目的 观察并比较注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白（益塞普）剂量递减方案与标准剂量维持方案治疗强直性脊柱炎（AS）的疗效及安全性。方法 选择2015年1月—2016年6月共18个月在我院治疗的80例AS患者为研究对象,随机分为两组,A组40例,给予益塞普递减方案治疗,B组40例,给予益塞普标准剂量维持方案治疗,比较两组的用药疗效及安全性。结果 治疗后,两组的BASDAI、BASFI评分,腰背痛VAS评分,血清CRP、ESR水平均低于治疗前（P<0.05）,但两组组间比较未见统计学意义（P>0.05）;在治疗期间,A组与B组的不良反应发生率（32.50%、55.00%）及复发率（27.50%、22.50%）比较均无统计学意义（P>0.05）;经统计,A组的年平均药物费用为（47 391±4 830）元,少于B组（82 038±5 127）元（P<0.05）。结论 采用益塞普剂量递减方案治疗AS安全有效,能在短时间内控制疾病活动及改善临床症状,且花费更低,患者接受度更高。

Objective To observe and compare the clinical effect and safety of dose reduction scheme for recombinant human tumor necrosis factor receptor antibody fusion protein （hTNFR：Fc,etanercept） for injection and standard dose maintenance scheme in treatment of ankylosing spondylitis （AS）. Methods 80 cases of patients with AS and who were treated in our hospital from January 2015 to June 2016 for 18 months were selected as the research objects,and were randomly divided into two groups.The group A of 40 cases were treated with etanercept of degressive scheme therapy,while the group B of 40 cases were treated with etanercept of standard dose maintenance therapy. Then,the clinical effect and safety of drug use of two groups were compared. Results The BASDAI,BASFI score,VAS score of low back pain,serum CRP and ESR levels of two groups after treatment were lower than those before the treatment （P < 0.05）,but there was no statistical significance between the two groups （P > 0.05）. During the treatment,there was no significant difference in the incidence of adverse reactions （32.50%,55%） and recurrence rate （27.50%,22.50%） between group A and group B （P > 0.05）. By statistics,the average annual drug cost in group A was RMB （47 391±4 830） yuan,which was less than that in group B of RMB （82 038±5 127） yuan （P < 0.05）. Conclusion The etanercept of degressive scheme therapy in treatment of AS are safe and effective,which may control disease activity and improve clinical symptoms in a short time,and low costs. The patient will receive higher degree of acceptance.

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 探讨尿清舒颗粒治疗泌尿系统感染伴有尿路结石的疗效。方法 选取我院2015年1月—2017年1月收治的80例泌尿系统感染伴有尿路结石患者纳入研究对象,以随机数表法分为观察组与对照组,各40例。对照组静脉滴注亚胺培南-西司他丁进行治疗,观察组在对照组基础上加服尿清舒颗粒。对比两组结石排出疗效及治疗前后尿白细胞镜检、中段尿液的普通细菌和真菌培养数量,尿频、尿急、尿痛、血尿、排尿不尽、腰酸乏力评分各项指标。结果 观察组结石排出疗效优于对照组差异有统计学意义(P＜0.05);观察组治疗后尿白细胞镜检与治疗前及对照组治疗后对比下降、两组治疗后中段尿液的普通细菌和真菌培养数量与治疗前对比降低,差异有统计学意义(P＜0.05);观察组治疗后尿频、尿急、尿痛、血尿、排尿不尽、腰酸乏力评分与治疗前及对照组治疗后对比降低,差异有统计学意义(P＜0.05)。结论 尿清舒颗粒治疗泌尿系统感染伴有尿路结石可有效发挥抗菌作用,排出结石,缓解患者临床症状,且安全性较高,具有较高的临床应用价值。

目的 探究肺表面活性物质联合高频振荡通气治疗新生儿呼吸窘迫综合征的有效性及安全性。方法 选取我院新生儿科2016年2月—2018年7月收治的120例呼吸窘迫综合征新生患儿作为研究对象,随机将其分为常规组和试验组,每组各60例。常规组实施肺表面活性物质联合常频振荡通气治疗,试验组采取肺表面活性物质联合高频振荡通气治疗,比较两组治疗前后的肺氧合功能和并发症发生情况。结果 PaO₂、OI、a/A PO₂等指标在治疗前两组差异无统计学意义(P＞0.05),治疗后试验组均要优于常规组,差异有统计学意义(P＜0.05);常规组的并发症发生率为35.0%(21/60),试验组的并发症发生率为18.3%(11/60),试验组低于常规组,差异有统计学意义(P＜0.05)。结论 新生儿呼吸窘迫综合征采用肺表面活性物质联合高频振荡通气治疗效果显著,并发症少,安全性高。

目的 探讨吗替麦考酚酯联合泼尼松治疗儿童紫癜性肾炎的临床疗效。方法 将2016年2月—2018年2月在广州开发区医院儿科和广州市第一人民医院儿科收治的36例紫癜性肾炎肾病综合征型患者根据治疗分为联合组和对照组,每组18例。联合组采用吗替麦考酚酯和泼尼松治疗,对照组采用泼尼松治疗。比较两组患儿治疗前后血肌酐(Scr)、总胆固醇(Chol)、24 h 尿蛋白定量、血白蛋白(ALB) 。结果 联合组治疗效果优于对照组,差异有统计学意义(Z=-2.461,P ＜ 0.05) ; 联合组治疗后24 h尿蛋白定量下降,血肌酐(Scr)降低,总胆固醇(Chol)下降和血白蛋白(ALB)升高,两组实验室指标差异有统计学意义(P＜ 0.05) 。结论 吗替麦考酚酯联合泼尼松治疗紫癜性肾炎治疗效果明确,可以降低血肌酐和胆固醇,改善尿蛋白水平,提升血白蛋白浓度,治疗效果明显,能有效控制病情,在临床上值得推广应用。

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 观察小剂量阿帕替尼联合经肝动脉化疗栓塞术(TACE)对晚期肝癌的疗效。方法 选择2016年1月1日—2017年12月31日在我院住院治疗的晚期肝癌患者38例,将其随机分为对照组和观察组,每组19例,对照组给予TACE治疗,观察组在TACE治疗的基础上联合口服阿帕替尼(250 mg/d)。随访两组患者的存活状态,Kaplan-Meier 法计算中位生存期,并绘制生存曲线,采用log-rank法比较两组患者生存曲线的差异。结果 对照组和观察组中位生存期分别为4.3月、5.8月,两组生存曲线比较有差异(χ²=4.691,P=0.043)。结论 相比于单纯TACE治疗,小剂量阿帕替尼联合TACE方案可以延长晚期肝癌患者的生存期。

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.

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.