目的 观察腹部八法治疗餐后不适综合征(postprandial distress syndrome,PDS)伴焦虑状态的临床疗效.方法 将88例PDS伴焦虑状态的患者随机分为对照组和治疗组,各44例.治疗组采用腹部八法治疗,对照组采用口服枸橼酸莫沙比利治疗,共治疗4周.治疗前后以及4周、8周随访时分别对2组进行餐后不适综合征症状积分、HAMA焦虑量表评分,记录2组治疗过程中的不良反应.结果 治疗后,治疗组总有效率97.7％,高于对照组的86.4％,差异有统计学意义(P＜0.05).与治疗前比较,治疗4周后及4、8周随访时,2组餐后腹胀不适、早饱、胃纳减少、嗳气、上腹灼热症状积分及总分均降低(P＜0.05);2组8周随访时上腹灼热评分比较,差异无统计学意义(P＞0.05),其他各项评分治疗组均低于对照组(P＜0.05).治疗4周及4、8周随访,2组HAMA评分均较治疗前降低(P＜0.05),且治疗组HAMA评分均低于对照组(P＜0.05).治疗过程中及8周随访时,2组均未出现不良反应.治疗组无明显复发,对照组有4例患者在治疗结束后4～8周出现复发.结论 腹部八法能够明显缓解PDS患者的临床症状和焦虑状态,安全且无复发.

目的:应用Meta分析针刺联合中药内服治疗糖尿病视网膜病变(diabetic retinopathy,DR)的临床疗效.方法:检索PubMed、Embase、Web of Science、Cochrane Library、中国知网(CNKI)期刊数据库、万方数据库及中国生物医学文献数据库(SinoMed)中针刺联合疗法治疗DR的文献,运用Stata进行Meta分析.结果:共纳入10篇文献,Meta分析结果显示,与其他治疗疗法相比,针刺联合中药内服显著提高了总有效率(RR=1.21,95％CI为1.13～1.30)、视力水平(WMD=0.18,95％CI为0.11～0.25)、黄斑厚度(WMD=-32.25,95％CI为-48.94～-15.56)和视敏度(WMD=2.92,95％CI为2.57～3.27),与对照组相比差异均有统计学意义(P<0.01).结论:针刺联合中药内服用于治疗DR可以显著提高患者视力水平和视敏度,降低黄斑厚度,减缓疾病发展,改善患者症状.

目的 探讨阿托伐他汀联合二甲双胍治疗初发2型糖尿病伴高脂血症的疗效及患者糖代谢、血脂指标的变化.方法 选择初发2型糖尿病伴高脂血症患者130例,根据随机数字表法将其分为观察组(n=70)和对照组(n=60),对照组采用二甲双胍治疗,观察组采用阿托伐他汀联合二甲双胍治疗,比较2组患者的疗效、血糖、血脂水平变化及不良反应情况.结果 观察组总有效率为92.86％,显著高于对照组总有效率73.33％,组间比较差异具有统计学意义(P＜0.05).治疗前,2组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平无显著差异;2组患者空腹血糖、餐后2h血糖水平及HbA1c无较大差异.治疗前后2组患者空腹血糖、餐后2h血糖水平和HbA1c比较有较大差异(P＜0.05).治疗后,2组患者空腹血糖、餐后2h血糖、HbA1c水平降低(P＜0.05).2组患者治疗过程中出现恶心、呕吐、胃肠道反应及低血糖症状,观察组总不良反应发生率为11.43％,高于对照组不良反应发生率15.00％.结论 阿托伐他汀联合二甲双胍治疗初发2型糖尿病伴高脂血症取得显著的效果,可有效改善患者血糖、血脂水平,具有较高的安全性.

目的 观察孙氏降糖饮治疗气阴两虚型2型糖尿病的临床疗效.方法 将入选的90例气阴两虚型2型糖尿病患者随机分为2组,各45例,均给予基础治疗,对照组予二甲双胍治疗,治疗组加用孙氏降糖饮中药治疗.比较治疗12周后患者空腹(FPG)及餐后2h血糖(2 hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、胰岛素敏感指数(ISI)、体质指数(BMI)、中医证候积分及血常规、肝肾功的变化情况.结果 治疗12周后,治疗组与对照组FPG、2hPG、HbA1c、FINS均有明显下降,治疗组较对照组下降显著,差异有统计学意义(均P＜0.05);ISI均较治疗前明显升高,治疗组较对照组升高显著,差异有统计学意义(P＜0.05);BMI均较治疗前降低,但2组差异无统计学意义(P＞0.05).治疗组中医证候疗效显著优于对照组,差异有统计学意义(P＜0.05);2组血常规、肝肾功均无明显变化.结论 孙氏降糖饮配合二甲双胍治疗2型糖尿病,能够显著降低患者的血糖指标,减轻胰岛素抵抗,缓解临床不适症状,安全有效.

