目的 观察保留括约肌挂线法和瘘管切除术治疗复杂性肛瘘的临床效果。方法 选择2010年10月—2013年10月期间收治的复杂性肛瘘患者共122例,并随机均分为A、B两组。其中A组采用保留括约肌挂线法,B组采用瘘管切除术,比较两组患者的近远期治愈率、愈合时间以及后遗症的发生情况。结果 两组患者分别采用保留括约肌挂线法和瘘管切除治疗后均达到治愈标准,近期治愈率及复发率两组间无统计学差异。术后情况,A组愈合时间为(20.74±5.62)天,B组为(19.19±6.84)天,P>0.05,组间无统计学差异,但A组中后遗症的发生率为3.28%,B组中的后遗症发生率为37.70%,χ²=14.182,P<0.05,A组中后遗症的发生率明显低于B组。结论 保留括约肌挂线法与瘘管切除术均能很好地治疗肛瘘,其中保留括约肌挂线法在保存肛门正常生理功能,减少术后后遗症发生等方面较后者有优势,值得临床推广。

Objective To observe the effect of sphincter preservation seton applied in complex anal fistulas treatment. Methods 122 cases of patients with complex anal fistulas treated from October 2010 to 2013 were selected and divided into A and B group randomly and equally. And sphincter preservation seton was applied in A group, while fistula resection applied in B group. The cure rate of short and long term, healing time and occurrence of sequel were compared. Results Standard cure was got in both groups, and there were no statistically significant difference between the cure rates and recurrence rates of short term in the 2 groups. Healing time in A group was (20.74±5.62) days, and (19.19±6.84) days in B group (P>0.05), and no statistically significant difference was between the 2 groups. Occurrence of sequel was 3.28% in A group, while 37.70% in B group, (χ²=14.182, P<0.05), and the occurrence of sequel in A group was much lower than that in B group. Conclusion Complex anal fistulas could be treated well by both sphincter preservation seton and fistula resection, and normal physiological function of anus could be better retained by sphincter preservation seton, and the superiority of reduction of postoperative sequelae was apparent by former surgical. It was worthy of clinical use.

目的 探讨经皮穴位电刺激对脑卒中偏瘫患者上肢运动功能的影响。方法 37例脑卒中患者随机分为TAES组(n=19)和安慰刺激组(n=18)。两组常规治疗相同。TAES组采用KD-2A型经皮神经电刺激治疗仪治疗,刺激部位选择患侧上肢的4个穴位(肩髃、曲池、外关、合谷),频率100 Hz,脉宽0.2 ms,强度以患者最大耐受强度为限;每天治疗1次,每次60 min,连续3周共15次;安慰刺激组接受治疗的部位、时间和疗程与TAES组相同,但每次治疗时没有电流输出。治疗前、治疗第2周、治疗第3周分别用上肢Fugl-Meyer评分和改良Barthel指数评分(MBI)评定上肢运动功能及日常生活活动能力。结果 治疗前,两组患者间的一般情况、FMA-UE 评分和MBI评分的比较差异无统计学意义(P>0.05)。经过治疗,两组患者的FMA-UE和MBI评分与治疗前比较均有改善(P<0.05);TAES组FMA-UE和MBI评分的改善较安慰刺激组明显(P<0.05)。结论 TAES治疗能够提高脑卒中患者上肢运动功能,提高生活自理能力。

Objective To investigate the effect of transcutaneous accupoint electrical stimulation (TAES) in enhancing upper limb function in subjects with stroke. Methods 37 subjects with first stroke were randomly assigned into 2 groups:TAES group(n=19) and placebo stimulation group(n=18). All subjects received the same standard rehabilitation. In the TAES group, Model KD-2A stimulator was applied with 0.2 ms pulses, at 100 Hz within the subject's tolerance level on the 4 acupuncture points (LI15, L I11, LI4, and SJ5) in the affected upper limb for 60 min, 5 days a week for 3 weeks; The time and the course of treatment of the placebo stimulation group were as well as the TAES group's, but no current output for each treatment. All subjects in the 2 groups received standard rehabilitation program. Measurements including Fugl-Meyer motor assessment (FMA-UE) and modified Barthel index(MBI) on affected side were recorded before treatment after 2 and 3 weeks' treatments. Results After 3 weeks treatments,the function scores on affected side of the two groups were improved significantly(P<0.05). And function scores of the TAES group were significantly improved than those of the placebo group (P<0.05). Conclusion Transcutaneous accupoint electrical stimulation significantly may improve the recovery of upper limb function.

