摘要:目的:探索丹紅注射液聯合長春西汀對老年血管性癡呆患者智能狀況的改善效果。方法:將116例符合血管性癡呆標準的患者分為對照組和治療組。對照組用血塞通0.4 g,治療組用丹紅注射液20 mL和長春西汀10 mg,10 d為1個療程,6個月共6個療程,其后分別采用中文版簡易智能狀態檢查(MMSE)量表進行積分,用中國修訂韋氏成人量表(WAISRC)進行智力測驗比較。結果:根據WAISRC測驗結果,兩組1年后知識、領悟、算術、相似、數字廣度、詞匯、數字符號、填圖、圖片排列等項目比較,治療組積分明顯高于對照組t=1.98～5.25,Plt;0.05或001),治療組治療前后上述項目自身對照積分亦有顯著提高(t=1.68～4.25,Plt;0.05或0.01)。結論:丹紅注射液聯合長春西汀能有效抑制神經細胞的凋亡,改善腦部供血,減少腦功能的受累.治療血管性癡呆,對老年群體的康復有積極的治療作用。Abstract: Objective:To investigate the curative effect of DanHong injection and Vinpocetine injection in improving intelligence of vascular dementia (VD) patients. Methods: One hundred and sixteen patients with VD were randomly assigned to treat with Danhong at a daily dose of 20 mL and Vinpocetine at a daily dose of 10 mg (treatment group) and Xuesaitong at a daily dose of 0.4 g alone (control group) for 10 day as a course. The duration was six months for 6 courses. To score using the Mini. Mental state examination (MMSE) of Chinese version and WAISRC were conducted after 1 year. Results: At the end of one year, according to WAISRC examination. The scores of knowledge, comprehension, arithmetic, acquaintance, digit span,vocabulary figure,fill the diagram and toy bricks were significantly higher than those of the control group (t=1.985.25 Plt;0.05).Before and after treatment, there was a significant difference in the treatment group (t=1.684.25 Plt;0.05 or 0.01).Conclusion: DanHong injection and Vinpocetine injection are effective to inhibit the apoptosis of nerve cells. and decrease the tiredness of brain function. It has a certain effect in treatment of vascular dementia and plays a good role in the rehabilitation of oldage community
Objective To construct a nomogram model for predicting delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) in emergency departments. Methods All patients with acute carbon monoxide poisoning who visited the Department of Emergency of Zigong Fourth People’s Hospital between June 1st, 2011 and May 31st, 2023 were retrospectively enrolled and randomly divided into a training set and a testing set in a 6∶4 ratio. LASSO regression was used to screen variables in the training set to establish a nomogram model for predicting DEACMP. The discrimination, calibration, and clinical practicality were compared between the nomogram and Glasgow Coma Scale (GCS) in the training and testing sets. Results A total of 475 patients with acute carbon monoxide poisoning were included, of whom 41 patients had DEACMP. Age, GCS and aspartate aminotransferase were selected as risk factors through LASSO regression, and a nomogram model was constructed based on these factors. The areas under the receiver operating characteristic curves for nomogram and GCS to predict DEACMP in the training set were 0.897 [95% confidence interval (CI) (0.829, 0.966)] and 0.877 [95%CI (0.797, 0.957)], respectively; and those for nomogram and GCS to predict DEACMP in the testing set were 0.925 [95%CI (0.865, 0.985)] and 0.858 [95%CI (0.752, 0.965)], respectively. Compared with GCS, the performance of nomogram in the training set (net reclassification index=0.495, P=0.014; integrated discrimination improvement=0.070, P=0.011) and testing set (net reclassification index=0.721, P=0.004; integrated discrimination improvement=0.138, P=0.009) were both positively improved. The calibration of nomogram in the training set and testing set was higher than that of GCS. The decision curves in the training set and testing set showed that the nomogram had better clinical net benefits than GCS. Conclusion The age, GCS and aspartate aminotransferase are risk factors for DEACMP, and the nomogram model established based on these factors has better discrimination, calibration, and clinical practicality compared to GCS.
Objective To develop the short version of the elderly disability assessment scale (EDAS-SF), and to evaluate its validity and reliability. Methods We conducted a face-to-face investigation in five rural communities in Suining and three urban communities in Chengdu city for elderly adults. We consulted gerontologists and rehabilitation physicians through an internet survey. Proper items were selected from the EDAS according to the results from the following statistical methods: critical ration, Cronbach’s α, correlation coefficient and exploratory factor analysis. Based on these work, the EDAS-SF was developed. The Cronbach’s α was used to assess the internal reliability and confirmatory factor analysis (CFA) to assess the construct validity of the EDAS-SF. Results A totally of 916 elderly adults were surveyed, among which, 887 finished the questionnaire, accounting for 96.8%. The mean age of the studied population was 70.8±6.9 years old. Finally, seven items were chosen for the EDAS-SF which included mental function, organ function, communication, activity, self-care, family function, economic and social function. The Cronbach’s α of the scale was 0.836. Except for the " economy and social function” dimension and the " communication” dimension, the Cronbach’s α of other dimensions were higher than 0.8. EDAS-SF was proved to have good internal reliability. In addition, the CFA indicated that the theoretical model of the EDAS-SF was well fit to the data of the checking sample, which meant EDAS-SF had good construct validity. Conclusion The current study develops the short version of elderly disability assessment scale. The internal reliability and construct validity of the EDAS-SF are good.
