目的 探究应用烤瓷+活动义齿修复在牙列重度磨耗伴缺失患者治疗中对咀嚼效能的影响。方法 选定本院2019年2月—2021年2月口腔科接诊的71例牙列重度磨耗伴缺失患者,按随机数字表法分为2组,对比组和病例组各35例,对比组接受常规义齿修复治疗,病例组接受采纳烤瓷+活动义齿修复,对比2组临床疗效、咀嚼功能、Fricton指数、并发症总发生率。结果 临床总有效率病例组(94.44%)高于对比组(74.29%),病例组治疗后咀嚼效率、咬合力均比对比组高,P均＜0.05。病例组治疗后Fricton指数低于对比组,病例组并发症总发生率(2.78%)低于对比组(20.00%),P均＜0.05。结论 烤瓷+活动义齿修复可有效提高牙列重度磨耗伴缺失患者咬合力、咀嚼功能,改善颞下颌关节功能,且并发症较少,效果确切。

目的 探讨胰岛素联合乌司他丁在高脂血症性重症胰腺炎中的临床疗效。方法 研究资料来自广州市花都区人民医院肝胆胰外科自2018年—2020年收治的72例高脂血症性重症胰腺炎患者资料,所有患者按照不同治疗方案随机分为3组,每组各24例。对照组采用急性胰腺炎常规治疗(即生长抑素+液体疗法);乌司他丁组则于常规组上联用乌司他丁;而研究组在常规及联合乌司他丁治疗基础上加用胰岛素强化治疗,比较3组患者腹痛及胃肠功能恢复的时间、甘油三酯下降的水平,治疗前、治疗后第3天、7天的APACHE Ⅱ评分的变化情况。结果 研究组患者腹痛症状缓解及胃肠功能恢复时间均较对照组明显缩短、腹痛症状缓解时间较乌司他丁组缩短,且研究组甘油三酯下降水平较对照组和乌司他丁组快,而研究组第3天和第7天的APACHE-Ⅱ评分较常规组及乌司他丁组低,以上差别均有统计学意义(P<0.05)。结论 胰岛素联合乌司他丁可明显改善高脂血症合并重症急性胰腺炎腹部症状、缩短胃肠功能恢复时间、迅速降低血清甘油三酯水平,对患者近期疗效确切。

Objective To explore curative effect of insulin combined with ulinastatin in therapy of severe hyperlipidemic pancreatitis. Methods A total of 72 patients with hyperlipidemia complicated with severe acute pancreatitis were randomly divided into three groups according to different treatment plans, 24 cases in each group. The regular treatment of acute pancreatitis (somatostatin+liquid therapy) was carried out in control group. Base on the regular treatment of acute pancreatitis, ulinastatin was added in ulinastatin group. Base on the treatment of ulinastatin group, insulin was added in study group, and the time of abdominal pain and gastrointestinal function recovery, glycerin level and the APACHE Ⅱ score before and after treatment among three groups were compared. Results Compared with the control group and ulinastatin group, the time of abdominal pain relief and gastrointestinal function recovery in the study group were significantly shorter, the time of triglycerides level back to normal in the study group was shorter than the other two groups, while at the third and seventh day, the APACHE Ⅱ score of the study group was lower than that of other two groups, with statistical significance (P<0.05). Conclusions Insulin combined with ulinastatin could significantly improve abdominal symptoms of hyperlipidemia complicated with severe acute pancreatitis, promote the recovery of gastrointestinal function, and rapidly reduce the level of serum triglyceride.

目的 探究血清C反应蛋白与白蛋白比值(CRP/ALB)、中性粒细胞与淋巴细胞比值(NLR)、血糖不稳定指数(GLI)水平对重症肺炎患者预后的预测价值。方法 将我院2020年1月—2021年5月收治的126例重症肺炎患者作为研究对象,根据入院治疗28 d的预后情况,分为存活组(93例)和死亡组(33例)。对比2组患者的一般资料,采用多因素Logistic分析重症肺炎患者高危因素,应用ROC曲线评估血清CRP/ALB、NLR、GLI水平对重症肺炎患者预后的预测价值。结果 2组患者一般资料对比,NEU、CRP、APACHEⅡ、CRP/ALB、NLR、GLI水平差异有统计学意义(P<0.05);多因素Logistic回归分析显示APACHEⅡ评分、血清CRP/ALB、NLR、GLI水平是重症肺炎患者死亡的危险因素;ROC曲线分析结果显示,CRP/ALB、NLR、GLI曲线下面积分别为0.837,0.826,0.837。结论 CRP/ALB、NLR、GLI水平对重症肺炎患者预后均具有较高的预测价值,其中以CRP/ALB的预测价值最佳。

