目的 探讨MDS、MDS/AML及原发AML基因突变频谱的异同点及其临床意义。方法 选取98例MDS患者、32例MDS/AML患者及234例原发AML患者为研究对象,利用二代测序技术检测基因突变。结果 MDS组中突变率较高的基因突变为TET2(16.7%,16/96)、U2AF1(12.0%,6/50)、SF3B1(11.8%,9/76);MDS/AML组中突变率较高的基因突变为TP53(33.3%,2/6)、DNMT3A(30%,6/20)、IDH2(21.1%,4/19);原发AML组中突变率较高的基因突变为FLT3-ITD(18.0%,42/233)、NPM1(16.3%,38/233)、DNMT3A(14.9%,14/94)。DNMT3A(P=0.006)、IDH2(P=0.004)及NPM1(P=0.002)等基因突变在MDS与MDS/AML两组间的突变率有统计学差异;FLT3-ITD(P=0.001)、NPM1(P=0.002)、CEBPA(P=0.011)及IDH2(P=0.019)等基因突变在MDS与原发AML两组间的突变率有统计学差异;所有受检基因突变在MDS/AML与原发AML两组间的基因突变的突变率无统计学差异(P＞0.05)。结论 MDS、MDS/AML及原发AML基因突变的突变频谱具有相似性及异质性,从MDS到MDS/AML、原发AML基因突变的变化不仅影响疾病转归及预后而且可帮助鉴别MDS/AML和原发AML。

Objective To explore the similarities and differences of spectrum of gene mutations in patients with myelodysplastic syndrome, MDS/AML and de novo acute myeloid leukemia and their clinical significance. Methods 98 patients with MDS, 32 patients with MDS/AML, 234 patients with de novo AML were selected. Gene mutations were detected by second generation sequencing. Results The most frequent mutations in MDS were as follows:TET2(16.7%, 16/96), U2AF1(12.0%, 6/50), SF3B1(11.8%, 9/76); The most frequent mutations in MDS/AML were TP53(33.3%, 2/6), DNMT3A(30%, 6/20), IDH2 (21.1%, 4/19);The most frequent mutations in de novo AML were FLT3-ITD(18.0%, 42/233), NPM1(16.3%, 38/233), DNMT3A(14.9%, 14/94); DNMT3A(P=0.006),IDH2(P=0.004) and NPM1(P=0.002) were statistical difference between MDS and MDS/AML; FLT3-ITD(P=0.001),NPM1(P=0.002),CEBPA(P=0.011) and IDH2(P=0.019) were statistical difference between MDS and de novo AML;There were no siatistical significance (P>0.05) in the frequency of all detected gene mutations between MDS/AML and AML. Conclusion The spectrum of gene mutation of MDS, MDS/AML and primary AML have similarities and heterogeneity.The changes of gene mutations from MDS to MDS/AML and de novo AML not only affect disease outcome and prognosis, but also help to identify MDS/AML and de novo AML.

目的 分析KRAS基因突变在左半结肠、右半结肠癌分布几率的差异性。方法 回顾性分析我院病理科分子实验室2015年到2017年间接收的537例结肠癌手术标本,用ARMS-PCR法进行了KRAS基因的检测,并对左右半结肠腺癌KRAS基因突变比例进行χ²检验,P＜0.05为差异有统计学意义。结果 537例中有187(34.82%)例为右半结肠腺癌,左半结肠腺癌有350(65.18%)例。KRAS基因突变检测阳性例数为240例,阳性率为44.69%;右半结肠腺癌KRAS基因突变阳性数为114例,阳性率为60.96%;左半结肠癌KRAS基因突变阳性数为126例,阳性率为36.00%。双侧结肠腺癌KRAS基因突变差异有统计学意义。结论 右半结肠癌的患病例数低于左半结肠癌,右半结肠癌KRAS基因突变阳性率较左半结肠癌高,本研究为区分左右半结肠癌的分子靶向治疗提供了数据支持。

Objective To analyze the differences distribution of KRAS gene mutations in the left hemi colon cancer and right hemi colon cancer. Methods Retrospectively to analyse the 537 colorectal cancer patients who were received by our molecular laboratory of pathology from 2015 to 2017, ARMS-PCR method was used to detect the KRAS gene. The ratio of KRAS gene mutation in left and right hemi colon cancer was tested by χ² test, P<0.05 was considered statistically significant. Results There were 187(34.82%) patients with right hemi colon cancer; and there were 350 (65.18%)patients with left half hemi colon cancer. The KRAS positive patients were 240 cases, which were 44.69% in total. The positive patients with right hemi colon cancer were 114 cases which had a higher rate of 60.96%, the left hemi colon cancer patients were 126 cases with a lower rate of 36.00%. Conclusion The number of right hemi colon cancer was lower than the number of left hemi colon cancer. And the KRAS gene mutation in right hemi colon cancer had more positive than left hemi colon cancer. This study provides a number aid for treating right and left colon cancer in the subsequent molecular targeted drug therapy.

目的 探讨粪菌移植(FMT)在两种肠镜下盲肠置管术的临床应用。方法 将2016年1月—2017年6月在我院通过肠镜下盲肠置管术进行粪菌移植的200例患者,随机分为A组和B组,各100例。A组采用直接肠镜置管法完成置管,B组采用二次肠镜置管法完成置管,对两组操作的置管成功率、置管时间、平均疼痛评分、并发症等情况进行对比。结果 与A组相比较,B组到达盲肠时间略长但无统计学意义(14.95min vs 15.26min,P=0.68)、疼痛评分低(5.7 vs 4.8,P<0.05)、更低的并发症发生率(6 % vs 23 %,P<0.05)。结论 在粪菌移植内镜下盲肠置管术患者中,采用通过采用二次肠镜置管法与直接肠镜法相比较完成置管手术时间无统计学差异,但置管成功率高、患者的痛苦小、风险低,值得临床推广。

Objective To investigate the clinical application of fecal microbiota transplantation (FMT) in two kinds of colonoscopic cecal catheterization. Methods From January 2016 to June 2017, 200 patients who took colonoscopic cecal catheterization for fecal microbiota transplantation in our hospital were randomly divided into group A and group B, with 100 patients in each group.Group A used direct colonoscopy catheterization to complete catheterization, group B was treated by the second colonoscopy catheterization. The success rate of catheterization, catheterization time, average pain score and complication were compared between the two groups. Results Compared with group A, the time to reach the cecum in group B was slightly longer but not statistically significant (14.95min vs 15.26min,P=0.68). It had lower pain score (5.7 vs 4.8, P<0.05), lower complication rate. Conclusion Among the patients with colonoscopic cecal catheterization for fecal microbiota transplantation, there was no significant difference in the time of catheterization between the second colonoscopy and the direct colonoscopy, but it has the high success rate of catheterization and low pain, low risk, worthy of clinical promotion.

