美托洛尔联合泮托拉唑预防急性后循环供血区梗死致应激性溃疡出血的临床观察

目的 探讨美托洛尔联合泮托拉唑预防急性后循环供血区梗死并发应激性溃疡出血的临床效果。方法 以2013年6月～2016年6月本院收治的120例急性后循环供血区梗死患者作为研究对象,并随机分为对照组、A组及B组各40例; 对照组患者采用常规疗法治疗脑血管病,A组在对照组基础上加用泮托拉唑注射液进行治疗,B组在A组基础上给予美托洛尔口服,3组疗程均为14 d; 记录并比较3组的胃液pH变化、大便潜血率、应激性溃疡发生率、治愈率及病死率。结果 3组患者性别、年龄等资料比较无明显差异(P>0.05); 治疗3、7及14 d 3组胃液pH存在明显差异(P<0.05),组间两两比较,治疗3、7及14 d B组胃液pH(分别为3.4±0.9、4.7±1.3、5.7±1.6)显著高于A组(2.8±0.6、3.9±1.1、4.8±1.5)及对照组(2.3±0.5、3.0±0.9、3.8±1.2),A组胃液pH显著高于对照组,差异均具有显著性(P<0.05); 治疗14 d内,3组患者大便潜血发生率、应激性溃疡出血发生率、治愈率均存在显著性差异(P<0.05),组间两两比较,B组大便潜血发生率(20%)明显低于A组(32.5%)及对照组(47.5%),应激性溃疡出血发生率(0%)显著低于对照组(12.5%),治愈率(95%)明显高于对照组(72.5%),均有明显差异(P<0.05); 病死率B组低于另外2组,但无明显差异(P>0.05)。结论 美托洛尔口服联合泮托拉唑用于预防急性后循环供血区梗死致应激性溃疡出血,可明显改善胃内酸性环境,降低大便潜血发生率及应激性溃疡出血发生率,显著提高治愈率。     

尼莫地平治疗急性脑梗死的疗效及机制探讨

越来越多的动物试验证明,钙拮抗剂(CEB)对脑缺血性损害具有保护作用。我们自1997年1月以来应用尼莫地平治疗脑梗死40例,取得满意疗效,现报告如下。1　病例与分组本组急性脑梗死(ACI)患者共80例,男57例,女23例。均为首次发生的颈内动脉系统的急性脑梗死,发病后72小时内入院,符合中华医学会第四次全国脑血管病会议制定的诊断标准。按入院的顺序随机分为A组(治疗组)及B组(对照组),各40例。两组患者入院时年龄(63±7)岁比(63±9)岁,神经功能损评分27.83±10.26比20.52±11.61,发病于开始用药的时间19.1±14.6小时比(18.8±13.5)均无显著性差…     

帕金森病患者程序性学习的初步研究

目的研究三种学习记忆任务在非痴呆、并排除合并抑郁症的帕金森病（PD）病人中损害程度。方法采用程序性学习澳扩试软件Nissen二版（SRTT）、外显记忆项目为韦氏记忆量表，内隐记忆项目则采用自由组词和残图命名对16例Hoehn—Yahr分级Ⅰ-Ⅱ级的PD进行研究，其中程序性学习测试设置了正常对照组。结果在PD组未发现外显记忆和内隐记忆项目有统计意义的改变；统计学显示SRTT在正常组随着学习节数增加则明显缩短操作时间，错误也在减少，而PD组虽然错误显著减少，但操作时间改变无统计学意义。结论在PD早期患者中，程序性学习任务SRTT测试发现有选择性损害，而其他记忆项目如韦氏记忆量表、自由组词和残图命名评分则无异常，提示记忆的分离现象。     

