溃疡性结肠炎的中医药治疗

本文就溃疡性结肠炎的辨证分型治疗、辨病专方治疗、中成药治疗、局部给药治疗、针灸治疗、中西医结合治疗、个体化治疗及展望阐述了作者的观点及治疗经验。     

原发性肝癌多学科整体治疗方案的设计与实施

恶性肿瘤的治疗模式正在经历从传统的单项专科治疗向联合治疗,再向多学科综合治疗的转变。笔者提出了以整体医学观为基础的肿瘤多学科整体治疗(MDHT)模式以指导肿瘤综合治疗方案的设计与实施。MDHT模式涉及治疗目标、治疗方法和治疗疗程三个方面。以原发性肝癌为例,可以将整体治疗的靶向目标分为肿瘤局部病灶、区域病灶、系统病灶、器官基础病、全身内环境以及康复等六项基本目标。针对MDHT模式中各项治疗目标,可分别采用多种治疗方法的序贯疗法、同步治疗和交替疗法。整体治疗方案的实施是由不同治疗方法的多个治疗疗程来实现的。在肿瘤MDHT模式中,多学科治疗是治疗方式的体现,整体治疗是治疗目标的追求。MDHT的理念有助于指导多学科团队设计和实施肿瘤综合治疗方案。     

高压氧联合恩必普治疗急性脑梗死疗效观察

目的 观察高压氧联合恩必普治疗急性脑梗死的临床疗效和不良反应.方法选择发病72 h内的急性脑梗死患者90例,随机分为常规治疗组、高压氧治疗组和高压氧联合恩必普治疗组,各30例.常规治疗组接受脑梗死常规药物治疗,高压氧组在对照组治疗的基础上给予高压氧治疗,联合治疗组在给予高压氧治疗同时口服恩必普.治疗前及治疗后14 d、21 d采用欧洲卒中量表(ESS)评定患者神经功能,并观察治疗过程中的不良反应.结果与治疗前相比,3组患者治疗后14 d及21 d ESS评分均有所增高(P<0.01);与常规治疗组相比,高压氧治疗组治疗后21 d ESS评分开始有所增高(P<0.01),联合治疗组治疗后14 dESS评分即开始有所增高(P<0.01);与高压氧治疗组相比,联合治疗组治疗后14 d及21 dESS评分均显著增高(P<0.01).联合治疗组无特殊不良反应.结论高压氧联合恩必普治疗能促进急性脑梗死患者神经功能恢复,是一种安全有效的治疗方法.     

结肠途径治疗机治疗粪石性肠梗阻155例的临床研究

目的观察结肠途径治疗机治疗粪石性肠梗阻的临床疗效。方法将符合诊断标准的305例粪石性肠梗阻患者随机分为保守治疗组(75例)、手术治疗组(75例)与结肠途径治疗机组(155例)。三组均采用禁食、禁水、持续胃肠道减压、纠正水和电解质紊乱及酸碱失衡等对症治疗,手术治疗组在此基础上采用外科手术治疗,结肠途径治疗机组在此基础上采用结肠途径治疗机治疗。三组均治疗6d(1个疗程),治疗1个疗程后观察疗效。结果治愈率保守治疗组为53.33%,手术治疗组为100.00%,结肠途径治疗机组为96.77%。手术治疗组和结肠途径治疗机组的治愈率高于保守治疗组(P0.05)。手术治疗组与结肠途径治疗机组相比治愈率差异无统计学意义(P0.05)。并发症发生率保守治疗组为3.23%,手术治疗组为29.33%,结肠途径治疗机组为6.45%。手术治疗组高于结肠途径治疗机组和保守治疗组(P0.05),结肠途径治疗机组与保守治疗组相比较差异无统计学意义(P0.05)。结论结肠途径治疗机治疗粪石肠梗阻疗效与外科手术治疗的疗效相当,但结肠途径治疗机组治疗后副作用低,住院时间短。     

