目的 探讨分析氨茶碱治疗早产儿呼吸暂停的临床疗效及其在治疗过程中所出现的不良事件。方法 选取2014年9—2016年3月广州市第一人民医院新生儿科接受住院治疗的胎龄＜34周,生后2 h内入住新生儿科的早产儿42例。随机分为对照组和氨茶碱组,对照组(20例)给予保暖、吸氧、补充能量、保持呼吸道通畅、物理刺激等对症治疗,不使用氨茶碱及其它改善呼吸的药物;氨茶碱组(22例)患儿除给予对照组治疗措施外,同时给予氨茶碱静脉滴注,首剂负荷量5 mg/kg,在20min内完成,12 h后以2～2.5 mg/kg维持量,每隔12 h一次。观察两组的疗效与不良影响。结果 ①两组患儿性别、出生胎龄、出生体重、产前孕母糖皮质激素的应用、受孕方式、分娩方式、多胎妊娠、5min Apgar评分、机械通气及CPAP辅助通气例数、低-中流量吸氧(箱内或头罩给氧)例数等方面差异均无统计学意义(P均＞0.05)。②与对照组相比,氨茶碱组早产儿呼吸暂停(AOP)发生的次数较少,AOP消失所需时间较短,差异均有统计学意义(P＜0.05)。③不良影响方面,氨茶碱组脑白质发育不良发生率(63.6%,14/22例)显著高于对照组(25%,5/20例),差异有统计学意义(P＜0.05);两组患儿在听力检查异常、喂养不耐受、血糖紊乱、血脂代谢紊乱、血红蛋白下降、电解质紊乱、出院时体重及住院时间等方面均无统计学意义(P均＞0.05)。④氨茶碱组视网膜发育不完全的发生率(40.9%,9/22例)明显高于对照组(15.0%,3/20例),但差异无统计学意义(P＞0.05)。结论 小剂量氨茶碱在防治AOP方面的作用是值得肯定的,但它有可能增加早产儿脑白质发育不良的风险与视网膜发育不完全的风险。

Objective To investigate the clinical efficacy and adverse effects of aminophylline in prevention of apnea of prematurity. Methods Forty-two infants with gestational age ＜34 weeks admitted to department of pediatrics, Guangzhou first people's hospital between Sep. 2014 and Mar. 2016 were randomly divided into 2 groups: control group and aminophylline group. Control group(n=20): 20 infants received warming, oxygen inhalation, supplement energy, maintain airway patency, physical stimulation, such as symptomatic treatment, without aminophylline or any other drugs for improving breathing. Aminophylline group(n=22): In addition to the control group treatment measures, 22 infants received a loading dose of 5 mg/kg of aminophylline and then maintained by a dose of 2mg/kg with intravenous drip q 12 h. Then we compared the efficacy and adverse effects of the two groups. Results ①There was no significant difference in gender, gestational age, birth weight, maternal antenatal glucocorticoid application, pregnancy(including multiple pregnancy) and delivery,5 min Apgar score, oxygen therapy, the application of mechanical ventilation, nasal continuous positive airway pressure, and the low-medium flow oxygen inhalation between the 2 groups(all P＞0.05). ② Compared with the control group, the incidence of apnea in aminophylline group were significant lower, and the time needed for apnea to disappear were significant shorter(all P＞0.05). ③ The incidence of cerebral white matter development dysplasia of aminophylline group(63.6%,14/22 cases) were significant higher than the control group(25%,5/20 cases, P＜0.05). There was no statistically significant difference in hearing loss, feeding intolerance, blood glucose disturbance, blood lipid metabolism disorder, hemoglobin decrease, electrolyte disorder, body weight at discharge, the duration and cost of hospitalization between the 2 groups(all P＞0.05). ④ The incidence of retinal incompleted development of aminophylline group(40.9%, 9/22 cases) were higher than control group(15.0%, 3/20 cases), but there was no statistical significance between the 2 groups(P＞0.05). Conclusion Effects of aminophylline in treating apnea of prematurity is positive, but it is likely to increase the risk of premature brain white matter development dysplasia and the risk of retinal incompleted development.

