目的 比较冷冻前和复苏后脐带血样本的造血功能,探讨冷冻袋附属小管是否可用于脐带血质量控制及移植供体发放前复核。方法 选取2009年3月—2021年2月在广州脐血库冻存的53份脐带血为研究对象,常规复温后,从冷冻袋和附属小管抽取样本,分为冷冻前、小管复苏和大袋复苏组。评价各组的总有核细胞(total nucleated cells,TNCs)数、细胞活率、CD34阳性细胞数量、粒-巨噬细胞集落(colony-forming units-granulocyte/macrophages, CFU-GMs)数量、祖细胞集落(colony-forming units, CFUs)数量等质量参数。结果 小管复苏后TNCs数量、细胞活率、CFU-GMs数量及CFUs数量较冷冻前均显著减少,差异有统计学意义(P＜0.05),而二者的CD34阳性细胞数量差异无统计学意义(P＞ 0.05);大袋复苏后TNCs数量、细胞活率及CFUs数量较冷冻前各相应值比较,差异有统计学意义(P＜0.05),而二者的CD34阳性细胞数量及CFU-GMs数量差异无统计学意义(P＞ 0.05);小管复苏后的TNCs数量、细胞活率、CD34阳性细胞活率、CFU-GMs数量及CFUs数量较大袋复苏后的相应值均减少,差异有统计学意义(P＜0.05),而二者的CD34阳性细胞数量差异无统计学意义(P＞ 0.05)。小管复苏与大袋复苏后的各项参数存在高度相关性。结论 附属小管在一定程度上可作为脐血库质量控制和产品发放前复核的取材。

Objective To compare the hematopoietic function of cord blood before and after cryopreservation, and to explore whether sampling from the attached segment can be used for quality control of cord blood units and confirmatory testing before transplantation. Methods A total of 53 cryopreserved cord blood units from March 2009 to February 2021 in Guangzhou Cord Blood Bank were enrolled in this study. After routine thawing, samples were taken from main bag and its attached segment. They were divided into pre-freezing, post-thawing segment and post-thawing main bag groups. Total nucleated cells (TNCs), cell viability, CD34 positive cells, colony-forming units-granulocyte/macrophages(CFU-GMs)and colony-forming units (CFUs) were examined. Results The number of TNCs [(1.12±0.38)×10⁹], cell viability [(79.11±7.71)%], the number of CFU-GMs [(5.55±4.58)×10⁵] and the number of CFUs [(15.11±9.68)×10⁵] were significantly decreased in samples from post-thawing attached segments compared with those pre-freezing(P＜0.05), but there was no significant difference in the number of CD34 positive cells between two groups (P＞0.05). The number of TNCs [(1.25±0.40)×10⁹], cell viability [(84.75±5.89)%] and CFUs [(18.61±6.42)×10⁵] in samples from post-thawing main bags were significantly different from those pre-freezing (P＜0.05), but there were no significant differences in the number of CD34 positive cells and CFU-GMs between them (P＞0.05). The number of TNCs, cell viability, CD34 positive cell viability, the numbers of CFU-GMs and CFUs were significantly decreased in post-thawing segments compared with those in main bags after thawing (P＜0.05), but there was no significant difference in the number of CD34 positive cells between the two groups (P＞0.05). Spearman correlation analysis showed that the parameters of samples from main bag and its attached segment were highly correlated after thawing. Conclusion Cord blood from attached segment could be quality control sample for cord blood bank and confirmatory testing before product release in some degree.

目的 本研究对广州地区5家教学医院的鲍曼不动杆菌进行分子流行病学分析。方法 5家教学医院共采集138株鲍曼不动杆菌,利用多位点序列分型(multilocus sequence typing,MLST)及eBURST算法评价菌株之间的遗传关系。结果 MLST将138株鲍曼不动杆菌分为8个已有序列类型(STs),分别为ST195、ST208、ST457、ST136、ST254、ST548、ST445和ST53,还发现17个新STs。其中ST195的数量最多,占所有分离株的35.5%(49/138),其次为ST208,占所有分离株的21.0%(29/138)。eBURST算法分析显示以ST195为预测祖先型的克隆复合体(clonal complex, CC) 195在医院环境中广泛传播。结论 鲍曼不动杆菌CC195是广州地区的流行克隆,各家医疗机构应根据其自身实际制定感染防控策略。

Objective We analyzed the molecular epidemiology of A.baumannii isolated from 5 teaching hospitals in Guangzhou to identify the epidemic clone in this area. Methods A total of 138 strains of A.baumannii were collected from 5 teaching hospitals, and the genetic relationship was evaluated by multilocus sequence typing (MLST) and eBURST algorithm. Results MLST divided 138 strains of A.baumannii into 8 existing sequence types (STs), namely ST195, ST208, ST457, ST136, ST254, ST548, ST445 and ST53, and 17 new STs. Among them, ST195 had the largest number, accounting for 35.5% (49/138) of all isolates, followed by ST208, accounting for 21.0% (29/138) of all isolates. eBURST algorithm showed that the clonal complex (CC) 195, the predicted founder ST195, was widely spread in the hospital environment. Conclusion A.baumannii CC195 was an epidemic clone in Guangzhou area. Medical institution should develop infection prevention and control strategies according to its own actual conditions.

目的 探讨广州地区儿童2019新型冠状病毒(2019 novel coronavirus, 2019-nCoV)感染筛查/疑似病例的流行病学特点、发病特点、可能的原因及防控建议。方法 回顾性分析2020年1月20日—2020年2月29日广州市唯一一家儿童2019-nCoV感染隔离定点医疗单位隔离病房收治住院的符合儿童2019-nCoV感染筛查/疑似病例129例,对其流行病学、发病特点、临床特征、实验室检查及转归、随访等进行总结分析。 结果 男 79例,女 50例,最小1个月,最大13岁,中位数2岁,51例(39.5%)有武汉疫区旅游或居住史,20例(15.5%)有与来自疫区有呼吸道症状人员接触史,17例(13.1%)周边或社区有确诊病例,3例(2.3%)有确诊病人接触史(其中2例为家庭确诊病例密切接触史),38例(29.5%)为临床符合或聚集性发病;临床症状:发热121例(93.8%),咳嗽92例(71.3%),流涕50例(38.8%),32例伴有腹泻、呕吐/腹痛(24.8%),102例(79.0%)白细胞降低或正常,C反应蛋白(C-reactive protein,CRP)＜20 mg/L有103例(79.8%),57例(44.2%)胸片或CT示肺部斑片状影或实变;病原学检查:2019-nCoV实时荧光定量反转录PCR检测结果:所有患儿及陪同家属都有行咽拭子检查,只有21例患儿(16.3%)有行肛拭子检查,仅有1例(0.78%)家庭确诊病例密切接触者肛拭子阳性,但连续多次咽拭子结果阴性,余患者肛拭子和咽拭子及陪同家属咽拭子结果均阴性。其他病原学检查结果61例(47.3%),包括14例RSV阳性,9例流感病毒A,8例人偏肺病毒,6例肠道病毒,6例流感病毒B,6例肺炎支原体,4例副流感病毒1型,1例副流感病毒3型,2例人博卡病毒,3例腺病毒,1例肺炎克雷伯菌,1例人型葡萄球菌,其中1例合并副流感病毒1型及人博卡病毒。跟踪唯一1例确诊患者咽拭子多次检查均阴性,肛拭子持续19天后才转阴,一直无任何症状。其余患者好转出院后第3天、7天及14天进行随访,无异常发现。结论 儿童2019-nCoV感染筛查/疑似病例临床多表现为呼吸道或消化道症状,确诊主要依靠核酸检测,新冠病毒感染确诊率极低,而其将近50%病例能找到除新冠病毒外的其它相关病原体;高危患者为密切接触者,但存在漏诊的可能,肛拭子阳性率或高于咽拭子。

