米氮平治疗功能性消化不良伴发抑郁的临床研究

目的 探讨米氮平治疗功能性消化不良(functional dyspepsia,FD)伴发抑郁的疗效. 方法 将伴发抑郁障碍的81例FD患者随机分为治疗组(n=41)和对照组(n=40).对照组常规治疗,应用H2受体拮抗剂雷尼替丁和胃肠促动力剂莫沙比利.治疗组在常规治疗的基础上,加用具有双重作用的抗抑郁药米氮平(每片30mg)每晚1片.两组患者均接受相似的心理治疗,疗程8周. 结果 在常规药物治疗的基础上,加用米氮平,SDS积分和FD积分在第二周即有明显下降.并持续至治疗结束,有显著统计学意义(p<0.05.p<0.01).而对照组至治疗弟8周后,虽FD积分也有一定程度下降,但并无统计学显著差异. 结论 功能性消化不良伴发抑郁障碍在心理治疗及应用H2受体拮抗剂和胃肠促动力剂的基础上,加用抗抑郁药米氮平,取得了显著疗效,且副作用少.     

针刺治疗卒中后抑郁状态40例

卒中后抑郁 (PSD)是脑血管疾病常见的并发症之一。国外有关文献报道 ,PSD发生率从 2 0 %～ 79%不等 ,但多在 4 0 %～ 5 0 %。国内有研究报道 ,近四成脑卒中患者伴有程度不同的抑郁。临床上以抑郁、焦虑不宁、悲观失望、思维迟钝为主要症状 ,严重影响患者及家人的生活 ,为社会带来巨大负担。而最新统计表明 ,初次卒中后出现抑郁的患者容易诱发第 2次卒中 ,发病率为 30 %～ 5 0 %。目前临床治疗多以心理治疗和采用三环类抗抑郁药为主。口服抗抑郁药副作用大 ,脑血管患者难以接受。笔者从 1999年— 2 0 0 2年 ,用针刺系统治疗观察 4 0例 ,疗…     

30例难治性胃肠道疾病的心理状况分析

目的:探讨心理社会因素与难治性胃肠道疾病的关系及抗抑郁药和心理治疗对其疗效.方法:分别对30例健康正常人和难治性胃肠道疾病的患者进行症状自评量表(SCL-90)调查;再用抗抑郁药配合心理治疗,治疗8周后再进行上述量表的评定.结果:难治性胃肠道疾病患者的SCL-90各因子分除精神病性因子分与对照组差异不显著外,其余方面均明显高于正常对照组(P＜0.01);病人接受抗抑郁药物和心理治疗8周后,前后评分对比,患者精神和躯体症状均有明显改善.结论:难治性胃肠道疾病与心理因素有关,用抗抑郁药和心理治疗能改善病人的症状.     

抑郁症的长期治疗

1 问题提出在临床工作中,抑郁症的治疗相比于精神分裂症要容易,手段似乎也更多一些,各种机制的抗抑郁药、电休克(ECT)、短程心理治疗、药物治疗结合心理治疗等等。仅在药物治疗方面,随着抗抑郁药的推陈出新,临床医生在治疗方案的选择上就有了更多的自由度。但是,临床工作中还有许多问题需要临床医生去解决,抑郁症需不需要长期治疗?治疗到底维持多长时间?如何让抑郁病人有较好的治疗依从性?等等,本文重点探讨如何处理抑郁症的长期治     

冠心病介入治疗后伴发抑郁症的临床特点、治疗及预后

目的 探讨冠心病经皮冠状动脉介入（PCI）术后伴发抑郁症的临床特点、治疗及预后. 方法 冠心病PCI术后213例患者,其中62例伴发抑郁症,从年龄、性别、文化程度、居住地、经济收入等临床特点及其常见的精神心理原因等方面作分析.将62例患者回顾性分成两组：综合治疗（药物＋心理治疗）组31例,对照组（心理治疗组）31例.比较两组治疗后在抑郁评分、生存总质量、再住院率及主要心血管不良事件（MACE）发生率的变化. 结果 冠心病PCI术后伴发抑郁症,以文化程度越低、家庭经济条件越差（占46.2％）、病情越严重（心肌梗死占72.6％;二支、三支血管病变占79.0％）的患者居多.导致抑郁症的原因是多方面的,其中经济条件困难、负担过重（67.7％）、劳动力下降,无力担当家庭主力（51.6％）、担心冠心病再发（87.1％）是其主要原因.冠心病PCI术后伴发抑郁症的患者经药物和心理治疗后,患者抑郁评分、再住院率及MACE发生率下降,生存质量总分增高.综合治疗组效果优于对照组. 结论 冠心病患者PCI术后伴发抑郁症严重影响其短期和远期预后,加强药物和心理治疗（“双心治疗”）尤为必要.     

