芪骨胶囊联合骨瓜提取物注射液治疗中老年不稳定型桡骨远端骨折的疗效观察

目的探讨芪骨胶囊联合骨瓜提取物注射液治疗中老年不稳定型桡骨远端骨折的临床疗效。方法选取2015年10月—2016年12月高唐县人民医院收治的中老年桡骨远端骨折患者116例,随机分为对照组和治疗组,每组各58例。对照组静脉滴注骨瓜提取物注射液,50 mg加入5%葡萄糖溶液250 m L中,1次/d;治疗组在对照组的基础上口服芪骨胶囊,3粒/次,3次/d。两组均持续治疗4周。观察两组的临床疗效,同时比较两组治疗前后VAS评分、肿胀程度及其疼痛缓解、肿胀消除和骨折愈合的时间。结果治疗后,两组总有效率比较差异不具有统计学意义。治疗1、4周后,两组患者VAS评分和肿胀程度评分均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗1周后治疗组的上述评分明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组疼痛缓解时间、消肿时间以及骨折愈合时间均较对照组明显缩短,两组比较差异具有统计学意义(P0.05)。结论芪骨胶囊联合骨瓜提取物注射液治疗中老年不稳定型桡骨远端骨折能有效减轻患者疼痛和肿胀情况,缩短止痛、消肿以及骨折愈合的时间,具有一定的推广应用价值。     

On the road to precision,there is more practical medicine to be implemented

Estimates are that of the annual global burden of 1.5 million new cases of breast cancer, two-thirds have hormone receptor positive tumors; a majority of these women come from low- and middle-income countries. For adjuvant patients with hormone receptor positive tumors, a major goal is identification of a “precision medicine”, implying a genomic, test whose application will allow identification of those whose systemic treatment can be hormonal therapy alone. Such tests in current use are very expensive and thus in the foreseeable future are out of reach of most women who pay out of pocket.For some time it has been evident that quantitative scoring of tumors for intensity and prevalence of tumor-cell staining for estrogen or progesterone receptor (ER or PR) expression (the commonest system was first described by Allred and thus provides “Allred” scores) gives an inexpensive measure of likelihood of response to hormonal therapies – a different predictive, precision medicine tool. Majorities of hormone receptor positive tumors (one third of all patients) have “Allred” scores of 6–8 (versus scores of 3–5) for both ER and PR and these tumor-bearing patients benefit significantly more from hormonal treatments than their lowering scoring-afflicted women. When ER and PR quantitative intensity and prevalence scoring is combined with Her-2/neu testing and careful tumor histologic grading, luminal A and B type tumors can be well-defined and gene-expression testing adds little practical predictive information.For women with hormone receptor positive tumors, high quality, cost-effective “precision medicine” is available without tumor gene-expression testing.     

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study

BackgroundThrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital.AimTo determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children.MethodsChildren who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality.ResultsForty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV × PDW/Platelet count × PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69–10.99), 3.86 (95% CI, 1.53–9.75), 3.45 (95% CI, 1.38–8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45.ConclusionThe MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.     

心理疏导联合健康宣教对高位复杂肛瘘术后患者换药时切口疼痛的效果评价

目的：探讨心理疏导联合健康宣教对高位复杂肛瘘术后患者换药时切口疼痛的效果。方法将77例行肛肠外科手术治疗的高位复杂性肛瘘患者根据其术后护理方法分为对照组（n＝38）与观察组（n＝39）。对照组采用常规护理,观察组在此基础上采用心理疏导联合健康宣教。比较2组患者换药时及换药后10 min视觉模拟评分（ VAS评分）、健康教育达标率及护理工作满意度、换药后生活自理能力。结果（1）2组患者换药后10 min VAS评分与换药时比较差异有统计学意义（P＜0．05）,且从术后第2天开始,观察组患者换药后10 min VAS评分均显著小于对照组患者换药后10 min VAS评分,差异有统计学意义（P＜0．05）;（2）观察组患者健康教育达标率及护理工作满意度（94．84％,100％）均显著高于对照组（86．84％,89.47％）,差异有统计学意义（P＜0．05）;（3）观察组患者换药后生活自理能力优良率（89．74％）高于对照组（81.58％）,差异有统计学意义（P＜0．05）。结论心理疏导联合健康宣教可有效缓解高位复杂肛瘘术后患者换药时切口疼痛,改善患者生活质量,提高护理满意度及生活自理能力。     

