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 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 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 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 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 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 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 探讨二甲双胍和胰高糖素样多肽-1对2型糖尿病患者并发骨折恢复的影响。方法 选取2016年5月—2017年4月我院骨科收治的2型糖尿病并发骨折患者120例,按随机原则分为5组,每组24例,单药低剂量二甲双胍组(A1)、单药高剂量二甲双胍组(A2)、单药GLP-1组(B)、低剂量二甲双胍联合GLP-1组(C1)和高剂量二甲双胍联合GLP-1组(C2)。二甲双胍低剂量用药量为0.5 g/次,每日2次口服,高剂量用药量为0.5 g/次,每日4次口服。皮下注射利拉鲁肽每日1次,起始量为每日0.6 mg,1周增加为每日1.2 mg,再1周后增加为每日1.8 mg。血糖控制在理想水平后按照标准的手术方法和规程行相应的手术治疗。同时给予饮食控制及其它对症治疗。分别在1、3、6个月时检测其股骨颈骨密度值(BMD)和Harris系统评分。结果 随着治疗时间延长,A1组、C1组、C2组BMD值和Harris系统评分均增高, 在术后3月和6月时,C1组骨密度值和Harris评分高于A1组(P<0.05), C1组骨密度值和Harris评分高于C2组(P<0.05)。结论 胰高糖素样多肽-1可促进2型糖尿病患者骨折愈合、功能恢复,且与低剂量二甲双胍联用促进骨折愈合效果优于与高剂量二甲双胍联用。
Objective To investigate the effects of metformin and glucagon like polypeptide -1 on fracture recovery in patients with type 2 diabetes mellitus(DM). Methods We selected 120 patients with type 2 diabetes mellitus from May 2016 to April 2017 in department of orthopedicsin in our hospital and randomly divided them into 5 groups, 24 cases in each group,includingthe low dose of metformin monotherapy group (A1), the high dose of metformin monotherapy group (A2), single drug GLP-1 group (B), and GLP-1 group low dose of metformin combination (C1) and high dose of metformin combination with GLP-1 group (C2). The low dose of metformin was 0.5 g / time, 2 times a day for oral administration. The high dose was 0.5 g / time, 4 times a day. Subcutaneous injection of liraglutide was once daily, starting at a daily dose of 0.6 mg, 1.2 mg daily after 1 week and 1.8 mg daily after another week. After an ideal level of blood glucose control, corresponding surgical procedures should be performed according to standard surgical methods and procedures. Diet control and other symptomatic treatments were also given. The femoral neck bone mineral density (BMD) and the Harris system score were examined at the first, third, and sixth month respectively. Results With the prolongation of treatment time, the BMD value and Harris system score in the A1 group, C1 group, C2 group were increased. After surgery in March and June, the BMD and Harris score of C1 group were higher than that of A1 group (P<0.05). The bone mineral density and Harris score of C1 group was significantly higher than that of group C2 (P<0.05). Conclusion Glucagon like peptide -1 may promote the fracture recovery and functional recovery in patients with type 2 diabetes mellitus, and with combination of low dose metformin is more effective than that with high dose metformin.
目的 探究儿童抗NMDA受体脑炎临床特点、诊治及预后。方法 回顾性分析16例儿童抗NMDA受体脑炎的临床表现、辅助检查、治疗与预后。结果 16例患儿中,意识障碍16例, 语言障碍15例,运动障碍13例,11例惊厥发作。9例脑脊液NMDA受体抗体阳性,14例血清NMDA受体抗体阳性。16例患儿脑电图均出现背景中高波幅慢活动,头颅磁共振检查未见异常。所有患儿均接受丙种球蛋白联合激素冲击治疗,14例症状缓解,2例需加用利妥昔单抗治疗,症状缓解。结论 识别儿童抗NMDA受体脑炎多样临床表现,筛查NMDA受体抗体有助于早期诊断及治疗儿童抗NMDA受体脑炎。
Objective To investigate clinical features, diagnosis, treatment and prognosis of the patient with anti-NMDA receptor encephalitis in children. Methods The data of clinical feature,auxiliary examination of 16 cases with anti-NMDA receptor encephalitis in children were reviewed and analyzed. Results Of all 16 cases, there were 16 cases with decreased consciousness, 15 cases developed speech alteration, 13 cases developed movements disorder and 11 cases with seizure. Cerebrospinal fluid NMDA antibody were positive in 9 cases and serum NMDA antibody were positive in 14 cases. The EEG of 16 patients showed high-amplitude slow activity in the background. There were no significant abnormalities in head magnetic resonance imaging (MRI) of all children. After all children received gamma globulin combined hormone therapy, 14 cases had boen improved and another 2 cases need to be further treated combined with Rituximab. Conclusion Pediatric patients had diverse clinical manifestations. Screening of NMDA receptor antibody may help early diagnosis of anti-NMDA receptor encephalitis. And timely treatment may yield a favorable prognosis.
