目的 观察实施微信式延续护理干预对真菌性外耳道炎患者心理状态及治疗效果的影响。方法 选取我院2018 年12月—2019年12 月期间门诊治疗的110例真菌性外耳道炎患者为观察对象,将所选患者随机分为常规组和干预组,常规组55例,采取常规护理;干预组55例,在常规护理的基础上实施微信式延续护理干预。观察两组患者的心理状态及治疗依从性、治疗效果的变化。结果 干预组患者心理状态的改善、治疗依从性、治疗效果均优于常规组,差异有统计学意义(P＜0.05)。结论 在给予真菌性外耳道炎患者实施护理干预的过程中,加入微信式延续护理干预,患者的心理状态得到改善、治疗依从率增加及患者治疗的总有效率提高。因此微信式延续护理干预值得在临床护理中进一步推广。

Objective To observe WeChat continuous nursing intervention on mental state and therapeutic efficacy of fungal external auditory meatus. Methods 110 cases of fungal external auditory meatus treated in our hospital from December 2018 to December 2019 were selected as the observation objects,The selected patients were randomly divided into the conventional group and the intervention group,There were 55 cases in the conventional group,taking regular care; there were 55 cases in the intervention group,on the basis of routine nursing,WeChat continuous nursing intervention was implemented. The psychological status and treatment compliance of the two groups were observed,also changes in treatment outcomes. Results The improvement of psychological state,treatment compliance and treatment effect in the intervention group were better than that in the conventional group.The difference was statistically significant(P＜0.05). Conclusion In the course of nursing intervention for patients with fungal external auditory meatus,WeChat continuous nursing intervention was added.The psychological state of the patients has been improved,the rate of treatment compliance is increased and the total effective rate of treatment is increased greatly.Therefore,WeChat continuous nursing intervention is worthy of further promotion in clinical nursing.

目的 不同通道下的经皮肾镜取石术肾盂压力监测治疗鹿角形肾结石的临床分析。方法 选取我院2016年1月–2017年12月收治的鹿角形肾结石患者120例,通过随机分组,分别采用16F、18F、20F、22F、24F 作为手术通道,在气管插管全麻下置入8/9.8F 输尿管镜行经皮肾镜气压弹道碎石取石术,行经皮肾镜取石术,术中通过监测输尿管导管的压力,即肾盂内压并记录。测压系统每秒钟采集一次数据并录入数据库。观察不同通道下肾盂内压力以及取石速度。结果 在24F通道下肾盂内压力最低,与其他通道组进行比较,差异有统计学意义（P<0.05）;肾盂内压力大于40 cmH₂O时在24F通道下取石速度最短,与其他通道组进行比较,差异有统计学意义（P<0.05）;24F通道与22F通道下取石速度最快,与其他通道组进行比较,差异有统计学意义（P<0.05）。结论 肾盂内压监测使经皮肾镜取石术更加安全和精确,值得临床进一步推广应用。

Objective To investigate the pyelolithic pressure monitoring in percutaneous nephrolithotomy of different channel in treatment of renal staghorn calculi. Methods 120 patients of staghorn renal calculi in our hospital were selected from January 2016 to December 2017. These patients were randomly divided into 5 groups according to the operation channel（16F,18F,20f,22F,24F）. During operation,renal pelvis,ureter catheter pressure and operation time were recorded. Results The lowest renal pelvis pressure could be found in the 24F channel and the difference was statistically significant（P<0.05）. The lowest operation time could be found in the condition of the renal pelvis pressure of more than 40cmH₂O and 24F channel（P<0.05）. Beside of this, the fastest stone-free rate could be found in 22F and 24F channel（P<0.05）. Conclusion Monitoring of renal pelvic pressure makes percutaneous nephroscopic surgery more accurate and safety. It is worthy of clinical application.

目的 分析并探讨应用通窍活血汤配合舒血宁注射液在治疗糖尿病视网膜病变(单纯型)中的临床效果。方法 80例患者(80只眼)按照随机的方式将其列入对照组(40只眼)和治疗组(40只眼)两组,对照组给以调节血糖、饮食控制、运动疗法等常规治疗控制血糖稳定并口服通窍活血汤,治疗组在对照组的基础上,口服通窍活血汤再配合舒血宁注射液离子导入,所有患者均由同一位眼科专科医生分别在治疗前后对所选患者行眼压、视力、眼底镜检查,同时观察其治疗前后血液流变学、血脂变化情况,观察治疗效果。结果 治疗前后血糖、糖化血红蛋白改变无差异,治疗组视力、眼底均较对照组明显改善(P＜0.01),血液流变学,血及血脂各指标的改善较对照组比较有统计学意义(P＜0.01)。结论 通窍活血汤配合舒血宁注射液在单纯型糖尿病视网膜病变中的治疗效果显著,可有明显改善患者的血脂及血液流变学,安全可靠,适合临床长期推广应用,具有较高的社会效益和经济效益,值得临床推广应用。