经气管镜微创介入治疗146例支气管结核疗效分析

目的 探讨经支气管镜综合介入治疗与单纯局部介入治疗支气管结核的临床疗效.方法 将146例支气管结核病人随机分为5组,即单纯氩氦刀治疗组、高频电刀治疗组、冷冻治疗组、球囊扩张治疗组和综合治疗组(高频电刀或氩氦刀或冷冻治疗+球囊扩张),以上治疗均在全身标准四化抗结核治疗及辅助局部注药治疗的基础上进行局部微创介入治疗.观察比较经气管镜局部综合治疗组与各单纯局部治疗组的近期疗效.结果 高频电刀组:平均治疗1.18次,有效率30.23%;氩气刀治疗组:平均治疗1.29次,有效率31.91%;冷冻治疗组:平均治疗0.55次,有效率15.00%;球囊扩张组:平均治疗0.73次,有效率18.69%;综合治疗组:平均治疗0.83次,有效率96.69%.结论 支气管结核全身药物治疗疗效较差,辅助支气管镜局部综合介入治疗疗效显著,其疗效明显优于经支气管镜单纯介入治疗.     

老年人慢性便秘的非药物治疗

老年人便秘的发病率越来越高,严重影响老年人生活.老年人便秘的治疗目的:缓解症状、改善或恢复正常的排便.治疗原则:个体化的综合治疗,避免滥用泻剂.治疗方法:包括药物治疗、非药物治疗和外科手术治疗.器质性便秘的治疗应去除原发病因.     

艾滋病抗病毒治疗政策和策略分析与思考

目的把握艾滋病抗病毒治疗政策和策略现状,分析存在的问题,为调整完善艾滋病抗病毒治疗机制提供建议。方法采用文献回顾、数据资料收集和现场调查的方法。结果中国制定落实了艾滋病病人免费抗病毒治疗的政策和策略,建立了医疗机构和疾病预防控制机构服务相结合的治疗模式,探索建立了免费抗病毒治疗的药品供应、经费保障机制,将抗病毒治疗药品纳入城镇职工基本医疗保险支付范围,推动了抗病毒治疗工作的迅速开展,明显降低了病人的病死率。当前抗病毒治疗工作面临治疗服务规模和能力有限、治疗药品供应和管理机制不能适合治疗发展需要、治疗与现行基本医疗保障体系脱节、流动人口异地治疗办法尚不完善等问题。结论需要进一步健全以定点医疗机构为依托的抗病毒治疗服务体系,结合医改重建满足治疗需求的免费抗病毒治疗药品供应保障机制,将抗病毒治疗纳入现行的医疗保障范围,加快探索异地抗病毒治疗的办法     

肝癌综合治疗的现状

肝癌的各种治疗手段(如外科治疗、肝动脉/门静脉化疗栓塞术、消融治疗和放射治疗等),依据各自特点及疗效在治疗中综合运用,使肝癌的临床疗效有了明显提高.然而肝癌的治疗仍然是临床治疗的难点,如何合理应用各种综合治疗手段仍然存在一定的争议.对肝癌的治疗,单一从病程而忽视肝脏本身的功能储备来制定肝癌的治疗策略可能给患者带来严重的不利影响,仅通过单一治疗手段来治疗肝癌也必然影响患者的疗效.充分评价肝癌患者的病程以及肝脏的储备功能,优化各种治疗手段进行综合治疗是肝癌治疗发展趋势.     

放松疗法联合高压电位治疗脑卒中后睡眠障碍的临床疗效

目的分析放松疗法和高压电位治疗对脑卒中后睡眠障碍的治疗效果。方法选取60例脑卒中后睡眠障碍住院患者,随机分为三组,每组20例。对照组予以常规康复治疗;高压电位治疗组予以常规康复治疗加高压电位治疗;联合治疗组予以常规康复治疗加放松疗法联合高压电位治疗。各组患者常规的康复治疗方法相同。治疗前后各组行抑郁自评量表(SDS)、焦虑自评量表(SAS)、匹兹堡睡眠质量指数(PSQI)评定。结果对照组治疗前后3项评分均无明显差异(P0.05);高压电位治疗组治疗前后PSQI、SAS评分有明显差异(P0.05),但SDS评分无统计学差异(P0.1);联合治疗组治疗前后3项评分均有显著差异(P0.05)。治疗后高压电位治疗组和联合治疗组SDS、SAS、PSQI评分与对照组有明显差异(P0.05);联合治疗组SDS、SAS、PSQI评分较高压电位治疗组有明显差异(P0.05)。结论高压电位治疗可以改善脑卒中后患者的睡眠障碍,放松疗法联合高压电位治疗对脑卒中后患者的睡眠障碍有明显疗效。     

