出血性中风病因病机新认识

出血性中风是在正气内虚的基础上,因内伤积损日久而使暗风、伏火等邪气内生,遇气候骤变、情志相激等诱因扰动气机,使气机逆乱"气之与血,并走于上"则导致络破脉损、血液溢出脉络之外而发为中风,急性期病机由"瘀停脉外、压迫神机","津行不畅、痰水形成","诸邪胶结、化毒伤脑"三个病理过程共同构成,恢复期虽病情趋于稳定,但局部脑髓空虚使症状难以得到完全恢复而留有后遗症,而诸邪伏藏又为复中风和呆病的发生构成风险。     

基于络病理论探讨认知功能障碍的中医治疗进展

本文从络病理论角度出发,阐述络病理论与认知功能障碍的相关性。“络以通为用”,围绕此基本治疗原则,本文从毒损脑络、痰瘀互结、肾虚髓减等角度探讨认知功能障碍的病机,针对上述病机分别采用解毒通络、化痰散瘀、补肾生髓等治法,逐步阐明基于络病学说认识与诊治认知功能障碍的思路与方法,为认知功能障碍的病机、诊断和治疗提供中医思路。     

运用解毒活血补益法治疗肝纤维化的体会

由多种因素引起的肝脏损害和炎症,若进一步导致纤维结缔组织广泛增生和沉积,就形成肝纤维化。本人运用解毒活血补益法治疗肝纤维化,在临床上取得了较好的疗效,现将体会浅识于下,请同道指正。 1 毒、瘀、虚是肝纤堆化的病机特点 本病的病机特点为毒邪(湿毒和热毒)留恋、肝脉瘀阻及正气亏虐。湿毒之邪易损阳气,湿毒之邪羁留体内,脾之阳气最易受其害,热毒之邪羁于肝胆,肝藏血,肝热即血热,又因     

毒邪致中风的特点与清热解毒治疗思路初探

近年来,毒邪致中风理论在中风发病中的作用越来越受到重视.王永炎院士指出[1]:毒邪致病是中风病病情险恶,难以治愈的关键,提出了中风病"毒损脑络"的病机假说.本文就中风病毒邪的内涵与特点以及清热解毒治疗原则做一浅论,探讨中风病急性期中医药治疗的新思路.     

“分期”论治肝炎后肝硬化的经验总结

肝炎后肝硬化是我国的常见病,属中医学中"胁痛"、"黄疸"、"积聚"、"鼓胀"、"徵瘕"的范畴。肝炎后肝硬化病因为虚、毒、瘀、湿,病机是本虚标实,正虚以致毒邪内侵,其中正虚为本,肝毒、气滞、血瘀为疾病的基本致病条件,贯穿疾病始终,但不同时期有各自主要的致病特点,初期以肝肾阴虚为主,中期为脾虚湿盛,晚期为正虚邪盛,并因此制定治疗方案分期论治,临床中取得了较好疗效。     

肝豆状核变性肝纤维化的中西医研究进展

综述肝豆状核变性(HLD)肝纤维化的主要发病机制、发病特征、诊断技术及中西医研究进展。HLD肝纤维化以“铜毒内蕴,肝失疏泄”为病因病机,呈现出“以虚为主,因虚致实,虚实并见”的病机演变特点,治疗上当以“疏肝利胆、通腑利尿”为先,倡导分型论治该病证,形成了肝豆汤、肝豆灵片、肝豆扶木汤、清热利胆解毒方、补肾化痰祛瘀方等行之有效的中医方药。研究表明,中医药疗法可有效逆转HLD肝纤维化和部分肝硬化进程,在改善病人临床预后方面具有重要意义。     

酒精性肝纤维化"毒损肝络"病机假说的形成及临床意义

近年来,我国学者立足于中医基础理论,在中医药抗肝纤维化研究领域取得了一系列突破性的进展;结合现代医学的先进技术手段和研究成果进一步深化和发展传统中医“络病学”理论,形成了系统的酒精性肝纤维化“毒损肝络”病机假说。1酒精性肝纤维化“毒损肝络”病机假说的形成研究证     

