目的 评估SCORTEN评分与我国SJS/TEN患者疾病严重程度的一致性,比较单用糖皮质激素(TCS)和糖皮质激素—丙种球蛋白冲击(TCS-IVIG)联合治疗SJS/TEN的临床效果。方法 收集我院2005年6月—2015年5月住院的SJS/TEN患者,计算每例患者的SCORTEN评分,采用Hosmer-Lemeshow检验评估SCORTEN模型的预期死亡率和实际死亡率的拟合度;比较单用TCS和TCS-IVIG联合治疗的患者在疾病严重程度、住院天数、疾病控制时间和死亡率方面的差异。结果 SCORTEN模型的预期死亡率和实际死亡率之间的拟合度良好(各组P值均大于0.5);二组患者在住院天数、疾病控制时间和死亡率方面的差异没有统计学意义(P分别为0.105,0.910,0.701),但TCS-IVIG组患者的疾病严重程度显著高于TCS组(P=0.017)。结论 SCORTEN评分可以用于评估国内SJS/TEN患者的病情严重程度,并预测患者预后;与单用TCS相比,联合IVIG有助于提高重症SJS/TEN患者的救治效果。

Objectivs To evaluate the performance of SCORTEN in severity of SJS/TEN in China, and to compare the efficacy of corticosteroid therapy (TCS) and intravenous immunoglobulin combined therapy (TCS-IVIG). Methods Collected retrospectively the data of the SJS/TEN patients from June 2005 to May 2015 in our hospital. Hosmer-Lemeshow statistic were used to assess SCORTEN model calibration. And the differences between TCS group and TCS-IVIG group were compared in severity-of-illness, length of hospitalization, disease control time and mortality. Results A good calibration were found in all groups (all P＞0.5). Although the severity-of-illness in the TCS-IVIG group was significantly higher than that in the TCS group (P=0.017), there was no statistical significance between the two groups in length of hospitalization, disease control time and mortality (P=0.105, 0.910, 0.701, respectively). Conclusion SCORTEN can be used to assess the severity-of-illness in Chinese patients with SJS/TEN and to predict the prognosis. Compared with single TCS, It could improve the clinical outcomes of patients with severe SJS/TEN combined with IVIG.

目的 探讨内镜下逆行胰胆管造影( ERCP) 治疗胆总管结石患者的临床疗效及其相关并发症。方法 严格筛选纳入从2012年1月—2015年1月在我院行ERCP治疗的胆总管结石患者,归纳评估ERCP手术对胆总管结石治疗的有效性及安全性。结果 359例胆总管结石患者,其中行ERCP治疗共347例,其中9例因一般情况差无法耐受手术或无法配合而未予以实施ERCP治疗,其中3例因术中穿孔转为开放手术治疗。 1次性取净结石者311例(89.6%),结石2次以上(含2次)取净者27例(7.8%),放置胆道支架者9 例(2.6%)。ERCP 术后总胆红素(61.7±103.8) μmol/L; 直接胆红素(34.7±59.6) μmol/L; 谷丙转氨酶(62.8±74.2) U/L; 谷草转氨酶(48.3±61) U/L。术后 2 h血淀粉酶(115±162) U/L,无统计学差异(P＞0.05) ,24 h血淀粉酶(124.7±215.8)U/L,与术前相比差异有统计学意义(P＜0.05) 。术后寒战、发热、腹痛、黄疸等症状均有不同程度的减轻;肝功能术后明显好转(P＜ 0.05);术后平均住院天数4～6 d;出现并发症患者16例,其中急性胰腺炎占6例,急性胆管炎占5例,出血占3例,穿孔占2例,经对症支持治疗后均治愈出院。结论 ERCP 治疗胆总管结石安全、有效,临床疗效显著,是胆胰疾病重要的诊治手段。

