目的 探讨儿童不明原因肝功能异常的临床特点、病因及预后,为临床及时对因治疗提供帮助。方法 回顾性分析本院2016年1月—2017年12月期间205例以不明原因肝功能异常住院患者的临床资料,并对其临床特点、病因及预后进行分析。结果 在205例不明原因肝功能异常患者中,其中166例(80.97%)得到明确诊断,涉及多种疾病。其中分别为非嗜肝病毒所致感染性肝损104例(50.73%),遗传代谢疾病38例(18.54%),药物性肝损11例(5.37%),全身性疾病如川崎病6例(2.93%)、血液肿瘤疾病4例(1.95%)、营养不良3例(1.46%)等,原因未明 39例(19.02%)。结论 引起肝功能异常病因多且复杂。婴幼儿肝功能异常以非嗜肝病毒所致感染性肝损为主,感染主要为巨细胞病毒及EB病毒;遗传代谢性疾病、药物性肝损、全身性疾病也是造成肝功能异常的重要原因。

Objective To investigate the clinical features, etiology and prognosis of children patients with unexplained liver dysfunction. Methods The clinical data of 205 inpatients with unexplained liver dysfunction from January 2016 to December 2017 were analyzed retrospectively. The clinical characteristics, etiology and prognosis were analyzed. Results Of 205 patients with unexplained abnormal liver function, 166 patients with liver dysfunction (80.97%) were clearly diagnosed and involved in a variety of diseases. Among them, 104 cases were infected liver damage caused by non-hepatophilic virus, 38 cases were related to genetic metabolic diseases, 11 cases were drug-induced liver damage, 6 cases were Kawasaki disease, 4 cases were hematologic tumor diseases, 3 cases were malnutrition. The cause of abnormal liver function was not clear in 39 cases. Conclusion There are many and complicated causes of abnormal liver function, and part of the causes are unknown. Infantile liver dysfunction was mainly caused by non-hepatophilic virus, the first was cytomegalovirus, the second was Epstein-Barr virus; genetic metabolic disease, drug-induced liver damage, systemic disease are also an important cause of liver dysfunction.

目的 探讨科学的出院后营养管理对肠道术后新生儿体格追赶的效果,分析影响体格追赶的相关因素。方法 通过营养门诊对出院术后婴儿及社区婴儿进行个体化营养喂养指导和营养咨询,比较两组每月体质量、身长及头围,并随访至生后9月龄。两组生后半年生长趋势行重复测量检验。结果 第1月龄时,手术组患儿体质量、身长、头围均落后于对照组婴儿(P<0.001, P=0.004, P=0.008),第2月龄时,手术组患儿体质量、头围仍落后于对照组(P=0.003,P=0.031),第4月龄时,手术组体质量低于对照组(P=0.012),第5～9月龄,两组体格指标均无明显差异。生后半年内两组的生长趋势差异无统计学意义。前半年身长的增长与出生身长、父母文化以及父亲的不良习惯存在负相关关系,头围的增长与住院天数呈明显负相关关系、与出生以及首诊时的体格状况呈正相关关系。结论 合理喂养对新生儿肠道术后体格追赶有利,帮助其接近正常生长曲线。再次手术可能是导致体质量增长下降的主要因素,但未明显影响身长、头围的正常增长。出生时和就诊时的体格状况、父母教育程度和不良习惯以及住院天数均是影响体格追赶的相关因素。

Objective To investigate the effect of scientific nutrition management after discharge on neonatal physical catch-up after intestinal operation, and to analyze the related factors affecting physical catch-up. Methods Individualized nutritional feeding instruction and nutrition consultation were performed on infants and community infants after discharge from hospital through nutrition clinic. The monthly body weight, body length and head circumference were compared between the two groups, and followed up to 9 months old. The growth trend of the two groups in half a year after birth was tested by repeated measurement. Results At the first month of age, the body weight, body length and head circumference of the patients in the operation group were lower than those in the control group (P<0.001, P=0.004, P=0.008). At the second month, the body weight and head circumference of the operation group were still behind those of the control group (P=0.003, P=0.031), and at the fourth month of age, the weight and head circumference of the patients in the operation group were still lower than those in the control group. The body weight of the operation group was lower than that of the control group (P=0.012), and there was no diffence in the physical indexes between the two groups at the age of 5~9 months. There was no statistical significance in growth trend between the two groups within half a year after birth. The growth of body length in the first half of the year had a negative correlation with the length of birth, parents' culture and father's bad habits. The growth of head circumference had a negative correlation with the length of stay in hospital, and had a positive correlation with the physical condition at birth and at first visit. Conclusion Reasonable feeding is beneficial to the physical catch-up of the newborn after intestinal operation and helps them approach the normal growth curve. Reoperation may be the main cause of weight loss, but it does not affect the normal growth of body length and head circumference. The physical condition at birth and medical visit, parents' education level, bad habit and hospitalization days were all related factors of physical catch-up.

