目的：探讨中西医结合疗法在急性脑梗死临床中的应用价值。方法：选取2019年1月-2021年1月就诊的急性脑梗死患者120例入组研究，采用随机数字表法分为对照组和观察组，每组60例。对照组采用单纯西医治疗，观察组采用中西医结合治疗，对两组患者血超氧化物歧化酶(SOD)、脂质过氧化物血清丙二醛(MDA)、C反应蛋白(CRP)、同型半胱氨酸(HCY)等指标进行比较，分析两组患者的短期疗效差异；同时对两组患者神经功能缺损程度及Barthel指数进行评价和对比，以此评价两组患者的远期疗效差异。结果：观察组患者对应评价指标均优于对照组，提示观察组近期疗效、远期疗效均优于对照组，差异均有统计学意义(P＜0.05)。结论：中西医结合治疗急性脑梗死的临床疗效优于单纯使用西医治疗，可以促进患者脑梗死症状缓解、降低脑梗死造成的神经功能损伤程度，有利于提高脑梗死患者生活质量。

目的 探讨还原型谷胱甘肽添加治疗Wilson病(WD)神经系统症状的疗效及对氧化应激水平的影响.方法 将60例有神经系统损害症状的WD患者随机分为谷胱甘肽组及对照组,每组30例.对照组行驱铜治疗和低铜饮食,谷胱甘肽组在此基础上加用还原型谷胱甘肽(0.9～1.8 g/d),治疗4周.于治疗前后分别行改良Young量表评分评价神经功能,检测血清总抗氧化能力(TAC)、丙二醇(MDA)、谷丙转氨酶(ALT)、天冬氨酸转移酶(AST)及24 h尿铜水平.结果 与治疗前比较,治疗后谷胱甘肽组及对照组改良Young量表评分及MDA、ALT、AST水平均降低(均P<0.05),TAC、24 h尿铜水平显著升高(均P<0.05).与对照组比较,谷胱甘肽组治疗前Young量表评分及TAC、MDA、24 h尿铜、ALT、AST水平差异无统计学意义(均P>0.05).与对照组相比,谷胱甘肽组治疗后改良Young量表评分及MDA、ALT水平明显下降(均P<0.05),TAC、24 h尿铜水平显著升高(均P<0.05),AST水平差异无统计学意义(P>0.05).结论 还原型谷胱甘肽可加强排铜效果,提高抗氧化应激水平,改善WD患者的神经系统症状,安全性较高.

国家深化"医教协同"教育体制改革和实施"双轮驱动"发展战略对医学院校现有的人才培养模式提出了挑战.为了充分发挥教师、教辅及医师(简称"教辅医")三者协同联动作用,结合"教辅医"3个角色在教育教学中的特征,提出了"教辅医"三维矩阵协同的医学创新人才培养模式,设立"理论知识线""科研创新线""实践技能线",3条主线自成体系,有机联动,实现无缝对接,同时以基于主成分分析的人才培养模式评价方法作为效果反馈,搭建动态管理数据库,以达到最大化协同各类优势资源,贯穿"导师组"联合培养教学理念,逐步从单一趋同性培养向突出特色优势的综合性培养的转变,形成医学创新人才培养新体系.

Wilson病又称肝豆状核变性(Wilson disease,WD),是一种以铜代谢障碍为特征的常染色体隐性遗传性疾病.本病临床表现复杂多样,可表现为肝硬化、锥体外系症状、精神症状、角膜色素环(Kayser-Fleischer,K-F环)及急性溶血征象[1].本病的漏诊误诊率较高.然而,WD是少数可以治疗的神经遗传疾病之一,若能做到早诊断、早治疗,一般预后良好,反之病情会逐渐加重,造成不可逆的后果甚至危及生命[2].因此,对疑似WD患者的早期确诊就显得尤为重要.本文通过2例疑似WD患者的诊断过程探讨WD的诊断思路,以便于更好的应用临床.

