目的 探讨妇女阴道健康状况及阴道分泌物清洁度、线索细胞及唾液酸酶法检测细菌性阴道病(BV)的相关性。方法 随机抽取2013年4月—2014年6月本院妇科疑似细菌性阴道病患者标本835例,分别采用生理盐水直接涂片及分泌物直接涂片进行革兰氏染色两者相结合检查清洁度、线索细胞;唾液酸酶法检测BV。结果 清洁度Ⅰ～Ⅱ占27.55%,BV阳性率为2.40%,线索细胞检出率1.32%;清洁度Ⅲ～Ⅳ占72.45%,病原菌阳性率为46.23%,其中BV阳性率为30.55%,线索细胞检出率为23.48%。结论 清洁度异常率比正常率偏高;清洁度正常不一定没有细菌性阴道病; BV的出现严重威胁妇女身体健康,正确的诊断有重要意义,唾液酸酶法检测BV虽有快速、操作简单、显色结果易判断,但温度、时间、取材问题等受多种因素影响。

Objective To explore the correlation between the health of women's vagina and vaginal cleanness, clue cells and bacterial vaginosis(BV)which is tested by the sialic acid enzymatic method. Methods Randomly select 835 suspected cases of bacterial vaginosis in our hospital gynecology department in April 2013-June 2014. Every case was respectively done saline direct smear and vaginal secretion direct smear gram staining to check vaginal cleanness and clue cells. BV is tested by sialic acid enzymatic method. Results The cleanness of I-II accounted for 27.55%, BV positive rate was 2.40%, the positive rate of clue cells was 1.32%;the cleanness of degree III-IV accounted for 72.45%, the positive rate of pathogenic bacteria was 46.23%, the positive rate of BV was 30.55%, the positive rate of clue cells leads to 23.48%. Conclusion The rate of abnormal vaginal cleanness is higher than the normal.The nomal vaginal cleaness does not show no bacterial vaginosis. The emergence of BV seriously affects women's health, so the correct diagnosis is of great importance. Although the of the saliva acid enzyme to test BV is fast, operates easily and the color results are easily to be judged, but it can be influenced by other factors such as temperature, time, materials issues.

目的 探讨体感音乐疗法对青少年视疲劳患者症状缓解的影响。方法 选择青少年视疲劳患者72例,随机分为观察组和对照组各36例,两组患者均给予矫正用眼习惯、多运动、均衡饮食等护理,观察组在此基础上给予体感音乐疗法,3个月后比较两组视疲劳症状缓解情况。结果 干预后观察组视疲劳症状缓解程度及症状评分优于对照组,两组比较差异有统计学意义(P＜0.05)。结论 对青少年视疲劳患者实施体感音乐疗法,可起到促进眼部肌肉放松,改善微循环,增强睫状肌收缩力,改善虹膜睫状体调节功能,缓解视疲劳的效果。

Objective To explore the influence of vibroacoustic therapy on visual fatigue teenagers. Methods 72 visual fatigue teenagers were randomly and equally divided into the observation group and the control group. Both groups were accepted nursing in terms of the correction of eye habits, doing more sports and balanced diet, while the observation group was also accepted vibroacoustic therapy. After three months the conditions of these two groups in terms of visual fatigue were compared. Results After the intervention the degree of visual fatigue relief and the score of symptoms in the observation group were higher than those in the control group, and these differences have statistic significance (P＜0.05). Conclusion Vibroacoustic therapy can help visual fatigue teenagers to relax muscles of eyes, improve microcirculation, strengthen ciliary muscle contractile force, improve the regulatory function of iris ciliary and relieve visual fatigue.

