葛根素注射液治疗急性脑梗塞的疗效观察

目的：探讨葛根素注射液治疗急性脑梗塞的临床疗效。方法：100例急性脑梗塞患者分为治疗组50例和对照组50例。两组患者常规治疗基本相同，脑水肿者加用20％甘露醇注射液治疗。在此基础上，治疗组加用葛根素注射液治疗；对照组加用胞二磷胆碱注射液联合复方丹参注射液治疗。结果：治疗组总有效率为92％(46／50)，对照组总有效率为70％(35／50)，两组比较，有显著性差异(P=0．009)。结论：葛根素注射液能够改善脑部血液循环及促进脑细胞功能恢复，对治疗急性脑梗塞有显著的疗效。     

甘露醇对眩晕病人的疗效分析

目的探讨甘露醇对眩晕病人的治疗效果及应用价值。方法对46例眩晕病人分两组，治疗组28例加用150-250mL甘露醇，对照组18例末用甘露醇进行疗效对比分析。结果加用甘露醇的疗效显效到完全缓解0．5～3d。而未加用的显效到缓解2～6d。结论甘露醇对眩晕的疗效确切。     

季德胜蛇药加呋喃西林治疗甘露醇外渗的疗效观察

[目的]观察季德胜蛇药加1：5000呋喃西林溶液治疗甘露醇外渗的疗效。[方法]将50例因静脉输注甘露醇所致皮肤损伤病人随机分成对照组和观察组，对照组采用传统的50％硫酸镁溶液湿敷，观察组用季德胜蛇药加1：5000呋喃西林溶液外敷，观察两组疗效。[结果]观察组总有效率（88％）显著高于对照组（60％。P〈0．01），且治愈时间明显短于对照组（P〈0．01）。[结论]季德胜蛇药加1：5000呋喃西林溶液治疗甘露醇外渗所致的皮肤损伤效果明显优于50％硫酸镁外敷法。     

甘露醇联合糖皮质激素治疗周围性面神经麻痹的疗效观察

目的:观察甘露醇联合糖皮质激素治疗周围性面神经麻痹的临床疗效。方法:周围性面神经麻痹患者120例,随机分为对照组和治疗组,各60例。对照组给予常规治疗加用强的松口服,治疗组在常规治疗基础上加用甘露醇联合强的松口服治疗,比较2组疗效及肌电图改变。结果:治疗7 d时,治疗组总有效率78.33%,对照组总有效率56.67%,差异有统计学意义(P0.05);治疗14 d时,治疗组总有效率90.33%,对照组总有效率81.67%,差异有统计学意义(P0.05)。治疗7、14 d后,2组CMAP波幅均较前恢复,R1潜伏期均较前缩短,且治疗组较对照组幅度更为明显(P0.05)。结论:甘露醇联合地塞米松治疗周围性面神经麻痹临床效果更快更好,值得推广。     

血府逐瘀汤治疗局灶性脑挫裂伤的疗效观察

目的：观察血府逐汤治疗局灶性脑挫裂伤的临床疗效。方法：将３６例无明显或轻微中位效应的外伤性局灶性脑挫裂伤患者随机分为血府逐瘀汤治疗组（１９例）和地塞米松对照组（１７例），２组均用２０％甘露醇及神经细胞活性药物作基础治疗。治疗组伤后第３日起加服中药血府瘀汤，每日１例，连服２－３周；对照组加用地塞米松静滴，２周后减量停药，结果：２组在颅内压恢复正常及血性脑脊液转清方面均无显著性差异；而在临床闰状缓解率     

水蛭与甘露醇联合治疗脑梗塞疗效观察

观察水蛭与甘露醇联合治疗脑梗塞的临床疗效。治疗组１４１例，对照组７０例。结果表明：治疗组总有效率为９２．９％，显效率为７３．ｏ％；对照组总有效率为６８．５％，显效率为２８．５％。两组比较均有显著性差异。治疗组治疗后纤维蛋白原、血浆粘度、全血粘度、血细胞压积较治疗前均显著降低；而对照组治疗前后上述指标的比较无显著性差异。作者认为水蛭与甘露醇联合治疗脑梗塞疗效显著。     

