左卡尼汀对维持性血液透析患者合并慢性心力衰竭的疗效观察

目的：观察左卡尼汀对维持性血液透析患者合并慢性心力衰竭的疗效。方法：将60例维持性血液透析合并慢性心力衰竭患者随机分为A组（n=30,透析治疗）和B组（n=30,透析治疗联合左卡尼汀治疗）两组,比较两组的临床疗效及心功能指标与实验室检查指标治疗前后的变化。结果：在透析治疗的基础上应用左卡尼汀后,B组的疗效明显优于A组（P〈0.05）,且B组心功能指标改善较A组更明显（P〈0.05）。B组的实验室检查指标治疗后改善较A组更明显（P〈0.05）。结论：左卡尼汀对维持性血液透析患者合并慢性心力衰竭疗效确切,可明显改善患者的心功能,值得推广和应用。     

左卡尼汀辅助治疗维持性血液透析患者合并慢性心力衰竭临床疗效观察

目的观察左卡尼汀辅助治疗维持性血液透析患者合并慢性心力衰竭的疗效。方法选择合并有慢性心力衰竭、心功能Ⅲ级或Ⅳ级的维持性血液透析患者40例,随机分为治疗组和对照组临床,每组20例,所有患者均按照终末期肾病（ESRD）常规处理（降压、扩血管、纠正贫血、改善钙磷代谢紊乱、强心等治疗）。每周血液透析3次,每次4小时。治疗组每次血液透析后将左卡尼汀1g稀释于生理盐水20ml中缓慢静脉注射,对照组静脉注射生理盐水20ml,治疗16周后,比较两组患者治疗前后心功能分级变化情况及左室射血分数（LVEF）、左心室舒张末期内径（LVEDD）变化情况。结果治疗组患者治疗16周后心功能普遍改善1～2级,显效率40%,总有效率85%;而对照组显效率为15%,总有效率为50%,两组比较有统计学差异（P〈0.05）;治疗后治疗组较对照组LVEF上升,LVEDD缩小,两组比较有统计学差异（P〈0.05）。结论维持性血液透析患者合并慢性心力衰竭经左卡尼汀辅助治疗能够防止和减轻心室重构,改善心功能,提高维持性血液透析患者的生活质量。     

左卡尼汀联合促红素治疗维持性血液透析患者肾性贫血的临床观察

目的：探讨左卡尼汀联合促红素治疗维持性血液透析肾性贫血的临床疗效。方法：收集2012年1月-2013年1月在本院进行维持性血液透析肾性贫血患者90例,随机分成三组,分别为左卡尼汀联合促红素治疗组、左卡尼汀治疗组、促红素治疗组,每组30例。左卡尼汀治疗组在常规治疗基础上加用予左卡尼汀;促红素治疗组在常规治疗基础上加用EPO。左卡尼汀联合促红素治疗组在常规治疗加用左卡尼汀和EPO治疗。分析三组治疗1、6个月RBC、Hb、Hct情况。结果：三组治疗前与治疗后1、6个月RBC、Hb、Hct比较,差异均有统计学意义（P〈0.05）。治疗1、6个月后,左卡尼汀联合促红素治疗组RBC、Hb、Hct高于左卡尼汀治疗组和促红素治疗组（P〈0.05）;促红素治疗组RBC、Hb、Hct高于左卡尼汀治疗组（P〈0.05）。结论：左卡尼汀联合促红素治疗维持性血液透析肾性贫血比单一药物治疗疗效佳。     

左卡尼汀联合血液透析治疗慢性肾衰竭合并心力衰竭患者的效果

目的:观察左卡尼汀联合血液透析治疗慢性肾衰竭合并心力衰竭患者的效果。方法:选取46例慢性肾衰竭合并心力衰竭患者作为研究对象,按随机数字表法将其分为观察组与对照组各23例。对照组采用血液透析治疗,观察组在对照组基础上给予左卡尼汀治疗,比较两组治疗效果、治疗前后心功能指标水平和不良反应发生率。结果:观察组治疗总有效率为91.30%(21/23),明显高于对照组的65.22%(15/23),差异有统计学意义(P<0.05);观察组左室收缩末期内径和左室舒张末期内径明显小于对照组,左室射血分数高于对照组,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:左卡尼汀联合血液透析治疗慢性肾衰竭合并心力衰竭患者可提高治疗总有效率,以及改善心功能指标水平,优于单纯血液透析治疗效果。     

维持性血液透析患者肾性贫血采用左卡尼汀联合促红素治疗的临床体会

目的：探讨维持性血液透析患者肾性贫血采用左卡尼汀联合促红素的治疗效果。方法我院2011年2月—2014年4月间收治维持性血液透析肾性贫血患者30例,随机分为A、B、C 3组,分别给予常规剂量促红细胞生成素（EPO）、小剂量EPO联合左卡尼汀、常规剂量EPO联合左卡尼汀治疗。结果3组观察对象治疗6个月后红细胞比容（Hct）和血红蛋白（Hb）等观察指标对比具有统计学差异（P<0.05）。结论左卡尼汀联合促红素治疗维持性血液透析肾性贫血临床应用价值较高。     

