急性一氧化碳中毒156例临床分析

目的：分析急性一氧化碳中毒患者的发病特征,探讨急性一氧化碳中毒的防治策略。方法：对156例急性一氧化碳中毒病例进行回顾性分析。结果：156例急性一氧化碳中毒患者中,女性多于男性,男女之比为1∶1.64;平均年龄21.75岁,高发年龄段是18-27岁,占78.84%;燃气热水器使用不当是急性一氧化碳中毒的主要原因占91.67%;中毒事件的高发季节为冬春季节占94.23%;临床表现主要为头晕、头痛、意识障碍等神经系统症状;以高压氧为主的综合治疗措施可取得满意疗效,总有效率达94.23%,治愈率为87.82%,中毒6h内高压氧治疗（A组）与中毒6h后高压氧治疗（B组）相比可提高治愈率（P〈0.05）。结论：深圳地区急性一氧化碳中毒的发病具有明显的性别、年龄、中毒源、季节特征,需引起重视,广泛开展针对性宣传教育和采取有效防范措施是遏制急性一氧化碳中毒的重要手段,一旦中毒应尽早行高压氧为主的综合性治疗。     

纳洛酮联合高压氧治疗一氧化碳中毒中毒后迟发性脑病临床分析

目的观察纳洛酮联合高压氧治疗急性重度一氧化碳中毒的临床分析。方法对照组仅应用纳罗治疗,观察组应用纳洛酮联合高压氧治疗,对两组患者的治疗效果进行比较,比较内容:临床疗效、病死率、昏迷时间、迟发性脑病发生率。结果观察组总有效率为96%(48/50),对照组有效率84%(42/50)(P0.05),观察组明显高于对照组;观察组病死率为0,对照组病死率0.8%(4/50)(P0.05),观察组明显低于对照组;观察组昏迷时间为(17.7±7.0)h对照组昏迷时间为(25.3±7.4)h(P0.05),观察组低于对照组;观察组迟发性脑病发生率为0,对照组迟发性脑死亡率为16%(8/50)(P0.05)。结论纳洛酮联合高压氧治疗一氧化碳中毒临床疗效显著,有效降低患者病死率和迟发性脑病发生率,且昏迷时间得到缩短。     

血液透析联合血液灌流治疗重度急性有机磷农药中毒35例临床观察

目的探讨血液透析(HP)联合血液灌流(HD)治疗重度急性有机磷农药中毒患者的疗效。方法将69例重度急性有机磷农药中毒患者随机分成治疗组与对照组2组,治疗组在常规内科治疗的基础上采用血液透析与血液灌流联合治疗,对照组在常规内科治疗基础上给予血液灌流治疗。结果治疗组昏迷至清醒时间、胆碱酯酶活力恢复时间、住院时间均较对照组明显缩短(p<0·05或0·01),而治愈率较对照组明显升高(p<0·01)。结论应用HD联合HP治疗重度急性有机磷农药中毒可明显缩短住院时间,提高治愈率。     

高压氧联合纳洛酮治疗急性一氧化碳中毒

目的：评价高压氧联合纳洛酮治疗急性一氧化碳中毒的疗效。方法：对120例急性一氧化碳中毒患者采用高压氧联合纳洛酮及内科治疗者为治疗组；采用高压氧加内科治疗的117例一氧化碳中毒患者为对照组。并对两组的GCS评分、治愈率、死亡率及后遗症进行对比分析。结果：96h后两组Glascow评分（GCS）、治愈率、死亡率等进行比较，治疗组与对照组有显著差异（P〈0．01）。结论：高压氧联合纳洛酮治疗急性一氧化碳中毒疗效显著。     

血液灌流在重度有机磷农药中毒中的应用及护理

目的观察血液灌流重度有机磷农药中毒中的应用及护理。方法重度有机磷农药中毒84例患者随机分为对照组和治疗组，治疗组在常规内科治疗的基础上加用血液灌流（HP）并采取相应护理措施，对照组单纯行常规内科治疗护理。观察对照两组病例的治愈率、阿托品总用量、昏迷至清醒时间、胆碱酯酶活力恢复时间和并发症。结果治疗组阿托品总用量减少（P〈0．01），患者昏迷时间缩短（P〈0．05），治愈率提高（P〈0．05），并发症减少（P〈0．01）。结论对于重度有机磷农药中毒患者，除内科常规治疗外加用血液灌流，予以适当的护理能明显提高这类危重患者的治愈率。     

