恩替卡韦联合复方鳖甲软肝片治疗乙型肝炎肝硬化的临床观察

目的观察恩替卡韦联合复方鳖甲软肝片治疗乙型肝炎肝硬化的疗效和安全性。方法 84例乙型肝炎肝硬化患者随机分为恩替卡韦与复方鳖甲软肝片联合治疗组及单用恩替卡韦对照组,观察48周时两组患者肝纤维化指标。结果治疗48周后联合治疗组肝纤维化指标的下降值优于对照组。结论恩替卡韦联合复方鳖甲软肝片治疗乙型肝炎肝硬化明显优于单用恩替卡韦。     

慢性乙型肝炎肝硬化以复方鳖甲软肝片联合恩替卡韦治疗的效果分析

目的 探讨复方鳖甲软肝片联合恩替卡韦治疗慢性乙型肝炎肝硬化的效果,为提升该疾病的临床治疗效果、改善患者预后提供依据。方法 按照随机数字表法将2019年1月至2022年6月丹江口市第一医院收治的慢性乙型肝炎肝硬化患者75例,分为对照组(38例,恩替卡韦治疗)与观察组(37例,恩替卡韦+复方鳖甲软肝片治疗)。两组患者均连续用药6个月,比较两组患者乙肝病毒DNA定量(HBV-DNA)和不良反应发生率,治疗前后肝功能和肝纤维化指标。结果 与治疗前比,治疗1～6个月后两组患者HBV-DNA水平均逐渐降低,且不同时间点观察组均更低(P<0.05);治疗后两组患者层粘连蛋白、透明质酸、人Ⅲ型前胶原及丙氨酸氨基转移酶、总胆红素、天冬氨酸氨基转移酶均低于治疗前,且观察组均低于对照组(P<0.05)。两组患者不良反应总发生效率比较,差异无统计学意义(P>0.05)。结论 慢性乙型肝炎肝硬化患者在常规西药抗病毒的同时,联合使用中药复方鳖甲软肝片的效果显著,患者肝功能得以改善,并延缓肝纤维化进展,且安全性良好。     

复方鳖甲软肝片联合恩替卡韦治疗乙肝后肝硬化疗效观察

目的：探讨复方鳖甲软肝片联合恩替卡韦对乙肝后肝硬化的临床治疗效果。方法选取2011年10月至2013年10月在我院接受乙肝后肝硬化治疗的患者108例研究对象,随机分为观察组和对照组,每组54例患者。对照组患者给予恩替卡韦治疗,观察组患者在对照组患者的基础上加用复方鳖甲软肝片治疗,观察两组患者的临床治疗效果。结果观察组患者治疗的有效率以及肝功能和血清肝纤维化指标的改善明显优于对照组,具有统计学意义（P<0.05）。结论在对乙肝后肝硬化患者实施治疗的过程中,复方鳖甲软肝片联合恩替卡韦的运用可以提高治疗的有效率,更好的改善患者肝功能以及血清肝纤维化的指标,具有显著的效果,值得临床推广。     

恩替卡韦联合甘草酸二铵治疗慢性乙型病毒性肝炎效果及肝纤维化水平分析

目的:讨论恩替卡韦联合甘草酸二铵治疗慢性乙型病毒性肝炎效果及肝纤维化水平。方法:现随机选取2016年7月-2017年8月我院收治的慢性乙型病毒性肝炎患者68例作为研究对象,按照患者的就诊顺序将其分为观察组和对照组各34例,对照组患者应用恩替卡韦进行治疗,观察组则应用恩替卡韦联合甘草酸二铵予以治疗,对两组患者的治疗效果以及肝纤维化水平进行对比和分析。结果:观察组患者的治疗效果相对于对照组有明显优势(P<0.05),观察组患者的感纤维化改善水平明显优于对照组,且组间差异明显,存在统计学意义(P<0.05)。结论:恩替卡韦联合甘草酸二铵治疗慢性乙型病毒性肝炎效果明显,可明显降低肝纤维化水平,促进患者肝功能的恢复,值得临床应用和推广。     

恩替卡韦联合水飞蓟宾对慢性乙型病毒性肝炎患者肝功能及肝纤维化指标的影响

目的探讨恩替卡韦联合水飞蓟宾对慢性乙型病毒性肝炎患者肝功能及肝纤维化的影响。方法 200例慢性乙型病毒性肝炎患者依据治疗方式的不同分为两组各100例,观察组使用恩替卡韦联合水飞蓟宾治疗,对照组使用恩替卡韦治疗,比较两组的肝功能和肝纤维化指标。结果治疗6个月后,两组的ALT、 TBil、 AST、 HA、 IVC、 LN水平均显著低于治疗前,且观察组显著低于对照组(P <0.05)。结论恩替卡韦联合水飞蓟宾治疗慢性乙型病毒性肝炎患者能够有效缓解肝纤维化损伤,改善肝功能。     

恩替卡韦联合肝复胶囊治疗乙型肝炎肝硬化42例疗效观察

目的观察恩替卡韦联合肝复胶囊治疗乙型肝炎肝硬化的临床疗效。方法将72例乙型肝炎肝硬化随机分成两组,治疗组(42例)接受恩替卡韦联合肝复胶囊治疗;对照组(30例)单纯接受恩替卡韦治疗。疗程均为9个月。观察治疗前后丙氨酸转氨酶(ALT)复常率、HBe Ag阴转率、HBV DNA检测不到率及肝纤维化等指标的变化情况。结果治疗9个月后治疗组肝功能指标复常率明显高于对照组,治疗组ALT(25.60±35.82)U/L,TBIL(18.82±9.76)μmol/L;对照组ALT(45.57±44.42)U/L,TBIL(24.33±12.14)μmol/L,两组对比,P<0.05。血清肝纤维化指标亦有明显改善,治疗组HA(197.4±32.4)LN(65.7±34.7)PCⅢ(102.2±17.2)IV-C(89.4±14.2),对照组HA(327.8±51.7)LN(92.4±36.5)PCⅢ(181.3±25.5)IV-C(132.4±2.7),两组对比,P<0.05。结论恩替卡韦联合肝复胶囊治疗乙型肝炎肝硬化疗效优于恩替卡韦单一用药。     

肝硬度评估恩替卡韦联合肝胆舒康抗肝纤维化

目的通过FibroScan检测观察肝胆舒康联合恩替卡韦抗肝纤维化的疗效。方法选取2016年1月-2018年1月联勤保障部队第906医院收治的70例慢性乙型肝炎肝硬化代偿期患者,均为6个月前口服恩替卡韦并出现完全应答者,按治疗方法分为联合组40例和单一组30例,联合组给予恩替卡韦联合肝胆舒康治疗,单一组给予恩替卡韦单独治疗,疗程均为2年,比较两组患者治疗前后肝纤维化血清指标:透明质酸(HA),层粘连蛋白(LN),IV型胶原(CIV)水平以及肝硬度值(LSM)的变化。结果治疗后,两组HA、CIV、LN指标低于治疗前,差异均有统计学意义(P0.05),组间比较肝纤维化各项指标均有所下降,但差异无统计学意义(P0.05)。治疗后,所测肝硬度值:联合组Child-pughA级LSM、ChildB级LSM低于治疗前;且联合组明显低于单一组,差异均有统计学意义(P0.05)。结论通过Fibroscan评估恩替卡韦联合肝胆舒康治疗乙肝肝硬化更能体现抗肝纤维化的疗效,联合治疗有临床意义。     

恩替卡韦联合阿德福韦酯对慢性乙型肝炎患者肝纤维化及血清ALT、TBIL、GGT水平的影响

目的探讨恩替卡韦与阿德福韦酯联合治疗对慢性乙型肝炎患者肝纤维化及血清谷丙转氨酶(ALT)、总胆红素(TBIL)、谷氨酰转肽酶(GGT)水平的影响。方法选择本院94例慢性乙型肝炎患者,依据随机数字表法分为对照组和观察组,每组各47例。对照组予以阿德福韦酯治疗,观察组给予恩替卡韦+阿德福韦酯治疗,两组患者均持续治疗6个月,对比两组的临床疗效、不良反应,检测并对比两组治疗前后肝纤维化指标[Ⅲ型前胶原(PCⅢ)、层粘连蛋白(LN)、透明质酸酶(HA)、甘胆酸(CG)]及血清ALT、TBIL、GGT水平变化情况。结果观察组治疗总有效率为87.23%(41/47)高于对照组的63.83%(30/47),差异有统计学意义(P0.05)。两组治疗前肝纤维指标及血清ALT、TBIL、GGT水平比较,差异无统计学意义(P0.05);治疗后观察组PCⅢ、LN、HA、CG及血清ALT、TBIL、GGT水平均低于对照组,差异有统计学意义(均P0.05)。两组不良反应发生率对比(14.98%vs 8.51%),差异无统计学意义(P0.05)。结论恩替卡韦与阿德福韦酯联合治疗慢性乙型肝炎可提高临床总有效率,有效改善患者肝纤维化及血清ALT、TBIL、GGT水平。     

恩替卡韦联合苦参素治疗慢性乙型肝炎患者肝组织病理学研究

目的探讨恩替卡韦联合苦参素治疗慢性乙型肝炎患者的临床及肝组织病理学疗效。方法将本科住院慢性乙型病毒性肝炎患者分为治疗组及对照组,对照组给予恩替卡韦治疗,治疗组给予恩替卡韦联合苦参素治疗,且治疗组在治疗前后给予肝组织病理学检查。对2组临床资料(包括肝功能、乙肝两对半、HBV DNA以及肝组织病理)进行疗效评价。结果 2组患者各项指标在治疗后均有所改善,治疗组患者HBe Ag转阴率、HBV DNA转阴率均优于对照组,差异有统计学意义(P0.05)。治疗组患者在治疗前、后肝组织病理得到明显改善,差异有统计学意义(P0.05)。结论恩替卡韦联合苦参素治疗慢性乙型肝炎患者具有协同作用,是一种优化的治疗方案,值得临床推广应用。     

复方鳖甲软肝片联合拉米夫定治疗慢性乙型肝炎肝纤维化疗效研究

目的对复方鳖甲软肝片及拉米夫定联合应用于慢性乙型肝炎肝纤维化的临床疗效进行观察和探讨研究。方法将近年来收治的93例慢性乙型肝炎肝纤维化患者临床资料进行回顾性分析,并随机分为选用复方鳖甲软肝片及拉米夫定进行治疗的治疗组(49例)和仅采用拉米夫定治疗的对照组(44例),且对照组不采用其他的免疫调节药物和抗纤维化类药物,两组患者均以12个月为一个疗程,治疗后对患者症状体征、肝功能及血清肝纤维指标等进行观察,对所得数据进行统计学处理分析。结论复方鳖甲软肝片对肝纤维化有阻止和逆转的作用,其与拉米夫定的联合使用是慢性乙型肝炎肝纤维化比较理想的治疗方法,疗效显著,值得在临床实践中广泛应用和推广。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.