中西医结合治疗结石性胆囊炎56疗效分析

目的观察中西医结合治疗结石性胆囊炎的临床疗效。方法将101例结石性胆囊炎随机分为两组，对照组45例给予西药解痉、止痛、利胆、控制感染、支持疗法等。治疗组56例在此基础上加用排石汤治疗。结果治疗组疗效总有效率为92．6％，对照组总有效率61．4％，两组疗效有显著差异（P〈0．01）。结论中西医结合治疗结石性胆囊炎疗效较好。     

联用甘露醇和复方大承气汤及脂肪乳治疗肾综合征出血热重度少尿15例

目的：观察甘露醇、复方大承气汤和脂肪乳联用治疗肾综合征出血热（ＨＦＲＳ）重度少尿期患者的疗效。方法：治疗组（１５例）与对照组（１４例）２组基础治疗相同外，治疗组给予甘露醇、复方大承气汤每隔３小时交替保留灌肠或同时口服甘露醇，并静滴脂肪乳治疗，与对照组单独用复方大承气汤保留灌肠和加用多巴胺、卡托普利、速尿治疗作比较。结果：治疗组有显著的导泻效果，大便量为１０００～４０００ｍｌ／ｄ，能有效地控制血尿素氮升高和降低病死率。治疗组死亡２例，病死率为１３．３％；对照组死亡９例，病死率为６４．３％。对尿蛋白转阴、少尿持续时间的治疗２组无明显差异。结论：本疗法有显著的导泻作用，能有效地控制血尿素氮升高和降低重度少尿期患者的病死率。适宜于无透析条件的基层医院推广应用。     

都梁软胶囊联合氟桂利嗪预防偏头痛32例

目的：观察都梁软胶囊联合氟桂利嗪预防偏头痛的临床疗效。方法：64例偏头痛患者随机分为治疗组和对照组,每组32例。治疗组用都梁软胶囊加氟桂利嗪治疗,对照组用谷维素治疗。60d后观察两组头痛指数的变化。停药半年内临床疗效对比。结果：治疗组及对照组的头痛指数与治疗前比较均有下降（P〈0．05或P〈0．01）,且治疗组治疗效果更为显著（P〈0．01）。治疗组总有效率高于对照组（分别为93．75％和56．25％,P〈0．05）。结论：都梁软胶囊联合氟桂利嗪是预防偏头痛的有效方法。     

合用刺五加与甘露醇治疗脑梗塞的疗效观察

目的：观察合用刺五加与甘露醇治疗脑梗塞的疗效。方法：将１６８例脑梗塞患者随机分为治疗组９７例和对照组７１例。治疗组静滴刺五加和甘露醇，对照组静滴维脑路通和能量合剂，其它治疗２组基本相同，均１４日为１个疗程。分别观察治疗前后２组患者临床症状、体征及血液流变学指标变化。结果：治疗组痊愈１９例，显效４８例，进步２４例，无效６例，总有效率９３．８１％；对照组痊愈９例，显效１９例，进步３０例，无效１３例，总有效率８１．６９％。２组比较有非常显著性差异（Ｐ＜０．０１）。血液流变学指标，治疗组治疗后有显著进步，对照组个别指标有显著进步。结论：静滴刺五加与甘露醇治疗脑梗塞为安全有效的方法。     

穴位热痛刺激治疗无先兆偏头痛的近期镇痛疗效观察

目的 观察穴位热痛刺激治疗无先兆偏头痛患者的近期镇痛疗效。 方法 采用随机数字表法将120例无先兆偏头痛患者分为观察组及对照组，每组60例。对照组患者给予西比灵口服，每晚1次，每次5 mg，治疗4周为1个疗程。观察组患者在对照组干预基础上辅以穴位热痛刺激，取穴风池、率谷、阳陵泉、外关、太阳、印堂，选用Pathway疼痛及感觉评估系统配置的圆形刺激器，当刺激器加热至54.5 ℃时发放可调节脉冲热刺激，单个脉冲热刺激其脉宽为0.3 s，刺激间隔10 s，每个穴位连续刺激5次后换下一穴位，各穴位循环交替刺激，共治疗20 min，每日治疗1次，治疗4周为1个疗程。记录治疗前、后2组患者头痛发作频率、持续时间、疼痛视觉模拟评分(VAS)、头痛伴随症状评分、偏头痛特异生活质量问卷量表（MSQ）评分，并对比2组患者近期疗效差异。 结果 治疗后观察组患者头痛发作频率［（1.27±0.13）次/月］、头痛持续时间［（2.51±0.22）分钟/次］、疼痛VAS评分［（0.43±0.08）分］、头痛伴随症状评分［（0.21±0.20）分］、MSQ功能受限评分［（79.0±10.2）分］、功能障碍评分［（82.6±10.3）分］及情感评分［（85.2±10.5）分］均较治疗前及对照组明显改善（均P<0.05）；另外治疗后观察组患者总有效率（95.0%）亦显著优于对照组水平（80.0%），组间差异具有统计学意义（P<0.05）。所有患者在治疗期间其心率、血压均未出现不良反应，热痛刺激部位无感染、红肿等异常表现。 结论 穴位热痛刺激治疗无先兆偏头痛患者近期疗效显著，并且治疗过程安全可靠、副反应少，为偏头痛患者提供了一种新的治疗方法，值得临床推广、应用。     

