目的:探究中医升阳顾脾法联合常规西药治疗在神经根型颈椎病(CSR)患者治疗中的应用价值.方法:选取2018年1月-2020年1月厦门市中医院收治的156例CSR患者作为研究对象,根据随机数字表法分为对照组(n=78)、观察组(n=78).对照组采用常规西药治疗,观察组给予中医升阳顾脾法联合常规治疗.对比两组临床效果、治疗前后中医症候评分、血流动力学、颈椎功能缺损程度、疼痛程度、生活质量及不良反应发生情况.结果:观察组总有效率96.15％(75/78),显著高于对照组的84.62％(66/78)(P<0.05);治疗4周后,观察组中医症候积分低于对照组(P<0.05);治疗4周后,两组TMFV、PSV高于治疗前,RI、PI低于治疗前,且观察组TMFV、PSV高于对照组,RI、PI低于对照组(P<0.05);观察组不良反应总发生率7.69％(6/78),与对照组的12.82％(10/78)比较,差异无统计学意义(P>0.05).结论:采用中医升阳顾脾法辅助常规西药治疗CSR患者效果确切,能改善机体血液微循环,降低颈椎功能损伤程度,减轻症状及患者疼痛,提高患者生活质量,且安全性较高.

目的:比较侧卧位手法与手牵足蹬法对不同肩关节前脱位的疗效.方法:选取2016年3月-2018年12月于笔者所在医院急诊外科就诊的80例肩关节前脱位患者,按照不同的肩关节前脱位类型将其分为A1、A2、B1、B2组,每组20例.其中A1、A2组为单纯性肩关节前脱位患者,B1、B2组为肩关节前脱位合并肱骨大结节撕脱骨折患者.A1组采用侧卧位手法复位,A2组采用手牵足蹬法复位;B1组采用手牵足蹬法复位,B2组采用侧卧位手法复位.分别比较A1、A2组及B1、B2的疗效.结果:A1组成功率显著高于A2组,差异有统计学意义(P<0.05).B1组成功率显著高于B2组,差异有统计学意义(P<0.05).结论:单纯性肩关节前脱位采用侧卧位手法复位成功率更高,而对于肩关节前脱位合并肱骨大结节撕脱骨折采用手牵足蹬法复位成功率更高.

目的:分析中医辨证治疗在胁痛患者的临床效果.方法:选取2017年6月-2018年9月厦门市中医院收治的胁痛患者116例,随机分两组,对照组采用口服止痛药配合氟比洛芬贴膏常规治疗,观察组则采用中医辨证治疗.分别治疗1个疗程后观察两组临床效果及不良反应发生率.结果:观察组经中医辨证治疗后的总有效率为96.55％,高于对照组的79.31％,差异有统计学意义(P<0.05).观察组的不良反应发生率为6.90％,低于对照组的24.14％,差异有统计学意义(P<0.05).结论:在胁痛的治疗上,根据患者不同证型,采取中医辨证治疗的方法,能够取得更为显著的临床效果,同时不良反应少,治疗安全性更高.

目的:探讨经鼻高流量氧疗(HFNC)对心源性肺水肿(ACPE)的临床应用价值.方法:选取本院收治的ACPE患者29例,根据方法不同,将其分为常规氧疗组(A组)13例和HFNC治疗组(B组)16例.比较两组治疗前后的临床指标(Borg评分、HR、MAP、PaO2、PaCO2、SaO2、pH值、RR)、症状缓解时间、有创通气率、病死率及疗效.结果:治疗半小时后,B组HR、RR、Borg评分均低于A组,PaO2、SaO2水平均高于A组,差异均有统计学意义(P<0.05),但两组MAP、pH、PaCO2水平比较,差异均无统计学意义(P>0.05);B组症状缓解时间短于A组(P<0.05);两组有创通气率、病死率、有效率比较,差异均无统计学意义(P>0.05).结论:HFNC能快速改善ACPE患者的临床指标,缓解呼吸困难症状,故HFNC可能是治疗ACPE的有效辅助手段.