Objective To explore the epidemiological characteristics, onset characteristics, pathogenic mechanism of 2019-nCoV infection in children, and its control and prevention in Guangzhou. Methods From January 20, 2020 to February 29, 2020, a retrospective analysis was carried out on 129 suspected cases of 2019-nCoV infection admitted to the isolation ward of the only medical unit designated for children in Guangzhou. The epidemiology, disease characteristics, clinical characteristics, laboratory examination, outcome and follow-up were summarized and analyzed. Results There were 79 males and 50 females, with a minimum age of 1 month and a maximum age of 13 years. Anong them, 51 cases (39.5%) had a history of tourism or residence in the epidemic area of Wuhan, 20 cases (15.5%) had a history of contact with people with respiratory symptoms from the epidemic area, 17 cases (13.1%) with a confirmed case in the surrounding area or community, 3 cases (2.3%) had a history of contact with a confirmed patient (2 of them were family clustering cases), 38 cases (29.5%) were clinically suspected cases. Clinical symptoms: 121 cases with fever (93.8%), 92 cases with coughing (71.3%), 50 cases with runny nose (38.8%), 32 cases with diarrhea, vomiting or abdominal pain (24.8%). In 102 cases (79.0%), white blood cells were decreased or normal, 103 cases (79.8%) with CRP＜20 mg/L, and 57 cases (44.2%) showed focal infection on chest X-ray or CT scan. Etiological examination: only one case (0.78%) of the family confirmed cases had positive anal swab result, but the throat swab results were negative all the time. The anal swab and throat swab results of other patients and the throat swab results of their accompanying family members were negative. Other pathogens were detected in 61 cases (47.3%), including 14 RSV positive cases, 9 influenza A positive cases, 8 human metapneumovirus positive cases, 6 enterovirus positive cases, 6 influenza B positive cases, 6 Mycoplasma pneumoniae positive cases, 4 parainfluenza virus type 1 positive cases, 1 parainfluenza virus type 3 positive cases, 2 human bocavirus positive cases, 3 adenovirus positive cases, 1 Klebsiella pneumoniae positive cases, 1 Human Staphylococcus positive case, and 1 case with parainfluenza virus type 1 and human bocavirus. The only confirmed patient was followed up while multiple pharyngeal swab results were negative, and the positive anal swab results lasted for 19 days before turning negative and remained asymptomatic. Other patients were followed up on the 3rd, 7th and 14th day after discharge, and no abnormal findings were found. Conclusion Screening/suspected cases of 2019-nCoV infection in children were mostly clinically manifested as respiratory or gastrointestinal symptoms. The diagnosis rate of nucleic acids was extremely low, and there was a possibility of missed diagnosis. Nearly 50% of cases could find other relevant pathogens excluding the 2019-nCoV. The positive rate of anal swab results was higher than that of pharyngeal swab.

目的 本文旨在研究穿心莲内酯对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)患者血清学中的炎症反应因子及肺部功能改变的影响。方法 从我院已出院的患者中挑选2017年6月—2018年6月期间收治的AECOPD患者共80例,其中给予哌拉西林舒巴坦抗感染和雾化吸入布地奈德及复方异丙托溴铵治疗的患者为对照组,对照组的治疗方法基础上给予喜炎平注射液的患者为观察组,各40例。对2组患者接受治疗前后血清学中的基质金属蛋白酶-9 (matrix metalloproteinase-9, MMP-9)、降钙素原 (procalcitonin, PCT)、白介素-6 (interleukin-6, IL-6) 水平和肺功能指标等方面进行比较。结果 2组治疗前血清学MMP-9、PCT、IL-6和肺功能指标第1秒用力呼气容积(forced expiratory volume in one second, FEV1)、用力肺活量(forced vital capacity, FVC)、一秒率(FEV1/FVC)无差异(P＞0.05)。观察组经过治疗后MMP-9为(1995.13±347.281)pg/mL、IL-6为(7.98±3.23)pg/mL,低于对照组的(2159.30±367.477)pg/mL、(10.03±5.45)pg/mL(P＜0.05);观察组治疗后的PCT、FEV1、FVC和FEV1/FVC与对照组相比差异无统计学意义 (P＞0.05)。结论 穿心莲内酯在AECOPD患者中可以减少血清学中炎症因子,值得在临床中推广。