目的 探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ 4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法 采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65(分):3.06±1.10 比0.85±0.79,P<0.001;PSI(分):144.93±36.48比73.94±27.17,P<0.001; SMART-COP(分):6.54±1.41比 1.67±1.02,P<0.001; APACHEⅡ(分):20.79±5.69比7.94±3.87,P<0.001]。CURB-65≥3分、PSI≥130分、SMART-COP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0.940[95% CI:0.89~0.98, P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001],敏感度分别为65.6%、71.6%、100%、88.1%,特异度分别为100%、100%、78.7%、93.9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHE Ⅱ评分诊断效能更佳。

Objective To evaluate and compare the early diagnosis value of CURB-65,PSI,SMART-COP and APACHEⅡin patients with severe community-acquired pneumonia. Methods This was a prospective study conducted in department of respiratory in Guangzhou First People's Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February of 2014. The lowest scores within 24 hours of CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score,respectively,for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score were higher in SCAP as compared with that of CAP(CURB-65:3.0±1.1 vs 0.9±0.8,P<0.001;PSI:144.6±36.4 vs 73.9±27.1,P<0.001; SMART-COP:6.5±1.4 vs 1.6±1.0,P<0.001; APACHEⅡ:20.6±5.6 vs 7.9±3.8,P<0.001). ROC curve for CURB-65 score≥ 3 scores,PSI score≥ 130 scores,SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0.940[95%CI:0.89~0.98,P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001]. Sensitivity of four kinds of scoring system was 65.6%,71.6%,100%,88.1%, with specificity of 100%,100%,78.7%,93.9% respectively. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score,but the sensitivity was low and easy to miss diagnosis. SMART-COP and APACHEⅡscore systems had a better diagnostic value on SCAP.

目的 探讨在小剂量催产素基础上分别联合普贝生和COOK宫颈扩张球囊对足月妊娠引产的临床效果。方法 抽取110例足月妊娠孕妇住院资料,根据引产方式不同分为两组,各55例。A组采用小剂量催产素引产,B组在A组基础上加用COOK球囊引产,比较两组促宫颈成熟效果、母婴结局以及不良并发症情况。结果 两组孕妇引产前后Bishop 评分相比,差异显著（P<0.01）,此外,与A组相比,B组引产后Bishop 评分升高（P<0.01）。A组促宫颈成熟效果有效人数为48例,新生儿Apgar 评分为9.12±2.11,产后出血量（210.7±55.44）mL,阴道分娩人数为40例,而B组引产过程中各指标均显著改善。此外,B组未出现宫内感染和胎盘早剥,而胎儿窘迫和其他并发症降低（P<0.01）。结论 催产素联合COOK球囊对足月妊娠孕妇促宫颈成熟效果显著,降低剖腹产,母婴状态良好,减少不良并发症发生。

目的 研究布拉酵母菌与锌制剂联合应用对小儿迁延性腹泻患儿治疗的效果。方法 选取我院2017年1月—2017年12月收治的136例小儿迁延性腹泻患儿,将其随机分为联合组和对照组,每组各68例患儿,在基础补液、治疗的基础上,联合组采用布拉酵母菌药物联合锌制剂治疗,对照组单纯利用锌制剂治疗,比较两组治疗效果。结果 联合组总有效率97.06%,不良反应发生率4.41%,对照组总有效率88.24%,不良反应发生率14.71%,差异有统计学意义（P<0.05）。联合组患儿血检指标、锌含量、住院时间等指标与对照组比较有差异,（P<0.05）。结论 小儿迁延性腹泻是指患儿的腹泻症状迁延不愈造成严重的肠道炎症,患儿利用基础治疗效果不明显,加用布拉酵母菌与锌制剂对患儿治疗效果的改善作用明显。

