类风湿关节炎辨证施护的现状及研究进展

综述类风湿关节炎患者中西医护理和辨证施护的应用进展,及中医辨证施护的临床应用现状,提示中医辨证施护与类风湿关节炎转归关系密切,为今后临床开展类风湿关节炎辨证施护提供思路和依据。     

类风湿关节炎中医辨证分型研究概况

类风湿关节炎在中医辨证分型治疗方面有独特的优势,探讨类风湿关节炎的中医辨证分型有利于提高临床诊疗水平。文章对最近10余年的相关文献进行分析,分别从中医传统辨证分型、中医分期辨证、中医辨证分型与统计学、中医辨证分型与实验室指标、中医辨证分型与X线及超声检查、中医辨证分型与体质因素、中医辨证分型与地域差别、中医辨证分型与基因表达等方面进行综述。     

从太阳病论治类风湿关节炎探析

从太阳病角度对类风湿关节炎的辨证治疗进行理论剖析,为类风湿关节炎的经方治疗提供新思路。结合《伤寒杂病论》部分经典条文,从太阳病层面探讨类风湿关节炎的临床表现、病因病机及证治方药,挖掘太阳病本证经方治疗类风湿关节炎的作用机制。相关研究表明,在类风湿关节炎病程中与太阳病病证有诸多相同或相似的病机,从太阳病论治类风湿关节炎立论可靠,其能有效改善类风湿关节炎患者临床症状,提高临床疗效。     

李楠教授巧用中药药理学理论治疗类风湿关节炎经验

李楠教授对类风湿关节炎有多年的临床实践和研究,认为"湿热壅盛"为类风湿关节炎的病机关键,又是其临床最基本的证候类型,"祛风湿,清热解毒"为类风湿关节炎治疗的首要原则,可作为类风湿关节炎的辨证纲领。李楠教授治疗类风湿关节炎遵循中医辨证论治原则,又以现代药理学理论指导药味选择,做到真正意义上的"病证结合",特色鲜明且疗效确切。     

WORMS评分中滑膜炎症与膝骨性关节炎中医证型的关联性研究

目的 :探讨膝骨性关节炎性滑膜炎与膝骨关节炎中医证型的相关性。方法 :自2015年1月至2018年6月,选取213例膝骨关节炎的患者,进行中医辨证分型,其MRI影像进行WORMS评分,同时做WORMS评分中滑膜炎和中医证型的相关性分析。结果:213例患者中,风寒湿痹证25例(占11.7%),风湿热痹证84例(占39.4%),瘀血痹阻证43例(占20.2%),肝肾亏虚证61例(占28.6%);在WORMS评分中,滑膜炎评分为0分的12例(占5.6%),1分的60例(占28.2%),2分的50例(占23.5%),3分的91例(占42.7%);相关性分析中,差异有统计学意义,WORMS评分中滑膜炎3分组更容易发生在风湿热痹证中(χ~2=137.286,P=0.000)。结论:膝骨性关节炎滑膜炎患者临床上以风湿热痹型(39.4%,84/213)为主,这对于相关治疗有一定的指导意义。     

肾虚证物质基础研究的初步探讨

目的:通过对69例慢性肾脏病患者证候及理化指标的观察,初步探索中医"肾虚证"与肾脏内分泌物质的相关性。方法:对符合纳入标准的患者进行临床证候观察及辨证,同时进行肾素、血管紧张素Ⅱ、醛固酮、PTH等检验测定,最后应用SPSS17.0统计软件进行数据处理。结果:肾脏内分泌物质——肾素、血管紧张素Ⅱ、醛固酮、PTH与中医本虚证各证型有相关性。结论:初步探索肾脏内分泌物质与肾虚证各证型间存在一定的关系,肾素、血管紧张素Ⅱ、醛固酮、血红蛋白、PTH等肾脏内分泌物质有希望成为慢性肾脏病(CKD)阴阳失调及中医辨证分型的客观指标之一。     

慢性肾脏病3期肾络瘀痹证的中医证候研究

目的:探讨慢性肾小球肾炎(慢性肾炎)、慢性肾脏病(CKD)3期肾络瘀痹证的中医证候特点。方法:(1)采用前瞻性临床研究方法。(2)研究对象:慢性肾炎(CKD3期)、中医辨证为肾络瘀痹证(瘀痹证)。(3)分析瘀痹证发生率、中医证候特点。结果:(1)慢性肾炎(CKD3期)瘀痹证发生率74.2%,瘀痹肾虚风湿三联证最多见,单独瘀痹证少见。(2)瘀痹证中尿血积分值最高,且尿血与UPro/24h、UAlb/Cr呈正相关性(P<0.05)。结论:慢性肾炎(CKD3期)瘀痹证并不少见,并绝大多数与其他证型并存。瘀痹证以镜下多形性红细胞尿持续存在最具特征,在中医辨证中引入尿象检测将有助于提高辨证精准度。     

系统性红斑狼疮中医病名之论

通过总结中医古籍对系统性红斑狼疮病名等论述,包括"蝴蝶斑""阴阳毒""痹证""五脏痹""虚劳病"等名称,对其进行分析比较,探讨背后蕴含的病因病机,并结合现代医家对系统性红斑狼疮病名、辨证分型、治则治法等认识,丰富系统性红斑狼疮的辨病辨证治疗体系,为命名提供参考.     

骨质疏松症中医证候分布规律及相关性研究进展

骨质疏松症是中老年人常见病、多发病,属于中医"骨痿"、"骨痹"的范畴。中医学对其病因病机有着深刻的认识,但对其辨证分型存在不同的观点。为了使中医研究更加规范化、科学化,本文通过复习文献并结合自己的临床体会,对骨质疏松症中医辨证证候分布规律、证型分型规律及现代医学检查指标(如:骨密度、生化指标、基因蛋白组等)之间相关性的一些研究概况进行综述,为骨质疏松症的中医研究更加客观化、规范化,提供新思路、新方法。目前关于OP的中医证候分类多数是流于一般的释病、立法及用药说理等,并涉及脏腑、气血、经络等,没有体现病理实质,常常存在着不同的观点,分析其原因可能与学者根据个人的临床经验提出中医证型分类法,导致中医辨证分型比较混乱有关;其次,中医辨证分型易受观察者主观因素的影响等因素,均可导致硏究结果的不一致。所以,使用规范、统一,能充分反映疾病本质的中医证型分类法是研究中医"证"的关键所在,所得的结果才有可比性。     

桂枝汤类方治疗类风湿关节炎的研究进展

类风湿关节炎是临床常见的慢性难治性风湿病,临床治愈率低,致残率高.运用中医药治疗痹证具有悠久的历史,汉代张仲景将桂枝芍药知母汤用于痹证的治疗,开创了调和营卫法治疗痹证的先河,后世医家在此基础上运用桂枝汤类方加减化裁治疗痹证收效良好,可明显减轻患者的临床症状.并且,临床实践与实验研究也证实桂枝汤类方可以有效缓解类风湿关节...     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.