目的 研究分析甲强龙静脉注射对老年腹部全麻术患者血流动力学和呼吸动力学的影响。方法 选取2014年3月—2015年3月拟于我院行腹部全麻手术的老年患者76例,随机分为实验组和对照组,每组38例,均对其行全身麻醉。两组病人麻醉诱导用药咪达唑仑0.05 mg/kg,速眠安0.15 mg/kg,乙咪酯 0.2 mg/kg,气管插管后连接麻醉呼吸机。麻醉维持咪达唑仑和速眠安各0.05 mg/kg,给予实验组静脉注射甲强龙1 mL(40 mg),对照组静脉注射生理盐水1 mL。记录两组患者给药前(T₁)、给药后10 min(T₂)、20 min(T₃)、30 min(T₄)、40 min(T₅)的气道峰压(Ppeak)、气道平台压(Pplat)、肺的顺应性(Compl)、气道阻力(Raw)等呼吸动力学参数值。以及两组患者给药前20 min(T₀)和T₁～T₃患者的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)和心率(HR)等血流动力学参数值,并于以上各时间点采取两组患者静脉血测定其血浆中cAMP和cGMP含量。观察比较两组患者各时间点的数据变化以及拔管后10 min(T₆),15 min(T₇)和35 min(T₈)的RAMSAY镇静评分和RASS评分。结果 实验组在T₂～T₅时Compl明显增高,而同期Ppeak、Pplat、Raw则降低(P＜0.05)。与对照组相比较,实验组在T₀到T₄的SBP、DBP、MAP和HR无差异,且各时间点的数值低于同期对照组。两组患者在T₀和T₃cAMP和cGMP含量比较无差异,实验组cAMP和cGMP含量在T₁和T₂时低于对照组,两组患者在T₈时的Ramsay评分和RASS评分比较差异无统计意义,但实验组患者在T₆和T₇时的镇静评分高于对照组(P＜0.05),而同一时间点的RASS躁动——镇静量表评分则低于对照组(P＜0.05)。结论 甲强龙静脉注射能稳定老年腹部全麻术患者的血流动力学和呼吸动力学,抑制手术过程中的应激反应,改善苏醒质量和镇静效果,值得临床上推广使用。

目的 探讨清洁手术在围手术期间所出现的抗菌药物不合理现象的危险因素,提出应对措施。方法 选用我院普外科收治的四种清洁手术(骨折内固定取出手术、乳腺手术、甲状腺手术和疝气手术)患者460例,对所有患者在围手术期间抗菌药物的应用情况进行研究,并对其不合理使用危险因素进行多因素logistic回归分析。结果 患者在清洁手术中抗菌药物的应用率为100%,其中头孢菌素类药物的使用率最高,喹诺酮类药物次之,四种清洁手术的术后用药时间均>7天。对患者资料进行多因素logistic回归分析结果显示,围手术期抗菌药物的不合理使用危险因素主要包括无指征预防使用抗菌药物、给药时间不当、术后用药时间过长、药物选用不合理等七种危险因素(P<0.05)。结论 当前清洁手术的围手术期中,存在着抗菌药物不合理使用的情况,临床诊治过程中应强化科学应用意识和合理化使用观念,确保医药资源的充分利用。

目的 探讨S100B蛋白水平与进展性脑梗塞病情的相关性,分析不同 S100B 蛋白含量的患者预后情况。方法 选取2011年10月—2012年9月在我院接受治疗的急性进展性脑梗死患者80例为研究对象。比较不同脑损害程度,进展性脑梗塞患者S100B蛋白含量及NIHSS评分动态变化。结果 急性进展性脑梗死患者血清S100B蛋白含量在治疗后第1、3、7天均升高(P＜0.05),且第3天达最高,最高值随着脑梗死面积的增大而增加,第14天下降至最低,与对照组相比,差异有统计学意义(P<0.05)。急性进展性脑梗死患者NIHSS评分与治疗前相比,在治疗后第1、3、7天均升高(P＜0.05),且第3天达最高,最高值随着脑梗死面积的增大而增加,第14天下降至最低,与对照组相比,差异有统计学意义(P<0.05)。采用Pearson对患者血清S100B蛋白含量和NIHSS评分进行相关性分析,得出相关系数为0.583,P<0.05,即血清SI00B蛋白水平与NIHSS评分呈正相关。结论 急性进展性脑梗塞患者血清S100B蛋白水平与脑梗死损坏程度及神经功能正相关,可用来判定该类患者病情及预后情况。

