The clinical values of ultra-early enteral nutrition combined with microecopharmaceutics on patients with severe acute pancreatitis北大核心CSCD

Objective: To analyze the clinical values of super early enteral nutrition combined with microecopharmaceutics and delayed enteral nutrition on patients with severe acute pancreatitis. Methods: Clinical data of thirty patients diagnosed as severe acute pancreatitis in our emergency department during January 2013 and December 2017 were reviewed retrospectively. Patients were divided into the treatment group (n=l5, patients given enteral nutrition combined with microecopharmaceutics within 24 h after admission) and the control group (n=15, patients given delayed enteral nutrition after 48 h of admission). Two weeks after the treatment, the serum variables of C-reactive protein, total protein, albumin, recovery time of urine and blood amylase, length of hospital stay and APACHE II score were compared between the two groups by using paired samples t test. Results: The C-reactive protein [(46.7 ± 13.1) mg/L vs. (190.72 ± 19.3) mg/L, t=10.4, P<0.01] and APACHE II score [(7.2 ± 1.9) vs. (9.3 ± 2.4), t=2.7, P<0.05] of the treatment group were significantly lower than those in the control group. The total protein [(58.1 ± 6.3)g/L vs. (52.6 ± 5.4) g/L, t=2.5, P<0.05] and albumin [(29.9 ± 3.2)g/L vs. (22.0 ± 2.8) g/L, t=7.12, P<0.01] of the treatment group were significantly higher than those in the control group. The recovery time of urine amylase [(13.2 ± 2.1)d vs. (18.7 ± 3.9)d, t=4.9, P<0.01] and blood amylase [(7.5±3.0)d vs. (11.1 ±3.4) d, r=3.1, P<0.01], and length of hospital stay[(14.9±4.5)d vs. (27.1 ± 5.3) d, t=6.9, P<0.01] were significantly shorter in the treatment group compared with those in the control group. Conclusions: Ultra-early enteral nutrition combined with microecopharmaceutics can shorten the length of hospital stay of patients with severe acute pancreatitis, and is safe and effective. © 2018 Chinese Medical Association. All rights reserved.     

肌电生物反馈疗法对脑梗死患者记忆功能影响的研究

目的 探讨肌电生物反馈疗法对脑梗死患者记忆功能改善的有效性.方法 脑梗死患者120例,分为研究组60例和对照组60例,均给予常规药物治疗,研究组增加肌电生物反馈疗法.治疗前后均采用临床记忆量表、简易精神状态检查法检测.结果 经1个月治疗后,研究组指向记忆、图形再认、人像回忆、MQ数字广度(顺背)、数字广度(倒背)均比治疗前升高(17.88±4.24)分vs(20.91±6.07)分、(14.87±6.22)分vs(17.16±4.24)分、(19.16±5.32)分vs(23.98±5.26)分、(89.68±13.43)分vs(101.48±11.22)分、(4.95±1.95)分vs(6.80±1.52)分、(3.20±1.95)分vs(4.85±1.28)分(均P<0.05),视觉最快反应时间、视觉最慢反应时间、听觉最慢反应时间、缺失记忆均比治疗前减少(359±65)ms vs(248±45)ms、(2 190±228)ms vs(1 040±227)ms、(3 152±698)ms vs(2 515±449)ms、(5.27±2.12)个vs(4.30±1.86)个(均P<0.05);两组治疗后比较,研究组指向记忆、图形再认、人像回忆、MQ值、数字广度值均比对照组升高(均P<0.05),视觉最快反应时间、视觉最慢反应时间、听觉最慢反应时间、缺失记忆均比对照组减少(均P<0.05).结论 肌电生物反馈疗法结合常规药物治疗可以改善脑梗死患者的记忆功能.

