目的 本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法 选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果 本研究患者的平均年龄(84.23±4.92)a,按eGFR<60 mL·min^-1·1.73 m^-2定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 ①肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。②年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people's hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of (84.23±4.92),had being divided into two groups according to eGFR< 60 ml·min^-1·1.73 m^-2:renal insufficiency group (n=52) and normal renal function group (n=51).There were statistical significance in the number of lacunar lesions,score of white-matter hyperintensity,mixed lesions between groups(P<0.05). Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is positively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI,and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.

目的 利用新的分型方法指导现有的微创技术下内固定的选择,提示预后,帮助制定术后康复计划。方法 将200例患者随机分成两组,一组为旧Evans分型组,另一组为改良Evans分型组,通过多层螺旋三维CT重建引导下改良Evans分型,对三个重点区域(股骨内距、头颈部及粗隆外侧入针点部位)的CT成像,利用多平面重组(MPR)、表面遮盖显示(SSD)及容积再现(VR)等多种后处理,分析骨折线走形、局部的微骨折、骨小梁分布、骨皮质厚度的骨折部内环境变化。简化整合到Evans分型中。来实现完善影像分型,有效地指导微创手术。对比两组患者的疗效。结果 新Evans分型组98例患者愈合良好,时间为9~17周,中位数为11.2周。其中伤口感染3例,髋关节内翻畸形3例,骨骨头坏死3例,按照髋关节治疗标准评分,优53例,良31例,可9例,差7例。优良率(包括优和良)为84%。旧Evans分型组80例患者愈合良好,时间为9~18周,中位数为11.8周。其中伤口感染10例,髋关节内翻畸形5例,股骨头坏死8例,按照髋关节治疗标准评分,优48例,良26例,可10例,差16例。优良率(包括优和良)为74%。两组对比,新Evans分型组优良率明显高于旧Evans分型组,差异有统计学意义。P＜0.05。结论 多层螺旋三维CT重建引导下的改良Evans分型对老年脆骨性粗隆间骨折的微创治疗有重要的临床指导意义。

目的 探讨代谢综合征(metabolic syndrome, MS)(指包括高血压,糖尿病,高脂血症和腹型肥胖的一组综合征)在中国南方老年病人的患病率、及其与心血管事件和痴呆关系。方法 本研究为一个中国南方老年人代谢综合征的横断面研究。我们采集了患者的病史、人口学和生化资料。对比生化资料、心血管事件、痴呆等疾病在MS组和非MS组中的差异,并使用Logistic回归分析来寻找MS的独立影响因子。结果 本研究共纳入206例患者。其中有92(44.66%)例患者符合代谢综合征的诊断标准。女性在MS组中35例(38.04%)明显高于在非MS组中28例(24.56%)。整体年龄(86.74± 6.10),在MS组(86.37±5.74)和非MS组(87.04±6.38)对比中无统计学意义。生化资料对比中,白细胞[(7.46±2.38) vs (6.46±2.35),P=0.003]和血肌酐[94.50(68.50, 129.33) vs 78.00(64.50, 99.75),P=0.004]在MS组中较高。Logistics单因素回归分析及多因素回顾分析提示白细胞、血肌酐和女性为MS的独立风险因子。心肌梗塞(35例,38.04%和心绞痛(28例, 24.56%)在MS组中明显高于非MS组中心肌梗塞(10例,8.77%)和心绞痛(39例,34.21%),两组比较有统计学意义,Logistics回归分析发现MS是心肌梗塞和心绞痛的独立影响因子;但是心衰和中风在两组对比中无统计学差别。痴呆(包括老年性痴呆和血管性痴呆)在MS组中明显低于非MS组:26例(28.26%)vs 50例(43.86%),提示MS可能对痴呆有预防作用。结论 MS在中国南方老年患者中普遍存在,女性、白细胞、血肌酐为MS的独立影响因子;MS是心肌梗塞和心绞痛的独立影响因子;MS中痴呆明显低于非MS组,可能对痴呆有预防保护性作用。

