目的 比较不同浓度罗哌卡因横纹肌阻滞应用于剖宫产术后镇痛的临床效果。方法 选取2015年3月—2016年3月于我院剖宫产的孕妇300例,随机分为A组、B组、C组,每组100例,A组产妇给予质量浓度为1.5 g/L的罗哌卡因1.5 mg/kg,B组产妇给予质量浓度为2 g/L的罗哌卡因1.5 mg/kg,C组产妇给予质量浓度为2.5 g/L的罗哌卡因1.5 mg/kg,同时给予所有产妇镇痛泵辅助镇痛。记录观察所有产妇术后6 h、12 h、24 h、36 h、48 h的疼痛视觉模拟评分(VAS)、镇痛泵按压次数、产妇对镇痛效果的满意程度以及腹横肌平面阻滞(TAP)不良反应发生情况。结果 B、C组产妇的VAS评分均低于A组产妇(P＜0.05),24 h后C组产妇的VAS评分低于B组产妇(P＜0.05);与B、C组产妇相比,A组产妇的镇痛泵按压次数更多,镇痛效果满意度较低(P＜0.05),同时B组产妇的镇痛泵按压次数多于C组产妇(P＜0.05);3组产妇均未出现术后不良反应。结论 使用质量浓度为2.5 g/L的罗哌卡因横纹肌阻滞进行剖宫产术后镇痛,效果显著、安全性较高,临床中可推广使用。

Objective To compare the clinical effects of different concentrations of ropivacaine for postoperative analgesia after cesarean section. Methods 300 cases of pregnant women undergoing cesarean section in our hospital from March 2015 to March 2016 were selected and were randomly divided into group A, group B and group C with 100 cases in each group. The patients in group A were given 0.15% ropivacaine 1.5 mg/kg, 0.20% ropivacaine 1.5 mg/kg in group B and 0.25% ropivacaine 1.5 mg/kg in group C, and at the same time all the pregnant women were given analgesic pump assisting analgesia. The pain visual analogue scales (VAS) of the pregnant women were recorded at 6 hours, 12 hours, 24 hours and 36 hours after cesarean section and the number of times of analgesia pressing pump were also recorded. The satisfaction degree of analgesic effect and the TAP occurrence of adverse reactions of the patients were also recorded. Results The VAS scores of group B and group C were lower than that of group A(P<0.05). 24 hours after cesarean section, the VAS score of group C was lower than that of group B (P<0.05). Compared with group B and C, the number of times of analgesia pressing pump in group A were more but the analgesic effect of satisfaction was lower (P<0.05), and at the same time the number of times of analgesia pressing pump in group B were more than those in group C (P<0.05). No adverse reactions were found in the three groups. Conclusion The treatment of using of 0.25% of ropivacaine for muscle block for postoperative analgesia after cesarean section is effective and safe, which may be widely used in clinical practice.

目的 探讨逍遥散治疗首发抑郁症的疗效与5-HT2A受体基因多态性的关联。方法 采用病例对照研究方法,以120例首发抑郁症患者(研究组)和120例正常人(对照组)为研究对象,研究组予逍遥散治疗,疗程8周。于治疗前后采用汉密顿抑郁量表评定。采用高温连接酶检测反应法(LDR)检测5-HT2A受体基因,分析其与抗抑郁药物疗效的关系。结果 5-HT2A受体基因(T102C)T／C基因型、C／C基因型频率及等位基因频率与对照组相比差异无统计学意义(P﹥0.05)。不同基因型的疗效无差异(P﹥0.05)。结论 5-HT2A受体基因(T102C)多态性与逍遥散治疗抑郁症的疗效无关联。

