Background:Jian Pi Sheng Sui Gao (JPSSG), a Chinese traditional herbal paste, possesses certain efficacy in patients with cancer-related fatigue (CRF); however, its related mechanism remains unclear. Hence, network pharmacology analysis, followed by in vivo and in vitro experiments were conducted in this study with the aim to evaluate the effect of JPSSG on CRF and clarify its potential mechanism.Methods:Network pharmacology analysis was performed. Subsequently, 12 mice were injected with CT26 cells to establish CRF mouse models and randomly divided into a model group (n=6) and JPSSG group (n=6); meanwhile, another 6 normal mice served as a control group. Then, 3.0 g/kg JPSSG was given to mice in JPSSG group for 15 days, while mice in the n control and model groups received phosphate-buffered saline (PBS) of the same volume for 15 days. For the in vitro experiment, CT26 conditioned medium (CM) was established; meanwhile, the mitochondrial damage model was constructed through C2C12 myotubes stimulated with H2O2. C2C12 myotubes were divided into 5 groups: control group (without treatment), CM group, CM + JPSSG group, H2O2 group, and H2O2 + JGSSP group.Results:Network pharmacology analysis identified 87 bioactive compounds and 132 JPSSG-CRF interaction targets. Moreover, according to the Kyoto Encyclopedia of Genes and Genomes enrichment analysis and the subsequent in vivo and in vitro experiments, JPSSG activated adenosine 5'-monophosphate-activated protein kinase-silent-information-regulator factor 2-related-enzyme 1 (AMPK-SIRT1) and hypoxia-inducible factor-1 (HIF-1) signaling pathways during CRF. Moreover, the in vivo experiment showed that JPSSG attenuated CRF in mice, reflected by increased distance traveled, mobile time in open field test, and swimming time in exhaustive swimming test, and decreased absolute rest time and tail suspension test in the JPSSG group (vs. model group). Furthermore, JPSSG upregulated gastrocnemius weight, adenosine triphosphate (ATP), superoxide dismutase (SOD), and the cross-sectional area of the gastrocnemius. With regard to in vitro study, JPSSG elevated cell viability, B-cell lymphoma-2, ATP, SOD, and mitochondrial membrane potential, while it decreased apoptosis rate, cleaved-caspase3, malondialdehyde, and reactive oxygen species in C2C12 myotubes.Conclusions:JPSSG ameliorates CRF via alleviating skeletal myoblast cell apoptosis, oxidative stress, and mitochondrial dysfunction in an AMPK-SIRT1- and HIF-1-dependent manner.

