目的 探讨胆道手术后带T管出院患者院外护理需求及移动健康教育的作用效果.方法 选取2019年8月1-31日我院行胆道手术后带T管出院的116例患者作为研究对象.出院前调查患者对T管护理知识的掌握程度与院外护理需求.出院后实施移动健康教育,借助微信渠道实施健康宣教、在线咨询与指导等院外护理.回院复查时再次调查患者院外护理知识掌握程度.随访患者在此期间并发症发生情况及对移动健康教育的满意度情况.结果 移动健康教育干预前患者对护理知识的掌握程度评分为(31.35±5.06)分,干预后患者对护理知识的掌握程度评分为(50.81±6.42)分,评分较干预前显著升高(P＜0.05).116例患者中出现5例管道移位或脱落、3例腹部不适、1例皮肤刺激,未出现胆道感染;总的并发症发生率为7.76％,总满意度为98.28％.结论 胆道手术后带T管出院患者对院外护理需求较高,院外T管护理知识掌握水平低,需要加强出院后的健康教育.采用移动健康教育能改善其院外护理知识的掌握程度,减少并发症的发生,提升患者的满意度.

肥胖的发病率在逐年升高是一个严重的公共卫生问题.在肥胖的多种综合治疗方法中,中医治疗取得了显著效果,其多从痰湿辨证入手,但作用机制仍不明确.近年来,许多研究不仅发现痰湿和免疫系统之间存在密切关系,还揭示了免疫机制在肥胖发病过程中起重要作用.本文通过概述痰湿型肥胖的外周及肠道免疫机制,发现痰湿型肥胖者脂肪组织中I型免疫相关细胞增多,随其分泌的促炎因子增多表现为慢性低度炎症,肠道免疫机制则与肠道淋巴细胞、细胞因子、免疫球蛋白及菌群的调节失调相关.并进一步探讨化痰祛湿中药治疗肥胖的潜在机制,为从痰湿论治肥胖提供相关科学依据.

Objective: To evaluate the effect of insulin pump on perioperative patients with type 2 diabetes and the role of health economics by applying data envelopment analysis (DEA). Method: This retrospective study involved 639 patients with type 2 diabetes undergoing surgery in Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2009 to November 2017. All patients were treated with insulin during the perioperative period. They were divided into a insulin pump group for diabetes (perioperative blood glucose control with insulin pump, 369 cases) and a Non-insulin pump group (perioperative blood glucose control with subcutaneous insulin injection, 270 cases). Data Envelope analysis was applied to compare the input indicators of the two groups to total cost and total length of hospital stay. The output indicators of the two groups were blood glucose control time before surgery, mean fasting blood glucose, blood glucose in the first sky after surgery, days of antibiotic use, and hospital stay after surgery. Result: In the aspect of comparison of scale efficiency, the efficiency values of the pump set in the C2R model and BC2 model are better than those of the unused pump set. In Another aspect of the relaxation variables, the higher the surgical level, the closer the pump group is to the ideal state compared with the non-pump group, in terms of improving average fasting blood glucose, antibiotic use days, preoperative blood glucose control time, first day postoperative fasting blood glucose, and postoperative hospitalization days. Conclusion: Insulin pump can quickly and stably control blood glucose levels and shorten the length of hospital stay during the perioperative period of type 2 diabetes patients. It is suggested that the application of insulin pump in perioperative period may have better benefits and is worthy of clinical promotion. Disclosure W. Song: None. J. Wen: None. L. Zhao: None. G. Fan: None. M. Luo: None. J. Liang: None. J. Zhang: None. C. Yang: None. Q. Wang: None. Z. Gao: None. L. Ma: None.

