目的 比较腹腔镜阑尾切除术结合快速康外科(FTS)观念与传统开腹阑尾切除术的疗效差异。方法 回顾分析奉新县人民医院普通外科2001年2月—2003年4月和2010年7月—2013年6月收治的96例阑尾炎患者,随机分为两组,每组各48例,分别为传统开腹手术组(对照组)和腹腔镜阑尾切除术联合FTS组(实验组),检测术前1 d及术后第1 d、第3 d白细胞计数(White blood cell,,WBC)、C-反应蛋白(CRP)、白细胞介素-6(IL-6),同时比较两组术式的手术时间、住院时间、消化功能恢复时间及术后并发症的发生率。结果 实验组与对照组术后第1 d、第3 d外周血WBC、CRP、IL-6均显著高于术前,两组之间相比较差异有统计学意义(P＜0.05);实验组平均手术时间(62±18)min,对照组平均手术时间(55±21)min,两组相比差异无显著性(P＞0.05);实验组平均住院天数为(4.2±1.3)d,对照组平均住院天数为(7.6±1.5)d,两组相比差异有统计学意义(P＜0.05);实验组术后消化功能恢复时间为(23.3±9)h,对照组为(30.5±11)h,两组相比较差异有统计学意义(P＜0.05);实验组未出现术后并发症病例,对照组出现3例切口感染病例,2例粘连性肠梗阻病例,1例盆腔感染病例,两组手术并发症发生情况相比较差异有统计学意义(P＜0.05)。结论 腹腔镜阑尾切除术结合快速康复外科理念,可有效缩短病人住院天数及促进术后恢复,值得临床广泛应用。

Objective To compare laparoscopic appendectomy surgery combined with fast track surgery(FTS)concept and conventional open appendectomy difference in efficacy. Methods To retrospective analysis Fengxin country people's hospital of general surgery from February 2001 to April 2003 and July 2010 to June 2013,a total of 96 cases of appendicitis were randomly divided into two groups,each included 48 cases,namely conventional open appendectomy group(control group)and the laparoscopic appendectomy combined FTS group(experimental group). The changes of white blood cell count(White blood cell,WBC),C-reactive protein(CRP),interleukin-6(IL-6)were detected in the first day before surgery and the 1,3 day after surgery,while the surgical operative time,the length of hospital stay and digestive function recovery, surgical incision pain,and the rate of postoperative complications were compared between the two groups. Results The levels of WBC,CRP, IL-6 at day 1 and day 3 after surgery were significantly higher than before surgery,and there was significant difference between the experimental group and control group(P<0.05). The average operation time of the experimental group and the control group were respectively (62±18)min and (55±21)min,and there was no significant difference(P＞0.05). Meanwhile the average time of hospital stay and digestive function recovery were obviously shorter in the experimental group than in the control group(P＜0.05). There was no postoperative complications in experimental group. There were 3 cases of incision infection and 1 case of intestinal obstruction and 1 pelvic infection in control group. It showed significant difference between the two groups(P<0.05). Conclusion Laparoscopic Appendectomy Surgery combined with fast track surgery,which can effectively shorten patients average time of hospital stay,reduce postoperative complications and promote postoperative recovery. It is worthy in clinical use widely.

目的 探讨延续性护理干预对癌痛患者服药依从性及疼痛治疗效果的影响。方法 选取105例住院治疗的中度至重度癌痛患者,均需服用阿片类药物止痛治疗,单日出院的患者(48例)设为对照组,双日出院的患者(57例)设为干预组。对照组在出院前由责任护士给予常规的用药指导;实验组则在此基础上,于出院后提供延续性护理干预,对患者每周进行电话回访1次,每个出院患者至少回访4次,比较两组患者出院4周后服药依从性及疼痛治疗效果的差异。结果 实验组服药依从性、疼痛治疗效果高于对照组(P＜0.05)。结论 延续性护理干预能提高出院癌痛患者服药依从性及疼痛治疗效果,改善患者的生存质量。

Objective To investigate the impact of continuing nursing on the medication compliance and effect of pain treatment in patients with cancer pain. Methods 105 cases of hospitalized patients with medium to severe cancer pain were selected,need to take opioid analgesic therapy,they were divided into the control group who were single-day discharged(n=48)and intervention group who were double-day discharged(n=57),when discharged,the control group was received conventional health education of medication by the specialized nurses;on this basis,the experimental group was received continuing nursing after discharge,the patients had a return visit by telephone once a week,each patient were visited 4 times at least. After 4 weeks,the medication compliance and effect of pain treatment in the two groups were compared. Results In the experimental group,the medication compliance of patients and effect of pain treatment were significantly higher than those of the control group(P＜0.05). Conclusion The continuing nursing intervention can significantly improve the medication compliance and effect of pain treatment for discharged patients with cancer pain,and improve the quality of life.