急性左心衰竭是急诊科较为常见的急危重症,是一种以左心室结构和功能严重障碍为主要症状的综合征,其往往会引起呼吸功能不全,导致低氧血症甚至危及患者生命.近年来,一种新型的无创通气方式——经鼻高流量氧疗(high flow nasal cannulae therapy,HFNC),由于其可产生气道正压,对心肺有一定的支持功能,而且耐受性好、对气道有加温和湿化的优点,故而被认为是可替代或与NIPPV序贯的有益的呼吸治疗措施[1].目前HFNC在COPD、ARDS、肺炎等方面的研究较多,但在急性左心衰合并呼吸衰竭方面的研究较为少见.

目的 探讨血浆内毒素的检测在呼吸机相关性肺炎患者中的诊断价值及对其预后的评估作用.方法 选择我院急诊科ICU呼吸机相关性肺炎患者52例,根据内毒素检测结果,将其分为内毒素检测阳性组29例(A组)组及内毒素检测阴性组23例(B组);采用鲎试剂的显色基质法,检测血浆内毒素含量,以≥0.4 EU/mL为阳性结果,分析比较两组的临床指标.结果 A组合并真菌感染及肝功能不全患者的比率显著高于B组(P<0.05);两组合并脓毒血症、多脏器功能不全(MODS)、急性呼吸窘迫综合征(ARDS)、弥漫性血管内凝血(DIC)等指标比较,差异无统计学意义(P>0.05);两组病死率比较,差异无统计学意义(P>0.05).结论 血浆内毒素检测可能不是作为诊断革兰氏阴性菌呼吸机相关性肺炎的有效诊断指标,对其预后评估无明显作用.

BACKGROUND:Fuzi, which is the processed lateral roots of Aconitum carmichaeli Debx. (Ranunculaceae), is a traditional herbal medicine that is well known for its excellent pharmacological effects and acute toxicity. Aconitum alkaloids are responsible for its pharmacological activity and toxicity. Although a large number of studies on Fuzi have been reported, no comprehensive review on its pharmacokinetics has yet been published.PURPOSE:This paper seeks to present a comprehensive review regarding the phytochemistry, pharmacokinetic features and toxicity of Fuzi. The regulation of drug-metabolizing enzymes (DMEs) and efflux transporters (ETs) by Fuzi is also concluded. Additionally, the use of Fuzi as a personalized medicine based on the bioavailability barrier (BB), which mainly comprises DMEs and ETs, is discussed.METHODS:All available information on Fuzi was collected by searching for key words in PubMed, ScienceDirect, CNKI, Google Scholar, Baidu Scholar, and Web of Science.RESULTS:Aconitum alkaloids, which mainly include diester-diterpene alkaloids (DDAs), monoester-diterpene alkaloids (MDAs) and unesterified-diterpene alkaloids (UDAs), could be detected after Fuzi ingestion in vivo. The Aconitum alkaloids are rapidly absorbed in the intestine and extensively distributed in the body. DMEs, especially CYP3A4/5, are responsible for various types of metabolic reactions of the Aconitum alkaloids. ETs, including P-glycoprotein (P-gp), multidrug resistance-associated protein 2 (MRP2), and breast cancer resistance protein (BCRP), are involved in the efflux of the DDAs and MDAs. The kidney is the most important organ involved in the excretion of the Aconitum alkaloids. DDAs are the main toxic compounds present in Fuzi, and their acute toxicity is mainly due to their effects on the voltage-dependent sodium channels. Furthermore, Fuzi can substantially regulate DMEs and ETs.CONCLUSIONS:The toxicity of DDAs is acute. However, further investigations are necessary to determine the exact toxicological mechanisms. The significant impact of Fuzi on DMEs and ETs suggests that the co-administration of Fuzi with drugs that are substrates of DMEs and/or ETs may cause herb-drug interactions (HDIs). The BB network controlled exposure to the Aconitum alkaloids in vivo. Polymorphisms of DMEs and ETs in different individuals contribute to the differences in the efficacy and toxicity of Fuzi ingestion. In the future, the use of Fuzi as personalized medicine based on the BB network is necessary and practical to achieve ideal therapeutic efficacy with minimal toxicity.

