目的 探讨食管癌根治术中肾脏区域组织氧饱和度(rSO2)与术后肾功能异常的相关性.方法 选择拟行食管癌根治术的患者 116 例,男 93 例,女23 例,年龄18～64 岁,BMI＜24 kg/m2,ASA Ⅱ或Ⅲ级.术中连续监测左侧肾脏rSO2.设定麻醉诱导后肾脏 rSO2 为基础值,当术中肾脏rSO2 绝对值≤50％或低于基础值的 75％时,定义为肾脏rSO2 异常下降.记录术前及术后 24h尿素氮(BUN)、血清肌酐(SCr),术后肾功能异常定义为术后 24h 血浆 SCr＞130 μmol/L 或 BUN＞7.5 mmol/L.根据术后是否出现肾功能异常将患者分为两组:肾功能正常组和肾功能异常组.采用列联系数分析术中肾脏rSO2 异常下降与术后肾功能异常的相关性.结果 有40 例(34.5％)患者术中出现肾脏rSO2 异常下降,有45 例(38.8％)患者术后出现肾功能异常.二元Logistic回归分析显示男性是术后肾功能异常的危险因素(OR=5.490,95％CI 1.526～19.754,P=0.009).食管癌根治术中肾脏rSO2 的异常下降与术后肾脏功能异常呈正相关(rs =0.587,P=0.009).结论 食管癌根治术中肾脏rSO2 异常下降与术后肾功能异常呈正相关.

内镜黏膜下剥离术(ESD)是治疗胃黏膜和黏膜下病变的有效方法。然而，由于ESD操作中视野有限，对医师的技术要求高，且存在手术时间长，以及易并发术中穿孔、出血等问题，无法达到最佳疗效，从而导致其临床应用受到一定限制。近年来，辅助牵引技术的发展极大改善了ESD的治疗效果。本文总结并讨论了目前临床常用的ESD辅助牵引方法在胃部病变中的应用情况。

目的 分析胃癌根治术后肝功能异常(LA)的相关影响因素.方法 回顾性收集2018年6月至2020年12月择期行胃癌根治术的1013例患者临床资料,男699例,女314例,年龄24～92岁,ASAⅡ或Ⅲ级.根据术后第1天是否发生LA将患者分为两组:肝功能正常组(NLA组)和肝功能异常组(LA组).LA定义为血清中以下任一肝酶浓度升高:谷丙转氨酶>40 U/L,谷草转氨酶>40 U/L,γ?谷氨酰转移酶>49 U/L,碱性磷酸酶>135 U/L,总胆红素>17.1μmol/L,直接胆红素>6.8μmol/L.比较两组临床资料,将P<0.15的指标纳入二元Logistic回归模型分析.结果 术后第1天有577例(57.0％)患者发生LA.与NLA组比较,LA组肥胖、吸烟史、贫血、腹腔镜手术、输血、使用其他血管活性药物、使用酮咯酸氨丁三醇、高PETCO2比例明显升高,晶体输注量、出血量、尿量、总入超量明显增多,输液速度明显减慢,多巴胺使用比例明显降低,手术时间明显延长(P<0.15).二元Logistic回归分析显示,肥胖(OR=2.149,95％CI 1.241～3.720)、吸烟史(OR=1.913,95％CI 1.012～3.616)、使用酮咯酸氨丁三醇(OR=1.771,95％CI 1.025～3.060)、手术时间(每延长10 min,OR=1.148,95％CI 1.083～1.217)是术后LA的独立危险因素,总入超量(每增加100 ml,OR=0.872,95％CI 0.806～0.944)、尿量(每增加100 ml,OR=0.999,95％CI 0.998～1.000)、使用多巴胺(OR=0.500,95％CI 0.291～0.860)是术后LA的保护因素(P<0.05).结论 肥胖、吸烟史、酮咯酸氨丁三醇的使用、手术时间延长是术后LA的独立危险因素,合理的围术期输液管理及适量使用多巴胺以维持稳定的循环及尿量有利于保护肝功能.

