超声清创联合重组人表皮生长因子治疗肛周脓肿感染的疗效观察

  目的  探讨超声清创联合重组人表皮生长因子(RhEGF)治疗肛周脓肿感染的疗效。  方法  选取2019年2月—2021年2月衢州市中医医院收治的112例肛周脓肿感染患者,按照治疗方法的不同将其分为超声组(37例)、RhEGF组(37例)、观察组(38例)。3组患者均常规给予抗菌药物,超声组给予超声清创治疗,RhEGF组给予RhEGF治疗,观察组给予超声清创联合RhEGF治疗。比较3组患者临床指标水平、疼痛程度、创面细菌清除率、微循环指标水平。  结果  观察组创面愈合时间[(15.49±2.18)d]、住院时间[(15.53±2.06)d]短于超声组[(18.06±2.01)、(18.52±1.73)d]、RhEGF组[(17.84±1.93)、(17.98±1.85)d, F=18.291、26.852,均P < 0.001];3组患者治疗后1 d视觉模拟量表评分低于治疗前(均P < 0.05),且观察组低于超声组、RhEGF组(F=30.093,P < 0.001);3组患者治疗后3 d创面细菌清除率高于治疗后1 d(均P < 0.05),且观察组治疗后1、3 d创面细菌清除率高于超声组、RhEGF组(F=22.183、31.650,均P < 0.001);3组患者治疗后1 d创面血流量、经皮氧分压及血清表皮生长因子水平高于治疗前(均P < 0.05),且观察组高于超声组、RhEGF组(F=4.406、20.210、51.552,P值为0.015、 < 0.001、 < 0.001)。  结论  超声清创联合RhEGF治疗肛周脓肿感染疗效显著,有助于患者早日康复。      

老年慢性阻塞性肺疾病合并肺结核的早期诊断及治疗探讨

目的分析住院老年人慢性阻塞性肺疾病（COPD）合并肺结核的临床特点,探讨其早期诊断及治疗措施。方法对48例住院老年COPD合并肺结核患者的临床资料进行回顾性分析。结论老年COPD合并肺结核的临床症状、体征、影像学及辅助检查均不典型,且合并症、并发症多,漏诊、误诊率高。应引起临床医师的高度重视,以早期诊断,及时治疗。     

健脾活血解毒汤辅助治疗缓解期溃疡性结肠炎效果观察

目的 探讨健脾活血解毒汤辅助治疗缓解期溃疡性结肠炎(UC)的效果.方法 选取2019年7月至2020年6月该院肛肠科收治的缓解期UC患者96例,随机分为观察组与对照组各48例.对照组口服柳氮磺吡啶肠溶片,观察组在对照组基础上口服健脾活血解毒汤,连用12周.比较两组疗效、中医症状积分、结肠镜下黏膜形态评分、血清炎性因子、...     

早期双水平气道正压通气治疗老年重叠综合征并发呼吸衰竭临床分析

目的探讨早期双水平气道正压通气（BiPAP）呼吸机治疗老年重叠综合征（OS）合并呼吸衰竭临床疗效。方法42例OS伴呼吸衰竭老年患者,随机分为常规治疗组19例和常规治疗加BiPAP组（BiPAP组）23例,比较两组治疗前后动脉血气、多导睡眠图仪（PSG）及插管率、病死率、住院时间及不良反应。结果早期使用BiPAP患者,PaO2、PaCO2、最长呼吸暂停时间、呼吸暂停低通气指数、插管率及住院时间优于常规治疗组,且无明显不良反应。结论早期使用BiPAP呼吸机治疗合并呼吸衰竭是一种安全有效的方法,且可减少插管率,缩短住院时间。     

补肾活血汤治疗虚哮30例临床观察

目的:观察补肾活血汤治疗虚哮的临床疗效。方法:将45例虚哮患者随机分为两组,治疗组30例口服补肾活血汤,对照组15例口服阿斯美胶囊和头孢拉定;两组均以10天为1疗程,主要观察两组治疗前后中医证侯疗效和主要症状疗效。结果:治疗组中医证候疗效和主要症状疗效的显效率分别为60.0%、70.0%,对照组则分别为20.0%、33.4%,治疗组和对照组总有效率分别为90.0%、80.0%;两组显效率、总有效率比较,差异均有显著性意义(P<0.05)。结论:补肾活血汤治疗虚哮在提高中医证候疗效和改善主要症状方面均优于西药组。     

环孢素A对肺纤维化大鼠模型TGF-β1／Smad3表达的影响

目的研究环孢素A（CsA）对大鼠肺纤维化的干预作用及TGF—β1／Smad3信号转导通路的作用机制。方法54只SD大鼠随机分为对照组、模型组和干预组。模型组、干预组经气管内注入博莱霉素（BLM，5mg／kg）诱导肺纤维化模型，干预组次日CsA灌胃进行干预，对照组用生理盐水代替。各组注药后7天、14天和28天3个时间点分别处死6只大鼠。观察肺泡炎及肺纤维化程度；用免疫组织化学法检测转化生长因子β1（TGF-β1）和smad3的表达；TUNEL检测28天各组大鼠肺组织细胞凋亡情况。结果对照组肺泡结构正常，模型组7天时以肺泡炎改变为主，14天时肺泡炎较前有所减轻，28天时以广泛性肺纤维化为主。干预组病理改变与模型组有同一规律，但肺泡炎和肺纤维化程度都轻于模型组。干预组各时间点TGF-β1和smad3表达明显低于模型组（P〈0．05），28天时大鼠肺组织中细胞凋亡指数干预组明显低于模型组。结论环孢素A可下调博莱霉素致肺纤维化大鼠肺组织TGF-β1／Smad3介导的细胞内信号转导途径，减少肺组织上皮细胞的凋亡，最终改善肺间质纤维化。     

