目的 通过观察隔姜灸神厥穴并同时口服黄芪汤治疗脓毒症急性肾损伤患者的效果分析,初步探讨该方法能否改善患者的APACHEⅡ评分,入住重症监护病房的时间有没有缩短,14天内死亡率有否差异。方法 以2014年1月—2015年8月于我院确诊的脓毒症急性肾损伤患者为研究对象,观察常规治疗(对照组)及常规治疗基础上给予隔姜灸神厥穴同时口服黄芪汤治疗(治疗组)对脓毒症急性肾损伤患者危重情况的影响。结果 治疗组患者的危重指标(APACHEⅡ评分)明显改善,患者治疗5天后组间比较差异有统计学意义(P<0.05);两组患者入住重症监护病房的时间比较,患者治疗第四周χ²=4.5241,P=0.0334,差异有统计学意义(P<0.05);14天死亡率差异无统计学意义(P>0.05)。结论 隔姜灸神厥穴同时口服黄芪汤治疗能有效改善脓毒症急性肾损伤患者的APACHEⅡ评分,入住重症监护病房的时间减少。

目的 观察吉西他滨联合萘达铂治疗铂类敏感复发性卵巢癌的近期疗效与不良反应。方法 回顾性分析潍坊市人民医院2013年1月—2014年6月治疗的60例复发性卵巢癌病例,分为吉西他滨联合萘达铂(GN)方案化疗组30例和吉西他滨联合卡铂(GC)方案化疗组30例。GN方案组,吉西他滨1.0 g/m²,d1、8;萘达铂80 mg/m²,d1,21d为1周期;GC方案组,吉西他滨1.0 g/m²,d1、8;卡铂按AUC=5计算,d1,21 d为1周期。结果 GN方案组近期有效率56.0%,GC方案组近期有效率60.0%,两组比较差异无统计学意义(χ² =0.069,P=0.793)。两组最常见的毒性反应均是骨髓抑制,GC组骨髓抑制发生率较GN组骨髓抑制发生率稍高,但两组比较差异无统计学意义(P>0.05)。结论 两种方案治疗铂类敏感型复发性卵巢癌疗效无统计学差异,GN方案组不良反应较轻。

Objective To evaluate the clinical effect of GN chemotherapy protocol and GC chemotherapy protocol treatment of recurrent ovarian cancers. Methods We retrospectively analyzed the data of 60 patients with recurrent ovarian cancers in our hospital from January 2013 to June 2014. Divided into gemcitabine and nedaplatin (GN)chemotherapy group and Gemcitabine and carboplatin(GC)chemotherapy group, 30 patients in each group.Patients in GP protocol group were given Gemcitabine 1.0 g/m²,d1,8;and naphthalene(80 mg/m²,d1),21d was a period of treatment; Patients in GC protocol group were given gemcitabine 1.0 g/m²,d1,8;and carboplatin AUC=5 by calculation,21d was a period of treatment. Results For patients in GN protocol group,the short term response rate was 56.0%.For patients in GC protocol group,the short term response rate was 60.0%,the difference was not statistically significant(χ²=0.069,P=0.793). Two of the most common toxicities were myelosuppression, incidence of myelosuppression GC was slightly higher than GN, and the difference was not statistically significant. Conclusion The therapeutic effects of two chemotherapy protocols have no statistically significant difference in treatment of platinum sensitive recurrent ovarian cancer. Toxicity of GN group is light.

目的 为避免和减少颈部手术对喉返神经损伤,本文利用尸体解剖探讨喉返神经走向与分布以及与周围组织的相关性。方法 将20具用甲醛固定的成年尸体标本喉返神经(40侧)及其分支解剖;肉眼观察其与甲状腺、甲状腺下动脉和Berry's韧带相关性;测量喉返神经入喉点与甲状软骨下角的距离,以及甲状软骨下角至锁骨中点与胸骨柄上端的距离。结果 喉返神经与甲状腺下动脉交叉比例为96%,交叉点在甲状腺下极平面之上占88%,喉返神经位于甲状腺下动脉及其分支的前方与后方分别为22%与50%,经过Berry's韧带后方占95%,喉返神经入喉点至甲状软骨下角的距离(8.2±2.5)mm。结论 喉返神经与甲状腺下动脉和甲状腺韧带关系复杂,甲状软骨下角可作为喉返神经定位标志。

