目的 探讨揭阳地区急性下呼吸道感染住院患儿病毒病原学特点。方法 对2 125例急性下呼吸道感染患儿应用直接免疫荧光法(DIF)进行A型流感病毒(甲型流感病毒IFA)、B型流感病毒(乙型流感病毒IFB)、呼吸道合胞病毒(RSV)、腺病毒(AdV)、副流感病毒1(PIVⅠ)、2(PIVⅡ)和3型(PIVⅢ)进行病毒学检测。结果 2 125例患儿鼻咽部分泌物标本中有538例检测出至少1种病毒,总阳性率25.3％,其中RSV 阳性率(19.7%)明显高于其他病毒,具有统计学意义。春、夏、冬季的RSV阳性率大致相当,明显高于秋季。婴儿期组RSV阳性率(27.2%)最高,幼儿期组(18.7%)次之,均显著高于学龄前期、学龄期,后2组阳性率无统计学差异,青春期组未检出RSV。结论 病毒是急性下呼吸道感染的重要病原体,而其中又以RSV为著,RSV感染具有显著的季节性和年龄特征性。

Objective To investigate the viral etiology feature in hospitalized children with acute lower respiratory infection in Jieyang area. Methods A total of 2 125 children with acute lower respiratory tract infection were screened by direct immune fluorescence assay (DIF) for influenza virus A (IFA), influenza virus B (IFB), respiratory syncytial virus (RSV), adenovirus (AdV), parainfluenza virus I (PIV Ⅰ), PIV Ⅱ and PIV Ⅲ. Results In 2 125 cases of nasopharyngeal secretory specimens, 538 cases were detected at least one kinds of viruses. The total positive rate was 25.3%, of which the positive rate of RSV (19.7%) was higher than that of other viruses. The positive rate of RSV was similar in spring, summer and winter, much higher than that in autumn.The positive rate of RSV in infancy group (27.2%) was the highest,then the second was the toddler's age(18.7%), both of which were higher than that in preschool age group and school age group. There was no significant difference in the positive rate between preschool age group and school age group. In addition, RSV was not detected in the adolescence group. Conclusion Virus is an important pathogen of acute lower respiratory tract infection. The most common virus is RSV, infection of which has seasonal and age characteristics.

目的 分析广州市区2014—2016年无偿献血血液报废情况,探讨降低血液报废措施,减少血液报废。方法 收集并统计广州市区2014—2016年血液报废情况,分别统计报废血液比例。结果 2014—2016年报废血液产品共170 576 U,报废率为5.99%;非检验原因报废率(3.11%)高于检验原因报废率(2.88%),检验原因报废率呈逐年下降趋势,其中ALT及HBsAg报废率较高,非检验原因报废率呈逐年上升,其中乳糜血报废率较高。结论 进一步加强献血宣传和征询工作,以及做好团队献血的快速筛查工作,提高工作人员的操作水平,均有利于进一步降低血液报废率。

Objective To analysis blood products and disposal situation in Guangzhou from 2014-2016 to provide measures for reduce the scrap rate. Methods Collecting and statistical analysis of blood products scrap rate from 2014-2016 in Guangzhou respectively. Results A total of 170 576U blood products were scrapped in 2014-2016 and the scrap rate was 5.99%, in which non-detection scrap rate (3.11%) was higher than detection scrap rate (2.88%). Non-detection scrap rate was decreasing these years, among which ALT and HBsAg had a large proportion, while detection scrap rate was increasing, in which chylaemia scrap rate was the most highest. Conclusion We need to strengthen and publicize blood donation, as well as do well rapid screening of team blood donation and improve the operating level of staff.

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.

目的 探讨品管圈活动提高出院产妇母乳喂养调查问卷在随访系统回复率中的效果。方法 成立“品管圈组织”,确立“提高出院产妇母乳喂养调查问卷在随访系统的回复率”为主题,对活动前2月~14月回复率低进行原因分析,拟定实施对策,比较实施前后问卷的回复率。结果 出院产妇母乳喂养调查问卷在随访系统的回复率由29.9%提高到了71.7%,差异有统计学意义(P<0.001)。结论 通过品管圈活动可提高出院产妇母乳喂养调查问卷在随访系统的回复率。

Objective To explore the application and effect of the quality control circle(QCC) on the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system. Methods We set up a quality control circle, identified the project of improving the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system, analyzed the reasons of the low response rate from February to April. Then, we established and implemented improvement measures and compared the result before and after implementation. Results The response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system was raised from 29.9% to 71.7% (P<0.001). Conclusion With application of QCC program, the response rate in the obstetric patient discharge questionnaire on breast-feeding in the follow-up system is improved.

