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中国临床实用医学
中国临床实用医学杂志社编辑部
中国临床实用医学

中国临床实用医学杂志社编辑部

王兆发

月刊

1673-8799

zglcsyyx@tom.com

010-64299468

100013

北京市东城区和平里七区16号楼449室

中国临床实用医学/Journal China Clinical Practical Medicine
查看更多>>本刊为国内外公开发行的专业性学术期刊，以广大临床医务工作者为读者对象，报道医疗领域内领先的科研成果和临床诊疗经验，帮助广大临床医师提高学术水平，解决在临床中遇到的具体问题。办刊宗旨：促进医学学术交流，加速医疗卫生技术成果推广，普及新理论、新方法，为临床教学科研服务。2007年中华医学会与万方数据携手推动医药信息服务，该刊电子版已独家授权万方数据来实现其数字化服务推广。
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    多模态影像技术对不同病理类型肺癌患者骨转移的诊断及转移灶分布特点分析

    杨卷红吴博云崔丝雨童丽...
    1-6页
    查看更多>>摘要：目的 探讨多模态影像技术对不同病理类型肺癌患者骨转移的诊断效能及转移灶的分布特点。 方法 本研究为队列研究，选取2020年3月至2021年4月宝鸡市中心医院肿瘤科收治的632例肺癌患者，男480例，女152例，年龄(63.5±8.39)岁，年龄范围为38～84岁。患者分别行胸部CT检查及全身骨显像检查并行图像分析，统计患者的肺癌骨转移情况，比较胸部CT检查、全身骨显像检查及胸部CT检查联合全身骨显像检查(联合检查)的诊断效能及其一致性。 结果 632例患者中，肺鳞癌221例，肺腺癌251例，小细胞肺癌160例，骨转移164例。联合检查的灵敏度[98.8%(162/164)]及阴性预测值[99.5%(436/438)]高于全身骨显像检查[95.7%(157/164)、98.1%(418/425)]及胸部CT检查[61.6%(101/164)、88.1%(465/528)]、漏诊率[1.2%(2/164)]低于全身骨显像检查[4.3%(7/164)]及胸部CT检查[38.4%(63/164)]。肺腺癌患者的胸部CT检查(Kappa＝0.707)、全身骨显像检查(Kappa＝0.832)及联合检查(Kappa＝0.906)一致性优于小细胞肺癌患者(Kappa＝0.668、Kappa＝0.800、Kappa＝0.855)及肺鳞癌患者(Kappa＝0.629、Kappa＝0.642、Kappa＝0.783)；联合检查的一致性优于全身骨显像检查及胸部CT检查。肺鳞癌[13.6%(30/221)]、肺腺癌[35.5%(89/251)]、小细胞肺癌[28.1%(45/160)]骨转移发生率比较，差异有统计学意义(P<0.05)。肺鳞癌骨转移单发于胸廓骨[40.0%(12/30)]、脊柱骨[20.0%(6/30)]及四肢骨[3.3%(1/30)]，单部位骨转移率为63.3%(19/30)，多部位骨转移率为36.7%(11/30)；肺腺癌骨转移单发于胸廓骨[11.2%(10/89)]、脊柱骨[9.0%(8/89)]、四肢骨[3.4%(3/89)]及骨盆骨[2.2%(2/89)]，单部位骨转移率为25.8%(23/89)，多部位骨转移率为74.2%(66/89)；小细胞肺癌骨转移单发于胸廓骨[4.4%(2/45)]、脊柱骨[4.4%(2/45)]及四肢骨[2.2%(1/45)]，单部位骨转移率为11.1%(5/45)，多部位骨转移率为88.9%(40/45)。 结论 联合检查的灵敏度、阴性预测值及漏诊率优于全身骨扫描检查及胸部CT检查，肺腺癌的检查一致性优于小细胞肺癌及肺鳞癌，联合检查的一致性优于全身骨显像检查及胸部CT检查。肺鳞癌多单发于胸廓骨或脊柱骨，而小细胞肺癌骨转移常好发于多个部位，肺腺癌次之。 Objective To investigate the diagnostic efficacy of multimodal imaging in bone metastases of lung cancer patients with different pathological types and the distribution characteristics of metastases. Methods This study was a cohort study, a total of 632 patients with lung cancer were selected from the department of Medical Oncology in Baoji Centeral Hospital from March 2020 to April 2021, including 480 males and 152 females, aged(63.5±8.39)years old, ranging form 38 to 84 years old.The patients underwent chest CT examination and systemic bone imaging examination and parallel image analysis, counted the bone metastasis of lung cancer, and compared the diagnostic efficacy and consistency of chest CT examination, systemic bone imaging examination and chest CT examination combined with systemic bone imaging examination(combined examination). Results Of the 632 patients, including 221 patients had pulmonary squamous cell carcinoma and 251 patients had pulmonary adenocarcinoma and 160 patients had small cell lung carcinoma, with 164 patients had bone metastasis.The sensitivity[98.8%(162/164)]and negative predictive value[99.5%(436/438)]of combined examination were higher than those of whole body bone imaging[95.7%(157/164), 98.1%(418/425)]and chest CT[61.6%(101/164), 88.1%(465/528)], and the rate of missed diagnosis [1.2%(2/164)]was lower than those of whole body bone imaging[4.3%(7/164)]and chest CT[38.4%(63/164)].The consistency of chest CT(Kappa=0.707), body bone imaging(Kappa=0.832)and combined examination(Kappa=0.906)in patients with pulmonary adenocarcinoma was better than that in patients with small cell lung carcinoma(Kappa=0.668, Kappa=0.800, Kappa=0.855)and pulmonary squamous cell carcinoma(Kappa=0.629, Kappa=0.642, Kappa=0.783).The consistency of combined examination was better than that of whole body bone imaging and chest CT.The incidence of bone metastasis among pulmonary squamous cell carcinoma[13.6%(30/221)], pulmonary adenocarcinoma[35.5%(89/251)]and small cell lung carcinomathe[28.1%(45/160)]compare, differences were statistically significant(P<0.05).The bone metastasis of pulmonary squamous cell carcinoma occurred in thoracic bone[40.0%(12/30)], spine bone[20.0%(6/30)]and limbs bone[3.3%(1/30)], the single site metastasis rate was 63.3%(19/30), and the multiple site bone metastasis rate was 36.7%(11/30).The bone metastasis of pulmonary adenocarcinoma in thoracic bone[11.2%(10/89)], spine bone[9.0%(8/89)], limbs bone[3.4%(3/89)]and pelvis bone[2.2%(2/89)], the single site metastasis rate was 25.8%(23/89), and the multiple site bone metastasis rate was 74.2%(66/89).Small cell lung carcinoma bone metastases occur in the sternum bone[4.4%(2/45)], spine bone[4.4%(2/45)], and extremities bone[2.2%(1/45)], the single site metastasis rate was 11.1%(5/45), and the multiple site bone metastasis rate was 88.9%(40/45). Conclusions The sensitivity, negative predictive value and missed diagnosis rate of combined examination were superior to those of systemic bone imaging examination and chest CT, and the consistency of pulmonary adenocarcinoma was superior to that of small cell lung carcinoma and pulmonary squamous cell carcinoma, the consistency of combined examination was better than that of whole body bone imaging and chest CT.Pulmonary squamous cell carcinoma mostly occurs in the thoracic bone or spine, while metastasis of the small cell lung carcinoma bone usually occurs in multiple sites, followed by pulmonary adenocarcinoma.

