目的 针对胆结石手术患者,评价应用快速康复外科(ERAS)理念辅助护理的实践效果,同时分析其对患者术后并发症以及机体康复情况的影响。方法 选取本院在2019年8月—2020月5月间收治的84例胆结石手术患者为研究对象,采取随机数字表法对纳入患者进行随机分组:实施常规护理干预的患者作为本研究的对照组,实施快速康复外科护理干预的患者作为本研究的干预组;对比术后患者并发症发生情况及恢复情况。结果 干预组患者术后拔管、首次肛门排气、排便及住院时间较对照组均有缩短(P<0.05);且干预组穿孔、感染、胰腺炎等总并发症发生几率低于对照组(2.38% vs 14.28%,P<0.05)。结论 在护理胆结石手术患者中,采取快速康复外科护理干预可有效预防多种术后并发症的发生,并能够有效加快患者术后康复进程,建议推广。

Objective To evaluate the practical effect of assisted nursing with the concept of enhanced recovery after surgery (ERAS) for patients underwent cholelithiasis surgery, and analyze its impact on postoperative complications and physical rehabilitation. Methods Eighty-four patients underwent cholelithiasis operation in our hospital from August, 2019 to May,2020 were selected as the research objects, and the patients were randomly divided into two groups by random number table. The control group was given routine nursing intervention, while the observation group was given nursing intervention based on ERAS.The postoperative complications incidence and recovery of patients were compared. Results Data showed that the postoperative extubation time, first anal exhaust, defecation time and hospitalization time in the observation group were significantly shorter than those in the control group (P<0.05). The total incidence of complications in the observation group was significantly lower than that in the control group (2.38% vs 14.28%, P<0.05). Conclusions In nursing patients undergoing cholelithiasis surgery, ERAS nursing intervention can effectively prevent the occurrence of a variety of postoperative complications, and can effectively speed up the process of postoperative rehabilitation, which is recommended to popularize.

目的 观察龙氏正骨手法配合浮针临床上治疗颈源性头痛的疗效。方法 将本院80例颈源性头痛患者按1:1随机分为观察组和对照组,观察组采用龙氏正骨手法配合浮针治疗,对照组采用龙氏正骨手法治疗,于1疗程后比较2组临床疗效、疼痛视觉模拟评分(VAS)和颈椎活动度评分(ROM)情况。结果 治疗后两组VAS较治疗前均有改善(P<0.05),观察组较对照组明显(P<0.05)。2组ROM较治疗前均有改善(P<0.05),组间差异无统计学意义(P>0.05)。治疗组的愈显率高于对照组(P<0.05)。结论 龙氏正骨手法配合浮针治疗颈源性头痛能更好地减轻疼痛程度,方便高效。

Objective To observe the clinical effect of Long's bone-setting manipulation combined with floating acupuncture therapy on cervicogenic headache. Methods A total of 80 patients with cervicogenic headache in our hospital were randomly divided into observation group and control group evenly. The observation group was treated with Long's bone-setting manipulation combined with floating acupuncture therapy, and the control group was treated with Long's bone-setting manipulation only. After one course of treatment, the clinical efficacy,pain visual analogue score (VAS) and cervical joint range of motion (ROM) in the two groups were compared. Results After treatment, the VAS of the two groups was improved compared with that before treatment (P<0.05), and the VAS of the observation group was significantly higher than that of the control group (P<0.05). ROM in the two groups was improved compared with that before treatment (P<0.05), and there was no significant difference between the two groups (P>0.05). The effective rate of the treatment group was higher than that of the control group (P<0.05). Conclusions Long's bone-setting manipulation combined with floating acupuncture therapy in the treatment of cervicogenic headache can better reduce the degree of pain, which is convenient and efficient.