目的 探讨CD117在肺基底样细胞鳞状细胞癌(BSCC)与小细胞肺癌(SCLC)中的鉴别诊断作用。方法 免疫组织化学检测CD117在肺BSCC与SCLC中的表达情况,并进行统计学分析,同时文献复习CD117在这两种肿瘤中的表达情况。结果 CD117在SCLC中特异性高表达(阳性率为78%),并且具有高的敏感度、特异度、阳性预测值及阴性预测值(分别为100%、78.2%、68.7%、100%),与文献报道一致(阳性率37%～100%);而在BSCC中未见有CD117的表达,文献未见有CD117在BSCC中表达情况报道。结论 CD117有可能成为鉴别诊断BSCC与SCLC的重要指标之一。但由于本报道例数有限,还需要更大型的研究进一步证明CD117在鉴别诊断二者中的敏感度及特异度。

Objective To investigate the role of CD117 in differentiating basaloid squamous cell carcinoma (BSCC) from small cell carcinoma (SCLC) in lung. Methods Immunohistochemistry staining of CD117 and statistic data were analyzed in BSCC and SCLC, and relevant literature were reviewed. Results CD117 was specifically expressed in high level ( positive rate 78%) in SCLC with high sensitivity, specificity, positive predictive value and negative predictive value (respectively 100%、78.2%、68.7%、100%), which was highly consistent with literature reports (positive rate 37%-100%). CD117 was not detected in BSCC in our report and it was the same as in literatures. Conclusion Although our results showed that it was possible that the expression of CD117 would play an important role in differentiating BSCC from SCLC, due to limited cases in number, more studies are needed to elucidated the sensitivity and specificity.

目的 探讨孕母甲状腺疾病的新生儿第一个月生长速率和甲状腺功能与2岁时神经发育结局之间的相关性。方法 2013年1月—2014年12月在我院出生的156例孕母甲状腺疾病的新生儿为实验组,观察其第1个月体质量、身长及头围生长的速率,生后当天、第7天、第28天的总甲状腺素(TT4)及促甲状腺素(TSH)的水平;妊娠期无高危因素的母亲分娩的正常新生儿中随机抽取150例为正常对照组,观察生后新生儿第1个月体质量、身长及头围生长的速率,2组均在2岁内分别每3个月均接受随访评估,2岁时行贝利婴幼儿发展量表进行Bailey智力发育指数(MDI)、精神运动发育指数(PDI)的评分。采用回归分析检验新生儿生后第一个月体质量、身长及头围生长的速率,新生儿生后当天、第7天、第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI之间的关联性。结果 ①实验组生后第1个月体质量(29.5±4.2 g/d)、身长(1.18±0.67 cm/周)及头围(0.79±0.39 cm/周)生长的速率慢于正常对照组的体质量(35.4±6.3 g/d)、身长(1.69±0.85 cm/周)及头围(1.10±0.42 cm/周)生长的速率,2组差异有统计学意义(t值分别为9.672、5.882、6.768,P均<0.05);②实验组2岁时MDI(108±15)、PDI评分(109±16)低于正常对照组MDI(115±14)、PDI评分(118±11),2组差异有统计学意义(t值分别为16.129、21.279,P均<0.05);③实验组孕母甲状腺疾病的新生儿生后第1个月体质量、身长及头围生长的速率与2岁时MDI、PDI呈正相关(相关系数分别为:0.874,0.842,0.890,0.857,0.871,0.845,t值分别为22.584,59.296,65.441,61.214,62.662,59.507,P均<0.05);④实验组孕母甲状腺疾病的新生儿生后当天、第7天及第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI呈负相关(相关系数分别为:-0.878,-0.894,-0.890,-0.690,-0.654,-0.702,t值分别为73.167,81.273,74.166,11.523,10.548,12.103,P均<0.05)。结论 母亲妊娠期患有甲状腺疾病会影响新生儿生后第1个月体质量、身长、头围生长的速率及2岁时的精神运动、智力发育,落后于母亲妊娠期无高危疾病的正常新生儿。另外孕母甲状腺疾病的新生儿第1个月体质量、身长及头围生长的速率和生后当天、生后第7天 及第28天的T4及TSH的水平与2岁时MDI、PDI密切相关。

