目的 探讨外周血CD34阳性（CD34⁺）细胞计数对普乐沙福自体干细胞动员效果的预测价值。方法 回顾性分析2021年5月—2023年7月中山大学附属第七医院使用人粒细胞集落刺激因子（G-CSF）联合普乐沙福进行自体干细胞动员的13例患者临床资料,分析普乐沙福动员前后外周血CD34⁺细胞计数的变化及干细胞采集情况。结果 共有13例患者纳入研究,包括淋巴瘤10例和多发性骨髓瘤3例。多发性骨髓瘤患者中1例为新诊断,另2例为复发患者;淋巴瘤患者中3例为套细胞淋巴瘤,6例为弥漫大B细胞淋巴瘤（包括1例复发）,1例为B细胞淋巴瘤（不能明确类型）。本研究纳入的患者均使用G-CSF动员,在使用普乐沙福后CD34⁺细胞计数均升高,使用普乐沙福前中位CD34⁺细胞计数为13.3（2.5~76.1）/μL,使用普乐沙福后中位CD34⁺细胞计数为73.6（10.4~208.70）/μL,升高4.18（1.99~13.60）倍。13例患者中有2例患者在使用普乐沙福前外周血CD34⁺细胞计数<5 /μL,均动员失败。Spearman相关分析结果显示,使用普乐沙福后CD34⁺细胞计数与使用普乐沙福前CD34⁺细胞数呈正相关（r_s=0.769,P=0.003）。多元线性回归分析显示,使用普乐沙福后CD34⁺细胞计数能较好地预测采集结果（P=0.004）。结论 监测外周血CD34⁺细胞计数可预测普乐沙福自体干细胞动员效果,使用普乐沙福后CD34⁺细胞计数越多,CD34⁺细胞采集量越大。

Objective To explore the predictive value of peripheral blood CD34⁺ cell count for the stem cell mobilization effect of plerixafor．Methods The clinical data of 13 patients who used granulocyte colony-stimulating factor + plerixafor for stem cell mobilization in the Seventh Affiliated Hospital of Sun Yat-sen University from May 2021 to July 2023 were retrospectively analyzed．The changes of peripheral blood CD34⁺ cell count in all patients before and after the mobilization of plerixafor were analyzed．Results In 13 enrolled patients,there were 10 lymphoma patients and 3 multiple myeloma（MM）patients．One patient was newly diagnosed with MM,and the other two were recurrent patients．The lymphoma cases included 3 mantle cell lymphoma,6 diffuse large B cell lymphoma and 1 B cell non-Hodgkin's lymphoma（type cannot be specified）．The CD34⁺ cell counts were increased in all patients when mobilized with granulocyte colony-stimulating factor before plerixafor．The CD34⁺ cell count was 13.3（2.5~76.1）/μL and 73.6（10.4~208.70）/μL before and after the use of plerixafor,between which the difference was statistically significant（Z=0.578,P<0.05）,and the median increased of 4.18（1.99~13.6）times．There were 2 patients failed in mobilizing whose CD34⁺ cell count was less than 5 /μL before using plerixafor．Spearman analysis showed that there was a positive correlation in peripheral blood CD34⁺ cell count before and after the use of plerixafor（r_s=0.80,P=0.032）．The CD34⁺ cell count after using plerixafor was a good predictor of the collection results（P=0.002）．Conclusions Monitoring the CD34⁺ cell count in peripheral blood has a certain predictive value for the stem cell mobilization effect of plerixafor．The higher of CD34⁺ cell count after the use of plerixafor,the higher of CD34⁺ collection．

