目的 探讨内镜活检Crohn病（CD）的临床病理特征,为临床提供更可靠的诊断。方法 回顾性分析内镜活检12例CD的临床表现、内窥镜特征,采用HE染色及免疫组化EnVision二步法。结果 显微镜下CD的组织学形态主要特征是非干酪样坏死性肉芽肿、裂隙状溃疡、黏膜及黏膜下层不均匀分布的重度炎症,淋巴管扩张和纤维组织增生,免疫组化染色CD68、D2-40、S-100均表达。结论 CD是一肿少见的炎症性肠病,回盲部及末段回肠是最好发部位,主要表现反复腹泻、血便等症状,内镜下见多灶溃疡,不连续性病变等特征,组织学见裂隙性溃疡,黏膜及黏膜下层的重度炎症且不均匀分布,位于生发中心的非干酪结节病样肉芽肿、淋巴管扩张和纤维组织增生等非特异性特征,可靠的病理诊断要结合临床、内镜、影像等检查及多部位多次活检。

Objective To investigate the clinical and pathological features of endoscopic biopsy tissue of Crohn disease （CD） and further to provide more reliable evidence for clinic. Methods A retrospective analysis of 12 cases of endoscopic biopsy tissue about CD’s clinical manifestations and endoscopic features,by HE staining and immunohistochemistry EnVision two-step method. Results The morphology of CD specimen is characterized by non-caseous necrotizing granuloma,ulceration,mucosal and submucosal uneven distribution of severe inflammation,dilated lymph vessels and fibrous hyperplasia. Immunohistochemical staining , all of cases express CD68,D2-40 and S-100. Conclusion CD is a rare inflammatory bowel disease. The majority of CD arises in ileocecal and terminal ileum. The main symptoms show repeated diarrhea,bloody stool and others. Endoscopic examination revealed multifocal ulcers,discontinuous lesions and other characteristics. Histological examination showed that there were nonspecific features such as fissure ulcer,severe inflammation in mucosa and submucosa with uneven distribution,non-caseous sarcoid-like granuloma in the germinal center,lymphangiectasis and fibrous tissue hyperplasia. An reliable pathological diagnosis is made that depends on many examinations including clinical,endoscope,radiology and multiple biopsy.

目的 探讨高龄患者（≥65岁）腹股沟嵌顿疝术后肺部感染的相关因素。方法 以我院手术治疗的60例腹股沟嵌顿疝术后肺部感染的高龄患者为观察组,行1∶1匹配病例对照研究,应用单因素及多因素条件Logistic回归对相关因素进行分析,计算各因素与肺部感染的OR值及其95%可信区间。结果 研究提示术前血清白蛋白≤35 g/L（P=0.013）、术前血红蛋白≤100 g/L（P=0.029）、既往慢性阻塞性肺气肿病史（P=0.014）及抽烟（P=0.008）、手术时间≥2 h（P=0.021）、手术切除部分肠管（P=0.032）、气管插管（P=0.024）、手术季节为冬季（P=0.030）为危险因素;预防性使用抗生素（P=0.018）、术后雾化（P=0.023）、良好睡眠（P=0.048）为保护因素。结论 高龄患者腹股沟嵌顿疝术后肺部感染的发生与相关生化指标、既往史、治疗过程、环境因素等密切相关。

Objective To investigate the correlation factors of elderly patients with inguinal incarcerated hernia surgery related lung infection. Methods A hospital-based 1∶1 matched case-control study was conducted among elderly patients with inguinal incarcerated hernia surgery related lung infection,calculated the factors associated with the extent of lung infection,and the 95% confidence interval. Results The analysis showed that pre-ALB≤35g/L（P=0.013）,pre-Hb≤100g/L（P=0.029）,COPD（P=0.014）,smoking（P=0.008）,operation time（P=0.021）,bowel resection（P=0.032）,endotracheal intubation（P=0.024） and operation in winter（P=0.030） were the risk factors of lung infection,while the prophylactic use of antibiotics（P=0.018）,aerosol inhalation（P=0.023） and good sleep（P=0.048） were the protective factors. Conclusion Some biochemical indicators,past history,therapeutic process and environmental factors were closely related to inguinal incarcerated hernia surgery related lung infection in elderly patients.

目的 探讨鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿的临床疗效。方法 选择2014年8月-2017年8月我院收治的60例鼻前庭囊肿患者为研究对象,根据手术方式不同分为两组,每组各30例。对照组采用传统唇龈沟径路鼻前庭囊肿切除术进行治疗,观察组采用鼻内镜鼻前庭囊肿揭盖术治疗;评价两组手术情况、术后疼痛程度及并发症发生情况,术后随访1年,观察两组患者的复发情况。结果 对照组手术时间、术中出血量、术后住院时间分别为（44.78±8.13）min、（37.09±7.11）mL、（7.27±1.45）d均高于观察组的（17.91±4.26）min、（8.85±3.12）mL、（5.02±1.06）d,差异有统计学意义（P<0.05）;对照组术后24 h、48 h、72 h的VAS评分分别为（3.53±1.07）分、（2.84±1.12）分、（2.34±0.69）分均高于观察组的（2.92±1.14）分、（2.21±1.00）分、（1.73±0.76）分,差异有统计学意义（P<0.05）;对照组术后并发症发生率为26.67%,复发率为20.00%,高于观察组的6.67%、0.00%,差异有统计学意义（P<0.05）。结论 鼻内镜鼻前庭囊肿揭盖术治疗鼻前庭囊肿疗效显著,具有手术时间短、出血量少的优点,可减轻患者术后疼痛,减少术后并发症的发生,利于加速患者恢复,预后较好。