带贮氧袋面罩吸氧联合胞二磷胆碱注射液及纳洛酮对 急性一氧化碳中毒的临床疗效

目的研究带贮氧袋面罩吸氧联合胞二磷胆碱注射液及纳洛酮治疗急性一氧化碳(CO)中毒患者的临床效果。方法选取2013年3月至2018年3月舞钢市人民医院治疗的急性CO中毒患者104例,采用随机数表法将患者分为观察组和对照组,每组52例。两组患者均接受胞二磷胆碱注射液及纳洛酮治疗,对照组在此基础上采用常规面罩吸氧,观察组采用带贮氧袋面罩吸氧,对两组患者的临床效果进行比较。结果观察组患者治疗总有效率为92.31%(48/52),与对照组的90.38%(47/52)比较,差异无统计学意义(P>0.05);观察组患者昏迷转清醒时间、自觉症状消失时间、住院天数均短于对照组,差异有统计学意义(均P<0.05);观察组患者迟发性脑病发生率为1.92%(1/52),低于对照组的15.38%(8/52),差异有统计学意义(P<0.05)。结论带贮氧袋面罩吸氧联合胞二磷胆碱注射液及纳洛酮治疗急性CO中毒的效果显著,能有效促进患者康复,降低迟发性脑病发生率。     

急性一氧化碳中毒并发迟发性脑病相关因素分析

目的:探讨急性一氧化碳中毒后迟发性脑病(DEACMP)发生的临床相关因素。方法:选择急性一氧化碳中毒患者145例,根据是否并发DEACMP,分为并发DEACMP 46例患者(观察组)和未并发DEACMP 99例患者(对照组)两组,统计分析两组患者年龄、性别、急性期昏迷时间、接受高压氧治疗时间、脑血管病、糖尿病、吸烟饮酒史及头颅CT/MRI等因素与发生DEACMP的相关性。结果:145例患者中,DEACMP发生率31.72%;观察组和对照组年龄>40岁患者所占比率分别为60.9%和76.8%,两组比较具有统计学意义(P<0.05);观察组昏迷时间<12h7例(15.2%),25~48h10例(21.7%),>48h15例(32.6%),与对照组分别比较,均有统计学差异(P<0.05);观察组CO中毒后接受高压氧治疗时间<2h和>4hDEACMP的发生率分别为8.7%和63.0%,与对照组比较,均有统计学差异(P<0.01);观察组头颅CT/MRI异常DEACM发生率为80.4%,显著高于对照组43.40%(P<0.01);观察组既往基础病如高血压、糖尿病,吸烟史、饮酒史的,分别与对照组比较,均具有统计学差异(P<0.05)。Logistic回归分析结果显示,年龄>40岁、昏迷时间、接受高压氧治疗时间、头颅CT/MRI异常、高血压、糖尿病、饮酒史均为DEACMP发生的独立危险因素。结论:急性一氧化碳中毒并发DEACMP存在多种危险因素,尤其年龄、昏迷时间、接受高压氧治疗时间、头颅CT/MRI异常、高血压、糖尿病、饮酒史等为主要因素。     

四磨汤加味联合吗丁啉治疗功能性消化不良

目的观察四磨汤加味联合吗丁啉治疗功能性消化不良的疗效。方法将80例功能性消化不良患者随机分成两组,对照组38例,餐前30min口服吗叮啉10mg,3次/d;治疗组42例在此基础上加用四磨汤加味,1剂/d,分2次水煎服。两组均4周为一疗程,观察治疗前、后症状的变化。结果治疗组总显效率83·3%,总有效率95·2%;对照组总显效率57·9%,总有效率76·3%,两组比较差异有显著性(P<0·01和P<0·05),治疗组在主要症状改善方面明显优于对照组(P<0·01或P<0·05)。结论四磨汤加味联合吗丁啉是治疗功能性消化不良有效的方法之一,两药联合治疗可提高治疗效果。     

纳洛酮联合高压氧治疗小儿急性重症一氧化碳中毒60例临床观察

目的探讨纳洛酮联合高压氧治疗小儿急性重症一氧化碳中毒的疗效。方法112例急性重症一氧化碳中毒患儿分为对照组（52例）和治疗组（60例）。对照组给予高压氧、防治脑水肿、促进脑细胞功能恢复、应用呼吸兴奋剂、防治并发症及对症处理。治疗组在对照组治疗基础上加用纳洛酮0．03mg／（kg&#183;h）静脉注射，意识清醒后，按10μg/（kg&#183;h）静脉滴注4～6h，每日1次，10天为1个疗程。结果治疗组昏迷时间为（3．80&#177;1．73）h，较对照组[（7．42&#177;4．02）h]显著缩短（P〈0．01）。治疗组迟发性脑病发生率（3．30％）较对照组（23．08％）明显下降（P〈0．01）。治疗组病死率（3．30％）较对照组（23．08％）明显降低（P〈0．01）。结论纳洛酮联合高压氧治疗小儿急性重症一氧化碳中毒疗效显著，值得临床推广应用。     

刺五加、纳络酮注射液联合治疗急性脑梗死(附27例报告)

目的观察刺五加、纳络酮注射液对急性脑梗死的治疗效果。方法将52例急性脑梗死随机分为对照组(25例)和观察组(27例);对照组采用常规给药,观察组使用刺五加注射液与纳络酮注射液联合治疗;比较2组的临床疗效。结果观察组治愈率为44．4％,总有效率为92．6％;对照组治愈率为24．0％,总有效率为80．0％,2组比较,治愈率(P<0．01)、总有效率(P<0．05)均有显著性差异。结论刺五加注射液与纳络酮注射液联合治疗急性脑梗死可明显提高疗效。     

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.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

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.