并发子宫肌瘤不孕患者行子宫肌瘤切除术后妊娠情况及影响因素研究

目的:研究子宫肌瘤术后对不孕妇女生育结局的影响。方法:选择2009年1月至2011年4月在我院行子宫肌瘤手术的165例患者为研究对象,收集所有患者临床的基本资料、肌瘤的特征信息以及术后随访信息。结果:不孕妇女行子宫肌瘤术后共有75名患者妊娠,总共妊娠80次。总的妊娠率为45.45%。正常活产胎儿数共58例,活产率为72.5%。分娩方式主要是以剖宫产为主,占了81.03%。将所有研究对象根据妊娠结局的不同,分为妊娠组和未妊娠组,妊娠娠组和未妊娠组在年龄、不孕时间、不孕类型、肌瘤数目和肌瘤类型等方面比较,差异均有统计学意义(P0.05)。结论:并发子宫肌瘤的不孕妇女实行子宫切除术能提高妊娠率和活产率,分娩方式主要以人工分娩为主,患者的年龄越大,肌瘤类型以多发为主,妊娠率越低,故子宫肌瘤患者应该尽早进行外科治疗。     

从痰瘀互结论治眩晕

从痰瘀互结的理论阐述眩晕的病因病机、中医理论基础、治疗及现代研究,为眩晕从痰瘀同治的治法方面提供理论依据。     

FLAG方案治疗小儿复发难治性急性白血病临床研究

目的探讨FLAG方案（氟达拉滨,阿糖胞苷,粒细胞集落刺激因子）治疗小儿复发难治性急性白血病的疗效。方法采用FLAG方案[氟达拉滨30mg／（m^2·d）X5＋阿糖胞苷2g／（m^2·d）×5d＋粒细胞集落刺激因子5μg/（kg·d）]治疗21例2—13岁的小儿复发难治性急性白血病,其中急性非淋巴细胞性白血病（AML）15例,急性淋巴细胞性白血病（ALL）6例。首次复发（R1）后首选FLAG方案者8例,次选10例,原发难治2例,第三次缓解（CR3）后FLAG巩固治疗1例。结果21例患儿中1例作为缓解后巩固治疗,1例因化疗后感染死亡而无法评估FLAG应用后缓解率;其他19例可评估患儿中9例（47％）获完全缓解（CR）,3例（16％）部分缓解（PR）,7例（37％）无效（NR）,总有效率63％。其中AMLCR率57％,ALL为20％;R1后首选FLAG方案者CR率为57％,次选为20％。应用FLAG后患儿中性粒细胞〉0．5×10^9／L的中位时间为21（12～36）天,血小板〉20×10^9/L的中位时间为19．4（13～30）天。21例患儿中18例合并感染（86％）,除1例死亡外其余均得到有效控制,治疗相关死亡率为4．76％。FLAG治疗后7例患儿进行了造血干细胞移植治疗,目前2例无病存活,分别已移植后无病生存14个月和56个月,其他4例死于移植相关并发症,1例死于移植后复发。另外14例非移植患儿中1例因FLAG相关感染死亡,7例因NR而放弃治疗或合并感染死亡,FLAG治疗有效的6例患儿中2例放弃治疗,4例复发死亡。本组患儿FLAG治疗后中位生存时间5个月。结论FLAG方案治疗小儿复发难治性白血病疗效肯定,毒副作用可以耐受;AML选择FLAG的疗效优于ALL;复发后首选FLAG治疗效果好于次选者。     

癌症患者家庭照顾者负担评估工具的研究进展

癌症患者家庭照顾者负担影响照顾者的生活质量与家庭照顾质量,是影响癌症患者及其家庭照顾者心理健康的重要因素。该文从癌症患者家庭照顾者负担的普适性、特异性评估量表的特性、应用领域等方面对国内外癌症患者家庭照顾者负担评估工具进行综述,分析现有癌症患者家庭照顾者负担评估工具存在的问题并提出建议,以期为建立和应用本土化测评工具提供借鉴,并为开展相关研究提供参考。     

