目的 探讨广州地区老年人维生素D水平及其与骨密度、甲状旁腺激素的相关性。方法 收集2016年6月—12月在广州市第一人民医院老年病科就诊的患者。检测25-羟维生素D、甲状旁腺激素、Ⅰ型前胶原氨基端前肽、β-Ⅰ型胶原C端肽、腰椎和髋部骨密度。将患者分为维生素D缺乏组(≤20 ng/mL)、维生素D不足组(20～30 ng/mL)、维生素D充足组(≥30 ng/mL)。结果 ①426例研究对象的平均年龄是(79.77±7.69)岁,25羟维生素D平均值是(20.38±8.20)ng/mL。维生素D缺乏、不足、充足者比例分别是53%(226/426)、34.3%(146/426)、12.7%(54/426)。②25羟维生素D水平随年龄增加而降低。25羟维生素D与股骨颈和全髋骨密度呈正相关(r=0.18,P＜0.001),与甲状旁腺激素呈负相关(r=-2.05,P＜0.001)。结论 广州地区老年人维生素D不足及缺乏十分普遍。维生素D与股骨颈、髋部骨密度呈正相关,与甲状旁腺激素呈负相关。

Objective To investigate the vitamin D level of elder people in Guangzhou and the relationship in vitamin D, bone mineral density and parathyroid hormone. Methods To screening elderly patients in the geriatric department of Guangzhou First peoples Hospital from June to December 2016.Serum 25-hydroxy vitamin D,parathyroid hormone,procollagen typeⅠN-terminal propeptide,β-crosslaps of C-telopeptide of typeⅠcollagen,bone mineral density were measured.Three groups were divided according to the serum 25(OH)D level,including deficiency group(≤20 ng/mL),insufficiency group(20-30 ng/mL) and sufficiency group(≥30 ng/mL). Results The mean age of the 426 subjects was 79.77±7.69 years old. The average level of 25(OH)D was 20.38±8.20 ng/mL. The proportion of vitamin D deficiency, insufficient and sufficient persons were 53% (226/426), 34.3% (146/426), and 12.7% (54/426). The level of 25 hydroxy vitamin D was decreased with age.Correlation analysis showed that 25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density(r=0.18,P＜0.001),was negatively correlated with parathyroid hormone(r=-2.05,P＜0.001). Conclusion Vitamin D deficiency or insufficiency is highly prevalent in elderly men in Guangzhou.25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density, negatively correlated with parathyroid hormone.

目的 分析25羟维生素D[25(OH)D]在新疆汉族及维吾尔族老年男性2型糖尿病(T2DM)合并骨质疏松(OP)患者中的水平及与骨密度(BMD)的相关性。方法 收集住院的汉族、维吾尔族老年男性T2DM患者281例,根据民族及骨密度值将其分为汉族非骨质疏松(NOP)组127人(A组)、汉族骨质疏松(OP)组21人(B组)、维族NOP组103人(C组)、维族OP组30人(D组),记录四组患者的25(OH)D水平并进行比较,分析25(OH)D与BMD的相关性。结果 同一民族中,B组的25(OH)D低于A组(P<0.05),D组的25(OH)D低于C组(P<0.05); T2DM合并OP患者中,D组的25(OH)D低于B组(P<0.05); 相关性分析显示,25(OH)D与BMD呈正相关。结论 维吾尔族老年男性T2DM合并OP患者较汉族患者的25(OH)D水平低,25(OH)D水平低的T2DM患者更易合并OP,25(OH)D检测有助于识别T2DM患者合并OP的风险。