    肺癌肺癌骨转移全身骨显像检查胸部CT检查骨转移灶

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    子宫动脉下行支结扎术联合子宫下段压迫缩窄缝合治疗凶险性前置胎盘剖宫产术中出血的临床效果

    张萍索辉王园园秦婷...
    7-11页
    查看更多>>摘要：目的 探究子宫动脉下行支结扎术(DUAL)联合子宫下段压迫缩窄缝合(LUCS)治疗凶险性前置胎盘(PPP)患者剖宫产术中出血的临床效果。 方法 本研究为病例对照研究，选取2020年6月至2023年6月开封一五五医院妇产科收治的100例PPP剖宫产术中出血患者，年龄(34.21±3.57)岁，年龄范围为24～42岁。根据不同的止血方法将患者分为B-Lynch缝合组与DUAL联合LUCS组，每组50例。B-Lynch缝合组采用改良B-Lynch缝合术及子宫下段纱布填塞进行止血，DUAL联合LUCS组采用DUAL术与LUCS进行止血。比较两组患者子宫切除率、子宫动脉栓塞率、手术用时、术中出血量、术后24 h失血量、术中输血量、住院时间、缩宫素、卡前列素氨丁三醇使用情况、恶露持续时间及术后并发症发生情况。 结果 DUAL联合LUCS组患者子宫切除率[4.0%(2/50)]及子宫动脉栓塞率[6.0%(3/50)]均低于B-Lynch缝合组[16.0%(8/50)、22.0%(11/50)]，差异有统计学意义(P<0.05)。DUAL联合LUCS组患者手术用时[(88.75±4.94)min]、术中出血量[(1 247.13±108.66)ml]、术后24 h出血量[(1 550.14±110.55)ml]、术中输血量[(703.52±89.31)ml]均少于B-Lynch缝合组[(108.95±5.25)min、(1 667.54±134.67)ml、(2 160.88±154.56)ml、(1 051.42±102.65)ml]，差异有统计学意义(P<0.05)。DUAL联合LUCS组患者缩宫素使用量及恶露持续时间与B-Lynch缝合组比较，差异无统计学意义(P>0.05)；DUAL联合LUCS组患者住院时间[(9.66±2.21)d]短于B-Lynch缝合组[(12.85±2.23)d]，卡前列素氨丁三醇使用量[(557.31±36.97)μg]少于B-Lynch缝合组[(723.56±52.14)μg]，差异有统计学意义(P<0.05)。DUAL联合LUCS组患者并发症发生率与B-Lynch缝合组比较，差异无统计学意义(P>0.05)。 结论 DUAL联合LUCS用于PPP剖宫产术中出血患者可快速止血，手术时间短，可减少术中及术后24 h失血量，减少子宫切除及子宫动脉栓塞的发生，缩短手术用时及住院时间，且具有较好的手术安全性，可用于PPP剖宫产术中出血患者的治疗。 Objective To investigate the clinical effect of descending uterine artery ligation(DUAL)combined with lower uterine compression suture(LUCS)in the treatment of hemorrhage during cesarean section in patients with dangerous placenta previa(PPP). Methods This study was a case-control study, a total of 100 patients with hemorrhage during PPP cesarean section were selected from the department of Obstetrics and Gynecology of Kaifeng 155 Hospital from June 2020 to June 2023, aged(34.21±3.57)years old, ranging from 24 to 42 years old.According to different hemostatic methods, the patients were divided into B-Lynch suture group and DUAL combined LUCS group, 50 cases in each group.B-Lynch suture group received modified B-Lynch suture and lower uterine gauze tamponage for hemostasis, while the DUAL combined with LUCS group received DUAL and LUCS for hemostasis.The hysterectomy rate, uterine artery embolization rate, operation time, intraoperative blood loss, 24 h postoperative blood loss, intraoperative blood transfusion, length of hospital stay, use of oxytocin, carprost tramine, duration of lochia and postoperative complications were compared between the two groups. Results The hysterectomy rate[4.0%(2/50)]and uterine artery embolization rate [6.0%(3/50)]in DUAL combined LUCS group were lower than those in B-Lynch suture group [16.0%(8/50)and 22.0%(11/50)], and the difference was statistically significant(P<0.05).Operation time [(88.75±4.94)min], intraoperative blood loss [(1 247.13±108.66)ml], 24 h postoperative blood loss [(1 550.14±110.55)ml], the amount of intraoperative blood transfusion [(703.52±89.31)ml]in DUAL combined LUCS group were lower than those in B-Lynch suture group [(108.95±5.25)min, (1 667.54±134.67)ml, (2 160.88±154.56)ml, (1 051.42±102.65)ml], the differences were statistically significant(P<0.05).There was no significant difference in the amount of oxytocin and duration of lochia in DUAL combined LUCS group compared with B-Lynch suture group(P>0.05).The length of hospital stay [(9.66±2.21)d]in DUAL combined LUCS group was shorter than that in B-Lynch suture group [(12.85±2.23)d], and the amount of carprost troamine [(557.31±36.97)μg]was lower than that in B-Lynch suture group [(723.56±52.14)μg], the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between DUAL combined LUCS group and B-Lynch suture group(P>0.05). Conclusions DUAL combined with LUCS can be used for rapid hemostasis in patients with bleeding during PPP cesarean section, short operation time, reduce intraoperative and postoperative 24 h blood loss, reduce the occurrence of hysterectomy and uterine artery embolization, shorten the operation time and hospital stay, and have good surgical safety, which can be used for the treatment of patients with bleeding during PPP cesarean section.

