慢性阻塞性肺疾病是一种临床常见病,肺功能检查作为诊断慢性阻塞性肺疾病(COPD)的金标准,存在重症患者配合欠佳难以完成检查等问题.CT检查具有较高分辨率,能较好显示COPD患者肺部的主要病变及其继发征象,然而,常规CT检查主要依靠放射科医生主观评估,受个人经验等影响较大,且无法对COPD患者肺气肿等病变进行具体量化,随着影像学检查技术及计算机后处理技术的不断发展,越来越多学者对CT定量测量展开了研究,CT定量测量在显示肺气肿病变及小气道方面具有独特优势,并能对患者的并发症进行详细评估,实现了从肉眼观察到定量评估的转换,本文将从CT定量测量在COPD中的应用展开综述,探讨其诊断及临床应用价值.

目的:观察虚拟现实技术(VR)结合多体位智能化(MPI)下肢康复机器人在卒中患者康复中的应用效果.方法:选取2018年5月至2020年4月该院收治的86例卒中患者进行前瞻性研究,按照随机数字表法分为对照组和观察组各43例.对照组采用MPI下肢康复机器人干预,观察组在对照组基础上联合VR干预.比较两组干预前后Berg平衡量表(BBS)评分、下肢运动功能(FMA)评分、卒中患者运动功能评估量表(MAS)评分、功能性步行量表(FAC)分级、简易智能精神状态检查量表(MMSE)评分、Barthel指数(BI)评分.结果:干预后,观察组BBS、FMA、MAS评分均高于对照组,差异有统计学意义(P<0.05);观察组FAC分级优于对照组,差异有统计学意义(P<0.05);观察组MMSE、BI评分均高于对照组,差异有统计学意义(P<0.05).结论:VR结合MPI下肢康复机器人应用于卒中患者,可改善患者平衡能力和认知功能,提升下肢运动功能和步行能力,其效果优于单纯MPI下肢康复机器人干预.

脑卒中是由于各种原因造成的脑组织局部区域血供异常,而产生的脑组织损伤[1].其病因主要是由脑血栓形成、脑出血、脑梗死及蛛网膜下腔出血等引起,其中脑血栓形成为最主要的原因[2].据相关研究显示,我国每年有约150万新发脑卒中,该病病死率、致残率较高,且病发率会随年龄增长而增加[3].部分幸存者中会有高达70％～80％的概率遗留不同程度的残疾,丧失日常生活活动能力,神经功能缺失,且伴有不同程度的抑郁情绪[4].主要表现为消极、悲观、思维迟缓等情感障碍,希望水平低下.这不仅是一种心理反应,还会影响躯体功能使术后恢复过程艰难、漫长,严重影响患者的生活质量,同时患者家庭也承受着沉重的经济负担和生活压力[5].因此,科学有效的护理治疗方案尤为重要.基于此,本研究采用聚焦解决模式对脑卒中后偏瘫患者Barthel指数及日常生活活动能力的影响加以探讨,现报告如下.

目的 研究分析CT灌注成像对烟雾病术后桥血管再通及手术前后脑血流变化.方法 选择我院2019年1月-2021年1月接诊的15例浓烟病患者,所选患者均拟执行颅内颈内动脉闭塞的搭桥手术,手术治疗前、手术后行CT灌注扫描及CT血管造影,对病人手术前后脑血流量(CBF)、脑血容量(CBV)、均值时间(MTT)和达峰时间(TTP)开展全面分析、定性研究,测算术侧/另一侧相对比值(rCBF、rCBV、rTTP及rMTT值).结果 15例病人手术后CT血管造影显示血管均顺畅.15例病人手术前、手术治疗侧与对照侧CT灌注扫描变量值对比,患肢大脑中动脉分布区的CBF减少,CBV提升,MTT增加;浓烟病患者血管搭桥术后手术治疗侧与手术前对比发现,大脑中动脉分布中rCBF提升,rCBV无变化,rMTT减少.差别有统计学意义(P值<0.05).结论 灌注成像对烟雾病术后桥血管再通及手术前后脑血流变化的评估准确,可反应血管形态以及血容量变化,对手术前后脑血流变化的评价具备重要价值.

