目的 探究老年下肢骨折患者接受人性化手术室护理的价值.方法 选取2017年3月～2019年3月老年下肢手术患者100例,随机分为对照组(常规手术室护理)与观察组(人性化手术室护理)各50例,对比两组干预效果.结果 (1)观察组满意度(98.00％)高于对照组(84.00％),差异有统计学意义(P<0.05);(2)观察组SAS评分、SDS评分低于对照组,差异有统计学意义(P<0.05).结论 将该护理模式运用于老年下肢骨折手术患者的手术室护理效果显著,值得推广.

目的:探讨自拟消渴Ⅱ号方治疗早期糖尿病肾病的临床疗效.方法:选择90例2型糖尿病肾病患者,Mogensen分期为糖尿病肾病早期,随机分为对照组44例,治疗组46例,两组均予二甲双胍或阿卡波糖或(和)胰岛素治疗,对照组加用厄贝沙坦(商品名:安博维)150mg,日一次口服,治疗组加用自拟消渴Ⅱ号方,日一剂水煎,分2次口服,12周一疗程.结果:两组治疗后治疗组总有效率优于对照组(P<0.01),两组治疗后FPG、FINS、HbA1C、HOMA-IR、UAER均较治疗前明显下降,且治疗组下降幅度优于对照组.结论:自拟消渴Ⅱ号方可降低早期糖尿病肾病患者血糖,改善胰岛素抵抗,减少尿蛋白,能有效防治早期DN的发生发展.

目的 观察银杏叶提取物对早期糖尿病肾病(DN)大鼠炎性反应表达的影响,探讨银杏叶提取物保护糖尿病肾病肾脏的部分机制.方法 成年雄性Wistar大鼠随机分成对照组、糖尿病组和银杏叶提取物.采用腹腔注射链脲佐菌素的方法建立DN模型,银杏叶组灌胃银杏叶片溶液96 mg/(kg·d),并于实验12周时对动物进行处理,ELISA方法检测白细胞介素-6(IL-6)、晚期糖基化终产物(AGEs)、血浆Nod样受体蛋白-3(NLRP3)水平及免疫组织化学检测肾组织纤连蛋白和胶原Ⅳ蛋白水平的变化,并对部分肾脏标本进行肾脏肥大指数检测.结果 1)与对照组比较,模型组BUN和Cr水平均升高(P＜0.05);与模型组比较,银杏叶组BUN和Cr浓度明显下降(P＜ 0.01或P＜0.05);2)与对照组相比较,模型组IL-6、AGEs、NLRP3表达水平均增高(P＜ 0.05);与模型组比较,银杏叶组IL-6、AGEs、NLRP3表达水平均明显下降(P＜0.01);3)与对照组相比较,模型组FN、CoⅣ蛋白表达水平均增高(P＜0.05).与模型组比较,银杏叶组FN、CoⅣ蛋白表达水平均明显下降(P＜0.01).结论 炎性反应参与了DN的发病发展,银杏叶提取物可能通过抑制NLRP3炎症小体激活和AGEs-RAGE相互作用,对DN大鼠起到肾脏保护作用.

目的 观察消渴Ⅱ号方联合厄贝沙坦片治疗早期糖尿病肾病(DN)的临床疗效及对患者炎症因子的影响.方法 将102例早期DN患者按照随机数字表法分为2组,均予基础治疗.对照组50例应用厄贝沙坦片治疗;治疗组52例应用消渴Ⅱ号方联合厄贝沙坦片治疗.2组均12周为1个疗程,治疗1个疗程.比较2组临床疗效、中医证候疗效;比较2组治疗前后证候积分变化;比较2组治疗前后血糖指标空腹血糖(FPG)、餐后2h血糖(2 hPG)及糖化血红蛋白(HbA1c)变化;比较2组治疗前后肾功能指标尿素氮(BUN)、血肌酐(Cr)、尿白蛋白排泄率(UAER)及24h尿蛋白定量变化;比较2组治疗前后炎症因子血清白细胞介素6(IL-6)、IL-18、肿瘤坏死因子α(TNF-α)变化.结果 治疗组总有效率92.3％,对照组总有效率82.0％,治疗组疗效优于对照组(P＜0.05).2组治疗后神疲乏力、口干舌燥、肢体麻木、胸胁痛积分均较本组治疗前降低(P＜0.05),且治疗组降低更明显(P＜0.05).2组治疗后FPG、2 hPG、HbA1c均较本组治疗前降低(P＜0.05),且治疗组治疗后HbA1c低于对照组(P＜0.05).2组治疗后BUN、Cr、UAER、24 h尿蛋白定量均较本组治疗前降低(P＜0.05),且治疗组降低更明显(P＜0.05).2组治疗后IL-6、IL-18及TNF-α均较本组治疗前降低(P＜0.05),且治疗组降低更明显(P＜0.05).结论 消渴Ⅱ号方联合厄贝沙坦片治疗早期DN,能有效改善患者临床症状和肾功能,抑制炎症反应.