目的 研究新辅助化疗联合保肢手术治疗骨肉瘤的临床效果。方法 根据既往治疗骨肉瘤方法的不同,将56例患者分为对传统保肢组（A组）和现代保肢组（B组）,各28例。A组用采用传统保肢方案,即保肢手术+术后化疗方案进行;B组采用现代保肢方案,即新辅助化疗+保肢手术+术后化疗方案进行。化疗方案均采用CTX + VCR +MTX+ ADM方案,比较两组转移/复发率、术后1 年、2年及 3 年生存率、肢体功能、临床疗效情况。结果 比较两组的转移/复发率及3年后的死亡率,B组低于A组(P<0.05);肢体功能优良率及临床疗效,B组高于A组(P<0.05)。结论 新辅助化疗联合保肢手术能够降低骨肉瘤患者转移/复发率、死亡率,改善肢体功能,提高临床疗效。

Objective To study the clinical effect of neoadjuvant chemotherapy combined with limb salvage surgery for osteosarcoma. Methods Based on the previous methods of treating osteosarcoma, 56 patients were divided into the traditional limb salvage group (A group) and the modern limb salvage group (B group), 28 cases for each. The traditional limb salvage surgery + postoperative chemotherapy regimen were used in group A, and modern limb salvage regimen was performed in group B, ie neoadjuvant chemotherapy + limb salvage surgery + postoperative chemotherapy. The CTX + VCR +MTX+ ADM protocol was used in the chemotherapy regimens. The metastasis/recurrence rate, the 1-year, 2-year and 3-year survival rates, limb function, and clinical efficacy were compared between the two groups. Results The metastasis/recurrence rate and the mortality rate after 3 years in the two groups were compared. The B group was lower than that of the group A (P<0.05). The excellent rate of limb function and clinical efficacy were higher in the B group than that of in the group A (P<0.05). Conclusion Neoadjuvant chemotherapy combined with limb salvage surgery may reduce the metastasis/recurrence rate and mortality of osteosarcoma patients, improve limb function and increase clinical efficacy.

目的 分析针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的临床效果。方法 选择我院收治的乳腺肿物患者200例进行观察（2012年1月—2017年12月）,针对200例乳腺肿物患者存在的305个乳腺不可触及肿物进行活检检查,采用随机分组的方式将其分成两组后针对常规组100例乳腺肿物患者实施传统手术治疗,针对治疗组100例乳腺肿物患者实施超声引导下微创旋切活检术治疗,对比两组的治疗效果。结果 两组乳腺肿物患者之间对比的术中出血量、术后愈合时间、术后并发症发生率、治疗显效率存在差异（P<0.05）,统计学有意义;且超声引导下微创旋切活检术对于乳腺癌的诊断检出率较高。结论 针对乳腺不可触及肿物实施超声引导下微创旋切活检术治疗的疗效显著,促进患者预后。

Objective To analysis of the clinical effect of ultrasound guided minimally invasive rotary biopsy for untouchable breast masses. Methods A total of 200 patients with breast masses were selected for observation （January 2012 to December 2017）, and 305 untouchable breast masses in 200 patients were examined by biopsy. It was divided into two groups randomly and then treated with traditional surgical treatment for 100 patients with breast masses in the routine group and 100 patients with breast masses in the treatment group with minimally invasive biopsy under the guidance of ultrasound. The therapeutic effects of the two groups were compared. Results There were differences between the two groups in the amount of intraoperative bleeding, postoperative healing time, the incidence of postoperative complications and the effective rate of treatment （P < 0.05）, and the differences were statistically significant （P < 0.05）. The diagnostic rate of breast cancer was higher with minimally invasive rotary biopsy guided by ultrasound. Conclusion The effect of ultrasound-guided minimally invasive rotary biopsy on untouchable breast masses is significant and promotes the prognosis of the patients.

目的 探讨临床全程导师制结合OSCE考试法对实习护生评判性思维的影响。方法 将176名在我院实习的本科实习护生随机分为两组,每组88人。对照组采用传统的临床带教和考核方式进行带教,实验组采用临床全程导师制结合OSCE考试法进行带教。记录两组理论考试成绩、实践技能成绩及护理病历成绩,比较两组实习护生教学前后评判性思维能力,比较两组实习护生干预后对临床带教模式的整体评价。结果 实验组理论考试成绩、实践技能成绩、护理病历成绩得分均高于对照组（P<0.05）。开展教学后两组评判性思维能力量表（CTDI-CV）各维度评分及总分均升高,实验组各维度评分及总分均高于对照组（P<0.05）。开展教学后实验组对临床带教模式的整体评价均高于对照组（P<0.05）。结论 临床全程导师制结合OSCE考试法,有助于提高本科实习护生的评判性思维能力。

