目的 探讨八段锦联合呼吸训练对社区慢性阻塞性肺疾病(COPD)患者的疗效研究。方法 选取本社区2016年6月—2017年4月期间收治的重度及极重度稳定期COPD患者70例。随机分为A组(25例)、B组(23例)和C组(22例)。A组患者采用八段锦联合呼吸训练治疗,B组患者仅采用呼吸锻炼,C组患者不采用锻炼方式。记录对比三组患者治疗前后的肺功能、六分钟步行距离和圣乔治呼吸评分。结果 A组和B组患者肺功能均比治疗前及比C组改善(P＜0.05),且A组改善更明显(P＜0.05);A组和B组步行距离均比治疗前及C组增加(P＜0.05),且A组比B组增加程度更大(P＜0.05);A组和B组圣乔治呼吸评分均比治疗前及C组降低(P＜0.05),且A组比B组降低更多(P＜0.05)。结论 对COPD患者,八段锦联合呼吸训练可改善患者肺功能和运动能力,缓解呼吸困难,对患者活动及生活各方面的影响。具有较好的临床效果,值得临床推广应用。

Objective To study the effect of Baduanjin exercise combined with breathing training on patients with chronic obstructive pulmonary disease (COPD) in community. Methods We selected 70 patients with severe and extremely severe COPD at stable period in the community from June 2016 to April 2017. The patients were randomly divided into group A (25 cases), group B (23 cases) and group C (22 cases). Patients in group A were treated with Baduanjin exercise combined breathing training, while group B patients only used breathing exercise, and group C patients did not have exercise. We recorded and compared the lung function, six-minute walking distance and St Georges breathing score before and after treatment in the three groups. Results The pulmonary function of patients in group A and group B had been improved more than that before the treatment and of group C (P<0.05), and group A had been improved (P<0.05); the walking distance in group A and group B increased more than that before the treatment and of group C (P<0.05), and group A increased a greater degree than that of group B (P<0.05); The St Georges breathing score in group A and group B decreased than before the treatment and of group C (P<0.05); and group A decreased more than that of group B (P<0.05). Conclusion The Baduanjin exercise combined with breathing training may improve the pulmonary function and athletic ability of the patients with COPD, relieve dyspnea, reduce the influence of the illness on the activities activities of daily living of the patients. It has good clinical effect and is worthy of clinical application.

目的 探讨腔镜手术治疗老年肺癌的疗效及对肺功能的影响。方法 我们纳入90例老年肺癌患者作为研究对象,随机抽签分为2组,各45例。观察组45例行胸腔镜肺癌切除术,对照组45例行传统开胸肺癌切除术。比较两组患者手术时间、术中出血量、胸腔引流时间、淋巴结清扫数量、术后住院时间、疼痛评分、肺功能及术后并发症情况。结果 两组手术时间、淋巴结清扫数量无差异(P>0.05);观察组术后胸腔引流时间、术中出血量、疼痛评分、住院时间少于对照组(P＜0.05)。观察组术后并发症总发生率低于对照组(P＜0.05)。观察组术后一秒用力呼气容积、用力肺活量、肺活量、一秒用力呼气容积与用力肺活量比值恢复情况优于对照组(P＜0.05)。结论 腔镜微创手术用于老年肺癌患者能够显著降低围术期并发症,缩短患者术后恢复时间,且有助于改善肺功能。

Objective To investigate the efficacy and safety of endoscopic surgery in the treatment of elderly patients with lung cancer. Methods 90 elderly patients with lung cancer in our hospital were divided into two groups,45 cases in each group. The observation group was treated with thoracoscopic lung resection in 45 cases, the control group of 45 cases received conventional open lung cancer resection. The operation time, intraoperative blood loss, thoracic drainage time, lymph node dissection, postoperative hospital stay, pain score, pulmonary function assessment and postoperative complications were compared. Results There were no significant differences in the operation time and lymph node dissection between the two groups (P>0.05). The thoracic drainage time,intraoperative blood loss pain score and hospitalization time in the observation group were lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). The forced expiratory volume, forced vital capacity, vital capacity, one-second forced expiratory volume and forced vital capacity of the observation group were better than those in the control group after operation(P<0.05). Conclusion Endoscopic minimally invasive surgery may significantly reduce perioperative complications in elderly patients with lung cancer, shorten the postoperative recovery time and improve lung function.

目的 比较不同浓度罗哌卡因横纹肌阻滞应用于剖宫产术后镇痛的临床效果。方法 选取2015年3月—2016年3月于我院剖宫产的孕妇300例,随机分为A组、B组、C组,每组100例,A组产妇给予质量浓度为1.5 g/L的罗哌卡因1.5 mg/kg,B组产妇给予质量浓度为2 g/L的罗哌卡因1.5 mg/kg,C组产妇给予质量浓度为2.5 g/L的罗哌卡因1.5 mg/kg,同时给予所有产妇镇痛泵辅助镇痛。记录观察所有产妇术后6 h、12 h、24 h、36 h、48 h的疼痛视觉模拟评分(VAS)、镇痛泵按压次数、产妇对镇痛效果的满意程度以及腹横肌平面阻滞(TAP)不良反应发生情况。结果 B、C组产妇的VAS评分均低于A组产妇(P＜0.05),24 h后C组产妇的VAS评分低于B组产妇(P＜0.05);与B、C组产妇相比,A组产妇的镇痛泵按压次数更多,镇痛效果满意度较低(P＜0.05),同时B组产妇的镇痛泵按压次数多于C组产妇(P＜0.05);3组产妇均未出现术后不良反应。结论 使用质量浓度为2.5 g/L的罗哌卡因横纹肌阻滞进行剖宫产术后镇痛,效果显著、安全性较高,临床中可推广使用。

Objective To compare the clinical effects of different concentrations of ropivacaine for postoperative analgesia after cesarean section. Methods 300 cases of pregnant women undergoing cesarean section in our hospital from March 2015 to March 2016 were selected and were randomly divided into group A, group B and group C with 100 cases in each group. The patients in group A were given 0.15% ropivacaine 1.5 mg/kg, 0.20% ropivacaine 1.5 mg/kg in group B and 0.25% ropivacaine 1.5 mg/kg in group C, and at the same time all the pregnant women were given analgesic pump assisting analgesia. The pain visual analogue scales (VAS) of the pregnant women were recorded at 6 hours, 12 hours, 24 hours and 36 hours after cesarean section and the number of times of analgesia pressing pump were also recorded. The satisfaction degree of analgesic effect and the TAP occurrence of adverse reactions of the patients were also recorded. Results The VAS scores of group B and group C were lower than that of group A(P<0.05). 24 hours after cesarean section, the VAS score of group C was lower than that of group B (P<0.05). Compared with group B and C, the number of times of analgesia pressing pump in group A were more but the analgesic effect of satisfaction was lower (P<0.05), and at the same time the number of times of analgesia pressing pump in group B were more than those in group C (P<0.05). No adverse reactions were found in the three groups. Conclusion The treatment of using of 0.25% of ropivacaine for muscle block for postoperative analgesia after cesarean section is effective and safe, which may be widely used in clinical practice.

目的 探讨胰岛素抵抗对缓解期双相障碍患者转归和社会功能的影响。方法 对双相I型患者90例以及正常对照组30例进行体质量指数、空腹血糖、胰岛素等测定,计算胰岛素抵抗指数;长期治疗应答回顾标准量表评估治疗应答、大体社会功评估量表评估社会功能,分析胰岛素抵抗对双相患者转归和社会功能的影响。结果 患有2型糖尿病或胰岛素抵抗的双相障碍患者治疗应答反应差(2.50和2.93 vs 4.77,F=5.636,P<0.01;OR=6.07和4.78,P<0.01),双相发作次数多(0和0.03 vs 0.33,F=59.475,P<0.01),社会功能更差(GAF:56.90和53.23 vs 73.93,F=6.010,P<0.05;OR=1.59和4.82,P<0.01)。治疗应答、社会功能与胰岛素抵抗指数呈负相关(r=-0.383和-0.307,P<0.01)。社会功能与治疗反应、非典型抗精神病药物和药物副反应相关(r=0.467, -0.314,-0.407,P<0.05或P<0.01)。结论 共病糖尿病或胰岛素抵抗可能是双相障碍治疗抵抗、社会功能损害的一个重要的因素。

Objective To investigate the effect of insulin resistance on outcome and social function in patients with bipolar disorder at remission stage. Methods The body mass index(BMI),the levels of fasting plasma glucose,insulin and glyeosylated hemoglobin were detected in 90 BD patients without diabetes(BD group)and 30 normal controls (NC group). Alda scale was used to assess treatment response, and Global Assessment of Functioning Scale was used to assess social function. The effect of insulin resistance on outcome and social function was analyzed. Results Patients with bipolar disorder with type 2 diabetes or insulin resistance have poor response to treatment(2.50,2.93 vs 4.77,F=5.636,P<0.01;OR=6.07& 4.78,P<0.01), more recurrences (0,0.03 vs 0.33,F=59.475,P<0.01;OR=1.59&4.82,P<0.01), and worse social function (GAF:56.90,53.23 vs 73.93,F=6.010,P<0.05). Treatment response and social function were negatively correlated with insulin resistance index (r=-0.383,-0.307,P<0.01), and social function was associated with treatment response, atypical antipsychotics, and side effects (r=0.467, -0.314,-0.407,P<0.05 or P<0.01). Conclusion Diabetes mellitus or insulin resistance may be important factor in therapeutic resistance and social function to patients with bipolar disorder.

目的 观察PNF技术配合寰枢椎复位对颈源性眩晕的临床疗效。方法 48例颈源性眩晕患者随机分为2组,PNF组24例给予寰枢椎旋转复位配合PNF技术治疗;对照组24例单纯给予旋转复位,分别在疗程结束后1天、1个月、半年回访。治疗前后应用颈性眩晕症状及功能评估量表和VAS视觉模拟疼痛评定量表进行疗效评定。结果 2组在短期治疗效果上没有显著的临床差别,但在中长期的疗效巩固、预防复发上,PNF组优于单纯寰枢椎旋转复位组。结论 PNF技术配合旋转复位能提高颈源性眩晕的临床疗效。

Objective To observe the clinical effect of PNF technique on cervicogenic vertigo. Methods 48 patients with cervicogenic vertigo were randomly divided into two groups, 24 patients in the PNF group; 24 patients were treated with atlantoaxial rotation and PNF. The control group (24 cases) was treated with rotational reduction. Before and after treatment, the curative effect of cervical vertigo and function evaluation scale and VAS visual analogue pain rating scale were used to evaluate the curative effect. Results There was no significant clinical difference between the two groups in the short-term treatment effect. But in the long-term effect of consolidation, prevention of recurrence, PNF group was superior to the simple atlantoaxial rotation reduction group. Conclusion PNF technique combined with rotational reduction may improve the curative effect of cervicogenic vertigo.

目的 总结本地区低龄婴儿侵袭性B族链球菌(GBS)感染的流行病学特点, 为临床预防和诊治提供指导。方法 对2012年1月—2015年12月广州地区两家三甲妇儿专科医院收治的0～89 d低龄婴儿侵袭性GBS感染病例进行回顾性分析。结果 研究期间两院共收治侵袭性GBS感染病例120例,2015年感染病例数为2012年的2.8倍,感染病例的发生无明显季节倾向。早发型感染以败血症合并肺炎(46.3%)为主,围产期多伴有一个或以上的高危因素,死亡率为7.4%;晚发型感染以败血症合并脑膜炎(占42.4%),多以发热为首发症状,其中42%伴有神经系统症状,14.6%遗留神经系统后遗症。结论 广州地区低龄婴儿侵袭性GBS感染病例呈逐年增加趋势,临床应重视新生儿GBS感染的预防,加强感染高风险新生儿的管理,及时诊治,改善预后。

Objective To describe the epidemiological characteristics of invasive group B streptococcal (GBS) infection among infants during the past 4 years in Guangzhou, in order to provide scientific basis for the prevention and control of the disease. Methods Medical records of infants with invasive GBS infection from two tertiary hospitals in Guangzhou from January 2012 to December 2015 were reviewed. Results There were 120 infants with invasive GBS infections during the past 4 years in two tertiary hospitals, the number of patients increased from 2012 to 2015, and the occurrence of infectionshad no obvious seasonal tendencies. Among infants with EOD, the most common syndrome was sepsis complicated pneumonia (46.3%), respiratory sign and at least one of perinatal risk factors were commonly recorded, and the mortality rate was 7.4%. By contrast, a higher proportion of late-onset cases manifested as sepsis associated with meningitis (42.4%), fever was the most common presentation and 42% LOD cases accompanied by neurological symptoms, 14.6% infants had neurological sequelae. Conclusion The number of GBS-infected infants increased during the past 4 years in Guangzhou. Relevant departments should pay attention to the prevention of neonatal GBS infection, strengthen the management of high risk newborns to improve the prognosis.

目的 调查新疆疏附县基层医务人员对男童外生殖器畸形的认知及筛查能力,为制定新疆少数民族地区医务人员培训计划提供数据支持。方法 采用自行设计的问卷调查表,对新疆疏附县人民医院、乡卫生院及村医进行问卷调查,确定其对男童外生殖器畸形的认知程度。采用SPSS 13.0进行数据分析,比较维、汉两族医务人员的认知差异。结果 发放调查问卷400份,收回有效问卷365份,占91.25%。调查发现,新疆疏附县基层医务人员对外生殖器畸形相关知识认知正确率超50%的占参与问卷调查的54.79%。其中男性21.92%,女性32.87%。汉族医务人员对外生殖器畸形相关知识认知正确率超50%的占参与问卷调查的汉族医务人员50%,维族约57.40%,统计分析显示差异无统计学意义(P＜0.05);有关外生殖器畸形相关知识获取途径中,未参加相关知识培训占61.64%,参加过培训者38.36%;在临床实践中主动筛查新生儿外生殖器畸形者86.30%,发现外生殖器畸形病例者27.39%。结论 新疆疏附县基层医务人员普遍缺乏男童外生殖器畸形相关诊疗知识,在实际工作中发现并恰当处置此类疾病的能力亦相对欠缺。因此提高新疆少数民族地区基层医务人员对男童外生殖器畸形的诊断和治疗能力非常必要。

Objective To survey on the recognition and diagnosis capability of frontline healthcare workers in boy's genital malformation in Shufu, Xinjiang. Thereby to provide data support for the healthcare workers training there. Methods We designed a questionnaire and carried out a survey in Shufu people's hospital, township clinics and village doctors. Based on SPSS 13.0 data analysis, we made comparison on recognition difference between the Han and Uygur healthcare workers. Results 400 questionnaires were handed out, among them 365 were valid which accounted for 91.25%. The survey showed that there were 54.79% survey participators whose recognition correct rate was over 50% in Shufu, Xinjiang (21.92% for man, 32.87% for woman), 50% Han healthcare workers whose recognition correct rate was over 50% and that of 57.4% in Uygur peers.There was no significant difference in statistics(P<0.05). It accounted for 38.36% that participating in training as the access to relevant knowledge of genital malformation,but 61.64% was not. In clinical practice, 86.3% of survey participators screen the possibility of newborn genital malformation. And 27.39% of screened newborn have genital malformation. Conclusion The frontline healthcare workers in Shufu, Xinjiang at large are short of diagnosis knowledge on boy's genital malformation, as a result that they are difficult to recognize and give proper treatment on such cases in practice. The status thereby shows that it is critical to improve the diagnosis and treatment capability of frontline healthcare workers in boy's genital malformation in Xinjiang ethnic group area.

目的 探讨山莨菪碱联合黄体酮治疗高原地区急性肾绞痛的临床疗效。方法 将2016年9月—2017年6月收治的60例急性肾绞痛患者随机分成2组,试验组和对照组各30人,试验组应用黄体酮注射液40 mg肌肉注射,山莨菪碱10 mg加入质量浓度为50 g/L的葡萄糖注射液250 mL静脉滴注;对照组仅用山莨菪碱10 mg加入质量浓度为50 g/L的葡萄糖注射液250 mL静脉滴注。给药前、后15min、30min、1 h及4 h对患者疼痛采用视觉模拟评分(VAS)评价其疗效,并观察其起效时间和不良反应。结果 治疗组和对照组总有效率分别为 93.3%和70.0%,2组比较差异有统计学意义( P<0.05);2组药物起效时间比较有差异(P<0.05);给药后15min至4 h,试验组VAS评分均低于对照组(P<0.05)。结论 山莨菪碱联合黄体酮治疗高原急性肾绞痛安全有效,联用明显优于只采用山莨菪碱。