目的:观察自拟消渴Ⅱ号方治疗早期糖尿病肾病的临床疗效.方法:选择86例2型糖尿病肾病患者,Mo gensen分期为糖尿病肾病早期,随机分为对照组40例、治疗组46例,两组均予二甲双胍或拜糖平或(和)胰岛素治疗,对照组加用厄贝沙坦口服,每日1次,每次1片;治疗组在对照组基础上加用自拟消渴Ⅱ号方治疗,12周为1个疗程.结果:两组治疗后总有效率比较有显著性差异(P＜0.01)两组患者治疗后FPg、UAER、Cys-c、HCY、LDL-C、TC比较均较治疗前明显下降,且治疗组UAER、Cys-c、HCY下降幅度优于对照组.结论:消渴Ⅱ号方可降低早期糖尿病肾病患者UAER、Cys-c、HCY指标,能提高西药常规治疗该病的总有效率.

目的 探讨自拟消渴Ⅱ号方对早期糖尿病肾病患者免疫功能的影响.方法 选择60例2型糖尿病肾病患者,Mogensen分期为糖尿病肾病早期,随机分为治疗组和对照组,对照组28例,治疗组32例,2组均予二甲双胍或拜糖平或(和)胰岛素治疗.对照组在基础治疗的基础上加用厄贝沙坦口服,每日1次,每次1片;治疗组在对照组治疗的基础上加用自拟消渴Ⅱ号方汤剂.治疗前后观察2组证候疗效、空腹血糖、尿白蛋白排泄率及免疫功能.结果 2组治疗后总有效率比较差异有统计学意义(P＜0.01).治疗组能明显改善患者临床症状,改善CD4+、CD8+、CD4+/CD8+水平.结论 自拟消渴Ⅱ号方能提高早期糖尿病肾病治疗疗效,增强患者免疫力,有效改善临床症状.

Objective To investigate the effects of heat-sensitive moxibustion combined with puncture and bLoodLetting on hemorheoLogy and cerebraL bLood fLow parameters of cedar spondyLosis of vertebraL artery type (CSA). Methods A totaL of 130 patients with CSA who met the incLusion criteria were randomLy divided into 2 groups, 65 patients in each group. The observation group was treated with heat-sensitive moxibustion combined with bLood-Letting, and the controL group was treated with conventionaL acupuncture. Both groups were treated for 14 days. The TranscraniaL DoppLer was used to monitor the peak veLocity of systoLic (Vs) of the intracraniaL vertebraL artery and basiLar artery, the peak veLocity of diastoLic (Vd) and the riresistante index (RI). The whoLe bLood viscosity (RBV), pLasma specific viscosity (RPV), the hematocrit (HCT) and the erythrocyte sedimentation rate (ESR) were detected and the cLinicaL efficacy was evaLuated. ResuLts The totaL effective rate was 93.9% (61/65) in the observation group and 80.0% (52/65) in the controL group. The difference between the two groups was statisticaLLy significant (χ2=5.482, P=0.019). After treatment, the RBV, the RPV, HCT and ESR in the observation group were significantLy Lower than the controL group. The Vs on the Left side of the vertebraL artery in the observation group was significantLy higher than that in the controL group (t=2.087, P=0.039), and the Vs and Vd in the right vertebraL artery were significantLy higher than the controL group ( t vaLues were 3.505, 3.161, respectiveLy, aLL Ps<0.01). The RI of the observation group was significantLy Lower than the controL group (t=2.425, P=0.017). The Vs and Vd of the basiLar artery in the observation group were significantLy higher than the controL group (t vaLues were 2.716, 4.748, aLL Ps<0.01), and the RI was significantLy Lower than the controL group (t=3.299, P=0.001). ConcLusions Moxibustion combined with bLoodLetting can reLieve the symptoms of CSA patients, improve the vertebrobasiLar bLood suppLy and improve cLinicaL efficacy.

