酮替芬治疗50例感染后咳嗽的疗效观察

目的：观察酮替芬联合孟鲁司特钠和右美沙芬治疗感染后咳嗽的疗效。方法100例感染后咳嗽患者分成2组,观察组口服酮替芬1mg,每天2次,孟鲁司特钠10mg每晚1次,右美沙芬片15mg每天3次。对照组口服孟鲁司特钠10mg,每晚1次,右美沙芬片15mg,每天3次。治疗时间为2周。结果两组治疗2周后咳嗽积分和视觉模拟评分均较治疗前有显著性改善,差异有统计学意义（P＜0．01）。治疗2周后两组间比较,观察组疗效优于对照组,差异有统计学意义（P＜0．05）。结论酮替芬联合孟鲁司特钠和右美沙芬治疗感染后咳嗽较孟鲁司特钠联合右美沙芬治疗感染后咳嗽疗效更好。     

孟鲁司特钠治疗感染后咳嗽疗效观察

目的探讨孟鲁司特钠治疗感染后咳嗽的疗效。方法感染后咳嗽患者60例,随机分为观察组和对照组各30例,观察组给予口服孟鲁司特钠10mg,1次/d,右美沙芬片30mg,3次/d;对照组口服右美沙芬片30mg,3次/d,疗程均为10d。在治疗前及治疗后分别根据咳嗽症状积分表进行评分,观察两组治疗后评分的改善率,评估疗效。结果治疗后观察组改善率（67±11）%;对照组改善率（47±10）%,两组比较差异有统计学意义（P〈0.01）。结论孟鲁司特钠可以改善感染后咳嗽患者的临床症状,是有效的治疗方法。     

93例感冒后咳嗽患者中西医结合治疗分析

目的 探讨中西医结合治疗感冒后咳嗽的临床疗效.方法 对93例感冒后咳嗽患者随机分为2组,观察组49例在给予马来酸氯苯那敏和盐酸伪麻黄碱治疗的基础上加用止嗽散化裁,对照组49例患者给予马来酸氯苯那敏和盐酸伪麻黄碱治疗;比较2组患者的临床疗效.结果 观察组疗效优于对照组.结论 中西医结合治疗感冒后咳嗽较单纯西药治疗有更好的效果.     

沙美特罗替卡松治疗感染后咳嗽的临床观察

目的探讨沙美特罗替卡松治疗感染后咳嗽的效果。方法以本院感染后咳嗽患者118例为研究对象,按照随机数字表法,将患者随机分为沙美特罗组(58例)和氯苯那敏组(60例),前者吸人沙美特罗替卡松(50μg沙美特罗,500μg替卡松),每次1吸,2次/日,后者口服氯苯那敏片,每次4mg,2次/日,疗程均为2周。观察治疗前后咳嗽症状的差异。结果吸入沙美特罗替卡松组患者和口服氯苯那敏组患者咳嗽症状都有明显改善,与治疗前比较差异有显著性,沙美特罗替卡松组治疗效果明显优于氯苯那敏组。结论吸入沙美特罗替卡松对感染后咳嗽有较好的治疗作用。     

