目的 观察恩替卡韦治疗e抗原阳性慢性乙型病毒性肝炎慢加急性肝衰竭(CHB-ACLF)的近期疗效及安全性。方法 选择e抗原阳性CHB-ACLF患者60例,均为我院2016年6月—2017年6月收诊,随机分为各30例的治疗组(采用恩替卡韦治疗)与对照组(采用拉米夫定片治疗),连续用药6个月后,对比疗效及安全性差异。结果 治疗6个月后,治疗组的ALB、PTA水平高于对照组,TBIL、ALT水平低于对照组,MELD评分与HBV-DNA定量少于对照组(P＜0.05);治疗后6个月,两组的HBV-DNA转阴率均高于治疗后1、3个月,且治疗组高于对照组(P＜0.05);治疗期间,治疗组患者死亡4例(13.33%),对照组患者死亡6例(20.00%),两组的死亡率比较无统计学意义(P＞0.05)。结论 恩替卡韦分散片是一种安全、有效的抗e抗原阳性CHB-ACLF药物,能有效抑制病毒复制和改善肝功能,促进患者预后转归。

目的 了解医务人员临床工作中血源性职业暴露的情况、暴露后的心理健康状况及其影响因素,采取干预措施,保障医务人员身心健康。方法 对医院2013年1月—2017年12月上报的79例血源性职业暴露者,在1个月内进行现状调查,同时采用自填式问卷症状自评量表(SCL-90)对调查对象进行调查,对其暴露后的心理影响程度进行评估。结果 医务人员在发生血源性职业暴露后其中躯体化因子、人际关系敏感因子、抑郁因子、焦虑因子在职业暴露前后的比较及与未发生职业暴露的医务人员相比较,均有不同程度的提高,差异均有统计学意义(P<0.001)。单因素分析显示影响血源性职业暴露后医务人员的心理健康状况的因素有年龄、职业、工龄、既往发生职业暴露史和患者患传染病种类(P<0.05)。其中年龄在21~25岁年龄的医务人员的得分较高,职业为医生和陪护工人的得分较高,工龄在1~5年的得分较高,既往发生过职业暴露的医务人员得分较高,患者患传染病类型为梅毒及暴露源不明的得分较高。结论 医务人员在发生血源性职业暴露后,其心理健康状态可受到较大影响;工龄、既往发生职业暴露史和患者患传染病种类是医务人员发生血源性职业暴露后心理状况健康的独立影响因素。医院管理者在重视预防及减少职业暴露的同时,更应关注血源性职业暴露后的心理变化,及时提供心理支持和医疗帮助。

目的 总结预防接种认知干预对儿童预防接种效果的影响。方法 对2018年5—9月在东莞企石镇接种百白破疫苗的儿童家属按接种时间顺序分为对照组254名、实验组248名,对照组家属按常规方法进行预防接种,实验组在常规接种基础上,结合不按时接种、延迟接种等问题对幼儿家属开展多种多样的百白破疫苗预防知识、不良反应观察处理、接种注意事项等知识宣教和培训干预,总结两组儿童在按时接种、延迟接种、疫苗接种知识、不良反应表现与处理、接种注意事项知识的掌握、服务满意度等情况。结果 实验组幼儿按时接种率比对照组高,延迟接种率比对照组低,结果有差异(P＜0.05);家属对疫苗接种知识、不良反应表现和处理、接种注意事项等知识的掌握比对照组高,结果有差异(P＜0.05)。结论 实施家属预防接种认知干预管理能提高家属掌握预防接种知识和不良反应护理知识;提高儿童疫苗接种率和及时接种率,提高预防接种服务管理效果。

