目的 探讨颈动脉残端压(SP)联合电生理监测在颈动脉内膜切除术(CEA)中的应用价值。方法 回顾性分析19例CEA患者临床资料,通过监测SP、体感诱发电位(SEP)和运动诱发电位(MEP),以确定术中是否放置转流管;比较术前和术后6月美国国立卫生院卒中量表(NIHSS)评分和改良Rankin量表(mRS)评分变化情况。结果 10例患者SP≥50mmHg,SEP和MEP监测无异常,术中未放置转流管;5例患者SP<50 mmHg,SEP波幅下降>50％,MEP监测正常,予以放置转流管;3例患者SP≥50 mmHg,SEP波幅下降>50％,MEP监测正常,予以放置转流管;1例患者SP>50 mmHg,SEP监测正常,MEP波幅下降>50％,未放置转流管。所有患者手术均获得成功,无手术死亡率。患者术后6月NIHSS评分和术前无统计学差异(P>0.05),但术后6月mRS评分较术前下降(P<0.05)。结论 通过术中SP、SEP和MEP联合监测,有助于避免CEA术后缺血性脑卒中的发生,提高CEA手术的安全性。

Objective To investigate the value of stamp pressure(SP), somatosensory and motor evoked potentials(SEP,MEP) monitoring in carotid endarterectomy. Methods 19 patients with carotid endarterectomy were retrospectively analyzed.SP, SEP and MEP were monitored during the operation.National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (mRS) were used to evaluate the neurological function before and 6 months after surgery. Results Intraluminal shunting was not performed in 10 patients with normal SP, SEP and MEP.However, intraluminal shunting technique was used in 5 patients (SP<50 mmHg and SEP fluctuation decreased by 50％) and 3 patients (SP≥50 mmHg and SEP fluctuation decreased by 50％).1 patient showed the fluctuation of MEP decreased by 50％, while SP and SEP was normal, no shunting was performed.All patients were successfully operated, and no mortality occurred.The mRS score, not the NIHSS score, revealed statistically difference between preoperation and 6 months after surgery (P<0.05). Conclusion The combination of SP, SEP and MEP monitoring maybe useful for preventing ischemic stroke after carotid endarterectomy, increasing the safety of surgery.

目的 比较脂溶性高杉尖三酯碱(HHRT)与水溶新丝裂霉素C(MMC)和5-氟尿嘧啶(5-Fu)三种药物对人Tenon's囊成纤维细胞(HTFs)增殖率的抑制情况。方法 采用冻存的人眼Tenon's囊成纤维细胞,常规复苏体外培养稳定后,接种于96孔板,分别加入不同浓度HHRT、MMC及5-Fu,继续培养;采用MTT法于加药后24 h、48 h、72 h检测不同浓度HHRT、MMC及5-Fu对体外培养的人眼Tenon囊成纤维细胞增值率的抑制情况。结果 一定浓度的HHRT、MMC及5-Fu,对HTFs的抑制作用呈现不同的剂量和时间依赖性,在药物浓度达到相应程度作用72 h后三者对HTFs的最大抑制率均可达70%以上,且组间对比差异有统计学意义。结论 三种药物均对人眼Tenon's囊成纤维细胞增殖具有明显抑制作用,其最大抑制率均可达70%以上,三种药物对成纤维细胞抗增殖效应的时间浓度依赖性有所差别。

Objective To investigate and compare the inhibitory effects of Mitomycin C(MMC), 5-Fluorouracil(5-Fu) and Homoharringtonine(HHRT) on cultured Human Tenon's fibroblasts(HTFs) proliferation. Methods Fibroblasts were recovered and cultured from cell bank.Fibroblasts were treated with different concentration of MMC, 5-Fu and HHRT for 48h and 72h respectively. The proliferation of fibroblasts was detected using MTT assay. Results Fibroblasts were cultured in MMC, 5-Fu or HHRT demonstrated a dose-dependent and time-dependent inhibition of fibroblasts proliferation.The maximum inhibition rate was found when HTFs were treated with different concentration of MMC, 5-Fu or HHRT for 72h. And the three agents maximum inhibition rates were all more than 70%. The differences of proliferation in control and treated groups was statistically significant(P<0.01). Conclusion The three agents had inhibitory effect on HTFs. And the three agents maximum inhibition rates were all more than 70%. The inhibitory effects of MMC,5-Fu and dexamethasone on fibroblast proliferationwas MMC>HHRT>5-Fu.

