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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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    磁共振多参数定量技术用于诊断肝癌结节的价值

    李贞旭童姗姗张晓亚向旭...
    79-82页
    查看更多>>摘要：目的 分析磁共振(MRI)多参数定量技术用于诊断肝癌结节的价值。 方法 观察性研究。抽取2021年4月至2023年6月南阳市中心医院收治的73例肝脏结节患者为研究对象，均行MRI、CT诊断，以病理结果为"金标准"，比较MRI、CT对肝癌结节和再生性结节的诊断结果、诊断效能、诊断预测值(阳性预测值、阴性预测值)；对比肝癌结节和再生性结节MRI动态增强扫描定量参数[最大下降斜率(MSD)、最大上升斜率(MSI)、获得平均强化时间(MEF)]、MRI定量参数[增强率(ER)、脂肪分数(FF)、表观扩散系数(ADC)]。 结果 本组73例疑似肝癌结节患者，病理检查确诊肝癌结节44例，再生性结节29例；采用MRI诊断出肝癌结节43例，再生性结节30例；采用CT诊断出肝癌结节42例，再生性结节31例。MRI诊断灵敏度、特异度、准确度(93.18%，41/44；93.10%，27/29；93.15%，68/73)高于CT诊断(77.27%，34/44；72.41%，21/29；75.34%，55/73)，漏诊率、误诊率(6.82%，3/44；6.90%，2/29)低于CT诊断(22.73%，10/44；27.59%，8/29)，P<0.05。MRI诊断阳性预测值与CT诊断比较差异未见统计学意义(P>0.05)；MRI诊断阴性预测值(90.00%，27/30)高于CT诊断(67.74%，21/31)，P<0.05。肝癌结节MSD参数高于再生性结节，MSI、MEF参数低于对照组(P<0.05)。肝癌结节ER值、ADC值低于再生性结节，FF值高于再生性结节(P<0.05)。 结论 肝癌结节和再生性结节患者MRI图像纹理参数、增强扫描参数和定量参数存在明显差异，采用MRI多参数定量技术诊断肝癌结节可提高诊断效果。 Objective To analyze the value of multi-parametric quantitative magnetic resonance imaging (MRI) in the diagnosis of liver cancer nodules. Methods A total of 73 patients with liver nodules treated in Nanyang Central Hospital from April 2021 to June 2023 were selected as the research objects of the observational study. And they all underwent MRI and computed tomography (CT) examinations for diagnosis. Taking the pathological results as the gold standard, the diagnostic results, diagnostic efficiency, and diagnostic predictive values (positive predictive value, negative predictive value) of MRI and CT in the diagnosis of liver cancer nodules and regenerative nodules were compared. Parameters of dynamic contrast-enhanced MRI, including maximum slope of decrease (MSD), maximum slope of increase (MSI) and mean enhancement time (MEF), and MRI quantitative parameters, including enhancement rate (ER), fat fraction (FF) and apparent diffusion coefficient (ADC), of liver cancer nodules and regenerative nodules were compared. Results Among the 73 patients with suspected liver cancer nodules, pathological examination identified 44 cases with liver cancer nodules and 29 cases with regenerative nodules. MRI identified 43 cases with liver cancer nodules and 30 cases with regenerative nodules. CT identified 42 cases with liver cancer nodules and 31 cases with regenerative nodules. The sensitivity, specificity, and accuracy of MRI (93.18%, 41/44 93.10%, 27/29 93.15%, 68/73) were higher than those of CT (77.27%, 34/44 72.41%, 21/29 75.34%, 55/73) in the diagnosis while the missed diagnosis rate and misdiagnosis rate of MRI (6.82%, 3/44 6.90%, 2/29) were lower than those of CT (22.73%, 10/44 27.59%, 8/29), P<0.05. There was no statistically significant difference in the positive predictive values between MRI and CT (P>0.05). The negative predictive value of MRI (90.00%, 27/30) was higher than that of CT (67.74%, 21/31),P<0.05. The MSD of liver cancer nodules was higher than that of regenerative nodules, while the MSI and MEF of liver cancer nodules were lower than those of the regenerative nodules (P<0.05). The ER and ADC values of liver cancer nodules were lower than those of regenerative nodules, while the FF value was higher than that of regenerative nodules (P<0.05). Conclusions There are significant differences in MRI texture parameters, contrast enhanced parameters, and quantitative parameters between liver cancer nodules and regenerative nodules. Multiparametric quantitative MRI can improve the diagnostic efficiency for liver cancer nodules.

