黄连温胆汤治疗冠心病心绞痛70例疗效评价

目的探讨研究中医药复方治疗冠心病心绞痛的临床疗效。方法共收集符合纳入标准的冠心病患者120例,将入组的冠心病心绞痛患者随机分为对照组和治疗组,对照组给予临床常规的西医基础治疗,治疗组则在常规的西医基础治疗上加服黄连温胆汤加减方,在治疗2周、4周后,分别观察两组症状总积分、临床疗效及心电图的改善情况。结果治疗组症状总积分、临床疗效及心电图的改善情况明显优于对照组(P<0.05)。结论黄连温胆汤化裁方能明显改善患者的临床症状,提高生存质量,可在临床推广。     

内消瘰疬片联合化疗治疗颈淋巴结核120例

目的评价内消瘰疬片联合化疗治疗淋巴结核的有效性及安全性。方法 120例淋巴结核患者在抗结核化疗基础上联合内消瘰疬片治疗,与单纯抗结核化疗治疗相比较,观察1、2、4月末临床症状及B超的变化。结果治疗组1、2、4月末临床症状及病灶缩小均优于对照组。结论内消瘰疬片联合化疗药对症状改善及病灶缩小效果显著,值得临床推广。     

临床路径在腹股沟疝治疗及护理中的应用效果

目的讨论研究临床路径应用于腹股沟疝的治疗及护理效果。方法选取我院外科腹股沟疝气患者100例。随机分为研究组、对照组,各50例。其中研究组采用临床路径方法进行治疗及护理;对照组采用日常护理。比较两组患者术后治疗、恢复时间及术后并发症发生率等指标。结果手术恢复情况及费用比较显示临床路径组患者其恢复时间及治疗费用等指标均显著优于常规治疗组患者(P<0.05)。并发症发生人数比较显示经临床路径治疗及护理组患者其各类并发症发生人数均显著少于日常治疗组患者(P<0.05)。结论应用临床路径可有效提高腹股沟疝治疗效率,在短时间内帮助患者恢复健康,降低并发症发生率。另外,可帮助患者减轻心理负担,缓解精神压力,在一定程度上降低医疗费用。增加患者与医务人员交流,提高其治疗依从性,促进医患关系和谐,显著提高护理质量。     

丽珠肠乐及莫沙必利治疗肝衰竭42例

目的观察丽珠肠乐及莫沙必利治疗慢加急性（亚急性）肝衰竭临床疗效。方法将2003年1月至2007年12月间住院的慢加急性（亚急性）肝衰竭患者随机分为治疗组及对照组,对照组仅给予内科综合治疗,治疗组在此基础上加丽珠肠乐及莫沙必利口服治疗,疗程1月。结果治疗组临床疗效优于对照组（P〈0.01）,治疗组治疗后出血、感染、肝性脑病、肝肾综合征、腹水并发症少于对照组。结论丽珠肠乐及莫沙必利治疗慢加急性（亚急性）肝衰竭临床疗效显著,预后明显改善。     

一个值得深思的问题：重症治疗是病情导向抑或治疗目标导向

临床治疗的进行, 一定要有目标;没有目标的干预方法, 不能称之为治疗。目标导向的治疗, 不仅只用于重症, 其他疾病或综合征的临床管理亦需要相应的治疗目标。临床治疗通常有三种表现形式:疾病作为目标导向的治疗、病情作为目标导向的治疗及治疗目标导向的病程进展。不同的临床治疗形式, 主要是对机体损伤机制的理解不同、临床管理的策略不同、治疗方法的实施标准不同, 从而导致预后的不同。医学在不断发展, 医务人员的认识和临床行为的演变亦在其中。     

小儿脑外积液34例治疗体会

目的总结小儿脑外积液的临床特征、分型及治疗方法的选择。方法分析我院治疗的34例脑外积液患儿的临床资料及治疗效果。结果 34例患儿经治疗后,28例临床症状消失或明显好转出院,在出院后3个月后复查积液均消失;4例出院时CT检查积液无明显减少,但临床症状减轻,出院后3个月复查积液减少;2例出院时临床症状及CT检查均无改善。提出了分型及治疗方案。结论小儿脑外积液的原因是多方面的,临床表现缺乏特异性,详细的病史及CT检查有利于明确诊断及分型;根据分型指导治疗方法的选择,有利于提高治疗效果。     

养阴法治疗肿瘤的研究进展

肿瘤的综合治疗包括手术、化疗、放疗、免疫治疗、分子靶向治疗、中医药治疗等,其中中医药治疗是肿瘤治疗的特色,贯穿整个治疗过程.养阴法是中医治疗肿瘤的重要方法之一,在术后及放化疗后运用尤多,本研究就其治疗肿瘤的临床及实验机理研究进展作一综述,以冀更好地指导临床.     

