综述

胃小间质瘤临床诊断与治疗研究进展

Progress in clinical diagnosis and treatment of gastric small stromal tumor

:114-118
 
现代人面临更大的工作与生活压力,每天的生活节奏较快,因此经常出现饮食不规律、饮食结构不合理等现象,这样就增加了肠胃疾病的发生率。胃肠道间质瘤(GIST)以人体胃肠道最为常见的肿瘤疾病,该病患者占全部胃肠道间叶性肿瘤患者人数的80%以上。GIST根据疾病进展、间质瘤体积等不同因素又能够分为不同的疾病类型,需采取对应的诊断措施与治疗措施。本文将针对胃小间质瘤的流行病学、临床症状、临床诊断以及治疗措施等进行研究与分析,以供参考。
Modern people are facing greater pressure in work and life,and the pace of daily life is fast.Therefore,irregular diet and unreasonable diet structure often occur,which increases the incidence of gastrointestinal diseases.Gastrointestinal stromal tumor(GIST)is the most common tumor disease in human gastrointestinal tract,accounting for over 80% of all patients with gastrointestinal mesenchymal tumors.GIST can be divided into different types according to different factors such as disease progression and stromal tumor volume,thus corresponding diagnostic and therapeutic measures should be taken.This paper studied and analyzed the epidemiology,clinical symptoms,clinical diagnosis and treatment of gastric small stromal tumors for reference.
论著

前瞻性护理在预防老年吸入性肺炎中的应用

Research on prospective nursing in the prevention of aspiration pneumonia in the elderly

:100-103
 
目的 探究前瞻性护理对老年吸入性肺炎的影响和作用。方法 选择2017年8月—2018年12月住院采取常规护理的94例老年患者作为对照组,选择2019年1月—2020年10月住院的114例老年患者作为观察组进行前瞻性护理,比较对照组和观察组吸入性肺炎的发病率。结果 观察组吸入性肺炎发病率低于对照组(P<0.05)。结论 前瞻性护理可及早筛选并识别老年患者发生吸入性肺炎的危险因素,依此采取相应的护理措施,降低吸入性肺炎的发病率。
Objective To explore the effect of prospective nursing on preventing aspiration pneumonia in elderly patients.Methods A total of 94 elderly patients who were hospitalized from August 2017 to December 2018 and received routine care were selected as the control group,and 114 elderly patients who were hospitalized from January 2019 to October 2020 were selected as the observation group for prospective care,and the incidence of aspiration pneumonia in the control group and the observation group were compared.Results The incidence of aspiration pneumonia in the observation group was lower than that in the control group(P<0.05).Conclusions Prospective nursing can identify risk factors of aspiration pneumonia in elderly patients,and take appropriate nursing measures to reduce the incidence of aspiration pneumonia.
论著

