目的 构建前瞻性效益评估模型,探讨其在当前医疗设备管理中的应用价值.方法 首先构建出前瞻性效益评估模型,然后选择4类医疗设备,再依据不同的管理模式进行分组,2019年1-12月使用的医疗设备200台设定为参照组,其运用常规的科室分责管理;再选择2020年1-12月使用的医疗设备200台设定为研究组,其运用前瞻性效益统筹管理模式,最后对比两组成本效益、社会效益、设备管理费用的增幅状态,以及对比医疗设备的开机率.结果 对比医疗设备成本与社会效益增幅结果显示,研究组效益增幅优于参照组,并且每个月的增幅保持较为稳定的状态,参照组效益的增幅则表现出较大的浮动状态.研究组成本效益、社会效益、设备管理费用的增幅及医疗设备开机率分别为(5.60±1.07)％、(6.55±1.62)％、(0.88±0.31)％、(95.02±2.13)％,而参照组各项指标为(4.19±1.58)％、(4.49±1.88)％、(1.83±0.65)％ 和(90.22±2.51)％,研究组各项指标优于参照组,差异有统计学意义(P<0.05).结论 利用前瞻性效益评估模型能够提高医院在医疗设备全生命周期管理的能力,并且能够增加成本及社会效益,进一步提升临床对患者的服务质量,同样能够对医院开展现代化的建设及管理起到促进作用.

Objective The aim of this study was to investigate the short-term efficacy of Heye Tiaozhi Shugan, a kind of herbal medicine, decoction in dealing with patients with nonalcoholic fatty liver diseases（NAFLD）. Methods 56 patients with NAFLD were recruited in our hospital between April 2019 and April 2021, and were randomly divided into control and observation group, with 28 patients in each group. All patients were supervised for health education, like exercise and diet guidance. The patients in the control group were treated with polyene phosphatidylcholine and glycyrrhizinic acid tables, and those in the observation group were treated with the herbal medicine at base of medication in the control. The regimen lasted for 12 weeks. The TCM syndrome scores were evaluated, and serum total cholesterol（TC）, triglyceride（TG）, low density lipoprotein cholesterol（LDL-C） and high density lipoprotein cholesterol（HDL-C） levels were assayed. Results At the end of three month treatment, the hypochondriac pain, depression, poor appetite, abdominal distension and loose stool scores as obtained by TCM evaluation were（1.0±0.3）,（0.8±0.2）,（0.7±0.2）,（0.7±0.2） and（1.0±0.1）, significantly lower than [（1.4±0.7）,（1.3±0.3）,（1.3±0.3）,（1.2±0.3） and（1.4±0.3）, P ＜ 0.05] in the control; serum TG and LDL-C levels in the observation group were（1.8±0.5）mmol/L and（2.7±0.6）mmol/L, significantly lower than [（2.4±0.8）mmol/L and（3.9±0.8）mmol/L, respectively, P＜0.05], while serum HDL-C level was（1.8±0.6）mmol/L, significantly higher than [（1.1±0.4）mmol/L, P＜0.05] in the control; serum alanine aminotransferase, aspartate aminotransferase, gamma glutamine transferase and alkaline phosphatase levels in the observation group were（46.1±8.9）U/L,（31.9±9.0）U/L,（38.7±11.2）U/L and（66.1±12.2）U/L, all significantly lower than [（55.7±9.4）U/L,（44.3±10.7）U/L,（49.7±12.5）U/L and（74.4±14.7）U/L, respectively, P＜0.05]. Conclusion The Heye Tiaozhi Shugan decoction, a herbal medicine compound, in treatment of NAFLD patients with special TCM syndrome, could improve blood lipid metabolism, and needs further investigation.

目的:通过对病因病机的分析,初探新型冠状病毒肺炎的辨证论治,以期对本病的中医诊疗提供临床思路.方法:通过对《温病学》研习、深入疫区中医专家对本病的分析及各省卫建委发布的新型冠状病毒感染的肺炎中医药治疗方案,对本病的辨证论治进行探析.结果:早期多以感受湿邪疫毒之气为主,且偏寒湿,治疗以散寒除湿,透邪芳香辟秽为主;随着病情进展,湿郁化热,湿毒热充斥肺脏,损伤肺络,热壅肠腑,治疗以清热解毒,化湿通腑为主;若上述两个阶段未遏制,则病邪进一步深入,导致内陷心包,出现内闭外脱之证,闭症以泻火除湿,开窍醒神为主,脱症以回阳救逆为主;恢复期正虚邪恋,正虚则以气阴两虚和脾气亏损为要,余邪仍以湿为患,故在治疗上益气养阴,健脾利湿.结论:新型冠状病毒肺炎致病因素以“湿”邪为主,“湿、毒、瘀、闭”为主要病机,肺脾为主要病位,治疗上以化湿解毒,避秽化浊,开窍醒神为主,全程应重视固护脾胃,避免过度使用寒凉药物.

目的:评价小续命汤配合针刺运动疗法治疗颞颌关节功能紊乱症的临床疗效,并探讨其机制.方法:将纳入标准的150例颞颌关节功能紊乱症患者随机分为观察组和对照组各75例,均获得随访,观察组给予小续命汤配合针刺运动疗法;对照组给予针刺运动疗法,两组均10 d为1疗程,共治疗1疗程;观察治疗1疗程后两组VAS评分、颞合关节紊乱评价、生活质量及临床疗效,并进行对比分析.结果:两组患者治疗后DI、PI、CMI评分均较治疗前降低(P<0.05);治疗后观察组DI、PI、CMI评分更低于对照组(P<0.05);两组患者治疗后生理功能、社会功能、情感角色、心理健康评分均较治疗前增高(P<0.05);治疗后观察组生理功能、社会功能、情感角色、心理健康评分更高于对照组(P<0.05);两组患者治疗后VAS评分均低于治疗前(P<0.05);治疗后观察组VAS评分更低于对照组(P<0.05);治疗后,观察组总有效率为96.0％(72/75),对照组为92.0％(69/75),两组总有效率比较,差异有统计学意义(χ2=7.682,P=0.021).结论:小续命汤配合针刺运动疗法能够有效缓解颞颌关节功能紊乱患者的临床症状,改善生活质量、提高临床疗效.

目的 探讨血清同型半胱氨酸(tomocysteine,Hcy)和血栓素B2(thromboxane B2,TXB2)水平与突发性聋发病及疗效的相关性.方法 选取60例突发性聋患者,随机分为治疗组和实验组,另选60例健康人为对照组,均行听力学检查,并检测血清Hcy和TXB2;实验组在治疗组治疗方案基础上口服叶酸.结果 突发性聋患者血清Hcy和TXB2较正常人明显升高(tHcy=215.553,tTXB2=111.616,P<0.01);治疗后二者水平均明显下降(t治疗组Hcy=5.523,t实验组Hcy=6.946,t治疗组TXB2=3.141,t实验组TXB2=4.587,P<0.01),且实验组明显低于治疗组(tHcy=45.354,tTXB2=16.932,P<0.01);实验组听力改善有效率(90％)及显效率(70％)与治疗组(86.7％和56.7％)无统计学差异(P>0.05);两组患者血清Hcy和TXB2在P=0.01水平上呈显著正相关(r=0.639).结论 高Hcy和TXB2可能是突发性聋发病的高危因素;叶酸对高Hcy和TXB2有治疗作用,对听力改善作用有待进一步研究;高TXB2很可能是高Hcy致突发性聋发病的重要途径.

目的 制备雄黄乳膏,观察其治疗带状疱疹的临床疗效.方法 将雄黄利用水飞法进行炮制,采用乳剂型基质制成O/W型乳膏剂;以阿昔洛韦乳膏为对照组,共治疗带状疱疹患者200例,观察其临床疗效.结果 雄黄乳膏制备工艺和质量控制方法可行;雄黄乳膏组临床观察总有效率为93％,起效时间和治愈时间较短,不良反应少,差异均具有统计学意义(P＜0.05).结论 雄黄乳膏制剂工艺科学合理,使用方便,疗效比阿昔洛韦更优,不良反应少,值得临床推广使用.

Objective:To observethe characteristics of TCM dialectical typing Syndrome of of Senile Pneumo-nia in Xi an area .Methods :1200 cases of elderly patients aged over 65years old were selected from Xi'an Hospital of traditional Chinese medicine and Shaanxi provincal hospital of traditional Chinese medicine .We collect clinical symp-tom information and use selfmade《questionnaire of TCM syndrome characteristics of senile pneumonia in Xi'an area》to investigated .Results :Among the 1200 case of senile pneumonia ,1086 cases belonged to the inductive type of the author(inculding 352cases of kidney yin deficiencya heat and stasis invading the lung ,344 cases of kidney yanggas ) deficiency cold blood stasis in the lung ,400 cases of spleen and kidney deficiency phlegm and blood stasis obstructing lung ) ,114cases belonged to other syndromes(such as cold、heat、dryness、fire etc) .Conclusion :Most of the TCM Syndromes of elderly pneumonia belong to the scope of the author's induction ,providing TCM theory and treatment basis for elderly patients with pneumonia in Chinese medicine .