茶碱类药物在支气管哮喘治疗中的合理应用

茶碱类药物在支气管哮喘(简称哮喘)治疗中有悠久的历史,合理应用茶碱,在哮喘规范化治疗中占有一席之地,本文就茶碱类药物的作用机制、在哮喘治疗中的临床应用及注意事项等作一概述,以期在临床中合理使用茶碱,发挥其应有的治疗作用,提高临床用药的安全性。     

无创正压通气治疗急性左心衰竭应用的初步探讨

目的探讨无创正压机械通气(NIPPV)治疗急性左心衰竭临床应用的最佳时机。方法选择61例急性左心衰竭的患者,在内科常规治疗的基础上随机分为两组:治疗组在治疗初期即采用无创双水平(BiPAP)正压通气,对照组先予以面罩吸氧,2h后进行无创通气,观察治疗前及治疗后2h、8h后临床症状、生命体征、动脉血气分析等指标变化及24h后的临床疗效。结果治疗组患者在治疗2h后的各项指标、8h后的部分指标变化与同期对照组比较有显著差异,治疗24h后,治疗组总有效率93.6%;对照组总有效率80%(P<0.05)。结论急性左心衰治疗初期是应用无创正压通气的最佳时机,临床见效快,并且成功率高,可供临床选择应用。     

米力农治疗小儿先天性心脏病合并重症肺炎及心力衰竭临床观察

目的研究米力农治疗小儿先天性心脏病合并重症肺炎及心力衰竭的临床效果。方法本次纳入2017年6月至2018年5月收治的74例先天性心脏病合并重症肺炎及心力衰竭患儿展开研究,按照入院先后顺序分为两组,对照组37例予以常规专科治疗,观察组37例联合米力农治疗。将两组的临床指标改善情况、心功能指标、临床效果进行比对。结果观察组先天性心脏病合并重症肺炎及心力衰竭患儿的临床指标改善时间短于对照组,治疗后的LVEF、LVSF以及临床总有效率高于对照组,治疗后的LVDD低于对照组,差异具有统计学意义(P0.05)。结论在小儿先天性心脏病合并重症肺炎及心力衰竭的治疗中应用米力农有助于临床疗效的提高及临床症状体征的改善,可恢复心功能。     

Echocardiographic assessment of myocardial strain

Echocardiographic strain imaging, also known as deformation imaging, has been developed as a means to objectively quantify regional myocardial function. First introduced as post-processing of tissue Doppler imaging velocity converted to strain and strain rate, strain imaging has more recently also been derived from digital speckle tracking analysis. Strain imaging has been used to gain greater understanding into the pathophysiology of cardiac ischemia and infarction, primary diseases of the myocardium, and the effects of valvular disease on myocardial function, and to advance our understanding of diastolic function. Strain imaging has also been used to quantify abnormalities in the timing of mechanical activation for heart failure patients undergoing cardiac resynchronization pacing therapy. Further advances, such as 3-dimensional speckle tracking strain imaging, have emerged to provide even greater insight. Strain imaging has become established as a robust research tool and has great potential to play many roles in routine clinical practice to advance the care of the cardiovascular patient. This perspective reviews the physiology of myocardial strain, the technical features of strain imaging using tissue Doppler imaging and speckle tracking, their strengths and weaknesses, and the state-of-the-art present and potential future clinical applications.     

Strain Imaging: The Emergence of Speckle Tracking Echocardiography into Clinical Pediatric Cardiology

Speckle tracking echocardiography measures myocardial strain and allows for the quantification of regional and global left and right ventricular function. A growing body of literature is supporting its transition from research into clinical practice. This article aims to provide a practical review of strain imaging as it applies to congenital and pediatric heart disease, with the goals of increasing literacy and advocating for greater clinical integration.     

Positron emission tomography in ischemic heart disease

Non-invasive assessment of ischemic heart disease remains a challenging task, even with a large armory of diagnostic modalities. Positron emission tomography (PET) is an advanced radionuclide technique that has been available for decades. Originally used as a research tool that contributed to advances in the understanding of cardiovascular pathophysiology, it is now becoming established in clinical practice and is increasingly used in the diagnosis and risk stratification of patients with ischemic heart disease. PET myocardial perfusion imaging has a mean sensitivity and specificity of around 90% for the detection of angiographically significant coronary artery disease, and is also highly accurate for assessing the prognosis of patients with ischemic heart disease. Depending on the radiotracer used, it can provide information not only on myocardial perfusion but also on myocardial metabolism, which is essential for viability assessment. The potential of this imaging technique has been further increased with the introduction of hybrid scanners, which combine PET with computed tomography or cardiac magnetic resonance imaging, offering integrated morphological and functional information and hence comprehensive assessment of the effects of atherosclerosis on the myocardium. The scope of this review is to summarize the role of PET in ischemic heart disease.     

