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 探讨钙调磷酸酶结合蛋白1(calcineurin binding protein 1, Cabin1)在肾小管上皮细胞(renal tubular epithelial cells,RTECs)线粒体损伤中的作用机制。方法 采用siRNA干预体外培养RTECs,敲低Cabin1的表达,继而以电镜观察其对RTECs线粒体形态的影响。结果 在对照组和阴性对照组中Cabin1蛋白在RTECs中有高表达,采用siRNA干预RTECs后,Cabin1蛋白的表达量较对照组和阴性对照组降低50%以上(P＜0.05)。对照组与阴性对照组中,线粒体形态规则,呈圆形或椭圆形,线粒体膜完整,线粒体嵴清晰可见。敲低组中,线粒体肿胀,呈长条形或不规则形,线粒体膜、线粒体嵴结构模糊甚至消失。结论 敲低Cabin1引起RTECs的线粒体形态学异常,提示Cabin1是维持RTECs线粒体正常功能的重要分子。

Objective To investigate the role of calcineurin binding protein 1 (Cabin1) in renal tubular epithelial cells (RTECs) mitochondrial dysfunction. Methods Knocked down Cabin1 in RTECs with siRNA, Western bolt was applied to detect the level of Cabin1 protein. The morphology of mitochondria in RTECs were observed under microscopy. Results In control and negative control groups, Cabin1 protein was obviously expressed in RTECs. After knocked down by siRNA, Cabin1 protein expression was decreased (P＜0.05). In Cabin1 knocked down group, mitochondria changed from large and ellipsoid shape to the small, long and irregulars. Morover, mitochondria were swollen and cristae were remarkably dissolved. Conclusion Knocked down Cabin1 induced RTECs mitochondrial dysfunction, which indicates Cabin1 is a crucial factor regulating mitochondrial function.

目的 探讨血必净注射液对SAP大鼠TLR4信号通路介导肠黏膜屏障功能障碍的影响。方法 24只SD大鼠随机分成空白组(n=8)、对照组(n=8)和治疗组(n=8)。对照组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射制备SAP模型,空白组采用等量生理盐水逆行注射。治疗组在造模3 h后经鼠尾静脉注射血必净注射液(3 mL/kg)。三组大鼠造模后观察24 h,然后处死取胰腺和小肠组织送病理检查,采用荧光RT-PCR技术检测TLR4和NF-κB表达水平,采用ELSIA法检测血清TNF-α、IL-6、淀粉酶(AMS)及二胺氧化酶(DAO)水平,比较三组大鼠各项指标。结果 对照组和治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平均高于空白组(P>0.05),治疗组小肠组织TLR4和NF-κB表达以及血清TNF-α、IL-6、AMS及DAO水平低于对照组(P＜0.05)。结论 血必净注射液通过干预SAP大鼠TLR4信号通路,降低小肠组织TLR4和NF-κB的表达,减轻小肠组织的炎症反应,对肠黏膜屏障具有一定的保护作用。

Objective To investigate the effect on intestinal mucosal barrier dysfunction (IBF) of Xuebijing injection mediated by Toll-like receptor 4 (TLR4) signal pathway in rats of severe acute pancreatitis (SAP). Methods 24 Sprague Dawley (SD) rats were randomly divided into Sham group (n=8), control group (n=8) and treatment group (n=8). The SAP model was established by retrograde injection of 4.5% sodium taurocholate into the biliopancreatic duct in control group and treatment group, while control group was injected with the same amount of saline. In treatment group, Xuebijing injection (3 mL/kg) was injected via tail vein after 3h of modeling. All rats were monitored and sacrificed after 24 hours of modeling. Samples of pancreas and intestine were collected for pathologic determination. A fluorescent RT-PCR was used to determine the expression of TLR4 and NF-κB of small intestine. The serum levels of TNF-α, IL-6, amylase (AMS) and diamine oxidase (DAO) were measured by using ELISA. All parameters of three groups were compared. Results The expression of TLR4 and NF-κB of small intestine in control group and treatment group were higher than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). The expression of TLR4 and NF-κB of small intestine in treatment group were lower than it in control group (P<0.05), as well as the serum levels of TNF-α, IL-6, AMS and DAO (P<0.05). Conclusion Xuebijing injection may not only reduce the expression of TLR4 and NF-κB of small intestine, but also alleviate the inflammation reaction of small intestine by interfering with TLR4 signal pathway, which may have a protective effect on intestinal mucosal barrier in SAP rats.

