目的 初步探讨微泡增强的脉冲式超声治疗脾创伤出血的作用机制。方法 14只健康家犬随机分为3组,超声微泡组(MEUS组)6只、单纯超声组(TUS组)4只、单纯微泡组(MB组)4只。开腹切割脾建立脾破裂出血模型,MEUS组用脉冲式超声治疗仪辐照伤口,同时静脉匀速推注微泡;TUS组超声治疗时静脉推注生理盐水;MB组超声治疗仪假照的同时静脉推注微泡。治疗完毕,进行超声造影评价,并送病理组织学检查。结果 MEUS组造影示靶区造影增强缺损或者低灌注,但较粗大血管仍为增强显影。病理组织学见脾窦、微小血管扩张充血、血管周围组织水肿,血小板聚集,微小血管血栓形成。结论 微小血管血栓形成、微血管淤血扩张、周围组织水肿压迫是超声联合微泡治疗脾创伤出血的可能机理。

Objective To investigate the mechanism of haemostatic effect induced by microbubble(MB)enhanced therapeutic ultrasound(TUS)on splenic trauma. Methods 14 healthy dogs were divided into 3 groups.Six animals were treated by microbubble-enhanced therapeutic ultrasound(MEUS),the other eight animals were treated with TUS only group(n=4)and the MB only(n=4)served as the controls.The spleens of all animals were surgically exposed and a 20 mm long,5 mm deep incision was created on the spleens using scalpel.Contrast enhanced ultrasound(CEUS)was performed to assess the blocking effects of splenic circulation.The targeted spleens were harvested for pathological examination. Results A non-enhanced or perfusion defect region was formed within the treated area.The histological results showed splenic sinus hyperemia,microvascular hyperemia,perivascular tissue edema,platelet aggregation and intravascular thrombosis. Conclusion The mechanism of haemostatic effect on splenic trauma by microbubble enhanced ultrasound maybe intravascular thrombosis,microvascular hyperemia and perivascular tissue edema oppression simultaneously.

目的 调查盐酸氨溴索对放射性肺损伤中转化生长因子β1(TGF-β1)以及肿瘤坏死因子α(TNF-a)水平的影响。方法 选取共98例在放射治疗局部晚期肺癌患者,随机分为治疗组和对照组。自放疗开始予治疗组中患者盐酸氨溴索口服,剂量60 mg,每天三次,持续应用3个月。然后对两组患者血浆中TGF-β1和TNF-α的水平进行分析。临床症状和病情变化情况采用高分辨率计算机断层扫描进行检测。结果 对照组中TGF-β1水平显著升高(11.8±5.5 ng/mL),而在盐酸氨溴索治疗组中,增加不显著(5.5±2.6 ng/mL,P＜0.001)。同样,对照组中TNF-α的水平也较治疗组中升高,(对照组:5.1±1.3,治疗组:2.6±0.8 ng/mL,P＜0.001)。结论 盐酸氨溴索能有效降低放疗后血浆TGF-β1及TNF-α水平,降低早期出现的放射性肺炎和晚期出现的肺纤维化发生机率,提高治疗效果及患者生活质量。

Objective The aim is to investigate the effect of ambroxol on radiation lung injury and the expression of transforming growth factor β1(TGF-β1),and tumor necrosis factor α(TNF-α)in plasma. Methods Ninety-eight patients with locally advanced lung cancer in radiotherapy were randomized into treatment and control groups.Patients in the treatment group took ambroxol orally at a dosage of 60 mg,three times per day for 3 months from the beginning of radiotherapy.The expression of TGF-β1 and TNF-αin plasma was analyzed.The clinical symptoms and lung diffusing capacity were monitored using high resolving power computed tomography. Results The level of TGF-β1 in the control group was increased(11.8 ± 5.5 ng/mL),whereas in ambroxol-treated patients,the increase was not significant(5.5 ± 2.6 ng/mL,P＜0.001). Radiotherapy-induced elevation of TNF-α levels,seen in control patients,was also abolished after treatment with ambroxol(5.1 ± 1.3 vs 2.6 ± 0.8 ng/mL,P＜0.001). Conclusion Ambroxol can obviously decrease the plasma TGF-β1 and TNF-α levels after radiotherapy,and decrease the chances of early radiation pneumonitis and late pulmonary fibrosis,and improve treatment effect and quality of life of patients.

目的 分析复方丹参注射液对轻度子痫前期患者肾功能与妊娠结局的影响。方法 对照组:在1000 mL浓度为5%的葡萄糖注射液中加入60 mL浓度为25%的硫酸镁,每天静滴1次,以连续静滴5 d为一个疗程;观察组:在250 ml浓度为5%的葡萄糖注射液中加入20 mL复方丹参注射液行静脉滴注治疗,每天静滴1次,以连续静滴5 d为一个疗程。结果 观察组的总有效率为96.88%,对照组为78.13%,观察组高于对照组,两组存在差异(P<0.05)。结论 为了有效改善轻度子痫前期患者的妊娠结局及预后,建议在临床中推广使用复方丹参注射液。

Objective The Objective of the investigation was to study how compound danshen injection(CDI)affected the kidney function and pregnant outcomes of patients diagnosed as mild preeclampsia. Methods Samples are randomly divided into two groups:observation group,in which patients were treated with magnesium sulfate,and control group,in which patients were treated with Danshen injection. Results In control group the treatment showed valid effect in 78.13% of the patients,and in observation group the ratio was 96.88%, which was remarkably higher. Conclusion To improve the pregnant outcomes and prognosis of mild preeclampsia,compound danshen injection should be recommended during the clinical practice.

目的 探讨针灸治疗在体外受精—胚胎移植技术的临床效果。方法 以2013年8月—2015年8月在顺德妇幼保健院生殖科,因不孕进入IVF/ICSI周期的108例患者为研究对象,按照随机自愿原则将其分为三组,针刺组、安慰针刺组、对照组各36例,针刺组:在移植前24小时、移植后30分钟进行相关的针刺治疗,安慰针刺组:针刺穴位与妊娠无关,对照组:不使用针刺疗法,比较三组临床效果。结果 治疗后针刺组Ⅰ型内膜血流类型及PI、RI、S/D低于治疗前,Ⅱ+Ⅲ型内膜下血流类型高于治疗前,差异有统计学意义(P＜0.05)。针刺组总有效率高于安慰针刺组、对照组,三组差异有统计学意义(P＜0.05)。针刺组种植成功率、妊娠成功率及活产率均高于安慰针刺组、对照组,三组差异有统计学意义(P＜0.05)。结论 在体外受精—胚胎移植技术中为患者实施针灸治疗可改善子宫内膜下血流情况,提高临床疗效、改善妊娠结局。

Objective To investigate clinical results of acupuncture treatment in vitro fertilization-embryo transfer technology. Methods August 2013-August 2015 reproductive and child health hospital in Shunde branch,due to infertility entering IVF/ICSI cycles of 108 patients for the study,in accordance with the principle of voluntary they were randomly divided into three groups,the acupuncture group,placebo group and control group 36 cases,respectively.Acupuncture group:24 hours before transplantation,30 minutes post-transplant treatment of infertility acupuncture.Placebo group:acupuncture and were unrelated to infertility.The control group:acupuncture was not used.We compared three groups of clinical effect. Results In the treatment of type Ⅰ endometrial blood flow in the acupuncture group type and PI,RI,S/D were significantly lower than before treatment,Ⅱ+Ⅲ,endometrial blood type under were significantly higher than before treatment.the difference was significance(P<0.05). The acupuncture group was more efficient than placebo group and the control group,the three groups was significant(P<0.05). The success rate of acupuncture group planting,the success rate of pregnancy and live birth rates were higher than placebo group and the control group,the three groups was significant differences(P<0.05). Conclusion In vitro fertilization-embryo transfer technology into the implementation of acupuncture treatment for patients can improve blood flow under the endometrium,improve clinical outcomes and improve pregnancy outcomes.