目的 了解5.12汶川大地震24個月后震區小學生的心理健康狀況，為進行震后長期心理危機干預提供依據。 方法 于2010年5月即汶川大地震發生后24個月，分別使用創傷應激量表兒童版（CRIES-13）、兒童抑郁障礙自評量表（DSRSC）、長處與困難問卷（SDQ）學生版，調查了553名來自于彭州災區的小學生的心理健康狀況及其影響因素。 結果 ① 災區小學生CRIES-13總分為（22.98 ± 12.29）分，其中大于劃界分（30分）者為143人，占總人數的25.9%；女性總分高于男性（Z=?2.031，P=0.042）；震后被轉移至安全地點的時間越長（OR=1.025，P=0.012）、家人傷亡越嚴重（OR=1.141，P=0.021），其CRIES-13總分大于劃界分的可能性越高。② 災區小學生DSRSC總分為（11.07 ± 5.78）分，其中總分大于劃界分（15分）者為120人，占總人數的21.7%；女性總分高于男性（Z=?2.508，P=0.012）；災區小學生的年齡（r=0.098，P=0.021）、震后被轉移至安全地點的時間（r=0.117，P=0.004）與DSRSC總分呈正相關。③ 災區小學生SDQ總困難因子得分為（14.97 ± 5.44）分，62.9%的人報告自身存在主觀困難；女性的情緒因子、親社會因子得分高于男性（Z=?3.123，P=0.002；Z=?2.243，P=0.025）；年齡越大，品行因子（χ2=7.604，P=0.023）、親社會因子（χ2=8.102；P=0.017）得分增加。 結論 震后災區小學生的心理健康狀況受到性別、年齡、震后被轉移至安全地點的時間、家人傷亡程度的影響，震后長期心理危機干預應綜合考慮這些相關因素以確定高危人群。
ObjectiveTo evaluate the effect of early preoperative mobilization on the rehabilitation of the elderly patients with hip fractures after operation.MethodsThe clinical data of 16 elderly patients with hip fractures between February 2017 and April 2018 who met the selection criteria was retrospectively analyzed. There were 8 males and 8 females, with an average age of 80.3 years (range, 69-90 years). There were 8 cases of intertrochanteric fracture and 8 cases of femoral neck fracture. The preoperative American Society of Anesthesiologists (ASA) scored 2.94±0.43. There were 3 cases of cardiovascular and cerebrovascular diseases, 6 cases of essential hypertension, 5 cases of respiratory diseases, 3 cases of diabetes, and 2 cases of other system diseases. The time from injury to admission was 4 hours to 14 days with an average of 39.5 hours. On the day of admission or on the first day after admission, the patient started to exercise on the floor underwent analgesia treatment. And the patients were treated with closed reduction (9 cases) or artificial hip arthroplasty (7 cases). The time from admission to operation was 4 to 25 days, with an average of 7.4 days. At the time of admission, after the first ground movement before operation, on the second day after operation, and at last follow-up, the Barthel Index was used to assess the patients’ self-care ability, and Barthel effectiveness (BE) was calculated. The complications were observed and recorded during follow-up.ResultsAll 16 patients underwent operation successfully. The hospital stay was 8 to 24 days, with an average of 14.1 days. All patients were followed up 2.5-16.0 months with an average of 6.5 months. One patient developed postoperative pulmonary infection; the remaining patients had no surgical-related complications. No patient died during the follow-up. The Barthel Index scored 30.63±5.56 at admission, 53.13±9.50 after the first ground movement before operation, 60.63±6.09 on the second day after operation, and 96.25±4.84 at last follow-up. There were significant differences in Barthel Index scores between different time points (P<0.05). The BE was 0.23±0.06 after the first ground movement before operation, 0.30±0.04 on the second day after operation, and 0.66±0.06 at last follow-up. There were significant differences in BE between different time points (P<0.05).ConclusionFor elderly patients with hip fractures who have long waiting time before operation, early preoperative mobilization has a positive impact on patients’ activities of daily living.
