目的:探讨供血动脉化疗栓塞联合氩气刀及冷冻治疗中晚期中央型肺鳞癌的疗效、安全性和对肺功能改善影响.方法:161例中晚期中央型肺鳞癌随机分为供血动脉化疗栓塞联合氩气刀及冷冻治疗组(干预组)和单纯全身静脉化疗组(对照组),两组化疗方案均为GP方案(吉西他滨+顺铂).比较两组患者治疗6月后的临床疗效、不良反应发生及肺功能改善情况.结果:随访6个月,干预组和对照组治疗有效率分别为58.62％和36.48％,生存率分别为93.1％(81/87)和79.7％(59/74),两组差异统计学有意义(P<0.05).治疗后两组患者FEV1、FVC指标均有所改善,干预组改善情况更显著(P<0.05).两组患者不良反应的发生情况有所差异,干预组化疗常见副作用发生率较单纯全身静脉化疗组低.结论:供血动脉化疗栓塞联合支气管镜下氩气刀及冷冻治疗中晚期中央型肺鳞癌在近期疗效、肺功能改善及安全性方面皆优于传统化疗,临床应用价值大,值得推广应用.

目的:通过精细化管理,加强医院运营管理,以提高医院运营效率和效益,促进医院高质量发展.方法:实施综合目标精细化管理改革,发挥医院运营管理对员工的激励导向作用.结果:医务人员积极性提高,满意度、认同感、归属感显著增强、运营管理理念得到认可.结论:精细化管理能够有效提升医院各方面管理水平,促进医院运营效率和效益双提升.

目的:探讨荧光支气管镜活检诊断小细胞肺癌的临床价值.方法:回顾性分析经荧光支气管镜活检诊断的84例小细胞肺癌患者的临床资料,观察小细胞肺癌患者镜下表现、钳取技巧和临床特点.结果:经荧光支气管镜钳检阳性率(97.62％)高于刷检阳性率(90.05％),差异有统计学意义(P<0.05).84例小细胞肺癌的影像学表现为胸腔积液4例、阻塞性肺炎21例、肺周结节或团块29例、纵膈以及肺门团块影45例;病灶位置为左侧44例、右侧40例;镜下分型为混合型6例、管腔外压型10例、管壁浸润型28例、管内增生型40例.结论:小细胞肺癌影像学表现缺乏明显特征,结界、肿块是小细胞肺癌的主要表现;经荧光支气管镜钳检诊断小细胞肺癌阳性率较高,可为临床诊治提供参考依据.

目的:探讨磁共振扩散加权成像(diffusion weighted magnetic resonance imaging,DW-MRI)对肺癌患者的鉴别诊断效果.方法:前瞻性选取广元市中心医院2015年5月至2018年2月经常规CT检查发现肺结节的68例患者为研究对象,患者于手术或穿刺活检前行常规MRI和DW-MRI检查,以病理学检验结果为诊断金标准,对不同扩散敏感系数(b值)下良性肺结节和恶性肺结节病变与脊髓信号强度百分比(lesion-to-spinal cord ratio,LSR)进行检测,对具有鉴别诊断价值的LSR进行诊断效果分析.结果:68例肺结节患者经手术或穿刺活检病理检查恶性肺结节患者38例(恶性组),良性肺结节患者30例(良性组).在b值为400 s/mm2和600 s/mm2时,恶性组LSR值明显高于良性组(P<0.05);与病理结果相对照,b值为400 s/mm2时的灵敏度为63.16％,特异度为73.33％,准确率为67.65％;b值为600 s/mm2时的灵敏度为71.05％,特异度为66.67％,准确率为69.12％.根据受试者工作特征(receive operating characteristic,ROC)曲线,b值为400 s/mm2时,LSR值67.86％为最佳临界值,曲线下面积(area under the curve,AUC)为0.691,b值为600 s/mm2时,LSR值56.58％为最佳临界值,AUC为0.711.结论:DW-MRI计算LSR值对诊断恶性肺结节有一定的临床价值.

