老年急性心肌梗塞临床特点

随着人口的老年化,老年急性心肌梗塞(AMI 有逐年增多的趋势,老年人(AMI)与中年人比较有许多不同之处,分析我院10年来202例 AMI 住院患者,60岁以上(老年组)72例,其中男性54例,女性18例,男:女=3:1.与同期60岁以下(非老年组)130例对比,老年人 AMI的临床特点有:1.女性发病率增加,2、症状不典型.主要表现在无疼性及心外型 AMI 多,经临床观察年龄越高症状越不典型,多数以胃痛、晕厥,     

不同性别急性心梗患者的临床特征及院内治疗预后分析

目的:观察首次确诊为急性心肌梗死(AMI)患者的临床特征并分析不同性别人群的在入院治疗及院内短期预后的差异。方法:回顾性分析2010年2月至2012年4月在沈阳军区总医院心内科初次确诊为AMI的患者271例,并按性别分为两组,其中男性组180例,女性组91例,统计其临床特征、入院后的药物和手术治疗情况,以及院内并发症及预后情况,分析总结两组患者各自的特点和差异。结果:女性患者的年龄要大于男性患者(63±14vs71±11,P0.001),且同时更易患有高血压等心血管疾病合并症(73.3%vs 58.2%,P0.05)。女性患者的发病至入院治疗时间长于男性(P0.001),且入院后行PCI治疗的比例要明显低于男性患者(67%vs 79.4%,P0.05)。初步分析结果表明,女性患者的院内死亡率高于男性(11%vs 3.3%,OR:3.11,95%CI:1.53-7.15),但排除不均衡因素的影响后,男女患者的院内死亡率无明显差异(OR:2.11,95%CI:0.68-5.12)。结论:两性AMI患者的临床特征、入院后治疗及院内短期预后均存在一定差异。根据女性患者的临床特征和院内治疗及预后的现状,应进一步加强对女性高危人群的冠心病诊治知识普及和教育,且对入院后的女性患者应采取更为积极的药物和介入手术治疗手段,以改善预后。     

格拉司琼联合隔药灸治疗肝癌介入术后恶心呕吐临床观察

目的:观察格拉司琼联合隔药灸治疗肝癌介入术后恶心呕吐临床疗效。方法:将符合纳入标准的肝癌介入术后恶心呕吐患者72例,分为治疗组与对照组,每组36例,对照组给予注射用盐酸格拉司琼静脉滴注治疗,治疗组在对照组的基础上给予隔药灸治疗。观察两组患者恶心、呕吐症状、胃液引流量及胃管留置时间,统计临床疗效。结果:治疗后治疗组在恶心、呕吐症状评分、胃液引流量、胃管留置时间方面明显均低于对照组(均P0.05)。治疗组、对照组临床疗效总有效率分别为91.67%、72.22%,比较有统计学意义(P0.05)。结论:格拉司琼联合隔药灸可以明显改善肝癌介入术后恶心呕吐症状,缩短胃管留置时间,临床疗效显著。     

不同性别急性心肌梗死合并心衰患者院内治疗及一年随访情况的比较

目的:比较不同性别急性心肌梗死(Acute Myocardial Infarction,AMI)合并心衰患者住院期间院内治疗方式、一年随访用药依从性及心血管不良事件发生情况。方法:收集我院2014年10月至2015年6月收治的136例急性心肌梗死合并心衰患者,分析和比较不同性别患者入院时的临床特征、住院期间治疗方式、一年随访过程中用药依从性以及心血管不良事件发生率的差异。结果:本研究共入组136例急性心肌梗死合并心衰患者,其中男性患者70(51.47%)例,女性66(48.53%)例。男性患者具有吸烟史、饮酒史的比例显著高于女性患者(62.86%vs 28.79%,P=0.001;35.71%vs 10.61%,P=0.001),但具有糖尿病史的比例明显低于女性(35.71%vs 53.03%,P=0.042);男性患者住院期间接受溶栓或经皮冠状动脉介入(Percutaneous Coronary Intervention,PCI)治疗的比例明显高于女性(62.86%vs 45.45%,P=0.042);男性患者一年随访期间出现胸痛、卒中的比例低于女性(11.43%vs 24.24%,P=0.050;2.86%vs 12.12%,P=0.050);但出血事件的发生率高于女性(10.00%vs 0%,P=0.014)。结论:男性急性心肌梗死合并心衰患者住院期间接受溶栓或PCI治疗的比例明显高于女性;一年随访过程中出现胸痛、卒中事件率低于女性,但出血事件的发生率高于女性。     

