目的 观察联合缩宫素与间苯三酚在基层医院分娩中疗效。方法 选用高明区人民医院2013年8月—2014年10月要求自然分娩的初产妇200例,随机分成两组,孕妇进入临产时,观察组予双管输液,予缩宫素2.5U+5%葡萄糖注射液静滴,另一静脉通路5%葡萄糖注射液250 mL+间苯三120 mg静滴;对照组仅予缩宫素2.5U+5%葡萄糖注射液静滴。比较两组产妇各产程时间、分娩方式、新生儿情况、产后出血量。结果 观察组第一产程、第二产程、第三产程时间均短于对照组(P＜0.01),剖宫产率3%及新生儿窒息率3%均低于对照组21%,和13%;P＜0.01;产后2小时出血量较对照组少(109.38±16.13)mL vs(185.00±30.71)mL, P＜0.01。结论 临产孕妇联合间苯三酚与缩宫素,可缩短产程,降低剖宫产率,降低新生儿窒息发生率,减少产后出血量,推荐基层医院使用。

Objective To investigate the effect of oxytocin combined with phloroglucinol in childbirth in primary hospital. Methods A total of 200 primiparas admitted to department of obstetrics in Gaoming people's hospital from August 2013 to October 2014　were selected as study subjects. The cases were randomly divided into observation group (100 cases) and control group (100 cases). In labor, cases in control group were given oxytocin 2.5 U and 5% glucose injection 500 mL, and were given 5% glucose injection 250 mL and phloroglucinol 120 mg by double tube intravenous infusion. Cases in observation group were only given oxytocin 2.5 U and 5% glucose injection 500 mL intravenous infusion. The duration of delivery、delivery mode、the condition of newborn and volume of bleeding after labor were compared between two groups. Results For the first、second and third stages of labor, duration of delivery in observation group were significantly shorter than that in control group (P＜0.01), Both cesarean delivery rate [3%(3/100)] and the incidence of neonatal asphyxia[3%(3/100)] in observation group were significantly lower than that in control group 21%(21/100)and 13%(13/100;P＜0.01). The volume of bleeding during two hours after labor in observation group was less than that in control group (109.38±16.13)mL vs 185.00±30.71 mL, P＜0.01. Conclusion In the stages of labor, the use of oxytocin combined with phloroglucinol can shorten the duration of delivery, reduce the cesarean delivery rate and the incidence of neonatal asphyxia and reduce the volume of bleeding after labor. It is worth recommending to use in primary hospital.

目的 比较肺炎支原体肺炎(MPP)、非MPP患儿和健康儿童的免疫球蛋白、补体水平,以探讨儿童MPP体液免疫指标的变化规律。方法 分别检测52例MPP、55例非MPP患儿和33例健康儿童的血清免疫球蛋白(IgG、IgA、IgM)、补体(C3、C4),并比较儿童MPP急性期和恢复早期体液免疫指标。结果 MPP组急性期血清IgM、C3、C4水平高于非MPP组急性期和健康儿童(P<0.05)。儿童MPP恢复早期IgM水平高于急性期,C4水平低于急性期(P<0.05)。结论 与非MPP和健康儿童比较,MPP患儿存在明显体液免疫功能紊乱,从急性期到恢复早期,血清IgM逐渐升高,补体C4先升高后降低,自身免疫反应可能参与了儿童MPP的发病过程。

Objective To investigate the changes of serum immunoglobulins and complement in children with mycoplasma pneumoniae pneumonia (MPP). Methods 52 children with MPP, 55 children with non-MPP and 33 healthy children were enrolled. The levels of serum immunoglobulins (IgG, IgA and IgM) and complements (C3, C4) were detected. Results Compared with the non-MPP group and healthy control, the levels of IgM, C3 and C4 in MPP group during their acute phase were significantly higher (P<0.05). And among the MPP group the levels of IgM were hisher and C4 were lower than that in the acute phase. Conclusion Immune function disturbance exists in children with MPP. From acute to recovery stage, the level of IgM increased while C4 increased firstly and then decreased. Immune injury may be involved in the pathophysiology of childhood MPP.

目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.