老年抑郁症门诊心理治疗的疗效观察

目的观察心理治疗在门诊老年抑郁症治疗中的作用。方法将60例来自在门诊接受治疗的老年抑郁症患者,随机分为两组,其中30例采用单纯抗抑郁药物氟西汀治疗,作为对照组;其余30例采用抗抑郁药物氟西汀合并心理治疗,作为研究组。采用汉密尔顿抑郁量表（HAMD）分别于治疗前及治疗后2,4,6,8周评定疗效;用副反应量表（TESS）评定不良反应。结果两组疗效显著,副反应轻微,但研究组较对照组起效快,依从性好。结论在门诊抗抑郁药物治疗老年抑郁症的同时,应注重配合心理治疗。     

稳定型心绞痛伴抑郁症48例治疗体会

目的:通过对稳定型心绞痛并抑郁症患者常规抗心绞痛药物及心理治疗,探讨"双心"治疗(基础心脏病治疗加心理干预、抗抑郁药物治疗)对冠心病的治疗效果。方法:将48例稳定型心绞痛合并抑郁症患者随机分为两组,A组常规抗心绞痛药物治疗;B组在常规药物治疗基础上加以心理干预及抗抑郁药物治疗。结果:常规治疗组显效6例,有效8例;常规治疗组加心理治疗组显效11例,有效12例,两组比较,差异有统计学意义(P<0.05)。结论:稳定型心绞痛合并抑郁症患者,"双心"治疗(基础心脏病治疗加心理治疗),明显改善临床症状,不良反应无明显增加。     

30例难治性胃肠道疾病的心理状态分析

目的：探讨心理社会因素与难治性胃肠道疾病的关系及抗抑郁药和心理治疗对其疗效。方法：分别对30例健康正常人和难治性胃肠道疾病的患者进行症状自评量表（SCL－90）调查；再用抗抑郁药配合心理治疗，治疗8周后再进行上述量表的评定。结果：难治性胃肠道疾病患者的SCL－90各因子分除精神病性因子分与对照组差异不显著外，其余文献均明显高于正常对照组（P＜0．01），病人接受抗郁药物和心理治疗8周后，前后评分对比，患者精神和躯体症状均有明显改善。结论：难治性胃肠道疾病与心理因素有关，用抗抑郁药和心理治疗能改善病人的症状。     

48例癫痫伴发抑郁和焦虑患者的临床分析

为探讨癫痫患者伴发抑郁/焦虑的发生情况及治疗对策.采用抑郁自评量表/焦虑自评量表(SDS/SAS)对48例癫痫患者进行评定及临床分析,同时选择50例健康人员作为对照组;结果,癫痫组与对照组抑郁/焦虑的发生率差异有统计学意义(X~2=29.399,JP<0.01).癫痫病程≥5年和<5年者抑郁/焦虑伴发率差异有统计学意义(X~2=6.09.P<0.05).癫痫患者中不同程度的伴发有抑郁/焦虑症状,心理治疗很必要,是提高癫痫患者生活质量的有效途径.     

新型抗抑郁药物的一些临床应用问题

1　新型抗抑郁药物的种类新型抗抑郁药物有四种类型 :选择性 5 -羟色胺 (5 -HT)再摄取抑制剂 (SSRIs,如氟西汀、帕罗西汀、色去林 ) ,可逆性单胺氧化酶抑制剂 A(如吗氯贝胺 ) ,选择性5 - HT-去甲肾上腺素再摄取抑制剂 (如万拉法新 ) ,以及5 - HT2 受体激活剂 (如脱尔凡 )。新型抗抑郁药物不同于三环类抗抑郁药物 (TCAs) ,不同于非选择性不可逆性单胺氧化酶抑制剂 (MAOIs) ,不同于四环类抗抑郁药物。2　适应症对于轻性抑郁症心理治疗与药物治疗一样有效 ,对于中度抑郁症药物治疗效果较好 ,对于重性抑郁症电抽搐治疗 (ECT)是最为有效…     