目的 观察消渴Ⅱ号方治疗早期2型糖尿病肾病(DN)临床疗效及对患者肾纤维化相关因子的影响.方法 将78例DN患者按照随机数字表法分为2组,2组均予常规基础治疗.对照组38例加厄贝沙坦片治疗,治疗组40例在对照组治疗基础上加消渴Ⅱ号方治疗,均治疗12周.比较2组治疗前后尿白蛋白排泄率(UAER)、24 h尿蛋白定量、胱抑素C(Cys-C)、转化生长因子β1(TGF-β1)、Ⅳ型胶原水平变化及临床疗效.结果 治疗组总有效率92.5％(37/40),对照组总有效率81.6％(31/38),治疗组临床疗效优于对照组(P<0.05).2组治疗后UAER、24 h尿蛋白定量及Cys-C、TGF-β1、Ⅳ型胶原水平均较本组治疗前降低(P<0.05),且治疗组均低于对照组(P<0.05).结论 消渴Ⅱ号方可降低早期DN患者血Cys-C、TGF-β1、Ⅳ型胶原水平,延缓肾纤维化进程,从而延缓DN的发展.

目的 通过随机对照试验,探讨热敏灸配合刺络放血治疗椎动脉型颈椎病(CSA)的临床疗效及安全性.方法 将254例CSA患者随机分为治疗组和对照组,每组127例.治疗组采用热敏灸配合刺络放血中医综合疗法治疗,对照组采用常规针灸治疗,半个月内治疗12次观察疗效,比较2组治疗前后及治疗半年随访症状与功能评分及临床疗效.结果 热敏灸配合刺络放血中医综合治疗组治疗后愈显率为71. 65% 、随访时的愈显率为74. 02% ,均优于对照组的51. 97% ,38. 58% (P均<0. 05),2组治疗后及随访时临床症状与功能评分均较治疗前明显提高(P均<0. 05).结论 热敏灸配合刺络放血中医综合疗法的近期及远期疗效均显著优于普通针刺治疗者.

目的:探讨接受放疗的肺癌患者发生放射性肺损伤(radiation-induced lung injury,RILI)的相关因素.方法:对110例肺癌患者进行三维适形放疗,每次1.8～2.2 Gy,1次/d,5次/周,采用5～7个照射野照射,总剂量≥56 Gy.收集所有患者的相关临床因素,根据剂量体积直方图记录双肺、患侧肺、健侧肺V5,V10,V15,V20,V30,V40,平均肺剂量(mean lung dose,MLD)和计划靶区体积,放疗前测定血清IL-6,IL-8和TGF-β1水平.观察各临床因素和放射物理参数与RILI发生的相关性,分析RILI发生的相关因素.结果:110名患者均成功完成放疗计划,临床因素中放疗剂量、血清IL-8,TGF-β1水平与RILI发生有关,物理参数中双肺V5,双肺V10,双肺MLD,患侧肺V5,健侧肺V5与RILI发生有关,差异均有统计学意义(P＜0.01),将上述有统计学意义的变量进行logistic多因素分析,放疗总剂量≥64 Gy,健侧肺V5及放疗前IL-8是接受放疗的肺癌患者发生RILI的相关因素.结论:RILI的发生是多种因素互相作用的结果,放疗总剂量≥64 Gy,健侧肺V5及放疗前血清IL-8水平是肺癌患者发生RILI的独立影响因素.

