人工智能与医学

工智能在结肠镜检查质量控制方面的应用

Application of artificial intelligence in quality control of colonoscopy

:581-590
 
       传统的结肠镜检查质量评估方式具有主观性强、费时费力等缺点。近年来,人工智能(AI)技术在结肠镜检查质量控制方面展现出客观性、即时性、全面性等优势,具有广阔的应用前景。文章全面探讨了AI在结肠镜检查质量控制中的多个应用场景,包括评估肠道准备质量、记录退镜时间、息肉识别和分类、预测早期结直肠癌浸润深度等方面,并通过具体的研究案例和数据分析了AI技术的有效性和优势。AI技术有望在提升结肠镜检查质量、促进结直肠癌的早诊早治方面发挥更加重要的作用,但面对技术、伦理及法规等多方面的挑战,未来需要持续努力,不断优化算法,加强跨学科合作,推动AI技术在医疗领域的健康、快速发展。
     Traditional colonoscopy quality assessment methods have strong subjectivity and are time-consuming.In recent years,artificial intelligence technology has shown objectivity,timeliness,and comprehensiveness in colonoscopy quality control,with broad application prospects.This article comprehensively explores multiple application scenarios of AI in colonoscopy quality control,encompassing assessments of bowel preparation quality,recording of withdrawal times,polyp identification and classification,and prediction of early colorectal cancer invasion depth.Through specific research cases and data analysis,the effectiveness and advantages of AI technology are elucidated.AI technology is expected to play an increasingly significant  role in enhancing the quality of colonoscopy and promoting early diagnosis and treatment of colorectal cancer.However,facing challenges from technology,ethics,regulations,and other aspects,continued efforts are  needed in the future to continuously optimize algorithms,strengthen interdisciplinary collaboration,and promote the healthy and rapid development of AI technology in the medical field.
人工智能与医学

人工智能在炎症性肠病图像诊断的应用进展

Progress of image diagnosis by artificial intelligence in inflammatory bowel disease

:571-580
 
       人工智能(AI)这一新兴技术的出现和应用给炎症性肠病(IBD)的诊断带来了巨大的变革。越来越多的研究着手于开发基于机器学习(ML)和深度学习(DL)的诊断模型,并获得了良好的诊断性能,尤其是在IBD的图像诊断,卷积神经网络(CNN)等模型由于其出色的图像分析能力,在内镜检查和组织病理检查等方面具有十分可观的发展前景。近年来AI诊断模型的应用越发广泛,但与此同时,关于算法、数据库及其应用方面仍存在一些难以忽视的局限性。本文将主要就图像识别方面对AI在IBD诊断中的应用进行综述,以期为IBD精准图像诊断领域下步研究提供参考。
        As an emerging technology,artificial intelligence(AI)has brought great changes to the precise diagnosis of inflammatory bowel disease(IBD).More and more  researches have developed diagnostic models which are based on machine learning(ML)and deep learning(DL)and obtained satisfactory diagnostic performance.Especially in the image  diagnosis of IBD,convolutional neural network(CNN)and  other models  have  considerable  development  prospects in  endoscopy  and histopathology due to their excellent image analysis capabilities.In recent years,the application of AI diagnostic models has become more and more widespread,but at the same time,there are still some limitations about algorithms,databases and their applications that cannot be ignored.This review mainly focused on the application of AI in IBD diagnosis from the aspect of image recognition,to provide a reference for IBD diagnosis towards precision medicine.
医院管理

处方前置审核现状及问题剖析

Pre-prescription audit status quo and problem analysis

:566-570
 
       处方前置审核工作是推动临床合理用药的重要措施,对转变医院药学服务模式具有重要意义。传统处方点评为回顾性的事后点评,存在滞后性和局限性,不能实时监控合理用药。相比而言,处方前置审核可以及时、有效地干预问题处方,简化不合格处方修改流程,提高就诊患者的取药效率,而人机结合更能发挥药学信息智能化等多重优势。前置审核工作在各医院开展形式及发展水平不一,探讨新型模式,建立自主维护知识库,制定基本化原则,完善个性化原则,对前置审核系统进行全面人工筛查,可从源头上拦截或干预医生的不合理处方,促进用药规范性,提高处方或医嘱合理率,实现药学智慧信息化,辅助临床合理用药。
       Pre-prescription audit is an important measure to promote clinical rational use of drugs,which is of great significance to the transformation of hospital pharmaceutical care mode.Traditional prescription review for retrospective review has lag and limitations,can not real-time monitoring rational drug use.By contrast,pre-prescription audit can timely and effective intervene problem prescription,simplify the unqualified prescription modification process,improve the efficiency of patients take medicine,and man-machine combination can make more pharmaceutical information intelligent multiple advantages.Advanced audit work in various hospitals presents different forms and development level,exploring the new mode,establishing independent maintenance knowledge base,developing basic principles,perfecting personalized principle,comprehensive check of advanted audit system,can intercept or intervene doctors unreasonable prescription from the source,contribute to normative,improve the prescription or advice reasonable rate,realize pharmaceutical wisdom informatization,auxiliary clinical rational use of drugs.
医院管理

