目的 评价阿奇霉素序贯疗法治疗小儿支原体肺炎的临床疗效及药物经济学效果。方法 将我院儿科于2011年3月—2013年8月收治的522例支原体肺炎患儿随机分为静滴组(n=265)和序贯组(n=287),两组均给予阿奇霉素进行疗程为5 d的治疗,静滴组采用静脉滴注的给药方法进行治疗,序贯组采用静脉滴注2 d后口服序贯给药3 d的方法进行治疗,运用药物经济学原理对两种给药方案进行成本－效果分析。结果 静滴组和序贯组的总有效率分别为94.0%(249/265)和92.7%(266/287),两组比较差异无统计学意义(P>0.05),但静滴组的成本高于序贯组(P<0.01);静滴组和序贯组的不良反应发生率分别为34.7%(92/265)和26.9%(76/287),两组比较差异有统计学意义(P<0.05)。结论 采用序贯疗法治疗小儿支原体肺炎符合安全、有效、经济的临床用药原则,值得临床广泛推荐。

Objective To evaluate the clinical efficacy and pharmacoeconomic effect of sequential therapy of azithroycin on treatment of community mycoplasmal pneumonia(MP)in chindren. Methods 522 cases with MP from March 2011 to August 2013 in pediatrics department of our hospital were randomly divided into intravenous-drip group(n=265)and sequential-therapy group(n=287),and both two groups were treated by azithromycin for 5 days.The intravenous-drip group was treated with intravenous drip of azithromycin,and the sequential-therapy group was treated with azithromycin in the way of intravenous drip for 2 days and oral-taken for 3 days.The two treatments were cost-effectiveness analyzed by pharmacoeconomic theory. Results The total efficiency of the sequential-therapy group and intravenous-drip group were 94.0%(249/265)and 92.7%(266/287),respectively.There was no different between the sequential-therapy group and the intravenous-drip group(P<0.05).But the cost in intravenous-drip group was higher than that in sequential-therapy group(P<0.01).The incidence of adverse reaction of the sequential-therapy group and intravenous-drip group were 94.0% 34.7%(92/265)and 26.9%(76/287),respectively.And it was significant different between the two groups(P<0.05). Conclusions The treatment of sequential therapy of azithromycin is safety,effective and economical.And it is worthy to be widely recommended in clinical.

目的 探讨经皮穴位电刺激对脑卒中偏瘫患者下肢功能的影响。方法 41例脑卒中患者随机分为TAES组和安慰刺激组,分别为21例和20例。两组常规治疗相同。TAES组采用KD-2A型经皮神经电刺激治疗仪治疗,刺激部位选择患侧下肢的4个穴位(足三里ST 36、太冲LV 13、阳陵泉GB 34、昆仑BI 60),频率100 Hz,脉宽0.2 ms,强度为患者最大耐受强度为限;安慰刺激组接受治疗的部位时间和疗程与TAES组相同,但每次治疗时没有电流输出。治疗前、治疗2周、治疗3周分别用综合痉挛量表(CSS)评定踝关节痉挛,Fugl-Meyer运动评定量表中下肢部分(FMA)评定下肢运动功能,Berg平衡量表(BBS)评定平衡功能。结果 组内比较:治疗2周和治疗3周后与治疗前比较两组CSS、FMA下肢部分、BBS评分差异有统计学意义(P<0.05);组间比较:治疗2周和3周后,TAES组CSS、FMA、BBS评分优于安慰刺激组,差异有统计学意义(P<0.05)。结论 TAES治疗能减轻脑卒中患者偏瘫下肢痉挛程度和提高平衡功能,改善下肢运动能力。

Objective To investigate the effect of transcutaneous accupoint electrical stimulation(TAES)in enhancing motor and functional recovery of the lower extremity in subjects with stroke. Methods 41 subjects with first stroke were randomly assigned into 2 groups:TAES group and placebo stimulation group.All subjects received the same standard rehabilitation.In the TAES group.Model KD-2A stimulator was applied with 0.2 ms pulses,at 100 Hz within the subject's tolerance level on the 4 acupuncture points(ST 36,LV 3,GB 34,and Bl 60)in the affected lower legs for 60 min,5 days a week for 3 weeks;The time and the course of treatment of the placebo stimulation group was as well as the TAES group's,but no current output for each treatment.All subjects in the 2 groups received standard rehabilitation program.Measurements including composite spasticity score(CSS)for the spasticity of the ankle planter flexors,Fugl-Meyer motor assessment(FMA)for the lower extremity,and Berg Balance Scale(BBS)for balance were recorded before treatment,after 2 and 3 weeks' treatment. Results After 2 and 3 weeks of treatment,the CSS score in the TAES group was significantly lower than the placebo stimulation group(P<0.05)and the FMA score and BBS score in the TAES group was significantly higher than the placebo stimulation group(P<0.05). Conclusion Transcutaneous accupoint electrical stimulation significantly decreased ankle plantar flexor spasticity and improve motor function of the affected lower extremity.

