目的 分析存在颈动脉粥样硬化斑块青老年患者的斑块超声表现特征并探讨其临床价值.方法 回顾性分析2017年1～12月在笔者科室确诊颈动脉粥样硬化斑块的青年患者297例为青年组,选择同期确诊颈动脉粥样硬化斑块的老年患者302例为老年组,同期颈动脉超声检查无斑块青年50例为空白对照组.对比分析各组的血压、空腹血糖、血脂及颈动脉粥样硬化斑块的分布位置、回声特征、Crouse积分等参数.结果 青年组收缩/舒张压明显高于空白对照组,青年组舒张压、甘油三酯及总胆固醇值均高于老年组(P<0.05).青年组斑块Crouse积分、颈动脉中度以上狭窄发生率均低于老年组(P<0.05).青年组及老年组均以不稳定斑块为主,青年组以均质低回声斑块为主,且比例高于老年组(79.6％vs 36.3％,P=0.000),而老年组以不均质回声斑块为主,占56.0％.青年组斑块分布以颈动脉分叉部为主,其他部位相对少见.老年组颈动脉分叉部斑块比例低于青年组(42.8％vs 70.7％,P=0.000).青年组脑梗死患者多见均质低回声斑块,占87.10％,以颈动脉分叉部多见,占74.19％.老年脑梗死患者以不均质回声斑块为主,占41.67％,分布以颈动脉分叉处合并其他多部位为主,占62.5％.结论 青老年患者颈动脉硬化斑块的超声表现特点及伴发脑梗死等情况存在差异,对于临床诊治具有一定的指导意义和参考价值.

目的 本研究旨在应用应变及应变率成像技术探讨2型糖尿病患者周围动脉弹性改变特点及相关影响因素.方法 选取有血管并发症的2型糖尿病患者40例(T2DMVC组),无血管并发症的2型糖尿病患者42例(T2DM组),健康对照组60例.用高频线阵探头测量双侧颈总动脉、肱动脉、股动脉和胫前动脉的IMT值,用Xstrain自动分析软件获取各动脉壁各节段最大圆周应变平均值(Smax)和应变率的平均值(SRmax),进一步计算各动脉应变及应变率比值.结果 与对照组比较,T2DM及T2DMVC组双侧颈动脉及股动脉的IMT值均增高,应变和应变率均明显下降(P均＜0.05).与T2DM组比较,T2DMVC组双侧胫前动脉应变及应变率明显减低(P＜0.05).多元线性回归分析表明,影响颈动脉和肱动脉与下肢动脉间Smax及SRmax比值的独立风险因素包括病程、甘油三酯、低密度脂蛋白胆固醇;影响颈动脉与肱动脉、股动脉与胫前动脉间Smax及SRmax比值的独立风险因素包括病程、糖化血红蛋白及甘油三酯.结论 应变及应变率成像技术不仅可以反映2型糖尿病患者单支周围动脉的应变情况,还可通过不同周围动脉间的应变比值反映其相对变化.

目的 探讨床旁照护系统对胃肠癌住院患者健康宣教掌握率及满意度的影响.方法 选取2016年5～12月温州医科大学附属第二医院(育英儿童医院)胃肠外科住院治疗的胃肠癌患者92例为研究对象.根据随机数字表法分为两组,观察组(48例)接受床旁照护系统服务;对照组(42例)未使用床旁照护系统.比较两组患者对各项健康宣教知识的掌握率及住院满意度.结果 观察组患者对各项健康宣教知识掌握程度明显高于对照组,两组差异有统计学意义(χ2＝50.041,P＜0.05).观察组患者住院满意度明显高于对照组(95.8%比79.5%,χ2＝6.332,P＝0.033).结论 使用床旁照护系统能有效提高胃肠癌患者住院期间对各项健康宣教知识掌握程度,提高患者对护士满意度,从而提高了科室的影响力及医院形象.