Objective To evaluate the clinical effect of Xueluokang decoction lavipeditum on diabetic peripheral neuropathy(DPN) of cold-stagnation and blood-stasis type.Methods From January 2017 to January 2018,70 DPN patients in Beijing Hepingli Hospital were randomly divided into observation group and control group,with 35 cases in each group.Both groups were treated by rational diet,exercise guidance,hypoglycemic drugs and mecobalamin tablets.The control group was given lavipeditum with warm water and the observation group had lavipeditum with Xueluokang decoction once daily for 4 weeks.Total curative effect,score of Toronto Clinical Scoring System(TCSS),vibration perception threshold(VPT) were assessed and adverse reactions were observed.Results Total effective rate in observation group was significantly higher than that in control group[85.7％ (30/35) vs 60.0％ (21/35)] (P ＜ 0.05).After treatment,TCSS score and VPT of bilateral lower limbs were lower than those before treatment and they were lower in observation group than those in control group [(3.2 ± 0.8) vs (6.2 ± 0.6),left VPT:(14.1 ±1.9)V vs (18.2±2.1)V,right VPT:(13.5 ±1.5)V vs (18.0 ± 1.6)V] (all P＜ 0.05).There was no significant difference of the incidence of adverse reactions between groups (P ＞ 0.05).Conclusion Xueluokang decoction lavipeditum can alleviate clinical symptoms,improve TCSS score and VPT in DPN oatients.

现代医学中的“血糖”,在中医学中应当属于“水谷精微”的范畴.贺仲晨主任认为初发糖尿病血糖异常及胰岛素抵抗与“脾主运化”、“脾藏精”、“脾主内”等功能失调有关,并提出脾主糖的理论.在调理脾胃的治疗方法上,可从养脾阴、益脾气、化脾湿等方面入手.根据辨证,或与清胃同施,或与益肾相兼,终这脾运得健,水谷精微的转输与利用恢复正常,血糖降低、糖尿病并发症等得以好转为目的.

目的 研究血清新蝶呤对急性冠状动脉综合征(ACS)患者早期诊断和判断预后的临床意义.方法 选取2009年9月至2011年12月急诊就诊的ACS患者400例,其中不稳定型心绞痛(UAP)组325例,急性心肌梗死(AMI)组75例,选取同期健康体检者400例(对照组).检测ACS患者入院第1、3、7天和对照组血清新蝶呤水平及血脂、肝功能、肾功能等,并对各组检验结果进行比较.结果 AMI组和UAP组入院第1天血清新蝶呤水平显著高于对照组[(8.21±4.31)、(6.18±3.37)μg/L比(2.31±0.76) μg/L],差异有统计学意义(P＜0.01),而各组之间的年龄、性别构成、收缩压、舒张压、血糖、血脂、肝功能、肾功能等比较差异无统计学意义(P＞0.05).AMI组血清新蝶呤水平于入院第1、3、7天均显著高于UAP组[(8.21 ±4.31)μg/L比(6.18±3.37)μg/L、(5.87±2.34) μg/L比(4.04±1.73) μg/L、(3.35±1.67)μg/L比(2.85±0.75) μg/L],差异有统计学意义(P＜0.05),且两组血清新蝶呤水平随患者入院时间延长呈逐渐下降趋势(P＜0.05).结论 血清新蝶呤水平升高与ACS的发生有关,可能是不稳定斑块及ACS的预测因子.

Objective: Objective: To investigate the differences of the scores from different raters in taking the Acute Physiology and Chronic Health Evaluation(APACHEII) and the causes of the difference.Methods: Two doctors got the APACHE II scores from the same 32 cases of severe patients.The consistency of the data and scores of each indicator were prospectively analyzed and the causes of the inconsistence were discussed.Results: The consistency of APACHE II score from two doctors was low(Kapp = 0.695).The consistency of chronic health score(Kappa = 0.75) and age score(Kappa = 0.956) were better,but they were of poor agreement(Kappa = 0.728) in terms of acute physiology score(APS).From the indicators of APS,the two doctors recorded a total of 160 different raw data,and eventually got 52 different physiological scores.The highest proportion of three items,were first for the serum potassium(8 / 11),second for AaDO2(9 / 20),and third for the mean arterial pressure(11/25).The main reason causing the difference scores was the differences of physiological indicators(85.2%).Nine differences in scores were found when taking the same data,of which eight were caused by not following oxygenation rate score,and the other one is caused by different values.Conclusion: In order to further improve the accuracy of scores,it is necessary to strengthen the assessment criteria and do professional training positively.

