严仲庆运用经方治疗失眠症验案四则

[目的]探讨严仲庆老师运用经方治疗失眠症的临床经验。[方法]以4则案例为本,从病因病机、治则治法方面论述严仲庆老师运用经方治疗失眠症的临床经验,对其遣方用药特色予以总结。[结果]严仲庆老师认为,失眠症的主要病机为阳不交阴,与心、肺、肝、肾有着密切的联系,阴血亏虚和肝阳不足均为临床上引起失眠症的常见病因。其主要证型为心肺阴虚内热、心肾阴虚火旺、心肝阴血亏虚、肝郁肝阳不足等,常用养心润肺、凉血清热,滋阴清火、交通心肾,滋阴养血、宁心安神,疏肝理气、助阳益心之法。[结论]严仲庆老师临证处方精当,临床运用经方治疗失眠症疗效确切,其经验值得学习。     

醋调吴茱萸敷贴涌泉穴辅助治疗心因性失眠症60例疗效观察

为观察醋凋吴茱萸敷贴涌泉穴辅助治疗心因性失眠症临床疗效,将60例心因性失眠患者,随机分为治疗组和对照组进行疗效观察.治疗组采取"参芪五味子片+安神补脑液+醋调吴茱萸敷贴涌泉穴"治疗方法,对照组采取常规加"参芪五味子片+安神补脑液"的治疗方法,观察两组治疗效果.结果,治疗组总有效率为80.00%,对照组为56.70%.认为醋调吴茱萸敷贴涌泉穴辅助治疗心因性失眠症具有一定临床疗效.     

药膳猪心茯神汤治疗心脾两虚型失眠症临床研究

目的:观察药膳猪心茯神汤治疗心脾两虚型失眠症的临床疗效.方法:选取心脾两虚型失眠症门诊患者38例,给予药膳猪心茯神汤进行食疗.15 d为1疗程,连续治疗2个疗程.结果:痊愈2例,显效12例,有效17例,无效6例,总有效率为83.8％.患者治疗前后中医证候学指标积分、PSQI指数总积分比较均有统计学意义(P＜0.05).结论:药膳猪心茯神汤能够有效缓解失眠症患者各种症状,具有较好临床疗效.     

穴位埋线治疗心肾不交型不寐56例疗效分析

目的观察穴位埋线治疗心肾不交型不寐临床疗效.方法将患者根据中医四诊合参诊断为不寐,心肾不交型的56位患者,分别给予穴位埋线治疗一疗程.观察治疗后的临床疗效.结果治疗56例,有效率达93%.结论埋线治疗失眠症疗效较好、易操作、治疗时间短、病患易于接受.     

失眠症治疗经验浅谈

探讨失眠症治疗的方法和经验,为临床实践提供新的思路。采取脏腑辨证的思路,认为失眠病位在心,与肝脾胃肾有关,分为肝火扰心、心脾两虚、心肾不交、胃失和降四种证型,治疗以补虚泄实、调整脏腑阴阳、安神定志为基本原则。     

柴龙解郁丹治疗肝郁气结型成人失眠症的临床疗效观察

目的:观察柴龙解郁丹对肝气郁结型成人失眠症患者的疗效及安全性.方法:将在我院门诊就诊的60例肝郁气结型成年失眠症患者采用随机数字法分为中药组和西药组,各30例.西药组口服西药艾司唑仑片治疗,中药组服用我院生产的柴龙解郁丹治疗,总疗程均为3周.对比两组匹兹堡睡眠质量指数(PSQI)量表评分、中医证候积分、临床疗效及安全性...     

从“心下痞”“失眠”中医证候分析慢性胃炎的防治思路

以心下痞、失眠为切入点,从引起原因、诊断、防治、预后等多方面分析中西医对慢性胃炎的认识,找出慢性胃炎在预防、诊断、治疗中的优化策略。从病症统一的角度分析中西医慢性胃炎的优化治疗思路。心下痞且失眠症患者中患有慢性胃炎的概率为99%,从心下痞及失眠的角度防治慢性胃炎有很强的实践及指导意义。诊断上,因为慢性胃炎与失眠、心下痞有高度相关性,慢性胃炎患者表现为心下痞或者失眠症状的概率为99%,所以从失眠、心下痞入手,判断慢性胃炎有很强的参考意义;治疗上,以中医失眠、心下痞症为抓手,可以将慢性胃炎分成痰湿中阻证、湿热阻胃证、肝胃不和证、脾胃虚弱证、胃阴不足证5个证型,可以适当地运用加减变化对应的方剂进行治疗;预防上,因慢性胃炎发病与情志、饮食、饮酒等高发因素关系密切,饮食的合理化、情志中和化、运动适当化可以从不同的角度降低慢性胃炎的发病率。     

围绝经期失眠症肝郁患者的常见症状及证素特点研究

目的探讨围绝经期失眠症肝郁患者的常见症状及证素特点,为围绝经期失眠症的临床治疗提供思路。方法选择100例围绝经期失眠症肝郁患者,采用证素积分的方法,通过四诊资料规范化采集,分析围绝经期失眠症肝郁患者的症状分布情况及不同肝郁分级患者的病位、病性证素特点。结果围绝经期失眠肝郁患者症状发生频率较高的依次为易激动、潮热汗出、眩晕、骨关节肌肉痛、感觉异常等;主要病位证素为肾、脾、胞宫和心神;主要实证病性证素为痰、湿、血瘀和热;虚证病性证素为阴虚、气虚、血虚与阳虚。结论围绝经期失眠肝郁患者多兼肾、脾、胞宫和心神等脏腑的病理改变,虚实夹杂为本病的基本病机特点。     

东红主任疏肝养血法治疗失眠临床经验介绍

失眠症是临床常见的多因素导致的睡眠障碍性疾病。东红主任依据多年临床经验,治疗失眠症中首辨虚实,脏腑多从心、肝两脏论证,她认为虚证多因气血阴阳亏虚,主要在阴血不足导致阴不纳阳,故注重养心血以安神,实证多以气郁不畅为主,易夹杂痰、湿、热、瘀所导致阳盛不入于阴,重在疏肝祛邪。创立疏肝养血法治疗失眠症,并据证选药,自拟疏肝养血方配合健脾宁心、化湿和胃、活血化瘀为主的中医辨证用药,在治疗失眠中取得较好的疗效。     

心肾阳虚型心衰竭研究概况

慢性心衰竭又称充血性心衰竭(congestive heart fail-ure,CHF),是以肺循环或体循环静脉系统瘀血为特征的临床综合征.化学药治疗虽取得一定效果,但因毒性和不良反应明显,临床应用受到限制.而中医药治疗CHF不良反应较少,疗效持久.CHF的常见证候有心气阴虚证、心肾阳虚证、心阳虚脱证、阴阳两虚证等,其中心肾阳虚证是一种重要的临床证型,现将其研究概况阐述如下.     

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.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.