    凶险性前置胎盘子宫动脉下行支结扎术子宫下段压迫缩窄缝合改良B-Lynch缝合术临床治疗效果

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    二尖瓣置换术后患者新发心房颤动与心脏迷走神经功能变化的相关性研究

    王镜涵李保银张誉籍张丹阳...
    12-15页
    查看更多>>摘要：目的 探讨因单纯二尖瓣关闭不全行二尖瓣置换术(MVR)发生术后心房颤动(POAF)与心脏迷走神经功能变化的关系。 方法 本研究为病例对照研究，选取2020年3月至2023年7月北部战区总医院心血管外科收治的290例因二尖瓣关闭不全需行MVR出现POAF的患者，男160例，女130例，年龄(58.20±10.53)岁，年龄范围为48～77岁。根据术后心脏相邻RR间期差值的平方根(RMSSD)指标将患者分为迷走神经功能减低组(RMSSD<15 ms，n＝78)、迷走神经功能正常组(RMSSD为15～39 ms，n＝182)和迷走神经功能亢进组(RMSSD>39 ms，n＝30)。观察患者MVR围术期RMSSD变化趋势，分析围术期迷走神经功能改变和MVR发生POAF的关系。 结果 290例患者术前7 d的RMSSD指标[(26.48±13.81)ms]高于术后7 d[(23.73±12.79)ms]，差异有统计学意义(P<0.05)。迷走神经功能减低组术后RMSSD指标[(12.15±1.91)ms]低于术前[(13.39±1.35)ms]，迷走神经功能正常组术后RMSSD指标[(23.97±6.39)ms]低于术前[(24.15±5.90)ms]，迷走神经功能亢进组术后RMSSD指标[(52.36±12.53)ms]低于术前[(56.34±20.29)ms]，差异均有统计学意义(P<0.05)。迷走神经功能减低组患者的POAF发生率[34.6%(27/78)]低于迷走神经功能正常组[52.2%(95/182)]，差异有统计学意义(P<0.05)；迷走神经功能亢进组的POAF发生率[43.3%(13/30)]低于迷走神经功能正常组，差异无统计学意义(P>0.05)；迷走神经功能亢进组的POAF发生率高于迷走神经功能减低组，差异无统计学意义(P>0.05)。 结论 MVR术后患者心脏迷走神经功能变化和POAF的关系是非线性的，术后迷走神经功能正常时心房颤动发生率更高。 Objective To investigate the relationship between postoperative atrial fibrillation(POAF)and vagal nerve function after mitral valve replacement(MVR)due to simple mitral valve insufficiency. Methods This study was a case-control study, a total of 290 patients with POAF due to MVR who were selected from the department of Cardiovascular Surgery of General Hospital of Northern Theater Command from March 2020 to July 2023, including 160 males and 130 females, aged(58.20±10.53)years old, ranging form 48 to 77 years old.Patients were divided into reduced vagus function group [root mean square of difference-value of adjacent RR interval(RMSSD)<15 ms,n=78)], normal vagus function group(RMSSD 15 to 39 ms, n=182)and hypervagus function group(RMSSD>39 ms,n=30)according to the RMSSD.To observe the change trend of RMSSD in patients with MVR during perioperative period, and analyze the relationship between the change of vagus nerve function and POAF in MVR. Results The RMSSD index of 290 patients 7 days before surgery [(26.48±13.81)ms]was higher than that 7 days after surgery [(23.73±12.79)ms], and the difference was statistically significant(P<0.05).The RMSSD indexes of the three groups were lower after surgery than before surgery.The postoperative RMSSD index [(12.15±1.91)ms]in the vagus nerve reduction group was lower than that before operation [(13.39±1.35)ms], the postoperative RMSSD index [(23.97±6.39)ms]in the normal vagus nerve function group was lower than that before operation [(24.15±5.90)ms], and the postoperative RMSSD index[(52.36±12.53)ms]in the vagus hyperfunction group was lower than that before surgery [(56.34±20.29)ms], the difference was statistically significant(P<0.05).The incidence of POAF in the reduced vagus nerve function group [34.6%(27/78)]was significantly lower than that in the normal vagus nerve function group [52.2%(95/182)], and the difference was statistically significant(P<0.05).The incidence of POAF in hypervagus group [43.3%(13/30)]was lower than that in normal vagus group, and the difference was not statistically significant(P>0.05).The incidence of POAF in the hypervagus group was higher than that in the hypovagus group, and the difference was not statistically significant(P>0.05). Conclusions The relationship between vagal function and new-onset atrial fibrillation in patients after MVR is nonlinear, and the incidence of atrial fibrillation is higher when the postoperative vagus nerve function is normal.

    二尖瓣置换术术后心房颤动相邻RR间期差值的平方根心脏迷走神经

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    血小板与淋巴细胞比值和乳酸脱氢酶与卡瑞利珠单抗治疗的晚期食管鳞癌患者预后的相关性研究

    尚皓天王莉张建国杨永亮...
    16-22页
    查看更多>>摘要：目的 探究中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、全身免疫炎症指数(SII)、乳酸脱氢酶(LDH)指标与接受卡瑞利珠单抗免疫治疗的晚期食管鳞癌患者预后的相关性。 方法 本研究为回顾性队列研究，选取2020年7月至2022年6月在连云港市第二人民医院肿瘤科收治的64例食管鳞癌患者，男12例，女52例，年龄68(63，74)岁，年龄范围为52～85岁。收集患者的一般资料和治疗前1周的外周血液指标，通过受试者操作特征曲线确定最佳截断值，采用Kaplan-Meier法进行生存分析，采用Cox比例风险模型对无进展生存期和总生存期分别进行单因素和多因素分析预后因素。 结果 NLR的曲线下面积为0.841，最佳截断值为4.6；PLR的曲线下面积为0.842，最佳截断值为194.5；SII的曲线下面积为0.792，最佳截断值是725.4；LDH的曲线下面积为0.731，最佳截断值为277.0 U/L。在Cox单因素分析中，LDH、NLR、SII与无进展生存期相关(P<0.05)，多因素分析结果提示LDH与无进展生存期独立相关(P<0.05)。在Cox单因素分析中，肿瘤分期、LDH、NLR、PLR、SII与总生存期相关(P<0.05)，多因素分析结果提示肿瘤分期、LDH、PLR与总生存期独立相关(P<0.05)。生存曲线分析显示，LDH≤277.0 U/L比LDH>277.0 U/L有较长的无进展生存期，LDH≤277.0 U/L比LDH>277.0 U/L有较长的总生存期，PLR≤194.5比PLR>194.5有较长的总生存期。联合指标的曲线下面积(0.876)高于单一LDH曲线下面积(0.713)和单一PLR曲线下面积(0.842)，表明LDH联合PLR的预测价值更高。 结论 LDH、PLR对晚期食管鳞癌患者接受卡瑞利珠单抗治疗预后有关，并且LDH联合PLR的预测价值高于单一指标，NLR、SII并未发现与预后有一定相关性。 Objective To investigate the correlation of neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), systemic immune-inflammation index(SII), lactate dehydrogenase(LDH)and prognosis of patients with advanced esophageal squamous cell carcinoma receiving immunotherapy with the camrelizumab. Methods This study was a retrospective cohort study, a total of 64 patients with advanced esophageal squamous cell carcinoma admitted to the department of Oncology in the Second People′s Hospital of Lianyungang from July 2020 to June 2022, including 12 males and 52 females, aged 68(63, 74)years old, age ranging from 52 to 85 years old.The general data of the patients and peripheral blood indexes 1 week before treatment were collected, the optimal cut-off value was determined by the receiver operator characteristic curve, the Kaplan-Meier method was used for survival analysis, and the Cox proportional risk model was used to analyze prognostic factors by univariate and multivariate analyses for progression-free survival and overall survival respectively. Results The area under the curve of NLR was 0.841, with an optimal cut-off value of 4.6 the area under the curve of PLR was 0.842, with an optimal cut-off value of 194.5 the area under the curve of SII was 0.792, with an optimal cut-off value of 725.4 and the area under the curve of LDH was 0.731, with an optimal cut-off value of 277.0 U/L.In the Cox univariate analysis, LDH, NLR, SII were associated with progression-free survival(P<0.05), and the results of multifactorial analysis suggested that LDH was independently associated with progression-free survival(P<0.05).In Cox univariate analysis, tumor stage, LDH, NLR, PLR, and SII were associated with overall survival(P<0.05), and the results of multifactorial analysis suggested that tumor stage, LDH, and PLR were independently associated with overall survival(P<0.05).Survival curve analysis showed that LDH≤277.0 U/L had a longer progression-free survival than LDH>277.0 U/L, LDH≤277.0 U/L had a longer overall survival than LDH>277.0 U/L, and PLR≤194.5 had a longer overall survival than PLR>194.5.The area under the curve of the combined index(0.876)was higher than the area under the curve of single LDH(0.713)and the area under the curve of single PLR(0.842), suggested that the predictive value of LDH combined with PLR was higher. Conclusions LDH and PLR were associated with prognosis in patients with advanced esophageal squamous cell carcinoma receiving immunotherapy with the camrelizumab, and the predictive value of LDH combined with PLR was higher than that of a single indicator, NLR and SII were not found to be associated with a certain prognosis.

