目的 通过对基层卫生人员进行心肺复苏标准化流程培训从而提升其急救能力,探讨分析基层急救能力培训中存在的问题并提出改进措施.方法 对邯郸20个县市区的52名基层卫生人员进行心肺复苏技能培训,并采用调查问卷的形式对培训前后基层卫生人员的标准化心肺复苏基础、理论知识、操作技能情况进行分析,汇总问题.结果 参加培训的52名学员中培训合格43名,合格率为82.70％.经过标准化心肺复苏培训,学员在急救意识、基础理论和技能操作等方面有了较大提高.培训后理论知识正确率提升15.38％,差异有统计学意义.通过问题整理汇总发现基层卫生人员在心肺复苏技能方面存在急救意识薄弱、基础知识不扎实和实际操作能力差等问题.进一步分析后整理出严格遵循课程要求、坚持小班授课、给予学员充足学习时间等改进措施.结论 通过在基层卫生人员中开展标准化心肺复苏急救培训可以有效地提高急救意识、理论知识和技能操作水平;开展系统化、标准化心肺复苏流程培训可以有效建立基层卫生人员理论知识培训体系、提升急救意识,提高急救能力和素质,同时对保障基层人民健康有重要意义.

近年来,邯郸市医疗康养相结合的模式日趋发展,医疗服务行业对于医养模式的需求逐渐增加,康养机构发展逐渐加快,引进国际化智能医疗养老模式日渐成熟,医养结合模式的养老机构建设初具规模.但部分康养机构存在医学专业人才短缺等现实问题.据此,本项目着重于邯郸市"医康养健教"相结合的方式,意图为邯郸市医疗康养事业发展提供参考.

河北工程大学临床医学院妇产科教研室根据妇产科学教学大纲要求,围绕知识点,总结国内外案例库建设经验,汲取妇产科临床教学中的重点案例进行比对分析,构建适合本科生学习的案例库,为一流本科课程建设提供了有力的保障.为培养专业的临床医学人才奠定了坚实的基础.

针对新型冠状病毒(COVID-19)精准药物研发问题,围绕COVID-19感染人体细胞的基本步骤,如病毒表面蛋白结合人体细胞受体、病毒穿透细胞膜、病毒脱壳、病毒核酸释放与复制、病毒蛋白表达与成熟、新病毒装配等,预测针对这些环节设计小分子化合物、抗体或反义RNA片段等,进而抑制病毒关键分子如Spike蛋白、RdRp聚合酶、3CL水解酶及多种关键的RNA基因序列,最终达到精准治疗新型冠状病毒感染的目的.

目的:探讨不同来源标准化病人在急诊科实践教学中的应用价值和意义,为有效评价学生实习能力提供可靠的标准化病人.方法:以河北工程大学临床2018级实习生作为研究对象,根据其临床综合成绩随机分为志愿者组、电子模型组和患者志愿组进行临床实践教学授课.采用调查问卷评价学生学习感受和教学效果.通过考试评价学生临床思维能力.结果:电子模型组对临床技能训练教学效果最佳;患者志愿组临床沟通能力教学效果和临床思维学习效果最佳.结论:患者志愿组在急诊科临床实践过程中更有利于学生体验情景式教学,充分发挥学习主动性,更好地在教学过程中将理论知识和临床实践相结合,是一种较为可靠的提高临床胜任力的教学方法.