目的 分析呼吸康复治疗对农村地区慢性阻塞性肺疾病(COPD)稳定期患者BODE评分系统的影响。方法 将我院收治的60例COPD稳定期患者作为研究对象,随机分为对照组与观察组,每组30例。对照组常规治疗,观察组则给予呼吸康复治疗方案。比较两组患者治疗前后BOBE评分系统的变化。结果 治疗后,观察组BMI、FEV1%、MMRC分级、6MWD分别为(22.4±1.1)kg/m²,(68.6±3.6)%,(1.3±0.2)级,(256.3±36.3)m,BODE指数评分降低至(3.4±1.0)分,ADL为(78.2±6.4)分,QOL为(67.8±2.6)分,与对照组相比差异有统计学意义(P<0.05);且观察组炎性因子水平下降幅度高于对照组(P<0.05)。结论 在农村地区COPD稳定期患者的临床治疗中,采用呼吸康复治疗方案,患者BODE评分系统指标改善显著,值得推广。

Objective To analyze the influence of respiratory rehabilitation treatment on BODE coring system of patients with chronic obstructive pulmonary disease (COPD) in stable phase in rural areas. Methods 60 patients with COPD in stable phase admitted into the hospital were selected as the research object and were randomly divided into control group and observation group with 30 cases in each. The control group received conventional treatment while the observation group received respiratory rehabilitation treatment. The changes of BOBE coring system in the two groups before and after the treatment were compared. Results After the treatment, BMI, FEV1% MMRC classification and 6MWD of the observation group were (22.4±1.1) kg/m², (68.6±3.6)%, (1.3±0.2) and (256.3±36.3) m respectively. The BODE index score decreased to (3.4±1.0), ADL (78.2±6.4), and QOL (67.8 + 2.6).compared with those of the control group, the difference was statistically significant (P< 0.05). And the decline level of inflammatory factors in the observation group was significantly higher than that of the control group (P<0.05). Conclusion In the clinical treatment of patients with COPD in stable phase in rural areas, respiratory rehabilitation treatment were adopted, the improvement of BOBE coring system indexes is significant. It is worthy to be popularized.

目的 回顾性分析采用内镜下氩离子凝固术治疗胃出血的治疗效果,为临床治疗胃出血提供经验及理论基础。方法 选取2010年1月—2014年7月我院收治的胃出血患者199例,随机分为两组,分别对其进行内镜下氩离子凝固术治疗和内镜下高频电凝治疗,总结对比其治疗效果,并对其并发症情况进行统计。结果 经治疗后,A组28例胃黏膜溃烂出血患者未再出血27例(96.43%),E组22例胃黏膜溃烂出血患者未再出血例数17例(77.27%),差异有统计学意义(P<0.05);A组治疗后形成局部炎性肉芽肿及发生胃穿孔的百分比低于E组,差异有统计学意义(P<0.05)。结论 采用内镜下氩离子凝固术治疗胃出血,止血率高,并发症发生率低,效果良好,值得在临床中推广使用。

Objective A retrospective analysis was performed using endoscopic argon plasma coagulation treatment of stomach bleeding, to provide experience and theoretical basis for the clinical treatment of stomach bleeding. Methods January 2010-July 2014 199 cases of bleeding in patients admitted to our hospital.They were randomly divided into two groups and had therapeutic endoscopic argon plasma coagulation. We summarized the treatment effect and its complications statistics. Results After therapy, 27 gastric mucosa fester patients(96.43%) of 28 patients in group A stopped bleeding and 17 gastric mucosa fester patients(77.27%) of 22 patients in group B stopped bleeding and the difference is statistical significance(P<0.05), and the incidence rate of inflammatory granuloma and gastric perforation of group A is significant lower than that of group B (P<0.05). Conclusion Endoscopic argon plasma coagulation therapy is taken to treat gastrorrhagia, hemostasis rate is higher and complication rate is lower. It is worth widely using in the clinic.

