目的 应用NRS2002、MNA-SF两种营养筛查方法评估住院老年冠心病患者营养风险,观察营养风险与营养指标及心功能的关系。方法 选取2017年8月-2018年6月在我院全科医学科住院的老年冠心病患者129例,使用两种方法分别进行营养筛查,分成存在营养风险组和不存在营养风险组,完善血常规、生化、心功能检查,统计两组各项指标之间的关系,及两种营养筛查方法与各项指标的相关性。结果 NRS2002筛查出营养风险发生率为38.76%,MNA-SF筛查出营养风险发生率75.97%。与不存在营养风险组比较,存在营养风险组的BMI、HB、ALB下降,且NRS-2002评分中存在营养风险组pro-BNP较不存在营养风险组明显升高。两种营养筛查方法与HB、PA、ALB、pro-BNP均有相关性。结论 运用两种营养筛查方法,结合各项指标能更好对老年冠心病患者进行营养风险评估。

Objective To analyze the preoperative nutritional screening results of the nutritional risk screening 2002（NRS2002） and the Mini Nutritional Assessment Short Form（MNA-SF） in 129 elderly patients with coronary heart disease and their relationships with some nutritional indicators and heart function. Methods NRS2002 and MNA-SF were used to evaluate the nutritional risk of 129 elderly patients with coronary heart disease. We divided the patients into nutritional risk group and non- nutritional risk group. The relationships between two groups with the nutritional indicators and the heart function were analyzed,and the value of the two nutritional screening tools was compared. Results The incidence rate of malnutrition by using NRS2002 was 38.76% and that of MNA-SF was 75.97% among 129 CHD patients. The nutritional risk group had lower BMI,HB and ALB. Nutritional risk group that was screened by NRS2002 had higher pro-BNP. And the two nutritional risk texts were related to HB,PA,ALB and pro-BNP. Conclusion It would be better to use two methods and some indicators to analyze the nutritional risk in elderly CHD patients in the hospital.

目的 探索使用血浆中溶血磷脂酸 LPA作为老年糖尿病患者发生缺血性心脑血管病早期预警指标。方法 在公共卫生项目开展的基础上,将老年糖尿病患者随机分为观察组和对照组。对照组实施糖尿病规范管理,观察组在对照组的基础上进行血浆LPA 的水平定期检测,对LPA 明显升高者,予降脂、抗纤溶、抗血小板凝集等干预措施,比较两组间缺血性心脑血管病发生率和病情严重程度。结果 观察组缺血性脑血管发病率高于对照组,差异有统计学意义（P<0.05）。中、重型缺血性脑血管病患者的血浆LPA高于轻型组（P<0.05）,且重型组高于中型组（P<0.05）结论 血浆LPA值可作为老年糖尿病患者发生缺血性心脑血管病的预警因子,值得在基层老年糖尿病患者规范化管理中常规应用。

Objective To explore the early warning index of ischemic cardiocerebrovascular disease in elderly diabetic patients with plasma LPA. Methods On the basis of public health project,elderly diabetic patients were randomly divided into observation group and control group. Control group adopted diabetes management implementation,while observation group adopted periodic testing of the levels of plasma LPA on the basis of the control group,implementing fall fat,resisting fibrinolytic,antiplatelet aggregation and other interventions if LPA significantly increased. We compared the ischemic cardio-cerebrovascular disease incidence and disease severity between the two groups. Results The incidence of cerebral ischemia in the observation group was higher than that in the control group,and the difference was statistically significant （P<0.05）. Medium and heavy plasma LPA is higher than the light of ischemic cerebrovascular disease group （P < 0.05）,and heavy above medium group （P < 0.05） Conclusion The plasma LPA values can be used as early warning factor in elderly patients with diabetes occuring ischemic cardio-cerebrovascular disease and promote its application.

目的 观察肺保护性通气策略对肺功能不全胃肠手术患者术后转归影响。方法 选取2016年4月—2017年3月期间我院收治的90例肺功能不全胃肠手术患者作为研究对象,根据随机数字表将患者随机分为观察组和对照组,每组各45例。对照组采用传统机械通气方式,观察组采用肺保护性通气方式。观察两组患者动脉血气指标、自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间及住院期间术后肺部并发症发生情况。结果 两组患者麻醉时间、手术时间、晶胶液输入情况、麻醉药物用量差异无统计学意义（P>0.05）。观察组患者术后PaO₂高于对照组,差异有统计学意义（P<0.05）。两组患者自主呼吸恢复时间、清醒时间、拔管时间、PACU观察时间比较,差异均无统计学意义（P>0.05）。观察组患者住院期间PPCs发生率低于对照组,差异有统计学意义（P<0.05）。结论 肺保护性通气策略可有效改善肺功能不全胃肠手术患者术后氧合,降低患者住院期间PPCs发生率,对于患者术后转归具有积极的作用。

