Objective To explore the association between screening for Down's syndrome and adverse pregnancy outcomes. Methods Retrospective cohort study was conducted in Beijing Chaoyang Hospital covering pregnant 7 682 pregnant women from Mar 31, 2014 to Apr 29, 2021 in a continuum period. Results The prevalence of high screening risk was 6.40% (492 cases) and the incidence of adverse pregnancy outcome was 1.30%(100 cases). The incidence of adverse outcome (4.27%) in high risk group was significantly higher than that in low risk group (1.10%). After adjusting for diabetes, family history of hereditary diseases, smoking and drinking alcohol, the incidence odds of adverse outcomes for high screening risk subjects was 4.022 times (95% CI:2.405-6.442) as that for low risk. The high Down's syndrome risk score meant high incidence of adverse outcomes(P＜0.001). The incidences of malformations, chromosome abnormalities and stillbirth for high screening risk subjects were higher than those for low risk. The incidence odds of adverse outcomes increased to 1.019 times with the increase of 1 ng/mL for AFP and 2.258 times with the increase of 1 for AFP MOM. The incidence odds of adverse outcomes declined to half with the increase of 1 ng/mL for uE3 or uE3 MOM. Conclusions Down's syndrome screening high risk is indicators for organ malformations, limb deformity, chromosome abnormalities and still birth. High level of AFP and low level of uE3 may increase the occurrence of adverse pregnancy outcomes.

目的 探讨氢呼气试验在功能性肠病(FBD)患者小肠细菌过度生长情况分析中的应用.方法 分析2018年1月至2020年6月首都医科大学宣武医院消化科收治的1 224例FBD患者和175例健康志愿者的临床资料,按罗马Ⅳ诊断标准分为功能性便秘(574例)、功能性腹胀(272例)、功能性腹泻(62例)及肠易激综合征组(316例),所有纳入研究的患者和健康志愿者已行乳果糖氢呼气试验,分析检查结果.结果 FBD各亚型在小肠细菌过增长(SIBO)阳性率、OCTT延长发生率、回肠反流发生率均高于正常对照组(P＜0.05).功能性便秘组OCTT延长发生率明显高于其他亚型(P＜0.05);功能性便秘组OCTT时间明显高于其他亚型(P＜0.05),该组SIBO阳性患者OCTT时间明显长于SIBO阴性患者;功能性腹泻组OCTT时间明显短于其他亚型,该组SIBO阳性患者OCTT时间明显短于SIBO阴性患者.结论 SIBO与FBD密切相关,明确诊断SIBO可有助于FBD的治疗.各亚型FBD肠道传输时间有不同的表现,LBT可以较准确的反映功能性肠病患者存在的动力情况.氢呼气试验作为一种无创检测方法,可广泛应用于FBD的诊断.

目的 探讨埃索美拉唑、阿莫西林、克拉霉素三联用药对老年冠心病伴幽门螺杆菌(Hp)感染患者血脂指标的影响.方法 回顾性分析首都医科大学宣武医院自2018年9月至2020年6月收治的108例老年冠心病伴Hp感染患者的临床资料.54例患者仅接受冠心病常规治疗,纳入未根除组;54例患者在冠心病常规治疗基础上联合埃索美拉唑、阿莫西林、克拉霉素三联用药根除Hp,纳入根除组.连续用药10 d后,比较两组患者治疗前后的血脂指标.结果 两组患者治疗后的总胆固醇、低密度脂蛋白胆固醇水平均低于治疗前,差异有统计学意义(P<0.05);根除组患者治疗后的甘油三酯水平低于治疗前,差异有统计学意义(P<0.05);根除组患者治疗后的高密度脂蛋白胆固醇水平高于治疗前,且高于未根除组,差异有统计学意义(P<0.05).结论 埃索美拉唑、阿莫西林、克拉霉素三联用药根除Hp有利于调节老年冠心病伴Hp感染患者的脂质代谢,可改善患者预后.