目的:探讨肺呼吸康复治疗对慢性阻塞性肺疾病(COPD)缓解期患者临床疗效及用力肺活量(forced vital capacity,FVC)、第一秒用力呼气容积(forced expiratory volume in the first second,FEV1)、FEV1/FVC的影响.方法:选取2018年4月-2020年4月本院收治的COPD缓解期患者126例,按随机数字表法将其分为对照组与研究组,每组63例.对照组给予常规康复治疗,研究组在对照组的基础上给予肺呼吸康复治疗.比较两组功能性呼吸困难及临床症状的治疗效果;比较两组治疗前后肺功能指标、6 min步行距离及生活质量.结果:研究组功能性呼吸困难、胸闷气短及咳嗽治疗有效率均高于对照组(P<0.05);研究组治疗后FEV1/FVC、FEV1、FVC均高于对照组(P<0.05);研究组治疗1、3个月时的6 min步行距离及生活质量评分均优于对照组(P<0.05).结论:COPD缓解期患者应用肺呼吸康复治疗,能够更好地改善患者呼吸困难、咳嗽、胸闷等临床症状,显著提高生活质量、运动耐力及肺功能各项指标,值得临床推广.

目的 建立小白花地榆总鞣质的含量测定方法.方法 采用比色法,以没食子酸为对照品,测定小白花地榆总鞣质含量.结果 以没食子酸计,小白花地榆鞣质浓度在0.986～9.86μg/mL范围内呈良好线性关系(r=0.9996);平均回收率为99.79％,RSD为2.74％(n=8).结论 本实验方法操作简便、准确、稳定性及重复性好,可用于小白花地榆总鞣质的含量测定.

目的:探讨胃腺癌病理类型与胃C T灌注成像参数值间的相关性.方法:选取2015年1月到2019年7月期间在我院接受治疗的胃腺癌患者93例.经CT灌注成像,所得数据使用专用软件,进行分析,得血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)和表面通透性(the permeabil ity surface,PS)数据值.根据胃镜病理分三组:低分化组、中分化组及高分化组,并分析各组间的相互联系.结果:高分化胃腺癌患者21例、中分化腺癌患者27例、低分化胃腺癌患者45例,比较3组,高分化组与中分化组、高分化组与低分化组B F、B V和P S的差异均有统计学意义(P<0.05).而3组M T T值无统计学差异(P>0.05).B F、B V、MTT、PS与不同T分期差异有统计学意义.结论:胃CT灌注成像可前瞻性评估胃腺癌的病理类型.

胃癌是我国常见的恶性肿瘤之一,发病率和死亡率在消化道肿瘤中居首位 [1].寻找更好的治疗方法以减少手术创伤及术后并发症,越来越被临床医生所重视.腹腔镜下胃癌根治术逐渐被人们推崇,腹腔镜最大的困难是淋巴结的清扫,而淋巴结往往在血管周围分布,清除过程中要沿着血管进行,胃周血管(如腹腔血管)变异较多,增加了胃周淋巴结清扫的难度 [2].现在CT血管成像技术日臻完善,术前即可清晰显示腹腔动脉及其分支的解剖情况,结合CT灌注成像也可评价胃腺癌病灶的血流动力学情况.本研究探讨CT血管成像联合灌注成像在胃腺癌中的临床应用,现报道如下.

