目的 了解河源市无偿献血人群中丙型肝炎病毒(HCV)感染情况及HCV感染合并乙型肝炎病毒(HBV)、人类免疫缺陷病毒(HIV)以及梅毒螺旋体(TP)感染的情况,为当地预防和控制输血传播性疾病提供实验室依据。方法 选择2010年1月1日—2015年12月31日河源市中心血站无偿献血者71 618例,采用酶联免疫吸附试验(ELISA)方法检测其血浆抗-HCV、乙型肝炎表面抗原(HBsAg)、抗-TP及HIV(Ag/Ab),统计分析抗HCV阳性无偿献血者合并感染HBV、HIV和TP的情况。结果 71 618例无偿献血者标本中抗-HCV、HBsAg 、抗-TP及HIV(Ag/Ab) 阳性率分别为0.56％(402例)、1.48％(1 062例)、1.14％(821例)、0.09％(61例);初次献血者抗-HCV、HBsAg 、抗-TP及HIV(Ag/Ab)阳性率均高于多次献血者(P＜0.05);402例抗-HCV阳性无偿献血者中合并HBsAg、抗-TP、HIV(Ag/Ab) 阳性率分别为1.74%(7例)、4.98%(20例)、0.25%(1例)。结论 抗-HCV阳性献血者合并TP感染率显著高于抗-HCV阴性无偿献血者, HCV合并HBV、HIV感染率低。

目的 对比观察罗哌卡因及布比卡因应用于患有妊娠期高血压的产妇行剖宫产时腰麻联合硬膜外麻醉的临床效果。方法 将103例择期行剖宫产手术的妊娠期高血压患者随机分为罗哌卡因组51例及布比卡因组52例分别采用对应药物进行麻醉,研究两组阻滞效果、心血管系统变化情况及不良反应发生情况。结果 两组间麻醉镇痛效果及优良率比较,差异没有统计学意义(P>0.05)。罗哌卡因组感觉及运动阻滞起效时间较布比卡因组长,运动阻滞恢复时间较布比卡因组短(P<0.05)。心血管系统变化情况比较,麻醉5min、10min时两组收缩压及平均动脉压均降低,但布比卡因组波动更大,两组间比较差异显著(P<0.05),心率及血氧饱和度比较无差异(P>0.05)。罗哌卡因组不良反应出现时间较布比卡因组晚,同时其不良反应发生率较布比卡因组低(χ²=4.1599,P<0.05)。结论 罗哌卡因及布比卡因在阻滞时间上略有差异,麻醉镇痛效果相当,但鉴于妊高症产妇本身心血管系统存在基础问题,运用罗哌卡因对心血管系统的影响较小,安全性更高,更值得推荐使用。

目的 探讨替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病的临床疗效及安全性。方法 前瞻性选取本院2012年4月—2015年10月收治的80例急性冠脉综合征合并妊娠糖尿病患者,按随机数字表法分为对照组、实验组,每组40例,实验组采用替罗非班辅助低分子肝素治疗,对照组使用单独低分子肝素治疗方案,比较两组治疗后血浆蛋白-A(PAPP-A)以及超敏C反应蛋白(hs-CRP)水平;比较两组内出血情况以及血小板计数的变化。结果 两组治疗后PAPP-A以及hs-CRP水平均有所下降,实验组下降幅度高于对照组,对比差异有统计学意义(P＜0.05);两组内出血发生率分别为10.0%、40.0%,均无严重出血情况发生,实验组轻度出血3例,中度出血1例,对照组轻度出血10例,中度出血6例,实验组轻中度出血率低于对照组(P＜0.05);两组治疗前血小板计数对比差异无统计学意义(P＞0.05),治疗后实验组血小板计数下降明显,对照组血小板计数无明显变化,两组不同时间点血小板计数差异无统计学意义(P＞0.05)。结论 替罗非班辅助低分子肝素治疗急性冠脉综合征合并妊娠糖尿病患者具有一定的效果,且用药安全性较高。

目的 观察自拟中药方内服外洗结合冲击波治疗足底筋膜炎的临床疗效。方法 收集在我院门诊就诊的符合条件足底筋膜炎患者50例,采用自拟四物四藤汤内服外洗结合冲击波治疗,运用VAS评分法及疼痛减轻百分数评定治疗前与治疗后1周、2周、1月的疗效比较。结果 治疗前后VAS评分比较(P<0.05),组间比较有统计学意义,且前两周效果更明显,总有效率为94.00%,患者满意度为96.00%。结论 本治疗方法对足底筋膜炎是有明显疗效的,可以在临床上进一步推广验证。

