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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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    凝视稳定性训练在双侧前庭功能低下患者中的应用效果

    李广丹蔡丽史夏刘小敏...
    80-82页
    查看更多>>摘要：目的 分析凝视稳定性训练在双侧前庭功能低下患者中的应用效果。 方法 抽取2022年1月至2023年1月平煤神马医疗集团总医院双侧前庭功能低下患者94例，按照随机数字表法分为对照组和研究组，每组47例。对照组采用常规药物治疗，研究组在对照组基础上采用凝视稳定性训练。对比两组症状改善时间、前庭功能(扫视波幅度、自发眼震强度、摇头眼震强度)。 结果 研究组总有效率(97.87%，46/47)高于对照组(74.47%，35/47)，P<0.05。研究组耳鸣消失时间、眩晕消失时间、听力恢复正常时间短于对照组(P<0.05)。治疗后，研究组扫视波幅度、自发眼震强度、摇头眼震强度低于对照组(P<0.05)。 结论 凝视稳定性训练应用于双侧前庭功能低下患者中效果显著，能快速缓解患者临床症状，改善其前庭功能。 Objective To analyze the therapeutic effect of gaze stability training on bilateral vestibular dysfunction. Methods A total of 94 patients with bilateral vestibular dysfunction treated in General Hospital of Pingmei Shenma Group from January 2022 to January 2023 were selected, and they were divided into control group and study group according to random number table method, with 47 cases in each group. The control group was treated with conventional drugs, and the study group was treated by gaze stability training based on the treatment of the control group. The symptom improvement time, vestibular function (saccade amplitude, spontaneous nystagmus intensity, head-shaking nystagmus intensity) were compared between the two groups. Results The total effective rate in the study group (97.87%, 46/47) was higher than that in the control group (74.47%, 35/47), P<0.05. The disappearance time of tinnitus, disappearance time of dizziness, and normal hearing recovery time in the study group were shorter than those in the control group (P<0.05). After treatment, the saccade amplitude, spontaneous nystagmus intensity, and head-shaking nystagmus intensity in the study group were lower than those in the control group (P<0.05). Conclusions Gaze stability training has obvious effects on patients with bilateral vestibular dysfunction. It can quickly relieve the clinical symptoms of patients, and improve vestibular function.

    前庭功能低下凝视稳定性训练前庭功能

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    经皮肝穿刺胆道引流术后并发胆道感染的影响因素分析

    张海霞李甲马艳丽
    83-85页
    查看更多>>摘要：目的 探讨经皮肝穿刺胆道引流术(PTCD)后并发胆道感染的影响因素。 方法 抽取2020年9月至2023年3月于南阳市中心医院行PTCD治疗的患者112例，按术后是否并发胆道感染分为未感染组(90例)与感染组(22例)。收集两组一般资料及临床指标，采用单因素分析、多因素Logistic回归模型对PTCD术后胆道感染的影响因素进行分析。 结果 单因素分析结果显示，引流方式、术前凝血酶原时间、术前血红蛋白及总胆红素水平是PTCD术后胆道感染的影响因素(P<0.05)。多因素Logistic回归分析结果显示，引流方式、术前血红蛋白水平是PTCD术后胆道感染的独立危险因素(P<0.05)。 结论 引流方式、术前血红蛋白是PTCD术后胆道感染的独立危险因素，术前预防性使用抗生素对PTCD术后胆道感染发生并无明显影响。 Objective To analyze the influencing factors of biliary tract infections after percutaneous transhepatic cholangial drainage (PTCD). Methods A total of 112 patients who underwent PTCD treatment in Nanyang Central Hospital from September 2020 to March 2023 were selected, and the patients were divided into the non-infected group (90 cases) and the infected group (22 cases) according to whether biliary tract infection after operation. The general information and clinical indicators of the two groups were collected and compared, and univariate analysis and multivariate logistic regression models were used to analyze the influencing factors of biliary tract infection after PTCD. Results The results of univariate analysis showed that drainage method, preoperative prothrombin time, preoperative hemoglobin and level of total bilirubin were influencing factors of biliary tract infection after PTCD (P<0.05). Results of multivariate logistic regression analysis showed that drainage method and preoperative level of hemoglobin were independent risk factors for biliary tract infection after PTCD (P<0.05). Conclusions Drainage method and preoperative hemoglobin are independent risk factors for biliary tract infection after PTCD. Preoperative prophylactic antibiotics have no significant impact on the occurrence of biliary tract infection after PTCD.

