A CLINICAL OBSERVATION ON THE THERAPEUTIC EFFECT OF CERVICAL SPONDYLOPATHY OF NERVE ROOT TYPE TREATED BY COMBINED CERVICAL TRACTION AND ELECTROACUPUNCTURE

Objective: To observe the therapeutic effect of combined cervical traction and electroacupuncture (EA) on Cervical Spondylopathy of Nerve Root Type (CSNRT). Methods: 145 patients diagnosed as CSNRT were randomized into 3 groups: combined treatment group, EA group, and cervical traction (CT) group. The combined group was treated with traction followed by EA of Dazhui (大椎 GV 14), Fengchi (风池 GB 20), cervical Jiaji (夹脊 EX-B 2), etc.. Patients of two control groups were only treated by either CT or EA. Results: The markedly-effective rate and total effective rate were 76.0% and 94.0% respectively in the combined treatment group, 62.5% and 81.25% respectively in CT group, and 63.82% and 82.97% respectively in EA group. The therapeutic effect of the combined treatment group was significantly superior to that of two control groups (P<0.05). At 6-month follow-up, the above two markedly-effective and total effective rates in the combined treatment group remained 74.0% and 92.0%, still significantly higher than that in two control groups. Conclusion: Combining cervicle traction with EA treatment can effectively eliminate or relieve the symptoms and signs in patients with nerve root type cervical spondylopathy.

CLINICAL OBSERVATION ON TREATMENT OF NERVE-ROOT TYPE CERVICAL SPONDYLOSIS WITH ACUPUNCTURE, TRACTION PLUS SELF-EXERCISE OF QIGONG

Purpose: To observe the therapeutic effect of acupuncture combined with traction and Qigong exercise for treatment of nerve root type cervical spondylosis. Methods: A total of 130 nerve root type cervical spondylosis patients were randomly divided into acupuncture + traction + Qigong exercise (ATQE) group (n=59), acupuncture + Qigong exercise (AQE) group (n=40) and traction + Qigong exercise (TQE) group (n=31). Main acupoints used were Fengchi (GB 20) and cervical Jiaji (EX B 2) on the affected side. Results: After one month’s treatment, in ATQE, AQE and TQE groups, 43 (72.88%), 18 (45.00%) and 12 (45.16%) had remarkable amelioration, 14 (23.72%), 14 (35.00%) and 10 (32.26%) were effective, and 2 (3.39%), 8 (20.00%) and 7 (22.58%) had no apparent changes with the total effective rates being 96.61%, 80.00% and 77.41% respectively. The therapeutic effect of ATQE group was significantly superior to that of AQE and TQE groups (P<0.01).

In-situ Horizontal Extrusion Test of Herbaceous Root-Soil with Different Root Types

The influence of different types of roots on the soil is complex and still remains unclear.Four in-situ extrusion tests were conducted on two types of root systems,namely fibrous and tap root system,for three plants,Eleusine indica,Potentilla anserine,and Artemisia argyi,according to the classification in Botany,and the thrust-displacement curves and failure patterns of different samples were analysed by comparison to fill the aforementioned gap.Results reveal that the roots can reduce the characteristics of soil brittleness and enhance its capability to resist large deformation,and different root types contribute different effects to the strain-hardening behavior of the root-soil mass.The contribution of the fibrous root system to strength is limited,whilst the tap root system substantially enhances strength and stiffness.Results of failure patterns show that fibrous and tap root systems affect soil solidification and surface cracking reduction.However,the effect of the tap root system depends on the composition of lateral and tap roots:long and rich lateral roots are effective for resisting the creation of cracks,but thick tap roots with few and thin lateral roots may lead to several surface cracks.

Wet Cupping Therapy Improves Local Blood Perfusion and Analgesic Effects in Patients with Nerve-Root Type Cervical Spondylosis

Objective： To observe wet cupping therapy（WCT） on local blood perfusion and analgesic effects in patients with nerve-root type cervical spondylosis（NT-CS）. Methods： Fifty-seven NT-CS patients were randomly divided into WCT group and Jiaji acupoint-acupuncture（JA） group according a random number table. WCT group（30 cases） was treated with WCT for 10 min, and JA group（27 cases） was treated with acupuncture for 10 min. The treatment efficacies were evaluated with a Visual Analogue Scale（VAS）. Blood perfusion at Dazhui（GV 14） and Jianjing（GB 21） acupoints（affected side） was observed with a laser speckle flowmetry, and its variations before and after treatment in both groups were compared as well. Results： In both groups, the VAS scores significantly decreased after the intervention（P〈0.01）, while the blood perfusion at the two acupoints significantly increased after intervention（P〈0.05）; however, the increasement magnitude caused by WCT was obvious compared with JA（P〈0.05）. Conclusion： WCT could improve analgesic effects in patients with NT-CS, which might be related to increasing local blood perfusion of acupunct points.

