纳络酮血肿腔内注射治疗高血压脑出血的临床观察

目的 比较纳络酮血肿腔内注射与静脉注射对高血压脑出血的疗效。方法 40例高血压脑出血患者随机分为A、B两组。两组均采取锥颅血肿穿刺置管抽吸和脑室外引流治疗。A组血肿腔内局部注射纳络酮，B组静脉滴注纳络酮。比较两组患者治疗前后颅内压、GCS评分、脑脊液内皮素-1（ET-1）水平。对患者进行三月以上的随访。结果 40例脑出血患者发病后48hET-1平均水平明显高于非脑出血患者。A组发病后第3天、第7天ET-1峰值较B组明显低（P〈0．01）；A组术后颅内压较B组降低更明显（P〈0．01）；连续GCS评分较B组明显高（P〈0．01），平均清醒天数缩短；A组治疗有效率明显高于B组（P〈0．05）。结论 纳络酮血肿腔内注射较静脉注射可明显提高脑出血患者疗效，改善预后。     

颈交感神经节阻滞治疗偏头痛及其对交感神经皮肤反应的影响

目的探讨颈交感神经节阻滞治疗偏头痛的疗效及其对交感神经皮肤反应的影响。方法颈交感神经节阻滞受用颈6横突法，每日1次，两侧交替阻滞，共7次；应用神经电生理测定36例偏头痛患者治疗前后和30例健康人交感神经皮肤反应（SSR）。结果偏头痛患者经颈交感神经节阻滞后头痛次数减少、头痛时间缩短、程度减轻，与治疗前比较有显著性差异（P〈0．01）。偏头痛患者交感神经皮肤反应的潜伏期均明显长于对照组（P〈0．01），而波幅显著低于对照组（P〈0．01）；颈交感神经节阻滞后偏头痛患者交感神经皮肤反应恢复正常。结论颈交感神经节阻滞治疗偏头痛具有良好的疗效，并能改善偏头痛患者的自主神经功能（ANS）。     

A型肉毒毒素重复治疗偏头痛的临床疗效

目的 探讨A型肉毒毒素重复注射治疗偏头痛的疗效与安全性。方法 对30例偏头痛患者均进行2次A型内毒毒素注射治疗,两次均采用颅周固定位点注射,初次治疗间隔6个月以上后进行第2次治疗,2次治疗后分别于第1,2,3个月评定头痛发作天数、头痛发作次数、疼痛程度、偏头痛残疾程度及不良反应。结果 二次A型肉毒毒素注射治疗后偏头痛发作天数、发作次数、疼痛程度、残疾程度均较治疗前缓解（F分别为3．86,5．23,9．37,5．67;P〈0．05）,但两次治疗后各观察点评定指标比较差异无统计学意义（P〉0．05）。结论 A型肉毒毒素重复治疗偏头痛有效、安全,较初次治疗无差异．     

舍曲林与阿米替林治疗躯体形式障碍的对照研究

目的比较舍曲林与阿米替林治疗躯体形式障碍的疗效及安全性。方法将88例躯体形式障碍患者随机分为舍曲林组46例，阿米替林组42例，疗程6周。于治疗前及治疗第2、4、6周末采用HAMD、HAMA评定临床疗效，TESS评定不良反应。结果治疗2、4、6周末，两组HAMD、HAMA总分与治疗前比较均有极显著性下降（P〈0．01），但同期两组间比较均无显著性差异（P均〉0．05）。两组在治疗期间TESS总分比较有极显著性差异（P均〈0．01），不良反应发生率舍曲林组明显低于阿米替林组，且程度轻，其有显著或极显著性差异（P〈0．05或0．01）。结论两药治疗躯体形式障碍疗效相当，但舍曲林的安全性明显较阿米替林高，依从性好。     