孟鲁司特口服联合吸入用复方异丙托溴铵溶液雾化吸入治疗儿童感染后咳嗽临床观察

目的研究孟鲁司特口服联合吸入用复方异丙托溴铵溶液雾化吸入治疗儿童感染后咳嗽的临床疗效。方法选择2013年4月至2015年3月北京丰台医院收治的感染后咳嗽患儿74例,按照随机数字表法分为观察组和对照组,各37例。对照组口服孟鲁司特钠咀嚼片,1~5岁剂量为4 mg/d,6~10岁剂量为5 mg/d,每日1次;观察组在此基础上联合吸入用复方异丙托溴铵溶液雾化吸入,每日2次,疗程均为10 d。比较两组患儿治疗前后咳嗽评分变化,观察两组患儿临床症状消失时间、临床疗效和不良反应发生情况。结果两组患儿治疗5、10 d咳嗽评分均较治疗前呈下降趋势,观察组在治疗5、10 d的下降速度更快[观察组:(2.01±0.33)分、(1.03±0.14)分比(2.51±0.48)分;对照组:(1.47±0.21)分、(0.31±0.05)分比(2.51±0.48)分],两组在组间、不同时点间、组间·不同时点间交互作用比较差异有统计学意义(P<0.05)。观察组患儿的咳嗽症状缓解时间和消失时间显著短于对照组[(6.4±1.2)d比(8.9±2.2)d、(8.4±2.1)d比(11.0±3.0)d],差异有统计学意义(P<0.01)。观察组患儿总的有效率显著高于对照组[91.89%(34/37)比70.27%(26/37)](P<0.05)。两组不良反应发生率比较差异无统计学意义[2.70%(1/37)比5.41%(2/37)](χ2=0.3474,P>0.05)。结论孟鲁司特口服联合吸入用复方异丙托溴铵溶液雾化吸入治疗儿童感染后咳嗽,能缩短患儿的临床症状缓解时间和消失时间,临床疗效良好,安全性高。     

小青龙汤加减治疗嗜酸粒细胞性支气管炎的临床疗效及其对效应细胞、炎症介质的影响

目的 探讨小青龙汤加减治疗嗜酸粒细胞性支气管炎的临床疗效及其对效应细胞、炎症介质的影响。方法 选取嗜酸粒细胞性支气管炎患者120例,随机分为观察组与对照组,每组各60例。对照组每天吸入丙酸倍氯米松气雾剂2次,250μg/次；观察组予小青龙汤加减治疗,两组均治疗2个月。于治疗前、治疗2个月后比较两组外周血嗜酸粒细胞(Eos)计数进行诱导痰细胞性检查,计算诱导痰Eos分类,测定Eos阳离子蛋白及白三烯C4水平；进行咳嗽评分,比较临床疗效,记录不良反应。结果 治疗后,两组诱导痰Eos分类、Eos阳离子蛋白、白三烯C4 水平及咳嗽评分均不同程度的降低 (t=3.99~9.20,P＜0.05或P＜0.01)；且观察组诱导痰Eos分类、Eos阳离子蛋白、白三烯C4 水平及咳嗽评分均低于对照组(t=3.62~5.37,P＜0.05)。观察组与对照组总有效率分别为93.10%、80.36% (χ2 =4.05,P＜0.05)。观察组1例述恶心但未呕吐,1例右上臂出现一过性红斑,略感瘙痒。对照组2例患者出现喉部不适的症状,均予以2.5%碳酸氢钠溶液漱口后好转。结论 小青龙汤加减治疗嗜酸粒细胞性支气管炎具有良好的疗效,降低了诱导痰Eos、嗜酸粒细胞阳离子蛋白、白三烯C4等效应细胞和炎症介质的水平,消除或改善了咳嗽症状,且没有长期应用激素的副作用,优于吸入糖皮质激素的治疗效果。     

吸入性糖皮质激素对咳嗽变异性哮喘气道炎症和高反应性的影响

目的 分析吸入性糖皮质激素对咳嗽变异性哮喘患者气道炎症和高反应性的影响.方法 选取2017年2月至2018年10月本院收治的62例咳嗽变异性哮喘患者为观察组,另选同期60名本院健康体检者为对照组.观察组给予吸入性糖皮质激素治疗1年,观察并比较两组气道指标,比较观察组患者治疗前后气道反应及气道炎症的变化情况.结果 观察组嗜酸性粒细胞在其他炎症细胞中的占比高于对照组,差异有统计学意义(P<0.05);两组FEV1、FEV1/FVC比较差异无统计学意义;随着治疗时间的增加,观察组气道反应性FEV1-PD20水平、气道炎症水平IL-10逐渐升高,气道炎症水平IL-5逐渐降低,与治疗前比较差异均有统计学意义(P<0.05).结论 长期吸入性糖皮质激素治疗咳嗽变异性哮喘患者效果显著,可有效控制气道炎症,促进气道高反应性好转,值得临床推广应用.     