目的 探讨非霍奇金淋巴瘤(NHL)合并HBV感染患者化疗过程中肝功能监测的临床意义。方法 以2014年3月—2016年6月我院21例NHL合并HBV感染患者为研究对象,所有患者采用CHOP方案进行化疗,治疗2~6周期。 分别于化疗前后对患者肝功能进行检查,采用荧光定量PCR法进行乙肝病毒DNA复制情况检测;肝功能出现中重度异常患者进一步测定凝血酶原活动度(PTA)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fb)等,同时对NHL辅助性标志物进行监测,主要包括β₂微球蛋白(β₂-MG)及乳酸脱氢酶(LDH)。结果 随着化疗进行,患者ALT、GLB、胆红素水平逐渐增高(P<0.05),ALB、PA水平逐渐降低(P<0.05);相比于化疗进行2个周期,进行4～6周化疗者肝功能损害率和重症肝炎发生率均升高,差异有统计学意义(P<0.05)。结论 NHL合并HBV感染患者化疗过程中对肝功能监测,有助于防止重症肝炎发生,并降低病死率,具有重要临床意义。

目的 探讨后稳定型全膝关节置换术患者术后股骨后髁偏距变化对早期功能的影响。方法 选取2013年1月—2016年1月我院收治的121例骨关节炎接受单侧后稳定型膝关节置换患者,记录所有患者术前与术后股骨后髁偏距,根据股骨后髁偏距变化情况分为A组(股骨后髁偏距不变或增加)与B组(股骨后髁偏距减小)。对两组患者进行至少12个月的随访,比较其骨关节炎指数评分(WOMAC)、美国膝关节协会评分(KS)、美国膝关节外科学会评分系统(HSS)及膝关节功能之间的差异。结果 术后,2组患者在前髁偏距变化、股骨假体屈曲角、胫骨后倾角、胫骨角方面差异无统计学意义(P＞0.05)。但术后1年A组患者在WOMAC评分、HSS评分和负重主动屈曲范围方面改善优于B组患者,差异有统计学意义(P＜0.05)。结论 重建股骨后髁偏距能够改善后稳定型全膝关节置换术患者术后早期的骨关节炎症状,并提升患者负重位主动屈曲范围,有一定临床价值。

Objective To explore the stabilized total knee arthroplasty effects on early functional changes of condylar offset. Methods 121 cases of posterior stabilized total knee arthroplasty in our hospital from Jan.2013 to Jan.2016 were enrolled in the study. All patients with preoperative and postoperative posterior condylar offset records, according to the changes of femoral condylar offset were divided into A group and B group. The patients in the two groups were followed for at least 12 months, and the differences in the Osteoarthritis Index score (WOMAC), the American Knee association score (KS), HSS score and knee function were compared. Results After surgery, two patients in the anterior condylar offset changes, femoral prosthesis flexion angle, tibial angle, tibial angle difference was not statistically significant (P > 0.05). But after 1 years, the improvement of WOMAC score, HSS score and weight-bearing active flexion range in group A was better than that in group B, the difference was statistically significant (P < 0.05). Conclusions The reconstruction of the posterior condylar offset can improve the stability after total knee arthroplasty in patients with early osteoarthritis symptoms, and enhance the active flexion range of patients with weight-bearing, which has some clinical value.