本文从康复治疗学专业课程体系、实践教学、学生创新能力和职业素养的培养、考核体系四个方面对康复治疗学本科人才培养模式的构建进行探讨,以期为丰富康复治疗学专业教学实践提供思路。

This paper is to investigate the construction of undergraduate educational talent cultivation mode of rehabilitation therapeutics from the following aspects: Curriculum system, practice teaching, cultivating students' innovative ability and professional quality and the assessment system, aimed to provide a reference for rehabilitation therapeutics teaching practice.

目的 了解佛山市南海区美沙酮治疗门诊重入组维持治疗患者与长期维持治疗患者的治疗依从性。方法 选择佛山市南海区第五人民医院美沙酮治疗门诊自2007年12月—2013年12月30日的全部重入组治疗者作为研究组,同时选择部分长期维持治疗者作为对照组。对全部研究对象通过查阅社区门诊美沙酮维持治疗管理系统及问卷调查获取患者资料。结果 MMT重入组患者与长期维持治疗患者的职业状况、经济来源、居住情况之间的差异有统计学意义(P<0.05);重入组MMT治疗者与对照组相比,无业/待业的比例较大(88.7% vs 73.3%),多数为独居(26.1% vs 5.3%);而对照组MMT治疗者的经济来源大多来自家庭朋友供给(85.3%)。两组患者首次吸毒年龄和吸毒方式的分布之间存在差异(P<0.05)。重入组MMT治疗者与对照组相比,患者的首次吸毒年龄主要集中在20~30岁,占61.4%;重入组患者注射吸毒比例更高。重入组在治者的服药剂量低于对照组;且重入组在治者的服药参与率、尿检参与率均低于对照组,而重入组在治者的尿检阳性率低于对照组。结论 MMT门诊患者中重入组者占较大比例,重入组在治MMT患者的服药依从性较长期维持治疗患者差。

目的 分析丁苯酞软胶囊联合疏血通治疗急性脑梗死的临床效果。方法 随机抽取我院近几年来收治的急性脑梗死患者87例,按照患者治疗方式分为两组,两组患者均予以常规治疗,对照组43例在此基础上以疏血通治疗,治疗组44例患者在此基础上以丁苯酞软胶囊联合疏血通治疗,对比两组患者治疗效果。结果 治疗组临床疗效总有效率较对照组临床疗效总有效率提高18.8%,两组患者治疗后NIHSS评分较治疗前降低,治疗组治疗后NIHSS评分较对照组低,心理健康、社会功能、精神功能及日常能力较对照组相比,P<0.05。两组患者治疗前后未发生肝肾功能异常情况,无出血等不良反应。结论 丁苯酞软胶囊联合疏血通治疗急性脑梗死具有效果,可改善患者神经功能缺损,临床价值确切。

目的 探讨脑梗塞与雌激素及高同型半胱氨酸血症之间的相关性。方法 纳入我院2013年1月—2014年11月确诊为脑梗塞的患者100例,正常对照的健康体检者100例,比较两组患者的血浆高同型半胱氨酸和雌激素水平。结果 脑梗死患者的血浆同型半胱氨酸水平高于正常组,两组比较差异有统计学意义(P＜0.05);高同型半胱氨酸血症脑梗塞组为72例,正常组为18例,两组比较差异有统计学意义(P＜0.05);同型半胱氨酸的阳性率男性为92%,女性为44%,男性患者高于女性,(P＜0.05);脑梗塞组雌激素水平降低,脑梗塞和雌激素水平呈负相关(P＜0.05),有糖尿病和酗酒的患者E2水平低于无糖尿病和酗酒的E2水平,差异有统计学意义(P＜0.05)。结论 急性脑梗塞患者同型半胱氨酸水平高于正常组,雌激素水平低于正常组,高同型半胱氨酸血症是脑梗死的重要危险因素,雌激素为脑梗塞患者的保护性因素。