背景:左心疾病相关性肺动脉高压患者是目前最大的肺动脉高压人群,急需新的治疗方式、药物以及针对左心疾病相关性肺动脉高压(Pulmonary Hypertension due to Left Heart Disease,PH-LHD)的临床研究,中医药已显示出一定的治疗潜力和优势.目的:本研究通过收集PH-LHD患者的中医临床证候学资料,以期了解PH-LHD的证素分布规律及与疾病严重程度指标之间的相关性,初步探索PH-LHD中医证型出现形式,明确PH-LHD优势证素及与疾病严重程度相关的证素类型,为中医药临床辨证施治提供依据.方法:采用横断面的研究方法,从2017年6月-2018年12月于北京中医药大学东直门医院住院部收集314例PH-LHD患者,排除数据不全及患者拒绝配合等因素,共收集整理293例PH-LHD患者资料,完成293份中医证候调查表,通过频数、相关性、回归分析等数据统计方法进行研究,从中得出PH-LHD的证素分布规律、证素与心肺功能等与疾病严重程度相关指标之间的相关性、证素之间的内在关系,从而得出PH-LHD常见症状、体征、证素、可能出现的证素组合形式及与疾病严重程度相关的证素.结果:本研究调查PH-LHD临床常见8个证素,按照总的出现频次各证素由高到低排列依次为血瘀>气虚>痰浊>水饮>阴虚>阳虚>气滞>血虚.出现频次最多的四种证素分别是血瘀、气虚、痰浊、水饮,其中血瘀、气虚出现频次明显高于其他证型,这也符合气血理论是心系相关疾病的重要理论基础,痰浊、水饮也是PH-LHD发展过程中出现较多的病理产物;分析提取出54种复合证素类型,其中最常见的8种复合证型出现频次由高到低排列依次为气虚+血瘀>血瘀+痰浊>气虚+血瘀+水饮>气虚+血瘀+痰浊=气虚+阴虚>气虚+阴虚+血瘀+痰浊=血瘀+气滞、阳虚+水饮,其中两证素组合形式构成比最大,两证素组合形式中气虚+血瘀出现频次最多,在三证素中出现频次最高的复合证素是气虚+血瘀+水饮;研究将肺动脉高压分为轻度、中度、重度,其中轻度肺动脉高压患者有222例,中度肺动脉高压患者有55例,重度肺动脉高压患者有16例,轻度肺动脉高压患者证素出现频次排序为血瘀>气虚>痰浊>水饮>阴虚>阳虚>气滞>血虚,中度肺动脉高压患者证素出现频次排序为血瘀>气虚=水饮>阳虚>阴虚=痰浊>血虚,重度肺动脉高压患者证素出现频次排序为血瘀>痰浊>气虚>水饮>阴虚>阳虚>气滞>血虚;PH-LHD中医证素与氨基末端脑钠肽前体(N-terminal pro-brain Natriuretic Peptide,NT-proBNP)、左心室射血分数(Left Ventricular Ejection Fraction,LVEF)及肺动脉收缩压相关性分析得出水饮与疾病严重程度相关,差异均有统计学意义(P<0.05),其中水饮与NT-proBNP及肺动脉收缩压呈正相关,与LVEF呈负相关;通过数据分析进一步说明了以气、血、水功能失调所致"气虚血瘀,痰饮内停"之"心肺痰饮病"即PH-LHD的中医病因病机理论.结论:PH-LHD患者以气虚、血瘀为基本病机,随着疾病进展出现痰浊、水饮病理产物,其中水饮证与NT-proBNP、肺动脉收缩压呈正相关,和LVEF呈负相关,提示水饮与疾病严重程度密切相关,气虚、水饮、血瘀、痰浊集合可以反映PH-LHD患者最主要的疾病特征,气虚血瘀为基本病理基础,痰浊为重要的病理产物,水饮为PH-LHD的最终结果.

阵发性心房颤动发作突发突止,急骤多变,以心中悸动不安、脉结代为主症.取象比类思维是中医学理论的重要思想,据中医学取象比类思维方式,阵发性心房颤动发作的特征与风邪善动、风胜则摇的致病特点类似.笔者团队认为心风是阵发性心房颤动的重要因素,倡导从"心风内动"论治阵发性心房颤动.心风包括实风与虚风,以虚风为主.心主神明,主血脉.心之阴阳亏虚,导致心之气血逆乱,心脏主神明、主血脉的生理功能异常,则虚风内动,发为心悸.此外尚有肝阳上亢化风;脾虚生痰,痰郁日久化热,热极生风;湿属土,木属风,肺脾肾气化失常,水湿痰饮泛滥,而致湿极,则湿反克木,出现震颤等"风"之状;肝郁气滞出现血瘀,气血相搏,形成类似"风"的征象.心体阴阳失衡,兼夹肝风、痰浊、水饮、瘀血、热邪等实邪,激发心风,可诱发心悸.从心风论治阵发性心房颤动,宜重视阴阳平和,强调滋心肾之阴,以平虚风,同时重镇安神,以灭心风.对于夹杂实邪者,在调和阴阳的基础上兼顾实邪,以达临床疗效.

