Sodium-Glucose Cotransporter-2 Inhibitor-Related Diabetic Ketoacidosis: Accuracy Verification of Operational Definition

BackgroundThe most important aspect of a retrospective cohort study is the operational definition (OP) of the disease. We developed a detailed OP for the detection of sodium-glucose cotransporter-2 inhibitors (SGLT2i) related to diabetic ketoacidosis (DKA). The OP was systemically verified and analyzed.MethodsAll patients prescribed SGLT2i at four university hospitals were enrolled in this experiment. A DKA diagnostic algorithm was created and distributed to each hospital; subsequently, the number of SGLT2i-related DKAs was confirmed. Then, the algorithm functionality was verified through manual chart reviews by an endocrinologist using the same OP.ResultsA total of 8,958 patients were initially prescribed SGLT2i. According to the algorithm, 0.18% (16/8,958) were confirmed to have SGLT2i-related DKA. However, based on manual chart reviews of these 16 cases, there was only one case of SGLT2i-related DKA (positive predictive value = 6.3%). Even after repeatedly narrowing the diagnosis range of the algorithm, the effect of a positive predictive value was insignificant (6.3–10.0%, P > 0.999).ConclusionOwing to the nature of electronic medical record data, we could not create an algorithm that clearly differentiates SGLT2i-related DKA despite repeated attempts. In all retrospective studies, a portion of the samples should be randomly selected to confirm the accuracy of the OP through chart review. In retrospective cohort studies in which chart review is not possible, it will be difficult to guarantee the reliability of the results.     

盐酸羟考酮复合右美托咪定在子痫前期患者剖宫产术后镇痛、镇静中的临床观察

目的:探讨不同剂量的盐酸羟考酮和右美托咪定复合用于子痫前期患者剖宫产术后镇痛、镇静的有效性和安全性。方法:120例子痫前期患者随机分为A、B、C 3组,各组40例。术后入重症监护病房(ICU)时连接盐酸羟考酮注射液和右美托咪定持续泵注镇痛、镇静治疗。A组采用低剂量盐酸羟考酮每小时0.5 mg+右美托咪定每小时0.3μg/kg持续泵注;B组采用中剂量盐酸羟考酮每小时0.75 mg+右美托咪定每小时0.3μg/kg持续泵注;C组采用高剂量盐酸羟考酮每小时1 mg+右美托咪定每小时0.3μg/kg持续泵注。记录3组患者术毕入ICU时(T0)、入ICU后2小时(T1)、4小时(T2)、6小时(T3)、8小时(T4)、12小时(T5)、24小时(T6)、48小时(T7)静息及按压宫底时的数字疼痛评分法(NRS)评分、按压宫底前后平均血压(MAP)、心率(HR),各时点静息时镇静满意者比例及恶心、呕吐、瘙痒、呼吸抑制、头晕痛等不良反应和子痫、脑出血、心力衰竭等并发症情况。结果:A组中静息NRS评分在T2~T7高于T1(P<0.05);在T2~T5时静息和按压时差异有统计学意义(P<0.05)。A组MAP、HR在T2~T5时点按压前后相比,差异有统计学意义(P<0.05)。B、C两组患者静息、按压NRS评分在T2~T7各时点低于A组(P<0.05);B、C两组间MAP、HR在按压前后各时点比较差异均无统计学意义(P>0.05)。B、C两组镇静满意者例数在T1~T7时点所占比例高于A组(P<0.05)。3组间恶心、呕吐、呼吸抑制发生率差异无统计学意义(P>0.05)。无子痫、脑出血、心力衰竭等并发症发生。结论:盐酸羟考酮每小时0.75mg+右美托咪定每小时0.3μg/kg持续静脉泵注用于子痫前期患者剖宫产术后48小时内镇痛、镇静,安全有效。     

