【摘要】目的探讨子宫内膜异位症患者子宫内膜组织中巨噬细胞移动抑制因子(macrophage migration inhibitory factor,MMIF)表达的临床意义。方法2007年10月2008年10月应用免疫组化法检测MMIF在82例子宫内膜异位症患者的异位内膜组织、正常位置内膜组织和58例非子宫内膜异位症患者(对照组)正常位置子宫内膜组织的表达。结果①子宫内膜异位症患者在4个不同分期的异位内膜组织中MMIF的表达均明显高于其正常位置内膜组织(Plt;005);②子宫内膜异位症患者不同内膜组织中MMIF的表达较对照组明显增高;③随着分期的增加,MMIF在异位内膜组织中及其正常位置内膜组织中表达均逐渐上调,但只有Ⅳ期与Ⅰ期内膜组织的MMIF表达差异具有统计学意义(Plt;005)。结论MMIF与子宫内膜异位症的发生、发展密切相关。
目的:探讨保留肛门外括约肌低位直肠癌保肛手术的应用。方法: 在全直肠系膜切除的基础上,应用国产一次性管状吻合器,对32例低位直肠癌行保留肛门外括约肌超低位结肛吻合,随访12～36个月。回顾性分析其根治性、术后排便功能、手术并发症、局部复发率。结果: 全组病例术后病理检查无切端癌残留,无大便失禁,无吻合口漏;全组无手术死亡;肿瘤局部复发率9.4%(3/32)。结论: 低位直肠癌保留肛门外括约肌保肛手术,遵循肿瘤根治的原则下,能保留患者正常的肛门排便功能,明显改善该类患者的生活质量。
Objective To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction (AMI). Methods Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis. Results Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02). Conclusion Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.
ObjectiveTo compare the clinical effect of day surgery mode and inpatient operation mode for intertrochanteric fracture in elderly patients.MethodsThirty-seven elderly patients with intertrochanteric fracture treated in day surgery mode in the Second Hospital of Shanxi Medical University from July 2018 to July 2019 were retrospectively included. At the same time, another 37 elderly patients with intertrochanteric fracture treated in general inpatient operation mode in the same period were randomly selected. The preoperative waiting time, operation time, length of hospital stay, hospital expenses, postoperative complications, and clinical effect were compared between the two groups.ResultsThere was no significant difference in operation time [(56.21±10.75) vs. (58.81±12.56) min] or postoperative Harris hip scores (1 month after surgery: 61.03±7.74 vs. 59.47±7.42; 3 months after surgery: 85.40±4.22 vs. 85.03±4.33) between the two groups (P>0.05). In terms of the preoperative waiting time [(23.17±3.18) vs. (52.64±10.12) h], length of hospital stay [(2.01±0.97) vs. (8.34±4.22) d], hospital expenses [(4.012±0.771)×104 vs. (4.679±1.117)×104 yuan], and the incidence of deep venous thrombosis during perioperative period (10.8% vs.37.8%), the day surgery mode group had more obvious advantages than general inpatient operation mode group (P<0.05).ConclusionsDay surgery mode is safe and effective for intertrochanteric fracture in elderly patients. It is worthy of great application for clinical work in the future.
ObjectiveTo explore the application of clinical pathway in patients undergoing orthopedic day surgery.MethodsPatients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2020 were selected as the clinical pathway group, and all of them were managed by clinical pathway. Patients who were scheduled for orthopedic treatment at Day Surgery Department of the Second Hospital of Shanxi Medical University from May to October 2019 were selected as the routine group, and all of them were managed by conventional clinical methods. The general conditions of patients, physicians’ work efficiency, medical costs and medical quality were compared between the two groups.ResultsThe clinical pathway group included 246 patients, and the routine group included 391 patients. There was no significant difference in gender, age or disease distribution between the two groups (P>0.05). Compared with the routine group, the clinical pathway group had obvious advantages in terms of average time spent by a physician in issuing a medical order each time [(5.64±3.29) vs. (2.12±1.05) min], average number of revisions per physician’s order (1.40±0.24 vs. 0.38±0.19), rate of filing medical records within 3 days (90.28% vs. 97.97%), hospital costs [(7462.10±1035.01) vs. (6252.52±1189.05) yuan], drug costs [(652.21±88.53) vs. (437.17±108.20) yuan], length of stay [(1.23±1.04) vs. (1.02±0.18) d] and delayed discharge rate (7.93% vs. 2.03%), with statistically significant differences (P<0.05). There was no significant difference between the two groups in terms of unplanned reoperation rate, unplanned rehospitalization rate, or patient satisfaction (P>0.05).ConclusionCompared with routine clinical management, clinical pathway management can improve work efficiency, reduce medical cost and improve medical quality more effectively in the implementation of orthopedic day surgery, which has very positive effects and is worthy of promotion and application.