目的 探讨盐酸普萘洛尔凝胶外涂治疗婴幼儿浅表性血管瘤的疗效及安全性。方法 选取我院2015年5月—2017年5月收治的60例患有浅表性血管瘤的婴幼儿为研究对象,随机分为观察组和对照组,各30例。对照组口服盐酸普萘洛尔片治疗,观察组采用质量浓度为5 g/L的(20 g∶100 mg)盐酸普萘洛尔凝胶外涂方法治疗,疗程3个月。观察两组患者治疗效果及不良反应情况。结果 治疗后,采用Achauer评定疗效,观察组Ⅰ级患儿1例,Ⅱ级患儿6例,Ⅲ级患儿12例,Ⅳ级患儿8例,Ⅴ级患儿3例,总有效率为96.67%(29/30),对照组Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级分别为2例、8例、10例、6例、4例,总有效率为93.33%(28/30),两组患者差异无统计学意义(P>0.05);两组患者治疗后血管瘤血流峰值及阻力系数较治疗前均得到改善(P<0.05),而两组间差异均无统计学意义(P>0.05);不良反应情况,除观察组发生3例涂抹部位发红外,两组患者均未发生严重不良反应。结论 采用盐酸普萘洛尔凝胶外涂治疗婴幼儿浅表性血管瘤疗效显著,安全可靠,临床上值得进一步推广。
Objective To evaluate the efficacy and safety of Propranolol hydrochloride gel in the external application treatment of superficial hemangioma in infants. Methods We selected 60 infants with superficial hemangioma treated in our hospital from May 2015 to May 2017 and to randomly divide them into the observation group and the control group, each with 30 cases. The control group was treated with Propranolol hydrochloride tablets, and the observation group was treated with 0.5% (20 g∶100 mg) Propranolol hydrochloride gel external application method, the course of treatment was 3 months.We observed the therapeutic effects and adverse reactions of the two groups. Results After treatment, with the Achauer evaluation, patients with grade Ⅰ had 1 case, grade Ⅱ 6 cases, grade Ⅲ 12 cases, grade Ⅳ 8 cases, Ⅴ-grade 3 cases, and the total effective rate was 96.67% (29/30), while the grade Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ in the control group included 2 cases, 8 cases, 10 cases, 6 cases, 4 cases, and the total effective rate was 93.33% (28/30), there was no significant difference between the two groups (P>0.05); The hemangioma peak flow and resistance coefficient of patients in the two groups were significantly improved than that before the treatment (P<0.05), and all with no statistically significant difference between the two groups (P>0.05). As to the adverse reactions, except the applying parts of 3 cases having rubefaction occurred in the observation group, two groups of patients had no serious adverse reactions. Conclusion External application of Propranolol hydrochloride gel in the treatment of superficial hemangioma in infants is effective, safe and reliable. It is worthy of further promotion in clinic.
目的 观察不同血液净化方式对维持性血液透析(MHD)患者透析中低血压(IDH)的干预作用。方法 选择透析中低血压患者30例,随机分为血液透析(HD)组,血液透析滤过(HDF)组,血液灌流联合血液透析(HP+HD)组,各组均为10例。比较三组患者透析中低血压的发生率。分别于首次治疗前、后,治疗24周后测定血清血β2-微球蛋白(β2-MG)、N末端B型利钠肽原(NT-proBNP)、血浆白蛋白(ALB)。结果 ①HDF+HD、HP+HD组透析中低血压发生率降低(P<0.05)。②与治疗前相比,首次治疗后HDF能降低血β2-MG水平(P<0.05);治疗24周后,HP+HD、HDF组均可降低血β2-MG浓度(P<0.05),且HP+HD组下降更明显(P<0.05)。首次治疗及治疗24周后,HD组均不能降低NT-proBNP水平,而HDF、HP+HD组均能有效降低血NT-proBNP浓度(P<0.05)。首次治疗和治疗24周后3组患者ALB水平的差异均无统计学意义,同期3组患者ALB水平的差异亦不显著(P>0.05)。结论 HDF或HP+HD能有效降低MHD患者IDH的发生率,值得推广。
Objective To explore the efficacy of different blood purification methods on intradialytic hypotension(IDH) in maintenance hemodialysis (MHD) patients. Methods Thirty MHD patients with IDH were randomly divided into three groups: hemodialysis(HD) group(n=10),hemodiafiltration(HDF) group(n=10),hemoperfusion combined with hemodialysis (HP+HD) group(n=10). The changes of blood pressure in therapy and the frequency of intradialytic hypotension were compared.Before and after the first treatment,after 24 weeks of treatment serum blood beta 2-microglobulin(β2-MG),serum NT-proBNP,albumin(ALB)weremeasured. Results ①Compared with HD group,the frequency of intradialytic hypotension was significantly reduced in HDF and HP+HD group(P<0.05). ② In HFD group serumβ2-MG decreased after the first dialysis session(P<0.05). After the treatment for 24 weeks, serumβ2-MG levels decreased in HP+HD and HFD group (P<0.05),especially in HP+HD group(P<0.05). Serum NT-proBNP cannot decreased after first dialysis session and after the treatment for 24 weeks in HD group, however, can decreased in HFD and HP+HD group (P<0.05). There were no changes of ALB levels between three groups after first dialysis session and after the treatment for 24 weeks (P>0.05). Conclusion Hemodiafiltration or hemoperfusion associated with hemodilysis can improve the hemodynamic stability in IDH patients, it can be used as a long term therapy.
