目的 本研究旨在探讨肺癌合并肺栓塞的相关危险因素及肺栓塞对肺癌患者预后的影响。方法 检索2000年1月—2020年3月万方、中国知网、维普期刊、Medline Pubmed及EMBASE数据库中所有相关文献,并使用RevMan 5.3软件进行统计分析。结果 9项临床病例对照研究共1 179例患者纳入本研究。分析结果显示肺癌合并肺栓塞患者的中位生存时间明显低于单纯肺癌患者(HR=2.82,95%CI[2.06,3.87],P＜0.000 1)。危险因素分析显示腺癌发生肺栓塞的风险高于非腺癌(比值比(OR)=3.07, P＜0.000 1),III-IV期患者发生肺栓塞的风险明显高于I-II期患者(OR=2.97,P＜0.000 1),D-二聚体水平高的患者发生肺栓塞的风险是正常患者的4.32倍(P<0.000 1),白细胞(WBC) >11×109/L的患者发生肺栓塞的风险是WBC≤11×109/L患者的6.62倍(P＜0.000 1)。化疗史和中心静脉置管显著增加肺栓塞风险,OR值分别为3.02 (P＜0.000 1)和2.30 (P＜0.000 1)。然而,吸烟史、饮酒史、性别、糖尿病、COPD、高血压病等临床因素与肺栓塞发生无统计学相关性。结论 肺栓塞的发生明显影响肺癌患者的预后,其相关的危险因素为病理类型、分期、化疗史、中心静脉导管置入史、D-二聚体升高、白细胞＞11×10⁹/L。

Objective To investigate the risk factors of developing pulmonary embolism and its influence on the prognosis of lung cancer patients. Methods The following databases such as Wanfang Database, China National Knowledge Infrastructure (CNKI), Chinese Weipu Database, Medline Pubmed and EMBASE were searched to identify relevant articles which were published during January 2000 to March 2020. Statistical analysis was performed using RevMan 5.3 software. Results 9 controlled trials incorporating 1 179 patients were included in this study. The results showed that the overall survival of lung cancer patients complicated with pulmonary embolism was significantly lower than that of lung cancer patients without pulmonary embolism (HR=2.82, 95%CI[2.06,3.87], P<0.000 1). The analysis on risk factors of developing pulmonary embolism showed that adenocarcinoma had a higher risk of pulmonary embolism than non-adenocarcinoma with Odds Ratio (OR)=3.07 (P<0.000 1). Patients in stage III-IV encountered significantly higher risk of pulmonary embolism than those in stage I-II (OR=3.07,P<0.000 1). Furthermore, the risk of pulmonary embolism in patients with high level of D-dimer was 4.32 times higher than in normal patients (P<0.000 1), and 6.62 times higher than those with WBC ≤11×10⁹/L (P<0.000 1). Additionally, the history of chemotherapy and central venous catheterization significantly increased the risk of pulmonary embolism, with OR of 3.02 (P<0.000 1) and 2.30 (P<0.000 1), respectively. However, smoking, alcohol consumption, gender, diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease, hypertension were not statistical correlated with the occurrence of pulmonary embolism in lung cancer patients. Conclusion The occurrence of pulmonary embolism significantly affects the prognosis of patients with lung cancer, and the related risk factors were pathological type, stage, chemotherapy, central venous catheterization, increased D-dimer level, and WBC>11×10⁹/L.

目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.

目的 探讨无偿献血者ABO血型正反定型初筛结果不一致的原因分析。方法 选取2019年6月1日—2020年11月30日本血站的无偿献血者样本,采用Metis150全自动血型分析仪进行ABO正反定型初筛。初筛结果正反定型不一致先进行试管法复核,结果仍不一致时送血型参比实验室做进一步确认,并对造成ABO血型正反定型不一致的原因进行分析。结果 44 808例无偿献血者样本中初筛结果ABO血型正反定型不一致134例,发生率为0.30%。导致ABO正反定型不一致原因为:因方法学不同可经盐水介质试管法复检确认65例(48.51%);吸取红细胞或血浆异常加样量不准确25例(18.66%);仪器判读错误4例(2.98%);血型参比实验室通过延长反应时间或改变反应温度确定因抗体缺失或减少22例(16.42%)、冷凝集素2例(1.49%);增加抗A1、抗AB、抗H血清和吸收放散试验确定亚型6例(4.48%)、抗原减少2例(1.49%);洗涤自身红细胞吸收放散后定型、吸收后血清反定型确定不规则抗体8例(5.97%)。40例血型参比实验ABO血型血清学检测结果为:O型21例(52.50%)、A型8例(20%)、B型7例(17.5%)、AB型4例(10.00%)。结论 ABO血型正反定型不一致的原因很复杂。严格规范操作,减少不规则抗体对结果的影响,防止弱亚型的漏检等有效措施确保临床输血的安全。