Comparison of intravenous valproate versus intramuscular dihydroergotamine and metoclopramide for acute treatment of migraine headache

OBJECTIVE: To determine the effectiveness and tolerability of intravenous valproate for the acute treatment of migraine headache with or without aura (International Headache Society diagnostic criteria 1.1 and 1.2) compared with intramuscular metoclopramide 10 mg followed 10 minutes later by intramuscular dihydroergotamine 1 mg. BACKGROUND: Divalproex sodium is approved for prophylaxis of migraine headache. We studied the possible effectiveness of intravenous sodium valproate for the treatment of acute migraine headache. Valproate offers a treatment option for patients with migraine who recently have used a triptan or dihydroergotamine, theoretically avoiding the risk of drug interactions or cardiovascular complications. DESIGN/METHODS: In an open-label randomization, patients with an established diagnosis of migraine with or without aura were administered either intravenous valproate or intramuscular dihydroergotamine with metoclopramide to treat moderate-to-severe migraine headache of 24 to 96 hours' duration. Forty patients alternately received either 500 mg intravenous valproate or 10 mg metoclopramide intramuscularly followed by 1 mg dihydro- ergotamine. Patients rated severity of headache and the presence or absence of nausea, photophobia, or phonophobia at baseline, and at 1, 2, 4, and 24 hours. RESULTS: With intravenous valproate, 50% of patients reported headache improvement from moderate or severe to none or mild at 1 hour following treatment, 60% reported such improvement at 2 hours, 60% at 4 hours, and 60% at 24 hours. Corresponding improvement rates for dihydroergotamine were 45% at 1 hour, 50% at 2 hours, 60% at 4 hours, and 90% at 24 hours. Intravenous valproate and intramuscular dihydroergotamine provided similar relief from associated migrainous symptoms (nausea, photophobia, and phonophobia) during the first 4 hours following treatment. While none of the patients who received intravenous valproate experienced drug-related side effects during treatment, 15% of patients who took dihydroergotamine experienced one or more episodes of nausea and diarrhea during the first 4 hours of treatment. CONCLUSIONS: Intravenous valproate is similar in effectiveness to dihydroergotamine/metoclopramide as abortive therapy for prolonged moderate-to-severe acute migraine headache. Although the results were not statistically significant (P =.3635), intravenous valproate appears to offer a safe, effective, and well-tolerated treatment for patients with acute migraine. Relative to dihydroergotamine/metoclopramide, however, headache relief was not as likely to be sustained at 24 hours as with intravenous valproate.     

Magnetic resonance imaging of the brain in patients with migraine

Magnetic resonance imaging (MRI) was studied in 91 patients with migraine and in 98 controls. Risk factors known to cause MRI lesions were carefully examined. In 36 patients with migraine (39.6%), small foci of high intensity on T2-weighted and proton-density-weighted images were seen in the white matter. Of patients with migraine who were less than 40 years old and without any risk factor, 29.4% showed lesions on MRI; this was significantly higher than the 11.2% for the group of age-matched controls (n = 98). The lesions were distributed predominantly in the centrum semiovale and frontal white matter in young patients, but extended to the deeper white matter at the level of basal ganglia in the older age group. The side of the MRI lesions did not always correspond to the side of usual aura or headache. Migraine-related variables such as type of migraine, frequency, duration or intensity of headache or consumption of ergotamine showed no significant correlation with the incidence of MRI abnormalities. Our data indicated that migraine may be associated with early pathologic changes in the brain.     

