Objective To observe and analyze the effect of combined application of acupoint application and foot bath with traditional Chinese medicine on vertigo of phlegm turbid and upper Mongolia type. Methods 112 patients with phlegm turbid upper Mongolia type vertigo were divided into the control group and the observation group.The patients were treated in our hospital from July 2021 to June 2022.The patients in the control group were treated with western medicine.The patients in the observation group were treated with acupoint application and traditional Chinese medicine foot bath on the basis of the treatment in the control group.The clinical efficacy, TCM syndrome score, hemodynamics, vertigo disorder scale（DHI） Improvement of Activity Balance Confidence Scale（ABC）. Results Compared with the clinical efficacy of the two groups, the total clinical efficacy of the observation group was significantly higher（P＜0.05）. Before treatment, there was no significant difference in the scores of main syndrome, secondary syndrome, concurrent syndrome and tongue coating pulse condition among the groups（P＞0.05）. After treatment, the scores of TCM syndromes in the observation group were significantly lower than those in the control group, and the scores of each item were statistically significant（P＜0.05）.There was no statistically significant difference in the comparison of hemodynamic indexes between the groups before treatment（P＞0.05）.After treatment, the levels of Vm, BA, RVA and RVA in the observation group were higher than those in the control group, and there was significant difference in the levels of hemodynamic indexes between the two groups（P＜0.05）.There was no significant difference in vertigo and balance confidence scores of patients before treatment（P＞0.05）.After treatment, the DHI score of patients in the observation group was lower than that in the control group, and the ABC score was higher than that in the control group（P＜0.05）. Conclusion The combination of acupoint application and foot bath with traditional Chinese medicine can effectively improve the clinical symptoms and hemodynamics of patients with phlegm turbid and Mongolian vertigo, which is helpful to further improve the clinical treatment effect and enhance the patients’ confidence in activity balance.

目的:观察全息刮痧疗法在失眠症患者中的应用效果.方法:选取2020年1月-2021年1月福建中医药大学附属人民医院神经内科110例失眠症患者.根据随机抽签法将其分为对照组和观察组,各55例.对照组采用耳穴压豆治疗,观察组在对照组基础上采用全息刮痧疗法治疗.对两组临床疗效及治疗前后睡眠质量进行比较.结果:观察组总有效率为89.09％,高于对照组的67.27％(P<0.05).治疗后两组入睡时间、睡眠时间、睡眠障碍、睡眠效率、日间功能、催眠药物、睡眠质量评分及总分均较治疗前降低(P<0.05),且观察组入睡时间、睡眠时间、睡眠障碍、睡眠效率、日间功能、催眠药物、睡眠质量评分及总分均低于对照组(P<0.05).结论:采用全息刮痧疗法对失眠症患者进行治疗,明显改善患者失眠症状,可有效提高患者的睡眠质量,疗效显著,值得推广.

目的 调查新媒体时代医学本科生医德教育现状,分析其影响因素,探讨有效运用新媒体加强与改进医德教育实效的对策建议.方法 采用问卷法对F中医药大学5488名本科生对新媒体的认识及使用状况、医德认识、医德教育现状及新媒体的应用等方面进行调查,并对获得数据进行统计分析.结果 新媒体已广泛普及,手机已经成为医学生普遍使用的新媒体工具.67％ 的调查对象每天使用新媒体的时间≥1小时,82.1％ 的调查对象使用时间集中在晚上到睡前(18～24时),新媒体对调查对象的学习产生积极和消极的影响;调查对象普遍认可医德教育的意义,但认为还存在教育手段与途径单一(59.7％)、缺乏情感体验和实践性、难以内化(56.6％)、重视程度不够(52.1％)等问题;90％ 以上的调查对象认可增加或借鉴中西方传统医德教育内容和方式,78.3％ 调查对象认可采用视频、66.2％ 认可图片文字相结合的形式等建议.结论 新媒体已广泛普及,医学院校应积极面对医德教育迎来的诸多挑战,通过增强医学生对医德的理解、提升师生的信息化素养和媒介素养、加强新媒体的规范和有效利用、不断丰富和创新医德教育的内容与模式等对策切实提高医学生的医德教育水平.

