电话随访对围绝经期综合征妇女激素替代治疗依从性和效果的影响

目的探讨电话随访对围绝经期综合征妇女小剂量雌激素、孕激素替代治疗依从性和效果的影响。方法选取2008年至2012年在医院进行小剂量雌激素和孕激素治疗的围绝经期综合征患者200例,按照随机数字表法分为观察组与对照组,各100例,均给予小剂量雌激素和孕激素治疗,对照组患者不进行电话随访,观察组患者定期进行电话随访,治疗6个周期后对患者的临床症状和疗效进行对比。结果治疗后,观察组患者的临床症状发生率显著低于对照组(P<0.05);观察组患者的治疗依从性显著优于对照组(P<0.05);观察组的治疗有效率为91.00%,显著高于对照组的69.00%(P<0.05)。结论电话随访是提高围绝经期综合征妇女小剂量雌激素、孕激素替代治疗依从性和效果的一种有效手段,值得临床推广。     

补肾调冲法联合激素替代疗法治疗围绝经期综合征的临床研究

目的探讨补肾调冲法联合激素替代疗法治疗围绝经期综合征的疗效,验证其疗效的肯定性及加用中药治疗的稳定性。方法选择绝经后患围绝经期综合征妇女62例随机分成治疗组和对照组,进行2个疗程共6个月的治疗及观察。结果治疗组有效率达96.87%,对照组有效率达86.67%,两组比较差异有统计学意义(P<0.05)。对每位患者的Kupperman症状积分进行治疗前后对照,治疗后治疗组和对照组均明显低于治疗前得分(P<0.01),治疗后治疗组得分比对照组明显降低(P<0.05);治疗后治疗组E2显著上升,FSH和LH等指标较治疗前显著下降(P<0.05),但各项指标的上升与下降程度与对照组比较差异无显著性意义(P>0.05)。结论补肾调冲法联合激素替代疗法治疗围绝经期综合征疗效肯定、副作用小、值得推广。     

激素替代联合心理疏导治疗围绝经期综合征临床疗效观察

目的观察激素替代联合心理疏导治疗围绝经期综合征的临床疗效。方法将89例改良Kupperman评分在20分以上的围绝经期综合征患者随机分成2组,观察组采用戊酸雌二醇和黄体酮周期序贯疗法同时心理疏导治疗,对照组仅进行戊酸雌二醇和黄体酮周期序贯疗法治疗,治疗前后血雌二醇(E2)、尿促卵泡素(FSH)、黄体生成素(LH)、血脂总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)的变化,以及患者与家庭及社会关系的改变。结果两组患者激素水平及血脂均有明显改善,但组间比较差异没有统计学意义(P>0.05),观察组患者与家庭和社会关系改善情况也好于对照组。结论激素替代联合心理疏导治疗围绝经期综合征整体疗效好于单纯激素替代治疗。     

小剂量黛力新联合护理干预围绝经期综合征妇女32例

目的探讨小剂量黛力新联合护理干预对围绝经期综合征妇女心理状态和治疗依从性的影响。方法选择65例围绝经期综合征妇女,随机分为观察组(32例)和对照组(33例)。两组患者均予以口服黛力新片10 mg、每日1次,观察组同时予以综合性护理干预治疗,均观察12周。比较两组患者治疗前后抑郁自评量表(SDS)和焦虑自评量表(SAS)评分和治疗依从性的变化。结果两组患者治疗前SAS和SDS评分比较差异无明显统计学意义(P>0.05)。治疗12周后,两组患者的SAS和SDS评分均较治疗前明显下降(P<0.05或P<0.01),且观察组下降幅度较对照组更明显(P<0.05)。治疗12周后,观察组的治疗依从性明显高于对照组(χ2=5.11,P<0.05)。结论小剂量黛力新联合综合性护理干预治疗围绝经期综合征的疗效肯定,能明显改善围绝经期综合征妇女的抑郁、焦虑等负性情绪,提高患者治疗依从性,从而改善预后。     