Abstract：

Objective To study the efficacy of electromyographic biofeedback therapy for rehabilitation of the memorial function of patients with cerebral infarction. Methods 120 patients with cerebral infarction were assigned to the study group (60 cases) and the control group (60 cases). Both control group and study group received drug therapy,but the study group received electromyographic biofeedback therapy besides. Both groups were assessed with the clinic memory scale,mimi-mental state examination. Results After treatment for one month, point memory, graph recognition, portrait recall, MQ grade, number extent (direct recitation) ,number extent (antidromic recitation) of the study group were higher than those before treatment, (17.88±4.24) scores vs (20. 91+6. 07) scores, (14.87±6.22) scores vs (17.16±4.24) scores, (19.16±5. 32) scores vs (23. 98± 5. 26) scores, (89. 68±13.43) scores vs (101.48±11.22) scores , (4. 95±1.95) scores vs (6.80±1.52) scores, (3.20 ± 1.95) scores vs (4. 85± 1.28) scores(P <0.05),the fastest vision reaction time, the slowest vision reaction time, the slowest hearing reaction time, absence memory of the study group were lower than those before treatment,(359±65) ms vs (248±45) ms, (2 190±228) ms vs (1 040±227) ms, (3 152± 698) ms vs (2 515 ±449) ms, (5.27 ± 2.12) numbers vs (4.30 ± 1.86) numbers(all P < 0. 05); After treatment, point memory,graph recognition, portrait recall, MQ grade, number extent of the study group were higher than those in the control group (all P <0.05), the fastest vision reaction time, the slowest vision reaction time,the slowest hearing reaction time, absence memory of the study group were lower than those in the control group(all P <0. 05). Conehusion Electromyographic biofeedback therapy in combination with routine drug therapy could obviously improve the memorial function of patients with cerebral infarction.     

Effect of low-dose glucocorticoid on corticosteroid insufficient patients with acute exacerbation of chronic obstructive pulmonary disease

BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insuffi ciency(CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit(ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group(n=32) and a control group(n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone(150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers ofinfl ammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value 0.05 was considered statistically signifi cant.RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4%. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI(23.8% vs. 8.7%, P0.01). KaplanMeier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group(P0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group(18.2±9.5 vs. 25.8±4.1, P0.05). Treatment with low-dose glucocorticoid obviously decreased the markers ofinfection and inflammation(P0.01), such as C-reactive protein(13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α(26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin(3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group(P0.01).CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers ofinfection and infl ammation.     

腹腔镜与开腹脾切除术治疗特发性血小板减少性紫癜的护理

Objective To compare the similarities and the differences of nursing care on patients with idiopathic thrombocytopenic purpura. Underwent laparoscope splenectomy and open splenectomy. Methods A total of 122 cases admitted from October 1996 to September 2008 were selected and investigated prospectively.Among them, 72 cases were underwent laparoscope spleneetomy, the other 50 cases were accepted open splenectomy. Indexes of the recovery after operation were compared. Results The mean operation time was longer in the laparoscopic splenectomy group than that in the open group ( 135.3 min vs 108.5 min,P ＜0. 05).The laparoscopic group decreased more significantly than the open group in blood loss ( 110 ml vs 185 ml),abdominal drainage volume ( 100 ml vs 230 ml), the off-bed ambulation time(26. 2 h vs 46.9 h), the anal aerofluxus time(28.9 h vs 68. 1 h) ,food intake time(32. 2 h vs 72.3 h), and post operative hospitalization (8.5 d vs 15. 1 d). Postoperative pain was significantly less in LS group ( P ＜ 0. 05 ). There were no differences in postoperative complication, treatment effectiveness and temperature between two groups (P ＞ 0. 05 ).Conclusions Laparoscope splenectomy, whereas of less traumatic and low morbidity, results in comparable effects as open splenectomy for the treatment of idiopathic thrombocytopenic purpura.. It has important significance to know both similarities and differences of clinical nursing care for patients undergoing the two ways of splenectomy, in order to enhance the nursing quality for peri-operative patients with splenectomy via laparoscope and promote their postoperative rehabilitation.     

腹腔镜与开腹脾切除术治疗特发性血小板减少性紫癜的护理

Objective To compare the similarities and the differences of nursing care on patients with idiopathic thrombocytopenic purpura. Underwent laparoscope splenectomy and open splenectomy. Methods A total of 122 cases admitted from October 1996 to September 2008 were selected and investigated prospectively.Among them, 72 cases were underwent laparoscope spleneetomy, the other 50 cases were accepted open splenectomy. Indexes of the recovery after operation were compared. Results The mean operation time was longer in the laparoscopic splenectomy group than that in the open group ( 135.3 min vs 108.5 min,P ＜0. 05).The laparoscopic group decreased more significantly than the open group in blood loss ( 110 ml vs 185 ml),abdominal drainage volume ( 100 ml vs 230 ml), the off-bed ambulation time(26. 2 h vs 46.9 h), the anal aerofluxus time(28.9 h vs 68. 1 h) ,food intake time(32. 2 h vs 72.3 h), and post operative hospitalization (8.5 d vs 15. 1 d). Postoperative pain was significantly less in LS group ( P ＜ 0. 05 ). There were no differences in postoperative complication, treatment effectiveness and temperature between two groups (P ＞ 0. 05 ).Conclusions Laparoscope splenectomy, whereas of less traumatic and low morbidity, results in comparable effects as open splenectomy for the treatment of idiopathic thrombocytopenic purpura.. It has important significance to know both similarities and differences of clinical nursing care for patients undergoing the two ways of splenectomy, in order to enhance the nursing quality for peri-operative patients with splenectomy via laparoscope and promote their postoperative rehabilitation.     

