1.Therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and increased middle cerebral artery blood flow in 48 patients
Haizhou QIAN ; Linling YIN ; Zhiqiang WU ; Huan YANG
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):2-7
Objective:To investigate the therapeutic effect of sequential therapy with butylphthalein on acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow in patients.Methods:The clinical data of 92 patients with acute cerebral infarction and mild-to-moderate increases in middle cerebral artery blood flow who received treatment at the Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2018 to October 2021 were retrospectively analyzed. These patients were divided into a study group and a control group using a random number table method. The control group was given an intravenous infusion of butylphthalein sodium chloride injection, while the study group took oral butylphthalein soft capsules after intravenous infusion of butylphthalein sodium chloride injection. The baseline data, hemodynamics, neurological function, and clinical outcomes were compared between the two groups. At 90 days after treatment, the National Institutes of Health Stroke Scale (NIHSS), the Activity of Daily Living Scale (ADL), and the modified Rankin Scale (mRS) were used to evaluate clinical outcomes. Transcranial Doppler ultrasound (TCD) examination was performed to evaluate hemodynamic changes.Results:A total of 92 patients completed all the observation indices as required, including 48 patients in the study group and 44 patients in the control group. There were no significant differences in demographics, vascular risk factors, laboratory results, NIHSS score, ADL score, or arterial hemodynamics of the diseased brain between the two groups (all P > 0.05). At 90 days after treatment, the NIHSS score in the study group was significantly lower than that in the control group [(4.00 ± 1.95) points vs. (4.91 ± 2.08) points; t =-2.16, P = 0.033]. The ADL score in the study group was significantly higher than that in the control group [(82.71 ± 9.56) points vs. (76.25 ± 11.47) points; t = 2.94, P = 0.004]. The good rate of outcomes in the study group was significantly higher than that in the control group [70.83% (34/48) vs. 50.00% (22/44); χ2 = 4.18, P = 0.041]. There were significant differences in the peak systolic velocity [(152.33 ± 9.58) cm/s vs. (157.41 ± 11.77) cm/s; t = 2.27, P = 0.025] and the mean velocity [(90.00 ± 8.30) cm/s vs. (94.45 ± 9.07) cm/s; t = -2.46, P = 0.016] of the middle cerebral artery between the study and control groups. The difference in pulsitility index between the two groups was not statistically significant [(0.97 ± 1.06) vs. (1.01 ± 1.21); t = 1.69, P = 0.093]. Compared with the poor outcome group, patients in the good outcome group had lower NIHSS and ADL scores after discharge (both P < 0.001), and the proportion of patients who received sequential therapy with butylphthalein in the good outcome group was higher [(60.70% (34/56) vs. 38.90% (14/36); χ2 = 4.18, P = 0.041]. Conclusion:Sequential therapy with butylphthalein can reduce neurological deficits, promote neurological function recovery, improve the hemodynamics of diseased blood vessels, and greatly improve daily living activities in patients with acute cerebral infarction complicated by mild to moderate increases in middle cerebral artery blood flow.