    经皮肝穿刺胆道引流术胆道感染

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    重症急性胰腺炎患者术后行早期肠内营养联合肠外营养与单独全肠外营养支持的效果比较

    赵圆圆范静雯崔胤宋斌...
    86-89页
    查看更多>>摘要：目的 比较早期肠内营养联合肠外营养与单独全肠外营养支持在重症急性胰腺炎(SAP)术后辅助治疗中的效果。 方法 抽取2021年3月至2023年1月郑州大学第一附属医院肝胆胰外一科收治的SAP手术患者101例为研究对象，按照随机数字表法分为对照组(50例)与观察组(51例)。对照组术后行全肠外营养支持，观察组采用早期肠内营养联合肠外营养支持。比较两组治疗前后营养指标(总蛋白、白蛋白、前白蛋白)、细胞免疫水平(CD4＋、CD8＋、CD4＋/CD8＋)、急性生理与慢性健康状况Ⅱ(APACHE-Ⅱ)评分。 结果 治疗7 d后，两组总蛋白、白蛋白、前白蛋白水平均高于治疗前，且观察组高于对照组(P<0.05)。治疗7 d后，两组CD4＋、CD4＋/CD8＋水平高于治疗前，CD8＋低于治疗前(P<0.05)；治疗7 d后，观察组CD4＋、CD4＋/CD8＋水平高于对照组，CD8＋低于对照组(P<0.05)。治疗7 d后，两组APACHE-Ⅱ评分低于治疗前，且观察组低于对照组(P<0.05)。 结论 相较于单独全肠外营养，SAP术后行早期肠内营养联合肠外营养，患者营养状态与机体免疫功能改善更理想，继而有助于进一步减轻患者病情。 Objective To compare the effect of early enteral nutrition combined with parenteral nutrition versus total parenteral nutrition support alone in the postoperative treatment of severe acute pancreatitis (SAP). Methods A total of 101 patients with SAP admitted to the Department of Hepatobiliary and Pancreatic Surgery I in the First Affiliated Hospital of Zhengzhou University from March 2021 to January 2023 were selected as the study subjects. And they were divided into control group (50 cases) and observation group (51 cases) by random number table method. The control group received postoperative total parenteral nutrition support, while the observation group received early enteral nutrition combined with parenteral nutrition support. The nutritional indicators (total protein, albumin, prealbumin), levels of cellular immune assessed by cluster of differentiation 4+ (CD4+ ), cluster of differentiation 8+ (CD8+ ) and CD4+ /CD8+, and acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) score were compared between the two groups before and after treatment. Results After 7 days of treatment, the levels of serum total protein, albumin and prealbumin of the two groups were higher than those before treatment, while the observation group had higher levels of serum total protein, albumin and prealbumin compared with the control group (P<0.05). After 7 days of treatment, the levels of CD4+ and CD4+ /CD8+ of the two groups increased, and the level of CD8+ of the two groups decreased compared with preoperative levels (P<0.05). After 7 days of treatment, the levels of CD4+ and CD4+ /CD8+ of the observation group were higher, and the level of CD8+ was lower, compared with the control group (P<0.05). After 7 days of treatment, the APACHE-Ⅱ score of the two groups were lower than those before treatment, moreover, the APACHE-Ⅱ score of the observation group was lower than that of the control group (P<0.05). Conclusions Compared with total parenteral nutrition support alone, the combination of early enteral nutrition and parenteral nutritional support after surgery for SAP can better improve the nutritional status and body immune function of patients, which can help to further alleviate the disease condition.

    胰腺炎急性肠内营养肠外营养营养指标细胞免疫

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    24 h动态心电图对不同年龄段儿童心肌炎心率变异性的评估价值