目的 分析脑出血(intracerebral hemorrhage,ICH)在SWI和CT中的影像学表现,比较SWI和CT两种检查方式在ICH及脑微小血管出血(cerebral microbleeds,CMBs)中的优势。方法 采用回顾性分析2018年1月—2019年12月在广州市第一人民医院收治的76例疑诊ICH患者行SWI及CT检查,对确诊为ICH及CMBs的病例数据进行统计。结果 SWI与CT在ICH诊断结果的比较,差异无统计学意义(P>0.05);在CMBs诊断结果的比较中,SWI诊断准确率高于CT(P<0.05);另外在SWI与CT的联合检查中,诊断准确率高于SWI与CT独立检查。结论 脑出血患者的SWI和CT的影像表现均能将出血灶显示清楚,除此之外,SWI还能发现CT未能发现的有关血管的微小病灶。SWI作为一种新型技术,在ICH及CMBs方面起着至关重要的作用,与CT相辅相成。两者在医疗诊断中扮演着不可或缺的角色,为医疗的精准实施保驾护航。

目的 观察翘芩清肺剂中药免煎颗粒剂及饮片煎煮剂的体外抑制金黄色葡萄球菌和鲍曼不动杆菌抑菌的效果,以评估其体外抑菌效果的差异,为翘芩清肺剂临床应用提供新的思路及科学依据。方法 使用KB试纸扩散法和改良液体稀释法观察翘芩清肺剂中药免煎颗粒剂和饮片煎煮剂对金黄色葡萄球菌ATCC25923、鲍曼不动杆菌ATCC19606的最小抑菌浓度(MIC)。结果 用KB法检测颗粒冲服剂和饮片煎煮剂金黄色葡萄球菌最低抑菌浓度为1.38 g/mL(P<0.01);鲍曼不动杆菌最低抑菌浓度为2.75 g/mL(P<0.01)。用改良液体稀释法冲服剂金黄色葡萄球菌最低抑菌浓度为10.0 g/mL(P<0.01);鲍曼不动杆菌最低抑菌浓度为5.5 g/mL(P<0.01)。煎煮剂两菌MIC均为5.5 g/mL(P<0.01)。饮片煎煮剂效果较冲服剂好(P<0.01)。结论 翘芩清肺剂中药免煎颗粒冲服剂及饮片煎煮剂均可有效抑制金黄色葡萄球菌和鲍曼不动杆菌的生长,饮片煎煮剂的抑菌效果比免煎颗粒剂较优;对鲍曼不动杆菌的抑菌效果均较金黄色葡萄球菌弱,但无显著性差异性。

Objective To observe the antibacterial effects of Qiaoqinqingfei traditional Chinese medicine decoction and herbal concentrate-granules on Staphylococcus aureus (SA) and Acinetobacter baumannii (AB) in vitro. To assess the different antibacterial effects in vitro between them. It would provide a new idea and scientific basis for the clinical application of Qiaoqinqingfei Formula. Methods The KB test paper diffusion method and modified liquid dilution method were used to observe the minimum inhibitory concentration (MIC) of Qiaoqinqingfei traditional Chinese medicine decoction and herbal concentrate-granules on the Staphylococcus aureus ATCC25923 and Acinetobacter baumannii ATCC19606. Results The MIC of SA and AB in the two form of Qiaoqinqingfei were 1.38 g/mL (P<0.01) and 2.75 g/mL(P<0.01) by the KB test paper diffusion method. The MIC of SA and AB in herbal concentrate-granules of Qiaoqinqingfei were10.0 g/mL (P<0.01) and 5.5 g/mL (P<0.01) by the modified liquid dilution method. And the MIC of SA and AB in decoction both were 5.5 g/mL (P<0.01) in traditional Chinese medicine decoction of Qiaoqinqingfei. Decoction was better than granules (P<0.01). Conclusion Traditional Chinese medicine decoction and herbal concentrate-granules of Qiaoqinqingfei may both effectively inhibited the growth of SA and AB. The bacteriostatic effect of decoction was better than decoction-free granules. The bacteriostatic effect of AB was weaker than Staphylococcus aureus, but there was no significant difference between them.

