目的:探讨清疡汤灌肠方联合美沙拉嗪肠溶片治疗溃疡性结肠炎(大肠湿热证)的临床效果.方法:采用随机抽样的随机方法选取我院2020年9月-2021年11月间就诊的60例溃疡性结肠炎(大肠湿热证)患者作为研究对象,其中观察组的30例患者采用清疡汤中药灌肠联合美沙拉嗪肠溶片治疗,对照组单一使用美沙拉嗪肠溶片口服,比较两组患者改良Mayo的评分、中医症候积分、Baron内镜评分等方面的影响.结果:治疗后观察组改良Mayo的评分、临床有效率、临床缓解率均明显优于对照组(P<0.05).治疗后观察组中医证候评分为(4.02±0.38)分.明显低于对照组的(6.63±0.52)分,差异显著(P<0.05);观察组总有效率为93.3％,明显高于对照组的73.3％,差异同样显著(P<0.05).治疗前两组患者肠镜像积分比较无统计学差异(P>0.05);治疗后观察组肠镜像积分明显低于对照组(P<0.05).结论:清疡汤灌肠方联合美沙拉嗪肠溶片治疗溃疡性结肠炎疗效确切,相较于单一西医治疗有着显著的优势,能让患者以良好的精神状态尽快参加工作或社会活动,值得在临床中推广应用.

目的:探讨基于内痈理论治疗活动期湿热毒证溃疡性结肠炎(UC)的临床疗效及对炎性因子的影响.方法:60例活动期湿热毒证UC患者随机分为观察组和对照组,各30例.对照组给予对症支持治疗,并给予美沙拉嗪肠溶片治疗4周,观察组在此基础上从痈论治,疗程为4周.比较两组患者近期临床疗效、肠镜表现及炎性因子(IL-2、IL-6、TNF-α)表达的变化.结果:观察组的临床疗效显著优于对照组(P<0.05);两组治疗后肠镜下表现均明显改善,观察组脓血糜烂、黏膜溃疡比例较对照组显著降低(P<0.05);治疗后,观察组血清IL-2水平明显升高,IL-6、TNF-α水平明显降低,且与对照组比较,差异均有统计学意义(P<0.05).结论:在西医基础上联合内痈理论治疗活动期湿热毒证UC疗效显著,不仅可快速缓解临床症状,还能有效改善肠黏膜病理变化,减轻炎性反应.

慢性萎缩性胃炎(CAG)是消化系统的常见病、多发病,表现为胃黏膜慢性炎症性病变及胃固有腺体萎缩,对于伴发肠上皮化生(IM)和/或中重度不典型增生(DYS)者被世界卫生组织(WHO)列为胃癌前病变(PLGC).流行病学研究数据显示,PLGC是胃黏膜转化为胃癌的关键阶段,患者胃癌发生相对危险度(RR)高达12.9[1].目前,西医对PLGC仍缺乏特殊有效的方法 ,导致病情迁延难愈且反复发作,而中医学认为,肝气郁结、脾胃虚弱、外邪犯胃所致肝胃不和是该病基本病机之一,且多与情志失调相关,"和"法在其治疗上具有一定优势,但仍未达成共识[2].本研究拟对PLGC患者在西医治疗的基础上从和论治,旨在探讨其临床疗效及对中医症候的影响.

溃疡性直肠炎是一种慢性非特异性直肠炎症性疾病,病理表现为直肠黏膜及其下层浸润,其病程长、迁延不愈、反复发作,我国人群的患病率约为 1. 5％ ～ 8. 0％,并呈逐年上升趋势[ 1 - 2].溃疡性直肠炎的病因及发病机制目前尚未完全阐明,西医治疗受限,多采用抗生素、免疫抑制剂、激素等控制炎症反应和免疫调节,但缓解率仅为55％ ～ 73％ [3],且持续使用不良反应多,停药后复发率高.溃疡性直肠炎在中医学属于"滞下""泄泻""痢疾"等范畴,临床上以脾虚湿热证多见,近年来中医辨证治疗表现出一定的优势[4].本研究尝试采用中药保留灌肠、离子导入联合治疗湿热蕴结型溃疡性直肠炎患者,旨在为该病的中医药治疗提供参考依据.

