目的 探讨非霍奇金淋巴瘤(NHL)合并HBV感染患者化疗过程中肝功能监测的临床意义。方法 以2014年3月—2016年6月我院21例NHL合并HBV感染患者为研究对象,所有患者采用CHOP方案进行化疗,治疗2~6周期。 分别于化疗前后对患者肝功能进行检查,采用荧光定量PCR法进行乙肝病毒DNA复制情况检测;肝功能出现中重度异常患者进一步测定凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fb)等,同时对NHL辅助性标志物进行监测,主要包括β₂微球蛋白(β₂-MG)及乳酸脱氢酶(LDH)。结果 随着化疗进行,患者ALT、GLB、胆红素水平逐渐增高(P<0.05),ALB、PA水平逐渐降低(P<0.05);相比于化疗进行2个周期,进行4～6周化疗者肝功能损害率和重症肝炎发生率均升高,差异有统计学意义(P<0.05)。结论 NHL合并HBV感染患者化疗过程中对肝功能监测,有助于防止重症肝炎发生,并降低病死率,具有重要临床意义。

目的 探讨抗肿瘤联合营养支持治疗对老年晚期恶性肿瘤癌因性疲倦及厌食行为的影响。方法 选取2015年4月—2017年4月晚期恶性肿瘤老年患者160例,随机分为抗肿瘤治疗组(对照组)和抗肿瘤联合营养支持治疗组(观察组),各80例,对比分析两组治疗前、后癌因性疲倦及厌食行为评分情况。结果 治疗前,两组厌食行为、癌因性疲倦评分比较无差异(P>0.05);治疗后,观察组厌食行为及癌因性疲倦评分均低于对照组(P<0.05)。结论 营养支持治疗在老年晚期恶性肿瘤患者厌食行为及癌因性疲倦方面的改善效果显著,一定程度上提高患者生活质量,减轻痛苦,具有较高临床应用价值。

目的 探讨分析莫西沙星对2型糖尿病合并肺部感染患者内皮素及降钙素基因相关肽的影响。方法 回顾性分析2015年1月—2016年1月来我院就诊并确诊为2型糖尿病合并肺部感染的84例患者的临床资料,根据治疗方案将其分为对照组和观察组,每组各42例。对照组患者给予常规治疗,观察组患者在对照组的治疗基础上予以莫西沙星治疗。观察两组患者治疗后内皮素以及降钙素基因相关肽的变化。结果 ①观察组总有效率(92.86%)优于对照组(78.57%),两组患者间总有效率的比较有统计学意义(P<0.05);②两组患者治疗前ET、CGRP水平无差异(P>0.05)。治疗后,观察组ET水平低于对照组,CGRP水平高于对照组(P<0.05)。结论 临床应用莫西沙星治疗2型糖尿病合并肺部感染具有明显的临床疗效,值得临床推广应用。

目的 评价调强放疗后颞颌关节损伤的鼻咽癌患者的生存情况。方法 2010年2月—2013年11月期间90例经调强放疗后出现颞颌关节损伤的鼻咽癌患者,鼻咽病灶放疗剂量70～74Gy/32～33f,转移淋巴结放疗剂量64～70Gy/32～33f,高危区预防性放疗剂量58～66Gy/32～33f,低危区预防性放疗剂量54～58Gy/32～33f,采用顺铂、奈达铂或多西他赛行同步化疗。回顾性分析患者的张口困难程度、近期疗效、无局部复发生存、无远处转移生存及总生存情况,同时评价放疗毒副反应。结果 ①颞颌关节损伤:97.8%的患者为Ⅰ级损伤,2.2%的患者为Ⅱ级损伤,无Ⅲ~Ⅳ级重度放射性损伤;②近期疗效:完全缓解67例(74.5%),部分缓解21例(23.3%),稳定1例(1.1%),进展1例(1.1%),总有效率(ORR)为97.8%(88/90),疾病控制率(DCR)为98.9%。③生存情况:中位随访时间57个月(5～84个月),5年无局部复发生存率、无远处转移生存率和总生存率分别为85.6%、71.1%和73.3%。④不良反应:3~4度不良反应有白细胞减少(发生率为24.4%)、中性粒细胞减少(发生率为21.1%)和血小板减少(发生率为1.1%)等血液学毒性以及口腔黏膜炎(发生率为43.3%)、呕吐(发生率为1.1%)和放射性皮炎(发生率为3.3%)等非血液学毒性。结论 鼻咽癌调强放疗后颞颌关节损伤以I度为主;调强放疗后出现颞颌关节损伤的鼻咽癌患者以T3~T4为主,但仍可获得较满意的局控率、较低的远处转移率和较高的总生存率,且安全性较高。