目的:探讨肺癌三维适形放疗所致放射性肺炎的影像学表现.方法:对新乐市中医医院收治的40例肺癌患者进行三维适形放疗,放疗结束后1～2月进行胸部平扫,观察40例放射性肺炎的影像学表现.结果:放射性肺炎早期表现为照射野范围内的片状密度增高影,边缘模糊,与周围肺组织分界不清;随病情进展,病灶表现为不规则高密度影,边缘清楚,内部见空气支气管征;晚期病灶密度进一步增高,边缘较清楚,周围见纤维条索影,病灶体积较大时,该侧肺脏体积可缩小.结论:放射性肺炎影像学表现有一定特点,但应与放疗后复发、普通肺炎和肺不张鉴别.

目的:观察热敏灸配合刺络放血疗法治疗椎动脉型颈椎病的临床疗效.方法:将符合标准的椎动脉型颈椎病患者按数字表法随机分为治疗组和对照组,每组各125例.治疗组采用热敏灸配合刺络放血综合疗法治疗,对照组采用常规针灸治疗,对比观察治疗后患者头晕等临床症状和椎-基底动脉供血的改善情况.结果:治疗组总有效率93.60％,明显高于对照组的80.80％ (P ＜0.05),并且在提高主观症状积分及改善椎基底动脉供血等方面显著优于对照组(P＜0.05).结论:热敏灸、刺络放血综合疗法对改善椎-基底动脉供血、缓解椎动脉型颈椎病患者的临床症状、提高患者生活质量有积极的临床意义,且本方法系统、安全、有效,适宜推广.

Objective To observe the effect of ginkgo biloba extract on renal function and the expression of toll-like receptor 4 (TLR4),interleukin-6 (IL-6)and tumor necrosis factor-α(TNF-α)in diabetic nephrop-athy (DN)rats,and to explore its possible mechanism. Methods 30 adult male Wistar rats were randomly divided into control group,diabetic group and ginkgo biloba extract treatment group,with 10 rats in each group. The diabetic group and ginkgo biloba extract group were established by intraperitoneal injection of streptozotocin. After successful modeling,ginkgo biloba extract group was administered with 96 mg/kg ginkgo solution;blank control group and dia-betic group were intragastrically administered with equal volume of 0.9% sodium chloride injection once a day for 12 weeks. After 12 weeks of gavage,24 h urine protein quantitation,fasting blood glucose (FPG),urea nitrogen (BUN),creatinine (Cr)levels,and the contents of TLR4,IL -6 and TNF -α levels in renal tissues were ob-served.Results The levels of FPG in diabetic rats 48 hours after modeling and 12 weeks after gavage were higher than those in control group (P＜0.05). The levels of FPG in ginkgo biloba extract group 48 hours after modeling were similar to those in diabetic group (P＞0.05),but the levels of FPG in diabetic rats 12 weeks after gavage were lower than those in diabetic group (P＜0.05). The proteinuria,BUN and Cr levels in the diabetic rats were higher than those in the blank control group at 24 h after 12 weeks of gavage (P＜0.05). The proteinuria,BUN and Cr levels in the ginkgo biloba extract group were lower than those in the diabetic group at 24 h after 12 weeks of gavage (P ＜0.05). The levels of TLR4,IL -6 and TNF -α in renal tissues of diabetic rats were higher than those of control group after 12 weeks of gavage (P＜0.05). The levels of TLR4,IL-6 and TNF-α in renal tissues of ginkgo biloba extract group were lower than those of diabetic group after 12 weeks of gavage (P＜0.05). Conclusion Ginkgo biloba extract has a protective effect on the renal function of diabetic rats,and prevents the occurrence and development of DN. The mechanism may be related to inhibiting the expression of TLR4 in renal tissues and reducing the release of inflammatory factors IL-6 and TNF-α.