目的 氧化苦参碱对视网膜母细胞瘤细胞SM-106凋亡的诱导作用及机制。方法 以不同作用时间(24 h、48 h、72 h)和不同作用浓度(12.5 μl/mL、25 μl/mL、50 μl/mL、100 μl/mL)氧化苦参碱处理视网膜母细胞瘤细胞SM-106,分别采用流式细胞仪及western blot检测视网膜母细胞瘤细胞SM-106细胞凋亡及其凋亡因子(Bax、Bcl-2)蛋白表达。结果 氧化苦参碱可促进SM-106细胞体外凋亡,上调Bax蛋白表达及Bax/Bcl-2蛋白表达比值,下调Bcl-2蛋白表达,并呈现剂量及时间依赖性。结论 氧化苦参碱可诱导视网膜母细胞瘤细胞SM-106凋亡,调控凋亡因子Bax、Bcl-2的表达是其可能作用机制。

Objective To evaluate the apoptosis and its mechanism of retinoblastoma cells SM-106 induced by oxymatrine. Methods Retinoblastoma cells SM-106 were treated with different time(24 h、48 h、72 h)and different concentrations(12.5 μl/mL, 25 μl/mL, 50 μl/mL or 100 μl/mL) of oxymatrine. The apoptosis and protein expression of apoptosis factors (Bax and Bcl-2) were respectively determined by flow cytometry and western blot. Results Oxymatrine significantly promoted the SM-106 cells apoptosis in vitro, raised Bax protein expression and Bax/Bcl-2 protein expression ratio, reduced the Bcl-2 protein expression, and showed the dose and time dependent. Conclusion Oxymatrine is able to induce the apoptosis in retinoblastoma cells SM-106. Regulating apoptosis related gene Bax and Bcl-2 expression may be the mechanism of apoptosis.

目的 对颞下颌关节紊乱病患者的心理健康状况进行分类别的评估分析。方法 随机选择口腔科门诊就诊的颞下颌关节紊乱病患者88例为病例组,健康正常人92例为对照组,心理科抑郁患者92例及焦虑患者90例为心理疾病组,采用症状自评量表(SCL-90)量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克人格问卷(EPQ)进行问卷调查,将量表调查结果分别归类整理后,使用统计软件SPSS13.0进行统计学分析。结果 TMD患者与正常对照组相比,在SCL-90、SAS、SDS评分中多项有统计学意义,在病例组中,多次患病和初次患病相比、高学历与低学历患者相比,在焦虑和抑郁上有统计学意义。颞下颌关节紊乱病患者与心理疾病患者相比,心理疾病患者在焦虑和抑郁上得分高于颞下颌关节紊乱病患者。结论 颞下颌关节紊乱病患者存在着不同程度的心理障碍,但远未达到心理疾病的程度,且颞下颌关节紊乱病患者中的不同群体心理状况也有所不同,这对于TMD患者心理上的疏导提供了一定的依据。

Objective To explore the research and analysis of temporomandibular disorder(TMD)patients' psychological states. Methods People diagnosed in the dental clinic were identified as target population.Totally, 88 patients with TMD were recruited as case control,whereas 92 normal people,92 patients with mental depression and 90 patients with dysphoria disorders were collected as control group.Questionnaire survey was carried out based on Symptom Checklist(SCL-90),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)and Eysenck Personality Questionnaire(EPQ). Correlations between TMD and psychological factors were assessed using the statistical methods. Results Compared with normal people,patients with TMD showed statistically significant diversity in SCL-90,SAS and SDS.In subgroup analysis of patients with TMD,patients with repeated disease history or advanced education degree presented significant variation in terms of depression and anxiety when compared with those with first diagnosed or lower education degree.Compared with patients with mental illnesses,patients with TMD showed significant lower score in depression and anxiety. Conclusion In TMD treatment we should not only adapt traditional physical therapy,medical therapy,corrective therapy and surgical treatment but also pay attention to psychological treatment to correct the patients' negative emotions,which may improve the symptoms and actively terminate disease process.