目的 研究在脑病科临床教学中采用案例教学法(CBL)与标准化病人(SP)相结合的教学模式的教学效果.方法 选取2017年1月-2017年12月于安徽中医药大学第一附属医院实习的安徽中医药大学五年制临床医学专业学生72名,随机分为研究组和对照组,每组各36名学生,研究组给予CBL与SP相结合的教学模式,对照组仅采取CBL,比较2组在脑病科的理论知识及临床实践能力考核成绩的差异,并在教学结束后对2组学生进行相关问卷调查.结果 2组理论知识考核成绩无明显差异(P＞0.05);但研究组临床实践能力考核成绩优于对照组,差异具有统计学意义(P＜0.05);并且问卷调查显示CBL与SP相结合的教学模式对提高学生学习兴趣、提高记忆效率、提高临床操作能力、提高临床思维能力、提高医患沟通能力、提高对师满意度均有优势(P＜0.05).结论 CBL与SP相结合的教学模式在提高学生的临床实践能力方面比CBL有优势.

目的:本研究以养血益肝、调心安神之法,采用复方枣仁安神胶囊之药调控5-HT、IL-1β、PGD2,来改善睡眠,从而对中医药作用于机体的靶点进行探讨.方法 将90例患者随机分为观察组(复方枣仁安神胶囊组)和对照组(佐匹克隆组)及安慰剂组,通过观察治疗前后三组中医证候疗效、匹兹堡睡眠质量指数(PSQI)评分及5-HT、IL-1β、PGD2的变化.结果 1.临床疗效:疗后治疗组总有效率为70％,对照组73.33％,两组比较差异无统计学意义(P>0.05).与安慰剂组对比,差异有计学意义(P<0.01).2.中医症候疗效:疗后治疗组中医症候治疗总有效率为70％,对照组为16.67％,差异有统计学意义(P<0.05).3.量表积分型指标评估:1.PSQI量表:疗后治疗组及对照组的PSQI积分较用药前有明显差异(P<0.05),而安慰剂组的变化差值未有统计学意义.2.中医症候积分分析:疗后治疗组较对照组及安慰剂组在中医症候方面有明显的改善(P<0.01或0.05).4.实验室指标变化:疗后治疗组及对照组中5-HT、IL-1β、PGD2均可升高,但差异无统计学意义(P>0.05),与安慰剂组对比均有统计学差异(P<0.01).

目的:观察复方枣仁安神胶囊联合小剂量曲唑酮治疗失眠伴焦虑状态患者的临床疗效.方法将符合标准的60例失眠患者随机分为2组,对照组采用曲唑酮治疗,治疗组在对照组基础上加用复方枣仁安神胶囊.治疗4周后,分析2组治疗前后临床疗效、中医证候积分、动态脑电图中睡眠参数、HAMA评分、PSQI的变化.结果:①临床总有效率:治疗组临床总有效率86％,与对照组相比(80％),差异无统计学意义(P＞0.05);②中医证候积分:治疗前后,2组患者中医证候各因子评分及总分评分均具有统计学意义(P＜0.05或P＜0.01),组间相比较,治疗组优于对照组(P＜0.01);③2组动态脑电图睡眠参数:治疗后治疗组总睡眠时间、非快速眼动期(NREM)时间、睡眠效率改善明显(P＜0.05);④HAMA总分评分:治疗前后2组HAMA总分评分差异均显著降低,其中以治疗组降低明显(P＜0.01),有统计学意义;⑤PSQI总分及各因子积分:治疗前后,2组患者PSQI各因子及总分评分,差异有统计学意义(P＜0.05),2组组间比较,睡眠质量、入睡时间、睡眠效率、持续时间及总分比较,差异显著(P＜0.01).结论:复方枣仁安神胶囊联合小剂量曲唑酮治疗失眠伴焦虑抑郁状态疗效显著,副作用小.