Objective To summarize the effect of cognitive intervention on children's vaccination. Methods The family members of children vaccinated with DPT vaccine in Qishi Town of Dongguan City from May to September 2018 were divided into control group 254 and experimental group 248 according to the sequence of vaccination time. The family members of control group were vaccinated by routine methods. On the basis of routine vaccination, the experimental group carried out a variety of preventive knowledge and adverse reactions observation of DPT vaccine to the family members of children in combination with the problems of untimely vaccination and delayed vaccination. The knowledge propaganda and training intervention of treatment and vaccination precautions were summarized. The situation of two groups of children in timely vaccination, delayed vaccination, vaccination knowledge, adverse reaction performance and treatment, knowledge of vaccination precautions and service satisfaction were summarized. Results The vaccination rate of children in the experimental group was higher than that in the control group, and the delayed vaccination rate was lower than that in the control group. The results showed statistical difference (P＜0.05). The knowledge of vaccination, adverse reactions, treatment and matters needing attention of family members were higher than that in the control group, and the results showed statistical difference (P＜0.05). Conclusion Implementing cognitive intervention management of family vaccination may improve family members'knowledge of vaccination and nursing of adverse reactions, improve children's vaccination rates and timely vaccination rates, and improve the management effect of vaccination service.

目的 探讨不同中医体质老年糖尿病患者心率变异性与自主神经功能的关系。方法 选取2016年3月—2017年4月在我院治疗的老年糖尿病患者250例,检测各中医体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF、HF、LF/HF以及空腹血糖(FBG)、糖化血红蛋白(HbA1c)。结果 总偏颇体质患者SDNN、SDANN、SDNNI、RMSSD、PNN50%、LF和HF分别为(88.37±10.02)ms、(78.82±9.44)ms、(41.14±11.43)ms、(22.28±6.53)ms、(10.03±4.33)ms、(203.38±78.23)ms²和(122.21±80.03)ms²,低于平和质患者(P＜0.05),而LF/HF为(1.68±0.43),高于平和质患者(P＜0.05);血瘀质患者SDNN、SDANN、SDNNI、RMSSD和PNN50低于气虚质、阴虚质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF、HF低于气虚质、血瘀质、痰湿质、湿热质和其他型患者(P＜0.05);阴虚质患者LF/HF低于气虚质、血瘀质、痰湿质、湿热质患者(P＜0.05);其他型患者SDNN、SDANN、SDNNI、RMSSD、PNN50、LF、HF高于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05),而LF/HF低于气虚质、阴虚质、痰湿质、湿热质患者(P＜0.05);不同中医体质患者FBG、HbA1c比较差异无统计学意义(P＞0.05)。结论 糖尿病患者偏颇体质较平和质患者心率变异性降低,表现为交感神经张力增大,迷走神经张力降低,其平衡协调破坏。

Objective To explore the relationship between heart rate variability and autonomic nervous function in elderly diabetic patients with different constitutions of traditional Chinese medicine. Methods 250 elderly patients with diabetes mellitus in our hospital from March 2016 to April 2017 were selected; the SDANN, SDNNI, RMSSD, PN50%, LF, HF, LF/HF, fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) were measured. Results In patients with general biased constitution, SDANN, SDNNI, RMSSD, PN50%, LF and HF were (88.37±10.02) ms, (78.82±9.44) ms, (41.14±11.43) ms, (22.28±6.53) ms, (10.03 ±4.33) ms, (203.38±78.23) ms² and (122.21±80.03) ms², which were lower than those in patients with plain constitution (P＜0.05), while LF/HF was (1.68±0.43), which was higher than that in patients with plain constitution (P＜0.05); in patients with blood stasis, SDANN, SDNNI, RMSSD and PN50 were lower than those with Qi deficiency, Yin deficiency, phlegm-dampness, damp-heat and other types (P＜0.05); LF and HF in Yin deficiency type patients were lower than those in Qi deficiency type, blood stasis type, phlegm-dampness type, damp-heat type and other types (P＜0.05); LF/HF in Yin deficiency patients was lower than that in Qi deficiency patients, blood stasis patients, phlegm-dampness patients and damp-heat patients (P＜0.05); SDANN, SDNNI, RMSSD, PN50, LF and HF in other types of patients were higher than Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05), while LF/HF was lower than those with Qi deficiency, Yin deficiency, phlegm-dampness and damp-heat (P＜0.05); there was no significant difference in FBG and HbA1c in patients with different constitutions of TCM (P>0.05). Conclusion The heart rate variability of biased constitution patients with diabetes mellitus was lower than that of patients with mild constitution, manifested by increased sympathetic nerve tension, decreased vagal nerve tension and destroyed balance and coordination.

