Objective:To analyze the clinical characteristics of pediatric patients with Beh?et′s disease.Methods:The clinical characteristics of 86 newly diagnosed children with Beh?et′s disease admitted to the rheumatology department of Beijing Children′s Hospital from July 2015 to December 2020 were analyzed retrospectively. Statistical product and service solutions (SPSS) 26 was used for statistical analysis. The normal distribution of measurement data is expressed in Mean± SD, and the non normaldistribution of measurement data was expressed in median(minimum, maximum). The counting data was expressed in frequency (cases) and percentage. Results:There was no gender difference in the incidence of Beh?et′s disease in 86 children.The age of onset was 0.1~15.9 years, with an average of (7±4) years, and the age of diagnosis was 1.3~16.6 years, with an average of (10±4) years.The course of disease from onset to diagnosis was 0.5~168 months, with a median course of 21 months. Among 86 cases, 52 cases (60.5%) showed the most common oral ulcer at the onset, followed by 19 cases (22.1%) with fever. In terms of clinical manifestations: the most common clinical manifestation was oral ulcer in 82 cases (95.3%), followed by fever in 58 cases (67.4%), and gastrointestinal symptoms in 44 cases (51.2%). The common manifestation of digestive system involvement was abdominal pain and diarrhea. Ten cases (11.6%) had ocular symptoms, 13 cases (15.3%) had vascular involvement, and 3 cases (3.5%) had pulmonary involvement. Fourteen cases (16.2%) had family history. Fourty seven patients (54.7%) had elevated leukocyte, 65 patients (75.6%) had elevated CRP and 72 patients (83.7%) had elevated ESR.Conclusion:Beh?et′s disease in children is usually insidious in onset and infants may suffer from this disease. Oral ulcer is the most common clinical manifestation, followed by fever. For patients with fever of unknown cause, Beh?et′s disease should be noted. In terms of involvement of important organs, digestive tract involvement is more common in childhood, followed by large blood vessels and eyes.

Objective:To summarize the existing problems in the follow-up management of the clinical research project on cerebrovascular diseases at the National Clinical Research Center for Neurological Diseases, Affiliated Beijing Tiantan Hospital, Capital Medical University, and propose solutions and strategies to improve the level of follow-up management in clinical research, this study provided a reference basis.Methods:A comprehensive quality control system was established based on the follow-up management platform, data collection platform, quality control platform, and project management platform.Results:Strategies were proposed for key points in each stage of clinical research follow-up, quality control of the follow-up process, and follow-up progress. Furthermore, a follow-up assistant software management system was established.Conclusions:The follow-up management platform established by this study can timely address the issues encountered during follow-up, help standardize the follow-up management of clinical research, improve the follow-up rate, and ensure the quality of follow-up data.

目的 探索应用病组收治结构制定平均住院日目标值的方法,科学合理缩短平均住院日.方法 收集某院2018年1月1日-2019年12月31日出院患者住院病案首页数据,通过单因素方差分析方法,验证ALOS目标值测算方法一(纳入病组收治结构因素)和方法二(直接使用北京市住院医疗服务绩效平台各专业组ALOS标杆值)的测算值与实际值的统计学差异.运用多重比较分析方法,进一步比较两种方法的测算精确性.结果 根据单因素方差分析检验结果,两组方法的测算值与实际值的P值为0.98,表明两种测算方法测算的ALOS目标值与实际值均无统计学差异.进一步采用多重比较分析法来判断两种方法的测算精度,2019年实际平均住院日为7.56天,方法一全院测算值为7.54天,各科室测算值与实际值组间标准差为1.03.方法 二全院测算值为7.82天,各科室测算值与实际值组间标准差为1.80.结论 纳入历史病组收治结构因素测算ALOS目标值方法准确性、科学性、可操作性更强,更适合医疗机构作为每年度平均住院日目标值的测算方法.

