李文金教授针灸辨证验案举隅

笔者有幸随李文金教授学习两年,深有所获,现将蛇串疮、眩晕、呃逆的针灸疗法总结如下,供大家参考。     

急性脑卒中伴顽固性呃逆的病因分析及干预

目的探讨急性脑卒中后顽固性呃逆患者的有效护理干预。方法对我院急性脑卒中伴发顽固性呃逆患者的治疗及护理干预进行回顾性总结。结果对急性脑卒中伴顽固性呃逆患者及早进行心理和护理干预，可使急性脑卒中患者的病情得以稳定和康复。结论顽固性呃逆是脑卒中的并发症之一，可以引起失眠、无力、感染等诸多症状，加重病情，及时终止呃逆的发生，有利于脑卒中的康复。     

指压攒竹穴配合足三里穴位注射治疗恶性肿瘤顽固性呃逆20例

[目的]观察指压穴位加穴位注射治疗顽固性呃逆20例临床疗效。[方法]将患者随机分为两组,治疗组采用指压攒竹穴,同时配合胃复安足三里穴位注射,对照组予单纯胃复安足三里穴位注射3d后评效。[结果]治疗组总有效率(95%)明显高于对照组(70%)。[结论]指压攒竹穴加足三里穴位注射对治疗肿瘤患者顽固性呃逆有显著疗效。     

Persistent hiccups after attempted interscalene brachial plexus block

OBJECTIVE: We describe a case of persistent hiccups after attempted interscalene brachial plexus block. CASE REPORT: A 38-year-old man was admitted for arthroscopic repair of a right shoulder injury. An interscalene block was attempted in the preoperative area and combined with general anesthesia for surgery. The procedure lasted 5(1/4) hours. After transfer to the recovery room, the patient complained of severe right shoulder pain and had no discernible sensory or motor block. He was noted to be hiccuping. The patient was discharged home the following morning but returned 2 days later complaining of persistent hiccups since surgery, with associated insomnia and nausea. He was readmitted and given chlorpromazine 50 mg intravenously every 8 hours and metoclopramide 10 mg intravenously every 6 hours. The patient was discharged 4 days later on chlorpromazine 25 mg by mouth every 8 hours and baclofen 5 mg by mouth every 12 hours, with hiccups greatly reduced in both intensity and frequency. Hiccups ceased 1 day after discharge. Eighteen days after surgery, he was off all medication with no return of his hiccups; 1 month later he remains hiccup free. CONCLUSIONS: Persistent hiccups have many postulated causes, including several that are common in the perioperative period, but this is the first time to our knowledge that persistent hiccups have been described in association with attempted interscalene brachial plexus block.     

揿针联合坐位咳嗽疗法对脑卒中后气管切开患者顽固性呃逆的疗效观察

目的 探讨揿针联合坐位咳嗽疗法对治疗脑卒中后气管切开患者顽固性呃逆的临床疗效。方法 选取浙江省人民医院2018年11月至2020年10月收治的脑卒中后气管切开顽固性呃逆住院患者52例,根据随机数字表法将其分为观察组和对照组,每组各26例,观察组采取揿针联合坐位咳嗽疗法治疗顽固性呃逆,对照组采取常规的盐酸氯丙嗪注射液+盐酸甲氧氯普胺注射液(胃复安)联合治疗,疗程均为6 d。通过对两组患者治疗前后的生活质量评分、呃逆症状积分、咳嗽反射分级量表评分等观察指标进行科学评价,观察其最终的临床疗效。结果治疗后,与对照组相比,观察组的呃逆症状积分[(4.62±1.53)分vs.(3.12±1.03)分]、咳嗽反射分级量表评分[(2.35±0.63)分vs.(1.69±0.55)分]均降低,观察组的生活质量评分[(10.15±1.38)分vs.(11.38±1.79)分]、总有效率(92.3%vs. 73.1%)均增高(P0.05)。结论 揿针联合坐位咳嗽诱发与常规的药物治疗对脑卒中后气管切开患者的顽固性呃逆均有一定的疗效,但前者的治疗效果优于后者,可明显提高患者的生活质量,改善患者的呃逆症状,前者对咳嗽反射重塑效果明显优于后者,可以进一步促进气道分泌物的排出,值得临床推广应用。     

Clinical analysis of neuromyelitis optica presenting as intractable nausea,vomiting and hiccups

