作为中医药文化瑰宝,针灸在疾病治疗中展现出独特价值,但其标准化操作、疗效量化评价及安全风险控制仍是制约现代化转型的关键问题。随着人工智能技术的突破性发展,机器学习在医疗领域引发的技术革命为针灸创新提供了新机遇。超声医学凭借可视化、定量化及动态监测优势,与机器学习算法形成技术协同,推动传统针灸向精准化、智能化方向迈进。通过超声成像实时定位穴位层次结构与针体轨迹,结合机器学习对多维数据的深度分析,显著提升了针刺治疗的精准性与安全性,同时为建立客观疗效评价体系提供了技术支撑。文章旨在全面回顾超声引导下机器学习技术在针灸研究领域的应用状况,深入剖析现有研究中存在的挑战与局限,并前瞻性地探讨未来的研究方向与趋势,旨在为针灸实践与应用研究的深化与发展提供理论指导与实践启示。
As an invaluable component of traditional Chinese medicine,acupuncture boasts a distinctive value in thetreatment of diseases.However,the standardization of its practice,the quantitative assessment of its therapeutic efficacy,and the implementation of safety risk control measures remain pivotal challenges hindering its modernization and transformation.The advent of artificial intelligence technology has precipitated a technological revolution in the medical field,thereby generating novel opportunities for innovation in acupuncture.The integration of ultrasound medicine and machine learning algorithms,leveraging their respective strengths in visualization,quantification and dynamic monitoring,has emerged as a technological synergy.This synergy is poised to propel traditional acupuncture towards precision and intelligence.The integration of ultrasound imaging with machine learning algorithms enables real-time localization of acupoints and needle trajectory,enhancing the precision and safety of acupuncture treatment.Additionally,it facilitates the development of objective efficacy evaluation systems.The present article aims to comprehensively review the application of ultrasound-guided machine learning technology in the field of acupuncture and moxibustion research.It does so by first analyzing the challenges and limitations of existing research and then prospectively exploring future research directions and trends.The article’s ultimate aim is to provide theoretical guidance and practical inspiration for the deepening and development of acupuncture and moxibustion practice.
目的 本文聚焦DeepSeek这一国产人工智能技术,结合护理临床实践,系统探讨其在护理场景中的应用潜力、现存问题及应对策略。方法 检索国内外相关文献,与现有通用人工智能技术对比,进行综述,并提出思考和建议。结果 预计DeepSeek在护理文书自动化、个性化护理方案生成、临床决策支持、护理质控及教育培训等提供适配应用路径,针对性的服务和解决方案等。结论 DeepSeek可通过多模态技术整合与跨平台互补策略,推动护理服务向智能化、精准化方向发展,为缓解护理人力短缺、优化资源分配提供新思路。
Objective This study focuses on DeepSeek,a domestic artificial intelligence technology,systematically exploring its application potential,existing issues,and targeted strategies in nursing clinical scenarios through integration with practical nursing care contexts.Methods Relevant literatures from both domestic and international sources were collected,compared with existing Artificial General Intelligence(AGI)technologies,to conduct a review,and propose reflections and recommendations.Results Through literature review and technical comparisons,the results proposed specific application paths for DeepSeek in scenarios such as automated nursing documentation,personalized care plan generation,clinical decision support,quality control,and education.It further addressed issues including data privacy,ethical risks,and technical limitations.Conclusions The findings suggest that DeepSeek can integrate multimodal technologies and cross-platform complementary strategies to promote intelligent and precise nursing services,offering innovative solutions to alleviate nursing shortages and optimize resource allocation.