目的 探讨胰岛素联合乌司他丁在高脂血症性重症胰腺炎中的临床疗效。方法 研究资料来自广州市花都区人民医院肝胆胰外科自2018年—2020年收治的72例高脂血症性重症胰腺炎患者资料,所有患者按照不同治疗方案随机分为3组,每组各24例。对照组采用急性胰腺炎常规治疗(即生长抑素+液体疗法);乌司他丁组则于常规组上联用乌司他丁;而研究组在常规及联合乌司他丁治疗基础上加用胰岛素强化治疗,比较3组患者腹痛及胃肠功能恢复的时间、甘油三酯下降的水平,治疗前、治疗后第3天、7天的APACHE Ⅱ评分的变化情况。结果 研究组患者腹痛症状缓解及胃肠功能恢复时间均较对照组明显缩短、腹痛症状缓解时间较乌司他丁组缩短,且研究组甘油三酯下降水平较对照组和乌司他丁组快,而研究组第3天和第7天的APACHE-Ⅱ评分较常规组及乌司他丁组低,以上差别均有统计学意义(P<0.05)。结论 胰岛素联合乌司他丁可明显改善高脂血症合并重症急性胰腺炎腹部症状、缩短胃肠功能恢复时间、迅速降低血清甘油三酯水平,对患者近期疗效确切。

Objective To explore curative effect of insulin combined with ulinastatin in therapy of severe hyperlipidemic pancreatitis. Methods A total of 72 patients with hyperlipidemia complicated with severe acute pancreatitis were randomly divided into three groups according to different treatment plans, 24 cases in each group. The regular treatment of acute pancreatitis (somatostatin+liquid therapy) was carried out in control group. Base on the regular treatment of acute pancreatitis, ulinastatin was added in ulinastatin group. Base on the treatment of ulinastatin group, insulin was added in study group, and the time of abdominal pain and gastrointestinal function recovery, glycerin level and the APACHE Ⅱ score before and after treatment among three groups were compared. Results Compared with the control group and ulinastatin group, the time of abdominal pain relief and gastrointestinal function recovery in the study group were significantly shorter, the time of triglycerides level back to normal in the study group was shorter than the other two groups, while at the third and seventh day, the APACHE Ⅱ score of the study group was lower than that of other two groups, with statistical significance (P<0.05). Conclusions Insulin combined with ulinastatin could significantly improve abdominal symptoms of hyperlipidemia complicated with severe acute pancreatitis, promote the recovery of gastrointestinal function, and rapidly reduce the level of serum triglyceride.

目的 探讨自拟补肝益肾壮腰汤联合脊柱推拿、牵引对腰椎间盘突出症(LDH)患者肌电图和腰椎功能的影响及临床效果。方法 选取106例LDH患者采用随机数字表法分为观察组和对照组各53例。对照组行脊柱推拿及牵引治疗,观察组在此基础上加用自拟补肝益肾壮腰汤。记录2组患者治疗前及治疗3个月后的腰椎功能程度[Oswestry功能障碍指数(ODI)]、肌电图[平均功率频率(MPF)、中位频率斜率(MFs)、平均肌电波幅(AEMG)]、运动功能障碍程度[日本骨科协会下腰痛量表(JOA)]及疼痛程度[视觉模拟评分法(VAS)]评估结果差异。结果 治疗3个月后,2组JOA评分、VAS评分及各项肌电图参数(MPF、MFs、AEMG)均较治疗前有提升,且观察组均高于对照组(P均＜0.05);ODI评分则较治疗前下降(P均＜0.05),且观察组低于对照组(P＜0.05)。结论 自拟补肝益肾壮腰汤联合脊柱推拿及牵引能明显改善LDH患者腰椎功能,促进肌力恢复、缓解肌肉疲劳、减轻疼痛,有较高的临床实用价值。

