目的 探究纽扣钢板内固定方法治疗新鲜Rockwood Ⅲ型以上肩锁关节脱位的效果。方法 选取2013年1月—2017年12月在我院诊断并治疗的肩锁关节脱位(Rockwood Ⅲ型以上)60例,随机分为观察组(30例)与对照组(30例),观察组采用纽扣钢板内固定方法,对照组采用锁骨钩钢板方法。对比两组治疗前后肩功能指标(Constant-Murley)、手术的治疗疗效指标(Karlsson)的优良率,以及手术时间和术中出血量。结果 治疗前两组的Constant-Murley评分无差异(P＞0.05),治疗后两组评分均提高(P＜0.05),其中观察组高于对照组(P＜0.05);观察组的Karlsson评分优良率、术中出血量均优于对照组(P＜0.05),观察组的手术时间高于对照组(P＜0.05)。结论 纽扣钢板内固定能够有效恢复患者正常肩部功能,具有良好的治疗效果,同时对患者造成的创伤较小。

Objective To observe the effect of button plates in treatment of Rockwood Ⅲ and greater acromioclavicular dislocation. Methods From January 2013 to December 2017, 60 Rockwood Ⅲ and greater acromioclavicular dislocation patients in our hospital were randomly divided into observe group(30 cases)and control group (30 cases), the observe group received button plates treatment, the control group received clavicula hook plate treatment. The shoulder function(Constant-Murley)of two groups before and after treatment were compared, and the effect of operation(the good rate of Karlsson), surgical time and intraoperative bleeding of two groups were also compared. Results There were no difference in shoulder function between two groups before treatment(P＞0.05). The indices were increased after treatment(P<0.05), and the indices in the observe group were higher than that of control group(P＜0.05), The good rate of Karlsson index, intraoperative bleeding of observe group were better than that of control group(P＜0.05).The surgical time of observe group were better than that of control group(P＜0.05). Conclusion Button plate's internal fixation nay better improve the shoulder function; it has better therapeutic effect, and smaller trauma to patient.

目的 探讨神经导航辅助神经内镜经鼻蝶入路切除垂体瘤的疗效。方法 将2014年10月—2018年4月我院接诊的20例垂体瘤患者纳入本研究,按照随机数字表法均分为观察组和对照组各10例,对照组患者行常规神经内镜下经鼻蝶入路垂体瘤切除术,观察组患者行神经导航辅助神经内镜下经鼻蝶入路垂体瘤切除术,比较两组患者手术及术后住院情况(包括手术时间、术中出血量及术后住院时间)、手术效果(包括显效率和总有效率)、手术前后血清内分泌指标变化情况(包括GH、PRL水平)以及术后并发症情况(即术后并发症发生率)。结果 观察组患者手术时间、术中出血量及术后住院时间均低于对照组,差异有统计学意义(P＜0.05);观察组显效率和总有效率均略高于对照组,但两组间手术效果并差异无统计学意义(P＞0.05);观察组患者治疗后血清生长激素(GH)、催乳素(PRL)水平均低于对照组,差异有统计学意义(P＜0.05);两组患者术后并发症发生率无统计学差异。结论 神经导航辅助神经内镜经鼻蝶入路切除垂体瘤疗效显著,手术时间短、术中出血少、术后恢复快,可明显改善患者内分泌指标,值得临床推荐。

