内蒙古中西部地区基于症状诊断的胃食管反流病患病情况及其影响因素研究

[目的]调查内蒙古中西部地区成人基于症状诊断的胃食管反流病(GERD)患病情况,并分析GERD发病的影响因素。[方法]随机抽取内蒙古中西部地区年龄≥18岁的社区及体检居民5 607例。采用胃食管反流病量表(GerdQ)调查基于症状的GERD患病率,并采用单因素和多因素分析探讨该地区GERD发病的影响因素。[结果]GerdQ评分≥8分者414例(7.4%)。单因素分析发现BMI、经常吃巧克力或甜食、夜间觉醒或早醒、睡眠时间<6 h、慢性胃炎、消化道肿瘤、高血压、冠心病、血脂异常、慢性咽炎、慢性气管炎与GERD相关。进一步的多因素分析显示,BMI、经常吃巧克力或甜食、睡眠时间<6 h、慢性胃炎、消化道肿瘤、血脂异常、慢性咽炎、慢性气管炎可能是GERD的危险因素。[结论]内蒙古中西部地区成人基于症状诊断的GERD患病率高于全国水平,肥胖、经常吃巧克力或甜食、睡眠时间<6 h等、慢性胃炎、消化道肿瘤、血脂异常、慢性咽炎、慢性气管炎可能是GERD的危险因素。     

肝胃不和与慢性胃炎、溃疡病的发病关系

通过临床观察，发现慢性胃炎、溃疡病发病机制主要在于肝气失于疏泄，胃腑失于和降（胃气阻滞，胃络瘀阻），脏腑功能失调而发病。故肝胃不和为慢性胃炎、溃疡病的基本病机。探讨如下。1七情损伤与慢性胃炎、溃疡病发病的关系慢性胃炎与溃疡病的发病原因西医有胃酸相关学说，胆     

慢性胃炎患者消化不良症状、胃动力功能及有关因素的多中心调研

目的调查慢性胃炎患者消化不良症状、胃动力功能，并探讨有关的发病因素。方法对全国25家医院门诊胃镜诊断为慢性胃炎的745例患者进行问卷调查，包括一般资料、消化不良症状，分析胃黏膜糜烂和非糜烂患者的症状、胃对不透x线标志物的排空功能以及有关因素的影响。结果745例慢性胃炎患者中，最常见症状是饱胀感、上腹不适、上腹痛和嗳气，分别占73．4％、63．1％、61．3％和52．2％；除上腹痛和嗳气外，慢性胃炎有或无黏膜糜烂患者的症状谱相近；除上腹痛外，其余各症状均在餐后更易发生（P〈0．05）。36．4％的慢性胃炎患者胃排空明显减缓，糜烂和非糜烂患者的胃排空明显减慢，分别占39．0％和34．7％。结论糜烂和非糜烂慢性胃炎患者除上腹痛外，两组均表现为消化不良症状，胃动力功能异常是慢性胃炎不可忽视的因素。     

神农丸的临床应用研究

目的评价神农丸治疗浅表性胃炎和萎缩性胃炎的临床疗效和胃黏膜的病理变化。方法选择慢性胃炎患者165例，随机分为观察组和对照组，对照组选用胃复春。均为口服治疗，3个月为1个疗程。对患者治疗前后都进行胃镜检查，观察胃黏膜的变化。结果神农丸对慢性胃炎有通络止痛、散结消肿等功能，并有调节胃黏液分泌，促进萎缩的胃黏膜恢复等多种作用。结论神农丸治疗慢性胃炎效果较好。     

老年人慢性胃炎与幽门螺杆菌感染的关系

老年人慢性胃炎与幽门螺杆菌感染的关系张瑛华我们收集了１９９５年４月至１９９６年３月因上消化道症状行胃镜检查并确诊为慢性胃炎（除外消化性溃疡和胃癌）的１５７例老年患者的资料，以了解老年人慢性胃炎与幽门螺杆菌（Ｈｐ）感染的关系，并与同期非老年患者作对比，...     

