阿仑膦酸钠治疗老年糖尿病合并骨质疏松的临床效果

目的观察阿仑膦酸钠治疗老年糖尿病合并骨质疏松的临床效果。方法选取2017年6月至2018年12月期间我院收治的100例糖尿病合并骨质疏松的老年患者作为研究对象,根据入院的奇偶顺序分别纳入对照组和治疗组,各50例。对照组给予常规方法治疗,治疗组在对照组的基础上给予口服阿仑膦酸钠治疗。两组均治疗3个月。比较2组患者治疗前后骨代谢标志物Ⅰ型胶原交联氨基端肽(NTXI)、Ⅰ型胶原交联羧基端肽(CTXI)、抗酒石酸酸性磷酸酶5b(TRACP5b)和血骨钙素(BGP)、骨密度(BMD)和骨碱性磷酸酶(BALP)等,并比较2组患者临床治疗效果。采用SPSS 18.0软件对数据进行统计学分析。结果治疗组的总有效率明显高于对照组,差异具有统计学意义(92.0%和64.0%,P0.05)。治疗前两组患者的NTXI、CTXI、TRACP5b、BGP、BMD和BALP等水平差异均无统计学意义(P0.05)。治疗后,2组NTXI、CTXI、TRACP5b、BGP和BALP水平均显著低于治疗前,且治疗组显著低于对照组[NTXI:(32.22±5.45)和(43.02±5.74)nmol/L;CTXI:(178.36±16.43)和(208.34±19.22)ng/L;TRACP5b:(3.10±0.81)和(3.86±0.85)ng/L; BGP:(2.16±0.46)和(5.44±1.37)μg/L及BALP:(237.33±18.28)和(270.43±21.12)U/L],差异均有统计学意义(P0.01)。治疗后,2组BMD均显著高于治疗前,且治疗组显著高于对照组[(0.97±0.17)和(0.82±0.13)g/cm~2],差异具有统计学意义(P0.01)。结论阿仑膦酸钠治疗老年糖尿病合并骨质疏松的临床效果显著,值得临床推广。     

鼻腔结构异常矫正对鼻内镜手术效果的影响

目的观察鼻内镜下鼻腔结构矫形对鼻窦联合手术疗效的影响,并探讨其安全性和可行性。方法鼻息肉、鼻窦炎310例（487例）,按照鼻内镜术中是否同期行鼻腔结构矫形分为2组,矫形组139例（223侧）,对照组171例（264例）;术后随访6个月～2年。分析比较2组患者术后疗效及并发症发生情况。结果矫形组患者术中平均出血量为142．5ml,对照组为123．7ml,差异无统计学意义（P〉0．05）;矫形组并发症发生率34．5％、对照组31．6％,P〉0．05。矫形组总有效率97．3％,明显高于对照组的73．1％（P〈0．01）。结论鼻内镜下同期完成鼻腔结构矫形和鼻窦联合手术,能够明显提高鼻窦手术疗效,但不会增加术中出血量及术后并发症,安全性好。     

网孔状硅胶引流管与丝裂霉素C在鼻内镜额窦手术中的应用

Objective To investigate effect about application of mesh silica-drainage tube and mitomycin C (MMC) synchronization in endoscopic sinus surgery. Methods We selected 65 patients (116 sides)who have been operated on under nasal endoscopy in this study,included chronic frontal sinusitis,frontal mucocele,osteoma and inverted papilloma. 35 patients (64 sides) of the total was performed to apply mesh silica-drainage tube and MMC synchronization in endoscopic sinus surgery, which as MMC group;the other 30 patients (52 sides) who were not apply it as a control. What's more, all patients were followed 2 ～ 3 years after operation, and the postoperative efficacy and the incidence of complication in the two groups were compared. Results The total effective rate in MMC group(97.4%) was higher.than that of the control group(72.9%) (P<0.01). In MMC group, nasal adhesion after endoscopic sinus surgery was 1 case, and the incidence of complication was 1.6% ;but in control group, nasal adhesion was 7 cases,the ostium of frontal sinus atresia 1 case, the nasofrontal duct stenosis 2 cases, recurrence of the polyps or tumors 2 cases, so the incidence of complication was 23.1% The incidence of complication rate in MMC group was lower than that of the control group (P<0.01)Conclusion To apply mesh silica-drainage tube and mitomycin C synchronization in endoscopic sinus surgery can improve clinical effects of operation method, and postoperative complications are obviously decreased. So this method is convenient, safe and effective.     

