目的 探讨肝硬化患者临床凝血功能检验中全自动血凝仪测定的应用及临床价值。方法 选取2018年1月—2020年1月我院收治的64例肝硬化患者(肝硬化组),并纳入同期来我院接受健康体检者64例(对照组),应用全自动血凝仪对肝硬化患者临床凝血指标检测。再将肝硬化组患者分为出血组与无出血组,比较对照组与肝硬化组、出血与无出血组、不同肝功能分级患者血小板参数与PT检测结果。结果 与对照组比较,肝硬化组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与肝硬化无出血组比较,肝硬化出血组PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05);与Child-Pugh A级患者比较,肝硬化Child-Pugh B级与C级患者PDW、PT、MPV、INR水平更高,PCT、PLT水平更低(P＜0.05)。结论 在肝硬化患者病情评价中凝血功能检验发挥重要作用,可为患者临床治疗提供有效理论依据,诊断准确率较高,有利于临床治疗措施制定。因此,凝血功能检验应在肝硬化疾病诊断中广泛应用。

Objective To explore the application and clinical value of automatic blood coagulation apparatus in clinical coagulation function test of patients with cirrhosis. Methods A total of 64 patients with cirrhosis admitted to our hospital from January 2018 to January 2020 (cirrhosis group) were selected, and 64 healthy subjects admitted to our hospital during the same period (control group) were included. The clinical coagulation indexes of patients with cirrhosis were detected by automatic blood coagulation apparatus. Patients in cirrhosis group were divided into bleeding group and non-bleeding group; platelet parameters and PT test results were compared between control group and cirrhosis group, bleeding group and non-bleeding group, and patients with different liver function grades. Results Compared with the control group, the levels of PDW, PT, MPV and INR in cirrhosis group were higher, and the levels of PCT and PLT were lower (P＜0.05). Compared with liver cirrhosis non-bleeding group, the levels of PDW, PT, MPV and INR were higher in liver cirrhosis with bleeding group, and the levels of PCT and PLT were lower (P＜0.05). Compared with Child-Pugh A patients, the levels of PDW, PT, MPV and INR in Child-Pugh B and C patients with cirrhosis were higher, and the levels of PCT and PLT were lower (P＜0.05). Conclusion The test of coagulation function plays an important role in the evaluation of patients with cirrhosis, and can provide effective theoretical basis for the clinical treatment of patients with high diagnostic accuracy, which is conducive to the formulation of clinical treatment measures. Therefore, the test of coagulation function should be widely used in the diagnosis of cirrhosis.

目的 探讨超声引导下宫颈癌根治术的应用效果及对患者远期生存率的影响。方法 选取本院2015年1月—2017年12月共收治的70例宫颈癌患者作为研究对象,将2016年7月—2017年12月纳入的患者作为观察组,2015年1月—2016年6月纳入的患者作为对照组,各35例,给予对照组患者常规腹腔镜根治术,给予观察组患者超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗。对比两组患者的治疗效果、远期生存率与复发率以及术后6个月、1年、2年、3年的FACT-G评分情况。结果 两组疾病控制率对比无差异(97.14% vs 85.71%,P＞0.05);观察组的治疗总有效率为高于对照组的(85.71% vs 60.00%,P＜0.05);观察组和对照组患者1年生存率对比无差异(P＞0.05),观察组2年、3年生存率高于对照组(P＜0.05),观察组和对照组1年局部复发率对比无差异(P＞0.05),观察组的2年、3年局部复发率低于对照组(P＜0.05);观察组术后6个月、1年、2年、3年的FACT-G评分高于对照组(P＜0.05)。结论 应用超声引导定位下腹腔镜宫颈癌根治术联合高强度凝聚超声热凝技术治疗宫颈癌能够提升患者的治疗效果,减少疾病复发和提高远期生存率,提升患者的生存质量,值得临床应用推广。

