目的 本研究旨在探讨颈椎手法治疗对颞下颌关节紊乱症患者的疗效,为其临床应用及推广提供依据。方法 将符合入组条件的40例诊断为颞下颌关节紊乱症的患者随机分为实验组(20例)和对照组(20例)。对照组给予物理治疗,包括超声波及超短波治疗。实验组除与对照组一样的物理治疗外,还给予手法治疗,包括椎旁软组织放松按摩,颈椎复位及枕后肌群抑制技术。两组的治疗均持续2周,每周5次,总共10次。两组患者分别在治疗前和治疗后评估其咬肌的压痛阈值、最大张口度、咀嚼肌(咬肌和颞肌)在静息状态下表面肌电平均电位、咀嚼肌在最大用力状态下表面肌电峰值均值,并计算咀嚼肌不对称性指数、总体活动不对称性指数。结果 组内前后比较:对照组患者治疗后仅部分咀嚼肌的静息电位、最大张口度和咬肌压痛阈值的改变有统计学意义(P<0.05);实验组治疗后所有的指标的改变均有统计学意义(P<0.05)。组间比较:通过比较两组治疗前后的差值,结果显示所有指标改变都有统计学意义(P<0.05)。实验组的静息电位和咀嚼肌不对称性指数下降更多(P<0.05),而最大张口度和咬肌压痛阈值增加得更多(P<0.05)。结论 相比单纯运用理疗的方式,采用颈椎手法治疗联合物理治疗对颞下颌关节紊乱患者,其疗效更加明显。

目的 观察手指点穴结合利水消散包外敷对癌性腹水的疗效。方法 选择我科收治的癌性腹水患者60例为研究对象,随机分为对照组和治疗组各30例。对照组常规限水、限钠、利尿护理,治疗组在常规护理的基础上,实施手指点穴结合利水消散包外敷腹部,7天为1疗程,共干预3个疗程后进行疗效评价,观察两组患者治疗前后体质量、腹围变化、生活质量评分(KPS)。结果 治疗组总有效率为86.66%,对照组为56.67%,治疗组临床疗效优于对照组(P＜0.05),两组治疗后平均体质量、腹围均比本组治疗前降低,且治疗组治疗前后差值大于对照组(P＜0.05),治疗组治疗后KPS评分也高于对照组(P＜0.05)。结论 手指点穴结合利水消散包外敷对癌性腹水有减轻疗效,能改善患者生活质量,操作简单,成本低,易被患者接受,适宜在临床应用。

Objective To observe the efficacy of finger-pointing combined with the dispersal package of outer application of the water to cancerous ascites. Methods 60 patients with cancerous ascites were selected as study subjects, randomly divided into treatment group and control group, with 30 cases each. The control group of patients using conventional water limit, sodium limit, diuretic car,in treatment group, on the basis of conventional care, the implementation of finger-pointing combined with water dissipation package outside the abdoment was take.We took the navel as the center,7 days for 1 course of treatment.After a total of 3 courses of intervention, the efficacy evaluation was carried out, to observe the two groups of patients before and after treatment in weights, abdominal circumference changes, qualities of life score (KPS). Results The total efficiency treatment group was 86.66%, the control group was 56.67%, the clinical efficacy of the treatment group was better than that of the control group (P <0.05), the average weight and abdominal circumference were lower after treatment in both groups than before treatment, and the difference between treatment group before and after treatment was greater than that of the control group (P <0.05), and the KPS score after treatment group was also higher than that of the control group (P<0.05). Conclusion Finger point slot combination with the ex-envelope of water dissipation has reduced the effect of cancerous ascites, can improve the quality of life of patients, simple operation, low cost, easy to be accepted by patients, suitable for clinical application.

目的 探讨支气管肺类癌的CT表现,为临床诊断提供更多信息。方法 回顾性地分析我院8例经病理证实的支气管肺类癌患者的CT资料及临床表现,并复习相关文献。结果 8例CT表现均为肺内单发病灶,其中周围型2例,中央型6例,病理证实非典型类癌2例,典型类癌6例;6例边界清楚,且密度多均匀;2例呈分叶状,1例边缘毛糙、伴短毛刺;5例病灶内部见钙化灶,1例病灶内见脂肪成分,1例见少量胸积液;5例肿块表现为“冰山征”,2例表现为支气管腔内结节,1例病灶边缘毗邻支气管分支;6例出现阻塞性肺不张或肺实变;增强扫描5例强化较明显,CT值升高≥30HU,其中2例不典型类癌强化不均匀,2例见可见强化血管影;3例呈轻-中度强化表现。结论 支气管肺类癌的CT表现具有一定特征性,对于临床诊断有一定价值,但其确诊多需要依靠病理检查。