Objective To study the effect and efficacy of Anisodamine combined with Progesterone in the treatment of acute renal colic in plateau area. Methods From September 2016 to June 2017, 60 cases of acute renal colic patients were randomly divided into experimental group or control group. Both groups are 30 cases. The test group applied the injection of progesterone injection 40 mg by muscle injection and Anisodamine 10mg to the concentration of 5% of glucose injection in 250 mL by intravenous drip. In the control group, only using 10 mg of Anisodamine was added to the 250 mL intravenous drip of 5% glucose injection. The visual Analogue Scale/Score(VAS) was used to evaluate the efficacy of the patients before dosing, after dosing of 15min, 30min, 1 h and 4 h, and we observed their effective time and adverse reactions. Results The total effective rate of treatment group and control group was 93.3 % and 70.0 % respectively. There was a statistically significant difference between the two groups (P<0.05). The VAS score of the experimental group was lower than that in the control group (P<0.05). Conclusion Anisodamine combined with Progesterone is safe and effective in the treatment of plateau acute renal coli, and is obviously better than only using Anisodamine.

目的 前瞻性探讨三维增强磁共振血管成像(3D CE-MRA)技术在显示骶前区血管的可行性。方法 选取40例因盆腔病变常规行MRI检查的成年患者,采用ACHIEVA 3.0T双源磁共振扫描仪对患者盆腔骶前区血管行DCE-MRA扫描,利用后处理工作站采用最大密度投影(MIP)及容积再现重组(VR)进行血管重建成像以最佳显示骶前区动脉及静脉,主要观察骶前区血管的影像学解剖。结果 40例骶正中动脉均显示清晰,成功率为100%;骶正中动脉均开口于腹主动脉分叉后上方,沿骶骨前面走行至尾骨尖,管径平均为(1.42±0.06)mm(1.30 mm～1.50 mm);骶前区静脉显示率为75%(30/40),可见骶前区静脉呈阶梯状分布。结论 应用3D CE-MRA可以清晰显示部分骶前区血管,可为骶前区手术提供个体局部影像学解剖信息。

Objective To explore the feasibility of three-dimensional enhanced magnetic resonance angiography (3D CE-MRA) in the presacral blood vessels. Methods 40 adult patients with pelvic lesions were examined by ACHIEVA 3.0T dual-source magnetic resonance scanner. DCE-MRA was used to scan the pelvic sacral anterior vessel. The maximal density projection (MIP) and the post volume reproducibility (VR) were reconstructed for optimal reconstruction of the anterior sacral arteries and veins, primarily to observe the anatomy of the anterior sacral vessels. Results 40 cases of sacral median artery were clear, the success rate was 100%; the sacral median arteries open in the abdominal aorta bifurcation after the top along the sacrum to the coccyx tip, the average diameter of (1.42±0.06) mm (1.30 mm-1.50 mm); the rate of the presacral venous display was 75% (30/40), showing that the anterior sacral vein was ladder-like distribution. Conclusion The application of 3D CE-MRA can clearly show some presacral blood vessels, which may provide individual local anatomical information for sacral precancerous surgery.

目的 探讨红外线照射联合中药穴位贴敷在骨外科术后护理工作中的应用。方法 选择2014年2月—2015年6月我院收治的120例骨外科手术治疗患者,随机分为对照组与观察组,每组各60例;两组患者均给予饮食、心理、排便训练等常规护理,观察组在常规护理基础上给予中药穴位贴敷联合红外线照射综合护理,比较两组患者术后自主排便功能恢复情况,采用汉密尔顿抑郁量表(HAMD)与汉密尔顿焦虑量表(HAMA)评估患者干预前后心理状态,于术后不同时间采用视觉模拟评分法(VAS)对患者的疼痛情况进行评定,记录患者住院时间及下肢深静脉血栓发生情况。结果 术后观察组自主排便恢复情况(88.3%)高于对照组(73.3%)(χ²=4.357,P＜0.05),观察组自主排便恢复时间低于对照组(t=5.422,P＜0.05);术后5、30 d两组患者HAMD和HAMA评分均性降低(P＜0.05),观察组低于对照组(P＜0.05);术后5、10、20 d观察组患者疼痛评分比对照组降低(P＜0.05);观察组患者住院时间少于对照组(P＜0.05),观察组下肢深静脉栓发生率1.7%低于对照组6.7%,但无统计学意义(P＞0.05)。结论 红外线照射联合中药穴位贴敷可改善骨外科手术术后患者自主排便功能,降低患者心理压力,促进手术后恢复。