Objective To study the prevalence and correlation between the metabolic syndrome MS (including hypertension, diabetes, hyperlipidemia and obesity) with cardiovascular and dementia in the elderly people of south China. Methods This cross-sectional research studied metabolic syndrome of the elderly in south China. We collected the demographics and chemotic data and compared them in MS and non-MS group. And Logistic regression was used to analyze the independent factor of MS and the relationship between MS and the cardiovascular disease and dementia. Results This study included 206 patients and 92 (44.66%) of them were diagnosed as MS. 35 patients (38.04%) in MS group were female and 28 female cases (24.56%) in non-MS group. The mean age of the sample was (86.74±6.10) and the comparison between the MS group (86.37±5.74) and non-MS group (87.04±6.38) was not significantly different. White blood cell (WBC) (7.46±2.38 vs 6.46±2.35,P=0.003) and serum creatinine (Scr) was significantly [94.50(68.50,129.33) vs 78.00(64.50, 99.75),P=0.004]in MS group versus in non-MS group. Single factor and Multinomial logistic regression found WBC, serum creatinine and female gender were the independent risk factors of MS. Myocardial infarction (35, 38.04%) and angina (28, 24.56%) were significantly higher in MS group than that in non-MS group (10, 8.77%) and (39, 34.21%), respectively, with P<0.05. Logistic regression found MS was an independent risk factor of myocardial infarction and angina but not in heart failure and stroke. Dementia (including Alzheimer disease and vascular dementia) was found lower in MS group (26, 28.26%) than that in non-MS group (50, 43.86%), the difference was significant and this means MS could be protective for dementia. Conclusion MS is prevalent in the elderly of south China. Female gender, WBC and Scr were independent factors of MS; MS was the independent risk factor of myocardial infarction and angina; dementia was significantly lower in MS group, implying MS could be protective to dementia.

目的 探讨断指再植术后血管危象发生情况及危险因素。方法 收集2015年8月—2016年12月我院行断指再植术患者66例临床资料行回顾性分析,根据患者术后是否发生血管危象分为A组(发生血管危象)和B组(未发生血管危象),收集两组患者一般临床资料,采用单因素和多因素Logistic 回归分析影响断指再植术患者术后血管危象发生的危险因素。结果 单因素分析得出,性别、年龄、吸烟史、指别、外伤原因、末端断离及缺血时间在A、B两组间比较有统计学意义(P＜0.05)。多因素分析得出,性别、年龄、吸烟史、指别、外伤类型、末端断离、缺血时间均为影响断指再植术术后血管危象发生危险因素。结论 血管危象为断指再植术常见并发症,影响发生血管危象危险因素较多,临床中应针对性进行预防和干预,以降低断指再植术患者术后血管危象发生率,提高断指存活率。

目的 总结本地区低龄婴儿侵袭性B族链球菌(GBS)感染的流行病学特点, 为临床预防和诊治提供指导。方法 对2012年1月—2015年12月广州地区两家三甲妇儿专科医院收治的0～89 d低龄婴儿侵袭性GBS感染病例进行回顾性分析。结果 研究期间两院共收治侵袭性GBS感染病例120例,2015年感染病例数为2012年的2.8倍,感染病例的发生无明显季节倾向。早发型感染以败血症合并肺炎(46.3%)为主,围产期多伴有一个或以上的高危因素,死亡率为7.4%;晚发型感染以败血症合并脑膜炎(占42.4%),多以发热为首发症状,其中42%伴有神经系统症状,14.6%遗留神经系统后遗症。结论 广州地区低龄婴儿侵袭性GBS感染病例呈逐年增加趋势,临床应重视新生儿GBS感染的预防,加强感染高风险新生儿的管理,及时诊治,改善预后。

Objective To describe the epidemiological characteristics of invasive group B streptococcal (GBS) infection among infants during the past 4 years in Guangzhou, in order to provide scientific basis for the prevention and control of the disease. Methods Medical records of infants with invasive GBS infection from two tertiary hospitals in Guangzhou from January 2012 to December 2015 were reviewed. Results There were 120 infants with invasive GBS infections during the past 4 years in two tertiary hospitals, the number of patients increased from 2012 to 2015, and the occurrence of infectionshad no obvious seasonal tendencies. Among infants with EOD, the most common syndrome was sepsis complicated pneumonia (46.3%), respiratory sign and at least one of perinatal risk factors were commonly recorded, and the mortality rate was 7.4%. By contrast, a higher proportion of late-onset cases manifested as sepsis associated with meningitis (42.4%), fever was the most common presentation and 42% LOD cases accompanied by neurological symptoms, 14.6% infants had neurological sequelae. Conclusion The number of GBS-infected infants increased during the past 4 years in Guangzhou. Relevant departments should pay attention to the prevention of neonatal GBS infection, strengthen the management of high risk newborns to improve the prognosis.