目的 为构建更加健全和可靠的医保体系,制定有效、公平和可持续的医保支付方式提出建议。方法 对医保支付方式及各地医保支付方式改革的实践进行综合比较,总结改革的效果和经验。结果 通过引入绩效导向的支付机制、推动综合付费方式、细化按疾病阶段付费、结合互联网医疗、强化数据能力、健全监管等方面推进医保支付方式改革。结论 医保支付方式是规范医疗机构和医生医疗服务的重要手段,结合浙江省、广东省广州市等省市积极探索疾病诊断相关分组、按病种分值付费等医保支付方式,改革需要综合考虑医疗体制、经济发展水平、人口结构等各方利益和多个因素,通过综合实施,构建更加有效、公平和可持续的医保支付方式。
Objective Provide suggestions for building a more sound and reliable medical insurance system,and developing effective,fair and sustainable medical insurance payment methods.Methods The payment methods of medical insurance and the practice of medical insurance payment reform in various regions were comprehensively compared the effectiveness and experience of the reform were summarized.Results The reform of medical insurance payment mode was promoted by introducing performance-oriented payment mechanism,promoting comprehensive payment mode,refining payment by disease stage,combining Internet medicine,strengthening data capability,improving supervision,etc.Conclusions The payment method of medical insurance is an important means to standardize the medical services of medical institutions and doctors.In combination with the active exploration of Diagnosis Related Groups,Diagnosis Intervention Packet and other medical insurance payment methods in provinces and cities such as Zhejiang and Guangzhou Guangdong.The reform needs to comprehensively consider the interests and multiple factors of the medical system,economic development level,population structure,etc.To build a more effective,fair,and sustainable medical insurance payment method through comprehensive implementation.
目的 面向采血人群的“智慧服务”是智慧医院构建的重要内容,引进智能采血管理系统有助于采血“智慧服务”的实现。文章介绍了广州市属大型三甲医院应用智能采血管理系统的实践,并对于系统出现的问题进行整理及分析,以找出有效解决对策。方法 将采血系统出现故障后的解决对策改良前后分为对照组和观察组,记录采血过程中出现故障的原因及次数,采血故障解决对策改良后的数据为观察组。结果 观察组相较于对照组各项故障的发生率显著降低。结论 在智慧医院构建背景下引进智能采血系统可有助于实现采血“智慧服务”,但在实施过程中应做好新旧采血方式的衔接并落实问题收集和对策制定。
Objective Intelligent Service for blood collection crowd is an important content of intelligent hospital,the introduction of intelligent blood collection management system is conducive to the implementation of “Intelligent Service” blood collection.This paper introduces the application of Intelligent Blood Collection Management System in Guangzhou first-class Hospital,collectis and analyses common systematic problems,to effectively find out the solutions.Materials and methods The patients were divided into control group and observation group before and after the improvement of the countermeasures after the failure of the blood collection system,the reasons and times of the failure were recorded,and the data after the improvement of the countermeasures were taken as the observation group.Results The incidence of various faults in the observation group was significantly lower than that in the control group.Conclusions The introduction of intelligent blood collection system under the background of the construction of smart hospital can help realize the “intelligent service” of blood collection,but in the implementation process,it is necessary to do a good job in the connection of old and new blood collection methods and implement the problem collection and countermeasures.