目的 比较胆总管切开探查术后留置T管和胆总管切开探查并一期缝合术后胆管内支架引流这两种模式治疗胆管疾病的手术疗效。方法 对2012年—2014年期间收治的90例需择期行胆总管探查的患者进行前瞻性随机对照研究。按照实验方式分为T管组40例和单管内支架组50例。对比分析两组胆总管置管缝合手术时间、住院时间、治疗总费用、生活质量指数值以及并发症发生率,包括引流失败率(T管滑脱、内支架管滑脱、移位)、胆漏、胆道感染、胰腺炎和残石率。结果 开腹胆总管探查术术后内支架引流患者的出院前生存质量评价高于T管引流患者,住院时间少于T管引流患者,置管及胆管缝合时间长于T管引流患者(均为P＜0.05);术后两组患者间的治疗总费用和非计划脱管、胆漏、胆道感染、胰腺炎、残石率和不能拔/脱管等术后并发症发生率的差异无统计学意义(P＞0.05)。结论 内镜下胆道支架内引流术(Endoscopic retrograde biliary drainage,ERBD)移植于胆总管切开探查并一期缝合术具有可行性、安全性及治疗效果确切,显著缩短患者住院时间、加快患者康复提高患者出院前的生存质量,并放宽胆总管一期缝合指征。

Objective To compare the clinic research between biliary stent insertion drainage and T-tube drainage after choledochotomy. Methods The clinical data of 90 cases from 2012 to 2014 were analyzed in a prospectively randomized trial, and they were divided into two groups by T-tube drainage and biliary stent insertion drainage. Cathetering and suture time, length of stay, hospital costs, life quality and incidence of complications were compared, respectively. Results After open common bile duct exploration (OCBDE), the life quality of stent group was significantly higher than that of T-tube group, the length of stay in stent group was shorter, and cathetering and suture time of bile duct in stent group was longer than that of T-tube group (P＜0.05); There were no significant differences between the two groups in the hospital costs and incidences of postoperative complications including bile leakage, early stent dislodgement, biliary infection, pancreatitis and residual stone (P＞0.05). Conclusion Endoscopic retrograde biliary drainage (ERBD) with primary closure after choledochotomy is a safe, effective and feasible procedure for the management of choledocholithiasis, it can significantly reduce the postoperative hospital stay and improve the life quality of patients and expand the indications for primary closure of CBD incision.

目的 了解广东省某区级三甲综合医院住院老年人慢性非传染性疾病(慢非病)疾病谱及性别差异随年度推移的变化。方法 回顾性分析南方医科大学附属南海医院2006—2014年老年人出院资料。结果 住院老年人疾病谱中名列前位的疾病除了肺炎、急性胃肠道疾病,余为慢非病。慢非病比例逐年下降(65.8%~57.8%, P<0.01),疾病谱明显变化:脑血管疾病由第一位占21.3%降至17.0%居第二,恶性肿瘤从10.4%升至18.8%居第一。性别有差异:男性慢阻肺和恶性肿瘤的构成比多于女性;慢非病比非慢非病、男性比女性慢非病的人均住院总费用高(P<0.05)。结论 总结9年来南海区三甲综合医院住院诊治的慢非病居高及攀升病种、性别差异,制定措施优化医疗资源配置、减轻社会经济负担。

Objective To analyze the alteration of disease distribution and gender-differences of chronic non-communicable diseases (NCD) in hospitalized elderly from a large Comprehensive Hospital of Guangdong province. Methods Retrospective observational study including profile of discharged elderly in Nanhai hospital attached to Southern medical university from the year 2006 to 2014. Results In the top rank of diseases in hospitalized elderly, all were NCDs other than pneumonia and acute gastrointestinal diseases. The proportion of NCD accounted for all hospitalized elderly was reduced year by year, changed from 65.8% to 57.8%, P<0.01. Disease distribution of NCD altered obviously, showing that cerebrovascular disease (CVD) decreased from the first 21.3% to the second 17.0%, malignancy increased from 10.4% to 18.8% ranking as the first. Gender-differences did exist. Greater constituent ratio of chronic obstructive pulmonary disease (COPD) and malignancy were found in men than women yearly. NCD showed higher hospitalized expenses than non-NCD per capita, that of men were higher than women (P<0.05). Conclusion Summarizing the top and increasing rank of NCD and gender-differences in hospitalized elderly in a large comprehensive hospital, Nanhai district, Foshan city of 9 years, policy and program could be guided to optimize the distribution of medical resources and try to reduce the output of social economic burden.