目的:总结气管插管在急救中应用的经验。方法:回顾性分析2007-01/2009-02北京市和平里医院急诊进行的78例气管插管抢救危重患者的临床资料。结果:78例急诊气管插管中,72例为1次插管成功。6例为2次插管后成功。结论:气管插管是急诊抢救危重患者的基础,对保证进一步心肺复苏、挽留手术机会以及提高危重患者抢救成功率有重要意义。

目的探讨急性冠脉综合征(ACS)患者血浆同型半胱氨酸(Hcy)含量与颈动脉内膜中层厚度(IMT)的相关性。方法2008年6月—2009年5月在我院急诊就诊的ACS患者268例,分为非高Hcy组(≤15μmol/L)和高Hcy组(>15μmol/L),进行Hcy、IMT、血脂和血糖检测,并对吸烟、饮酒等相关危险因素进行调查。结果(1)与非高Hcy组比较,高Hcy组的右颈内动脉、左颈总动脉、左颈内动脉的IMT值显著升高(P均<0.05);(2)Hcy与右颈内动脉、左颈总动脉、左颈内动脉IMT值及饮酒、吸烟呈正相关(r=0.11～0.27,P均<0.05),与HDL-C呈负相关(r=-0.15,P<0.05)。结论ACS患者Hcy与颈动脉IMT、吸烟、饮酒呈正相关,与高密度脂蛋白胆固醇呈负相关。

Objective:To explore dynamic state change of the serum neopterin level(Npt)in patients with acute coronary syndromes(ACS).Methods:30 patients with unstable angina pectoris(UAP) group and 30 patients with acute myocardial infarction (AMI) group were as experimental group,and 30 healthy persons were as normal group.Serum neopterin levels on 1st,3rd,7th,day of the experimental group,and normal group were examined respectively.Results:Serum neopterin levels on 1st day of experimental group were significantly higher than those of normal group(P0.01);serum neopterin level of experimental group on 1 st,3rd day was significantly higher than that on 7th day(P0.05).Conclusion:High neopterin levels is correlated with acute coronary syndromes(ACS).It maybe a predictor of vulnerable plaques and ACS.

目的 评估颅面部疼痛是否可以是心肌缺血的唯一症状,以及由心脏起源的颅面部疼痛的发生率、分布情况和性别差异.方法 连续选取到我院急诊室就诊并已证实有心肌缺血的患者186例,评估是否存在颅面部疼痛.对存在颅面部疼痛的患者研究其疼痛位置、放射区域及疼痛的细节.结果 71例(38%)在心肌缺血时感觉到颅面部区域疼痛;女性的发生率高于男性(P=0.031).11例(6%)颅面部疼痛是心肌缺血过程中的唯一症状,其中3例为急性心肌梗死(AMI).结论 颅面部疼痛可由心肌缺血引起,并且可以是心肌缺血的唯一症状,这一点必须在对牙痛和口面部疼痛的诊断时被考虑到.

目的探讨不同剂量的阿托伐他汀治疗急性冠状动脉综合症的疗效.方法90例急性冠脉综合征患者随机分为3组:A组为常规治疗组(30例)予以常规治疗但不用降脂药物;B组(30例)为20mg阿托伐他汀治疗组;C组为40mg阿托伐他汀治疗组(30例);30例稳定性心绞痛患者为对照组。90例急性冠脉综合征患者在治疗2周前后分别测定血清高敏C反应蛋白(hs-CRP)及血脂水平。结果90例急性冠脉综合征患者就诊时的血清高敏CRP水平明显高于对照组稳定性心绞痛患者(P<0.05),B、C组治疗2周后血清高敏CRP较前有明显下降(P<0.05),而以C组作用更明显。结论急性冠脉综合征患者血清高敏CRP水平增高,早期他汀类药物强化治疗可使急性冠脉综合征患者获益更大。

