张善举教授治疗功能性消化不良临证经验

张善举教授从事中医内科临床工作近30年,对消化病的诊治有其独特的见解,选用参苓白术散加味治疗功能性消化不良,疗效甚佳。     

参苓白术散联合西药治疗溃疡性结肠炎的Meta分析

[目的]系统评价参苓白术散联合西药治疗溃疡性结肠炎(UC)的临床疗效。[方法]计算机检索中国知网(1982~2015)、万方(2001~2015)、维普(1989~2015)、读秀(1996~2015)、PUBMED(1991~2015)、PLoS公共医学科学图书馆(1991~2015)、PMC美国国家医学图书馆生命科学期刊(1991~2015)等数据库,收集参苓白术散联合西药治疗UC的随机对照试验(RCT),由2位评价者独立按照纳入与排除标准筛选文献、提取资料和评价质量后,采用RevMan5.3软件进行Meta分析。[结果]共纳入10个文献,包含884例患者。参苓白术散联合西药组在治疗UC的总有效率[OR=3.30,95%CI(2.25,4.82),P0.01]、显效率[OR=2.02,95%CI(1.54,2.65),P0.01]均优于对照组,有效率与对照组相近[OR=1.08,95%CI(0.78,1.50),P=0.64],无效率则低于对照组[OR=0.30,95%CI(0.21,0.44),P0.01]。差异有显著统计学意义。漏斗图分析不对称,表明存在发表性偏倚。[结论]参苓白术散联合西药组治疗UC的疗效优于对照组。     

川芎茶调散加减治疗三叉神经痛42例疗效分析

目的：探讨川芎茶调散加减对三又神经痛的治疗效果，以供参考。方法：选择2009年10月-2012年9月我院三叉神经痛患者84例作为研究对象，根据随机分组。A组接受卡马西平治疗，B组同时接受川芎茶调散加减治疗。连续治疗4周后评价疗效，对比两组患者总有效率的差异性。结果：对比两组总有效率发现，B组明显高于A组，差异具有统计学意义（P〈0．05）。结论：采用川芎茶调散加减辅助治疗三叉神经痛具有一定的优越性，值得推广应用。     

高剂量灵芝孢子粉干预戊四氮致痫模型大鼠海马及皮质区神经细胞Bcl-2、Bax的表达

采用中药灵芝孢子粉低、中、高剂量（150, 300, 450 mg/kg）干预戊四氮致癫痫模型28 d，并设空白对照组。经免疫组织化学染色和TUNEL检测后发现，与模型相比，灵芝孢子粉高剂量组大鼠海马和皮质区神经细胞TUNEL阳性细胞数及Bax阳性细胞数均减少，而Bcl-2阳性表达细胞数增加。Morris水迷宫实验检测结果显示，灵芝孢子粉高剂量组大鼠逃避潜伏期缩短，跨过原平台次数增加。说明高剂量灵芝孢子粉上调癫痫模型大鼠海马和皮质区神经细胞Bcl-2蛋白的表达，抑制Bax免疫反应及癫痫所致的神经细胞凋亡，明显改善其学习记忆功能。     

疏肝化痰消癖散与乳块消片治疗肝郁气滞型乳腺增生症的疗效对比

目的：比较疏肝化痰消癖散[1]与乳块消片[2]治疗肝郁气滞型乳腺增生症的疗效。方法随机选取该院2012年9月—2014年10月收治的肝郁气滞型乳腺增生症[3]患者80例为研究对象,随机分为治疗组和对照组两组,治疗组采用疏肝化痰消癖散进行治疗,对照组采用乳块消片进行治疗。观察两组患者的病情好转情况,统计治愈率和总有效率。结果经过统计分析后,治疗组采用疏肝化痰消癖散进行治疗的总有效率为80%,对照组采用乳块消片进行治疗的总有效率为70%,治疗组总体有效率高于治疗组的10.0%。两组之间的差异有统计学意义(P＜0.05)。两组患者在治疗期间都没有发生严重不良反应,主要是轻微的消化道反应,患者可以忍受。结论治疗组的治愈率、总有效率均明显高于对照组(P＜0.05)。因此,疏肝化痰消癖散治疗乳腺增生的临床疗效明显,同时病情不易复发,不良反应小,适用于乳腺增生患者的临床治疗。     

