目的 了解化脓性脑膜炎患儿常见后遗症的种类及发生率,探讨可能导致化脓性脑膜炎患儿预后不良的高危因素。方法 选取129例化脑性脑膜炎患儿,患儿分为预后不良组及预后良好组,统计各种后遗症的发生率,并寻找预后不良的危险因素。结果 随访的80例患儿中,有较轻后遗症者12例,有严重后遗症者13例,包括智力低下11例,运动障碍8例,双侧听力障碍4例,继发性癫痫4例,10例患儿合并有两种或以上严重后遗症,最常见为智力低下合并运动障碍。行为问题共检查48例患儿,有行为问题患儿17例。预后不良组和预后良好组在发热总时间>7天、入院后反复抽搐≥3次、昏迷(Glasgow昏迷评分<8分)、感染性休克、瞳孔异常、肢体活动障碍为出现预后不良的危险因素,两组比较差异有统计学意义(P＜ 0.05)。结论 本研究发现,化脓性脑膜炎患儿的后遗症表现多种多样,提示患儿应该进行系统的随访;同时,本研究还发现昏迷、感染性休克等临床症状是导致预后不良的危险因素。早期识别这些症状,并给予早期干预,将对患儿的预后有着重要意义。

Objective To investigate the types and incidence of common sequelae in children with bacterial meningitis.To investigate the risk factors for adverse outcome of childhood bacterial meningitis. Methods Selected 129 children with bacterial meningitis all cases were divided into adverse outcome group and favorable outcome group.According to the incidences of different kinds of sequelae,The risk factor effecting bad prognosis were studied. Results A total of 80 children were successfully followed.Of them,12 might only have mild sequelae and 13 had serious sequelaes.Among these children who had serious sequelae,11 of them had mental retardation,8 of them had motor deficit,4 of them had bilateral hearing loss and 4 of them had secondary epilepsy.10 children had multiple serious sequelae,thes most common multiple impairment combinations were mental retardation plus motor deficit.48 parents of the children completed the Child Behaviour Checklist and found out 17(35.42%)of their children had behavioral disorders.Adverse outcome group and favorable outcome group,the length of fever(>7 days),repeated convulsions after admission(≥3 times),coma(Glasgow coma scale score <8 points),septic shock,abnormal pupils,limb movement disorder.There were significantly difference between the two groups(P＜ 0.05). Conclusions This study showed that there are different kinds of sequelaes of children with bacterial meningitis,it indicated that these children should be follow-up to track the effect.On the other hand,this study found out that the high risk factors with adverse outcome might be coma,septic shock and so on.It indicated that if we could identify the high risk factors in the early stage and then interpose them immediately,it might beneficial to improve the quality of life of the children.

目的 体外构建胶原—壳聚糖复合支架材料,分析其物理化学性质及生物相容性,探讨其应用于组织工程支架材料的可行性。方法 利用冷冻干燥的方法构建三维多孔的胶原支架材料,通过甲醛交联以及添加壳聚糖的方法改善其物理化学性能。通过体外降解实验以及电镜扫描的方法检测材料的各项物理化学指标;通过细胞接种的方法研究材料的生物相容性。结果 胶原—壳聚糖复合材料通过冷冻干燥的方法,能够获得稳定的三维多孔结构,电镜显示孔隙贯通,体外降解速度降低,并且能够支持细胞生长。理化性质分析显示该结构适合细胞生长,具有良好的生物相容性。结论 本课题体外构建胶原—壳聚糖复合支架材料,满足组织工程生物材料的理化以及生物相容性要求,为其应用于组织工程支架材料提供重要的依据。

Objective We build up the Collagen-Chitosan compound scaffold in vitro,and study the physical,chemical and biological properties,to analyze the feasibility in tissue engineering. Methods The three-dimensional porous scaffold was obtained by freezing-drying method,and optimized by using formaldehyde and Chitosan.We used hydrolysis in vitro and SEM scanning to investigate its physical and chemical properties.The biocompatibility of scaffold was analyzed in MEF cells. Results Collagen-Chitosan compound scaffold we obtained by freezing-drying method was a kind of stable 3D vesicular structure.The scaffold degenerated in decreased velocity in vitro.The physical and chemical properties showed that it was suitable for the cells grow in it,which suggested that it has a good biocompatibility. Conclusion This kind of Collagen-Chitosan compound scaffold is constructed.It's qualified by the physical and chemical properties,and biocompatibility which the biomaterials require.The evidence are important for its application in tissue engineering.

