目的:总结重症医学科多重耐药菌(MDRO)肺部感染患者的中医证候要素、证型与病原学相关资料,分析两者联系.方法:临床分析2013年5月至2015年12月广州市番禺区中心医院及广州市番禺区中医院重症医学科就诊的MDRO肺部感染患者,采用描述性统计学方法,计算证候、症状的频数、构成比;总结分析其临床特征、病原学资料和中医辨证分型的异同.结果:纳入研究患者141例,分析145株多重耐药菌,在重症医学科肺部感染多重耐药菌分布中革兰氏阴性菌明显占优势,约占总耐药菌的77.93％,排前4位的依然是铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌及肺炎克雷白菌,共占革兰氏阴性菌的70.80％.革兰氏阳性菌只占22.07％,以金黄色葡萄球菌、表皮葡萄球菌为主.中医证型分析中实证占80.00％,而痰热壅肺证比例尤为突出,占38.62％;虚证占20.00％,其中以气阴两虚证为主,占15.17％.革兰氏阴性菌主要表现为痰热壅肺、气阴两虚、风热犯肺、肺胃热盛证,而革兰氏阳性菌以肺胃热盛、痰热壅肺为主要证型;铜绿假单胞菌感染多见痰热壅肺证(51.72％);大肠埃希菌感染以痰热壅肺证为主(35.29％);鲍曼不动杆菌感染主要以气阴两虚证为主(33.33％);肺炎克雷白菌感染则以痰热壅肺证(37.50％)及肺胃热盛证(31.25％)为主;耐药金葡菌感染以痰热壅肺证(28.57％)及肺胃热盛证(28.57％)为主.结论:多重耐药菌肺部感染的中医证型仍以实证为主,痰热壅肺证是多重耐药菌的主要中医证候,虚证以气阴两虚为主,亦不可忽视.ICU肺部感染多重耐药菌与中医辨证之间存在一定程度的交叉相关性,在治疗中要重视清热化痰及益气养阴药物和方法的运用.

目的:观察“肺感2方”治疗多重耐药菌(multi-drug resistant organisms,MDRO)肺部感染的临床疗效.方法:67例MDRO肺部感染患者随机分为观察组34例和对照组33例.对照组根据多重耐药细菌药敏结果选择抗生素治疗及对症支持治疗,观察组在对照组基础上给予“肺感2方”,并观察疗效及不良反应,2周为1个疗程.结果:治疗后2周观察组及对照组在急性生理与慢性健康评分(acute physiology and chronic health evaluation,APACHEⅡ评分)、降钙素原(procalcitonin,PCT)、C反应蛋白(C reactive protein,CRP)及氧和指数均有改善,观察组APACHEⅡ评分、PCT及氧合指数分别为(11.82+7.19)分、(0.49±0.34) μg·L-1、(331.23±35.25),对照组APACHEⅡ评分、PCT及氧合指数分别为(15.31±6.76)分、(0.86±0.62) μg·L-1、(312.53±20.25),两组比较,差异均有统计学意义(P＜0.05).两组治疗后CRP均较治疗前明显改善(P＜0.05),但两组治疗后比较,差异无统计学意义(P＞0.05).观察组患者细菌清除率为77.78％,对照组为52.94％,两组比较,差异有统计学意义(P＜0.05).对照组有效率为69.70％,观察组为91.18％,两组比较,差异有统计学意义(P＜0.05).两组不良反应发生率比较,差异无统计学意义(P＞0.05).结论:“肺感2方”治疗多重耐药菌肺部感染临床疗效显著.

Objective To observe the effects of Guizhi Fuling Capsule in the treatment of patients with carotid atherosclerosis (CAS). Methods One hundred and thirty-eight CAS patients with carotid intima-media thickening and / or plaque formation confirmed by ultrasonic from March 2011 to June 2012 were involved in this study. The patients were randomly divided into three groups: the treatment group (50 cases, treated with Guizhi Fuling Capsule 3 times daily, 4 granules for each time), the western medicine control group (the control group 1, 46 cases, treated with aspirin enteric-coated tablets 100 mg, once daily), and the Chinese medicine control group (the control group 2, 42 cases, treated with compound Danshen Dripping Pill 3 times daily, 10 pills for each time). All groups were treated for 6 months. The concentration of serum lipids, plasma endothelin (ET-1) and nitric oxide (NO), the changes of Platelet CD41, CD63, CD62P, the changes of bilateral carotid artery intima-media thickness (IMT), plaque morphology before treatment and 6 months after treatment were detected respectively. Results ① No significant difference was found in serum lipids, ET, NO concentration between the three groups before treatment and after treatment (P>0.05). ② CD41, CD63, CD62P levels in the treatment group after treatment were significantly lower than those before treatment (P<0.05), while no significant difference were found in both control group 1 and control group 2 (P>0.05). ③ IMT, unstable plaque and plaque area in the treatment group were significantly better than those in the control group 1 and control group 2 (P<0.05). ④No serious adverse reactions were found in the treatment group group. Conclusion Guizhi Fuling Capsule could reduce the number of unstable plaque in the carotid artery and its area, decrease IMT, and improve endothelial function and anti-platelet activity in patients with CAS.

Objective To study the mechanism of using Chinese medicine tarragon soup to prevent and cure pregnancy induced hypertension syndrome(PIM). Methods Analyze and review the occurrence of pregnancy induced hypertension syndrome(PIH) in 116 cases of pregnant women taking tarragon soup and compare the results with those of ordinary pregnant women. Results No serious pregnancy induced hypertension syndrome(PIH) occurs in 116 cases of pregnant women taking tarragon soup while the occurrence rate of non-serious PIH stands higher than ordinary pregnant women. Non-serous PIH occurs after the whole term of gestation. Conclusions Taking tarragon soup may retard the occurrence and lower the degree of pregnancy induced hypertension syndrome(PIH).

近几年来,笔者采用中药治疗功能性消化不良56例,取得满意疗效,报告如下. 1临床资料 共76例中,男36例,女40例,年龄18～70岁.随机分为治疗组56例,对照组20例.

笔者自2000年以来,运用刺五加注射液配合激光血管内照射治疗椎基动脉供血不足性眩晕,取得满意疗效,现报道如下:

近年来笔者采用中西医结合方法治疗泌尿系结石64例,疗效较好,现报道如下.