辛开苦降法联合奥美拉唑治疗60例胃食管反流病临床观察

[目的]观察辛开苦降法对胃食管反流病(GERD)患者临床症状及心理状态的干预效果。[方法]收集60例GERD患者,并随机分为对照组和治疗组。对照组予奥美拉唑,治疗组在此基础上联合辛开苦降方,疗程为8周。以反流性疾病问卷量表(RDQ)、胃镜检查、焦虑自评量表(SAS)和抑郁自评量表(SDS)对疗效进行评估。[结果]2组治疗后RDQ各症状积分及总分均明显下降(P0.01),且治疗组下降更为显著;治疗后2组总体有效率分别为90.0%和70.0%,镜下有效率分别为90.9%和70.8%,治疗组均优于对照组(P0.05);治疗后治疗组SAS和SDS积分均明显低于对照组(P0.05)。[结论]辛开苦降法联合奥美拉唑治疗8周后可有效缓解烧心、反酸等症状,改善焦虑、抑郁状态,其疗效明显优于单独奥麦拉唑治疗。     

非糜烂性胃食管反流病与心理因素相关性的临床研究

[目的]通过调查60例非糜烂性胃食管反流病（non-erosive reflux disease,NERD）患者的耐性量表（RDQ）、焦虑自评量表（SAS）、抑郁自评量表（SDS）评分,探讨NERD与心理因素的相关性。[方法]随机分配60例NERD患者,治疗组30例用疏肝通降调神法治疗,对照组30例用疏肝通降法治疗,观测2组的临床疗效,客观评价加用调神法对NERD患者的疗效、心身状况、生活质量的影响。[结果]2组患者治疗前RDQ评分与SDS、SAS评分均呈显著正相关（P〈0.05）;治疗后RDQ评分与SDS、SAS评分相关性下降（P〉0.05）,以治疗组下降幅度更为明显。治疗后,2组RDQ、SDS、SAS评分与同组治疗前比较,差异均有统计学意义（P〈0.05）;与对照组治疗后比较,治疗组治疗后SDS、SAS评分显著改善（P〈0.05）。[结论]NERD患者与心理因素明显相关,疏肝通降法加用调神法在改善NERD患者症状的同时可改善患者的心理症状及生活质量。     

解郁颗粒治疗中轻度抑郁症的临床观察

目的观察疏解郁颗粒治疗中轻度抑郁症的临床疗效。方法选取2013年9月—2017年10月西安市中医医院收治的100例中轻度抑郁症病人,随机分为治疗组(40例)、逍遥丸对照组(30例)、氟西汀对照组(30例)。治疗组给予院内制剂解郁颗粒治疗,逍遥丸对照组、氟西汀对照组分别给予逍遥丸和盐酸氟西汀胶囊治疗。观察3组治疗前后汉密尔顿抑郁量表(HAMD)、抑郁自评量表(SDS)、焦虑自评量表(SAS)、中医症状评分变化。根据HAMD及中医症状评分量表评分结果评价疗效。结果治疗组总有效率为87.50%,逍遥丸对照组总有效率为80.00%,氟西汀对照组总有效率为86.67%,治疗组与氟西汀对照组比较差异无统计学意义(P0.05),治疗组与逍遥丸对照组比较差异有统计学意义(P0.05)。治疗4周后,3组HAMD、SAS、SDS评分均低于治疗前,差异均有统计学意义(P0.05)。治疗4周后,治疗组HAMD、SDS评分与氟西汀对照组比较差异无统计学意义(P0.05),治疗组、氟西汀对照组HAMD、SDS评分低于逍遥丸对照组(P0.05),3组间SAS评分比较差异有统计学意义(P0.05)。治疗4周后,3组少寐多梦、眠浅易醒、心烦易怒、情绪低落、郁郁不欢、倦怠乏力均较治疗前有改善(P0.05或P0.01)。治疗组少寐多梦、眠浅易醒、心烦易怒、情绪低落、郁郁不欢较治疗前改善明显(P0.01);逍遥丸组与氟西汀组情绪低落、郁郁不欢较治疗前改善明显(P0.01)。结论解郁颗粒治疗抑郁症的临床疗效及改善抑郁症状方面与氟西汀相当,但优于逍遥丸。     

