王晓燕教授分时间论治内伤杂病经验总结

文章总结王晓燕教授分时间论治失眠、头痛、发热的临床经验,从理论总结到典型病案举例,充分阐明王晓燕教授对分时间论治内伤杂病的认识,说明分时间论治疾病的有效性,扩展临床辨证思维,以进一步学习与研究。     

米那普仑治疗老年卒中后抑郁的临床疗效

目的 探讨米那普仑对比舍曲林治疗老年卒中后抑郁症的临床疗效和不良反应。方法 选取2018年1月～2019年6月我院收治的48 例诊断为脑卒中后抑郁的老年患者,随机分为两组,研究组使用米那普仑,对照组使用舍曲林,治疗8 周,采用汉密尔顿抑郁量表（HAMD）和神经功能缺损量表（CSS）、匹兹堡睡眠质量指数量表（PSQI）、副反应量表（TESS）评定临床疗效、睡眠质量指数和不良反应。结果 研究组和对照组治疗老年脑卒中后抑郁的HAMD、CSS、PSQI 评分无显著性差异,总有效率分别为88.0%和91.3%,差异无统计学意义（P＞0.05）;副反应量表显示研究组与对照组均未出现严重不良反应,两组间无统计学差异（P＞0.05）。结论 米那普仑有利于老年脑卒中后抑郁患者改善抑郁症状,促进神经功能康复,提高生活能力,是一种安全有效、副反应少的抗老年卒中后抑郁药。     

从圆运动理论治疗不寐

人体的气机通过降、沉、升、浮,如环无端不停地进行圆运动。人体中焦轴轮不利,气机升、降、浮、沉失和,脏腑阴阳失交,便会引起圆运动运转失常,从而产生不寐。治疗应以"复圆"为原则,顺应圆运动的规律,恢复人体气机、调整脏腑阴阳,阴平阳秘,气血调和,神安则寐。在临床上,可将不寐分为心阴不足证、肾阳亏虚证、肝阳不足证、脾胃失和证,其中,心阴不足证治以滋阴降火、安神定志,方选天王补心丹合交泰丸加减;肾阳亏虚证治以温补肾阳、宁心安神,方选附子汤合桂枝甘草龙骨牡蛎汤加减;肝阳不足证治以养肝镇惊、安神定志,采用"升肝降胆"之法,方选酸枣仁汤加减;脾胃失和证治以补阳泻阴、宁心安神,方选补脾胃泻阴火升阳汤加减。     

“三神针”治疗中风后失眠

目的:观察"三神针"对中风后失眠患者睡眠质量的改善情况及其对血清褪黑素(melatonin,MT)和5-羟色胺(5-hydroxytryptamine,5-HT)的影响。方法:将70例中风后失眠患者随机分为试验组和对照组各35例。对所有患者予以基础治疗及恢复治疗。治疗组采用"三神针"为主进行治疗,对照组采用普通针刺治疗。每天1次,每周治疗5次,每次留针30 min,2周为1个疗程,共治疗2个疗程。对所有病例治疗前后进行匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)、失眠严重指数量表(insomnia severity index,ISI)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分及MT、5-HT含量对比,并对治疗过程中遇到的不良事件进行记录。结果:两组PSQI各因子及总分比较,差异有统计学意义(P<0.05);两组ISI评分比较,差异有统计学意义(P<0.05);两组HAMA、HAMD评分比较,差异有统计学意义(P<0.05);试验组有效率97.14%(34/35),对照组有效率82.86%(29/35),两组比较,差异有统计学意义(P<0.05);两组均未出现明显不良反应。结论:"三神针"选穴合理精妙,临床疗效确切,能显著改善中风后失眠患者的PSQI评分、HAMD评分、HAMA评分、ISI评分,改善患者的不适症状,是一种疗效好、痛苦小、易接受的治疗方案。     

枣仁安神胶囊联合唑吡坦治疗失眠症的临床研究

目的探讨枣仁安神胶囊联合唑吡坦治疗失眠症的临床疗效。方法选取2017年6月—2018年6月在沈阳市安宁医院诊治的失眠症患者86例,根据用药差别分为对照组(43例)和治疗组(43例)。对照组患者睡前口服酒石酸唑吡坦片,10 mg/次,1次/d;治疗组在对照组基础上睡前口服枣仁安神胶囊,5粒/次,1次/d。两组患者均经4周治疗。观察两组患者临床疗效,同时比较治疗前后两组患者PSQI、HADS、PHQ-9、中医症状总积分、QLQ-C30和WEMWBS评分、睡眠质量和血清学指标。结果治疗后,对照组临床总有效率为81.40%,显著低于治疗组的95.35%,两组比较差异具有统计学意义(P0.05)。经治疗,两组PSQI、HADS、PHQ-9、中医症状总积分均显著降低(P0.05),QLQ-C30、WEMWBS评分显著升高(P0.05),且治疗组患者这些项目评分明显好于对照组(P0.05)。治疗后,两组患者总睡眠时间、REM睡眠时间及睡眠效率明显提高(P0.05),睡眠潜伏期和觉醒时间明显缩短(P0.05),且治疗组睡眠质量明显好于对照组(P0.05)。治疗后,两组患者血清5-羟色胺(5-HT)水平显著升高(P0.05),定皮质醇(COR)、白细胞介素-2(IL-2)、食欲素A(Orexin-A)、白细胞介素-6(IL-6)水平显著降低(P0.05),且治疗组患者血清5-HT、Orexin-A、COR、IL-2、IL-6水平明显好于对照组(P0.05)。结论枣仁安神胶囊联合唑吡坦治疗失眠症可有效改善患者相关症状,提高睡眠质量和生活质量,有利于患者焦虑抑郁状态和心理健康状态改善。     