Objective To investigate the application effect of ultrasound-guided radical hysterectomy for cervical cancer and its influence on the long-term survival rate of patients. Methods A total of 70 patients with cervical cancer admitted from January 2015 to December 2017 were selected as the research subjects, and the patients enrolled from July 2016 to December 2017 were selected as the observation group, patients from January 2015 to June 2016 as the control group, each with 35 cases. The control group was given conventional laparoscopic radical hysterectomy, and the observation group was given ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation technology. The treatment effect, long-term survival rate, recurrence rate and FACT-G scores 6 months, 1 year, 2 years and 3 years after operation were compared between the two groups. Results There were no significant differences in disease control rates between the two groups (97.14% vs 85.71%, P>0.05); the total effective rate of treatment in the observation group was higher than that in the control group (85.71% vs 60.00%, P<0.05). There was no significant difference in the 1-year survival rate between the observation and the control group (P>0.05). The 2-year and 3-year survival rate of the observation group were higher than that of the control group (P<0.05). There was no significant difference in comparison of 1-year local recurrence rate between the observation group and the control group (P>0.05). The 2-year and 3-year local recurrence rate of the observation group were lower than that of the control group (P<0.05). FACT-G scores in the observation group after surgery at 6 months, 1 year, 2 years, and 3 years were significantly higher than the control group (P<0.05). Conclusion The application of ultrasound-guided laparoscopic radical hysterectomy combined with high-intensity ultrasound coagulation in the treatment of cervical cancer can improve the treatment effect, reduce disease recurrence rate, increase long-term survival rate, and improve the quality of life of patients, which is worthy of clinical application and promotion.

目的 探讨个体化低速率对比剂注射方案联合低管电压扫描在低体质量指数(body mass index,BMI)受检者头颈部CT血管成像的可行性。方法 选取我科2020年1月—2020年11月低BMI受检者头颈部CTA检查90例进行研究,随机分成三组,每组30例。A组80 kV扫描,低流速、低总量注射方案; B组120 kV扫描,高流速、低总量注射方案;C组为120kV扫描条件,高流速、高总量注射方案。对比各组注射流速、注射总量、辐射剂量长度乘积(dose legth product,DLP),评价各组图像的主动脉弓、颈总动脉、基底动脉、胸锁乳突肌中段的CT值、信噪比及对比信噪比,由两名有经验的放射科医生对各组图像质量进行主观评价。结果 图像质量主观评价A、B两组图像评分集中在4分段,C组图像评分集中在3分段,A、B组与C组主观评分比较差异有统计学意义(P<0.05)。A组对比剂注射流速和DLP比B、C组分别下降27.75%、47.10%;A、B组对比剂注射总量较C组下降39.87%,差异有统计学意义(P<0.05)。A组各血管CT值对应比B、C组数值稍高,除主动脉弓CT值外其余血管客观参数对比均有差异(P<0.05)。结论 低BMI受检者头颈部CT血管个体化低流速精准对比剂注射方案联合低管电压扫描技术在获得满足诊断要求图像质量的前提下,既能降低受检者对比剂注射速率和注射风险,又能降低辐射剂量,值得推广应用。

Objective To explore the feasibility of individualized low rate contrast agent injection scheme combined with low tube voltage scanning in CTA imaging of low body mass index(BMI) subjects' head and neck. Methods Ninety cases of head and neck CTA examination of low BMI subjects in our department from January 2020 to November 2020 were selected for the study, and randomly divided into three groups with 30 cases in each group. Group A applied 80 kV scanning, low flow rate and low total volume injection scheme. Group B applied 120 kV scanning, high flow rate, low total volume injection scheme. Group C applied 120 kV scanning, high flow rate and high total volume injection scheme. The injection velocity, injection volume, radiation dose length product (DLP) among three groups were compared. In each image of the aortic arch, common carotid artery, basilar artery and the central part of sternocleidomastoid, the CT value, the signal-to-noise ratio and contrast-to-noise ratio were evaluated. Two experienced radiologists performed image quality evaluation. Results Image quality in group A and B by subjective evaluation got 4 points out of 4, and group C got 3 points out of 4, and there was statistical difference between group A, B and C in subjective evaluation of image quality (P<0.05). The injection velocity and DLP of contrast agent in group A were 27.75% and 47.10% lower than those in group B and C, respectively. The total amount of contrast agent injection in groups A and B was decreased by 39.87% compared with group C, with statistical difference (P<0.05). The corresponding CT values of each vessel in group A were slightly higher than those in group B and C, and there were statistically significant differences in the Objective parameters of other vessels except for aortic arch (P<0.05). Conclusion The combination of individualized low flow rate and precise contrast agent injection scheme with low tube voltage scanning technology for low BMI subject could not only reduce the injection rate and risk of contrast agent, but also reduce radiation dose, on the premise of meeting the diagnostic requirements of image quality. It is worthy of popularization and application.