目的:探讨黄连温胆汤加减治疗心悸(室性早搏)痰火扰心证的中医证候改善及预后情况,为临床治疗提供依据.方法:选取我院2018年1月～2020年1月收治的心悸(室性早搏)痰火扰心证患者90例进行研究.按照随机数表法将患者分为两组各45例.对照组给予常规药物治疗,观察组给予黄连温胆汤加减治疗.于治疗一个月后观察比较两组患者的临床疗效,不良反应发生率,并比较治疗前后两组患者中医证候评分及室性早搏次数.结果:观察组总有效率明显高于对照组(86.67％ vs 68.89％),差异有统计学意义(P＜0.05);治疗后,观察组患者中医证候单项评分中,心悸[(1.91±0.32)分]、胸闷[(1.47±0.26)分]、气短[(0.87±0.15)分]、乏力[(0.74±0.17)分]、心烦[(0.33±0.07)分]、口干[(0.62±0.19)分]、失眠[(0.21±0.04)分]、脉象[(0.73±0.17)分]、舌象[(1.07±0.15)分]、纳差[(0.19±0.03)分]均明显低于对照组[(2.76±0.56)分、(2.26±0.51)分、(1.67±0.33)分、(1.68±0.26)分、(0.89±0.23)分、(0.96±0.31)分、(0.38±0.09)分、(1.04±0.29)分、(1.26±0.26)分、(0.33±0.06)分],差异有统计学意义(P＜0.05);观察组患者治疗后室性早搏次数[(1290.00±210.10)次]明显少于对照组[(3112.80±280.20)次],差异有统计学意义(P＜0.05).结论:黄连温胆汤加减治疗心悸(室性早搏)痰火扰心证临床疗效显著,可促进患者中医证候的改善,减少室性早搏次数,安全性高,值得临床推广应用.

室性早搏属中医"心悸"范畴,其发病特点与中医"风证"有相似之处."风为百病之长",外风、内风均可导致室性早搏的发生.外风可由表及里或直中于心而发病,多伴有表证,治疗上应注重风药的使用;内风多由热极生风、痰热生风、肝风内动、血虚生风、阴虚动风等扰动心神而发病,在清热、化痰、平肝、养血、滋阴的基础上,亦当注重祛风熄风."邪之所凑,其气必虚."无论外风、内风致悸,皆应重视补益心气、养心安神,使心神得养,则邪不可干而风自止.

To systematically evaluate the efficacy and safety of Ningxinbao Capsules in treatment of arrhythmia by Meta-analysis. Randomized controlled trial(RCT) or quasi-randomized control trial(Quasi-RCT) on Ningxinbao Capsules treating arrhythmia were obtained by computer-based retrieval in CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Cochrane Library and EMbase as well as manual retrieval, with time limit from database establishment to April 7, 2020. According to the inclusion and exclusion criteria of trials, all RCTs were screened and evaluated. Then the effective data were collected and RevMan 5.3 Meta-analysis software was used for analysis. Thirteen trials were included, involving 1 379 patients in total. Ningxinbao Capsules combined with anti-arrhythmia Western medicine were adopted as the intervention, and the patients in control group were treated with the anti-arrhythmia Western medicine alone. Meta-analysis results showed that as compared to control group, Ningxinbao Capsules combined with anti-arrhythmia Western medicine group was superior in clinical efficacy, dynamic electrocardiogram and average heart rate in patients with bradycardia, with indicated statistically significant differences. Ningxinbao Capsules had fewer adverse reactions and could relieve the toxic and side effects of anti-arrhythmia medicine possibly. The study showed that Ningxinbao Capsules played a role in treatment of arrhythmia and was relatively safe. However, due to the limited quality of the included studies, high-quality clinical trials are needed to verify the conclusions.

目的 系统评价血栓心脉宁治疗冠心病的临床疗效及安全性.方法 计算机检索中国知网(CNKI)、万方数据库(WanFang Date)、维普数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Cochrane Library、EMbase以及手工检索相关资料,全面收集血栓心脉宁治疗冠心病病人的随机对照试验(RCT).所有数据库检索时限均为建库至2019年9月30日.根据纳入和排除标准对文献进行筛选,采用RevMan5.3软件进行Meta分析.结果 本研究共纳入8篇文献,涉及病人751例.Meta分析结果显示:治疗组心绞痛改善总有效率[RR=1.24,95％CI(1.15,1.33),P<0.00001]、心电图改善总有效率[RR=1.24,95％CI(1.10,1.39),P=0.0005]高于对照组,差异均有统计学意义;治疗组与对照组不良反应发生率比较差异无统计学意义[RR=0.77,95％CI(0.36,1.64),P=0.50].证据等级显示:心绞痛改善总有效率及心电图改善总有效率为低级,不良反应为极低级.结论 现有证据表明,血栓心脉宁能够有效提高冠心病心绞痛及心电图改善总有效率,且具有良好的安全性.