目的:探讨银杏叶提取物(ginkgo biloba extract,GBE)对糖尿病肾病(diabetic nephropathy,DN)大鼠氧化应激及肿瘤坏死因子-α(tumor necrosis factor,TNF-α)表达的影响.方法:将72只大鼠随机分为对照组、DM组和DM+ GBE组,每组各24只.采用一次性腹腔注射链脲佐菌素(60 mg·kg-1)的方法建立DM模型,造模成功后,DM+ GBE组给予96mg·kg-1·d-1的CBE灌胃,对照组及DM组均以生理盐水以同等剂量灌胃.检测各组大鼠给药前后尿素氮(blood ureanitrogen,BUN)、肌酐(serum creatinine,Scr)、尿酸(uric acid,UA)水平及大鼠的肾组织匀浆丙二醛(malonaldehyde,MDA)、一氧化氮(nitric oxide,NO)、TNF-α、总氧化状态(total oxidation state,TOS)水平.并对部分肾脏进行HE染色,高倍显微镜下观察肾小管和肾小囊的变化.结果:给药第12周,与对照组比较,DM组大鼠体质量明显降低;与DM组比较,DM+GBE组体质量明显增加,差异均有统计学意义(P＜0.05).给药第12周,与对照组比较,DM组及DM+ GBE组血糖水平升高;与DM组比较,DM+ GBE组血糖水平降低,差异均有统计学意义(P＜0.05).与对照组比较,DM组UN、UA的水平增高;与DM组大鼠比较,DM+ GBE组大鼠UN和UA浓度明显下降,差异均有统计学意义(P＜0.05).与对照组比较,DM组大鼠肾组织匀浆中MDA、TOS、NO、TNF-α水平升高;与DM组大鼠比较,DM+ GBE组大鼠肾组织匀浆中MDA、TOS、NO、TNF-α水平明显降低,差异均有统计学意义(P＜0.05).结论:氧化应激和继发的炎症反应参与了糖尿病肾病的发病发展过程,银杏叶提取物能减轻氧化应激及继发的炎症反应从而对糖尿病肾病肾脏起到保护作用.

Objective:To study the effect of ginkgo biloba extract(GBE) on the inflammatory response mediated by NLRP3 inflammasome in STZ-induced diabetic nephropathy (DN) rats and to explore the mechanism by which GBE protects the kidney of diabetic nephropathy.Methods..Wistar rats were randomly divided into the control group,diabetic group(DM) and diabetic nephropathy Ginkgo biloba group(DM+GBE).DM model was established by intraperitoneal injection of streptozotocin (60 mg/kg),and the animals were treated for 12 weeks of experiment.The levels of caspase-1,IL-1β and IL-18 were detected by immunohistochemistry.The expression of NLRP3,apoptosis-related speckle-like protein(ASC) and IL-1 β mRNA were detected by RT-PCR.The levels of serum TNF-α and IL-1β were detected by ELISA.Results:Compared with the control group,the level of blood glucose in DM group increased(P＜0.01).Compared with DM group,the blood glucose level decreased in the DM + GBE group,with significant difference (P ＜ 0.05).Compared with the control group,the levels of IL-1 β and IL-18 in renal cortex of DM group were significantly increased (P＜0.05).Compared with DM group,IL-1[β and IL-18 levels were lower,the difference was statistically significant (P＜ 0.01).The level of caspase-1 decreased slightly,with no significant difference (P＞ 0.05).Compared with the control group,the expression of NLRP3,ASC and IL-1β mRNA in DM group was significantly increased (P＜0.05).Compared with DM group,NLRP3,ASC and IL-1β mRNA levels were decreased,and the difference was statistically significant(P＜ 0.01).Compared with the control group,the levels of TNF-oα and IL-1 β were significantly increased in DM group (P＜ 0.05).Compared with DM group,the levels of TNF-α and IL-1β were decreased,and the difference was statistically significant (P＜0.01).Conclusion:The expression and activation of inflammatory factors related to NLRP3 may be involved in the occurrence and progression of DN.Inflammatory response may be alleviated by the intervention of Ginkgo biloba extract,suggesting that the protective mechanism of Ginkgo Biloba extract may be through inhibition of NLRP3 inflammatory body activity to achieve.