生物反馈结合舍曲林治疗焦虑症的对照研究

目的 探讨生物反馈结合舍曲林治疗焦虑症的疗效。方法 将焦虑症患者按随机分组法分为反馈治疗结合舍曲林组（反馈组45例）和舍曲林药物治疗组（对照组44例），观察6周，分别于治疗前及治疗后第2、6周采用汉密顿焦虑量表（HAMA）评定两组临床疗效。结果 反馈组治疗后2，6周末HAMA评分均较治疗前显著下降（P〈0．05或P〈0．01），而对照组治疗6周末差异有显著性（P〈0．01）；治疗6周末两组间评分及临床疗效差异无显著性（P〉0．05）；反馈组用药剂量低于对照组（P〈0．05）。结论 两组方法治疗焦虑症均有显著疗效，生物反馈结合舍曲林治疗的效果优于单纯舍曲林治疗，且可明显缩短疗程，减少医疗开支。     

阿立哌唑与利培酮治疗精神分裂症的对照研究

目的比较阿立哌唑与利培酮治疗精神分裂症患者的疗效、不良反应及生活质量的影响。方法将68例精神分裂症患者,随机分为阿立哌唑组（研究组）和利培酮组（对照组）,每组34例,分别给予阿立哌唑与利培酮治疗8周,采用阳性和阴性综合征量表（PANSS）评定疗效,治疗中需处理的不良反应症状量表（TESS）评定不良反应,以生活质量综合评定问卷（GQOLI-74）评定生活质量。结果两组治疗后第4、8周末PANSS量表总分及各因子分与治疗前比较均显著降低（P〈0．01）。两组不良反应均较轻微,研究组不良反应发生率61．8％,对照组不良反应发生率70．6％,两组不良反应总发生率差异无统计学意义（P〉0．05）。研究组不良反应主要为失眠,且多于对照组（P〈0．05）,对照组在口干、静坐不能、肌强直、体质量增加、泌乳、月经异常、血糖升高不良反应方面多于研究组（P〈0．05,P〈0．01）。治疗后第8周末与治疗前比较两组GQOLI-74总分、躯体健康、心理健康及社会功能均显著升高（P〈0．01）。结论阿立哌唑与利培酮治疗精神分裂症疗效相当,不良反应小,均可提高患者生活质量。     

吸烟对首发住院精神分裂症患者近期疗效的影响

目的探讨吸烟对首发住院精神分裂症患者近期疗效的影响。方法将102例首发住院的精神分裂症男性患者按是否吸烟分成吸烟组、非吸烟组，均予8周的非典型抗精神病药物治疗，采用阳性和阴性症状量表（PANSS）评定临床疗效。结果两组治疗前PANSS总分差异无显著性（P〉0．05），治疗后两组PANSS总分均有显著下降（P〈0．01）；吸烟组治疗后PANSS总分高于非吸烟组（P〈0．01），临床显效率低于非吸烟组（P〈0．01）；吸烟组抗精神病药物使用剂量高于非吸烟组（P〈0．05）。结论吸烟可能影响首发精神分裂症的近期疗效。     

小剂量尿激酶并尼莫地平治疗急性脑梗死的安全性和有效性

目的探讨小剂量尿激酶并尼莫地平治疗急性脑梗死患者的安全性和有效性。方法选择发病6～72h的急性脑梗死患者120例，随机分为对照组、尿激酶组和尼莫地平组各40例，全部患者均给予常规治疗，尿激酶组还给予尿激酶治疗，尼莫地平组还给予尿激酶＋尼莫地平治疗，并于治疗前和治疗后14、30d采用RI量表及治疗前和治疗后90d采用mRS量表评价患者神经功能。结果治疗后14、30d尿激酶组的BI评分明显优于对照组（P〈0．05），尼莫地平组与对照组比较则有显著性差异（P〈0．01），且明显优于尿激酶组（P〈0．05）；治疗后90dmRS量表评价尿激酶组、尼莫地平组分别与对照组比较有显著性差异（P〈0。01），且尼莫地平组与尿激酶组比较也有显著性差异（P〈0．01）。结论小剂量尿激酶合用尼莫地平治疗可以有效地改善急性脑梗死患者的神经功能缺损，提高生活能力，改善生活质量，且安全性较好。     