Objective To investigate the effect of self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction on electromyography and lumbar function and clinical efficacy in patients with lumbar disc herniation (LDH). Methods A total of 106 patients with LDH were randomly divided into observation group and control group. The control group was treated with spinal massage and traction, and the observation group was treated with self-made Bugan Yishen Zhuangyao decoction on this basis. The degree of lumbar spine function [Oswestry disability index (ODI)], electromyography [mean power frequency (MPF), median frequency slope (MFS), average EMG amplitude (AEMG)], the degree of motor dysfunction [Japanese Orthopaedic Association (JOA) score] and the degree of pain [visual analog scale (VAS)] before and 3 months after treatment were recorded and compared. Results After 3 months of treatment, JOA score, VAS score and EMG parameters (MPF, MFS and AEMG) in the two groups were significantly higher than those before treatment, and those in the observation group were higher (P<0.05); ODI score was significantly lower than that before treatment (all P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusions The self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction can significantly improve the lumbar function of patients with LDH, promote the recovery of muscle strength, relieve muscle fatigue and pain, and with high clinical practical value.

目的 探讨左卡尼汀联合生脉注射液对维持性血液透析低血压心脏功能的影响。方法 选取我院2016年1月—2020年2月收治的维持性血液透析反复低血压患者120例,随机分为对照组(n=40)、左卡尼汀组(n=40)和联合组(n=40)。3组均采用常规治疗,左卡尼汀组加用左卡尼汀,联合组加用左卡尼汀联合生脉注射液。分析3组治疗前后低血压发生率、血压指标、心肌酶谱、心肌梗死定量指标及超声心动图指标变化。收集3组治疗过程中发生不良反应情况。结果 联合组低血压发生率低于对照组和左卡尼汀组(P＜0.05);联合组治疗后透析中最低收缩压、透析中平均动脉压、透析后收缩压、透析后平均动脉压均高于对照组和左卡尼汀组(P＜0.05);联合组治疗后心肌谱酶、心肌梗死定量指标均低于对照组及左卡尼汀组(P＜0.05);3组治疗前后肺动脉收缩压、右室壁舒张末期厚度、右室舒张末期内径、左室舒张末期内径、右室收缩末期面积、右室舒张末期面积差异无统计学意义(P＞0.05);联合组治疗后左室射血分数高于对照组和左卡尼汀组(P＜0.05);3组不良反应发生率差异无统计学意义(P＞0.05)。结论 左卡尼汀联合生脉注射液可降低维持性血液透析患者低血压的发生率,改善患者心功能,具有较好的疗效及安全性。

Objective To investigate the effect of L-carnitine combined with Shengmai Injection on cardiac function in patients with maintenance hemodialysis hypotension. Methods A total of 120 maintenance hemodialysis patients with recurrent hypotension in our hospital from January 2016 to February 2020 were randomly divided into control group (n=40), L-carnitine group (n=40) and combination group (n=40). The three groups were treated with conventional treatment, L-carnitine group was added with L-carnitine, and the combination group was given levocarnitine combined with Shengmai Injection. The incidence of hypotension, blood pressure index, myocardial enzyme spectrum, quantitative index of myocardial infarction and echocardiography index were obtained and analyzed before and after treatment. The adverse reactions in the three groups were collected. Results The incidence of hypotension in combination group was lower than that in control group and L-carnitine group (P<0.05). After treatment, the minimum systolic blood pressure, mean arterial pressure during dialysis, systolic blood pressure after dialysis and mean arterial pressure after dialysis in the combination group were higher than those in the control group and L-carnitine group (P<0.05). After treatment, the myocardial spectrum enzyme and myocardial infarction quantitative indexes in the combination group were lower than those in the control group and L-carnitine group (P<0.05). There were no significant differences in pulmonary artery systolic pressure, diastolic right ventricular wall thickness, diastolic right ventricular width, diastolic left ventricular width, systolic right ventricular area and diastolic right ventricular area among the three groups before and after treatment (P>0.05). The left ventricular ejection fraction of the combination group was higher than that of the control group and L-carnitine group (P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusions L-carnitine combined with Shengmai Injection could reduce the incidence of hypotension in maintenance hemodialysis patients, improve the cardiac function, with good efficacy and safety.

