目的 探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

目的 探讨右美托咪定与咪达唑仑在儿童牙科患者术前镇静中的作用及安全性。方法 选取2020年6月—2021年1月需行择期全麻牙科治疗的60例患儿作为研究资料,将其根据数字法随机分为对照组(采取咪达唑仑)与观察组(采取右美托咪定)各30例,比较2组患儿的镇静效果。结果 2组患儿经麻醉后,观察组患儿的自主呼吸恢复时间、苏醒时间以及拔管时间低于对照组,经统计学分析有差异(P＜0.05);患儿在给药前Ramsay镇静评分中比较无差异;在给药10 min、20 min、30 min时Ramsay镇静评分均能达到2分以上,但经统计学比较无差异;血氧饱和度未发现异常,而且在给药观察期间患儿的血氧饱和度也在95%以上;但经统计学分析,患儿在给药前和给药10 min、20 min、30 min时心率、呼吸以及血氧饱和度均无差异(P＞0.05)。结论 右美托咪定与咪达唑仑均能成功用于儿童牙科患者术前镇静中,但经本文研究发现右美托咪定其效果更为显著些,而且绝大多数患儿能够配合与父母分离、配合麻醉面罩,降低患儿术后躁动发生率。

目的 探讨性别、年龄、日剂量、合并用药、药物厂家等因素对使用阿立哌唑患者稳态血药浓度的影响,为临床合理用药提供依据。方法 收集深圳市康宁医院2019年1月—2021年2月使用阿立哌唑住院患者血药浓度监测数据样本229份,包括患者性别、年龄、日剂量、合并用药、药物厂家等基本信息,使用SPSS 25.0统计学软件对数据进行回顾性分析。结果 经多元线性回归分析,本研究仅性别、日剂量能解释阿立哌唑血药浓度的变化。使用阿立哌唑患者血药浓度剂量比值(C/D)女性组高于男性组(P＜0.01),阿立哌唑合用丙戊酸盐组高于无合用组(P＜0.05),年龄、其他合并、药物厂家用药对阿立哌唑(C/D)值的影响无统计学差异。结论 阿立哌唑C/D值与性别有关,合并用药对其有一定影响,不同药物厂家的阿立哌唑C/D值无统计学差异,临床应加强治疗药物监测,根据血药浓度及临床诊疗效果,结合药物经济学因素优化给药方案。

Objective To provide the reference for clinical rational use of aripiprazole,to investigate the effects of gender, age, daily dose, concurrent medication, drug manufacturer and other factors on the steady-state serum concentration in aripiprazole patients. Methods Serum concentration monitoring data of 229 inpatients using aripiprazole in Shenzhen Kangning Hospital from January 2019 to February 2021 was collected, including patients' gender, age, daily dose, concurrent medication, drug manufacturer and other basic information, which were retrospectively analyzed by SPSS 25.0 statistical software. Results In this study, only gender and daily dose could explain the significant changes of aripiprazole serum concentration after multiple linear regression analysis. The serum concentration/dose ratio (C/D) was significantly higher in female patients than in male patients (P＜0.01), and the group of aripiprazole combined with valproate was markedly higher than the non-combined group (P＜0.05). Nevertheless, there were no statistically significant differences in the effects of age, concurrent medication and drug manufacturer on aripiprazole C/D values. Conclusions The C/D value of aripiprazole was closely related to gender, and concurrent medication had a certain effect on it. There was no statistical difference in the aripiprazole C/D value among different drug manufacturers. This study suggested that clinical monitoring of therapeutic drugs should be strengthened, and the prescription should be optimized based on serum concentration and therapeutic efficacy, combined with pharmacoeconomic factors.