院前急救医疗服务的资源利用情况分析

Analysis of the resource utilization of pre-hospital emergency medical services

:92-99
 
目的 分析华北地区某医院院前急救医疗服务的资源利用状况,并依据相关影响因素针对院前急救医疗服务过程中存在问题提出相应对策。方法 收集2021年3月—2022年4月期间就诊于华北地区某医院急诊科患者的一般资料、就诊过程、症状特征。依据是否接受过院前急救服务、是否为疾病急性发作的危重症患者将患者分为4组,分析比较4组患者在一般资料、疾病病症特点两个方面是否存在统计学差异,探索影响院前急救医疗资源合理利用的相关因素。结果 本研究总计收纳患者病例5 800例,其中接受院前急救医疗服务的患者共840例占总调查人数的14.5%,其中危重症患者530例(63.1%),非危重症患者310例(36.9%);未接受院前急救医疗服务的患者为4 960例占总调查人数的85.5%,其中危重症患者803例(16.2%)。对所得数据采用多因素回归方法分析得知,在急诊科接受的危重症患者中急性胸痛与突发性头痛是选择不使用院前急救医疗措施的独立影响因素。在非危重症患者中发热、外伤、腹痛是非急重症患者接受院前急救医疗服务的独立影响因素。结论 院前急救医疗服务资源的提供与利用在实际应用的过程中存在资源闲置与服务空缺的问题。危重症患者在入院前仍有较大比例的患者没有选择接受院前急救医疗服务。该情况表明当前居民对危重症患者危重症状及院前急救医疗服务了解与认知不足,对此有必要加强对居民关于院前急救服务的科普宣教工作,并借助现有医疗服务力量支持院前急救医疗服务的规范与准则,这对保障患者生命安全,争取危重症患者存活机会,促进急救资源合理利用具有重要意义。
Objective To analyze the resource utilization status of pre-hospital emergency medical services in a hospital in North China,and to propose corresponding countermeasures for problems in the process of pre-hospital emergency medical services according to relevant influencing factors.Methods From March 2021 to April 2022,the general data,treatment process and symptom characteristics of patients who were treated in the emergency department of a hospital in North China were collected.According to whether they had received pre-hospital emergency services and whether they were critically ill patients with acute onset of disease,the patients were divided into four groups.Whether there were statistical differences in the general data and disease characteristics of the four groups of patients,and the relevant factors affecting the rational utilization of pre-hospital emergency medical resources were explored.Results This study included 5 800 patients,of which 840 patients receiving pre-hospital emergency medical services,accounted for 14.5% of the total survey,including 530(63.1%)and 310 non-critically ill patients(36.9%);4 960 patients not receiving pre-hospital emergency medical services accounted for 85.5% of the total survey,including 803(16.2%)of critically ill patients.Analysis by multivariate regression methods on the obtained data showed that acute chest pain and sudden headache in critically ill patients in the emergency department were independent influencing factors in choosing not to use pre-hospital emergency medical measures.Fever,trauma,and abdominal pain in non-critically ill patients were independent factors influencing the reception of pre-hospital emergency medical services.Conclusions The provision and utilization of pre-hospital emergency medical service resources have the problem of idle resources and service vacancies in the process of practical application.A significant proportion of critically ill patients still do not choose to receive pre-hospital emergency medical services before admission.This situation shows that the current residents have insufficient understanding and cognition of critical symptoms and pre-hospital emergency medical services,and it is necessary to strengthen the scientific popularization and education of residents on pre-hospital emergency services,and support the norms and guidelines of pre-hospital emergency medical services with the help of existed medical services,which is of great significance for ensuring the safety of patients' lives,striving for the survival opportunities of critically ill patients,and promoting the rational use of emergency resources.
论著

麦默通微创旋切术加置引流对乳腺良性肿物患者术后康复进程及并发症发生率的影响

Effect of minimally invasive excision by Mammotome with drainage on the postoperative recovery process and complication rate of patients with benign breast masses

