浅谈偏头痛的药物治疗

偏头痛(Migraine,M),是血管舒缩功能障碍引起的脑血管疾病.近年来,抗偏头痛药物药理学的研究不断有新的进展,但偏头痛的发病机理仍无统一理论,临床治疗方法各异.本文拟介绍一些偏头痛的药物治疗方法,侧重阐述临床用药特点.     

针灸联合中药治疗偏头痛的临床疗效分析

目的：探讨针灸和中药联合治疗偏头痛的临床效果，为临床治疗偏头痛提供参考。方法100例偏头痛患者，随机分为对照组和治疗组，每组50例，治疗组患者接受针灸和中药治疗，对照组接受西药治疗，两组患者均以1周为1个治疗周期，进行3个治疗周期后对患者的临床治疗效果进行对比分析。结果经治疗，两组患者的临床偏头痛症状有较大的改善，治疗组的总有效率是94%，对照组的总有效率是68%，两组比较差异具有统计学意义(P<0.05)。结论针灸和中药联合进行偏头痛治疗的效果比单纯使用西药治疗的效果突出，是临床中治疗偏头痛的比较好的方法，可以推广使用。     

浅谈偏头痛的中西医治疗体会

目的浅谈偏头痛中西医治疗的临床体会。方法将偏头痛患者随机分为二组,治疗组以中药通窍活血汤和川芎茶调散加西药钙离子拈抗剂为主,对照组以西药钙离子拮抗剂为主,疗程结束后对比二组治疗效果。结果治疗组效果明显优于对照组,差异显著。结论中药通窍活血汤和川芎茶调散加西药钙离子拮抗剂治疗偏头痛作用肯定,值得临床推广。     

速效救心丸及养血清脑颗粒治疗偏头痛的临床观察

目的观察速效救心丸、养血清脑颗粒治疗偏头痛的临床疗效。方法 150例偏头痛患者随机分为3组,治疗组A50例(中医辨证为气滞血瘀型),应用速效救心丸;治疗组B50例(中医辨证为血虚肝旺型),养血清脑颗粒治疗。比较组50例,盐酸氟桂利嗪治疗。观察相比3组患者治疗后的疗效及症状比照。结果治疗1月后,两个治疗组患者疗效明显高于比较组(P<0.05),治疗组症状分级较比较组改善明显(P<0.01)。结论运用中药辨证选择速效救心丸及养血清脑颗粒治疗偏头痛疗效显著,能可行控制头痛发作,最大程度地改善患者生活质量,为治愈偏头痛顽疾提供了新的思路。     

曲普坦类药物的新剂型

偏头痛是一种常见病、多发病。治疗偏头痛的曲普坦类药物均可口服片剂给药，其中只有舒马曲普坦可以皮下注射。口腔崩解片和非口服用药途径(皮下注射、鼻腔和直肠给药)适合吞咽困难或不喜欢吞咽的患者，以及伴有恶心/呕吐的偏头痛患者。口腔崩解片和鼻喷剂，无需液体，可以随时随地使用，在偏头痛刚刚发作时及时治疗。目前，口服片剂因其用药方便，是病人和医师的首选，而新的剂型口腔崩解片和鼻喷剂将成为偏头痛患者理想的一线药物。     

盐酸灭吐灵可缓解偏头痛

盐酸灭吐灵具有抗恶心特性,因此成为抗急性偏头痛的辅助药物。由于发现接受本品静注的偏头痛急诊患者在接受第二种药物治疗前即可康复,于是对本品进行一项随机对照临床试验,以评价单独用本品对偏头痛的作用。 50例18～20岁患严重、典型或普通偏头痛患者,分成二组:24例静注本品10mg;26例静注生理盐水。用数字计分评价疼痛缓解。给药组16例(67％)在给药后1小时内疼痛缓解。对照组5例(19％)缓解。未见显著的不良反应。研究者们推测,本品的作用     

镁盐类药的临床新用

镁盐类药的临床新用１、硫酸镁治疗偏头痛急性发作钙拮抗剂对偏头痛具有显著疗效，镁系生理性钙桔抗剂，从药理学作用推论也可以治疗偏头病。上海第二医大新华医院蒋锦琪等，对１６例偏头痛患者试用硫酸镁治疗。方法：２５％硫酸镁２０ｍｌ加入１０％葡萄糖液５００ｍｌ中...     

