目的 探讨农村地区糖尿病患者在镇卫生院—村卫生站一体化管理模式下的效果。方法 于2013年10月—2014年9月对花山镇26个村1267名糖尿病患者实行镇卫生院—乡村卫生站一体化管理,镇卫生院定期组织医疗队到村卫生站健康宣教、义诊、体检,村卫生站乡医为本村糖尿病患者开展跟踪随访、血糖监测、用药及饮食运动指导。一年后比较患者的规范管理率、血糖控制率。结果 实施管理后农村糖尿病患者的规范管理率和血糖控制达标率均有提高,尤以血糖控制达标率为明显。结论 对农村社区糖尿病患者实施镇卫生院—村卫生站一体化管理能更好地跟踪监测患者血糖水平,增强患者防病意识,有效提高农村社区糖尿病患者血糖控制率。

目的 研究探讨适合基层医院开展白内障复明手术的手术方式。方法 随机抽取我院2010年4月—2014年4月收治的白内障患者1560例为研究对象。所有患者的患眼有2460只。并将其随机分成观察组和对照组,每组患者患眼分别有1230只。对照组采用大切口(巩膜隧道)有缝线白内障(囊外)摘除并人工晶状体植入手术,观察组患者采用小切口(巩膜隧道) 无缝线白内障(囊外)摘除并人工晶状体植入手术治疗的方法,并对两组的疗效进行分析。观察患者手术后的视力、术中以及术后并发症、住院费用等。结果 治疗结果显示,观察组患者的视力术后7天在0.4以上的患者占有89.7%,对照组患者视力在0.4以上的患者占有87.3%。差异无统计学意义(P＞0.05)。手术时间对照组长于观察组,手术费用对照组略高于观察组,差异有统计学意义(P<0.05)。两组在术中后囊膜破裂的发生率、前房型人工晶体植入的比例、上袢缝合固定后房型人工晶体植入比例比较,差异有统计学意义(P<0.05),观察组上述情况少于对照组。结论 在基层医院进行白内障复明活动,采用小切口(巩膜隧道) 无缝线白内障(囊外)摘除并人工晶状体植入手术治疗的方法疗效可靠,并发症少,手术时间短,住院总费用较低,有利于我们在资金、设备有限的情况下在限定的时间内完成较多的白内障复明手术。因此,在基层医院开展的白内障扶贫复明活动中小切口白内障(囊外)摘除并人工晶状体植入手术方法值得推广。

目的 探讨光疗对早产儿血浆β-内啡肽含量的影响及与早产儿呼吸暂停的相关性。方法 收集我院住院早产儿92例,检测早产儿光疗前、中、后的血浆β-内啡肽及血清电解质、血糖及pH值,并将光疗过程中出现呼吸暂停者纳入光疗呼吸暂停组28例,无呼吸暂停者纳入光疗非呼吸暂停组44例,并设非光疗无呼吸暂停早产儿为对照组20例,比较组间上述指标的差异。结果 各组早产儿的血清电解质、血糖、血液pH值在光疗前、中、后无变化,差异无统计学意义(P>0.05)。光疗呼吸暂停组的血浆β-内啡肽浓度在光疗前、中、后无变化,差异无统计学意义(P>0.05),光疗呼吸暂停组和非呼吸暂停组之间血浆β-内啡肽的浓度无变化,差异无统计学意义(P>0.05),光疗组与非光疗组β-内啡肽浓度无变化,差异也无统计学意义(P>0.05)。结论 早产儿光疗前后β-内啡肽浓度无变化,呼吸暂停与β-内啡肽含量无相关性。

目的 了解惠州地区无偿献血者中抗-Mur及Mur抗原的频率,为指导临床输血及建立稀有血型红细胞库提供依据。方法 用微板盐水法和凝聚胺法筛查8686名自愿无偿献血者血浆中的抗-Mur,再用微柱凝胶卡方法进一步确认;采用人源抗-Mur血清检测1119名献血者Mur抗原的红细胞表型。结果 无偿献血者血清中抗-Mur频率为0.35%(31/8686),男女间的差异有统计意义(P<0.05),女性高于男性;Mur抗原阳性频率为5.61％(63／1119)。结论 惠州地区无偿献血者中抗-Mur频率较高,而Mur抗原阳性则相对较常见,在输血前检查项目中增加Mur血型抗原抗体检测是非常必要的。

Objective To investigate the frequency of anti-Mur and Mur antigen among blood donors in Huizhou city and provide data for guiding clinical transfusion and establishing red blood cells library of rare blood type. Method Micro-plate brine method and polybrene method are used to screen anti-Mur from 8686 blood donors. DG Gel Coombs cards are used to confirm the result. Human anti-Mur serum is used to screen the phenotypes from other 1119 blood donors. Results The frequency of anti-Mur was 0.35%(31/8686). The differences between men and women had statistical significance (P<0.05), of which women were higher than men. The frequency of Mur antigen positive was 5.61％(63／1119). Conclusion The blood donors in Huizhou showed a high frequency of anti-Mur and a relatively high frequency of Mur antigen, so it is very necessary to add test method of Mur blood group antigen and antibody before the donors carry out the blood transfusion process.