目的:观察丙酸倍氯米松雾化吸入联合孟鲁司特钠对咳嗽变异性哮喘(CVA)患者气道炎症控制及外周血免疫球蛋白4(IgG 4)及细胞间黏附分子-1(ICAM-1)水平影响.方法:采用便利抽样的方法,纳入120例CVA患者为调查对象,按照数字表法将其随机分成对照组和研究组,每组60例.对照组仅给予吸入丙酸倍氯米松混悬液进行治疗,研究组在对照组治疗基础上加用孟鲁司特钠进行治疗,两组均连续治疗12周,比较研究组和对照组中患者治疗成功率和复发率,并分析两组患者治疗前后血清白细胞介素(IL-5、IL-8和IL-10)、外周血免疫球蛋白4(IgG 4)、细胞间黏附分子-1(ICAM-1)水平以及肺功能支气管舒张试验的变化情况.结果:研究组哮喘控制率优于对照组(75.00％/50.00％),差异有统计学意义(x2=4.658,P=0.031);治疗后,研究组患者IL-5、IL-8、IL-10和TNF-α的水平明显低于对照组(P＜0.05);治疗后研究组血清IgG 4水平高于对照组,ICAM-1水平低于对照组,差异均有统计学意义(P＜0.05);治疗后随访3个月,对照组复发11例(18.33％),研究组复发2例(3.33％),两组比较差异有统计学意义(x2 =6.988,P=0.008).结论:丙酸氟替卡松通过与孟鲁司特钠的联合作用,对于治疗咳嗽变异性哮喘效果显著,有效降低炎症因子及ICAM-1水平,并且对提高IgG 4水平也有很大疗效,值得推广和应用.

目的:探讨提高临床科室管理质量的对策,提出建设性意见.方法:随机抽取广元市中心医院临床科室医生188人,采用匿名填写问卷的方式对其进行调查,用EXCEL软件统计分析调查结果.结果:临床医生对科室管理总体满意度较高,其中满意度较高的两项为科室的团队精神和协作意识、工作氛围;不满意度较高的三项为薪酬分配、学科建设、科室对年轻医务人员的培养.结论:通过对临床医生进行满意度调查,管理者可发现管理中存在的问题,改进医院管理政策和措施、工作条件等,提高医生、患者满意度,提高医院管理水平.

Objective Diagnostic value of diffusion-weighted imaging with MRI in voxel pheromone for pulmonary atelectasis in patients with lung cancer. Methods A total of 177 patients with atelectasis admitted to Guangyuan Central Hospital of Sichuan Province were selected. Among them, 112 patients with pulmonary atelectasis caused by central lung cancer were experimental group, and patients with pulmonary atelectasis caused by pneumonia were 65 control subjects. In both groups, pleural MRI images of central lung cancer and pneumonia were detected by MR pheripherial incoherent motion diffusion weighted imaging. The image-related parameters of the two groups were analyzed. Results The results of diffusion-weighted imaging of MRI in voxels in both groups showed that central lung cancer tissues expressed high signals on T2 WI, while those in obstructed lung tissues had low signals, and their signal intensity was different. Patients are identified and classified. By comparing the parameters of lung lesions in the two groups of patients, the D value and D * value of the experimental group were (0.65 ± 0.18) × 10-3 mm2/s and (19.76 ± 6.24) × 10-3 mm2/s, respectively. The D value and D* value of the group were (0.66 ± 0.15) × 10-3 mm2/s and (20.13 ± 8.31) × 10-3 mm2/s; the data in the experimental group was lower than the control group, but the difference was not statistically significant (P＞ 0.05), f (％) value of the test group and the control group, the difference was statistically significant (t =-5.1751, P ＜ 0.05). Conclusion The diffusion-weighted imaging of incoherent motion in MRI voxels has high clinical diagnostic value for central pulmonary atelectasis.

