目的 通过本研究观察卡培他滨单药维持治疗晚期乳腺癌患者的临床疗效。方法 纳入本院2014年4月1日—2016年9月31日收治的晚期乳腺癌(复发、转移性乳腺癌)患者64例,均经过解救化疗达到缓解并稳定,按随机数字表法将所有入选对象分为治疗组与对照组(各32例),治疗组给予口服卡培他滨维持治疗,对照组给予定期(每12周)复查评价,比较2组患者的临床疗效、PFS、OS及生活质量。结果 治疗组的临床有效率(18.75%)、临床控制率(78.13%)均显著优于仅给予定期复查的对照组(3.12%)、(56.25%)(P＜0.05);治疗组维持治疗后生活质量改善者21例(65.63%),优于对照组9例(28.13%)(P＜0.05);治疗组用药期间出现Ⅰ～Ⅱ度为主的手足综合征、腹泻、恶心呕吐等毒副反应,均可耐受, Ⅲ-Ⅳ度毒副反应少发生。综合评估显示治疗组中位PFS为(9.6±1.4)个月、中位OS为(20.5±2.8)个月显著长于对照组(6.1±1.5)个月、(15.8±3.1)个月,两组中位PFS、中位OS比较差异有统计学意意义(P＜0.05)。结论 在晚期乳腺癌治疗中使用卡培他滨单药维持治疗具有显著的疗效,可延长患者的生存期,并提高患者的生活质量,毒副反应较轻,可作为晚期乳腺癌维持治疗的首选药物之一,值得临床推广应用。

目的 观察尝试采用激素替代疗法(hormonereplace menttherapy,HRT)治疗更年期疾病的干眼症的临床疗效。方法 将80例(160眼)干眼症患者随机分成2组,治疗组40例(80眼)在滴人工泪液的基础上采用激素替代疗法(HRT)口服治疗。对照组40例(80眼)单纯采用人工泪液滴眼液滴双眼。两组同时给予综合护理。3个月后观察疗效。结果 治疗组总有效率82.5%,对照组总有效率60%,两组总有效率比较差异有统计学意义(P<0.05),治疗组疗效优于对照组。结论 在人工泪液滴眼液滴双眼的基础上尝试采用激素替代疗法(HRT)治疗更年期疾病的干眼症患者,效果优于单纯应用人工泪液点眼。

Objective To investigate the role of hormone replace menttherapy (HRT) in treating xerophthalmia among patients with climacteric disease. Methods Eighty xerophthalmia patients (160 eyes) were randomly divided into two groups. Forty patients in the treatment group (80 eyes) were treated using combined HRT and artificial drops. Forty patients in the control group (80 eyes) were treated using artificial drops alone. All patients were provided comprehensive nursing. The evaluation of clinical effects was performed after 3 months of treatment. Results The total effective rate of both groups was 82.5% in the treatment group and 60% in the control group, respectively (P<0.05). Conclusion Combined HRT and artificial drops is more effective in treating climacteric disease-related xerophthalmia than using artificial drops only.

目的 探讨DPP-4抑制剂西格列汀对成人隐匿性自身免疫性糖尿病(LADA)早期患者胰岛β细胞功能的影响。方法 把14例新诊断为LADA患者随机分为两组,胰岛素治疗100 mg/d西格列汀(A组,n=7)或无西格列汀(B组,n=7)共治疗9个月。结果 9个月后两组之间的血糖和糖化血红蛋白水平无差异。9个月后A组空腹C肽(FCP),餐后C肽(CP),和ΔCP(ΔCP=2 h CP-FCP)水平与基线相比无明显差别(P＞0.05),B组FCP,2 h的CP和ΔCP进行比较基线显著下降(P<0.05)。A组2 h CP水平明显高于B组(P<0.05)。结论 胰岛素与西格列汀联用较单用胰岛素治疗成人隐匿性自身免疫糖尿病早期患者似乎能更好保护胰岛β细胞功能,西格列汀或可延长LADA非胰岛素依赖期的时间。