米氮平与阿米替林对脑卒中后抑郁患者疗效与认知功能的影响

目的探讨米氮平与阿米替林治疗脑卒中后抑郁的临床疗效及对患者认知功能的影响。方法将64例脑卒中后抑郁患者随机分为研究组（米氮平组）32例,对照组（阿米替林组）32例。于治疗前和治疗第1周、2周、4周、6周末采用汉密顿抑郁量表和P300电位进行抑郁状态和认知功能测定。结果治疗前2组HAMD评分差异无统计学意义,治疗各时段2组评分均较治疗前显著下降（P％0．05或0．01）,治疗1周末和2周末研究组评分较对照组下降更显著（P〈0．05）,研究组总分减分率较对照组升高更显著（P〈0．05）;治疗1周末2组P300电位测定差异均有统计学意义（P〈0．05）,但治疗6周末研究组P300电位N2、P3波潜伏期缩短和P3波幅升高较对照组显著（P〈0．05）;治疗6周末2组服药依从性均较治疗前显著提高（P〈0．01）,研究组较对照组提高更显著（P〈0．01）;治疗后研究组不良反应发生率21．9％,对照组为46．9％,差异有统计学意义（x2=4．43,P〈0．05）。结论米氮平治疗脑卒中后抑郁疗效与阿米替林相当,但米氮平起效明显快于阿米替林,且对改善卒中后抑郁患者的认知功能、提高治疗的依从性明显优于阿米替林。     

尼莫地平对脑出血后继发性脑损害保护作用临床研究

目的探讨尼莫地平对脑出血后继发性脑损害的保护作用机理。方法60例脑出血患者随机分为尼莫地平组与常规治疗组，所有患者均分别在治疗前后观察脑水肿、临床神经功能缺损评分、Barthel指数评分、临床疗效及日常生活依赖程度的变化。结果尼莫地平组和常规治疗组治疗后水肿带均明显缩小，尼莫地平组缩小更为明显（P〈0．01）；治疗后尼莫地平组临床神经功能缺损评分较常规治疗组明显降低（P〈0．01）；治疗后尼莫地平组较常规治疗组BI评分明显增加，日常生活活动依赖程度明显减低（P〈0．01）；治疗后尼莫地平组临床疗效总有效率（73％）显著高于常规治疗组（40％）（P〈0．05）；治疗后尼莫地平组较常规治疗组日常生活活动依赖程度明显减低（P〈0．05）。结论尼莫地平治疗脑出血有确切疗效，可减轻脑水肿，保护神经细胞，可减轻患者神经功能缺损程度，提高患者生活质量。     

Prophylactic treatment of chronic tension-type headache using botulinum toxin type A

Chronic tension-type headache is a common condition, the pathophysiology of which is not well understood. Over-activity of the pericranial muscles is thought to play a role, although sustained muscle contraction is probably a consequence, rather than a cause, of headache. Botulinum toxin type A (BTX-A) is useful in many conditions involving excessive muscle contraction and may therefore be effective in relieving the pain associated with this type of headache. To investigate the efficacy of BTX-A in relieving pain associated with chronic tension-type headache, a double-btind, randomised, placebo-controlled study was carried out, in which 37 patients received BTX-A, injected into the temporalis or cervical muscles of the neck. Clinical outcome was measured over a 4-month study period using headache diaries and chronic pain index scores. Patients treated with BTX-A showed an improvement in headache severity over the 4-month study period, with 13 out of 22 patients showing a 25, 50 or >50% improvement in headache score at Month 3 compared with two out of 15 patients in the placebo group. The number of headache-free days increased significantly in the BTX-A-treated patient group, and patients recorded an improvement in quality of life following BTX-A injection. It can be concluded that intramuscular injection of BTX-A is an effective treatment for chronic tension-type headache.     

