基于"好大夫在线"网站先天性心脏病医疗服务数据和患者评价数据,采用数据分析和可视化方法,阐述在线医疗网站先天性心脏病医疗服务现状,并针对平台机制完善提出建议.

目的 观察电针“百会”配“足三里”穴对肠易激综合征(IBS)模型大鼠内脏敏感性及其情绪心理行为的双重调节作用.方法 采用母子分离加幼鼠醋酸灌肠法制备IBS大鼠模型,32只大鼠随机分为正常组、模型组、模型束缚组、电针组(电针“百会”配“足三里”穴).造模后,正常组、模型组不做处理,模型束缚组只捆绑束缚不治疗,电针组捆绑束缚并电针20 min,隔日1次,共5次.末次电针后对大鼠进行腹部回撤反射(AWR)及自主行为测试,采用反转录-聚合酶链反应(RT-PCR)方法检测大鼠丘脑中降钙基因相关肽(CGRP) mRNA的表达.结果 电针后模型大鼠内脏敏感性降低,自主行为增多,丘脑中CGRP mRNA表达降低.结论 电针“百会”配“足三里”穴能够有效改善IBS模型大鼠的慢性内脏痛及其情绪心理障碍.

Objective To observe the clinical of the thunder fire moxibustion therapy in the treatment of lumbar intervertebral disc protrusion.Methods 33 patients with lumbar intervertebral disc protrusion were treated with the thunder fire moxibustion,bird-pecking moxibustion and circling moxibustion.The change of symptoms and signs were observed.Results After treatment,the ODI symptom index score improved significantly(P<0.05)and 10 cases(30.30%)were cured,11 cases were markedly effective(33.33%),8 cases were effective(24.24%),and the total effective rate was 87.88%.Conclusion The thunder fire moxibustion therapy has good curative effect on lumbar intervertebral disc protrusion.

文章通过检索中国知网、万方、维普等数据库,综述了2010~2015年针灸治疗膝关节骨性关节炎的不同方案以及临床疗效的相关文献,以期为今后膝关节骨性关节炎的针灸治疗方案的选择提供依据.中医治疗膝关节骨性关节炎的原则是内补肝肾,外除风、寒、湿,佐以养血柔筋,多采用中药内服兼外用;而针灸在止痛效应上有确切疗效.文中通过对针灸治疗膝关节骨性关节炎的临床疗效肯定,阐述了不同的针灸治疗方案产生不同的疗效,联合采用两种以上的针灸治疗方案可以明显提高疗效.

Objective To observe the effects of electro-acupuncturing (EA)at “Baihui”(DU20)and“Zusanli”(ST36)on the visceral sensitivity and emotional and psychological behavior of the irritable bowel syndrome (IBS)model rats,and to explore the double adjustment of electro-acupuncture on chron-ic visceral pain with emotional and psychological dysfunction.Methods Wistar immature rats were ran-domly divided into normal group,model group and electro-acupuncture group.The IBS model was in-duced by mechanical colorectal irritation of acetic acid combined with maternal separation in the postnatal period.Rats of normal group and model group underwent no intervention while those of electro-acupunc-ture group were needled at “Baihui”and “Zusanli”every other day for ten days.The visceral sensitivity was evaluated and the open-filed test was used,and the mRNA of neurokinin-1(NK1)receptor was de-tected by using RT-PCR.Results The treatment of acupuncture reduced significanty the visceral sensi-tivity,crossing activity and vertical activity in open field test,and the mRNA expression of NK1.Con-clusion The double adjustment of electro-acupuncturing at “Baihui”and “Zusanli”on chornic visceral sensitivity with emotional and psychological dysfunction was proved.

目的:探讨中医寒凝血瘀证动物模型的制备方法.方法:对近年来制备寒凝血瘀证动物模型的方法进行比较、分析及综合评价.结论:制备符合中医辩证施治理论特点的寒凝血瘀证动物模型的方法繁多,综合相关文献报道,认为制备寒凝血瘀证动物模型的关键因素是温度,尚需进一步的摸索.

目的：观察电针足三里、天枢穴对肠易激综合征模型大鼠肠系膜微血管管径及血浆中降钙基因相关肽(CGRP)、血管活性肠肽(VIP)水平的影响，探讨针刺治疗IBS的可能机制。方法：以Wistar幼鼠为研究对象,分为正常组、模型组、天枢组、足三里组，天枢和足三里组,采用联合作用型方法制备IBS大鼠模型，从第6周束缚及电针干预，隔日1次，共7次。模型组只束缚不针刺，正常组不做任何处理。治疗结束后，采用XW-B-3冷光源微循环显微仪观察各组大鼠肠系膜微循环不同时间段的管径；采用酶联免疫法(Elisa)检测大鼠血浆中CGRP、VIP的含量。结果：①肠系膜微血管管径：与正常组比较，模型组血管管径在即刻、10分钟、30分钟时明显收缩(P＜0.05)；与模型组比较，天枢组、足三里组血管管径扩张，天枢组20分钟P＜0.05，即刻、30分钟P＜0.01，足三里组各时间段血管管径与模型组比较(P＜0.01)。②血浆CGRP、VIP含量：与正常组比较模型组大鼠血浆中VIP含量升高(P＜0.05)；电针足三里组大鼠血浆中CGRP、VIP含量升高(P＜0.05、P＜0.01)。与模型组比较电针足三里组大鼠血浆中CGRP升高(P＜0.01)。结论：肠易激综合征模型大鼠表现为明显的微循环功能障碍，血浆中血管内皮相关物质CGRP、VIP水平紊乱。针灸可有效调节紊乱的CGRP、VIP水平，进而扩张微血管，改善微循环功能障碍，起到治疗作用。