目的 分析、探讨正常压力性脑积水发病机制、临床特点、手术指征及疗效。方法 回顾性分析我院自2005年1月—2015年1月采用侧脑室-腹腔分流术治疗53例正常压力性脑积水患者临床资料。结果 随访0.5~3年,总有效率为79.2%,无效率为20.8%,不良反应发生率为5.6%,不同临床特点患者的疗效有显著性差异(P＜0.05)。结论 提高对正常压力性脑积水认识,尽早确诊,选用合适压力的分流管,及时行脑室-腹腔分流术,注意防治并发症,以提高手术疗效。

Objective To explore the pathogenesis, clinical features, operation indication as well as therapeutic effect of hydrocephalus with normal pressure. Methods 53 patients underwent the ventriculo-peritoneal shunt from our hospital from Jan 2005 to Jan 2015 were retrospectively studied. Results Follow-up period was 0.5 to 3 years. Total efficacy rate was 79.2%; The failure rate was 20.8%; The incidence rate of adverse reaction was 5.6%. There were significance statistically for therapeutic effect between different groups(P＜0.05). Conclusion It is important to strengthen the awareness and diagnosis for hydrocephalus with the normal pressure. The suitable shunt duct and the ventriculo-peritoneal shunt in time will decrease complications and improve surgical therapeutic effect.

目的 通过本研究观察卡培他滨单药维持治疗晚期乳腺癌患者的临床疗效。方法 纳入本院2014年4月1日—2016年9月31日收治的晚期乳腺癌(复发、转移性乳腺癌)患者64例,均经过解救化疗达到缓解并稳定,按随机数字表法将所有入选对象分为治疗组与对照组(各32例),治疗组给予口服卡培他滨维持治疗,对照组给予定期(每12周)复查评价,比较2组患者的临床疗效、PFS、OS及生活质量。结果 治疗组的临床有效率(18.75%)、临床控制率(78.13%)均显著优于仅给予定期复查的对照组(3.12%)、(56.25%)(P＜0.05);治疗组维持治疗后生活质量改善者21例(65.63%),优于对照组9例(28.13%)(P＜0.05);治疗组用药期间出现Ⅰ～Ⅱ度为主的手足综合征、腹泻、恶心呕吐等毒副反应,均可耐受, Ⅲ-Ⅳ度毒副反应少发生。综合评估显示治疗组中位PFS为(9.6±1.4)个月、中位OS为(20.5±2.8)个月显著长于对照组(6.1±1.5)个月、(15.8±3.1)个月,两组中位PFS、中位OS比较差异有统计学意意义(P＜0.05)。结论 在晚期乳腺癌治疗中使用卡培他滨单药维持治疗具有显著的疗效,可延长患者的生存期,并提高患者的生活质量,毒副反应较轻,可作为晚期乳腺癌维持治疗的首选药物之一,值得临床推广应用。

目的 探讨爪形肋骨接骨板内固定治疗多发肋骨骨折的临床价值及意义。方法 收集2015年6月—2016年12月收治多发肋骨骨折40例,其中手术内固定20例,保守治疗组20例,比较分析两组临床治疗情况。结果 所有患者均痊愈出院,手术内固定组比保守治疗组疼痛明显减轻,胸管留置时间、下床自主活动时间及住院时间短,并发症发生率低,胸廓畸形矫正更满意,差异有统计学意义(P＜0.05)。结论 爪形肋骨接骨板内固定术治疗多发肋骨骨折固定效果满意,手术操作简单、创伤小,术后并发症少,恢复快,值得临床推广应用。

Objective To investigate the clinical value and significance of rib jaw-shaped bone plate in the treatment of multiple rib fractures. Methods 40 patients with multi-rib fractures were selected from June 2015 to November 2016. 20 cases were performed of rib jaw-shaped bone plate in the surgical treatment,20 cases of conservative treatment. The clinical treatment conditions of two groups were compared. Results Patients in both groups were all cured. Pain perception, hospital stay time, retain time of thoracic duct and independent ambulation time in surgery group were obviously reduced comparing with conservative treatment group as well as the surgical complications. There was a significant differences(P＜0.05). Conclusion Rib jaw-shaped bone plate for the treatment of multiple rib fractures has satisfactory results.Its advantages are as follows:simple and quick operative technique,minimal invasive surgery,less complications, fast recovery. It is worthy of clinical application.