Objective:To investigate the effect of platelet antibody screening and cross-matching on platelet transfusion in patients with acute immune thrombocytopenia (AITP).Methods:A total of 97 patients with AITP were screened for antibody, of which 33 (34.02%, 33/97) were antibody positive and 64 (65.98%, 64/97) were antibody negative. There were no significant differences in platelet infusion times and antibody positive rate between observation group and control group ( t=0.98, χ2=0.33, both P values>0.05).The effective rate of the observation group was higher than that of the control group(93.88% vs. 64.58%, χ2=12.71, P<0.05).Compared with 1 h after infusion, the CCI value of observation group was higher than that of control group at 1 and 24 h after infusion [×10 9/L: (12.60±2.64) vs (8.61±1.48), (7.37±1.55) vs (5.09±0.85); t values were 9.21 and 8.96, respectively, both P values<0.05].After infusion, the levels of prothrombin time(PT) in AITP patients in the observation group and control group both increased, and thrombin time(TT) and activated partial thromboplastin time(APTT) levels decreased.The coagulation function indexes of the observation group were better than those of the control group[S: (12.60±2.64)vs(8.61±1.48), (7.37±1.55)vs(5.09±0.85); t values were 9.21, 8.96, both P values <0.05)].The incidence of adverse reactions in the observation group was 12.5%, which was lower than 32.65% in the control group( χ2=4.525, P<0.05). Conclusion:Platelet antibody screening and blood cross-matching can effectively improve the transfusion effect, coagulation function and blood transfusion safety in patients with acute AITP.

本文在PubMed、中国知网、万方医学数据库中,对PD-1/PD-L1类药物引起骨髓抑制的个案报道进行系统检索,共得文献55篇.按照入选标准/剔除标准筛选纳入20篇(22例),其中男性14例(占63.6％).使用PD-1/PD-L1抑制剂1周期后发生骨髓抑制12例(占54.55％),17例为Ⅳ级反应(占77.3％),16例表现为血小板减少症(占72.73％),2例表现为全血细胞减少症(占9.09％).为临床了解PD-1/PD-L1抑制剂引起骨髓抑制发生特点、制定监护计划及处理该类不良反应提供依据.

Objective: To assess the accuracy of photoscreening for detecting refractive amblyopia risk factors (ARFs) in Chinese preschool children aged 4 to 5 years. Methods: A cross-sectional study. Comprehensive ocular examinations were conducted for preschool children in Nanjing, China from September to December, 2016. Photoscreening (Plusoptix A12C) was applied for refractive screening without cycloplegia. Voluntary children and children suspected of eyes abnormalities received cycloplegic retinoscopy (CR). Results of photoscreening and CR were compared using Wilcoxon signed rank test, and Bland-Altman plot were used to assess the agreement between the photoscreener and CR. According to the updated preschool vision screening guidelines from American Association for Pediatric Ophthalmology and Strabismus (AAPOS) in 2013, CR was adopted for identifying children with ARFs, which was considered as a golden standard. Based on the golden standard, the accuracy of 5 sets of referral criteria (including sensitivity standard, Matta/Silbert standard, AAPOS2013 standard, Alaska Blind Child Discovery standard, specificity standard) for photoscreener were tested. Receiver operating characteristics curves were constructed applied to evaluate the quality of the photoscreener in refractive ARFs detection and to find probably the best cut-off points. Results: In total, 1 986 children [mean age, (4.57±0.29) years] received comprehensive examinations, including 1 084 boys and 902 girls. The test ability of photoscreening was 99.04% (1 967/1 986) in the preschool children, and 96.56%(1 827/1 892) of the children got a reliable result within three screening attempts. In 538 children who had data of CR, refractive error of one child exceeded the upper limit of the photoscreener value setting, which was directly categorized as hyperopia, so in the end, 537 children were included to analyze the comparison between the two tests. The measurement values of photoscreening were lower than those of CR in sphere, cylinder and spherical equivalent [(0.75 (0.50, 1.25) D vs. 1.25 (1.00, 1.75) D, Z=-10.36, P<0.01; -0.50 (-0.75, -0.25) D vs. -0.25 (-0.75, 0.00) D, Z=-11.10, P<0.01; 0.63 (0.38, 0.88) D vs. 1.00 (0.75, 1.50) D, Z=-13.33, P<0.01]. The 95% limit of agreement cover rates between the photoscreening and CR in sphere, cylinder and spherical equivalent was 96.28% (517/537), 95.34% (512/537) and 96.65% (519/537), respectively. Based on the golden standard, 47 (8.74%) children had refractive ARFs, and the range of sensitivity, specificity, Youden index, positive predictive values and negative predictive values for detecting refractive ARFs of the 5 common used referral criteria was from 63.83% to 97.87%, from 53.36% to 97.56%, from 0.51 to 0.80, from 16.73% to 74.51% and from 96.57% to 99.62%, respectively. Considering particular refractive ARFs on the basis of the receiver operating characteristic curves, the optimal cut-off point for astigmatism was set at 1.38 D. Conclusion: Photoscreening could be an applicable tool to detect refractive ARFs in preschool children. (Chin J Ophthalmol, 2020, 56: 189-196).

