三仁汤加减治疗内科杂症举隅

三仁汤出自吴鞠通的《温病条辨》，由杏仁、白蔻仁、生薏苡仁、飞滑石、白通草、竹叶、厚朴、半夏组成。秦伯未在《谦斋医学讲稿》中说：“三仁汤为湿温证的通用方，用杏仁辛宣肺气以开其上，白豆蔻、厚朴、半夏苦辛温通以降其中，薏苡仁、通草、滑石淡渗湿热以利其下”。诸药同用，共奏宣畅气机、清热利湿之功。笔者在临床中，将其用于治疗内科杂症，收到了满意的疗效。现举例介绍如下。     

无痛性高位小切口胆囊切除术的探讨

目的探讨无痛性高位小切口胆囊切除术的适应证、方法及利弊。方法对260例患者采用右上腹高位经腹直肌切口、吸引器剥吸及顺逆结合法切除胆囊,术后硬膜外镇痛。结果手术时间平均90 min;247例(94.6%)顺利完成手术,发生胆管损伤6例(2.3%),术中扩大切口13例,241例(92.7%)术后48 h卧床无痛。结论无痛性高位小切口胆囊切除如适应证选择适当,则是一种安全、可行、创伤小、痛苦少、恢复快的手术方法。     

辛伐他汀联合非诺贝特治疗混合性高脂血症62例临床观察

近年来随着社会的发展、生活水平的提高,混合性高脂血症[总胆固醇(TC)、低密度脂蛋白(LDL-C)、甘油三酯(TG)的升高]的发病率也逐年升高,纠正血脂异常在冠心病的一级预防和二级预防中具有重要意义,治疗上使用一种降脂药难以使血脂水平满意达标,常需要联合作用机制不同的降脂药物,但长期以来对其联合治疗安全性的担忧限制了其联合应用[1].     

腰麻与硬膜外联合麻醉对老年下腹部及下肢手术患者血流动力学的影响

目的观察腰硬联合麻醉对老年高龄患者下腹部及下肢手术过程中血流动力学的影响。方法选择80例下支及下腹部手术的老年高龄患者,随机分为腰硬联合麻醉组和硬膜外组,每组40例,腰硬联合麻醉组注入0.5%布比卡因2 mL,硬膜外组给予1.5%利多卡因10~15 mL,2组患者麻醉平面均控制在T10以下。观察并记录麻醉前、手术开始及手术开始15 min 2组患者SBP,DBP,HR,Sp(O2)的变化及及术中使用麻黄碱例数。结果2组患者麻醉后均有不同程度的血压下降,腰硬联合麻醉组术中血流动力学比较稳定,术中只有5例使用小剂量麻黄碱提升血压,且无局麻药毒性反应和低颅压症状;而硬膜外组术中有23例使用麻黄碱,而且随手术时间延长和硬膜外给药次数的增加均有不同程度寒战、肌张力增高、头晕、嗜睡等局麻药毒性反应症状。结论腰硬联合麻醉在老年高龄患者下腹部及下肢手术的应用同硬膜外麻醉一样安全有效,血流动力学更稳定。     

钢缆内固定系统治疗髌骨骨折

自2006年7月至2008年8月，本院采用钢缆内固定系统治疗髌骨骨折18例，取得满意的临床疗效，现报告如下。     

脾胃病临证治法心得

脾胃病常表现为本虚标实，或虚实夹杂，往往以脾胃虚弱为本，水湿、湿热、瘀血、浊毒为标，且有升降失常、寒热相兼的特点。故笔者治疗脾胃病，常采用多种治法，并结合辨证分型，灵活用药，获满意疗效，现分述如下。     

肠易激综合征患者的睡眠特征

Objective To investigate the sleep features in the patients with irritable bowel syndrome (IBS) and compare the sleep quality between those IBS patients who were with and without anxiety and depression.Methods Pittsburgh sleep quality index questionnaire (PSQI), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were measured in the 145 IBS patients and 59 regular physical examination volunteers.IBS patients were also divided into two subgroups-patients with or without anxiety and depression based on cutoff scores of SAS and SDS.Comparisons of sleep quality were made between subgroups, and between IBS patients and volunteer controls.Results Compared with the controls,the SAS raw score, SDS raw score and SAS positive incidence in IBS patients were shown statistically significant differences (P ＜ 0.05 ), while the SDS positive incidence had no statistically significant difference(P ＞ 0.05 ).PSQI total scores were significantly higher in the IBS patients without anxiety and depression (P ＜ 0.05), 3 domains (sleep quality, sleep disturbances and daytime function disorder) were also found statistically significant differences ( P ＜ 0.05 ), compared with the controls.The IBS patients with anxiety and depression were statistically significantly different from the controls ( P ＜ 0.05 ) in 6 domains (sleep quality, sleep latency, sleep efficiency, sleep disturbances, sleep time and daytime function disorder) and significantly higher PSQI total scores( P ＜ 0.05 ).Statistically significant differences (P ＜0.05) were also found in all 7 domains and with higher PSQI total scores in IBS patients with anxiety and depression, compared with IBS patients without anxiety and depression.Conclusions IBS patients were more likely to have sleep abnormality, mainly in sleep quality, sleep disturbances and daytime function disorder and PSQI total scores.The abnormalities of these factors were independent of emotional disorder.However, emotional disorder worsened the sleep disorder in IBS patients.     

卡介菌多糖核酸注射液联合依巴斯汀治疗慢性荨麻疹疗效观察

目的探讨使用卡介菌多糖核酸注射液联合依巴斯汀治疗慢性荨麻疹疗效,以供临床参考。方法卡介菌多糖核酸注射液与口服依巴斯汀治疗慢性荨麻疹并与单纯口服依巴斯汀对照观察。结果治疗组患者总有效率为81.39%;对照组患者总有效率为52.38%。治疗组总有效率明显优于对照组,P<0.05。结论采用卡介菌多糖核酸注射液联合依巴斯汀治疗慢性荨麻疹疗效较好,不良反应较少,值得在临床推广使用。     

HPLC测定圣济鳖甲丸中二苯乙烯苷的含量

目的 建立高效液相色谱法测定圣济鳖甲丸中制何首乌的2,3,5,4′-四羟基二苯乙烯-2-Ο-β-D-葡萄糖苷(简称二苯乙烯苷)的含量。 方法 采用高效液相色谱法,色谱柱为Agilent Extend-C₁₈(250 mm×4.6 mm,5 µm),流动相为乙腈-水(14∶86),检测波长为320 nm,流速为1.0 mL·min^-1。结果 二苯乙烯苷在48.64~243 2 ng内线性关系良好(r＝1.000)。平均回收率为100.22%(RSD=0.45%,n＝7)。结论 该方法简单、快速、重复性好,可作为圣济鳖甲丸的质量控制方法。