Objective To observe the effect of lung protective ventilation strategy on postoperative outcome of patients with pulmonary insufficiency of gastrointestinal surgery. Methods 90 patients with pulmonary insufficiency gastrointestinal surgery in our hospital from April 2016 to March 2017 were selected as study subjects. According to the random number table,patients were randomly divided into observation group and control group,with 45 cases in each group. The control group used traditional mechanical ventilation,and the observation group used lung protective ventilation. Arterial blood gas parameters,spontaneous breathing recovery time,awakening time,extubation time,PACU observation time and postoperative pulmonary complications in both groups were observed. Results There was no significant difference in anesthesia time,operation time,crystal glue fluid input,and anesthetic drug dosage between the two groups （P>0.05）. The postoperative PaO₂ was higher in the observation group than in the control group （P<0.05）. There was no significant difference between the two groups in spontaneous breathing recovery time,awakening time,extubation time,and PACU observation time （P>0.05）. The incidence of PPCs was lower in the observation group than that in the control group,and the difference was statistical difference （P<0.05）. Conclusion Lung protective ventilation strategy may effectively improve postoperative oxygenation in patients with pulmonary insufficiency and gastrointestinal surgery,reduce the incidence of PPCs during hospitalization,and have a positive effect on postoperative outcome.

目的 探讨生物电抗无创心排监测（bioreactance noninvasive cardiac output monitoring,NICOM）心指数（cardiac index,CI）和总外周阻力指数（total peripheral resistance index TPRI）对呼吸困难病因诊断的临床价值。方法 采用前瞻性观察性研究的方法 ,纳入急性呼吸困难或慢性呼吸困难急性加重的患者共113例,临床医师根据2010年中华医学会心血管病学分会编委会组织编写的《急性心力衰竭诊断和治疗指南》为金标准分为心力衰竭组（n=55）和非心力衰竭组（n=58）,通过NICOM监测CI、TPRI,构建受试者工作特征曲线（receiver operating characteristic curve,ROC曲线）,分析CI和TPRI对心力衰竭的诊断价值。结果 心力衰竭组患者的CI低于非心力衰竭组（P<0.001）;心力衰竭组患者TPRI高于非心力衰竭组（P<0.001）;利用ROC曲线进行分析,CI曲线下面积（area under the curve,AUC）为0.792（95%CI：0.708~0.875,P=0.000）,当CI截断值取2.65L/（min·m²）时,诊断心力衰竭的敏感度为63.6%,特异度为87.9%;TPRI的AUC为0.733（95%CI：0.641~0.825,P=0.000）,当TPRI截断值取2 353dynes.sec/（cm⁵·m²）时,诊断心力衰竭的敏感度为72.7%,特异度为67.2%;CI联合TPRI诊断心力衰竭的敏感度为80%,特异度为65.5%。结论 NICOM监测CI对心力衰竭所致的呼吸困难特异度高,联合TPRI监测可提高敏感度。

Objective To investigate the clinical values of etiological diagnosis by testing cardiac index CI and total peripheral resistance index TPRI using bioreactance noninvasive cardiac output monitoring NICOM in patients with dyspnea. Methods Prospective,observational study was taken in 113 adult patients admitted with dyspnea or acute exacerbation of dyspnea in stable disease. The patients were divided into two groups namely heart failure group （n=55）and non-heart failure group（n=58） according to the guidelines on the diagnosis and treatment of acute heart failure（2010） as the standard criterion. All patients underwent CI and TPRI test by using NICOM. Receiver operating characteristic curve（ROC curve） was plotted to evaluate the diagnostic value of CI and TPRI. Results Compared with non-heart failure group,the CI was worse（P<0.001）,and the TPRI was elevated（P<0.001）. ROC curve showed that the area under the curve（AUC） of CI was 0.792（95%CI：0.708~0.875,P=0.000）. The cut-off of CI was 2.65L/min/m²,the sensitivity was 63.6%,and specificity was 87.9%. The AUC of TPRI was 0.733（95%CI：0.641~0.825,P=0.000）. The cut-off of CI was 2 353dynes.sec/cm⁵/m²,the sensitivity was 72.7%,and specificity was 67.2%. The sensitivity of CI combined TPRI was 80%,and specificity was 65.5%. Conclusion NICOM monitoring CI have high specificity,and combined TPRI monitored may improve sensitivity for dyspnea caused by heart failure.