目的 探讨在早期早产儿配方奶(PF)喂养失败下,更换母乳(HM)或深度水解奶(eHF)对极低出生体质量儿喂养不耐受(FI)的改善情况。方法 选择2016年1月—2018年1月在广州市妇女儿童医疗中心出生、生后PF喂养失败、出现FI的极低出生体质量儿84例,根据家长HM喂养意愿及条件,分为HM喂养组38例和eHF喂养组46例,比较2组患儿更换喂养配方后FI消失时间、FI改善率、达全肠内喂养时间及体质量增长情况等喂养结局。结果 相对于eHF喂养组,HM喂养组FI消失时间更快,FI改善率更高,达全肠内喂养时间更快,差异有统计学意义。HM喂养组平均每日体质量增长量、出院时体质量均明显大于eHF喂养组,住院时间更短,出院时宫外发育迟缓(EUGR)发生率更低,差异有统计学意义。2组患儿坏死性小肠结肠炎、胆汁淤积症、院内感染发生率比较无统计学差异。结论 当极低出生体质量儿PF喂养失败、出现FI时,选择HM或eHF均可改善FI,但HM效果更好,达全肠内喂养时间更快且体质量增长更理想,出院时EUGR发生率较低。

Objective To investigate the improvement of feeding intolerance (FI) by changing human milk (HM) or extensively hydrolyzed formula(eHF) after failure of preterm formula (PF) feeding in very low birth weight (VLBW) infants. Methods Eighty-four VLBW infants who were born in Guangzhou Women and Children's Medical Center from January 2016 to January 2018 with PF feeding failure and FI were divided into HM feeding group (n=38) and eHF feeding group (n=46) according to their parents' HM feeding willingness and conditions.The time of FI disappearance, FI improvement rate, total enteral feeding time and weight gain were compared between the two groups after changing feeding formula. Results Compared with the eHF feeding group, the disappearance time of FI, the time of getting total intestinal feeding in the HM feeding group were shorter, and the improvement rate of FI was higher,the differences were statistically significant.The average daily weight increase and discharge weight of the HM feeding group were significantly more than those of the eHF feeding group, and the length of hospital stay, the incidence of extrauterine growth retardation(EUGR) at discharge were lower, the differences were statistically significant.There was no significant difference in the incidence of necrotizing enterocolitis, cholestasis and nosocomial infection between the two groups. Conclusions In the case of failure of PF feeding and FI in VLBW infants, both HM and eHF could ameliorate FI, but HM had a better effect, with a shorter time of getting total intestinal feeding, better weight gain and a lower incidence of EUGR at discharge.

目的 研究羌活胜湿汤对风湿外感头痛患者的疗效。方法 选择2018年1月—2020年12月我院收治的62例风湿外感头痛患者,随机分为2组。对照组服用5 mg的氟桂利嗪胶囊,每晚1次;观察组联用羌活胜湿汤。比较2组风湿外感头痛患者的有效率,治疗前后的睡眠质量评分和视觉模拟评分法(VAS)评分。结果 观察组风湿外感头痛患者的有效率(96.77%)高于对照组(80.64%) (P<0.05);治疗前,2组风湿外感头痛患者的VAS评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的VAS评分降低(P<0.05),且观察组风湿外感头痛患者的VAS评分更低(P<0.05);治疗前,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分无差异(P>0.05),治疗后,2组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分降低(P<0.05),且观察组风湿外感头痛患者的夜间苏醒、入睡时间、睡眠深度、早醒、白天情绪、梦境情况、气色和白天身体状况评分低于对照组(P<0.05)。结论 羌活胜湿汤对风湿外感头痛患者有显著的疗效,与其能明显减轻疼痛程度和改善睡眠质量有关。

