Objective To investigate the clinical efficacy of Jiedu Huayu Hushen prescription in the treatment of acute－on-chronic liver failure（ACLF）complicated by hepatorenal syndrome（HRS）and its effect on endotoxemia. Methods Clinical data were collected from 96 patients with ACLF complicated by HRS who were diagnosed and treated in The First Affiliated Hospital ofGuangxi University of Chinese Medicine from March 2020 to June 2022，and they were divided into observation group and control group using a random number table，with 48 patients in each group. In addition to comprehensive Western medicine therapy，the patients in the control group were given norepinephrine and albumin，while those in the observation group were given Jiedu Huayu Hushen prescription combined with norepinephrine and albumin，and the course of treatment was 2 weeks for both groups. The two groups were compared in terms of serum endotoxin level，traditional Chinese medicine（TCM）syndrome score，24－hour urine volume，renal function，liver function，coagulation function，and clinical outcome. The independent－samples t test was used for comparison of continuous data between two groups，paired t－test was used for comparison before and after treatment within the group；and the chi－square test was used for comparison of categorical data between two groups. Results Compared with the control group after 2 weeks of treatment，the observation group had a significantly lower TCM syndromes core（P<0.05）， significantly lower levels of endotoxin，blood urea nitrogen，serum creatinine，cystatin C，and prothrombin time（all P<0.05），and significantly higher levels of glomerular filtration rate，24－hour urine volume，serum albumin，and prothrombin time activity（all P<0.05）. After 2 weeks of treatment，the observation group had a significantly higher overall response rate than the control group（87.50% vs 66.67%，P<0.05）. Conclusion Based on comprehensive Western medicine therapy，Jiedu Huayu Hushen prescription can reduce serum endotoxin level，improve liver and renal function and coagulation function，and increase urine volume in patients with ACLF complicated by HRS，with a better clinical efficacy than Western medicine therapy alone.

目的:为进一步做好肝硬化住院患者整体护理工作,促进患者康复,分析心理护理干预对肝硬化患者治疗状态的影响.方法:选择2018年10月至2019年10月广西中医药大学第一附属医院住院的肝硬化患者60例,随机分为对照组和观察组各30例.对照组采用常规护理方法,观察组在此基础上采用心理护理干预方法.4周后比较两组患者焦虑、抑郁、健康调查表评分及临床依从性,计算患者对护理服务满意度.结果:护理干预4周后,两组患者SAS和SDS评分较前均有所降低,统计分析可知观察组的效果优于对照组(P<0.05);两组患者在SF-36各领域评分较前均升高,观察组在多个领域高于对照组(P<0.05);观察组患者的依从性及护理满意度高于对照组(P<0.05).结论:在常规护理基础上,增加心理护理能有效改善肝硬化患者整体生活状态,有利于疾病的治疗和康复.

目的:比较研究基于思维导图的中医内科学专业研究生教育与传统教学对学生批判思维能力提升的效果,为中医内科专业研究生人才培养模式改革与完善提供客观依据.方法:采用批判性思维量表对实验班和传统班进行调查分析.结果:实验班学生批判性思维量表总分、寻找真相、分析能力、求知欲、认知成熟度、思想开放、系统化能力、自信心得分明显高于传统班学生(P<0.05);实验班的临床应用题显著优于传统班(P<0.05),而两班的客观题期末考试成绩相似(P>0.05).结论:基于思维导图的中医内科研究生教育能促进医学生临床批判性思维的培养.

Objective To explore the effect of Zhuang medicine cream and acupoint sticking on preventing and treating recurrent respiratory tract infection (RRTI) in children.Methods 92 cases (10 cases drop out) of recurrent respiratory infection (as lung and spleen-qi deficiency syndrome) were divided into experimental group and control group according to the random number table method.The experimental group was treated with Zhuang medicine cream and acupoint sticking, and the control group was taken orally with the same prescription drugs, the total dosage of the 2 groups was equal, the other treatment and nursing measures were the same, the course of treatment was 60 days, the observation period last 1 year, the observation index was the number of annual incidence, the average course of disease, the level of immunoglobulin (IgA, IgG, IgM) and the safety of drug use.Results The number of annual incidence and the average course of disease after treatment in the 2 groups were significantly lower than before (P＜0.05).The levels of IgA and IgG in the 2 groups were significantly higher than those before the treatment (P＜0.05), and the experimental group was better than the control group, and the changes of IgM were not statistically significant.No adverse reaction was found in 2 groups.Conclusion The application of antiperspirant retention cream and Zhuang medicine point can improve the immunity of children with RRTI, and has a good effect on reducing the number of annual onset and shortening the course of disease.

