目的 观察利伐沙班对心力衰竭（HF）合并心房颤动（AF）患者凝血因子及预后情况的影响。方法 采用前瞻性研究,纳入平顶山市第二人民医院2021年1月—2022年4月期间收治的123例HF合并AF患者,以数字随机表法将入组患者分为常规组（61例）和试验组（62）例,两组均行起搏器植入术（CRTD）治疗,常规组予以常规抗凝治疗辅助CRTD,试验组予以利伐沙班辅助CRTD,所有患者术后均开展一年随访,比较两组患者治疗前后的抗Xa凝血因子、心肌损伤标志物、心功能指标变化情况,以及术后血栓栓塞、心血管死亡事件发生情况。结果 治疗前,两组患者的Xa凝血因子,心肌损伤标志物,心功能指标比较差异无统计学意义（P>0.05）;在不同抗凝方案下,观察组治疗1 d后的抗Xa凝血因子为（130.44±20.18）IU/mg,治疗3 d后的抗Xa凝血因子为（115.36±20.77）IU/mg,治疗7 d的抗Xa凝血因子为（90.25±20.44）IU/mg,均低于常规组[（145.33±20.19）IU/mg、（128.45±20.16）IU/mg、（103.34±20.17）IU/mg],差异有统计学意义（P<0.05）。治疗后,试验组的肌酸激酶同工酶为（7.52±2.16）U/L,心肌肌钙蛋白Ⅰ为（0.52±0.12）ng/mL,乳酸脱氢酶为（126.41±20.45）U/L,均低于常规组[（8.44±2.28）U/L、（0.94±0.31）ng/mL、（140.33±20.25）U/L],差异有统计学意义（P<0.05）。治疗后,观察组的左室射血分数为（56.12±10.41）%,高于常规组（50.24±10.33）%,左室舒张末期内径为（47.11±10.25）mm,左室舒张末期容积为（36.72±10.43）mL,均低于常规组（53.28±10.14）mm、（42.77±10.36）mL,差异有统计学意义（P<0.05）。随访期间,试验组的血栓栓塞事件发生率为4.84%（3/62）,心血管死亡事件发生率为3.23%（2/62）,均低于常规组[19.67%（12/61）、14.75%（9/61）],差异有统计学意义（P<0.05）。结论 利伐沙班辅助CRTD能有效增强HF合并AF患者的抗Xa凝血因子活性,对减轻心肌损伤、改善心功能并降低血栓栓塞或心血管死亡风险均有积极意义。

Objective To observe the effect of rivaroxaban on coagulation factors and prognosis in patients of heart failure（HF）with atrial fibrillation（AF）．Methods This is a prospective study．The patients were included from January 2021 to April 2022 in Pingdingshan Second People’s Hospital．The study subjects were 123 patients with HF and AF．The enrolled patients were divided into the conventional group（61 cases）and the experimental group（62 cases）by the method of digital random table．Both groups were treated with cardiac resynchronization therapy with defibrillator（CRTD）．The conventional group was treated with conventional anticoagulation therapy to assist CRTD,and the experimental group was treated with rivaroxaban to assist CRTD．All patients were followed up for one year after surgery,the changes in anti-Xa coagulation factors,myocardial injury markers,cardiac function indicators,as well as the incidence of postoperative thromboembolism and cardiovascular death events between the two groups of patients before and after treatment were compared．Results Before treatment,there were no statistically significant differences in Xa coagulation factor,myocardial injury markers and cardiac function indicators between the two groups of patients（P>0.05）．Under different anticoagulation regimens,the anti-Xa coagulation factor levels in the observation group were（130.44±20.18）IU/mg after 1 day of treatment,（115.36±20.77）IU/mg after 3 days of treatment,and（90.25±20.44）IU/mg after 7 days of treatment,which were lower than that in the conventional group [（145.33±20.19）IU/mg,（128.45±20.16）IU/mg,（103.34±20.17）IU/mg]（P<0.05）．After treatment,the CK-MB level of the experimental group was（7.52±2.16）U/L,cTnI was（0.52±0.12）ng/mL,and LDH was（126.41±20.45）U/L,which were lower than that of the conventional group [（8.44±2.28）U/L,（0.94±0.31）ng/mL,（140.33±20.25）U/L]（P<0.05）．After treatment,the left ventricular ejection fraction of the observation group was（56.12±10.41）%,which was higher than the conventional group（50.24±10.33）%,left ventricular diameter was（47.11±10.25）mm,left ventricular end disastolic volume was（36.72±10.43）mL,which were lower than the conventional group（53.28±10.14）mm,（42.77±10.36）mL（P<0.05）．During the follow-up period,the incidence of thromboembolism events in the experimental group was 4.84%（3/62）,and the incidence of cardiovascular death events was 3.23%（2/62）,which was lower than the conventional group [19.67%（12/61）,14.75%（9/61）]（P<0.05）．Conclusions Rivaroxaban assisted CRTD can effectively enhance the activity of anti-Xa coagulation factors in patients with HF and AF,which has positive significance in reducing myocardial injury,improving cardiac function and reducing the risk of thromboembolism or cardiovascular death．

