复法制方辨治胃痞夹杂证

针对胃痞夹杂证的治疗,应从五脏六腑整体观出发,方能取得更好疗效,此正是周仲瑛教授所创病机辨证方法。临证审证求机,针对复合病机,虚实夹杂者当以补消并用,寒热错杂者当以寒热平调。扶正重在升降气机、健脾安胃,或滋肾或宁心,祛邪包括理气解郁、消食导滞、祛风除湿或清热化痰等复法制方,每方药味15~25味,看似杂乱,实则切合复合病机,每获良效。     

Quality-specific taste impairment following the application of chlorhexidine digluconate mouthrinses

Although chlorhexidine has been widely used in the prevention and treatment of gingivitis, its effects on taste sensation have not been well studied. The purpose of the present study was to evaluate taste alterations following regular applications of 0.2% chlorhexidine mouthrinses. 24 healthy and non-smoking clinical instructors, dental assistants and dental students were divided into 3 groups after having reached a status of clinical gingival health by 4 weeks of supervised oral hygiene procedures. Following this, they were asked to abolish all mechanical oral hygiene for a period of 14 days, during which time they rinsed twice daily with different mouthrinses. Group A rinsed with a 0.2% chlorhexidine solution, group B served as control and utilized a 0.001 molar solution of quinine hydrochloride as a placebo rinse. A second control group (C) rinsed with distilled water. At days -3 and -2, as well as at days 1, 2, 13 and 14 of the experimental period, and 1 and 2 days after cessation of the rinsing, taste sensitivity was evaluated by a magnitude estimation, suprathreshold scaling procedure for the 4 taste qualities--sweet, salty, sour and bitter. 6 different concentrations of each of sucrose, sodium chloride, citric acid and quinine hydrochloride were utilized. Magnitude estimations of the perceived intensities of each series of test solutions were calculated. The analysis of co-variance revealed significant differences at the short-term and treatment-related suprathreshold scaling responses between both control groups (B, C) and the test group (A) for the sodium chloride magnitude estimation function. However, no significant inter-group differences in the magnitude estimation function were found for the remaining taste qualities.(ABSTRACT TRUNCATED AT 250 WORDS)     

肛管直肠恶性黑色素瘤8例临床病理学特征分析

目的 探讨肛管直肠恶性黑色素瘤的临床、内镜及病理学特征,对其诊断进行指导。方法 采用回顾性分析方法分析8例肛管直肠恶性黑色素瘤患者的临床表现、内镜下所见及病理学特征。结果 本次研究的患者共8例,其中男性3例,女性5例,平均年龄为58.63岁;临床病理学分析发现该8名患者的肿瘤结构复杂,细胞形态多样,瘤细胞由上皮样、梭形及未分化小细胞等多种细胞构成;免疫组织化学结果显示S-100(强+)、Vimentin(强+)、HMB45(强+)、MelanA(强+),CK(-)、LCA(-),Ki-67增殖指数为20%~90%。随访时间1～96个月不等,术后1年、2年、5年患者的生存率分别为37.5%、25.0%、12.5%。结论 肛管直肠恶性黑色素瘤临床症状多样,诊断及鉴别诊断依赖内镜下所见及免疫组织化学染色等。肿瘤切除程度与预后密切相关,对所有患者建议术后再进行辅助化疗、免疫治疗及靶向治疗。     

肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁的手术配合

  目的  总结肠镜、腹腔镜辅助肛门成型术在治疗中高位先天性肛门闭锁手术护理配合方法,为该手术提供标准化的手术护理配合流程。  方法  回顾性分析首都儿科研究所附属儿童医院2019年11月—2020年6月行肠镜腹腔镜辅助肛门成形术治疗中高位先天性肛门闭锁16例,所有患者均在肠镜下定位直肠尿道瘘,环形切开直肠盲端瘘口周围黏膜,并在腹腔镜下游离直肠,最后行直肠肛门吻合。总结手术配合过程和护理要点。  结果  16例患儿均顺利完成手术,肠镜时长中位数为45.0(29.5,60.0)min,手术总时长中位数为188.5(167.5,211.3)min,术中出血量约5~10 mL。术后恢复良好,术后住院中位时间为5.5 d, 术后复查逆行膀胱造影均无尿道憩室、尿道瘘及尿道狭窄等并发症的发生。  结论  肠镜腹腔镜辅助肛门成型治疗中高位先天性肛门闭锁是安全可行的,具有创伤小,定位准确、并发症少等优点。手术护士专业技术的正规培训、充分做好术前准备、术中做好体温保护措施、动态实时监测生命体征、无菌操作严格、仪器设备的有效管理、规范的手术体位安置、熟练掌握配合技术及良好的医护患沟通是手术成功的关键。      

生物反馈疗法治疗出口梗阻型便秘的临床观察

为观察生物反馈疗法治疗出口梗阻型便秘的疗效,对36例出口梗阻型便秘患者采用生物反馈疗法治疗,比较治疗前后便秘症状及肛门直肠压力的变化。结果显示,经生物反馈疗法治疗后：（1）治疗患者便秘临床症状的有效率为77．8％,治疗后大便性状、排便次数、伴随症状等有所改善;（2）肛管静息压、直肠感觉阈值、直肠最大耐受量、肛管直肠反射阈值降低（P〈0．05）。结果表明,生物反馈疗法治疗出口梗阻型便秘效果满意,是一种无创、简单有效的治疗手段。     