目的 通过比较肺泡灌洗液中内毒素检测与革兰氏染色对革兰氏阴性菌呼吸机相关性肺炎的诊断价值,探寻出一种更好的诊断革兰氏阴性菌呼吸机相关性肺炎的方法 .方法2014年10月至2016年1月入住本院综合ICU的呼吸机相关性肺炎患者,根据肺泡灌洗液中病原学结果 ,将其分为革兰氏阴性菌感染组(A组)和非革兰氏阴性菌感染组(B组).采用鲎试剂的显色基质法,检测肺泡灌洗液内毒素含量,分析比较两组的内毒素水平;比较革兰氏染色为阴性菌(C组)和内毒素检测≥6 EU/ml组(D组)患者中革兰氏阴性菌呼吸机相关性肺炎所占的比例数;并采用受试者工作特诊曲线(ROC)分析泡灌洗液内毒素检测的灵敏度和特异度等.结果最终有65例患者纳入本研究,其中A组51例,B组14例,A组肺泡灌洗液中内毒素水平显著高于B组(P<0.05);D组中革兰氏阴性菌呼吸机相关性肺炎所占的比例显著高于C组(P<0.05);ROC曲线分析表明,以≥6 EU/ml为界点,肺泡灌洗内毒素检测革兰氏阴性杆菌脓毒血症的灵敏度95.9％,特异度68.7％,阳性预测值92.0％,阴性预测值77.8％,曲线下面积为0.857(P<0.05).结论 肺泡灌洗液内毒素检测是一种快速诊断革兰氏阴性菌呼吸机相关性肺炎非常有效的方法,其作用显著优于革兰氏染色法.

ObjectiveResearch and analysis of different skin flap for the repair of hand injury repair of soft tissue defect in patients with clinical efficacy.MethodsSelect 76 cases of soft tissue defects hand injury patients grouped according to differ-ences in the use of flaps for the observation group and the control group. The control group was abdominal pedicle flap treat-ment; observation group perforator flap Therapy. Group 2 patients were observed clinically excellent rate and complications and healing time, IL-6, IL-8, TNF, LPS level and so on.Results After treatment, the observation group IL-6, IL-8, TNF, LPS levels compared with control group. Excelent observation group was significantly highe. Two groups of patients the incidence of complications and the average healing time, antimicrobial drug use time, histopathological scores.Conclusion Treatment of hand trauma repair soft tissue defect of patients can be improved inflammatory mediators and cytokines of patients with perfora-tor flap repair method, reduce complications, shorten the healing time, improve the therapeutic effect.

Objective To investigate the correlation of severity and prognosis of patients with community-acquired pneumonia( CAP) to their adrenal function. Methods 72 CAP patients were divided into the low risk group(n =40) and the high risk group(n =32) according to pneumonia severity index(PSI). The concentration of serum cortisol and ACTH were compared. The correlations among them were investigated as well. Results The concentration of serum cortisol,ACTH and PSI in the high risk group were all significantly higher than those in the low risk group( P 0. 05). The concentration of serum cortisol and ACTH was positively correlated with PSI( r = 0. 291 and 0. 281 respectively,P 0. 05). Analysis indicated that the area under the receiver operating characteristic( ROC) curves was 0. 843(95% CI 0. 754-0. 943) for serum cortisol and the number of death in hospital,and 0. 707(95% CI 0. 551-0. 863) for ACTH. Conclusion Serum cortisol and ACTH are closely related to the severity of CAP, which may be the effective parameters in the assessment of the severity and prognosis of CAP.

目的 探讨间质性肺疾病患者血清脑钠肽与心肺功能的相关性及对预后的评估作用.方法 回顾性选取2010年2月至2013年4月入住厦门市中医院的间质性肺疾病患者的临床资料.采用Pearson和Spearman统计学方法分析患者脑钠肽与心脏多普勒、肺功能各项检查指标的相关性,并将患者分为存活组和死亡组、合并肺动脉高压组与未合并肺动脉高压组,对各项临床指标进行预后价值比较.结果 共纳入38例间质性肺疾病患者,其血清B型脑钠肽水平与心脏多普勒右心功能的各项指标、肺动脉收缩压、右心房内径、右心室内径、右心室舒张末期内径均有较好的相关性(P＜0.05),而与左心功能的各项指标无显著相关性(P＞0.05);与一氧化碳弥散量占预计值百分比(DLCO％ pred)有显著相关性(P＜0.05).死亡组和肺动脉高压组患者的脑钠肽水平,以及除右心房内径外其余右心功能指标均显著高于存活组和无肺动脉压组(P＜0.05),而前两组DLCO％ pred显著低于后两组(P＜0.05).结论 间质性肺疾病患者血清脑钠肽水平能较好地反映其右心功能情况,提示间质性肺疾病患者有不同程度的肺血管受累,导致肺血管阻力的增加.而高水平的脑钠肽水平提示患者预后差,病死率高.

