目的 分析乳腺恶性肿瘤患者的诊断和治疗方法的动态变化,了解该疾病的患者诊治相关行为方式的变化。方法 抽取我院1999年—2014年收治的所有乳腺恶性肿瘤患者,比较不同初诊时间和初诊年龄分组间,患病部位、肿瘤大小、手术方式、治疗方式的差异。结果 比较1999年—2004年组、2005—2009年组,近年诊断的肿瘤最大直径有所下降,经过卡方比较,构成比有差异(χ²=14.2,P=0.007)。近年诊断的患者更愿意选择积极的改良根治术作为手术治疗方式(χ²=38.8,P<0.001)。就不同年龄而言,年轻的患者选择改良根治术和化疗的比例也较年老的患者高,而年龄大的患者则选择姑息治疗的比例较高(χ²=154.9,P<0.001)和(χ²=129.8,P<0.001)。结论 乳腺恶性肿瘤的认知的加强,诊治技术的提高,乳腺恶性肿瘤能够更早的被发现诊断,治疗方式的选择也更加积极。

Objective To analyze the dynamic changes of breast cancer diagnosis and treatment. and to understand the changes of related behaviors of the patients. Methods From 1999 to 2014, breast cancer patients were chosen, the differences of tumor size, operation and treatment were not compared. Results The results were compared within different groups of diagnosis years, such as 1999-2004,2005-2009, and 2010-2015. The maximum diameter of the tumor diagnosed in recent years was decreased, χ²=14.2,P= 0.007. At the same time, patients that were diagnosed in recent years were more likely to choose radical surgery as surgical treatment, χ²=38.8,P<0.001. Comparing within groups of different ages, more patients chose radical surgery and chemotherapy in younger patients than older ones, we found that the older patients chose a higher proportion of palliative care, χ²=154.9,P<0.001 and χ²=129.8,P<0.001. Conclusion Understan-ding of breast cancer malignancies was enhanced. Breast cancer may be diagnosed earlier and the choice of treatment is more positive with the development of technology.

目的 观察百草枯中毒后大鼠血液中炎症因子的变化,以及大承气汤结合氢化可的松在百草枯中毒治疗中的作用。方法 选用广东省实验动物所的160只SD大鼠,雌雄各半。其中随机抽取 120 只大鼠给予百草枯溶液按18 mg/kg的剂量一次性腹腔注射给药,制造百草枯中毒大鼠模型其余 40只大鼠不作处理,作为正常组。再将模型组分为大承气汤联合氢化可的松组、氢化可的松组及盐水对照组,观察大鼠中毒情况,观察并分析给药后1 d、3 d以及5 d大鼠的肺组织以及血清炎症因子TNF-α、IL-2、IL-6等的变化情况。结果 正常对照组在中毒后1 d、3 d未见大鼠死亡,在5 d有1只动物死亡;模型组大鼠TNF-α、IL-2、IL-6水平高于对照组,差异有统计学意义(P<0.05);正常对照组大鼠各因子水平,随着中毒时间的延长逐渐增加,均有差异(P<0.05);大承气汤联合氢化可的松组给药后各时间点TNF-α、IL-2、IL-6降低,与氢化可的松组、盐水对照组均有差异(P<0.05)。结论 大鼠百草枯中毒后,肺组织发生纤维化改变,且TNF-α、IL-2、IL-6因子的水平升高,随着时间的推移,呈现上升趋势;大承气汤对百草枯中毒大鼠肺组织具有保护作用,可能调控各炎症因子作用,减缓病情进展来实现。

目的 通过超声造影成像技术( CEUS)观察颈动脉斑块内新生血管的情况,探讨颈动脉斑块的厚度与新生血管的关系。方法 选择颈动脉粥样硬化患者40例,经常规超声确诊存在斑块,共64个,应用CEUS成像技术检测斑块内新生血管情况。结果 不同厚度的颈动脉斑块的增强强度与斑块厚度成正相关(r=0.897 6,P=0.000 0)。结论 超声造影成像技术可以在常规超声的基础上通过检测斑块内的新生血管,进而判断斑块的性质,提供更多有用的信息进一步评估颈动脉斑块内新生血管增强强度与斑块厚度存在线性正相关性。