The type, position and age effect on the cutting reproduction of Picea crassifolia and its rooting mechanism in the Qilian Mountains

Picea crassifolia Kom, a perennial arbor spe- cies is recognized as one of the most adaptable plants found to date in Qilian Mountains. To explore the cutting reproduction technology of P. crassifolia and reveal its rooting mechanism, cuttings of P. crassifolia with different cutting types （softwood, hardwood and root）, positions （top, upper, middle and bottom） and ages （7, 10, 15, 20, 25 year-old） were cultivated in a field experiment. One- year old softwood and hardwood cuttings were collected from 7-, 10-, 15-, 20-, and 25 year-old healthy ortets to analyze the changes from endogenous hormones and organic nutrients. Results indicate that the softwood cut- tings （0.5-1.0 cm in diameter） from upper branches of 15 year-old ortets shows better growth performance by improving rooting indexes, including a significant increasein rooting rate and a decrease in basal rot rate. Concomi- tantly, increasing rooting quantity and root length also increased. It is noteworthy that the high rooting rate of P. crassifolia cuttings due to its ability to accumulate high concentrations of indole-3-acetic acid （IAA） and total carbon （TC） rather than abscisic acid （ABA） and total nitrogen （TN）. The rooting rate was mainly regulated by the IAA/ABA and TC/TN ratio. In summary, our results suggest that the softwood cuttings （0.5-1.0 cm in diameter） from upper branches of 15 year-old P. crassifolia can be considered as an effective strategy to improve cutting rooting rate, and the IAA/ABA and TC/TN ratio was one of the main factors limiting the cutting rooting rate of P. crassifolia.

iRootSP糊剂热牙胶垂直加压与AH-Plus糊剂热牙胶垂直加压、iRootSP冷侧压在C形根管充填中的效果比较

目的 对比爱汝特(iRootSP)糊剂热牙胶垂直加压与环氧树脂类糊剂(AH-Plus)热牙胶垂直加压、iRootSP冷侧压在C形根管充填中的效果。方法 选取2021年5月至2022年6月在秦皇岛市海港医院接受C形根管充填治疗的患者102例,依据随机数字表法分为A组(n=34)、B组(n=34)、C组(n=34)。A组采取iRootSP冷侧压法,B组采取iRootSP糊剂热牙胶垂直加压法,C组采取AH-Plus糊剂热牙胶垂直加压法。统计3组根管充填操作用时、根管充填效果、治疗效果、治疗前及治疗1个月、3个月后疼痛程度(VAS)评分。结果 (1)3组根管充填操作用时差异有统计学意义(P<0.05),A组根管充填操作用时短于B组、C组(P<0.05),B组根管充填操作用时与C组比较,差异无统计学意义(P>0.05)。(2)3组根管充填效果比较差异无统计学意义(P>0.05)。(3)3组治疗效果比较差异无统计学意义(P>0.05)。(4)治疗后1个月、3个月,3组VAS分值较治疗前降低,且A组VAS分值低于B组、C组,差异有统计学意义(P<0.05)。结论 采取iRootSP糊剂热牙胶垂直加压与AH-Plus糊剂热牙胶垂直加压、iRootSP冷侧压用于C形根管充填均能取得良好效果,但iRootSP冷侧压法操作简单,且更有助于减轻疼痛感,临床实际可根据患者具体状况选取对应治疗方式。

iRoot SP冷侧法在C型根管填充治疗牙体牙髓病中的应用效果

目的:探讨iRoot SP冷测法在C型根管填充治疗牙体牙髓病中的应用效果。方法:选取2019年7月—2022年7月苏州市第九人民医院收治的70例牙体牙髓病患者作为研究对象,按照随机数字表法分为对照组和观察组,各35例。对照组采取热牙胶垂直加压法,观察组采取iRoot SP冷测法。比较两组充填效果、临床疗效及牙周状态。结果:两组适填率、欠填率、超填率比较,差异无统计学意义(P>0.05)。观察组治疗总有效率高于对照组,差异有统计学意义(P=0.032)。治疗后,观察组探诊出血指数、菌斑指数、牙龈指数及牙周袋深度均低于对照组,差异有统计学意义(P<0.001)。结论:iRoot SP冷测法在C型根管填充治疗牙体牙髓病中的应用效果显著,可保证填充效果,提高临床疗效,改善牙周状态。

