目的 系统评价心脉通治疗冠心病的临床疗效及其安全性。方法 2名研究者独立系统地检索心脉通治疗冠心病的文献,其中包括维普中文科技期刊全文数据库(VIP)、PubMed 电子期刊全文数据库、中国学术期刊全文数据库(CNKI)、The Cochrane Library 数据库、万方数据库等6个数据库。同时运用Review Manager 5.4 软件进行本研究的数据处理。结果 最终共纳入8篇文献,共计985名心脉通治疗冠心病患者。治疗前后的临床疗效、发作频率、血脂水平的Meta分析结果显示心脉通组优于常规治疗组。有3项纳入试验报告不良反应。结论 心脉通治疗冠心病的临床疗效优于常规治疗。心脉通不仅可以降低冠心病发作频率,缩短其发作持续时间,还能调节血脂水平,在治疗冠心病方面疗效确切,值得临床参考应用。

Objective To systematically evaluate the clinical efficacy and safety of Xinmaitong in the treatment of coronary heart disease (CHD). Methods Two researchers searched the literatures of Xinmaitong in the treatment of coronary heart disease independently and systematically, including VIP Chinese Sci-tech Journal full-text Database (VIP), PubMed Electronic Journal full-text Database, Chinese Academic Journal full-text Database (CNKI), The Cochrane Library Database and Wanfang Database. At the same time, Review Manager 5.4 software was used to process the data of this study. Results A total of 8 articles were included, and a total of 985 patients with coronary heart disease were treated with Xinmaitong. The results of Meta analysis of clinical efficacy, attack frequency and blood lipids level before and after treatment showed that Xinmaitong group was better than routine treatment group. Three items were included in the report of adverse reactions. Conclusions The clinical effect of Xinmaitong in the treatment of coronary heart disease was better than that of routine treatment. Xinmaitong can not only reduce the frequency and duration of coronary heart disease attack, but also regulate blood lipids level. Xinmaitong was effective in the treatment of coronary heart disease and is worthy of clinical reference.

目的 观察龙氏正骨手法配合浮针临床上治疗颈源性头痛的疗效。方法 将本院80例颈源性头痛患者按1:1随机分为观察组和对照组,观察组采用龙氏正骨手法配合浮针治疗,对照组采用龙氏正骨手法治疗,于1疗程后比较2组临床疗效、疼痛视觉模拟评分(VAS)和颈椎活动度评分(ROM)情况。结果 治疗后两组VAS较治疗前均有改善(P<0.05),观察组较对照组明显(P<0.05)。2组ROM较治疗前均有改善(P<0.05),组间差异无统计学意义(P>0.05)。治疗组的愈显率高于对照组(P<0.05)。结论 龙氏正骨手法配合浮针治疗颈源性头痛能更好地减轻疼痛程度,方便高效。

Objective To observe the clinical effect of Long's bone-setting manipulation combined with floating acupuncture therapy on cervicogenic headache. Methods A total of 80 patients with cervicogenic headache in our hospital were randomly divided into observation group and control group evenly. The observation group was treated with Long's bone-setting manipulation combined with floating acupuncture therapy, and the control group was treated with Long's bone-setting manipulation only. After one course of treatment, the clinical efficacy,pain visual analogue score (VAS) and cervical joint range of motion (ROM) in the two groups were compared. Results After treatment, the VAS of the two groups was improved compared with that before treatment (P<0.05), and the VAS of the observation group was significantly higher than that of the control group (P<0.05). ROM in the two groups was improved compared with that before treatment (P<0.05), and there was no significant difference between the two groups (P>0.05). The effective rate of the treatment group was higher than that of the control group (P<0.05). Conclusions Long's bone-setting manipulation combined with floating acupuncture therapy in the treatment of cervicogenic headache can better reduce the degree of pain, which is convenient and efficient.

目的 探讨艾灸联合五禽戏治疗颈型颈椎病的疗效。方法 选择我院2019年3月—2020年11月收治的116例颈型颈椎病患者作为研究对象,随机分为实验组和对照组,各58例。其中对照组患者给予艾灸常规治疗,观察组患者在上述治疗的基础上外加五禽戏康复治疗。比较2组患者治疗前后的颈部症状积分、颈椎活动度(ROM)评分、McGill疼痛问卷(MPQ)、Northwick Park颈部疼痛量表(NPQ)评分,观察2组疗效、不良反应及预后情况。结果 实验组治疗有效率高于对照组,预后复发率低于对照组(P<0.05)。与治疗前相比,2组患者治疗后的NPQ评分、MPQ 评分、颈部症状积分、ROM评分均降低,且实验组降低更明显(P<0.05)。结论 颈部症状积分、颈椎活动度及NPQ评分可以较好地对五禽戏联合艾灸治疗颈型颈椎病的疗效进行反映评价,具有一定的临床应用价值。