目的 对比观察单孔、单操作孔及三孔胸腔镜治疗早期非小细胞肺癌(NSCLC)的临床疗效。方法 选择125 例早期NSCLC患者,分为单孔组(38例)单操作孔组(42例)和三孔胸腔镜组(45例),观察3组手术结果和并发症发生率。结果 3组患者均顺利完成手术,无中转开胸。单孔组手术时间长于单操作孔及三孔组,差异有统计学意义(P＜0. 05)。对比所有3组手术患者的术中出血量及淋巴结清扫数目、术后总引流量及引流管留置时间、术后并发症发生率,差异无统计学意义(P＞0. 05)。单孔组及单操作孔组术后疼痛程度评分优于三孔组,差异有统计学意义(P＜0. 05)。结论 单孔及操作孔胸腔镜治疗早期NSCLC已可取代三孔胸腔镜技术,其术后恢复快,疗效确切,其中单孔手术对设备及胸腔镜医师操作技术熟练程度等要求更高,故在设备仍未有突破性的进展时,单操作孔胸腔镜手术可作为治疗早期NSCLC的优先选择。

Objective To compare the clinical effects of uniportal video-assisted thoracic surgery (VATS), single utility port VATS and 3-portal VATS lobectomy for patients with early stage non-small cell lung cancer. Methods Patients were divided into uniportal VATS lobectomy group(n=38), single utility port VATS lobectomy group(n=42) and 3-portal VATS lobectomy group (n=45). The surgical results and complication rates were observed. Results All patients completed the operation successfully, no one was changed to open operation. Operation time in uniportal VATS lobectomy group were longer than single utility port VATS lobectomy group and 3-portal VATS lobectomy group(P＜0. 05). There were no significant differences in intraoperative blood loss, number of lymph node dissection, the amount and time of postoperative extubation, and the incidence of postoperative complications(P＞0. 05). Post-operative pain score were higher in 3-portal VATS lobectomy group than in uniportal VATS lobectomy group and single utility port VATS lobectomy group (P＜0. 05). Conclusion Uniportal VATS lobectomy and single utility port VATS lobectomy can replace the 3-portal VATS lobectomy in treatment of early NSCLC, because of the faster postoperative recovery and curative effect. Uniportal VATS lobectomy requires special equipment and more operation skills, as there is no breakthrough in the equipment, single utility port VATS lobectomy may still be used as the first choice for treatment of early NSCLC.

目的 对于急性脑梗死患者联用依达拉奉、阿加曲班注射液治疗的临床效果进行观察。方法 运用随机、开放以及对照原则,将发病12～48 h内的80位急性脑梗死患者,随机分为40例对照组、40例联合组,2组都以对症治疗以及常规治疗为基础,在此之上,对照组以依达拉奉进行治疗,联合组以依达拉奉辅以阿加曲班进行治疗,将2组最终治疗疗效作比较,对2组患者治疗前后血清hs-CRP、凝血功能状况、日常活动能力、血流变指标以及NIHSS评分的动态变化进行实时观察。结果 就总有效率而言,对照组的72.5%显著低于联合组的92.5%,P<0.05。经治疗,2组患者凝血功能指标、血清hs-CRP、血流变指标以及NIHSS评分均有所下降,联合组较之对照组降幅更为显著(P<0.05),较之2组治疗前后,差异无统计学意义(P>0.05)。2组都不曾有不良反应出现。结论 应用依达拉奉辅以阿加曲班进行治疗急性脑梗死患者,可显著提升临床疗效,促进患者神经功能及日常活动能力恢复,减少炎症反应发生,改善预后,且无明显不良反应。

