目的 探究宫腔镜结合避孕药治疗子宫内膜息肉的临床疗效与对其安全性的分析。方法 随机选取2016年2月—2017年12月内160例子宫内膜息肉患者,分为对照组(80例,宫腔镜治疗)和观察组(80例,宫腔镜结合屈螺酮炔雌醇片治疗),对比两组临床疗效及不良反应的差异性。结果 与对照组相比,观察组患者月经改善效果更佳,其复发率更低,差异有统计学意义(P＜0.05);在不良反应的对比中,观察组结果与对照组结果相比较,不存在较大差异(P>0.05)。结论 宫腔镜结合避孕药治疗子宫内膜息肉取得了一定的临床疗效,不良反应并不显著,可推广运用。

Objective To explore the clinical efficacy and safety of hysteroscopy combined with contraceptives in the treatment of endometrial polyps. Methods From February 2016 to December 2017, 160 patients with endometrial polyps were randomly selected and divided into control group (80 cases treated by hysteroscopy) and observation group (80 cases treated by hysteroscopy combined with drospirenone and ethinyl estradiol tablets). The differences of clinical efficacy and adverse reactions between the two groups were compared. Results Compared with the control group, the observation group had better menstruation improvement effect and lower recurrence rate. The difference was statistically significant (P<0.05). In the comparison of adverse reactions, there was no significant difference between the observation group and the control group (P>0.05). Conclusion Hysteroscopy combined with contraceptives has achieved certain clinical efficacy in the treatment of endometrial polyps, and the adverse reactions are not significant, which can be popularized and applied.

目的 探讨应用三管引流法在防治直肠癌前切除术后吻合口漏中的疗效。方法 选取在我科2018年4月—2020年3月接受腹腔镜或者开腹直肠癌前切除术患者186例,将患者随机分为两组,研究组(三管引流法)96例,对照组(常规引流法)90例,进行对比研究。比较两组患者术后吻合口漏及恢复情况。结果 研究组患者吻合口漏发生率、非计划手术率、回肠造口率低于对照组(P＜0.05),吻合口漏患者中,研究组体温恢复正常时间、C反应蛋白(CRP)恢复正常时间及住院时间均少于对照组,差异均有统计学意义(P＜0.05)。结论 应用三管引流法,可预防直肠癌前切除术后吻合口漏,通过非手术治疗避免非计划二次手术,缩短吻合口漏患者恢复时间,显示更好的临床疗效。

Objective To explore and evaluate the clinical application value of three-tube drainage for the treatment of anastomotic leakage after low anterior resection for rectal cancer. Methods We retrospectively analyzed a total of 186 rectal cancer patients after low anterior resection for rectal cancer in our hospital from April 2018 to March 2020. According to the difference of prevention to anastomotic leakage, these patients were divided into two groups randomly that 90 cases used conventional drainage as control group, and 96 cases used three-tube drainage as study group. Postoperative recovery and anastomotic leakage were compared between these two groups. Results The rate of anastomotic leakage, ileostomy and unplanned reoperation of study group were lower than those of control group (P＜0.05).The times returned to normal of body temperature and C-reactive protein (CRP), the average length of stay in hospital of study group were shorter than those of control group respectively (P＜0.05). Conclusion The application of three-tube drainage may prevent anastomotic leakage and unplanned reoperation after low anterior resection for rectal cancer and shorten postoperative recovery time, to reveal better clinical effects.