电针联合五音疗法治疗伴焦虑抑郁状态溃疡性结肠炎40例临床观察

[目的]观察电针神道八阵穴联合徵调干预对伴焦虑抑郁状态溃疡性结肠炎患者临床疗效的影响。[方法]选取溃疡性结肠炎伴有焦虑抑郁状态患者80例,随机分为观察组和对照组,每组40例。对照组采用氟哌噻吨美利曲辛片治疗,观察组采用电针神道八阵穴联合徵调干预疗法。观察治疗前后中医症状、直肠黏膜评分、国际焦虑自评量表(SAS)、抑郁自评量表(SDS)评分,统计临床疗效。[结果]治疗后观察组在结肠症状总积分、直肠黏膜积分、SAS评分、SDS评分均低于与对照组,比较均有统计学意义(均P<0.05);观察组总有效率为92.50%,对照组总有效率为72.50%,差异有统计学意义(P<0.05)。[结论]电针神道八阵穴联合徵调干预疗法明显改善溃疡性结肠炎患者的焦虑、抑郁情绪,能明显提高临床疗效。     

辛开苦降法治疗非糜烂性胃食管反流病的临床疗效研究

[目的]观察辛开苦降法治疗非糜烂性胃食管反流病(NERD)的临床疗效。[方法]选择2015年1月~2016年12月于我院门诊就诊的NERD患者94例,按随机数字表法随机分为治疗组和安慰剂组。治疗组予辛开苦降方免煎剂口服,安慰剂组予中药安慰剂口服,治疗4周后对比2组患者反流症状评分、焦虑抑郁评分、生活质量评分及中医证候评分,评价临床疗效。[结果]治疗后治疗组反流症状评分、焦虑抑郁评分、生活质量评分及中医证候评分均明显高于安慰剂组(P0.05);治疗组反流症状有效率为87.23%,安慰剂组有效率为44.68%;治疗组明显高于安慰剂组,差异有统计学意义(P0.05);治疗组中医证候疗效总有效率85.11%,安慰剂组总有效率48.94%,治疗组明显高于安慰剂组,差异有统计学意义(P0.05)。[结论]辛开苦降法能够明显改善NERD患者反流症状及焦虑抑郁情绪,提升患者的生活质量。     

心理因素对质子泵抑制剂维持治疗老年非糜烂性反流病患者生活质量的影响

目的 探讨心理因素对质子泵抑制剂维持治疗的老年非糜烂性反流病(NERD)患者生活质量的影响. 方法 选择我院已确诊且用质子泵抑制剂(埃索美拉唑)维持治疗半年以上老年NERD患者76例,根据临床症状,参照反流性疾病问卷,将76例患者分为有症状组和无症状组,分别对两组患者进行Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)评分.并同时用胃食管反流病相关生活质量量表(GERD HRQL)和SF 36健康量表评估患者生活质量. 结果 与无症状组及健康对照组比较,有症状组SAS、SDS 评分明显升高(P＜0.05),GERD-HRQL评分增高(x2=19.689,P＜0.01),SF-36除生理功能外的其他7个健康维度评分明显降低(P＜0.05).相关分析发现,有症状组SAS、SDS得分与GERD-HRQL评分呈正相关(P＜0.01),与SF-36除生理功能外的其他7个健康维度评分呈负相关(P＜0.05). 结论 质子泵抑制剂疗效差的老年NERD患者,多数合并心理问题,生活质量明显下降;老年NERD患者心理异常与生活质量下降明显相关.     