ObjectiveTo investigate the effects of nutritional therapy on body composition in overweight/obese children with systemic lupus erythematosus（SLE）during the treatment with glucocorticoid（GC）.MethodsThe SLE children（7-18 years old）who received GC treatment and were overweight/obese admitted in our hospital from December 2018 to June 2022 were recruited in this study. After meeting the inclusion and exclusion criteria and signing the informed consent form, all subjects were included in the observation group. Then, nutrition therapy was given with an energy target of the 90% of the level recommended by the Dietary Guidelines for Chinese Residents according to ages. After the intervention for 24 weeks, a break for 6 months was given to these subject in order to avoid information exchange among them. Subsequently, our inclusion and exclusion criteria were employed again to recruit the subjects in the control group. The children from the control group were only given nutrition education. All these participants were followed up by clinic visits at 4, 12 and 24 weeks after intervention. Main observation indicators included anthropometric measurement, results of laboratory tests, and dosage of GC.ResultsThere were 60 SLE children enrolled in this study, and 40 in the observation group and 20 in the control group. No statistical differences were found in baseline data（sex ratio, age, BMI and dosage of GC）between the 2 groups. No differences were seen in body fat percentage（BPF）and visceral fat area（VFA）at baseline between the 2 groups. But the 2 indicators were decreased in the observation group（P<0.05）, and increased in the control group（P<0.05）in 12 and 24 weeks after intervention. The dosage of GC was declined in both group in 12 and 24 weeks（P<0.05）, but there was no difference between the 2 groups（P>0.05）.ConclusionNutritional therapy can improve BFP and VFA in overweight/obese SLE children during the treatment with GC.

目的 观察小切口联合负压封闭引流术治疗哺乳期乳腺脓肿的临床效果,为基层医院的临床治疗提供参考.方法 选取2021年6月至2022年6月首都医科大学附属北京潞河医院住院治疗的乳腺脓肿患者146例为研究对象.按照随机单双数法,将其分为观察组和对照组,各73例.对照组采用小切口切开引流术,观察组在对照组的基础上联合负压封闭引流术.比较两组切口长度、伤口愈合时间、疼痛评分;术后随访3个月,观察两组复发情况及继续哺乳率.结果 两组切口长度的比较,差异无统计学意义(P＞0.05);观察组伤口愈合时间短于对照组,数字评分法评分低于对照组(P＜0.05).观察组术后脓肿复发率低于对照组,继续哺乳率高于对照组(P＜0.05).结论 哺乳期乳腺脓肿行小切口联合负压封闭引流术能够缩短患者愈合时间,减低患者疼痛,减少脓肿复发,使更多的患者继续哺乳,临床操作简便,适合基层医院应用.

目的 评价髂筋膜间隙阻滞在老年股骨颈骨折髋关节置换围手术期的镇痛效果和安全性.方法 回顾性分析2019年1月至2020年1月首都医科大学附属北京友谊医院平谷医院收治的66例行髋关节置换手术的股骨颈骨折患者,按照围手术期镇痛方式不同分为2组.试验组予以塞来昔布和髂筋膜间隙阻滞,对照组仅以塞来昔布镇痛.比较两组围手术期静息及动态疼痛评分、手术时间、抬腿15.以上所需时间、住院时间、术后不良反应和并发症.结果 试验组患者的术后 6、12、24、48 h 静息 VAS评分分别为(3.67±0.74)、(4.70±0.64)、(4.79±0.65)、(4.67±0.69)分,均显著低于对照组[(4.88±0.65)、(5.52±0.76)、(5.39±0.83)、(5.39±0.97)分],搬运时、术后 6、12、24 h 和 48 h 动态 VAS评分分别为(6.00±1.00)、(5.03±0.47)、(5.70±0.64)、(5.97±0.73)、(5.79±0.74)分,均明显低于对照组[(7.39±0.83)、(6.21±0.65)、(6.76±0.71)、(6.36±0.90)、(6.42±0.97)分],差异均有统计学意义(P＜0.05).试验组的手术时间、抬腿15.以上所需时间、术后平均住院时间分别为(134.09±19.58)min、(30.45±3.18)h、(13.24± 4.09)d,均短于对照组[(146.36±28.13)min、(38.10±2.67)h、(13.67±4.67)d,差异均有统计学意义(P＜0.05).试验组术后1、2、3 d补救镇痛次数分别为(0.15±0.36)、(0.45±0.51)、(0.39±0.50)次,均小于对照组[(0.58±0.50)、(0.79±0.55)、(0.64±0.49)次],差异均有统计学意义(P＜0.05).试验组不良反应、并发症发生率分别为6.06％、9.09％,明显少于对照组(27.27％、39.39％),差异均有统计学意义(P＜0.05).结论 髂筋间隙膜阻滞镇痛可明显减轻老年股骨胫骨折髋关节置换患者围手术期疼痛,缩短手术时间及住院时间,减少药物不良反应及并发症,促进患者术后康复.