:87-91
 
目的 探究麦默通(Mammotome)微创旋切术加置引流对乳腺良性肿物患者术后疼痛、炎性应激指标及并发症的影响。方法 选取本院2020年1月—2022年1月收治的100例乳腺良性肿物患者,简单随机法进行分组,每位患者赋予1位随机数,1~51号为实验组,采用Mammotome微创旋切术加置引流,52~100号为对照组,实施Mammotome微创旋切术。对比2组治疗效果、围术期指标、术前及术后1 d、3 d疼痛程度(NRS评分)、术前及术后3 d炎性应激指标及并发症情况。结果 2组病灶清除率(100.00%、97.96%)、并发症发生率(3.92%、16.32%)间无差异(P>0.05);相较于对照组,实验组手术时间较长,残腔积液较少,住院时间较短(P<0.05);术后1 d、3 d实验组NRS评分低于对照组(P<0.05);术后3 d 2组C反应蛋白、白介素-6、白介素-1β、降钙素原水平较术前上升,且实验组上升幅度小于对照组(P<0.05)。结论 Mammotome微创旋切术加置引流治疗乳腺良性肿物能减少残腔积液,降低炎症反应程度,有助于术后切口愈合,缓解术后疼痛,且不增加并发症风险。
Objective To investigate the effect of Mammotome minimally invasive excision with drainage on postoperative pain,inflammatory stress indexes and complications in patients with benign breast tumors.Methods A total of 100 patients with benign breast tumors admitted to our hospital from January 2020 to January 2022 were selected and grouped by simple random method,each patient was assigned a random number.Patients No.1 to No.51 were included in the experimental group,treated with Mammotome minimally invasive excision with drainage.Patients No.52 to No.100 were included in the control group,treated with Mammotome minimally invasive excision.The treatment effect,perioperative indicators,pain level(NRS score)and inflammatory stress indexes before and 1st and 3rd days after operation and complications were compared between the two groups.Results There were no significant differences in the lesion clearance rate(100.00% vs 97.96%)and the complication rate(3.92% vs 16.32%)between the two groups(P>0.05).Compared with the control group,the experimental group had longer operation time,less residual cavity liquid and shorter hospital stay(P<0.05).The NRS score of the experimental group was lower than that of the control group at 1st and 3rd days after operation(P<0.05).On the third day after operation,the levels of C-reactive protein,interleukin- 6,interleukin-1β and procalcitonin in the two groups were increased compared with those before operation,and the increase in the experimental group was smaller than that in the observation group(P<0.05).Conclusions Mammotome minimally invasive excision with drainage in the treatment of benign breast tumors can reduce residual cavity fluid accumulation,reduce the degree of inflammatory response,help postoperative incision healing,relieve postoperative pain,and without increasing the risk of complications.
论著

TIMELESS、RAB2A、ASPM在乳腺癌组织中的表达及与临床特征相关性

Expression of TIMELESS,RAB2A and ASPM in breast cancer and their correlation with clinical features

:80-86
 
目的 分析TIMELESS、鼠肉瘤病毒家族相关蛋白2A(RAB2A)、异常纺锤体样小头畸形相关基因(ASPM)在乳腺癌组织中的表达及与临床特征相关性。方法 选取2019年2月—2021年2月我院乳腺癌组织标本84例作为研究组、正常乳腺组织标本53例作为对照组,采用荧光定量聚合酶测定TIMELESS、ASPM,采用Western blot检测RAB2A蛋白表达情况,分析上述三个指标在乳腺癌中表达及与临床特征相关性。结果 对比对照组,研究组TIMELESS、ASPM表达较高,RAB2A较低(P<0.05)。TIMELESS、RAB2A、ASPM与乳腺癌淋巴结浸润、TNM分期、分化程度相关(P<0.05)。TIMELESS、RAB2A、ASPM为影响乳腺癌发生的危险因素(P<0.05)。TIMELESS、RAB2A负相关(r=-0.383、P=0.001);TIMELESS、ASPM正相关(r=0.397、P=0.001);RAB2A、ASPM负相关(r=-0.257、P=0.018)。对比TIMELESS、RAB2A、ASPM单一检测,三者联合检测对乳腺癌的诊断价值较高(P<0.05)。结论 乳腺癌患者TIMELESS、ASPM呈高表达,RAB2A呈低表达,上述三个指标与乳腺癌高度相关,可作为乳腺癌发生的检测指标。
Objective To analyze the expression of TIMELESS,murine sarcoma virus family related protein 2A(RAB2A)and abnormal spindle like microcephaly related gene(ASPM)in breast cancer tissues and their correlation with clinical features.Methods A total of 84 breast cancer tissue samples from our hospital from February 2019 to February 2021 were selected as the study group and 53 normal breast tissue samples were selected as the control group.Time,ASPM and RAB2A protein expression were determined by fluorescent quantitative polymerase,and RAB2A protein expression was detected by Western blot.The expression of the above three indicators in breast cancer and their correlation with clinical characteristics were analyzed.Results Compared with the control group,the study group had higher TIMELESS and ASPM expression levels and lower RAB2A level(P<0.05).TIMELESS,RAB2A and ASPM expressions were correlated with lymph node infiltration,TNM stage and differentiation of breast cancer(P<0.05).TIMELESS,RAB2A and ASPM were the risk factors of breast cancer(P<0.05).TIMELESS and RAB2A were negatively correlated(r=-0.383,P=0.001);TIMELESS and ASPM were positive correlated(r=0.397、P=0.001);RAB2A and ASPM were negatively correlated(r=-0.257,P=0.018).Compared with the single detection of TIMELESS,RAB2A and ASPM,the combined detection had higher diagnostic value for breast cancer(P<0.05).Conclusions Patients with breast cancer had high expression of TIMELESS and ASPM,and low expression of RAB2A.The above three indicators were highly correlated with breast cancer and can be detection indicators for breast cancer.
论著