Effects of curcumin on sodium currents of dorsal root ganglion neurons in type 2 diabetic neuropathic pain rats

Along with the development of economy and society, type 2 diabetic mellitus(T2DM) has become one of the most common diseases at the global level. As one of the complications of T2 DM, diabetic neuropathic pain(DNP) stubbornly and chronically affects the health and life of human beings. In the pain field, dorsal root ganglion(DRG) is generally considered as the first stage of the sensory pathway where the hyperexcitability of injured neurons is associated with different kinds of peripheral neuropathic pains. The abnormal electrophysiology is mainly due to the changed properties of voltage-gated sodium channels(VGSCs) and the increased sodium currents(INa). Curcumin is an active ingredient extracted from turmeric and has been demonstrated to ameliorate T2 DM and its various complications including DNP effectively. The present study demonstrates that the INa of small-sized DRG neurons are significantly increased with the abnormal electrophysiological characteristics of VGSCs in type 2 diabetic neuropathic pain rats. And these abnormalities can be ameliorated efficaciously by a period of treatment with curcumin.

低磷胁迫对不同根型苜蓿光合及叶绿素荧光特性的影响

为探究不同根型苜蓿播种当年及生长第二年叶片光合及荧光特性对低磷胁迫的响应和适应能力,以根蘖型、直根型、根茎型苜蓿为研究对象,采用盆栽试验研究低磷胁迫对各根型苜蓿光合作用参数、类胡萝卜素含量、叶绿素含量及叶绿素荧光参数的影响。结果表明:低磷胁迫下,不同根型苜蓿的叶绿素a、叶绿素b、类胡萝卜素和叶绿体色素含量、光合、荧光参数均降低,与常磷相比以上各参数降幅分别为2.9%~47.9%、2.1%~47.8%、8.1%~57.8%、2.6%~7.8%、0.5%~60.2%、1.1%~52.0%,表明非气孔因素限制磷胁迫下苜蓿的光合作用,且低磷胁迫下苜蓿植株光反应中心遭到破坏,光合性能减弱。各根型苜蓿的胞间CO_(2)浓度、水分利用效率及非光化学淬灭系数均增加,增幅分别为2.9%~12.2%、10.0%~96.5%和5.7%~27.4%;播种当年及生长第二年根茎型清水紫花苜蓿的叶绿素a、叶绿素b、类胡萝卜素、叶绿体色素含量及净光合速率、气孔导度、气孔限制值受低磷胁迫影响最大,较常磷处理分别下降47.9%、47.8%、57.8%、47.8%、37.5%、22.1%、19.8%和16.6%、24.5%、16.6%、19.0%、35.4%、54.2%、24.2%,直根型和根蘖型苜蓿较根茎型苜蓿表现出更强的耐低磷胁迫能力。相关性分析表明,低磷胁迫下供试苜蓿叶片PSII系统结构及其生理状态受到损伤,且叶绿素大量分解,抑制光合电子传递,使光合作用受阻。

中医辨证施护联合综合性康复训练对神经根型颈椎病患者的影响

目的:探讨中医辨证施护联合综合性康复训练对神经根型颈椎病(cervical spondylotic radiculopathy,CSR)患者的干预效果。方法:选取82例CSR患者,参考随机数字表法分为对照组、观察组各41例。对照组予综合性康复训练,观察组在此基础上给予中医辨证施护干预,两组连续治疗4周,比较两组颈椎病临床评价量表(cervical spondylosis clinical evaluation scale,CASCS)评分、颈功能活动度、临床疗效及血液流变学指标。结果:治疗4周后,两组CASCS单项指标评分、颈功能活动度单项指标均显著提升,且观察组较对照组提升更显著(P<0.05);观察组总有效率[97.56%(40/41)]高于对照组[80.49%(33/41)](P<0.05)。治疗4周后,两组全血黏度高切、中切、低切以及血浆黏度均下降,且观察组较对照组降低更显著(P<0.05)。结论:中医辨证施护联合综合性康复训练干预可有效改善CRS患者的临床症状、颈椎活动度及血液流变学指标,提高临床疗效。