Objective To analysis the level of 25 hydroxy vitamin D[25(OH)D] in Xinjiang Han and Uyghur elderly male patients with T2DM and osteoporosis, and the correlation between 25(OH)D levels and bone mineral density(BMD). Methods We collected 281 cases of T2DM patients from Hans and Uyghurs, divided them into four groups according to the nationality and BMD: Han non-osteoporosis(NOP) group including 127 cases(group A), Han osteoporosis(OP) group 21 cases(group B), Uyghur NOP group 103 cases(group C), Uyghur OP group 30 cases(group D). Recorded and compared their 25(OH)D levels, and analyzed the correlation between 25(OH)D levels and BMD. Results In the same nationality,the level of 25(OH)D in group B were lower than those in group A(P<0.05), and group D were lower than those in group C(P<0.05); In T2DM patients combined with OP, the levels of 25(OH)D in group D were lower than those in group B(P<0.05); Correlation analysis showed that 25(OH)D was positively correlated with BMD. Conclusion The level of 25(OH)D in elderly male patients with T2DM combined with osteoporosis, those of Uyghurs are lower than those of Hans. T2DM patients with lower 25(OH)D level are more likely to combine OP. The 25(OH)D level test may help to identify the risk of combining OP in T2DM patients.

目的 本研究旨在探讨血浆chemerin水平与原发性高血压合并心房颤动的相关性。方法 选择2016年2月—2017年12月期间在广州市第一人民医院心内科及老年心内科住院的高血压患者160例,根据是否合并心房纤颤分为心房纤颤组(AF组,n=72)及非心房纤颤组(NAF组,n=88),另选取140例我院体检中心体检结果正常的正常健康人作为对照组(CON组,n=140)。采用全自动生化检测仪测定甘油三脂、总胆固醇、低密度脂蛋白、C反应蛋白等生化学指标;使用ELISA法检测血浆chemerin水平。结果 AF组患者的血浆chemerin水平较NAF组患者升高[(180.45±15.23)ng/mL vs(162.36±13.44)ng/mL,P<0.05],且均较CON组升高[(142.36±11.83)ng/mL,P<0.05)],多元Logistic回归分析显示血浆chemerin水平与高血压病合并心房纤颤呈独立相关性(OR 1.112, 95% CI 1.023～1.302;P<0.001)。结论 高血浆chemerin水平可能是预测高血压合并心房纤颤的独立危险因素,血清chemerin可能成为一种预测高血压发生心房纤颤的重要生物学标记物。

Objective To explore the relationship between chemerin levels and permanent atrial fibrillation in patients with hypertension. Methods A total of 160 patients with hypertension were enrolled in this study. All the patients were classified as AF(n=72) or NAF(n=88) based on the permanent atrial fibrillation or not. And 140 healthy people were collected as a control group(CON). Triglycerides, total cholesterol, low density lipoprotein cholesterol and C-reactive protein were measured by automatic biochemical detector. Serum chemerin levels were determined by enzyme-linked immunosorbent assay(ELISA). Results Serum chemerin levels were higher in AF patients than those in NAF patients(180.45±15.23 ng/mL vs 162.36±13.44 ng/mL,P<0.05). They were both higher than that of the CON patients(142.36±11.83 ng/mL,P<0.05). Multivariate logistic regression demonstrated that chemerin level was independently associated with the permanent atrial fibrillation in patients with hypertension(OR 1.112, 95% CI 1.023～1.302;P<0.001). Conclusion Serum chemerin is an independent risk factor for permanent atrial fibrillation with hypertension. The results suggest that chemerin might be a useful biomarker for predicting the permanent atrial fibrillation with hypertension.