目的 观察程序性死亡受体1（PD-1）联合细胞毒性T淋巴细胞相关蛋白4（CTLA-4）双免疫疗法对改善晚期乳腺癌近期疗效及远期预后的影响。方法 选择2020年5月—2022年5月商丘市第一人民医院收治的124例晚期乳腺癌患者为研究对象,经随机数字表法将其分为对照组（60例）和观察组（64例）,对照组予以常规PD-1单抗免疫疗法治疗,观察组采用PD-1联合CTLA-4双免疫疗法治疗,比较2组患者治疗前后肿瘤标志物水平、治疗后病灶缓解情况,对所有患者开展为期1年随访,统计并对比2组的不良反应发生情况及远期生存情况。结果 治疗前,2组患者的肿瘤标志物水平比较差异均无统计学意义（均P>0.05）;治疗后,观察组的癌胚抗原为（3.36±0.17）ng/mL,糖类抗原15-3为（25.33±5.28）U/mL,糖类抗原19-9为（38.77±5.62）U/mL,均低于对照组[（5.27±1.36）ng/mL、（28.44±5.18）U/mL、（41.25±5.46）U/mL,均P<0.05]。治疗后,观察组的完全缓解率为21.88%（14/64）,部分缓解率为31.25%（20/64）,病情稳定率为37.50%（24/64）,均高于对照组[8.33%（5/60）、13.33%（8/60）、23.33%（14/60）],肿瘤生长率为（30.27±5.18）%,肿瘤超进展率为6.25%（4/64）,均低于对照组[（33.49±5.32）%、18.33%（11/60）,均P<0.05]。治疗后,观察组的不良反应发生率为34.38%（22/64）,略高于对照组33.33%（20/60）,组间比较差异无统计学意义（P>0.05）;观察组的中位无进展生存期为（9.33±2.25）月,中位总生存期为（10.76±3.32）月,均高于对照组[（7.25±2.31）月、（7.41±1.62）月,均P<0.05]。结论 PD-1联合CTLA-4双免疫疗法能有效改善晚期乳腺癌的近期疗效及远期预后,此疗法未明显增加不良反应发生风险,安全性高。

Objective To observe the effect of programmed cell death protein-1（PD-1）combined with cytotoxic T lymphocyte-associated antigen-4（CTLA-4）dual immunotherapy on the short-term efficacy and long-term prognosis of advanced breast cancer．Methods A total of 124 patients with advanced breast cancer who were admitted to the First People's Hospital of Shangqiu City from May 2020 to May 2022 were selected as the research objects．They were randomly divided into the control group（60 cases）and the observation group（64 cases）by the method of random number table．The control group was treated with conventional PD-1 monoclonal antibody immunotherapy,and the observation group was treated with PD-1 combined with CTLA-4 double immunotherapy．The levels of tumor markers before and after treatment and the focal remission after treatment were compared between the two groups．All patients were followed up for one year,the incidence of adverse reactions and long-term survival between the two groups were compared．Results Before treatment,there was no statistically significant difference in the levels of tumor markers between two groups（all P>0.05）．After treatment,the carcino-embryonic antigen content of the observation group was（3.36±0.17）ng/mL,CA153 was（25.33±5.28）U/mL,and CA199 was（38.77±5.62）U/mL,which were lower than those of the control group [（5.27±1.36）ng/mL,（28.44±5.18）U/mL,（41.25±5.46）U/mL,all P<0.05]．After treatment,the complete remission rate of the observation group was 21.88%（14/64）,partial remission rate was 31.25%（20/64）,and stable disease rate was 37.50%（24/64）,all higher than those of the control group [8.33%（5/60）,13.33%（8/60）,23.33%（14/60）];tumor growth rate of the observation group was（30.27±5.18）%,hyper progressive disease rate was 6.25%（4/64）,both lower than those of the control group [（33.49±5.32）%,18.33%（11/60）,both P<0.05]．After treatment,the incidence of adverse reactions in the observation group was 34.38%（22/64）,slightly higher than that in the control group 33.33%（20/60）（P>0.05）．The median progression free survival of the observation group was（9.33±2.25）months,and the median overall survival was（10.76±3.32）months,both higher than those of the control group [（7.25±2.31）months and（7.41±1.62）months]（P<0.05）．Conclusions PD-1 combined with CTLA-4 dual immunotherapy can effectively improve the short-term efficacy and long-term prognosis of advanced breast cancer．This therapy does not significantly increase the risk of side effects,which is safe．