口服α1一受体阻滞剂防治肛肠病术后尿潴留的疗效分析

为探讨口服α1一受体阻滞剂防治肛肠病术后尿潴留的临床疗效,回顾于我科行手术治疗的340例肛肠病患者资料,根据术后是否应用α1一受体阻滞剂分为两组,其中应用α卜受体阻滞剂的设为试验组（哈乐,口服,0．2rαg／次,每天1次,230例）,未应用α1一受体阻滞剂的设为对照组[110例）。对比两组患者术后尿潴留发生率、首次排尿时间;发生尿潴留后,两组患者均接受导尿处理,试验组男性患者继续服用α1一受体阻滞剂,对比观察两组男性患者导尿时的疼痛程度、尿道黏膜损伤情况及留置导尿管后下尿路的刺激症状。结果显示,试验组术后尿潴留发生率明显低于对照组,P〈O．05;术后首次排尿时间明显短于对照组,P〈O．05。试验组发生尿潴留的男性患者导尿时的疼痛程度明显轻于对照组,P〈O．05;尿道黏膜损伤率及留置导尿管后下尿路的刺激症状发生率明显低于对照组,P〈O．05。结果表明,口服α1一受体阻滞剂可有效降低肛肠病术后尿潴留的发生率,接受导尿处理的男性患者口服α1阻滞剂可缓解置导尿管时的不适,减少留置导尿管所引起的下尿路刺激症状,具有较高的临床应用价值。     

小剂量腰俞穴麻醉加局部麻醉用于肛肠病手术509例临床观察

为观察小剂量腰俞穴麻醉加局部麻醉对肛肠科常规手术患者的麻醉效果及术后不良反应,观察施行小剂量腰俞穴麻醉成功后的509例肛肠病患者在行局部麻醉时的疼痛程度、麻醉完成后术中的疼痛程度,并分别进行评分。术中观察患者是否存在麻醉不良反应,术后观察患者发生尿潴留的情况。结果显示,509例患者在施行腰俞穴加局部麻醉过程中均达到了基本无痛,整个手术中完全无痛。21例患者行腰俞穴麻醉后出现轻微头晕,均未出现其他麻醉不良反应。术后有24例出现尿潴留,发生率为4．7％。结果表明,小剂量腰俞穴麻醉加局部麻醉既无单纯局部麻醉的疼痛,又无神经阻滞麻醉的不良反应,术后尿潴留发生率低,适于在肛肠科常规手术中应用。     

肛肠科围手术期患者的心理护理

目的依据肛肠科围手术期患者心理护理需求,进行针对性护理,提高其对手术应对能力,顺利度过围手术期。方法160例择期手术患者随机分为观察组及对照组,前者给予术前访探、术中陪护、术后随访等整体护理,后者给予传统的功能制护理。结果比较2组患者在恐惧失眠、担心一次不能治愈、围手术期MAP、HR波动、术后并发症等方面,对照组明显高于观察组,差异有显著意义(P<0.05);担心术中疼痛、害羞恐惧方面,2组有极显著性差异(P<0.01)。结论肛肠科围手术期心理护理在减轻患者恐惧心理、缓解心理应激、保证各项治疗顺利进行具有重要辅助作用。     

便秘主导型肠易激综合征患者结、直肠肛门动力学的临床研究--附50例检测分析

目的:研究便秘主导型肠易激综合征患者的结肠、直肠动力和直肠感觉功能.方法:用不透X线法的结肠传输试验检测50例便秘主导型肠易激综合征(constipation predominant irritable bowel syndrom,C-IBS)患者及42名正常受试者(对照组)的结肠传输时间(colonic transit time,CTT)和结肠传输指数(transit index,TI),并用结肠传输指数分型;同时用肛门直肠测压方法测定C-IBS患者和对照组的肛门直肠压力、直肠感觉阈值和直肠顺应性.结果:C-IBS患者的全结肠及各节段结肠传输时间均高于对照组,C-IBS患者的肛管静息压、直肠静息压与对照组比较差异均无统计学意义(P＞0.05),肛门括约肌最大收缩压低于对照组,最大耐受容量及直肠顺应性均明显高于对照组(P＜0.01),且发现不同传输类型的C-IBS患者的肛门直肠测压的结果不尽相同.结论:C-IBS患者存在结肠、肛门直肠动力及直肠感觉功能异常,结肠传输试验与肛门直肠测压相结合,更有助于明确便秘的类型.     

The Lindblom roller.

Neuropathic pain is caused by injury of the peripheral or central nervous system. The neurological examination of the sensory system in neuropathic pain patients guides the anatomical localization of the injury. Among the sensory modalities to be tested, priority should be given to those subserved by small peripheral sensory fibers or by the spinothalamic tract that most commonly are abnormal in neuropathic pain patients. Testing of cold and warm perception was traditionally carried out in the clinic using tubes filled with water at different temperatures, a cumbersome method that has limited the routine examination of these sensory modalities. The Lindblom roller offers a practical and effective method of readily testing temperature perception and is among the best available clinical tools for delineating the anatomical boundaries of a sensory abnormality. Routinely use of the Lindblom roller shall be standard bedside clinical assessment of neuropathic pain patients. To exemplify this statement we describe two patients affected by complex and fluctuating painful sensory abnormalities caused by an extradural mass compressing the spinal cord. The level of the injury was readily localized with a roller kept at room temperature.