连续性血液净化治疗对严重脓毒症患者内皮细胞功能的影响

目的 观察连续性血液净化(CBP)对严重脓毒症患者的治疗作用,探讨CBP对严重脓毒症患者内皮细胞功能的影响.方法 按随机原则将严重脓毒症患者分为常规对照组22例,联合CBP组23例.两组患者均按照2008年脓毒症全球治疗指南常规治疗,联合CBP组同时行连续性静-静脉血液滤过(CVVH),置换液量为40 ml·kg-1·h-1,治疗72 h.分别于治疗前及治疗24 h、72 h(治疗终止10 min)行动脉血气分析,测定血浆活化蛋白C(APC)、可溶性细胞间黏附分子-1(sICAM-1)及血管性血友病因子(vWF)含量,并观察患者重症监护病房(ICU)住院时间、机械通气时间及28 d病死率.结果 联合CBP组患者ICU住院时间(d)及机械通气时间(d)均明显短于常规对照组(9.12±3.07比11.64±4.82;5.52±3.48比8.02±5.25,均P<0.05);28 d病死率明显低于常规对照组[13.0%(3/23)比40.9%(9/22),P<0.05].治疗72 h后,两组急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分(分)均明显下降,且联合CBP组下降程度优于常规对照组(3.96±4.07比1.68±2.43,P<0.05).常规对照组治疗前后APC、sICAM-1及vWF均无明显变化.联合CBP组APC在治疗72 h出现增高,sICAM-1在治疗24 h后、vWF在治疗72 h均较治疗前明显下降,且72 h时APC(μg/L)和vWF(mg/L)与常规对照组比较差异有统计学意义(15.12±7.57比10.01±5.83;1.58±0.73比2.64±1.34,P<0.05和P<0.01).所有死亡患者(12例)治疗前后APC、sICAM-1及vWF均无明显变化.存活组患者(33例)治疗72 h APC浓度(μg/L)较治疗前升高(13.55±7.11比10.37±7.60,P<0.01);sICAM-1(μg/L)及vWF(mg/L)均低于死亡组患者(61.03±45.58比104.64±71.08;1.88±1.21比2.70±0.95,均P<0.05).结论 CBP治疗能改善严重脓毒症患者受损的内皮细胞功能,减轻病情的严重程度,改善预后.

Abstract：

Objective To investigate the effect of continuous blood purification (CBP) in patients with severe sepsis, and to evaluate the change in endothelial cell function in patients with severe sepsis during CBP therapy. Methods According to random principle, 45 patients were divided into control group (n=22) and CBP group (n=23). All patients of both groups received routine treatment according to international guidelines 2008 for management of severe sepsis, but the patients in the CBP group also received continuous veno-venous hemofiltration (CVVH) for 72 hours, the ultrafiltrate volume was 40 ml·kg-1·h-1. Blood gas analysis was done before and 24 hours and 72 hours after CVVH therapy. The activated protein C (APC), soluble intercellular adhesion molecule-1 (sICAM-1) and von Willebrand factor (vWF) were measured. Also the length of stay in intensive care unit (ICU), time of mechanical ventilation, and death rate of patients in 28 days were observed. Results Compared with control group, the length of stay in ICU (days) and length of use of ventilator (days) in CBP group were shorter (9.12±3.07 vs. 11.64±4.82, 5.52±3.48 vs. 8.02±5.25, both P<0.05), and the death rate in 28 days was lower [13.0% (3/23) vs. 40.9% (9/22), P<0.05]. After therapy, patients in CBP group showed more reduction in the APACHEⅡ score compared with control group (3.96±4.07 vs. 1.68±2.43, P<0.05). Patients in control group showed less change in APC, sICAM-1 and vWF. APC in CBP group increased at 72 hours, and sICAM-1 and vWF of CBP group respectively decreased at 24 hours or 72 hours, while the APC (μg/L) and vWF (mg/L) at 72 hours showed significant change compared with that of the control group (15.12±7.57 vs. 10.01±5.83, 1.58±0.73 vs. 2.64±1.34, P<0.05 and P<0.01). In patients who died in 28 days (12 patients) there were little changes in APC, sICAM-1 and vWF, while patients who lived for 28 days (33 patients), showed significantly more reduction in sICAM-1 (μg/L) and vWF (mg/L, 61.03±45.58 vs. 104.64±71.08, 1.88±1.21 vs. 2.70±0.95, both P<0.05). The APC value (μg/L) was increased after treatment in patients who survived for 28 days (13.55±7.11 vs. 10.37±7.60, P<0.01). Conclusion CBP therapy can protect endothelial cell function and ameliorate dysfunction, and it reduces the severity of the severe sepsis as well as improves the outcome of patients with severe sepsis.     

