目的 探讨腹腔镜下输卵管积水既往手术史对血清AMH和卵巢储备功能的影响。方法 选择2016年1月—2016年12月期间在中山市博爱医院生殖内分泌科就诊拟行体外受精—胚胎移植术患者,按照既往的输卵管积水的不同处理方式将患者分为腹腔镜下双侧输卵管切除术组(A组,n=52)、腹腔镜下双侧输卵管开窗术组(B组,n=71)、双侧输卵管阻塞或通而不畅而无积水组(C组,n=96),比较各组在促排卵首日AMH、以及AFC、FSH、LH、E2、孕酮的差异,比较各组Gn治疗时间和用量,以及注射HCG日的成熟卵泡数的差异。结果 A组的AMH、LH低于B组和C组(P<0.05),而B组和C组间AMH、LH差异无统计学意义(P>0.05)。A组AFC水平低于C组(P<0.05),而E2水平高于C组(P<0.05)。A组的FSH高于B组和C组(P<0.05),B组和C组间FSH差异无统计学意义(P>0.05)。三组间孕酮差异无统计学意义(P>0.05)。A组的注射HCG日的成熟卵泡数低于B组和C组(P<0.05),而B组和C组间成熟卵泡数差异无统计学意义(P>0.05)。A组Gn用量高于B组和C组(P<0.05),而B组和C组间Gn用量差异无统计学意义(P>0.05)。三组间Gn治疗时间差异无统计学意义(P>0.05)。结论 通过AMH等指标检测,腹腔镜输卵管切除术会降低患者的卵巢储备功能,而开窗术则影响相对较小,对有生育要求的妇女应考虑行输卵管开窗术等方式以保护卵巢功能。

目的 探讨自由体位分娩方式和传统体位分娩方式对产后盆底功能的影响。方法 2015年3月—2016年3月在广州市妇女儿童医疗中心定期产检并分娩单胎初产阴道分娩610例产妇,按分娩方式分为自由体位分娩298例为实验组,传统体位分娩312例为对照组,对两组产妇会阴损伤,产后6～8周筛查盆底肌力,探讨不同体位分娩方式对产后盆底肌力的影响。结果 实验组阴道静息压,阴道收缩压、Ⅰ类肌纤维强度、 Ⅱ类肌纤维强度、阴道收缩持续时间均较对照组有增加,差异性均有统计学意义(P<0.05)。结论 自由体位分娩方式不降低产后盆底肌力,对产后盆底有保护作用。

Objective To analyze the effects of liberal intrapartum postures on the pelvic floor function of postpartum. Methods 610 pregnant women (vaginal delivery,single birth,and head position) were classified and analyzed in Guangzhou Women and Children Medical Center from March 2015 to March 2016. All the pregnant women were mature without pregnancy complications; 298 pregnant women who adopted free posture delivery were selected as observation group,312 pregnant women who adopted traditional posture delivery were selected as control group. We counted the number of perineal injury incidence of the two group,and the pelvic floor strength of the two groups was measured after fetal birth after 6 to 8 weeks. Results We compared the vaginal resting pressure(VRP),vaginal squeezing pressure(VSP),classⅠfiber strength, class Ⅱ fiber strength and the time of vaginal contraction between the two groups. Pelvic floor muscle strength was significantly stronger in the observation group than that in the control group (P<0. 05). Conclusion There is a closely association between the different intrapartum postures and the pelvic floor function of postpartum. Adopting free posture delivery has no adverse impact on pelvic floor function of postpartum, which can protect the function of female pelvic floor.