目的 探讨影响初次机采血小板献血者再次捐献的相关因素,为制定机采献血者保留策略提供依据。方法 选择2016年1月1日—2016年12月31日在广州血液中心首次成功捐献机采血小板的13 899例献血者为研究对象,分析每个献血者献血时性别、年龄、文化程度、是否发生献血不良反应与下一年度是否再次捐献机采血小板的相关性。结果 男性献血者再次捐献率(10.68%)高于女性献血者再次捐献率(8.94%),差异有统计学意义(P＜0.01);献血者年龄18～25岁组再次捐献率最高为12.86%,46～60岁组再次捐献率最低为6.46%,差异有统计学意义(P＜0.001);献血者文化程度高中或职中组再次捐献率最高为11.23%,本科或以上组再次捐献率最低为8.94%,差异有统计学意义(P＜0.001);未发生不良反应献血者再次捐献率(10.37%)高于发生不良反应献血者再次捐献率(5.56%),差异有统计学意义(P＜0.01)。结论 男性、年龄较小、文化程度较低和未发生献血不良反应的献血者更愿意返回再次捐献机采血小板,对这部分献血者采取针对性保留措施,有利于建立起一支固定捐献机采血小板的献血者队伍。

Objective To explore the related factors affecting the re-donation of the first apheresis platelet donors, and to provide a basis for the retention strategy. Methods A total of 13 899 blood donors who successfully donated apheresis platelets for the first time in Guangzhou Blood Center from January 1, 2016 to December 31, 2016 were selected as subjects. The correlation among gender, age, education level, adverse reactions of blood donation and whether platelet collection was re-donated in the next year was analyzed. Results Re-donation rate of male blood donors (10.68%) was higher than that of female blood donors (8.94%). The difference was statistically significant (P<0.01). Re-donation rate of blood donors aged 18～25 was the highest 12.86%, and that of 46～60 was the lowest 6.46%. The difference was significant (P<0.001). Re-donation rate of high school or vocational college blood donors was the highest 11.23%. The lowest re-donation rate was 8.94% in the undergraduate group or above, and the difference was statistically significant (P< 0.001). The re-donation rate of donors without adverse reactions (10.37%) was higher than that of donors with adverse reactions (5.56%). The difference was statistically significant (P<0.01). Conclusion Male, younger, less educated and no adverse reactions to blood donation are more willing to return to donate platelet again. Targeting these donors for reserve measure will conducive to the establishment of a fixed platelet donor team.

目的 探讨胸苷激酶1活性检测在胸腔积液鉴别诊断中的敏感度及特异度。方法 回顾性分析诊断明确的肺炎旁胸腔积液、结核性胸腔积液、癌性胸腔积液患者的临床资料,收集并检测三组患者胸腔积液标本中胸苷激酶1活性并进行比较。结果 三组胸腔积液胸苷激酶1含量分别为: 肺炎旁胸腔积液组: (1.18±0.73)pmol/L、结核组活性(1.31±0.64)pmol/L、癌性组(2.07±1.47)pmol/L。统计分析显示癌性组胸苷激酶1含量高于肺炎旁胸腔积液组及结核组,差异有统计学意义,而肺炎旁组与结核组胸苷激酶1含量无统计学差异。在诊断价值分析方面,当胸苷激酶1≥1.28 pmol/L时支持癌性胸腔积液诊断,但是当胸苷激酶1＜1.28 pmol/L时,无法鉴别肺炎旁和结核性胸腔积液。因此,胸苷激酶1对于癌性胸腔积液的诊断价值较好,对肺炎旁胸腔积液和结核性胸腔积液鉴别诊断效能差。临床可考虑与其他指标,如降钙素原、腺苷脱氨酶等指标联合诊断。结论 胸腔积液胸苷激酶1含量在癌性胸腔积液与非癌性胸腔积液的鉴别诊断中有较好诊断价值。