血必净与低分子肝素对严重脓毒症患者凝血功能及预后的影响

Objective To compare between the impact of Xuebijing injectio (a Chinese herbal medicine preparation) and that of low molecular weight heparin (LMWH) on coagulation function and prognosis in patients with severe sepsis, so as to guide the treatment of sepsis. Method A total of 89 patients with severe sepsis were randomly(random number) divided into 3 groups, namely Xuebijing group (group A),LMWH group (group B) and routine group (group C). The patients of group C received a series of remedies according to the guideline for severe sepsis. The patients of group A were treated with Xuebijing injectio in addition to routine treatment. The patients of group B were treated with LMWH along with routine treatment.Data of blood coagulation function tests and APACHE Ⅱ score of patients in three groups before and after treatment were analyzed respectively. The 28-day mortality and length of hospital stay were compared among three groups. All data were analyzed by using t-test, Analysis of Variance, q-test, x2-test and rank sum treatment, all markers of the blood coagulation function tests in group A improved significantly after treatment (P＜0.01), while only some markers of the blood coagulation function tests improved in the other two groups ( P ＜ 0. 05 or P ＜ 0. 01 ); After treatment, the blood coagulation function in group A improved significantly more than that in other two groups ( P ＜ 0.05 ), while there were some markers of the blood coagulawith the data before treatment, the APACHE Ⅱ score in group A and group B decreased after treatment (P＜0.05). After treatment, the APACHE Ⅱ score of group A and group B decreased significantly more than that of group C ( P ＜ 0.05). But there was no significant difference between group A and group B ( P ＞Xuebijing obviously improves the blood coagulation function in patients with severe sepsis, while LMWH only improves some markers of the coagulation function tests. Both Xuebijing and LMWH reduce mortality and improve prognosis of patients with sepsis.     

血小板活化与炎症反应在高血压患者中的改变及其相关性研究

目的 探讨高血压患者血小板活化与炎症反应的改变及其相关性.方法 选择61例原发性高血压患者(高血压组)和64例阵发性室上性心动过速患者(对照组),测定其血清超敏C-反应蛋白(hs-CRP)及平均血小板体积.结果 高血压组患者血清hs-CRP浓度[(3.51±1.95)mg/L]明显高于对照组[(1.15±0.77)mg/L],差异有统计学意义(P＜0.05),平均血小板体积大于对照组[分别为(11.19±2.18)fl与(9.20±2.31)fl],差异有统计学意义(P＜0.05),两者之间呈线性相关(r=0.452,P=0.003).结论 高血压患者存在炎症反应及血小板活化,作为炎症反应及血小板活化的两个观察指标,两者相互作用具有相关性,与高血压的发生发展有密切关系.

Abstract：

Objective To investigate the changes and correlation between platelet activation and inflammatory response in patients with essential hypertension(EH). Methods Sixty-one patients with essential hypertension and sixty-four patients with paroxysmal supraventricular tachycardia as control group were enrolled in the study. The levels of high sensitivity C reactive protein ( hs-CRP ) and mean platelet volume ( MPV ) were measured and compared between the control group and the essential hypertension group. Results Compared with the control group,the levels of hs-CRP and MPV in the EH group were significantly higher( [3.51 ± 1.95]mg/L vs [ 1.15 ± 0. 77 ] mg/L, P ＜ 0. 05 ). The MPV in the EH group was significantly higher than that in the control group ( [ 11.29 ± 2. 18 ] flvs [ 9. 20 ± 2. 31 ] fl, P ＜ 0. 05 ). The level of hs-CRP positively correlated to the level of M PV (r = 0. 452, P = 0. 003 ). Conlusions There were inflammatory response and platelet activation in patients with EH and the serum levels of hs-CRP and MPV is correlated with the development of essential hypertension.     