目的 研究黄连水煎剂对体外建立的金黄色葡萄球菌生物膜(bacterial biofilm,BF)的作用,及黄连水煎剂联合苯唑西林钠对金黄色葡萄球菌作用。方法 由广西医科大学第一附属医院检验科提供金黄色葡萄球菌菌株34134,采用二倍稀释法分别测出黄连水煎剂和苯唑西林钠对金黄色葡萄球菌的最低抑菌浓度(minimum inhibitory concentration MIC),在体外使用腹膜透析管建立金黄色葡萄球菌生物膜模型,加入不同浓度的黄连水煎剂和苯唑西林钠作用3天和7天后,琼脂平板菌落计数法评估细菌粘附腹透管的能力,结晶紫染色法行载体表面BF半定量,银染法快速鉴定BF。结果 黄连水煎剂MIC为16 mg/mL,苯唑西林钠MIC为4 μg/mL,3天BF模型中,1/2MIC黄连水煎剂、1/4MIC黄连水煎剂、1/8MIC黄连水煎剂、1/16MIC黄连水煎剂、1/2MIC苯唑西林钠、1/4MIC苯唑西林钠作用下的金黄色葡萄球菌的菌落计数分别为(39.333 3±3.994 2)×10⁶ CFU/mL、(52.366 7±3.537 8)×10⁶ CFU/mL、(81.266 7±3.341 8)×10⁶ CFU/mL、(90.900 0±2.040 1)×10⁶ CFU/mL、(50.866 7±2.208 6)×10⁶ CFU/mL、(77.666 7±2.880 7)×10⁶ CFU/mL,空白组的菌落计数为(92.033 3±3.890 6)×10⁶ CFU/mL,与空白组相比较,1/2MIC黄连水煎剂,1/4MIC黄连水煎剂、1/8MIC黄连水煎剂、1/2MIC苯唑西林钠、1/4MIC苯唑西林钠的差异有统计学意义(P<0.001),1/16MIC黄连水煎剂与空白组比较,差异无统计学意义(P=0.173)。7天的BF模型中,1/2黄连水煎剂比1/2苯唑西林钠抑制金黄色葡萄球菌生物膜形成的作用更强(P<0.001),结晶紫、银染也得到相似的结果,进一步的研究发现在1/16MIC黄连水煎剂的作用下,加入不同浓度的苯唑西林钠,此时苯唑西林钠的最低抑菌浓度为0.25 μg/mL。结论 黄连水煎剂能抑制金黄色葡萄球菌生物膜的形成,并且在苯唑西林钠联合黄连水煎剂时,能有效地提高苯唑西林钠的疗效,为治疗金黄色葡萄球菌导致的腹膜透析相关性腹膜炎提供新的治疗方案,同时也提高了抗生素的疗效,为临床上减少耐药菌的产生提供了帮助。

Objective To study the effect of Coptis chinensis decoction on bacterial biofilm(BF)in vitro and the effect of Coptis chinensis decoction combined with oxacillin sodium on Staphylococcus aureus. Methods Staphylococcusaureus strain 34 134 was provided by the First Affiliated Hospital of Guangxi Medical University. Using doubling dilution method to measure the minimum inhibitory concentration of Coptis decoction and Oxacillin sodium on Staphylococcus aureus,respectively. In vitro, peritoneal dialysis tube was used to establish Staphylococcus aureus biofilm model after adding different concentrations of Coptis decoction and Oxacillin sodium for 3 days and 7 days, we used Agar plate count method to assess bacterial adhesion on the dialysis tube, crystal violet staining and semi quantitative method to measure the BF of the surface of the carrier and silver staining(light microscopy) rapid identification of BF. Results The MIC of Coptidis decoction was 16 mg/ml, and that of Oxacillin sodium was 4 μg/mL. In the BF model after 3 days, the colony counting of bacteria of 1/2MIC Coptis decoction, 1/4MIC Coptis decoction, 1/8MIC Coptis decoction,1/16MIC Coptis decoction, 1/2MIC Oxacillin sodium,1/4MIC Oxacillin sodium were(39.333 3+3.994 2)×10⁶(52.366 7+3.537 8),CFU/mL×10⁶, CFU/mL×10⁶(81.266 7+3.341 8), CFU/mL(90.900 0+2.040 1)×10⁶,CFU/mL(50.866 7+2.208 6)×10⁶, CFU/mL(77.666 7+2.880 7)×10⁶ CFU/mL, colony counting of blank group was(92.033 3+3.890 6)×10⁶ CFU/mL, respectively. Compared with the blank group, 1/2MIC Coptis decoction, 1/4MIC Coptis decoction,1/8MIC Coptis decoction,1/2MIC Oxacillin sodium,1/4MIC Oxacillin sodium all had differences in statistical significantce(P=0.001), but 1/16MIC Coptis decoction had no statistically significant(P=0.173). In the BF model after 7 days, colony counting bacteria, crystal violet and silver staining showed similar results. Further studies showed that under the effect of 1/16MIC Coptis decoction, the minimum inhibitory concentration of oxacillin sodium was 0.25 μg/mL. Conclusion Coptis decoction could inhibit the formation of Staphylococcus aureus biofilm, and oxacillin sodium combined with Coptidis decoction was effective to improve the curative effect of oxacillin sodium, providing new treatment for peritoneal dialysis related peritonitis that is caused by Staphylococcus aureus improving the efficacy of antibiotics, and providing help for the clinical on reducing the generation of antibiotic resistant bacteria.