自噬是细胞内一种溶酶体依赖的降解途径,可通过降解细胞器和蛋白质等细胞成分来维持细胞的功能和存活.以肝脏为实验研究对象对自噬的调节及功能认识有很大贡献.大量证据表明自噬在诸如病毒性肝炎、酒精性脂肪肝、非酒精性脂肪肝、急性肝损伤、药物性肝损伤、肝癌等多种肝脏疾病的发生发展中有重要作用.本文综述了近年来自噬在肝脏生理、病理中的作用,以期为肝病治疗提供借鉴和帮助.

Objective: This study aimed to investigate the surgical methods and prognosis of patients who underwent reoper-ation after local resection of differentiated thyroid carcinoma. Methods: A total of 80 thyroid carcinoma patients undergoing re-operation, including residual lobectomy and contralateral lobectomy, central compartment lymph node dissection, functional neck dissection etc. , in Jiangsu Cancer Hospital from December 2012 to October 2006 after near total thyroidec-tomy or local resection of differentiated thyroid carcinoma in other hospital were assigned to the reoperation group and analyzed retrospectively. Another 160 differentiated thyroid cancer pa-tients who underwent total thyroidectomy at the same time were randomly selected as control group. Complications, survival and prognosis in the two groups were compared. Results: In the reoperation group, residual cancer cells were observed in the thy-roid gland in 18 (22. 5% ) cases and in lymph nodes in 56(70% ) cases, and there were 5 cases of unilateral recurrent nerve injury and 1 case of bilateral injury (overall incidence rate=7. 5% ) after first operation in other hospital. There were 2 cases of new recurrent nerve injury (2. 5% ), 6 cases of hypoparathyroidism (7. 5% ), 1 case of superior laryngeal nerve injury, 0 case of esophageal injury and 0 case of postoperative hemorrhage after second surgery. In the control group, standard surgical method was adopted, and there were 9 cases of postoperative parathyroid dysfunction (including 3 cases of permanent parathy-roid dysfunction), 2 cases of recurrent laryngeal nerve injury, 1 case of superior laryngeal nerve injury, 1 case of esophageal injury and 3 cases of postoperative hemorrhage. In the over 5-year follow up, two cases of recurrence was found in the reopera-tion group, and 3 cases of recurrence and 1 death were found in the control group. There were significant difference in the inci-dence of recurrent laryngeal nerve injury between two groups, and no significant differences in other complications and progno-sis. Conclusion: Reoperation is needed after nonstandard thyroid cancer operation. Important tissue should be fully identified in the operation to reduce the incidence of complications. Timely remedial operation does not affect the prognosis of the patient.