目的 本研究旨在探讨血浆chemerin水平与原发性高血压合并心房颤动的相关性。方法 选择2016年2月—2017年12月期间在广州市第一人民医院心内科及老年心内科住院的高血压患者160例,根据是否合并心房纤颤分为心房纤颤组(AF组,n=72)及非心房纤颤组(NAF组,n=88),另选取140例我院体检中心体检结果正常的正常健康人作为对照组(CON组,n=140)。采用全自动生化检测仪测定甘油三脂、总胆固醇、低密度脂蛋白、C反应蛋白等生化学指标;使用ELISA法检测血浆chemerin水平。结果 AF组患者的血浆chemerin水平较NAF组患者升高[(180.45±15.23)ng/mL vs(162.36±13.44)ng/mL,P<0.05],且均较CON组升高[(142.36±11.83)ng/mL,P<0.05)],多元Logistic回归分析显示血浆chemerin水平与高血压病合并心房纤颤呈独立相关性(OR 1.112, 95% CI 1.023～1.302;P<0.001)。结论 高血浆chemerin水平可能是预测高血压合并心房纤颤的独立危险因素,血清chemerin可能成为一种预测高血压发生心房纤颤的重要生物学标记物。

Objective To explore the relationship between chemerin levels and permanent atrial fibrillation in patients with hypertension. Methods A total of 160 patients with hypertension were enrolled in this study. All the patients were classified as AF(n=72) or NAF(n=88) based on the permanent atrial fibrillation or not. And 140 healthy people were collected as a control group(CON). Triglycerides, total cholesterol, low density lipoprotein cholesterol and C-reactive protein were measured by automatic biochemical detector. Serum chemerin levels were determined by enzyme-linked immunosorbent assay(ELISA). Results Serum chemerin levels were higher in AF patients than those in NAF patients(180.45±15.23 ng/mL vs 162.36±13.44 ng/mL,P<0.05). They were both higher than that of the CON patients(142.36±11.83 ng/mL,P<0.05). Multivariate logistic regression demonstrated that chemerin level was independently associated with the permanent atrial fibrillation in patients with hypertension(OR 1.112, 95% CI 1.023～1.302;P<0.001). Conclusion Serum chemerin is an independent risk factor for permanent atrial fibrillation with hypertension. The results suggest that chemerin might be a useful biomarker for predicting the permanent atrial fibrillation with hypertension.

目的 分析25羟维生素D[25(OH)D]在新疆汉族及维吾尔族老年男性2型糖尿病(T2DM)合并骨质疏松(OP)患者中的水平及与骨密度(BMD)的相关性。方法 收集住院的汉族、维吾尔族老年男性T2DM患者281例,根据民族及骨密度值将其分为汉族非骨质疏松(NOP)组127人(A组)、汉族骨质疏松(OP)组21人(B组)、维族NOP组103人(C组)、维族OP组30人(D组),记录四组患者的25(OH)D水平并进行比较,分析25(OH)D与BMD的相关性。结果 同一民族中,B组的25(OH)D低于A组(P<0.05),D组的25(OH)D低于C组(P<0.05); T2DM合并OP患者中,D组的25(OH)D低于B组(P<0.05); 相关性分析显示,25(OH)D与BMD呈正相关。结论 维吾尔族老年男性T2DM合并OP患者较汉族患者的25(OH)D水平低,25(OH)D水平低的T2DM患者更易合并OP,25(OH)D检测有助于识别T2DM患者合并OP的风险。

Objective To analysis the level of 25 hydroxy vitamin D[25(OH)D] in Xinjiang Han and Uyghur elderly male patients with T2DM and osteoporosis, and the correlation between 25(OH)D levels and bone mineral density(BMD). Methods We collected 281 cases of T2DM patients from Hans and Uyghurs, divided them into four groups according to the nationality and BMD: Han non-osteoporosis(NOP) group including 127 cases(group A), Han osteoporosis(OP) group 21 cases(group B), Uyghur NOP group 103 cases(group C), Uyghur OP group 30 cases(group D). Recorded and compared their 25(OH)D levels, and analyzed the correlation between 25(OH)D levels and BMD. Results In the same nationality,the level of 25(OH)D in group B were lower than those in group A(P<0.05), and group D were lower than those in group C(P<0.05); In T2DM patients combined with OP, the levels of 25(OH)D in group D were lower than those in group B(P<0.05); Correlation analysis showed that 25(OH)D was positively correlated with BMD. Conclusion The level of 25(OH)D in elderly male patients with T2DM combined with osteoporosis, those of Uyghurs are lower than those of Hans. T2DM patients with lower 25(OH)D level are more likely to combine OP. The 25(OH)D level test may help to identify the risk of combining OP in T2DM patients.

目的 探讨广州地区老年人维生素D水平及其与骨密度、甲状旁腺激素的相关性。方法 收集2016年6月—12月在广州市第一人民医院老年病科就诊的患者。检测25-羟维生素D、甲状旁腺激素、Ⅰ型前胶原氨基端前肽、β-Ⅰ型胶原C端肽、腰椎和髋部骨密度。将患者分为维生素D缺乏组(≤20 ng/mL)、维生素D不足组(20～30 ng/mL)、维生素D充足组(≥30 ng/mL)。结果 ①426例研究对象的平均年龄是(79.77±7.69)岁,25羟维生素D平均值是(20.38±8.20)ng/mL。维生素D缺乏、不足、充足者比例分别是53%(226/426)、34.3%(146/426)、12.7%(54/426)。②25羟维生素D水平随年龄增加而降低。25羟维生素D与股骨颈和全髋骨密度呈正相关(r=0.18,P＜0.001),与甲状旁腺激素呈负相关(r=-2.05,P＜0.001)。结论 广州地区老年人维生素D不足及缺乏十分普遍。维生素D与股骨颈、髋部骨密度呈正相关,与甲状旁腺激素呈负相关。

Objective To investigate the vitamin D level of elder people in Guangzhou and the relationship in vitamin D, bone mineral density and parathyroid hormone. Methods To screening elderly patients in the geriatric department of Guangzhou First peoples Hospital from June to December 2016.Serum 25-hydroxy vitamin D,parathyroid hormone,procollagen typeⅠN-terminal propeptide,β-crosslaps of C-telopeptide of typeⅠcollagen,bone mineral density were measured.Three groups were divided according to the serum 25(OH)D level,including deficiency group(≤20 ng/mL),insufficiency group(20-30 ng/mL) and sufficiency group(≥30 ng/mL). Results The mean age of the 426 subjects was 79.77±7.69 years old. The average level of 25(OH)D was 20.38±8.20 ng/mL. The proportion of vitamin D deficiency, insufficient and sufficient persons were 53% (226/426), 34.3% (146/426), and 12.7% (54/426). The level of 25 hydroxy vitamin D was decreased with age.Correlation analysis showed that 25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density(r=0.18,P＜0.001),was negatively correlated with parathyroid hormone(r=-2.05,P＜0.001). Conclusion Vitamin D deficiency or insufficiency is highly prevalent in elderly men in Guangzhou.25 hydroxy vitamin D level was positive correlated with the femoral neck and total hip bone density, negatively correlated with parathyroid hormone.