目的 探讨表皮生长因子受体-酪氨酸激酶抑制药(EGFR-TKI)靶向治疗对是否伴恶性胸腔积液非小细胞肺癌(NSCLC)患者的疗效差异.方法 回顾性分析120例晚期NSCLC患者的病历资料,根据患者是否伴有恶性胸腔积液分为A组66例(伴有胸腔积液)和B组54例(不伴有胸腔积液),两组均采用基础治疗+EGFR-TKI治疗,比较两组患者的疗效差异及治疗前和治疗3个月后的KPS评分、血清癌胚抗原(CEA)、鳞状上皮细胞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)、血管内皮细胞生长因子(VEGF)水平的变化.结果 A组患者的缓解率为50.00％、总有效率为81.82％,均低于B组的70.37％、94.44％,两组比较,差异均有统计学意义(P﹤0.05).治疗前,A组和B组患者的血清CEA、SCC、NSE、VEGF水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者的血清CEA、SCC、NSE、VEGF水平均较本组治疗前降低(P﹤0.05),且A组患者的血清CEA、SCC、NSE、VEGF水平均明显高于B组,差异均有统计学意义(P﹤0.01).治疗前、治疗后两组患者的KPS评分比较,差异均有统计学意义(P﹤0.05),但A组患者治疗前后的KPS评分差值明显低于B组患者,差异有统计学意义(P﹤0.01).结论 EGFR-TKI靶向治疗对是否伴恶性胸腔积液NSCLC患者均具有一定的临床效果,但是对不伴恶性胸腔积液的患者效果更好,患者的KPS评分提高的更多.

Objective To investigate the relationship between the mutation of epidermal growth factor receptor (EGFR) gene and the biological behavior of lung cancer patients with malignant pleural effusion. Method 100 patients with lung cancer, including 43 cases with malignant pleural effusion (study group), and 57 patients without pleural effu-sion (control group), were observed for the EGFR mutation status. Result The overall EGFR mutation rate in the study group was 72.09%, significantly higher than that of the control group at 19.30%(P<0.05);the EGFR mutation rate of pa-tients with high, moderate and low differentiation in study group was 69.23%, 71.43%and 77.78%, which were signifi-cantly higher than those in the control group, respectively (P<0.05);gender, age, smoking status and differentiation de-gree were independent of the EGFR mutation rate in study group (P>0.05);the Kappa value of the EGFR gene test results obtained from pleural effusion and biopsy specimens was 0.466 (P<0.05), indicating a moderate consistency. Conclusion EGFR mutation rate is higher in lung cancer patients with malignant pleural effusion, but is not associated with gender, age , smoking status and differentiation degree.

目的探讨高通量血液透析对维持性血液透析患者钙磷代谢的影响,为临床维持性血液透析合并有钙磷代谢紊乱的患者提供新的血液透析治疗思路。方法纳入2013年1月至2015年1月于我院门诊行维持性透析治疗且合并有高磷血症及继发性甲状旁腺功能亢进的患者80例,将其随机分为高通量血液透析组（甲组）和普通血液透析组（乙组）;比较透析前及透析后3个月、6个月患者血磷、血钙、骨密度、全段甲状旁腺素（immunoreactive parathyroid hormone,iPTH）、血红蛋白（hemoglobin,Hb）、C反应蛋白（C-reactive protein,CRP）透析充分性及患者的生活质量（如皮肤瘙痒、骨痛、关节痛）的变化。采用SPSS 20.0软件进行数据分析,P＜0.05表示差异有统计学意义。结果治疗3个月后甲组患者的血磷、iPTH、CRP水平较治疗前有降低,血钙及Hb较治疗前有升高,但治疗前后差异无统计学意义（P＞0.05）;乙组患者治疗3个月后患者的血磷、iPTH、CRP水平较治疗前升高,血钙及Hb较治疗前有降低,差异无统计学意义（P＞0.05）;治疗3个月后2组间比较,血磷、血钙、iPTH和CRP无差异（P＞0.05）。治疗6个月后甲组患者的血磷、iPTH、CRP水平较治疗前明显降低,血钙及Hb较治疗前明显升高,治疗前后差异有统计学意义（P＜0.05）;乙组患者治疗6个月后患者的血磷、iPTH水平较治疗前明显升高,差异有统计学意义（P＜0.05）;血钙及Hb较治疗前有升高,差异无统计学意义（P＞0.05）;治疗6个月后2组间比较,甲组血磷、iPTH、CRP较乙组降低（P＜0.05）,血钙较乙组升高（P＜0.05）。随着治疗时间的延长,甲组患者皮肤瘙痒、骨痛、关节痛的症状逐渐减轻,乙组患者的上述症状无明显改善;2组间比较,甲组关节痛和皮肤瘙痒较乙组明显缓解（P＜0.05）。2组患者治疗前后骨密度检测、透析充分性无明显差异（P＞0.05）。结论高通量血液透析对于维持性血液透析患者钙磷代谢紊乱、继发性甲状旁腺功能亢进、减轻皮肤瘙痒程度、贫血及生活质量有较好的改善作用。