Objective To explore the efficacy of moxibustion combined with Wuqinxi in treating cervical spondylosis. Methods The 116 patients with cervical spondylosis admitted to our hospital from March 2019 to November 2020 were selected as the research objects, and they were divided into experimental group and control group by random number method, with 58 cases in each group. The patients in the control group were given conventional moxibustion treatment, and the patients in the observation group were treated with Wuqinxi rehabilitation therapy on the basis of moxibustion. The scores of neck symptom, cervical spine range of motion (ROM), McGill pain questionnaire (MPQ), Northwick Park neck pain questionnaire(NPQ) scores before and after treatment were compared between the two groups, and the differences in clinical efficacy and prognosis of the two groups were observed. Results The effective rate of treatment in the experimental group was significantly higher than that of the control group, and the recurrence rate was significantly lower than that of the control group (P<0.05). Compared with that before treatment, NPQ score, MPQ score, neck symptom score, ROM score were significantly reduced in both groups after treatment, and the reduction of these indicators was more significant in the experimental group, with statistically significant differences (P<0.05). Conclusions The neck symptom score, cervical ROM and NPQ score could better reveal and evaluate the efficacy of Wuqinxi combined with moxibustion in the treatment of cervical spondylosis, and had certain clinical application value.

目的 探讨应用56孔冷盐水(STSF)压力导管高功率消融模式治疗老年阵发性房颤患者的有效性和围手术期安全性。方法 回顾性分析广州市第一人民医院2019年1月—2021年6月使用STSF导管高功率消融模式行射频治疗的老年阵发性房颤患者68例(STSF组),匹配同期年龄、性别、左房直径、左室射血分数无差异且使用6孔冷盐水 (ST)压力导管常规功率消融的老年房颤患者71例(ST组),比较2组患者之间的即刻环肺静脉隔离成功率、单圈隔离成功率、手术时间、X线透视时间、消融时间、术中盐水灌注量,以及并发症发生率。结果 2组患者都成功完成环肺静脉电隔离,STSF组单圈隔离成功率与ST组无差异(左侧肺静脉92.6% vs 90.1%,P>0.05;右侧肺静脉83.8% vs 87.3%,P>0.05),与ST组比较,STSF组手术及消融时间缩短[(70.9±10.0)min vs (79.1±14.2)min,P<0.001;(25.4±4.5)min vs(30.5±6.3)min,P<0.001],灌注量更低[(406.5±46.3)mL vs (729.2±106.1)mL;P<0.001],X线透视时间相近[(6.5±2.5)min vs(7.3±2.6)min;P=0.056]。2组围手术期并发症率均较低(2.9% vs 3.9%;P=0.39),STSF组2例术中发生气体爆破,但未引起心包填塞,ST组有2例术后出现心衰,利尿后好转,1例出现持续性胸痛,胃镜提示食道糜烂,予流质饮食及质子泵抑制剂治疗后恢复。结论 应用STSF导管高功率消融模式在老年阵发性房颤患者行肺静脉大环隔离可提高消融效率,减少术中液体负荷,且不增加围手术期风险。

Objective To investigate the effectiveness and perioperative safety of ThermoCool SmartTouch SurroundFlow (STSF) catheter high-power ablation mode in the treatment of elderly patients with paroxysmal atrial fibrillation. Methods A total of 68 elderly patients with paroxysmal atrial fibrillation who used STSF catheter high-power ablation mode (STSF group) in Guangzhou First People's Hospital from January 2019 to June 2021 were analyzed retrospectively. There were 71 elderly patients with atrial fibrillation who had no significant difference in age, sex, left atrial diameter and left ventricular ejection fraction, used ThermoCool SmartTouch (ST) catheters for conventional power ablation (ST group) at the same time. The success rate of immediate circumferential pulmonary vein isolation, single lap isolation, operation time, X-ray fluoroscopy time, ablation time, intraoperative saline perfusion volume and the incidence of complications were compared between the two groups. Results Both groups of patients successfully completed circular pulmonary vein electrical isolation. There was no significant difference in the success rate of single-circle isolation between STSF group and ST group (left pulmonary vein 92.6% vs 90.1%, P>0.05; right pulmonary vein 83.8% vs 87.3%, P>0.05). Compared with ST group, STSF group had shorter operation and ablation time [(70.9±10.0) min vs (79.1±14.2) min, P<0.001; (25.4±4.5) min vs (30.5±6.3) min, P<0.001], lower perfusion volume [(406.5±46.3)mL vs (729.2±106.1)mL, P<0.001], similar X-ray fluoroscopy time [(6.5±2.5)min vs (7.3±2.6)min, P=0.056 ]. The perioperative complication rate of the two groups was low (2.9% vs 3.9%, P=0.39). Two cases of STSF group had steam pops during operation but did not cause pericardial tamponade, and 2 cases of ST group had postoperative heart failure occurred and improved after diuresis. One case developed persistent chest pain, which gastroscope indicated esophageal erosion, and recovered after liquid diet and PPI treatment. Conclusions Using STSF catheter high-power ablation mode to perform pulmonary vein isolation in elderly patients with paroxysmal atrial fibrillation could improve ablation efficiency, reduce intraoperative fluid load, and without increasing perioperative risk.