目的 观察肌内效贴联合物理治疗急性踝关节扭伤的临床疗效。方法 将52例急性踝关节扭伤患者随机均分为肌内效贴联合物理治疗组(观察组)和常规物理治疗组(对照组),分别于治疗前及治疗后第5、10天时观察患部肿胀程度和VAS评分及踝关节kofoed评分。结果 治疗后第5、10天时两组肿胀程度和VAS评分较治疗前好转(P＜0.05),kofoed评分较治疗前升高(P＜0.05)。观察组在肿胀改善、VAS评分及kofoed评分方面均优于对照组(P＜0.05)。结论 肌内效贴联合物理治疗改善急性踝关节伤患者临床症状,改善踝关节功能,临床疗效优于单纯物理治疗。

Objective The purpose of this pilot study was to investigate the effectiveness of kinesio taping combined with conventional physiotherapy for acute ankle sprain patients. Methods 52 acute ankle sprain patients were randomly divided into kinesio taping combined with conventional physiotherapy group(observation group) and the conventional physiotherapy group(control group),and to observe the changes of the affected part of swelling and the visual analogue scale(VAS)and the extent of the ankle joint function recovery situation at the fifth day and the tenth day respectively. Results Two groups suffering from swelling part and the VAS was improved after the treatment at the fifth day and the tenth day (P<0.05), and the ankle kofoed scores were increased too (P<0.05). The observation group in improving the swelling, VAS and kofoed score were significantly better than the control group (P< 0.05). Conclusion Kinesio taping combined with conventional physiotherapy can be a more effective therapeutic technique for treating acute ankle sprain.

目的 探讨血浆D-二聚体及纤维蛋白原在社区获得性肺炎患者严重程度评估的应用价值。方法 收集110例社区获得性肺炎患者的临床资料,根据CURB-65评分标准对患者进行分组,分别测定患者血浆D-二聚体及纤维蛋白原水平,比较其在不同分组间的差异及通过ROC曲线了解其在重症社区获得性肺炎诊断中的价值。结果 不同CURB-65分组间D-二聚体、纤维蛋白原水平比较差异有统计学意义(P<0.05),重症肺炎组D-二聚体、纤维蛋白原水平明显高于非重症肺炎组(P<0.05)。ROC曲线显示入院D-二聚体、纤维蛋白原水平诊断重症肺炎曲线下面积(AUC)分别为0.815、0.777。结论 血浆D-二聚体及纤维蛋白原可以有效评估社区获得性肺炎患者病情的严重程度,其是诊断重症肺炎的一个良好指标。

Objective To evaluate the prediction and evaluation of plasma D-dimer and fibrinogen levels upon the severity of community acquired pneumonia(CAP). Methods Clinical variables of 180 patients with CAP were evaluated and divided into different groups by CURB65.Plasma D-dimer and fibrinogen were measured to compare their levels among different groups and evaluate the prediction in the diagnosis of the severe CAP by ROC curve. Results The mean D-dimer and fibrinogen level were different significantly among different CURB65 groups. D-dimer and fibrinogen level of severe CAP were significantly higher than non-serious pnrumonia group. The area under the curve of the D-dimer, fibrinogen in the diagnosis of severe pneumonia were 0.815, 0.777. Conclusion Plasma D-dimer and fibrinogen can effectively evaluate the severity of illness in patients with community acquired pneumonia and they could be useful for assessment of the severity of CAP.

目的 探讨NCPM理论指导下的临床营养诊疗工作在疾病治疗中解决临床营养问题的重要作用与临床价值。方法 对我院临床营养医师运用NCPM理论参与治疗的典型病例进行分析与总结。结果 临床营养医师运用NCPM理论指导临床诊疗工作,可按照临床营养诊疗工作流程,梳理临床营养诊疗思路,确定并围绕临床营养问题诊断,制定和调整临床治疗方案,提高临床疗效、缩短疗程、降低患者医疗风险。结论 临床营养医师将NCPM理论知识和临床实践相结合,有助于医院临床营养工作流程建立并有效实施;有助于临床医生与临床营养医生建立规范临床营养诊疗思路;在参与制定住院患者临床营养诊疗工作中,体现为提高临床疗效、缩短疗程、降低患者医疗风险,改善临床疗效等临床价值,应推广应用NCPM开展临床诊疗工作。

Objective The purpose of this article was to explore the clinical value of clinical nutrition diagnosis and treatment which was in the instruction of NCPM theory and the important role to solve the problem of clinical nutrition in treating disease. Methods We analyzed and summarized the typical cases that were treated using the theory of NCPM by clinical dietitians in our hospital. Results Clinical dietitians applied the theory of NCPM to guide clinical diagnosis and treatment work,and organizedthe clinical nutrition diagnosis and treatment clearly, indentified the clinical nutrition issues and around the issues they made and adjusted clinical treatment plan according to clinical nutrition diagnosis process, which increased the clinical curative effect,shortened period of treatment and reduced the patients' medical risk. Conclusion Clinical dietitiansorganizedNCPM theoretical knowledge with clinical establishment and implement effectively of clinical nutrition work process in hospital, practice, which contributed to the meamwhile whichhelp clinical doctors and clinical dietitians estabish the thought of clinical nutrition diagnosis and during the clinical nutrition diagnosis work which reflected improving the clinical curative effect, shortened period of treatment and reduced the patients' medical risk and improving the clinical outcome. Therefore it is important to popularize NCPM to carry out clinical diagnosis and treatment work.

目的 分析立体定向体部放射治疗(SBRJ)应用于孤立性肺肿瘤的疗效,探讨其临床价值。方法 采用拓能(TOPSLANE)全身X线立体定向放射治疗系统治疗15例孤立性肺肿瘤患者,其中I期非小细胞肺癌患者8例,单个肺转移瘤患者7例。单次剂量为5~8Gy／次,每天1次,每周3次,共8~10次,总剂量50~64Gy,生物有效剂量(BED)75~115Gy。分析治疗的近期疗效、急性放射损伤和局部控制率。结果 3例患者完全缓解(20.0%),10例患者部分缓解(66.7%),2例患者病灶稳定(13.3%),没有疾病进展的患者。15例患者总有效率为86.7%(13/15)。BED<90Gy的患者有效率为33.3%,而BED>90Gy的患者有效率为100%,差异有统计学意义(P＜0.05)。3例患者出现2级急性放射损伤,未见3级以上毒副反应。1年和2年局控率分别为92.3%和81.2%。结论 SBRT治疗孤立性肺肿瘤可获得较好的近期疗效和局部控制率,急性放射损伤较轻。

Objective To analyze the efficacy of stereotactic body radiation therapy(SBRT) onsolitary pulmonary tumor and explore its clinical value. Methods TOPSLANE X-ray stereotactic body radiation therapy system was used for treatment of fifteen patients with solitary pulmonary tumor, including eight patients with stage I non-small cell lung cancer and seven patients with single lung metastasis. Fraction dose of 5 to 8Gy was prescribed once a day, three times a week, totally 8 to 10 times to a total dose of 50 to 64 Gy and biological effective dose(BED) of 75 to 115Gy. Short-term efficacy, acute radiation injury and local control rate were analyzed. Results After treatment, there were three patients with complete response (CR) (20.0%), ten patients with partial response (PR) (66.7%), tow patients with stable disease (SD) (13.3%), and no patients with progressive disease (PD). The total response rate was 86.7% (13/15). The response rate was 33.3% in patients with BED <90 Gy, while it was 100% in patients with BED> 90 Gy, and the difference was statistically significant (P<0.05). Grade 2 acute radiation injuries were observed in three patients, and no toxicity greater than grade 3 was observed. The 1-year and 2-year local control rate was 92.3% and 81.2%, respectively. Conclusion SBRT on solitary pulmonary tumor has good short-term efficacy and local control rate with mild acute radiation injury.

目的 调查I-IIa期宫颈鳞状细胞癌患者术后随诊和复发情况,并探索随诊和复发的相关因素。方法 分析2011年1月—2012年6月中山市妇幼保健院收治的128例宫颈鳞状细胞癌患者的临床资料,分析他们的术后随诊情况及其影响因素。将有液基薄层细胞学(TCT)及盆腔检查者视为有效随诊的患者,分析肿瘤复发情况及其影响因素。结果 128例患者中,有效随诊104例(占总人数的81.25%)。年龄组越小,随诊率越高(P=0.034);城市患者较农村患者,随诊率高(P=0.028);文化程度越高,随诊率越高(P=0.028);职业为公务员、教师、公司职员或自由职业、个体,随诊率比职业为家庭妇女和工人更高(P=0.030)。在104例随诊者中,2年复发8例(占7.7%)。临床分期较晚,肿瘤直径>4cm,病理类型,脉管内瘤栓阳性,淋巴结转移阳性是影响患者2年复发的危险因素(P<0.05)。结论 临床分期,肿瘤直径,脉管内瘤栓阳性,淋巴结转移等临床病理特征与患者复发密切相关。应针对宫颈癌患者社会人口学特点制定措施,提高随诊率。