Objective To explore the prognostic predictive value of serum CRP/ALB, NLR and GLI in patients with severe pneumonia. Methods A total of 126 patients with severe pneumonia treated in our hospital from January 2020 to May 2021 were divided into survival group (93 cases) and death group (33 cases) according to the prognosis of 28 days of hospitalization. The general data of the two groups were compared, the high-risk factors of patients with severe pneumonia were analyzed by multivariate logistic, and the predictive value of serum CRP/ALB, NLR and GLI levels on the prognosis of patients with severe pneumonia was evaluated by ROC curve. Results There were significant differences in the levels of NEU, CRP, APACHE Ⅱ, CRP/ALB, NLR and GLI between the two groups (P<0.05); multivariate logistic regression analysis showed that APACHE Ⅱ score, serum CRP/ALB, NLR and GLI were the risk factors of death in patients with severe pneumonia; ROC curve analysis showed that the areas under CRP/ALB, NLR and GLI curves were 0.837, 0.826 and 0.837 respectively. Conclusions The levels of CRP/ALB, NLR and GLI had high predictive value in the prognosis of patients with severe pneumonia, among which CRP/ALB had the best predictive value.

目的 比较来曲唑和氯米芬治疗极严重少精子症的治疗效果。方法 选取2020—2021年在本生殖中心门诊50例极严重少精子症病例,分为2组,A组(来曲唑,研究组n=26)、B组(氯米芬,对照组n=24)。结果 来曲唑和氯米芬治疗后1月、3月,A组精子浓度明显提高,优于B组[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]。通过卵胞浆内单精子注射/体外受精胚胎移植治疗,A组妊娠16例(61.5%),B组妊娠11例(45%)。2组治疗后的血清卵泡刺激素、黄体生成素、睾酮升高[(5.9±3.8) vs (20.3±2.6);(3.6±2.8) vs (9.5±5.7);(13.6±10.5) vs (25.3±10.8),P<0.05],A组雌二醇水平降低[(36.8±20.6) vs (7.6±2.5),P<0.05]。结论 来曲唑治疗极严重少精子症有较理想的临床治疗效果,明显优于氯米芬。

Objective To explore and compare the therapeutic effects of letrozole and clomiphene in the treatment of extremely severe oligospermia. Methods A tatal of 50 cases of extremely severe oligosperospermia in the reproductive center from 2020 to 2021 were selected and divided into two groups, group A (letrozole, study group n=26) and B (clomiphene, control group n=24). Results After letrizole and clomiphene treated for 1 and 3 months, sperm concentration in group A was significantly better than group B[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]. With ICSI/IVF, 16 cases (61.5%) succeed in encyesis in group A, 11 cases (45%) in group B. Serum follicle stimulating hormone, luteinizing hormone and testosterone levels were significantly increased after treatment [(5.9±3.8) vs (20.3±2.6), (3.6±2.8) vs (9.5±5.7), (13.6±10.5) vs (25.3±10.8), P<0.05]. The level of estradiol in group A decreased [(36.8±20.6) vs (7.6±2.5), P<0.05]. Conclusions Letrozole has ideal clinical treatment effect, which is obviously superior to clommiphene.

