心血管内科患者的合理用药及用药安全的探讨

目的：探讨该院心血管内科患者的合理用药及用药安全问题，为合理治疗提供依据。方法对2010年9月至2013年9月期间该院心血管内科收治的83例高血压患者，使用自行设计的调查问卷进行患者的用药情况及用药依从性进行调查，并对临床用药中出现的问题进行分析。结果（1）降压治疗方案中使用较多的是钙通道阻断剂（CCB）和血管紧张素转换酶抑制剂（ACEI）。（2）病程小于10年的患者用药依从率（22．2％）明显低于病程大于或等于10年的患者（35．7％），差异具有统计学意义（ P＜0．05）。（3）抗菌药物应用不合理所占比例最大，达到38．5％，联合应用不合理达到30．1％。结论该院心内科高血压患者临床用药中出现的问题主要是抗菌药物使用不合理及配伍不合理等，应积极总结经验，构建合理安全的治疗方案以提高药效。     

臭氧大自血疗法治疗带状疱疹的临床观察

带状疱疹后遗神经痛（postherpeticneuralgia，PHN）是带状疱疹（herpeszoster，HZ）最常见的并发症之一，临床多发于中老年患者，60岁以上老年患者PHN的发病率可高达50％～70％，PHN的发生与患者的年龄、疱疹严重程度、伴发疾病、细胞及体液免疫反应以及患者心理状态等因素有关，目前除早期积极有效的治疗带状疱疹外尚无满意的方法可以预防PHN的发生。HZ的治疗除了早期正规地抗病毒、激素、免疫增强剂和镇痛治疗外，近年来应用于临床的臭氧大自血疗法为我们提供了一种新的选择。我们将臭氧大自血疗法用于HZ的治疗，取得了较好的疗效。现报道如下。     

老年2型糖尿病患者发生低血糖的原因分析

目的：分析老年2型糖尿病患者发生低血糖的原因。方法回顾2010年3月至2011年3月于我院就诊的102例老年2型糖尿病患者的临床资料,对患者发生低血糖时的临床症状、治疗方案、低血糖发生时间、相关因素等进行分析。结果老年2型糖尿病患者发生低血糖时的临床症状以饥饿、心悸、乏力、出汗等交感神经兴奋表现（50％）和无症状低血糖（22.6％）比例为主。治疗方案中以注射胰岛素组低血糖发生率比例高（53.9％）;以凌晨2-6点多见（53.9％）;强化胰岛素治疗和进餐与用药时间差错是影响低血糖发生的相关因素。结论了解老年2型糖尿病患者发生低血糖的原因,针对性地提出护理对策,有利于降低老年2型糖尿病患者低血糖发生率。     

加巴喷丁治疗带状疱疹后神经痛的疗效

目的观察加巴喷丁治疗带状疱疹后神经痛（PHN）的临床疗效和安全性。方法将84例PHN患者按入院的先后顺序分为2组：治疗组（加巴喷丁组,43例）和对照组（卡马西平组,41例）。治疗组采用加巴喷丁胶囊治疗,对照组采用卡马西平片治疗。观察2组治疗前,治疗后7、14、21和28dVAS评分、24h睡眠时间、临床疗效及不良反应的情况。结果治疗组总有效率明显高于对照组（97．7％比65．9％,P〈0．05）。治疗组治疗后7、14、21和28dVAS得分均较对照组明显下降（均P〈0．05）,而睡眠时间均较对照组增加（均P〈0．05）。治疗组出现嗜睡4例,眩晕3例,乏力2例,厌食3例;对照组出现嗜睡4例,眩晕4例,乏力3例,厌食2例。结论加巴喷丁治疗PHN疗效确切,不良反应少,有利于改善患者的睡眠质量及生活质量。     