目的 粪菌移植(fecal microbiota transplantation,FMT)是治疗疾病的新途径,本文总结我院408例(1 085例次)FMT的临床疗效和安全性。FMT治疗艰难梭菌感染有效率达80%,抗生素相关性腹泻68%,炎症性肠病52%,功能性肠病65%,代谢性疾病50%,其他疾病57%,安全性良好,未见严重不良事件发生,结果和多数文献相符。还需更多随机对照试验才能明确FMT的临床价值。

目的 探讨无创血流动力学监测(non-invasive cardiac output monitoring,NICOM)在儿童脓毒性休克早期液体复苏的临床应用评价。方法 选取2019年1月—2020年6月期间在我院PICU患儿诊断为儿童脓毒性休克61例,随机分为对照组(未接受NICOM监测29例)和干预组(接受NICOM监测32例),记录液体复苏后6、12、24小时血气分析(pH值、剩余碱、乳酸)、尿量以及病死率、NICOM监测(CO、CI、SVR、SV、SVRI、HR、MAP)等结果。结果 液体复苏6 小时后两组HR、MAP、乳酸、剩余碱、尿量比较无统计学差异 (P>0.05),液体复苏12 h后干预组乳酸较对照组降低,差异有统计学意义(P<0.05);液体复苏24 h后两组HR、MAP、乳酸、剩余碱及尿量比较,差异均有统计学意义 (P<0.05)。干预组治疗后12 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05),干预组治疗后24 h在CO、CI、SVR、SV、SVRI、HR、MAP较治疗前改善,差异均有统计学意义(P<0.05)。结论 NICOM具有敏感度及准确率高,且操作简单,可有效用于指导脓毒性休克早期液体复苏,针对个体化治疗提供客观依据,正确指导容量管理,具有科学实用价值,值得推广。

Objective To evaluate the clinical application of non-invasive cardiac output monitoring (NICOM) for early fluid resuscitation in children with septic shock. Methods 61 children diagnosed with septic shock in the PICU at our hospital between January 2019 and June 2020 were randomly divided into a control group (29 without NICOM monitoring) and an intervention group (32 with NICOM monitoring), and the results of blood gas analysis (pH,lactate and residual base), urine volume, and mortality, and NICOM monitoring (CO, CI, SVR, SVRI, HR, and MAP) were recorded at 6, 12, and 24 h after fluid resuscitation. Results There was no statistically significant difference in HR, MAP, lactic acid, residual base and urine volume between the two groups after 6 h of fluid resuscitation (P>0.05), and lactic acid was lower in the intervention group than that in the control group after 12 h of fluid resuscitation (P<0.05); the differences in HR, MAP, lactic acid, residual base and urine volume between the two groups after 24 h of fluid resuscitation were all statistically significant (P<0.05). The differences were statistically significant (P<0.05) in CO, CI, SVR, SVI, HR, and MAP at 12 h and at 24 h after treatment in the intervention group compared with that of the pre-treatment (P<0.05). Conclusion NICOM has high sensitivity and accuracy and it can be operated in simple processes. It may be effectively applied to guide the early fluid resuscitation of septic shock. It also provides Objective evidence for individualized treatment and correctly guides volume management. Its scientific and practical value makes it worth promoting.

目的 探讨联合镇静胃肠镜检查在安全性、可行性的效果以及优势方面的临床应用,为优化诊疗流程、方便患者提供科学依据。方法 纳入我院2017年6月—2018年3月行镇静胃肠镜检查的140例患者为研究对象,采用便利抽样法随机分为两组,观察组70例患者行联合镇静胃肠镜检查,对照组70例患者行胃肠镜分次检查。记录并对比分析两组患者的预约时间、检查时长、不适反应、疼痛程度、满意度、检查费用。结果 观察组在预约时间和检查时长、检查后心率变化,患者满意度和检查费用方面,与对照组相比有统计学差异(P＜0.05),而在血压、血氧、镇静及遗忘程度、疼痛程度及不适反应方面无统计学差异(P＞0.05)。结论 联合镇静胃肠镜检查在临床应用方面安全可行,具有便宜、时间少、患者配合度好、符合患者意愿、而且满意度高的优势,值得推广。

Objective To explore the scientific evidence in optimization of diagnosis and treatment process for patients' convenience, we evaluated the clinical effect of gastrointestinal endoscopy with sedation on the safety, feasibility and advantage. Methods We enrolled 140 patients who came to our hospital for gastrointestinal endoscopy from June 2017 to March 2018. We used the convenience sampling method that the patients were randomly divided into two groups: observation group of 70 patients with combined endoscopy, and the control group of 70 patients with seperate endoscopy. We recorded and compared the two groups of patients of appointment time, inspection time, pain degree, patient satisfaction, and cost. Results The two groups were different in the appointment time, inspection time, heart rate changes after endoscopy, patient satisfaction and the costs (P<0.05), while no significant difference was found in blood pressure, blood oxygen degree, sedation, pain degree and discomfort reaction(P>0.05). Conclusion Combined sedative gastrointestinal endoscopy is safe and feasible in clinical application, with the advantages of low cost, less time, good patient cooperation, in line with the wishes of patients, and high satisfaction, which is worthy of popularization.