目的 分析福鼎医院骨科金黄色葡萄球菌(SAU)的临床分布及耐药情况,为临床合理使用抗菌药物提供参考.方法 采用回顾性分析法,对2017-2019年该院分离SAU的分布情况和耐药性进行分析.结果 福鼎医院骨科2017-2019共检出616株SAU;骨科患者感染SAU的年龄主要在40～60岁(44.0％),病例数的男女比分别为2.89(142:49)、2.52(169:67)和2.44(134:55);临床标本来源以伤口分泌物为主(89.3％),近3年均位居骨科病原菌分离首位,主要分离自手足显微外科和创伤骨科;对青霉素的耐药率均＞98.0％,其它抗生素耐药率多＜50％,万古霉素、替考拉宁和利奈唑胺耐药菌株未检出;近3年骨科的耐甲氧西林的金黄色葡萄球菌(MRSA)检出率为35.4％～37.7％.结论 金黄色葡萄球菌是福鼎医院骨科最常见病原菌.长期监测骨科SAU耐药性变化,对指导临床合理应用抗菌药物非常重要.

阮诗玮教授系福建省名中医,多年从事临床,擅用角药治疗肾系疾病.慢性肾脏病多因风热犯肺,母病及子,肺热下迫于肾,损伤血络,邪伤肾络,肾失封藏,导致尿血;上焦病不治,可传下焦,而下焦为肾脏所居之地,故若上焦有湿热者,湿热之邪下转侵犯肾脏;热久蕴于下焦,尿液受其煎熬,日积月累,尿中杂质结为砂石就形成“石淋”.角药源自《素问·至真要大论》“君一臣二,奇之制也”理论,利用中药基本特性,将三味中药合理巧妙配伍,有如三足鼎立,互为犄角.阮诗玮教授在辨状态论治的思维上,临证时通过全面掌握肾系疾病患者机体整体状态,根据宏观与微观、大系统与子系统的动态病理变化理论,针对不同机体状态的肾系疾病患者,采用多个由3个药物组成的组方进行诊疗.阮诗玮教授常使用:山萸肉、熟地黄、淮山药;枇杷叶、射干、郁金;干姜、五味子、细辛;连翘、薄荷、栀子;黄柏、知母、桂枝;金樱子、芡实、覆盆子;上已菜、鬼箭羽、茜草炭;金钱草、海金沙、鸡内金;生地黄、秦艽、豨莶草;荷叶、黄芩、大黄;薄荷、滑石、甘草等角药组合,以补益肺肾、凉血止血、活血化痰、补肾除湿,疗效卓著.详述阮教授临证常用11组角药的组成功效、配伍要点、适应病症,对阮教授治疗肾系疾病用药经验做一总结.

阮诗玮教授系福建省名中医,从医三十余年,擅长运用药对治疗慢性肾脏病.阮诗玮教授根据慢性肾脏病临床症候特点及血肌酐、尿蛋白、血小板等实验室相关检测指标结果,采用辨病与辨证相结合、宏观与微观相结合、现代医学与传统医学相结合的辨治理念,在长期的临床实践中积累了丰富的用药经验,形成了“治水必先温通”“温阳兼祛邪,善后重温补”等治疗慢性肾脏疾病学术思想.慢性肾脏病病机在于脾肾两脏虚损,久病而正气渐损,卫外不固,失于御外,易感受外邪而出现标证,故而痰浊瘀毒蕴、肺气不宣、上焦郁热、肾失封藏,其症候多为倦怠乏力,腰酸膝软,口干咽燥,五心烦热,夜尿清长,面色萎黄.阮诗玮教授常选用大黄配六月雪、牛蒡子配蝉蜕、升麻配黄连、荷叶配薄荷、沙苑子配覆盆子、白藓皮配地肤子、双钩藤配乌点规、仙茅配淫羊藿、墨旱莲配女贞子、蒲黄配五灵脂、三棱配莪术、茜草配紫草、王不留行配路路通,以求温补脾肾阳、通畅气机、固肾摄精.阮诗玮教授针对慢性肾脏疾病中医学主症及兼症在辨证的基础上做到药症相应,药物成对,从而达到药简功专,事半功倍的治疗效果,文章详述阮教授临证常用13组药对的组成功效、配伍要点、适应病症,对阮教授治疗慢性肾脏病的用药经验做一总结.

