清金化痰汤对慢性阻塞性肺疾病急性加重期的临床疗效、炎症反应和气道黏液高分泌的影响

目的:探讨中药方剂清金化痰汤对慢性阻塞性肺疾病急性加重期(AECOPD)的临床疗效、炎症反应和气道黏液高分泌的影响。方法:符合AECOPD入选标准患者80例,随机分为清金化痰汤组(治疗组)和常规治疗组(对照组),每组40例。两组患者均常规给予低流量吸氧、抗感染、祛痰平喘等治疗,清金化痰汤治疗组在此基础上加用中药清金化痰汤口服或鼻饲,两组患者观察时间均为14d。通过评估两组患者抗菌药物使用时间的长短,治疗前后(入院当天和治疗14d)的血气分析及中医证候积分;入院第1d、7d、14d患者外周血中的白细胞计数、中性粒细胞百分比、C-反应蛋白(CRP)、降钙素原、肿瘤坏死因子-α(NF-α)、白介素1β(IL-1β)、白介素8(IL-8)、中性粒细胞弹性蛋白酶(NE)、基质金属蛋白酶-9(MMP-9);痰液中的黏蛋白5AC(MUC5AC)含量来探讨清金化痰汤对AECOPD的临床疗效、炎症反应及气道黏液高分泌的影响。结果:治疗组的抗生素使用时间显著低于对照组,治疗前后的中医证候积分、血气分析结果显著好于对照组,差异有统计学意义(P<0.05);两组患者的炎症指标及NE、MMP-9、MUC5AC的含量均低于入院时,但清金化痰汤组下降水平显著优于对照组,差异具有统计学意义(P<0.05)。结论:在常规西药治疗基础上,配合中药清金化痰汤治疗AECOPD,在改善患者临床症状、控制感染方面比单纯西医常规治疗效果更优,其作用机理可能与该方能够在一定程度上抑制炎症因子、减轻气道黏液高分泌有关。     

Long-term follow-up for recurrent stenosis: A prospective randomized study of expanded polytetrafluoroethylene patch angioplasty versus primary closure after carotid endarterectomy

Purpose: To determine the effect of primary closure (PC) versus expanded polytetrafluoroethylene patch graft angioplasty (PGA) on the incidence of recurrent stenosis (>50% lumen diameter narrowing) after carotid endarterectomy (CEA), 87 patients undergoing 100 consecutive CEA were prospectively randomized into two groups.Methods: Forty-four patients underwent 51 PC, and 43 patients underwent 49 PGA. All patients were evaluated after operation by duplex scanning at 1.5, 12, 24, and 36 months. There were no significant differences in the demographic characteristics or operative indications for CEA between the two patient groups. Complete follow-up was achieved in 86% (75/87) of the patients during the 36-month surveillance period.Results: The perioperative permanent neurologic morbidity in the PC and PGA groups was noted to be 4% and 2%, respectively (PC = 2/51 vs PGA = 1/49, p = 0.58). Three additional reversible cerebral ischemic events occurred in the postoperative period (PC = 2/51 vs PGA = 1/49, p = 0.58). Other morbidity included immediate postoperative hemorrhage requiring reexploration (1/51) in the PC group and an infected expanded polytetrafluoroethylene patch requiring removal and replacement with autogenous vein (1/49). Long-term follow-up detected a single patient with significant bilateral restenoses of his primarily closed carotid arteries. None of the patients in the PGA group had restenoses (PC = 2/51 vs 0/49, p = 0.50). In addition, no postoperative dilation of the common or internal carotid arteries or perioperative death was observed.Conclusions: In patients undergoing CEA, these data demonstrate no significant difference in the perioperative morbidity or mortality between PC and PGA. Use of the patch did not engender patients to patch rupture or aneurysmal degeneration as previously described with vein patch angioplasty procedures. This series supports effective use of either technique to achieve minimal rates of restenosis. (J VASC SURG 1994;19:198-205.)     

Phytotherapy and physical therapy in the management of chronic prostatitis–chronic pelvic pain syndrome

International Urology and Nephrology - Chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) is one of the four category prostatitis, and the prevalence is over 90–95% in prostatitis....     

简型层次分析法在眼科病床合理安排评价中的应用

利用简型层次分析方法建立眼科病床合理安排方案的评价体系．并通过具体实例进行实证分析。为医院管理决策者提供可靠决策依据。     

Reduning Injection prevents carrageenan-induced inflammation in rats by serum and urine metabolomics analysis

Objective: To elucidate the anti-inflammatory mechanism of Reduning Injection (RDN) by analyzing the potential biomarkers and metabolic pathways of the carrageenan-induced inflammatory model from the overall metabolic level. Methods: Rat inflammatory model was established by carrageenan. UPLC-Q-TOF/MS was used to detect and analyze changes of endogenous metabolites in the serum and urine of carrageenan-induced inflammatory rats. Combined with multivariate analysis and databases analysis, inflammatory-related potential biomarkers were screened and identified to analyze possible metabolic pathways. The reliability and biological significance of these biomarkers was verified by metabolic network analysis and correlation analysis with pharmacodynamic indicators. Results: A total of 16 potential biomarkers were screened and identified by multivariate analysis and metabolite databases, among which 13 species could be adjusted by RDN. The metabolism pathway analysis revealed that histidine metabolism, sphingolipid metabolism, and tyrosine metabolism were greatly disturbed. Their biomarkers involved urocanic acid, sphingosine, and norepinephrine, all of which showed a callback trend after RDN treatment. The three biomarkers had a certain correlation with some known inflammatory-related small molecules (histamine, arachidonic acid, Leukotriene B4, and PGE2) and pharmacodynamic indicators (IL-6, IL-1β, PGE2 and TNF-α), which indicated that the selected biomarkers had certain reliability and biological significance. Conclusion: RDN has a good regulation of the metabolic disorder of endogenous components in carrageenan-induced inflammatory rats. And its anti-inflammatory mechanism is mainly related to the regulation of amino acid and lipid metabolism. This research method is conducive to the interpretation of the overall pharmacological mechanism of Chinese medicine.     

