目的 探讨多指标联合监测在冠心病(CHD)早期诊断中的应用。方法 选择2018年6月—2018年12月在我院就诊的患者180例,其中动脉硬化中低危人群60例(低危组),动脉硬化中高危人群60例(高危组),确诊的冠心病患者(CHD组),另选取健康体检者60例为对照组。分析血浆游离脂肪酸、高敏C反应蛋白、尿β-2微球蛋白、血清25羟维生素D及血脂水平与冠心病之间的关系。结果 低危组、高危组和CHD组患者FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平均高于对照组,血清25羟维生素D₃、HDL-C水平均低于对照组,差异均有统计学意义(P＜0.05);低危组、高危组和CHD组患者的血清FFA、hs-CRP、β₂-MG、TC、TG、LDL-C水平逐渐升高,血清25羟维生素D₃、HDL-C逐渐降低,以CHD组最为显著。冠心病患者血清HDL-C的敏感度高于其他各指标(P＜0.05);血清FFA、hs-CRP的特异度高于其他各指标(P＜0.05)。结论 多指标联合检测对于早期诊断冠心病患者有一定意义。

Objective To explore the application of multi-index combined monitoring in early diagnosis of coronary heart disease (CHD). Methods 180 patients were selected from June 2018 to December 2018 in our hospital. Among them, 60 patients with middle and low risk of atherosclerosis (low risk group), 60 patients with middle and high risk of atherosclerosis (high risk group), 60 patients with confirmed coronary heart disease (CHD group), and 60 healthy people were selected as control group. The relationship between plasma free fatty acid, high sensitivity C-reactive protein, urinary β-2 microglobulin, serum 25-hydroxyvitamin D and blood lipid levels and coronary heart disease was analyzed. Results The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group were higher than those in control group, and serum levels of 25-hydroxyvitamin D3 and HDL-C were lower than those in control group (P<0.05). The levels of FFA, hs-CRP, beta 2-MG, TC, TG and LDL-C in low-risk group, high-risk group and CHD group increased gradually, while serum levels of 25-hydroxyvitamin D3, H-MG, TC, TG and LDL-C increased gradually. DL-C decreased gradually, especially in CHD group. The sensitivity of serum HDL-C in patients with coronary heart disease was higher than that of other indicators (P<0.05), and the specificity of serum FFA and hs-CR P was higher than that of other indicators (P<0.05). Conclusion The combined detection of multiple indicators has certain significance for the early diagnosis of coronary heart disease.

目的 探讨后稳定型全膝关节置换术患者术后股骨后髁偏距变化对早期功能的影响。方法 选取2013年1月—2016年1月我院收治的121例骨关节炎接受单侧后稳定型膝关节置换患者,记录所有患者术前与术后股骨后髁偏距,根据股骨后髁偏距变化情况分为A组(股骨后髁偏距不变或增加)与B组(股骨后髁偏距减小)。对两组患者进行至少12个月的随访,比较其骨关节炎指数评分(WOMAC)、美国膝关节协会评分(KS)、美国膝关节外科学会评分系统(HSS)及膝关节功能之间的差异。结果 术后,2组患者在前髁偏距变化、股骨假体屈曲角、胫骨后倾角、胫骨角方面差异无统计学意义(P＞0.05)。但术后1年A组患者在WOMAC评分、HSS评分和负重主动屈曲范围方面改善优于B组患者,差异有统计学意义(P＜0.05)。结论 重建股骨后髁偏距能够改善后稳定型全膝关节置换术患者术后早期的骨关节炎症状,并提升患者负重位主动屈曲范围,有一定临床价值。

Objective To explore the stabilized total knee arthroplasty effects on early functional changes of condylar offset. Methods 121 cases of posterior stabilized total knee arthroplasty in our hospital from Jan.2013 to Jan.2016 were enrolled in the study. All patients with preoperative and postoperative posterior condylar offset records, according to the changes of femoral condylar offset were divided into A group and B group. The patients in the two groups were followed for at least 12 months, and the differences in the Osteoarthritis Index score (WOMAC), the American Knee association score (KS), HSS score and knee function were compared. Results After surgery, two patients in the anterior condylar offset changes, femoral prosthesis flexion angle, tibial angle, tibial angle difference was not statistically significant (P > 0.05). But after 1 years, the improvement of WOMAC score, HSS score and weight-bearing active flexion range in group A was better than that in group B, the difference was statistically significant (P < 0.05). Conclusions The reconstruction of the posterior condylar offset can improve the stability after total knee arthroplasty in patients with early osteoarthritis symptoms, and enhance the active flexion range of patients with weight-bearing, which has some clinical value.

