目的 研究颅内压(ICP)监测联合浮动骨瓣减压术在治疗颅脑损伤中对颅内压及脑血流指标的影响。方法 选取我院2019年3月—2021年3月收治的拟行骨瓣减压术的颅脑损伤患者106例作为研究对象,按照手术方法不同分为对照组(n＝53)、观察组(n＝53)。对照组采用传统去骨瓣减压术(DC)治疗,观察组采用ICP监测联合浮动骨瓣减压术治疗。对比2组ICP、脑血流指标[平均流速(Vm)、收缩期血流速度(Vs)、血管搏动指数(PI)]及并发症发生情况。结果 术后1、3、7 d观察组ICP、PI低于对照组,Vm、Vs高于对照组(P＜0.05);术后观察组并发症总发生率9.43%低于对照组37.74%(P＜0.05)。结论 采用ICP监测联合浮动骨瓣减压术治疗颅脑损伤能降低患者ICP,改善脑血流状态,降低术后并发症,避免二次手术,减轻患者经济负担。

Objective To study the effect of intracranial pressure (ICP) monitoring combined with floating bone flap decompression on intracranial pressure and cerebral blood flow index in the treatment of craniocerebral injury. Methods A total of 106 patients admitted to our hospital from March 2019 to March 2021 were selected as study subjects and divided into control group (n=53) and observation group (n=53).The control group was treated with traditional decompressed craniectomy (DC), and the observation group was treated with ICP monitoring combined with floating bone flap decompression.The ICP, cerebral blood flow index [mean flow velocity (Vm), systolic flow velocity (Vs), vascular pulsatility index (PI)] and complications were compared between the two groups. Results ICP and PI were lower in observation groups on 1,3 and 7 d, Vm and Vs were higher (P <0.05); the incidences of complications in observation group (9.43%), such as electrolyte disorder, pulmonary infection, abnormal renal function and incisional hernia, were lower in the control group (37.74%, P<0.05). Conclusions ICP monitoring combined with floating bone flap decompression could reduce ICP, improve cerebral blood flow, reduce postoperative complications, avoid secondary surgery and reduce economic burden.

目的 分析120例动眼神经麻痹患者的病因及临床特点。方法 收集2019年5月—2021年7月我科收治的120例动眼神经麻痹患者临床资料进行分析,统计所有患者的病因、临床特点、治疗结果。结果 120例患者均急性起病,单眼发病105例(87.50%)、双眼发病15例(12.50%),所有患者均有不同程度的上睑下垂、眼球外下斜视、眼球转动受限、复视,入选患者中年龄构成占比最大的为41~60岁(49例,40.83%);在120例动眼神经麻痹患者中,明确诊断103例(85.83%)、病因诊断未明确17例(14.17%),完全性动眼神经麻痹23例(19.17%)、不完全性动眼神经麻痹97例(80.83%)。病因占比最多的分别是糖尿病18例(15.00%)、动脉瘤16例(13.33%)、脑梗死15例(12.50%);持续治疗3个月后,痊愈者88例(73.33%)、有效者21例(17.50%),无效者11例(9.17%)。结论 动眼神经麻痹的病因以糖尿病、动脉瘤、脑梗死最为常见,临床表现可有不同程度的上睑下垂、眼球外下斜视、眼球转动受限、复视,大多数患者经过积极治疗后可痊愈或好转,在临床中需结合多种诊断技术及原发性疾病进行诊断和治疗。

