参苓白术散联合肠内营养对危重病患者预后的影响:多中心随机对照研究

目的探讨中药参苓白术散联合肠内营养对危重病患者预后的影响。方法采用多中心、随机、对照、双盲的方法,将四家医院纳入的220例危重症患者分为治疗组(112例)和对照组(108例),两组均给予西医常规治疗,治疗组在此基础上给予参苓白术散颗粒(10 g/袋),每次1袋,口服或经胃管鼻饲,每日4次,对照组给予等量安慰剂治疗,疗程至转出ICU。观察两组患者入ICU后新发感染率、呼吸机带机时间、ICU住院时间和治疗前后急性生理与慢性健康(APACHEⅡ)评分、血红蛋白、白蛋白、前白蛋白水平。比较两组胃肠营养耐受情况和病死率。结果与本组治疗前比较,两组治疗后前白蛋白、白蛋白水平差异有统计学意义(P<0.05),治疗组APACHEⅡ评分降低(P<0.05)。治疗后与对照组比较,治疗组前白蛋白、白蛋白水平升高(P<0.05),治疗组呼吸机带机时间、ICU住院时间、APACHEⅡ评分、胃肠营养不耐受发生率均明显减少(P<0.05)。两组入ICU后新发感染的发生率及病死率比较,差异无统计学意义(P>0.05)。结论参苓白术散可改善危重病患者肠内营养的耐受性,提高患者血浆白蛋白水平,改善患者营养状态,缩短机械通气时间。     

高效液相色谱法测定罂黄散中吗啡的含量

 目的 建立罂黄散中吗啡含量的测定方法。 方法 采用高效液相色谱法测定样品中 吗啡的含量。色谱条件：色谱柱为Hypersil Kromasil C 8 柱（150 mm×4.6 mm,5 μm）;流动相：乙腈-0.01 mol/L 磷酸氢二钾-0.005 mol/L庚烷磺酸钠（18:41:41）;流速：1 ml/min;柱温：室温;检测波长：220 nm。 结果 吗啡含量在1.5~30.0 μg/ml范围内线性关系良好（ r =0.9999） ,平均加样回收率为99.16 ％,RSD为1.17％（ n =6）。 结论 所建方法简便、准确、专属性强,可用于罂黄散制剂的质量控制。     

华盖散加味治疗痰咳102例疗效观察

目的：观察华盖散加味治疗痰咳的临床疗效，方法：将１６２例符合肺炎，慢性支气管炎急性发作诊断，以嘛嗽、咯痰为主要表现的患，随机分为中药辩证治疗（治疗组）１０２例和单纯西药治疗（对照组）６０例，治疗组按《中医药症诊断疗效标准》辩证分型为痰湿蕴肺型２４例，痰热壅肺型３６例，肺阴亏虚型１２例，肝火犯肺型２６例，肺气亏虚型４例，采用华盖散加味辨证治疗。对照组采用西药克咳敏加化痰口服液治疗。结果：治疗总有效率为９４％，对照组总有效率为８０％，治疗组疗成优于对照组（Ｐ〈０．０５），结论：提示华盖散加味确为治疗痰咳的有效方剂之一。     

