目的 观察改良直接抽吸取栓术（ADAPT）治疗急性前循环大动脉栓塞性脑卒中的有效性与安全性。方法 回顾性分析2022年3月—2023年2月在广州市第一人民医院采用改良ADAPT治疗急性前循环大动脉栓塞性脑卒中的12例患者临床资料。该改良技术核心是血栓抽吸导管或颅内支持导管管头明确越过血栓后才开始直接使用20 mL的注射器进行手动持续抽吸;所有患者术后依据临床症状和影像表现启动规范抗凝药物治疗,每月门诊随访观察有无再发卒中。结果 12例患者闭塞血管均成功再通,其中改良脑梗死溶栓（mTICI ）2b~2c级3例（25%）,mTICI 3级9例（75%）;从穿刺到血管再通平均时间为37.7 min,首次取栓再通8例（66.7%）,其中颈内动脉闭塞首次取栓再通成功率达80%,出院时平均美国国立卫生研究院卒中量表（NIHSS）评分（9.00±9.22）分,与术前基础NIHSS评分相比,平均下降7分,术后90 d功能恢复良好（mRS评分0~2分）9例（75%）;术后脑出血3例（25%）,其中1例为小点状出血（HI1）而无明显症状、1例为血肿<梗死面积的30%并有轻微占位效应的出血（PH1）恢复良好、1例为血肿>梗死面积的30%并有明显占位效应的出血（PH2）术后自动出院,12例患者筛查病因均发现有心房纤颤,9例患者术后依据临床症状和影像表现在早期开展规范抗凝二级预防管理后无再复发。结论 改良ADAPT是治疗急性大动脉栓塞性脑卒中的一种安全可行选择,血管再通效率高,血栓逃逸概率低、临床疗效良好。对心房纤颤患者实施规范抗凝管理可有效预防脑卒中复发。

Objective To observe the efficacy and safety of modified-a direct aspiration first-pass technique（ADAPT）in the treatment of acute anterior circulation aorta embolic stroke．Methods The clinical data of 12 patients with acute anterior circulation arterial embolic stroke treated by modified-ADAPT in our hospital from March 2022 to February 2023 were analyzed retrospectively．The core of the modified technique is that the head of the thrombus aspiration catheter or intracranial support catheter clearly crosses the thrombus before manual continuous suction with a 20 mL syringe．After operation,all patients started standard anticoagulant therapy according to clinical symptoms and imaging manifestations,and monthly outpatient follow-up was conducted to observe whether there was recurrent stroke．Results Occlusive vessels were successfully recanalized in 12 patients,including 3 cases（25%）of mTICI 2b-2c grade and 9 cases（75%）of mTICI 3 grade．The average time from puncture to vascular recanalization was 37.7 min,and the first thrombectomy and recanalization was performed in 8 cases（66.7%）．The success rate of internal carotid artery occlusion was 80%．The average NIHSSS score at discharge was（9.00±9.22）．Compared with the preoperative NIHSS score,the average score decreased by 7 points．90 days after operation,the function recovered well in 9 cases（75%）．Postoperative cerebral hemorrhage occurred in 3 cases（25%）,including 1 case of punctate hemorrhage without obvious symptoms,1 case of good recovery of PH1 and 1 case of automatic discharge after PH2．12 patients were found to have atrial fibrillation after screening,9 patients had no recurrence after anticoagulation secondary prevention management according to clinical symptoms and imaging manifestations．Conclusions Modified-ADAPT is a safe and feasible choice for the treatment of acute arterial embolism stroke,with high recanalization efficiency,low thrombus escape probability and good clinical effect．Standardized anticoagulation management can effectively prevent the recurrence of stroke in patients with atrial fibrillation．

目的 探讨药物服务干预对老年高血压患者的治疗及用药安全性的影响。方法 选取2020年6月—2021年12月潮州市中医药研究所门诊部和潮州市中医医院高血压患者90例为研究对象,采用随机数字表法分为观察组45例（给予药物服务干预）,对照组45例（给予常规用药指导）。比较干预后血压控制水平、健康知识认知、治疗依从性、自我管理行为、生活质量及药物不良反应等情况。结果 干预后,观察组舒张压、收缩压、不良反应发生率均低于对照组（P<0.05）。干预后,观察组健康知识认知水平、治疗依从率、自我管理行为评分、生活质量评分均高于对照组（P<0.05）。结论 采用药物服务干预的方式能够较好控制老年高血压患者血压水平,提升其健康知识认知水平与治疗依从性,改善自我管理行为状况,提高生活质量。

