基于中西医协同诊疗,在北京医院老年多学科诊疗深厚积淀基础上,结合目前本院援鄂医疗队接管的武汉华中科技大学同济医院中法新城院区B区11东病房收治的老年新型冠状病毒肺炎患者的临床实践,从老年人新型冠状病毒肺炎的发病特征、中西医协同诊疗等方面进行初步探析,尤其从中西医优势互补、诊疗互通、有主有辅、中医特色发挥等方面进行进一步思考和观点阐释.

目的 探讨鼾证(阻塞性睡眠呼吸暂停低通气综合征)与2型糖尿病关联的中医证素特征.方法 选取2015年1月-2017年6月在北京医院中医科门诊或病房就诊的患者299例,经病史询问及多导睡眠检测检查,将患者分为2型糖尿病组142例、鼾证组63例、鼾证合并2型糖尿病组94例,参照《证素辨证学》进行证素分析,并探讨各组间主要证素的差异.结果 脾证在3组中比例均为最高,分别为76.76％、69.84％、71.28％;鼾证组与鼾证合并2型糖尿病组肾证、血瘀证比例比较差异有统计学意义(P＜0.05);2型糖尿病组与鼾证合并2型糖尿病组湿证、血瘀证、热证、气虚证比例比较差异有统计学意义(P＜0.05).具备4个及以上证素非老年患者50例,占33.33％;老年患者92例,占61.74％.结论 鼾证合并2型糖尿病患者出现血瘀证的概率较高,年龄对证素分布有一定影响,老年患者更常见4个及以上复合证素.

目的 采用《中西医结合老年衰弱评估量表》评估老年住院患者的衰弱状况,探讨适合中国老年人特点的衰弱评估方法.方法 收集填写108例老年住院患者的临床资料,根据《中西医结合老年衰弱评估量表》计算中西医结合衰弱积分(中西医FI),根据《FI-CGA量表》计算衰弱积分(综合FI),根据《CFS-09表》计算衰弱分级.比较3种评估方法的相关性,进一步比较不同性别、年龄、住院天数、住院费用患者的衰弱状况.结果 本研究纳入的老年患者中西医FI平均值为(0.28 +0.15)分、综合FI的平均值为(0.23 +0.08)分、衰弱分级平均值为(3.44±1.01)分;男女性别中西医FI、综合FI、衰弱分级比较差异无统计学意义(P＞0.05);随年龄增长、住院天数增加、住院费用增加,中西医FI、综合FI、衰弱分级均明显增加,差异均有统计学意义(P＜0.05);经相关性分析,中西医FI与综合FI、衰弱分级均呈正相关(P＜0.05),综合FI与衰弱分级呈正相关(P＜0.05).结论 《中西医结合老年衰弱评估量表》评估结果符合临床实际,基本反映了本组住院老年患者的衰弱状态.

目的 总结姜良铎教授对于老年感染相关发热性疾病特殊性的认识,以及治疗中的用药特点及辨证思路.方法 收集姜良铎教授门诊治疗老年发热性疾病处方,对其药物品种、类别及药物配伍联系用SPSS 20.0软件进行统计分析.结果 共收集处方477张,使用中药18类211种,以清热药和补虚药为主,其中清热药使用频次多于补虚药,但补虚药的使用种类多于清热药.结论 姜良铎教授治疗老年热病用药以清热药和补虚药为主,体现了泻实为主、补虚为辅的用药特点,切合老年热病具有本虚的内伤基础的病机特点.

目的:观察苁蓉益肾颗粒治疗肾虚型慢性肾小球肾炎蛋白尿的疗效.方法:口服苁蓉益肾颗粒治疗34例肾虚型慢性肾小球肾炎蛋白尿患者12周,观察治疗前后患者主要症状的变化,并测定治疗前后患者24 h尿蛋白量及肾功能.结果:与治疗前比较,苁蓉益肾颗粒能显著改善肾虚型慢性肾小球肾炎患者的主要症状(P<0.01),能降低患者24 h尿蛋白量(P<0.05).结论:苁蓉益肾颗粒对肾虚型慢性肾小球肾炎蛋白尿有较好的治疗作用.

急性有机磷农药中毒(AOPP)是我国目前发生率最高的急性中毒之一,重症病死率高,可达30%～60%[1],主要致死原因为肺水肿、休克、脑水肿,患者也常因器官功能衰竭而死亡.作者以成功抢救重度复合有机磷中毒并发多器官衰竭(MOF)1例患者为主线,结合近年救治的有机磷中毒病例,体会如下.

Objective To observe and evaluate the clinical effect of Huoxin capsule on angina pectoris of coronary atherosclerosis heart disease (CAHD). Methods 180 cases with CAHD were randomly divided into treatment group and control group. The control group was treated with pentaerythritol tetranitrate and the treatment group with Huoxin capsule. Curative efficacy was compared between treatment and control group. Results The total effective rates of symptomatic improvements in treatment group and control group were 88.89% and 81.11%. The total effective rates of electrocardiogram improvements were 68.89% and 54.44%. There were not significant differences (P0.05). After treating, the accumulating points of syndrome of the treatment group dropped more, the treatment group was superior to the control group. Conclusions The curative effects of Huoxin capsule on angina of coronary arheroselerosis heart disease is exact. It can take effect quickly and improve the whole symptom of the patients noticeably.

Objective To investigate the influence of rosiglitazonemaleate on insulin resistance in fructose-fed rat . MethodsSix-week-old male Sprague-dawley rats were fed either normal rat chow (control,n=15) or fructose-rich diet (FFR,n=15). For the last four weeks, the rats were treated with normal saline (control and FFR) or rosiglitazone maleate (n=15) 2 mg·(kg·d)-1 by gavage,then euglycemic hyperinsulinemic glucose clamp technique was performed to evaluate insulin sensitivity(IS). Blood pressure was elevated with tail-cuff method. And plasma free fatty acid(FFA),fasting insulin(FI),total cholesterol(TC),triglyceride(TG),high density lipoprotein-cholesterol(HDL-C) were observed.ResultsBlood pressure of the rosiglitazone maleate and FFR groups was significantly increased comparing to control groups, weight was significantly lower in FFR compared with control (P0.05) after 4 , 8 weeks. Blood glucose was no significantly difference among three groups. The IS,FFA and FI were significantly lower in rosiglitazone maleate compared with FFR(P0.05,0.01),and recovered to the same as the control.Conclusion Rosiglitazone maleate may improved insulin resistance ,decreased FFA,FINS and TG in FFR model.