Objective To investigate the follow-up rate after surgical treatment and the recurrence rate among patients with cervical squamous cell carcinoma in I-IIa stage, and identify associated factors. Methods The clinical data of 128 cases of cervical squamous cell carcinoma from January 2011 to June 2012 in Zhongshan maternal and child health hospital was collected. Follow up record of these cases was analyzed and factors associated with follow up were identified. Patients having taken thinprep liquid-based cytology test (TCT) and pelvioscopy were treated as cases being followed effectively, and their recurrence and associated factors were analyzed. Results Among the 128 patients, 104(81.25%) were effectively followed. Patients with younger age(P=0.034), living in city (P=0.028), with higher education level(P=0.028) had higher follow-up rate. Civil servants, teachers and freelancers had higher follow-up rate than housewives and workers (P=0.030).Eight of the 104 effectively followed cases recurred within two years after surgery, accounting for 7.7%. The associated factors of recurrence included clinical stage, tumor diameter, larger than 4cm, the depth of myometrial invasion, deeper than 2/3, vascular tumor thrombus positive, and lymph node metastasis positive (P<0.05). Conclusion Clinical stage, tumor size, vascular tumor thrombus positive, lymph node metastasis positive were associated with recurrence. Tailored strategies should be developed to improve the follow up rate based on the social and demographic characteristics of patients.

目的 探讨CAl99在T2DM患者与健康人群中的差异及CAl99与糖化血红蛋白(HBAlc)的相关性。方法 收集2013年1月—9月T2DM患者382例,选择同期健康体检者90例作为对照组,分别检测血清CA199与HbA1c水平,根据HbA1c水平将T2DM患者分为血糖控制组(HbA1c<7.5%),控制不佳组(HbA1C≧7.5%),T2DM患者CA199水平与对照组比较,以体重指数、空腹血糖、HbA1c等为自变量,比较各变量对CA199的影响程度。结果 T2DM患者中CA199水平高于对照组,两者比较差异有统计学意义(t=3.45,P=0.005),血糖控制不佳组CA199阳性率(21.4%)高于血糖控制组(4%),差异有统计学意义(χ²=43.33,P=0.006),HBAlc控制组(4%)与健康体检者(0.9%)无显著差异(t=0.347,P=0.254,),CA199水平与HbA1c的相关系数最高(r=0.573,P=0.004)。结论 T2DM患者CA199水平和HbA1c存在相关性, 2型糖尿病患者CAl99升高与长期血糖控制不佳有关。

Objective To explore the differences in patients with T2DM and healthy people and to explore the correlation between CA199 and HbA1c in patients with T2DM. Methods 382 patients with T2DM and 90 healthy subjects for control group were collected from January to September in 2013.The level of CA199 and HbA1c were measured by chemiluminescence method and high performance liquid chromatography assay respectively. Accordingto the level of HbA1c,patients were divided in to blood glucose controlled group(HbA1c<7.5%) and blood glucose uncontrolled group (HbA1c≧7.5%).The level of CA199 were compared with control group. Sex, age, course of disease, body mass index, fasting blood glucose and HbA1c were included as independent variables for multiple stepwise regression analysis, to compare of influences of the variables on the CA199. Results The level of CA199 in T2DM patients was significantly higher than those of healthy subjects(t=3.45, P=0.005) and the positive rate of CA199 in blood glucose uncontrolled group(21.4%) was significantly higher than those of controlled group(4.0%)(χ²=43.33,P=0.006),there is no significant difference between in blood glucose controlled group(4.0%) and healthy people group(0.9%)(t=0.347,P=0.254).Among the many variables, the level of CA199 and HbA1c correlation coefficient was the highest (r=0.573, P=0.004. Conclusion There was a close correlation between CA199 level and HbA1c.There was a correlation between the positive level of CA199 and uncontrolled blood glucose.

