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浅谈“五刺法”治疗“五痹”
针灸治疗中的"五刺法"源于《灵枢@官针篇》中的一种治疗方法.其中包括:半刺、豹纹刺、关刺、合谷刺、输刺五种.它们以其特有的操作手法,相对于不同的病症,临床上有其独到的治疗效果.
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Acupuncture treatment integrated with cupping for enhancing the therapeutic effect is a technique in Yang's school of acupuncture carried forward from generation to generation. The author's grandfather created Yang's shallow puncturing and cupping therapy to enhance the effect of promoting blood flow and removing blood stasis in the light of his clinical experience. In this therapy, the gentle puncturing and heavy tapping are carried out with the seven-star needle until light bleeding occurs, followed by drawing out of pituita or stagnant blood and coagula by cupping, in an attempt to promote tissue regeneration by removing blood stasis for promoting the flow of qi and blood in the meridians. The therapy has been developed by Dr. Yang Yifang (the author's father) in clinical practice over the past six decades. Satisfactory therapeutic results have been obtained in clinical practice, which are introduced with examples below.
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Large and small doses of drugs for improving blood circulation and removing blood stasis were used in model rats to treat mild chronic hepatic damage induced by carbon tetrachloride (CCl4). The results show that large dose of Dang Gui (当归 Radix Angelicae Sinensis) and Dan Shen (丹参 Radix Salviae Miltiorrhizae) (drugs for regulating blood flow) and small dose of Yu Jin (郁金 Radix Curcumae) and Niu Xi (牛膝 Radix Achyranthis Bidentatae) (drugs for activating blood flow) can significantly elevate the activity of SOD (P<0.05) and/or lower the T/K ratio, markedly reduce the MDA content (P<0.05 or P<0.01) and significantly decrease the activities of ALT and AST (P<0.05 or P<0.01), demonstrating that these drugs are effective in combating oxygen free radicals (OFR) in chronic liver damage. On the contrary, large dose of Tu Bie Chong (土鳖虫 Eupolyphaga seu Steleophaga) and E Zhu (莪术 Rhizoma Curcumae) (drugs for removing blood stasis) tend to increase the ALT and AST (P<0.05) activities. The results suggest that the synergism of elevation of the SOD activity and reduction of T/K ratio contributes to the action of drugs for improving blood circulation and removing blood stasis in combating the liver damage induced by CCl4.
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川芎嗪、当归注射液对DIC大鼠血小板功能和器官血流量的影响
川芎嗪、当归作为活血化瘀中药,已广泛应用于临床治疗心脑血管疾病.研究表明,川芎嗪、当归具有明显改善微循环及防止心、肝、肾等缺血与再灌注损伤的作用[1~2].
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麻醉药物对脑血流动力学的影响
健康成人的脑循环通过自身调节可为神经系统活动定量提供氧和葡萄糖,该自身调节会受术中麻醉用药的影响,进而改变脑的氧和能量供应.使用麻醉药物的同时控制颅内压(intracranial pressure,ICP)在正常范围,是手术安全的前提之一.颅内压由骨性颅腔的内容物,如脑组织、颅内血容量,脑脊液所决定.颅腔内容物在颅内静脉回流不受损的情况下.很大程度上取决于脑血流量(cerebral blood flow,CBF)以及脑脊液生成和吸收的平衡.麻醉药物通过多种机制改变脑血流量.
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灰度模式血流显像—一种全新的超声血流成像技术
灰度模式血流成像(B-mode blood flow imaging,B-flow),也可称为灰度血流图或二维血流图。它是一种利用GE公司的数字化编码超声技术来实现灰阶图像下血流回声直接显示的一种新的成像技术。通俗一点地说,就是将流动的血流中的极微弱的回声(多为RBC等血液成分的散射信号,在普通二维模式下一般呈无回声)信号进行适当增强,使我们在进行二维扫查的同时,清晰直观地看到血管内血液的流动情况[1]。相对于传统的血流成像方式(如彩色多普勒血流图、彩色多普勒能量图等),B-flow具有其本身的许多优点。下面将对B-flow的成像原理、成像的优缺点、图像的基本调节、以及B-flow的临床意义和其初步临床应用等方面进行初步探讨。
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磁共振灌注成像在颅内占位性病变中的应用(综述)
常规磁共振(MR)检查对于颅内肿瘤的发现和定性有很大价值,但在估计肿瘤的恶性程度、区分肿瘤复发与放、化疗后坏死等方面仍存在很大限制.近年来,MR灌注成像(perfusion MR,PMR)通过测量几个血流动力学参数来观察脑的微循环灌注,用于评价急性脑梗死、脑肿瘤、脱髓鞘病变以及治疗效果等[1],较常规CT、MR有独特的优点.这些参数包括脑血容量(cerebral blood volume,CBV)、脑血流量(cerebral blood flow,CBF)及平均通过时间(mean transit time,MTT)等.其中,用于颅内占位性病变的研究已有多量报道,且主要集中于脑胶质瘤的术前分级诊断.在评价颅内占位性病变中,以CBV有价值[2].