围绝经期妇女应用雌激素的体会

目的观察探讨围绝经期妇女应用雌激素替代治疗的效果,总结其临床经验及体会。方法选取我院2009年7月至2011年7月72例围绝经期的妇女,均给予雌激素替代治疗,分别监测治疗前后患者血中的激素水平、子宫内膜厚度的变化及临床症状改善情况。结果经治疗后临床症状完全消失37例,部分消失30例,无改变有5例,总有效率为93.1%;血中的FSH、LH水平均比治疗前明显下降,E2水平比治疗前明显升高,治疗前后差异显著(P<0.05),具有统计学意义;治疗子宫内膜增厚有13例,其余患者皆无明显增厚,治疗前后子宫内膜厚度比较无明显差异(P>0.05),无统计学意义。结论对围绝经期妇女应用小剂量的雌激素替代治疗,能够有助于改善围绝经期的一系列临床症状,调节体内的激素水平恢复正常,全面提高围绝经期妇女的生活质量,有重要的临床意义。     

戊酸雌二醇片联合黄体酮治疗围绝经期综合征效果观察

目的探讨激素替代疗法治疗围绝经期综合征的疗效。方法从本院2011年9月至2013年9月收治的围绝经期妇女中选择100例,按治疗方法不同分为观察组和对照组两组,每组各50例。对照组实施常规治疗,观察组实施激素替代治疗,给予戊酸雌二醇片和黄体酮胶囊治疗。治疗前后检测所有患者的激素水平,利用Kupperman改良评分对所有患者进行围绝经期综合征评分。结果治疗前,两组患者的激素水平差异均无统计学意义;治疗后,观察组垂体分泌卵巢激素（FSH）低于对照组,雌二醇（E2）水平高于对照组,差异均有统计学意义。且较之本组治疗前,观察组的FSH水平显著下降,E2水平显著上升。但对照组较之本组治疗前,FSH、E2水平未出现明显变化。疗效方面,观察组痊愈率和总有效率均显著高于对照组,差异有统计学意义。结论对围绝经期妇女实施激素替代治疗可以有效改善患者激素水平和临床症状,治疗中需要严格掌握相应的适应证,避免产生并发症。     

清脑复神口服液佐治围绝经期妇女综合征抑郁焦虑60例

目的：观察雌激素替代疗法联合中药清脑复神口服液治疗围绝经期妇女综合征的临床疗效。方法选择医院内分泌科2013年8月至2014年8月收治的患者120例,随机分为对照组和治疗组,各60例。对照组患者口服谷维素,每次10 mg,每日2次;治疗组患者口服复合雌激素片联合中药清脑复神口服液,治疗15 d后加用黄体酮胶囊(每日150 mg )。两组均以30 d为1个疗程,共治疗4个疗程。结果治疗组患者的总有效率为63.33%,显著优于对照组的28.33%（ P＜0.05）;两组患者的Kupperman评分和汉密顿抑郁量表( HAMD )评分与治疗前相比均得到改善,治疗组改善更明显（ P＜0.05）;治疗组患者各项激素指标改善效果均明显优于对照组（ P＜0.05）;两组患者的不良反应发生情况相似,且均未出现严重不良反应。结论雌激素替代疗法联合中药清脑复神口服液可显著改善围绝经期妇女综合征的抑郁焦虑症状,不良反应少,值得临床推广。     

逍遥丸联合小剂量激素对绝经综合征患者血清雌激素的影响及疗效

目的探讨逍遥丸联合小剂量激素对绝经综合征患者血清雌激素水平的影响及临床疗效。方法选取2013年4月~2015年2月于浙江省丽水市第二人民医院妇产科住院诊断为围绝经期综合征患者96例,按随机数字表法分组,对照组48例给予小剂量激素治疗,研究组48例采用逍遥丸联合小剂量激素治疗,治疗前后采血测定血清雌激素水平,记录Kupperman评分和子宫内膜厚度,同时对比临床疗效。结果对照组总有效率79.17%低于研究组总有效率93.75%,差异具有统计学意义(P<0.05);研究组治疗后卵泡刺激素(follicle stimulating hormone,FSH)和黄体生成素(luteinizing hormone,LH)水平低于对照组,雌二醇(estradiol,E2)水平高于对照组,Kupperman评分低于对照组,子宫内膜厚度显著厚于对照组,差异具有统计学意义(P<0.05)。结论采用逍遥丸联合小剂量激素能改善围绝经期综合症患者血清E2、FSH和LH水平,安全性高。     