Objective To observe the effects of combination artificial kidney on the prognosis of patients receiving maintenance hemodialysis. Methods Eighty-four patients who underwent maintenance hemodialysis in our hospital from January 2015 to June 2015 were randomly divided into two groups, in whom 42 patients were treated by combination artificial kidney dialysis ( HD+HP group) ,however,the other 42 patients were treated by conventional hemodialysis ( HD group) ,and the changes of blood pressure, blood phosphorus, parathyroid hormone (iPTH), itch of skin and dialysis efficiency were observed and compared between two groups,with follow-up until December 2015 for all the patients,the general status and incidence of complicatioms were observed and compared between two groups. Results The levels of blood phosphorus,iPTH, skin itch scores and systolic pressure in HD+HP group after 12 -week dialysis were significantly lower than those in HD group ( P <0. 05),however, the levels of URR and KT/V were significantly higher than those in HD group ( P <0. 05). The average follow-up time in HD+HP group was (20. 1 ± 1. 3) weeks,which in HD group was (19. 8 ± 1. 2) weeks. The levels of BMI,URR,ALB and up to the standard rate of calcium-phosphorus product in HD+Hp group at the last folow-up were significantly higher than those in HD group ( P <0. 05). The incidence rates of cardiovascular complications, skin itch, peripheral nerve infection, renal osteopathy or arthropathy in HD+HP group were significantly lower than those in HD group (P<0. 05 ). Conclusion The effects of combination artificial kidney dialysis are superior to those of conventional hemodialysis,which can remove the middle or macromolecular toxins that can not be removed by conventional hemodialysis, moreover, which can control blood pressures and calcium-phosphorus balance,improve the general status and prognosis of patients with terminal stage renal failure.

Objective: To improve the interventional treatment of bronchial artery malformation feeding artery embolization intractable hemoptysis better therapeutic effect. Methods: From May 2009 - December 2013 DSA angiography confirmed cases of hemoptysis caused by bronchial artery malformation, 54 cases were randomly divided into treatment group and control group, treatment group gelatin sponge (GS) joint polyvinyl alcohol particles (PVA) and / or coils of 32 patients in the control group was simply GS22 cases. All patients 1d, 1 week, 1 month, 6 months, 1 year follow-up data variance, rank sum test for analysis.Results:Follow-up treatment group were cured 28 cases, effective in three cases, one case effectively. In the control group were cured 14 cases, effective in 5 cases, 2 cases. Treatment group was higher efficiency, lower relapse rate than the control group, the two groups and testP<0.05, the difference was statistically significant.Conclusion: Feeding artery embolization for the treatment of bronchial artery malformation intractable hemoptysis significant effect, method is safe, durable, bleeding quickly, recurrence rate, effective intervention to improve hemoptysis.Effectively improve the success rate of interventional treatment of hemoptysis.

