解放军预防医学杂志2004年第22卷学科分类总题录索引

述　评关于预防为主卫生工作方针确立和　实施的历史回顾涂通今等 (1) :1…………………………重大紧急疫情的特点与应对策略柴光军 (2 ) :79……………军事预防医学专业课程体系改革的思考　和实践王　冬等 (3) :15 7…………………………………适应形势加强建设严格执法努力开创　军队卫生监督工作新局面袁永林 (5 ) :32 1………………美国炭疽事件的医学处置及启示马　静等 (6 ) :4 0 7………加强军队防疫队伍建设对策探讨王守广等 (6 ) :4 10………劳动卫生学短效催眠药三唑仑、唑吡坦和佐匹克隆对　人体认知能力的影响李砚峰等 (1) :10…     

短效催眠药唑吡坦和三唑仑对人体前庭功能的影响

目的 :探讨两种短效催眠药唑吡坦和三唑仑对人体前庭功能的影响 ,为在应急条件下对飞行员服用该药提供试验依据。方法 :8名受试者 ,采用三阶段交叉双盲给药设计方法 ,分别交叉服用三唑仑 (0 .2 5mg)、唑吡坦 (10mg)、安慰剂 ,每次间隔 1周 ,在服药前 1h及服药后1、2、3、4、6、8、10h分别进行一组前庭功能测试 ,包括视动性眼震 (OKN)、前庭眼动反射 (VOR)、前庭眼动反射固视抑制 (VOR -Fix)、视前庭眼动反射 (VVOR)。结果 :与安慰剂组比较 ,服用唑吡坦和三唑仑后均能显著降低VOR、OKN、SPT增益 ,在服药 2h后降到最低〔VOR :(0 .5 1± 0 .0 4 ) ,(0 .5 2± 0 .0 5 )vs (0 .6 7± 0 .13) ;OKN :(0 .32± 0 .0 2 ) ,(0 .6 2± 0 .0 6 )vs (0 .82± 0 .0 7) ;SPT :(0 .71± 0 .14 ) ,(0 .6 6± 0 .0 6 )vs (0 .93± 0 .0 3)〕。其中唑吡坦对OKN增益的降低要强于三唑仑 ,但这种影响持续时间不长 ,在服药 6h后即消失。两种短效催眠药对VVOR增益、SPT相位及VOR -Fix均无明显影响。结论 :唑吡坦及三唑仑对人体前庭功能具有一定的影响 ,但这种影响持续时间较短 ,对人体的空间定向及平衡能力无残留后遗效应     

滥用新型安眠药可致残

正安眠药以巴比妥类为第一代,苯二氮艹卓受体激动剂类为第二代,非苯二氮艹卓类受体激动剂等新型安眠药物为第三代。由于苯二氮艹卓类药物不良反应较多,现在越来越多的新型镇静催眠药物被批准用于临床,其主要种类有唑吡坦、佐匹克隆、右佐匹克隆、扎来普隆、雷美替胺、阿戈美拉汀、特斯美尔通等。右佐匹克隆、扎来普隆、唑吡坦     

说说安眠药的那些事

<正>安眠药即镇静催眠药,主要有以下几类:(1)巴比妥类药物,如苯巴比妥等;(2)苯二氮卓类药物(又称安定类药物),如氯硝西泮、地西泮等;(3)其他类,如佐匹克隆、唑吡坦等。很多患者对服用安眠药有种种疑惑,本文就常见的问题作一解答。长期服安眠药会成瘾吗长期服安眠药会成瘾吗?成瘾相关的临床表现主要包括耐受性、戒断症状及     

浅谈失眠的药物治疗

正目前临床治疗失眠的药物,主要包括苯二氮艹卓类受体激动剂(BZRAs)、褪黑素受体激动剂、食欲素受体拮抗剂和具有催眠效应的抗抑郁药物。药物种类的选择非苯二氮艹卓类药物(non-BZDs)唑吡坦、右佐匹克隆和佐匹克隆属于快速起效的催眠药物,能够诱导睡眠始发,治疗入睡困难和睡眠维持障碍。扎来普隆的半衰期较短,仅适用于     

滥用安眠药危害大

右佐匹克隆、扎来普隆、唑吡坦这三种安眠药都是处方药,属于二类精神药品。按照规定,只有精神科医生以及取得二类精神药品处方资格的医生才能开出,且只能在医院买到。然而,有些患者为贪图方便,会利用家人的此类药物,或通过其他途径来获取此类药物,继而自行服药。殊不知,处方药不遵医嘱或不在药师的指导下自行服用,会产生严重药物不良反应,可致人残疾甚至死亡。     