中药祛痛汤结合多虑平治疗带状疱疹后遗神经痛疗效观察

目的：探讨中药祛痛汤结合多虑平治疗带状疱疹后遗神经痛（PHN）的临床效果。方法选择自2011年9月以来接诊的PHN患者90例,分为试验组和对照组,每组各45例。对照组患者采取常规西药治疗,肌肉注射维生素B1和B12以及多虑平;试验组在对照组的基础上再加上口服中药祛痛汤治疗。每个疗程10d,治疗持续3个疗程。治疗结束后立即采用视觉模拟评分法（VAS）对患者疼痛进行评分,比较两组治疗效果。结果试验组综合疗效评定为痊愈12例,显效18例,好转11例,无效4例,总有效率达到91．1％;对照组综合疗效评定为痊愈8例,显效14例,好转13例,无效10例,总有效率达到77．8％,两组有效率相比差异有统计学意义（P＜0．05）;两组患者不良反应比较差异无统计学意义（P＞0．05）。结论中药祛痛汤结合多虑平治疗PHN的效果明显,无明显不良反应,是PHN较佳的治疗选择之一,值得在临床上进一步推广。     

急性带状疱疹伴神经痛两种疗法效果比较

目的：比较两种治疗方法对疱疹消退期、镇痛效果以及发生后遗神经痛（PHN）的影响情况。方法：将60例急性带状疱疹（AHZ）伴神经痛病人随机分为两组，每组30例。I组接受抗病毒药等传统疗法，Ⅱ组采用抗病毒药及神经阻滞疗法。治疗后记录疱疹消退期、镇痛效果以及PHN情况。结果：I组疱疹消退时间为（16．1&;#177;3.7)d，Ⅱ组为（12．9&;#177;6．9)d，相差显著（P＜0．05）；I组止痛优良率27％，Ⅱ组为97％，相差非常显著（P＜0．01）；I组PHN3例，Ⅱ组为1例（仅上1／2病区），相差不显著。结论：Ⅱ组的治疗方法缩短了带状疱疹消退期，更为重要的是及时、有效地控制了神经痛，明显减轻了患者的痛苦,对预防PHN显示了良好的作用。     

复方甘草酸苷片治疗带状疱疹后遗神经痛的疗效

带状疱疹后遗神经痛（PHN）是指带状疱疹皮损消退后,受累区皮肤疼痛持续3个月以上,因其发生率高（9％～13％带状疱疹患者可出现PHN,60岁以上老年患者PHN发病率高达50％～70％,持续时间长（可达3．5年）,迄今仍有50％的PHN未得到合理、有效的治疗,     

类风湿因子及Anti-CCP与患者临床免疫学特征的关系分析

目的：探讨类风湿因子（RF）、抗环状瓜氨酸肽抗体（Anti-CCP）与患者临床免疫学特征之间存在的相关性。方法选取2012年5月至2014年7月在该院门诊就诊及住院的178例类风湿关节炎患者作为研究对象,并对患者的 RF、Anti-CCP 两项指标进行检测。结果患者中 RF 呈现阳性的比例为94.94％（169／178）,Anti-CCP 呈现阳性的比例为79.78％（142／178）;病程超过1年患者占73.03％（130／178）,类风湿关节炎患者的病程与 Anti-CCP 抗体现阳性率呈相关（P ＜0.05）,与 RF 阳性率不存在相关性（P ＞0.05）。结论类风湿因子特异性较弱,抗环状瓜氨酸肽抗体（Anti-CCP）特异性突出,对早期诊断和临床治疗中发挥着极大的作用和价值,并和类风湿关节炎患者病情的严重性存在正相关关系。     