目的 观察社区综合防治健康管理模式对社区高血压患者血压控制疗效及药物经济学的影响。方法 收集2012年7月—2013年7月广州参与研究的三级医院及社区卫生服务中心收治的原发性高血压病患者2 383例,病例入组后随机分为综合管理组和常规治疗组。记录及随访两组高血压患者基线血压值、降压药物使用方案、是否更换药物、血压控制疗效及药物经济学相关费用情况。结果 与常规治疗组相比,综合管理组患者血压治疗效果较好,显效率及总有效率提高[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001];高血压治疗及管理的药物费用虽有升高(t=16.186,P＜0.001),但相关的门诊费用、住院费用、护理费用及总费用降低(t=25.647, t=35.785, t=22.274,t=73.710,P＜0.001);在降压方案方面,从减少抗高血压药物使用,减少费用考虑,单独用药方式适合单纯性轻度高血压患者,从费用效果分析上,成本效果比以单药组最低,联用药组逐渐增大;增量成本-效果比:二药联用降压方案优于其他降压联合方案,因而两药联用降压为兼顾疗效和成本的降压较佳组合。结论 应用社区综合防治模式对高血压患者进行干预,效果满意,能够有效降低成本-效果比,值得临床推广应用。

Objective To investigate the effects of comprehensive prevention and control measures on the therapeutic efficient and pharmacoeconomics in community hypertension patients. Methods 2383 cases of hypertension were collected from July 2012 to July 2013 in the tertiary and community hospitals in Guangzhou, which were randomly divided into general therapy group, in which the patients were treated by general administration of drugs, and comprehensive management group that the patients were visited regularly. The sources of drugs, drugs use and changes in drugs were investigated. Results Compared with the general therapy group, better treatment effects were achieved in the comprehensive group. The apparent efficiency and total efficiency were both increased in the comprehensive group[(60.71% vs 46.01%); (90.20% vs 71.06%), P＜0.001]. Although the therapy and pharmacy fees were slightly increased in the comprehensive group as compared to the control group (t=16.186, P＜0.001), the outpatient expenses,hospitalization expenses, nursing expenses and the total expenses were decreased(t=25.647; t=35.785; t=22.274;t=73.710;P＜0.001). Considering reducing the use of drugs and decreasing the cost, the method of using single drug is beneficial to the patients of low-risk mild hypertension. The method of using calcium antagonist is the most economical and reasonable way. Conclusion Standardizing management of hypertension in community is effective in improving hypertension treatment and decreasing the cost, which is thus worth popularizing.

目的 分析并探讨T细胞斑点技术诊断结核性胸膜炎的临床价值。方法 将2014年5月—2016年5月收治61例的结核性胸膜炎的患者和61例非结核性胸膜炎的患者同时行外周血和胸水的T细胞斑点实验,对各组数据进行统计学处理与分析。结果 结核组血T-SPOT的阳性率为88.52%,高于非结核组的16.39%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为88.52％、83.61%、85.71%、86.44%、5.40、0.14、0.72。结核组胸水T-SPOT的阳性率为90.16%,高于非结核组的8.20%,(P<0.001),其诊断结核性胸膜炎的灵敏度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比、youden指数分别为90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82。联合外周血及胸水T-SPOT检测阳性率为91.80%,特异度为93.44%,阳性似然比为14.00,阴性似然比为0.09,youden指数为:0.85。结论 T细胞斑点实验检测对结核性胸膜炎有较高的临床诊断价值,外周血及胸水T-SPOT联合检测可提高诊断率,可作为结核性胸膜炎快速早期诊断的有效辅助手段。

Objective To analysis the value of T-SPOT.TB in the diagnosis of tuberculous pleurisy. Methods A total of 61 patients with clinically suspected tuberculous pleurisy (group A) and 61 cases of other diseases caused by pleural effusion (group B)admitted from May 2014 to May 2015 from the Guangzhou Chest Hospital had peripheral blood T-SPOT.TB and pleural effusion T-SPOT.TB,for each group of data for statistical processing and analysis. Results The positive rate of T-SPOT in the blood of the group A was 88.52%, which was higher than group B, (P<0.001) (16.39.0%). And the sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 88.52%, 83.61%,85.714%, 86.44%, 540, 0.14, 0.72 respectively by peripheral blood T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of pleural effusion T-SPOT in the group A was 90.16%, which was also higher than group B (P<0.001). The sensitivity, specificity, positive predictive value and negative predictive value, positive likelihood ratio(LR+), and negative likelihood ratio(LR－), Youden index were 90.16％、91.80%、91.67%、90.32%、11.00、0.11、0.82 respectively by pleural effusion T-SPOT.TB in diagnosis of tuberculosis pleurisy. The positive rate of the joint tests of T-SPOT in peripheral blood and in peripheral blood was 91.80%, the specificity was 93.44%, the positive likelihood ratio was 14, the negative likelihood ratio was 0.09, and the youden index was 0.85. Conclusion T-SPOT.TB for the diagnosis of tuberculous pleurisy has a higher clinical value in the diagnosis. The joint tests of T-SPOT in peripheral blood and in pleural effusion may improve the positive rate in the diagnosis of tuberculous pleurisy. The joint tests of T-SPOT in peripheral blood and in pleural effusion have an important reference for diagnosing suspected tuberculous pleurisy quickly, early and accurately.

目的 应用中国膳食平衡指数(DBI-07)对活动期溃疡性结肠炎(Ulcerative Colitis,UC)患者进行膳食质量评价,并分析其与营养指标、活动度等的关系,为UC患者制订科学的营养干预措施提供依据。方法 选取我院符合纳入标准的82例UC患者进行研究,用食物频率法对患者进行膳食调查,应用膳食平衡指数DBI-07评分系统进行评价,同时进行人体测量及营养指标测定。数据用SPSS 17.0软件进行处理分析。结果 本研究中68.3%的UC患者体质量近半年有不同程度降低,40.2%的患者存低白蛋白血症,34.1%的合并贫血。UC患者TS平均值-20.02±7.97; LBS平均值-22.15±6.78, 其中54.9%存在轻度膳食摄入不足、37.8%存在中度摄入不足;DQD平均值24.27±6.21,其中轻、中度失衡分别占80.5%、17.1%。LBS绝对值与体质量减轻程度呈正相关,P<0.05,与血清白蛋白负相关,P<0.01;DQD与白蛋白呈负相关,P<0.01;4 UC患者LBS绝对值与UC活动度呈正相关,P<0.01;DQD值与UC活动度负相关,P<0.01。结论 以中国膳食平衡指数DBI-07评价UC患者膳食质量,92.7%的患者存在低、中度摄入不足,97.6%的UC患者存在膳食失衡,均明显高于健康人群。摄入不足是UC患者营养不良的重要原因,应对UC患者进行营养补充或营养支持。

Objective To survey the diet quality of UC patients using Chinese diet balance index(DBI-07) and explore their relationship with nutritional index and activity of disease, thereby to provide evidences of nutritional therapy for UC patients. Methods 82 adult UC patients who met the inclusion criteria were included in our study. They were investigated with food frequency questionnaires(FFQ) and diet quality was assessed with DBI-07. Anthropometric measurement and blood examinations were done. Data were analyzed with SPSS 17 software. Results 68.3% of the UC patients loss their weight during the recent 6 months. 40.2% of the patients were found hypoalbuminemia and 34.1% were complicated with anemia. The mean TS,LBS and DQD were -20.02±7.97, -22.15±6.78 and 24.27±6.21 respectively. Percentage of patients in slightly or moderately deficit of food intake were 54.9% and 37.8%. Percentage of the UC patients in slightly or moderately dietary imbalance were 80.5% and 17.1%.The absolute value of LBS and DQD were negatively correlated with serum albumin respectively, and both of them were positively correlated with activity of UC. Conclusion Evaluating the quality of UC with DBI-07,92.7% of UC patients were in slightly or moderately deficit of food intake,97.6% were in slightly or moderately dietary imbalance. These percentages were higher than that of healthy people. It indicated that deficit of food intake is an important reason resulting in malnutrition. Nutrition therapy is essential for UC patients.

