临床营养有肠内营养和肠外营养两种.其中胃肠管喂养肠内营养被认为是一种标准的治疗方法.肠内营养因其保持肠黏膜完整,并发症少,技术要求低,价格低廉等优点而被广泛应用.作为ICU患者的一种治疗方法,肠内营养越来越受到人们的重视,尤其是危重患者,由于摄入食物不足,消化道黏膜萎缩,肠蠕动减弱,患者营养状况降低,抵抗力降低,病程延长.在肠内营养支持过程中,采取有效的护理措施,取得了满意的效果.因此,对于ICU危重患者肠内营养的护理发展情况,非常具有研究的必要.

三仁汤始载于清代吴鞠通的《温病条辨》,是治疗湿温病的经典方剂,原方由8味中药组成,其配伍具有分消走泄的特点,湿热之邪从上、中、下三焦驱除;分消走泄法即疏通气机,清泄湿热,使三焦湿热逐步清除的一种治疗方法,“分消”即分开消除,给湿邪以不同出径,导湿热邪浊排除体外,“走泄”即外泄、外透,舒展气机,则气通湿除,祛邪外达.由此可见,三仁汤作为祛湿剂,将“分消走泄”作为立方依据,在治疗内湿兼有邪热证方面疗效显著,临床应用范围也相当广泛.查阅近10年资料,依据三焦辨证理论,概述三仁汤的方证理论和临床应用进展,阐述其在上、中、下三焦疾病应用中的疗效及可能作用机制,为有效开发利用三仁汤提供理论依据.新型冠状病毒肺炎(COVID-19)席卷全球,寻求有效的防治方法是医学界面临的巨大挑战,对于COVID-19,尽管病因属“疫戾”之气,但从致病特点来看,众多医家虽有或“寒”或“热”或“毒”不同见解,但均认同“湿”的临床特点,具有“湿邪”属性的COVID-19,由于湿邪黏腻,“在一经不移”,病势缠绵,迁延难愈,除发热、咳嗽等主证外,还突出表现为食少纳呆、脘腹胀满、大便溏泻等湿阻中焦的症状特点.三仁汤作为治疗湿温病的经典方剂在新型冠状病毒肺炎防治的应用前景值得探索.

目的:观察冬病夏治穴位贴敷疗法治疗小儿反复呼吸道感染的临床疗效.方法:将280例反复呼吸道感染患儿随机分为治疗组和对照组,脱落后,治疗组为121例,对照组为122例.2组在每年的三伏季节应用冬病夏治穴位贴敷疗法治疗,治疗组采用中药贴敷,对照组采用安慰剂贴敷.2组患儿均连续贴敷3年,从第1年贴敷完成后开始每3个月随访1次,共随访2年.结果:治疗组第2、3年末总有效率分别为71.07％ (86/121)、91.74％(111/121),均高于对照组的21.31％(26/122)、54.10％(66/122),2组比较,差异均有统计学意义(P＜0.05).治疗组第2、3年末中医证候疗效总有效率分别为29.75％(36/121)、61.98％(75/121),高于对照组的10.66％(13/122)、23.77％(29/122),2组比较,差异均有统计学意义(P＜0.05).治疗组第2、3年末反复呼吸道感染每年发病次数、病程、病种及中医证候积分均优于对照组,2组比较,差异均有统计学意义(P＜0.05).结论:应用冬病夏治穴位贴敷疗法治疗小儿反复呼吸道感染具有一定的临床疗效,值得临床推广.

术后胃肠功能障碍 (postoperative gastrointestinal disorder, PGD)是胃肠动力出现障碍的一种以非机械性梗阻为特征、胃肠排空障碍为主要表现的胃肠动力紊乱综合征.胃肠神经功能平衡失调是其机制之一 , 胃肠电活动减弱 , 平滑肌细胞收缩受到抑制 , 胃肠平滑肌处于舒张的相对静止状态 , 进而产生腹胀、肠鸣音减弱或排便困难等 , 可进一步发展为早期术后肠梗阻[1].

目的:探讨在胆囊结石伴有胆总管结石患者治疗中应用微创手术的临床疗效.方法:2016年5月-2018年5月收治胆囊结石合并胆总管结石患者100例,随机数字表法分为两组各50例.开腹组实施开腹手术治疗,微创组实施微创手术治疗.比较两组患者住院时间、排气时间、手术时间以及并发症情况.结果:开腹组患者手术时间、住院时间、排气时间、下床时间及术中出血量均高于微创组,差异有统计学意义(P<0.05).微创组并发症发生率低于开腹组,差异有统计学意义(P<0.05).结论:应用微创手术治疗胆囊结石合并胆总管结石,能够缩短住院时间,降低并发症发生率,安全性高,治疗效果显著,值得在临床中广泛应用.