目的 了解足月小样儿生后早期的潮气呼吸肺功能及1岁内发生喘息的情况。方法 选择我院2015年3月—2016年3月阴道分娩的足月小样儿及同期胎龄相近、阴道分娩的健康足月儿,比较2组生后5~7天的潮气呼吸肺功能各项指标及1岁内发生喘息的次数。结果 2组出生胎龄、性别、Apgar评分、母亲吸烟史、一级亲属中哮喘史比较均无差异;研究组中分钟通气量(MV)、潮气量(VT/kg)、达峰时间比(TPEF/TE)、达峰容积比(VPEF/VE)均低于对照组,差异有统计学意义(P＜0.05);呼吸频率(RR)、吸气时间(Ti)、呼气时间(Te)、吸呼比(Ti/Te)、潮气呼吸呼气峰流(PTEF)比较无差异(P＞0.05);研究组1岁内发生喘息的次数多于对照组,差异有统计学差异。结论 足月小样儿生后早期肺容量小于健康足月儿,小气道阻塞更明显,可能影响1岁内发生喘息的几率。

目的 探讨孕母甲状腺疾病的新生儿第一个月生长速率和甲状腺功能与2岁时神经发育结局之间的相关性。方法 2013年1月—2014年12月在我院出生的156例孕母甲状腺疾病的新生儿为实验组,观察其第1个月体质量、身长及头围生长的速率,生后当天、第7天、第28天的总甲状腺素(TT4)及促甲状腺素(TSH)的水平;妊娠期无高危因素的母亲分娩的正常新生儿中随机抽取150例为正常对照组,观察生后新生儿第1个月体质量、身长及头围生长的速率,2组均在2岁内分别每3个月均接受随访评估,2岁时行贝利婴幼儿发展量表进行Bailey智力发育指数(MDI)、精神运动发育指数(PDI)的评分。采用回归分析检验新生儿生后第一个月体质量、身长及头围生长的速率,新生儿生后当天、第7天、第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI之间的关联性。结果 ①实验组生后第1个月体质量(29.5±4.2 g/d)、身长(1.18±0.67 cm/周)及头围(0.79±0.39 cm/周)生长的速率慢于正常对照组的体质量(35.4±6.3 g/d)、身长(1.69±0.85 cm/周)及头围(1.10±0.42 cm/周)生长的速率,2组差异有统计学意义(t值分别为9.672、5.882、6.768,P均<0.05);②实验组2岁时MDI(108±15)、PDI评分(109±16)低于正常对照组MDI(115±14)、PDI评分(118±11),2组差异有统计学意义(t值分别为16.129、21.279,P均<0.05);③实验组孕母甲状腺疾病的新生儿生后第1个月体质量、身长及头围生长的速率与2岁时MDI、PDI呈正相关(相关系数分别为:0.874,0.842,0.890,0.857,0.871,0.845,t值分别为22.584,59.296,65.441,61.214,62.662,59.507,P均<0.05);④实验组孕母甲状腺疾病的新生儿生后当天、第7天及第28天的TT4及TSH水平与中位数的差值与2岁时MDI、PDI呈负相关(相关系数分别为:-0.878,-0.894,-0.890,-0.690,-0.654,-0.702,t值分别为73.167,81.273,74.166,11.523,10.548,12.103,P均<0.05)。结论 母亲妊娠期患有甲状腺疾病会影响新生儿生后第1个月体质量、身长、头围生长的速率及2岁时的精神运动、智力发育,落后于母亲妊娠期无高危疾病的正常新生儿。另外孕母甲状腺疾病的新生儿第1个月体质量、身长及头围生长的速率和生后当天、生后第7天 及第28天的T4及TSH的水平与2岁时MDI、PDI密切相关。

Objective To investigate the correlation between the growth rate, thyroid function in the first month and neurodevelopmental outcome at the age of 2 in the infants of the maternal thyroid disease. Methods We chose 156 infants of maternal thyroid disease from January 2013 to December 2014 born in our hospital as the experimental group and 150 normal infants of their mothers without high risk factors during pregnancy as the control group. We observed the rate of weight, length and head circumference growth in the first month and TT4 、TSH level at the 1^st day, 7^th day, and 28^th day after birth. We followed up two groups every 3 months up to the age of 2. We assessed Bailey mental development index (MDI) and psychomotor development index (PDI) at the age of 2. Regression analysis was used to test the correlation between the growth rate, TT4,TSH level in the 1^st month and MDI, PDI at the age of 2. Results ① The rate of growth rate in the 1^st month of the experimental group was slower than the control group. It was statistically significant difference between the two groups (P<0.05); ②MDI, PDI at the age of 2 in the experimental group were lower than those of the control group. It was statistically significant difference between the two groups (P<0.05); ③The rate of growth rate in the first month of the experimental group was positively related to MDI and PDI at the age of 2.④The difference between the level of TT4,TSH at the 1^st day, 7thday, and 28^th day and the median after birth was negatively related to MDI and PDI at the age of 2. Conclusion The maternal thyroid disease will affect the first month growth rate and neurodevelopmental outcome at the age of 2 of their infants. Their infants will grow behind than the normal newborns on pregnancy without high-risk disease.The growth rate of the first month and the level of T4 and TSH on the 1^st day, 7^th day, and 28^th day in maternal thyroid disease are closely related MDI and PDI at the age of 2.

