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中国实用医刊
中国实用医刊

秦省

半月刊

1674-4756

zgsyyk@163.com

0371-65920096

450003

河南省郑州市经三路七号

中国实用医刊/Journal Chinese Journal of Practical Medicine
查看更多>>1974年1月创刊，中华人民共和国卫生部主管，中华医学会主办。本刊原名《中原医刊》，中国期刊全文数据库全文收录期刊、中国学术期刊综合评价数据库统计刊源期刊、中国核心期刊（遴选）数据库收录期刊、万方数据-数字化期刊群收录期刊。重点报道内、外、妇、儿等学科进展，以及新理论、新成果等。设有论著、临床实践、经验交流、临床研究、药物与临床、综述、误诊分析等栏目。
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    经导管主动脉瓣置换术治疗重度主动脉瓣狭窄合并主动脉瓣关闭不全的效果

    张红伟王艳龙慧珍李佳佳...
    1-4页
    查看更多>>摘要：目的 探讨经导管主动脉瓣置换术(TAVR)治疗重度主动脉瓣狭窄(AS)合并主动脉瓣关闭不全(AI)的效果。 方法 随机对照研究。抽取2022年3月至2023年3月河南省胸科医院收治的重度AS合并AI患者74例，按照随机数字表法分为对照组与研究组，每组37例。对照组采用外科主动脉瓣置换术治疗，研究组采用TAVR治疗。比较两组术前、术后6个月主动脉瓣指标[主动脉瓣流速(AV)、主动脉瓣瓣口面积(AVA)、主动脉瓣跨瓣峰值压差]、心功能[左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWT)、左心室收缩末期内径(LVESD)]。比较两组并发症发生率。 结果 术后6个月，研究组AV、主动脉瓣跨瓣峰值压差低于对照组，AVA高于对照组(P<0.05)。术后3 d，研究组LVEDD、LVPWT、LVESD低于对照组(P<0.05)。研究组并发症发生率(5.41%，2/37)低于对照组(24.32%，9/37)，差异有统计学意义(χ2＝5.23，P＝0.022)。 结论 TAVR用于重度AS合并AI患者中效果显著，能改善主动脉瓣指标和患者心功能，降低切口愈合不良、肺部感染等并发症发生风险。 Objective To investigate the effect of transcatheter aortic valve replacement (TAVR) in the treatment of severe aortic valve stenosis (AS) complicated by aortic valve insufficiency (AI). Methods A total of 74 patients with severe AS complicated by AI treated in Henan Provincial Chest Hospital from March 2022 to March 2023 were selected for the randomized controlled study. And they were divided into the control group and the study group using a random number table method, with 37 cases in each group. The control group was treated by surgical aortic valve replacement, and the study group was treated by TAVR. The aortic valve indexes, including aortic valve velocity (AV), aortic valve opening area (AVA) and aortic valve peak transvalvular pressure difference, and cardiac function assessed by left ventricular end diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPWT) and left ventricular end systolic diameter (LVESD) were compared between the two groups before and 6 months after surgery. The incidence of complications of the two groups were copmpared. Results Compared with the control group, the AV and aortic valve peak transvalvular pressure difference in the study group were lower, but the AVA was higher 6 months after surgery (P<0.05). Compared with the control group, the LVEDD, LVPWT, and LVESD in the study group were lower 3 days after surgery (P<0.05). The incidence of complications in the study group (5.41%, 2/37) was lower than that in the control group (24.32%, 9/37), and the difference was significant (χ2=5.23, P=0.022). Conclusions TAVR has a significant effect in the treatment of severe AS complicated by AI, which can improve aortic valve indexes and cardiac function, and reduce the risk of complications, such as poor incision healing and pulmonary infection.

    主动脉瓣狭窄主动脉瓣关闭不全经导管主动脉瓣置换术

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    关节镜辅助下闭合复位经皮固定微创手术治疗踝关节周围骨折的临床观察