    预后晚期食管鳞癌卡瑞利珠单抗免疫治疗炎症指数血小板与淋巴细胞比值

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    动脉瘤性蛛网膜下腔出血介入栓塞术后并发脑积水的危险因素分析

    曹晓璐揣春阳周梦赵甜...
    23-28页
    查看更多>>摘要：目的 分析动脉瘤性蛛网膜下腔出血(SAH)实施介入栓塞术后并发脑积水的危险因素。 方法 本研究为回顾性病例对照研究，选取2022年6月至2023年6月南阳医学高等专科学校第一附属医院神经内科收治的接受介入栓塞术治疗的106例动脉瘤性SAH患者，男56例，女50例，年龄(60.33±5.18)岁，年龄范围为42～78岁。比较术后并发脑积水患者及未并发脑积水患者的一般资料及临床资料，采用单因素及多因素logistic回归模型分析并发脑积水的危险因素。 结果 动脉瘤性SAH术后，并发脑积水患者46例，未并发脑积水患者60例。单因素分析结果显示，并发脑积水患者的年龄≥60岁[65.2%(30/46)]、合并高血压[50.0%(23/46)]、动脉瘤最大径≥5 mm[60.9%(28/46)]、入院时GCS评分≤8分[67.4%(31/46)]、动脉瘤位于椎基底动脉系统[69.6%(32/46)]、Hunt-hess分级为Ⅲ～Ⅴ级[84.8%(39/46)]、术后合并ICH[41.3%(19/46)]、术后合并脑室出血[43.5%(20/46)]、采用脑室外引流[67.4%(31/46)]占比均高于未并发脑积水患者[46.7%(28/60)、28.3%(17/60)、41.7%(25/60)、36.7%(22/60)、48.3%(29/60)、50.0%(30/60)、33.3%(20/60)、25.0%(15/60)、21.7%(13/60)、43.3%(26/60)]，差异有统计学意义(P<0.05)。logistic多因素回归分析结果显示，年龄≥60岁(OR＝3.363，95%CI：1.339～8.414)、合并高血压(OR＝3.803，95%CI：1.614～8.669)、动脉瘤位于颈内动脉系统(OR＝1.938，95%CI：1.326～7.661)、Hunt－hess为Ⅲ～Ⅴ级(OR＝4.874，95%CI：1.288～8.617)、合并ICH(OR＝9.801，95%CI：1.233～9.916)、合并脑室出血(OR＝2.806，95%CI：1.252～8.931)、采用脑室外或腰大池引流(OR＝5.807，95%CI：1.331～9.445)为导致患者术后并发脑积水的独立危险因素(P<0.05)。 结论 年龄≥60岁、合并高血压、动脉瘤位于椎基底动脉系统、Hunt-hess为Ⅲ～Ⅴ级、合并ICH、合并脑室出血、采用脑室外引流为导致患者术后并发脑积水的独立危险因素。 Objective Analyze the risk factors of hydrocephalus after interventional thrombectomy for arterial subarachnoid hemorrhage(SAH). Methods This study was a retrospective case-control study, a total of 106 patients with aneurysmal SAH who underwent interventional embolization treatment were selected from the department of Neurology in the First Affiliated Hospital of Nanyang Medical College from June 2022 to June 2023, aged(60.33±5.18)years old, ranging form 42 to 78 years old.Compare the general and clinical data of postoperative patients with and without concurrent hydrocephalus, and use univariate and multivariate logistic regression models to analyze the risk factors for concurrent hydrocephalus. Results There were 46 cases complicated with hydrocephalus and 60 cases without hydrocephalus after aneurysmal SAH.The results of univariate analysis showed that the postoperative patients with concurrent hydrocephalus had an age of ≥60 years old[65.2%(30/46)], concomitant hypertension[50.0%(23/46)], aneurysm maximum diameter ≥5 mm[60.9%(28/46)], Glasgow coma scale(GCS)score≤8 points at admission[67.4%(31/46)], aneurysm located in the vertebrobasilar artery system[69.6%(32/46)], aneurysm Hunt less gradeⅢtoⅤ[84.8%(39/46)], preoperative cerebral hemorrhage range>30%[52.2%(24/46)], after surgery concomitant intracerebral hemorrhage[ICH, 41.3%(19/46)], after surgery concomitant of intraventricular hemorrhage[43.5%(20/46)], using extraventricular or lumbar cistern drainage[67.4%(31/46)]with a higher proportion than the postoperative patients without concurrent hydrocephalus[46.7%(28/60), 28.3%(17/60), 41.7%(25/60), 36.7%(22/60), 48.3%(29/60), 50.0%(30/60), 33.3%(20/60), 25.0%(15/60), 21.7%(13/60), 43.3%(26/60)], the differences were statistically significant(P<0.05).The results of logistic multiple regression analysis showed that age≥60 years old(OR=3.363, 95%CI: 1.339 to 8.414), concomitant hypertension(OR=3.803, 95%CI: 1.614 to 8.669), aneurysm located in the internal carotid artery system(OR=1.938, 95%CI: 1.326 to 7.661), Hunt-ness grade ⅢtoⅤ(OR=4.874, 95%CI: 1.288 to 8.617), after surgery concomitant ICH(OR=9.801, 95%CI: 1.233 to 9.916), after surgery concomitant of intraventricular hemorrhage(OR=2.806, 95%CI: 1.252 to 8.931), using extraventricular or lumbar cistern drainage(OR=5.807, 95%CI: 1.331 to 9.445) were independent risk factors for postoperative hydrocephalus in patients(P<0.05). Conclusions Age≥60 years old, concomitant hypertension, aneurysm located in the internal carotid artery system, Hunt-ness grade ⅢtoⅤ, after surgery concomitant ICH, after surgery concomitant of intraventricular hemorrhage, using extraventricular or lumbar cistern drainage were independent risk factors for postoperative hydrocephalus in patients.

