目的 探讨胸腰椎爆裂性骨折(TLBF)应用经伤椎椎弓根钉固定结合经椎弓根植骨治疗的临床效果。方法 选取我院2013年7月—2016年7月收治的28例TLBF患者,均行经伤椎椎弓根钉固定结合经椎弓根植骨治疗。详细记录所有患者术中出血量、手术时间及住院时间等围术期情况;比较28例患者手术前后影像学指标、腰背部疼痛视觉模拟评分法(VAS)评分及Frankel分级;随访期间并发症情况。结果 与术前相比,28例患者术后1个月、3个月时的椎体前后缘高度、Cobb角及VAS评分,均更优(P<0.01);经Ridit分析知,28例患者术后6个月时Frankel分级显著优于术前(P<0.01);术后随访6个月期间内,未见内固定松动、断裂等情况,且并未发生因椎弓根植骨而引起的神经症状。结论 TLBF应用经伤椎椎弓根钉固定结合经椎弓根植骨治疗能有效复原与保持脊柱生物力学稳定性,矫正后凸畸形,减少患者术后痛苦与并发症,改善神经功能,安全可靠,具有较高临床推广价值。

Objective To investigate the effects of the pedicle screw fixation combined with pedicle bone graft in treatment of thoracolumbar burst fracture(TLBF). Methods Selected 28 patients with TLBF treated in our hospital from July, 2013 to July, 2016, all of whom were treated with the pedicle screw fixation combined with pedicle screw fixation in the treatment of vertebral pedicle screw fixation. Recorded all patients' detailed situations on preoperative period of bleeding volume, operation time and length of stays. Compared 28 patients' imaging parameters, back pain visual analogue scale (VAS) score and Frankel classification before and after operation. And to observe the complications during follow-up as well. Results Compared with the pre-operation, 28 patients' anterior and posterior margin height, Cobb angle and VAS score were significantly better (P<0.01) than that of one month and three months after the operation. According to the Ridit analysis, six months after the operation, 28 patients' Frankel classification was better than that of pre-operation (P<0.01). No internal fixation loosening or breakage was found during the follow-up period of 6 months, and there was no nerve symptoms caused by pedicle screw fixation. Conclusion The pedicle screw fixation combined with pedicle screw fixation in treatment of thoracolumbar burst fracture(TLBF) can effectively restore and maintain the biomechanical stability of the spine, correct kyphosis, reduce postoperative pain and complications, improve nerve function and be safe and reliable,have higher clinical value.

目的 研究老年慢性阻塞性肺病(COPD)患者血清IL-33水平与其病程分期的相关性。方法 选择60例老年COPD患者作为观察组,按病程分期分为稳定期组和急性加重组,另选择15例非COPD老年患者作为对照组;分别检测血清IL-33水平。结果 各组组间比较结果显示,AECOPD组和COPD稳定期组的血清IL-33水平均高于对照组(P<0.05),其中,AECOPD组的比COPD稳定期组的更高(P<0.05)。结论 血清IL-33水平在老年COPD患者中增高,急性加重期更明显,提示IL-33在老年人COPD发生、发展中可能起重要作用。

Objective To have relevant research between serum IL-33 level and the stage of disease in elderly patients with chronic obstructive pulmonary disease(COPD). Methods 60 elderly patients with COPD were selected as the observation group, who were divided into stable COPD group and AECOPD group. The other 15 patients with non-COPD were selected as the control group. The serum IL-33 levels were detected respectively. Results The comparison results between the groups showed that the serum IL-33 levels in the AECOPD group and the stable COPD group were higher than those in the control group(P<0.05), which was higher in the AECOPD group than in the COPD group(P<0.05). Conclusion Serum IL-33 levels were increased in elderly patients with COPD, the increase in acute exacerbation was more obvious, suggesting that IL-33 may play an important role in the occurrence and development of COPD in the elderly.