    张晔李佳佳
    5-8页
    查看更多>>摘要：目的 探究关节镜辅助下闭合复位经皮固定微创手术治疗踝关节周围骨折的效果。 方法 抽取2020年6月至2022年10月临沂市中医医院收治的106例踝关节周围骨折患者，按随机数字表法分为对照组与观察组，每组53例。对照组行常规切开复位内固定术治疗，观察组行关节镜辅助下闭合复位经皮固定微创手术治疗。比较两组手术指标(手术时间、术中出血量、切口长度、骨折愈合时间及住院时间)、并发症发生率。采用Baird－Jackson踝关节功能评分评估两组治疗前后踝关节功能，并进行比较。比较两组治疗前后骨性标志物[骨钙素、骨碱性磷酸酶(BALP)、β－胶原降解产物(β－CTX)]水平。 结果 两组手术时间比较差异未见统计学意义(P>0.05)；观察组术中出血量少于对照组，切口长度、骨折愈合时间及住院时间短于对照组，差异有统计学意义(P<0.05)。术后3个月，观察组Baird－Jackson评分表中疼痛评分、功能评分、活动度评分均高于对照组(P均<0.05)。术后3个月，观察组骨钙素、BALP水平均高于对照组，β－CTX低于对照组，差异有统计学意义(P<0.05)。观察组并发症发生率(3.77%，2/53)低于对照组(15.09%，8/53)，差异有统计学意义(χ2＝3.98，P＝0.046)。 结论 关节镜辅助下闭合复位经皮固定微创手术治疗踝关节周围骨折，可有效减轻手术创伤，减少术中出血量，改善骨代谢，促进踝关节功能恢复，降低并发症发生风险。 Objective To investigate the effects of minimally invasive arthroscopic assisted closed reduction and percutaneous fixation in the treatment of periarticular fractures of ankle. Methods A total of 106 patients with periarticular fractures of ankle admitted to Linyi Traditional Chinese Medical Hospital from June 2020 to October 2022 were selected, and they were divided into control group and observation group, with 53 cases in each group. The control group was treated by conventional open reduction and internal fixation, while the observation group was treated by minimally invasive arthroscopic assisted closed reduction and percutaneous fixation. The surgical indicators (operation time, intraoperative bleeding volume, incision length, fracture healing time and hospital stay) and incidence of complications were compared between the two groups. The Baird-Jackson ankle function score was used to assess the ankle function before and after treatment, and the scores of the two groups were compared. The preoperative and postoperative levels of bone markers, including osteocalcin, bone alkaline phosphatase (BALP) and β-isomerized C-terminal telopeptide of type-I collagen (β-CTX), were compared between the two groups. Results There was no significant difference in operation time between the two groups (P>0.05). The observation group had less intraoperative bleeding volume, shorter incision length, shorter fracture healing time, and shorter hospital stay, compared with the control group (P<0.05). Three months after operation, the Baird-Jackson ankle function scores, including pain score, functional score and activity score, of the observation group were higher than those of the control group (allP<0.05). Compared with the control group, the levels of osteocalcin and BALP of the observation group were significantly higher, and the β-CTX level was lower 3 months after operation (P<0.05). The incidence of complications in the observation group (3.77%, 2/53) was lower than that in the control group (15.09%, 8/53), with significant difference (χ2=3.98, P=0.046). Conclusions Minimally invasive arthroscopic assisted closed reduction and percutaneous fixation, in the treatment of periarticular fractures of ankle, can effectively reduce surgical trauma, decrease intraoperative bleeding, improve bone metabolism, promote ankle function recovery, and reduce the risk of complications.

    关节镜踝关节周围骨折闭合复位经皮固定踝关节功能骨性标志物并发症

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    内镜逆行胰胆管造影胆道支架置入引流治疗不可切除恶性胆道狭窄的效果观察