针刺治疗偏头痛39例疗效观察

偏头痛是临床常见病,主要表现为一侧或双侧发作性、搏动性剧烈疼痛,发病率高,疼痛剧烈,给患者带来极大痛苦,严重影响患者的工作和生活,也给社会和医疗卫生系统带来了巨大的经济负担[1]。笔者采用针刺方法治疗偏头痛,取得较好疗效,现报道如下。     

个性化程序化护理干预在偏头痛性眩晕患者治疗中的应用

<正>偏头痛性眩晕在临床晕眩门诊中是一种反复多发性疾病,临床表现多为视线旋转、头晕、恶心、头痛昏沉甚至剧烈的偏头痛[1]。给患者的日常工作和学习造成极大的困扰与痛苦,给患者造成沉重的心理压力。本试验在采用药物治疗的同时应用个性化程序化护理在偏头痛性眩晕患者的临床应用中取得了良好的效果,现报告如下。1资料与方法1.1一般资料     

尼莫地平与乙酰水杨酸对偏头痛患者镇痛疗效的比较

目的:比较乙酰水杨酸肠溶片与尼莫地平胶囊对偏头痛患者镇痛的疗效,为偏头痛患者临床治疗提供参考。方法:选取2013年2月—2015年2月间收治的偏头痛患者108例,根据治疗方法的不同将其分为观察组(58例)和对照组(50例);观察组患者均给予乙酰水杨酸肠溶片治疗,对照组患者均给予尼莫地平胶囊治疗,比较治疗1月和随访5月偏头痛患者镇痛的疗效。结果:观察组患者临床治疗后的总有效率为72.41%高于对照组为56.00%(P<0.05);随访过程中观察组患者的复发率为3.45%低于对照组患者为16.00%(P<0.05),并发症的发生率为3.45%明显低于对照组为16.00%(P<0.05)。结论:采用乙酰水杨酸治疗偏头痛患者镇痛疗效优于尼莫地平,且治疗过程中患者的复发率、并发症发生率较低。     

A Review of CDER’s Novel Drug Approvals for 2016

This past year was another successful year for the new drugs program in FDA’s Center for Drug Evaluation and Research (CDER). CDER reviewed and approved 22 novel drugs, most of which have the potential to add significant clinical value to the care of thousands of patients with serious and life-threatening diseases. Among the novel drugs approved in 2016 were the first treatment for patients with spinal muscular atrophy, the first drug approved to treat Duchenne muscular dystrophy, a new drug to treat hallucinations and delusions in people with Parkinson’s disease, another to treat patients with a rare chronic liver disease known as primary biliary cirrhosis, and two new treatments for patients with hepatitis C. There were also new oncology drugs to treat patients with ovarian cancer, bladder cancer, soft tissue sarcoma, and chronic lymphocytic leukemia - as well as two new diagnostic agents for detecting certain forms of cancer.     

超声e-Flow对脑梗死患者颈动脉斑块内新生血管的检测

目的探讨超声e-Flow对脑梗塞患者颈动脉斑块内新生血管的检测中的价值。方法回顾性分析河北燕达医院2008年1月至2009年3月住院的脑梗死患者69例的临床资料,该组患者均采用超声e-Flow对脑部颈动脉斑块进行检测,总结检测结果。结果超声100个斑块中有66个可见新生血管,其中软斑40个,硬斑0个,混合斑块26个。34个超声未见新生血管的斑块中,硬斑块17个,软斑块8个,混合斑块9个。且未显示新生血管组的斑块厚度显著小于显示新生血管组的斑块厚度,P<0.05。结论超声e-Flow对于斑块内新生血管较为敏感,且由于操作更为简便,费用更低,值得临床推广。     

Antiplatelet therapy in early management of non-ST-segment elevation acute coronary syndrome: the 2002 and 2007 guidelines from North America and Europe

The American College of Cardiology, American Heart Association, and the European Society of Cardiology published updated guidelines in 2007 for patients with non-ST elevation acute coronary syndrome. In this article, we review the recommendations for antiplatelet therapy and supporting data, highlight new changes, and describe differences between the European and North American guidelines. The new guidelines provide more details regarding the selection of an early conservative versus an early invasive approach based on the patient's profile and balance between ischemic and bleeding risks. Important new recommendations include wider endorsement for low-dose aspirin maintenance therapy, longer duration of clopidogrel following percutaneous coronary intervention, additional guidance regarding surgery in selected patients on clopidogrel, identification of patients most likely to benefit from glycoprotein IIb/IIIa inhibitors (with appropriate dose modification in patients with renal failure), and the option to use early clopidogrel with bivalirudin in patients managed invasively who are at increased risk of bleeding. The new guidelines also discourage the concomitant use of nonsteroidal anti-inflammatory drugs and delineate indications for adding warfarin to antiplatelet therapy. Because antiplatelet therapy is the cornerstone of management of patients with non-ST elevation acute coronary syndrome, health care providers should make themselves familiar with the new data and latest guideline recommendations.     

New therapeutic strategies for the treatment of acute lymphoblastic leukaemia

Although contemporary treatments cure more than 80% of children with acute lymphoblastic leukaemia (ALL), some patients require intensive treatment and many patients still develop serious acute and late complications owing to the side effects of the treatments. Furthermore, the survival rate for adults with ALL remains below 40%. Therefore, new treatment strategies are needed to improve not only the cure rate but also the quality of life of these patients. Here, we discuss emerging new treatments that might improve the clinical outcome of patients with ALL. These include new formulations of existing chemotherapeutic agents, new antimetabolites and nucleoside analogues, monoclonal antibodies against leukaemia-associated antigens, and molecular therapies that target genetic abnormalities of the leukaemic cells and their affected signalling pathways.     