氯丙嗪和氯氮平对未经系统治疗精神分裂症患者认知功能的影响

目的 比较典型和非典型抗精神病药对未经系统治疗的精神分裂症患者认知功能的影响.方法 将164例未经系统治疗的精神分裂症住院患者随机分为氯丙嗪组(83例)和氯氮平组(81例),进行双盲对照治疗研究.于治疗前和治疗第12周末各做1次韦氏成人智力量表(WAIS-R)、韦氏记忆量表(WMS)、铁槽铁钉测验、手指敲击试验、动作功能测验、手功能协调测验、连线测验A和B、威斯康星卡片分类测验(WCST)及言语流利性测验10项神经心理测查.结果 治疗第12周末,氯氮平组各项认知功能测查结果 均明显好于氯丙嗪组(P<0.05～0.01);在控制入组时测查的水平和可能的干扰因素(年龄、文化程度和治疗第12周末的阳性症状、阴性症状、药物副反应的程度)后,大部分检测指标两组间差异仍有显著性[氯丙嗪组和氯氮平组WAIS-R操作智商分别为(76.8±19.2)分和(90.5±16.9)分,WMS总分分别为(56.3±24.5)分和(75.4±21.9)分,完成连线测验B的时间分别为(213.9±97.4)s和(143.7±78.5)s,P均=0.000];氯氮平组各项认知功能指标均有所好转,而氯丙嗪组在16项认知功能指标中有7项恶化.结论 未经系统治疗的精神分裂症患者在第1次住院治疗时,氯氮平对其认知功能有改善作用,而氯丙嗪对认知功能的某些方面有损害.     

脑卒中后精神障碍临床观察

我们自1993年～1998年对脑卒中患者的精神障碍及相关因素进行初步研究,报告如下:表1　精神障碍组与精神正常组神经功能缺损评定结果组别例数分值(x±s)疾病严重程度轻(0～15)中(16～30)重(31～45)正常组6213.8±7.617250PSD2419.1±6.3*3201CND156.3±6.8*2121MID1011.3±7.1901PSM418.0±8.7220注:*与正常组比较P<0.05　　资料:经头颅CT证实且无明显失语及意识障碍的脑卒中患者115例。男72例,女43例。年龄45～85岁,平均年龄64±6.1岁。脑梗塞90例(78.2%),脑出血25例(21.8%)。采用DSM～III诊断标准,对符合诊断标准,既往无精神病…     

耳穴压丸与安定治疗失眠的对照分析

近年来,用王不留行籽耳穴压丸治疗失眠已屡有报道(刘傲霜,新中医1991;4:36),为进一步验证其疗效,笔者采用安定为标准药,进行对照研究。病例均为近一年来的门诊患者,均有较严重的失眠。随机分成两组,A组为耳穴治疗30例,其中男性10例,女性20例;B组为安定治疗30例,男性12例,女性18例。平均年龄32.5±8.4岁,病程2.1±1.4年,两组差异均无显著意义(P>0.05)。     

高胰岛素血症与缺血性脑血管病的关系

将71名缺血性脑血管病患者分为A、B两组;A组:微、小脑血管病组(n=33);B组:大脑血管病变组(n=38)。测试所有病人的空腹血糖、胰岛素和C-肽水平。结果显示A组的胰岛素水平明显高于B组(A组:40.50±19.89μu/ml,B组;14±7.27μu/ml,P<0.01 t检验)。提示高胰岛素血症是微小脑血管病变的危险因素。     

不同稀释度A型肉毒毒素治疗痉挛性斜颈的疗效观察

目的　观察不同稀释度A型肉毒毒素 (BTX A)治疗痉挛性斜颈 (ST)的疗效。方法　 2 7例患者随机分为A(14例 )、B(13例 )两组 ,分别采用 12 5U/ml和 5 0U/ml稀释度BTX A注射治疗。结果　A组患者BTX A平均用量 (15 0± 35 74 )U ,有效率 92 .86 % (13/ 14 ) ,药效持续时间 (18 72± 4 5 6 )周。B组患者BTX A平均用量 (2 70± 5 6 74 )U ,有效率 84 .6 2 % (11/ 13) ,药效持续时间 (19 0 5± 5 12 )周。A组患者BTX A平均用量显著低于B组 (P <0 0 0 1) ,有效率和药效持续时间两组差异无显著性 (均P >0 0 5 )。结论　使用 12 5U/ml稀释度BTX A注射治疗ST与 5 0U/ml疗效相似 ,但可显著减少BTX A用量     