目的 对比分析二氧化锆全瓷冠与钴铬合金烤瓷冠修复牙体牙列缺损的临床疗效。方法 选择2008年3月以来广东工业大学医院口腔科和江西省萍乡市安源区现代口腔门诊部牙体牙列缺损全冠修复患者150例364颗,随机分为2组,实验组采用二氧化锆全瓷冠75例185颗,对照组采用钴铬合金烤瓷冠75例179颗,修复后随访2年对比观察,结果采用χ²检验分析。结果 两组在修复体完整性、固位、边缘密合度、牙敏感症状、继发龋、邻面接触点、过敏反应方面差异无统计学意义(P＞0.05);但在牙龈状况、龈缘着色、颜色匹配方面差异有统计学意义(P＜0.01)。结论 二氧化锆全瓷冠修复体美学效果和生物相容性优于钴铬合金烤瓷冠。

Objective To compare and analyze the clinical effects of restoring tooth dentition defect by using zirconium dioxide full porcelain crowns and cobalt chromium alloy porcelain crowns. Methods 150 patients with 364 teeth suffering from tooth dentition defect in hospital of guangdong university of technology and modern stomatology clinic in pingxiang since March of 2008 are chosen and randomly divided into two groups. 75 patients with 185 teeth in the experimental group are restored with zirconium dioxide full porcelain crowns and 75 patients with 179 teeth in the control group are restored with cobalt chromium alloy porcelain crowns, which was followed up with 2-year observation. Results There is no statistical significance between the two groups in terms of repair integrity, retention, edge adaptation, tooth sensitivity symptoms, secondary caries, contact points, and allergic reaction(P＞0.05). But statistical significance exists in gingival status, gingival coloration, and color matching(P＜0.01). Conclusion Zirconium dioxide full porcelain crowns are superior to cobalt chromium alloy porcelain crowns in aesthetic effect and biocompatibility.

目的 探讨经皮穴位电刺激对脑卒中偏瘫患者下肢功能的影响。方法 41例脑卒中患者随机分为TAES组和安慰刺激组,分别为21例和20例。两组常规治疗相同。TAES组采用KD-2A型经皮神经电刺激治疗仪治疗,刺激部位选择患侧下肢的4个穴位(足三里ST 36、太冲LV 13、阳陵泉GB 34、昆仑BI 60),频率100 Hz,脉宽0.2 ms,强度为患者最大耐受强度为限;安慰刺激组接受治疗的部位时间和疗程与TAES组相同,但每次治疗时没有电流输出。治疗前、治疗2周、治疗3周分别用综合痉挛量表(CSS)评定踝关节痉挛,Fugl-Meyer运动评定量表中下肢部分(FMA)评定下肢运动功能,Berg平衡量表(BBS)评定平衡功能。结果 组内比较:治疗2周和治疗3周后与治疗前比较两组CSS、FMA下肢部分、BBS评分差异有统计学意义(P<0.05);组间比较:治疗2周和3周后,TAES组CSS、FMA、BBS评分优于安慰刺激组,差异有统计学意义(P<0.05)。结论 TAES治疗能减轻脑卒中患者偏瘫下肢痉挛程度和提高平衡功能,改善下肢运动能力。

Objective To investigate the effect of transcutaneous accupoint electrical stimulation(TAES)in enhancing motor and functional recovery of the lower extremity in subjects with stroke. Methods 41 subjects with first stroke were randomly assigned into 2 groups:TAES group and placebo stimulation group.All subjects received the same standard rehabilitation.In the TAES group.Model KD-2A stimulator was applied with 0.2 ms pulses,at 100 Hz within the subject's tolerance level on the 4 acupuncture points(ST 36,LV 3,GB 34,and Bl 60)in the affected lower legs for 60 min,5 days a week for 3 weeks;The time and the course of treatment of the placebo stimulation group was as well as the TAES group's,but no current output for each treatment.All subjects in the 2 groups received standard rehabilitation program.Measurements including composite spasticity score(CSS)for the spasticity of the ankle planter flexors,Fugl-Meyer motor assessment(FMA)for the lower extremity,and Berg Balance Scale(BBS)for balance were recorded before treatment,after 2 and 3 weeks' treatment. Results After 2 and 3 weeks of treatment,the CSS score in the TAES group was significantly lower than the placebo stimulation group(P<0.05)and the FMA score and BBS score in the TAES group was significantly higher than the placebo stimulation group(P<0.05). Conclusion Transcutaneous accupoint electrical stimulation significantly decreased ankle plantar flexor spasticity and improve motor function of the affected lower extremity.