Objective To evaluate the neovascularization in carotid plaques by gray-scale harmonic contrast echocardiography (CEUS), and to investigate the relationship between the thickness of carotid artery plaque and the neovascularization.Methods 40 patients with carotid atherosclerosis were selected, and 64 plaques were diagnosed by regular ultrasound. The neovascularization in plaques was detected by CEUS imaging technique.Results The enhanced strength of carotid plaques with different thickness was positively correlated with plaque thickness (r=0.8976,P=0.0000).Conclusion Ultrasound contrast imaging can detect angiogenesis within the plaque based on conventional ultrasound, and then determine the nature of the plaque. More useful information is provided to further evaluate the linear positive correlation between the intensity of neovascularization and the thickness of plaque in carotid plaque.

目的 分析2011—2016年间铜绿假单胞菌分离株的耐药性及变迁情况, 为临床合理用药提供科学依据。方法 对2011年1月—2016年12月广州市第一人民院患者各类标本中分离到的铜绿假单胞菌2 257株进行细菌鉴定及药敏试验,并对耐药性变迁进行统计分析。结果 铜绿假单胞菌在痰液标本中的检出率最高为56.9％;6年铜绿假单胞菌平均耐药率以妥布霉素最低,为9.9%,对哌拉西林/他唑巴坦、头孢吡肟、头孢他啶、左氧氟沙星、环丙沙星、亚胺培南、庆大霉素等药物的耐药率均＜20%,在2013年耐药率最低,此后三年逐年上升。结论 铜绿假单胞菌对广州市第一人民院常用抗生素的耐药率在近3年呈逐年上升趋势, 临床医师应根据药敏结果合理选择抗菌药物, 以提高疗效和减缓耐药菌的产生。

Objective To analyze the changes of drug resistance of Pseudomonas aeruginosa (Pae) and to provide basis for the use of antibiotics in clinic. Methods 2 257 strains of Pae were cultured and isolated in the First People Hospitalof Guangzhou from 2011 to 2016, API bacterial identification system was applied to carry out bacterial identification and K-B method was used for drug sensitivity analysis. Results Most of the Pae (56.9％) were detected from the sputum specimen. It showed the highest sensitivity to tobramycin. The drug resistance of Pae to piperacillin/tazobactam, cefepime, ceftazidime, levofloxacin, ciprofloxacin, imipenem and gentamicin in 2013 was the lowest and has been increasing year by year. Conclusion Pseudomonas aeruginosa isolated in our hospital showed a rising trend of clinical drug resistance in the past three years. It was of the top priority for clinicians to use antibiotics rationally to retard the production of drug resistant strains.

目的 探讨我院17年间前列腺癌患者的临床特征如发病年龄、前列腺特异性抗原(PSA)、Gleason评分、分期及穿刺阳性率等的变化。方法 采用回顾性分析,对广州市第一人民医院2000—2016年泌尿外科1 231例穿刺活检的患者及564例前列腺癌患者资料进行分析,按患者的诊断时间分为A组(2000—2005年)、B组(2006—2009年)、C组(2010—2012年)、D组(2013—2014年)、E组(2015—2016年),对各组的年龄、PSA、Gleason评分、分期及穿刺活检阳性率进行统计学分析,看各组间的各项指标差异是否有统计学意义。结果 5组年龄均值(73.36,73.74,72.05,73.40,72.96岁)、PSA均值(208.95,190.25,173.19,283.54,148.69 μg/L)及穿刺活检阳性率均值(48%,43%,37%,44%,39%)差异均无统计学意义(P均>0.05)。5组Gleason均值为6.80,6.73,7.12,6.93,7.32,A、B组和E组Gleason评分差异有统计学意义(P均<0.05),其余各组Gleason评分差异均无统计学意义(P均>0.05)。TNM分期转化得分5组均值为5.96,6.80,7.05,7.31,6.83, A和C组、D组、E组差异均有统计学意义(P均<0.05),其余各组TNM分期转化得分差异均无统计学意义(P均>0.05)。结论 17年间前列腺癌患者诊断时的年龄、PSA水平及穿刺活检阳性率没有显著变化。

