为了更全面了解公众的肝脏健康状况,以及对保肝护肝类中药(包括中药饮片和中成药)的认识和接受程度,本文采用随机发放问卷并对调查结果进行统计学分析的方法.结果发现,民众对肝脏健康非常关注,但缺乏相关知识.因此,建议通过网络媒体对民众开展有关肝脏健康、合理使用保肝护肝类中药(包括中药饮片和中成药)的通识教育,以达到提高公众健康水平的目的.

OBJECTIVE To observe the clinical effect of modified Wuling Powder in the treatment of central serous chorioretinopathy(CSC) according to syndrome differentiation.METHODS Sixty patients with CSC were randomly divided into the treatment group and the control group, 30 cases in each group.The treatment group was intervened by orally taking modified Wuling Powder, and the control group was treated with orally taking vitamin B1 tablets and vitamin C tablets, with one course lasting for one month.Clinical effects were observed after 3 courses of treatment.RESULTS The total effective rate in the treatment group was 96.7%, and 73.3% in the control group.The curative effect was better in the treatment group than that of the control group(P<0.05).Vision, FFA fluorescence leakage area and edema degree were compared before and after treatment to be significantly different in two groups(P<0.01).The treatment group was better than the control group(P<0.05).CONCLUSION Modified Wuling Powder has good curative effects in the treatment of CSC.

目的:探讨清热化痰肃肺止咳法在慢性支气管炎(CB)急性发作期痰热郁肺证的应用情况.方法:选取我院收治的60例CB患者,按照随机数字表法均分为两组.对照组予以常规西医治疗,治疗组在此基础上,予清金化痰汤加减治疗.结果:与对照组同期比较,治疗组治疗后中医症候总积分较低(P<0.01),PCS、MCS评分均较高(P<0.01).治疗组治疗后血清hs-CRP、TNF-α、IL-8水平,均低于对照组同期(P<0.01).结论: CB急性发作期(痰热郁肺证)应用常规西医疗法结合中医清热化痰肃肺止咳法治疗更能迅速减轻患者的临床症状,控制机体炎症反应,提高生活质量.

目的:观察中药复方参黄膏敷神阙穴(脐)治疗促术后气滞血瘀型胃肠功能不全早期康复的疗效及安全性.方法:采用前瞻性、多中心、随机、双盲、安慰剂平行对照实验设计方案,300例腹部术后存在胃肠功能不全患者且中医辨证为气滞血瘀型患者,随机分成参黄膏组(150例)及安慰剂组(150例),术后24h开始敷神阙穴(脐)治疗,观察肛门排气、排便时间,肠蠕动恢复时间,中医症候积分,血清胃动素、生长抑素等疗效指标及不良事件等安全性指标.结果与安慰剂组比较,参黄膏组肛门排气、排便、肠蠕动恢复时间、中医症状显著改善(P＜0.05或P＜0.01),治疗后第5天血清胃动素及生长抑素差异有统计学意义(P＞0.05).结论:中药贴剂参黄膏可使腹部术后气滞血瘀型患者肛门排气排便时间提前,促术后肠蠕动及胃肠功能早期康复,改善患者临床症状,耐受性良好.

目的 观察参黄散贴剂敷神阙穴对腹部术后胃肠功能不全气滞血瘀型患者的临床疗效及安全性.方法 将220例胃肠道肿瘤术后胃肠功能不全气滞血瘀型患者随机分为参黄散组和安慰剂组各110例.参黄散组在基础治疗同时给予参黄散贴剂,以肚脐(神厥穴)为中心贴于腹部,每日1次,共治疗7日;安慰剂组在基础治疗同时给予安慰剂贴剂,给药方法同参黄散组.记录两组患者术后首次排气时间、首次排便时间、肠蠕动恢复情况及肠鸣音恢复时间,并进行中医证候评分判定中医证候疗效,测定术前及术后1、5天时血清胃动素(MOT)、生长抑素(SS)水平,记录不良反应.结果 参黄散组中医证候疗效总有效率为96.4％,安慰剂组为89.1％,参黄散组总有效率明显高于安慰剂组(P＜0.05).参黄散组肠鸣音恢复时间、首次排气时间及首次排便时间均较安慰剂组提前(P＜0.01).参黄散组术后第2、3、4天首次排气例数明显多于安慰剂组(P＜0.05或P＜0.01).参黄散组术后第3、4、5天首次排便例数明显多于安慰剂组(P＜0.05或P＜0.01).参黄散组术后第3天出现有效肠蠕动患者比例明显高于安慰剂组(P＜0.01).两组患者术后第2、3、4、5天中医证候积分均明显低于术后第1天(P＜0.05);参黄散组患者术后第2、3、4天中医证候积分明显低于同时间点的安慰剂组(P＜0.05或P＜0.01).两组患者术后第1天血清SS和MOT较术前比较差异有统计学意义(P＜0.05),两组均无严重不良事件发生.结论 参黄散贴剂可使胃肠肿瘤术后气滞血瘀型患者首次排气、排便时间提前,促术后肠蠕动及胃肠功能早期康复,改善患者临床症状,耐受性良好.