Kawasaki disease in an infant after administration of hexavalent vaccine

Kawasaki disease is a vascular disorder of unknown etiology that affects children. Kawasaki disease mainly involves medium-sized blood vessels and may cause cardiovascular complications, particularly coronary artery aneurysms. Concern has been raised against various types of vaccines becoming potential risk factors for Kawasaki disease. Here, we describe a case of a 4-month-old Saudi infant who presented with incomplete Kawasaki disease a few hours after receiving his hexavalent vaccine and there was a significant dilatation of all coronary arteries. Although a relationship between vaccinations and Kawasaki disease has been suggested, there is no strong evidence of an increased risk or causal association. This possibility of adverse effects is rare but should be observed and further investigated.     

基于痰、瘀角度论血脂异常的中医治疗策略

基于痰、瘀角度,结合现代医学研究成果,阐述血脂异常的病因病机,并重点从痰瘀辨证论治、辨病论治等论述血脂异常的中医治疗策略。近年来体质与疾病之间关系研究受到重视,认为痰瘀体质与血脂异常密切相关,因此在血脂异常治疗中应注重配合痰瘀体质调理。     

肠道菌群与女性生殖疾病的关系研究进展

肠道菌群的形成和增殖始于出生,其组成的改变主要取决于遗传、营养和环境因素。人体肠道内定植着千余种细菌,有高度的多样化。随着高通量测序技术、生物信息学和培养组学的发展,使得研究者能够更深入地探索微生物群的组成及其功能,肠道菌群与人体疾病之间的相关性研究蓬勃开展。肠道菌群在人体的生理、代谢、营养和免疫功能中都起着重要的作用,肠道菌群与宿主之间的微妙平衡影响不同疾病的发展。越来越多的研究聚焦于肠道菌群改变与女性生殖疾病的关联。从动物模型研究到人体研究,目前已有多项研究结果表明肠道菌群整体多样性的改变、特定细菌丰度的变化以及菌群比例的失衡与女性生殖疾病密切相关,如多囊卵巢综合征、子宫内膜异位症、妊娠并发症和不良妊娠结局,但目前对其机制的研究还很有限。以特定肠道菌群或其代谢物为靶点,在女性生殖相关疾病的诊断和治疗的临床研究中已初步展露效果。未来需要进一步地开展机制研究明确肠道菌群与女性生殖相关疾病的因果关系,以及设计更为严谨的临床试验明确有效治疗的标准,为肠道菌群在疾病预防、诊断和治疗中的应用提供更多依据。本文拟对肠道菌群与多囊卵巢综合征、子宫内膜异位症以及复发性流产的关系研究进展进行综述。     

Atrial fibrillation and hyperthyroidism: a new look at their relationship and therapy with lidoflazine

Various kinds of dysrhythmias are found in association with hyperthyroidism but especially atrial fibrillation. The causal relationship of chronic atrial fibrillation and the endocrine disorder is controversial, as is its therapeutic management. Six patients with this particular combination of disorders were treated with lidoflazine: a new anti-anginal drug with anti-arrhythmic activity. All six patients returned to sinus rhythm on lidoflazine treatment although still hyperthyroid and remained in sinus rhythm during the follow up period ranging from 5 to 14 months. This occurred independently of antithyroid treatment. Some evidence is put forward that dysrhythmias and most commonly chronic atrial fibrillation are triggered off by hyperthyroidism or other disorders but that they are maintained by permanent cardiac damage due to arteriosclerosis, hypertension, coronary heart disease or rheumatic valve disease.     

