张锡纯临床应用代赭石经验撷菁

张锡纯溯源《神农本草经》,根据临床应用代赭石的丰富经验,认为代赭石乃救颠扶危之大药也,其对代赭石的用法、用量,也有其独到之处,纵观张氏全方可发现赭石以生用与量大为特色。张氏还根据临床病情创制许多代赭石新方,重视代赭石配伍,扩大主治范围、活用经方。本文最后还详录代赭石治验部分医案,以案证论,理论结合临床,希以此与同道共学之。     

天津市冠心病住院患者膳食结构及与疾病严重程度的相关分析

目的了解天津市冠心病患者的膳食结构及营养摄入情况,分析其与疾病严重程度的相关性,对患者的饮食及生活行为进行合理指导。方法于2017年6-9月选取天津市胸科医院心内科收治入院且确诊为冠心病的患者304例作为研究对象,其中男性152例,女性152例。采取问卷调查的形式,询问调查对象的一般特征与各种食物的摄入情况并进行体格和实验室检查。采用SPSS 19.0软件进行t检验、χ~2检验和Spearman秩相关分析。结果冠心病患者膳食结构中粮谷类、蔬菜和油脂类的摄入量接近或符合膳食宝塔推荐摄入量;水果类、鱼虾类、奶类和豆类的摄入未达到膳食宝塔的推荐量;畜禽肉类、蛋类和食盐的摄入超过推荐量。每标准人日摄入能量为1 910 kcal,占能量需要量的84.9%。蛋白质与碳水化合物的摄入量偏高。钾、钙、锌、镁、硒、锰、硫胺素、核黄素和抗坏血酸摄入不足。有一部分患者的三大营养物质供能比例过高或过低。冠心病的严重程度与性别、吸烟、血脂异常、超敏C反应蛋白和空腹血糖的相关性具有统计学意义(rs分别为-0.152,0.152,0.119,0.215和0.117,P0.05,P0.01)。结论冠心病患者的膳食结构及营养素不平衡现象依然存在,应针对男性、吸烟人群、血脂异常和血糖异常人群进行重点预防,倡导均衡的饮食模式,远离不良的生活方式。     

雌激素对原代成骨细胞骨形成的影响

了解雌激素对培养的原代成骨细胞骨形成的影响。观察添加雌激素后直接对成骨细胞骨形成的作用，并用VOnKossa免疫染色法定量表示骨形成。结果显示：雌激素对该原代成骨细胞无促进骨形成作用。     

动脉性门静脉DSA的质量保证

肝癌病人行门静脉DSA检查对介入性治疗具有重要的指导意义。怎样获得优质的门静脉图像，清楚显示门静脉血流情况，显示肿瘤所致门静脉异常，缩短介入操作时间，减少医患的辐射损伤，节省费用，是门静脉DSA质量保证的主要内容。现根据我们自己的实践经验，对动脉性门脉DSA的质量保证问题作如下探讨。1动脉性门脉DSA插入动脉的选择门静脉的血液主要来自胃肠道和脾脏。重要属支有肠系膜上、下静脉，脾静脉，胃左、右静脉。由于场系膜上静脉血流量占门脉血流量的比例较大，常规动脉性门脉造影多选择肠系膜上动脉，以便较多的造影剂回流入门…     

参苓白术散对肠道菌群及免疫调节作用的探讨

参苓白术散是治疗脾虚泄泻的常用方,对调节肠道菌群、增强机体免疫力均有明显作用,故可明确参苓白术散治疗脾虚泄泻的机制与肠道菌群以及机体免疫平衡相关,为临床使用参苓白术散治疗脾虚泄泻提供参考依据。     

Analysis of the factors influencing hospitalization charges for neonatal congenital heart disease

Background Congenital heart disease(CHD)is the most common congenital anomaly affecting 1.35 million newborns globally every year. Children affected by CHD would normally come across growth failure at a young age. As complex CHD has a high mortality rate,it needs to be corrected as soon as possible after birth.Methods The medical records of infants with diagnosed CHD according to International Classification of Diseases(ICD)10 th Revision codes(January 2009-June 2017)who underwent cardiac surgery were reviewed. In the 431 patients who met the study criteria,their clinical characteristics,outcomes and cost data were collected.Linear regression models were used to determine the hospitalization cost after adjustment for demographic and other risk factors. Results For the 431 patients who met the study criteria,the median hospital stay was 24 days(range 17～34 days),which was not significantly changed over 9 years. The median inflation-adjusted total hospital cost was $80634(range $64585～97831),which was on the increase. The predominant influential factors of hospitalization expenses were hospitalization days,hospitalization deaths,European surgical scores,postsurgical complications and preoperative ventilator assistance. The least amount of hospitalization expenses was spent when hospitalization stay ≤ 10 days and ARISTOTLE surgery total score ≤ 12.25. Hospitalization expenses were related to hospitalization days when it was 10 days to 24 days. The expenses of deaths were higher than the survivors when hospitalization stay was 25 days to 48 days,the number of postsurgical complications ≥ 1.The expenses of deaths reached the highest when the hospital stay ≥ 49 days with the number of postsurgical complications ≥ 3. Conclusion The hospitalization expense of neonate's CHD has been increasing in recent years. Different hospitalization stays and surgical procedure difficulties,postsurgical complications and hospital deaths could affect the total cost of hospitalization.[S Chin J Cardiol 2019;20(2):86-94]     

鹦鹉热的流行病学

衣原体有两类,即对人引起沙眼、尿道炎、第四性病的沙眼衣原体(chlamydia trachomatis)和对人及鸟类引起鹦鹉热的鹦鹉热衣原体(Chlamydia psittaci)。目前已知鹦鹉热衣原体对鹦鹉目中的57种鸟类有感染性,并对人类有反复感染力。另外,还可以感染14个目74种鸟类,这些鸟类还是人的传染源。人感染后主要表现为肺炎、支气管炎等呼吸道症状,有时甚至引起死亡。在家畜和观赏及野生动物中有各种衣原体感染症,这些动物具备了人的感染症状。近来,作为鸟类及其他动物的一种人畜共患传染病受到了各国重新注意。1954年日本北海道大学兽医     

婴儿肺炎时呼吸系统静态顺应性及阻力变化

目的 :探讨婴儿肺炎时呼吸系统静态顺应性 (Crs)及阻力 (Rrs)的变化。方法 :用美国森迪公司的 2 6 0 0型肺功能仪 ,利用被动流速容量技术 (PFV)对 2 7例重症肺炎、5 2例普通肺炎及 37例正常婴儿进行每公斤呼吸系统静态顺应性 (Crs/kg)及Rrs。结果 :重症肺炎组、普通肺炎组无论大于 6个月或小于 6个月婴儿Crs/kg均较正常对照组降低。Rrs较正常组增高 ,3组的差异有显著意义 (P <0 0 5 )。结论 :婴儿肺炎时Crs/kg降低 ,Rrs增高 ,且随病情愈严重改变愈明显。PFV无需患儿主动配合 ,且无创伤性 ,能为婴儿肺炎时病情的严重程度及肺功能的损害程度提供客观依据。     

药盒置入术后创伤面渗血的治疗

介入治疗术中应用皮下埋置药盒是近年来兴起的一种新技术,对晚期肿瘤的局部治疗有一定的临床意义。 我院自1994年下半年起开展介入埋置药盒术,11例病人中原发性晚期肝癌5例、转移性肝癌5例、子宫癌术后复发1例。出现术后创伤面大量渗血5例,出血量均在150～200毫升左右。全部病例经过局部加压包