目的 对比分析电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效。方法 将我院2018年11月—2020年11月间收治的92例胸腺瘤患者作为本次实验案例,根据随机双盲原则进行分组,其中对照组46例患者采用传统开胸手术治疗,观察组46例患者采用电视胸腔镜手术治疗,对于2组患者治疗中的临床疗效进行对比分析。结果 观察组术后的肺功能指标下降幅度小于对照组,且观察组的手术时间、胸管引流时间、下床活动时间、住院时间均短于对照组,出血量、引流量低于对照组,切口长度小于对照组,P＜0.05,组间指标数据存在统计学差异。结论 电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效相比,前者具有明显的优势,创伤小、恢复快、对于患者肺功能的影响更小。

目的 分析区级医院甲型流行性感冒患者的临床特征,为基层医院甲型流感的早期诊断及防控工作提供科学依据。方法 对2019年12月广州市番禺区中心医院发热门诊就诊的具有流感样症状的发热患者共628例,进行咽拭子甲型流感病毒核酸检测,收集患者临床资料,包括性别、年龄、体温、症状、血常规,根据核酸检测结果分为阴性组及阳性组,2组结果进行比较。结果 甲型流感病毒核酸检测阳性患者共116例,阳性率为18.5%。阳性组发病年龄以14～19岁所占比例最大,共91例(78.4%)。阳性组平均年龄小于阴性组(P＜0.05)。阳性组发病体温以38.1～39 ℃所占比例最大,共47例(46.5%)。阳性者平均体温高于阴性组(P＜0.01)。症状方面,阳性组仅鼻塞流涕比例较阴性组高(P＜0.05)。阳性组白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值、淋巴细胞百分比均低于阴性组(P＜0.01)。结论 2019年冬季甲型流感患者以青少年为主,单纯症状较难区分甲型流感及普通感冒,需结合血常规特别是白细胞计数、中性粒细胞绝对值、淋巴细胞绝对值的降低进行分析。

Objective The clinical characteristics of patients with influenza A in district hospital were analyzed to provide scientific basis for early diagnosis, prevention and control of influenza A in primary hospital. Methods A total of 628 patients with influenza-like symptoms from Guangzhou Panyu Central Hospital in December 2019 were enrolled, and the clinical data was collected, including gender, age, body temperature, symptoms, and blood test results. According to the result of influenza A nucleic acid detection, patients were divided into negative group and positive group, and the clinical data of these two groups were compared. Results A total of 116 patients were positive in influenza A virus nucleic acid detection, which positive rate was 18.5%. In the positive group, patients aged 14-19 accounted for the largest proportion, with 91 patients (78.4%). The mean age of the positive group was significantly lower than that of the negative group (P＜0.05). Body temperature ranged from 38.1 to 39 ℃ accounted for the largest proportion in the positive group, with 47 patients (46.5%). The mean body temperature of the positive group was significantly higher than that of the negative group (P＜0.01). In terms of symptoms, only the proportion of nasal congestion in positive group was higher than that in negative group (P＜0.05). In terms of blood test results, WBC count, neutrophil absolute value, lymphocyte absolute value and lymphocyte percentage in the positive group were significantly lower than those in the negative group (P＜0.01). Conclusions The majority of patients with influenza A in the winter of 2019 were teenagers, and it was difficult to distinguish influenza A from the common cold only by symptoms. The differential diagnosis should be carried out in combination with the blood routine analysis, especially the decrease in the white blood cell count, the absolute value of neutrophil and the absolute value of lymphocytes.

目的 探讨性别、年龄、日剂量、合并用药、药物厂家等因素对使用阿立哌唑患者稳态血药浓度的影响,为临床合理用药提供依据。方法 收集深圳市康宁医院2019年1月—2021年2月使用阿立哌唑住院患者血药浓度监测数据样本229份,包括患者性别、年龄、日剂量、合并用药、药物厂家等基本信息,使用SPSS 25.0统计学软件对数据进行回顾性分析。结果 经多元线性回归分析,本研究仅性别、日剂量能解释阿立哌唑血药浓度的变化。使用阿立哌唑患者血药浓度剂量比值(C/D)女性组高于男性组(P＜0.01),阿立哌唑合用丙戊酸盐组高于无合用组(P＜0.05),年龄、其他合并、药物厂家用药对阿立哌唑(C/D)值的影响无统计学差异。结论 阿立哌唑C/D值与性别有关,合并用药对其有一定影响,不同药物厂家的阿立哌唑C/D值无统计学差异,临床应加强治疗药物监测,根据血药浓度及临床诊疗效果,结合药物经济学因素优化给药方案。