目的 探讨以跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床应用效果。方法 将2020年1月—10月重症医学科收治的100例ARDS患者随机分为对照组和观察组各50例,对照组采用小潮气量辅助控制通气治疗,观察组以跨肺压(transpulmonary pressure,Ptp)为导向选择最佳呼气末正压(positive end-expiratory pressure,PEEP)进行机械通气治疗,观察比较两组患者治疗前和治疗48 h的呼吸动力学指标、血气分析指标,随访28 d病死率。结果 治疗48 h,潮气量、PEEP、肺静态顺应性、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂观察组明显高于对照组(P＜0.05);随访28 d病死率观察组和对照组比较差异无统计学意义(P＞0.05)。结论 以Ptp为导向选择最佳PEEP的机械通气治疗ARDS可以有效改善患者的呼吸动力学指标和血气分析指标,不增加ARDS的病死率,值得临床推广应用。

Objective To investigate the clinical effect of positive end-expiratory pressure(PEEP) ventilation guided by transpulmonary pressure (Ptp) in acute respiratory distress syndrome (ARDS). Methods Between January and October 2020, 100 cases of ARDS treated in intensive care unit were randomly divided into control group and observation group with 50 cases each. Control group used auxiliary control small tidal volume ventilation therapy, and observation group used the best PEEP mechanical ventilation therapy with the guiding of Ptp. The respiratory dynamics index, blood gas analysis results, follow-up of 28d case fatality rate before and 48h after treatment between the two groups were compared. Results After 48h of treatment, tidal volume、PEEP、pulmonary static compliance、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂ of the observation group were all higher than those of the control group (P<0.05). There was no statistically significant difference in mortality between the two groups at 28d follow-up (P＞0.05). Conclusion Mechanical ventilation with the best PEEP guided by Ptp could effectively improve the respiratory dynamic index and blood gas analysis results of patients with ARDS, without increasing the mortality of ARDS, which is worthy of clinical application.

目的 研讨不同促排方案在非卵巢多囊样改变高反应人群的疗效。方法 回顾分析2018年1月—2019年12月在我院进行体外受精助孕患者共711周期(含389个胚胎移植周期)。分为三组:A组:采用卵泡期长方案414周期(232个移植周期)。B组:采用黄体期长方案221周期(121个移植周期);C组:采用拮抗剂方案76周期(36个移植周期)。结果 A组的卵泡输出率(follicular output rate,FORT)最高;B组获卵数、2PN数、卵泡卵母细胞转化指数为三组中最高,但临床妊娠率、种植率最低;C组的人绒毛膜促性腺激素日促黄体生成素、每卵雌二醇水平为三组最高,但FORT、≥16 mm优势卵泡数最低。结论 在非卵巢多囊样改变高反应患者中,卵泡期长方案较黄体期长方案更利于改善妊娠结局,拮抗剂方案更经济、安全。

