目的 分析献血者献血后血肿(瘀斑)应用不同治疗方法的效果。方法 随机选取147例在广州血液中心献血后出现血肿(瘀斑)的献血者,根据其采用处理方式的差异分为甲组(n=66)、乙组(n=48)、丙组(n=33),为甲组献血者实施冷热敷法,为乙组献血者实施马铃薯片贴敷法,为丙组献血者实施喜辽妥(多磺酸粘多糖)软膏外敷法。结果 乙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=4.63,P＜0.05),丙组献血者临床总有效率高于甲组献血者,差异有统计学意义(χ²=13.99,P＜0.05),丙组献血者临床总有效率高于乙组献血者,2组差异有统计学意义(χ²=3.99,P＜0.05)。结论 献血者献血后血肿应用喜疗妥软膏外敷法疗效确切,可使其身心健康得到改善。

Objective To analyze the effects of different treatment methods on blood donors with haematoma(or bruise) after blood donation. Methods 147 blood donors with haematoma(or bruise) after blood donation in our blood station were randomly selected. According to the difference of treatment methods, they were divided into group A (n=66), group B (n=48) and group C (n=33), for the group A of blood donors to carry out cold and hot compress method, for the group B blood donors to implement the potato slice application method, for the group C blood donors to implement the hi-treatment ointment external application method. Results The total effective rate of group B blood donors was higher than that of group A blood donors. The difference was statistically significant (χ²=4.63,P＜0.05). The total clinical effective rate of group C blood donors was higher than that of group A blood donors. There is statistical significance (χ²=13.99,P＜0.05). The total effective rate of donors in group C was higher than that in group B. The difference between the two groups was statistically significant (χ²=3.99,P＜0.05). Conclusion The effect of external application of Hirudoid(Mucopolysaccharide Polysulfate Cream) on blood donors after blood donation is effective, which may improve their physical and mental health.

目的 探究肛裂切除带状皮瓣推移术对陈旧性肛裂患者肛门功能的影响。方法 收集我院2017年5月—2018年9月间收治的120例陈旧性肛裂患者资料,按随机数字法将其分为对照组(58例)和研究组(62例),对照组患者接受侧方内括约肌切开术治疗,研究组患者接受肛裂切除带状皮瓣推移术治疗。比较两组临床指标、肛门功能及并发症情况。结果 研究组创面愈合时间、住院时间低于对照组,而手术时间高于对照组(P<0.05);与术前相比,术后1周、术后1月、术后半年,两组Wexner评分均出现下降,且研究组低于对照组(P<0.05);研究组便血、尿潴留、肛门疼痛、肛缘水肿、创口感染、肛门失禁等并发症发生率低于对照组(P<0.05)。结论 肛裂切除带状皮瓣推移术治疗陈旧性肛裂效果显著,可提高肛门功能,降低并发症,值得临床推广。

Objective To investigate the effect of anal fissure excision bandage flap operation on anal function in patients with old anal fissure. Methods The data of 120 patients with old anal fissure who were admitted to our hospital from May 2017 to September 2018 were collected for retrospective analysis. They were divided into control group (58 cases) and research group (62 cases) according to the random number method. The control group received lateral sphincter incision. The patients in the study group underwent treatment of anal fissure excision bandage flap operation. The clinical indicators, anal function and complications were compared between the two groups. Results The healing time and hospitalization time of the study group were lower than that of the control group, and the operation time was higher than that of the control group (P<0.05). Compared with the preoperative period, 1 week after surgery, 1 month after surgery, and half a year after surgery, the Wexner scores of the two groups showed a significant decrease, and the study group was lower than the control group (P<0.05). The incidence of complications such as blood in the stool, urinary retention, anal pain, anal edema, wound infection and anal incontinence were lower in the study group than in the control group (P<0.05). Conclusion Anal fissure excision bandage flap operation for the treatment of old anal fissure is effective, which may improve anal function and reduce complications. It is worthy of clinical promotion.

