目的 分析心力衰竭伴快速心房颤动(简称:心衰伴快速房颤)患者接受胺碘酮急诊抢救治疗的效果及对24 h心室率的影响。方法 将2017年1月—2020年12月急诊接诊且行西地兰治疗的60例心衰伴快速房颤患者作为对照组,将同期急诊接诊且行胺碘酮治疗的60例心衰伴快速房颤患者作为观察组,对组间心功能指标、炎症因子水平、心室率、临床疗效、药物不良反应展开分析。结果 ①组间心功能指标、炎症因子水平在治疗前无差异,P>0.05;观察组心功能指标、炎症因子水平在治疗后优于对照组,P<0.05;②组间心室率在治疗前无差异,P>0.05;观察组治疗后4 h、12 h、24 h心室率均低于对照组,P<0.05;③观察组5例无效(8.33%),对照组14例无效(23.33%),P<0.05;④观察组药物不良反应率(3.33%)与对照组药物不良反应率(5.00%)无差异,P>0.05。结论 在急诊抢救心衰伴快速房颤患者时采用胺碘酮,可以改善患者心功能、炎症反应、心室率,加之无明显不良反应,值得推广。

Objective To analyze the efficacy of emergency treatment with amiodarone and its influence on 24-hour ventricular rate in patients with heart failure and rapid atrial fibrillation. Methods From January 2017 to December 2020, 60 patients with heart failure and rapid atrial fibrillation who received emergency treatment and cedilanide treatment were selected as the control group, and 60 patients with heart failure and rapid atrial fibrillation who received emergency treatment and amiodarone treatment at the same period were selected as the observation group. Results ① There was no significant difference in cardiac function index and inflammatory factors level between the two groups before treatment, P>0.05.The cardiac function index and inflammatory factors level of the observation group were more improved than those of the control group after treatment, P<0.05. ② There was no significant difference in ventricular rate between the two groups before treatment, P>0.05.The ventricular rates of the observation group at 4 h, 12 h and 24 h after treatment were lower than those of the control group, P< 0.05. ③ Treatment for 5 cases (8.33%) in the observation group, 14 cases (23.33%) in the control group were ineffective, P<0.05. ④ There was no significant difference in the adverse drug reaction incidence between the observation group (3.33%) and the control group (5.00%), P>0.05. Conclusion Amiodarone could improve the cardiac function, inflammatory reaction and ventricular rate of patients with heart failure and rapid atrial fibrillation in emergency treatment, and there was no obvious adverse reaction, so it is worthy of promotion.

目的 探讨老年吸入性肺炎的危险因素,建立风险预测模型,以期降低老年吸入性肺炎的发病率。方法 选取2017年8月28日—2020年 10月30日广州市第一人民医院老年病科住院治疗的老年肺炎患者205例,按照是否发生吸入性肺炎分为吸入性肺炎组和非吸入性肺炎组,对比2组患者的各项指标,分析老年吸入性肺炎的危险因素,建立风险预测模型,采用ROC曲线对模型进行预测效果检验。结果 多因素Logistic回归分析结果显示,脑梗塞、帕金森、留置胃管、长期卧床为老年吸入性肺炎的危险因素(P<0.05)。模型公式为Logit(P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀。该模型ROC曲线下面积为0.894。结论 本研究中的模型预测效果良好,可为医护人员预测老年患者发生吸入性肺炎的概率,及时采取相应的预见性护理及干预性治疗。

Objective To explore the risk factors of aspiration pneumonia in the elderly and establish the risk prediction model, in order to reduce the incidence of aspiration pneumonia in the elderly. Methods A total of 205 elderly patients with pneumonia who were hospitalized in the department of geriatrics, Guangzhou First People's Hospital from August 28, 2017 to October 30, 2020, were divided into aspiration pneumonia group and non-aspiration pneumonia group according to whether aspiration pneumonia occurred. The indicators of the two groups of patients were compared, the risk factors of aspiration pneumonia in the elderly were analyzed, the risk prediction model was established, and the prediction effect of the model was tested by receiver operating characteristic curve. Results Multivariate Logistic regression analysis showed that cerebral infarction, Parkinson's disease, indwelling nasogastric tube, and being bedridden were risk factors for aspiration pneumonia in elderly patients (P<0.05). The model formula was Logit (P)=-2.952+1.221X₂+2.417X₃+2.388X₈+1.683X₁₀. The area under receiver operating characteristic curve of this model was 0.894. Conclusion The prediction effect of the model in this study was good, which could predict the probability of aspiration pneumonia in elderly patients for medical staff, and to timely take the corresponding predictive care and interventional treatment.