目的 观察氟伐他汀联合环磷腺苷葡胺治疗慢性肺心病急性加重期的临床疗效。方法 将我院收治的74例慢性肺心病急性加重期病人,使用随机数字表法分为联合用药组与对照组,每组各37例。对照组单独使用环磷腺苷葡胺,联合用药组在对照组的基础上加服氟伐他汀。两组疗程均为7周。观察比较两组患者治疗前后的NO,ET-1,CRP,PaO₂水平以及治疗效果。结果 经7周疗程治疗后,对照组有效率为64.86%,联合用药组94.59%。两组间比较,差异有统计学意义(P<0.05)。两组NO,ET-1,CRP,PaO₂水平比较,联合用药组均优于对照组,差异有统计学意义(P<0.05)。结论 氟伐他汀联合环磷腺苷葡胺治疗慢性肺心病急性加重期的临床疗效更为显著,值得临床推广。

Objective To observe the clinical efficacy of combined treatment of Fluvastatin combined with Meglumine Adenosine Cyclophosphate on acute exacerbation of chronic pulmonary heart disease. Methods 74 patients with acute exacerbation of chronic pulmonary heart disease were randomly divided into combined treatment group and control group. The control group was treated by Meglumine Adenosine Cyclophosphate for 7 weeks.The combined treatment group was treated by Meglumine Adenosine Cyclophosphate and Fluvastatin for 7 weeks. The clinical efficacy and the score of NO,CRP,ET-1,PaO₂ were assessed before and after the treatment. Results After 7 weeks treatment, the total clinical efficacy rate was 64.86% in the control group and 94.59% in the combined treatment group. The differences between them has statistically significant(P<0.05). The score of NO,ET-1,CRP,PaO₂ in combined treatment group were significantly improved compared to control group (P<0.05). Conclusion The clinical efficacy of Fluvastatin combined with Meglumine Adenosine Cyclophosphate on acute exacerbation of chronic pulmonary heart disease is more efficient. It is worth to develop clinically.

目的 探讨规范二级预防下老老年人轻型卒中复发的危险因素。方法 收集我院80岁及以上、既往有轻型卒中病史、并进行规范二级预防半年以上的老老年患者的临床资料:一般资料、既往病史及用药情况、入院时血压及基础生化指标、影像学资料、缺血性卒中复发情况。根据有无复发缺血性卒中将患者分为复发组和无复发组两组,分析以上因素在两组间的差异。结果 80例患者中复发缺血性脑卒中共26例,复发率32.5%。统计结果显示,轻型卒中复发组与合并高血压病、入院时收缩压、D二聚体水平呈正相关,其相关系数分别为0.265(P=0.018)、0.232(P=0.038)和0.222(P=0.048)。复发组收缩压升高比例高于无复发组(χ²=6.919,P=0.031)。非条件Logistic多因素分析显示:合并高血压病[OR 95%CI=(1.162,10.230)]、收缩压升高[OR 95%CI=(0.997,68.840)]与轻型缺血性卒中复发相关。结论 合并高血压病、收缩压升高是老老年人轻型卒中规范二级预防下复发独立危险因素。

Objective To analyze the recurrence risk factors of aged patients with minor ischemic stroke under standardized secondary prevention. Methods Patients over 80 years old and with minor ischemic stroke history were enrolled, and the following data were collected: demographic characteristics, medical history, current medicine, blood test, imaging findings and recurrence of ischemic strokes. Patients were divided into two groups: the recurrence group and the non-recurrence group. Chi-square test,logistic regression models were performed to assess correlations between baseline variables and recurrence of minor stroke events. Results In our study, 26 patients had recurrent minor ischemic stroke(32.5%). The prevalence of recurrence of minor stroke was positively correlated with hypertension(CI 0.265, P 0.018), SBP(CI 0.232,P 0.038), d-2-dimer(CI 0.232,P 0.048). Patients in recurrence group are more likely to presented with SBP elevation compared to non-recurrence group(χ²=6.919, P=0.031). Unconditional logistic regression analysis showed that hypertension, especially high SBP significantly related to minor ischemic stroke recurrence. Conclusion Hypertension,especially elevated SBP, were considered as an independent risk factors for aged old patients with minor ischemic stroke who received standardized secondary prevention.