目的 比较腹腔镜前列腺癌根治术(laparoscopic radical prostatectomy,LRP)后发生尿失禁(postprostatectomy incontinence,PPI)与没有发生PPI的患者在尿动力学上的差异,为临床诊疗提供尿动力学依据。方法 对87例LRP术后的患者按术后是否并发PPI分成两组,行尿动力学检查后进行比较分析。结果 PPI组患者术中保留一侧或双侧神经血管束的比例少于非PPI组,且最大尿道闭合压(maximum urethral closure pressure,MUCP)、最大膀胱容量(maximum cystometric capacity,MCC)、排尿时膀胱开口压力和最大逼尿肌压均较非PPI组低。而腹压漏尿点压试验阳性与临床上是否漏尿并不完全相符。多变量回归分析表明,术中保留神经血管束、MUCP和MCC是PPI的相关因素。结论 PPI与LRP术中保留神经血管束、MUCP和MCC独立相关。尿动力学检查能为更精准有效指导临床治疗提供依据。

Objective To compare the urodynamic parameters in men with and without postprostatectomy incontinence(PPI) after laparoscopic radical prostatectomy(LRP). Methods 87 patients of prostatic carcinoma after LRP were divided into two groups according to have PPI or not. After urodynamic study, the data were collected to find the difference. Results Overall, the proportion of preservation of unilateral or bilateral neurovascular bundles(NVBs) during LRP was lower in PPI group than that in non-PPI group. Besides, the patients in PPI group had lower maximum urethral closure pressure (P=0.04), maximum cystometric capacity (P=0.04), detrusor pressure during opening (P=0.02)and maximum detrusor pressure (P<0.001), as compared with those in non-PPI group. In the multivariate logistic regression, the preservation of unilateral or bilateral NVBs, MUCP and MCC were identified as the related factor with PPI. Conclusion PPI is significantly associated with the preservation of unilateral or bilateral NVBs, MUCP and MCC. Urodynamic test can be used to make the treatment for PPI. It will be more accurate and effective in clinical practice.

目的 探讨在待产孕妇中应用中医药辨证护理对促进气血虚弱型足月妊娠孕妇宫颈成熟的临产前护理策略及临床效果。方法 选取中医辨证为气血虚弱型的足月妊娠单胎头位初产妇180例,随机分为对照组即催产素组及常规护理组60例,中医药辨证护理组即在对照组的基础上入院后即给予中药口服加辨证护理60例,空白组即期待观察组及常规护理组60例。观察三组治疗前后宫颈Bishop评分,阴道及宫颈分泌物FFN(胎儿纤连蛋白)定性测定,分娩结局及对母胎的影响。结果 中医药辨证护理组在临产率、阴道分娩率及宫颈评分、FFN测定等方面较对照组及空白组均有差异,P<0.05。结论 对于气血虚弱型足月妊娠在入院后开展中医药辨证护理对临产前宫颈成熟有辅助作用,对于提高顺产率,降低高危分娩促进母儿健康有积极作用,值得推广。

Objective To explore the prenatal care strategy of applying Chinese medicine dialectical care to promoting cervical ripening of full-term pregnant women with qi-blood deficiency and its clinical effect. Methods We chose 180 first-time, full-term pregnant women with single fetus cephalic presentation who were diagnosed as with qi-blood deficiency and then randomly divided them into three groups, 60 in control group with oxytocin and usual care; 60 in group of Chinese medicine dialectical care, which provided oral use of Chinese medicine and dialectical care after those women being admitted to hospital; 60 in blank group with usual observation and care. We did Bishop assessment of neck of uterus before and after treatment in these three groups, conducted qualitative test in FFN (Fetal Fibronectin), the secreta from vagina and neck of uterus, and observed delivery outcome as well as the influence to mother and child. Results Compared with control group and blank group, the group ofChinese medicine dialectical care was outstanding in terms of labor rate, vaginal delivery rate, and FFN test(P<0.05). Conclusion Chinese medicine dialectical care boosts cervical ripening of full-term pregnant women with qi-blood deficiency. It is helpful to increase natural labor rate, reduce high-risk delivery, and promote health of mother and child. Therefore it is worth to be popularized.