    葛秀珍张海云庄培丽马艳丽...
    9-11页
    查看更多>>摘要：目的 探讨内镜逆行胰胆管造影胆道支架置入引流治疗不可切除恶性胆道狭窄(MBS)的临床效果，以期对完善治疗方案起到指导作用。 方法 回顾性抽取2017年5月至2022年5月新乡医学院第一附属医院收治的不可切除MBS患者97例，依据治疗方案分为研究组(48例)与对照组(49例)。对照组行经皮肝穿刺胆道引流术(PTCD)，研究组行内镜逆行胰胆管造影胆道支架置入引流。比较两组手术指标、康复指标、并发症、肝功能指标。 结果 研究组术中出血量少于对照组(P<0.05)。研究组住院时间、黄疸消退时间、腹痛消退时间短于对照组(P<0.05)。术后1周，研究组血清直接胆红素、天冬氨酸转氨酶、总胆红素水平低于对照组(P<0.05)。研究组并发症发生率(6.25%，3/48 )低于对照组(20.41%，10/49)，差异有统计学意义(P<0.05)。 结论 内镜逆行胰胆管造影胆道支架置入引流治疗不可切除MBS效果明显，可改善手术指标，缩短康复进程，改善肝功能，手术安全性较好。 Objective To investigate the effect of biliary stent implantation and drainage under endoscopic retrograde cholangiopancreatography in the treatment of unresectable malignant biliary stricture (MBS), in order to guide the improvement of treatment plan. Methods A total of 97 patients with unresectable MBS admitted to the First Affiliated Hospital of Xinxiang Medical University from May 2017 to May 2022 were retrospectively selected. And the patients were divided into study group (48 cases) and control group (49 cases) according to treatment regimen. The control group underwent percutaneous transhepatic cholangial drainage (PTCD), while the study group underwent biliary stent placement and drainage under endoscopic retrograde cholangcreatography. The surgical indicators, rehabilitation indicators, complications and liver function indicators of the two groups were compared. Results The study group had less intraoperative bleeding compared with the control group (P<0.05). The study group had shorter hospital stay, jaundice resolution time, and abdominal pain resolution time compared with the control group (P<0.05). One week after surgery, the study group had lower levels of serum direct bilirubin, aspartate transaminase and total bilirubin compared with the control group (P<0.05). The incidence of complications in the study group (6.25%, 3/48) was significantly lower than that in the control group (20.41%, 10/49),P<0.05. Conclusions Biliary stent implantation and drainage under endoscopic retrograde cholangioangiography has a remarkable effect in the treatment of unresectable MBS, which can improve surgical indicators, shorten rehabilitation process, and improve liver function, with good surgical safety.

    胆道狭窄恶性支架置入肝功能并发症

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    腹腔镜辅助阴式全子宫切除术与开腹子宫切除术治疗巨大子宫肌瘤的效果比较

    李琳张慧仝亚娟马艳丽...
    12-15页
    查看更多>>摘要：目的 比较腹腔镜辅助阴式全子宫切除术与开腹子宫切除术治疗巨大子宫肌瘤的效果。 方法 回顾性抽取2020年1月至2022年12月洛阳市第三人民医院收治的巨大子宫肌瘤患者86例，依据术式分为研究组(49例)和对照组(37例)。研究组采用腹腔镜辅助阴式全子宫切除术治疗，对照组采用传统开腹子宫切除术治疗。比较两组围术期指标、并发症发生率、手术前后炎性指标和性激素水平。 结果 研究组手术时间、术后住院时间、术后下床时间短于对照组，术中出血量少于对照组，差异有统计学意义(P<0.05)。研究组术后并发症发生率(4.1%，2/49)低于对照组(21.6%，8/37)，P<0.05。术前，两组C反应蛋白、性激素水平比较差异未见统计学意义(P>0.05)；术后，两组C反应蛋白、促黄体生成素(LH)、促卵泡生成激素(FSH)水平高于术前，研究组C反应蛋白水平低于对照组，研究组LH、FSH水平高于对照组，差异有统计学意义(P<0.05)。 结论 腹腔镜辅助阴式全子宫切除术治疗巨大子宫肌瘤效果更佳，可缩短手术时间，减轻炎性反应程度。 Objective To compare the effects of laparoscopic-assisted vaginal total hysterectomy versus traditional open hysterectomy in the treatment of massive uterine fibroids. Methods Eighty-six patients with massive uterine fibroids admitted to Luoyang Third People’s Hospital from January 2020 to December 2022 were selected retrospectively, and the patients were divided into study group (49 cases) and control group (37 cases) according to the surgical procedure. The study group were treated by laparoscopic-assisted vaginal total hysterectomy, while the control group were treated by traditional open hysterectomy. The perioperative indicators, incidence of complications, preoperative and postoperative levels of inflammatory indicators, and sex hormones were compared between the two groups. Results The operative time, postoperative hospital stay and ambulation time in the study group were shorter than those in the control group, while the intraoperative blood loss of the study group was less than that of the control group (P<0.05). The incidence of postoperative complications in the study group (4.1%, 2/49) was lower than that in the control group (21.6%, 8/37),P<0.05. There was no significant in levels of C-reactive protein and sex hormones between the two groups before the operation (P>0.05). After the operation, the levels of C-reactive protein, luteinizing hormone (LH) and follicle stimulating hormone (FSH) of the two groups were significantly higher than those before the operation, however, the study group had lower level of C-reactive protein, higher level of LH and higher level of FSH compared with the control group (P<0.05). Conclusions Laparoscopic-assisted vaginal total hysterectomy is more effective in the treatment of massive uterine fibroids, which can shorten the operation time and reduce the degree of inflammatory response.