不稳定型心绞痛患者发病危险因素的性别差异分析

目的:探讨不同性别人群发生不稳定型心绞痛(UAP)的相关危险因素。方法:选择本院住院部收治的138例UAP患者为UAP组及80例同期经冠状动脉造影检查冠脉正常的非CHD者为对照组进行研究,对不同性别UAP患者发病的相关因素进行分析和比较。结果:男性UAP组和男性对照组在吸烟、高血压病史、高密度脂蛋白胆固醇(HDL-C)、半胱氨酸(Hcy)、维生素B12(Vit B12)和叶酸(FA)方面存在显著性差异(P0.05),两组其它指标比较无显著性差异(P0.05);女性UAP组和女性对照组在高血压病史、糖尿病病史、尿酸(UA)、Hcy、VB12和FA方面存在显著性差异(P0.05),两组其它指标比较无显著性差异(P0.05)。Logistic回归分析显示:吸烟、高血压、HDL、Hcy、和Vit B12水平为男性UAP患者发病的独立危险因素(P0.05~0.01);高血压、UA、Hcy、Vit B12和FA水平为女性UAP患者发病的独立危险因素(P0.05)。结论:不同性别人群发生UAP的危险因素不同,血浆Hcy和UA水平为女性UAP的独立危险因素,而血浆Hcy水平为男性UAP的独立危险因素。     

AMI患者院前延误时间分布及心肌梗死后不同时间段的预后分析

目的:分析急性心肌梗死(acute myocardial infarction,AMI)院前延误时间分布及心肌梗死后不同时间段的预后情况。方法:选取AMI患者共208例,分析不同院前延误时间(pre-hospital delay times,PDT)患者的治疗情况、心室纤颤发生率、复苏成功率和死亡率。采用Logistic回归分析,分析影响PDT的相关因素。结果:61 min-120 min溶栓治疗率最高,为87.04%;121 min-240 min PCI/CABG治疗率最高,为20.93%;720min药物治疗率最高,为100%,但无显著差异(P0.05)。其中药物治疗组的PDT为(323.86±23.07)min,显著高于PCI/CABG组(108.69±10.84)min和溶栓组(112.35±15.73)min,(P0.05)。首诊医院、处理方式、感知严重性、夜间发病和PDT具有显著相关性(P0.05)。PDT≤120min组的心室纤颤发生率为12.26%,显著高于PDT12 min组(P0.05)。结论:患者和家属应加强学习AMI相关知识,缩短PDT,尽早诊治,避免因心室纤颤导致的死亡。     