    吴好冯文文王芳常青...
    90-94页
    查看更多>>摘要：目的 研究24 h动态心电图对不同年龄段儿童心肌炎心率变异性的评估价值。 方法 回顾性队列研究。抽取2021年3月至2022年9月郑州大学附属儿童医院收治的116例心肌炎患儿作为研究组，按照患儿年龄段分为低年龄(年龄<4岁)组47例和高年龄(年龄≥4岁)组69例，并以1∶1配比抽取同期健康体检儿童116例作为对照组，按照儿童年龄分为低年龄(年龄<4岁)对照组52例和高年龄(年龄≥4岁)对照组64例。均行24 h动态心电图检查，比较各组儿童心率和心率变异性指标[正常窦性心律RR间期的标准差(SDNN)、每5 min RR间期标准差(sDANN)、相邻RR间期差值>50 ms的心搏个数占RR间期总数的百分比(PNN50)、24 h全程相邻RR间期差值的均方根(rMSSD)]水平。 结果 低年龄组最慢心率、平均心率[(67.59±6.85)、(110.86±12.05)次/min]均高于低年龄对照组[(60.03±6.02)、(99.31±9.76)次/min]，P均<0.05；高年龄组最慢心率、平均心率[(59.86±4.02)、(97.85±10.53)次/min]均高于高年龄对照组[(54.03±3.21)、(91.05±8.92)次/min]，P均<0.05。低年龄组SDNN、sDANN、PNN50、rMSSD水平低于低年龄对照组(P<0.05)；高年龄组SDNN、PNN50、rMSSD水平低于高年龄对照组(P<0.05)。低年龄组最快心率、最慢心率、平均心率均高于高年龄组(P均<0.05)；低年龄组SDNN、sDANN、PNN50、rMSSD水平均低于高年龄组(P均<0.05)。 结论 心肌炎患儿的24 h动态心电图心率较高，且心率变异性指标水平较低，不同年龄段心肌炎患儿心率和心率变异性指标水平存在明显差异性，年龄越低，患儿心率越高，心率变异性指标水平越低。 Objective To investigate the value of 24-hour dynamic electrocardiogram in evaluating heart rate variability in children with myocarditis of different ages. Methods In this retrospective cohort study, 116 children with myocarditis treated in Children’s Hospital Affiliated of Zhengzhou University from March 2021 to September 2022 were selected as the study group, and they were further divided into a low-age group (age < 4 years, 47 cases) and a high-age group (age ≥4 years, 69 cases) according to the age of the children. A total of 116 children who underwent physical examination in the same period were selected as the control group with a ratio of 1∶1. According to the age of the children, children in the control group were divided into a low-age control group (age < 4 years, 52 cases) and a high-age control group (age ≥4 years, 64 cases). The 24-hour dynamic electrocardiogram examination was performed on all selected children. The heart rate and heart rate variability indexes, including standard diviation of all normal-to-normal intervals (SDNN), standard diviation of 5-min average normal-to-normal intervals (sDANN), percentage of intervals, >50 ms different from preceding interval (PNN50) and the 24-hour root mean square of successive differences in adjacent normal-to-normal intervals (rMSSD) were compared among each group. Results The minimum heart rate and average heart rate in the low-age group were 67.59±6.85 and (110.86±12.05) times/min, higher than the 60.03±6.02 and (99.31±9.76) times/min in the low-age control group (all P<0.05). The minimum heart rate and average heart rate in the high-age group were 59.86±4.02 and (97.85±10.53) times/min, higher than the 54.03±3.21 and (91.05±8.92) times/min in the high-age control group (allP<0.05). The levels of SDNN, sDANN, PNN50 and rMSSD in the low-age group were lower than those in the low-age control group (P<0.05). The levels of SDNN, PNN50 and rMSSD in the high-age group were lower than those in the high-age control group (P<0.05). The maximum heart rate, minimum heart rate and average heart rate in the low-age group were higher than those in the high-age group (allP<0.05). The levels of SDNN, sDANN, PNN50 and rMSSD in the low-age group were lower than those in the high-age group (allP<0.05). Conclusions Children with myocarditis have higher heart rates and lower levels of heart rate variability indicators showed by 24-hour dynamic electrocardiogram. There are obvious differences in the level of heart rate and heart rate variability among children with myocarditis in different age groups. The heart rate variability in children with myocarditis is lower in children with younger age and higher heart rate.