目的 通过比较治疗组服药前、后骨密度及骨代谢指标的变化情况,并将治疗组、对照组分别作对比,观察壮骨颗粒治疗绝经后女性骨量减少及骨质疏松、改善其骨代谢的临床疗效。方法 将研究对象随机分为两组,治疗组服用壮骨颗粒＋迪巧,对照组只服用迪巧。结果 壮骨颗粒组治疗后血清中的PINP、β-Crosslaps及N-MID下降(P＜0.05);与治疗前相比,腰椎(L2-L4)BMD提高(P＜0.05);壮骨颗粒能改善绝经后女性骨代谢及提高骨密度的效果优于迪巧组。结论 壮骨颗粒是治疗绝经后女性骨量减少及骨质疏松、提高骨量、改善骨代谢情况的安全有效药物。

目的 探讨血清降钙素原(PCT)与中性粒细胞淋巴细胞比率(NLR)对预测急性胰腺炎(AP)继发急性肺损伤(ALI)的临床适用性。方法 回顾性分析60个AP病例,对合并ALI的实验组和没有合并ALI的对照组治疗前后血清PCT和NLR进行均数比较、相关性分析、ROC分析等统计分析。结果 两组间治疗前NLR(P=0.019)与治疗期间血清PCT平均值(P<0.001)有统计学差异,ROC分析:治疗前NLR、治疗期间血清PCT平均值对于预测ALI的灵敏度、特异度、约登指数分别为0.778、0.889;0.690、0.881;0.468、0.77,两者的差异有统计学意义(P=0.0134)。结论 急性胰腺炎早期治疗前,NLR对于预测ALI有一定的参考价值,而在急性胰腺炎后期,治疗期间的血清PCT平均值对于预测ALI有着良好的灵敏度和特异度,具有一定的临床适用性。

Objective To investigate the clinical applicability of serum procalcitonin levels and neutrophil-to-lymphocyte ratio (NLR) in predicting acute lung injury(ALI) secondary to acute pancreatitis(AP). Methods Sixty cases of AP were recruited to explore their serum-PCT and NLR before/after treatment. Means comparison, correlation analysis, ROC analysis were carried out. Results The NLR before treatment (P=0.019)and serum-PCT after treatment(P<0.001)were statistical significance of two groups(ALI、NON-ALI). In ROC analysis, the sensitivity, specificity, Jorden index of above two index were 0.778、0.889;0.690、0.881;0.468、0.77 respectively. There were statistically significant differences between them(P=0.0134). Conclusion In the early phase before treatment in AP, NLR has certain reference value in predicting ALI. On the other hand, in the later phase after treatment in AP, serum-PCT has great sensitivity, specificity and clinical applicability.

目的 探讨压力管理对改善中年高血压患者生活质量的效果。方法 采用便利抽样法,把首次在我院住院的中年高血压患者115例按时间段分为实验组60例和对照组55例,对照组给予常规护理,实验组采用压力管理干预,分住院期和出院后康复期两阶段进行。使用抑郁自评量表和SF-36量表分别在出院前和出院后1个月进行测评。结果 干预后实验组患者抑郁标准分降低,SF-36量表各维度分及总分升高,与对照组比较差异均有统计学意义(P＜0.05)。结论 对中年高血压患者实施有针对性、整体性、延续性和激励性的压力管理,可提高其生活质量。

Objective To explore the influence of stress management on the improvement of quality of life of middle-aged patients with hypertension. Methods According to convenience sampling, 115 middle-aged patients with hypertension who were the first time admitted to our hospital were divided, on the basis of different periods, into the test group (60 patients) and the control group (55 patients). The control group was accepted normal nursing, while the test group was accepted the stress management intervention that performed during hospitalization and after patients discharged from the hospital. Both groups were assessed, by using self-rating depression scale and SF-36 scale, before discharging from hospital and one month after discharging from hospital. Results After the intervention, the test group experienced reductions in depression standard score and increases in dimension scores and total scores of SF-36 scale.compared with those of the control group, these changes had statistical significant (P＜0.05). Conclusion Selective, integrated, continuous and stimulating stress management can help middle-aged patients with hypertension to improve the quality of life.

目的 通过比较术前螺旋CT诊断与X线、超声诊断,并分析螺旋CT的影像学表现,探讨急诊螺旋CT在外伤性肠及肠系膜损伤诊断及定位的价值。方法 回顾性分析经手术证实的65例行急诊平扫的肠或肠系膜损伤的术前CT、X线、B超等影像诊断结果,比较不同影像报告与术后诊断的符合情况,分析外伤性肠及肠系膜损伤的CT诊断的特点。结果 对肠及肠系膜损伤的CT诊断准确率高于X线、B超诊断准确率,差异有统计学意义(P=0.012,P<0.001),螺旋CT对外伤性肠及肠系膜损伤有对应的征象,利于做出定位诊断。结论 螺旋CT对腹部外伤性肠及肠系膜损伤具有良好的诊断及定位的价值。

