目的 探讨原发性高血压患者全膝关节置换术(total knee arthroplasty,TKA)后低钾血症的影响因素.方法 回顾性分析我院运动医学研究所2016年1月～10月169例原发性高血压接受TKA的临床资料,依据术后血钾水平分为术后低血钾组(n = 56)和术后正常血钾组(n = 113),单因素分析筛选有统计学差异的变量进行多因素logistic回归分析.结果 单因素分析显示钙通道阻滞剂(calcium channel block,CCB)、术中出血量、围手术期镇痛、术前估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、术前血尿素氮、术前血钾2组间差异有显著性(P＜0.05).多因素logistic回归提示术前血钾(OR =0.005,P = 0.000)、围手术期股神经阻滞(femoral nerve block,FNB)镇痛(OR = 0.139,P = 0.001)为术后低钾血症发生的保护因素,CCB为术后低钾血症发生的危险因素(OR = 3.570,P= 0.011).结论 术前血钾水平高、围手术期FNB镇痛能降低原发性高血压患者TKA术后发生低钾血症的风险,口服CCB类降压药物增加术后发生低钾血症的风险.

OBJECTIVE:To analyze the preoperative pulmonary function in rotator cuff injury patients and the possible influencing factors.METHODS:All the rotator cuff surgery patients who underwent pre-operative pulmonary function examination in Peking University Third Hospital from Jan. 2020 to Jun. 2020 were retrospectively reviewed. Their perioperative medical records and main parameters of pulmonary function were collected from database management system, and their gender, age, body mass index (BMI), smoking history, time from injury, visual analogue scale (VAS) and other factors impacting on preoperative pulmonary function were studied.RESULTS:Twenty-nine patients with rotator cuff injury were included, among whom 1 patient was reported to have restrictive ventilation dysfunction and 2 patients to have obstructive ventilation dysfunction. All the three patients denied the history of respiratory diseases, and had no respiratory symptoms. In all enrolled patients, the mean forced expiratory volume in one second (FEV1)/ forced vital capacity (FVC) was 79.2%±5.9%, and the mean VAS pain score was 3.66±1.26. In addition, the dynamic pulmonary functions (FVC, FEV1) were reduced in more than half of the elderly, and the total lung capacity (TLC) was lower than the estimated value in 2/3 of the elderly. There were significant differences in three main indexes of pulmonary functions between genders, and the percentage of the estimated TLC between normal BMI group (18 kg/m2 < BMI < 24 kg/m2) and overweight/obesity group (BMI≥24 kg/m2) was significantly different. Based on the injury time longer than 1 year or not, the results indicated that FVC and TLC were significantly different between the two groups.CONCLUSION:In addition to gender and age, time from injury and severity of pain, as well as overweight/obesity, may influence pulmonary function outcomes in the elderly rotator cuff patients. Targeted intervention can be carried out on these factors before surgery. Preoperative lung function test can be used as one of the basic evaluation indexes for respiratory training and rehabilitation of patients.

目的 探讨原发性高血压病人行全膝关节置换术(total knee arthroplasty,TKA)围术期血压达标的影响因素.方法 回顾性分析我院运动医学研究所2016年1～10月257例原发性高血压行TKA的临床资料,入选169例,分为血压不达标组(n=91)和血压达标组(n=78),先进行单因素分析,有统计学差异的变量通过多因素logistic回归评价与围术期血压达标的相关性.结果 单因素分析显示有统计学差异的因素包括入院收缩压、入院脉压差、围术期镇痛、术后24 h内最大疼痛数字评分(Numerical Rating Scale,NRS),P值分别为0.000、0.001、0.000、0.002.多因素logistic分析结果显示,股神经阻滞为围术期血压不达标的保护性因素(OR=0.049,P=0.000),入院收缩压升高为围术期血压不达标的独立预后因素(OR=14.491,P=0.000).结论 股神经阻滞镇痛有利于原发性高血压病人行TKA围术期血压达标,入院收缩压和脉压差升高不利于围术期血压达标,且入院收缩压≥140 mm Hg、入院脉压差≥60 mm Hg增加围术期血压不达标的风险.

Objective To investigate the cognitive dysfunction of inpatients in geriatric department general hospital and to analyze the influencing factors.Methods A total of 205 patients hospitalized in Peking University Third Hospital were evaluated by mini-mental state examination (MMSE).All patients were divided into cognitive impairment group and non cognitive impairment group.The general characteristics,prevalence,biochemistry indexes,comorbidities,and color ultrasound-detected plaque and stenosis in carotid arteries and artery of lower extremity were analyzed and compared between two groups.The logistic multiple regression analysis was used to explore the influencing factors of cognitive dysfunction.Results The differences in age(P=0.027),education (P =0.003),marital status(P=0.000),living situation(P=0.001),hypertension history(P =0.031),type 2 diabetes mellitus (T2DM) history (P =0.036),cerebrovascular disease history (P 0.043)and HbA1c(P=0.032)were statistically significant between cognitive impairment and non cognitive impairment group (all P＜ 0.05).Logistic multiple regression analysis showed that age,marital status,T2DM history,cerebrovascular disease history and comorbidities were positively correlated with cognitive impairment(all P＜0.05).Education was negatively correlated with cognitive impairment(P＜0.05).Conclusions Cognitive impairment is associated with age,education,marital status,T2DM history,cerebrovascular disease history and comorbidities.