我院住院患者抗菌药物使用情况调查分析

目的了解住院患者抗菌药物临床使用情况及存在的问题。方法对我院2010年随机抽取的住院手术病例400例及非手术病例400例抗菌药物的用药频度（DDDs）和费用情况进行调查分析。结果我院2010年DDDs排序前三位的抗菌药物为左氧氟沙星、哌拉西林钠-舒巴坦钠和奥硝唑注射液;预防用药〉72h的病例占84．00％。非手术的400例中使用抗菌药物者128例（32．00％）：治疗性用药92例（71．88％）,预防性用药36例（28．12％）;单用一种抗菌药物94例（73．44％）,二联用药34例（26．56％）,无三联及以上用药。手术的400例中324例（81．00％）为预防性用药;术前使用抗菌药物12例（3．00％）、术后24h内停用6例（1．50％）,术后〉24—48h用药13例（3．25％）,〉48—72h用药45例（11．25％）,〉72h用药336例（84．00％）。400例手术患者中I类切口无联合用药情况,Ⅱ类切口联合用药113例（42．64％）。结论住院患者抗菌药物使用情况存在细菌培养送检率较低、手术患者预防用药时间长、抗菌药物选择不当等问题,应加强与规范临床合理用药。     

不同初始剂量加巴喷丁联合神经阻滞治疗带状疱疹后神经痛的比较

加巴喷丁（gabapentin,1-氨基甲基-环已烷乙酸）先后在英美等国作为癫痫病的治疗药物上市,后来还发现其在糖尿病性神经痛、带状疱疹后神经痛（PHN）等其他的神经病理性疼痛也有独特效果。加巴喷丁对PHN患者同样有效,即使长期服用,也较为安全。本文通过初始常规剂量与初始小剂量的加巴喷丁联合神经阻滞治疗PHN,在疗效、不良反应以及患者依从性方面作比较,旨在探讨加巴喷的初始合适剂量,以进一步指导临床治疗PHN合理用药。     

The role of sympathetic nerve blocks in herpes zoster and postherpetic neuralgia

The most common complication of herpes zoster in immunocompetent patients is postherpetic neuralgia (PHN). Sympathetic blocks have been traditionally used for patients with herpes zoster and PHN with three different therapeutic goals: pain relief during acute herpes zoster, pain relief during PHN, and prevention of PHN by treating patients with acute zoster. The role of sympathetic blocks in herpes zoster and PHN remains controversial due to methodologic shortcomings in published studies and the limited current understanding of the role of the sympathetic nervous system in mediating pain. Current theories of the pathophysiology of PHN, the role of the sympathetic nervous system in herpes zoster and PHN, and published studies investigating use of sympathetic nerve blocks in herpes zoster and PHN are reviewed.     

超激光疼痛治疗仪照射治疗带状疱疹性神经痛的临床研究

应用超激光疼痛治疗仪（Ｓｕｐｅｒ Ｌｉｚｅｒ ＨＡ－５５０，简称ＳＬ）治疗带状疱疹性神经痛病人７０例，其中带状疱疹（ＨＺ）５２例，带状疱疹后神经痛（ＰＨＮ）１８例。疗效以视觉模拟评分法（ＶＡＳ）评价。全组总有效率达８８．６％，疗效与病程有关，而与患者年龄无关。病程≤３个月组显效率明显优于〉３个月组（Ｐ〈０．０１），ＨＺ急性期应用Ｓｕｐｅｒ Ｌｉｚｅｒ照射不仅镇痛效果良好（总有效率９４．２％），而且     

带状疱疹后神经痛患者疼痛护理研究进展

带状疱疹后神经痛是带状疱疹最常见的并发症,严重影响患者生活质量.本文从带状疱疹后神经痛的概述、临床表现、疼痛评估工具和疼痛护理的研究进展进行综述,以期为临床更有效地帮助带状疱疹后神经痛患者缓解疼痛、提高生活质量提供借鉴和参考.     

Herpes zoster in older adults. (Duke University Medical Center, Durham, NC) Clinical Infectious Diseases. 2001;32:1481–1486.