    子宫肌瘤巨大腹腔镜辅助阴式全子宫切除术C反应蛋白

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    2015—2021年驻马店市急性冠心病事件的流行病学特征

    谢峥赵继业李浩傅利霞...
    15-18页
    查看更多>>摘要：目的 分析2015—2021年驻马店市急性冠心病事件的流行病学特征。 方法 回顾性观察性研究。对2015—2021年驻马店市1 587例急性冠心病事件进行调查研究，分析不同年份、不同年龄(<35岁、35～45岁、46～55岁、56～65岁、66～75岁、>75岁)、不同性别、不同诊断分型(冠心病猝死、急性心肌梗死)、不同职业(农民、工人、无业人员、干部、其他人员)患病率和临床表现情况(典型胸痛、不典型胸痛、无痛)。 结果 调查的1 587例急性冠心病事件患者中，2015、2016、2017、2018、2019、2020、2021年患病率逐渐增高；<35岁、35～45岁、46～55岁、56～65岁、66～75岁、>75岁患者随年龄增长患病率逐渐增高。男性发病率(69.06%，1 096/1 587)高于女性(30.94%，691/1 587)。调查的1 587例急性冠心病事件患者中，患病率由高到低依次为农民、工人、无业人员、干部、其他人员；急性心肌梗死患病率(87.52%，1 389/1 587)高于冠心病猝死(12.48%，198/1 587)。急性冠心病事件临床表现以典型胸痛为主，其次为不典型胸痛、无痛。 结论 2015—2021年驻马店市急性冠心病事件发生率逐渐增高，男性患病率和农民患病率较高，并以急性心肌梗死为主，临床症状主要表现为典型胸痛。 Objective To analyze the epidemiological characteristics of acute coronary disease events in Zhumadian from 2015 to 2021. Methods This study was a retrospective observational research. A total of 1 587 cases of acute coronary disease event in Zhumadian from 2015 to 2021 were investigated. The prevalence and clinical manifestations (typical chest pain, atypical chest pain, painless) in different years, in patients with different ages (<35 years, 35-45 years, 46-55 years, 56-65 years, 66-75 years, >75 years), in patients with different genders, in patients with different diagnostic typing (sudden coronary disease death, acute myocardial infarction), in patients with different occupations (farmers, workers, unemployed, cadres, others) were analyzed. Results Among the 1 587 patients with acute coronary disease events surveyed, the incidence gradually increased in 2015, 2016, 2017, 2018, 2019, 2020 and 2021 the incidence of acute coronary disease events gradually increased with age in the order of <35 years old, 35-45 years old, 46-55 years old, 56-65 years old, 66-75 years old, and>75 years old. The incidence of males (69.06%, 1 096/1 587) was higher than that of females (30.94%, 69.06%). Among the 1 587 patients with acute coronary disease event investigated, the incidence of farmers was the heighest followed by workers, unemployed individuals, cadres, and other individuals. The incidence of acute myocardial infarction (87.52%, 1 389/1587) was higher than that of sudden death from coronary disease (12.48%, 198/1 587). Conclusions The incidence of acute coronary disease events in Zhumadian gradually increases from 2015 to 2021. The prevalence of males and farmers are higher, and acute myocardial infarction is the main type. Typical chest pain is the main clinical symptom.