目的 探讨超声二维应变成像评价规范化治疗对2型糖尿病患者颈动脉弹性影响的可行性, 为规范化治疗对颈动脉弹性影响提供评价指标.方法 选择2015年6月至2016年5月于温州医科大学附属第二医院门诊新确诊的63例2型糖尿病 (T2DM) 患者为研究对象.根据颈动脉内膜中层厚度 (CIMT) 分为:CIMT增厚组30例 (1.0 mm≤CIMT<1.5 mm) 和CIMT正常组33例 (CIMT<1.0 mm) .对研究对象进行右侧颈总动脉二维短轴图像收缩期峰值圆周应变 (CS) 和应变率 (CSr) 的测量, 给予规范化治疗6个月后重复以上超声检查, 比较两组患者治疗前后CS、CSr的变化率, 并比较两组患者在治疗前后体质指数 (BMI) 、收缩压 (SBP) 、舒张压 (DBP), 空腹血糖 (FPG) 、糖化血红蛋白 (Hb A1C) 、总胆固醇 (TC) 、甘油三酯 (TG) 、高密度脂蛋白胆固醇 (HDL-C) 和低密度脂蛋白胆固醇 (LDL-C) 的变化情况.用SPSS 17.0统计软件包进行t检验.结果 规范化治疗前CIMT增厚组Hb A1C大于CIMT正常组, 差异有统计学意义 (P<0.01);治疗后, Hb A1C在两组间比较差异无统计学意义 (P>0.05) .规范化治疗后, 两组患者FPG、Hb A1C和BMI均低于治疗前, 差异有统计学意义 (P<0.01) .治疗前后, CIMT增厚组的CS和CSr均低于CIMT正常组, CS、CSr的变化率均低于CIMT正常组, 差异均有统计学意义 (P<0.05) .治疗后, 两组患者的CS、CSr均高于本组治疗前, 差异均有统计学意义 (P<0.01) .结论 超声二维应变成像可用来评价规范化治疗对2型糖尿病患者颈动脉应变的影响, 在颈动脉弹性功能的评价上具有一定的临床实用价值.

Objective To explore the application effect of bedside care system in the management of hospitalized patients.Methods Totally 86 hospitalized patients admitted in hospital from May 1st 2016 to July 30th 2016 in department of gastrointestinal surgery of the 2rd Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University were selected as the research object. 42 cases receiving bedside care service system were divided into the observation group,while 44 cases not receiving bedside care system were divided into the control group. Satisfaction of patients with medical experience including the health education,health entertainment and information services were compared between two groups. The satisfaction of hospitalization and the education master degree were also compared between two groups.ResultsIn the observation group, patients' satisfaction with health education,health entertainment and information services were 85.7%,92.9% and 81.0%,and they were all higher than that of the control group (χ2=7.570,11.942,7.908;P<0.05). The overall hospitalization satisfaction was 95.2% in the observation group,which was higher than 81.8% in the control group (χ2=2.573,P>0.05). There were 35 (83.3%) patients who completely understand the knowledge of health education in the observation group,while only 26 (59.1%) patients who completely understand in the control group (χ2=6.125,P<0.05).Conclusions The usage of bedside care system can effectively improve the hospitalized patients' satisfaction with the experience of health education,health entertainment and information services. By bedside care system,the hospitalized patients can understand the health education easily,which can improve their satisfaction during the stay in hospital,and the medical workers can manage patients smoothly.

Objective To explore the feasibility of endothelial function of dorsal artery of foot in patients with type 2 diabetes(T2DM) by high frequency ultrasound combined with warm bath test.MethodsThirty-five patients with T2DM and thirty normal people were collected,all subjects were examined by high frequency ultrasound.Diameter of brachial artery in baseline and after reactive hyperaemia were detected;Diameter of dorsal artery of foot in baseline and after the foot immersed in 40℃ warm water for 5 minutes were acquired.Flow mediated dilatation of dorsalis pedis artery(FMDDPA) and flow mediated dilatation of brachial artery(FMDBA) were calculated and compared.Multiple stepwise regression analysis was used to examine the correlation between FMDDPA and hemoglobin A1c(HbAlc). Results The FMDDPA and FMDBA were decreased in patients with T2DM (P<0.01).The FMDDPA and FMDBA were correlated significantly(r=0.864,P<0.01).In stepwise regression analysis,HbA1c is the most affecting factor for FMDDPA (R2=0.321,P<0.01).Conclusions Ultrasound combined with warm bath test can be used to detect the change of endothelial function of dorsal artery of foot in patients with T2DM,which have a certain clinical application value in endothelial function of terminal limb artery.

Objective: To study the clinical and pathological features of primary IgA nephropathy (IgAN) combined with primary hypertension in 88 cases.Methods: A retrospective case series of 88 patients who were diagnosed as IgAN by renal biopsy and diagnosed with primary hypertension by clinical in our hospital between January 1997 to June 2013.Results: The mean age of the 88 cases of IgAN with hypertension was (44.7±11.27) years. Their hypertension history (median 36 months) was longer than IgAN’s (2 months). Forty-eight cases had family hypertension history, accounting for 54.5%. Sixty-six cases (75.0%) showed asymptomatic urine abnor-malities, followed by 10.2% nephrotic syndrome and 11.4% chronic nephritis. Among the 29 cases (33.0%) of renal dysfunction (eGFR<90 mL/min), there were 6 cases (6/9) with the low-gravity urine and 21 cases (21/29) with the high NAG enzyme urine. Among the 88 cases, 52 cases (52/87) had the left ventricular wall thicken-ing and (or) left atrial enlargement change, and 76 cases (76/80) had hypertension retinopathy. The renal biopsy showed Haas 1~3 grade level together accounted for 87.5% of lesions, severe glomerular sclerosis accounted for 19.3%, cases of moderate to severe renal interstitial disease accounted for 34.1%, and renal small artery disease accounted for 78.4%.Conclusion: The clinical and pathological manifestations of IgAN combined with hyper-tension patients are mostly mild; the cases of low eGFR mostly complicated with renal tubular dysfunction; the renal biopsy shows most glomerular lesion is mild, whereas the renal tubulo-interstitial and renal artery lesion is severe.Some cases show that tubulointerstitial lesions and glomerular lesions do not parallel, and the renal small artery lesions are exist. In IgAN patients with hypertension, the blood pressure may be the main factor to affect the renal prognosis.