    心肌炎儿童心率变异性24h动态心电图

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    18 F-FDG PET/CT在老年食管癌分期诊断中的应用价值

    张龙敏丁小琳佟梓滨常青...
    94-97页
    查看更多>>摘要：目的 分析18氟-氟代脱氧葡萄糖正电子发射计算机断层扫描(18F-FDG PET/CT)在老年食管癌分期诊断中的应用价值。 方法 观察性研究。抽取2019年4月至2022年8月南阳市中心医院收治的老年食管癌患者69例，均行常规CT和18F-FDG PET/CT诊断，以病理结果为"金标准"，比较18F-FDG PET/CT和CT诊断TNM分期的诊断结果和诊断效能(灵敏度、特异度、准确度)。 结果 69例老年食管癌患者，病理结果显示T分期21例，N分期27例，M分期21例。CT和18F-FDG PET/CT诊断T分期特异度、准确度比较差异未见统计学意义(P>0.05)；18F-FDG PET/CT诊断T分期灵敏度(100.00%，21/21)高于CT诊断(66.67%，14/21)，P<0.05。CT和18F-FDG PET/CT诊断N分期特异度比较差异未见统计学意义(P>0.05)；18F-FDG PET/CT诊断N分期灵敏度(96.30%，26/27)、准确度(92.75%，64/69)高于CT诊断(48.15%，13/27；79.71%，55/69)，P<0.05。CT和18F-FDG PET/CT诊断M分期特异度、准确度比较差异未见统计学意义(P>0.05)；18F-FDG PET/CT诊断M分期灵敏度(100.00%，21/21)高于CT诊断(61.90%，13/21)，P<0.05。 结论 18 F-FDG PET/CT在老年食管癌分期诊断中应用价值良好，可提高诊断效能，为临床诊断提供科学依据。 Objective To analyze the application value of 18F-flurodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in staging diagnosis of esophageal cancer in elderly patients. Methods In the observational study, 69 elderly patients with esophageal cancer treated in Nanyang Central Hospital from April 2019 to August 2022 were selected, and they underwent conventional CT and 18F-FDG PET/CT for diagnosis. Taking the pathological results as the gold standard, the diagnostic results and diagnostic efficacy (sensitivity, specificity, accuracy) of 18F-FDG PET/CT and CT in the diagnosis of tumor-node-metastasis stage were compared. Results Among the 69 elderly patients with esophageal cancer, the pathological results showed 21 cases in T stage, 27 cases in N stage and 21 cases in M stage. There were no significant differences in the specificity and accuracy of CT and 18F-FDG PET/CT in diagnosis of T stage (P>0.05). The sensitivity of18F-FDG PET/CT in diagnosing T stage was 100.00% (21/21), which was higher than the 66.67% (14/21) of CT (P<0.05). There was no significant difference between CT and18F-FDG PET/CT in the diagnosis of N stage (P>0.05). The sensitivity and accuracy of18F-FDG PET/CT in the diagnosis of N stage were 96.30% (26/27) and 92.75% (64/69), respectively, which were higher than the 48.15% (13/27) and 79.71% (55/69) of CT (P<0.05). There were no significant differences in the specificity and accuracy of CT and18F-FDG PET/CT in the diagnosis of M stage (P>0.05). The sensitivity of18F-FDG PET/CT in diagnosing M stage was 100.00% (21/21), which was higher than the 61.90% (13/21) of CT (P<0.05). Conclusions 18F-FDG PET/CT has good application value in staging diagnosis of esophageal cancer in elderly patients, which can improve the diagnostic efficacy and provide scientific basis for clinical diagnosis.

    食管癌老年18氟-氟代脱氧葡萄糖正电子发射计算机断层扫描

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    颈部血管超声血流显像和CTA在颈动脉重度狭窄患者术前诊断、术后随访中的应用价值