目的 回顾性分析常规放射检查中儿童胸部复合型骨折漏诊的原因,并且探讨多层螺旋CT后处理技术在儿童胸部复合型骨折中的诊断价值。方法 搜集本院2012年1月—2015年8月间因外伤行胸部照片和CT扫描的外伤患儿共123例,男81例,女42例,年龄9个月～15岁,平均年龄4.3岁。所有病例在完成胸部照片后1~3 d,进行胸部容积CT扫描,并对数据进行三维重建后处理,其结果与常规DR检查结果相比较。结果 在123例患儿中,常规胸部DR片显示明确胸部骨折39例61处,其中胸部单纯性骨折24例,胸部复合型骨折15例。可疑骨折48例;36例未见明确骨折但存在胸部合并症。CT检查显示明确的胸部骨折76例,142处,其中胸部单纯性骨折42例,胸部复合型骨折34例。与胸部DR平片相比,CT显示胸部新增骨折有18处在单纯性骨折病例中,63处在复合型骨折病例中。CT重建技术对复合型骨折的检出率高于DR平片,差异有统计学意义(P＜0.05)。结论 胸部CT容积扫描并综合运用三维重建技术处理,可以提高胸部复合型骨折的检出率,相对于常规放射照片更能提供详细和直观的信息,包括骨折部位、类型、程度以及邻近结构的损伤,并对治疗方案的选择及预后的评估有重要指导价值。
Objective To investigate the reasons for missed diagnoses of children's chest complex fractures in chest radiographs and to discuss the value of multi-slice spiral CT (MSCT) reconstruction in the diagnosis of children's chest complex fractures. Methods 123 children underwent chest digital radiography(DR) and MSCT scans after traumas were collected in our hospital between January 2012 and August 2015. This population consisted of 81 male and 42 female patients, with a mean age of 4.3 years(range from 9 months to 15 years). All participants underwent chest MSCT scans in 1-3 days after completing chest DR, and then we used 3D reconstruction to process the data and compared the results with those processed by DR. Results By chest DR tests we identified 39 cases (61 places) out of 123 participants with 24 simple fractures, 15 complex fractures. And 48 chest fractures were suspected. We also identified 36 cases had chest complications without fracture. By MSCT scans 76 cases (142 places) were identified, among which 42 were simple and 34 were complex. Compared with chest DR, MSCT scans can identified 18 more places of simple fractures and 63 more places of complex fractures. It was statistically significant higher detection rate of MSCT scan than DR. Conclusion Chest MSCT scan combined 3D reconstruction technology can increase the detection rate of chest complex fracture. Compared with DR, it provides more detailed and visualized information, including fracture position, type, severity and adjacent structure damage. It has important guiding value on the selection of therapy and prognosis evaluation.