目的 探讨CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。方法 对2021年5月—2024年5月商丘市第一人民医院收治的82例非小细胞肺癌手术治疗患者进行回顾性分析,将其分为观察组,另选取82例肺部良性肿瘤患者作为对照组,收集其术前CT增强延迟扫描结果,以术后病理诊断结果为金标准,分析CT增强延迟扫描技术在非小细胞肺癌术前诊断中的应用价值。并对比不同临床病理特征非小细胞肺癌患者CT增强延迟扫描的CT增强值,采用Spearman相关性分析法分析CT增强值与非小细胞肺癌病理特征的关系。结果 CT增强延迟扫描显示观察组患者分叶征(12.50% vs 53.57%)、内部空泡征数量(6.25% vs 39.29%)低于对照组(χ 2 =26.560、24.680,P<0.05),观察组患者边缘毛刺(56.25% vs 17.86%)、胸部凹陷征(59.38% vs 14.29%)、高于对照组(χ 2 =43.330、64.600,P<0.05);82例非小细胞肺癌通过CT增强延迟扫描共确诊79例,CT增强延迟扫描诊断对非小细胞肺癌的准确率为96.34%(79/82),与病理诊断结果100.00%对比差异无统计学意义(χ 2 =3.060,P=0.080);82例非小细胞肺癌平均CT增强值为(39.14±7.31),不同性别、年龄、肿瘤最大直径、淋巴结浸润情况患者CT增强值对比差异无统计学意义(P>0.05),不同病理类型[腺癌(43.75±7.15)vs 鳞癌(34.74±6.12)]、细胞分化程度[中、低分化(45.71±7.21)vs 高分化(32.81±5.11)]、临床分期[Ⅰ期(31.03±2.12)vs Ⅱ期(36.61±3.13)vs Ⅲa期(46.32±6.83)]患者、淋巴结转移[是(42.75±4.21)vs 否(35.77±8.13)]CT增强值对比差异有统计学意义(t/F=5.243、8.804、84.828、4.378,P<0.05);Spearman相关分析结果显示:病理类型、细胞分化程度、临床分期、淋巴结转移与非小细胞肺癌患者CT增强值呈正相关(r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008,P<0.05)。结论 CT增强延迟扫描技术对非小细胞肺癌术前确诊具有重要价值,其诊断准确率与病理诊断并无显著差异,且可通过CT增强延迟扫描技术确定患者CT增强值,从而为非小细胞肺癌患者术后病理特征判断提供参考。
Objective To explore the application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer(NSCLC).Methods A retrospective analysis was conducted on 82 patients with NSCLCwho underwent surgical treatment in a hospital from May 2021 to May 2024.They were included into an observation group and another 82 patients with benign lung tumors were included in the control group.The preoperative CT enhanced delayed scanning results were collected,and the postoperative pathological diagnosis was used as the “gold standard” to analyze the application value of CT enhanced delayed scanning in the preoperative diagnosis of NSCLC.And the CT enhancement values of delayed CT scans in NSCLC patients with different clinical and pathological features were compared,and Spearman correlation analysis was used to analyze the relationship between CT enhancement values and pathological features of NSCLC.Results CT enhanced delayed scanning showed that the number of lobular(12.50% vs 53.57%)and internal vacuolar signs(6.25% vs39.29%)in the observation group was significantly lower than that in the control group(χ 2 =26.560,24.680,P<0.05),while the edge spicules(56.25% vs 17.86%)and chest depression signs(59.38% vs 14.29%)in the observation group were significantly higher than that in the control group(χ 2 =43.330,64.600,P<0.05).A total of 79 cases of 82 NSCLC were diagnosed by CT-enhanced delayed scan,and the accuracy of CT-enhanced delayed scan diagnosis for NSCLC was 96.34%(79/82),with no significant difference from the pathological diagnosis result of 100.00%(χ 2 =3.060,P=0.080).The average CT enhancement value of 82 NSCLC cases was(39.14±7.31).There was no significant difference in CT enhancement values among patients of different genders,ages,maximum tumor diameter,and lymph node infiltration(P>0.05).Patients with different pathological types [adenocarcinoma(43.75±7.15)vs squamous cell carcinoma(34.74±6.12)],degree of cell differentiation [moderate,and low differentiation(45.7±7.21)vs high differentiation(32.81±5.11)],clinical stage [I(31.03±2.12)vs II(36.61±3.13)vs IIIa(46.32±6.83)] and lymph node metastasis [yes(42.75±4.21),vs no(35.77±8.13)] CT enhancement had significant difference(t/F=5.243,8.804,84.828,4.378,P<0.05).The Spearman correlation analysis results showed that pathological type,degree of cell differentiation,clinical stage,lymph node metastasis were positively correlated with CT enhancement values in NSCLC patients(r=0.431,P=0.021;r=0.511,P=0.009;r=0.586,P=0.005;r=0.579,P=0.008).Conclusions CT enhanced delayed scanning has important value in preoperative diagnosis of NSCLC.Its diagnostic accuracy is not significantly different from pathological diagnosis,and the CT enhanced value of patients can be determined through CT enhanced delayed scanning,providing reference for postoperative pathological feature judgment of NSCLC patients.