Dysmenorrhea,one of the common gynecological diseases,has high incidence rate and affects work and life of people negatively,attracting researchers' more and more attentions. Many studies have found that treating dysmenorrhea by acupuncture is effective. However,the way to improve the effect of treating dysmenorrhea by acupuncture and maintain its efficacy repeatedly is still a major issue for the researchers. Doctors in traditional medical history think highly about Deqi( getting feeling of acupuncture) with regarding it as a very important key to produce a therapeutic effect in acupuncture treating process. Nowadays a large number of clinical trials are constantly expanded to deeply clarify Deqi and find out its standardization,and furthermore guide clinical treatment well. Through reading related articles and records,and combined with own medical experiences,the author tried to make a brief summary of Deqi influencing acupuncture treatment of primary dysmenorrhea so as to discuss the study with our peers in medicine.

Objective:Comparison of the adjusting action of electro-acupuncture on Guanyuan(RN 4) and Dachangshu(BL 25) points to high sensitivity of IBS model rats of viscera,to discuss the mechanism of the acu-points.Methods:The IBS model of animals were made by acetic acid retention-enema method,and then divided into model group,EA RN 4 group and EA BL 25 group.Observation of the influence of electro-acupuncture to high sensitivity of model rats of viscera and testing the changes of NPY content in their spinal cord and brain tissue and bowels tissue of each group.Results:①Compared with the model group,electro-needling on RN 4 point and BL 25 point can remarkably improved the capacity threshold value of abdomen raising of rats(P0.05),electro-needling on RN 4 point can remarkably improved capacity threshold value of back hunching up of rats(P0.05).②Compared with model group,electro-needling on RN 4 point could remarkably increase NPY content in thalamus(P0.01),the content of NPY electro-needling BL 25 point increased significantly in the spinal cord(P0.05).Conclusion:RN 4 and BL 25 point are located at the same nerve segment in spinal cord,but RN 4 has a better effect of restraining the high sensitivity of viscera of IBS model rats than BL 25 point.It is conjectured that RN 4 point not only has local adjusting effect as same as BL 25 point,but also has adjusting effect for the disorder of brain-gut axis.

目的:观察电针“百会”配“足三里”穴对慢性内脏痛模型大鼠情绪心理行为的改变,结合大鼠海马和结肠组织中5-HT水平的变化,旨在阐明针刺缓解疼痛及改善情绪心理障碍的部分机制.方法:选取肠易激综合征(IBS)大鼠为慢性内脏痛动物模型,随机分为正常组、模型组、模型束缚组、针“百会”配“足三里”组(以下简称治疗组).造模结束后第2天,正常组、模型组不做任何处理,模型束缚组只捆绑束缚不治疗,治疗组捆绑束缚进行电针处理20 min.隔日1次,共治疗5次.治疗结束后,对大鼠进行高架十字迷宫测试,采用酶联免疫法(Elisa)检测大鼠海马和结肠组织中5-HT的水平.结果:1)高架十字迷宫测试,与正常组比较,模型组OE％和OT％值明显降低(P＜0.05)；与模型组比较,治疗组OE％和OT％值明显升高(P＜0.01,P＜0.05).2)5-HT水平比较,与正常组比较,模型组、模型束缚组海马中5-HT水平升高(P＜0.05)；与模型组比较,治疗组海马中5-HT水平降低(P＜0.05)；与模型束缚组比较,治疗组海马中5-HT水平降低(P＜0.05).与正常组比较,模型组、模型束缚组结肠中5-HT水平降低(P＜0.05)；与模型组比较,治疗组结肠中5-HT水平升高(P＜0.05)；与模型束缚组比较,治疗组结肠中5-HT水平升高(P＞0.05).3)海马/结肠5-HT比值,与正常组比较,模型组、模型束缚组海马和结肠中5-HT比值升高(P＜0.05)；与模型组比较,治疗组海马和结肠中5-HT比值降低(P＜0.05)；与模型束缚组比较,治疗组海马和结肠中5-HT比值降低(P＞0.05).结论:电针百会配足三里穴能够调节脑肠轴中5-HT水平的失调,进而减轻疼痛症状,使焦虑状态得到改善.