目的 探讨粪菌移植(FMT)在两种肠镜下盲肠置管术的临床应用。方法 将2016年1月—2017年6月在我院通过肠镜下盲肠置管术进行粪菌移植的200例患者,随机分为A组和B组,各100例。A组采用直接肠镜置管法完成置管,B组采用二次肠镜置管法完成置管,对两组操作的置管成功率、置管时间、平均疼痛评分、并发症等情况进行对比。结果 与A组相比较,B组到达盲肠时间略长但无统计学意义(14.95min vs 15.26min,P=0.68)、疼痛评分低(5.7 vs 4.8,P<0.05)、更低的并发症发生率(6 % vs 23 %,P<0.05)。结论 在粪菌移植内镜下盲肠置管术患者中,采用通过采用二次肠镜置管法与直接肠镜法相比较完成置管手术时间无统计学差异,但置管成功率高、患者的痛苦小、风险低,值得临床推广。

Objective To investigate the clinical application of fecal microbiota transplantation (FMT) in two kinds of colonoscopic cecal catheterization. Methods From January 2016 to June 2017, 200 patients who took colonoscopic cecal catheterization for fecal microbiota transplantation in our hospital were randomly divided into group A and group B, with 100 patients in each group.Group A used direct colonoscopy catheterization to complete catheterization, group B was treated by the second colonoscopy catheterization. The success rate of catheterization, catheterization time, average pain score and complication were compared between the two groups. Results Compared with group A, the time to reach the cecum in group B was slightly longer but not statistically significant (14.95min vs 15.26min,P=0.68). It had lower pain score (5.7 vs 4.8, P<0.05), lower complication rate. Conclusion Among the patients with colonoscopic cecal catheterization for fecal microbiota transplantation, there was no significant difference in the time of catheterization between the second colonoscopy and the direct colonoscopy, but it has the high success rate of catheterization and low pain, low risk, worthy of clinical promotion.

目的 分析KRAS基因突变在左半结肠、右半结肠癌分布几率的差异性。方法 回顾性分析我院病理科分子实验室2015年到2017年间接收的537例结肠癌手术标本,用ARMS-PCR法进行了KRAS基因的检测,并对左右半结肠腺癌KRAS基因突变比例进行χ²检验,P＜0.05为差异有统计学意义。结果 537例中有187(34.82%)例为右半结肠腺癌,左半结肠腺癌有350(65.18%)例。KRAS基因突变检测阳性例数为240例,阳性率为44.69%;右半结肠腺癌KRAS基因突变阳性数为114例,阳性率为60.96%;左半结肠癌KRAS基因突变阳性数为126例,阳性率为36.00%。双侧结肠腺癌KRAS基因突变差异有统计学意义。结论 右半结肠癌的患病例数低于左半结肠癌,右半结肠癌KRAS基因突变阳性率较左半结肠癌高,本研究为区分左右半结肠癌的分子靶向治疗提供了数据支持。

Objective To analyze the differences distribution of KRAS gene mutations in the left hemi colon cancer and right hemi colon cancer. Methods Retrospectively to analyse the 537 colorectal cancer patients who were received by our molecular laboratory of pathology from 2015 to 2017, ARMS-PCR method was used to detect the KRAS gene. The ratio of KRAS gene mutation in left and right hemi colon cancer was tested by χ² test, P<0.05 was considered statistically significant. Results There were 187(34.82%) patients with right hemi colon cancer; and there were 350 (65.18%)patients with left half hemi colon cancer. The KRAS positive patients were 240 cases, which were 44.69% in total. The positive patients with right hemi colon cancer were 114 cases which had a higher rate of 60.96%, the left hemi colon cancer patients were 126 cases with a lower rate of 36.00%. Conclusion The number of right hemi colon cancer was lower than the number of left hemi colon cancer. And the KRAS gene mutation in right hemi colon cancer had more positive than left hemi colon cancer. This study provides a number aid for treating right and left colon cancer in the subsequent molecular targeted drug therapy.