针灸治疗糖尿病周围神经病变临床研究

目的探讨针灸应用于临床糖尿病周围神经病变治疗的临床治疗效果。方法选择该院2013年1月—2014年8月间收治的60例患有糖尿病周围神经病变患者,根据患者的临床治疗方法不同,将上述所有患者分为观察组及对照组,每组各30例患者。对照组30例患者均进行常规临床治疗方法进行治疗,观察组30例患者除进行常规临床治疗外,应用针灸方法进行治疗,对比两组患者的临床治疗效果。结果观察组30例患者中,经临床治疗显效患者17例,经临床治疗有效患者10例,其临床治疗有效率高达90.00;相比较对照组30例患者中,经临床治疗显效患者12例,经临床治疗有效患者8例,其临床治疗有效率为66.67%。即观察组患者的临床治疗效果显著优于对照组患者的临床治疗效果。结论观察组患者均应用临床常规治疗方法合并针灸疗法对于周围神经病变患者进行治疗,其临床治疗效果相比较对照组患者应用临床常规治疗方法的临床治疗效果更为显著,具有临床广泛推广应用的价值。     

卒中后痉挛与上运动神经元综合征

卒中后肢体痉挛是影响功能恢复的主要因素之一，一直是康复治疗的重点。目前对痉挛的认识不够统一，在痉挛的发生机制、鉴别和治疗观念上也存在很多争议。文章对卒中后痉挛的危害、发生机制、鉴别诊断和治疗进展，以及与上运动神经元综合征之间的关系进行了综述。     

卒中后痉挛与上运动神经元综合征

卒中后肢体痉挛是影响功能恢复的主要因素之一,一直是康复治疗的重点。目前对痉挛的认识不够统一,在痉挛的发生机制、鉴别和治疗观念上也存在很多争议。文章对卒中后痉挛的危害、发生机制、鉴别诊断和治疗进展,以及与上运动神经元综合征之间的关系进行了综述。     

Long lasting spasticity in controlled vasospastic angina

OBJECTIVE: To evaluate changes in coronary artery spasticity in patients with vasospastic angina who had been stable for years under continuous drug treatment. METHODS: Follow up coronary angiography was performed under intracoronary ergonovine provocation in 27 well controlled patients with vasospastic angina and no organic stenosis; the tests were done > 24 months after the initial coronary angiography, in which occlusive spasm had been induced by the same regimen of ergonovine provocation. RESULTS: The mean (SD) follow up period was 47.2 (21.6) months. All patients had been free from angina attack for more than 24 months under treatment with antianginal drugs. During this follow up period, organic stenosis developed in only one case. Occlusive spasm was observed during follow up coronary angiography in 23 patients. Spasm with 90% narrowing was observed in three other patients, and diffuse significant narrowing was seen in the final patient. No significant difference was found in spasticity (p = 0.75) between the initial and the follow up tests. CONCLUSIONS: Repeated ergonovine provocation during coronary angiography after a controlled period of several years showed that coronary spasm remains inducible in most patients. Discontinuance of drug treatment during the remission from anginal attacks achieved by medication may put the patient at high risk.     

Thromboxane A2 as an enhancing factor of coronary vasospasticity in variant angina

To clarify the role of thromboxane A2 (TXA2) in evoking coronary spasm, we compared coronary arterial spasticity induced by ergonovine maleate (EM) with coronary sinus thromboxane B2 (TXB2: a stable catabolite of TXA2) in 34 patients with documented variant angina and 11 patients with chest pain syndrome (CPS). We also examined the effect of OKY-1581 (8 mg/kg, i.v.), a TXA2 synthetase inhibitor, on the coronary arterial spasticity of these patients. When blood samples were taken from coronary sinus just before EM test, all patients with variant angina exhibiting markedly augmented TXB2 levels (424 +/- 138 pg/ml), had positive EM test results, while CPS exhibiting lower TXB2 levels (223 +/- 38 pg/ml), had negative EM test. We found that the amounts of EM needed to induce coronary spasm were inversely correlated with TXB2 levels in coronary sinus. In 7 out of these 8 patients, OKY-1581 was found to attenuate the increased spasticity with reduction of coronary sinus TXB2 levels. In 3 patients, an EM rechallenge at symptomatically quiescent stage resulted in negative test with augmented TXB2 levels being markedly decreased. These findings indicate that increased TXA2 in circulating plasma is closely correlated with the hypersensitivity of coronary arteries to EM in patients with variant angina, suggesting a possible role of augmented TXA2 production in the enhancement of coronary vascular spasticity.     