Objective To investigate the efficacy of different progestin-primed ovarian stimulation in non-polycystic ovarian morphology(non-PCOM) patients with high ovarian response. Methods A total of 711 cycles for in-vitro fertilization treatment(including 389 embryos transfer cycles) in our hospital from October 2018 to November 2019 were summarized in this retrospective study. All the patients were divided into three groups. In group A, 414 cycles for follicular phase gonadotropin-releasing hormone(GnRH) agonist long protocol(including 232 embryos transfer cycles)was used. In group B, 221 cycles for luteal phase GnRH agonist long protocol(including 121 embryos transfer cycles)was used. In group C, 76 cycles for GnRH antagonist protocol(including 36 embryos transfer cycles)was used. Results Follicular output rate(FORT) in group A was the highest. The number of oocytes, 2PN embryos and follicle-to-oocyte index in group B were the highest among the three groups,while the clinical pregnancy rate and implantation rate were the lowest. Luteinizing hormone on human chorionic gonadotropin injection day、estradiol level per follicle in group C were the highest,while FORT and the number of ≥16 mm dominant follicles were the lowest. Conclusion In non-PCOM patients with high ovarian response,follicular phase GnRH agonist protocol had better pregnancy outcome compared with luteal phase GnRH agonist protocol, and the GnRH antagonist protocol appeared to be more economical and safe.

目的 探讨大黄穴位贴联合直肠指力刺激在脑卒中后便秘患者的应用效果。方法 本研究选择2019年1月—2019年12月间我院收治的脑卒中后便秘患者90例,随机分成A组(大黄穴位贴组),B组(直肠指力刺激组),C组(大黄穴位贴联合直肠指力刺激组)三组,每组30例。记录三组患者便秘治疗有效率,采用Wexner便秘评分系统评估三组患者治疗前后的便秘程度并进行自身前后对比。结果 三组干预前后Wexner评分采用自身配对非参数秩和检验,差异有统计学意义(P＜0.05)。三组干预前后差值采用Kruskal-Wallis H检验结果差异有统计学意义(H=26.211,P＜0.05),经过两两对比,差异有统计学意义(P＜0.05)。值得注意的是,干预后C组Wexner评分下降。干预后C组患者的有效率高于其他两组,有效率结果为C组(90%)＞B组(80%)＞A组(53.5%),差异有统计学意义(P＜0.05)。结论 相较于单一应用大黄穴位贴或直肠指力刺激,大黄穴位贴联合直肠指力刺激治疗效果更好,可有效降低便秘发生率,提高病人生活质量。

Objective To explore the effect of rhubarb acupoint application combined with rectal finger force stimulation in patients with constipation after stroke. Methods In this study, 90 patients with post-stroke constipation admitted to our hospital from January 2019 to December 2019 were randomly divided into group A (rhubarb acupoint application group), group B (rectal finger force stimulation group) and group C (rhubarb acupoint application combined with rectal finger force stimulation group), 30 cases in each group. The effective rates of constipation treatment in the three groups were recorded, and the Wexner constipation scoring system was used to evaluate the degree of constipation before and after treatment among three groups. Results The Wexner scores of the three groups before and after treatment were analyzed by self-paired non-parametric rank sum test, and the differences were statistically significant (all P<0.05). The difference among the three groups before and after treatment using Kruskal-Wallis H test was statistically significant (H=26.211, P<0.05), and after pairwise comparison, the differences were statistically significant (P<0.05). It was worth noting that the Wexner score of group C dropped significantly after treatment. The effective rate of treatment in group C was significantly higher that those in the other two groups. The result showed effective rate of group C (90%)＞ group B (80%)＞group A (53.5%), the difference was statistically significant (P<0.05). Conclusion Compared with the single treatment of rhubarb acupoint application or rectal finger force stimulation, the combined treatment had better efficacy, which reduced incidence of constipation and improved the quality of life of patients.

目的 探讨“分-全带教”在提高门诊实习生处方审核能力的应用效果。方法 对2016届实习生进行“分-全带教”,在实习初期、后期组织实习生对100张门诊处方进行处方审核,登记审核结果。结果 实施“分-全带教”后,处方成功审核例数实习初期的163例(27.17%)提高到后期的487例(81.17%)。结论 应用“分-全带教”模式,有利于门诊实习生掌握处方审核技巧,在提高实习生处方审核能力中有良好应用前景。

Objective To make a discussion of the application result of point-all teaching model in improvement of prescription review ability of interns at outpatient service process. Methods To implement point-all teaching model on interns enrolled in 2016. To ask them to review 100 outpatient prescription at the beginning and ending of the internship respectively and record the results of their review. Results After the implementation of point-all teaching model, the correct review of the prescription has been improved from 163 (27.17%) at the beginning to 487 (81.17%) at the ending. Conclusion The point-all teaching model is conducive for interns at outpatient department to master the technique for review, so it is promising in the improving the prescription review ability of interns.