目的 探讨中药吴茱萸治疗术后早期炎性肠梗阻的临床疗效,并探讨其应用价值。方法 将50例术后早期炎性肠梗阻患者随机分为治疗组(吴茱萸封包+常规西药治疗)和对照组(常规西药治疗),观察比较腹胀、腹痛、便秘、呕吐等临床表现、腹平片结果;对比分析2组患者腹胀缓解时间、肠鸣音恢复时间、排气排便时间、胃液引流量。结果 ①治疗组治愈率80.8%,高于对照组41.7%,有差异(P＜0.01);②治疗组腹胀缓解、肠鸣音恢复、肛门排气排便时间及24 h胃液引流量均较对照组缩短,差异有统计学意义(P＜0.05)。结论 吴茱萸封包穴位外敷能显著提高术后早期炎性肠梗阻临床疗效。

Objective To explore the clinical curative effect of Wuzhuyu in treatment of early inflammatory bowel obstruction and its application value. Methods 50 cases of early inflammatory bowel obstruction were randomly divided into the treatment group (Wuzhuyu packet+conventional western medicine treatment) and the control group (routine western medicine treatment), to observe the results of abdominal distention, abdominal pain, constipation, vomiting. The time of abdominal distension of the two groups, the recovery time of the bowel sound, the time of exhaust defecation and the drainage of gastric juice were compared and analyzed. Results ① The cure rate of treatment group 80.8% was higher than the control group of 41.7%, and the difference was statistical significant (P<0.01);② the time of abdominal distention of the treatment group, the recovery of the intestinal singing tone, the time of exhaust defecation and the drainage of the gastric juice were shortened than that of the control group, and the difference was statistical significant (P< 0.05). Conclusion The clinical effect of the treatment of early postoperative inflammatory bowel obstruction may be significantly improved by Wuzhuyu closure.

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

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

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

目的 探讨及比较CURB-65、PSI、SMART-COP及APACHEⅡ 4种临床评分对重症社区获得性肺炎(SCAP)患者的早期诊断价值。方法 采用前瞻性研究方法,收集2011年10月—2014年2月广州市第一人民医院呼吸内科收治的67例SCAP及同期33例普通CAP患者的临床资料,记录入组后24小时内CURB-65、PSI、SMART-COP及APACHEⅡ评分的最差值,比较4种临床评分系统对SCAP的早期诊断价值。结果 SCAP组CURB-65、PSI、SMART-COP及APACHEⅡ评分均高于普通CAP组患者[CURB-65(分):3.06±1.10 比0.85±0.79,P<0.001;PSI(分):144.93±36.48比73.94±27.17,P<0.001; SMART-COP(分):6.54±1.41比 1.67±1.02,P<0.001; APACHEⅡ(分):20.79±5.69比7.94±3.87,P<0.001]。CURB-65≥3分、PSI≥130分、SMART-COP≥3分及APACHEⅡ≥15分诊断SCAP的受试者工作特征曲线(ROC)下面积(AUC)分别为0.940[95% CI:0.89~0.98, P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001],敏感度分别为65.6%、71.6%、100%、88.1%,特异度分别为100%、100%、78.7%、93.9%。结论 CURB-65及PSI评分特异度好,但敏感度低,易漏诊,SMART-COP和APACHE Ⅱ评分诊断效能更佳。