    动脉瘤性蛛网膜下腔出血介入栓塞术脑积水危险因素

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    2型糖尿病与高血压对因退行性二尖瓣关闭不全行二尖瓣置换术患者围术期心率变异性的影响

    方卉张聪于浩李晓宇...
    29-33页
    查看更多>>摘要：目的 探讨2型糖尿病(T2DM)与高血压对因退行性二尖瓣关闭不全行二尖瓣置换术(MVR)患者围术期心率变异性(HRV)的影响。 方法 本研究为回顾性病例对照研究，选取2021年1月至2022年12月北部战区总医院心血管外科收治的150例因退行性二尖瓣关闭不全行MVR的患者，男76例，女74例，年龄60.23(54.00，64.50)岁，年龄范围为43～76岁。根据患者既往是否患有高血压和(或)T2DM将患者分为对照组(未患有高血压及T2DM，n＝42)、单纯高血压组(n＝51)、单纯T2DM组(n＝28)及合并组(高血压合并T2DM，n＝29)。比较手术前后7 d及术后7 d四组间HRV[相邻NN间隔的标准差(SDNN)、每5 min的均值的标准差(SDANN)和相邻NN间隔的平方差的均值的平方根(rMSSD)]水平。 结果 术后7 d，患者SDANN[49.30(38.40，65.30)ms]、SDNN[54.00(43.10，69.90)ms]及rMSSD[14.90(12.50，33.10)ms]水平低于术前[63.80(51.30，81.50)ms、76.00(60.00，94.00)ms、22.70(17.70，28.20)ms]，差异有统计学意义(P<0.05)。对照组、单纯高血压组、单纯T2DM组及合并组患者术后SDANN[75.30(69.00，81.55)ms、57.35(53.20，62.80)ms、44.60(40.65，47.65)ms、30.50(27.50，34.20)ms]、SDNN[80.70(75.20，87.50)ms、62.55(57.95，66.73)ms、48.70(44.45，51.55)ms、33.30(31.00，36.90)ms]和rMSSD[47.40(42.70，57.15)ms、24.65(18.65，29.43)ms、13.40(12.80，14.05)ms、10.60(8.80，11.50)ms]水平比较，差异有统计学意义(P<0.05)。术后7 d，对照组与单纯高血压组SDNN差值为(33.50±9.56)ms；对照组与单纯T2DM组SDNN差值为(71.00±9.15)ms；对照组与合并组SDNN差值为(105.00±10.15)ms；单纯高血压组与单纯T2DM组SDNN差值为(37.50±9.07)ms；单纯高血压组与合并组SDNN差值为(71.50±10.08)ms，差异有统计学意义(P<0.05)。 结论 高血压和T2DM对二尖瓣置换患者HRV有不利影响，T2DM影响更大。 Objective To investigate the effect of type 2 diabetes mellitus(T2DM)and hypertension on perioperative heart rate variability(HRV)in patients with degenerative mitral regurgitation undergoing mitral valve replacement(MVR). Methods This study was a retrospective case-control study, a total of 150 patients who underwent MVR due to degenerative mitral insufficiency admitted to the department of Cardiovascular Surgery of the Northern Theater General Hospital from January 2021 to December 2022, including 76 males and 74 females, aged 60.23(54.00, 64.50)years old, ranging from 43 to 76 years old.Patients were divided into control group(no hypertension and T2DM, n=42), simple hypertension group(n=51), simple T2DM group(n=28)and merge group(both hypertension and T2DM, n=29)according to whether they had previous hypertension and/or T2DM.The levels of HRV[standard deviation of adjacent NN intervals(SDNN), standard deviation of mean values every 5 min(SDANN)and square root of mean squared squared values of adjacent NN intervals(rMSSD)]were compared between the four groups at 7 days before surgery and 7 days after surgery. Results At 7 days after surgery, the levels of SDANN[49.30(38.40, 65.30)ms], SDNN[54.00(43.10, 69.90)ms]and rMSSD[14.90(12.50, 33.10)ms]in the patient were lower than those before surgery[63.80(51.30, 81.50)ms, 76.00(60.00, 94.00)ms, 22.70(17.70, 28.20)ms], the differences were statistically significant(P<0.05).Patients in control group, simple hypertension group, simple T2DM group and merge group had SDANN[75.30(69.00, 81.55)ms, 57.35(53.20, 62.80)ms, 44.60(40.65, 47.65)ms, 30.50(27.50, 34.20)ms], SDNN[80.70(75.20, 87.50)ms, 62.55(57.95, 66.73)ms, 48.70(44.45, 51.55)ms, 33.30(31.00, 36.90)ms]and rMSSD[47.40(42.70, 57.15)ms, 24.65(18.65, 29.43)ms, 13.40(12.80, 14.05)ms, 10.60(8.80, 11.50)ms], the differences were statistically significant(P<0.05).At 7 days after surgery, the difference of SDNN between control group and simple hypertension group was(33.50±9.56)ms.The difference of SDNN between control group and simple T2DM group was(71.00±9.15)ms.The difference of SDNN between control group and merge group was(105.00±10.15)ms.The difference of SDNN between simple hypertension group and simple T2DM group was(37.50±9.07)ms.The difference of SDNN between the simple hypertension group and the merge group was(71.50±10.08)ms, and the differences were statistically significant(P<0.05). Conclusions Hypertension and T2DM have adverse effects on HRV in mitral valve replacement patients, and T2DM has a greater effect.