Objective The Objective of the study was to investigate the effects of the DPP-4 inhibitor on β-cell function in patients with recent-onset latent autoimmune diabetes in adults LADA. Methods Fourteen recently diagnosed LADA patients were randomized into two groups, A and B, to receive insulin therapy with 100 mg/d sitagliptin (group A, n=7) or without sitagliptin (group B, n=7) for 9 months. Results There were no differences in the clinical baseline data between the two groups. During the 9 months of follow-up, there were no significant differences in glucose and glycosylated hemoglobin levels between the two groups. At 9 months, there were not different in group A including fasting C-peptide (FCP), 2-hour postprandial C-peptide (CP), and ΔCP(ΔCP=2 h CP-FCP) levels (P>0.05). Compared with baseline, whereas in group B the levels of FCP, 2-hour CP and ΔCP were significantly decreased compared with baseline (P<0.05). Levels of 2-hour CP were higher in group A, it was higher than group B at 9 months (P<0.05). Conclusion LADA patients treated with sitagliptin and insulin was more likely maintain β-cell function by comparison with insulin alone. Sitagliptin administration in patients with LADA might prolong the insulin-free period.

目的 探究麻黄附子细辛汤联合参麦注射液治疗缓慢型心律失常的临床疗效。方法 以2015年9月—2016年9月在我院治疗缓慢型心律失常的90例患者作为研究对象,采用随机方式,分为两组,各45例,参麦注射液治疗作为对照组,观察组在对照组给药基础上合用麻黄附子细辛汤治疗,比较分析两组临床治疗效果。结果 观察组治疗总有效率为84.44%,临床疗效明显优于对照组64.44%,两组差异有统计学意义(P<0.05);中医证候评分,观察组治疗后较对照组低,组间差异有统计学意义(P<0.05);治疗后患者心率升高,且观察组优于对照组(P<0.05)。结论 临床治疗缓慢型心律失常,选用麻黄附子细辛汤合用参麦注射液,疗效显著,临床用药可推广应用。

目的 观察镜像视觉反馈和改良强制性运动治疗对脑卒中偏瘫患者上肢功能的影响。方法 前瞻性纳入2013年12月—2016年10月在我院收治的、临床资料完整的脑卒中偏瘫患者117例,随机将患者分4组:A组30例,B组29例,C组28例和D组30例,所有患者均接受常规综合康复治疗,连续治疗4周。在常规综合康复治疗的基础上,B组和C组分别增加镜像视觉反馈训练和改良强制性运动治疗,D组则同时另加镜像视觉反馈和改良强制性运动治疗。主要观察指标包括治疗前、后的Fugl-Meyer量表(FMA)、上肢功能测试(upper extremity function test, UEFT)和改良Barthel指数(MBI)的评分。结果 4组患者治疗后的FMA、UEFT和MBI评分分别为:A组(26.37±3.44)、(43.30±3.46)、(56.27±4.76),B组(29.17±2.82)、(45.41±3.40)、(58.72±4.48),C组(29.46±3.16)、(45.71±2.37)、(58.82±3.89),D组(31.93±2.74)、(48.83±3.57)、(62.17±4.51),与治疗前组内相比,配对t检验显示差异有统计学意义(P＜0.05);单因素方差分析发现,D组明显优于A、B、C 3组,差异有统计学意义(P＜0.05);B、C 2组均优于A组,差异有统计学意义(P＜0.05);B、C 2组间比较,差异无统计学意义(P＞0.05)。结论 在常规综合康复训练基础上,单独联合镜像视觉反馈或改良强制性运动治疗均能改善脑卒中偏瘫患者上肢运动功能和日常生活自理能力,但同时联合应用两种疗法,疗效更佳。

