脾虚证患者某些消化道功能和细胞免疫功能指标的观察

检测１０４例脾证患者之血清胃泌素、尿Ｄ－木糖排泄率及血Ｔ淋巴细胞亚群，与３０例健康人对照结果患者上述指标的检测值均低于正常（Ｐ〈０．０１，〈０．０５），提示脾虚证患者的消化道功能和细胞免疫功能处于低下紊乱状态。观察结果为探讨脾虚证的本 客观化指标的选择累积了资料。     

温补培元方对脾虚与脾肾阳虚模型细胞免疫功能的实验研究

目的：研究温补培元方治疗脾虚及脾阳虚证的作用机制。方法：采用利血平和大黄复制成的脾虚、脾肾阳虚动物模型,以温补培元方作为药物组,检测动物巨噬细胞功能、脾细胞自然杀伤（NK）细胞活性及刀豆素A（Con A）刺激的淋巴细胞掺入率（LIR）、红细胞免疫以及白细胞介素－2（IL－）含量。结果：温补培元方组以上指标与病理模型组相比差异有显著性意义（P＜0．05,＜0．01）。结论：整节整个机体的细胞免疫,可能是温补培元方对脾虚、脾肾阳虚证作用的具体环节之一。     

脾不统血证血小板聚集功能的研究

目的：探索脾不统血证发病机制与血小板聚集功能的关系。方法：中医诊断脾虚证伴有慢性多部位反复出血患者,选择其中血小板计数正常、凝血像无明显异常者共146例,采用Chronolog血小板聚集仪检测患者血小板聚集率。结果：应用3种常用诱聚剂诱导患者血小板出现聚集缺陷者76例,其缺陷率占52．05％;对照组为脾虚证无出血者82例,其血小板聚集缺陷者21例,占25．61％。两组之间差异有非常显著性意义（x^2=14.63,P＜0．01）。结论：脾不统血证反复出血的发病机制,半数病例可能与血小板聚集功能缺陷有关,但其确切病机有待进一步研究。     

慢性胃脘痛患者中医证型与核素胃排空功能关系的初步探讨

采用国际上先进的放射核素标记试餐法，测定45例典型中医分型的慢性胃脘痛患者的液体胃排空功能，并与18例正常对照组进行比较，旨在探讨慢性胃脘痛中医证型与胃排空功能紊乱的关系。结果显示脾胃虚弱组胃半排空时间较正常对照组明显缩短（P＜0．01），说明脾胃虚弱者液体胃排空加快；肝胃不和组和肝胃郁热组的胃排空时间较脾胃虚弱组明显延长（P＜0．01），而脾虚肝郁组不论与正常对照组或脾胃虚弱组比较均无显著差异（P＞0．05）。提示中医慢性胃脘痛虚、实证型的排空状态截然不同，并可能各自有着不同的病理生理基础。     

老年心力衰竭患者自主神经功能与心功能的相关性研究

目的 探讨老年心力衰竭(CHF)患者自主神经功能活动与心功能受损严重程度的相关性。方法 分析61例老年CHF患者和30例对照者的心率变异性时域指标及心功能指标。结果 CHF组与对照组比较，HRV各测值均非常显著降低(均P＜0．001)；HRV各测值均随心功能的下降而呈递减性下降，在心功能各级别间具有显著差异(P＜0．05或P＜0．001)，SDNN和TI下降与心功能NYHA分级呈负相关(P＜0．01)。结论 老年CHF患者存在着严重的自主神经功能受损和失衡，且与心功能损害程度密切相关。     

肝郁脾虚患者血清胃泌素、胃动素的初步观察

我们测定了２３例慢性乙肝患者血清胃泌素、胃动素并且将其结果与肝郁脾虚证相联系。结果表明肝郁脾虚证患者血清胃泌素、胃动素异常率明显高于肝郁证患者，进一步分析发现脾虚症状的形成似乎伴随着这两种激素的异常。使用某些中草药可以纠正脾虚症状及异常的血清胃泌素、胃动素。     

健脾为主辨证治疗对慢性乙型肝炎患者外周血树突状细胞表型功能的影响

目的:研究健脾为主辨证治疗对脾虚为主不同中医证候类型慢性乙型肝炎(CHB)患者,外周血树突状细胞(DC)表型、功能的影响.方法:CHB患者60例,中医诊断符合脾虚肝郁、脾虚湿热、脾肾两虚等证候,每组20例,10名健康人为正常对照组.分离各组外周血单个核细胞,体外诱导培养DC;流式细胞仪测定DC表型;ELISA法测定DC分泌IL-10含量;同步检测患者生化指标及HBV DNA水平;各组患者分别予健脾法为主的中药辨证治疗,疗程为3个月,治疗结束后重复指标检测.结果:CHB患者DC体外诱导增殖能力较正常人下降,DC成熟表面标记物显著低于正常人(P＜0.05);不同中医证候类型患者DC表面标记物表达水平存在差异;其中脾虚肝郁组CD8O、CD1a、HLA-DR表达阳性率显著高于脾肾两虚组(P＜0.05);CHB患者DC培养上清液中IL-10含量显著高于正常人(P＜0.05),脾肾两虚组DC培养上清液中IL-10含量显著高于中脾虚肝郁组(P＜0.05).治疗后各组DC成熟度及分泌功能均有不同程度改善,其中脾虚肝郁组CD80、CD86、CD1a表达率较治疗前显著提高(P＜0.05),脾虚湿热组、脾肾两虚组CD80、CD86、CD1a、HLA-DB表达率较治疗前显著提高,而IL-10含量显著降低(P＜0.05);治疗后除脾虚湿热组CD80表达高于脾肾两虚组外,各型DC表面标记物与IL-10比较,差异无显著性意义.结论:在CHB发病过程中,脾虚为主不同中医证候患者DC的表型及功能低下并存在差异,中药辨证治疗可改善DC表型及功能.     

病毒性肝炎中医辨证各型的自然杀伤细胞活性的探讨

本文对５１例乙型病毒性肝炎（乙肝）进行中医辨证分型，采用ＬＤＨ释放法析测其外周血中的自然杀伤细胞（ＮＫ）活性，３４名建康人做为对照。结果是以虚证为主的肝肾阴虚证、脾肾阳虚证和瘀血阻络证ＮＫ细胞活性明显低于对照组，Ｐ＜０．０５～０．０１。以实证为主的热重于湿证、湿热并重证、湿阻脾胃证、湿热中阻证和肝郁脾虚证的ＮＫ细胞活性较正常对照组无明显差异，Ｐ＞０．０５。说明肝炎患者免疫功能低下与病程长短、病位深浅、病情轻重密切相关。提示ＮＫ细胞活性检测，可做为中医辨证虚实的客观指标；肝炎早期如采用中医辨证治疗，可能是防止肝炎慢性化、肝硬化和肝癌的措施之一。     

慢性胃病脾虚患者胃窦粘膜胃泌素细胞和分泌生长抑素细胞的变化及其意义

目的：观察以慢性胃病为主的脾虚患者胃窦粘膜分泌胃泌家(Gas)细胞(G细胞)、生长抑素(SS)细胞(D细胞)与脾虚证发生的关系。方法：将84例脾虚患者分为脾胃虚寒组、脾虚夹热组、胃阴不足组、脾胃湿热组、肝胃不和组，应用免疫组化技术标记胃窦粘膜G、D细胞，并定量分析。结果：以慢性胃病为主的脾虚证患者G、D细胞数均减少，D细胞面积缩小，G/D细胞数和细胞面积比值均增高(P＜0．05)。结论：G、D细胞的变化可能是慢性胃病脾虚证胃肠功能障碍的一个重要病理机制。     

冠脏病变对心脏左室舒缩功能的影响

目的：通过超声心动图检查，探讨冠脏病变对左室收缩，舒张功能的影响。方法：67例行冠状动脉造影检查，据检查结果被分成冠心病组（46例），正常对照组（25例），分别行超声心动图检查，测量其每搏量，心输出量，左室短轴缩短率，射血分数，二尖瓣口E，A峰血流速度（E，A峰值）及E／A比值。结果：与正常对照组比较，冠心病组收缩功能指标中每搏量增加（P＜0．01）。舒张功能指标中E峰降低（P＜0．05），A峰升高（P＜0．01），E／A比值降低（P＜0．01）。结论：冠脉病变影响心脏功能，早期先影响舒张功能。     

Research and Evaluation of the Influence of the Construction of the Gate and the Influence of the Piston Velocity on the Distribution of Gases into the Volume of the Casting

Distribution of gasses to the cast volume and volume of pores can be maintained within the acceptable limits by means of correct setting of technological parameters of casting and by selection of suitable structure and gating system arrangement. The main idea of this paper solves the issue of suitability of die casting adjustment—i.e., change of technological parameters or change of structural solution of the gating system—with regards to inner soundness of casts produced in die casting process. Parameters which were compared included height of a gate and velocity of a piston. The melt velocity in the gate was used as a correlating factor between the gate height and piston velocity. The evaluated parameter was gas entrapment in the cast at the end of the filling phase of die casting cycle and at the same time percentage of porosity in the samples taken from the main runner. On the basis of the performed experiments it was proved that the change of technological parameters, particularly of pressing velocity of the piston, directly influences distribution of gasses to the cast volume.     

县级以下综合医疗机构医务人员对现代结控知识的认识现状调查

目的本文旨在了解医务人员现代结控知识掌握的现状及培训效果?方法于培训前后进行问卷调查,内容包括:病例发现?结核病诊断及化疗?结果培训前疫情报告和转诊,回答正确者占75.2%?71.7%;对临床表现?查痰和诊断依据,回答正确者占83.5%?42.5%?40.8%;抗痨药物?用药方法?化疗原则?短化方案?短化疗程?治愈标准六项,回答正确者占58%?14.4%?20.8%?9.2%?17%?24.3%?培训后再次调查发现,90%以上医务人员对现代结控基本知识已掌握?结论各级医务人员现代结控知识是很贫乏的,因此,对其进行系统培训是极为必要的,此项工作省时?省力?投入少,可收到事半功倍的效果。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

Preservation of the pylorus in resection of the head of the pancreas

Pylorus preservation has been advocated to decrease the morbidity associated with the classical or standard pancreaticoduodenectomy. The proposed advantages are decreased incidence of peptic ulceration, dumping syndrome, and nutritional problems. However, after an initial period of enthusiasm for the procedure, it is now being found that marginal ulceration at the duodenojejunal anastomosis is encountered with increasing frequency. Delay in gastric emptying occurs frequently, with an overall incidence of 30%. With the availability of better pancreatic enzyme supplements, the current incidence of nutritional problems and weight loss after the standard Whipple procedure is unknown. Whether there is a difference in long-term survival after the two procedures performed for adenocarcinoma of the head of the pancreas is still debatable. A controlled trial is needed to answer many of these questions, and pylorus-preserving pancreaticoduodenectomy should be used cautiously until further data become available.