典型植物根系对紫色土化学属性和化学蚀变指数的影响

为探究植物根系形态对紫色土风化的影响,以云南元谋干热河谷区典型植被(锥连栎、华西小石积、牛筋草和裸地)覆盖条件下的紫色土为研究对象,研究了不同植被类型根系在不同土层的分布特征及其对各土层养分含量和化学蚀变指数(CAI)的影响。结果表明:裸地、乔木、灌木、草本覆盖下紫色土化学蚀变指数分别为73.98~78.87、78.53~84.68、77.89~82.18、77.91~81.04,且均表现为随土层深度增加而降低。各植被的根系均集中分布于0~20 cm土层,不同植物根系体积存在明显差异,乔木、草本和灌木覆盖下的根系体积与裸地相比分别增加145.17%、144.78%、74.98%,乔木、灌木和草本的根系表面积与裸地相比分别增加651.16%、610.79%、181.62%。土壤中养分含量随土层深度的增加而降低。随着土层深度的增加,有机质、碱解氮、有效磷和速效钾含量呈降低趋势,裸地和乔木覆盖下的pH呈增加趋势,而草本和灌木覆盖下的pH则呈相反趋势。相关性分析结果表明,土壤的CAI值与土壤有机质、碱解氮含量呈显著正相关(P<0.05),相关系数高达0.520、0.591;土壤p H、有效磷含量与土壤CAI值呈显著负相关(P<0.05),土壤CAI值与根系体积、根系表面积呈极显著正相关(P<0.01),相关系数高达0.693、0.621。综上,植物根系对于土壤的化学风化具有较明显的促进作用。

喀斯特林地细根碳氮磷生态化学计量特征的季节变化及其影响因子

植物细根养分生态化学计量特征是植被适应土壤环境的一种策略。为了解喀斯特地区不同林地类型细根碳(C)氮(N)磷(P)的生态化学计量比值的季节变化及其影响因素,该文研究了喀斯特地区灌木林和乔木林活细根和死细根的C、N、P含量和比值及其与环境因子的关系。结果表明:(1)总体上乔木林两类细根C、N、P含量高于灌木林,表明乔木物种细根对养分的吸收和储存比灌木物种更强。另外,两种林地类型活细根C含量显著高于死细根(P<0.05),而活细根N、P含量则低于死细根。(2)两种林地类型的两类细根C含量在雨季均低于旱季;灌木林活细根N、P含量在雨季高于旱季,而乔木林相反。灌木林活细根C∶N、C∶P和N∶P比值在雨季均低于旱季;乔木林两类细根的C∶N和C∶P比值在雨季高于旱季,而N∶P比值则是雨季低于旱季。雨季较低的活细根N∶P比值,表明灌木林和乔木林的植物在雨季的P限制程度较低。(3)两种林地类型上坡两类细根的C含量均高于中坡和下坡,而灌木林下坡N、P含量相对较高,乔木林中坡N、P含量相对较高;灌木林上坡两类细根C∶N、C∶P、N∶P比值相对较高,乔木林下坡两类细根的C∶N比值高于其他坡位而C∶P和N∶P比值是上坡高于其他坡位,表明两种林地中的植物在上坡受P限制影响较强,在中下坡受影响较弱。(4)冗余分析表明,林地类型、有效磷、季节是细根C、N、P养分含量及比值的主要影响因子,它们的单独解释量分别为18.8%、6.6%、6.5%。上述结果表明,在人工促进植被恢复时应考虑适当的林地类型、季节以及坡位差异造成的N∶P比值变化的影响,以便加快喀斯特生态系统的恢复。

Expression of gamma-aminobutyric acid type A receptor α_2 subunit in the dorsal root ganglion of rats with sciatic nerve injury

The γ-aminobutyric acid neurotransmitter in the spinal cord dorsal horn plays an important role in pain modulation through primary afferent-mediated presynaptic inhibition. The weakening of γ-aminobutyric acid-mediated presynaptic inhibition may be an important cause of neuropathic pain. γ-aminobutyric acid-mediated presynaptic inhibition is related to the current strength of γ-aminobutyric acid A receptor activation. In view of this, the whole-cell patch-clamp technique was used here to record the change in muscimol activated current of dorsal root ganglion neurons in a chronic constriction injury model. Results found that damage in rat dorsal root ganglion neurons following application of muscimol caused concentration-dependent activation of current, and compared with the sham group, its current strength and γ-aminobutyric acid A receptor protein expression decreased. Immunofluorescence revealed that γ-aminobutyric acid type A receptor α2 subunit protein expression decreased and was most obvious at 12 and 15 days after modeling. Our experimental findings confirmed that the y-aminobutyric acid type A receptor α2 subunit in the chronic constriction injury model rat dorsal root ganglion was downregulated, which may be one of the reasons for the reduction of injury in dorsal root ganglion neurons following muscimol-activated currents.