目的 探讨连续性肾脏替代治疗(CRRT)在治疗重症急性胰腺炎(SAP)中的临床意义。方法 回顾分析2018年1月—2019年1月在我院接受救治的SAP患者64例,根据治疗方案的不同分为观察组和对照组, 每组各搜集32例,2组患者基线水平一致。对照组为采用常规内科方案治疗的病例, 观察组为对照组治疗方案基础上联合CRRT的病例,分析对比2组治疗后的各项疗效指标。结果 2组患者治疗后5~7 d内APACHE Ⅱ评分[(11.02±3.14)vs(13.98±3.27)分]、甘油三脂[(4.02±1.05)vs(5.62±1.11)mmol/L]、C反应蛋白[(88.25±6.73)vs(104.41±10.28)ng/L]、降钙素原[(13.12±4.33)vs(18.55±3.96)ng/mL、血尿素氮[(7.33±1.72) vs (11.24±2.76) mmol/L]、血肌酐[(69.51±15.03) vs(91.12±19.17)mmol/L]相较治疗前均降低,观察组患者上述指标水平下降幅度超过对照组,结果分析差异有统计学意义(t=3.693, 5.924, 7.440, 9.362, 5.235, 6.801, 5.018,P均＜0.001)。观察组患者治疗期间疾病症状缓解时间[(3.15±1.26)vs (5.22±1.51) d]、体征指标稳定时间[(2.52±1.38) vs (4.39±1.50) d]、胃肠功能恢复时间[(4.48±1.27) vs (6.21±1.55) d]以及ICU住院时间[(15.03±2.21) vs (18.44±3.27) d]均低于对照组,结果分析差异有统计学意义(t=5.954, 5.190, 4.884,4.888,P均＜0.05)。结论 与常规内科治疗相比,联合CRRT治疗SAP能够显著改善各项炎症指标,有助患者快速脱离重症危险状态,具有积极的临床价值。

Objective To explore the clinical significance of continuous renal replacement therapy (CRRT) in the treatment of severe acute pancreatitis (SAP). Methods Retrospective analysis of 64 patients with SAP in our hospital from January 2018 to January 2019 was carried out. The patients were divided into the observation group and the control group according to different treatment regimens, with 32 cases in each group, and the baseline levels of the two groups were consistent. Patients in the control group were treated with conventional medical treatment, and the patients in the observation group were treated with CRRT on the basis of the control group, and the efficacy of the two groups were analyzed and compared. Results The APACHE II scores [(11.02±3.14) vs (13.98±3.27)]、triglyceride[(4.02±1.05) vs (5.62±1.11) mmol/L], C-reactive protein[(88.25±6.73) vs (104.41±10.28) ng/L], procalcitonin[(13.12±4.33) vs (18.55±3.96) ng/mL], blood urea nitrogen[(7.33±1.72) vs (11.24±2.76) mmol/L], serum creatinine[(69.51±15.03)vs(91.12±19.17)mmol/L] of patients in both groups were significantly decreased within 5-7 days after treatment compared with those before treatment, and the decrease of the above indicators in the observation group was significantly greater than that in the control group, P<0.05. The remission time of symptoms[(3.15±1.26) vs (5.22±1.51) d], the stabilization time of signs[(2.52±1.38) vs (4.39±1.50) d], the recovery time of gastrointestinal function[(4.48±1.27) vs (6.21±1.55) d] and the length of ICU stay[(15.03±2.21) vs (18.44±3.27) d] in the observation group were lower than those in the control group, and the analysis of the results was statistically significant (t=5.954, 5.190, 4.884,4.888,all P＜0.05). Conclusions Compared with conventional medical treatment, additional CRRT treatment can significantly improve the inflammatory indicators of SAP, help patients survive from critical state of SAP, which has positive clinical value.

目的 探讨甲状腺乳头状癌患者在严重短期甲减的状态下甲状腺功能及相关因素对血脂水平的影响。方法 纳入61例通过病理确诊为甲状腺乳头状癌的患者,采集所有患者在手术前与碘治疗前的甲状腺功能水平与血脂水平等资料,比较患者不同性别、年龄、术式、淋巴结转移情况等相关因素对血脂的影响。结果 碘治疗前的全部血脂指标均高于手术前的基线水平;在促甲状腺激素 (TSH)>60 mIU/L组中的总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(APO-A1)、载脂蛋白B(APO-B)、脂蛋白(LP)水平明显高于TSH≤60 mIU/L组;女性患者的甘油三酯(TG)、动脉硬化指数(AI)水平明显低于男性患者,男性组的HDL-C、APO-A1水平低于女性组,年龄>45岁的患者TC水平高于年龄≤45岁的患者,差异均有统计学意义(P均＜0.05);不同术式及淋巴结转移分组间的血脂水平未见明显差异(P＞0.05);TC水平与游离三碘甲状原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺素(T4)水平呈负相关(r分别为-0.342、-0.370、-0.340),HDL-C、LDL-C及APO-B水平与T4水平呈负相关(r分别为-0.294、-0.354、-0.324),APO-A1水平与FT4、三碘甲状腺原氨酸(T3)、T4水平呈负相关(r分别为-0.306、-0.262、-0.263),LPa水平与T3、T4水平呈负相关(r分别为-0.268、-0.313)。结论 甲状腺乳头状癌碘治疗前短期甲减可以导致全套血脂指标升高,在此甲减状态下程度越严重的甲减可产生越高的血脂水平,同时男性患者与中老年患者也可伴随更高的血脂水平。

