大黄温阳活血灌肠方与高位全结肠透析联合温阳救逆降浊汤治疗肾阳虚衰型慢性肾衰竭随机平行对照研究

[目的]观察自拟灌肠方与高位全结肠透析联合温阳救逆降浊汤治疗肾阳虚衰型慢性肾衰竭疗效。[方法]使用随机平行对照方法,将60例住院患者按随机数字表分为两组;均使用温阳救逆降浊汤（附子20g,干姜10g,炙甘草15g,茯苓30g,姜半夏15g,大黄10g,黄芪、山萸肉、芡实各30g）,1剂/d,水煎200mL,早晚口服,阳虚四肢厥冷、身重困倦、血尿素氮、肌酐偏高,每周逐渐增加附子用量,临证加减。对照组30例大黄温阳活血（大黄、牡蛎各30g,附子20g,肉苁蓉30g,丹参15g,当归20g,等）,1剂/d,水煎200mL,保留灌肠,20~30min/次,1次/d。治疗组30例①结肠透析机,高位结肠透析：洗肠三遍;将纯水与一定比例离子配制成离子水透析液作为结肠透析的透析液放入恒温液箱,将透析液加温至合适的温度并恒温,关闭排污管节制钳,灌注透析液至大肠;肠内注入透析液150~200mL,患者适当保留,排出透析液;②大黄温阳活血灌肠方治疗同对照组。连续治疗7d为1疗程,疗程间休息3d。观测临床症状、血肌酐、尿素氮、血红蛋白、不良反应。连续治疗3疗程,判定疗效。[结果]治疗组显效20例,有效6例,无效4例,总有效率86.67%。对照组显效14例,有效8例,无效8例,总有效率73.33%。治疗组疗效优于对照组（P〈0.05）。生化指标治疗组优于对照组（P〈0.05,P〈0.01）。[结论]大黄温阳活血灌肠方与高位全结肠透析联合温阳救逆降浊汤治疗肾阳虚衰型慢性肾衰竭,疗效满意,无副作用,值得推广。

自制清毒养血灌肠方保留灌肠治疗慢性肾功能衰竭40例

目的:观察中药保留灌肠治疗肾功能不全的疗效。方法:80例病人随机分为A、B两组,A组单用常规对症处理,B组在常规对症处理基础上,加用中药保留灌肠。两组治疗前均做血尿素氮、血肌酐、血红蛋白的检测,治疗2个月后复查。结果:治疗组总有效率明显高于对照组,治疗组治疗后血肌酐、尿素氮明显下降,血红蛋白明显升高,与对照组比较有显著性差异(P<0.05),有统计学差异。结论:中药保留灌肠治疗肾功能不全疗效优于单纯常规治疗。

健脾活血灌肠汤治疗溃疡性结肠炎48例分析

目的:观察健脾活血灌肠汤治疗慢性溃疡性结肠炎的疗效。方法:将102例慢性溃疡性结肠炎分为健脾活血灌肠汤治疗组和西药对照组。治疗组给予健脾活血灌肠汤1次/日保留灌肠;对照组口服柳氮磺胺吡啶,1.5g/次,4次/日,症状缓解后改为0.5g/次,3次/日,重症患者加服强的松片20mg,1次/日顿服。两组治疗4周1疗程,4周后复查结肠镜和大便常规,对比疗效。结果:治疗组总有效率85.42%,对照组总有效率87.04%。两组总有效率比较差异无显著性差异(P>0.05)。结论:健脾活血灌肠汤保留灌肠治疗慢性溃疡性结肠炎疗效确切,同规范西药治疗疗效相当,未见明显不良反应。