Objective To investigate the of thymidine kinase 1in differential diagnosis of pleural effusion. Methods A retrospective analysis of thymidine kinase1 activity in the parapneumonic pleural effusion and tuberculous pleural effusion and malignant pleural effusion were conducted. Results The thymidine kinase 1 of this three groups are respectively: parapneumonic group (1.18±0.73pmol/L), tuberculosis group (1.31±0.64pmol/L), and cancer group (2.07±1.47pmol/L). It was shown that the activity of thymidine kinase 1 in cancer group was higher than that of inflammation group and tuberculosis group, the difference was statistical significance, but there was no significant difference between parapneumonic group and tuberculosis group. It supported the diagnosis of malignant pleural effusion when thymidine kinase 1 was greater than or equal to 1.28pmol/L, but when the thymidine kinase 1 was less than 1.28pmol/L, it was impossible to distinguish parapneumonic pleural effusion and tuberculous pleural effusion. Therefore, the diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion is well, but the diagnosis efficiency of thymidine kinase 1 in parapneumonic pleural effusion and tuberculous pleural effusion is not well. Conclusion The diagnosis efficiency of thymidine kinase 1 in malignant pleural effusion and non-malignant pleural effusion is well.

目的 对比分析自动弹力线痔疮套扎术(RPH)与外剥内扎术联合治疗及吻合器痔上黏膜环切术(PPH)单独治疗重度混合痔的临床疗效。方法 选取2017年5月—2018年5月我院收治的100例重度混合痔患者,将其随机分为研究组(50例)与对照组(50例)。对照组患者采取PPH治疗,研究组患者采取RPH联合外剥内扎术治疗,对比两组患者治疗效果、手术相关指标,并观察术后肛门功能评分差异。结果 研究组患者的临床疗效高于对照组(P<0.05);手术时间及术中出血量、住院时间两组患者比较,研究组低于对照组(P<0.05)。研究组患者术后干便、气体、稀便、生活方式发生变化、需衬垫等肛门功能评分低于对照组(P<0.05)。结论 RPH与外剥内扎术联合治疗重度混合痔效果优于单独应用PPH治疗,值得临床推广。

Objective To study the efficacy and its influence on anal function of RPH combined with external ligation and internal ligation in the treatment of severe mixed hemorrhoids. Methods 100 patients with severe mixed hemorrhoids admitted to our hospital from May 2017 to May 2018 were selected as research subjects. They were randomly divided into the study group and the control group, 50 cases in each group. The control group was treated with PPH, and the study group was treated with RPH combined with external stripping and internal ligation. The therapeutic effect and operation related indexes of the two groups were compared, and the postoperative anal function scores were observed. Results The clinical efficacy of the study group was higher than that of the control group (P<0.05), and the intraoperative bleeding volume, operation time and hospitalization time of the study group were lower than that of the control group (P<0.05). The anal function scores such as dry stool, gas, dilution, lifestyle changes and padding requirement in the study group were lower than those in the control group (P<0.05). Conclusion RPH combined with external stripping and internal ligation is better than PPH alone in the treatment of severe mixed hemorrhoids.

目的 评估湿化高流量鼻导管通气治疗早产儿呼吸暂停的效果。方法 选取2014年1月—2016年1月在我院新生儿科住院并诊断为呼吸暂停的早产儿64例,随机分为HHFNC组和NCPAP组各32例,2组在氨茶碱治疗失败后分别采用HHFNC和NCPAP 2种无创辅助呼吸支持。观察2组的治疗效果、无创通气时间、总用氧时间、1周内置管率及不良反应发生率。结果 HHFNC组和NCPAP组治疗早产儿呼吸暂停的有效率分别为90%和86%,差异无统计学意义(P＞0.05);2组在无创通气时间、总用氧时间及1周内置管率方面比较无统计学差异(P＞0.05);HHFNC组鼻损伤、喂养不耐受发生率低于NCPAP组,差异有统计学意义(P＜0.05),NEC和ROP发生率比较无统计学意义(P＞0.05)。结论 HHFNC治疗早产儿呼吸暂停的效果与NCPAP相仿,HHFNC可降低早产儿鼻损伤、喂养不耐受发生率,而且并未增加NEC和ROP发生率,临床更适用于早产儿呼吸暂停。

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。