Objectives To investigate the influence of thyroid function and related factors on blood lipid levels in patients with papillary thyroid cancer under short-term severe hypothyroidism. Methods Sixty-one patients with papillary thyroid carcinoma diagnosed by pathology were included. The data of thyroid function and blood lipid levels of all patients before operation and iodine treatment were collected. The effects of gender, age, operation mode, lymph node metastasis and other related factors on blood lipid were compared. Results Before iodine treatment, all blood lipid indexes were higher than the baseline level before operation. The levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (APO-A1), apolipoprotein B (APO-B), lipoproteins (LP) in the thyroid stimulating hormone (TSH)>60 mIU/L group were significantly higher than those in the TSH≤60 mIU/L group.Triglyceride (TG) and arteriosclerosis index (AI) levels were significantly lower in female patients compared with male patients, HDL-C and APO-A1 levels were lower in male patients compared with female patients, and TC levels were higher in patients aged>45 compared with those aged≤45, with significant differences (all P<0.05). No significant differences were observed in lipid levels among the different surgical procedures and lymph node metastasis subgroups (P>0.05). TC levels were negatively correlated with free triiodothyronines (FT3), free thyroxine (FT4), thyroxine (T4) levels (r=-0.342,-0.370,-0.340,respectively). HDL-C, LDL-C, and APO-B levels were negatively correlated with T4 levels (r=-0.294, -0.354, -0.324,respectively), APO-A1 levels were negatively correlated with FT4, triiodothyronine (T3), T4 levels (r=-0.306,-0.262,-0.263,respectively), and LP levels were negatively correlated with T3 and T4 levels (r=-0.268,-0.313, respectively). Conclusions Short term hypothyroidism before iodine treatment for papillary thyroid cancer could lead to the increase of full set of blood lipid indexes, male patients and middle-aged and elderly patients could also be accompanied by higher blood lipid levels.

目的 分析重症流感相关性脑病患儿的临床特点及诊治要点。方法 回顾性分析2017年5月—2020年4月收入我院PICU的17例重症流感相关性脑病患儿的临床资料进行回顾性分析。结果 17例患儿中男性10例、女性7例,起病年龄3(2～5)岁。所有患儿均出现发热,1(0～3.5)天后出现神经系统症状,包括惊厥发作(88%)和昏迷(88%)。头颅影像学检查病变主要分布在丘脑、脑干、髓质脑室周围白质,呈对称性和多灶性改变。经颅多普勒检查出现脑血流速度减慢呈震荡波、钉子波的5例患儿均死亡。16例患儿予机械通气,2例予连续性肾替代治疗,死亡8例,存活者出院前均遗留不同程度神经系统损害。结论 儿童重症流感相关性脑病以发热、惊厥和昏迷为主要表现,头颅影像学及脑电图、经颅多普勒等检查有助于早期诊断和预后判断,早期联合应用甲强龙冲击及IVIG的有效性仍需进一步研究。