厄贝沙坦联合左卡尼汀治疗维持性血液透析患者心力衰竭32例疗效观察

目的观察厄贝沙坦联合左卡尼汀对维持性血液透析患者慢性心力衰竭的疗效观察。方法 32例维持性血液透析患者伴慢性心力衰竭经充分透析及强心药、血管扩张药等治疗疗效欠佳患者,给予口服厄贝沙坦150 mg/d联合左卡尼汀1.0静脉注射2~3次/周,治疗1个月。观察治疗前后患者症状。患者心率、血压、心胸比、左室短轴缩短率、左室射血分数、心功能变化。结果治疗后患者精神、食欲、透析中肌痉挛和低血压等症状较治疗前明显降低（P﹤0.05）,自觉症状明显减轻。心率、血压、心胸比与治疗前比较均明显下降（P〈0.05）,左室短轴缩短率、左室射血分数增加（P〈0.05）,心功能改善1~2级。结论厄贝沙坦联合左卡尼汀治疗维持性血液透析患者心力衰竭疗效确切,能提高患者生活质量。     

左卡尼汀联合促红细胞生成素治疗维持性血透患者贫血的临床观察

目的观察左卡尼汀联合促红细胞生成素（r-HEpo）对维持性血透患者（MHD）贫血的疗效及对促红细胞生成素剂量的影响。方法将55例维持性血透贫血患者随机分为两组,均在血液透析治疗后皮下注射r-HEpo,剂量100～150u/kg,分为2～3次注射,当Hb≥100g/L,RBC压积（Hct）≥30后逐渐减量,治疗组每次透析后予以左卡尼汀1.0iv,疗程三月。结果两组Hb、Hct较治疗前均有所提高（P〈0.01）,治疗组较对照组提高更明显（P〈0.05）,治疗组促红细胞生成素维持量少。结论左卡尼汀联合促红细胞生成素能提高维持性血透患者贫血的治疗疗效,减少促红细胞生成素的用量。     

左卡尼汀与促红细胞生成素对肾性贫血患者的疗效观察

目的观察左卡尼汀与促红细胞生成素对维持性血液透析患者肾性贫血的疗效。方法将60例维持性血液透析患者随机均分成2组,A组血液透析后皮下注射促虹细胞生成素,每周100～150U／kgI待血细胞比容（Hct）上升至30％后战量。B组在A组治疗基础上加甩左卡尼汀1．0g,静脉注射,每周2次,观察12周。结果B组的血红蛋白（Hb）．血细胞比客水平显著高于A组（P〈0．05）。B组于治疗后促红细胞生成素用量较治疗前明显减少,而A组促虹细胞生成素用量无明显改变。结论左卡尼汀与促红细胞生成素联合治疗维持性血液透析患者贫血可提高促虹细胞生成素疗效,减少其用量。     

沙库巴曲缬沙坦对维持性血液透析合并慢性心力衰竭患者心功能改善情况的观察

目的：观察沙库巴曲缬沙坦是否有助于改善维持性血液透析(MHD)合并慢性心力衰竭患者的心功能。方法：选取2021年1月—2022年1月期间于我院血液净化中心进行维持性血液透析治疗6个月以上且合并慢性心力衰竭的29例患者，观察患者使用沙库巴曲缬沙坦治疗前后，其血压、心率、心功能分级(NYHA)、左室射血分数(LVEF)、左房内径(LAD)、左室舒张末期内径(LVDD)、左室后壁厚度(LVPW)、左室短轴缩短率(LVFS)、NT-ProBNP等指标的变化。结果：治疗6个月后患者的血压、心功能分级、LVEF、LAD、LVDD、LVFS、NT-ProBNP均有明显改善(P<0.05),而治疗6个月后患者的心率、LVPW无明显改善(P>0.05)。结论：沙库巴曲缬沙坦可显著改善维持性血液透析合并慢性心力衰竭患者的血压、心功能，有较大临床应用价值。     

慢性肾衰竭患者的心脏结构及心功能改变与血压的关系

目的研究慢性肾衰竭（CRF）息者心脏超声左室肥大（LVH）与高血压的关系。方法CRF患者83例，男42例，女41例。年龄20～90（平均54.8）岁。其中维持性血液透析（HD）患者56例，接受肾替代治疗前（ND）患者27例。彩色多普勒心脏超声检查左室舒张末内径增大（LVEDd）。室间隔舒张末厚度（IVS）左室后壁舒张未厚度（PWTH）。射血分数（EF），检测血Hb和HCT，血清肌酐（SCr），测量血压，透析患者于透析前采血和超声检查，根据Devereux和Reichex公式计算左室心肌重量指数（LVMI）。应用sPss软件分析数据相关性。结果83例CRF患者71．8％有LVH。37．35％存在LVEDd增大，57.83％存在室间隔舒张未厚度（IVS）增厚，57．83％存在左室后壁舒张末厚度（PWTH）增厚，14．5％有左室射血分数（EF）下降。CRF患者的收缩与LVMI的相关系数为0．347，P=0．001。舒张压与LVMI的相关系数为0．380，P=0.0001。血清肌酐与LVMI的相关系数为0．301，P=0．006。收缩压、舒张压及SCr与EF值为负相关，但P〉0．1。结论LVH与血压、SCr水平明显相关。对肾衰竭合并高血压的患者，血压的控制有助于减少左室肥厚的发生，降低心血管疾病（CVD）的发病率和痛死率．提高肾功能不全患者的生存质量.     

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…