Objective To investigate the effect of drug service intervention on the treatment and drug safety of elderly patients with hypertension．Methods From June 2020 to December 2021,a total of 90 patients with hypertension from Chaozhou Institute of traditional Chinese Medicine and Chaozhou Hospital of Traditional Chinese Medicine were selected as the study objects,and were divided into observation group（45 cases,given drug service intervention）and control group（45 cases,given routine drug guidance）by random number table method．The blood pressure control level,health knowledge cognition level,treatment compliance,self-management behavior,quality of life and adverse drug reactions of elderly patients with hypertension were compared after intervention．Results After intervention,the incidence of diastolic blood pressure,systolic blood pressure and adverse drug reactions in the observation group were lower（P<0.05）．After intervention,the health knowledge cognition level,treatment compliance rate,self-management behavior score and quality of life score of the observation group were higher（P<0.05）．Conclusions The use of drug service intervention can better control the blood pressure level of elderly patients with hypertension,improve their health knowledge cognition and treatment compliance,improve self-management behavior and improve quality of life．

目的 系统评价胰岛素联用α-葡萄糖苷酶抑制剂(AGIs)治疗成人1型糖尿病(T1DM)的疗效和安全性。方法 检索中英文数据库,纳入关于胰岛素联用AGIs治疗成人T1DM患者的随机或非随机对照试验。使用Review Manager 5.3软件进行Meta分析。结果 共纳入10项研究,616例患者。与安慰剂或空白对照相比,在有效性方面,胰岛素联合AGIs可改善成人T1DM患者的糖化血红蛋白;降低平均血糖、空腹血糖和餐后2小时血糖;改善血糖波动情况,包括平均血糖波动幅度和最大血糖波动幅度(均P<0.05)。在安全性方面,AGIs增加总不良反应发生的风险(P<0.05),其中主要是胃肠道不适,但未增加低血糖的发生率和发生次数(均P>0.05)。胰岛素联合AGIs减少了每日胰岛素总剂量(P<0.05),但对体重、甘油三酯和高密度脂蛋白胆固醇无显著影响(均P>0.05)。结论 胰岛素联合AGIs可降低成人T1DM患者的糖化血红蛋白,改善血糖水平和血糖波动情况。AGIs不会增加低血糖的风险,但需重视其不良反应,特别是胃肠道不良反应。

Objective To systematically evaluate the efficacy and safety of adding alpha-glucosidase inhibitors (AGIs) to insulin therapy in adult patients with type 1 diabetes (T1DM). Methods Articles about randomized or non-randomized controlled trials of insulin combined with AGIs in adult patients with T1DM were retrieved from Chinese and English database. Meta-analyses were performed by using Review Manager 5.3. Results A total of 616 patients were included from 10 clinical trials. Compared with adding placebo or nothing, in terms of efficacy, the addition of AGIs resulted in decreased HbA1c, mean blood glucose, fasting plasma blood glucose and 2-hour postprandial blood glucose levels (all P<0.05). And this scheme improved the glucose variability including mean amplitude of glycemic excursions and the largest amplitude of glycemic excursions (P<0.05, respectively). As to safety, AGIs increased the risk of total adverse reactions (P<0.05), most of them were gastrointestinal complaints, while the occurrence and the frequency of hypoglycemia were similar (P>0.05, respectively). This scheme could also lead to the reduced total daily insulin dose (P<0.05) but had no significant effect on body weight, triglyceride or cholesterol concentration (P>0.05, respectively). Conclusions The addition of AGIs to insulin therapy in adult patients with T1DM may reduce HbA1c and improve the glucose levels and glucose variability. But total adverse effects especially the gastrointestinal complaints should also be considered in the use of AGIs although it does not increase the risk of hypoglycemia.