不同性别腰椎间盘突出症患者脊柱-骨盆矢状位参数差异研究

目的:探讨不同性别腰椎间盘突出症(Lumbar disc herniation,LDH)患者脊柱-骨盆矢状位参数差异特点。方法:回顾性分析2014年1月至2016年3月在第四军医大学西京医院脊柱外科因LDH住院手术治疗,且具有术前脊柱站立位全长X线片的患者共222例,其中男l25例,女97例,年龄20-80岁,平均年龄50.97岁;应用图形分析软件Surgimap进行参数测量,在站立位全长脊柱侧位x线片上测量参数包括:骨盆投射角(Pelvic incidence,PI)、骨盆倾斜角(Pelvic tilt,PT)和骶骨倾斜角(Sacral slope,SS),胸椎后凸角(Thoracic Kyphosis,TK)、腰椎前凸角(Lumbarlordosis,LL)、矢状面垂直轴(Sagittal vertical axis,SVA)。根据性别分组,比较不同性别之间各参数、发病累及节段、不同年龄段发病率之间的差异。应用SPSS 19.0对数据进行统计分析。结果:LDH患者男女性别之间比较发现,男性PI 43.82±8.66°,女性PI 47.75±8.50°,P=0.001(P0.05),具有统计学显著性差异,年龄、PT、SS、LL、TK、SVA无显著性差异;不同性别LDH患者所累及节段分别进行统计,P=0.480(P0.05),无统计学显著性差异;不同性别LDH患者不同年龄段的发病率进行统计,应用Pearson卡方检验进行统计分析,P=0.024(P0.05),具有统计学显著性差异。然后将各年龄段发病率通过u检验进行比较,20-40岁段P=0.023(P0.05),具有统计学显著性差异。结论:PI也可能与LDH的发病有关,男性患者PI小于女性患者,可能是在LDH发病中男性多于女性,且男性更早发病的一个重要原因。     

2型糖尿病患者呼吸丙酮影响因素分析

呼出气中的丙酮是糖尿病的潜在生物标志物,本文利用基于光腔衰荡光谱(cavity ringdown spectroscopy,CRDS)技术的呼吸丙酮分析仪对2型糖尿病患者(type 2 diabetic,T2D)呼出气中的丙酮浓度进行定量测量,分析丙酮与患者临床指标的关系,探索影响呼出气中丙酮浓度的因素,以期为糖尿病呼吸丙酮的临床应用提供参考.利用CRDS技术的呼吸丙酮分析仪测量147名T2D患者(81名男性,66名女性,年龄14~83岁)的512个呼出气体样品和52名健康人(30名男性,22名女性,年龄20~48岁)的119个呼出气体样品.对呼出气中的丙酮浓度与相应的血糖(blood glucose,BG)、糖化血红蛋白(glycohemoglobin A1C,A1C)、性别、年龄、身体质量指数(body mass index,BMI)、糖尿病患病年限及气体样本采集状态等指标,进行相关性统计分析并构建丙酮的多元线性回归模型.结果表明,性别、气体样本采集状态、BMI、年龄、A1C及BG等指标影响T2D患者的呼吸丙酮浓度.健康人呼吸丙酮浓度与性别、年龄及BMI无相关关系.T2D患者呼吸丙酮与BG及A1C均有弱相关关系,相关系数分别为0.093和0.1246.男性呼吸丙酮平均体积分数(1.75×10-6)显著性高于女性(1.15×10-6),且男性呼吸丙酮浓度随年龄的升高而降低(R=-0.154).男性呼吸丙酮浓度与BMI呈负相关(R=-0.2),且BMI25的患者呼吸丙酮平均体积分数(1.75×10-6)高于BMI25的患者(1.25×10-6).女性呼吸丙酮浓度与患病年限呈正相关(R=0.17),而男性呈负相关(R=-0.14).男性和女性空腹呼吸丙酮浓度均高于餐后2 h的呼吸丙酮浓度.多元线性回归分析结果表明,影响呼吸丙酮浓度的因素为:性别(β=0.374)、气体样本采集状态(β=-0.289)、A1C(β=0.083)、BG(β=0.002)、BMI(β=-0.046)及年龄(β=-0.009).     

不同性别间颈动脉粥样硬化相关危险因素差异的研究

目的:探讨中年人群中不同性别间颈动脉粥样硬化相关危险因素的差异。方法:将104例中年颈动脉粥样硬化患者作为研究对象,其中男53例,女51例,比较两组体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白(a)[Lp(a)]、空腹血糖(FBG)、血尿酸(UA)、超敏CRP(hs-CRP)的差异。结果:男性组BMI、TG、UA较女性组高,HDL-C、Lp(a)较女性组低,差异有统计学意义(P<0.05)。结论:有些颈动脉粥样硬化相关危险因素在不同性别中年人群中具有差异。     

