珍菊降压片治疗轻中度高血压

目的观察珍菊降压片治疗轻中度高血压的有效性和安全性。方法门诊轻中度高血压患者196例,随机分为珍菊降压片单用组和珍菊降压片与赖诺普利片合用组。两组疗程均为12周。结果单用组总有效率89．42％,合用组总有效率98．91％（P〉0．05）,不良反应轻微。结论单用或合用珍菊降压片治疗轻中度高血压病均安全有效。     

珍菊降压片对高血压患者脉压的影响

目的观察珍菊降压片对高血压的疗效和对患者脉压的影响。方法对60例高血压患者随机分为两组,对照组给予苯磺酸氨氯地平,治疗组在应用苯磺酸氨氯地平治疗的基础上加用珍菊降压片,并分别于治疗前、治疗2周、4周末测量血压并计算脉压。结果治疗至第4周末,治疗组总有效率高于对照组;治疗组的收缩压、舒张压和脉压明显降低,与对照组比较差异有统计学意义（P〈0．05）。结论珍菊降压片具有稳定的降压效果,与钙离子拮抗剂合用能够提高高血压患者的血压达标率,明显降低脉压而保护靶器官。     

珍菊降压片临床新用途探讨

珍菊降压片是一种复方制剂,由野菊花、珍珠层粉及芦丁三味中药(或提取物)和盐酸可乐定与氢氯噻嗪两味西药组方。其有效成分为野菊花内酯等,对正常及高血压模型动物均有降压作用,降压时心排出量无明显变化,总外周力下降。现代药理研究证实珍菊降压片除具有清热解毒、平肝降压、宁心安神作用外,在扩张血管、改善血管通透性,保护高血压患者心脏、改善高脂血症兔内皮功能、辅助治疗脑梗死及降低血液粘稠度等方面也有重要作用。     

HPLC测定珍菊降压片中氢氯噻嗪和芦丁的含量

目的:建立高效液相色谱法测定珍菊降压片(野菊花,氢氯噻嗪,芦丁等)中氢氯噻嗪和芦丁的含量.方法:以Spherisorb C18(4.6mm×250mm,5μm)为色谱柱,以0.05mol·mL-1枸橼酸溶液-乙腈(80:20)用三乙胺调节pH值至4.1±0.1为流动相,流速为1.0mL·min-1,检测波长为270nm.结果:氢氯噻嗪在10～50μg·mL-1(r=0.9994).芦丁在40～200μg·mL-1(r=0.9993)范围内均与峰面积呈良好的线性关系,平均回收率分别为99.5%,99.4%.结论:本法快速,准确.可同时测定氢氯噻嗪和芦丁的含量.     

珍菊降压片对高血压患者血糖及胰岛素敏感性的影响*

目的探讨珍菊降压片对高血压患者血糖及胰岛素敏感性的影响。方法选取2014年9月—2017年9月本中心收治的高血压患者200例,依据随机数字表法分为珍菊组和常规组,每组各100例。常规组给予常规降压治疗,珍菊组在常规组基础上给予珍菊降压片治疗,比较两组血清钾(K+)、总胆固醇(TC)、三酰甘油(TG)、空腹胰岛素(FIns)、空腹血糖(FPG)、餐后2 h血糖(2 hPG)、收缩压(SBP)、舒张压(DBP)和不良反应情况。结果两组治疗前后血清K+、TC、TG、FIns、FPG和2 hPG水平比较,差异无统计学意义(P0.05);两组治疗后SBP、DBP明显低于治疗前,珍菊组治疗后SBP、DBP明显低于常规组,差异有统计学意义(P0.05);两组不良反应发生率基本相同,差异无统计学意义(P0.05)。结论珍菊降压片对高血压患者血糖及胰岛素敏感性无显著影响,但可以有效提高患者的降压效果,且具有良好的安全性,值得临床作进一步推广。     

