Clinical Effects of the Qi-acupuncture Therapy of TCM on Portal Hypertension

Objective:To explore the effective prevention and treatment of portal hypertension(PH).Methods:A total of 220 patients who came to our hospital from March 2015 to October 2018 were treated.They were randomly divided into the treatment group and the control group,each with 110 cases.Before treatment,there was no significant differences in age,sex,clinical symptoms,signs,laboratory tests and color Doppler ultrasound related examinations between the 2 groups(P>0.05).Among them,the treatment group on the basis of traditional Chinese and Western medicine treatment in our hospital,the Qi-acupuncture therapy of TCM was added.The extra meridian acupoints along with acupoints were selected.The control group received conventional treatment with traditional Chinese and Western medicine in our hospital.Results:There were significant differences in clinical symptoms,signs and chemistry between groups after treatment(P<0.01).There were significant differences in test,color ultrasound related examination and so on(P<0.01).Those in the treatment group was significantly better than the control group(P<0.01).Conclusion:On the basis of the Qi-acupuncture therapy of TCM,selecting extra meridian acupoint and acupoints can effectively treat PH.

The clinical features and effects with target therapy for post splenectomy pulmonary hypertension

Objective To analyze the clinical features and effects of target therapy of post splenectomy pulmonary hypertension, and improve the diagnosis and treatment of the disease.Methods Clinical data of 18 patients with post splenectomy pulmonary hypertension admitted to our hospital from October 2006 to March 2017 were systematically reviewed.

Non-pharmacological therapy of TCM for the treatment of essential hypertension

Non-pharmacotogicat treatment is an important means to control hypertension, with many advantages such as tow cost, tess medication, stable btood pressure, tess compHcations, and improved prognosis. This article reviews the research progress of non-drug treatment of hypertension in Chinese medicine in the past five years, and evaluates traditional Chinese medicine such as TCM Qigong, Wuhuo opera, Ba Duanjin and Taijiquan, and Chinese medicine acupuncture, moxibustion, massage, apptication, acupoint embedding and other traditional Chinese medicine. The effect of external treatment in hypertension control provides guidance for non-drug therapy to control hypertension.

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension:State of the art

Chronic thromboembolic pulmonary hypertension(CTEPH)is a complex chronic disease in which pulmonary artery stenosis or obstruction caused by organized thrombus can lead to increased pulmonary artery pressure and pulmonary vascular resistance,ultimately triggering progressive right heart failure and death.Currently,its exact mechanism is not fully understood.Pulmonary endarterectomy(PEA)has immediate effects with low perioperative mortality and satisfactory prognosis in experienced expert centers for CTEPH patients with proximal lesions.Nevertheless,37%of patients are deemed unsuitable for PEA surgery due to comorbidities and other factors,and nearly half of the operated patients have residual or recurrent pulmonary hypertension.Riociguat is the only approved drug for CTEPH,although its effect is limited.Balloon pulmonary angioplasty(BPA)is a promising alternative treatment for patients with CTEPH.After more than 30 years of development and refinements,emerging evidence has confirmed its role in patients with inoperable CTEPH or residual/recurrent pulmonary hypertension,with acceptable complications and comparable longterm prognosis to PEA.This review summarizes the pathophysiology of CTEPH,BPA history and development,therapeutic principles,indications and contraindications,interventional procedures,imaging modalities,efficacy and prognosis,complications and management,bridging and hybrid therapies,ongoing clinical trials and future prospects.

