目的 观察右美托咪定联合鸡尾酒给药方案用于髋关节置换术后患者自控静脉镇痛(PCIA)的疗效.方法 将2017年3月—2018年9月在石家庄市中医院拟择期实施髋关节置换术的90例患者按照随机数字表分为PCIA组、右美托咪定+PCIA组和鸡尾酒给药方案+右美托咪定+PCIA组,每组30例.PCIA组术后给予PCIA镇痛(阿扎司琼0.8 mg/kg+地佐辛0.3 mg/kg,锁定时间20 min);右美托咪定+PCIA组在PCIA组基础上加用右美托咪定2.0μg/kg实施PCIA镇痛;鸡尾酒给药方案+右美托咪定+PCIA组在右美托咪定+PCIA组基础上给予鸡尾酒给药方案(肾上腺素0.3 mg+酮咯酸30 mg+罗哌卡因400 mg+吗啡5 mg+生理盐水70 mL局部注射).观察3组不同时间血流动力学、疼痛视觉模拟评分(VAS)、镇静Ramsay评分、PCIA按压次数和不良反应情况.结果 3组术后2 h、术后4 h、术后8 h、术后12 h收缩压(SBP)、平均动脉压(MAP)、心率(HR)均较术前显著增高(P均<0.05),鸡尾酒给药方案+右美托咪定+PCIA组和右美托咪定+PCIA组以上时间点各指标均显著低于PCIA组(P均<0.05);鸡尾酒给药方案+右美托咪定+PCIA组和右美托咪定+PCIA组以上指标在术后48 h恢复至术前,但PCIA组仍高于术前(P<0.05);3组术后2,4,12,48 h活动状态下和静息状态下的疼痛VAS评分鸡尾酒给药方案+右美托咪定+PCIA组显著低于右美托咪定+PCIA组(P<0.05),右美托咪定+PCIA组显著低于鸡尾酒给药方案+右美托咪定+PCIA组(P均<0.05).3组术后2,4,8,12,48 h的镇静Ramsay评分鸡尾酒给药方案+右美托咪定+PCIA组显著低于右美托咪定+PCIA组(P均<0.05),右美托咪定+PCIA组显著低于PCIA组(P均<0.05).鸡尾酒给药方案+右美托咪定+PCIA组PCIA按压次数、补救镇痛药比例均显著低于右美托咪定+PCIA组(P均<0.05),右美托咪定+PCIA组显著低于PCIA组(P均<0.05);鸡尾酒给药方案+右美托咪定+PCIA组镇痛满意度评分显著高于右美托咪定+PCIA组(P均<0.05),右美托咪定+PCIA组显著高于PCIA组(P均<0.05);鸡尾酒给药方案+右美托咪定+PCIA组恶心呕吐发生率显著低于右美托咪定+PCIA组(P<0.05),右美托咪定+PCIA组显著低于PCIA组(P<0.05),鸡尾酒给药方案+右美托咪定+PCIA组与右美托咪定+PCIA组头晕头痛、寒战发生率均显著低于PCIA组(P均<0.05);3组其余不良反应发生率比较差异无统计学意义(P均>0.05).结论 右美托咪定联合鸡尾酒给药方案用于髋关节置换术后患者PCIA,不仅能够稳定血流动力学,还能提高术后镇痛镇静效果,且不良反应少,安全性高.