Objective In an attempt to reduce the risk of intraoperative recurrent laryngeal nerve (RLN) damage, human autopsy was conducted to determine the distribution of RLN and its relationship with surroundings. Methods With the naked eye observation, 20 formalin-fixed adult cadavers were examined. The relationships between RLN and inferior thyroid artery and inferior horn of thyroid cartilage were defined. Both the distance between entering point and inferior horn of thyroid cartilage and the distance between inferior horn of thyroid cartilage and middle point of clavicle bone or upper margin of stern were measured. Results The proportion of cases for recurrent laryngeal nerves intercrossed with inferior thyroid artery and for the crossing above the plane of inferior pole was respectively 88% and 96%. Therecurrent laryngeal never in front and rear of the inferi of thyroid artery and its branches were 22% and 50%,respectivdly.Most cases of RLN were behind Berry s suspensory ligament (95%). The distance between entering point of recurrent laryngeal nerve and inferior horn of thyroid cartilage was 8.2±2.5mm. Conclusion The results suggested that the correlation between RLN and its surrounding tissues is very complicated. The inferior horn of thyroid cartilage may be a useful marker for RLN.

目的 探讨ε-3多不饱和脂肪酸在胃肠道肿瘤患者化疗后的胃肠道毒性及生活质量的作用。方法 在研究前经过化疗筛选,按照WHO化疗副反应在2级或者以上的50名住院的胃癌或者直结肠癌患者,随机分为对照组(单纯化疗)(n=25)和研究组(化疗加ε-3多不饱和脂肪酸)(n=25),两组的化疗方案均为化疗筛选的方案。预防性每天静脉使用ε-3多不饱和脂肪酸 200 mg,连续5天,记录评估胃肠道并发症,如恶心、呕吐和腹泻,以及KPS评分、血清白蛋白、IL-2、IFN-γ和CRP。结果 与对照组比较,恶心、呕吐和腹泻评分、IL-2、IFN-γ和CRP低于于对照组,相反,生活质量评分研究组高于对照组,差异有统计学意义(P<0.05)。结论 预防性使用ε-3多不饱和脂肪酸能够减轻胃肠道肿瘤患者化疗后的胃肠道毒性症状、降低全身炎症因子反应并改善生活质量。

Objective To explore the effect omega-3polyunsaturated fatty acid omega-3 FA on clinical manifestations of gastrointestinal toxicity and quality of life (QOL) induced by chemotherapy for patients with gastric or colorectal cancer. Methods After screening chemotherapy, Fifty patients with gastric or colorectal cancer, according to developing WHO side-effect grading system of grade 2 or higher were randomly divided into either control group (n=25) or omega-3 FAs group (n=25) during next cycle of chemotherapy. In the control group, the patients received the same chemotherapy regimens as screening cycle and in the omega-3 FA group, received chemotherapy and omega-3 FAs. Prophylactic intravenous 200 mL /d was given for 5 days. The gastrointestinal complications such as nausea,vomiting or diarrhoea and Karnofsky performance status(KPS ),IL-2,IFN-γandCRP,ect, were evaluated respectively. Results Compared with the control group, the scores of nausea vomiting and diarrhea and IL-2,IFN-γor CRP levels decreased , significantly,on the contrary, the score of QOL increased. There was significantly statistical difference (P<0.05). Conclusion Prophylactic intravenous omega-3 FA can ameliorate clinical manifestations of gastrointestinal toxicity and systemic inflammatory response syndrome(SIRS) induced by chemotherapy and improve QOL for patients with gastric or colorectal cancer.

目的 观察单唾液酸四己糖神经节苷脂联合复方丹参片在治疗难治性癫痫的脑保护作用。方法 选取2010年1月—2015年10月于我院进行治疗的80例难治性癫痫患者为研究对象,随机分为对照组和治疗组。对照组患者给予常规抗癫痫药物治疗,而治疗组患者在对照组治疗基础上给予单唾液酸四己糖神经节苷脂联合复方丹参片治疗。治疗一疗程后,对两组患者进行疗效判定;并分别在治疗前后使用韦氏成人智力量表(WAIS-RC)和韦氏记忆量表(WMS-RC)对两组患者的智商和记忆商进行测评,并比较分析。结果 ①观察组患者的治疗总有效率为97.5%高于对照组的87.5%(P<0.05)。②治疗后,观察组患者的语言智商、操作智商、总智商和记忆商得分分别为(95.4±8.5)分、(94.8±12.5)分、(92.8±7.5)分和(93.5±8.2)分,均高于治疗前的(89.5±7.2)分、(91.5±10.1)分、(88.5±6.9)分和(82.5±10.0)分,且也均高于对照组治疗后的(75.4±6.8)分、(80.6±9.8)分、(80.1±5.9)分和(76.9±8.2)分,以上差异均有统计学意义(P<0.05)。治疗后,对照组患者的智商和记忆商均见的下降,均低于治疗前各分数,以上差异有统计学意义(P<0.05)。结论 神经节苷脂联合复方丹参片治疗难治性癫痫临床效果显著,且具有一定的脑保护效果,可为以后临床治疗难治性癫痫患者提供参考依据。