2.Characteristics of sleep disorders in 102 patients with Alzheimer's disease and the intervention effect of integrated traditional Chinese and western medicine
Quan PAN ; Jiao XIAO ; Qin ZHOU
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):8-13
Objective:To investigate the characteristics of sleep disorders in patients with Alzheimer's disease and the intervention effect of integrated traditional Chinese and Western medicine.Methods:A total of 102 patients with Alzheimer's disease who had sleep disorders and received treatment at Huzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine were included in the observation group. A total of 102 patients who concurrently received physical examination in the same hospital were included in the control group. Clinical consultation was performed to analyze the types and characteristics of sleep disorders in patients with Alzheimer's disease. The included patients with Alzheimer's diseae were divided into group A and group B using the random number table method, with 51 patients per group. Group A received routine western medicine intervention, while group B received traditional Chinese medicine intervention and routine western medicine intervention. The types of sleep disorders were observed in patients with Alzheimer's disease and older adult patients who undergo physical examination. The changes in traditional Chinese medicine syndrome score and sleep quality were evaluated in groups A and B.Results:The incidence rates of screaming, difficulty in falling asleep, excessive daytime sleepiness, nocturnal restlessness, obstructive sleep apnea syndrome, and fragmented sleep in the observation group were 13.73% (14/102), 58.82% (60/102), 49.02% (50/102), 49.02% (50/102), 24.51% (25/102) and 98.04% (100/102), respectively, which were significantly higher than 1.96% (2/102), 23.53% (24/102), 17.65% (18/102), 4.90% (5/102), 5.88%(6/102) and 50.98% (52/102), respectively in the control group ( χ2 = 9.76, 26.22, 22.58, 50.40, 13.73, 59.46, all P < 0.05). After intervention, the scores of insomnia, dizziness and tinnitus, mental confusion, and forgetfulness in group B were 1.0 (0.00, 1.00) point, 0.00 (0.00, 1.00) point, 0.00 (0.00, 1.00) point, and 1.00 (1.00, 1.00) point, respectively, which were significantly lower than (1.00, 2.00) points, 1.00 (1.00, 2.00) points, 1.00 (0.00, 1.00) points, and 1.00 (1.00, 2.00) points in group A ( Z = -1.86, -2.13, -2.36, -2.00, all P < 0.05). After intervention, the Pittsburgh Sleep Quality Index score and the Modified Epworth Sleepiness Scale score in Group B were (7.56 ± 1.93) points and (13.02 ± 2.06) points, respectively, which were significantly lower than (10.87 ± 2.21) points and (16.44 ± 2.87) points in group A ( t = 8.05, 6.91, both P < 0.001). Conclusion:The main characteristics of sleep disorders in patients with Alzheimer's disease include screaming, difficulty in falling asleep, excessive daytime sleepiness, nocturnal restlessness, obstructive sleep apnea syndrome, and fragmented sleep. Combined traditional Chinese and western medicine can alleviate clinical symptoms and improve sleep quality in patients with Alzheimer's disease who have sleep disorders.
3.Ginkgo ketone ester dropping pills combined with agatroban injection for the treatment of acute cerebral infarction
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):14-18
Objective:To investigate the clinical efficacy of ginkgo ketone ester dropping pills combined with agatroban injection in the treatment of acute cerebral infarction.Methods:This prospective case-control study was conducted on 120 patients with acute cerebral infarction who were treated at The Hospital of Shanxi University of Chinese Medicine between April 2020 and April 2022. These patients were randomly divided into a control group and a study group using the random number table method, with 60 patients in each group. The control group received intravenous injections of agatroban based on conventional treatment, while the study group received treatment with ginkgo ketone ester dropping pills combined with agatroban injection based on conventional treatment. The treatment duration was 2 weeks. Clinical efficacy was evaluated after continuous treatment for 2 weeks.Results:The overall response rate in the study group was 95.0% (57/60), which was significantly higher than 80.0% (48/60) in the control group ( χ2 = 6.17, P = 0.012). After treatment, the Barthel index in the study group was (65.3 ± 7.3) points, which was significantly higher than (59.8 ± 7.5) points in the control group ( t = -4.07, P < 0.001). The modified Rankin Scale score and the National Institutes of Health Stroke Scale score in the study group were (1.2 ± 0.4) points and (4.6 ± 0.7) points, which were significantly lower than (2.4 ± 0.6) points and (7.6 ± 1.1) points, respectively, in the control group ( t = 12.89, 17.82, both P < 0.001). Interleukin-6, hypersensitive C-reactive protein, and tumor necrosis factor-α levels in the study group were significantly lower than those in the control group ( t = 10.10, 18.25, 14.15, all P < 0.001). The nitric oxide levels in the study group were significantly higher than those in the control group, while endothelin 1 and thromboxane A2 levels in the study group were significantly lower than those in the control group ( t = -7.65, 10.77, 21.90, all P < 0.001). There was no significant difference in incidence of adverse reactions between the two groups ( P > 0.05). Conclusion:The combination of ginkgo ketone ester dropping pills and agatroban injection has a remarkable therapeutic effect on acute cerebral infarction. The combined therapy can reduce the severity of neurological deficits in patients, promote brain function recovery, improve quality of life, adjust serum inflammatory factors, and thereby be worthy of clinical application.
