目的 分析多囊卵巢综合征患者性激素水平与胰岛素抵抗关系。方法 此次研究所设置的观察组对象为我院收入的多囊卵巢综合征患者,均在2017年5月—2020年7月入院,入选患者共100例。选取同一时期到我院进行相关检查的健康育龄女性100例作为对照组。分别检测、统计2组女性的性激素[包括性激素黄体生成素(LH)、睾酮(T)、雌二醇(E2)、卵泡刺激素(FSH)]、空腹血糖(FBG)、空腹胰岛素(FINS)以及胰岛素抵抗指数,对性激素水平与胰岛素抵抗关系进行分析。结果 相比于对照组,观察组女性的LH、T水平更高(P＜0.05),E2、FSH水平更低(P＜0.05),且FBG、FINS、胰岛素抵抗指数均更高(P＜0.05)。观察组中,胰岛素抵抗与非胰岛素抵抗患者的性激素水平与胰岛素抵抗指数,胰岛素抵抗女性与非胰岛素抵抗女性的LH、TE2、FSH水平均具有差异(P＜0.05)。LH、E2、FSH水平与胰岛素抵抗指数无相关性(P＞0.05),T水平与胰岛素抵抗指数呈正相关(P＜0.05)。结论 多囊卵巢综合征患者的性激素出现了一定的分泌紊乱现象,其中T水平与胰岛素抵抗具有相关性。

Objective To analyze the relationship between sex hormone levels and insulin resistance in patients with polycystic ovary syndrome. Methods The subjects of the observation group set up in this study were patients with polycystic ovary syndrome admitted to our hospital, all of whom were admitted from May 2017 to July 2020, and a total of 100 patients were enrolled.One hundred healthy women of childbearing age who came to our hospital for relevant examinations during the same period were selected as the control group.Sex hormone [including luteinizing hormone (LH), testosteron (T), estradiol (E2), follicle stimulating hormone (FSH)] levels, fasting blood glucose (FBG) level, fasting insulin (FINS) level, and insulin resistance index were detected and summerized in the two groups of women separately, and the relationship between sex hormone levels and insulin resistance was analyzed. Results Compared with the control group, women in the observation group had higher LH and T levels (P<0.05), lower E2 and FSH levels (P<0.05), and higher FBG, FINS levels, and insulin resistance index (P<0.05). In the observation group, sex hormone levels and insulin resistance index in insulin-resistant and non-insulin-resistant patients, and LH, TE2, and FSH levels in insulin-resistant and non-insulin-resistant women were different (P<0.05). There was no correlation between LH, E2, and FSH levels and insulin resistance index (P> 0.05), and T level were positively correlated with insulin resistance index (P<0.05). Conclusion Patients with polycystic ovary syndrome showed some disturbance in the secretion of sex hormones, among which T level were correlated with insulin resistance.

目的 分析心力衰竭伴快速心房颤动(简称:心衰伴快速房颤)患者接受胺碘酮急诊抢救治疗的效果及对24 h心室率的影响。方法 将2017年1月—2020年12月急诊接诊且行西地兰治疗的60例心衰伴快速房颤患者作为对照组,将同期急诊接诊且行胺碘酮治疗的60例心衰伴快速房颤患者作为观察组,对组间心功能指标、炎症因子水平、心室率、临床疗效、药物不良反应展开分析。结果 ①组间心功能指标、炎症因子水平在治疗前无差异,P>0.05;观察组心功能指标、炎症因子水平在治疗后优于对照组,P<0.05;②组间心室率在治疗前无差异,P>0.05;观察组治疗后4 h、12 h、24 h心室率均低于对照组,P<0.05;③观察组5例无效(8.33%),对照组14例无效(23.33%),P<0.05;④观察组药物不良反应率(3.33%)与对照组药物不良反应率(5.00%)无差异,P>0.05。结论 在急诊抢救心衰伴快速房颤患者时采用胺碘酮,可以改善患者心功能、炎症反应、心室率,加之无明显不良反应,值得推广。