Objective:To investigate the clinical effect of flupentixol and melitracen tablets combined with conventional therapy on the treatment of elderly chronic gastritis with depression.Methods:28 pa-tients who were admitted in our hospital from 2012.1 to 2013.12 were randomly divided into two groups. Control group(n=14)was given inhibition of gastric acid secretion and HP,treatment group(n=14)was given flupentixol and melitracen tablets additionally.1 tablets each time in the morning daily for 8 weeks. The clinical effect, symptoms of depression and sleep between the two groups were compared.Results:There was no significant difference on the total effective rate between the two group.The SDS score were significantly improved in two groups after treatment(t =5.75,2.74;P <0.05),there was significant difference in SDS score between two groups(t=3.59,P<0.05),and the PSGI score in treatment group was significantly improved than that in control treatment(t=4.53,P<0.05).Conclusion:Combination use of flupentixol and melitracen tablets with conventional therapy on the treatment of elderly chronic gas-tritis with depression can eliminate physical discomfort,improve depression,break the vicious circle be-tween mental and physical symptoms.

<正>《伤寒论》云"少阴病,自利清水,色纯青,心下必痛,口干燥者,可下之,宜大承气汤"。这是"热结旁流"概念最早的源头。明.吴又可正式提出"热结旁流"的概念,他在《温疫论·大便》中云"热结旁流者,以胃家实,内热壅闭,先大便闭结,续得下利,纯臭水,全然无粪"。热结旁流在临床上容易误诊,下面结合文献及临床探讨临证体会。

Objective: To investigate clinical effectiveness and safety of triple therapy of anti-HP infection treatment and weifuchun on chronic atrophic gastritis(CAG) combined with peptic ulcer(PU).Methods:104 cases of CAG combined with PU were randomly divided into two groups,including 52 cases in treatment group,and 52 cases in control group.All the cases was treated with omeprazole+amoxicillin+ clarithromycin capsule for 2 weeks,then omeprazole was given for 4 weeks,and treatment group was given weifuchun additionally for 4 weeks.The improvement of clinical syptoms,HP eradication rate,1-year recurrence rate,chronic inflammation degree of gastric mucosa and side effects during treatment were compared.Result:After treatment,the total effective rate for CAG and PU in treatment group were 94.2% and 92.3%,which were significantly higher than 80.8% and 75.0 % in control group(P0.05).There was significant difference on HP eradication rate and 1-year recurrence rate between treatment group and control group(86.5% vs.67.3%,20.0%vs.34.2%)(P0.05).After treatment,the chronic inflammation degree of gastric mucosa in both group improved significantly than that before treatment,while the improvement in treatment group was more remarkably than that in control group(P0.05).There was no serious side effect was found in both groups during treatment.Conclusions: It is more effective for triple therapy of anti-HP infection treatment and weifuchun in the treatment of CAG combined with PU than simple use of triple therapy,and it can obviously increase the HP eradication rate,reduce the recurrence rate and side effects.

Objective To investigate the relationship between Helicobacter pylori (Hp) infection with long term use of aspirin and upper gastrointestinal bleeding. Methods Out-patients with long term use of aspirin 100 mg/d were given endoscopy and Hp testing; patients with peptic ulcer,acute gastric mucosal lesion,gastric cancer,gastric esophageal varices were excluded. Of the 3 809 cases enrolled,2 802 cases were Hp-positive and 1 007 were Hp-negative. Patients were followed up for 2 years,and upper gastrointestinal bleeding was observed. Hp was eradicated by anti-Hp therapy in 144 Hp-positive patients with upper gastrointestinal bleeding,and these patients were randomly divided into two groups,72 patients were treated with famotidine 40 mg before going to bed and the remaining 72 patients did not receive intervention and served as control,both groups continued to take aspirin and followed 2-year to observe the occurrence of upper gastrointestinal bleeding. Results The rate of upper gastrointestinal bleeding in patients taking low-dose aspirin was significantly higher in ≥ 60 years of age group than in 60 years of age group (P0.05); upper gastrointestinal bleeding occurred in 146 cases (5.21%) of the Hp-positive group and in 30 cases (2.98%) of the Hp-negative group. Difference between the two groups was statistically significant (P0.05). Upper gastrointestinal bleeding rate in famotidine intervention group was 2.78% (2 cases) and in control group was 11.1% (8 cases) (P0.05). Conclusions Sixty years of age and older taking low-dose aspirin increased the risk of upper gastrointestinal bleeding; Hp infection and long-term use of low-dose aspirin can increase the risk of upper gastrointestinal bleeding; famotidine intervention can effectively reduce the risk of upper gastrointestinal bleeding in patients taking low dose aspirin in long term.