4.Clinical characteristics of Creutzfeldt-Jakob disease in Guizhou Province from 2017 to 2021
Ping WU ; Weijia JIANG ; Dian HE
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):19-22
Objective:To analyze the incidence, epidemiology, and clinical characteristics of Creutzfeldt-Jakob disease (CJD) in Guizhou Province from 2017 to 2021 and provide a scientific basis for monitoring of CJD in Guizhou Province.Methods:In this retrospective study, epidemiological and clinical information on suspected CJD cases reported by nine hospitals in Guizhou Province was collected and analyzed based on the laboratory test results of cerebrospinal fluid, blood, and skin samples from the patients.Results:From 2017 to 2021, a total of 47 patients with suspected CJD were reported in Guizhou Province, including 22 confirmed patients. Of these patients, 18 patients (18/22) were clinically diagnosed with sporadic CJD, 2 patients (2/22) were clinically suspected of having sCJD, and 2 patients (2/22) were confirmed to have genetic CJD. All patients primarily presented with rapid progressive dementia, and abnormal magnetic resonance imaging findings of the head are the main auxiliary examination results (16/20). The positive rate of 14-3-3 protein in cerebrospinal fluid was high (14/21). The blood sample PRNP gene testing revealed that 129 amino acids were M/M homozygous, while 219 amino acids were E/E homozygous. Except for T188K and E200K mutations detected by PRNP gene testing in 2 gCJD cases, no other site mutations were found, and 5 cases were positive for skin PrPSc. Patients' geographical distribution showed no obvious clustering. Patients have a wide range of occupations. The male-to-female ratio was 13:9, with a median age of 64 years. The majority of the patients were Han Chinese, and there was no special epidemiological history. Conclusion:The majority of the confirmed CJD patients in Guizhou Province from 2017 to 2021 are sporadic CJD patients, and their residence, occupation, gender ratio, age distribution, and other characteristics are consistent with the incidence patterns of sporadic CJD.
5.Correlation between serum ischemia modified albumin and calmodulin expression levels and neurological impairment in patients with cerebral small vessel disease
Lianghe DU ; Guohao ZHAO ; Qiaoyan LI
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):23-28
Objective:To investigate the correlation between serum ischemia modified albumin (IMA) and calmodulin (CaM) expression levels and neurological impairment in patients with cerebral small vessel disease.Methods:The clinical data of 140 patients with cerebral small vessel disease (CSVD) who received treatment at The Third People Hospital in Liaocheng between April 2020 and December 2021 were retrospectively analyzed. On admission, serum levels of CaM and IMA were measured using an enzyme-linked immunosorbent assay and an albumin-cobalt binding test. Patients' neurological function was evaluated using the National Institutes of Health Stroke Scale (NIHSS). Patients' transient cerebral ischemia, urinary incontinence, and gait disturbance were evaluated using the National Institute of Neurological Disorders and Stroke Scale. Patients' cognitive function was evaluated using the Montreal Cognitive Assessment scale. The influential factors of serum IMA and CaM expression levels in patients with CSVD were analyzed. The factors that affect the severity of neuological imairment in patients with CSVD and their correlation with serum IMA and CaM expression levels were analyzed.Results:The gender, age, presence or absence of gait disorders, and presence or absence of urinary incontinence of patients were not correlated with serum IMA and CaM levels (all P > 0.05). The serum levels of IMA [(38.5 ± 5.3) × 103U/L, (38.5 ± 4.7) × 103U/L, (39.0 ± 4.4) × 103U/L] and CaM [(190.4 ± 34.5) μg/L, (191.2 ± 26.7) μg/L, (199.7 ± 24.8) μg/L] in patients with cognitive impairment, dizziness and vertigo, and transient cerebral ischemia were significantly higher than those in patients with normal cognitive function, patients without dizziness and vertigo, or patients without transient cerebral ischemia [(27.3 ± 4.4) × 103U/L, (21.0 ± 3.8) × 103U/L, (20.5 ± 5.1) × 103U/L, (180.6 ± 29.6) μg/L, (179.5 ± 28.6) μg/L, (168.6 ± 32.4) μg/L, t = 14.10, 24.36, 22.50, all P < 0.05]. There were significant differences in cognitive impairment (38/16/9), dizziness and vertigo (39/16/8), transient cerebral hemorrhage (35/16/9), NIHSS score [(3.6 ± 0.8) points, (7.5 ± 0.9) points, (16.2 ± 3.2) points], CaM levels [(125.3 ± 20.5) μg/L, (185.5 ± 23.6) μg/L, (237.9 ± 54.3) μg/L], and IMA levels [(21.2 ± 3.5)] × 103 U/L, [(38.5 ± 4.3) × 103 U/L, (74.9 ± 5.4) × 103 U/L] among patients with mild, moderate, and severe neurological impairment ( t = 32.87, 11.28, 12.42, 34.59, 151.73, 147.84, all P < 0.05). The results of multivariate analysis indicated that cognitive impairment ( OR = 1.578, 95% CI: 1.043-2.386), transient cerebral ischemia ( OR = 2.396, 95% CI: 1.156-4.969), dizziness and vertigo ( OR = 1.906, 95% CI: 1.086-3.345), NIHSS score ( OR = 2.171, 95% CI: 1.162-4.056), CaM level ( OR = 2.022, 95% CI: 1.268-3.224), and increased IMA levels ( OR = 2.090, 95% CI: 1.313-3.325) were independent influential factors for worsened neurological impairment (all P < 0.05). The serum levels of IMA and CaM in patients with CSVD were significantly positively correlated with the severity of neurological impairment ( r = 5.45, 8.33, both P < 0.05). Conclusion:The elevated serum levels of IMA and CaM in patients with CSVD serve as independent risk factors for neurological impairment, and these levels are positively correlated with the severity of neurological impairment.
6.Effect of donepezil hydrochloride combined with memantine on cognitive function in patients with Alzheimer's disease
Jingfang LIU ; Jingyan LIU ; Guangwen SONG
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):29-33
Objective:To analyze the effect of donepezil hydrochloride combined with memantine on cognitive function in patients with Alzheimer's disease (AD).Methods:A randomized controlled trial was conducted among 90 patients with AD who were treated at the Zaozhuang Mental Health Center from January 2021 to March 2023. The patients were divided into a donepezil group and a combination group using a random number table grouping method, with 45 patients in each group. The donepezil hydrochloride group received only oral administration of donepezil hydrochloride tablets, while the combination group received oral administration of both donepezil hydrochloride tablets and memantine tablets. The two groups were continuously treated for 12 weeks. Before and after treatment, the Activities of Daily Living scale (ADL) score, the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD) score, the Mini-Mental State Scale (MMSE) score, and biochemical indicators (homocysteine, neuron-specific enolase, and S100 β) were compared between the two groups. Adverse drug reactions were observed in each group.Results:After treatment, the ADL, BEHAVE-AD, and MMSE scores in the combination group were (78.9 ± 6.1) points, (5.2 ± 0.5) points, and (22.8 ± 2.2) points, respectively, and they were (65.2 ± 5.9) points, (9.6 ± 0.9) points, and (19.4 ± 2.4) points, respectively, in the donepezil hydrochloride group. The ADL and MMSE scores in the combination group were significantly higher than those in the donepezil hydrochloride group ( t = 10.83, 7.01, both P < 0.001). The BEHAVE-AD score in the combination group was significantly lower than