目的 研究经皮肾镜碎石术围手术期尿路感染应用磷霉素氨丁三醇治疗的临床效果。方法 纳入2019年1月—2021年1月我院收治的80例经皮肾镜碎石术围手术期尿路感染的患者为研究对象,按照随机数表法分为2组,各40例,术毕对照组静脉滴注左氧氟沙星氯化钠,观察组口服磷酸素氨丁三醇。观察2组干预后临床疗效,治疗后尿细菌培养转阴率,2组血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、单核细胞趋化蛋白-1(MCP-1)、血红素加氧酶-1(HO-1)、降钙素原(PCT)等炎性因子水平及细菌学疗效,并分析干预期间不良反应发生情况。结果 观察组总有效率为87.50%,高于对照组的65.00%(P＜0.05)。观察组尿细菌培养转阴率为97.5%,高于对照组的80.0%(P＜0.05)。治疗后,2组血清hs-CRP、IL-6、MCP-1、HO-1及PCT水平均较治疗前下降,且观察组低于对照组(P＜0.05)。2组粪肠球菌清、金黄色葡萄球菌清除率比较差异无统计学意义(P＞0.05),观察组大肠埃希菌清除率为86.97%,高于对照组的61.54%(P＜0.05)。干预期间,观察组不良反应总发生率为10.00%,与对照组的12.5%比较,差异无统计学意义(P＞0.05)。结论 相比于左氧氟沙星氯化钠注射液,采用磷霉素氨丁三醇可有效提高经皮肾镜碎石术患者围手术期尿路感染临床控制效果,改善患者的炎症因子水平,安全性较高。

目的 本文主要探讨信迪利单抗联合化疗治疗复发转移食管癌的临床有效性和安全性。方法 选取2018年1月—2020年1月我院收治的复发转移食管癌患者共98例纳入研究。按照随机数字表法将患者分为对照组(49例)和观察组(49例),对照组给予多西他赛75 mg/m²+顺铂75 mg/m²治疗,观察组在对照组的基础上给予信迪利单抗(200 mg)治疗,分析比较2组临床疗效及不良反应,主要评估指标是随访期间患者中位生存时间。结果 观察组临床治疗有效率高于对照组(P<0.05);与治疗前比较,2组治疗后血清糖类抗原-199(CA-199)、癌胚抗原(CEA)及肿瘤特异生长因子(TSGF)水平均降低(P<0.05);与对照组比较,观察组治疗后血清CA-199 、CEA及TSGF水平降低(P<0.05);2组临床不良反应主要以恶心呕吐、皮疹等为主,观察组免疫相关不良事件发生率高于对照组(P<0.05),但总不良反应发生率比较无差异(P>0.05);随访至2020年10月,观察组中位OS为16个月(5～27个月),对照组中位总生存期(OS)为9个月(3～23个月),观察组中位OS长于对照组(P<0.001)。结论 信迪利单抗联合化疗可提高复发转移食管癌的临床治疗效果,降低肿瘤抗原水平,延长患者生存时间,且临床较为安全。

目的 探讨不同入路显微手术治疗基底节区高血压脑出血的效果。方法 将我院2017年1月—2021年3月期间98例患者分组,按照随机数字表法分为对照组49例,给予颞叶皮层入路显微手术治疗,观察组49例给予经外侧裂入路显微手术治疗,观察2组预后状态、术后情况、日常生活能力及并发症发生情况。结果 术后半年,观察组预后状况优良率(81.63%)高于对照组(59.18%,P<0.05);观察组血肿消除率(95.92%)大于对照组(81.63%,P<0.05),2组手术时间[观察组(141.22±20.15)min,对照组(134.49±22.58)min]对比差异无统计学意义(P>0.05);观察组日常生活能力优于对照组(P<0.05);观察组并发症(14.28%)与对照组对比无统计学意义(10.20%,P>0.05)。结论 相较于颞叶皮层入路,外侧裂入路下显微手术治疗基底节区高血压脑出血患者对血肿清除效果更佳,以此提高手术预后及生活能力,不会增加手术时间及术后并发症发生情况。