目的 分析全瓷冠与高嵌体对后牙牙体缺损的修复效果及对牙周炎性反应的影响。方法 用随机抽签法将我科2022年2月—2023年5月接治的50例后牙牙体缺损者分为对照组（签号为奇数,全瓷冠修复）与高嵌体组（签号为偶数,高嵌体修复）,各25例,对比两组修复效果（指标为修复体佩戴时间及总体康复时间）、牙周炎性反应、口腔健康指数及并发症发生率。结果 高嵌体组修复体佩戴时间（14.38±2.51）d、总体康复时间为（59.66±4.47）d,短于对照组的（21.96±2.87）d、（93.84±5.26）d（P<0.001）;高嵌体组牙周正常率（88.00%）高于对照组（64.00%）（P<0.05）;高嵌体组修复后的GI、PLI、SBI分别为（0.81±0.19）分、（0.85±0.16）分、（1.04±0.25）分,低于对照组的（0.97±0.23）分、（1.01±0.22）分、（1.31±0.28）分（P<0.05）;高嵌体组并发症发生率（8.00%）接近于对照组（12.00%）（P>0.05）。结论 修复后牙牙体缺损时选用高嵌体修复法可取得相对更好的修复效果,能够缩短患者佩戴修复体时间,加速其康复进程,对牙周炎性反应的减轻、口腔健康的改善均有积极影响,且并发症风险较小,整体效果更优。

Objective To analyze the effect of all-porcelain crown and onlay on posterior tooth defect repair and periodontitis reaction. Methods Fifty cases of posterior dental defects treated in our department from February 2022 to May 2023 were divided into control group（odd-numbered,all-porcelain crown restoration）and onlay group（even-numbered,onlay restoration）with 25 cases each．The repair effect,periodontitis response,oral health index and complication rate were compared between the two groups. Results The wearing time and overall recovery time of the onlay group were shorter than those of the control group（P<0.001）．The periodontal normal rate in the onlay group was higher than that in the control group （P<0.05）．gingival index,plaque index,sulcus bleeding index of the onlay group after repair were lower than those of the control group（P<0.05）．The complication rate of the high inlays group was close to that of the control group（P>0.05）. Conclusions In the repair of post-dental defects,the use of onlay repair can achieve relatively better repair effects,shorten the time for patients to wear the prosthesis,accelerate the rehabilitation process,have a positive impact on the reduction of periodontitis reaction and the improvement of oral health．The risk of its complications is small,and the overall effect is better．

目的 研究注水法内镜下冷圈套器切除术在5~10 mm 无蒂型大肠息肉中的临床疗效。方法 纳入120例阳春市中医院收治的5~10 mm 无蒂型大肠息肉患者,合计246枚息肉,根据结肠息肉切除方式不同分为内镜下注水法冷圈套器切除术（UCSP）与传统内镜下冷圈套器切除术（CCSP）两组,每组分别纳入60例患者。比较两组息肉部位、息肉大小、术后病理诊断、完整息肉切除率、术后病理深度、息肉回收率、手术时间、术中瞬时性出血率、迟发性穿孔率、迟发性出血率以及手术时间、Boston及视觉模拟评分法（VAS）评分。结果 两组息肉部位、息肉大小、术后病理诊断、完整息肉切除率、息肉回收率、术中瞬时性出血率、迟发性穿孔率、迟发性出血率以及Boston评分比较差异均无统计学意义（P>0.05）;UCSP组术后病理深度[（8.80.5）mm]大于CCSP组[（5.90.4）mm]（P<0.01）,CCSP 组手术时间[（21.32.4）min],较UCSP组[（25.71.1）min]缩短（P<0.01）,VAS评分UCSP组[（2.60.7）分]优于CCSP组[（2.90.3）分]（P<0.001）。结论 UCSP能有效、安全5~10 mm无蒂型大肠息肉,术后深度的病理组织学评估获得更高的肌层黏膜切除深度,虽然UCSP手术时间较长,但术后腹痛发生率较低。