目的 :探讨右美托咪定复合丙泊酚用于内镜下食管胃静脉曲张手术麻醉的效果及安全性.方法 :选择我院择期行内镜下食管胃静脉曲张套扎术的患者随机分为A组(丙泊酚组,n=41例)和B组(右美托咪定复合丙泊酚组,n=42例).A组患者采用丙泊酚1.5~2mg/kg行麻醉诱导,4~8mg.kg-1.h-1进行麻醉维持;B组患者采用右美托咪定0.5ug/kg(10分钟)+丙泊酚1~1.5mg/kg进行麻醉诱导,3~5mg.kg-1.h-1进行麻醉维持.统计2组给药前(T1)、给药后5min(T2)、给药后10min(T3)、给药后20min(T4)、给药后30min(T5)生命体征(HR、MAP、RR、SPO2)及T1~T5时间点血清中肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(COR)含量的变化及2组丙泊酚总使用量、手术时间、麻醉苏醒时间以及围术期不良反应.结果 :A组患者丙泊酚总使用量明显高于B组,T2~T5时间点HR明显高于B组患者,T2~T3时间点MAP明显低于B组患者,T4-T5时间点E、NE、COR明显高于B组,围术期体动、呛咳、低氧血症、头晕的发生率明显高于B组,差异均有统计学意义,p<0.05.2组患者手术时间、麻醉苏醒时间差异无统计学意义,p>0.05.结论 :右美托咪定复合丙泊酚用于内镜下食管胃静脉曲张手术不仅可以减少丙泊酚的用量、降低围术期不良反应的发生,而且可以减少围术期患者的应激反应,维持生命体征的平稳.

Objective:To explore the application value of personalized care in the primiparas for interventional prenatal diagnosis.Method:210 primiparas with interventional prenatal diagnosis in our hospital from May 2013 to May 2015 were selected as observation objects,they were randomly divided into the control group and the observation group,105 cases in each group. The control group was given routine nursing care,the observation group was given personalized care.The Hamilton anxiety scale (HAMA) score and vital sign between the two groups were observed and compared.Result:There was no statistically significant difference in HAMA score of the two group before treatment(P>0.05).The HAMA score of the observation group before puncture and after puncture examination were (23.15±5.66)points and (18.12±5.36)points,which were significantly lower than (26.16±5.03)points and (20.31±5.13)points of the control group,the differences were statistically significant(P<0.05). And there were no statistically significant difference in heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure (DBP),breathing rate(R) and the blood oxygen saturation(SpO2) of the two group before treatment(P>0.05).But at the end of the inspection,the HR,SBP and DBP of the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05).There were no statistically significant difference in R and SpO2 between the two group(P>0.05).Conclusion:Personalized care can effectively relieve the negative emotions of primiparas for interventional prenatal diagnosis,and to a certain extent,can improve maternal vital signs during inspection,is worthy of clinical promotion.

目的 探讨水中分娩对耻骨联合分离发生率的影响.方法 观察实施水中分娩的产妇450例(研究组)耻骨联合分离发生情况,并与同期实施传统分娩的450例产妇(对照组)进行比较.结果 对照组发生耻骨联合分离47例(10.4％),研究组发生20例(4.4％),两组比较,差异有统计学意义(P＜0.01).结论 水中分娩能增加产妇盆底肌肉的张力和弹性,使关节韧带松弛柔软,有助于胎儿顺利通过产道,减少产后耻骨联合分离的发生,促进自然分娩.

目的：探讨中医正骨手法预防产后耻骨联合分离发生的价值。方法将自然分娩的1800例产妇随机分为研究组和对照组各900例，对照组自然分娩时仅给予保护会阴的措施，研究组在保护会阴的同时给予中医正骨手法，追踪记录2组产妇发生耻骨联合分离的情况，比较2组耻骨联合分离发生率的差异。结果对照组发生耻骨联合分离Ⅰ度67例（7．44％），Ⅱ度21例（2．33％），Ⅲ度6例（0．67％），总发生率10．44％；研究组发生耻骨联合分离Ⅰ度37例（4．11％），Ⅱ度11例（1．22％），Ⅲ度1例（0．11％），总发生率5．44％，2组总发生率比较差异有统计学意义（P ＜0．05）。结论助产师在产妇生产时引入中医正骨手法，能有效避免或减轻产后耻骨联合分离的发生率，值得临床推广。

目的 观察利美达松贴敷结合中药和手法按摩治疗急性乳腺炎的临床效果.方法 将300例急性乳腺炎患者随机分为A、B、C3组,3组都给予常规治疗即全身给予广谱抗生素控制感染,疗程6d;并给予手法按摩,2次/d,疗程6d;口服中药汤剂,1剂/d,连服6d.A组配合利美达松贴敷,B组配合地塞米松贴敷,C组配合皂角液离子导入,均2次/d,疗程6d.观察乳房红、肿、热、痛及全身症状好转情况.结果 A组有效率100％,治愈率96％;B组有效率88％,治愈率52％;C组有效率84％,治愈率50％.A组疗效明显优于B组和C组.结论 利美达松贴敷治疗急性乳腺炎能迅速消退乳腺组织肿胀,促进乳汁排出通畅,有利于配合中药和手法按摩迅速消除乳房红、肿、热、痛及全身症状,而且疗程短,疗效高,患者痛苦小,无不适,操作方便,患者乐于接受.