咳嗽变异性哮喘(CVA)在我国儿童慢性咳嗽病因中居首位,其病理改变与典型哮喘相似,且发展为典型哮喘的可能性大.CVA主要由气道炎症而发病,此种气道炎症与嗜酸粒细胞有密切关系.呼出气一氧化氮(FeNO)作为气道炎症的生物标志物,其检测气道炎症的功能在CVA的诊疗中具有广阔的应用前景.虽然FeNO在CVA患儿诊断、鉴别诊断及疗效评估等方面均具有一定的临床意义,但其正常浓度范围及在各个方面的参考值仍需进一步研究.

Objective Through observation the law of skin temperature changes in the acupoints, including heart-related acupoints and heart-irrelevant acupoints of rats in the normal myocardial state, myocardial ischemia injury state, and the state with low frequency or high frequency electro-acupuncture (EA) intervention, we try to explore the correlation of body function and the related acupoints.Methods 50 male Wistar rats were randomly divided into the control group, sham-operation group, the model group, the low-frequency EA group and high-frequency EA group. Both therapeutic groups were applied needle to "Neiguan" after successfully producing the model of rats with myocardial ischemia. Each group contained 10 rats. After three days of acupuncture treatment, we detected the changes of electrocardiogram, and test the skin temperature by infrared thermal imaging technology around the area of "Neiguan", "Zusanli", "Yanglingquan".Results Compared with the normal control group, the skin temperatures of bilateral Neiguan, Zusanli were significantly decreased in rats with myocardial ischemia injury (P<0.01,P<0.05). Compared with the model group, the skin temperatures of bilateral Neiguan were markedly increased after low frequency or high frequency electro-acupuncture treatment (P<0.05,P<0.01).Conclusion When the myocardial is in different state, there are some features of the skin temperature changes around the heart-related acupoints, especially in Neiguan, following that is Zusanli.

This paper systematically analyzed the response of different acupoints in the same meridian when the bodv in diff~nt conditions including the normal physiological state,the pathological state of disease damage and acupuncture interwention with low frequency,and compared the differences of acupuncture on different acupoints in the same meridian on the regulatory effects on the related viscera function.It finds that there are some differences of acupuncture on different acupoints in the same meridian on the response and regulatory effects on the related viscera function when the body in different conditions.

Objective To observe over-time changes in rat blood flow in the skins of related meridian points during physiological status, the pathological state of ischemic myocardial injury and low or high frequency electroacupuncture intervention and explore the post effect of different frequency electroacupuncture on related meridian points after treating ischemic myocardial injury. Method Fifty male Wister rats were randomized into five groups: blank control, sham operation, model, low frequency electroacupuncture (meridian point A) and high frequency electroacupuncture (meridian point B), 10 rats each. Blood flow in the skins of bilateral points Neiguan (PC6), Ximen (PC4) and Tianquan (PC2), and non-meridian and non-acupoint control points was measured by laser speckle contrast imaging in every group immediately and at 30 and 60 min after the end of three treatments. Statistical analysis was made. Result Blood flow in the skins of bilateral points Neiguan, Ximen and Tianquan was significantly lower in the blank control group than in the model group (P<0.01,P<0.05). Blood flow in the skin of every acupoint increased in varing degrees after low or high frequency electroacupuncture treatment. Blood flow in bilateral points Neiguan, Ximen and Tianquan regions in meridian point group A was closer to that in the blank control group immediately after treatment. Blood flow in three left-side and three right-side acupoint regions in meridian point group B was closer to that in the blank control group at 30 and 60 min, respectively, after treatment. Conclusion The immediate effect of low frequency electroacupuncture on blood flow in acupoint regions is better than high frequency electroacupuncture during intervention in ischemic myocardial injury. The post effect of high frequency electroacupuncture on blood flow in acupoint regions is better than low frequency electroacupuncture during intervention in ischemic myocardial injury.

目的 通过观察不同频率电针治疗心肌缺血大鼠后不同时间相关经脉穴位“内关”“郄门”“天泉”穴皮肤温度的变化情况,探寻针刺治疗心肌缺血损伤后其相关经脉穴位反映的后效应.方法 雄性Wistar大鼠随机分为空白对照组、假手术组、心肌缺血损伤组(简称模型组)、经穴低频电针组(简称经穴A组)和经穴高频电针组(简称经穴B组).经穴A组、经穴B组均在成功制备模型的基础上给予电针治疗.于第3天电针治疗后,检测各组大鼠心电图,记录经穴即刻、30 min、60 min红外热像图并进行数据测量和分析.结果 心肌缺血损伤时,相关经脉穴位皮肤温度均升高;电针治疗后,各穴区温度不同程度下降,近端“天泉”“郄穴”最接近正常态相同穴区温度.电针治疗结束即刻,经穴A组双侧“内关”、双侧“郄门”、左侧“天泉”体表温度较经穴B组更接近空白对照组;电针治疗结束30 min时,经穴B组双侧“内关”“郄门”更接近空白对照组;电针治疗结束60 min时,经穴B组双侧“内关”、右侧“郄门”、右侧“天泉”更接近空白对照组.结论 低频电针或高频电针治疗后,大鼠心包经经脉线上穴区温度会下降,低频电针起效快,持续时间短,高频电针起效慢,后效应持续时间长.