Herpes zoster (HZ) strikes millions of older adults annually worldwide and disables a substantial number of them via postherpetic neuralgia (PHN). Key aged‐related clinical, epidemiological, and treatment features of zoster and PHN are reviewed in this article. HZ is caused by renewed replication and spread of the varicella‐zoster virus (VZV) in sensory ganglia and afferent peripheral nerves in the setting of age‐related, disease‐related, and drug‐related decline in cellular immunity to VZV. VZV‐induced neuronal destruction and inflammation causes the principal problems of pain, interference with activities in daily living, and reduced quality of life in elderly patients. Recently, attempts to reduce or eliminate HZ pain have been bolstered by the findings of clinical trials that antiviral agents and corticosteroids are effective treatment for HZ and that tricyclic antidepressants, topical lidocaine, gabapentin, and opiates are effective treatment for PHN. Although these advances have helped, PHN remains a difficult condition to prevent and treat in many elderly patients. Comment by Miles Day, M.D. This article reviews the epidemiology clinical features diagnosis and treatment of acute herpes zoster. It also describes the treatment of postherpetic neuralgia. While this is a good review for the primary care physician, the discussion for the treatment for both acute herpes zoster and postherpetic neuralgia do not mention invasive therapy. It is well documented in pain literature that sympathetic blocks with local anesthetic and steroid as well as subcutaneous infiltration of active zoster lesions not only facilitate the healing of acute herpes zoster but also prevents or helps decrease the incidence of postherpetic neuralgia. All patients who present to the primary care physician with acute herpes zoster should have an immediate referral to a pain management physician for invasive therapy. The treatment of postherpetic neuralgia is a challenging experience both for the patient and the physician. While the treatments that have been discussed in this article are important, other treatments are also available. Regional nerve blocks including intercostal nerve blocks, root sleeve injections, and sympathetic blocks have been used in the past to treat postherpetic neuralgia. If these blocks are helpful, one can proceed with doing crynourlysis of the affected nerves or also radio‐frequency lesioning. Spinal cord stimulation has also been used for those patients who are refractory to noninvasive and invasive therapy. While intrathecal methylprednisolone was shown to be effective in the study quoted in this article one must be cautious not to do multiple intrathecal steroid injections in these patients. Multilple intrathecal steroid injections can lead to archnoiditis secondary to the accumulation of the steroid on the nerve roots and in turn causing worsening pain.     

The human histocompatibility leukocyte antigen (HLA) haplotype is associated with the onset of postherpetic neuralgia after herpes zoster

In some herpes zoster patients, pain persists for more than 3 months or more after healing of vesicular eruptions; this condition is termed postherpetic neuralgia (PHN). We have recently reported the association of the human histocompatibility leukocyte antigens (HLA) haplotype, HLA-A*3303-B*4403-DRB1*1302 with PHN patients; however, it has not been determined whether the haplotype is also associated with herpes zoster that did not develop subsequent PHN. To distinguish whether the haplotype is associated with herpes zoster or the development of PHN, we examined if herpes zoster patients without subsequently PHN are also associated with the HLA haplotype or not. Herpes zoster patients were followed up for more than 6 months, and HLA alleles and haplotypes were compared among the PHN patients (n = 52) the herpes zoster patients who did not develop PHN (n = 42) and healthy controls (n = 125). The frequencies of the risk haplotype in the PHN patients, in the healthy controls and in the herpes zoster patients without subsequent PHN were 16.3, 5.2 and 4.8%, respectively. While the frequency of the risk haplotype was significantly higher in the PHN patients than in the healthy controls (P = 0.0006) no difference was observed between the herpes zoster patients without subsequent PHN and the healthy controls. No significant association was found between the duration of symptoms or the site of herpes zoster and the HLA alleles and the haplotype. These results suggest that the HLA-A*3303-B*4403-DRB1*1302 haplotype plays an important role in the development of PHN after herpes zoster, but not in the onset of herpes zoster.     