    高血压2型糖尿病心率变异性二尖瓣置换退行性二尖瓣关闭不全

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    单核细胞趋化蛋白-1、白细胞介素-18、超敏C反应蛋白、可溶性髓系细胞触发受体-1联合检测对急性上呼吸道感染患儿的早期诊断价值

    段慧慧程蒙付永娟蔡艳丽...
    34-39页
    查看更多>>摘要：目的 探讨单核细胞趋化蛋白-1(MCP-1)、白细胞介素-18(IL-18)、可溶性髓系细胞触发受体-1(sTREM-1)、超敏C反应蛋白(hs-CRP)水平联合检测对急性上呼吸道感染患儿的早期诊断价值。 方法 本研究为回顾性病例对照研究，选取2022年1月至2023年3月平顶山市第二人民医院儿科收治的76例急性上呼吸道感染患儿作为观察组，男42例，女34例，年龄(8.54±1.17)岁，年龄范围为5～12岁；选取76名同期健康体检儿童作为对照组，男44名，女32名，年龄(8.82±1.42)岁，年龄范围为6～14岁。比较两组小儿的血清MCP-1、IL-18、hs-CRP、sTREM-1水平；分析血清MCP-1、IL-18、hs-CRP、sTREM-1水平与急性上呼吸道感染的相关性，血清MCP-1、IL-18、hs-CRP、sTREM-1水平联合检测对急性上呼吸道感染患儿的早期诊断效能，以及血清MCP-1、IL-18、hs-CRP、sTREM-1高水平患儿发生急性上呼吸道感染的危险度。 结果 观察组MCP-1、IL-18、hs-CRP、sTREM-1水平[(185.46±23.57)pg/ml、(124.17±13.68)ng/L、(14.18±1.57)mg/L、(39.17±5.21)pg/ml]高于对照组[(61.35±11.49)pg/ml、(78.25±9.67)ng/L、(3.62±0.79)mg/L、(6.28±2.04)pg/ml]，差异有统计学意义(P<0.05)。MCP-1、IL-18、hs-CRP、sTREM-1水平与急性上呼吸道感染均呈正相关(P<0.05)；MCP-1、IL-18、hs-CRP、sTREM-1水平升高为急性上呼吸道感染发生的独立危险因素(P<0.05)；MCP-1、IL-18、hs-CRP、sTREM-1水平联合检测诊断急性上呼吸道感染患儿的曲线下面积为0.803，灵敏度为93.42%，均明显高于血清MCP-1、IL-18、hs-CRP、sTREM-1水平单独检测结果(P<0.05)。MCP-1、IL-18、hs-CRP、sTREM-1高水平患儿发生急性上呼吸道感染危险度是低水平的2.772倍、2.365倍、1.611倍、1.894倍(P<0.05)。 结论 MCP-1、IL-18、hs-CRP、sTREM-1水平与急性上呼吸道感染的发生均显著正相关，且联合检测对急性上呼吸道感染患儿具有较高的早期诊断效能。 Objective To investigate early diagnostic value of monocyte chemotactic protein-1(MCP-1), interleukin-18(IL-18), hypersensitive C-reactive protein(hs-CRP)and soluble myeloid cell trigger receptor-1(sTREM-1)in children with acute upper respiratory tract infection. Methods This study was a retrospective case-control study, a total of 76 children with acute upper respiratory tract infection admitted to the department of Pediatrics of Pingdingshan the Second People′s Hospital from January 2022 to March 2023 were selected as the study group, including 42 males and 34 females, aged(8.54±1.17)years old, ranging from 5 to 12 years old, a total of 76 healthy children were selected as the control group, including 44 males and 32 females, aged(8.82±1.42)years old, ranging from 6 to 14 years old.The serum levels of MCP-1, IL-18, hs-CRP and sTREM-1 were compared between the two groups.To analyze the correlation between serum MCP-1, IL-18, hs-CRP, sTREM-1 levels and acute upper respiratory tract infection.The efficacy of combined detection of serum MCP-1, IL-18, hs-CRP, sTREM-1 levels in the early diagnosis of children with acute upper respiratory tract infection, and the risk of acute upper respiratory tract infection in children with the high levels of serum MCP-1, IL-18, hs-CRP and sTREM-1. Results The levels of MCP-1, IL-18, hs-CRP and sTREM-1 in the study group[(185.46±23.57)pg/ml, (124.17±13.68)ng/L, (14.18±1.57)mg/L, (39.17±5.21)pg/ml]were higher than those in the control group[(61.35±11.49)pg/ml, (78.25±9.67)ng/L, (3.62±0.79)mg/L, (6.28±2.04)pg/ml], the differences were statistically significant(P<0.05).The levels of MCP-1, IL-18, hs-CRP and sTREM-1 were positively correlated with acute upper respiratory tract infection(P<0.05).The elevated levels of MCP-1, IL-18, hs-CRP and sTREM-1 were independent risk factors for acute upper respiratory tract infection(P<0.05).The area under curve of MCP-1, IL-18, hs-CRP and sTREM-1 combined detection was 0.803 and the sensitivity was 93.42%, which were significantly higher than the results of serum MCP-1, IL-18, hs-CRP and sTREM-1 alone(P<0.05).The risk of acute upper respiratory tract infection in children with high levels of MCP-1, IL-18, hs-CRP and sTREM-1 was 2.772 times, 2.365 times, 1.611 times and 1.894 times of those with low levels(P<0.05). Conclusions The levels of MCP-1, IL-18, hs-CRP and sTREM-1 are significantly positively correlated with the occurrence of acute upper respiratory tract infection, and the combined detection had high early diagnostic efficacy in children with acute upper respiratory tract infection.

    白细胞介素-18急性上呼吸道感染单核细胞趋化蛋白-1可溶性髓系细胞触发受体-1超敏C反应蛋白

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    不同类型主动脉瓣病变对行主动脉瓣置换患者围术期左心室心肌肥厚情况的影响

