目的 观察手术前静滴不同剂量复方麝香注射液对老年患者全麻术后早期轻度认知障碍(MCI)发生的影响。方法 选择下肢与下腹部手术全麻患者120例(ASA Ⅰ-Ⅱ级),将其随机分为4组,组Ⅰ(n=30,对照),采用质量浓度为9 g/L的生理盐水100 mL静脉滴注;组II(n=30):应用低剂量复方麝香注射液(0.1 mL/kg,加入质量浓度为9 g/L的生理盐水100 mL)手术开始前0.5 h静脉滴注,其速率为200 mL/h;组Ⅲ(n=30): 应用中剂量复方麝香注射液(0.2 mL/kg), 药物配伍、治疗时间和注射速度与组Ⅱ相同;组Ⅳ(n=30):高剂量复方麝香注射液(0.3 mL/kg),用药方法同组Ⅱ。各组术前用药、麻醉诱导、术中麻醉深度、麻醉苏醒等用药与方法相同;观察各组患者术前、术后第1天、3天、7天的CCSE、FAQ、MMSE评分等。结果 4组患者手术时间、麻醉时间、术中出血量、苏醒时间基本相同(P>0.05),4组手术后第1天、3天及7天CCSE、FAQ、MMSE认知功能评分均减少, 组Ⅱ、组Ⅲ、组Ⅳ下降的变化幅度较小,得分高于组Ⅰ(P<0.05),组Ⅱ、组Ⅲ、组Ⅳ组间比较差异无统计学意义(P﹥0.05);术后第1天、3天、7天MCI发生率,组Ⅰ分别为66.7%、33.3%和16.7%;组Ⅱ为50.0%、16.7%和6.7%;组Ⅲ为50.0%、16.7%和6.7%。组Ⅳ为46.7%、20.0%和10.0%,用药组比组Ⅰ降低(P<0.05),但组Ⅱ、组Ⅲ、组Ⅳ之间无明显差异(P﹥0.05);4组术后不良反应组间比较差异无统计学意义。结论 术前静脉滴注复方麝香注射液0.1 mL/kg可有效降低老年患者全麻术后MCI的发生,增加麝香注射液剂量(0.2 mL/kg、0.3 mL/kg)对于老年手术患者MCI未见增效作用,临床选用静滴的剂量0.1 mL/kg即可。

Objective To observe the effect of different doses of compound musk injection before operation on early mild cognitive impairment (MCI) in elderly patients after general anesthesia. Methods We selected 120 cases of lower limb and lower abdominal surgery general anesthesia (ASA level Ⅰ-Ⅱ),and divided them randomly into 4 groups: Group Ⅰ (n=30,control): 0.9% saline 100mL intravenous infusion; Group Ⅱ (n=30): low dose compound musk injection (0.1 mL/kg,add 0.9% saline 100 mL), 0.5h before the start of surgery, intravenous drip, the rate was 200 mL/h; Group Ⅲ (n=30): medium dose compound musk injection (0.2 mL/kg), the same as group Ⅱ in drug compatibility,treatment time and injection rate; Group Ⅳ (n=30): high dose compound musk injection (0.3 mL/kg), the same as group Ⅱ in drug compatibility, treatment time and injection rate. Each premedication, induction of anesthesia, anesthesia depth,intraoperative awake and anesthesia medication were the same. And we observed each group about preoperative and postoperative CCSE,FAQ and MMSE(mini-mental state examination) score of the 1st days,3rd days and 7th days. Results In the 4 groups of patients,the operation time,anesthesia time,intraoperative blood loss,recovery time were basically the same (P>0.05); CCSE,FAQ,MMSE cognitive function scores of 4 groups were reduced after operation on the first day,the third day and the seventh day; group Ⅱ,group Ⅲ,group Ⅳ decreased slightly.The scores were higher than group Ⅰ (P<0.05),and there were no significant differences between group Ⅱ,group Ⅲ and group Ⅳ (P>0.05); The incidence of MCI in first days, third day and seventh day after operation respectively was: group Ⅰ 66.7%,33.3% and 16.7%; group Ⅱ 50%,16.7% and 6.7%; group Ⅲ 50%,16.7% and 6.7%; group Ⅳ 46.7%,20% and 10%.Those of the drug groups were lower than group Ⅰ (P<0.05), but there was no significant difference between group Ⅱ, group Ⅲ and group Ⅳ (P>0.05).There were no significant differences in the 4 groups in postoperative adverse reactions. Conclusion Preoperative intravenous infusion of compound musk injection 0.1 ml/kg, may effectively reduce the incidence of MCI in elderly patients after general anesthesia. Increasing musk injection dose (0.2 ml/kg,0.3 ml/kg and 0.4 mg/kg) was no synergistic effect on MCI in elderly patients,0.1ml/kg is enough.