消肿化瘀膏治疗骨性关节炎的临床疗效

Clinical effect of Xiaozhonghuayu ointment in the treatment of osteoarthritis

:75-79
 
目的 探讨消肿化瘀膏治疗骨性关节炎的临床疗效。方法 选择2017年5月—2022年1月在本院诊治的骨性关节炎患者124例作为研究对象,根据简单分配原则把患者分为消肿化瘀膏组与传统药物组各62例。传统药物组给予传统药物治疗,消肿化瘀膏组给予消肿化瘀膏治疗,判定2组患者治疗总显效率、疼痛评分、关节评分、血清中炎症因子水平变化。结果 消肿化瘀膏组治疗后的总显效率为98.4%,高于传统药物组的83.9%(P<0.05)。治疗后,2组的疼痛评分都低于治疗前(P<0.05),且消肿化瘀膏组低于传统药物组(P<0.05)。2组治疗后的关节评分都高于治疗前(P<0.05),且消肿化瘀膏组与传统药物组相比升高(P<0.05)。2组治疗后的血清白介素-1β、白介素-6水平都低于治疗前(P<0.05),且消肿化瘀膏组较传统药物组降低更多(P<0.05)。结论 消肿化瘀膏治疗骨性关节炎能有效抑制血清炎症因子的表达,缓解疼痛,改善关节功能,提高患者的总体治疗效果。
Objective To explore the clinical efficacy of Xiaozhonghuayu ointment in the treatment of osteoarthritis.Methods From May 2017 to January 2022,124 patients with osteoarthritis who diagnosed and treated in our hospital were selected as the research subjects.According to the simple allocation principle,the patients were divided into the Xiaozhonghuayu ointment group and the traditional medicine group with 62 cases each.The traditional medicine group was treated with traditional medicine,and the Xiaozhonghuayu ointment group was treated with Xiaozhonghuayu ointment.The total therapeutic efficiency,pain score,joint score,and the changes of serum inflammatory factors were compared in the two groups.Results The total efficiency of Xiaozhonghuayu ointment group after treatment were 98.4%,which were higher than 83.9% in the traditional medicine group(P<0.05).The pain scores in both groups after treatment were lower than those before treatment(P<0.05),and that in the Xiaozhonghuayu ointment group were lower than the traditional medicine group(P<0.05).The joint scores of the two groups after treatment were higher than those before treatment(P<0.05),and that in the Xiaozhonghuayu ointment group were higher than the traditional medicine group(P<0.05).After treatment,the levels of serum interleukin-1β and interleukin-6 in the two groups were significantly lower than those before treatment(P<0.05),compared with the traditional medicine group,those levels in the Xiaozhonghuayu ointment group also decreased significantly after treatment(P<0.05).Conclusions Xiaozhonghuayu ointment in the treatment of osteoarthritis can effectively inhibit the expressions of serum inflammatory factors,promote pain relief,improve joint function,and improve the overall therapeutic effect of patients.
论著

