）,总体比较差异有统计学意义（χ²=13.880,P<0.001）;第1次注射时和注射后1个月、2个月的CRT（μm） 319.50（269.50,390.50）, 271.00（219.00,296.25） 和234.50（182.75,273.25）总体比较差异有统计学意义（χ²=11.978,P<0.05）,第1次注射时和注射后1个月、2个月后的 ARNFL（μm）86.00（76.25,98.00） 83.00（76.00,95.50）和 83.00（76.25,94.75） 总体比较差异无统计学意义（χ²=11.978,P>0.05）,第1次注射时和注射后1个月、2个月眼压（kPa）2.27（1.97,2.44）,16.0（13.7,17.0）,和 2.00（1.84,2.31） 总体比较差异无统计学意义（χ²=1.604,P>0.05）。结论 玻璃体腔注射康柏西普治疗湿性老年性黄斑变性对视网膜神经纤维厚度无明显的损害,安全且有效,但仍需要大样本量及长期随访观察。

Objective To observe the effect on the thickness of retinal nerve fibers in the patients with wet age-related macular degeneration by adopted intravitreal injection with Conbercept. Methods We analyzed 18 cases （18 eyes） that conform to the standard from 35 cases（38 eyes） retrospectively,who were treated with wet age-related macular degeneration by adopted intravitreal injection with Conbercept in Shaoguan Yuebei People's Hospital Affiliated to Shantou University from October in 2016 to October in 2017.After undergoing best corrected visual acuity （BCVA）,intraocular pressure （IOP） and fluorescein angiography （FFA）,all of them were adopted intravitreal injection with 0.05mL Conbercept. We observed the changes of best corrected visual acuity （BCVA） and retinal nerve fiber thickness （RNFL） after 1 and 2 months of adopted intravitreal injection with 0.05 mL Conbercept. Results 18 eyes were adopted intravitreal injection Conbercept 54 times totally. All the eyes were injected three times. After 3 months of injection,OCT showed that the visual acuity of 18 eyes improved and the thickness of CRT decreased. The BCVA values at the first injection,after the first injection and after the second injection were 0.1（0.04,0.12）,0.20（0.10,0.30）和0.25（0.12,0.30）respectively. The overall difference was statistically significant （χ²=13.880,P< 0.001）. CRT（μm）values at the first injection,after the first injection and after the second injection were 319.50（269.50,390.50）,271.00（219.00,296.25） and 234.50（182.75,273.25）respectively. The overall difference was statistically significant （χ²=11.978,P< 0.05）. ARNFL（μm）values at the first injection,after the first injection and after the second injection were 86.00（76.25,98.00）,83.00（76.00,95.50） and 83.00（76.25,94.75）respectively. There was no significant difference （χ²=11.978,P> 0.05）. The IOP（mmHg）values at the first injection,after the first injection and after the second injection were 17.0（14.8,18.3）,16.0（13.7,17.0）,和 15.0（13.8,17.3）respectively. There was no significant difference（χ²=1.604,P>0.05）. Conclusion There was no obvious damage to the retinal nerve fiber by adopted intravitreal injection with Conbercept to treat the patients with wet age-related macular degeneration. That’s safe and effective,but need a large sample to follow-up for a longtime.

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.

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 探讨一次不明原因流产与精子DNA损伤的关系。方法 收集有一次不明原因流产史的患者作为实验组,同时以有正常妊娠史的患者为对照组,分别比较两组男方年龄、精子密度、精子活力、精液量和精子DNA断裂指数有无差异。以SPSS 16.0为统计软件,进行独立样本的t检验。结果 两组的精液量、精子密度及活力均无差异,实验组男方年龄小于对照组(P<0.05),但实验组的DFI要高于对照组(P<0.01)。结论 本研究对照组年龄高于实验组,而DFI正好相反。这说明不明原因的自发流产与男方精子DFI密切相关,随着DFI的增加,流产风险增加。

Objective To investigate the relationship between unexplained abortion and sperm DNA damage. Methods Patients with a history of unexplained abortion were enrolled as an experimental group, and patients with a normal pregnancy history were used as a control group. The differences in age, sperm density, sperm motility, semen volume, and sperm DNA break index were compared between the two groups. The independent sample t test was performed using the statistical software of SPSS 16.0. Results There was no significant difference in semen volume, sperm density and motility between the two groups. The age of the male group in the experimental group was lower than that in the control group (P<0.05), but the DFI of the experimental group was higher than that of the control group, and the difference was statistical significance (P<0.01). Conclusion The age of the study control group was higher than that of the experimental group, while DNA fragmentation index DFI was the opposite, which indicated that unexplained spontaneous abortion was closely related to the male sperm DFI, and the risk of miscarriage may increase with the increase of DFI.