目的 对比颈动脉内膜剥脱术（CEA）不同时间预处理对患者术后应激反应及神经功能的影响。方法 回顾性收集2019年12月—2022年12月在我院择期行CEA术治疗的74例颈动脉狭窄（CS）患者临床资料,按远隔缺血预处理（RIPC）时间不同分成2组,其中A组37例（术前1 h进行预处理）、B组37例（术前24 h进行预处理）。对比2组术前1 d、麻醉诱导后、切皮时交感神经反应指标[收缩压（SBP）、心率（HR）、舒张压（DBP）]变化及手术前后简易精神状态评价量表（MMSE）评分、应激指标[去甲肾上腺素（NE）、白细胞介素-6（IL-6）、皮质醇（Cor）]、神经功能指标[脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S-100β）]水平。结果 与A组相比,麻醉诱导后B组SBP、HR、DBP水平更高,切皮时SBP、HR、DBP水平更低（P<0.05）;与A组相比,B组术后7 d、30 d MMSE评分更高（P<0.05）;术后12 h、24 h 2组血清NE、Cor、IL-6水平均较术前1 d升高（P<0.05）,但2组比较差异无统计学意义（P>0.05）;与A组相比,B组术后12 h、24 h血清S-100β、NSE水平更低,血清BDNF水平更高（P<0.05）。结论 CEA术前实施RIPC可减轻脑损伤,发挥脑保护作用,但与术前1 h实施RIPC相比,于术前24 h实施RIPC更有助于维持机体血流动力学稳定,促进认知功能及预后恢复。

Objective To compare the effects of different time preconditioning of carotid endarterectomy（CEA）on postoperative stress response and neurological function．Methods From December 2019 to December 2022,74 patients with carotid stenosis（CS）who were selected for CEA treatment in our hospital were retrospectively collected and divided into two groups according to the time of remote ischemic preconditioning（RIPC）,including 37 cases in group A（preconditioning at 1 hour before surgery）and 37 cases in group B（preconditioning at 24 hours before surgery）．The changes of sympathetic response indexes [systolic blood pressure（SBP）,heart rate（HR）,diastolic blood pressure（DBP）] in the 2 groups at 1 d before surgery,after the anesthesia induction,and at the time of skin incision before and after surgery,and the scores of the Mini-Mental State Examination（MMSE）,stress indexes [norepinephrine（NE）,interleukin-6（IL-6）,cortisol（Cor）],and neurological function indexes [brain-derived neurotrophic factor（BDNF）,neuron specific enolase（NSE）,central nervous specific protein（S-100β）]．Results Compared with group A,the levels of SBP,HR and DBP in group B after anesthesia induction were higher,and the levels of SBP,HR and DBP were lower during skin resection（P<0.05）．Compared with group A,group B had higher MMSE scores at 7 and 30 days after surgery（P<0.05）．The serum levels of NE,Cor and IL-6 in the 2 groups were increased 12 h and 24 h after surgery compared with 1 day before surgery（P<0.05）,but there was no significant difference between the 2 groups（P>0.05）．Compared with group A,serum S-100β and NSE levels in group B were lower at 12 h and 24 h after surgery,and serum BDNF level was higher in group B（P<0.05）．Conclusions The administration of RIPC before CEA can reduce brain injury and play a protective role in brain．However,compared with the administration of RIPC 1 h before surgery,the administration of RIPC 24 h before surgery is more conducive to maintaining hemodynamic stability,promoting cognitive function and prognostic recovery．

目的 探索整体针联合运动处方应用于伴骨质疏松症（OP）的膝骨关节炎（KOA）患者全膝关节置换术（TKA）术前预康复的可行性、有效性及其对Wnt/β-catenin通路的影响。方法 2021年5月—2022年4月在广州市第一人民医院南沙医院骨科住院治疗的伴OP的KOA患者随机入组,分3组：A组予常规术前宣教和准备;B组在A组基础上,术前应用标准化运动处方3周;C组在A组基础上,术前联合应用整体针和运动处方3周。比较术前3周、术前1天、术后8周视觉模拟疼痛评分（VAS）、关节活动度（ROM）、膝关节功能评分（HSS）的组间差异,并比较术中关节液β连环蛋白（β-catenin）、基质金属蛋白酶-13（MMP-13）、重组人Dickkopf相关蛋白-1（DKK-1）含量的组间差异。结果 共纳入50例受试者,A组15例,B组18例,C组17例。术前1天组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术后8周组间方差分析显示：B、C组VAS均低于A组（P<0.05）,C组VAS低于B组（P<0.05）;B、C组ROM均高于A组（P<0.05）,B、C组ROM比较差异无统计学意义（P>0.05）;B、C组HSS均高于A组（P<0.05）,C组HSS高于B组（P<0.05）。术中关节液标志物含量组间方差分析显示：B、C组β-catenin、MMP-13含量均低于A组（P<0.05）,C组β-catenin、MMP-13含量均低于B组（均P<0.05）;B、C组DKK-1含量均高于A组（均P<0.05）,C组DKK-1含量高于B组（P<0.05）。结论 整体针联合运动处方在OP患者TKA术前应用切实可行,可有效缓解疼痛、改善功能。整体针可增强运动处方的正向预康复作用,其作用机制可能与Wnt/β-catenin通路调节有关。