目的 探讨¹³¹I联合甘氨双唑钠治疗分化型甲状腺癌(differentiated thyroid carcinoma,DTC)骨转移的临床疗效。方法 以我院96例DTC骨转移患者为研究对象,随机分为对照组和观察组各48例,对照组仅予¹³¹I治疗,观察组予¹³¹I联合甘氨双唑钠治疗,比较两组的临床疗效、转移灶清除效果及不良反应。结果 根据骨痛评价标准,观察组的有效率(71.00%)高于对照组(48.00%)(P＜0.05)。根据血清甲状腺球蛋白(thyroglobulin,Tg)评价标准,观察组的有效率(77.00%)高于对照组(58.00%)(P＜0.05)。根据病灶影像学评价标准,观察组的有效率(48.00%)高于对照组(27.00%)(P＜0.05)。两组不良反应发生率差异无统计学意义(P＞0.05)。结论 ¹³¹I联合甘氨双唑钠可提高DTC骨转移患者临床疗效,具有临床推广意义。

Objective To explore the clinical effect of ¹³¹I combined with sodium glycididazole in the treatment of differentiated thyroid cancer (DTC) with bone metastasis. Methods Ninty-six patients with DTC bone metastasis were randomly divided into the control group and the observation group, forty-eight patients in each group. The control group was treated with ¹³¹I only, while the observation group was treated with ¹³¹I combined with glycididazole sodium. The clinical effect, metastasis clearance effect and adverse reactions of the two groups were compared. Results The effective rate of the observation group (71.00%) was higher than that of the control group (48.00%) (P<0.05) according to the evaluation criteria of bone pain. The effective rate of the observation group (77.00%) was higher than that of the control group (58.00%) (P<0.05) according to the evaluation criteria of serum thyroglobulin (Tg). The effective rate of the observation group (48.00%) was higher than that of the control group (27.00%) (P<0.05) according to the imaging evaluation criteria. There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion The combination of ¹³¹I and sodium glycidazole can improve the clinical effect of patients with DTC bone metastasis, which has clinical significance for promotion.

目的 探讨双靶点微创联合尼莫地平治疗丘脑出血破入脑室患者的安全性及对NIHSS评分的影响。方法 选择2017年1月—2020年1月期间本院收治的54例丘脑出血破入脑室患者作为研究资料,随机分组各27例,对照组行单纯侧脑室体外引流术治疗,观察组行立体定向下侧脑室联合丘脑血肿双靶点微创穿刺引流术治疗,均实施尼莫地平治疗,观察两组手术并发症,测定治疗不同阶段患者NIHSS评分、ADL评分、神经损伤指标、创伤应激指标变化。结果 并发症率比较,观察组7.41%低于对照组29.63%,P＜0.05;治疗后,观察组NSE、NGF、β-EP、Cor均降低,且低于对照组,P＜0.05;治疗后,观察组NIHSSL评分降低且低于对照组,ADL评分升高且高于对照组,P＜0.05。结论 针对丘脑出血破入脑室患者采取立体定向下侧脑室联合丘脑血肿双靶点微创穿刺引流术及尼莫地平治疗可进一步改善神经功能及生活质量,且手术安全性高,创伤应激恢复改善,神经损伤恢复快,并发症少,值得推广。

Objective To investigate the safety of double target minimally invasive surgery combined with nimodipine in the treatment of patients with thalamic hemorrhage breaking into ventricle and its influence on NIHSS score. Methods From January 2017 to January 2020, 54 patients with thalamic hemorrhage ruptured into ventricles in our hospital were selected as the research data, and they were randomly divided into 27 cases in each group. The control group was treated with external drainage of lateral ventricle alone, and the observation group was treated with stereotactic double target minimally invasive puncture and drainage of hypothalamic hematoma. The changes of NIHSS score, ADL score, nerve injury index and trauma stress index in different stages of treatment were determined. Results The complication rate of the observation group was 7.41%, lower than that of the control group 29.63%, P<0.05; after treatment, NSE, NGF, β-EP, Cor in the observation group were decreased, and lower than those in the control group, P<0.05; after treatment, NIHSSL score of the observation group was decreased, lower than that of the control group, ADL score was increased and higher than that of the control group, P<0.05. Conclusion For patients with thalamic hemorrhage breaking into ventricles, stereotactic double target minimally invasive puncture drainage combined with thalamic hematoma and nimodipine treatment may further improve the neurological function and patients’ quality of life, and the operation safety is high, the recovery of traumatic stress is improved, the recovery of nerve injury is quick, and the complications are less, which is worthy of promotion.

