参苓白术散辅助治疗初治肺结核患者的效果观察

目的探讨参苓白术散辅助治疗初治肺结核的临床效果。方法选择2018年1～12月肺结核患者100例为研究对象,随机分为观察组与对照组,各50例。两组均给予2SHRZ/4HR治疗,观察组在此基础上给予参苓白术散辅助治疗。比较两组治疗后中医证候积分,中医证候疗效、病灶变化,痰菌转阴率,红细胞沉降率及不良反应。结果 (1)治疗后,两组ESR较治疗前均显著下降,差异有统计学意义(P0.05);治疗后,观察组ESR显著低于对照组,差异有统计学意义(P0.05)。(2)治疗后,两组中医证候积分较治疗前均显著改善,差异有统计学意义(P0.05);治疗后,观察组中医证候积分显著低于对照组,差异有统计学意义(P0.05)。(3)秩和检验显示,观察组中医证候疗效显著优于对照组,差异有统计学意义(P0.05)。(4)秩和检验显示观察组治疗后病灶显著吸收率显著高于对照组,差异有统计学意义(P0.05)。(5)观察组治疗后45例痰菌转阴,转阴率为90.0%;对照组36例痰菌转阴,转阴率为72.0%。两组比较差异有统计学意义(P0.05)。(6)观察组不良反应严重程度显著低于对照组,差异有统计学意义(P0.05)。结论参苓白术散辅助治疗初治肺结核,可显著改善症状,提高痰菌转阴率,能有效缓解患者不良反应情况。     

环丝氨酸联合胸腺肽肠溶片治疗耐多药肺结核的效果及对患者细胞免疫功能的影响

目的 观察环丝氨酸联合胸腺肽肠溶片治疗耐多药肺结核的效果,分析其对患者细胞免疫功能的影响。方法选取2016年5月至2017年8月我院收治的耐多药肺结核患者69例为研究对象。采用随机数字表法将其分为环丝组(n=34)及对照组(n=35)。对照组采用耐多药肺结核标准治疗方案进行治疗,环丝组在对照组的基础上采用环丝氨酸联合胸腺肽溶片治疗,治疗周期为24个月,评估两组治疗前后的临床效果及治疗前后的免疫指标变化情况。结果 治疗24个月后,环丝组痰结核菌转阴、胸部X线病灶吸收及空洞缩小较治疗3个月后显著升高,较对照组显著升高,差异有统计学意义(P0.05);环丝组患者的CD4+、CD4+/CD8+显著高于对照组,CD8+显著低于对照组,差异有统计学意义(P0.05)。结论 环丝氨酸联合胸腺肽肠溶片治疗耐多药肺结核具有良好的临床转归效果,可进一步提高肺结核诊治疗效。     

补肾活血方联合低分子肝素钠治疗肾虚血瘀型抗磷脂抗体阳性复发性流产

目的:观察补肾活血方联合低分子肝素钠治疗肾虚血瘀型抗磷脂抗体阳性复发性流产患者的临床疗效。方法:60例肾虚血瘀型抗磷脂抗体阳性复发性流产患者随机分为观察组30例和对照组30例。对照组患者给予低分子肝素钠,观察组患者在对照组治疗基础上给予补肾活血方。比较两组患者临床疗效、中医证候积分、中医证候疗效、抗磷脂抗体转阴率、活产率及不良反应。结果:观察组临床疗效的有效率为93.33%,对照组为80.00%,两组有效率比较,差异有统计学意义(P0.05)。两组患者治疗后中医证候积分显著低于治疗前,差异有统计学意义(P0.05);观察组治疗后证候积分显著低于同期对照组(P0.05)。观察组中医证候疗效的有效率为90.00%,对照组为76.67%,两组有效率比较,差异有统计学意义(P0.01)。观察组抗磷脂抗体转阴率为96.67%,对照组为83.33%,两组比较,差异有统计学意义(P0.05)。观察组活产率为90.00%,对照组为76.67%,两组比较,差异有统计学意义(P0.01)。两组不良反应发生率比较,差异无统计学意义(P0.05)。结论:补肾活血方联合低分子肝素钠治疗肾虚血瘀型抗磷脂抗体阳性复发性流产疗效显著,可降低中医证候积分,提高中医证候疗效、抗磷脂抗体转阴率及活产率。     