儿童咳嗽变异性哮喘93例疗效分析

目的 探讨儿童咳嗽变异性哮喘的临床疗效.方法 将93例儿童咳嗽变异性哮喘患儿随机分成对照组口服酮替芬;观察组I吸入糖皮质激素和观察组Ⅱ口服顺尔宁,疗程均为3个月.三组均服博利康尼至咳嗽消失.结果 三组治疗临床缓解时间差异无统计学意义(P>0.05),3月后总有效率,对照组与观察组Ⅰ差异显著(P<0.01),对照组与观察组Ⅱ差异显著(P<0.05),观察组之间无明显差异(P>0.05).疗程结束后半年随访复发率,对照组高于观察组(P<0.05),观察组之间无明显差异(P>0.05).结论 口服酮替芬、吸入糖皮质激素、口服顺尔宁控制儿童咳嗽变异性哮喘均有效.总体上吸入糖皮质激素和口服顺尔宁优于酮替芬,而吸入糖皮质激素与口服顺尔宁疗效相当.     

变应性咳嗽的临床特征与气道炎症特点

目的探讨变应性咳嗽(AC)的诊断、治疗及其气道炎症特点。方法采用《咳嗽的诊断与治疗指南(草案)》的病因诊断程序,对158例慢性咳嗽患者进行病因诊断;结合诱导痰方法,分析痰液中细胞分类,分别采用荧光酶免疫法、酶联免疫吸附法测定诱导痰上清液中总IgE、嗜酸粒细胞阳离子蛋白(ECP)、白细胞介素-8(IL-8)的浓度。并以13例正常人和20例嗜酸粒细胞性支气管炎患者作对照;口服氯雷他定10 mg/d,2周,部分患者同时口服泼尼松10～15 mg/d或甲基氢化泼尼松8～12 mg/d,1周。结果 22例符合AC诊断,占慢性咳嗽的13.9%,多表现为慢性干咳,肺功能正常,组胺激发试验阴性。AC患者中性粒细胞(57.62±29.35)%较正常人(30.70±16.04)%显著增高(P<0.01),巨噬细胞(37.62±29.49)%较正常人(67.98±15.83)%明显降低(P<0.01),嗜酸粒细胞和淋巴细胞与正常人比较差异无统计学意义。AC患者诱导痰上清液中ECP浓度19.30(2.00～200.00)mg/L和IL-8浓度12.82(1.92～118.92)mg/L较正常人显著升高(P<0.01,P<0.05)。AC患者糖皮质激素或抗过敏治疗1周后,大部分患者的咳嗽消失。结论 AC是引起慢性咳嗽的一个重要原因,气道具有以中性粒细胞为主的炎症,抗过敏或抗炎治疗效果良好。     

孟鲁司特钠口服与利巴韦林、氨溴索雾化吸入联合治疗小儿感染后咳嗽效果研究

目的探讨孟鲁司特钠口服与利巴韦林、氨溴索雾化吸入联合治疗小儿感染后咳嗽的临床效果。方法选择166例感染后咳嗽患儿,随机分为两组,各83例。对照组采用孟鲁司特钠口服联合氨溴索雾化吸入治疗,观察组在对照组基础上联合利巴韦林雾化吸入治疗,观察两组治疗后3、5、7 d疗效及不良反应;并随访2个月,观察两组复发情况。结果观察组治疗后3、5、7 d总有效率均高于对照组(P<0.01),3例无效患儿抗炎后再次出现感染后咳嗽,给予联合雾化吸入治疗后痊愈;对照组16例治疗无效患儿给予联合雾化吸入治疗后痊愈。治疗期间两组均未见明显不良反应。随访2个月,观察组复发率低于对照组(P<0.01)。结论孟鲁司特钠口服与利巴韦林、氨溴索雾化吸入联合治疗小儿感染后咳嗽疗效确切,且操作简单、易行,适合在基层医院推广应用。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.