目的 探讨ε-3多不饱和脂肪酸在胃肠道肿瘤患者化疗后的胃肠道毒性及生活质量的作用。方法 在研究前经过化疗筛选,按照WHO化疗副反应在2级或者以上的50名住院的胃癌或者直结肠癌患者,随机分为对照组(单纯化疗)(n=25)和研究组(化疗加ε-3多不饱和脂肪酸)(n=25),两组的化疗方案均为化疗筛选的方案。预防性每天静脉使用ε-3多不饱和脂肪酸 200 mg,连续5天,记录评估胃肠道并发症,如恶心、呕吐和腹泻,以及KPS评分、血清白蛋白、IL-2、IFN-γ和CRP。结果 与对照组比较,恶心、呕吐和腹泻评分、IL-2、IFN-γ和CRP低于于对照组,相反,生活质量评分研究组高于对照组,差异有统计学意义(P<0.05)。结论 预防性使用ε-3多不饱和脂肪酸能够减轻胃肠道肿瘤患者化疗后的胃肠道毒性症状、降低全身炎症因子反应并改善生活质量。

Objective To explore the effect omega-3polyunsaturated fatty acid omega-3 FA on clinical manifestations of gastrointestinal toxicity and quality of life (QOL) induced by chemotherapy for patients with gastric or colorectal cancer. Methods After screening chemotherapy, Fifty patients with gastric or colorectal cancer, according to developing WHO side-effect grading system of grade 2 or higher were randomly divided into either control group (n=25) or omega-3 FAs group (n=25) during next cycle of chemotherapy. In the control group, the patients received the same chemotherapy regimens as screening cycle and in the omega-3 FA group, received chemotherapy and omega-3 FAs. Prophylactic intravenous 200 mL /d was given for 5 days. The gastrointestinal complications such as nausea,vomiting or diarrhoea and Karnofsky performance status(KPS ),IL-2,IFN-γandCRP,ect, were evaluated respectively. Results Compared with the control group, the scores of nausea vomiting and diarrhea and IL-2,IFN-γor CRP levels decreased , significantly,on the contrary, the score of QOL increased. There was significantly statistical difference (P<0.05). Conclusion Prophylactic intravenous omega-3 FA can ameliorate clinical manifestations of gastrointestinal toxicity and systemic inflammatory response syndrome(SIRS) induced by chemotherapy and improve QOL for patients with gastric or colorectal cancer.

目的 探讨难治性肠易激综合征(RIBS)患者的生活质量及影响因素。方法 采用症状严重程度量表(IBS-SSS)、汉密尔顿焦虑/抑郁量表(HAMA/HAMD)和生活质量量表(IBS-QOL)对601例消化专科门诊连续IBS患者和同期匹配的100例健康体检者进行测评,并通过多重线性回归分析探讨RIBS患者生活质量的影响因素。结果 RIBS组IBS-QOL总评分及IBS-QOL8个维度评分低于非RIBS组和健康对照组(P<0.05)。RIBS不同亚型间的IBS-QOL总评分无统计学意义(P>0.05),但在冲突行为、健康忧虑、社会反映3个维度方面有统计学意义(P<0.05)。IBS-SSS症状评分和焦虑症状评分为RIBS患者生活质量的影响因素。结论 难治性IBS患者的生活质量差,临床症状和焦虑情绪为其重要影响因素。

Objective To explore quality of life and its risk factors in patients with refractory irritable bowel syndrome(RIBS). Methods 601 IBS patients in gastroenterology clinic and 100 healthy volunteers were invited to complete irritable bowel syndrome- symptom severity scale (IBS-SSS), the Hamilton Rating Scale of Anxiety/ Depression (HAMA/HAMD), Irritable bowel syndrome-quality of life(IBS-QOL). And multiple linear regression analysis was used to explore the determinants of quality of life in patients with RIBS. Results The overall score and subscale scores of IBS-QOL in RIBS group were lower than those in the non-RIBS and healthy group (P<0.05). There were no significant differences in the overall scores of IBS-QOL among different subtypes of RIBS. However, the interference with activities, health anxious, social reaction scores were different among the subtypes (P<0.05). Multiple linear regression analysis demonstrated that quality of life in RIBS was independently associated with the scores in IBS-SSS and HAMA. Conclusion Quality of life in RIBS is obviously decreased. Quality of life in RIBS is closely related to clinical symptoms and anxiety condition.