中医慢性咽炎的辨证论治进展

慢性咽炎属中医“喉痹”的范畴，主要是由于脏腑亏虚，阴阳失衡所致。中医从整体出发认为本病系机体各脏腑津液失调在咽部的表现，在临床上中医辨证论治的方法较西医有较大的优势。本文从慢性咽炎的病理病机出发，系统综述了近年来中医对慢性咽炎辨证论治的研究成果。咽喉疾病有实证，热证，寒证不同表现。局部症状为标，全身症状为本，本着治病必求其本的原则，如二者表现一致，应采用标本兼治，二者表现不同，对慢性疾患，则着重内治调理为主，外用药辅助治疗，因此对于慢性咽炎的不同类型，应采取辨证施治的原则。对于慢性咽炎不同个体的临床论治，也必须辨证施之。     

海尔曼螺杆菌感染的微生物学、流行病学与诊治研究

众所周知，慢性胃炎和消化性溃疡是世界性的常见病、多发病，但其病因及发病机制迄今未全阐明．1983年澳大利亚学者Marshall和Warren从慢性胃炎患者胃粘膜分离出幽门螺杆菌（Helicobacterpylori,Hp），随后的研究证明该菌是慢性胃炎和大多数消化性溃疡的病原菌，长期带菌和胃的持续炎症还可能促进胃癌的发生，从而为慢性胃病的病因学研究开辟了一个新的途径．正当HP热潮席卷全球并取得重大进展的时期，英国学者Dent[1]于1987年又从慢性胃炎粘膜发现了另一种与Hp相似的螺旋菌，起初将其命名为人胃螺旋菌（Gtisl则咖rillumhomjnis，Gb）归…     

胃黏膜保护剂与慢性胃炎

慢性胃炎是由各种病因引起的胃黏膜慢性炎性反应。根据内镜及病理组织学改变，通常将慢性胃炎分为非萎缩性（浅表性）胃炎及萎缩性胃炎。前者是指胃黏膜层仅有淋巴细胞和浆细胞为主的浸润性改变，而无腺体萎缩；后者指胃黏膜腺体萎缩并常伴化生性改变（肠化或假幽门腺化生）。胃黏膜损伤和修复过程的演变，使慢性胃炎的病理组织变化多端，可表现为炎性反应、萎缩和化生，甚至异型增生。     

慢性咽炎的辨治体会

慢性咽炎与中医虚火喉痹相类似 ,临床多见 ,以病程长 ,缠绵难愈 ,反复发作为其特点。笔者在临床自拟“清咽汤”治慢性咽炎 ,取得了较好疗效 ,现介绍如下。1　清咽汤组成　　连翘 15 ｇ ,麦冬 15ｇ ,玄参 12 ｇ ,蝉衣 10 ｇ ,防风 10ｇ ,桔梗10ｇ ,甘草 10 ｇ ,赤芍 12 ｇ ,丹参 15ｇ ,蜂蜜 15 ｇ。加减 :肺阴虚型治以清咽汤加百合 15 ｇ、川贝 10 ｇ、生地 15ｇ ;肾阴虚型治以清咽汤合知柏地黄汤 ;胃阴虚型患者多有慢性胃炎、胃溃疡等消化系统疾病 ,治疗应先控制其原发病 ,然后以清咽汤加石斛 15 ｇ、生地12 ｇ、川连 6ｇ ;脾肾阳虚型治以清…     

十年间胃镜诊断慢性胃炎差异的临床分析

慢性胃炎是指不同病因引起的胃黏膜慢性炎症或萎缩性病变，临床上十分常见。本病的诊断主要依赖于胃镜检查和胃黏膜多部位活组织病理学检查。十年间，高分辨率电子胃镜发展和应用，对慢性胃炎的诊断准确度有所提高。但在实际工作中，我们发现慢性胃炎的胃镜与病理诊断一致性较差，本研究通过对我院胃镜中心2001年和2011年经胃镜诊断为慢性胃炎的病例进行分析，探讨及评估十年间两者对慢性胃炎的诊断差异以及造成两者之间差异的相关因素。     

Chronic kidney disease in patients with non-ST-segment elevation acute coronary syndromes

Purpose

Chronic kidney disease has been linked to high mortality rates in patients with ST-segment elevation myocardial infarction but has not been well described for patients with non-ST-segment elevation acute coronary syndromes. We examined the treatment and outcomes of patients with both non-ST-segment elevation acute coronary syndromes and moderate to severe chronic kidney disease.

Subjects and Methods

We evaluated 45 343 patients with non-ST-segment elevation acute coronary syndromes enrolled in the CRUSADE Quality Improvement Initiative and compared treatments and outcomes in patients with and without moderate to severe chronic kidney disease.

Results

Patients presenting with moderate to severe chronic kidney disease (n = 6560) were older, more often diabetic, and more likely to present with signs of congestive heart failure. Adherence to Class IA/IB guidelines recommendations was lower in patients with moderate to severe chronic kidney disease, who were significantly less likely to be treated with medications, undergo invasive cardiac procedures, and be given discharge counseling. Moderate to severe chronic kidney disease was associated with a 50% increased risk of mortality and a 70% increased likelihood of transfusion. Despite having a higher risk of adverse outcomes, patients with moderate to severe chronic kidney disease were treated less aggressively than patients with normal renal function.