阻塞性睡眠呼吸暂停低通气综合征与胃食管反流病

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)与胃食管反流病(GERD)是两种性质不同的疾病,两者之间存在潜在联系。有观点认为OSAHS可能引起GERD,GERD又可能引起OSAHS,两者互为因果关系;另有观点认为OSAHS与GERD之间无因果关系,只是因存在一些共同发病的危险因素而相互伴随。OSAHS与GERD之间是因果还是伴随关系仍不清楚。两者之间关系的进一步研究有助于正确地指导临床诊断与治疗。     

Causal authorship and the equality principle: a defence of the acts/omissions distinction in euthanasia

This paper defends the acts/omissions distinction which underpins the present law on euthanasia, from various criticisms (including from within the judiciary itself), and aims to show that it is supported by fundamental principles. After rejecting arguments that deny the coherence and/or legal relevance of the distinction, the discussion proceeds to focus on the causal relationship between the doctor and the patient's death in each case. Although previous analyses, challenging the causal efficacy of omissions generally, are shown to be deficient, it is argued that in certain cases of causing death by omission the causal authorship of the doctor lapses. The final part of the paper examines why this should be morally significant and proposes an answer in terms of the principle of equality. Assuming all other factors are equal, the infringement of this principle provides an additional reason against actively killing a patient, which is not present in cases of passively letting die.     

Causal authorship and the equality principle: a defence of the acts/omissions distinction in euthanasia

This paper defends the acts/omissions distinction which underpins the present law on euthanasia, from various criticisms (including from within the judiciary itself), and aims to show that it is supported by fundamental principles. After rejecting arguments that deny the coherence and/or legal relevance of the distinction, the discussion proceeds to focus on the causal relationship between the doctor and the patient's death in each case. Although previous analyses, challenging the causal efficacy of omissions generally, are shown to be deficient, it is argued that in certain cases of causing death by omission the causal authorship of the doctor lapses. The final part of the paper examines why this should be morally significant and proposes an answer in terms of the principle of equality. Assuming all other factors are equal, the infringement of this principle provides an additional reason against actively killing a patient, which is not present in cases of passively letting die.     

偏头痛与卵圆孔未闭的研究进展

偏头痛是临床常见的慢性致残性的神经系统疾病,超过半数的患者会因为偏头痛的发作而影响正常生活。近年来,大量研究表明偏头痛与卵圆孔未闭之间存在着一定的联系,但因为卵圆孔未闭发病率较高且引发偏头痛发作的病理机制不明,两者之间的因果关系尚存争议,经皮卵圆孔封堵术是否为治疗卵圆孔未闭合并偏头痛的有效治疗手段亦成为研究热点。该文将围绕卵圆孔未闭与偏头痛的相关性、两者间可能存在的发病机制以及封堵术治疗偏头痛的疗效展开综述。     

Prevention of coronary heart disease: the role of high density lipoproteins.

There is now strong evidence that the risk of developing clinical coronary heart disease (CHD) in apparently healthy middle-aged men is inversely related to the plasma high density lipoprotein (HDL) cholesterol concentration. This reflects an underlying relationship between HDL cholesterol concentration and the severity of coronary atherosclerosis. This new information represents a significant development in atherosclerosis research. In the author''s opinion, however, it is not yet justifiable, or indeed possible, to utilize this knowledge in CHD prevention programmes for 3 reasons. Firstly, there is still little prospective information on HDL and CHD in women, in younger subjects and in patients with existing clinical disease. Secondly, although there are at least 2 working hypotheses, a causal relationship between HDL metabolism and atherogenesis has not yet been established. Thirdly, there is still a relative paucity of information on the environmental determinants of HDL concentration and metabolism. Thus, premature attempts at intervention in an uncontrolled manner, and particularly the use of drugs for an HDL-raising effect, might only confuse the issue. While further research is being undertaken, attention should continue to be directed towards other reversible coronary risk factors (including hypercholesterolaemia, hypertension, and cigarette smoking) in CHD prevention programmes.     

热毒理论与心病关系源流探析

以热毒理论指导冠心病辨证治疗,在近年临床取得较好疗效。本文尝试梳理热毒理论与心病关系的源流,以期探索热毒与心病之间的内在关系,为心病的临床治疗提供依据和思路。以"热毒""心痛"为主线对历代相关文献进行搜索梳理。"热毒"在《黄帝内经》中作为病因首次被提出,而"心痛"作为病名则早在马王堆汉墓出土的《足臂十一脉灸经》中已被提到,"热毒"与"心痛"的联系自春秋战国时期即被提出,历经各代发展,成熟于明清。本文依年代梳理历代医家对"热毒"与"心病"关系的认识,以及对其症状、病因病机及治法方药理论的探索过程。现代关于心系疾病病因病机理论的研究是对古代认识的延伸与阐发,热毒与心病关系的源流发展,可为现代心系疾病的研究提供参考。