胃食管反流病误诊为呼吸道疾病36例分析

胃食管反流病（GRED）是由胃内容物反流引起不适症状和（或）并发症的一种疾病。其典型症状是烧心与反流。部分患者可伴有食管外症状,少数患者因缺乏明显反酸,烧心等胃食管反流症状,极易误诊。我院2006-01/2008-12共收治以呼吸道症状为突出表现的胃食管反流病患者36例,均曾误诊为呼吸道疾病,现浅析误诊原因如下。     

益气活血注射液治疗肺心病急性发作期患者肺阻抗血流图的变化

肺阻抗图系生物阻抗对肺血管容积检测的一种新技术,是无创伤性检测方法之一。我组从1989年冬～1991年春,采用益气活血注射液、硝苯吡啶及一般对照,对住院的慢性肺心病急性发作期患者 (简称肺心病)分组进行治疗,结果如下。     

系统性红斑狼疮并发急性胰腺炎1例报告

患者 男,47岁,因中上腹胀痛伴恶心呕吐1 d、加重4 h于2006年3月22日入院.入院前1 d,患者无明显诱因出现中上腹胀痛,呈阵发性加剧,无放射,伴恶心,呕吐胃内容物.     

Clinical observation on the effect of dexamethasone and chinese herbal decoction for purgation in severe acute pancreatitis patients

Objective:To investigate the effect of dexamethasone(Dx) combined with modified Dachengqi Decoction(大承气汤,DCQD),a Chinese herbal decoction for purgation,on patients with severe acute pancreatitis(SAP) accompanied with systematic inflammatory response syndrome(SIRS).Methods:A total of 81 patients diagnosed as SAP were randomly assigned to a control group or treatment group according to a random number table generated from an SPSS software.The patients in the control group(38 cases) received standard treatment and Chinese herbal decoction for purgation;those in the treatment group(43 cases) received additional 1 mg/(kg·d) dexamethasone(Dx) treatment for three days based on the above treatment.The mortality rate,acute respiratory distress syndrome(ARDS),renal failure,hemorrhage,sepsis,pancreatic pseudocyst, pancreatic abscess,operability,and days of hospitalization were compared between the two groups.Results: Three patients in the control group and eight patients in the treatment group dropped out from the study with a drop-out rate of 7.8%and 18.6%,respectively,and no statistics difference was shown between the two groups (P>0.05).Dx treatment significantly reduced ARDS rate and shortened the length of hospitalization compared to those in the control group(7/35,20.0%versus 15/35,42.9%,P=0.0394;32.5±13.2 days versus 40.2±17.5 days,P=0.0344).Other parameters including the mortality rate were not significant different between the two groups.Conclusion:Dx combined with DCQD could decrease the risk of developing ARDS in SAP patients with SIRS and shorten their length of hospitalization.     

Summary of integrative medicine for severe acute pancreatitis: 26-year clinical experiences and a report of 1 561 cases

Objective:To investigate the changing trends of clinical management for severe acute pancreatitis(SAP) with integrative medicine.Methods:Clinical data of 1 561 patients with SAP from 1980 to 2005 was retrospectively analyzed.The mortality and morbidity of complications were compared.Results:Of the 1 561 patients,400 patients accepted surgical operation,while the rest were treated conservatively with integrative medicine.There was a change toward conservative management together with Chinese purgative herbal medication use after 1990(22.4%from 1980-1990 compared with 45.5%from 1991-1993) because of high postoperative mortality.From 1994-2005,the treatment integrating Western medicine with Chinese herbal medications came to be preferred over the classic Western operation-based method.This change was associated with decreased morbidity(35.4%in 1980-1990 compared with 24.7%in 1991-1993 and 11.0%in 1994-2005,P<0.05) and lower mortality(40.52%of 1980-1990 compared with 17.17%of 1991- 1993 and 10.25%of 1994-2005,P<0.05).Conclusion:The combination of conservative management with Chinese herbal medicines is preferable to classic Western medicine treatment to reduce morbidity and mortality of SAP,while surgery becomes a supplemental option.     

大承气汤降低急性胰腺炎腹内高压

We evaluated effect of modified Da-Cheng-Qi Decoction (DCQD) on intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). A randomised, placebo controlled trial of modified DCQD therapy in patients with predicted SAP was conducted. Forty-two patients were enrolled from West China Hospital over the period January to December 2008, and were randomly divided to DCQD treatment group and placebo group. Randomisation stratified for Acute Physiology and Chronic Health Evaluation II (APACHE II) score, treatment group and placebo group were similar at baseline. Intra-abdominal pressure (IAP) was assessed by measuring intravesical pressure. Compared to placebo group, modified DCQD treatment significantly decreased IAP on day 4-8 (p < 0.05), APACHE-II score on day 6-8 (p < 0.05), CRP on day 8 (p < 0.01), renal failure rate (p < 0.05) and length of hospitalization (LOH) (p < 0.05). Moreover, oxygenation index was significantly improved in DCQD group than placebo group (p < 0.05). However, there were no statistically significant differences in Balthazar CT score, shock rate, intensive care unit transfer rate, and mortality between the two groups. In conclusion, this study provided evidence that modified DCQD can effectively relieve IAH and decrease LOH for patients with SAP. However, larger clinical trials are still needed to justify our findings.     

外周血单核细胞HLA-DR在急性胰腺炎中应用的研究进展

急性胰腺炎(AP)是常见的急腹症之一,其中20% ～ 30%为SAP,常引起SIRS,既而引起MODS,病死率高达20% ～ 25%[1].患者病死与疾病的严重程度和是否发生感染密切相关.目前临床上预测SAP严重性的指标很多,但缺乏一个预测AP并发感染概率的客观指标.人类白细胞抗原(human leukocyte antigen, HLA)最近10余年成为胰腺炎研究中的热点,并取得了较大的进展.     

丹参注射液在多脏器功能失常综合征治疗中的应用及其意义

有资料表明 ,ＭＯＤＳ是内、外、妇、儿各科较为常见的危急重症。如不及早诊断和治疗将进一步发展为多器官衰竭 (ＭＯＦ ) ,到了ＭＯＦ阶段 ,则更危重、死亡率更高[1～ 3 ] 。由于其发病率和死亡率都很高 ,已成为当今急救医学和危重病医学领域中急需研究和探索的新课题。“由于中医药的运用 ,使我国在ＭＯＤＳ治疗方面居国际领先地位”[4 ] 。根据笔者长期临床观察 ,中西医结合确实能明显提高该病症的疗效[1,5] 。长期治疗观察和有关资料表明 :ＭＯＤＳ有严重的瘀血症存在。“多器官衰竭 (ＭＯＦ)存在严重的瘀血症”[6] “瘀……是ＭＯＤＳ…