降压治疗对脑卒中二级预防的临床证据

目的综合分析与脑卒中有关的降压治疗大样本随机对照试验,为脑卒中二级预防提供临床证据.方法计算机检索Medline(1966～2003年6月),对已公开发表的大样本随机对照降压治疗预防脑卒中再发的临床试验进行综合分析.分析指标为脑卒中事件、冠心病事件及总死亡率等.结果共纳入脑卒中后抗高血压治疗的随机对照试验(PATS)、多中心培哚普利降压治疗脑卒中/一过性脑缺血发作的随机对照临床试验(PROGRESS)和心脏结局预防评估研究(HOPE)3个试验进行综合分析.结果显示:降压治疗组较安慰剂对照组降低脑卒中再发危险率28%,降低冠心病危险率15%,降低总死亡率11%;降压治疗不仅能降低脑血管病或心血管病高危者伴高血压的脑卒中再发危险,而且对未伴高血压者也能降低其脑卒中危险.结论降压治疗对脑卒中二级预防是有益的.     

肌内注射硬结的临床防治研究

目的预防并治疗臀部肌内注射的硬结形成。方法将100例住院患者随机分为实验组（W型注射法）和对照组（常规肌内注射法）各50例,取右侧臀部注射,比较两组患者注射部位不良反应的发生情况;取同期双侧臀部均有硬结的患者40例,采用自身对照的方法,比较跌打丸外敷与湿热敷治疗硬结的效果。结果实验组与对照组完成观察期例数、接受注射平均天数、注射部位出现局部反应的例数及最初出现局部反应的平均天数,经统计学检验,P值均小于0．01;跌打丸外敷治疗硬结的有效率显著优于湿热敷（P〈0．01）。结论W型注射法可降低肌注硬结形成率,跌打丸外敷是治疗肌注硬结的有效方法。     

The Role of Cognitive-Behavioral Therapy and Fluoxetine in Prevention of Recurrence of Major Depressive Disorder

This study evaluated the role of cognitive-behavioral therapy (CBT) and fluoxetine in preventing recurrence of a depressive episode during maintenance phase treatment for patients with remitted major depressive disorder (MDD). Patients (n = 52) completed open acute fluoxetine treatment and sustained remission during a 28-week randomized continuation treatment (CBT + fluoxetine vs. fluoxetine only). They were assigned to one of four maintenance treatments: CBT + fluoxetine, CBT + placebo, fluoxetine only, and placebo only. There were no statistically significant differences in MDD recurrence between maintenance treatments, but continued antidepressant treatment (with or without CBT) provided an 18–21% lower MDD recurrence rate than placebo. These findings are consistent with those of recent antidepressant studies of chronic and recurrent MDD populations. Although sample sizes were small, CBT did not significantly lower rates of MDD recurrence.     

认知行为疗法与西酞普兰对抑郁症患者局部脑血流的影响

目的探讨认知行为疗法与喜酞普兰对抑郁症患者局部脑血流的影响。方法38例抑郁症患者分为认知行为治疗组18例和西酞普兰药物治疗20例。采用99Tcm-双半胱乙酯局部脑血流灌注单光子发射计算机断层扫描（SPECT）显像结合感兴趣区（ROI）技术,对两组患者治疗前后的局部脑血流变化和汉密尔顿抑郁量表（HAMD）评分进行比较。结果治疗后,两组患者的抑郁症状均有改善,但西酞普兰组早于认知行为治疗组;两种治疗方法均可增加右基底节血流量,认知行为治疗组亦有右边缘系统扣带回后部局部血流量增加,西酞普兰组亦有右颞叶后部局部脑血流量增加。结论两种治疗方法对抑郁症均有效,但改善脑血流的部位不同。     

现代电痉挛治疗精神障碍184例疗效观察

[目的]探讨早期、定期纤支镜支气管肺泡灌洗术预防亚低温治疗患者并发肺部感染或肺不张的价值及安全性.[方法]选取重型颅脑损伤接受亚低温治疗患者108例,随机分为对照组和治疗组,治疗组在对照组常规处理基础上, 行纤维支气管镜下支气管肺泡灌洗,比较两组患者出现肺部感染或肺不张影像学改变的发生情况.[结果]对照组并发肺部感染或肺不张的发生率均高于实验组,且两组相比有显著差异（ P 〈0.01）.[结论]应用纤支镜早期、定期进行支气管肺泡灌洗术,能够显著降低重型颅脑损伤患者亚低温治疗过程中并发肺部感染及肺不张的发生率.     

Lithium Therapy for Bipolar Disorder

The management of bipolar disorder (BD) may be challenging because of the disease state itself. In addition, the maintenance of the drug level of lithium plays a vital role in preventing acute manic or mixed episodes. This article reviews the drug properties of lithium, the current treatment guidelines for BD, and best practices in monitoring lithium therapy, as well as the characteristics and classification of BD.     

Cariprazine in Bipolar Disorder: Clinical Efficacy, Tolerability, and Place in Therapy

Cariprazine is a dopamine D3-preferring D3/D2 receptor partial agonist in late-stage clinical development for the treatment of bipolar disorder (manic/mixed and depressive episodes), as well as for schizophrenia, and as an adjunctive agent for the treatment of major depressive disorder. Three phase 2 or 3, 3-week, randomized controlled trials in bipolar mania or mixed episodes have been completed and reported as poster presentations or in press releases by the manufacturer. Superiority over placebo on the Young Mania Rating Scale total score was evidenced for daily doses of cariprazine 3–12 mg/day. In short-term randomized controlled trials, cariprazine does not appear to adversely impact metabolic variables, prolactin, or the electrocardiogram (ECG) QT interval. The most commonly encountered adverse events in the mania trials were extrapyramidal disorder, akathisia, insomnia, vomiting, restlessness, sedation, vision blurred, and pain in extremity in the phase 2 trial where this was presented in a poster, and akathisia, extrapyramidal disorder, tremor, dyspepsia, vomiting, dizziness, diarrhea, somnolence, restlessness, and pyrexia for the phase 3 trial where this was presented in a poster. With the exception of akathisia and extrapyramidal disorder, the differences in incidence versus placebo for these events were generally small. If approved by regulatory authorities, cariprazine would join aripiprazole as the second dopamine receptor partial agonist antipsychotic available for clinical use in persons with bipolar mania or mixed episodes. Cariprazine differs from aripiprazole in terms of dopamine D3 receptor selectivity. Further studies would be helpful to discern the distinguishing features of cariprazine from other antimanic agents.     

敷脐疗法防治急性心肌梗死患者便秘的临床观察

目的：探讨中药穴位贴敷防治急性心肌梗死患者卧床导致便秘的有效措施。方法：对48例急性心肌梗死患者随机分为对照组和观察组各24例。观察组通过辨证,采用中药散剂调成膏状,敷于神阙穴;对照组常规口服通便药物。5 d为1个疗程。结果：观察组总有效率达96%,对照组总有效率为83%,两组比较差异有显著性（P〈0.01）。结论：中药穴位贴敷治疗急性心肌梗死患者便秘,安全有效,并且弘扬了祖国医学,值得推广。