急性主动脉夹层(acute aortic dissection,AAD)是严重影响人类生命健康的大血管疾病,其临床治疗方案选择是住院医师培训的重点和难点.案例教学法(case-based learning,CBL)是指以案例为教材,在教师的指导下,运用多种方式启发学生独立思考,从而达到教学目的的一种教学方法.现从教学目标的确定、教案的设计、教学实施、教学评价及移动学习课程5个方面介绍了CBL教学法在AAD疾病教学工作中的初步探索过程.

目的:评估青年ST段抬高型心肌梗死(STEMI)冠状动脉3支病变患者临床特点和影响因素.方法:连续入选2011年1月至2021年10月,在北京同仁医院就诊的≤45岁并行冠状动脉造影首次诊断阻塞性冠状动脉疾病导致的STEMI患者312例.根据冠状动脉造影结果,分为冠状动脉3支病变(TVD)组和非3支病变(NTVD)组.比较两组临床资料,采用二分类Logistic回归模型分析冠状动脉3支病变影响因素.结果:与NTVD组相比,TVD组患者年龄更大,吸烟比例更高,有糖尿病、高脂血症、高血压病史更多、空腹血糖、HbA1c、LDL-C水平更高(P＜0.05).结论:青年STEMI冠状动脉3支病变患者比例较高,年龄、吸烟、糖尿病、高脂血症、高血压病史和入院时LDL-C水平是青年STEMI患者冠状动脉3支病变的危险因素,除年龄外均为可防可控的危险因素,提示STEMI冠状动脉3支病变已成为一种生活方式病.

Purpose Pain management is a challenging issue in elderly patients with hip fracture. Despite the accepted clinical outcomes following hip surgery, pain and prolonged recovery time are the most difficult consequences associated with the rehabilitation process. The purpose of this study was to evaluate pain relief and functional improvement associated with the Fascia Iliaca Compartment Block (FICB) during the perioperative period of elderly patients with hip fracture. Patients and methods This study included 120 elderly patients with hip fracture, who were admitted to our institution between January 2019 and December 2020. The participants were subsequently randomly divided into the routine analgesia (RA) and fascia iliaca compartment block (FICB) groups. Inter-group differences were compared via VAS scores at rest and during movement, Harris hip scores (HHS), presence of complications, adverse events after surgery, and length of hospital stay. Results The FICB group VAS scores at rest at 6 hour, 1 and 3 days, and 1 week after surgery were significantly lower than the RA group (P < .05). Moreover, the FICB group VAS scores with movement were markedly lower at 6 hour, 1 and 3 days, as well as 1 and 2 weeks after surgery (P < .05). The HHS of the FICB and RA groups were (53.41±8.63) and (40.02±9.61), respectively, on the seventh day after surgery, and the difference was statistically significant (P < .05). The incidence of postoperative complications and adverse events in the FICB group were not statistically different from the RA group. The average hospital stay of the FICB group was 2.12 days shorter than the RA group, but the difference did not reach statistical significance (P = .13). Conclusion FICB provides superior analgesic effect both at rest and with movement, along with rapid short-term recovery of hip function following surgery in elderly patients with hip fracture, without increasing postoperative complications or adverse events.