目的 探讨艾滋病继发真菌感染患者病情的临床特点与治疗措施。方法 选取2019年4月—2020年4月我院收治的艾滋病继发真菌感染患者90例,对所有患者的病情特点进行分析,并及时采取有效地治疗措施。分析患者真菌感染部位、病情临床特点、治疗效果。结果 患者真菌感染部位中,排在前三位的为口腔、肺、食道,占比为44.4%(40/90)、30.0%(27/90)、23.3%(21/90);90例患者中,感染真菌排在前三位的为白色念珠菌、马尔尼菲青霉菌、新型隐球菌,占比为36.7%(33/90)、24.4%(22/90)、16.7%(15/90);90例患者中,显效32例(35.5%)、有效46例(51.1%)、无效12例(13.4%),有效率为86.6%(78/90)。结论 艾滋病继发真菌感染患者中,感染的主要部位主要为口腔、肺、食道,其中感染的真菌主要有白色念珠菌、马尔尼菲青霉菌、新型隐球菌。对患者及时进行有效地抗逆转录病毒治疗可以降低患者死亡率,提高治疗效果。

Objective To explore the clinical characteristics and treatments of AIDS secondary fungal infection. Methods A total of 90 patients with secondary fungal infection of AIDS admitted to our hospital from April 2019 to April 2020 were selected, and the characteristics of all patients were analyzed, and effective treatment measures were taken in time. The sites of fungal infection, clinical characteristics and therapeutic effects were analyzed. Results The top three fungal infection sites were oral cavity, lung and esophagus, accounting for 44.4% (40/90), 30.0% (27/90) and 23.3% (21/90). Among the 90 patients, candida albicans, penicillium marneffei and cryptococcusneoforme ranked the top three, accounting for 36.7% (33/90), 24.4% (22/90) and 16.7% (15/90). Of the 90 patients, 32 had obvious effects (35.5%), 46 had effective effects (51.1%) and 12 had no effects (13.4%), and the effective rate was 86.6% (78/90). Conclusion In the patients with secondary fungal infection of AIDS, the main sites of infection were oral cavity, lung and esophagus, in which the main infected fungi were candida albicans, penicillium marneffei and cryptococcus neofordii. Timely and effective antiretroviral therapy can reduce the mortality and improve the treatment effect.

目的 观察电针联合重复经颅磁刺激(rTMS)治疗对卒中后抑郁伴失眠患者的疗效并探讨这种联合治疗的机制。方法 对83例PSD患者随机分为rTMS组28例、电针联合rTMS治疗组25例及药物治疗组30例。电针联合rTMS组在对患者进行rTMS治疗基础上予电针治疗2周,并常规给予选择性五羟色胺重摄取抑制剂(SSRI)草酸艾司西酞普兰抗抑郁药物治疗;rTMS组仅采用重复经颅磁刺激治疗2周;药物组给予同种抗抑郁剂治疗。三组于治疗前及治疗2周后接受17项汉密尔顿抑郁量表(HAMD)和匹茨堡睡眠量表(PSQI)评估及多导睡眠监测(PSG)。结果 三组的HAMD评分、PSQI评分及睡眠参数在治疗基线水平均无明显差异。2周后不同治疗组间HAMD计分降低值总体差异有统计学意义(P<0.001)。药物治疗组HAMD计分降低值小于rTMS组和电针联合rTMS组(P<0.05),电针联合rTMS组HAMD计分降低值大于药物组及rTMS组(P<0.05);组间PSQI计分降低值总体差异有统计学意义 (P<0.05)。电针联合rTMS组PSQI计分降低值大于药物组及rTMS组(P<0.05),而药物组及rTMS组之间的PSQI计分降低值无统计学差异(P<0.05);组间PSG中总睡眠时间(F=16.735,P<0.001)及睡眠效率(F=87.548,P<0.001)治疗前后差值总体差异有统计学意义。电针联合rTMS组总睡眠时间的改善优于药物组及rTMS组(P<0.01),而药物组及rTMS组之间总睡眠时间的改善无统计学差异(P<0.05);电针联合rTMS组睡眠效率的提高优于药物组及rTMS组(P<0.001),而药物组及rTMS组之间的睡眠效率的提高无统计学差异(P>0.05)。结论 电针联合rTMS治疗可显著改善PSD的抑郁情绪、睡眠质量及改善总睡眠时间及睡眠效率,效果优于药物治疗组及rTMS组,体现了电针联合rTMS对PSD治疗的增效作用。

