飞秒激光辅助的SMILE因其微创、准确性、安全性、可预测性、稳定性好的特点越来越受患者和术者的欢迎,随着大家对手术的期望值增加,视觉质量成为反应手术效果极其重要的因素之一,而高阶像差又是评定视觉质量尤为重要的指标。本文对飞秒激光SMILE的眼高阶像差及其影响因素进行综述。

Femtosecond laser-assisted SMILE is more and more popular with patients and the operators because of the minimal invasion, efficacy, safety, predictability and stability. But with the increase of people's expectations of the surgery, visual quality become one of the important factors which reacts operation effect extremely, and higher-order aberration is an especially important index when evaluate the visual quality. In this paper, the higher-order aberration and its influence factors of femtosecond laser-assisted SMILE were summarized.

目的 探讨肺淋巴管肌瘤病(PLAM)的临床特征,诊断和治疗,提高对PLAM的认识,合并顽固性低氧血症时需警惕并发肺动脉栓塞,预防漏诊及误诊。方法 回顾分析1例确诊的PLAM合并肺栓塞患者病例资料,并结合相关文献进行复习。结果 PLAM是以弥漫性肺囊性病变为特征的一种罕见的缓慢进展的肿瘤性疾病,好发于育龄期女性,临床表现为呼吸困难、反复自发性气胸和乳糜胸。肺功能多表现为阻塞性或混合性通气功能障碍和弥散功能障碍,动脉血气显示低氧血症。高分辨CT(HRCT)示双肺弥漫性薄壁囊性改变。病理学检查示肺组织淋巴管增生和扩张,管外平滑肌细胞明显增生。诊断主要依靠高分辨CT、肺功能以及病理组织活检。血管内皮生长因子D是无创且可靠的血清学诊断标准。雷帕霉素抑制剂如西罗莫司科可有效治疗本病。结论 育龄期妇女,如反复出现自发性气胸、活动后呼吸困难,胸部HRCT示双肺弥漫分布囊状改变,临床上应想到PLAM可能。随疾病的进展出现顽固性的呼吸困难、低氧血症不能纠正时,需考虑是否合并存在肺动脉栓塞的可能,CT肺动脉造影可确诊。

目的 探讨医护合作客观结构化临床考试(OSGE)培训对手术室低年资护士应急能力的影响效果。方法 对36名手术室低年资护士进行医护合作OSGE培训,于培训前和培训后3个月对低年资护士进行手术意外事件应对能力、实际参与应对手术意外事件能力以及对手术配合满意度的测评。结果 培训后低年资护士在医护配合、抢救仪器准备、抢救能力、病情评估、应对能力的得分显著提高,在护士抢救到位时间、抢救仪器到位时间、静脉穿刺成功时间明显缩短,医护对手术配合满意度明显提升,与培训前比较差异均有统计学意义(P＜0.05)。结论 对手术室低年资护士进行医护合作OSGE培训,可提高其对手术意外事件应对能力和实际参与应对手术意外事件能力,提高医护人员对手术配合的满意度,降低手术风险。

Objective To explore the effect of Objective structured clinical examination (OSGE) training on theemergency ability of nurses in the operation room. Methods Medical cooperation OSGE training was taken for 36 junior nurses in operation room. We evaluated their undergo operation contingency ability, participation contingency ability and operation cooperation in 3 months before and after training. Results After the training, the junior nurses in medical care cooperation, rescue ability, equipment preparation, condition assessment, coping ability were significantly higher. Nurses′s in-place time, equipments in place time, puncture time were shortened. Cooperation satisfaction was improved significantly. Compared with that before training, the differences were statistically significant (P<0.05). Conclusion Medical cooperation OSGE training for junior nurses in operation room may improve undergo operation contingency ability, coping contingency ability and operation cooperation, reduce the risk of surgery.

目的 分析雷替曲塞致药品不良反应(ADR)的特点及相关因素影响,为临床用药提供参考依据。方法 以“雷替曲塞”、“不良反应”、“raltitrexed”等为检索词,在中国期刊网全文数据库(CNKI)、维普中文期刊数据库等检索近5年的文献,共纳入符合标准文献28篇进行整理,分析雷替曲塞所致ADR类型及在不同给药剂量、联合化疗或同步放疗及老年患者、特殊给药途径下ADR发生的特点。结果 雷替曲塞常见的ADR包括消化系统症状、中性粒细胞减少和转氨酶升高,而中性粒细胞减少和转氨酶升高对临床治疗影响较大。给药剂量对ADR影响较小,而联合放疗会增加骨髓抑制的风险;在两药联合化疗时,雷替曲塞与长春瑞滨联合致中性粒细胞减少的风险增加;雷替曲塞引起的转氨酶升高多为Ⅰ~Ⅱ级,高龄(≥70 a)、肝转移对转氨酶升高影响不大。结论 雷替曲塞在不同治疗方案中的ADR发生存在差异,临床应用时应注意监测,防范严重和罕见ADR的发生。