Objective To evaluate and compare the early diagnosis value of CURB-65,PSI,SMART-COP and APACHEⅡin patients with severe community-acquired pneumonia. Methods This was a prospective study conducted in department of respiratory in Guangzhou First People's Hospital. We included 67 SCAP patients and 33 CAP patients between October of 2011and February of 2014. The lowest scores within 24 hours of CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score,respectively,for each patients were recorded. Prediction of SCAP as made in four scoring systems was compared. Results CURB-65 score,PSI score,SMART-COP score,APACHE Ⅱ score were higher in SCAP as compared with that of CAP(CURB-65:3.0±1.1 vs 0.9±0.8,P<0.001;PSI:144.6±36.4 vs 73.9±27.1,P<0.001; SMART-COP:6.5±1.4 vs 1.6±1.0,P<0.001; APACHEⅡ:20.6±5.6 vs 7.9±3.8,P<0.001). ROC curve for CURB-65 score≥ 3 scores,PSI score≥ 130 scores,SMART-COP score≥3 scores and APACHE Ⅱ score ≥ 15 scores in the early diagnosis SCAP were 0.940[95%CI:0.89~0.98,P<0.001],0.933[95%CI:0.88~0.97,P<0.001],0.999[95%CI:0.99~1.0,P<0.001],0.976[95%CI:0.95~0.99,P<0.001]. Sensitivity of four kinds of scoring system was 65.6%,71.6%,100%,88.1%, with specificity of 100%,100%,78.7%,93.9% respectively. Conclusion The specificity of diagnosis was better in the CURB-65 and PSI score,but the sensitivity was low and easy to miss diagnosis. SMART-COP and APACHEⅡscore systems had a better diagnostic value on SCAP.

早期干预是预防和减少早产儿神经系统损伤的有效措施,可以促进早产儿的正常发育并减轻神经系统伤残的发生,对提高儿童综合素质和家庭幸福都至关重要。在早产儿早期干预过程中存在与医学伦理原则不相适应的方面,如医疗设施不足、医疗措施不当、专业人员不足,早产儿干预预后的不确定性,治疗时机与家长经济及遵医行为之间的冲突,家长知情选择和知情同意不足等,本文结合医学伦理学的观点对0~3岁早产儿在早期干预中存在的问题进行分析并提出相应的建议。

Early intervention is an effective measure to prevent and reduce the nervous system injury in preterm infants,It can promote the normal development of preterm infants and reduce the occurrence of the nervous system disability.It is vital to improve the comprehensive quality of children and family quality of life. In the stage of premature infant intervention,there are some aspects that are incompatible with the medical ethics principle,i.e. inadequate medical facilities,improper medical measures,lack of professionals,premature infants intervention prognosis uncertainty,the conflict between the timing of treatment and the parents' economic and compliance behaviors,parents' informed choice and informed consent. etc. This paper analyzes the problems in early intervention of 0~3 year old preterm infants and puts forward corresponding suggestions according to the viewpoint of medical ethics.

目的 应用Synapsys人体姿势平衡系统对早期帕金森病(Parkinson's disease, PD)患者姿势障碍定量测试评价效果分析。方法 收集我院神经内科2015年7月-2016年7月收治的早期PD患者52例,随机分为试验组和对照组,每组26例。两组患者均给予常规治疗措施,试验组在常规治疗基础上给予康复治疗措施,最后两组均使用Synapsys人体姿势平衡系统和Berg平衡量表对患者进行评估和训练,观察测试结果。结果 干预前动态和静态异常比例组间差异无统计学意义(P>0.05);干预后试验组动态和静态异常分别为34.62%、30.77%,低于对照组的69.23%、73.08%,差异有统计学意义(P<0.05);干预前Berg平衡量表评分组间差异无统计学意义(P>0.05),干预后试验组评分高于对照组,差异有统计学意义(P<0.05);干预后两组Berg平衡量表评分均升高,其中试验组干预前后比较差异有统计学意义(P<0.05)。结论 应用Synapsys人体姿势平衡系统对早期PD患者姿势障碍准确定量测试,以评价康复效果,并且对于康复治疗具有重要作用。

Objective To analyze the clinical effects of quantitative test on early Parkinson's patients who suffering in postural disorders by using synapsys posturography system (SPS). Methods 52 cases of early Parkinson's patients who treated in our department of neurology from July 2015 to July 2016 were collected and divided into experimental and control groups randomly, 26 cases in each group. During the treatment, cases in experimental group and control group received the same conventional treatments. Meanwhile, on the base of conventional treatments, the cases in experimental group also received recovery therapy. Finally, the clinical effects of different treatments in two groups were evaluated by using SPS and Berg balance scale (BBS). Results Before intervention, the dynamic and static abnormal proportion between two groups had no significant difference (P>0.05); However, after the intervention, dynamic and static abnormal proportion in experimental group were 34.62%、30.77%, respectively, which was lower than those in control group (Dynamic: 69.23%; Static:73.08%), and the difference was significant (P<0.05); In addition, the result of BBS showed there was no difference between the experimental group and control group before intervention (P>0.05), while the scores of BBS in experimental group was higher than that in control group after intervention, and the difference was significant (P<0.05); At the same time, the scores of BBS in each group were both increased after the intervention, especially in the experimental group, and the difference in experimental group was significant (P<0.05). Conclusion The quantitative test on early Parkinson's patients who suffering in postural disorders can perform accurately by using synapsys posturography system. And the synapsys posturography system can also evaluate the recovery effects, which is important for the recovery treatment.