Herpes zoster and postherpetic neuralgia: prevention and management

The recognizable appearance and the dermatomal distribution of herpes zoster lesions usually enable a clinical diagnosis to be made easily. Herpes zoster and postherpetic neuralgia occur mainly in older patients. The role of the varicella vaccine in preventing herpes zoster is uncertain, but is being studied. There is evidence to support using antiviral therapy and possibly low-dose tricyclic antidepressants to prevent postherpetic neuralgia. There is good evidence that treating herpes zoster with antiviral medication is beneficial, particularly in patients older than 50 years with severe outbreaks. The use of steroids has an unfavorable risk-benefit ratio. In patients who develop postherpetic neuralgia, there is good evidence to support treatment with gabapentin and tricyclic antidepressants. More evidence for treatment with capsaicin cream, lidocaine patch, and opioids is needed. Intrathecal methylprednisolone is an option for patients with persistent pain.     

Neuralgia and zovirax treatment of patients with herpes zoster

AIM: To estimate the occurrence of postherpetic neuralgia (PHN) arising after acute period of herpes zoster (HZ) and determination of zovirax efficiency in PHN prevention. MATERIALS AND METHODS: Of a total of 102 patients with HZ aged 17-89 years, 20 patients aged 26-83 years were given zovirax. RESULTS: Acute pain syndrome in PHN was observed in more that one-third of HZ patients. Patients over 60 years of age were more predisposed to PHN. Zovirax reduced the duration of acute rash and its healing, decreased the number of patients with zoster-associated pain and PHN patients. CONCLUSION: Zovirax is effective and safe in preventing PHN in HZ patients.     

躯干部带状疱疹急慢性期脑功能低频振荡幅度观察

目的:利用功能性磁共振技术比较躯干部带状疱疹患者2个时期的低频振荡幅度,通过图像化方式描述不同时期带状疱疹患者大脑神经功能活动的情况。方法:将符合条件的6名带状疱疹患者在不同阶段分别给予功能磁共振扫描,扫描后通过统计软件处理分析得到低频振幅(ALFF)数据统计结果,将对比结果通过软件图像化。然后对两者统计学差异部分进行分析。结果:对比慢性期与带状疱疹后神经痛期的ALFF结果,前者较后者数值升高的区域有:左前扣带回、双侧侧脑岛、双侧小脑、左梭状回。结论:前扣带回、脑岛、小脑、梭状回等部位在躯干部位的带状疱疹后神经痛的机制中起重要作用。     

Psychosocial Risk Factors for Postherpetic Neuralgia: A Prospective Study of Patients With Herpes Zoster

The results of previous studies using retrospective methods or small samples have suggested that there may be psychosocial risk factors for postherpetic neuralgia (PHN). We conducted a prospective study in which 110 patients with herpes zoster were assessed within the first month after rash onset with measures of acute pain and five broad domains of psychosocial functioning-physical, role, social, and emotional functioning, and stress and social support. Twenty of the 102 patients with follow-up data were diagnosed with PHN, defined as pain that had persisted for 4 months after rash onset. Measures of role functioning, personality disorder symptoms, and disease conviction during herpes zoster each made independent contributions to predicting either presence or intensity of PHN in logistic and linear regression analyses that controlled for relevant demographic and clinical variables, including age and acute pain intensity. These findings indicate that psychosocial variables are risk factors for the development of PHN. PERSPECTIVE: The results of this prospective study of patients with herpes zoster suggest that future research on the mechanisms and prevention of PHN should consider psychosocial as well as neurobiologic processes.     

Neurology (65)

Herpes zoster and postherpetic neuralgia in the elderly. (University of Virginia, Charlottesville, VA) Geriatr Nurs 2000;21:132–136.
This article described herpes zoster (HZ), its causes, diagnosis, treatment, and associated complications. Postherpetic neuralgia (PHN), the most common complication of HZ, is the primary focus of the discussion. PHN is defined broadly as chronic pain that persists after the characteristic vesicular rash of HZ has resolved.