针刺与中医药物结合辨证治疗特发性主观性耳鸣的疗效

 目的 观察针刺与中医药物结合辨证治疗特发性主观性耳鸣的疗效。方法 选择2018-01至2021-09于解放军总医院第八医学中心中医科就诊的特发性主观性耳鸣患者106例,依据患者治疗意愿分为针药结合组和单纯针刺组两组。单纯针刺组予针刺治疗,针药结合组在针刺治疗的基础上联合中药治疗。两组治疗周期4周。于治疗前、治疗4周后、治疗结束后3个月填写耳鸣严重程度评估量表(TEQ)进行评分,判定疗效和复发,比较2组疗效和复发率差异。结果 (1)针药结合组纳入可分析病例55例,单纯针刺组纳入43例。两组在性别、年龄、病程3个方面差异具均有统计学意义(P＜0.05)。进行倾向性评分匹配法后,两组各有38例达到了所设置的匹配容差,保证了两组基线的可比性。(2)治疗4周后,针药结合组TEQ评分较单纯针刺组明显降低,差异有统计学意义(P＜0.05),针药结合组总有效率89.47%,优于于单纯针刺组71.05%(P＜0.05)。(3)治疗结束3个月后随访,针药结合组复发率(5.88%)低于单纯针刺组(18.52%),差异有统计学意义(P＜0.05)。结论 针刺与中医药物辨证治疗特发性主观性耳鸣疗效优于单纯针刺治疗。     

治疗冠心病心绞痛中成药的合理应用

1用药原则1.1辨证论治依据中医辨证理论,冠心病心绞痛分为心血瘀阻证型、痰浊痹阻证型、阴寒凝滞证型、气阴两虚证型、心肾阳虚证型5种类型。同时,冠心病心绞痛有虚实之分,稳定型心绞痛以虚症为主;不稳定型心绞痛以痰浊瘀血、痹阻心脉实症为主。因此,应先确定冠心病心绞痛的类型及证候,再确定用药。1.2针对病因中成药治疗冠心病心绞痛,应根据类型及证候不同选药。心血瘀阻证宜活血化瘀、通络止痛;痰浊痹阻证宜化痰泻浊、宣痹通阳;阴寒凝滞证宜     

薄氏腹针治疗慢性失眠62例临床观察

目的观察薄氏腹针治疗失眠症的临床疗效。方法62例慢性失眠患者均接受薄氏腹针疗法治疗,以中脘、下脘、气海、关元、双侧滑肉门、外陵为基础穴位,根据不同证型加用其他薄氏腹穴,隔日1次,连续治疗8次。治疗后,统计临床疗效、不同证型之间的疗效,比较PSQI治疗前后评分、不同证型之间的评分。结果62例慢性失眠症患者,总有效率为96.77%,痊愈率为24.19%,不同证型之间的疗效没有显著性差异（P〉0.05）;治疗前后PSQI有显著性差异（P〈0.01～0.05）,肝阳上扰型治疗前后PSQI分数变化与心脾亏损型、心肾不交型比较有显著性差异（P〈0.05）,脾胃不和型治疗前后分数变化与心脾亏损型比较有显著性差异（P〈0.05）。结论薄氏腹针对慢性失眠的疗效肯定,而且相对长于心脾亏损型、心肾不交型和心胆气虚型慢性失眠患者的治疗。     

穴位贴敷治疗肠易激综合征用药及选穴规律分析

目的 探讨穴位贴敷治疗肠易激综合征(irritable bowel syndrome,IBS)用药及选穴规律.方法检索建库至2020年3月期间在中国知网、维普、万方、PubMed数据库发表的穴位贴敷治疗IBS的临床研究文献,对纳入文献的用药及选穴做频次分析、聚类分析和关联规则分析.结果 共纳入90篇文献,涵盖98味中药...     

同型半胱氨酸水平与脑梗死中医证型关系研究

目的 探讨脑梗死中医辨证分型与血清同型半胱氨酸(HomocysteinelHcy)水平相关性研究.方法 随机入组88例脑梗死患者,对脑梗死患者按中医辨证分为风痰瘀阻证、阴虚风动证、气虚血瘀证、痰热腑实证、风痰火亢证、风火上扰证、痰湿蒙神证7组,测定脑梗死患者血清同型半胱氨酸水平,并进行比较.结果 中医证型与血清同型半胱氨酸关系:经卡方检验,P<0.05,各中医证型之间的Hcy值存在差异的.结论 脑梗死患者中医证型分布是以风痰瘀阻、气虚血瘀、阴虚风动三型为主,脑梗死患者各证型血清同型半胱氨酸水平之间是有差异的,气虚血瘀、痰热腑实、风火上扰证型的Hcy水平较其他证型水平高.     