目的 观察十一酸睾酮联合左卡尼汀治疗特发性弱精症的疗效。方法 回顾性分析2012年11月—2014年6月在我科诊断为弱精子症的386例患者的临床资料,按标准分成轻(A组)、中(B组)、重(C组)3组。分别给予左卡尼汀、十一酸睾酮联合左卡尼汀治疗,观察两种治疗方法对特发性弱精子症的疗效。结果 A组、B组患者两种治疗方法治疗后精子PR均有升高,差异有统计学意义(P＜0.05),C组患者给予左卡尼汀治疗患者治疗后PR无改善,差异无统计学意义(P＞0.05);十一酸睾酮联合左卡尼汀治疗患者治疗后PR升高,差异有统计学意义(P＜0.05)。A、B、C组患者给予左卡尼汀治疗的有效率分别是47.6%,41.7%,18.9%,总有效率为37.9%;A、B、C组患者给予十一酸睾酮联合左卡尼汀治疗的有效率分别是52.6%,45.5%,34.7%,总有效率为45.5%。A组、B组患者两种治疗方法疗效无差异(P＞0.05);C组患者给予十一酸睾酮联合左卡尼汀组有效率高于给予左卡尼汀组,差异有统计学意义(P＜0.05)。结论 十一酸睾酮联合左卡尼汀治疗特发性弱精子症的疗效优于左卡尼汀单一用药。

Objective To observe the effects of eleven acid testosterone combined with L-carnitine on curing idiopathic asthenospermia. Methods Retrospective analysed the clinical data of 386 patients with asthenospermia patients from November 2012 to June 2014 in our department.According to the standard,the patients were divided into mild A,moderate B,severe C in 3 groups,given L-carnitine treatment and given eleven acid testosterone combined with L-carnitine treatment.We observed effect of the two therapeutic methods for the treatment of idiopathic asthenospermia. Results The sperm PR were increased,In group A and group B patients after treated.The difference was statistically significant(P<0.05).In group C,the patients received the treatment of L-carnitine,the sperm PR has no obvious improvement,There was no significant difference(P>0.05).The patients received the treatment of eleven acid testosterone combined with L-carnitine the sperm PR significantly increased,the difference was statistically significant(P<0.05).The treatment efficiency of A,B,C group received L-carnitine were 47.6%,41.7%,18.9%,the total effective rate was 37.9%.The treatment efficiency of A,B,C group received eleven acid testosterone combined with L-carnitine were 52.6%,45.5%,34.7%,the total effective rate was 45.5%;There was no significant difference in group A and group B(P>0.05).The treatment efficiency in group C received eleven acid testosterone combined with L-carnitine group is obviously higher than that given L-carnitine group,the difference was statistically significant(P<0.05). Conclusion The curative effect of eleven acid testosterone combined with L-carnitine in the treatment of idiopathic asthenospermia is better than that of L-carnitine single drug treatment.

目的 探讨针灸治疗在体外受精—胚胎移植技术的临床效果。方法 以2013年8月—2015年8月在顺德妇幼保健院生殖科,因不孕进入IVF/ICSI周期的108例患者为研究对象,按照随机自愿原则将其分为三组,针刺组、安慰针刺组、对照组各36例,针刺组:在移植前24小时、移植后30分钟进行相关的针刺治疗,安慰针刺组:针刺穴位与妊娠无关,对照组:不使用针刺疗法,比较三组临床效果。结果 治疗后针刺组Ⅰ型内膜血流类型及PI、RI、S/D低于治疗前,Ⅱ+Ⅲ型内膜下血流类型高于治疗前,差异有统计学意义(P＜0.05)。针刺组总有效率高于安慰针刺组、对照组,三组差异有统计学意义(P＜0.05)。针刺组种植成功率、妊娠成功率及活产率均高于安慰针刺组、对照组,三组差异有统计学意义(P＜0.05)。结论 在体外受精—胚胎移植技术中为患者实施针灸治疗可改善子宫内膜下血流情况,提高临床疗效、改善妊娠结局。

