加强基层培训,不断提高对非ST段抬高型急性冠状动脉综合征的诊治水平

简要介绍《非ST段抬高型急性冠状动脉综合征基层诊疗指南(2019年)》制订的背景和涵盖内容。基层医疗机构医师应熟悉心肌损伤标志物肌钙蛋白(cTn)检测在非ST段抬高型急性冠状动脉综合征早期诊断中的重要性,重视其早期评估和危险分层,规范治疗策略,以改善长期预后。     

体力活动、心肺适能和心血管结局研究引发的对心房颤动患者体力活动的思考

心房颤动(房颤)的发病率在全球范围内仍在不断上升,并对心血管疾病发病率和病死率产生显著的不利影响。体育锻炼对降低心血管疾病患病率、发病率和病死率的获益是不可否认的。然而,体力活动与房颤的发病之间存在复杂的相关性。房颤患者体力活动、心肺适能和心血管结局研究(HUNT研究)为较高体力活动和心肺适能对房颤患者预后的潜在获益提供了新的证据。未来有必要开展进一步的随机对照研究,评估不同强度体力活动对不同类型房颤患者长期预后的影响。     

3- to 24-month Follow-up on COVID-19 with Pulmonary Tuberculosis Survivors after Discharge: Results from a Prospective,Multicenter Study

ObjectiveCoronavirus disease 2019 (COVID-19) and tuberculosis (TB) are major public health and social issues worldwide. The long-term follow-up of COVID-19 with pulmonary TB (PTB) survivors after discharge is unclear. This study aimed to comprehensively describe clinical outcomes, including sequela and recurrence at 3, 12, and 24 months after discharge, among COVID-19 with PTB survivors.MethodsFrom January 22, 2020 to May 6, 2022, with a follow-up by August 26, 2022, a prospective, multicenter follow-up study was conducted on COVID-19 with PTB survivors after discharge in 13 hospitals from four provinces in China. Clinical outcomes, including sequela, recurrence of COVID-19, and PTB survivors, were collected via telephone and face-to-face interviews at 3, 12, and 24 months after discharge.ResultsThirty-two COVID-19 with PTB survivors were included. The median age was 52 (45, 59) years, and 23 (71.9%) were men. Among them, nearly two-thirds (62.5%) of the survivors were moderate, three (9.4%) were severe, and more than half (59.4%) had at least one comorbidity (PTB excluded). The proportion of COVID-19 survivors with at least one sequela symptom decreased from 40.6% at 3 months to 15.8% at 24 months, with anxiety having a higher proportion over a follow-up. Cough and amnesia recovered at the 12-month follow-up, while anxiety, fatigue, and trouble sleeping remained after 24 months. Additionally, one (3.1%) case presented two recurrences of PTB and no re-positive COVID-19 during the follow-up period.ConclusionThe proportion of long symptoms in COVID-19 with PTB survivors decreased over time, while nearly one in six still experience persistent symptoms with a higher proportion of anxiety. The recurrence of PTB and the psychological support of COVID-19 with PTB after discharge require more attention.     

我院2008—2010年复方帕吉林片与其他抗高血压药应用比较

目的:了解我院复方帕吉林片与其他抗高血压药的应用情况。方法:对我院2008-2010年复方帕吉林片的销售金额、用药频度(DDDs)、销售金额/DDDs排序比与其他常用抗高血压药进行比较,并通过问卷方式对该药的应用情况进行调查、分析。结果:复方帕吉林片的销售金额和DDDs逐年增长,居我院抗高血压药应用的第1位;问卷调查显示,患者对该品种价格及降压效果均满意,在常用抗高血压药品种中居首位。结论:复方帕吉林片在我院就诊高血压患者中与其他常用抗血压药比较应用情况良好。     