目的 观察HB13对SD大鼠的一般生殖毒性。方法 SD大鼠,雌雄各100只,分为低、中、高剂量组(20、40和80 mg/(kg·d))和对照组(0.5%羧甲基纤维素钠溶液),每组25只。雄鼠于交配前28 d给药,雌鼠于交配前14天给药,给药至妊娠第7天。雄鼠交配后处死,孕鼠于妊娠第14天颈椎脱臼处死,观察HB13对雌雄鼠一般情况、生育力和胚胎发育的影响。结果 与对照组相比,HB13高、中剂量组雄鼠给药期体重减轻,睾丸系数及附睾系数增大,异常精子率升高;高剂量组还使雄鼠生育力降低。给予高、中剂量HB13的雌鼠妊娠后体重较对照组减轻,着床后丢失率增高,吸收胎数增加,活胎数减少,连胎子宫重降低;高剂量组HB13还使雌鼠生育率及着床数降低,着床前丢失率升高。结论 HB13低剂量对雌、雄性大鼠无一般生殖毒性;中剂量对孕鼠早期胚胎发育有明显干扰作用;高剂量对雌、雄大鼠生育力有显著降低作用并且对早期胚胎发育有明显干扰作用。

Objective To study the general reproductive toxicity of HB13 in SD rats. Methods SD rats, 100 females and 100 males, were divided into low, medium and high dose groups 20, 40 and 80 mg/(kg·d) and the control group (0.5% CMC-Na), The rats were given HB13 for 28 days in male rats and 14 days in female rats respectively before mating, and then mated. The HB13 treatment continued until the 7th day of pregnancy. When the female rats were confirmed pregnant, the male rats were executed and the female rats were executed on the 14th day of pregnancy. Then we can observe the effect of HB13 on fertility and embryonic development in rats. Results Compared with the control group, the body weight of medium, high dose group reduced significantly, the coefficient of testicular and epididymis, abnormal sperm rate increased significantly. High dose group of HB13 also made the fertilityof male rats decline; The body weight, live births uterus weight (including the fetus) of pregnant rats in high and medium group decreased significantly. At the same time, the rate of lost oosperm and absorbed embryo increased. The high dose group of HB13 can also reduce the fertility of female rats. Conclusion The low dose group of HB13 didn't have general reproductive toxicity in rats, the medium dose group impaired early embryonic development, but the high dose group can significantly reduce the fertility of both male and female rats, and can impair the development of embryonic.

目的 分析我院2011—2015年我院儿科住院患者下呼吸道病原菌分布及其耐药性。方法 采用全自动生化鉴定仪对痰标本分离株进行鉴定,用全自动微生物药敏系统和纸片扩散法对病原菌的耐药性进行检测,并用头孢硝噻吩纸片法对β-内酰胺酶进行检测。结果 2011—2015年共分离得到下呼吸道病原菌518株,包括肺炎链球菌(21.62%)、金黄色葡萄球菌(16.99%)、流感嗜血杆菌(14.48%)、肺炎克雷伯菌(11.97%)、大肠埃希菌(8.11%)、卡他莫拉菌(5.41%)、鲍曼不动杆菌(3.86%)和铜绿假单胞菌(3.86%)等。药敏结果显示,肺炎链球菌对克林霉素(90.18%)、红霉素(92.86%)和复方新诺明(87.50%)的耐药率较高,金黄色葡萄球菌则对青霉素G(90.91%)和红霉素(68.18%)有较强耐药性,未发现对万古霉素或利奈唑胺耐药的革兰阳性球菌。流感嗜血杆菌对氨苄西林耐药率为32%,与其β-内酰胺酶阳性率较一致,肺炎克雷伯菌和大肠埃希菌对头孢类药物(17.33%~45.33%)和喹诺酮类药物(34.67%~50.67%)耐药性较高,并发现1株碳青霉烯耐药的肺炎克雷伯菌。结论 本院下呼吸道感染病原菌谱较广,主要包括多种革兰阳性球菌和革兰阴性杆菌,并对多种抗菌药物表现出较强耐药性,临床应注重合理应用相关抗生素,严格防控病原菌的医院感染及传播。