Objective To analyze the efficacy of emergency treatment with amiodarone and its influence on 24-hour ventricular rate in patients with heart failure and rapid atrial fibrillation. Methods From January 2017 to December 2020, 60 patients with heart failure and rapid atrial fibrillation who received emergency treatment and cedilanide treatment were selected as the control group, and 60 patients with heart failure and rapid atrial fibrillation who received emergency treatment and amiodarone treatment at the same period were selected as the observation group. Results ① There was no significant difference in cardiac function index and inflammatory factors level between the two groups before treatment, P>0.05.The cardiac function index and inflammatory factors level of the observation group were more improved than those of the control group after treatment, P<0.05. ② There was no significant difference in ventricular rate between the two groups before treatment, P>0.05.The ventricular rates of the observation group at 4 h, 12 h and 24 h after treatment were lower than those of the control group, P< 0.05. ③ Treatment for 5 cases (8.33%) in the observation group, 14 cases (23.33%) in the control group were ineffective, P<0.05. ④ There was no significant difference in the adverse drug reaction incidence between the observation group (3.33%) and the control group (5.00%), P>0.05. Conclusion Amiodarone could improve the cardiac function, inflammatory reaction and ventricular rate of patients with heart failure and rapid atrial fibrillation in emergency treatment, and there was no obvious adverse reaction, so it is worthy of promotion.

目的 观察靳三针治疗卒中后认知功能障碍(PSCI)的临床疗效。方法 选取广州市第一人民医院南沙医院中医科、神经内科、精神科卒中后出现认知功能障碍的患者60 例,随机分为治疗1组,治疗2组和对照组,每组20例。对照组予盐酸多奈哌齐片口服,治疗1组予靳三针治疗,治疗2组予多奈哌齐口服及靳三针治疗。各组均在治疗前、治疗12周进行中医症候临床疗效评定和精神状态简易量表(MMSE)评定。结果 MMSE疗效评定中,治疗1组和对照组总有效率相当,治疗2组治疗有效率高于对照组及治疗1组。中医症候疗效评定中,治疗2组愈显率高于对照组及治疗1组,治疗2组愈显率较治疗1组明显升高,对比差异有统计学意义(P<0.05)。对照组、治疗1组、治疗2组经过12周治疗后MMSE评分较前升高,治疗前后比较差异均有统计学意义(P<0.05)。3组中风病诊断与疗效评定评分治疗后有所下降,治疗前后比较差异有统计学意义(P<0.05)。治疗2组与对照组、治疗1组对比,2组对比差异均有统计学意义(P<0.05)。结论 靳三针联合多奈哌齐治疗PSCI效果明显,针刺与药物结合应用治疗更有利于PSCI的恢复。

Objective To observe the clinical effect of Jin's three-needle therapy on post-stroke cognitive impairment (PSCI). Methods A total of 60 patients with cognitive dysfunction after stroke in the department of traditional Chinese medicine (TCM), department of neurology and department of psychiatry in Nansha Hospital of Guangzhou First People's Hospital were randomly divided into treatment group 1, treatment group 2 and control group, 20 cases in each group.The control group was given donepezil hydrochloride orally, the treatment group 1 was given Jin's three-needle therapy, the treatment group 2 was given donepezil oral therapy and Jin's three-needle therapy.All groups were assessed with mini-mental state examination (MMSE) before and 12 weeks after treatment. Results In MMSE, the total effective rate of treatment group 1 was similar to that of control group, and the effective rate of treatment group 2 was higher than that of control group and treatment group 1.In the evaluation of TCM symptom curative effect, the cure rate of the group 2 was higher than that of the control group and the group 1.The effective rate of group 2 was significantly higher than that of group 1 (P< 0.05). After 12 weeks of treatment, MMSE scores in control group, group 1 and group 2 were significantly higher than those before treatment (P< 0.05). The score of diagnosis and curative effect of stroke in three groups decreased after treatment, and the difference was statistically significant (P<0.05). There were significant differences between control group, group 1 and group 2 (P< 0.05). Conclusion Jin's three-needle therapy combined with donepezil is effective in the treatment of PSCI.Acupuncture combined with medicine is more beneficial to the recovery of PSCI.