动脉瘤性SAH继发重度脑血管痉挛相关因素研究

目的探讨动脉瘤性蛛网膜下腔出血继发重度脑血管痉挛的相关因素。方法回顾本院近5年收治的118例动脉瘤性SAH病人临床及影像学资料;评估入院时临床因素,判定脑血管痉挛程度;统计分析其相关因素。结果重度痉挛组年龄为(44.0±10.9)岁,明显小于无痉挛组的(52.1±11.4)岁和轻中度痉挛组的(50.7±10.7)岁(P=0.007);重度痉挛组的脑内血肿量为(24.87±3.72)m l、白细胞计数为(17.40±4.1)×109,大于轻中度痉挛组的(18±3.26)m l、(12.14±2.91)×109和无痉挛组的(9±1.41)m l、(9.08±2.16)×109(P均<0.001);年龄与血管痉挛程度呈负相关r=-0.241(P=0.008);脑内血肿量和白细胞计数峰值均与血管痉挛程度呈正相关r=0.753(P<0.01)和r=0.694(P=0.001)。结论低年龄、较大的脑内血肿量和白细胞计数峰值是重度脑血管痉挛相关因素。     

番泻叶治疗药源性便秘双盲对照研究

将180例药源性便秘患者随机分为三组。A 组服番泻叶20g/日。B组服酚酞O.5g/日,C 组服大黄20g/日。经双盲对照观察有效率 A 组98%、B 组70%、C 组88%。经 X~2检验三组间有极显著性差异。药效产生时间(?±S)依次为:8.16±4.42、11.38±6.86、9.35±5.42小时,经 t 检验,A、B 组有极显著差异;B.C 组有显著差异;A.C 组差异不显著。结论:番泻叶效果最佳。     

Italian multicentre study of carpal tunnel syndrome: study design

In September 1996, during a carpal tunnel syndrome (CTS) symposium, the Italian CTS Study Group was funded. The group designed a strict clinical and neurophysiological protocol for performing a wide multicentre study on idiopathic CTS in hands. In addition to the traditional evaluations, the group also adopted a validated patient-oriented measurement in order to obtain comprehensive and reliable data for the clinical picture. The study was designed to: (1) better assess the clinical picture of the CTS population, especially using new measurement tools (patient-oriented); (2) evaluate the sensitivity of an electrodiagnostic protocol; (3) re-evaluate the validity of a neurophysiological classification; and (4) evaluate the influence of social status and quantify some of the aspects regarding economic and social costs. The study design is described.Participating members of the Italian CTS Study Group: L. Bertin, Padova; T. Carboni, Neurology, Civil Hospital S. Benedetto del Tronto (AP); P.G. Di Pasqua, Neurology, Paediatric Hospital Bambin Gesù, Palidoro (RM); R. Eleopra, Neurology Division, Arcispedale S. Anna, Ferrara; F. Giannini, Institute for Nervous and Mental Diseases, University of Siena; P. Girlanda, Institute of Neurological and Neurosurgical Sciences, University of Messina; M. Giunchedi, Neurophysiology Laboratory, Hospital of Lavagna (GE); A. Grippo, Neurophysiopathology, Civil Hospital, Viareggio (LU); A. Insola, Neurophysiopathology, Orthopaedic Trauma Centre, Rome; R. Liguori, Neurology, University of Bologna; S. Lori, Neurophysiopathology, ASL 10, Florence; R. Lucchetti, Department of Orthopaedics, Traumatology & Hand Surgery, State Hospital, San Marino (RSM); E. Mariani, Neurophysiopathology, Clinical Institute for Specialization, Milano; D. Murasecco, Neurology, University of Perugia; L. Padua, Neurology, Catholic University, Rome; F. Pisano, Neurophysiopathology, S. Maugeri Foundation IRCCS, Veruno (NO); M. Romano, Neurophysiopathology, Villa Sofia CTO, Palermo; C. Speranzini, Neurology, Hospital A. Murri, Fermo (AP); E Tironi, Neurophysiopathology, Ospedali Riuniti, Bergamo; A. Uncini, Regional Centre for Neuromuscular Diseases, Hospital SS Annunziata, Chieti     