目的 对比分析甲氨蝶呤(methorexate,MTX)联合超声监视下清宫与甲氨蝶呤、子宫动脉栓塞术(uterine artery embolization,UAE)联合清宫治疗停经7周内Ⅱ-Ⅲ型剖宫产瘢痕妊娠(ceasarean scarpregnancy,CSP)的效果。方法 回顾性分析我院自2016年1月—2017年12月收治的停经7周内Ⅱ-Ⅲ型CSP患者的临床资料,按随机、平衡、对照原则分别筛选69例MTX+清宫治疗患者作为A组,68例MTX+UAE+清宫治疗患者作为B组,对比两组治疗成功率、一般治疗情况及术后并发症发生率,并统计两组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间。结果 两组术后恢复良好,术中、术后均未发生不可控制宫腔出血现象,胎囊组织均全部清出,A组术中出血量、子宫切除发生率、发热、术后盆腹腔疼痛及肝功能损伤发生率均低于B组,术后第1天血β-hCG下降超过50%及治疗成功率、住院时间均高于B组,且该组月经周期恢复时间、血β-hCG恢复至正常时间、疤痕妊娠病灶消失时间亦较B组短(P﹤0.05)。结论 于停经7周内Ⅱ-Ⅲ型CSP患者而言,行MTX+清宫治疗或可在不增加出血风险基础上避免UAE相关并发症及副反应。

Objective To comparatively analyze the effects of methotrexate (MTX) combined with uterine curettage under ultrasonic monitoring and MTX, uterine artery embolization (UAE) combined with uterine curettage in the treatment of cesarean scar pregnancy (CSP) within 7 weeks of menopause. Methods The clinical data of patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause who were admitted to the hospital from January 2016 to December 2017 were analyzed retrospectively. Another 69 cases treated with MTX combined with uterine curettage were selected as group A and 68 cases treated with MTX+UAE+uterine curettage were selected as group B. The success rate of treatment, general situation of treatment and the incidence of adverse reactions were compared between the two groups. The time of menstrual recovery, the recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions were statistically analyzed. Results The two groups recovered well after operation, and there was no uncontrollable uterine bleeding. All fetal sac tissues were cleared. The intraoperative blood loss, hysterectomy rate, incidence rates of fever, postoperative abdominopelvic pain and liver function injury in group A were less/lower than those in group B, The rate of blood β-hCG decreasing more than 50% on the 1st day after operation, the success rate of treatment and hospitalization time of groups A were higher/longer than those of group B, while the time of menstrual recovery, recovery time of blood β-hCG and the disappearance time of scar pregnancy lesions was shorter than that of group B(P<0.05). Conclusion MTX combined with uterine curettage may avoid complications and side effects of UAE in patients with type Ⅱ-Ⅲ CSP within 7 weeks of menopause, without increasing the risk of bleeding.

目的 比较改良包皮环切缝合器法(缝合器组)与传统包皮环切法(传统手术组)治疗包皮过长及包茎的临床疗效。方法 分析本专科近2年收治的300例手术患者(缝合器组209例,传统手术组91例)。对比手术时间、术中出血量、术后疼痛、术后排尿情况、愈合后外观满意度。采用视觉模拟评分(VAS)评估术后疼痛。结果 缝合器组手术时间为(5.41±1.39)min,术中出血量(2.41±1.66)mL,术后疼痛评分(3.59±0.89)分, 切口愈合时间(7.36±1.33)d。传统手术组手术时间为(33.96±2.62)min。术中出血量(15.40±3.66)mL,术后疼痛评分(4.76±1.17)分, 切口愈合时间(8.15±2.13)d。缝合器组在手术时间、出血量、术后疼痛评分、切口愈合时间、愈合后外观方面均优于传统手术组(P<0.05),且疼痛主要在术后6 h内。而术后出血、血肿发生率两组相近。上述并发症分别经血肿清除、切口再缝合、加压包扎及口服抗炎消肿药物等处理后愈合。术后1月内缝合钉未脱落18例(8.61%),返院人工去除。两组均未出现切口裂开,包皮口狭窄。结论 一次性包皮环切缝合器行包皮环切术具有创伤小、痛苦小、并发症少、安全性高、外观整齐美观等优点,但也要掌握手术关键环节的技巧以减少并发症的发生。

Objective To compare the clinical efficacy of modified disposable circumcision stapler and conventional circumcision in the treatment of redundant prepuce. Methods 300 patients with redundant prepuce or phimosis from May 2014 to May 2016 with who underwent modified disposable circumcision stapler (n=209) or traditional circumcision (n=91) were reviewed retrospectively. Comparisons were made between the two groups in the operation time, blood loss, postoperative pain score, time of wound healing, post-circumcision bleeding and postoperative satisfaction with penile appearance. Results The disposable circumcision stapler group showed great advantages over the traditional circumcision group in mean operation time, blood loss, postoperative visual analog scale (VAS) score for pain, time to wound healing and postoperative satisfaction with the penile appearance (P<0.05). However, there were no significant difference in post-circumcision bleeding, and other complications (P>0.05). Conclusion The disposable circumcision stapler is of convenience, safety and efficacy with shorter operation time, less pain and less complication. However, we should improve operative skills and avoid postoperative complications.

目的 研究护理干预对慢性阻塞性肺疾病患者抑郁焦虑情绪的效果。方法 选取2015年2月—2017年3月我院收治的慢性阻塞性肺疾病患者84例为观察对象。2015年2月—2016年2月入院患者42例为对照组,遵医嘱给予治疗,同时均予以常规慢性阻塞性肺疾病知识宣教。2016年3月—2017年3月入院患者42例为观察组在对照组基础上予以优质护理干预。分别比较干预前后两组患者抑郁、焦虑及干预前后肺功能变化、患者满意度、生活质量。结果 干预后观察组抑郁自评量表(SDS)、焦虑自评量表(SAS)评分分别为(20.05±5.24)分、(21.57±6.03)分,均低于对照组(28.57±5.29)分、(31.72±6.14)分,差异有统计学意义(P＜0.05)。干预后观察组FEV1水平(2.00±0.33)L,高于对照组的(1.68±0.25)L、观察组FEV1/FVC水平分别为(69.50±7.95)%,高于对照组的(65.18±8.43)%,差异有统计学意义(P＜0.05)。观察组患者满意度为95.24%(40/42),高于对照组的73.81%(31/42),差异有统计学意义(P＜0.05)。观察组患者各项SF-36评分均高于对照组,均P＜0.05差异有统计学意义。结论 优质护理干预可缓解患者负性情绪,改善肺功能,提高满意度及生活质量。

Objective To study effects of nursing intervention in paitents with chronic obstructive pulmonary disease. Methods 84 patients with chronic obstructive pulmonary disease admitted to our hospital from February 2015 to March 2017 were selected as the observation objects. From February 2015 to February 2016, 42 patients admitted to the control group were treated with conventional therapy. From March 2016 to March 2017, 42 patients admitted to the hospital as the observation group were given quality nursing intervention on the basis of the control group. The depression, anxiety, lung function changes, patient satisfaction and quality of life before and after intervention were compared between the two groups before and after intervention. Results After the intervention, the SDS and SAS scores of the observation group were (20.05±5.24), (21.57±6.03), which were lowered than that of the control group (28.57±5.29), (31.72±6.14), the difference was statistical significance (P<0.05). After intervention, the level of FEV1 in the observation group (2+0.33) L was higher than that in the control group (1.68+0.25) L, and the FEV1/FVC level in the observation group was (69.50+7.95)%, which was higher than that in the control group (65.18+8.43)%,the difference was statistical significance (P<0.05). Satisfaction of patients in the observation group was 95.24% (40/42), higher than the control group 73.81% (31/42),the difference was statistical significance (P<0.05). The SF-36 scores of the observation group were higher than those of the control group, P<0.05, the difference was statistical significance. Conclusion High quality nursing intervention may effectively alleviate depression, anxiety and other negative emotions, improve lung function, satisfaction and quality of life.