目的 探讨盐酸普萘洛尔凝胶外涂治疗婴幼儿浅表性血管瘤的疗效及安全性。方法 选取我院2015年5月—2017年5月收治的60例患有浅表性血管瘤的婴幼儿为研究对象,随机分为观察组和对照组,各30例。对照组口服盐酸普萘洛尔片治疗,观察组采用质量浓度为5 g/L的(20 g∶100 mg)盐酸普萘洛尔凝胶外涂方法治疗,疗程3个月。观察两组患者治疗效果及不良反应情况。结果 治疗后,采用Achauer评定疗效,观察组Ⅰ级患儿1例,Ⅱ级患儿6例,Ⅲ级患儿12例,Ⅳ级患儿8例,Ⅴ级患儿3例,总有效率为96.67%(29/30),对照组Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级分别为2例、8例、10例、6例、4例,总有效率为93.33%(28/30),两组患者差异无统计学意义(P>0.05);两组患者治疗后血管瘤血流峰值及阻力系数较治疗前均得到改善(P<0.05),而两组间差异均无统计学意义(P>0.05);不良反应情况,除观察组发生3例涂抹部位发红外,两组患者均未发生严重不良反应。结论 采用盐酸普萘洛尔凝胶外涂治疗婴幼儿浅表性血管瘤疗效显著,安全可靠,临床上值得进一步推广。

Objective To evaluate the efficacy and safety of Propranolol hydrochloride gel in the external application treatment of superficial hemangioma in infants. Methods We selected 60 infants with superficial hemangioma treated in our hospital from May 2015 to May 2017 and to randomly divide them into the observation group and the control group, each with 30 cases. The control group was treated with Propranolol hydrochloride tablets, and the observation group was treated with 0.5% (20 g∶100 mg) Propranolol hydrochloride gel external application method, the course of treatment was 3 months.We observed the therapeutic effects and adverse reactions of the two groups. Results After treatment, with the Achauer evaluation, patients with grade Ⅰ had 1 case, grade Ⅱ 6 cases, grade Ⅲ 12 cases, grade Ⅳ 8 cases, Ⅴ-grade 3 cases, and the total effective rate was 96.67% (29/30), while the grade Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ in the control group included 2 cases, 8 cases, 10 cases, 6 cases, 4 cases, and the total effective rate was 93.33% (28/30), there was no significant difference between the two groups (P>0.05); The hemangioma peak flow and resistance coefficient of patients in the two groups were significantly improved than that before the treatment (P<0.05), and all with no statistically significant difference between the two groups (P>0.05). As to the adverse reactions, except the applying parts of 3 cases having rubefaction occurred in the observation group, two groups of patients had no serious adverse reactions. Conclusion External application of Propranolol hydrochloride gel in the treatment of superficial hemangioma in infants is effective, safe and reliable. It is worthy of further promotion in clinic.

目的 探讨腔镜手术治疗老年肺癌的疗效及对肺功能的影响。方法 我们纳入90例老年肺癌患者作为研究对象,随机抽签分为2组,各45例。观察组45例行胸腔镜肺癌切除术,对照组45例行传统开胸肺癌切除术。比较两组患者手术时间、术中出血量、胸腔引流时间、淋巴结清扫数量、术后住院时间、疼痛评分、肺功能及术后并发症情况。结果 两组手术时间、淋巴结清扫数量无差异(P>0.05);观察组术后胸腔引流时间、术中出血量、疼痛评分、住院时间少于对照组(P＜0.05)。观察组术后并发症总发生率低于对照组(P＜0.05)。观察组术后一秒用力呼气容积、用力肺活量、肺活量、一秒用力呼气容积与用力肺活量比值恢复情况优于对照组(P＜0.05)。结论 腔镜微创手术用于老年肺癌患者能够显著降低围术期并发症,缩短患者术后恢复时间,且有助于改善肺功能。

Objective To investigate the efficacy and safety of endoscopic surgery in the treatment of elderly patients with lung cancer. Methods 90 elderly patients with lung cancer in our hospital were divided into two groups,45 cases in each group. The observation group was treated with thoracoscopic lung resection in 45 cases, the control group of 45 cases received conventional open lung cancer resection. The operation time, intraoperative blood loss, thoracic drainage time, lymph node dissection, postoperative hospital stay, pain score, pulmonary function assessment and postoperative complications were compared. Results There were no significant differences in the operation time and lymph node dissection between the two groups (P>0.05). The thoracic drainage time,intraoperative blood loss pain score and hospitalization time in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). The forced expiratory volume, forced vital capacity, vital capacity, one-second forced expiratory volume and forced vital capacity of the observation group were better than those in the control group after operation(P<0.05). Conclusion Endoscopic minimally invasive surgery may significantly reduce perioperative complications in elderly patients with lung cancer, shorten the postoperative recovery time and improve lung function.