珍菊降压片合用雷氏丹参片对高衄压病人的心脏保护作用分析

目的分析珍菊降压片合用雷氏丹参片对高血压病人的心脏保护作用,为临床保护高血压患者的心脏提供科学依据。方法选择2010年4月-2011年9月在我院进行治疗的高血压患者142例,将其随机分为两组,每组71例,对照组采用珍菊降压片进行治疗,治疗组采用珍菊降压片联合雷氏丹参片进行治疗,治疗一段时间后,观察两组患者的血压变化情况、心肌耗氧指数及左心室肥厚的逆转情况,并对其进行总结与分析。结果经过治疗后,治疗组71例患者中显效率为60．56％,无效率为9．86％,总有效率高达90．14％;对照组71例患者中显效率为39．44％,无效21率为29．57％,总有效率为70．43％;比较两组的显效率及总有效率得P〈0．05．差异具有统计学意义：另外两组的血压变化情况、心肌耗氧指数及左心室肥厚的逆转情况,治疗前后统计学处理得P〈0．05,且治疗组均比对照组疗效明显。结论珍菊降压片合用雷氏丹参片对高血压病人的心脏有保护作用,故可在临床上推广与应用。     

替米沙坦联合硝苯地平治疗高血压病的疗效分析

目的 临床研究采用替米沙坦联合硝苯地平缓释片治疗高血压的疗效.方法 本文将选取笔者所在医院收治的154例高血压患者,随机分为观察组与对照组,分别采用联合用药和单独使用硝苯地平缓释片进行临床治疗,观察两组患者的临床疗效及不良反应.结果 经过一个疗程的临床治疗后,其中DBP、SBP、HR值较治疗前均有明显下降,而观察组治疗后的DBP、SBP、HR值明显由于对照组;观察组患者的临床总有效率为96.10%,而对照组的临床总有效率为80.52%,差异具有统计学意义(P﹤0.05);观察组患者不良反应率3.9%;对照组患者不良反应率14.29%.结论 通过临床实践研究,在高血压临床治疗中运用替米沙坦联合硝苯地平缓释片治疗方法,与单独使用硝苯地平缓释片相比疗效更为显著且不良反应率更低.     

替米沙坦在慢性充血性心力衰竭中的疗效分析

目的观察联合血管紧张素Ⅱ受体拮抗剂替米沙坦治疗慢性充血性心力衰竭（CHF）的临床疗效及安全性。方法选择慢性充血性心力衰竭患者34例,根据治疗情况随机分成两组,常规治疗组14例给予内科常规抗心力衰竭治疗,试验组20例在常规治疗的基础上加用替米沙坦治疗。治疗前后观察静息心率（HR）、收缩压（SBP）、舒张压（DBP）、心功能级别、左室舒张末内径（LVEDD）、左室射血分数（LVEF）及心脏指数（CI）。结果两组患者的各项指标在治疗后均较治疗前有明显改善,但试验组较常规治疗组改善更为显著,其临床疗效优于常规治疗组（P〈0．05）。结论在常规抗心衰治疗基础上加用替米沙坦可明显改善患者心功能,是一种安全有效的临床治疗方法。     

替米沙坦联合氨氯地平与氨氯地平单药治疗原发性高血压病的疗效及安全性比较

目的:分析比较替米沙坦联合氨氯地平与氨氯地平单药治疗原发性高血压病的疗效及安全性.方法:选取2014年9月至2015年9月在我院进行治疗的原发性高血压病患者100例作为本次观察对象,根据不同的治疗方法将其分成对照组和观察组,每组50例;对照组予以氨氯地平单药治疗,观察组患者予以替米沙坦联合氨氯地平进行治疗;对比分析两组患者的治疗疗效以及不良反应发生情况.结果:观察组患者的治疗有效率为96.00%明显高于对照组的82.00%,P<0.05,组间差异显著,具有统计学意义;观察组患者的不良反应发生率为6.00%与对照组的不良反应发生率8.00%相比,差异不明显,P>0.05,无统计学意义.结论:使用替米沙坦联合氨氯地平与氨氯地平治疗原发性高血压,比单独使用氨氯地平的疗效更显著;安全性高,值得临床推广.     

关注中西药复方制剂珍菊降压片的用药风险

药品不良反应信息通报制度是我国药品监督管理部门为保障公众用药安全而建立的一项制度。《药品不良反应信息通报》(以下简称《通报》)公开发布以来,对推动我国药品不良反应监测工作、保障广大人民群众用药安全起到了积极作用。     

