目的:探究非创伤性股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)患者病程对人工全髋关节置换术(total hip arthroplasty,THA)后患者疼痛、功能恢复及生活质量的影响。方法:回顾性分析2022年9月—2024年3月诊断为国际骨循...目的:探究非创伤性股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)患者病程对人工全髋关节置换术(total hip arthroplasty,THA)后患者疼痛、功能恢复及生活质量的影响。方法:回顾性分析2022年9月—2024年3月诊断为国际骨循环研究会(Association Research Circulation Osseous,ARCO)Ⅲ、Ⅳ期的ONFH并于南京医科大学第一附属医院行THA治疗的患者。根据患者病程分为短病程组(病程≤3年)与长病程组(病程>3年)。对比两组患者手术时间、住院时间、总失血量、术前术后的视觉模拟疼痛评分(visual analogue scale,VAS)、髋关节Harris功能评分、双下肢不等长(leg length discrepancy,LLD)、臀中肌肌肉脂肪浸润程度(muscle fat infiltration,MFI)、骨盆倾斜角度(pelvic obliquity angle,POA)以及术后并发症发生率。结果:共纳入219例患者,短病程组149例,长病程组70例。与短病程组相比,长病程组患者手术时间长(P<0.001)、住院时间久(P=0.036)、总失血量多(P=0.016),术后3 d、5 d、1个月的VAS疼痛评分高(P=0.034、<0.001、<0.001),术后1个月髋关节Harris评分低(P<0.001),术前双下肢不等长明显(P<0.001),臀中肌脂肪浸润程度大(P<0.001),术前术后骨盆倾斜角大(P<0.001),而在术后3个月疼痛VAS评分、术后3、6个月髋关节Harris评分、双下肢不等长及术后并发症方面,两组差异无统计学意义(P>0.05)。结论:与病程长的患者相比,病程短的患者在接受THA治疗后短期内疗效较好。展开更多
目的:探讨优化胰岛素耐量试验(insulin tolerance test,ITT)中胰岛素用量计算方法在垂体功能减退患者中的应用效果。方法:收集2021年2月—2023年3月收治的106例垂体功能减退患者进行ITT,其中男性79例,女性27例,年龄14~61岁。试验中使用...目的:探讨优化胰岛素耐量试验(insulin tolerance test,ITT)中胰岛素用量计算方法在垂体功能减退患者中的应用效果。方法:收集2021年2月—2023年3月收治的106例垂体功能减退患者进行ITT,其中男性79例,女性27例,年龄14~61岁。试验中使用胰岛素优化公式得出胰岛素剂量,即体重×{-0.034+0.000176×[0.5×(空腹胰岛素+180 min胰岛素)+60 min胰岛素+120 min胰岛素]+0.009846×体质量指数(body mass index,BMI)},分别监测试验前30 min、静脉推注即刻及推注后30、45、60、90、120 min患者血糖变化并记录主诉。结果:106例患者均完成试验,无1例出现低血糖昏迷、垂体危象等严重临床反应。其中76例(71.70%)在试验开始后30 min即发生低血糖,22例(20.75%)在试验开始后45 min发生低血糖,其余8例(7.55%)试验未激发成功。比较106例患者血糖曲线下面积(area under the curve of glucose,AUC_(Glu)),发现伴有2种激素(生长激素和皮质醇)同时缺乏者较单一激素(生长激素)缺乏者整体血糖水平更低。所有患者试验结束时血糖均恢复正常。结论:在临床中使用优化的ITT胰岛素用量计算方法,计算得出的试验用胰岛素注射剂量会使患者低血糖发生时间前移,提示护士在试验前应做好充分评估,试验过程中应密切关注患者主诉及血糖变化,做好相应的试验护理。展开更多
BACKGROUND Noonan syndrome(NS)is an autosomal dominant,multisystem disorder with a prevalence of 1 in 1000-2500.Multiple etiologies have been proposed for short stature in NS,including resistance to growth hormone(GH)...BACKGROUND Noonan syndrome(NS)is an autosomal dominant,multisystem disorder with a prevalence of 1 in 1000-2500.Multiple etiologies have been proposed for short stature in NS,including resistance to growth hormone(GH)and GH deficiency(GHD).Irrespective of the presence of GHD,NS is a Food and Drug Administration-approved indication for recombinant-GH therapy.Few case reports of combined anterior pituitary hormone deficiency(CPHD)in NS have been reported.AIM To describe the clinico-biochemical characteristics of NS with CPHD and to assess the response to recombinant GH therapy.METHODS An ambispective case-control study was conducted to compare the clinicohormonal profile and response to recombinant-GH in pediatric patients with NS and CPHD and pediatric patients with NS but without CPHD.RESULTS Five children with NS and CPHD were compared to 6 patients with NS but without CPHD.The most common anterior pituitary hormone involvement in combination with GHD was adrenocorticotrophic hormone deficiency causing hypocortisolemia(n=3,60%),followed by hypogonadotropic hypogonadism and secondary hypothyroidism(n=1 each).Pituitary hypoplasia was seen in the magnetic resonance imaging of all patients with CPHD.Patients with NS and CPHD had lower standard deviation scores of height(-4.18 vs-2.52,P=0.009),bodyweight,and body mass index but a slightly better first year response to recombinant GH(9.2 vs 5.5,P=0.06).There were no differences in dysmorphisms and other anomalies between the two groups.Patients with NS and CPHD had a similar response to GH as patients with CPHD but without NS.One patient with NS and CPHD developed hypocortisolism after GH initiation.CONCLUSION Hypoplasia of the pituitary and GHD with involvement of other pituitary hormones may be seen in NS and may determine response to recombinant GH therapy.展开更多