目的 探讨功能区矢状窦镰旁脑膜瘤患者采用显微镜手术对其手术情况及症状改善的影响。方法 选2015年5月—2018年5月我院择期行手术治疗的40例功能区矢状窦镰旁脑膜瘤患者,参照随机数表法分为对照组(n=20)和研究组(n=20)。对照组采用常规手术治疗,研究组采用显微镜手术,对比两组手术情况及术后症状情况。结果 研究组术中输血量及肿瘤全切除率比对照组均低,住院时间和手术时间均较短,差异有统计学意义(P＜0.05);相较于对照组,研究组术后症状改善发生率较高(95.00% vs 60.00%),症状加重发生率较低(0.00% vs 35.00%),差异有统计学意义(P＜0.05)。结论 显微镜手术可有效减少功能区矢状窦镰旁脑膜瘤患者术中输血量,缩短手术时间,改善临床症状,促进患者术后恢复。

Objective To investigate the effect of microsurgery on the operation and symptom improvement of patients with para-sagittal sinus meningioma in functional area. Methods From May 2015 to May 2018, 40 patients with parasickle meningioma of sagittal sinus in our hospital were randomly divided into two groups: control group (n = 20) and study group (n = 20). The patients in the control group were treated with conventional operation, and the patients in the study group were treated with microscope. Results The volume of blood transfusion and the total resection rate of tumor in the study group were lower than those in the control group, and the duration of hospitalization and operation were shorter than those in the control group. Compared with the control group, the incidence of symptom improvement in the study group was higher (95.00% vs 60.00%), the incidence of symptom exacerbation was lower (0.00% vs 35.00%), the difference was statistically significant (P< 0. 05). Conclusion Microscopy may effectively reduce the amount of blood transfusion, shorten the operation time, improve clinical symptoms and promote postoperative recovery in patients with parasagittal sinus meningioma.

目的 初步探讨D-二聚体对判断女性恶性肿瘤病情和疗效观察的应用价值与诊断效能。方法 选取2016年3月—2017年12月间在佛山第一人民医院乳腺肿瘤内科住院治疗的女性恶性肿瘤患者149例,早期术后患者(术后组)58例,晚期复发转移患者(晚期组)91例,测定其接受化疗前后的血浆D-二聚体水平(分别记作D1、D2),分析D-二聚体浓度变化(ΔD=D2-D1)与疗效的相关性。D-二聚体浓度(ng/mL)用中位数(四分位间距)表示,治疗前后配对样本比较用Wilcoxon秩和检验,两组间独立+样本比较用Mann-Whitney U检验,以Spearman法分析两组资料的相关性是否有统计学意义。结果 术后组患者化疗后D-二聚体水平低于化疗前(ΔD=-184.8,P<0.0001),D1、D2均与年龄正相关(P<0.01),r²分别为0.356,0.389。晚期组患者中,化疗后有33例出现病情进展(progressive disease, PD组),58例获得疾病缓解或稳定(非PD组)。PD组化疗前基线水平高于非PD组(1 586 vs 754.2,P<0.01),接受化疗后PD组D-二聚体较基线水平升高(ΔD=1 124,P<0.0001),非PD组较基线水平下降(ΔD=-153.3,P=0.004 5),PD组化疗后D-二聚体水平高于非PD组(2 511 vs 525.8,P<0.01)。以ΔD、D1、D2诊断是否PD分别进行受试者工作特征曲线(receiver operating characteristic curve,ROC)分析,结果显示ROC曲线下面积分别为0.8 603(95% CI:0.768 5~0.952 0)、0.674 0(95% CI:0.558 2~0.759 7)、0.895 6(95%CI:0.829 1~0.962 1),对诊断PD有一定准确性。当ΔD＜-145.4 ng/mL、D1>1 375 ng/mL、D2>1 033 ng/mL时,Youden指数最大,诊断PD的准确性较高。结论 血浆D-二聚体的变化与肿瘤负荷密切相关,有助于女性恶性肿瘤病情的判断和疗效观察及评价预后,对辅助判断病情进展上的具有较高的诊断效能。

