济川煎临证新用举隅

济川煎源自《景岳全书》。笔者近年运用济川煎治疗有肾阳虚表现的癃闭症及女性尿道综合征患者，疗效满意。现介绍如下：     

抑郁症患者心理治疗的临床研究

目的 通过对照的方法,对抑郁症患者使用单纯抗抑郁药物治疗和药物合并心理治疗的疗效进行比较,探讨心理治疗在抑郁症患者治疗中的作用.方法 选取抑郁症患者120例,随机分成两组.对照组60例,男女各半,年龄18～65岁,平均(38.9±2.53)岁;心理治疗组60例,男女各半,年龄19～67岁,平均(39.7±3.12)岁.两组患者均给予帕罗西汀(商品名赛乐特)20mg/d,对照组单纯用药物治疗,心理治疗组药物加心理治疗,疗程8周.分别于第0周(基线)、干预后第2周、第4周、第8周使用汉密顿抑郁量表(HAMD)和抑郁自评量表(SDS)进行评分.结果 药物合并心理治疗组的治疗效果优于对照组(P＜0.05),且治疗时间越长,两组的疗效差异越明显.结论 心理治疗对抑郁症患者的康复有积极的作用,药物治疗合并心理治疗较单纯药物治疗更有利.     

肝癌患者的临终关怀

肝癌早期不易被发现 ,一旦发现多属晚期 ,患者对突如其来的沉重打击 ,出现绝裂的心理反应。针对其心理反应过程 ,适时进行临终关怀 ,让患者安全渡过其心理适应期 ,以主动的态度去追求最后生活质量。1　临床资料　　我院 2 0 0 1年共收治 7例肝癌患者 ,男 5例 ,女 2例 ,年龄40 70岁 ,平均 5 5岁。他们心理反应处于不同的阶段。其中出现震惊与否认阶段 1例 ,愤怒阶段 1例 ,协议、乞求阶段 2例 ,抑郁及接受阶段 3例。2　临终关怀方法2 .1　根据患者病情及心理承受能力 ,决定是否告诉他 (她 )真实病情　随着病情加重 ,患者会怀疑自己是否患癌症 …     

铁调节蛋白2基因多态性与阿尔茨海默病及血管性痴呆的相关分析

Objective To evaluate the association of 2616c/T polymorphism in iron regulatory protein 2(IRP2)gene with Alzheimer disease(AD)and Vascular dementia(VD).Methods In this study,281 patients with AD,60 with VD,and 285 normal aged were recruited.The 2616C/T polymorphism in IRP2 gene was analyzed by using polymerase chain reaction-restriction fragment length polymorphism.And the cognitive function was assessed with the Mini-Mental State Examination(MMSE).Results (1)No significant difieFences were demonstrated in IRP2 genotype or allele frequencies between AD patients and controls(χ2=2.46,P=0.292;χ2=2.17,P=0.141 respectively).However,when AD patients were stratified by disease severity.the frequency of T allele carriers in the moderate to severe AD patients was 78.0%,significantly higher than that in controls(69.8%;χ2=4.106,P＜0.05).Logistic regression analysis demonstrated that the age-,sex-and ApoE-adiusted OR of modcrate to severe AD patient with T allele was 1.62(95% CI=1.03-2.54).The frequency of T allele carriers or T allele in VD patients was higher than that of controls,but the difference was not statistically significant(P＞0.05).(2)The frequency of tit genotype or T allele in the moderate to severe AD patients was significantly higher than that in mild AD patients(25.8%vs.12.5%,χ2=5.477,P＜0.05;51.9%vs.40.3%,χ2=5.803,P＜0.05 respectively).(3)MMSE scores of the AD patients with TT genotype was significantly lower than ones with CC or CT genotype(P=0.028;P=0.014 respectively).Conclusion The 2616C/T polymorphism in the IRP2 gene is possibly associated with moderate to severe AD.but not associated with VD.And the TT genotype may be a risk factor for cognitive impairment of patients with AD in Chinese Han.     

