目的 探讨噻托溴铵喷雾剂(能倍乐)对合并有前列腺肥大(BPH)的慢性阻塞性肺疾病急性加重的影响。方法 2017年9月—2019年9月在我院呼吸与危重症医学科的AECOPD的男性患者167例,年龄51～96岁,平均(74.26±7.6)岁。分别为AECOPD组、AECOPD+噻托溴铵喷雾剂治疗组。比较AECOPD合并BPH与能倍乐的关系。结果 AECOPD患者合并有BPH的45人(52.94%),能倍乐治疗合并有BPH的AECOPD患者48人(58.53%),两组比较差异无统计学意义(P＞0.05)。其中,AECOPD患者合并有BPH患者中有10人(11.76%)出现尿频、夜尿多;尿潴留的4人(4.7%);同时口服哈乐和保列治的16人(18.82%);要置尿管导尿的5人(5.8%)。能倍乐治疗AECOPD患者合并有BPH患者中有7人(8.53%)出现尿频、夜尿多;尿潴留的1人(1.21%);同时口服哈乐和保列治的20人(24.39%);要置尿管导尿的3人(3.6%),比较差异均无统计学意义(P＞0.05)。结论 能倍乐不增加合并BPH的COPD患者的急性加重;也不增加治疗BPH的药物使用。能倍乐对于稳定期合并BPH的COPD患者治疗是安全的。

Objective To investigate the effect of Spiriva Respimat on acute exacerbation of COPD with benign prostatic hyperplasia(BPH). Methods The 167 patients who were hospitalized for acute exacerbation of chronic obstructive pulmonary disease (COPD)(aged 51～96 years) with an average age of (74.26±7.6) years and the 82 patients treated with Spiriva Respimat in the department of respiratory and critical care medicine of our hospital from September 2017 to September 2019 were reviewed. In our pilot study, 48 AECOPD patients with BPH patients were enrolled as the treatment group and another 45 similar cases as the control group. In the former group Spiriva Respimat was administered and the control group was not. Results There were 45 patients (52.94%) with BPH in AECOPD group and 48 patients (58.53%) with BPH in Spiriva Respimat group. There was no statistical significance between the two groups (P>0.05). Among them, 10 patients (11.76%) with AECOPD and BPH had frequent urination and night urination, 4 patients (4.7%) of urinary retention, 16 patients (18.82%) who had oral Harnal and Finasteride, 5 patients (5.8%) need catheterization. In the AECOPD patients with BPH treated with Spiriva Respimat, 7 patients (8.53%) had frequent urination and night urination, 1 patient (1.21%) had urinary retention, 20 patients (24.39%) had oral Harnal and Finasteride, and 3 patients (3.6%) were managed through catheterization (P>0.05). Conclusion Spiriva Respimat does not increase the acute exacerbation of COPD patients with BPH, nor does it increase the use of drugs to treat BPH. It is safe to treat COPD patients with BPH in stable stage.

目的 研究我院自拟肿痛消方中药离子导入联合关节镜手术治疗膝骨性关节炎的疗效。方法 将76 例膝骨性关节炎患者分为2组,即肿痛消方离子导入联合关节镜组和单纯关节镜组,在治疗前、后分别对两组患者进行Lysholm膝关节功能评分。结果 肿痛消方联合关节镜手术治疗对膝骨性关节炎的治疗效果有明显的提高,总有效率达到92.11%,高于对照组。结论 肿痛消方联合关节镜手术治疗对膝骨性关节炎具有良好的治疗效果。可明显降低患者的疼痛感,改善膝关节功能,促进骨关节的恢复。

Objective To study the effect of Zhongtongxiao formula combined with arthroscopy in the treatment of knee osteoarthritis. Methods 76 patients with knee osteoarthritis were divided into two groups, namely, the group of Zhongtongxiao square ion-implantation combined with arthroscopy and the group of arthroscopy alone. Lysholm knee function scores were performed on the two groups before and after treatment. Results The therapeutic effects of Zhongtongxiao formula combined with arthroscopic surgery on knee osteoarthritis were improved, the total effective rate was 92.11%, higher than the control group. Conclusion Zhongtongxiao formula combined with arthroscopy has good therapeutic effect on knee osteoarthritis.It can obviously reduce the pain of patients, improve the function of knee joint and promote the recovery of bone and joint.