目的 探讨苯作业非酒精性脂肪肝工人丙氨酸氨基转移酶(ALT)水平与颈动脉粥样硬化的关系。方法 190名的苯作业非酒精性脂肪肝工人分为ALT异常组(ALT≥40 U/L)及ALT正常组(ALT＜40 U/L)。ALT异常组再根据ALT水平分为依据ALT水平分为G1组(60例,40 U/L≤ALT＜60 U/L),G2组(40例,60 U/L≤ALT＜80 U/L),G3组(35例, ALT＞80 U/L)。观察各组颈部动脉有否内膜增厚或斑块形成。结果 与ALT异常组颈动脉内膜增厚检出率和颈动脉斑块检出率明高于ALT正常组(P<0.05)。颈动脉内膜增厚检出率和颈动脉斑块检出率与ALT正常组相比较,G1组差异无统计学意义(P＞0.05), G2组有统计学意义(P<0.05),G3组有差异(P<0.01)。颈动脉内膜增厚检出率在G1组、G2组和G3组中逐渐增加,并有统计学意义(P<0.05)。G3组颈动脉斑块检出率与G1组比较,有差异(P<0.01)。结论 苯作业非酒精性脂肪肝工人中,血清ALT水平升高与颈动脉粥样硬化密切相关。ALT≥60 U/L的苯作业非酒精性脂肪肝人群更容易患颈动脉粥样硬化,应进行必要的预防和治疗。

Objective To explore the relationship between serum alanine aminotransferase levels(ALT) and carotid atherosclerosis in benzene exposed workers with nonalcoholic fatty liver disease. Methods 190 Benzene exposed workers with nonalcoholic fatty liver disease were enrolled divided into abnormal ALT group(n=135) and normal ALT group(n=55), the abnormal ALT group was further divided into three groups according to the levels of serum alanine minotransferase (ALT): group1(G1,60 subjects, 40 U/L≤ALT＜60 U/L),group2(G2,40 subjects, 60 U/L≤ALT＜80 U/L),and group3(G3,35 subjects, ALT＞80 U/L),observed if carotid has only thick endomembrane or with plaques. Results The rate of thick endomembrane of carotid and the detection rate of plaque in the abnormal ALT group are higher than those in the normal ALT control group (P<0.05). Compared with the normal ALT control group, no significant different was found in the rate of thick endomembrane of carotid and the detection rate of plaque in G1,but G2 was significantly different(P<0.05),G3 was extremely significantly different(P<0.01). The rate of thick endomembrane of carotid in G1,G2 and G3 increased, among the three groups. There were statistically significant differences in the rate of thick endomembrane of carotid(P<0.05). benzene exposed workers with nonalcoholic fatty liver disease in G3 showed extremely statistical differences on the detection rate of plaque compared to those in G1(P <0.01). Conclusion The increased level of ALT in benzene exposed workers with nonalcoholic fatty liver disease is closely related to carotid atherosclerosis. The benzene exposed workers with nonalcoholic fatty liver disease whose ALT≥60 U/L are apt to carotid atherosclerosis, should accept the necessary precaution and treatment.

目的 了解消化性溃疡发病特点,分析溃疡在秋冬和冬春之交发病情况的差异。方法 对我院10年胃镜检查结果进行统计分析。结果 共检出消化性溃疡8592例,其中十二指肠溃疡6875例,胃溃疡1121例,复合性溃疡596例,三者的检出率分别为12.72%、2.07%和1.10%,十二指肠溃疡明显多于胃溃疡,两者之比为6.13∶1。季节上,十二指肠溃疡与胃溃疡的检出率在秋冬之交高于春冬之交,十二指肠溃疡的检出率在春冬季高于夏秋季,复合性溃疡在冬季高发,秋季最低。胃溃疡好发于胃窦,其次是胃角;十二指肠球部溃疡的好发部位依次为前壁、大弯、小弯、后壁。十二指肠溃疡、胃溃疡和复合性溃疡的高发年龄段为30~39岁、40~49岁和 40~59岁。结论 十二指肠溃疡明显多于胃溃疡,十二指肠溃疡与胃溃疡的检出率在秋冬之交高于春冬之交。消化性溃疡的发病在性别、年龄、季节等方面上具有明显差异。