目的 对比纤维支气管镜肺灌洗治疗和常规治疗重症肺部感染患者的临床疗效。方法 将2015年5月—2017年4月间在我院接受治疗的92例重症肺部感染患者作为研究对象,按照随机数字表分为实验组(n=46)和对照组(n=46),其中对照组采用常规对症治疗,实验组加以实施纤维支气管镜肺灌洗治,治疗后,纤支镜气道灌洗检测两组患者的血气分析指标变化,采用ELISA测定血清炎症因子含量,及放射免疫法测定血清应激激素含量。结果 经比较,实验组患者治疗后的PaO₂、SaO₂、PaCO₂高于对照组患者(P<0.05);实验组患者的血清炎症因子hs-CRP、IL-6、IL-8水平低于对照组患者(P<0.05);此外,实验组患者的Ang-II、NE、Cor含量低于对照组患者(P<0.05)。结论 纤支镜气道灌洗可有助于改善重症肺部感染患者的肺通气功能,降低全身炎症应激程度,促进疾病康复。

Objective To compare the clinical efficacy of bronchoalveolar lavage and conventional treatment in patients with severe pulmonary infection. Methods 92 patients with severe pulmonary infection treated in our hospital from May 2015 to April 2017 were selected as research objects. They were randomly divided into experimental group (n=46) and control group (n=46). The control group was treated with conventional symptomatic treatment, The experimental group implemented bronchoscopy lung lavage treatment. After treatment, blood gas bronchoscopic airway lavage in two groups were detected with analysis indexes. Serum inflammatory factors were determined by ELISA, and the serum levels of stress hormones were determined by radioimmunoassay. Results After the treatment, the PaO₂, SaO₂ and PaCO₂ in the experimental group were higher than those in the controlgroup(P<0.05). The levels of serum inflammatory factors hs-CRP, IL-6、IL-8 in the experimental group were lower than those in the control group (P<0.05); in addition, the levels of Ang-II, NE and Cor in the experimental group were lower than those in the control group(P<0.05). Conclusion Bronchoscopy airway lavage may help to improve the pulmonary ventilation function of patients with severe pulmonary infection, reduce the degree of systemic inflammatory stress, and promote disease recovery.

目的 探讨中药熏洗与膝关节自我锻炼管理对改善老年骨性膝关节炎功能康复效果。方法 选择90例在本院就诊的老年骨性关节炎患者,按数字表法分为观察组和对照组各45例,对照组采用膝关节康复护理知识教育、膝部中药熏洗与揉搓按摩等治疗,观察组在此治疗护理上加强对患者进行膝关节功能训炼和自我活动行为管理;随访6周,评价两组患者膝关节肿胀、疼痛、训练依从性、膝关节功能。结果 膝关节疼痛缓解、肿胀消退观察组优于对照组;膝关节功能康复效果观察组优于对照组,活动训练依从性观察组高于对照组。结论 应用中药熏洗与加强患者膝关节自我活动训炼管理,可缓解膝关节疼痛、减轻膝关节肿胀,改善患者膝关节功能,提高患者自我功能训练的依从性和生活质量。

Objective To explore the effect of traditional Chinese medicine fumigation and knee joint exercise management on the rehabilitation of senile osteoarthritis of the knee. Methods 90 cases in our hospital for treatment of senile osteoarthritis were randomly divided into observation group and control group with 45 cases in each group, the control group used the knee joint rehabilitation nursing knowledge education, herbal fumigation and massage knee treatment; the observation group on the treatment and nursingwith strengthening the function of knee joint training and self behavior management for the patients; 6 weeks of follow-up, we have evaluation of two groups of patients with knee joint swelling, pain, and knee joint function training compliance. Results The knee joint pain, swelling, knee joint function rehabilitation effect in the observation group were better than that of control group; training compliance in the observation group was better than that of control group. Conclusion The application of herbal fumigation and strengthen the self training of patients with knee joint activity management, may relieve the pain of knee joint, swelling and improve knee function. Theirtraining compliance and quality of life have been increased.

目的 探讨持续负压吸引在微通道经皮肾镜取石术治疗鹿角形肾结石的临床效果。方法 选取2016年1月—2017年12月在我院确诊鹿角形肾结石并行经皮肾镜取石术治疗的病例138例;根据通道大小、有无负压吸引装置分为观察组和对照组,其中观察组66例,采用20F微通道联合持续负压吸引,对照组72例,采用22F标准通道,无负压吸引。比较两组的术中生命体征变化、肾盂内压力以及术后发热的发生率。结果 观察组在术中血压和心率等生命体征变化、肾盂内压力以及术后发热的发生率均低于对照组,差异有统计学意义(P<0.05)。结论 微通道联合负压吸引行经皮肾镜取石术治疗鹿角形肾结石可以有效降低肾盂内压力,有效维持生命体征的稳定,减少术后发热的发生率,提高手术安全性。

Objective To explore the clinical effect of percutaneous nephrolithotomy for treatment of staghorn kidney stonesusingmicro-channel combined with vacuum suction. Methods A total of 138 patientsofstaghorn kidney stones with PCNL in our hospital from January 2016 to December 2017 were included and divided into experimental group and control group according to the size of the channel and the vacuum suction device. Y-type minimally invasive dilatation drainage kit of 20F micro-channelandvacuum suctionwere used in experimental group within 66 patients.A standard channel (22F diameter) without vacuum suction was used in control group within 72 patients. The changes in vital signs, intrapelvic pressureand incidence of postoperative fever were compared between experimental and control groups. Results The vital signs variety of blood pressure and heart rate, intrapelvic pressure and incidence of postoperative fever in experimental group were lower than those in control group(P<0.05). Conclusion Micro-channel combined with vacuum suctioninpercutaneous nephrolithotomy for treatment of staghorn kidney stones could effectively maintenance of stable vital signs, reduce intrapelvic pressure and the incidence ofpostoperative fever, and improve the safety of surgery.

目的 探讨早期功能训练对环状软骨上喉部分切除术后喉癌患者吞咽功能的影响效果。方法 将54例患者按入院时间的先后分为对照组26例和干预组28例,对照组按常规护理,干预组进行早期吞咽功能训练,于患者出院前、出院后1个月和3个月进行效果测评。结果 干预组于出院前、出院后1个月、出院后3个月吞咽功能恢复正常和SSA评分下降优于对照组,两组比较差异均有统计学意义(P＜0.05)。结论 对环状软骨上喉部分切除术后喉癌患者实施早期功能训练可改善患者吞咽功能障碍、促进快速康复。

Objective To investigate the effect of early functional training on the swallowing function of laryngectomy patients after partial laryngectomy with cricoid. Methods According to the admission time, 54 patients were divided into control group (26 cases) and intervention group (28 cases). The control group was given routine nursing, while the intervention group received early swallowing function training. The effect was evaluated before and after discharge, 1 months and 3 months after discharge. Results In the intervention group, the swallowing function returned to normal and the SSA score in the intervention group before discharge, 1 months after discharge and 3 months after discharge was lower than that in the control group. The difference between the two groups was statistically significant (P<0.05). Conclusion Early functional training for laryngectomy patients after partial laryngectomy may improve the patient's swallowing dysfunction and promote rapid rehabilitation.

