目的:探讨高血压病中医证型的分布规律,为中医临床防治高血压病提供参考依据.方法:选取 2017 年 1 月—2021 年 12 月甘肃中医药大学附属医院医院信息系统中高血压病住院患者 1261 例,对收集的病例资料进行回顾性研究,采用卡方检验分析中医证型在性别、年龄、病程、高血压病分级以及高血压病合并症上的分布规律.结果:高血压病中医证型的分布为痰瘀互结610例(610/1261,48.4％)、肝肾阴虚167例(167/1261,13.2％)、气虚血瘀124例(124/1261,9.8％)、肝阳上亢123例(123/1261,9.8％)、肾气亏虚106例(106/1261,8.4％)、痰湿中阻74例(74/1261,5.9％)、阴虚阳亢57例(57/1261,4.5％).高血压病中医证型在性别分布上的差异具有统计学意义(P＜0.05),男性高血压病患者以痰瘀互结、肝阳上亢为主,女性高血压病患者以痰瘀互结、肝肾阴虚为主;高血压病中医证型在年龄分布上的差异具有统计学意义(P＜0.05),70岁以下的高血压病患者以痰瘀互结、肝阳上亢为主,70 岁以上的高血压病患者以痰瘀互结、肝肾阴虚为主.高血压病中医证型在高血压病合并症分布上的差异具有统计学意义(P＜0.05),且高血压病合并糖尿病、脑卒中、冠状动脉粥样硬化性心脏病(简称冠心病)、心功能不全与高血压肾病的差异有统计学意义(P＜0.005).高血压病中医证型在病程和高血压病分级分布上的差异无统计学意义(P＞0.05).结论:高血压病中医证型的分布以痰瘀互结和肝肾阴虚为主,高血压病中医证型在性别、年龄和高血压病合并症上存在不同的分布规律,中医临床上可以参考本研究结果,精准防治高血压病.

参芪扶正注射液是由党参与黄芪提取而成的中药注射液.作为胃癌的良好辅助治疗药物,参芪扶正注射液的主要作用是益气扶正和增效解毒,能有效改善胃癌患者的机体免疫力和生活质量,减轻放疗、化疗导致的毒副作用,增强治疗效果,还可通过抑制胃癌细胞增殖,促进胃癌细胞凋亡,降低侵袭力以及帮助改善胃癌细胞化疗敏感性等作用机制达到辅助治疗胃癌的作用.本文综述参芪扶正注射液辅助治疗胃癌的临床作用及机制研究现状,为今后胃癌的防治提供参考.

Objective To investigate the occupational injuries status among emergency medical staff in Lanzhou and analyze the related risk factors.Methods From March 2022 to July 2022,the researchers used the cluster random sampling method to select medical staff in emergency departments of 11 hospitals in Lanzhou as the study subjects, designed the occupational injury questionnaire on the template of existing questionnaire and carried out this investigation.Results The overall incidence of sub-health among emergency medical staff in Lanzhou was 75.48%,mainly manifested by poor sleep quality（74.52%）,dizziness, brain distention, and muscle pain（74.04%）;the overall incidence of occupation-related injuries was 76.44%（159/208）,dominated by needle-stick injuries（35.10%） and oral ulcers（29.46%）;the overall incidence of occupation-related diseases was 64.90%（135/208）,mainly being neurasthenia（35.10%） and lumbar cervical spondylosis（22.12%）. By univariate and multivariate logistic regression analysis, working years＞10 years, frequent exposure to radiation such as X-rays, frequent exposure to hazardous chemical substances, and frequent exposure to patients with infectious diseases were the main risk factors for the sub-health status among emergency medical staff（P＜0.05 or P＜0.01）;tertiary hospitals, age＞40 years, and frequent breaking of ampoules or use of sharp instruments were risk factors for occupationally related injuries（P＜0.05 or P＜0.01）;years of work＞10 years, low job satisfaction, frequent exposure to light radiation, and frequent facing to death were risk factors for occupationally related diseases（P＜0.05 or P＜0.01）.Conclusion The ratio of incidence of sub-health, occupational-related injuries, and occupational-related diseases among emergency medical staff in Lanzhou is high, and it is recommended to strengthen the training of medical staff in occupational protection, especially the emergency treatment measures after occupational exposure.