目的 了解细菌性脑膜炎患儿脑脊液的主要病原菌分布及耐药性分析,为临床抗感染治疗提供依据.方法 收集我院住院患儿脑脊液标本分离菌株,采用法国生物梅里埃VITEK-2全自动细菌鉴定分析仪鉴定菌种,纸片扩散法(K-B法)进行药敏试验,应用WHONET 5.6软件对结果进行统计分析.结果 培养分离64株病原菌,阳性率为1.72％(64/3728).我院患儿脑脊液主要病原菌为大肠埃希菌32.81％,肺炎链球菌21.88％、无乳链球菌14.06％.按照年龄组划分,新生儿组检出率最高的是无乳链球菌37.5％ (9/24),非新生儿的主要致病菌则为大肠埃希菌,其次为肺炎链球菌,并且随着年龄增长,肺炎链球菌所占的比重越来越大.大肠埃希菌对美洛培南、阿米卡星、哌拉西林/他唑巴坦、头孢替坦、亚胺培南的敏感性较高,均大于90％;肺炎链球菌对青霉素和头孢噻肟的耐药率仅为8.3％和7.1％、对克林霉素、红霉素、磺胺甲嗯唑/甲氧苄啶的耐药率均超过70％;无乳链球菌除对青霉素敏感性达100.0％,对克林霉素、红霉素的耐药性均超过50％.结论 大肠埃希菌、肺炎链球菌、无乳链球菌是本院儿童细菌性脑膜炎最常见的病原菌,这为本地区进行经验用药提供依据.

高血压病理状态是在潜在因素综合作用下形成的,其中包含个体因素、自然因素与社会因素.高血压疾病的发生、发展受到疾病风险因素的影响,疾病风险因素包含体质差异的风险因素、证的变化风险因素与病的传变风险因素.从整体把握状态,阐明潜在因素以及风险因素对高血压病理状态形成及疾病发生进展的影响,构建风险预警模型,是实现高血压风险预警的关键路径,能为高血压病的预防与管理决策提供参考依据.

《伤寒论》用药特点独特,同时体现“因时制宜”的思想,至今仍广泛运用于临床诊治.准确的诊断是治疗的前提,而中药又是中医治疗的重要手段.掌握用药规律,明确用药时宜对于提高疗效、避免误诊误治有极大的意义.因此,笔者通过对《伤寒论》用药特点进行探析,从药性、药量、剂型、时宜4个方面来论述其体现的中医避误思维,主要从医者角度阐述用药的精当与合乎时宜的辨证联系,最后从患者角度强调指导服药的重要性,提出应注重中医健康管理师人才的培养,同时不断推进对中医避误思维及方法的思考与探索.

目的 观察外用重组人表皮生长因子(recombinant human epidermal growth factor for external use,rhEGF)对扁桃体切除术后创面愈合及疼痛程度的疗效.方法 60例因慢性扁桃体炎或扁桃体肥大行扁桃体切除的患者随机分成两组,试验组于扁桃体术后创面喷洒rhEGF治疗,对照组扁桃体术后创面未用任何药物.观察两组患者创面白膜形成与完全脱落时间,创面愈合情况及疼痛程度.结果 与对照组比较,试验组创面白膜完全脱落时间更短,创面愈合情况更好,术后第3、5、7天创面疼痛程度更轻(P＜0.05),而创面白膜形成时间和术后第1天疼痛程度两组无统计学差异(P＞0.05).结论 扁桃体术后局部应用rhEGF可以加快创面愈合,减轻患者痛苦.

太阳病已发汗,医家辨证不明,误行吐下温针等法而成变证.医家常由变证症状不变、病机不同致误;不明变证传变,汗下失序致误;此外,药物的煮服法从另一个角度反映了中医的辨证思维,临证中却常被医家忽略而致误.太阳病变证是中医临床误诊误治的一个缩影,笔者通过分析太阳病误后下利症同证异致误、变证传变误断、药物煮服方法避误3个方面,探讨太阳病变证相关条文的辨治对中医避误的启发.