目的 利用新的分型方法指导现有的微创技术下内固定的选择,提示预后,帮助制定术后康复计划。方法 将200例患者随机分成两组,一组为旧Evans分型组,另一组为改良Evans分型组,通过多层螺旋三维CT重建引导下改良Evans分型,对三个重点区域(股骨内距、头颈部及粗隆外侧入针点部位)的CT成像,利用多平面重组(MPR)、表面遮盖显示(SSD)及容积再现(VR)等多种后处理,分析骨折线走形、局部的微骨折、骨小梁分布、骨皮质厚度的骨折部内环境变化。简化整合到Evans分型中。来实现完善影像分型,有效地指导微创手术。对比两组患者的疗效。结果 新Evans分型组98例患者愈合良好,时间为9~17周,中位数为11.2周。其中伤口感染3例,髋关节内翻畸形3例,骨骨头坏死3例,按照髋关节治疗标准评分,优53例,良31例,可9例,差7例。优良率(包括优和良)为84%。旧Evans分型组80例患者愈合良好,时间为9~18周,中位数为11.8周。其中伤口感染10例,髋关节内翻畸形5例,股骨头坏死8例,按照髋关节治疗标准评分,优48例,良26例,可10例,差16例。优良率(包括优和良)为74%。两组对比,新Evans分型组优良率明显高于旧Evans分型组,差异有统计学意义。P＜0.05。结论 多层螺旋三维CT重建引导下的改良Evans分型对老年脆骨性粗隆间骨折的微创治疗有重要的临床指导意义。

目的 探讨血清铁蛋白及超敏C反应蛋白联合检测对急性脑出血患者的临床意义。方法 2012年1月—2015年12月,自发性脑出血的患者77例,男42例,女35例;年龄45～82 a,平均年龄(67.19±10.17)a。根据Rankin 评分将患者分成两组,A组,MRS≤2分,预后良好; B组,MRS＞2分,预后差;另选取同期健康体检者35例作为健康对照组,即C组。分别于入院时、发病后第3天、7天、14天时,采静脉血化验血常规、Hs-CRP及SF;于入院时和发病后第3天时,进行头颅CT检查。采用美国国立卫生院神经功能缺损评分(National Institutes of Health Stroke Scale,NIHSS) 分别于入院及随访12个月时,对两组患者神经功能损伤及恢复情况进行评估。结果 77例脑出血患者在发病12个月随访时, 53例患者MRS≤2分,预后良好;24例患者MRS＞2分,预后较差。于入院时、发病后第3天、7天、14天,脑出血患者的Hs-CRP及SF水平均显著高于健康体检人员,差异具有统计学意义(P<0.05);在各时间点脑出血患者中的预后较差组Hs-CRP及SF水平均不同程度高于预后良好组;但在入院发病后第3天则显著高于预后良好组,差异具有统计学意义(P<0.05),同时,脑出血患者中的预后较差组脑水肿量及水肿系数均显著高于预后良好组,差异具有统计学意义(P<0.05)。影响脑出血预后的独立危险因素包括NIHSS评分(P=0.012),Hs-CRP(P=0.027)和SF水平(P=0.041)。结论 Hs-CRP及SF水平在一定程度上可作为脑出血预后的重要评估指标。