Objective To study the clinical efficacy of endoscopic cold snare resection using water injection method in 5-10 mm pedunculated colorectal polyps. Methods A total of 120 patients with 5-10 mm sessile colorectal polyps admitted to Yangchun Traditional Chinese Medicine Hospital were selected as the research subjects．A total of 246 polyps were enrolled,and the patients were divided into two groups based on the different methods of endoscopic resection：underwater cold snare polypectomy（UCSP）and conventional cold snare polypectomy（CCSP）,with 60 patients enrolled in each group．Compare the location,size,postoperative pathological diagnosis,complete polypectomy rate,postoperative pathological depth,polyp recovery rate,surgical time,instantaneous intraoperative bleeding rate,delayed perforation rate,delayed bleeding rate,surgical time,Boston and VAS scores between two groups. Results Two groups of polyp locations,polyp size,postoperative pathological diagnosis,complete polyp resection rate,polyp recovery rate,the instantaneous intraoperative bleeding rate,delayed perforation rate,delayed bleeding rate,and Boston score,all of above were not significant different（P>0.05）;the postoperative pathological depth in the UCSP group[（8.8±0.5）mm] was significantly greater than that in the CCSP group[（5.9±0.4）mm]（P<0.01）,and the surgical time in the CCSP group[（21.3±2.4）min] was shorter than that in the UCSP group[（25.7±1.1）min]（P<0.01）． The VAS score in the UCSP group（2.6±0.7）was significantly better than that in the CCSP group（2.9±0.3）（P<0.001）. Conclusions The underwater cold snare polypectomy can achieve good therapeutic results in patients with 5-10 mm sessile colorectal polyps．Further pathological evaluation of postoperative can obtain deeper of myomucosal resection．Although the UCSP group has a longer surgical time,the incidence of postoperative abdominal pain is lower．

目的 观察低浓度布比卡因联合全身麻醉在腹腔镜下直肠癌根治术中的应用及对患者体征及苏醒质量的影响。方法 选择2020年1月—2021年6月在信阳一五四医院实施腹腔镜镜下直肠癌根治术治疗的126例直肠癌患者为研究对象,通过抽签法对患者进行分组,将其中63例列为全麻组,术中单纯实施全身麻醉,其余63例列为联合组,术中采用低浓度布比卡因联合全身麻醉,比较两组患者体征变化情况,苏醒质量,麻醉相关不良反应,并开展为期1.5年的随访,评估两组患者远期生存质量。结果 联合组术中、术后的心率、平均动脉压均低于全麻组（P<0.05）;术后,联合组的Steward麻醉苏醒评分略低于全麻组、麻醉恢复室停留时间略高于全麻组（P>0.05）;但联合组的视觉模拟疼痛评分、镇静评分均低于全麻组（P<0.05）;联合组的麻醉相关不良反应发生率略高于全麻组（P>0.05）;随访期间,联合组的肠癌患者生存质量测定量表各维度评分均高于全麻组（P<0.05）。结论 低浓度布比卡因联合全身麻醉的麻醉效果更加平稳、安全性高。