目的 探究炔雌醇环丙孕酮联合胰岛素增敏剂治疗多囊卵巢综合征疗效。方法 选取广东省第一荣军医院妇科2018年8月—2020年8月收治的100例多囊卵巢综合征患者作为研究对象,采用随机数字表法将患者分为对照组(n=50)和观察组(n=50),2组患者均给予炔雌醇环丙孕酮治疗,观察组此外联合胰岛素增敏剂治疗,比较2组患者治疗前、治疗30 d后血清性激素、抗缪勒管激素(AMH)水平、代谢指标水平以及临床疗效(包括排卵、妊娠等)。结果 治疗前,2组患者血清性激素、AMH水平比较,差异不具有统计学意义(P>0.05),治疗后,2组患者AMH、血清性激素水平均有所下降,且观察组低于对照组(P<0.05)。治疗前,2组患者代谢指标比较,差异不具有统计学意义(P>0.05),治疗后2组患者代谢指标水平均有所下降,且观察组低于对照组(P<0.05)。观察组治疗有效率高于对照组(P<0.05)。结论 使用单一药物治疗具有局限性,将炔雌醇环丙孕酮与胰岛素增敏剂相联合治疗能够有效降低患者胰岛素代谢指标水平以及性激素水平,提高患者受孕几率,具有良好的治疗效果。

Objective To explore the efficacy of ethinylestradiol and cyproterone combined with insulin sensitizer in the treatment of polycystic ovary syndrome. Methods A total of 100 patients with polycystic ovary syndrome treated in the Department of Gynecology of the First Invalids Hospital of Guangdong Province from August 2018 to August 2020 were selected as the research object. The patients were divided into control group (n=50) and observation group (n=50). The patients in both groups were given ethinylestradiol cyproterone. In addition, the observation group was treated with insulin sensitizer. The levels of serum sex hormone, anti-Müllerian hormone (AMH), metabolic index level and clinical efficacy (including ovulation, pregnancy, etc.) before treatment and 30 days after treatment were compared. Results Before treatment, the levels of serum sex hormone and AMH had no significant difference between two groups (P>0.05). After treatment, the levels of AMH and serum sex hormone both decreased in two groups, and those in observation group were lower than those in control group (P<0.05). Before treatment, it had no significant difference in metabolic indexes (P>0.05). After treatment, the levels of metabolic indexes in the two groups decreased, and those in observation group were lower than those in control group (P<0.05). The effective rate of the observation group was higher than the control group (P<0.05). Conclusions Using single drug treatment has limitations. The combination of ethinylestradiol cyproterone and insulin sensitizer can reduce insulin metabolism and sex hormone levels, improve the probability of pregnancy, which have a good therapeutic effect.

目的 比较来曲唑和氯米芬治疗极严重少精子症的治疗效果。方法 选取2020—2021年在本生殖中心门诊50例极严重少精子症病例,分为2组,A组(来曲唑,研究组n=26)、B组(氯米芬,对照组n=24)。结果 来曲唑和氯米芬治疗后1月、3月,A组精子浓度明显提高,优于B组[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]。通过卵胞浆内单精子注射/体外受精胚胎移植治疗,A组妊娠16例(61.5%),B组妊娠11例(45%)。2组治疗后的血清卵泡刺激素、黄体生成素、睾酮升高[(5.9±3.8) vs (20.3±2.6);(3.6±2.8) vs (9.5±5.7);(13.6±10.5) vs (25.3±10.8),P<0.05],A组雌二醇水平降低[(36.8±20.6) vs (7.6±2.5),P<0.05]。结论 来曲唑治疗极严重少精子症有较理想的临床治疗效果,明显优于氯米芬。