目的 为初步评估在无创辅助通气基础上进行雾化肺表面活性物质(AS)治疗呼吸窘迫综合征(RDS)早产儿的安全性及效果,开展了此项临床研究。方法 2019年7月—2020年6月,经监护人知情同意,符合入选标准的RDS早产儿,入院后在经鼻间歇正压通气(NIPPV)基础上,通过振动筛网雾化器系统给予100 mg/kg注射用牛肺表面活性剂,雾化完毕继续无创辅助通气。详细观察及记录患儿在雾化初期的生命体征及血气分析结果,记录在雾化治疗期间不良反应发生情况以及患儿病情转归情况。结果 20例患儿参与研究,1例出生后26天死亡,其余均存活出院。5例在AS治疗后3天内无创辅助通气失败。和雾化前比较,AS治疗后1小时患儿血气分析主要指标均改善,血氧饱和度上升,心率下降(P＜0.05),但血压及呼吸机参数无明显变化(P＞0.05)。在雾化过程中,所有患儿无明显不良反应发生。结论 此项临床研究初步显示AS联合无创辅助通气治疗早产儿RDS是安全可行的,但尚需进一步临床研究评估其效果。

Objective To evaluate the safety and efficacy of non-invasive ventilation with aerosolized surfactant (AS) in the treatment of premature infants with respiratory distress syndrome (RDS). Methods From July 2019 to June 2020, in this unblinded Phase I study, the premature infants with RDS who met the criteria with the informed consent of their guardians were enrolled. They were treated with nasal intermittent positive pressure ventilation (NIPPV) and received one dose (100 mg/kg) of aerosolized surfactant by vibrating mesh system (Aeroneb Solo) after hospitalization. The vital signs, adverse reactions and blood gas during areosolizing were recorded and prognosis of them also recorded in detail. Results Twenty infants were enrolled, nineteen completed the study, one died in 26 days. Five infants still required endotracheal intubation and mechanical ventilation after AS treatment. One hour after AS treatment, infants' oxygen saturation and indicators of pulse oximetry improved (P＜0.05), and heart rate decreased (P＜0.05) , but blood pressure and parameters of ventilator had no change (P＞0.05). Infants all tolerated the aerosol treatment well. No other significant adverse events were identified. Conclusion We have demonstrated the feasibility and safety of AS treatment in preterm infants with RDS receiving non-invasive respiratory support. The treatment was well tolerated by infants and clinical caregivers , but still need further study.

目的 探讨臂丛神经阻滞和关节腔内注射局麻药联合应用在肩关节镜手术中的应用价值。方法 对肩关节镜手术患者100例进行研究,2018年8月—2020年8月入组,根据随机数字表法分组处理,对照组和观察组各为50例,前者用臂丛神经阻滞,后者与关节腔内注射局麻药联合,比较2组麻醉效果、不同阶段疼痛程度、肩关节功能。另对比2组不良反应。结果 观察组麻醉起效时间、苏醒时间和拔管时间分别为(10.72±2.45)min、(8.21±1.32)min和(9.52±1.12)min,与对照组对应指标有差异(P<0.05);2组术前疼痛程度和肩关节功能对比无差异(P>0.05),观察组术后6 h、术后24 h和术后48 h疼痛评分依次为(1.31±0.27)分、(2.87±0.52)分和(3.44±0.42)分,术后6 h、术后12 h、术后24 h和术后48 h镇静评分分别为(2.92±0.32)分、(2.54±0.24)分、(2.38±0.12)分和(2.27±0.15)分,术后1周、1个月和3个月的肩关节功能评分分别为(50.12±4.54)分、(56.18±4.12)分和(73.16±4.78)分,较之于对照组有差异(P<0.05);对照组和观察组出现不良反应的概率分别为18.00%和4.00%(P<0.05)。 结论 在肩关节镜手术中联合应用臂丛神经阻滞联合关节腔内注射局麻药麻醉方式,可提高麻醉效果,术后镇痛和镇静效果明显,也可减少不良反应,对患者肩关节功能改善作用明显,存在广泛应用价值。

