目的:分析万病回春清肺汤治疗支气管扩张伴感染的效果和对肺功能的影响.方法:选择2021年1月-2022年7月湛江市第二中医医院收治的支气管扩张伴感染痰热型患者共80例进行研究,采用随机数字表法分成观察组、对照组,各40例,观察组予以万病回春清肺汤加西医常规治疗,对照组予以西医常规治疗.比较两组总有效率;治疗前后咳嗽、咯痰、胸闷气短及口干等中医症候积分;第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC％、肺活量(VC)等肺功能指标水平;血白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)及降钙素原(PCT)等炎症因子水平.结果:观察组总有效率为95.00％,高于对照组的77.50％(P<0.05).治疗前,两组咳嗽、咯痰、胸闷气短、口干等中医症候积分积分相比,差异均无统计学意义(P>0.05);治疗后,观察组各项中医症候积分均低于对照组(P<0.05).治疗前,两组FEV1、FVC、FEV1/FVC％、VC水平相比,差异均无统计学意义(P>0.05);治疗后,观察组各项肺功能指标水平均高于对照组(P<0.05).治疗前,两组WBC、hs-CRP、PCT相比,差异均无统计学意义(P>0.05);治疗后,观察组各项炎症因子水平均低于对照组(P<0.05).结论:万病回春清肺汤对支气管扩张伴感染疗效理想,能改善患者的临床症状和肺功能,缓解炎症反应,值得采用.

目的:探讨独活寄生合剂对老年膝骨关节炎(KOA)患者全膝关节核磁共振成像积分(WORMS)和血清中软骨代谢标志物的影响,观察独活寄生合剂治疗老年KOA的临床疗效.方法:选取KOA患者80例,随机分成对照组和治疗组,各40例.对照组予以盐酸氨基葡萄糖胶囊口服;治疗组加用独活寄生合剂口服,均治疗8周.观察治疗前后Western Ontario and McMaster Universities(WOMAC)量表评分变化;用WORMS积分进行放射学疗效评估;酶联免疫吸附(ELISA)法检测治疗前后血清中软骨代谢标志物软骨寡聚基质蛋白(COMP)和蛋白聚糖水平.结果:治疗组总有效率(86.84％)明显高于对照组(71.79％)(P＜0.05);与治疗前比较,两组WOMAC评分改善,膝关节WORMS积分减少,COMP和蛋白聚糖含量降低,差异均具有统计学意义(P＜0.05);且治疗组优于对照组(P＜0.05).结论:独活寄生合剂可有效缓解老年性KOA临床症状,改善膝关节影像学损害,降低软骨代谢标志物含量而保护KOA软骨.

Objective To evaluate the efficacy of siege scheme of TCM for acute cerebral infarction bowel and visceral strike (block pattern). Methods Totally 110 patients were randomly divided into TCM siege scheme group (55 cases) and control group (55 cases) by randomized parallel controlled study with foresight and multicenter. The control group was treated with the standardized treatment, and TCM siege scheme group was treated with TCM siege scheme, including mild hypothermia TCM pillow therapy, TCM rectal enema, and other multiple treatments based on the standardized treatment. The Glasgow Coma Scale (GCS), the time of pulling out urine tube and nasal feeding tube, and the number of tracheotomy caused by illness changes of the two groups were compared. Results The baseline data of two groups have good comparability (P>0.05). On 10, 15 d of treatment, the number of lucid people in the TCM siege scheme group was significantly more than that in the control group (P<0.05). Compared with the control group, treatment group had less number of tracheotomy, and shorter time of success pulling out urine tube and nasogastric feeding tube (P<0.05). Conclusion TCM siege scheme can improve the consciousness of ischemic stroke in patients with acute cerebral infarction bowel and visceral strike, reduce complications, shows shorter successful pull urine tube and nasogastric feeding, and provides guarantee conditions for further rehabilitation treatment.