目的 设计并验证适合Beckman AU5811全自动生化分析仪试剂针和搅拌棒的交叉污染分析方法,找到产生的原因并制定有效的污染避免措施。方法 以反应盘内圈项目(ALT、TBIL、GGT、ALB、TBA、LDH1、CK、Cr、GLU、CO2、TC、HDL-C、APOA1、Ca 、Fe、Cu、HCY 、AFU、PA)作为实验项目,按设计的检测顺序进行交叉污染实验,各项目间的污染率以不超过95%～105%为判断标准。结果 内圈项目中TC、HCL-C对TBA分别存在试剂针和搅拌棒的污染,Ca对Cr存在搅拌棒的污染,Cu对Fe存在试剂针的污染,GGT、ALB、LDH1对CO2都有搅拌棒的污染,TC、TBIL对Cu也存在搅拌棒的污染。结论 采用该方法能有效快速地对Beckman AU5811生化分析仪上的所有项目进行交叉污染实验,确定交叉污染产生的关联项目并采取污染避免措施减少交叉污染,保证检验结果的准确。

Objective To design and verify an analytical method for the cross contamination of Beckman AU5811 automatic biochemical analyzer's reagent needle and stir bar and find the reasons, and make effective measures to avoid contamination. Methods Use the inner ring items (ALT,TBIL,GGT,ALB, TBA,LDH1,CK,Cr,GLU,CO2,TC,HDL-C,APOA1,Ca,Fe,Cu,HCY,AFU,PA) as theexperiment objects and do the cross contamination experiment according to the test order. The standard for the cross contamination level is limited to 95-105% among all items. Results TC and HCL-C were found to have contaminated TBA both in reagent needle and stir bar model, Ca contaminated Cr in the stir bar model; Cu contaminated Fe in the reagent needle model; GGT,ALB and LDH1 contaminated CO2 in stir bar model; TC and TBIL contaminated Cu in the stir bar model. Conclusion The method used in this experiment can effectively identify and analyze the cross contamination of all the items in Beckman AU5811 automatic biochemical analyzer. In addition, it can help to adopt corresponding measures to reduce cross contamination.

目的 观察等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛的临床疗效。方法 将183例椎间盘源性腰痛患者随机分为对照组91例、治疗组92例,分别予综合疗法联合神经阻滞治疗、等离子消融髓核成形术联合神经阻滞治疗,观察两组患者治疗前后目测类比疼痛(Visual Analog Scale VAS)评分、改良Stauffer-Coventry评定系统术后日常活动及满意率等指标。结果 治疗组VAS评分和日常活动及满意率均优于对照组(P<0.05或P<0.001)。结论 等离子消融髓核成形术联合神经阻滞治疗椎间盘源性腰痛疗效显著,值得临床推广。

Objective To observe the effect of percutaneous low-temperature disk plasma ablation (PLDA) and nerve block(NB) on discogenic low back pain. Methods 183 patients were randomly divided into two groups: the control group (n=91) and the treatment group (n=92). Corresponding methods were used to treat everyone, to observe two groups VAS before and after the treatment, daily activities and satisfaction rate of improved Stauffer Coventry evaluation system etc. Results The VAS, daily activities and satisfaction rate of the treat group were distinctly more than that's of the control group (P<0.05 or P<0.001). Conclusion PLDA and NB has the therapeutic effects on the discogenic low back pain patients which is worth promoting.

目的 广州市卫生局高度重视北部山区卫生事业建设,开展了大型医院与乡镇卫生院的对口帮扶工作,目前省市大型医院对农村的地区的帮扶以疾病的诊治及设备支持为主,健康教育是一项投入少而效益大的保健措施,本文探讨大型医院针对农村地区的科学的、行之有效的教育健康的工作模式,建立农村卫生科普体系,全面提高人民群众总体健康水平和生活质量,有着重要的政治、经济及公共卫生学意义。

目的 对2010—2014年广州市越秀区食物中毒事件的流行病学特征进行分析,探讨引起食物中毒的危险因素并对其进行分析,为制定预防措施提供依据。方法 收集广州市越秀区五年内发生的13起食物中毒事件的资料,使用构成比、频数等对事件进行分析,按发生时间、致病因素、就餐场所等因素进行分析。结果 2010—2014年广州市越秀区共发生食物中毒13起,发病65例,住院7例,平均每起发病5例,罹患率8.17%,没有死亡病例。第四季为食物中毒高发季节,共5起(占38.46%)。微生物污染是主要致病因素,共11起(占84.62%),以副溶血性弧菌和金黄葡萄球菌为主。餐饮服务单位是食物中毒发生的主要场所,7起(占53.85%)。结论 针对广州市越秀区食物中毒高发季节、主要致病因素和发生场所等特点,应加强对餐饮业加工环节监督管理,加强餐饮从业人员的卫生知识培训,以减少食物中毒的发生。