目的 探讨以跨肺压导向的呼气末正压通气在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床应用效果。方法 将2020年1月—10月重症医学科收治的100例ARDS患者随机分为对照组和观察组各50例,对照组采用小潮气量辅助控制通气治疗,观察组以跨肺压(transpulmonary pressure,Ptp)为导向选择最佳呼气末正压(positive end-expiratory pressure,PEEP)进行机械通气治疗,观察比较两组患者治疗前和治疗48 h的呼吸动力学指标、血气分析指标,随访28 d病死率。结果 治疗48 h,潮气量、PEEP、肺静态顺应性、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂观察组明显高于对照组(P＜0.05);随访28 d病死率观察组和对照组比较差异无统计学意义(P＞0.05)。结论 以Ptp为导向选择最佳PEEP的机械通气治疗ARDS可以有效改善患者的呼吸动力学指标和血气分析指标,不增加ARDS的病死率,值得临床推广应用。

Objective To investigate the clinical effect of positive end-expiratory pressure(PEEP) ventilation guided by transpulmonary pressure (Ptp) in acute respiratory distress syndrome (ARDS). Methods Between January and October 2020, 100 cases of ARDS treated in intensive care unit were randomly divided into control group and observation group with 50 cases each. Control group used auxiliary control small tidal volume ventilation therapy, and observation group used the best PEEP mechanical ventilation therapy with the guiding of Ptp. The respiratory dynamics index, blood gas analysis results, follow-up of 28d case fatality rate before and 48h after treatment between the two groups were compared. Results After 48h of treatment, tidal volume、PEEP、pulmonary static compliance、PaCO₂、PaO₂、SaO₂、PaO₂/FiO₂ of the observation group were all higher than those of the control group (P<0.05). There was no statistically significant difference in mortality between the two groups at 28d follow-up (P＞0.05). Conclusion Mechanical ventilation with the best PEEP guided by Ptp could effectively improve the respiratory dynamic index and blood gas analysis results of patients with ARDS, without increasing the mortality of ARDS, which is worthy of clinical application.

目的 探讨食管胃静脉曲张精准断流术与改良“三明治”法治疗食管胃静脉曲张的临床疗效。方法 选取共50例食管胃底静脉曲张患者,按随机数字法分为精准治疗组和对照组,精准治疗组(n=25)行内镜下食管胃静脉曲张精准断流术,对照组(n=25)接受改良“三明治”法内镜治疗。分析对比两组的止血成功率、再出血率、治疗显效率、并发症发生率、聚桂醇和组织胶用量、治疗时间及住院天数等指标。结果 治疗后随访3个月,术后3天内止血率两组均为100％。再出血率精准治疗组为4%,对照组为32%,差异有统计学意义(P=0.010)。静脉曲张治疗显效率精准治疗组为84%,对照组出血率为52%,差异有统计学意义(P=0.015)。并发症发生率在两组间差异无统计学意义(P>0.05)。聚桂醇和组织胶平均用量在两组间差异无统计学意义(P>0.05)。精准治疗组平均治疗时间为(32.60±6.44)min,对照组为(40.60±7.26)min,差异有统计学意义(P<0.0001);精准治疗组平均住院天数为(8.12±1.24)d,对照组为(9.12±1.39)d,差异有统计学意义(P=0.010)。结论 内镜下精准断流术治疗食管胃静脉曲张再出血率低、效果好、安全性高。