Objective To explore the of the clinical curative effect and the analysis of recurrence comparing gelatin sponge( GS) in combination with yvinyl alcohol( PVA) particles with single application of GS and PVA to big haemoptysis blood supply artery embolization. Methods To 95 cases of large hemoptysis patients,randomly divided into treatment group and control group,treatment group GS joint PVA,a total of 52 cases,control group 1 application PVA21 example,22 cases of control group 2 application of GS. Some follow-up surveys took 3 months others took 12 months. Results There were immediate hemostasis 52 cases,effective rate of treatment group was 100%,the recurrence rate was 7. 7%( 4 /52). In the control group 1the rate of immediately stop bleeding was 90%( 19 /21),the recurrence rate was 19%( 4 /21); In the control group.( 2) the rate of immediate bleeding was 82%( 17 /22),the recurrence rate was 23%( 6 /22); effectiveness in treatment group is higher than the control group 2 the recurrence rate was lower than those of control group,the difference was of statistically significant( P<0. 05). Conclusion GS joint PVA completely radical embolization all big hemoptysis patients participate in lesions of blood vessels and treatment of primary disease,curative effect is distinct,the method is safe,durable,stop bleeding quickly,postoperative recurrence rate is low,improve successful rate effectively with the treatment of the big haemoptysis interventional.

Objective To evaluate factors influencing the severity of MPP.Methods 186 MPP children admitted to Guangyuan Center hospital from 2005 to 2009 were involved into the study.Indirect microparticle agglutinin assay and cold agglutinins titer were conducted at both admission and discharge.A total of 186 children with MPP were grouped by age: ≤ 2 years of age(28 patients),3~5 years of age(79 patients),and ≥ 6 years of age(79 patients).They were also grouped by pneumonia pattern: bronchopneumonia group(94 patients) and segmental/lobar pneumonia group(92 patients).In addition,the children aged≥6 years(79 patients) were classified into three groups based on the severity of pneumonia: bronchopneumonia group(25 patients),mild segmental/lobar group(31 patients),and severe segmental/lobar group(23 patients).Ages,clinical symptoms,pulmonary lesions,laboratory findings and seroconversion rate of the 186 children with MPP were retrospectively analyzed.Results The fever in the three age groups all lasted ≥7 days.There were significant differences among the three different age groups in bronchopneumonia,segmental/lobar,white blood cell count,neutrophil,lymphocyte,platelet count and C-reactive protein values(P0.05).The age,duration of fever,hospitalization,WBC count,neutrophil,lymphocyte,absolute lymphocyte count,platelet count,CRP,ESR and seroconversion rate were significantly different between the bronchopneumonia group and the segmental/lobar group(P0.05).Hospitalization,CRP and seroconversion rate were significantly different among the bronchopneumonia group,the mild segmental/lobar group and the severe segmental/lobar group(P0.05).Conclusion In MPP,older children had longer fever and more severe pulmonary lesions.The severity of pulmonary lesions was associated with the absence of diagnostic IgM antibodies and lymphocyte count.Rapid pairing IgM serologic test is of great importance for early diagnosis of MPP.

目的探索胸部损伤浮动胸壁中前支肋骨骨折内固定的有效方法。方法回顾性分析2007年1月至2009年12月广元市中心医院43例多发性前支肋骨骨折患者采用形状记忆环抱接骨板内固定治疗的临床资料,根据手术方式不同,将43例分为两组,常规手术组:18例,其中男16例,女2例;年龄(38.5±3.8)岁,采用常规手术方法行肋骨内固定术;改良手术组:25例,其中男21例,女4例;年龄(36.4±5.6)岁;采用改良手术方法行肋骨内固定术。对两种手术方法的难易程度、手术时间和术后效果进行比较。结果围术期无死亡,术后两组患者胸廓形状均恢复正常,反常呼吸消失,呼吸困难显著改善,肋骨骨折均达到解剖复位。术后无肺部、胸腔、切口感染和肺不张等并发症发生。改良手术组手术时间[(74.80±9.41)min vs.(91.94±17.42)min,P=0.006]和术中出血量[(34.20±14.70)ml vs(.83.33±20.72)ml,P=0.000)]明显短于或少于常规手术组。随访28例(改良手术组17例、常规手术组11例),随访时间1个月～1年,失访15例。随访期间两组患者肋骨骨折均愈合,无胸廓畸形和呼吸功能受损,亦未见记忆环抱接骨板脱落、断裂和移位。患者恢复正常生活或工作。结论前支肋骨骨折内固定的改良手术操作简单、方便、创伤小、出血少和临床效果好,值得临床推广应用。