目的 观察不同疗程吗替麦考酚酯(MMF)治疗激素依赖或激素抵抗成人微小病变肾病(MCD)的疗效和复发率。方法 2011年2月—2013年8月我院收治的25例激素依赖或抵抗成人MCD,随机分为短疗程组12例和长疗程组13例。短疗程组给予MMF联合口服泼尼松治疗6个月,观察12月,长疗程组治疗18个月,前6个月治疗同短疗程组,此后单用小剂量MMF维持,观察两组的疗效及复发率。结果 长疗程组有1例因严重感染在第2月退出研究,其余24例均完成18月的随诊;两组在治疗第6月时尿蛋白定量降低、血浆白蛋白升高,均与治疗前有差异(均P<0.05);与第6月比较,疗程结束时短疗程组尿24小时蛋白定量升高(P<0.05),长疗程组尿24小时定量无明显改变(P>0.05);治疗第6月两组均有9例完全缓解(75%),两组无差异(χ²=0.372,P>0.05);治疗第18月时与第6月比较,短疗程组6例复发(54.54%),长疗程组有2例复发(18.18%),两组复发率比较无差异(χ²=0.076,P>0.05)。结论 MMF能有效诱导缓解成人MCD,小剂量维持治疗可以有效降低复发率。

Objective To observe the efficacy and recurrence rates of mycophenolate mofetil (MMF) on hormone-dependent or steroid-resistant adult minimal change disease (MCD). Methods We retrospectively reviewed the records of adult patients at Shunde district hospital of traditonal Chinese medicine of Foshan for minimal change from February 2011 to August 2013. All patients who were hormone-dependent or steroid-resistant were collected. Twenty-five patients were randomly divided into short or long course group. The patient at short course group was given MMF combined with oral prednisone for 6 months, and the long course group was given for 18 months. Patient demographics, efficacy of medicines and recurrence rates were observed. Results Except one case of the long course group quitting at the second month because of severe infection, the other cases all finished the 18 months of follow up. At the 6 month after therapy with MMF, in both group, the 24h urine protein had lowered significantly (P<0.05) and the serum albumin level had risen remarkably (P<0.05). At the end of the follow up, compared with the 6 month after therapy, the 24 h urine protein of the short course group had increased (P<0.05), while those of the long course group had no obvious difference (P>0.05). At the 6 month after therapy, there were 9 cases achieved complete remission.There was no significant difference between the two groups (χ²=0.372, P>0.05). At the end of the follow up, compared with the 6 month after therapy, there were 6 cases experienced relapse (54.54%) in the short course group and 2 cases of those in the long course group (18.18%), but with no significant difference between them (χ²=0.076, P>0.05). Conclusion MMF can induce the remission of adult MCD efficiently, and its low dose maintenance treatment can decrease recurrence rates.

目的 评估SCORTEN评分与我国SJS/TEN患者疾病严重程度的一致性,比较单用糖皮质激素(TCS)和糖皮质激素—丙种球蛋白冲击(TCS-IVIG)联合治疗SJS/TEN的临床效果。方法 收集我院2005年6月—2015年5月住院的SJS/TEN患者,计算每例患者的SCORTEN评分,采用Hosmer-Lemeshow检验评估SCORTEN模型的预期死亡率和实际死亡率的拟合度;比较单用TCS和TCS-IVIG联合治疗的患者在疾病严重程度、住院天数、疾病控制时间和死亡率方面的差异。结果 SCORTEN模型的预期死亡率和实际死亡率之间的拟合度良好(各组P值均大于0.5);二组患者在住院天数、疾病控制时间和死亡率方面的差异没有统计学意义(P分别为0.105,0.910,0.701),但TCS-IVIG组患者的疾病严重程度显著高于TCS组(P=0.017)。结论 SCORTEN评分可以用于评估国内SJS/TEN患者的病情严重程度,并预测患者预后;与单用TCS相比,联合IVIG有助于提高重症SJS/TEN患者的救治效果。