Objective To analyze the etiology and clinical characteristics of 120 patients with oculomotor nerve paralysis. Methods The clinical data of 120 patients with oculomotor paralysis treated in our department from May 2019 to July 2021 were collected and analyzed, and the etiology, clinical characteristics and treatment results of all patients were summarized. Results All 120 patients had acute onset, 105 cases (87.50%) had monocular onset and 15 cases (12.50%) had binocular onset.All patients had different degrees of ptosis, exophthalmos, hypotropia, limited eye rotation and diplopia.The largest age composition among the selected patients was 41 ~ 60 years old (49 cases, 40.83%).Among 120 patients with oculomotor nerve palsy, 103 cases (85.83%) were clearly diagnosed, 17 cases (14.17%) were not, 23 cases (19.17%) were complete oculomotor nerve palsy and 97 cases (80.83%) were incomplete oculomotor nerve palsy.The most common causes were diabetes mellitus (18 cases, 15%), aneurysms (16 cases, 13.33%), and cerebral infarction (15 cases, 12.50%).After 3 months of continuous treatment, 88 cases (73.33%) were cured, 21 cases (17.50%) were improved and 11 cases (9.17%) had few changes. Conclusions The main causes of oculomotor nerve palsy were diabetes mellitus, aneurysm and cerebral infarction.The clinical manifestations could be varying degrees of ptosis, exophthalmos and strabismus, limited rotation of eyeball and diplopia.Most patients could be cured or improved after treatment.In clinical practice, a variety of diagnostic techniques and primary diseases should be combined to diagnose and treat those patients.

目的 观察达雷妥尤单抗联合来那度胺及地塞米松(DRd)方案巩固治疗序贯达雷妥尤单抗和来那度胺两药维持治疗1例高龄高危初治多发性骨髓瘤患者的疗效、生存时间和不良反应。方法 回顾分析广州市第一人民医院老年病科血液肿瘤科2019年3月收治的1例高龄高危初治多发性骨髓瘤患者的临床资料,并复习相关最新文献。结果 患者应用伊沙佐米、来那度胺和地塞米松方案诱导治疗13疗程后只达到部分缓解的疗效,未能进一步缓解,且不良反应多且严重,后改为DRd方案巩固治疗2疗程后,达到完全缓解,继续使用达雷妥尤单抗联合来那度胺两药维持治疗,不良反应少,至随访结束总生存期和无进展生存期均为35个月。结论 含达雷妥尤单抗方案巩固和维持治疗可能会改善高龄高危初治多发性骨髓瘤患者的预后,延长生存时间,耐受性好。

Objective To observe the efficacy, survival time and adverse reactions of daratumumab combined with lenalidomide and dexamethasone (DRd) in the consolidation treatment of sequential daratumumab and lenalidomide maintenance treatment of an elderly patient with high-risk newly diagnosed multiple myeloma. Methods The clinical data of the elderly patient with newly diagnosed multiple myeloma treated in the Department of Geriatrics, Hematology & Oncology Ward, Guangzhou First People's Hospital in March 2019 were retrospectively analyzed, and the relevant latest literatures were reviewed. Results After 13 courses of induction treatment with isazomib, lenalidomide and dexamethasone, it only achieved partial remission, but failed to further remission, and there were many serious adverse reactions.Later, it was changed to DRd therapy to consolidate treatment.After 2 courses of treatment, it achieved complete remission.After that, we continued to use daratumumab combined with lenalidomide for maintenance treatment, with few adverse reactions.At the time of submission, the overall survival and progression free survival were 35 months. Conclusions Consolidation and maintenance therapy with daratumumab may improve the prognosis, prolong survival time and with good tolerance in elderly patients with high-risk newly diagnosed multiple myeloma.

目的 分析血红蛋白水平对上肢骨折患者深静脉血栓形成(DVT)的影响。方法 采用回顾性分析法,对2018年1月—2021年6月期间来我院进行治疗的386例上肢骨折患者展开研究,依据患者是否发生DVT分为DVT组(n=114)和对照组(n=272)。对2组患者的各项一般资料和临床资料进行比较,对有统计学意义的因素进一步行Logistic多因素回归分析,探究上肢骨折患者发生DVT的危险因素,并Pearson分析血红蛋白水平与各危险因素的相关性。结果 与对照组相比,DVT组患者为女性、年龄＞60岁、体质量指数(BMI)＞25 kg/m²、冠状动脉粥样硬化性心脏病、糖尿病、合并其他骨折、受伤至超声检查时间≥3 d、受伤至手术时间＞5 d、纤维蛋白降解产物(FDP)≥35 mg/L、凝血酶时间(TT)≥17 s、血红蛋白≤120 g/L、血小板计数/血红蛋白比值≥2.5、血糖≥8 mmol/L、全身麻醉、术后住院时间＜7 d的发生率升高,差异有统计学意义(P＜0.05)。Logistic多因素回归分析显示,年龄＞60岁、BMI＞25 kg/m²、受伤至手术时间＞5 d、血红蛋白≤120 g/L、血小板计数/血红蛋白比值≥2.5、血糖≥8 mmol/L是上肢骨折患者发生DVT的危险因素(P＜0.05)。上肢骨折患者的血红蛋白水平与年龄、BMI、受伤至手术时间、血小板计数/血红蛋白比值、血糖水平呈现负相关(P＜0.05)。结论 血红蛋白≤120 g/L是上肢骨折患者发生DVT的危险因素,与DVT的发生存在相关性。