目的 探讨两种麻醉方式下老年腹腔镜结直肠癌根治术患者的肺内分流及氧合功能改变.方法 选取该院在两种麻醉方式下行腹腔镜下结直肠癌根治术的老年患者60例为研究对象,分为全身麻醉组(A组)、硬膜外阻滞复合全身麻醉组(B组),每组30例.观察并比较两组患者入室后10 min(T0)、气管插管后10 min(T1)、气腹1 h(T2)、气腹2 h(T3)、关闭气腹后10min(T4)、拔管时(T5)时的平均动脉压(MAP)、心率(HR)及中心静脉压(CVP).比较T0、T2、T3、T5时刻的肺内血分流率(QS/QT)、乳酸(ABL)及一氧化氮合酶(iNOs).记录两组患者术中丙泊酚、瑞芬太尼的用药量及苏醒时间.结果 A组患者QS/QT在T2、T3、T5时刻明显高于B组(P＜0.01),ABL在T3、T5时刻高于B组(P＜0.05).A组和B组患者QS/QT在T2、T3、T5时刻均明显高于T0时刻(P＜0.01).A组患者ABL在T3、T5时刻明显高于T0时刻(P＜0.01),B组患者ABL在T5时刻高于T0时刻(P＜0.05).A组患者HR、MAP在T2、T3、T5时刻均高于B组(P＜0.01),CVP在T2、T3时刻高于B组(P＜0.01).A组患者丙泊酚、瑞芬太尼用量,苏醒时间及拔管时间明显高于B组(P＜0.01).结论 硬膜外阻滞复合全身麻醉可降低老年腹腔镜结直肠癌根治术患者术中的肺内分流,改善氧合功能.

目的 通过检测经左旋孕酮治疗后的河北工程大学附属医院子痫前期孕妇血液中免疫细胞的数量、细胞因子以及临床指标的变化,探讨左旋孕酮对子痫前期孕妇的治疗作用及其机制.方法 在河北工程大学附属医院妇产科抽取60例孕妇(正常组20例;子痫前期组20例,实验组:经左旋孕酮治疗的子痫前期患者20例)外周血,分别检测CD4+T、CD8+T细胞的数量、细胞因子IL-10、TNF-α.的水平.观察子痫前期组和实验组患者平均动脉压、24h尿量、24h尿蛋白量的变化.结果 治疗前,与正常组相比,子痫前期组和实验组患者CD4+T细胞数量[(12.12±0.36)％、(12.34±0.42)％]、TNF-d含量[(636.03±72.13)10-3ng/ml、(636.03±72.13) 10-3 ng/ml]、均明显增加,CD8+T细胞数量[(19.35±0.59)％、(19.73±0.67)％]、IL-10含量[(97.56±63.28)10-3ng/,m、(96.87 ±21.35) 10-3ng/ml]均明显减少,其差异均有统计学意义(P＜0.05);经治疗后,子痫前期组和实验组患者CD4+T细胞数量[(11.06±0.22)％、(11.92±0.42)％]、TNF-α含量[(543.06±45.71) 10-3 ng/ml、(591.73±32.64)10-3 ng/ml]、24 h尿蛋白量[(7.2±2.7)mg]均明显降低,而CD8+T细胞数量[(23.62±1.21)％、(21.37±1.52)％]、IL-10含量[(143.82±51.25)10-3 ng/ml、(121.76±39.42)10-3 ng/ml]、24 h尿量[(2 411.7±201.7) ml]均明显上升,实验组优于子痫前期组,与治疗前相比,其差异均有统计学意义(P＜0.05).结论 左旋孕酮可通过调节子痫前期患者外周血中T淋巴细胞亚群及其所分泌的细胞因子来改善患者24 h尿量和尿蛋白的含量.