    肝癌再生性结节磁共振

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    血浆miR－455－5p、miR－483－5p及PCT检测诊断小儿脓毒症的价值

    甄明慧杨丽君常青
    83-85页
    查看更多>>摘要：目的 分析血浆微小核糖核酸－455－5p(miR－455－5p)、微小核糖核酸－483－5p(miR－483－5p)、降钙素原(PCT)检测诊断小儿脓毒症的价值。 方法 回顾性抽取2020年1月至2022年12月郑州大学附属儿童医院收治的脓毒症患儿106例，按照病情严重程度分为非休克组(63例)和休克组(43例)，另按照1∶1比例抽取106例健康体检儿童作为健康组。所有儿童均接受miR－455－5p、miR－483－5p、PCT水平检测，比较各组间的miR－455－5p、miR－483－5p、PCT水平，并分析miR－455－5p、miR－483－5p、PCT单独检测及三者联合检测的诊断结果、诊断效能。 结果 非休克组、休克组miR－455－5p、miR－483－5p、PCT水平高于健康组，休克组miR－455－5p、miR－483－5p、PCT水平高于非休克组(P<0.05)。本组106例脓毒症患儿和106例健康儿童中，经miR－455－5p检查显示阳性86例，阴性76例；经miR－483－5p检查显示阳性82例，阴性74例；经PCT检查显示阳性88例，阴性81例；经联合检查显示阳性99例，阴性89例。联合检查灵敏度(93.40%，99/106)、准确度(88.68%，188/212)高于miR－455－5p检查(81.13%，86/106；76.42%，162/212)、miR－483－5p检查(77.36%，82/106；73.58%，156/212)、PCT检查(83.02%，88/106；79.72%，169/212)，P<0.05。 结论 脓毒症患儿的miR－455－5p、miR－483－5p、PCT水平较高，且miR－455－5p、miR－483－5p、PCT联合检测能提升诊断灵敏度、准确度，降低漏诊率，为患儿靶向治疗提供参考依据。

    脓毒症微小核糖核酸－455－5p微小核糖核酸－483－5p降钙素原

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    经颅多普勒超声发泡试验在卵圆孔未闭致隐源性脑卒中筛查中的应用价值

    吴天义刘小敏
    86-89页
    查看更多>>摘要：目的 分析经颅多普勒超声(TCD)发泡试验在卵圆孔未闭(PFO)致隐源性脑卒中筛查中的应用价值。 方法 前瞻性研究。抽取2022年11月至2023年11月于南阳南石医院接受PFO筛查的116例隐源性脑卒中患者作为研究对象，所有患者均行TCD发泡试验与经食管超声心动图(TEE)，以TEE结果作为"金标准"，统计TCD对PFO致隐源性脑卒中的诊断结果与诊断效能，分析TCD在PFO致隐源性脑卒中筛查中的应用价值。 结果 116例隐源性脑卒中患者中，TEE检出阴性64例，阳性52例，其中卵圆孔形态为小型13例，中型22例，大型17例；TCD发泡试验显示Ⅰ级65例，Ⅱ级24例，Ⅲ级15例，Ⅳ级12例；TCD发泡试验检出阴性65例，阳性51例。TCD诊断PFO致隐源性脑卒中的结果与TEE诊断结果的一致性较强(Kappa＝0.88，P<0.001) TCD诊断PFO致隐源性脑卒中的灵敏度、特异度、准确度、阳性预测值及阴性预测值均>90%，具有较高的诊断效能。 结论 TCD发泡试验在PFO中具有较高的诊断效能，可作为PFO致隐源性脑卒中筛查中首选的无创诊断方法。 Objective To analyze the application value of transcranial Doppler ultrasound (TCD) foaming experiment in detection of cryptogenic stroke caused by patent foramen ovale (PFO). Methods A total of 116 patients with cryptogenic stroke who underwent PFO screening in Nanshi Hospital of Nanyang from November 2022 to November 2023 were selected as the study subjects of the prospective study. All selected patients underwent TCD foaming experiment and transesophageal echocardiography (TEE) examinations. Taking the TEE results as the gold standard, the diagnostic results and diagnostic efficacy of TCD for cryptogenic stroke caused by PFO was analyzed and the application value of TCD in screening for cryptogenic stroke caused by PFO was analyzed. Results Among the 116 patients with cryptogenic stroke, TEE detected out 64 cases negative and 52 cases positive. Among them, 13 cases had small foramen ovale, 22 cases had medium foramen ovale, and 17 cases had large foramen ovale. TCD foaming experiment identified 65 cases of grade I, 24 cases of grade Ⅱ, 15 cases of grade Ⅲ, and 12 cases of grade Ⅳ. TCD foaming experiment confirmed 65 cases negative and 51 cases positive. The consistency between the results of TCD and TEE in the diagnosis of cryptogenic stroke caused by PFO was strong (Kappa=0.88, P<0.001). The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of TCD in diagnosing cryptogenic stroke caused by PFO were all greater than 90%, indicating high diagnostic efficacy. Conclusions TCD foaming experiment has high diagnostic efficacy for PFO, and it can be the preferred non-invasive diagnostic method of screening for cryptogenic stroke caused by PFO.