Objective To explore the feasibility,effectiveness and impact on the Wnt/β-catenin pathway of combined holistic acupuncture and exercise prescription for preoperative rehabilitation in knee osteoarthritis（KOA）patients with osteoporosis（OP）undergoing total knee arthroplasty（TKA）．Methods KOA patients with OP were divided into three groups randomly：Group A received conventional preoperative education and preparation,Group B received standardized exercise prescription for three weeks additionally,Group C received combined holistic acupuncture and exercise prescription for three weeks additionally．Between-group differences in visual analogue scale（VAS）pain scores,range of motion（ROM）and knee joint function scores（HSS）were compared at 3 weeks preoperatively,1 day preoperatively and 8 weeks postoperatively．Differences in intraoperative joint fluid levels of β-catenin,MMP-13 and DKK-1 were also compared．Results A total of 50 participants were included,with 15 in Group A,18 in Group B and 17 in Group C．Baseline conditions were comparable among the three groups．One-day preoperative analysis showed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM was higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Groups B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Eight-week postoperative analysis revealed that VAS scores were lower in both Groups B and C compared to Group A（P<0.05）,and VAS score was lower in Group C compared to Group B（P<0.05）．ROM were higher in Groups B and C compared to Group A（P<0.05）,with no statistically significant between-group difference between Group B and C．HSS scores were higher in Groups B and C compared to Group A（P<0.05）,and HSS score was higher in Group C compared to Group B（P<0.05）．Intraoperative joint fluid biomarker analysis showed that β-catenin and MMP-13 levels were lower in Groups B and C compared to Group A（P<0.05）,and β-catenin and MMP-13 levels were lower in Group C compared to Group B（P<0.05）．DKK-1 levels were higher in Groups B and C compared to Group A（P<0.05）,and DKK-1 level was higher in Group C compared to Group B（P<0.05）．Conclusions Combined holistic acupuncture and exercise prescription is feasible and effective for preoperative rehabilitation in TKA for KOA patients with OP．Holistic acupuncture enhances the positive pre-rehabilitation effect of exercise prescription,and its mechanism may be related to the regulation of the Wnt/β-catenin pathway．

目的 探讨孕期盆底肌锻炼联合产后盆底功能康复治疗对产后女性盆底功能障碍的防治效果。方法 选取2019年1月—2020年6月在我院产科门诊定期产检,B超确认为单胎足月顺产,剔除妊娠合并症及并发症,符合入组标准病例共316例,随机分成观察组和对照组,观察组131例,对照组185例,观察组在孕12周开始宣教孕期定期行盆底肌Kegel运动,并在产后42天开始行盆底康复治疗仪治疗6周,统计临床疗效,2组均在产后42天、3个月、6个月统计2组盆底功能检测、盆底器官脱垂(pelvic organ prolapse,POP)和压力性尿失禁(stress urinary incorrtinence,SUI)发生情况。结果 观察组和对照组一般资料,2组在年龄、分娩孕周、新生儿平均体重无统计学差异(P＞0.05),2组盆底功能进行检测比较,产后42天观察组阴道收缩持续时间、Ⅱ类肌纤维强度(85.24±22.19 cmH₂O)高于对照组(74.14±19.94 cmH₂O),差异具有统计学意义(P＜0.05),产后3月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(76.41±16.42 cmH₂O;4.35±1.78 s;94.15±18.25 cmH₂O)高于对照组(62.45±17.55 cmH₂O;3.89±1.52 s;88.55±18.36 cmH₂O),差异具有统计学意义(P＜0.05),产后6月观察组I类肌纤维强度、阴道收缩持续时间、Ⅱ类肌纤维强度(79.56±15.78 cmH₂O;5.46±2.01 s;99.78±23.47 cmH₂O)明显高于对照组(67.63±14.45 cmH₂O;4.13±1.45 s;90.16±18.75 cmH₂O),差异具有统计学意义(P＜0.05)。对比2组POP和SUI发生率情况,产后42天观察组SUI发生率(28.24%)低于对照组(35.14%),差异具有统计学意义(P＜0.05);产后3月观察组POP和SUI发生率(18.32%;13.74%)低于对照组(22.70%;17.83%),差异具有统计学意义(P＜0.05),产后6月观察组POP和SUI发生率(0.00%;0.07%)明显低于对照组(8.10%;11.89%),差异具有统计学意义(P＜0.05)。 结论 孕期行盆底肌锻炼联合产后盆底功能康复治疗能明显改善产后盆底功能状态,显著降低产后盆底功能障碍性疾病的发生率。