目的 前瞻性探讨三维增强磁共振血管成像(3D CE-MRA)技术在显示骶前区血管的可行性。方法 选取40例因盆腔病变常规行MRI检查的成年患者,采用ACHIEVA 3.0T双源磁共振扫描仪对患者盆腔骶前区血管行DCE-MRA扫描,利用后处理工作站采用最大密度投影(MIP)及容积再现重组(VR)进行血管重建成像以最佳显示骶前区动脉及静脉,主要观察骶前区血管的影像学解剖。结果 40例骶正中动脉均显示清晰,成功率为100%;骶正中动脉均开口于腹主动脉分叉后上方,沿骶骨前面走行至尾骨尖,管径平均为(1.42±0.06)mm(1.30 mm～1.50 mm);骶前区静脉显示率为75%(30/40),可见骶前区静脉呈阶梯状分布。结论 应用3D CE-MRA可以清晰显示部分骶前区血管,可为骶前区手术提供个体局部影像学解剖信息。

Objective To explore the feasibility of three-dimensional enhanced magnetic resonance angiography (3D CE-MRA) in the presacral blood vessels. Methods 40 adult patients with pelvic lesions were examined by ACHIEVA 3.0T dual-source magnetic resonance scanner. DCE-MRA was used to scan the pelvic sacral anterior vessel. The maximal density projection (MIP) and the post volume reproducibility (VR) were reconstructed for optimal reconstruction of the anterior sacral arteries and veins, primarily to observe the anatomy of the anterior sacral vessels. Results 40 cases of sacral median artery were clear, the success rate was 100%; the sacral median arteries open in the abdominal aorta bifurcation after the top along the sacrum to the coccyx tip, the average diameter of (1.42±0.06) mm (1.30 mm-1.50 mm); the rate of the presacral venous display was 75% (30/40), showing that the anterior sacral vein was ladder-like distribution. Conclusion The application of 3D CE-MRA can clearly show some presacral blood vessels, which may provide individual local anatomical information for sacral precancerous surgery.

目的 观察2型糖尿病并急性脑梗死患者颅内血管病变特点。方法 回顾分析住院的T2DM并急性脑梗死组与非DM 脑梗死组各110例,对比两组的生化检查、美国国立卫生院卒中量表(National Institutes of Health Stroke, NIHSS)评分、梗塞灶及狭窄血管等。结果 两组在年龄、性别、血压方面无统计学差异。T2DM并急性脑梗死组在C反应蛋白、总胆固醇、糖化血红蛋白、尿素氮、肌酐、NIISS评分显著高于非DM 脑梗死组。T2DM并急性脑梗死组以小穿支动脉供血区梗死、大穿支动脉供血区梗死联合皮质支动脉供血区梗死的多发性脑梗死多见,狭窄血管见于大血管合并小血管。结论 T2DM并急性脑梗死患者病灶为多发性,狭窄血管更广泛,病情较严重,预后差,应积极防治。

目的 观察氟伐他汀联合环磷腺苷葡胺治疗慢性肺心病急性加重期的临床疗效。方法 将我院收治的74例慢性肺心病急性加重期病人,使用随机数字表法分为联合用药组与对照组,每组各37例。对照组单独使用环磷腺苷葡胺,联合用药组在对照组的基础上加服氟伐他汀。两组疗程均为7周。观察比较两组患者治疗前后的NO,ET-1,CRP,PaO₂水平以及治疗效果。结果 经7周疗程治疗后,对照组有效率为64.86%,联合用药组94.59%。两组间比较,差异有统计学意义(P<0.05)。两组NO,ET-1,CRP,PaO₂水平比较,联合用药组均优于对照组,差异有统计学意义(P<0.05)。结论 氟伐他汀联合环磷腺苷葡胺治疗慢性肺心病急性加重期的临床疗效更为显著,值得临床推广。

Objective To observe the clinical efficacy of combined treatment of Fluvastatin combined with Meglumine Adenosine Cyclophosphate on acute exacerbation of chronic pulmonary heart disease. Methods 74 patients with acute exacerbation of chronic pulmonary heart disease were randomly divided into combined treatment group and control group. The control group was treated by Meglumine Adenosine Cyclophosphate for 7 weeks.The combined treatment group was treated by Meglumine Adenosine Cyclophosphate and Fluvastatin for 7 weeks. The clinical efficacy and the score of NO,CRP,ET-1,PaO₂ were assessed before and after the treatment. Results After 7 weeks treatment, the total clinical efficacy rate was 64.86% in the control group and 94.59% in the combined treatment group. The differences between them has statistically significant(P<0.05). The score of NO,ET-1,CRP,PaO₂ in combined treatment group were significantly improved compared to control group (P<0.05). Conclusion The clinical efficacy of Fluvastatin combined with Meglumine Adenosine Cyclophosphate on acute exacerbation of chronic pulmonary heart disease is more efficient. It is worth to develop clinically.