金凤丸联合氯米芬治疗PCOS合并不孕患者的疗效及对雄激素水平的影响

目的 观察金凤丸联合氯米芬治疗多囊卵巢综合征(PCOS)合并不孕患者的疗效及对雄激素水平的影响.方法 选择2017年1月至2019年12月在该院诊治的PCOS合并不孕患者96例,根据随机数字表法将患者分为观察组和对照组,每组48例.对照组予以氯米芬治疗,观察组在对照组的基础上予以金凤丸治疗.比较两组的疗效、排卵率、妊娠...     

胰腺切除患者术后低血糖影响因素分析

目的 探讨胰腺切除术后患者低血糖发生的影响因素,为临床实施预防护理策略提供参考.方法 选取319例胰腺切除手术患者作为研究对象,收集患者一般资料、疾病信息以及血糖相关资料,并进行影响因素分析.结果 41例(12.9％)患者术后发生低血糖.年龄≥65岁(OR=2.612),BMI＜18.5(OR = 5.849)、18....     

补肾生血解毒复方联合环孢素软胶囊治疗再生障碍性贫血临床研究

目的:观察补肾生血解毒复方联合环孢素软胶囊治疗再生障碍性贫血(AA)的临床疗效。方法:选取50例AA患者,随机分为观察组和对照组,每组25例。2组均给予环孢素软胶囊治疗,观察组在此基础上给予补肾生血解毒复方治疗,30 d为1个疗程,2组均治疗2个疗程。比较2组临床疗效及不良反应;比较2组治疗前后中医证候评分、CD4⁺T细胞亚群水平、血常规和骨髓增生程度。结果:观察组总有效率为96.00%,高于对照组的68.00%(P<0.05)。治疗后,2组心悸、头晕、周身乏力、盗汗、出血及形寒肢冷评分均较治疗前降低(P<0.05),观察组上述中医证候评分均低于对照组(P<0.05)。治疗后,2组CD4⁺CD25⁺、CD4⁺CD25⁺Fox P3⁺、CD4⁺IFN-γ⁺及CD4⁺Th17水平均较治疗前升高(P<0.05),观察组CD4⁺CD25⁺     

Effect of Intraoperative and Postoperative Infusion of Dexmedetomidine on the Quality of Postoperative Analgesia in Highly Nicotine-Dependent Patients After Thoracic Surgery: A CONSORT-Prospective,Randomized, Controlled Trial

