养生益肾汤对早期糖尿病肾病气阴两虚证的防治研究

目的:探讨养生益肾汤对早期糖尿病肾病(DN)气阴两虚证病情延缓作用及对血清肿瘤坏死因子-α(TNF-α),转化生长因子-β(TGF-β),血小板源生长因子(PDGF)和血管内皮生长因子(VEGF)水平的影响。方法:170例患者区组随机化按数字表法分为西医组和中西医结合组各85例。西医组给予生活方式指导;控制血糖和降压,纠正脂质代谢紊乱;厄贝沙坦片,1片/d,内服。中西医结合组在西医组治疗的基础上加用养生益肾汤,1剂/d。两组疗程均为6个月,并进行18个月随访。记录24个月内由DNⅢ期发展为DNⅣ期和肌酐(SCr)升高1倍等终点事件的发生情况;检测尿白蛋白排泄率(UAER),血肌酐(SCr),空腹血糖(FBG),糖化血红蛋白(Hb Alc),血脂包括胆固醇(TC),甘油三酯(TG),高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)检测和尿微量白蛋白与肌酐的比值(ACR)等指标,进行气阴两虚证评分,检测治疗前后TNF-α,TGF-β,PDGF和VEGF水平。结果:经Ridit分析,中西医结合组患者的临床疗效优于西医组(P0.05);中西医结合组终点事件的发生率为7.41%,低于西医组的19.51%(χ2=5.113,P0.05);在治疗后3个月时,中西医结合组ACR较治疗前下降,并低于同期西医组水平(P0.05);在治疗后6个月时,中西医结合组UAER,SCr,ACR,Hb Alc,LDL-C均低于同期西医组水平(P0.05),HDL-C则高于同期西医组水平(P0.05);中西医结合组在治疗后3个月和6个月时气阴两虚证评分均低于西医组(P0.05);治疗后中西医结合组后TNF-α,TGF-β,PDGF和VEGF水平均低于西医组(P0.01)。结论:采用养生益肾汤配合西医常规干预方法对早期DN进行防治,能保护患者的肾功能,对DN病情起到延缓作用,降低终点事件的发生率,其作用机制可能与下调TNF-α,TGF-β,PDGF和VEGF等细胞炎症因子水平有关。     

需求调查表在心内科首次住院病人中的应用

[目的]了解需求调查表在首次住院心内科病人中的应用效果。[方法]抽取2010年8月—2011年8月在心内科首次住院病人160例,随机分为实验组及对照组各80例,实验组通过发放需求调查表了解病人的需求,然后根据病人的不同需求提供针对性的护理服务与指导;对照组采用常规方法护理。观察两组病人治疗效果、住院时间及满意度。[结果]实验组治疗效果、住院时间及病人满意度都明显优于对照组。[结论]通过对首次住院心内科病人发放问卷调查表,了解病人需求,并采取针对性护理措施,可促进病人康复,缩短住院时间,提高病人满意度。     

二段式柱状种植义齿修复的临床研究

目的通过分析二段式柱状(BLB)种植体的植入并修复,观察其成功及失败相关因素,探讨其临床应用效果。方法选择30例共54颗牙列缺损行BLB种植体的植入并修复,进行3年不同时期的观察,统计种植体成功率、种植体骨吸收及满意度调查等。结果 30例共54颗种植体3年成功率达98%,满意度为90.7%,骨吸收量1个月、1年、3年分别为(0.52±0.20)mm,(0.74±0.25)mm,(1.02±0.31)mm。结论 BLB种植体植入后骨结合形成良好,短期内成功率高,适用于各种类型的牙列缺损的种植修复,是一种较理想的种植体。     

子宫内膜癌创伤后成长水平及影响因素分析

目的 探讨子宫内膜癌创伤后成长水平及影响因素,以期为提高该类患者创伤后成长水平提供指导依据.方法 选取2017年9月至2019年11月贺州市人民医院收治的子宫内膜癌患者168例作为研究对象,对其一般资料、领悟社会支持、创伤后成长情况进行调查统计.使用单因素和多重线性回归分析其中影响因素.结果 患者的创伤后成长水平总分为...     