The efficacy of subcutaneous sumatriptan in the treatment of recurrence of migraine headache.

OBJECTIVES: To investigate the efficacy of a second subcutaneous dose of 6 mg sumatriptan in the treatment of recurrence of headache after successful treatment of a migraine attack with an initial 6 mg dose. METHODS: In a prospective, randomised, placebo controlled, double blind, parallel group study, 803 patients were treated for one to three migraine attacks with severe or moderate headache with a subcutaneous injection of 6 mg sumatriptan. Any subsequent recurrence of migraine headache was treated with a randomised second injection of sumatriptan or placebo. Recurrence was defined as a headache of moderate or severe intensity occurring 1-24 hours after the initial dose in a patient whose headache had been relieved by sumatriptan (reduction of headache severity from severe or moderate to mild or none after one hour). RESULTS: Headache recurrence was reported by 10%-15% of patients. At each attack, 6 mg sumatriptan given subcutaneously was significantly (P < 0.0005) more effective than placebo at relieving recurrent headache after one hour (84%-93% v 31%-50% of patients); 76%-83% of patients reported headache relief one hour after the initial dose of sumatriptan. Sumatriptan was generally well tolerated. CONCLUSIONS: Up to 15% of patients with migraine experience significant recurrence of headache after successful treatment with subcutaneous sumatriptan, and this recurrence is effectively treated by a further dose of subcutaneous sumatriptan.     

天麻素联合尼莫地平治疗偏头痛急性发作期临床研究

目的探讨天麻素注射液联合尼莫地平片治疗偏头痛急性发作期的疗效及安全性。方法选取开封市中心医院神经内科收治的240例急性期偏头痛患者,随机分为对照组(120例)和实验组(120例)。对照组常规口服尼莫地平片,实验组在口服尼莫地平片的基础上加用天麻素注射液,对比分析2组患者在2周后的临床疗效、颅内血流速度及不良反应情况。结果经2周治疗,2组患者头痛发作频率显著降低、头痛持续时间缩短、头痛程度亦减轻,实验组总有效率91.67%,明显高于对照组的82.50%,差异有统计学意义(P=0.011)。TCD检测发现,实验组患者治疗后大脑前动脉和大脑中动脉血流速度明显低于治疗前和对照组,差异有统计学意义(P<0.05);实验组不良反应发生率明显低于对照组,差异有统计学意义(P<0.05)。结论天麻素注射液联合尼莫地平片可明显提高偏头痛急性发作期的临床疗效,有效降低大脑前动脉和大脑中动脉的平均血流速度,提高患者生活质量,且不良反应少。     

A comparative trial of botulinum toxin type A and methylprednisolone for the treatment of tension-type headache

Tension-type headache (TH) is a common condition, the pathophysiology of which remains undetermined. Evidence implicates sustained contraction of pericranial muscles to be a major cause. A recent preliminary study demonstrated the effectiveness of botulinum toxin type A (BTX-A) in patients suffering from chronic TH. To further investigate this, we performed a study to compare the efficacy of BTX-A with the steroid methylprednisolone (both administered with the local anesthetic lidocaine), when administered by injection into the tender points of cranial muscles in patients with TH. A significant decrease in the median pain score (assessed using a standard visual analogue scale ) was observed at 60 days post injection of BTX-A compared with the pain score achieved following steroid therapy. All patients treated with BTX-A experienced a gradual decrease in median pain severity scores at 30 days and 60 days post treatment. The beneficial effects of BTX-A therapy continued to improve 60 days following injection, whereas the effects of steroid therapy at this time point began to decline. This study clearly demonstrates the effectiveness of BTX-A for the treatment of TH.     