目的 调查住院患儿的营养风险及营养状况,探讨儿科营养风险筛查新方法的应用。方法 使用新的儿科营养风险筛查工具,对住院患儿进行营养风险筛查,根据体格测量评价儿童营养状况;与国外三种儿科营养风险筛查工具比较一致性。结果 402例住院患儿中高营养风险患儿占24.1%,营养不良的检出率为18.4%。有36.8%的患者接受营养支持,其中肠外营养支持率为23.1%,肠内营养支持率为16.7%,PN:EN为1.39:1。结论 对住院患儿采用新方法做营养风险筛查,能客观地反映住院患儿的营养风险,为临床营养支持提供依据。

Objective To investigate nutritional risk and the nutritional status in hospitalized children,and to validate the new screening tool of nutritional risk in hospitalized pediatric patients. Methods The nutritional risk of hospitalized pediatric patients was investigated using the new screening tool,and compared with other three pediatric nutritional risk screening tools;the nutritional status was assessed according to children physical measurement. Results Among 402 hospitalized children,children with high nutritional risk accounted for 24.1%.The overall prevalence of malnutrition was 18.4%.The proportion of patients receiving nutritional support was 36.8%.The rate of parenteral and enteral nutrition support was 23.1% and 16.7%,respectively.The ratio of parenteral nutrition to enteral nutrition was 1.39:1. Conclusion The new screening tool can reflect the possible nutritional risk in hospitalized pediatric patients objectively and provide the basis for clinical nutritional support.

目的 回顾分析椎体成形术(PVP)对于治疗骨质疏松性新鲜椎体压缩骨折(OVCF)患者的疗效。方法 收集2011年1月—2012年6月新鲜OVCF患者伤后两周内行PVP术治疗共34例(51个椎体)。于术前1天、术后3天、1个月、3个月、6个月、12个月予VAS、ODI评分,并行X线检查以测量病椎前、中、后缘的高度和病椎cobb角。结果 纳入研究的34个病例中,患者术后各时间点随访中VAS和ODI评分均较术前1天明显改善(P<0.05)。术后各时间点随访中行X线检查时,术后各次随访中椎体前缘、中段、病椎cobb角均较术前有较为明显的矫正(P<0.05)。结论 应用PVP治疗新鲜OVCF疗效满意,可快速缓解疼痛、改善生活质量和矫正病椎后凸畸形。

Objective To study the efficiency and safety of percutaneous Vertebroplasty(PVP) for the fresh osteoporotic vertebral compression fractures(OVCF). Methods 34 patients (30 females and 4 males), mean age 75.8 years old(75.79±9.32, range 60 to 93 years old) hospitalized between January 2011 to June 2012 were reviewed retrospectively in this study. Evaluation at follow-up time point(1 day before PVP, 3rd day, 1st, 3rd, 6th, 12th month after PVP) included the pain score with VAS, mobility improvement with ODI and the measurement of anterior, middle and posterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra with X-ray image. Results For the 34 patients by followed up 1 year, the mean VAS score and ODI decreased significantly after PVP at any follow-up time compared with the 1 day before operation. Anterior and middle body height and the focal kyphotic angle at any follow-up time after PVP was improved statistically significant compared with the preoperative value(P<0.05). Conclusion Percutaneous vertebroplasty results in prompt pain relief, rapid rehabilitation and kyposis reduction, it is a safe and effective procedure for treating fresh osteoporotic vertebral compression fractures.

