强直性脊柱炎(AS)是一种慢性炎症性自身免疫性疾病,属不可逆型风湿病[1].该病起病隐匿,早期临床症状不明显,随着病情的加重出现炎性腰痛、外周关节炎等,病变部位以脊柱为主,累及骶髂关节和外周关节,引起脊柱强直和纤维化,甚至导致心、肺、眼等脏器病变.由于发病机制尚不完全明确,目前临床治疗难度较大[2].西医治疗主要以药物干预为主,常用非甾体抗炎镇痛药联合抗风湿类药物控制炎症,减轻及缓解症状,但会发生单一或叠加的不良反应,如消化道反应、肝肾功能损害、骨髓抑制等,影响或加重患者病情[3].中医治疗以整体理念为指导,辨证施治,内外兼治,方法多样,今年来取得了较大进展[4].本研究旨在观察中药内服和外敷合治强直性脊柱炎的疗效.报道如下.

目的:探索中西医结合诊疗思维管理方法在医院康复科中的应用效果.方法:医院2019年4月～2020年10月的144例康复科患者被选为研究对象,随机抽取并将康复科患者分为对照组和观察组,每组72例.对照组实施常规诊疗管理方法.观察组实施中西医结合诊疗思维管理方法.采用生活活动能力Barthel指数评估量表对患者的生活质量进行评价,计算诊疗思维总满意率.结果:观察组生活活动能力Barthel评分高于对照组(P＜0.05).观察组诊疗思维总满意率高于对照组(P＜0.05).结论:医院康复科实施中西医结合诊疗思维管理方法后能够有效提高康复科患者的生活质量,同时还有助于促进康复科患者对医院诊疗思维的满意度.

Objective:To investigate the relationship between serum fibroblast growth factor 21/23 level, trauma severity and prognosis in middle-aged and older adult patients with traumatic fracture.Methods:A total of 126 middle-aged and older adult patients with traumatic facture who received treatment in the Second People's Hospital of Lishui, China between June 2017 and June 2019 were included in the study group. Fifty healthy controls who concurrently received physical examination in the Second People's Hospital of Lishui were included in the control group. The study group was divided into five subgroups according to relevant criteria: mild, moderate, severe, poor prognosis and good prognosis. The levels of C-reactive protein (CRP), procalcitonin (PCT), FGF21 and FGF23 were measured.Results:On admission, serum CRP, PCT, FGF23, FGF2 levels in the study group were (19.18 ± 5.66) mg/L, (0.71 ± 0.20) μg/L, (79.75 ± 18.62)μg/L,(52.10 ± 16.34) μg/L, respectively, and they were significantly higher than those in the control group [ (7.60 ± 2.61) mg/L, (0.30 ± 0.11) μg/L, (40.18 ± 10.33) μg/L, (30.11 ± 10.19) μg/L, t = 18.888, 17.750, 18.336, 11.032, all P < 0.001). On admission, serum CRP, PCT, FGF23, FGF2 levels in the study group were (19.18 ± 5.66) mg/L, (0.71 ± 0.20) μg/L, (79.75 ± 18.62) μg/L, (52.10 ± 16.34) μg/L, respectively, and they were significantly increased at 1 day [(21.59 ± 4.53) mg/L, (0.79 ± 0.22) μg/L, (83.85 ± 19.07) μg/L, (55.18 ± 16.55) μg/L, t = 3.72, 3.29, 1.56, 1.56, P < 0.05, P < 0.05, P = 0.122, P = 0.122] and 3 days after surgery [(23.15 ± 3.16) mg/L, (0.80 ± 0.24) μg/L, (88.11 ± 19.80) μg/L, (59.70 ± 16.07) μg/L, t = 6.65, 3.12, 3.59, 3.77, all P < 0.05] , and significantly decreased at 7 days after surgery [(14.35 ± 4.02) mg/L, (0.52 ± 0.16) μg/L, (50.06 ± 15.50) μg/L, (32.18 ± 12.52) μg/L, t = 8.31, 8.58, 13.77, 11.11, all P < 0.001]. On admission, there were significant differences in serum CRP, PCT, FGF23, FGF21 levels between mild, moderate and severe groups ( F = 25.087, 15.851, 15.831 and 12.645, all P < 0.001). On admission, serum CRP, PCT, FGF23, FGF21 levels in the poor prognosis group were significantly higher than those in the good prognosis group ( t = 5.757, 4.984, 3.189 and 4.006, all P < 0.001). The receiver operating characteristic curve (ROC) analysis results showed that serum CRP, PCT, FGF23, FGF21 levels in patients with traumatic fracture on admission had a certain value in the prediction of poor prognosis. Combined detection of these four indexes had the highest value, with AUC (0.95 CI) of 0.877 (0.783-0.982). Conclusion:Serum FGF21 and FGF23 levels have a certain value in the prediction of severity and prognosis of traumatic fracture in middle-aged and older adult patients.

目的 探讨系统护理对抑郁症患者心理及生活质量的影响.方法 2016年6月至2017年6月该院收治的抑郁症患者90例,随机分为观察组与对照组各45例.两组均给予规范化抗抑郁药物治疗及常规护理,观察组实施系统护理干预.比较两组干预前后心理健康状况及生活质量.结果 观察组汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分明显低于对照组,健康调查简表各项评分高于对照组,差异均有统计学意义(P<0.05).结论 在常规治疗基础上实施系统护理干预,能明显改善抑郁症患者的心理状况及生活质量.