Conclusions

These findings suggest that, in patients with moderate to severe chronic kidney disease, safety concerns about adverse outcomes and the absence of trial data for this population may limit the use of guidelines-recommended therapies and interventions for non-ST-segment elevation acute coronary syndromes. The decreased use of discharge counseling in patients with moderate to severe chronic kidney disease and non-ST-segment elevation acute coronary syndromes may represent therapeutic nihilism.     

大断下片治疗慢性泄泻172例疗效观察

采用古方大断下片对脾胃虚弱型，胃阳虚衰型，脾虚夹湿型慢性泄泻患者进行厂治疗研究。１７２例中临床治愈１０４例，显效３０例，好转１９例，无数１９例、总治愈率为６０．４７％，有效率为８８．９５％。三型疗效比较Ｐ＞０．０５。     

慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病的关联性探讨

目的探讨慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病的关联性,并为慢性乙型病毒性肝炎合并慢性胆囊炎的治疗提供借鉴。方法选取住院的轻、中度慢性乙型病毒性肝炎396例为研究对象。查空腹血糖、餐后2 h血糖,糖耐量试验筛查糖尿病;做肝胆B超或CT筛查慢性胆囊炎,统计并比较有糖尿病者和无糖尿病者慢性胆囊炎的发生率。以同时合并慢性胆囊炎和糖尿病（或糖耐量异常）者72例为治疗Ⅰ组,单纯合并慢性胆囊炎者119例为治疗Ⅱ组。两组治疗方法相同,比较治疗效果。治疗Ⅰ组无效者,加胰岛素治疗,观察疗效。结果慢性胆囊炎发生率,有糖尿病者100.0％（72/72）,无糖尿病者36.7％（119/324）,两者比较差异有统计学意义（P＜0.01）。分组治疗,治疗Ⅰ组肝功能复常率及总有效率显著低于治疗Ⅱ组（P＜0.01）;胆道声像改善总有效率亦显著低于治疗Ⅱ组（ P＜0.01）。治疗Ⅰ组肝功能治疗无效者,加胰岛素治疗后,总有效率为68.3％。结论慢性乙型病毒性肝炎合并慢性胆囊炎与糖尿病密切相关,且糖尿病的存在直接影响到肝功能及胆道病变的治疗效果,但可通过胰岛素治疗获得良好预后。慢性乙型病毒性肝炎合并慢性胆囊炎时,排查糖尿病尤为重要。     

Emerging Trends in Pain Medication Management: Back to the Future: A Focus on Ketamine

Providers face many challenges when faced with pain management. Pain is complex, difficult to understand and diagnose, and especially enigmatic to manage. The discovery of nonopioid agents for pain management has become particularly important considering the ongoing opioid epidemic. This review is focused on revisiting ketamine, an agent that has historically been used for anesthesia, in new ways to manage pain. Ketamine has unique pharmacologic properties that may prevent the development of pain as well as reduce chronic pain. This has led to the use of ketamine for perioperative analgesia as well as chronic pain syndromes. In select patients with pain refractory to other treatment modalities, ketamine may provide much needed relief.     

重组人生长激素治疗慢性肝病低蛋白血症的临床观察

目的　探讨重组人生长激素对慢性肝病低蛋白血症的治疗效果。方法　 5 6例慢性肝病患者随机分为治疗组 2 8例和对照组 2 8例 ,在相同的护肝治疗基础上 ,治疗组应用重组人生长激素 4U ,皮下注射 ,每日一次 ,连续应用 14天。对照组应用 2 0 %人血白蛋白 5 0ml ,静脉滴注 ,每日一次 ,连续应用 14天。观察治疗前 ,治疗结束当天 ,治疗结束后 14天的临床症状及肝功能的改善情况。结果　治疗组的白蛋白治疗前为 2 7.12± 4.0 6g/L ,治疗结束当天为 3 1.45± 4.76g/L ,治疗结束后 14天为 3 1.6± 4.62g/L ;对照组的白蛋白治疗前为 2 6.88± 4.68g/L ,治疗结束当天为 3 3 .3 5± 5 .84g/L ,治疗结束后 14天为 2 8.42± 3 .84g/L。结论　重组人生长激素可有效地改善慢性肝病患者的低蛋白血症。     

Chronic proctalgia and chronic pelvic pain syndromes: new etiologic insights and treatment options

This systematic review addresses the pathophysiology, diagnostic evaluation, and treatment of several chronic pain syndromes affecting the pelvic organs:chronic proctalgia, coccygodynia, pudendal neuralgia, and chronic pelvic pain. Chronic or recurrent pain in the anal canal, rectum, or other pelvic organs occurs in 7% to 24% of the population and is associated with impaired quality of life and high health care costs. However, these pain syndromes are poorly understood, with little research evidence availab...     