肺癌发病及骨转移相关因素分析

目的:探讨肺癌发病的可能相关因素。方法:选择87例确诊为肺癌的患者,收集患者的一般资料,临床信息以及诊断和治疗信息,其中伴骨转移者39例。结果:发病年龄平均67.8岁;6例(35.3%)女性患者为吸烟者,58例(97.7%)男性患者有吸烟史。女性吸烟人数及吸烟量增多;咳嗽为最常见的症状;病理组织学男性患者多为鳞癌,女性腺癌多见;Ⅲ和Ⅳ期明显多于Ⅰ期和Ⅱ期。虽然外科手术治疗后可以提高患者生存时间,接受外科手术患者仍较少。骨转移与性别、年龄和放化疗与否无关,与病理类型有关。结论:年龄、吸烟与肺癌发病密切相关,多数患者就诊时为中晚期,多只能接受姑息治疗,早期诊断及其重要。腺癌患者需警惕骨转移。     

非阿片类镇痛复合静脉全麻在鼾症手术患者中的疗效

目的:观察三重措施预防为基础,联合非阿片镇痛药复合静脉全麻在行鼾症手术患者术后恶心呕吐的应用效果。方法:选择择期行鼾症手术男性病人80例,随机分为两组:吸入麻醉组(inhalation group, IHLA组)和静脉麻醉组(intravenous group, TIVA组),每组40例,两组均采用三重措施预防恶心呕吐,IHLA组采用以舒芬太尼为基础复合七氟烷吸入麻醉,TIVA组以氯胺酮和右美托咪定镇痛基础上丙泊酚全凭静脉麻醉。评估两组病人恶心呕吐危险系数,采用李克特量表(Likert scale),记录并分析两组患者术后6~8 h在麻醉后监测治疗室(post anesthesia care unit, PACU)及病房24 h恶心呕吐发生情况及补救用药用量。结果:两组患者一般临床资料、恶心呕吐风险评分、手术时间、术后恢复期补救用药量人数无显著差异(P>0.05);IHLA组在PACU恶心呕吐发生率为39.5%,TIVA组发生率为18.9%,两者相比有显著性差异(P<0.05);IHLA组病房24 h恶心呕吐严重程度高于TIVA组,两组术后需要补救应用抗呕吐药物用量无显著差异(P>0.05)。结论:以三重措施预防为基础,与吸入麻醉相比,非阿片类镇痛药复合静脉麻醉可以减少肥胖病人鼾症手术术后恶心呕吐发生率和严重程度,降低围术期风险,有利于患者早期恢复。     

Symptoms of a first acute myocardial infarction in women and men

Background: Many studies have compared women and men for symptoms of acute myocardial infarction (AMI), but findings have been inconsistent, largely because of varying inclusion criteria, different study populations, and different methods.Objective: The purpose of this study was to analyze gender differences in symptoms in a well-defined, population-based sample of women and men who experienced a first AMI.Methods: Information on symptoms was collected from the medical charts of all patients with a first AMI, aged 25 to 74 years, who had taken part in the INTERGENE (Interplay Between Genetic Susceptibility and Environmental Factors for the Risk of Chronic Diseases) study. INTERGENE was a population-based research program on risk factors for cardiovascular disease. Medical charts were reviewed for each patient to determine the symptoms of AMI, and the prevalence of each symptom was compared according to sex.Results: The study included 225 patients with a first AMI: 52 women and 173 men. Chest pain was the most common symptom, affecting 88.5% (46/52) of the women and 94.8% (164/173) of the men, with no statistically significant difference between the sexes. Women had significantly higher rates of 4 symptoms: nausea (53.8% [28/52] vs 29.5% [51/173]; age-adjusted odds ratio [OR] = 2.78; 95% CI, 1.47–5.25), back pain (42.3% [22/52] vs 14.5% [25/173]; OR = 4.29; 95% CI, 2.14–8.62), dizziness (17.3% [9/52] vs 7.5% [13/173]; OR = 2.60; 95% CI, 1.04–6.50), and palpitations (11.5% [6/52] vs 2.9% [5/173]; OR = 3.99; 95% CI, 1.15–13.84). No significant gender differences were found in the proportions of patients experiencing arm or shoulder pain, diaphoresis, dyspnea, fatigue, neck pain, abdominal pain, vomiting, jaw pain, or syncope/lightheadedness. No significant differences were found in the duration, type, or location of chest pain. The medical charts listed numerically more symptoms in women than in men; 73.1% (38/52) of the women but only 48.0% (83/173) of the men reported >3 symptoms (age-adjusted OR = 3.26; 95% CI, 1.62–6.54).Conclusions: Chest pain is the most common presenting symptom in both women and men with AMI. Nausea, back pain, dizziness, and palpitations were significantly more common in women. Women as a group displayed a greater number of symptoms than did men.     