    张聪满红王莹莹许丹...
    40-45页
    查看更多>>摘要：目的 探讨不同类型主动脉瓣病变对行主动脉瓣置换(AVR)患者围术期左心室心肌肥厚情况的影响。 方法 本研究为回顾性病例对照研究，选取2020年5月至2023年6月北部战区总医院心血管外科收治的248例重度慢性主动脉瓣病变患者，男126例，女122例，年龄(68.20±7.53)岁，年龄范围60～75岁，根据瓣膜病变类型将患者分为瓣膜狭窄组(n＝80)、瓣膜关闭不全组(n＝80)及狭窄合并关闭不全组(n＝88)，瓣膜狭窄组为患者主动脉瓣重度狭窄，瓣膜关闭不全组为患者主动脉瓣重度关闭不全，狭窄合并关闭不全组为患者主动脉瓣重度狭窄合并主动脉瓣重度关闭不全；比较手术前后三组患者肾小球滤过率(GFR)、左心室质量指数(LVMI)、血清胱抑素C(Cys C)水平。 结果 术后7 d，瓣膜狭窄组、瓣膜关闭不全组及狭窄合并关闭不全组患者Cys C[(1.15±0.27)mg/L、(1.94±0.36)mg/L、(1.29±0.36)mg/L]、LVMI[(127.19±9.51)g/m2、(144.90±6.25)g/m2、(129.20±4.25)g/m2]水平比较，差异有统计学意义(P<0.05)。瓣膜狭窄组Cys C水平低于瓣膜关闭不全组，狭窄合并关闭不全组Cys C水平低于瓣膜关闭不全组，瓣膜狭窄组LVMI水平低于瓣膜关闭不全组，狭窄合并关闭不全组LVMI水平低于瓣膜关闭不全组，差异有统计学意义(P<0.05)。 结论 AVR术后早期主动脉瓣关闭不全患者心肌肥厚加重情况较瓣膜狭窄患者及瓣膜狭窄合并关闭不全组患者严重。 Objective To investigate the effect of different types of aortic valve diseases on left ventricular hypertrophy in patients undergoing aortic valve replacement(AVR). Methods This study was a retrospective case-control study, a total of 248 patients who received with severe chronic aortic valve disease admitted to the department of Cardiovascular Surgery in General Hospital of Northern Theater Command from May 2020 to June 2023, including 126 males and 122 females, aged(68.20±7.53)years old, ranging form 60 to 75 years old.According to the type of valvular lesions, the patients were divided into valvular stenosis group(n=80), valvular insufficiency group(n=80)and combined group(n=88), the valve stenosis group was severe aortic stenosis, the valvular insufficiency group was severe aortic regurgitation, and the combined group was severe aortic stenosis combined with severe aortic regurgitation.The differences in left ventricular mass index(LVMI)and serum cystatin C(Cys C)values between the three groups before and after surgery were compared. Results At 7 days after surgery, the levels of Cys C[(1.15±0.27)mg/L, (1.94±0.36)mg/L, (1.29±0.36)mg/L]and LVMI[(127.19±9.51)g/m2, (144.90±6.25)g/m2, (129.20±4.25)g/m2]were compared among patients with valvular stenosis group, valvular insufficiency group and combined group, the differences were statistically significant(P<0.05).The levels of Cys C in the valvular stenosis group were lower than that in the valvular insufficiency group, the levels of Cys C in the combined group were lower than that in the valvular insufficiency group.The levels of LVMI in the valvular stenosis group were lower than that in the valvular insufficiency group, the levels of LVMI in the combined group were lower than that in the valvular insufficiency group, the differences were statistically significant(P<0.05). Conclusions Myocardial hypertrophy was more severe in patients with early aortic regurgitation after AVR than in patients with valvular stenosis and patients with valvular stenosis combined with regurgitation.

    左心室质量指数主动脉瓣置换左心室心肌肥厚胱抑素C

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    丁苯酞注射液联合胞磷胆碱片治疗急性脑梗死的效果

    刘芳尹园园姚远刘博...
    46-50页
    查看更多>>摘要：目的 探讨丁苯酞注射液联合胞磷胆碱片对急性脑梗死(ACI)患者美国国立卫生研究院卒中量表(NIHSS)、改良Rankin量表(mRS)评分及血清相关细胞因子水平的影响。 方法 本研究为病例对照研究，选取2022年1月至2023年6月郑州市第二人民医院神经内科收治的80例ACI患者，男47例，女33例，年龄(60.90±4.70)岁，年龄范围为51～71岁，根据治疗方案不同将患者分为丁苯酞注射液组与联合组，每组40例。丁苯酞注射液组采用丁苯酞注射液治疗，联合组采用丁苯酞注射液联合胞磷胆碱片治疗。比较两组患者临床治疗效果、治疗前后的NIHSS、mRS评分、血脂水平[高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇、甘油三酯]及血清相关细胞因子[C反应蛋白(CRP)、同型半胱氨酸(Hcy)、D-二聚体]水平。 结果 联合组患者临床治疗效果有效率[92.5%(37/40)]高于丁苯酞注射液组[75.0%(30/40)]，差异有统计学意义(P<0.05)。治疗后，联合组患者NIHSS评分[(3.42±0.59)分]、mRS评分[(1.22±0.24)分]均低于丁苯酞注射液组[(5.88±1.24)分、(2.03±0.31)分]；联合组患者HDL-C[(1.58±0.13)mmol/L]高于丁苯酞注射液组[(1.41±0.16)mmol/L]，LDL-C[(2.09±0.33)mmol/L]、总胆固醇[(3.25±0.46)mmol/L]、甘油三酯[(1.01±0.27)mmol/L]均低于丁苯酞注射液组[(3.15±0.37)mmol/L、(4.82±0.51)mmol/L、(1.58±0.31)mmol/L]；联合组患者CRP[(4.92±1.08)mg/L]、Hcy[(13.23±4.08)μmol/L]、D-二聚体[(131.95±12.18)μg/L]均低于丁苯酞注射液组[(7.11±1.63)mg/L、(19.79±5.24)μmol/L、(159.84±16.72)μg/L]，差异均有统计学意义(P<0.05)。 结论 丁苯酞注射液联合胞磷胆碱片可显著提高临床治疗效果，降低ACI患者NIHSS、mRS评分，改善体内血脂水平及炎症反应。 Objective To investigate the effect of butylphthalide injection combined with citicoline tablets on the National Institutes of Health Stroke Scale(NIHSS)and modified Rankin scale(mRS)scores and serum levels of related cytokines in patients with acute cerebral infarction(ACI). Methods This study was a case-control study, selected 80 patients with ACI of the department of Neurology in Zhengzhou Second Hospital from January 2022 to June 2023, there were 47 males and 33 females, aged(60.90±4.70)years old, ranging from 51 to 71 years old.The patients were divided into the butylphthalide injection group and the combination group according to different treatment plans, with 40 cases in each group.The butylphthalide injection group was treated with butylphthalide injection, while the combination group was treated with butylphthalide injection combined with citicoline tablets.The clinical efficacy of the two groups of patients was compared, as well as the NIHSS, mRS scores, blood lipid levels [high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), total cholesterol, triglycerides]and serum-related cytokines [C-reactive protein(CRP), homocysteine(Hcy), D-dimer(D-D)]levels before and after treatment. Results The clinical efficacy rate of the combined group [92.5%(37/40)]was higher than that of the butylphthalide injection group [75.0%(30/40)], and the difference was statistically significant(P<0.05).After treatment, the NIHSS score [(3.42±0.59)scores]and mRS score [(1.22±0.24)scores]of patients in the combined group were lower than those in the butylphthalide injection group [(5.88±1.24)scores and(2.03±0.31)scores] the HDL-C level [(1.58±0.13)mmol/L]of patients in the combined group was higher than that of the butylphthalide injection group [(1.41±0.16)mmol/L], while LDL-C level [(2.09±0.33)mmol/L], total cholesterol level [(3.25±0.46)mmol/L]and triglyceride level[(1.01±0.27)mmol/L]were lower than those in the butylphthalide injection group [(3.15±0.37)mmol/L, (4.82±0.51)mmol/L, (1.58±0.31)mmol/L] the CRP [(4.92±1.08)mg/L], Hcy [(13.23±4.08)μmol/L], D-D [(131.95±12.18)μg/L]and PTX3 [(1.74±0.28)μg/L]in the combined group were lower than those in the butylphthalide injection group [(7.11±1.63)mg/L, (19.79±5.24)μmol/L, (159.84±16.72)μg/L, (2.61±0.35)μg/L], and the differences were statistically significant(P<0.05). Conclusions Citicoline combined with butylphthalein can reduce the NIHSS and mRS scores in ACI patients, and improve blood flow parameters and lipid levels in middle cerebral artery.