目的 探讨健康成人颈段气管的体外高频超声影像特点,为开展体外超声在检测颈段气管病变应用作前期研究。方法 应用体外高频超声观察120例健康成人颈段气管结构的声像表现,并对气管环T1-T4的内外横径、气管环厚度、相邻气管环间距进行测量和统计学分析。结果 120例志愿者均获得了颈段气管前、侧壁声像图,以及气管环T1-T4内外横径、气管环厚度、相邻气管环间距测值。结论 体外高频超声可以清晰显示气管形态和细微支撑结构,并进行部分径线测量,有望成为评估颈段气管病变的一种有价值的辅助手段。

Objective We investigated features of the healthy adult cervical tracheas in order to studying cervical tracheal lesions by extracorporeal high-frequency ultrasound EHFUS. Methods EHFUS examination of the trachea was performed in 120 asymptomatic adult volunteers. We observed imaging features of the healthy adult cervical tracheas, and measured TRID, TRED, TRTh and TRAS to analysis. Results The cervical tracheal anterior and side wall ultrasonograms, and measurements were obtained in all subjects. Conclusion The cervical tracheal shape and the fine structure of support can be seen in EHFUS, and partly of diameter measurements were obtained. Thus EHFUS may be a valuable assistant method to assess cervical tracheal lesions of support structure.

目的 探讨雷公藤甲素防治大鼠青光眼术后滤过泡纤维化的可行性。方法 选取Wistar大鼠100只分为两组,对照组和观察组各50例。采用房水释放联合激光房角光凝法建立青光眼大鼠模型,然后所有大鼠均进行青光眼手术。手术后,观察组大鼠使用雷公藤甲素预防治疗青光眼术后滤过泡纤维化,对照组大鼠使用5-氟尿嘧啶预防治疗青光眼术后滤过泡纤维化。观察比较防治滤过泡纤维化效果。结果 观察组大鼠的眼压在手术后第1天与对照组相比无差异(P＞0.05),在第6天、14天低于对照组(P＜0.05),观察组大鼠滤过泡面积在手术后第1天、6天、14天均小于对照组大鼠(P＜0.05);观察组大鼠的治疗后滤过泡分型Ⅰ型和Ⅱ型均优于对照组,Ⅲ型和Ⅳ型均低于对照组(P＜0.05);观察组术后不良反应发生率为12.16%,低于对照组22.86%(P＞0.05)。结论 雷公藤甲素防治大鼠青光眼术后滤过泡纤维化效果明显,且安全性较高,值得临床广泛运用推广。

Objective To investigate the feasibility of triptolide in prevention and cure rats glaucoma surgery fibrosis. Methods 100 cases of Wistar rats were divided into two groups, with 50 cases in the control group and the observation group.Glaucoma rat model were built by aqueous release combined with laser photocoagulation, and all rats underwent glaucoma surgery. After surgery, the rats in the observation group were observed their triptolide preventive treatment in glaucoma surgery fibrosis, the control rats were observed their 5-fluorouracil preventive treatment in glaucoma surgery fibrosis.The effects of prevention and treatment of bleb fibrosis were compared. Results The intraocular pressure of rats in observation group in the first day after surgery compared with the control group has no significant difference (P>0.05), on the 6th、 14th day it was lower than the control group rats(P<0.05). Filtration area in the observation group on first, 6th day, 14th days after surgery, was less than the control rats(P<0.05); In the observation group, the type Ⅰ and type Ⅱ of filtering bleb were better than those of the control group, the type Ⅲ and type Ⅳ were lower than those of the control group (P<0.05);The adverse reaction rate was 12.16% in observation group, it was lower than the control group 22.86% (P<0.05). Conclusion Triptolide in prevention and cure of rats glaucoma surgery fibrosis is obvious, and high security. It is worthy of promotion.

