仲景方药的剂量与煎服法

<正> 治疗疾病,正确的辨证固屑重要,但组方用药、药用剂量、煎服方法等方面亦不能忽视。王三虎认为药物用量,是组方用药的重要方面,直接影响治疗效果。古人有“中医不传之秘在量上”之说。徐灵胎说:“煎药之法,最宜深讲,药之效不效,全在于此……,方虽中病,而煎法失度,药必无效;……药虽中病,而服之不得其法,非特无功,反而有害”。所以仲景记载的药用量、煎服方法对后世影响深远。     

呋喃唑酮初治方案治疗幽门螺杆菌感染效果的Meta分析

目的评价以呋喃唑酮为基础的方案在幽门螺杆菌初次治疗中的疗效与安全性。方法电子检索Cochrane图书馆（2009年第1期）、PubMed（1992～2009.1）、OVID数据库（1994～2009.1）、万方数据库（1994～2009.1）、中国期刊网（1994～2009.1）、维普中文科技期刊全文数据库（1994～2009.1）,收集以呋喃酮唑为基础的方案初次治疗幽门螺杆菌感染的随机对照试验（RCT）,评价纳入研究质量,用RevMan5.0软件进行统计分析。结果共纳入5个RCT,合计499例患者。其方法学质量等级为B的4个,为C的1个。呋喃唑酮组与对照组幽门螺杆菌根除率的ITT分析分别为78.3%与66.8%,PP分析分别为83.1%与70.9%,其RR（95%CI）分别为1.18（0.86,1.62）、1.17（0.88,1.57）;呋喃唑酮与对照组轻度不良反应发生率分别为40.8%与39.4%,重度不良反应发生率为7.8%与3.7%,其RR（95%CI）分别为1.03（0.79,1.36）、1.86（0.84,4.09）。结论以呋喃唑酮为基础的方案在幽门螺杆菌初次治疗疗效与对照组相似,轻中度及重度不良反应发生率无明显升高,可考虑作为幽门螺杆菌一线治疗方案。受纳入研究数量及质量限制,上述结论尚需大样本、高质量的RCT进一步证实。     

后生元在结直肠癌中的研究进展

<正>结直肠癌是目前最常见的恶性肿瘤之一。在2022全美癌症统计报告中,前列腺癌、肺癌和结直肠癌大约占男性所有癌症发病的48%;乳腺癌、肺癌和结直肠癌则占女性新确诊病例的51%。不同性别中,结直肠癌的死亡率均位列第三^[1]。虽然结肠镜的普及对诊断、治疗起着一定作用,但其在全球的发病率和死亡率仍然呈上升趋势。     

食管上段胃粘膜异位症

食管上段胃粘膜异位症是指胃粘膜出现于食管上段,可引起一些临床症状,重者引起溃疡、出血、狭窄等并发症,极少数可发生癌变,需引起消化科和内镜医师的重视。     

护理干预对幽门螺杆菌根除率的影响

幽门螺杆菌是慢性活动性胃炎、消化性溃疡、胃癌和黏膜相关淋巴组织淋巴瘤的重要病因。Hp根治方案很多，其中埃索美拉唑加两种抗生素的三联疗法仍然是当前一线治疗方案。尽管该方案初次十分有效，     

钛夹预防结直肠息肉切除术后不良事件疗效的Meta分析

背景钛夹预防性夹闭创面对结直肠息肉切除术后迟发性出血及穿孔等不良事件的作用尚不明确,目前关于钛夹预防作用的有效性尚未达成共识.目的评价钛夹对预防结直肠息肉内镜下切除术后不良事件的疗效.方法计算机检索Pub Med?EMBASE?Cochrane library?万方中关于结直肠息肉术中是否使用钛夹预防术后不良事件的研究,评价纳入研究质量,并用Revman 5.3软件进行统计学分析.结果共有7项RCT纳入标准,共计3777例患者, 1880例患者术中使用钛夹预防性夹闭创面(钛夹组), 1897例患者术中不使用钛夹夹闭创面(非钛夹组). Meta分析结果显示:钛夹组较非钛夹组的术后迟发性出血率低,差异具有统计学意义(2.55%vs 4.48%, P=0.01, 95%CI:0.40-0.80);而钛夹组较非钛夹组的术后穿孔率无明显差异(0.66%vs 1.04%, P=0.42, 95%CI:0.21-1.92).亚组分析显示,钛夹对预防结直肠息肉术后出血的作用,主要体现在大小≥20 mm的息肉上,对20 mm息肉的预防效果不佳(RR=1.18, 95%CI:0.62-2.23, P=0.62; RR=0.47, 95%CI:0.29-0.77, P=0.003);钛夹对近端结肠息肉与远端结肠息肉切除术后的预防迟发性出血作用无明显差异(RR=0.57, 95%CI:0.18-1.80, P=0.34; RR=0.78, 95%CI:0.06-10.33, P=0.85).结论钛夹可预防结直肠息肉切除术后迟发性出血的发生,且主要体现在≥20 mm的病变中,此外钛夹对术后穿孔的预防作用不大.     