左氧氟沙星和卷曲霉素联合治疗对肺结核患者痰结核菌素转阴比率的影响

目的探讨左氧氟沙星和卷曲霉素联合治疗对肺结核患者痰结核菌素转阴比率的影响。方法选取2018年9月至2019年9月我院收治的肺结核患者110例作为研究对象,随机分成观察组和对照组,每组各55例。对照组采用常规疗法,观察组采用左氧氟沙星和卷曲霉素联合治疗。治疗结束后,比较两组患者治疗后的痰菌转阴率、空洞闭合率以及病灶吸收率变化,比较两组患者治疗前后的免疫指标变化及临床常见不良反应发生率。结果治疗后,观察组患者的痰菌转阴率、空洞闭合率以及病灶吸收率均高于对照组,差异有统计学意义(P0.05);治疗前,两组患者CD4~+、CD8~+、CD3~+以及CD4~+/CD8~+T比较,差异无统计学意义(P0.05),治疗后,观察组CD4~+及CD3~+高于对照组,CD8~+低于对照组,差异有统计学意义(P0.05),治疗后两组CD4~+/CD8~+比较,差异无统计学意义(P0.05);治疗后,观察组不良反应总发生率低于对照组,差异有统计学意义(P0.05)。结论左氧氟沙星与卷曲霉素联合治疗时,能够增强患者的痰菌转阴效率,提高空洞的闭合效果以及增大对病灶的吸收程度,值得临床应用。     

百合固金汤合秦艽鳖甲散治疗阴虚火旺型肺结核患者的效果

目的:观察百合固金汤合秦艽鳖甲散治疗阴虚火旺型肺结核患者的效果。方法:选取98例阴虚火旺型肺结核患者为研究对象,按照随机数字表法分为对照组和观察组各49例。对照组采用西医常规抗结核治疗,观察组在对照组基础上联合百合固金汤合秦艽鳖甲散治疗,比较两组临床疗效、痰菌转阴率、治疗前后中医证候积分、炎性指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞计数(WBC)]水平及不良反应发生率。结果:观察组治疗总有效率为87.76%,高于对照组的61.22%,差异有统计学意义(P<0.05);观察组治疗3、6个月痰菌转阴率均高于对照组,差异有统计学意义(P<0.05);观察组咳嗽气短、反复咯血、潮热盗汗、神疲乏力等中医证候积分均低于对照组,差异有统计学意义(P<0.05);观察组CRP、TNF-α、WBC水平均低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率为6.12%,低于对照组的22.45%,差异有统计学意义(P<0.05)。结论:百合固金汤合秦艽鳖甲散联合西医常规抗结核治疗阴虚火旺型肺结核患者,可提高临床疗效和痰菌转阴率,降低中医证候积分和炎性指标水平,且安全性高,其效果优于单纯西医常规抗结核治疗。     

左氧氟沙星联合卷曲霉素治疗方案对耐多药肺结核患者免疫功能及肝功能的影响

目的:研究左氧氟沙星联合卷曲霉素治疗方案对耐多药肺结核患者免疫功能及肝功能的影响.方法:将本院收治的耐多药肺结核患者90例纳入研究,随机分为观察组和对照组两组,观察组给予左氧氟沙星、卷曲霉素联合常规化疗方案,对照组给予常规化疗方案,比较两组的痰菌转阴情况、免疫功能、肝功能指标.结果:观察组治疗后的痰菌转阴率明显高于对照组,差异有统计学意义(P＜0.05);CD4+T细胞以及IgA、IgG、IgM含量明显高于对照组,CD8+T细胞含量明显低于对照组,差异有统计学意义(P＜0.05);两组的血清碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(STB)、总蛋白水平比较,差异无统计学意义(P＞0.05).结论:左氧氟沙星联合卷曲霉素治疗方案有助于杀灭结核杆菌,改善免疫功能,且不会加重肝脏负担,是治疗耐多药肺结核的理想方法.     

平喘固本汤联合补肺汤对稳定期COPD患者肺功能、中医证候积分及免疫功能的影响

目的:观察平喘固本汤联合补肺汤治疗稳定期慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者的临床疗效及其对患者肺功能、中医证候积分及免疫功能的影响。方法:79例稳定期COPD患者随机分为对照组35例和观察组44例。对照组给予常规西医治疗;观察组在对照组治疗基础上给予平喘固本汤、补肺汤。比较两组患者治疗前后肺功能指标:第1秒用力呼气量(forced expiratory volume in one second,FEV1)、用力肺活量(forced vital capacity,FVC)及FEV1/FVC,中医证候积分,免疫功能指标:CD_3~+、CD_4~+、CD_4~+/CD_8~+,并比较两组患者临床疗效。结果:治疗前两组患者FEV1、FVC及FEV1/FVC比较,差异均无统计学意义(P0.05);治疗后,观察组患者FEV1、FVC及FEV1/FVC与治疗前比较,差异均有统计学意义(P0.05);且观察组患者FEV1、FVC及FEV1/FVC均显著高于对照组(P0.05)。治疗前,两组中医证候积分比较,差异均无统计学意义(P0.05);治疗后,两组中医证候积分均显著下降(P0.05),且观察组咳嗽、咳痰、胸痛、呼吸困难、皮肤晦暗无泽、口干口渴、疲倦乏力及盗汗自汗等证候积分均显著低于对照组(P0.05)。治疗前,两组患者免疫功能指标比较,差异均无统计学意义(P0.05);治疗后,两组患者CD_4~+、CD_4~+/CD_8~+均显著改善(P0.05),观察组CD_4~+、CD_4~+/CD_8~+均显著高于对照组(P0.05)。观察组有效率为93.18%,对照组为74.29%,两组有效率比较,差异有统计学意义(P0.05)。结论:平喘固本汤联合补肺汤治疗稳定期COPD患者临床疗效显著,可显著改善患者肺功能、免疫功能及临床症状。     