Objective To investigate changes of inpatients with prostate cancer in the last 17 years such as age of onset, prostate specific antigen (PSA), Gleason score, prostate cancer staging and positive rate of prostate biopsy. Methods A retrospective analysis was conducted in 1 231 cases of biopsy patients of urology and 564 patients with prostate cancer who were hospitalized in the First People's Hospital of Guangzhou from 2000 to 2016. According to the time of diagnose. All the patients were divided into five groups: group A(2000-2005),group B(2006-2009),group C(2010-2012), group D(2013-2014)and group E(2015-2016). The age, PSA, Gleason score, staging and positive rate of prostate biopsy were compared to realize whether the indicators of the differences between groups was statistically significant. Results In five groups, means of age, PSA, Gleason score and prostate biopsy positive rate are respectively 73.36,73.74,72.05,73.40,72.96 years; 208.95,190.25,173.19,283.54,148.69 μg/L;6.80,6.73,7.12,6.93,7.32; 5.96,6.80,7.05,7.31,6.83 and 48%,43%,37%,44%,39%. There was no significant difference in age, PSA and positive rate of prostate biopsy (P>0.05). The Gleason scores of group A and group E, group B and group E were statistically significant (P<0.05), while the other groups had no significant differences in Gleason score (P>0.05). There werestatistical significancein TNM staging score between group A and group C,group D, group E(P <0.05),while the other groups had nostatistical significance (P>0.05). Conclusion There are no change of prostate cancer patients in diagnosis of age, PSA levels and positive rate of prostate biopsy in the past 17 years.

目的 探讨持续负压吸引在微通道经皮肾镜取石术治疗鹿角形肾结石的临床效果。方法 选取2016年1月—2017年12月在我院确诊鹿角形肾结石并行经皮肾镜取石术治疗的病例138例;根据通道大小、有无负压吸引装置分为观察组和对照组,其中观察组66例,采用20F微通道联合持续负压吸引,对照组72例,采用22F标准通道,无负压吸引。比较两组的术中生命体征变化、肾盂内压力以及术后发热的发生率。结果 观察组在术中血压和心率等生命体征变化、肾盂内压力以及术后发热的发生率均低于对照组,差异有统计学意义(P<0.05)。结论 微通道联合负压吸引行经皮肾镜取石术治疗鹿角形肾结石可以有效降低肾盂内压力,有效维持生命体征的稳定,减少术后发热的发生率,提高手术安全性。

Objective To explore the clinical effect of percutaneous nephrolithotomy for treatment of staghorn kidney stonesusingmicro-channel combined with vacuum suction. Methods A total of 138 patientsofstaghorn kidney stones with PCNL in our hospital from January 2016 to December 2017 were included and divided into experimental group and control group according to the size of the channel and the vacuum suction device. Y-type minimally invasive dilatation drainage kit of 20F micro-channelandvacuum suctionwere used in experimental group within 66 patients.A standard channel (22F diameter) without vacuum suction was used in control group within 72 patients. The changes in vital signs, intrapelvic pressureand incidence of postoperative fever were compared between experimental and control groups. Results The vital signs variety of blood pressure and heart rate, intrapelvic pressure and incidence of postoperative fever in experimental group were lower than those in control group(P<0.05). Conclusion Micro-channel combined with vacuum suctioninpercutaneous nephrolithotomy for treatment of staghorn kidney stones could effectively maintenance of stable vital signs, reduce intrapelvic pressure and the incidence ofpostoperative fever, and improve the safety of surgery.

