酮替芬治疗50例感染后咳嗽的疗效观察

目的：观察酮替芬联合孟鲁司特钠和右美沙芬治疗感染后咳嗽的疗效。方法100例感染后咳嗽患者分成2组,观察组口服酮替芬1mg,每天2次,孟鲁司特钠10mg每晚1次,右美沙芬片15mg每天3次。对照组口服孟鲁司特钠10mg,每晚1次,右美沙芬片15mg,每天3次。治疗时间为2周。结果两组治疗2周后咳嗽积分和视觉模拟评分均较治疗前有显著性改善,差异有统计学意义（P＜0．01）。治疗2周后两组间比较,观察组疗效优于对照组,差异有统计学意义（P＜0．05）。结论酮替芬联合孟鲁司特钠和右美沙芬治疗感染后咳嗽较孟鲁司特钠联合右美沙芬治疗感染后咳嗽疗效更好。     

孟鲁司特钠治疗感染后咳嗽疗效观察

目的探讨孟鲁司特钠治疗感染后咳嗽的疗效。方法感染后咳嗽患者60例,随机分为观察组和对照组各30例,观察组给予口服孟鲁司特钠10mg,1次/d,右美沙芬片30mg,3次/d;对照组口服右美沙芬片30mg,3次/d,疗程均为10d。在治疗前及治疗后分别根据咳嗽症状积分表进行评分,观察两组治疗后评分的改善率,评估疗效。结果治疗后观察组改善率（67±11）%;对照组改善率（47±10）%,两组比较差异有统计学意义（P〈0.01）。结论孟鲁司特钠可以改善感染后咳嗽患者的临床症状,是有效的治疗方法。     

93例感冒后咳嗽患者中西医结合治疗分析

目的 探讨中西医结合治疗感冒后咳嗽的临床疗效.方法 对93例感冒后咳嗽患者随机分为2组,观察组49例在给予马来酸氯苯那敏和盐酸伪麻黄碱治疗的基础上加用止嗽散化裁,对照组49例患者给予马来酸氯苯那敏和盐酸伪麻黄碱治疗;比较2组患者的临床疗效.结果 观察组疗效优于对照组.结论 中西医结合治疗感冒后咳嗽较单纯西药治疗有更好的效果.     

沙美特罗替卡松治疗感染后咳嗽的临床观察

目的探讨沙美特罗替卡松治疗感染后咳嗽的效果。方法以本院感染后咳嗽患者118例为研究对象,按照随机数字表法,将患者随机分为沙美特罗组(58例)和氯苯那敏组(60例),前者吸人沙美特罗替卡松(50μg沙美特罗,500μg替卡松),每次1吸,2次/日,后者口服氯苯那敏片,每次4mg,2次/日,疗程均为2周。观察治疗前后咳嗽症状的差异。结果吸入沙美特罗替卡松组患者和口服氯苯那敏组患者咳嗽症状都有明显改善,与治疗前比较差异有显著性,沙美特罗替卡松组治疗效果明显优于氯苯那敏组。结论吸入沙美特罗替卡松对感染后咳嗽有较好的治疗作用。     