that in the donepezil hydrochloride group ( t = -28.67, P < 0.001). After treatment, serum levels of homocysteine, neuron-specific enolase, and S100 β in the combination group were (17.8 ± 3.6) μmol/L, (16.8 ± 2.7) μg/L, and (17.4 ± 7.5) μg/L, respectively, which were significantly lower than (21.5 ± 3.3) μmol/L, (20.4 ± 3.7) μg/L, and (23.5 ± 5.1) μg/L in the donepezil hydrochloride group ( t = -5.08, -5.27, -4.51, all P < 0.001). The incidence of adverse drug reactions in the combination group was 13.3% (6/45), which was slightly, but not significantly, higher than 8.9% (4/45) in the donepezil group ( χ2 = 0.45, P = 0.502). Conclusion:The combination of donepezil hydrochloride and memantine can effectively improve the mental and behavioral symptoms and cognitive function of patients with AD, improve daily living ability, and do not increase adverse reactions. The combined therapy has high clinical application value.
7.Improvement effect of acupuncture combined with rehabilitation training on neurological and motor functions in patients with acute cerebral infarction
Guifei ZHOU ; Jing YU ; Qian LI
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):34-39
Objective:To investigate the improvement effect of acupuncture combined with early rehabilitation training on clinical efficacy, traditional Chinese medicine syndrome score, and neurological and motor functions of patients with acute cerebral infarction.Methods:A total of 76 patients with acute cerebral infarction who received treatment in the Department of Neurology at Jinhua Municipal Central Hospital from June 2019 to June 2022 were included in this prospective study. These patients were randomly divided into an observation group and a control group using the random number table method, with 38 patients in each group. The control group received early rehabilitation training, while the observation group received acupuncture combined with early rehabilitation training. The clinical efficacy was compared between the two groups. Pre- and post-treatment traditional Chinese medicine symptom scores and neurological and motor functions were compared between the two groups.Results:The overall response rate in the observation group was 89.47% (34/38), which was significantly higher than 67.59% (25/38) in the control group ( Z = 2.41, P = 0.016). After treatment, the scores of hemiplegia, mouth and eye deviation, and speech difficulty in both groups were significantly decreased compared with before treatment, and the observation group showed a greater degree of decline in these indices than the control group ( t = 4.73, P < 0.001; t = -10.58, P < 0.001; t = 6.42, P < 0.001). After treatment, the neurological deficit scale scores in each group were decreased compared with before treatment, and the observation group showed a greater degree of decline compared with the control group ( t = -7.33, P < 0.001). After treatment, the Fug-Meyer motor function scale and Barthel index scores in each group were significantly increased compared with before treatment, and the observation group showed a greater degree of increases compared with the control group ( t = 3.72, P < 0.001; t = -5.02, P < 0.001). After treatment, the bare hand muscle strength scores of the core muscles in both groups of patients were increased compared with before treatment, and the observation group showed a greater improvement compared with the control group ( t = 3.31, P < 0.001). Conclusion:Acupuncture combined with rehabilitation training can enhance clinical efficacy, improve traditional Chinese medicine syndrome scores, enhance neurological and motor functions, and strengthen core muscle strength in patients with acute cerebral infarction. This treatment approach is worthy of being further promoted in clinical practice.