目的 探讨血浆纤维蛋白原(FIB)水平与结直肠恶性肿瘤转移的关系.方法 回顾性分析确诊结直肠腺癌并行手术治疗患者80例,术前测取血浆FIB值,术中记录肿瘤大小及局部、远处转移情况,并与术后病理对照,评价两者关系.结果 FIB水平与结直肠癌是否发生转移有明显相关性,包括远处及淋巴转移.而与患者年龄、肿瘤部位、浸润深度差异无显著性.logistic回归分析显示高纤维蛋白原血症(>0.0382g/L)是结直肠癌患者淋巴转移的重要影响因素.结论 高纤维蛋白原血症是大肠癌转移的高危险因素.

目的 探讨血浆纤维蛋白原(FIB)水平与大肠癌淋巴结转移的关系.方法 回顾性分析笔者医院2008～2012年确诊大肠癌无远处转移患者行手术治疗80例,术前测取血浆FIB值,术中记录肿瘤大小及淋巴结转移情况,并与术后病理对照,评价两者关系.结果 FIB水平与大肠癌是否发生淋巴结转移有明显相关性(P＜0.05),而与患者年龄,肿瘤部位,浸润深度无统计学差异.Logistic回归分析显示高FIB血症(＞382.25mg/dl)是大肠癌患者淋巴结转移的重要影响因素.结论 高FIB血症是大肠癌淋巴结转移的高危险因素,可以作为预测大肠癌淋巴结状态的有效指标.

目的:观察中药复方参黄贴敷神阙穴治疗促术后胃肠功能不全早期康复的疗效及安全性.方法:采用前瞻性、多中心、随机、双盲、安慰剂平行对照实验设计方案,400例腹部术后存在胃肠功能不全患者,按中央数字随机法随机分成参黄贴剂组(200例)及安慰剂组(200例),术后开始敷神阙穴治疗5d,观察肛门排气、排便时间,肠蠕动恢复时间,中医症状评分,血清胃动素、生长抑素等疗效指标及不良反应等指标.结果:与安慰剂组比较,参黄贴剂组肛门排气、排便时间、肠蠕动恢复时间、中医症状显著改善(P＜0.05),术后第5天血清胃动素参黄贴剂组高与宽慰补组(P＜0.05),而生长抑素参黄贴剂组低于安慰剂组(P＜0.05),基线各指标比较及安全性指标差异无统计学意义.结论:中药复方参黄贴可使腹部术后患者肛门排气排便时间提前,促术后胃肠功能早期康复,改善患者临床症状,耐受性良好.

Objective To explore main risk factors of post-operative severe complications in elderly patients with gastric cancer.Methods From January 2006 to June 2011,a total of 236 elderly patients to receive gastrectomy for gastric carcinoma were retrospectively analyzed in this casecontrol study.The factors affecting post-operative severe complications were analyzed by multivariate logistic regression analysis.Results Age was younger in patients without than those with postoperative complications [(72.9±5.8) years vs.(80.6±6.7) years,t=-9.194,P=0.000].Serum levels of hemoglobin and albumin were higher in patients without than with post-operative complications [(109.94±18.72) g/L vs.(98.75±18.82) g/L,(38.37±5.52) g/L vs.(33.69± 3.35) g/L,t=4.391,7.080,both P=0.000].Operation time was shorter in patients without than with post-operative complications [(3.1 ± 1.0) hours vs.(3.6 ± 1.1) hours,t =-3.507,P =0.001)].Intraoperative blood transfusion volume was less in patients without than with post-operative complications [(2.5±4.4) L vs.(2.8±5.5) L,t=-4.901,P=0.000)].The long diameter of tumor was shorter in patients without than with post-operative complications [(4.5 ± 2.8) cm vs.(5.3± 2.7) cm,t =-2.111,P =0.036)].Logistic regression analysis revealed that chronic obstructive pulmonary disease (COPD),serum albumin level,age,operation time and blood transfusion volume were associated with postoperative severe complications.Logistic regression equation was as follow:P=1/[1+e(16.22-033X1+0.99X3-390X4-192X5-493X9)].Conclusions COPD,operation time,blood transfusion volume,serum albumin level and age are the main independent risk factors for post-operative severe complications in elderly patients with gastric cancer.

Objective To assess the risk factors of postoperative death in elder patients with gastric cancer. Methods The clinical data of 236 elder patients with gastric cancer undergoing gastrectomy were retrospectively analyzed. Univariate analysis was performed with 56 clinical variables first, then, multivariate logistic regression analysis was used for selected vari-ables and the logistic regression model was established. The accuracy, sensitivity and specificity of the logistic model to predi-cate the probability of postoperative death were assessed. Results The postoperative mortality in this group of patients was 8.9%. Nine clinical variables, including chronic obstructive pulmonary disease(COPD), cardiac diseases, procedure duration, size of tumor long diameter, volume of fluid infusion, differentiation grade of tumor, serum level of hemoglobin, serum level of albumin and age entered the multivariate analysis. Logistic regression analysis revealed that COPD and age were significantly associated with postoperative death in elder patients. And a logistic regression equation to predict postoperative death was established P=1/[1+e (24.8795-0.3198X1-2.1803X9)]. The accuracy, sensitivity and specificity of the logistic model were 95.3%, 100%and 47.6%respectively. Conclusion COPD and age are the independent risk factors of postoperative death for elder patients with gastric cancer.