中医辨证辅助治疗对肺结核痰涂片阳性患者转阴率的影响研究

目的:探讨中医辨证辅助治疗对肺结核痰涂片阳性患者治疗效果的影响。方法:选取本院2011年1月-2013年12月治疗的100例肺结核病患者,根据随机数字表法分为观察组和对照组,每组各50例,两组患者均给予西药标准化疗方案,观察组给予中医辨证辅助治疗。治疗1、3、6个月后评价疗效,重点观察临床症状好转率、痰菌转阴率及影像学好转率。结果:治疗1个月后,两组患者的临床症状好转率、痰菌转阴率及影像学好转率比较差异均无统计学意义(P0.05);治疗3个月后及6个月后,观察组患者的临床症状好转率、痰菌转阴率及影像学好转率显著高于对照组,两组比较差异均有统计学意义(P0.05)。100例患者中有7例患者在治疗过程中发生肝功能异常,其中观察组有3例,对照组有4例,两组比较差异无统计学意义(P0.05)。结论:中医辨证论治辅助治疗肺结核痰涂片阳性患者,能起到满意的效果。     

益气润肺汤联合黄芪注射液对耐药肺结核患者临床症状及机体免疫功能影响

目的研究益气润肺汤联合黄芪注射液对耐药肺结核患者临床症状及机体免疫功能影响。方法选择2014年1月-2016年3月间收治的80例耐多药性肺结核患者,将其随机分为对照组和观察组,每组40例,两组患者均给予强化期化疗6个月及巩固期化疗12个月。对照组患者在此基础上给予益气润肺汤,4周为1个疗程,连续3个疗程。观察组患者在对照组的基础上,加用黄芪注射液,连续使用6个月。比较两组患者体液免疫指标免疫球蛋白IgA、Ig E、补体C3、C4,细胞免疫指标CD3+、CD4+、CD8+、CD25+和自然杀伤细胞(NK),痰菌转阴情况,中医证候评分和不良反应发生情况,并评价疗效。结果与本组治疗前比较,观察组治疗后CD3+、CD4+、CD8+、NK升高,CD25+和CD4+/CD8+降低,且与对照组治疗后比较,观察组CD3+、CD4+、CD8+、NK升高(P 0. 05),CD25+和CD4+/CD8+降低(P 0. 05),差异有统计学意义。治疗后,两组IgA、Ig E降低(P 0. 05),C3、C4升高(P 0. 05),其中观察组IgA、Ig E含量低于对照组(P 0. 05),C3、C4高于对照组(P 0. 05),差异有统计学意义。强化期结束后,两组痰菌阴转率比较差异无统计学意义;疗程结束后,观察组痰菌阴转率高于对照组(P 0. 05),差异有统计学意义。与本组治疗前比较,两组治疗后中医证候评分减少(P 0. 05),且观察组治疗后评分低于对照组(P 0. 05),差异有统计学意义。观察组治疗后总有效率高于对照组(P 0. 05),观察组不良反应发生率低于对照组(P 0. 05)。结论对耐药肺结核患者采用益气润肺汤联合黄芪注射液治疗,能够提高疗效,改善患者病情,提高痰菌阴转率,并改善患者免疫功能,不良反应少,值得临床推广。     

莫西沙星联合卷曲霉素治疗耐多药肺结核的临床效果

目的:观察莫西沙星联合卷曲霉素治疗耐多药肺结核的效果。方法:选择耐多药肺结核患者26例,采用住院号的奇偶将其分为观察组与对照组各13例。对照组采用莫西沙星治疗,观察组在对照组基础上给予卷曲霉素联合治疗。对比两组患者的免疫系统功能指标(CD4~+、CD8~+、IgG、IgA、IgM)、痰抗酸杆菌(AFB)转阴率及药物不良反应情况。结果:观察组治疗后的CD4~+、CD8~+、IgG、IgA、IgM水平均明显优于对照组,AFB转阴率明显高于对照组,差异均有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:采用莫西沙星联合卷曲霉素治疗耐多药肺结核的效果优于单纯莫西沙星治疗效果。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.