Objective To evaluate the applicability of the Chinese version of SF-36 ( v. 2 ) scale for evaluating the quality of life of hospitalized patients with chronic heart failure. Methods From September 2013 to December 2014, 159 patients with chronic heart failure(NYHA I-IV), who were older than 18 years, clear mind and well self-expressed, were selected as participants. Questionnaire surveys included general survey and SF-36(v. 2) scale. Internal consistency reliability, binary reliability and construct validity were all analyzed as indicators to evaluate SF-36 ( v. 2 ) scale. Results A total of 159 questionnaires were issued and 159 valid questionnaires were recovered. The eight dimensions of SF-36(v. 2) scale including physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), social function (SF), vitality (VT), role-emotion(RE), and mental health (MH) score conversion were (41.57 ±24.86), (48.35 ±21.64), (69.18 ± 25. 68), (31. 28 ± 16. 01), (48. 90 ± 19. 53), (45. 05 ± 22. 76), (59. 43 ± 24. 31), (57. 55 ± 19. 03); the floor effects were 2. 5%, 4. 4%, 3. 1%, 4. 4%, 3. 1%, 6. 3%, 0. 6%, 1. 3%; the ceiling effects were 0. 0%, 3. 8%, 21. 4%, 0. 0%, 0. 0%, 1. 9%, 3. 1%, 0. 0%. The item-convergent validity all achieved the standard (r≥0. 4), and the total scaling success rate of item-convergent was 100. 00%; the dimensions′success rates of item-discriminant validity of RP, BP, RE and SF were all 100%, the rest of four dimensions were PF 95. 71%, GH 85. 71%, VT 89. 29%, MH 94. 29%, and the total success rate was 94. 69%. Internal consistency reliability ranged from 0. 738 to 0. 919; the binary reliability ranged from 0. 808 to 0. 963. Within factors analysis, two common factors were confirmed, separately representing physical health and mental health, altogether making contribution of 61. 66% cumulative variance. Conclusions As the revision of SF-36(v. 1), SF-36(v. 2) scale seemed more friendly in layout for questions and answers, the floor and ceiling effects significantly reduced. Additionally, it also shows good reliability and validity in the evaluation of quality of life of hospitalized patients with chronic heart failure, and the SF-36(v. 2) scale can be used to evaluate the quality of life ( QOL) of patients with chronic heart failure.

Objective To survey the quality of life and its influencing factors among patients with dilated cardiomyopathy in the heart failure stage.Methods During September of 2013 to December of 2014,80 patients diagnosed of dilated cardiomyopathy in the heart failure stage were recruited as participants in major hospital in Wenzhou city.All of them finished questionnaires including general condition questionnaire and Chinese version of SF-36 v2,and corresponding pathography were read by investigators to complete the general condition questionnaire.The descriptive statistics analysis was used to describe general data of participants;mean ± standard deviation was used to analyze measurement data;percentage was used to analyze count data;rank-sum test was used to compare two or multiple groups;multiple factor logistic regression analysis (Pin =0.05,Pout =0.1) was used to analyze influencing factors of physical component summary and mental component summary based on the norm of the SF-36v2 with the independent variables showing a statistical significance in one-way ANOVA.Results The scores of eight dimensions (physical function;role-physical;bodily pain;general health;vitality;social function;role-emotional;mental health);reported health transition two component summary (PCS:physical component summary;MCS mental component summary) of the SF-36 v2 were all significantly lower in patients with dilated cardiomyopathy in the heart failure stage,and they were 20.18± 14.66,31.91 ± 10.00,45.07 ± 11.49,30.76±7.01,37.56± 11.59,24.87± 11.67,36.01 ± 13.97,36.47± 11.29,26.96± 12.09,40.75 ±12.28 respectively.One-way ANOVA showed that gender (Z=-2.05,P=0.04),education (H=8.37,P=0.02),belief (Z=-2.19,P=0.03),insurance (H=8.49,P=0.01),actual annual income (H=6.52,P=0.04),NYHA classes (H=5.55,P=0.04),comorbidity (Z=-2.27,P=0.02)significantly influenced physical component summary,while marital status (Z=-2.37,P=0.02),age (H=10.51,P=0.01),living condition (H=19.76,P=0.00) significantly influenced mental component summary.Multiple factor Logistic regression analysis showed gender (t=3.50,P=0.00),education(t=2.70,P=0.01),NYHA classes (t=-2.84,P=0.01) and comorbidity (t=-3.52,P=0.00) were the main factors influencing the patients' physical component summary,while marital status (t=2.88,P=0.01) was the only one factor influencing the patients' mental component summary.Conclusions The quality of life among patients with dilated cardiomyopathy in the heart failure stage was low.Better managing and controlling comorbidity and heart failure,and strengthening partner' support were the key measures to improve the quality of life among patients with dilated cardiomyopathy in the heart failure stage.