阿米替林防治偏头痛的临床观察

目的:探索小剂量阿米替林对预防和治疗偏头痛的临床疗效、安全性和使用方法。方法:随机、单盲。阿米替林为试验组168例,西比灵为对照组126例,服药时间为3个月,疗效评价时间分别为服药后第3个月、第6个月及第9个月各一次,共3次。结果:阿米替林组的防治效果明显优于西比灵组（P<0.001）,不良反应较轻微。讨论:小剂量阿米替林防治偏头痛有肯定的疗效,而且副作用小、安全、价廉、无依赖性,并能改善睡眠,调整情绪。     

Efficacy of intravenous magnesium sulfate in the treatment of acute migraine attacks

OBJECTIVE: To study the efficacy and tolerability of 1 g of intravenous magnesium sulfate as acute treatment of moderate or severe migraine attacks. BACKGROUND: Migraine is a common disorder in which not only the pain but also the accompanying symptoms such as nausea and vomiting reduce activity and productivity of sufferers. Many drugs used for the treatment of acute migraine attacks have many side effects, are not well tolerated, are ineffective in some patients, or cannot be used during pregnancy or in patients with ischemic heart disease. Magnesium deficiency has been proposed to play a role in the pathophysiology of migraine, and recently treatment of migraine with magnesium has gained considerable interest. METHODS: This was a randomized, single-blind, placebo-controlled trial including 30 patients with moderate or severe migraine attacks. Fifteen patients received 1 g intravenous magnesium sulfate given over 15 minutes. The next 15 patients received 10 mL of 0.9% saline intravenously. Those in the placebo group with persisting complaints of pain or nausea and vomiting after 30 minutes also received 1 g magnesium sulfate intravenously over 15 minutes. The patients were assessed immediately after treatment, and then 30 minutes and 2 hours later. Intensity of pain, accompanying symptoms, and side effects were noted. RESULTS: All patients in the treatment group responded to treatment with magnesium sulfate. The pain disappeared in 13 patients (86.6%); it was diminished in 2 patients (13.4%); and in all 15 patients (100%), accompanying symptoms disappeared. In the placebo group, a decrease in pain severity but persisting nausea, irritability, and photophobia were noted in 1 patient (6.6%). Accompanying symptoms disappeared in 3 patients (20%) 30 minutes after placebo administration. All patients initially receiving placebo were subsequently given magnesium sulfate. All of these patients responded to magnesium sulfate. In 14 patients (93.3%), the attack ended; in 1 patient (6.6%), pain intensity decreased; and in all 15 patients (100%), accompanying symptoms disappeared. Both the response rate (100% for magnesium sulfate and 7% for placebo) and the pain-free rate (87% for magnesium sulfate and 0% for placebo) showed that magnesium sulfate was superior to placebo. Twenty-six patients (86.6%) had mild side effects which did not necessitate discontinuing treatment during magnesium sulfate administration. CONCLUSION: Our results show that 1 g intravenous magnesium sulfate is an efficient, safe, and well-tolerated drug in the treatment of migraine attacks. It is possible that magnesium sulfate could be used in a broader spectrum of patients than other drugs commonly used for attack treatment. In view of these results, the effect of magnesium sulfate in acute migraine should be examined in large-scale studies.     

灵通胶囊治疗头痛的临床研究

目的:观察灵通胶囊对无先兆偏头痛(Migraine without aura)和高频发作性紧张型头痛(Fre-quent episodic tension-type headache,FETTH)的即时止痛疗效。方法:头痛患者共95例随机分配到灵通组和元胡组(对照组)。其中无先兆偏头痛入灵通组25例服药51例次,入元胡组28例服药53例次;FETTH入灵通组25例服药39例次,入元胡组17例服药27例次。分别于疼痛时即时服用灵通胶囊2粒和元胡止痛颗粒2包。将疼痛程度分级量化,由患者记录服药前和服药后2小时内每30分钟时的疼痛程度。以服药后2小时疼痛减轻程度≥50%作为有效。结果:无先兆偏头痛有效率在灵通组为68.6%,在元胡组为32.1%(P<0.001);FETTH有效率在灵通组为76.9%,在元胡组为59.3%(P>0.05);两种头痛的综合有效率在灵通组为72.2%,在元胡组为41.3%(P<0.001)。灵通组在服药30分钟后各时点的疼痛评分显著低于元胡组(P<0.001)。结论:灵通胶囊对两种头痛有明显的即时止痛疗效。     

Magnesium in the prophylaxis of migraine-a double-blind, placebo-controlled study

