帕罗西汀治疗脑梗死后抑郁症44例疗效观察

脑梗死后病人常伴有抑郁症和或呈抑郁状态,近两年来,我们应用帕罗西汀治疗脑梗死后抑郁症取得较好疗效,现总结报道如下.     

卒中后抑郁的诊断与治疗的研究进展

卒中后抑郁（PSD）是脑卒中后常见并发症之一,严重影响患者的康复和生活质量,目前临床上对PSD尚未引起足够重视,对其治疗手段尚不十分全面.本文就PSD的诊断及治疗进展进行综述.     

脑梗死后抑郁症

目的:探讨脑梗死后抑郁症的临床特点。方法:采用Zung抑郁自评量表,对252例脑梗死病人进行抑郁评估。结果:脑梗死后抑郁症发生率为44.44％;抑郁发生率与年龄、病灶部位无显著关系,但与病人日常生活障碍程度有关(P<0.01)。结论:脑梗死后可发生抑郁症,病人日常生活能力障碍越重,抑郁发生率越高,应引起重视。     

博乐欣治疗脑梗死后抑郁症24例疗效观察

脑梗死后出现的抑郁状态严重影响患者神经功能的恢复。2001年1月～2002年10月，我们对24例脑梗死后抑郁症患者给予博乐欣(万拉法新)治疗，取得良好效果。     

综合疗法加高压氧治疗老年脑梗死后抑郁症29例报告

老年人脑梗死后常伴有精神症状 ,尤其是情感障碍、思维障碍和行为异常为表现的抑郁症更为常见 ,以至影响生活质量。1998年 6月至 2 0 0 0年 10月 ,我们采用高压氧治疗脑梗死后抑郁症患者 2 9例 ,取得较满意效果 ,现报告如下。临床资料 :本文 5 4例脑梗死后抑郁症患者 ,均为首次     

卒中后抑郁诊断及治疗的进展

卒中后抑郁（post—stroke depression,PSD）是指脑卒中后出现不同程度的抑郁症状且症状持续2周以上,其主要表现为情感低落、兴趣减退、悲观、厌世、烦躁、缺乏主动性以及全身疲劳等症状。     

抗抑郁治疗对老年脑梗死患者脑血流的影响

目的 研究抗抑郁治疗对老年脑梗死患者脑血流量的影响.方法 首次发病1个月后的老年脑梗死患者120例,随机分为抗抑郁治疗组和对照组各60例,抗抑郁治疗组予心理干预和盐酸舍曲林50～100 mg,1次/d,口服.两组治疗前和治疗后4 w、12 w进行神经功能缺损程度评分(NIHSS)、日常生活活动能力(ADL)和HAMD等量表评估,以及经颅三维多普勒(TCD)检查.结果 抗抑郁治疗组脑梗死患者治疗后4、12 w HAMD评分为10.5±4.8和7.9±2.1,明显低于治疗前和对照组;NIHSS评分为15.7±4.2和14.1±3.2,ADL评分68.7±14.8和75.6±12.7,与对照组比较显著提高(P<0.05～0.01).两组治疗4 w和12 w后脑血流量均改善,但治疗组尤为显著,明显高于对照组(P<0.05～0.01).结论 抗抑郁治疗可以明显提高急性脑梗死患者脑血流量,改善患者抑郁症状和预后.     

心理干预与脑梗死后抑郁的关系研究

目的 探讨心理干预与脑梗死后抑郁、焦虑的关系.方法 将76例脑梗死患者随机分为观察组和对照组,各38例,均常规治疗原发脑血管疾病.观察组在基础治疗的同时实施为期4周的心理干预措施.于心理干预前及心理干预4周末采用症状自评量表(SCL-90)分别测评两组患者.结果 干预前两组SCL-90评分比较,差异无统计学意义(P＞0.05);经4 周心理干预后观察组抑郁、焦虑评分低于对照组,差异有统计学意义(P＜0.05).结论 心理干预可有效改善脑梗死后的心理健康状况,减少抑郁的发生.     

脑梗死后抑郁患者的护理干预

目的 探讨影响脑梗死后抑郁的发生因素,观察护理干预的效果.方法 选取2008-2010年我科45例脑梗死后抑郁患者通过分析抑郁因素给予护理干预.结果 45例患者均治愈出院,无一例出现并发症,抑郁发生率降低.结论 脑梗死后抑郁患者配合治疗,并给予有效的护理干预指导,能明显改善卒中后抑郁患者的预后,提高患者的生存质量.     