Objective To evaluate the efficacy of resection for pituitary tumors through transsphenoidal approach with endoscopic neuronavigation assisted. Methods From October 2014 to April 2018, 10 patients with pituitary tumor were operated in our hospital with neuronavigation, which were set as the observation group. Meanwhile, 10 patients with pituitary tumor underwent surgical treating through transsphenoidal approach without neuronavigation were set as the control group. SPSS 19.0 were used for statistical analysis to compare the difference between the two groups, including the operation time, blood loss, hospitalization time, hormone level, clinical total efficiency, and complications in the two groups. Results The operation time, blood loss and hospitalization time of the observation group were less than that of the control group, and there was statistical significance (P<0.05). The efficiency rate and overall efficiency rate of the observation group were a little more than that of the control group, but there was no statistical significance (P＞0.05). The level of growth hormone (GH) and prolactin (PRL) of the observation group were less than that of the control group, and there was statistical significance (P<0.05). And there was no statistical significance between the incidence rate of postoperative complications of the two groups. Conclusion The efficacy of resection for pituitary tumors through transsphenoidal approach with endoscopic neuronavigation is significant, which may shorten the course, reduce the blood loss, quicken recovery of a patient from operation, and improve the hormone level. It is worthy to be recommended to clinical application.

目的 分析小婴儿化脓性脑膜炎的临床特点,探讨其预测因子。方法 回顾性分析我科2015—2017年53例小月龄化脓性脑膜炎患儿的临床资料。以同时期、同年龄层的细菌感染患儿81例为观察组。通过单因素和多因素分析进行两组比较。结果 单因素分析提示早产儿、激惹、嗜睡、前囟紧张、颈强直及循环不良方面有差异。脑脊液白细胞数量、蛋白浓度、糖浓度,糖与同期血糖比值以及乳酸脱氢酶浓度均有明显差异。多因素分析提示仅脑脊液蛋白及乳酸脱氢酶有统计学意义。受试者工作曲线显示脑脊液蛋白、乳酸脱氢酶及两项指标合并的诊断效能均较高。结论 小婴儿化脓性脑膜炎患儿缺乏典型表现,密切关注早产儿基础疾病,激惹、嗜睡、前囟紧、颈强直及循环不良的临床表现,脑脊液蛋白及乳酸脱氢酶等实验室指标,有利于早期识别,及时干预,减少不良事件的发生。

Objective We aimed to analyze the clinical characteristics of community acquired purulent meningitis(PM) in infants and explore the predictors of early diagnosis. Methods Retrospective study was done with patients in our NICU from Jan 2015 to Dec 2017 aged during 29 days to 90 days. We divided them into two groups, 53 of which diagnosed PM were included as a case group, while 81 of which admitted inpatients with fever at the same periods and in the same age ranges were included as a control group. Factors including adverse basic events, clinical manifestations, laboratory examinations and so on were compared between two groups. Results Univariate analysis showed that premature, manifestations such as irritability, lethargy, bulging fontanelle,a stiff neck and the poor circulation, and cerebrospinal fluid(CSF) data like the mount of white blood cell, concentration of CSF protein, concentration of CSF glucose, CSF/blood glucose ratio, concentration of CSF lactate dehydrogenase were different between two groups. In the multivariate analysis, concentration of CSF Protein(＞0.450 g/L, OR=5.819, P=0.002) and concentration of CSF lactate dehydrogenase(＞28.300 U/L,OR=7.892, P＜0.001) were proven to be independent risk factors for the diagnosis of PM. Receiver operating characteristic (ROC) analysis revealed that the CSF protein, the CSF lactate dehydrogenase and the combination of the two factors had an increased area under the curve (AUC), the mounts of each which were 0.839,0.867 and 0.890. Conclusion Patients with PM in early infantile period are often lack of atypical clinical characteristics. We need pay highly attention to the adverse basic events, irritability, lethargy, bulging fontanelle,a stiff neck, poor circulation and CSF results. The independent predictors for early diagnosis were concentration of CSF protein and lactate dehydrogenase. It indicates that if the predictors could be identified early, diagnosis could be made timely and interventions could be operated immediately. It will be beneficial for progression-free and overall survival.

