摘要:目的: 观察格列美脲对2型糖尿病患者心血管的保护作用并探讨其可能的机制。 方法 :112例T2DM患者随机分为格列美脲组(格列美脲+二甲双胍)和对照组(格列本脲+二甲双胍),观察治疗前后两者空腹及餐后两小时血糖(FBG,2hPBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、HOMA模型胰岛素抵抗指数(HOMAIR)、甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、同型半胱氨酸(HCY)、血浆脂联素的变化。 结果 :两组患者的TC、LDLC、TG、FBG、2hPBG都较治疗前降低,连续服用6个月以上格列美脲的T2DM患者其血浆HCY、HOMAIR、血糖水平明显下降,血浆脂联素水平明显升高,与对照组相比差异有统计学意义(〖WTBX〗P lt;005)。 结论 :格列美脲能降低多项心血管危险因子水平,对血脂、HCY和动脉粥样硬化都有良性调节作用,其作用基础可能与改善胰岛素抵抗,增加血浆脂联素相关。Abstract: Objective: To observe the protective effects and to explore mechanisms of glimepiride on cardiovascular system of Type 2 Diabetes Mellitus. Methods : 112 patients with type 2 diabetes mellitus were randomly divided into treatment group (glimepiride combined with metformin) and control group (glibenclamide combined with metformin). The fasting blood glucose (FBG), 2hPBG, hemoglobin A1c (HbA1c), FINS, HOMAIR, blood lipid (TC, TG, LDLC and HDLC), HCY (homocysteine) and adiponectin were detected before and after treatment. Results : In all cases, the level of TC、LDLC、TG、FBG、2hPBG were decreased after treated with glimepiride or glibenclamide combined with metformin for 6 monthes. Moreover, the level of HCY, HOMAIR and blood glucose were decreased and the level of adiponectin was increased significantly than that of in control group (Plt;005). Conclusion : Glimepiride showed the effective on decreasing the risk factor of cardiovascular system disease with regulation of blood lipid, HCY, and improve the atherosclerosis. The effective of glimepiride on cardiovascular system was relation to improved the insulin resistance and increase the adiponectin.
ObjectiveTo summarize the research progress of ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) in normal-sized lymph node metastasis of colorectal cancer.MethodThe relevant literatures published recently at domestic and abroad about USPIO enhanced MRI in normal-sized lymph node metastasis of colorectal cancer were collected and reviewed.ResultsUSPIO, a kind of lymph node targeted magnetic resonance contrast agent, could be used to evaluate lymph node metastasis of malignant tumors. USPIO enhanced MRI could detect normal-sized lymph node metastasis in colorectal cancer effectively compared with normal MRI. It provided a higher diagnostic performance than normal enhanced MRI. In addition, USPIO enhanced MRI could also distinguish inflammatory and metastatic lymph nodes better that were difficult to be distinguished by normal enhanced MRI.ConclusionUSPIO enhanced MRI shows a certain potential for clinical application in detecting normal-sized lymph node metastasis of colorectal cancer, but it has not been widely used in China.
Objectives We aimed to assess the methodological qual ity of RCT on acupuncture for migraine prophylaxis. Methods With the searching terms including acupuncture, migraine, prophylaxis and prevent, etc, the database of the Cochrane Library (Issue 4, 2007), MEDLINE (1966-2007), EMBase (1966-2007), CBM (1978-2007) and CMCC (1994-2007) were searched from their date of start publ ication. Chinese medical journals and relevant academic conference proceedings were hand searched as well. Several items in included trials were assessed, including methodology, diagnostic criteria, inclusion/exclusion criteria, acupuncture/control interventions, outcome measures and follow-up, etc. Result Among the 12 included trials, 9 trials overseas were high-qual ity and 3 in China were low-quality. Frequency or days of migraine attacks and SF-36/SF-12 were often evaluated as outcome measures in western countries, while headache index was used in China. Among the 12 trials, 9 reported the follow-up outcomes and 8 mentioned adverse events. Conclusion There was no high qual ity trial on acupuncture for migraine prophylaxis in China. The outcome measures in trials published in China by now can not evaluate the outcomes of acupuncture for migraine prophylaxis accurately. To study designs, advantages of trials oversea can be used for reference. To Chinese cl inical physicians, prophylactic therapy and abortive therapy of migraine should be distinguished in order to design high-qual ity study on acupuncture for migraine prophylaxis.