目的 探讨冠心病患者血清视黄醇结合蛋白4 (retinal binding protein 4,RBP4)水平的变化,及其与氧化应激、颈动脉粥样硬化的关系.方法 选取老年冠心病患者100例及健康体检者100例,采用酶联免疫吸附法测定血清RBP4水平,黄嘌吟氧化酶法及硫代巴比妥酸显色法分别测定血清超氧化物歧化酶活性和丙二醛水平,高分辨彩色血管多普勒超声仪测量颈动脉粥样斑块面积和内-中膜厚度(IMT).结果 冠心病组血清RBP4[(35.10±5.76)ng/ml比(27.82±4.90)ng/ml]和丙二醛[(14.21±1.22)μmol/L比(9.89±1.64)μmol/L]水平,以及颈动脉粥样斑块面积[(15.27±1.16)mm2比(10.13±2.53)mm2、IMT(1.19±0.13)mm比(1.03±0.16)mm]均明显高于健康体检者组(P＜0.0l),血清超氧化物歧化酶活性[(76.49±13.82)kU/L比(93.29±12.11)kU/L,P＜0.01]则明显低于健康体检者组.血清RBP4水平与丙二醛(R=0.486)、颈动脉粥样斑块面积(R=0.354)及IMT(R=0.388)呈正相关(P＜0.05),与血清超氧化物歧化酶活性呈负相关(R=-0.343,P＜0.05).结论 老年冠心病患者血清RBP4水平明显升高,并且升高的RBP4水平与氧化应激损伤及颈动脉粥样硬化程度呈正相关.

Objective To investigate the effect of University of Wisconsin (UW) preservation solution (UW solution) infection on the recovery after liver transplantation. Methods Clinical data of 68 patients with allograft orthotopic liver transplantation from Jun. 2014 to Apr. 2017 in Nanjing Drum Tower Hospital were collected. The cases with infected UW solution were classified into positive group, and the cases with non-infected UW solution were classified into negative group. The postoperative liver function, occurrence of acute kidney injury (AKI) and postoperative infection were compared between the two groups. Results After liver transplantation, there was no difference of patients' liver function between two groups postoperative 1, 3, 7, 10 d (P>0.05). The incidence of postoperative AKI was 45.7% in the positive group, which was significantly higher than that in the negative group (18.1%, P=0.028). The incidence of blood infection and ascites infection in the positive group were significantly higher than those in the negative group (P=0.01, 0.039, respectively) when UW solution culture showed two kinds of bacteria and (or) fungi. Conclusion UW solution infection can increase the incidence of postoperative AKI, and UW solution culture with two kinds of bacteria and (or) fungi can increase the risk of postoperative blood infection and ascites infection.

目的 对哮喘患者实施全方位护理,探析对患者肺功能及满意度的影响.方法 自我院利用随机选取办法抽取56例哮喘患者临床资料,利用抽签法分组,观察组28例,行全方位护理,对照组28例,行常规护理.将2组患者护理干预后组间数据进行统计学分析.结果 观察组患者护理干预后肺功能、满意度均明显更优,对比对照组患者,差异较为明显,P＜0.05.结论 对哮喘患者实施全方位护理可明显改善患者肺功能及满意度,值得临床借鉴.

目的 探讨甲状腺术后低钙血症和甲状旁腺功能减退的影响因素以及资料分析.方法回顾江苏省肿瘤医院头颈外科2016年1月至2017年1月收治的183例经手术治疗的甲状腺疾病患者手术后低钙血症和甲状旁腺功能减退情况.分析年龄、性别、病理诊断、中央区淋巴结清扫、颈侧区淋巴结清扫、手术范围、手术时间、术前血钙水平、术前甲状旁腺激素水平与术后甲状旁腺功能减退及低钙血症的关系.结果 183例术后病理诊断为甲状腺癌163例(89.07%),甲状腺其他疾病20例(10.93%).术后141例甲状旁腺功能正常的患者中7例(4.96%)发生低钙血症,42例甲状旁腺功能减退的患者中26例(61.91%)发生低钙血症.单因素分析显示,性别、中央区淋巴结清扫、颈侧区淋巴结清扫、手术范围、手术时间、术前甲状旁腺激素水平与术后甲状旁腺功能减退相关.年龄、性别、中央区淋巴结清扫、颈侧区淋巴结清扫、手术范围、手术时间与术后低钙血症相关.结论 手术范围大、女性、行中央区淋巴结清扫、行颈侧区淋巴结清扫、手术时间长、术前甲状旁腺激素水平低的患者术后甲状旁腺功能减退的发生率高.手术范围大、年龄较大、女性、行中央区淋巴结清扫、行颈侧区淋巴结清扫以及手术时间长的患者术后低钙血症的发生率高.

