功能性排便障碍的生物反馈治疗

罗马Ⅲ专家委员会在近年研究基础上,对功能性肛门直肠病的诊治标准进行了修订,将功能性便秘的出口梗阻型归入功能性肛门直肠病中,称为功能性排便障碍。功能性排便障碍包括盆底失迟缓和排便时直肠推进力不足所引起的排便困难。近年来认为脑-肠轴功能异常是也是引起便秘的重要原因。胃肠动力异常、内脏高敏感等可通过中枢神经系统（CNS）与肠神经系统（ENS）的脑-肠相互作用产生影响。生物反馈治疗因无创伤、无毒副作用、安全有效被认为是治疗功能性排便障碍的首选。     

直肠肛门测压与生物反馈治疗功能性便秘在临床中的应用

目的探讨功能性便秘患者直肠肛门压力变化及生物反馈治疗对功能性便秘的疗效。方法180例功能性便秘患者（便秘组）被纳入本研究,采用维迪胃肠肠动力检测和生物反馈仪行直肠肛门测压和生物反馈治疗,治疗前后分别对患者进行临床症状评分,并记录直肠、肛管静息压、肛管自主收缩持续时间及直肠肛门抑制反射域。60倒无排便异常患者（对照组）作为正常对照,接受直肠肛门测压。结果①与正常对照组比较,功能性便秘患者直肠、肛管静息压、肛管自主收缩持续时间及直肠肛门抑剞反射域值均明显增高（P〈0．05）。②治疗后便秘患者临床症状减轻,显效45例,有效96例,总有效率约78．3％。直肠、肛管静息压、肛管自主收缩持续时间及直肠肛门抑制反射域值降低（P〈0．05）。结论功能性便秘患者存在直肠肛门压力异常,生物反馈治疗可通过改善直肠肛门压力异常达到治疗便秘的目的。     

肛门直肠测压在功能性便秘中的临床应用

目的 观察功能性便秘患者的肛门直肠动力学改变.方法 采用肛门直肠测压方法检测189例功能性便秘患者的肛门直肠静息压、缩榨压、直肠初始感觉阈值、排便阈值、最大耐受容量指标及反常运动情况.结果所有患者均有直肠肛门运动功能的异常,有32.2%的患者出现了排便时的反常运动.结论功能性便秘患者存在肛门直肠动力和感觉异常,肛门直肠测压为便秘的分型和治疗提供了重要依据,值得临床推广.     

生物反馈治疗出口梗阻型便秘临床观察

功能性便秘是一种具有持续性排便困难、排便次数减少或排便不尽感的功能性肠病,其治疗多年来困扰着临床医生。国外报道应用生物反馈治疗便秘,获得令人鼓舞的疗效,但至今国内尚未广泛开展。出口梗阻型便秘是功能性便秘的一种,是由于肛门直肠附近的组织或器官发生生理性改变导致的排便困难。为评估生物反馈治疗不同亚型出口梗阻型便秘的临床疗效，我们针对不同型的特点采取了不同措施与疗程并进行比较，现报道如下。     

便秘型肠易激综合征直肠感觉功能和肛门动力学研究

目的观察便秘型肠易激综合征(IBS-C)直肠感觉功能及肛门动力学变化.方法采用PCpolygraf HR高分辨多道胃肠动力测定仪,对20例IBS-C患者与18例健康对照组测定直肠-肛门的压力变化,直肠对容量刺激的感觉阈值、排便阈值及直肠的顺应性.结果直肠肛门的静息压、模拟排便时直肠肛门的收缩压、肛门内外扩约肌的净减压,与对照组相比差异无显著性(P＞0.05),而肛门直肠的屏障压、直肠对容量刺激的感觉阈值、排便阈值及直肠的顺应性均高于对照组(P<0 05).结论便秘型IBS存在直肠感觉功能的异常及肛门的动力异常.     

针灸治疗老年功能性便秘的临床疗效与作用机制研究概况

功能性便秘是老年人群的常见疾病。研究表明,针灸在增加患者的排便次数、改善排便困难、降低疾病复发率、提高患者的生活质量等方面具有较好的效果,其作用机制与调节肠神经系统及相关神经递质、改善肛门直肠动力学相关指标,以及对中枢神经-肠道-微生物（即脑-肠轴）的调节作用有关。通过对单纯针刺、针药结合、穴位埋线、耳穴压丸等方法治疗老年功能性便秘的临床与机制研究概况进行评述,以期为针灸治疗老年人群功能性便秘机制研究提供更多思路与方向。     

生物反馈疗法治疗功能性排便障碍研究进展

正功能性排便障碍(functional defecation disorder,FDD)是慢性便秘的一种亚型,其主要特征是排便时盆底肌和肛门外括约肌不协调收缩,和(或)直肠推进力不足,引起肛门出口阻力增加,导致粪便无法正常排出,对患者生活质量产生严重影响~([1-2])。目前,药物、食物调整、运动等方法治疗FDD效果欠佳~([3])。研究证实,生物反馈疗法可以显著改善FDD患者的便秘症状,被多项国内外指南和共识推荐为治疗FDD     

普芦卡必利对慢传输型便秘疗效的临床观察

便秘是临床常见症状,常表现为肠传输时间延长、直肠肛管运动不协调。按病理生理学机制,功能性疾病所致的便秘可分为慢传输型便秘、排便障碍型便秘、混合型便秘、正常传输型便秘。结肠动力下降所引起的结肠传输功能异常,使粪便在肠道停留时间过长的便秘,即STC,此类型便秘占功能性便秘的45.5%[1]。临床上通常予一般治疗、泻剂、促动力药或手术方法治疗,其中新型促动力药普芦卡必利(Prucalopride,Pru)对STC有显著治疗作用。     

72例中老年功能性便秘患者肛门直肠动力学特点分析

目的探讨中老年功能性便秘患者肛门直肠动力学特点。方法选择72例中老年功能性便秘患者进行肛门直肠压力测定,并与48例青年功能性便秘患者进行比较。结果中老年功能性便秘患者的肛管最大收缩压明显低于青年患者（P＜0.05）;初始感觉阈值、初始排便阈值、最大耐受阈值均明显高于青年患者（均P＜0.05）;模拟排便时肛残余压、引起肛门直肠抑制反射的最小容积、肛残余压异常率均明显高于青年患者（均P＜0.05）。结论中老年功能性便秘患者盆底肌肉群收缩能力明显减弱,盆底肌群改变造成的出口梗阻严重,直肠灵敏度较低。     

生物反馈治疗在功能性便秘患者中的应用

目的：研究功能性便秘患者临床症状评分以及肛门直肠压力,评价生物反馈治疗对功能性便秘患者临床症状、肛门直肠压力的影响。方法给予2012年3月-2013年3月我院符合罗马Ⅲ诊断标准的53例功能性便秘患者生物反馈治疗,至少1个疗程后再行临床症状评分及肛门直肠压力测定。结果生物反馈治疗后患者便秘症状评分显著降低,有效率83.00%;与治疗前相比,肛管静息压、肛门括约肌最大缩榨压、直肠最初感觉容量、初始便意感觉容量和最大耐受容量均显著改善(P<0.05)。结论生物反馈治疗可改善功能性便秘患者的临床症状及肛门直肠动力异常,安全有效。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…