Objective To explore the characteristics of cognitive function and corresponding factors in young and middle-aged patients with type 2 diabetes mellitus（T2DM） with obstructive sleep apnea hypopnea syndrome（OSAHS）.Methods A total of 364 young and middle-aged T2DM patients with OSAHS hospitalized in the Endocrine Metabolism Department of the Third Affiliated Hospital of Soochow University from January 2020 to December 2021 were enrolled, and the patients were allocated to the cognitive impairment（CI） group（n=187） and normal cognitive（NC） group（n=177） based on Addenbrooke’s Cognitive Examination Ⅲ（ACE-Ⅲ） in Chinese version. The clinical data of the two groups were compared. Multivariate Logistic regression analysis was applied to explore the independent factors of cognitive dysfunction in middle-aged and young T2DM patients with OSAHS. Two-way ANOVA of body mass indexes（BMI） and apnea hypopnea index（AHI） on ACE-Ⅲ scores were performed. Results The 187（51.4%） patients had CI. The total score of ACE-Ⅲ and five cognitive dimensions in CI group were lower than those in NC group（P＜0.05）. Multivariate Logistic regression analysis showed that education years, AHI, BMI and oxygen desaturation index were independent risk factors for CI（all P＜0.05）. The ACE-Ⅲ scores difference between different BMI groups were statistically significant regardless of the AHI（F=9.732, P=0.000）. ACE-Ⅲ scores of patients with different AHI decreased gradually increase in BMI, and the interaction effects of BMI and AHI on ACE-Ⅲ score were insignificant（F=1.198, P=0.311）. Conclusion The incidence of CI in middle-aged and young patients with T2DM and OSAHS is higher, BMI, AHI, oxygen desaturation index, as well as education years may be risk factors for CI in the population.
目的 探讨血清胱抑素C水平与非阻塞性冠状动脉(冠脉)疾病的关系.方法 选取2021年6月-2021年12月在保定市第一中心医院心内科住院择期行冠脉造影的疑似老年冠心病患者331例,根据冠脉造影结果分为冠脉正常组和非阻塞性冠脉病变组,根据冠脉狭窄支数分为单支、双支、三支病变,计算Gensini积分.比较两组的一般临床资料和生化指标,并进行多因素Logistic回归分析.结果 两组体质指数(BMI)、血小板、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、吸烟及冠心病家族史比较差异无统计学意义(P＞0.05);非阻塞性冠脉病变组年龄、性别构成、高血压率、糖尿病率、高血脂率、胱抑素C水平显著高于对照组(P＜0.05或＜0.01).在非阻塞性冠脉病变患者中胱抑素C水平升高者与胱抑素C水平正常者相比,其单支病变所占比例(28.1％ vs 46.7％,P＜0.05)较低而三支病变所占比例(37.5％ vs 20.0％,P＜0.05)较高.且随着胱抑素C水平的增高,Gensini积分也显著增高,二者呈正相关(r=0.525,P＜0.01).多因素Logistic回归分析结果显示,年龄、性别、高血脂、胱抑素C是非阻塞性冠脉病变的危险因素.结论 血清胱抑素C水平可能是非阻塞性冠脉疾病的独立预测因子.
生理困难气道是指从开始气管插管至过渡到正压通气期间,患者的生理变化会增加心肺及其他并发症的风险.低血压、低氧血症、代谢性酸中毒及右心功能障碍等生理紊乱因素,显著增加了围插管期发生低血压和心力衰竭的风险.生理困难气道在急诊重症患者中尤为明显,但也可发生在生理紊乱的健康人中,如肥胖者、妊娠期和儿童.了解生理困难气道患者的生理变化和风险,对优化生理紊乱和采取相关措施避免气管插管并发症尤为重要.本文回顾临床上常见的生理性困难气道,并根据现有证据对其的管理策略进行综述.
目的 总结以发热为主要症状的 自发性肾出血(spontaneous perirenal hemorrhage,SPH)有效鉴别诊断及治疗方法.方法 回顾性分析1例不典型症状为首发表现的SPH的临床资料,并结合文献进行讨论.结果 患者老年男性,以"发热10 d,血肌酐升高1周"入院.无外伤及手术史,临床表现仅为高热,无腰痛、腹痛、休克等症状,结合实验室及影像学检查,诊断为SPH.经超声引导下穿刺引流及抗感染治疗,患者体温恢复正常.结论 临床医生有必要充分了解SPH不典型症状,以期为临床诊治此类疾病提供依据和经验.
合并慢性心脏基础疾病的患者突发急性呼吸困难时,鉴别诊断是否为心源性因素对后续治疗至为关键.近年来,肺超声逐渐兴起,并越来越受到临床医师的认可.肺超声以准确性、无创性、动态性和可重复性等优势,逐渐成为床旁急性呼吸困难的一线鉴别诊断工具.联合心肺超声技术是以血流动力学理论为基石,将肺脏作为血流动力学的器官去看待,通过超声可视化技术为"视窗",更为深刻地了解肺部渗出性病变与心功能、容量负荷等因素的关系.本文对肺超声在心脏急重症疾病合并肺水肿的理论、技术和临床诊疗思路进行综述,以供参考.