目的 研究超声内镜(EUS)对结直肠癌(CRC)术前分期和指导手术方案的应用价值。方法 选取我院2014年11月—2015年11月结直肠外科收治的52例CRC患者,均接受根治性切除术治疗并经术中病理观察确诊,并以手术病理TNM分期结果作为金标准。术前对入选患者行超声内镜检查,参考金标准回顾性分析超声内镜的TNM分期诊断效果。结果 该52例CRC患者EUS诊断结果显示肿瘤侵犯浸润T分期(T1～T4)准确率分别为87.50%、80.00%、94.12%、83.33%,较手术病理金标准无差异(P>0.05);EUS诊断淋巴结转移N分期(N0～N2)准确率分别为76.92%、79.17%、86.67%,其中N0、N2准确率较金标准无差异(P>0.05),但N1分期准确率较金标准偏低(P<0.05)。结论 虽然ENS对淋巴结转移程度尤其是N1的诊断准确度存在一定误差,但从整体来看EUS能较好的观察CRC患者肿瘤侵犯浸润深度和判断淋巴结转移情况,术前结合EUS诊断结果有利于患者术前病理分期,并为选择合适的手术方案提供参考依据。

Objective To study the application value of endoscopic ultrasonography (EUS) in preoperative staging of colorectal cancer (CRC) and guidance of surgical procedures. Methods 52 cases of patients with CRC who were admitted in the department of colorectal surgery of our hospital from November 2014 and November 2015 were selected. All of them underwent radical resection and were confirmed by surgical and pathological observation. Surgical and pathological TNM staging results were taken as golden standard. Before surgery, endoscopic ultrasonography was performed in the selected patients. Referring to the gold standard, TNM staging diagnostic effects of endoscopic ultrasonography were retrospectively analyzed. Results The EUS diagnostic results of 52 patients with CRC showed that the accuracy rates of tumor invasion T stage (T1-T4) were 87.50%, 80.00%, 94.12% and 83.33% respectively. There was no significant difference, compared with surgical and pathological golden standard (P>0.05); The accuracy rates of EUS in diagnosis of lymph node metastasis N stage (N0-N2) were 76.92%, 79.17% and 86.67%, respectively. There was no significant difference in accuracy rate in N0 and N2, compared with the gold standard (P>0.05), but the accuracy in N1 stage was lower than that of gold standard (P<0.05). Conclusion Although ENS has some errors in the diagnosis of degree of lymph node metastasis, especially N1, on the whole, EUS can be better to observe the depth of tumor invasion and lymph node metastasis in patients with CRC. The diagnosis combining with EUS before surgery is helpful to the preoperative pathological staging, and provide reference for the selection of appropriate surgical procedures.

目的 探讨糖尿病自我管理支持对社区2型糖尿病患者生化指标控制的影响。方法 2015年1月1日前已确诊为2型糖尿病患者,随机分为对照组和干预组,对照组303例按照广州市基本公共卫生服务包要求进行定期随访、体检及健康教育,干预组130例进行自我管理支持干预,观察两组生化指标的变化。结果 与对照组比较,自我管理支持组的空腹血糖、总胆固醇、甘油三酯、谷丙转氨酶、尿酸控制效果较好,差异有统计学意义(P<0.05)。结论 自我管理支持对社区2型糖尿病患者生化指标控制的效果良好,值得推广。

Objective To evaluate the control effect of biochemical criterion in patients with type 2 diabetes under diabetes self-management support in community. Methods 130 patients with type 2 diabetes in community from January 2015 to December 2015 accepting the diabetes self-management support were chosen as research group, another 303 diabetic patients without the diabetes self-management support were set as control group, the effect of management was analyzed. Results There was statistically significant difference (P<0.05) in biochemical criterion including blood sugar (BS), total cholesterol (TC), triglyceride (TG), alanine aminotransferase (ALT) and uric acid (UA). Conclusion Control effect of biochemical criterion was good in the diabetes self- management support for people with type 2 diabetes, which was worth to be popularized.

目的 探索利伯曼康复治疗对慢性精神分裂症患者社会功能的影响。方法 选取长期住院的慢性精神分裂症患者130例,随机分为研究组65例和对照组65例,研究组实施利伯曼康复治疗,在康复训练前与训练后的第1、3月末分别采用护士用住院病人观察量表(NOSIE)和住院精神病人康复疗效评定量表(IPROS)对患者进行评价。结果 患者通过利伯曼康复治疗后,NOSIE量表总积极分、社会能力、社会兴趣、个人整洁等得分有明显提高;IPROS量表的工疗情况生活能力社交能力讲究卫生能力都有较明显的提高(T、P<0.01)。结论 利伯曼康复治疗对患者的社会功能的改善有积极的意义。

Objective To explore the impacts of Lieberman rehabilitation technique on chronic schizophrenic patient's quality of life. Methods 130 patients diagnosed with chronic schizophrenia with over 5-year long hospitalization were divided into two groups randomly, with 65 samples at either study group or control group. Team to implement a lieberman rehabilitation. NOSIE and IPROS were used by nurse to assess the performance of all samples in one month after the beginning of the study and three months after the beginning study. Results After intervention, the performance of samples in study group indicated that patients had significantly higher score in NOSIE total score, social ability, social interest, individual tidiness. Patient's total negative points including irritability, mental performance, retardation and depression were decreased. IPROS living ability and social ability has improved significantly(P≤0.01). Conclusion Lieberman rehabilitation technique can improve patients'social function.