传统与新型抗精神病药治疗精神分裂症疗效及病房管理满意度比较

目的比较传统与新型抗精神病药治疗精神分裂症的疗效和病房管理满意程度。方法将72例患者随机分为两组,分别用传统和新型抗精神病药物治疗6周,用阳性和阴性症状量表、精神病评定量表及护理观察量表对患者满意度进行评分。结果两组患者疗效相当,医务人员满意度比较差异有统计学意义(P<0.05)。结论新型药物组患者社会能力、兴趣等显著高于传统药物组。新型药物组认知功能损害少,社会康复程度高,医生护士需要改变病房传统管理模式。     

晚期非小细胞肺癌治疗的新趋势

当今肺癌研究的热点是以与肿瘤发生、发展相关的驱动基因为靶点,研发新的药物,进行有针对性的个体化分子靶向治疗,从而改善患者预后。靶向药物、新型化疗药物、抗血管新生药物以及治疗性疫苗等各种治疗手段在晚期非小细胞肺癌(NSCLC)患者的治疗中均取得了显著的进展。其中表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)对于EGFR突变阳性NSCLC患者无论在一线、维持还是二线治疗中疗效均得到肯定;替吉奥胶囊有望成为晚期NSCLC一线、二线治疗新的选择;克唑替尼是棘皮动物微管结合蛋白4与间变淋巴瘤激酶融合基因(EML4-ALK)阳性患者治疗的新标准;抗血管新生药物在NSCLC的治疗疗效得到了进一步证实;EGF疫苗在晚期NSCLC治疗中的结果值得期待。这些成果将会改变目前晚期NSCLC的治疗策略,而基于患者临床特点及分子分型的个体化治疗将成为晚期非小细胞肺癌治疗的新趋势。     

Waiting for reimbursement of new medicines in Canada: it's time for a rethink

Available evidence indicates that patients who have private sector drug insurance are immediately covered for all new medically necessary drugs certified by Health Canada, with few exceptions. The experience for patients who are dependent on public drug programmes is much worse. Evidence indicates that, on average across the provinces, far less than half of the drugs certified by Health Canada are finally approved by the provinces for public reimbursement. Publicly insured patients also wait up to 1 year longer than privately insured patients to get insurance coverage for new drugs. Evidence also shows that public drug coverage varies widely across provinces.     

严重多发伤院内急救模式的效果探讨

目的探讨严重多发伤院内急救模式的效果。方法比较2010年6月至2012年6月采用新模式（A组）与传统模式（B组）救治严重多发伤患者急诊术前时间、漏诊、病死率、平均住院天数与并发症情况。结果A组患者创伤后得到有效救治的时间为（16．8±8．5）min,B组为（57．2±11．9）min,差异有统计学意义（t=2．66,P〈0．01）。A组病死1例（3．4％）,致残7例（24．1％）;B组病死3例（9．7％）,致残16例（51．6％）;两组患者的病死率与致残率差异有统计学意义（P〈0．05）。结论新急救模式有效提高了严重多发伤患者的救治水平,使患者的病死率和致残率明显降低。     

Evaluation of six gentamicin nomograms using a bayesian parameter estimation program

A new set of guidelines for the administration of gentamicin was developed by estimating steady-state peak and trough gentamicin concentrations for simulated patients with known weights and creatinine clearances. The most appropriate doses to achieve target peak concentrations of 5-10 mg/L and troughs of less than 2 mg/L were then tabulated. The performance of these new guidelines was assessed using data collected from 60 patients who had received gentamicin and had at least two serum concentration measurements. Individual estimates of clearance and volume of distribution were obtained using a Bayesian parameter estimation program and these estimates were used to predict the steady-state peak and trough concentrations that would arise from the new guidelines and five other previously published nomograms (Mawer, Chan, Hull-Sarubbi, Rule of Eight, and Dettli). The new guidelines, the Dettli nomogram, and the Hull-Sarubbi table achieved similar percentages (52-57%) of patients within the target ranges (5-10 mg/L for peak and less than 2 mg/L for trough), although 28% of patients had predicted peak concentrations below 5 mg/L with the new method compared to 15% with the other two. Only 38% of patients were within both ranges when the Mawer nomogram and the Rule of Eight methods were used. Since a large percentage of patients would have achieved concentrations outside of the target ranges no matter which nomogram was used, serum concentration monitoring is still recommended to confirm dose requirements.     

（足母）外翻矫形器的研制与临床应用

目的探讨新型（足母）外翻矫形器的研制与临床应用的效果。方法设计并制出新型（足母）外翻矫形器并结合临床给（足母）外翻患者使用。共计34例（足母）外翻患者使用。其中男性3例,女性31例。年龄21～71岁,平均42岁。（足母）外翻角度15.2°～20.4°,平均为（17.4±2.1）°。结果经治疗3个月,改善疼痛症状的患者有5例,占7例疼痛患者的71.43%。矫正（足母）外翻患者3例,占（足母）外翻患者的8.82%。3位患者的平均年龄为25岁。24例（足母）外翻患者HVA未增大,占（足母）外翻患者的70.59%。结论该新型（足母）外翻矫形器具有矫形功能,并且对20～30岁年轻的患者效果明显。