Objective To evaluate the childhood asthma control test(C-ACT) on the assessment of asthma by exploring the correlations among C-ACT,disease severity,the control level of pediatric asthma,disease partition and the changes in the pulmonary function as well as the score range,and to evaluate the feasibility and effectiveness of C-ACT's application to guide children's asthma control.Methods Two hundred and five children with asthma in the Pediatric Asthma Outpatient of Xiamen Hospital of Fujian University of Traditional Chinese Medicine from October 2011 to October 2015 were enrolled and randomly divided into control group and experimental group by random number table.The patients in the experimental group were monitored by the C-ACT with corresponding guidance,while patients in control group were treated without the monthly guidance of C-ACT after C-ACT involvement at the first time.C-ACT questionnaire score surveys were completed by all patients and their parents under the guidance of asthmatic specialists or nurses.Pulmonary function,disease severity and disease partition and the control level of pediatric asthma were detected and evaluated by doctors before and after treatment.The correlation between the results of C-ACT and the changes in the clinical indicators was assessed,and the improvement of lung function and the control rate of asthma were evaluated in 2 groups after 1 year.Results (1) There was no significant difference in gender,age and disease severity distribution based on the results of pulmonary function assessment between the control group and the experimental group (all P ＞ 0.05).(2) The C-ACT scores in normal,slight abnormal,moderately abnormal and severely abnormal pulmonary function were (24.79-± 2.20) scores,(21.67 ± 1.93) scores,(17.07-± 2.01) scores and (12.67 ± 1.81)scores,respectively,which showed the pulmonary function had a positive correlation with C-ACT scores (F =314.0,P ＜ 0.000 1).(3)Assessment of the reliability of C-ACT:the α value of Cronbach's coefficient for the scale was 0.867,which showed the high reliability.The correlation coefficients between the C-ACT score and the percentage of predicted value of forced expiratory volume in one second(FEV1％),the percentage of peak expiratory flow in the predicted value (PEF％) were 0.683 and 0.712,respectively,which also showed the strong reliability.(4) C-ACT scores in intermittent attacks of asthma,slight persistent asthma,moderate persistent asthma,severe persistent asthma were (24.47 ± 2.26) scores,(22.17 ± 1.86) scores,(17.42 ± 2.52) scores and (13.27 ± 2.11) scores,respectively,which showed the severity of asthma was positively associated with C-ACT scores (F =244.0,P ＜ 0.000 1).(5) C-ACT scores in controlled,partly controlled and uncontrolled asthma were (24.32 ± 2.34) scores,(18.87 ± 1.95)scores and (14.03 ± 1.32) scores,which showed the control levels of asthma had a positive association with C-ACT scores(F =394.0,P ＜ 0.000 1).(6)C-ACT scores in different disease partitions of green,yellow and red area were (24.72 ± 2.04) scores,(18.17 ± 2.03) scores and (15.06 ± 1.93) scores,which showed the diseases partition had an association with C-ACT scores (F =367.2,P ＜ 0.000 1).(7) After treatment of 3 months,6 months and 12 months,the control rates in the control group were 28.71％,67.33％,81.19％,but they were 44.23％,79.81％,95.19％ in the experimental group respectively.The control rates were higher in the experimental group than those in the control group,and the differences were significant (x2 =5.318,4.114,9.722,all P ＜ 0.05).Conclusion The C-ACT is highly correlated with pulmonary function,and our study show the C-ACT score range can help to make a quick assessment of disease severity,disease partition and the control level of children asthma.The application of C-ACT for the treatment of asthma has a good effect and it can be recommended and applied to childhood suitable for the promotion and application of children asthma clinics and community medical institutions at all levels of hospitals.

本文首先对长期照护模式进行分类,并针对国内外老年群体长期照护现状进行分析,接着通过文献资料和实地调查获取当前老年群体长期照护存在的问题,然后总结出长期照护模式选择的影响因素包括年龄、价格和健康状况等,最后针对存在问题和需求提出老年群体长期照护的对策.

After investigated the setting situation of internal medicine clinic departments of 77 prefecture-level city-level TCM hospitals in 6 provinces in East China,the author find that:many TCM hospitals imitated the mode of clinical internal medicines,excessively subdivide internal medicine clinic to many departments,and more than half of TCM hospitals did not set up TCM internal departments.There was a big difference between the excessive subdivision system and the thinking of TCM.It not only caused the patient to see a doctor blindly but also limited the doctors' thinking.The lacking of holism and the ignoring of syndrome differentiation was very easy to cause misdiagnosis.Hence,the author explored and analyzed the cause of misdiagnosis of excessively subdivided departments in internal medicine clinic of TCM hospitals and put forward some thoughts and explorations in the setting of departments in TCM hospitals and some methods to raise the TCM basic literacy of guiding personnel and so on to avoid misdiagnosis and mistreatment.