针灸接脊、脊中穴治疗腹痛57例临床观察

以针灸接脊、脊中穴治疗腹痛患者５７例（男１７例，女４０例），其中国家队教练员、运动员４８例。治法：取接脊、脊中穴，“以痛为俞”，指压二穴，取疼痛明显之穴针灸，或用双手拇指指尖按压。亦可辨证配穴，随证加减。疗效：针灸１次腹痛消除者３２例，占５６．１４％；显效１７例，占２９．８３％；好转５例，占８．７７％。总有效率９４．７４％。文中还总结了针感、运针法，探讨了病因病机。     

耳鸣习服疗法临床效果评估

 目的 评估耳鸣习服疗法(tinnitus retraining therapy, TRT)对耳鸣患者治疗的临床效果。方法 将长期以严重主观耳鸣为主诉的67位患者随机分为两组,一组采用TRT疗法治疗(34例),一组作为对照组(33例),治疗周期12个月。本研究采用耳鸣残疾评估量表(tinnitus handicap inventory, THI)作为评估素材,对TRT组和对照组在TRT治疗开始前和结束后分别进行疗效评估。结果 TRT组及对照组受试者在首次评估中,THI平均总分分别为62.40分(SD=8.532)和61.90分(SD=8.367),对照组在两次THI评估中未见统计学差异。TRT组在治疗前和治疗后总分和各条目得分差异均有统计学意义(P<0.0001)。经TRT治疗后患者功能性、情感性及严重性得分均得到显著性改善。结论 耳鸣习服疗法治疗耳鸣能够取得良好的临床效果。     

癫痫病是可以治愈的

著名癫痫病专家许新升答患者问(之二) "新生克痫灵”系列药物的药理作用是什么? 我院研制的"新生克痫灵”系列药物,是一种内服与外用相结合的抗癫痫新药,临床治疗癫痫起到了豁痰开窍、镇心安神、息风定惊之效."新生克痫灵”配方中主要成分:石菖蒲、朱砂、磁石、琥珀、天竺黄、羚羊角、天麻、钩藤、僵蚕、全蝎、蜈蚣、黄芪、紫河车等60余种中草药.具有芳香散燥、除痰开窍作用的石菖蒲,适用于痰浊、壅闭及癫狂等症,大剂量服用对癫痫发作有较好的控制作用.朱砂、磁石具有镇心安神、清热、补肾益精作用,属镇心安神之品,主要用于癫痫重症者,癫痫发作控制后逐渐减量停用.琥珀有镇心、安神作用,用于治疗癫痫有较好的疗效.天竺黄具有清热、豁痰、定惊作用,尤其用于小儿惊痫抽搐,其性和缓,是理想的药物.羚羊角、天麻、钩藤、僵蚕、全蝎、蜈蚣具有息风定惊、平肝、主泻肝火、清心肺作用,用于惊痫抽搐,同时又因痫症日久伤及正气,以黄芪、紫河车、玉竹、益智仁补气、滋阴壮阳、扶正固本、阴生阳长、化生有源,紧扣心、肝、肾三脏之病机,集清热化痰、疏肝理气、平肝息风、补肾益脑、开窍宁心于一炉,对于各种类型的痫症发作都有显著疗效.     

调剂饮片与临床疗效的关系

使用饮片是中医传统用药方法之一,其灵活性强,有利于通过辨证、立法、组方、遣药而发挥群药疗效,只要调剂符合医师处方意图和调配准确无误,就能使中医的理、法、方、药取得一致.因此,饮片调剂工作的好坏直接影响临床疗效的发挥和用药安全.     