目的研究综合疗法在小儿弱视治疗中的应用效果。方法选择2010年8月至2012年6月在我院收治的120例195只眼睛的弱视儿童临床综合治疗资料进行回顾性的分析和研究。结果 120例弱视儿童,经过综合性治疗后,135只眼睛基本治愈,57只眼睛有所进步,3只眼睛无效。结论对弱视儿童采取有效的综合治疗措施,可以提高弱视治疗效果,帮助弱视儿童恢复视力,值得在临床治疗中推广和应用。

准分子激光原位角膜磨镶术(LASIK)在我国已经开展了二十年,其治疗近视、远视、散光的准确性已经被广泛认可,是目前屈光手术中的主流手术方式.随着时间的延长,患者数量的增加,外伤导致角膜瓣移位,皱褶为其主要并发症之一.越来越多关于角膜瓣损伤的问题已经受到重视.我们实施该手术18年,本文报告几种临床上经常遇到的角膜瓣的损伤.

目的评价眼前节全景仪引导的个体化准分子激光上皮瓣下角膜磨镶术（laser subepithelial keratomileusis,LASEK）治疗偏中心切削所致不规则散光的效果,并比较术前和术后不同时间角膜不规则状态的变化。方法收集10例（18眼）因行屈光手术而发生偏中心的患者,伴有严重的不良视觉症状,行眼前节全景仪引导的个体化LASEK治疗。所有患者在术前和术后1个月、3个月和6个月均行眼前节全景仪检查,并对手术前后所有患者的裸眼视力（uncorrected visual acuity,UCVA）、最佳矫正视力（best corrected visual acuity,BCVA）、角膜表面非球面性（Q值）、角膜表面变异指数、角膜表面垂直不对称指数等进行比较。结果 UCVA由术前0.26±0.15变为术后6个月0.85±0.11,BCVA术前0.69±0.20变为术后6个月1.02±0.04,UCVA、BC-VA与术前相比差异均有显著统计学意义（均为P=0.00）。Q值术前为0.56±0.29,术后1个月、3个月时分别为0.21±0.52、0.36±0.42,差异均有统计学意义（均为P＜0.05）;术后6个月为0.54±0.48,与术前相比差异无统计学意义（P＞0.05）。角膜表面变异指数术前为65±11,术后6个月降低为59±8,差异有统计学意义（P＜0.05）。角膜表面垂直不对称指数术前为0.78±0.12,术后6个月降低为0.24±0.18,差异也有统计学意义（P=0.04）。术后切削区中心偏移明显改善,光学区居中,并且光学区较术前有所扩大。结论眼前节全景仪引导的个体化LASEK手术矫治偏中心所致的角膜不规则散光安全、有效,能整体上改善角膜不规则状态。

目的 观察并比较高度近视患者行前弹力层下角膜磨镶术(sub-Bowman′s keratomileusis,SBK)和准分子激光上皮瓣下角膜磨镶术(laser-assisted subepithelial keratomileusis,LASEK)手术前及手术后不同时期的视力、泪膜破裂时间(break up time,BUT)、角膜后表面高度及眼波前像差的变化特点,为高度近视患者的手术方式选择提供依据.方法 将43例86眼的高度近视患者随机分为SBK组及LASEK组.分别于术前,术后1周、1个月、3个月及6个月检查裸眼视力(uncorrected visual acuity,UCVA)、最佳矫正视力(best corrected visual acuity,BCVA)、BUT、OCULYZER 眼前节分析系统测量角膜后表面高度;ALLEGRO像差仪获取眼慧差(coma aberration,Coma)、球差(spherical aberration,SA)并进行比较.结果 SBK术后视力恢复快,2种手术术后3个月BUT恢复至术前水平,角膜后表面均无明显前凸;SBK、LASEK术后眼高阶像差均有所增加,术后3个月内SBK组有相对较低的高阶像差.术后6个月2组眼高阶像差异无统计学意义.结论 SBK与LASEK治疗高度近视均具有良好的视觉质量.