目的:观察腋下静脉留置针在早产儿静脉输液中的应用效果.方法:选取100例早产低出生体重儿,将其随机分为观察组(n=50)和对照组(n=50).对照组50例采用四肢静脉穿刺留置套管针,而观察组干预方法为腋静脉进行穿刺留置套管针.结果:对照组留置时间(1.84±0.7)d,观察组留置时间为(5.84±1.0)d,观察组的局部不良反应少于对照组,两组比较差异均有统计学意义(P<0.05).结论:腋下静脉留置技术操作简单、并发症少,为早产儿的抢救开辟一条方便、安全的静脉通路,是一种经济、实用的好方法.

目的 观察血府逐瘀膏加减辨证治疗气滞血瘀型原发性帕金森病患者伴随的非运动症状之疗效. 方法 将符合中医气滞血瘀的证型标准的90例患者随机分为治疗组与对照组. 疗程均为2个月,对比治疗前后NMSS频数积分进行评估疗效. 结果与结论 血府逐瘀汤膏联合多巴丝肼片对非运动症状有所改善.

目的:探讨六味地黄汤对Ⅱ型糖尿病患者的临床疗效及血液指标的影响.方法:将80例Ⅱ型糖尿病患者随机分为观察组和对照组各40例,对照组患者口服二甲双胍和阿卡波糖进行治疗,观察组患者在对照组的基础上加用六味地黄汤治疗,观察比较两组患者的临床疗效、血糖水平和血液流变学变化情况.结果:经过治疗,观察组患者治疗总有效率为87.5％,显著高于对照组的77.5％,两组患者临床疗效比较差异具有统计学意义(P＜0.05).观察组患者2hPG、FPG、HbA1c水平显著低于对照组,组间比较差异具有统计学意义(P＜0.05).两组患者治疗后全血黏度、血浆比黏度、血细胞压积、红细胞电泳时间、红细胞沉降率等血液流变学指标均较治疗前显著降低,差异具有统计学意义(P＜0.05),且观察组患者各指标降低程度显著优于对照组,差异具有统计学意义(P＜0.05).结论:在常规西药的基础上加用六味地黄汤治疗Ⅱ型糖尿病临床疗效显著,可有效降低患者血糖水平,改善微循环,值得临床推广应用.

由于活血化瘀法在帕金森患者中疗效显著,本文就活血化瘀中医病机、“瘀血”理论的实验室数据、相关分子水平研究及临床应用结论进行总结与探讨.

目的:探讨茯苓甘草汤治疗肺动脉高压气虚血瘀证患者的临床疗效.方法:将54例肺动脉高压气虚血瘀证患者随机分为实验组和对照组各27例,两组患者均给予常规西药治疗,在此基础上,对照组患者加用硝苯地平控释片,实验组患者加用茯苓甘草汤,治疗3个月后比较两组患者中医证候积分、临床疗效,并记录两组患者治疗前后肺动脉收缩压、肺功能和血液流变学指标变化情况.结果:经过治疗,实验组患者中医证候积分显著低于对照组,差异具有统计学意义(P＜0.05);实验组患者总有效率为92.6％,对照组为81.5％,实验组临床疗效显著优于对照组,差异具有统计学意义(P＜0.05);实验组患者血液流变学指标均明显改善,与对照组比较差异具有统计学意义(P＜0.05).结论:采用茯苓甘草汤治疗肺动脉高压气虚血瘀证效果显著,可明显改善患者肺功能和肺部血液循环,疗效优于硝苯地平,值得临床推广应用.

蓝花参为桔梗科植物蓝花参[Wahlenbergia marginata (Thunb.)A.DC]的根或全草[1],为民间习用草药,福建省各地有分布且应用历史较久,又名寒草、金线吊葫芦.本品性平,味甘微苦,有补虚健脾、化痰止咳等作用,用于小儿疳积、自汗盗汗、咳嗽痰多等症[2].蓝花参的药学研究和临床报道较多[3-4],但药理研究报道甚少.为适应蓝花参临床应用需要,我们进行了蓝花参止咳化痰的药效试验和急性毒性(LD50)试验,现将结果报道如下.