Objective To investigate the clinical efficacy of nasal endoscopic nasal vestibular cyst uncovering for nasal vestibular cyst. Methods Sixty patients with nasal vestibular cysts admitted to our hospital from August 2014 to August 2017 were enrolled in the study. They were divided into two groups according to different surgical methods,30 in each group. The control group was treated with traditional sacral sulcus cystectomy. The observation group was treated with nasal endoscopic nasal vestibular cyst uncovering for nasal vestibular cyst. The operation status,postoperative pain degree and complications were evaluated. After one year,the recurrence of the two groups of patients was observed. Results The operation time,intraoperative blood loss and postoperative hospital stay were （44.78±8.13） min,（37.09±7.11） mL,and （7.27±1.45）d,respectively,which were higher than the observation group （17.91±4.26） min. （8.85±3.12） mL,（5.02±1.06） d,the differences were statistically significant （P<0.05）;the VAS scores of the control group at 24h,48h,72h were （3.53±1.07） points,（2.84±1.12）. The scores of （2.34±0.69） were higher than those of the observation group （2.92±1.14）,（2.21±1.00）,and （1.73±0.76）,the differences were statistically significant （P<0.05）. The postoperative complication rate was 26.67%,and the recurrence rate was 20.00%,which was higher than that of the observation group （6.67%,0.00%）. The differences were statistically significant （P<0.05）. Conclusion Endoscopic nasal vestibular cyst is a significant treatment for nasal vestibular cyst. It has the advantages of short operation time and less bleeding. It may reduce postoperative pain,reduce postoperative complications,and accelerate the recovery of patients. It is good at prognosis.

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 探讨TBL教学法在物理治疗学教学资源库建设中的应用效果。方法 选取我校康复治疗学专业2013级和2014级各60名学生为研究对象,分别作为传统教学组和试验教学组,传统教学组采用传统教学方法,试验教学组在传统教学方法的基础上,采用TBL教学法参与教学资源库建设的方式来完成教学。学期结束对学生进行实践技能、理论考试及问卷调查评估。结果 在牵引疗法的考核中,两组实践技能成绩无差异(P＞0.05),其它项目试验教学组实践技能成绩均高于传统教学组(p＜0.05)。试验教学组理论考试成绩高于传统教学组,对教学的满意度也更高。结论 采用TBL教学法建设物理治疗学教学资源库,不仅能提高教学效果,而且有助于加快实践教学资源库的建设。

Objective To explore the application effect of TBL teaching method in the construction of physiotherapy teaching resources library. Methods We selected 60 students from the 2013 and 2014 grades of rehabilitation therapy in our school respectively, who were used the traditional teaching method group and the experimental teaching method group. The traditional teaching method group adopted the traditional teaching method. The experimental teaching method group was based on the traditional teaching methods, and used TBL to participate in the construction of a teaching resource library. At the end of the semester, students will be assessed on practical skills, theoretical examinations, and questionnaire surveys. Results In the assessment of traction therapy, there was no significant difference in the performance of the two groups (P>0.05). The other experimental skills of the experimental teaching group were better than those of the traditional teaching group (p<0.05). Theoretical test scores of experimental teaching group are higher than the traditional one, and satisfaction with teaching is also higher than the latter. Conclusion Using TBL teaching method to build a library of physiotherapy teaching resources may not only improve the teaching effect, but also help to speed up the construction of practical teaching resources.

目的 探讨血清ApoA-1浓度与食管鳞状上皮细胞癌的相关性及其预后价值。方法 对我院2010年1月—2012年10月收治的食管鳞状上皮细胞癌患者的血清ApoA-1浓度进行回顾性调查分析,与我院体检中心2009年1月—2009年4月219例正常人群的血清ApoA-1浓度作为对照组进行统计学处理分析。结果 210例食管鳞状上皮细胞癌患者组和219例健康对照组在性别和年龄比较均无统计学差异(P>0.05)。血清ApoA-1 浓度在ESCC组的pTNM和临床分期均有统计学差异(P<0.05)。与ApoA-1水平高的患者相比,ApoA-1水平低的患者的总体生存率更低(P=0.002)。结论 血清ApoA-1 水平是食管鳞状上皮细胞癌食管癌的一个重要的预后因素。

目的 探究不同类型职业病危害因素对暴露工人生命质量的影响。方法 在某市电子制造业、灯饰制造业、金属冶炼业等能够接触到粉尘、铅、苯以及噪声的6家企业中,采用整群随机抽样法,共计抽取742人为研究对象,对上述企业2015—2017年的职业病危害因素检测报告进行回顾性分析,主要对各企业的职业病危害因素以及暴露水平实施分析,并对企业员工的生命质量情况实施调查。结果 三种不同行业之间的有机溶剂检测合格率比较差异均有统计学意义(P＜0.05),其中有机溶剂检测合格率最低的是金属冶炼业;三种不同行业的粉尘检测合格率差异以及噪声检测合格率比较差异无统计学意义(P＞0.05),其中灯饰制造业的噪声及粉尘检测合格率最低;各行业工作人员的生理、社会功能,心理、情感职能,精神健康,身体疼痛、活力以及总计健康评分差异有统计学意义(P＜0.05),电子制造企业的各项评分均高于金属冶炼业以及灯饰制造业。多重线性回归分析结果发现,电子制造企业的生理与心理健康维度得分均高于灯饰制造业、金属冶炼业,差异有统计学意义(P＜0.05),且主要与运动锻炼以及所从事的行业有较大关联。结论 不同类型的职业病危害因素暴露水平存在一定差异,企业职工的生命质量也会因此受到不同程度的影响,应对存在噪声、粉尘以及大量使用有机溶剂等职业病危害因素企业作为健康监护的重点。