目的 比较甲苯磺酸瑞马唑仑和丙泊酚在超声胃镜检查中的有效性和安全性。方法 采用随机对照的研究方法,选择接受超声胃镜病人60例,分为观察组(29例)和对照组(31例)。观察组采用甲苯磺酸瑞马唑仑麻醉,对照组采用丙泊酚。观察麻醉过程中不同时点的血流动力学指标、改良警觉/镇静(MOAA/S)评分各时刻的变化、苏醒及离室时间、围术期不良事件。结果 观察组的血流动力学影响更小;观察组可进入足够的镇静深度,而对照组的镇静程度更深;2组起效时间相似,且迅速苏醒而离室,但在苏醒及离室时间方面观察组稍短;不良事件对照组高于观察组。结论 甲苯磺酸瑞马唑仑应用于无痛超声胃镜检查,其对血流动力学影响小,能产生足够的镇静深度,能使患者迅速苏醒,且不良事件发生率低,总体有效性和安全性优于丙泊酚。

Objective To compare the efficacy and safety of remimazolam tosilate and propofol in painless ultrasonic gastroscopy. Methods In a randomized, single-blind controlled study, 60 patients undergoing ultrasonic gastroscopy were selected and divided into observation group (31 cases) and control group (29 cases). Observation group was anesthetized with remimazolam tosilate, while control group was anesthetized with propofol. Two groups' hemodynamic index, perioperative adverse events, changes of MOAA/S score, awakening and departure time were observed at different time points during anesthesia. Results The observation group had less changes on hemodynamics. The observation group had enough depth of sedation, while the control group had a deeper degree of sedation. The onset time of the two groups was similar and both awoke quickly and left, but the awakening time and leaving time in the observation group were slightly shorter. Adverse events in the control group were more than those in the observation group. Conclusions Remimazolam tosilate for painless ultrasonic gastroscopy had little effect on hemodynamics, which can generate enough depth of sedation, and make patients wake up quickly. In addition, the incidence of its adverse events was low, and the overall effectiveness and safety were superior to those of propofol.

目的 探讨重组人干扰素α2b喷雾剂治疗儿童流行性感冒的疗效及安全性。方法 选取我院2017年1月—2020年2月所收治的80例儿童流行性感冒患者,按1:1随机分为实验组及对照组,每组患儿40例,对照组患者给予奥司他韦治疗,实验组患者在对照组治疗基础上联合重组人干扰素α2b喷雾剂治疗,对比2组患者的疗效及安全性。结果 实验组患儿咽痛症状消失时间(2.01±0.23)d、体温恢复正常时间(2.18±0.30)d、咳嗽症状消失时间(1.68±0.52)d、治疗时间(5.41±0.36)d均短于对照组(t=26.001、9.766、19.277、28.089,P＜0.05);实验组患儿治疗有效率95.0%高于对照组治疗有效率(χ²=4.114,P＜0.05);实验组患儿的不良反应发生率低于对照组(χ²=4.021,P＜0.05)。结论 重组人干扰素α2b喷雾剂治疗儿童流行性感冒的方案可获取较为理想的治疗效果,保证患儿用药安全性,尽快缓解患儿的临床症状,促使患儿病情康复,促进患儿健康生长,该治疗方案可在临床中推广应用。

Objective To explore the efficacy and safety of recombinant human interferon α2b spray in the treatment of influenza in children. Methods Eighty children with influenza who were admitted to our hospital from January 2017 to February 2020 were randomly divided into experimental group and control group evenly, with 40 children in each group. Oseltamivir treatment was given to the control group, the experimental group was treated with recombinant human interferon α2b spray on the basis of oseltamivir, and the efficacy and safety of the two groups were compared. Results In the experimental group, the time for the disappearance of sore throat was (2.01±0.23) d, the time for the body temperature returned to normal was (2.18±0.30) d, the time for the cough to disappear was (1.68±0.52) d, and the treatment time was (5.41±0.36) d, which were all shorter than the control group (t=26.001, 9.766, 19.277, 28.089, P<0.05). The treatment effective rate of children in the experimental group was 95.0%, which was significantly higher than that in the control group (χ²=4.114, P<0.05); the incidence of adverse reactions in experimental group was significantly lower than that in the control group (χ²= 4.021, P<0.05). Conclusions The recombinant human interferon α2b spray for the treatment of influenza in children could obtain a more ideal therapeutic effect, ensure the safety of the children's medication, relieve the clinical symptoms as soon as possible, promote the improvement of the children's condition, and promote the healthy growth of the children. The treatment plan can be promoted and applied in clinical practice.

