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 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 探究百令胶囊联合前列地尔对早期糖尿病肾病患者血液流变学及肾功能影响。方法 选我院2020年1月—2021年1月期间100例糖尿病肾病患者为研究对象,将其以随机数字表法分为对照组、观察组,各50例,分别应用前列地尔治疗、前列地尔+百令胶囊治疗,比较2组治疗前后血液流变学指标、肾功能指标。结果 治疗前2组血浆粘度、全血粘度、红细胞聚集指数水平相近,差异无统计学意义(P＞0.05);治疗后观察组血浆粘度、全血粘度、红细胞聚集指数水平较对照组低,差异有统计学意义(P＜0.05);治疗前2组微量蛋白排泄率(UAER)、血尿素氮(BUN)、血肌酐(Scr)水平相近,差异无统计学意义(P＞0.05);治疗后观察组UAER、BUN、Scr水平较对照组低,差异有统计学意义(P＜0.05);2组治疗期间均未见严重不良反应。结论 对早期糖尿病肾病患者应用百令胶囊+前列地尔治疗,可改善其血液流变学指标及肾功能指标,降低炎症反应程度,治疗安全且疗效理想。

Objective To explore the effect of Bailing capsule combined with alprostadil on hemorheology and renal function in patients with early diabetic nephropathy. Methods A total of 100 patients with diabetic nephropathy in our hospital from January 2020 to January 2021 were randomly divided into control group and observation group, 50 cases in each group.They were treated with alprostadil and alprostadil with Bailing capsule respectively.The indexes of hemorheology and renal function before and after treatment were compared between the two groups. Results Before treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of plasma viscosity, whole blood viscosity and erythrocyte aggregation index of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). Before treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the two groups were similar, and the differences were not statistically significant (P > 0.05). After treatment, the levels of urine albumin excretion ratio, blood urea nitrogen and serum creatinine in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). There was no serious adverse reaction in the two groups during the treatment. Conclusion Bailing capsule combined with alprostadil in the treatment of early diabetic nephropathy can improve the indexes of hemorheology and renal function, lower the inflammatory reaction, and the treatment is safe and effective.

目的 观察中等强度有氧运动联合力量训练对老年高尿酸血症(HUA)尿酸、身体机能及生活质量影响分析。方法 2019年1月—2019年12月在我社区收治的老年HUA患者60例纳入研究,随机数字表法进行分组,选取其中的30例患者实施常规饮食、运动指导为对照组,另30例患者配合中等强度有氧运动联合力量训练为研究组。比较2组患者对干预的依从性,干预前、后的血尿酸水平,身体机能及生活质量评分(WHOQOL-100评分)。结果 2组患者均在干预期内完成训练,依从性优良率比较,差异无统计学意义(P＞0.05)。干预前2组患者的血尿酸水平、身体机能比较,差异无统计学意义(P＞0.05)。干预后2组患者的血尿酸水平、安静心率较干预前降低,研究组低于对照组,而肺活量则较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。干预前2组患者的WHOQOL-100评分比较,差异无统计学意义(P＞0.05),干预后2组WHOQOL-100各项评分较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。结论 在老年HUA患者的相关指导中,运用中等强度有氧运动联合力量训练的运动干预,可较为明显的降低血清血尿酸水平,降低并平稳安静心率,提升肺活量,提升生活质量,效果理想。

Objective To observe the effect of moderate intensity aerobic exercise combined with strength training on uric acid level, physical function and quality of life in elderly patients with hyperuricemia (HUA). Methods Sixty elderly patients with HUA were treated in our center from January 2019 to December 2019. They were randomly divided into two groups, 30 cases in each group. Among them, 30 cases given routine diet and exercise guidance were included in control group, and the other 30 cases given moderate intensity aerobic exercise combined with strength training on the basis of the control group were included in study group. The compliance, blood uric acid level, physical function and quality of life (WHOQOL-100 scores) before and after the intervention were compared between the two groups. Results Two groups of patients completed the training within the expected time, and there was no significant difference in compliance (P＞0.05). Before the intervention, there were no significant differences in blood uric acid level and physical function between the two groups (P＞0.05). After the intervention, the serum uric acid level and resting heart rate of the two groups were lower than those before the intervention, and those of the research group were even lower than the control group, while the vital capacity was higher than that before the intervention, and the research group was higher than the control group, those differences were significant (P＜0.05). Before the intervention, there was no significant difference in WHOQOL-100 score between the two groups (P＞0.05). After the intervention, the scores of WHOQOL-100 in the two groups were higher than those before the intervention, and that in the study group was higher than the control group (P＜0.05). Conclusions In the relevant guidance of elderly patients with hyperuricemia (HUA), the application of moderate intensity aerobic exercise combined with strength training can significantly lower the serum uric acid level, reduce and stabilize the resting heart rate, improve the vital capacity and quality of life, with ideal effect.