Objective To investigate the expression of CD47 in multiple myeloma (MM) and its clinical significance.Methods From September 2016 to May 2018,all of 25 cases of MM patients who were diagnosed and treated in Hongqi Hospital Affiliated to Mudanjiang Medical University were selected as research subjects,and enrolled in study group.In study group,there were 15 males and 10 females with the age of (58.5 ±-4.2) years.Twelve MM patients were treated with CTD (cyclophosphamide+ thalidomide+ dexamethasone) regimen and the rest 13 cases with VAD (vincristine + pirarubicin + dexamethasone)regimen.Six cases of individuals who received physical examination in the same period and the same hospital were included in control group.In control group,there were 3 males and 3 females with the age of (56.3±4.1) years.CD47 expression levels of mononuclear cells in bone marrow from MM patients and peripheral blood from healthy individuals were detected by flow cytometry.Relationships between CD47 expression in MM patients and complete remission (CR),recurrence in study group were analyzed.The positive expression rate of CD47 of subjects in two groups,and CR rates of MM patients with different treatment regimens and CD47 expressions in study group were compared by Fisher's exact probability method.The procedure of this study is accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2013.Informed consent was obtained from all participants.Results ① CD47 positive expression rate of MM patients in study group was 40.0％ (10/25),and was significantly higher than that of 0(0/6) in control group,and the difference was statistically significant (P =0.018).② In study group,CR rate of MM patients with positive CD47 expression was 20.0％ (2/10),and was significantly lower than that of 73.3％ (11/15) in patients with negative CD47 expression,and the difference was statistically significant (P =0.013).CR rate of MM patients receiving CTD regimen with positive CD47 expression was 16.7％ (1/6),and was significantly lower than that of 83.3％ (5/6) in pactients with negative CD47 expression,and the difference was statistically significant (P =0.040).CR rate of MM patients receiving VAD regimen with positive CD47 expression was 16.7％ (1/6),and was significantly lower than that of 85.7％ (6/7) in patients with negative CD47 expression,and the difference was also statistically significant (P =0.029).③ There was no statistically significant difference in CR rate between patients with positive CD47 expression who were treated with VAD and these who were treated with CTD regimen (P=0.773).And there was no statistically significant difference in CR rate between patients with negative CD47 expression who were treated with VAD and these who were treated with CTD regimen (P =0.731).④ All 2 MM patients with positive CD47 expression who obtained CR,and 2 of 11 MM patients with negative CD47 expression had relapsed.Conclusions The expression rate of CD47 on bone marrow mononuclear cells in MM patients was significantly higher and was related to curative effect and prognosis of MM patients.CD47 may be used as a potential auxiliary evaluation indicator for efficacy and prognosis in MM.This conclusion is limited to the clinical analysis of a small sample,and it requires large sample,multi-center,randomized controlled trials for further study and verification.

目的:分析探讨PBL(问题式学习)与CBL(案名教学法)教学法在外科学教学中的优缺点分析.方法:选取120名5年制外科学临床医学本科生作为观察对象,并将其分为2组,即观察组和对照组各60名,观察组采用CBL教学法,对照组采用PBL教学法,通过理论考试及调查问卷方式分析两种教学方式的优缺点.结果:与对照组的总有效率比较,治疗组的总有效率明显更高,经比较,两组存在显著统计学差异(p<0.05);对照组在师生互动、课堂气氛、独立学习能力方面的认可率明显高于观察组,而在综合分析及团队协作能力方面明显低于观察组,经比较,存在显著统计学差异(p<0.05).结论:在外科学教学中,PBL和CBL教学法均各有优势,大部分学生比较认可CBL教学法.

Objective To examine the distribution and drug resistance of common pathogenic bacteria isolated in small children with bronchopneumonia in Mudanjiang region of Heilongjiang province and to provide a theoretical basis for the treatment and prevention of bronchopneumonia in small children. Methods We randomly recruited 200 infants and small children receiving treatment for bronchopneumonia in Hongqi Hospital Affiliated to Mudanjiang Medical College from December 2015 through December 2016. Sputum specimens of the participants were collected for culture and drug susceptibility test of pathogenic bacteria. The distribution and antibiotic resistance of the isolated pathogenic bacteria were analyzed. Results For all the sputum specimens, totally 84 bacterial strains were isolated and the culture-positive rate was 42.00 ％. Of all the strains, 29 (34.52 ％) were gram-positive and 55 (65.48 ％) were gram-negative; and the detection rate of gram-negative bacteria was significantly higher than that of gram-positive bacteria. The first two identified gram-positive bacteria were Staphylococcus aureus and Streptococcus pneumoniae, accounting for 72.41 ％ of the gram-positive strains isolated; while the first two gram-negative bacteria were Klebsiella pneumoniae and Escherichia coli, accounting for 70.91 ％ of the gram-negative strains. Antibiotic susceptibility tests revealed highly resistant strains of Staphylococcus aureus and Streptococcus pneumoniae to ampicillin/sulbactam (Unasyn), tetracycline, penicillin G, oxacillin, and ampicillin (AMP); Klebsiella pneumoniae to Unasyn, AMP, aminotram (AZT), trimethoprim-sulfamethoxazole (SMZCo), and cefuroxime (CXM); and Escherichia coli to Unasyn, AMP, AZT, SMZCo, cephalosporin, CXM, and ceftriaxone. Conclusion Gramnegative bacterial are major bacteria pathogens for bronchopneumonia and the isolated pathogenic bacteria of bronchopneumonia are highly resistant to antibiotics commonly used among infants and small children in Mudanjiang region; the results need to be concerned in clinical medication for the disease.