目的 探讨老年冠心病患者,应用简易营养评价精简法(MNA-SF)进行营养评估的可行性和价值,并评价营养状态对住院日等治疗相关指标的影响.方法 采用前瞻性研究,随机入选住院的老年冠心病患者86例,根据MNA-SF评分分为营养正常组45例及营养不良组41例.研究对象又根据是否合并糖尿病分为糖尿病组38例,非糖尿病组48例.同时获取血脂、尿酸、蛋白等实验室检查结果,比较MNA-SF评分对营养评估的一致性.并以MNA-SF评分作为营养状态的量化指标,观察其与住院日的相关性.结果 与营养正常组比较,营养不良组跌倒风险、住院天数明显升高[(11.14±6.31)分vs (7.91±4.68)分,P＜0.05;(17.49±7.01)d vs (12.93±4.37)d,P＜0.05],白蛋白和MNA-SF评分明显降低[(37.57±5.11)g/L vs (40.01±3.79)g/L,P＜0.05;(9.07±2.05)分vs (12.87±1.04)分,P＜0.01].糖尿病组与非糖尿病组跌倒风险和住院日比较,差异无统计学意义(P＞0.05).多重线性回归分析显示,MNA-SF评分与住院日呈负相关(r=-0.614,P=0.000),回归方程为:住院日=36.459-0.614×MNA-SF评分.结论 老年冠心病患者中,白蛋白水平降低是营养不良的表现之一.营养不良会增加跌倒的风险,并且导致住院日明显延长.

Objective To evaluate the clinical efficacy and safety of long-term use of finasteride in the treatment of patients with benign prostatic hyperplasia(BPH).Methods The clinical data of patients with BPH receiving finasteride 5 mg daily for more than 7 years were analyzed.Results The prostate volumes were significantly reduced from (48.0 ± 12.5) ml before treatment to (41.0 ±8.4)ml after treatment (t = 2.04,P＜ 0.05 ).The serum levels of prostatic specific antigen (PSA)were (3.8 ± 1.5) μg/L and ( 1.5 ± 1.1 ) μtg/L before and after treatment,respectively(t = 5.30,P＜0.05),but 2 times in PSA post-treatment were (2.9 ± 2.2) μg/L with no difference versus pretreatment (t= 1.38,P＞ 0.05).International prostate symptome score (IPSS) after treatment (17.1±4.5) was significantly improved as compared with pre-treatment (21.1 ± 7.0) (t = 2.09,P＜0.05).1 case with acute urinary retention and 1 case with hematuria occurred and no other side effects were found during treatment.Conclusions Long-term use of finasteride for the treatment of BPH is effective,safe and worthy of wide use.

嗜酸粒细胞性支气管炎是一种以慢性咳嗽为临床表现的疾病。临床特征多为慢性刺激性干咳或咳少许黏痰,诱导痰中嗜酸粒细胞增多,肺功能正常,糖皮质激素治疗效果良好。自1989年Gib-son(1)首次报道本病以来,国内外学者开始在慢性咳嗽的患者中进行筛查,发现欧美国家中嗜酸粒细胞性支气管炎占慢性咳嗽的10~20%,我国广州呼吸病研究所报道高达22%。目前该病的病因和发病机制尚不十分清楚,是否为一种独立的疾病尚有分歧。本文对到目前为止关于嗜酸粒细胞性支气管炎的研究进行总结。

Objective To compare the frequencies of tumor necrosis factor -α(TNF-α) gene-308 polymorphism in chronic obstructive pulmonary disease (COPD) patients and controls,to analyze the relationship of this polymorphism with COPD in Chinese.Methods 101 COPD patients and 96 controls who have no airway obstruction were included in this study.Genomic DNA was extracted from peripheral blood samples by using standard method.Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique was used to determine the polymorphism in the tumor necrosis factor-αgene-308 position.TNF-α G allele can be digested into two fragments by NcoⅠ,while the TNF-α A allele can not be digested.Results There were no significant differences in allele and genotype frequencies between COPD and control.However,in smokers the OR of A allele was higher than that of G allele.Conclusion The polymorphism in TNF-α gene-308 position alone is not associated with COPD,but increase the risk to develop COPD in smokers .