Objective To analyze the change and clinical significance of serum ischemia modified albumin(IMA) level in patients with dilated cardiomyopathy.Methods From January 2015 to January 2017 in the Affiliated Hospital of Hebei University of Engineering,a total of 55 patients with dilated cardiomyopathy were selected as observation group,meanwhile 40 healthy people admitted to this hospital for physical examination were selected as control group.Family history of heart disease, serum levels of IMA,BNP and hs-CRP,LVEF and blood lipids index were compared between the two groups,serum levels of IMA,BNP and hs-CRP,and LVEF were compared in dilated cardiomyopathy patients with different NYHA grades,meanwhile correlations of serum IMA level with serum levels of BNP and hs-CRP,and LVEF were analyzed by Pearson correlation analysis. Results Proportion of patients with family history of heart disease,serum levels of IMA,BNP and hs-CRP in observation group were statistically significantly higher than those in control group,while LVEF,TC,HDL and LDL in observation group were statistically significantly lower than those in control group(P<0.05);no statistically significant differences of LDL/HDL ratio was found between the two groups(P>0.05).Serum levels of IMA,BNP and hs-CRP in dilated cardiomyopathy patients withⅢ- or Ⅳ-NYHA grade were statistically significantly higher than those in dilated cardiomyopathy patients with Ⅱ-NYHA grade,while LVEF in dilated cardiomyopathy patients withⅢ- or Ⅳ-NYHA grade was statistically significantly lower than that in dilated cardiomyopathy patients with Ⅱ-NYHA grade(P<0.05);serum levels of IMA,BNP and hs-CRP in dilated cardiomyopathy patients with Ⅳ-NYHA grade were statistically significantly higher than those in dilated cardiomyopathy patients with Ⅲ -NYHA grade,while LVEF in dilated cardiomyopathy patients with Ⅳ -NYHA grade was statistically significantly lower than that in dilated cardiomyopathy patients withⅢ-NYHA grade(P<0.05).Pearson correlation analysis results showed that,serum IMA level was positively correlated with serum levels of BNP(r=0.543) and hs-CRP(r=0.718) in patients with dilated cardiomyopathy,respectively(P<0.05),was negatively correlated with LVEF(r=-0.388,P<0.05).Conclusion Serum IMA level is significantly increased in patients with dilated cardiomyopathy,and it is closely correlated with cardiac function and inflammatory reaction.

目的 探讨在每搏变异度(SVV)指导补液的老年结肠癌根治术中,不同BIS值对患者应激反应的影响.方法 将60例静吸复合麻醉下行结肠癌根治术的老年患者随机分为两组(每组n=30):L组(BIS值50~59),D组(BIS值40~49).术中按晶胶比为2:1补液,使SVV维持在8~12.记录患者在入室后20 min(T0)、插管后即刻(T1)、手术开始(T2)、手术开始后60 min(T3)、手术开始后120 min(T4)、手术结束(T5)、拔管后30 min(T6)的心率(HR)、平均动脉压(MAP)的值和心输出量(CO)、每搏量(SV)及SVV在T1、T2、T3、T4、T5时点的值.记录术中补液量及血流动力学波动情况.检测患者T0、T4、T6时点血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)、血糖(Glu)水平.结果 与T0相比,L组患者HR在T4~T6明显增加(P<0.05,P<0.01),MAP在T1、T2显著下降(P<0.05),在T4~T6增加(P<0.05,P<0.01);D组HR各时点无显著变化,MAP在T1~T5下降(P<0.05,P<0.01);同时L组HR在T4~T6明显高于D组(P<0.05),MAP在T3~T6高于D组(P<0.05).D组术中补液量多于L组(P<0.05),高血压发生率低于L组(P<0.05).两组患者Cor、ACTH、Glu在T4、T6均显著升高(P<0.05,P<0.01);L组患者Cor在T4、T6明显高于D组(P<0.05).结论 在SVV指导补液的老年结肠癌根治术中患者麻醉深度维持在BIS值40~49能较好地抑制机体的应激反应,更有利于维持血流动力学的稳定.

Objective To investigate the effects of different depth of anesthesia on ScvO2 and ABL in elderly patients with gastrointestinal cancer. Methods Totally 55 elderly patients undergoing gastrointestinal sur-gery were randomly divided into deep anesthesia group(BIS40-49)(group D,n=27)and light anesthesia group (BIS50-59)(group S,n = 28). While SVV value was fixed,fluid management was conducted while monitoring CVP. HR,MAP,the change of central venous oxygen saturation and lactic acid index were recorded in different time points. Results Propofol dosage in group D and group S indicated statistical significance(P<0.05). ScvO2 in group S in T3~T5 was higher than that in T0 and the difference was statistically significant(P < 0.05). Com-pared with ScvO2 in T3 in group D,that in group S was significantly higher and the difference was statistically sig-nificant(P<0.01),but no significant difference was found in other time point in 2 groups(P>0.05). There was no significant difference between and within ABL groups in each time period(P>0.05). There was no significant difference in terms of other indicators between 2 groups. Conclusions For elderly patients with gastrointestinal surgery,shallow anesthesia can improve tissue oxygenation and reduce the amount of anesthetics.