目的 研究多排螺旋CT低剂量扫描在浸润型肺结核化疗期间复查的应用价值。方法 选取100例浸润型肺结核化疗期病人为研究对象,对选取100例患者行常规剂量胸部CT扫描后再行低剂量扫描。比较常规剂量组和低剂量组CT扫描的图像质量及疗效评估。结果 两组扫描肺窗图像质量比较无统计学差异(P＞0.05);两组肺窗薄层多平面重建图像质量比较无统计学差异(P＞0.05); 两组软组织窗图像质量有统计学意义(P< 0.05)。观察组ED、DLP和CTDIvol等指标低于对照组(P＜0. 01),即观察组受检者CT扫描辐射剂量低于对照组(P＜0.01)。结论 多排螺旋CT低剂量胸部扫描用于浸润型肺结核的复查,可以获得与常规剂量接近的肺窗图像质量,满足肺结核病灶的分析评估,并可有效减少胸部CT扫描中的辐射剂量;既能满足肺结核复查的疗效评估,又提高了肺结核CT复查的安全性,还有效节约检查成本。
Objective To study the application of low-dose scan of multidetector row CT(MDCT)in the chemotherapy of infiltrative tuberculosis. Methods 100 patients with infiltrative pulmonary tuberculosis who were under treatment were selected. All patients accepted conventional-dose and low-dose scan of MDCT. The image quality and treatment effect of two groups were compared. Results The image quality on lung window of two groups did not differ significantly(P＞0.05). The image quality on lung window with multiplanar reconstruction of two groups also did not differ significantly(P＞0.05). The image quality on soft-tissue window differed significantly (P<0.05). The ED, DLP and CTDIvol of the low-dose group were significantly lower than those of the conventional-dose group. Conclusion For MDCT follow-up examination of patients with infiltrative tuberculosis, the image quality on lung window with low dose is similar to the image quality with conventional dose. It may effectively reduce the exposure dose of CT examination. This cost-effective modality not may can meet the curative effect evaluation of TB, but also can improve the security of the follow-up examination of patients.
目的 分析妊娠期慢性乙型肝炎病毒携带者病毒载量与孕妇肝功能、妊娠并发症的相关性。方法 将本院2015年1月—12月间在本院住院并于本院分娩的携带慢性乙型肝炎病毒(HBV)的86例孕妇作为本次研究对象,于住院期间分娩前测定孕妇HBV脱氧核糖核酸(HBV-DNA)定量,依据HBV-DNA定量测定结果将全部患者分为阴性组与阳性组,分别对比2组患者的临床资料、肝功能、妊娠并发症发生率及母婴结局;分析HBV-DNA载量与孕妇妊娠期肝功能及妊娠并发症的相关性。结果 2组孕妇的年龄、BMI、孕次与产次均无差异,P>0.05;阴性组患者妊娠期肝功能指标优于阳性组,P<0.01。阴性组中羊水量异常(偏多或偏少)发生率高于阳性组,P<0.05;其他妊娠期并发症发生率2组均未见差异,P>0.05。2组母婴结局均未见统计学差异,P>0.05。HBV载量与ALT肝功能指标均呈正相关,0<r<1,说明HBV-DNA越高则ALT越高,孕妇的肝功能越差。HBV载量与并发症发生间基本不相关,|r|<0.3,P>0.05。结论 慢性乙型肝炎病毒携带者妊娠期时随着病毒载量的升高,孕妇的肝功能有所下降仍可维持在正常标准,但与妊娠并发症的发生无相关性;提示对HBV-DNA阳性的孕妇给予密切监护,通过临床常规对症治疗能够保证母婴安全。
Objective To analyze the correlation between viral load of chronic hepatitis B virus infection and liver function and pregnancy complications. Methods We selected 86 cases of pregnant women with chronic hepatitis B virus(HBV)in our hospital from January 2015 to December 2015 as the research objects, and then during the hospitalization to test the quality of the HBV deoxyribonucleic acid (HBV-DNA)for them before delivery. According to the HBV-DNA quantitative results, all patients were divided into low dosage group and high dosage group, and then the clinical data, liver function, the incidence rate of pregnancy complications and the outcomes of the two groups were compared; at last we analyzed the correlation among the HBV-DNA load, liver function of pregnant women during pregnancy and pregnancy complications. Results There was no difference between the two groups of pregnant women in the age, BMI, pregnancy and birth time, P>0.05; the low dose group was better than the high dose group in the liver function index during the pregnancy, P<0.01. The incidence of abnormal amniotic fluid volume (more or less) in the low dose group was higher than that in the high dose group, P<0.05; there was no significant difference between the two groups in the incidence of other complications, P>0.05. There was no statistical difference between the two groups in maternal and neonatal outcomes, P>0.05. The HBV load was positively correlated with the two liver function indexes ALT, 0<r<1, indicating that the higher the HBV-DNA, the higher theALT, the worse the liver function of the pregnant women. There was no correlation between HBV load and complications, |r|<0.3, P>0.05. Conclusion Chronic hepatitis B virus carriers during pregnancy with increasing viral load, liver function of pregnant women declined to maintain in normal level, but not associated with pregnancy complications; that of HBV-DNA positive pregnant women given close monitoring of disease through clinical routine treatment can ensure the safety of mother and child.