IntroductionHealthcare workers risk of exposure to the influenza virus in their work, is a high-risk group for flu infections. Thus WHO recommends prioritizing flu vaccination for them–an approach adopted by >40 countries and/or regions worldwide.MethodsCross-sectional studies on influenza vaccination rates among healthcare workers were collected from PubMed, EMBASE, CNKI, and CBM databases from inception to February 26, 2023. Influenza vaccination rates and relevant data for multiple logistic regression analysis, such as odds ratios (OR) and 95% confidence intervals (CI), were extracted.ResultsA total of 92 studies comprising 125 vaccination data points from 26 countries were included in the analysis. The meta-analysis revealed that the overall vaccination rate among healthcare workers was 41.7%. Further analysis indicated that the vaccination rate was 46.9% or 35.6% in low income or high income countries. Vaccination rates in the Americas, the Middle East, Oceania, Europe, Asia, and Africa were 67.1, 51.3, 48.7, 42.5, 28.5, and 6.5%, respectively. Influencing factors were age, length of service, education, department, occupation, awareness of the risk of influenza, and/or vaccines.ConclusionThe global influenza vaccination rate among healthcare workers is low, and comprehensive measures are needed to promote influenza vaccination among this population.Systematic review registrationwww.inplysy.com, identifier: 202350051.

目的 调查兰州市三级医院急诊医护人员工作场所暴力的流行病学特征及影响因素,为急诊科开展医护人员工作场所暴力的职业防护提供理论依据.方法 于2022年3-7月,采用整群随机抽样的方法,选取兰州市7家公立三级医院的156名急诊科医护人员作为研究对象,使用已有问卷为模板设计本次工作场所暴力问卷并展开调查.结果 急诊科医护人员中,共有93人在过去一年里遭受过工作场所暴力,总发生率为59.62％.其中以语言暴力为主,发生率为57.05％,躯体暴力和性骚扰的发生率分别为28.85％和7.05％.暴力事件主要发生在抢救室、病房和大厅走廊,以患者及陪员共同施暴为主;施暴原因主要是酗酒或药物滥用(53.76％)、不合理要求被拒(43.01％);医护人员采取的应对方式以忍让回避(63.44％)与耐心解释(62.37％)为主.经单因素及多因素logistic回归分析结果显示,性别、职称、是否参加防暴培训是兰州市急诊医护人员遭受工作场所暴力的独立影响因素(OR=0.452、2.964、2.336,P＜0.05).结论 急诊医护人员遭受工作场所暴力的问题普遍存在,严重影响了医护人员的身心健康,应根据暴力事件的流行病学特征和影响因素积极采取针对性的防范策略.

术后慢性疼痛(chronic postsurgical pain,CPSP)是指患者在手术后2个月以上,仍存在手术相关性疼痛且除外其他病因(如慢性感染、恶性肿瘤复发等)所致疼痛[1]。成人CPSP的发生率为11.5-47.0%,严重疼痛发生率可达2%-10%[2]。即便手术做得很成功，术后患者伤口愈合良好，但仍有部分患者遭受慢性疼痛的折磨，更有甚者疼痛持续多年，严重影响患者的身心健康。西药治疗疼痛疗效显著，但是由止痛药带来的耐药性及不良反应，往往给患者带来新的困扰。中医外治、内服在缓解疼痛方面取得了一定的疗效，但目前尚欠缺大量临床资料研究,因此值得深入研究与推广。

目的 探索肛周脓肿合并糖尿病患者行中医护理对住院时间及血糖指标的影响.方法 选择2018年4月—2019年6月期间60例肛周脓肿合并糖尿病患者为试验对象,选择单双号随机化分组,各30例,观察组采用中医护理,对照组采用常规护理,随后对比两组患者护理后的糖化血红蛋白、空腹血糖、餐后2h血糖、创面愈合时间、住院时间、护理满意度.结果 观察组糖化血红蛋白(5.39±0.53)％、餐后2 h血糖(9.11±1.35)mmol/L、空腹血糖(6.23±0.55)mmol/L优于对照组,差异有统计学意义(P<0.05),创面愈合时间(20.62±2.13)d、住院时间(22.39±2.54)d短于对照组,差异有统计学意义(P<0.05),护理满意度(100.00％)高于对照组,差异有统计学意义(P<0.05).结论 中医护理用于肛周脓肿合并糖尿病患者效果显著,可降低血糖水平,缩短住院时间.