围绝经期女性雌激素替代疗法对激素水平的影响

目的:探讨围绝经期女性雌激素替代疗法对激素水平的影响。方法:选取2013年6月~2016年5月136例围绝经期综合征患者按随机数字表法分成观察组和对照组,每组各68例。对照组采用常规对症治疗,观察组在常规治疗的基础上采用雌激素替代疗法进行治疗,对比两组治疗前、后的激素水平、症状评分。结果:两组治疗前激素各指标水平及各症状评分均无明显差异(P0.05);观察组治疗后雌二醇(E_2)水平明显高于对照组(P0.05);观察组黄体生成素(LH)、促卵泡激素(FSH)水平明显低于对照组(P0.05);观察组治疗后各症状评分明显低于对照组(P0.05)。结论:围绝经期女性雌激素替代疗法能有效的提高患者的激素水平,从而改善临床症状。     

低剂量雌激素替代疗法对围绝经期症状及激素水平的影响价值分析

目的观察分析低剂量雌激素替代疗法对围绝经期症状及激素水平的影响和其具体应用价值。方法从我院围绝经期综合征患者中随机抽取118例,采用随机数字表法分为观察组和对照组,各59例。对照组应用孕激素甲羟孕酮进行治疗,观察组在对照组基础上加用雌激素戊酸雌二醇片治疗,观察并比较两组用药前后围绝经期症状及激素水平变化情况。结果治疗后,两组Kupperman积分均低于治疗前,观察组Kupperman积分低于对照组,组间数据差异明显(P 0.05)。治疗后,两组雌二醇(E2)、促黄体生成素(LH)及促卵泡激素(FSH)水平较治疗前均有改善,观察组改善幅度大于对照组,且组间数据差异有统计学意义(P 0.05)。治疗前后两组子宫体积、内膜厚度间的数据差异无统计学意义(P 0.05)。结论低剂量雌激素替代疗法应用于围绝经期妇女时可对其临床症状进行改善或消除,调节激素水平,且不良反应少,有临床推广应用价值。     

总负荷积分与冠脉Gensini积分的相关性分析

目的 探讨半定量分析指标总负荷积分(SSS)和冠脉Gensini积分的相关性.方法 入选29例确诊或疑似的冠心病患者,行核素灌注显像(静息+腺苷负荷)和冠状动脉造影(CAG).应用ECTool Box软件对心肌灌注图像进行分析,计算SSS.应用定量冠状动脉造影(QcA)软件测算冠脉狭窄程度,结合病变部位计算冠脉Gensini积分.将两种积分进行分析.结果 Gensini积分随SSS升高逐渐升高,两者呈正相关(P<0.01).结论 SSS可作为预测冠脉狭窄程度的无创性半定量指标,是独立于CAG之外冠心病危险程度和预后的评估指标.     

A bioavailability score

Responding to a demonstrated need for scientists to forecast the permeability and bioavailability (F) properties of compounds before their purchase, synthesis, or advanced testing, we have developed a score that assigns the probability that a compound will have F > 10% in the rat. Neither the rule-of-five, log P, log D, nor the combination of the number of rotatable bonds and polar surface area successfully categorized compounds. Instead, different properties govern the bioavailability of compounds depending on their predominant charge at biological pH. The fraction of anions with >10% F falls from 85% if the polar surface area (PSA) is < or = 75 A(2), to 56% if 75 < PSA < 150 A(2), to 11% if PSA is > or = 150 A(2). On the other hand, whereas 55% of the neutral, zwitterionic, or cationic compounds that pass the rule-of-five have >10% F, only 17% of those that fail have > 10% F. This same categorization distinguishes compounds that are poorly permeable from those that are permeable in Caco-2 cells. Further validation is provided with human bioavailability values from the literature.     