胆康胶囊联合头孢哌酮钠舒巴坦钠治疗慢性胆囊炎的临床研究

目的探讨胆康胶囊联合头孢哌酮钠舒巴坦钠治疗慢性胆囊炎患者的临床效果。方法选取2016年7月—2017年7月国药东风花果医院收治的慢性胆囊炎患者175例,随机分成对照组(87例)和治疗组(88例)。对照组患者静脉滴注注射用头孢哌酮钠舒巴坦钠,4.0 g加入5%葡萄糖注射液100 mL,2次/d。治疗组患者在对照组的基础上口服胆康胶囊,4粒/次,3次/d。两组患者均治疗2周。观察两组患者临床疗效,同时比较治疗前后两组患者临床症状积分、VAS评分、SF-36评分、肿瘤坏死因子-α(TNF-α)、β-内啡肽(β-EP)和超氧化物歧化酶(SOD)水平及不良反应情况。结果治疗后,对照组和治疗组临床有效率分别为82.76%和95.45%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者右腹部疼痛,腹胀,恶心、厌油等症状积分均显著下降(P0.05),且治疗组患者各项症状积分比对照组降低的更明显(P0.05)。治疗后,两组患者VAS比治疗前均显著降低(P0.05),SF-36评分显著升高(P0.05),同时治疗组患者VAS和SF-36评分比对照组患者改善更明显(P0.05)。治疗后,两组患者TNF-α和β-EP水平显著降低(P0.05),SOD血清水平显著升高(P0.05),同时治疗组患者TNF-α、β-EP和SOD血清水平明显优于对照组患者(P0.05)。治疗期间,对照组患者不良反应发生率为18.39%,显著高于治疗组的5.68%,两组患者比较差异具有统计学意义(P0.05)。结论胆康胶囊联合头孢哌酮钠舒巴坦钠治疗慢性胆囊炎患者临床疗效显著,并可改善患者的临床症状,降低不良反应发生率。     

天麻钩藤颗粒联合司来吉兰治疗帕金森病的临床研究

目的研究天麻钩藤颗粒联合盐酸司来吉兰片治疗帕金森病的临床疗效。方法选取2016年12月—2017年9月在郯城县妇幼保健计划生育服务中心进行治疗的帕金森病患者78例为研究对象,采用Excel表法随机分为对照组和治疗组,每组各39例。对照组患者于早餐后1 h口服盐酸司来吉兰片,第1~3天,1片/次,1次/d,第4天后若无异常则调整剂量至2片/次,1次/d。治疗组患者在对照组治疗的基础上口服天麻钩藤颗粒,5 g/次,3次/d。两组患者均持续治疗12周。观察两组的临床疗效,比较两组患者的自主神经症状量表(SPOCA-AUT)评分、帕金森病综合评分量表(UPDRS)评分、改良Webster评分、血清学指标和不良反应情况。结果治疗后,对照组和治疗组的总有效率分别为76.9%、92.3%,两组比较差异有统计学意义(P0.05)。治疗后,两组SPOCA-AUT、UPDRS和改良Webster评分均显著下降,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组评分明显低于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组患者血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、丙二醛(MDA)和血清胱抑素C(Cys-C)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);且治疗后治疗组血清学指标水平明显低于对照组,两组比较差异有统计学意义(P0.05)。对照组和治疗组的不良反应率分别为7.7%、10.3%,两组不良反应率比较没有统计学意义。结论天麻钩藤颗粒联合盐酸司来吉多片治疗帕金森疗效显著,可降低机体炎症程度,改善患者神经功能、认知功能和运动能力,且安全性较好,具有一定的临床推广运用价值。     

杞菊地黄丸联合环丙沙星治疗慢性肾盂肾炎的疗效观察

目的探讨杞菊地黄丸联合环丙沙星治疗慢性肾盂肾炎的临床效果。方法选取日照市妇幼保健院在2015年12月—2016年12月收治的慢性肾盂肾炎患者141例,随机分成对照组(70例)和治疗组(71例)。对照组患者口服盐酸环丙沙星片,1片/1次,3次/d;治疗组在对照组的基础上口服杞菊地黄丸,8丸/次,3次/d。所有患者均经过规律治疗4周。观察两组患者临床疗效,比较治疗前后两组患者主要症状积分、肾功能指标和不良反应情况。结果治疗后,对照组患者临床总有效率为85.71%明显低于治疗组的98.59%,停药半年内对照组和治疗组的重新感染率分别为12.86%、2.82%,两组比较差异具有统计学意义(P0.05)。治疗后,两组主要症状积分明显降低(P0.05);且治疗组积分明显低于对照组(P0.05)。治疗后,两组患者的血清肌酐、血尿素氮和尿微量白蛋白水平均显著降低(P0.05);且治疗组患者肾功能指标水平明显低于对照组(P0.05)。治疗期间,治疗组患者不良反应发生率为4.23%,明显低于对照组患者的17.14%,两组比较差异具有统计学意义(P0.05)。结论杞菊地黄丸联合环丙沙星治疗慢性肾盂肾炎疗效显著,可降低停药半年内重新感染率,具有一定的临床推广应用价值。     

接骨七厘片联合鹿瓜多肽治疗四肢骨折的疗效观察

目的探讨接骨七厘片联合鹿瓜多肽治疗四肢骨折的临床有效性与安全性。方法选取2012年6月—2015年6月天津市第五中心医院收治的四肢骨折患者82例,根据用药方案不同分成对照组和治疗组,每组各41例。对照组患者静脉滴注注射用鹿瓜多肽,24 mg加入生理盐水,1次/d;治疗组患者在对照组基础上口服接骨七厘片,5片/次,2次/d。两组患者均连续治疗8周。观察两组患者临床疗效,比较治疗前后两组患者四肢骨折愈合时间、视觉模拟评分(VAS)评分和SF-36评分。结果治疗后,对照组临床总有效率为78.05%,显著低于治疗组的95.12%,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组患者胫骨干、尺桡骨、股骨干、肱骨干骨折愈合时间均明显短于对照组患者,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者VAS评分显著降低,SF-36评分显著升高,同组比较差异具有统计学意义(P0.05);且治疗组患者VAS评分和SF-36评分改善情况明显优于对照组(P0.05)。结论接骨七厘片联合鹿瓜多肽治疗四肢骨折可显著提升患者的临床有效率,改善患者的疼痛症状与生活质量。