目的 探讨糖化血红蛋白(HbA1c)联合超敏C反应蛋白(hs-CRP)在筛查妊娠期糖尿病(GDM)的临床意义。方法 选择2013年9月1日—2014年8月31日在我院妇产科孕期产前检查及分娩的孕妇,根据糖耐量试验(OGTT)、HbA1c和hs-CRP检查,筛查出92例孕妇为GDM组,并随机抽取OGTT正常的健康孕妇90例为NGT组,25例健康孕龄女性为对照组,分析3组FPG、HbA1c、hs-CRP及OGTT结果。结果 GDM组OGTT、HbA1c、hs-CRP高于NGT组和对照组,差异有统计学意义(P<0.01),NGT组与对照组比较,HbA1c、hs-CRP浓度差异无统计学意义(P>0.05),但3组FPG差异无统计学意义(P>0.05),Pearson相关分析显示,HbA1c与hs-CRP呈正相关(r=0.79,P<0.01)。结论 GDM患者HbA1c、hs-CRP水平升高,HbA1c联合hs-CRP可能成为GDM筛查的良好指标。

Objective To evaluate the feasibility of combination of glycosylated hemoglobin A1c(HbA1c) and high-sensitivity CRP in screening of gestational diabetes mellitus(GDM). Methods According to glucose tolerance test(OGTT),HbA1c and hs-CRP during 24~28 pregnant weeks,92 women with GDM (GDM group) and 90 normal pregnant women (NGT group) were enrolled in this study with another 25 women of child-bearing age as the control group. The results of FBG, OGTT, HbA1c and hs-CRP among three groups were analyzed. Results OGTT, HbA1c and hs-CRP level in GDM group were higher than that in NGT group and control group (P<0.05), but there were no significant differences of the level of FPG of 3 groups(P>0.05).Compare with NGT group and control group, There were no significant differences of the level of HbA1c and hs-CRP(P>0.05). Pearson correlation analysis showed that HbA1c had significant association with hs-CRP(r=0.79, P<0.01). Conclusion HbA1c and hs-CRP level in GDM group were increased, HbA1c combined with hs-CRP could be of some value in screening of GDM.

目的 了解广州地区儿童患者分离的社区获得性耐甲氧西林金黄色葡萄球菌(CA-MRSA)临床分离株的分子特征。方法 收集2009年—2014年我院分离获得的65株CA-MRSA临床分离株,PCR法检测杀白细胞素(PVL)基因阳性菌株,多位点基因序列类型(MLST)测定MRSA菌株的序列类型,多重PCR法对MRSA菌株进行葡萄球菌mec盒式染色体(SCCmec)分型。结果 65株CA-MRSA分离株中PVL基因阳性31株,阳性率47.69%;MLST分型表明以ST5933.84%(22/65)及ST8823.07%(15/65)为主;SCCmec分型中发现3种类型,分别为SCCmecⅡ 32.30%(21/65)、SCCmecⅣ 49.23%(32/65)及SCCmecⅤ 18.46%(12/65),未存在未能分型菌株。结论 广州地区儿童患者分离的CA-MRSA临床分离株的PVL基因阳性率相对较高,SCCmecIV型、V型可形成小范围内的流行,其基因表型存在多种ST分型。

Objective To investigate the molecular characteristic of Community-acquired Methicillin-resistant Staphylococcus aureus(CA-MRSA) isolates from pediatric patients in Guangzhou. Methods 65 non-duplicate strains of Community-acquired Methicillin-susceptible Staphylococcus aureus(CA-MSSA) isolated from our hospital in 2009-2014 were investigated. Panton-valentine leukocidin(PVL) gene was detected by polymerase chain reaction(PCR). The sequence type (ST) of each strain was determined by muhilocus sequence typing (MLST). The genotypes of staphylococcal cassette chromosome mec(SCCmec) of the CA-MRSA isolates were confirmed by multiplex PCR. Results Among 65 isolates of CA-MRSA, the positive rate of PVL genes was 47.69%(31／65). The most common MLST type was ST59 (n=22, 33.84%), followed by ST88 (n=15, 23.07%). Three SCCmec types were found. The most common type was SCCmecIV (49.23%, 32/65), followed by SCCmecⅡ (32.30%, 21/65) and SCCmecV (8.46%, 12/65). Conclusion The PVL gene-positive rate of CA-MRSA isolates in our hospitals is at a relatively high level. SCCmec type IV and SCCmec type V could spread among hospitals and cause a small scale epidemic. Their phenotypes have a variety of ST types.