Electrocupuncture combined rehabilitation therapy for upper limb spasticity after stroke: A protocol for systematic review and meta-analysis

Background:The purpose of this study was to evaluate the effectiveness and safety of electroacupuncture combined with rehabilitation in the treatment of spasticity after stroke.Methods:To collect relevant literature, we will research following databases: Medicine, PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wan-Fang Database, Chongqing VIP Chinese Science and Technology Periodicals Database and China Biomedical Database; the time is from its creation to May 2021, and the language is limited to Chinese and English. In addition, we will retrieve other literature resources, including the Chinese Clinical Trial Register and conference papers. Two reviewers will independently complete the literature screen and data extraction, and quality assessment of the included studies will be independently completed by two other researchers. The primary outcomes included the Modified Ashworth scale (MAS) and the simplified Fugl-Meyer Assessment scale (SFMA). The Modified Barthel Index (MBI), the China Stroke Scale (CSS), and adverse reactions as secondary outcomes were assessed. RevMan V.5.4.1 software will be used for meta-analysis, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to assess the quality of evidence.Results:This systematic review will provide a high-quality synthesis to evaluate the efficacy and safety of electroacupuncture combined with rehabilitation therapy in the treatment of upper limb spasticity after stroke, providing a reference for the safe and effective treatment of upper limb spasm after stroke.Conclusion:This study provides evidence that electroacupuncture combined with rehabilitation therapy is effective.Ethics and dissemination:The protocol of the systematic review does not require ethical approval because it does not involve humans. This article will be published in peer-reviewed journals and presented at relevant conferences.Systematic review registration:INPLASY202160005.     

乙醇阻滞胫神经运动支治疗脑卒中足下垂

目的观察胫神经运动支乙醇阻滞腓肠肌治疗老年脑卒中偏瘫后足下垂的临床结果。方法22例腓肠肌痉挛导致足下垂脑卒中偏瘫老年患者在电刺激引导定位下接受胫神经运动支无水酒精阻滞。采用踝跖屈改良Ashworth分级、踝阵挛分级以及被动踝关节活动度分别在注射前、注射后即刻、1 d、1周、1月以及3月进行肌痉挛严重程度评估。结果19例患者在3月随访期中改良Ashworth分级均明显下降,3例1周后进行重复注射。与注射前比较,注射后Ashworth分级（MAS）、踝阵挛分级（Clonus）、被动踝关节活动度（PROM）有显著性差异（P〈0.01）。3月期间未发现严重的不良反应。结论胫神经运动支乙醇阻滞腓肠肌治疗脑卒中后偏瘫足下垂安全有效。     

Coronary vasospastic activity at sites of percutaneous transluminal coronary angioplasty: evaluation using intracoronary acetylcholine administration]

To investigate coronary vasospastic activity after percutaneous transluminal coronary angioplasty (PTCA), we performed intracoronary injection of acetylcholine in 55 patients, mean 3.3 months after successful PTCA. Coronary spasm was defined as transient total or subtotal occlusion of the PTCA sites. Sixty-nine lesions of the 55 patients were examined to determine whether spasm was provoked by incremental doses of acetylcholine. Restenosis was defined as coronary luminal narrowing of > or = 50% after nitroglycerin or isosorbide dinitrate. Twenty of the 55 patients (36%) and 23 of the 69 lesions (33%) had coronary spasm. There was no correlation between the incidence of coronary spasm and the interval from PTCA to the acetylcholine test. The spasm was provoked in 17 lesions of the 50 non-restenotic lesions (34%) and was also provoked in 6 of the 19 restenotic lesions (32%). On the other hand, restenoses occurred in 6 of the 23 spastic lesions (26%) and in 13 of the 43 non-spastic lesions (28%). There was no correlation between the incidence of coronary spasm and the occurrence of restenoses. Twenty-four patients had undergone acetylcholine provocative test before PTCA. Among these 24 patients, 11 had coronary spasm before PTCA, and 7 had coronary spasticity after PTCA. Four patients who had positive evidence of coronary spasm before PTCA did not show negative spasm after PTCA. On the other hand, 3 patients who did not show evidence of coronary spasm showed positive evidence of coronary spasm after PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect on spasticity after performance of dynamic-repeated-passive ankle joint motion exercise in chronic stroke patients

Spasticity associated with abnormal muscle tone is a common motor disorder following stroke, and the spastic ankle may affect ambulatory function. The purpose of this study was to investigate the short-term effect of dynamic-repeated-passive ankle movements with weight loading on ambulatory function and spastic hypertonia of chronic stroke patients. In this study, 12 chronic stroke patients with ankle spasticity and inefficient ambulatory ability were enrolled. Stretching of the plantar-flexors of the ankle in the standing position for 15 minutes was performed passively by a constant-speed and electrically powered device. The following evaluations were done before and immediately after the dynamic-repeated-passive ankle movements. Spastic hypertonia was assessed by the Modified Ashworth Scale (MAS; range, 0-4), Achilles tendon reflexes test (DTR; range, 0-4), and ankle clonus (range, 0-5). Improvement in ambulatory ability was determined by the timed up-and-go test (TUG), the 10-minute walking test, and cadence (steps/minute). In addition, subjective experience of the influence of ankle spasticity on ambulation was scored by visual analog scale (VAS). Subjective satisfaction with the therapeutic effect of spasticity reduction was evaluated by a five-point questionnaire (1 = very poor, 2 = poor, 3 = acceptable, 4 = good, 5 = very good). By comparison of the results before and after intervention, these 12 chronic stroke patients presented significant reduction in MAS and VAS for ankle spasticity, the time for TUG and 10-minute walking speed (p < 0.01). The cadence also increased significantly (p < 0.05). In addition, subjective satisfaction with the short-term therapeutic effect was mainly good (ranging from acceptable to very good). In conclusion, 15 minutes of dynamic-repeated-passive ankle joint motion exercise with weight loading in the standing position by this simple constant-speed machine is effective in reducing ankle spasticity and improving ambulatory ability.     

Botulinum toxin for the management of muscle overactivity and spasticity after stroke

Stroke is a major cause of disability involving the arm and leg. This disability results from the upper motoneuron syndrome (UMN) evident after stroke. It is commonly associated with spasticity and muscle overactivity, which can lead to abnormal limb posturing that interferes with active and passive function. The origin of limb deformity in patients with UMN is based on the concept of unbalanced agonist and antagonist muscle forces acting across joints. In the past decade, botulinum toxin A (BTX-A) a new medication that modifies muscle force and, hence, can treat muscle imbalance, has become available and has renewed interest in the management of muscle overactivity and spasticity after stroke. A reduction in muscle tone, painful spasms, and improved functionality can be obtained. Research and clinical reports support the concept that chemodenervation with BTX-A is an excellent intervention for treating focal muscle overactivity and spasticity secondary to stroke. Many muscles differing in size, shape, and location have been injected, and clinical effectiveness is particularly notable in elbow flexors, ankle plantar flexors, and smaller limb muscles, such as intrinsics of the hand and wrist. Smaller muscles are readily accessible for injection and require smaller amounts of toxin.     

Dolichoectasia of the Intracranial Arteries

Dolichoectasia is a dilatation and elongation of the arteries, usually affecting intracranial basilar and vertebral arteries. It may cause posterior circulation stroke or transient ischemic attacks independent of atherosclerotic disease. Compression of cranial nerves or brainstem leads to hemifacial spasm, trigeminal neuralgia, or brainstem dysfunction (temporary or permanent). Intracranial bleeding is another possible manifestation. In general, the mortality and morbidity is higher in patients with dolichoectasia. Progression of arterial dilatation or elongation is an ominous sign for poor prognosis. Optimal treatment for vertebrobasilar dolichoectasia is uncertain. Adequate control of blood pressure may prevent ischemic or hemorrhagic stroke. In case of ischemic stroke, antiplatelet treatment is indicated for the prevention of recurrent stroke. However, the risk of hemorrhagic stroke should be considered in patients with severe forms of dolichoectasia. Close observation and follow-up neuroimaging is recommended to monitor the progression of the disease and appearance of new ischemic or hemorrhagic lesions. Surgical decompression may be reserved for the medically intractable patients with trigeminal neuralgia or hemifacial spasm.