Objective Sichuan Guangyuan nephropathy renal biopsy data were summarized and used to speculate that the local characteristics of its epidemiology. Methods Court 2004 to 2011 in December, 366 cases of kidney patients, their renal biopsy data analyzed and summarized, and explored the pathological type of Guangyuan City, kidney disease patients, clinical manifestations and epidemiological school characteristics. Results Male 43.4%, 56.6% of women, different age distribution shows the highest prevalence of between 30 to 50 crowd. Nephrotic syndrome from the disease clinical classification, up to 175 cases (47.8%), second place is a chronic glomerulonephritis in 112 cases (30.6%). From 366 cases in patients with primary glomerular diseases (PGD) in the etiology of view up to 194 cases (53.0%), followed by secondary glomerulonephritis, 141 cases (38.5%), tubulointerstitial disease (TIDs) in 13 cases (3.6%), metabolic diseases (HERD), 11 cases (3.0%). Conclusion The cases of the Guangyuan primary glomerular disease, PGD's disease accounted for 53.0% of the total number of patients 40 years of age accounted for 69.8%; secondary glomerular diseases SGN (38.5%) in the text, which, IgA nephropathy,29.8%, purpura nephritis (with HSPN) 2.5%, lupus nephritis (LN) 5.5%, three kinds of secondary renal disease accounted for 98.2%.

Objectve To evaluate the distribution features of silicosis small shadow's image in lung at early stage.Methods The X-ray images of Pneumoconiosis Shadow-likes' changing in lung of 754 persons in 12 726,who once participated in railway construction,but did not meet the standards of silicosis stage I diagnostic criteria,were analyzed.Results The image distribution features of silicosis small shadow in lung at early stage are: most in lower lung field,less in upper,and more in the right than in the left.The combination of appearance at the right and left lung at the same time: most in bilateral lower field followed by bilateral middle field.Conclusion The distribution of silicosis small shadow's image in lung at early stage has some regularity and characteristic,and is very important for guiding prevention,diagnosis and treatment of pneumoconiosis.

Objective discussion supersonic localization after skin kidney puncture living tissue inspection technique at place municipal hospital kidney disease's clinical value.Method review analyzed my courtyard admitted August,2004 346 examples which to May,2011 after the skin kidney puncture living tissue inspection to suspect highly the kidney pathological change's patient's clinical material,summarized this group of patient puncture success ratio,pathological diagnosis being clear about rate and the complication.Result 346 example patient puncture success ratio is 99.1%,surgery mean time for 21.5±7.5min,selection qualified rate 99.4%.Some 7 example patient presents the complication,3 examples present the naked eye hematuria,4 example kidney week haematoma,obtains satisfaction the pathology result,are most by the proliferative renal glomerulus nephritis patient.Conclusion supersonic localization after skin kidney puncture living tissue inspection technique security,reliable,the time is short,is high to the kidney disease diagnosis rate of accuracy,the complication are few.

Objective To evaluate the clinical value of CT guided percutaneous lung biopsy.Methods Lung lesions of 153 patients underwent percutaneous lung biopsy by automatic cutting needle biopsy(18G).Results A total of 153 patients were punctured successfully,including 129 cases of cancer(48 cases had consistent pathologic and biopsy results),7 cases of inflammation,7 cases of necrotic tissue,5 cases of tuberculosis and 4 cases of fungus.Thirty-six patients had compilactions,including 32 cases of pneumothorax(20.9%),3 cases of hemoptysis or bloody sputum(1.9%)and 1 case of pleural bleeding.All the patients were discharged after treatment.Conclusion CT-guided percutaneous needle biopsy of lung lesions is safe and effective,with high diagnosis rate,fewer complications and high clinical value.

Objective:To explore the reason and prevention of postoperative anastomotic leakage in patients with esophageal carcinoma,so as to reduce occurrence of the complications.Methods: Analyze the reasons of postoperative anastomotic leakage in 1,812 cases with esophageal cancinoma.Results: Postoperative anastomotic leakage is happened to 11 examples in 1,812 cases with esophageal carcinoma,the occurrence is 0.64%.Conclusions: The reasons of postoperative anastomotic leakage is comprehensive and is related to preoperative preparation,surgical operation,and postoperative management.