目的 分析曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗卵巢子宫内膜异位囊肿(OEC)患者的效果。方法 选取我院2019年1月—2020年5月期间收治的OEC患者108例,采用随机抽签法分成研究组与对照组,各54例。对照组行腹腔镜下卵巢囊肿剥除术治疗,研究组基于对照组加用曲普瑞林治疗,统计对比2组疗效、妊娠率以及术前、术后6个月、1年血清性激素水平[卵泡刺激素(FSH)、黄体生成素(LH)、抗苗勒管激素(AMH)]、血清高迁移率组蛋白B1(HMGB1)、视黄醇结合蛋白4(RBP4)、糖类抗原125(CA125)水平。结果 研究组治疗总有效率92.59%高于对照组75.93%(P＜0.05);术后6个月、1年研究组LH、FSH低于对照组,AMH高于对照组(P＜0.05);术后6个月、1年研究组CA125、RBP4、HMGB1低于对照组(P＜0.05);研究组妊娠率59.26%高于对照组29.63%(P＜0.05)。结论 曲普瑞林联合腹腔镜下卵巢囊肿剥除术治疗OEC患者时,可改善性激素水平,提高妊娠率,降低血清CA125、RBP4、HMGB1水平。

目的 探究不同麻醉方式对患有冠心病的老年患者外科介入不良心血管事件作用的对比。方法 选取2020年1月—2021年1月,我院确诊的冠心病患者,且无心脏外科干预手术80 例,随机分为研究干预组(n=40)和空白对照组(n=40),研究组采用2%的七氟醚,对照组用丙泊酚联合瑞芬太尼,维持麻醉血浆靶浓度在3.0～6.0 mg/L 之间,方式为静脉泵注;分析2组病人外科术后负性心脏情况控制影响; 结果 研究组和对照组患者的肌酸激酶存在差异,同时心脏肌钙蛋白T的高低也存在差异(P均<0.05);研究组在术后的负性心血管情况发病率均低于空白对照组,其中研究组的心源性猝死、心律紊乱不齐和心脏源性的休克等的病变率要远低于对照组,统计学差异存在意义(P均＜0.05);而其中研究组的心力衰竭与对照组相比,差异不具有统计学意义(P＞0.05)。结论 相比于静脉麻醉,吸入式麻醉能够趋好性降低非心脏手术术后负性心脏相关风险的发生率,该研究对于临床实践有一定的参考意义和实践可操作性,可以考虑普及推广。

目的 分析团体认知行为干预联合揿针全程护理对胃癌晚期癌痛患者心理状态的影响。方法 选取我院115例胃癌晚期癌痛患者(2018年3月—2021年1月),依照干预方案不同分为3组。对照1组(37例)接受团体认知行为干预,对照2组(38例)接受揿针全程护理干预,观察组(40例)接受团体认知行为干预联合揿针全程护理干预,比较3组干预效果。结果 疼痛爆发时疼痛缓解情况:观察组疼痛爆发时疼痛缓解率均较对照1组、对照2组高(P＜0.05);心理状态:干预1个月后,3组心理状态均得到改善,且观察组汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分均较对照1组、对照2组低(P＜0.05);护理满意度:与对照1组、对照2组对比,观察组护理满意度较高(P＜0.05)。结论 团体认知行为干预联合揿针全程护理应用于胃癌晚期癌痛患者,能有效缓解疼痛,改善心理状态,且护理满意度高。

Objective To analyze the effect of group cognitive behavior intervention combined with whole-process nursing of pressing needle on the psychological state of patients with advanced gastric cancer pain. Methods A total of 115 patients with advanced gastric cancer pain in our hospital (from March 2018 to January 2021) were selected and divided into 3 groups according to different intervention methods. Control group 1 (37 cases) received group cognitive behavioral intervention, control group 2 (38 cases) received whole-course nursing intervention of pressing needle, and observation group (40 cases) received whole-process nursing intervention of group cognitive behavioral intervention combined with pressing needle. The intervention effects of the three groups were compared. Results Pain relief when pain burst: the pain relief rate of observation group was higher than control group 1 and control group 2 (P<0.05). Mental state: after 1 month of intervention, the mental state of the 3 groups was improved, and the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the observation group were lower than those in control group 1 and control group 2 (P<0.05). Nursing satisfaction: compared with control group 1 and control group 2, nursing satisfaction of observation group was higher (P<0.05). Conclusions Group cognitive behavior intervention combined with whole-process nursing of pressing needle applied to patients with advanced gastric cancer pain could effectively relieve pain, improve psychological state, and nursing satisfaction.