心力衰竭合并抑郁症的诊断与治疗

心力衰竭（简称心衰）是一种致死率和致残率很高的临床综合征,是心血管领域亟需解决的重大医学问题。临床数据表明,心衰患者具有较高的抑郁症风险,约30%的心衰患者罹患抑郁症。抑郁症会严重降低心衰患者生活质量,也会增加心衰患者的再入院和死亡风险。目前,心衰合并抑郁症的机制尚不完全清楚,临床上也缺乏有效的干预手段。因此,抑郁症仍是心衰患者管理中的一个不可忽视的问题。本文就心衰合并抑郁症的流行病学特点、对心衰患者预后的影响、诊断及治疗进行总结。     

不同脑梗死分型与脑卒中后抑郁和认知功能障碍的关系

目的探讨不同脑梗死分型与脑卒中后抑郁(PSD)和认知功能障碍的关系。方法选择脑卒中急性期患者158例,脑出血35例,脑梗死123例(其中PSD患者55例,非PSD患者68例)。发病2周后采用汉密尔顿抑郁量表和简易智能状态检查量表(MMSE)进行评分,并进行TOAST和牛津郡社区脑卒中项目(OCSP)分型。结果与非PSD患者大动脉粥样硬化型和部分前循环梗死比较,PSD患者大动脉粥样硬化型和部分前循环梗死PSD发生率明显升高(P=0.002,P=0.000),小动脉闭塞型和腔隙性梗死患者PSD发生率明显降低(P=0.002,P=0.003)。与非小动脉闭塞型、非腔隙性梗死患者比较,小动脉闭塞型、腔隙性梗死患者MMSE评分明显升高(P=0.021,P=0.038)。脑出血患者发生认知功能障碍比率大于脑梗死患者(34.3%vs 14.6%,P=0.013)。结论大动脉粥样硬化型患者PSD发生率较高,小动脉闭塞型和腔隙性梗死患者PSD发生率较低、认知功能受损程度轻;部分前循环梗死患者PSD发生率较高、认知功能受损程度重。脑出血较脑梗死易发生认知功能障碍。     

Diagnosis of tuberculosis: present and future

Current methods used worldwide for diagnosis of tuberculosis (TB) are not markedly different from those used 50 years ago. The standard has been to demonstrate microbiologically the presence of Mycobacterium tuberculosis in secretions and/or tissue from the patient. Improvements have been made that permit greater sensitivity for the examination of stained smears and for more rapid detection of growth of the organism using radiometric techniques. New methods for diagnosis that may well eliminate the need for smear and culture of specimens are under varying stages of development. These new methods are based on the detection of specific components of the organisms or on detection of specific antibodies produced by the patient. Some of these methods will require expensive and sophisticated equipment, and this will make them much less available in developing countries. The use of gene probes for diagnosis of TB is in use now on a limited scale. For the near future, we predict that nucleic acid techniques will be developed for use worldwide. These techniques will have a sensitivity and specificity never before achieved; they should be less expensive than standard methods, and the time required for analysis of a sample and the reporting of results will be reduced to 1 day.     

电针联合氟西汀对卒中后抑郁症患者抑郁状态及神经功能的影响

目的观察电针联合氟西汀对卒中后抑郁症（PSD）患者抑郁状态及神经功能的影响。方法将95例PSD患者随机分为A、B、C三组,分别采用电针、氟西汀、电针联合氟西汀治疗。治疗前后根据哈密顿抑郁量表（HAMD）、神经功能缺损量表及副反应量表（TESS）评分,评定其抑郁程度、神经功能缺损程度及不良反应。结果治疗6周后,三组治疗前后组内及治疗后组间HAMD评分、神经功能缺损评分、TESS评分比较均有统计学差异（P均〈0.05）,其中C组优于A组及B组（P均〈0.05）。结论电针联合氟西汀能更好地改善PSD患者的抑郁状态,促进其神经功能恢复,且不良反应少,值得临床应用。     

脑卒中后抑郁障碍的临床分析

目的分析脑卒中后抑郁障碍(post-stroke depression disorder,PSDD)的发病相关因素。方法对入选的697例脑卒中患者的性别、年龄、脑卒中类型、脑卒中病灶部位、美国国立卫生研究院脑卒中量表(National Institutesof Health Stroke Scale,NIHSS)神经功能缺损程度评分、Barthel指数(BI)、汉密尔顿抑郁量表评分(HamiltonRating Scale for Depression,HAMD)进行记录,并对不同分类中PSDD发生率进行比较。结果脑出血PSDD发生率明显高于脑梗死PSDD发生率(26.6%vs 16.3%,x~2=6.48,P=0.01)。PSDD患者入院时NIHSS评分明显高于无PSDD患者[(6.00±4.60)分vs(4.52±3.74)分],BI评分明显低于无PSDD患者[(57.40±26.54)分vs(68.1 6±25.76)分],差异有统计学意义(P<0.01)。PSDD患者入院时NIHSS评分HAMD呈正相关(r=0.21,P<0.01),入院时BI评分与HAMD呈负相关(r=-0.18,P<0.01)。logistic回归分析显示,入院时BI评分是抑郁的保护因素(标准偏回归系数=-0.02,OR=0.98,95%CI:0.98～0.99,P<0.01)。结论 PSDD与脑卒中类型、入院时NIHSS评分及BI评分有关。     