Association of secreted frizzled-related protein 4 (SFRP4) with type 2 diabetes in patients with stable coronary artery disease

Background

The interplay between the novel adipokine retinol-binding protein-4 (RBP4) and coronary artery disease (CAD) is still obscure. We investigated the relationship between RBP4 levels and the presence and severity of angiographically proven CAD and determined its possible role in acute myocardial infarction (AMI).

Methods

305 individuals with angiographically proven CAD (CAD-patients), were classified into 2 subgroups: 1) acute myocardial infarction (AMI, n = 141), and 2) stable angina (SA, n = 164). Ninety-one age- and sex-matched individuals without CAD, but with at least 2 classical cardiovascular risk factors, served as controls (non-CAD group). RBP4 serum levels were measured at hospital admission and were analyzed in relation to the coronary severity stenosis, assessed by the Gensini-score and the number of coronary narrowed vessels. Other clinical parameters, including insulin levels, HOMA-IR, hsCRP, glycaemic and lipid profile, and left-ventricular ejection fraction were also assessed.

Results

Serum RBP4 levels were significantly elevated in patients with CAD compared to non-CAD patients (39.29  ± 11.72 mg/L vs. 24.83  ± 11.27 mg/L, p < 0.001). We did not observe a significant difference in RBP4 levels between AMI and SA subgroups (p = 0.734). Logistic regression analysis revealed an independent association of CAD presence with serum RBP4 (β = 0.163, p = 0.006), and hsCRP (β = 0.122, p = 0.022) levels, in the whole study group. Among variables, hsCRP (β = 0.220), HDL (β = β0.150), and RBP4 (β = 0.297), correlated in both univariate and multivariate analysis with CAD severity (R² = 0.422, p < 0.001). Similarly, RBP4 concentrations increased with the number of coronary narrowed vessels (p < 0.05).

Conclusion

Patients with CAD, both SA and AMI, showed elevated RBP4 serum levels. Notably, increased RBP4 concentration seemed to independently correlate with CAD severity, but no with AMI.

Trial registration

The ClinicalTrials.gov Identifier is: NCT00636766

     

Hot Flashes and Fatigue Relieved by Metformin

ObjectiveTo describe 3 patients with long-standing hot flashes, excessive sweating, and fatigue whose symptoms were ameliorated with metformin.MethodsIn this case series, we report the findings of laboratory evaluations, including assessments for thyroid, gonadal, adrenal, and pancreatic disorders, in 3 patients referred for endocrine evaluation. A 75-g oral glucose tolerance test with measurement of fasting and postprandial glucose and insulin concentrations was conducted. A trial of metformin, 500 mg twice daily, was initiated in all patients.ResultsEvaluation of factors that are associated with hot flashes and increased sweating did not establish the cause of the patients’ symptoms. The 3 patients had normal glucose tolerance test results and hyperinsulinemia. Metformin therapy markedly relieved the symptoms in all patients.ConclusionsHyperinsulinemia without hypoglycemia may produce a sympathoexcitatory response that manifests as hot flashes and increased sweating. Metformin may have sympathoinhibitory actions that alleviate these symptoms. (Endocr Pract. 2009;15:30-34)     