目的 探讨术中控制性减压对儿童重型颅脑损伤的治疗作用。方法 122例儿童重型颅脑损伤需要开颅手术减压患者,术中随机分成控制性减压手术研究组(60例)和常规手术治疗对照组(62例)进行治疗,观察两组患者术后脑梗死的发生率及预后。结果 研究组术后脑梗塞发生率为6.7％(4例),低于对照组的17.7％(11例)(P<0.05);术后6个月采用GOS标准进行预后判定,治疗组不良预后(重残、植物状态、死亡)有9例占15.0%,低于对照组的23例(37.1%)(P<0.05)。结论 术中采用控制性减压能减少儿童重型颅脑损伤患者术后脑梗塞的发生率及明显改善患者的预后。

Objective To investigate the clinical efficacy of intraoperative controlling decompression in treating of severe craniocerebral injuries in children. Methods 122 cases of severe craniocerebral injuries in children who needed surgical decompression by craniotomy were randomly divided into control decompression surgical group(60 cases)and conventional surgical group(62 cases).The incidence of postoperative cerebral infarction and the outcome according to GOS scores after 6 months were observed in two groups. Results The incidence of postoperative cerebral infarction was 6.7% in controlling decompression surgical group and 17.7% in conventional surgical group. The differences between two groups were statistical significant(P<0.05); The all poor prognosis patients(severely disabled, vegetative state and death) were 9 cases in controlling decompression surgical group and 23 cases in conventional surgical group. The differences between two groups were statistical significant(P<0.05). Conclusion Intraoperative controlling decompression can significantly reduced the incidence of postoperative cerebral infarction and improved the poor prognosis patients of severe craniocerebral injuries in children.

目的 评价自我管理小组干预对社区2型糖尿病患者的管理效果。方法 在2013年底选取本区社区卫生服务中心100例患者研究,运用自身对照方法,管理1年后对其自我管理效能、生化指标、空腹血糖、糖化血红蛋白进行比较。结果 管理一年后饮食控制、运动控制、药物依从性、监测依从性、足部护理等指标差异有统计学意义(P<0.05)。空腹血糖、糖化血红蛋白、总胆固醇、尿酸下降,差异有统计学意义(P<0.05)。空腹血糖达标率由12%上升到37%,糖化血红蛋白达标率由10%上升到34%,差异有统计学意义(P<0.05)。结论 自我管理小组干预提高了社区2型糖尿病患者自我管理水平,改善了主要的生化指标,值得社区推广应用。

Objective To evaluate the function of self-management group program on patients with type 2 diabetes in community. Methods Self-management was carried out for one year among 100 patients with type 2 diabetes, the effect of management was analyzed. Results There was statistically significant difference in diet control, motion control, drug compliance, monitoring compliance, and foot care after one year intervention (P<0.05). GLU, HbA1c, CHOL, UA were decreased. The difference was statistically significant (P<0.05). Conclusion Self-management of group intervention is effective in patients with type 2 diabetes, is worthy of further popularization and application.