文摘目的:探究非创伤性股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)患者病程对人工全髋关节置换术(total hip arthroplasty,THA)后患者疼痛、功能恢复及生活质量的影响。方法:回顾性分析2022年9月—2024年3月诊断为国际骨循环研究会(Association Research Circulation Osseous,ARCO)Ⅲ、Ⅳ期的ONFH并于南京医科大学第一附属医院行THA治疗的患者。根据患者病程分为短病程组(病程≤3年)与长病程组(病程>3年)。对比两组患者手术时间、住院时间、总失血量、术前术后的视觉模拟疼痛评分(visual analogue scale,VAS)、髋关节Harris功能评分、双下肢不等长(leg length discrepancy,LLD)、臀中肌肌肉脂肪浸润程度(muscle fat infiltration,MFI)、骨盆倾斜角度(pelvic obliquity angle,POA)以及术后并发症发生率。结果:共纳入219例患者,短病程组149例,长病程组70例。与短病程组相比,长病程组患者手术时间长(P<0.001)、住院时间久(P=0.036)、总失血量多(P=0.016),术后3 d、5 d、1个月的VAS疼痛评分高(P=0.034、<0.001、<0.001),术后1个月髋关节Harris评分低(P<0.001),术前双下肢不等长明显(P<0.001),臀中肌脂肪浸润程度大(P<0.001),术前术后骨盆倾斜角大(P<0.001),而在术后3个月疼痛VAS评分、术后3、6个月髋关节Harris评分、双下肢不等长及术后并发症方面,两组差异无统计学意义(P>0.05)。结论:与病程长的患者相比,病程短的患者在接受THA治疗后短期内疗效较好。
文摘目的:探讨优化胰岛素耐量试验(insulin tolerance test,ITT)中胰岛素用量计算方法在垂体功能减退患者中的应用效果。方法:收集2021年2月—2023年3月收治的106例垂体功能减退患者进行ITT,其中男性79例,女性27例,年龄14~61岁。试验中使用胰岛素优化公式得出胰岛素剂量,即体重×{-0.034+0.000176×[0.5×(空腹胰岛素+180 min胰岛素)+60 min胰岛素+120 min胰岛素]+0.009846×体质量指数(body mass index,BMI)},分别监测试验前30 min、静脉推注即刻及推注后30、45、60、90、120 min患者血糖变化并记录主诉。结果:106例患者均完成试验,无1例出现低血糖昏迷、垂体危象等严重临床反应。其中76例(71.70%)在试验开始后30 min即发生低血糖,22例(20.75%)在试验开始后45 min发生低血糖,其余8例(7.55%)试验未激发成功。比较106例患者血糖曲线下面积(area under the curve of glucose,AUC_(Glu)),发现伴有2种激素(生长激素和皮质醇)同时缺乏者较单一激素(生长激素)缺乏者整体血糖水平更低。所有患者试验结束时血糖均恢复正常。结论:在临床中使用优化的ITT胰岛素用量计算方法,计算得出的试验用胰岛素注射剂量会使患者低血糖发生时间前移,提示护士在试验前应做好充分评估,试验过程中应密切关注患者主诉及血糖变化,做好相应的试验护理。
文摘BACKGROUND Noonan syndrome(NS)is an autosomal dominant,multisystem disorder with a prevalence of 1 in 1000-2500.Multiple etiologies have been proposed for short stature in NS,including resistance to growth hormone(GH)and GH deficiency(GHD).Irrespective of the presence of GHD,NS is a Food and Drug Administration-approved indication for recombinant-GH therapy.Few case reports of combined anterior pituitary hormone deficiency(CPHD)in NS have been reported.AIM To describe the clinico-biochemical characteristics of NS with CPHD and to assess the response to recombinant GH therapy.METHODS An ambispective case-control study was conducted to compare the clinicohormonal profile and response to recombinant-GH in pediatric patients with NS and CPHD and pediatric patients with NS but without CPHD.RESULTS Five children with NS and CPHD were compared to 6 patients with NS but without CPHD.The most common anterior pituitary hormone involvement in combination with GHD was adrenocorticotrophic hormone deficiency causing hypocortisolemia(n=3,60%),followed by hypogonadotropic hypogonadism and secondary hypothyroidism(n=1 each).Pituitary hypoplasia was seen in the magnetic resonance imaging of all patients with CPHD.Patients with NS and CPHD had lower standard deviation scores of height(-4.18 vs-2.52,P=0.009),bodyweight,and body mass index but a slightly better first year response to recombinant GH(9.2 vs 5.5,P=0.06).There were no differences in dysmorphisms and other anomalies between the two groups.Patients with NS and CPHD had a similar response to GH as patients with CPHD but without NS.One patient with NS and CPHD developed hypocortisolism after GH initiation.CONCLUSION Hypoplasia of the pituitary and GHD with involvement of other pituitary hormones may be seen in NS and may determine response to recombinant GH therapy.