在过去20年中,随着治疗手段的不断发展,极大改善了2型糖尿病(T2DM)患者的预后,但心血管疾病(CVD)仍是T2DM患者死亡的主要原因[1-3].越来越多证据表明钠-葡萄糖共转运蛋白2(SGLT2)抑制剂和胰高血糖素样肽1受体激动剂(GLP-1RAs)能显著降低主要不良心血管事件(MACE)的风险[4-11],且SGLT2抑制剂还可以显著降低心力衰竭(心衰,HF)住院和糖尿病肾病(DKD)进展的风险.由此引发了针对T2DM患者治疗策略的重大转变,即由血糖控制到全面降低心血管(CV)风险.2020年8月,美国心脏病学会(ACC)对《2018 ACC关于降低2型糖尿病以及动脉粥样硬化性心血管疾病患者心血管风险的新型疗法专家共识》(以下简称《2018年指南》)[12]进行更新,发布了《2020降低2型糖尿病患者心血管风险新型疗法的专家共识》[13](以下简称《2020年指南》),以指导T2DM患者使用新型药物来降低心血管风险.本文对其内容进行介绍和解读,为我国降低T2DM患者CV风险提供参考.

目的:探讨超声血流向量显像(VFM)技术在原发性高血压左心室肥厚(LVH)诊断中的应用价值.方法:收取42例左室肥厚原发性高血压患者为LVH组,36例左室不肥厚原发性高血压患者为心室正常组,30例健康体检者为对照组.所有受试者均接受常规心动图、VFM检查及双频脉冲多普勒检查,记录常规超声数据、等容收缩期能量耗损(IVC-EL)、等容舒张期能量耗损(IVR-EL)、射血期能量损耗(EP-EL)以及充盈期能量耗损(FP-EL),利用工作特征曲线(ROC)评估VFM技术诊断高血压LVH的价值.结果:LVH组患者的BMI、SBP、DBP、常规心脏超声指标LVMI、左房前后径(LAD)、室间隔厚度(IVSd)、左心室后壁厚度(LVPW)均明显高于对照组(P<0.01).LVH组不同心动周期EL的EP-EL、IVC-EL均高于心室正常组和对照组(P<0.001),但FP-EL低于心室正常组和对照组(P<0.05).ROC结果显示:EP-EL、IVC-EL和FP-EL诊断LVH高血压的AUC分别为0.757、0.732和0.737,95％CI分别为0.652～0.862、0.623～0.842和0.629～0.846.结论:VFM技术的EL参数(包括EP-EL、IVC-EL和FP-EL)有望成为诊断原发性高血压LVH的指标之一.

目的 系统评价通心络胶囊治疗糖尿病心肌病(DCM)的临床疗效.方法 计算机检索PubMed、EMbase、Ovid Cochrane、中国期刊全文数据库(CNKI)、万方数据知识服务平台(WanFang Data)、维普中文期刊数据库(VIP)、中国生物医学文献数据库(CBM)、中国生物文献服务系统、中国博士学位论文全文数据库、中国优秀硕士生学位论文全文数据库,同时手工检索及向药厂索要相关资料,全面收集使用通心络胶囊治疗DCM病人的所有随机对照试验,检索时限均为从建库至2020年1月.由两名评价者独立进行文献筛选、提取资料和风险偏倚评价,然后采用RevMan 5.3软件进行Meta分析,并系统评价各研究结果 .结果 共纳入11项研究,共766例病人,均为非安慰剂随机对照研究,研究质量总体不高.试验组总有效率高于对照组[OR=4.64,95％CI(2.91,7.40),Z=6.43,P<0.00001].心功能方面,疗程4周试验组射血分数[MD=3.99,95％CI(3.39,4.59),Z=13.02,P<0.00001]、左室短轴缩短率[MD=2.92,95％CI(0.83,5.02),Z=2.74,P=0.006]、舒张早期充盈峰值流速[MD=0.14,95％CI(0.09,0.19),Z=5.29,P<0.00001]高于对照组,舒张晚期充盈峰值流速低于对照组[MD=-0.14,95％CI(-0.17,-0.10),Z=6.88,P<0.00001];每次2～4粒服用的试验组二尖瓣舒张早期的血流速度与心房收缩期峰值血流速度的比值(E/A)高于对照组[MD=0.28,95％CI(0.25,0.31),Z=17.53,P<0.00001],每次3粒服用的试验组E/A高于对照组[MD=0.26,95％CI(0.22,0.30),Z=11.48,P<0.00001].心脏结构方面,疗程4周试验组左室舒张末内径[MD=-6.90,95％CI(-8.41,-5.40),Z=8.99,P<0.00001]、左房内径[MD=-2.16,95％CI(-2.79,-1.53),Z=6.73,P<0.00001]、室间隔舒张末厚度[MD=-0.76,95％CI(-1.06,-0.45),Z=4.87,P<0.00001]均低于对照组,每次2～4粒服用的试验组左室后壁舒张末厚度低于对照组[MD=-1.40,95％CI(-1.80,-1.00),Z=6.88,P<0.00001].血液流变学方面,试验组全血黏度[MD=-0.95,95％CI(-1.15,-0.74),Z=9.07,P<0.0001]、血浆黏度[MD=-0.08,95％CI(-0.13,-0.04),Z=3.86,P=0.0001]、纤维蛋白原[MD=-0.26,95％CI(-0.31,-0.22),Z=11.36,P<0.00001]均低于对照组.血糖方面,试验组空腹血糖[MD=-0.92,95％CI(-1.05,-0.78),Z=13.22,P<0.00001]、餐后血糖[MD=-1.52,95％CI(-1.63,-1.42),Z=28.77,P<0.00001]、糖化血红蛋白[MD=-1.15,95％CI(-1.27,-1.03),Z=18.52,P<0.00001]均低于对照组.结论 当前证据表明,在常规治疗基础上加用通心络胶囊能明显改善DCM病人临床症状、心功能、心脏结构、血液流变学及血糖等指标.