    缺血性脑卒中隐源性卵圆孔未闭经颅多普勒超声发泡实验经食管超声心动图诊断效能

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    妊娠期糖尿病患者血小板参数及凝血指标检验的临床意义

    孙晖郝旭李秀娥任莉...
    89-92页
    查看更多>>摘要：目的 探讨妊娠期糖尿病(GDM)患者血小板参数及凝血指标检验的临床意义。 方法 随机对照研究。抽取2021年1月至2022年10月西安第一医院收治的100例GDM患者为观察组，另抽取同期100例健康孕妇为对照组。均于孕中期采血开展血小板参数、凝血指标检测，比较两组血小板参数[血小板计数(PLT)、血小板平均体积(MPV)、血小板分布宽度(PDW)]、凝血指标[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D－二聚体(D－D)、纤维蛋白原(FIB)]。随访至分娩，比较两组不良妊娠结局发生率。采用Pearson相关性分析血小板参数、凝血指标与不良妊娠结局的相关性。 结果 观察组PLT低于对照组，MPV、PDW高于对照组，差异有统计学意义(P<0.05)。观察组TT、APTT、PT短于对照组，FIB、D－D高于对照组，差异有统计学意义(P<0.05)。观察组不良妊娠结局发生率(32.00%，32/100)高于对照组(6.00%，6/100)，差异有统计学意义(χ2＝21.96，P<0.001)。Pearson相关性分析结果显示，PLT、TT、APTT、PT与GDM患者不良妊娠结局呈负相关(r＝－0.42、－0.42、－0.44、－0.44，P<0.05)，MPV、PDW、FIB、D－D与GDM患者不良妊娠结局呈正相关(r＝0.40、0.42、0.43、0.46，P<0.05)。 结论 GDM患者血小板参数、凝血指标可出现异常变化，会增加不良妊娠结局风险。 Objective To investigate the clinical significance of platelet parameters and coagulation parameters testing for gestational diabetes (GDM). Methods A total of 100 patients with GDM admitted to Xi’an First Hospital from January 2021 to October 2022 were selected as the observation group for the randomized controlled study. And 100 healthy pregnant women during the same period were selected as the control group. Blood samples were collected during mid pregnancy for platelet parameters and coagulation parameters testings. The platelet parameters, including platelet count (PLT), mean platelet volume (MPV) and platelet distribution width (PDW), and coagulation parameters, including thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer (D-D) and fibrinogen (FIB), were compared between the two groups. Patients in the two groups were followed up until delivery. The incidence of poor pregnancy outcomes of the two groups were compared. Pearson correlation analysis was used to investigate the correlations of platelet parameters and coagulation parameters with poor pregnancy outcomes. Results Compared with the control group, the observation group had lower PLT, higher MPV and higher PDW (P<0.05). The TT, APTT, and PT of the observation group were shorter than those of the control group, while FIB and D-D of the observation group were higher than those of the control group (P<0.05). The incidence of poor pregnancy outcomes of the observation group (32.00%, 32/100) was higher than that of the control group (6.00%, 6/100), and the difference was significant (χ2=21.96, P<0.001). Pearson correlation analysis revealed that PLT, TT, APTT and PT were negatively correlated with poor pregnancy outcomes in patients with GDM (r=-0.42, -0.42, -0.44, -0.44 P<0.05) MPV, PDW, FIB and D-D were positively correlated with poor pregnancy outcomes in patients with GDM (r=0.40, 0.42, 0.43, 0.46 P<0.05). Conclusions Patients with GDM may experience abnormal changes in platelet parameters and coagulation parameters, which can increase the risk of poor pregnancy outcomes.