Objective To investigate the correlation between the growth rate, thyroid function in the first month and neurodevelopmental outcome at the age of 2 in the infants of the maternal thyroid disease. Methods We chose 156 infants of maternal thyroid disease from January 2013 to December 2014 born in our hospital as the experimental group and 150 normal infants of their mothers without high risk factors during pregnancy as the control group. We observed the rate of weight, length and head circumference growth in the first month and TT4 、TSH level at the 1^st day, 7^th day, and 28^th day after birth. We followed up two groups every 3 months up to the age of 2. We assessed Bailey mental development index (MDI) and psychomotor development index (PDI) at the age of 2. Regression analysis was used to test the correlation between the growth rate, TT4,TSH level in the 1^st month and MDI, PDI at the age of 2. Results ① The rate of growth rate in the 1^st month of the experimental group was slower than the control group. It was statistically significant difference between the two groups (P<0.05); ②MDI, PDI at the age of 2 in the experimental group were lower than those of the control group. It was statistically significant difference between the two groups (P<0.05); ③The rate of growth rate in the first month of the experimental group was positively related to MDI and PDI at the age of 2.④The difference between the level of TT4,TSH at the 1^st day, 7thday, and 28^th day and the median after birth was negatively related to MDI and PDI at the age of 2. Conclusion The maternal thyroid disease will affect the first month growth rate and neurodevelopmental outcome at the age of 2 of their infants. Their infants will grow behind than the normal newborns on pregnancy without high-risk disease.The growth rate of the first month and the level of T4 and TSH on the 1^st day, 7^th day, and 28^th day in maternal thyroid disease are closely related MDI and PDI at the age of 2.

目的 观察同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗治疗糖尿病性黄斑水肿的临床疗效。方法 选择2014年7月—2016年11月在我院就诊的68例(72只眼)患有老年性白内障合并糖尿病性黄斑水肿患者,分为2组,治疗组(32例,34只眼)行同轴微切口超声乳化白内障术联合玻璃体腔注射雷珠单抗;对照组(36例,38只眼)单纯行白内障超声乳化摘除;观察指标包括术前、术后最佳矫正视力、眼压及黄斑中心凹视网膜厚度,观察时间为术前、术后1周、1月、3月、6月、12月。结果 术后两组最佳矫正视力与术前相比差异有统计学意义(P<0.01);术前及术后1周2组最佳矫正视力无差异,术后1月、3月、6月、12月治疗组最佳矫正视力均优于对照组;术前2组患者黄斑中心凹视网膜厚度相比无明显差异,术后各个时间点治疗组黄斑中心凹视网膜厚度均低于对照组,二者相比差异有差异性(P均<0.001);两组患者术前及术后眼压无差异(P<0.05)。结论 对老年性白内障合并糖尿病性黄斑水肿患者,术中联合玻璃体腔注射雷珠单抗,可减轻术后黄斑水肿,改善患者术后中、远期视力。

Objective To assess the safety and efficiency of combination of micro incision phacoemulsification (PHACO) surgery and intravitreal ranibizumab injection in patients with cataract and diabetic macular edema. Methods The selected 68 patients (72 eyes) with age-related cataract and diabetic macular edema were randomly divided into two groups: the PHACO and intravitreal Ranibizumab injection (treatment group, 32 cases, 34 eyes), and only PHACO (control group, 36 cases, 38 eyes) in our hospital from July 2014 to November 2016. Preoperative and postoperative best corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. The time points included preoperative day, 1 week, 1 month, 3 months, 6 months and 12months after surgery. Results Postoperative BCVA during the follow-up period was higher than the initial BCVA in both groups (P<0.01). There was no statistically significant difference between both groups in BCVA at pre-operation and 1 week after surgery. In the treatment group, the postoperative BCVA was significantly higher than the control group at 1 month, 3 months, 6 months and 12months after operation. The mean CMT in the treatment group was lower than the control group in all the follow-up time. There was no statistically significant difference in IOP between two groups preoperatively and postoperatively during the follow-up period (P>0.05). Conclusion Additional intravitreal ranibizumab injection after PHACO surgery reduced macular edema and preserved this improvement in the mid-and-long term of BCVA.

目的 研究血清胃蛋白酶原(PG)、胃泌素17(G-17)水平和HP感染与慢性萎缩性胃炎(CAG)和肠上皮化生的相关性。方法 连续选择2016年6月—2017年6月于我院诊断慢性非萎缩性胃炎60例,CAG 40例和肠上皮化生40例,比较患者血清PGI、II和PGI/II,G-17水平以及HP阳性感染率。结果 CAG和肠上皮化生患者PGI和PGI/II低于非萎缩性胃炎患者,而PGII水平升高,G-17水平和HP阳性感染率也增加,差异均有统计学意义(P＜0.05)。结论 血清PG、G-17水平和HP感染是CAG和肠上皮化生的重要机制。

Objective To study correlation in serum pepsinogen(PG),gastrin 17(G-17) levels and helicobacter pylori(HP) infection and chronic atrophic gastritis(CAG), intestinal metaplasia. Methods A total of 60 cases as non-CAG,40 of CAG and other 40 of intestinal metaplasia from June 2016 to June 2017 were consecutives enrolled, then to compare differences of serum PGI,II,PGI/II,G-17 levels, HP infection positive rate. Results The PGI and PGI/II values in patients with CAG and intestinal metaplasia were both lower than non-CAG patients, while PGII level got more,G-17 level and HP infection positive rate were higher too(P＜0.05). Conclusion The expressions of serum PG,G-17 and HP infection may be the important mechanism to CAG and intestinal metaplasia.