目的 探讨Bcl-2、COX-2在宫颈癌新辅助化疗前后表达的意义, 以及新辅助化疗(NACT)对宫颈癌的近期临床疗效。方法 对32例宫颈癌患者,采集NACT治疗前后的宫颈癌组织标本,采用免疫组织化学SP法检测组织中的Bcl-2及COX-2表达。结果 ①经NACT后,治疗总有效率(CR+PR)为75%,无效率(PD+SD)为25%。②宫颈癌组织中Bcl-2、COX-2的表达均出现明显下降,差异均有统计学意义(P<0.05);临床有效组中Bcl-2、COX-2的表达在NACT后出现显著下降(P<0.05),无效组中Bcl-2、COX-2的表达在NACT前后无明显统计学意义(P>0.05)。结论 Bcl-2、COX-2的表达情况对评价宫颈癌患者新辅助化疗效具有肯定的临床意义,宫颈癌行NACT后近期疗效良好。

Objective To investigate the expression of Bcl-2 and COX-2 in cervical cancer before and after neoadjuvant chemotherapy; To evaluate the efficacy of neoadjuvant chemotherapy(NACT) for cervical cancer in the recent clinical effects. Methods To select 32 cases of patients with cervical cancer, collect the cervical cancer tissues before and after NACT, immunohistochemical SP method was used to detect the expression of Bcl-2and COX-2 in the tissues. Results After neoadjuvant chemotherapy, total effective rate (CR+PR) was 75%(24/32), inefficient rate(PD+SD) was 25%(8/32). The expression of Bcl-2 and COX-2 of cervical cancer patients who had neoadjuvant chemotherapy (NACT), before and after, had great differences. The difference had statistical significance (P<0.05); The expression of Bcl-2 and COX-2 were significantly lower after neoadjuvant chemotherapy in clinical effective group(P<0.05), there is no statistical significance in clinical non-effective group(P>0.05). Conclusion The expression of Bcl-2 and COX-2 of cervical cancer patients has certain clinical significance in evaluating the effect of neoadjuvant chemotherapy in cervical cancer patients. Recent curative effect after NACT in the cervical cancer patients is good.

目的 探讨脉管炎围手术期出现焦虑症状及影响因素和护理以提高在围手术期的生活质量。方法 通过对脉管炎患者进行问卷调查焦虑发生及影响因素。结果 脉管炎围手术期患者出现焦虑是十分常见的,生活质量下降直接或间接影响手术的成功率。结论 有效的护理干预能改善各方面的焦虑因素,使患者在围手术期保持心情舒畅,从而适应截肢形象的改变,提高生活质量。

目的 探索在神经外科护理教学中使用周期目标教学模式对学生理论知识、护理技能的作用与意义。方法 采用统一标准百分制操作与理论考核,比较周期目标教学模式和一对一带教模式下护理学生护理理论与技能掌握、应用的差异。结果 实验组学生理论考核和操作考核成绩比一对一带教学生成绩高。结论 周期目标教学模式使学生的实习思路清晰,提高了学生实习的积极主动性;实习目标明确,促进了护生在专科技能操作上的提高。对提高我科护理教学质量起到积极的促进作用。

目的 “看病难”这个与社会民生密切相关的难题,长期困扰广大民众。主要表现在看病流程复杂,挂号、候诊排队时间长,就诊指引不清晰,服务水平低。移动互联网时代,各个传统行业都在转变运营模式,医院应如何因势利导,寻求“破冰”良策。本文结合佛山市中医院的应用案例,对利用微信公众号^[1]改造现有业务流程,有效解决“看病难”问题进行讨论分析。

The problem “proper health care is difficult to get” is closely related to the people's livelihood,which has plagued the people for a long period of time.The difficulties mainly focused on the complex process,long-time waiting,unclear instruction and the low level of service.In the time of mobile internet,each traditional industry is shifting the operation mode.What the hospital should do to is to make the best use of the advantages to solve the problems.The purpose of the research is to optimize the current processes and to solve the problem of “Proper health care is difficult to get” by using Wechat public number combined with the cases in Foshan hospital of traditional Chinese medicine.