目的 探讨MDS、MDS/AML及原发AML基因突变频谱的异同点及其临床意义。方法 选取98例MDS患者、32例MDS/AML患者及234例原发AML患者为研究对象,利用二代测序技术检测基因突变。结果 MDS组中突变率较高的基因突变为TET2(16.7%,16/96)、U2AF1(12.0%,6/50)、SF3B1(11.8%,9/76);MDS/AML组中突变率较高的基因突变为TP53(33.3%,2/6)、DNMT3A(30%,6/20)、IDH2(21.1%,4/19);原发AML组中突变率较高的基因突变为FLT3-ITD(18.0%,42/233)、NPM1(16.3%,38/233)、DNMT3A(14.9%,14/94)。DNMT3A(P=0.006)、IDH2(P=0.004)及NPM1(P=0.002)等基因突变在MDS与MDS/AML两组间的突变率有统计学差异;FLT3-ITD(P=0.001)、NPM1(P=0.002)、CEBPA(P=0.011)及IDH2(P=0.019)等基因突变在MDS与原发AML两组间的突变率有统计学差异;所有受检基因突变在MDS/AML与原发AML两组间的基因突变的突变率无统计学差异(P＞0.05)。结论 MDS、MDS/AML及原发AML基因突变的突变频谱具有相似性及异质性,从MDS到MDS/AML、原发AML基因突变的变化不仅影响疾病转归及预后而且可帮助鉴别MDS/AML和原发AML。

Objective To explore the similarities and differences of spectrum of gene mutations in patients with myelodysplastic syndrome, MDS/AML and de novo acute myeloid leukemia and their clinical significance. Methods 98 patients with MDS, 32 patients with MDS/AML, 234 patients with de novo AML were selected. Gene mutations were detected by second generation sequencing. Results The most frequent mutations in MDS were as follows:TET2(16.7%, 16/96), U2AF1(12.0%, 6/50), SF3B1(11.8%, 9/76); The most frequent mutations in MDS/AML were TP53(33.3%, 2/6), DNMT3A(30%, 6/20), IDH2 (21.1%, 4/19);The most frequent mutations in de novo AML were FLT3-ITD(18.0%, 42/233), NPM1(16.3%, 38/233), DNMT3A(14.9%, 14/94); DNMT3A(P=0.006),IDH2(P=0.004) and NPM1(P=0.002) were statistical difference between MDS and MDS/AML; FLT3-ITD(P=0.001),NPM1(P=0.002),CEBPA(P=0.011) and IDH2(P=0.019) were statistical difference between MDS and de novo AML;There were no siatistical significance (P>0.05) in the frequency of all detected gene mutations between MDS/AML and AML. Conclusion The spectrum of gene mutation of MDS, MDS/AML and primary AML have similarities and heterogeneity.The changes of gene mutations from MDS to MDS/AML and de novo AML not only affect disease outcome and prognosis, but also help to identify MDS/AML and de novo AML.

目的 急性Stanford A型主动脉夹层(AAAD)患者往往需急诊手术,以挽救其生命。手术通常存在高风险。术后常见并发症包括:神经系统、呼吸系统、胃肠道、肝、肾脏等多器官系统的功能障碍,以及全身感染,其使得术后过程更加复杂。 因此, 围术期护理极为重要。方法 2016年2月—2018年2月, 共完成了24 例 AAAD患者的手术。术前所有病人收治科室ICU。手术方式为Bentall+Sun'氏术。 围术期,对患者随机分组进行密切观察和护理。A组:常规组(routine nursing):对患者给予常规护理;B组:整体组(integrated nursing):除了常规的基本护理外,加强了围术期镇静、镇痛和术后并发症的专业化的整合护理。结果 两组共24例成功完成了手术。两组术前资料比较,无显著差异。整体护理组ICU停留时间和住院时间短于常规组(P<0.05);护理满意度、生活质量比较,整体组患者优于常规组(P<0.05)。结论 护士提供的围术期专业化技术的整体护理,可改善患者围术期的治疗效果,促进康复。