目的 研究地佐辛复合丙泊酚对腹式子宫切除术牵拉反应的预防作用。方法 选择择期行腹式子宫切除术患者60例(ASA I ~Ⅱ级),随机分成三组。所有患者给予腰麻,麻醉平面调节并固定于T₆后,给予A组患者0.1 mg/kg地佐辛,静脉注射;B组静脉注射0.1 mg/kg地佐辛后丙泊酚持续泵注2~4 mg/(kg·h);C组单次静注丙泊酚1.5 mg/kg后持续泵注2~4mg/(kg·h)。记录麻醉前(T₀)、腰麻平面固定后(T₁)、静注药物后5min(T₂)、切皮(T₃)、牵拉子宫时(T₄)、术毕(T₅)患者的HR、MAP及Ramesay镇静评分;评价肌松效果、牵拉反应、患者舒适度及满意度。结果 三组患者一般情况无差异(P＞0.05);与T₀相比,Ⅲ组T₂及T₅时刻MAP与T₀相比差异有统计学意义(P＜0.05),T₂、 T₃ 、T₄及T₅时刻HR与T₀相比差异有统计学意义(P＜0.05);与T₀相比,Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、 T₃及T₄时刻均升高,差异有统计学意义(P＜0.05);Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、T₃及T₄时刻高于I组,差异有统计学意义(P＜0.05)。牵拉反应评价I组评为优的患者个数明显少于II组及III组,评为良及差的患者个数多于II组及III组,此差异有统计学意义(P＜0.05);II组及III组舒适度及满意度评定为优的患者个数明显多余I组,差异有统计学意义(P＜0.05)。结论 0.1 mg/kg地佐辛复合丙泊酚可以很好预防腹式子宫切除手术中的牵拉反应,提高患者舒适度和满意度。

Objective To observe whether dezocine combined with propofol can prevent intra operative dragging reaction during hysterectomy or not. Methods Sixty patients(ASAⅠ~Ⅱ)which through hysterectomy surgery were randomly arranged to 3 groups. All the patients were under spinal anesthesia, adjusted the anesthesia plane to T6. Group l: dezocine 0.1 mg/kg were intravenous injected, Group ll: dezocine 0.1 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h were intravenous pumped, Group lll: propofol 1.5 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h intravenous were pumped. HR、MAP and Ramesay scale were recorded at the time points of pre-anesthesia(T₀)、pre-injection(T₁)、5 min after injection(T₂)、skin incision(T₃)、dragging uterus(T₄)、after surgery(T₅),the effect of muscle relaxation and the reaction of patients were recorded in the mean time, comfort degree and satisfaction degree of patients were evaluated after surgery. Results There was no significant difference of general condition between the three groups (P>0.05). At the time point of T₂ and T₅, MAP of Group lll patients were significant lower than the base value(P<0.05). At the time point of T₂、T₃、T₄ and T₅, HR of Group lll patients were significant lower then base value(P<0.05). Dragging reaction during the surgery were significant reduced in Group ll and Group lll but not in Group l(P<0.05). Group ll and Group lll patients felt more comfortable and more satisfied than Group l patients(P<0.05). Conclusion 0.1 mg/kg dezocine combined with propofol can prevent intra operative dragging reaction and make patient feel more comfortable during hysterectomy.

目的 了解化脓性脑膜炎患儿常见后遗症的种类及发生率,探讨可能导致化脓性脑膜炎患儿预后不良的高危因素。方法 选取129例化脑性脑膜炎患儿,患儿分为预后不良组及预后良好组,统计各种后遗症的发生率,并寻找预后不良的危险因素。结果 随访的80例患儿中,有较轻后遗症者12例,有严重后遗症者13例,包括智力低下11例,运动障碍8例,双侧听力障碍4例,继发性癫痫4例,10例患儿合并有两种或以上严重后遗症,最常见为智力低下合并运动障碍。行为问题共检查48例患儿,有行为问题患儿17例。预后不良组和预后良好组在发热总时间>7天、入院后反复抽搐≥3次、昏迷(Glasgow昏迷评分<8分)、感染性休克、瞳孔异常、肢体活动障碍为出现预后不良的危险因素,两组比较差异有统计学意义(P＜ 0.05)。结论 本研究发现,化脓性脑膜炎患儿的后遗症表现多种多样,提示患儿应该进行系统的随访;同时,本研究还发现昏迷、感染性休克等临床症状是导致预后不良的危险因素。早期识别这些症状,并给予早期干预,将对患儿的预后有着重要意义。

Objective To investigate the types and incidence of common sequelae in children with bacterial meningitis.To investigate the risk factors for adverse outcome of childhood bacterial meningitis. Methods Selected 129 children with bacterial meningitis all cases were divided into adverse outcome group and favorable outcome group.According to the incidences of different kinds of sequelae,The risk factor effecting bad prognosis were studied. Results A total of 80 children were successfully followed.Of them,12 might only have mild sequelae and 13 had serious sequelaes.Among these children who had serious sequelae,11 of them had mental retardation,8 of them had motor deficit,4 of them had bilateral hearing loss and 4 of them had secondary epilepsy.10 children had multiple serious sequelae,thes most common multiple impairment combinations were mental retardation plus motor deficit.48 parents of the children completed the Child Behaviour Checklist and found out 17(35.42%)of their children had behavioral disorders.Adverse outcome group and favorable outcome group,the length of fever(>7 days),repeated convulsions after admission(≥3 times),coma(Glasgow coma scale score <8 points),septic shock,abnormal pupils,limb movement disorder.There were significantly difference between the two groups(P＜ 0.05). Conclusions This study showed that there are different kinds of sequelaes of children with bacterial meningitis,it indicated that these children should be follow-up to track the effect.On the other hand,this study found out that the high risk factors with adverse outcome might be coma,septic shock and so on.It indicated that if we could identify the high risk factors in the early stage and then interpose them immediately,it might beneficial to improve the quality of life of the children.