    姚延丹秦砚戈张胜龙李沆...
    98-101页
    查看更多>>摘要：目的 探讨颈部血管超声血流显像(CDFI)和CT血管造影(CTA)在颈动脉重度狭窄患者术前诊断、术后随访中的应用价值。 方法 回顾性研究。抽取2021年5月至2022年9月于河南省第三人民医院及河南省人民医院接受手术治疗的114例颈动脉狭窄患者作为研究对象，所有患者均在术前、术后半年实施CDFI、CTA检查，均随访半年。以数字减影血管造影(DSA)检查结果为"金标准"，统计CDFI、CTA诊断颈动脉重度狭窄的诊断结果和诊断效能，比较术前和术后半年患者的CDFI检查结果[狭窄段收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)]和CTA检查结果(狭窄远端直径、最小残余直径)。 结果 114例颈动脉狭窄患者中，经DSA检查确诊重度狭窄79例，非重度狭窄35例；CDFI诊断出重度狭窄75例，非重度狭窄27例；CTA诊断出重度狭窄77例，非重度狭窄30例。CDFI诊断颈动脉重度狭窄的灵敏度、特异度、准确度[94.94%(75/79)、77.14%(27/35)、89.47%(102/114)]与CTA诊断[97.47%(77/79)、85.71%(30/35)、93.86%(107/114)]比较差异未见统计学意义(P>0.05)。术后半年，患者的PSV、EDV水平均低于术前(P均<0.05)，患者的狭窄远端直径、最小残余直径均大于术前(P均<0.05)。 结论 CDFI、CTA对颈动脉重度狭窄的诊断效能相当，均有较高的灵敏度和准确度，均能指导手术及术后随访检查，临床可根据患者实际情况选择合适的诊断方法。 Objective To analyze the value of cervical vascular ultrasound color Doppler flow imaging (CDFI) and computed tomography angiography (CTA) in preoperative diagnosis and postoperative follow-up of patients with severe carotid artery stenosis. Methods This study was a retrospective trail. A total of 114 patients with carotid artery stenosis who underwent surgical treatment in Henan No.3 Provincial People’s Hospital from May 2021 to September 2022 were selected as the study subjects. All patients underwent CDFI and CTA examinations before and 3 months after surgery, and they were followed up for 6 months. Results of digital subtraction angiography (DSA) was used as the gold standard, the results and efficacy of CDFI and CTA in diagnosing severe carotid artery stenosis were compared. The results of CDFI examination, including peak systolic velocity (PSV) and end diastolic velocity (EDV), and CTA results (narrowing distal diameter, minimum residual diameter) of patients were compared before and 6 months after surgery. Results Among the 114 patients with carotid artery stenosis, DSA identified 79 cases of severe stenosis and 35 cases of non-severe stenosis. CDFI identified 75 cases of severe stenosis and 27 cases of non-severe stenosis. CTA identified 77 cases of severe stenosis and 30 cases of non-severe stenosis. There was no significant difference in sensitivity, specificity and accuracy between CDFI (94.94%, 75/79 77.14%, 27/35 89.47%, 102/114) and CTA (97.47%, 77/79 85.71%, 30/35 93.86%, 107/114) in the diagnosis of severe carotid artery stenosis (P>0.05). Six months after operation, the levels of PSV and EDV were lower than preoperative levels (allP<0.05), while the narrowing distal diameter and minimum residual diameter were higher (allP<0.05). Conclusions CDFI and CTA have similar diagnostic efficacy in diagnosing severe carotid artery stenosis, with high sensitivity and accuracy. They can guide surgery and postoperative follow-up examinations. In clinical practice, appropriate diagnostic methods can be selected based on the actual situation of patients.

    颈动脉狭窄颈部血管超声血流显像CT血管造影

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    盐酸氨溴索联合盐酸丙卡特罗治疗小儿肺炎支原体肺炎的临床观察