目的 初步探究针刺数量对小儿脑瘫肌张力及粗大运动功能的影响。方法 选取我院2017年1月—2019年11月接收的脑瘫患儿78例,以随机数表法分组,常规针刺组39例,采用一般治疗加常规针刺穴位;增穴针刺组39例,在常规针刺组治疗基础上增加13个穴位治疗。对比2组患儿三个疗程后的肌张力及粗大运动功能。结果 治疗三个疗程后,常规针刺组肌张力评分稍低于增穴针刺组,粗大运动功能量表(GMFM-88)评分稍低于增穴针刺组,但差异没有统计学意义(P＞0.05)。结论 针刺疗法可以有效辅助脑瘫患儿治疗,但是增多穴位不一定能明显改善患儿肌张力和粗大运动功能。

Objective To explore the effect of acupuncture quantity on muscle tension and gross motor function in children with cerebral palsy. Methods From January 2017 to November 2019, 78 children with cerebral palsy who were treated in our hospital were collected. 78 children with cerebral palsy were randomly divided into two groups. The conventional acupuncture group (39 cases) were treated with general treatment and conventional acupuncture points. And the more-needle acupuncture group (39 cases) were treated with adding another 13 more acupuncture points. Muscle tension and gross motor function were compared between the two groups after three courses of treatment. Results After three courses of treatment, the muscle tension score of the conventional acupuncture group was slightly lower than that of the more-needle acupuncture group, and the gross motor function scale (GMFM-88) score was slightly lower than that of the more-needle acupuncture group, but the difference was not statistically significant (P>0.05). Conclusion Acupuncture therapy can effectively assist the treatment of children with cerebral palsy, but increasing acupoints may not improve the muscle tension and gross motor function of children with cerebral palsy.

目的 总结一个以心脏损害为首发症状的假肥大肌营养不良症家系的遗传学及临床特征。方法 对先证者和家系成员进行临床观察、并收集其血清酶、胸片、心电图、 心脏彩色超声、肌肉组织活检及抗肌萎缩蛋白基因突变检测等结果。结果 先证者及家系成员患者符合假肥大肌营养不良症诊断,但以心脏扩大为首发症状,表现为心肌酶谱异常,心电图异常,心彩超提示扩张型心肌病,同时骨骼肌受累不明显,基因检测提示先证者及家系成员患者携带抗肌萎缩蛋白基因外显子40的无义突变[c.5632C>T, p(Gln1878^*)]。结论 该家系成员患者符合X连锁扩张型心肌病诊断,患者存在新发的抗肌萎缩蛋白基因无义突变。

Objective To summarize the genetic and clinical characteristics of a family with Duchenne muscular dystrophy (DMD) with cardiac damage as the first symptom. Methods The results of clinical observations, laboratory tests, chest radiographs, electromyography, echocardiography, muscle tissue biopsies, and DMD gene mutations were collected. Results Patients with probands and family members met the diagnosis of DMD. However, cardiac enlargement was the first symptom, presenting as abnormal myocardial enzyme spectrum, abnormal electrocardiogram, and dilated cardiomyopathy in echocardiography, while skeletal muscle involvement was not obvious. One nonsense pathogenic mutation c.5632C>T, p(Gln1878^*) of exon 40 in the DMD gene was identified in the patients with probands and family members. Conclusion The patients of this family met the diagnosis of x-linked dilated cardiomyopathy, and a new nonsense pathogenic mutation of DMD gene was identified in this family.