目的 研究放射性 ¹³¹I 在甲亢伴甲状腺结节中的应用价值。方法 纳入我院90例甲亢患者,根据其是否伴甲状腺结节分为无结节组(51例)、结节组(39例),均接受放射性 ¹³¹I 治疗。比较两组治疗总有效率,分析两组治疗前后血清甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT3)及游离甲状腺素(FT4)水平。结果 无结节组治疗总有效率74.51%,结节组为58.97%,差异无统计学意义(P＞0.05);两组治疗后TSH均高于治疗前(P＜0.05),FT3、FT4均低于治疗前(P＜0.05),TPOAb、TGAb较治疗前比较差异均无统计学意义(P＞0.05);无结节组治疗后FT3、FT4低于结节组(P<0.05),TPOAb、TGAb、TSH较结节组比较差异均无统计学意义(P＞0.05)。结论 放射性 ¹³¹I 治疗甲亢伴甲状腺结节效果好,且操作简单,副作用少,值得临床推广使用。

Objective To study the value of radioactivity ¹³¹I in hyperthyroidism with thyroid nodules. Methods Ninety patients with hyperthyroidism in our hospital were divided into non-nodule group (51 cases) and nodule group (39 cases) according to whether they had thyroid nodules or not. All patients received ¹³¹I radiation therapy. The total effective rate was compared between the two groups. The serum levels of thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) were analyzed before and after treatment. Results The total effective rate was 74.51% in non-nodule group and 58.97% in nodule group, with no significant difference (P>0.05);after treatment, TSH was higher in both groups than that before treatment (P<0.05), FT3 and FT4 were lower than that before treatment (P<0.05), TPOAb and TGAb had no significant difference compared with that before treatment (P>0.05);FT3 and FT4 in nodule-free group were lower than those in nodule group (P<0.05). TPOAb, TGAb and TSH had no significant difference compared with nodule group (P>0.05). Conclusion Radioactive ¹³¹I treatment of hyperthyroidism with thyroid nodules has good effect, simple operation and few side effects, which is worthy of clinical application.

目的 探讨食管胃静脉曲张精准断流术与改良“三明治”法治疗食管胃静脉曲张的临床疗效。方法 选取共50例食管胃底静脉曲张患者,按随机数字法分为精准治疗组和对照组,精准治疗组(n=25)行内镜下食管胃静脉曲张精准断流术,对照组(n=25)接受改良“三明治”法内镜治疗。分析对比两组的止血成功率、再出血率、治疗显效率、并发症发生率、聚桂醇和组织胶用量、治疗时间及住院天数等指标。结果 治疗后随访3个月,术后3天内止血率两组均为100％。再出血率精准治疗组为4%,对照组为32%,差异有统计学意义(P=0.010)。静脉曲张治疗显效率精准治疗组为84%,对照组出血率为52%,差异有统计学意义(P=0.015)。并发症发生率在两组间差异无统计学意义(P>0.05)。聚桂醇和组织胶平均用量在两组间差异无统计学意义(P>0.05)。精准治疗组平均治疗时间为(32.60±6.44)min,对照组为(40.60±7.26)min,差异有统计学意义(P<0.0001);精准治疗组平均住院天数为(8.12±1.24)d,对照组为(9.12±1.39)d,差异有统计学意义(P=0.010)。结论 内镜下精准断流术治疗食管胃静脉曲张再出血率低、效果好、安全性高。