    吴静王思明曹静波刘小敏...
    102-105页
    查看更多>>摘要：目的 探讨盐酸氨溴索联合盐酸丙卡特罗治疗小儿肺炎支原体肺炎(MPP)的临床效果。 方法 抽取2019年12月至2022年3月河南大学淮河医院收治的MPP患儿92例，采用随机数字表法分为丙卡特罗组与氨溴索组，每组46例。氨溴索组采用盐酸氨溴索治疗，丙卡特罗组在氨溴索组基础上采用盐酸丙卡特罗治疗。比较两组治疗效果、症状消失时间、炎症因子[C反应蛋白(CRP)、干扰素-γ(IFN-γ)、白细胞介素-2(IL-2)]水平、免疫功能[T淋巴细胞(CD3＋、CD4＋、CD8＋)]及不良反应发生率。 结果 丙卡特罗组总有效率(93.48%，43/46)高于氨溴索组(78.26%，36/46)，P<0.05。丙卡特罗组症状消失时间短于氨溴索组(P<0.05)。治疗后，丙卡特罗组CRP、IFN-γ、IL-2水平低于氨溴索组(P<0.05)；治疗后，丙卡特罗组CD3＋、CD4＋高于氨溴索组，CD8＋低于氨溴索组(P<0.05)。丙卡特罗组不良反应发生率(8.70%，4/46)与氨溴索组(4.35%，2/46)比较差异未见统计学意义(P>0.05)。 结论 盐酸氨溴索联合盐酸丙卡特罗治疗MPP的效果较好，能减轻机体炎症，提高免疫功能，缓解临床症状，且治疗安全性良好。 Objective To investigate the clinical effect of ambroxol hydrochloride combined with procaterol hydrochloride in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children. Methods A total of 92 children with MPP treated in Huaihe Hospital of Henan University from December 2019 to March 2022 were selected, and they were divided into procaterol group and ambroxol group by random number table method, with 46 cases in each group. The ambroxol group was treated with ambroxol hydrochloride, while the procaterol group was treated with procaterol hydrochloride based on the treatment of the ambroxol group. The treatment efficacy, symptom disappearance time, levels of inflammatory factors, including C-reactive protein (CRP), interferon-γ (IFN-γ) and interleukin-2 (IL-2), immune function assessed by T lymphocytes, including cluster of differentiation 3+ (CD3+ ), cluster of differentiation 4+ (CD4+ ) and cluster of differentiation 8+ (CD8+ ), and incidence of adverse reactions of the two groups were compared. Results The total effective rate of the procaterol group (93.48%, 43/46) was higher than that of the ambroxol group (78.26%, 36/46), P<0.05. The symptom disappearance time in the procaterol group was shorter than that in the ambroxol group (P<0.05). After treatment, the levels of CRP, IFN-γ and IL-2 in the procaterol group were lower than those in the ambroxol group (P<0.05). After treatment, CD3+ and CD4+ in the procaterol group were higher than those in the ambroxol group, while CD8+ was lower than that in the ambroxol group (P<0.05). There was no significant difference in the incidence of adverse reactions between the procaterol group (8.70%, 4/46) and the ambroxol group (4.35%, 2/46),P>0.05. Conclusions Ambroxol hydrochloride combined with procaterol hydrochloride has a good effect in the treatment of MPP. It can reduce inflammation, improve immune function, and alleviate clinical symptoms, which has good treatment safety.

    肺炎支原体盐酸氨溴索盐酸丙卡特罗肺功能

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    硝苯地平缓释片联合硫酸镁治疗妊娠期高血压疾病的临床效果

    张文文王雪勤张蕾马文娟...
    106-109页
    查看更多>>摘要：目的 分析硝苯地平缓释片联合硫酸镁治疗妊娠期高血压疾病(HDCP)的效果及对血管内皮功能、母婴结局的影响。 方法 抽取2020年10月至2022年5月河南科技大学附属许昌市中心医院收治的HDCP患者72例，随机分为对照组和联合组，每组36例。对照组给予硫酸镁进行治疗，联合组给予硝苯地平缓释片＋硫酸镁进行治疗。比较两组临床疗效、收缩压、舒张压、24 h尿蛋白量、子宫动脉血流参数[收缩期最大流速(Vmax)、收缩期峰值流速/舒张末期流速(S/D)、阻力指数(RI)、搏动指数(PI)]、血管内皮功能[可溶性血管内皮生长因子受体-1(sFlt-1)、内皮素1(ET-1)、一氧化氮(NO)、可溶性内皮因子(sEng)]及母婴结局。 结果 联合组总有效率(91.67%，33/36)高于对照组(72.22%，26/36)，P<0.05。干预后，两组收缩压、舒张压、24 h尿蛋白量、PI、S/D、RI均较干预前降低，且联合组上述指标均低于对照组；两组Vmax均较干预前升高，且联合组Vmax高于对照组(P<0.05)。干预后，两组sEng、ET-1、sFlt-1均较干预前降低，NO均较干预前升高，且联合组sEng、ET-1、sFlt-1低于对照组，联合组NO高于对照组(P<0.05)。联合组不良母婴结局发生率(13.89%，5/36)低于对照组(36.11%，13/36)，P<0.05。 结论 硝苯地平缓释片联合硫酸镁可降低HDCP患者的血压水平，减少不良母婴结局，并改善血管内皮功能。 Objective To analyze the clinical effects of nifedipine sustained-release tablets combined with magnesium sulfate in the treatment of hypertensive disorders of pregnancy (HDCP), and its influence on vascular endothelial function, maternal and infant outcomes. Methods A total of 72 patients with HDCP admitted to Xuchang Central Hospital Affiliated to Henan University of Science and Technology from October 2020 to May 2022 were selected as study subjects, and they were randomly divided into control group and combination group, with 36 cases in each group. The control group was treated with magnesium sulfate, while the combination group was treated with nifedipine sustained-release tablets combined with magnesium sulfate. The clinical efficacy, systolic blood pressure, diastolic blood pressure, 24-hour urine protein content, uterine artery blood flow parameters, including systolic maximum flow velocity (Vmax), peak systolic velocity/end diastolic (S/D), resistance index (RI) and pulsatility index (PI), vascular endothelial function, assessed by soluble Fms-like tyrosine kinase 1 (sFlt-1), endothelin-1 (ET-1), nitric oxide (NO) and soluble endoglin (sEng), and outcomes of maternal and infant were compared between the two groups. Results The total effective rate of the combination group (91.67%, 33/36) was higher than that of the control group (72.22%, 26/36), P<0.05. After intervention, the systolic blood pressure, diastolic blood pressure, 24-hour urine protein content, PI, S/D, and RI of both groups decreased, compared with these indexes before intervention (P<0.05) and the above indicators in the combination group were lower than those in the control group (P<0.05). After intervention, the Vmax of both groups were higher than those before intervention, and the Vmax of the combination group was higher than that of the control group (P<0.05). After intervention, the levels of sEng, ET-1 and sFlt-1 in both groups were lower than those before intervention, while the levels of NO in both groups were higher (P<0.05) and the levels of sEng, ET-1 and sFlt-1 in the combination group were lower than those in the control group, while the levels of NO in the combination group was higher than that in the control group (P<0.05). The incidence of adverse maternal and infant outcomes in the combination group (13.89%, 5/36) was lower than that in the control group (36.11%, 13/36),P<0.05. Conclusions The combination of nifedipine sustained-release tablets and magnesium sulfate in the treatment of HDCP can lower the patient’s blood pressure level, reduce adverse maternal and infant outcomes, and improve the patient’s vascular endothelial function.