目的 探讨内镜下黏膜切除术患者肠道准备教育程序的优化方法及改善效果。方法 选择2022年12月—2023年12月广州市中西医结合医院接收的内镜下黏膜切除术患者180例进行研究,电脑随机编号按奇偶数分为两组各90例,对照组采取常规肠道准备教育工作,观察组实施基于优化的教育程序展开教育工作,比较两组依从性、肠道准备质量、满意度、不适症状发生情况。结果 观察组饮食依从率96.88%、服药依从率98.44%、运动依从率93.75%,均高于对照组的78.13%、79.69%、71.88%(χ 2 分别为6.172、7.745、7.120,P分别为0.012、0.005、0.007)。观察组左侧、横结肠、右侧等评分及肠道准备质量总分高于对照组(t分别为7.175、6.442、5.971、8.234,均P<0.001)。观察组肠道准备满意度为98.89%,高于对照组的88.89%(χ 2 =7.842,P=0.005)。观察组恶心11.11%、呕吐4.44%、腹胀5.56%、腹痛0.00%,低于对照组的22.22%、13.33%、14.44%、6.67%(χ 2 分别为4.000、4.390、3.950、4.310,P分别为0.045、0.036、0.046、0.037)。结论 对内镜下黏膜切除术患者实施基于优化的教育程序展开肠道准备教育工作可提高患者肠道准备依从性,保证良好的肠道准备质量和肠道清洁度,提高患者的满意度,有助减少肠道不适症状。
Objective To explore the optimization method and improvement effect of bowel preparation education program in patients undergoing endoscopic mucosal resection.Methods A total of 180 patients with endoscopic mucosal resection admitted to the hospital from December 2022 to December 2023 were selected for the study.They were randomly divided into two groups with 90 cases in each group.The control group was given routine bowel preparation education,and the observation group was given education based on optimized education procedures.The compliance,quality of bowel preparation,satisfaction and discomfort symptoms were compared between the two groups.Results The diet compliance rate 96.88%,medication compliance rate 98.44%,exercise compliance rate 93.75% in the observation group were significantly higher than 78.13%,79.69%,71.88% in the control group(χ 2 =6.172,7.745,7.120,P=0.012,0.005,0.007).The scores of left colon,transverse colon and right colon and the total score of bowel preparation quality in the observation group were significantly higher than those in the control group(t=7.175,6.442,5.971,8.234,all P<0.001).The satisfaction of bowel preparation in the observation group(98.89%)was significantly higher than that in the control group(88.89%)(χ 2 =7.842,P=0.005).Nausea 11.11%,vomiting 4.44%,abdominal distension 5.56%,abdominal pain 0.00% in the observation group were significantly lower than 22.22%,13.33%,14.44%,6.67% in the control group(χ 2 =4.000,4.390,3.950,4.310,P=0.045,0.036,0.046,0.037).Conclusions The implementation of bowel preparation education based on optimized education program in patients undergoing endoscopic mucosal resection can improve the compliance of bowel preparation,ensure good quality of bowel preparation and bowel cleanliness,improve patient satisfaction,and reduce the occurrence of intestinal discomfort symptoms,which is worthy of promotion.
目的 探讨自行设计教育路径在非内分泌科糖尿病患者同质化管理中的应用效果。方法 采用时间分段法将200例非内分泌科住院糖尿病患者分为对照组和研究组各100例,对照组所在非内分泌科各科室责任护士在糖尿病联络护士指导下进行糖尿病常规健康教育,研究组自行设计非内分泌科糖尿病健康教育路径并实施同质化管理,观察比较两组患者糖尿病知识知晓程度、血糖水平、自我管理能力、护理满意度。结果 出院时研究组患者密西歇根糖尿病知识测试问卷(DKT)评分(18.37±3.06)分,对照组为(16.01±3.59)分,研究组高于对照组(t=5.004,P<0.05);管理6个月空腹血糖(FBG)、餐后2h血糖(2hPBG)、糖化血红蛋白(HbAlc)分别为[7.00(7.00,8.00)]mmol/L、[8.00(6.00,9.00)]mmol/L、[7.50(6.00,8.00)]%,对照组分别为[8.00(7.00,10.00)]mmol/L、[9.00(8.00,11.00)]mmol/L、[8.00(7.00,9.00)]%,研究组均低于对照组(Z=6.398、5.248、3.034,均P<0.05);研究组糖尿病自我管理能力行为量表(SDSCA-6)评分、纽卡斯尔护理满意度量表(NNSS)评分分别为(35.36±4.75)分、(83.42±6.92)分,对照组分别为(30.90±7.56)分、(72.31±9.26)分,研究组均高于对照组(t=4.998、9.614,均P<0.05)。结论 糖尿病教育路径结合同质化管理能提高非内分泌科住院糖尿病患者糖尿病知识的掌握程度,有效控制血糖水平,提高患者自我管理能力和对护理工作满意度。