目的 探讨自拟补肝益肾壮腰汤联合脊柱推拿、牵引对腰椎间盘突出症(LDH)患者肌电图和腰椎功能的影响及临床效果。方法 选取106例LDH患者采用随机数字表法分为观察组和对照组各53例。对照组行脊柱推拿及牵引治疗,观察组在此基础上加用自拟补肝益肾壮腰汤。记录2组患者治疗前及治疗3个月后的腰椎功能程度[Oswestry功能障碍指数(ODI)]、肌电图[平均功率频率(MPF)、中位频率斜率(MFs)、平均肌电波幅(AEMG)]、运动功能障碍程度[日本骨科协会下腰痛量表(JOA)]及疼痛程度[视觉模拟评分法(VAS)]评估结果差异。结果 治疗3个月后,2组JOA评分、VAS评分及各项肌电图参数(MPF、MFs、AEMG)均较治疗前有提升,且观察组均高于对照组(P均＜0.05);ODI评分则较治疗前下降(P均＜0.05),且观察组低于对照组(P＜0.05)。结论 自拟补肝益肾壮腰汤联合脊柱推拿及牵引能明显改善LDH患者腰椎功能,促进肌力恢复、缓解肌肉疲劳、减轻疼痛,有较高的临床实用价值。

Objective To investigate the effect of self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction on electromyography and lumbar function and clinical efficacy in patients with lumbar disc herniation (LDH). Methods A total of 106 patients with LDH were randomly divided into observation group and control group. The control group was treated with spinal massage and traction, and the observation group was treated with self-made Bugan Yishen Zhuangyao decoction on this basis. The degree of lumbar spine function [Oswestry disability index (ODI)], electromyography [mean power frequency (MPF), median frequency slope (MFS), average EMG amplitude (AEMG)], the degree of motor dysfunction [Japanese Orthopaedic Association (JOA) score] and the degree of pain [visual analog scale (VAS)] before and 3 months after treatment were recorded and compared. Results After 3 months of treatment, JOA score, VAS score and EMG parameters (MPF, MFS and AEMG) in the two groups were significantly higher than those before treatment, and those in the observation group were higher (P<0.05); ODI score was significantly lower than that before treatment (all P<0.05), and the observation group was significantly lower than the control group (P<0.05). Conclusions The self-made Bugan Yishen Zhuangyao decoction combined with spinal massage and traction can significantly improve the lumbar function of patients with LDH, promote the recovery of muscle strength, relieve muscle fatigue and pain, and with high clinical practical value.

目的 探讨左卡尼汀联合生脉注射液对维持性血液透析低血压心脏功能的影响。方法 选取我院2016年1月—2020年2月收治的维持性血液透析反复低血压患者120例,随机分为对照组(n=40)、左卡尼汀组(n=40)和联合组(n=40)。3组均采用常规治疗,左卡尼汀组加用左卡尼汀,联合组加用左卡尼汀联合生脉注射液。分析3组治疗前后低血压发生率、血压指标、心肌酶谱、心肌梗死定量指标及超声心动图指标变化。收集3组治疗过程中发生不良反应情况。结果 联合组低血压发生率低于对照组和左卡尼汀组(P＜0.05);联合组治疗后透析中最低收缩压、透析中平均动脉压、透析后收缩压、透析后平均动脉压均高于对照组和左卡尼汀组(P＜0.05);联合组治疗后心肌谱酶、心肌梗死定量指标均低于对照组及左卡尼汀组(P＜0.05);3组治疗前后肺动脉收缩压、右室壁舒张末期厚度、右室舒张末期内径、左室舒张末期内径、右室收缩末期面积、右室舒张末期面积差异无统计学意义(P＞0.05);联合组治疗后左室射血分数高于对照组和左卡尼汀组(P＜0.05);3组不良反应发生率差异无统计学意义(P＞0.05)。结论 左卡尼汀联合生脉注射液可降低维持性血液透析患者低血压的发生率,改善患者心功能,具有较好的疗效及安全性。