目的 探讨激光心肌血运重建(Transmyocardial Laser revascularization, TMLR)辅助冠状动脉旁路移植术治疗严重冠心病的临床疗效及 11年随访结果。方法 25例严重冠心病患者行不停跳冠状动脉旁路移植术(off-pump coronary artery bypass, OPCAB)并辅以激光心肌血运重建术(TMLR组),回顾性总结了其术前、术中、术后及 11年随访资料,并与同期进行的 95例单纯不停跳冠状动脉旁路移植术(OPCAB组)病人资料进行比较分析。结果 TMLR组在平均远端吻合口数比 OPCAB组少,而手术时间、术后硝普钠用量比OPCAB组多,其他如术后机械通气时间、ICU停留时间、术后住院天数和术后常见并发症,2组之间均无差异;平均 11年随访资料中,胸闷痛、心衰、新出现 ST-T改变发生率、再发急性心梗、再次 PCI处理、LVEF和血管桥闭塞率,2组间无明显区别;死亡率二者之间也没有区别。结论 TMLR术辅助冠状动脉旁路移植术虽然手术时间比较长,血管活性药物应用较多,但术后康复和 11年随访资料显示与单纯 OPCAB术有相似的结果,说明 TMLR术作为冠状动脉旁路移植术的补充,对那些冠脉血管细小且钙化狭窄严重而不适合冠状动脉旁路移植术的冠心病患者是获益的。

Objective To explore and analyze the clinical effect of off-pump coronary artery bypass (OPCAB) combined transmyocardial laser revascularization(TMLR) of severe coronary artery disease and 11 years follow-up. Methods 25 cases with sever coronary artery disease were treated through OPCAB and TMLR, and the clinical data and 11 years follow-up data were summarized and analyzed retrospectively, compared with the data of the patients treated by only OPCAB. Results There were less mean bypass graft numbers in TMLR group than in OPCAB group. Operation time and the amount of sodium nitroprusside in TMLR group were more than that in OPCAB group. But intubation time, ICU stay time, postoperative stay time and postoperative common complications were not different between two groups. 11 years postoperative follow-up results indicated that chest pain, heart disfunction, ST-T alteration, AMI, PCI treatment again, LVEF and bypass graft occlusion rate were not obviously between two groups. Conclusion TMLR combined OPCAB may result in good outcome and improve long term survival.

目的 筛选九头狮子草治疗小鼠细菌性阴道炎的有效部位。方法 采用金黄色葡萄球菌、大肠埃希菌菌悬液注入小鼠阴道建立小鼠细菌性阴道炎动物模型,观察九头狮子草各极性部位对细菌性阴道炎的治疗作用。结果 九头狮子草水提液、石油醚提取部位和70%乙醇提取部位对病原菌转阴率和阴道黏膜炎症的治愈程度均有提高,其中,对金黄色葡萄球菌的转阴率分别为60%、50%、40%,对大肠埃希菌的转阴率分别为80%、70%、50%。结论 九头狮子草石油醚提取部位和70%乙醇提取部位为其治疗细菌性阴道炎的有效部位。

Objective To study the active parts of Peristrophe japonica of vaginitis treatment effect. Methods The bacterial vaginitis model was established by injecting the bacteria of Staphylococcus aureus and Escherichia coli into the vagina of the mice and the treatment effect of each extract of Peristrophe japonica was observed. Results Three drug administration groups (including water extract of Peristrophe japonica, ligarine fraction and 70% ethanol fraction) showed marked treatment effect on the vaginitis models. The effect of water extract of Peristrophe japonica group were stronger than that of the ligarine fraction and 70% ethanol fraction groups. The pathogens seroconversion rates in Staphylococcus aureus were orderly as follows: 60%, 50%, 40%. The pathogens seroconversion rates in Escherichia coli were orderly as follows: 80%, 70%, 50%. Conclusion The ligarine fraction and 70% ethanol fraction of Peristrophe japonica might be the active extracts of curing vaginitis.