Objective To explore the application effect of self-designed education path in homogenization management of non-endocrinology diabetic patients.Methods A total of 200 inpatients with diabetes in non-endocrinology departments were divided into control group and research group with 100 cases in each group.The responsible nurses in the non-endocrinology departments of the control group conducted routine diabetes health education under the guidance of diabetes liaison nurses.The research group designed its own non-endocrinology diabetes health education path and implemented homogenized management.The knowledge level of diabetes mellitus,blood sugar level,self-management ability and nursing satisfaction of the two groups were observed and compared.Results At discharge,the DKT score of the study group was(18.37±3.06) and that of the control group was(16.01±3.59),which was higher than that of the control group(t=5.004,P<0.05).After 6 months management,FBG,2 HPBG and HbAlc of study group were[7.00(7.00,8.00)] mmol/L,[8.00(6.00,9.00)] mmol/L,[7.50(6.00,8.00)]%,respectively,while those in the control group was[8.00(7.00,10.00)]mmol/L,[9.00(8.00,11.00)]mmol/L and[8.00(7.00,9.00)]%,respectively.The study group was lower than the control group(Z=6.398,5.248,3.034,all P<0.05).SDSCA-6 scores and NNSS scores in the study group were(35.36±4.75)scores and(83.42±6.92)scores,respectively,while those in the control group were(30.90±7.56)scores and(72.31±9.26)scores,which were higher in the study group than in the control group(t=4.998,9.614,all P<0.05).Conclusions The combination of diabetes education pathway and homogenized management can improve the mastery of diabetes knowledge,effectively control blood sugar level,improve patients’ self-management ability and satisfaction with nursing work.
目的 探究经鼻间歇正压通气(NIPPV)和经鼻持续正压通气(NCPAP)作为早产儿呼吸窘迫综合征气管插管机械通气拔管后无创呼吸支持过渡的临床效果的差异。方法 纳入2021年1月—2023年6月在广东省吴川市妇幼保健计划生育服务中心治疗的新生儿呼吸窘迫综合征早产儿66例,用随机数字表法将患儿分为NIPPV组(33例)和NCPAP组(33例)。NIPPV组患儿予经鼻间歇正压通气作为过渡期无创呼吸支持,NCPAP组患儿则予以经鼻持续正压通气作为过渡期无创呼吸支持。对比两组患儿治疗前后血气分析结果、脱机失败率、无创呼吸支持时间、无创后吸氧时间、总给氧时间等指标。结果 接受无创呼吸支持12 h后,NIPPV组患儿的PaO2升至(76.46±1.10)mmHg,高于NCPAP组患儿的(75.51±2.15)mmHg(t=2.249,P=0.028)。此外,NIPPV组患儿的SaO2升至(96.36±0.52)%,也高于NCPAP组患儿的(96.07±0.59)%(t=2.138,P=0.034)。而NIPPV组患儿的PaCO2则降至(41.39±0.74)mmHg,较NCPAP组患儿的(41.87±0.95 )mmHg低(t=-2.230,P=0.025)。NIPPV组无创呼吸支持时间为(3.09±0.52)d,短于NCPAP组的(3.45±0.62)d,且该差异有统计学意义(t=2.584,P=0.012)。同样的,NIPPV组总给氧时间(9.52±0.76)天较NCPAP组的(10.00±0.79)天短,且该差异有统计学意义(t=-2.548,P=0.013)。而两组在脱机失败率、无创呼吸支持后吸氧时间、不良反应发生率等方面比较差异无统计学意义(均P>0.05)。结论 与NCPAP模式相比,早产儿拔管后应用NIPPV模式进行无创呼吸支持取得的临床效果更优。
Objective To explore the difference of clinical effect of nasal intermittent positive pressure ventilation(NIPPV)and nasal continuous positive pressure ventilation(NCPAP)as non-invasive respiratory support mode after extubation in preterm infants with endotracheal intubation.Methods Sixty-six cases of preterm infants with neonatal respiratory distress syndrome treated in our hospital from January 2021 to June 2023 were included.All the subjects were randomly divided into NIPPV group(n=33)and NCPAP group(n=33).The blood gas analysis results,weaning failure rate,non-invasive respiratory support time,oxygen inhalation time after noninvasive ventilation,total oxygen administration time.were compared between the two groups.Results