Objective To investigate the effects of mirror visual feedback (MVF) and modified constraint-induced movement therapy (mCIMT) on upper extremity function in post-stroke hemiplegics. Methods 117 patients with hemiplegia post-stroke were collected prospectively from December 2013 to October 2016, and randomly divided into the following four groups: group A (n=30), group B (n=29), group C (n=28) and group D (n=30). All patients were trained with conventional comprehensive rehabilitation therapy for four weeks, while the group B and group C were respectively trained with MVF and mCIMT based on conventional comprehensive rehabilitation therapy. Finally, the group D was simultaneously trained with MVF and mCIMT. The investigation duration was set as four weeks for all groups. The Fugl-Meyer Assessment (FMA) score, Upper Extremity Function Test (UEFT) score, and Modified Barthel Index (MBI) score were used as main index of clinical effects. Results After treatment, the scores of FMA, UEFT and MBI were respectively (26.37±3.44),(43.30±3.46),(56.27±4.76) in group A, (29.17±2.82), (45.41±3.40), (58.72±4.48) in group B, (29.46±3.16), (45.71±2.37), (58.82±3.89) in group C, (31.93±2.74), (48.83±3.57), (62.17±4.51) in group D.Comparing with the scores before treatment, the paired-sample t test showed that there were significant differences (P<0.05). The single factor variance test showed that the scores of the group D were significant better than those scores in group A, group B and group C (P<0.05); furthermore the scores of the group B and group C were significant better than the group A (P<0.05). However, there were no difference at those scores between the group B and group C (P＞0.05). Conclusion Based on conventional comprehensive rehabilitation, single combined with MVF or mCIMT may significantly improve the function of upper limb and activities of daily living (ADL) in post-stroke patients with hemiplegia. However, simultaneous combined with MVF and mCIMT will be more effective than the single one.

目的 对于急性脑梗死患者联用依达拉奉、阿加曲班注射液治疗的临床效果进行观察。方法 运用随机、开放以及对照原则,将发病12～48 h内的80位急性脑梗死患者,随机分为40例对照组、40例联合组,2组都以对症治疗以及常规治疗为基础,在此之上,对照组以依达拉奉进行治疗,联合组以依达拉奉辅以阿加曲班进行治疗,将2组最终治疗疗效作比较,对2组患者治疗前后血清hs-CRP、凝血功能状况、日常活动能力、血流变指标以及NIHSS评分的动态变化进行实时观察。结果 就总有效率而言,对照组的72.5%显著低于联合组的92.5%,P<0.05。经治疗,2组患者凝血功能指标、血清hs-CRP、血流变指标以及NIHSS评分均有所下降,联合组较之对照组降幅更为显著(P<0.05),较之2组治疗前后,差异无统计学意义(P>0.05)。2组都不曾有不良反应出现。结论 应用依达拉奉辅以阿加曲班进行治疗急性脑梗死患者,可显著提升临床疗效,促进患者神经功能及日常活动能力恢复,减少炎症反应发生,改善预后,且无明显不良反应。

目的 观察PNF技术配合寰枢椎复位对颈源性眩晕的临床疗效。方法 48例颈源性眩晕患者随机分为2组,PNF组24例给予寰枢椎旋转复位配合PNF技术治疗;对照组24例单纯给予旋转复位,分别在疗程结束后1天、1个月、半年回访。治疗前后应用颈性眩晕症状及功能评估量表和VAS视觉模拟疼痛评定量表进行疗效评定。结果 2组在短期治疗效果上没有显著的临床差别,但在中长期的疗效巩固、预防复发上,PNF组优于单纯寰枢椎旋转复位组。结论 PNF技术配合旋转复位能提高颈源性眩晕的临床疗效。

Objective To observe the clinical effect of PNF technique on cervicogenic vertigo. Methods 48 patients with cervicogenic vertigo were randomly divided into two groups, 24 patients in the PNF group; 24 patients were treated with atlantoaxial rotation and PNF. The control group (24 cases) was treated with rotational reduction. Before and after treatment, the curative effect of cervical vertigo and function evaluation scale and VAS visual analogue pain rating scale were used to evaluate the curative effect. Results There was no significant clinical difference between the two groups in the short-term treatment effect. But in the long-term effect of consolidation, prevention of recurrence, PNF group was superior to the simple atlantoaxial rotation reduction group. Conclusion PNF technique combined with rotational reduction may improve the curative effect of cervicogenic vertigo.