目的 研究PF诱导化疗联合调强放疗及二维放疗对鼻咽癌近远期疗效影响的回顾性分析。方法 回顾性分析2008年1月—2008年12月中山大学附属肿瘤医院收治的101例鼻咽癌患者治疗情况,按照治疗方案技术分为调强组(n=42)和二维组(n=59)。比较两组患者临床疗效,近期毒副反应及生存情况。结果 放疗结束时调强组患者总缓解率92.86%与二维组77.97%比较差异有统计学意义(P<0.05)。调强组Ⅲ-Ⅳ级胃肠道反应26.19%及黏膜炎14.29%发生率与二维组比较显著较少,差异有统计学意义(P<0.05)。两组患者远期毒副反应及生存率比较无显著差异(P>0.05)。结论 PF诱导化疗联合调强放疗治疗鼻咽癌患者,近远期临床疗效好,毒副反应少。

Objective To study the effects of PF induced chemotherapy combined with intensity modulated radiation therapy and two-dimensional radiotherapy on the short and long term curative effects in nasopharyngeal carcinoma. Methods The treatment condition of 101 cases of patients with nasopharyngeal carcinoma who were treated in the Tumor Hospital Affiliated to San Yat-sen University between January and December 2008 were retrospectively analyzed. According to different treatments, the cases were divided into the intensity modulated group and the two-dimensional group. The clinical curative effects, short-term toxic and side effects and survival status were compared between the two groups. Results At the end of radiotherapy, the total remission rate in the intensity modulated group was 92.86% while in the two-dimensional group was 77.97% (P<0.05). In the intensity modulated group, the incidence rates of grade Ⅲ-Ⅳgastrointestinal tract reactions (26.19%) and mucositis (14.29%) were significantly lower than those in the two-dimensional group (P<0.05). There was no significant difference in long-term side effects and survival rate between the two groups (P>0.05). Conclusion PF induced chemotherapy combined with intensity modulated radiation therapy in the treatment of patients with nasopharyngeal carcinoma has good short and long-term curative effects and few toxic and side effects.

目的 探讨同步放化疗治疗晚期非小细胞肺癌(NSCLC)的临床疗效。方法 选取我院2014年收治的晚期NSCLC患者102例,随机分为观察组和对照组,对照组以紫杉醇联合顺铂化疗方案(TP)化疗治疗,观察组加用三维适形放疗同步放化疗治疗,观察两组的临床疗效和不良反应。结果 观察组和对照组患者的总有效率分别为43.14%和21.57% (P<0.05),两组患者的总控制率分别为84.31%和66.67% (P<0.05)。两组患者Ⅲ～Ⅳ级胃肠道反应、白细胞减少、骨髓抑制的发生率差异无统计学意义(P>0.05),观察组比对照组增加了放射性肺炎和放射性食管炎的发生 (P<0.05)。两组患者生活质量比较,差异具有统计学意义(P＜0.05)。结论 同步放化疗治疗晚期NSCLC可以显著提高治疗的总有效率、肿瘤的控制率及生活质量,但也使不良反应增加,选择治疗方案时应根据个体情况综合考虑。

Objective To study the clinical efficacy of concurrent chemoradiotherapy in the treatment of advanced non small cell lung cancer (NSCLC). Methods 102 cases of advanced NSCLC treated in our hospital in 2014 were selected and randomly divided into the observation group and the control group. Patients in control group were treated by chemotherapy with Paclitaxel combined Cisplatin (TP), while those in observation group were treated by concurrent chemoradiotherapy with three- dimensional conformal radiotherapy and TP. The clinical efficacy and adverse reactions of the two groups were observed. Results The total effective rate of the observation group and the control group were 43.14% and 21.57% (P<0.05), respectively. The total control rate of the two groups were 84.31% and 66.67%(P<0.05). In two groups III ~ IV gastrointestinal tract reaction, leukopenia, bone marrow suppression occurrence had no statistical significance(P>0.05). Incidence of radiation pneumonitis and radiation esophagitis increased in observation group(P<0.05). The difference of quality of life between the two groups was statistically significant(P<0.05). Conclusion Concurrent radiotherapy and chemotherapy in the treatment ofadvanced non-small cell lung cancer(NSCLC)can not only significantly improve the treatment, tumor control rate and quality of life, but also make adverse reaction increased. Treatment options should be chosen based on individual circumstances into account