儿童早期预警评分与新生儿危重病例评分在新生儿败血症病情评估的应用

目的探讨儿童早期预警评分(PEWS)与新生儿危重病例评分(NCIS)评估新生儿败血症(NSE)病情的价值。方法采用PEWS和NCIS评估112例NSE患儿临床资料,并对评分结果行相关性分析。结果两种评分结果存在负相关(r=-0.766,P<0.05)。107例存活患儿PEWS和NCIS中位分值为1分和102分,优于5例死亡NSE患儿的5分和84分(Z=5.25、3.77,P<0.05)。结论 PEWS和NCIS均能可靠反映NSE患儿病情。     

实例探讨药物引起SJS或TEN的评分方法——Naranjo评分与ALDEN评分比较

药物引起的史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）是一种罕见严重的不良反应,其特征是广泛性的皮肤表皮剥离和黏膜侵犯。当评估可疑药物和SJS或TEN之间的因果关系时,除了Naranjo评分外,最近根据两个大型的病例对照研究结果所衍生的ALDEN评分也提供了新思路。本文结合1例同时服用对乙酰氨基酚和头孢拉定导致中毒性表皮坏死综合征的案例,应用ALDEN评分及Naranjo评分分析两种药物与ADR间的关联性,并讨论此两种评分方法的差异性及适宜性。     

Indirect inference based on the score

The efficient method of moments (EMM) estimator is an indirect inference estimator based on the simulated auxiliary score evaluated at the sample estimate of the auxiliary parameters. We study an alternative estimator that uses the sample auxiliary score evaluated at the simulated binding function, which maps the structural parameters of interest to the auxiliary parameters. We show that the alternative estimator has the same asymptotic properties as the EMM estimator but in finite samples behaves more like the distance‐based indirect inference estimator of Gouriéroux et al.     

颅脑损伤GCS评分与CT像计分对临床预后的相关性研究

目的 探讨GCS得分与CT图像之间的关系.方法 511例颅脑损伤患者连续进行10 mm厚度和区间CT切片扫描,根据CT图像得分和临床GCS标准,CT图像计分理想总分为15分,依据积分情况分为轻型(≤5分)33例,中型(6～10分)247例和重型(≥11分)231例.GCS评分为:轻型(13～15分)61例,中型(9～12分)311例,重型(3～10分)139例.结果 两种评分之间比较差异无统计学意义.结论 CT图像计分与GCS评分在颅脑损伤病情分级存在相关性,随着GCS评分病情的加重而CT图像计分呈增高的趋势.     

CT冠状动脉钙化积分与传统危险积分临床应用的对比

目的探讨320排容积CT冠状动脉钙化积分的临床应用价值。方法回顾性分析2014年12月—2015年5月在济南军区总医院行CT扫描及常规冠状动脉造影检查的60例患者资料,以常规造影为诊断标准,将患者分为冠心病组(28例,狭窄≥50%)与对照组(32例,狭窄<50%),利用CT计算每例患者总钙化积分及四大分支钙化积分,比较两组积分的差异性。同时,分析患者钙化积分与弗明汉危险积分的相关性。结果冠心病组钙化积分明显高于对照组,两组差异均有统计学意义(P<0.05)。患者钙化积分与弗明汉危险积分呈中度相关(r=0.641)。结论冠状动脉钙化积分评定在冠心病诊断中有重要价值,可作为临床预测冠心病的危险方法之一。     

Development of a COPD severity score

ABSTRACT

Objective: Treatment of chronic obstructive pulmonary disease (COPD) is based on symptom control. This suggests that COPD severity can be determined by analyzing treatment intensity. The objective of this analysis was to develop and validate a severity score for adult COPD based on treatments.