摄血复疡汤灌肠联合回医按摩与各单用法治疗溃疡性结肠炎的疗效比较

目的：探讨中药灌肠联合回医按摩治疗溃疡性结肠炎（UC）的临床疗效。方法采用前瞻性随机对照研究方法，选择2013年1月至2014年12月宁夏回族自治区人民医院中医科收治的UC患者390例。按随机信封法将患者分为西药对照组（88例）、单纯中药灌肠组（102例）、单纯回医按摩组（94）、灌肠联合按摩组（106例）。西药对照组口服柳氮磺吡啶，每次0.75 g，每日3次。单纯中药灌肠组采用自拟中药摄血复疡汤（地榆炭15～20 g，白及15 g，败酱草15～30 g，半枝莲15～30 g，黄连15 g，炙甘草15 g，炒诃子10 g，生山药15～30 g，茜草15 g）保留灌肠，每日1次，采用一大、二慢、三温、四动的原则施行（即：大药量，250 mL；灌药速度慢，在15～20 min内灌完；药液要温，以不烫手为准，一般以39～41℃为宜，灌肠管周围用热水袋加温，以保持药液温度恒定；左侧卧20 min，胸腹位20 min，右侧卧20 min）。单纯回医按摩组采用手掌或拇指、食指根据患者患病部位的大小、深浅、轻重，分别施行按、摩、揉、拿等特殊手法，每次30 min，每日1次。灌肠联合按摩组中药灌肠及回医按摩方法同上，4组疗程均为15 d。疗程结束后观察4组患者的疗效及主要症状改善情况。结果单纯中药灌肠组、单纯回医按摩组、灌肠联合按摩组患者治疗后腹痛、腹泻、里急后重、脓血便、发热等症状积分均较治疗前明显下降，且各组治疗后各积分明显低于西药对照组〔腹痛（分）：0.45±0.75、0.56±0.57、0.35±0.96比1.13±0.86；腹泻（分）：0.76±0.91、0.78±0.69、0.55±0.81比1.43±0.34；里急后重（分）：0.52±0.37、0.44±0.23、0.21±0.13比0.72±0.98；脓血便（分）：0.43±0.34、0.50±0.24、0.52±0.76比0.68±0.44；发热（分）：0.32±0.56、0.35±0.65、0.26±0.45比0.49±0.77；均P＜0.05〕。单纯中药灌肠组、单纯回医按摩组、中药灌肠联合按摩组临床总有效率明显高于西药对照组〔78.4%（80/102）、85.1%（80/94）、93.4%（99/106）比62.5%（55/88），均P＜0.05〕。结论中药摄血复疡汤灌肠联合回医按摩治疗UC的疗效优于单纯口服西药或单纯中药灌肠、回医按摩治疗。

补气活血方保留灌肠配合超声介入治疗盆腔炎的疗效分析

目的浅析盆腔炎治疗中补气活血方保留灌肠配合超声介入的临床效果。方法本次58例研究对象均是2017年2月—2018年5月我院收治的盆腔炎患者,1:1分组时利用掷骰子法,对照组单纯采用超声介入治疗,观察组患者治疗中利用补气活血方保留灌肠配合超声介入方式,对比两组临床效果。结果观察组治疗总有效率为93.10%,而对照组仅为72.41%;同时,观察组患者经过治疗症状评分、体征评分、白介素6水平、C反应蛋白水平均明显降低,与对照组相比较降幅更明显。两组数据进行对比,差异统计学意义(P均<0.05)。结论盆腔炎患者通过补气活血方保留灌肠配合超声介入治疗,有助于病情恢复,快速缓解炎症,减少复发,在临床中值得大力推广应用。

凉血止痢方灌肠治疗结肠炎34例

目的:观察中药方保留灌肠治疗结肠炎的临床疗效。方法:选择68例结肠炎患者,将其平均分为治疗组和对照组,两组患者各34例。治疗组予以凉血止痢方(白头翁、地榆炭、黄柏、白及粉)保留灌肠治疗,对照组予以柳氮磺吡啶治疗,观察两组患者的临床治疗效果及不良反应发生率。结果:治疗组患者的治疗的总有效率明显高于对照组患者(P<0.05);治疗组患者不良反应发生率明显低于对照组患者(P<0.05)。结论:凉血止痢方灌肠应用于结肠炎临床治疗中的效果显著,可降低不良反应的发生。

调气活血组方治疗盆腔瘀血综合征的临床疗效观察

目的:观察调气活血组方治疗盆腔瘀血综合征(PCS)的临床疗效及作用机制。方法:将78例PCS患者随机分为中药治疗组(48例)和西药对照组(30例),观察治疗前后临床症状、体征等改善情况,以及血浆前列腺素、血液流变学变化。结果:治疗组临床治愈(39.58％)、总有效率(89.58％)明显优于对照组(分别为20.00％、66.66％);治疗组具有改善血凝状态、加快瘀血吸收、镇痛、调节免疫功能等多种综合效应。结论:调气活血组方为治疗PCS的一种有效方法,其疗效明显优于西药对照组(P<0.01)。