Objective To observe the application of low concentration bupivacaine combined with general anesthesia in laparoscopic radical resection of rectal cancer and its effect on the physical signs and recovery quality of patients. Methods In this study,126 rectal cancer patients who underwent laparoscopic radical resection of rectal cancer in Xinyang 154th Hospital from January 2020 to June 2021 were selected as the research subjects．The patients were divided into groups by drawing lots．Among them,63 patients were included in general anesthesia group,and the rest 63 patients were included in combined group．Low-concentration bupivacaine combined with general anesthesia was used in combined group during the operation．The changes of physical signs and the quality of recovery were compared between the two groups．Anesthesia related adverse events,and the long-term quality of life of the two groups of patients was evaluated through one-year and a half follow-up. Results The heart rate and mean arterial pressure during and after surgery in the combined group were lower than those in the general anesthesia group（P<0.05）．After surgery,the Steward anesthesia recovery score of the combined group was slightly lower than that of the general anesthesia group,and the PACU stay time was slightly higher than that of the general anesthesia group（P>0.05）．However,the VAS score and Richmond Agitation-Se dation Scale score of the combined group were lower than those of the general anesthesia group（P<0.05）．The incidence of anesthesia related adverse reactions in the combination group was slightly higher than that in the general anesthesia group（P>0.05）．During the follow-up period,the FACT-C scores of all dimensions in the combination group were higher than those in the general anesthesia group（P<0.05）. Conclusions The anesthesia effect of low concentration bupivacaine combined with general anesthesia is significant and safe．

目的 探讨脊柱微调手法治疗产后腰椎-骨盆复合体疼痛的临床疗效及对腰椎前凸曲度（LL）和骨盆入射角度（PI）的调整作用,为产后腰椎-骨盆复合体疼痛的治疗提供理论依据。方法 选取2022年7月—2023年7月在上海市杨浦区中医医院推拿科和上海中医药大学附属岳阳中西医结合医院推拿科门诊治疗的产后腰椎-骨盆复合体疼痛患者共82例,随机分为对照组和治疗组,每组41例。对照组采用传统理筋推拿手法,治疗组采用脊柱微调手法治疗,两组疗程均为8周,观察临床疗效,比较两组患者的疼痛数字评分法（NRS）、Oswestry功能障碍指数（ODI）、LL和PI在治疗前后组间与组内的变化。结果 治疗组总有效率为95.12%,对照组总有效率为75.60%,治疗组优于对照组（P<0.05）。治疗后,两组NRS评分、ODI评分较治疗前均有下降,且治疗组优于对照组（P<0.05）。治疗后,两组LL和PI测量较治疗前均无明显变化,治疗组与对照组比较差异无统计学意义（P>0.05）。结论 脊柱微调手法能有效减轻患者疼痛、提升日常活动功能,但对腰椎曲度、骨盆入射角未产生移位影响,安全性高。

Objective To explore the clinical efficacy of spinal fine adjustment manipulation in the treatment of postpartum lumbopelvic pain（PLPP） and its role in adjusting lumbar lordosis and pelvic incidence,and to provide theoretical basis for the treatment of PLPP. Methods A total of 82 patients with PLPP who were treated in the outpatient clinics of the Tuina Department of Yangpu District Hospital of Traditional Chinese Medicine and the Tuina Department of Yueyang Hospital of Integrative Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine from July 2022 to July 2023 were selected and randomly divided into the control group and the treatment group,with 41 cases in each group．The control group was treated with the traditional tendon manipulation and the treatment group was treated with spinal fine adjustment manipulation,and the course of treatment for both groups was 8 weeks．Clinical efficacy was observed,and the changes of pain Numerical Rating Scale（NRS）,Oswestry disability index（ODI）,lumbar lordosis（LL）,and pelvic incidence（PI）of the two groups were compared between the two groups and within the two groups before and after the treatment. Results The total effective rate was 95.12% in the treatment group and 75.60% in the control group,and the treatment group was superior to the control group（P<0.05）．After treatment,the NRS and ODI of both groups were lower than before treatment,and the treatment group was better than the control group（P<0.05）． After treatment,there was no significant change in LL and PI in both groups compared to pre-treatment．There was no significant difference between the treatment group and the control group（P>0.05）. Conclusions Spinal fine adjustment manipulation can effectively reduce the pain of patients and improve the function of daily activities,but it has no displacement effect on LL and PI,which is safe and suitable for clinical promotion and application．

目的 分析我院羊水栓塞患者的临床资料及诊治经过,总结羊水栓塞致弥散性血管内出血（DIC）患者输血治疗救治经验。方法 回顾性分析2016年1月1日—2022年12月31日在广州医科大学附属第二医院番禺院区分娩并发羊水栓塞患者的症状、实验室辅助检查、用药诊治经过及妊娠结局。结果 在6 104次孕晚期分娩记录中,共发生3例羊水栓塞,高龄产妇1例、经产妇2例、多产1例。3例均并发DIC,产后出血1 500~3 000 mL。其中1例行子宫切除术,2例保留子宫,均抢救成功,无患者死亡。结论 根据有限数据推论羊水栓塞罕见、凶险,病情进展快,多继发产后出血、DIC,主要依靠临床表现进行诊断,早期识别诊断和处理,产科快速反应团队及多学科协作,给予高级生命支持,有效止血并科学地成分输血纠正凝血功能障碍及DIC,是改善孕产妇结局的关键。