目的 分析复方丹参注射液对轻度子痫前期患者肾功能与妊娠结局的影响。方法 对照组:在1000 mL浓度为5%的葡萄糖注射液中加入60 mL浓度为25%的硫酸镁,每天静滴1次,以连续静滴5 d为一个疗程;观察组:在250 ml浓度为5%的葡萄糖注射液中加入20 mL复方丹参注射液行静脉滴注治疗,每天静滴1次,以连续静滴5 d为一个疗程。结果 观察组的总有效率为96.88%,对照组为78.13%,观察组高于对照组,两组存在差异(P<0.05)。结论 为了有效改善轻度子痫前期患者的妊娠结局及预后,建议在临床中推广使用复方丹参注射液。

Objective The Objective of the investigation was to study how compound danshen injection(CDI)affected the kidney function and pregnant outcomes of patients diagnosed as mild preeclampsia. Methods Samples are randomly divided into two groups:observation group,in which patients were treated with magnesium sulfate,and control group,in which patients were treated with Danshen injection. Results In control group the treatment showed valid effect in 78.13% of the patients,and in observation group the ratio was 96.88%, which was remarkably higher. Conclusion To improve the pregnant outcomes and prognosis of mild preeclampsia,compound danshen injection should be recommended during the clinical practice.

目的 调查盐酸氨溴索对放射性肺损伤中转化生长因子β1(TGF-β1)以及肿瘤坏死因子α(TNF-a)水平的影响。方法 选取共98例在放射治疗局部晚期肺癌患者,随机分为治疗组和对照组。自放疗开始予治疗组中患者盐酸氨溴索口服,剂量60 mg,每天三次,持续应用3个月。然后对两组患者血浆中TGF-β1和TNF-α的水平进行分析。临床症状和病情变化情况采用高分辨率计算机断层扫描进行检测。结果 对照组中TGF-β1水平显著升高(11.8±5.5 ng/mL),而在盐酸氨溴索治疗组中,增加不显著(5.5±2.6 ng/mL,P＜0.001)。同样,对照组中TNF-α的水平也较治疗组中升高,(对照组:5.1±1.3,治疗组:2.6±0.8 ng/mL,P＜0.001)。结论 盐酸氨溴索能有效降低放疗后血浆TGF-β1及TNF-α水平,降低早期出现的放射性肺炎和晚期出现的肺纤维化发生机率,提高治疗效果及患者生活质量。

Objective The aim is to investigate the effect of ambroxol on radiation lung injury and the expression of transforming growth factor β1(TGF-β1),and tumor necrosis factor α(TNF-α)in plasma. Methods Ninety-eight patients with locally advanced lung cancer in radiotherapy were randomized into treatment and control groups.Patients in the treatment group took ambroxol orally at a dosage of 60 mg,three times per day for 3 months from the beginning of radiotherapy.The expression of TGF-β1 and TNF-αin plasma was analyzed.The clinical symptoms and lung diffusing capacity were monitored using high resolving power computed tomography. Results The level of TGF-β1 in the control group was increased(11.8 ± 5.5 ng/mL),whereas in ambroxol-treated patients,the increase was not significant(5.5 ± 2.6 ng/mL,P＜0.001). Radiotherapy-induced elevation of TNF-α levels,seen in control patients,was also abolished after treatment with ambroxol(5.1 ± 1.3 vs 2.6 ± 0.8 ng/mL,P＜0.001). Conclusion Ambroxol can obviously decrease the plasma TGF-β1 and TNF-α levels after radiotherapy,and decrease the chances of early radiation pneumonitis and late pulmonary fibrosis,and improve treatment effect and quality of life of patients.

目的 初步探讨微泡增强的脉冲式超声治疗脾创伤出血的作用机制。方法 14只健康家犬随机分为3组,超声微泡组(MEUS组)6只、单纯超声组(TUS组)4只、单纯微泡组(MB组)4只。开腹切割脾建立脾破裂出血模型,MEUS组用脉冲式超声治疗仪辐照伤口,同时静脉匀速推注微泡;TUS组超声治疗时静脉推注生理盐水;MB组超声治疗仪假照的同时静脉推注微泡。治疗完毕,进行超声造影评价,并送病理组织学检查。结果 MEUS组造影示靶区造影增强缺损或者低灌注,但较粗大血管仍为增强显影。病理组织学见脾窦、微小血管扩张充血、血管周围组织水肿,血小板聚集,微小血管血栓形成。结论 微小血管血栓形成、微血管淤血扩张、周围组织水肿压迫是超声联合微泡治疗脾创伤出血的可能机理。