目的 初步研究木棉花水提取物抗炎镇痛作用。方法 采用二甲苯和醋酸作为致炎和致痛因子,通过小鼠耳廓肿胀实验、腹腔毛细血管通透性实验与扭体实验,考察灌胃高、中、低剂量的木棉花水提取物的抗炎、镇痛作用。结果 小鼠对于木棉花水提取物的最大耐受量为300 g/kg;木棉花水提取物高剂量(150 g/kg)和中剂量(100 g/kg)均能抑制小鼠耳廓肿胀,降低小鼠腹腔血管通透性;木棉花水提取液各剂量组均能有效地减少小鼠的扭体次数,且作用随剂量增加而增强。结论 木棉花水提取物具有抗炎镇痛作用。

Objective To study the anti-inflammatory and analgesic effect of water extract of Bombax malabaricum DC. Flower. Methods The xylene and acetic acid were used as inflammation and pain factors. The auricle swelling test,intraperitoneal capillary permeability test and writhing experiment were performed to study the anti-inflammatory and analgesic effect with high,medium and low dose of water extract of Bombax malabaricum DC. Flower. Results The maximum tolerated dose of mice for Bombax malabaricum DC. Flower was 300 g/kg. High dose (150 g/kg) and medium dose (100 g/kg) of water extract of Bombax malabaricum DC. Flower could both inhibit mouse auricle swelling and reduce mouse peritoneal vascular permeability. All dosages of the water extract of Bombax malabaricum DC. Flower were effective in reducing the number of writhing in mice,and the effect is strengthened with the increase of dosage. Conclusion Water extract of Bombax malabaricum DC. Flower has anti-inflammatory and analgesic effects.

目的 探讨生脉注射液联合环磷腺苷治疗慢性心力衰竭的临床疗效及对其心功能的影响。方法 选择本院2016年3月—2017年4月收治的90例慢性心力衰竭患者,随机将其分为2组,各45例。对照组采用环磷腺苷静脉滴注治疗,在此基础上观察组加用生脉注射液治疗,比较两组临床疗效、心功能及药物不良反应。结果 2个疗程后,观察组总有效率、LVEF、CI及CO水平均较对照组高,差异有统计学意义(P＜0.05);两组治疗期间药物不良反应率相比,差异无统计学意义(P＞0.05)。结论 生脉注射液联合环磷腺苷可提高慢性心力衰竭临床疗效,改善心功能,且用药安全性较高。