Objective To analyze the clinical data,diagnosis and treatment of patients with amniotic fluid embolism in our hospital,and to summarize the experience of blood transfusion treatment for disseminated intravascular coagulation（DIC） patients with amniotic fluid embolism. Methods From January 1,2016 to December 31,2022,the symptoms,laboratory tests,drug treatments and pregnancy outcomes of patients with amniotic fluid embolism during delivery in Panyu Hospital,the Second Affiliated Hospital of Guangzhou Medical University were retrospectively analyzed. Results There were 3 cases of amniotic fluid embolism in 6 104 late pregnancy records,accounting for 1/3 of the elderly parturients,2/3 of the multiparas and 1/3 of the prolific parturients．All three cases had DIC and postpartum hemorrhage of 1 500-3 000 mL．Among them,1 case underwent hysterectomy and 2 cases saved the uterus,all of which were successfully rescued without death. Conclusions Amniotic fluid embolism is rare,dangerous disease with rapid progression,often followed by secondary postpartum hemorrhage and DIC,and mainly relies on clinical manifestations for diagnosis．Early identification,diagnosis and treatment,rapid response team in obstetrics and multidisciplinary collaboration,advanced life support,effective hemostasis and scientific component blood transfusion to correct coagulation dysfunction and DIC,are the keys to improve maternal outcomes．

目的 探讨系统化护理流程干预对脑出血患者急救效果及预后的影响。方法 采用回顾性分析的方法,选取2022年2月—2023年2月新乡医学院第三附属医院急诊收治的210例脑出血患者,将2022年2月—2022年8月采取常规护理干预的105例患者作为常规组,将2022年9月—2023年2月采取系统化护理流程干预的105例患者作为研究组。对比两组患者抢救效率、急救效果、并发症发生率、预后水平、护理满意度情况。结果 研究组患者抢救总时间、会诊至确诊、分诊至会诊、接诊至分诊以及出诊反应时间短于常规组（P<0.05）;研究组急救总有效率高于常规组,并发症发生率低于常规组（P<0.05）;出院1个月、3个月后,两组患者神经功能缺损量表（NIHSS）评分均降低,简易智能状态检查量表（MMSE）评分升高,研究组变化幅度更大（P<0.05）;研究组患者护理满意度高于常规组（P<0.05）。结论 针对脑出血患者在急救过程中采取系统化护理流程干预能够提升患者的抢救效率和急救效果,并发症发生率低,改善患者的神经功能缺损情况,提升预后水平,且患者满意度较高。

Objective To explore the impact of systematic nursing process intervention on the emergency response and prognosis of patients with cerebral hemorrhage．Methods By retrospective analysis,210 patients with cerebral hemorrhage admitted to the emergency department of the Third Affiliated Hospital of Xinxiang Medical College from February 2022 to February 2023,105 patients with routine nursing intervention from February 2022 to August 2022 were selected as the routine group,and 105 patients with systematic nursing process intervention from September 2022 to February 2023 were selected as the study group．The rescue efficiency,first aid effect,complication rate,prognosis levels and nursing satisfaction of the two groups were compared．Results The total rescue time,consultation to diagnosis,triage to consultation,reception to triage and the response time to visit in the study group were significantly lower（P<0.05）．The total emergency response rate of the study group was higher than that of the conventional group,and the incidence of complications was significantly lower（P<0.05）．One month and 3 months after discharge,NIHSS score decreased in both groups,MMSE score increased,and the change range was greater in the study group（P<0.05）．The nursing satisfaction of the study group was significantly higher（P<0.05）．Conclusions For patients with cerebral hemorrhage,systematic nursing process intervention in the first aid process can improve the rescue efficiency and first aid effect of patients,reduce the incidence of complications,improve the neurological function defect of patients,improve the prognosis level,and the patient satisfaction is higher．