目的 探讨中药熏洗联合微波照射对肛周脓肿术后患者创面愈合效果的影响.方法 选取2018年1—11月福建中医药大学附属人民医院收治的82例肛周脓肿术后患者作为研究对象,随机分为对照组和试验组,每组41例.两组术后均给予常规护理,对照组接受多功能微波治疗仪治疗,试验组在此基础上加用中药熏洗,比较两组创面愈合时间、视觉模拟评分法(VAS)评分及治疗效果.结果 试验组总有效率高于对照组,差异有统计学意义(P<0.05).治疗后,试验组VAS评分低于对照组,创面愈合时间短于对照组,差异均有统计学意义(P<0.01).结论 中药熏洗联合微波照射在肛周脓肿术后患者中的应用效果显著,能够减轻患者的疼痛,缩短创面愈合时间,促进患者康复.

目的 观察混合痔腰麻术后取舒适卧位联合中医护理的临床效果.方法 回顾性分析800例腰麻(椎管内麻醉)下行痔上黏膜环切订合术的住院患者临床资料.根据腰麻术后体位不同分为观察组和对照组,每组400例.对照组术后取去枕平卧位6 h,加常规护理;观察组术后取舒适卧位,加中医护理.比较2组患者护理效果差异.结果 2组患者血压、脉搏、呼吸稳定率、术后48 h头痛、头晕发生率比较差异无统计学意义(P>0.05);术后6 h双下肢活动均恢复正常.观察组患者总舒适度为97.5％,高于对照组的1.3％(P<0.01);观察组患者术后尿潴留发生率为4.0％,低于对照组的16.0％(P<0.01);观察组患者总满意度为98.8％,高于对照组的95.0％(P<0.01).结论 混合痔腰麻术后取舒适卧位联合中医护理有利于提高患者的舒适度及护理满意度,值得临床推广应用.

目的 探讨中药熏洗治疗联合舒适护理在混合痔术后切口疼痛水肿的临床疗效.方法 选取2016年11月～2017年12月我院肛肠二科收治的混合痔术后切口水肿患者70例,按随机数字法分为治疗组和对照组各35例,治疗组给予中药熏洗治疗+舒适护理,对照组给予中药熏洗治疗,两组均以7天为1个疗程,治疗2个疗程后比较两组患者术后切口水肿消退情况.结果 两组患者术后伤口感染、肛缘水肿消退、疼痛消失情况以及创面愈合情况比较,差异均有统计学意义(均P<0.05).两组患者的临床治疗总有效率比较,治疗组达91.43％,对照组为74.28％,差异有统计学意义(P<0.05).结论 中药熏洗联合舒适护理治疗混合痔术后切口水肿的临床效果显著,值得推广应用.

Objective Observe the clinical efficacy of the lithospermum oil on treatment of the postoperative anal fistula and effect on serum TGF-β1,Smad3 level.Methods Ninety anal fistula cases were randomly divided into three groups:the lithospermum oil group (30 patients),and the skin hemorrhoids group(30 patients).The vaseline group (30 patients).The lithospermum oil group were treated with lithospermum oil and the skin hemorrhoids group were treated with the skin hemorrhoids and the vaseline group were treated with vaseline,and observe the curative effect in edema,pain,bleeding on the first day,the seventh day,the fourteenday,the twenty-one day after operation and test the serum TGF-β1and Smad3 levels in the blood separately by ELISA.Results Three groups can relieve postoperative symptom of edema,pain,bleeding.The lithospermum oil group were significant differences in the score of edema,pain and bleeding between the skin hemorrhoids group and vaseline groups (P<0.05).After the treatment,the serum TGF-β1and Smad3 levels of the lithospermum oil group were statistically significant with the skin hemorrhoids group and vaseline groups on the seventh day,the fourteenday,the twenty-one day (P<0.05).After the treatment,the serum Smad3 levels were lower than before in the same group.The results are statistically significant(P<0.05).The serum Smad3 levels were no statistical significance in three groups on the twenty-one day.Conclusion Lithospermum oil have a good curative effect in edema caused by postoperative,and the effect was better than the skin hemorrhoids and vaseline.Lithospermum oil can effectively improve the content of TGF-β1 and reduce the content of Smad3,and promote wound healing.