Objective To investigate the clinical efficacy and complications of endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of common bile duct stones. Methods Cases received ERCP therapy from January 2012 to January 2015 were studied retrospectively,and evaluated the safety and efficacy of therapeutic ERCP in patients with common bile duct calculi. Results 359 Cases of patients with common bile duct stones treated successfully with 347 cases,among them 9 cases unable to implementation of ERCP because of bad surgery tolerance,3 cases of intraoperative perforation to have surgical operation treatment. The stones were removed completely one time in 311 cases(89.6%). More than two times removing net calculi in 27 cases(7.8%). 9 cases were placed biliary stent (2.6%). Postoperative total bilirubin ERCP:61.7 ±103.8 μmol / l; Postoperative bilirubin direct: 34.7±59.6 μmol/l; Postoperative ALT:62.8±74.2 U/L; Postoperative AST: 48.3±61 U/L; Postoperative 2 h blood amylase was 115±162 U/L. It showed no significant difference (P＞0.05).24 h blood amylase was 124.7±215.8 U/L,there was significant difference compared with before operation(P＜0.05). Postoperative chills,fever, pain,jaundice have different degrees of ease. Postoperative liver function was improved significantly(P＜0.05). The postoperative average length of stay in common bile duct stones was 4～ 6 days. Complications occurred in 16 cases,including 6 cases of acute pancreatitis,5 cases of acute cholangitis,3 cases of bleeding,perforation in 2 cases. After treatment they were cured and discharged. Conclusion ERCP is safe,effective in treatment of common bile duct stones. It is an important means in treatment in bile duct diseases

目的 对切开复位与撬拨复位内固定术治疗SandersⅡ型跟骨骨折临床疗效进行比较。方法 回顾分析2014年10月—2016年6月陕西中医药大学附属医院收治的58例SandersⅡ型跟骨骨折患者临床资料,切开组29例,其中男24例、女5例,平均年龄(37.10±3.45)a;闭合组29例,其中男26例、女3例,平均年龄(36.60±3.15)a。采用Maryland及AOFAS评分系统评定临床功能。结果 X线显示两组患者术后Bohler角及Gissane角均恢复,比较差异没有统计学意义(P>0.05)。撬拨复位组术中出血量、住院天数及手术时间均明显少于切开复位组(P<0.05)。撬拨组出现2例针孔感染,换药后感染消失。切开组出现2例切口感染,1例切口裂开,2例刀口皮缘坏死,长期换药后全部好转;1例腓肠神经损伤。两组并发症发生率比较差异有统计学意义(P<0.05)。结论 对于治疗SandersⅡ型跟骨骨折,两组术式均能取得良好疗效,经皮撬拨复位克氏针内固定较切开复位钢板内固定具有时间成本小、创伤小、痛苦少、并发症少等优点。

目的 观察自拟中药方内服外洗结合冲击波治疗足底筋膜炎的临床疗效。方法 收集在我院门诊就诊的符合条件足底筋膜炎患者50例,采用自拟四物四藤汤内服外洗结合冲击波治疗,运用VAS评分法及疼痛减轻百分数评定治疗前与治疗后1周、2周、1月的疗效比较。结果 治疗前后VAS评分比较(P<0.05),组间比较有统计学意义,且前两周效果更明显,总有效率为94.00%,患者满意度为96.00%。结论 本治疗方法对足底筋膜炎是有明显疗效的,可以在临床上进一步推广验证。

Objective To observe clinical curative effect of TCM oral use and external wash combined with application of shock wave in the treatment of plantar fasciitis. Methods To collect 50 cases of patients with plantar fasciitis in our hospital clinic,use Siwusiteng medical herbal decoction combined with shock wave treatments, elevate VAS score and the percentage of pain relief before and after treatment at 1 week, 2 weeks, and 1 month. Results VAS score before and after treatment was statistically significant(P<0.05), and the effect of the first two weeks is more obvious. The total effective rate was 94.00%,patient satisfaction was 96.00%. Conclusion This treatment has obvious curative effect on plantar fasciitis, and it could be further promoted in clinical verification.