目的 对兰索拉唑肠溶片联合氟哌噻吨美利曲辛治疗焦虑糜烂性胃炎患者的治疗效果进行研究。方法 选取2013年1月—2015年1月在我院收治的伴有焦虑情绪的糜烂性胃炎患者106例。随机分为对照组,给予兰索拉唑肠溶片治疗,观察组,给予兰索拉唑肠溶片联合氟哌噻吨美利曲辛治疗,并且对疗效进行比较。结果 治疗前,两组患者在腹痛、腹胀、反酸、嗳气以及黏膜糜烂各指标评分比较,差异无统计学意义(P>0.05);治疗后,2组患者以上指标均有所改善,并且观察组患者同期指标改善均优于对照组(P<0.05);治疗前,两组患者胃黏膜中PGE2和MDA含量无差异(P>0.05);治疗后,两组患者的PGE2均上升,而MDA则下降,并且观察组患者PGE2含量比对照组高,MDA则比对照组低,差异均有统计学意义(P<0.05);治疗前,两组患者HAMA、HAMD评分差异不明显,无统计学意义(P>0.05);治疗后,两组患者焦虑情况均有所改善,并且观察组患者情绪改善程度优于对照组患者,差异均有统计学意义(P<0.05);观察组不良反应发生率为5.6%,对照组不良反应发生率5.6%,差异无统计学意义,P>0.05。结论 兰索拉唑与氟哌噻吨美利曲辛联合应用有助于改善糜烂性胃炎患者的病情,并且可以缓解患者的焦虑情绪,安全性高,值得临床推广。

Objective To observe the clinical efficacy of lansoprazole enteric-coated tablets combined with flupentixol-melitracen in treating anxiety patients with erosive gastritis. Methods 106 patients with erosive gastritis and anxiety in our hospital from January 2013 to January 2015 were divided into an observation group and a control group, with 53 patients in each group. The control group was given lansoprazole enteric-coated tablets alone, and the observation group was treated with lansoprazole enteric-coated tablets and flupentixol-melitracen. Clinical symptoms and mucosal erosion were compared between the two groups of patients before and after treatment. Gastric mucosa malondialdehyde (MDA) and prostration E2 (PGE2) contents, anxiety and depression status were also assessed. Results After treatment, the scores of abdominal pain, bloating, acid reflux, belching, and mucosal erosions were significantly lower in the observation group than in the control group (P< 0.05). PGE2and MDA contents in the gastric mucosa in the observation group were different from those in the control group(P< 0.05). HAMA and HAMD scores were lower in the observation group than in the control group (P< 0.05). There was no difference of adverse reaction rate between the control group and the observation group (P>0.05). Conclusion Lansoprazole enteric-coated tablets combined with flupentixol-melitracen has better clinical efficacy than lansoprazole enteric-coated tablets only in patients with erosive gastritis and anxiety in terms of the improvement of clinical symptoms and mucosal erosion and the relief of negative emotions.

目的 探讨GDM孕早、中期脂肪细胞因子Chemerin、RBP4水平的变化。方法 采用前瞻性研究,测定38例GDM及40例正常孕妇孕早、中期血清Chemerin、RBP4水平,分析其与胰岛素抵抗的相关性。结果 GDM组孕妇孕早、中期血清Chemerin、RBP4水平及HOMA-IR均较对照组升高,差异有统计学意义(P<0.05);两组孕妇孕中期血清Chemerin、RBP4水平均较孕早期升高,差异有统计学意义 (P<0.05);Chemerin、RBP4水平与IR成正相关,差异有统计学意义(P<0.05)。结论 GDM孕妇孕早、中期脂肪细胞因子Chemerin、RBP4水平升高,Chemerin、RBP4水平的升高与IR有一定相关性。

Objective To discuss the serum levels of the Adipokine Chemerin、RBP4 of Gestational Diabetes Mellitus(GDM) in early pregnancy and middle pregnancy. Methods In prospective study, pregnant women, venous blood was collected from 40 controls and 38 GDM during early pregnancy (9-12weeks)and middle pregnancy (22-26weeks). Serum insulin, Chemerin, RBP4 were measured by enzyme-linked immunosorbent assay (ELISA). Results Mean serum levelsof Chemerin and RBP4 were significantly higher among GDM cases compared with controls during early pregnancy and middle pregnancy(P<0.05). In two groups, Mean serum levels of Chemerin and RBP4 in middle pregnancy were significantly higher than those in early pregnancy (P<0.05).During early pregnancy and middle pregnancy, the Chemerin and RBP4 levels were positively related with HOMA-IR (P＜0.05). Conclusion There is evidence of a positive association elevated Chemerin and RBP4 concentration of early pregnancy and middle pregnancy with increased GDM risk.