卒中临床路径实施概述

文章介绍和总结了国外目前卒中临床路径实施的概况，包括临床路径的简介、卒中临床路径的模式、实施效果（优点及存在的问题）以及卒中临床路径的制订。     

利培酮的不良反应

利培酮(risperidone)是一种新型的抗精神病药，大量的双肓对照试验和临床观察表明，其对精神分裂症的阳性、阴性症状的疗效优于传统抗精神病药，对其它精神障碍也有效。随着其在临床上的广泛应用，近年来，有不少作者陆续报道该药的…些副作用，现综述如下。     

乙状窦后入路显微手术切除大型听神经瘤的临床研究

目的 探讨经乙状窦后入路显微镜下切除大型听神经瘤的手术技巧,减少神经损伤和并发症. 方法 采用经乙状窦后入路显微手术切除大型听神经瘤21例,对肿瘤暴露、显微手术技巧、手术中特殊情况及并发症进行分析. 结果肿瘤全切除18例,次全切除3例,面神经功能保留17例,听力保留5例.术中出现心跳短暂停止1例,术后短期并发症4例,无死亡病例.结论 经乙状窦后入路显微镜下的切除大型听神经瘤是安全的手术方法 ,良好的手术技巧、对解剖的熟悉是全切肿瘤、减少神经损伤和并发症的关键.     

铁调节蛋白2基因多态性与阿尔茨海默病及血管性痴呆的相关分析

Objective To evaluate the association of 2616c/T polymorphism in iron regulatory protein 2(IRP2)gene with Alzheimer disease(AD)and Vascular dementia(VD).Methods In this study,281 patients with AD,60 with VD,and 285 normal aged were recruited.The 2616C/T polymorphism in IRP2 gene was analyzed by using polymerase chain reaction-restriction fragment length polymorphism.And the cognitive function was assessed with the Mini-Mental State Examination(MMSE).Results (1)No significant difieFences were demonstrated in IRP2 genotype or allele frequencies between AD patients and controls(χ2=2.46,P=0.292;χ2=2.17,P=0.141 respectively).However,when AD patients were stratified by disease severity.the frequency of T allele carriers in the moderate to severe AD patients was 78.0%,significantly higher than that in controls(69.8%;χ2=4.106,P＜0.05).Logistic regression analysis demonstrated that the age-,sex-and ApoE-adiusted OR of modcrate to severe AD patient with T allele was 1.62(95% CI=1.03-2.54).The frequency of T allele carriers or T allele in VD patients was higher than that of controls,but the difference was not statistically significant(P＞0.05).(2)The frequency of tit genotype or T allele in the moderate to severe AD patients was significantly higher than that in mild AD patients(25.8%vs.12.5%,χ2=5.477,P＜0.05;51.9%vs.40.3%,χ2=5.803,P＜0.05 respectively).(3)MMSE scores of the AD patients with TT genotype was significantly lower than ones with CC or CT genotype(P=0.028;P=0.014 respectively).Conclusion The 2616C/T polymorphism in the IRP2 gene is possibly associated with moderate to severe AD.but not associated with VD.And the TT genotype may be a risk factor for cognitive impairment of patients with AD in Chinese Han.     

新生儿多脏器畸形1例

患儿，女，1天，该新生儿系第一胎第一产，孕34^ 2周早产。出生即时Apgar评分2分(心率82次／分、呼吸浅表、哭声弱各得1分)。经新法复苏，5分钟5分，10分钟、20分钟分别为8分及9分后转入新生儿监护病房。其母孕早期无感冒、发热史，无服药史，无有害物质接触史，无阴道流血史。孕24^ 3周开始，定期产检6次，孕32周后宫高线高于正常范围，     

米氮平与多虑平治疗脑卒中后抑郁对照研究

米氮平 (Mirtazapine ,商品名瑞美隆 ,南京欧加农制药有限公司 )作为第一个去甲肾上腺素能和特异性五羟色胺能抗抑郁药 (NaSSA) [1] ,其抗抑郁效果好 ,不良反应少[2 ] 。关于其对脑卒中后抑郁的治疗情况 ,作者尚未见国内有所报道。为此 ,我们进行了米氮平与传统三环类抗抑郁药 (多虑平 )治疗脑卒中后抑郁的对照研究 ,结果报告如下。对象与方法一、对象1.入组标准 :住院患者 ,性别不限 ;符合CCMD 2 R“脑卒中后抑郁”诊断标准 ;Hamilton抑郁量表 (HAMD)评定 17分以上 ;均为脑出血或脑梗死 ,CT结果阳性 ;意识清楚 ,检查合作 ;病期大于…