目的 分析与比较不同血运重建策略对急性心肌梗死合并多支血管病变患者的疗效,以探讨其临床价值。方法 选取本院在2012年8月—2015年8月期间收治的急性心肌梗死合并多支血管病变患者,对每个患者均成功行PCI后,按随机数字表法分为实验组与对照组,实验组于发病后7～10天行预防性急诊PCI,并对非梗死相关血管病变进行干预;对照组则根据患者的缺血情况对非梗死相关血管病变行急诊PCI。随访2年,并记录2组患者主要心脏不良事件、其它心血管事件以及再次急诊PCI情况。结果 共有450例患者完成2年的随访,实验组患者有226例,对照组患者有224例。2组患者的全因病死率(χ²=7.040,P=0.008)、心脏不良事件(P均>0.05)以及心力衰竭发生率(χ²=1. 527,P=0.217)均无统计学差异。与对照组相比,实验组再发心绞痛(χ²=21.092,P<0.001)、心因性再住院(χ²=22.893,P<0.001)和再次支架治疗(χ²=17.835,P<0.001)的发生率均明显较低,而其相关血管血运重建率较高。且实验组随访2年时,β受体阻滞剂(χ²=7.040,P=0.008)和硝酸酯类药物(χ²=63.889,P<0.001)服用率均明显较高。结论 急性心肌梗死合并多支血管病变患者在成功行急诊干预梗死相关血管后,且预防性干预非梗死相关血管,可使再发心绞痛、再次支架治疗以及心因性再住院的发生率显著降低。

Objective By analyzing and comparing the effects of different revascularization strategies on patients with acute myocardial infarction complicated with multi-vessel disease, to explore its clinical value.Methods Selecting the patients with acute myocardial infarction complicated with multi-vessel disease from August, 2012 to August, 2015 in our hospital (Zhaoqing No.2 People's Hospital), after each patient was successfully treated with PCI, divided them into experimental group and control group by random number table method, the experimental groups were treated with preventive emergency PCI after the onset 7-10 days, and the intervention of non-infarct-related vascular diseases were done;the control groups were treated with emergency PCI for the non-infarct-related vascular diseases according to the patient's lack of blood. Visiting them randomly for 2 years, the main cardiac adverse events, other cardiovascular events and one more emergency PCI situation in the two groups were recorded.Results A total of 450 patients completed two years of follow-up, with 226 patients in the experimental group and 224 patients in the control group. All-cause mortality (χ2=7.040,P=0.008), cardiac adverse events (P> 0.05)and incidence of heart failure (χ2=1. 527,P=0.217) were no statistically significant difference between the two groups. Compared with the control group, the incidence of angina pectoris (χ2=21.092,P<0.001), cardiologic rehospitalization (χ2=22.893,P<0.001)and one more stent treatment (χ2=17.835,P<0.001) of the experimental group was significantly lower, but the revascularization rate was higher of their related blood vessels. And when the experimental group was followed up for 2 years, the taking rate of β-blockers (χ2=7.040,P=0.008) and nitrates (χ2=63.889,P<0.001) was significantly higher.Conclusion After the patients with acute myocardial infarction complicated with multi-vessel disease were successfully treated with emergency PCI to intervene the infarct-related blood vessels, and at the same time the intervention of the non-infarct-related blood vessels were done, the recurrence of angina pectoris, stent treatment and cardiopulmonary rehospitalization was significantly reduced.

目的 了解社区医护人员的心理健康状况,评估心理干预措施效果,找到提高社区医护人员心理健康状况的有效措施。方法 采用《症状自评量表 SCL-90》对社区医护人员的心理健康状况进行基线调查,在干预3、6、9个月时分别进行SCL-90复测,以评估心理干预措施效果;根据《医护人员工作压力测试量表》的调查结果制定有针对性的心理干预措施并适时调整。结果 社区医护人员SCL-90测评总分和躯体化、强迫、人际敏感、焦虑、敌对、恐怖、偏执7个因子得分均高于全国常模水平(P<0.05);经过综合干预,随访期间SCL-90测评总分呈逐步下降趋势,干预6个月时,除人际敏感因子外,SCL-90测评总分及各因子分已趋于正常水平,与全国常模比较差异没有统计学意义(P<0.05)。至9个月时,人际敏感因子得分也恢复至正常水平。结论 社区医护人员心理健康状况低于全国常模水平,进行针对性的综合干预可提高其心理健康水平,实验显示干预时长应不低于6个月。

