氟哌噻吨美利曲辛片治疗脑卒中后抑郁疗效观察

目的观察氟哌噻吨美利曲辛片（黛力新）治疗脑卒中后抑郁（PsD）的疗效。方法入选的60例PSD患者随机分成两组,治疗组（30例）服用黛力新,每日早、午各服1片,连服4周;对照组（30例）服用阿普唑仑片与七叶神安片各1片,每日3次,连服4周。结果治疗组治疗后Hamilton抑郁量表评分为（10．06±5．98）分,较治疗前的（24．86±6．94）分显著下降（P〈0．01）;对照组治疗前后比较差异无统计学意义（P〉0．05）。治疗组治疗后神经功能缺损评分为（9．16±6．98）分,较治疗前的（19．36±7．54）分显著下降（P〈0．01）;而对照组治疗前后比较差异无统计学意义（P〉0．05）。结论黛力新治疗PSD疗效明显,并能促进神经功能康复,且依从性好,不良反应少,安全性好。     

自拟柴胡解郁化痰汤联合氟哌噻吨美利曲辛片治疗抑郁症临床观察

目的:观察自拟柴胡解郁化痰汤联合氟哌噻吨芙利曲辛片治疗抑郁症疗效及不良反应.方法:130例抑郁症患者随机分为治疗组和对照组各65例,两组患者均口服氟哌噻吨美利曲辛片1片,2次/d,治疗组在对照组的基础上加服自拟柴胡解都化痰汤,疗程8用.结果:治疗组在HAMD评分减分率较对照组下降显著(P<0.01).结论:自拟柴胡解都化痰汤联合氟哌噻吨芙利由辛片服用能有效改善抑郁症状并且减少不良反应,优于单纯应用氟哌噻吨美利曲辛片.     

中医辨证分型治疗肛门直肠神经官能症的临床研究

目的:探讨中医辨证分型内服汤剂治疗在肛门直肠神经官能症中的临床疗效,为临床提供新的治疗方法和理论基础.方法:本研究纳入81例肛门直肠神经官能症患者,采用中医辨证分型内服汤剂治疗49例,采用口服氟哌噻吨美利曲辛片32例,根据治疗前后患者症状好转情况、治疗前后焦虑及抑郁评分比较以评价两组患者疗效.结果:两组患者在年龄、性别...     

微生态制剂联合氟哌噻吨美利曲辛治疗肠易激综合征疗效分析

目的探讨微生态制剂联合氟哌噻吨美利曲辛治疗肠易激综合征的疗效。方法 82例肠易激综合征患者随机分成对照组和治疗组,治疗组采用微生态制剂和氟哌噻吨美利曲辛片;对照组单用氟哌噻吨美利曲辛片,疗程均为4周。结果治疗组总有效率为90.5%;对照组总有效率为80.0%,两组比较差异有统计学意义（P〈0.05）,均无不良反应发生。结论微生态制剂联合氟哌噻吨美利曲辛是治疗肠易激综合征的有效治疗方案。     

黛力新对高血压伴焦虑状态患者情绪和血压影响的研究

目的探讨黛力新（氟哌噻吨美利曲辛）对原发性高血压伴焦虑状态患者血压及焦虑情绪的影响。方法选择门诊就诊的高血压伴焦虑状态患者68例,随机分为实验组（氨氯地平＋黛力新）和对照组（氨氯地平）,并随访4周,观察两组治疗前后焦虑量表评分、血压的变化情况。结果实验组治疗后焦虑量表评分明显降低（P〈0.05）,而对照组无明显变化（P〉0.05）,两组治疗后相比差异有统计学意义（P〈0.05）;治疗后两组血压均较治疗前降低（P〈0.05）;治疗后的血压进行两组间比较,实验组血压降低程度优于对照组（P〈0.05）。结论黛力新能有效缓解高血压伴焦虑状态患者的焦虑情绪,可协同降压药物提高降压疗效。     

氟哌噻吨美利曲辛治疗感觉敏感性膀胱过度活动症的疗效研究

目的:探讨氟哌噻吨美利曲辛治疗感觉敏性膀胱过度活动症(OAB)的临床疗效。方法:2019年7月～2019年12月门诊就诊的OAB患者中,选取临床以时刻尿意感为主要症状、尿动力检查膀胱初始尿意容量<150 mL且无明显逼尿肌过度活动的女性OAB患者72例,随机分为氟哌噻吨美利曲辛试验组36例和托特罗定对照组36例,试验组每天口服氟哌噻吨美利曲辛1片(含氟哌噻吨0.5 mg和美利曲辛10 mg),对照组每天口服托特罗定缓释片4 mg,两组治疗周期均为12周,每组患者治疗前后分别评估24 h排尿日记、OABSS评分、OAB-V8评分、生活质量QOL评分以及尿动力检查,分析比较两组的临床疗效及安全性。结果:试验组和对照组在治疗前患者OABSS评分、OAB-V8评分以及尿动力检测膀胱初始尿意容量差异均无统计学意义(P>0.05);试验组和对照组治疗12周后OABSS评分分别为(4.3±1.9)分和(4.8±2.1)分(P>0.05)、OAB-V8评分分别为(9.3±4.9)分和(11.6±4.7)分(P<0.05)、尿动力膀胱初始尿意容量分别为(165.5±31.8)mL...     