Objective To explore the features of peptic ulcer disease, and analyze difference of incidence in difference months. Methods Gastroscopy results were collected and analyzed in our hospital. Results A total of 8592 cases of peptic ulcer were collected, including 6875 cases of duodenal ulcer, 1121 cases of gastric ulcer and 596 cases of compound ulcer, the detection rate were 12.72%, 2.07% and 1.10% respectively. Duodenal ulcer presented significantly more than gastric ulcer, the ratio was 6.13∶1. As to season changed, the detection rate of duodenal ulcer and gastric ulcer in the months when autumn turns winter were higher than in the months when winter turns spring. The detection rate of duodenal ulcers in winter and spring were higher than summer and autumn. Compound ulcer had highest incidence in winter and lowest in autumn. As to predilection site, gastric ulcer was mainly in gastric antrum, followed by gastric angle, duodenal ulcer was mainly in anterior wall. The peak age of duodenal ulcer, gastric ulcer and compound ulcer were 30~39, 40~49, and 40~59 years old. Conclusion Duodenal ulcer was remarked more than gastric ulcer. The detection rate of duodenal ulcer and gastric ulcer in the months when autumn turns winter was high than in the months when winter turns spring. The incidence of peptic ulcer has obvious differences in gender, age, season, etc.

目的 观察喉罩通气下全凭七氟醚吸入麻醉在妇科宫腔镜手术中的应用价值。方法 60例拟行妇科宫腔镜手术的患者随机分为七氟醚和丙泊酚组,每组30例,记录不同时间点两组患者的平均动脉压(MAP),脉搏血氧饱和度(SpO₂)、苏醒时间以及术后恶心,呕吐、躁动的发生率。结果 A组患者血流动力学指标波动较少,苏醒时间A组明显短于B组,差异有显著性(P<0.05)。两组患者诱导后MAP,HR均较诱导前显著下降(P<0.05)。B组患者术中MAP,HR值显著低于A组(P<0.05),拔除喉罩即刻两组MAP,HR差异无显著性(P>0.05)。结论 喉罩下全凭七氟醚吸入麻醉对患者的血流动力学的影响较小,适用于妇科宫腔镜手术。

Objective To observe the effect of laryngeal mask airway(LMA) combined with sevoflurane inhalation anaesthesia in gynecological hysteroscopy operation. Methods Sixty patients, classified from ASAⅠtoⅡscheduled for hysteroscopic operation were randomly divided into sevoflurane inhalation anesthesia group (group A) and propofol intravenous anesthesia group(group B).The mean arterial pressure (MAP), pulse oxygen saturation (SpO₂), recovery time and the incidence of nausea, vomiting and recovery time were recorded at different time points of the two groups. Results The hemodynamic index of the patient in the group A fluctuated seldom,and the recovery time was significantly shorter than that in the B group, and the differences were significant (P<0.05).The MAP and the HR were all decreased after anesthesia induction compared with those of before in both groups (P<0.05).The MAP and the HR in the group B was significantly lower than that in the group A (P<0.05), there were no significant differences in MAP and HR between the two groups of patients with laryngeal mask airway removal. Conclusion Small hemodynamic influence is taken with the technique of laryngeal mask airway(LMA) combined with sevoflurane inhalation anesthesia. It is suitable for gynecological hysteroscopic operation.

目的 了解惠州市早产儿视网膜病变的发病状况,并探讨相关危险因素。方法 回顾分析我院在2015年1月—2015年9月776例(1552只眼)早产儿和低体重儿的眼病筛查资料。结果 776例早产儿中,发现各期ROP共27例,检出率3.479%,其中包括1期11例(18只眼),2期11例(22只眼),3期2例(4只眼),AP-ROP3例(6只眼)。统计学分析显示,ROP组和无ROP组在出生胎龄、出生体重、吸氧史间比较,差异有统计学意义,提示早产、低出生体重与ROP的发生密切相关。结论 惠州地区ROP发病率3.479%,出生体重、出生胎龄、吸氧史及宫内缺氧、母体慢性高血压合并妊娠等孕期母体因素都是影响其发生的高危因素。

Objective To study the incidence of retinopathy of prematurity and to analyse the risk factors for ROP. Methods A retrospective analysis was conducted on 776 premature children from January 2015 to September 2015. Results In the 776 premature babies examinaion, 26 cases(54 eyes, 3.479%)developed ROP, including 11 cases (18 eyes) suffering from stage 1,11 cases (22 eyes) from stage 2,2 cases (4 eyes) from stage 3,3cases (6 eyes) from AP-ROP. The results of statistical analysis showed that gestational age, birth weight and oxygen therapy were significantly to ROP. Clinical analysis indicated that prematurity, low birth weight and oxygen therapy were closely related to the occurrence of ROP. Conclusion The incidence of ROP in Huizhou city is 3.479%. The gestational age, birth weight ,intrauterine hypoxia, and maternal prenatal factors such as chronic hypertension with pregnancy are the high risk factors of ROP.