小针刀联合内热针治疗飞行人员腰椎间盘突出症的效果及对血清SP、5-HT和关节功能的影响

目的 探究小针刀联合内热针治疗飞行人员腰椎间盘突出症(lumbar disc herniation,LDH)的效果及对其血清P物质(substance P,SP)、5-羟色胺(5-hydroxytryptamine,5-HT)和关节功能的影响.方法 选取2018年7月—2019年10月在大连康复疗养中心治疗的74例飞行人员LDH患者,采用简单随机化法分为2组,各37例.对照组予以内热针治疗,研究组予以小针刀联合内热针治疗.比较2组临床疗效、治疗前后血清SP、5-HT水平、腰部活动度和关节功能评分.结果 研究组治疗总有效率(91.89％)高于对照组(72.97％)(P<0.05);研究组疗程结束后血清SP、5-HT水平低于对照组(P<0.05);研究组疗程结束后腰部前屈、后伸、侧屈度大于对照组(P<0.05);研究组疗程结束后关节功能评分高于对照组(P<0.05).结论 采用小针刀联合内热针治疗飞行人员LDH患者的疗效显著,能进一步改善血清SP、5-HT表达,增强患者关节功能.     

Dealing with cancer--conversations with radiotherapy patients

Thirty in-patients treated by radiotherapy were questioned in qualitative interviews about the information they had received from the physicians and their way to deal with the disease and the physicians. Furthermore 18 persons out of this group were accompanied continuously. The confidential relationships between the patients and the author of the study brought about spontaneous conversations showing some new aspects of the way to experience disease and therapy. Despite a poor prognosis and an initially insufficient information, the patients formulated their questions openly. Generally they desired a clearer communication. They criticized above all the lack of information and attention from the physicians. A need for confidence, frankness, and the conveyance of a justified hope was expressed. The physician's stress and resulting lack of time was complained of. During the time of accompanying which lasted several weeks, it became evident that information means a way to deal with the disease to which the patient can make his individual contribution. The majority of questions as well as emotional reactions as fear or depression came from those patients who seemed to be quiet persons.     

Radiochemotherapy with temozolomide for patients with glioblastoma

Background

The objective of this retrospective analysis was to assess long-term outcome and prognostic factors of unselected patients treated for glioblastoma (GB) at a single center with surgery, standard radiotherapy (RT), and concomitant temozolomide (TMZ). From 1999?C2005, the institutional protocol included surgery and RT with TMZ. From 2005 on, adjuvant TMZ was routinely added.

Patients and Methods

Between April 1999 and September 2009, 181 patients with GB were treated with RT (60 Gy in 30 fractions) and concomitant TMZ (75 mg/m²/day throughout RT). Biopsy only had been performed in 53 patients (29.3%), 128 patients (70.7%) had undergone resection, which was complete based on postoperative MRI in 51 patients (28.2%). Adjuvant TMZ was applied in 67 of 181 patients (37%).

Results

Median overall survival (OS) and progression-free survival (PFS) were 15.0 (95% CI, 13.1?C16.8) and 7.2 months (95% CI, 5.9?C8.5), respectively. After complete resection, partial/subtotal resection and biopsy, median OS was 23.20, 14.75, and 7.89 months (p < 0.001), respectively. In multivariate Cox proportional hazards regression models, extent of resection (p < 0.0001), Karnofsky??s performance score (p < 0.0001) and adjuvant TMZ (p = 0.001) were significant independent prognostic factors for OS. RT with concomitant TMZ was well tolerated in the majority of patients and could be completed as scheduled in 146 patients (80.7%), while 11 patients (6.1%) discontinued RT. Another 35 patients (19.3%) interrupted concomitant chemotherapy.

Conclusion

RT with concomitant TMZ is a feasible regimen with acceptable toxicity in routine practice. Our data are compatible with a beneficial effect of adjuvant TMZ on OS and PFS.     

湿润烧伤膏与手术联合治疗褥疮的护理

目的 :减少溃疡期褥疮的术前准备时间 ,缩短褥疮的总病程。方法 :将 1996年 5月至 2 0 0 2年 5月收住院的 4 2例溃疡期褥疮病人按随机原则分为 2组 ,2 1例术前用湿润烧伤膏纱换药处理 ,为A组 (试验组 ) ;2 1例用庆大霉素紫草油纱布换药处理 ,为B组 (对照组 )。 2组病例的年龄、性别、发病原因、病灶部位、病灶范围等经统计学处理 ,无显著性差别 ,有可比性。两组病人均换药至创面新鲜行皮瓣转移手术 ;比较两组平均术前换药时间 ,及换药 +手术的总住院日。术前术后两组患者均运用护理程序施行整体护理。结果 :A组术前平均换药时间为 8 4 9± 2 2 3天 ,B组为 15 6 0± 6 70天 ;A组平均治愈时间为 2 0 5 0± 4 81天 ,B组为 35 31± 7 70天。结论 :湿润烧伤膏换药与庆大霉素紫草油纱布换药比较 ,前者可明显缩短褥疮手术的术前准备时间及病人的总住院天数。     