Home-made fenestrated amplatzer occluder for atrial septal defect and pulmonary arterial hypertension

我们报导一个病人的管理与根据氏族的缺点( ASD )和有最近的严重肺的 hypertension.A 65岁的孩子男性诊断了的 atrial atrial serital 缺点被指我们有休息和锻练的患心脏代偿失调的正确的心失败的中心导致了 dispnea ，严重肺的 hypertension.Right 心 catheterization 证实了一个吝啬的肺的压力关于 55 mmHg 和有一个顺从的大汽球的 2.7 .An 吸藏测试的 Qp/Qs

Potential impact of specific therapy on pregnant women with pulmonary arterial hypertension without cardiac shunt:a descriptive study in northern China

Background:Pregnancy in women with pulmonary arterial hypertension(PAH)is a fatal condition,despite the effectiveness of PAH-specific therapies.The coverage status and effect of specific therapies in pregnant patients with PAH without cardiac shunts in China remain unclear.To investigate this issue,we conducted a multicenter retrospective study in northern China.Methods:The study included 85 patients who were admitted to 4 clinical centers in Shandong Province between October 2010 and August 2020.Maternal endpoint events included(1)maternal death and/or(2)major adverse cardiac events,both occurring during pregnancy or within 6 weeks postpartum.Results:Although the overall mortality rate was encouraging(11.8%),the number of patients receiving PAH-specific therapies was extremely low(28.2%).Moreover,only 15.3%of patients received adequate duration of PAH-specific therapy(≥4 weeks)before delivery,and this subgroup showed the lowest major adverse cardiac events rate(7.7%)compared with that in the untreated(19.7%)and short-time treated groups(<4 weeks;54.5%).Conclusion:Pregnant patients with PAH without cardiac shunts face significantly increased mortality risks.Short-term PAH-specific therapy does not guarantee favorable maternal outcomes.Prepregnancy screening,early identification,and timely intervention are expected to improve maternal outcomes in pregnant women with PAH.

Pulmonary arterial hypertension associated with systemic sclerosis: Current diagnostic approach and therapeutic strategies

Pulmonary arterial hypertension(PAH) represents a devastating vascular complication of systemic sclerosis(SSc) and is found in 10%-15% of cases carrying a severe prognosis. PAH has a dramatic impact on the clinical course and overall survival, being the single most common cause of death in patients with this entity. The clinical course and aggressive progression of PAH has led clinicians to perform annual screening for it, since early detection and diagnosis are the cornerstone of a prompt therapeutic intervention. The diagnosis of PAH can be challenging to clinicians, particularly in its early stages, since in the context of SSc, the multiple causes of dyspnea need to be assessed. Doppler echocardiography represents the best initial screening tool, however, right heart catheterization remains the gold standard and definitive diagnostic means. Remarkable advances have been achieved in elucidating the pathogenesis of PAH in the past two decades, leading to the development of disease-specific targeted therapies: prostacyclin analogues, endothelin receptor antagonists and inhibitors of five phosphodiesterase pathways. However, the clinical response to these therapies in SSc-associated PAH has not been as great as the one seen with idiopathic PAH. This review also focuses on the diagnosis and novel therapies that are currently available for PAH, as well as potential future therapeutic developments based on newly acquired knowledge of diverse pathogenic mechanisms.

中医药治疗特发性肺纤维化研究进展

特发性肺纤维化是原因不明的慢性进行性致纤维化间质性肺炎,主要见于中老年男性,局限于肺,临床上呈渐进性呼吸困难和肺功能恶化,组织病理学和胸部HRCT表现为特征性的寻常型间质性肺炎。特发性肺纤维化属中医学“肺痿、肺痹”范畴,中医对此病的认识历史悠久,优势明显,近年来受到越来越多的重视,通过对近5年多(2018年—至今)中医药在特发性肺纤维化的研究文献进行总结,主要从病机(“肺虚络瘀”论、“热毒滞络”论、“肺寒络凝”论、其他)、临床研究(古方、自拟方、中成药、六字诀呼吸操、热敏灸)2方面进行了综述,以期为此病的治疗提供有益的参考。

平肝熄风胶囊联合耳穴压豆治疗中青年高血压疗效观察

目的:观察平肝熄风胶囊联合耳穴压豆治疗中青年高血压患者的临床疗效。方法:将100例中青年高血压患者随机分为两组各50例。对照组予生活方式干预及常规降压药物治疗,治疗组在对照组基础上予平肝熄风胶囊联合耳穴压豆治疗。两组均治疗8周。观察两组中医证候总有效率、降压总有效率情况,比较两组治疗前后24 h动态血压、尿微量白蛋白及生活质量评分变化。结果:治疗后,治疗组血压、24 h动态血压、尿微量白蛋白水平均明显低于对照组(P<0.05),治疗组中医证候疗效、降压疗效、生活质量均优于对照组(P<0.05)。结论:平肝熄风胶囊联合耳穴压豆治疗中青年高血压疗效较好,可降低患者血压,改善临床症状,提高生活质量。