Objective To evaluate the clinical value of MRI examination in the diagnosis and guidance of operation complexity a-nal fistula.Methods Preoperative MRI findings of 32 patients with complex anal fistula confirmed by operation were analyzed ret-rospectively,and compared with the operation results.Results The pre-operation MRI results of 32 patients with complex anal fis-tula revealed that there were 43 fistulas,10 anus week abscesses,58 orificium fistulas,comparing the MRI diagnosis with operation results,coincidence rate of fistula,anus week abscesses,orificium fistula was 100.0%,100.0%,89.3%,respectively.MRI manifes-tations of fistula were that T1 WI manifestations of fistula was or low signal,T2 WI and T2 WI fat suppression sequence manifesta-tions of fistula was high signal,fistula presented a tubular shape obviously as T1 WI enhancement scanning,internal opening repre-sented as intensive dot,complicated embranchment,two type signal of fistula appeared at the same time.MRI manifestations of ab-scesses were that circular,ellipse,irregular form and horseshoe-shape,T1 WI manifestations of abscesses was low signal,there was gas in abscess cavity of some patients;intestinal tube surrounding of some patients were involved by abscess cavity,and up through the edge of bladder to the perineum.Conclusion MRI examination could accurately display the number of complex anal fistula,fis-tula walking and branch,the position of internal opening,correlativity between fistula and surrounding muscles,status of abscess, which could provide guidance for anorectal surgery.

目的：对钆喷酸葡胺对比剂代替碘对比剂行美国GE 64排128层螺旋冠状动脉CT血管造影（CTA）的临床安全性及得到影像诊断图像的效果进行分析。方法选取2013年10月至2014年3月在该院就诊的40例临床高度怀疑冠状动脉粥样硬化性心脏病（冠心病）患者，同时对碘剂过敏，伴甲状腺功能亢进、糖尿病、基础肾功能不全等，均运用钆喷酸葡胺行冠状动脉CTA检查，观察钆喷酸葡胺对比剂的不良反应，并由5位专家对冠状动脉主干、分支进行分析并作出诊断。结果各患者冠状动脉显像都非常清晰，CT值测量准确，由5位专家分别对冠状动脉狭窄程度进行判断，均可达到诊断目的。40例患者运用钆喷酸葡胺剂量为44.1～60.0 mL，平均（48.0±9.7）mL。钆喷酸葡胺按0．6 mL/kg给药，40例患者均未发生过敏反应。结论对碘对比剂有严重反应的患者，用钆喷酸葡胺作对比剂代替行GE 64排128层螺旋冠状动脉CTA非常安全，得到图像效果基本可以达到诊断目的。

Objective To explore the relationship between serum creatinine ( Scr ) , blood urea nitrogen ( BUN) and lung image changes in uremic patients .Methods According to the chest CT ,X-ray and related findings , 256 patients with uremia were divided into 84 cases of uremia ( uremic lung group ) and non-uremic lung 172 cases ( non-uremic lung group ) .The chest CT and X-ray examination ,Scr and BUN levels were observed .Results Uremic lung group had five types of image findings,including alveolar edema (67.86%),pulmonary interstitial edema (16.67%),pulmonary congestion syndrome(8.33%),pleural effusion(4.76%) and pulmonary interstitial fibrosis (2.38%).The Scr[(1 145.6 ±236.4)μmol/L]and BUN [(38.9 ±6.1)mmol/L]levels in uremic lung group were significantly higher than those in the non-uremic lung group[(905.3 ±138.9)μmol/L,(23.8 ±5.6)mmol/L](t=8.128,4.782,all P<0.05).Conclusion The image of uremic lung is mainly pulmonary edema ,and radiological and pathological changes are closely related with Scr and BUN levels .

便秘是临床常见症状,病因复杂繁多,中医学认为便秘与脾胃和肾的关系密切,属大肠传导功能异常所致,便秘易引起多种疾病,如肛肠功能性疾病、胃肠神经功能紊乱、结肠癌、诱发心脑血管意外、妇科疾病等.中医辨证施治,将便秘分为:气秘、热秘、冷秘;分别由气虚、血虚、阴虚所致.在临床,一般患者经过生活调理和药物治疗,便秘症状都会得到改善,因此,一旦患有便秘,要立即找出原因,及时治疗,以免后患.