    冠心病急性冠心病事件流行病学特征

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    HER－2低表达乳腺癌的临床病理特征及预后分析

    李晓娜刘松鸽王军凯傅利霞...
    19-24页
    查看更多>>摘要：目的 探究人表皮生长因子受体－2(HER－2)低表达乳腺癌的临床病理特征，分析HER－2低表达对乳腺癌预后的影响。 方法 单中心临床研究。抽取2015年6月至2018年12月在河南科技大学附属许昌市中心医院接受抗肿瘤治疗的乳腺癌患者114例作为研究对象，依据HER－2表达强度分为HER－2低表达组76例和HER－2零表达组38例。回顾性分析两组患者的临床病理资料和随访资料，采用Kaplan－Meier法绘制无病生存(DFS)曲线和总生存(OS)曲线，比较两组患者的3年和5年DFS率和OS率。 结果 HER－2低表达组患者的雌激素受体(ER)阳性率、激素受体(HR)阳性率、Ki－67<30%占比、腋窝淋巴结转移率、组织分化类型中低分化占比均高于HER－2零表达组(P均<0.05)。两组患者的年龄、体质指数、月经状态、肿瘤家族史、病理类型、T分期、TNM分期比较，差异未见统计学意义(P>0.05)。HER－2低表达组和HER－2零表达组的3年DFS率分别为84.21%(64/76)和92.11%(35/38)，3年OS率分别为92.11%(70/76)和97.37%(37/38)；5年DFS率分别为63.16%(48/76)和81.58%(31/38)，5年OS率分别为80.26%(61/76)和92.11%(35/38)。HER－2低表达组患者5年DFS率低于HER－2零表达组(P<0.05)；两组患者的3年DFS率、3年OS率及5年OS率比较，差异未见统计学意义(P>0.05)。 结论 HER－2低表达乳腺癌的ER阳性率高，Ki－67表达率低，腋窝淋巴结转移率高，5年DFS率低，这些临床病理特征为HER－2低表达乳腺癌患者的个体化、精准化治疗提供了新思路。 Objective To investigate the clinicopathologic features of breast neoplams with low expression of human epidermal growth factor receptor 2 (HER-2), and to analyze the influence of low-expression HER-2 on the prognosis of breast neoplams. Methods A total of 114 cases of breast neoplams who received anti-tumor therapy in Xuchang Central Hospital Affiliated to Henan University of Science and Technology from June 2015 to December 2018 were enrolled in the single center clinical study. According to the intensity of HER-2 expression, the selected patients were divided into the HER-2 low expression group (76 cases) and the HER-2 zero expression group (38 cases). The clinicopathologic data and follow-up data of the two groups were analyzed retrospectively. The disease-free survival (DFS) and overall survival (OS) curves were drawn by Kaplan-Meier method, and the rate of 3- and 5-year DFS and OS of the two groups were compared. Results The positive rate of estrogen receptor (ER), positive rate of hormone receptor (HR), proportion of Ki-67<30%, axillary lymph node metastasis rate, proportion of low-differentiation tissue of the HER-2 low-expression group were higher than those of the HER-2 zero expression group (allP<0.05). There was no significant difference in age, body mass index, menstrual status, family history of tumor, pathological type, T stage and tumor-node-metastasis stage between the two groups (P>0.05). The 3-year DFS rate of the HER-2 low-expression group and the HER-2 zero-expression group were 84.21% (64/76) and 92.11% (35/38), respectively, while the 3-year OS rate of the two groups were 92.11% (70/76) and 97.37% (37/38), respectively. The 5-year DFS rate of the HER-2 low-expression group and the HER-2-zero expression group were 63.16% (48/76) and 81.58% (31/38), respectively while the 5-year OS rate of the two groups were 80.26% (61/76) and 92.11% (35/38), respectively. The 5-year DFS rate of the HER-2 low-expression group was lower than that of the HER-2 zero-expression group (P<0.05). There was no significant difference in the 3-year DFS rate, 3-year OS rate, or 5-year OS rate between the two groups (P>0.05). Conclusions HER-2 low-expression breast neoplams have a high positive rate of ER, low rate of Ki-67 expression, high rate of axillary lymph node metastasis, and low 5-year DFS rate. These clinicopathological features provide a new idea for individualized and precise treatment of breast neoplams with low-expression of HER-2.

    乳腺癌人表皮生长因子受体－2低表达病理特征预后

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    右美托咪定复合罗哌卡因臂丛神经阻滞对上肢手术患者的镇静镇痛效果