Effectiveness of non-pharmacological interventions for treating post-stroke depression: Study protocol of an umbrella review of systematic reviews and meta-analyses

Background:Many systematic reviews and meta-analyses have evaluated the effectiveness of non-pharmacological therapies to improve symptoms of post-stroke depression (PSD) and reduce disability and mortality in patients with PSD. However, no research has appraised the credibility of the evidence. This study aims to summarize and evaluate the current evidence for non-pharmacological treatment of PSD and to seek effective treatment with reference to reliable evidence.Methods:We searched the electronic databases EMBASE, MEDLINE, Cochrane Central, PubMed, PROSPERO, Web of Science, and CINAHL. We will search articles from the above database for all published meta-analyses to December 2021 to evaluate the effect of non-pharmacological treatment of PSD. Two reviewers will extract the general characteristics of the included articles, as well as participants, interventions, outcome measures, and conclusions. The quality evaluation of each systematic review will be conducted with reference to the AMSTAR 2 tool. The effect size of each review will be recalculated using either a fixed-effects or a random-effects model. Cochrane''s Q test and I² statistics will be used to evaluate the heterogeneity between studies. To determine whether a systematic review had small study effects, we will use the Egger test. We expect to extract valid evidence and classify it from strong to weak.Results:The findings of this umbrella review will provide effective evidence for the non-pharmacological treatment of PSD.Conclusion:Our research conclusion will provide clinical staff and PSD patients with appropriate treatment recommendations.Ethics and dissemination:As the data were obtained from published materials, there is no need for ethical approval for this umbrella review. The findings of this umbrella review will be published in a peer-reviewed journal.INPLASY registration number:INPLASY2021100083.     

Anal cancer treatment:Current status and future perspectives

Anal cancers(AC)are relatively rare tumors.Their incidence is increasing,particularly among men who have sex with other men due to widespread infection by human papilloma virus.The majority of anal cancers are squamous cell carcinomas,and they are treated according to stage.In local and locally advanced AC,concomitant chemoradiation therapy based on mitomycin C and 5-Fluorouracil(5-FU)is the current best treatment,while metastatic AC,chemotherapy with 5-FU and cisplatin remains the gold standard.There are no indications for induction or maintenance therapies in locally advanced tumors.Many novel strategies,such as targeted therapies,vaccination,immunotherapy and photodynamic therapy are in clinical trials for the treatment of AC,with promising results in some indications.     

Diagnosis and treatment of depression in older community-dwelling adults: 1992-2005

OBJECTIVE: To examine evolving patterns of depression diagnosis and treatment in older U.S. adults in the era of newer‐generation antidepressants. DESIGN: Trend analysis using data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare enrollees, from 1992 to 2005. SETTING: Community, usual care. PARTICIPANTS: Older Medicare fee‐for‐service beneficiaries. MEASUREMENTS: Depression diagnoses and psychotherapy use identified from Medicare claims; antidepressant use identified from detailed medication inventories conducted by interviewers. RESULTS: The proportion of older adults who received a depression diagnosis doubled, from 3.2% to 6.3%, with rates increasing substantially across all demographic subgroups. Of those diagnosed, the proportion receiving antidepressants increased from 53.7% to 67.1%, whereas the proportion receiving psychotherapy declined from 26.1% to 14.8%. Adjusting for other characteristics, odds of antidepressant treatment in older adults diagnosed with depression were 86% greater for women, 53% greater for men, 89% greater for whites, 13% greater for African Americans, 84% greater for metropolitan‐area residents, and 55% greater for nonmetropolitan‐area residents. Odds of antidepressant treatment were 54% greater for those diagnosed with major depressive disorder (MDD) and 83% greater for those with other depression diagnoses, whereas the odds of receiving psychotherapy was 29% lower in those with MDD diagnoses and 74% lower in those with other depression diagnoses. CONCLUSION: Overall diagnosis and treatment rates increased over time. Antidepressants are assuming a more‐prominent and psychotherapy a less‐prominent role. These shifts are most pronounced in groups with less‐severe depression, in whom evidence of efficacy of treatment with antidepressants alone is less clear.     

未分化脊柱关节病的诊断与治疗

未分化脊柱关节病是一类具有典型脊柱关节病表现的临床综合征，但不符合强直性脊柱炎、银屑病关节炎、肠炎性关节病、瑞特综合征的诊断标准。临床上存在诊断的不确定性，常常被误诊误治，值得注意。