舒肝解郁胶囊治疗伴轻中度抑郁症的功能性消化不良的临床效果观察

[目的]观察舒肝解郁胶囊治疗伴轻中度抑郁症状的功能性消化不良(functional dyspepsia,FD)患者的临床疗效及不良反应。[方法]将245例伴轻中度抑郁症的FD患者随机分为观察组与对照组,采用随机双盲对照研究,2组均服用多潘立酮片、雷贝拉唑片,观察组135例加服舒肝解郁胶囊,对照组110例加服用安慰剂,疗程均为4周。比较2组治疗前后临床疗效、胃肠道症状评定量表(gastrointestinal symptom rating scale,GSRS)积分、医院焦虑抑郁量表(hospital anxiety depression scale,HADS)抑郁症状评分及不良反应。[结果]治疗4周后,观察组显效24例(17.8%),有效81例(60.0%),无效30例(22.2%),总有效率为77.8%;对照组显效4例(3.6%),有效35例(31.8%),无效71例(64.5%),总有效率为35.5%;观察组总有效率显著高于对照组(P0.05)。观察组GSRS积分及HADS抑郁症状评分均显著低于对照组(P0.05)。[结论]舒肝解郁胶囊联合质子泵抑制剂及促胃动力药治疗伴轻中度抑郁症状的FD疗效显著,安全可靠。     

奥美拉唑联合沉香化气胶囊治疗非糜烂性反流病60例

[目的]观察沉香化气胶囊治疗非糜烂性反流病(NERD)的临床疗效.[方法]105例NERD患者随机分2组,分别为治疗组(沉香化气胶囊加奥美拉唑肠溶胶囊)、对照组(奥美拉唑肠溶胶囊),治疗4周后总结2组患者临床疗效.[结果]治疗组治疗NERD起效时间快,且效果明显优于对照组(P＜0.01,＜0.01).[结论]沉香化气胶囊在治疗NERD中具有较好的疗效.     

振源胶囊治疗冠心病慢性心力衰竭伴焦虑抑郁状态病人临床疗效分析

目的观察振源胶囊治疗冠心病慢性心力衰竭伴焦虑抑郁状态病人的临床疗效。方法随机选择2014年1月—2014年12月于我院心内科收治的60例冠心病慢性心力衰竭伴焦虑抑郁状态病人,采用随机数字表法分为试验组(30例)和对照组(30例)。对照组予以常规西药治疗+心理干预,试验组在对照组治疗基础上加用振源胶囊,10d为1个疗程,观察3个疗程。治疗后比较两组病人心功能、中医症状、焦虑自评量表(SDS)、抑郁自评量表(SAS)。结果治疗后试验组病人心功能疗效、中医症状疗效均高于对照组,差异有统计学意义(P0.05)。治疗后对照组SDS及SAS评分无明显改善,差异无统计学意义(P0.05),试验组SDS及SAS评分比治疗前显著下降,差异有统计学意义(P0.01),且治疗后试验组评分明显低于对照组,差异有统计学意义(P0.01)。结论振源胶囊能明显提高冠心病慢性心力衰竭病人的临床疗效,改善病人的焦虑抑郁状态。     

黛力新对冠心病伴焦虑抑郁患者治疗效果和生活质量的影响

目的探讨黛力新与抗心肌缺血治疗对冠心病伴焦虑抑郁患者的疗效和对生活质量的影响。方法冠心病伴焦虑抑郁患者128例,随机被均分为观察组和对照组,分别给予抗心肌缺血药物联合黛力新治疗,单纯抗心肌缺血治疗。疗程8周时观察临床症状、心电图及焦虑自评量表和抑郁自评量表评分的变化;半年后采用中国心血管病人生活质量评定问卷进行生活质量评估。结果观察组心绞痛和心电图疗效分别为92.19%和84.38%,明显高于对照组的79.69%和68.75%(P均<0.05),观察组焦虑自评量表和抑郁自评量表评分在治疗后显著下降(P均<0.01),且显著优于对照组(P均0.05);观察组中国心血管病人生活质量评定问卷的得分均高于对照组(P均<0.01)。结论黛力新治疗冠心病伴焦虑、抑郁患者效果良好,能够改善患者的生活质量。     

肿瘤病人弓形虫感染分析

在肿瘤的发生和发展进程中 ,多伴有免疫功能低下或缺陷 ,从而极易遭受各种感染。弓形虫是机会感染因子 ,当患者免疫功能受损时 ,易于感染 ,还会使隐性感染激活 ,引起低热不退、淋巴结肿和脑神经系统的反应 ,此现象尚未引起临床医师的重视。近年来 ,我们对 4 0 9例肿瘤病人进行了弓形虫感染及弓形虫病的分析观察 ,报告如下 :1　材料与方法1 1　材料　 30 4例病人血清取自江西省肿瘤医院住院或门诊病人 ,随机抽样后低温保存待检 ,10 5例取自其他医院送检样品 ,有急性症状者随到随检 ,以便及时做病原学检测。1 2　弓形虫病诊断方法1 2 1　免疫…     