目的探讨非ST段抬高急性冠状动脉综合征(ACS)患者早期介入治疗与单纯药物治疗对预后的影响。方法收集2005年9月至2007年11月入院的非ST段抬高ACS患者共181例临床资料,分成单纯药物治疗组和介入治疗组,随访患者发病30d和6个月心血管不良事件的发生率。结果与早期单纯药物治疗相比,早期介入治疗能够降低30d和6个月时心血管不良事件(P<0.05)。经随访,中危患者早期介入治疗组与药物治疗组30d时心血管不良事件发生率分别为8.1%和9.5%,6个月随访时分别为11.7%和15.0%,差异均无统计学意义(P>0.05);高危患者心血管不良事件30 d时的发生率分别为14.6%和43.4%,6个月时发生率分别为25.8%和86.9%,差异均有统计学意义(P<0.05)。结论对于中危患者早期介入治疗和药物保守治疗对心脏事件的影响差异无统计学意义,而对于高危患者早期介入治疗可显著降低近期和远期的心脏事件的发生率。

Objective To study on whether atrial fibrillation(AF)is associated with an increased risk for acute coronary syndrome(ACS)in emergency department(ED)patients with chest pain syndromes.Methods We collected the datum of the patients with chest pain in the ED of our hospital from July 2001 to August 2006.The enrolled patients were divided in two groups:AF group and control group.Measured outcomes were ACS acute myocardial infarction(AMI),and unstable angina(UA).The relative risks of ACS associated with AF were evaluated.Results 140 patients with AF and 683 matched control subjects were selected.The rates of AMI in AF group and control group were 11.4% and 10.8%,respectively;those of UA were 16.4% and 15.8%,respectively,and those of ACS were 27.9% and 26.7%,respectively.The relative risks of ACS did not increase in the patients with AF:AMI,1.05 95% confidence interval(CI)=0.63~1.75;and UA,1.05(95% CI=0.6~1.7);ACS,1.05(95% CI=0.78~1.40).Conclusion AF of the patients with chest pain syndromes in ED is not associated with an increased risk for ACS.

目的探讨血清CRP水平变化在感染性肺炎治疗中的应用。方法对160例确诊为感染性肺炎的住院患者和同期门诊上呼吸道感染80例以及87例健康人分别进行CRP、白细胞总数和白细胞分类测定。结果门诊患者的CRP(73.3±3.6)mg/L显著低于我院患者(132±11.3)mg/L;住院患者治疗前为(132±11.3)mg/L,治疗后降低到(33.7±28.8)mg/L,差异有显著性(P<0.001)。结论血清C-反应蛋白增高可作为诊断感染性肺炎时判断其愈后及疗效判定的一项指标。

Objective To investigate the relationship between the sensitivity of cardiac markers and the symptom duration.Methods We divided all adult patients who presented to our Emergency Dcpartment(ED)with symptoms suggesting of acute myocardial infarction(AMI)into two groups.Patients in one group came to the ED late(6～24h)after their symptom's onset,and the other patients in another group arrived earlicr(<6h).We drew serum samplc for creatine phosphokinase(CK),CK-MB,and troponin T upon arrival(time 0)and 2h later.Compared the sensitivity of three commonly used cardiac markers between two groups.Results For time 0,the sensitivity of all three markers for acute MI was significantly higher among those subjects with symptoms of 6 or more hours' duration as compared to those with less.At the time of the 2-h sample,the differences in sensitivities were much less and were not statistically significant.Conclusion The cardiac marker values obtained at time 0 among Emergency Department patients who arrive 6 or more hours after cardiac symptom onset provide significantly higher sensitivities as compared to those obtained in patients who arrive earlier.For troponin T,the increase in sensitivity approaches threefold.

Objective To assess the relationship of C-reactive protein(CRP) elevation with long-term outcomes and heart failure in patients with acute coronary syndrome(ACS).Methods CRP level was measured in 446 ACS patients on admission in emergency department.All-cause mortality and rate of rehospitalisation for acute myocardial infarction(AMI) and congestive heart failure(CHF) were obtained for up to 3 years' follow up.Results Patients with CRP level above cut-off had a higher rate for death and CHF readmission.After adjusting for troponin T level,high CRP level(>7.44 mg/L) was still significantly associated with high risk for death and CHF.Conclusions ACS patients with early CRP level elevation have higher risk for death and heart failure.

自1994年6月至2000年1月,本院急诊科用尿激酶静脉溶栓治疗AMI100例,现将临床资料分析如下: