目的 研究比较低流量异氟烷与七氟烷麻醉在小儿腹腔镜手术中的麻醉效果。方法 选取在我院进行腹腔镜手术治疗的小儿患者120例作为研究对象,随机分为异氟烷和七氟烷两组,每组各60例,分别采用低流量异氟烷和七氟烷进行麻醉,比较两组患儿的相关麻醉参数,以及入睡、苏醒、拔管时间和不良反应情况。结果 两组患儿的不同时期脉搏氧饱和度、心率、呼气末二氧化碳浓度比较无差异(P＞0.05);七氟烷组患儿的不同时期的平均动脉压具有较强的稳定性,而异氟烷组患儿在诱导期间、手术过程中平均动脉压降低,差异有统计学意义(P＜0.05)。结论 在小儿腹腔镜手术过程,采用低流量七氟烷进行麻醉,可以使手术过程中血流动力学更加稳定,缩短术后拔管时间,减少术后不良反应发生,更易满足小儿腹腔镜手术的麻醉要求。

Objective To investigate efficacy between low flow isoflurane and sevoflurane in pediatric laparoscopic surgery. Methods 120 cases of children underwent laparoscopic surgery in our hospital were randomly divided into two groups. 60 patients in isoflurane group were given low-flow isoflurane anesthesia; 60 patients in sevoflurane group were given low-flow isoflurane anesthesia. Heart rate (HR), mean arterial blood pressure (MAP), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) at different period, sleep and awakening time, extubation time, and adverse reactions of two groups were observed. Results Heart rate (HR), pulse oxygen saturation (SpO₂), end-tidal partial pressure of carbon dioxide (EtCO₂) of two groups at different period had no significantly difference (P>0.05). Mean arterial blood pressure (MAP) of two groups at different period had significantly difference (P<0.05). The sleep time and recovery time of two groups had no significant difference (P>0.05). The extubation time of sevoflurane was significantly lower than isoflurane group (P<0.05). The adverse reaction rate of sevoflurane was significantly lower than isoflurane group (P<0.05). Conclusion Low flow isoflurane and sevoflurane can be used in pediatric laparoscopic surgery, and the efficacy of sevoflurane is better.

目的 回顾分析我院胆石症患者个体化治疗方案的效果。方法 2006年8月—2015年1月,我院治疗不同类型胆石症患者3176例,其中胆囊结石2987例,其他类型胆管结石患者189例,定期复查B超等影像检查并最长随访9年,从并发症和术后主观症状、残石率和结石复发率等情况,了解治疗效果。结果 全组患者均手术成功, 大部分自觉症状明显好转,胆囊结石患者平均手术时间(35.7±14.5)分钟, 平均住院时间(3.5±2.5)天;胆管结石平均手术时间(70.3±31.5)分钟,平均住院时间(9.5±4.7)天。胆囊结石残留率0.1%,保胆术式结石复发率8.1%;胆管结石残留率3.7%和复发率5.5%。结论 胆石症患者病情繁杂多样,尤其是肝内胆管结石,治疗需要个体化。

Objective To retrospective analyze the effect of individualization treatment of calculus of cholelithiasis patients. Methods 3176 patients with different kind of cholelithiasis were treated in our hospital during Aug 2006 to Jan, 2015, including 2987 gallstone patients and 189 calculus of bile duct patients. Periodic review of B ultrasound and follow-up was taken after the surgery for 9 years, recording and analyzing intraoperative and postoperative complications, symptoms, residual stones and stone recurrence rate and other, and to evaluate the therapeutic effect. Results Surgeries of all the patients were performed successfully. Postoperative follow-up indicated that symptoms were relieved. The operative duration of gallstone patients was (35.7 ± 14.5) min, and the average hospitalization time was (3.5±2.5) days. The operative duration of calculus of bile duct patients was (70.3± 31.5) min, and the average hospitalization time was (9.5±4.7) days. And the calculus residual rate and recurrence rate of gallstone patients was 0.1% and 8.1% individually. The calculus residual rate and recurrence rate of calculus of bile duct patients was 3.7% and 5.5%. Conclusion Conditions of calculus of cholelithiasis patients are complicated, especially calculus of intrahepatic duct patient. It is necessary to take individual treatment schedule for them.

目的 探讨OAB与CP/CPPS的症状及诊断的重叠情况,为临床诊疗提供参考。方法 151例中青年男性患者入选为研究对象,按OAB及CP/CPPS的定义及诊断标准将其分为OAB组、CP/CPPS组及OAB+CP/CPPS组,并对OAB+CP/CPPS组进行诊断性治疗对研究对象进行明确诊断;根据年龄分为:18~25岁组、26~35岁组和36~49岁组,比较各年龄组患者OAB及CP/CPPS的重叠情况;对各组患者的临床症状进行分析比较,了解其重叠情况。结果 在151例研究对象中,可诊断为OAB、CP/CPPS、OAB+CP/CPPS的分别有62例(41.06%)、32例(21.19%)、57例(37.75%),因此OAB与CP/CPPS的诊断重叠率为37.75%,明显大于CP/CPPS患者的诊断率;各年龄组间诊断重叠率无差异(P>0.05);症状的重叠方面,OAB+CP/CPPS组有尿急、尿频、夜尿症、急迫性尿失禁、尿不尽感、排尿困难、泌尿生殖系疼痛和或不适症状的分别为57例(100.00%)、50例(87.72%)、21例(36.84%)、2例(3.51%)、12例(21.05%)、2例(3.51%)、57例(100.00%),其中,尿急、尿频及泌尿生殖系疼痛或不适症状的重叠率最高;OAB+CP/CPPS组经诊断性治疗后诊断为OAB患者约61.40%,而CP/CPPS患者为38.60%。结论 OAB与CP/CPPS两者间有相当高的重叠率且远高于CP/CPPS的诊断率,在OAB与CP/CPPS两者诊断重叠的患者中为OAB的可能性更大。

Objective To explore symptoms and diagnosis of overlap between OAB and CP/CPPS, providing reference for clinical treatment. Methods 151 cases of young men were enrolled in the study. According to the definition and diagnostic criteria of OAB and CP/CPPS, we divided the study subjects into OAB group, CP/CPPS group and OAB+CP/CPPS group. And OAB+CP/CPPS group would get a two-week diagnostic treatment to study a clear diagnosis. We also divided the subjects into 18-25 age group, 26-35 year-old age group and 36-49 group according to the age, comparing the overlap of OAB and CP/CPPS in different age groups. The symptoms of the subjects in each group were analyzed to compare and study the overlap. Results Among these 151 cases, 62 cases (41.06%) can be diagnosed as OAB, 32 cases (21.19%) as CP/CPPS, 57 cases (37.75%) as OAB+CP/CPPS. Therefore, OAB and CP/CPPS diagnostic overlap was 37.75%, significantly higher than the diagnosis of CP/CPPS patients; no significant difference (P>0.05) among all age groups diagnostic overlap rate; overlapping terms of symptoms, OAB + CP/CPPS group urgency, urinary frequency, nocturia, urgency incontinence, urine not the flu, difficulty urinating, or genitourinary pain and discomfort were 57 cases (100.00%), 50 cases (87.72%), 21 cases (36.84%), 2 cases (3.51%), 12 cases (21.05%), 2 cases (3.51%), 57 patients (100.00%), which overlap ratio urgency, frequency, and genitourinary pain or discomfort was high; OAB+CP/CPPS group after diagnosis diagnostic treatment of OAB patients was about 61.40%, while CP/CPPS patients was 38.60%. Conclusion There is high overlap rate between OAB and CP/CPPS, which is much higher than the diagnostic rate of CP/CPPS. It is likely to have an OAB when a patient is diagnosed as OAB or CP/CPPS at the same time.

目的 探讨莫西沙星结合抗结核药物治疗糖尿病合并肺结核患者的临床疗效分析。方法 将本组126例糖尿病合并肺结核患者分为对照组(n=63)和观察组(n=63);对照组给予降血糖治疗及抗结核药物降糖治疗,观察组在对照组治疗基础上服用莫西沙星;两组治疗均以3个月为一个疗程,2个疗程后统计疗效。结果 观察组总有效率(93.65%)高于对照组(76.19%),差异有统计学意义(P<0.05);观察组痰菌检测转阴率(94.59%)高于对照组(79.49%),差异有统计学意义(P<0.05);治疗过程中观察组与对照组出现不良反应情况相比较差异无统计学意义(P＞0.05)。结论 莫西沙星结合抗结核药物治疗糖尿病合并肺结核疗效显著,具有较强的杀菌作用。

Objective To investigate the clinical efficacy of moxifloxacin combining with antituberculosis drug in the treatment of diabetic patients with pulmonary tuberculosis. Methods A group of 126 patients of diabetes complicated with pulmonary tuberculosis were divided into control group (n=63) and observation group (n=63); the control group was given by hypoglycemic therapy and therapy of antituberculosis drug only, and the observation group was also given by moxifloxacin; two groups were treated for 3 months as a course.The clinical efficacy was evaluated after 2 courses. Results The total effective rate of observation group (93.65%) was significantly higher than that of the control group (80.95%), and the difference was statistically significant (P<0.05); the negative sputum rate of observation group (94.59%) was higher than that of the control group (79.49%), and the difference was statistically significant (P<0.05); there was no statistically significant difference between the observation group and the control group in adverse effects. Conclusion The curative effect of moxifloxacin combining with antituberculosis drug in the treatment of diabetes mellitus complicated with pulmonary tuberculosis was good, with strong bactericidal effect.

目的 探讨肝脏脂肪变性对肝脏切除手术安全性及预后的影响。方法 选取2012年1月—2014年12月在我院接受肝切除术治疗的肝癌患者172例,根据HE染色结果,172例患者中无脂肪变性106例(对照组),轻度脂肪变性42例(轻度组),中重度脂肪 24例(中重度组),比较各组患者基本资料(性别、年龄等)、手术情况、生化指标、术后并发症、住院时间等。结果 三组患者体重指数(BMI)差异有统计学意义(P＜0.05),中重度组BMI最高,为(26.94±3.14)kg/m²;中重度组患者手术时间、术中出血量、输注红细胞和肝门阻断时间分别为(182.39±42.17)min、(553.07±50.22)mL、(1.18±0.34)U和(20.15±6.07)min,均高于其他两组(P＜0.05);中重度组患者重度并发症发生率为45.83%,高于对照组和轻度组的9.43%和9.52%(P＜0.05);中重度组住院时间和ICU时间分别为(23.06±7.30)d和(3.71±1.03)d,高于其他两组(P＜0.05)。结论 轻度肝脏脂肪变性对手术基本无影响,而中重度脂肪变性会增加手术时间和出血、重度并发症发生较多,不利于手术的安全性以及预后。

Objective To explore the effect of liver steatosis on liver resection safety and the prognosis. Methods Selected from January 2012 to December 2014 in our hospital liver resection of 172 cases of liver cancer patients, according to the results of HE staining, 172 patients without fatty degeneration in 106 cases (control group), 42 cases of mild steatosis (mild steatosis group), 24 cases of severe fatty (moderate and severe steatosis group),observed each group patients the clinical characteristics, surgery situation, biochemical index, postoperative complications, hospitalization time, etc. Results Body mass index(BMI)of patients in the three groups difference was statistically significant (P<0.05), moderate and severe steatosis group had the highest BMI (26.94±3.14)kg/m²; in moderate and severe steatosis group, surgery time, intraoperative bleeding volume, infusion of red blood cells and hepatic portal occlusion time were (182.39±42.17) min, (553.07±50.22) ml, (1.18±0.34) U and (20.15±6.07) min. They were significantly higher than that of the control group and mild steatosis group (P<0.05); moderate and severe steatosis patients with severe complication rate was 45.83%,significantly higher than that in the control group and the mild steatosis 9.43% and 9.52%. The difference was statistically significant (P<0.05); In moderate and severe steatosis group, hospitalization time and ICU were (23.06±7.30) d and(3.71±1.03) d, significantly higher than that in the control group and the mild steatosis group(P<0.05). Conclusion Mild liver steatosis have no effect on the surgery, severe liver steatosis may increase the surgery time and bleeding, severe complications occurred more, is not conducive to the safety of the surgery and prognosis.

目的 探讨老年人血尿酸(serum uric acid,SUA)水平与阿尔茨海默病(Alzheimer's disease,AD)的相关性。方法 选择227例我院老年病科住院患者为研究对象,其中阿尔茨海默病67例,其余160例为非AD组。收集病史、吸烟史、服药史,并检测血尿酸、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBS)、血肌酐(Cr)水平。比较各SUA四分位数水平AD的发生率,并进行相关性分析。结果 AD组血尿酸水平低于非AD组,差异有统计学意义(P＜0.01);多因素分析筛选出年龄、性别、缺血性脑卒中是危险因素(P＜0.05),而服用他汀、SUA、HDL-C是保护因素(P＜0.05)。对AD和SUA的四个分组做Spearman等级相关分析(rs=-0.285,P<0.001),结果呈等级负相关。结论 血尿酸水平与老年人AD相关,血尿酸可能是AD发病的保护性因素。

Objective To explore the correlation between serum uric acid(SUA) level and Alzheimer's disease(AD) in elderly patients. Methods 67 cases of the elders with Alzheimer's disease and 160 elders matching with age and gender were enrolled from Jan 2013 to Dec 2014 in the study,the blood levels of biochemical factors such as SUA,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting blood sugar(FBS) and creatinine(Cr) were measured by automatic biochemistry analyzer in the two groups. The related factors such as history of disease,smoking and medication history were collected. The correlation between the level of SUA and AD was analyzed. Results The serum uric acid levels in AD group were significantly lower than those in control group(P＜0.01). Multivariate logistic regression analysis showed that age, gender, ischemic stroke were risk factors, and taking statin, SUA, and HDL-C were protective factors(P＜0.05). Spearman correlation tests indicated that there was an inverse correlation between SUA levels and AD(rs=-0.285,P<0.001). Conclusion Serum uric acid level is significantly related to AD in the elderly.SUA may be a protective factor of the occurrence of AD.

目的 了解青海省北京/W系结核分枝杆菌分布特征。方法 收集青海地区结核分支杆菌临床分离株,采用RD105缺失基因检测鉴定北京/W系结核分枝杆菌。结果 共收集237株结核分枝杆菌临床分离株,采用RD105缺失基因检测鉴定北京/W系结核分枝杆菌220株,占92.8%,非北京/W结核分枝杆菌,共17株,占7.2%。北京/W系结核分枝杆菌在青海地区性别与民族分布差异没有统计学意义(P＞0.05)。结论 北京/W结核分枝杆菌为青海地区流行菌株,在人群易于发生感染和传播。

Objective To ascertain the epidemiological characteristics of Beijing/W lineage Mycobacterium tuberculosis in Qinghai Province. Methods M. tuberculosis clinical isolates were collected and identified with an RD105 deletion test.Statistical analysis was performed by using the test. Results Totally, 237 clinical isolates of M. tuberculosis were collected in which 220 strains (92.8%) belonged to the Beijing/W lineage of M. tuberculosis while 17strains (7.2%) belonged to the non-Beijing/W lineage of M. tuberculosis according to the RD105 deletion test. There were no significant differences in the distribution of Beijing/W lineage of M. tuberculosis in the gender and nationality (P＞0.05). Conclusion Beijing/W lineage of M. tuberculosis were prevalent in Qinghai province and prone to having infection and transmission in the crowd.

目的 分析总结12例原发性肺淋巴上皮瘤样癌(LELC)的临床病理特点。方法 回顾性分析12例肺LELC患者的临床病理资料。结果 12例肺LELC患者的组织学标本中,肿瘤细胞均明显表达HCK,原位杂交EBER阳性率为91.7%。全组中位生存期61.3个月,2年和5年生存率分别为84.6%和57.7%。结论 原发性肺LELC临床罕见,发病可能与EB病毒感染有关,经及时治疗有较好的预后。

Objective To investigate the pathological and clinical significance of 12 cases with primary Lymphoepithelioma-like carcinoma of the lung (LELC). Methods Retrospectively detectded and analyzed the clincalpathological feature of 12 cases of LELC of the lung. Results Histological study showed that tumor cells were significantly expressed HCK by immunohistochemistry staining and showed out 91.7% positive rate of EBER by situ hybridization. In this series, the median survival time was 61.3 months. The overall 2 and 5 year survival rates of the 12 cases were 84.6% and 57.7%. Conclusion Pulmonary LELC is very rare. It may be associated with Epstein-Barr virus infection, and has a batter prognosis after therapy.

目的 探讨磷酸二酯酶4抑制剂对人肺泡巨噬细胞(AM)吞噬非生物性颗粒及革兰阳性菌、阴性菌能力的影响。方法 使用Ficolll-Hypaque密度梯度法将外周血单核细胞分离的静脉血,在含有2 ng/m GM-CSF的培养液中经12天诱导培养成AM替代细胞模型—单核细胞源性巨噬细胞(MDM)。用酶标仪检测MDM经磷酸二酯酶4抑制剂Rolipram预处理过夜(16~18 h)后吞噬荧光标记的非生物颗粒Beads和热灭活的流感嗜血杆菌(H.influenzae)、金黄色葡萄球菌(S.aureus)量的改变,另使用MTT法检测细胞活性。结果 成功建立的MDM细胞模型对Beads和细菌的吞噬呈时效关。Rolipram在实验浓度(10^~8~10^-5 M)下对MDM吞噬Beads、H.influenzae和S.aureus能力无明显促进或抑制作用,也不影响MDM的活性。结论 磷酸二酯酶4抑制剂不会因升高巨噬细胞内cAMP水平而影响其吞噬非生物颗粒和细菌的能力。

Objective To investigate the influence of phosphodiesterases 4 inhibitor on the phagocytosis of non-biological particles and gram-positive bacteria, gram-negative bacteria by human alveolar macrophages. Methods Peripheral blood mononuclear cells (PBMCs) were isolated from venous blood from 12 healthy volunteers using Ficoll-Hypaque density gradients. Monocytes were incubated with media containing 2 ng/ml GM-CSF for 12d to allow full differentiation into macrophage (MDM), a functionally equivalent model of human AM. MDM were pretreated with Rolipram overnight (16-18h),phagocytosis of fluorescent labeled beads and H.influenzae,S.aureus by MDM was measured using a fluostar optima fluorimeter. Cell viability was assay with MTT. Results MDM phagocytosis of beads and bacteria was a time-dependant process. Rolipram in the concentration of 10^-8-10^-5M didn't inhibit or promote phagocytosis of beads and bacteria by MDM, and didn't affect the cell viability. Conclusion Phosphodiesterases 4 inhibitor would not affect the human macrophage phagocytic capacity of non-biological particles and bacteria associated with enhanced intracellular cAMP level.

目的 确定CD4⁺CD25⁺Treg调节性T细胞在重症肺炎克雷伯菌肺炎中的表达以及意义,探讨CD4⁺CD25⁺Treg在重症肺炎克雷伯菌肺炎的免疫抑制中的调控作用。方法 通过气管内滴注肺炎克雷伯菌菌液建立重症肺炎模型。采用流式细胞仪检测CD4⁺CD25⁺Treg细胞及酶联免疫吸附法(ELISA)等方法检测各种细胞因子。结果 重症肺炎克雷伯菌肺炎大鼠的脾脏和肺中CD4⁺CD25⁺Treg的数量增加。使用了CD25抗体(PC61)去除机体内源性的CD4⁺CD25⁺Treg,分别去除脾脏和肺的94%和90%的CD4⁺CD25⁺Treg。CD25抗体组在建模4 h,12 h及24 h后,肺部MPO及血清IL-1,IL-6,MIP-2较对照组高(P<0.05),肺和BLA比对照组高(P<0.05),CD25抗体组大鼠生存率比对照组低(P<0.05)。结论 内源的CD4⁺CD25⁺Treg对大鼠抑制重症肺炎克雷伯菌肺炎的过度免疫损害反应起到保护作用。

Objective To confirm the expression and meaning of the T regular cell in the severe Klebsiella pneumonia, and to evaluate the regular and control affect in the immunologic suppression of the severe Klebsiella pneumonia. Methods To build the severe pneumonia model by intratracheally inoculated with Klebsiella pneumoniae bacteria. To check sorts of inflammation factors by the methods of ELISA and flow cytometry. Results The quantity of the CD4⁺CD25⁺Treg in the splenic and lungs of the mice with severe Klebsiella pneumonia were increased. Anti-CD25Ab(PC61) was used to remove endogenousCD4⁺CD25⁺Treg. Anti-CD25 treatment remove 90% of CD4⁺CD25⁺Treg cells. The cytokine production(IL-1β,IL-6,MIP-2)in the anti-CD25-treated group were significantly increased. And it also increased significantly in the airway neutrophil infiltration, while the survival rate had been decreased. Conclusion Endogenous CD4⁺CD25⁺Treg can provide obvious protection effect to the restraining the over immunity damage of the severe Klebsiella pneumonia for the mice.