经尿道柱状水囊前列腺扩开术两种手术方式治疗良性前列腺增生效果分析

目的探究经尿道等离子腔内前列腺剜除术(plasmakinetic enucleation and resection of the prostate,PKERP)与经尿道等离子切除术(plasmakinetic resection of prostate,PKRP)对体积<100mL良性前列腺增生(benign prostatic hyperplasia,BPH)患者膀胱功能、性功能和并发症所产生的影响。方法选取2017年3月至2018年9月钟祥市人民医院泌尿外科诊治的100例良性前列腺增生患者为研究对象。按照不同手术方法将其分为观察组和对照组,每组50例患者。观察组患者采取经尿道等离子腔内前列腺剜除术(PKERP),对照组患者采取经尿道等离子切除术(PKRP)。比较两组患者治疗后的膀胱功能、性功能和并发症发生情况。结果两组患者经过治疗后,同组比较,国际前列腺症状评分(international prostate symptom scores,IPSS)和生活质量评分(quality of life,QOL)评分均有显著降低,其差异均具有统计学意义(均P<0.05)。组间比较发现,观察组患者的IPSS评分为(6.84±1.13)分,QOL评分为(1.17±0.26)分,均显著低于对照组患者,其差异均具有统计学意义(t=5.351,4.082,均P<0.05)。两组患者治疗前后最大尿流率(the maximum flow rate,Qmax)、最大尿道关闭压(maximum urethral closure pressure,MUCP)和国际勃起评分表(intemational index of erectile function 5,IIEF-5)比较,同组差异均具有统计学意义(均P<0.05);同时,观察组患者治疗后Qmax[(16.74±3.16)mL/s]、MUCP[(36.04±5.22)cm H2O]、IIEF-5[(24.76±3.57)分]均显著高于对照组患者,其差异均具有统计学意义(t=5.827,8.193,4.696,均P<0.05)。观察组患者并发症总发生率(4.0%)显著低于对照组患者(30.0%),其差异具有统计学意义(χ2=6.171,P<0.05)。结论 PKERP对于良性前列腺增生治疗后患者的膀胱功能的保留,性功能的保留效果更好,并发症显著降低,具有较高安全性,值得临床推广应用。     

感音神经性聋患儿伴分泌性中耳炎同期人工耳蜗植入效果分析

目的探讨伴分泌性中耳炎的感音神经性聋患儿同期植入人工耳蜗术后的听觉言语康复效果。方法回顾性分析安徽医科大学第一附属医院2015年1月到2017年12月期间伴分泌性中耳炎同期植入人工耳蜗的感音神经性聋患儿30例(A组)的临床资料,并与同期不伴分泌性中耳炎的感音神经性聋患儿30例(B组)比较。所有患儿均采用面隐窝入路植入人工耳蜗,术后随访24个月,采用听觉行为分级(categories of auditory performauce-Ⅱ,CAP-Ⅱ)和言语可懂度分级(speech intelligibility rating,SIR)评估并比较两组患儿的听觉言语康复效果。结果 A组患儿同期植入人工耳蜗后均未出现术后并发症,术前A组CAP-II评分为0.87±1.07分,SIR评分为1.07±0.37分,术后分别为5.07±0.91和3.73±0.87分,术后较术前明显提高(P<0.01)。B组术前CAP-II评分为0.93±1.17分,SIR评分为1.10±0.40分,术后分别为5.23±0.77和3.77±0.73分,术后较术前明显提高(P<0.01)。A组与B组之间术前、术后CAP-II和SIR评分差异均无统计学意义(P>0.05)。结论感音神经聋患儿伴分泌性中耳炎患儿同期人工耳蜗植入安全可行,且分泌性中耳炎对术后听觉言语康复效果无明显影响。     

Otosclerosis surgery: Assessment of patient comfort

ObjectivesTo evaluate operative comfort and stress in patients undergoing stapedotomy for otosclerosis under local versus general anesthesia.Material and methodsConsecutive otosclerosis patients managed over a 9-month period responded to 3 validated questionnaires to assess peri- and post-operative comfort: Glasgow Benefit Inventory, Cohen's Perceived Stress Scale and the Posttraumatic Stress Disorder Checklist Scale. These results and audiometric data were compared between local and general anesthesia groups.ResultsTwenty-one patients were included in the local anesthesia group and 7 in the general anesthesia group, after exclusion of patients with history of otosclerosis surgery. There was no significant inter-group difference on Glasgow Benefit Inventory (P = 0.38) or Posttraumatic Stress Disorder Checklist Scale (P = 0.86). Perceived Stress Scale scores were higher in the general anesthesia group (P = 0.038). In total, 67% of patients reported no discomfort under local anesthesia, and 86% were ready to undergo the procedure under local anesthesia again. There were no significant differences in postoperative symptoms, or in air-bone gap ≤ 10 dB (local anesthesia 81%, general anesthesia 71%; P = 0.156).ConclusionsLocal anesthesia in otosclerosis surgery did not increase stress or postoperative symptoms compared to general anesthesia. Audiometric results were not affected by type of anesthesia.     