Objective To investigate the risk factors for intubation in patients with severe asthma for deepening recognition and therapeutic experience. Methods We retrospectively col ected and analyzed the clinical information of patients with severe asthma admit ed to our hospital from Jan, 2010 to Feb, 2013. We divided the patients into tow groups, one group is receiving normal treatments (A group) ,the other is receiving intubation and mechanical ventilation (B group). Clinical data in tow groups were compared and analyzed. Results There were 42 patients included in our study, of them, 26 patients who received normal treatments, 16 patients who received intubation and mechanical ventilation. Univariate analysis demonstrated that the ratio of history of intubation, steroid dependence, poor compliance , mortality and the rate of complication in group A patients were significantly higher than group B ( <0.05). The dosage of steroid and duration of hospitalization in group A patiens were markedly higher than group B ( <0.05).There were no significant dif erence in age and gender between tow group. Conclusion History of intubation, corticosteroid dependence and poor compliance maybe the risk factors leading to intubation and receiving mechanical ventilation. Patients with severe asthma who require intubation and mechanical ventilation have higher morbidity, and the condition are more severe. Great at ention should be paid.

Objective To investigate the factors to early ef icacy of community acquired pneumonia (CAP) for properly assessing il ness condition, promptly adjusting therapy and improving prognosis. Methods We sorted and analyzed the data and clinical information about the hospitalized patients with CAP from Nov, 2010 to Dec, 2012. Furthermore, we classified the CAP patients into early response group and early failure group according to clinical criteria. Both single factor and multiple logistic regression analysis were conducted. Results 98 patients were included in our study, Of them, 65 patients were classified as early responder and 55 patients were considered to be early failures. Single factor analysis demonstrated older age(≥65 years), with underlying disease, Also, discordant antibiotic therapy, multilobar infiltrate, respiratory failure, CURB-65 score≥3, gram-negative pneumonia were more frequently found in early failure group ( P<0.05). Independent factors associated with early failure were older age (≥65 years), CURB-65 score≥3, gram-negative pneumonia and discordant treatment were independent factors associated with early failure. Early failure patients had markedly high rates of complications and mortality. Conclusion Early failure were associated with high complications and mortality rates. Age≥65 years, CURB-65 score≥3, gram-negative pneumonia, discordant antibiotic therapy were factors influencing early efficacy of CAP.

Objective :Evaluation and analysis of manual reduction and small splint and plaster clinical curative effect of treatment of distal radius fractures .Methods :94 cases of distal radius fracture were randomly divided into control group and observation group ,the control group were treated with manipulative reduction and splinting ;observation group were treated with manual reduction and small splint and plaster fixation .Evaluation of 2 groups of patients with wrist joint function recovery and pain and clinical effect .Results :To observe the fracture healing time and the wrist joint treatment of excellent and good rate was (27 .67 ± 5 .85)d ,91 .49% (43/47) and control group (45 .21 ± 7 .35) d , 74.47% (35/47) comparison (P< 0 .05) .After treatment ,2 groups of patients with pain scores were significantly de‐creased ,and the observation group than in the control group (P< 0 .05) .The complication rate was 4 .26% in obser‐vation group was significantly lower than the control group 10 .64% (χ2 = 7 .84 ,P< 0 .05) .Conclusion :Patients treated with manual reduction and small splint and plaster fixation for the treatment of fractures of the distal radius ,it can re‐lieve pain of patients ,accelerate fracture healing ,promote the recovery of wrist function .