Objective To observe the cerebral protective effects of monomial four hexose ganglioside combined with compound salvia miltrorrhiza tablets (CSMT) in patients with refractory epilepsy. Methods 80 patients with refractory epilepsy patients treated in our hospital between January 2010 and October 2015 were randomly divided into control group and treatment group. The control group patients were treated with conventional antiepileptic drug therapy, and the treatment group patients were treated with monomial four hexose ganglioside, CSMT and conventional antiepileptic drug therapy. The efficacy in two groups' patients was determined after a course of treatment. The IQ and memory quotient in two groups' patients before and after treatment were evaluated by the Wechsler Adult Intelligence Scale (WAIS-RC) and the Wechsler Memory Scale (WMS-RC) respectively and comparative analysed. Results ①The total effective rate in the treatment group (97.5%) was significantly higher than that in the control group (87.5%) (P<0.05). ②The verbal IQ (95.4±8.5), performance IQ (94.8 ± 12.5), total IQ (92.8 ± 7.5) and memory quotient (93.5 ± 8.2) scores in the treatment group after treatment were significantly higher than those before treatment (89.5 ± 7.2), (91.5 ± 10.1), (88.5 ± 6.9), (82.5 ± 10.0) respectively, and also were significantly higher than those in the control group after treatment (75.4 ± 6.8), (80.6 ± 9.8), (80.1 ± 5.9) and (76.9 ± 8.2) respectively (P<0.05). The IQ and memory quotient in the control groups' patients after treatment were significantly decline and lower than before treatment, which had a statistically significant difference (P<0.05). Conclusion Ganglioside combined with CSMT in the treatment of refractory epilepsy can receive significant clinical effect and own a certain brain protective effect, which provide reference to the future clinical treatment of refractory epilepsy patients.

目的 分析ITP患者血清中IgG型抗体糖基化的特异性,初步探讨其特异性与临床症状的相关性。方法 选取健康献血员30例、ITP患者13例及健康怀孕妇女23例,纯化血清中的IgG型抗体,应用nano-LC-MS法分析糖基化种类及水平,对比分析ITP患者血清中IgG型抗体的糖基化特异性。结果 ① ITP 患者血清中IgG型抗体的半乳糖糖基化水平为47.08±2.69,低于健康怀孕妇女(50.93±2.21),高于健康献血员(42.88±2.00)(P<0.05);② ITP 患者岩藻糖基化水平为81.16±2.49低于健康献血员(82.60±2.56)(P>0.05),同时低于健康怀孕妇女(86.17±2.23)(P<0.05);③ITP 患者唾液酸化水平为3.93±1.20,高于健康献血员(3.69±1.19),低于健康怀孕妇女(4.28±0.88)(P>0.05)。④ITP 患者乙酰葡糖氨基化水平为10.53±1.41,低于健康献血员(11.54±1.76),高于健康怀孕妇女(10.13±1.45)(P>0.05)。结论 ITP患者血清中的IgG型抗体的岩藻糖基化、半乳糖糖基化水平的特异性可能是其产生有别于健康怀孕妇女的临床症状的的分子基础。

Objective To investigate the glycosylation specificity of the IgG antibody in ITP. Methods Choose 30 healthy donors, 23 healthy pregnants and 13 ITP patients, purified the IgG antibody from serum, analysied the level of all kinds of glycosylation. Compared with healthy donor and healthy pregnants to find the specificity of the IgG antibody in ITP patients. Results ① The galacosylation of IgG antibody in ITP patients was 47.08±7.24,lower than healthy pregnants (50.93±4.91), higher than healthy donor (42.88±4.01), and the healthy pregnants were higher than healthy donor (P<0.05). ② The fucosylation in ITP patients was 81.16±6.2, lower than healthy donors (82.60±2.56) (P>0.05), higher than healthy pregnants(86.17±2.23)(P<0.05); ③The sialylation in ITP patients was 3.93±1.20, higher than healthy donors (3.69±1.19), lower than healthy pregnants (4.28±0.88)(P>0.05); ④The GlcNAc in ITP patients was 10.53±1.41, lower than healthy donors (11.54±1.76), higher than healthy pregnants (10.13±1.45)(P>0.05). Conclusion The specificity of IgG antibody in ITP patients in galacosylation and fucosylation may be the molecule base of ITP's clinic symptom.