Objectivs To evaluate the performance of SCORTEN in severity of SJS/TEN in China, and to compare the efficacy of corticosteroid therapy (TCS) and intravenous immunoglobulin combined therapy (TCS-IVIG). Methods Collected retrospectively the data of the SJS/TEN patients from June 2005 to May 2015 in our hospital. Hosmer-Lemeshow statistic were used to assess SCORTEN model calibration. And the differences between TCS group and TCS-IVIG group were compared in severity-of-illness, length of hospitalization, disease control time and mortality. Results A good calibration were found in all groups (all P＞0.5). Although the severity-of-illness in the TCS-IVIG group was significantly higher than that in the TCS group (P=0.017), there was no statistical significance between the two groups in length of hospitalization, disease control time and mortality (P=0.105, 0.910, 0.701, respectively). Conclusion SCORTEN can be used to assess the severity-of-illness in Chinese patients with SJS/TEN and to predict the prognosis. Compared with single TCS, It could improve the clinical outcomes of patients with severe SJS/TEN combined with IVIG.

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 探讨内镜下逆行胰胆管造影( ERCP) 治疗胆总管结石患者的临床疗效及其相关并发症。方法 严格筛选纳入从2012年1月—2015年1月在我院行ERCP治疗的胆总管结石患者,归纳评估ERCP手术对胆总管结石治疗的有效性及安全性。结果 359例胆总管结石患者,其中行ERCP治疗共347例,其中9例因一般情况差无法耐受手术或无法配合而未予以实施ERCP治疗,其中3例因术中穿孔转为开放手术治疗。 1次性取净结石者311例(89.6%),结石2次以上(含2次)取净者27例(7.8%),放置胆道支架者9 例(2.6%)。ERCP 术后总胆红素(61.7±103.8) μmol/L; 直接胆红素(34.7±59.6) μmol/L; 谷丙转氨酶(62.8±74.2) U/L; 谷草转氨酶(48.3±61) U/L。术后 2 h血淀粉酶(115±162) U/L,无统计学差异(P＞0.05) ,24 h血淀粉酶(124.7±215.8)U/L,与术前相比差异有统计学意义(P＜0.05) 。术后寒战、发热、腹痛、黄疸等症状均有不同程度的减轻;肝功能术后明显好转(P＜ 0.05);术后平均住院天数4～6 d;出现并发症患者16例,其中急性胰腺炎占6例,急性胆管炎占5例,出血占3例,穿孔占2例,经对症支持治疗后均治愈出院。结论 ERCP 治疗胆总管结石安全、有效,临床疗效显著,是胆胰疾病重要的诊治手段。

Objective To investigate the clinical efficacy and complications of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of common bile duct stones. Methods Cases received ERCP therapy from January 2012 to January 2015 were studied retrospectively,and evaluated the safety and efficacy of therapeutic ERCP in patients with common bile duct calculi. Results 359 Cases of patients with common bile duct stones treated successfully with 347 cases,among them 9 cases unable to implementation of ERCP because of bad surgery tolerance,3 cases of intraoperative perforation to have surgical operation treatment. The stones were removed completely one time in 311 cases(89.6%). More than two times removing net calculi in 27 cases(7.8%). 9 cases were placed biliary stent (2.6%). Postoperative total bilirubin ERCP:61.7 ±103.8 μmol / l; Postoperative bilirubin direct: 34.7±59.6 μmol/l; Postoperative ALT:62.8±74.2 U/L; Postoperative AST: 48.3±61 U/L; Postoperative 2 h blood amylase was 115±162 U/L. It showed no significant difference (P＞0.05).24 h blood amylase was 124.7±215.8 U/L,there was significant difference compared with before operation(P＜0.05). Postoperative chills,fever, pain,jaundice have different degrees of ease. Postoperative liver function was improved significantly(P＜0.05). The postoperative average length of stay in common bile duct stones was 4～ 6 days. Complications occurred in 16 cases,including 6 cases of acute pancreatitis,5 cases of acute cholangitis,3 cases of bleeding,perforation in 2 cases. After treatment they were cured and discharged. Conclusion ERCP is safe,effective in treatment of common bile duct stones. It is an important means in treatment in bile duct diseases

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