Objective To explore and compare the therapeutic effects of letrozole and clomiphene in the treatment of extremely severe oligospermia. Methods A tatal of 50 cases of extremely severe oligosperospermia in the reproductive center from 2020 to 2021 were selected and divided into two groups, group A (letrozole, study group n=26) and B (clomiphene, control group n=24). Results After letrizole and clomiphene treated for 1 and 3 months, sperm concentration in group A was significantly better than group B[(4.5±3.1) vs (2.0±1.3);(8.3±3.5) vs (2.0±1.8),P<0.05]. With ICSI/IVF, 16 cases (61.5%) succeed in encyesis in group A, 11 cases (45%) in group B. Serum follicle stimulating hormone, luteinizing hormone and testosterone levels were significantly increased after treatment [(5.9±3.8) vs (20.3±2.6), (3.6±2.8) vs (9.5±5.7), (13.6±10.5) vs (25.3±10.8), P<0.05]. The level of estradiol in group A decreased [(36.8±20.6) vs (7.6±2.5), P<0.05]. Conclusions Letrozole has ideal clinical treatment effect, which is obviously superior to clommiphene.

目的 探讨连续性肾脏替代治疗(CRRT)在治疗重症急性胰腺炎(SAP)中的临床意义。方法 回顾分析2018年1月—2019年1月在我院接受救治的SAP患者64例,根据治疗方案的不同分为观察组和对照组, 每组各搜集32例,2组患者基线水平一致。对照组为采用常规内科方案治疗的病例, 观察组为对照组治疗方案基础上联合CRRT的病例,分析对比2组治疗后的各项疗效指标。结果 2组患者治疗后5~7 d内APACHE Ⅱ评分[(11.02±3.14)vs(13.98±3.27)分]、甘油三脂[(4.02±1.05)vs(5.62±1.11)mmol/L]、C反应蛋白[(88.25±6.73)vs(104.41±10.28)ng/L]、降钙素原[(13.12±4.33)vs(18.55±3.96)ng/mL、血尿素氮[(7.33±1.72) vs (11.24±2.76) mmol/L]、血肌酐[(69.51±15.03) vs(91.12±19.17)mmol/L]相较治疗前均降低,观察组患者上述指标水平下降幅度超过对照组,结果分析差异有统计学意义(t=3.693, 5.924, 7.440, 9.362, 5.235, 6.801, 5.018,P均＜0.001)。观察组患者治疗期间疾病症状缓解时间[(3.15±1.26)vs (5.22±1.51) d]、体征指标稳定时间[(2.52±1.38) vs (4.39±1.50) d]、胃肠功能恢复时间[(4.48±1.27) vs (6.21±1.55) d]以及ICU住院时间[(15.03±2.21) vs (18.44±3.27) d]均低于对照组,结果分析差异有统计学意义(t=5.954, 5.190, 4.884,4.888,P均＜0.05)。结论 与常规内科治疗相比,联合CRRT治疗SAP能够显著改善各项炎症指标,有助患者快速脱离重症危险状态,具有积极的临床价值。

Objective To explore the clinical significance of continuous renal replacement therapy (CRRT) in the treatment of severe acute pancreatitis (SAP). Methods Retrospective analysis of 64 patients with SAP in our hospital from January 2018 to January 2019 was carried out. The patients were divided into the observation group and the control group according to different treatment regimens, with 32 cases in each group, and the baseline levels of the two groups were consistent. Patients in the control group were treated with conventional medical treatment, and the patients in the observation group were treated with CRRT on the basis of the control group, and the efficacy of the two groups were analyzed and compared. Results The APACHE II scores [(11.02±3.14) vs (13.98±3.27)]、triglyceride[(4.02±1.05) vs (5.62±1.11) mmol/L], C-reactive protein[(88.25±6.73) vs (104.41±10.28) ng/L], procalcitonin[(13.12±4.33) vs (18.55±3.96) ng/mL], blood urea nitrogen[(7.33±1.72) vs (11.24±2.76) mmol/L], serum creatinine[(69.51±15.03)vs(91.12±19.17)mmol/L] of patients in both groups were significantly decreased within 5-7 days after treatment compared with those before treatment, and the decrease of the above indicators in the observation group was significantly greater than that in the control group, P<0.05. The remission time of symptoms[(3.15±1.26) vs (5.22±1.51) d], the stabilization time of signs[(2.52±1.38) vs (4.39±1.50) d], the recovery time of gastrointestinal function[(4.48±1.27) vs (6.21±1.55) d] and the length of ICU stay[(15.03±2.21) vs (18.44±3.27) d] in the observation group were lower than those in the control group, and the analysis of the results was statistically significant (t=5.954, 5.190, 4.884,4.888,all P＜0.05). Conclusions Compared with conventional medical treatment, additional CRRT treatment can significantly improve the inflammatory indicators of SAP, help patients survive from critical state of SAP, which has positive clinical value.