目的观察电针结合通腑中药对腹式全宫术后胃肠功能的影响。方法按照临床随机对照试验方法,按1:1的比例将40例腹式全宫术后患者随机分为观察组和对照组,两组均在手术前后行中西医标准化治疗,观察组则在中西医标准化治疗的基础上实施双侧足三里穴电针加口服加味小承气汤。疗程3d。结果术后观察组的肠鸣音恢复时间、肛门主动排气时间、排便时间和腹胀发生与对照组比较差异均有统计学意义(P<0.05)。结论电针足三里配合加味小承气汤口服对促进腹式全宫术后胃肠功能恢复具有较好的效果。

目的:观察补肾健脾中药复方治疗卵巢早衰(POF)的临床疗效。方法:用补肾健脾中药复方对20例卵巢早衰患者予以治疗3个月,观察治疗前后临床症状改善及月经来潮情况;血清FSH、LH、E2水平变化;阴道B超测定子宫三径线长度。结果:治疗后患者的临床症状改善有效率达100%;月经复潮率达80%;能使患者血清E2水平明显升高,FSH、LH水平明显降低;能促进子宫肌肉的发育和肥厚。结论:补肾健脾中药复方对卵巢早衰患者疗效肯定,对血清FSH、LH、E2水平有明显的调节作用。

目的 观察补肾中药结合情志疗法对绝经综合征患者Kupperman评分及血清激素水平的影响.方法 将81例绝经综合征患者随机分为3组,中药组30例给予补肾中药治疗,中药加情志治疗组(简称中加情组)25例在中药组治疗基础上加用情志治疗,西药组26例予激素替代(HRT)治疗,3组疗程均为12周.评价3组综合疗效,观察单项症状改善情况、血清激素水平变化情况及不良反应等.结果 3组综合疗效相当,对潮热、出汗等血管舒缩症状中药组和中加情组效果较明显.对失眠、抑郁、易激动等精神神经症状中加情组疗效较好,对泌尿生殖道症状西药组效果较明显,中药组对绝经综合征患者血清E2水平有明显的改善作用;中加情组及中药组治疗绝经综合征,安全可靠,无毒副作用.结论 补肾中药结合情志疗法对绝经综合征有治疗作用,能明显改善患者的神经精神症状.

目的:观察完带汤配合外用克霉唑栓治疗复发性念珠菌性阴道炎的临床疗效.方法:将52例患者随机分为2组,对照组25例采用克霉唑栓150mg阴道纳药治疗;治疗组27例在对照组治疗基础上加用完带汤(组成:白术、山药、党参、白芍、柴胡、陈皮、荆芥穗、车前子、苍术、甘草)治疗.结果:2组治疗前及治疗后3～7天临床症状评分及治疗后3～7天各临床症状改善情况组间比较,差异均无显著性意义(P＞0.05).2组停药3～7天临床症状改善情况比较,差异均无显著性意义(P＞0.05).2组停止治疗后12周复发率比较,差异有显著性意义(P＜0.05),治疗组复发率低于对照组.治疗后3～7天、4周、8周2组痊愈、显效、有效、无效组间比较,差异均无显著性意义(P＞0.05),但停药第12周后2组痊愈、显效、有效、无效组间比较,差异均有显著性意义(P＜0.05).表明治疗组有较好的远期疗效.结论:完带汤配合克霉唑栓外用治疗复发性念珠菌性阴道炎,后期疗效较巩固,治愈后不易复发.

Objective: To observe the clinical efficacy of Penyanqing Capsule (PYQC) in treating pelvic inflammation of Qi-stagnation with blood stasis syndrome.Methods: The randomized, single blinded, parallel positive drug controlled method was adopted, with 82 patients assigned into two groups by envelop method. The 42 patients in the treated group received PYQC 3 times a day, 4 capsules each time taken orally; the 40 patients in the control group were given orally Fuyankang tablets (FYKT) 3 times a day, 6 tablets each time. The therapeutic course for both groups was 2 months, and 2 courses of treatment were given successively to observe the comprehensive effect, changes of symptoms and signs before and after treatment. The effects of PYQC on hemorrheological character in part of the patients and on the pathogenetic chlamydia and mycoplasma were also observed.Results: The total effective rate in the treated group was 83.3%, which was insignificantly different from that in the control group (77.5%,P> 0.05). However, PYQC could significantly lower the hemorrheologic indexes in patients and showed definite influence on the pathogenetic chlamydia and mycoplasma.Conclusion: PYQC has good therapeutic effect in treating chronic pelvic inflammation of Qi-stagnation with blood stasis syndrome, and showed definite effect on chlamydia and mycoplasma.

目的:探讨“病例导入式”教学法在临床学科的应用,并对此教学模式的效果作出评价。方法:在循证医学教育观指导下,以中西医结合方向七年制学生为研究对象,中西医结合妇产科学部分课程采用随机分组,根据“以问题为基础的学习”(PBL)的教学模式理论,应用“病例导入式”教学法,实施中西医结合妇科课堂教学课程。结果:根据考试成绩的分析可以看出,对于反映基础理论知识掌握情况的客观题得分实验组与对照组比较无明显差异;而反映综合、分析、归纳能力的主观题得分实验组明显高于对照组(P值<0.01);总体得分实验组明显高于对照组(P值<0.01)。学生问卷调查显示:大多数学生(≥70%)认为“病例导入式”教学法能将基础理论与临床问题联系,提高临床实践、自学能力;多数学生(≥60%)认为能激发学习兴趣,提高思考、记忆、归纳能力;52.5%的学生认为该方法可提高学习效率。结论:“病例导入式”教学法有利于提高学生的综合、分析、归纳能力,有必要改革传统的教学方法来提高教学效果。

从医学教育的角度来看,循证医学教育观是一种与传统教学模式不同的教学方法,是一种新的临床医学教育观,它集中体现在"以问题为基础的学习"(Problem-based Learning,PBL)上.华西医科大学[1]应用PBL原理,设计了以病例为引导的教学方式(Case BaseStudy,CBS),并运用于二级基础主干学科的教学中,发现CBS能激发学生的学习兴趣,提高学生的思考能力和记忆能力.在总结长期大量的妇科教学工作经验后,我们认为,CBS应用于临床课程更具可行性和优越性.但是,在采用新的教学模式的同时,也不应完全放弃传统教学方法中稳定、系统的优点.因此,我们在病例导人的同时,西医采用SOAP[2]格式的案例教学,即对病人的健康问题按照主观资料(Sulbjective data,S)、客观资料(Objective data,O)、评估(Assessment,A)、计划(Plan,P)的描述为主线,注意中医病因-病机-症状-辨证论治穿插其中的系统学习.我们把这种汇集传统及现代教学法精髓,注重中西医结合,将CBS应用于临床课程的教学法暂命名为"病例导入式"教学法.

由于骨质疏松起病的隐匿性,治疗起效的缓慢性和极大的社会危害性,对医务工作者和研究人员如何预防、诊断和治疗提出了一系列难题.

经腹子宫全切除术是妇科常见的手术,阴道残端出血是术后常见的并发症之一.为探讨其原因,笔者回顾了1996年1月～1997年12月208例经腹全子宫切除术且月经周期基本正常的患者资料,分析其术后阴道出血与月经周期的关系,现将结果报道如下.

我院妇科从1995年开设骨质疏松症专科门诊以来,积累了一定的临床经验和体会.现介绍如下.

[目的]探讨由丹参、赤芍、枳实、毛冬青、延胡索等组成的盆炎清胶囊治疗慢性盆腔炎的药理作用,从抗炎、镇痛、免疫及微循环方面阐明其作用机制.[方法]采用小鼠热板法了解盆炎清胶囊的镇痛作用;通过观察盆炎清胶囊对小白鼠耳廓肿胀的影响、对大白鼠琼脂肉芽肿的影响了解盆炎清胶囊的抗炎作用;通过观察盆炎清胶囊对小白鼠单核吞噬细胞功能的影响,及对大白鼠肠系膜微循环的影响了解盆炎清胶囊对免疫及微循环的作用.[结果]盆炎清胶囊能提高小鼠痛阈值;抑制二甲苯所致的小鼠耳廓肿胀及大白鼠琼脂肉芽肿重量;改善由去甲肾上腺素(NA)所致的大白鼠肠系膜微循环障碍,并能提高小白鼠单核吞噬细胞吞噬功能.[结论]盆炎清胶囊具有良好的消炎镇痛作用,能改善由炎症所致的红、肿、热、痛等症状;同时具有改善微循环的作用,能增加机体局部血供,促进炎症吸收;并能提高机体的免疫功能.以上结果为本方在临床上治疗慢性盆腔炎提供了药效学依据.

