高钾血症是指血清钾浓度超过5 .5 mmol/L的一种病理生理状态,急诊发生率为3.6％[1].美国急诊每年高钾血症相关疾病超过80 万例,其中近7万例以高钾血症为第一诊断,45～84岁年龄段占75％[2].高钾血症具有潜在心律失常的致命性风险,尤其对有基础疾病患者.多项研究发现,老年患者高钾血症与心血管病病死率升高相关,增加室性心律失常的风险[3,4].武警特色医学中心消化科收治1例腹泻后高钾血症致严重心律失常的高龄患者,治疗效果良好.

The article has reviewed theShengyang-Yiweidecoction for the disease of digestive system, such as diarrhea-predominant pattern irritable bowel syndrome(D-IBS), chronic gastritis, diabetic gastric paralysis (DGP), ulcerative colitis (UC) and chronic diarrhea. Recently,Shengyang-Yiwei decoction was also used in some other diseases, such as diseases of urinary system, diseases of nervous system, orthopedic diseases, gynecological diseases and so on. This review aimed to provide reference and evidence for the clinic application ofShengyang-Yiwei decoction.

目的 探讨善胃系列方分型论治慢性萎缩性胃炎(CAG)癌前病变的临床疗效.方法 选取2013年7月-2014年12月在中国人民武装警察部队后勤学院附属医院首长保健科和消化科门诊接受治疗的CAG癌前病变患者90例.根据CAG癌前病变中医证候诊断标准分为血瘀热毒型30例、热毒伤阴型30例、气阴两虚型30例,按血瘀热毒型、热毒伤阴型、气阴两虚型分别给予善胃Ⅰ、Ⅱ、Ⅲ号中药全成分配方颗粒进行辨证治疗6个月.于治疗前和治疗后观察患者症状的变化情况,并进行综合疗效、中医证候疗效、幽门螺杆菌(Hp)转阴率、胃镜疗效和病理疗效评价.结果血瘀热毒型、热毒伤阴型、气阴两虚型患者综合疗效的总有效率分别为90.0％ (27/30)、93.3％ (28/30)、70.0％ (21/30).血瘀热毒型、热毒伤阴型和气阴两虚型患者治疗后中医证候疗效得分与治疗前比较,差异均有统计学意义(P＜0.05).治疗后血瘀热毒型、热毒伤阴型和气阴两虚型患者的Hp转阴率分别为89.3％ (25/28)、68.2％ (15/22)、46.2％ (6/13).血瘀热毒型、热毒伤阴型、气阴两虚型患者胃镜疗效的总有效率分别为73.3％(22/30)、80.0％ (24/30)、63.3％ (19/30).血瘀热毒型、热毒伤阴型和气阴两虚型患者治疗后病理疗效得分与治疗前比较,差异均有统计学意义(P＜0.05).结论 善胃系列方可明显改善CAG癌前病变患者的临床症状、中医证候疗效、胃镜疗效和病理疗效,提高Hp转阴率.

Combined pathogenesis of blood stasis always exists in the course of CAG with macroscopic and micro-scopic changes caused by it,we expound the two Chinese medicine’s rationality used in CAG from traditional effica-cy,modern pharmacological effects and clinical application compatible related to CAG. Grasping pathogenesis of blood stasis and using the two medicines reasonably on CAG often have good effect. It is worthy of making further study on putting sparganium stoloniferum and curcuma phaeocaulis applied to the treatment of CAG in clinic,but it also needs to strengthen experimental mechanism research accordingly in order to make better clinical guidance.

张仲景在《伤寒论》厥阴篇中用乌梅丸治疗蛔厥证和久痢.其寒温并用,清上温下,辛开苦降,调补气血阴阳,用治上热下寒、寒热错杂之证.现代药理研究表明,乌梅丸可促进炎症及黏膜损害修复,调节胃肠功能.消化系统疾病多有上热下寒、寒热错杂的病机特点.乌梅丸可用于治疗慢性溃疡性结肠炎、腹泻型肠易激综合征、慢性萎缩性胃炎、慢性腹泻等消化系统疾病.

目的:观察柴胡加龙骨牡蛎合附子理中加减方治疗慢性萎缩性胃炎伴焦虑抑郁患者的临床疗效.方法:65例慢性萎缩性胃炎伴焦虑抑郁患者随机分为治疗组35例和对照组30例.治疗组给予柴胡加龙骨牡蛎合附子理中加减方,每日1剂.对照组给予胃复春片,每次4片,每日3次;黛力新,每次1片,早、中各1次.两组分别治疗6个月,比较两组患者临床疗效、胃镜下征象、病理半定量积分、临床症状积分、焦虑抑郁定量评分及不良反应.结果:治疗组总有效率为88.6％,对照组总有效率为56.7％,差异有统计学意义.两组治疗后胃镜下征象积分、病理半定量积分、临床症状积分比较,差异均有统计学意义;两组焦虑抑郁定量评分比较,差异无统计学意义;治疗组治疗前后胃镜下征象积分、病理(萎缩、肠上皮化生)半定量积分、临床症状积分及焦虑抑郁定量评分比较,差异均有统计学意义;对照组治疗前后病理(萎缩)半定量积分和焦虑抑郁定量评分差异有统计学意义;两组不良反应差异无统计学意义.结论:柴胡加龙骨牡蛎合附子理中加减方可明显改善慢性萎缩性胃炎伴焦虑抑郁患者的胃粘膜病变和临床症状.