目的 对比观察海桐皮汤熏洗应用于膝骨性关节炎关节镜清理术后的临床疗效。方法 于2012年1月—2014年1月,从我院骨科住院患者中选取因膝骨性关节炎行关节镜清理术病例60例,随机分为两组,对照组术后给予常规康复治疗措施,治疗组在常规康复治疗的基础上于术后2周拆线后配合海桐皮汤熏洗治疗,治疗周期4周。对比两组患者治疗前后的WOMAC评分,分析其疗效差异。结果 两组患者WOMAC评分术后2周比较无差异P＞0.5;治疗4周后,两组患者较术后2周有所降低(P＜0.5),但治疗组疗效优于对照组(P＜0.5)。结论 海桐皮汤熏洗疗法可改善膝骨性关节炎关节镜清理术后膝关节功能,操作简便,成本低廉,无副作用,值得临床推广应用。

目的 根据产后不同时期的乳房的生理特点,采用中医综合疗法及护理进行回乳,观察其疗效。方法 选取哺乳期断乳的妇女57例,随机分为治疗组30例及对照组27例,治疗组采用中医综合疗法回乳,对照组口服溴隐亭回乳。结果 治疗组回乳效果优于对照组,出现乳房胀痛及乳腺炎的发生率低于对照组,且无不良反应。结论 中医综合疗法回乳安全,效果显著,对回乳时出现的乳房胀痛等兼证有很好的改善,对乳腺炎的发生起了更好的预防作用。

Objective According to the physiological characteristics of postpartum breast, through the combined treatment of traditional Chinese medicine and nursing for delactation,and to observe the effects. Methods A total of 57 women who wanted for delactation, were selected and randomly divided into two groups, there are 30 cases in the treatment group and 27 cases in the control group, the treatment group were treated with traditional Chinese medicine and nursing, while the control group used oral bromocriptine for delactation. Results The treatment group is better than the control group, the incidence of mastitis and breast swelling in treatment group is lower than the control group, and there was no adverse reaction. Conclusion The treatment of delactation with combined treatment of traditional chinese medicine and nursing is safe and effective, it can reduce suffering of women and prevent the occurrence of mastitis.

目的 探究酒石酸美托洛尔联合辛伐他汀治疗的临床疗效。方法 对我院2013年2月—2014年5月间收治的80例心律失常患者的临床资料进行回顾性分析,将80例患者随机划分为研究组与对照组,两组各40例;对照组40例心律失常患者给予酒石酸美托洛尔治疗,研究组在对照组的治疗基础上给予辛伐他汀治疗,比较研究组患者与对照组患者的临床治疗效果。结果 研究组患者临床治疗总有效率高于对照组,两组差异有统计学意义(P＜0.05);研究组患者室性期前收缩次数、房性期前收缩次数低于对照组,两组差异有统计学意义(P＜0.05);研究组患者与对照组患者不良反应发生例数无统计学意义(P＞0.05)。结论 心律失常行辛伐他汀治疗的临床疗效显著,值得临床推广应用。

目的 探讨血糖控制情况对胰岛素抵抗型糖尿病合并肺结核的临床治疗转归的影响。方法 选取我站收治的胰岛素抵抗型糖尿病合并肺结核的患者180例,随机分成对照组和观察组两组,每组各90例,对照组给予常规监测晨起空腹血糖和餐后2 h血糖,观察组给予监测血糖谱(包括三餐前、三餐后2 h、凌晨3点和晨起空腹血糖);观察组与对照组中患者均利用2HRSZ(E)／10HR(E)方案来进行治疗;记录两组患者治疗前后空腹血糖、餐后2 h血糖、痰菌阴转情况、X线胸片病灶情况和空洞变化情况,对比分析两组的临床治疗效果。结果 观察组的痰菌阴转、X线胸片病灶、空洞变化等均比对照组的效果好,且两组差异有统计学意义(P＜0.05);观察组的总体有效率87.8%(79/90)高于对照组的71.1%(64/90),两组差异有统计学意义(χ²=7.655,P=0.006)。结论 控制血糖能有效提高胰岛素抵抗型糖尿病合并肺结核的临床治疗效果,在临床上值得推广应用。