Objective: To observe the effects of electroacupunture(EA) point and Zusanli point on the visceral sensitivity and Emotional psychology behavior change of the irritable bowel syndrome rat model,and to combine the level of 5-HT in IBS rat model on hippocampi to discuss parts of the mechanism of IBS with emotional psychological disorder in the acupuncture treatment.Methods: To set WISTAR rats as the model of irritable bowel syndrome rats.The postnatal rats were randomized into the normal group,the model group,the model bound group,the EA Baihui and Zusanligroup(Hereinafter referred to as treatment group).No treatment was done in the normal group and the model group.The model bound group was bounded but not given EA.The treatment group was started to be given EA after duplicating the mold 2nd days.The visceral sensitivity evaluation and Open-field test were operated in rat after the end of treatment.The level of 5-HT in rat hippocampal was measured with Elisa.Results:(1)The estimation of the visceral sensitivity: compared with the normal group,the value of the model group rat belly raising and back hunch-up decreased(P0.05).Compared with the model group,the value of the treatment group rat belly raising and back hunch-up increased obviously(P0.01,P0.05).(2) The Open-flied test: compared with the normal group,the value of rat level activities and vertical activities in the model group and model bound group decreased obviously(P0.01,P0.05).Compared with the model group,the value of rat level activities and vertical activities in the treatment group increased obviously(P0.01,P0.05).Compared with the model bound group,the value of rat level activities and vertical activities in the treatment group increased(P0.05).(3) The level of 5-HT: compared with the normal group,the level of 5-HT was ascent in the model group(P0.05).Compared with the model group,the level of 5-HT was descend in the treatment group(P0.05).Compared with the model bounded group,the level of 5-HT was descend in the treatment group(P0.05).Conclusion: EA Baihui,Zusanli point can reduce the visceral sensitivity and the level of 5-HT in IBS rat model on hippocampi;it can also relieve pain and improve the emotional psychological disorder.

目的:对比电针与艾灸百会对束缚模型大鼠血清1肿瘤坏死因子（TNFα-）及白介素（IL-1）含量的变化,探讨其变化的规律。方法:以束缚模型大鼠为研究对象,电针、艾灸百会穴,采用放射免疫法测定大鼠血清中TNFα-及IL-1的含量变化。结果:与正常组比较,模型组、针刺百会组血清中TNFα-及IL-1的含量均降低趋势,而艾灸百会组的含量有升高趋势,各组间未见无统计学意义（P＞0.05）。与束缚模型组比较,针刺百会组TNFα-及IL-1的含量有降低趋势,艾灸百会组的含量有升高趋势,各组间比较无统计学意义（P＞0.05）。与针刺组比较,艾灸组TNFα-及IL-1的含量均升高,其中2组间IL-1含量的比较有统计学意义（P＜0.05）。结论:针刺和艾灸作为不同的治疗介入方法,对束缚模型大鼠血清TNFα-及IL-1的含量均有不同程度的影响,以艾灸百会穴的调节作用较为明显。束缚模型大鼠血清IL-1、TNFα-含量均有所降低,而艾灸组TNFα-及IL-1的含量明显升高。相关研究结果表明:IL-1和TNFα-可以诱生IL-2,而IL-2又可以通过自分泌效应对机体发挥正向调节作用,从而启动机体内源性自稳机制,调整紊乱的免疫功能,最终达到提高机体内在应变能力。

目的:观察电针足三里穴、天枢穴对肠易激综合征模型大鼠血浆中降钙基因相关肽( CGRP)、血管活性肠肽(VIP)、内皮素(ET)含量的影响,进一步探讨针刺治疗肠易激综合征的部分机制.方法:选取VISTAR幼鼠为研究对象制备肠易激大鼠模型,实验分为正常组、模型组、天枢组、足三里组.天枢组和足三里组从第6周采用自制布袋束缚及电针处理,隔日1次,共7次.正常组不做任何处理.治疗结束后,麻醉状态下采用腹主动脉取血5mL,置于EDTA抗凝管中,离心,取上清液置于-20℃冰箱内冻存待测,采用酶联免疫法(Elisa)检测大鼠血浆中CGRP、VIP、ET的含量.结果:1)与正常组比较:模型组大鼠血浆中VIP、ET含量升高,统计学处理差异有统计学意义(P ＜0.01、P＜0.05)；电针足三里组大鼠血浆中CGRP、VIP含量升高,经统计学处理差异有统计学意义(P＜0.05、P＜0.01).2)与模型组比较:电针天枢组大鼠血浆中CGRP、VIP含量升高,经统计学处理差异有统计学意义(P＜0.05)；电针足三里穴大鼠血浆中CGRP含量升高,经统计学处理差异有统计学意义(P＜0.01).结论:结果显示,肠易激综合症模型大鼠血浆中CGRP、VIP、ET水平异常,进而引起三者之间的比值失调,可能是导致肠易激综合征发生的机制之一,而针刺可以通过调节三者之间的紊乱状态进而达到对肠易激综合征的治疗作用.且足三里、天枢穴的调节作用各具特点.