Objective To analyze the antimicrobial resistance and the profile of pathogens from lower respiratory tract infections in pediatric in patients. Methods Sputum bacterial isolates were identified by an automated biochemical identification system. Antimicrobial resistance was detected by an automated drug susceptibility detection system and the disc diffusion method. The β-lactamases was tested by the nitrocefin disc detection method. Results Five hundred and eighteen bacterial pathogens were isolated from sputum samples during 2011-2015, including streptococcus pneumoniae(21.62%), staphylococcus aureus(16.99%), haemophillus influenzae(14.48%), klebsiella pneumoniae(11.97%), escherichia coli(8.11%), moraxelle catarrhalis(3.8%), acinetobacter baumanii(3.86%) and pseudomonas aeruginosa(3.86%). High resistant rates were detected for S. pneumoniae to clindamycin(90.18%), erythromycin(92.86%) and sulfamethoxazole (85.50%), while S. aureus was highly resistant to penicillin G(90.91%) and erythromycin(68.18%). Resistance to vancomycin and linezolid was not detected for gram positive cocci. The resistant rate to ampicillin was 32% for H. influenzae, which was in concordance with the production of β-lactamases. Relatively high resistance was detected for K. pneumoniae and E. coli to cephalosporins and quinolones. A carbapenem-resistant K. pneumoniae isolate was also detected. Conclusion Multiple bacterial species were isolated from lower respiratory tract infections in our hospital, including different species of gram positive cocci and gram negative bacilli, and these isolates exhibited high resistance to antibiotics tested. The clinical use of antibiotics and hospital infection and transmission of these pathogens should be controlled.

目的 探讨脑钠肽(BNP)在协助判断肺结核合并呼吸衰竭疗效及预后的价值。方法 2013年1月—2014年12月我院收治初治菌阳肺结核合并呼衰共81例,分别在抗结核、呼衰治疗前及2 周末行BNP、动脉血气分析及胸部X线检查;按住院号对应随机数字表随机抽取我院同期初治菌阳肺结核无合并呼衰104例作为对照组,采集两组数据进行回顾性病例对照研究。结果 肺结核合并呼衰BNP高于单纯肺结核11.4倍(1115.11 pg/mL比97.60 pg/mL),全肺结核高于非全肺结核3.4倍(1549.82 pg/mL比449.47 pg/mL)。治疗前BNP与PaO₂、SaO₂和pH值呈负相关,与PaCO₂呈正相关,治疗后两者无相关性。2周末 BNP是治疗前0.57倍(632.41 pg/mL比1115.11 pg/mL),死亡组高于存活组8.7倍(3119.63 pg/mL比359.84 pg/mL)。结论 肺结核合并呼衰BNP升高,治疗后随病情好转持续下降,有可能成为协助判断疗效及估测预后的指标之一。

Objective Discussion about value of brain natriuretic peptide (BNP) in helping to determine the efficacy and prognostic of pulmonary tuberculosis combine with respiratory failure. Methods 81 cases were admitted from January 2013 to December 2014 in our hospital of early treatment sputum positive pulmonary tuberculosis with respiratory failure. And the cases were carried out BNP, arterial blood gas analysis and chest X-ray before treatment and after two weeks respectively.104 cases of earlier sputum positive pulmonary tuberculosis accompanied with respiratory failure were randomly drawn according to the corresponding random number of hospitalization as a control group. Two sets of data were collected to conduct retrospective case-control study. Results BNP of pulmonary tuberculosis combine with respiratory failure is 11.4 times higher than that of tuberculosis alone (1115.11 pg/mL compare 97.60 pg/mL), the whole TB is 3.4 times higher than non-full-tuberculosis (1549.82 pg/mL t compare 449.47 pg/mL). Before treatment, BNP was negatively correlated to PaO₂, SaO₂ and pH BNP was positively correlated with PaCO₂. There was no correlation after treatment between BNP and PaCO₂.After two weeks BNP is 0.57 times of the pre-treatment (632.41 pg/mL compared 1115.11 pg/mL). The group of death is 8.7 times higher than the survival group (3119.63 pg/mL compared 359.84 pg/mL). Conclusion BNP was significantly increased in patient accompanied tuberculosis with respiratory failure .The condition is continued to decline after treatment. There is likely to be one of the indicators of helping to determine the efficacy and estimate prognosis.