Objective To explore the prevention and treatment effect of pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy on postpartum pelvic floor dysfunction in women. Methods From January 2019 to June 2020, women in our hospital's obstetrics outpatient department for regular obstetric checkups were selected, which ultrasound confirmed it was a singleton full-term delivery. The cases of stillbirth, fetal malformation and placenta previa were excluded. A total of 316 cases met the inclusion criteria and were randomly divided into the observation group and the control group, with 131 cases in the observation group and 185 cases in the control group. Observation group started regular pelvic floor muscle Kegel exercises from 12 weeks of gestation,and accepted pelvic floor rehabilitation therapeutic treatment from 42 days to six weeks postpartum. We summerized the pelvic floor function tests results, pelvic organ prolapse (POP) and stress urinary incontinence (SUI) situation of both groups in 42 days, 3 months and 6 months postpartum. Results The general information of the observation group and the control group showed that there were no statistical differences in age, gestational age of delivery and average weight of newborn (P>0.05). The pelvic floor function 42 days after delivery of the two groups was tested and compared, duration of vaginal contraction and class Ⅱ muscle fiber strength of the observation group [(85.24±22.19) cmH₂O] was significantly higher than that of the control group [(74.14±19.94) cmH₂O], and the difference was statistically significant (P＜0.05). Class I muscle fiber strength, duration of vaginal contraction and class Ⅱ muscle fiber strength were observed at 3 months postpartum, those of observation group[(76.41±16.42) cmH₂O; (4.35±1.78) s; (94.15±18.25) cmH₂O] were significantly higher than that in the control group [(62.45± 17.55) cmH₂O; (3.89±1.52) s; (88.55±18.36) cmH₂O], and the difference were statistically significant (P<0.05). At 6 months postpartum, class I muscle fiber strength, vaginal contraction duration and class Ⅱ muscle fiber strength in observation group [(79.56±15.78) cmH₂O; (5.46±2.01) s; (99.78±23.47) cmH₂O] were significantly higher than that of the control group [(67.63±14.45) cmH₂O; (4.13± 1.45) s; (90.16±18.75) cmH₂O], and the difference were statistically significant (P<0.05). Comparison of the incidence of POP and SUI between the two groups showed that the incidence of SUI in the observation group at 42 days postpartum (28.24%) was significantly lower than that in the control group (35.14%), the difference was statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 3 months postpartum (18.32%; 13.74%) were significantly lower than that of the control group (22.70%; 17.83%), the difference were statistically significant (P＜0.05). The incidences of POP and SUI in the observation group at 6 months postpartum (0.00%; 0.07%) were significantly lower than that of the control group (8.10%; 11.89%), the difference were statistically significant (P＜0.05). Conclusion Pelvic floor muscle exercise during pregnancy combined with postpartum pelvic floor function rehabilitation therapy can significantly improve postpartum pelvic floor function and significantly reduce the incidence of postpartum pelvic floor dysfunction diseases.