医药价格改革对医疗费用和医保支出的影响——基于江苏省南京市区级公立医院的分析

目的：评价南京区级公立医院医药价格改革方案的合理性和可行性。方法：通过对南京市区级公立医院医药价格改革前后医疗费用数据的测算调研,模拟分析医保基金支出等重点指标的变化。结果：已试点的江宁区医院门诊和住院次均费用均下降,个人负担率住院持平、门诊有升有降。经模拟测算,即将推进改革的其它4个区级医院门诊和住院药占比、次均门诊费用均有所下降,次均住院费用上升,住院费用个人负担下降3.21个百分点,住院费用医保统筹基金增加支出占实际基金支出的7.74％。结论：医药价格改革减轻了患者个人负担;医保基金支出增加,风险有待防范;医药价格结构调整趋向合理,医疗技术和医护服务价值得到体现,补偿率偏高地区个人和医保统筹基金支出均增加。建议：破除“以药补医”机制,引导参保人员合理分流,推进医保支付方式改革,医保基金市级统筹、城乡统筹相结合,促进县级公立医院改革良性发展。     

清肠化湿方治疗溃疡性结肠炎的临床疗效及对ESR，PLT，D-二聚体的影响

目的：观察清肠化湿方治疗溃疡性结肠炎的临床疗效及治疗前后血沉（ESR）、血小板（PLT）、D-二聚体等指标的变化情况,评价其诱导缓解及对凝血指标的改善作用。方法：将59例确诊为轻、中度活动期溃疡性结肠炎且中医辨证属湿热内蕴证的患者分为中药治疗组和美沙拉嗪对照组。中药组予清肠化湿方口服及中药灌肠;美沙拉嗪组活动期予美沙拉嗪肠溶片4 g·d^-1口服,病情缓解后改为1.5 g·d^-1维持治疗。疗程共12周,治疗结束后评价总有效率、主要症状消失率、肠镜疗效及对ESR,PLT,D-二聚体等指标的影响。结果：中药组总有效率高于美沙拉嗪组（93.3% vs 79.3%,P<0.05）,主要症状便血及腹泻的消失率均优于美沙拉嗪组消失率（82.8% vs 58.6%,85.7% vs 60.0%,P<0.05）,肠镜疗效优于美沙拉嗪组（P<0.05）。中药组对于患者ESR,PLT的改善程度均优于美沙拉嗪组（P<0.05）,但是尚不能说明中药对于D-二聚体的改善优于美沙拉嗪组。结论：清肠化湿方是轻、中度溃疡性结肠炎有效且安全的治疗方案,在诱导缓解、改善症状、改善ESR,PLT等相关指标等方面优于美沙拉嗪。但是本研究未能发现中药对于D-二聚体的改善优于美沙拉嗪组。     

抵当汤联合吉西他滨治疗非肌层浸润性膀胱癌术后患者的疗效评价

目的:观察抵当汤联合吉西他滨膀胱灌注化疗治疗非肌层浸润性膀胱癌术后患者的临床疗效.方法:选择2015年1月至2019年9月期间于江苏省第二中医院、江苏省中医院就诊的非肌层浸润性膀胱癌患者100例随机分为观察组和对照组,其中观察组50例给予抵当汤联合吉西他滨膀胱灌注治疗,对照组50例给予安慰剂联合吉西他滨膀胱灌注治疗.在...     

舒糖康胶囊对糖尿病性周围神经病变大鼠坐骨神经传导速度的影响

目的观察舒糖康胶囊对糖尿病性周围神经病变（DPN）大鼠坐骨神经传导速度的影响及痛觉传导时间的影响。方法采用链脲菌素（STZ）造成大鼠糖尿病模型,给糖尿病大鼠连续25 d灌胃给予舒糖康胶囊8.0,2.0 g生药/kg,观察舒糖康胶囊对糖尿病性周围神经病变大鼠坐骨神经及尾神经感觉电生理的影响。结果舒糖康胶囊口服给药4周对糖尿病模型大鼠周围神经病变有明显的恢复作用,对痛觉的传导速度也有一定程度的恢复作用。结论舒糖康胶囊对糖尿病性周围神经病变大鼠有一定的治疗作用,对周围神经病变有明显的恢复作用,对痛觉的传导速度也有一定程度的恢复作用。     

六神胶囊联合头孢呋辛酯片治疗急性扁桃体炎的临床效果

目的 观察六神胶囊联合头孢呋辛酯片治疗急性扁桃体炎的临床效果。方法 将我院收治的84例急性扁桃体炎患者随机分为治疗组和对照组,各42例。治疗组给予六神胶囊联合头孢呋辛酯片治疗,对照组给予头孢呋辛脂片治疗。比较两组的临床疗效、中医证候积分、临床症状消失时间及炎症因子水平。结果 治疗组的治疗总有效率高于对照组（P<0.05）。治疗后,治疗组的主症、次症积分均低于对照组（P<0.05）。治疗后,治疗组的体温恢复时间、咽痛消失时间、扁桃体充血肿大消失时间、脓性分泌物消失时间均短于对照组（P<0.05）。治疗后,治疗组的血清TNF-α、IL-1β、IL-6、CRP、PCT、G-CSF水平低于对照组（P<0.05）。结论 六神胶囊联合头孢呋辛酯片可显著减轻急性扁桃体炎患者的临床症状、炎症反应,临床疗效显著。