Acute coronary syndromes in patients with renal disease: What are the issues?

Patients with chronic kidney disease and acute coronary syndromes are at high risk for both bleeding and ischemic events. This risk increases with the severity of renal insufficiency. Management for acute coronary syndromes in the setting of kidney disease is a paradox; as the benefit of current treatment is high, so is the risk for complications. Patients with chronic renal disease are frequently excluded from randomized clinical trials, and therefore, the optimal treatment strategies are often speculative in this high-risk patient population. Additional research is needed to further refine the optimal management of patients with chronic kidney disease in the setting of acute coronary syndromes.     

慢性病毒性肝炎279例病理诊断与中医证型的关系

目的:探讨慢性病毒性肝炎病理组织学诊断与中医辨证分型之间的关系,为中医辨证提供客观依据。方法:279例均为住院患者,男227例,女52例。全部病例经肝活检证实,其中轻度142例,中度91例,重度46例。慢性乙型肝炎274例,慢性丙型肝炎5例。中医辨证:湿热中阻53例,肝郁脾虚64例,肝肾阴虚29例,脾肾阳虚7例,血瘀血热101例,气阴两虚25例。临床治疗以辨证施治为主。结果:(1)279例慢性肝炎在病理诊断分型中,轻度占50.9%、中度占32.6％、重度占16.4％。(2)在轻度慢性肝炎中,湿热中阻、肝郁脾虚及肝肾阴虚证明显高于血瘀血热证.P=0.01、P<0.05。(3)湿热中阻、肝郁脾虚证的病理诊断分布情况依次为轻度>中度>重度,P<0.01、P<0.05;血瘀血热证轻度与中度分别>重度,P<0.05。但该证在重度中的发生率高于其他证型。(4)脾肾阳虚与气阴两虚证在各病理分型中的分布均无显著差异,P>0.05。结论:(1)慢性肝炎患者以轻度居多,占半数以上。(2)慢性肝病的病变早期以湿热中阻、肝郁脾虚为主证特点,病变部位多在气分;随着肝脏病理损害加重,病变部位及主导证型渐由气分至血分,以血瘀血热为主证特点。(3)治疗上主张早期宜注重清解湿热,疏肝健脾;中、晚期宜重视活血化瘀,凉血解毒。     

Latest developments in the assessment and management of chronic musculoskeletal pain syndromes in children

PURPOSE OF REVIEW: As many as 25% of new patients in pediatric rheumatology clinics present with idiopathic chronic pain and recent data suggest the prevalence of these conditions is increasing. Knowledge of the latest developments in assessment and treatment is critical for providing optimal clinical care. This review summarizes advances published in the past year forwarding our understanding of chronic musculoskeletal pain syndromes in children. RECENT FINDINGS: Research has recently focused on the impairment associated with chronic pain syndromes in children, issues impacting the diagnosis of these conditions, and the efficacy of pharmacological and psychosocial treatments. No diagnostic criteria have been developed for specific chronic pain syndromes in children; however, data from several studies substantiate the need for thorough assessment of the child and family in multiple domains. In addition, studies have expanded both pharmacologic and psychosocial treatment options for children with these syndromes. SUMMARY: Despite a growing body of research on chronic pain syndromes in children, there are no established standards of care. Data continues to support an interdisciplinary approach for effectively assessing and managing these conditions.     

慢性肾脏病患者心脑血管并发症流行病学意义

目的 探讨慢性肾脏疾病（CKD）患者的心脑血管并发症的发生率，分析心脑血管并发症的危险因素。方法 采用专用调查表进行问卷调查的方式，研究CKD患者心脑血管并发症发生率，以及心脑血管并发症与CKD之间相互影响的情况。结果 CKDⅠ～Ⅴ期患者共129例，其中男性57例，女性72例。CKD主要并发疾病依次为高血压（69．0％）、贫血（44．2％）、高血脂（43．4％）、心脏疾病（41．9％）、糖尿病（30．2％）等。肾小球滤过率（GFR）水平降低和高血压为CKD并发CVD的危险因素；C反应蛋白（CRP）水平、高血脂、年龄增加皆为脑血管并发症的危险因素。结论 GFR水平降低、高血压、CRP水平升高、高血脂、年龄增加为CKD心脑血管并发症的主要危险因素。早发现CKD并发症和严重程度，重视各种危险因素对CVD和CKD的影响有重要意义。