Postoperative hypoalbuminemia is an independent risk factor for acute kidney injury after cardiac surgery under cardiopulmonary bypass

Objective To investigate the effect of postoperative hypoalbuminemia on acute kidney injury (AKI) after cardiac surgery under cardiopulmonary bypass (CPB). Methods The clinical data of adult patients undergoing cardiac surgery under CPB were retrospectively analyzed. The difference between preoperative and postoperative serum albumin level was compared. The patients were divided into hypoalbuminemia group (≤35 g/L) and non-hypoalbuminemia group (＞35 g/L) according to the lowest serum albumin concentration within 48 hours after surgery. The incidence and severity of postoperative AKI were compared between the two groups. Univariate analysis and binary logistic regression analysis were used to evaluate the effect of postoperative hypoalbuminemia on the incidence of postoperative AKI. Results Among the 749 patients, the serum albumin level after cardiac surgery was significantly lower than that before surgery (Z=-15.739, P＜0.001), and the proportion of patients with hypoalbuminemia increased from 9.6% to 27.6%( χ2=83.516, P＜0.001). Postoperative AKI occurred in 273 patients, including 109 cases (52.7%) in hypoalbuminemia group and 164 cases (30.3%) in non-hypoalbuminemia group. The incidence of AKI in hypoalbuminemia group was significantly higher than that in non-hypoalbuminemia group ( χ2=32.443, P＜0.001), and the severity of AKI in hypoalbuminemia group increased than that in non-hypoalbuminemia group (Z=-2.098, P=0.036), and the time of hospital stay extended (Z=-2.442, P=0.015). After adjusted by gender, age, preoperative hypoalbuminemia, comorbidities (hypertension, hyperuricemia, diabetes mellitus, cerebrovascular disease), renal insufficiency, preoperative heart function, coronary angiography, CPB time, aorta blocking time, type of heart surgery and postoperative hypotension, binary logistic regression analysis revealed that postoperative hypoalbuminemia was an independent risk factor for CPB-associated AKI (OR=2.319, 95%CI 1.586-3.392, P＜0.001). Conclusions AKI is a common complication following cardiac surgery under CPB. Serum albumin after CBP is significantly lower than that before CBP, and postoperative hypoalbuminemia within 48 hours after surgery is an independent risk factor for AKI.     

非诺贝特联合双环醇治疗非酒精性脂肪性肝病患者肝组织PPARγ2 mRNA水平变化

目的 探讨应用非诺贝特联合双环醇治疗非酒精性脂肪性肝病(NAFLD)患者的疗效及肝组织过氧化物酶体增殖物激活受体γ₂(PPARγ₂)水平变化。方法 2018年2月～2019年12月我院收治的NAFLD患者66例,采用随机数字表法分为对照组33例和观察组33例,分别给予双环醇片口服或在此基础上给予非诺贝特片口服治疗,两组均治疗3个月。肝穿刺获得肝组织,采用PCR法检测肝组织PPARγ₂ mRNA水平,采用化学发光免疫分析法检测血清肿瘤坏死因子-α(TNF-α)和白介素-6(IL-6)水平,采用免疫比浊法检测血清超敏C反应蛋白(hs-CRP)水平,使用FC500型流式细胞仪检测外周血CD3⁺、CD4⁺和CD8⁺细胞百分比。结果 在治疗结束时,观察组总有效率为97.0%,显著高于对照组的66.7%(P<0.05);观察组肝组织PPARγ₂ mRNA相对水平为(1.5±0.1),显著高于对照组【(1.1±0.2),P<0.05】;观察组血清TNF-α水平为(26.4±3.1)pg/mL,显著低于对照组【(32.8±6.9)pg/mL,P<0.05】,血清IL-6水平为(35.9±4.9)ng/L,显著低于对照组【(46.4±5.8)ng/L,P<0.05】,血清hs-CRP水平为(5.1±1.4)mg/L,显著低于对照组【(8.4±1.9)mg/L,P<0.05】;观察组外周血CD3⁺细胞百分比为(80.2±11.5)%,显著高于对照组【(60.5±7.7)%,P<0.05】,外周血CD4⁺细胞百分比为(44.7±5.8)%,显著高于对照组【(31.4±4.8)%,P<0.05】,CD4⁺/ CD8⁺细胞比值为(1.5±0.4),显著高于对照组【(1.1±0.3),P<0.05】。结论 联合应用非诺贝特和双环醇治疗NAFLD患者有短期疗效,可能与提高了肝组织PPARγ₂水平,降低了血清炎症细胞因子水平有关,值得进一步研究。     