我国医保支付方式改革中的经验及思考

Experience and reflections on healthcare insurance payment reform in China

:559-565
 
       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。     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.
医院管理

智慧医院构建背景下智能采血管理系统的应用实践及故障分析

Application practice and fault analysis of intelligent blood collection management system under the background of intelligent hospital construction

:553-558
 
       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.
论著

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

The application value of CT enhanced delayed scanning in preoperative diagnosis of non-small cell lung cancer

:547-552
 
       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 (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.
论著

内镜下黏膜切除术肠道准备教育程序的优化及评价

Optimization and evaluation of bowel preparation education program for endoscopic mucosal resection

:542-546
 
       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.
论著

便携式超声仪 e-FAST 技术在批量伤员军地联合院前救治中的应用研究

The application of portable ultrasound e-FAST technology in pre hospital treatment of batch injured soldiers in military civilian joint hospitals

:537-541
 
          目的   探讨便携式超声仪超声重点评估(e-FAST)技术在批量伤员军地联合院前救治中的应用效果。方法    抽取2021年5月—2023年10月中国人民解放军联勤保障部队第九八八医院中心急诊科收治的80例批量伤员,均开展军地联合院前救治,按照治疗方案不同分为观察组和对照组,每组患者40例,其中对照组在救治现场行基于创伤严重程度(CRAMS)评分,进行常规急救处置,救护车返院后行CT检查并进行相应伤情治疗,观察组救治现场行CRAMS评分,进行常规急救处置,院前接诊医师在现场或救护车上使用便携式超声仪按照e-FAST流程检查相应部位,初步诊断后进行相应伤情治疗,对比两组患者治疗效果,两组患者诊断时间、初次医疗接触—进入手术室时间及入院诊断与出院时确定性诊断的符合率、两组患者治疗前后CRAMS评分及CRAMS≤8分抢救成功率。结果   观察组治疗有效率为95.0%,对照组为85.0%,对比差异无统计学意义(χ 2 =2.222,P=0.136);观察组患者的诊断时间(13.56±2.36)min、初次医疗接触—进入手术室时间(30.42±8.99)min均短于对照组[(23.64±5.69)、(52.27±12.60)min],差异有统计学意义t=10.349、8.928,P<0.05);观察组患者入院诊断与出院时确定性诊断的符合为97.5%,对照组患者入院诊断与出院时确定性诊断的符合为95.0%,差异无统计学意义(χ 2 =0.346,P=0.556);治疗后两组患者的CRAMS评分均升高,且观察组(9.87±2.62)分高于对照组(8.60±2.98)分,差异有统计学意义(t=2.024,P=0.046);观察组患者CRAMS≤8分的抢救成功率为97.50%,对照组CRAMS≤8抢救成功率为85.00%,观察组患者CRAMS≤8分的抢救成功率高于对照组(χ 2 =3.914,P=0.048)。结论    本研究从军地联合救治批量伤员切入,瞄准部队医院军民融合战略发展路线,本文针对便携式超声仪e-FAST应用范围前移,明显地提高急救人员院前救治能力,提高抢救成功率,值得临床参考。
       Objective  To explore the application effect of portable ultrasound e-FAST technology in the pre hospital treatment of batch wounded soldiers in military civilian joint hospitals.Methods  Eighty batch wounded patients admitted to the emergency department of 988 Hospital from May 2021 to October 2023 were selected,all of whom underwent military civilian joint pre hospital treatment.They were divided into an observation group and a control group according to different treatment plans,with 40 patients in each group.The control group received CRAMS scores at the treatment site for routine first aid treatment,CT scans after ambulance return to the hospital for corresponding injury treatment,the observation group  received CRAMS scores at the treatment site for routine first aid treatment,and the pre-hospital attending physician used a portable ultrasound instrument to examine the corresponding parts on site or in the ambulance according to the e-FAST process.After preliminary diagnosis,corresponding injury treatment was carried out.The treatment effects of the two groups of patients were compared,and the diagnosis time and initial diagnosis of the two groups of patients were compared.The time from medical contact to entering the operation room,the compliance rate of discharge and admission diagnoses,the CRAMS score before and after treatment,and the success rate of rescue with CRAMS ≤ 8 for both groups of patients were compared.Results  The effective rate of treatment in the observation group was 95.0%,while in the control group it was 85.0%,which difference was not statistically significant(χ 2 =2.222,P=0.136).The time to diagnosis(13.56±2.36)min,time to the operating room(30.42±8.99)min were shorter than that in the control group[(23.64±5.69),(52.27±12.60)min],with significant difference(t=10.349,8.928,P<0.05).The consistency  between the admission diagnosis and the definitive diagnosis at discharge of the observation group patients was 97.5%,while the consistency of the control group patients was 95.0%.There was no significant difference between the groups(χ 2 =0.346,P=0.556).After treatment,the CRAMS scores of both groups of patients increased,the observation group(9.87±2.62)was higher than that of the control group(8.60±2.98)(t=2.024,P=0.046).The success rate of CRAMS ≤ 8 rescue in the observation group was 97.50%,while the success rate in the control group was 85.00%.The success rate of CRAMS ≤ 8 rescue in the observation group was higher than that in the control group(χ 2 =3.914,P=0.048).Conclusions  This study focuses on the joint treatment of batch wounded soldiers by military and civilian forces,aiming at the development path of military civilian integration strategy in military hospitals.The application scope of portable ultrasound e-FAST has been moved forward,which significantly improves the pre hospital treatment ability of emergency personnel and improves the success rate of rescue.It is worth clinical reference.
论著