Objective To study the demographic and clinical characteristics, correlation of genotype and phenotype and treatment of Blau syndrome to facilitate early diagnosis and timely treatment of Blau syndrome. Methods Seventy-two patients with Blau syndrome from 11 centers from May 2006 to April 2022 were retrospectively analyzed, and their general information, clinical data, laboratory examination and treatment medication were collected. Results The distribution of patients with Blau syndrome was uniform in geographical north and south of China, and there was no obvious gender bias. The mean age of onset was (14.30±12.81) months, and the age of diagnosis was (55.18±36.22) months. 35% of patients with Blau syndrome happened before 1 year old, and all patients developed before 5 years old. 87.50% (63/72) had granulomatous arthritis, 65.28% (47/72) had rash, 36.11% (26/72) had ocular involvement, 27.78% (20/72) had fever, and 15.28% (11/72) had pulmonary involvement. Arthritic manifestations of Blau syndrome were most at risk, followed by rash, ocular involvement, and fever.The first 25 months of the disease, the risk of developing a rash was the greatest. The risk of developing arthritis was the greatest between 25 months and 84 months. The main mutations were p.R334Q and p.R334W, and patients with p.R334Q mutation had relatively high incidence of fever (35.71%[5/14] vs. 14.29%[1/7], P=0.43) and ocular involvement (42.86%[6/14]vs. 28.57%[2/7], P=0.51). There was a relatively high incidence of rash (85.71%[6/7] vs. 64.29%[9/14], P=0.59) in patients with the p.R334W mutation. Forty-five patients(62.50%)were treated with a combina-tion of glucocorticoid and methotrexate. Twenty-two patients were treated with tumor necrosis factor antagonist in addition to glucocorticoid and methotrexate. Conclusions The risk of different clinical manifestations of Blau syndrome from high to low was arthritis, followed by rash, ocular involvement and fever. The main treatment was glucocorticoid combined with methotrexate, to which biological agents could be added.

目的 探讨中药热奄包联合皮内针治疗腰椎间盘突出症的效果.方法 选择首都医科大学附属北京世纪坛医院2018年5月至2021年2月收治的90例腰椎间盘突出症患者,采用随机数字表分为治疗组和对照组各45例,患者均给予床边牵引治疗,对照组采用腰椎牵引及皮内针治疗,治疗组在此基础上给予中药热奄包疗法.观察两组临床疗效、腰椎疼痛程度、腰椎功能及活动度,并记录并发症发生情况.结果 治疗组主诉疼痛程度数字分级法(NRS)评分、日本骨科协会腰椎功能(JOA)评分及直腿抬高评分均优于对照组(P<0.05);两组并发症发生率比较差异无统计学意义(P>0.05);治疗组总有效率(93.33％)高于对照组(77.78％)(P<0.05).结论 中药热奄包联合皮内针用于治疗腰椎间盘突出症患者,可显著改善患者症状,提升其临床疗效,还能减轻或消除患者腰部疼痛,提高其腰椎功能及活动度,且不会增加并发症发生风险,安全性较高,具有临床应用前景.

Objective:To demonstrate the clinical significance of group A streptococcal infection (GAS) in patients with enthesitis related arthritis (ERA).Methods:A retrospective study was conducted on ERA (136) and PolyRF-/Oligo juvenile idiopathic arthritis (JIA) (272) patients in Beijing Children's Hospital from 2016 to 2018. Anti-streptococcal hemolysin "O" (ASO) was tested and documented in all patients. The infection rate of GAS was compared between patients with ERA and PolyRF-/Oligo JIA. Patients with ERA were divided to two groups according to the result of ASO (ASO positive and ASO negative). All the clinical data were documented and compared within the two groups. The statistical methods used mainly include t test, rank sum test, chi-square test, and Spearman correlation analysis.Results:The GAS infection rate of patients with ERA was higher than patients with PolyRF-/Oligo JIA (17.6% vs 9.5%, χ2=5.52, P=0.019). In ERA patients, clinical data were analyzed, and a statistical significant difference was observed in the presence of human leukocyte antigen (HLA)-B27 between ASO positive and ASO negative group [75.0%(18/24) vs 49.1%(55/112), χ2=5.329, P=0.021]. Statistical differences were found in Patrick's sign positive rate between the two groups [100%(24/24) vs 67.0%(75/112), χ2=10.61, P=0.001]. There was statistically significant difference between the two groups regarding the radiogr-aphic grading at the sacroiliac joint. More patients with positive ASO had grade Ⅲ damage at the sacroiliac joint compare to patients with negative ASO [68.2%(15/22) vs 28.4%(29/102), χ2=12.49, P<0.001]. The logarithmic of the ASO was slightly correlated with the radiographic grade of sacroiliac joint ( r=0.26, P=0.005). Conclusion:Patients with ERA are prone to be infected by GAS. It's probably related to HLA-B27 postivity for antigen presentation. Patients who were infected by GAS fre-quently have sacroiliac joint involvement, and tend to be more sever. This indicates that GAS may play an important role in the pathogenesis of sacroiliac joint destruction.