目的 探讨透明帽辅助下套扎切除小胃肠道间质瘤(gastrointestinal stromal tumor,GIST)的临床应用价值。方法 回顾性分析2017年2月—2020年2月在我院行透明帽辅助下小GIST套扎切除术151例患者的临床资料,分析其完整切除率、复发率、并发症发生率、手术时间、住院天数等指标。结果 151例小GIST患者中,瘤体位于胃底91例,胃体53例,胃窦7例,均采用透明帽辅助下完整切除病变。150例病变部位切除后肉眼及病理所见包膜完整无残留,1例分2次套扎后才完全切除肉眼无残留。术中活动性出血3例,无术后迟发性出血,术中主动穿孔105例,穿孔直径最大约1 cm。发生气胸及纵隔气肿3例,局限性腹膜炎3例,发热4例。所有病例经内镜下止血、修补及对症处理后均好转,无1例术中及术后转外科治疗;平均手术时间(28.3±7.6)min,平均住院时间为(4.3 ±1.9)天。病理结果显示极低危险度胃肠道间质瘤132例,低危险度胃肠道间质瘤19例。术后随访复查胃镜均无复发征象。结论 透明帽辅助下套扎切除术胃小GIST操作简单,安全、有效,具有临床推广的价值。

Objective To explore the clinical value of resection of small gastrointestinal stromal tumor(GIST) with transparent cap assisted band ligation. Methods The clinical data of 151 patients who underwent ligation of small GIST assisted with transparent cap in our hospital from February 2017 to February 2020 were retrospectively analyzed, and the complete resection rate, recurrence rate, and complication rate, operation time, hospitalization days and other indicators were analyzed. Results Among the 151 patients with small GIST, 91 cases were located in the fundus of the stomach, 53 cases were in the stomach body, and 7 cases were in the antrum of the stomach. All the lesions were completely resected with the aid of transparent cap. Among lesions of 150 cases, the envelopes were intact and no residue was seen by naked eyes and pathology examination, and 1 case was completely resected after 2 ligations. There were 3 cases of active bleeding, no delayed bleeding, and 105 cases of iatrogenic perforation during the operation. The maximum diameter of the perforation was about 1 cm. There were 3 cases of pneumothorax and mediastinal emphysema, 3 cases of localized peritonitis, and 4 cases of fever. After hemostasis, repair and symptomatic treatment under endoscopy, no case was transferred to surgical departmat during or after operation; the average operation time was (28.3±7.6) minutes, and the average hospital stay was (4.3±1.9) days. Pathological results showed there were 132 cases of very low-risk gastrointestinal stromal tumors and 19 cases of low-risk gastrointestinal stromal tumors. There was no sign of recurrence in the gastroscope during the follow-up. Conclusion The transparent cap assisted ligation resection of small GIST was simple, safe and effective, and had the value of clinical promotion.

目的 探讨富血小板血浆(platelet-rich plasma, PRP)联合髓芯减压治疗早期膝关节自发性骨坏死(spontaneous osteonecrosis of the knee, SONK)的临床疗效。方法 回顾性分析我院2015年6月—2020年6月收治Koshino分期为Ⅰ、Ⅱ期的SONK患者,按治疗方法不同分为单纯髓芯减压组(对照组 21例)和PRP注射+髓芯减压组(PRP组 22例),比较2组患者治疗前、后1月、3月、6月、12月的VAS评分、WOMAC评分,评估术前和随访时膝关节功能,并观察记录有无并发症。结果 43例患者术后随访12～62个月,2组患者治疗后均无切口感染、关节感染、深静脉血栓等并发症。2组患者术前VAS评分、WOMAC评分比较无统计学意义(P>0.05);VAS评分、WOMAC评分在术后1、3、6 、12月较术前比较差异均有统计学意义(P<0.05);与对照组相比,PRP组术后3、6、12月的VAS评分降低(P＜0.05),PRP组在术后6、12月的WOMAC评分改善(P＜0.05)。PRP组、对照组的总体有效率分别为90.48%(19/21)、77.27%(17/22),差异有统计学意义(P＜0.05)。在完成治疗12个月后至今的随访中,对照组共有6例患者、PRP组仅2例患者行单髁置换。结论 富血小板血浆联合髓芯减压治疗早期SONK,安全有效,临床疗效优于单纯髓芯减压术。