内侧副韧带加强重建后桡骨小头切除治疗青年肘关节恐怖三联征患者疗效观察

目的报告应用侧副韧带修补重建并桡骨小头切除手术方式治疗青年肘关节恐怖三联征、桡骨小头粉碎骨折患者的疗效观察。方法自2005年11月至2009年10月,本院共收治肘关节三联征损伤3例。桡骨小头骨折按Mason法分类均为Ⅲ型。3例患者均行冠状突固定、肘内外侧副韧带、关节囊修补、内侧副韧带加强、重建并桡骨小头切除术,术后克氏针辅助固定肱尺关节于屈肘90°前臂旋转中立位,石膏固定3周,然后拔除克氏针,去除石膏,开始屈伸和旋转康复训练。结果3例患者均随访1年以上,骨折愈合,按照Broberg和Morrey的肘关节功能评分2例为良,1例为可。结论肘关节恐怖三联征伴有桡骨小头粉碎骨折的青年患者,韧带及关节囊的重建异常重要,桡骨小头置换应当审慎,在确保韧带重建满意的情况下切除桡骨小头并未造成肘关节明显功能障碍。     

探索科研实验平台课程思政教育教学改革提升研究生综合素养

新时期"中国梦"大背景下对于高校大学生思政教育的关注度越来越高,新时代课程思政教育的根本任务为医学研究生思政教育指明了方向.本文立足于科研实验平台医学研究生教育教学特点,以课程思政理念对学生思政教育的意义分析为理论基础,充分把握当前科研实验平台医学研究生课程思政教育教学存在的问题,进而探讨在新时期以课程思政理念为引领,...     

鼓室注射曲安奈德和盐酸氨溴索治疗分泌性中耳炎疗效分析

目的 探讨鼓室内注射曲安奈德(triamcinolone acetonide,TA)和盐酸氨溴索(ambroxol)治疗分泌性中耳炎(otitis media with effusion,OME)的临床疗效.方法 将120例(148耳)OMF患者随机分为治疗组(60例.73耳)和对照组(60例,75耳),治疗组先行鼓室穿刺抽液.再注入曲安奈德40 mg和盐酸氨溴索30 mg;对照组在鼓室穿刺抽液后注入地塞米松5 mg.两组患者每周治疗一次,4周为一疗程.观察两组的治疗效果并作统计学分析.结果 治疗后随访3个月,治疗组痊愈31例(38耳),有效20例(24耳),总有效率为84.9%(62/73);对照组痊愈11例(14耳),有效25例(31耳).总有效率为60%(45/75),治疗组总有效率高于对照组,差异有统计学意义(P＜0.05).对于OME:导致的骨导听阈提高的疗效治疗组优于对照组.两组患者均未出现毒副作用.结论 鼓室内注射曲安奈德和盐酸氨溴索对治疗OME:安全有效,且无毒副作用.     

Nd：YAG激光鼓膜造孔加盐酸氨溴索治疗顽固性分泌性中耳炎的疗效分析

目的：探讨Nd：YAG激光鼓膜造孔加盐酸氨溴索治疗顽固性分泌性中耳炎的疗效。方法：对80例反复发作的顽固性分泌性中耳炎患者行Nd：YAG激光鼓膜造孔加盐酸氨溴索综合治疗，并跟踪随访。结果：随访6～24个月患者症状无复发，听力无下降，无永久性鼓膜穿孔及其他并发症。结论：Nd：YAG激光鼓膜造孔加盐酸氨溴索治疗顽固性分泌性中耳炎可明显提高疗效。     