Objective To investigate the CT findings of bronchial carcinoid and to provide more information for clinical diagnosis. Methods The CT findings and clinicaldata were retrospectively analyzed in 8 patientsconfirmed by biopsy. Results All the 8 cases manifested as single round mass on CT images, including 2 peripheral lesions and 6 central lesions. It was proved that 2 atypical tumors and 6 typical tumors. CT findings of these cases consisted of well-defined border and uniform density(6 cases),lobulated contour(2 cases) and rough margin with short burr(1 case). 5 cases contained calcification,1 case contained fat component and 1 case contained a small amount of pleural lesionscould present as an “iceberg sign”(5 cases), intra-bronchial nodule(2 cases) or near the edge of the bronchus(1 case).The obstructive atelectasis or pulmonary consolidation was found in 6 cases. On CT contrast scanning, these lesions presented relatively significant enhancement(5 cases),usually the CT value increased ≥30HU, in which 2 cases of atypical carcinoid were inhomogeneous enhancement, and 2 cases showed enhanced vascular and mild to moderte enhancement(3 cases). Conclusion The CT findings of bronchial carcinoid have certain characteristics, which are certain value for clinical diagnosis, but the final diagnosis mostly depends on pathology.

目的 探究宫腔镜结合避孕药治疗子宫内膜息肉的临床疗效与对其安全性的分析。方法 随机选取2016年2月—2017年12月内160例子宫内膜息肉患者,分为对照组(80例,宫腔镜治疗)和观察组(80例,宫腔镜结合屈螺酮炔雌醇片治疗),对比两组临床疗效及不良反应的差异性。结果 与对照组相比,观察组患者月经改善效果更佳,其复发率更低,差异有统计学意义(P＜0.05);在不良反应的对比中,观察组结果与对照组结果相比较,不存在较大差异(P>0.05)。结论 宫腔镜结合避孕药治疗子宫内膜息肉取得了一定的临床疗效,不良反应并不显著,可推广运用。

Objective To explore the clinical efficacy and safety of hysteroscopy combined with contraceptives in the treatment of endometrial polyps. Methods From February 2016 to December 2017, 160 patients with endometrial polyps were randomly selected and divided into control group (80 cases treated by hysteroscopy) and observation group (80 cases treated by hysteroscopy combined with drospirenone and ethinyl estradiol tablets). The differences of clinical efficacy and adverse reactions between the two groups were compared. Results Compared with the control group, the observation group had better menstruation improvement effect and lower recurrence rate. The difference was statistically significant (P<0.05). In the comparison of adverse reactions, there was no significant difference between the observation group and the control group (P>0.05). Conclusion Hysteroscopy combined with contraceptives has achieved certain clinical efficacy in the treatment of endometrial polyps, and the adverse reactions are not significant, which can be popularized and applied.

目的 了解广州市属医院儿科医生职业倦怠的现状及其社会支持的相关性,对儿科医生的职业倦怠干预提供参考依据。方法 采用职业倦怠量表和社会支持评定量表对广州市属医院儿科医生进行方便抽样调查,并运用Excel和SPSS 25.0对调查结果进行统计描述、方差分析和相关分析。结果 广州市属医院370名儿科医生中共有272人(73.51%)出现不同程度的职业倦怠,中度倦怠者居多,为117人(31.62%)。职业倦怠三个维度中情感耗竭维度得分最高,为(21.64±7.17)分;社会支持总分为(37.68±8.24)分,客观支持、主观支持、支持利用维度得分分别为(7.71±3.23)、(22.53±5.03)、(7.44±1.92)分。其中社会支持处于水平低者居多,为227人(61.35%)。职业倦怠各维度和社会支持各维度两两之间均呈负相关。结论 广州市属医院儿科医生存在较严重的职业倦怠状况,社会支持状况大多处于低水平,尤其客观支持状况较差。社会支持水平越高,职业倦怠程度越轻,提示在缓解职业倦怠时应当充分考虑社会支持对其职业倦怠的影响作用。