目的 对比分析电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效。方法 将我院2018年11月—2020年11月间收治的92例胸腺瘤患者作为本次实验案例,根据随机双盲原则进行分组,其中对照组46例患者采用传统开胸手术治疗,观察组46例患者采用电视胸腔镜手术治疗,对于2组患者治疗中的临床疗效进行对比分析。结果 观察组术后的肺功能指标下降幅度小于对照组,且观察组的手术时间、胸管引流时间、下床活动时间、住院时间均短于对照组,出血量、引流量低于对照组,切口长度小于对照组,P＜0.05,组间指标数据存在统计学差异。结论 电视胸腔镜手术与传统开胸手术在胸腺瘤治疗中的临床疗效相比,前者具有明显的优势,创伤小、恢复快、对于患者肺功能的影响更小。

目的 探讨性别、年龄、日剂量、合并用药、药物厂家等因素对使用阿立哌唑患者稳态血药浓度的影响,为临床合理用药提供依据。方法 收集深圳市康宁医院2019年1月—2021年2月使用阿立哌唑住院患者血药浓度监测数据样本229份,包括患者性别、年龄、日剂量、合并用药、药物厂家等基本信息,使用SPSS 25.0统计学软件对数据进行回顾性分析。结果 经多元线性回归分析,本研究仅性别、日剂量能解释阿立哌唑血药浓度的变化。使用阿立哌唑患者血药浓度剂量比值(C/D)女性组高于男性组(P＜0.01),阿立哌唑合用丙戊酸盐组高于无合用组(P＜0.05),年龄、其他合并、药物厂家用药对阿立哌唑(C/D)值的影响无统计学差异。结论 阿立哌唑C/D值与性别有关,合并用药对其有一定影响,不同药物厂家的阿立哌唑C/D值无统计学差异,临床应加强治疗药物监测,根据血药浓度及临床诊疗效果,结合药物经济学因素优化给药方案。

Objective To provide the reference for clinical rational use of aripiprazole,to investigate the effects of gender, age, daily dose, concurrent medication, drug manufacturer and other factors on the steady-state serum concentration in aripiprazole patients. Methods Serum concentration monitoring data of 229 inpatients using aripiprazole in Shenzhen Kangning Hospital from January 2019 to February 2021 was collected, including patients' gender, age, daily dose, concurrent medication, drug manufacturer and other basic information, which were retrospectively analyzed by SPSS 25.0 statistical software. Results In this study, only gender and daily dose could explain the significant changes of aripiprazole serum concentration after multiple linear regression analysis. The serum concentration/dose ratio (C/D) was significantly higher in female patients than in male patients (P＜0.01), and the group of aripiprazole combined with valproate was markedly higher than the non-combined group (P＜0.05). Nevertheless, there were no statistically significant differences in the effects of age, concurrent medication and drug manufacturer on aripiprazole C/D values. Conclusions The C/D value of aripiprazole was closely related to gender, and concurrent medication had a certain effect on it. There was no statistical difference in the aripiprazole C/D value among different drug manufacturers. This study suggested that clinical monitoring of therapeutic drugs should be strengthened, and the prescription should be optimized based on serum concentration and therapeutic efficacy, combined with pharmacoeconomic factors.

目的 探讨术前超声有关指标在预测腹腔镜胆囊切除术(LC)难易度中的价值,以预判LC手术的风险,减少手术的盲目性。方法 257例术前获得的超声参数包括:胆囊大小、胆囊壁厚度、胆囊黏膜面情况、胆囊内胆汁透声情况、胆囊结石最大直径、胆囊颈部结石嵌顿情况。术后资料包括手术时间、术中出血量、是否放置引流管、是否中转进腹手术、术后并发症。计算257例手术的平均时间并将其称为标准手术时间,将超过标准手术时间的、术中出血≥100 mL、术后放置引流管、中转开腹的手术定义为有难度手术。以此标准将257例手术患者分为容易组和困难组,应用χ²检验进行单因素分析,LC手术困难的危险因素;再对这些指标进行Logistic多元回归分析,确定预测LC难易的独立危险因素。结果 单因素分析,术前超声指标:胆囊大小>50 cm²、胆囊壁厚度>4 mm、胆囊结石最大直径>2 cm、胆囊颈部结石嵌顿、胆囊内胆汁透声差,是LC难度的危险因素。Logistic多元回归分析证实,胆囊大小、胆囊壁厚度、胆囊内胆汁透声差、胆囊颈部结石嵌顿等4项超声检测指标是困难LC的独立危险因素。结论 手术前胆囊超声检查可以客观评估LC难度,对指导术者选择LC病例具有一定的预测价值。