网孔状硅胶引流管与丝裂霉素C在鼻内镜额窦手术中的应用

Objective To investigate effect about application of mesh silica-drainage tube and mitomycin C (MMC) synchronization in endoscopic sinus surgery. Methods We selected 65 patients (116 sides)who have been operated on under nasal endoscopy in this study,included chronic frontal sinusitis,frontal mucocele,osteoma and inverted papilloma. 35 patients (64 sides) of the total was performed to apply mesh silica-drainage tube and MMC synchronization in endoscopic sinus surgery, which as MMC group;the other 30 patients (52 sides) who were not apply it as a control. What's more, all patients were followed 2 ～ 3 years after operation, and the postoperative efficacy and the incidence of complication in the two groups were compared. Results The total effective rate in MMC group(97.4%) was higher.than that of the control group(72.9%) (P<0.01). In MMC group, nasal adhesion after endoscopic sinus surgery was 1 case, and the incidence of complication was 1.6% ;but in control group, nasal adhesion was 7 cases,the ostium of frontal sinus atresia 1 case, the nasofrontal duct stenosis 2 cases, recurrence of the polyps or tumors 2 cases, so the incidence of complication was 23.1% The incidence of complication rate in MMC group was lower than that of the control group (P<0.01)Conclusion To apply mesh silica-drainage tube and mitomycin C synchronization in endoscopic sinus surgery can improve clinical effects of operation method, and postoperative complications are obviously decreased. So this method is convenient, safe and effective.     

慢性肥厚性鼻炎鼻内镜下不同术式临床 疗效观察及术后相关因素分析

目的 探讨鼻内镜手术治疗慢性肥厚性鼻炎临床疗效观察及影响术后嗅觉恢复相关因素。方法 回顾性分析268例慢性肥厚性鼻炎患者的临床资料及手术效果,根据鼻内镜下手术方式不同分为A组（低温等离子射频消融术）75例,B组（改良下鼻甲成形术）78例,C组（下鼻甲黏膜下微波治疗术）70例,D组（行下鼻甲部分切除术）45例,观察其临床疗效及术后影响嗅觉恢复的相关因素。结果 A组总的有效率为97.06%,明显高于B组（82.80%）（P <0.05）。A组并发症发生率为3.9%,明显优于B和D组（P <0.05）。A组的手术时间、术中出血量、恢复通气时间、黏膜恢复时间及VAS评分均明显高于B和D组（P <0.05）;A组手术时间、恢复通气时间、 黏膜恢复时间及VAS评分明显高于C组（P <0.05）,但术中出血量与C组差异无显著性（P >0.05）。多因素logistic 回归分析结果显示过敏因素是影响嗅觉恢复的独立危险因素。结论 慢性肥厚性鼻炎手术方式众多,鼻内镜下低温等离子射频消融术效果优于其余3种治疗方法,具有有效率高、并发症少及术后恢复快等优点,可以作为目前相对有效和安全的治疗方法。     

重度OSAHS并高血压患者行悬雍垂腭咽成形术前后血压变化分析

目的：观察重度阻塞性睡眠呼吸暂停低通气综合征（OSAHS）并高血压患者行悬雍垂腭咽成形术（UPPP）治疗前后血压变化。方法选择重度OSAHS同时合并高血压的患者32例,均有口服降压药3年以上而血压仍控制不佳病史。治疗采用改良UPPP手术,分别于手术前及手术后6个月时行多导睡眠图（PSG）监测和24 h动态血压监测,进行数据对比。结果①改良 UPPP手术6个月后睡眠呼吸暂停低通气指数（AHI）、呼吸暂停指数（AI）、微觉醒指数（MAI）中位数均明显降低（P＜0．05）;平均血氧饱和度（SaO2）和最低血氧饱和度（LSaO2）则明显升高（P＜0．05）;②UPPP术后6个月24 h动态血压监测发现,24 h平均收缩压（SBP）、舒张压（DBP）,日间、夜间的平均SBP、DBP均明显降低,与术前比较差异有统计学意义（P＜0．05）。结论行UPPP对于重度OSAHS合并高血压患者的血压控制,效果显著。