目的 使用分层应变技术评价以mFOLFOX6化疗的结直肠癌患者左心室功能的变化。方法 收集30例病理确诊为结直肠癌患者,各位患者均采用mFOLFOX6(5-氟尿嘧啶+奥沙利铂+亚叶酸钙)化疗方案,以自身对照做研究,分别于化疗前、化疗中期、化疗后期行心脏超声检查,获取常规参数,并采集左心室心尖四腔、三腔、两腔切面、短轴二尖瓣、乳头肌、心尖切面的三维动态图像,获取左心室的心肌心内膜下、中层、心外膜下心肌的纵向应变(GLSendo、GLSmid、GLSepi)及左心室心肌心内膜下、中层、心外膜下圆周应变(GCSendo、GCSmid、GCSepi)的数值,计算△GLS(△GLS=GLSendo-GLSepi),△GCS(△GCS=GCSendo-GCSepi),并比较这些数值的绝对值在化疗前后的变化。结果 无论化疗前还是化疗后,各层心肌均有跨壁梯度的存在。与化疗前相比:化疗后各层心肌应变参数的绝对值均降低,GLSendo和GCSendo、ΔGLS下降更为显著(P<0.05),其中,GLSendo的ROC曲线下面积为0.766,P<0.001,选25.3%为诊断界点,灵敏度为83.3%,特异度为70%;ΔGLS的ROC曲线下面积为0.749,P<0.001,选4.1%为诊断界点,灵敏度为76.7%,特异度为73.3%。结论 心肌分层应变技术有助于早期发现mFOLFOX6致结直肠癌患者左心室各层心肌功能的变化,GLSendo、ΔGLS是该技术中较为敏感的指标。

Objective To evaluate the changes of left ventricular function in patients with colorectal cancer treated with mFOLFOX6 using layer-specific strain analysis. Methods The data of 30 patients with pathologically diagnosed with colorectal cancer were collected. All patients were treated with mFOLFOX6 (5-fluorouracil+oxaliplatin+calcium leucovorin) chemotherapy. The self-control study was carried out before, during, and after chemotherapy, and cardiac ultrasound was performed to obtain conventional parameters, and three-dimensional dynamic images of the left ventricular apex four-chamber, three-chamber, two-chamber section, short-axis mitral valve, papillary muscle, and apical sectionare were acquired. The longitudinal strain of the three layer of myocardium (GLSendo、GLSmid、GLSepi) and the circumferential strain of myocardium (GCSendo、GCSmid、GCSepi) were collected, and △GLS (△GLS=GLSendo-GLSepi), △GCS (△GCS=GCSendo-GCSepi) were calculated, and the absolute values of these indexes before and after chemotherapy were compared. Results No matter before or after chemotherapy, there was a transmural gradient in each layer of myocardium. Compared with those before chemotherapy, the absolute values of myocardial strain parameters of each layer were reduced after chemotherapy, and GLSendo and GCSendo and ΔGLS decreased more significantly (P<0.05),while the area under the ROC curve of GLSendo was 0.766, P<0.001.Selecting 25.3% as the diagnostic boundary, the sensitivity was 83.3%, and the specificity was 70%.The area under the ROC curve of ΔGLS was 0.749, P<0.001. Selecting 4.1% as the diagnostic boundary, the sensitivity was 76.7%, and the specificity was 73.3%. Conclusions The myocardial layer-specific strain analysis is helpful for early detection of changes in the myocardial function of the left ventricle, which caused by mFOLFOX6 in patients with colorectal cancer. GLSendo and ΔGLS are sensitive indicators in this technique.