Objective To investigate the clinical efficacy of endoscopic selective varices devascularization and the modified Sandwich method on the treatment of esophagogastric varices. Methods 50 patients with esophagogastric varices were divided into therapy (endoscopic selective varices devascularization)group (n=25) and control group (n=25) by random number table method. The therapy group (n=25) received the treatment of endoscopic selective varices devascularization. The control group (n=25) was treated with modified Sandwich method injection. The success rate of hemostasis, rate of recurrent bleeding, rate of varices disappearance, complication rate, dosage of lauromacrogol and tissue adhesive, time of therapy and hospitalization days were compared and analyzed between the two groups. Results During the 3-month followup, the success rates of hemostasis were 100% in both groups 3 days after the treatments. The rates of recurrent bleeding in therapy group and control group were 4% and 32% respectively, with statistically significant difference (P=0.010). The rates of varices disappearance in therapy group and control group were 84%and 52% respectively, the difference (P=0.015) was statistically significant. There was no statistically significant difference in complication rates between the two groups(P>0.05). There was also no statistically significant difference in the average dosage of lauromacrogol and tissue adhesive between the two groups(P>0.05). The average time of therapy in therapy group and control group were(32.60±6.44)minutes and(40.60±7.26)minutes respectively, with statistically significant difference between the two groups(P=0.000). The average hospitalization days in therapy group and control group were(8.12±1.24)days and(9.12±1.39)days respectively, which is statistically significant difference between the two groups(P=0.010). Conclusion Endoscopic selective varices devascularization has the obvious advantage of a significant efficacy, low recurrence rate and high safety.

目的 探讨实时超声弹性成像技术联合常规超声检查在评估脑卒中患者颈动脉粥样硬化斑块稳定性中的临床应用价值。方法 收集我院收治的临床确诊脑卒中患者(卒中组)34例作为研究对象,另抽取同期存在颈动脉斑块但未发生过脑卒中的人群(对照组)56例作为对照研究对象,进行超声弹性成像检测,并对检查结果进行统计分析。结果 34例脑卒中患者发现颈动脉粥样硬化斑块57个,其中低回声斑块29个,混合回声斑块21个,强回声斑块7个;56例对照组患者发现颈动脉粥样硬化斑块75个,其中低回声斑块22个,混合回声斑块25个,强回声斑块28个;两组间比较斑块数量之间、斑块大小之间差异有统计学意义(P<0.05)。颈动脉粥样硬化低回声、混合回声及强回声斑块弹性评分依次升高,其斑块硬度值依次升高;两组间斑块的评分数量分布差异有统计学意义(P<0.05);对于同一类型斑块的硬度值两组间差异无统计学意义(P>0.05);脑卒中组不同类型斑块间的硬度值差异有统计学意义(P<0.05)。结论 超声弹性成像技术可对脑卒中患者颈动脉粥样硬化斑块的稳定性进行半定量评估,不同类型斑块因所含组织成分的不同其弹性应变率表现也不同,能有效补充常规超声检查的信息的不足,进而评估斑块的稳定性。

Objective To explore the clinical value of real-time ultrasound elastography combined with conventional ultrasound in assessing the stability of carotid atherosclerotic plaques in stroke patients. Methods Thirty-four patients with clinically confirmed stroke (stroke group) in our hospital were collected as the research object. Another 56 patients with carotid plaque but without stroke (control group) in the same period were selected as the control object for ultrasonic elastography detection, and the results were analyzed statistically. Results Thirty-four stroke patients were found 57 carotid atherosclerotic plaques, including 29 hypoechoic plaques, 21 mixed echoic plaques and 7 hyperechoic plaques; 56 control patients were found 75 carotid atherosclerotic plaques, including 22 hypoechoic plaques, 25 mixed echoic plaques and 28 hyperechoic plaques. There were significant differences between the number of plaques and the size of plaques (P<0.05). Carotid atherosclerosis low echo, mixed echo and strong echo plaque elasticity score increased in turn, the plaque hardness value increased in turn; the number of plaque scores between the two groups had statistical significance (P<0.05); for the same type of plaque hardness value between the two groups had no significant difference (P>0.05); There were significant differences in hardness values between the same types of plaques (P<0.05). Conclusion Ultrasound elastography may semi-quantitatively evaluate the stability of carotid atherosclerotic plaques in stroke patients. Different types of plaques have different elastic strain rates because of different tissue components. It may effectively complement the information deficiency of conventional ultrasound examination, and then evaluate the stability of plaques.