Objective To investigate the effect of L-carnitine combined with Shengmai Injection on cardiac function in patients with maintenance hemodialysis hypotension. Methods A total of 120 maintenance hemodialysis patients with recurrent hypotension in our hospital from January 2016 to February 2020 were randomly divided into control group (n=40), L-carnitine group (n=40) and combination group (n=40). The three groups were treated with conventional treatment, L-carnitine group was added with L-carnitine, and the combination group was given levocarnitine combined with Shengmai Injection. The incidence of hypotension, blood pressure index, myocardial enzyme spectrum, quantitative index of myocardial infarction and echocardiography index were obtained and analyzed before and after treatment. The adverse reactions in the three groups were collected. Results The incidence of hypotension in combination group was lower than that in control group and L-carnitine group (P<0.05). After treatment, the minimum systolic blood pressure, mean arterial pressure during dialysis, systolic blood pressure after dialysis and mean arterial pressure after dialysis in the combination group were higher than those in the control group and L-carnitine group (P<0.05). After treatment, the myocardial spectrum enzyme and myocardial infarction quantitative indexes in the combination group were lower than those in the control group and L-carnitine group (P<0.05). There were no significant differences in pulmonary artery systolic pressure, diastolic right ventricular wall thickness, diastolic right ventricular width, diastolic left ventricular width, systolic right ventricular area and diastolic right ventricular area among the three groups before and after treatment (P>0.05). The left ventricular ejection fraction of the combination group was higher than that of the control group and L-carnitine group (P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusions L-carnitine combined with Shengmai Injection could reduce the incidence of hypotension in maintenance hemodialysis patients, improve the cardiac function, with good efficacy and safety.

目的 比较广东云浮市进行药品专区执行国家药品集中采购(GPO)前后呼吸系统疾病患儿住院医疗费用,分析其住院医疗费用的影响因素。方法 选择云城区2019—2020年0~14岁城乡儿童呼吸系统疾病住院患儿,采用单因素和多元回归统计方法分析住院医疗费用的影响因素。结果 呼吸系统疾病儿童平均住院医疗费用国家集采前(4 872.38元)高于国家药品集采后(4 620.25元,P<0.05),药费分别占参保及参合患儿住院医疗费用的35.35%和27.39%,统筹支付费用参保与参合儿童分别占46.85%和57.59%。年龄、住院天数、转归、有无合并症、疾病分类、应用GPO药物、入院分类为呼吸系统疾病患儿住院医疗费用的共同影响因素,其中住院医疗费用随着患儿年龄增加、转归良好及应用GPO药物费用而减少,为负性联系;余住院天数、有无合并症、疾病分类、入院分类则与住院总费用有着正性联系。结论 提高患儿的转归,缩短平均住院日,做好药品专区及集中采购工作可降低儿童呼吸系统疾病的住院费用。

Objective To compare the inpatient medical expenses of children with respiratory diseases before and after the implementation of national group purchasing organization(GPO) in Yunfu City, Guangdong Province, and analyze the influencing factors of inpatient medical expenses. Methods The hospitalized children aged 0~14 with respiratory diseases from 2019 to 2020 in Yuncheng district implemented the GPO were selected. The influencing factors of hospitalization expense were analyzed by single factor and multiple regression statistical methods. Results The average hospitalization expense of children with respiratory diseases before the GPO implemented (4 872.38 yuan) was higher than after (4 620.25 yuan, P<0.05); the drug expense accounted for 35.35% and 27.39% of the hospitalization expense of the insured urban and rural children, and integrated payment accounted for 46.85% and 57.59%. Age, hospitalization days, outcome, comorbidities, disease classification, application of GPO drugs and admission classification were the common influencing factors of hospitalization expense of children with respiratory diseases. Hospitalization expense decreased with the increase of age, good outcome and application of GPO drugs, which was a negative correlation. And there was a positive relationship between the rest factors and the total cost of hospitalization. Conclusions To improve the outcome of children, shorten the average length of stay, doing a good job in drug zone and group procurement can reduce the hospitalization cost of children with respiratory diseases.