Objective To evaluate the applicability of the Chinese version of SF-36(v.2) scale for evaluating the quality of life of hospitalized patients with chronic heart failure. Methods From September 2013 to December 2014, 159 patients with chronic heart failure(NYHA I-IV), who were older than 18 years, clear mind and well self-expressed, were selected as participants. Questionnaire surveys included general survey and SF-36(v.2) scale. Internal consistency reliability, binary reliability and construct validity were all analyzed as indicators to evaluate SF-36(v.2) scale. Results A total of 159 questionnaires were issued and 159 valid questionnaires were recovered. The eight dimensions of SF-36(v.2) scale including physical function (PF), role-physical (RP), bodily pain (BP), general health (GH), social function (SF), vitality (VT), role-emotion(RE), and mental health (MH) score conversion were (41.57±24.86), (48.35±21.64), (69.18±25.68), (31.28±16.01), (48.90±19.53), (45.05±22.76), (59.43±24.31), (57.55±19.03); the floor effects were 2.5%, 4.4%, 3.1%, 4.4%, 3.1%, 6.3%, 0.6%, 1.3%; the ceiling effects were 0.0%, 3.8%, 21.4%, 0.0%, 0.0%, 1.9%, 3.1%, 0.0%. The item-convergent validity all achieved the standard (r≥0.4), and the total scaling success rate of item-convergent was 100.00%; the dimensions′ success rates of item-discriminant validity of RP, BP, RE and SF were all 100%, the rest of four dimensions were PF 95.71%, GH 85.71%, VT 89.29%, MH 94.29%, and the total success rate was 94.69%. Internal consistency reliability ranged from 0.738 to 0.919; the binary reliability ranged from 0.808 to 0.963. Within factors analysis, two common factors were confirmed, separately representing physical health and mental health, altogether making contribution of 61.66% cumulative variance. Conclusions As the revision of SF-36(v.1), SF-36(v.2) scale seemed more friendly in layout for questions and answers, the floor and ceiling effects significantly reduced. Additionally, it also shows good reliability and validity in the evaluation of quality of life of hospitalized patients with chronic heart failure, and the SF-36(v.2) scale can be used to evaluate the quality of life (QOL) of patients with chronic heart failure. Key words: Quality of life; Chronic heart failure; SF-36; Reliability and validity; Scale evaluation

Objective To investigate the coping style and social relational quality of patients with thyroid carcinoma, and analyze the relationship between them,so as to provide a new perspective to improve the coping style of patients with thyroid carcinoma.Methods 311 patients with thyroid carcinoma were surveyed by the Social Relational Quality Scale and the Medical Coping Style Questionnaire ( Chinese version) .The level of coping style was compared among the patients with different clinical features, and the pearson correlation analysis and multiple linear regression analysis were used to explore the relationship between coping style and social relational quality of patients with thyroid carcinoma.Results The scores of facing, yield and avoidance in the coping style were (18.96 ±2.54), (13.15 ±1.48) and (17.76 ±2.23), respectively.The scores of social relationship of family intimacy, family responsibility and friendship were (20.47 ±2.61),(15.22 ± 2.22) and (14.75 ±2.03), respectively.The total score of social relational quality was (50.44 ±5.51).The score of facing was positively correlated with the total score and the each dimension score of social relational quality (P<0.05).The scores of yield and avoidance were negatively correlated with the total score and the each dimension score of social relational quality ( P <0.05 ) .The differences of coping style in the patients with different family income, model of payment, course of disease and lymph node metastasis were significant ( P<0.05).Multiple linear regression analysis showed that the family income, payment method, lymph node metastasis and social relational quality were the predictors of coping style of patients with thyroid carcinoma(P<0.05). Conclusions The coping style was significantly correlated with social relational quality in patients with thyroid carcinoma.We should improve the coping style by improving the social relational quality.