基于痰、瘀、毒探讨“通因通用”治疗脑出血

基于痰浊、瘀血、毒邪主要致病因素对脑出血发生发展的影响,分析三者间常胶结为病,阻滞气机并损伤脑络,以致血溢脉外,血蓄于脑发为脑出血。介绍脑出血发生后,瘀血继而化水生痰,瘀血、痰浊、水肿阻塞脉络,损害脑髓,进一步加重病情的理论。试从痰、瘀、毒三个方面论述脑出血的病因病机,并从痰、瘀、毒角度阐述"通因通用"法治疗脑出血的重要意义。     

系统性红斑狼疮辨治规律初探

通过对系统性红斑狼疮的中医病因、病机、治疗大法及规律的探讨 ,认为本病的病因为内外合邪 ,以先天不足为本 ;基本病机为肾阴亏虚 ,瘀毒互结 ;提出“补肾化毒”的治疗大法 ,并认为 :辨治本病应牢牢抓住肾阴虚 ,处处不忘顾护这个“本” ,在此基础上进行辨证化裁 ,有守有变     

肝豆状核变性的历史和治疗

肝豆状核变性,是一种常染色体隐性遗传的铜代谢缺陷病.发病率为1/30万,是儿科常见的遗传代谢性疾病之一.儿童期肝豆状核变性,以肝病起病最多,但临床上以神经系统症状起病者也并不少见,甚至每个系统都有作为首发症状的报道.肝豆状核变性的治疗包括饮食控制、药物治疗和肝脏移植.药物治疗主要是青霉胺、曲恩汀、二巯基丙醇、二巯丙磺酸钠、二巯基丁二钠、连四硫代钼酸铵、锌剂.大多数内科螯合治疗有效,但对于部分失代偿肝硬化和暴发性肝豆状核变性,肝脏移植已成为肝豆状核变性治疗的主要手段.     

经心外膜下侧支循环逆向介入治疗冠状动脉慢性完全闭塞病变

目的 探讨应用我国市场已有器械,经心外膜下侧支循环血管,对慢性完全闭塞(CTO)病变行逆向经皮冠状动脉介入治疗(PCI)的可行性.方法 5例CTO病变均在常规正向PCI失败后,行逆向PCI.将7 F强支撑逆向指引导管送至供体血管,超滑导丝通过心外膜下侧支循环血管到达CTO病变远端,在微导管支持下交换较硬的导丝,逆向通过CTO病变,逆向导丝继续进入6 F正向指引导管,并在正向指引导管内球囊扩张锚定.逆向扩张病变后,正向导丝通过病变,用常规PCI方法完成手术.其中应用捕获逆向导丝技术和反向CART技术各1例.结果 在逆向导丝通过侧支循环的路径中,经左前降支至右冠状动脉远端3例,经左回旋支至右冠状动脉1例,经钝缘支至左前降支1例.其中4例成功开通CTO病变,完成支架置入术.另外1例虽然导丝及微导管到达CTO病变远端,但无法逆向通过闭塞病变.所有患者介入术中均未发生并发症.结论 在我国没有专门逆向PCI工具的情况下,如果室间隔支不适合作为逆向通道,心外膜下侧支循环在符合一定条件时也可作为逆向通道,进行CTO病变的逆向PCI.     

儿童肝豆状核变性97例分析

目的 总结儿童肝豆状核变性的临床表现以及肝脏组织病理学特点.方法 对97例确诊为肝豆状核变性儿童的就诊原因、临床表现、实验室及肝脏活组织病理学检查结果进行回顾性分析.结果 患者以肝功能异常或肝病表现就诊为主(74%).97例(100%)患者均有肝脏损害,44例(45%)神经系统异常,95例行K-F环检查患者中63例呈阳性;94例行血铜蓝蛋白检测患者中,91例降低,3例正常;37例患者行24 h尿铜检测,其中＞100 μg者25例.17例行病理检查的患者肝组织均有不同程度的炎症及纤维化,其中8例有脂肪变性,3例有糖原累积样改变.结论 儿童肝豆状核变性以肝病表现为主,角膜K-F环、血清铜蓝蛋白、24 h尿铜检查在早期诊断中均存在一定困难,肝脏病理检查对诊断有一定参考价值.     