    妊娠期糖尿病血小板参数凝血指标

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    经阴道超声联合血β－绒毛膜促性腺激素、孕酮诊断异位妊娠的价值

    张璐段莹莹邵敏马艳丽...
    93-96页
    查看更多>>摘要：目的 探讨经阴道超声联合血β－绒毛膜促性腺激素(β－HCG)、孕酮诊断异位妊娠的性能。 方法 抽取2019年5月至2021年4月濮阳市妇幼保健院收治的异位妊娠患者68例作为研究组，并以1∶1配比抽取同期正常妊娠者68例作为对照组。两组均进行经阴道超声检查及β－HCG、孕酮检测。比较两组β－HCG、孕酮水平，统计单项(β－HCG、孕酮、经阴道超声)及三项联合对异位妊娠的诊断结果、诊断效能、预测值。 结果 研究组β－HCG、孕酮水平低于对照组(P<0.05)。68例异位妊娠患者和68例正常妊娠孕妇中，β－HCG诊断出异位妊娠55例，正常妊娠51例；孕酮诊断出异位妊娠54例，正常妊娠52例；经阴道超声诊断出异位妊娠48例，正常妊娠50例；三项联合诊断出异位妊娠63例，正常妊娠64例。单项诊断(β－HCG、孕酮、经阴道超声)灵敏性(80.88%，55/68；79.41%，54/68；70.59%，48/68)、特异性(75.00%，51/68；76.47%，52/68；73.53%，50/68)、准确性(77.94%，106/136；77.94%，106/136；72.06%，98/136)低于三项联合诊断(92.65%，63/68；94.12%，64/68；93.38%，127/136)，漏诊率(19.12%，13/68；20.59%，14/68；29.42%，20/68)、误诊率(25.00%，7/68；23.53%，16/68；26.47%，18/68)高于三项联合诊断(7.35%，5/68；5.88%，4/68)，差异有统计学意义(P<0.05)。单项诊断(β－HCG、孕酮、经阴道超声)阳性预测值(76.39%，55/72；77.14%，54/70；72.73%，48/66)、阴性预测值(79.69%，51/64；76.47%，52/68；71.43%，50/70)低于三项联合诊断(94.03%，63/67；92.75%，64/69)，差异有统计学意义(P<0.05)。 结论 经阴道超声联合β－HCG、孕酮应用于异位妊娠诊断中，能提高诊断灵敏性、特异性和准确性，减少漏诊和误诊的发生，且预测值良好。 Objective To investigate the efficacy of transvaginal ultrasound combined with β-human chorionic gonadotrophin (β-HCG) and progesterone in diagnosis of ectopic pregnancy. Methods A total of 68 patients with ectopic pregnancy admitted to Puyang Maternity and Child Care Centers from May 2019 to April 2021 were selected as the study group, and 68 cases with normal pregnancy in the same period were selected as the control group with a ratio of 1∶1. Vaginal ultrasound, β-HCG and progesterone testings were performed in both groups. The levels of β-HCG and progesterone in the two groups were compared. And the diagnostic results, diagnostic efficacy and predictive value of β-HCG, progesterone, transvaginal ultrasound and combination of the them for ectopic pregnancy were counted. Results The levels of β-HCG and progesterone in the study group were lower than those in the control group ( P<0.05). Among the 68 women with ectopic pregnancies and 68 cases of normal pregnancy, β-HCG testing identified 55 cases of ectopic pregnancy and 51 cases of normal pregnancy progesterone testing identified 54 cases of ectopic pregnancy and 52 cases of normal pregnancy transvaginal ultrasound confirmed 48 cases of ectopic pregnancy and 50 cases of normal pregnancy and the combination of the three examinations identified 63 cases of ectopic pregnancy and 64 cases of normal pregnancy. The sensitivity of β-HCG (80.88%, 55/68), progesterone (79.41%, 54/68) and transvaginal ultrasound (70.59%, 48/68) were lower than that of the combination of the three (92.65%, 63/68) in the diagnosis of ectopic pregnancy (P<0.05). The specificity of β-HCG (75.00%, 51/68), progesterone (76.47%, 52/68) and transvaginal ultrasound (73.53%, 50/68) were lower than that of the combination of the three (94.12%, 64/68),P<0.05. The accuracy of β-HCG (77.94%, 106/136), progesterone (77.94%, 106/136) and transvaginal ultrasound (72.06%, 98/136) were lower than that of the combination of the three (93.38%, 127/136),P<0.05. The missed diagnosis rate of β-HCG (19.12%, 13/68), progesterone (20.59%, 14/68) and transvaginal ultrasound (29.42%, 20/68) were higher than that of the combination of the three (7.35%, 5/68),P<0.05. The misdiagnosis rate of β-HCG (25.00%, 17/68), progesterone (23.53%, 16/68) and transvaginal ultrasound (26.47%, 18/68) were higher than that of the combination of the three (5.88%, 4/68),P<0.05. The positive predictive values (76.39%, 55/72 77.14%, 54/70 72.73%, 48/66) and negative predictive values (79.69%, 51/64 76.47%, 52/68 71.43%, 50/70) of β-HCG, progesterone and transvaginal ultrasound were lower than those of the combination of the three (94.03%, 63/67 92.75%, 64/ 69),P<0.05. Conclusions Transvaginal ultrasound combined with β-HCG and progesterone in the diagnosis of ectopic pregnancy can improve the sensitivity, specificity and accuracy of diagnosis, and reduce the occurrence of missed diagnosis and misdiagnosis, with good predictive value.

    异位妊娠β－绒毛膜促性腺激素孕酮经阴道超声

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    沙库巴曲缬沙坦治疗高血压合并射血分数降低心力衰竭的效果分析

    周璇段立鸣张中华刘小敏...
    97-100页
    查看更多>>摘要：目的 探讨沙库巴曲缬沙坦对高血压合并射血分数降低心力衰竭(HFrEF)的临床疗效与安全性。 方法 随机对照研究。抽取2022年1月至2022年12月联勤保障部队第九八八医院收治的98例高血压合并HFrEF患者，以随机数字表法分为对照组与研究组，每组49例。对照组采用缬沙坦胶囊联合常规治疗，研究组采用沙库巴曲缬沙坦片联合常规治疗。比较两组患者收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、左心室射血分数(LVEF)、氨基末端脑钠肽前体(NT－proBNP)、6 min步行距离、治疗有效率及不良反应发生率。 结果 治疗后，两组患者SBP、DBP、MAP值均明显下降，且研究组低于对照组(P<0.05)；治疗12周后，两组LVEF、NT－proBNP、6 min步行距离均显著改善，且研究组LVEF、6 min步行距离优于对照组，NT－proBNP水平低于对照组(P<0.05)。研究组治疗总有效率(93.88%，46/49)高于对照组(79.59%，39/49)，P<0.05。两组患者不良反应发生率比较差异未见统计学意义(P>0.05)。治疗后12周，研究组因心力衰竭再入院率(4.08%，2/49)低于对照组(8.16%，4/49)，但差异未见统计学意义(P>0.05)。 结论 沙库巴曲缬沙坦是一种有效且安全的治疗高血压合并HFrEF的药物，可显著改善患者的血压和心功能。 Objective To investigate the clinical efficacy and safety of sacubitril/valsartan in the treatment of hypertension complicated by heart failure with reduced ejection fraction (HFrEF). Methods A total of 98 patients with hypertension complicated by HFrEF admitted to No. 990 Hospital of the Joint Logistic Support Force from January 2022 to December 2022 were selected for the randomized controlled study. And they were divided into control group and study group by random number table method, with 49 cases in each group. The control group received conventional treatment combined with valsartan capsules, and the study group received sacubitril/valsartan tablets combined with conventional treatment. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), left ventricular ejection fraction (LVEF), N-terminal pro B-type natriuretic peptide (NT-proBNP), 6-minute walking distance, effective rate and incidence of adverse reactions were compared between the two groups. Results After treatment, the SBP, DBP and MAP in the two groups decreased notably, and these indicators in the study group were lower than those in the control group (P<0.05). After 12 weeks of treatment, LVEF, NT-proBNP and 6-minute walking distance in both groups were significantly improved (P<0.05) moreover, the LVEF and 6-minute walking distance in the study group were better after 12 weeks of treatment, while the NT-proBNP level in the study group was lower compared with the control group (P<0.05). The total effective rate in the study group (93.88%, 46/49) was higher than that in the control group (79.59%, 39/49),P<0.05. There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). The rate of re-hospitalization for heart failure in the study group (4.08%, 2/49) was lower than that in the control group (8.16%, 4/49), but the difference was not significant (P>0.05). Conclusions Sacubitril/valsartan is an effective and safe drug in the treatment of hypertension complicated by HFrEF, which can significantly improve blood pressure and cardiac function.