目的 探讨血必净注射液对ANP大鼠肠道菌群及肠黏膜屏障功能的影响。方法 40只SD大鼠随机分为空白组、假手术组、ANP组和血必净治疗组(每组10只),空白组不作任何处理,假手术组翻动十二指肠后关腹,ANP组和治疗组用4.5%牛磺胆酸钠溶液胆胰管逆行注射建模,治疗组在建模后经鼠尾静脉注射血必净注射液(3 mL/kg)。24 h后处死大鼠并采样,ELISA法测血AMS、CRP、LPS、TNF-α、IL-6、IL-1β、DAO和D-乳酸等指标,粪菌样本行16SrRNA高通量测序分析,实时定量PCR法检测5种细菌数量,病理检测胰腺和回肠组织,比较各组大鼠的指标。结果 ①ANP组大鼠血AMS升高,CRP、LPS、TNF-α、IL-6、IL-1β、DAO、D-乳酸水平以及胰腺、小肠病理评分均高于空白组和假手术组(P<0.001);②治疗组AMS低于ANP组,血必净可降低上述各种血清指标水平和胰腺、小肠病理评分(P<0.001);③肠道菌群微生态分析显示,血必净可改善ANP大鼠粪菌的丰富度和多样性,缩小与空白组、假手术菌种种类的差异,增加厚壁菌门菌量;治疗组乳酸杆菌、双歧杆菌和普拉梭菌的菌量高于ANP组,肠球菌和大肠埃希的菌量低于ANP组(P<0.001)。结论 血必净可增加ANP大鼠肠道菌群的丰富度和多样性,增加有益菌的含量,减少内毒素和促炎因子释放,改善肠黏膜屏障功能。

Objective To investigate the effect of Xuebijing injection on intestinal flora and intestinal mucosal barrier function in ANP rats. Methods 40 SD rats were randomly divided into blank group, sham operation group, ANP group and Xuebijing treatment group (10 in each group). The sham operation group closed the abdomen after turning the duodenum. The ANP model was established by retrograde injection of 4.5% sodium taurocholate solution into the biliopancreatic duct. Xuebijing injection (3mL/kg) was injected into the tail vein of the rats in the treatment group. 24 hours later, the rats were sacrificed and sampled. AMS, CRP, LPS, TNF-, il-6, il-1, DAO and d-lactic acid were measured by ELISA. The fecal bacteria samples were analyzed by 16SrRNA sequencing technique. Real-time quantitative PCR was used to detect the populations of 5 bacteria in fecal sample. The pathology of pancreas and ileum were examined, and the indexes of rats in each group were compared. Results ①In ANP group, AMS was increased, levels of CRP, LPS, TNF-, il-6, il-1, DAO, d-lactic acid, pancreatic and intestinal pathology scores were higher than those in the blank group and the sham group (P<0.001).②In treatment group,AMS was lower than ANP group, and Xuebijing could reduce the levels of the above factors and scores of pancreatic and intestinal pathology (P<0.001).③ The microecological results of intestinal flora showed that Xuebijing treatment could improve the richness and diversity of fecal bacteria, reduce the difference between Xuebijing group and blank group and sham operation group, and increase the quantity of firmicutes. The amount of Lactobacillus, Bifidobacteria and Clostridium prasei in the Xuebijing group was higher than that in ANP group, while the amount of enterococci and Escherichia coli was lower than that in the ANP group (P<0.001). Conclusion Xuebijing can increase the richness and diversity of intestinal flora, increase the content of beneficial bacteria, reduce the release of endotoxin and pro-inflammatory factors, and improve the intestinal mucosal barrier function in ANP rats.

目的 研究在新型冠状病毒COVID-19疫情期间,政府采取的干预措施对医院检测的流行性感冒(简称流感)阳性率的影响,为制定流感预防措施提供依据,也为间接评价新型冠状病毒的预防效果提供参考。方法 回顾性收集广州市第一人民医院总院2018—2020年年廿三至正月十五期间的流感抗原检测数据,对政府干预前后的流感抗原检测阳性率进行分析比较。结果 在春节前后,2018年和2019年的流感检测阳性率总体上维持稳定。其中,2018年春节前后,流感阳性率在15.6%～46.5%范围内波动,2019年春节前后,流感阳性率在11.9%～30.4%范围内波动。2020年同期的流感阳性率变化曲线与前两年不同,在正月初四前曲线变化较为稳定,维持在20.0%～44.1%范围内。在正月初四后曲线呈现显著下降趋势,在正月十二和正月十五,流感检测阳性率变为0。进一步的分析表明,政府干预对流感阳性率的影响无性别差异,对5～64岁人群效果最佳。结论 当前针对新型冠状病毒COVID-19的政府干预措施能显著降低流感阳性率,预防流感的发生,也为预防同样以呼吸道传播为主的新型冠状病毒的传播提供了间接证据。