A patient with rectal ulcer with severe stenosis presenting with perforated peritonitis

We report a patient with rectal ulcer with severe stenosis, who underwent urgent surgical treatment for perforated peritonitis. The 54-year-old man suddenly developed cramping abdominal pain and fever while hospitalized, with signs of peritoneal irritation. An emergency laparotomy was performed, and severe stenosis of the rectum and a perforated lesion on the oral side approximately 10 cm distant from the stenosis were found, with massive abdominal purulent fluid. He was treated by rectosigmoid colon resection with transverse colon loop colostomy. Histopathologically, the stenosis was caused by ulceration extending to all muscular layers of the rectum, with inflammatory changes. Benign rectal stenosis is so rare that differential diagnosis from malignancy may be difficult when there are inflammatory changes in the surrounding tissues. However, it is necessary to keep in mind the likelihood of this disease in differentiation from rectal cancer. Received: December 21, 1998 / Accepted: May 28, 1999     

Evaluation of atrial vulnerability with transoesophageal stimulation in patients with atrioventricular junctional: Comparison with patients with ventricular pre-excitation and with normal subjects

The aim of our work was to evaluate the inducibility of atrialfibrillation in a group of patients with atrioventricular junctionalreentrant tachycardia and to compare it with that of patientswith a Kent-type ventricular pre-excitation (Wolff-Parkinson-Whitesyndrome) and a control group. One hundred and twenty-five subjects were separated into groups.Group 1 comprised 49 Wolff-Parkinson-White patients, with amean age of 26.4, range 10.66 years; group 2, 51 patients withatrioventricular junctional reentrant tachycardia inducibleby transoesophageal atrial stimulation andlor clinically documented,with a mean age of 43.4, range 16–78 years; group 3, 25control subjects with a mean age of2.64, range 13–76 years. Each subject underwent atrial transoesophageal stimulation withthe following protocol: programmed atrial stimulation with 1and 2 stimuli during atrial pacing of 100. min^–1 and 150.min^–1; atrial stimulation for 10 s at a rate of 200–300–400–500–600.min^–1 with intervals of 10 s between stimulations, fivesuccessive ‘ramp-up’ atrial stimulations for 9 swith the rate increasing from 100 to 800. min^–1 with intervalsof 10 s between stimulations. The end point was the completionof the protocol or induction of sustained atrial fibrillation(>1 min). The chi-square test was used for statistical analysis. Our resultsshowed that in group 1 atrial fibrillation was induced in 27149patients (55.1%); this was sustained in 13149 (26.5%) and non-sustainedin 14149 (28.5%); in group 2, atrial fibrillation was inducedin 22151 patients (43.0%); it was sustained in 7151 (13.7%)and non-sustained in 15151 (29.4%); in group 3, sustained atrialfibrillation was not induced in any subject and in only onesubject was a non-sustained atrial fibrillation (4 s) induced. The chi-square test showed that group 2 vs group 1 were non-significant,while group 2 vs group 3 and group 1 vs group 3 were significant(P<0.003 and P<0.0007, respectively). Therefore group 2 patients showed a greater atrial vulnerabilityin comparison to the control subjects and a similar vulnerabilityto group 1 patients. It is possible that the greater atrialvulnerability in the patients of group 2 was due to the doublenodal pathway.     

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.     

Treating patients with lupus with B-cell depletion

A new era in the treatment of systemic lupus erythematosus has dawned with the increasing introduction of monoclonal antibodies and other approaches, that target the key molecules involved in the pathogenesis of the disease. At present the ability to block the CD20 molecule on those B cells that carry this marker has proved the most effective way to treat patients resistant to conventional immunosuppressive drugs. However, these studies have all been open label and the results of double blind controlled studies are eagerly awaited.