Objective:Discuss the etiology of constipation;evaluate the accuracy and clinical significance of iconography in diagnosis of constipation based on colonic transit test and defecography.Methods:183 patients who had been diagnosed with constipation underwent colonic transit test.Patients who were considered outlet obstruction were further examined by defecography.Diagnosis was made according to the measurement standard established by Professor Gong Shuigen,and retrospective analysis was performed.Results:A total of 169 patients showed abnormal colonic transit.36 had actual slow-transit constipation;49 had pseudo-slow-transit constipation;and 127 had out-let obstructive constipation,among those 43 were accompanied with slow-transit constipation.Conclusion:Colonic transit test combined with defecography is the optimal,simple and noninvasive diagnostic method for constipation.The static and dynamic observation of colonic transit motility and the imaging manifestation of physiolog-ical process of defecation,especially the combination of both,enable us to further elucidate the etiology of constipation caused by slow colonic transit and functional outlet obstruction,and facilitate clinicians to design the most effective treatment.This method is significantly more advanced than the conventional barium enema technique and fiberocolonoscopy and has become the irreplaceable diagnostic method for constipation.

目的 探讨胆囊切除术后肝外胆管残余结石的原因与防治方法 .方法 对该院1997年6月至2007年5月收治的术前无肝内胆管结石而胆囊切除术后肝外胆管残余结石的55例患者的有关临床资料进行回顾性分析.手术方式:急诊19例(34.5%),择期手术36例(65.5%);OC 20例(36.4%),OC 加作胆道探查30例(54.5%),LC 5例(9.1%);术中造影14例(25.5%),术中未造影41例(74.5%).结果 残余结石在急诊与平诊的各种胆囊切除方式中均可发生,有术前术中缺乏高质量影像学检查或检查有缺陷、局部解剖不清、手术操作困难、术者经验不足或盲目自信以及多因素重叠等原因,但绝大多数可预防.55例残余结石分别经B超,T管造影、ERCP或MRCP检查确诊,并分别经EST拉网取石、胆道镜取石、再次开腹手术治愈.结论 针对残余结石的原因采取相应预防措施可将残余结石发生率降到低位,且根据残余结石具体情况选择适当治疗方式,均能获得良好结果 .

目的回顾分析54例乳房肿块的CT征像及X线软组织摄片征像,比较二者检出阳性率,讨论乳房肿块的诊断和鉴别诊断.方法收集经穿刺活检、手术病理证实的54例乳房肿块的CT片及X线软组织摄影片,比较分析肿块的性质、程度、范围、有无钙化,淋巴结有无转移,着重分析了CT征像.结果 54例乳房肿块良性38例,分别为乳腺增生24例,乳腺囊肿8例,纤维腺瘤6例,恶性肿瘤16例,经手术证实为乳腺癌15例,恶性乳突状瘤1例.CT诊断与病理证实符合率为96.3%,X线软组织摄片诊断与病理证实符合率为70.4%.结论结果表明CT诊断乳房肿块的阳性率明显高于X线软组织摄片,并且CT的空间分辨率和密度分辨率均较X线软组织摄片高.

目的评价HRCT(高分辨体层摄影术,X线计算机,HRCT)检查对间质性肺炎的诊断价值.方法对48例临床疑诊为间质性肺炎的患者,进行胸部HRCT与胸部平片检查,并对照分析.结果 48例临床疑诊为间质性肺炎的患者,经胸部HRCT诊断的有36例,而胸部平片诊断的有10例,二者比较有显著性差异(P<0.05),HRCT确诊的间质性肺炎患者,经临床激素及免疫抑制剂治疗,病情均得到控制或缓解.结论 HRCT对间质性肺炎的诊断率明显高于胸部平片,且HRCT的诊断,对治疗间质性肺炎具有高度的相关性.