Objective:To evaluate the systemic involvement, outcome and other disease characteristics of children with systemic lupus erythematosus (cSLE), and to explore the prognostic factors.Methods:cSLE treated in Beijing Children′s Hospital, Capital Medical University from January 1, 2016 to December 31, 2017 were enrolled in this study.Medical records including clinical manifestations and evaluation of affected systems, autoantibodies, treatment adjustment, and follow-up were collected and analyzed retrospectively.SPSS 21.0 was used for statistical analysis and mapping.The prognostic factors were studied by the Cox proportional risk regression model.Results:A total of 210 children were included, including 37 males and 173 females, with a male to female ratio of 1.0∶4.7.The average age of onset was (121.39±30.44) months.There were 167 (79.5%) patients with skin and mucous membrane damage, 137(65.2%) patients with blood system damage, 129(61.4%) patients with digestive system damage, 123(58.6%) patients with kidney damage, 119(56.7%) patients with skeletal and musculoskeletal system damage, 71(33.8%) patients with nervous system damage, 68(32.4%) patients with heart damage, and 60(28.6%) patients with respiratory system damage.The 90.95%(191/210) of the children enrolled presented moderate or high disease activity at the first visit.The effective rate was 76.92% (150/195) after 1-month follow-up and 96.95% (159/164) after 1-year follow-up.A high level of compliment C 3 was a protective factor for disease remission.The glucocorticoid level was declined to 5 mg or less in 42 children, and the median time was 40.5 (36.0, 42.0) months.Young onset age and no renal damage were protective factors for glucocorticoid reduction. Conclusions:cSLE tends to occur in female children with multiple involved systems and severe conditions.After reasonable treatment and follow-up, the disease can be alleviated or improved in one year.A high level of complement C 3 at the beginning of disease is conducive to rapid remission of the disease, and the young age of onset and no renal damage is conducive to rapid glucocorticoid reduction.

目的 快速评估复方利血平氨苯蝶啶片治疗高血压的有效性、安全性和经济性,为临床合理用药提供循证依据.方法 系统检索PubMed、Embase、Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库和卫生技术评估机构官方网站,检索时限为建库至2020年12月31日.根据纳入排除标准,由2名研究者独立筛选文献、提取资料并对纳入的文献进行质量评价,将研究结果汇总并进行定性描述分析.结果 共纳入16项研究,包括2项系统评价/Meta分析、5项经济学研究及9项随机对照试验,未纳入卫生技术评估(HTA)报告.有效性方面,与常规单方降压药物(利尿剂、β受体拮抗剂、钙通道阻滞剂及血管紧张素转化酶抑制剂等)相比,复方利血平氨苯蝶啶片可明显提高血压达标率和控制率,而在治疗总有效率方面效果相当,其中与苯磺酸氨氯地平片相比,复方利血平氨苯蝶啶片的降压幅度更大;与复方利血平片(复方降压片)等其他传统固定复方制剂相比,复方利血平氨苯蝶啶片可以明显提高降压总有效率;与厄贝沙坦氢氯噻嗪片相比,复方利血平氨苯蝶啶片可以明显提高治疗的总有效率和血压达标率.安全性方面,使用复方利血平氨苯蝶啶片的患者不良反应发生率和心脑血管事件发生率等与其他大部分对照药物相比无显著差异,而与吲达帕胺和复方利血平片相比,其不良反应发生率显著降低.经济性方面,与苯磺酸氨氯地平片等常规降压药物相比,复方利血平氨苯蝶啶片的成本-效果比及增量成本-效果比更具有经济性.结论 复方利血平氨苯蝶啶片治疗高血压具有良好的有效性、安全性和经济性,具有较高的临床价值.

主动脉夹层指主动脉腔内血液从主动脉内膜撕裂处进入主动脉中膜,使中膜分离,沿主动脉长轴方向扩展形成主动脉壁的真假两腔分离状态,发病时间<14 d为急性期.本病虽少见,但死亡率甚高[1].如不及时治疗,2周内死亡率达90％以上.急性主动脉夹层(AAD)临床表现多样,病情变化复杂,误诊率和漏诊率高,导致大多数患者得不到及时有效的治疗[2].