Growth and capacity for cost‐effectiveness analysis in Africa

As economic evaluation becomes increasingly essential to support universal health coverage (UHC), we aim to understand the growth, characteristics, and quality of cost‐effectiveness analyses (CEA) conducted for Africa and to assess institutional capacity and relationship patterns among authors. We searched the Tufts Medical Center CEA Registries and four databases to identify CEAs for Africa. After extracting relevant information, we examined study characteristics, cost‐effectiveness ratios, individual and institutional contribution to the literature, and network dyads at the author, institution, and country levels. The 358 identified CEAs for Africa primarily focused on sub‐Saharan Africa (96%) and interventions for communicable diseases (77%). Of 2,121 intervention‐specific ratios, 8% were deemed cost‐saving, and most evaluated immunizations strategies. As 64% of studies included at least one African author, we observed widespread collaboration among international researchers and institutions. However, only 23% of first authors were affiliated with African institutions. The top producers of CEAs among African institutions are more adherent to methodological and reporting guidelines. Although economic evidence in Africa has grown substantially, the capacity for generating such evidence remains limited. Increasing the ability of regional institutions to produce high‐quality evidence and facilitate knowledge transfer among African institutions has the potential to inform prioritization decisions for designing UHC.     

Discounting and decision making in the economic evaluation of health-care technologies

Discounting costs and health benefits in cost-effectiveness analysis has been the subject of recent debate - some authors suggesting a common rate for both and others suggesting a lower rate for health. We show how these views turn on key judgments of fact and value: on whether the social objective is to maximise discounted health outcomes or the present consumption value of health; on whether the budget for health care is fixed; on the expected growth in the cost-effectiveness threshold; and on the expected growth in the consumption value of health. We demonstrate that if the budget for health care is fixed and decisions are based on incremental cost effectiveness ratios (ICERs), discounting costs and health gains at the same rate is correct only if the threshold remains constant. Expecting growth in the consumption value of health does not itself justify differential rates but implies a lower rate for both. However, whether one believes that the objective should be the maximisation of the present value of health or the present consumption value of health, adopting the social time preference rate for consumption as the discount rate for costs and health gains is valid only under strong and implausible assumptions about values and facts.     

社区高血压患者规范化管理效果评价

目的探讨对社区高血压患者进行规范化管理的效果,为高血压患者的治疗提供依据。方法2009年3月到2011年12月在北京市西城区德胜社区6个卫生服务站,对经济收入比较稳定的286例高血压患者进行规范化管理,比较干预前后生活方式、服药依从性、腰围控制情况、高血压治疗率及控制率的变化。结果经3年规范化管理后,高盐饮食（每日食盐量≥8g）控制率明显提高,差异有统计学意义（x2=13．319,P〈0．05）,经常食用奶制品及豆制品率提高（每周食用次数≥5次）,差异有统计学意义（x2值分别为10．024、10．179,P〈0．05）;与干预前比较,干预后男、女性腰围正常率均提高,但仅女性差异有统计学意义（x2=15．207,P〈0．05）;患者血压控制达标率明显提高,差异有统计学意义（x2=69．764,P〈0．01）;3年服药依从性比较,差异无统计学意义（P〉0．05）;高血压药物治疗率干预前后差异无统计学意义（P〉0．05）。结论社区高血压患者规范化管理有助于改善患者的生活行为方式、健康状况,提高高血压控制率。     

结构经济分析及其在卫生服务领域中的应用

阐述卫生服务领域中开展结构经济学分析的必要性和重要意义，指出卫生服务领域开展结构经济学研究是合理利用卫生服务资源的需要，是发现医疗卫生服务系统中深层次问题的需要，也是发展卫生经济学研究方法的需要。     

流感灭活疫苗在中国应用效果的Meta分析

目的 了解流感疫苗免疫效果.方法 对国内1998年3月至2008年5月公开发表的符合入选标准的有关流感疫苗免疫效果的研究文献,根据各研究结果的同质性,利用随机效应模型或固定效应模型进行Meta分析.结果 初筛选出16篇文献,有13篇文献符合入选标准,11篇为队列研究,2篇为随机对照研究.对队列研究进行Meta分析发现流感疫苗预防流感样疾病效果,儿童为66%(51%～76%),成年人47%(25%～63%),老年人53%(20%～72%).结论 流感疫苗可有效预防各年龄段流感样疾病的发生.     