进食时机对尿毒症血液透析患者影响的研究

Influence study of eating timing on uremic hemodialysis patients

:65-69
 
目的 探讨进食时机对尿毒症血液透析患者的影响,为临床上此类研究提供参考依据。方法 选取2018年5月—2020年5月于我院进行血液透析的患者42例,根据自身随机对照法分为A组(n=21)和B组(n=21)。A组患者前六次在血液透析1.5 h时进食,后六次在血液透析2.5 h时进食;B组患者前六次在血液透析2.5 h时进食,后六次在血液透析1.5 h时进食。观察比较1.5 h和2.5 h进食的患者在血液透析前以及血液透析中不同时间点的血压和血糖。结果 2组患者在不同时间点的血压值和低血压发生率比较差异无统计学意义(P>0.05);血液透析1.5 h进食患者在透析2 h和3 h时血糖值明显高于2.5 h进食患者,比较差异具有统计学意义(P<0.05);血液透析1.5 h进食的患者在透析2 h时低血糖的发生率显著低于2.5 h进食患者,差异具有统计学意义(P<0.05)。结论 对尿毒症血液透析患者来说,于血液透析1.5 h进食能够有效降低患者低血压和低血糖的发生几率。
Objective To discuss the influence of eating timing on uremic hemodialysis patients,and to provide a reference for this kind of clinical research.Methods A total of 42 patients undergoing hemodialysis were selected in our hospital from May 2018 to May 2020 and were divided into group A(n=21)and group B(n=21)according to self randomized control method.Patients in group A ate at 1.5 hour of hemodialysis for the first six times,and at 2.5 hour of hemodialysis for the last six times;patients in group B ate at 2.5 hour of hemodialysis for the first six times,and at 1.5 hour of hemodialysis for the last six times.Observed and compared the blood pressure and blood sugar of patients who eat at 1.5 hour and 2.5 hour before hemodialysis and at different time points during hemodialysis.Results There were no significant differences in blood pressure and the incidence of hypotension between the two groups of patients at different time points(P>0.05);the blood glucose levels at 2 and 3 hour of the patients who ate at 1.5 hour of hemodialysis was significantly higher than that of the patients who ate at 2.5 hour,and the difference was statistically significant(P<0.05);the incidence of hypoglycemia at 2 hour of hemodialysis in patients who ate at 1.5 hour was significantly lower than that of patients who ate at 2.5 hour,and the difference was statistically significant(P<0.05).Conclusions For uremic hemodialysis patients,eating at 1.5 hour of hemodialysis could effectively reduce the incidence of hypotension and hypoglycemia.
论著

桥小脑角肿瘤微创切除术中应用神经内镜对其功能恢复及预后的影响

The effect of neuroendoscopy on functional recovery and prognosis of cerebellopontine angle tumors during minimally invasive surgery