Objective To investigate the effect of andrographolide on levels of serum inflammatory factors and pulmonary function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Eighty patients with AECOPD who were treated in our hospital from June 2017 to June 2018 were selected. Forty patients in the control group were given anti-infection treatment with piperacillin and sulbactam and aerosol inhalation with compound ipratropium bromide and budesonide, while other 40 patients in study group were given andrographolide additionally. The levels of serum matrix metalloproteinase-9 (MMP-9), procalcitonin (PCT), interleukin-6 (IL-6) and the pulmonary function indexes of patients in the two groups were observed and compared before and after treatment. Results There were no statistically significant differences in the serum levels of MMP-9, PCT and IL-6 and the pulmonary function indexes forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC of the two groups before treatment (P>0.05). After treatment, in the study group, the MMP-9 and IL-6 levels in serum were (1995.13±347.281)pg/mL and (7.98±3.23)pg/mL respectively, which were significantly lower than that in the control group [(2159.30±367.477) pg/mL and (10.03±5.45) pg/mL (P＜0.05)].Compared with the control group, differences in the PCT, FEV1, FVC and FEV1/FVC in the study group were not statistically significant (P>0.05). Conclusion Andrographolide had significant clinical effect on the treatment of AECOPD, which could reduce the levels of serum inflammatory factors and it is worthy of clinical application.

目的 探讨急性心肌梗死患者细胞色素P450酶基因(cytochrome P450,family 2,subfamily C,polypeptide 19,CYP2C19)多态性与高敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、白细胞介素-6(interleukin- 6,IL-6)及临床预后的相关性。方法 选取2019年5月—2020年5月入住我院心血管内科的急性心肌梗死患者182例作为研究对象,研究对象均接受经皮冠脉介入术,采取RT-PCR方法进行外周全血CYP2C19基因多态性的检测,并进行分组。口服阿司匹林300 mg和氯吡格雷300 mg后次日,测定血中hs-CRP和IL-6含量,治疗后12个月内,随访主要心血管不良事件。结果 182例急性心肌梗死患者中,快代谢组(CYP2C19*1/*1)患者最多,为78例(42.8%);中等代谢组(CYP2C19*1/*2、CYP2C19*1/*3),为65例(35.7%);慢代谢型组(CYP2C19*2/*2、CYP2C19*2/*3、CYP2C19*3/*3)最少,为39例(21.5%)。与快代谢组比较,中代谢组及慢代谢组hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05);与中代谢组比较,慢代谢组患者hs-CRP、IL-6水平均升高,差异有统计学意义(P<0.05)。CYP2C19基因型与hs-CRP及IL-6呈正相关(r=0.163、0.175,P<0.05)。中代谢组、慢代谢组患者1年内主要心血管不良事件发生率高于快代谢组患者(P<0.05)。结论 CYP2C19基因型与hs-CRP及IL-6具有相关性,CYP2C19基因型为中代谢型和慢代谢型能够激活机体炎症反应,影响急性心肌梗死患者的临床预后。