    高血压沙库巴曲缬沙坦射血分数降低的心衰治疗效果

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    芬吗通与替勃龙在围绝经期接受绝经激素治疗患者中的应用效果比较

    刘彩霞方明珠吴君梅马文娟...
    101-105页
    查看更多>>摘要：目的 比较芬吗通与替勃龙在围绝经期接受绝经激素治疗患者中的应用效果。 方法 随机对照研究。选取2020年1月至2022年1月郑州市妇幼保健院收治的围绝经期接受绝经激素治疗的患者144例，按照随机数字表法分为空白组、对照组和观察组，每组48例。空白组采用安慰剂进行对照，对照组采用替勃龙治疗，观察组采用芬吗通治疗。比较三组治疗前后血脂水平[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL－C)、低密度脂蛋白胆固醇(LDL－C)]，比较观察组和对照组治疗前后代谢指标[丙氨酸转氨酶(ALT)、血糖(GLU)、肌酐(Cr)]及临床症状(改良Kupperman评分)，比较观察组和对照组不良反应发生情况。 结果 治疗后，对照组和观察组TC、TG、LDL－C水平均低于空白组，HDL－C水平高于空白组(P<0.05) 观察组TC、TG、HDL－C、LDL－C水平与对照组比较差异未见统计学意义(P>0.05)。治疗前后，观察组ALT、GLU、Cr水平与对照组比较差异均未见统计学意义(P均>0.05)。治疗前及治疗1、3、6个周期后，观察组改良Kupperman评分与对照组比较差异均未见统计学意义(P均>0.05)；治疗1、3、6个周期后，观察组和对照组改良Kupperman评分均低于同组治疗前(P均<0.05)。观察组不良反应发生率(12.50%，6/48)与对照组(18.75%，9/48)比较差异未见统计学意义(P>0.05)。 结论 芬吗通和替勃龙在围绝经期接受绝经激素治疗患者中的疗效相当，均能在不影响机体代谢指标的情况下改善血脂水平，缓解患者临床症状，且不良反应较少。 Objective To compare the effect of fenmoston and tibolone in menopausal hormone therapy for perimenopausal women. Methods Conducted as a randomized controlled trail, the study included 144 perimenopausal women who received menopausal hormone therapy in Women and Infants Hospital of Zhengzhou from January 2020 to January 2022. And the selected patients were divided into blank group, control group and observation group according to the random number table method, with 48 cases in each group. The blank group was treated with placebo, the control group was treated with tibolone, and the observation group was treated with fenmoston. The preoperative and postoperative levels of blood lipid evaluated by total cholesterol (TC), triacylglycerol (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were compared among the 3 groups. The metabolic indicators, including alanine transaminase (ALT), glucose (GLU) and creatinine (Cr), and clinical symptoms assessed by modified Kupperman score were compared between the observation group and the control group before and after treatment. The incidence of adverse reactions of the observation group and the control group were compared. Results After treatment, the levels of TC, TG and LDL-C in the control group and the observation group were lower than those in the blank group, while the levels of HDL-C in the two groups were higher than those in the blank group (P<0.05) however, there was no statistically significant difference in the levels of TC, TG, HDL-C and LDL-C between the observation group and the control group (P>0.05). There were no significant differences in levels of ALT, GLU and Cr between the observation group and the control group before and after treatment (allP>0.05). There was no significant difference in modified Kupperman score between the observation group and the control group before treatment and after 1, 3 and 6 cycles of treatment (allP>0.05). The modified Kupperman scores after 1, 3, and 6 cycles of treatment in the observation group and the control group were lower than the preoperative scores in the same group (allP<0.05). There was no significant difference in the incidence of adverse reactions between the observation group (12.50%, 6/48) and the control group (18.75%, 9/48),P>0.05. Conclusions Fenmoston and tibolone have similar efficacy in menopausal hormone therapy for perimenopausal women, both of which can improve blood lipid level, relieve clinical symptoms, but do not affect metabolic indexes, with fewer adverse reactions.

    围绝经期绝经激素治疗芬吗通替勃龙

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    地西泮静脉推注与咪达唑仑肌肉注射治疗小儿惊厥的效果比较