Research design: Using principal components analysis, a COPD severity score was developed using data based on treatments extracted from an employer claims database (development group). Variables included were identified from literature review and clinical expert opinion. External validity was tested in a separate group of adult chronic bronchitis patients in whom principal components analysis was re-conducted and factor loadings were compared to the development group. Construct validity was tested by comparing the incidence of acute exacerbations of chronic bronchitis (AECB) in patients with high and lower severity scores. To illustrate the use of the COPD severity score, effectiveness of alternative AECB antibiotic treatments was compared in a separate patient sample categorized by severe versus mild/moderate COPD.

Results: In the development group (n = 2068),principal components analysis produced a single main factor for severity scoring. Of the 12 variables contributing to this factor, the 6 with the highest factor loadings were treatment related. The factor performed similarly in the external validity group (n = 9127) as it did in the development group. In construct validity testing, severe COPD patients were 4 times more likely to have AECB episodes than mild/moderate patients. Patients with severe COPD and an AECB were more likely to fail treatment with antibiotics than those with mild/moderate COPD. Based on the COPD severity score developed, we found that treatment of patients with severe COPD and an AECB with fluoroquinolones was more likely to result in treatment failure than treatment with macrolides (OR = 2.01; p = 0.03).

Conclusions: The analysis was successful in developing and validating a method to score COPD severity based on treatments. This method may prove useful in providing insights about the benefits of COPD treatments.     

现代国际创伤评分分类法

临床医学正从直观的、经验的“描述型”演变为深入的、量化的“解释型”。应用创伤评分评估伤情,特别是多发伤的伤情严重程度,正是创伤学向解释型转变的一个例证。创伤评分(分类)分为医院前和医院内两大部分。前者着眼于伤员的去向和现场处理;后者着眼于估计伤员的预后。另外,它对各医疗单位按统一标准比较疗效,考核和评定救治水平以及开展创伤流行病学研究,都具有极其重要的意义。现介绍几种国外常用的创伤分类法,供参考。1医院前创伤分类法指在事故现场或救护车上,医救人员根据所得数据(包括解剖、生理和伤因)对伤情迅速做出判断,决定该伤…     

Development of a COPD severity score

OBJECTIVE: Treatment of chronic obstructive pulmonary disease (COPD) is based on symptom control. This suggests that COPD severity can be determined by analyzing treatment intensity. The objective of this analysis was to develop and validate a severity score for adult COPD based on treatments. RESEARCH DESIGN: Using principal components analysis, a COPD severity score was developed using data based on treatments extracted from an employer claims database (development group). Variables included were identified from literature review and clinical expert opinion. External validity was tested in a separate group of adult chronic bronchitis patients in whom principal components analysis was re-conducted and factor loadings were compared to the development group. Construct validity was tested by comparing the incidence of acute exacerbations of chronic bronchitis (AECB) in patients with high and lower severity scores. To illustrate the use of the COPD severity score, effectiveness of alternative AECB antibiotic treatments was compared in a separate patient sample categorized by severe versus mild/moderate COPD. RESULTS: In the development group (n = 2068), principal components analysis produced a single main factor for severity scoring. Of the 12 variables contributing to this factor, the 6 with the highest factor loadings were treatment related. The factor performed similarly in the external validity group (n = 9127) as it did in the development group. In construct validity testing, severe COPD patients were 4 times more likely to have AECB episodes than mild/moderate patients. Patients with severe COPD and an AECB were more likely to fail treatment with antibiotics than those with mild/moderate COPD. Based on the COPD severity score developed, we found that treatment of patients with severe COPD and an AECB with fluoroquinolones was more likely to result in treatment failure than treatment with macrolides (OR = 2.01; p = 0.03). CONCLUSIONS: The analysis was successful in developing and validating a method to score COPD severity based on treatments. This method may prove useful in providing insights about the benefits of COPD treatments.