目的探讨影响弥漫性肺泡出血综合征(DAHS)患者预后的危险因素,益于我们选择正确的治疗方法及评估其预后.方法回顾性收集分析2006-02～2012-03入住我院的弥漫性肺泡出血综合征患者的资料,采用Logistic回归模型分析影响患者死亡的危险因素.结果最终有65例患者纳入本研究,主要病因为小血管炎、抗肾小球基底膜抗体疾病和结缔组织病,占总病例数的47.69%.多因素Logistic回归分析表明,死亡相关的危险因素分别为氧合指数(PaO2/FiO2)＜200 mg(OR 7.478,95% CI 95% 1.876～29.802)、APACHE Ⅱ评分≥25分(OR 5.136,95% CI 1.282～20.576)、急性肾功能障碍(OR 4.352,95% CI 1.101～17.205).结论PaO2/FiO2＜200 mg、APACHEⅡ评分≥25、急性肾功能障碍可能是影响弥漫性肺泡出血综合征患者预后的主要危险因素.

Objective To investigate the effect of low-dose erythromythin on lung function and radiology in patients with diffuse panbrochiolitis (DPB).Methods The data of nine patients with DPB hospitalized in respiratory department were collected and analyzed retrospectively.The changes of lung function and radiology after treatment with low-dose erythromythin were compared with pre-treatment.Results Compared with pre-treatment,after therapy,the predicted percentage of forced expiratory volume in one second (FEV1) ( 81.39 ％ ± 4.68 ％ vs 78.27 ％ + 4.98 ％ ),the predicted percentage of forced vital capacity (FVC) ( 80.93 ％± 5.46 ％ vs 76.59 ％ ± 5.57％ ),the ratio of FEV1 to FVC (65.34％±3.36％ vs 64.70％±3.43％) and the predicted percentage of forced expiratory volume with 75％ vital capacity (47.54％±5.71％ vs 42.76％ +3.79％) has been increased ( P ＜0.05).The ratio of residual volume to total lung capacity (46.74 ％±2.87 ％ vs 49.86 ％ + 3.25 ％ ) decreased markedly ( P ＜0.01).Conclusions Low-dose erythromythin can improve the lung function of the patients with DPB efficiently to alleviate the obstruction of small airway and gas trapping,and improve the change of radiology correlated with the small airway obstruction.

Background: Due to lack of country-specific norms in China, we established the reference range of plasma amino acids for younger Chinese children by reverse phase high-performance liquid chromatography (HPLC).Methods: Plasma proteins were precipitated with ethanol. L-Norvaline served as an internal standard. This HPLC method was based on automated precolumn derivatization using o-phthalaldehyde 3-mercaptopropionic acid for primary amino acids and 9-fluorenylmethyl chloroformate for secondary amino acids. Twenty-three amino acid derivatives were separated by a Zorbax Eclipse AAA column and detected fluorometrically. Plasma amino acids were measured in 108 healthy Chinese children (ages 0-5 years, 59 boys and 49 girls).Results: The assay was linear from 7.2 to 925.0 mu mol/L for all amino acids. Recovery of amino acids added to plasma samples was 93%-107%. Within-and between-run reproducibility was 0.18%-6.27% and 2.94%-16.15%, respectively. Sex-and age-specific plasma amino acid reference range for younger Chinese children was established. In our study, the boys had significantly higher levels of glutamine, citrulline, and tryptophan than girls (p<0.05), and the girls had a significantly higher level of alanine than boys (p<0.05). Compared with the 0- to 1-year group, the 1- to 5-year group had significantly higher levels of citrulline, valine, phenylalanine, isoleucine, and sarcosine and lower levels of aspartate, glutamate, serine, threonine, alanine, methionine, and tryptophan (p<0.05).Conclusions: This study validates the HPLC method described here as a simple, rapid, and reliable assay. The reference range of plasma amino acids for younger Chinese children is different from that for Caucasian children and will facilitate our clinical diagnosis in the future.

Objective to investigate the correlation between histamine bronchial provocation and hypertonic saline bronchial provocation test in patients with cough variant asthma.Methods 12 patients with cough variant asthma underwent histamine bronchial provocation and hypertonic saline bronchial provocation test respectively,and each test was separated by about one week.The cumulative dose of hypertonic saline and histamine were recorded,and the correlation between them was analyzed.Results Response to hypertonic saline correlated significantly with histamine response,the correlation parameter was 0.794,which have statistical significance(P<0.05).Conclusion There are significantly correlation between hypertonic saline and histamine in bronchial challenge test.