大黄贴敷联合复方聚乙二醇电解质散口服对便秘患者肠道准备给药时机的影响

目的探讨大黄贴敷神阙穴和天枢穴联合口服复方聚乙二醇电解质散(PGEP)在便秘患者肠道准备中的给药时机。方法选择行结肠镜检查的便秘患者300例,分3组,各100例。A组检查前1天晚上9点,行中药贴敷神阙穴和天枢穴,检查当天早上5~7点服完PGEP 139.12 g(2 000 ml);B组检查前1天晚上9点行中药贴敷神阙穴和天枢,检查当天上午10~12点服完相同剂量的PGEP;C组检查当天早上5点行中药贴敷神阙穴和天枢穴,早上5~7点服完相同剂量的PGEP。服药后4 h行结肠镜检查。应用Boston肠道准备量表(BBPS)评分,并对肠腔内气泡进行评分,比较3组患者肠道准备有效性、耐受性及安全性。结果 A组的肠镜检查时间(7.25±0.60)min明显短于B组(9.10±0.80)min和C组(10.50±0.55)min;A组的BBPS评分(8.50±0.35)分明显高于B组(7.35±1.25)分和C组(6.65±1.30)分;A组的肠腔内气泡评分(0.25±0.15)分明显低于B组(0.75±0.65)分和C组(0.55±0.50)分;A组肠道准备接受率、再次肠道准备接受率(96.00%、93.00%)明显高于B组(85.00%、70.00%)和C组(90.00%、88.00%);A组的总体不良反应评分(1.45±0.04)分明显低于B组(1.75±0.55)分和C组(1.60±0.25)分。差异均有统计学意义(P0.05)。结论检查前1天晚上9点大黄穴位贴敷联合检查当天早上5~7点口服PGEP对便秘患者行结肠镜检查肠道准备效果好。     

喘可治注射液联合布地奈德福莫特罗治疗慢性阻塞性肺疾病的疗效观察

摘 要 目的： 观察喘可治注射液联合布地奈德福莫特罗治疗慢性阻塞性肺疾病(COPD) 的疗效。方法: 120例COPD患者随机分为2组,观察组予布地奈德福莫特罗吸入同时肌注喘可治注射液,对照组单纯给予布地奈德福莫特罗吸入。治疗28 d,比较两组FEV₁%预计值、FEV₁ /FVC、6 min 步行距离(6MWD)等肺功能指标变化和急性加重次数,同时观察治疗期间两组药物不良反应的发生情况。结果: 治疗后2组肺功能和 6 MWD均较前改善;观察组比对照组FEV1%预计值改善更明显[（59.7±12.1) %和(49.8±11.3)%,P<0.05],至少有1次急性加重的患者数明显减少( 35%和62%,P＜0.01) ,并且两组的药品不良反应发生率差异无统计学意义。结论:喘可治注射液联合布地奈德福莫特罗比单用布地奈德福莫特罗能更好地改善COPD患者的肺功能,减少急性加重次数,不会增加药品的不良反应发生率。     

Efficacy of salbutamol via Easyhaler unaffected by low inspiratory flow

The fine particle dose delivered via dry powder inhalers (DPIs) is often affected by the inspiratory flow rate generated during inhalation. This has clinical implications, since the fine particle dose determines the amount of drug reaching the lungs. With Easyhaler DPI the fine particle dose remains relatively constant over the range of inspiratory flow rates from 30-60 l min(-1). The aim of this study was to confirm that clinical efficacy is maintained even at low flow rates by comparing the bronchodilating effect of salbutamol (100 microg) delivered via Easyhaler at a target inspiratory flow of 30 l min(-1) with the same dose of salbutamol via pressurised metered-dose inhaler (pMDI) plus spacer. This was a double-blind, randomized, cross-over study with double-dummy technique. Twenty-one paediatric and adult asthmatic patients completed the study, which was conducted over 2 study days. The main outcome parameter was forced expiratory volume in 1 sec (FEV1). The patients were trained to generate a low peak inspiratory flow rate (PIFR) of 30 l min(-1), and the actual PIFR through Easyhaler was recorded. The average PIFR through Easyhaler was 28.7 l min(-1). The difference in the maximum value of FEV1 (FEV1max) between the treatments after drug inhalation was 0.01 l. The mean of FEV1max was 2.67 l after pMDI plus spacer compared to 2.69 l after Easyhaler. Improvements in FEV1 were clinically significant. No significant differences between treatments were found. A reasonably low inspiratory flow rate through Easyhaler produces an equivalent improvement in lung function to a correctly used pMDI plus spacer. Hence, Easyhaler can be used with confidence in patients who may have difficulty in generating a high inspiratory flow rate, such as children and the elderly.     

中西医结合治疗消化性溃疡的疗效观察

目的观察自拟清胃散联合泮托拉唑、克拉霉素和铝碳酸镁片治疗消化性溃疡的临床疗效。方法 108例患者随机分为两组,对照组给予西药泮托拉唑、克拉霉素和铝碳酸镁片治疗。治疗组在对照组治疗基础上加用清胃散治疗,观察两组的临床疗效和复发情况。结果治疗组总有效率与对照组比较无显著性差异(P0.05);治疗组2年后复发率明显低于对照组(P0.05)。结论自拟清胃散联合泮托拉唑、克拉霉素和铝碳酸镁片治疗消化性溃疡,疗效与单用西药治疗无显著性差异,但2年后复发率明显优于对照组。     

Finally,after 56 years of type 1 diabetes: a regimen that works

Prior to the availability of degludec and regular human insulin inhalation powder in the type 1 diabetic patient glycemic control with subcutaneous insulin injections was difficult to obtain due to nocturnal, pre-prandial and often severe hypoglycemia as well as post-prandial hyperglycemia and hypoglycemia due to ‘stacking’ of insulin. A 62-year-old female with type 1 diabetes for 56 years who could not be controlled with continuous subcutaneous insulin aspart infusion obtained glycemic control without significant hypoglycemia or increased post-prandial glycemic excursions utilizing degludec insulin for basal needs and technosphere before meals and between meals if needed. The availability of degludec and technosphere insulin improved the management of brittle type 1 diabetes.