目的 调查广州市市级(三级)妇幼医院与广州市农村地区区级(二级)妇幼医院护士离职意愿与工作满意度情况。方法 以广州市某三级甲等妇幼医院和4所(花都、南沙、从化、增城)地区二级妇幼医院的3 026名护士为研究对象。应用护士工作满意度量表(MMSS)及离职意愿量表(TIQ)进行问卷调查,并比较分析不同级别妇幼医院护士的离职意愿和工作满意度的差异。结果 相比二级妇幼医院,三级妇幼医院护士的平均年龄较大、学历、职称和奖金均较高、有编制人数所占比例较大,差异有统计学意义(P<0.05)。二、三级妇幼医院护士离职意愿平均得分依次为(2.38±0.682)分、(2.87±0.570)分,工作满意度平均得分依次为(3.34±0.702)分、(3.00±0.482)分。差异均有统计学意义(P<0.05)。结论 相比二级妇幼医院,三级妇幼医院护士离职意愿更强,工作满意度更低,护理管理者可采取有效措施提高护士工作满意度。

Objectives To investigate the current status of nurses' turnover intention and job satisfaction in secondary and tertiary women and children's hospitals in Guangzhou. Methods 3 026 nurses were enrolled in this study, which were from a tertiary hospital in Guangzhou urban area and another 4 secondary hospitals located in rural districts, namely Huadu, Nansha, Conghua, Zengcheng. Systematic sampling was adopted. The Mueller/McCloskey Nurse Job Satisfaction Scale (MMSS) and Turnover IntentionQuestionaire(TIQ)were applied to carry out this investigation. Differences of nurses' turnover intention and job satisfaction between different levels' hospitals were compared and analyzed. Results Compared with those in the secondary hospitals, nurses in the tertiary maternity hospital were at higher average age, had better academic backgrounds with higher professional titles, more bonus and more positions of establishment. The differences all were statistically significant (P<0.05). The average scores of turnover intention for nurses from the secondary and tertiary hospitals were2.38±0.682 and 2.87 ±0.570 respectively. All the differences were statistically significant (P<0.05). Conclusion Compared with those in the secondary maternal and child health hospitals, nurses in the tertiary hospitals were more willing to leave and had lower job satisfaction. Nurse's managers may take effective measurses to increase nurse's satisfaction.

目的 制备以牛血清白蛋白为模型药物的壳聚糖纳米制剂(BAS/CS NPs)及其体内外性质的研究,并通过加入羧化壳聚糖(WCS)来改善聚阳离子制备的纳米粒(CS NPs)的安全性。方法 利用油包水乳化-冻干法制备而得的CS NPs,通过激光粒度分析仪测定纳米粒粒径和电荷,用BCA法测定纳米粒包封率和载药量,并用Caco-2 cells单层膜模型评价BAS/CS NPs的细胞摄取情况和跨膜转运,以Franz扩散池法考察吸收考察BAS/CS NPs的离体各个小肠段黏膜的渗透性能,采用荧光分光光度计测定累积渗透量。结果 所制备的BAS/CS NPs平均粒径 在100～500 nm之间,电荷(-42.32±2.56)mV,包封率为88.37±6.82(%),载药量7.48±0.50(%),细胞毒性和细胞摄取实验表明羧化壳聚糖的BAS/CS NPs能降低细胞的毒性,并发现在十二指肠纳米粒具有促进BSA吸收作用(P<0.05)。结论 BAS/CS NPs是通过打开细胞紧密连接的方式增加BSA在小肠内的吸收。WCS降低BAS/CS NPs的细胞毒性,增强了兔小肠的BSA运输。作用要优于广泛研究的聚阳离子纳米粒体系,为口服蛋白类药物的传递提供了新的渠道。

目的 研究对比胃癌患者术前胃镜活检病理与外科术后病理的异同并进行观察。方法 选取我院消化科于2016年7月—2017年12月收治的64例胃癌患者作为此次研究对象,术前均展开胃镜活检,术后展开外科病理检查,判断两种诊断方法的异同。结果 胃癌确诊率对比,术前胃镜活检后确诊胃癌患者占比85.9%(55/64),疑似胃癌患者占比10.9%(7/64),排除胃癌患者占比3.1%(2/64),术前胃镜活检确诊率85.9%,低于术后病理诊断95.3%,组间比较差异无统计学意义(P>0.05);胃镜活检病理结果对比,术前胃镜检查黏液腺癌占比35.9%,乳头状腺癌占比51.6%,均高于术后病理检查的25.0%、28.1%,组间比较差异具有统计学意义(P＜0.05);胃镜活检分化程度结果对比,胃镜病理与术后病理检查结果对比有明显差异,具有统计学意义(P＜0.05)。结论 对胃癌进行诊断时,尽管术前胃镜活检病理检查与外科术后病理检查结果存在差异,但术前胃镜活检对胃癌确诊率较为理想,可作为术前诊断参考,外科术后病理检查对全面评估胃癌病情具有较高应用价值,值得在临床中应用。

目的 探讨重组人表皮生长因子滴眼液联合玻璃酸钠治疗白内障术后干眼症的随机对照情况。方法 选取2017年度在本院实施白内障术后发生干眼症患者120例,采取随机分组方法分成观察组、对照组各60例,观察组给予重组人表皮生长因子滴眼液联合玻璃酸钠治疗,对照组给予玻璃酸钠滴眼液治疗,比较两组患者的临床疗效情况。结果 观察组有效率90%高于对照组73.33%,有差异;两组患者治疗前FL、BUT、SIT比较均无差异,P>0.05;治疗后,两组FL、BUT、SIT比较有差异,P<0.05; 两组患者治疗前视力评价比较均无差异,P>0.05;治疗后,两组视力评价比较有差异,P<0.05。结论 给予白内障术后干眼症患者采取重组人表皮生长因子滴眼液联合玻璃酸钠治疗,可提高临床疗效,对于改善相关临床体征、视力指标均具有重要临床价值。

目的 探讨幽门螺杆菌(Helicobacter pylori,Hp)感染与儿童过敏性紫癜(Henoch-Schnlein purpura,HSP)的相关性及预后关系,为临床疾病诊治提供一定依据。方法 随机选取2016年12月—2018年2月于我院就诊并经确诊的HSP儿童患者90例为观察组,另选取同期于我院就诊行体检的健康儿童90例为对照组,比较两组患者Hp感染情况。根据Hp感染情况及治疗方式将观察组分为A、B、C三组,其中A组(29例)为Hp(-)组,行常规治疗;B组(31例)为Hp(+)组,行常规治疗;C组(30例)为Hp(+)组,行常规治疗联合抗Hp治疗,比较三组患者治疗疗效。结果 观察组患者Hp感染阳性率高于对照组,差异有统计学意义(P<0.05);合并腹部症状的HSP患者Hp感染阳性率高于不合并腹部症状的HSP患者,差异有统计学意义(P<0.05);B组患者治疗有效率低于A组,C组患者治疗有效率高于B组,差异有统计学意义(P<0.05)。结论 Hp感染可能是HSP发病的原因之一,其腹部症状与Hp密切相关,根除Hp治疗可改善HSP患者预后。