Objective To analyze the influence of hemoglobin level on deep vein thrombosis (DVT) in patients with upper extremity fractures. Methods A retrospective study of 386 upper extremity fracture patients who came to our hospital for treatment from January 2018 to June 2021 was carried out.According to whether the patients had DVT or not, they were divided into DVT group (n=114) and control group (n=272).The general data and clinical data of the two groups were compared, and the statistically significant factors were further analyzed by Logistic multivariate regression analysis to explore the risk factors of DVT in patients with upper limb fractures, and analyzed the hemoglobin level and the risk factors correlation by Pearson. Results Compared with the control group, the DVT group had increased incidence in female, age >60 years old, body mass index (BMI) >25 kg/m², coronary heart disease, diabetes mellitus, other fractures, injury to ultrasonic time ≥3 days, injury to operation time >5 days, fibrin degradation products (FDP) ≥35 mg/L, thrombin time (TT) ≥ 17 s, hemoglobin ≤120 g / L, platelet count / hemoglobin ratio ≥2.5, blood glucose ≥8 mmol/L, general anesthesia and postoperative hospital stay <7 days, and the difference was significant (P<0.05).Logistic multivariate regression analysis showed that age>60, BMI>25 kg/m², time from injury to operation>5 days, hemoglobin≤120 g/L, platelet count/hemoglobin ratio ≥2.5, blood glucose ≥8 mmol/L were the risk factors of DVT in patients with upper extremity fractures (P<0.05).The hemoglobin level of those patients was negatively correlated with age, BMI, time from injury to operation, platelet count/hemoglobin ratio and blood glucose level (P<0.05). Conclusions Hemoglobin ≤120 g/L was a risk factor for DVT in patients with upper extremity fractures, and it was related to the occurrence of DVT.

目的 分析非小细胞肺癌化疗患者骨髓抑制发生状况及其影响因素。方法 回顾性分析2017年2月—2019年8月期间本院进行化疗治疗的80例非小细胞肺癌患者临床资料,统计非小细胞肺癌化疗患者骨髓抑制发生情况,并根据其情况分组;收集所有患者临床资料,分析非小细胞肺癌化疗患者骨髓抑制发生的相关影响因素。结果 80例非小细胞肺癌化疗患者中发生骨髓抑制45例,发生率为56.25%;经单因素及多项Logistic回归分析,年龄≥60岁、化疗方案为紫杉醇联合铂类,TNM分期在Ⅲ-Ⅳ期,发生骨转移是非小细胞肺癌化疗患者发生骨髓抑制的影响因素(OR＞1,P＜0.05)。结论 年龄≥60岁、化疗方案为紫杉醇联合铂类,TNM分期在Ⅲ-Ⅳ期,发生骨转移会增加非小细胞肺癌化疗患者骨髓抑制的发生风险,临床上可据此来制定合理的干预措施,以降低患者骨髓抑制的发生风险。

Objective To analyze the occurrence and influencing factors of bone marrow suppression in patients with non-small cell lung cancer (NSCLC) undergoing chemotherapy. Methods The clinical data of 80 patients with NSCLC who received chemotherapy in our hospital from February 2017 to August 2019 were retrospectively analyzed, the occurrence of bone marrow suppression in patients with NSCLC under chemotherapy was enrolled and grouped according to the situation; the clinical data of all patients were collected, the related influencing factors of bone marrow suppression in patients were analyzed. Results Among 80 cases of patients with NSCLC, 45 cases occurred bone marrow suppression, the incidence was 56.25%; after univariate and multivariate Logistic regression analysis, age ≥ 60 years old, chemotherapy of paclitaxel combined with platinum, TNM stage in stage III -IV, the occurrence of bone metastasis were the influencing factors of bone marrow suppression in patients with NSCLC under chemotherapy (OR>1, P<0.05). Conclusions Age ≥ 60 years old, chemotherapy of paclitaxel combined with platinum, TNM stage in stage III -IV, the occurrence of bone metastasis will increase the risk of bone marrow suppression in patients with NSCLC chemotherapy. Therefore, reasonable intervention measures can be carried out to reduce the risk.