目的 探究乙型病毒性肝炎不同状态合并2型糖尿病患者的临床特点。方法 对62例乙型肝炎病毒携带合并2型糖尿病(组1)、129例乙型病毒性肝炎合并2型糖尿病(组2)和83例乙型病毒性肝炎肝硬化合并2型糖尿病(组3)患者的临床资料进行回顾性分析。结果 各组间在性别和年龄上差异有统计学意义(χ²=11.133、P=0.004,F=7.640、P=0.001)。3组研究对象糖化血红蛋白(HbA1c)、总胆固醇(Tch)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血清白蛋白(ALB)、总胆红素(TBIL)、直接胆红素(DBIL)、间接胆红素(IBIL)和总胆汁酸(TBA)水平差异有统计学意义(F=4.028、P=0.019,F=4.140、P=0.017,F=3.172、P=0.044,F=6.701、P=0.002,F=53.156、P<0.001,F=4.920、P=0.008,F=4.173、P=0.017,F=7.181、P=0.001,F=9.170、P<0.001)。进一步两两比较,肝炎肝硬化组HbA1c、Tch 、LDL-C、ALB水平降低,但TBIL、IBIL、TBA增高,分别与另2组比较差异有统计学意义(P<0.05);组2空腹血糖(FBG)、HDL-C水平最高,前者高于组1,后者高于组3。各组糖尿病并发症居前三的都是周围神经病变、糖尿病肾病和糖尿病视网膜病变。结论 乙型病毒性肝炎合并2型糖尿病时其不同状态间具有不同的疾病特点,主要体现在携带状态Tch、TG、LDL-C高水平,肝炎状态FBG高水平,肝炎肝硬化状态HbAlc、ALB低水平但胆红素、胆汁酸水平高,在糖尿病并发症方面均以周围神经病变、糖尿病肾病和糖尿病视网膜病变为主。

Objective To study the clinical feature of different viral hepatitis B status with type 2 diabetes. Methods A retrospective analysis was carried out on 62 hepatitis B virus carriers with type 2 diabetes (group 1),129 viral hepatitis B patients with type 2 diabetes (group 2) and 83 viral hepatitis B cirrhosis patients with type 2 diabetes (group 3). Results The differences in gender and age among the three groups were significantly different (χ²=11.133, P=0.004 and F=7.640,P=0.001). The levels of HbA1c, total cholesterol (Tch), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), serum albumin (ALB), total bilirubin(TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL)and total bile acid (TBA)in three groups were significantly different (F=4.028, P=0.019.F=4.140, P=0.017.F=3.172, P=0.044.F=6.701, P=0.002.F=53.156, P<0.001.F=4.920, P=0.008.F=4.173, P=0.017.F=7.181, P=0.001.F=9.170, P<0.001). In further pairwise comparison, the levels of HbA1c, Tch, LDL-C and ALB of group 3 decreased significantly compared with other two groups, but the levels of TBIL, IBIL and TBA increased, with significant differences.The levels of fasting blood glucose(FBG) and HDL-C in group 2 were the highest,and the FBG was significantly higher than that in group 1, while the HDL-C was significantly higher than that in group 3.In the three groups, the top three diabetic complications were peripheral neuropathy, diabetic nephropathy and diabetic retinopathy. Conclusion Different statuses of viral hepatitis B with type 2 diabetes had different disease characteristics, mainly reflected in the high levels of Tch, TG and LDL-C in the hepatitis B virus carriers, high FBG level in the viral hepatitis B patients, low levels of HbAlc and ALB but high levels of bilirubin and bile acid in the cirrhosis patients.Peripheral neuropathy, diabetic nephropathy and diabetic retinopathy were the main complications of diabetes.