Objective To Summarize the literature on adverse drug reactions(ADR) of Raltitrexed,in order to provide reference for the rational use of the drug in clinic. Methods Raltitrexed and adverse reaction were both used as key words to retrieve articles in CNKI and VIP database, 28literatures which met the inclusion and exclusion criteria were collected and analyzed. The characteristics of ADR were analyzed indifferent dosage, combined chemotherapy or radiotherapy, elderly patients and using with special administration. Results The main adverse reactions of Raltitrexed in the treatment included digestive system symptoms, neutropenia and elevation of aminotransferase, and the latter two had a great influence on the clinical treatment.Combination with radiotherapy increased the risk of myelosuppression. Incidence of neutropenia in combination Raltitrexed with Vinorelbine was higher. Transaminase elevations were generally Ⅰ-Ⅱ grades. Age(≥70 a) and liver metastasis had little effected on transaminase increase. Conclusion There were differences in the occurrence of ADR in different therapeutic schemes. Attention should be paid to ADRs of Raltitrexed especially to monitoring and reporting rare and severe ADRs in clinic.

目的 观察比较术中及术前化疗干预对进展期胃恶性肿瘤手术患者p53、ki-67表达及预后的影响,为临床化疗时间的选择提供理论依据。方法 自2014年8月—2015年5月,我院共收入胃恶性肿瘤患者40例,将40例患者随机分为两组,每组各20例,保证两组患者在性别、年龄、胃癌分期等方面可比,无统计学差异(P＞0.05),标记为Ⅰ组和Ⅱ组。Ⅰ组20例患者于术前进行化疗干预,Ⅱ组在术中给予化疗干预。观察比较两组患者p53、ki-67表达状况及预后。结果 Ⅰ组及Ⅱ组治疗后p53及ki-67均比治疗前升高,差异有统计学意义(P<0.05)。但是治疗后,Ⅰ组和Ⅱ组的p53表达状况组间差异不明显,无统计学意义(P>0.05)。治疗前后,AI差异有统计学意义(P<0.05)。Ⅰ组效果明显好于Ⅱ组,两者差异有统计学意义(P <0.05)。术后六个月、一年随访时发现两组复发率、死亡率差别不大,无统计学意义(P>0.05),术后两年随访发现Ⅱ组复发率、死亡率明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论 术中化疗的疗效优于术前化疗,患者预后较术前化疗好。

Objective To observe the effect of intraoperative and preoperative chemotherapy on the expression of p53, Ki-67 and prognosis in patients with advanced gastric cancer. Methods 40 cases of advanced gastric cancer in our hospital from Aug 2014 to May 2015 were enrolled in the study, and were divide into 2 groups randomly. In group I, 20 patients received chemotherapy intervention befoerer operation, and the other group received chemotherapy intervention during operation. The expressions and prognosis of p53 and Ki-67 were observed and compared between the two groups. Results Group Ⅰ and group Ⅱ after treatment, p53 and Ki-67 were higher than that before treatment, with statistical significance(P<0.05). However, there was no significant difference in the expression of p53 between group Ⅰ and group Ⅱ after treatment, and there was no significant difference(P>0.05). Before and after treatment, the difference of AI was significant, with statistical significance (P<0.05). The effect of group Ⅰ was obviously better than that of group Ⅱ, the difference was statistically significant(P<0.05). Six monthse after the operation and one year follow-up found two groups of recurrence rate and mortality rate had no significant difference(P>0.05). After two years follow-up found the group Ⅱ recurrence rate, mortality was lower than in group Ⅰ (P<0.05). Conclusion The effect of intraoperative chemotherapy is better than that of preoperative chemotherapy, and the prognosis is better than that of preoperative chemotherapy.

目的 探索不同浓度苯妥英钠(PHT)对大鼠牙周膜干细胞(rat periodontal ligament stem cells, rPDLSCs)粘附于牙根面的影响,为PHT应用于牙周重建提供一定的实验依据,为牙周炎的治疗提供了新思路。方法 提取大鼠rPDLSCs,培养并纯化。通过多项诱导分化、表面标记物鉴定后,使细胞在不同浓度PHT刺激条件下,与牙骨质片共同培养,检测粘附于牙骨质片上的细胞量并作比较。结果 20～80 mg/L 浓度范围内的PHT能够促进rPDLSCs的粘附数量,40 mg/L PHT组促进粘附的效果最强。实验组与对照组有显著统计学差异。结论 适合浓度的PHT可以促进rPDLSCs粘附于牙骨质表面,40 mg/L PHT组促进粘附的效果最强。

Objective To investigate the effects of PHT on attachment of rat periodontal ligament stem cells (rPDLSCs) to cementum chips, in order to provide a certain experimental basis for periodontal regeneration and new ideas for therapy of periodontitis. Methods To isolate rPDLSCs from SD rats, culture and purify them. To identify the cells by their apperance, induced multi-direction differentiation potential and cell surface markers. The rPDLSCs were cultured with cementum chips under the action of different concentrations of PHT. Then testing and comparing the amount of cells attached on the cementum chips in different groups. Results The concentraion among 20～80 mg/L of PHT can increase the number of attached cells. 40 mg/L PHT can promote the cells attachment mostly. Conclusion A proper concentration of PHT may promote rPDLSCs to attach to cementum chips′ surface, 40 mg/L PHT may promote the cell attachment mostly.