目的 分析基于中医针灸的康复训练对小儿脑瘫的临床疗效。方法 选择我院2016年2月—2017年3月接受治疗的脑瘫患儿88例,根据患儿入院接受疗法不同分为研究组(n=45)和对照组(n=43)。对照组给予康复训练治疗,研究组给予康复训练联合中医针灸治疗。比较两组患者治疗3个月后的临床效果,以及治疗前后粗大运动功能、生活质量评分变化。结果 治疗3个月后,研究组总有效率95.56 %明显高于对照组69.76 %(P<0.05);两组患儿粗大运动功能、生活质量、认知功能及自理动作评分均有提高,但研究组以上指标评分明显高于对照组(P<0.05)。结论 基于康复训练联合针灸干预脑瘫患儿可改善患儿粗大运动功能,提高患儿生活质量,效果显著。

目的 探究以临床护理路径为主的健康教育在二胎异位妊娠患者中的应用效果。方法 选取2016年1月—2017年6月收治的80例二胎异位妊娠患者,随机分为实验组40例和对照组40例,实验组:实施以临床护理路径为主的健康教育,对照组以常规指导,比较两组临床效果。结果 实验组患者在健康教育知晓率、护理满意率方面与对照组比较,有差异(P<0.05);实验组在住院时间、住院费用及并发症发生率方面与对照组比较(P<0.05),观察组焦虑评分与抑郁评分均低于对照组(P<0.05)。结论 二胎异位妊娠患者运用临床护理路径进行健康教育,可有效提高患者对于异位妊娠疾病的了解程度,提高治疗护理依从性,促进患者早日康复出院,提高护理满意度,值得推广普及。

Objective To study the effect of applying clinical nursing pathway on health education of second womb ectopic pregnancy and explore more effective health education modes. Methods 80 patients with second-trimester ectopic pregnancy were randomly divided into experimental group (40 cases) and control group (40 cases). The experimental group was given health education through clinical nursing pathway. The control group was given routine guidance. We compared the effects of health education in two groups. Results 40 patients in the experimental group were compared with the 40 patients in the control group in terms of awareness rate of health education and satisfaction rate of care, P<0.05; the experimental group was compared with the control group in terms of length of stay, hospitalization costs, and complication rate, P<0.05 The anxiety scores and depression scores in the observation group were lower than those in the control group, P<0.05. There was a statistical difference between the two groups. Conclusions Applying clinical nursing pathway on health education of second womb ectopic pregnancy patients may effectively improve patients' understanding of ectopic pregnancy diseases, improve compliance of nursing care, facilitate patients to be discharged and improve satisfaction of nursing satisfaction, clinical care services in the popularization.

目的 对临床护士实施预防住院患者误吸教育干预,评价干预措施对护士预防误吸知识及护理行为的影响。方法 选取我院神经系统相关科室的110名护士为研究对象,通过一系列教育干预,对比干预前后护士在预防误吸知识及护理行为等方面的改变,评估干预措施的效果。结果 110名护士均对培训满意;培训前护士预防误吸知识的平均得分为(65.6±9.6)分,培训后平均得分为(92.5±6.5)分,培训前后得分的差异有统计学意义(P<0.05)。培训后89份(89%)跟踪调查卷明确表示护士在工作中运用了培训所学的知识。结论 对护士进行有组织、有计划的教育干预能提高护士预防与处理患者误吸的知识水平,并能对护士预防和处理患者误吸的行为产生积极影响。

Objective To evaluate the effect of educating nurses on how to prevent and reduce aspiration rate of patients. Methods 110 nurses were recruited from neurological department in our hospital and were trained systematically about the prevention and nursing of aspiration. We compared the scores they had before and after training. Results 110 nurses were all satisfied with the training. The pre-education test score about the aspiration knowledge was 65.6±9.6 while the post-education test score was 92.5±6.5. The difference of the score before and after training was statistically significant difference (P<0.05). The follow-up study indicated that 89% nurses are applying the knowledge gained from the training to their clinical work. Conclusion It's suggested that well-organized educational training may improve nurses' performance of preventing patients from aspiration and treating patients when they had aspiration, which left a positive effect on nurses' behavior.