    丁苯酞注射液胞磷胆碱片急性脑梗死美国国立卫生研究院卒中量表改良Rankin量表血脂水平炎症反应

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    下肢康复机器人辅助步态训练对脑卒中下肢运动功能障碍的运动功能与运动生物力学变化研究

    李琼杨勇李晓婷王莎...
    51-56页
    查看更多>>摘要：目的 探究下肢康复机器人辅助步态训练对脑卒中下肢运动功能障碍的运动功能与运动生物力学参数的影响。 方法 本研究为随机对照研究，选取2021年6月至2022年12月西安高新医院神经康复科收治的62例脑卒中伴下肢运动功能障碍患者，男33例，女29例，年龄(59.2±7.1)岁，年龄范围为40～65岁。采用随机数表法将患者随机分为常规治疗组与联合治疗组，每组31例。常规治疗组给予临床常规康复治疗，联合治疗组在常规治疗组基础上采用下肢康复机器人辅助步态训练联合运动疗法。比较两组改良Barthel指数(MBI)评分、下肢Fugl-Meyer运动功能量表(FMA-LE)评分、Berg平衡量表(BBS)评分、Holden步行功能(FAC)分级、质心轨迹长度和面积、步态时空参数及摆动相关关节活动角度变化情况。 结果 治疗后联合治疗组MBI评分[(79.1±9.5)分]、FMA-LE评分[(25.3±4.1)分]、BBS评分[(44.7±7.4)分]高于常规治疗组[(68.7±7.9)分、(19.8±3.7)分、(39.2±8.3)分]，FAC分级Ⅳ级占比[45.2%(14/31)]多于常规治疗组[6.5%(2/31)]，差异有统计学意义(P<0.05)。治疗后联合治疗组质心轨迹长度[(85.2±6.6)cm]、面积[(4.3±1.4)cm2]低于常规治疗组[(106.3±6.2)cm、(9.8±1.6)cm2]，差异有统计学意义(P<0.05)。治疗后联合治疗组步长[(49.1±9.4)cm]、步宽[(16.0±4.9)cm]、步速[(47.3±9.3)cm/s]、步行周期[(1.1±0.2)s]、双足支撑[(21.9±6.5)%]及单足支撑(49.1±8.6)%]均优于常规治疗组[(38.3±6.5)cm、(18.7±5.6)cm、(38.4±8.6)cm/s、(1.4±0.5)s、(30.4±7.2)%、(39.6±8.5)%]，差异有统计学意义(P<0.05)。治疗后联合治疗组最大屈髋角度[(36.5±3.7)°]、最大屈膝角度[(48.9±5.2)°]、最大踝背屈角度[(7.1±2.3)°]大于常规治疗组[(33.8±4.1)°、(42.1±4.4)°、(4.3±1.7)°]，最大伸髋角度的绝对值[(2.3±1.4)°]、最大伸膝角度[(1.7±0.6)°]、最大踝跖屈角度[(12.7±1.1)°]小于常规治疗组[(4.9±1.5)°、(3.6±1.1)°、(13.5±1.8)°]，差异有统计学意义(P<0.05)。 结论 针对脑卒中下肢运动功能障碍患者采用下肢康复机器人辅助步态训练联合改良强制性运动疗法可改善髋、膝、踝关节活动角度、质心位置及异常步行运动模式，提高患者步态稳定性、协调性及动态平衡能力，利于患者康复，安全有效。 Objective To explore the effects of lower limb rehabilitation robot-assisted gait training combined with exercise therapy on motor function and biomechanical parameters of lower limb motor dysfunction after stroke. Methods This study was a randomized controlled study, a total of 62 patients with stroke and lower limb motor dysfunction were admitted to the department of Neurological Rehabilitation in Xi′an Gaoxin Hospital from June 2021 to December 2022, including 33 males and 29 females, aged(59.2±7.1)years old, the age ranging from 45 to 65 years old.A random number table was used to divide patients into conventional treatment group and the combination treatment group, with 31 cases in each group.The conventional treatment group received clinical routine rehabilitation treatment, and the combination treatment group received lower limb rehabilitation robot assisted gait training combined with exercise therapy on the basis of the conventional treatment group.The modified barthel index(MBI)score, lower limb Fugl-Meyer assessment scale(FMA-LE)score, berg balance scale(BBS)score, functional ambulation category(FAC)grade, centroid locus length and area, temporal and spatial parameters of gait, and wiggle-related joint motion Angle were compared between the two groups. Results After treatment, the MBI score [(79.1±9.5)points], FMA-LE score [(25.3±4.1)points]and BBS score [(44.7±7.4)points]of the combined treatment group were higher than those of the conventional treatment group [(68.7±7.9)points, (19.8±3.7)points, (39.2±8.3)points], the proportion of FAC grade Ⅳ[45.2%(14/31)]was higher than that of conventional treatment group [6.5%(2/31)], and the differences were statistically significant(P<0.05).After treatment, the centroid track length [(85.2±6.6)cm]and area [(4.3±1.4)cm2]in the combination treatment group were lower than those in the conventional treatment group [(106.3±6.2)cm, (9.8±1.6)cm2], and the differences were statistically significant(P<0.05).After treatment, the step length [(49.1±9.4)cm], step width [(16.0±4.9)cm], step speed [(47.3±9.3)cm/s], walking cycle [(1.1±0.2)s], bipedal support [(21.9±6.5)%]and single foot support [(49.1±8.6)%]of the combination treatment group were superior to the conventional treatment group [(38.3±6.5)cm, (18.7±5.6)cm, (38.4±8.6)cm/s, (1.4±0.5)s, (30.4±7.2)%, (39.6±8.5)%], the differences were statistically significant(P< 0.05).After treatment, the maximum hip flexion angle [(36.5±3.7)°], the maximum knee flexion angle [(48.9±5.2)°]and the maximum ankle dorsiflexion angle [(7.1±2.3)°]in the combined treatment group were higher than those in the conventional treatment group [(33.8±4.1)°, (42.1±4.4)°, (4.3±1.7)°].The absolute values of maximum hip extension angle [(2.3±1.4)°], maximum knee extension angle [(1.7±0.6)°]and maximum ankle plantar flexion angle[(12.7±1.1)°]were lower than those of conventional treatment group [(4.9±1.5)°, (3.6±1.1)°, (13.5±1.8)°], and the differences were statistically significant(P<0.05). Conclusions For patients with lower limb motor dysfunction after stroke, the use of lower limb rehabilitation robot assisted gait training combined with improved mandatory exercise therapy can improve the hip, knee and ankle joint activity angle, center of mass position and abnormal walking movement pattern, and improve the gait stability, coordination and dynamic balance ability of patients, which is beneficial to the rehabilitation of patients, safe and effective.

    运动疗法下肢康复机器人脑卒中下肢运动功能障碍运动功能

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