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研究

Construction and application of self-design education path and homogeneity management in diabetic patients of non endocrine department

:529-536
 
       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.
论著

达泊西汀联合达克罗宁胶浆治疗早泄的临床研究

Clinical study on the treatment of premature ejaculation with dapoxetine combined with dacronine mucilage

:523-528
 
       目的   探讨盐酸达泊西汀联合达克罗宁胶浆治疗早泄的临床疗效。方法   选取男科门诊146例早泄患者,随机分组,对照组服用达泊西汀片,研究组为达泊西汀片和达克罗宁胶浆联合治疗,再将研究组分为阴茎头敏感度高组和敏感度正常组,记录各组治疗前、治疗8周后早泄相关指标。结果   治疗后对照组阴道内射精潜伏期(IELT)、早泄诊断量表(PEDT)和早泄指数量表(IPE)中Q6+Q7分别为(4.68±2.79)、(9.52±2.14)、(6.48±1.30),研究组IELT、PEDT和Q6+Q7分别为(6.09±3.09)、(7.52±1.92)、(7.85±1.36),各组相关指标均较治疗前改善(P<0.05),研究组各指标改善程度优于对照组(P<0.05);治疗后敏感度高组IELT、PEDT和Q6+Q7分别为(6.76±2.99)、(6.84±1.53)、(8.16±1.10),敏感度正常组IELT、PEDT和Q6+Q7分别为(5.13±3.02)、(8.50±2.03)、(7.40±1.59),敏感度高组各指标改善程度优于敏感度正常组(P<0.05);对照组、研究组总有效率分别为69.86%(51/73)、84.93%(62/73),研究组治疗效果优于对照组(P<0.05);敏感度高组、敏感度正常组总有效率分别为93.02%(40/43)、73.33(22/30),敏感度高组治疗效果优于敏感度正常组(P<0.05)。结论    达泊西汀联合达克罗宁胶浆治疗早泄效果显著,阴茎头敏感患者联合达克罗宁胶浆治疗受益更大。
       Objective  To investigate the clinical efficacy of dapoxetine hydrochloride combined with dclonine mucilage in the treatment of premature ejaculation.Methods  A total of 146 patients from andrology department with premature ejaculation were selected and randomly divided into control group and research group.The control group was treated with dapoxetine alone,while the research group was treated with dapoxetine combined with dacronine mucilage.The  research group was divided into high sensitivity group and normal sensitivity group.The indexes  related to premature ejaculation were  recorded before treatment and 8 weeks after treatment.Results  After treatment,intravaginal ejaculatory latency time(IELT),Premature Ejaculation Diagnosis Tool(PEDT)and Q6+Q7 of the index of premature ejaculation(IPE)in control group were(4.68±2.79),(9.52±2.14)and (6.48±1.30),respectively,while IELT,PEDT and Q6+Q7 in research group were(6.09±3.09),(7.52±1.92) and (7.85±1.36),respectively.The relevant indexes in all groups were significantly improved compared with those before treatment(P<0.05),and the improvement of all indexes in research group was better than that in control group(P<0.05).After treatment,IELT,PEDT and Q6+Q7 in the highly sensitivity group were(6.76±2.99),(6.84±1.53)and(8.16±1.10),respectively,while IELT,PEDT and Q6+Q7 in the normal sensitivity group were(5.13±3.02),(8.50±2.03)and(7.40±1.59),respectively.The improvement of all indexes in the high sensitivity group was better than that in the normal sensitivity group(P<0.05).The total effective rate of the control group and the research group was 69.86%(51/73)and 84.93%(62/73),respectively.The therapeutic effect of the research group was significantly better than that of the control group(P<0.05).The total effective rate of the high sensitivity group and the normal sensitivity group was 93.02%(40/43)and 73.33%(22/30),respectively.The therapeutic effect of the high sensitivity group was significantly better than that of the normal sensitivity group(P<0.05).Conclusions  Dapoxetine combined with dacronine mucilage has significant effect in the treatment of premature ejaculation,and the patients with high sensitivity of penile head will benefit more from combined dacronine mucilage therapy.
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