2型糖尿病慢性并发症相关因素分析

目的:分析住院的2型糖尿病患者一般情况及慢性并发症相关情况,总结其发病的特点,指导临床,全面干预,治疗其慢性并发症。方法:对于我院糖尿病科2003年1月至2006年10月住院2型糖尿病患者685例,进行回顾性分析。结果:有糖尿病家族史占36.2%,女性有巨大胎儿史占4.09%,高脂血症占56.79%,高血压52.12%,冠心病43.65%,脑梗死13.14%,胰岛素抵抗与体重指数、血脂成正相关。结论:住院2型糖尿病患者并发症较多,存在胰岛素抵抗。治疗糖尿病,应降糖、降压、降脂相结合;肥胖者,往往存在胰岛素抵抗,必要时联合胰岛素增敏剂,防治并发症。     

短信平台中医干预对2型糖尿病患者血脂管理效果评价

目的 探索2型糖尿病患者血脂管理的新模式.方法 将85例2型糖尿病合并脂代谢异常的患者,分为短信组和对照组,短信组采用短信平台中医干预方式进行健康教育,对照组采用常规方式进行健康教育,观察2种不同方法对2型糖尿病患者血脂管理的影响.结果 2组患者LDL-C、TC、TG均显著下降,差异具有统计学意义（P＜0.05）,2种方法之间比较无统计学差异（P＞0.05）.结论 短信平台中医干预与常规方式健康教育均对2型糖尿病患者血脂管理有益,但短信平台中医干预不受时间空间限制,在糖尿病患者血脂管理方面具有一定的优势,值得进一步研究推广.     

Clinical treatment of depressive patients with Anshendingzhi decoction

OBJECTIVE： To determine the effects of Anshendingzhi decoction（ASDZD） on depression, to com-pare ASDZD with Danzhixiaoyao pill（DZXYP）, and to provide evidence for the clinical treatment of depression with Traditional Chinese Medicine.METHODS： Seventy-eight patients with depression were enrolled from 2011 to 2013 in this double-blinded study. Patients were randomly divided into two groups： ASDZD（treatment group, n=39）and DZXYP（control group, n=39）. Hamilton Depressive Scale and TCM Syndrome Differentiation Scale were used to assess depression and efficacy before treatment and 2, 4, and 6 weeks after treatment.The Treatment Emergent Symptoms Scale（TESS）was used to evaluate adverse reactions, observe,and record treatment outcomes.RESULTS： ASDZD was significantly more effective than DZXYP. There were significant differences between the two groups in terms of recovered patients, overall response rate, and TESS score（all P〈0.05）.CONCLUSION： ASDZD is an effective treatment for depression. ASDZD could improve clinical symptoms and warrants further clinical research and application.     

妊娠糖尿病中西医临床治疗的思考

近年随着经济生活水平的不断提高,妊娠糖尿病(gestational diabetes mellitus,GDM)的发病率呈逐年上升趋势,已经严重威胁孕产妇及新生儿的健康及生命。妊娠糖尿病的发病机制尚不十分清楚,目前认为与胰岛素抵抗及分泌不足、遗传易感、炎性反应、代谢紊乱等关系密切。妊娠糖尿病诊断标准,24～28周孕妇空腹8 h以上,直接口服葡萄糖75 g,行口服葡萄糖耐量试验,空腹血糖5.1 mmol·L~(-1),餐后1 h血糖10.0 mmol·L~(-1),餐后2 h血糖8.5 mmol·L~(-1)即可明确诊断。西医治疗上主要是依据饮食、运动、药物、教育、监测为原则,根据血糖情况选择妊娠B级安全药物胰岛素治疗为主,辅以膳食纤维补充剂等。中医将妊娠糖尿病归为"消渴病"范畴,是因素体禀赋不足,孕后多食滋补厚腻之品,或怒或思或愁,情志失常,造成体内阴液亏虚而发病。中医主要通过食疗、传统功法以及中药的干预进行防治,改善妊娠结局。因此,早期筛查、诊断,中西医综合治疗,实现辨证论治的个体化方案,有助于提高疗效,降低妊娠糖尿病的发病率,减少低血糖的发生,有效改善妊娠糖尿病患者母婴的不良结局及预后。     

吕仁和教授辨治慢关格经验总结

关格最早记载于《黄帝内经》中,历代医家对关格亦多有论述。文章从病因病机、治疗原则、辨证论治及治疗特点等方面介绍了吕仁和教授诊治慢关格的学术思想和临床经验。