    魏勇宋国军梁琪常青...
    24-27页
    查看更多>>摘要：目的 分析右美托咪定复合罗哌卡因臂丛神经阻滞对上肢手术患者的镇静、镇痛效果。 方法 随机对照研究。抽取2022年1月至2022年12月西安市中医医院收治的上肢手术患者120例，按随机数字表法分为对照组和观察组，每组60例。对照组行罗哌卡因臂丛神经阻滞，观察组在对照组基础上加以右美托咪定。比较两组麻醉效果、血流动力学、镇静镇痛效果及不良反应发生率。 结果 观察组感觉、运动神经阻滞起效时间[(10.41±2.38)、(16.21±2.31)min]短于对照组[(12.79±2.67)、(19.42±3.70)min]，维持时间[(649.77±45.63)、(526.89±31.65)min]长于对照组[(503.86±38.97)、(389.77±25.87)min]，P<0.05。麻醉后30 min、术毕时，观察组平均动脉压、心率均高于对照组(P均<0.05)；术后1、3、6 h，观察组Ramsay镇静评分高于对照组，VAS评分低于对照组(P<0.05)。两组不良反应发生率比较差异未见统计学意义(P>0.05)。 结论 右美托咪定复合罗哌卡因臂丛神经阻滞可缩短麻醉起效时间，保障上肢手术患者血流动力学稳定，且镇静镇痛效果良好，无严重不良反应。 Objective To analyze the sedative and analgesic effect of dexmedetomidine combined with ropivacaine brachial plexus block on patients undergoing upper limb surgery. Methods A total of 120 patients who experienced upper limb surgery in Xi’an Traditional Chinese Medicine Hospital from January 2022 to December 2022 were selected for the randomized controlled study. And they were divided into control group and observation group by random number table method, with 60 cases in each group. The control group received ropivacaine brachial plexus block, while the observation group received dexmedetomidine based on the regimen of the control group. The anesthesia effect, hemodynamics, sedative and analgesic effects, and adverse reactions were compared between the two groups. Results The onset time of sensory and motor nerve block in the observation group were (10.41±2.38) min and (16.21±2.31) min, respectively, which were shorter than the (12.79±2.67) min and (19.42±3.70) min in the control group (P<0.05). The maintenance time of sensory and motor nerve block in the observation group were (649.77±45.63) min and (526.89± 31.65) min, respectively, longer than the (503.86±38.97) min and (389.77±25.87) min in the control group (P<0.05). At 30 minutes after anesthesia and at the end of surgery, the average arterial pressure and heart rate in the observation group were higher than those in the control group (allP<0.05). At 1, 3 and 6 hours after surgery, the Ramsay sedation scores in the observation group were higher than those in the control group, and the VAS score in the observation group was lower than that in the control group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions Dexmetomidine combined with ropivacaine brachial plexus block can shorten the onset time of anesthesia, ensure hemodynamic stability in patients undergoing upper limb surgery, and have good sedative and analgesic effects, without severe adverse reactions.

    臂丛神经阻滞右美托咪定罗哌卡因不良反应

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    经皮椎体后凸成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折的效果观察

    王成军辛红伟李世飞张允帅...
    28-31页
    查看更多>>摘要：目的 分析经皮椎体后凸成形术(PKP)联合唑来膦酸治疗骨质疏松性椎体压缩骨折(OVCF)的临床效果。 方法 抽取2020年3月至2022年3月开封市中心医院收治的OVCF患者96例，按随机数字表法分为单一组和联合组，每组48例。单一组予以PKP手术治疗，联合组在单一组基础上联合唑来膦酸治疗。比较两组疼痛程度[疼痛数字评分量表(NRS)评分]、功能障碍情况[Oswestry功能障碍指数(ODI)]、伤椎矫正情况(后凸Cobb角、伤椎高度)、骨密度、骨代谢指标[血清骨钙素(SOC)、Ⅰ型前胶原氨基端前肽(PINP)水平]、骨折再发生率及不良反应发生率。 结果 术后1年，联合组NRS、ODI评分均低于单一组(P均<0.05)；联合组后凸Cobb角小于单一组，伤椎高度高于单一组(P<0.05)；联合组骨密度大于单一组(P<0.05)；联合组SOC水平高于单一组，PINP水平低于单一组(P<0.05)；联合组骨折再发生率(0.00%，0/48)低于单一组(12.50%，6/48)，P<0.05；联合组不良反应发生率(6.25%，4/48)与单一组(16.67%，8/48)比较，差异未见统计学意义(P>0.05)。 结论 PKP联合唑来膦酸治疗OVCF，能够减轻患者疼痛程度，提高伤椎矫正效果，改善骨代谢和骨密度情况，减轻功能障碍，降低骨折再发生率，且安全性良好。 Objective To analyze the effects of percutaneous kyphoplasty (PKP) combined with zoledronic acid in the treatment of osteoporotic vertebral compression fractures (OVCF). Methods A total of 96 patients with OVCF treated in Kaifeng Central Hospital from March 2020 to March 2022 were selected, and they were divided into single group and combined group according to random number table method, with 48 cases in each group. The single group was treated by PKP, and the combined group was treated with zoledronic acid based the treatment of the single group. The pain level assessed by numerical rating scale (NRS) score, functional impairment assessed by Oswestry disability index (ODI), vertebral correction (kyphotic Cobb angle, height of injured vertebra), bone density, bone metabolism indicators, including serum osteocalcin (SOC) and type I procollagen N-terminal peptide (PINP), fracture recurrence rate, and incidence of adverse reactions were compared between the two groups. Results One year after operation, the scores of NRS and ODI in the combined group were lower than those in the single group (all P<0.05). The kyphotic Cobb angle in the combined group was smaller than that in the single group, while the injured vertebral height in the combined group was lower than that in the single group (P<0.05) the bone mineral density of the combined group was higher than that of the single group (P<0.05) the SOC level in the combined group was higher than that in the single group, while the PINP level was lower than that in single group (P<0.05). The recurrence rate of fracture in the combined group (0.00%, 0/48) was lower than that in the single group (12.50%, 6/48),P<0.05. There was no significant difference in the incidence of adverse reactions between the combined group (6.25%, 4/48) and the single group (16.67%, 8/48),P>0.05. Conclusions PKP combined with zoledronic acid in the treatment of OVCF can alleviate pain, improve the correction effect of injured vertebra, improve bone metabolism and bone mineral density, alleviate dysfunction, and reduce the recurrence rate of fracture, with good safety.