    张超雁尹丽常珊珊马艳丽...
    105-108页
    查看更多>>摘要：目的 比较地西泮静脉推注与咪达唑仑肌肉注射治疗小儿惊厥的临床效果。 方法 回顾性抽取2022年1月至2023年9月南阳市第二人民医院收治的惊厥患儿73例，依据治疗方案分为地西泮组(40例)和咪达唑仑组(33例)。地西泮组采用地西泮静脉推注治疗，咪达唑仑组采用咪达唑仑肌肉注射治疗。比较两组治疗效果、药物起效时间、住院时间、血清C反应蛋白水平、免疫功能[免疫球蛋白M(IgM)、免疫球蛋白G(IgG)]及不良反应发生率。 结果 咪达唑仑组总有效率(93.94%，31/33)高于地西泮组(67.50%，27/40)，差异有统计学意义(P<0.05)。咪达唑仑组药物起效时间、住院时间、止抽后至清醒时间短于地西泮组(P<0.05)。治疗后，咪达唑仑组C反应蛋白水平低于地西泮组(P<0.05)。治疗后，咪达唑仑组IgM、IgG水平低于地西泮组(P<0.05)。咪达唑仑组不良反应发生率(3.03%，1/33)低于地西泮组(22.50%，9/40)，P<0.05。 结论 与地西泮静脉推注比较，咪达唑仑肌肉注射治疗小儿惊厥的效果更好，能缩短药物起效时间和住院时间，调节血清CRP水平和免疫功能，且安全性较好。 Objective To compare the clinical effects of diazepam intravenous injection and midazolam intramuscular injection in the treatment of pediatric convulsions. Methods A total of 73 children with convulsions treated in Nanyang Second General Hospital from January 2022 to September 2023 were retrospectively selected, and the children were divided into diazepam group (40 cases) and midazolam group (33 cases) according to the treatment regimen. The diazepam group was treated with diazepam intravenous injection, while the midazolam group was treated with midazolam intramuscular injection. The curative effect, onset time of drug, hospital stay, level of serum C-reactive protein (CRP), immune function, including immunoglobulin M (IgM), immunoglobulin G (IgG) and incidence of adverse reactions were compared between the two groups. Results The total effective rate of the midazolam group was 93.94% (31/33), higher than the 67.50% (27/40) of the diazepam group (P<0.05). Compared with the diazepam group, the onset time of drug, length of hospital stay and time from stopping shaking to regaining consciousness in the midazolam group were shorter, while the level of C-reactive protein in the the midazolam group was lower after treatment (P<0.05). After treatment, the levels of IgM and IgG in the midazolam group were lower than those in the diazepam group (P<0.05). The incidence of adverse reactions in the midazolam group was 3.03% (1/33), lower than the 22.50% (9/40) in the diazepam group (P<0.05). Conclusions Compared with diazepam intravenous injection, midazolam intramuscular injection is more effective in the treatment of convulsion in children. It can shorten the onset time of drug and length of hospital stay, regulate serum level of C-reactive protein, and correct immune function, with better safety.

    惊厥地西泮咪达唑仑不良反应

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    A型肉毒毒素对不同时期脑卒中后肢体痉挛的疗效分析

    王少华张萌刘立夏常青...
    109-112页
    查看更多>>摘要：目的 分析A型肉毒毒素对不同时期脑卒中后肢体痉挛的治疗效果。 方法 非随机对照研究。抽取2018年9月至2023年6月濮阳市安阳地区医院收治的96例脑卒中后痉挛性偏瘫患者作为研究对象，按照痉挛发病时期分为早期组、中期组、晚期组，每组32例。患者入院后均采用A型肉毒毒素注射治疗。比较三组患者治疗前后肢体痉挛程度、步行功能及生活质量的变化。 结果 治疗前，三组Ashworth痉挛分级比较差异未见统计学意义(P>0.05)；治疗2～8周后，三组Ashworth痉挛分级均呈下降趋势，但三组间比较差异未见统计学意义(P>0.05)。治疗前，三组6 min步行试验(6WMT)、功能性步行量表评分比较差异未见统计学意义(P>0.05)；治疗2周后，三组6WMT、功能性步行量表评分均有所好转，至治疗后4、8周，早期组步行速度最快，功能性步行量表评分最高，与其他两组比较差异有统计学意义(P<0.05)。 结论 A型肉毒毒素对不同时期脑卒中后肢体痉挛均有一定的治疗效果，尤其是在脑卒中后肢体痉挛发生6个月内完成注射将达到最佳成效。 Objective To analyze the effect of botulinum toxin type A on limb spasticity after stroke at different stages. Methods A total of 96 patients with spastic hemiplegia after stroke admitted to Anyang District Hospital in Puyang City from September 2018 to June 2023 were selected as the study objects of the non-randomized clinical controlled study. And the patients were divided into early group, middle group and late group according to onset periods of spasm, with 32 cases in each group. All patients were treated with botulinum toxin A injection after admission. The changes of limb spasm degree, walking function and activities of daily life in the three groups were compared before and after treatment. Results Before treatment, there was no statistically significant difference in Ashworth spasm grade among the three groups (P>0.05). After 2 to 8 weeks of treatment, Ashworth spasm grade decreased in all three groups, but there was no significant difference among the three groups (P>0.05). Before treatment, there were no significant differences in 6-minute walking test (6WMT) distance and functional walking scale scores among the three groups (P>0.05). After 2 weeks of treatment, the 6WMT distance and functional walking scale score in the three groups were improved (P<0.05). After 4 and 8 weeks of treatment, the early group had the fastest walking speed and the highest functional walking scale score, with statistically significant differences in comparison with the other two groups (P<0.05). Conclusions Botulinum toxin type A has a certain therapeutic effect on limb spasticity after stroke in different stages, especially, completing botulinum toxin type A injection within 6 months after onset of post-stroke limb spasticity can achieve the optimum effect.