Objective To investigate the clinical effect of platelet-rich plasma(PRP) combined with core decompression in the treatment of early spontaneous osteonecrosis of the knee(SONK). Methods A retrospective analysis of SONK patients with Koshino stage I and Ⅱ admitted to our hospital from June 2015 to June 2020 was carried out. According to the different treatment methods, patients were divided into core decompression group (control group, 21 patients), and knee joint cavity PRP injection combined with core decompression group (PRP group, 22 patients). The VAS scores and WOMAC scores before treatment, 1, 3, 6 and 12 months after surgery were compared between the two groups to assess the knee joint function, and observed whether there were complications. Results Forty-three patients were followed up for 12 to 62 months after the operation. After treatment, the two groups had no complications such as wound infection, joint infection, or deep vein thrombosis. The preoperative VAS score and WOMAC score of the two groups were not significantly different (P>0.05);compared with those before the operation, VAS score and WOMAC score were significantly different at 1, 3, 6, and 12 months after the operation (P<0.05); compared with the control group, the VAS score of the PRP group was significantly reduced at 3, 6, and 12 months after surgery (P<0.05), and the WOMAC score of the PRP group was significantly improved at 6 and 12 months after surgery (P<0.05). The overall effective rates of the PRP group and the control group were 90.48% (19/21) and 77.27% (17/22) respectively, and the difference between the two groups was statistically significant (P<0.05). In the follow-up 12 months after the completion of the treatment, 6 patients in the control group and 2 patients in the PRP group underwent unicondylar replacement. Conclusion The combination of platelet-rich plasma and core decompression in the treatment of early SONK was safe and effective, and the clinical effect was better than that of core decompression only.

目的 探讨剖宫产围术期患者采用布托啡诺治疗寒战的最佳剂量。方法 选取2019年10月—2020年11月期间于本院分娩的150例剖宫产妇女作为研究对象,按照随机数字表法分为A组、B组、C组,各组50例。A组给予0.01 mg/kg布托啡诺静脉注射,B组给予0.02 mg/kg,C组给予0.03 mg/kg。比较3组临床疗效、血流动力学、镇静(Ramesay)评分、不良反应、新生儿Apgar评分。结果 3组治疗有效率、 血流动力学、T₁、T₂时间段Ramesay评分及1 min、5 min、10 min 新生儿Apgar评分比较,差异无统计学意义(P＞0.05);C组不良反应发生率高于B组与A组(P＜0.05);T₃时间段Ramesay评分C组＜B组＜A组(P＜0.05)。结论 0.02 mg/kg剂量布托啡诺治疗剖宫产围术期寒战效果最为理想,产妇围术期血流动力学稳定,不良反应较轻,且对新生儿无明显影响。

Objective To investigate the optimal dose of butorphanol in the treatment of shivering in patients underwent cesarean section. Methods A total of 150 women with cesarean section in our hospital from October 2019 to November 2020 were selected as the research objects, and were divided into group A, group B and group C according to random number table method, with 50 cases in each group. Group A was given 0.01 mg/kg butorphanol intravenously, group B was given 0.02 mg/kg, and group C was given 0.03 mg/kg. Clinical efficacy, hemodynamics, sedation (Ramesay) scores, adverse drug reactions (ADR) and neonatal Apgar scores were compared among the three groups. Results There were no significant differences in effective rate, hemodynamics, Ramesay scores at T₁ and T₂ time periods and Apgar scores of neonates at 1 min, 5 min and 10 min among the three groups (P>0.05). The incidence of ADR in group C was higher than that in group B and A (P<0.05). Ramesay score at time of T₃ of group C was lower than group B and group A (P<0.05). Conclusion The 0.02 mg/kg dose of butorphanol in the treatment of perioperative shivering in cesarean section was the most ideal dose, perioperative hemodynamics of puerpera was stable, adverse reactions were mild, and there was no obvious influence on neonates.

目的 分析厄贝沙坦+美托洛尔治疗慢性充血性心力衰竭(congestive heart failure,CHF)的临床效果及对患者心功能影响。方法 选取本院2018年12月—2020年12月住院治疗的200例慢性CHF患者,根据不同的治疗方法分组,参照组100例患者采用厄贝沙坦治疗,治疗组100例患者采用厄贝沙坦+美托洛尔治疗,比较2组临床疗效、心功能指标、血清炎性因子、血清N端脑利钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)水平、不良反应发生率。结果 治疗组临床总有效率(97.00%)高于参照组(87.00%),治疗组治疗后左室射血分数(left ventricular ejection fraction,LVEF)高于参照组,治疗组治疗后左室舒张末期内径(left ventricular end diastolic diameter,LVEDd)、左室收缩末期内径(left ventricular end systolic diameter,LVESd)、血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C反应蛋白(hypersensitivity C-reactive protein,hs-CRP)、白细胞介素-6(interleukin-6,IL-6)、NT-proBNP、Hcy水平均低于参照组,差异均具有统计学意义(P＜0.05)。治疗组不良反应发生率(4.00%)与参照组(5.00%)比较,P>0.05。结论 厄贝沙坦+美托洛尔可有效改善慢性CHF患者心功能,减轻炎症反应,抑制NT-proBNP、Hcy释放,且不良反应较少。