Objective The aim of the study was to study the effect of government interventions on the positive rate of influenza detected in Guangzhou First People's Hospital during the outbreak of COVID-19, and to provide a basis to develop prevention measures against influenza and a reference for the indirect evaluation of the preventive effect of COVID-19. Methods Influenza antigen detection data of Guangzhou First People's Hospital were collected retrospectively from 23rd of the 12th lunar month to 15th of the 1st lunar month in 2018—2020, and the positive rates of influenza antigen detection before and after the government intervention were analyzed and compared. Results The positive rates of influenza were generally stable in 2018 and 2019 before and after the Spring Festival, where the positive rate fluctuated in the range of 15.6%～46.5% in 2018, and the positive rate fluctuates in the range of 11.9%～30.4% in 2019. The temporal change of the positive rate in 2020 was different from that of the previous two years. The positive rate curve was relatively stable before the fourth day of the first lunar month, maintaining a range of 20.0%～44.1% in 2020. After the fourth day of the first lunar month, the curve showed a significant downward trend. On the 12th and 15th day of the first lunar month, the positive rate of influenza became 0. Furthermore, the effect of government intervention on the positive rate of influenza showed no gender difference, and the effect was significant for people aged 5～64 years. Conclusion The current government intervention measures against COVID-19 could significantly reduce the positive rate of influenza, prevent the occurrence of influenza, and provide indirect evidence for the prevention of the spread of COVID-19, which was also mainly spread by respiratory tract.

目的 探究尿毒症继发性甲状旁腺功能亢进经甲状旁腺切除术治疗效果及安全性分析。方法 选取2017年6月—2019年5月于我院就诊的90例尿毒症继发性甲状旁腺功能亢进患者为研究对象,随机分为对照组与观察组,两组各45例。均采取同一药物治疗,对照组行次全切除治疗,观察组行甲状旁腺全切除术+前臂移植术。对比分析两组治疗效果、血生化指标及并发症。结果 观察组疗效优于对照组(P<0.05);观察组术后1周、1个月钙、iPTH、磷、钙磷乘积及ALP水平均低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论 甲状旁腺全切除+前臂移植治疗尿毒症继发性甲状旁腺功能亢进疗效显著,并发症风险低,值得推广。

目的 探讨鼻咽癌个案管理模式,并评价临床中运用的效果。方法 回顾性将2017年8月—2018年4月93例新确诊的鼻咽癌患者作为对照组,按鼻咽癌患者的一般护理常规进行护理。2018年5月—2019年8月新确诊的鼻咽癌患者96例为实验组,实施个案管理比较两种方法的临床运用效果。结果 与对照组比,实验组诊断期完成检查时间和首次住院天数短、既定治疗计划完成率和治疗期间复诊依从性高,Ⅳ度骨髓抑制发生率低,差异均有统计学意义(P<0.05)。结论 鼻咽癌个案管理模式可为患者提供全程、连续性、高品质的护理,提高患者复诊依从性、提高治疗计划完成率,提高医疗护理质量,值得临床推广应用。

Objective To explore the case management mode of nasopharyngeal cancer (NPC) and evaluate the effect of clinical application. Methods 93 patients newly diagnosed NPC from August 2017 to April 2018 were used as the control group,and the general nursing routine was followed. 96 patients newly diagnosed NPC from May 2018 to August 2019 were taken as the experimental group,and accepted case management. Results Compared with the control group,the test time of the experimental group was shorter,the first hospital stay was shorter,the completion rate of treatment was higher,the patient's compliance of follow-up during treatment was better,incidence of grade Ⅳ myelosuppression was lower.The difference was statistically significant (P< 0.05). Conclusion The case management mode of NPC may provide seamless and high-quality nursing for NPC patients,improve the completion rate of treatment,improve the patient's compliance of follow-up and improve the quality of medical care,which is worthy of clinical application.