目的 探讨Sirius与A超对不同程度近视患者中央角膜厚度(CCT)的测量差异。方法 对225例(450眼)拟行角膜屈光手术的近视患者,按低、中、高度近视分三组,依次用Sirius和A超测量CCT。 测量结果行配对t检验、 Pearson相关及 Bland-Altman分析。结果 低、中、高度近视组中,Sirius所测CCT均数分别为(542.61±29.19)μm、(543.96±27.02)μm、(547.25±22.53)μm;A超CCT均数分别为(538.51±29.12)μm、(540.98±26.56)μm、(542.19±21.64)μm。不同近视组中,Sirius测量值均略大于A超值,且两者高度正相关,差异有统计学意义(P<0.05)。Bland-Altman分析,不同近视组中,两种仪器测量CCT的一致性较好。结论 Sirius在绝大多数情况下能够替代传统的A超角膜测厚仪,但对拟行激光手术的高度近视患者应该综合考虑两种仪器测量结果。

Objective To study the measurement differences of central corneal thickness(CCT) in different degree of myopia by Sirius and ultrasound pachymetry(UP). Methods 225 myopic subjects(450 eyes)were recruited and divided into three groups according to the degree of refractive errors. The CCT were obtained from the eyes for each subjects using the Sirius and UP. Data were compared by using paired t-tests and the Pearson correlations. Bland- Altman analysis of all pairs were determined. Results The mean CCT in low myopic group obtained from Sirius and UP were (542.61±29.19)μm and(538.51±29.12)μm,respectively. The mean CCT in medium myopic group by Sirius and UP were(543.96±27.02)μm and(540.98±26.56)μm.The measured mean CCT in high myopic group were(547.25±22.53)μm and(542.19±21.64)μm by Sirius and UP. The mean CCT measurements between the two instruments were high correlated and statistically different(P<0.05) in the three groups respectively. In different myopia groups Sirius has good coincidence with UP in measuring CCT according to the Bland-Altman plot. Conclusion In vast majority of cases,Sirius can replace traditional UP in measuring CCT. But for the preopreative examination of the high myopia patients, we need to think twice about the difference between the two measurements.

目的 探讨微泡增强的超声空化对荷瘤兔乳腺癌的治疗效果。方法 建立兔VX2乳腺癌模型,肿瘤兔随机分成两组,超声微泡组及单纯超声组,各组于治疗前及治疗后分别行超声造影,分析造影前后肿瘤灌注情况。结果 超声微泡组治疗前后造影灰阶值改变明显,造影灰阶值从治疗前的(20.26±2.59)降至(3.71±1.61)(P<0.01);而单纯超声组肿瘤造影灰阶值无明显统计学差异(P>0.05)。结论 微泡增强的超声空化对荷瘤兔乳腺癌有一定的治疗效果。

Objective To investigate the treatment effect of microbubbles-enhanced ultrasound cavitation on VX2 breast tumor in rabbits. Methods The rabbit model of VX2 breast tumor were established. The rabbits were randomly divided into two groups, microbubbles-enhanced ultrasound (US+MBs) group and standard ultrasound (US) group. The VX2 breast tumor perfusion were imaged and assessed using contrast enhanced ultrasonography (CUES) before and after treatment. Results The contrast enhanced grayscale value (GSV) of VX2 breast tumors decreased significantly in the US+MBs group, from 20.26±0.59(before treatment) to 3.71±.761 (after treatment)(P<0.01). While there was no significance of GSV before and after treatment (P>0.05) in the US group. Conclusion Microbubble-enhancement ultrasound cavitation has a certain therapeutic effect on the VX2 breast tumor in rabbits.