Objective To explore the correlation between helicobacter pylori infection and children allergic purpura disease and its prognosis, and provide some basis for clinical diagnosis and treatment. Methods A total of 90 children with allergic purpura who were treated in our hospital from December 2016 to Feb 2018 were randomly selected as observation group. 90 healthy children who were admitted to our hospital for physical examination during the same period were selected as the control group, and the Hp infection in the two groups was compared. According to Hp infection and treatment, the observation group was divided into three groups: A, B and C, among which group A (29 cases) was Hp (-) group, and routine treatment was performed.Group B (31 cases) were Hp (+) group, and routine treatment was performed. group C (30 cases) were Hp (+) group, and conventional treatment combined with anti-hp treatment were performed. We compared three groups of .curative effects. Results The positive rate of Hp infection in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05).The positive rate of Hp infection in HSP patients with abdominal symptoms was higher than that in HSP patients without abdominal symptoms, and the difference was statistically significant (P<0.05). The effective rate of treatment in group B was significantly lower than that in group A, and the effective rate of treatment in group C was higher than that in group B, and the difference was statistically significant (P<0.05). Conclusion Hp infection may be one of the causes of HSP, and its abdominal symptoms are closely related to Hp, and the eradication of Hp treatment would improve the prognosis of HSP patients.

目的 分析河源地区医疗机构临床用血合理性现状,提高临床合理输血水平。方法 选择本地区临床用血量前三位的3家综合性医院,随机抽取其2017年住院患者1 012例输血病例,判断每次输血合理性并对不合理输血原因进行分析。结果 1 012份输血病例中合理输血病例718例,合理性输血比例为70.94%。不同血制品和临床科室间用血合理性比例差异具有统计学意义(χ²=6.734、6.119,P=0.000、0.000)。红细胞输注不合理原因主要为指征过宽和无指征输血,血浆、血小板、冷沉淀输注不合理原因主要为无指征输血。结论 加强医疗机构临床用血管理,真正做到科学用血、合理用血,节约用血。

目的 研究宫腔镜治疗子宫粘连性所致不孕症的临床疗效,为临床相关治疗提供参考。方法 选取我院于2016年11月—2017年11月收治的180例子宫粘连性所致不孕症患者作为观察对象,按照随机数表法平均分成两组。其中观察组90例采用宫腔镜治疗,对照组90例采用传统输卵管通液治疗。对比两组患者治疗前后性激素水平、临床指标及妊娠结局变化。结果 两组间相比,治疗前后 LH、FSH、E2、P等性激素水平无变化,且治疗后观察组与对照组相比,差异均无统计学意义(P>0. 05);两组间相比,治疗后观察组患者的术中出血量、手术时间、住院天数均少于对照组,差异有统计学意义(P<0. 05);两组间相比,治疗后观察组患者的足月分娩率高于对照组,早产率低于对照组,差异有统计学意义(P<0. 05)。结论 宫腔镜治疗子宫粘连性所致不孕症,与传统输卵管通液治疗相比,对性激素水平无影响,但可显著降低患者住院时间及术中出血量,有效提高足月分娩率,值得在临床上推广。

目的 以临床病例为研究对象,探讨年龄与性别对鼻咽癌自我病情延误的影响,寻找鼻咽癌科普宣教的重点靶标人群。方法 收集2015年4月—2015年12月广州医科大学附属肿瘤医院放疗科鼻咽癌病区收治的经活检病理确诊初治鼻咽癌患者62例(年龄28～77岁,中位年龄49岁),记录患者主诉症征出现至病理确诊鼻咽癌其相关症状的持续时间,采用t检验和Pearson相关分析探讨性别及年龄对鼻咽癌确诊前相关症征持续时间的影响。结果 62例患者确诊前均自我发现鼻咽癌相关症征,其中43例(69.4%)发现鼻咽原发灶相关症状,35例(56.5%)发现颈部淋巴肿大症状。Pearson相关分析显示,鼻咽癌确诊前颈部淋巴结肿大持续时间与年龄呈正相关(P＜0.05);t检验结果显示,男性患者鼻咽癌确诊前症状持续时间大于女性患者(P＜0.05)。结论 年龄较大和男性人群鼻咽癌自我病情延误较为严重,应该作为包括临床症状在内的鼻咽癌科普宣教的重点人群。

目的 探讨6野切线射野方式调强放疗(6F-IMRT)用于左侧乳腺癌根治术后放疗的临床价值。方法 纳入我院70例左侧乳腺癌根治术患者为研究对象,进行模拟CT增强扫描,三维重建后勾画大体靶区,分别对每个患者靶区设计4F-IMRT、5F-IMRT、6F-IMRT三种治疗计划,规定计划靶区(PTV)达到95%的处方剂量前提下,分析三种治疗计划PTV所受照射的平均剂量、最大剂量、最小剂量,95%、100%等剂量线包绕的靶区体积(V₉₅、V₁₀₀),适形度指数(CI)及剂量不均匀指数(HI),并比较三种计划下心脏、双肺、右乳受照射剂量。结果 各治疗计划靶区最大剂量、最小剂量、平均剂量比较无统计学意义(P＞0.05)。6F-IMRT的V₉₅、V₁₀₀均高于4F-IMRT、5F-IMRT,差异有统计意义(P＜0.05)。4F-IMRT、5F-IMRT、6F-IMRT的CI呈递增趋势,HI呈递减趋势,各组间比较差异有统计学意义(P＜0.05)。三种放疗计划中心脏的平均剂量、V₃₀,双肺的平均剂量、V₂₀、右乳平均剂量比较无显著差异(P＞0.05)。三种放疗计划中,4F-IMRT右乳V₁₀显著低于5F-IMRT、6F-IMRT,差异有统计学意义(P＜0.05),但均在最大耐受剂量范围内。结论 与4F-IMRT、5F-IMRT相比,6F-IMRT用于左侧乳腺癌根治术后放疗有明显剂量学优势,可提高靶区照射剂量,靶区适形程度及剂量均匀性均较好,而且并不会增加周围正常器官照射剂量。

目的 观察ST段抬高型急性心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)中应用不同转运模式的应用疗效。方法 选取我院80例行急诊PCI的STEMI患者,有31例患者的12导联心电图由救护车上的急救人员通过手机微信传输到指定的东莞市大朗医院胸痛中心微信群(远程早期干预组),有49例患者自行来院就诊(传统就诊组),比较两组患者的临床疗效。结果 远程早期干预组患者的D-to-B时间低于传统就诊组(P<0.01),D-to-B达标率高于传统就诊组(P<0.01);远程早期干预组患者住院费用、平均住院天数、住院期间病死率及心力衰竭发生率均低于传统就诊组(P<0.05)。结论 相比较传统就诊模式,远程转运模式能显著提高STEMI患者PCI术的治疗效果,并有效改善其预后情况,临床效益较好,值得实践推广。

目的 研究脊柱经皮内镜椎间孔入路和椎板间入路治疗腰椎间盘突出的临床应用效果。方法 本次选取的研究对象为2016年1月—2017年12月期间在我院进行治疗的腰椎间盘突出患者,将60例患者根据红蓝球分组法分为两组,30例/组。将实施脊柱经皮内镜椎间孔入路椎间盘切除术的患者纳入PETD组,将采用椎板间入路椎间盘切除术的患者设为PEID组。将两组腰椎间盘突出患者的手术相关指标、治疗优良率、ODI评分、VAS评分进行比对。结果 观察组腰椎间盘突出患者的手术时间、C型臂透视次数同对照组相比存在差异(P＜0.05);术后卧床时间和住院时间、治疗优良率组间对比无统计学意义;两组术后三个月时的ODI评分、VAS评分均较术前更优(P<0.05)。结论 在腰椎间盘突出治疗中脊柱经皮内镜椎间孔入路、椎板间入路的效果相当,临床上需患者的实际情况和解剖特点选择适合的入路方式和手术方法。