目的 了解广州市区全血乳糜血报废的趋势变化和献血人群特征,并分析其背后的原因,为进一步减少全血乳糜血报废提供参考依据。方法 通过广州血液中心信息系统检索,统计2017—2019年期间中心全血乳糜血报废量、报废率等相关数据,并分层统计性别、年龄、献血方式与报废的关系,提出有效减少乳糜血报废的对策。结果 2017—2019年期间广州血液中心共采集制备3 003 998单位血液,因乳糜血原因报废的血液达69 311单位,报废率2.31%,占总报废的44.02%。其中,男性献血者乳糜血报废率显著高于女性献血者,报废血液主要为18～40岁年龄段的无偿献血,约一半报废血来自团体献血者。结论 加大献血知识的宣传,特别是团体献血者;做细献血前征询工作和献血后跟踪随访;关注男性和年轻献血者,进一步减少全血乳糜血报废几率。

Objective To evaluate the trend of scrapped chylemia blood in whole blood collection and the characteristics of blood donors in urban area of Guangzhou, analyze the reasons behind so as to provide reference for further reducing chylemia blood scrapped. Methods Search the whole blood collection and scrapped chylemia blood data from 2017 to 2019 through the information system of Guangzhou Blood Center, stratifiy gender,age,donation way, and look for solutions. Results 3 003 998 U blood component were collected and prepared from 2017 to 2019. Totally 69 311 U chylemia blood were scrapped due to chylemia blood, accounting for 44.02% of the total discarded blood. Scrapped chylemia blood rate were significantly higher among male blood donors than among female donors,and mainly aged from 18-40 donors. About half of the discarded blood came from group donors. Conclusion Greater efforts to publicize especially for group donors,careful consultation before blood donation and follow-up after blood donation should be taken. We should pay close attention to male and young blood donors, so as to further reduce the possibility of scrapped chylemia blood.

目的 探讨品管圈活动在降低使用肠内营养制剂患者肠内营养相关性腹泻发生率的应用效果。方法 由全科医学科的11名护士组成品管圈小组,按品管圈实施步骤首先确定“降低使用肠内营养制剂患者肠内营养相关性腹泻的发生率”为活动主题,对肠内营养患者发生腹泻的情况和护士对肠内营养相关性腹泻认知情况进行现状调查,分析引起肠内营养相关性腹泻的原因,制定并实施相应的整改措施。结果 开展品管圈活动后使用肠内营养制剂腹泻率由原来的50%降低到21.03%,两者差异有统计学意义(χ²=24.859,P＜0.001)。将肠内营养制剂加温到38 ℃～40 ℃输注的腹泻率为28.10%,在常温下20 ℃～29 ℃输注的腹泻率为14.5%,两者差异有统计学意义(χ²=7,P＜0.05),达到了目标值;开展品管圈后圈能力较开展前高,差异有统计学意义(P＜0.05)。结论 开展品管圈活动可有效降低使用肠内营养制剂患者相关性腹泻的发生率,同时增强护理人员质量管理能力。

Objective To investigate the efficacy of quality control circle(QCC) activities in reducing the incidence of enteral nutrition-related diarrhea in patients using enteral nutritionpreparations. Methods According to the QCC's steps, 11 nurses from general medicine department participated in the QCC group first determined the theme as:Reduce the incidence of enteral nutrition preparations correlated diarrhea in patients with enteral nutrition.The situation of diarrhea in patients with enteral nutrition and the cognition of nurses on enteral nutrition-related diarrhea were investigated, the causes of enteral nutrition-related diarrhea were analyzed, and corresponding corrective measures were formulated and implemented. Results After carrying out the QCC program, the incidence rate of enteral nutrition preparation-associated diarrhea decreased from 50% to 21.03%, the result indicated statistical significance(χ²=24.859,P＜0.001). The diarrheal rate for warmed enteral nutrition preparations at 38℃-40℃ was 28.10%, and for those under room temperature at 20℃-29℃ was 14.5%, the result of these two groups indicated statistical significance (χ²=7,P＜0.05),target number was achieved. The ability of quality control for the nurses are improved compared to that before QCC activity, noted statistical significance (P＜0.05). Conclusion QCC activity has effectively reduced the incidence of diarrhea in patients who use enteral nutrition preparations as well as enhance the management ability of nurses in providing quality care.

目的 观察低出生体重早产儿应用抗生素后肠道菌群的动态变化。方法 选取2018年6月—2019年7月在广州市第一人民医院住院的10名低出生体重早产儿,在出生时、出生后1~2周、出生后2~3周、出生后3~4周、出生后4~5周、出生后5~6周时分别收集粪便样本,通过16s高通量测序检测患儿粪便菌群变化并统计分析。结果 应用抗生素后的低出生体重早产儿肠道菌群α多样性(Shannon指数、Simpson指数、ACE指数和PD_whole_tree指数)下降(P均<0.05),肠道菌群结构在门、科、属水平均发生改变,其中Alistipes、Bacteroides、Lactobacillus、unidentified_Lachnospiraceae、unidentified_Ruminococcaceae、Alloprevotella、unidentified_Cyanobacteria、Bacillus、Stenotrophomonas和Acinetobacter菌属相对丰度减少(P均<0.05)。结论 低出生体重早产儿应用抗生素后肠道菌群多样性下降,肠道菌群结构发生改变,并在抗生素停用后仍持续,针对性补充益生菌或益生元可能有助于肠道菌群恢复稳态。