目的 比较术前和术后不同时间角膜不规则状态的变化,评价个体化准分子激光上皮下角膜磨镶术(laser-assisted subepithelial keratomileusis,LASEK)治疗不规则散光的效果.方法 收集曾行眼前节全景仪引导的个体化LASEK手术治疗的不规则散光患者23例(40眼)的临床资料.所有患者在术前和术后1个月、3个月和6个月均行眼前节全景仪检查.并对手术前后所有患者的裸眼视力( uncorrected visual acuity,UCVA)、最佳矫正视力( best corrected visual acuity,BCVA)、角膜表面非球面性(Q值)、角膜表面变异指数(index of surface variance,ISV)等进行分析比较.结果 UCVA术前为0.39±0.15,术后6个月为0.95±0.11.BCVA术前为0.79±0.20,术后6个月为1.00±0.04.UCVA、BCVA和术前相比差异有统计学意义(P＜0.05).Q值术前为+0.66±0.28,术后1、3、6个月时分别为+0.24±0.58、+0.41±0.49、+0.38±0.53,术前与术后比较差异有统计学意义(P＜0.05);ISV术前为55±10,术后6个月降低为35±8,差异具有统计学意义(P＜0.05).结论 眼前节全景仪引导的个体化LASEK手术能显著提高患者的UCVA,整体上改善角膜不规则状态.

近年来,儿童外伤性尿道断裂的数量呈上升趋势,尿道闭锁由于病变部位深,传统开放手术损伤大,术野小,操作困难.随着腔内技术的发展,泌尿外科的大部分手术都可以通过腔内手术解决,也包括尿道狭窄及尿道闭锁.为探讨女童创伤性尿道闭锁的治疗方法,我院自2007年1月至2011年1月采用小儿膀胱镜结合尿道内切开镜辅助下行尿道会师术方法探通尿道7例,疗效满意,现总结分析如下.

Objective: To investigate the expression of SDF-1 and its receptor CXCR4 in placenta of patients of hypertensive disorder complicating pregnancy,analyze the relationship between their expression and the development of hypertensive disorder complicating pregnancy.Methods: The expression intension and extent of SDF-1,CXCR4 in placenta of patients of hypertensive disorder complicating pregnancy were measured by Immunohistochemical method.Results: Along with the deterioration and development of hypertensive disorder complicating pregnancy,the expression intension and extent of SDF-1 and CXCR4 in placenta were gradually decreasing.The expression intension and extent of SDF-1 were superior to the expression intension and extent of CXCR4.Conclusions: The variety of the expression intension and extent of SDF-1,CXCR4 has an important relationship with the development of hypertensive disorder complicating pregnancy.

新生儿期性别畸形的60％～70％是女性假两性畸形,最常见的原因为先天性肾上腺皮质增生( congenital adrenal hyperplasia,CAH)[1],临床并不多见,且常延迟诊治.2007年7月至2010年3月,我们共收治3例CAH所致女性假两性畸形,经手术矫治结合糖皮质激素替代治疗,效果满意。

自从1993年我国引进第一台准分子激光治疗仪以来,近20年来准分子激光屈光性角膜手术发展迅速,数以千万的近视患者摘掉了眼镜.但术后相当一部分患者会发生干眼症,大约2%～6%的患者会出现点状角膜炎,48%～59%的患者会有干眼的症状[1].干眼已经成为准分子激光角膜屈光手术后最常见的并发症之一[2].为进一步研究不同术式泪膜稳定性的差异,我们对2009年1月至2010年12月在我院行准分子激光治疗高度近视的患者43例(86眼),通过对术后泪膜破裂时间的变化进行观察分析,报告如下.