    骨折骨质疏松性椎体压缩骨折经皮椎体后凸成形术唑来膦酸

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    血清NTproBNP、hs－cTnI、D－二聚体水平在急性心肌梗死介入治疗预后评估中的应用

    潘伟英刘小敏
    32-36页
    查看更多>>摘要：目的 分析N末端前脑钠肽(NTproBNP)、超敏肌钙蛋白(hs－cTnI)、D－二聚体水平在急性心肌梗死介入治疗患者预后评估中的应用价值。 方法 抽取2020年1月至2022年1月漯河市第二人民医院收治的116例急性心肌梗死介入治疗患者为研究对象。所有患者入院时均采集血液标本，进行NTproBNP、hs－cTnI、D－二聚体检测，随访6个月，观察患者预后情况，分析入院时NTproBNP、hs－cTnI、D－二聚体水平在急性心肌梗死介入治疗患者预后评估中的应用价值。 结果 116例急性心肌梗死介入治疗患者NTproBNP为(1 638.20±419.52)ng/L，hs－cTnI为(3.02±1.28)ng/mL，D－二聚体为(286.35±94.25)μg/L。不同年龄、Killip心功能分级、预后的急性心肌梗死介入治疗患者NTproBNP比较，差异有统计学意义(P<0.05)。不同Killip心功能分级、预后的急性心肌梗死介入治疗患者hs－cTnI、D－二聚体比较，差异有统计学意义(P<0.05)。经点二列相关性分析显示，NTproBNP与年龄、Killip心功能分级呈正相关(r>0，P<0.05)，与预后呈负相关(r<0，P<0.05)。经点二列相关性分析显示，hs－cTnI、D－二聚体与Killip心功能分级呈正相关(r>0，P<0.05)，与预后呈负相关(r<0，P<0.05)。绘制受试者工作特征曲线结果显示，NTproBNP、hs－cTnI、D－二聚体评估急性心肌梗死介入治疗患者预后的曲线下面积均>0.7，具有一定评估价值，联合评估价值更高。 结论 NTproBNP、hs－cTnI、D－二聚体水平与急性心肌梗死介入治疗患者预后密切相关，在预后评估中具有重要价值。 Objective To analyze the role of N-terminal pro brain natriuretic peptide (NTproBNP), hypersensitive troponin (hs-cTnI) and D-dimer levels in evaluation on prognosis of interventional therapy for acute myocardial infarction. Methods A total of 116 patients with acute myocardial infarction were treated in Luohe Second People’s Hospital from January 2020 to January 2022. Blood samples were collected from all selected patients at admission for NTproBNP, hs-cTnI and D-dimer testings. The patients were followed up for 6 months to observe the prognosis and analyze the application value of levels of NTproBNP, hs-cTnI and D-dimer in evaluating prognosis of interventional therapy for acute myocardial infarction. Results The levels of NTproBNP, hs-cTnI and D-dimer of the 116 patients with acute myocardial infarction were (1 638.20±419.52) ng/L, (3.02±1.28) ng/mL and (286.35±94.25) μg/L, respectively. There were significant differences in level of NTproBNP among acute myocardial infarction patients with different ages, with different Killip cardiac function grades and with different prognoses after interventional therapy ( P<0.05). There were significant differences in levels of hs-cTnI and D-dimer among acute myocardial infarction patients with different Killip cardiac function grades and with different prognoses (P<0.05). Results of point-biserial correlation test showed that NTproBNP was positively correlated with age and Killip cardiac function grade (r>0,P<0.05), and was negatively correlated with prognosis (r<0,P<0.05). Results of point-biserial correlation test showed that hs-cTnI and D-dimer were positively correlated with Killip cardiac function grade (r>0,P<0.05), and were negatively correlated with prognosis (r<0,P<0.05). Results of receiver operating characteristic curve showed that the area under the curve of NTproBNP, hs-cTnI and D-dimer in evaluating the prognosis of interventional therapy for acute myocardial infarction were all >0.7, which had a certain evaluation value moreover, the evaluation value of combination of them was higher. Conclusions The levels of NTproBNP, hs-cTnI and D-dimer are closely related to the prognosis of interventional therapy for acute myocardial infarction, and have important value in prognosis evaluation.