Objective To observe the effect of Huangxiong Kangshuan capsule on serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels in patients with acute cerebral infarction. Methods Ninety-two patients with acute cerebral infarction admitted to the First Affiliated Hospital of Anhui University of Traditional Chinese Medicinefrom July 2013 to December 2016 were enrolled, and they were divided into an observation group (47 cases) and a control group (45 cases) by random number table. The control group was given conventional treatment of ischemic cerebrovascular disease, while the observation group was additionally treated by Huangxiong Kangshuan capsule orally taken, once 3 tablets, 3 times a day, on the basis of routine treatment; the duration of treatment was 2 weeks in both groups. After 2 weeks of treatment, the clinical effects of the two groups and the changes of serum hs-CRP and IL-6 levels were observed.Results After treatment, the levels of serum hs-CRP and IL-6 were decreased significantly compared with those before treatment in the two groups [observation group: hs-CRP (mg/L) was 6.18±2.17 vs. 14.11±3.01, IL-6 (ng/L): 28.10±11.47 vs. 120.83±24.51; control group: hs-CRP (mg/L) was 8.89±2.46 vs. 13.97±2.69, IL-6 (ng/L) was 49.48±16.43 vs. 115.25±24.05], and the degree of decline in the observation group was more significant than that in the control group [hs-CRP (mg/L): 6.18±2.17 vs. 8.89±2.46, IL-6 (ng/L): 28.10±11.47 vs. 49.48±16.43, bothP < 0.01]; the total effective rate of the observation group was significantly higher than that of the control group [87.2% (41/47) vs. 71.1% (32/45),P < 0.05]. Conclusion Huangxiong Kangshuan capsule can decrease the serum hs-CRP and IL-6 levels in patients with acute cerebral infarction, and has a role in brain protection and nerve function defect improvement.

动物模型在现代医学研究中具有重要的地位,然而建立适应中医学特点的病证结合动物模型却较为困难.目前,建立病证结合动物模型多是根据中医理论复制证候模型,再根据西医理论复制疾病模型,将结果认为是中医证候模型.中国古代对动物模型的早期认识是以解剖结构、治病本能及施加各种治疗手段后的结果观察为基础的,如《本草衍义》中记载了通过喂自然铜治疗大雁骨折模型,得出了铜具有接骨的功效[1].

目的:观察瓜蒌薤白白酒汤对缺血性脑卒中模型大鼠血液流变学的影响,探究其作用机制.方法:给药7d,末次给药后40 min向一侧颈内动脉注入血栓栓子复制模型.术后24 h取脑组织,进行各项指标测定.结果:与模型组比较,瓜萎薤白白酒汤可降低脑卒中大鼠血小板聚集率,降低血液粘稠度(P ＜0.05或P＜0.01),改善模型大鼠脑组织病理状态.结论:瓜蒌薤白白酒汤对大鼠缺血性脑卒中有预防作用,其作用机制可能与改善血液流变学有关.

目的:观察复方枣仁安神胶囊联用曲唑酮治疗失眠伴焦虑状态患者的临床疗效.方法:选择符合要求的病例,随机分成对照组和治疗组各30例,对照组单用曲唑酮,治疗组用复方枣仁安神胶囊联用曲唑酮,治疗1月,采用中医证候积分、汉密尔顿焦虑量表(HAMA)、匹兹堡睡眠质量指数(PSQI)进行治疗前后的病情评价.结果:对照组基本痊愈3例,显效7例,有效6例,无效14例,愈显率为33.3％,总有效率53.3％.治疗组基本痊愈4例,显效13例,有效8例,无效5例,愈显率为56.7％,总有效率为83.3％.2组愈显率、总有效率比较,差异均有显著性意义(P＜0.05).2组治疗后较治疗前的HAMA评分均有明显改善(P＜0.05),治疗组改善情况较对照组改善也有明显差异(P＜0.05).2组治疗后较治疗前的PSQI均有明显改善(P＜0.05),治疗组改善情况较对照组改善也有明显差异(P＜0.05).2组1月后检查患者的造血功能(血液学检查),肝、肾功能(血液生化学),心电图检查,均没有发现异常.结论:复方枣仁安神胶囊联用曲唑酮治疗失眠伴焦虑状态患者的临床疗效确切,副反应少,联合应用比单用曲唑酮效果更明显.

细胞因子作为炎症反应中活化细胞产生的具有高活性、多功能的可溶性肽,可通过多种机制调控心血管功能.常见的细胞因子有白细胞介素、肿瘤坏死因子α、一氧化氮、血管紧张素Ⅱ、内皮素.

目的 探讨瓜蒌薤白白酒汤大、中、小剂量对硬膜下血肿模型大鼠血清中炎症因子的影响.方法 建立硬膜下血肿大鼠模型,随机分为假手术组、模型组、阳性组(华佗再造丸)、瓜蒌薤白白酒汤大、中、小剂量组,每组10只,各组连续灌胃14d后,腹主动脉取血,以酶联免疫吸附测定法(ELISA)检测各组血清中IL-2、IL-6、IL-8、TNF-α的水平.观察各项指标的差异性及瓜蒌薤白白酒汤大、中、小剂量组对硬膜下血肿的治疗作用,并对瓜蒌薤白白酒汤大、中、小剂量组的治疗效果进行对比.结果 瓜蒌薤白白酒汤高、中剂量组能够升高硬膜下血肿模型大鼠血清炎症因子IL-2水平,升高IL-6、IL-8水平,与模型组比较,差异具有统计学意义(P＜0.01、P＜0.05).结论 瓜蒌薤白白酒汤能减小血肿面积起到有效的脑保护作用.

AIM To observe the protective effect of Gualou Xiebai Baijiu Decoction( Trichosanthis Fructus,Allii macrostemi Bulbus,wine) on myocardial ischemia reperfusion injury in rats. METHODS By ligatig left anterior descending branch of coronary artery,the model of myocardial ischemia-reperfusion injury in rats was established and reperfused for 180 min after ischemia for 30 min,then rats were executed to be measured. RESULTS Compared with the model group,Gualou Xiebai Baijiu Decoction could inhibit ECG S-T segments elevation in rats with myocardial ischemia and reduce the myocardial infarct size. Gualou Xiebai Baijiu Decoction could significantly reduce the release of LDH and Creatine Kinase in serum. Conclusion Gualou Xiebai Baijiu Decoction can protect the myocardial ischemia / reperfusion injury in rats.

目的:观察盐酸川芎嗪治疗椎-基底动脉供血不足的临床疗效。方法:将50例椎基底动脉供血不足的患者分为观察组26例与对照组24例,观察组使用川芎嗪与长春西汀,对照组使用长春西汀进行治疗,疗程14d,对2组临床疗效包括患者症状、体征及脑彩超指标进行观察。结果:观察组有效率达96.2%,对照组有效率达70.8%,2组有显著差异(P<0.05);结论:盐酸川芎嗪注射液对治疗椎-基底动脉供血不足疗效显著。

Objective To observe the intervention effects of Huangputongqiao Capsules on the traditional Chinese medicine(TCM)syndrome and serum levels of lipids and C-reactive protein(CRP)in patients with vascular dementia.Methods Sixty-nine patients with vascular dementia were randomly divided into two groups:control group(n=35)and study group(n=34).The control group received donepezil,while the study group received Huangputongqiao Capsules and donepezil.The treatment outcomes were evaluated based on TCM syndrome and serum levels of total cholesterol(TC),triglyceride(TG),and CRP. Results Five patients in control group and four patients in study group were lost to follow-up.After treatment,the control group showed no significant improvements in TCM syndrome score and serum levels of TC,TG,and CRP(P0.05)but significant decrease in Alzheimers disease assessment scale-cognitive subscale(ADAS-Cog)score(P0.05);the study group showed significant decreases in TCM syndrome score,ADAS-Cog score,and serum levels of TC,TG,and CRP(P0.05);the TCM syndrome score, ADAS-Cog score,and serum levels of TC,TG,and CRP were significantly lower in the study group than in the control group(P0.05or P0.01).Conclusion Huangputongqiao Capsules can improve the TCM syndrome in patients with vascular dementia.The action mechanism of Huangputongqiao Capsules may involve reducing serum lipids and inhibiting vascular inflammatory response.

目的:通过运用蒙特利尔认知评估量表(MoCA)和简易精神状态检查(MMSE)对血管性认知障碍(VCI)患者进行筛查,来观察MoCA中文版在VCI诊断过程中的有效性;比较MoCA与MMSE的敏感性;观察MoCA在中药治疗血管性认知障碍过程中的运用价值。方法:对75例受试者同时进行MoCA和MMSE量表检测,并记录积分;对2组受试者之间MoCA结果进行检验,了解MoCA的有效性和敏感性;比较MoCA在无痴呆型血管性认知障碍(VCIND)组与血管性痴呆(VaD)组的子项目积分,了解VCIND与VaD患者的神经心理学特征;对A组检出的VCI患者进行中医证候积分计算并给予中药黄蒲通窍胶囊治疗,6周后复查中医证候积分、MoCA及MMSE评分。结果:MoCA和MMSE评定结果高度相关(r=0.932,P<0.001)。A组和B组的MoCA总分有显著性差异(P<0.01)。VCIND组与VaD组之间的MoCA结果比较,除命名、注意力、语言、抽象子项目差异无显著性意义外(P>0.05),其他子项目的分值和总分在2组之间的差异均有高度显著性意义P<0.05。VCI患者MoCA评分和中医证候积分在一定程度上负相关;中药黄蒲通窍胶囊治疗前后的MoCA和MMSE评分及中医证候积分均有显著性差异(P<0.05)。结论:MoCA中文版具有良好的有效性和敏感性,可用于血管性认知功能障碍患者的早期筛查;VaD较VCIND在视空、执行、记忆、定向方面损害进一步加重;中药黄蒲通窍胶囊可以改善VCI患者的认知功能及中医证候积分;MoCA可用于中药治疗血管性认知障碍的疗效评估并优于MMSE。