目的 观察隔药壮灸神阙穴治疗女性黄褐斑的临床疗效及对血清性激素水平的影响。方法 将72例患者随机分为2组,治疗组38例和对照组34例,治疗组予隔药壮灸神阙穴治疗,对照组予口服维生素C、维生素E治疗,10次为1个疗程,第2、4、6疗程末观察疗效,治疗前后测定月经第2～3天血清雌二醇(E2)、孕酮(P)、泌乳素(PRL)、卵泡刺激素(FSH)、黄体生成素(LH)、睾酮(T)水平。结果 第6疗程末治疗组总有效率为83.33％,对照组总有效率30.30%,治疗组疗效优于对照组(P＜0.05),治疗组治疗前后E2、LH下降水平有统计学意义(P＜0.05)。对照组治疗前后E2、P、PRL、FSH、LH、T水平变化不明显(P＞0.05)。治疗后2组E2、LH比较,差异有统计学意义(P＜0.05)。结论 隔药壮灸神阙穴治疗女性黄褐斑临床疗效较好,可能通过调节性激素而起到治疗作用。

Objective To observe the clinical efficacy on female chloasma treated with acupuncture of Zhuang minority medicine at Shengque xue and its influence on sex hormone levels. Methods 72 cases were divided randomly into a treatment group(38 cases) and a control group(34 cases). In treatment group, acupuncture of Zhuang minority medicine at Shengque xue was applied. In control group, oral administration of vitamin C and vitamin E were given. The cases of treatment group were treated ten times as one session. At the end of 2,4,6 treatment session efficacy were analyzed respectively. The levels of serum estradiol(E2), progesterone(P), prolactin(PRL), follicule stimulating hormone(FSH), luteinizing hormone(LH) and testosterone(T) were detected on day 2-3 of menstruation. Results At the end of 6 treatment session the total effective rate was 83.33％ in treatment group and was 30.30% in control group, the efficacy in treatment group were superior to that in control group, with significant difference(P＜0.05). In treatment group, the levels of LH and E2 after treatment were lower as compared with those before treatment(P＜0.05). In control group, there were no obvious changes in E2,P, PRL, FSH, LH and T before and after treatment(P＞0.05). The levels of LH and E2 after treatment were significantly different in comparison of two groups(P＜0.05). Conclusion Acupuncture of Zhuang minority medicine at Shengque xue achieves a definite efficacy on female chloasma in clinic and its pharmacological mechanism may be relevant with its regulation on sex hormone levels for the patients.

目的 探讨莫西沙星结合抗结核药物治疗糖尿病合并肺结核患者的临床疗效分析。方法 将本组126例糖尿病合并肺结核患者分为对照组(n=63)和观察组(n=63);对照组给予降血糖治疗及抗结核药物降糖治疗,观察组在对照组治疗基础上服用莫西沙星;两组治疗均以3个月为一个疗程,2个疗程后统计疗效。结果 观察组总有效率(93.65%)高于对照组(76.19%),差异有统计学意义(P<0.05);观察组痰菌检测转阴率(94.59%)高于对照组(79.49%),差异有统计学意义(P<0.05);治疗过程中观察组与对照组出现不良反应情况相比较差异无统计学意义(P＞0.05)。结论 莫西沙星结合抗结核药物治疗糖尿病合并肺结核疗效显著,具有较强的杀菌作用。

Objective To investigate the clinical efficacy of moxifloxacin combining with antituberculosis drug in the treatment of diabetic patients with pulmonary tuberculosis. Methods A group of 126 patients of diabetes complicated with pulmonary tuberculosis were divided into control group (n=63) and observation group (n=63); the control group was given by hypoglycemic therapy and therapy of antituberculosis drug only, and the observation group was also given by moxifloxacin; two groups were treated for 3 months as a course.The clinical efficacy was evaluated after 2 courses. Results The total effective rate of observation group (93.65%) was significantly higher than that of the control group (80.95%), and the difference was statistically significant (P<0.05); the negative sputum rate of observation group (94.59%) was higher than that of the control group (79.49%), and the difference was statistically significant (P<0.05); there was no statistically significant difference between the observation group and the control group in adverse effects. Conclusion The curative effect of moxifloxacin combining with antituberculosis drug in the treatment of diabetes mellitus complicated with pulmonary tuberculosis was good, with strong bactericidal effect.