Ⅰ～Ⅱ期子宫内膜异位症合并不孕患者术后基于体质辨识的中医综合治疗疗效观察

[目的]探讨Ⅰ~Ⅱ期子宫内膜异位症(EM)合并不孕患者术后基于体质辨识的中医综合治疗的临床疗效.[方法]将180例住院行宫腹腔镜联合手术的Ⅰ~Ⅱ期EM合并不孕患者随机分为试验组和对照组,每组各90例.2组患者均给予常规宫腹腔镜手术和术后经阴道卵泡监测指导同房3个月经周期的基础治疗,试验组在基础治疗的同时,根据患者体质辨识结果给予中药内异方加减口服和排毒活血灌肠方保留灌肠的中医综合治疗3个月经周期,对照组除基础治疗外无其他特殊治疗.观察2组患者治疗前后体质变化情况,并于术后每个月随访患者的妊娠情况.[结果](1)180例EM合并不孕患者的体质以阳虚质、血瘀质、气郁质为主,是EM合并不孕患者的高发体质.治疗3个月经周期后,试验组的平和质比例高于对照组,气郁质比例低于对照组,差异有统计学意义(P<0.05);试验组的平和质较治疗前明显增加,阳虚质、血瘀质、气郁质均较治疗前明显减低,差异均有统计学意义(P<0.05),而对照组各体质治疗前后比较差异均无统计学意义(P>0.05).(2)术后2年内,试验组的总妊娠率为68.89%(62/90),明显高于对照组的43.33%(39/90),差异有统计学意义(P<0.01).试验组在术后6个月和12个月的妊娠率分别为36.67%(33/90)和42.11%(24/57),均明显高于对照组的11.11%(10/90)和21.25%(17/80),差异均有统计学意义(P<0.01).(3)采用Kaplan-Meier生存分析法计算2组累积妊娠率,试验组的累积妊娠率高于对照组(P<0.05),且试验组的妊娠时间(中位妊娠时间9个月)明显短于对照组(平均妊娠时间18个月),差异有统计学意义(P<0.001).[结论]Ⅰ~Ⅱ期EM合并不孕患者,在宫腹腔镜联合手术后使用基于体质辨识的中医综合治疗,能改善患者偏颇的体质,提高患者术后妊娠率,明显缩短中位妊娠时间,具有良好的临床疗效.

中西医结合治疗对卵巢子宫内膜异位症囊肿术后体质改善和复发的疗效观察

目的观察中医综合治疗卵巢子宫内膜异位症囊肿患者术后体质改善和复发的临床疗效。方法选择卵巢子宫内膜异位症囊肿并要求手术治疗的患者80例,分为中西医结合治疗组(病例组)和常规治疗组(对照组),各40例。基础治疗为常规腹腔镜手术联合术后Gn-RHa治疗3个月,病例组在基础治疗的基础上根据患者体质辨识结果予口服“内异方”加减和“排毒活血灌肠方”保留灌肠治疗3个疗程。对照组除基础治疗外,无特殊治疗。结果(1)80例卵巢子宫内膜异位症囊肿患者的体质以阳虚质、血瘀质、气郁质为主。在治疗3个月后,病例组的平和质比例高于对照组,阳虚质、血瘀质、气郁质比例低于对照组,差异具有统计学意义(P<0.05);病例组的平和质较治疗前明显增加,阳虚质、血瘀质、气郁质均较治疗前明显减低,差异具有统计学意义(P<0.05),而对照组的各体质在治疗前后体质变化无统计学意义(P>0.05)。(2)术后2年内病例组总复发率5.00%(2/40)明显低于对照组22.50%(9/40),差异均具有统计学意义(P<0.05)。结论中西医结合治疗对卵巢子宫内膜异位症囊肿术后患者,能改善患者偏颇的体质,大大降低患者术后复发率。

景谷县一起牛出败的诊治

牛出败又称牛巴氏杆菌病,是由多杀性巴氏杆菌引起的一种急性传染病。一般呈散发性,通常是突然发病,以发生高热、肺炎和内脏广泛出血为特征,特别是肠道的广泛性出血,故中兽医称为血灌肠病,多数病例于发病后数小时突然死亡。1发病及治疗情况景谷县威远镇训岗村昔文小组属偏远山区,交通不便,自然条件差,牛以自繁自养、散养放养方式饲养。

无缝隙护理在急性胰腺炎合并高脂血症患者血液灌流联合血必净灌肠中的应用

目的探讨无缝隙护理在急性胰腺炎合并高脂血症患者血液灌流联合血必净灌肠中的应用效果。方法选2018年1月至2020年1月解放军总医院收治的急性胰腺炎合并高脂血症患者46例,随机分为两组,均采用血液灌流联合血必净灌肠治疗。对照组行常规护理,研究组行无缝隙护理。比较两组各项临床指标、各阶段复发率、依从性、护理满意度。结果对照组血清甘油三酯(TG)、血淀粉酶(AMY)和超敏C反应蛋白水平(hs-CRP)均高于研究组,差异有统计学意义(P<0.05),对照组的各阶段复发率高于研究组,差异有统计学意义(P<0.05),对照组依从率、护理满意度低于研究组,差异有统计学意义(P<0.05)。结论急性胰腺炎合并高.脂血症患者在血液灌流联合血必净灌肠治疗中采取无缝隙护理,效果显著,不仅能改善患者临床症状、治疗依从性和护理满意度,还能减少临床复发率。