8.Effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding
Jingwen TANG ; Rui YANG ; Huiyun SHEN ; En WANG
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):40-44
Objective:To investigate the clinical effect of endoscopic injection of norepinephrine on cerebral infarction complicated by stress-induced gastrointestinal bleeding.Methods:A total of 150 patients with cerebral infarction complicated by stress-induced gastrointestinal bleeding who were admitted to the Intensive Care Unit of Lishui City People's Hospital from October 2020 to October 2021 were included in this study. These patients were randomly divided into a control group and an observation group using the random number table method, with 75 patients in each group. Patients in the control group received routine clinical treatment, while those in the observation group received endoscopic injection of norepinephrine in addition to routine clinical treatment. The hemostatic time, blood transfusion volume, and length of hospital stay were compared between the two groups. The stress index and inflammatory index were compared between the two groups before and after treatment. The hemostatic effect and adverse reactions were evaluated in each group.Results:The hemostatic time, blood transfusion volume, and length of hospital stay in the observation group were (16.16 ± 4.36) hours, (385.35 ± 41.28) mL, and (5.35 ± 1.28) days, respectively, which were significantly shorter or less than (27.27 ± 6.34) hours, (447.07 ± 32.07) mL, and (7.07 ± 2.07) days in the control group ( t = 12.50, 10.22, 6.12, all P < 0.001). After treatment, the levels of cortisol, norepinephrine, antidiuretic hormone, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-α in the observation group were (288.33 ± 19.53) mmol/L, (29.17 ± 4.26) μg/L, (4.08 ± 1.08) mU/L, (38.27 ± 8.72) ng/L, (6.69 ± 1.35) μg/L, and (6.37 ± 1.51) mg/L, respectively, which were significantly lower than (327.22 ± 22.01) mmol/L, (39.32 ± 5.54) μg/L, (5.36 ± 1.22) mU/L, (51.24 ± 13.23) ng/L, (8.67 ± 2.29) μg/L, and (11.44 ± 3.13) mg/L in the control group ( t = 11.44, 12.57, 6.80, 7.08, 6.45, 12.63, all P < 0.001). The overall response rate of hemostasis in the observation group was 94.67% (71/75), which was significantly higher than 82.67% (62/75) in the control group ( χ2 = 5.37, P < 0.05). The incidence of adverse reactions in the observation group was 8.00% (6/75), which was slightly, but not significantly, lower than 14.67% (11/75) in the control group ( χ2 = 1.66, P > 0.05). Conclusion:Endoscopic injection of norepinephrine for the treatment of cerebral infarction complicated by stress-induced gastrointestinal bleeding can rapidly stop bleeding, effectively reduce inflammation,improve stress index, and be highly safe.
9.Clinical study on ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in difficult airways
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):45-51
Objective:To evaluate the clinical efficacy of ultrasound-guided superior laryngeal nerve block combined with cricothyroid membrane puncture for awake tracheal intubation in difficult airways.Methods:A total of 80 patients scheduled for general anesthesia surgery owing to difficult airways at Marine Police Corps Hospital of Chinese People's Armed Police Force from August 2019 to February 2023 were included in this prospective study. These patients were randomly divided into a control group and an observation group ( n = 40 per group). Both groups of patients underwent fiberoptic bronchoscope-guided awake tracheal intubation through the nasal route. Before intubation, the control group received surface anesthesia combined with cricothyroid membrane puncture anesthesia, while the observation group received superior laryngeal nerve block combined with cricothyroid membrane puncture anesthesia. During the intubation process, hemodynamic indicators of the patients were monitored, the duration of the intubation operation was recorded, and the degree of sedation and cough response was evaluated. Before and after intubation, the levels of serum stress response factors were determined, and the satisfaction level of patients with the intubation operation was investigated. Results:At the time points T1 (immediately after the tracheal tube enters the glottis) and T2 (after the tracheal tube enters the trachea), the heart rate in the observation group was (84.08 ± 8.25) times/minute and (82.64 ± 7.81) times/minute, respectively, and the mean arterial pressure in the observation