Objective To investigate the effect of electric acupuncture combined with Repetitive Transcranial Magnetic Stimulation (rTMS) treatment of poststroke depression with insomnia and analyze the therapeutic mechanism of this method. Methods 83 patients with PSD were randomly divided into the group of electric acupuncture combined with rTMS (n=32), rTMS group (n=32) and drug treatment group (n=32). The patients in the group of electric acupuncture combined with rTMS were given with the electric acupuncture treatment for 2 weeks on the basis of rTMS treatment, and also were regularly and continuously administrated with antidepressant drug (escitalopram citalopram). The rTMS group were only given with rTMS for 2 weeks, and the patients of the drug treatment group were administrated with the same antidepressant. At the baseline and 2th week, the 17-item Hamilton depression scale (17-HAMD), Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were evaluated. Results The sleep parameters, PSQI scores and HAMD scores among three groups had no significant difference at baseline. After 2 weeks, the overall difference of HAMD score reduction between different treatment groups was statistically significant (P<0.001). The HAMD score reduction in the drug treatment group was less than that in the rTMS group and the electric acupuncture combined rTMS group (P<0.05), and the HAMD score reduction in the electric acupuncture combined rTMS group was greater than that in the drug group and the rTMS group (P<0.05). The overall difference of PSQI score reduction between groups was significant (P<0.05). The PSQI score reduction value of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.05), while there was no significant difference in the PSQI score reduction value between the drug group and the rTMS group (P<0.05). The overall difference of total sleep duration (F=16.735,P<0.001) and sleep efficiency(F=87.548,P<0.001) evalted by PSG among groups was significant. The changes of both the total sleep duration and sleep efficiency of electric acupuncture combined with rTMS group was greater than that of the drug group and the rTMS group (P<0.001), while there was no significant difference neither in the changes of total sleep duration nor sleep efficiency between the drug group and the rTMS group before and after treatment among the groups (P>0.05). Conclusion Electroacupuncture combined with rTMS treatment may improve the efficacy of depression, sleep quality, the total sleep duration and sleep efficiency of PSD, and the effect is better than that of the drug treatment group and the rTMS group, which reflects the synergic effect of electroacupuncture combined with rTMS on PSD treatment.

目的 观察低频电刺激治疗对脑卒中偏瘫疗效,并分析其对患者周围神经电生理学与形态学的影响。方法 选取本院94例脑卒中偏瘫患者,以数字表法随机分为两组,各47例,对照组接受基础康复治疗,实验组予以早期综合康复治疗(于对照组基础上进行低频电刺激治疗),比较两组治疗前后Berg平衡量表(BBS)评分、Fugl-Meyer运动功能(FMA)评分、关节(腕与踝)主动活动范围(AROM)、周围神经电生理学[感觉神经传导速度(SCV)、运动神经传导速度(MCV)、动态肌电图]与形态学[腕横纹正中神经(MN)横截面积(CSA)、宽度(W)以及厚度(T)]。结果 实验组治疗后BBS评分、上肢与下肢FMA评分高于对照组(P＜0.05),腕与踝AROM大于对照组(P＜0.05);实验组治疗后腓总神经与胫神经SCV、MCV高于对照组(P＜0.05),肱二头肌与腓肠肌协同收缩率均低于对照组(P＜0.05);两组治疗前后MN的CSA、T比较无差异(P＞0.05),实验组治疗后MN的W大于对照组(P＜0.05)。结论 低频电刺激联合早期综合康复治疗可有效提高脑卒中偏瘫患者平衡能力、关节活动度及上下肢功能,改善周围神经电生理学与形态学,减轻周围神经损伤。