Objective To observe clinical curative effect of TCM oral use and external wash combined with application of shock wave in the treatment of plantar fasciitis. Methods To collect 50 cases of patients with plantar fasciitis in our hospital clinic,use Siwusiteng medical herbal decoction combined with shock wave treatments, elevate VAS score and the percentage of pain relief before and after treatment at 1 week, 2 weeks, and 1 month. Results VAS score before and after treatment was statistically significant(P<0.05), and the effect of the first two weeks is more obvious. The total effective rate was 94.00%,patient satisfaction was 96.00%. Conclusion This treatment has obvious curative effect on plantar fasciitis, and it could be further promoted in clinical verification.

目的 研究并分析优质护理对消化性溃疡患者的临床疗效以及护理满意度的影响。方法 入选2014年8月—2015年10月收治的184例消化性溃疡患者作为研究对象, 根据电脑随机数字将患者随机分为研究组和对照组,各92例。对照组男50例,女42例,年龄18～60 a,平均年龄(43.7±2.1)a,病程2～10 a,平均(5.2±0.4)a,研究组男48例,女44例,年龄20～59 a,平均(42.3±3.6)a,病程2～10 a,平均(5.2±0.4)a。患者入院后均给予消化性溃疡常规基础治疗(四联疗法),在此基础上给予对照组患者常规护理,研究组患者优质护理,对比两组患者的临床疗效和护理满意度。结果 经研究观察对比,研究组消化性溃疡患者的临床疗效明显优于对照组,研究组消化性溃疡患者的总有效率为95.65%,对照组为79.35%,两组数据对比差异有统计学意义(P＜0.05)。研究组患者治疗后烧心、上腹痛、嗳气等症状减轻明显较对照组显著,所需时间更短,胃镜检查显示研究组患者经优质护理处理后溃疡愈合时间明显缩短,愈合明显优于对照组,上述对比差异有统计学意义(P＜0.05)。研究组护理满意度为96.74%,对照组护理满意度仅83.69%,研究组高于对照组,差异有统计学意义(P＜0.05)。结论 优质护理能够明显缩短溃疡愈合时间,促进患者痊愈,提高消化性溃疡患者的疗效和护理满意度,值得临床推广和应用。

Objective To study and analyze the effect of high quality nursing on curative effect of patients with peptic ulcer and nursing satisfaction. Methods 98 cases of peptic ulcer patients income for treatment from August 2014 to October 2015 were selected as study subjects. The patients were randomly divided into study group and control group, 49 cases in each group. The control group included male 28 case,female 21 case,aged 18～60 years old, average age (43.7±2.1) years, disease duration of(2～10)years, average(5.2±0.4) years.Study group included male 24 cases, female 25 cases, aged 20～59 years old, average age (42.3±3.6) years, disease duration of (2～10) years, average (5.2±0.4) years. After the patient was admitted to hospital, they were treated with digestive ulcer routine treatment (quadruple therapy). On this basis,patients in the control group were given routine nursing care, the study group patients with high quality nursing, compared with the two groups of patients with clinical efficacy and nursing satisfaction. Results Study group patients with peptic ulcer clinical, curative effect was obviously superior to the control group. The study group patients with peptic ulcer, total efficiency was 95.91%, It was 79.59% in the control group, the difference between the data of two groupshad statistical significance (P<0.05). Study group nursing satisfaction was 97.96%, the control group was only81.63%. The study group was significantly higher than the control group, the difference was statistically significant (P<0.05). Quality care may significantly shorten the average length of stay in patients, the difference was statistically significant (P<0.05). Conclusion High quality nursing may significantly shorten the average length of stay in patients with peptic ulcer, improve the curative effect of peptic ulcer patients and nursing satisfaction. It is worthy of clinical popularization and application.

