彝族地区小儿结核性脑膜炎临床特征分析

目的分析彝族地区小儿结核性脑膜炎的临床特征,探讨早期诊断的有效方法,减少误诊。方法回顾性分析2010年1月-2012年12月我院71例临床诊断结核性脑膜炎的住院患儿病例资料。结果农村彝族患病率高,占全组病例90．1％,全组病例仅4例有明确卡介苗接种史。全组患儿主要临床表现为：发热,神经系统症状颅内压增高和脑膜刺激征。胸部X线片或胸部cT异常31例（47．0％）,其中粟粒型结核6例（19．4％）。全组69例行头部CT,42例异常,阳性率为60．9％,其中33例伴随脑积水改变（46．5％）。结论发热伴颅内压增高,脑神经损害是小儿结核性脑膜炎常见的表现。彝族地区卡介疫苗接种覆盖率低,发病率高,应重视宣传及加强对基层的防疫工作。头颅CT是结核性脑膜炎早期诊断和判断预后比较有效的方法。对疑诊患者或脑脊液不典型患者应早期行头部CT及胸部X线片检查。     

清胰颗粒对重症急性胰腺炎大鼠肠黏膜上皮紧密连接的保护作用

目的：探讨清胰颗粒对重症急性胰腺炎（SAP）大鼠肠黏膜上皮紧密连接的保护作用。方法：24只健康雄性Wistar大鼠随机分为假手术组、SAP组和清胰颗粒组。采用3.5%牛磺胆酸钠胆胰管逆行注射制备SAP大鼠模型,清胰颗粒组于造模前2 h、造模后6 h和18 h分别给予清胰颗粒灌胃,SAP组以同样的方法给予安慰剂。各组分别于造模后24 h取末端回肠,HE染色,光镜下观察病理组织学改变,采用Chiu’小肠组织损伤评价标准对肠黏膜损伤进行评价,应用Western blot和实时荧光定量PCR法检测回肠黏膜上皮紧密连接蛋白（Occludin）表达。结果：与假手术组相比,SAP组大鼠Chiu’小肠组织损伤评分（4.6±0.6） vs （0.0±0.0）明显升高,与SAP组相比,清胰颗粒组Chiu’小肠组织损伤评分（2.0±0.4）vs（4.6±0.6）明显降低;Western blot和实时荧光定量PCR结果显示,与假手术组相比SAP组大鼠Occludin蛋白表达（1.2±0.4）vs（3.2±0.4）和mRNA表达（1.3±0.3）vs（2.9±0.5）明显降低（P＜0.05）;与SAP组相比,清胰颗粒组 Occludin蛋白表达（4.1±0.4）vs（1.2±0.4）和mRNA表达（4.2±0.3）vs（1.3±0.3）明显升高（P＜0.05）。结论：清胰颗粒能减轻SAP大鼠肠黏膜损伤程度,这一作用可能与增强肠黏膜紧密连接蛋白Occludin表达有关。     

The relationship between external bony defects and widened lateral interorbital distance in frontoethmoidal encephalomeningocele

PurposeThe aim of this study was to identify the prevalence of the abnormal lateral interorbital distance (LIOD), micropthalmia or anopthalmia and incidence of hydrocephalus in frontoethmoidal encephalomeningocele (FEEM), and to identify the correlation between the external bony defects and a widened lateral orbital wall.Materials and methodsFEEM patients who were treated in the Faculty of Medicine, Chiang Mai University between January 1, 2006, and December 31, 2016, were retrospectively reviewed from the medical records. We included the patients who had undergone head computed tomography (CT) of the facial bones. Exclusion criteria were any patients who had undergone prior facial surgery or had maxillofacial bone trauma before they underwent a CT scan, craniofacial disease such as facial clefts, frontonasal dysplasia, craniosynostosis, and inter-frontal encephalocele. Measurements were taken from the CT images to establish the diameter of the external bony defect, medial interorbital distance and lateral interorbital distance. The relationships between the external bony defect and widened LIOD were analyzed. Patients were divided into two groups: those with normal LIOD and those with wide LIOD.ResultsA total of 94 FEEM patients were evaluated. Thirteen patients (13.83%) had a wider than normal LIOD. The incidence of micropthalmia or anopthalmia was 9.57% and hydrocephalus was 45.74%. From a univariable model, there were no statistically significant differences in terms of patient characteristics between the LIOD groups, except for sex. The proportion of wide LIOD was higher in male patients (male vs female; 20.34% vs 2.86%, p = 0.027). The proportion between the external bony defect and the LIOD (EL ratio) associated with a wide LIOD was shown in a cutoff point of 23% (AuROC = 73.27%, 95%CI = 59.87%–86.66%). The multivariable analysis indicated factors associated with abnormal LIOD were an EL ratio of 23% (adjusted RR = 1.98, 95% CI = 1.58–2.51) and male sex (adjusted RR = 6.85, 95% CI = 2.00–23.55).ConclusionThere is an association between the EL ratio and widening of the LIOD. An EL ratio greater than 23% could be used to moderately predict a wide LIOD. A large external bony defect may be associated with lateral displacement of the orbit causing true hypertelorism. Therefore, orbital translocation must be considered in patients with a wide LIOD.     