Objective To investigate the clinical significance of combined detection of serum ferritin and high sensitive C reactive protein in patients with acute cerebral hemorrhage. Methods From January 2012 to December 2013, 77 cases with cerebral hemorrhage male 42, female 35; aged 45 to 82 year old, average age (67.19±10.17)years old. According to MRS(Modified Rankin Scale) score criteria, patients were divided into good prognosis group(group A) with MRS ≤2, and poor prognosis group (group B)with MRS ＞2. Another 35 cases of healthy physical examination were selected as the healthy control group(group C). RT(Routine blood test), Serum Ferritin(SF)and Hs-CRP were tested at the time of admission, the third, the seventh and the fourteenth day from onset of the disease respectively. Head CT were done at the time of admission, the third day from onset of the disease respectively. Neurological assessment were scored according to the NIHSS criteria(National Institutes of Health Stroke Scale) for the patients in the two groups at the time of admission and 12 months of follow up. Results 77 cases of cerebral hemorrhage were followed up for 12 months, 53 cases with MRS ≤2, the prognosis was good; And 24 cases with MRS >2, the prognosis was poor. The levels of Hs-CRP and SF were all higher in patients with cerebral hemorrhage than that in healthy control group (P<0.05) at the time of admission, the third day,seventh and fourteen day from onset of the disease respectively. The levels of Hs-CRP and SF were higher in group B than that in control group at the time of admission, the third day, the seventh day and the fourteenth day from onset of the disease respectively, but only at the time of admission, three days from onset of the disease, the difference was statistically significant (P<0.05). At the same time, the brain edema and edema index in the group B were higher than those in group A. The independent risk factors influencing the prognosis of cerebral hemorrhage were NIHSS score (P=0.012), Hs-CRP(P=0.027) and SF(P=0.041). Conclusion Hs-CRP and SF may be important indicators of the prognosis for cerebral hemorrhage in a certain degree.

目的 探讨小肠出血的诊断策略。方法 回顾性分析我院2010年1月— 2015年6月收治的42例小肠出血病例的诊治经历。结果 42例患者中肿瘤15例(35.7% );血管发育不良和畸形10例(23.8%);炎性肠病9例(21.4%),憩室7例(16.7%),原因不明1例(2.4%)。气钡双重造影阳性率11.8%;B超检查阳性率15%;核素扫描阳性率44.4%;CT检查阳性率46.7%;血管造影阳性率50%,小肠镜检查阳性率58.9%;胶囊内镜阳性率61.5%;术中肠镜检查阳性率88.9%。结论 小肠出血病因多样,检查缺乏特异性;隐性出血者可选择CT或胶囊内镜,结果阳性者进一步可行小肠镜检查或治疗;活动性出血患者选择ECT或DSA,手术探查或术中肠镜是最后选择。

Objective To investigate the diagnosis of small intestinal haemorrhage. Methods The diagnosis and treatment of 42 cases of small intestinal haemorrhage between January 2010 and June 2015 were analyzed retrospectively. Results Among the patients, small bowel tumors were found in 15 cases,angiodysplasia in 10,inflammation disease in 9,diverticulum in 7 and obscure bleeding in 1 each. Positive rate of diagnostic methods was followed:enteroclysis 11.7％,B-ultrasound 15%, ECT 44.5%,CT 46.7％,DSA 50%, device-assisted enteroscopy 58.9％, capsule endoscopy 61.5%,enteroscope examination during operation 88.9%. Conclusion There are various etiological factors and lack of specificity in small intestinal haemorrhage. Capsule endoscopy or CT should be used first if the patient had occult bleeding, positive patients were suggested to taken enteroscopy. ECT and DSA must be applicable for active bleeding or other positive patients. Operation or enteroscope examination during operation could be the last measure.

目的 探讨手动杠杆式胸外按压心肺复苏(CPR)装置对院内心肺复苏按压质量和复苏疲劳的影响。方法 将12名医学生志愿者分为手动杠杆式胸外按压CPR装置组(LDCPR)(n=6)和徒手标准CPR组(STCPR)(n=6)模拟院内心肺复苏场景进行CPR试验。LDCPR组采用手动杠杆式胸外按压CPR装置对模拟人进行连续6min连续胸外按压,STCPR组徒手对模拟人进行6min连续胸外按压。监测复苏期间按压的深度、频率以及按压者的心率和疲劳程度等变化。结果 随着连续胸外按压的进行,按压者的心率和疲劳程度都在不断增加,有效按压深度超过5 cm次数逐渐减少,但是在连续胸外按压的第4～6min,LDCPR组按压者的心率较STCPR组慢(P<0.05),疲劳程度较轻(P<0.05),有效按压的比例更高(P<0.05)。按压频率两组比较无明显差异。结论 在本模拟人试验中,手动杠杆式胸外按压CPR装置可减轻按压者疲劳,有助于提高院内CPR时长时间胸外按压的质量。