    心肌梗死介入治疗N末端前脑钠肽超敏肌钙蛋白D－二聚体

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    脑膜瘤患者显微术后脑水肿加重风险的列线图模型构建

    王德群刘海巍陈辉常青...
    37-41页
    查看更多>>摘要：目的 探讨脑膜瘤患者显微术后脑水肿加重的影响因素，并构建列线图模型进行预测和验证。 方法 回顾性收集2012年9月至2022年9月驻马店市第一人民医院收治的180例行显微术脑膜瘤患者的临床资料，依据术后脑水肿加重情况分为脑水肿加重组(40例)和脑水肿未加重组(140例)。采用Logistic回归分析影响脑膜瘤患者显微术后脑水肿加重的因素，根据回归分析结果构建风险预测模型，利用R软件构建列线图，并绘制受试者工作特征曲线评估风险模型的预测效能。 结果 两组患者性别、年龄、肿瘤长径、Simpson分级、高血压、糖尿病、心脏病情况比较，差异未见统计学意义(P>0.05)；脑水肿加重组术中静脉损伤、术前癫痫、肿瘤部位与脑水肿未加重组比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示，术前癫痫、肿瘤部位、术中静脉损伤是脑膜瘤患者显微术后脑水肿加重的危险因素(OR>1，P<0.05)。绘制列线图构建脑膜瘤患者显微术后脑水肿加重风险预测模型，验证模型的区分度显示C－index＝0.824，说明该模型具有良好的区分度；绘制标准曲线显示，校准曲线和Y－X直线相近，模型准确度良好；对模型预测效能进行验证，风险模型评估脑膜瘤患者显微术后脑水肿加重的曲线下面积为0.824，95%CI为0.751～0.898，P<0.001。 结论 肿瘤部位、术前癫痫、术中静脉损伤是脑膜瘤患者显微术后脑水肿加重的影响因素，基于以上因素构建的脑膜瘤患者显微术后脑水肿加重的风险预测模型具有一定的预测价值。 Objective To investigate the influencing factors of brain edema exacerbation after microscopic surgery for meningioma, and to construct a column chart model for prediction and validation. Methods The clinical data of 180 patients with meningioma treated by microscopic surgery in the First People’s Hospital of Zhumadian from September 2012 to September 2022 were retrospectively collected. According to the severity of postoperative brain edema, they were divided into brain edema exacerbation group (40 cases) and the non-worsen brain edema group (140 cases). Logistic regression analysis was used to analyze the factors affecting the exacerbation of brain edema after microscopic surgery in patient with meningioma. A risk prediction model was constructed based on the regression analysis results, and a column chart was constructed using R software. The predictive efficacy of the risk model was evaluated by drawing the receiver operating characteristic curve. Results There was no significant difference in gender, age, tumor major diameter, Simpson grade, hypertension, diabetes and heart disease between the two groups (P>0.05). There were significant differences in venous injury, preoperative epilepsy, and tumor location between the brain edema exacerbation group and the no-worsen brain edema group (P<0.05). Results of logistic regression analysis showed that preoperative epilepsy, tumor location and intraoperative venous injury were risk factors for brain edema exacerbation after microscopic surgery for meningioma (OR>1,P<0.05). The discrimination of prediction model, constructed by column chart, for risk of brain edema exacerbation after microscopic surgery for meningioma showed that C-index = 0.824, indicating that the model had good discrimination. The standard curve showed that the calibration curve was similar to the Y-X line, and the accuracy of the model was good. The area under the curve of the risk model for evaluating the brain edema exacerbation after microscopic surgery for meningioma was 0.824, and the 95%CI was 0.751-0.898, P<0.001. Conclusions The influencing factors for brain edema exacerbation after microscopic surgery for meningioma include tumor location, preoperative epilepsy and intraoperative venous injury. The risk prediction model based on the above factors has certain predictive value for the brain edema exacerbation after microscopic surgery for meningioma.

    脑膜瘤显微术脑水肿列线图模型

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