目的 分析ITP患者血清中IgG型抗体糖基化的特异性,初步探讨其特异性与临床症状的相关性。方法 选取健康献血员30例、ITP患者13例及健康怀孕妇女23例,纯化血清中的IgG型抗体,应用nano-LC-MS法分析糖基化种类及水平,对比分析ITP患者血清中IgG型抗体的糖基化特异性。结果 ① ITP 患者血清中IgG型抗体的半乳糖糖基化水平为47.08±2.69,低于健康怀孕妇女(50.93±2.21),高于健康献血员(42.88±2.00)(P<0.05);② ITP 患者岩藻糖基化水平为81.16±2.49低于健康献血员(82.60±2.56)(P>0.05),同时低于健康怀孕妇女(86.17±2.23)(P<0.05);③ITP 患者唾液酸化水平为3.93±1.20,高于健康献血员(3.69±1.19),低于健康怀孕妇女(4.28±0.88)(P>0.05)。④ITP 患者乙酰葡糖氨基化水平为10.53±1.41,低于健康献血员(11.54±1.76),高于健康怀孕妇女(10.13±1.45)(P>0.05)。结论 ITP患者血清中的IgG型抗体的岩藻糖基化、半乳糖糖基化水平的特异性可能是其产生有别于健康怀孕妇女的临床症状的的分子基础。

Objective To investigate the glycosylation specificity of the IgG antibody in ITP. Methods Choose 30 healthy donors, 23 healthy pregnants and 13 ITP patients, purified the IgG antibody from serum, analysied the level of all kinds of glycosylation. Compared with healthy donor and healthy pregnants to find the specificity of the IgG antibody in ITP patients. Results ① The galacosylation of IgG antibody in ITP patients was 47.08±7.24,lower than healthy pregnants (50.93±4.91), higher than healthy donor (42.88±4.01), and the healthy pregnants were higher than healthy donor (P<0.05). ② The fucosylation in ITP patients was 81.16±6.2, lower than healthy donors (82.60±2.56) (P>0.05), higher than healthy pregnants(86.17±2.23)(P<0.05); ③The sialylation in ITP patients was 3.93±1.20, higher than healthy donors (3.69±1.19), lower than healthy pregnants (4.28±0.88)(P>0.05); ④The GlcNAc in ITP patients was 10.53±1.41, lower than healthy donors (11.54±1.76), higher than healthy pregnants (10.13±1.45)(P>0.05). Conclusion The specificity of IgG antibody in ITP patients in galacosylation and fucosylation may be the molecule base of ITP's clinic symptom.

目的 评价围术期目标导向液体治疗用于老年高危患者的优越性。方法 50例行择期全髋关节置换术的老年患者,随机分成传统液体治疗组(C组)和目标导向治疗组(GDT组),每组25例。C组以MAP和CVP为指导进行围术期液体管理,GDT组以每搏量(SV)和氧供指数(DO₂I)最大化进行围术期液体管理。观察和比较两组患者围术期液体出入量、MAP、HR、SV和CI等参数。结果 GDT组总输液量、晶体液和胶体液的输注总量均高于C组(P＜0.05);GDT组各时点MAP、HR、SV和CI高于C组(P＜0.05),与基础值比较,GDT组无变化,而C组在麻醉后和应用骨水泥后,MAP、HR、SV和CI一过性下降(P＜0.05)。结论 与传统围术期液体管理方案相比,以SV和DO₂I最大化为目标的GDT方案用于高危病人全髋置换手术,能使心脏前负荷处于更理想的充盈状态,血流动力学更稳定,并能有效预防骨水泥引起的循环抑制作用。

Objective To evaluate the priority of goal-directed fluid therapy(GDT) in high risk elderly patients. Methods Fifty elderly patients undergoing total hip replacement were randomly divided into traditional fluid therapy group(group C) and goal-directed fluid therapy group(group GDT). Group C received perioperative fluid management based on MAP and CVP, while Group GDT received goal-directed fluid therapy based on SV and DO₂I optimization. MAP, HR, SV, and CI were recorded at different time points; the intraoperative blood loss, fluid volume, and urine volume were also recorded. Results The total fluid volume, colloid volume and crystal volume of group GDT were much more than group C(P＜0.05); the intraoperative MAP, HR, SV, and CI in group GDT were much higher than group C(P＜0.05); compared withbaseline of MAP, HR, SV, and CI, there were no obvious change in group GDT, while there were significant decline in group C, especially after anesthesia and implantation of bone cements(P＜0.05). Conclusion Compared with traditional fluid management strategy, SV and DO₂I optimization based goal-directed fluid therapy has a significant priority in high risk elderly patients undergoing total hip replacement.It can maintain better preload and provide more stable hemodynamic status, and prevent cardiac side effect induced by implantation of bone cements