Objective To investigate the clinical significance of the relationship between serum C reactive pro-tein (CRP) and time in patients with acute carbon monoxide poisoning (ACOP). Methods A retrospective analysis was performed on 90 cases of ACOP patients, who admitted to Department of Emergency of our hospital from November 2014 to March 2017. According to the degree of poisoning on admission, these patients were divided into three groups:mild poisoning group, moderate poisoning group, severe poisoning group, with 30 cases in each group. Meantime, 30 cases of health examination in the same hospital were taken as the control group. The serum CRP at 12, 24, 48, 72, 96 hours after admission was tested and compared. The patients with ACOP were followed up for 2 months after treatment. According to whether the appearance of delayed encephalopathy, the patients were divided into encephalopathy group and encephalopathy group. The correlation between the difference of CRP value between different groups and the degree of poisoning with the pathogenesis of delayed encephalopathy were analyzed. Results Twelve hours after the admis-sion, the CRP levels of the control group, Mild poisoning group, moderate poisoning group, severe poisoning group were re-spectively (3.35±0.91) mg/L, (3.81±0.28) mg/L, (13.26±1.85) mg/L, (26.70±1.70) mg/L, and the differences between the three groups were statistically significant (P<0.05). With the prolongation of treatment time, the level of CRP in different carbon monoxide poisoning groups showed an increasing trend. The CRP level in the mild and moderate poisoning group reached the highest value at 24 h, and then decreased gradually. The CRP level in the severe poisoning group reached the highest value at 48 h, and then decreased gradually. In the severe poisoning group, the serum CRP levels at 24 h, 48 h, 72 h and 96 h after ad-mission were significantly different from those in the mild poisoning group and moderate poisoning group (P<0.01). After the treatment, the patients with ACOP were followed up for 2 months. The patients were divided into the encephalopathy group (30 cases) and non-encephalopathy group (60 cases) according to whether there was delayed encephalopathy, and the encepha-lopathy group were all moderate and severe poisoning patients. Conclusion Early CRP value can be used as an indicator di-agnose the degree of poisoning and predicate the prognosis of patients.

目的 探讨不同脑电双频指数(BIS)状态下对老年胃肠手术术中炎性因子的影响.方法 选择择期全麻下行胃肠手术的老年患者60例,性别不限,年龄65~75岁,ASA分级Ⅱ或Ⅲ级.按随机数字表法分为两组(n=30):深BIS组(D组)和浅BIS组(L组),D组术中BIS值维持在40~49之间,L组术中BIS值维持在50~59之间,从切皮至术毕通过丙泊酚靶控复合吸入七氟醚调节BIS值在目标值范围,记录麻醉开始(T0)、气管插管后即刻(T1)、切皮(T2)、术中1 h(T3)、术中2 h(T4)、术毕(T5)、拔管后5 min(T6)时的HR、MAP.于T0、T4、T6采中心静脉血2 mL用于检测血清TNF-α和IL-6浓度,记录术中输液量、出血量、尿量、丙泊酚用量、瑞芬太尼用量、麻醉时间和手术时间.结果 L组血浆TNF-α和IL-6的浓度在T6时明显低于D组(P<0.05).组内比较,两组血浆TNF-α的浓度在T6时均较T0时明显升高(P<0.05),两组血浆IL-6的浓度在T4和T6时均较T0时明显升高(P<0.05).L组丙泊酚用量明显少于D组(P<0.05).结论 全麻下老年胃肠道手术患者术中BIS值范围控制在50~59之间时的炎性因子表达水平较BIS值在40~49之间低;术中血流动力学均较平稳,相对较浅的麻醉深度即可满足手术要求,且不会增加炎性因子的释放.