Seventy four patients with severe asthma were admitted from January of 2006 to February of 2008. Among them 36 patients suffered from controlled severe asthma, 38 with difficult controlled asthma. The demographic information, occupational environmental exposure, smoking history and accompanied diseases were analyzed. In refractory asthma group, occupational and environmental exposure (24, 63.2%) and poor compliance (22, 57.9%)were significantly associated with the disease (P < 0. 05); The rates of rhinitis (17, 44. 7%), gastroesophageal reflux disease (15, 39.5%), allergic bronchopulmonary aspergillosis (1,2.6%), churg-strauss syndrome (1, 2. 6%), obstructive sleep apnea (1, 2. 6%), endotracheal tuberculosis (2,5.3%) and smoking were higher than those of controlled severe asthma group, however, without the statistical significance (P > 0. 05). Conclusions Occupational exposure, environmental exposure and poor compliance were the major risk factors for refractory asthma.

Objective To explore a more effective ventilatory method with less adverse effect to treat acute lung injury (ALI) through comparison of the effects on cardiopulnonary function in ALI canine between pressure limited controlled ventilation(PLCV) and airway pressure release ventilation (APRV),and both of them combined with continous tracheal gas insufflation(CTGI).Methods 24 hybrid healthy dogs after being anesthetized and intubated were placed in supine position,ALl were induced by injection of 0.1 mL/kg purified oleic acid into the right atrial catheter slowly,and then, were randomized into four groups to receive pressure limited controlled ventilation (group A),pressure limited controlled ventilation combined with continous tracheal gas insufflation (groupB),airway pressure release ventilation(group C)and airway pressure release ventilation combined with continous tracheal gas insufflation (group D) respectively.There were six dogs in each group.Positive end expiratory pressure (PEEP) was set at 8cmH2O,inspiratory airway pressure was adjusted to the value that produced a tidal volume of 6-8 mL/kg,the inspiratory to expiratory time ratio was set at 1:2 and the ventilator rate was maintained at 20Bpm,in group A and B; Dogs in group C and D were maintained spontaneous breathing,the low pressure(Plow)was set at 8 cmH_2O,the duration of Plow (Tlow) was set for 2 second,the method of setting high pressure level (Phigh) was similar to previous approach,the duration of high pressure was set for 1 second,the total release rate were 20 Bpm,the fraction of inspiratory oxygen(FiO2) was 100%;Flow rate of CTGI was set at 10L/min of pure oxgen.The condition of oxygenation,respiratory mechanics and hemodynamics were measured during experiment.Results During ventilation,oxygenation index (OI) were significantly higher than thoseof ALI(P<0.05),and which were greater after 3 and 4 hour of ventilation than those of 1 hour in each group;At the end of ventilation,OI in group C and group D were significantly increased than those of 2 hour(P<0.05); Among groups,OI in group C and group D were higher than those of group A and grou B respectively (P<0.05).Arterial partial pressure of carbon dioxide (PCO2) in group A and group C increased persistently during ventilation,there were markedly change among different phrases(P<0.05);In group B,PCO_2 were greater from 2 hour to 4 hour than those of ALI(P<0.05),which were substantially higher at 3 hour and 4 hour than 1 hour.There were no significant change in group D.;Among groups,group A was the highest;There were no significant difference between group B and group D(P >0.05).The ratio of shunted blood to total perfusion(Qs/QT) declined greatly after ventilation,which was evidently low- er at the end of ventilation than those of 1 hour in groups(P<0.05);Both group C and group D were significantly lower than group A and group B respectively (P<0.05).Finally,static compliance of respiratory system (CRS,sta) were higher than those of ALI in group A and group B(P<0.05),which in group C and group D were greater at post-ventilation of 2 hour and 4 hour than those of ALl(P<0.05);In group C and group D,CBS,sta were markedly greater than those of group A and group B respectively(P<0.05).Peak airway pressure(PIP) in group B were higher than any other groups(P <0.05),which have no significant difference among other groups.Cardic output (CO) decreased markedly after ventila- tion in group A and B compared with ALI(P<0.05),which substantially greater in group D than those of group A(P< 0.05)at last.During ventilation,the ascended amplitude of mean pulmonary arterial pressure(re_PAP)in group A was the greatest,group C were only inferior to group A;Lung injury score were higher in group A and group B than those of group C and group D,but without statistical significance.Conclusion Compared with PLCV,APRV combined with CTGI is a more effective method for treatment of ALI.