孟鲁司特口服联合吸入用复方异丙托溴铵溶液雾化吸入治疗儿童感染后咳嗽临床观察

目的研究孟鲁司特口服联合吸入用复方异丙托溴铵溶液雾化吸入治疗儿童感染后咳嗽的临床疗效。方法选择2013年4月至2015年3月北京丰台医院收治的感染后咳嗽患儿74例,按照随机数字表法分为观察组和对照组,各37例。对照组口服孟鲁司特钠咀嚼片,1~5岁剂量为4 mg/d,6~10岁剂量为5 mg/d,每日1次;观察组在此基础上联合吸入用复方异丙托溴铵溶液雾化吸入,每日2次,疗程均为10 d。比较两组患儿治疗前后咳嗽评分变化,观察两组患儿临床症状消失时间、临床疗效和不良反应发生情况。结果两组患儿治疗5、10 d咳嗽评分均较治疗前呈下降趋势,观察组在治疗5、10 d的下降速度更快[观察组:(2.01±0.33)分、(1.03±0.14)分比(2.51±0.48)分;对照组:(1.47±0.21)分、(0.31±0.05)分比(2.51±0.48)分],两组在组间、不同时点间、组间·不同时点间交互作用比较差异有统计学意义(P<0.05)。观察组患儿的咳嗽症状缓解时间和消失时间显著短于对照组[(6.4±1.2)d比(8.9±2.2)d、(8.4±2.1)d比(11.0±3.0)d],差异有统计学意义(P<0.01)。观察组患儿总的有效率显著高于对照组[91.89%(34/37)比70.27%(26/37)](P<0.05)。两组不良反应发生率比较差异无统计学意义[2.70%(1/37)比5.41%(2/37)](χ2=0.3474,P>0.05)。结论孟鲁司特口服联合吸入用复方异丙托溴铵溶液雾化吸入治疗儿童感染后咳嗽,能缩短患儿的临床症状缓解时间和消失时间,临床疗效良好,安全性高。     

吸入性糖皮质激素对咳嗽变异性哮喘气道炎症和高反应性的影响

目的 分析吸入性糖皮质激素对咳嗽变异性哮喘患者气道炎症和高反应性的影响.方法 选取2017年2月至2018年10月本院收治的62例咳嗽变异性哮喘患者为观察组,另选同期60名本院健康体检者为对照组.观察组给予吸入性糖皮质激素治疗1年,观察并比较两组气道指标,比较观察组患者治疗前后气道反应及气道炎症的变化情况.结果 观察组嗜酸性粒细胞在其他炎症细胞中的占比高于对照组,差异有统计学意义(P<0.05);两组FEV1、FEV1/FVC比较差异无统计学意义;随着治疗时间的增加,观察组气道反应性FEV1-PD20水平、气道炎症水平IL-10逐渐升高,气道炎症水平IL-5逐渐降低,与治疗前比较差异均有统计学意义(P<0.05).结论 长期吸入性糖皮质激素治疗咳嗽变异性哮喘患者效果显著,可有效控制气道炎症,促进气道高反应性好转,值得临床推广应用.     

小青龙汤加减治疗嗜酸粒细胞性支气管炎的临床疗效及其对效应细胞、炎症介质的影响

目的 探讨小青龙汤加减治疗嗜酸粒细胞性支气管炎的临床疗效及其对效应细胞、炎症介质的影响。方法 选取嗜酸粒细胞性支气管炎患者120例,随机分为观察组与对照组,每组各60例。对照组每天吸入丙酸倍氯米松气雾剂2次,250μg/次；观察组予小青龙汤加减治疗,两组均治疗2个月。于治疗前、治疗2个月后比较两组外周血嗜酸粒细胞(Eos)计数进行诱导痰细胞性检查,计算诱导痰Eos分类,测定Eos阳离子蛋白及白三烯C4水平；进行咳嗽评分,比较临床疗效,记录不良反应。结果 治疗后,两组诱导痰Eos分类、Eos阳离子蛋白、白三烯C4 水平及咳嗽评分均不同程度的降低 (t=3.99~9.20,P＜0.05或P＜0.01)；且观察组诱导痰Eos分类、Eos阳离子蛋白、白三烯C4 水平及咳嗽评分均低于对照组(t=3.62~5.37,P＜0.05)。观察组与对照组总有效率分别为93.10%、80.36% (χ2 =4.05,P＜0.05)。观察组1例述恶心但未呕吐,1例右上臂出现一过性红斑,略感瘙痒。对照组2例患者出现喉部不适的症状,均予以2.5%碳酸氢钠溶液漱口后好转。结论 小青龙汤加减治疗嗜酸粒细胞性支气管炎具有良好的疗效,降低了诱导痰Eos、嗜酸粒细胞阳离子蛋白、白三烯C4等效应细胞和炎症介质的水平,消除或改善了咳嗽症状,且没有长期应用激素的副作用,优于吸入糖皮质激素的治疗效果。     