摘要:目的: 探讨非体外循环冠状动脉旁路移植术(offpump coronary artery bypass grafting,OPCABG)患者的围术期管理。 方法 : 回顾分析2005 年7 月至2008 年6 月的200 例择期非体外循环下冠状动脉旁路移植术患者200例,诱导用咪唑安定005～01 mg/kg,依托咪酯03 mg/kg,芬太尼5～15 μg／kg,罗库溴铵05～10 mg／kg,麻醉维持采用持续泵注异丙酚1～4 mg/kg·h,,间断辅以05%～20%异氟烷吸入,术中随手术操作时出现的血流动力学变化,用血管活性药物调整。 结果 : 麻醉效果满意,术中血压心率基本满意。本组患者苏醒时间,拔管时间和ICU停留时间为(178±42) min、(105±40)h、(18±63)h。术毕180例患者在12 h内拔管。180例预后良好,无麻醉并发症。 结论 :非体外循环下冠状动脉旁路移植术麻醉管理的关键是合理的应用麻醉药和血管活性药来维持血流动力学平稳。Abstract: Objective: To summarize the technique and evaluate the effect of anesthesia for offpump coronary artery bypass surgery (OPCAB). Methods :From July of 2005 through June of 2008,two hundred consecutive patients undergoing OPCAB were retrospectively studied. Anesthesia was induced with midazolam 00501mg/kg, or etomidate 03mg/kg and fentanyl 515μg/kg. Anesthesia was maintained with isoflurane 05%20% and oxygen, combined with propofol 14mg/(kg·h). Intraoperative hypotension resulting from either surgical procedure or anesthetics should be dealt with inotropes immediately. Results :Intraoperative hemodynamics deviation was tolerated with the support of inotropics. The mean of patients of consciousness recovery time, tracheal extubation time and stay in ICU time were 178±42 min,105±40 hours and 18±63 hours. The patients were discharged in 80±12 days. Racheal intubation were remained 12 hours in 180 patients after operation, 180 patients had good recovery without any anesthesia complications. Conclusion : Rational use of anesthetics and inotropics to stabilize hemodynamics during operation plays a key role in successful OPCAB.
ObjectiveTo investigate the application value and research progress of PST technique in preventing anastomotic leakage after rectal cancer surgery. MethodThe related literatures at home and abroad in recent years about the application of left colon artery preservation, suture of anastomotic stoma and closure of pelvic floor peritoneum, and indwelling anal canal （PST technology for short） in rectal cancer surgery were searched and summarized. ResultsPST technology could prevent anastomotic leakage after rectal cancer surgery from many angles, reduce infection and inflammation, promote postoperative rehabilitation and improve the quality of life of patients, and it is simple and easy to do. The great advantages of PST technology are gradually verified and recognized in clinic. ConclusionPST is a safe and feasible method to prevent anastomotic leakage and relieve the symptoms of anastomotic leakage.
Objective To observe the effectiveness of prevention and management of venous thromboembolism (VTE) in the day surgery wards, analyze the influencing factors of VTE occurrence in postoperative patients, in order to reduce the occurrence of VTE adverse events, improve the utilization of medical resources, and enhance the quality of day care. Methods The patient data of the Daytime Diagnosis and Treatment Center of Deyang People’s Hospital between January 2020 and December 2023 were retrospectively selected. According to the implementation time of VTE prevention and control in the day surgery wards, patients between 2022 and 2023 were selected as the observation group, and patients between 2020 and 2021 were selected as the control group. The incidence and the influencing factors of postoperative of VTE were compared between the two groups. Results A total of 2 300 patients were included, with 1 150 cases in each group. The comparison of in-hospital [12 cases (1.0%) vs. 3 cases (0.3%)] and post discharge [7 cases (0.6%) vs. 1 case (0.1%)] VTE incidence rates between the control group and the observation group showed statistically significant differences (P＜0.05). Among the 9 specialties in the Daytime Diagnosis and Treatment Center, the incidence of VTE in thoracic surgery (1.58%), vascular surgery (1.51%), and hepatobiliary surgery (1.29%) ranked among the top 3. The results of multiple logistic regression analysis showed that fourth grade surgery, lower limb surgery, and large intraoperative bleeding (>100 mL) were the influencing factors for postoperative VTE (P<0.05). Conclusions There are many reasons for VTE occurrence, and it is necessary to prevent and treat VTE in the day surgery ward. More attention should be paid to the patient’s surgical grading, intraoperative bleeding volume, and surgical site.