目的 探讨降低院前病情识别风险的护理研究。方法 对106例患者进行院前急救护理,53例患者使用简单临床评分(SCS)作为对照组,53例患者采用改良早期预警评分(MEWS)模式作为观察组,并按照院前危重患者救治护理模式实施院前急救护理。比较救治结果。结果 观察组患者院前急救总耗时间缩短,转运成活率和满意度提高,转运并发症发生率低于对照组,差异有统计学意义(P<0.05)。MEWS评分评估28 d生存率的AUC为0.861(P＜0. 001),临界值为6.98分,敏感度87.2%,特异度91.6%,优于SCS。结论 早期预警评分模式可以降低院前病情识别风险,提高救治成功率和护理质量,对患者预后有较好的敏感性和准确性。

Objective To explore the nursing in reducing risk of patients' pre-hospital condition recognition. Methods 106 patients were treated by emergency care in pre-hospital period. Among all patients a simple clinical scoring condition assessment(SCS) were given to 53 patients, who were in control group, and other 53 cases were treated by modified early warning score model (MEWS), who were in observation group. Emergency care was given to all critical patients in pre-hospital period. Then we compared the effects. Results The pre-hospital consumed time was significantly less, transportation survival rate and satisfaction rate of patients were both higher, complication rate was lower in observation group than control group(P＜0.05). The AUC was 0.861(P＜0. 001) of MEWS for evaluating survival rate after 28 days by the ROC curve analysis. The score of cutoff value was 6.98, sensitivity was 87.2%, specificity was 91.6%, which were all better than SCS. Conclusion Early warning score model may decrease the risk of condition recognition in pre-hospital period, improve rescue success rate and nursing quality, providing a better sensitivity and accuracy for prognosis evaluation.

目的 探讨分阶段延续护理对改善留置输尿管支架管老年农民患者并发症的效果。方法 按时间顺序将106例患者分为对照组52例和观察组54例,对照组给予常规电话随访,观察组实施三个阶段的延续护理。30天后测评患者并发症持续时间和发生率、自我管理能力。结果 观察组腰痛、血尿、膀胱刺激征持续时间缩短,尿路感染、支架管移位和滞留的发生率下降,自我管理能力各维度评分升高,与对照组比较差异均有统计学意义(P＜0.01)。结论 分阶段延续护理能提高留置输尿管支架管老年农民患者的自我管理能力,增强依从性,减少并发症的发生,促进早日康复。

Objective To investigate the effect of staged continuous nursing on complications in elderly agricultural-workerpatients with indwelling ureteral stent. Methods According to the chronological order, 106 patients were divided into control group (52 cases) and observation group (54 cases). The control group received routine telephone follow-up, and the observation group received three stages of continuous care. 30 days later, the complications' duration, incidence and self-management ability were assessed. Results In the observation group, pain, hematuria and bladder irritation were obviously shorten. Urinary tract infection and the incidence of stent displacement and retention were decreased. Scores in all dimensions of self management ability were increased. Comparing with the control group, it had significant difference (P<0.01). Conclusion The phased continuous nursing may improve the self-management ability of the elderly agricultural-worker with indwelling ureteral stents, strengthen the compliance, reduce the occurrence of complications and promote early rehabilitation.

目的 探讨中医妇科门诊患者的焦虑及抑郁的发生情况,优化诊治工作,更好地服务患者。方法 采用焦虑自评量表(SAS)和 抑郁自评量表(SDS)评定190名中医妇科门诊患者的心理状态。结果 中医妇科患者焦虑均分高于正常常模组(P＜0.05),抑郁评分与全国常模相比则无统计学差异(P＞0.05),有焦虑及抑郁症状的患者分别为6.3%及10%。结论 中医妇科门诊患者的焦虑症状较正常人群高,医生在临床诊治过程应重视对患者心理状态的评价,并进行相应的心理干预及人文关怀, 以提高患者对治疗的依从性和满意度,为其身体及心理健康打下良好基础。

Objective To explore the occurrences of anxiety and depression in female TCM gynecology outpatients, and thus to make improvements in diagnosis, treatment, and service for the patients. Methods We adopted Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) to evaluate the mental status of 190 TCM gynecology outpatients. Results Anxiety scores in TCM gynecology group were higher than those in the normal group (P＜0.05), while there was no statistical difference in depression scores between these two groups (P＞0.05). Among the outpatients, 6.3% had symptoms of anxiety, and 10% had symptoms of depression. Conclusion TCM gynecology outpatients show more anxiety symptoms than normal people. We should pay attention to the assessment of those patients' mental status in the process of diagnosis and treatment, and offer psychological intervention and humane care to those patients accordingly. In this way, we could enhance patients' compliance and satisfaction, and help them build a solid foundation in physical health as well as in mental health.