Objective To detect the serum estrogen level in women with involution al depression (ID) and to study the effect of estrogen on the occurrence of ID. Methods Serum estrogen levels at 7:00 am were detec ted by r adioimmunoassay in 40 normal menopausal women (Group A) and 49 cases of ID (Grou p B), and compared with those of 36 cases previously detected. Results Estro gen level was much lower in Group B than Group A (P 0.01 ) but similar to Group C (P 0.05 ). Co nclusion The occurrence of ID in menopausal women may be related to t he decrease of estrogen level, but the specific correlation of the above two has not been proved yet.

经前期紧张综合征现代医学对其病因尚未完全明了,治疗方面仅限于对症及激素治疗,远期疗效不容乐观,复发率较高.本病伴随月经周期而发,影响妇女的生活和工作.因此如何对证审因施治,预防或减少复发,获取远期疗效,成为我们临床治疗上的难点.

抑郁症是一个严重影响人类健康的疾病.目前,在发达国家中抑郁症是15种主要的致残原因之一.预测到2020年,抑郁症将成为仅次于癌症的人类第二大致残因素[1,2].

目的　探讨中医综合疗法对女性抑郁症患者的治疗效果。方法　对60例更年期及经前期抑郁症患者运用中医辨证论治配合情志疏导法进行治疗，其中更年期妇女抑郁症49例，经前期抑郁症11例。采用汉密尔顿抑郁量表(HAMD)17项，对患者治疗前及治疗4周后进行评分，给予临床疗效评定。结果　60例女性抑郁症患者经中医综合治疗，治疗前后自身对照研究结果经HAMD评分，治疗后总分显著下降(P＜0.01)。60例患者经治疗4周后，治愈35例，好转19例，临床总有效率为90%，痊愈率为58%。结论　提示中医综合疗法对女性抑郁症的治疗具有较好的前景，是一种值得推广的治疗方法。

慢性盆腔炎是妇科常见病、多发病,根据其临床表现,应归属于中医"妇人腹痛”、"带下病”等范畴.<中药新药临床研究指导原则>指出气滞血瘀是其主要证型,我们通过对较大量临床资料的观察分析,对慢性盆腔炎病因病机有一些新的认识并用于指导临床治疗,取得了满意疗效,现论述于下.

To observe the therapeutic effect of Putian Capsule on dysmenorrhea,hypermenorhea,menostaxis associated with endometriosis, 70 cases of endometriosis were randomly allocated to two groups:the treatment group (Putian Capsule)and the control group (Tianqi Tongjing Capsule). The results showed that the total effective rate of Putian Capsule for dysmenorrhea,hypermenorrhea and menostaxis was 85%, 89.7% and 92% respectively,and the differences were significant except for that of dysmenorrhea as compared with the control group.The rate of EMAb turning to negative was 45.45%,which was higher than that in the control group (P 0.01 ).It is indicated that Putian Capsule possesses a definitive effect on endometriosis.

Objective To evaluate the relationships between ureaplasma urealyticum(UU),chlamydia trachomatis(CT)infection and pelvic inflammatory disease(PID).Methods Sauples from 168 cases of PID were examed,cultured for UU and antigen examination was used to detect CT in the cervical swabs.Results Among the 168 cases of PID,the positive rate of CT was 25.0%(42/168),UU was 30.4%(17/168).Conclusion The result showed that CT and UU were the important factors in the formation of PID,the detection of CT and UU should be applied to the clinical diagnosis of PID.