Ketamine anesthesia reduces intestinal ischemia/reperfusion injury in rats

AIM: To investigate the effects of ketamine anesthesia on the motility alterations and tissue injury caused by ischemia/reperfusion in rats. METHODS: Thirty male Wistar rats weighing 200-250 g were used. Ischemia was induced by ob-structing blood flow in 25% of the total small intesti-nal length (ileum) with a vascular clamp for 45 min, after which either 60 min or 24 h of reperfusion was allowed. Rats were either anesthetized with pento-barbital sodium (50 mg/kg) or ketamine (100 mg/kg). Control groups received sham surgery. After 60 min of reperfusion, the intestine was examined for mor-phological alterations, and after 24 h intestinal basic electrical rhythm (BER) frequency was calculated, and intestinal transit determined in all groups. RESULTS: The intestinal mucosa in rats that were anesthetized with ketamine showed moderate altera-tions such as epithelial lifting, while ulceration and hemorrhage was observed in rats that received pento-barbital sodium after 60 min of reperfusion. Quantita-tive analysis of structural damage using the Chiu scaleshowed significantly less injury in rats that received ketamine than in rats that did not (2.35 ± 1.14 vs 4.58 ± 0.50, P < 0.0001). The distance traveled by a mark-er, expressed as percentage of total intestinal length, in rats that received pentobarbital sodium was 20% ± 2% in comparison with 25.9% ± 1.64% in rats that re-ceived ketamine (P = 0.017). BER was not statistically different between groups. CONCLUSION: Our results show that ketamine anesthesia is associated with diminished intestinal injury and abolishes the intestinal transit delay induced by ischemia/reperfusion.

Effects of penehyclidine hydrochloride in small intestinal damage caused by limb ischemia-reperfusion

AIM:To investigate the protective effect of penehyclidine hydrochloride post-conditioning in the damage to the barrier function of the small intestinal mucosa caused by limb ischemia-reperfusion(LIR) injury. METHODS:Male Wistar rats were randomly divided into three groups(36 rats each) :the sham-operation group(group S) ,lower limb ischemia-reperfusion group(group LIR) ,and penehyclidine hydrochloride postconditioning group(group PHC) .Each group was divided into subgroups(n=6 in each group) according to ischemic-reperfusion time,i.e.immediately 0 h(T1) ,1 h(T2) ,3 h(T3) ,6 h(T4) ,12 h(T5) ,and 24 h(T6) .Bilateral hind-limb ischemia was induced by rubber band application proximal to the level of the greater trochanter for 3 h.In group PHC,0.15 mg/kg of penehyclidine hydrochloride was injected into the tail vein immediately after 3 h of bilateral hind-limb ischemia.The designated rats were sacrificed at different time-points of reperfusion;diamine oxidase(DAO) ,superoxide dismutase(SOD) activity,myeloperoxidase(MPO) of small intestinal tissue,plasma endotoxin,DAO,tumor necrosis factor-α(TNF-α) ,and interleukin(IL) -10 in serum were detected in the rats. RESULTS:The pathological changes in the small intestine were observed under light microscope.The levels of MPO,endotoxin,serum DAO,and IL-10 at T1-T6,and TNF-αlevel at T1-T4 increased in groups LIR and PHC(P<0.05) compared with those in group S,but tissue DAO and SOD activity at T1-T6 decreased(P<0.05) .In group PHC,the tissue DAO and SOD activity at T2-T6,and IL-10 at T2-T5 increased to higher levels than those in group LIR(P<0.05) ;however,the levels of MPO,endotoxin,and DAO in the blood at T2-T6,and TNF-αat T2 and T4 decreased(P<0.05) . CONCLUSION:Penehyclidine hydrochloride post-conditioning may reduce the permeability of the small intestines after LIR.Its protection mechanisms may be related to inhibiting oxygen free radicals and inflammatory cytokines for organ damage.