Objective To explore the application and influence of the whole course mentor system combined with OSCE on the critical thinking ability of undergraduate clinical student nurses. Methods 176 undergraduate clinical student nurses were divided to control group and experimental group,88 for a group respectively. Control group used traditional clinical teaching method while the experimental group used whole course mentor system combined with OSCE. The theory and practice assessment scores ,medical record writing scores and critical thinking scores of clinical student nurses before and after the implementation of the two teaching modes were compared. Results The theory and practice assessment scores and medical record writing scores of the students in the experimental group were better than those of students in the control group（P<0.05）. The score of CTDI-CV was increased in both two groups after intervention. The score of all dimensions in CTDI-CV was better improved in the experimental group than that of controls （P<0.05）. And the evaluation of teaching mode of the experimental group was better than the control group（P<0.05）. Conclusion The teaching method of the whole course mentor system combined with OSCE is helpful to improve undergraduate clinical student nurses'ability of critical thinking.

早期干预是预防和减少早产儿神经系统损伤的有效措施,可以促进早产儿的正常发育并减轻神经系统伤残的发生,对提高儿童综合素质和家庭幸福都至关重要。在早产儿早期干预过程中存在与医学伦理原则不相适应的方面,如医疗设施不足、医疗措施不当、专业人员不足,早产儿干预预后的不确定性,治疗时机与家长经济及遵医行为之间的冲突,家长知情选择和知情同意不足等,本文结合医学伦理学的观点对0~3岁早产儿在早期干预中存在的问题进行分析并提出相应的建议。

Early intervention is an effective measure to prevent and reduce the nervous system injury in preterm infants,It can promote the normal development of preterm infants and reduce the occurrence of the nervous system disability.It is vital to improve the comprehensive quality of children and family quality of life. In the stage of premature infant intervention,there are some aspects that are incompatible with the medical ethics principle,i.e. inadequate medical facilities,improper medical measures,lack of professionals,premature infants intervention prognosis uncertainty,the conflict between the timing of treatment and the parents' economic and compliance behaviors,parents' informed choice and informed consent. etc. This paper analyzes the problems in early intervention of 0~3 year old preterm infants and puts forward corresponding suggestions according to the viewpoint of medical ethics.

目的 对江门市新会区会城街道的严重精神障碍患者监护人进行守护APP干预并评价干预效果影响。方法 以会城街道辖区内登记在国家精神障碍信息系统1 488在册精神障碍患者作为研究对象,随机抽取分为安装守护APP组1 084例和无安装守护APP组404例。安装组通过监护人使用守护APP实现责任医生对患者进行动态监护和实时监护,提供免费咨询、心理干预、服药指导及随访管理服务;无安装组采用常规随访康复管理措施干预。干预满一年后对比分析两组患者康复措施落实情况、服药依从性（治疗率）、病情及社交改善情况、复发住院率、肇事肇祸率及家属疾病知识知晓情况等指标。结果 安装守护App组患者服药依从性（治疗率）及康复措施落实率高于无安装组,家属对精神疾病知识知晓良好率较高;干预后安装组患者的SCL-90评分及心理社交功能评估表评分改善情况优于无安装组,复发住院率和肇事肇祸率明显较低,以上差异均有统计学意义。结论 守护APP平台帮助医生与监护人把严重精神障碍患者的监护工作真正落到实处,康复效果优于传统的康复方法,值得进一步推广应用。

Objective Guardianship APP intervention was conducted for the guardians of severe mental disorders in Huicheng,Xinhui district,Jiangmen city and the effect of intervention was evaluated. Methods 1 488 psychiatric patients in the unit area were taken as the research objects,which were randomly divided into the guardian APP installation group of 1084 cases and the non - installation group of 404 cases. The installation group uses guardian APP to realize the dynamic guardianship and real-time monitoring of the patients,and we provided free charge consultation,psychological intervention,medication guide,case tracking and follow-up management services. The non installation group adopted the routine rehabilitation management measures after discharge. After a year the implementation of rehabilitation measures,compliance,condition and social improvement,relapse rate of hospitalization,accident rate and knowledge of family disease between the two groups of patients were compared and analyzed. Results The compliance and rehabilitation measures of the patients in the App group were higher than those in the non installation group. The rate of knowledge about mental illness was higher in family members,and the improvement of SCL-90 score and psychosocial function assessment score after intervention was better than that of non installation group. The rate of relapse hospitalization and cause trouble were lower. The differences above were statistically significant. Conclusion The guardian APP platform helps doctors and guardians to make the monitoring work of patients with severe mental disorder really practical,and the rehabilitation effect is better than the traditional rehabilitation method,which is worthy of further promotion and application.