抗肿瘤坏死因子α制剂治疗溃疡性结肠炎的荟萃分析

Objective To pool the data of studies and evaluate the efficacy and safety of TNFα blocking agents in the treatment of ulcerative colitis(UC).Methods The randomized clinical trials(RCT)that compared the efficacy or safety of TNFα in the treatment of UC were researched from Pubmed. OVID. EMBASE. Cochrane library, CNKI, Wanfang data and VIP Chinese Scientific and Technologic Periodical Database. Statistical heterogeneity between trials was evaluated by Revman 5.0 and was considered to exist when P＜0.1.Heterogeneity of the included articles was tested. which was used to select proper effect model to calculate. Publication bias was investigated through visual inspection of funnel plots. Results Nine RCT including 1226 cases were analyzed. Eight hundred and six cases had received TNFα treatment and 420cases had received placebo or glucocorticoid treatment. Compared with placebo or glucocorticoid groups, TNFα group achieved significantly higher rates of short-term clinical response, short-term clinical remission, long-term clinical response.10ng-term clinical remission and the total OR were 2.36(95%C,1.34-4.15),2.42(95%CI 1.22-4.81).3.22(95%CI2.28-4.55)and 2.82(95%CI1.91-4.16)respectively. TNFα group was less likely to undergo colectomy than placebo group and the total OR was 0.31(95%CI0.20-0.48).TNFα could not improve the mucosal healing and quality of lire. No significant difference was found in adverse effect between TNFα group and placebo or glueoeortieoid group(OR=1.07(95%CI0.55-2.09,P=0.84)).The rate of serious adverse effect in TNFα group was less than placebo or glueoeorticoid groups (OR=0.65,95%CI0.48-0.89,P=0.007).Inspection of the funnel plots for all dichotomous data measures had not revealed evidence of publication bias. Conclusions Patients with moderately to severely active UC treated with TNFαhave effective clinical response and clinical remission and are less likely to undergo colectomy than those receiving placebo or glucocorticoid. TNFα treatment is safe for UC but can not improve the mucosal healing and quality of life. Large-scale, high-quality RCTs ale needed to confirm or refuse the available evidence.     

葛琳仪运用清法分期论治溃疡性结肠炎经验

总结葛琳仪教授运用清法分期论治溃疡性结肠炎的经验。认为溃疡性结肠炎核心病机为肠腑湿热,提出治疗以清法为基础,立清化、清疏、清润、清养四法。溃疡性结肠炎活动期病机为肠腑湿热、气血壅滞、瘀毒蕴积,治以清化兼清疏为法,清化法常用白头翁汤配伍黄芩、马齿苋、蒲公英为基本方以清化湿热、凉血解毒止痢;同时配合清疏法,常用柴胡、醋香附、木香、枳壳、槟榔等理气之品,当归、侧柏叶、地榆炭等调血之品。缓解期病机为正气亏虚且肠腑湿热瘀毒余邪未尽,治以清养、清润为法,清润法主要针对阴津受损者,自拟清润益肠汤;清养法主要针对脾胃虚弱者,自拟清养健脾汤。     

简讯

本刊讯受中央卫生部委托,上海中医学院继中医内科师资进修班之后,又于去年9月上旬举办了中医外科、中医儿科两个师资进修     

秦伯未治疗咳嗽的临床经验

秦伯未先生,为近代著名老中医之一。早年曾跟随上海名医丁甘仁为师,且又博览群书,理论联系实践,能汇集各家之长。秦老一生著书甚多,又热心讲学,为继承和发展中医事业、培养中医人才作出了一定的贡献。秦老在临床治疗