目的 探讨中西医结合治疗慢性心衰合并慢性肾衰竭临床疗效.方法 选择60例慢性心力衰竭伴慢性肾衰竭患者,随机分为治疗组和对照组,对照24例,治疗组36例,两组均予西医的扩冠、强心、利尿、降压、降脂、改善微循环治疗,治疗组在对照组治疗的基础上加用自拟中药方,两组均以3个月为一疗程.结果 两组治疗前后总有效率比较有显著性差异(P＜0.01),两组患者治疗后EF较治疗前明显升高,BNP较治疗前明显下降,且治疗组BNP下降幅度优于对照组(P＜0.05).结论 中西医结合治疗慢性心衰合并慢性肾衰竭患者疗效确切,可提高心功能,延缓肾功能的进展.

目的:观察自拟健脾渗湿涩肠止泻中药口服配合脐疗、耳穴贴压三位一体治疗慢性非特异性溃疡性结肠炎的疗效.方法:将确诊的140例慢性非特异性溃疡性结肠炎患者随机分为2组,治疗组70例予自拟健脾渗湿涩肠中药口服配合脐疗、耳穴贴压;对照组70例采用柳氮磺吡啶口服.15天为1疗程,3个疗程后统计疗效.结果:治疗组总有效率94.28％,对照组为70.00％,两组比较差异有统计学意义(P＜0.05),治疗组优于对照组.结论:健脾渗湿涩肠中药口服配合脐疗、耳穴贴压治疗慢性非特异性溃疡性结肠炎临床疗效显著.

目的:探讨自拟黄蛭方治疗糖尿病肾病的临床疗效.方法:选择210例2型糖尿病肾病患者,Mogensen分期为临床期糖尿病肾病,随机分为治疗组和对照组,对照组103例予拜糖平或(和)胰岛素治疗,血压高者予依那普利或替米沙坦(或缬沙坦),治疗组107例在对照组治疗的基础上加用自拟黄蛭方,两组均以3个月为1疗程.结果:两组治疗前后总有效率比较有显著性差异(P＜0.01).两组患者治疗后血肌酐、尿酸、β2-MG、24h尿蛋白均较治疗前明显下降,且治疗组血肌酐、β2-MG、24 h尿蛋白下降幅度优于对照组(P＜0.05).两组患者治疗后血白蛋白较治疗前明显升高,且治疗组血白蛋白升高幅度优于对照组.结论:黄蛭方对早期糖尿病肾病的多个发病环节可直接干预并有确切的疗效,能有效防治早期DN的发生发展.

Objective:To examine the effects of Ginkgo biloba extract(GBE) on oxidative stress and imflammation system in rats with diabetic nephropathy(DN),and investigate its protective effects as well as its mechanism on DN.Methods:The seventytwo wistar rats were randomly divided into three groups,such as control group,DN group and DN treated with GBE group.Using intraperitoneal injection of streptozotocin (60mg/kg) to induce diabete model.The kidneys were harvested for pathology observation,12 weeks later.The serum fasting blood glucose(FBG),total cholesterol,triglyceride,interleukin-6,blood insulin,SOD,blood creatinine,24 hours urine protein,the glomerular basement membrane thickening,and the numbers of total glomerular cells and monocytes were measured.Results:(1)In the modeling process,1 rat died in DN group,47 rats with model.(2)Blood glucose of the survival rats was more than 16.7 mmol/L.During the process of cultivating,one rat died.(2)In the process of modeling,the DN group weight increased obviously.At twelfth weeks,fasting blood glucose,triglyceride,interleukin-6,high sensitive C-reactive protein,serum insulin,serum creatinine and 24 h urine protein was highest in the DN group; SOD in the control group was the highest; comparison between groups showed statistically significant difference (P＜0.05).(3) in the process of modeling,the blood interleukin-6,creatinine and fasting blood glucose has gradually on the rise; SOD decreased; the difference was statistically significant in DM group and DM+GBE group at different time segments (P＜0.05).Conclusion:GBE may play a role by oxidative stress and reduced the formation process of inflammation in response to DN.

在临床工作中,我们发现部分慢性乙型肝炎,HBV-DNA、HBeAg均阴性,但肝功能反复异常,此类病人无抗病毒指征,一般保肝药物效果欠佳,治疗很棘手,我们运用自拟益肾活血汤治疗32例,效果较好,现报道如下: