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Narrative medicine emphasizes paying attention to patients, and aims to improve doctors’ empathy for patients and their ability to reflect on their own medical behaviors by cultivating their narrative abilities of understanding, explanation, and feedback. Traditional Chinese medicine has always focused on people-oriented, syndrome differentiation and treatment, and focused on the physical and mental dual health of individuals. The medical humanistic spirit embodied by the two naturally coincides. From the perspective of narrative medicine, the ancient famous doctors in China have demonstrated their superb narrative ability of listening, communication, and reflection, which are valuable resources for narrative medicine and have important value and significance for enriching and developing narrative medicine.
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ObjectiveTo evaluate the effect of the therapy of dispelling stasis， removing toxin， and promoting urination （modified Linggui Zhugantang combined with Xuebijing injection） on the prognosis of sepsis-induced cardiomyopathy （SICM）. MethodA total of 96 patients were randomly assigned into an observation group and a control group， with 48 patients in each group. The patients in the control group received sepsis bundle， and those in the observation group additionally received the therapy of dispelling stasis， removing toxin， and promoting urination （intravenous drip of Xuebijing injection and oral administration of modified Linggui Zhugantang）. The course of treatment in both groups was 7 days. The disease and prognosis indicators ［28-day mortality， intensive care unit （ICU） length of stay， major adverse cardiac events （MACE）， acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ）， sequential organ failure assessment （SOFA） score， and mortality in emergency department sepsis （MEDS） score］， cardiac function indicators ［left ventricular ejection fraction （LVEF）， E/A ratio of peak velocity blood flow from left ventricular relaxation in early diastole （the E wave） to peak velocity flow in late diastole caused by atrial contraction （the A wave）， E/e′ ratio of mitral peak velocity of early filling （E） to early diastolic mitral annular velocity （e′）， and afterload-corrected cardiac performance （ACP）］， myocardial injury markers ［high-sensitivity cardiac troponin T （hs-cTnT）， N-terminal pro-brain natriuretic peptide （NT-proBNP）， heart-type fatty acid-binding protein （H-FABP）， and high mobility group box-1 （HMGB-1）］， hemodynamic indicators ［extravascular lung water index （EVLWI）， global end-diastolic volume index （GEDVI）， cardiac index （CI）， and systemic vascular resistance index （SVRI）］， and TCM syndrome scores were assessed and compared between the two groups. ResultThe 28-day mortality and the incidence of MACE in the observation group were slightly lower than those in the control group. The ICU length of stay in the observation group was shorter than that in the control group （P<0.05）. After treatment， APACHE Ⅱ， SOFA， MEDS， syndrome score of stasis-caused internal obstruction， E/e′ ratio， hs-cTnT， NT-proBNP， H-FABP， and HMGB1 decreased compared with those before treatment （P<0.05）， while LVEF， E/A ratio， and ACP increased （P<0.05）. Moreover， the changes were more significant in the observation group （P<0.05）. On days 3， 5， and 7 after treatment， the EVLWI and SVRI in the observation group were lower than those in the control group （P<0.05）， while CI showed an opposite trend （P<0.05）. The observation group had higher GEDVI than the control group on days 3 and 5 after treatment （P<0.05）. ConclusionOn the basis of conventional bundle therapy， modified Linggui Zhugantang combined with Xuebijing injection with the effect of dispelling stasis， removing toxin， and promoting urination can inhibit the generation of myocardial injury markers and improve hemodynamics to shorten the length of ICU stay， mitigate the TCM syndrome， and reduce the risk of death， thereby improving the prognosis of SICM.
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Objective To evaluate sacral nerve stimulation (SNS) in the treatment of spastic pelvic floor syndrome (SPFS).Method In this study,36 patients of spastic pelvic floor syndrome who received SNS treatment from 2011.3 to 2011.12,were reviewed in terms of clinical curative effect,changes of anal pressure and defecography.Result After a course of SNS treatment,patients were followed up for 3 months,12 cases were cured,22 cases improved and 2 cases were ineffective,the total effective rate was 94.4％.The symptoms such as endless defecate feeling,difficulty in defecation,anal pain and anal obstruction feeling improved significantly (P ＜0.01 ).After the therapy,rectal anal reflex( RAR)threshold value volume rose,anal maximum contraction pressure (AMCP),anal rest perssure (ARP) decreased (P ＜ 0.01 ).While the anal longest contraction time (ALCT)and rectal rest pressure (RRP) did not change significantly (P ＞ 0.05 ).After treatment,when patient defecate the anorectal angle (ARA) increases,the puborectal muscle spasm notch (PMSN)attenuates (P ＜ 0.01 ).Conclusions SNS is effective and minimally invasive in treating spastic pelvic floor syndrome.