Objective To investigate the effect of Qianghuo Shengshi decoction on patients with wind-damp headache. Methods A total of 62 cases of patients with wind-damp headache who were treated in our hospital from January 2018 to December 2020 were selected and divided into two groups randomly. The control group took 5 mg of flunarizine capsules once a night; the observation group took Qianghuo Shengshi decoction additionally. The effective rate, sleep quality score and visual analogue scale(VAS) score before and after treatment were compared between the two groups of patients. Results The effective rate of the observation group (96.77%) was significantly higher than that of the control group (80.64%, P<0.05). Before treatment, the VAS scores of the two groups of patients with exogenous wind-damp headache were not significantly different (P>0.05). After treatment, the VAS scores of the two groups were significantly reduced (P<0.05), and the score drop of the observation group was significant (P<0.05). Before treatment, there were no significant differences in night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition score between the two groups (P>0.05), after treatment, the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in both groups were significantly decreased (P<0.05), and the scores of night awakening, sleep time, sleep depth, early awakening, daytime mood, dream condition, complexion and daytime physical condition in patients with wind-damp headache in the observation group were significantly lower than those in the control group (P<0.05). Conclusions Qianghuo Shengshi decoction had a significant effect on patients with wind-damp headache, and its was related to its ability of significant pain reduction and sleep quality improvement.

目的 探究空心加压螺钉(CCS)和股骨颈系统(FNS)两种不同的内固定方法治疗60岁以下患者股骨颈骨折的疗效。方法 回顾性研究2018年1月—2019年9月期间在我院接受内固定手术治疗的100例股骨颈骨折患者,根据内固定方式不同,分为FNS组(观察组)和CCS组(对照组),比较2组患者的术后并发症、围手术期特征;并在手术前和手术后1年使用Harris髋关节评分(HHS)评估关节功能。结果 2组患者中,观察组的手术时间和围手术期出血量均大于对照组(P<0.05);术后观察组的骨愈合时间低于对照组,且观察组股骨颈短缩程度也低于对照组(P<0.05);观察组螺钉切除发生率以及术后并发症总发生率均低于对照组(P<0.05)。结论 年龄小于60岁的股骨颈骨折患者通过CCS或FNS治疗可以获得满意的临床效果。 FNS 具有优异的生物力学性能,并显示出更高的整体结构稳定性。

Objective To explore the curative effect of two different internal fixation methods, cannulated compression screw (CCS) and femoral neck system (FNS), in the treatment of femoral neck fractures in patients under 60 years old. Methods Retrospectively studied 100 patients with femoral neck fractures who underwent internal fixation surgery in our hospital from January 2018 to September 2019. According to different internal fixation methods, they were divided into FNS group (observation group) and CCS group (control group). The postoperative complications and perioperative characteristics of the two groups of patients were compared, and the Harris Hip Score (HHS) was used to assess joint function before and 1 year after the operation. Results In the two groups of patients, the operation time and perioperative blood loss of the observation group were more than those of the control group (P<0.05); the bone healing time of the observation group was shorter than that of the control group, and the degree of femoral neck shortening in the observation group was also lower than the control group (P<0.05); the incidence of screw resection and the total incidence of postoperative complications in the observation group were lower than those in the control group (P<0.05). Conclusions Patients with femoral neck fractures under 60 years old could obtain satisfactory clinical results through CCS or FNS treatment. FNS had excellent biomechanical properties and showed significantly higher overall structural stability.

目的 对腹腔镜子宫肌瘤切除术围手术期应用抗菌药物的情况进行回顾性分析,并分析腹腔镜子宫肌瘤切除术围手术期感染的影响因素。方法 选择2018年5月—2021年5月在我院行腹腔镜子宫肌瘤切除术的患者72例进行回顾性分析。收集患者一般资料及抗生素使用情况,根据有无术后感染将患者分为2组,比较2组患者上述各资料,并采用多因素分析法判断各因素对腹腔镜子宫肌瘤切除术后感染的综合作用。结果 本次纳入的72例腹腔镜子宫肌瘤切除术患者共有16例出现术后感染,术后感染率为22.22%。多因素Logistic回归分析结果显示:年龄≥50岁、手术时间≥60 min、合并糖尿病为腹腔镜子宫肌瘤切除术围手术期感染的危险因素,预防性使用抗生素、术前≤2 h抗生素使用、术后抗生素使用≤48 h为保护性因素(P<0.05)。结论 腔镜子宫肌瘤切除术患者术后感染率为22.22%,抗菌药物使用时机及使用时间对腹腔镜子宫肌瘤切除术患者术后感染有重要的影响,此外患者年龄、手术时间、合并糖尿病情况也与患者术后感染有关。