目的 探讨自由体位分娩方式和传统体位分娩方式对产后盆底功能的影响。方法 2015年3月—2016年3月在广州市妇女儿童医疗中心定期产检并分娩单胎初产阴道分娩610例产妇,按分娩方式分为自由体位分娩298例为实验组,传统体位分娩312例为对照组,对两组产妇会阴损伤,产后6～8周筛查盆底肌力,探讨不同体位分娩方式对产后盆底肌力的影响。结果 实验组阴道静息压,阴道收缩压、Ⅰ类肌纤维强度、 Ⅱ类肌纤维强度、阴道收缩持续时间均较对照组有增加,差异性均有统计学意义(P<0.05)。结论 自由体位分娩方式不降低产后盆底肌力,对产后盆底有保护作用。

Objective To analyze the effects of liberal intrapartum postures on the pelvic floor function of postpartum. Methods 610 pregnant women (vaginal delivery,single birth,and head position) were classified and analyzed in Guangzhou Women and Children Medical Center from March 2015 to March 2016. All the pregnant women were mature without pregnancy complications; 298 pregnant women who adopted free posture delivery were selected as observation group,312 pregnant women who adopted traditional posture delivery were selected as control group. We counted the number of perineal injury incidence of the two group,and the pelvic floor strength of the two groups was measured after fetal birth after 6 to 8 weeks. Results We compared the vaginal resting pressure(VRP),vaginal squeezing pressure(VSP),classⅠfiber strength, class Ⅱ fiber strength and the time of vaginal contraction between the two groups. Pelvic floor muscle strength was significantly stronger in the observation group than that in the control group (P<0. 05). Conclusion There is a closely association between the different intrapartum postures and the pelvic floor function of postpartum. Adopting free posture delivery has no adverse impact on pelvic floor function of postpartum, which can protect the function of female pelvic floor.

目的 分析乳腺恶性肿瘤患者的诊断和治疗方法的动态变化,了解该疾病的患者诊治相关行为方式的变化。方法 抽取我院1999年—2014年收治的所有乳腺恶性肿瘤患者,比较不同初诊时间和初诊年龄分组间,患病部位、肿瘤大小、手术方式、治疗方式的差异。结果 比较1999年—2004年组、2005—2009年组,近年诊断的肿瘤最大直径有所下降,经过卡方比较,构成比有差异(χ²=14.2,P=0.007)。近年诊断的患者更愿意选择积极的改良根治术作为手术治疗方式(χ²=38.8,P<0.001)。就不同年龄而言,年轻的患者选择改良根治术和化疗的比例也较年老的患者高,而年龄大的患者则选择姑息治疗的比例较高(χ²=154.9,P<0.001)和(χ²=129.8,P<0.001)。结论 乳腺恶性肿瘤的认知的加强,诊治技术的提高,乳腺恶性肿瘤能够更早的被发现诊断,治疗方式的选择也更加积极。

Objective To analyze the dynamic changes of breast cancer diagnosis and treatment. and to understand the changes of related behaviors of the patients. Methods From 1999 to 2014, breast cancer patients were chosen, the differences of tumor size, operation and treatment were not compared. Results The results were compared within different groups of diagnosis years, such as 1999-2004,2005-2009, and 2010-2015. The maximum diameter of the tumor diagnosed in recent years was decreased, χ²=14.2,P= 0.007. At the same time, patients that were diagnosed in recent years were more likely to choose radical surgery as surgical treatment, χ²=38.8,P<0.001. Comparing within groups of different ages, more patients chose radical surgery and chemotherapy in younger patients than older ones, we found that the older patients chose a higher proportion of palliative care, χ²=154.9,P<0.001 and χ²=129.8,P<0.001. Conclusion Understan-ding of breast cancer malignancies was enhanced. Breast cancer may be diagnosed earlier and the choice of treatment is more positive with the development of technology.