目的 对比紫杉醇脂质体(LEP)与紫杉醇(PTX)联合顺铂(DDP)治疗晚期非小细胞肺癌(NSCLC)的临床疗效及安全性。方法 晚期NSCLC患者48例,随机分为对照组和试验组,对照组采用紫杉醇175 mg/m²,试验组采用紫杉醇脂质体175 mg/m²,均联合顺铂75 mg/m²化疗,21天为1个周期,治疗2个周期后评价疗效,记录近期疗效与治疗期间不良反应。结果 近期疗效:对照组有效率37.50%,疾病控制率为79.17%,试验组有效率为41.67%,疾病控制率为83.33%,两组差异均无统计学意义(P>0.05)。不良反应:白细胞减少、贫血及血小板减少的发生率两组差异无统计学意义(P>0.05),脱发和恶心、呕吐的发生率两组差异亦无统计学意义(P>0.05),但试验组皮疹、呼吸困难、肌肉痛及周围神经炎的发生率明显低于对照组,差异有统计学意义(P<0.05)。结论 紫杉醇脂质体治疗晚期NSCLC与紫杉醇疗效相当,但周围神经炎及过敏反应较紫杉醇为轻。

Objective To compare the efficacy and safety of paclitaxel liposome combined with cisplatin and paclitaxel combined with cisplatin in the treatment of advanced non-small cell lung cancer (NSCLC). Methods 48 patients with advanced NSCLC were randomized into two groups, experimental group were given paclitaxel liposome at 175 mg/m²,and control group were given paclitaxel at 175 mg/m². Both groups combined with DDP at 75 mg/m² per cycle every 21 days.The efficacy and safety were evaluated after two cycles. Results The overall response rate was 37.50% in experimental group and 41.67% in control group, and the disease control rate was 79.17% in experimental group and 83.33% in control group. There was no significant difference between two groups(P>0.05). Though there was no significant difference in incidence of neutropenia,anemia, thrombocytopenia and alopecia, nausea and vomiting, but the occurred rates of rash、muscle pain and peripheral neuritis were significantly lower in experimental group than those in control group. Conclusion In the treatment of advanced NSCLC, both paclitaxel liposome combined with cisplatin and paclitaxel combined with cisplatin have similar efficacy, but paclitaxel liposome can significantly reduce the incidence of peripheral neuritis and serious hypersensitive reactions.

目的 统计分析2011—2014年我院分离的肠杆菌科细菌数据,探讨耐碳青霉烯肠杆菌科细菌(CRE)的流行特征。方法 收集肠杆菌科细菌,根据药敏结果筛选出CRE菌株,并对相关临床资料进行统计分析。结果 共分离得到CRE菌株187株,标本来源依次为尿液(32.6%)、痰液(28.9%)和血液(10.7%)。从科室分布来看,39.0%的菌株来自重症监护室病区,23.0%的菌株来自泌尿外科病区,在其它病区呈散发分布。菌株的种属分布方面,肺炎克雷伯菌的比例为39.6%, 大肠埃希菌的比例为20.9%;从病人年龄构成来看,50岁以上高龄患者的分离比例达74.4%。CRE的分离数目随年份的递增而不断升高。结论 耐碳青霉烯肠杆菌科细菌的流行率呈现逐年递增的趋势,临床应合理使用相关抗生素,预防和控制CRE在医院环境中的流行。

Objective To investigate the epidemiological features of carbapenem resistant Enterobacteriaceae in a collection of clinical Enterobacteriaceae strains isolated during 2011-2014 from our hospital. Methods The Enterobacteriaceae strains were collected and CRE strains were screened by their resistance to carbapenems. Clinical information was analyzed to characterize the epidemiological traits of CRE strains. Results The total number of CRE isolates was 187. These CRE strains were isolated from various clinical specimens, including urine(32.6%), sputum (28.9%), blood (10.7%), and so on. These strains were frequently isolated from intensive care units (ICU) (39.0%) and department of Urology (23.0%). The most frequently isolated species were Klebsiella pneumoniae (39.6%), Escherichia coli (20.9%). The isolation rate is much higher in elderly patients more than 50 years old (74.4%). The percentage of CRE isolates were kept on increasing by years. Conclusion The prevalence carbapenem resistant Enterobacteriaceae in our hospital is increasing every year and it is important to prevent and control the transmission and outbreaks of CRE in the hospital by proper use of related antibiotics in clinical treatment.