目的 分析基于视觉传达理论的照顾者思维导图教育在宫颈环扎手术患者中的应用效果。方法 选取2018年1月—2020年1月在我院顺利完成宫颈环切手术的116例患者及主要照顾者为研究对象,采用简单随机法将其分为对照组和观察组,各58例。对照组照顾者给予常规健康教育,观察组照顾者给予基于视觉传达理论的照顾者思维导图教育。比较2组主要照顾者干预前后的照顾负担评分和家属照顾能力测量表(FCTI)评分,并比较2组患者干预前后的焦虑、抑郁水平和健康行为评分,比较2组患者的妊娠结局。结果 干预后较干预前2组主要照顾者的各项照顾负担评分、FCTI评分均降低,且观察组较低;干预后较干预前2组患者的焦虑自评量表、抑郁自评量表评分均降低,且观察组较低。干预后2组患者的各项健康行为评分较干预前均升高,且观察组较高,差异有统计学意义(P＜0.05)。观察组患者的流产、感染的发生率低于对照组,观察组患者的足月分娩产的发生率高于对照组,差异有统计学意义(P＜0.05)。结论 宫颈环扎手术患者的主要照顾者采用基于视觉传达理论的照顾者思维导图教育能够有效缓解其照顾负担,提升照顾能力,进而缓解患者的负性情绪,提高其健康行为,改善妊娠结局。

Objective To analyze the application effect of caregiver mind mapping education based on visual communication theory in patients undergoing cervical cerclage. Methods A total of 116 patients who successfully completed cervical cerclage in our hospital and their main caregivers from January 2018 to January 2020 were selected as the research objects.They were divided into control group and observation group by simple random method, with 58 cases in each group.The caregivers in the control group were given routine health education, and those in the observation group were given mind mapping education based on visual communication theory.The scores of care burden and family caregiver task inventory (FCTI score) of the two groups of main caregivers before and after intervention were compared, and the anxiety, depression levels and health behavior score of the two groups before and after the intervention were compared, and the pregnancy outcome of the two groups was also compared. Results After the intervention, the care burden score and FCTI score of the main caregivers of the two groups were lower than those before the intervention, and the observation group was lower; after intervention, the Self-Rating Depression Scale, Self-Rating Anxiety Scale scores of the two groups were lower than those before intervention, and the observation group was lower.The health behavior scores after intervention were higher than that before intervention, and the observation group were higher (P<0.05).The incidence of abortion and infection in the observation group was lower than that in the control group, and the incidence of full-term delivery in the observation group was higher than that in the control group (P<0.05). Conclusions The caregiver mind mapping education based on visual communication theory can effectively alleviate the care burden, improve the care ability, alleviate the negative emotion of patients, improve their health behavior and improve the pregnancy outcome.

目的 探讨低强度体外冲击波联合本体感觉训练治疗双侧颞下颌关节紊乱病的临床疗效。方法 给予1例双侧颞下颌关节紊乱病半年余患者低强度体外冲击波联合本体感觉训练治疗2周,比较治疗前、治疗2周后的最大张口度(MIO)、疼痛压力阈值(PPT)和Fricton颞下颌关节紊乱指数量表 (CMI),并于2个月后随访。结果 经过2周治疗,MIO、PPT和CMI均出现明显改善,2个月后随访未出现反弹,持续改善。结论 低强度体外冲击波联合本体感觉训练治疗颞下颌关节关节紊乱病临床疗效显著。

Objective To investigate the clinical efficacy of low intensity extracorporeal shock wave combined with proprioceptive training in the treatment of bilateral temporomandibular disorders (TMD). Methods A patient with bilateral TMD was treated with low intensity extracorporeal shock wave combined with proprioceptive training for 2 weeks.The maximal interincisal opening (MIO)、pain pressure thresholds (PPT), and Fricton's craniomandibular index (CMI) were compared before and after treatment,and followed up for 2 months. Results After 2 weeks of treatment, MIO, PPT and CMI were significantly improved, and there was no relapse after 2 months of follow-up. Conclusions Low intensity extracorporeal shock wave combined with proprioceptive training was effective in treating TMD.