目的 对出生缺陷知信行健康教育模式效果进行策略分析与探讨,为进一步完善围产期保健服务及健康教育工作提供合理化建议。方法 采用《孕期妇女出生缺陷基本知识知晓率专题测评问卷》并结合实际情况设定有关信念、行为方面的7个问题,对2011年1月—2013年6月期间在中心孕妇学校参加健康教育活动课堂的孕妇进行调查,并应用决策树模型对中心现有的出生缺陷知信行健康教育模式效果进行探讨。结果 预防出生缺陷知识方面,对初高中及中专文化程度的孕期妇女加强出生缺陷预防知识健康教育的预期收益合计达到51.2%,可作为重点目标人群;预防出生缺陷信念方面,主要决定因素是户籍类型和年龄,加大对本地户籍及25岁以上流动妇女人群的健康教育,促进孕期妇女树立预防出生缺陷信念的预期收益累计达95.9%;预防出生缺陷行为方面,主要影响因素是产检医生的嘱咐,受到嘱咐的孕期妇女预期收益为62.3%。结论 为了达到出生缺陷防治目标与健康教育整体效果的提高,应将预防出生缺陷的健康教育工作重点放在初高中及中专文化程度人群,本地户籍孕期妇女和25岁以上流动性孕期妇女又是需要树立预防出生缺陷信念的重点人群,强化产检医生的嘱托义务是提高孕期妇女出生缺陷知信行健康教育模式效果的有力保证。

Objective To identify factors related to the knowledge, attitude and practice KAP of birth defects prevention among pregnant women, and provide reasonable suggestions to improve perinatal health services and health education. Methods Using cluster sampling method, 5500 participants from pregnant women school were enrolled. Information on “awareness of basic knowledge of birth defects” and 7 questions about attitudes and practice to participant actual situation was gathered through personal interviews using a structured questionnaire. The related factors were analyzed by classification tree model of SPSS 19.0. Results As to birth defects related knowledge, prospective return was more than 50% in the pregnant women with junior, senior high school and technical secondary school education level. As to birth defects prevention faith, the main determinant was census register types; prospective return of pregnant women who were local permanent residents and floating population aged ≥25 years was 95.9%. The main influencing factor of practice was prenatal doctor's education; prospected return was 62.3% after strengthening the health education of prenatal doctor. Conclusion In order to improve birth defects education effect, pregnant women who have junior, senior high school and technical secondary school education level and are local permanent residents or floating population aged ≥25 years should be key targeted population. Prenatal doctor's health education will be a powerful guarantee.

目的 观察术前宣教对支撑喉镜喉肿物摘除患者全麻苏醒期的影响。方法 选择择期支撑喉镜喉肿物摘除全身麻醉手术的患者72例。随机分成两组进行效果对比,一组为接受常规护理的对照组,另一组为本次接受术前宣教观察组。分别对两组患者术后苏醒期躁动发生情况、心血管变化及配合性进行对比。结果 观察组患者通过术前宣教,有效减少全麻苏醒期患者躁动相关情况的发生,其心率、血压水平也较稳定,与对照组相比较差异有统计学意义(P<0.05);两组患者配合性相比较,差异有统计学意义(P<0.05)。结论 对支撑喉镜喉肿物摘除行全麻手术的患者进行术前宣教护理,可以有效减少苏醒期患者躁动的发生率,减轻气管拔管对心血管影响。提高整体治疗护理效率,达到更高的满意度,该方法切实可行,值得临床广泛运用。

Objective To obeserve the effect of preoperative education on the recovery period of general anesthesia after suspension laryngoscopic surgery. Methods Seventy-two adult patients undergoing suspension laryngoscopic surgery were randomly divided for the effect contrast.Routine nursing were adopted for control-group while the only difference for the observation group was the preoperative education. The occurrence of emergence agitation, hemodynamic, and compliance degree were compared between the two groups. Results Through preoperative education,observation group can significantly reduce the occurrence of agitation effectively and keep hemodynamics more stable than control group.Moreover,the compliance degree in two groups also has statistical significance (P<0.05). Conclusion Preoperative education can succeed in reducing the incidence of emergence agitation,inhibiting the responses to endotracheal extubation after suspension laryngoscopic surgery. Thus, preoperative education is feasible to enhance the overall effectiveness of treatment and nursing care. It is worth in popularization and application in clinical practice.