Objective To investigate the clinical significance and diagnostic value of plasma D-dimer measurement in response evaluation of female patients with tumor. Methods 149 female cancer patients were enrolled, in which there were 58 post-operative early staged cases(post-operative group), 91 metastatic cases(metastatic group). D-dimer levels before chemotherapy (D1) and after the last cycle of chemotherapy (D2) were assessed and analyzed to examine whether they are correlated to response of therapy. D-dimer levels were presented as median(25^th percentile,75^th percentile) and compared using Wilcoxon signed-rank test(for paired samples) and Mann-Whitney U test(for independent samples). Spearman rank tests were conducted to show the correlation of two variables. Results In post-operative group,D2 was lower than D1(ΔD=-184.8,P<0.0001),and both of D1 and D2 were positively correlated with age(r²= 0.356,0.389,respectively,P<0.01). In metastatic group, after chemotherapy,33 cases had progressive diseases(PD group), while 58 cases gained response or stable diseases(non-PD group). Baseline D-dimer level of PD group was higher than that of non-PD group(1586 vs 754.2,P<0.01),and after chemotherapy the case was similar(2511 vs 525.8,P<0.01). After chemotherapy, D-dimer level increased in PD group(ΔD=1124,P<0.0001), and decreased in non-PD group(ΔD=-153.3,P=0.0045).We compared the abilities of the ΔD(ΔD=D2-D1), D1and D2 to discriminate between responders and non-responders using receiver operating characteristic curves(ROC). The areas under the curve (AUC) of the ΔD, D1and D2, were 0.8603(95%CI:0.7685-0.9520)、0.6740(95%CI:0.5582-0.7597)、0.8956(95%CI:0.8291-0.9621), respectively. The appropriate cut-off values with biggest Youden index of D-dimer for non-responders were as follows: ΔD＜-145.4 ng/mL,D1>1375ng/mL,D2>1033ng/mL. Conclusion Plasma D-dimer level is strongly associated with tumor burden. D-dimer could be used to predict prognosis and treatment response in female patients with tumor.

目的 探讨血浆BNP预测急性肺栓塞患者发生心血管疾病的临床价值。方法 选择2017年1月—2017年12月在我院诊断为急性肺血栓栓塞患者97例为研究对象,根据有无出现心血管并发症分为观察组(21例)和对照组(76例)。比较两组间实验室指标的差异性和相关性,并采用ROC曲线分析BNP预测急性肺栓塞患者发生心血管疾病的临床价值。结果 观察组共出现21例心血管并发症,占21.65%。观察组中BNP、Hs-CRP 、TnI 、AST、CK和DD的浓度分别为(413.01±33.09)(pg/mL)、(20.49±2.88)mg/L、(0.154±0.103)μg/L、(131.23±27.05)U/L、(421.64±50.70)U/L和(1.95±0.18)mg/L,高于对照组(P<0.05)。Spearman相关性分析,血浆BNP水平与Hs-CRP 、TnI 、AST、CK和DD水平呈正相关(r=0.802、0.718、0.683、0.705、0.753,P<0.05)。ROC曲线分析,BNP的AUC面积最高,为0.834(95%CI:0.795~0.935),敏感度和特异度分别为90.5%和87.5%,联合诊断的AUC面积为0.892(95%CI:0.811~0.976),敏感度和特异度分别为84.6%和91.3%。结论 血浆BNP对于预测急性肺栓塞患者发生心血管疾病具有极高临床价值,采取多指标联合检查可以更加有效发现心血管疾病的发生。