中医外治法治疗老年高血压病合并认知障碍的研究进展

近年来老龄人口持续增加,老年高血压病合并认知障碍的发病率逐年升高。在中医学中,老年高血压病合并认知障碍多为虚实夹杂之证,其病因病机复杂,临床以肾精亏虚、髓海不足为主。西医学研究发现,会因为衰老可导致脑血流量减少,出现功能障碍,动脉高血压病进一步加剧了这种功能障碍。此外,血压水平和认知功能障碍有所关联的潜在机制可能和大脑中与高血压病相关的β淀粉样蛋白积累有关系。虽然该病的发病机理正处于研究阶段,尚未被完全认识,但是对该病的治疗已刻不容缓。现代医学单纯依靠西药治疗该病并不能达到临床预期,且伴随不同程度的耐药性和不良反应。近年来中医外治法发展迅速,在一定程度上弥补了西药治疗存在的问题和不足,且对该病治疗效果显著。本研究通过检索大量关于老年高血压病合并认知障碍的病因病机以及中医外治法治疗该病的文献研究,发现在脏腑经络学说的指导下,耳穴压豆、穴位贴敷、经穴推拿、针灸疗法作用于人体可使气血得以畅行,培补正气,有效地缓解临床症状且疗效稳定持久,在治疗该病方面具有独特的优势。因于此,文章对老年高血压病合并认知障碍的病因病机及中医外治法进行分析与论述,以期为该病的预防和治疗提供新的思路和方法。

新生儿持续肺动脉高压患儿血清CXCL8、CXCL12与一氧化氮吸入治疗临床转归的关系

目的探讨新生儿持续肺动脉高压(persistent pulmonary hypertension of newborn,PPHN)患儿血清人CXC型趋化因子配体8(C-X-C motif chemokine ligand 8,CXCL8)、CXCL12与一氧化氮吸入治疗临床转归的关系。方法选择2021-08/2023-05月作者医院收治并给予一氧化氮吸入治疗的PPHN患儿135例为研究对象。根据患儿出院时临床转归结局分为死亡组(n=32)和存活组(n=103)。比较两组PPHN患儿血清CXCL8、CXCL12水平。单因素及多因素Logistic回归模型分析接受一氧化氮吸入治疗PPHN患儿临床转归的影响因素。受试者工作特征(receiver operating characteristic,ROC)曲线分析血清CXCL8、CXCL12对接受一氧化氮吸入治疗PPHN患儿临床转归的预测价值。结果死亡组患儿血清CXCL8、CXCL12水平显著高于存活组(P均<0.05)。多因素Logsitic回归分析结果显示,血清CXCL8水平升高、血清CXCL12水平升高、早产、出生时Apgar评分0~3分、合并并发症是接受一氧化氮吸入治疗的PPHN患儿死亡的危险因素,肺表面活性物质应用、吸入一氧化氮早期反应则是保护因素(P<0.05)。ROC曲线分析结果显示,血清CXCL8、CXCL12联合检测对接受一氧化氮吸入治疗的PPHN患儿死亡预测的曲线下面积(area under the curve,AUC)为0.828,大于血清CXCL8、CXCL12单独检测(AUC分别为0.762、0.714)。结论PPHN患儿血清CXCL8、CXCL12水平升高与接受一氧化氮治疗的不良临床转归有关,且CXCL8、CXCL12水平升高是PPHN患儿死亡的危险因素。CXCL8、CXCL12联合检测对接受一氧化氮治疗PPHN患儿死亡具有较高的预测价值。