浅析黑龙江省大豆根腐病研究现状

大豆根腐病为大豆主要病害之一,具有发病范围广、卵孢子存活时间长、危害重等特点,严重制约黑龙江省大豆产业发展。为提高黑龙江省大豆根腐病防控技术水平,文章综述黑龙江省大豆根腐病致病菌种类及分布、发病症状及特点、抗病品种鉴定及防治措施,以期为黑龙江省大豆根腐病防治及研究提供理论依据,助力黑龙江省大豆产业振兴。

防己黄芪汤联合穴位埋线治疗脾虚痰湿型单纯性肥胖的回顾性队列研究

目的:观察防己黄芪汤联合穴位埋线治疗脾虚痰湿型单纯性肥胖的疗效与安全性。方法:采用回顾性队列研究方法,选取上海市嘉定区中医医院代谢与肥胖专病门诊收治的单纯性肥胖患者,最终纳入统计分析共175例,其中治疗组95例,对照组80例。治疗组予以防己黄芪汤联合穴位埋线治疗,对照组予以二甲双胍缓释片治疗,疗程3个月,观察患者体质量、腰围、BMI、减重结局、中医证候疗效等主要指标;胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)和血脂等次要指标;肝肾功能等安全性指标。结果:与对照组比较,治疗组患者随时间的延长,体质量、BMI、腰围明显下降,达到临床减重结局的发生率明显更高,且治疗组HOMA-IR、HbA1c、甘油三酯等指标明显改善(P<0.05)。中医证候疗效方面,治疗组总有效率89.47%(85/95),优于对照组51.25%(41/80),差异具有统计学意义(P<0.05)。治疗过程中两组患者均未见肝肾功能异常。结论:防己黄芪汤联合穴位埋线可明显减轻患者体质量,改善血糖和胰岛素抵抗以及脂代谢,患者依从性良好,具有较好的安全性。

不同功能型沉水植物对溶解氧影响及环境效应

研究选用刺苦草(Vallisneria spinulosa)、黑藻(Hydrilla verticillata)和穗花狐尾藻(Myriophyllum spicatum)分别代表底层型、冠层少根型和冠层多根型沉水植物,通过中宇宙实验,探索不同功能型沉水植物在生长过程中水柱和沉积物中溶解氧(DO)浓度及其相关指标的差异。实验结果表明:不同处理组水柱DO浓度存在显著差异,空白组水柱DO浓度显著低于植物处理组,且空白组水柱总氮(TN)和总磷(TP)浓度降低程度最少;黑藻组比叶面积、叶面积指数、净增长生物量、相对生长速率和水柱DO浓度最大,能够有效降低水柱TP和TN浓度;穗花狐尾藻组株高最高,提升水柱DO浓度显著高于刺苦草,水柱TP降低程度最大;刺苦草组比根长、单株总根长和根冠比最大,提升沉积物深度6 cm以内的DO效果最好,沉积物铁含量最高,沉积物总氮(TN)、总碳(TC)含量和间隙水总溶解性磷(TDP)浓度最低。在修复富营养湖泊过程中,可根据水和沉积物缺氧状况,合理配置底层型和冠层型沉水植物,构建释氧能力较强的群落,从沉积物表层到水柱上层均为湖泊提供充足的氧气,从而更加有利于清水态的形成。

针灸刮痧疗法联合颈椎牵引治疗神经根型颈椎病临床观察

目的:观察针灸刮痧疗法联合颈椎牵引治疗神经根型颈椎病的效果。方法:90例按照随机数字表法分为两组各45例。两组均用颈椎牵引治疗,研究组加用针灸刮痧疗法。结果:研究组总有效率、颈椎关节活动度和颈椎病临床症状评价表(CASCS)评分高于对照组(P<0.05),降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)水平、颈部功能障碍指数(NDI)和疼痛指数(VAS)评分低于对照组(P<0.05),根性疼痛消失时间、肢体麻木消失时间和握力恢复时间短于对照组(P<0.05)。结论:针灸刮痧疗法联合颈椎牵引治疗神经根型颈椎病效果较好。