噻托溴铵联合莫西沙星治疗轻中度慢性阻塞性肺疾病急性加重期的临床研究

目的 探讨噻托溴铵联合莫西沙星治疗轻中度慢性阻塞性肺疾病急性加重期的临床疗效。方法 回顾性收集2019年12月—2022年11月首都医科大学北京友谊医院平谷医院呼吸科收治的78例轻中度慢性阻塞性肺疾病急性加重期患者的病例资料，根据治疗方案的不同将患者分为对照组和治疗组，每组各39例。对照组静脉滴注盐酸莫西沙星氯化钠注射液，0.4 g/次，每次输液时间≥90 min。治疗组在对照组基础上使用噻托溴铵吸入粉雾剂，1粒/次，通过粉雾吸入器吸入给药装置吸入使用，1次/d。两组疗程为10 d。观察两组临床疗效，比较治疗前后两组咳嗽、咳痰评估问卷（CASA-Q）评分、血气分析指标、改良版英国医学研究委员会呼吸困难问卷（mMRC）评分及外周血中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和血清C反应蛋白（CRP）水平。结果 治疗后，治疗组总有效率是97.44%，较对照组的79.49%显著提高（P＜0.05）。治疗后，两组CASA-Q中咳嗽症状、咳嗽影响、咳痰症状、咳痰影响评分及其总分均较治疗前显著增加（P＜0.05）；且治疗后，治疗组CASA-Q评分高于对照组（P＜0.05）。治疗后，两组动脉血氧分压（pO₂）均显著上升，而动脉血二氧化碳分压（pCO₂）均显著下降（P＜0.05）；且治疗后，治疗组患者血气指标改善优于对照组（P＜0.05）。治疗后，两组患者mMRC评分均显著降低（P＜0.05）；且治疗后，治疗组mMRC评分低于对照组（P＜0.05）。治疗后，两组外周血NLR、PLR和血清CRP水平均显著下降（P＜0.05）；且治疗后，NLR、PLR和血清CRP水平均以治疗组降低更显著（P＜0.05）。结论 噻托溴铵联合莫西沙星治疗轻中度慢性阻塞性肺疾病急性加重期患者具有良好的疗效，能安全有效地缓解患者呼吸道症状，改善动脉血气和肺功能，调节机体炎症状态。     

养阴益气活血冲剂拮抗小鼠脑缺血时血中肾上腺素水平增高的作用

目的：观察自制的养阴益气活血冲剂对小鼠脑缺血时血中儿茶酚胺水平的影响。方法：健康ICR小鼠灌服不同剂量阴益气活血冲剂和尼莫地平1h后，在水合氯醛麻醉下，结扎双侧颈总动脉和迷走神经8min造成脑缺血，取血后用高效液相色谱－－电化学联合检测法测定各组动物血浆中儿茶酚胺水平。结果：缺血小鼠血浆中去甲肾上腺素和肾上腺素浓度显著增加（P＜0．01），养阴益气活血冲剂各组和尼莫地平组血浆中肾上腺素水平与正常组相比无显著差异（P＞0．05），结论：小鼠结扎双人侧带迷走神经的颈总动脉可致血中去甲肾上腺素和肾上腺素释放增加，自制的养阴敢活血冲剂可阻止血浆肾上腺素升高。     

Observation on Therapeutic Effects of Shengmai Powder(生脉散)in Treating Acute Viral Myocarditis

Objective: To evaluate the clinical efficacy of Shengmai Powder (SMP, 生脉散) in treating acute viral myocarditis objectively. Methods: One hundred and twenty-four patients with acute viral myocarditis were randomized into the treated group (SMG, n=64) and the control group(CG, n=60 ). Such myocardial nutrient medicine as ATP, CoA, Vit-C, were given to both groups. And to the treated group, 40 ml of Shengmai Injection per day was given intravenously for 2 weeks, which was followed by oral intake of Shengmai granule, one package three times daily for another 2 weeks in total. The same anti-arrhythmia agents were applied to both groups, and no fructose-1, 6-diphosphate (FDP) for either. Semi-quantitative scoring method was adopted to observe such symptoms as chest stuffiness, palpitation and chest pain before treatment and four weeks after treatment. Meanwhile, ECG, dynamic ECG by Holter monitor, left ventricular enddiastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), serum neutralizing antibody of virus Coxsackie B, cardiac troponin I (cTnl) and cardiac troponin T (cTnT) were examined. Results: (1) Compared with the control group, more significant improvement was got in SMG in respects of chest stuffiness, palpitation, chest pain and arrhythmia ( P＜0.05 or P＜0.01). (2) Negative converting rates of cTnl , cTnT in the two groups were 59.46% vs 35.48%, 68.75% vs 42.31% respectively (P＜0.05). (3) LVEDD before and after treatment in SMG was 52.44±3.40 mm and 48.81± 2.23mm respectively, while that in the control group was 52.31±3.74 mm and 49.92±2.67mm respectively; LVEF before and after treatment in SMG was 60.67±4.62 % and 65.02±4.16 % respectively, while that in the control group was 60.91± 4.26 % and 63.67±3.17 %. There was obvious improvement in the two parameters in both groups, but the improvement in SMG was superior to that in the control group (P＜0.05). Conclusion: SMP shows a good effect in improving clinical symptoms and signs, heart function, abnormal ECG and inflammatory injury inde xes in patients with acute viral myocarditis.     