12例肝豆状核变性诊断分析

目的探讨肝豆状核变性的临床特征,旨在提高临床医生对本病的认识。方法回顾分析12例肝豆状核变性患者的临床表现、实验室指标和特殊检查结果。结果 12例患者在就诊过程中均有不同程度的诊断延误,发病年龄为11～46岁,7例治疗后症状缓解,其中5例随访1～5年,病情无变化2例（16.6%）,死亡1例（8.3%）。结论本病以肝病为首发症状者居多,易被长期误诊或诊断不明,早期驱铜治疗对预后至关重要。     

17例肝豆状核变性病例分析

目的探讨肝豆状核变性的临床特点,加深对该病的认识,提高早期诊断率。方法回顾性分析17例肝豆状核变性患者的临床资料。结果 17例患者（其中3例有明确的家族遗传史）平均发病年龄为（25.3±8.1）岁。其中10例以神经精神症状为主,6例以消化系统症状为主,1例表现为溶血性贫血。17例患者中13例K-F环阳性（76.5%）,8例患者头颅MR I检查发现异常（47.1%）,7例出现不同程度的转氨酶升高（41.2%）,绝大部分出现血清铜和铜蓝蛋白含量减低。结论肝豆状核变性青少年多见,以神经系统和肝损害为主要表现,血清铜、铜蓝蛋白降低,角膜K-F环阳性是其重要改变。     

Coronary septal collaterals as an access for the retrograde approach in the percutaneous treatment of coronary chronic total occlusions.

OBJECTIVES: To investigate the feasibility and safety of the percutaneous dilatation of coronary septal collaterals and to allow its use as an access for retrograde approach to percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs). BACKGROUND: Despite improvements in percutaneous techniques and materials, CTO recanalization success rate is still suboptimal. The retrograde approach allows to significantly increase this success rate. However, its application via a bypass graft or epicardial collateral can potentially result in severe complications. A safer retrograde access is desired and would allow broadening the application of the retrograde approach in the percutaneous treatment of CTOs. METHODS: After a failed antegrade CTO recanalization attempt, a retrograde approach via septal collaterals was tried in 21 patients (19 males, 2 females). The septal collateral was accessed via the contralateral patent coronary artery and was crossed with a hydrophilic floppy wire. After successful wire crossing of the septal collateral, sequential low pressure dilatation was performed with a 1.25 or 1.5 mm balloon to allow the delivery of a balloon catheter up to the distal CTO site. RESULTS: Successful wire crossing and balloon dilatation of septal collaterals was achieved in 19 cases and in 17 cases, respectively. Postdilatation septal collateral diameter increased significantly reaching a mean diameter of 1.46 +/- 0.38 mm. Retrograde CTO recanalization was successfully performed in 71% of the cases. No major complications occurred. CONCLUSIONS: Coronary septal collaterals can be used as an access for the retrograde approach in the percutaneous treatment of CTOs.     

Lymphoscintigraphy in plastic bronchitis,A pediatric case report

Plastic bronchitis (PB) is an uncommon, potentially fatal disease, marked by endobronchial cast formation causing variable degrees of respiratory distress. Primary and secondary pulmonary lymphatic abnormalities have been identified among the underlying mechanisms of cast formation. We present a case of PB where lymphoscintigraphy demonstrated the underlying lymphatic defect. A 6‐year‐old Hispanic male with congenital heart disease (CHD; post‐Fontan) presented with recurrent pneumonia, respiratory distress. Bronchoscopy showed inflamed hypervascular mucosa and thick mucus plugs; no casts were seen. Later, PB was diagnosed after the patient expectorated a bronchial cast. Cast analysis showed lymphocytic aggregates with mucin and fibrin. Lymphoscintigraphy revealed abnormal lymphatic collaterals and retrograde trace reflux into the superior mediastinum, a picture consistent with thoracic duct lymph leakage into the tracheobronchial tree. The pathogenesis of PB is not fully understood, especially in patients with CHD. Chyle in bronchial casts suggests abnormal lymphatic flow. Reports of lymph flow abnormalities, especially endobronchial lymph leakage in CHD are limited. Lymphoscintigraphy in our case demonstrated clear evidence of retrograde lymph reflux and leakage into the bronchial tree. The case presented suggests that in some patients following Fontan surgery, high intrathoracic lymphatic pressure and retrograde lymph flow may contribute to recurrent cast formation. Finding the underlying lymphatic abnormality helps in specific case management. Lymphoscintigraphy is a safer and easier method than lymphangiography. Surgical lymphatic–venous shunting may be possible in select cases. Pediatr Pulmonol. 2013; 48:515–518. © 2012 Wiley Periodicals, Inc.     