Objective To investigate the effect of Bulbus Fritillariae Cirrhosae medicated serum on the proliferation of the bronchial smooth muscle cells (BSMC),the tube formation and the expressions of vascular endothelial growth factor (VEGF) in BSMC.Methods The murine were sensititized and challenged with ovalbumin (OVA) to establish asthma model and Bulbus Fritillariae Cirrhosae medicated serum was prepared.The BSMC were cultured in vitro and randomly divided into the blank serum group,the low dose group and the high dose group.The proliferations of BSMC,the lengths of the tube formation,the expressions of VEGF and VEGF mRNA were detected.Results Compared with the blank serum group,the proliferations of BSMC,the lengths of the tube formation,the expressions of VEGF and VEGF mRNA of the low dose group and the high dose group were increased significantly (P ＜ 0.05).Conclusion Bulbus Fritillariae Cirrhosae medicated serum can inhibit the proliferations of BSMC and the lengths of the tube formation,and the possible mechanisms may be related to reduce the expressions of VEGF.

目的 探析精细护理在多通道经皮肾输尿管镜取石术治疗复杂肾结石中的应用效果.方法 选择我院收治的复杂肾结石患者60例,均在我院进行多通道经皮肾输尿管镜取石术治疗.根据入院顺序(单双号)进行分组,观察组进行精细化护理干预,对照组进行常规护理干预.分析护理效果.结果 观察组患者的护理总有效率高于对照组,观察组患者的护理满意度高于对照组,两组患者对比差异明显,且P<0.05,具有统计学意义.结论 对进行多通道经皮肾输尿管镜取石术治疗复杂肾结石患者采用精细化护理,临床效果显著,值得广泛应用.

目的:优化原花青素羟丙基-β-环糊精包合物的最佳制备工艺。方法:以包合率为指标,采用正交试验方法,对包合物的制备工艺进行优化。结果:确定最佳制备工艺投料质量比（原花青素和羟丙基-β-环糊精的质量比1:4）、羟丙基-β-环糊精质量分数30%、包合温度20℃、包合时间2.5h。结论:用溶液搅拌法对原花青素进行包合方法可行,包合率为24.5%。

目的：总结应用256层螺旋CT观察胰腺实性假乳头状瘤的影像特点及诊断价值。方法回顾性分析经手术后病理确诊的16例胰腺实性假乳头状瘤的CT影像资料,总结胰腺实性假乳头状瘤的CT影像特点。结果16例胰腺实性假乳头状瘤均为单发,男2例,女14例,平均年龄28.3岁；临床表现无特异性；其中位于胰头者9例,胰体者2例,胰尾者5例；肿块多较大,边缘光整,平均最大径为7.8 cm, CT平扫呈囊实性肿块,5例病灶内出现钙化灶,钙化呈斑片状、条状。增强扫描动脉期肿块轻度强化,静脉期肿块实性部分持续强化,呈渐进性强化,病灶中心囊变区无强化。结论胰腺实性假乳头状瘤有其特定的好发人群及特征性的CT表现,多层螺旋CT对胰腺实性假乳头状瘤具有诊断价值的。

