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 探讨地西他滨(DAC)联合沙利度胺对骨髓增生异常综合征(MDS)患者的病态造血及疗效的影响。方法 以本院自2014年6月—2020年5月收治的MDS患者为研究总体,行便利抽样法选择60例于收治期间行输血、抗感染及诸如促红生成素 (EPO)+集落刺激因子(CSF)等细胞因子治疗效果不佳的MDS开展研究,按完全区化原则设立对照组及观察组,予以对照组沙利度胺治疗,观察组则于对照组基础上施予地西他滨(DAC)行联合治疗,比较2组疗效、血象相关指标、病态造血改善情况及预后转归。结果 观察组ORR为51.61%,与对照组的26.67%相比更高,差异有统计学意义(P<0.05);经治疗,2组血小板计数(PLT)、血红蛋白(HGB)、中性粒细胞计数(ANC)水平均见一定程度上升,骨髓原始细胞(bls)水平则见下降,观察组PLT、HGB、ANC相较于对照组更高,bls水平则更低(P<0.05);于2020年5月截止随访,随访时间8~96个月,中位随访时间68个月。于治疗及随访中行骨髓形态检查及染色体核型鉴别均表现正常。关于病态造血改善情况,2组T1率比较,差异无统计学意义(P>0.05);观察组国际预后积分系统评分整体优于对照组(P<0.05);2组Ⅰ~Ⅳ级不良反应比较,差异无统计学意义(P>0.05);观察组5年总生存时间率为63.33%,相较于对照组的36.67%更高(P<0.05)。结论 相较于单一沙利度胺治疗,应用地西他滨联合沙利度胺治疗MDS,疗效更为确切,且可改善血象指标,拥有一定T1率,且预后转归表现较好。

Objective To investigate the impact of decitabine (DAC) combined with thalidomide on dyshaematopoiesis and efficacy in patients with myelodysplastic syndrome (MDS). Methods Patients with MDS admitted to our hospital from June 2014 to May 2020 were selected as the research population.Among them, 60 MDS cases were selected by convenience sampling method, which had poor therapeutic effect with treatment of blood transfusion, anti-infection and cytokines treatments such as erythropoietin (EPO)+ colony stimulating factor (CSF). The control group and the observation group were set up according to the principle of complete block, and the control group was treated with thalidomide while the observation group was treated with decitabine (DAC) on the basis of the control group.The efficacy, hemogram-related indicators, improvement of dyshaematopoiesis and prognosis outcomes were compared between the two groups. Results The overall response rate (ORR) of the observation group was higher than that of the control group (51.61%vs 26.67%, P<0.05). After treatment, the levels of platelet (PLT), hemoglobin (HGB) and absolute neutrophil count (ANC) in the two groups were increased to a certain extent while the level of bone marrow blasts(bls) was decreased, and the levels of PLT, HGB and ANC of the observation group were higher than those of the control group while the level of bls was lower (P<0.05). The follow-up deadline was May 2020, and the follow-up time was 8-96 months and the median follow-up time was 68 months.During treatment and follow-up, bone marrow morphology examination and chromosome karyotype identification results were normal.Regarding the improvement of dyshaematopoiesis, the difference in T1 rate between the two groups was not statistically significant (P>0.05). The revised International Prognostic Scoring System prognosis score of the observation group was better than that of the control group (P<0.05). There were no statistically significant differences between the two groups in terms of grade I~IV adverse reactions (P>0.05). The 5-year overall survival rate of the observation group was 63.33%, which was higher than 36.67%of the control group (P<0.05). Conclusion Compared with thalidomide only treatment, the application of decitabine combined with thalidomide in the treatment of MDS had a more accurate efficacy, improved hemogram indicators, and had a certain T1 rate and good prognosis outcomes.

目的 探讨老年吸入性肺炎的危险因素,建立风险预测模型,以期降低老年吸入性肺炎的发病率。方法 选取2017年8月28日—2020年 10月30日广州市第一人民医院老年病科住院治疗的老年肺炎患者205例,按照是否发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,对比2组患者的各项指标,分析老年吸入性肺炎的危险因素,建立风险预测模型,采用ROC曲线对模型进行预测效果检验。结果 多因素Logistic回归分析结果显示,脑梗塞、帕金森、留置胃管、长期卧床为老年吸入性肺炎的危险因素(P<0.05)。模型公式为Logit(P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀。该模型ROC曲线下面积为0.894。结论 本研究中的模型预测效果良好,可为医护人员预测老年患者发生吸入性肺炎的概率,及时采取相应的预见性护理及干预性治疗。

Objective To explore the risk factors of aspiration pneumonia in the elderly and establish the risk prediction model, in order to reduce the incidence of aspiration pneumonia in the elderly. Methods A total of 205 elderly patients with pneumonia who were hospitalized in the department of geriatrics, Guangzhou First People's Hospital from August 28, 2017 to October 30, 2020, were divided into aspiration pneumonia group and non-aspiration pneumonia group according to whether aspiration pneumonia occurred. The indicators of the two groups of patients were compared, the risk factors of aspiration pneumonia in the elderly were analyzed, the risk prediction model was established, and the prediction effect of the model was tested by receiver operating characteristic curve. Results Multivariate Logistic regression analysis showed that cerebral infarction, Parkinson's disease, indwelling nasogastric tube, and being bedridden were risk factors for aspiration pneumonia in elderly patients (P<0.05). The model formula was Logit (P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀. The area under receiver operating characteristic curve of this model was 0.894. Conclusion The prediction effect of the model in this study was good, which could predict the probability of aspiration pneumonia in elderly patients for medical staff, and to timely take the corresponding predictive care and interventional treatment.

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 探究2型糖尿病患者的肾糖阈(RTG)及相关因素。方法 本院对2014年12月—2018年9月466例2型糖尿病患者为研究对象,正常肾糖阀值为8.9～10 mmol/L,据此将患者分为高阀值组、中等阀值组以及低阀值组,不同组肾糖范围分别为RTG＞10 mmol/L、8.9 mmol/L≤RTG≤10 mmol/L、RTG＜8.9 mmol/L,以此对各组生化特征进行分析。结果 高阀值组与中等阀值组相比,RTG值、年龄、病程、空腹血糖(FPG)、体质量指数(BMI)、总胆固醇(TC)、血糖均值(MBG)、24 h血糖对比差异明显,P＜0.05。高阀值组与低阀值组相比,RTG值、性别、FPG、BMI、TC、MBG、糖化血红蛋白(HbA1C)对比有差异,P＜0.05。性别、年龄、BMI、HbA1C、TC以及低密度酶蛋白胆固醇(LDL-C)与2型糖尿病相关,且呈正比关系,P＜0.05;通过多元线性回归分析发现,2型糖尿病的影响因素主要有BMI、HbA1C、LDL-C,数据具有统计学意义,P＜0.05。结论 较多2型糖尿病患者肾糖阀值较高,且肾糖阀值与HbA1C、LDL-C相关。

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。