Objective To observe the dynamic changes of gut microbiota in premature infants with low birth weight after antibiotics therapy. Methods 10 low birth weight premature infants hospitalized in Guangzhou First People's Hospital from June 2018 to July 2019 were included. Fecal samples were collected at birth, 1~2 weeks after birth, 2~3 weeks after birth, 3~4 weeks after birth, 4~5 weeks after birth and 5~6 weeks after birth, respectively. The changes of fecal microbiota were detected and analyzed by 16s high-throughput sequencing. Results The α-diversity of gut microbiota (Shannon index, Simpson index, ACE index and PD_whole_tree index) in low birth weight preterm infants treated with antibiotics decreased (P<0.05). The structure of gut microbiota changed at phylum, family and genus levels, among which Alistipes, Bacteroides, Lactobacillus, unidentified_Lachnospiraceae, unidentified_Ruminococcaceae, Alloprevotella, unidentified_Cyanobacteria, Bacillus, Stenotrophomonas and Acinetobacter decreased (P<0.05). Conclusion The diversity of gut microbiota in low birth weight preterm infants decreased and the structure of gut microbiota changed after antibiotic therapy. Targeted supplementation of probiotics or prebiotics may contribute to the recovery of gut microbial homeostasis.

目的 比较唑来膦酸对 PVP(椎体成形术)治疗OVCF(骨质疏松椎体压缩性骨折)术后再发骨折的影响。方法 收集2016年12月—2018年6月在我院骨科接受PVP治疗患者共70例,其中40人在术后接受了唑来膦酸治疗(观察组),30人在术后接受了安慰剂治疗(对照组),两组患者均给予维生素D和钙剂基础治疗。记录术后6个月、1年、2年腰椎骨密度;术后2年内伤椎及邻近椎体再发骨折情况。结果 观察组伤椎再发骨折率(1/40,2.5%)低于对照组(2/30,6.67%)(P＜0.05);观察组邻椎再发骨折率(2/40,5%)低于对照组(7/30,23.33%)(P＜0.05)。结论 唑来膦酸能较好地预防PVP术后再发骨折。

Objective To compare the effect of zoledronic acid on the treatment of osteoporotic vertebral compression fracture after percutaneous vertebroplasty PVP. Methods From December 2017 to June 2019, a total of 70 patients who received PVP in the hospital medical plastic surgery clinic, 40 patients were collected received zoledronic acid (group A) and 30 patients received placebo (group B) after operation. Both groups received basic treatment of vitamin D and calcium. The bone mineral densits (BMD) of lumbar vertebrae were recorded at 6 months, 1 year and 2 years after operation, and the recurrent fractures of injured vertebrae and adjacent vertebrae were recorded at 2 years after operation. Results The rate of recurrent fracture of vertebrae in group A (1/40, 2.5%) was lower than that in group B (2/30, 6.67%); the rate of recurrent fracture of adjacent vertebrae in group A (2/40, 5%) was grcartly lower than that in group B (7/30, 23.33%). Conclusion Zoledronic acid can prevent recurrent fracture after PVP.

目的 氧气雾化吸入体位对颈椎前路减压植骨融合术后吞咽困难的影响。方法 将在2017年2月—2019年10月期间行颈椎前路减压植骨融合术患者(2～3节段)123例随机分成两组:A组(n=56,半卧位行氧气雾化), B组(n=67,平卧位行氧气雾化)。比较两组术后吞咽困难发生及程度、持续时间情况和患者对氧气雾化吸入方法满意度。结果 A组术后吞咽困难发生率低于B组(P=0.042),并且吞咽困难程度动态变化中总体优于B组;两组吞咽困难持续时间无统计学差异(P=0.826)。A组患者对氧气雾化吸入方法满意度优于B组患者(P=0.022)。结论 半卧位氧气雾化吸入能降低颈椎前路术后吞咽困难的发生及严重程度。

Objective To investigate the effect of aerosol inhalation position on dysphagia after multi-segment anterior cervical decompression and bone graft fusion. Methods 123 patients undergoing anterior cervical decompression and bone graft fusion during February 2017 to October 2019 were randomly divided into two groups: group A (n=56, aerosol inhalation in semireclining position), group B (n=67, aerosol inhalation in the supine position). The incidence, extent and duration of dysphagia were compared between the two groups. Results The incidence of postoperative dysphagia in group A was lower than that in group B (P=0.042), and the degree of dysphagia were better than that in group B in the dynamic changes. There was no statistical difference in the duration of dysphagia between the two groups (P=0. 826). Patients in group A had greatly better satisfaction with the aerosol inhalation position than patients in group B (P=0.022). Conclusion Aerosol inhalation in semireclining position can reduce the incidence and severity of dysphagia after anterior cervical spine surgery.