目的 分析总结异丙酚静脉麻醉复合利多卡因乳腺后间隙局部浸润麻醉在乳腺多发性肿块真空辅助微创旋切术的临床应用体会。方法 通过对我院2012年3月—2015年3月380例乳腺多发性肿物在异丙酚静脉麻醉复合利多卡因乳腺后间隙局部浸润麻醉下行真空辅助微创旋切术的病例,进行回顾性综合分析。结果 手术前、中和手术后血氧饱和度无明显变化;手术中平均动脉压、心率与术前比较,差异有统计学意义(P<0.05);麻醉效果好,术后并发症少。结论 乳腺多发性肿物真空辅助微创旋切术采用异丙酚静脉麻醉复合利多卡因乳腺后间隙局部浸润麻醉,安全可行,患者依从性好、满意度和耐受度较高,临床效果满意。

Objective To investigate the applicative value of Propofol intravenous anesthesia combining with local infiltration anesthesia in vacuum assisted biopsy minimal invasive system for multiple breast lumps excision. Methods Encor minimally invasive surgery was performed under Propofol intravenous anesthesia together with local infiltration anesthesia in 380 cases with multiple breast lumps admitted to our department from March 2012 to March 2015. Anesthesia effect, SpO₂, MAP and HR were analyzed retrospectively. Results All 380 patients achieved good anesthetic effect for completing multiple breast lumps excision. The postoperative complications were less. There was no obvious change of oxyhemoglobin saturation (SpO₂) before, during and after the surgery period (P>0.05). The mean arterial pressure (MAP) and heart rate (HR) had statistical significance compared the surgery period with the pre-operative time (P<0.05). Conclusion Vacuum assisted biopsy minimal invasive system under Propofol intravenous anesthesia combining with local infiltration anesthesia is a safety and feasible method for multiple breast lumps excision. It has more advantages including perfect anesthetic effect, good patient compliance, higher satisfaction and higher tolerance level.

目的 探讨临床常用非侵袭性检查指标诊断膀胱出口梗阻(BOO)的准确性及可靠性。方法 回顾性研究2003年11月—2015年11月在广州市第一人民医院就诊并接受压力—流率测定(PFS)的男性LUTS/BPH患者,以侵袭性的PFS为诊断BOO的“金标准”,以前列腺体积(PV)、移行带体积(TZV)、移行带指数(TZI)、前列腺特异性抗原(PSA)、最大尿流率(Qmax)、剩余尿量(PVR)、剩余分数(RF)等非侵袭性检查指标为诊断指标进行诊断试验评价。结果 筛选1319例患者纳入统计分析。以ICS列线图为诊断标准,PV、TZV、TZI、PSA、Qmax、RF、PVR诊断BOO的ROC曲线下面积(AUC)分别为0.803、0.807、0.698、0.775、0.740、0.679、0.641;以Schaefer列线图为诊断标准,PV、TZV、TZI、PSA、Qmax、RF、PVR诊断BOO的AUC分别为0.806、0.814、0.713、0.773、0.721、0.684、0.642。结论 PV、TZV、TZI、PSA、Qmax、RF、PVR等非侵袭性指标对筛查及诊断中老年男性BOO有一定的参考价值及临床意义,其中TZV、PV、PSA、Qmax的诊断准确性较高。

Objective To evaluate and assess the efficacy and validity of the most common and noninvasive parameters in daily clinical practice for detecting bladder outlet obstruction (BOO) in elderly male compared with the golden standard pressure-flow study (PFS). Methods Retrospectively analyze the outpatients and inpatients of male LUTS/BPH from November 2003 to November 2015 in Guangzhou First People's Hospital. Collect the PFS parameters and other noninvasive parameters including PV, TZV, TZI, PSA, Qmax, RF, and PVR. Receiver operating characteristic (ROC) curve was used to evaluate the efficiency of each parameter for detecting BOO. Statistic analyses were performed using SPSS (Version 21). Results The data from 1319 patients were analyzed. According to the ICS-nomogram. The areas under the ROC curve (AUCs) of PV, TZV, TZI, PSA, Qmax, RF, and PVR for detecting BOO were 0.803, 0.807, 0.698, 0.775, 0.740, 0.679, and 0.641, respectively. According to the Schaefer's nomogram, the AUCs of PV, TZV, TZI, PSA, Qmax, RF, and PVR for detecting BOO were 0.806, 0.814, 0.713, 0.773, 0.721, 0.684, and 0.642, respectively. Conclusion PV, TZV, TZI, PSA, Qmax, RF, and PVR would help predicting BOO in elderly male noninvasively, and providing valuable reference and guidance in clinical decision. TZV, PV, PSA and Qmax supply preferable accuracy for detecting BOO, with better sensitivity and specificity.