Objective To analyze the clinical effect of irbesartan combined with metoprolol in the treatment of chronic congestive heart failure (CHF) and its influence on cardiac function. Methods A total of 200 patients with chronic CHF in our hospital from December 2018 to December 2020 were selected and divided into two groups according to different treatment methods. One handred patients in the control group were treated with irbesartan, and 100 patients in the treatment group were treated with irbesartan + metoprolol. The clinical efficacy, cardiac function indexes, serum inflammatory factors, serum NT-proBNP, Hcy levels and adverse reactions of the two groups were compared. Results The total effective rate of the treatment group (97.00%) was higher than that of the control group (87.00%), LVEF of the treatment group was higher than that of the control group, LVEDd, LVESd, serum TNF-α, hs-CRP, IL-6, NT-proBNP, Hcy levels of the treatment group were lower than those of the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the treatment group (4.00%) was higher than that in the control group (5.00%),P>0.05. Conclusion Irbesartan + metoprolol could effectively improve cardiac function, reduce inflammatory reaction, inhibit the release of NT-proBNP and Hcy in patients with chronic CHF, with less adverse reactions.

目的 分析疼痛护理对直肠癌癌痛患者不良情绪及爆发性疼痛的影响。方法 选取2020年4月—2020年6月我院收治的68例直肠癌癌痛患者作为研究对象,通过随机分组的方式将患者分为2组,对照组使用常规临床护理模式,观察组使用疼痛护理模式,对比2组患者的癌痛程度、不良情绪及爆发性疼痛的发生率。结果 2组患者在接受不同护理模式后,SF-MPQ评分相较于护理前出现了下降(P＜0.05),其中观察组的评分与对照组比较下降(P＜0.05),但护理前2组比较并无差异(P＞0.05);2组患者在接受不同护理模式后,功能维度评分和总体健康评分相较于护理前出现了上升(P＜0.05),且与对照组比较观察组得分升高(P＜0.05),2组患者在接受不同护理模式后,症状维度评分相较于护理前降低(P＜0.05),且与对照组比较观察组的评分下降(P＜0.05);服药依从率对比结果显示,观察组(94.12%)的依从性优于对照组(61.76%),组间比较有差异(P＜0.05);爆发性疼痛对比结果显示,观察组(8.82%)低于对照组(47.06%),组间比较有差异(P＜0.05)。结论 疼痛护理可以有效应用于直肠癌癌痛患者的护理中,其不仅可以减轻患者的癌痛程度,还有利于调节患者的不良情绪,降低患者的爆发性疼痛发生率,宜广泛应用及推广。

Objective To analyze the influence of pain nursing on the negative mood and explosive pain of patients with rectal cancer pain. Methods A total of 68 patients with colorectal cancer pain in June 2020 were included as research objects, and divided into two groups by randomized grouping.Routine clinical care was applied on the control group, pain nursing was applied on the observation group.The incidence of cancer pain, negative emotions and explosive pain in both groups of patients were compared. Results After applying different care plans, two groups of patients had a significant decrease in the SF-MPQ score (P<0.05), in which the score of the observation group was significantly lower than the control group (P<0.05), however, there were no significant differences before nursing (P>0.05). Two groups of patients were significantly improving in function scoring and the overall health scoring after receiving different care modes (P<0.05), and the observation group was significantly higher than the control group (P<0.05). The symptom dimension scores were significantly lower than before accepting different care modes (P<0.05), and the control group was significantly higher (P<0.05). The comparative results of the medicinal compliance of observation group (94.12%) were better than the control group (61.76%,P<0.05); outbreak pain comparative results showed the observation group (8.82%) was significantly lower than that of the control group (47.06%,P<0.05). Conclusion Pain nursing can be effectively used in the nursing of patients with rectal cancer pain.It can not only reduce the degree of cancer pain, but also help regulate the patient's negative mood and reduce the incidence of explosive pain.It should be widely used and promoted.