group was (92.57 ± 8.32) mmHg (1 mmHg = 0.133 kPa) and (103.27 ± 9.16) mmHg, respectively, which were significantly lower compared with those in the control group ( t = 5.92-12.56, all P < 0.001). At T1 and T2, there was no significant difference in blood oxygen saturation (SpO 2) between the observation and control groups ( t = 0.34-0.43, P = 0.652-0.726). The duration of the intubation operation in the observation group was (8.96 ± 1.15) minutes, which was significantly shorter than (11.47 ± 1.39) minutes in the control group ( t = 6.84, P < 0.001). The Ramsay sedation score during intubation in the observation group was 3 (2,3) points, which was significantly higher than 2 (1,3) points in the control group ( Z = 9.26, P < 0.001). The cough response score in the observation group was 1 (0,1) point, which was significantly lower than 1 (0, 2) points in the control group ( Z = 4.37, P < 0.001). The serum levels of stress response factors norepinephrine and adrenaline in the observation group were significantly lower than those in the control group ( t = 14.58-25.94, both P < 0.05). The overall patient satisfaction in the observation group was 97.50%, which was significantly higher than that in the control group ( χ2 = 4.51, P = 0.034). Conclusion:Superior laryngeal nerve block combined with cricothyroid membrane puncture can be used for anesthetic management of awake nasal tracheal intubation in difficult airways. This combined approach can improve patient hemodynamic stability and sedation, shorten the duration of intubation, reduce stress responses during intubation, and enhance patient satisfaction.
10.Efficacy of the combination of semaglutide, insulin degludec, and metformin in the treatment of type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity
Chinese Journal of Primary Medicine and Pharmacy 2024;31(1):52-56
Objective:To investigate the efficacy of the combination of semaglutide, insulin degludec, and metformin in the treatment of type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity.Methods:A total of 160 patients with type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity were included in this case-control study after receiving treatment at Bayannur Hospital from April 2022 to March 2023. These patients were divided into a control group and an observation group based on different treatment regimens, with 80 patients in each group. The control group was treated with degludec insulin combined with metformin, while the observation group was treated with semaglutide, degludec insulin, and metformin. The treatment lasted for 12 weeks in both groups. The changes in fasting plasma glucose, 2-hour postprandial blood glucose (2 h PG), glycosylated hemoglobin, time in range for 2 h PG, fasting insulin, Homeostatic Model Assessment for Insulin Resistance index, body mass index, and visceral fat area and adverse reactions were monitored.Results:The overall response rate in the observation group was 100% (80/80), which was significantly higher than 97.5% (78/80) in the control group (χ 2 = 11.03, P < 0.05). After treatment, the levels of 2 h PG, glycosylated hemoglobin, fasting insulin, Homeostatic Model Assessment for Insulin Resistance index, body mass index, visceral fat area in the observation group were (7.35 ± 0.17) mmol/L, (6.08 ± 0.24)%, (10.30 ± 2.58) μU/mL,(2.69 ± 0.66), (24.40 ± 0.68) kg/m 2, (80.20 ± 8.94) cm 2, respectively, which were significantly lower than (7.92 ± 0.24) mmol/L, (6.34 ± 0.27)%,(13.71 ± 3.13) μU/mL,(3.57 ± 0.83), (26.77 ± 3.49) kg/m 2, (116.12 ± 34.09) cm 2 respectively in the control group ( t = -0.73, -3.74, -4.20, -4.15, -3.35, -5.10, all P < 0.05). The time in range for 2 h PG in the observation group was (72.68 ± 4.09)%, which was significantly higher than (50.16 ± 10.00)% in the control group ( t = -10.42, P < 0.05). The incidence of adverse reactions in the observation group was 3.8% (3/80), which was slightly, but not significantly, higher than 2.5% (2/80) in the control group ( P > 0.05). Conclusion:The combination of semaglutide, degludec insulin, and metformin demonstrates an ideal clinical effect in the treatment of type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity. This combined approach can effectively regulate fasting and postprandial blood glucose levels, markedly decrease the body mass index and visceral fat levels, and improve insulin resistance while not significantly increasing the incidence of adverse reactions.

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