目的 研究米氮平和文拉法辛二药连用治疗抑郁症的临床疗效和安全性,以及对患者认知功能及生活质量的影响。方法 选取125例抑郁症患者随机分为三组,A组42例给予文拉法辛,B组41例给予米氮平,C组42例给予米氮平及文拉法辛,疗程均为8周。采用HAMD-17、GQOLI-74集WMS-RC量表作为评价指标。结果 用药8周后总有效率比较,C组>B组>A组,同时,C组与其他两组比较有差异(P<0.05)。治疗前,三组患者WMS-RC各项评分比较无差异(P>0.05),治疗8周后,三组患者各项认知功能均有改善;其中,联合用药的改善效果最为显著。相较于治疗前,三组患者GQOLI-74评分均有不同程度上升,但C组患者上升幅度更大(P<0.05)。结论 联合应用来治疗难治性抑郁症疗效显著,且能帮助恢复患者的认知能力,研究过程中未发现较明显不良反应,故提倡临床推广。

Objective To study on the clinical efficacy and safety of mirtazapine and venlafaxine in the treatment of refractory depression, as well as to improve cognitive function and quality of life in patients. Methods 125 patients were randomly assigned to three groups, including group A: 42 cases with venlafaxine, group B: 41 cases with mirtazapine, group C 42 cases with mirtazapine and venlafaxine, 8 weeks for a course. Results After the treatment, total effective rate: group C>group B>group A. There's no difference between WMS-RC among three groups. After treatment for 8 weeks, cognitive function of three groups was enhanced, and group C was the most significant. GQOLI-74 scores of the three groups were increased, but group C of patients increased even more sharply (P<0.05). Conclusion Mirtazapine and venlafaxine may effectively improve the quality of life and cognitive function of patients with depression. It's high safety and worthy of clinical promotion and application.

目的 研究二次剖宫产后续妊娠的分娩方式。方法 选取广州市妇女儿童医疗中心2015年8月1日—2017年12月31日的第三次及以上妊娠孕妇资料,要求前两次均为剖宫产,本次妊娠为头位单胎。分析本次妊娠相关因素及最终分娩方式、妊娠结局及围产儿情况。结果 二次剖宫产后阴道分娩与急诊、择期剖宫产相比,三组子宫破裂、新生儿窒息等的发生率差异无统计学意义。成功阴道分娩者本次均为自然临产。结论 二次剖宫产后,第三次妊娠分娩方式的选择包括顺产及剖宫产,在妊娠结局、母儿并发症方面差异无统计学意义,有阴道试产史是成功阴道分娩的有利因素。孕妇尤其是自然临产孕妇可在严密监护下选择阴道试产。

Objective To study the delivery mode after two previous cesareans. Methods We selected pregnant women, single cephalic, following two previous cesareans in Guangzhou Women and Children Medical Center, from August 1, 2015 to December 31, 2017. Analysis of this pregnancy related factors and final delivery mode, the maternal and fetal morbidities were studied. Results There wasn't statistical significance in the incidence of uterine rupture, neonatal asphyxia among vaginal birth after two previous cesareans, selected cesarean section and emergency cesarean section. And the success cases of vaginal delivery are natural labor. Conclusion The delivery modes after two previous cesareans include vaginal delivery and cesarean section. There are no statistical significance in pregnancy outcomes. Vaginal trial history are the favorable factors of successful vaginal delivery. Especially in pregnant women with natural vaginal labor we can choose vaginal delievery under intensive care.

目的 探讨利拉鲁肽与二甲双胍对新诊断2型糖尿病患者骨代谢的影响。方法 选取2016年1月—2017年6月在我院就诊并确诊为新诊断2型糖尿病患者50例,按照随机数字表法将研究对象随机分为利拉鲁肽组及二甲双胍组,每组各25人。两组患者均单药治疗24周后比较两组患者骨密度、骨代谢指标变化情况。结果 两组患者骨密度、血清ALP以及BGP、PINP水平治疗前后相比,无改变(P>0.05);而利拉鲁肽组患者的β-CTx水平较治疗前降低(P<0.05);两组患者治疗后FPG、2hFPG、HOMA-IR、HbA1c均较治疗前下降(P<0.05),而空腹胰岛素较治疗前上升(P<0.05);利拉鲁肽组患者治疗24周后BMI值低于治疗前(P<0.05)。结论 利拉鲁肽与二甲双胍对新诊断2型糖尿病患者骨密度的影响均不明显,两种药物可有效降低血糖,改善胰岛素抵抗,利拉鲁肽在使用过程中可明显降低患者血清β-CTx水平,但其是否存在骨质保护作用仍需进一步研究。