目的 为初步评估在无创辅助通气基础上进行雾化肺表面活性物质(AS)治疗呼吸窘迫综合征(RDS)早产儿的安全性及效果,开展了此项临床研究。方法 2019年7月—2020年6月,经监护人知情同意,符合入选标准的RDS早产儿,入院后在经鼻间歇正压通气(NIPPV)基础上,通过振动筛网雾化器系统给予100 mg/kg注射用牛肺表面活性剂,雾化完毕继续无创辅助通气。详细观察及记录患儿在雾化初期的生命体征及血气分析结果,记录在雾化治疗期间不良反应发生情况以及患儿病情转归情况。结果 20例患儿参与研究,1例出生后26天死亡,其余均存活出院。5例在AS治疗后3天内无创辅助通气失败。和雾化前比较,AS治疗后1小时患儿血气分析主要指标均改善,血氧饱和度上升,心率下降(P＜0.05),但血压及呼吸机参数无明显变化(P＞0.05)。在雾化过程中,所有患儿无明显不良反应发生。结论 此项临床研究初步显示AS联合无创辅助通气治疗早产儿RDS是安全可行的,但尚需进一步临床研究评估其效果。

Objective To evaluate the safety and efficacy of non-invasive ventilation with aerosolized surfactant (AS) in the treatment of premature infants with respiratory distress syndrome (RDS). Methods From July 2019 to June 2020, in this unblinded Phase I study, the premature infants with RDS who met the criteria with the informed consent of their guardians were enrolled. They were treated with nasal intermittent positive pressure ventilation (NIPPV) and received one dose (100 mg/kg) of aerosolized surfactant by vibrating mesh system (Aeroneb Solo) after hospitalization. The vital signs, adverse reactions and blood gas during areosolizing were recorded and prognosis of them also recorded in detail. Results Twenty infants were enrolled, nineteen completed the study, one died in 26 days. Five infants still required endotracheal intubation and mechanical ventilation after AS treatment. One hour after AS treatment, infants' oxygen saturation and indicators of pulse oximetry improved (P＜0.05), and heart rate decreased (P＜0.05) , but blood pressure and parameters of ventilator had no change (P＞0.05). Infants all tolerated the aerosol treatment well. No other significant adverse events were identified. Conclusion We have demonstrated the feasibility and safety of AS treatment in preterm infants with RDS receiving non-invasive respiratory support. The treatment was well tolerated by infants and clinical caregivers , but still need further study.

目的 探讨臂丛神经阻滞和关节腔内注射局麻药联合应用在肩关节镜手术中的应用价值。方法 对肩关节镜手术患者100例进行研究,2018年8月—2020年8月入组,根据随机数字表法分组处理,对照组和观察组各为50例,前者用臂丛神经阻滞,后者与关节腔内注射局麻药联合,比较2组麻醉效果、不同阶段疼痛程度、肩关节功能。另对比2组不良反应。结果 观察组麻醉起效时间、苏醒时间和拔管时间分别为(10.72±2.45)min、(8.21±1.32)min和(9.52±1.12)min,与对照组对应指标有差异(P<0.05);2组术前疼痛程度和肩关节功能对比无差异(P>0.05),观察组术后6 h、术后24 h和术后48 h疼痛评分依次为(1.31±0.27)分、(2.87±0.52)分和(3.44±0.42)分,术后6 h、术后12 h、术后24 h和术后48 h镇静评分分别为(2.92±0.32)分、(2.54±0.24)分、(2.38±0.12)分和(2.27±0.15)分,术后1周、1个月和3个月的肩关节功能评分分别为(50.12±4.54)分、(56.18±4.12)分和(73.16±4.78)分,较之于对照组有差异(P<0.05);对照组和观察组出现不良反应的概率分别为18.00%和4.00%(P<0.05)。 结论 在肩关节镜手术中联合应用臂丛神经阻滞联合关节腔内注射局麻药麻醉方式,可提高麻醉效果,术后镇痛和镇静效果明显,也可减少不良反应,对患者肩关节功能改善作用明显,存在广泛应用价值。