:61-64
 
目的 探讨桥小脑角肿瘤微创切除术中应用神经内镜对其功能恢复及预后的影响,以便临床寻找出更有效的治疗方案,进而改善患者预后。方法 本次研究对象为赣州市人民医院2017年6月—2022年1月收治的82例桥小脑角肿瘤患者,用随机数字表法将其分为对照组(41例)和实验组(41例)。对照组患者给予常规显微手术治疗,实验组患者给予神经内镜辅助常规显微手术治疗,2组患者均于术后观察8周。比较2组患者肿瘤全切率,手术时间、住院时间及住院费用,术前及术后2、4、8周格拉斯哥预后量表(GOS)评分,以及术后8周内并发症发生情况。结果 肿瘤全切率:实验组患者术后8周(90.24%)与对照组(73.17%)相比,处于更高水平;手术时间、住院时间:实验组患者与对照组相比,处于更短水平;GOS评分:术前至术后2周,2组患者评分均呈下降趋势,术后2周至8周,2组患者评分呈升高趋势,其中实验组术后2、4、8周与对照组相比,处于更高水平,差异有统计学意义(P<0.05);并发症总发生率:术后8周内,实验组患者(4.88%)与对照组(17.07%)相比,差异无统计学意义(P>0.05)。结论 桥小脑角肿瘤微创切除术中应用神经内镜,可有效缓解患者的临床症状,优化手术相关指标,减轻神经功能受损,提高肿瘤全切率,改善预后,且安全性高。
Objective To investigate the effect of neuroendoscope on functional recovery and prognosis of patients with cerebellopontine angle tumor after microinvasive resection,so as to find out more effective treatment and improve the prognosis of patients.Methods The subjects were 82 patients with cerebellopontine angle tumors admitted to Ganzhou People's Hospital from June 2017 to January 2022.They were divided into control group(n = 41)and experimental group(n = 41)by random number table method.Patients in the control group were treated with conventional microsurgery,while patients in the experimental group were treated with neuroendoscope assisted conventional microsurgery.All patients were observed for 8 weeks after operation.The total tumor resection rate,operation time,hospitalization time,hospitalization expense,Glasgow Outcome Scale(GOS)score before and 2,4,8 weeks after operation,and complications within 8 weeks after operation were compared between the two groups.Results Compared with the control group(73.17%),the patients in the experimental group had a higher resection removal rate of tumor after 8 weeks of operation(90.24%).Patients in the experimental group had a shorter operation time and hospital stay than those in the control group.From pre-operation to 2 weeks after operation,the GOS scores of patients in both groups showed a downward trend,and from 2 weeks to 8 weeks after operation,the scores of patients in both groups showed an upward trend,and the patients in the experimental group were at a higher level than those in the control group at 2,4,8 weeks after operation,the difference were statistically significant(P < 0.05).Within 8 weeks after surgery,there was no significant difference in total incidence of complications between the experimental group(4.88%)and the control group(17.07%,P > 0.05).Conclusions The application of neuroendoscope in the minimally invasive surgery of cerebellopontine angle tumor can effectively relieve the clinical symptoms of patients,optimize the operation-related indexes,reduce the damage of nerve function,increase the total resection rate of tumor,improve the prognosis,and with high safety.
论著

精神分裂症患者不同肾功能水平与血清酶水平的关系研究

Relationship between different levels of renal function and serum enzymes in patients with schizophrenia

:56-60
 
microglobulin')">β2 microglobulin,intercellular adhesion molecules,schizophrenia,acute kidney injury" split="">serum creatine kinase microglobulin')">β2 microglobulin,intercellular adhesion molecules,schizophrenia,acute kidney injury" split="">myoglobin microglobulin')">β2 microglobulin,intercellular adhesion molecules,schizophrenia,acute kidney injury" split="">2 microglobulin')
目的 分析精神分裂症患者体内的肌酸激酶(CK)、肌红蛋白(MYO)、β2微球蛋白(β2-MG)、细胞间黏附分子(ICAM)水平随患者精神状态及肾功能损害程度的变化,探讨其对患者早期急性肾损伤(AKI)可能的作用机制。方法 根据肾功能水平将 80例精神分裂症患者分为4组,并设立健康对照组(同期我院门诊健康体检者)20例。采用酶联免疫吸附法检测血清CK、MYO 、ICAM,采用放射免疫法检测β2-MG水平,分析其与患者精神状态变化及肾功能损害程度的关联。结果 精神分裂症患者中肾功能损害组的血清CK、MYO、ICAM、β2-MG值高于健康对照组及肾功能正常组,差异具有统计学意义(F=623.534,30.437,636.776,88.283,P<0.05),精神分裂症AKI 1期组到AKI 3期组CK、MYO、β2-MG、ICAM数值均比对照组升高(P<0.05),3组之间如上指标的比较差异有统计学意义(P<0.05)。结论 精神分裂症肾功能损害患者的血清CK、MYO、ICAM、β2-MG的异常升高能反映出患者的精神状态及肾功能损害程度,提示临床可通过检测如上血清指标来监测患者的精神状态及肾功能。
Objective To study the changes of serum creatine kinase(CK),myoglobin(MYO),β2 microglobulin(β2-MG),intercellular adhersion molecule(ICAM)with the mental state and the degree of renal function damage of patients,to explore the possible mechanism of their effects on early acute kidney injury(AKI)in patients with schizophrenia.Methods A total of 80 schizophrenic patients were divided into 4 groups according to their renal function level,and 20 healthy controls(who underwent physical examination during the same period)were included.At the same time,enzyme linked apta-sorbent assay was used to detect serum CK,MYO and ICAM levels in each group,and radioimmunoassay was used to detect serum β2-MG level in each group.The correlation between the above indexes and the changes of mental state and the degree of renal function damage was analyzed.Results The serum CK,MYO,ICAM and β2-MG values in schizophrenia renal impairment groups were higher than those in healthy control group,and the differences were statistically significant(F=623.534,30.437,636.776,88.283,P<0.05),and the comparison of the above indexes among the three groups was statistically significant(P<0.05).Conclusions The abnormal increase of serum CK,MYO,ICAM and β2-MG can reflect the patient's mental state and the degree of renal function damage,it suggesting that the clinical staff can monitor the patient's mental state and renal function through daily serum collection and analysis.
论著