Objective To analyze the characteristics, diagnosis and treatment of severe influenza-associated encephalopathy in children. Methods The clinical data of 17 children with severe influenza-associated encephalopathy admitted to PICU from May 2017 to April 2020 were retrospectively analyzed. Results Among the 17 cases, 10 were male and 7 were female, and the onset age was 3 (2-5) years old. All children developed fever, and neurological symptoms 1 (0-3.5) days later, including seizures (88%) and coma (88%). The lesions were mainly distributed in the thalamus, brainstem and medullary ventricular white matter, showing symmetry and multifocal changes. All the 5 cases with slowed cerebral blood flow velocity and presented shock wave or nail wave died. 16 children were on mechanical ventilation, 2 with continuous renal replacement therapy, and 8 died. All the survivors had varying degrees of neurological damage before discharge. Conclusion Severe influenza-associated encephalopathy of childhood is mainly characterized by fever, convulsions and coma. Cranial imaging, EEG, TCD and other examinations are helpful for early diagnosis and prognosis judgment. The effectiveness of early combined application of methylprednisolone and IVIG still needs further study.

目的 观察早期经鼻肠内营养(ENEN)对中-重度急性胰腺炎(MSAP+SAP)患者的治疗效果。方法 回顾性分析2014年9月—2019年5月期间,广东药科大学附属第一医院消化内科收治的50例MSAP及SAP患者临床资料,根据患者营养支持治疗方式不同,将患者分为观察组(n=25)和对照组(n=25)。观察组患者采用ENEN治疗,对照组采用肠外肠内营养联合(PNEN)治疗。对比两组患者治疗后血清白蛋白(ALB)、血清前白蛋白(PA)、C-反应蛋白(CRP)、急性生理与慢性健康(APACHE Ⅱ)评分、序贯器官功能衰竭(SOFA)评分及多器官功能障碍综合征(MODS)发生率。结果 经过治疗后,观察组患者ALB水平、PA水平高于对照组,CRP水平低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者APACHE Ⅱ评分、SOFA评分低于对照组,差异有统计学意义(P＜0.05)。经过治疗后,观察组患者MODS发生率低于对照组,差异有统计学意义(P＜0.05)。结论 ENEN治疗MSAP及SAP患者可有效改善患者营养状态和健康状况,降低机体炎症反应,减少MODS发生率。

Objective To observe the effect of early nasal enteral nutrition(ENEN) on patients with moderate to severe acute pancreatitis(MSAP+SAP). Methods A retrospective analysis of the clinical data of 58 patients with(MSAP+SAP) admitted to the department of gastroenterology, the First Affiliated Hospital of Guangdong Pharmaceutical University from September 2014 to May 2019, according to the different nutritional support treatment methods, the patients were divided into observation groups(n=25) and control group(n=25). Patients in the observation group were treated with ENEN, and the control group was treated with Parenteral nutrition and enteral nutrition(PNEN). Serum albumin(ALB), serum prealbumin(PA), C-reactive protein(CRP), acute physiology and chronic health evaluation(APACHE II) score, sequential organ failure assessment(SOFA) score, and incidence of multiple organ dysfunction syndrome(MODS) were compared between the two groups. Results After treatment, the ALB and PA level of the observation group were higher than those of the control group, and the CRP level was lower than that of the control group, the difference was statistically significant(P<0.05). After treatment, the APACHE II score and SOFA score of the observation group were lower than those of the control group, and the difference was statistically significant(P<0.05). After treatment, the incidence of MODS in the observation group was lower than that in the control group, and the difference was statistically significant(P<0.05). Conclusion ENEN treatment of MSAP and SAP may effectively improve the nutritional status and health of patients, reduce the body's inflammatory response and reduce the incidence of MODS.

目的 观察和评价重症毒蕈中毒(PMP)患者的临床资料,探讨血液灌流(HP)联合血液滤过(HF)与单独血液滤过治疗的疗效比较。方法 收集本院2016年8月—2018年10月救治的32例重症急性毒蕈中毒并发中毒性肝损伤、急性肾衰竭、中毒性心肌炎、消化道出血、中毒性脑病、急性血管内溶血等患者的临床资料,将32例患者分为治疗组和对照组,治疗组14例,采用持续静脉-静脉血液滤过24 h串联灌流2 h;对照组18例,采用单独血液滤过24 h,疗程2～3 d。两组患者内科常规治疗基本相同。结果 14例治疗组在内科常规治疗基础上联合血液灌流+血液滤过,好转率为92.9%(13/14);18例对照组在内科常规治疗基础上单用血液滤过,好转率为61.1%(11/18),两组好转率比较,差异有统计学意义(P<0.05)。治疗组患者黄疸、少尿、黑便、意识障碍等症状减轻,优于对照组;血清AST、ALT、TBil、DBil、PT、APTT水平较治疗前改善,优于对照组,差异有统计学意义(P均<0.05)。结论 毒蕈中毒患者常合并多脏器功能障碍(MODS),及早进行血液灌流联合血液滤过治疗较单独血液滤过能更有效的清除蛋白结合毒素和血清炎症因子,从而减轻内脏器官损害,改善肝、肾和凝血功能,治疗效果显著。