负荷超声心动图在缺血性心脏病中的临床应用进展

近年来,随着缺血性心脏病发病率的逐年升高,无创评估影像技术越来越受到人们关注。负荷超声心动图作为一项较成熟的技术,目前已用于缺血性心脏病的诊断、存活心肌的评价、危险分层和预后的评估。心肌声学造影、斑点追踪成像技术和三维超声心动图等超声新技术的发展,使负荷超声心动图的诊断准确性和特异性均有提升,相信未来会更广泛地应用于临床。     

提高核素心肌显像在冠心病诊断中的临床价值

核素心肌显像在冠心病的诊断中具有重要价值。由于受多种因素影响,尚未被大多数医院或冠心病患者接受。本文通过加强同临床医师的沟通使核素心肌规范化,充分发挥门控心肌显像的优势,结合心肌代谢显像鉴别存活心肌,选择合适的病人进行诊断性核素心肌显像检查等方面的论述,旨在提高核素心肌显像的临床应用价值和冠心病的诊断水平,充分合理应用医疗资源,减少病人痛苦和住院费用。     

Left ventricular noncompaction: an unusual cause of ventricular ectopic beats.

Isolated ventricular ectopic beats (VEB) are a frequent finding in clinical practice. Determining their etiology and risk stratification strategies requires exclusion of non-cardiac causes and structural heart disease. However, with advances in imaging techniques, molecular biology and electrophysiology, the concept of structural heart disease has changed, and it is important to consider the benefits of using these techniques in cases that have not been entirely clarified. The authors describe the case of a patient with frequent isolated VEB, with a find diagnosis of isolated noncompaction of the lefts ventricle following cardiac magnetic resonance imaging. They present an uncommon cause of VEB, which has raised questions regarding its real prevalence. Better diagnostic accuracy is expected with the use of new imaging techniques.     

糖尿病心肌病临床诊疗新进展

糖尿病心肌病（DC）最初描述为糖尿病患者在除外高血压、冠心病、瓣膜性疾病及先天性心脏病等存在的情况下发生心力衰竭。目前认为DC是线粒体功能紊乱、能量代谢障碍、脂毒性、晚期糖基化终产物形成、内皮细胞受损、微循环障碍、内质网应激、RAAS激活、自噬功能减退、心脏自主神经病变、miRNA调节异常等多种因素相互协同、共同作用，导致心肌细胞凋亡、胶原沉积、基质增生、间质纤维化，微血管病变及冠状动脉病变。早期可发生舒张功能障碍或心脏纵向应变能力减退等亚临床DC表现，随着病程进展，晚期射血分数逐渐下降，心功能严重受损。临床可通过使用超声、磁共振成像、核素显像早期发现心脏舒缩功能参数或结构的异常，尤其是组织多普勒超声、磁共振T1-mapping技术及心肌细胞外体积测定等方法近年来逐步引人重视。此外，还发现某些生物学标志物与DC相关。目前关于DC的治疗还未形成共识，缺乏有效的治疗手段。因此还需进一步的基础及临床研究提供更明确的诊疗方向。     

Role of cardiac imaging in heart failure

Heart failure is the leading cause of mortality and rehospitalization in Western countries. With the development of new technologies applied to medical diagnostic pathways, cardiovascular imaging has rapidly gained ground. Therefore, the clinical cardiologist has to keep updated on the management of such innovative diagnostic tools which were once the exclusive domain of radiologists. The need to understand a new language is fundamental for the selection of diagnostic and therapeutic strategies in patients with heart failure, which is often the final destination for many cardiovascular diseases. Alongside standard diagnostic techniques such as chest radiography two-dimensional ultrasound and cardiac color Doppler, all of which are indispensable in daily practice, innovative tools have been defining their incremental role in cardiovascular imaging. Cardiac magnetic resonance (CMR), cardiac computed tomography (CT), speckle tracking, 3D echocardiography, new applications in nuclear medicine (SPECT MIBG), and "cardiac hybrid imaging" are emerging for research and are also playing a pivotal role in the clinical scenario. These techniques are useful the for non-invasive acquisition of diagnostic and prognostic information in heart failure. Whether the radiological and economic impact of these new technologies is sustainable is a question the clinical cardiologist will need to answer when considering the cost/benefit of the diagnostic tool selected among these methods.     

The Role of Imaging in Measuring Disease Progression and Assessing Novel Therapies in Aortic Stenosis

Aortic stenosis represents a growing health care burden in high-income countries. Currently, the only definitive treatment is surgical or transcatheter valve intervention at the end stages of disease. As the understanding of the underlying pathophysiology evolves, many promising therapies are being investigated. These seek to both slow disease progression in the valve and delay the transition from hypertrophy to heart failure in the myocardium, with the ultimate aim of avoiding the need for valve replacement in the elderly patients afflicted by this condition. Noninvasive imaging has played a pivotal role in enhancing our understanding of the complex pathophysiology underlying aortic stenosis, as well as disease progression in both the valve and myocardium. In this review, the authors discuss the means by which contemporary imaging may be used to assess disease progression and how these approaches may be utilized, both in clinical practice and research trials exploring the clinical efficacy of novel therapies.     

Doin' the twist: new tools for an old concept of myocardial function

It has been known for some time that the heart rotates during the cardiac cycle in concert with radial and longitudinal motion. With advances in imaging technology, it has been appreciated that the apex and base of the heart rotate in different directions, resulting in a twisting or torsional motion. A new echocardiographic technique, "speckle tracking imaging", permits accurate quantification of this motion. Torsion as well as the timing and magnitude of the rate of torsion (torsional velocity) may provide important new insights into cardiac physiology and disease.