目的 探讨以整合照护理念为基础的综合干预体系对稳定性冠心病患者衰弱的影响。方法 选择2021年8月—2022年6月在驻马店市中医院诊治的老年稳定性冠心病患者78例,根据1∶1随机数字表法分为两组,每组各39例。常规组给予常规护理,整合组在常规组护理的基础上给予以整合照护理念为基础的综合干预体系,记录两组患者的预后情况。结果 两组患者在护理3个月后的平衡测试评分、座椅站立测试评分均低于护理前,整合组护理3个月后的平衡测试评分、座椅站立测试评分与常规组相比也降低（P<0.05）。整合组护理3个月后的躯体、心理、社会、精神等维度的生活质量评分均高于常规组（P<0.05）。整合组随访1年的靶血管重建、心肌梗死、心源性死亡、冠状动脉再狭窄等主要心血管事件不良事件发生率为5.13%,常规组为25.64%,整合组低于常规组（P<0.05）。结论 以整合照护理念为基础的综合干预体系能缓解老年稳定性冠心病患者的衰弱状况,改善患者的生活质量,降低主要心血管事件不良事件发生率。

Objective To explore and analyze the effects of a comprehensive intervention based on integrated care on the frailty of elderly stable coronary heart disease（CHD）patients．Methods From August 2021 to June 2022,78 cases of elderly stable CHD patients who were diagnosed and treated in Zhumadian City Hospital of Traditional Chinese Medicine were selected．According to a 1：1 random number table method,78 patients were divided into the integrated group and the traditional group,with 39 cases of each group．The traditional group was given routine care,while the integrated group was given a comprehensive intervention based on integrated care concepts on the basis of the traditional group's care,and the patients' prognosis was recorded．Results The balance test scores and chair stand test scores of both groups after 3 months of nursing care were lower than those before nursing care．The balance test scores and chair stand test scores of the integrated group after 3 months of nursing care were also significantly lower than those of the traditional group（P<0.05）．After 3 months of nursing care,the quality of life scores in physical,psychological,social,and spiritual dimensions in the integrated group were significantly higher than those in the traditional group（P<0.05）．The incidence of major cardiovascular adverse events such as cardiac death,myocardial infarction,target vessel reconstruction,and coronary artery restenosis during a one-year follow-up in the integrated group was 5.13%,compared to 25.64% in the traditional group．The integrated group was significantly lower than the traditional group（P<0.05）．Conclusions The application of a comprehensive intervention based on integrated care concept in elderly stable CHD patients can alleviate frailty,improve quality of life,and reduce the incidence of major cardiovascular adverse events．

目的 分析老年患者腰-硬联合麻醉术中给予不同剂量瑞马唑仑的有效性及安全性。方法 纳入2020年5月—2023年4月在武穴市第一人民医院手术需进行腰-硬联合麻醉的老年患者126例,随机分为低剂量组[42例,术中持续泵注2 μg/（kg·min）瑞马唑仑]、中剂量组[42例,术中持续泵注3 μg/（kg·min）瑞马唑仑]、高剂量组[42例,术中持续泵注4 μg/（kg·min）瑞马唑仑],评估患者麻醉前（T0）、麻醉给药5 min（T1）、15 min（T2）、30 min（T3）时镇静程度并记录生命体征指标,记录患者麻醉起效时间、阻滞完善时间,统计麻醉给药后恶心呕吐、低血压等不良反应发生情况。结果 三组患者T1、T2、T3时Ramsay评分较T0时均升高（P<0.05）,中剂量组、高剂量组T2、T3时Ramsay评分高于低剂量组（P<0.05）,高剂量组T2、T3时Ramsay评分高于中剂量组（P<0.05）,低剂量、中剂量组T2、T3时平均动脉压、心率高于高剂量组（P<0.05）;高剂量组、中剂量组麻醉起效时间、阻滞完善时间均短于低剂量组（P<0.05）;低剂量组、中剂量组低氧血症、低血压等不良反应总发生率低于高剂量组（P<α,α=0.017）。结论 老年患者腰-硬联合麻醉术中给予3 μg/（kg·min）的瑞马唑仑效果较为理想,其镇痛作用优于2 μg/（kg·min）,对生命体征的影响低于4 μg/（kg·min）,不良反应较少,兼顾镇静作用与麻醉安全性。