目的 研究探讨重症监护病房(ICU)病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法 回顾性分析2015年ICU住院患者送检细菌分离培养及药敏试验结果。结果 ICU共送检标本1 326份,分离出病原菌554株,其中革兰阴性病原菌462株(83.4%),革兰阳性病原菌48株(8.7%),真菌44株(7.9%)。革兰阴性杆菌前5位依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌,且多耐药菌株比例较高。革兰阳性病原菌以金黄色葡萄球菌为主,32株(66.7%),MRSA检出率78.3%(25/32)。结论 加强重症监护病房的细菌及药敏监测,根据病原菌药敏结果指导临床合理使用抗菌药物,控制耐药菌株的产生,预防及控制院内感染及感染暴发。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in intensive care unit(ICU) and provide scientific evidence for clinically reasonable use of antibiotics. Methods Specimens from hospitalized intensive care unit patients in 2015 were obtained for routine bacterial isolation and culture. Results A total of 554 bacterial strains were isolated from 1326 specimens, in which Gram-negative bacilli accounted for 462 stains (83.4%),Gram-positive cocci accounted for 48 stains (8.7%),and fungi accounted for 44 stains (7.9%). Gram-negative bacilli of the top five were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Serratia marcescens and Escherichia coli,and the rate of multiple resistant bacteria was relatively high.Staphylococcus aureus were the main Gram-positive cocci, including MRSA accounted for 78.3%(25/32). Conclusion The monitoring of ICU clinical pathogens and their resistance should be strengthened. It is a great significance to use antibiotics rationally according to the results of susceptibility testing, in order to control the occurrence of resistant bacteria , prevent and control hospital infection and infection outbreak.

目的 研究并探讨产前优生筛查对出生缺陷的干预作用。方法 于2013年1月—2015年12月,选取69 183例孕产妇的临床资料进行回顾性研究,胎儿总数为69 262例,所有孕产妇在妊娠期均进行产前优生筛查,对产前筛查结果进行分析,统计胎儿异常例数,采取相应的产前干预措施,并对未检出胎儿异常的孕产妇进行跟踪随访,观察其妊娠结局,统计出生缺陷儿娩出例数及产前筛查漏检率。结果 69 262例胎儿中,共有7 470例胎儿检出异常,其胎儿异常率为10.79%,其中2013年检出1 910例,2014年检出2 569例,2015年检出2 991例,其检出率分别为9.15%、10.70%、12.17%,最终经产前诊断检查确定为出生缺陷的胎儿共98例,均采用引产术以终止妊娠。对未检出异常的61 792例胎儿进行跟踪随访后发现,其中17例胎儿在孕期流产,有9例出生缺陷儿娩出,其出生缺陷发生率为0.1 457‰,其产前筛查漏检率为0.1 456‰。结论 在产前对孕产妇进行产前优生筛查,并根据产前筛查结果进行相应的干预,可有效检出异常胎儿,及时终止异常妊娠,有利于减少缺陷儿的出生,促进优生优育。

Objective To study and discuss intervention effects of prenatal eugenic screening in birth defects. Methods From January 2013 to December 2015, we did retrospective study on the clinical data of 69 183 cases of pregnant in which there were 69 262 fetal cases, made prenatal eugenic screening for all pregnant women. Prenatal screening results were analyzed, fetal abnormal cases were calculated. We took appropriate prenatal intervention measures, and followed up pregnant women who had no detection of fetal abnormal. We observed the pregnancy outcome, and calculated the defected childbirth cases and prenatal screening miss rates. Results 69 262 cases of fetus, a total of 7 470 cases of fetal abnormalities were detected. The fetal abnormality rate was 10.79%, of which 1 910 cases were in 2013, 2 569 cases in 2014, 2 991 cases in 2015. The detection rates respectively were 9.15%, 10.70%, 12.17%. 98 cases were determined as fetal birth defects by the final prenatal diagnosis examination, in which all adopted induction of labor to terminate pregnancy. 61 792 cases who were not detected anomalies were followed up in which 17 cases of fetus were found and had abortion during pregnancy, and 9 cases of fetal birth defects were delivered . The incidence of birth defects was 0.1 457 ‰, the prenatal screening miss rate was 0.1 456 ‰. Conclusion Pregnant women were made prenatal eugenic screening and according to the result of prenatal screening we took corresponding intervention, which is effective detect abnormal fetus. We may have timely termination of abnormal pregnancy,and reduce birth defects. It may promote human eugenics.