目的:应用状态空间模型对我国甲肝、乙肝、丙肝的月发病率进行拟合和预测,分析预测准确率与发病周期规律的关系,为肝炎发病率的预测提供新方法.方法:对2005-2013年我国甲肝、乙肝、丙肝的月发病率建立状态空间模型,应用MATLAB软件中的SSM工具包对模型进行拟合,并对2014年1-12月的发病率进行预测;通过数据标准化,建立发病率周期规律性评价指标.结果:甲肝、乙肝和丙肝的月发病率预测相对误差的平均值分别为17.03％、6.30％和2.03％,标准化数据周期标准差均值分别为0.214 3、0.195 2和0.172 4.结论:状态空间模型能较好地应用于肝炎发病率的拟合和预测,标准化数据周期评价指标的标准差越小,预测效果越好.

目的探讨中药熏洗对后循环缺血患者睡眠的影响。方法选择80例后循环缺血患者为研究对象，并将其按随机数字表法分成观察组(40例)和对照组(40例)。对照组给予常规护理；观察组给予中药熏洗院在常规护理的基础上给予中药汤液足浴。比较两组匹兹堡睡眠指数量表评定睡眠质量的改善情况。结果应用10 d中药熏洗后，观察组睡眠质量显著高于对照组，差异有统计学意义(<0.05)。结论中药熏洗对后循环缺血患者改善睡眠效果好，值得进一步探讨。

探讨通过选择合适的溶剂、配合适当的护理减轻鼠神经生长因子注射后疼痛的影响。两组分别使用2ml灭菌注射用水、0.9%氯化钠注射液溶解注射，注射后采用数字分段式与文字描述式两种方法按性别、年龄、使用不同溶剂分组评估观察疼痛发生和疼痛的程度，给予心理、针对治疗药物使用情况下预防疼痛的护理减轻患者疼痛感，提高患者对治疗的接受度、提高生活质量。两组患者中氯化钠注射液组疼痛发生及疼痛程度小于灭菌注射用水组。

<正>多发性硬化是一种以中枢神经系统白质脱髓鞘性病变为特征的自身免疫疾病,病变可累及大脑半球、视神经、脊髓和小脑,以白质受累为主,病程中以复发-缓解为特点[1],病灶散在,症状体征多变,常为病变部位不同组合构成临床症状谱。以往该病多采取单纯甲强龙冲击治疗或丙种球蛋白治疗,本院在2003～2007年收治30例患者采用两者联用,疗效显著,不良作用小,现将护理体会介绍如下。

<正>神经内科患者由于多种原因造成躯体所受到损害的事件常有发生,其中以跌伤、烫伤、误吸、噎食、自伤、伤人较为常见,尤以跌伤多见,由于意外的发生可使患者造成不同程度的后

应激性溃疡是泛指各种应激状态下发生的胃肠道溃疡性病变,临床上以上消化道出血为主要表现,常发生于急性重症脑血管病发病后2～15 d,是一种不良征兆[1],如果并发大量出血时可危及患者生命导致死亡,是急性重症脑血管病的严重并发症之一.本科于2002年至2007年收治了62例急性重症脑血管病患者,现将其预防应激性溃疡的护理介绍如下.

1 临床资料 26例患者中,男19例,女7例,年龄22～73岁,平均41.2岁;其中15例有明确的上呼吸道感染病史,4例有劳累史,原因不明者7例;发病部位:左侧17例,右侧9例,临床首发症状为耳痛或伴有头面部及舌咽部痛者19例,伴声音嘶哑2例,随后出现耳廓及外耳道丘疹或簇集性丘疱疹,并有不同程度的面瘫(发病后3～5 d),听力下降,不同程度耳鸣、眼震、平衡失调等.