肺动脉高压治疗药物新靶点的研究进展

肺动脉高压是一种复杂的心肺血管疾病,由于极高的致死率、致残率,一度被称为心血管领域的“恶性肿瘤”。目前,已上市肺动脉高压靶向药物在我国的广泛应用极大地提高了患者的生存率,然而,现有药物仍存一定的局限性,如疗效欠佳、不良反应严重等。近年来,随着对肺动脉高压发病机制研究的不断深入,越来越多的新靶点和新通路的发现为治疗肺动脉高压提供了更多的可能。TLR3激动剂Poly(I∶C)、STAT3信号通路的Corosolic acid等都已经进入临床试验阶段,有望填补现有靶向药物治疗的不足。与此同时,许多药物(如布洛芬、左西孟旦等)也有望成为肺动脉高压的靶点药物。本文主要总结了肺动脉高压新靶点治疗药物的研究现况,以期为今后肺动脉高压的研究和靶向治疗提供理论依据。

经鼻高流量氧疗气道护理在高血压脑出血术后肺部感染中的应用

目的:探讨加温加湿经鼻高流量氧疗气道护理联合乙酰半胱氨酸雾化吸入在高血压脑出血术后肺部感染中的应用效果。方法:选择2022年10月—2023年5月收治的62例高血压脑出血术后非机械通气患者,随机分为对照组和观察组,每组31例。对照组采用氧驱面罩雾化器气道湿化护理联合乙酰半胱氨酸雾化吸入治疗,观察组采用加温加湿经鼻高流量氧疗气道护理联合乙酰半胱氨酸雾化吸入治疗。比较两组血气指标、气道阻力(Raw)、痰液黏稠度、气道湿化评分与舒适度评分,统计两组不良反应发生情况以及总满意度。结果:干预后两组动脉血二氧化碳分压(PaCO_(2))、Raw低于干预前,且观察组低于对照组(P<0.05)。干预后两组动脉血氧分压(PaO_(2))及血氧饱和度(SaO_(2))高于干预前,且观察组高于对照组(P<0.05)。干预后观察组痰液黏稠度情况优于对照组(P<0.05)。观察组气道湿化评分、舒适度评分及并发症总发生率低于对照组(P<0.05)。观察组满意度高于对照组(P<0.05)。结论:乙酰半胱氨酸雾化吸入联合加温加湿经鼻高流量氧疗气道护理可明显改善高血压脑出血术后肺部感染患者血气指标,降低痰液黏稠度,患者舒适度更高,不良反应更少,满意度更高。

动脉型肺动脉高压治疗研究进展

动脉型肺动脉高压(PAH)是一种慢性进展性心肺疾病,其主要病理改变是血管收缩和肺动脉增生性重构以及右心室肥厚引起肺动脉压力持续升高。深入探究PAH发病机制可以发现,其相关途径有血管增生、血管壁重构、氧化应激、炎症反应与基因调控等。虽然近年来PAH在治疗方面取得很大进展,但其死亡率仍然很高,当前临床治疗方法并未有效改善预后,该病对患者身体、社会、工作和情感等方面产生了很大影响。本文将对PAH治疗方面最新研究进行综述,以期为PAH临床治疗提供新的线索。

靶向异常通路的动脉性肺动脉高压新型药物研发

动脉性肺动脉高压(pulmonary arterial hypertension,PAH)是以肺血管阻力和肺动脉压力升高为主要表现的肺血管疾病,肺小血管重塑是其重要病理改变,如不及时治疗可导致右心室衰竭,威胁生命。目前针对PAH的治疗选择有限,已上市药物的主要作用是扩张肺血管,虽能缓解症状,但对预后的改善效果不佳。近年来,对PAH发病机制的研究取得了多项突破,多种信号通路的异常对PAH的作用已被逐渐阐明,以这些通路中的关键成员为靶点,已有多种新型药物正在研发和开展临床试验。本综述将这些疾病相关的信号通路归纳为5类,讨论针对这些异常通路的药物研发最新进展,重点关注已进入Ⅱ期临床试验阶段的新药物,探讨其作用机制及疗效,以期为今后PAH的新药研发提供参考。