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穿支低灌注发病机制在内囊预警综合征病因中的参与二例
例1:患者男,66岁,既往"2型糖尿病"病史,反复发作性左侧肢体力弱5h,再发无缓解1h于2010年6月14日9:00入院,入院前反复发作4次,1h前再发无缓解,体征:左侧肢体肌力4级,左侧巴氏征(+),急诊CT血流灌注成像(computerized tomography perfusion,CTP)检查提示右侧基底节区低灌注:脑血流量(cerebral blood flow,CBF)增加、脑血容量(cerebral blood volume,CBV)略增加、平均通过时间(mean transit time,MTr)延长,颈动脉+头颅CTA未见明显异常,24h后左侧肢体力弱仍无缓解,头颅DWI检查提示右侧基底节脑梗死,见图1.
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彩色多普勒超声诊断胎儿下腔静脉离断并奇静脉异常连接一例
孕妇,30岁,孕2产0,末次月经2010年2月7日,于2010年9月26日来我院行常规产科超声检查.超声显示:胎位头位, 双顶径8.56 cm,头围30.56 cm,腹围26.83 cm,股骨长6.21 cm,肱骨长5.55 cm,羊水指数8.7 cm,胎儿心率142次/min,脐动脉收缩期峰值流速/舒张末期流速(ratio of peak-systolic to end-diastolic blood flow velocities,S/D)2.39,搏动指数(pulse index,PI)0.87,阻力指数(resistance index,RI)0.58,胎盘:位于后壁.胎儿上腹部横切面示肝脏及胃泡位于右上腹,胃泡紧贴肝下缘,腹主动脉和下腔静脉与脊柱的对称关系消失,腹主动脉右前方无肝段下腔静脉,为扩张的奇静脉,腹主动脉与奇静脉均位于脊柱右侧并平行排列,奇静脉位于主动脉右后侧(图1).
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正电子发射断层成像术在肥厚型心肌病中的应用:发现微血管功能异常所致的心肌低灌注
肥厚型心肌病是常见的遗传性心脏疾病,其在人群中患病率约为2/1000,以表型表达和临床表现差异极大为特点--从完全无症状到猝死、疾病进展和心力衰竭相关并发症等~([1-3]).微血管水平的心肌缺血与疾病表达和临床后果密切相关,是一些致命性并发症,如室性心律失常、猝死、左心室重构和收缩功能障碍的直接原因~([9-16]).
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“胎盘血管阻力的新型评分方法”点评
BackgroundUmbilical artery Doppler veloci-metry is a routine method for fetal surveillance in high-risk pregnancy.Uterine artery Doppler seems to give comparable information,but it can be diffi-cult to interpret as there are two arteries,which might show notching and/or increased pulsatility index (PI)as signs of increased vascular imped-ance.Combining the information on vascular re-sistance on both sides in a new score might simplify and improve evaluation of placental circulation.MethodsUterine and umbilical artery Doppler velocimetry was evaluated in 633 highrisk pregnan-cies.The managing clinician was informed only a-bout the umbilical artery flow.The umbilical ar-tery flow spectrum was semiquantitatively divided into four blood flow classes (BFC ),expressing signs of increasing vascular resistance.The uterine artery Doppler flow spectrum was divided into five uterine artery scores (UAS),taking into account presence/absence of notching and/or increase in PI.By adding UAS to BFC,a new placental score (PLS)was constructed with values ranging from 0 to 7,indicating general placental vascular resistance.The scores were related to three outcome variables:small-for-gestational age (SGA),premature delivery (<37 weeks),and cesarean section.ResultsAll three score systems showed a significant relationship between signs of increasing vascular resistance and outcome.The new PLS showed the best association to adverse outcomes, with optimal cut-off at values exceeding score 3.ConclusionDoppler velocimetry on both sides of the placenta showed a strong relationship to an adverse outcome of pregnancy. The new PLS showed a better relationship to adverse perinatal outcome than the BFC and the UAS.The PLS can simplify evaluation of uteroplacental and fetopla-cental Doppler velocimetry.
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Persimmon leaf flavonoid has been shown to enhance brain ischemic tolerance in mice, but its mechanism of action remains unclear. The bilateral common carotid arteries were occluded using a micro clip to block blood flow for 10 minutes. After 10 minutes of ischemic preconditioning, 200, 100, and 50 mg/kg persimmon leaf flavonoid or 20 mg/kg ginaton was intragastrical y administered per day for 5 days. At 1 hour after the final administration, ischemia/reperfusion models were estab-lished by blocking the middle cerebral artery for 2 hours. At 24 hours after model establishment, compared with cerebral ischemic rats without ischemic preconditioning or drug intervention, plasma endothelin, thrombomodulin and von Wil ebrand factor levels significantly decreased and intercel-lular adhesion molecule-1 expression markedly reduced in brain tissue from rats with ischemic pre-conditioning. Simultaneously, brain tissue injury reduced. Ischemic preconditioning combined with drug exposure noticeably improved the effects of the above-mentioned indices, and the effects of 200 mg/kg persimmon leaf flavonoid were similar to 20 mg/kg ginaton treatment. These results indicate that ischemic preconditioning produces tolerance to recurrent severe cerebral ischemia. However, persimmon leaf flavonoid can elevate ischemic tolerance by reducing inflammatory reactions and vascular endothelial injury. High-dose persimmon leaf flavonoid showed an identical effect to ginaton.
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正常与勃起功能障碍老年人阴茎背动脉横切面积和血流量的临床研究
勃起功能障碍病因病机复杂,迄今尚未明了[1],为探讨血管因素对老年勃起功能的影响,以脉冲超声多普勒探测阴茎背动脉横切面图形,以微机图像扫描仪测量其面积并计算出血流量,结合血液流变学原理提示血管口径和血流量在老年勃起功能障碍中起重要作用.
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应用能谱CT研究肝硬化门静脉高压患者肝血流动力学变化
肝血流CT灌注扫描可获取肝动脉指数(hepatic artery index,HAI)、肝血流量(hepatic blood flow,HBF)、肝血容量(hepatic blood volume,HBV)、平均通过时间(mean transit time,MTT)、表面通透性(permeability of capillary vessel surface,PS)等肝灌注参数[1-3].
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Objective To study the endovascular treatment of artery rupture caused by injury on which surgery was impossibly performed. Methods All 76 patients underwent selective angiography to make accurate diagnosis. Endovascular occlusion of the target artery with a balloon catheter was accomplished and surgical vessel repair followed in 13 cases. Under the condition that the blood supply of the remote limb on which the artery rupture was detected remained normal, the injured artery was obstructed completely with either detachable balloon or coil in 63 cases.Results No complication, disability, or death was found in any case.Conclusions Occlusion of the blood flow of the target vessel with balloon catheter is an easy, effective and safe preoperational approach for patients who fail to be treated perfectly with direct surgery.
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常用麻醉药对胎儿大脑应该是安全的
杜克大学医学中心(Duke University Medical Center)的研究人员在研究中发现,绵羊怀孕期间接触麻醉药,似乎不会对胎儿大脑发育产生不良影响[General anesthesia improves fetal cerebral oxygenation without evidence of subsequent neuronal injury. J Cereb Blood Flow Metab,2005 Mar 9(Epub ahead of print)].根据测定的大脑氧合数据,这些全麻药物似乎还可以促进胎羊大脑的氧合水平.
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脑灌注压监控在重型颅脑损伤治疗中的应用
脑血流量(cerebral blood flow,CBF)恒定是维持正常脑功能的基础,而稳定的脑灌注压(cerebral perfusion pressure,CPP)是CBF恒定的决定因素,CPP维持较高水平能使脑缺血的风险降至小[1].2005年6月至2007年6月我们随机选取格拉斯哥(GCS)评分3~8 分的60例重型颅脑损伤患者持续CPP监测,控制CPP≥70 mm Hg,研究CPP监测在重型颅脑损伤临床治疗中的价值,现报告如下.
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脑动脉脉动指数增高及其血流变化
随着医学科技的进步,早期动脉硬化越来越早的被人类发现.脑动脉硬化是各类脑血管病的早期表现,发现和治疗早期脑动脉硬化对脑血管病的防治有非常重大的意义,与减少脑血管病的发生也有密切关系.本文采用经颅彩色多普勒(TCD)测得大脑中动脉(MCA)的大血速(S)与脉动指数(PI)即大血流速-小血流速(D)与平均血流速(M)之比值.对血液流变学、神经系统症状及早期动脉硬化作进一步分析.
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盐酸纳络酮对急性脑梗死后神经功能所损的改善作用
Background:Naloxone hydrochloride injection produced by Guang dong Kangli Company was applied to treat acute infarction,which acheived markedly effect.It was found recently,when cerebral ischemia and infarction,hypothalamus arcuate nuclei release much β -endorphin,which inhibited neuron activity and made secondary lesion of CNS heavier.Further lead to disturbance of limb,mentality change even coma.Naloxone might resist blood flow decrease caused by β -endorphin,enhance oxgen supply of brain tissue,lighten lesion of cerebral perfusion.
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运动加头针对脑卒中后偏瘫患者肌力恢复的效果观察
Background: Needling special scalp region can deroppilate meridian, increase blood flow of brain, alleviate cerebral vascular spasm, promote collateral formation, delete local spasm and joint dysfunction. Motion training can improve metabolism and regulation of central nervous system and veggetable nervous system;moteover induce the formation of eompensatory mechanism.