目的 研究黄连水煎剂对体外建立的金黄色葡萄球菌生物膜(bacterial biofilm,BF)的作用,及黄连水煎剂联合苯唑西林钠对金黄色葡萄球菌作用。方法 由广西医科大学第一附属医院检验科提供金黄色葡萄球菌菌株34134,采用二倍稀释法分别测出黄连水煎剂和苯唑西林钠对金黄色葡萄球菌的最低抑菌浓度(minimum inhibitory concentration MIC),在体外使用腹膜透析管建立金黄色葡萄球菌生物膜模型,加入不同浓度的黄连水煎剂和苯唑西林钠作用3天和7天后,琼脂平板菌落计数法评估细菌粘附腹透管的能力,结晶紫染色法行载体表面BF半定量,银染法快速鉴定BF。结果 黄连水煎剂MIC为16 mg/mL,苯唑西林钠MIC为4 μg/mL,3天BF模型中,1/2MIC黄连水煎剂、1/4MIC黄连水煎剂、1/8MIC黄连水煎剂、1/16MIC黄连水煎剂、1/2MIC苯唑西林钠、1/4MIC苯唑西林钠作用下的金黄色葡萄球菌的菌落计数分别为(39.333 3±3.994 2)×10⁶ CFU/mL、(52.366 7±3.537 8)×10⁶ CFU/mL、(81.266 7±3.341 8)×10⁶ CFU/mL、(90.900 0±2.040 1)×10⁶ CFU/mL、(50.866 7±2.208 6)×10⁶ CFU/mL、(77.666 7±2.880 7)×10⁶ CFU/mL,空白组的菌落计数为(92.033 3±3.890 6)×10⁶ CFU/mL,与空白组相比较,1/2MIC黄连水煎剂,1/4MIC黄连水煎剂、1/8MIC黄连水煎剂、1/2MIC苯唑西林钠、1/4MIC苯唑西林钠的差异有统计学意义(P<0.001),1/16MIC黄连水煎剂与空白组比较,差异无统计学意义(P=0.173)。7天的BF模型中,1/2黄连水煎剂比1/2苯唑西林钠抑制金黄色葡萄球菌生物膜形成的作用更强(P<0.001),结晶紫、银染也得到相似的结果,进一步的研究发现在1/16MIC黄连水煎剂的作用下,加入不同浓度的苯唑西林钠,此时苯唑西林钠的最低抑菌浓度为0.25 μg/mL。结论 黄连水煎剂能抑制金黄色葡萄球菌生物膜的形成,并且在苯唑西林钠联合黄连水煎剂时,能有效地提高苯唑西林钠的疗效,为治疗金黄色葡萄球菌导致的腹膜透析相关性腹膜炎提供新的治疗方案,同时也提高了抗生素的疗效,为临床上减少耐药菌的产生提供了帮助。

Objective To study the effect of Coptis chinensis decoction on bacterial biofilm(BF)in vitro and the effect of Coptis chinensis decoction combined with oxacillin sodium on Staphylococcus aureus. Methods Staphylococcusaureus strain 34 134 was provided by the First Affiliated Hospital of Guangxi Medical University. Using doubling dilution method to measure the minimum inhibitory concentration of Coptis decoction and Oxacillin sodium on Staphylococcus aureus,respectively. In vitro, peritoneal dialysis tube was used to establish Staphylococcus aureus biofilm model after adding different concentrations of Coptis decoction and Oxacillin sodium for 3 days and 7 days, we used Agar plate count method to assess bacterial adhesion on the dialysis tube, crystal violet staining and semi quantitative method to measure the BF of the surface of the carrier and silver staining(light microscopy) rapid identification of BF. Results The MIC of Coptidis decoction was 16 mg/ml, and that of Oxacillin sodium was 4 μg/mL. In the BF model after 3 days, the colony counting of bacteria of 1/2MIC Coptis decoction, 1/4MIC Coptis decoction, 1/8MIC Coptis decoction,1/16MIC Coptis decoction, 1/2MIC Oxacillin sodium,1/4MIC Oxacillin sodium were(39.333 3+3.994 2)×10⁶(52.366 7+3.537 8),CFU/mL×10⁶, CFU/mL×10⁶(81.266 7+3.341 8), CFU/mL(90.900 0+2.040 1)×10⁶,CFU/mL(50.866 7+2.208 6)×10⁶, CFU/mL(77.666 7+2.880 7)×10⁶ CFU/mL, colony counting of blank group was(92.033 3+3.890 6)×10⁶ CFU/mL, respectively. Compared with the blank group, 1/2MIC Coptis decoction, 1/4MIC Coptis decoction,1/8MIC Coptis decoction,1/2MIC Oxacillin sodium,1/4MIC Oxacillin sodium all had differences in statistical significantce(P=0.001), but 1/16MIC Coptis decoction had no statistically significant(P=0.173). In the BF model after 7 days, colony counting bacteria, crystal violet and silver staining showed similar results. Further studies showed that under the effect of 1/16MIC Coptis decoction, the minimum inhibitory concentration of oxacillin sodium was 0.25 μg/mL. Conclusion Coptis decoction could inhibit the formation of Staphylococcus aureus biofilm, and oxacillin sodium combined with Coptidis decoction was effective to improve the curative effect of oxacillin sodium, providing new treatment for peritoneal dialysis related peritonitis that is caused by Staphylococcus aureus improving the efficacy of antibiotics, and providing help for the clinical on reducing the generation of antibiotic resistant bacteria.