Objective To explore the correlation of cytochrome P450 gene (CYP2C19) polymorphism with hypersensitive C-reaction protein (hs-CRP), interleukin-6 (IL-6) and prognosis in patients with acute myocardial infarction (AMI). Methods A total of 182 patients with AMI admitted to cardiology department from May 2019 to May 2020 were selected as the research objects, all subjects underwent percutaneous coronary intervention (PCI), and CYP2C19 gene polymorphism in peripheral blood was detected by RT-PCR, which was grouping basis. One day after taking aspirin 300 mg and clopidogrel 300 mg orally, the levels of hs-CRP and IL-6 in patients' plasma were measured. The major adverse cardiovascular events (MACE) were followed up for 12 months after treatment. Results Among 182 patients with AMI, 78 patients (42.8%) were in the fast metabolism group (CYP2C19*1/*1), 65 patients (35.7%) in medium metabolism group (CYP2C19*1/*2, CYP2C19*1/*3), 39 patients (21.5%) in the slow metabolism group (CYP2C19*2/*2, CYP2C19*2/*3, CYP2C19*3/*3).Compared with the fast metabolism group, hs-CRP and IL-6 levels in the medium and slow metabolism group were significantly higher (P<0.05); compared with the medium metabolism group, hs-CRP and IL-6 levels in the slow metabolism group were significantly increased (P<0.05). CYP2C19 genotype was positively correlated with hs-CRP and IL-6 levels (r=0.163, 0.175,P<0.05). The incidences of MACE in the medium and slow metabolism groups were higher than that in the fast metabolism group (P<0.05). Conclusion CYP2C19 genotypes were associated with hs-CRP and IL-6 levels. Medium and slow metabolism types of CYP2C19 gene can activate the inflammatory response and affect the clinical prognosis of patients with AMI.

介绍了欧洲标准评估框架(CAF)的具体内涵。从国家三级公立医院绩效考核、现代医院管理制度构建、医院高质量发展实现和全面推进健康中国建设四个方面对我国三级公立医院实施卓越绩效管理的必要性进行了分析。在此基础上,提出基于CAF的我国三级公立医院卓越绩效管理实现策略:将卓越绩效管理理念贯穿医院管理全过程;构建基于CAF的三级公立医院内部卓越绩效考核指标体系;构筑基于CAF的卓越绩效考核医院内部运行机制;打造符合院情的卓越绩效考核自评模式。

目的 对冠心病治疗过程中出现迷走神经反射的原因进行分析探讨,并进行高效防治措施的总结。方法 本研究采用现况研究进行调查。本研究以在本院2021年1月—2021年3月就诊并临床诊断为冠心病的患者作为研究对象,经过纳入、排除标准筛选,共挑选出240名患者作为研究对象。根据文献分析得知拔鞘管可能是影响冠心病介入治疗过程中出现迷走神经反射的重要原因,因此将研究对象分为2组,实验组130人,对照组110人。对2组患者进行冠状动脉腔内血管成形术+支架置入术。实验组在患者进行鞘管拔出时进行局部麻醉;对照组则按照常规方法对鞘管进行拔出,分析2组患者迷走神经发生反射的几率,运用统计学软件进行数据分析对比。结果 根据数据分析结果可知,2组患者出现迷走神经反射的几率并不相同,通过差异性分析可知2组数据的差异具有统计学意义,且观察组发生率低于对照组(P<0.05)。结论 建议在临床上对冠心病进行介入治疗时,拔除鞘管的过程应该加入合理的干预,以减少患者出现迷走神经反射的几率,增强患者预后。

目的 探究右美托咪定对二尖瓣置换术患者左右心室收缩和舒张功能影响。方法 选我院2019年1月—2020年12月期间110例二尖瓣置换术患者为研究对象,以随机数字表法分为对照组、观察组,各55例,分别实施常规静脉复合麻醉、常规静脉复合麻醉+切皮后微量泵注右美托咪定(负荷剂量1 μg/kg,10 min后维持每小时0.5 μg/kg至术毕),比较2组麻醉诱导后(T0)、体外循环(CPB)停机后30 min(T1)、CPB停机后60 min(T2)血流动力学指标,心肌损伤因子水平、左右心室收缩及舒张功能。结果 T1、T2时2组患者心率(HR)较T0高,平均动脉压(MAP)较T0低(P＜0.05);2组各时间点HR、MAP比较未见统计学差异(P＞0.05);T2时2组肌钙蛋白Ⅰ、肌酸激酶同工酶水平较T0时高,观察组T2时以上指标较对照组低(P＜0.05);各时间点2组二尖瓣瓣环等容收缩期峰值速度、三尖瓣舒张早期血流峰值速度/三尖瓣环舒张早期血流峰值速度无差异(P＞0.05);T2时观察组二尖瓣舒张早期血流速度峰值/二尖瓣瓣环舒张早期峰值速度、三尖瓣瓣环等容收缩期峰值速度较对照组低(P＜0.05)。结论 在二尖瓣置换术中使用右美托咪定,可减少患者心肌功能损伤,改善心室心肌舒张、收缩功能。