目的 对比分析电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效。方法 将我院2018年11月—2020年11月间收治的92例胸腺瘤患者作为本次实验案例,根据随机双盲原则进行分组,其中对照组46例患者采用传统开胸手术治疗,观察组46例患者采用电视胸腔镜手术治疗,对于2组患者治疗中的临床疗效进行对比分析。结果 观察组术后的肺功能指标下降幅度小于对照组,且观察组的手术时间、胸管引流时间、下床活动时间、住院时间均短于对照组,出血量、引流量低于对照组,切口长度小于对照组,P＜0.05,组间指标数据存在统计学差异。结论 电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效相比,前者具有明显的优势,创伤小、恢复快、对于患者肺功能的影响更小。

目的 使用金标免疫层析法检测儿童腹泻粪便标本,将其轮状病毒的结果进行分析汇总。方法 选取本院2020年1月—2021年1月收治的86例儿童腹泻者,根据金标免疫层析法的检测方式,将检测结果为阳性者的轮状病毒粪便标本进行回顾性分析。将86例阳性者的轮状病毒粪便标本送往我市疾控中心,采用逆转录-聚合酶链式反应(RT-PCR)进行检测,分析对比检测情况。结果 86例儿童腹泻感染经金标免疫检测为阳性者80例,阳性率为93.02%,同时将86例粪便标本送往本市疾控中心采用RT-PCR检测验证70例阳性,轮状病毒阳性率为81.39%,两种检测方法相比,金标免疫检测结果其准确度更高;80例阳性者中,1岁以下的婴幼儿为31例,占38.75%,较为多见,其次为1岁、2岁的儿童,各占23.75%、25.00%。季节性以秋季和冬季为轮状病毒的高发期,11-12月份36例,占45.00%,1-2月、9-10月18例、16例,占22.50%、20.00%;男女性别比中2组阳性率比较,经统计学分析无明显差异性(χ²=2.500,P＞0.05)。结论 轮状病毒多以5岁以下的婴幼儿为主,秋冬季节较为常见,采取金标免疫层析法的检测方式,来检测儿童的粪便标本,其操作简单,可快速准确地检测出轮状病毒,且该方法具有一定的临床诊断价值,值得推广应用。

目的 系统评价胰岛素联用α-葡萄糖苷酶抑制剂(AGIs)治疗成人1型糖尿病(T1DM)的疗效和安全性。方法 检索中英文数据库,纳入关于胰岛素联用AGIs治疗成人T1DM患者的随机或非随机对照试验。使用Review Manager 5.3软件进行Meta分析。结果 共纳入10项研究,616例患者。与安慰剂或空白对照相比,在有效性方面,胰岛素联合AGIs可改善成人T1DM患者的糖化血红蛋白;降低平均血糖、空腹血糖和餐后2小时血糖;改善血糖波动情况,包括平均血糖波动幅度和最大血糖波动幅度(均P<0.05)。在安全性方面,AGIs增加总不良反应发生的风险(P<0.05),其中主要是胃肠道不适,但未增加低血糖的发生率和发生次数(均P>0.05)。胰岛素联合AGIs减少了每日胰岛素总剂量(P<0.05),但对体重、甘油三酯和高密度脂蛋白胆固醇无显著影响(均P>0.05)。结论 胰岛素联合AGIs可降低成人T1DM患者的糖化血红蛋白,改善血糖水平和血糖波动情况。AGIs不会增加低血糖的风险,但需重视其不良反应,特别是胃肠道不良反应。