老年患者草绿色链球菌群感染的临床特征

目的探讨老年患者草绿色链球菌群感染的临床特征和病原菌特点。 方法收集2016年6月至2020年12月济宁医学院附属医院细菌数据库中诊断为草绿色链球菌群感染的老年患者,年龄≥65岁,对其相关临床资料进行回顾性分析及总结。 结果共收集患者75例,其中男性39例(52.00%),伴基础疾病者55例(73.33%)。30例(40.00%)患者以急性发热起病。分离菌群部位以正常无菌部位例数最多(58/75,77.33%)。具体致病菌分群：缓症链球菌11例(14.67%)、血链球菌14例(18.67%)、咽峡炎链球菌群50例(66.67%)。合并革兰氏阴性杆菌感染6例(8.00%),诱发中毒性休克综合征2例(2.67%)。药敏结果显示对红霉素、克林霉素、左氧氟沙星的耐药率分别为65.33%(49/75)、68.00%(51/75)、16.00%(12/75),对头孢曲松(6.67%,5/75)、头孢噻肟(4.00%,3/75)耐药率低。 结论草绿色链球菌群作为常见的感染菌群,在老年人群中易发生机会感染。临床症状以发热常见,致病菌可累及多个系统,严重时可诱发中毒性休克综合征。     

Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux

OBJECTIVE:To assess the effectiveness and safety of Traditional Chinese Medicine(TCM) treatment of non-acute bronchial asthma complicated by gastroesophageal reflux.METHODS:We searched databases from MEDLINE,Cochrane Library,CNKI,VIP,CBM,Wanfang Data,and TCM Database Systems.All randomized,controlled trials(RTCs) of TCM treatment of non-acute asthma complicated by gastroesophageal reflux were included.Data were independently collected by two reviewers.The standards for assessing quality described in the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate articles.Meta-analyses were conducted using RevMan 5.0.17 software.Heterogeneity was assessed,and a corresponding effects model was used to merge and analyze results.Indexes used to evalu-ate curative effects were:clinical efficacy,symptom scores,pulmonary function values,and adverse incidents.Effectiveness was indicated using risk ratio(RR) or mean difference(MD),and 95% confidence intervals(CIs) were calculated.RESULTS:Six RCTs were included,involving 304 patients with non-acute asthma complicated by gastroesophageal reflux.The treatment groups received Chinese drugs alone or TCM combined with standard Western medical treatment,and the control groups received standard Western medical treatment alone.Standard Western medical treatment included anti-inflammatory drugs and bronchodilators for asthma,and drugs to promote gastric peristalsis and inhibit gastric acid production for gastroesophageal reflux.Methodological quality was low in all six RCTs.Two RCTs showed that clinical efficacy was higher in the treatment group than in the control group(RR:1.43,95%CI:1.10 to 1.87 vs RR:1.51,95% CI:1.09 to 2.08).One RCT showed that the asthma score was lowered more effectively in the treatment group than in the control group(MD:-1.10,95% CI:-2.04 to-0.16).Two RCTs showed that the gastroesophageal reflux score was reduced more effectively in the treatment group than in the control group(RR:-3.70,95% CI:-4.30 to 3.10 vs RR:-5.30,95% CI:-6.32 to-4.28).One RCT showed that some pulmonary function values were improved more effectively in the treatment group than in the control group(P< 0.05).No differences were seen in the various indexes between groups in the other RCTs.No adverse reactions,dropout rates,or follow-up rates were reported in any of the RCTs.CONCLUSIONS:The clinical symptoms ofnon-acute asthma complicated by gastroesophageal reflux can be improved by some Chinese drugs.Curative effects can be increased by combining the use of TCM with Western medicine.Because of the small quantity and low quality of research reported to date,it is necessary to conduct further RCTs to confirm these results.The results of this systematic review indicate that the quality of future clinical trials should be improved by including larger patient numbers,correctly randomizing patients into study groups,using blinding methods to measure and assess outcomes,and using accepted indexes to evaluate curative effects.     

三氧化二砷治疗支气管哮喘的研究进展

祖国医学对支气管哮喘的认识已有数千年历史,《黄帝内经》是最早记载"哮喘"的医学文献,以后历代本草均有砒石(主要含三氧化二砷的矿物药)治疗哮喘的记载.随着支气管哮喘发病机制研究的深入及哮喘气道炎症学说的逐步完善,认识到骨髓CD34 祖细胞分化反应增强,在维持哮喘慢性气道炎症中具有至关重要的作用,同时为基于此的治疗哮喘新药的研制提供了广阔的前景.根据国内外近年有关骨髓造血祖细胞参与哮喘发病的研究进展和三氧化二砷(As2O3)治疗支气管哮喘的研究状况作一综述.