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。

目的 探讨高血压性脑出血在不同时点给药丹参酮ⅡA磺酸钠的疗效分析及对神经保护作用。方法 选取我院2014年10月—2016年10月期间收治的66例高血压性脑出血患者作为研究对象,按照随机数字表的方法分为观察组(n=33)和对照组(n=33),对照组患者于入院后第10天采用丹参酮ⅡA磺酸钠进行治疗,观察组则于入院后第3天采用丹参酮ⅡA磺酸钠进行治疗,分别对2组患者的临床疗效、不良反应、治疗前后的神经功能以及随访一年的脑卒中影响量表(SIS)进行客观比较。结果 经比较,观察组患者的临床总有效率为90.90%,对照组的临床总有效率为69.70%,2组比较,差异有统计学意义(P<0.05);观察组患者的不良反应稍低于对照组,但2组比较差异无统计学意义(P>0.05);此外,观察组患者治疗后的神经功能评分优于对照组和治疗前,差异有统计学意义(P<0.05);在随访一年的时间里发现,观察组患者的SIS量表亦更优于对照组(P<0.05)。结论 早期采用药丹参酮ⅡA磺酸钠治疗高血压性脑出血的临床疗效显著,不良反应相对较小,且在一定程度上发挥了保护患者神经功能的作用,值得推广。

Objective: To investigate the effect of tanshinone II A sulfonate treatment on hypertensive cerebral hemorrhage at different time and the neuroprotective effect. Methods: In our hospital from October 2014 to October 2016 66 cases of hypertensive cerebral hemorrhage patients were enrolled as the research object, according to the random number table method divided into observation group (n=33) and control group (n=33), patients in the control group on the tenth day after admission of sodium tanshinone A sulfonate treatment, The observation group was treated with tanshinone A sodium sulfonate on the third day after admission. The clinical efficacy, adverse reactions, neurological function before and after treatment, and Stroke Scale (SIS) were compared between the two groups. Results: by comparison, the observation group of patients with clinical total efficiency 90.90%, clinical control group in the total efficiency 69.70%, compared with significant difference (P<0.05); to observe the adverse reaction of patients was slightly lower than that of control group, but the difference between the two groups was not statistically significant (P>0.05); in addition, the patients in the observation group the neurological score was significantly better than the control group and before treatment, the difference was significant (P<0.05); Conclusion: the early treatment of sodium tanshinone II A sulfonate in the treatment of hypertensive intracerebral hemorrhage has a significant clinical effect, a relatively small adverse reaction, and to a certain extent, it plays a protective role in patients with neurological function, and is worthy of promotion.

目的 探究血必净联合乌司他丁治疗重症急性胰腺炎的疗效及对血清细胞因子水平的影响。方法 选择2016年2月—2017年3月我院收治的重症急性胰腺炎患者88例,随机将其为两组,各44例。对照组采用乌司他丁治疗,在此基础上给予观察组血必净治疗,比较2组临床疗效、血清细胞因子及药物不良反应。结果 观察组总有效率较对照组高,TNF-α、IL-6、hs-CRP水平较对照组低,差异有统计学意义(P＜0.05);观察组不良反应率略低于对照组,但差异无统计学意义(P＞0.05)。结论 血必净联合乌司他丁可提高重症急性胰腺炎临床疗效,减轻炎性反应,且不增加不良反应率,安全性较高。

目的 观察两种不同剂量的阿托品对右美托咪定心脏窦房结及房室结抑制作用的逆转效果。方法 健康志愿者20名,男12名,女8名,18～30岁。受试者先后给予右美托咪啶(1.5±0.5)μg/kg负荷量,持续泵注量(0.75±0.25)μg/(kg·h)进行试验观察。试验过程中如受试者心率＜(50±5)次/分,房室结前传2∶1小于150次/分的受试者随机进入0.5 mg阿托品剂量拮抗组(A₁),1 mg阿托品剂量拮抗组(A₁),每组10例。与泵注前(T₀),静脉泵注右美托咪定后(50±5)min(T₁),阿托品静脉推注后(10±5)min(T₂)经食道左心房调搏测定窦房结恢复时间(SNRT),校正窦房结恢复时间(CSNRT),房室结前传2∶1点阻滞点和房室结有效不应期(AVNERP)测量。结果 组内比较:泵注右美托咪定后T₁时点与基础值T₀时点比较两组窦房结及房室结功能受到抑制,SNRT 均延长(P<0.05),CSNRT比较无差异(P>0.05),房室结前传2∶1阻滞点降低(P<0.05), AVNERP延长(P<0.05)。阿托品使用后T₂时点的A₁组的各指标及A₂组的AVNERP恢复到基础水平(P>0.05),A₂组的SNRT、CSNRT均较T₀时点缩短(P<0.05),A₂组房室结前传2∶1阻滞点均较T₀时点增高(P<0.05)。组间比较:2组T₀时窦房结及房室结功能各指标比较均无差异(P>0.05),T₂时点A₂组SNRT、AVNERP较A₁缩短(P<0.01),T₂时点A₂组2∶1阻滞点均较A₁组增高(P<0.05)。结论 0.5 mg阿托品能逆转右美托咪定心脏窦房结及房室结抑制作用,1 mg阿托品增进右美托咪定影响下的窦房结及房室结传导功能。

Objective To investigate two different doses atropine make reverse effects on the function of sinus node and the atrioventricular node inhibiting action dexmedetomidine (Dex). Methods 20 healthy volunteers were included in the clinical trials aged 18~30 years (12 male, 8 female). The volunteers were administered with Dex at loading dose 1.5±0.5 μg/kg and then at 0.75±0.25 μg/(kg·h). During the trail, the volunteers who happened the minimal heart rate less than 50±5 bpm, atrioventricular node forward 2∶1 block point less than 150 bpm needed to randomly accept 0.5 mg(group A₁)or 1 mg(group A₂)atropine to antagonize(n=10). SNRT, CSNRT, AVN 2∶1 block point and AVNERP were recorded through TELAP. Results Intra-group comparison indicated functional parameters of SN and AVN were inhibited by Dexsat T₁. SNRT were prolonged (P<0.05), AVN 2∶1 block point were decreased (P<0.05),AVNERP were prolonged at T₁ compared with T₀(P<0.05). All indexes in group A₁ and AVNERP in group A₂ were back to basal level after using atropine at T₂(P<0.05). SNRT, CSNRT were shorted at T₂ compared with T₀ in group A₂(P<0.05). AVN 2∶1 block point had more increased at T₂ compared with T₀ in group A2(P<0.05). Inter-group comparison indicated no significant differences in functional parameters of SN、AVN at T₀(P>0.05). SNRT, AVNERP were shorted at T₂ in group A₂ compared with group A₁. AVN 2∶1 block point were increased at T2 in group A₂ compared with group A₁. Conclusion 0.5 mg atropine may reverse the function of SN and AVN that are inhibited by Dex. 1 mg atropine may increase functions of SN and AVN that are inhibited by Dex.