从“宣、化、利”法浅析张怡治疗湿病经验

湿性重浊、粘滞,易伤脾阳及阻滞气机,易夹杂它邪为患,所致疾病缠绵难愈,在内、外、妇、儿中均可见其存在。加上川渝地区独特的地形、气候及饮食因素,张怡认为脾胃系统疾病中感染湿邪患者十之八九,治疗湿病多以三焦辨证为纲,通过“轻宣上焦、运化中焦、淡利下焦”畅通三焦给邪气以出路及顾护脾胃减少湿邪产生,标本结合,在临床中取得了良好的疗效。该文选取张怡教授其中一则医案和同道分享,浅析张怡治疗湿病的辨证思路及组方特色。张怡治疗湿病经验丰富,临床效果好,值得推广及借鉴。     

丹红注射液配合苯溴马隆片治疗痛风实例

通过丹红注射液配合苯溴马隆片治疗痛风实例,说明中西医结合治疗痛风,具有治疗效果良好、无反复且副作用少的优势。     

痉瘫丹治疗创伤性痉挛型截瘫临床疗效分析

目的观察痉瘫丹治疗创伤性痉挛型截瘫的临床疗效,并探讨其作用机制。方法将56例痉挛型截瘫患者分为治疗组(28例)和对照组(28例),对照组采用西药常规治疗,治疗组在常规治疗基础上加用中药痉瘫丹,于治疗前后观察临床疗效。结果两组总有效率,治疗组为89.3%,对照组为53.5%,差异有显著性(P<0.05)。治疗组痉挛消失率为57.2%,明显高于对照组的21.4%,差异有显著性(P<0.01)。结论中药痉瘫丹对痉挛型截瘫临床症状有明显改善作用,与常规治疗合用疗效更显著。     

敛肺止咳饮治疗肺纤维化43例

目的观察敛肺止咳饮对于肺间质纤维化的治疗效果。方法对于43例肺纤维化患者，给予口服中汤药敛肺止咳饮，4周为1疗程，3个疗程后观察疗效。结果43例中，显效8例，占18．60％；有效27例，占62．79％；无效8例，占18．60％；总有效率为81．37％。结论敛肺止咳饮对于肺间质纤维化的治疗具有比较明显的疗效。     

血塞通注射液治疗脑梗塞临床观察

目的观察血塞通注射液对脑梗塞的疗效。方法治疗组应用血塞通500 mg,加生理盐水500 mL滴注,1次/d。对照组低分子右旋糖酐注射液500 mL,1次/d;连用21 d观察疗效。结果用血塞通注射液治疗脑梗塞90例,基本痊愈21例,显著进步41例,进步24例,总有效率89.58%,与对照组相比有统计学意义(P<0.05)。结论血塞通治疗脑梗塞安全有效。     

碟脉灵注射液治疗糖尿病周围神经病变80例观察

目的:观察碟脉灵注射液治疗糖尿病周围神经病变的疗效。方法:治疗组80例用碟脉灵注射液治疗,对照组40例用丹参注射液治疗,疗程均为4周。结果:治疗组疗效优于对照组(P<0.05),且无明显不良反应。结论:碟脉灵注射液治疗糖尿病周围神经病变疗效满意。     

关于加快彝医药发展的思考

介绍了彝族医药从最初的原始阶段到现如今被逐步发掘研究的发展历程,肯定了彝药价值的巨大潜力和开发天然药物资源的重要性,同时也指出了目前认识和开发彝药资源的局限性。针对彝药开发中的实际情况提出了几点建议,以期促进彝族医药的快速发展。