自奥津一郎于1987年首次报道内镜辅助下行腕管松解术以来,腕管综合征的内镜治疗术式得到大量创新、改良。现本文就各种内镜术式优劣势做一概述。

目的 观察吉西他滨联合萘达铂治疗铂类敏感复发性卵巢癌的近期疗效与不良反应。方法 回顾性分析潍坊市人民医院2013年1月—2014年6月治疗的60例复发性卵巢癌病例,分为吉西他滨联合萘达铂(GN)方案化疗组30例和吉西他滨联合卡铂(GC)方案化疗组30例。GN方案组,吉西他滨1.0 g/m²,d1、8;萘达铂80 mg/m²,d1,21d为1周期;GC方案组,吉西他滨1.0 g/m²,d1、8;卡铂按AUC=5计算,d1,21 d为1周期。结果 GN方案组近期有效率56.0%,GC方案组近期有效率60.0%,两组比较差异无统计学意义(χ² =0.069,P=0.793)。两组最常见的毒性反应均是骨髓抑制,GC组骨髓抑制发生率较GN组骨髓抑制发生率稍高,但两组比较差异无统计学意义(P>0.05)。结论 两种方案治疗铂类敏感型复发性卵巢癌疗效无统计学差异,GN方案组不良反应较轻。

Objective To evaluate the clinical effect of GN chemotherapy protocol and GC chemotherapy protocol treatment of recurrent ovarian cancers. Methods We retrospectively analyzed the data of 60 patients with recurrent ovarian cancers in our hospital from January 2013 to June 2014. Divided into gemcitabine and nedaplatin (GN)chemotherapy group and Gemcitabine and carboplatin(GC)chemotherapy group, 30 patients in each group.Patients in GP protocol group were given Gemcitabine 1.0 g/m²,d1,8;and naphthalene(80 mg/m²,d1),21d was a period of treatment; Patients in GC protocol group were given gemcitabine 1.0 g/m²,d1,8;and carboplatin AUC=5 by calculation,21d was a period of treatment. Results For patients in GN protocol group,the short term response rate was 56.0%.For patients in GC protocol group,the short term response rate was 60.0%,the difference was not statistically significant(χ²=0.069,P=0.793). Two of the most common toxicities were myelosuppression, incidence of myelosuppression GC was slightly higher than GN, and the difference was not statistically significant. Conclusion The therapeutic effects of two chemotherapy protocols have no statistically significant difference in treatment of platinum sensitive recurrent ovarian cancer. Toxicity of GN group is light.

目的 统计分析2011—2014年我院分离的肠杆菌科细菌数据,探讨耐碳青霉烯肠杆菌科细菌(CRE)的流行特征。方法 收集肠杆菌科细菌,根据药敏结果筛选出CRE菌株,并对相关临床资料进行统计分析。结果 共分离得到CRE菌株187株,标本来源依次为尿液(32.6%)、痰液(28.9%)和血液(10.7%)。从科室分布来看,39.0%的菌株来自重症监护室病区,23.0%的菌株来自泌尿外科病区,在其它病区呈散发分布。菌株的种属分布方面,肺炎克雷伯菌的比例为39.6%, 大肠埃希菌的比例为20.9%;从病人年龄构成来看,50岁以上高龄患者的分离比例达74.4%。CRE的分离数目随年份的递增而不断升高。结论 耐碳青霉烯肠杆菌科细菌的流行率呈现逐年递增的趋势,临床应合理使用相关抗生素,预防和控制CRE在医院环境中的流行。

Objective To investigate the epidemiological features of carbapenem resistant Enterobacteriaceae in a collection of clinical Enterobacteriaceae strains isolated during 2011-2014 from our hospital. Methods The Enterobacteriaceae strains were collected and CRE strains were screened by their resistance to carbapenems. Clinical information was analyzed to characterize the epidemiological traits of CRE strains. Results The total number of CRE isolates was 187. These CRE strains were isolated from various clinical specimens, including urine(32.6%), sputum (28.9%), blood (10.7%), and so on. These strains were frequently isolated from intensive care units (ICU) (39.0%) and department of Urology (23.0%). The most frequently isolated species were Klebsiella pneumoniae (39.6%), Escherichia coli (20.9%). The isolation rate is much higher in elderly patients more than 50 years old (74.4%). The percentage of CRE isolates were kept on increasing by years. Conclusion The prevalence carbapenem resistant Enterobacteriaceae in our hospital is increasing every year and it is important to prevent and control the transmission and outbreaks of CRE in the hospital by proper use of related antibiotics in clinical treatment.

目的 探讨锥形纤维桩核与金属铸造桩核在残冠残根修复治疗中的临床效果。方法 65例患者共计69颗残冠残根经完善的根管治疗后采用锥形玻璃纤维桩树脂核和全冠修复,另外32例41颗牙经铸造桩核冠修复,观察疗效对比。结果 所有病例每年复查一次,平均随访期为2年,69颗纤维桩修复患牙未发现牙根折裂,其中66颗全冠与桩核固位稳定,无主诉不适、牙周健康、患者对修复体美学效果与咀嚼功能均感满意。3例失败病例分别为全冠、纤维桩核松动脱落各1颗,有1颗纤维桩折断,成功率为95.6%。金属铸造桩核组41颗患牙失败4例,其中根折2例,均已拔除,牙龈炎伴牙龈及修复体颈缘变色1例,改用纤维桩修复,继发龋1例,成功率为90.2%。结论 纤维桩树脂核具有美学效果好,机械性能好,无腐蚀,耐疲劳,易拆除,不易根折等优点,可替代铸造桩核作为理想的冠、残根桩核修复材料。