目的 探讨纵隔髓外造血(EMH)的临床特点,从而为其诊断、治疗提供参考意见。方法 总结分析我科收治的1例双侧后纵隔骨髓外造血组织多发瘤样增生,并对近10年来国内相关文献报道的27例病例进行回顾性分析。结果 患者需行手术活检取得病理诊断,确诊髓外造血。结论 纵隔髓外造血瘤样增生是一种罕见特殊的良性病变, 预后良好。但因其临床表现和影像学均缺乏特异性,当临床中遇到发生在后纵隔脊柱旁的占位性病变,同时患有贫血的患者应考虑EMH 的可能性,给予经皮穿刺或者胸腔镜下活检来取得细胞学诊断,从而避免不必要的手术治疗。

Objective To probe into the clinical features of mediastinal extramedullary hematopoiesis (EMH), for providing a reference for clinical diagnosis and treatment. Methods The clinical data was studied in a case of mediastinal EMH from our department, and 27 case reports from domestic published literatures over the last decade were analyzed retrospectively. Results Of the 27 patients, 15 received surgical excision, while the other 12 underwent needle biopsy. In our patient, the diagnosis of EMH was made by mini thoracotomy and open biopsy. Conclusion Mediastinal EMH is a rare disease and its prognosis is well. Because there is no obvious specific clinical symptoms and imaging appearances, the possibility of EMH should be considered when a patient with a mediastinal tumor associated with anemia is encountered. Diagnosis can be achieved by needle biopsy or video-assisted thoracic surgery (VATS) in order to prevent unnecessary surgical procedures.

目的 建立胎儿左、右肺面积及肺头比的正常参考值范围。方法 对501例正常单胎妊娠12～40周胎儿在标准四腔心切面应用手工描绘法分别描迹左肺、右肺面积,分别除以头围获得左、右肺头比。结果 获得正常妊娠胎儿左、右肺面积及肺头比各孕周参考值范围。胎儿左、右肺面积及肺头比均随孕周的增长而增大。结论 正常妊娠胎儿左、右肺面积及肺头比与孕周呈正相关。不同孕周LHR参考值的建立有利于临床评价膈疝及其他胸腔占位性疾病的预后。

Objective To establish reference intervals for fetal left and right lung areas and lung area to head circumference ratio (LHR). Methods In 501 cases of normal singleton pregnancy between 12 to 40 weeks, the left and right lung areas were measured respectively by ultrasound in the standard four chamber view, using manual tracing of the limits of the lungs. The left and right LHR were calculated when head circumferences were divided by the left and right lung area. Results Normal fetal reference intervals of left and right lung areas and LHR with gestational age were obtained. Fetal left and right lung areas and LHR increased with gestational age. Conclusion Fetal left and right lung areas and LHR values positively correlated with gestational age in normal pregnancy. Normal reference intervals of fetal LHR for every gestational age are valuable for evaluation of prognosis of fetal diaphragmatic hernia and other pulmonary peripheral space-occupying lesions.

目的 目前对于生物反馈发挥治疗作用的机理还未完全研究清楚,该实验借助近似熵(ApEn)这一新型的非线性研究方法,研究在生物反馈过程中心电的变化,从而希望发现生物反馈对心脏功能的潜在影响。方法 总数30人的健康正常受试者纳入研究,其中20人为生物反馈实验组,10人为正常对照组。该实验采用肌电生物反馈作为反馈方法,同时记录心电的变化。实验所得数据采用非线性动力学参数—近似熵(ApEn)进行研究。结果 实验组的平均心率在最后两个生物反馈阶段高于对照组。随着实验进展,实验组的心率标准差逐渐缩小,而心率和心电ApEn明显增高。结论 该实验发现生物反馈能够影响心电生理系统,使得心脏系统变得更加健康,展现出更强的抗应激能力,从而揭示了生物反馈潜在的治疗机理。

Objective The mechanism about biofeedback is not complete clear. Our aim was to study changes of cardiac function (electrophysiology) during biofeedback with the help of approximate entropy (ApEn), and a potential new mechanism about neurofeedback may be detected. Methods A total of 30 healthy volunteers participated in this study which consisted of the neurofeedback group(n=20) and the control group (n=10). We applied electromyogram neurofeedback as the feedback method, and simultaneously recorded electroencephalogram(EEG) and electrocardiogram(ECG). We applied the nonlinear analysis ApEn assess obtained data. Results In the biofeedback group the average of heart rate was higher than that of control group in the last two sessions. As the biofeedback experiment sessions were progressed, the standard deviation of heart rate gradually reduced and the ApEn of ECG increased with statistic significance in the biofeedback group. Conclusion We found that biofeedback can influence cardiac electrophysiological system and make cardiac systems progress healthily and achieve greater ability of anti-stress.