儿童咳嗽变异性哮喘93例疗效分析

目的 探讨儿童咳嗽变异性哮喘的临床疗效.方法 将93例儿童咳嗽变异性哮喘患儿随机分成对照组口服酮替芬;观察组I吸入糖皮质激素和观察组Ⅱ口服顺尔宁,疗程均为3个月.三组均服博利康尼至咳嗽消失.结果 三组治疗临床缓解时间差异无统计学意义(P>0.05),3月后总有效率,对照组与观察组Ⅰ差异显著(P<0.01),对照组与观察组Ⅱ差异显著(P<0.05),观察组之间无明显差异(P>0.05).疗程结束后半年随访复发率,对照组高于观察组(P<0.05),观察组之间无明显差异(P>0.05).结论 口服酮替芬、吸入糖皮质激素、口服顺尔宁控制儿童咳嗽变异性哮喘均有效.总体上吸入糖皮质激素和口服顺尔宁优于酮替芬,而吸入糖皮质激素与口服顺尔宁疗效相当.     

变应性咳嗽的临床特征与气道炎症特点

目的探讨变应性咳嗽(AC)的诊断、治疗及其气道炎症特点。方法采用《咳嗽的诊断与治疗指南(草案)》的病因诊断程序,对158例慢性咳嗽患者进行病因诊断;结合诱导痰方法,分析痰液中细胞分类,分别采用荧光酶免疫法、酶联免疫吸附法测定诱导痰上清液中总IgE、嗜酸粒细胞阳离子蛋白(ECP)、白细胞介素-8(IL-8)的浓度。并以13例正常人和20例嗜酸粒细胞性支气管炎患者作对照;口服氯雷他定10 mg/d,2周,部分患者同时口服泼尼松10～15 mg/d或甲基氢化泼尼松8～12 mg/d,1周。结果 22例符合AC诊断,占慢性咳嗽的13.9%,多表现为慢性干咳,肺功能正常,组胺激发试验阴性。AC患者中性粒细胞(57.62±29.35)%较正常人(30.70±16.04)%显著增高(P<0.01),巨噬细胞(37.62±29.49)%较正常人(67.98±15.83)%明显降低(P<0.01),嗜酸粒细胞和淋巴细胞与正常人比较差异无统计学意义。AC患者诱导痰上清液中ECP浓度19.30(2.00～200.00)mg/L和IL-8浓度12.82(1.92～118.92)mg/L较正常人显著升高(P<0.01,P<0.05)。AC患者糖皮质激素或抗过敏治疗1周后,大部分患者的咳嗽消失。结论 AC是引起慢性咳嗽的一个重要原因,气道具有以中性粒细胞为主的炎症,抗过敏或抗炎治疗效果良好。     

咳嗽变异性哮喘患者主观评估和客观检测之间的相关性

目的 研究咳嗽变异性哮喘患者咳嗽生活质量问卷调查和1s用力呼出量/用力肺活量比值及峰流速变异率之间的相关性及其意义.方法 选取52例咳嗽变异性哮喘患者作为研究对象,并按照哮喘严重程度分级的标准分为A组(CVA Ⅰ级组)、B组(CVAⅡ级组)、C组(CVAⅢ级组)、D组(CVAⅣ级组)四组;所有研究对象首诊时和规范治疗3月后均完成咳嗽生活质量问卷(CQLQ)调查,同时进行1 s用力呼出量/用力肺活量比值(FEV1%)测定和峰流速变异率(PEFR)监测.结果 (1)规范治疗前,A、B、C、D四组各组间FEV1%与PEFR均差异有显著性(P<0.05).且两者具有明显负相关性(r=-0.995,P<0.01);各组间CQLQ差异无显著性(P0.05),虽然整体研究时CQLQ与FEV1%和PEFR的相关性有统计学意义(r=-0.302,0.274,P<0.05),但各组内CQLQ与FEV1%和PEFR的相关性不确切.(2)经规范治疗后,CQLQ改变值与FEV1%和PEFR改变值之间呈显著正相关(r=0.777,0.747,P<0.01).结论 CQLQ不宜代替FEV1%、PEFR等客观指标用于咳嗽变异性哮喘病情严重程度的判定,但可以代替FEV1%、PEFR作为咳嗽变异性哮喘疗效观察的简易指标.     

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…