Objective To compare the clinical effect differences between hemoperfusion combined with hemofiltration with simple hemofiltration in treatment of severe mushroom poisoning patients. Methods 32 patients with toxic hepatitis,toxic myocarditis,toxic encephalopathy and acute renal failure due to poisonous mushroom were divided into two groups: treating group(n=14) and control group(n=18).Patients of treating group received continuous veno-venous hemofiltration for 24 hours combined with hemoperfusion for 2 hours.The cases of control group only received hemofiltration for 24 hours. Results After the treatment,the improvement rate in treating group were higher than that in control group(P<0.05).The disturbance of consciousness,jaundice,oliguria,melena in treating group were improved obviously and serum levels of AST、ALT、TBil、DBil、PT、APTT were reduced than those in controls(P<0.05). Conclusion Compared with simple hemofiltration,early hemoperfusion combined with hemofiltration for patients with severe toadstool poisoned can not only remove protein binding toxin and serum inflammatory factors,but also improve liver,kidney and coagulation function.

目的 观察灵芝孢子粉对中重度慢性阻塞性肺疾病(COPD)稳定期患者肺功能、6分钟步行距离及T淋巴细胞亚群的影响。方法 选取稳定期中重度COPD门诊患者19例,服用灵芝孢子粉6个月后观察患者服药前后肺功能的变化及循环血液中CD4⁺、CD8⁺T淋巴细胞的比例变化,症状评分(CAT评分)以及对6 MWT的影响。结果 服用灵芝孢子粉6个月后,中重度COPD患者的六分钟步行距离延长,平均增加19 m(P＜0.01),患者的CAT评分也有改善(P＜0.01),患者肺功能与服药前相比有改善趋势,其中FEV₁较服用前平均增加60 mL(P>0.05),FVC平均增加为130 mL(P<0.01),FEV₁/FVC比例降低0.47(P>0.05);外周血CD4⁺T淋巴细胞比例增加(P<0.01),CD8⁺和CD4⁺/CD8⁺T淋巴细胞亚群比例未见明显变化(P＞0.05)。结论 服用灵芝孢子粉6个月后对肺功能无明显作用,但能改善中重度COPD患者的CAT症状评分,可能与升高CD4⁺T淋巴细胞比例有关。

Objective To observe the effects of Ganoderma lucidum spore powder on lung function, 6-minute walking distance and T lymphocyte subsets in patients with moderate to severe chronic obstructive pulmonary disease(COPD). Methods Nineteen patients with moderate-to-severe COPD outpatients in stable phase were enrolled. After taking Ganoderma lucidum spore powder for 6 months, the changes of lung function and the proportion of CD4⁺ and CD8⁺ T lymphocytes in circulating blood, the symptom score(CAT score) and impact on the 6 MWT were observed. Results After taking Ganoderma lucidum spore powder for 6 months, the six-minute walking distance of patients with moderate to severe COPD was prolonged, with an average increase of 19 meters(P<0.01). The patient's CAT score was also improved(P<0.01). There was an improvement trend in increasing average FEV1 by 60 mL(P>0.05), FVC increased to 130 mL(P<0.01) and the FEV1/FVC ratio decreased by 0.47(P>0.05). The proportion of CD4⁺ T lymphocytes in peripheral blood increased(P<0.01), and the proportion of CD8⁺ and CD4⁺/CD8⁺ T lymphocyte subsets did not reach the significance(P>0.05). Conclusion After taking Ganoderma lucidum spore powder for 6 months, it has no significant effect on lung function, but it may improve the CAT symptom score of patients with moderate to severe COPD, which may be related to the increase of CD4⁺ T lymphocyte ratio.