目的:探讨临床护理路径在肝衰竭患者健康教育中的应用效果.方法:将80例肝衰竭患者随机分为观察组和对照组各40例.对照组采用常规护理模式护理,观察组采用临床护理路径护理,比较2组健康知识掌握情况、护理满意率、住院时间、住院费用等.结果:观察组患者的健康知识掌握率和护理满意率均明显高于对照组,观察组患者的住院时间和住院费用均明显少于对照组.结论:将临床护理路径应用于肝衰竭患者的护理中,可显著提高患者的健康教育质量.

目的 观察解毒化瘀颗粒在ACLF治疗中对Th17细胞介导的免疫应答的干预效应及临床疗效.方法 采用开放性、区组随机、平行对照临床实验方法,随机分为治疗组(解毒化瘀颗粒+西医基础综合)和对照组(西医基础综合治疗),采用全自动生化检测系统检测血清ALT、TBIL、PTA等相关生化指标,流式细胞仪分析患者IL-17+细胞的数量,与采集的外周血中的CD4+细胞比较,得到Th17细胞频率的变化情况,评价解毒化瘀颗粒在治疗ACLF中对Th17细胞介导的免疫应答的干预作用.结果 治疗组患者的肝功能及凝血功能、预后改善情况、病死率等方面优于对照组(P＜0.05);治疗组外周血中Th17细胞在CD4+T细胞中的比例较对照组显著下降,差异具有统计学意义(P＜0.05).结论 中西医结合方案的临床疗效要优于单纯西医治疗方案;其作用机制可能是通过降低ACLF患者外周血CD4细胞中IL-17+细胞的细胞数量,从而降低Th17细胞的频率,干预Th17细胞介导的免疫应答,达到改善ACLF患者预后的目的.

目的:以正常大鼠为参照,探索急性肝衰竭(AHF)大鼠血清中的差异性代谢物.方法:采用腹腔注射脂多糖(LPS)和D-氨基半乳糖胺(D-GaIN)建立AHF大鼠模型.收集30只AHF和30只正常大鼠的血清样本,采用气相色谱-质谱联用(GC/MS)的代谢组学方法对样本进行检测,并采用主成分分析(PCA)和偏最小二乘法-判别分析(PLS-DA)方法进行建模分析,结合t检验进行组间比较,最终确定AHF大鼠血清代谢物谱中特异性的代谢物.结果:在AHF组大鼠血清中有11个主要代谢物与正常大鼠血清比较差异有统计学意义(P＜0.05),包括甘氨胆酸、甘氨鹅脱氧胆酸、牛磺鹅脱氧胆酸、甘氨酸、海藻糖、十六烷酸酰胺、卵磷脂、油酸酰胺、硬脂酰胺、甘露糖、硬脂酸.结论:与正常大鼠比较,AHF组大鼠血清中存在差异性代谢物,这些代谢物可能作为AHF特异性生物标志物,并有助于揭示AHF的发病机制.

Objective:To explore correlation between endotoxin level in plasma and Child-Pugh score in patients with chronic severe hepatitis (CSH)in different pattern of Traditional Chinese Medicine (TCM).Methods:100 hospitalized cases with CSH from department of liver disease were divided into five groups according to the TCM pattern identification.Normal control group was set up with 20 healthy adults.Child-Pugh score and endotoxin in plasma were calculated and tested respectively in each group and then statistic analysis were made.Results:Endotoxin was not detected in 20 healthy adults.The correlation coefficient in the pattern of heat toxin entering blood was largest and its correlation coefficient was r =0.751 (P ＜ 0.01).The following pattern was heat toxin flaming and its correlation coefficient was r =0.481 (P ＜ 0.01).The remaining three groups also had certain correlation,but the correlation coefficient were slightly less than those of the heat toxin entering blood group and heat toxin flaming group.Conclusion:There was a positive correlation relationship between Endotoxin level and Child-Pugh score.With higher endotoxin level,Child-Pugh score was higher and the mortality was also higher in patients with different TCM patterns.