目的:观察痰湿质肥胖人群腹型肥胖相关指标与其外周血T辅助细胞(T helper cells,Th)亚群比例变化的相关性.方法:共入选61例病例,根据中医体质评判标准及体重指数(body mass index,BMI)分为痰湿质肥胖组32例及非痰湿质肥胖组29例,另纳入30名BMI正常且中医体质辨识为平和质的健康人作为平和质正常对照组.采用流式细胞仪单克隆免疫荧光法分选Th1、Th2细胞并计算其比值,生物电阻抗检测内脏脂肪面积,皮脂厚度计测量腹部皮下脂肪厚度,测量身高、腰围(WC)并计算腰臀比(WHR)、腰高比(WHtR)等腹型肥胖指标,进一步分析这些腹型肥胖指标与Th1/Th2比值的关联性.结果:痰湿质肥胖组的Th1细胞比率、Th1/Th2比值均显著高于非痰湿质肥胖组、平和质正常对照组(P＜0.05);痰湿质肥胖组、非痰湿质肥胖组的Th2比率均明显低于平和质正常对照组(P＜0.05).相关分析结果显示,痰湿质肥胖组的内脏脂肪面积、腹部皮下脂肪厚度、WC、WHR及WHtR分别与Th1/Th2比值呈正相关关系(r=0.509,r=0.714,r=0.788,r=0.491,r=0.778,P＜0.05).结论:痰湿质肥胖患者体内均存在明显的Th1/Th2细胞比率失衡且与腹部脂肪堆积及腹型肥胖程度明显相关.这可能是痰湿质人群具有更高的腹型肥胖患病率的原因之一.

目的 对范冠杰教授运用"动-定序贯八法"治疗糖尿病周围神经病变的临床医案进行数据挖掘分析,寻求其组方用药规律.方法 筛选并纳入范冠杰教授运用"动-定序贯八法"治疗的糖尿病周围神经病变门诊临床医案197例,应用中医辅助传承系统(TCMISS)V 2.5软件建立数据库,并进行相关数据挖掘.结果 共筛选出方剂370首,方剂中使用频次排名前10位的药物分别为丹参、甘草、牡丹皮、生地黄、茵陈、莪术、白芍、薏苡仁、薄荷、葛根;高频药对42条,核心组合38个,新处方4个.结论 通过对"动-定序贯八法"治疗糖尿病周围神经病变的临床医案中的药物之间关联性的定量描述,提取核心组合,并进一步发现符合动-定序贯组方规律的新处方及新组合,可为研发防治糖尿病周围神经病变的中药制剂提供参考.

目的:利用中医传承辅助系统(TCMISS)软件对既往中医药治疗高尿酸血症的中药处方进行组方规律分析,为临床辨证及处方用药提供思路.方法:分别检索中国知网(CNKI)、万方、维普、中国生物医学数据库(CBM)4个数据库1989-2016年中药治疗高尿酸血症的相关文献,对符合标准的175篇文献中的181首处方录入中医辅助平台软件,分析处方中药物的使用频次及用药模式,挖掘药物核心组合和新处方.结果:对筛选出的181首中药处方进行分析,得出药物的使用频次、常用药物组合及药对,其中核心用药为苍术、黄柏、薏苡仁、牛膝、土茯苓、萆薢、威灵仙,挖掘出28个核心组合和14首新处方.结论:高尿酸血症常用的药物以利水渗湿药、清热药、补益药、活血化瘀药为主,治法以清热利湿,健脾渗湿,补益肝肾,兼以活血化瘀为主.

目的:对近30多年来国内关于中医药治疗早中期脾肾阳虚型糖尿病肾病的文献进行挖掘分析,寻求中医药治疗早中期脾肾阳虚型糖尿病肾病方剂的组方用药规律.方法:检索CNKI、万方、维普等数据库,筛选纳入有关中医药治疗早中期脾肾阳虚型糖尿病肾病的文献,建立数据库,并进行相关数据挖掘,分析其配伍及用药规律.结果:共筛选出治疗早中期脾肾阳虚型糖尿病肾病方剂47首,对其进行分析,方剂中出现频次较高的前10味药物分别为黄芪、丹参、山药、生地黄、山2萸、茯苓、当归、太子参、泽泻.挖掘出高频药对8个,核心组合2个,新处方6个.结论:本研究应用数据挖掘方法,系统总结了早中期脾肾阳虚型糖尿病肾病用药规律,为临床辨证论治和进一步的科学研究提供数据支撑.