目的 筛选结直肠癌（CRC）差异性表达的长链非编码RNA（lncRNA）,并进行临床标本验证,研究其对结肠癌细胞HCT116功能的作用。方法 利用lncRNA PCR芯片对3对CRC组织和癌旁对照组织筛选差异性表达的lncRNA,确定候选研究lncRNA GAPLINC,RT-qPCR对21例临床样本进行验证其表达的差异性;同时构建GAPLINC表达质粒及其沉默体siRNA转染HCT116细胞,研究其对细胞凋亡、迁移及侵袭能力的影响。结果 lncRNA芯片实验结果提示CRC组织中存在大量的差异性表达的lncRNA,其中GAPLINC在CRC组织表达稳定增加,21例临床样本进一步验证了其在肿瘤组织中表达增加（P<0.05）;转染GAPLINC表达质粒后,HCT116细胞凋亡被抑制,同时其迁移及侵袭能力增强,转染siRNA抑制GAPLINC的表达后,则出现相反的结果。结论 利用lncRNA芯片可对CRC差异性表达lncRNA进行批量筛选,GAPLINC在CRC组织中表达稳定增加,具有促癌作用,在CRC发生发展中可能起着重要作用。

Objective To screen the differentiational expression of lncRNA in CRC tissue,confirm it in large simple of clinical specimens,and study its effects on human colorectal cells HCT116 cell line. Methods We screened the lncRNA which expressed differently in 3 CRC tissues and their pair-non carcinour tissues by lncRNA arrays;chose the over expressed lncRNA which played the potential role of oncogene for further researching,and tested the difference in 21 clinical specimens by RT-qPCR. We cultured the HCT166 cells,and then constructed expressed plasmids pcCDNA3.1-GAPLINC and synthesized GAPLINC siRNA,transfected the plasmids and siRNA into HCT116 cells;to study the changes of HCT116 cells behavior,the transwell assays were carried on;the changes of apoptosis of HCT116 cells were tested by flow cytometry. Results There existed many lncRNA which expressed differently between CRC tissues and normal control tissues by lncRNA arrays,there were 21 lncRNA down expressed,and 3 lncRNA up expressed;among these lncRNA,GAPLINC over expressed stably,and its high level of expression was approved in 21 clinical specimens by the test of RT-qPCR. We constructed the expressed plasmids pcCDNA3.1-GAPLINC and synthesizing GAPLINC siRNA successfully;after transfecting pcCDNA3.1-GAPLINC into HCT116 cells,the over expression of GAPLINC increased the migration and invasion of the HCT166 cells （P<0.05）,decreased the proportion of cell apoptosis （P <0.05）;by contraries,knocked down the expression of GAPLINC inhibited invasion and migration of HCT116 cells （P<0.05）,and promoted the apoptosis of the HCT116 cells （P <0.05）. Conclusion It could screen the different expression of lncRNA in large quantities by lncRNA arrays,and GAPLINC expressed highly and stably in CRC tissues. GAPLINC played a role of oncogene,which promoted the proliferation and invasion of CRC cells,and inhibited the apoptosis of CRC cells,which meant playing an important role in the carcinoma and development of CRC.

代谢综合征(MS)是临床上多个症候群构成的代谢紊乱聚合体。近几十年来,MS的发病率和患病率一直呈上升趋势。笔者整理近5年关于老年代谢综合征研究的相关文献,分析老年人群代谢综合征患病情况、特点及影响因素等,并对老年代谢综合征的防治提出一些建议。

目的 通过皮肤点刺筛查慢性荨麻疹的变应原,为临床治疗提供依据。方法 采用“阿罗格”点刺液对2 974例临床确诊慢性荨麻疹患者行皮肤点刺试验进行29种变应原的检测,并设阳性(0.1%组胺)及阴性(生理盐水)对照,记录阳性反应的变应原和反应强度。结果 2 974名受试者中,呈阳性反应人数有1 052人,阳性率为35.37%;阳性反应结果中,受试者对蟑螂、粉尘螨、屋尘螨最为敏感,阳性率分别为78.80%、78.04%和73.76%;不同性别、月份、年龄组的阳性反应种数与反应强度无统计学上的差异:不同变应原的反应强度秩和检验(χ²=9 741.284,P<0.001)差异有统计学意义,受试者对蟑螂、粉尘螨、屋尘螨、杂草、虾和霉菌Ⅰ等的过敏强度较大。结论 皮肤点刺作为慢性荨麻疹筛查变应原的方法之一,能筛选出阳性反应强度最大的前几个变应原,临床能为患者进行行为干预规避过敏原或进一步脱敏治疗提供参考依据。