目的 探讨中药吴茱萸治疗术后早期炎性肠梗阻的临床疗效,并探讨其应用价值。方法 将50例术后早期炎性肠梗阻患者随机分为治疗组(吴茱萸封包+常规西药治疗)和对照组(常规西药治疗),观察比较腹胀、腹痛、便秘、呕吐等临床表现、腹平片结果;对比分析2组患者腹胀缓解时间、肠鸣音恢复时间、排气排便时间、胃液引流量。结果 ①治疗组治愈率80.8%,高于对照组41.7%,有差异(P＜0.01);②治疗组腹胀缓解、肠鸣音恢复、肛门排气排便时间及24 h胃液引流量均较对照组缩短,差异有统计学意义(P＜0.05)。结论 吴茱萸封包穴位外敷能显著提高术后早期炎性肠梗阻临床疗效。

Objective To explore the clinical curative effect of Wuzhuyu in treatment of early inflammatory bowel obstruction and its application value. Methods 50 cases of early inflammatory bowel obstruction were randomly divided into the treatment group (Wuzhuyu packet+conventional western medicine treatment) and the control group (routine western medicine treatment), to observe the results of abdominal distention, abdominal pain, constipation, vomiting. The time of abdominal distension of the two groups, the recovery time of the bowel sound, the time of exhaust defecation and the drainage of gastric juice were compared and analyzed. Results ① The cure rate of treatment group 80.8% was higher than the control group of 41.7%, and the difference was statistical significant (P<0.01);② the time of abdominal distention of the treatment group, the recovery of the intestinal singing tone, the time of exhaust defecation and the drainage of the gastric juice were shortened than that of the control group, and the difference was statistical significant (P< 0.05). Conclusion The clinical effect of the treatment of early postoperative inflammatory bowel obstruction may be significantly improved by Wuzhuyu closure.

目的 探讨应用三维斑点追踪技术(3D-STI)评价冠心病患者左前降支冠状动脉支架置入(PCI)术前、术后左室局部收缩功能。方法 对30例接受左前降支PCl术的患者分别于术前、术后3～5天,术后3个月进行常规及三维超声心动图检查,获得患者左前降支冠状动脉供血的7个心肌节段(即前壁基底段、前间隔基底段、前壁中间段、前间隔中间段、前壁心尖段、前间隔心尖段及心尖帽)的收缩期纵向应变、径向应变、圆周应变及面积应变,分析冠状动脉支架植入术前、后各参数的变化规律。结果 PCI术后3～5天5/7节段纵向应变(前壁基底段、前壁中间段、前间隔基底段、前间隔中间段、前壁心尖段)、3/7节段面积应变(前壁基底段、前壁中间段、前间隔中间段)、3/7节段圆周应变(前壁基底段、前间隔基底段、前壁中间段)及2/7节段径向应变(前间隔基底段、前壁中间段)较术前相应心肌节段升高,差异有统计学意义(P＜0.05),PCI术后3个月左前降支供血各心肌节段纵向、圆周、径向及面积应变较术前、术后3～5天均升高,差异有统计学意义(P＜0.05)。结论 3D-STI能够早期评价冠心病患者左前降支冠状动脉PCI治疗前后左室局部收缩功能的改善,为临床早期评价PCI疗效及后续治疗提供诊断依据。

Objective To evaluate the left ventricular regional systolic function before and after left anterior descending coronary artery stent implantation (PCI) using three-dimensional speckle tracking imaging (3D-STI) in patients with coronary artery disease. Methods 30 patients who received left anterior descending PCl were underwent routine and three-dimensional echocardiography before and after 3~5 days, 3 months to obtain longitudinal strain(LS), radial strain(RS), circumferential strain(CS)and area strain(AS) of the seven myocardial segments(BA,BAS,MA,MAS,AA,AS,A ),which accepted blood from the left anterior descending coronary artery. We analyzed the changes of the parameters before and after the coronary stent implantation. Results The 5/7 segment of the longitudinal strain(BA,MA,BAS,MAS,AA), 3/7 segment of area strain(BA,MA,MAS), 3/7 segment of circumferential strain (BA,BAS,MA)and 2/7 segment of radial strain (BAS,MAS)at 3~5 days after PCI were higher than that before the operation. The difference was statistically significant (P＜ 0.05). The longitudinal, circumferential, radial and area strain of the left anterior descending branch at 3 months after the operation were higher than that before and 3~5 days after the operation. The difference was statistically significant (P＜ 0.05). Conclusion 3D-STI may early evaluate the improvement of left ventricular regional systolic function before and after coronary artery PCI treatment in patients with coronary heart disease, and provide a basis for early clinical evaluation of PCI effect and follow-up treatment.