Objective To understand the mental health status of community health care workers, assess the effect of psychological intervention measures, and find effective measures to improve the mental health status of community health care workers.Methods With the help of Symptom Checklist SCL-90, we firstly carried out baseline survey on community medical staff mental health; then retested that at 3, 6 and 9 months later. Thus, we could assess the effect of psychological intervention. According to the results of the medical staff working pressure test questionnaire, we could develop targeted psychological intervention measures and adopt prompt adjustment.Results Community health care personnel SCL-90 evaluation score and 7 factors scores(physical,forced,interpersonal sensitivity,anxiety,hostility,terror,and paranoia) were higher than the national norm(P<0.05);after comprehensive intervention in the 9 months follow-up,the SCL-90 evaluation score was decreasing gradually.After intervention for 6 months,except for the interpersonal sensitivity factor,SCL-90 total scores and the other factor scores tend to normal levels, to compare the national norm, there was no statistical significance in differences (P<0.05). 9 months later, the scores of interpersonal sensitivity also return to normal levels.Conclusion The mental health status of community health care workers was lower than the national norm,the comprehensive intervention may improve their mental health level, and the experiment showed that the intervention should be no less than 6 months.

目的 研究结肠黑变病(melanosis coli,MC)对结肠息肉的影响。方法 从2014年1月—2017年1月在石河子大学医学院第一附属医院行电子结肠镜的21 708例患者中选取符合条件的522例结肠黑变病患者组成MC组,随机选取569例患者组成非MC组,分析比较2组的一般情况及与结肠息肉的关系,非正态分布的计量资料以中位数表示,采用秩和检验,两组计数资料采用χ²检验。结果 结肠黑变病组年龄中位数为64岁(51～73岁),非结肠黑变病组年龄中位数为54岁(47～64岁),2组性别无统计学差异;MC组、非MC组结肠息肉检出率分别为47.8%和40.2%,P=0.013,差异有统计学意义;在病理类型上2组均为炎性息肉检出率最低,腺瘤性息肉检出率最高分别达 58.0%和51.5%,病理类型无统计学差异;在盲肠及降结肠检出率均很低,多发部位、直肠、乙状结肠检出率相对较高,但差异均无统计学意义;结肠息肉大小集中在0~9 mm范围内,2组所占百分比分别高达92.0%和91.3%,≥20 mm息肉检出率均很低,分别为0.40%,0.44%,息肉大小无统计学差异。结论 MC组息肉检出率高于非MC组,差异有统计学意义;2组结肠息肉病理类型、发病部位、息肉大小差异均无统计学意义。

Objective Studying the effect of melanosis coli (MC) on colonic polyps.Methods This is a reospectively review of patients with electronic colonoscopy in our hospital from January 2014 to January 2017. A total of 522 cases of colorectal melanosis (MC) were composed of MC group, and 569 patients were randomly selected to form a non-mc group. The comparison of basic information between the two groups and the relationship of colon polyp and colon cancer was analyzed.Results The median age of the colon melanosis group was 64 years (51~73 years old), and the median age of the non-colonic melanosis group was 54 years (47 to 64 years old), with no statistically significant differences between the two groups.The detection rate of colon polyps in MC group was 47.8%. The detection rate of colon polyps in non-mc group was 40.2%, P= 0.013, and the difference was statistically significant.The two groups of polyps had the lowest detection rate of inflammatory polyps in pathological types, and the detection rate of adenomatous polyps was up to 58.0% and 51.5% respectively, but there was no statistically significant difference between the two groups. In the cecum, the detection rate of the descending colon was low, and the detection rate of multiple sites, rectum and sigmoid colon was relatively high, but the difference was not statistically significant.The size of colon polyps was concentrated in the range of 0~9 mm, and the percentages of the two groups were as high as 92.0% and 91.3% respectively, while the detection rate of the size being more than 20mm was low, that is 0.40% and 0.44%. But there was no statistical difference between the two groups.Conclusion The detection rate of polyps in MC group was higher than that in non-mc group, and the difference was statistically significant.There was no statistically significant difference between the two groups of colon polyps pathology, pathogenesis, and polyp size.