The effects of anisodamine and dobutamine on gut mucosal blood flow during gut ischemia/reperfusion

AIM: To determine if anisodamine is able to augment mucosal perfusion during gut I/R ischemia-reperfusion. METHODS: A jejunal sac was formed in Sprague Dawley rat. A Laser Doppler probe and a tonometer were inserted into the sac which was filled with saline. The superior mesenteric artery was occluded (SMAO)for 60 minutes followed by 90 minutes of reperfusion. At the end of 60 minutes of SMAO, either 0.2 mg/kg of anisodmine or dobutamine was injected into the jejunal sac. Laser Doppler mucosal blood flow and regional PCO2 (PrCO2)measurements were made. RESULTS: Mucosal blood flow was significantly increased at 30,60 and 90 minutes of reperfusion (R30, R60, R90) when intraluminal anisodamine or dobutamine was present compared to intraluminal saline only(44+/-3.3% or 48+/-4.1% vs 37+/-2.6% at R30, 57+/-5.0% or 56+/-4.7% vs 45+/-2.7% at R60, 64+/-3.3% or 56+/-4.2% vs 48+/-3.4% at R90,respectively P【0.05). Blood flow changes were also reflected by lowering of jejunal PrCO2 measurements after intraluminal anisodamine or dobutamine compared with that of the saline controls (41+/-3.1 mmHg or 44+/-3.0 mmHg vs 49+/-3.7 mmHg at R30,38+/-3.7 mmHg or 40+/-2.1 mmHg vs 47+/-3.8 mmHg at R60,34+/-2.1 mmHg or 39+/-3.0 mmHg vs 46+/-3.4 mmHg at R90, respectively, P【0.05). Most interesting finding was that there were significantly higher mucosal blood flow and lower jejunal PrCO2 in anisodamine group than those in dobutamine group at 90 minutes of reperfusion(64+/-3.3% vs 56+/-4.2% for blood flow or 34+/-2.1 mmHg vs 39+/-3.0 mmHg for PrCO2, respectively, P【0.05), suggesting that anisodamine had a more lasting effect on mucosal perfusion than dobutamine. CONCLUSION: Intraluminal anisodamine and dobutamine can augment mucosal blood flow during gut I/R and alleviate mucosal acidosis. The results provided beneficial effects on the treatment of splanchnic hypoperfusion following traumatic or burn shock.

Pyrrolidine dithiocarbamate reduces ischemia-reperfusion injury of the small intestine

AIM： To evaluate whether pyrrolidine dithiocarbamate （PDTC）, an enhancer of HO production, attenuates intestinal IR injury. METHODS： Eighteen male rats were randomly allocated into three groups： （a） sham; （b） IR, consisting of 30 min of intestinal ischemia, followed by 2-h period of reperfusion; and （c） PDTC treatment before IR. Intestinal microvascular perfusion （IMP） was monitored continuously by laser Doppler flowmetry. At the end of the reperfusion, serum samples for lactate dehydrogenase （LDH） levels and biopsies of ileum were obtained. HO activity in the ileum was assessed at the end of the reperfusion period. RESULTS： At the end of the reperfusion in the IR group, IMP recovered partially to 42.5% of baseline （P〈0.05 vs sham）, whereas PDTC improved IMP to 67.3% of baseline （P〈0.01 vs IR）. There was a twofold increase in HO activity in PDTC group （2 062.66±106.11） as compared to IR （842.3±85.12） （P〈0.001）. LDH was significantly reduced （P〈0.001） in PDTC group （585.6±102.4） as compared to IR group （1 973.8±306.5）. Histological examination showed that the ileal mucosa was significantly less injured in PDTC group as compared with IR group. CONCLUSION： Our study demonstrates that PDTC improves the IMP and attenuates IR injury of the intestine possibly via HO production. Additional studies are warranted to evaluate the clinical efficacy of PDTC in the prevention of IR injury of the small intestine.

Apoptosis induction with polo-like kinase-1 antisense phosph-orothioate oligodeoxynucleotide of colon cancer cell line SW480

AIM： To investigate the effects of polo-like kinase-1 （PLK1） antisense phosphorothioate oligodeoxynucleotide （ASODN） on apoptosis and cell cycle of human colon cancer cell line SW480. METHODS： After SW480 colon cancer cells were transfected with PLK1 ASODN, Northern and Western blot analyses were used to examine PLK1 gene expression in cancer cells. We studied apoptosis using terminal uridine deoxynucleotidyl nick end labeling. Apoptosis and cell cycle of SW480 cells were examined by fluorescence-activated cell sorter scan. RESULTS： The levels of PLK1 mRNA and protein were greatly inhibited by PLK1 ASODN in SW480 cancer cells transfected with PLK1 ASODN. Apoptosis index （AI） induced PLK1 ASODN in a time- and dose-dependent manner. Results from FLM showed that sub-2N DNA content of transfected cancer cells was significantly increased and arrested at G2/M compared with control groups. CONCLUSION： PLK1 ASODN can induce apoptosis of human colon cancer cell line SW480.