The migraine prophylactic effect of 10 mmol magnesium twice-daily has been evaluated in a multicentre, prospective, randomized, double-blind, placebo-controlled study. Patients with two to six migraine attacks per month without aura, and history of migraine of at least 2 years, were included. A 4-week baseline period without medication was followed by 12 weeks of treatment with magnesium or placebo. The primary efficacy end-point was a reduction of at least 50% in intensity or duration of migraine attacks in hours at the end of the 12 weeks of treatment compared to baseline. With a calculated total sample size of 150 patients, an interim analysis was planned after completing treatment of at least 60 patients, which in fact was performed with 69 patients (64F, 5M), aged 18–64 years. Of these, 35 had received magnesium and 34 placebo. The number of responders was 1 in each group (28.6% under magnesium and 29.4% under placebo). As determined in the study protocol, this was a major reason to discontinue the trial. With regard to the number of migraine days or migraine attacks there was no benefit with magnesium compared to placebo. There were no centre-specific differences, and the final assessments of treatment efficacy by the doctor and patient were largely equivocal. With respect to tolerability and safety, 45.7% of patients in the magnesium group reported primarily mild adverse' events like soft stool and diarrhoea in contrast to 23.5% in the placebo group.     

Sublingual Administration of Flunarizine for Acute Migraine: Will Flunarizine Take the Place of Ergotamine?

SYNOPSIS
Clinical effectiveness of 10 mg sublingual flunarizine during 89 headache attacks was observed in 68 chronic headache patients. The study population consisted of 36 patients with migraine, 12 with combined headache, 11 with muscle contraction headache (MCH) and nine with cluster headache. Improved cases, defined as cases showing more than moderate improvement, were 75.0% in the migraine group, 50.0% in the combined headache group, 18.2% in the MCH group and 33.3% in the cluster headache group. The migraine group showed a significantly higher percentage of improved cases than did the MCH group (p<0.002). The group in which subjects received flunarizine within 10 min. from the beginning of headache, showed significantly better improvement than did the group in which subjects were treated after 10 min. (p<0.01). No remarkable side effects were observed except for transient numbness of the tongue and a feeling of sleepiness. Four typical case histories utilizing flunarizine administration, and a case showing recovery from angiospasm after sublingual flunarizine administration during an angiographic examination, are reported. A possible favorable role of flunarizine during migraine attacks is discussed. Double blind studies based on the present observations are necessary.     

An instrument to assess patient perceptions of satisfaction with acute migraine treatment (EXPERT Study)

(Headache 2011;51:590‐601) Objective.— The objective of the nationwide EXPERT survey carried out in France in 2005 was to compare satisfaction with treatment with treatment effectiveness in migraine patients consulting general practitioners (GPs) for migraine, and to establish an instrument to easily evaluate the adequacy of acute treatment of migraine. Background.— Many migraine patients feel satisfied with their current acute treatment of migraine whereas objective evaluation reveals poor treatment effectiveness. Methods.— A total of 2108 GPs included 11,274 migraine patients. Satisfaction with treatment was evaluated using a 4‐point verbal scale and a 10‐cm visual analog scale (VAS). Treatment effectiveness was assessed by the 4‐item questionnaire designed by the French Medico‐Economic Evaluation Service (ANAES) and the French Society for the Study of Migraine Headache (SFEMC). Results.— In total, 5224 patients (49.8%) stated that they were satisfied with their treatment. Mean VAS score was 5.1. Only 17% of patients (1789/10,539) gave positive responses at the 4 questions of the ANAES/SFEMC questionnaire. VAS score was high for patients satisfied with their treatment and with good treatment effectiveness. Two VAS thresholds were determined using receiver operating characteristic curves that allowed easy identification, with high sensitivity and specificity, of patients satisfied/dissatisfied with their current treatment and with good/poor treatment effectiveness. Based on EXPERT data, this instrument showed that only 16% of patients using triptans (597/3719) were dissatisfied and reported poor treatment effectiveness, whereas treatment was inadequate for 63% of those using aspirin or nonsteroidal anti‐inflammatory drugs (1882/2992), 74% of those using paracetamol or other analgesics (2229/2998), and 53% of those using ergotamine (253/474). Conclusions.— The new instrument should allow easy identification in general practice of the patients receiving an effective or ineffective acute treatment of migraine and thus facilitate the implementation of treatment guidelines for migraine.