目的 了解中山市7家医院金黄色葡萄球菌感染的临床分布,并对耐药基因进行检测,为临床经验治疗金黄色葡萄球菌感染提供用药及分子生物学依据。方法 收集2015年1月—2015年6月中山市7家医院分离到的金黄色葡萄球菌,使用ATB半自动细菌鉴定及药敏分析仪(法国梅里埃)对分离到的菌株进行鉴定及药敏试验,使用PCR技术对耐甲氧西林金黄色葡萄球菌(MRSA)的耐药基因进行检测。结果 7家医院共分离到89株金黄色葡萄球菌,其中MRSA检出33株,检出率为37.1%。金黄色葡萄球菌主要来源于呼吸内科(32株,36.0%)、骨科(20株,22.5%),主要分离自痰(41株,46.1%),伤口分泌物(16株,18%),对万古霉素、替考拉宁、奎奴普丁/达福普丁、复方新诺明、左氧氟沙星、诺氟沙星具有较高敏感性,MRSA对常用抗菌药物耐药率高于甲氧西林敏感金黄色葡萄球菌。共有32株MRSA检出bla_mecA基因,检出率为97%。结论 MRSA耐药情况较为严峻,临床科室应根据微生物培养报告合理使用抗菌药物。bla_mecA基因在MRSA检出较高,是MRSA主要的耐药机制。

Objective To analyze clinical distribution of Staphylococcus aureus infections from 7 hospitals in Zhongshan city, as well as to provide basis of empirical treatment and molecular biology for Staphylococcus aureus infections. Methods Staphylococcus aureus were collected from January 2015 to June 2015 in Zhongshan city, and then the strains were identified and tested antibiotic susceptibility by using ATB semiautomatic analyzer(Merieux). Resistance gene of methicillin-resistant Staphylococcus aureus(MRSA) was detected by polymerase chain reaction. Results 89 strains of Staphylococcus aureus were isolated from 7 hospitals and with prevalence of 33 strains of MRSA. Of all strains, 32(36.0%) were isolated from respiratory medicine and 20(22.5%) from orthopedics. 41(46.1%) strains of Staphylococcus aureus were isolated from sputum and 16(18.0%) from wound secretion. 89 strains of Staphylococcus aureus had highly susceptibility to vancomycin, teicoplanin, quinupristin/dalfopristin, cotrimoxazole, levofloxacin, norfloxacin. Resistance rates to commonly used antimicrobial drugs of MRSA were significantly higher than methicillin-sensitive. A total of 32 MRSA were detected carrying bla_mecA gene with the detection rate of 97%. Conclusion Clinical departments should be based on microbial culture report for rational use of antibiotics because of MRSA with more serious drug resistance. The gene of bla_mecA is the main mechanism of resistance for MRSA.

目的 探讨小脑延髓池注射纳洛酮对心肺复苏大鼠脑神经保护的作用机制。方法 将30只雄性SD大鼠随机分为假手术组、常规复苏组和纳洛酮复苏组。采用窒息法建立大鼠心脏骤停模型,复苏的同时给予药物治疗。恢复自主循环(ROSC)后24 h取脑组织,荧光定量PCR法检测脑组织c-Fos mRNA表达水平,免疫组化法检测脑组织c-Fos蛋白的表达。结果 与常规复苏组比较,纳洛酮可显著降低大鼠脑组织c-Fos mRNA及蛋白表达量(P<0.01)。结论 小脑延髓池注射纳洛酮可及时有效的作用于c-Fos基因,发挥脑神经保护作用。

Objective To investigate the neuroprotective mechanism of naloxone injected into cisterna magna on cerebral ischemia-reperfusion. Methods Thirty adult male SD rats were randomly divided into sham group, conventional cardiopulmonary resuscitation (CPR) group and naloxone CPR group. Asphyxiation was used to set up rat cardiac arrest model, and corresponding drugs were given when the resuscitation was carried out. The Brain tissues were taken at 24 h after restoration of spontaneous circulation(ROSC). Fluorescence quantitative polymerase chain reaction (PCR) and immunohistochemical was used to detect the expression of c-Fos proteins was used to detect the expression of c-Fos mRNA level. Results Compared with the conventional CPR group, Naloxone could significantly decrease the expression of c-Fos protein and c-Fos mRNA in rat brain. Conclusion Naloxone injected into cisterna magna can promptly and effectively act on c-Fos gene, playing a neuroprotective role.