小儿病毒性腹泻的临床预后及危险因素分析

目的:探讨小儿病毒性腹泻的临床预后及危险因素。方法:纳入病例是2018年1月至2019年12月本院收治的200例小儿病毒性腹泻患者,回顾性分析其临床资料,分析小儿病毒性腹泻的临床特点。根据疾病痊愈情况分组,将128例痊愈患者作为实验组,72例未痊愈患者作为参照组,Logistic分析小儿病毒性腹泻患者疾病痊愈的危险因素。结果:200例患者中,HAstV感染121例,占60.50%;HAD感染36例,占18.00%;HUCV感染15例,占7.50%;HRV感染10例,占5.00%;混合感染18例,占9.00%。HAstV类型病毒性腹泻患者临床症状以呼吸道症状、发热、呕吐为主;HAD类型病毒性腹泻患者临床症状以发热、呕吐为主;HUCV类型病毒性腹泻患者临床症状以呼吸道症状、发热为主;HRV类型病毒性腹泻患者临床症状以发热、呕吐为主;混合感染类型病毒性腹泻患者临床症状以呼吸道症状、发热、呕吐为主。年龄、中枢神经损害、心肌损害、近1 w是否接触过腹泻是小儿病毒性腹泻患者疾病痊愈的危险因素,P0.05。结论:小儿病毒性腹泻不同感染类型,临床症状各不相同。小儿病毒性腹泻患者预后与年龄、中枢神经损害、心肌损害、近1 w是否接触过腹泻有着极为密切的联系,应当引起临床重视与关注。     

Presence and extent of cardiac computed tomography angiography defined coronary artery disease in patients presenting with syncope

Background

In syncope patients, presence of coronary artery disease (CAD) is associated with poor prognosis. However, data concerning CAD prevalence in syncope patients without known cardiovascular disease are lacking. Therefore, the aim of this study was to investigate presence and extent of CAD in syncope patients.

Methods

We included 142 consecutive patients presenting with syncope at the outpatient cardiology clinic who underwent coronary computed tomography (CT) angiography. Syncope type was ascertained by two reviewers, blinded for coronary CT angiography results. Of the patients, 49 had cardiac syncope (arrhythmia or structural cardiopulmonary disease) and 93 had non-cardiac syncope (reflex [neurally-mediated], orthostatic or of unknown cause). Cardiac syncope patients were compared with matched stable chest pain patients regarding age, gender, smoking status, diabetes mellitus type 2 and systolic blood pressure.

Results

Distribution of CAD presence and extent in cardiac and non-cardiac syncope patients was as follows: 72% versus 48% any CAD; 31% versus 26% mild, 8% versus 14% moderate and 33% versus 7% severe CAD.Compared with non-cardiac syncope, patients with cardiac syncope had a significantly higher CAD presence and extent (p = 0.001). Coronary calcium score, segment involvement and stenosis score were also higher in cardiac syncope patients (p-values ≤0.004). Compared to the chest pain control group, patients with cardiac syncope showed a higher, however, non-significant, prevalence of any CAD (72% versus 63%) and severe CAD (33% versus 19%).

Conclusion

Patients with cardiac syncope show a high presence and extent of CAD in contrast to non-cardiac syncope patients. These results suggest that CAD may play an important role in the occurrence of cardiac syncope.

     