目的 本文主要对接受两种不同的甲氨蝶呤治疗方式与腹腔镜保守治疗输卵管妊娠患者治疗效果进行比较,了解不同治疗方案所具有的优势。方法 选择参与者为收治的输卵管妊娠患者200例(时间选择:2018年1月—2020年12月),以治疗方案进行分组(共2组,各100例)。对照组进行腹腔镜下输卵管线性切开术治疗,术中应用甲氨蝶呤治疗;研究组在术前进行甲氨蝶呤肌注,48小时后进行腹腔镜输卵管线性切开术治疗;比较治疗结果。结果 2组输卵管通畅率、术后持续异位妊娠率比较有差异,2组比对有统计学意义(P<0.05)。 2组手术指标(手术时长、术中出血量、β-hCG恢复至正常时间)比较有差异,2组比对有统计学意义(P<0.05)。结论 输卵管妊娠患者选择腹腔镜下输卵管线性切开术治疗时联合术前肌注甲氨蝶呤或术中应用甲氨蝶呤治疗,均可有助于输卵管妊娠症状的进一步缓解。但在此次治疗中患者术前接受甲氨蝶呤肌注+腹腔镜输卵管线性切开术联合治疗取得的疗效比常规的术中应用甲氨蝶呤更具有治疗优势,患者手术时长明显缩短,术中出血量明显降低,有效的避免反复电凝止血造成对输卵管造成的伤害,对输卵管功能进行有效保护,可推广。

目的 分析CT肺动脉栓塞指数(PAOI)与急性肺栓塞(APE)患者右心功能与预后的相关性。方法 以收治的86例疑似患者为研究对象,均行CT肺动脉成像(CTPA)检查,共60例APE患者,依据患者病情严重程度分为轻度、中度与重度,而无APE患者26例(对照组),分析左右心室最大短轴内径(RVd/LVd)、左右心室最大截面积比(RVA/LVA)、右心室短轴最大直径(RVMSA)、左心室短轴最大内径(LVMSA)、主肺动脉直径(MPAd)、上腔静脉直径(SVCd)、奇静脉直径(AZd)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)以及动脉血氧饱和度(SaO₂)与PAOI的相关性,并分析患者预后情况。结果 经比较,中、重度患者RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平高于轻度患者,而LVMSA低于轻度患者(P<0.05);且重度患者RVd/LVd、RVMSA水平高于中度,而RVA/LVA、LVMSA、MPAd与AZd水平比较无意义(P>0.05);3组SVCd水平比较P>0.05,其他参数指标比较差异明显(P<0.05);APE患者的PaO₂、PaCO₂以及SaO₂水平随着患者病情的加重呈现出逐渐下降趋势,且3组患者的PaO₂对比差异有统计学意义(P<0.05);PaO₂、PaCO₂和SaO₂与PAOI均呈负相关,且仅有PaO₂的差异存在统计学意义(P<0.05);POAI对APE患者的死亡有着一定的预测价值(P<0.05),最佳切点值58.91%,敏感度为85.29%,特异度为89.93%,其他数据未见明显诊断预测价值(P>0.05)。故RVd/LVd、RVA/LVA、RVMSA、MPAd与AZd水平与PAOI成正相关,而LVMSA水平与PAOI成负相关,与SCVd无关。结论 PAOI与APE患者的右心功能各参数以及动脉血气各参数均有密切关联性,可将其作为患者预后评估的有效指标。