Objective To explore the effect of liraglutide and metformin on bone metabolism in newly diagnosed type 2 diabetic patients. Methods From January 2016 to June 2017, 50 patients with type 2 diabetes mellitus admitted to our hospital were selected. According to the random number table method, the subjects were randomly divided into liraglutide group and metformin group, 25 in each group. Changes in bone mineral density and bone metabolism were compared between the two groups after 24 weeks of monotherapy. Results That there was no significant change in bone mineral density, serum ALP, TPINP,and BGP levels before and after treatment (P>0.05). The β-CTx levels in patients in the liraglutide group were lower than that before treatment (P<0.05); FPG, 2hFPG, HOMA-IR, and HbA1c levels in the two groups were lower than that before treatment (P<0.05). Fasting insulin was higher than that before treatment (P<0.05); BMI was lower in the liraglutide group after 24 weeks of treatment than that before treatment (P<0.05). Conclusion The effects of liraglutide and metformin on the bone mineral density of patients with newly diagnosed type 2 diabetes are not obvious. Liraglutide may reduce serum β-CTx levels during use. We need to have further study whether it has a bone protection.

目的 了解先兆早产孕妇的抑郁和唾液皮质醇浓度,探讨两者间的相关性。方法 共纳入138例先兆早产孕妇作为研究对象。采用爱丁堡产后抑郁量表(Edinburgh Postpartum Depression Scale,EPDS)测量其抑郁状况,同时收集8am、16pm、23pm的唾液进行皮质醇浓度检测。以EPDS≥9.5分为界值,将研究对象分为抑郁组和非抑郁组。采用独立样本t检验比较两组唾液皮质醇浓度,采用Pearson相关分析抑郁和唾液皮质醇浓度的相关性。结果 先兆早产孕妇的抑郁平均得分为(8.8±4.97)分。抑郁(EPDS≥9.5分)检出率为46.4%。8am、16pm、23pm的唾液皮质醇浓度分别为(14.07±7.36)ng/mL、(9.27±5.03)ng/mL、(5.71±3.92)ng/mL。总研究对象的EPDS与8amSC(r=0.257,P=0.002)、16pmSC(r=0.303,P＜0.001)存在相关;非抑郁组孕妇的EPDS与8amSC(r=0.306,P=0.008)、16pmSC(r=0.203,P=0.048)存在相关。结论 先兆早产孕妇抑郁者比例较高。抑郁与唾液皮质醇存在中低度相关性。产科医护人员应关注先兆早产孕妇的心理健康状况,即使是抑郁相对较轻者,也要帮助其改善抑郁状况以获得良好的妊娠结局。

