目的 探究电针复合臂丛神经阻滞在上肢骨折手术麻醉中的应用价值.方法 选取2018年4月至2021年4月在南阳市中心医院行上肢骨折手术麻醉的患者共136例,采用随机数字表分为观察组和对照组,各68例.对照组予以臂丛神经阻滞麻醉,观察组予以电针复合臂丛神经阻滞麻醉.比较两组患者手术时麻醉状况(麻醉阻滞起效用时、麻醉药物使用量、麻醉持续时间)、患者各时间段[麻醉前(T1)、麻醉后10 min (T2)、手术开始时(T3)、手术结束后(T4)]血流动力学参数[心率(HR)、平均动脉压(MAP)],比较术后1h、3h、12 h、24 h患者疼痛状况[视觉模拟评分法(VAS评分)],记录因麻醉导致不良反应(心动过缓、呼吸困难、头晕、恶心呕吐、总不良反应)发生率.结果 观察组麻醉阻滞起效用时、麻醉药物使用量分别为(3.84±1.23)min和(29.46±5.72)mL,均低于对照组的(6.17±1.79)min和(34.95±6.41)mL(P均＜0.001);观察组麻醉持续时间为(324.31±19.57)min,长于对照组的(305.26±18.54)min(P＜ 0.001);T1时,血流动力学参数(HR、MAP)差异无统计学意义(P均＞0.05),T2～T4时,观察组患者T2、T3、T4各时段HR分别为(80.72±11.84)次/min、(82.13±8.54)次/min、(79.54±6.27)次/min,MAP分别为(91.26±12.27)mmHg(1 mmHg=0.133 kPa)、(97.71±8.45)mmHg、(90.67±7.54)mmHg均低于对照组T2、T3、T4时段HR (88.69±12.08)次/min、(86.27±8.45)次/min、(86.27±8.45)次/min及T2、T3、T4时段MAP(96.73±10.94)mmHg、(107.24±9.14)mmHg、(101.26±8.47)mmHg(P均＜0.05),观察组总不良反应发生率为14.71％低于对照组总不良反应发生率35.29％(P＜ 0.05).结论 电针复合臂丛神经阻滞对上肢骨折手术有着较好的麻醉效果,较高的安全性.

目的 探讨长链非编码RNA ENST00000418539.1(LncRNA ENST00000418539.1)是否通过调控miR-24的表达影响过氧化氢(H2 O2)诱导心肌细胞氧化应激损伤.方法 体外培养大鼠心肌细胞H9c2,200μmol/L H2 O2处理心肌细胞48 h建立模型,分别将乱序无意义阴性序列(si-NC)、ENST00000418539.1小分子干扰RNA(si-ENST00000418539.1)、si-ENST00000418539.1与阴性对照(anti-miR-NC)、si-ENST00000418539.1与miR-24特异性寡核苷酸抑制剂(anti-miR-24)转染至心肌细胞,使用H2 O2处理心肌细胞.实时荧光定量聚合酶链反应检测ENST00000418539.1、miR-24的表达量;流式细胞术检测细胞凋亡率;检测丙二醛(MDA)、乳酸脱氢酶(LDH)水平;双荧光素酶报告实验验证ENST00000418539.1、miR-24的靶向关系;蛋白免疫印迹法检测半胱氨酰天冬氨酸特异性蛋白酶3(Caspase-3)、半胱氨酰天冬氨酸特异性蛋白酶9(Caspase-9)的表达.结果 与对照组比较,模型组细胞凋亡率明显升高(P<0.05),Caspase-3、Caspase-9蛋白水平明显升高(P<0.05),MDA、LDH水平明显升高(P<0.05);与模型组、si-NC组比较,si-ENST00000418539.1组细胞凋亡率明显降低(P<0.05),Caspase-3、Caspase-9蛋白水平明显降低(P<0.05),MDA、LDH水平明显降低(P<0.05);双荧光素酶报告实验证实ENST00000418539.1可靶向结合miR-24.与si-ENST00000418539.1+anti-miR-NC组比较,si-ENST00000418539.1+anti-miR-24组细胞凋亡率明显升高(P<0.05),Caspase-3、Caspase-9蛋白水平明显升高(P<0.05),MDA、LDH水平明显升高(P<0.05).结论 干扰ENST00000418539.1表达可负向调控miR-24的表达,从而抑制H2 O2诱导心肌细胞凋亡及减轻氧化应激损伤.

目的:研究大剂量谷维素联合β-受体阻滞剂治疗心血管神经症的效果.方法:选取2018年1月至2019年1月在南阳市中心医院住院治疗的心血管神经症患者80例作为研究对象,按治疗方式分类:对照组40例应用小剂量谷维素治疗,观察组40例应用大剂量谷维素+β-受体阻滞剂治疗,对比患者负性情绪、心血管神经症症状评分和治疗效果.结果:经过治疗,观察组患者的汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)及症状评分均显著低于对照组(P＜0.05);治疗总有效率比较观察组显著高于对照组[95.00％VS 67.50 ％](P＜0.05).结论:心血管神经症患者采用大剂量谷维素与β-受体阻滞剂联合治疗效果显著,可改善患者的负性情绪,缓解心血管神经症症状,治疗效果得到提升.

Objective:To investigate the risk factors of occurrence of fragmented QRS complexe (fQRS) in angina pectoris patients with coronary stenosis> 70%.Methods:A total of 230 angina pectoris patients with coronary stenosis>70% who were treated in Department of Cardiovascular Medicine, Nanyang Central Hospital from July 2018 and October 2019 were enrolled. According to results of 12-lead synchronous electrocardiogram (ECG) examination, patients who had fQRS were selected as the observation group (70 cases), and patients without fQRS were selected as the control group (160 cases). The clinical data, ECG parameters and ultrasound results of the two groups were observed, and their relationships with fQRS were analyzed.Results:The ages and fasting blood glucose (FPG) levels in the observation group were higher than those in the control group ( P<0.05). The fQRS time limit, left ventricular end-diastolic dimension (LVEDD), and right atrial dimension (RAD) of the observation group were higher than those of the control group, while the left ventricular ejection fraction (LVEF) was lower than that of the control group ( P<0.05). Spearman correlation analysis showed that age, FPG, fQRS time limit, LVEDD, LVEF and RAD were positively correlated with fQRS ( P<0.05), but atrial premature beat and ventricular premature beat had no significant correlation with fQRS ( P>0.05). Multivariate logistic regression analysis revealed that old age, increased FPG levels, longer QRS time limit, increased LVEDD and decreased LVEF were independent risk factors for fQRS in angina pectoris patients with coronary stenosis>70% ( P<0.05). Conclusions:Old age, increased FPG levels, longer QRS time limit, increased LVEDD and decreased LVEF are important risk factors for the occurrence of fQRS in angina pectoris patients with coronary stenosis>70%. The relevant groups should be paid attention, for which strengthened intervention and clinical treatment should be performed.