目的 探讨活性臭氧水在失禁性皮肤炎中的应用效果。方法 将123例失禁性皮肤炎患者按入院时间分为对照组、银离子组、实验组各41例,分别给患者使用氧化锌软膏、银离子敷料和活性臭氧水进行治疗,治疗后对治疗效果、愈合时间以及患者对疗效的满意度进行评估。结果 治疗后银离子组、实验组有效率达100%,实验组、银离子组患者愈合时间比较接近,与对照组比较差异有统计学意义(P＜0.05);治疗后实验组的满意度为100%,银离子组为90.24%,对照组为60.98%。结果显示实验组更优于银离子组,且与对照组比较差异有统计学意义(P＜0.01)。结论 利用活性臭氧水治疗失禁性皮肤炎不仅能有效地提高创面的愈合能力,缩短愈合时间,而且方便、安全、高效、成本低。
Objective To investigate the efficacy of ozone water in the treatment of incontinence dermatitis. Methods 23 cases of incontinence dermatitis were divided into control group, silver ion group and experimental group respectively. Each group consists of 41 cases. The patients were treated with Zinc oxide ointment in control group, ionic silver dressing in silver ion group and activity of ozone water treatment in experimental group. Healing time and curative effect, as well as satisfaction assessment of patients after treatment were studied. Results It showed that both silver ion group and experimental group achieved an effective rate of 100%. The healing time of experimental group and silver ion group were relatively similar, while that of control group is significant differentt (P<0.05). Satisfaction assessment showed that the experimental group after treatment was 100%, while silver ion group was 90.24% and 60.98% in the control group. Results showed that experimental group is better than that of silver ion group, and both groups were statistically significant different to control group (P<0.01). Conclusion The use of ozone water in the treatment of incontinence dermatitis can not only effectively improve the wound healing ability, shorten the healing time, but also is convenient, safe and low cost.
目的 对比双腔耐高压PICC和股静脉置管在IV级心力衰竭患者中的应用效果。方法 选取我院 2016年1月—12月收治的端坐位IV级心力衰竭患者61例,按照便利抽样的方法将其随机分成研究组31例和对照组30例。研究组患者行耐高压PICC置管,对照组患者行双腔中心股静脉置管,观察2组患者的一次性置管成功率、导管头端位置、并发症发生率、留置导管天数和患者满意度等相关临床指标。结果 研究组患者的一次插管成功率为 93.55%(29例),高于对照组的83.33%(25例)(P<0.05);研究组患者的并发症发生率低于对照组(P<0.05)。结论 对IV级心力衰竭患者在端坐位下予以耐高压PICC 插管进行治疗,能提高一次置管成功率,降低并发症发生率,提高患者满意度,可作为患者抢救时的首选静脉通道。
Objective To compare the effect of dual chamber high pressure PICC (peripherally inserted central catheter) and femoral vein CVC(central venous catheter)catheterization in patients with IV class heart failure. Methods From January to December 2016, 61 patients with congestive heart failure in the sitting position were selected from our hospital. According to the convenient sampling method, they were randomly divided into the study group (31 cases) and the control group(n=30). The study group were treated with high pressure PICC tube, the control group underwent femoral vein catheterization. Two groups of patients with the success rate of catheterization, catheter tip location, complications, indwelling catheter days and related clinical indicators of patient satisfaction were observed. Results The successful rate of intubation in the study group was 93.55% (29 cases), higher than that of the control group (25 cases)(P<0.05), and the incidence of complications in the study group was lower than that of the control group(P<0.05)(83.33%). Conclusion Treatment for patients with heart failure IV be in sitting position under high pressure PICC intubation, may improve the success rate of catheterization, reduce the incidence of complications, improve patient satisfaction, and be the first choice when the rescue of patients with venous channel.