SOX方案与FOLFOX4治疗进展期胃癌的临床疗效、毒副作用及生存时间比较研究

目的:探讨SOX方案与FOLFOX4治疗进展期胃癌的临床疗效、毒副作用及生存时间。方法:选取2013年10月到2014年10月期间唐山市人民医院收治的进展期胃癌患者90例作为研究对象,根据随机数字表法将其分为SOX组与FOLFOX4组,两组均为45例。SOX组患者给予奥沙利铂+替吉奥胶囊进行治疗,FOLFOX4组给予奥沙利铂+亚叶酸钙+氟尿嘧啶进行治疗。比较两组患者的疾病缓解率、疾病控制率、毒副反应、1年生存率、2年生存率和3年生存率。结果:两组患者的的疾病缓解率和疾病控制率经统计分析差异均无统计学意义(P0.05)。两组患者红细胞下降、血小板下降、腹泻、外周神经症状、手足综合征、肝功能异常发生率比较差异均无统计学意义(P0.05),FOLFOX4组I-II级白细胞下降、恶心呕吐的发生率高于SOX组(P0.05),两组III-IV级白细胞下降、恶心呕吐的发生率比较差异无统计学意义(P0.05)。两组患者的1年生存率、2年生存率、3年生存率经统计分析差异均无统计学意义(P0.05)。结论:SOX方案与FOLFOX4治疗进展期胃癌的临床疗效相近,且患者的生存时间无明显差异,但SOX方案的白细胞下降、恶心呕吐等毒副反应程度较轻。     

复发性胆源性胰腺炎的临床特征及危险因素分析

目的:研究复发性胆源性胰腺炎(RGP)的临床特征及危险因素。方法:选择从2012年1月至2017年1月在本院接受治疗的80例RGP患者作为观察组,另选同期在本院接受治疗的胆源性胰腺炎(GP)患者86例作为对照组,分析观察组患者的临床特征及两组患者的致病因素,采用Logistic回归分析RGP的危险因素。结果:在RGP患者的临床特征中,复发次数均较多,平均达到(3.21±0.23)次。发病诱因则主要是胆囊结石、胆总管结石及高脂血症;临床症状主要是黄疸、呕吐、恶心、腹痛、腹胀;并发症主要包括胆管炎、胰腺脓肿以及腹水;临床体征主要有出血征象、腹肌紧张、腹部压痛等。观察组的男性、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症、手术治疗的患者致病率分别高于对照组,并且观察组急性生理与慢性健康评分(APACHE-Ⅱ)明显高于对照组,差异均有统计学意义(P0.05)。由多因素Logistic回归分析可知,导致RGP的危险因素有男性、高APACHE-Ⅱ评分、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症以及手术治疗。结论:RGP患者的临床特征具有一定的规律性,其中男性、高APACHE-Ⅱ评分、重度胰腺炎、合并胆总管结石、胆胰管开口狭窄、有高脂血症以及手术治疗是导致RGP发生的危险因素。     

昂丹司琼联合泮托拉唑对宫颈癌同步放化疗所致恶心呕吐的临床疗效

摘要 目的：研究昂丹司琼联合泮托拉唑对宫颈癌同步放化疗所致恶心呕吐的临床疗效。方法：选择2018年1月～2020年1月我院收治的79例宫颈癌患者,均采取同步化疗,将其随机分为两组。对照组在当天化疗前30 min和随后的6 d连续静脉注射昂丹司琼,每次8 mg,1次/d;同时给予地塞米松磷酸钠注射液10 mg,1次/d。观察组在昂丹司琼的基础上静脉注射泮托拉唑,每次40 mg,1次/d,给药的时间与昂丹司琼相同。比较两组宫颈癌患者恶心呕吐的完全缓解率、癌因性疲乏评分和不良反应的发生情况。结果：两组化疗第1、2 d恶心呕吐的完全缓解率比较差异无明显统计学意义(P>0.05),观察组化疗第3、4、5、6 d恶心呕吐的完全缓解率分别为76.92 %、79.49 %、87.18 %、87.18 %,均明显高于对照组(P<0.05);观察组的癌因性疲乏评分为(45.39±7.29)分,明显低于对照组的(67.24±8.36)分(P<0.05);两组的乏力嗜睡、便秘、椎体外系反应、失眠/不安、腹泻、轻度头痛的发生率比较无明显统计学差异(P>0.05)。结论：昂丹司琼联合泮托拉唑对宫颈癌同步放化疗所致恶心呕吐的疗效显著优于单用昂丹司琼治疗,并能明显减轻癌因性疲乏,且安全性高。