Objective By understanding the current situation of job burnout of pediatricians in Guangzhou municipal hospitals and the correlation of social support, to provide reference basis for pediatricians to intervene in job burnout. Methods The Burnout Inventory and the Social Support Rating Scale were used for pediatricians in Guangzhou municipal hospitals, and Excel and SPSS 25.0 were used to conduct statistical description, variance analysis and correlation analysis of the survey results. Results There were 272 pediatricians (73.51%) showed different degrees of job burnout of the 370 pediatricians in Guangzhou municipal hospitals, among which 117 pediatricians (31.62%) showed moderate burnout. Among the three dimensions of job burnout, the highest score was emotional exhaustion (21.64±7.17). The total score of social support was (37.68±8.24), and the dimensions of the objective support, the subjective support and the utilization of support were (7.71±3.23), (22.53±5.03), (7.44±1.92), respectively. Among them 227 (61.35%) had low level of social support. Additionally, there was a negative correlation between each dimension of job burnout and each dimension of social support. Conclusion Pediatricians in Guangzhou municipal hospitals have more serious job burnout, and most of them have low level of social support, especially poor objective support. The higher level of social support will have the lower degree of job burnout. It suggests that the impact of social support on job burnout should be fully considered for alleviating job burnout.

目的 对我院静脉用药调配中心2017年1月—2019年12月期间的不合理医嘱情况进行汇总及分析,以提高合理用药水平。方法 收集2017年1月—2019年12月广州市第一人民医院静脉用药调配中心的不合理医嘱资料进行回顾性分析,归纳不合理医嘱类型、汇总分析不合理医嘱表现以及改正不合理情况。结果 主要不合理医嘱类型包括溶媒选择错误、溶媒量过多或过少、药物剂量不合理、药物配伍禁忌、其他(用药频次错误、药物选择错误、重复用药等)。结论 根据不合理医嘱情况的汇总分析,及时与临床科室沟通改正,保证合理用药。

Objective To summarize and analyze their rational prescriptions in pharmacy intravenous admixture services(PIVAS)of our hospital from January 2017 to December 2019,so as to improve the level of rational drug use. Methods The data of irrational prescriptions from January 2017 to December 2019 in the pharmacy intravenous admixture services of Guangzhou First People's Hospital were collected for retrospective analysis, and the types of irrational prescriptions were summarized, the performance of irrational prescriptions was analyzed and the irrational situation was corrected. Results The main types of irrational prescriptions include incorrect selection of solvent, improper consumption of solvent, improper drug dosage, incompatibility and others(improper frequency of administration, incorrect selection of drug, repeated administration, etc.). Conclusion According to the summary and analysis of irrational prescriptions, we timely communicate with clinical departments and ensure rational drug use.

目的 通过血常规分析和C反应蛋白(CRP)水平检测,探讨其对儿童甲型和乙型流感的辅助诊断价值,为临床治疗提供参考依据。方法 选择3 069名甲型流感患儿、2 307名乙型流感患儿、855名健康儿童,统计分析血常规参数以及CRP水平。采用ROC曲线分析血常规对甲乙型流感的区分效能。结果 甲组白细胞计数(WBC)均值高于正常组,乙组则相反,甲乙组中性粒细胞百分比(Neut%)、中性粒细胞与淋巴细胞百分比比值(NLR)、单核细胞百分比(Mono%)的均值高于正常组,甲乙组淋巴细胞百分比(Lymph%)、血小板计数(PLT)的均值低于正常组。甲组中性粒细胞计数(Neut#)、单核细胞计数(Mono#)、CRP、PLT的均值均高于乙组,Lymph%和淋巴细胞计数(Lymph#)的均值低于乙组。甲组在WBC>13×10⁹/L、Neut%>70.7、Lymph%<19.1的构成比高于乙组。NLR预测甲型流感临界值为2.08(敏感度为75.9%,特异度为89.4%),预测乙型流感临界值为2.11(敏感度为50.5%,特异度为89.8%)。结论 血常规参数和CRP水平变化可用于判断流感患儿是否存在细菌感染,指导临床用药;NLR作为一种新型预测标志物,其变化可以对区分甲型、乙型流感,尤其是甲型流感具有临床价值。