目的 探讨前列地尔联合依帕司他对糖尿病足患者创面肉芽组织肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白介素-6 (interleukin-6,IL-6)及血管内皮生长因子(vascular endothelial growth factor,VEGF)表达的影响。方法 将90例糖尿病足患者随机分为研究组和对照组,每组45例,对照组予常规治疗,研究组在常规治疗基础上给予前列地尔+依帕司他联合治疗。监测两组患者创面愈合率,患肢足背血流动力学及腓总神经传导速度,创面肉芽组织TNF-α、IL-6、VEGF含量及基因表达变化。结果 治疗后第2、4周研究组较对照组创面愈合率升高,差异有统计学意义(P<0.05);治疗后两组患者足背动脉血流动力学及腓总神经传导速度均有改善,而研究组疗效更明显(P<0.05);治疗后研究组患者创面肉芽组织TNF-α、IL-6含量及基因表达较对照组降低,VEGF含量及基因表达则升高(P<0.05)。结论 前列地尔联合依帕司他联合治疗可改善糖尿病足患者足背动脉血流动力学,促进受损神经功能恢复;降低糖尿病足患者创面肉芽组织TNF-α、IL-6表达,减轻免疫损伤;增加VEGF基因表达,促进血管生成,加速创伤愈合。

Objective To investigate the effects of alprostadil combined with epalrestat on the expression of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in granulation tissue in patients with diabetic foot patients.Methods Totally 90 cases with diabetic foot were randomly divided into study group (45 cases)and control group(45 cases). The control group received conventional treatment for 4 weeks and the study group additionally received combination of alprostadil and epalatone for 4 weeks. The curative rate of wound healing, limb dorsal hemodynamics, peroneal nerve conduction velocity and the levels of TNF-α, IL-6 and VEGF in the granulation tissue of the wound were monitored in the two groups.Results The wound healing rate of the study group was significantly higher than that of the control group at the 2nd and 4th week after treatment (P<0.05). After treatment, the hemodynamics and peroneal nerve conduction velocity were improved (P<0.05). The contents and expressions of TNF-α and IL-6 in the granulation tissue of the treatment group were significantly lower than that of the control group, and the content of VEGF and gene expression were significantly increased in the study group (P<0.05).Conclusion The combination therapy of alprostadil and epalrestat may improve the hemodynamics of dorsalis pedis artery in patients with diabetic foot and promote the recovery of damaged nerve function.Also it may reduce the expression of TNF-α and IL-6 in the granulation tissue of diabetic patients and reduce the immune injury. It promotes angiogenesis and accelerates wound healing by increasing VEGF gene expression.

目的 观察⁹⁹锝-亚甲基二膦酸盐对前列腺癌骨转移患者骨痛、骨质疏松的治疗效果。方法 对76例前列腺癌骨转移患者给予⁹⁹锝-亚甲基二膦酸盐治疗1年(每疗程15 d,每天静滴22 mg,15 d为一个疗程,共12个疗程),比较治疗前及治疗1年后患者骨密度(BMD)值及血清钙、磷、碱性磷酸酶、骨钙素、I型胶原交联羧基末端肽、1,25二羟维生素D3等指标的变化。结果 云克治疗后腰椎(L1-4)及左股骨颈、大转子及小转子骨密度(BMD)值均较治疗前增加(P＜0.05);云克治疗后AKP、ICTP均较治疗前明显下降(P＜0.01)。OC云克治疗后较治疗前增加(P＜0.05)。血钙、血磷、1,25-二羟维生素D3云克治疗后与云克治疗前相比无明显变化,P<0.05。前列腺癌骨转移轻度骨痛组及中度骨痛组治疗1年后骨痛VAS评分明显降低,差异有统计学意义,P＜0.05。重度骨痛组云克治疗前、治疗后VAS评分比较,差异无统计学意义,P<0.05。结论 ⁹⁹锝-亚甲基二膦酸盐在治疗前列腺癌骨转移的骨痛、骨质疏松方面,具有缓解骨痛,促进骨增殖,抑制骨吸收,提高骨密度,防治骨质疏松的作用。