目的 探究肛裂切除带状皮瓣推移术对陈旧性肛裂患者肛门功能的影响。方法 收集我院2017年5月—2018年9月间收治的120例陈旧性肛裂患者资料,按随机数字法将其分为对照组(58例)和研究组(62例),对照组患者接受侧方内括约肌切开术治疗,研究组患者接受肛裂切除带状皮瓣推移术治疗。比较两组临床指标、肛门功能及并发症情况。结果 研究组创面愈合时间、住院时间低于对照组,而手术时间高于对照组(P<0.05);与术前相比,术后1周、术后1月、术后半年,两组Wexner评分均出现下降,且研究组低于对照组(P<0.05);研究组便血、尿潴留、肛门疼痛、肛缘水肿、创口感染、肛门失禁等并发症发生率低于对照组(P<0.05)。结论 肛裂切除带状皮瓣推移术治疗陈旧性肛裂效果显著,可提高肛门功能,降低并发症,值得临床推广。

Objective To investigate the effect of anal fissure excision bandage flap operation on anal function in patients with old anal fissure. Methods The data of 120 patients with old anal fissure who were admitted to our hospital from May 2017 to September 2018 were collected for retrospective analysis. They were divided into control group (58 cases) and research group (62 cases) according to the random number method. The control group received lateral sphincter incision. The patients in the study group underwent treatment of anal fissure excision bandage flap operation. The clinical indicators, anal function and complications were compared between the two groups. Results The healing time and hospitalization time of the study group were lower than that of the control group, and the operation time was higher than that of the control group (P<0.05). Compared with the preoperative period, 1 week after surgery, 1 month after surgery, and half a year after surgery, the Wexner scores of the two groups showed a significant decrease, and the study group was lower than the control group (P<0.05). The incidence of complications such as blood in the stool, urinary retention, anal pain, anal edema, wound infection and anal incontinence were lower in the study group than in the control group (P<0.05). Conclusion Anal fissure excision bandage flap operation for the treatment of old anal fissure is effective, which may improve anal function and reduce complications. It is worthy of clinical promotion.

目的 探讨利用微信群保留机采血小板无偿献血者的应用效果。方法 从本血站穿越安全输血标准化管理系统中调取2015年1月1日—2018年12月31日捐献机采血小板无偿献血者信息,根据初次捐献机采血小板后是否自愿加入机采微信群的机采血小板无偿献血者分为实验组和对照组,统计分析各组机采血小板无偿献血者重复献血 2～3 次和≥4 次以上机采血小板无偿献血者人数及平均献血次数。结果 2015—2018年间机采血小板采集量、献血人数及平均献血次数逐年上升;重复献血 2～3 次和≥4 次以上人数,实验组均高于对照组,机采血小板平均献血次数实验组均高于对照组,其中2016年和2018年实验组机采血小板平均献血次数高于对照组(P<0.05)。结论 通过机采微信群预约与管理机采血小板无偿献血者可提高机采血小板招募的工作效率,有效扩大和稳定机采血小板无偿献血者固定队伍。

目的 探讨脑动静脉畸形(AVM)破裂出血发生的危险因素。方法 回顾性研究2014年—2018年我院收治的AVM病例42例,根据有无破裂出血,分为出血组和非出血组,对AVM破裂出血发生的相关因素进行统计学分析。结果 通过相关性及逐步回归分析,表明AVM破裂出血的独立危险因素为: 深部静脉引流和低龄患者。结论 对于引流静脉为深部静脉引流类型和低龄的AVM患者,应积极尽早治疗。

Objective To analyze the risk factors related to cerebral arteriovenous malformation(AVM)with hemorrhage. Methods The clinical data of 42 patients with AVM between 2014 and 2018 were respectively studied. According to the presence of rupture, the cases were divided into bleeding group and non-bleeding group. The factors associated with the occurence of AVM rupture were statistically analyzed. Results The correlation and logistic regression analysis suggested that the deep venous drainage and young patients were the independent risk factors for AVM rupture. Conclusion The young patients and the patients with deep venous drainage should be operated as soon as possible to avoid hemorrhage.

目的 研究罗哌卡因阻滞用于胸腹腔镜联合食管癌根治术后镇痛的临床效果。方法 胸腹腔镜联合食管癌根治术患者60例,分为: 观察组(n=30),缝合切口时用0.25%盐酸罗哌卡因10 mL于切口局部浸润;对照组(n=30) 不做局部浸润麻醉处理;记录二组术后2 h、6 h、12 h、24 h、48 h的疼痛视觉模拟评分(VAS)及血浆皮质醇浓度。结果 观察组术后2 h、6 h、12 h VAS评分优于对照组,术后12 h观察组血浆皮质醇浓度低于对照组。结论 罗哌卡因术终阻滞术后12 h内镇痛效果明显。

Objective To evaluate the efficiency of postoperative analgesia with ropivacaine block after thoracoscopic-lapacoscopic esophagectomy (TLE). Methods Totally 60 patients with esophageal cancer underwent TLE were divided into two groups: observation group(n=30)with 0.25% ropivacaine hydrochloride solution 10 mL injection around incision before end of the operation; control group(n=30)without the treatment. The VAS and the plasma Cortisol concentration at 2 h、6 h、12 h、24 h、48 h after surgery were recorded. Results The VAS at 2 h、6 h、12 h after surgery in observation group was higher than that of the control group,but not at 24 h、48 h after surgery. The plasma Cortisol concentration in the observation group was higher than that of in the control at 12 hours postoperatively. Conclusion Ropivacaine block of incision is helpful to have analgesic effect within 12 hours after TLE.