目的：观察麻醉期间目标导向液体治疗对阿尔茨海默病患者胃肠手术术后认知功能的影响。方法选择118例拟行腹部胃肠手术的阿尔茨海默病患者，随机分为观察组和对照组各59例，观察组麻醉期间采用目标导向液体治疗，对照组麻醉期间采用常规补液方案，分别于术前1d及术后第1、3、7天采用简易精神状态量表（ MMSE评分）、蒙特利尔认知评估量表（ MoCA评分）、美国国立卫生研究院卒中量表（ NIHSS评分）评定认知功能。分别于术前1d及术后第1、3、7天采集两组动脉血、颈内及脑回流静脉血，观察两组脑氧代谢情况[包括颈静脉血氧饱和度（ SjvO2）、桡动脉－颈内静脉球部血氧含量差（ Da-jvO2）、脑氧摄取率（ CEO2）、桡动脉－颈内静脉球部乳酸差（ VADL）]，观察两组术中低血压、心律失常、谵妄等并发症发生情况。结果术前1 d、术后第1天观察组MMSE评分、MoCA评分均高于对照组（P均＜0．05）。术前1 d、术后第1天观察组NIHSS评分均低于对照组（P均＜0．05）。观察组并发症反应发生率低于对照组（P＜0．05）。术前1 d、术后第1天观察组SjvO2均高于对照组（P均＜0．05）。术前1 d、术后第1天观察组Da-jvO2、CEO2均低于对照组（P均＜0．05）。结论麻醉期间目标导向液体治疗可改善阿尔茨海默病患者胃肠手术术后认知功能。

目的:观察冠心病患者心脏外膜脂肪体积(EATV)及局部的炎症因子水平,并分析其与冠状动脉粥样硬化斑块易损性的关系.方法:收集2012年1月至2015年7月,在胸外科行外科手术的患者113例,其中冠心病患者67例,其余46例为心脏瓣膜病患者.所有患者术前均行双源CT检测EATV及斑块的性质,术中取心脏外膜脂肪及胸腔脂肪,比较两组患者不同部位脂肪中局部炎症因子基质金属蛋白酶MMP-2的水平,并通过ELISA法检测局部磷脂酶A2水平.再对血管正性重构的临床指标进行多因素Logistic回归分析.结果:冠心病组患者的身体质量指数(BMI)、LDL-C、吸烟人数、高血压人数、EATV、局部MMP-2 mRNA和蛋白表达水平、磷脂酶A2水平、血管正性重构数均明显高于瓣膜病组.再对冠心病组患者中有无血管正性重构进行单因素分析,结果发现:体质量指数、高血压人数、LDL-C、EATV、纤维斑块体积及钙化斑块体积均存在差异(P＜0.05).再纳入多因素Logistic回归分析:EATV、心外膜脂肪分泌的炎症因子、高血压是发生正性重构的独立危险因素.结论:EATV、心外膜脂肪分泌的炎症因子是发生斑块易损性的独立危险因素,有别于其他传统危险因素.早期对心外膜脂肪体积以及炎症因子水平进行控制,有助于增加斑块的稳定性.