Objectives To discover the depression status and salivary cortisol(SC)level among women with threatened preterm labor, and find their associations. Methods 138 pregnant women with threatened preterm labor were recruited in this study. Edinburgh Postpartum Depression Scale (EPDS) was applied to assess women's depression, and their saliva were collected at 8am, 16pm,23pm to test the cortisol level. EPDS≥9.5 was set as the cut-off value to assign the participants to depressive group(EPDS≥9.5) and non-depressive group (EPDS＜9.5). Independent samples t-test was used to compare the difference of salivary cortisol of the two groups, and Pearson correlation analysis was also applied to calculated the associations between depression and salivary cortisol. Results The average scores of EPDS in total women were (8.8±4.97). The incidence of depression (EPDS≥9.5) was as high as 46.4%.The average level of salivary cortisol at 8am,16pm and 23pm were(14.07±7.36) ng/mL, (9.27±5.03)ng/mL and (5.71±3.92)ng/mL respectively. EPDS in total women was associated with 8amSC(r=0.257, P=0.002) and 16pmSC(r=0.303, P＜0.001). EPDS in non-depressive group were also associated with 8amSC (r=0.306,P=0.008) and 16pmSC(r=0.203, P=0.048). Conclusion Women with threatened preterm labor have a high incidence of depression. There was a low-moderate level of association between maternal depression and salivary cortisol. Obstetrical doctors and nurses should focus on maternal psychological health level in women with threatened preterm labor. Even those individuals comparatively with a less severe depression, we need help them to minimize the severity of depression to achieve satisfying pregnant outcomes.

目的 探究和分析本组腹主动脉瘤腔内治疗病例并发症发生的原因及预防、处理策略。方法 对本团队在2014年1月—2017年12月实施的37例腹主动脉瘤腔内修复手术病例进行回顾性分析。结果 共有11例发生并发症,其中3例为术中I型内漏、1例术后支架移位致Ⅰ型内漏、1例术后Ⅲ型内漏、1例术中Ⅳ型内漏,全部经处理后内漏消失;术后髂动脉支架内血栓1例,经取栓后血流恢复;术后股动脉狭窄闭塞1例,经取栓并行股动脉人工血管置换后血流恢复;术后移植物反应1例,对症处理后症状消失出院;2例双侧髂内动脉栓塞致术后盆腔疼痛,随访疼痛消失,无跛行。结论 腹主动脉瘤腔内修复治疗本身存在内漏、血栓、血管入路损伤、移植物反应等相关并发症。术前正确评估并严格掌握适应症以及具有成熟的操作经验,是减少并发症发生的关键。

Objective To discuss and analyze the occurrence causes, prevention and treatment methods of complications in the endovascular repair of patients with abdominal aortic aneurysm. Methods Totally 37 cases of patients with abdominal aortic aneurysm underwent endovascular repair in our hospital from January 2014 to December 2017 were retrospectively analyzed. Results The complications were occurred in 11 cases, which including intra-operative typeⅠendoleak in 3 cases, postoperative typeⅠendoleak caused by stent displacement in 1 case; intra-operative type Ⅲ endoleak in 1 case; postoperative type Ⅳ endoleak in 1 case. all of the endoleak events disappeared after dealing. There was postoperative iliac artery stent thrombosis in 1 case, the blood flow was restored after thrombectomy; postoperative femoral artery stenosis or occlusion in 1 case, the blood flow was restored after thrombectomy and femoral artery artificial vascular replacement; postoperative host versus graft reaction in 1 case, no stent infection was found; and postoperative bilateral pelvic pain caused by internal iliac artery embolization in 2 cases, the pain disappeared during the follow-up visit, and the patients were free from lameness. Conclusion The complications related to endoleak, thrombosis, vascular approach injury and host versus graft reaction are existing with the endovascular repair itself of abdominal aortic aneurysm. The correct preoperative evaluation as well as strict control of indications and mature operational experience are the key to reduce the occurrence of complications.

目的 通过波幅整合脑电图(aEEG)长程监测评估胆红素水平(TSB)、脑干听觉诱发电位(BAEP)及脑电图(EEG)异常程度对足月新生儿睡眠结构的影响。方法 对159例高胆红素血症足月新生儿行12小时床边监测长程脑电图,计算aEEG上睡眠-觉醒周期(SWC)安静睡眠(QS)时间长度比例、收集当日的TSB、BAEP及EEG结果。结果 在159例病人中,数据可视化结果显示随着胆红素水平的升高、EEG及BAEP异常程度的增加,QS期的比例逐渐减少。逐步广义线性模型结果证实胆红素水平及EEG异常是导致安静睡眠比例减少的主要因素,而BAEP异常程度则不显著。结论 随着胆红素水平的增高及脑电图异常率的增加,足月新生儿睡眠-觉醒周期安静睡眠比例逐渐减少,SWC结构发生改变。