Evaluation of diaphragmatic dysfunction after surgical treatment of type A aortic dissection by ultrasound: Incidence,risk factors and influence on outcomes北大核心CSCD

Objective: To study the incidence, possible risk factors, and influence on patient outcomes of diaphragmatic dysfunction in patients after surgical treatment of type A aortic dissection using ultrasound. Methods: Patients who received replacement of hemiarch or total arch with concomitant procedures concerning aortic pathology, and an elephant trunk procedure for the descending aorta were prospectively enrolled in this study from February to May 2017. After surgery, they were transferred to the cardiac surgical intensive care unit. They were divided into two groups based on diaphragmatic excursion: diaphragmatic dysfunction (DD) group and diaphragmatic function normal (DN) grouBilateral diaphragmatic excursions were evaluated using ultrasound during spontaneous breathing trial by T-tube. The differences in demographic characteristics, operation-related variables and outcomes were compared between the two groups. Results: A total of 42 patients were enrolled in this study, and 32 of them suffered from diaphragmatic dysfunctions. Compared with DN group, the excursion of the influenced diaphragm in DD group was significantly reduced[(0.450 ± 0.331)cm vs. (1.801 ± 0.616)cm, P<0.01], while the excursion of the non-influenced diaphragm was not reduced[(2.013±0.655)cm vs. (1.801±0.616) cm, P=0.254]. Diaphragmatic thickness was comparable [(0.184±0.028)cm vs. (0.189±0.028)cm, P=0.559] between the two groups while thickening fraction was significantly reduced in DD group[(4.67%±3.63)% vs. (23.58%±10.69)%, P<0.01]. Meanwhile, respiratory rate was significantly higher in DD group as compared to DN group [(24.13 ± 4.98)times/min vs. (20.50 ± 3.17)times/min, P=0.037]. Patients in DD group showed longer cross-clamp duration[(121.78±27.75)min vs. (93.10±18.84)min, P=0.004] and longer cardiopulmonary bypass duration [(208.09±32.78)min vs. (182.70±24.38)min, P=0.03] than patients in DN grouFurthermore, binary logistic analysis indicated that longer cross-clamp duration was the potential risk factor for diaphragmatic dysfunction after type A aortic dissection surgery. Mechanical ventilation duration was longer in DD group than in DN group (88 h vs. 37 h, P=0.194) but without statistical significance. The usage of noninvasive ventilation was significantly increased in DD group as compared to DN group (46.88% vs. 10%, P=0.036). Other outcomes such as post-operative complications, mortality, ICU length of stay were comparable between the two groups. Conclusions: Diaphragmatic dysfunction was very common after surgical treatment of type A aortic dissection. Longer duration of cross-clamp was considered as a potential risk factor of diaphragmatic dysfunction. A sequential management of noninvasive ventilation after extubation was feasible for diaphragmatic dysfunction after surgical treatment of type A aortic dissection. © 2018 Chinese Medical Association. All rights reserved.     

念珠菌抗原金标法检测聚维酮碘辅助治疗外阴阴道假丝酵母菌病效果的临床价值

目的探讨金标免疫层析检测技术（GICA）检测聚维酮碘辅助治疗外阴阴道假丝酵母菌病的临床价值。方法将96例VVC患者分为治疗组（n=48）和对照组（n=48）。治疗组患者予氟康唑口服、硝呋太尔制霉菌素及聚维酮碘外用;对照组患者予氟康唑口服、硝呋太尔制霉菌素阴道软胶囊外用,而不用聚维酮碘。采用GICA比较2组的治疗效果。结果 GICA较显微镜检查及临床症状评价有较高的符合率。治疗组和对照组患者的总有效率分别为97.92%、91.66%,复发率分别为4.16%、20.83%,二者差异均有统计学意义（P〈0.05）。结论聚维酮碘在VVC治疗中具有较好的辅助治疗作用,GICA较显微镜检查更为准确。     

阴道固有免疫因子TLR4和HD5与复发性外阴阴道假丝酵母菌病的相关性研究

目的通过对阴道局部固有免疫特点的研究,探讨复发性外阴阴道假丝酵母菌病(RVVC)的发病机制。方法采用酶联免疫吸附试验测定30例外阴阴道假丝酵母菌病(VVC)患者(VVC组)、24例RVVC患者(RVVC组)及26例健康妇女(对照组)的宫颈阴道灌洗液Toll样受体4(TLR4)及人防御素5(HD5)的水平。结果 VVC组、RVVC组妇女宫颈阴道灌洗液中,TLR4含量明显高于对照组,差异均有统计学意义(t分别=4.41、7.19,P均<0.05),但VVC组TLR4含量虽然高于RVVC组,但差异无统计学意义(t=1.04,P>0.05);VVC组、RVVC组HD5浓度高于对照组,但差异无统计学意义(t分别=1.03、1.57,P均>0.05)。结论阴道局部免疫环境TLR4异常可能是VVC、RVVC发作的主要原因之一,HD5可能与VVC、RVVC的发病无关系。     