目的：探讨去甲氧柔红霉素（IDA）与预激方案（CAG）联合治疗首发性老年急性髓细胞白血病（AML）的临床效果。方法收集该院2008年6月到2012年1月收治的AML患者80例，按照随机数字表法分为观察组和对照组，每组40例，均给予相应的支持治疗，观察组给予IDA与CAG方案联合治疗，对照组给予柔红霉素（ DA）方案治疗，观察两组治疗效果、生存时间及不良反应。结果观察组治疗有效率为92．5％，控制率为97．5％，高于对照组的67．5％，82．5％（P＜0．05）。观察组平均生存时间高于对照组（P＜0．05），观察组1、2、3年生存率分别为84．6％、58．9％、41．8％，明显高于对照组的61．0％、36．8％、26．4％（均P＜0．05）。两组血红蛋白减少、血小板减少、恶性、呕吐、肾功能异常、骨髓抑制时间具有统计学差异（P＜0．05），肺部感染、直肠、膀胱炎、肝功能损害无统计学差异（P＞0．05）。结论 IDA与CAG联合治疗首发性老年AML效果显著，毒副反应少，具有一定安全性。

目的 探讨血液肿瘤患者化疗期间的静脉护理的临床经验.方法 选择于2013年1月~2015年1月来我院接受治疗的65例血压肿瘤患者为研究对象,采用静脉留置针,对其临床护理经验进行总结. 结果 65例血液肿瘤患者使用静脉留置针进行静脉化疗,全程中没有药物外泄等的发生.有1例患者产生静脉炎,根据诊断标准判断为1级,并发症的发生率为1.54%.该患者经过对症治疗后痊愈.结论 血液肿瘤患者在化疗时,使用静脉留置针进行输液,可以有效保护静脉,降低患者的痛苦,提高患者的生存质量,提高护理的质量,具有重要的临床应用价值.

目的:建立一种应用电化学指纹图谱技术测定复方中药祛痘软膏剂含量的方法.方法:采用电化学指纹图谱技术,以诱导时间为评价指标,对复方中药祛痘软膏剂含量进行测定.结果:中药浸膏粉检测范围6～34mg/mL,回归方程:t=6898-183.5c,R=0.9970,日内RSD为1.07％,日间RSD为1.68％,加样回收率RSD＜ 1％,三批样品含量(相当标示量)在98.6％ ～101.4％,符合要求.结论:通过方法学考察,建立一种有效、便捷、可靠、准确地评价中药软膏剂的方法.

目的 探讨二氧化碳(CO2)用于结肠镜检查的效果及安全性.方法 行结肠镜检查患者100例随机分为CO2组和空气组各50例,检查时分别注入CO2和空气,比较2组检查前、镜头达阑尾开口及检查结束时pa(CO2)水平,记录镜头到达阑尾开口及检查1、6、12h时腹痛、腹胀评分,检查后1h行腹部X线检查评定结肠膨胀程度评分.结果 2组镜头达阑尾开口及检查结束时pa(CO2)与检查开始前比较差异均无统计学意义(P＞0.05);2组各时间点pa(CO2)比较差异均无统计学意义(P＞0.05);CO2组检查前及检查1、6h腹痛评分[(2.43±0.22、2.22±0.21、1.34±0.18)分]、腹胀评分[(3.08±0.26、2.10±0.20、1.69±0.10)分]和检查后1h结肠膨胀程度评分[(2.42±0.14)分]均低于空气组[腹痛评分(4.60±0.53、3.50±0.39、2.52±0.33)分、腹胀评分(4.70±0.50、3.30±0.32、2.56±0.32)分、结肠膨胀程度评分(4.14±0.46)分](P＜0.05).结论 与结肠镜检查中应用空气相比,应用CO2可减轻术中及术后腹痛、腹胀症状,且不增加CO2潴留.

In order to evaluate influence of comprehensive nursing intervention on quality of life in patients with peptic ulcer,Hongqi Hospital Affiliated to Mudanjiang Medical University in April 2014-April 2015 admitted 70 cases of peptic ulcer patients were randomly divided into treatment group and the control group , the control group received routine care approach,integrated nursing care group intervention,compared two groups of patient care satisfaction scores result of living activities.Nursing care patients satisfaction 97.14%,the living activity of the living activity of care patients (appetite,physical functioning,sleep and spiritual life)score results and scores of patients in the control group had significant results contrast differences (P<0.05),with statistical significance.The result showes that peptic ulcer patients with comprehensive care interventions ,can significantly improve the quality of life of patients and improve nursing satisfaction ,worthy of clinical application.