A型肉毒毒素联合重复经颅磁刺激治疗眼睑痉挛合并焦虑抑郁的临床观察

目的 观察肉毒毒素联合重复经颅磁刺激治疗对眼睑痉挛合并焦虑抑郁的治疗效果。方法 纳入良性特发性眼睑痉挛(Benign essential blepharospasm,BEB)伴焦虑/抑郁患者63例,其中单纯A型肉毒毒素(Botulinum toxin A,BTX-A)注射治疗组28例,肉毒毒素联合重复经颅磁刺激(Repetitive transcranial magnetic stimulation,rTMS)治疗组35例,随访6个月; 在治疗前后通过Cohen Albert标准分级、眨眼次数及患者满意程度评价总体疗效; 通过SDS和SAS量表评分评估患者抑郁焦虑情况; 比较2组疗效、起效时间、持续时间及焦虑抑郁量表评分。结果 单纯BTX-A治疗和联合rTMS治疗均能明显改善患者症状,有效率分别为92.86%、94.29%(P>0.05); 单纯BTX-A治疗组的疗效持续时间为(13.04±3.48)周,联合rTMS治疗组的疗效持续时间为(16.89±3.39)周(P<0.01); 单纯BTX-A治疗组及联合rTMS治疗组治疗前SDS评分分别为(62.19±5.77)、(63.50±7.97)分(P>0.05),SAS评分分别为(66.07±9.43)、(64.89±8.38)分(P>0.05); 单纯BTX-A治疗组及联合rTMS治疗组治疗2个月后SDS评分分别为(49.69±7.90)、(49.46±6.73)分(P>0.05),SAS评分分别为(53.88±7.34)、(48.79±6.62)分(P<0.05)。结论 A型肉毒毒素联合重复经颅磁刺激治疗能有效提高特发性眼睑痉挛患者的疗效,延长眼睑痉挛缓解持续的时间,明显改善抑郁焦虑,特别是对减轻患者焦虑明显优于单纯BTX-A治疗。     

甲氧氯普胺联合赖氨匹林治疗偏头痛的对照分析

目的分析甲氧氯普胺联合赖氨匹林治疗偏头痛的疗效。方法 84例偏头痛患者随机分为2组。常规组采用赖氨匹林治疗,甲氧氯普胺组在常规组基础上给予甲氧氯普胺治疗。比较2组偏头痛治疗总有效率、药物不良反应发生率、干预前后偏头痛发作次数及每次发作持续时间、头痛VAS评分。对比治疗前后红细胞聚集指数、血小板黏附率、血浆黏度、纤维蛋白原。结果甲氧氯普胺组总有效率高于常规组(P0.05);2组药物不良反应发生率比较差异无统计学意义(P0.05)。治疗后甲氧氯普胺组偏头痛发作次数、偏头痛每次发作持续时间、头痛VAS评分优于常规组(P0.05);红细胞聚集指数、血小板黏附率、血浆黏度、纤维蛋白原优于常规组(P0.05)。结论甲氧氯普胺联合赖氨匹林治疗偏头痛的疗效优于单纯应用赖氨匹林。     

A randomized trial of divalproex sodium extended-release tablets in migraine prophylaxis

OBJECTIVE: To evaluate the efficacy and safety of extended-release divalproex sodium compared with placebo in prophylactic monotherapy treatment of migraine headache. METHODS: This was a double-blind, randomized, placebo-controlled, parallel-group study. Subjects with more than two migraine headache attacks during a 4-week baseline were randomly assigned in a 1:1 ratio at each center to receive either extended-release divalproex sodium or matching placebo once daily for 12 weeks. Subjects initiated treatment on 500 mg once daily for 1 week, and the dose was then increased to 1,000 mg once daily with an option, if intolerance occurred, to permanently decrease the dose to 500 mg during the second week. Reduction from baseline in 4-week migraine headache rate was the primary efficacy variable. Migraine headaches separated by a < 24-hour headache-free interval were counted as single migraines in calculating migraine headache rates. Tolerance and safety were also evaluated. RESULTS: The mean reductions in 4-week migraine headache rate were 1.2 (from a baseline mean of 4.4) in the extended-release divalproex sodium group and 0.6 (from a baseline mean of 4.2) in the placebo group (p = 0.006); reductions with extended-release divalproex sodium were significantly greater than with placebo in all three 4-week segments of the treatment period. No significant differences were detected between treatment groups in either the overall incidence or in the incidence of any specific treatment-emergent adverse event; 8% of subjects treated with extended-release divalproex sodium and 9% of those treated with placebo discontinued for adverse events. CONCLUSION: Extended-release divalproex sodium is an efficacious, well-tolerated, safe, and easy-to-use once-a-day prophylactic antimigraine medication.     