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 本研究探讨补肾养骨口服液对强直性脊柱炎的疗效及其安全性。方法 本研究为随机对照试验,研究了补肾养骨口服液+塞来昔布胶囊对比单纯用塞来昔布胶囊治疗强直性脊柱炎的效果,观察指标有腰臀痛程度、僵硬持续时间、红细胞沉降率(erythrocyte sedimentation rate,ESR)、C-反应蛋白(C-reactive protein,CRP)、ASAS 20改善标准,观察时间点为第1和第12周。在整个研究过程中,通过血液、肝脏和肾功能测试来监测安全性,并记录不良反应。结果 有60名患者参加了此次试验。①两组治疗均有效:补肾养骨口服液+塞来昔布胶囊组30例(80.3%),塞来昔布组30例(60.8%),两组的ASAS 20都达到改善标准;但补肾养骨口服液+塞来昔布胶囊组效果好于塞来昔布组(P＜0.05)。②两组监测指标(腰臀痛程度、僵硬持续时间、ESR、CRP)对比,治疗后改善显著,而且补肾养骨口服液+塞来昔布胶囊组比塞来昔布组改善更明显。③两组治疗前后血常规、肝肾功能未见异常,但补肾养骨口服液+塞来昔布胶囊组不良反应发生率12.5%,而塞来昔布组为52.5%,两组差异具有统计学意义(P＜0.05)。结论 本研究说明了补肾养骨口服液在治疗强直性脊柱炎中具有疗效,且较安全。

目的 分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇接受胰岛素治疗对妊娠结局的影响及安全性。方法 将2018年7月—2020年7月接诊且行常规治疗的50例GDM孕妇作为对照组,将同期接诊且在对照组基础上行胰岛素治疗的50例GDM孕妇作为观察组,对组间血糖控制效果、生活质量(SF-36)、治疗效果、不良妊娠结局、不良反应展开分析。结果 (1)组间血糖指标在治疗前无明显差异(P＞0.05);治疗后,观察组血糖控制效果优于对照组(P<0.05);(2)观察组SF-36评分高于对照组,且治疗效果(96.00%)优于对照组(82.00%,P<0.05);(3)观察组出现3例不良妊娠结局(6.00%),对照组出现11例不良妊娠结局(22.00%,P<0.05);(4)观察组发生3例不良反应(6.00%),对照组发生2例不良反应(4.00%,P＞0.05)。结论 对GDM孕妇实施胰岛素治疗,可以改善孕妇血糖水平,减少不良妊娠结局,提高孕妇生活质量,安全可靠,值得推广。

Objective To analyze the effect and safety of insulin therapy on pregnancy outcome in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 50 pregnant women with GDM who received conventional treatment from July 2018 to July 2020 were induded in the control group, and 50 pregnant women with GDM who received insulin treatment on the basis of the control group were induded in the observation group. Results (1) There was no significant difference in blood glucose index between two groups before treatment(P＞ 0.05); after treatment, the blood glucose control effect of the observation group was better than that of the control group(P<0.05); (2) SF-36 score of the observation group was higher than that of the control group, and the treatment effect (96.00%) was better than that of the control group (82.00%,P<0.05); (3) there were 3 cases of adverse pregnancy outcomes (6.00%) in the observation group and 11 cases (22.00%) in the control group; (4) there were 3 cases of adverse reactions (6.00%) in the observation group and 2 cases (4.00%) in the control group(P＞ 0.05). Conclusion Insulin therapy for pregnant women with GDM could improve the blood glucose level of pregnant women, reduced adverse pregnancy outcomes, improved the quality of life of pregnant women, which is safe and reliable, and is worthy of promotion.

目的 探究尿毒症继发性甲状旁腺功能亢进经甲状旁腺切除术治疗效果及安全性分析。方法 选取2017年6月—2019年5月于我院就诊的90例尿毒症继发性甲状旁腺功能亢进患者为研究对象,随机分为对照组与观察组,两组各45例。均采取同一药物治疗,对照组行次全切除治疗,观察组行甲状旁腺全切除术+前臂移植术。对比分析两组治疗效果、血生化指标及并发症。结果 观察组疗效优于对照组(P<0.05);观察组术后1周、1个月钙、iPTH、磷、钙磷乘积及ALP水平均低于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论 甲状旁腺全切除+前臂移植治疗尿毒症继发性甲状旁腺功能亢进疗效显著,并发症风险低,值得推广。