Objective To investigate clinical studies in elderly bladder carcinomaradical resection treatment goal directed fluid. Methods Seventy-six elderly patients with radical resection of bladder cancer were selected who were randomly divided into two groups. 38 patients received routine treatment as group I. Based on routine treat-ment, 38 patients received goal-directed fluid therapy as groupⅡ. Treatment effect was compared between the two groups. Results Cardiac index(CI), stroke volume variation(SVV), mean arterial pressure(MAP), central ve-nous pressure(CVP), central venous oxygen saturation(ScvO2), oxygen supply index(DO2I), oxygen consump-tion index( VO2 I) , oxygen uptake rate( ERO2 ) were significantly higher in groupⅡthan those in groupⅠat T1 , T2 , T3 , T4 , while lactate( Lac) , S100βwere significantly lower in group II than those in groupⅠat T1 , T2 , T3 , T4 . The urine volume and colloidal infusion were significantly more in group Ⅱthan those in group Ⅰat T1 , T2 , T3 , T4 , while the crystalloid infusion volume, total liquid infusion volume, hospitalization time and expenses were significantly less in group Ⅱ than those in groupⅠ, while the complication incidences of nausea, vomiting or hy-potension were significantly lower in group Ⅱ than those in group Ⅰ. The postoperative first passage of flatus and postoperative food-taking time were significantly earlier in groupⅡthan those in groupⅠ( P<0. 05 ) . Conclusion Goal-directed fluid therapy is beneficial for stabilization of hemodynamic status, maintenance of oxygen balance of supply and demand, as well as rapid postoperative recovery in elderly patients with radical resection of bladder cancer.

目的:观察安络化纤丸对瘀热互结型晚期病毒性肝炎肝硬化的效果.方法:将78例纳入研究的患者根据入院先后顺序进行随机分组,对照组40例,观察组38例,两组患者均予常规抗病毒、护肝治疗;观察组患者加用安络化纤丸,观察两组患者肝功能、Child-pugh评分、肝纤维化4项、肝脏彩超指标、免疫功能(T细胞亚群)的改善情况;观察不良反应.结果:观察组及对照组有效率分别为89.43％及57.20％(P ＜0.05);观察组患者肝功能、Child-pugh评分、肝纤维化4项、肝脏彩超指标、免疫功能等各项指标的改善情况均更优(P＜0.05);未发现不良反应.结论:安络化纤丸可以进一步提高瘀热互结型晚期病毒性肝炎肝硬化的临床效果,毒副作用轻,改善患者免疫力,优于单用西药治疗,值得推广.

Objective To detect the content of epicardial adipose tissue volume ( EATV ) and the levels of matrix metalloproteinase 2 (MMP-2) and phospholipase A2(PLA2) in the epicardial adipose tissues of patients with coronary heart disease ( CHD) and to analyze the significance.Methods A total of 113 patients receiving thoracic surgery were collect-ed, including 67 patients with coronary heart disease (CHD group) and 46 cases with heart valve disease (valvular disease group) .EATV and the nature of the plaque were detected by dual-source CT before surgery to determine whether vascular positive remodeling happened.Then, epicardial adipose tissue ( EAT) and intrathoracic adipose tissue ( TAT) were collect-ed.MMP-2 mRNA and protein levels were detected by RT-PCR and Western blotting.The PLA2 level was detected by ELISA.Finally, the factors related to vascular positive remodeling were analyzed by the logistic regression.Results The EATV in the CHD group was (128.08 ±45.34) cm3 , and (84.21 ±25.37) cm3 in the valvular disease group.There were respectively 36 and 10 cases of vascular positive remodeling in the two groups (all P＜0.01).The MMP-2 mRNA and protein expression levels, PLA2 in EATV of the CHD group were significantly higher than those of the valvular disease group (all P＜0.05), but the differences of the above indexes were not statistically significant in the thoracic adipose tis-sues (all P＞0.05).EATV, MMP-2, PLA2 and high blood pressure were the independent risk factors for the development of vascular positive remodeling in CHD patients.Conclusions The levels of EATV, MMP-2 and PLA2 in the epicardial adipose tissues of CHD patients were increased.EATV, MMP-2 and PLA2 were the independent risk factors for the devel-opment of vascular positive remodeling in CHD patients.