Objective To investigate the impacts of total serum bilirubin level (TSB), EEG and BAEP abnormalities to full term neonates' sleep-wake cycles' (SWC) structure through the amplitude-integrated electroencephalography (aEEG). Methods Quiet sleep (QS) ratio of SWC within 12 hours of 159 neonates with hyperbilirubinermia were obtained from the aEEG traces, total serum bilirubin (TSB) level, EEG and BAEP results of the recording day were also recorded. Results QS ratio of SWC decreased along with the elevated TSB level, EEG and BAEP abnormality in 159 cases. Furthermore stepwise generalized linear regression model comfirmed the TSB level, EEG abnormalities were the key factors for the reduced QS ratio while the BAEP was no statistically significant. Conclusion Full term neonates' SWC showed a constructive change by means of QS ratio reduction according to the elevating TSB level and EEG abnormality.

目的 研究分析急性呼吸窘迫综合征(ARDS)患者血清甲状腺素变化与疾病的严重程度的相关性。方法 选取2016年1月—2018年1月在我院重症医学科收治的123例急性呼吸窘迫综合征及41例非急性呼吸窘迫综合征患者,根据2012柏林定义,ARDS又再划分为轻度组(26.67 kPa2/FiO₂≤40.00 kPa,PEEP或CPAP≥0.49 kPa)、中度组(13.33 kPa2/FiO₂≤26.67 kPa,PEEP≥0.49 kPa) 及重度缺氧组(PaO₂/FiO₂≤13.33 kPa,PEEP≥0.49 kPa),同时再选取同一时段内在我院进行常规体检的41例健康成人作为对照,对他们血清的甲状腺激素水平测定。结果 健康成人对照组与非ARDS组比较, 血清TSH、FT4、TT4、FTS、TT3水平测定差异没有统计学意义(P＞0.05),ARDS组较另外两组以上指标均有降低(P＜0.05),轻、中、重三组间比较,血清甲状腺素的差异存在统计学意义。结论 急性呼吸窘迫综合征患者血清甲状腺素水平与缺氧程度呈正相关,随着疾病严重程度加大,其水平差异的变化更加明显,动态监测甲状腺素水平对疾病严重程度的判断和对预后的评估具有重大意义。

Objective To analyze serum thyroid hormone level change of acute respiratory distress syndrome and the correlation between the severity of disease. Methods 123 cases (including mild 26.67 kPa2/FiO₂≤40.00 kPa,PEEP or CPAP≥0.49 kPa,moderate 13.33 kPa 2/FiO₂≤26.67 kPa,PEEP≥0.49 kPa and severe PaO₂/FiO₂≤13.33 kPa,PEEP≥0.49 kPa)of patients with acute respiratory distress syndrome and 41 cases of non-ARDS were involved. from January 2016 to January 2018 in our hospital and 41 cases of healthy people by routine check-up in our hospital during the same period were selected,then the serum thyroid hormone levels were determined. Results Compared with healthy control group,TSH、FT4、TT4、FTS、TT3 level in non-ARDS group has no statistical difference(P＞0.05),while compared with the rest of the two groups,all indexes in ARDS group were lower (P＜0.05). And TSH、FT4、TT4、FT3、TT3 levels in moderate ARDS group decreased compared with those in relatively mild ARDS (P＜0.05). The level of each index in severe ARDS group decreased compared with the moderate ARDS group (P＜0.05). There was statistical difference in detection index level in three groups. Conclusion The serum thyroid hormone level of ARDS patients is positively correlated with hypoxemia. As the pathological severity changes ,the level of hypoxemia changes are more apparent. Dynamic monitoring of serum thyroid hormone is of great significance in severity judgement and prognosis evaluation.