氟哌噻吨美利曲辛联合其他药物治疗非糜烂性胃食管反流病疗效的荟萃分析

摘要目的 了解氟哌噻吨美利曲辛联合常规药物与单用常规药物治疗非糜烂性胃食管反流病（NERD）疗效的差异。方法检索中国学术文献总库、万方数据库及学位论文数据库、中国维普全文数据库、PubMed外文期刊数据库并辅以人工检索和其他检索,检出氟哌噻吨美利曲辛联合其他常规药物与单用常规药物治疗NERD的研究进行比较分析,并在此基础上进行异质性检验和合并效应量的估计。结果共检出23项氟哌噻吨美利曲辛联合其他常规药物治疗NERD的临床试验,异质性检验χ2＝63.32,自由度（df）＝22,P＜0.000 01,I2＝65%,随机效应模型的相对危险度（RR）＝1.33,95%CI（1.23～1.43）,提示联合用药优于单药治疗;敏感性分析和亚组分析均证实了此结果。结论与单用常规药物比较,氟哌噻吨美利曲辛联合常规药物可提高NERD患者的总有效率。     

急性期中小量脑出血患者抑郁的临床特点及影响因素分析

目的 研究分析急性期脑出血患者抑郁的临床特点及影响因素。方法 入选2019年1月至2022年12月期间入住本院的符合标准的160例急性期中小量脑出血患者为研究对象，将入组患者使用贝克抑郁量表初筛，分为抑郁组与非抑郁组，抑郁组患者采用17项汉密尔顿抑郁量表评估抑郁严重程度，并分析抑郁的影响因素。结果 160例急性期中小量脑出血患者中发生抑郁68例，占42.5%。其中轻度抑郁37例，占54.4%，中度抑郁31例，占45.6%，无重度抑郁患者。多因素分析显示，二组患者在年龄、对疾病了解程度、偏瘫等方面差异有统计学意义（P<0.05）。结论 急性期中小量脑出血患者抑郁发生率高，但程度不重。年龄、对疾病的了解程度、偏瘫为急性期脑出血患者抑郁发生的独立影响因素，临床上及早对此类患者采取正向措施，积极改善抑郁情况，提高治疗效果。     

氟西汀治疗癫痫伴发抑郁的疗效观察

目的:探讨氟西汀治疗癫痫伴发抑郁的疗效和安全性.方法:收集40例符合癫痫伴发抑郁的患者,在维持原抗癫痫药物的治疗基础上,辅助给予氟西汀治疗,疗程8周.分别于治疗后2、4、6、8周采用汉密尔顿抑郁量表( HAMD)评定疗效,同时监测各种不良反应.结果:40例患者经氟西汀治疗后HAMD评分均有不同程度的下降,治疗前后评分比较有统计学差异,且副反应较轻,无严重不良反应发生.结论:氟西汀治疗癫痫伴发抑郁既有效又安全.     

肠舒饮治疗习惯性便秘临床观察

为观察肠舒饮治疗习惯性便秘的临床疗效,将72例习惯性便秘（气血亏虚型）患者随机分为两组,治疗组38例采用肠舒饮治疗;对照组34例,予车前番泻颗粒治疗,观察两组用药后情况。结果显示,治疗组和对照组治疗两个疗程后的总有效率分别为92．11％和91．18％（P〉0．05）,不良反应发生率分别为13．16％和35．29％（P〈0．05）。结果表明,肠舒饮治疗习惯性便秘疗效确切,且不良反应少,值得临床推广。     

选择性臂丛神经根切断治疗上肢痉挛脑瘫的远期疗效评价

目的评价选择性臂丛神经根切断治疗上肢痉挛性脑瘫的远期疗效。方法对1997年3月-2002年1月间施行选择性臂丛神经根切断术治疗上肢痉挛性脑瘫的患者，进行随访并对远期功能进行评价，采用Lazareg肌张力分级标准评定临床效果。结果16例17侧获得随访，随访时间为5．0～9．7年，平均8．6年。手术方式为选择性臂丛神经根全根切断10侧，部分切断2侧，高选择性分束切断5侧；其中切断神经根为颈63次，颈816次。术后远期疗效优3例，有效5例，无效8例9侧。结论选择性臂丛神经根切断治疗上肢痉挛性脑瘫远期大多数疗效下降和无效，但术前严格选择痉挛较局限的病例、术中进行高选择性臂丛神经根分束切断、术后坚持长期康复训练仍然能获得较好的疗效。     