Objective To investigate the influence of different anesthesia depth on postoperative cognitive dysfunction in elderly patients with laparoscopic cholecystectomy .Methods Ninety‐four elderly patients with lap‐aroscopic cholecystectomy were selected in hospital from October 2011 to December 2013 ,who were treated anes‐thesia depth monitoring by Bispectral index (BIS) .Patients were randomly divided into two groups .Forty‐seven patients were maintained 50‐59 in BIS as control group .Forty‐seven patients were maintained 40‐49 in BIS as ob‐servation group .Cognitive function was evaluated by mini mental state examination (MMSE) .Cognitive function at different time points (preoperative ,extubation 1 h ,extubation 3 h ,postoperative 1 d ,postoperative 3 d ,post‐operative 7 d) ,wake conditions ,extubation and changes of related indexes (Hcy ,HIF‐1α) were compared be‐tween two groups .Results MMSE score at extubation 1 h ,extubation 3 h in observation group were significantly lower than those in control group .Recovery time ,extubation time and orientation recovery time in observation group were significantly later than those in control group .Related indexes (Hcy ;HIF‐1α) before skin incision , cholecystectomy ,extubation 30 min in observation group were significantly lower than those in control group . Differences were statistically significant (P< 0 .05) .Conclusion It has larger influence on postoperative early cognitive dysfunction in elderly patients with laparoscopic cholecystectomy ,which intraoperative BIS maintained 40‐49 .And then it gradually returned to normal level ,which has better inhibitory effect on Hcy and HIF‐1α.That is worthy of clinical use .

Objective To investigate influence of goal-directed fluid therapy on intraoperative coagulation state in elderly patients with radical resection of bladder cancer .Methods One hundred and twenty-two elderly patients with radical resection of bladder cancer were selected in hospital from October 2012 to October 2014 ,who were randomly divided into two groups .Sixty one patients received routine treatment as control group .Sixty one patients received goal-directed fluid therapy as observation group .Changes of intraoperative blood coagulation in-dexes(ACT ,CR ,PF ,D-dimer) and related indexes (SVV ,ScvO2 ,CI) were compared between two groups .Re-sults CT ,CR ,PF ,D-dimer and ScvO2 significantly increased at T1 while SVV and CI significantly decreased in two groups until the end of surgery .ACT ,CR ,PF and D-dimer at T1 ,T2 ,T3 ,T4 in observation group were sig-nificantly lower than those in control group .SVV ,ScvO2 and CI in observation group were significantly higher than those in the control group .Differences were statistically significant (P<0 .05) .Conclusion Goal-directed fluid therapy is helpful to maintain intraoperative coagulation indexes stability in elderly patients with radical resec-tion of bladder cancer ,which can improve ScvO2 and reduce SVV ,CI .It is worthy of clinical use .

目的：观察食管内局部注射沙培林对食管癌患者放疗后免疫功能的影响。方法选择92例行食管癌放疗患者，随机分为观察组和对照组各46例。对照组行常规放疗方案前无操作；观察组于放疗前在胃镜引导下行食管内局部注射沙培林5KE，20d 后再次局部注射沙培林5KE，完成放疗疗程。随访观察对照组和观察组治疗前后机体免疫状态变化，同时记录患者局控率及生存期。结果观察组机体内免疫状态检测 CD3+ T、CD3+ CD4+ T 及CD3+ CD8+ T 分别为（65.29±0.57）％、（36.52±0.47）％、（31.42±0.42）％，对照组检测结果分别为（65.31±0.42）％、（35.19±0.21）％、（29.19±0.13）％，2组体内 CD3+ CD4+ T 及 CD3+ CD8+ T 细胞免疫水平差异有统计学意义（t ＝17.523、34.401，P ﹤0.01）；随访2年，观察组生存率为23.08％，中位生存时间16个月，对照组生存率为11.54％，中位生存时间10个月，2组比较差异有统计学意义（P ﹤0.05）。结论食管癌患者放疗前局部注射沙培林能够保护放疗患者机体内细胞的免疫功能，改善患者放疗后体内免疫环境，增强抑瘤效应，提高生活质量，延长生存期。