目的 观察保留括约肌挂线法和瘘管切除术治疗复杂性肛瘘的临床效果。方法 选择2010年10月—2013年10月期间收治的复杂性肛瘘患者共122例,并随机均分为A、B两组。其中A组采用保留括约肌挂线法,B组采用瘘管切除术,比较两组患者的近远期治愈率、愈合时间以及后遗症的发生情况。结果 两组患者分别采用保留括约肌挂线法和瘘管切除治疗后均达到治愈标准,近期治愈率及复发率两组间无统计学差异。术后情况,A组愈合时间为(20.74±5.62)天,B组为(19.19±6.84)天,P>0.05,组间无统计学差异,但A组中后遗症的发生率为3.28%,B组中的后遗症发生率为37.70%,χ²=14.182,P<0.05,A组中后遗症的发生率明显低于B组。结论 保留括约肌挂线法与瘘管切除术均能很好地治疗肛瘘,其中保留括约肌挂线法在保存肛门正常生理功能,减少术后后遗症发生等方面较后者有优势,值得临床推广。

Objective To observe the effect of sphincter preservation seton applied in complex anal fistulas treatment. Methods 122 cases of patients with complex anal fistulas treated from October 2010 to 2013 were selected and divided into A and B group randomly and equally. And sphincter preservation seton was applied in A group, while fistula resection applied in B group. The cure rate of short and long term, healing time and occurrence of sequel were compared. Results Standard cure was got in both groups, and there were no statistically significant difference between the cure rates and recurrence rates of short term in the 2 groups. Healing time in A group was (20.74±5.62) days, and (19.19±6.84) days in B group (P>0.05), and no statistically significant difference was between the 2 groups. Occurrence of sequel was 3.28% in A group, while 37.70% in B group, (χ²=14.182, P<0.05), and the occurrence of sequel in A group was much lower than that in B group. Conclusion Complex anal fistulas could be treated well by both sphincter preservation seton and fistula resection, and normal physiological function of anus could be better retained by sphincter preservation seton, and the superiority of reduction of postoperative sequelae was apparent by former surgical. It was worthy of clinical use.

目的 观察克氏针钢丝张力带及镍钛聚髌器治疗不同类型髌骨骨折的疗效, 探讨两种手术方式的临床适应证及治疗优点。方法 选取2011年3月—2013年12月,成都中医药大学附属医院骨科住院部45例髌骨骨折患者,术后通过Lyshoml膝关节评分等标准,对患者康复情况进行评估,并对数据加以分析, 比较两种治疗方法的临床效果。结果 两种治疗方法在治疗效果上无差异, 观察后分析:髌骨横形骨折可选克氏针钢丝张力带治疗; 粉碎性骨折采用镍钛聚髌器疗效满意。结论 两种髌骨骨折内固定方法临床疗效相似,但镍钛聚髌器兼有复位良好,固定稳定,操作简便等优点,对于粉碎性髌骨骨折更为适用。

Objective To observe the curative effect of Kirschner wire tension band and Ni Ti patellar concentrator in the treatment of different types of patellar fracture,study the clinical indications on and therapeutic advantages of this two kinds of operation methods. Methods By selecting 45 cases of patellar fracture patients hospitalized in the department of orthopedics,the affiliated hospital of Chengdu university of TCM from 2011-03 to 2013-12.To assess the patients rehabilitation by Lyshoml knee score (standard) after operation and analysis the data,compare the clinical effects of this two methods. Results There is no significant differences between this two methods. After observation and analysis:transverse fracture of patella can be treated with kirschner wire and tension band and Comminuted fracture treated with Ni Ti patellar concentrator will be better. Conclusion This two kinds of operation methods have a similar curative effect in the Clinical reatment of patella fracture, but the Ni Ti patellar concentrator has a good function of reduction, stable fixed and easy to operation,Particularly suitable for Comminuted fracture of patellar.