Smoking is one of the most common addictions in the world. Nicotine inhalation could increase the risk of cardiorespiratory diseases. However, the solution that improved postoperative analgesia for highly nicotine-dependent patients undergoing thoracic surgery has not been specifically addressed.This CONSORT-prospective, randomized, double-blinded, controlled trial investigated the efficacy of combination of dexmedetomidine and sufentanil for highly nicotine (Fagerstrom test of nicotine dependence ≥6)-dependent patients after thoracic surgery.One hundred seventy-four male patients who underwent thoracic surgery were screened between February 2014 and November 2014, and a total of forty-nine were excluded. One hundred thirty-two highly nicotine-dependent male patients who underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia were divided into 3 groups after surgery in this double-blind, randomized study: sufentanil (0.02 μg/kg/h, Group S), sufentanil plus dexmedetomidine (0.02 μg/kg/h each, Group D1), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.04 μg/kg/h) (Group D2). The patient-controlled analgesia (PCA) program was programmed to deliver a bolus dose of 2 ml, with background infusion of 2 ml/h and a lockout of 5 min, 4-hour limit of 40 ml, as our retrospective study. The primary outcome measure was the cumulative amount of self-administered sufentanil; the secondary outcome measures were pain intensity (numerical rating scale, NRS), level of sedation (LOS), Bruggrmann comfort scale (BCS), functional activity score (FAS), and concerning adverse effects.The amount of self-administered sufentanil were lower in group D2 compared with S and D1 groups during the 72 hours after surgery (P < 0.05), whereas the total dosage and dosage per body weight of sufentanil were significantly lower in D1 group than that of S group only at 4, 8, and 16 hours after surgery (P < 0.05). Compared with S group, the NRS scores at rest at 1, 4, and 8 hours after surgery and with coughing at 4, 8, 16, and 24 hours after surgery were significantly lower in D2 group (P < 0.05). However, compared with D1 group, the NRS scores both at rest and with coughing at 4 and 8 hours after surgery were significantly lower in D2 group (P < 0.05). The NRS scores both at rest and with coughing show that there were no significant differences between D1 group and S group at each time point after surgery (P > 0.05). LOS of group D2 was higher than S and D1 groups at 1 hour after surgery (P < 0.05), BCS of group D2 was higher than S and D1 groups at 4, 8, and 16 hours after surgery (P < 0.05), and FAS of group D2 was higher than S and D1 groups at 48 and 72 hours after surgery (P < 0.05). The number of rescue analgesia during 72 hours after surgery in D2 group was lower than S and D1 groups (P < 0.05). There were no significant differences among the 3 groups in terms of baseline clinical characteristics and postoperative adverse effects except for itching (P > 0.05).Among the tested patient-controlled analgesia options, the addition of dexmedetomidine (0.04 μg/kg/h) and sufentanil (0.02 μg/kg/h) showed better analgesic effect and greater patient satisfaction without other clinically relevant side effects for highly nicotine-dependent patients during the initial 72 hours after thoracic surgery.Trial Registration: chictr.org (ChiCTR-TRC-14004191).     

Delayed acute kidney injury recognition is not associated with poor short?term outcomes: a propensity score matched study

Objective Acute kidney injury (AKI) is common but usually under?diagnosed in hospitalized patients, of the impact of which on patients is still unclear. The paper was aimed to investigate the impact of delayed recognition of AKI on short?time prognosis of patients through a propensity score matched study． Methods From Oct 2013 to Sep 2014,1401 adult hospitalized patients with AKI in the First Affiliated Hospital of Nanjing Medical University were divided into delayed recognition group and timely?diagnosed group according to propensity score matching (1∶1) without replacement method. Primary endpoint was 30?day all?cause mortality, and secondary endpoints included recovery of kidney at discharge, length of hospitalization, length of intensive care unit stay and hospital costs．Results There were significant differences in age, department distribution, complications, stage of AKI, Charlson index, APACHEⅡ score, SOFA score between the two groups before matching. After matching, there were no significant difference in demographic data, department distribution, complications, stage of AKI, Charlson index, APACHE II score, SOFA score between the two groups except in blood urea nitrogen (P=0.039) and use of diuretics (P=0.018). Delayed recognition of acute kidney injury was not associated with 30?day all?cause mortality in univariate (P=0.711) and multivariate Logistic regression analyses. The secondary endpoints did not differ in two groups. Conclusion Delayed acute kidney injury recognition did not associate with poor short?term outcomes in adult hospitalized patients．     

老年癌症患者恐惧疾病进展与希望水平的相关性研究

目的了解老年癌症患者恐惧疾病进展及希望水平现状,并探讨两者相关性。方法采用一般资料调查表、中文版恐惧疾病进展简化量表和Herth希望量表对226例老年癌症患者进行调查。结果老年癌症患者恐惧疾病进展总分为(35. 04±6. 49)分,希望总分为(34. 93±5. 07)分。老年癌症患者恐惧疾病进展总分及各维度得分与希望总分及各维度得分呈负相关(均P 0. 01)。结论老年癌症患者恐惧疾病进展水平较高,且与希望水平有显著相关性,提高患者希望水平可改善其恐惧疾病进展水平。