目的 观察百令胶囊辅助缬沙坦治疗IgA肾病效果及对患者肾功能、细胞免疫调节、尿足细胞标志蛋白的影响。方法 选取2019年5月—2021年5月西部战区总医院肾内科收治经肾活检确诊为IgA肾病,筛选治疗方案中尚未使用激素及免疫抑制剂的80例患者,按住院先后顺序随机分为观察组和对照组,每组各40例。对照组给予缬沙坦治疗,观察组给予百令胶囊辅助缬沙坦治疗,治疗12周后,比较2组的疗效、治疗前后肾功能指标[24 h蛋白尿(24 h Upro)、尿素氮(BUN)、血肌酐(SCr)、尿红细胞(RBC)计数]、1型/2型辅助性T细胞(Th1/Th2)代表细胞因子[γ-干扰素(IFN-γ)、白介素-4(IL-4)]、尿足细胞标志蛋白[尿足萼糖蛋白(PCX)、尿足细胞B7-1分子(B7-1)]水平。结果 治疗12周后,观察组的治疗总有效率为95.0%,高于对照组的82.5%;观察组的24 h Upro、BUN、SCr、尿RBC计数低于对照组,IFN-γ、Th1/Th2低于对照组、IL-4高于对照组,尿PCX、B7-1水平低于对照组;差异均有统计学意义(P<0.05)。结论 百令胶囊辅助缬沙坦治疗IgA肾病患者,可以提高临床疗效,有效保护患者肾功能,调节其免疫状态,减轻肾损伤。

Objective To observe the effects of Bailing capsules assisting valsartan in the treatment of IgA nephropathy and its influence on renal function, cellular immune regulation and urine prodocytes marker protein. Methods From May 2019 to May 2021, 80 patients with IgA nephropathy confirmed by renal biopsy in the Nephrology Department of Western Theatre Command General Hospital, who had not used hormones or immunosuppressants in the treatment were selected.Patients were divided into observation group and control group according to the order of hospitalization, 40 cases in each group.The control group was given valsartan, and the observation group was given Bailing capsules and valsartan.After 12 weeks of treatment, the efficacy, the levels of renal function indexes [24 h proteinuria (24 h Upro), urea nitrogen (BUN), serum creatinine (SCr), urinary red blood cell (RBC) count], type 1/type 2 helper T cells (Th1/Th2) represent cytokines [interferon-γ (IFN-γ), interleukin-4 (IL-4)], urine prodocytes marker protein [urine podocalyxin (PCX), urinary podocyte B7-1 molecule (B7-1)] before and after treatment were compared between the two groups. Results After treatment, the total effective rate in observation group was higher than that in control group (95.0% vs 82.5%).The 24 h Upro, BUN, SCr levels and urine RBC count in observation group were lower than those in control group, IFN-γ and Th1/Th2 levels were lower than those in control group, the IL-4 level was higher than that in control group, and the levels of urine PCX and B7-1 were lower than those in control group.Those differences were statistically significant (P<0.05). Conclusions Bailing capsules assisting valsartan in the treatment of IgA nephropathy can improve clinical efficacy, effectively protect the renal function of patients, regulate the immune status, and alleviate renal injury.