逍遥散加味治疗乳腺癌术后伴发抑郁症

目的 观察逍遥散加味治疗乳腺癌术后伴发抑郁症的临床疗效.方法 将68例乳腺癌术后伴发抑郁症患者随机分为治疗组和对照组,各34例,在常规化疗基础上,治疗组给予逍遥散加味治疗,对照组给予帕罗西汀治疗,连续治疗4周,观察2组治疗后2、4、6周的HAMD评分及治疗前、后1、2、4周白细胞、红细胞及血小板变化.结果 治疗后2组HAMD评分均有不同程度降低(P＜0.05),治疗组在同一时间HAMD评分降低程度明显优于对照组(P＜0.05);治疗组在同一时间骨髓抑制缓解程度明显优于对照组(P＜0.05).结论 逍遥散加味在乳腺癌术后伴发抑郁症患者的治疗中能明显改善HAMD评分,并快速缓解化疗后的骨髓抑制.     

Needle image plates compared to conventional CR in chest radiography: Is dose reduction possible?

Purpose

To compare image quality of standard-dose computed radiography and dose reduced needle-technology CR for supine CXR in a clinical setting.

Materials and methods

We prospectively evaluated 128 radiographs of 32 immunocompromised patients. For each patient four clinical CXR were performed within one week, two with powder image plates (PIP; Fuji ST-V) and two with needle image plates (NIP; Agfa DXS) at standard and half dose, respectively. One experienced radiologist and two residents blinded to dose level and kind of imaging system rated different anatomical structures, image noise, tubes/lines and abnormalities on a image quality scale from 1 to 10 (1 = poor, 10 = excellent). The rating scores were tested for statistical differences using analysis of variance with repeated measures.

Results

A statistical difference (p < 0.05) was found for the two systems as well as for the two dose levels. Overall rating scores were 6.5 for PIP with full dose, 6.2 for PIP with half dose, 7.6 for NIP with full dose and 7.4 for NIP with half dose. There was a significant difference in favour of the NIP system at the same dose level. Also the NIP images obtained at half dose were ranked significantly better compared to the PIP images at standard dose. The differences in ranking of anatomical structures and abnormalities were more pronounced in low absorption areas (pulmonary vessels, parenchyma) than in high absorption areas (mediastinum, spine).

Conclusion

For supine chest radiograms the NIP technology allows for a dose reduction of 50% while providing higher image quality.     

柴胡疏肝散加减联合手术治疗肝胆管结石35例临床观察

目的 探讨疏肝法联合手术治疗肝胆管结石的临床疗效。方法 将67例胆总管结石患者随机分为对照组（32例）和观察组（35例）,对照组患者行腹腔镜胆总管探查术治疗,观察组患者在对照组治疗的基础上术后口服加减柴胡疏肝散。干预1周后,观察两组患者机体功能恢复情况和炎症指标、肝功能水平,随访12个月后观察结石复发率。结果 与对照组比较,观察组患者肛门排气时间、进食时间、术后住院时间均明显缩短（P＜0.05）;与治疗前比较,两组患者术后7 d血清超敏C-反应蛋白（high-sensitive C-reaction protein, hs-CRP）、丙氨酸氨基转移酶（alanine aminotransferase,ALT）、天冬氨酸氨基转移酶（aspartate aminotransferase,AST）、谷氨酰基转移酶（gamma glutamyltransferase,GGT）、碱性磷酸酶（alkaline phosphatase,ALP）水平均明显降低（P＜0.05）,观察组患者血清hs-CRP、AST、GGT降低程度显著大于对照组（P＜0.05）;观察组结石复发率显著低于对照组（χ2=6.118,P=0.013）。结论 术后应用疏肝中药能够促进机体胃肠功能恢复,缩短住院时间,降低炎症指标,改善肝功能及降低结石再生和复发率。