传统功法对慢性阻塞性肺疾病的康复效果研究

慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)近年已成为成年人口常见的慢性疾病,社会逐渐重视其预防与治疗。本研究通过分析传统功法干预COPD临床研究的结果,揭示传统功法改善COPD患者的康复效果。研究显示,传统功法如太极拳、五禽戏、八段锦和六字诀,能够改善COPD患者的肺功能、炎症水平和运动能力。太极拳虽未直接显示肺功能指标的改善,但能够改善患者的呼吸问题;六字诀能增强呼吸肌和四肢的力量与耐力;八段锦则有助于改善患者的认知和情绪状态。总的来说,传统功法为COPD患者提供了一个有效的康复选择,但仍需更多临床对照试验来进一步确认其效果,并为患者制定合适的康复方案。

肺动脉高压患者中医证型与肺功能的相关性研究

目的 分析探讨肺动脉高压(PH)患者的中医证素分布特征以及中医证型与肺功能等临床指标的相关性。方法 分析307例患者的中医证素分布情况以及中医证型与肺功能、血气分析、血常规等指标的相关性,评估肺功能与血气分析、血常规中证型相关指标之间的关系。结果 PH的中医辨证要素中病位证素分布呈肺>心>肾>脾>肝的趋势,其中肺、心出现频次居前两位;病性证素分布呈气虚>血瘀>阳虚>阴虚>痰浊>寒>水饮>血虚>热>气滞的趋势,其中气虚、血瘀出现频次居前两位,气虚血瘀证也是最多见的证型。肺功能、血气分析、血常规有关指标在各中医证型间有明显差异,痰热郁肺证中FVC%pred、FEV1%pred、FEV1/FVC(%)、动脉血二氧化碳分压(PaCO_(2))、LY%、MONO%最低,NEUT%最高。肺功能相关指标与PaCO_(2)、NEUT%呈负相关,与LY%呈正相关。结论 气虚、血瘀为PH的基本病机,痰热郁肺证肺功能最差,PH患者肺功能与血气分析、血常规有关指标存在一定相关性,肺功能检查有助于判定中医证型。

耳穴压豆联合中医情志护理治疗高血压合并焦虑(肝郁化火型)的疗效观察

目的:观察耳穴压豆联合中医情志护理治疗肝郁化火型高血压合并焦虑患者的临床疗效。方法:收集100例肝郁化火型高血压合并焦虑患者,随机分为对照组和观察组各50例,对照组采用规范的西医降压治疗,观察组在对照组基础上予以耳穴压豆联合中医情志护理干预。比较两组患者中医临床疗效、中医证候积分、血压情况、焦虑自评量表(SAS)评分及抑郁自评量表(SDS)评分变化。结果:治疗后,观察组患者白昼、夜间收缩压及舒张压均低于对照组(P<0.05);观察组中医疗效有效率为74.00%(37/50),优于对照组的52.00%(26/50)(P<0.05);治疗后观察组患者中医证候积分、SAS评分及SDS评分均低于对照组(P<0.05)。结论:耳穴压豆联合中医情志护理能有效改善肝郁化火型高血压合并焦虑患者临床症状,值得临床推广应用。

黄芪百合桔梗汤治疗肺结节术后咳嗽30例

目的 观察自拟黄芪百合桔梗汤治疗30例肺结节术后咳嗽的临床疗效。方法 盱眙县中医院呼吸科门诊2019年11月—2022年9月接诊的60例肺结节术后不需要放化疗,伴术后咳嗽的患者,依照治疗方法不同,随机分为观察组和对照组,各30例。对照组患者给予蜜炼川贝枇杷膏治疗,观察组给予黄芪百合桔梗汤治疗。结果 治疗14 d后,观察组临床疗效总有效率高于对照组(P<0.05),观察组患者VAS改善比对照组更明显,差异存在统计学意义(P<0.05),观察组患者治疗后7 d和14 d时疼痛程度改善也同样优于对照组(P<0.05)。结论 自拟黄芪百合桔梗汤治疗肺结节术后咳嗽疗效确切,值得临床推广。