目的 探索内源性神经干细胞在大鼠海马可溶性因子中的体外发育归宿及分化鉴定。方法 显微镜下分离Wistar大鼠海马组织放置于低温DMEM/12培养基,低温振荡2小时后高速离心(15000 g),获取实验所用海马组织可溶性因子。取材出生1天的Wistar乳鼠海马中的内源性神经干细胞(endogenous neural stem cells, ENSCs),将ENSCs分别于含海马可溶性因子终浓度为0(对照组)、50、100、200、400 μl/mL的无血清DMEM/F12培养基中培养6天并每日观察,使用免疫细胞化学、Western Blot印记技术比较各组ENSCs中Nestin、CD133的表达量;同时计量并比较各组ENSCs成球个数,以探索在模拟颅内微环境情况下,ENSCs发育、归宿及分化。进一步于最适宜的海马可溶性因子终浓度中分化神经球,对分化的细胞行神经元特异性蛋白入(如:β-tubullin III、MAP2)及胶质细胞特异性蛋白(如:GFAP、S100及p75 NGFR)免疫细胞化学检测。结果 大鼠ENSCs在培养基中呈单细胞漂浮生长,球形; ENSCs于海马可溶性因子各实验分组中培养第2天呈细胞球状态,对照组中无细胞球形成(与100 μl/mL组比较,P₁=0.00),100 μl/mL组与对照组比较有统计学意义(P₁=0.00<0.05);至第6天,在100 μl/mL组中的细胞球数量明显多于其余各组(P₁'=P₂'=P₃'=P₄'=0.00)。在免疫细胞化学检测中,100 μl/mL组中细胞球表达干细胞高亲和蛋白Nestin、CD133阳性,Western Blot免疫印迹检测其中Nestin、CD133蛋白高于对照组。进一步分化试验中,细胞球呈贴壁生长的单细胞状态、有突起伸出、长梭形,免疫细胞化学检测分化的细胞表达胶质细胞特异性蛋白GFAP、S100、p75NGFR阳性,但不表达神经元特异性蛋白β-tubullin III与MAP2。结论 大鼠ENSCs在终浓度为100 μl/mL的HSF作用下,可促进 ENSCs的增殖分裂;ENSCs在同样浓度下的HSF中可进一步分化为表达GFAP、S100、p75NGFR阳性的胶质样细胞;100 μl/mL的HSFS是ENSCs的一种生理性诱导剂或参与促进ENSCs增殖、分化及通过细胞替代或因子分泌等机制修复神经损伤。

Objective The aim of this study was to explore induction and differentiation of endogenous neural stem cells(ENSCs) in the hippocampus soluble factors(HSF) from the hippocampus of adult Wistar rats by mimicking an intracranial microenvironment. Methods After Wistar rats sacrificed, the hippocampus tissue was obtained in cold DMEM/F12. After centrigued and filtered, the HSF was stored at -20℃. The ENSCs was obtained from the hippocampus tissue of a neonate Wistar rat. Collected the tissue, digested and obtained the ENSCs. After we observed the morphology, the ENSCs were cultured in different concentration (0、50、100、200、400 μl/mL) of HSF for 6 days, and compared the expression of Nestin and CD133 by immunocytochemistry. Meanwhile,we compared the Nestin and CD133 protein by western blot. And then we explored the optimal concentration of HSF by the numbers of all groups on the second and sixth day. Furthermore, we did the differentiated experiment using the same concentration of HSF. Results The number of neurospheres in the 100 μg/mL group was significantly higher than those in the other groups on the 6th day. Immunofluorescence revealed that the neurospheres from ENSCs in the 100 μg/mL group more highly expressed nestin and CD133 than control. This result was confirmed by western blot analysis. The neurospheres can differentiate into glia-like cells in 100 μg/mL HSF and 1% FBS expressing GFAP, S100 and P75 NGFR by immunofluorescence. Conclusion These data indicated that HSF alone, mimicking a destination of ENSCs in vitro, could induce and differentiate neurospheres from ENSCs, as a new method to get NSCs and glia-like cells differentiated from ENCs to repair the diseases of center nervous system.