目的 探讨暴露喉返神经的甲状腺手术后患者发生声音嘶哑的原因。方法 选取于2019年1月—2020年12月间在我院接受甲状腺手术且在术中暴露喉返神经的患者,对出现术后声音嘶哑的19例患者进行为期12个月的临床随访,观察研究对象术后声音嘶哑的发生特点、持续时间并进行直接喉镜及颈部超声检查。结果 发生声音嘶哑的19例患者中,5例存在术中喉返神经损伤情况,其余14例患者术中喉返神经暴露及保护良好。直接喉镜检查示,该14例患者中,4例存在声带充血水肿现象,1例发生勺状软骨半脱位。术后1周左右的超声检查显示,该14例患者中有11例存在不同程度的创腔内积液。结论 虽常规暴露喉返神经减少了术后声嘶的发生率,但术中喉返神经损伤仍然是造成患者术后声嘶的原因之一。此外,术后创腔积液、麻醉插管导致的声带损伤及其他插管相关并发症等非直接手术因素也是造成这些患者术后声嘶的重要原因,应引起临床重视。

Objective To explore the cause of hoarseness of voice in patients after thyroidectomy with recurrent laryngeal nerve exposure. Methods The patients from January 2019 to December 2020 underwent thyroidectomy with exposure of recurrent laryngeal nerve during operation were selected. There were 19 cases of hoarseness of voice after operation followed up for 12 months. Postoperative observations included the characteristics of the hoarseness of voice, duration, and direct laryngoscope neck ultrasonography. Results A total of 19 patients had voice hoarseness, only 5 of them had recurrent laryngeal nerve injury during operation, the other 14 patients had good exposure and protection of recurrent laryngeal nerve. Direct laryngoscope showed that 4 of 14 patients had vocal cord edema and 1 had subluxation of arytenoid cartilage. About 1 week after operation, ultrasound examination showed that 11 of 14 patients had varying degrees hydrops of wound cavity. Conclusions Although the routine exposure of recurrent laryngeal nerve reduces the incidence of postoperative hoarseness of voice, the injury of recurrent laryngeal nerve is still a cause of postoperative hoarseness of voice. In addition, non-operative direct factors, such as fluid accumulation in the operative field, vocal cord injury caused by anesthetic intubation and other intubation related complications, are also important reasons for postoperative hoarseness of voice in these patients, which we should pay more attention to.

目的 探索胸部CT值在胸腔积液鉴别诊断的价值。方法 81例胸腔积液患者纳入本研究,胸腔积液分为渗出液、漏出液、恶性胸腔积液及良性胸腔积液。建立平均CT值的ROC曲线,计算曲线下面积。结果 81例胸腔积液患者中59例为渗出液,22例为漏出液;恶性胸腔积液33例,良性胸腔积液48例。渗出液组平均CT值(16.68±6.76)Hu高于漏出液组(5.50±3.42)Hu(P<0.000 1)。ROC曲线分析结果显示,胸腔积液平均CT值对区分渗出液和漏出液具有较高的准确性(曲线下面积为0.944 5)。当最佳界值为≥9.99 Hu时,其敏感度为88.14%,特异度为90.91%;恶性胸腔积液组平均CT值(15.38±7.29)Hu与良性胸腔积液组平均CT值(12.45±8.03)Hu没有差异(P=0.098 1)。结论 在胸腔积液的鉴别诊断过程中,胸部CT的CT值在鉴别漏出液及渗出液中有一定的价值,但尚不能用于鉴别良性及恶性胸腔积液。

Objective To explore the value of chest CT value in the differential diagnosis of pleural effusion. Methods A total of 81 patients with pleural effusion were included in this study, including exudate, transudate, malignant pleural effusion and benign pleural effusion.The ROC curve of average CT value was established and the area under the curve was calculated. Results Among 81 patients with pleural effusion, 59 cases were exudative, 22 cases were transudative, 33 cases were malignant pleural effusion and 48 cases were benign pleural effusion.The mean CT value of the exudate group, (16.68±6.76) Hu, was significantly higher than (5.50±3.42) Hu of the transudate group (P<0.000 1).ROC curve analysis showed that the mean CT value of pleural effusion had high accuracy in distinguishing exudate from transudate (area under the curve was 0.9445).When the cut-off value for exudative effusion was over 9.99 Hu, the sensitivity and specificity were 88.14% and 90.91%, respectively.The mean CT value of malignant pleural effusion group, (15.38±7.29) Hu, was not significantly different from (12.45±8.03) Hu of benign pleural effusion group (P=0.098 1). Conclusions In the differential diagnosis of pleural effusion, the chest CT value can be used to identify transudate and exudate, but not benign and malignant pleural effusion.