目的 探讨快速康复外科(enhanced recovery after surgery, ERAS)理念在膀胱癌根治加回肠膀胱术后护理的有效性和安全性。方法 分析我院2012年1月—2016年12月行膀胱癌根治加回肠膀胱术的患者共98例,其中ERAS组47例,传统组51例。比较两组术后伤口感染率、出血率、吻合口瘘率、肺部感染率及术后住院日等指标。结果 两组患者的伤口感染率、出血率、吻合口瘘率无差异,ERAS组的肺部感染率4.26%低于传统组21.57%,差异有统计学意义(P＜0.05)。ERAS组的术后住院日短于对照组[(8.53±1.82)vs (13.21±2.16)],差异有统计学意义(P＜0.05)。ERAS组的30天内再入院率6.38%低于传统组19.61%,差异有统计学意义(P＜0.05)。两组的非计划再次手术率无统计学差异。结论 快速康复外科理念应用在膀胱癌根治加回肠膀胱术后护理是有效和安全的,ERAS能减少术后并发症及缩短术后住院日。

目的 研究多排螺旋CT低剂量扫描在浸润型肺结核化疗期间复查的应用价值。方法 选取100例浸润型肺结核化疗期病人为研究对象,对选取100例患者行常规剂量胸部CT扫描后再行低剂量扫描。比较常规剂量组和低剂量组CT扫描的图像质量及疗效评估。结果 两组扫描肺窗图像质量比较无统计学差异(P＞0.05);两组肺窗薄层多平面重建图像质量比较无统计学差异(P＞0.05); 两组软组织窗图像质量有统计学意义(P< 0.05)。观察组ED、DLP和CTDIvol等指标低于对照组(P＜0. 01),即观察组受检者CT扫描辐射剂量低于对照组(P＜0.01)。结论 多排螺旋CT低剂量胸部扫描用于浸润型肺结核的复查,可以获得与常规剂量接近的肺窗图像质量,满足肺结核病灶的分析评估,并可有效减少胸部CT扫描中的辐射剂量;既能满足肺结核复查的疗效评估,又提高了肺结核CT复查的安全性,还有效节约检查成本。

Objective To study the application of low-dose scan of multidetector row CT(MDCT)in the chemotherapy of infiltrative tuberculosis. Methods 100 patients with infiltrative pulmonary tuberculosis who were under treatment were selected. All patients accepted conventional-dose and low-dose scan of MDCT. The image quality and treatment effect of two groups were compared. Results The image quality on lung window of two groups did not differ significantly(P＞0.05). The image quality on lung window with multiplanar reconstruction of two groups also did not differ significantly(P＞0.05). The image quality on soft-tissue window differed significantly (P<0.05). The ED, DLP and CTDIvol of the low-dose group were significantly lower than those of the conventional-dose group. Conclusion For MDCT follow-up examination of patients with infiltrative tuberculosis, the image quality on lung window with low dose is similar to the image quality with conventional dose. It may effectively reduce the exposure dose of CT examination. This cost-effective modality not may can meet the curative effect evaluation of TB, but also can improve the security of the follow-up examination of patients.

目的 探究儿童抗NMDA受体脑炎临床特点、诊治及预后。方法 回顾性分析16例儿童抗NMDA受体脑炎的临床表现、辅助检查、治疗与预后。结果 16例患儿中,意识障碍16例, 语言障碍15例,运动障碍13例,11例惊厥发作。9例脑脊液NMDA受体抗体阳性,14例血清NMDA受体抗体阳性。16例患儿脑电图均出现背景中高波幅慢活动,头颅磁共振检查未见异常。所有患儿均接受丙种球蛋白联合激素冲击治疗,14例症状缓解,2例需加用利妥昔单抗治疗,症状缓解。结论 识别儿童抗NMDA受体脑炎多样临床表现,筛查NMDA受体抗体有助于早期诊断及治疗儿童抗NMDA受体脑炎。

Objective To investigate clinical features, diagnosis, treatment and prognosis of the patient with anti-NMDA receptor encephalitis in children. Methods The data of clinical feature,auxiliary examination of 16 cases with anti-NMDA receptor encephalitis in children were reviewed and analyzed. Results Of all 16 cases, there were 16 cases with decreased consciousness, 15 cases developed speech alteration, 13 cases developed movements disorder and 11 cases with seizure. Cerebrospinal fluid NMDA antibody were positive in 9 cases and serum NMDA antibody were positive in 14 cases. The EEG of 16 patients showed high-amplitude slow activity in the background. There were no significant abnormalities in head magnetic resonance imaging (MRI) of all children. After all children received gamma globulin combined hormone therapy, 14 cases had boen improved and another 2 cases need to be further treated combined with Rituximab. Conclusion Pediatric patients had diverse clinical manifestations. Screening of NMDA receptor antibody may help early diagnosis of anti-NMDA receptor encephalitis. And timely treatment may yield a favorable prognosis.

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.