Objective To provide the reference for clinical rational use of aripiprazole,to investigate the effects of gender, age, daily dose, concurrent medication, drug manufacturer and other factors on the steady-state serum concentration in aripiprazole patients. Methods Serum concentration monitoring data of 229 inpatients using aripiprazole in Shenzhen Kangning Hospital from January 2019 to February 2021 was collected, including patients' gender, age, daily dose, concurrent medication, drug manufacturer and other basic information, which were retrospectively analyzed by SPSS 25.0 statistical software. Results In this study, only gender and daily dose could explain the significant changes of aripiprazole serum concentration after multiple linear regression analysis. The serum concentration/dose ratio (C/D) was significantly higher in female patients than in male patients (P＜0.01), and the group of aripiprazole combined with valproate was markedly higher than the non-combined group (P＜0.05). Nevertheless, there were no statistically significant differences in the effects of age, concurrent medication and drug manufacturer on aripiprazole C/D values. Conclusions The C/D value of aripiprazole was closely related to gender, and concurrent medication had a certain effect on it. There was no statistical difference in the aripiprazole C/D value among different drug manufacturers. This study suggested that clinical monitoring of therapeutic drugs should be strengthened, and the prescription should be optimized based on serum concentration and therapeutic efficacy, combined with pharmacoeconomic factors.

目的 考察灯盏花素辅助阿替普酶治疗溶栓时间窗外急性脑梗死的疗效。方法 选取82例溶栓时间窗外急性脑梗死患者,随机分成实验组(40例)和对照组(42例)。对照组给予阿替普酶治疗,实验组在对照组基础上给予灯盏花素治疗。比较治疗前及治疗2周后,2组患者的神经功能缺损程度[国立卫生研究院卒中量表(NIHSS)]、脑梗死区域组织灌注情况[相对脑血容量(rCBV)、脑血流量水平(CBF)]、血流变学指标[高切全血黏度(HSBV)、低切全血黏度(LSBV)、血浆黏度(PV)、红细胞比容(HCT)]、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)]。结果 治疗2周后,2组NIHSS评分及HSBV、LSBV、PV、HCT、MDA水平皆低于治疗前,且实验组低于同一时间对照组(P＜0.05);2组rCBV、CBF、SOD水平皆高于治疗前,且实验组高于同一时间对照组(P＜0.05)。结论 灯盏花素辅助阿替普酶治疗溶栓时间窗外急性脑梗死的治疗效果较好,有利于逆转患者神经功能缺损程度,增加梗死区域灌注量,改善患者血流情况,对其预后康复有利。

Objective To investigate the efficacy of breviscapine combined with alteplase in the treatment of acute cerebral infarction beyond thrombolytic time window. Methods A total of 82 patients with acute cerebral infarction beyond thrombolytic time window were randomly divided into experimental group (40 cases) and control group (42 cases). The control group was treated with alteplase, and the experimental group was treated with breviscapine on the basis of the control group. Before and 2 weeks after treatment, the degree of neurological deficit [National Institutes of Health Stroke Scale (NIHSS)], regional tissue perfusion of cerebral infarction [relative cerebral blood volume (rCBV), cerebral blood flow (CBF)], hemorheological indexes [high shear whole blood viscosity (HSBV), low shear whole blood viscosity (LSBV), plasma viscosity (PV), hematocrit (HCT)], the indexes of oxidative stress [malondialdehyde (MDA) and superoxide dismutase (SOD)] were compared between the two groups. Results After 2 weeks of treatment, NIHSS score, HBSV, LSBV, PV, HCT and MDA levels of the two groups were significantly lower than those before treatment, and those of the experimental group were significantly lower than the control group at the same time (P＜0.05). The rCBV, CBF and SOD levels of the two groups were significantly higher than those before treatment, while those of the experimental group was significantly higher than the control group (P＜0.05). Conclusions Breviscapine combined with alteplase in the treatment of acute cerebral infarction beyond thrombolytic time window had good therapeutic effect, which was beneficial to improve the degree of neurological deficit, increase the perfusion volume of infarcted area, improve the cerebral blood flow of patients, and was beneficial to the prognosis and rehabilitation.