目的:通过对卡泊芬净预防和治疗侵袭性真菌病的安全性、有效性及经济性进行快速卫生技术评估(health technology assessment,HTA),为临床合理用药及各层面的决策提供循证依据.方法:系统检索PubMed、EMBase、the Cochrane Library、中国知网、万方数据库、维普数据库和国内外HTA机构官方网站,纳入卡泊芬净对比其他阳性药或联合用药预防或治疗侵袭性真菌感染的HTA报告、系统评价/荟萃分析(Meta分析)和药物经济学研究,并对纳入文献进行统计分析.结果 与结论:最终纳入14篇Meta分析、22篇药物经济学研究.结果 显示,卡泊芬净在治疗或预防侵袭性真菌感染过程中,具有良好的安全性,其有效性不劣于其他抗真菌药.经济性方面,在大多数发达国家(如美国、英国、法国、德国、意大利和澳大利亚等),卡泊芬净均具有成本-效果优势.在我国开展的药物经济学研究中,仅在粒细胞缺乏伴发热患者的初始经验性抗真菌治疗时,卡泊芬净比伏立康唑更经济;在预防和治疗侵袭性真菌感染时,氟康唑及米卡芬净均比卡泊芬净更经济.当然,对于卡泊芬净在我国的经济性评价还需要深入开展更多大规模的研究,以支持决策.

目的 探讨急诊冠状动脉旁路移植术(CABG)对危重症患者的近远期疗效.方法 回顾性分析2008至2013年于首都医科大学宣武医院行急诊CABG的冠状动脉粥样硬化性心脏病(冠心病)患者157例,根据术前心电图及高敏肌钙蛋白I(hs-cTnI)是否升高分为急性冠脉综合征组(A组,n=116)和非急性冠脉综合征组(N组,n=41),根据发病至手术时间,将急性冠脉综合征组分为大于12 h组(n=33例),小于12 h组(n=83例).统计围手术期临床资料及术后2年的随访情况,行组间比较.结果 入组患者男性120例,女性37例,平均年龄(68.51±10.45)岁,两组基线资料比较差异无统计学意义(P>0.05),围术期A组死亡13例,死亡率11.2％,N组死亡1例,死亡率2.4％,两组差异有统计学意义(P<0.05).在围术期监护室入住时间、术后住院天数上N组短于A组,两组差异有统计学意义(P<0.05),N组生存率优于A组,但两者无统计学差异.A组亚组比较,大于12 h组在术后死亡率及ICU天数,术后住院天数上显著升高(P≤0.05).结论 掌握好适应证,急诊CABG作为一种抢救性治疗是安全、有效的,越早手术,术后疗效越好.

Objective To report a case of atrial septal defect (ASD) with congenital fibrinogen deficiency (CFD), and review the literature. Methods A case of secondary ASD with CFD treatment in Xuanwu Hospital of Capital Medical University was reported, and the defect was repaired under CPB on beating heart. The management experience of cardiac surgery under CPB in patients with CFD was summarized by means of PubMed database and literature analysis. Results This patient was female, 30 years old. She was admitted to the hospital with the complaint that ASD was found for 8 months after physical examination. On admission, echocardiography showed that the atrial septum was interrupted by about 34 mm. Color Doppler flow imaging (CDFI) detection indicated systolic left to right shunt, the pressure difference of tricuspid regurgitation was 66 mmHg, systolic pulmonary artery pressure (SPAP) was 76 mmHg, ejection fraction (EF) was 64%. Coagulation function: Prothrombin time was >120 s, thrombin time >240 s, activated partial thrombin time >180 s, and fibrinogen 1.5 g. Three days later ASD repair was performed under CPB on beating heart. Infusion of fibrinogen 2 g was performed by venous injection during operation, and another fibrinogen 2 g was given after heparin was neutralized by protamine. Operation time was 3.5 hours, and CPB time was 45min. Fibrinogen 4 g per day was supplemented postoperatively for 5 days. At the 3rd day chest drainage tube was removed. The patient was discharged at the 7th day. There were no hemorrhage and thrombosis complications. After 3 months, outpatient follow-up showed the surgical incision healed well, echocardiography showed no residual shunt in the atrial septum, and EF value was 67%. A total of 8 English literatures were obtained after searching PubMed database and manually screening, including 875 patients with hypofibrinogenemia after CPB cardiac surgery. Among them, 604 were males (69.0%) and 271 were females (31.0%). There were 6 case reports, including 1 infant (5 days old, weight 2.5 kg) and 5 adult cases, and they were all male. Patients with abnormal afibrinogenemia may have both bleeding and thromboembolic symptoms. Patients with fibrinogen deficiency who undergo CPB cardiac surgery need to be supplemented with fibrinogen, cryoprecipitation or fresh frozen plasma during the perioperative period to prevent severe postoperative bleeding complications. Conclusion Patients with fibrinogen deficiency should be given a individualized perioperative management plan according to the quantitative and other coagulation indexes of fibrinogen in plasma for cardiac surgery under CPB. DOI: 10.11855/j.issn.0577-7402.2021.03.07