Objective To investigate the changes of cognitive function of epileptic patients after antiepileptic drugs (AEDs) therapy. Methods Twenty eight cases of epileptic patients with new diagnosis and untreatment from March 2015 to February 2016 were collected. According to the seizure type, degree of attack and drug efficacy, patients were divided into three groups and treated with one of three AEDs, including Lamotrigine (LTG), Oxcarbazepine (OXC), and Sodium valproate (VPA). Among them, 11 were LTG group, 12 were OXC group and 5 were VPA group.Then the patients were followed up for 1 year. The clinical memory scale was used to analyze cognitive function of epileptic patients before and after therapy. Results Compared to 30 cases of healthy volunteers, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05) and image free recall (P<0.01) of epileptic patients were obviously decreased before AEDs therapy.AEDs therapy reduced or controlled seizures in new diagnostic epileptic patients, and the total effective rate was 85.7%. In the clinical memory scale tests, the scores of memory quotient (P<0.01), directed memory (P<0.05), associative learning (P<0.05), portrait characteristics contact memory (P<0.05) were improved after therapy. The scores of image free recall and meaningless graphics recognition were also improved, but there was no statistical significance. Besides, there was a statistically significant improvement in the score of portrait characteristics contact memory after LTG treatment (P<0.05), and directed memory after VPA treatment (P<0.05). Conclusions Epileptic patients accompanied with cognitive deficits before drug intervention. Through standard AEDs treatment, seizures could be better controlled. The cognitive function of epileptic patients was not declined after short-term（within 1 year） intervention of LTG, OCX or VPA. Moreover some parts of the cognitive domain could be improved.
ObjectiveBased on the localization of resource-based relative value scale (RBRVS) in H Hospital, to implement a surgical performance management model reform with the main surgery as the core, and to construct a more scientific and fair surgical performance distribution system. MethodsA surgical performance management model with the main surgery as the core was constructed. Relevant data such as RBRVS, diagnosis related groups (DRG), case mixed index (CMI), and surgical time of 65 915 inpatient elective surgeries in H Hospital in 2023 were collected and organized. Large sample historical data analysis was conducted using SPSS software, and the rationality of the optimized surgical performance management model was verified through key indicators. ResultsThe total coefficient of multiple orders for surgery in the 22 departments included in the study was highly correlated with the main surgery coefficient (γ>0.85), and the matching coefficients for each specialty were significantly different (P<0.001). The surgical performance management model with the main surgery as the core showed a significant improvement in the key indicators (doctor’s time resource investment and surgical risk and difficulty). ConclusionBy implementing a surgical performance management model with the main surgery as the core, we aim to strengthen the performance orientation that reflects the risks and difficulty of diagnosis and treatment, as well as the value of doctor services. This will guide clinical practice to return to the essence of medicine, support the development of discipline construction, and further stimulate the vitality and motivation of clinical work.
【摘要】 目的 研究全身麻醉腹部手術患者術前焦慮對術后疼痛、鎮痛藥用量及對術后鎮痛滿意度的影響。 方法 選取2009年8月-2010年4月68例ASAⅠ～Ⅱ級，擬行氣管插管全身麻醉的腹部手術患者，術前采用狀態-特質焦慮量表和抑郁評分量表進行焦慮程度的測評，術后觀察VAS疼痛評分、總的鎮痛藥用量以及患者對鎮痛的滿意度，分析術前焦慮與術后VAS評分、鎮痛藥用量及鎮痛滿意度的相關性。 結果 68例受試者術前STAI為50±13，BDI為16±13，術后VAS評分為4.0±2.1，術后24 h鎮痛藥芬太尼的用量為（0.80±0.21） mg；術后鎮痛藥用量、患者鎮痛滿意度評分與術前STAI明顯相關（r=0.68和r=-0.88，Plt;0.01）。術后VAS評分與術前STAI及BDI也有一定的相關（r=0.35和r=0.3）。 結論 術前焦慮程度可以影響腹部手術患者對鎮痛治療的滿意度， 顯著增加鎮痛藥用量。【Abstract】 Objective To investigate the effect of preoperative anxiety on postoperative pain, amount of analgesics and satisfaction of postoperative pain relief for patients undergoing abdominal surgery with general anesthesia. Methods A total of 68 patients undergoing abdominal surgery with general anesthesia from August 2009 to April 2010 were selected (ASA I-II). Preoperational anxiety levels were evaluated using State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory (BDI) and postoperative VAS pain score, the total amount of analgesics used and satisfaction of pain relief were observed. The relationship between preoperative anxiety and post-operative VAS score, and total amount of analgesics used and satisfaction of pain relief were analyzed. Results The mean STAI and BDI of 68 samples were 50±13 and 16±13, respectively; the mean postoperative VAS was 4.0±2.1, and the mean amount of analgesics fentanyl used in 24 hours after the operation was (0.80±0.21) mg; the amount of post-operative analgesics used and the satisfaction of pain relief of the patients were found to be highly related to pre-operative STAI (r=0.68, -0.88; Plt;0.01). Post-operative VAS score was also related to preoperational STAI and BDI (r=0.35, 0.3). Conclusion Preoperative anxiety is closely related to the postoperative analgesics and satisfaction of pain relief for patients who had abdominal operation. Severe preoperative anxiety can significantly increase the amount of postoperative analgesics used and dissatisfaction of pain relief.