目的:探讨针刺治疗对脑梗死后吞咽障碍的临床疗效。方法:将符合纳入标准的脑梗死并发吞咽障碍的病人60例,随机分成针刺组和对照组各30例,对照组进行常规治疗,针刺组在常规治疗基础上加针刺治疗,6d为1个疗程,休息1d后进行第2个疗程,最长治疗4个疗程,观察2组病人治疗后的临床疗效。结果:针刺组临床疗效明显优于对照组(P<0.05),且无明显不良反应。结论:针刺治疗脑梗死后吞咽障碍有显著疗效,是提高这类病人的康复率、改善吞咽功能的疗效确切、操作简单的治疗方法。

AIM To observe the efficacy and safety of glutathione tablets in the treatment of hepatolenticular degeneration.METHODS All confirmed 151 patients with hepatolenticular degeneration treated with zinc gluconate and Gandouling tablet were randomly divided into three groups:56 for GSH group(glutathione 20 mg·kg~(-1)·d~(-1),po),50 for DMSA group(dimercaptosuccinic acid 60 mg·kg~(-1)·d~(-1),po),and 45 for PCA group(penicillamine 25 mg·kg~(-1)·d~(-1),po).All patients were treated for 12 weeks,clinical data were recorded and adverse reactions were observed before and after the treatment.RESULTS The 24 h urinary copper contents in DMSA group and PCA group after the treatment were significantly higher than those before the treatment(P0.01),and the white blood cell count in PCA group was lower than that before the treatment(P0.05).In the GSH group,the total bilirubin and alanine aminotransferase abnormality indicators were restored after the treatment(P0.05)with no significant difference in 24 h urinary copper content(P0.05).The efficacy rate and adverse reaction rate were 88%and 4%in the GSH group,82%and 18%in the DMSA group,89%and 38%in the PCA group,respectively.There was no significant difference in efficiency among the three groups by the Ridit analysis(P0.05),but the adverse reaction rates among them had statistically significant differences (P0.05).CONCLUSION The effect of glutathione tablets in the treatment of hepatolentcular degeneration is reliable and secure.

目的 观察常规方案联合温阳通脉颗粒口服治疗脾肾阳虚型缺血性中风患者的临床疗效.方法 选择60例符合中医辨证为脾肾阳虚型的缺血性中风患者,按随机数字表法分为观察组和对照组,每组30例.两组均给予西医常规治疗,观察组同时加服温阳通脉颗粒,疗程均为4周.观察两组治疗后中医证候积分、临床疗效、神经功能缺损程度[中国卒中量表评分(CSS)]、日常生活能力状态[巴塞尔指数(BD]以及凝血指标的变化情况.结果 观察组中医证候改善的愈显率和总有效率均明显高于对照组(愈显率:82.8％比44.4％,总有效率:96.6％比74.1％,P＜ 0.01和P＜0.05);治疗2周后中医证候总积分(分)均较对照组明显改善(36.87±7.95比42.87±9.59,P＜0.05),临床疗效愈显率较对照组明显升高(62.1％比40.7％,P＜0.05).观察组在减少CSS、增加BI、延长凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)方面与对照组比较差异均有统计学意义(P＜0.05或P＜0.01).结论 温阳通脉颗粒治疗缺血性中风疗效显著,在改善临床症状的同时,能够减轻神经功能缺损程度,提高日常生活能力,并对凝血指标有积极影响.