综述肥厚型心肌病(HCM)中西医病因病机及治疗方法,提示目前治疗以防治并发症、减轻症状、延缓疾病进展为主,主要治疗方法包括西医内科药物治疗、介入治疗、外科手术治疗、分子水平治疗及中医药治疗方法.近年来基因干预治疗取得了重大进展,为根治肥厚型心肌病提供了方向.

Abstract Purpose: In this experiment, spontaneously hypertensive rats (SHR) were used to further explore the antihypertensive effect of acupuncture twirling reinforcing and reducing manipulation and the central effect mechanism of regulating blood pressure. Methods: 32 male SHR rats were randomly divided into 4 groups: twirling reinforcing manipulation group (RF), twirling reducing manipulation group (RD), electroacupuncture group (EA) (n = 8) and model group (M) (n = 8) and 8 WKY rats were used as blank control group (WKY). Group RD, RF and EA SHR took bilateral Taichong(LR3) point for acupuncture twirling method or electroacupuncture treatment, while WKY and M group did not use any acupuncture manipulation, but only carried out the same grasping and fixation. The differential proteins in cerebellum were screened by proteomic technology, and the key proteins and pathways involved in the pathogenesis of hypertension were selected.Results: RD, RF and EA lowered the blood pressures of the SHRs by varying degrees. The results of Parallel reaction monitoring(PRM) verification showed that among all the differential proteins, 13 differentially expressed proteins (DEPs) were selected for PRM verification. The KEGG annotations of differential proteins are involved in the regulation of lipolysis, autophagy, gap junction, phosphate inositol metabolism, splicing, lysosome, thermogenesis and RNA transport in adipocytes, etc. Conclusion: The results of the current study demonstrated that RD, RF and EA manipulations at the LR3 point reduced blood pressure and that RD was the most effective of the techniques used. Different acupuncture techniques have different pathways for screening and activating cerebellar differential proteins.

胸痹心痛以逐年升高的发病率逐渐成为医疗热点,病因病机复杂,总以阳微阴弦为要.本文基于祖国医学阴阳理论,探讨阳气与胸痹心痛发病的关联,认为五脏阳虚均可致胸痹心痛.并依据阳气与该病的密切联系,认为在治疗胸痹的临床实践中必须重视扶助阳气.