艾司氯胺酮对剖宫产术后镇痛及RAAS系统、产后抑郁的影响

Effects of esketamine on postoperative analgesia and RAAS system and postpartum depression after cesarean delivery

:51-55
 
目的 分析艾司氯胺酮对剖宫产术后镇痛及肾素-血管紧张素-醛固酮系统(RAAS)、产后抑郁情况发生的影响。方法 研究对象为2020年5月—2021年6月在我院行剖宫产的96例孕产妇,根据麻醉药物的不同分为研究组50例和对照组46例,2组孕产妇均给予腰硬联合麻醉行剖宫产术,研究组于手术切皮前5 min静脉注射艾司氯胺酮0.2 mg/kg,对照组静脉注射等量生理盐水。比较2组孕产妇术后疼痛评分(VAS评分)、肾素活性(PRA)、血管紧张素-II(AT-II)、醛固酮(ALD)、爱丁堡产后抑郁量表(EPDS)、不良反应的发生情况。结果 与对照组比较,术后各时间点研究组孕产妇VAS评分均明显较低,差异具有统计学意义(P<0.01)。2组T1、T2、T3各时间点RAAS各指标均明显低于T0时间点(P<0.05);研究组在T1、T2时间点RAAS各指标均明显低于对照组,差异具有统计学意义(P<0.05)。研究组术后3 d、术后6周EPDS评分均明显低于对照组(P<0.01)。2组不良反应总发生率比较无差异(P>0.05)。结论 艾司氯胺酮用于剖宫产术后镇痛效果显著,对产妇RAAS影响较小,并可缓解产妇抑郁症状,且不良反应发生率较低。
Objective To analyze the effect of esketamine on analgesia and renin angiotensin aldosterone system(RAAS)and the occurrence of postpartum depression after cesarean delivery.Methods The subjects were 96 pregnant women who underwent cesarean section in our hospital from May 2020 to June 2021,they were divided into 50 cases in the study group and 46 cases in the control group.Both groups of pregnant women were given combined spinal epidural anesthesia for cesarean section.The patients in study group were injected with esmketamine 0.2 mg/kg intravenously 5 minutes before skin incision,and those in control group were injected with the same amount of saline intravenously.The postoperative pain scores(VAS score),plasma renin activity(PRA),angiotensin-II(AT-II),aldosterone(ALD),Edinburgh Postpartum Depression Scale(EPDS),and the occurrence of adverse effects were compared between the two groups.Results Compared with the control group,maternal VAS scores were significantly lower in the study group at all postoperative time points,and the differences were statistically significant(P<0.01).The indexes of RAAS were significantly lower in both groups at T1,T2 and T3 time points than at T0 time point(P<0.05);the indexes of RAAS were significantly lower in the study group at T1 and T2 time points than in the control group,and the differences were statistically significant(P<0.05).The postoperative EPDS scores in the study group were significantly lower than those in the control group at 3 d and 6 weeks(P<0.01).There was no difference in the overall incidence of adverse reactions between the two groups(P>0.05).Conclusions Esketamine is effective for postoperative analgesia after cesarean section,with less effect on maternal RAAS,and can relieve maternal depressive symptoms,and has a low incidence of adverse reactions.
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