2021年ACOG关于产后阶梯式多模式药物镇痛的建议及要点解读

产后疼痛是困扰产妇的常见问题,如治疗不当可能会导致阿片类药物滥用、产后抑郁和疼痛长期存在等不良后果。因此,美国妇产科医师学会（American College of Obstetricians and Gynecologists,ACOG）于2021年9月提出了针对产后疼痛的临床共识,专门对产后疼痛的一般管理、阴道分娩、剖宫产术后、母乳喂养时及出院后疼痛的处置给出了治疗建议与指导,强调了阶梯式多模式药物镇痛方法与个体化用药原则。推荐临床用药可遵循“非阿片类镇痛药（如对乙酰氨基酚和非甾体抗炎药）—弱阿片类药物—强阿片类药物（必要时）”阶梯式给药原则,并可合理联合用药。对此进行简要介绍与要点解读。     

施普瑞对冠心病患者胰岛素敏感性的影响

目的观察施普瑞对冠心病患者胰岛素敏感性的影响.方法40例血压正常、非糖尿病的冠心病患者,施普瑞治疗前及1.2g/d治疗10周后,分别检测空腹血糖、空腹血浆胰岛素、血胆固醇、甘油三酯、高密度脂蛋白-胆固醇,计算胰岛素敏感指数,并以38例性别、年龄、体重指数相当的正常人为对照组.结果2组空腹血糖差异无显著性(P＞0.05),冠心病组空腹血浆胰岛素显著升高,胰岛素敏感性指数显著降低(P＜0.01),施普瑞治疗10周后,空腹血浆胰岛素水平明显下降(P＜0.01),胰岛素敏感性指数显著增高(P＜0.05),血脂代谢明显改善.结论施普瑞在纠正冠心病患者血脂代谢异常的同时,对其胰岛素敏感性也有明显的改善.     

0．75％罗哌卡因硬膜外麻醉用于妇产科手术的临床观察

目的 观察０．７５％罗哌卡因硬膜外用于妇产科手术的临床效果、方法 选择７２例ＡＳＡＩ－Ⅱ级妇产科手术随机分为两组．Ｉ组为０．７５％罗哌卡因组（３６例）Ⅱ组为０．５％布比卡因组（３６例）,两组均取腰１－２行硬膜外穿刺,观察两组的感觉阻滞、运动阻滞、镇痛效果及对循环呼吸的影响和不良反应,结果 两组感觉阻滞达Ｔ８的时间。切皮时ＶＡＳ评分、运动恢复时间有显著性差异（Ｐ＜０．０５）,不良反应中寒颤的发生率Ⅰ组明显比Ⅱ组少（Ｐ＜０．０５）,结论０．７５％罗哌卡因具有起效时间快,镇痛效果好,运动阻滞恢复早,对循环呼吸的影响小,神经毒性低的临床特点。     

伤病比在医院维权中的运用

为了保证民法的公平原则,避免医疗纠纷赔偿案件审理中忽视患者本身病情所致的不良后果的情况,对损伤与疾病对患者预后的影响进行了研究.介绍了伤病比的来源,论述了伤病比在医疗纠纷处理中的适用 范围,伤病比的级别与医院承担的赔偿额度.指出应增强伤病比意识,促进医与法的完美结合.     

洛赛克治疗症状性胃食管反流病95例临床观察

目的了解洛赛克强力抑酸作用对胃食管反流病(GERD)患者临床症状改善及胃镜下食管炎症改善情况.方法将95例GERD病人随机分为两组,用洛赛克(20mg qd)50例,雷尼替丁(150mg Bid)45例,疗程4周,停药2周后胃镜复查,观察临床症状及食管炎症改善情况.结果治疗组临床症状改善有效率为91.6%,对照组为50.4%.治疗组胃镜下食管炎症改善有效率为70%,对照组为29.2%.治疗组明显优于对照组.结论对GERD病人抑制胃酸分泌,减轻其对食管粘膜的损伤和改善临床症状洛赛克有较好的疗效,其作用已被公认,但在食管炎症愈合方面疗效不太满意,如与促动力药物合用,可望更高疗效.     

止泻颗粒剂治疗小儿消化不良性肠炎136例

运用止泻颗粒剂与思密达作对照治疗小儿消化不良性肠炎,治疗组136例,对照组80例,2组总有效率分别为95．5％,37．5％,疗效比较具有显著性差异,P＜0．01。     

Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?

BackgroundAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.MethodsA retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.ResultsSixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.ConclusionAt our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%.     

中药解郁胶囊治疗老年抑郁症的临床疗效观察

目的：观察中药解郁胶囊对老年抑郁症的临床疗效和安全性。方法：选取2020年11月至2021年12月甘肃中医药大学附属医院住院或门诊患者200例作为研究对象,按照纳入标准最终产生研究观察对象100例,健康对照组来自我院组织的年龄在60~80岁的健康体检的老年人100例。观察组中男37例,女63例,对照组中男43例,女57例。对照组采取常规治疗,观察组采取中医综合疗法治疗。对2组患者治疗前后减分情况、中医证候分析、服药及依从情况、不良反应及抑郁焦虑因子等无创性指标的影响。结果：对老年抑郁症的治疗效果主要从汉密尔顿抑郁量表减分情况及证候减分率体现,2组经过12个月中药和抗抑郁综合治疗,中医证候量表减分率（8.2±3.1）和（7.8±3.2）,比对照组的（8.8±3）与（8.4±3.6）,P值为0.001 6和0.001 3,治疗前后均有明显变化,差异有统计学意义（P<0.05）,中医证候量表减分率比较,差异有统计学意义（P<0.05）,从服药后出现的不良反应来看,中医综合观察组应明显低于对照观察组,差异有统计学意义（P<0.05）。从中医组治疗患者的依从性分析,差异有统计学意义（P<0.05）。结论：中药解郁胶囊与中医综合治疗患者治疗效果显著,依从性更佳。