目的 观察十一酸睾酮联合左卡尼汀治疗特发性弱精症的疗效。方法 回顾性分析2012年11月—2014年6月在我科诊断为弱精子症的386例患者的临床资料,按标准分成轻(A组)、中(B组)、重(C组)3组。分别给予左卡尼汀、十一酸睾酮联合左卡尼汀治疗,观察两种治疗方法对特发性弱精子症的疗效。结果 A组、B组患者两种治疗方法治疗后精子PR均有升高,差异有统计学意义(P＜0.05),C组患者给予左卡尼汀治疗患者治疗后PR无改善,差异无统计学意义(P＞0.05);十一酸睾酮联合左卡尼汀治疗患者治疗后PR升高,差异有统计学意义(P＜0.05)。A、B、C组患者给予左卡尼汀治疗的有效率分别是47.6%,41.7%,18.9%,总有效率为37.9%;A、B、C组患者给予十一酸睾酮联合左卡尼汀治疗的有效率分别是52.6%,45.5%,34.7%,总有效率为45.5%。A组、B组患者两种治疗方法疗效无差异(P＞0.05);C组患者给予十一酸睾酮联合左卡尼汀组有效率高于给予左卡尼汀组,差异有统计学意义(P＜0.05)。结论 十一酸睾酮联合左卡尼汀治疗特发性弱精子症的疗效优于左卡尼汀单一用药。

Objective To observe the effects of eleven acid testosterone combined with L-carnitine on curing idiopathic asthenospermia. Methods Retrospective analysed the clinical data of 386 patients with asthenospermia patients from November 2012 to June 2014 in our department.According to the standard,the patients were divided into mild A,moderate B,severe C in 3 groups,given L-carnitine treatment and given eleven acid testosterone combined with L-carnitine treatment.We observed effect of the two therapeutic methods for the treatment of idiopathic asthenospermia. Results The sperm PR were increased,In group A and group B patients after treated.The difference was statistically significant(P<0.05).In group C,the patients received the treatment of L-carnitine,the sperm PR has no obvious improvement,There was no significant difference(P>0.05).The patients received the treatment of eleven acid testosterone combined with L-carnitine the sperm PR significantly increased,the difference was statistically significant(P<0.05).The treatment efficiency of A,B,C group received L-carnitine were 47.6%,41.7%,18.9%,the total effective rate was 37.9%.The treatment efficiency of A,B,C group received eleven acid testosterone combined with L-carnitine were 52.6%,45.5%,34.7%,the total effective rate was 45.5%;There was no significant difference in group A and group B(P>0.05).The treatment efficiency in group C received eleven acid testosterone combined with L-carnitine group is obviously higher than that given L-carnitine group,the difference was statistically significant(P<0.05). Conclusion The curative effect of eleven acid testosterone combined with L-carnitine in the treatment of idiopathic asthenospermia is better than that of L-carnitine single drug treatment.

目的 探讨经皮穴位电刺激对脑卒中偏瘫患者下肢功能的影响。方法 41例脑卒中患者随机分为TAES组和安慰刺激组,分别为21例和20例。两组常规治疗相同。TAES组采用KD-2A型经皮神经电刺激治疗仪治疗,刺激部位选择患侧下肢的4个穴位(足三里ST 36、太冲LV 13、阳陵泉GB 34、昆仑BI 60),频率100 Hz,脉宽0.2 ms,强度为患者最大耐受强度为限;安慰刺激组接受治疗的部位时间和疗程与TAES组相同,但每次治疗时没有电流输出。治疗前、治疗2周、治疗3周分别用综合痉挛量表(CSS)评定踝关节痉挛,Fugl-Meyer运动评定量表中下肢部分(FMA)评定下肢运动功能,Berg平衡量表(BBS)评定平衡功能。结果 组内比较:治疗2周和治疗3周后与治疗前比较两组CSS、FMA下肢部分、BBS评分差异有统计学意义(P<0.05);组间比较:治疗2周和3周后,TAES组CSS、FMA、BBS评分优于安慰刺激组,差异有统计学意义(P<0.05)。结论 TAES治疗能减轻脑卒中患者偏瘫下肢痉挛程度和提高平衡功能,改善下肢运动能力。

Objective To investigate the effect of transcutaneous accupoint electrical stimulation(TAES)in enhancing motor and functional recovery of the lower extremity in subjects with stroke. Methods 41 subjects with first stroke were randomly assigned into 2 groups:TAES group and placebo stimulation group.All subjects received the same standard rehabilitation.In the TAES group.Model KD-2A stimulator was applied with 0.2 ms pulses,at 100 Hz within the subject's tolerance level on the 4 acupuncture points(ST 36,LV 3,GB 34,and Bl 60)in the affected lower legs for 60 min,5 days a week for 3 weeks;The time and the course of treatment of the placebo stimulation group was as well as the TAES group's,but no current output for each treatment.All subjects in the 2 groups received standard rehabilitation program.Measurements including composite spasticity score(CSS)for the spasticity of the ankle planter flexors,Fugl-Meyer motor assessment(FMA)for the lower extremity,and Berg Balance Scale(BBS)for balance were recorded before treatment,after 2 and 3 weeks' treatment. Results After 2 and 3 weeks of treatment,the CSS score in the TAES group was significantly lower than the placebo stimulation group(P<0.05)and the FMA score and BBS score in the TAES group was significantly higher than the placebo stimulation group(P<0.05). Conclusion Transcutaneous accupoint electrical stimulation significantly decreased ankle plantar flexor spasticity and improve motor function of the affected lower extremity.

目的 评价阿奇霉素序贯疗法治疗小儿支原体肺炎的临床疗效及药物经济学效果。方法 将我院儿科于2011年3月—2013年8月收治的522例支原体肺炎患儿随机分为静滴组(n=265)和序贯组(n=287),两组均给予阿奇霉素进行疗程为5 d的治疗,静滴组采用静脉滴注的给药方法进行治疗,序贯组采用静脉滴注2 d后口服序贯给药3 d的方法进行治疗,运用药物经济学原理对两种给药方案进行成本－效果分析。结果 静滴组和序贯组的总有效率分别为94.0%(249/265)和92.7%(266/287),两组比较差异无统计学意义(P>0.05),但静滴组的成本高于序贯组(P<0.01);静滴组和序贯组的不良反应发生率分别为34.7%(92/265)和26.9%(76/287),两组比较差异有统计学意义(P<0.05)。结论 采用序贯疗法治疗小儿支原体肺炎符合安全、有效、经济的临床用药原则,值得临床广泛推荐。

Objective To evaluate the clinical efficacy and pharmacoeconomic effect of sequential therapy of azithroycin on treatment of community mycoplasmal pneumonia(MP)in chindren. Methods 522 cases with MP from March 2011 to August 2013 in pediatrics department of our hospital were randomly divided into intravenous-drip group(n=265)and sequential-therapy group(n=287),and both two groups were treated by azithromycin for 5 days.The intravenous-drip group was treated with intravenous drip of azithromycin,and the sequential-therapy group was treated with azithromycin in the way of intravenous drip for 2 days and oral-taken for 3 days.The two treatments were cost-effectiveness analyzed by pharmacoeconomic theory. Results The total efficiency of the sequential-therapy group and intravenous-drip group were 94.0%(249/265)and 92.7%(266/287),respectively.There was no different between the sequential-therapy group and the intravenous-drip group(P<0.05).But the cost in intravenous-drip group was higher than that in sequential-therapy group(P<0.01).The incidence of adverse reaction of the sequential-therapy group and intravenous-drip group were 94.0% 34.7%(92/265)and 26.9%(76/287),respectively.And it was significant different between the two groups(P<0.05). Conclusions The treatment of sequential therapy of azithromycin is safety,effective and economical.And it is worthy to be widely recommended in clinical.