我院实施“总量控制结构调整”成效分析

总结了医院1999—2002年“总量控制结构调整”(以下简称“总控”)改革方案的实施结果。运用终末统计指标对医院1999—2002年门诊、病房工作效率和工作质量、疾病构成、经济收益指标进行分析。表明2002年各项指标均优于前3年，“总量控制结构调整”引发了医院内部管理的改革，促进了卫生资源的合理利用，提高了效率与效益，“总控”符合当前卫生改革的趋势。     

山东省医疗保障工作开展成效分析及对策探讨

目的:通过对山东省综合医改中期评估的相关医疗保障数据进行分析,评价判断山东省医改中医保改革任务的落实完成情况、取得的成效,探寻山东目前在推进医疗保障改革进程中存在的主要问题,并分析产生这些问题的深层次原因。方法:通过调查,对山东省17地市医保调研数据进行描述性统计分析。结果:总结了山东省医保改革过程中取得的成效及存在的主要问题。结论:实施医改以来,山东省的医疗保障工作取得了一定的成绩的同时也存在问题,针对改革中遇到的新情况、新问题,提出山东推动医保工作顺利实施的对策和十二五期间医改实施方案的编制思路。     

Contemporary multilevel analysis of the effectiveness of water fluoridation in Australia

Aims: Water fluoridation was extended in Queensland, Australia, across 2009–2011. A research program was commenced to inform the rationale for and the outcome of this program, to estimate the effectiveness of water fluoridation in preventing caries and to predict changes in caries experience as a result of the extension of fluoridation. Methods: Queensland children were selected through a stratified random sample selection in 2010–2012. Oral epidemiological examinations provided individual‐level outcomes for decayed, missing or filled primary or permanent tooth surfaces: dmfs (among 5–8‐year‐olds) and DMFS (9–14‐year‐olds). Explanatory factors at the individual‐level, school‐level and area‐level fluoridation status were derived. Data were weighted to represent the population. Three‐level multilevel multivariable models were sequentially specified for negative binomial distribution of dmfs/DMFS to estimate rate ratios (RR). The effectiveness of area‐level water fluoridation was evaluated in the full models controlling for other factors. Results: Data from 2,214 5–8 year‐olds and 3,186 9–14 year‐olds from 207 schools in 16 areas were analysed. Queensland's average dmfs was 4.23 and DMFS 1.47. The lowest levels of dental caries were observed in long‐term fluoridated Townsville. In the full models, Townsville children had significantly lower caries experience (RR for dmfs: 0.61 (95%CI: 0.44–0.82); RR for DMFS 0.60 (95%CI: 0.42–0.88)) compared with children in non‐fluoridated areas. Conclusion: Comparison of caries experience of children at the time of the extension of water fluoridation supported the rationale for this population health measure.     

孕妇夫妻双方参与健康教育效果观察

目的:探讨孕妇夫妻双方参与治疗妊娠剧吐健康教育对改善临床症状的效果。方法:随机将120例妊娠剧吐孕妇分为实验组和对照组,实验组孕妇夫妻双方参与妊娠剧吐的健康教育;对照组仅对孕妇本人进行健康教育,观察两组孕妇的疗效情况。结果:实验组病情恢复显著优于对照组,有临床意义(P<0.05)。结论:夫妻双方参与妊娠剧吐的健康教育能有效地改善患者的临床症状,缩短病程,是促进妊娠剧吐孕妇积极配合治疗及保证临床疗效的重要环节。     

Sensitivity analysis in economic evaluation: A review of published studies

A structured methodological review of journal articles published in 1992 was undertaken to determine whether recently published economic evaluation studies deal systematically and comprehensively with uncertainty. Ninety three journal articles were identified from a range of searches including a computerised search of the MEDLINE CD-Rom database. Articles were reviewed to determine how they had handled uncertainty in: a) data sources; b) generalisability; c) extrapolation; and d) analytic method. Articles were subsequently assessed to determine how they had represented this uncertainty in terms of the overall results of their analysis. Finally, studies were rated on the basis of their overall performance with respect to dealing systematically and comprehensively with uncertainty. Despite the numerous books and articles devoted to the appropriate methods to be employed by analysts conducting economic evaluation, 22 (24%) studies failed to consider uncertainty at all and 35 (38%) studies employed sensitivity analysis in a manner judged as inadequate. In all, 36 (39%) studies were judged to have given at least an adequate account of uncertainty with 13 (14%) of those judged to have provided a good account of uncertainty. Such disappointing results may reflect a general lack of detail in much of the methods literature concerning how sensitivity analysis should be applied and how results should be presented. Journal editors and readers of economic evaluation articles should acquaint themselves with the methods for handling uncertainty in order that they can critically evaluate the extent to which authors have allowed for uncertainties inherent in their analysis.