目的:观察针灸联合中药内服治疗面瘫后遗症的临床疗效.方法:将70例面瘫后遗症患者随机分为两组各35例.对照组采取常规针刺治疗,治疗组在对照组基础上增加柴胡疏肝散合牵正散汤加减内服治疗,6次为1个疗程,3个疗程后参照House-Brackmann面神经功能评价分级系统分别对两组进行疗效评价.结果:治疗组痊愈和率总有效率分别为40.0％与97.7％,优于对照组的15.6％与78.1％,两组比较差异有统计学意义(P＜0.05).结论:柴胡疏肝散合牵正散加减联合常规针刺治疗面瘫后遗症疗效优于单独针刺治疗.

目的:观察中药沐足按摩配合中药内服治疗肾性水肿的护理疗效观察.方法:100例肾性水肿患者,采用随机数字表法分为对照组和观察组,各50例.治疗组采用中药沐足按摩配合中药内服+肾内科常规护理,对照组采用肾内科常规护理.观察治疗14d后水肿的护理疗效.结果:通过14d的疗程,治疗组有效率为96.0％,高于对照组的66.0％,差异有统计学意义(x2=12.74,P＜0.05).两组在使用中未发生不良反应.结论中药沐足按摩配合中药内服能有效缓解肾性水肿.

Objective To observe the clinical efficacy of bloodletting cupping at Dazhui (GV14) plus scraping in treating hordeolum. Method Forty-four patients with hordeolum were randomized into a control group and a treatment group, 22 cases in each group. The control group was intervened by bloodletting cupping at Dazhui, while the treatment group was by bloodletting cupping at Dazhui plus scraping. The size of the infection on eyelid was observed before and after treatment, and the recovery rate was calculated. Result The total effective rate was 81.8% in the control group versus 95.5% in the treatment group, and the total effective rate in the treatment group was higher than that in the control group (P<0.05); the sizes of the eyelid infection were significantly reduced in both groups after treatment (P<0.05), and the reduction in the treatment group was more significant than that in the control group (P<0.05). Conclusion Bloodletting cupping at Dazhui plus scraping can effectively improve the symptoms, reduce infection size, and enhance the clinical efficacy in treating hordeolum.

夏阳教授是天津中医药大学第一附属医院妇科主任医师、教授,善吸取前贤之精华,师古而不泥古,在治疗青春期功能性子宫出血(简称功血)有其独到见解,其辨证施治,用药灵活,每获良效.现将夏老师治疗青春期功血的经验介绍如下.

痤疮是一种毛囊与皮脂腺的慢性炎症,其病情顽固难愈,失治误治可能会留下永久性瘢痕,好发于面、胸、背等富含皮质腺的部位,初起时是小丘疹和脓疱,能挤出粉渣样物,严重时伴有结节、囊肿、疤痕、色素沉着.导师夏阳教授在临床中擅用丹栀逍遥散化裁治疗肝郁血热型痤疮,疗效满意,报道如下.

雾化吸入是用雾化装置将药液分散成细小的雾粒,通过鼻或口吸入,沉积于呼吸道和(或)肺部的给药方法,是呼吸科一项重要治疗手段.通过雾化给药,可以达到缓解支气管痉挛、稀化痰液、防治呼吸道感染等作用,尤其适应于气流受限疾病,如AECOPD和哮喘急性发作.由于它直接作用于靶器官,因此药物起效快、用药量少、局部药物浓度高而全身不良反应少等优点.不足之处是雾化型药物费用较贵,雾化器有动力要求而携带不方便.

目的:观察柴胡疏肝散联合黛力新治疗脑卒中后抑郁症的临床疗效.方法:对脑卒中后抑郁症50例运用柴胡疏肝散合黛力新治疗,连续服药14天为1个疗程,治疗3个疗程后统计疗效.结果:临床痊愈28例,显效19例,好转2例,无效1例,总有效率为94％.结论:柴胡疏肝散联合黛力新治疗脑卒中后抑郁症具有较好的临床疗效.

目的：观察直肠滴入壳聚糖凝胶联合艾灸治疗混合痔术后肛缘水肿的疗效。方法采用随机对照观察，治疗组150例采用直肠滴入壳聚糖凝胶联合艾灸治疗＋术后常规护理，对照组150例采用术后常规护理，观察治疗后第七天、第十四天观察肛缘水肿的疗效。结果治疗组在治愈率和总有效率上均优于对照组（ P＜0．05）。两组在使用中未发生不良反应。结论直肠滴入联合艾灸疗法能有效缓解肛缘水肿。

风邪,或外感或内生,是瘙痒最重要的致病因素,且与湿、热、瘀相兼为病。瘙痒性皮肤病,临证从风辨治,会收到较好疗效。