目的:观察中医综合护理对脑卒中后偏瘫(HAS)患者步行能力及肢体功能的影响.方法:选取2018年3月～2019年12月126例HAS患者进行研究,按随机数字表法分为对照组、观察组.对照组采用一般护理,观察组在一般护理的基础上加用中医综合护理.结果:治疗前两组患者改良Barthel指数(MBI)、Berg平衡量表(BBS)、Fugl-Meyer运动功能量表(FMA)、中风专用生活质量量表(SS-QOL)评分差异不显著(P＞0.05),治疗后两组患者MBI、BBS、FMA、SS-QOL评分均增高,观察组MBI、BBS、FMA、SS-QOL评分均高于对照组(P＜0.05).治疗前两组患者步行功能分级差异不显著(P＞0.05),治疗后两组患者步行功能分级均改善,观察组步行功能分级改善程度优于对照组(P＜0.05).治疗前两组患者步速、步长、左右步长差、步宽差异不显著(P＞0.05),治疗后两组患者步速、步长均提高,左右步长差、步宽减小;观察组步速、步长均高于对照组,左右步长差、步宽均小于对照组(P＜0.05).结论:中医综合护理明显改善HAS患者的肢体运动功能和步态,提高步行能力,进而改善日常生活能力和生活质量.

目的:探讨心外膜左心耳夹闭在心房颤动外科治疗中的安全和有效性,为心房颤动治疗提供临床选择.方法:回顾性分析2019年1月至2020年12月,首都医科大学宣武医院心脏外科收治的单组心心房颤动动病例的临床资料,其中男15例,女15例,年龄39～86岁,平均年龄(63.7±9.5)岁.阵发性心房颤动22例,持续性心房颤动8例,其中长期持续性心房颤动5例.入组患者中,孤立性心房颤动7例,合并冠心病18例,瓣膜病2例,房间隔缺损1例,同时合并冠心病和瓣膜病2例.所有患者均接受心外膜左心耳夹闭治疗及其他相应手术.患者出院前均行头颅磁共振及心脏CTA检查,以评估左心耳闭合效果、心耳夹移位情况以及有无心房颤动相关脑卒中.结果:所有患者行心外膜左心耳夹闭术,其中单纯行左心耳夹闭7例,同期联合单纯冠状动脉移植术18例,联合冠状动脉旁路移植术和二尖瓣置换术1例,联合冠状动脉移植术、二尖瓣成形和射频消融术1例,联合房间隔缺损修补和三尖瓣成形1例,联合二尖瓣成形和置换术各1例.16例患者采用传统胸骨正中切口,14例采用小切口技术,其中左侧肋间小切口 12例,胸骨倒"L"型小切口 2例.7例孤立性心房颤动患者采用电视胸腔镜下左侧肋间小切口技术,手术时间44～66 min,平均(56.0±7.9)min.围手术期死亡患者2例,死因均为心力衰竭继发多脏器衰竭.术后随访6～10个月,平均(6.8±1.4)个月;随访期间,1例患者因长期营养不良、肺部和手术切口感染并发呼吸衰竭和败血症死亡;所有随访患者无心房颤动相关卒中症状及体征,头颅磁共振检查未见新发脑梗死病灶;心脏CTA显示左心耳血流沟通及左心房血栓形成,无心耳夹移位、变形表现.结论:心外膜左心耳夹闭是治疗心房颤动安全可行的外科方案,可作为临床外科医师治疗心房颤动的新策略.