目的 评估关节松动联合运动疗法对颞下颌关节慢性不可复性盘前移位患者的疗效。方法 采用随机对照方法,将46例慢性不可复性盘前移位患者随机分为联合治疗组(n=24)及对照组(n=22), 对照组仅接受传统治疗(包括超短波、超声波、软组织按摩及健康教育),治疗组在传统治疗的基础上应用关节松动联合运动疗法。在治疗前和治疗后2周采用最大张口度(maximal interincisal opening,MIO)、目测类比法(visual analog scale,VAS)、口腔健康影响程度量表(health impact profile-14,HIP-14)评价疗效。结果 治疗前两组患者一般情况类似。治疗后两组颞下颌关节MIO、VAS、HIP-14得分较治疗前改善(P<0.05),组间比较,治疗组在MIO、VAS、HIP-14评分比对照组改善(P<0.05)。结论 关节松动联合运动疗法治疗颞下颌关节慢性不可复性盘前移位疗效明显,值得推广。

Objective To evaluate the effectiveness of joint mobilization combined with therapeutic exercise in patients with chronic anterior disc displacement without reduction of temporomandibular joints. Methods 46 patients with chronic anterior disc displacement without reduction were randomly divided into two groups. The treatment group of 24 cases received joint mobilization combined with therapeutic exercise and conventional therapy (ultrashort-wave diathermy, ultrasound therapy, soft tissue massage, health education), 22 cases in the control group received conventional treatment.The treatment was administered for 2 weeks. The baseline and endpoint outcome assessment measures were maximal interincisal opening (MIO),visual analogue scale(VAS)score and oral health impact profile (HIP-14). Results After the treatment, significant improvements were observed in the two groups of all the outcome measurements (P<0.05).Maximal interincisal opening, visual analogue scale and oral health impact profile were improved significantly in the treatment group than in the control group (P<0.05). Conclusion Joint mobilization combined with therapeutic exercise can improve the symptoms of chronic anterior disc displacement without reduction.

目的 通过比较利伐沙班、依若肝素和非抗凝治疗对全膝关节表面置换术后的疗效,分析全膝关节置换术后抗凝治疗的必要性、有效性及安全性。方法 选取2010年1月—2013年8月我科收治的全膝关节表面置换术的患者154例,按治疗方式分成利伐沙班组(A组)、依若肝素钠组(B组)及非抗凝组(C组)。观察各组术后静脉血栓栓塞发生率;术前及用药后凝血功能指标的变化;术后总失血量、显性失血量、隐性失血量;伤口情况;膝关节功能HSS评分。结果 A组与B组术后无静脉栓塞症发生,C组出现静脉栓塞症3例;A、B、C三组术前与术后凝血功能指标差异均无统计学意义(P>0.05);B组术后显性失血量高于A组(P<0.05);三组患者术前及术后各回访时间点膝关节功能HSS评分差异无统计学意义(P>0.05)。结论 抗凝药物预防全膝关节置换术后静脉血栓栓塞症的效果确切,利伐沙班与依若肝素疗效相当;抗凝治疗不会增加术后失血量及伤口并发症的发生率,且对术后膝关节中期功能恢复无影响。全膝关节表面置换术后使用抗凝治疗效果良好,安全性可。

Objective To compare the influence of anticoagulant therapy on the curative effect after total knee arthroplasty and evaluate the necessity, effectiveness and safety of anticoagulant therapy. Methods 154 patients after total knee arthroplastyfrom January 2010 to August 2013 in our department were divided into the rivaroxaban group (group A), the enoxaparin group (B group) and non anticoagulation group (group C) according to the treatments. It was observed that the postoperative venous thromboembolism incidence; changes of blood coagulation indexes before and after the operation; the total blood loss、dominant blood loss and hidden hemorrhage; the wound; the HSS score of knee function. Results None of postoperative venous thromboembolism occurred in group A and B, three cases of venous thromboembolism in group C;The differences of between preoperative and postoperative coagulation indexes in three groups had no statistical significance (P>0.05); Dominant blood loss in group B was significantly higher than that of group A (P<0.05); No statistical significance in the HSS scores of knee function of three group (P>0.05). Conclusion The effect of anticoagulant drugs on the prevention of venous thromboembolism after total knee arthroplasty is effective, same efficacy in the treatment with rivaroxaban or enoxaparin; anticoagulant therapy does not significantly increase the postoperative blood loss and the incidence of wound complications, does not influence the recovery of postoperative mid-term knee function. The use of anticoagulation therapy after total knee arthroplasty has good effect and be safety.