Objective Through blood analysis and C-reactive protein (CRP) level detection, to explore its value in the auxiliary diagnosis of influenza A and B in children, and to provide reference for clinical treatment. Methods 3 069 children with influenza A, 2 307 children with influenza B, and 855 healthy children were selected, and blood routine parameters and CRP levels were statistically analyzed. The ROC curve was used to analyze the discriminatory efficacy of blood routine on influenza A and B. Results The mean value of white blood cell count (WBC) in group A was higher than that in normal group, but in group B it had the opposite result. The percentage of neutrophils (Neut%), the ratio of neutrophils to lymphocytes (NLR), and the percentage of monocytes (the mean value of Mono%) is higher than that of normal group, and the mean value of lymphocyte percentage (Lymph%) and platelet count (PLT) of group A and B is lower than that of normal group. The mean values of neutrophil count (Neut#), monocyte count (Mono#), CRP and PLT in group A were higher than those in group B, and the mean values of Lymph% and lymphocyte count (Lymph#) were lower than those in group B. The composition ratios of group A in WBC>13×10⁹/L, Neut%>70.7, Lymph%<19.1 were higher than that in group B. The NLR predicted the critical value of influenza A was 2.08 (sensitivity 75.9%, specificity 89.4%), and the predicted influenza B threshold value was 2.11 (sensitivity 50.5%, specificity 89.8%). Conclusion Changes in blood routine parameters and CRP levels can be used to determine whether there is a bacterial infection in children with influenza and to guide clinical medication; NLR as a new predictive marker, its changes can distinguish influenza A or B. Especially in influenza A determination, it has clinical value.

目的 观察免疫球蛋白联合甲泼尼龙疗法对自身免疫性脑炎患者T淋巴细胞亚群、免疫球蛋白、白介素-6(IL-6)和CXC趋化因子13(CXC13)水平影响。方法 选取2017年1月—2020年3月本院收治的60例自身免疫性脑炎患者,采用随机数字表法分为观察组30例与对照组30例。对照组给予甲泼尼龙疗法,观察组在对照组结合免疫球蛋白治疗。两组均以4周后评价。比较两组疗效,治疗前后T淋巴细胞亚群、免疫球蛋白、IL-6、CXC13及简易智能精神状态检查量表(MMSE)变化。结果 观察组总有效率(83.33%)高于对照组(60.00%)(P<0.05)。观察组治疗后CD⁺₃、CD⁺₄和CD⁺₄/CD⁺₈高于对照组(P<0.05)。观察组治疗后血清IgA、IgG和IgM水平低于对照组(P<0.05)。观察组治疗后血清IL-6和CXC13水平低于对照组(P<0.05)。观察组治疗后MMSE评分高于对照组(P<0.05)。结论 免疫球蛋白联合甲泼尼龙疗法对自身免疫性脑炎患者疗效良好,且可增强机体细胞和体液免疫功能,降低IL-6和CXC13水平。

Objective To observe the effect of immunoglobulin combined with methylprednisolone on T lymphocyte subsets, immunoglobulin, interleukin-6 (IL-6) and CXC chemokine 13 (CXC13) in patients with autoimmune encephalitis. Methods 60 patients with autoimmune encephalitis admitted to our hospital from January 2017 to March 2020 were divided into 30 cases of observation group and 30 cases of control group. The control group was treated with methylprednisolone, and observation group was treated with immunoglobulin compared with the control group. The course of treatment in both groups was 4 weeks. The effects of the two groups were compared. The changes of T lymphocyte subsets, immunoglobulin, IL-6, CXC13 and MMSE before and after treatment were compared. Results Total effective rate (83.33%) of the observation group was higher than that of control group (60.00%) (P<0.05). After treatment, in the observation group, CD⁺₃, CD⁺₄ and CD⁺₄/CD⁺₈ were higher than that of control group (P<0.05); levels of serum IgA, IgG and IgM were lower than that of control group (P<0.05); serum levels of IL-6 and CXC13 were lower than that of control group (P<0.05); MMSE score was higher than that of control group (P<0.05). Conclusion Immunoglobulin combined with methylprednisolone is effective in the treatment of autoimmune encephalitis. It may enhance the cellular and humoral immune function, and reduce the levels of IL-6 and CXC13.