目的 探讨不同剂量阿托伐他汀治疗能否作用于脑血管储备能力机制,进而影响卒中后轻度认知功能障碍患者的认知功能水平及神经功能。方法 纳入2018年5月—2020年5月期间,在本院神经内科住院的100例卒中后轻度认知障碍患者。随机分为大剂量(阿托伐他汀40 mg/d)组和小剂量(阿托伐他汀10 mg/d)组。记录半年后的简易精神状态量表(MMSE)评分、神经功能评分(NIHSS)和脑血管储备能力。结果 大剂量组的MMSE评分、NIHSS评分优于小剂量组,大剂量组的脑血管储备能力改善明显,2组之间有统计学差异。脑血管储备能力提高与认知功能改善有相关性。结论 大剂量阿托伐他汀治疗可明显改善卒中后轻度认知功能障碍患者的脑血管储备能力,并促进患者认知功能及神经功能恢复。

Objective To investigate whether different doses of atorvastatin can contribute to the mechanism of cerebrovascular reserve capacity, and then affect the level of cognitive function and neurological function in patients with mild cognitive impairment after stroke. Methods A total of 100 patients with mild cognitive impairment after stroke hospitalized in the department of neurology from May 2018 to May 2020 were recorded. They were randomly divided into high-dose (atorvastatin 40 mg/d) group and low-dose (atorvastatin 10 mg/d) group. The Mini-Mental State Examination (MMSE), National Institute of Health Stroke Scale (NIHSS) and cerebrovascular reserve capacity were recorded half a year later. Results The scores of MMSE and NIHSS in the high-dose group were higher than those in the low-dose group. The cerebrovascular reserve capacity of the high-dose group was significantly improved, and there was significant difference between the two groups. There was a correlation between the improvement of cerebrovascular reserve capacity and cognitive function. Conclusions High dose of atorvastatin could significantly improve the cerebrovascular reserve capacity of patients with mild cognitive impairment after stroke, and promote the recovery of cognitive function and neurological function.

目的 探讨美多巴联合盐酸司来吉兰治疗帕金森患者的临床效果及对不良反应情况的影响。方法 选取我院2018年1月—2020年12月收治的96例帕金森患者,通过单双号抽签法将96例患者分为2组,分别为对照组、观察组(每组48例)。对照组给予美多巴治疗,观察组在美多巴联合盐酸司来吉兰进行治疗。然后对比2组患者治疗前后的临床疗效,采用帕金森统一评分量表计算精神状态 、运动功能和日常活动评分并记录不良反应的发生率。结果 对比2组患者治疗前后临床疗效,观察组患者临床总有效率高于对照组(87.50% vs 66.66%),差异有统计学意义(χ²=5.897,P=0.015);治疗后2组患者精神状态 、运动功能和日常活动评分低于治疗前(P<0.05),且观察组患者各项评分低于对照组,差异有统计学意义(t=8.250,P<0.001;t=4.388,P=<0.001;t=3.207,P=0.002);对比2组患者不良反应发生率,对照组与观察组不良反应发生率比较无差异(10.41% vs 12.50%,χ²=0.103,P=0.749),2组患者治疗后的不良反应均为一过性,停药或休息后可自行缓解。结论 美多巴联合盐酸司来吉兰治疗帕金森患者的临床疗效良好,能让患者精神状态、运动功能和日常生活得到显著改善,且不良反应较少。

Objective To explore the clinical effect of medopa combined with selegiline hydrochloride in the treatment of patients with Parkinson's disease and its impact on adverse reactions. Methods A total of 96 Parkinson's disease patients from January 2018 to December 2020 were selected and divided into two groups by the odd and even number drawing method, 48 cases each. The control group was treated with medopa, and the observation group was treated with selegiline hydrochloride on the basis of the control group. Then the clinical efficacy of the two groups were compared, and the Unified Parkinson's Disease Rating Scale was used to access the mental state, motor function and daily activity scores of the patients, and the incidence of adverse reactions was recorded. Results The total effective rate of the observation group was higher than that of the control group (87.50% vs 66.66%), with statistical significance(χ²=5.897,P=0.015). After treatment, the scores of mental state, motor function and daily activities were lower (P<0.05), and the scores of the observation group were significantly lower than those of the control group (t=8.250, P<0.001; t=4.388, P=<0.001; t=3.207, P=0.002);the incidence of adverse reactions had no differences (10.41% vs 12.50%, χ²=0.103, P=0.749). The adverse reactions were transient, which could be alleviated by drug withdrawal or rest. Conclusions Madopa combined with selegiline hydrochloride had a good clinical effect in the treatment of patients with Parkinson's disease. It could significantly improve the mental state, motor function and daily life of patients, with less adverse reaction, which is worthy of promotion.