FDA警告:滥用安眠药可致残致死

<正>右佐匹克隆、扎来普隆、唑吡坦这3种新型安眠药都是处方药,且还属于二类精神药品。按照规定,只有精神科医生以及取得二类精神药品处方资格的医生才能开出,且只能在医院买到,药店不允许销售。然而,有些患者为贪图方便,会利用家人的此类药物,或通过其他途径来获取此类药物,继而自行服药,美其名曰自我药疗。殊不知,处方药不遵医嘱或不在     

您了解褪黑素和褪黑素能类药物吗

<正>近几十年来,经济发展速度很快,生活节奏提速,工作压力加大,这让人们适应起来有一定的难度,各年龄段人群的焦虑水平提高,睡眠问题也增多,特别是中老年,大约有一半以上的中老年人抱怨睡眠不好。良好的睡眠对健康非常重要,长期睡眠不足会出现记忆力下降、注意力不集中、情绪不稳定、精神不好和躯体不适等症状。因此,如何有效改善睡眠就成了人们非常关注的问题。目前,临床上有很多治疗睡眠障碍的药物,人群中服用较多的有安定类、新型安眠药(唑吡坦、佐匹克隆、右佐匹克隆)等药物。这些药有一定疗效,但是服用一段时间后容易产生依赖性、耐药性,有的安眠药还影响记忆等认知功能,影响开车等操作,专家不建议人们长期使用。近年来对褪黑     

比较右佐匹克隆片与艾司唑仑片治疗戒毒人员睡眠障碍的临床疗效及对睡眠质量的影响

目的探讨在戒毒人员睡眠障碍治疗中右佐匹克隆片与艾司唑仑片对临床疗效及对睡眠质量的影响。方法选取2019年1月-2021年在2月在我院接受治疗的60例汕尾市强制隔离戒毒所学员作为研究对象,根据随机数字表法将患者分为两组,分别为观察组(n=30)与对照组(n=30),对照组使用艾司唑仑片治疗,观察组使用右佐匹克隆片治疗,对两组临床疗效、心理状态及对睡眠质量进行比较。结果观察组治疗总有效率与对照组相比明显更高(P<0.05);治疗后,两组汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分明显降低(P<0.05),观察组HAMA、HAMD评分较对照组明显更低(P<0.05);治疗后,两组睡眠状况问卷自评量表(SRSS)评分较治疗前明显降低(P<0.05),匹兹堡睡眠质量指数量表(PSQI)评分较治疗前明显提高(P<0.05),观察组SRSS评分明显低于对照组(P<0.05),PSQI评分明显高于对照组(P<0.05)。结论将右佐匹克隆片应用于戒毒人员睡眠障碍患者中可促进临床疗效的提高,有效改善患者心理状态,提高睡眠质量。     

佐匹克隆按需治疗精神分裂症伴有失眠症的临床疗效观察报告

目的:观察佐匹克隆治疗精神分裂症伴有失眠症的临床疗效与不良反应.方法:将64例住院精神分裂症伴有失眠症患者为观察组,随机选择在住院的62例精神障碍患者为对照组.观察组64例,按需口服佐匹克隆片7.5mg/次;对照组62例,连续口服佐匹克隆片7.5mg/次,两组疗程均为4周;有正或副主任医师带领三名主治医师对疗效进行评估、用不良反应量表(TESS)评价不良反应.结果:观察组64例患者中痊愈42例,显著进步14例,好转8例,无效0例;对照组62例患者中痊愈22例,显著进步33例,好转7例,无效0例,两组疗效间差异有显著统计学意义(χ<'2>,P<0.001).治疗过程中观察组不良反应发生率为15.6%(10/64);对照组不良反应发生率为14.5%(9/62).结论:佐匹克隆按需治疗精神分裂症伴有失眠症的疗效显著、副反应不明显,可作为治疗精神分裂症的辅助用药.     