Objective To investigate the clinical value of plasma BNP in predicting cardiovascular disease in patients with acute pulmonary embolism. Methods 97 cases of acute pulmonary thromboembolism diagnosed in our hospital from January to December 2017 were selected.The patients were divided into the observation group (21 cases) and control group (76 cases) according to whether there were cardiovascular complications.The differences and correlations of laboratory indexes between the two groups were compared, and the ROC curve was used to analyze the clinical value of BNP in predicting the occurrence of cardiovascular disease in patients with acute pulmonary embolism. Results 21 cases of cardiovascular complications occurred in the observation group, accounting for 21.65%.The concentration of BNP, Hs-CRP, TnI, AST, CK and DD in the observation group were (413.01±33.09) (pg/mL), (20.49±2.88) mg/L, (0.154±0.103) μg/L, (131.23±27.05) U/L, (421.64±50.70) U/L and (1.95±0.18) mg/L, which were higher than those of the control group(P<0.05). Spearman correlation analysis showed that plasma BNP levels were positively correlated with the levels of Hs-CRP, TnI, AST, CK and DD (r=0.802,0.718,0.683,0.705,0.753,P<0.05). The ROC curve analysis showed that the area of AUC of BNP was 0.834 (95%CI:0.795~0.935) of the highest, the sensitivity and specificity were 90.5% and 87.5% respectively. The area of combined diagnosis of AUC was 0.892 (95%CI:0.811~0.976),the sensitivity and specificity were 84.6% and 91.3%, respectively. Conclusion Plasma BNP is of high clinical value for predicting the incidence of cardiovascular disease in patients with acute pulmonary embolism. Multi-index combined examination may be more effective to detect the occurrence of cardiovascular disease.

目的 了解广州市海珠区肺结核患者登记情况及流行特征,为进一步做好海珠区肺结核防治提供依据。方法 收集2008—2017年海珠区结核病信息管理系统中按现住址登记的肺结核患者资料,采用描述性流行病学方法和相关统计方法对肺结核患者登记资料进行分析。结果 2008—2017年海珠区共报告登记肺结核患者 14 384 例,年报告发病率由2008年的105.3/10万下降到2017年的73.1/10万,呈下降趋势(χ²=164.973,P<0.001);男女发病相对比为2:1;各个年龄组均有发病,其中25～34岁年龄组发病人数最多,占总发病数的21.61%;职业分布方面,家务及待业人群最多,占总发病率34.48%,其次分别是其他(不固定职业),占17.29%,退休人群,占15.12%,学校学生占比5.52%。地区分布方面,各街道年平均发病率相差较大,最高为131.23/10万,最低的为66.40/10万,差异有统计学意义(χ² =164.973,P<0.001)。结论 广州市海珠区肺结核疫情呈逐年下降趋势,但部分街道肺结核发病率仍达100/10万以上。男性人群、25~34岁年龄组和低收入人群(家务及待业、不固定职业、退休人群)是防控的主要人群,学生肺结核发病人数多,要加强学校结核病防控和筛查工作。

Objective To understand the registration situation and epidemic characteristics of tuberculosis patients in Haizhu district of guangzhou, and to provide a basis for further prevention and treatment of tuberculosis in Haizhu district. Methods The data of tuberculosis patients registered at present address in the TB information management system of Haizhu district from 2008 to 2017 were collected, and the registration data of tuberculosis patients were analyzed using descriptive epidemiological methods and relevant statistical methods. Results From 2008 to 2017, 14 384 cases of tuberculosis patients were reported in Haizhu district. The annual reported incidence rate decreased from 105.3/100,000 in 2008 to 73.1/100,000 in 2017, showing a down ward trend (χ² = 164.973, P<0.001). The relative incidence of male and female was 2:1; all age groups had morbidity, of which 25~34 years old group had the largest number of cases, accounting for 21.61% of the total number of cases; in occupational distribution, household chores and unemployed were the most, accounting for 34.48 %, followed by other (non-fixed occupations), accounting for 17.29%, retired people, accounting for 15.12%, and school students accounting for 5.52%. In terms of regional distribution, the average annual incidence rate of each street varied greatly, with the highest being 131.23/100,000 and the lowest being 66.40/100,000. The difference is statistically significant(χ²=164.973,P<0.001). Conclusion The incidence of tuberculosis in Haizhu district of Guangzhou has been decreasing year by year, but the incidence of tuberculosis in some streets is still more than 100/100,000. Male population, 25~34 years old group and low-income population (domestic and underemployed, irregular occupation, retired population) are the main population for prevention and control. Students have a large number of cases of tuberculosis, so we need to strengthen prevention, control and screening of tuberculosis in schools.