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 观察控制性减压术对重型颅脑损伤患者神经功能、颅内压及预后的影响。方法 将我院2016年3月—2017年2月治疗的94例重型颅脑损伤患者作为研究对象,入选者均依据随机数表法分为两组,各47例。对照组实施大骨瓣减压术,观察组实施控制性减压术。观察手术前后两组神经功能、颅内压及预后等。结果 术前2组神经行为认知状态检查表(NCSE)评分、颅内压对比,差异无统计学意义(P＞0.05);术后观察组NCSE评分高于对照组,颅内压低于对照组,差异有统计学意义(P＜0.05);2组预后等级相比,观察组优于对照组,差异有统计学意义(P＜0.05)。结论 将控制性减压术应用于重型颅脑损伤患者中降颅内压效果良好,可恢复受损神经功能,提升患者康复效果,改善预后。

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 在糖尿病尿失禁女性患者中使用盆底肌功能训练手册,了解该手册对改善糖尿病女性尿失禁的作用。方法 将260例糖尿病尿失禁患者随机分为观察组、对照组,2组均进行常规盆底肌功能训练,每月提醒患者坚持训练,观察组在此基础上发放盆底肌功能训练手册,指导患者及家属填写方法, 每月检查填写记录情况;在治疗前、后评价2组患者尿失禁改善、观察心理健康改善情况。结果 观察组患者在干预后尿失禁改善、心理健康改善优于对照组。盆底肌功能训练手册准确真实反映患者治疗的落实情况,可督促患者落实治疗,从而提高治疗效果,提高患者生活质量。结论 盆底肌功能训练手册对糖尿病尿失禁患者实用性高,尤其对于记忆力下降的糖尿病患者实用性高。

目的 评估方体定向置管治疗创伤性非功能区硬膜外小血肿的疗效。方法 回顾分析65例创伤性非功能区硬膜外血肿患者,血肿量在15～30 mL。依据治疗方法分为2组,35例对照组患者采用传统药物治疗而30例观察组患者同时采用药物及方体定向置管治疗。对比分析2组患者住院期间血肿清除率及并发症发生率,术后3个月及6个月时再发头痛、焦虑及血肿清除的情况。结果 两组相比,观察组患者血肿清除率(66.7%),高于对照组(25.7%),两组差异有统计学意义,而并发症发生率,两组无统计学差异;3个月后再发头痛、焦虑及硬膜外血肿清除的情况存在显著差异;而6个月后上述情况无显著差异。结论 方体定向置管治疗在不增加患者并发症发生的同时,能在短时间内快速清除硬膜外血肿,降低患者伤后近期头痛、焦虑症状的发生,改善患者近期生活质量,具有一定临床应用的价值。

Objective To evaluate the clinic value the technique of Cuboid stereotactic catheter (TCSC) in the treatment of small-volume traumatic extradural hematoma in non-functional areas.Methods We performed a retrospectively analysis of 65 patients with small-volume(15-30 mL) traumatic extradural hematoma in non-functional areas. All of which were divided into two groups according to the different treatments. 35 cases treated with drugs were control group, while the rest of 30 cases with both drugs and TSCS were treatment group. The complication incidence and hematoma clearance rate in hospitalization time, recurrence rate of headache, anxiety,hematoma clearance rate at 3 and 6 months follow-up were compared between the two groups.Results The hematoma clearance rate in control group and treatment group were 25.7% and 66.7%,respectively. (P=0.001), while the complication rate was no obvious differences. The recurrence rate of headache, anxiety and hematoma clearance rate at 3 months follow-up were different between the two groups. These conditions were not happened at 6 months follow-up.Conclusion TCSC may eliminate the hematoma within a short hospitalization time by avoiding extra complication coincidence, improve the short-term life quality of patients such as relief the symptoms like headache and anxiety in the patients with small-volume(15~30 mL) traumatic extradural hematoma in non-functional areas. Above of results indicates the impact of this technique on neurosurgical practice.