介绍孙媛主任医师治疗眩晕的经验.孙媛认为眩晕的发生与心、肝、肾、脾功能失调相关,常见病理因素有风、痰、瘀、虚、郁,以风、痰、瘀相兼者最为多见,其病因病机主要是肝风内动,痰瘀互结,上蒙清窍,治以平肝息风、祛痰化瘀,自拟化痰祛瘀定眩汤治疗.临证常根据不同兼夹病因,辨证施治,灵活化裁用药,取得良好疗效.

孙媛主任认为“心痹者,脉不通”是胸痹的基本病机,即血脉瘀阻,且寒邪是导致胸痹心痛较为常见的危险因素之一,寒凝血瘀型胸痹在临床上较为多见,冬春较为多发,并依据多年临床经验,治疗以散寒通脉活血化瘀立法,遂用自拟方化瘀散寒通心汤加减,灵活运用于临床,取得良好效果.

纵观近几年国内发表的文献,柴胡加龙骨牡蛎汤的临床应用十分广泛,导师孙媛主任医师在临床上善于运用和解枢机法治疗心系疾病,取得了满意疗效,现通过查阅相关文献并结合临床跟师心得,对柴胡加龙骨牡蛎汤方证及和解枢机法进行分析.通过验案举例,介绍对该法的认识及临床应用体会,以飨同道.

冠心病心绞痛为临床常见病,属于中医学“胸痹”“心痛”等病范畴,胸痹病位在心,发病与脾胃关系尤为密切,故对脾胃的治疗十分重要.本文从脾与心的关系,分析“健脾培土,益气活血”“畅达中舟,行气化瘀”“醒脾化痰,开胸通痹”三法在论治胸痹中的临床应用.

目的 了解东丽区金钟街户籍居民主要死因的分布及其死亡率变化趋势,掌握居民健康影响因素,为进一步完善重点疾病防制措施和健康促进策略,延长居民寿命提供科学依据.方法 利用2007-2016年金钟街户籍居民死因监测资料,分析死因构成比、死亡率等指标.死因分类按照国际疾病分类(ICD-10)对根本死因进行编码.人口资料来源于东丽区公安局户籍部门统计资料.采用Excel 2010、SPSS 17.0软件进行x2检验、u检验.死亡时间趋势用年度变化百分比(APC)检验.结果 2007-2016年户籍居民年均粗死亡率为566.59/10万,年均标化死亡率为516.12/10万,全人群、男性的标化死亡率呈下降趋势,有统计学意义(APC分别为-2.57％、-3.05％,P＜0.05).金钟街户籍居民前10位死因依次为心脏病、恶性肿瘤、脑血管病、呼吸系统疾病、伤害、内分泌营养和代谢疾病、消化系统疾病、泌尿生殖系统疾病、神经系统疾病、肌肉骨骼和结缔组织疾病,占全部死亡人数的96.54％.全人群恶性肿瘤分类中胰腺癌标化死亡率呈上升趋势,而脑血管病、消化系统疾病、泌尿生殖系统疾病呈下降趋势,有统计学意义(APC分别为16.07％、-7.41％、-13.93％和-16.97％,P＜0.05).男性肺癌标化死亡率呈上升趋势,脑血管病呈下降趋势,有统计学意义(APC分别为5.97％、-11.31％,P＜0.05).女性胰腺癌标化死亡率呈上升趋势,消化系统疾病及伤害则呈下降趋势,有统计学意义(APC分别为16.88％、-24.50％和-20.07％,P＜0.05).结论 以心脑血管疾病、肿瘤等疾病为代表的慢性非传染性疾病正在成为影响金钟街居民健康的公共卫生问题,重视老年人慢性病干预工作,应采取全人群和高风险人群策略相结合的综合防控措施降低慢性病死亡率.

Objective:To analyze the palpitation prescription rule in Shengji Zonglu.Methods:The use of prescription information mining system (V1.0) statistical frequency of the drug and drug class frequency,and use medicine association rules and disease drug association rules analysis the relationship between syndrome and heart palpitations drugs.Results:According to the rule of drug analysis,the basic pathogenesis of palpitation is asthenia in origin and asthenia in superficiality,deficiency of heart Qi,treatment principle of replenishing Qi and calming the nerves,commonly used drugs are Ginseng,Poria,Radix Polygalae,Licorice,Radix Saposhnikoviae,Tabasheer,while different syndromes,choose different drugs.High frequency compatibility of medicines mainly is Poria-Licorice,Radix Ophiopogonis-Licorice,Ginseng-Licorice,etc.Conclusion:Systematic analysis on the palpitation prescription in Shengji Zonglu can understand the basic ideas for the treatment of palpitation disease,and guide the clinical application.

Objective To observe the clinical effect of Songling Xuemaikang Capsules combined with Candesartan Cilexetil Tablets in treatment of climacteric hypertension with Yin deficiency and Yang hyperactivity.Methods Climacteric women (70 cases) with hypertension hyperactivity in Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from March 2015 to October 2015 were randomly divided into control and treatment groups, and each group had 35 cases. Patients in the control group were po administered with Candesartan Cilexetil Tablets, 8 mg/time, once daily. Patients in the treatment group were po administered with Songling Xuemaikang Capsules on the basis of the control group, 1.5 g/time, three times daily. Patients in two groups were treated for 8 weeks. After treatment, the clinical efficacies were evaluated, and blood pressure and Traditional Chinese Medicine syndrome scores in two groups were compared.Results After treatment, the clinical efficacies of blood pressure in the control and treatment groups were 74.28% and 85.71%, respectively, and the clinical efficacies of Traditional Chinese Medicine syndrome in the control and treatment groups were 68.57% and 88.57%, respectively, and there were difference between two groups (P < 0.05). After treatment, systolic pressure and diastolic pressure in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the Traditional Chinese Medicine syndrome scores of dizziness, headache, feverish sensation over the five centers (palms, soles, and chest), palpitation, and insomnia in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups(P<0.05).Conclusion Songling Xuemaikang Capsules combined with Candesartan Cilexetil Tablets has clinical curative effect in treatment of climacteric hypertension with Yin deficiency and Yang hyperactivity, can significantly decrease blood pressure, and improve clinical symptoms, which has a certain clinical application value.

[目的]了解永久性结肠造口病人的自我效能和希望水平，并探讨二者之间的相关性。[方法]采用自制一般问卷、造口自我效能量表及 Herth 希望量表对196例结肠癌、直肠癌术后永久性结肠造口病人进行问卷调查。[结果]永久性结肠造口病人的自我效能量表得分为87.62分±18.41分；永久性结肠造口病人的希望水平得分为36.68分±3.94分；永久性结肠造口病人的自我效能与其希望水平呈正相关。[结论]永久性结肠造口病人的自我效能为中等水平，希望水平较差，护理人员应加强健康指导，提高其自我效能水平及希望水平，进而提高病人的生存质量。

棘突压迫综合征由赵建国[1]教授首次提出,脊柱任何一个部位的风湿活动会影响到周围的神经,从而在神经支配的相关区域出现一系列症状,且按压患者脊柱棘突相应的部位,会出现不同程度的压痛.根据棘突压痛部位不同,表现各异.临床表现以胸闷、心悸、胸背痛、眩晕、乏力为主,同时还包括关节疼痛、胃部不适者,少数患者出现耳鸣.棘突压痛以C3-T5最多见,少数患者可出现腰椎棘突压痛.不同部位压痛可出现相关神经支配区域的症状.例如以胸闷、心悸、胸背痛为主的患者,压痛多位于C7-T4棘突;胃部不适患者的压痛多位于T3-T7.棘突压痛综合征一般呈现症状重,各项检查无明显异常.发病年龄无明显特异性,幼儿成人皆可发病.临床误诊率高,笔者希望医界引起重视,特列举临床案例.

偏瘫痉挛状态是指因上运动神经元损害，使脊髓水平的中枢反射从抑制状态释放，产生肌张力增高，并伴有随意运动障碍、肌肉萎缩、疼痛等一系列症状，是中风患者最常见的残障表现之一，也是治疗中最棘手的后遗症。主要表现为上肢屈肌和下肢伸肌的共同运动模式，这种模式的存在严重妨碍了肢体功能活动和病人肢体功能恢复。中风偏瘫痉挛状态的治疗和康复对患者生活自理能力的改善，肢体运动功能的恢复，乃至最后重新回归社会具有重要的医学意义。探索高效、经济的治疗手段，让患者尽早回归家庭，回归社会，已是世人关注的焦点，已成为中外医学界瞩目的共同研究课题。现将近年治疗中风痉挛性瘫痪状态的文献综述如下。

Constructingacloudplatformfor 3Dmedicalimagepost-processingcanrealizethe virtualizationsharingofresources.Doctorscanreadtheoriginalimagedataandconductthe 3Dpost-processing quickly without being limited by time and place with this platform, which is of great importance to services like medical image teleconsultations, image referrals, distant education and so on. Moreover, it is important in improving the diagnosis and treat level and the use efficiency of image equipment in our hospital, thus improving the service quality and reducing the expenses.

Objective To observe the efficacy and safety of Shenfu Qiangxin Pills combined with benazepril hydrochloride in treatment of senile hypertension with heart failure.Methods Patients (64 cases) with senile hypertension with heart failure were randomly divided into treatment group and control group. Each had 32 cases. On the basis of conventional treatment, the patients in the control group were given Benazepril Hydrochloride Tablets 10 mg/time, once daily; The patients in the treatment group were given Shenfu Qiangxin Pills 6 g/time, twice daily on the basis of the control group. The patients in the two groups were taken continuous treatment for 8 weeks. After the treatment, traditional Chinese medicine syndrome efficacy, heart failure efficacy, and cardiac function indexes were observed.Results After the treatment, the total effective rates for the patients in both the treatment and control groups were 90.63% and 71.88% in traditional Chinese medicine syndrome efficacy with significant difference (P < 0.05). The total effective rates for the patients in both groups were 87.5% and 71.9% in heart failure efficacy, and the treatment group was better than the control group with significant difference (P < 0.05). Compared with the control group, left ventricular ejection fraction (LVEF) increased; Left ventricular end diastolic diameter (LVDD) lessened; Brain natriuretic peptide (BNP) decreased and the treatment group was better than the control group with significant difference (P < 0.05).Conclusion Shenfu Qiangxin Pills combined with benazepril hydrochloride is effective in the treatment of senile hypertension with heart failure, which is worthy of clinical application.

Objective To observe the clinical efficacy of Xiaozhi Capsules combined with fenofibrate in the treatment of hyperlipidemia. Methods Patients with hyperlipidemia (60 cases) who came to Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital from December 2012 to December 2013 for treatment were randomly divided into treatment and control groups (30 cases in each group). The patients in the control group werepo administered with Fenofibrate Tablets (200 mg), once daily. On the basis of the control group, the patients in the treatment group werepo administered with Xiaozhi Capsules (three grains), three times daily. Two patients were treated continuously for 8 weeks. After treatment, the clinical efficacy, syndrome curative efficacy of traditional Chinese medicine, and blood lipid indexes in two groups were observed.Results After treatment, the clinical curative effect, syndrome curative efficacy of traditional Chinese medicine, and blood lipid indexes had statistically differences, compared with those of the control group (P< 0.05).Conclusion Xiaozhi Capsules combined with fenofibrate has the remarkable clinical efficacy in the treatment of hyperlipidemia, which is worth of clinic application.

目的 观察单硝酸异山梨酯片联合定痛救心胶囊对冠脉介入术(PCI)后再发稳定型心绞痛的临床疗效和安全性.方法 将48例PCI后再发稳定型心绞痛患者随机分为治疗组(24例)和对照组(24例).对照组口服单硝酸异山梨酯片20mg/次,3次/d;治疗组口服定痛救心胶囊6粒/次,3次/d,单硝酸异山梨酯片的用法和用量同对照组,两组患者均持续治疗8周.治疗结束后,观察两组患者临床疗效、心电图变化、中医证候疗效.结果 治疗后治疗组临床疗效、心电图变化、中医证候疗效与对照组比较差异均有统计学意义(P＜0.05).结论 单硝酸异山梨酯片联合定痛救心胶囊能有效地改善PCI术后再发稳定型心绞痛患者的疗效,且无不良反应,值得临床推广.

近年来中医药防治再狭窄的研究取得了一定的进展，体现在中医对冠心病介入后再狭窄病机的认识及中药多途径、多靶点的整合调控作用。本文分别对再狭窄的病理机制以及中医药防治研究进展进行综述。

<正>双心医学又称为心理心脏病学或精神心脏病学,由胡大一教授首先在国内倡导的,是研究心理疾患与心脏病的相关性,即研究人的情绪与心血管系统之间的深层联系。随着传统医学模式向生物-心理-环境-社会医学模式转变,社会心理因素在疾病发生发展中起到的作用日益受到重视。冠心病常并发焦虑、抑郁、失眠、痴呆等"心"病,故称为"双心"疾病。

The coronary heart disease is a serious disease threating the health of people.Through a large number of clinical observations by the author,it is showed that the blood stasis and toxic heat are an important mechanism leading to the coronary heart disease.No matter it is on onset or remission period the mutual integration of blood stasis and toxic heat is existed from the beginning to the end of the disease.So blood stasis and noxious heat and stagnation of vessel are the key in the pathogenesis of coronary heart disease.The promoting blood flow and detoxification method can treat patients of coronary heart disease with blood stasis and toxic heat successfully.

马连珍教授从事中医心血管病的临床和研究40余年并积累了丰富的经验,尤其对慢性心衰的诊治有独到的见解。他认为该病的核心病因病机是心肾阳虚、血瘀水停,因此研制了参附强心丸以益气温阳、活血利水、通补兼施,从而改善患者心脏功能、症状、体征及中医证候,提高患者生活质量。

This paper illustrates the development demands,frame and function of the teaching observation monitoring system in our hospital,thus to provide a reference for system development and research.

<正>桂枝汤首见于张仲景的《伤寒论》,具有解肌祛风、调和营卫、滋阴和阳的功效。仲景在《伤寒论》和《金匮要略》中,以桂枝汤为基础方加减化裁而成的桂枝汤类方将近30首,被历代医家广泛应用。笔者运用其类方,宗其方义治疗各种心脏病,取得较好疗效,现分述如下。