目的 探讨在慢性肾炎中采用厄贝沙坦＋肾炎康复片对肾功能的影响。方法 在我院肾内科2018年3月—2020年8月收治的慢性肾炎患者中随机选取80例,按照抽签法分为2组,对照组(40例)采用厄贝沙坦,研究组在其基础上加用肾炎康复片,对比2组肾功能指标、临床疗效及不良反应。结果 治疗后2组肾功能指标均好转,且研究组血肌酐、尿素氮、24 h尿蛋白量均低于对照组,肾小球滤过率高于对照组(P＜0.05)。2组治疗总有效率对比差异显著(P＜0.05),不良反应对比无差异。结论 在对慢性肾炎的治疗中联用厄贝沙坦及肾炎康复片可有效提高肾功能,疗效显著。

Objective To investigate the effect of irbesartan and Shenyan Kangfu Tablet on renal function in chronic nephritis. Methods A total of 80 patients of chronic nephritis admitted in our hospital from March 2018 to August 2020 were randomly selected and divided into two groups by drawing lots. The control group (40 cases) received irberartan, while the research group added Shenyan Kangfu Tablet on the basis of irberartan. The renal function indexes, clinical efficacy and adverse reactions of the two groups were compared. Results After treatment, renal function indexes in both groups were improved, and serum creatinine, urea nitrogen and 24 h urinary protein levels in the research group were lower than those in the control group, and glomerular filtration rate was higher than that in the control group (P<0.05). The total effective rate was significantly different between the two groups (P<0.05), but there was no difference in adverse reaction rate. Conclusions In the treatment of chronic nephritis, irbesartan combined with Shenyan Kangfu Tablets could effectively improve renal function, and the effect is significant.

目的 探讨影响先天性甲状腺功能减低症患儿不同转归的早期因素。 方法 选取2013年12月—2017年3月期间在本中心筛查并确诊的先天性甲状腺功能减低症患儿共80例,经左旋甲状腺激素钠治疗2~3年后停药评估再随访1年以上者,根据疾病转归将患儿分为持续性甲低组(29例)与暂时性甲低组(51例)。对2组患儿的临床情况进行回顾性分析,寻求影响结局的早期因素。结果 持续性甲低与暂时性甲低患儿初筛促甲状腺激素值[ 63.89 (43.89, 114.25) vs 38.54 (27.27, 60.00) mIU/L]、促甲状腺激素恢复正常所需剂量[(4.29±1.46) vs (3.38±1.34) μg/(kg·d)]、早期甲状腺超声正常比例[58.6%(17/29)vs 90.2%(46/51)]差异有统计学意义(P<0.05)。其中初筛促甲状腺激素值(最佳临界值:37.825 mIU/L,AUC=0.745,灵敏度0.897,特异度0.490)和出生后第8个月左旋甲状腺激素钠给药剂量[最佳临界值3.38 μg/(kg·d),AUC=0.759,灵敏度 0.586,特异度 0.843]可早期区别持续性甲低与暂时性甲低患儿。结论 初筛促甲状腺激素值和出生后左旋甲状腺激素钠给药剂量对先天性甲状腺功能减低症患儿临床转归有早期预测作用。

Objective To investigate the early factors affecting different outcomes of children with congenital hypothyroidism (CH). Methods A total of 80 children with CH screened and diagnosed at Meizhou Maternal and Child Health Care and Family Planning Service Center between December 2013 and March 2017, who were treated with levothyroxine sodium for 2~3 years and then discontinued for assessment and followed up for over 1 year, were selected and divided into the permanent CH group (29 cases) and transient CH group (51 cases) according to disease outcomes. The clinical conditions of the children were retrospectively analysed to seek early factors affecting outcome. Results The initial screening thyroid hormone values [ 63.89 (43.89, 114.25) vs 38.54 (27.27, 60.00) mIU/L ], the required dose to restore normal thyroid hormone in permanent and transient CH group [(4.29±1.46) vs (3.38±1.34) μg/(kg·d)], and the proportion of early normal thyroid ultrasound [58.6% (17/29) vs 90.2% (46/51)] had significant differences(P<0.05). The initial screening thyroid hormone value (optimal threshold: 37.825 mIU/L, AUC=0.745, sensitivity 0.897 and specificity 0.490) and the levothyroxine sodium dosage at eighth month of age [optimal threshold 3.38 μg/(kg·d), AUC=0.759, sensitivity 0.586 and specificity 0.843] could early distinguish permanent and transient CH children. Conclusions Initial screening thyroid hormone values and postnatal levothyroxine sodium dosage had an early predictive effect on clinical outcome in children with CH.