    硝苯地平硫酸镁妊娠期高血压疾病

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    门冬胰岛素联合地特胰岛素治疗妊娠期糖尿病的效果观察

    姜克萍王冉张桂萍刘小敏...
    110-113页
    查看更多>>摘要：目的 研究门冬胰岛素联合地特胰岛素治疗妊娠期糖尿病的临床效果。 方法 抽取2019年3月至2021年2月南阳市第一人民医院收治的妊娠期糖尿病患者102例，按照随机数字表法分为单一组和联合组，每组51例。单一组采用门冬胰岛素治疗，联合组在单一组基础上采用地特胰岛素治疗。比较两组治疗效果、血糖达标时间，比较两组治疗前后血糖[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]水平、血清胆固醇(TC)、尿微量蛋白(mA1b)、总胆红素(TBil)水平，比较两组妊娠并发症发生率。 结果 联合组总有效率(94.12%，48/51)高于单一组(72.55%，37/51)，P<0.05。联合组FPG达标时间、2hPG达标时间短于单一组(P<0.05)。治疗后，联合组FPG、2hPG、HbA1c水平低于单一组(P<0.05)；治疗后，联合组TC、mA1b水平低于单一组，TBil水平高于单一组(P<0.05)。联合组妊娠并发症发生率(5.88%，3/51)低于单一组(23.53%，12/51)，P<0.05。 结论 门冬胰岛素联合地特胰岛素方案治疗妊娠期糖尿病疗效显著，能快速改善患者血糖水平和血清生化指标，缩短血糖达标时间，降低产后低血糖、产后出血等妊娠并发症的发生。 Objective To study the clinical effect of insulin aspart combined with insulin detemir in the treatment of gestational diabetes. Methods A total of 102 patients with gestational diabetes treated in Nanyang First People’s Hospital from March 2019 to February 2021 were selected, and they were divided into single group and combined group according to random number table method, with 51 cases in each group. The single group was treated with insulin aspart, and the combined group was treated with insulin detemir based on the treatment of the single group. The curative effect and blood glucose standard time in the two groups were compared. The blood glucose level, including fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2hPG) and glycosylated hemoglobin (HbA1c), level of serum total cholesterol (TC), level of microprotein (mA1b) and level of total bilirubin (TBil) were compared between the two groups before and after treatment. The incidence of pregnancy complications were compared between the two groups. Results The total effective rate of the combined group (94.12%, 48/51) was higher than that of the single group (72.55%, 37/51), P<0.05. The FPG standard time and 2hPG standard time of the combined group were shorter than those of the single group (P<0.05). After treatment, the levels of FPG, 2hPG and HbA1c in the combined group were lower than those in the single group (P<0.05). After treatment, the levels of TC and mA1b in the combined group were lower than those in the single group, and the level of TBil was higher than that in the single group (P<0.05). The incidence of pregnancy complications in the combined group (5.88%, 3/51) was lower than that in the single group (23.53%, 12/51),P<0.05. Conclusions Insulin aspart combined with insulin detemir has significant efficacy in the treatment of gestational diabetes, which can rapidly improve the blood glucose level and serum biochemical indexes, shorten the blood glucose standard time, and reduce the incidence of pregnancy complications, such as postpartum hypoglycemia and postpartum hemorrhage.