The Zurich study

Summary Hypomania in a 28- to 30-year-old cohort is described. Data were taken from a prospective longitudinal cohort study from the general population of Zurich, Switzerland. An estimated 1-year prevalence rate of hypomania of 4% was found. Over a period of time hypomania was associated with major depression and dysthymia. We found equal proportions of suicide attempts and equal rates of treated family members among hypomanics and depressives. Furthermore, the previous history of treatment of mild bipolars (hypomania with depression) and unipolar depressives was comparable. The sum of life events, several SCL-90R scores and the scores of distress in relationships were already elevated in hypomanics 7 years before diagnosis of hypomania, indicating an increased activity level, a generalized increase in neuroticism, and a relatively unvarying behaviour pattern in social relationships.This paper is number 10 in a series of articles concerning the results of the Zurich Study, published in this journal since 1984     

The Zurich study

Dysthymia was assessed in the prospective Zurich Cohort Study of young adults. The 1-year prevalence rate was around 3% if no exclusion criteria were applied. Pure dysthymics without major or recurrent brief depression accounted for about 1%. Most cases of dysthymia met the symptom criteria for major depressive disorder (MDD) and were characterized by a more continuous course. However, evidence presented in this paper suggests that a diagnosis separate from MDD is not warranted. The family history of dysthymic subjects did not differ from major depressives. The smaller group of primary dysthymics, on the other hand, did not differ from controls as regards family history for treated depression. The low prevalence rates, taken together with methodological problems involved in assessing dysthymia and the lack of a distinct course, suggest that dysthymia does not constitute a valid subtype of depression in an age group of 20-30 years of the community. Dysthymia belongs to the wide spectrum of major depressive syndromes and represents only a subgroup characterized by specific course characteristics.     

The Zurich study

Summary In the epidemiological Zurich cohort study a syndrome of Recurrent Brief Anxiety (RBA) was identified and operationalized. It had a 1-year prevalence rate of 2.7, males seemed to prevail slightly. RBA was highly associated with Recurrent Brief Depression (RBD) and panic, and to a minor extent with agoraphobia and dysthymia. The family history was positive for depression and anxiety (panic, generalized anxiety disorder). In studies of panic, one should look for the frequently associated syndromes of RBA and RBD.Supported by grant 32-9502/3.873-0.88 from the Swiss National Science Foundation     

The Zurich study

Summary The purpose of this study was to investigate antecedents of first incidence of major depressive disorder and recurrent brief depression with the help of a cohort of 20 year-old Swiss, who was interviewed four times up to age 30. Cases diagnosed as depressed at the third or fourth interview (age 28 or 30) were compared with never diagnosed controls for antecedents at the first and second interview (age 21 and 23). Besides retrospectively assessed childhood precursors, later depressives showed slight differences in their relationship to parents and friends and early symptoms of subclinical depression, persistent helplessness and a surplus of life events. These antecedents were mainly found in females. The most persistent antecedent of later depression for both sexes was a higher score than controls' on the SCL-90R (negative affectivity). Whether this finding signifies that proneness to the milder depressions in young adults is rooted in personality is subject to discussion.Supported by grant 32-9502/3.873-0.88 from the Swiss National Science Foundation