目的 探讨ε-3多不饱和脂肪酸在胃肠道肿瘤患者化疗后的胃肠道毒性及生活质量的作用。方法 在研究前经过化疗筛选,按照WHO化疗副反应在2级或者以上的50名住院的胃癌或者直结肠癌患者,随机分为对照组(单纯化疗)(n=25)和研究组(化疗加ε-3多不饱和脂肪酸)(n=25),两组的化疗方案均为化疗筛选的方案。预防性每天静脉使用ε-3多不饱和脂肪酸 200 mg,连续5天,记录评估胃肠道并发症,如恶心、呕吐和腹泻,以及KPS评分、血清白蛋白、IL-2、IFN-γ和CRP。结果 与对照组比较,恶心、呕吐和腹泻评分、IL-2、IFN-γ和CRP低于于对照组,相反,生活质量评分研究组高于对照组,差异有统计学意义(P<0.05)。结论 预防性使用ε-3多不饱和脂肪酸能够减轻胃肠道肿瘤患者化疗后的胃肠道毒性症状、降低全身炎症因子反应并改善生活质量。

Objective To explore the effect omega-3polyunsaturated fatty acid omega-3 FA on clinical manifestations of gastrointestinal toxicity and quality of life (QOL) induced by chemotherapy for patients with gastric or colorectal cancer. Methods After screening chemotherapy, Fifty patients with gastric or colorectal cancer, according to developing WHO side-effect grading system of grade 2 or higher were randomly divided into either control group (n=25) or omega-3 FAs group (n=25) during next cycle of chemotherapy. In the control group, the patients received the same chemotherapy regimens as screening cycle and in the omega-3 FA group, received chemotherapy and omega-3 FAs. Prophylactic intravenous 200 mL /d was given for 5 days. The gastrointestinal complications such as nausea,vomiting or diarrhoea and Karnofsky performance status(KPS ),IL-2,IFN-γandCRP,ect, were evaluated respectively. Results Compared with the control group, the scores of nausea vomiting and diarrhea and IL-2,IFN-γor CRP levels decreased , significantly,on the contrary, the score of QOL increased. There was significantly statistical difference (P<0.05). Conclusion Prophylactic intravenous omega-3 FA can ameliorate clinical manifestations of gastrointestinal toxicity and systemic inflammatory response syndrome(SIRS) induced by chemotherapy and improve QOL for patients with gastric or colorectal cancer.

目的 观察喉罩通气下全凭七氟醚吸入麻醉在妇科宫腔镜手术中的应用价值。方法 60例拟行妇科宫腔镜手术的患者随机分为七氟醚和丙泊酚组,每组30例,记录不同时间点两组患者的平均动脉压(MAP),脉搏血氧饱和度(SpO₂)、苏醒时间以及术后恶心,呕吐、躁动的发生率。结果 A组患者血流动力学指标波动较少,苏醒时间A组明显短于B组,差异有显著性(P<0.05)。两组患者诱导后MAP,HR均较诱导前显著下降(P<0.05)。B组患者术中MAP,HR值显著低于A组(P<0.05),拔除喉罩即刻两组MAP,HR差异无显著性(P>0.05)。结论 喉罩下全凭七氟醚吸入麻醉对患者的血流动力学的影响较小,适用于妇科宫腔镜手术。

Objective To observe the effect of laryngeal mask airway(LMA) combined with sevoflurane inhalation anaesthesia in gynecological hysteroscopy operation. Methods Sixty patients, classified from ASAⅠtoⅡscheduled for hysteroscopic operation were randomly divided into sevoflurane inhalation anesthesia group (group A) and propofol intravenous anesthesia group(group B).The mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), recovery time and the incidence of nausea, vomiting and recovery time were recorded at different time points of the two groups. Results The hemodynamic index of the patient in the group A fluctuated seldom,and the recovery time was significantly shorter than that in the B group, and the differences were significant (P<0.05).The MAP and the HR were all decreased after anesthesia induction compared with those of before in both groups (P<0.05).The MAP and the HR in the group B was significantly lower than that in the group A (P<0.05), there were no significant differences in MAP and HR between the two groups of patients with laryngeal mask airway removal. Conclusion Small hemodynamic influence is taken with the technique of laryngeal mask airway(LMA) combined with sevoflurane inhalation anesthesia. It is suitable for gynecological hysteroscopic operation.