3D打印模型在儿童先天性脊柱侧凸治疗中的应用研究

目的探讨3D打印模型在儿童先天性脊柱侧凸治疗中的应用疗效。方法回顾性分析2015年12月至2016年12月于首都医科大学附属北京儿童医院接受手术治疗的83例先天性脊柱侧凸患儿临床及影像学资料,根据是否使用3D打印模型分为试验组(n=44)和对照组(n=39),比较两组手术时间、术中透视次数、置钉准确性、矫形效果及并发症情况。结果本研究共纳入83例先天性脊柱侧凸患儿,其中男童47例,女童36例,平均手术年龄5.98 (1.5~13)岁。行半椎体切除术40例,Ponte截骨术31例,经椎弓根截骨术8例,全脊椎切除术4例。随访时间24~35个月。试验组患儿手术时间短于对照组[(180.92±16.74) min (201.51±27.60) min],差异有统计学意义(t=2.798,P<0.05),试验组术中出血量[(340.23±89.52) mL vs.(392.64±100.41) mL]及术中透视次数(4.36±0.89 6.05±1.28)明显少于对照组,差异有统计学意义(P<0.05);试验组置钉准确率高于对照组(93.55%vs 79.91%)(X^2=218.00,P<0.05),平均置钉时间明显短于对照组[(4.24±1.05) min vs.(8.35±2.29) min],差异有统计学意义(t=10.71,P<0.05)。两组患儿矫形率无明显差异(t=-1.135,P=0.272)。试验组与对照组患儿术后胸膜损伤、硬膜损伤发生率无明显差异(P>0.05)。结论 3D打印模型能清晰、直观显示先天性脊柱侧凸患儿的脊柱结构及形态,为制定手术计划及手术置钉提供帮助,从而提高置钉准确率,减少术中透视次数,缩短手术时间,减少术中出血量。     

坐骨重叠征与发育性髋关节脱位手术后再脱位的相关性分析

目的提出坐骨重叠征(ischium overlap sign,IOS)的概念,并分析其与发育性髋关节脱位(developmental dysplasia of the hip,DDH)手术后再脱位的关系。方法回顾性分析2013年9月至2017年5月山东大学附属省立医院治疗的88例(105髋)DDH患儿病例资料,其中男童16例、女童72例;平均年龄12(5~24)个月,平均随访时间34(15~59)个月;双侧17例,左侧63髋,右侧42髋;1髋为髋臼发育不良,11髋半脱位,93髋全脱位。术中行髋关节造影检查,按照Bowen标准选择闭合或切开复位石膏固定术。IOS是指在人类位髋关节造影平片上股骨头软骨内缘与坐骨外缘的重叠关系,二者重叠为Ⅰ度,相接为Ⅱ度,分离为Ⅲ度。将93髋全脱位按照IOS分度进行分组,比较组间再脱位发生率。结果 1髋髋臼发育不良和11髋半脱位者IOS均为Ⅰ度。93髋全脱位中IOSⅠ度14髋,Ⅱ度39髋,此两组均行闭合复位石膏固定,无再脱位病例;Ⅲ度40髋中,闭合复位石膏固定17髋,6髋再脱位;切开复位石膏固定23髋,1髋再脱位。本研究发现Ⅲ度组的再脱位发生率(7/40,17.5%)高于其他两组(P=0.006)。IOS为Ⅲ度的40髋中,闭合复位的再脱位发生率(6/17,35.3%)高于切开复位(1/23,4.4%),差异有统计学意义(X^2=4.518,P=0.034)。结论 IOS与DDH术后再脱位有一定的关系,IOS为Ⅲ度的髋关节如行闭合复位,再脱位的风险较高。