目的 探讨通络熄风汤联合西医基础治疗对缺血性脑卒中急性期的临床疗效观察及其安全性。方法 选择2013年4月—2015年4月之间于我院收治的缺血性脑卒中急性期患者112例随机分为联合组(n=56)与对照组(n=56)。两组缺血性脑卒中急性期患者均采用常规治疗,联合组在此基础上服用通络熄风汤。比较两组治疗总有效率,神经功能缺损积分,ADL评分,血清NSE水平及用药安全性。结果 联合组总有效率(91.07%)高于对照组(75.00%)(P<0.05);神经功能缺损评分治疗后联合组与对照组低于治疗前(P<0.05);神经功能缺损评分治疗后联合组低于对照组(P<0.05);ADL评分治疗后联合组与对照组高于治疗前(P<0.05);ADL评分治疗后联合组高于对照组(P<0.05);血清NSE水平治疗后联合组与对照组低于治疗前(P<0.05);血清NSE水平治疗后联合组低于对照组(P<0.05);联合组与对照组在用药期间均无发现有严重药物不良反应。结论 通络熄风汤联合西医基础治疗对缺血性脑卒中急性期的临床疗效明显,并且用药安全性良好。

目的 探讨鼻—空肠营养管在小儿急性胰腺炎中的疗效观察及护理。方法 采用回顾性分析法,选取2013年2月—2015年5月期间我院收治的116例急性胰腺炎患儿的临床资料,按照营养支持方法的不同将患儿分为对照组和观察组,每组58例。对照组患儿肠功能恢复后给予经口进食,观察组给予鼻—空肠营养管进行营养支持;并给予患儿针对性的护理措施。比较分析两组患儿的治疗效果。结果 观察组患儿平均住院时间、平均花费、并发症发生率、手术率及死亡率等指标均低于对照组(P＜0.05),差异有统计学意义。结论 鼻—空肠营养管应用于小儿急性胰腺炎具有较好的效果,降低患儿并发症发生率、手术发生率,缩短住院时间,减少住院消费,促进患儿康复。

Objective To observe the clinical efficiency of nasal jejunal nutrition in children with acute pancreatitis and explore the effective nursing. Methods The clinical characteristics of 116 children with acute pancreatitis from February 2013 to May 2015 in our medical center were retrospectively analyzed. Based on nutritional support, the patients were divided into two groups: the control group consisted of 58 patients receiving oral feeding after the recovery of bowel function, and the experiment group consisted of 58 patients with nasal jejunal nutrition. And all the patients were treated with special care on case-by-case. The efficiency was then compared between the two groups. Results Compared with the control group, the length of hospital stay, cost of care, the incidence of complications, the surgical proportion and the mortality were significantly decreased in the experiment group (P<0.05). Conclusion In the children with acute pancreatitis, application of nasal jejunal nutrition is more effective, leading to decrease incidences of complications and surgical proportion, shorten the length of hospital stay, reduce patients' cost, and finally help rehabilitation.

目的 评估大光斑低能量Q开关Nd:YAG激光治疗黄褐斑的疗效和安全性。方法 采用Q开关Nd∶YAG激光器以波长1064 nm,光斑6～7 mm,能量2.0～2.5 J/cm²,对黄褐斑患者进行治疗,以治疗处呈现微红为治疗终点,每月1次,治疗5次,共治疗黄褐斑36例。结果 36例患者中基本治愈8 例(22.23%),显效15例(41.67%),好转9例(25%),无效4例(11.11%),前两者之和为总有效率,达63.89%。患者耐受性好,无明显副作用。结论 大光斑低能量Q开关Nd:YAG激光为治疗黄褐斑提供了安全有效的方法。

Objective To evaluate the efficacy and security of Q-switched laser with Large Spot and Low Fluence for the treatment of melasma. Methods Thirty-six patients with melasma were enrolled in study. 1064 nm Q-switched Nd:YAG laser was used with light spot of 6-7 mm and 2.0-2.5 J/cm² in fluence.Treatments are ended when the melasma area turns slight red. Subjects were received a total of 5 treatments at one month intervals. Results Thirty-six patients completed the trial. 22.23% of patients achieved 90% to 100% clearance and 41.67% achieved 60% to 90% clearance. The total efficient rate reached 63.89% .Side effects was minimal and all the patients tolerated the treatment well. Conclusion Q-switched Nd:YAG laser with Large Spot and Low Fluence provides a safe and effective treatment method for melasma.