Objective To systematically evaluate the efficacy and safety of adding alpha-glucosidase inhibitors (AGIs) to insulin therapy in adult patients with type 1 diabetes (T1DM). Methods Articles about randomized or non-randomized controlled trials of insulin combined with AGIs in adult patients with T1DM were retrieved from Chinese and English database. Meta-analyses were performed by using Review Manager 5.3. Results A total of 616 patients were included from 10 clinical trials. Compared with adding placebo or nothing, in terms of efficacy, the addition of AGIs resulted in decreased HbA1c, mean blood glucose, fasting plasma blood glucose and 2-hour postprandial blood glucose levels (all P<0.05). And this scheme improved the glucose variability including mean amplitude of glycemic excursions and the largest amplitude of glycemic excursions (P<0.05, respectively). As to safety, AGIs increased the risk of total adverse reactions (P<0.05), most of them were gastrointestinal complaints, while the occurrence and the frequency of hypoglycemia were similar (P>0.05, respectively). This scheme could also lead to the reduced total daily insulin dose (P<0.05) but had no significant effect on body weight, triglyceride or cholesterol concentration (P>0.05, respectively). Conclusions The addition of AGIs to insulin therapy in adult patients with T1DM may reduce HbA1c and improve the glucose levels and glucose variability. But total adverse effects especially the gastrointestinal complaints should also be considered in the use of AGIs although it does not increase the risk of hypoglycemia.

目的 回顾性分析CT血管成像(CTA)在急诊出血性脑卒中患者中,在病因诊断、病程进展评估中的应用。方法 89例头颅平扫初诊急性出血性脑卒中病人,行CTA检查,通过后处理技术,对各种出血原因进行影像学特征分析,并根据图像特征评估血肿的稳定性,在24小时内复查CT平扫了解出血的发展。结果 89例急诊脑出血患者,CTA检查中83例病因明确,并采取相应的临床处理。5例(5.6%)病因不明确,以蛛网膜下腔出血患者为主,需临床进一步全面检查。1例患者不配合造影检查失败。CT平扫发现不稳定血肿22例,复查血肿增大16例,准确率72.2%。CTA判断血肿内持续出血患者14例,复查13例患者有血肿增大,准确率为92.8%。结论 CT平扫只能评估血肿的稳定性,而CTA出现血肿内高密度影时,高度提示血肿内出血仍在持续。急诊医生可通过CTA对脑出血患者进行病因的分析、病程的预估、及时诊断、定位,对指导治疗及手术方式有重要作用。

Objective To retrospectively analyze the value of computed tomographic angiography (CTA) on etiological diagnosis and progression evaluation in patients with emergent hemorrhagic stroke. Methods Eighty-nine patients with preliminary diagnosis of acute hemorrhagic stroke underwent CTA, then various bleeding causes were analyzed by post-processing.The stability of hematoma was evaluated according to the image features.Follow-up CT in 24 h were performed to show the development of hemorrhage. Results In 89 cases of patients with emergent cerebral hemorrhage, 83 cases had made clear diagnosis according to CTA, then the patients received specialized clinical management.The causes of hemorrhage were not clear in 5 cases (5.6%), and subarachnoid hemorrhage was found in the most of these patients, requiring further examination.Twenty-two cases of unstable hematoma were found by CT scan, and hematoma enlarged in 16 cases in follow-up scan, with an accuracy of 72.2%.Fourteen patients were diagnosed as persistent bleeding hematoma by CTA, among them 13 patients showed hematoma enlargement, with an accuracy of 92.8%. Conclusions CT scan can only evaluate the stability of the hematoma, but the CTA high density in the hematoma strongly suggests persistent bleeding in the hematoma.Emergency doctors can analyze the cause of cerebral hemorrhage, assess the progression of disease, timely diagnose, locate the bleeding point by CTA, and there is important value in guidance of treatment and surgical methods.