Synergy ascension of SnS/MoS2 binary metal sulfides on initial coulombic efficiency and stable capacity for lithium storage

Numerous efforts have been devoted to capability improvement and cycling stability in the past decades, and these performances have been significantly enhanced. Low initial coulombic efficiency is still a problem in the metal sulfide-based anode materials. This study developed a strategy to achieve high initial coulombic efficiency and superior capacity retention by interpenetrating binary metal sulfides of SnS and MoS₂ in a conductive carbon matrix. The synergy ascension of electrochemical performances for the metal sulfides is attributed to their mutual impeding effects on coarsening of metal grains and the capsule-shaped coating structure embedded in the carbon sheet architecture. The SnS/MoS₂/C composite was prepared by a simple NaCl template-assisted ball milling method, and showed excellent electrochemical performances in terms of a high initial coulombic efficiency up to 90.2% and highly stable reversibility with a specific capacity of 515.4 mA h g⁻¹ after 300 cycles at 1.0 A g⁻¹. All of these characteristics suggest that the proposed materials are superior among the previously reported metal sulfide-based anode materials for lithium-ion batteries.

Binary metal sulfides of SnS and MoS₂ interpenetrated in carbon sheets achieve high initial coulombic efficiency and superior capacity retention.     

消化性溃疡病人实施中医体质健康教育的效果观察

[目的]探讨实施中医体质个体化健康教育对消化性溃疡干预效果。[方法]采用问卷调查的方法,对160例消化性溃疡病人进行中医体质辨识,并将病人随机分为治疗组和对照组各80例。对照组在西医抑酸、抗幽门螺杆菌（HP）治疗的基础上进行常规健康教育指导;治疗组在西医抑酸、抗幽门螺杆菌治疗及常规健康教育的基础上,根据病人的中医体质类型,实施个体化健康教育的护理干预;出院3个月后电话回访,再次进行中医体质调查。比较两组病人的治愈率、有效率、复发率、临床症状及体征的缓解情况等。[结果]治疗组病人的治愈率、有效率较对照组有所提高（P〈0.01）;治疗组复发率及复诊率较对照组明显降低（P〈0.05）;治疗组中医体质评分较对照组的体质评分均有所下降（P〈0.01）,说明治疗组临床症状、体征缓解程度较对照组明显。[结论]实施中医体质个体化健康教育可减轻消化性溃疡病人的临床症状及体征,提高消化性溃疡病人的治愈率、好转率;降低疾病的复发率。     

原发性高血压患者自我管理能力现状调查分析

目的调查原发性高血压患者自我管理能力现状,为推进高血压管理工作提供理论依据。方法对2018年12月—2019年8月心血管内科住院治疗的104例原发性高血压患者采用背景情况调查表、中文版4条目Morisky用药依从性问卷、高血压人群健康自我管理能力测评量表进行问卷调查。结果本组患者中服药依从性高者27(25.96%)例、依从性低者77(74.04%)例。69.23%的患者健康自我管理行为处于低水平,64.42%的患者自我管理认知处于低水平,67.31%的患者自我管理环境水处于低水平。结论高血压患者自我管理能力仍有待改善,护理人员应根据患者的个体差异,开展针对性干预。     

超声定位在微创经皮肾镜钬激光碎石术中应用价值分析

目的：探讨超声定位在微创经皮肾镜钬激光碎石术中临床应用价值。方法选择患者50例,术中定位采用超声,统计患者穿刺次数及穿刺所耗时间,以及穿刺后发生的并发症。结果使用后穿刺次数显著少于使用前（P＜0.05）,同时穿刺所耗时间显著短于使用前（P＜0.05）,穿刺出现肝脾损伤、气胸、肾脏血管损伤和肾脏穿孔比例低于使用前（P＜0.05）。结论在超声定位下行经皮肾镜钬激光碎石治疗,减少反复穿刺带来的并发症,缩短操作时间,提高手术安全性、成功率有积极意义。