肺肠微生态平衡在人体防御感染、调节免疫和调节代谢等方面具有重要作用.本文从中医学和现代医学的研究论述了肺肠的关系以及肺肠微生态平衡的重要性,从而发现肠道菌群微生态失衡是呼吸道感染的机制之一.并且进一步论证了中医药中的健脾方剂能够通过增加肠道益生菌,减少致病菌,减少致病菌所释放的内毒素以及炎症介质,起到增强肠黏膜屏障的免疫保护和降低抗生素的耐药性等作用,从而减轻呼吸道感染,增加临床疗效.健脾方剂具有调节肠道微生态的作用,将成为临床治疗呼吸道感染新的切入点,这为呼吸道感染的临床治疗提供新思路.

Objective:To observe the clinical efficacy of ginkgo biloba extract (GBE) in treatment of Qi stagnation and blood stasis type of sudden deafness.Methods:132 patients were randomly divided into the control group and the treatment group,each of 66 cases.The control group took alprostadil and prednisone;the treatment group took alprostadil,prednisone and gingko biloba tincture.The changes of hearing threshold level,clinical symptoms,adverse reactions of two groups before and after treatment were compared,and clinical efficacy of two groups were evaluated.Results:The effective rate of treatment group was 92.42％,significantly higher than 75.76％ of control group (P ＜ 0.05);Compared with pre-treatment,the TCM symptom scores of two groups significantly decreased after treatment (P ＜ 0.05),and the treatment group was higher than control group (P ＜ 0.05);There was no statistical difference in the incidence of adverse reactions between the two groups (P ＞ 0.05).Conclusion:GBE for treating patients with Qi stagnation and blood stasis type of sudden deafness can significantly improve clinical efficacy,relieve clinical symptoms,promote hearing recovery and not increase adverse reactions.

目的 观察益气聪明汤治疗椎基底动脉供血不足性眩晕的疗效.方法 将96例椎基底动脉供血不足性眩晕患者随机分为2组,均采用常规支持对症治疗,治疗组加用益气聪明汤,对照组加用西比灵,比较2组疗效及治疗前后脑血流动力学和血脂情况.结果 2组治疗后脑血流速均有所提高,治疗组椎基底动脉血流速增快程度明显优于对照组,且能够降低血脂水平,提高高密度脂蛋白水平;治疗组总有效率为98％,优于对照组的71％ (P ＜0.05).结论 益气聪明汤治疗椎基底动脉供血不足疗效显著.

抑郁症属于中医情志病、郁证范畴.肝阴虚是抑郁症常见的证型之一,以抑郁心境、兴趣丧失、精力减退或丧失为主要症状.基于肝体阴用阳的生理特点,肝体不足常常直接影响肝用,导致肝主疏泄而条畅气机的生理功能受损,而导致上述症状的产生；同时,肝阴虚日久、阴损及阳亦可导致肝之阳气不振、疏泄无力,亦可导致情绪抑郁.因此,在治疗上“阴中求阳、阳中求阴”理念显得尤为重要,在滋补肝阴的同时佐以吴茱萸、黄芪等振奋肝阳(气)之品,以恢复肝的主疏泄条畅气机的生理功能,可以更快地缓解肝阴虚型抑郁症患者的临床症状.

Objective To discuss the effect of Orem self-care theory for patients with pelvic organ prolapse during peri-operative period.Methods Forty cases of patients with pelvic organ prolapse were chosen and randomly divided into the intervention and control group,each with 20 cases.The intervention group received nursing according to Orem self-care theory,while the control group received conventional rehabilitation guidance without self-care theory.Patients' rehabilitation situation was compared during peri-operative period to evaluate the effect of Orem self-care theory.Results The number of patients who could turn over by themselves without external force in 6 hours after surgery,who could bend and stretch their ankle joint in 24 hours,who could get off bed for exercise in 72 hours,who had good mental states and who were satisfied was respectively 19,18,19,18,18 in the intervention group,and 11,9,12,9,11 in the control group,and the differences were statistically significant (x2 =8.533,9.231,7.025,9.231,6.144,respectively; P ＜ 0.05).And the differences of number of patients who could expel intestinal gas through anus in 48 hours after surgery,who could urinate by themselves 2 hours after pulling out the catheter,and who could defecate by themselves in 3 days without difficulty between two groups were also statistically significant (x2 =8.533,7.025,7.025,9.231,respectively;P ＜ 0.05).Conclusions Orem self-care theory for patients with pelvic organ prolapse during peri-operative period can improve their self-care ability and nursing efficiency,which is practical and worthy of promoting.

Objective To observe the clinical efficacy on gastrointestinal function of the patients with chronic obstructive pulmonary diseases(COPD) treated with Zhizhu Huayu Decoction.Methods Sixty patients of COPD combined with gastrointestinal dysfunction were randomized into a treatment group and a control group,30 cases in each one.In the treatment group,the modified Zhizhu Huayu Decoction was prescribed,100 mL each time,twice a day after meal for oral administration.In the control group,Mosapride Citrate Tablets were prescribed,5 mg,three times a day,for oral administration 30 min before meal.The clinical efficacy was assessed in 4 weeks.Results The symptom score after treatment was different significantly as compared with that before treatment(P 0.05) in the two groups.The result in the treatment group was superior to the control group.The total effective rate was 86.7% in the treatment group and was 56.7% in the control group,indicating the statistically significant difference in comparison(P 0.01).Conclusion Zhizhu Huayu Decoction achieves the definite effect of the improvement of gastrointestinal function of the patients with COPD,relieves significantly the clinical symptoms and improves the quality of life.

目的 观察康艾注射液联合化疗治疗晚期消化道肿瘤的临床效果及其减毒增效作用.方法 将90例明确诊断的胃癌、食管癌、结直肠癌的患者按随机数字表法分为两组,治疗组(46例)采用化疗加康艾注射液,对照组(44例)单用化疗.观察两组近期疗效、化疗不良反应及生活质量改善情况.结果 治疗组与对照组近期疗效有效率分别为43.5％(20/46)和43.2％(19/44),两组比较差异无统计学意义(P＞0.05);治疗组生活质量改善率为82.6％(38/46),明显高于对照组的59.1％(26/44),差异有统计学意义(P＜0.05);治疗组Ⅲ～Ⅳ级白细胞减少、恶心呕吐发生率分别为6.52％(3/46)、8.70％(4/46),对照组分别为34.09％ (15/44)、38.64％(17/44),两组比较差异有统计学意义(P＜0.05).结论 康艾注射液对消化道肿瘤可协助化疗抗癌,改善患者生活质量,降低化疗不良反应.

Objective:To observe the clinical curative effect of modified Xuefu Zhuyu Decoction in treating reflux esophagitis (RE) accompanied by depression.Methods:Sixty patients suffered depression RE were randomly divided into treatment group(30 cases)and control group(30 cases). Patients in treatment group were given modified Xuefu Zhuyu Decoction, while the control group treated patients with omeprazole, domperidone, flupentixol and melitracen tablets. Clinical curative effect was evaluated according to the changes of score in clinical symptoms and zung Self-Rating Depression Scale(SDS) and observation under gastro scope.Results:Four weeks after treatment, the clinical symptom score and depression points of the treatment group were significantly better than that of the control group (P<0.05); eight weeks after treatment, there were no significant difference between the two groups on the total therapeutic effect (P>0.05). The follow-up conducted six month after drug withdrawal showed better total therapeutic effect in treatment group (P<0.05).Conclusion:Modified Xuefu Zhuyu Decoction has instant and satisfactory therapeutic effect along with low recurrence rate in treating reflux esophagitis accompanied by depression.

Objective To discuss the relationship of the patterns/syndromes in traditional Chinese medicine with the cerebral vascular lesion scope and stenosis severity for the patients with ischemic apoplexy and explore the objective indexes for the pattern/syndrome differentiation,prevention and treatment of ischemic apoplexy.Methods 86 cases of ischemic apoplexy and undergoing cerebral angiography were selected.In comparison,the relationship of the cerebral vascular lesion scope and stenosis severity was analyzed in terms of the patterns/syndromes of traditional Chinese medicine.Results The proportion of either wind phlegm stagnation pattern/syndrome or qi and blood stagnation pattern/syndrome in the group of cerebral vascular stenosis was higher than that in the normal cerebral vascular group(P0.05).In the normal cerebral vascular group,the proportion of wind phlegm and fire hyperactivity pattern/syndrome was higher than that in the cerebral vascular stenosis group(P0.05).The differences among the other patterns/syndromes were not statistically significant in comparison(P0.05).In the multi-vessel lesion group,the proportion of either wind phlegm stagnation pattern/syndrome or qi and blood stagnation pattern/syndrome was higher than that in the no-vessel lesion group and the single-vessel lesion group(P0.05).The differences among the other patterns/syndromes were not statistically significant in comparison(P0.05).Conclusion The outcomes of angiography are relevant with the different characteristics of the patterns/syndromes of ischemic apoplexy.The proportions of wind phlegm stagnation pattern/syndrome and qi and blood stagnation pattern/syndrome are getting higher obviously with the increase of the cerebral vascular lesion scope and the stenosis severity.

Objective To observe the clinical efficacy on anxiety disorder after breast cancer surgery treated with nourishing yin and clearing fire therapy.Methods In compliance with the diagnostic criteria of anxiety after breast cancer surgery and Chinese medicine differentiation as excessive fire due to yin deficiency pattern/syndrome,70 cases were enrolled and randomized into a treatment group and a control group,35 cases in each one.In the treatment group,the modified formula of tianwang buxin dan and danzhi xiaoyao san was prescribed for nourishing yin and clearing fire.In the control group,paroxetine was prescribed,10~20 mg,once a day.Separately,before treatment and in the 2nd,4th and 6th weeks after treatment,the Hamiltone Anxiety Scale(HAMA)was adopted for the assessment.The score reducing rate of HAMA was taken as the indicator of the efficacy assessment.The clinical efficacy was compared between two groups and the adverse reactions were observed.Results The difference in the clinical efficacy was not significant statistically between two groups(P0.05).In the 4th and 6th weeks after treatment,HAMA scores were all reduced remarkably in both groups as compared with those before treatment(P0.05 or P0.01).The difference between two groups was not significant statistically.The incidence and the severity of the adverse reactions in the treatment group were slightly lower than those in the control groups.Conclusion For the patients with anxiety disorder after breast cancer surgery,the therapy for nourishing yin and clearing fire achieves the good clinical efficacy and can remarkably improve the quality of life for cancer patients.

目的:观察芪枳三仁汤治疗恶性肿瘤患者化疗中应用5-HT3受体拮抗剂所致便秘的临床疗效。方法:将80例患者随机单盲分为治疗组40例和对照组40例,治疗组服用芪枳三仁汤,每周期化疗前3d开始至化疗结束后5d为1个疗程,对照组给予双歧杆菌三联活菌胶囊,化疗2个周期后观察患者治疗前后排便次数及排便困难程度的变化。结果:治疗组临床总疗效优于对照组(P<0.05),治疗组治疗后临床症状改善优于治疗前(P<0.05)。结论:芪枳三仁汤治疗5-HT3受体拮抗剂所致便秘有较好的临床疗效。

目的 探讨经脐单孔腹腔镜卵巢囊肿剔除术的手术护理配合要点.方法 对5例35岁以下经脐单孔腹腔镜卵巢囊肿剔除术的手术护理配合步骤进行回顾性总结.结果 5例经脐单孔腹腔镜卵巢囊肿剔除术均顺完成手术,术后随访切口甲级愈合,恢复好,无一例并发症发生.结论 认真做好术前访视,心理护理,正确准备手术器械及特殊用品,熟悉仪器性能,密切配合手术操作是手术成功的有效保证.经脐单孔法腹腔镜卵巢囊肿剔除满足了患者更微创、更美观、术后痛苦更少的心理需要,受到患者的欢迎。

>随着社会的进步和发展,人类平均寿命逐渐延长,人类步入老龄化社会。盆底损伤和功能退化造成的盆腔器官膨出(pelvic organ prolapse,POP)日益严重影响中老年女性的健康生活质量。手术是最常用的治疗POP的方法,传统的手术方式如:阴式子宫切除术,阴道前、后壁修补术等均存在

目的 探讨舒适护理在门诊宫腔镜检查护理中的应用.方法 将在我院门诊行宫腔镜检查患者随机分成两组,实验组(895例)实施舒适护理,对照组(992例)实施传统的常规护理.采用焦虑自评量表和WHO疼痛程度分级标准测定,比较两组检查时疼痛程度分级焦虑值.结果 实验组实施舒适护理后,患者术中心率波动小,术中、术后发生疼痛、焦虑例数较对照组明显下降,术后患者对手术室护理质量的满意度高.结论 舒适护理在门诊宫腔镜检查的应用,明显改善了患者心理及生理状态,降低了手术中患者疼痛的发生率,提高了患者对宫腔镜检查术的知晓度,为建立和谐的护患关系奠定了良好的基础.

国内使用雄黄等含砷中药治疗银屑病等顽疾在民间十分常见,但由于缺乏用药规范,近年来含砷中药的内服与外用不当所导致的慢性砷中毒屡有发生,自2001年3月至2008年3月我科诊治慢性药源性砷中毒患者32例,以下就其临床特点进行分析.

The traditional Chinese medicine Xiaoerqizhen pills,which contain realgar and cinnabar,are used for treatment of acute infantile convulsion and constipation.This paper reports that two adults developed chronic arsenic poisoning after prolonged use of high-dose Xiaoerqizhen pills.Patient 1,a 36-year-old woman,received 40～80 Xiaoerqizhen pills once daily for three years for constipation.Two to three months after starting Xiaoerqizhen pills use,she developed fatigue,anorexia,and dark skin pigmentation on her abdomen.In recent one year,she developed dizziness,headache,insomnia,and numbness of her limb ends.After admission,an examination showed pigmentation on his face,trunk,and extremities,pachyderma on palms and soles.Her blood arsenic level was 7.3 μg/L,and her urine arsenic level was 0.117 mg/L.Chronic arsenic poisoning was diagnosed.After completing three courses of therapy with sodium dimercaptopropane sulfonate,her symptoms markedly improved.Patient 2,a 40-year-old man,received 20～80 Xiaoerqizhen pills one to two times daily for 7 years for constipation.During the treatment,he gradually presented with fatigue,anorexia,nausea,abdominal distension,pigmentation over his entire body,severe keratodermia,and numbness of extremities,hepatoemegaly,splenomegaly,and anemia.His urine arsenic level was 4.28 mg/L.He was diagnosed with chronic arsenic poisoning.After completing five courses of therapy with sodium dimercaptopropane sulfonate,his symptoms were markedly improved and he was discharged.

目的观察曲美他嗪治疗不稳定型心绞痛的疗效.方法选择2001-03～06北京天坛医院不稳定型心绞痛病人44例,在常规治疗基础上随机分为两组,一组加用曲美他嗪,另一组应用硝酸脂类药物作为对照,服药2周.结果治疗后两组病人每天心绞痛发作次数、硝酸甘油片消耗量比较差异无显著性(P＞0.05),且两组分别较治疗前明显减少,ECG改善两组间比较差异无显著性.结论曲美他嗪治疗不稳定型心绞痛疗效肯定,并与硝酸脂类药相似.