目的 研究子宫内膜异位症生育指数（EFI）评分对子宫内膜异位症（EMT）患者腹腔镜术后生育指导的应用价值。方法 对2015年3月—2017年4月于我院进行腹腔镜手术治疗的76例EMT患者进行EFI评分,并依据其结果施加相应生育指导,随访2年观察患者术后妊娠情况。结果 随访2年结果显示,76例患者共出现68例妊娠,且其妊娠率及自然妊娠率随EFI评分减少而降低,组间均有性差异（P<0.05）;68例妊娠患者足月分娩率为76.47%,同时不同EFI评分患者不良妊娠结局比较,组间均无显著性差异（P>0.05）。结论 腹腔镜手术能够提高EMT患者妊娠率及自然分娩率,同时可根据EFI评分,综合评估患者的生育状况,对于指导术后处理的选择以及指导后续治疗均有重要参考意义。

Objective To study the application value of uterine endometriosis index （EFI） on the postoperative reproductive guidance of patients with endometriosis （EMT）. Methods From March 2015 to April 2017,76 EMT patients in our hospital underwent laparoscopic surgery for EFI score. On the basis of corresponding guidance,the patients were followed up and observed for 2 years for results in postoperative pregnancies. Results The two-year follow-up period showed that there were 68 cases of pregnancy in 76 cases. Pregnancy rate and natural pregnancy rate decreased with the decrease of EFI score. There was a difference between the groups （P<0.05）. The monthly delivery rate of 68 cases was 76.47%. At the same time,there were no significant differences between the groups in the pregnancy outcomes of patients with different EFI scores （P>0.05）. Conclusion Laparoscopic surgery can improve pregnancy rate and natural delivery rate of EMT patients. At the same time,according to the EFI score,comprehensive assessment of the patient's reproductive status is important for guiding the selection of postoperative treatment and for guiding follow-up treatment.

目的 不同通道下的经皮肾镜取石术肾盂压力监测治疗鹿角形肾结石的临床分析。方法 选取我院2016年1月–2017年12月收治的鹿角形肾结石患者120例,通过随机分组,分别采用16F、18F、20F、22F、24F 作为手术通道,在气管插管全麻下置入8/9.8F 输尿管镜行经皮肾镜气压弹道碎石取石术,行经皮肾镜取石术,术中通过监测输尿管导管的压力,即肾盂内压并记录。测压系统每秒钟采集一次数据并录入数据库。观察不同通道下肾盂内压力以及取石速度。结果 在24F通道下肾盂内压力最低,与其他通道组进行比较,差异有统计学意义（P<0.05）;肾盂内压力大于40 cmH₂O时在24F通道下取石速度最短,与其他通道组进行比较,差异有统计学意义（P<0.05）;24F通道与22F通道下取石速度最快,与其他通道组进行比较,差异有统计学意义（P<0.05）。结论 肾盂内压监测使经皮肾镜取石术更加安全和精确,值得临床进一步推广应用。

Objective To investigate the pyelolithic pressure monitoring in percutaneous nephrolithotomy of different channel in treatment of renal staghorn calculi. Methods 120 patients of staghorn renal calculi in our hospital were selected from January 2016 to December 2017. These patients were randomly divided into 5 groups according to the operation channel（16F,18F,20f,22F,24F）. During operation,renal pelvis,ureter catheter pressure and operation time were recorded. Results The lowest renal pelvis pressure could be found in the 24F channel and the difference was statistically significant（P<0.05）. The lowest operation time could be found in the condition of the renal pelvis pressure of more than 40cmH₂O and 24F channel（P<0.05）. Beside of this, the fastest stone-free rate could be found in 22F and 24F channel（P<0.05）. Conclusion Monitoring of renal pelvic pressure makes percutaneous nephroscopic surgery more accurate and safety. It is worthy of clinical application.

目的 本研究旨在采用连续气道监测法对患者呼吸力学指标进行动态观察,同时监测脑电双频指数（Bispectral index,BIS）和清醒镇静评分（The Observer's Assessment of Alertness/Sedation Scale,OAA/S）,全面系统地评估右旋美托咪定（dexmedetomidine ,Dex）对患者自主呼吸功能和镇静深度的影响,为Dex临床安全应用提供参考依据。方法 80例患者随机分为四组,Dex 0.5 μg/kg组（D₁组）,1.0 μg/kg组（D₂组）,1.5 μg/kg组（D₃组）和对照组（D₀组）,每组病人20例。麻醉诱导前35min分别静脉泵注Dex或0.9%生理盐水10 mL。记录预先给药前（T0 ）、预处理后5min（T1）、10min（T2）、15min（T3）、20min（T4）、25min（T5）和30min（T6）患者的潮气量（V_T）、分钟通气量（MV）、呼气末二氧化碳分压（P_ETCO₂）、呼吸频率（RR）、第一秒呼出率（FEV₁%）、顺应性环（PV环）、阻力环（FV环）、脉搏氧饱和度（SpO₂）、心率（HR）、平均动脉压（MAP）等呼吸力学参数和循环参数及脑电双频谱指数（BIS）及警觉/镇静评分（OAA/S）,并于T0、T1、T3和T6抽取动脉血行血气分析记录PaO₂、PaCO₂和pH值。结果 与对照组相比,D₁组的V_T、RR、MV、P_ETCO₂、FEV₁%、PaCO₂和SpO₂均无变化（P>0.05）,PV环和FV环形态基本正常;D₂组和D₃组MV分别降低16.9%和27.0%;PaCO₂分别升高11.0%和19.9%;FEV₁%分别下降11.0%和14.9%。四组患者均无发生呼吸暂停,而且所有患者SpO₂均在98%或以上。D₃组自主呼吸的PV环和FV环图形面积明显缩小（P<0.05）。D₁组BIS值均在85以上,OAA/S 4分为65%,镇静满意率低,OAA/S 3分仅20%;D₂组镇静满意率最高,OAA/S 3分达70%,且无出现过度镇静;D₃组有60%患者OAA/S评分小于或等于2。结论 静脉泵注Dex所产生的的镇静效应及其对呼吸力学的影响,随着泵注Dex剂量增大,患者镇静程度加深,虽然SpO₂仍在正常范围,但呼吸会受到一定抑制（PV环和FV环图形面积缩小,PaCO₂ 均上升）,临床推荐静脉泵注Dex剂量为0.5 μg/kg~1 μg/kg以策安全。

Objective The purpose of this study was to observe the dynamic indexes of respiratory mechanics in patients with continuous airway monitoring,and to monitor the Bispectral index （BIS） and the Observer's Assessment of Alertness/Sedation Scale （OAA/S）. We evaluated the effect of dexmedetomidine （Dex） on the autonomic respiratory function and the sedative depth of the patients in a comprehensive and systematic way,so as to provide reference for the clinical safety of Dex. Methods In the study,we randomly divided 80 patients into four groups,Dex 0.5,group g/kg （group D₁）,1 group g/kg （group D₂）,1.5 g/kg group （D₃ group） and control group （D₀ group）. There were 20 cases in each group. At about 35min before anesthesia induction,Dex or 0.9% saline 10 mL was injected intravenously. The following time points were selected： pre- administration （T0）,pre-treated 5min （T1）,pre-treated 10min （T2）,pre-processed 15min （T3）,pre-processed 20min （T4）,pre -treated 25min （T5） and pre-treated 30min. The following experimental parameters were recorded at the above time point： tidal volume （VT）,minute ventilation （MV）,end expiratory carbon dioxide partial pressure （P_ETCO₂）,respiratory frequency （RR）,first second exhalation rate （FEV1%）,compliance ring （PV ring）,resistance ring （FV ring）,pulse oxygen saturation （SpO₂）,heart rate （HR）,and respiratory mechanics parameters and circulatory parameters such as mean arterial pressure （MAP）,bispectral index （BIS） and vigilance / sedation score （OAA/S）. At the same time at T0,T1,T3 and T6,arterial blood gas was extracted,and PaO₂,PaCO₂ and pH values were recorded. Results Compared with the control group,the value of VT,RR,MV,PETCO₂,FEV1%,PaCO₂ and SpO₂ in group D₁ did not change significantly （P>0.05）,and the morphology of PV ring and FV ring were basically normal. In group D₂ and group D₃,MV decreased by 16.9% and 27% respectively;PaCO₂ increased by 11% and 19.9% respectively;FEV1% decreased by 11% and 14.9% respectively. No apnea occurred in the four groups,and all patients had SpO₂ at 98% or above. The area of PV rings and FV rings of spontaneous breathing in group D₃ was reduced （P<0.05）. The BIS values in group D₁ were above 85,OAA/S 4 was 65%,sedative satisfaction rate was low,20% patients had a score of 3 in OAA/S;group D₂ had the highest sedative satisfaction rate,70% of patients had a score of 3 in OAA/S,and no excessive sedation;60% of patients in group D₃ with an OAA/S score that was less than or equal to 2. Conclusion The sedation effect that was caused by intravenous infusion of Dex and its effect on respiratory mechanics are as follows： with the increase of Dex's dose,the degree of sedation is deepened. Although SpO₂ is still in the normal range,the respiration will be restrained （the area of PV ring and FV ring is narrowed,the value of PaCO₂ is increased）,and the clinical recommendation of intravenous infusion Dex is at a dose of 0.5µg /kg~1µg /kg for safety reasons. .

目的 观察利妥昔单抗在治疗造血干细胞移植后血小板输注无效的有效性和安全性。方法 回顾分析我院2014年1月—2017年6月收治的11例利妥昔单抗治疗的造血干细胞移植后血小板输注无效的病例资料,其中包括重型地中海贫血8例,急性髓系白血病1例,重型再生障碍性贫血2例。结果 10例造血干细胞移植后血小板输注无效患者经利妥昔单抗治疗,375 mg/m²,每周1次,2~3次后血小板输注无效的状况明显改善;1例造血干细胞移植后血小板输注无效患者接受1次利妥昔单抗治疗,仍存在血小板输注无效,最终因颅内出血死亡。结论 利妥昔单抗是治疗造血干细胞移植后血小板输注无效的一种很有效的治疗方法。

Objective The purpose of our study was to evaluate the efficacy and safety of rituximab in the treatment of platelet transfusion refractoriness after hematopoietic stem cell transplantation. Methods We retrospectively analyzed 11paitents （8 thalassemia major,2 sever aplastic anemia,and 1 acute myeloid leukemia） with platelet transfusion refractoriness after hematopoietic stem cell transplantation. All 11 patients received treatment of rituximab. Results 10 of 11 platelet transfusion refractoriness patients after hematopoietic stem cell transplantation had improvement of platelets transfusion,1 patient of 11 platelet transfusion refractoriness patients had no response and died of intracranial hemorrhage. Conclusion Rituximab is a promising treatment in patients with platelet transfusion refractoriness after hematopoietic stem cell transplantation.

目的 探讨胆碱能受体激动剂尼古丁对子痫前期大鼠的治疗作用及机制。方法 将30只妊娠SD大鼠分为对照组（n =10）、子痫前期组（n =10）和尼古丁治疗组（n =10）。子痫前期组中,大鼠妊娠第14天注射内毒素（l.0 μg/kg）;对照组给予等量生理盐水2 mL,研究组妊娠第14 天开始皮下注射尼古丁1 mg/（kg·d）至妊娠第19天。检测各组干预前后收缩压、24小时蛋白、妊娠结局和大鼠外周血IL-6,TNF-α,IFN-γ和IL-1β的表达水平。结果 和对照组相比,大鼠动脉收缩压妊娠第14天注射LPS后升高,治疗组中在尼古丁注射后,妊娠第16天、第18天较子痫前期组血压下降（14.99±0.48 vs 16.61±0.55 kPa,15.01±0.60 vs 17.04±0.49 kPa,P<0.05）;大鼠24 h蛋白尿在子痫前期组中妊娠第17、19天升高（P<0.05）,尼古丁治疗组尿蛋白较子痫前期组降低（P <0.05）。妊娠第20天,子痫前期组胎儿重量和对照组相比下降（P <0.05）,尼古丁治疗组较子痫前期模型组胎儿重量增加（P <0.05）。各组间存活胎儿数、胎盘重量差异无统计学意义（P >0.05）。子痫前期组炎性因子IL-6,TNF-α,IFN-γ和IL-1β 较对照组升高,差异有统计学意义;尼古丁治疗组IL-6,TNF-α,IFN-γ 和IL-1β 降低（P <0.05）。结论 胆碱能受体激动剂尼古丁通过降低炎性反应来改善子痫前期大鼠的妊娠结局。

Objective To examine the effects and mechanism of cholinergic receptor agonist nicotine on preeclampsia rats. Methods 30 pregnant SD rats were divided into control group（n=10）,preeclampsia group（n=10） and nicotine treatment group（n=10）.In preeclampsia group,rats were injected LPS（l.0 μg/kg） on the day 14th of gestation,the control rats were injected 2 mL of physical saline on the day 14th of gestation,the rats in nicotine treatment group were injected nicotine 1mg/（kg·d） from the day 14th to the day 19th of gestation. The systolic blood pressure,24 hour urine protein,pregnancy outcome and serum levels of IL-6,TNF-α,IFN-γ and IL-1β were compared between each groups. Results Compared to control group,the systolic blood pressure rose after LPS injection on the day 14th of gestation,the systolic blood pressure in nicotine treatment group decreased on the day 16th and the day 18th of gestation compared to preeclampsia group（14.99±0.48 vs 16.61±0.55 kPa,15.01±0.60 vs 17.04±0.49 kPa,P<0.05）.The 24 hour urine in preeclampsia group rose on day 17 and day 19 of gestation（P <0.05）,which decreased in nicotine group（P <0.05）. The fetal weight were higher in nicotine treatment group compared to the preeclampsia group,there were no statisitical difference in viable fetal number and placental weight among groups. The serum levels of IL-6,TNF-α,IFN-γ IL-1β were higher in preeclampsia group compared to the control group,while nicotine decreased the levels of IL-6,TNF-α,IFN-γ IL-1β（P <0.05）. Conclusion Nicotine improved pregnancy outcome of LPS induced preeclampsia rats by decreasing inflammatory levels.

目的 为科学合理的测算公立医院人员编制以及编制管理改革提供参考。方法 对各省市公立医院机构编制标准以及相关文献进行系统分析,系统总结编制影响因素以及编制测算方法。结果 公立医院人员编制受多方面因素影响,而现阶段人员编制测算主要以床位数与门诊量为主要考量因素,其他因素为辅。结论 结合我国公立医院人事管理改革方向,在公立医院人员编制管理上,首先需要科学核定医院应配备人员总量,全方位考虑各影响因素,并设定一定的可伸缩区间,使医院可根据实际情况在一定范围内自主选择。

Objective To provide references for public hospital personnel calculation and personnel system reform. Methods The related standards of public hospitals in various provinces and literatures were analyzed systematically to sum up influence factors and calculation methods. Results Public hospital personnel complement is affected by various factors. At this stage that was mainly measured by the number of beds and outpatient service,and supplemented by other factors. Conclusion With the reform of personnel management in public hospitals in our country, in the management of public hospital staff, the first need to scientifically measure the total amount of personnel that hospital should be equipped with considering various factors. And to set an interval, the hospital may make an independent choice according to the actual situation.

目的 分析不同性别学龄儿童行为问题影响因素,为促进儿童行为健康发展提供指导依据。方法 以儿童保健门诊就诊的学龄儿童200名,男童110例,女童90例,平均年龄为(7±15)a 为调查对象,采用儿童行为量表(CBCL)检测所有调查对象的行为问题。由男/女童父母在专业人员指导下进行问卷调查,对收集的数据使用SPSS 11.0统计软件进行资料分析。结果 本次调查中男、女童年龄差异无统计学意义,男、女童在检出儿童行为问题方面有明显的差异性(P<0.05,P<0.01)具有统计学意义。男童在强迫性、违纪方面明显高于女童,女童在抑郁、社交退缩、体诉方面高于男童。结论 儿童行为问题的发生,受多方面因素影响包括社会环境、家庭环境以及父母的教养方式,应根据男童和女童的不同行为特点,给予有效的干预让孩子的身心发展更趋稳定和健康,从而降低儿童行为问题的发生。

Objective To explore the influence factors of children's behavior problem in school-age children, and to provide the evidence for promoting healthier children's behavior. Methods The objects of our study included 200 school-aged children in health care clinic (110 boys and 90 girls ), the average age is 7(7±15)years, and we used the CBCL questionnaire to assess all the children's behavior problems. The CBCL questionnaire was finished by the parents of the children guided by the specialized investigator. The data was analyzed by the SPSS 11.0 software. Results The score of boys in compulsivity and disobey is significant higher than girls(P<0.05), and the girls have higher score in depression, social flinch and physical demands than boys(P<0.01). There is no significant difference between different genders in the age of the children. Conclusion Behavior problems of children were affected by many kinds of factors including social environment, family environment and parenting styles. We need to conduct appropriate behavior intervention according to the different behavior characteristics between boys and girls, to promote healthier children's behavior and to reduce the behavior problems of children.

目的 分析16G活检针应用于肾活检的安全性。方法 选取2014年3月—2016年7月收治的142例肾脏疾病患者临床资料,将其分为对照组(71例)、观察组(71例),对照组以18G针,观察组以16G针穿刺活检,观察比较两组穿刺取材情况以及取样后并发症情况。结果 观察组穿刺次数(1.95±0.52)次较对照组(2.83±0.65)次少,样本肾小球数(23.09±6.24)个较对照组(17.26±7.13)个多(P＜0.05);观察组穿刺成功率97.23%较对照组81.69%高(P＜0.05),并发症发生率18.06%较对照组23.95%略低(P＞0.05)。结论 采用16G活检针进行肾活检效果优于18G针,其取样成功率高,并发症少,具较高安全性。

目的 探讨精液白细胞和形态正常精子百分率的相关性。方法 随机选取2014年4月—2015年8月来生殖中心进行就诊的男性800例,分析患者精液中的白细胞数量以及分析患者的精子形态,比较二者的相关性。结果 正常形态精子百分率低于正常参考值的患者中有61.9％的白细胞数大于1×10⁶,精子形态正常的患者有38.9％患者的白细胞数大于1×10⁶,患者比例差异有统计学意义(P<0.05)。精子形态正常的患者(320例)和正常形态精子百分率低于正常参考值的患者(480例)相比,精子形态正常的比例远远大于正常形态精子百分率低于正常参考值的患者(P<0.05)。而正常形态精子百分率低于正常参考值的患者的头部异常、颈部和中间部分异常、尾部异常精子比例高于正常组(P<0.05)。正常形态精子百分率低于正常参考值的和正常形态的精子比例呈正相关;和大头精子百分率、锥形以及小头形态精子百分率呈负相关;和梨形以及其他形态的精子呈正相关。结论 精液中的白细胞可以影响精子的参数,使得患者精液中的颈部或中部异常形态、头部和尾部异常形态的精子比例提升,具体机制有待进一步研究。

目的 探讨Reversine对人肝星状细胞系LX-2凋亡的影响。方法 设对照组和Reversine干预组,其中Reversine干预组分为7个浓度,分别为1,5,10,20,40,80,120 μg/mL,CCK-8法检测Reversine对LX-2增殖的影响,选取最佳浓度。将细胞重悬在加入5 μL FITC-Annexin V和5 μL PI,用流式细胞仪进行了凋亡率分析,免疫荧光检测凋亡蛋白bcl-2及caspase 3。结果 Reversine可促进LX-2细胞凋亡,随着Reversine浓度增加,LX-2的凋亡可呈剂量依赖关系,其中10 μg/mL为最佳浓度,LX-2细胞的bcl-2蛋白的表达显著下降而cleaved-caspase 3的表达显著上升。结论 Reversine可通过促进caspase-3蛋白活化、抑制bcl-2蛋白表达的方式诱导LX-2凋亡。