经尿道前列腺等离子双极电切术治疗良性前列腺增生168例报告

目的评价经尿道前列腺等离子双极电切术（TUPKP）治疗良性前列腺增生（BPH）的疗效。方法总结运用TUPKP治疗168例BPH的临床资料。结果切除前列腺组织32～192g,平均58g。手术时间32—105min,平均65min。无电切综合征发生。随访3～6月,术前术后国际前列腺症状积分（IPSS）（25．8±2．7vs5．0±2．7）、生活质量评分（QOL）（5．2±0．5vs2．0±0．3）、最大尿流率（MFR）（8．4±2．1mL／8vs25．7±2．1ml／s）、平均尿流率（AFR）（5．5±0．6mL／svs12．2±1．6ml／s）、残余尿量（RU）（151．2±40．0mlvs25．2±13．2m1）,差异均具有统计学意义（P〈0．05）。结论TUPKRP治疗BPH具有安全有效、并发症少等优点,值得推广。     

2010～2012年假丝酵母菌株的分布及耐药性分析

目的探讨患者假丝酵母菌病（VVC）的致病菌株分布及药敏情况。方法对2010年1月至2012年12月该院进行阴道分泌物病原学检测结果进行回顾性调查分析。结果 3年检出VVC患者阳性数分别为248、291、381例,患者例数逐年增加;假丝酵母菌中非白假丝酵母菌比例逐年增加,分别为11.69%、18.21%和24.67%,差异有统计学意义（P〈0.01）;非白假丝酵母菌对咪康唑、伊曲康唑等常用抗真菌药物耐药率逐年上升,分别从6.90%和24.14%上升至11.89%和37.23%,分别与前1年比较差异有统计学意义（P〈0.05）。结论 VVC患者例数逐年增加,随着时间的推移,VVC的致病菌株以及其耐药性在一定程度上发生了改变。对VVC的治疗应重视其致病菌株的检测,并根据药敏试验结果合理选择抗真菌药物,提高VVC的治愈率。     

剖宫产术后瘢痕子宫妊娠的中晚期引产方式及效果分析

目的探究不同引产方式对剖宫产术后瘢痕子宫中晚期妊娠的影响。方法选取2012年5月至2015年4月该院收治的剖宫产术后行引产处理的瘢痕子宫中晚期妊娠患者68例,按照就诊顺序编号分为实验组和对照组。实验组患者采用腹羊膜腔行依沙吖啶注入,并接受米非司酮口服治疗;对照组使用单纯性依沙吖啶羊膜腔注入治疗,比较2组患者的临床疗效。结果 (1)引产时间及宫颈成熟评分:实验组患者胎盘排出至宫缩时间[(5.62±1.34)h]和宫缩至用药时间[(29.24±4.13)h]比对照组缩短[(11.22±3.62)、(35.26±5.64)h],差异有统计学意义(P0.05);宫颈成熟评分[(8.24±2.95)分]比对照组[(6.14±1.92)分]明显上升,差异有统计学意义(P0.05)。(2)引产效果:实验组引产成功率(94.12%)比对照组(64.71%)高,差异有统计学意义(P0.05)。(3)分娩期并发症及药物不良反应:实验组产后出血(2.94%)、软产道损伤(20.58%)、胎盘胎膜残留发生率(0)与对照组(2.94%、17.64%、2.94%)比较,差异无统计学意义(P0.05),但腹泻(11.76%)、恶心呕吐(14.70%)、寒战发热发生率(14.70%)均比对照组(0、0、0)高,差异有统计学意义(P0.05)。结论应用依沙吖啶+米非司酮联合引产方案可达终止瘢痕子宫中晚期妊娠目的,引产效果确切,具有临床价值。     