The effect of patients' noncompliance on their surgeons' obligations

Professional oaths and codes do not establish a firm basis for the obligation to treat all patients and they provide little or no clear guidance about whether patient nonadherence exempts a physician from a longstanding and still prevalent tradition in surgery supports a strong obligation to one's established patients. A personal belief in an obligation to serve those less fortunate or even less compliant could support sustained treatment and special assistance to a nonadherent patient. A collective, professional, objective, informed decision to exclude a patient who is highly likely to be nonadherent or incapable of adherence from the benefit of a scarce resource, such as a human organ, is defensible and appropriate. A surgeon's decision to deny care to an established but nonadherent patient is much less so. Adherence is as dependent on physician attitude, skill, and behavior as it is on patients' nonadherence. To the degree that it reflects less than competent management of this prevalent problem, it can be considered an error or complication that makes most surgeons feel even more obliged to mitigate or rectify the problem. This article describes the almost ubiquitous phenomenon of nonadherence; a way to reconceptualize noncompliance; and practical steps that can help predict, prevent, identify, and manage it. It is hoped that this helps surgeons reduce the frequency of nonadherence, make dealing with it less onerous, and consequently achieve better outcomes. It is reasonable to think about nonadherence in terms of three roles. The surgeon's role is to make the patient's choice informed, to be aware of the risk factors for nonadherence, and not make adherence any more difficult than it has to be. The patient's role is to make choices between value-laden alternatives. Society's role is equitably to distribute scarce medical resources to patients who can and want to adhere to the necessary regimen to benefit from them.     

The effect of patients' noncompliance on their surgeons' obligations

Effective physicians recognize that most patients have difficulty following instructions for a variety of reasons. That difficulty is best understood as nonadherence rather than noncompliance. The surgeon's role is to make the patient's choice informed, to be aware of the risk factors for nonadherence, and not to make adherence any more difficult than it has to be. The patient's role is to make choices between value-laden alternatives. Society's role is to distribute scarce medical resources equitably to patients who can and want to adhere to the necessary regimen to benefit from them.     

艾司氯胺酮防治围术期抑郁的研究进展

抑郁是围术期常见的情绪障碍,无论是术前并存抑郁还是术后新发抑郁,均会影响患者术后康复,且目前缺乏有效的干预措施。相关研究表明,艾司氯胺酮可以缓解围术期抑郁。本文对围术期抑郁、艾司氯胺酮及其抗抑郁机制、艾司氯胺酮在防治围术期抑郁中的应用及其相关不良反应进行综述,以期为艾司氯胺酮的临床应用及围术期抑郁的防治提供参考。     

Induced hypertension for the treatment of cerebral ischemia after subarachnoid hemorrhage. Direct effect on cerebral blood flow

The best treatment for symptomatic cerebral ischemia from presumed vasospasm after aneurysmal subarachnoid hemorrhage remains a matter of controversy. A direct effect of any treatment modality on regional cerebral blood flow has never been documented. In a series of 43 patients operated on for ruptured anterior circulation aneurysms, five patients (11.6%) developed clinical signs of cerebral ischemia postoperatively. In four of those patients, the diagnosis of "vasospasm" was made with measurements of cerebral blood flow (133Xe inhalation or intravenous injection, 10-16 detectors, cerebral blood flow infinity). Treatment with induced arterial hypertension with phenylephrine was instituted. Hemodilution was instituted in one patient; the other three patients already had hematocrits in the range of 33. Within 1 hour, the cerebral blood flow measurement was repeated to document the effect of treatment. The average pretreatment hemispherical blood flow on the operated side was 18.8 mL/100 g per minute, on the contralateral side 21.0 mL/100 g per minute. With treatment these flows increased to 30.8 and 35.8 mL/100 g per minute, respectively. There was also an immediate and obvious positive clinical effect in all patients. The role of measurement of cerebral blood flow in the clinical management of vasospasm is discussed. We stress the theoretical and practical advances of measurements of cerebral blood flow over cerebral angiography, especially in comatose patients.     

经脐单孔腹腔镜手术对异位妊娠、不孕症患者应激代谢的影响

目的:评估单孔腹腔镜手术对异位妊娠、不孕症患者机体应激及代谢的影响。方法:选择2012年1月至2012年6月56例异位妊娠、不孕症患者,以非随机方式分为单孔腹腔镜组(n=26)与传统腹腔镜组(n=30)。分别检测术前24 h、术后24 h、术后72 h血清中皮质醇、甲状腺激素及肝酶水平。结果:两组患者术后皮质醇均升高,传统组术后24 h皮质醇变化较显著,两组均于术后72 h恢复至术前水平。单孔组手术前后甲状腺相关激素水平较传统组轻微且恢复迅速,传统组波动较大。两组患者肝酶影响不明显。单孔组手术时间长于传统组。结论:单孔腹腔镜手术较传统腹腔镜手术对机体应激及代谢影响小,手术更微创,其安全性及有效性尚待大样本及长时间的对比研究。     

Assessment of cerebral pressure autoregulation

Cerebral pressure autoregulation, a sensitive homeostatic mechanism important for the control of cerebral blood flow, is impaired by disease pathology and some drugs commonly used during anaesthesia. Therefore, the assessment of cerebral pressure autoregulation can help optimize cerebral blood flow in patients who have suffered neurological insults. In this article, we outline the means available for testing cerebral pressure autoregulation, thus allowing the reader to decide on the best strategy to adopt in their particular operating theatre and intensive care setting.