After 12 hours of noninvasive respiratory support,PaO2 in the NIPPV group increased to(76.46±1.10)mmHg,which was significantly higher than that(75.51±2.15)mmHg in the NCPAP group(t=2.249,P=0.028).In addition,SaO2 in the NIPPV group increased to (96.36±0.52)%,which was also significantly higher than that(96.07±0.59)% in the NCPAP group(t=2.138,P=0.034).The PaCO2 in the NIPPV group decreased to (41.39±0.74)mmHg,which was lower than that(41.87±0.95)mmHg in the NCPAP group(t=-2.230,P=0.025).The duration of non-invasive respiratory support in the NIPPV group(3.09±0.52) days was shorter than that(3.45±0.62)days in the NCPAP group,and the difference was statistically significant(t=2.584,P=0.012).Similarly,the total duration of oxygen administration in the NIPPV group(9.52±0.76)days was shorter than that(10.00±0.79)days in the NCPAP group,and the difference was statistically significant(t=-2.548,P=0.013).There were no significant differences in weaning failure rate,oxygen inhalation time after noninvasive respiratory support,and incidence of adverse reactions between the two groups(P>0.05).Conclusions Compared with NCPAP mode,NIPPV mode for non-invasive respiratory support in preterm infants after extubating has better clinical effect,and it is worthy of clinical application.
目的 探讨复方黄芪颗粒(CHG)的抗疲劳作用及其机制。方法 48只雄性BALB/C小鼠随机分为空白对照组、低剂量(9.1 g/kg)、中剂量(18.2 g/kg)、高剂量(27.3 g/kg)CHG 3个试验组,每组12只。试验组给予不同剂量的复方黄芪颗粒溶液灌胃,空白对照组小鼠给予等体积生理盐水。给药30 d后,检测小鼠体内相关指标变化,观察其抗疲劳作用并分析相关机制。结果 与空白对照组相比,试验组小鼠体质量差异无统计学意义(P>0.05),小鼠力竭游泳时间及转棒耐力时间均明显延长(P<0.01),血尿素氮(BUN)、乳酸脱氢酶(LDH)、丙二醛(MDA)水平明显降低(P<0.01),肝糖原和肌糖原水平升高(P<0.05),超氧化物歧化酶(SOD)活性升高(P<0.01)。体外抗氧化试验表明CHG以剂量依赖性方式清除2,2-联氮-二(3-乙基-苯并噻唑-6-磺酸)二铵盐(ABTS)和1,1-二苯基-2-三硝基苯肼(DPPH)自由基。当CHG质量浓度为100.000 0 mg/mL时,CHG对DPPH自由基清除能力可达85.030 3%。当CHG质量浓度为25.000 0 mg/mL时,CHG对ABTS自由基清除能力可达96.357 2%。结论 CHG具有抗疲劳的作用,其作用机制可能与抗氧化作用相关。
Objective To investigate the anti-fatigue effects of compound Huangqi granules(CHG)and its mechanism.Methods Forty-eight male BALB/C mice were randomly divided into blank control group,9.1,18.2,27.3 g/kg CHG group(test groups).The test groups received different concentrations of CHG solution by gavage,and the blank control group mice were given equal volume saline.After 30 days of administration,the mice were tested,meanwhile the anti-fatigue effect and mechanism were investigated.Results Compared with blank control group,there was no significant difference in body weight(P>0.05).The exhaustive swimming time and rod turning endurance time of mice were significantly prolonged(P<0.01).The serum levels of blood urea nitrogen,lactate dehydrogenase and malondialdehyde were significantly decreased(P<0.01),while the liver and muscle glycogen levels(P<0.05)and superoxide dismutase activity were increased(P<0.01).In vitro antioxidant tests showed that CHG can remove (1,1-Diphenyl-2-picrylhydrazyl,ABTS) and (2,2’-azino-bis-3-ethylbenzothiazoline-6-sulfonic acid,DPPH) free radicals in a dose-dependent manner.When the CHG concentration is 100 mg/mL,the DPPH free radical scavenging ability of CHG can reach 85.030 3%.When the CHG concentration was 25 mg/mL,the scavenging ability of CHG to ABTS free radicals reached 96.357 2%.Conclusions CHG has anti-fatigue effect,and its mechanism may be related to anti-oxidation effect.