李建强针灸治疗顽固性失眠经验

顽固性失眠是临床常见病、多发病,严重影响患者的身心健康。李建强副教授认为人之寐寤由神主导,神安则寐,神动则寤。五脏不和、神不安其脏为顽固性失眠的主要病机;临证善用太冲、内关、三阴交、尺泽、太溪、照海、足三里七穴为基础穴组通调五脏,推广应用焦氏头针血管舒缩区于失眠的治疗中,博采众长,辨证施治,穴简效宏。     

Melatonin and its analogs in insomnia and depression

Benzodiazepine sedative-hypnotic drugs are widely used for the treatment of insomnia. Nevertheless, their adverse effects, such as next-day hangover, dependence and impairment of memory, make them unsuitable for long-term treatment. Melatonin has been used for improving sleep in patients with insomnia mainly because it does not cause hangover or show any addictive potential. However, there is a lack of consistency on its therapeutic value (partly because of its short half-life and the small quantities of melatonin employed). Thus, attention has been focused either on the development of more potent melatonin analogs with prolonged effects or on the design of slow release melatonin preparations. The MT(1) and MT(2) melatonergic receptor ramelteon was effective in increasing total sleep time and sleep efficiency, as well as in reducing sleep latency, in insomnia patients. The melatonergic antidepressant agomelatine, displaying potent MT(1) and MT(2) melatonergic agonism and relatively weak serotonin 5HT(2C) receptor antagonism, was found effective in the treatment of depressed patients. However, long-term safety studies are lacking for both melatonin agonists, particularly considering the pharmacological activity of their metabolites. In view of the higher binding affinities, longest half-life and relative higher potencies of the different melatonin agonists, studies using 2 or 3mg/day of melatonin are probably unsuitable to give appropriate comparison of the effects of the natural compound. Hence, clinical trials employing melatonin doses in the range of 50-100mg/day are warranted before the relative merits of the melatonin analogs versus melatonin can be settled.     

Transcranial direct current stimulation for the treatment of post-stroke depression in aphasic patients: a case series

ABSTRACT

Aphasia is a common consequence of stroke; it is estimated that about two-thirds of aphasic patients will develop depression in the first year after the stroke. Treatment of post-stroke depression (PSD) is challenging due to the adverse effects of pharmacotherapy and difficulties in evaluating clinical outcomes, including aphasia. Transcranial direct current stimulation (tDCS) is a novel treatment that may improve clinical outcomes in the traditionally pharmacotherapy-refractory PSD. Our aim was to evaluate the safety and efficacy of tDCS for patients with PSD and with aphasia. The Stroke Aphasic Depression Questionnaire (SADQ) and the Aphasic Depression Rating Scale (ADRS) were used to evaluate the severity of PSD. The diagnoses of PSD and aphasia were confirmed by a psychiatrist and a speech-language pathologist, respectively. In this open case series, patients (n = 4) received 10 sessions (once a day) of bilateral tDCS to the dorsolateral prefrontal cortex (DLPFC) and two additional sessions after two and four weeks, for a total of 12 sessions. All patients exhibited improvement in depression after tDCS, as indicated by a decrease in SADQ (47.5%) and in ADRS (65.7%). This improvement was maintained four weeks after the treatment. In this preliminary, open-label study conducted in four PSD patients with aphasia, bilateral tDCS over the DLPFC was shown to induce a substantial mood improvement; tDCS was safe and well tolerated by every patient. Stroke patients with aphasia can be safely treated for PSD with tDCS. Sham-controlled studies are necessary to evaluate this technique further.     

Prevalence of insomnia symptoms: results from an urban district in Ankara,Turkey

Objective. Characteristics of insomnia symptoms in Turkey are not well established. The goal of this study was to determine the prevalence of insomnia and related symptoms in an urban district of Turkey. Method. The study was carried out in Ankara, in an urban district with a population of 2665. Out of the 1332 people in the sample, 1034 in the 15–65 age range were included in the study. Interviews were conducted according to the “Sleep Disorders Assessment Questionnaire” developed by the researchers. The Insomnia Severity Index (ISI) was also given to the subjects with a sleep problem to measure the subjective quality and quantity of insomnia symptoms. Results and conclusion. A total of 29.4% of all participants reported a sleep problem, out of which 23.7% defined one or more of the insomnia symptoms which included difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early morning awakening (EMA), non-restorative sleep (NRS) and sleep deprivation (SD). Insomnia risk was found to be significantly increased with age, female sex, smoking and chronic medical illness. A total of 75.9% of participants who reported insomnia symptoms did not seek medical help for their complaint. According to the ISI, among the subjects with insomnia symptoms, 79 (32.2%) had subthreshold insomnia, 43 (17.6%) had clinical insomnia, 12 (4.9%) had severe clinical insomnia, while 88 (35.9%) did not score in the range indicating insomnia. The findings are discussed in the light of previous research and in relation to sociocultural factors emphasizing the need for public education on sleep disorders as medical conditions.