目的 建立HPLC法测定人血浆中亚胺培南浓度,并基于稳定性试验结果建立临床标本采样流程。方法 以0.01 mol·L^-1乙酸铵缓冲液(pH 6.8)-乙腈(95∶5,V∶V)为流动相,用Agilent Zorbax SB-AQ(4.6 mm×250 mm,5 μm)色谱柱,进样量30 μL,柱温30 ℃,流速1.0 mL·L^-1,紫外检测波长298 nm,分别考察了在不同温度,加入稳定剂等条件下亚胺培南的稳定性。结果 亚胺培南在3.30～105.60 μg·mL^-1线性关系良好(R²=0.999 1),定量下限为0.41 μg·mL^-1,批内回收率在97.83%～103.54%,批间回收率在99.43%～104.24%,日内、日间RSD＜15.0%;在稳定性血浆中,亚胺培南在低温、室温条件下可分别稳定72 h和18 h,在非稳定性血浆中,分别为24 h和6 h。结论 本方法简便、快速、准确,可用于监测亚胺培南浓度,且基于稳定性试验建立临床标本采样流程,能确保血药浓度监测结果准确性。

Objective To determine the concentration of imipenem in human plasma by HPLC method, and establish the sampling process of clinical specimens based on stability investigation result. Methods The mobile phase was consisted of 0.01 mol·L^-1 ammonium acetate buffer(pH 6.8)-acetonitrile(95∶5, V∶V), and using Agilent Zorbax SB-AQ column(4.6 mm×250 mm,5 μm)to investigat the stability of imipenem under different temperature and with or without stabilizer. The injection volume was 30 μL, the colum temperature was 30℃, the flow rate was 1.0 mL·L^-1 and the detection wavelength was 298 nm. Results Imipenem had a good correlation coefficient(R²=0.999 1)at concentration of 3.30-105.60 μg·mL^-1. The lower limit of quantification was 0.41 μg·mL^-1, the intra-batch and inter-batch recovery rate were 97.83%-103.54% and 99.43%-104.24%, the intra-day and inter-day RSD were less than 15.0%. In stabilized plasma, imipenem could maintain stable at low temperature for 72 h and room temperature for 18 h, in non-stabilized plasma for 24 h and 6 h respectively. Conclusions This method was simple, rapid and accurate, which was suitable for the imipenem therapeutic drug monitoring, and establishing the sampling process of clinical specimen based on stability test could ensure the accuracy of plasma concentration monitoring.

目的 系统评价心脉通治疗冠心病的临床疗效及其安全性。方法 2名研究者独立系统地检索心脉通治疗冠心病的文献,其中包括维普中文科技期刊全文数据库(VIP)、PubMed 电子期刊全文数据库、中国学术期刊全文数据库(CNKI)、The Cochrane Library 数据库、万方数据库等6个数据库。同时运用Review Manager 5.4 软件进行本研究的数据处理。结果 最终共纳入8篇文献,共计985名心脉通治疗冠心病患者。治疗前后的临床疗效、发作频率、血脂水平的Meta分析结果显示心脉通组优于常规治疗组。有3项纳入试验报告不良反应。结论 心脉通治疗冠心病的临床疗效优于常规治疗。心脉通不仅可以降低冠心病发作频率,缩短其发作持续时间,还能调节血脂水平,在治疗冠心病方面疗效确切,值得临床参考应用。

Objective To systematically evaluate the clinical efficacy and safety of Xinmaitong in the treatment of coronary heart disease (CHD). Methods Two researchers searched the literatures of Xinmaitong in the treatment of coronary heart disease independently and systematically, including VIP Chinese Sci-tech Journal full-text Database (VIP), PubMed Electronic Journal full-text Database, Chinese Academic Journal full-text Database (CNKI), The Cochrane Library Database and Wanfang Database. At the same time, Review Manager 5.4 software was used to process the data of this study. Results A total of 8 articles were included, and a total of 985 patients with coronary heart disease were treated with Xinmaitong. The results of Meta analysis of clinical efficacy, attack frequency and blood lipids level before and after treatment showed that Xinmaitong group was better than routine treatment group. Three items were included in the report of adverse reactions. Conclusions The clinical effect of Xinmaitong in the treatment of coronary heart disease was better than that of routine treatment. Xinmaitong can not only reduce the frequency and duration of coronary heart disease attack, but also regulate blood lipids level. Xinmaitong was effective in the treatment of coronary heart disease and is worthy of clinical reference.

目的 了解精神科护士的临床决策意识与其情绪智力水平的相关性。方法 采用护理临床决策量表(CDMNS),情绪智力量表(WLEIS)对来自广州市3家医院的230名精神科护士进行问卷调查,并对结果进行相关性分析。结果 精神科护士临床决策意识得分为(133.25±14.68)分,情绪智力得分为(74.15±11.77)分,精神科护士临床决策意识总分与情绪智力能力总分呈显著正相关(r=0.413,P＜0.05)。结论 精神科护士临床决策意识、情绪智力为中等水平,提高情绪智力水平有助于提高精神科护士的临床决策能力。

