目的 探讨CT增强检查中合理提高对比剂注入前预注射生理盐水的流速在减少肿瘤非首疗程化疗患者对比剂外渗发生率中的应用价值.方法 选取2019年7月至2020年10月在中南大学湘雅医院肿瘤化疗科接受非首疗程化疗行常规CT增强检查的1266例患者分为A组、B组、C组、D组、E组及F组,A组采用与对比剂相同速率(2.0 mL/s)进行生理盐水预注射,B组、C组、D组、E组及F组采用较对比剂注射流速依次递增0.1 mL/s速率进行生理盐水预注射.比较6组预注射外渗率及当各组预注射均未发生外渗时出现的对比剂外渗率情况.结果 A组与B组、C组及D组预注射外渗率比较,差异无统计学意义(P＞0.05).A组预注射外渗率低于E组和F组,差异有统计学意义(P＜0.05).A组与B组对比剂外渗率比较,差异无统计学意义(P＞0.05).A组对比剂外渗率高于C组、D组、E组和F组,差异有统计学意义(P＜0.05).结论 合理提高生理盐水预注射速率,能够有效降低肿瘤非首疗程化疗患者CT增强检查时对比剂的外渗风险.

目的 探讨中药坐浴联合吻合器痔上黏膜环切术(PPH)治疗环状脱垂性混合痔的疗效及优势.方法 研究对象选取2017年2月—2018年3月间收治的环状脱垂性混合痔患者104例,采用随机数字法将其分为对照组52例和治疗组52例.两组患者均行PPH术,术后给予对照组患者高锰酸钾坐浴,治疗组患者则采用中药坐浴.对比两组患者的治疗效果、住院情况、手术情况及术后恢复情况.结果 治疗后,治疗组患者治疗总有效率为96.15％,对照组患者治疗总有效率为94.23％,两组患者治疗有效率比较无明显差异(P>0.05).治疗组患者的创面愈合时间及住院时间均明显低于对照组(P<0.05),住院费用与对照组比较,差异无统计学意义(P>0.05).治疗组患者术后并发症发生率为5.77％,对照组患者术后并发症发生率为21.15％,治疗组患者术后并发症发生率明显低于对照组(P<0.05).治疗组术后3个月的生活方式、心理应付/行为、抑郁/自我感受、窘迫尴尬等FIQL评分比较均明显高于对照组(P<0.05).结论 中药坐浴联合PPH可明显促进环状脱垂性混合痔患者的术后恢复进程,且并发症发生率较低,对患者正常生活影响较小,临床效益好,值得推广实践.

Objective To investigate the clinical efficacy of different infusion regimens of cefoxitin in preventing postoperative infection of complex anal fistula. Methods A total of 120 patients with complex anal fistula undergoing ligation of intersphincteric fistula tract( LIFT) in Zhuzhou Central Hospital, Xiangya School of Medicine, Central South University from March 2016 to March 2018 were randomly divided into observation group and control group, with 60 cases in each group. The observation group had intravenous infusion of cefoxitin 1. 0 g at 0. 5 h before operation and cefoxitin 1. 0 g/time, 3 times/d since 6 h after operation. The control group had intravenous infusion of cefoxitin 1. 0 g at 1 h before operation and cefoxitin 1. 0 g/time, 3 times/d since 4 h after operation. Surgical effect was evaluated. Postoperative rehabilitation, infection and adverse drug reactions were observed. Serum bactericidal activity (SBA) was tested on the 2nd day after drug administration. Results The effective rate in observation group was higher than that in control group but no statistical difference was noticed (χ2 =2. 596, P =0. 107). Postoperative hospital stay time and wound healing time in observation group were significantly shorter and the incidence of poor wound healing was significantly lower than those in control group [(3. 4 ±1. 6)d vs (4. 5 ±1. 8)d, (21 ±5)d vs (24 ±5)d, 3. 3％(2/60) vs 15. 0％(9/60)](all P<0. 05). The incidence of postoperative infection in observation group was significantly lower than that in control group [3. 3％(2/60) vs 13. 3％(8/60)] (χ2 =3. 927, P=0. 048). There were no significant differences of Wexner score at discharge and the incidence of adverse drug reactions between groups ( all P >0. 05 ) . Trough SBA in observation group was significantly higher than that in control group [ ( 1. 18 ± 0. 27 ) vs ( 1. 06 ± 0. 25 ) ] ( t =2. 526, P =0. 013). Conclusion High dose of cefoxitin with short administration interval can improve the antibacterial effect on patients with complex anal fistula undergoing LIFT, reduce the risk of postoperative infection and promote recovery.

目的：对比320层CT血管造影（CTA）与数字减影血管造影（DSA）在老年下肢动脉闭塞性病变诊断中的应用效果。方法选取2011年5月至2013年5月在该院行下肢动脉CTA及DSA检查的28例老年下肢动脉闭塞性病变患者，将肾动脉水平以下的单侧下肢动脉和腹主动脉分为15个节段，共840个节段，对比320层CTA与DSA的诊断准确率、特异性、敏感性及显示的节段数。结果在全部的840个节段中，320层CTA诊断的准确率、特异性、敏感性分别为99％、98％、99％，DSA诊断的准确率、特异性、敏感性分别为99％、99％、99％。评估腘动脉以下区的动脉节段时320层CTA和DSA诊断的准确率、特异性、敏感性均98％、99％、100％；评估股动脉-腘动脉区节段时320层CTA诊断的准确率、特异性、敏感性分别为98％、98％、99％，DSA诊断分别为99％、98％、98％；评估主动脉-髂动脉区节段时320层 CTA诊断的准确率、特异性、敏感性分别为97％、98％、98％，DSA诊断分别为98％、98％、97％。另有1例腘动脉以下节段在320层CTA显影不清晰，50个节段在 DSA检查中显示不清晰，无法进行评估。结论320层CTA对老年下肢动脉闭塞性病变的诊断具有较高的准确率、特异性、敏感性，与 DSA 基本一致，且较 DSA能够显示出更多的节段。可作为老年下肢动脉闭塞性病变患者制定介入治疗方案的参考依据。