目的 了解老年冠脉支架植入患者的临床特征及治疗疗效。方法 按照纳入、排除标准入选2015年10月—2017年10月于我院住院并接受冠状动脉支架治疗的患者372例,分为女性组和男性组,收集临床资料并随访预后。结果 女性组157例,男性组215例,2组冠脉病变支数、发生心血管不良事件比例无统计学意义(P>0.05),女性组不稳定性心绞痛、合并糖尿病、高血压比例及胆固醇、甘油三酯、低密度脂蛋白、脂蛋白a、TSH水平均高于男性组(P<0.05),急性心肌梗死、吸烟比例及年龄、血肌酐均低于男性组(P<0.05)。结论 老年患者合并可控制的危险因素较多,女性要强调血糖、血脂的控制,男性要强调戒烟。冠脉病变支数、术后1年发生不良心血管事件比例无性别差异。

目的 探讨四磨汤联合穴位按摩对早产儿喂养不耐受的影响。方法 将165例出现喂养不耐受的早产儿分组,82例于常规治疗基础上予四磨汤加穴位按摩为研究组,另83例予常规治疗为对照组,观察两组早产儿发生呕吐、胃潴留、腹胀等情况,并在喂养2周后作胃泌素和胰岛素的测定。结果 研究组早产儿发生呕吐、腹胀、胃潴留例数及所占比例分别为 12(14.6%) 、13(15.9%) 、18(22.0),发生率低于对照组(P<0.05);研究组早产儿喂养前和喂养后血清胃泌素分别是(250.41±73.76)ng/L 和(308.27±70.67)ng/L,血清胰岛素是(7.63±2.12)ng/L和(9.43±3.13)ng/L,与对照组相比,2周后的血清胃泌素和胰岛素水平增高(P<0.05)。结论 健脾导滞法可减少早产儿呕吐、腹胀、胃潴留等症状的发生,促进血清胃泌素和胰岛素的分泌,减少早产儿的喂养不耐受的发生。

目的 研究输尿管镜下钬激光碎石术治疗输尿管结石疗效及对氧化应激指标的影响。方法 选取我院2016年3月—2017年4月间收治的输尿管结石患者60例,随机将其分为对照组和观察组,每组各30例。观察组接受输尿管钬激光碎石术治疗,对照组接受传统开放手术治疗。比较两组手术前后白细胞介素-10(IL-10)、C反应蛋白(CRP)、白细胞(WBC)等炎性因子以及皮质醇(Cor)、丙二醛(MDA)、超氧化物歧化酶(SOD)等氧化应激指标水平,同时比较两组碎石情况。结果 观察组手术时间、住院天数低于对照组,结石排净率高于对照组(P<0.05);术后,观察组IL-10、CRP、WBC高于对照组(P<0.05);观察组Cor、MDA低于对照组,而SOD高于对照组(P<0.05)。结论 输尿管镜下钬激光碎石术治疗输尿管结石疗效显著,能够抑制炎性因子,减轻应激反应,促进患者疾病康复,值得临床推广。

Objective To study the effect of ureteroscopic holmium laser lithotripsy in the treatment of ureteral calculi and its effect on oxidative stress. Methods Sixty patients with ureteral calculi admitted to our hospital from March 2016 to April 2017 were randomly divided into control group and observation group, with 30 cases in each group. The observation group received ureteroscopic holmium laser lithotripsy and the control group received conventional open surgery. We compared inflammatory factors such as interleukin-10 (IL-10), C-reactive protein (CRP), and white blood cells (WBC) before and after surgery, as well as cortisol (Cor), malondialdehyde (MDA), and superoxide dismutase (SOD) and other levels of oxidative stress indicators, while comparing the two groups of debris. Results The operation time and hospitalization days in the observation group were lower than those in the control group. The stone removal rate was higher than that in the control group (P<0.05). After operation, the IL-10, CRP and WBC in the observation group were higher than those in the control group (P< 0.05). Cor and MDA in the observation group were lower than the control group, and SOD was higher than the control group (P<0.05). Conclusion Ureteroscopic holmium laser lithotripsy is effective in the treatment of ureteral calculi. It can inhibit inflammatory factors, reduce stress response, and promote the recovery of patients' diseases. It is worthy of clinical promotion.