Bronchogenic carcinoma: staging with MR compared with staging with CT and surgery

Thirty-three patients suspected of having bronchogenic carcinoma were studied prospectively using magnetic resonance (MR). In this group, 30 underwent examination with computed tomography (CT), 15 underwent thoracotomy, six had mediastinal biopsy procedures performed, and eight underwent bronchoscopy. MR studies, which included transaxial spin-echo imaging (TR, 0.5 and 2.0 sec; TE, 28 and 56 msec) of all patients and sagittal or coronal imaging of 18, were performed without knowledge of CT findings, using only plain radiographs as a guide. CT and MR studies were interpreted separately. CT and MR provided comparable information regarding the presence and size of mediastinal lymph nodes. MR better discriminated mediastinal nodes from vascular structures. However, in two of 11 patients who had multiple mediastinal lymph nodes that were normal in size at CT examination and surgery, MR suggested a confluent abnormal mass, probably because of its poorer spatial resolution. MR was superior to CT in showing enlarged hilar lymph nodes, but CT was better for demonstrating bronchial abnormalities. In three of four patients who had a proved hilar mass with distal obstructive pneumonia, MR (TR, 2.0 sec) helped distinguish between the mass and collapsed lung.     

多虑平、雷尼替丁治疗消化性溃疡81例临床观察

1995年 1月～ 1 998年 2月 ,我们采用多虑平、雷尼替丁治疗消化性溃疡 (ＰＵ) ,并与雷尼替丁为对照组进行治疗观察 ,疗效满意 ,现总结报告如下。1　临床资料1 1　一般资料　本组 81例ＰＵ均因上腹痛、返酸、腹胀及食欲不振等症状 ,经胃镜诊断为溃疡活动期患者。病程 2个月～ 5ａ,平均 1 7ａ。伴有焦虑、抑郁及夜眠欠佳等症者59例。随机分为 2组 :治疗组 4 1例 ,男 3 8例 ,女 3例 ;年龄 1 8～ 3 6岁 ,平均 2 4岁。其中胃溃疡 1 1例 ,十二指肠球部溃疡 3 0例。对照组 4 0例 ,男 3 7例 ,女 3例 ;年龄 1 9～ 3 5岁 ,平均 2 4 5岁 ;胃溃疡 1 2…     

臭氧治疗船员下肢损伤89例

2006年10月至2007年4月,我科采用引进的德国赫尔曼Medozon型臭氧发生装置系统产生的臭氧治疗船员下肢损伤89例,疗效满意.现报告如下.     

Tumor Burden Assessment with Positron Emission Tomography with

Objective: In patients with advanced cancer, total tumor burden affects the likelihood of tumor response and has important implications for prognosis. The aim of this study was to select the optimum 2-[F-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG PET) tumor uptake parameter to accurately measure tumor burden in advanced metastatic renal cell cancer, in comparison with volumes measured with computed tomography (CT), as a reference test.Materials and Methods: Six patients with metastatic renal cell carcinoma measurable on CT were studied. CT and FDG PET scans were carried out on all patients within 4 weeks prior to their entry into a phase I-II radioimmunotherapy trial. CT-based evaluation of disease extent (tumor volume) and 4 PET-based measurements (standardized uptake value[SUVmax], SUVav, volume, and total lesion glycolysis [TLG]) were performed independently by a radiologist (VN) and a nuclear medicine physician (TA). The degree of correlation between conventional (CT) extent of disease and parameters describing tumor concentration of FDG was then determined.Results: Fifty-seven CT-measurable metastatic lesions in lung, abdomen, and scalp were evaluated in 6 patients. There was a high correlation between CT and FDG PET volume estimates for lesions greater than 5 cm(3) in size. However, a PET-derived parameter that embodies both FDG uptake and lesion size, the TLG, correlated better with CT-derived tumor volume than did FDG PET volume alone.Conclusion: Using CT volume as a gold standard, the optimal PET-based estimate of total tumor burden in patients with metastatic renal cancer is the sum over all lesions of the total lesion glycolysis.     

MEBO药纱门诊治疗烧(烫)伤71例的体会

作者报道用MEBO药纱敷盖门诊治疗烧（烫）伤71例，均获治愈。经随访1年，深Ⅱ度创面疤痕发生率为15％（3／20），浅Ⅲ度创面疤痕发生率为38．9％（7／18）。