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 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 评估产后女性的认知功能,并分析其认知功能受损的特点,以及分析可能的影响因素。方法 病例组选取健康单胎足月顺产初产妇、二胎产妇,对照组选取一般资料匹配的未生育女性,选用蒙特利尔认知评估(Montreal Cognitive Assessment Test,MoCA)北京版、伯明翰认知评估量表(Birmingham Cognitive Screen test,BCoS)普通话版评估认知功能。结果 实际入组病例组80例产妇,均完成MoCA量表,共42例产妇完成BCoS量表,对照组30例均完成MoCA、 BCoS评估。产妇组(80例)MCA得分为(26.26±2.28)分,低于未生育女性对照组MoCA分数(27.47±1.28)分(P<0.05),产妇组认知障碍发生率为30%高于对照组6.7%(P<0.05)。初产妇组MoCA分数(26.52±2.13)分,认知障碍发生率为26%,二胎产妇组MoCA分数(25.83±2.49)分,认知障碍发生率为36.7%,两者对比无明显差别(P>0.05)。产妇组(80例)在MoCA量表视空间与执行功能分项得分低于对照组(P<0.01);产妇组BCoS评分在故事瞬时回想、苹果删除总数、听觉注意、规则转换、手势模仿5个分项低于对照组(P<0.05)。产妇的受教育年限、分娩镇痛麻醉、总产程时间是产后认知功能下降的影响因素(P<0.05)。结论 ①产后妇女可能发生认知功能障碍,但初产妇与二胎产妇的认知障碍发生率无明显差别。②MoCA量表可以用于产妇产后认知功能筛查,BCoS量表可做为全面评估产妇产后认知功能的工具,产妇产后认知受损主要在视空间、注意力、执行功能(实践与行动能力)、记忆力领域。③产妇的受教育年限、分娩镇痛麻醉、总产程时间是产后认知功能下降的影响因素。

Objective To evaluate the cognitive function of postpartum women, and analyze the characteristics of cognitive dysfunction and the possible affecting factors. Methods The case group selected healthy single-born full-term primiparae (50 cases) and second birth parturient (30 cases), and the control group (30 cases) selected non-fertile women with general data matching. The Montreal Cognitive Assessment Test (MoCA) Beijing version and Birmingham Cognitive Screen test(BCoS) were used to evaluate cognitive function. Results Of the 80 cases in the case group, all completed the MoCA test, only 42 cases completed the BCoS test. The 30 cases in the control group all completed the MoCA and BcoS.The MoCA score of the case group (80 cases) was (26.26±2.28), which was lower than that of the control group (27.47±1.28) (P<0.05). The incidence of cognitive impairment in the case group was 30%, higher than the control group 6.7% (P<0.05). The MoCA score of the primiparae group was (26.52±2.13); the incidence of cognitive impairment was 26%; the MoCA score of the second birth parturient group was (25.83±2.49); the incidence of cognitive impairment was 36.7%.There was no significant difference in the MoCA score and the incidence of cognitive impairment between primiparae and second birth parturient (P> 0.05).The case group had lower scores on visual space and executive function of MoCA test than the control group (P<0.01).The score of BCoS test in the case group was lower than that in the control group in the five items of the instantaneous recall item of the story, apple deletion, auditory attention, Birmingham rule conversion and gesture imitation (P<0.05).The years of education, labor analgesia, and the total duration of labor were the factors that affected the cognitive function of postpartum women (P<0.05). Conclusion ①Postpartum women may have cognitive dysfunction, but there was no significant difference in the incidence of cognitive impairment between primiparae and second birth parturient group. ②The MoCA test can be used for the screening of cognitive impairment of postpartum women, and the BCoS test can be used as a tool to comprehensively evaluate the cognitive function of postpartum women. The cognitive impairment of postpartum women was mainly in the fields of visual space, attention, executive function (practice and action ability), and memory. ③The years of education, labor analgesia, and the total duration of labor were the factors that affect the cognitive function of postpartum women.