    妊娠期糖尿病门冬胰岛素地特胰岛素血糖

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    加味麻杏石甘汤治疗老年AECOPD对患者气道重塑及中医症候积分的影响

    张小强李冰常青
    114-117页
    查看更多>>摘要：目的 探讨老年慢性阻塞性肺疾病急性加重期(AECOPD)患者采用加味麻杏石甘汤治疗对其气道重塑、中医症候积分的改善情况。 方法 抽取2022年1月至2023年3月安阳市中医院收治的老年AECOPD患者138例，采用随机数字表法分为对照组和研究组，每组69例。对照组给予西医常规治疗，研究组在对照组用药基础上加用加味麻杏石甘汤，两组均治疗14 d。比较两组治疗前后的中医症候积分、气道重塑[气管壁平均管壁厚度(WT mean)、气道面积/总横截面积比值(WA)、气道壁厚度/外径比值(TDR)]及炎症反应[白细胞计数(WBC)、白细胞介素-8(IL-8)、白细胞介素-17(IL-17)]，比较两组治疗期间的安全性。 结果 治疗14 d后，两组咳嗽、咳痰、喘息、胸闷、发热、哮鸣音或湿啰音各项中医症候积分均低于治疗前，且研究组低于对照组(P<0.05)。治疗14 d后，两组气管壁WT mean、WA、TDR均低于治疗前，且研究组低于对照组(P<0.05)。治疗14 d后，两组外周血WBC、IL-8、IL-17水平均低于治疗前，且研究组低于对照组(P<0.05)。治疗期间，研究组总不良反应发生率(11.59%，8/69)与对照组(8.70%，6/69)比较差异未见统计学意义(P>0.05)。 结论 老年AECOPD患者采用加味麻杏石甘汤进行治疗能够缓解中医症候，改善患者气道重塑情况，减轻炎症反应，且安全性良好。 Objective To investigate the improvement of airway remodeling and traditional Chinese medicine symptom score in elderly patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) treated with added Maxing Shigan decoction. Methods A total of 138 elderly patients with AECOPD admitted to Anyang Traditional Chinese Medicine Hospital from January 2022 to March 2023 were selected, and they were divided into the control group and the study group by random number table method, with 69 cases in each group. The control group was treated with conventional western medicine, and the study group was treated with added Maxing Shigan decoction on the basis of the above-mentioned control group, both groups were treated for 14 days. Airway remodeling, traditional Chinese medicine symptom score assessed by mean wall thickness (WT mean), wall area (WA) and ratio of airway wall thickness to outer diameter (TDR), inflammatory response, including white blood cell count (WBC), serum interleukin-8 (IL-8) and interleukin-17 (IL-17) before treatment and 14 days after treatment between the two groups were compared, and the safety during treatment were compared between the two groups. Results After 14 days of treatment, the scores of various traditional Chinese medicine symptoms, such as cough, sputum, wheezing, chest tightness, fever, wheezing or wet rales, in both groups were lower than before treatment, and the scores in the study group were lower than those in the control group (P<0.05). After 14 days of treatment, the WT mean, WA and TDR in two groups were lower than before treatment, and the above indexes in the study group were lower than those in the control group (P<0.05). After 14 days of treatment, the levels of WBC, IL-8 and IL-17 in both groups decreased compared with levels before treatment, and the levels of WBC, IL-8 and IL-17 in the study group were lower than those in the control group (P<0.05). There was no statistically significant difference in the overall incidence of adverse reactions between the study group (11.59%, 8/69) and the control group (8.70%, 6/69),P>0.05. Conclusions The use of added Maxing Shigan decoction in the treatment of elderly patients with AECOPD can alleviate the symptoms of traditional Chinese medicine, improve the remodeling of the airway, and reduce the inflammatory response, with good safety.

    慢性阻塞性肺疾病老年加味麻杏石甘汤气道重塑中医症候积分炎症反应

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