目的 观察和研究功能锻炼和心理护理对中风后肩手综合征老年患者功能康复的影响,以及对运动功能、日常生活活动能力的影响。方法 选取2015年6月—2017年2月收治的中风后肩手综合征老年患者60例为研究对象,随机法分为干预组与对照组,各30例。干预组在给予内科常规治疗及护理的同时,采用功能锻炼心理干预等方法进行处理;对照组仅进行内科的常规治疗及护理。运动功能则采用Fugl-Meyer评分法(FMA)进行评分,而日常生活活动能力采用改良Barthel指数(MBI)进行评分。并比较两组患者干预前后焦虑、抑郁水平。结果 干预组FMA评分以及MBI评分均高于对照组,差异有统计学意义(P<0.05)。干预后干预组患者焦虑、抑郁评分低于对照组,两组比较差异有统计学意义(P<0.01)。结论 采用功能锻炼和心理护理能提高中风后偏瘫患者的运动功能以及日常生活活动能力,缓解或消除患者焦虑抑郁等负性情绪,效果明显,值得推广应用。
Objective To observe and study of functional exercise and psychological nursing for stroke shoulder hand syndrome after the influence of the elderly patients with functional rehabilitation, and the influence on motor function and ability of daily life activities. Methods 60 cases of elderly patients with apoplexy after apoplexy were selected from June 2015 to February 2017. They randomly were divided into two groups: intervention group and control group, each with 30 cases. The intervention group was treated with functional exercise psychological intervention with giving routine treatment and nursing care as the same time. The control group only conducted routine treatment and nursing care. The exercise function was rated by the Fugl-Meyer scoring method (FMA), while the improved Barthel index (MBI) was used to score the daily activities. The anxiety and depression levels were compared between the two groups. Results The FMA score of the intervention group and MBI score were higher than that of the control group, and the difference was statistically significant(P<0.05). The anxiety and depression scores of the intervention group were lower than those in the control group, and the difference between the two groups was statistically significant(P<0.01). Conclusion The functional exercise and psychological care may improve movement function in patients with hemiplegia after stroke, and daily life activities ability, alleviate or eliminate negative emotions, including anxiety depression. It is worth promoting.
目的 对于急性脑梗死患者联用依达拉奉、阿加曲班注射液治疗的临床效果进行观察。方法 运用随机、开放以及对照原则,将发病12～48 h内的80位急性脑梗死患者,随机分为40例对照组、40例联合组,2组都以对症治疗以及常规治疗为基础,在此之上,对照组以依达拉奉进行治疗,联合组以依达拉奉辅以阿加曲班进行治疗,将2组最终治疗疗效作比较,对2组患者治疗前后血清hs-CRP、凝血功能状况、日常活动能力、血流变指标以及NIHSS评分的动态变化进行实时观察。结果 就总有效率而言,对照组的72.5%显著低于联合组的92.5%,P<0.05。经治疗,2组患者凝血功能指标、血清hs-CRP、血流变指标以及NIHSS评分均有所下降,联合组较之对照组降幅更为显著(P<0.05),较之2组治疗前后,差异无统计学意义(P>0.05)。2组都不曾有不良反应出现。结论 应用依达拉奉辅以阿加曲班进行治疗急性脑梗死患者,可显著提升临床疗效,促进患者神经功能及日常活动能力恢复,减少炎症反应发生,改善预后,且无明显不良反应。
目的 对比热敏灸联合“合谷刺法”与温灸针“合谷刺法”治疗肩周炎的疗效。方法 2015年7月—2017年1月,筛选康复科收治的慢性肩周炎患者120例,按照随机数字表达法分组,对照1组、对照组2组、观察组各入选40例。对照1组采取温针灸“合谷刺法”,对照2组采取传统取穴针刺疗法,观察组热敏灸联合“合谷刺法”。对比3组疗效,治疗前后肩关节功能ASES量表(American Shoulder and Elbow Surgeons shoulder index)、VAS肩关节疼痛评分、肩关节活动度。结果 3组均未见退出例。观察组愈显率82.5%高于对照1组50.0%、对照组2组55.0%,差异有统计学意义(P＜0.05),观察组整体疗效与对照2组差异无统计学意义(P＞0.05)。治疗后,观察组、对照1组、对照2组VAS肩关节疼痛评分低于治疗前,观察组治疗后差值高于对照1组、对照2组,ASES评分高于治疗前,观察组治疗前后差值高于对照1组、对照2组,差异有统计学意义(P＜0.05)。治疗后,观察组、对照1组、对照2组前屈上举角度、外展上举与后伸角度、水平内收外展角度高于治疗前,观察组高于对照1组、对照2组,差异有统计学意义(P＜0.05)。结论 热敏灸联合“合谷刺法”与温灸针“合谷刺法”在治疗肩周炎疗效肯定,但前者减轻疼痛、改善功能方面有明显的优势。
目的 探究S100B蛋白、神经元特异性烯醇化酶与新生儿低血糖脑损伤的诊治相关性。方法 收集2014年1月—2016年12月来我院就诊出现低血糖脑损伤的新生儿116例,设为患病组,首先根据临床表现,分为两组,有低血糖症状组(n=54)和无低血糖症状组(n=62)。两组患儿均给予常规药物治疗,有效患者82例,为有效组,无效患者34例,为无效组。同期收集健康足月的新生儿53例,为健康对照组。患儿均于治疗前、后检测血清S100B蛋白、神经元特异性烯醇化酶水平,健康对照组新生儿也于同一时间点进行相同检测。观察各组新生儿血清S100B蛋白、神经元特异性烯醇化酶水平变化,并探究其水平变化与诊断及治疗效果的相关性。结果 低血糖症状组和无低血糖症状组患儿的血糖水平均低于和健康对照组(P<0.05);低血糖症状组患儿的低血糖扶持续时间高于无低血糖症状组(P<0.05)治疗后,各组的NSE和S100B的蛋白水平差异无统计学意义(P>0.05)。患儿血清NSE和S100B与血糖水平呈负相关(r=-0.131、-0.124、P<0.05),与低血糖持续时间呈正相关(r=0.135、0.129,P<0.05)。结论 血清NSE及S100B与患儿血糖水平相关,可作为新生儿低血糖脑损伤的早期诊断指标。血清NSE及S100B水平与治疗效果存在相关性并为负相关,血清水平越低,患者治疗效果越好。
目的 探讨在急诊冠心病快速心律失常患者中应用胺碘酮治疗的临床效果。方法 选取在我院接受治疗的164例冠心病快速心律失常患者进行研究,采用随机数字表法将其随机分为对照组和研究组,每组82例。对照组给予利多卡因治疗,研究组给予胺碘酮治疗,比较两组患者的临床治疗效果及不良反应发生情况,同时比较研究组中不同类型心律失常患者的治疗效果。结果 研究组患者治疗总有效率为89.0%,对照组为64.6%,两组比较均有差异(P＜0.05);采用胺碘酮治疗的研究组患者中,室性早搏患者的治疗总有效率最高,其次为阵发性房颤、持续性房颤、阵发性室性心动过速、室性心动过速,其中室性早搏和阵发性房颤治疗总有效率高于心动过速(P＜0.05)。结论 胺碘酮治疗急诊冠心病快速心律失常在适应症和禁忌症的严格掌握和心率、血压的密切监测的前提下效果更为确切,可作为首选药物应用。
目的 了解龙川地区肺炎支原体耐药情况,以便临床合理运用抗生素。方法 收集2014年—2015年间疑似肺炎支原体感染住院小儿患者的咽分泌物标本2 666例,同时作Mp培养及IgM检查,同为阳性者共149例进行耐药性统计分析。结果 在2 666例疑似感染患者中,培养肺炎支原体阳性149例,阳性率为5.59%,学龄前儿童(≤3岁)患者阳性率2.06%,学龄儿童(4～15岁)阳性率9.79% ,学龄儿童感染肺炎支原体与学龄前儿童比较有显著差异(P<0.05)。其中红霉素、阿奇霉素、罗红霉素、克林霉素、依托红霉素、克拉霉素、乙酰螺旋霉、交沙霉素、加替沙星、莫西沙星、环丙沙星、左氧氟沙星、多西环素、米诺环素耐药率分别为2%、12.4%、4%、22% 、2%、1%、80%、44%、2%、15%、10%、1%、61%、44%。冬季感染与在其他季节比较有差异(P<0.05)。结论 阿奇霉素,红霉素为代表大环内脂类抗生素仍可以作为临床一线经验用药,乙酰螺旋霉、交沙霉素耐药率大于40%,不建议作为经验药物使用。喹诺酮类抗生素耐药率一般小于15%,可作为肺炎支原体治疗的第二选择。四环素类抗生素在本地区耐药性高,不建议作为经验药物使用。要加强预防冬季肺炎支原体感染。