重复经颅磁刺激治疗偏头痛患者的临床研究

目的观察重复经颅磁刺激(rTMS)治疗偏头痛的疗效和安全性。方法入选的96例偏头痛患者分为rTMS组和假刺激组,每组48例,并记录患者一般资料。rTMS组患者接受经颅磁刺激治疗,隔日1次,15次为一疗程,并进行随访。假刺激组使用伪线圈,不产生治疗效应。记录头痛频率改善、视觉模拟评分量表(VAS)评分改善情况、临床疗效和不良反应等。结果与假刺激组相比,rTMS组患者在头痛发作频率和VAS改善以及临床疗效上均有所好转,差异有统计学意义(P<0.05)。随访过程中rTMS组3例患者出现头晕乏力,但均未发生严重不良反应。结论 tTMS治疗偏头痛是有效且相对安全的方法。     

A型肉毒毒素治疗慢性每日头痛的疗效与安全性

目的 观察A型肉毒毒素治疗慢性每日头痛的疗效与安全性.方法 治疗组给予A型肉毒毒素50 U,对照组给矛利多卡因加泼尼松龙5 ml.2组均用固定位点注射,分别于0、30、60、90 d观察头痛发作时间、头痛程度、生活质量及不良反应.结果 (1)治疗后30、60、90 d时,每月头痛发作天数在肉毒毒素治疗组为(14.0 ±7.8)d、(13.0±6.8)d和(13.0±6.4)d,对照组为(19.0±6.1)d、(21.0±6.1)d和(21.0±5.8)d,组间差异有统计学意义(Z=2.895、4.544、4.878,P＜0.01).(2)治疗后30 d肉毒毒素治疗组VAS评分为(3.6±1.5)分,对照组为(3.8±1.3)分,差异无统计学意义(Z=1.254,P=0.210);而60、90 d时肉毒毒素治疗组为(3.2±1.5)分和(3.1±1.6)分,对照组为(4.7±1.3)分和(5.0±1.5)分,差异有统计学意义(Z=4.950、5.096,均P=0.000).(3)2组生活质量均稍有改善.(4)肉毒毒素治疗组治疗慢性偏头痛效果好,未服预防性药物者效果较好.(5)各组不良反应均较轻.结论 A型肉毒毒素治疗慢性每日头痛有效、安全.     

盐酸洛美利嗪治疗偏头痛的疗效观察

目的评价国产盐酸洛美利嗪治疗偏头痛的疗效及安全性。方法采取随机、双盲、安慰剂对照进行观察,将入选的53例患者随机分为盐酸洛美利嗪治疗组(27例,口服盐酸洛美利嗪片5mg,每日2次)及对照组(26例,口服安慰剂每日2次),疗程共12周。以头痛发作频率为主要评定指标,发作持续时间、程度、伴随症状及头痛综合评分为次要评定指标;并记录不良反应。结果(1)治疗组治疗第4周、第8周及第12周末时,头痛发作频率、头痛持续时间、头痛程度、伴随症状及头痛综合评分较对照组极显著降低(均P<0.01);(2)总有效率治疗组为81.5%,极显著优于对照组(7.7%)(P<0.005)。两组治疗期间均无严重不良反应。结论国产盐酸洛美利嗪是安全有效防治偏头痛发作的药物。