目的 分析25羟维生素D[25(OH)D]在新疆汉族及维吾尔族老年男性2型糖尿病(T2DM)合并骨质疏松(OP)患者中的水平及与骨密度(BMD)的相关性。方法 收集住院的汉族、维吾尔族老年男性T2DM患者281例,根据民族及骨密度值将其分为汉族非骨质疏松(NOP)组127人(A组)、汉族骨质疏松(OP)组21人(B组)、维族NOP组103人(C组)、维族OP组30人(D组),记录四组患者的25(OH)D水平并进行比较,分析25(OH)D与BMD的相关性。结果 同一民族中,B组的25(OH)D低于A组(P<0.05),D组的25(OH)D低于C组(P<0.05); T2DM合并OP患者中,D组的25(OH)D低于B组(P<0.05); 相关性分析显示,25(OH)D与BMD呈正相关。结论 维吾尔族老年男性T2DM合并OP患者较汉族患者的25(OH)D水平低,25(OH)D水平低的T2DM患者更易合并OP,25(OH)D检测有助于识别T2DM患者合并OP的风险。

Objective To analysis the level of 25 hydroxy vitamin D[25(OH)D] in Xinjiang Han and Uyghur elderly male patients with T2DM and osteoporosis, and the correlation between 25(OH)D levels and bone mineral density(BMD). Methods We collected 281 cases of T2DM patients from Hans and Uyghurs, divided them into four groups according to the nationality and BMD: Han non-osteoporosis(NOP) group including 127 cases(group A), Han osteoporosis(OP) group 21 cases(group B), Uyghur NOP group 103 cases(group C), Uyghur OP group 30 cases(group D). Recorded and compared their 25(OH)D levels, and analyzed the correlation between 25(OH)D levels and BMD. Results In the same nationality,the level of 25(OH)D in group B were lower than those in group A(P<0.05), and group D were lower than those in group C(P<0.05); In T2DM patients combined with OP, the levels of 25(OH)D in group D were lower than those in group B(P<0.05); Correlation analysis showed that 25(OH)D was positively correlated with BMD. Conclusion The level of 25(OH)D in elderly male patients with T2DM combined with osteoporosis, those of Uyghurs are lower than those of Hans. T2DM patients with lower 25(OH)D level are more likely to combine OP. The 25(OH)D level test may help to identify the risk of combining OP in T2DM patients.

目的 探讨拔岗晋级结合激励机制在护士岗位管理的实践和体会。方法 在护士岗位管理中运用拔岗晋级结合激励机制,收集实施岗位管理前后1年护士满意度、患者满意度、护士职业获益感、护士职业投入、离职率资料,进行统计学分析。结果 实施后护士满意度、患者满意度、护士职业获益感、护士职业投入较实施前提高(P<0.05),离职率下降(P<0.05),差异有统计学意义。结论 建立在拔岗晋级及激励机制上的护士岗位管理能提高护士满意度,降低护士离职率,稳定护士队伍,能够提高护士职业获益感、护士职业投入,从而提高护士工作的主观能动性和工作积极性,为高质量护理服务和优质护理服务长效机制的建立奠定了基础,促进优质护理服务的可持续发展,提高护理管理效能。

Objective To explore the application and experience of job promotion combing with excitation mechanism in nurses position management. Methods We used job promotion combing with excitation mechanism in nurses position management to compare the satisfaction rate, perceived career benefit, work engagement and separation rate of nurses. Results After the application, the satisfaction rate, perceived career benefit and work engagement of nurses were increased, while separation rate of nurses was decreased(P<0.05), the difference has statistical significance. Conclusion The application may increase the satisfaction rate, perceived career benefit and work engagement of nurses, and decrease the separation rate of nurses, elevate the subjective initiative and work enthusiasm. Nursing quality is improved continuously. The management efficacy is promoted.