目的 探讨入院准备中心制度在我院乳腺外科住院预约统筹管理的实践情况。方法 2017年1月—12月广州市第一人民医院入院准备中心对乳腺外科30张床位实施病床集中预约管理,依据患者病情进行预约,合理安排患者入院。结果 2017年1至12月我院乳腺外科共预约入院1225人/次,成功办理预入院1096人/次,约占乳腺外科总入院人数的77.85%。预入院进行手术患者415人/次,其中3日内手术患者为285人/次,预入院三日内手术率为68.67%。结论 预入院制度对乳腺外科病床进行集中预约管理能有效保证床位充分使用,为患者提供方便、有效的医疗服务,值得基层医院推广。

目的 探讨品管圈活动在提高神经外科卧床患者便秘预防措施落实率中的的应用效果。方法 成立品管圈,确定以“提高神经外科卧床患者便秘预防措施落实率”为主题,进行现状调查,设定目标,进行要因分析,制定并实施措施,比较品管圈活动前后护士落实便秘预防措施情况。结果 实施品管圈活动后,神经外科卧床患者便秘预防措施落实率从活动前的41.59%上升至活动后85.6%,差异有统计学意义(P＜0.05)。结论 品管圈活动可以有效提高神经外科卧床患者便秘预防措施落实率,降低便秘的发生率,减轻患者痛苦,改善患者生活质量。

目的 探讨多种教学模式在加强医学生人文素养、沟通意识和沟通能力中的作用。方法 考察多种教学模式培养的临床学生(教学组)和传统模式培养的临床学生(对照组)在人文关怀、沟通技巧、职业素养、医患关系等方面的理论知识和病史询问为主的实践考核情况,并进行对比。结果 多种教学模式培养的临床学生在人文关怀、沟通技巧、职业素养、医患关系方面的理论成绩分别为(21.03±2.00、20.78±2.11、21.01±2.12、20.91±2.07),病史询问成绩为(16.03±2.13)分,传统模式培养的临床学生在人文关怀、沟通技巧、职业素养、医患关系方面的理论成绩分别为(20.29±2.26、19.84±2.33、20.24±2.49、20.05±2.32),病史询问成绩(14.89±2.43)分,均较多种模式培养组分数低,两组对比差异均有统计学意义(P<0.05)。结论 在神经病学教学中采用多种教学模式对提高学生沟通能力及人文素养有良好的效果。

目的 分析全科医学教学中应用第三方满意度调查,结合学生需求的实践效果。方法 2016年3—12月接收全科医学学生者60例,按照常规方法进行,2017年3—12月全科医学学生62例,教学中应用第三方满意度调查结合学生需求方法,观察教学效果。结果 第二年时,学生期末考试总成绩、病例题成绩、实习报告成绩,课外自学时间、利用网络自学时间、与他人讨论学习时间,教学效果总体评分、课间实习评分均高于第一年,差异有统计学意义(P＜0.05)。结论 全科医学教学中应用第三方满意度调查结合学生需求方法后,可有效的提升教学效果,增强学生的自学能力及自学意识。

Objective To analyze the practical effect of applying the third party satisfaction survey to the needs of the students in the teaching of general medicine. Methods From March 2016 to December 2016, 60 cases of general practice medical students were enrolled. According to the routine method, 62 cases of general medical students from March 2017 to December 2017 were selected. Third party satisfaction survey and student demand method were applied in teaching, and the teaching effect was observed. Results In th second year, students' final exam scores, the total score, case questions internship report scores, extracurricular self-study time, self-study time, learning time, using the network to discuss with othersthe teaching effect of practice during the total score, all above were higher than the first year, there was significant difference (P<0.05). Conclusion The application of third party satisfaction survey combined with students' needs method in general practice teaching may effectively improve teaching effect; enhance students' self-learning ability and self-learning consciousness.

目的 通过评估非直属附属医院临床教学质量的影响因素,探讨保障非直属附属医院同质化教学的方法。方法 将实习同学分为院校组和混合组两组,运用德尔菲法调查法对非直属附属医院临床教学过程中所遇到的困难进行分析,并提出教学改革的意见和评价。结果 得出的调查结论对教师、学生、医院教学管理人员和学校教学管理人员都提出了更高的要求,可以为达到同质化教学提供参考。结论 有针对性的开展临床教学工作,变被动教学为主动的教与学,使临床教学达到同质化,从而达到更佳的教学效果。

Objective To explore the methods of guaranteeing homogeneity teaching in Non-affiliated hospitals by assessing the factors affecting the quality of clinical teaching in Non-affiliated hospitals. Methods Divide the students into two groups:college group and mixed group,to meet the process of clinical teaching in Non-affiliated hospitals in difficulty were analyzed by using the Delphi survey method, and put forward opinions and evaluation. Results the survey findings put forward higher requirements for teachers, students, hospital teaching administrators and school teaching administrators, which can provide references for achieving homogeneity teaching. Conclusion targeted clinical teaching should be carried out to change passive teaching into active teaching and learning, so that clinical teaching can be homogenized, so as to achieve better teaching effect.

随着时代的发展,医学模式更具综合性,预防医学专业特性不仅体现其医学范畴,其综合性特点日益突出。因此预防医学专业医学生综合素质及创新能力的培养显得愈发重要。为了提高预防医学学生的综合素质及创新能力,我们从预防医学理论教学及实验教学开展了教学改革探讨。

雄激素性脱发是一种人群中常见的损容性疾病,其发病与多种因素有关,而遗传因素在发病率中具较大的影响。低能量激光疗法(Low-Level Laser Therapy)是近年来用于治疗雄激素性脱发的光疗技术。低能量激光是一种低能量,短波长的激光,因早期研究发现其具有促进毛发生长的作用而被用于研究治疗雄激素性脱发(AGA)。在低功率激光疗法中,通过使用低能量激光照射毛囊,使毛囊炎性反应得以减轻,同时促进细胞新陈代谢,从而使休止期毛囊复苏,达到促进毛发生长的作用。本文通过对低能量激光疗法治疗雄激素性脱发的机制及效果进行论述,并讨论局部治疗、系统治疗等其他方法联合低功率激光在AGA治疗中的研究进展。

Androgenetic alopecia is a common and ashamed disease in the human population. Its incidence is related to a variety of factors, and the gene have a greater impact on the incidence. Low-level laser therapy LLLT is a phototherapy technique for the treatment of androgenetic alopecia in recent years. Low-level laser means low-energy, short-wave length that have been used for research and treatment of androgenetic alopecia because of the early discovery which is promoting hair growth. In LLLT, the laser irradiates hair follicles, so that reduces the folliculitis, while promoting cell metabolism.From this, the dormant hair follicles resume growth. This article discusses the mechanism and effect of low-level laser therapy for the treatment of androgenetic alopecia, and further discusses the advancement of topical treatment, systemic treatment, and other methods which combined with low-level laser in the treatment of AGA.