Objective To understand the correlation between the clinical decision-making awareness of psychiatric nurses and their emotional intelligence. Methods Using the clinical decision-making in nursing scale (CDMNS) and Wong & Law emotional intelligence scale (WLEIS), a questionnaire survey was conducted among 230 psychiatric nurses in 3 hospitals in Guangzhou, and correlation analysis was performed on the results. Results The clinical decision consciousness score of psychiatric nurses was (133.25±14.68), and the emotional intelligence score was (74.15±11.77). The total score of clinical decision consciousness of psychiatric nurses was significantly positively correlated with the total emotional intelligence ability score (r=0.413, P<0.05). Conclusions The clinical decision-making awareness and emotional intelligence of psychiatric nurses were at a medium level. Increasing the level of emotional intelligence can help improving the clinical decision-making ability of psychiatric nurses.

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 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 探讨应用56孔冷盐水(STSF)压力导管高功率消融模式治疗老年阵发性房颤患者的有效性和围手术期安全性。方法 回顾性分析广州市第一人民医院2019年1月—2021年6月使用STSF导管高功率消融模式行射频治疗的老年阵发性房颤患者68例(STSF组),匹配同期年龄、性别、左房直径、左室射血分数无差异且使用6孔冷盐水 (ST)压力导管常规功率消融的老年房颤患者71例(ST组),比较2组患者之间的即刻环肺静脉隔离成功率、单圈隔离成功率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。结果 2组患者都成功完成环肺静脉电隔离,STSF组单圈隔离成功率与ST组无差异(左侧肺静脉92.6% vs 90.1%,P>0.05;右侧肺静脉83.8% vs 87.3%,P>0.05),与ST组比较,STSF组手术及消融时间缩短[(70.9±10.0)min vs (79.1±14.2)min,P<0.001;(25.4±4.5)min vs(30.5±6.3)min,P<0.001],灌注量更低[(406.5±46.3)mL vs (729.2±106.1)mL;P<0.001],X线透视时间相近[(6.5±2.5)min vs(7.3±2.6)min;P=0.056]。2组围手术期并发症率均较低(2.9% vs 3.9%;P=0.39),STSF组2例术中发生气体爆破,但未引起心包填塞,ST组有2例术后出现心衰,利尿后好转,1例出现持续性胸痛,胃镜提示食道糜烂,予流质饮食及质子泵抑制剂治疗后恢复。结论 应用STSF导管高功率消融模式在老年阵发性房颤患者行肺静脉大环隔离可提高消融效率,减少术中液体负荷,且不增加围手术期风险。

Objective To investigate the effectiveness and perioperative safety of ThermoCool SmartTouch SurroundFlow (STSF) catheter high-power ablation mode in the treatment of elderly patients with paroxysmal atrial fibrillation. Methods A total of 68 elderly patients with paroxysmal atrial fibrillation who used STSF catheter high-power ablation mode (STSF group) in Guangzhou First People's Hospital from January 2019 to June 2021 were analyzed retrospectively. There were 71 elderly patients with atrial fibrillation who had no significant difference in age, sex, left atrial diameter and left ventricular ejection fraction, used ThermoCool SmartTouch (ST) catheters for conventional power ablation (ST group) at the same time. The success rate of immediate circumferential pulmonary vein isolation, single lap isolation, operation time, X-ray fluoroscopy time, ablation time, intraoperative saline perfusion volume and the incidence of complications were compared between the two groups. Results Both groups of patients successfully completed circular pulmonary vein electrical isolation. There was no significant difference in the success rate of single-circle isolation between STSF group and ST group (left pulmonary vein 92.6% vs 90.1%, P>0.05; right pulmonary vein 83.8% vs 87.3%, P>0.05). Compared with ST group, STSF group had shorter operation and ablation time [(70.9±10.0) min vs (79.1±14.2) min, P<0.001; (25.4±4.5) min vs (30.5±6.3) min, P<0.001], lower perfusion volume [(406.5±46.3)mL vs (729.2±106.1)mL, P<0.001], similar X-ray fluoroscopy time [(6.5±2.5)min vs (7.3±2.6)min, P=0.056 ]. The perioperative complication rate of the two groups was low (2.9% vs 3.9%, P=0.39). Two cases of STSF group had steam pops during operation but did not cause pericardial tamponade, and 2 cases of ST group had postoperative heart failure occurred and improved after diuresis. One case developed persistent chest pain, which gastroscope indicated esophageal erosion, and recovered after liquid diet and PPI treatment. Conclusions Using STSF catheter high-power ablation mode to perform pulmonary vein isolation in elderly patients with paroxysmal atrial fibrillation could improve ablation efficiency, reduce intraoperative fluid load, and without increasing perioperative risk.