Objective To investigate the mechanism of haemostatic effect induced by microbubble(MB)enhanced therapeutic ultrasound(TUS)on splenic trauma. Methods 14 healthy dogs were divided into 3 groups.Six animals were treated by microbubble-enhanced therapeutic ultrasound(MEUS),the other eight animals were treated with TUS only group(n=4)and the MB only(n=4)served as the controls.The spleens of all animals were surgically exposed and a 20 mm long,5 mm deep incision was created on the spleens using scalpel.Contrast enhanced ultrasound(CEUS)was performed to assess the blocking effects of splenic circulation.The targeted spleens were harvested for pathological examination. Results A non-enhanced or perfusion defect region was formed within the treated area.The histological results showed splenic sinus hyperemia,microvascular hyperemia,perivascular tissue edema,platelet aggregation and intravascular thrombosis. Conclusion The mechanism of haemostatic effect on splenic trauma by microbubble enhanced ultrasound maybe intravascular thrombosis,microvascular hyperemia and perivascular tissue edema oppression simultaneously.

目的 探讨护理质量持续改进对康复医学科护理质量管理的影响。方法 制定康复医学科护理管理标准,比较改进前后护理专业基本技能评分和护患关系情况评分。结果 经过持续质量改进,康复医学科的护理质量显著提高。基础护理、护理文书和消毒隔离的评分显著提高,与改进前相比较,两组间的差异有统计学意义。护患关系融洽度和患者满意率提高,与改进前相比较,两组间差异有统计学意义;护理纠纷发生率降低,两组间差异有统计学意义。结论 在康复医学科护理管理中引进持续质量改进,可有效地提高护理质量,确保护理安全。

目的 探讨氟康唑治疗复发性外阴阴道假丝酵母菌病的临床效果。方法 选取2013年2月—2013年7月我院接受治疗的复发性外阴阴道假丝酵母菌病患者50例,患者采用口服氟康唑片治疗方式,服用三天,每天一次,每次150 mg,之后每周一次,持续服用6个月,同时配合制霉菌素以及冰硼散阴道上药,观察患者的治疗效果。结果 经过一周的治疗后,患者的临床症状和体征消失,通过镜检发现假丝酵母菌呈阴性。有49例患者在1个月和3个月的复查中没有复发情况,1例出现轻微的外阴不适并复发,1例患者在经过6个月治疗后复发,其假丝酵母菌实验室检查呈阳性。50例患者3个月的复发率为2%,6个月复发率为2%,有3例患者出现轻微的腹胀和恶心等情况。结论 采用氟康唑坚持半年的药物治疗能够提高外阴阴道假丝酵母菌疾病的治愈率并降低复发率,值得广泛推广应用。

目的 探讨综合中医护理措施在无痛人工流产术后调复中的效果。方法 将100例无痛人流病人随机分为观察组和对照组各50例,对照组手术前后予常规护理。观察组在对照组的基础上,采取综合中医护理措施。结果 观察组术后阴道出血量、出血时间、腹痛持续时间等少于对照组,月经按时复潮率高于对照组(P<0.05)。结论 综合中医护理干预对无痛人工流产病人具有良好的调复作用,可以有效地提高患者术后舒适度,促进患者早日康复,值得临床推广应用。

目的 对比观察海桐皮汤熏洗应用于膝骨性关节炎关节镜清理术后的临床疗效。方法 于2012年1月—2014年1月,从我院骨科住院患者中选取因膝骨性关节炎行关节镜清理术病例60例,随机分为两组,对照组术后给予常规康复治疗措施,治疗组在常规康复治疗的基础上于术后2周拆线后配合海桐皮汤熏洗治疗,治疗周期4周。对比两组患者治疗前后的WOMAC评分,分析其疗效差异。结果 两组患者WOMAC评分术后2周比较无差异P＞0.5;治疗4周后,两组患者较术后2周有所降低(P＜0.5),但治疗组疗效优于对照组(P＜0.5)。结论 海桐皮汤熏洗疗法可改善膝骨性关节炎关节镜清理术后膝关节功能,操作简便,成本低廉,无副作用,值得临床推广应用。

目的 探寻改良内眦赘皮、重睑组合手术并观察美学效果。方法 选取40例有内眦赘皮、重睑手术需求的患者,分为对照组和观察组,对照组采用传统内眦赘皮、重睑组合手术,观察组采用改良内眦赘皮、重睑组合手术,比较两组患者满意度、美学效果。结果 对照组患者满意度为60. 0%,观察组患者满意度为95. 0%,观察组患者满意度高于对照组(P<0. 05)。观察组美学效果优于对照组(P<0. 05)。结论 改良内眦赘皮、重睑组合手术能够充分矫正内眦赘皮的异常结构,更好暴露泪阜, 能成形鼻眶窝,使鼻根部具有起伏协调之曲线美感,具有较好美学效果的手术方法之一。