Objective:To observe the short-term efficacy of modified Yinchenzhufu decoction in patients with chronic liver failure (CLF).Methods:Three hundred eligible patients with CLF characterized by Yin jaundice syndrome were randomized equally to receive either western comprehensive treatment alone (control group, n =150) or in combination with modified Yinchenzhufu decoction (trial group, n =150) for 8 weeks.Baseline characteristics were compared between both groups prior to treatment initiation.At 8 weeks after treatment, pa-tients in both groups were compared to see if there was any difference in the efficacy parameters.In addition, a follow up was performed at 3 months for any difference in short-term outcomes between both groups.Results:The addition of modified Yinchenzhufu decoction was associat-ed with significantly reduced clinical symptom scores, as well as significantly improved liver function and coagulation function (all P <0.01 ), compared with western comprehensive treatment alone.Overall, significantly more patients responded to the combination therapy than to the monotherapy (P <0.01).Conclusion:Modified Yinchenzhufu decoction appears to have a significantly higher efficacy in protecting the liver, improving clinical symptoms, and reducing mortality in patients with CLF, compared with western comprehensive treatment alone.

This paper reviews traditional Chinese medicine (TCM) physicians′understanding of liver failure including its TCM causes, mechanisms, positions, and syndrome differentiation in various dynasties. The results suggest that modern researchers agree with ancient physicians on these aspects of liver failure. Based on achievements of ancient TCM physicians, modern researchers have further developed and improved their understanding of TCM causes, mechanisms, positions, and syndrome differentiation of liver failure. Moreover, this paper discusses the treatment of chronic liver failure with yang-supporting therapy, which provides a novel perspective and method for treating chronic liver failure.

Objective: To evaluate the efficacy of a Chinese-western combination therapy using the detoxification and stasis-resolving granules in patients with hepatitis B acute-on-chronic liver failure.Methods: Sixty eligible patients were randomized in 1∶1 ratio to receive conventional western medical therapy alone ( control group ) or in combination with the detoxification and sta-sis-resolving granules ( test group ) for 8 weeks.The duration of follow-up was 48 weeks.Overall outcomes and changes in liver function , coagulation function , plasma ammonia and HBV DNA from baseline were assessed and compared between both groups.Results: The combotherapy was associated with significantly improved liver function and coagulation function , compared with the monotherapy (P<0.05) .There were no significant differences in the changes in plasma ammonia or HBV DNA from baseline between both groups (P>0.05) .The overall response rate was 80.0%in the test group, compared with 53.3%in the control group (P<0.05) .The difference in survival at week 48 between both groups reached statistical significance (P<0.05), sug-gesting a definitive efficacy of the detoxification and stasis-resolving granules in patients with hepatitis B acute-on-chronic liver failure.Conclusion: Further research is warranted to investigate the superior efficacy of the detoxification and stasis -resolving granules-dominated combination therapy over conventional western medical therapy alone.This combotherapy should be consid-ered for frequent use in clinical practice.

乙肝后肝硬化是临床上常见的疾病之一,若其得到有效治疗则会阻止或廷缓其向失代偿期、肝癌、肝衰竭等终未期肝病发展.笔者通过临床中对1例乙肝后肝硬化患者的及时治疗,获效甚佳;并认为及时正确的抗乙肝病毒和抗肝纤维化治疗是成功治疗乙肝后肝硬化的关键所在.

<正>随着社会的发展,隐私权问题越来越受到人们关注,国家对于公民隐私权的立法也日趋完善。2010年7月1日起,《侵权责任法》正式施行,第一次以立法的形式明确了隐私权为具体人格权,规范了患者隐私权侵权主体的范围,为患者隐私权的保护提供了有力的法律依据。在门诊诊疗