Retrograde approach to an ostial left anterior descending chronic total occlusion through a left internal mammary artery graft

Retrograde approach to chronic total occlusions (CTO) has been described via saphenous vein grafts, septal and epicardial collaterals. We report for the first time a successful retrograde approach to an ostial left anterior descending (LAD) artery CTO through a failed left internal mammary artery (LIMA) to LAD anastamosis. This case demonstrates the technical aspects of using a LIMA conduit as a retrograde approach to CTO. © 2015 Wiley Periodicals, Inc.     

Application of septal wire surfing technology in retrograde intervention of chronic total occlusion

Background Septal Surfing Technology(SST) is one of the most important techniques for collateral channels(CCs) crossing in retrograde chronic total occlusion(CTO) of percutaneous coronary intervention(PCI). We examined this technique's usefulness in retrograde CTO-PCI cases. Methods We retrospective analyzed 728 consecutive CTO-PCI cases from January 2014 to September 2016. One hundred and forty-two patients who had undergone retrograde PCIs using septal collateral channels(CCs) were collected. Univariate and multivariate analyses were conducted to identify independent predictors for SST CCs crossing success. Results The CCs crossing success rate was 89.4% during retrograde PCI. Three factors were figured out as independent predictors, including CCs tortuosity(OR 0.164, 95%CI:0.041-0.657; P=0.011), diameter of distal CTO lesion(2.035, 95%CI:1.011-4.099; P=0.047) and LAD-CTO(OR 0.244, 95%CI:0.067-0.894; P=0.033). There were complications of CCs injury in 23.2% cases and 2.1% cases had cardiac tamponade without any in-hospital death. Conclusion SST is an effective method in collateral crossing during retrograde CTO-PCI. It has high successful rate regardless of the Werner Collateral Class of interventional collaterals, especially in invisible collaterals. This technology is feasible in daily practice of retrograde PCI.     

Coronary perforation with tamponade successfully managed by retrograde and antegrade coil embolization

In recent years, retrograde approach for chronic total occlusions has rapidly evolved, enabling a higher rate of revascularization success. Compared to septal channels, epicardial collaterals tend to be more tortuous, more difficult to negotiate, and more prone to rupture. Coronary perforation is a rare but potentially life-threatening complication of coronary angioplasty, often leading to emergency cardiac surgery. We report a case of a retrograde chronic total occlusion revascularization through epicardial collaterals, complicated by both retrograde and antegrade coronary perforation with tamponade, and successfully managed by coil embolization.     

肝豆汤治疗湿热内蕴型肝豆状核变性吞咽功能障碍的临床研究

目的观察肝豆汤治疗肝豆状核变性吞咽功能障碍的临床疗效。方法选取2018年12月—2019年7月安徽中医药大学第一附属医院脑病中心的住院病人80例,随机分为观察组和对照组,各40例;对照组给予吞咽训练、静脉输注二巯丙磺酸钠常规排铜治疗,观察组在对照组基础上加用肝豆汤治疗,连续治疗6 d为1个疗程,共治疗4个疗程。比较两组治疗前、治疗2个疗程末及4个疗程末吞咽评价量表评分、中医证候量表评分、24 h尿铜水平。结果治疗4个疗程后,观察组临床疗效总有效率高于对照组(65.0%与47.5%,P<0.05)。治疗2个疗程末及4个疗程末,观察组中医证候积分、吞咽评价量表评分较治疗前明显改善(P<0.05或P<0.01),且观察组中医证候积分、吞咽评价量表评分均较对照组明显改善(P<0.05或P<0.01)。治疗2个疗程末及4个疗程末,两组24 h尿铜较治疗前明显升高(P<0.01),治疗4个疗程末,观察组24 h尿铜均较对照组明显升高(P<0.01)。结论肝豆汤能改善湿热内蕴型肝豆状核变性吞咽功能障碍症状、中医证候积分、吞咽评价量表评分和24 h尿铜水平。