目的 研究音乐疗法对新生儿喂养不耐受的保护作用,以及对胃动素和胃泌素水平的影响。方法 将2013年3月—2015年6月在我院新生儿科住院治疗的40例喂养不耐受新生患儿随机分为音乐治疗组和常规治疗组,治疗干预后,比较两组的喂养不耐受情况以及GAS和MOT水平。结果 音乐治疗组腹胀缓解时间、吸吮吞咽功能建立时间、达足量喂养时间、静脉营养应用时间明显的短于常规治疗组,体重增加量明显的高于常规治疗组(P＜0.05);治疗后,音乐治疗组的GAS和MOT水平明显的高于常规治疗组(P＜0.05)。结论 音乐疗法可以促进新生儿喂养不耐受症状改善,提高患儿血清GAS和血浆MOT水平,促进其生长发育。

Objective To study music therapy for neonatal feeding intolerance protection, and the effects of levels of gastrin and motilin. Methods From March 2013 to June 2015 in newborn Department of Pediatrics in our hospital 40 cases feeding tolerance of newborns were randomly divided into music therapy group and routine treatment group, after treatment, compared feeding tolerance and GAS and MOT level in the two groups. Results Abdominal distension relieving time, sucking and swallowing function establishment time, full enteral feeding time, use of the parenteral nutrition in the music therapy group was fewer than the conventional therapy group. Weight gain was higher than that in the conventional treatment (P<0.05). After the treatment, GAS and MOT levels in the music therapy group were higher than conventional treatment group, the difference is statistical significant (P<0.05). Conclusion Music therapy may promote neonatal feeding intolerance symptoms and improve patients serum GAS and plasma MOT levels, promote their growth and development.

目的 探讨尼莫地平对无症状脑梗塞认知功能障碍的改善作用及安全性。方法 将80例无症状脑梗塞患者随机分为治疗组和对照组,每组40例,于治疗前及治疗后3月分别进行蒙特利尔认知量表(MoCA)、简易智能状态量表(MMSE)、画钟测验(CDT)评估,并比较2组的评分结果。结果 尼莫地平治疗后3月MMSE 评分为(26.35±3.26)分,MoCA评分为(25.53±4.31)分,CDT评分为(6.12±2.23)分,较对照组分别为MMSE 评分为(23.12±3.45)分,MoCA评分为(22.21±3.63)分,CDT评分为(4.35±2.61)分有改善,差异均有统计学意义(P<0.05)。80例患者中MoCA评测异常组在视空间与执行能力、延迟记忆、注意力及计算力、抽象思维等分项得分明显低于MoCA评测正常组(P<0.05)。结论 尼莫地平能有效改善无症状脑梗塞患者的认知功能,且安全性较高。

Objective To explore the role of nimodipine in improving cognitive function in silent cerebral infarction patients and its safety. Methods Eighty SCI patients were divided randomly into 2 groups.MMSE、MoCA and CDT scores were assessed before treatement and after 3 month of treatment.The results were compared between the 2 groups. Results MMSE、MoCA and CDT scores of Nimodipine group(26.35±3.26, 25.53±4.31, 6.12±2.23, respectively), improved when compared with the control(23.12±3.45, 22.21±3.63, 4.35±2.61,respectively),and the difference was statistical significance (P<0.05). The patients with abnormal MoCA had lower scores in several cognitive domains (visuospatial and executive abilities, delayed memory, attention and capacity of calculation, abstract thinking (P<0.05) compared with control group. Conclusion Nimodipine could improve effectively the cognitive function in SCI patients and with a higher safety.

目的 探讨加味骨洗方外治法用于治疗类风湿关节炎的疗效以及类风湿因子等临床指标的变化。方法 选取100例类风湿关节炎患者,随机分为治疗组和对照组各50例。治疗组给予加味骨洗方及TDP特定电磁疗灯导入的外治,对照组给予TDP特定电磁疗灯磁疗。结果 在缓解症状和恢复功能方面治疗组总有效率为84%,对照组总有效率为58%,治疗组各临床指标与对照组相比均有差异(P<0.05)。结论 加味骨洗方治疗类风湿关节炎疗效显著,能有效降低类风湿因子等炎性指标,值得临床推广。

Objective To discuss curative effects of rheumatoid arthritis treatment and clinical indicators transformation including rheumatoid factor by additional Guxi prescription external therapy. Methods We selected 100 patients who were suffered from rheumatoid arthritis, divided randomly into two groups. 50 patients for the treatment group and another 50 for the control group. The treatment group was treated by the additional Guxi prescription external therapy. While the control group was treated by the infrared magnetic therapy. Results The effective proportion of the treatment group was 84%, while the control group total was 58% in the aspect of relieve the symptoms and recovery of functions. Besides, all clinical indicators of the treatment group were inferior to the control group(P<0.05). Conclusion There are effects for treating rheumatoid arthritis by utilizing additional Guxi prescription external therapy. This therapy which can effectively reduce the inflammatory indexes of the rheumatoid factor is worth promoting clinically.