Background: Colorectal cancer (CRC) remains one of the leading contributors to cancer-related mortality and morbidity worldwide. Traditional Chinese medicines have been widely employed to treat various types of cancer in China. This investigation aims to determine the association between Chinese herbal medicine (CHM) therapy and survival outcomes in CRC patients with liver-limited metastases. Methods: A retrospective cohort study was performed among patients with colorectal liver metastases at the First Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangzhou, China. Data from a series of consecutive patients were collected via an electronic medical record system or telephone follow-up. We defined high exposure as a period of CHM therapy lasting more than 6 months. The primary outcome was overall survival. Results: The study included the data of 191 patients from January 2008 to December 2017; 126 patients (65.97%) met the inclusion criteria of high exposure to CHM. Multivariate analyses revealed that high exposure to CHM was associated with better overall survival (hazard ratio = 0.444, 95% confidence interval = [0.213, 0.926], P = .030). The association was further confirmed by a subgroup exploratory analysis. Conclusion: Long-term CHM therapy is correlated with improved survival outcomes in CRC patients with liver-limited metastases.

目的 全面总结八段锦的临床研究现状,为八段锦应用于临床医疗提供循证依据.方法 检索中国知网、万方数据、维普网、中国生物医学文献数据库,以及PubMed,EMbase,Cochrane Library外文数据库,检索时间自建库起至2017年12月31日,搜集所有与八段锦相关的临床研究,严格按照标准进行文献筛选与数据提取,采用SPSS 22.0软件分析基本信息、研究对象、样本量、八段锦练习、结局指标、研究结果等,采用RevMan 5.3软件中的Risk of bias (ROB)工具对纳入的随机对照试验进行方法学质量评价.结果 共纳入文献552篇,其中系统评价33篇(6.0％),随机对照试验379篇(68.6％),非随机对照试验46篇(8.3％),病例对照研究5篇(0.9％),队列研究6篇(1.1％),病例系列报道76篇(13.8％),以及研究方案7篇(1.3％).八段锦应用前10位的疾病依次为糖尿病、慢性阻塞性肺疾病、高血压病、冠心病、中风、颈椎病、高脂血症、腰椎间盘突出症、围绝经期综合征及膝关节骨性关节炎.八段锦的标准多选用国家体育总局2003年整理创编版本,平均每次练习时间为41 min,习练频次多为每天1或2次,每周练习3天以上,平均疗程4个月.93.6％ (510/545)的八段锦临床疗效研究获得了阳性结果,4.6％ (25/545)的研究疗效未明确,1.8％ (10/545)的研究为阴性结果.纳入的研究多为小样本量研究,随机对照试验的方法 学质量一般.尚未发现与八段锦干预有关的严重不良事件报道.结论 八段锦临床研究的数量较多,不同研究之间八段锦的干预措施差异明显,需要进一步规范统一.

Objective To explore the influence factors of abnormal blood pressure fluctuation in elderly patients with hypertension.Methods A total of 1 768 hypertensive patients aged 60 years or older admitted to Dongzhimen Hospital,Beijing University of Chinese Medicine between March 2016 to March 2017 were enrolled.Patients without abnormal blood pressure fluctuation were assigned to control group(n =1 553) and patients with abnormal blood pressure fluctuation were observation group(n =215).Comorbidities and risk factors of abnormal blood pressure fluctuation were analyzed.Results Logistic regression indicated that cerebral hemorrhage (odds ratio =29.37,P =0.01),cerebral infarction(odds ratio =21.35,P =0.01),lacunar infarction(odds ratio =17.44,P =0.01),cervical spondylosis(odds ratio =12.89,P =0.01),neurotic headache(odds ratio =9.32,P =0.03),emotional stress(odds ratio =11.83,P =0.01) and angina attack(odds ratio =6.41,P ＜ 0.01) were influence factors of abnormal blood pressure fluctuation.Conclusion Ischemic stroke,cervical spondylosis and hemorrhagic stroke are associated with abnormal blood pressure fluctuation in the elderly.

目的:观察益气泻肺养血方对心力衰竭合并贫血患者的心衰症状、hs-CRP、TNF-α的影响.方法:按随机数字表法将60例慢性心力衰竭合并贫血患者分为2组,对照组给予规范的西医心衰治疗方案及叶酸、铁剂治疗,治疗组加服益气泻肺养血方.治疗8周后,观察2组患者心电图、hs-CRP、TNF-α变化,评估心衰症状积分.结果:治疗组患者心衰症状积分明显改善,心率、hs-CRP、TNF-α等炎症因子水平明显降低.结论:益气泻肺养血方能改善心力衰竭合并贫血患者心衰症状,降低心率及炎症因子(hs-CRP、TNF-α)水平.