Objective To observe the curative effect of low frequency electrical stimulation treatment on stroke hemiplegia, and analyze its influences on peripheral nerve electrophysiology and morphology of patients. Methods A total of 94 patients with stroke hemiplegia in the hospital were randomly divided into two groups by number table method, 47 cases in each group. The control group was given basic rehabilitation treatment, while experimental group was given early comprehensive rehabilitation treatment (low frequency electrical stimulation on basis of control group). The scores of Berg Balance Scale (BBS) and Fugl-Meyer assessment (FMA), joint (wrist, ankle) active range of motion (AROM), peripheral nerve electrophysiology [sensory conduction velocity (SCV), motor conduction velocity (MCV), dynamic electromyogram (EMG) ] and morphology [cross-sectional area (CSA) of carpal transverse median nerve (MN), width (W), thickness (T)] before and after treatment were compared between the two groups. Results After treatment, scores of BBS, upper and lower limbs FMA in experimental group were higher than those in control group (P<0.05), AROM of wrist and ankle was larger than that in control group (P<0.05). After treatment, SCV and MCV of common peroneal nerve and tibial nerve in experimental group were higher than those in control group (P<0.05), while co-contraction rates of biceps and gastrocnemius muscles were lower than those in control group (P<0.05). Before and after treatment, there were no differences in CSA and T of MN between the two groups (P>0.05). After treatment, W of MN in experimental group was greater than that in control group (P<0.05). Conclusion Low-frequency electrical stimulation combined with early comprehensive rehabilitation therapy may effectively increase the balance ability, joint range of motion and upper and lower limb function of stroke patients with hemiplegia, improve peripheral nerve electrophysiology and morphology, and reduce peripheral nerve injury.

目的 探讨腹腔镜下卵巢癌减灭术联合化疗治疗卵巢癌的疗效。方法 选取2018年2月—2020年2月我院收治的68例卵巢癌患者,随机分为研究组和对照组各34例,对照组给予腹腔镜下卵巢癌减灭术,研究组给予腹腔镜下卵巢癌减灭术联合化疗。观察分析两组患者近期疗效、不良反应发生率、生存率以及相关手术情况等。结果 研究组近期疗效优于对照组(P＜0.05);研究组术后1年生存率高于对照组(P＜0.05),且并发症发生率低于对照组(P＜0.05);研究组理想减灭率优于对照组(P＜0.05),且腹水量及术中出血量少于对照组(P＜0.05),手术时间短于对照组(P＜0.05)。结论 减灭术联合化疗治疗卵巢癌可有效增强治疗疗效,降低多种化疗不良反应发生的可能性,并能使生存率得到进一步提升,可推广应用。

Objective To investigate the efficacy of laparoscopic ovarian cancer reduction combined with chemotherapy in the treatment of ovarian cancer. Methods A total of 68 ovarian cancer patients admitted to our hospital from February 2018 to February 2020 were randomly divided into study group and control group, 34 cases each. The control group was given laparoscopic ovarian cancer reduction surgery, while the study group was given laparoscopic ovarian cancer reduction surgery combined with chemotherapy. The short-term efficacy, incidence of adverse reactions, survival rate and related operation of the two groups were observed and analyzed. Results The short-term efficacy of the study group was better than that of the control group (P<0.05). The 1-year postoperative survival rate of the study group was higher than that of the control group (P<0.05), and the incidence of complications was lower than that of the control group (P<0.05). The ideal reduction rate of the study group was better than that of the control group (P<0.05), and the amount of abdominal water and intraoperative blood loss was less than that of the control group (P<0.05), and the operation time was shorter than that of the control group (P<0.05). Conclusion Laparoscopic ovarian cancer reduction combined with chemotherapy can effectively enhance the therapeutic effect, reduce the possibility of multiple adverse reactions of chemotherapy, and further improve the survival rate, which can be popularized and applied.

目的 探讨急性脑梗死采用丹红联合曲克芦丁脑蛋白水解物治疗的效果。方法 本文将2019年7月—2020年9月我院收治的88例急性脑梗死患者作为研究对象,应用简单数字表达法将患者随机分为两组,44例对照组和44例实验组,对照组患者应用丹红注射液治疗,实验组患者则在对照组基础上联合曲克芦丁脑蛋白水解物进行治疗,1个疗程后,统计分析用药后有效率、治疗前后NIHSS评分、血液流变学指标。结果 两组之间治疗后NIHSS评分、血液流变学指标相比,实验组较对照组低;用药后有效率相比,实验组较对照组高,P＜0.05。结论 采用丹红注射液治疗急性脑梗死的基础上给予曲克芦丁脑蛋白水解物治疗可提升疗效,改善患者神经功能缺损状态与血液循环,改善患者预后,促进患者早日康复。

Objective To investigate the effect of Danhong combined with troxerutin brain protein hydrolysate in the treatment of acute cerebral infarction. Methods 88 patients with acute cerebral infarction in our hospital from July 2019 to September 2020 were randomly divided into two groups, 44 cases in the control group and 44 cases in the experimental group. The effective rate, NIHSS score and hemorheology indexes before and after treatment were statistically analyzed after one course of treatment. Results After treatment, NIHSS score and hemorheology indexes of the experimental group were lower than those of the control group; the effective rate of the experimental group was higher than that of the control group, P<0.05. Conclusion On the basis of Danhong injection in the treatment of acute cerebral infarction, troxerutin cerebroprotein hydrolysate can improve the curative effect, improve the neurological deficit and blood circulation, improve the prognosis of patients, and promote the early recovery of patients.

目的 探讨D-二聚体在急诊胸痛中心早期鉴别诊断急性主动脉综合征(AAS)的重要性,以及讨论如何结合D-二聚体检测优化现有胸痛中心的急救流程。方法 收集近1年来我院胸痛中心收治的50例以胸痛为主诉的患者资料,其中25例最终确诊AAS的患者作为AAS组,以同一时期诊治的25例进行了急诊经皮冠状动脉介入治疗(PCI)确诊的急性非ST抬高型心肌梗死(NSTEMI)患者作为对照组。所有患者在首诊时检测血D-二聚体,通过绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),分析D-二聚体对AAS与NSTEMI的鉴别诊断价值,并探讨其优化胸痛中心救治流程的实际意义。结果 AAS组D-二聚体水平明显高于NSTEMI组,差异具有统计学意义(P<0.001),且在D-二聚体为89 500 μg/L时取得最佳截止点。结论 对于胸痛患者早期鉴别诊断,D-二聚体具有重要参考价值。

Objective To explore the importance of D-dimer in early differential diagnosis of acute aortic syndrome (AAS) in the emergency chest pain center. And to discuss how to combine D-dimer detection with optimizing the first aid process of existing chest pain centers. Methods The data of 50 patients who complained of chest pain in the chest pain center of our hospital in the past 1 year was collected, including 25 patients who were finally diagnosed as AAS group. Other 25 patients with acute non-ST elevation myocardial infarction (NSTEMI) diagnosed by emergency percutaneous coronary intervention (PCI) were included as control group. Blood D-dimer was detected in all patients at the first visit. By drawing receiver operating characteristic curve (ROC), the value of D-dimer in differential diagnosis between AAS and NSTEMI was analyzed, and the practical significance of optimizing the treatment process of chest pain center was discussed. Results The level of D-dimer in AAS group was significantly higher than that in NSTEMI group (P<0.001), and the best cutoff point was obtained when D-dimer was 895.00 μg/L. Conclusion D-dimer has reference significance for early differential diagnosis of patients with chest pain.