Objective To analyze the effectiveness and safety of different doses of remimazolam in elderly patients with combined spinal-epidural anesthesia．Methods From May 2020 to April 2023,126 elderly patients who needed combined spinal-epidural anesthesia in Wuxue First People's Hospital were included and randomly divided into low-dose group[42 cases,continuous infusion of 2 μg/（kg·min）reimazolam during operation],medium-dose group[42 cases,continuous infusion of 3 μg/（kg·min）reimazolam during operation],and high-dose group[42 cases,continuous infusion of 4 μg/（kg·min）reimazolam during operation]．The degree of sedation and vital signs were recorded at 5 minutes（T1）,15 minutes（T2）,and 30 minutes（T3）of administration,and the anesthesia effective time and block completion time were recorded,and the incidence of adverse reactions such as nausea,vomiting,and hypotension after anesthesia administration were recorded．Results The Ramsay scores at T1,T2 and T3 of the three groups were significantly higher than those at T0（P<0.05）．The Ramsay scores of the middle-dose group and high-dose group were significantly higher than those of the low-dose group at T2 and T3（P<0.05）．The Ramsay scores of the high-dose group were significantly higher than those of the middle-dose group at T2 and T3（P<0.05）．The mean arterial pressure and heart rate of the low-dose group and the middle-dose group at T2 and T3 were higher than those of the high-dose group（P<0.05）．The effective time of anesthesia and block completion time in the high-dose group and the middle-dose group were significantly shorter than those in the low-dose group（P<0.05）．The total incidences of adverse reactions such as hypoxemia and hypotension in the low-dose group and the middle-dose group were significantly lower than those in the high-dose group（P<α,α=0.017）．Conclusions The effect of 3 μg/（kg·min）remimazolam in elderly patients with spinal-epidural combined anesthesia is ideal,its analgesic effect is better than 2 μg/（kg·min）,the impact on vital signs is less than 4 μg/（kg·min）,with fewer adverse reactions,which is a balance between the sedative effect and the safety of anesthesia．

目的 探讨重复经颅磁刺激应用于帕金森病失眠患者中的效果及对睡眠质量的影响。方法 选取2021年1月—2022年3月南阳南石医院神经内科收治的帕金森病失眠患者100例,按照随机数字表法均分为参照组（n=50）和研究组（n=50）,参照组采用常规西药治疗,研究组在参照组基础上采用重复经颅磁刺激治疗,对比两组治疗效果、神经递质指标水平、帕金森症状表现及睡眠质量评分的差异。结果 研究组治疗总有效率98.00%（49/50）高于参照组82.00%（41/50）,对比差异有统计学意义（P<0.05）。治疗后,研究组神经递质多巴胺及5-羟色胺水平分别为（6.84±0.62）、（22.75±0.59）,均高于参照组,对比差异均有统计学意义（P<0.05）。治疗后,研究组帕金森病症状表现及睡眠质量总评分均低于参照组,对比差异均有统计学意义（P<0.05）。结论 重复经颅磁刺激应用到帕金森病失眠患者的治疗中,能提升疗效,明显改善患者睡眠质量和帕金森病症状。

Objective To investigate the effect of repetitive transcranial magnetic stimulation（rTMS）on Parkinson's insomnia and its influence on sleep quality．Methods A total of 100 Parkinson's patients with insomnia admitted to the Department of Neurology,Nanyang Nanshi Hospital from January 2021 to March 2022 were selected and divided into the reference group（n=50）and the study group（n=50）according to random number table method．The reference group was treated with conventional western medicine,and the study group was treated with rTMS on the basis of the reference group．The levels of neurotransmitters,symptoms of Parkinson's disease and sleep quality were compared．Results The effective rate of the study group was 98.00%（49/50）,which was higher than 82.00%（41/50）of the reference group,with statistical significance（P<0.05）．After treatment,the levels of dopamine and 5-hydroxytryptamine in the study group,（6.84±0.62）and（22.75±0.59）,were higher than those in the reference group,and the comparison was statistically significant（P<0.05）．After treatment,the total score of Parkinson's symptom and sleep quality in the study group were lower than those in the reference group,with statistical significance（P<0.05）．Conclusions The application of rTMS in the treatment of Parkinson's patients with insomnia can improve the curative effect,significantly improve the sleep quality and symptoms of Parkinson's disease,and is worthy of further application and promotion．