Objective We aimed to investigate simulated in-hospital cardiopulmonary resuscitation (CPR) quality and rescuer fatigue of external chest compression-only CPR by a manual leverage device(LDCPR). Methods All 12 volunteers (medical staffs: male 6 and female 6) were randomized to standard CPR by hand(STCPR)group (n=6)or LDCPR group(n=6). At STCPR group, continuous external chest compression-only was performed for 6 minutes to simulate in hospital cardiopulmonary resuscitation on a manikin; at LDCPR group, compression-only was performed for 6 minutes by a leverage device on a manikin. We measured blood pressure of the volunteers before and after performing each CPR technique, volunteers self-report fatigue scale and continuously monitored heart rate (HR) of the volunteers during each CPR technique by smart ring. CPR quality measures included chest compression rate and depth. Results During continuous external chest compression-only CPR, compressor's heart rate and fatigue scale were rising continuously, and percent of compress depth >5 cm were declining, too.Compressor's heart rate and fatigue scale were higher in the STCPR group than in the LDCPR group (P<0.05) during the fourth to sixth minutes CPR (P<0.05). Percent of compress depth > 5 cm was higher in the LDCPR group than in the STCPR group (P<0.05) during the fourth to sixth minutes of CPR (P<0.05).Compress rate had not differed between the 2 groups during CPR. Conclusion In the manikin study, manual leverage external chest compress device may reduce fatigue scale and improve long term compression quality during in-hospital cardiopulmonary resuscitation.

目的 观察比较术中及术前化疗干预对进展期胃恶性肿瘤手术患者p53、ki-67表达及预后的影响,为临床化疗时间的选择提供理论依据。方法 自2014年8月—2015年5月,我院共收入胃恶性肿瘤患者40例,将40例患者随机分为两组,每组各20例,保证两组患者在性别、年龄、胃癌分期等方面可比,无统计学差异(P＞0.05),标记为Ⅰ组和Ⅱ组。Ⅰ组20例患者于术前进行化疗干预,Ⅱ组在术中给予化疗干预。观察比较两组患者p53、ki-67表达状况及预后。结果 Ⅰ组及Ⅱ组治疗后p53及ki-67均比治疗前升高,差异有统计学意义(P<0.05)。但是治疗后,Ⅰ组和Ⅱ组的p53表达状况组间差异不明显,无统计学意义(P>0.05)。治疗前后,AI差异有统计学意义(P<0.05)。Ⅰ组效果明显好于Ⅱ组,两者差异有统计学意义(P <0.05)。术后六个月、一年随访时发现两组复发率、死亡率差别不大,无统计学意义(P>0.05),术后两年随访发现Ⅱ组复发率、死亡率明显低于Ⅰ组,差异有统计学意义(P<0.05)。结论 术中化疗的疗效优于术前化疗,患者预后较术前化疗好。

Objective To observe the effect of intraoperative and preoperative chemotherapy on the expression of p53, Ki-67 and prognosis in patients with advanced gastric cancer. Methods 40 cases of advanced gastric cancer in our hospital from Aug 2014 to May 2015 were enrolled in the study, and were divide into 2 groups randomly. In group I, 20 patients received chemotherapy intervention befoerer operation, and the other group received chemotherapy intervention during operation. The expressions and prognosis of p53 and Ki-67 were observed and compared between the two groups. Results Group Ⅰ and group Ⅱ after treatment, p53 and Ki-67 were higher than that before treatment, with statistical significance(P<0.05). However, there was no significant difference in the expression of p53 between group Ⅰ and group Ⅱ after treatment, and there was no significant difference(P>0.05). Before and after treatment, the difference of AI was significant, with statistical significance (P<0.05). The effect of group Ⅰ was obviously better than that of group Ⅱ, the difference was statistically significant(P<0.05). Six monthse after the operation and one year follow-up found two groups of recurrence rate and mortality rate had no significant difference(P>0.05). After two years follow-up found the group Ⅱ recurrence rate, mortality was lower than in group Ⅰ (P<0.05). Conclusion The effect of intraoperative chemotherapy is better than that of preoperative chemotherapy, and the prognosis is better than that of preoperative chemotherapy.

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 探讨幽门螺杆菌(HP)感染与不同年龄段健康体检人群中血脂异常发病率的相关性。方法 在健康体检人群中开展¹³C尿素呼气试验及血脂等检测,对比不同年龄段人群中HP感染率,研究HP感染与年龄及血脂异常的相关性。结果 不同年龄段人群之间的HP感染率无差异。HP阳性组的血脂异常患病率在30岁后的每个年龄段内均高于HP阴性人群,在60～69岁阶段两组人群差异最明显,血脂异常的发生率分别为74.29%vs 26.15%。结论 HP的感染与血脂异常相关,HP阳性组人群血脂异常患病率随年龄增高而增高的趋势较HP阴性组更加明显。