Objective To investigate the clinical efficacy of endoscopic selective varices devascularization and the modified Sandwich method on the treatment of esophagogastric varices. Methods 50 patients with esophagogastric varices were divided into therapy (endoscopic selective varices devascularization)group (n=25) and control group (n=25) by random number table method. The therapy group (n=25) received the treatment of endoscopic selective varices devascularization. The control group (n=25) was treated with modified Sandwich method injection. The success rate of hemostasis, rate of recurrent bleeding, rate of varices disappearance, complication rate, dosage of lauromacrogol and tissue adhesive, time of therapy and hospitalization days were compared and analyzed between the two groups. Results During the 3-month followup, the success rates of hemostasis were 100% in both groups 3 days after the treatments. The rates of recurrent bleeding in therapy group and control group were 4% and 32% respectively, with statistically significant difference (P=0.010). The rates of varices disappearance in therapy group and control group were 84%and 52% respectively, the difference (P=0.015) was statistically significant. There was no statistically significant difference in complication rates between the two groups(P>0.05). There was also no statistically significant difference in the average dosage of lauromacrogol and tissue adhesive between the two groups(P>0.05). The average time of therapy in therapy group and control group were(32.60±6.44)minutes and(40.60±7.26)minutes respectively, with statistically significant difference between the two groups(P=0.000). The average hospitalization days in therapy group and control group were(8.12±1.24)days and(9.12±1.39)days respectively, which is statistically significant difference between the two groups(P=0.010). Conclusion Endoscopic selective varices devascularization has the obvious advantage of a significant efficacy, low recurrence rate and high safety.

目的 探讨鼻咽癌个案管理模式,并评价临床中运用的效果。方法 回顾性将2017年8月—2018年4月93例新确诊的鼻咽癌患者作为对照组,按鼻咽癌患者的一般护理常规进行护理。2018年5月—2019年8月新确诊的鼻咽癌患者96例为实验组,实施个案管理比较两种方法的临床运用效果。结果 与对照组比,实验组诊断期完成检查时间和首次住院天数短、既定治疗计划完成率和治疗期间复诊依从性高,Ⅳ度骨髓抑制发生率低,差异均有统计学意义(P<0.05)。结论 鼻咽癌个案管理模式可为患者提供全程、连续性、高品质的护理,提高患者复诊依从性、提高治疗计划完成率,提高医疗护理质量,值得临床推广应用。

Objective To explore the case management mode of nasopharyngeal cancer (NPC) and evaluate the effect of clinical application. Methods 93 patients newly diagnosed NPC from August 2017 to April 2018 were used as the control group,and the general nursing routine was followed. 96 patients newly diagnosed NPC from May 2018 to August 2019 were taken as the experimental group,and accepted case management. Results Compared with the control group,the test time of the experimental group was shorter,the first hospital stay was shorter,the completion rate of treatment was higher,the patient's compliance of follow-up during treatment was better,incidence of grade Ⅳ myelosuppression was lower.The difference was statistically significant (P< 0.05). Conclusion The case management mode of NPC may provide seamless and high-quality nursing for NPC patients,improve the completion rate of treatment,improve the patient's compliance of follow-up and improve the quality of medical care,which is worthy of clinical application.

目的 探究骨质疏松性椎体压缩骨折治疗中3D打印技术的应用及其效果。方法 选取我院2016年1月—2018年10月收治的90例行经皮椎体成形术治疗的骨质疏松性椎体压缩骨折患者作为研究对象,随机分为常规组45例和实验组45例。常规组采用MR+常规穿刺方法,通过MR引导,注入骨水泥;实验组采用CT+3D打印技术,在应用CT的基础上,借助制作模型的引导,实施精准定位并实施手术治疗,对两组各项围术期治疗指标(手术时间、射线暴露次数、后凸Cobb角改善)和治疗前后的VAS评分、ODI评分以及骨水泥渗漏情况。结果 在手术时间、射线暴露次数、后凸Cobb角改善等围术期治疗指标方面,实验组均要优于常规组,差异有统计学意义(P<0.05)。在骨水泥渗漏发生率方面,常规组为17.78%(8/45),实验组为4.44%(2/45),实验组低于常规组,差异有统计学意义(P<0.05)。在VAS评分、ODI评分方面,常规组和实验组治疗前、治疗后相比差异均无统计学意义(P>0.05)。结论 骨质疏松性椎体压缩骨折经皮椎体成形术治疗中,配合3D打印技术能够有效提升治疗的有效性,促进患者的健康恢复,值得推广应用。