Objective To analyze the literatures on diabetic nephropathy(DN)at the early and middle stage dif-ferentiated as qi and blood deficiency and blood stagnation treated with Chinese herbal medicines in recent over 30 years of China and explore the rules of the formula combination of the disease.Methods Retrieved from the databases of CNKI, Wanfang and VIP,the literatures on DN at the early and middle stage differentiated as qi and blood deficiency and blood stagnation treated with Chinese herbal medicines were screened and included.Using TCM inheritance supporting system (TCMISS)of 2.5 Software,the database was set up and the data were mined.Results A total of 211 formulas were col-lected and analyzed for the treatment of DN at the early and middle stage differentiated as qi and blood deficiency and blood stagnation.The top 10 herbs with high frequency in the formulas were astragalus membranaceus,salvia miltiorrhiza, Chinese yam,radix rehmanniae recen,cornus,poria cocos,angelica sinensis,radix pseudostellariae and rhizome alismatis.A total 23 pairs of high-frequency used herbs and core combinations as well as 8 new prescriptions were mined.Conclusion Through the quantitative analysis on the medicinal relevance,the invisible experiences are mined widely and deeply and the new formulas of TCM are discovered for the treatment of DN at the early and middle stage differentiated as qi and blood de-ficiency and blood stagnation.All of those provide the new clue for the development of relevant new drugs of TCM.

目的：通过研究观察芒硝外敷腰部治疗重症急性胰腺炎腰疼的临床效果；总结芒硝外敷腰部治疗重症急性胰腺炎腰疼的护理方法。方法随机选取32例患有重症急性胰腺炎的患者，随机分成治疗组和对照组，每组16例。对照组患者给予胃肠减压，禁食，抑制胃液和胰液的分泌，补充水、电解质，纠正酸碱平衡失调，止痛，预防和控制感染，以及器官功能维护等基础治疗。治疗组在基础治疗的基础上，将芒硝外敷于腰部进行治疗，同时对症进行护理。观察记录两组患者腰痛缓解情况，并对此进行分析与讨论。结果与对照组相比，治疗组患者的腰痛缓解情况明显优于对照组。结论芒硝外敷腰部在治疗重症急性胰腺炎腰疼的症状上效果明显。

[Objective] To carry out a qualitative analysis on research design about the clinical treatment of bilious headache in domestic journals. [Methods] In accordance with the principle of clinical epidemiology, the scale in the literatures from 1979 to 2006 about the clinical evaluation on the treatment of bilious headache in the domestic journals was evaluated. [Results] The 32.8% of the literature used a randomized controlled trial, but the quality and reliability of random design were poor; the blind method was rarely used; no any article mentioned the quantity of samples and the race of the patients; half of the literatures (50.2% ) had no clear diagnostic criteria; 86.7% of the literatures mentioned the therapeutic standard, but in 795 of them (64.6%) the standard was the self-worked out; 18.9% of the literatures (233) used a clear statistical methods, but some of them method were less accurate. Other problems, requiring attention were the comparison of baseline between groups and the choice of indicators of the outcome, and so on. [Conclusions] Generally speaking, the quality in the TCM literatures about migraine treatment was not so high, and the experimental design and the statistical methods should to be enhanced.

<正>糖尿病已成为全球第3位威胁人类健康的慢性非传染性疾病[1],中国糖尿病(DM)的患病率增长较快,总数已达4 000万[2],其中绝大多数为2型糖尿病,中医药在防治糖尿病方面正彰显其独有特性,并已取得了良好的效果。有关糖尿病的证候研究已有许多报道,本文仅对近10年来2型糖尿病的中医证候研究文献进行总结。