目的 对乳腺癌中血管内皮生长因子－C(VEGF－C)的表达与淋巴结转移及预后的关系展开研究分析。方法 随机选取我院接收救治的50例乳腺癌患者,采用免疫组化法检测50例患者乳腺癌中VEGF－C的表达情况,研究乳腺癌VEGF－C的表达与淋巴结转移及预后的关系。结果 50例乳腺癌患者中,淋巴结节转移组,VEGF－C阳性23例,阳性率92.0%;未见淋巴结节转移组,VEGF－C阳性10例,阳性率40.0%;淋巴结节转移组VEGF－C阳性表达率高于未见淋巴结节转移组;不同年龄、肿瘤直径以及病理分型的乳腺癌,VEGF－C阳性表达率差异无统计学意义(P均＞0.05);不同临床分期乳腺癌中,I~II期乳腺癌VEGF－C阳性表达率(58.1%)低于III~IV期VEGF－C阳性表达率(84.2%),数据差异有统计学意义(P＜0.05)。结论 早期检测乳腺癌中VEGF－C表达情况,能够为临床早期判定乳腺癌是否转移提供一项可测参考指标,对临床治疗、预后评估可起到一定参考价值。

Objective To make expand research and analysis for breast cancer and vascular endothelial growthfactor-C(VEGF-C)expression and lymph node metastasis and prognosis. Methods 50 cases of breast cancer patients were random collected in our hospital to detect the expression of VEGF-C in patients with breast cancer using immunohistochemical staining,the relationship between breast cancer VEGF-C expression and lymph node metastasis and prognosis. Results In 50 cases of breast cancer,lymph node metastasis group,VEGF-C positive in 23 cases,the positive rate is 92.0%;no lymph node metastasis group,VEGF-C positive in 10 cases,the positive rate is 40.0%;lymph node metastasis group VEGF-C positive expression rate was significantly higher than that no lymph node metastasis group;different age,tumor size and histological type of breast cancer,the VEGF-C positive expression rate difference was not statistically significant(P＞0.05);different clinical stages of breast cancer,I ~ II breast cancer VEGF-C positive expression rate(58.1%)was significantly lower than the III ~ IV of VEGF-C positive expression rate(84.2%),the data were statistically significant differences(P<0.05). Conclusion Early detection of breast cancer in the expression of VEGF-C can determine for early clinical metastasis of breast cancer,can provide a reference index for clinical treatment and prognosis.

目的 对比分析二氧化锆全瓷冠与钴铬合金烤瓷冠修复牙体牙列缺损的临床疗效。方法 选择2008年3月以来广东工业大学医院口腔科和江西省萍乡市安源区现代口腔门诊部牙体牙列缺损全冠修复患者150例364颗,随机分为2组,实验组采用二氧化锆全瓷冠75例185颗,对照组采用钴铬合金烤瓷冠75例179颗,修复后随访2年对比观察,结果采用χ²检验分析。结果 两组在修复体完整性、固位、边缘密合度、牙敏感症状、继发龋、邻面接触点、过敏反应方面差异无统计学意义(P＞0.05);但在牙龈状况、龈缘着色、颜色匹配方面差异有统计学意义(P＜0.01)。结论 二氧化锆全瓷冠修复体美学效果和生物相容性优于钴铬合金烤瓷冠。

Objective To compare and analyze the clinical effects of restoring tooth dentition defect by using zirconium dioxide full porcelain crowns and cobalt chromium alloy porcelain crowns. Methods 150 patients with 364 teeth suffering from tooth dentition defect in hospital of guangdong university of technology and modern stomatology clinic in pingxiang since March of 2008 are chosen and randomly divided into two groups. 75 patients with 185 teeth in the experimental group are restored with zirconium dioxide full porcelain crowns and 75 patients with 179 teeth in the control group are restored with cobalt chromium alloy porcelain crowns, which was followed up with 2-year observation. Results There is no statistical significance between the two groups in terms of repair integrity, retention, edge adaptation, tooth sensitivity symptoms, secondary caries, contact points, and allergic reaction(P＞0.05). But statistical significance exists in gingival status, gingival coloration, and color matching(P＜0.01). Conclusion Zirconium dioxide full porcelain crowns are superior to cobalt chromium alloy porcelain crowns in aesthetic effect and biocompatibility.

目的 体外构建胶原—壳聚糖复合支架材料,分析其物理化学性质及生物相容性,探讨其应用于组织工程支架材料的可行性。方法 利用冷冻干燥的方法构建三维多孔的胶原支架材料,通过甲醛交联以及添加壳聚糖的方法改善其物理化学性能。通过体外降解实验以及电镜扫描的方法检测材料的各项物理化学指标;通过细胞接种的方法研究材料的生物相容性。结果 胶原—壳聚糖复合材料通过冷冻干燥的方法,能够获得稳定的三维多孔结构,电镜显示孔隙贯通,体外降解速度降低,并且能够支持细胞生长。理化性质分析显示该结构适合细胞生长,具有良好的生物相容性。结论 本课题体外构建胶原—壳聚糖复合支架材料,满足组织工程生物材料的理化以及生物相容性要求,为其应用于组织工程支架材料提供重要的依据。

Objective We build up the Collagen-Chitosan compound scaffold in vitro,and study the physical,chemical and biological properties,to analyze the feasibility in tissue engineering. Methods The three-dimensional porous scaffold was obtained by freezing-drying method,and optimized by using formaldehyde and Chitosan.We used hydrolysis in vitro and SEM scanning to investigate its physical and chemical properties.The biocompatibility of scaffold was analyzed in MEF cells. Results Collagen-Chitosan compound scaffold we obtained by freezing-drying method was a kind of stable 3D vesicular structure.The scaffold degenerated in decreased velocity in vitro.The physical and chemical properties showed that it was suitable for the cells grow in it,which suggested that it has a good biocompatibility. Conclusion This kind of Collagen-Chitosan compound scaffold is constructed.It's qualified by the physical and chemical properties,and biocompatibility which the biomaterials require.The evidence are important for its application in tissue engineering.

目的 了解化脓性脑膜炎患儿常见后遗症的种类及发生率,探讨可能导致化脓性脑膜炎患儿预后不良的高危因素。方法 选取129例化脑性脑膜炎患儿,患儿分为预后不良组及预后良好组,统计各种后遗症的发生率,并寻找预后不良的危险因素。结果 随访的80例患儿中,有较轻后遗症者12例,有严重后遗症者13例,包括智力低下11例,运动障碍8例,双侧听力障碍4例,继发性癫痫4例,10例患儿合并有两种或以上严重后遗症,最常见为智力低下合并运动障碍。行为问题共检查48例患儿,有行为问题患儿17例。预后不良组和预后良好组在发热总时间>7天、入院后反复抽搐≥3次、昏迷(Glasgow昏迷评分<8分)、感染性休克、瞳孔异常、肢体活动障碍为出现预后不良的危险因素,两组比较差异有统计学意义(P＜ 0.05)。结论 本研究发现,化脓性脑膜炎患儿的后遗症表现多种多样,提示患儿应该进行系统的随访;同时,本研究还发现昏迷、感染性休克等临床症状是导致预后不良的危险因素。早期识别这些症状,并给予早期干预,将对患儿的预后有着重要意义。

Objective To investigate the types and incidence of common sequelae in children with bacterial meningitis.To investigate the risk factors for adverse outcome of childhood bacterial meningitis. Methods Selected 129 children with bacterial meningitis all cases were divided into adverse outcome group and favorable outcome group.According to the incidences of different kinds of sequelae,The risk factor effecting bad prognosis were studied. Results A total of 80 children were successfully followed.Of them,12 might only have mild sequelae and 13 had serious sequelaes.Among these children who had serious sequelae,11 of them had mental retardation,8 of them had motor deficit,4 of them had bilateral hearing loss and 4 of them had secondary epilepsy.10 children had multiple serious sequelae,thes most common multiple impairment combinations were mental retardation plus motor deficit.48 parents of the children completed the Child Behaviour Checklist and found out 17(35.42%)of their children had behavioral disorders.Adverse outcome group and favorable outcome group,the length of fever(>7 days),repeated convulsions after admission(≥3 times),coma(Glasgow coma scale score <8 points),septic shock,abnormal pupils,limb movement disorder.There were significantly difference between the two groups(P＜ 0.05). Conclusions This study showed that there are different kinds of sequelaes of children with bacterial meningitis,it indicated that these children should be follow-up to track the effect.On the other hand,this study found out that the high risk factors with adverse outcome might be coma,septic shock and so on.It indicated that if we could identify the high risk factors in the early stage and then interpose them immediately,it might beneficial to improve the quality of life of the children.

目的 研究地佐辛复合丙泊酚对腹式子宫切除术牵拉反应的预防作用。方法 选择择期行腹式子宫切除术患者60例(ASA I ~Ⅱ级),随机分成三组。所有患者给予腰麻,麻醉平面调节并固定于T₆后,给予A组患者0.1 mg/kg地佐辛,静脉注射;B组静脉注射0.1 mg/kg地佐辛后丙泊酚持续泵注2~4 mg/(kg·h);C组单次静注丙泊酚1.5 mg/kg后持续泵注2~4mg/(kg·h)。记录麻醉前(T₀)、腰麻平面固定后(T₁)、静注药物后5min(T₂)、切皮(T₃)、牵拉子宫时(T₄)、术毕(T₅)患者的HR、MAP及Ramesay镇静评分;评价肌松效果、牵拉反应、患者舒适度及满意度。结果 三组患者一般情况无差异(P＞0.05);与T₀相比,Ⅲ组T₂及T₅时刻MAP与T₀相比差异有统计学意义(P＜0.05),T₂、 T₃ 、T₄及T₅时刻HR与T₀相比差异有统计学意义(P＜0.05);与T₀相比,Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、 T₃及T₄时刻均升高,差异有统计学意义(P＜0.05);Ⅱ组及Ⅲ组Ramesay镇静评分在T₂、T₃及T₄时刻高于I组,差异有统计学意义(P＜0.05)。牵拉反应评价I组评为优的患者个数明显少于II组及III组,评为良及差的患者个数多于II组及III组,此差异有统计学意义(P＜0.05);II组及III组舒适度及满意度评定为优的患者个数明显多余I组,差异有统计学意义(P＜0.05)。结论 0.1 mg/kg地佐辛复合丙泊酚可以很好预防腹式子宫切除手术中的牵拉反应,提高患者舒适度和满意度。

Objective To observe whether dezocine combined with propofol can prevent intra operative dragging reaction during hysterectomy or not. Methods Sixty patients(ASAⅠ~Ⅱ)which through hysterectomy surgery were randomly arranged to 3 groups. All the patients were under spinal anesthesia, adjusted the anesthesia plane to T6. Group l: dezocine 0.1 mg/kg were intravenous injected, Group ll: dezocine 0.1 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h were intravenous pumped, Group lll: propofol 1.5 mg/kg were intravenous injected and then propofol 2~4 mg/kg/h intravenous were pumped. HR、MAP and Ramesay scale were recorded at the time points of pre-anesthesia(T₀)、pre-injection(T₁)、5 min after injection(T₂)、skin incision(T₃)、dragging uterus(T₄)、after surgery(T₅),the effect of muscle relaxation and the reaction of patients were recorded in the mean time, comfort degree and satisfaction degree of patients were evaluated after surgery. Results There was no significant difference of general condition between the three groups (P>0.05). At the time point of T₂ and T₅, MAP of Group lll patients were significant lower than the base value(P<0.05). At the time point of T₂、T₃、T₄ and T₅, HR of Group lll patients were significant lower then base value(P<0.05). Dragging reaction during the surgery were significant reduced in Group ll and Group lll but not in Group l(P<0.05). Group ll and Group lll patients felt more comfortable and more satisfied than Group l patients(P<0.05). Conclusion 0.1 mg/kg dezocine combined with propofol can prevent intra operative dragging reaction and make patient feel more comfortable during hysterectomy.

目的 回顾分析椎体成形术(PVP)对于治疗骨质疏松性新鲜椎体压缩骨折(OVCF)患者的疗效。方法 收集2011年1月—2012年6月新鲜OVCF患者伤后两周内行PVP术治疗共34例(51个椎体)。于术前1天、术后3天、1个月、3个月、6个月、12个月予VAS、ODI评分,并行X线检查以测量病椎前、中、后缘的高度和病椎cobb角。结果 纳入研究的34个病例中,患者术后各时间点随访中VAS和ODI评分均较术前1天明显改善(P<0.05)。术后各时间点随访中行X线检查时,术后各次随访中椎体前缘、中段、病椎cobb角均较术前有较为明显的矫正(P<0.05)。结论 应用PVP治疗新鲜OVCF疗效满意,可快速缓解疼痛、改善生活质量和矫正病椎后凸畸形。

Objective To study the efficiency and safety of percutaneous Vertebroplasty(PVP) for the fresh osteoporotic vertebral compression fractures(OVCF). Methods 34 patients (30 females and 4 males), mean age 75.8 years old(75.79±9.32, range 60 to 93 years old) hospitalized between January 2011 to June 2012 were reviewed retrospectively in this study. Evaluation at follow-up time point(1 day before PVP, 3rd day, 1st, 3rd, 6th, 12th month after PVP) included the pain score with VAS, mobility improvement with ODI and the measurement of anterior, middle and posterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra with X-ray image. Results For the 34 patients by followed up 1 year, the mean VAS score and ODI decreased significantly after PVP at any follow-up time compared with the 1 day before operation. Anterior and middle body height and the focal kyphotic angle at any follow-up time after PVP was improved statistically significant compared with the preoperative value(P<0.05). Conclusion Percutaneous vertebroplasty results in prompt pain relief, rapid rehabilitation and kyposis reduction, it is a safe and effective procedure for treating fresh osteoporotic vertebral compression fractures.

目的 调查住院患儿的营养风险及营养状况,探讨儿科营养风险筛查新方法的应用。方法 使用新的儿科营养风险筛查工具,对住院患儿进行营养风险筛查,根据体格测量评价儿童营养状况;与国外三种儿科营养风险筛查工具比较一致性。结果 402例住院患儿中高营养风险患儿占24.1%,营养不良的检出率为18.4%。有36.8%的患者接受营养支持,其中肠外营养支持率为23.1%,肠内营养支持率为16.7%,PN:EN为1.39:1。结论 对住院患儿采用新方法做营养风险筛查,能客观地反映住院患儿的营养风险,为临床营养支持提供依据。

Objective To investigate nutritional risk and the nutritional status in hospitalized children,and to validate the new screening tool of nutritional risk in hospitalized pediatric patients. Methods The nutritional risk of hospitalized pediatric patients was investigated using the new screening tool,and compared with other three pediatric nutritional risk screening tools;the nutritional status was assessed according to children physical measurement. Results Among 402 hospitalized children,children with high nutritional risk accounted for 24.1%.The overall prevalence of malnutrition was 18.4%.The proportion of patients receiving nutritional support was 36.8%.The rate of parenteral and enteral nutrition support was 23.1% and 16.7%,respectively.The ratio of parenteral nutrition to enteral nutrition was 1.39:1. Conclusion The new screening tool can reflect the possible nutritional risk in hospitalized pediatric patients objectively and provide the basis for clinical nutritional support.

目的 对颞下颌关节紊乱病患者的心理健康状况进行分类别的评估分析。方法 随机选择口腔科门诊就诊的颞下颌关节紊乱病患者88例为病例组,健康正常人92例为对照组,心理科抑郁患者92例及焦虑患者90例为心理疾病组,采用症状自评量表(SCL-90)量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)、艾森克人格问卷(EPQ)进行问卷调查,将量表调查结果分别归类整理后,使用统计软件SPSS13.0进行统计学分析。结果 TMD患者与正常对照组相比,在SCL-90、SAS、SDS评分中多项有统计学意义,在病例组中,多次患病和初次患病相比、高学历与低学历患者相比,在焦虑和抑郁上有统计学意义。颞下颌关节紊乱病患者与心理疾病患者相比,心理疾病患者在焦虑和抑郁上得分高于颞下颌关节紊乱病患者。结论 颞下颌关节紊乱病患者存在着不同程度的心理障碍,但远未达到心理疾病的程度,且颞下颌关节紊乱病患者中的不同群体心理状况也有所不同,这对于TMD患者心理上的疏导提供了一定的依据。

Objective To explore the research and analysis of temporomandibular disorder(TMD)patients' psychological states. Methods People diagnosed in the dental clinic were identified as target population.Totally, 88 patients with TMD were recruited as case control,whereas 92 normal people,92 patients with mental depression and 90 patients with dysphoria disorders were collected as control group.Questionnaire survey was carried out based on Symptom Checklist(SCL-90),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)and Eysenck Personality Questionnaire(EPQ). Correlations between TMD and psychological factors were assessed using the statistical methods. Results Compared with normal people,patients with TMD showed statistically significant diversity in SCL-90,SAS and SDS.In subgroup analysis of patients with TMD,patients with repeated disease history or advanced education degree presented significant variation in terms of depression and anxiety when compared with those with first diagnosed or lower education degree.Compared with patients with mental illnesses,patients with TMD showed significant lower score in depression and anxiety. Conclusion In TMD treatment we should not only adapt traditional physical therapy,medical therapy,corrective therapy and surgical treatment but also pay attention to psychological treatment to correct the patients' negative emotions,which may improve the symptoms and actively terminate disease process.

目的 氧化苦参碱对视网膜母细胞瘤细胞SM-106凋亡的诱导作用及机制。方法 以不同作用时间(24 h、48 h、72 h)和不同作用浓度(12.5 μl/mL、25 μl/mL、50 μl/mL、100 μl/mL)氧化苦参碱处理视网膜母细胞瘤细胞SM-106,分别采用流式细胞仪及western blot检测视网膜母细胞瘤细胞SM-106细胞凋亡及其凋亡因子(Bax、Bcl-2)蛋白表达。结果 氧化苦参碱可促进SM-106细胞体外凋亡,上调Bax蛋白表达及Bax/Bcl-2蛋白表达比值,下调Bcl-2蛋白表达,并呈现剂量及时间依赖性。结论 氧化苦参碱可诱导视网膜母细胞瘤细胞SM-106凋亡,调控凋亡因子Bax、Bcl-2的表达是其可能作用机制。

Objective To evaluate the apoptosis and its mechanism of retinoblastoma cells SM-106 induced by oxymatrine. Methods Retinoblastoma cells SM-106 were treated with different time(24 h、48 h、72 h)and different concentrations(12.5 μl/mL, 25 μl/mL, 50 μl/mL or 100 μl/mL) of oxymatrine. The apoptosis and protein expression of apoptosis factors (Bax and Bcl-2) were respectively determined by flow cytometry and western blot. Results Oxymatrine significantly promoted the SM-106 cells apoptosis in vitro, raised Bax protein expression and Bax/Bcl-2 protein expression ratio, reduced the Bcl-2 protein expression, and showed the dose and time dependent. Conclusion Oxymatrine is able to induce the apoptosis in retinoblastoma cells SM-106. Regulating apoptosis related gene Bax and Bcl-2 expression may be the mechanism of apoptosis.

目的 探讨延续性护理干预对癌痛患者服药依从性及疼痛治疗效果的影响。方法 选取105例住院治疗的中度至重度癌痛患者,均需服用阿片类药物止痛治疗,单日出院的患者(48例)设为对照组,双日出院的患者(57例)设为干预组。对照组在出院前由责任护士给予常规的用药指导;实验组则在此基础上,于出院后提供延续性护理干预,对患者每周进行电话回访1次,每个出院患者至少回访4次,比较两组患者出院4周后服药依从性及疼痛治疗效果的差异。结果 实验组服药依从性、疼痛治疗效果高于对照组(P＜0.05)。结论 延续性护理干预能提高出院癌痛患者服药依从性及疼痛治疗效果,改善患者的生存质量。

Objective To investigate the impact of continuing nursing on the medication compliance and effect of pain treatment in patients with cancer pain. Methods 105 cases of hospitalized patients with medium to severe cancer pain were selected,need to take opioid analgesic therapy,they were divided into the control group who were single-day discharged(n=48)and intervention group who were double-day discharged(n=57),when discharged,the control group was received conventional health education of medication by the specialized nurses;on this basis,the experimental group was received continuing nursing after discharge,the patients had a return visit by telephone once a week,each patient were visited 4 times at least. After 4 weeks,the medication compliance and effect of pain treatment in the two groups were compared. Results In the experimental group,the medication compliance of patients and effect of pain treatment were significantly higher than those of the control group(P＜0.05). Conclusion The continuing nursing intervention can significantly improve the medication compliance and effect of pain treatment for discharged patients with cancer pain,and improve the quality of life.

目的 比较腹腔镜阑尾切除术结合快速康外科(FTS)观念与传统开腹阑尾切除术的疗效差异。方法 回顾分析奉新县人民医院普通外科2001年2月—2003年4月和2010年7月—2013年6月收治的96例阑尾炎患者,随机分为两组,每组各48例,分别为传统开腹手术组(对照组)和腹腔镜阑尾切除术联合FTS组(实验组),检测术前1 d及术后第1 d、第3 d白细胞计数(White blood cell,,WBC)、C-反应蛋白(CRP)、白细胞介素-6(IL-6),同时比较两组术式的手术时间、住院时间、消化功能恢复时间及术后并发症的发生率。结果 实验组与对照组术后第1 d、第3 d外周血WBC、CRP、IL-6均显著高于术前,两组之间相比较差异有统计学意义(P＜0.05);实验组平均手术时间(62±18)min,对照组平均手术时间(55±21)min,两组相比差异无显著性(P＞0.05);实验组平均住院天数为(4.2±1.3)d,对照组平均住院天数为(7.6±1.5)d,两组相比差异有统计学意义(P＜0.05);实验组术后消化功能恢复时间为(23.3±9)h,对照组为(30.5±11)h,两组相比较差异有统计学意义(P＜0.05);实验组未出现术后并发症病例,对照组出现3例切口感染病例,2例粘连性肠梗阻病例,1例盆腔感染病例,两组手术并发症发生情况相比较差异有统计学意义(P＜0.05)。结论 腹腔镜阑尾切除术结合快速康复外科理念,可有效缩短病人住院天数及促进术后恢复,值得临床广泛应用。

Objective To compare laparoscopic appendectomy surgery combined with fast track surgery(FTS)concept and conventional open appendectomy difference in efficacy. Methods To retrospective analysis Fengxin country people's hospital of general surgery from February 2001 to April 2003 and July 2010 to June 2013,a total of 96 cases of appendicitis were randomly divided into two groups,each included 48 cases,namely conventional open appendectomy group(control group)and the laparoscopic appendectomy combined FTS group(experimental group). The changes of white blood cell count(White blood cell,WBC),C-reactive protein(CRP),interleukin-6(IL-6)were detected in the first day before surgery and the 1,3 day after surgery,while the surgical operative time,the length of hospital stay and digestive function recovery, surgical incision pain,and the rate of postoperative complications were compared between the two groups. Results The levels of WBC,CRP, IL-6 at day 1 and day 3 after surgery were significantly higher than before surgery,and there was significant difference between the experimental group and control group(P<0.05). The average operation time of the experimental group and the control group were respectively (62±18)min and (55±21)min,and there was no significant difference(P＞0.05). Meanwhile the average time of hospital stay and digestive function recovery were obviously shorter in the experimental group than in the control group(P＜0.05). There was no postoperative complications in experimental group. There were 3 cases of incision infection and 1 case of intestinal obstruction and 1 pelvic infection in control group. It showed significant difference between the two groups(P<0.05). Conclusion Laparoscopic Appendectomy Surgery combined with fast track surgery,which can effectively shorten patients average time of hospital stay,reduce postoperative complications and promote postoperative recovery. It is worthy in clinical use widely.

目的 探讨双侧声带麻痹治疗方式的选择与疗效。方法 回顾分析本院自2000年1月—2007年12月收治的双侧声带麻痹患者16例手术治疗资料与术后随访情况。结果 16例双侧声带麻痹的患者总共接受了29次手术治疗。4例鼻咽癌放疗后患者接受1次气管切开术,其他12例患者总共接受了25次手术治疗,平均每人2.1次。术式包括:气管切开术、神经肌蒂移植术、喉声带外移术、支撑喉镜CO₂激光声带手术及喉裂开单侧声带切除。结论 目前针对双侧声带麻痹的手术治疗有多种术式可供选择,临床医生应结合患者具体情况为患者提供个性化的治疗方案。

Objective To investigate the choice of surgical treatments for patients with bilateral vocal cord paralysis. Methods A retrospective analysis the operation and postoperative treatments in patients with bilateral vocal cord paralysis,from Jannuary 2000 to December 2007 in our hospital. Results A total of 29 operations were applied in 16 cases patients with bilateral vocal cord paralysis.Four cases of patients with nasopharyngeal carcinoma were received one time tracheotomy after radiotherapy.The others were received operation therapy for a total of 25 times.The average operation times in these groups was 2.1.Among them:Two patients were received one time operation,accounted for 16.7%(2/12);Five patients were received two times operation,accounted for 41.7%(5/12);Three patients were received three times operation,accounted for 25%(3/12);One patient was received four times operation,accounted for 6.3%(1/12).The surgical treatments included of tracheotomy,neuromuscular pedicle transplantation,lateral cordopexy,the laryngoscope vocal cord operation by CO₂ laser and laryngofissure unilateral vocal cord resection. Conclusion There have a variety of surgical options for bilateral vocal cord paralysis.Clinicians should provide individualized treatment plans for patients combined with their specific circumstances.

目的 探讨1~ 6个月婴儿母亲饮食结构以及婴儿喂养方式两者与湿疹发病的关系,并观察对进食敏感食物母亲进行饮食干预治疗婴儿湿疹的疗效。方法 采用问卷方式调查705例婴儿母亲饮食结构及其婴儿的喂养方式,根据婴儿喂养方式不同分为纯母乳喂养组和纯人工喂养组,对纯母乳喂养组根据母亲哺乳期饮食结构,分为进食大量敏感食物组和进食少量敏感食物组以及非敏感食物组,比较不同喂养方式以及母亲不同饮食结构婴儿湿疹的患病率以及不同组别湿疹发病的相关性分析;并对进食敏感食物组湿疹患儿的母亲进行饮食干预,观察治疗效果。结果 广州地区纯母乳喂养婴儿湿疹患病率高于纯人工喂养组(P＜0.05),母乳喂养组中母亲进食敏感食物发病率高于非敏感食物(P＜0.001),进食敏感食物与湿疹发病率呈正相关关系(r=0.36)。对进食敏感食物母亲进行饮食人工干预后,婴儿湿疹患病率下降(P＜0.001)。结论 母亲进食敏感食物可能是婴儿湿疹高发的原因,对母亲进行饮食干预可有效减少婴儿湿疹的发病。

Objective Infantile eczema are possibly related to the feeding patterns and mother's dietary structure.The study in this paper is to investigate the relationship between them and evaluate the effect of diet intervention in breast feeding mother whose baby with eczema. Methods Infants were divided into 2 groups according to their feeding patterns:simple artificial feeding group and simple breast feeding group.In the simple breast feeding group,mothers were also divided into 3 levels according to their dietary structure.Mothers who ate a lot of allergenic food a day might get a dietary intervention.Prevalence rate of eczema was investigated and analyzed in each step. Results Simple breast feeding group had a higher eczema morbidity than simple artificial group(P＜0.05).The more allergenic food the mother ate,the higher occurrence of eczema of their babies(P＜0.001),which showed a positive correlation(r=0.36).The occurrence of eczema dropped significantly compared to the non intervention group(P＜0.001). Conclusion Mothers who are eating allergenic food is considered to a risk for infant's eczema. Food intervention is an effective method to reduce the prevalence rate.

目的 探讨血浆凝血酶原时间(prothrombin time,PT)和血清蛋白(albumin,Alb)检测在腹内高压(IAH)患者中的临床意义。方法 选取IAH患者30例,另取30例健康者作为对照组,分别检测检验指标PT和ALB。PT检测应用凝固酶法,Alb检测应用溴甲酚绿法。结果 IAH患者组PT、PTR高于对照组,差异有统计学意义(P＜0.05),患者组PTA、Alb低于对照组,差异有统计学意义(P＜0.05)。结论 IAH可引起凝血功能障碍及蛋白丢失,PT和Alb的检测有助于了解IAH患者的病情。

Objective To detect the significance of plasma prothrombin time(PT)and serum albumin(Alb)in patients with intra-abdominal hypertension(IAH). Methods Selected 30 patients with IAH,another 30 healthy persons as control group,were dectected PT and ALB.Coagulase method was used to dectect PT,bromocresol green method was used to dectect ALB. Results PT and PTR in IAH group were significantly higher than those in control group,the difference was statistically significant(P＜0.05),PTA and ALB in IAH group were significantly lower than those in control group,the difference was statistically significant(P＜0.05). Conclusion IAH may cause coagulation dysfunction and loss of protein,detection of PT and Alb is helpful to the understanding of the disease in patients with IAH.

目的 通过开展QC活动降低PICU患儿补液外渗发生率。减轻患儿不适,强化护士主动服务的意识,提高护理质量,提升管理效果。方法 成立QC小组,按照PDCA循环法,调查PICU患儿补液外渗情况及存在问题,制定对策,组织实施,定期对效果进行评价、总结。结果 外渗发生率由活动前的15.48%下降至活动后的10.44%,严重外渗发生率由活动前的2.38%下降至活动后的0.55%,P<0.05,差异有统计学意义。结论 QC活动有效降低PICU患者补液外渗发生率。

Objective To conduct QC activities to reduce the incidence of fluid extravasation in PICU patients. Relieve discomfort in PICU patients,and strengthen the awareness of nurses active service,improve quality of care and management effectiveness. Methods Establishing QC circle,applying the method of PDCA cycle,investigating fluid extravasation in PICU patients,analyzing the main reasons for fluid extravasation,developing countermeasures,Implementing strategies,summarizing and evaluating the effects regularly.Comparing the incidence of fluid extravasation in PICU patients before and after the activity. Results After the activity,the incidence of fluid extravasation decreased from 15.48% to10.44%,the incidence of severe fluid extravasation decreased from 2.38% to 0.55%,P<0.05,the difference was statistically significant. Conclusion The QC activity effectivelycan reduce the incidence of severe fluid extravasation in PICU patients.

目的 通过B超检查,掌握九龙镇农村已婚育龄妇女常见病的患病情况,总结和分析B超在普查中的应用价值。方法 对自愿参加普查的2775名20~59岁九龙镇育龄妇女进行子宫、附件的常规B超检查,对检出的妇科疾病进行统计分析。结果 在普查中检出多种妇科疾病,前三位的是子宫肌瘤、宫颈囊肿及附件包块;年龄段分布情况中,40~49岁居首位、30~39岁次之。结论 定期对农村育龄妇女进行B超普查是早期发现、早期诊断妇科病最简便、最有效的检查方法,在临床中具有重要的应用价值。

目的 观察真武四物汤足浴治疗阳虚血瘀型慢性心力衰竭(CHF)的临床疗效。方法 72例心功能Ⅱ-Ⅲ患者按随机数字表法分为治疗组(36例)和对照组(36例),对照组给予心衰常规治疗。治疗组在心衰常规治疗基础上加用真武四物汤足浴,每次30分钟,每日2次,共治疗4周。观察治疗后6 min步行距离改善情况。结果 治疗组心功能和中医症候总有效率分别为88.89%和94.44%,对照组总有效率分别为69.44%和66.67%,两组比较差异(P＜0.01或P＜0.05);两组治疗前后6 min步行距离比较差异(P＜0.05);两组治疗后6 min步行距离比较差异有统计学意义(P＜0.01)。结论 在常规治疗的基础上联合真武四物汤足浴,可以改善阳虚血瘀型慢性心力衰竭患者的临床症状,提高运动耐量,促进心力衰竭患者的康复。

目的 比较榄香稀和顺铂胸腔灌注治疗肺癌恶性胸腔积液的疗效。方法 肺癌合并恶性胸腔积液患者56例,榄香稀组29例:胸腔内注射榄香烯400 mg+地塞米松10 mg+2%普鲁卡因10 mL;顺铂组27例:顺铂80 mg+地塞米松10 mg。每周1次,治疗4周。同时记录不良反应。结果 56例均可评价疗效,榄香稀组完全缓解11例,部分缓解14例,有效率86.2%。顺铂组完全缓解6例,部分缓解10例,有效率59.3%,差异有统计学意义,榄香稀组生活质量较顺铂组改善。结论 榄香稀治疗恶性胸腔积液疗效好,可提高生活质量,毒副反应小。

目的 总结分析青光眼术后前房形成延缓的原因与处理措施。方法 选取2010年12月—2013年12月在我院行青光眼滤过术的84例患者(112眼),回顾性分析术后发生浅前房的原因及相应处理措施。结果 术后出现浅前房为26眼,占23.2%;其中高滤过泡引流过畅18眼(69.2%),结膜伤口渗漏5眼(19.2%),脉络膜脱离2眼(7.6%),恶性青光眼1眼(3.8%),大多数浅前房均经保守治疗恢复,1例需行再次手术。结论 青光眼术后前房延缓形成发生率较高,主要原因是脉络膜脱离、滤过作用强、结膜伤口渗漏、恶性青光眼等,及时发现并采取相应处理是浅前房恢复正常的关键。

目的 探讨影响机采双份血小板质量的因素,以提高机采血小板的制品质量。方法 收集本站2014年3月—9月机采双份血小板献血者资料,观察分析其一般情况,血细胞分离机运行参数及采前血常规对血小板采集质量的影响。结果 采集前血小板计数是影响机采双份血小板质量的重要因素,与血小板采集量成正相关(P<0.05)。而血小板平均体积、血小板体积分布宽度、大血小板比率则与血小板采集量成负相关(P<0.05)。结论 需正确分析献血者采前血常规,作出最优选择,保证机采双份血小板质量。

目的 探察老年冠心病无痛性心肌缺血的临床护理效果。方法 选取我院冠心病患者68例,按照护理方式的不同分为观察组与对照组,每组34例;对照组患者给予常规护理,观察组在对照组的基础上给予患者优质的临床护理;观察两组患者的临床护理效果。结果 临床护理后,两组患者的症状均有缓解,但观察组患者心肌缺血的发作次数、发作时间、ST段压低减少的次数及下移减少量显著优于对照组,结果差异有统计学意义(P＜0.05)。结论 对老年冠心病无痛性心肌缺血患者采用针对性合适的临床护理,缓解了患者的临床症状,减少了心肌缺血的发作次数,改善了患者的并发症,效果显著,值得推广。

目的 探讨青少年过敏性鼻炎与血清维生素D水平的相关性。方法 收集2012年4月—2014年4月经本院耳鼻喉科确诊的青少年过敏性鼻炎(AR)患者368例,为实验组;另选择同期本院健康体检者370例,为对照组。分别使用串联质谱仪检测其血清总维生素D、维生素D₂及维生素D₃浓度。结果 实验组中血清总维生素D、维生素D₂及维生的素D₃的检测结果分别为:20.92±3.35 ng/ml、3.64±0.82 ng/ml、18.83±3.62 ng/ml;对照组中血清总维生素D、维生素D₂及维生的素D₃的检测结果分别为:31.45±2.86 ng/ml、3.85±0.58 ng/ml、28.97±3.18 ng/ml;检测结果显示实验组与对照组总维生素D及维生素D₃水平均存在差异(P＜0.05),具有统计学意义,维生素D₂水平无差异(P＞0.05)。结论 青少年过敏性鼻炎血清维生素D水平比正常人群偏低,且以维生素D₃水平偏低为主,为临床诊治过敏性鼻炎患者提供重要依据。

目的 观察采用桂枝茯苓汤联合甲氨蝶呤治疗异位妊娠的效果。方法 纳入90例异位妊娠患者,随机分为3组各30例,A组服用甲氨蝶呤,B组服用桂枝茯苓汤,C组采用桂枝茯苓汤联合甲氨蝶呤治疗,观察3组的治疗效果及附件包块变化情况。结果 3组治愈率整体比较,差异有统计学意义(P<0.05)。C组的治愈率与A组、B组分别比较,差异均有统计学意义(P<0.05)。3组附件包块治疗有效率整体比较,差异有统计学意义(P<0.05)。C组的有效率与A组、B组分别比较,差异均有统计学意义(P<0.05)。结论 桂枝茯苓汤联合甲氨蝶呤治疗异位妊娠,在降低β-HCG、症状改善、缩小包块方面均有较好效果,且副反应少、经济、方便。

目的 研究低视力儿童“学校-社区-家庭”三位一体综合康复干预工作的具体效果。方法 2013年1月,选择广州市盲人学校新入学80名低视力儿童,随机分为两组,为期二年的跟踪研究。其中A组执行“学校-社区-家庭”三位一体综合康复干预,B组执行传统康复干预。就知识积累、心理健康、生活能力三个方面对两组儿童的具体数据收集,研究“学校-社区-家庭”三位一体综合康复干预与传统干预方式之间的区别。结果 A组低视力儿童较B组儿童的文化知识积累与生活能力训练成绩均有提高,两者差距在正常分布带内,A组低视力儿童的心理素质优于B组低视力儿童。A组低视力儿童的综合评价效果高于B组儿童。结论 低视力儿童“学校-社区-家庭”三位一体综合康复干预工作的具体效果优于传统康复干预方式。

目的 调查分析病案首页疾病诊断存在的问题,以提出针对性的干预对策。方法 由病案科编码员根据《卫生部关于修订下发住院病案首页的通知》相关规定,对抽取的4200份病案首页的疾病诊断进行检查,对疾病诊断问题分类记录,同时对其发生原因进行问卷调查,建立相应数据库,应用Excel统计工具进行统计分析。结果 共748份的疾病诊断存在问题,发生率高达17.8%,包括疾病诊断中主要诊断选择错误8.3%、疾病诊断的名称不规范7.6%,以及漏诊问题1.8%。疾病诊断存在问题发生率较高的临床科室为内分泌科38.0%,骨科科32.8%,肿瘤科31.6%。在读研究生最容易出现疾病诊断问题,发生率高达48.0%。结论 对疾病诊断存在问题的高发临床医师群体和临床科室进行针对性干预对策,有望降低病案首页疾病诊断问题的发生率。

Objective To investigate the defects analysis and targeted intervention on the diseases diagnosis in the home pages of medical records. Methods To conduct an inspection analysis on the four thousand and two hundred medical records according to the related requirements of “Notification on Standard writing in Home Pages of Hospitalization Medical Records announced by the Ministry of Health” by professional medical records staff.They found out and classified the defects on the diseases diagnosis in the home pages of medical records,at the same time,questionnaire survey were carried on to investigate the related causes,and the corresponding database establish ed.Excel statistical tools were applied for statistical analysis. Results There were defects on the diseases diagnosis in a total of seven hundred and forty-eight cases,the incidence of which was 17.8%,including 8.3% of mistakes of main diagnosis,7.6% of lack of standardization in diagnosis names,1.8% of missed diagnosis respectively.Defects on the diseases diagnosis occurred in a higher rate in the clinical departments,such as department of endocrine with 38.0%,department of orthopedics with 32.8%,and department of oncology with 31.6%.Graduate students most prone to make mistakes with defects on the diseases diagnosis,the incidence of which was 48.0%. Conclusion Targeted interventions to clinician groups and clinical departments with high incidence of defects on the diseases diagnosis,is expected to reduce the incidence of which in the home pages of medical records.

目的 “看病难”这个与社会民生密切相关的难题,长期困扰广大民众。主要表现在看病流程复杂,挂号、候诊排队时间长,就诊指引不清晰,服务水平低。移动互联网时代,各个传统行业都在转变运营模式,医院应如何因势利导,寻求“破冰”良策。本文结合佛山市中医院的应用案例,对利用微信公众号^[1]改造现有业务流程,有效解决“看病难”问题进行讨论分析。

The problem “proper health care is difficult to get” is closely related to the people's livelihood,which has plagued the people for a long period of time.The difficulties mainly focused on the complex process,long-time waiting,unclear instruction and the low level of service.In the time of mobile internet,each traditional industry is shifting the operation mode.What the hospital should do to is to make the best use of the advantages to solve the problems.The purpose of the research is to optimize the current processes and to solve the problem of “Proper health care is difficult to get” by using Wechat public number combined with the cases in Foshan hospital of traditional Chinese medicine.

目的 探索外科硕士研究生医患沟通培养教育方法。方法 通过对56位外科硕士研究生的医患沟通培养实践,研究医患沟通教育的培养模式和评估方法。结果 通过课程培养,56位外科硕士研究生有92.8%的外科硕士研究生认为课程“有很大帮助”;培养前后对“信息采集”、“尊重隐私”、“语言艺术”、“情感沟通”、“诊疗作用”等方面认知有差异(P＜0.05),而在“专业知识”方面培养前后无差异(P＞0.05)。结论 应当在外科硕士研究生中建立医患沟通培养课程和相应的评估体系。

Objective To explore graduates training and education methods of communicating between doctors and patients in surgery department. Methods 56 graduates of surgery were trained for communicating between doctors and patients as special education practice.Experiences of the training were summed up to identify educational methods for graduates. Results After the end of the training programs,52 graduates,92.8% of 56,considered the training “great help”. Around the training of “Information Gathering”,“Respect for Privacy”,“Language Arts”,“Emotional Communication”,“Treatment Effects ” cognition of the graduates were significantly different from the beginning(P＜0.05),while in the “Professional Knowledge” no significant difference(P＞0.05). Conclusion Patient communication training courses and the corresponding evaluation system should be established.

目的 探索在神经外科护理教学中使用周期目标教学模式对学生理论知识、护理技能的作用与意义。方法 采用统一标准百分制操作与理论考核,比较周期目标教学模式和一对一带教模式下护理学生护理理论与技能掌握、应用的差异。结果 实验组学生理论考核和操作考核成绩比一对一带教学生成绩高。结论 周期目标教学模式使学生的实习思路清晰,提高了学生实习的积极主动性;实习目标明确,促进了护生在专科技能操作上的提高。对提高我科护理教学质量起到积极的促进作用。

目的 探讨脉管炎围手术期出现焦虑症状及影响因素和护理以提高在围手术期的生活质量。方法 通过对脉管炎患者进行问卷调查焦虑发生及影响因素。结果 脉管炎围手术期患者出现焦虑是十分常见的,生活质量下降直接或间接影响手术的成功率。结论 有效的护理干预能改善各方面的焦虑因素,使患者在围手术期保持心情舒畅,从而适应截肢形象的改变,提高生活质量。