Objective To investigate the evaluation value of serum interleukin-34 (IL-34), macrophage migration inhibitor (MIF), osteopontin (OPN) and hypersensitive C-reactive protein (hs-CRP) in the diagnosis and prognosis of active pulmonary tuberculosis. Methods Clinical data of 100 patients with active pulmonary tuberculosis admitted from June 2019 to June 2022 were selected as an observation group and retrospectively analyzed. All patients received standardized anti-tuberculosis therapy for 6 months and were divided into a good prognosis group (76 cases) and a poor prognosis group (24 cases) according to the prognosis. Another 80 healthy volunteers who underwent physical examination during the same period were selected as the control group. Serum levels of IL-34, MIF, OPN and hs-CRP were detected in each group, and the value of serum IL-34, MIF, OPN and hs-CRP in the diagnosis and prognosis of active pulmonary tuberculosis was analyzed by receiver operating characteristic curve (ROC curve). Results Serum levels of IL-34, MIF, OPN and hs-CRP in the observation group were higher than those in the control group (all P<0.05). ROC curve showed that serum IL-34, MIF, OPN, hs-CRP had a certain diagnostic value in active pulmonary tuberculosis, with area under ROC curve (AUC) of 0.864, 0.870, 0.865, and 0.880, respectively (all P<0.01), and the combination of the four indexes had a higher diagnostic value (AUC=0.902, P<0.01). Serum levels of IL-34, MIF, OPN and hs-CRP in the good prognosis group were lower than those in the poor prognosis group (all P<0.05). ROC curve showed that serum IL-34, MIF, OPN, hs-CRP had a certain value in evaluating the prognosis of active pulmonary tuberculosis, with AUC of 0.850, 0.874, 0.837, and 0.842, respectively (all P<0.01), and the combined value of the four indexes was higher (AUC=0.923, P<0.01). Conclusion The combined detection of serum IL-34, MIF, OPN and hs-CRP has high value in the diagnosis and prognosis assessment of active pulmonary tuberculosis.
ObjectiveTo explore the effectiveness of traditional Chinese medicine (TCM) acupuncture analgesia after laparoscopic total extraperitoneal inguinal hernia repair (TEP), aiming to reduce the use of analgesics post-surgery. MethodsPatients who underwent unilateral TEP in the Department of Hernia and Abdominal Wall Surgery at our hospital from May 2022 to May 2023 were selected as research subjects. Those who met the inclusion and exclusion criterias were randomly assigned to three groups: TCM acupuncture analgesia group, traditional Chinese medicine acupuncture analgesia plus western medicine analgesia group (referred to as Chinese and western medicine analgesia group), and western medicine analgesia group. The basic information, postoperative numerical rating scale (NRS) pain scores, postoperative recovery indicators, and complication rates of the three groups were analyzed and compared.ResultsThere was no statistically significant differences in the basic data of patients across the three groups (P>0.05). There were significant differences in NRS score, recovery time of intestinal function, first urination time after operation and first ambulation time after operation at each time point after analgesia (6 h, the next morning, 48 h, 72 h and 96 h after operation) among the three groups (P<0.05). The NRS scores in both the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group were lower than those in the western medicine analgesia group (P<0.05), Additionally, postoperative recovery outcomes were better in the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group compared with the western medicine group (P<0.05). There was no significant difference of the above results compared between the TCM acupuncture analgesia group and the Chinese and western medicine analgesia group (P>0.05). There was no significant difference in postoperative complications among the three groups (P>0.05). ConclusionTCM acupuncture analgesia following TEP surgery is effective and leads to improved postoperative recovery compared with the use of oral analgesics alone, without an increase in adverse reactions.
