中药外敷治疗皮肤与软组织感染相关研究

目的：对近10年来中药外敷对皮肤软组织感染的治疗近况进行综述。方法：以西医：SSTIs、毛囊炎、疖、痈、淋巴管炎、急性蜂窝织炎、烧伤创面感染、手术后切口感染及褥疮感染;中医：痈、疽、疔、疖;中医外治等,为检索词,检索年限为1990——2010年,检索了中国知网数据库、重庆维普、清华同方、PubMed等,检索中医药对皮肤软组织感染的治疗近况文献,对其治疗方法进行分类并总结。结果：共搜索到50余篇中医文献。包括皮肤与软组织感染临床研究、实验报道、典型病例等。结论：中药外敷对皮肤与软组织感染的治疗有一定的优势。     

临床四则

一、麝香治疗急性化脓性软组织感染适应症:急性化脓性软组织感染(疖、痈、蜂窝织炎等),经抗菌素治疗不能控制化脓趋势者,或软组织感染早期,尚未经治疗者,如颈淋巴结炎、颌下淋巴结炎、急性乳腺炎、注射部位感染、皮肤疖肿等。用法与功效:将麝香调白酒数滴外敷,剂量视感染面积大小而定,面积小的不需包扎,若面积较大,可将调好的麝香放置在塑料纸上,持续包敷于感染部位,当酒挥发后,取下塑料纸,在原麝香上洒数滴酒,再行敷贴,使其保持湿润,促进局部吸收,加强抗菌止痛,消肿散结的作用.一般用三日后,感染面积明显缩小,化脓趋势得到控     

贝复济治疗糖尿病性难愈性溃疡18例体会

糖尿病患者常并发疖、痈等皮肤化脓性感染，一旦感染后疖痈又发展成脓肿，使皮肤形成难以愈合的慢性溃疡，我院自2000年3月-2005年12月应用贝复济（外用重组牛碱性成纤维细胞生长因子）治疗糖尿病性难愈性溃疡18例，取得满意效果，现将体会报告如下。     

疖之青霉素封闭疗法

大家都知道,治疗创伤、疖、痈、脓肿和其他化脓性疾病的方法是很多的。在这些病例中,我使用了青霉素封闭疗法。根据长期观察的结果,我确信使用这种治疗方法可使疖、痈迅速愈合,而病人亦可於短期内恢复劳动能力。青霉素封闭疗法的方法如下: 用等量乙醚与酒精混合溶液处理疖、痈或创伤周围的皮肤,俟酒精干燥以后,把配制好的青霉素溶液(400,000—500,000单位溶於0.25％奴佛卡因溶液中)沿放射方向注射於发炎灶的深部(注射3—4次,每次1—1.5毫升青霉素溶液)。在治疗疖、痈时,应在距浸润边缘的2—3厘米处进行注射。     

1例PICC置管患者导管破裂致皮肤软组织感染的护理体会

目的探讨1例PICC置管患者导管破裂致皮肤软组织感染的处理方法及护理措施。方法采取多学科会诊,予以拔除PICC导管,中药及土豆交替外敷,抗生素抗感染治疗、防血栓治疗等处理,进行有针对性的护理措施,患者右上肢皮肤软组织感染得以治愈。结果/结论及时发现,正确处理PICC导管破裂,同时增强护理人员的防范意识,正确维护导管,规范外敷用药操作,加强患者健康教育,可减少和预防PICC导管破裂致皮肤软组织感染的发生。     

巧用中成药治疖痈

疖和痈是临床上比较常见的两种急性化脓性皮肤病。西医通常采用对患处皮肤进行切开引流的方法来治疗此病。这种疗法虽然可以有效地治疗疖和痈,却常常给患者带来莫大的痛苦。经过多年的临床实践,笔者发现其实不用“动刀”也可以治疗疖和痈。下面,笔者就为大家介绍9种利用中成药来治疖和痈的方法：     

中药在社区中治疗皮肤化脓性感染的体会

皮肤化脓性感染如疖、痈、疔,丹毒等常为金黄色葡萄球菌、链球菌等感染引起的.分别采用大蒜、新鲜马齿苋和黄连浸泡液外用治疗2例皮肤化脓性感染,疗效显著,现报告如下.     

中药六合丹外敷治疗急性外科感染

我所应用中药六合丹外敷,治疗外科急性感染100例,包括疖42例,蜂窝织炎23例,痈19例,丹毒11例,淋巴管炎5例。方剂:我们应用的六合丹,是据四川医学院医疗系编著《急诊手册》介绍的方药加味组成的。其成份为:大     

黄连解毒汤配伍五味消毒饮治疗普通外科感染的疗效观察

外科感染是指需要手术治疗的感染性疾病和机体受创损后发生的感染，尽管抗菌药物不断增多，但发病率仍未降低。普通外科感染常指发生在皮肤和软组织的急性感染，包括：疖、痈、急性蜂窝织炎、丹毒、急性淋巴管或淋巴结炎等。因目前抗菌药物大量及广泛应用，则产生许多难治性耐药菌种，使部分外科感染治疗难度加大，故加用中药治疗，可缓解抗菌药物使用压力，降低耐药菌种产生，保证部分普通外科感染迅速恢复。现将笔者应用黄连解毒汤配伍五味消毒饮治疗外科感染的疗效观察。     

中医治疗小儿泌尿道感染文献计量学分析

检索1990—2016年学者在知网、万方数据库及MEDLINE等发表的与小儿泌尿道感染中医药文献574篇,严格按照纳入标准和排除标准对检索到的文献进行筛选分类,最终得到205篇中医及中西医结合治疗文献,7篇名老中医经验文献。通过文献学的计量方法,对文献的整体质量、中医辨证、选方、用药以及诊疗标准进行统计分析,全面了解小儿泌尿道感染中医治疗的情况及发展趋势。分析结果认为,小儿泌尿道感染的常见中医证候为膀胱湿热证、心火炽盛证、肝肾阴虚证、脾肾气虚证和气阴两虚证,中药方剂以八正散、知柏地黄丸、导赤散为基础方进行加减的应用频率较高,中药单味药以瞿麦、萹蓄、滑石、车前子、木通等为多见。针对这205篇文献进一步分析时发现,对于小儿泌尿道感染的诊断标准和疗效标准评价方法多种多样,缺乏统一规范的诊断、疗效标准评价体系,说明在该领域并未形成规范诊疗标准。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.