针刺奇穴结合辨证选穴治疗脑卒中后便秘

目的观察针刺奇穴结合辨证选穴治疗脑卒中后便秘患者的临床疗效。方法将脑卒中后便秘患者74例随机分为观察组和对照组各37例。观察组采用针刺治疗,每日1次,连续治疗10 d;对照组采用乳果糖口服溶液治疗,每日25 mL,早餐时一次口服,连续服用10 d。比较2组患者首次排便时间(首次治疗结束后至首次排便所需要的时间)、便秘评分(治疗后、随访时)及不良反应发生率。结果观察组的总有效率为 89.19%,优于对照组的75.68%(P<0.05);观察组的首次排便时间为(28.56±14.13)h,优于对照组的(45.07±23.28)h(P<0.05);观察组治疗后与随访时的便秘评分为(3.68±2.35)分和(5.13±1.65)分,优于对照组的(5.08±1.62)分和(7.22±1.97)分(均P<0.05);2组患者均未出现明显的不良反应。结论针刺奇穴结合辨证选穴能较好改善脑卒中后便秘患者的临床症状,与口服乳果糖口服溶液比较,具有见效快、疗效优、效果持续时间长的优势。     

《吴鞠通医案》石膏半夏配伍应用浅析

《吴鞠通医案》作为一本较为实用的临床参考书,对后世有重要指导意义。石膏、半夏二味的配伍使用尤为精当。本文拟从探本溯源、本草考究、配伍特点三方面对该配伍进行论述,以期有助于经典研读及临床应用。     

Timing of surgical fixation in traumatic spinal fractures: A systematic review

BackgroundThe optimal timing of fracture fixation following spinal injury is controversial. Many spinal fractures occur as part of polytrauma requiring a complex management strategy. Whilst the decision to stabilize unstable spinal column injuries is without debate, the duration between injury and definitive fixation can impact on the incidence of post-operative complications. This study was designed to systemically summarize and compare the complication profile of early vs late stabilization of spinal injuries, in an attempt to unveil an appropriate treatment protocol for traumatic spinal fractures.MethodsA comprehensive search strategy was performed on the PubMed, Cochrane, and Google Scholar databases using key words. The search strategy provided 1120 results. Forty-six articles were reviewed for full-text. Reference lists were analysed for potential additional texts.ResultsSixteen articles met the inclusion criteria and were included for systematic review. Studies were controversial and the overall result was inconclusive. Several studies favour early stabilisation to reduce post-surgical complication rates, especially in cases of patients with high Injury Severity Scale (ISS) scores. However, this is challenged by a small number of studies reporting a higher mortality rate in the early-stabilisation cohort.ConclusionDue to limited studies and a small overall cohort, the authors would cautiously recommend the early surgical fixation of unstable spine fractures in the stable trauma patient. For severely injured patients, the discordance among literature warrants the need for further investigation.     

Pituitary disease and anaesthesia

Patients with pituitary gland tumours comprise a significant proportion of the neurosurgical population, making transphenoidal pituitary surgery a relatively common procedure. These patients present unique anaesthetic challenges resulting from hormone hypersecretion, pituitary hypofunction or tumour mass effect. To understand this pathophysiology requires knowledge of normal pituitary anatomy and physiology. Respiratory and cardiovascular sequelae of pituitary tumours also pose anaesthetic challenges. We aim to review the key principles involved in the preoperative assessment, intraoperative management and postoperative care of these patients.     

一贯煎治疗干燥综合征临床疗效及安全性的系统评价

目的:系统评价一贯煎治疗干燥综合征临床疗效及安全性。方法:计算机检索PubMed、The Cochrane Library、EMbase、中国知网、维普和万方等数据库,检索时间截至2019年4月30日,收集一贯煎治疗干燥综合征的随机对照试验。由2位研究人员单独筛选文献、提取资料,分析纳入文献的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入6个研究,均为中文文献。Meta分析显示,一贯煎治疗组临床疗效明显优于对照组,差异有统计学意义(OR=4.11,95%CI=[2.30,7.34],P<0.00001)。共有2个研究提及不良反应,且治疗组不良反应例数少于对照组。结论:一贯煎治疗干燥综合征临床有效,且不易引起不良反应。因本研究纳入文献量少,西药种类繁多,受纳入文献方法学质量及干预措施不同等条件的局限,上述结论需要进一步实施更多高质量、样本量大的随机对照试验验证。     