目的 探讨乳腺深部脓肿患者采用麦默通微创旋切术治疗与传统切开引流术比较。方法 选取2016年2月—2017年1月我院收治乳腺深部脓肿患者62例为研究对象,根据患者自愿选择手术方式分为麦默通组(麦默通微创旋切术,38例)和传统组(传统切开引流术,24例),比较两组患者手术时间、术中出血量、住院时间、术后1 d疼痛、手术切口长度,并对两组患者随访6个月,比较脓肿复发及切口感染、乳房变形、皮肤感觉障碍、乳瘘等并发症发生率。结果 麦默通组患者手术时间、术中出血量、住院时间、术后1 d疼痛、手术切口长度均少于传统组(P＜0.05)。两组患者术后脓肿复发率无统计学意义(P＞0.05);麦默通组患者术后切口感染、乳房变性、皮肤感觉障碍、乳瘘发生率均低于传统组(P＞0.05)。结论 乳腺深部脓肿患者采用麦默通微创旋切术治疗,相对传统切口引流术可减轻患者手术创伤、缩短患者术后康复时间,降低术后并发症发生率,具有更为显著临床疗效。
目的 探讨影响老年患者用药依从性的原因及对策。方法 随机抽取我院区门诊就诊的老年患者进行问卷调查,了解其用药依从性及影响依从性原因,根据调查结果结合临床分析,实施相应的干预措施,评价实施对策前后患者用药依从性及影响依从性的原因。结果 实施干预措施后老年患者用药依从率从60.06%上升至84.39%,P＜0.05,差异有统计学意义。结论 通过对老年患者加强医药知识教育及医患沟通;简化用药方案;医院、社区、家庭给予支持等措施可提高老年患者用药依从性。
目的 通过监测供精人工授精技术(artificial insemination by donor,AID)助孕后妊娠患者,了解其子代出生缺陷和遗传代谢病情况,为建立规范的监测子代出生缺陷的机制提供理论依据。方法 随访供精人工授精技术助孕后妊娠分娩的患者,收集其子代临床资料,部分新生儿采集足跟血制成滤纸干血斑标本,进行串联质谱分析,筛查遗传代谢病,可疑对象进行重复检测和专科咨询检查。结果 收集分析2007年—2016年通过AID出生的4 261例子代临床资料,360例新生儿采集足跟血进行 50种遗传代谢病检测。子代出生缺陷率1.24%(不包括230例轻度地方病地中海贫血症、24例G6PD缺乏症和两病共患5例),360例中未发现重度地中海贫血症、先天性甲状腺低下症、苯丙酮尿症等其他遗传代谢病。本中心建立宣传教育新生儿遗传代谢病筛查和转诊制度。结论 供精人工授精技术助孕后妊娠出生的子代出生缺陷和遗传代谢病发病率低,冻存精子进行供精人工授精助孕,是一种较安全获得健康子代的辅助生殖技术。
目的 探讨急性脑卒中患者颈动脉粥样硬化斑块的超声形态学表现以及探讨不同超声形态学表现的诊断价值。方法 对所有入选受检者进行多层螺旋CT或磁共振(MRI)检查、常规颈动脉超声检查、彩色多普勒血流显像(CDFI)、超声造影技术(CEUS)的影像学资料进行回顾性分析;所入选病例组患者在发病2天内完成上述影像学检查,对照组受检者也在2天内完成上述影像学检查。结果 常规超声发现病例组颈动脉斑块45处、对照组11处;CDFI发现病例组颈动脉斑块远端血流频谱改变35例、对照组11例;超声造影发现颈动脉斑粥样硬化斑块处毛细血管现象病例组15例、对照组2例。斑块表面形态以及内部回声分布情况两项结果与对照组比较差异有统计学意义。结论 脑卒中患者与无症状颈动脉硬化受检者的斑块超声声像图中,斑块表面形态以及内部回声分布两项指标具有明显的鉴别诊断意义。提示表面不光整、内部回声分布不均匀的斑块导致急性脑卒中的可能性较大。
自奥津一郎于1987年首次报道内镜辅助下行腕管松解术以来,腕管综合征的内镜治疗术式得到大量创新、改良。现本文就各种内镜术式优劣势做一概述。
目的 探讨快速康复外科(enhanced recovery after surgery, ERAS)理念在膀胱癌根治加回肠膀胱术后护理的有效性和安全性。方法 分析我院2012年1月—2016年12月行膀胱癌根治加回肠膀胱术的患者共98例,其中ERAS组47例,传统组51例。比较两组术后伤口感染率、出血率、吻合口瘘率、肺部感染率及术后住院日等指标。结果 两组患者的伤口感染率、出血率、吻合口瘘率无差异,ERAS组的肺部感染率4.26%低于传统组21.57%,差异有统计学意义(P＜0.05)。ERAS组的术后住院日短于对照组[(8.53±1.82)vs (13.21±2.16)],差异有统计学意义(P＜0.05)。ERAS组的30天内再入院率6.38%低于传统组19.61%,差异有统计学意义(P＜0.05)。两组的非计划再次手术率无统计学差异。结论 快速康复外科理念应用在膀胱癌根治加回肠膀胱术后护理是有效和安全的,ERAS能减少术后并发症及缩短术后住院日。
目的 探讨优质护理模式干预对凶险性前置胎盘患者胎盘恢复及胎儿的影响。方法 选取2015年3月—2017年6月我院妇产科收治的凶险性前置胎盘患者80例,随机分为对照组和观察组,各40例,分别实施常规护理及优质护理模式干预,对比分析两组患者护理干预效果。结果 观察组患者术后大出血及感染总并发症发生率低于对照组(P<0.05)。观察组患者产前、产后总出血量低于对照组,同时新生儿Apgar评分高于对照组,其差异比较均有统计学意义(P<0.01)。结论 在凶险性前置胎盘患者中实施优质护理模式干预对胎盘恢复效果更显著于常规护理,同时改善新生儿健康情况。