Objective To investigate the value of spiral CT in enteral and mesenteric injury diagnosing and localizing caused by abdominal traumatic emergency,by the means of analyzing and comparing the preoperative CT report to X-ray and b-ultrasound reports. Methods 65 cases of confirmed enteral or mesenteric injury were recruited to explore their preoperative CT、X-ray and b-ultrasound features.Statistical analysis was conducted to calculate and compare the rate of sensitivity of 3 different test in diagnosing enteral and mesenteric injury. Results The accuracy of CT in diagnosing enteral and mesenteric injury were better than X-ray and b-ultrasound,the differences were statistical significance(P=0.012,P<0.001),and the CT features can help to localize the injury position. Conclusion Spiral CT scans have value in diagnosing enteral and mesenteric injury.

目的 探讨急性阑尾炎(acute appendicitis, AA)及急性感染性肠炎(acute infectious enteritis, AIE)患儿的阑尾高频超声影像特点及其显像敏感性。方法 回顾性分析临床确诊为急性阑尾炎患儿120例,急性感染性肠炎患儿160例,并对其行高频超声检查,另设120例正常儿童为对照组。分析高频超声阑尾显示率,阑尾外径,阑尾周围系膜炎性变化以及阑尾的位置等情况。结果 AA组、AIE组、对照组阑尾的显示率分别为96.7%、80.6%、68.3%,差异有统计学意义(P<0.05)。三组超声显示的阑尾外径分别为(8.5±2.2)mm、(4.3±0.8)mm、(3.5±0.7)mm,相互间差异亦均有统计学意义(P<0.05)。AA组所有的阑尾周围系膜炎症改变均可探及,但AIE组的阑尾周围系膜无变化。结论 小儿急性阑尾炎高频超声显像敏感性高,旨在为临床对AA早期诊断、早期治疗提供较准确全面的影像学依据。

Objective Use high-frequency ultrasound to determine the frequency of visualization and image feature of the appendix in children with acute appendicitis (acute appendicitis, AA) and with acute infectious enteritis (acute infectious enteritis, AIE). Methods The ultrasonic features of 120 children with AA, 160 children with AIE, and 120 randomly selected asymptomatic children were analyzed retrospectively. And their visualization rate, outer appendiceal diameter, presence or absence of inflamed periphery appendiceal mesenterium, and location of the appendix were recorded. Results The visualization rates of the appendix were 96.7%, 80.6%, and 68.3% for AA groups, AIE groups, and the control, respectively(P<0.05). The outer appendiceal diameters for the 3 groups were (8.5±2.2)mm, (4.3±0.8)mm, and (3.5±0.7)mm. Difference among the 3 groups was statistically significant also. Periphery appendiceal inflamed mesenterium was detected in all AA cases, but in none of the AIE cases. Conclusion High ultrasound imaging sensitivity of puerile acute appendicitis provided relatively accurate comprehensive imaging basis for clinical early diagnosis and early treatment.

目的 探讨糖化血红蛋白(HbA1c)联合超敏C反应蛋白(hs-CRP)在筛查妊娠期糖尿病(GDM)的临床意义。方法 选择2013年9月1日—2014年8月31日在我院妇产科孕期产前检查及分娩的孕妇,根据糖耐量试验(OGTT)、HbA1c和hs-CRP检查,筛查出92例孕妇为GDM组,并随机抽取OGTT正常的健康孕妇90例为NGT组,25例健康孕龄女性为对照组,分析3组FPG、HbA1c、hs-CRP及OGTT结果。结果 GDM组OGTT、HbA1c、hs-CRP高于NGT组和对照组,差异有统计学意义(P<0.01),NGT组与对照组比较,HbA1c、hs-CRP浓度差异无统计学意义(P>0.05),但3组FPG差异无统计学意义(P>0.05),Pearson相关分析显示,HbA1c与hs-CRP呈正相关(r=0.79,P<0.01)。结论 GDM患者HbA1c、hs-CRP水平升高,HbA1c联合hs-CRP可能成为GDM筛查的良好指标。

Objective To evaluate the feasibility of combination of glycosylated hemoglobin A1c(HbA1c) and high-sensitivity CRP in screening of gestational diabetes mellitus(GDM). Methods According to glucose tolerance test(OGTT),HbA1c and hs-CRP during 24~28 pregnant weeks,92 women with GDM (GDM group) and 90 normal pregnant women (NGT group) were enrolled in this study with another 25 women of child-bearing age as the control group. The results of FBG, OGTT, HbA1c and hs-CRP among three groups were analyzed. Results OGTT, HbA1c and hs-CRP level in GDM group were higher than that in NGT group and control group (P<0.05), but there were no significant differences of the level of FPG of 3 groups(P>0.05).Compare with NGT group and control group, There were no significant differences of the level of HbA1c and hs-CRP(P>0.05). Pearson correlation analysis showed that HbA1c had significant association with hs-CRP(r=0.79, P<0.01). Conclusion HbA1c and hs-CRP level in GDM group were increased, HbA1c combined with hs-CRP could be of some value in screening of GDM.