目的 通过研究统计痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血清T-SPOT.TB试验对肺结核的诊断敏感度、特异度、诊断预测值、诊断准确率,进一步探讨不同临床检测方法对肺结核的诊断价值,指导肺结核患者的临床诊治。方法 通过回顾性分析我院2017年1月—2019年12月呼吸内科、感染性疾病科诊断为活动性肺结核的患者,以痰结核菌培养结果为对照标准,分别统计出痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血T-SPOT.TB试验对肺结核的诊断敏感度、特异度、阳性预测值、阴性预测值、诊断准确率,探讨我院临床上四种实验室方法对诊断肺结核的临床价值。结果 通过上述方法统计出痰TB-DNA、痰分枝杆菌核酸、痰涂片找抗酸杆菌、血T-SPOT.TB试验对肺结核的诊断敏感度分别是84.7%、88.1%、74.7%、96.0%,特异度分别是65.3%、69.2%、86.5%、17.8%,阳性预测值分别是83.0%、85.%、92.0%、70.7%,阴性预测值分别是68.1%、73.5%、62.1%、68.4%,诊断准确率分别是78.2%、82.0%、78.5%、70.5%。结论 跟传统方法痰结核菌培养、痰涂片找抗酸杆菌比较,TB-DNA、分枝杆菌核酸、TB-SPOT.TB试验在时效、灵敏度方面更具优势,能敏感检测出人体是否感染肺结核,对患者的早期诊断及指导治疗具有重要意义。

Objective To investigate the diagnostic sensitivity, specificity, predictive value and diagnostic accuracy of TB-DNA, mycobacterium sputum nucleic acid, acid-fast bacilli on sputum smear and serum T-SPOT.TB test for tuberculosis, so as to further explore the significance of different clinical detection methods for tuberculosis and guide the clinical diagnosis and treatment of tuberculosis patients. Methods By retrospective analysis of January 2017-December 2019, patients from respiratory medicine, infectious diseases departments diagnosed with active tuberculosis, sputum culture results of tuberculosis bacterium as control standard, we figured out sputum TB-DNA, sputum mycobacterium nucleic acid blood, sputum smear for acid fast bacilli, T-SPOT. TB test to the diagnosis sensitivity, specific degree, positive predictive value, negative predictive value, diagnostic accuracy, to explore the clinical value of four clinical laboratory methods in our hospital. Results According to the above methods, the diagnostic sensitivity of sputum TB-DNA, sputum mycobacterial nucleic acid, sputum acid-fast bacilli on smear and blood T-SPOT.TB test for tuberculosis was 84.7%、88.1%、74.7%、96.0%, and the specificity was 65.3%、69.2%、86.5%、17.8%, respectively. The positive predictive value was 83.0%、86.6%、92.0%、70.7%, and the negative predictive value was 68.1%、73.5%、62.1%、68.4%, respectively. The diagnostic accuracy was 78.2%、82.0%、78.5%、70.5%, respectively. Conclusion Compared with the traditional methods of culture and sputum smear for acid-fast bacilli, TB-DNA, mycobacterial nucleic acid and T-SPOT.TB test had more advantages in terms of timeliness and sensitivity. It is great significance for the early diagnosis and treatment of patients to detect whether they are infected with tuberculosis sensitively.

目的 探讨应用三管引流法在防治直肠癌前切除术后吻合口漏中的疗效。方法 选取在我科2018年4月—2020年3月接受腹腔镜或者开腹直肠癌前切除术患者186例,将患者随机分为两组,研究组(三管引流法)96例,对照组(常规引流法)90例,进行对比研究。比较两组患者术后吻合口漏及恢复情况。结果 研究组患者吻合口漏发生率、非计划手术率、回肠造口率低于对照组(P＜0.05),吻合口漏患者中,研究组体温恢复正常时间、C反应蛋白(CRP)恢复正常时间及住院时间均少于对照组,差异均有统计学意义(P＜0.05)。结论 应用三管引流法,可预防直肠癌前切除术后吻合口漏,通过非手术治疗避免非计划二次手术,缩短吻合口漏患者恢复时间,显示更好的临床疗效。

Objective To explore and evaluate the clinical application value of three-tube drainage for the treatment of anastomotic leakage after low anterior resection for rectal cancer. Methods We retrospectively analyzed a total of 186 rectal cancer patients after low anterior resection for rectal cancer in our hospital from April 2018 to March 2020. According to the difference of prevention to anastomotic leakage, these patients were divided into two groups randomly that 90 cases used conventional drainage as control group, and 96 cases used three-tube drainage as study group. Postoperative recovery and anastomotic leakage were compared between these two groups. Results The rate of anastomotic leakage, ileostomy and unplanned reoperation of study group were lower than those of control group (P＜0.05).The times returned to normal of body temperature and C-reactive protein (CRP), the average length of stay in hospital of study group were shorter than those of control group respectively (P＜0.05). Conclusion The application of three-tube drainage may prevent anastomotic leakage and unplanned reoperation after low anterior resection for rectal cancer and shorten postoperative recovery time, to reveal better clinical effects.