对高等中医药院校的学生而言,临床教学是其从"学院"迈向"医院"的必经之路,"翻转课堂"教学模式颠覆了以往传统的"灌输式"教学模式。应用翻转课堂教学模式对北京中医药大学临床教学的西医内科学课程进行教学改革以评估其教学效果,结果发现,83.78%的学生认为教学效果满意,翻转课堂教学模式不仅锻炼了他们主动学习的积极性和自学能力,还培养了很多非技术能力,并初步显现了良好的教学效果。

1 病例资料 患者,女,84岁.因"阵发性头晕2周,加重1天"于2017年10月23日入院.患者10年前因头晕,就诊于当地医院,测血压150/90mmHg,诊断为高血压,予牛黄降压丸(2丸,qd),患者间断服用,血压维持在150 ~140/100 ~90 mmHg.2016年因阵发性头晕就诊于当地医院门诊,查头颅CT,腔隙性脑梗死,老年性脑改变,未进行处理.1d前患者无明显诱因出现阵发性头晕伴乏力,就诊于社区医院,测血压180/107 mmHg,予丹参酮ⅡA磺酸钠注射液40 mg,ivd,qd,富马酸比索洛尔片5 mg,po,qd,替米沙坦片40 mg,po,qd;症状未减轻.为求进一步诊治,患者于2017年10月23日首次入院治疗.患者冠心病10余年,未服用相关药物.无糖尿病,无高脂血症,无中风,无痛风,无青光眼,无肺结核,无肝炎等传染病史,无外伤、输血史,无手术史;无药物、食物过敏史;无吸烟、饮酒史.患者父母体健,否认家族病史及类似疾病.入院体检:T 36.5℃,P 80次/min,R 19次/min,BP 190/108 mmHg.实验室检查:WBC 7.90×109·L-1,RBC 4.78×1012·L-1,Hb 151.9 g·L-1,Plt 281.2×109·L-1;葡萄糖(GLU)5.01 mmol ·L-1;肌酐(SCr)57.9 μmol·L-1;总蛋白(TP)73.2 g·L-1;白蛋白(Alb)41.3 g·L-1;丙氨酸氨基转移酶(ALT)29 U· L-1.患者入院后停用牛黄降压丸,予丹红注射液40 ml,ivd, qd活血化瘀、通脉舒络;予硝苯地平缓释片10 mg,po,qd降血压.10月24日患者血压160/100 mmHg,10月25日血压142/90 mmHg.10月27日患者阵发性头晕缓解,眠安纳可,神志清,血压150/90 mmHg,律齐.患者胸部CT示:升主动脉增粗,主动脉硬化,左冠状动脉管壁钙化.头部CT示:双侧基底节、右侧侧脑室旁腔隙性梗死.10月27日加用长春西汀注射液(河南润弘制药股份有限公司,批号:1704172)30 mg,加入0.9% 氧化钠注射液500 ml,输液对症治疗,其余药品如常使用.患者次日诉使用该药后当晚失眠,此后连续2d患者均出现失眠.患者自诉频繁醒来,醒后入睡困难,几乎是整夜持续失眠,醒后日间困倦乏力明显,起床时没有熟睡感,对生活有一定影响.停用长春西汀注射液,其余药品仍继续使用,患者失眠症状消失.考虑患者失眠很可能与长春西汀注射液有关,为该药的不良反应.患者中医诊断为眩晕,痰瘀互结证;西医诊断为腔隙性脑梗死;高血压3级,很高危组.10月31日患者血压140/90 mmHg,病情好转出院.

病例:患者,男,74岁.因“发作性喘憋20余年,双下肢水肿3年,加重2个月”于2017年10月23日首次入院.患者入院诊断为心力衰竭.患者于20余年前发热、咳嗽、喘憋伴有喉间痰鸣声重,就诊于外院,诊断为“肺部感染”.予抗生素治疗后体温正常,出现发作性喘憋、胸闷、喉间痰鸣时未行肺功能检查,考虑为“支气管哮喘”,予醋酸地塞米松片0.75 mg qd口服控制发作,服药至今,喘憋控制尚可.患者老年男性,神志清,精神可,发育正常,营养中等,自主体位,查体合作.患者药源性库欣综合征临床表现较为典型:满月脸,面圆而呈暗红色,颧红如妆.