目的 本研究旨在探讨2型糖尿病不同程度肾病与chemerin、SOD及MDA的相关性。方法 选取2016年1月—2017年12月期间于广州市第一人民医院内分泌科门诊和住院的患者100例,根据尿白蛋白/肌酐比(ACR)分为正常尿蛋白组(NA组,n=33),微量白蛋白尿组(MA组,n=34)及大量蛋白尿组(CA组,n=33),另选取32例我院体检中心体检结果正常的正常健康人作为对照组(NC组,n=32),测定血糖、糖化血红蛋白、血肌酐、ACR、24小时尿蛋白定量、胆固醇、甘油三酯、SOD、MDA、chemerin等水平。结果 SOD的水平:NC组> NA组> MA组>CA组(P<0.05);MDA的水平:CA组>MA组>NA组>NC组(P<0.05);Chemerin水平:CA组>MA组>NA组>NC组(P<0.05)。相关性分析提示ACR与血清SOD呈负相关,与MDA、chemerin呈正相关。多元回归分析显示,病程、胆固醇、糖化血红蛋白、chemerin是影响ACR的主要因素。结论 Chemerin、MDA、SOD可能参与糖尿病肾病的发生发展,检测其水平可以在一定程度上反映2型糖尿病肾病患者的病情严重程度。

Objective To explore the relationship between different type of Type 2 diabetes nephropathy and chemerin,SOD,MDA. Methods A total of 100 inpatients and outpatients were enrolled in this study between January 2016 and December 2017 in Guangzhou First People's Hospital. They were divided into normal urinary protein group (NA group, n=33), microalbuminuria group (MA group, n=34) and massive proteinuria group (CA group, n=33) based on ACR. Another 32 healthy people were collected as a control group in medical examination center (NC group, n=32). The levels of blood sugar, glycated hemoglobin, serum creatinine, ACR, 24-hour urinary protein, cholesterol, triglyceride, SOD, MDA and chemerin were measured. Results The level of SOD: NC group > NA group > MA group > CA group (P< 0.05). The level of MDA: CA group > MA group > NA group > NC group (P< 0.05). The level of chemerin: CA group > MA group > NA group > NC group (P< 0.05). Correlation analysis showed that ACR was negatively correlated with serum SOD and positively correlated with MDA and chemerin. Multivariate logistic regression demonstrated that course of disease, CHOL, HbA1c and chemerin were the main factors affecting ACR. Conclusion Chemerin, MDA and SOD may be involved in the occurrence and development of diabetic nephropathy. Chemerin, MDA and SOD may reflect the severity of type 2 diabetic nephropathy