电针颈夹脊联合中药治疗神经根型颈椎病的效果观察

目的:观察电针颈夹脊联合中药治疗神经根型颈椎病的效果。方法:选取2023年1—10月毕节市金沙县中医医院针灸科收治的神经根型颈椎病患者70例作为研究对象,依据随机数表法分为参照组与观察组,各35例。参照组接受电针治疗,观察组采用电针颈夹脊联合中药治疗。比较两组治疗效果、不良反应发生情况及疼痛程度。结果:观察组治疗总有效率高于参照组,差异有统计学意义(P=0.012)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。治疗前,两组视觉模拟评分法(VAS)评分比较,差异无统计学意义(P>0.05);治疗后,两组VAS评分均降低,观察组低于参照组,差异有统计学意义(P<0.001)。结论:电针颈夹脊联合中药治疗神经根型颈椎病的效果确切,可改善肩颈部疼痛程度,且未增加不良反应。

中医正骨联合针灸治疗神经根型颈椎病患者的效果观察

目的探讨神经根型颈椎病患者应用中医正骨联合针灸治疗的临床效果。方法临床纳入2021年10月至2023年10月洛阳伊滨区诸葛镇卫生院收治的72例神经根型颈椎病患者进行研究,按照随机数字表法将入选者分为对照组与实验组,每组各36例。对照组患者采用针灸治疗,实验组患者采用中医正骨联合针灸治疗。观察两组治疗效果、颈肩功能、中医证候积分、颈椎活动度及生活质量。结果实验组治疗有效率(94.44%)高于对照组(77.78%),差异具有统计学意义(P<0.05)。治疗后,实验组患者颈椎功能障碍指数(NDI)评分低于对照组,日本骨科协会颈髓功能评分(JOA)及Constant-Murley肩关节功能评分(CMS)均高于对照组,差异均有统计学意义(P<0.05)。治疗后,实验组患者各项中医证候积分(肢体疼痛、颈肩疼痛、眩晕恶心)均低于对照组,差异均有统计学意义(P<0.05)。治疗后,实验组颈椎前屈、后伸、侧屈及侧旋的最大角度均大于对照组,差异均有统计学意义(P<0.05)。治疗后,实验组患者生活质量各项评分(生理功能、生理职能、活力、社会功能、机体疼痛、精神健康、情感职能、健康总体自评评分)均高于对照组,差异均有统计学意义(P<0.05)。结论中医正骨联合针灸治疗神经根型颈椎病的治疗效果较好,能改善患者颈椎功能、脊髓功能及肩功能障碍,降低中医证候积分,改善患者活动受限症状,提高生活质量,临床有较好的应用效果。

基于医疗失效模式与效应分析框架的社区2型糖尿病临床惰性形成原因及对策研究

背景自2009年起,社区2型糖尿病(T2DM)健康管理作为国家基本公共卫生服务项目在全国得到推广实施,但由于临床惰性(即发现问题未能及时采取干预措施)的影响,造成患者血糖长期控制效果不佳,因此如何克服临床惰性以提高血糖控制率是优化糖尿病健康管理所面临的一项重要而紧迫的任务。目的识别社区T2DM健康管理过程中临床惰性发生的关键失效模式,系统分析关键失效模式的发生原因,并提出相应的干预对策措施。方法立足社区实情,以医疗失效模式与效应分析(HFMEA)框架为指导,通过实地调研、访谈及文献归纳分析法初步明确社区T2DM健康管理流程、临床惰性发生的原因及干预措施。文献检索时间为2020-01-01—2023-06-30。在此基础上,应用德尔菲法,选择16名专家于2022-01-10—02-25期间进行两轮专家咨询,最终确定社区T2DM健康管理过程中临床惰性发生的关键失效模式、发生原因和干预措施。结果第一轮和第二轮专家权威系数分别为0.791和0.729。最终通过计算风险优先指数(RPN)量化确定了社区T2DM健康管理过程中临床惰性发生的10个关键失效模式,按RPN从大到小,依次为未(及时)胰岛素治疗、未(及时)戒酒、未(及时)常规转诊、未(及时)戒烟、未(及时)紧急转诊、未(及时)三联治疗、未(及时)控制体质量、未(及时)调整膳食结构、未(及时)二联治疗和未(及时)发现低血糖,并从患者、医生及卫生系统层面阐明了关键失效模式形成的根本原因,制定了针对性的干预措施。结论制定的临床惰性干预措施具有较高的科学性和权威性,为优化社区T2DM健康管理模式奠定了基础。