目的:探讨自体富血小板凝胶联合黄芪汤加减治疗在糖尿病足溃疡中的应用价值.方法:选取上海市第六人民医院2016年1月～2019年1月收治的糖尿病足溃疡患者84例,根据随机数字表法分成对照组(n=42)、观察组(n=42).对照组采用自体富血小板凝胶治疗,观察组采用自体富血小板凝胶联合黄芪汤加减治疗.比较两组治疗效果,分别在治疗前、治疗3个月后采血检测两组血液流变学指标,包括高切全血粘度、低切全血粘度、血浆粘度、红细胞比积、红细胞沉降率,并检测两组足背动脉踝肱指数、胫后动脉踝肱指数的变化,记录两组不良反应情况.结果:观察组总有效率为95.24％,显著高于对照组的80.95％.两组治疗后高切全血粘度、低切全血粘度、血浆粘度、红细胞比积、红细胞沉降率均低于治疗前,且观察组显著低于对照组.两组治疗后足背动脉、胫后动脉踝肱指数均高于治疗前,且观察组显著高于对照组.两组腹泻、皮疹、食欲下降、恶心发生率比较无显著差异.结论:与单用自体富血小板凝胶相比,采用自体富血小板凝胶联合黄芪汤加减治疗,能进一步改善糖尿病足溃疡患者的血液流变学与足背动脉、胫后动脉踝肱指数,不良反应少,总体疗效可靠.

目的 观察依折麦布联合瑞舒伐他汀对2型糖尿病合并高脂血症患者的临床疗效及安全性.方法 将124例2型糖尿病合并高脂血症患者随机分为对照组和试验组,每组62例.对照组给予瑞舒伐他汀钙片治疗,初始剂量为5 mg,每日1次,根据血脂控制情况调整剂量.试验组在对照组的基础上给予依折麦布10 mg,口服,每日1次.2组均连续治疗3个月.比较2组患者的空腹血糖、脂肪细胞因子水平,并统计2组临床治疗总有效率和药物不良反应发生情况.结果 治疗后,试验组和对照组的总有效率分别为91.94％(57例/62例)和79.03(49例/62例),差异有统计学意义(P<0.05).治疗后,试验组和对照组空腹血糖(FBG)分别为(6.21±0.34)和(6.42±0.37)mmol·L-1,糖化血红蛋白(HbA1c)分别为(6.37±0.52)％和(7.14±0.57)％,脂联素(ADPN)分别为(19.85±2.34)和(14.98±1.62)μg·mL-1,内脂素(Visfatin)分别为(48.98±5.07)和(42.66±4.69)μg·mL-1,丝氨酸蛋白酶抑制剂(Vaspin)分别为(3.36±0.89)和(4.52±1.21)μg·mL-1,趋化素(Chemerin)分别为(82.11±15.98)和(98.66±21.71)ng·mL-1,差异均有统计学意义(均P<0.05).试验组和对照组的总药物不良反应发生率分别为6.45％(4例/62例)和3.23％(2例/62例),差异无统计学意义(P>0.05).结论 依折麦布联合瑞舒伐他汀治疗2型糖尿病合并高脂血症可改善患者血脂指标、减轻炎症反应,平稳血糖.

Objective:To investigate the clinical effect of arthroscopic synovectomy in the treatment of refractory rheumatoid arthritis (RA).Methods:The clinical data of 108 patients with refractory RA who were treated at the Huishan Second People′s Hospital and the Wuxi Fifth People′s Hospital of from January 2017 to December 2020 with complete clinical data were retrospectively selected, and they were divided into the observation group (54 cases) and the control group (54 cases) according to the different treatment methods. The control group was treated with anti-rheumatic drugs (methotrexate+ leflunomide tablets) for six months, while the observation group was treated with arthroscopic synovectomy and anti-rheumatic drugs for six months after operation. The excellent and good rate of joint function after six months, serum levels of helper T cells 1 (Th1), regulatory T cells (Tregs), clinical symptom score and morning stiffness time before and after six months were observed. Chi-square test or t test was used for data analyses.Results:After six months of treatment, the excellent and good rate of joint function in the observation group was 83%, which was higher than 63% in the control group ( χ2=5.704, P<0.05). After six months of treatment, the levels of serum tumor necrosis factor α (TNF-α), interferon-γ (IFN-γ), interleukin-2 (IL-2) and the percentage of Th1 cell subsets in the two groups were lower than those before the treatment, and the data in the observation group were lower than the control group (t=2.057, 2.734, 2.372, 2.360, all P<0.05). The percentages of cluster differentiation(CD)4+ CD25+ cells, CD4+ CD25+ CD127+ cells and Tregs cell subsets were higher than before treatment, and the data in the observation group were higher than the control group (t=2.792, 5.443, 2.432, all P<0.05). After six months of treatment, the joint swelling, joint tenderness and joint pain scores in the two groups were lower than those before treatment, while those in the observation group were lower than those in the control group (t=2.669, 4.900, 3.545, all P<0.05). The morning stiffness time was shorter than before treatment, and the observation group was shorter than the control group (t=4.210, P<0.05).Conclusion:Arthroscopic synovectomy could adjust the expression level of Th1 and Treg cells in the patients with refractory RA, promote the improvement of their clinical symptoms, and may have significant effect.

目的:探讨对泌尿系结石患者采用经皮肾镜下行钬激光碎石的临床效果.方法:回顾我院2008年10月--2010年12月,我科收治的100例泌尿系结石患者临床资料,对全部患者进行微创下经皮肾镜的穿刺,再以钬激光碎石.结果:全部患者中,有96例一次性碎石成功,另外4例由于穿刺失败改行开放性手术.其手术时间在40分钟-100分钟之间.均无输血以及严重的术后并发症发生.结论:对泌尿系结石患者采用经皮(微创)肾镜下行钬激光碎石,安全有效,应予临床推广.

目的:探讨急腹症患者合理应用腹腔镜手术进行治疗的临床效果。方法:回顾2008年10月至2011年3月于我科应用腹腔镜进行诊治的100例急腹症患者的临床资料。结果:应用腹腔镜进行手术的患者为96例(占96.0%),这96例患者均临床治愈并出院,患者手术时间与出血量,以及住院时间与伤口愈合和术后疼痛等各方面均具有显著性的效果;对患者术后、出院前以及随访检查均未发现其出现并发症。结论:对急腹症患者合理的应用腹腔镜手术进行治疗,具有术后恢复快,手术部位无瘢痕,临床并发症少等诸多优点,均具有重要的临床意义。

目的:观察对胫骨平台骨折患者应用外支架与内固定的临床效果.方法:回顾我院2007年10月——2009年12月,我科收治的40例胫骨平台骨折患者临床资料,随机分为观察组与对照组,每组患者20例,对对照组20例患者应用切开复位进行内固定治疗,对观察组20例患者应用内固定与骨外固定架结合治疗,并对两组疗效进行对比.结果:观察组20例患者其膝关节的功能评定各项指标(①自我评价评分；②疼痛；③主动活动能力；④活动范围；⑤稳定性)均明显高于对照组(P＜0.05),2例发生术后并发症,明显少于对照组(9例).结论:依据患者胫骨平台骨折的类型与状况,合理选择患者手术时机与手术方式,能够保证患者关节的稳定性,同时改善患者胫骨平台骨折其治疗效果,还能够尽早恢复患者关节的功能,以减少其发生临床并发症.