目的 探讨头孢丙烯与玉屏风散联合治疗急性细菌感染性鼻窦炎的临床作用,研究其改善症状和体征的程度及时间,并得出其有效性.方法 研究选择2010年1月-2013年1月就诊符合诊断标准的患者作为研究对象,共调查200例,将其随机分为治疗组和对照组,每组各100例,观察组给予玉屏风散与头孢丙烯口服治疗,对照组仅用头孢丙烯治疗,两组药物均在应用7d后停服,并记录临床症状、典型体征的改善程度及开始改善时间,统计其痊愈率及有效率,采用SPSS软件16.0,计量资料分析采用t检验,计数资料分析采用x2检验.结果 治疗组在鼻塞(x2 =3.18,P=0.01)、流涕(x2=3.23,P=0.01)、鼻道有黏性分泌物(x2=3.23,P=0.01)、鼻黏膜肿胀肥厚(x2=3.05,P=0.02)等症状的改善程度均优于对照组;治疗组在鼻塞(t=1.78,P=0.03)、流涕(t=1.26,P=0.04)、头痛(t=1.68,P=0.03)、咳嗽(t=1.84,P=0.02)等症状的改善时间均比对照组早;患者痊愈率及总有效率治疗组分别为75.0％及98.0％,对照组分别为53.0％及83.0％,治疗组均高于对照组(x2=8.67,P＜0.01及x2=7.34,P＜0.01).结论 玉屏风散与头孢丙烯联合治疗在改善症状体征的程度、时间上均优于单一使用头孢丙烯组;急性细菌感染性鼻窦炎采用玉屏风散联合头孢丙烯治疗,临床疗效更佳,可予推广应用.

Objective To investigate the effect of Shenhuang Powder on intestinal motility disorder after abdominal surgery in mice. Methods Ninety healthy male ICR rats were randomly divided into the model group,Shenhuang powder group and the sham operation group. The model group and Shenhuang powder group were prepared into the intestinal motility disorder models. In the sham operation group only exploratory laparotomy was applied. The above-mentioned groups were then randomly divided into 2 h、4 h and 6 h groups. Thirty minutes after the model was successfully established, in the Shenhuang powder group Shenhuang powder oblatum was applied on bellybutton while equal volume of fine sandbag were used in the sham operation group and the model group. At the end of 2 h、4 h and 6 h after treatment, the serum levels of motilin and somatostatin and carbon-ink transit rate were detected. Results The carbon-ink transit rate in Shenhuang powder group was significantly higher than that in model group at 6 hours after operation. The serum levels of motilin and somatostatin were significantly higher than those in sham operation group and model control group at 2 and 4 hours after operation (P 0.05). Conclusion Shenhuang powder can promote the recuperation of enterokinesia in mice after abdominal surgery.

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肠吻合是普通外科常用的手术操作,传统的吻合方法为手工缝合,费时费力,并存在一定的吻合口瘘和吻合口狭窄发生率,且特殊部位如盆腔低位吻合还存在技术上的难题.1985年Hardy等[1]发明了非缝合性生物可缮分解吻合环(biofragmentable anastomosis ring,BAR),并应用于胃肠吻合.1997年后,国内逐渐开展了此项技术,但大宗病例报道不多.现将本院近年来施行的86例的情况作一回顾分析,并与同期行手缝肠吻合者作一对照,报道如下.

目的:探讨第三型腹膜炎的临床特征及治疗方法。方法:回顾性分析26例第三型腹膜炎患者的临床资料,并与同期继发性腹膜炎相比较。结果:第三型腹膜炎患者手术次数、入住ICU天数、MODS发病率及死亡率均高于继发性腹膜炎;采用中西医结合方法治疗的第三型腹膜炎患者死亡率为46.2%,明显低于文献报道。结论:第三型腹膜炎是一类临床处理棘手的疾病,有较高的死亡率,中西医结合治疗可提高临床疗效。

AIM:To investigate the relationship between concentration changes of soluble intercellular adhesion molecule-1 (sICAM-1) in severe acute pancreatitis (SAP) and associated lung injury in rat. METHODS:A Rat SAP model was established by retrograde injection of 30 g/L sodium tau- rocholate into bile-pancreatic duct.Rats were sacrificed at 0,3,6,12,24 hours and their sera and left lungs collected.Sera sICAM-1 and my- eloperoxidase (MPO) activity in lung tissue were measured. RESULTS:Increases in sera sICAM-1 concen- trations were evident at 3 hours after SAP in- duced,and the MPO activity of lung tissue was significantly increased at 6 hours.Sera sICAM-1 concentration positively correlation with MPO activity (r=0.897). CONCLUSION:The concentration change of serum sICAM-1 is associated with the pathologi- cal injury magnitude of lung in rat severe acute pancreatitis.