目的:观察泰山磐石散合寿胎丸治疗脾肾两虚型先兆流产的临床疗效.方法:搜集本院门诊收治的60例脾肾两虚型先兆流产患者,将其随机分为治疗组和对照组各30例,治疗组采用中西医结合的方法进行治疗,对照组用黄体酮治疗.治疗2周后对患者疗效进行评价.结果:治疗组治愈率为76.7％,总有效率为93.3％;对照组治愈率为43.3％,总有效率为63.3％.两组比较差异均有统计学意义(P＜0.05).结论:泰山磐石散合寿胎丸结合西药黄体酮适用于脾肾两虚型先兆流产者,较单纯黄体酮治疗疗效更好.

Objective To evaluate the effects of acupuncture with different stimulation intensity at Sanyinjiao (SP6) on uterine contraction and expression of endocrine-related molecular receptor gene in rats with dysmenorrhea of cold coagulation pattern and to explore whether there is association between“deqi ( qi arrival)” and stimulus intensity. Methods Diestrus female rats were randomly divided into 4 groups, in-cluding saline control group, model control group, deqi group ( with strong stimulus) and No deqi group ( with weak stimulus) . The levels of uterine contraction was recorded during 20 mins acupuncture treat- ment. The expression of PGF2α mRNA was measured. Results Compared with the model control group, the uterine contraction wave number and uterine activity were significantly reduced in deqi group. The ex-pressions of PGF2αmRNA in both deqi and No deqi group were also reduced compared with model group. Conclusion Our finding indicates that using thick needles, deep insertion with hand-manipulation seems more effective and could achieve desired level of “deqi” in dysmenorrhea rats.

目的:探讨产后恶露不绝的主要病因及治疗方法.方法:对40例产后恶露不绝患者采用活血化瘀止血法治疗,并进行疗效观察.结果:用活血化瘀止血法治疗产后恶露不绝有效率为90％.结论:血瘀是导致产后恶露不绝的主要病因,运用活血化瘀止血法治疗产后恶露不绝效果显著.

Objective To observe the effect of needling on the structure,function and level of nitric oxide (NO)of the liver in rats with simulated weightlessness,so as to explore the protective mechanism of acu-puncture on liver injury.Methods Twenty male clean grade Wistar rats were randomly divided into nor-mal group,model group,pretreatment group and treatment group(each n =5).The rats of normal group&nbsp;received no treatment,and those of other three groups were tail -suspended for 4 weeks to establish weightlessness model.Electroacupuncture at the points of Shenshu (BL23),Pishu (BL20)and Sanyin-jiao (SP60)once daily for 30 min was applied one week ahead of tail-suspension in pre-treatment group, while in treatment group the needling treatment applied at the same three points once every other day for 14 d was carried out at the day when the rats was tail -suspended.The changes of hepatic histological structure were observed,and the activity of alanine aminotransferase(ALT)in serum and the content of NO in liver were measured.Results The hepatic cell degeneration were observed around the central vein in model group;the degree of degeneration relieved in both electroacupuncture treatment groups.Further-more,the curative effect of the pre-treatment group was better than the treatment group.Compared with normal group,the activity of ALT in serum and the content of NO in liver in model group increased signif-icantly (P <0.05,P <0.01).Compared with model group,the activity of ALT in serum and the con-tent of NO in liver in the pre-treatment group significantly reduced(P <0.05),however,those in treat-ment group had no obvious difference.Compared with pre-treatment group,the activity of ALT tended to increase and the content of NO increased significantly(P <0.01)in the acupuncture group.Conclusion The effects of relieving hepatic injury and dysfunction induced by weightlessness,which potentially was related to the content of NO,in the pre-treatment group were superior to those in the treatment group.

曹保利教授采用中药人工周期疗法治疗腹腔镜电凝止血术后卵巢储备功能下降,疗效显著.

卵巢早衰(premature ocarina failure,POF)是指女性青春期发育后到40岁前各种原因导致的以卵巢功能衰竭、卵巢萎缩、体内低雌激素(E2＜ 25 ng/L)以及高血清促性腺激素(FSH ＞40 U/L)为特征的一类疾病[1].发病率为1％～3.8％,占继发性闭经原因的2％ ～ 10％ [2～3],现将该病的中西医结合研究进展综述如下.