目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。

目的 了解医务人员临床工作中血源性职业暴露的情况、暴露后的心理健康状况及其影响因素,采取干预措施,保障医务人员身心健康。方法 对医院2013年1月—2017年12月上报的79例血源性职业暴露者,在1个月内进行现状调查,同时采用自填式问卷症状自评量表(SCL-90)对调查对象进行调查,对其暴露后的心理影响程度进行评估。结果 医务人员在发生血源性职业暴露后其中躯体化因子、人际关系敏感因子、抑郁因子、焦虑因子在职业暴露前后的比较及与未发生职业暴露的医务人员相比较,均有不同程度的提高,差异均有统计学意义(P<0.001)。单因素分析显示影响血源性职业暴露后医务人员的心理健康状况的因素有年龄、职业、工龄、既往发生职业暴露史和患者患传染病种类(P<0.05)。其中年龄在21~25岁年龄的医务人员的得分较高,职业为医生和陪护工人的得分较高,工龄在1~5年的得分较高,既往发生过职业暴露的医务人员得分较高,患者患传染病类型为梅毒及暴露源不明的得分较高。结论 医务人员在发生血源性职业暴露后,其心理健康状态可受到较大影响;工龄、既往发生职业暴露史和患者患传染病种类是医务人员发生血源性职业暴露后心理状况健康的独立影响因素。医院管理者在重视预防及减少职业暴露的同时,更应关注血源性职业暴露后的心理变化,及时提供心理支持和医疗帮助。

目的 探讨不同中医体质老年糖尿病患者心率变异性与自主神经功能的关系。方法 选取2016年3月—2017年4月在我院治疗的老年糖尿病患者250例,检测各中医体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF、HF、LF/HF以及空腹血糖(FBG)、糖化血红蛋白(HbA1c)。结果 总偏颇体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF和HF分别为(88.37±10.02)ms、(78.82±9.44)ms、(41.14±11.43)ms、(22.28±6.53)ms、(10.03±4.33)ms、(203.38±78.23)ms²和(122.21±80.03)ms²,低于平和质患者(P＜0.05),而LF/HF为(1.68±0.43),高于平和质患者(P＜0.05);血瘀质患者SDNN、SDANN、SDNNI、RMSSD和PNN50低于气虚质、阴虚质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF、HF低于气虚质、血瘀质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF/HF低于气虚质、血瘀质、痰湿质、湿热质患者(P＜0.05);其他型患者SDNN、SDANN、SDNNI、RMSSD、PNN50、LF、HF高于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05),而LF/HF低于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05);不同中医体质患者FBG、HbA1c比较差异无统计学意义(P＞0.05)。结论 糖尿病患者偏颇体质较平和质患者心率变异性降低,表现为交感神经张力增大,迷走神经张力降低,其平衡协调破坏。

Objective To explore the relationship between heart rate variability and autonomic nervous function in elderly diabetic patients with different constitutions of traditional Chinese medicine. Methods 250 elderly patients with diabetes mellitus in our hospital from March 2016 to April 2017 were selected; the SDANN, SDNNI, RMSSD, PN50%, LF, HF, LF/HF, fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) were measured. Results In patients with general biased constitution, SDANN, SDNNI, RMSSD, PN50%, LF and HF were (88.37±10.02) ms, (78.82±9.44) ms, (41.14±11.43) ms, (22.28±6.53) ms, (10.03 ±4.33) ms, (203.38±78.23) ms² and (122.21±80.03) ms², which were lower than those in patients with plain constitution (P＜0.05), while LF/HF was (1.68±0.43), which was higher than that in patients with plain constitution (P＜0.05); in patients with blood stasis, SDANN, SDNNI, RMSSD and PN50 were lower than those with Qi deficiency, Yin deficiency, phlegm-dampness, damp-heat and other types (P＜0.05); LF and HF in Yin deficiency type patients were lower than those in Qi deficiency type, blood stasis type, phlegm-dampness type, damp-heat type and other types (P＜0.05); LF/HF in Yin deficiency patients was lower than that in Qi deficiency patients, blood stasis patients, phlegm-dampness patients and damp-heat patients (P＜0.05); SDANN, SDNNI, RMSSD, PN50, LF and HF in other types of patients were higher than Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05), while LF/HF was lower than those with Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05); there was no significant difference in FBG and HbA1c in patients with different constitutions of TCM (P>0.05). Conclusion The heart rate variability of biased constitution patients with diabetes mellitus was lower than that of patients with mild constitution, manifested by increased sympathetic nerve tension, decreased vagal nerve tension and destroyed balance and coordination.