目的 研究电针治疗对重性抑郁障碍患者的抑郁状态的影响。方法 本研究共分为3组,药物组、和药物+电针组及对照组(每组各50 例),药物组给予艾司西酞普兰抗抑郁治疗连续6周,药物+电针组在给予艾司西酞普兰抗抑郁治疗的基础上,进行电针治疗6周。比较治疗前后三组的HAMD 24 项评分,并对三组的HAMD 24 项评分与血清细胞炎症因子IL-1β、IL-2、IL-6、TNF-α水平进行相关性分析。采用多元逐步回归法,分析影响基线药物组和药物+电针组HAMD 24 项评分的主要因素。结果 与治疗前比较,药物组和药物+电针组患者治疗后HAMD 24 项评分均降低,差异有统计学意义(P＜0.05或P＜0.01),与药物组比较,治疗后药物+电针组HAMD 24 项评分较低,差异有统计学意义(P＜0.05或P＜0.01)。药物组HAMD 24 项评分与血清细胞炎症因子IL-6(r=0.335,P<0.001)、TNF-α(r=0.269,P<0.001)、IL-2(r=0.257,P=0.001)和IL-1β(r=0.205,P=0.021)呈正相关。药物+电针组HAMD24 项评分与血清细胞炎症因子IL-6(r=0.338,P<0.001)、TNF-α(r=0.271,P<0.001)、IL-2(r=0.255,P=0.015)和IL-1β呈正相关(r=0.208,P=0.026)。影响药物组HAMD24 项评分的主要因素有:血清细胞炎症因子IL-6、TNF-α、IL-1β、IL-2、婚姻(已婚)、文化程度(受教育年限少),标准化回归系数分别为0.585、0.516、0.452、0.318、-0.290、0.262(P＜0.05或P＜0.01)。影响药物+电针组HAMD24 项评分的主要因素有:血清细胞炎症因子IL-6、TNF-α、IL-2、IL-1β、婚姻(已婚)、文化程度(受教育年限少),标准化回归系数分别为0.592、0.521、0.448、0.323、-0.295、0.271(P＜0.05或P＜0.01)。结论 药物联合电针治疗能有效改善重性抑郁障碍患者的抑郁状态,细胞炎症因子与HAMD24 项评分相关,可影响重性抑郁障碍患者的抑郁状态。

Objective To explore the effect of electroacupuncture on patients with severe depression. Methods Patients was divided into three groups, acupuncture group, drug group and the control group. Each group had 50 patients. The drug group was treated with escitalopram for 6 weeks.The acupuncture group were treated with escitalopram and electroacupuncture for 6 weeks. We compared the HAMD24 among 3 groups before or after treatment. The correlation of the levels of IL-1 β, IL- 2, IL- 6, TNF-α and the total HAMD24 score among 3 groups were taken by the correlation analysis. And the main factors influencing the total HAMD24 score before the study were analyzed by the multiple inear step regression method. Results Compared with the pre-treatment group, the HAMD score of the drug group and the acupuncture group decreased after treatment, the difference was statistically significant (P<0.05 or P<0.01). Compared with the drug group, the HAMD score of the acupuncture group was lower after treatment; the difference was statistically significant (P<0.05 or P<0.01). The drug group, HAMD scores were positively correlated with IL- 6, TNF-α, IL- 2 and IL-1 β (r=0.335, 0.269, 0.257 and 0.205, respectively, P<0.05 or P<0.01). The acupuncture group HAMD scores were positively correlated with IL- 6, TNF-α, IL- 2 and IL-1 β(r=0.338, 0.271, 0.255 and 0.208, respectively, P<0.05 or P<0.01). The main factors influencing the HAMD score before the study included: serum cytokines IL- 6, TNF-α, IL β, IL- 2, marriage and education. The standardized regression coefficients were 0.585,- 0.516, 0.452, 0.318, 0.290, 0.262, respectively (P<0.05 or P<0.01). The main factors influencing the HAMD score of the drug group before the study included: serum cytokines IL- 6, TNF-α, IL β, IL- 2, marriage and education. The standardized regression coefficients were 0.585,- 0.516, 0.452, 0.318, 0.290, 0.262, respectively (P<0.05 or P<0.01). The main factors of the acupuncture group influencing the HAMD score before the study included: serum cytokines IL- 6, TNF-α, IL β, IL- 2, marriage and education. The standardized regression coefficients were 0.592,0.521,0.448,0.323,- 0.295,0.271(P＜0.05 or P＜0.01). Conclusion Escitalopram combination with electroacupuncture may improve the the depressive state. Inflammatory cytokines were associated with HAMD24 scores and it affects the depressive state of patients with major depressive disorder.