Objective To analyze risk factors of acute kidney injury （AKI） after cardiac surgery in adults and develop a clinical score system to predict postoperative AKI. Methods Clinical data of 3 500 consecutive patients undergoing cardiac surgery from June 2010 to April 2011 in Beijing Anzhen Hospital of Capital Medical University were retrospectively analyzed. According to whether they had postoperative AKI，all these patients were divided into AKI group and non-AKI group. AKI group was consisted of 1 407 patients （40.2%） with a mean age of 58±12 years，including 1 004 male patients （71.4%）. The non-AKI group was consisted of 2 093 patients （59.8%） with a mean age of 55±13 years，including 1 259 male patients （60.2%）. Predictive score system of postoperative AKI was established by univariate analysis between the AKI and non-AKI group and multivariate logistic regression and then verified. Results The predictive score system was as followed：male gender （2 points），every 5 years older than 60 years （1 point），diabetes mellitus （2 points），preoperative use of angiotensin converting enzyme inhibitor or angiotensin AT1 receptor blocker （1 point），every 10 ml / （min·1.73 m2） of preoperative estimated glomerular filtration rate （eGFR） under 90 ml / （min·1.73m2） （1 point），preoperative NYHA class Ⅳ （3 points），cardiopulmonary bypass time＞120 minutes （2 points），intraoperative hypotension duration＞60 minutes （2 points），postoperative hypotension duration＞60 minutes （3 points），postoperative peak dosage of intravenous furosemide＞100 mg/day （3 points），postoperative peak dosage of intravenous furosemide 60-100 mg/day （2 points），and postoperative mechanical ventilation time＞24 hours （2 points）. The predictive score system presented a good discrimination ability with the area under the receiver operating characteristic（ROC）curve of 0.738 with 95% CI 0.707 to 0.768，while it also presented a good calibration with Hosmer-Lemeshow statistic （P=0.305）. Conclusion A clinical predictive score system for AKI after cardiac surgery in adults is established，which may help clinicians implement early preventive interventions.
Abstract： Objective To summarize early clinical result of total cavopulmonary connection, and analyze the risk factors contributing to prolonged postoperative recovery. Methods Between February 2009 and August 2010, 58 patients with functional univentricular complex congenital heart disease received total cavopulmonary connection in Beijing Fu Wai Hospital. All of them were diagnosed by echocardiogram and angiography including 26 patients with single ventricle, 10 patients with tricuspid atresia, 4 patients with pulmonary artery atresia, 5 patients with double outlet rightventricle, 1 patient with transposition of great arteries, and 12 patients with corrected transposition of the great arteries.Fifty seven patients underwent extracardiac conduit total cavopulmonary connection, and only one patient underwent total cavopulmonary connection with an intracardiac lateral tunnel. According to their postoperative pleural drainage volume and duration, these 58 patients were divided into a large pleural drainage volume group (17 patients with 10 males and 7 females, mean age of 8.61±6.73 years）that included patients with large volume and long duration of pleural drainage, and a little pleural drainage volume group (41 patients with 15 males and 26 females, mean age of 7.21±4.24 years) . A univariable analysis was conducted to compare the risk factors that effected recovery result between the two groups. Results There was no death in hospital period. The average length of hospital stay was 12.30±9.80 d . Average drainage time (18.00±5.50 d versus 5.00±2.20 d , t= -1.967, P ＜ 0.05）, drainage volume (12.30±2.60 ml/(kg·d) versus 2.80±1.70 ml/(kg·d), t=-3.221, P ＜ 0.05), and hospital stay (20.10±7.20 d versus 7.20±1.10 d, t=-2.003, P ＜ 0.05） of the large pleural drainage volume group were significantly larger or longer than those of the little pleural drainage volume group. Univariate analysis showed that preoperative pulmonary pressure measured by catheter in the large pleural drainage volume group was significantly higher than that in the little pleural drainage volume group (17.42±5.34 mm Hg versus 13.91±5.22 mm Hg，t=-2.073，P ＜ 0.05). Conclusions The mortality and major morbidities after total cavopulmonary connection are low in the current era. Preoperative high pulmonary pressure is a risk factor for large amount of pleural drainage and prolonged recovery.