Objective To observe the change characteristic of wavefront aberration of high myopic patients before and different time after sub-bowman's keratomileusis (SBK) and laser-assisted subepithelial keratomileusis (LASEK).Methods 43 patients (86 eyes) were divided randomly into two groups:SBK group and LASEK group.To observe and compare the higher-order aberrations before and 1week,1month,3months,6months after operation.Results High order aberration especially Coma and SA increased poetoperatively in both two groups.Conclusion High order aberration increased after SBK and LASEK and was relatively low in 3 months after SBK.

Objective To observe the clinical efficacy of Changchun'an Sustained Release Capsules combined laser photocoagulation in treating retinal vein occlusion.Methods One hundred and twenty cases were randomly divided into research group and control group.Fifty-six cases in control group were treated with photocoagulation,and sixty-four cases in research group were treated with photocoagulation and Changchun'an Sustained Release Capsules.The clinical efficacy of eye ground and improvment of eyesight were observed after three months.Results The effective rate for eye ground was 84.4% in research group and 62.5% in control group,the effective rate was higher in research group than in the control group(P0.01);the improvment rate for eyesight in research group was 78.1%,higher than 53.6% in the control group(P0.01).Conclusion Changchun'an Sustained Release Capsules and/combined combing with laser photocoagulation has positive effects on retinal vein occlusion.

AIM:To evaluate the clinical effect of oculyzer-guided laser in situ keratomileusis(LASIK) and conventional LASIK on the correction of hyperopia and hypermetropic astigmatism.METHODS:Totally 55 patients(110 eyes) were randomly divided into two groups.One group of 25 patients(50 eyes) were performed with oculyzer-guided customized LASIK,the other group of 30 patients(60 eyes) with conventional LASIK.Postoperative uncorrected visual acuity(UCVA),refraction and decentered ablation complication were observed.RESULTS:The postoperative visual acuity of the two groups both improved significantly and the postoperative refraction regressed in varying degrees.In oculyzer-guided customized LASIK group,the postoperative UCVA was better and the refraction at 6 months after operation was more reliable.There was statistical difference between the two groups(P<0.05).The incidence rate of postoperative decentered ablation in oculyzer-guided customized LASIK group was obviously less than that in conventional LASIK group and presented significantly statistical difference(P<0.01).CONCLUSION:Oculyzer-guided customized LASIK for hyperopia showed better visual acuity,less postoperative complication and was predictable.

目的 比较角膜地形图引导的准分子激光角膜磨镶术 (laser in situ keratomileusis,LASIK) 与传统的LASIK 在矫正远视及远视散光中的临床疗效.方法 采用随机数字表法将55例患者 110 眼分为2组,分别行角膜地形图引导的个体化切削治疗(topography-guided customized ablation treatment,T-CAT)引导的LASIK(25例50眼)和传统LASIK(30例60 眼).比较2组术后视力变化、屈光度变化、偏中心切削并发症.结果 2组患者术后视力均明显提高,屈光度均有不同程度回退,T-CAT引导的LASIK组与传统LASIK组比较,术后裸眼视力更好,6个月时屈光度更稳定,差异有统计学意义(P<0.05);T-CAT引导的LASIK组术后偏中心切削发生率明显少于传统LASIK组,差异有统计学意义(P<0.01).结论 T-CAT引导的LASIK手术治疗远视预测性和术后视力更好,术后并发症更少.

Objective To evaluate the surgery treatment for aged conjunctivochalasis with epiphora. Methods 18 eyes of 13 patients with epiphora from aged conjuctivochalasis underwent surgical treatment.All the patients were followed up 1-6 months. Results All cases after operation were considered effective.The syndrome of tearing of 3 eyes was mitigated.One eye still teared because of membrane covering lacrimal point.Syndrome of tearing disappeared when membrane was removaled.The recovery rate was 83.33%.There was no residual after operation. Conclusion The surgery of removaling conjunctiva and lacrimal caruncle partly is safe and effective of aged conjunctivochalasis.