Objective To retrospectively analyze the perioperative application of antibacterial drugs during laparoscopic myomectomy, and to analyze the influencing factors of infection during the perioperative period of laparoscopic myomectomy. Methods Seventy-two patients who underwent laparoscopic myomectomy in our hospital from May 2018 to May 2021 were selected for retrospective analysis. The patients were divided into two groups according to postoperative infection status. The above data were compared between the two groups, and the comprehensive effects of various factors on postoperative infection after laparoscopic myomectomy were determined by multivariate analysis. Results There were 16 cases of 72 patients underwent laparoscopic myomectomy had postoperative infection, and the postoperative infection rate was 22.22%. Multivariate Logistic regression analysis showed that age over 50, operation time over 60 minutes, and with diabetes mellitus were the risk factors of perioperative infection in laparoscopic myomectomy. Prophylactic use of antibiotics, preoperative use of antibiotics in less than 2 hours and postoperative use of antibiotics in less than 48 hours were protective factors (P<0.05). Conclusions The infection rate of patients underwent laparoscopic myomectomy was 22.22%. The time and length of antibiotics use had important influence on postoperative infection of patients underwent laparoscopic myomectomy. In addition, age, operation time and complicated with diabetes mellitus were also related to postoperative infection.

目的 探究血清C反应蛋白与白蛋白比值(CRP/ALB)、中性粒细胞与淋巴细胞比值(NLR)、血糖不稳定指数(GLI)水平对重症肺炎患者预后的预测价值。方法 将我院2020年1月—2021年5月收治的126例重症肺炎患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(93例)和死亡组(33例)。对比2组患者的一般资料,采用多因素Logistic分析重症肺炎患者高危因素,应用ROC曲线评估血清CRP/ALB、NLR、GLI水平对重症肺炎患者预后的预测价值。结果 2组患者一般资料对比,NEU、CRP、APACHEⅡ、CRP/ALB、NLR、GLI水平差异有统计学意义(P<0.05);多因素Logistic回归分析显示APACHEⅡ评分、血清CRP/ALB、NLR、GLI水平是重症肺炎患者死亡的危险因素;ROC曲线分析结果显示,CRP/ALB、NLR、GLI曲线下面积分别为0.837,0.826,0.837。结论 CRP/ALB、NLR、GLI水平对重症肺炎患者预后均具有较高的预测价值,其中以CRP/ALB的预测价值最佳。

Objective To explore the prognostic predictive value of serum CRP/ALB, NLR and GLI in patients with severe pneumonia. Methods A total of 126 patients with severe pneumonia treated in our hospital from January 2020 to May 2021 were divided into survival group (93 cases) and death group (33 cases) according to the prognosis of 28 days of hospitalization. The general data of the two groups were compared, the high-risk factors of patients with severe pneumonia were analyzed by multivariate logistic, and the predictive value of serum CRP/ALB, NLR and GLI levels on the prognosis of patients with severe pneumonia was evaluated by ROC curve. Results There were significant differences in the levels of NEU, CRP, APACHE Ⅱ, CRP/ALB, NLR and GLI between the two groups (P<0.05); multivariate logistic regression analysis showed that APACHE Ⅱ score, serum CRP/ALB, NLR and GLI were the risk factors of death in patients with severe pneumonia; ROC curve analysis showed that the areas under CRP/ALB, NLR and GLI curves were 0.837, 0.826 and 0.837 respectively. Conclusions The levels of CRP/ALB, NLR and GLI had high predictive value in the prognosis of patients with severe pneumonia, among which CRP/ALB had the best predictive value.