肌骨超声影像在肩痛患者糖皮质激素注射治疗中的应用价值

目的观察肌骨超声影像在肩痛患者糖皮质激素注射治疗中的应用价值,总结肌骨超声影像引导注射糖皮质激素治疗的效果,为临床研究提供依据与支撑。方法前瞻性选取2016年2月至2019年2月期间于庆阳市人民医院就诊接受治疗且符合相关收纳标准的肩痛患者200例为观察对象,依据随机数字表法将其分为观察组(n=100)与对照组(n=100)。对照组患者予以盲法注射糖皮质激素,观察组患者给予肌骨超声影像引导注射糖皮质激素治疗。比较2组患者临床效果,治疗前和治疗后3个月疼痛视觉模拟评分法(VAS)评分以及Neer肩关节功能评分变化,并总结肌骨超声影像评估结果。结果观察组的临床有效率显著高于对照组(85.00%vs. 60.00%),差异有统计学意义(P <0.05)。治疗后3个月,观察组与对照组患者疼痛VAS评分相较治疗前显著下降[(2.03±0.13)分vs.(6.98±1.23)分、(5.38±0.15)分vs.(7.24±0.57)分],且观察组VAS评分较对照组降低更明显,差异有统计学意义(P <0.05)。治疗3个月后,2组患者Neer肩关节功能评分均较治疗前明显升高[(89.12±5.12)分vs.(41.65±3.63)分、(77.48±4.05)分vs.(42.34±3.37)分],且观察组评分较对照组升高更明显,差异有统计学意义(P <0.05)。肌骨超声影像的评估结果显示,患者主要以滑囊炎、粘连性肩关节囊炎、肱二头肌长头肌腱炎等为主。结论肌骨超声影像引导注射糖皮质激素治疗肩痛,临床效果稳定且显著,明显缓解患者疼痛且改善关节功能,肌骨超声评估能够为治疗提供参考,值得推荐应用。     

细菌性阴道病及假丝酵母菌病的感染情况及相关因素分析

目的了解本地区女性细菌性阴道病（BV）及外阴阴道假丝酵母菌病（VVC）的发病情况及影响疾病的相关因素。方法回顾性分析2011-2013年本院1967例女性体检情况,并进行统计分析,采用问卷调查方式分析影响BV、VVC发病的相关因素。结果1967例体检检出282例女性VVC,检出率14．34％（282／1967）;检出231例BV,检出率11．74％（231／1967）;VVC以25～35岁性活跃期年龄段检出率较高,BV发病率各年龄层差异无统计学意义（P〉0．05）;VVC及BV治疗效果及疗效影响因素经Logistic分析,流产为影响治疗效果的危险因素;男方配合治疗及使用避孕套为康复效果的保护性因素。结论VVC与BV均与阴道微生态失衡相关,治疗中应注意指导患者养成健康的卫生习惯,注重男方协同治疗,阻断交叉感染,以保证良好的治疗效果。     

小剂量阿奇霉素联合噻托溴铵治疗稳定期慢性阻塞性肺疾病的临床研究

目的观察小剂量阿奇霉素联合噻托溴铵粉吸入剂治疗稳定期慢性阻塞性肺疾病（COPD）患者的临床疗效及安全性。方法110例稳定期COPD患者随机分为噻托溴铵单药组（A组）36例、阿奇霉素联合噻托溴铵组（B组）38例、常规治疗对照组（C组）36例3组。A组在常规治疗基础上给予吸入噻托溴铵粉吸入剂18恤g,每日1吸;B组吸入噻托溴铵并同时予阿奇霉素片每次250mg口服,2次／周;C组仅接受常规治疗。疗程均为6个月。结果3组治疗6个月后咳嗽、咳痰、气促评分及急性加重情况、6min步行距离及生活质量评分比较,差异有统计学意义（F值分别为29．37、62．56、7．59、148．35、317．68、16．60,P均〈0．01）。与c组治疗后比较,B组治疗后病例急性加重次数明显减少[（2．1＋0．6）次与（4．9±0．7）次,P〈0．05];临床症状评分咳嗽[（1．3±0．5）分与（2．2±0．6）分,19〈0．05]、咳痰[（1．0±0．2）分与（1．7±0．3）分,P〈0．05]、气促[（1．5±0．8）分与（2．1±0．6）分,P〈0．05]、运动耐力[6min步行距离（370．00±14．26）m与（290．00±12．85）m,P〈0．05]及生活质量[SGRQ总分：（293-8）分与（42±11）分,P〈0．05]明显改善。B组与A组治疗后比较,急性加重次数[（2．1±0．6）次与（3．2±0．8）次,P〈0．05]、临床症状评分咳嗽[（1．3±0．5）分与（1．8±0．4）分,P〈0．05]、咳痰[（1．0±0．2）与（1．3±0．3）分,P〈0．05]、气促[（1．5±0．8）分与（1．9±0．6）分,P〈0．05）]、运动耐力[6min步行距离（370．00±14．26）m与（330．00±13．76）m,P〈0．05]及生活质量[（SGRQ总分：（29±8）分与（36±10）分,P〈0．05]改善优于A组,差异均有统计学意义。结论小剂量阿奇霉素联合噻托溴铵治疗稳定期COPD,疗效佳,优于噻托溴铵单药治疗,且安全性高。     