目的 了解广东地区糖尿病足患者创面病原菌分布及耐药性变迁。方法 回顾性分析A组(2010年1月—2014年12月就诊的糖尿病足患者)和B组(2015年1月—2018年1月就诊的糖尿病足患者)研究者创面病原菌分布及耐药性变迁。结果 B组中创面G⁺菌及G^-菌均有下降趋势且G^-菌下降较快,细菌种类明显增加,真菌及混合感染明显上升,A组以金黄色葡萄球菌、铜绿假单胞菌、大肠埃希菌感染为主;B组以金黄色葡萄球菌、奇异变形杆菌、铜绿假单胞菌及真菌感染为主;B组相对于A组的细菌耐药性增加。结论 近年来糖尿病足患者病原菌种类明显增加且混合感染及真菌感染上升,且其耐药性增加,因此早期经验用药而后根据药敏选择抗菌药物治疗是糖尿病足感染治疗的关键。

Objective To investigate the distribution and drug resistance of pathogenic bacteria in diabetic foot wounds in Guangdong area. Methods Patients with diagnosis of diabetic foot between group A (from Jan 2010~Dec 2014 ) and group B (from Jan 2015 to Jan 2018) were retrospectively analyzed. We studied the bacteria distribution and drug resistance of pathogenic changes of group A and group B. Results In group B, both G+ and G- bacteria had a decreased trend while G- bacteria decreased rapidly, but the species of bacteria increased obviously just as fungi and mixed infection increased obviously. Bacteria infection in group A were mainly about Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli wihle group B were Staphylococcus aureus, Proteus mirabilis, Aeruginosa and Fungal infection; the resistance of group B to A was lower. Conclusion In recent years, kinds of pathogenic bacteria of diabetic foot were significantly increased and the mixed infection and increased fungal infection as well as its drug resistance increased, so the early experience of medication choice of antibiotics based on drug sensitivity and treatment are the key to the treatment of diabetic foot infection.

目的 探究和分析本组腹主动脉瘤腔内治疗病例并发症发生的原因及预防、处理策略。方法 对本团队在2014年1月—2017年12月实施的37例腹主动脉瘤腔内修复手术病例进行回顾性分析。结果 共有11例发生并发症,其中3例为术中I型内漏、1例术后支架移位致Ⅰ型内漏、1例术后Ⅲ型内漏、1例术中Ⅳ型内漏,全部经处理后内漏消失;术后髂动脉支架内血栓1例,经取栓后血流恢复;术后股动脉狭窄闭塞1例,经取栓并行股动脉人工血管置换后血流恢复;术后移植物反应1例,对症处理后症状消失出院;2例双侧髂内动脉栓塞致术后盆腔疼痛,随访疼痛消失,无跛行。结论 腹主动脉瘤腔内修复治疗本身存在内漏、血栓、血管入路损伤、移植物反应等相关并发症。术前正确评估并严格掌握适应症以及具有成熟的操作经验,是减少并发症发生的关键。

Objective To discuss and analyze the occurrence causes, prevention and treatment methods of complications in the endovascular repair of patients with abdominal aortic aneurysm. Methods Totally 37 cases of patients with abdominal aortic aneurysm underwent endovascular repair in our hospital from January 2014 to December 2017 were retrospectively analyzed. Results The complications were occurred in 11 cases, which including intra-operative typeⅠendoleak in 3 cases, postoperative typeⅠendoleak caused by stent displacement in 1 case; intra-operative type Ⅲ endoleak in 1 case; postoperative type Ⅳ endoleak in 1 case. all of the endoleak events disappeared after dealing. There was postoperative iliac artery stent thrombosis in 1 case, the blood flow was restored after thrombectomy; postoperative femoral artery stenosis or occlusion in 1 case, the blood flow was restored after thrombectomy and femoral artery artificial vascular replacement; postoperative host versus graft reaction in 1 case, no stent infection was found; and postoperative bilateral pelvic pain caused by internal iliac artery embolization in 2 cases, the pain disappeared during the follow-up visit, and the patients were free from lameness. Conclusion The complications related to endoleak, thrombosis, vascular approach injury and host versus graft reaction are existing with the endovascular repair itself of abdominal aortic aneurysm. The correct preoperative evaluation as well as strict control of indications and mature operational experience are the key to reduce the occurrence of complications.