Objective To investigate clinical results of acupuncture treatment in vitro fertilization-embryo transfer technology. Methods August 2013-August 2015 reproductive and child health hospital in Shunde branch,due to infertility entering IVF/ICSI cycles of 108 patients for the study,in accordance with the principle of voluntary they were randomly divided into three groups,the acupuncture group,placebo group and control group 36 cases,respectively.Acupuncture group:24 hours before transplantation,30 minutes post-transplant treatment of infertility acupuncture.Placebo group:acupuncture and were unrelated to infertility.The control group:acupuncture was not used.We compared three groups of clinical effect. Results In the treatment of type Ⅰ endometrial blood flow in the acupuncture group type and PI,RI,S/D were significantly lower than before treatment,Ⅱ+Ⅲ,endometrial blood type under were significantly higher than before treatment.the difference was significance(P<0.05). The acupuncture group was more efficient than placebo group and the control group,the three groups was significant(P<0.05). The success rate of acupuncture group planting,the success rate of pregnancy and live birth rates were higher than placebo group and the control group,the three groups was significant differences(P<0.05). Conclusion In vitro fertilization-embryo transfer technology into the implementation of acupuncture treatment for patients can improve blood flow under the endometrium,improve clinical outcomes and improve pregnancy outcomes.

目的 初步探讨微泡增强的脉冲式超声治疗脾创伤出血的作用机制。方法 14只健康家犬随机分为3组,超声微泡组(MEUS组)6只、单纯超声组(TUS组)4只、单纯微泡组(MB组)4只。开腹切割脾建立脾破裂出血模型,MEUS组用脉冲式超声治疗仪辐照伤口,同时静脉匀速推注微泡;TUS组超声治疗时静脉推注生理盐水;MB组超声治疗仪假照的同时静脉推注微泡。治疗完毕,进行超声造影评价,并送病理组织学检查。结果 MEUS组造影示靶区造影增强缺损或者低灌注,但较粗大血管仍为增强显影。病理组织学见脾窦、微小血管扩张充血、血管周围组织水肿,血小板聚集,微小血管血栓形成。结论 微小血管血栓形成、微血管淤血扩张、周围组织水肿压迫是超声联合微泡治疗脾创伤出血的可能机理。

Objective To investigate the mechanism of haemostatic effect induced by microbubble(MB)enhanced therapeutic ultrasound(TUS)on splenic trauma. Methods 14 healthy dogs were divided into 3 groups.Six animals were treated by microbubble-enhanced therapeutic ultrasound(MEUS),the other eight animals were treated with TUS only group(n=4)and the MB only(n=4)served as the controls.The spleens of all animals were surgically exposed and a 20 mm long,5 mm deep incision was created on the spleens using scalpel.Contrast enhanced ultrasound(CEUS)was performed to assess the blocking effects of splenic circulation.The targeted spleens were harvested for pathological examination. Results A non-enhanced or perfusion defect region was formed within the treated area.The histological results showed splenic sinus hyperemia,microvascular hyperemia,perivascular tissue edema,platelet aggregation and intravascular thrombosis. Conclusion The mechanism of haemostatic effect on splenic trauma by microbubble enhanced ultrasound maybe intravascular thrombosis,microvascular hyperemia and perivascular tissue edema oppression simultaneously.

目的 探讨护理质量持续改进对康复医学科护理质量管理的影响。方法 制定康复医学科护理管理标准,比较改进前后护理专业基本技能评分和护患关系情况评分。结果 经过持续质量改进,康复医学科的护理质量显著提高。基础护理、护理文书和消毒隔离的评分显著提高,与改进前相比较,两组间的差异有统计学意义。护患关系融洽度和患者满意率提高,与改进前相比较,两组间差异有统计学意义;护理纠纷发生率降低,两组间差异有统计学意义。结论 在康复医学科护理管理中引进持续质量改进,可有效地提高护理质量,确保护理安全。

负压病房是救治呼吸道传染病病人的重要医疗设置,如何在短时间内完成负压病房的相关配置是考验护理组快速反应能力和有效组织能力。我院2014年收治了第一例人感染性H7N9禽流感合并ARDS和多器官功能衰竭病人,呼吸内科护理组在2小时内完成了负压病房的相关配置,包括抢救隔离设施、人员调配、医护协调、心理辅导等一系列工作,探索出一套应对爆发性呼吸道传染病的护理模式。

凝血功能障碍是围术期临床关注的重点,评价方式较多,其中血栓弹力图(TEG)可根据凝血过程中血凝块的黏弹性变化所描绘出的图像,反映全血的凝血和纤溶能力,其结果快速准确,被广泛应用围术期凝血功能监测。

Coagulopathy is a key concern around operation period.Thromboelastography (TEG) is in the process of image based on viscoelastic changes of coagulation of blood clots depicted, to reflect the blood coagulation and fibrinolytic capacity. TEG test result is quickly and accurately, therefore it is widely used in the perioperative monitoring of blood coagulation function, blood transfusion guide, hypercoagulation monitoring, prevention of thrombosis.