三间隙引流术和传统切开挂线术在治疗肛周脓肿中的应用价值

目的观察和比较三间隙引流术与传统切开挂线术治疗肛周脓肿的临床效果,并评价其应用价值。方法采用前瞻性随机对照研究方法,选取2017年6月至2019年6月盐城市第三人民医院收治的95例肛周脓肿患者,按照简单随机分组法将患者分为两组:对照组患者(n=47)行传统切开挂线术治疗,观察组患者(n=48)行三间隙引流术治疗。观察两组患者的手术相关指标(包括手术时间、术中出血量、创面愈合时间、住院时间),采用Wexner量表评价两组患者治疗前以及治疗后1 d、7 d、30 d的肛门功能,以视觉模拟评分法(VAS)评价两组患者治疗前以及治疗后1 d、7d、30 d的患处疼痛情况,统计两组患者治疗期间的创面感染、肛瘘形成、肛门缺损或畸形等并发症发生率。结果两组患者的手术时间比较差异无统计学意义(26. 93±7. 63 min vs. 25. 49±6. 31 min)(P> 0. 05);观察组患者的术中出血量(24. 69±4. 63 ml vs. 16. 93±3. 27 ml)、创面愈合时间(27. 59±4. 27 d vs. 22. 61±6. 59 d)、住院时间(16. 27±6. 41 d vs. 12. 95±5. 63 d)均少于对照组,差异具有统计学意义(P <0. 05)。观察组患者术后1 d的Wexner量表评分低于对照组(9. 26±1. 58分vs. 7. 88±1. 65分),差异具有统计学意义(P <0. 05),治疗后7 d(4. 69±1. 63分vs. 4. 28±1. 37分)、30 d时(2. 73±0. 67分vs. 2. 51±0. 58分)两组Wexner量表评分比较差异无统计学意义(P>0. 05)。治疗后1 d时两组患者VAS评分比较(6. 75±1. 22分vs. 6. 05±1. 64分),差异无统计学意义(P>0. 05),观察组患者术后7 d、30d的疼痛VAS评分低于对照组(3. 05±0. 41分vs. 2. 33±0. 34分、2. 25±0. 25分vs. 1. 17±0. 24分),差异具有统计学意义(P <0. 05)。两组患者创面感染(4. 26%vs. 2. 08%)、肛门缺损或畸形发生率(2. 13%vs. 0)比较差异无统计学意义(P>0. 05);观察组的肛瘘形成发生率低于对照组(6. 38%vs. 2. 08%),差异具有统计学意义(P <0. 05)。结论相较于传统切开挂线术,三间隙引流术治疗肛周脓肿的疗效确切,术后疼痛缓解快,恢复迅速,肛瘘形成率低,具有较高的临床应用价值。     

血小板功能相关指标检查在脓毒症患者中的采用分析

目的检测脓毒症患者血小板功能相关指标变化,并分析其临床意义。方法选取医院2014~2015年的50例脓毒症患者作为研究组,选取同期50例体检健康对象作为对照组,检测2组血小板功能相关指标,观察其变化及意义。结果研究组患者血小板计数(PLT)、血小板分布宽度(PDW)、血小板平均容积(MPV)、大血小板比率(P-LCR)和P选择素分别为(145.7±21.5)×109/L、(24.6±6.3)%、(12.4±2.0)fL、(65.3±7.3)%、(81.5±9.7)%,对照组患者PLT、PDW、MPV、P-LCR和P选择素分别为(251.3±27.8)×109/L、(15.3±3.7)%、(7.7±1.6)fL、(32.2±6.2)%、(61.5±8.4)%。研究组患者PLT值显著低于对照组,而PDW、MPV、P-LCR和P选择素均显著高于对照组,2组数据差异有统计学意义(P0.05)。急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分小于10分组PLT值显著高于APACHEⅡ评分大于或等于10且小于或等于19分组、APACHEⅡ评分大于或等于20分组,而PDW、MPV、P-LCR和P选择素均显著低于APACHEⅡ评分大于或等于10且小于或等于19分组、APACHEⅡ评分大于或等于20分组,3组间数据比较差异有统计学意义(P0.05)。结论脓毒症患者的血小板处于激活状态,且各项指标的检测对判断脓毒症病情程度有重要意义。