Objective To explore the value of preoperative ultrasound indicators in predicting the difficulty of laparoscopic cholecystectomy (LC), in order to predict the risk of LC surgery and reduce the blindness of surgery. Methods The preoperative ultrasonographic parameters of 257 cases included gallbladder size, gallbladder wall thickness, gallbladder mucosal surface, bile sound transmission in gallbladder, maximum diameter of gallstone, and gallstone incarceration in gallbladder neck. Postoperative data included operation time, intraoperative blood loss, whether drainage tube was placed, whether transfer to abdominal surgery, and postoperative complications. The average operation time of the 257 cases was calculated and called the standard operation time, and the operation that exceeded the standard operation time, intraoperative bleeding ≥100 mL, postoperative drainage tube placing, and conversion of abdominal operation were defined as difficult operation. According to this standard, 257 patients were divided into the easy group and the difficult group. The χ² test was used for univariate analysis to identify the risk factors of difficult LC operation. Logistic multiple regression analysis was performed to determine the independent risk factors for predicting LC difficulty. Results According to unifactor analysis, preoperative ultrasound indicators: gallbladder size >50 cm², gallbladder wall thickness >4 mm, maximum diameter of gallstone >2 cm, gallbladder neck stone incarceration, and poor bile ultrasound transmission in gallbladder were risk factors for LC difficulty. Logistic multiple regression analysis confirmed that gallbladder size, gallbladder wall thickness, poor bile ultrasound transmission in gallbladder and stone incarceration in gallbladder neck were independent risk factors for difficult LC. Conclusions Ultrasound examination of gallbladder before operation could objectively evaluate the difficulty of LC, and had certain predictive value for guiding the surgeon to select LC cases.

目的 观察中等强度有氧运动联合力量训练对老年高尿酸血症(HUA)尿酸、身体机能及生活质量影响分析。方法 2019年1月—2019年12月在我社区收治的老年HUA患者60例纳入研究,随机数字表法进行分组,选取其中的30例患者实施常规饮食、运动指导为对照组,另30例患者配合中等强度有氧运动联合力量训练为研究组。比较2组患者对干预的依从性,干预前、后的血尿酸水平,身体机能及生活质量评分(WHOQOL-100评分)。结果 2组患者均在干预期内完成训练,依从性优良率比较,差异无统计学意义(P＞0.05)。干预前2组患者的血尿酸水平、身体机能比较,差异无统计学意义(P＞0.05)。干预后2组患者的血尿酸水平、安静心率较干预前降低,研究组低于对照组,而肺活量则较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。干预前2组患者的WHOQOL-100评分比较,差异无统计学意义(P＞0.05),干预后2组WHOQOL-100各项评分较干预前提升,研究组高于对照组,差异有统计学意义(P＜0.05)。结论 在老年HUA患者的相关指导中,运用中等强度有氧运动联合力量训练的运动干预,可较为明显的降低血清血尿酸水平,降低并平稳安静心率,提升肺活量,提升生活质量,效果理想。

Objective To observe the effect of moderate intensity aerobic exercise combined with strength training on uric acid level, physical function and quality of life in elderly patients with hyperuricemia (HUA). Methods Sixty elderly patients with HUA were treated in our center from January 2019 to December 2019. They were randomly divided into two groups, 30 cases in each group. Among them, 30 cases given routine diet and exercise guidance were included in control group, and the other 30 cases given moderate intensity aerobic exercise combined with strength training on the basis of the control group were included in study group. The compliance, blood uric acid level, physical function and quality of life (WHOQOL-100 scores) before and after the intervention were compared between the two groups. Results Two groups of patients completed the training within the expected time, and there was no significant difference in compliance (P＞0.05). Before the intervention, there were no significant differences in blood uric acid level and physical function between the two groups (P＞0.05). After the intervention, the serum uric acid level and resting heart rate of the two groups were lower than those before the intervention, and those of the research group were even lower than the control group, while the vital capacity was higher than that before the intervention, and the research group was higher than the control group, those differences were significant (P＜0.05). Before the intervention, there was no significant difference in WHOQOL-100 score between the two groups (P＞0.05). After the intervention, the scores of WHOQOL-100 in the two groups were higher than those before the intervention, and that in the study group was higher than the control group (P＜0.05). Conclusions In the relevant guidance of elderly patients with hyperuricemia (HUA), the application of moderate intensity aerobic exercise combined with strength training can significantly lower the serum uric acid level, reduce and stabilize the resting heart rate, improve the vital capacity and quality of life, with ideal effect.