目的 比较宫腔镜病灶切除术与超声监测下吸宫术治疗剖宫产瘢痕部位妊娠(CSP)的有效性。方法 回顾性分析2021年7月—2023年10月在南宁市妇幼保健院确诊为I、Ⅱ型CSP并接受治疗的129例患者,停经时间在38~83 d,中位停经时间48 d。其中42例患者接受了宫腔镜病灶切除术治疗(A组),87例患者接受超声监测下吸宫术治疗(B组),比较两组患者术后1、3、7、14 d的人绒毛膜促性腺激素水平以及手术出血量、手术时间、住院时间、住院花费。结果 两组患者在术后1 d,血清HCG水平下降,下降幅度均超过50%,且A组患者术后1 d血清HCG的下降幅度及下降速率大于B组患者(P<0.05);术后3、7、14 d,两组血清HCG水平仍持续下降。另外,A组患者手术出血量、手术时间、住院时间、住院花费分别为(15.35±14.53)mL、(60.73±53.05)min、(4.33±1.90)d、(6 689.23±2 216.19)元;B组患者手术出血量、手术时间、住院时间、住院费用分别为(26.09±29.24)mL、(51.59±54.46)min、(4.82±1.83)d、(6 270.34±2 547.85)元。A组患者术中出血量低于B组、住院时间短于B组(P<0.05),手术时间及住院费用与B组比较差异无统计学意义(P均>0.05)。结论 宫腔镜病灶切除术与超声监测下吸宫术均能有效治疗CSP,但宫腔镜病灶切除术在术后血清HCG的下降幅度及下降速率、术中出血量、住院时间等方面优于超声监测下吸宫术,而且手术时间和住院费用并没有显著增加。
Objective To compare the efficacy between hysteroscopic resection surgery and ultrasound-guided uterine aspiration in the treatment of cesarean scar pregnancy(CSP).Methods A retrospective analysis was performed in 129 patients diagnosed with CSP(type I or Ⅱ)and treated in Nanning Maternal and Child Health Hospital from July 2021 to October 2023.Their duration of amenorrhea was between 38~83 d,with a median of 48 days.Among them,42 patients were treated with hysteroscopic resection surgery therapy(group A),87 patients were treated with ultrasound-guided uterine aspiration therapy and(group B).Then,the levels of human chorionic gonadotropin(HCG),the amount of the intraoperative bleeding volume,surgical time,hospitalization time,and hospitalization expenses were compared between the two groups at one,three,seven and 14 days postoperativey.Results After one day of surgery,the serum HCG levels of two groups significantly decreased,with a decrease of more than 50%,and the magnitude and rate of decrease in serum HCG levels of group A were significantly larger than those of group B(P<0.05);After three,seven,and 14 day of surgery,serum HCG levels continued to decrease.Furthermore,the intraoperative bleeding volume,surgical time,hospitalization time,hospitalization expenses in group A were(15.35±14.53)mL,(60.73±53.05)min,(4.33±1.90)d,(6 689.23±2 216.19)yuan,respectively.That in group B were(26.09±29.24)mL,(51.59±54.46)min,(4.82±1.83)d,(6 270.34±2 547.85)yuan,respectively.Compared to group B,the intraoperative bleeding volume of group A was significantly lower(P<0.05),and the hospitalization time is shorter,while there was no significant difference in surgical time and hospitalization expenses.Conclusions Both of hysteroscopic resection surgery and ultrasound-guided uterine aspiration can treat cesarean scar pregnancy effectively,but the former is superior to the latter in terms of the magnitude and rate of decrease in serum HCG levels after surgery,intraoperative bleeding volume,and hospitalization time,with no significant increase in surgical time and hospitalization expenses.