目的 体外构建胶原—壳聚糖复合支架材料,分析其物理化学性质及生物相容性,探讨其应用于组织工程支架材料的可行性。方法 利用冷冻干燥的方法构建三维多孔的胶原支架材料,通过甲醛交联以及添加壳聚糖的方法改善其物理化学性能。通过体外降解实验以及电镜扫描的方法检测材料的各项物理化学指标;通过细胞接种的方法研究材料的生物相容性。结果 胶原—壳聚糖复合材料通过冷冻干燥的方法,能够获得稳定的三维多孔结构,电镜显示孔隙贯通,体外降解速度降低,并且能够支持细胞生长。理化性质分析显示该结构适合细胞生长,具有良好的生物相容性。结论 本课题体外构建胶原—壳聚糖复合支架材料,满足组织工程生物材料的理化以及生物相容性要求,为其应用于组织工程支架材料提供重要的依据。

Objective We build up the Collagen-Chitosan compound scaffold in vitro,and study the physical,chemical and biological properties,to analyze the feasibility in tissue engineering. Methods The three-dimensional porous scaffold was obtained by freezing-drying method,and optimized by using formaldehyde and Chitosan.We used hydrolysis in vitro and SEM scanning to investigate its physical and chemical properties.The biocompatibility of scaffold was analyzed in MEF cells. Results Collagen-Chitosan compound scaffold we obtained by freezing-drying method was a kind of stable 3D vesicular structure.The scaffold degenerated in decreased velocity in vitro.The physical and chemical properties showed that it was suitable for the cells grow in it,which suggested that it has a good biocompatibility. Conclusion This kind of Collagen-Chitosan compound scaffold is constructed.It's qualified by the physical and chemical properties,and biocompatibility which the biomaterials require.The evidence are important for its application in tissue engineering.

目的 对比分析二氧化锆全瓷冠与钴铬合金烤瓷冠修复牙体牙列缺损的临床疗效。方法 选择2008年3月以来广东工业大学医院口腔科和江西省萍乡市安源区现代口腔门诊部牙体牙列缺损全冠修复患者150例364颗,随机分为2组,实验组采用二氧化锆全瓷冠75例185颗,对照组采用钴铬合金烤瓷冠75例179颗,修复后随访2年对比观察,结果采用χ²检验分析。结果 两组在修复体完整性、固位、边缘密合度、牙敏感症状、继发龋、邻面接触点、过敏反应方面差异无统计学意义(P＞0.05);但在牙龈状况、龈缘着色、颜色匹配方面差异有统计学意义(P＜0.01)。结论 二氧化锆全瓷冠修复体美学效果和生物相容性优于钴铬合金烤瓷冠。

Objective To compare and analyze the clinical effects of restoring tooth dentition defect by using zirconium dioxide full porcelain crowns and cobalt chromium alloy porcelain crowns. Methods 150 patients with 364 teeth suffering from tooth dentition defect in hospital of guangdong university of technology and modern stomatology clinic in pingxiang since March of 2008 are chosen and randomly divided into two groups. 75 patients with 185 teeth in the experimental group are restored with zirconium dioxide full porcelain crowns and 75 patients with 179 teeth in the control group are restored with cobalt chromium alloy porcelain crowns, which was followed up with 2-year observation. Results There is no statistical significance between the two groups in terms of repair integrity, retention, edge adaptation, tooth sensitivity symptoms, secondary caries, contact points, and allergic reaction(P＞0.05). But statistical significance exists in gingival status, gingival coloration, and color matching(P＜0.01). Conclusion Zirconium dioxide full porcelain crowns are superior to cobalt chromium alloy porcelain crowns in aesthetic effect and biocompatibility.