目的 比较甲苯磺酸瑞马唑仑和丙泊酚在超声胃镜检查中的有效性和安全性。方法 采用随机对照的研究方法,选择接受超声胃镜病人60例,分为观察组(29例)和对照组(31例)。观察组采用甲苯磺酸瑞马唑仑麻醉,对照组采用丙泊酚。观察麻醉过程中不同时点的血流动力学指标、改良警觉/镇静(MOAA/S)评分各时刻的变化、苏醒及离室时间、围术期不良事件。结果 观察组的血流动力学影响更小;观察组可进入足够的镇静深度,而对照组的镇静程度更深;2组起效时间相似,且迅速苏醒而离室,但在苏醒及离室时间方面观察组稍短;不良事件对照组高于观察组。结论 甲苯磺酸瑞马唑仑应用于无痛超声胃镜检查,其对血流动力学影响小,能产生足够的镇静深度,能使患者迅速苏醒,且不良事件发生率低,总体有效性和安全性优于丙泊酚。

Objective To compare the efficacy and safety of remimazolam tosilate and propofol in painless ultrasonic gastroscopy. Methods In a randomized, single-blind controlled study, 60 patients undergoing ultrasonic gastroscopy were selected and divided into observation group (31 cases) and control group (29 cases). Observation group was anesthetized with remimazolam tosilate, while control group was anesthetized with propofol. Two groups' hemodynamic index, perioperative adverse events, changes of MOAA/S score, awakening and departure time were observed at different time points during anesthesia. Results The observation group had less changes on hemodynamics. The observation group had enough depth of sedation, while the control group had a deeper degree of sedation. The onset time of the two groups was similar and both awoke quickly and left, but the awakening time and leaving time in the observation group were slightly shorter. Adverse events in the control group were more than those in the observation group. Conclusions Remimazolam tosilate for painless ultrasonic gastroscopy had little effect on hemodynamics, which can generate enough depth of sedation, and make patients wake up quickly. In addition, the incidence of its adverse events was low, and the overall effectiveness and safety were superior to those of propofol.

目的 建立HPLC法测定人血浆中亚胺培南浓度,并基于稳定性试验结果建立临床标本采样流程。方法 以0.01 mol·L^-1乙酸铵缓冲液(pH 6.8)-乙腈(95∶5,V∶V)为流动相,用Agilent Zorbax SB-AQ(4.6 mm×250 mm,5 μm)色谱柱,进样量30 μL,柱温30 ℃,流速1.0 mL·L^-1,紫外检测波长298 nm,分别考察了在不同温度,加入稳定剂等条件下亚胺培南的稳定性。结果 亚胺培南在3.30～105.60 μg·mL^-1线性关系良好(R²=0.999 1),定量下限为0.41 μg·mL^-1,批内回收率在97.83%～103.54%,批间回收率在99.43%～104.24%,日内、日间RSD＜15.0%;在稳定性血浆中,亚胺培南在低温、室温条件下可分别稳定72 h和18 h,在非稳定性血浆中,分别为24 h和6 h。结论 本方法简便、快速、准确,可用于监测亚胺培南浓度,且基于稳定性试验建立临床标本采样流程,能确保血药浓度监测结果准确性。

Objective To determine the concentration of imipenem in human plasma by HPLC method, and establish the sampling process of clinical specimens based on stability investigation result. Methods The mobile phase was consisted of 0.01 mol·L^-1 ammonium acetate buffer(pH 6.8)-acetonitrile(95∶5, V∶V), and using Agilent Zorbax SB-AQ column(4.6 mm×250 mm,5 μm)to investigat the stability of imipenem under different temperature and with or without stabilizer. The injection volume was 30 μL, the colum temperature was 30℃, the flow rate was 1.0 mL·L^-1 and the detection wavelength was 298 nm. Results Imipenem had a good correlation coefficient(R²=0.999 1)at concentration of 3.30-105.60 μg·mL^-1. The lower limit of quantification was 0.41 μg·mL^-1, the intra-batch and inter-batch recovery rate were 97.83%-103.54% and 99.43%-104.24%, the intra-day and inter-day RSD were less than 15.0%. In stabilized plasma, imipenem could maintain stable at low temperature for 72 h and room temperature for 18 h, in non-stabilized plasma for 24 h and 6 h respectively. Conclusions This method was simple, rapid and accurate, which was suitable for the imipenem therapeutic drug monitoring, and establishing the sampling process of clinical specimen based on stability test could ensure the accuracy of plasma concentration monitoring.