Outpatient thyroidectomy in the pediatric population

Preoperative optimization and patient education have allowed for the transition of thyroid surgery to the outpatient setting over the last few decades. Performing these operations in the outpatient setting has proven to be cost-effective and safe in the adult population. The purpose of this study is to evaluate the safety and efficacy of outpatient thyroid surgery in the pediatric population. A retrospective review from December 2015 to February 2019 of patients under the age of 18 years of age undergoing thyroidectomy performed by two endocrine surgeons at a large academic was performed. There were 55 consecutive operations performed in 51 patients for thyroid pathology, two were excluded as they were inpatient procedures. Cases were reviewed for complications, unplanned same-day admission, 30-day admission, unplanned reoperation, and death. Mean age was 15 ± 0.3 years (range 9–18 years), 79% of the patients were female. Operations were performed for Graves’ disease (n = 29), thyroid cancer (n = 9), thyroid nodule (n = 6), multinodular goiter (n = 4), Hashimoto’s disease (n = 3), and toxic adenoma (n = 2). Operations performed included: total thyroidectomy (n = 36), thyroid lobectomy (n = 13), total thyroidectomy with lymph node dissection (n = 2), and lateral neck dissection (n = 2). All patients were discharged home within 6 h after completion of the operation. Five (9.4%) patients had transient hypoparathyroidism, with parathyroid hormone levels <10 pg/mL immediately postoperatively. One patient (1.9%) developed a postoperative hematoma on postoperative day six and required reoperation and readmission. Two patients (3.8%) had permanent hypoparathyroidism and one had transient hoarseness (1.9%). There were otherwise no readmissions or ED visits. In conclusion, outpatient thyroid surgery is safe and effective for pediatric patients.     

社区护理干预对提高糖尿病患者生活质量的影响

对８２例糖尿病患者实施社区护理干预，２个月后评估干预效果：血糖下降，生活质量提高；使疾病对社会活动的影响减少，抑郁和焦虑障碍减轻；本文还讨论了社区护理干预的方法和组织形式     

国人版角膜接触镜配戴者生活质量量表的研制与评估

目的：研制国人版角膜接触镜配戴者生活质量量表（CLIQ）并评估其信度和效度,分析得分的影响因素。方法：对英国原版CLIQ进行翻译、回译、文化调试,形成国人版量表。采用横断面研究,选择2015年4─12月在温州医科大学附属眼视光医院就诊的角膜接触镜配戴者205例进行问卷调查, 其中再随机选取20例由2名调查员分别进行调查,对问卷数据进行统计分析。结果：回收有效问卷201例。视功能维度因应答率小于50%被删除。量表Cronbach's α系数为0.77,眼部症状维度为0.68, 便利性、经济和情感维度均>0.7,量表Guttmann Split-Half系数为0.89,眼部症状、便利性、经济和情感维度分别为0.75、0.78、0.65和0.93。认知维度Cronbach's α系数和Guttmann Split-Half系数均为 0.49故被删除;删除条目20后健康关注维度Cronbach's α系数和Guttmann Split-Half系数分别为0.68 和0.73。2名调查员之间的评分结果高度相关（r=0.87～0.99,P<0.001）。各条目的条目水平内容效度指数为0.83～1.00,量表的平均水平内容效度指数为0.95。探索性因子分析提取的5个因子分别对应各维度,累计方差贡献率60.43%。眼部症状维度与年龄（r=-0.153,P=0.03）和戴镜年数（r=-0.167, P=0.018）轻度相关,情感维度与戴镜年数轻度相关（r=0.209,P=0.003）。量表总分在不同戴镜年数[（3.60±0.34）年 vs. （3.71±0.32）年,P=0.026、每月戴镜天数[（3.60±0.33）d vs. （3.70±0.33）d, P=0.041]和无/有眼部症状（3.71±0.32 vs. 3.60±0.34,P=0.021）的配戴者间差异有统计学意义。软镜配戴者的经济维度对分高于硬镜配戴者（t=2.588,P=0.017）。结论：删去视功能维度、认知维度和条目20后,CLIQ量表的信度和效度较好,戴镜年数越长、每月戴镜天数越多以及无眼部症状的患者得分较高,硬镜配戴者在花费方面的担忧更多。     

老年习惯性便秘的社区干预效果评估

目的探讨社区干预对老年习惯性便秘的效果。方法收集辖区内常驻老年习惯性便秘患者154例,在征得本人及家属同意,接受并积极配合本社区干预措施情况下,治疗3个月,并采用调查问卷的形式,对干预前、后患者便秘症状好转情况进行比对分析。结果135例老年习惯性便秘患者经社区干预性治疗3个月后,痊愈38例(28.15%)、好转83例(61.48%)、无效14例(10.37%),总有效率89.63%,且干预前后患者对便秘相关因素认知情况、心理干预情况均有显著差异,应用SPSS软件建立数据库并进行统计分析。以P<0.05差异有统计学意义。结论社区的正确干预,对老年习惯性便秘是行之有效的。为了早日缓解便秘患者的痛苦,提高生活质量,我们应大力推广。