Vomiting and hiccups can be the manifestations of numerous systemic and neurological illnesses. Intractable nausea, vomiting and hiccups (INH) are reported as possible initial manifestations of neuromyelitis optica (NMO), but not correctly identified. Awareness of these atypical presentations is conducive to NMO early diagnosis and proper treatment to prevent further disability. In this paper, 12 NMO were reported, whose intractable vomiting and hiccups were the sole manifestations of the first attack and other attacks involving spinal cord and optic nerves developed later. All the patients were women and serum aquaporin 4 antibody (AQP4-Ab) of 83% patients was positive. MRI of 50% patients showed T2-weighted imaging/fluid attenuated inversion recovery hyperintensity which were longitudinally extensive transverse myelitis or linear signal changes. Sixty-seven percent of patients had medulla lesions, in which dorsomedial and area postrema were involved.     

丁香柿蒂汤治疗腹部手术后并发顽固性呃逆疗效观察

目的：观察丁香柿蒂汤治疗腹部手术后并发顽固性呃逆临床疗效。方法：50例确诊病例,给予丁香柿蒂汤,每日1剂,水煎服,服药1-5d。结果：50例,痊愈38例,显效7例,好转3例,无效2例,治愈率为76%,有效率为96%。结论：丁香柿蒂汤治疗腹部手术后并发顽固性呃逆临床疗效满意。     

Counting fetal hiccups using a fetal movement acceleration measurement recorder

Objective: To clarify the degree of fetal hiccup occurrence by using a fetal movement acceleration measurement recorder.

Methods: A total of 23 pregnant women recorded fetal movements weekly or biweekly between 28 and 39 gestational weeks at home with the recorder. Fetal hiccups were defined as regular sharp oscillations – which occurred at 2–4?second intervals, more than 15 times per minute – on the maternal abdomen. The duration and frequency of the hiccup bouts were counted. The data were classified into an early (28–33 weeks) gestational group and a late (34–39 weeks) group, and compared between the two.

Results: A total of 164 records were obtained, and the total time analyzed amounted to 1035?hours. The mean incidence of a fetal hiccup bout at an early group was 0.19 times per hour, and it decreased to 0.15 at a late group (p?=?0.02). The durations of fetal hiccup bouts were 8.17 and 7.88?minutes at an early and a late group, respectively, with no significant difference (p?=?0.64).

Conclusions: The duration of a fetal hiccup bout did not change after 28 gestational weeks; however, incidence slightly decreased from an early to a late group.     

俞募配穴针刺治疗顽固性呃逆的临床研究

目的?观察俞募配穴不同用穴方案(单穴、配穴)针刺治疗顽固性呃逆的临床疗效。方法?选取我院自2016年5月至2018年5月收治的90例顽固性呃逆患者，采取随机数字表法分为A组、B组及C组，每组各30例，A组取胃俞穴，B组取中脘穴，C组取胃俞募配穴，对3组患者分别进行20次的针刺治疗，对比治疗前后呃逆症状评分、临床疗效、胃动力学指标变化及生活质量评分。结果?A组、B组及C组治疗后与治疗前相比呃逆症状评分均降低（P<0.01），C组治疗后相比于A组、B组治疗后呃逆症状评分降低更加显著（P<0.01）。C组分别与A组、B组相比临床总有效率较高，差异具有统计学意义（P<0.01）。A组、B组及C组治疗后与治疗前相比胃收缩频率、收缩幅度及胃排空率均升高，C组治疗后分别与A组、B组治疗后相比胃收缩频率、收缩幅度及胃排空率升高较为显著，差异具有统计学意义（P<0.05）。C组治疗后分别与A组、B组治疗后相比精神状态、饮食及睡眠评分升高较为显著，差异具有统计学意义（P<0.05）。结论?胃俞穴、中脘穴及胃俞募配穴针刺治疗顽固性呃逆虽均可获得一定的疗效，但胃俞募配穴针刺治疗更能够有效地缓解临床症状及体征，改善胃动力学指标，促进提高生活质量。      

杜元灏教授针刺治疗顽固性呃逆经验

杜元灏教授基于《灵枢》中呃逆的外治法，提出了“平抑胃气，调神止呃”的治疗原则，疗效显著。文章总结杜元灏教授治疗顽固性呃逆经验，并从神经解剖学和神经生理学角度进行了阐述，也借此探讨针灸治疗内脏疾病的思路。