    A型肉毒毒素不同时期脑卒中肢体痉挛

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    美托洛尔联合他汀类药物治疗冠心病心律失常的疗效观察

    刘梅王秀丽张娜马文娟...
    112-115页
    查看更多>>摘要：目的 分析美托洛尔联合他汀类药物治疗冠心病心律失常的临床效果。 方法 随机对照研究。抽取2020年7月至2022年7月济南市第二人民医院收治的冠心病心律失常患者100例，按照随机数字表法分为对照组与观察组，每组50例。对照组给予美托洛尔单药治疗，观察组给予美托洛尔联合他汀类药物治疗。比较两组临床疗效、心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)，每分钟输出量(CO)]、血管内皮功能[内皮素－1(ET－1)、血管内皮生长因子(VEGF)，一氧化氮(NO)]、心率变异性[高频功率(HF)、低频功率(LF)，窦性R－R间期标准差(SDNN)]及不良反应发生情况。 结果 观察组总有效率(96.0%，48/50)高于对照组(78.0%，39/50)，差异有统计学意义(P<0.05)。治疗后，两组LVEF、LVEDD、LVESD、CO水平均较治疗前明显改善，且观察组优于对照组(P<0.05)；两组ET－1、VEGF、NO水平均较治疗前明显改善，且观察组优于对照组(P<0.05)；两组HF、LF、SDNN指标均较治疗前升高，且观察组高于对照组(P<0.05)。观察组不良反应发生率(8.0%，4/50)与对照组(6.0%，3/50)比较，差异未见统计学意义(P>0.05)。 结论 美托洛尔联合他汀类药物治疗冠心病心律失常疗效显著，可改善患者的心功能、血管内皮功能，且不良反应少，患者接受度高。 Objective To analyze the effect of metoprolol combined with statins in the treatment of arrhythmia in coronary heart disease. Methods Conducted as a randomized controlled trial, the study included 100 patients with coronary heart disease complicated by arrhythmia admitted to Jinan Second People’s Hospital from July 2020 to July 2022. And they were divided into a control group and an observation group using a random number table method, with 50 cases in each group. The control group was given metoprolol monotherapy, and the observation group was given metoprolol combined with statins therapy. The clinical efficacy, cardiac function indexes, including left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and cardiac output (CO), vascular endothelial function assessed by endothelin-1 (ET-1), vascular endothelial growth factor (VEGF) and nitric oxide (NO), heart rate variability assessed by high frequency (HF), low frequency (LF), standard diviation of normal to normal intervals (SDNN), and adverse reactions were compared between the two groups. Results The total effective rate of the observation group (96.0%, 48/50) was higher than that of the control group (78.0%, 39/50), and the difference was significant (P<0.05). After treatment, the levels of LVEF, LVEDD, LVESD, and CO in both groups were significantly improved compared with these indexes before treatment (P<0.05) and the above indicators in the observation group were better than those in the control group after treatment (P<0.05). The levels of ET-1, VEGF and NO in both groups were significantly improved compared with these indexes before treatment, and the above indicators in the observation group were better than those in the control group (P<0.05). After treatment, the HF, LF, and SDNN in both groups increased compared with these indexes before treatment, and the above indicators in the observation group were higher than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the observation group (8.0%, 4/50) and the control group (6.0%, 3/50),P>0.05. Conclusions Metoprolol combined with statins has significant therapeutic effects in the treatment of arrhythmia in coronary heart, which can improve cardiac function and vascular endothelial function, with few adverse reactions but high acceptance.

    冠心病心律失常美托洛尔他汀类药物心功能

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