Effects of Tyrosine,Phentermine, Caffeine d-amphetamine,and Placebo on Cognitive and Motor Performance Deficits During Sleep Deprivation

Abstract

Cognitive and motor performance are critical in many circumstances and are impaired by sleep deprivation. We administered placebo, tyrosine 150 mg/kg, caffeine 300 mg/70 kg, phentermine 37.5 mg and _d-amphetamine 20 mg at 15.30 h following overnight sleep deprivation and compare their effects on cognitive and motor performance in healthy young men. Tests of visual scanning, running memory, logical reasoning, mathematical processing, the Stroop task, four-choice serial reaction time, time wall take, pursuit tracking, visual vigilance, Trails (B) task and long-term memory were evaluated at standardized intervals before, during and after sleep deprivation and drugs. Performance decrements with sleep deprivation occurred in visual scanning, running memory, logical reasoning, mathematical processing, the Stroop test, the time wall test, tracking and visual vigilance. Interestingly, with sleep deprivation some tests improved and others did not deteriorate. Improvements with medication following sleep deprivation were seen in running memory, logical reasoning, mathematical processing, tracking and visual vigilance. Although less effective than _d-amphetamine, tyrosine improved performance on several tests. We conclude that all drugs tested improved at least some aspects of cognitive and motor performance after sleep deprivation. As a naturally occurring amino acid, and thus amenable to nutritional strategies, tyrosine may deserve further testing.     

Effects of calcium channel inhibitors on ethanol effects and pharmacokinetics in healthy volunteers

Previous studies have shown that calcium channel antagonists alter the effects of alcohol in animals and humans. We selected a phenylalkylamine, verapamil, and a dihydropyridine, nimodipine, to determine whether these drugs would affect the subjective or psychomotor effects of ethanol in humans. Subjects ingested verapamil (80 mg, PO), nimodipine (30 and 60 mg, PO), or placebo 60 min before drinking an alcohol (0.7 g/kg) or placebo beverage. Subjects' mood, psychomotor performance, physiological status, and blood alcohol levels were assessed up to 3 h after beverage ingestion. Alcohol increased “drunk” ratings and impaired psychomotor performance (p < 0.05). Blood alcohol levels were decreased by nimodipine pretreatment, but not by verapamil pretreatment. Subjective and psychomotor effects of alcohol were not altered as a function of nimodipine or verapamil pretreatment. Nimodipine, verapamil, and alcohol, either alone or in combination, had no effect on blood pressure or heart rate.     

Association Between Zolpidem Use and Glaucoma Risk: A Taiwanese Population-Based Case-Control Study

Background

To date, the relationship between zolpidem use and subsequent risk of glaucoma in a Taiwanese population has not been assessed.

Methods

We used data from the National Health Insurance system to investigate whether zolpidem use was related to glaucoma risk. A 1:4 matched case-control study was conducted. The cases were patients newly diagnosed with glaucoma from 2001 to 2010. The controls were randomly selected non-glaucoma subjects matched by sex and age (±5 years). Zolpidem exposure and/or the average dosage of zolpidem used (mg/year) were evaluated. Medical comorbidities were considered as confounding factors. Multiple logistic regression models were used to evaluate the potential risk of zolpidem exposure on glaucoma with/without adjustment for the effects of confounding variables.

Results

The exposure rate of zolpidem use in the glaucoma group was significantly higher than that of the control group (2.8% vs. 2.0%, P < 0.0001). The adjusted odds ratio (OR) of the risk of glaucoma for those with zolpidem use vs. those without was 1.19 (95% confidence interval [CI], 1.02–1.38). Compared to non-zolpidem users, zolpidem users with an average dose of more than 200 mg/year had significantly increased risk of glaucoma (OR 1.31, 95% CI 1.03–1.68).

Conclusions

This study suggests that the use of zolpidem might increase the risk of subsequent glaucoma. Further confirmatory studies are recommended to clarify this important issue.Key words: zolpidem, glaucoma, Taiwanese     

Effects of Meal Composition on Blood Alcohol Level, Psychomotor Performance and Subjective State after Ingestion of Alcohol

Moderating effects of meal composition on psychomotor performance impairment and feelings after alcohol were examined in a between-subjects design. Fifty-one male volunteers fasted or received either a high carbohydrate (85% energy) or a high protein (94% energy) meal. Alcohol was administered at a dose to achieve a blood alcohol level (BAL) of 60 mg/100 ml, as a placebo. Subjects performed a dual task of primary tracking and secondary reaction time and a five-choice reaction time task. Feelings were also assessed by rating. The high carbohydrate meal reduced BAL at peak and 2 h after drinking, but a high protein meal had no significant effect. Although performance was impaired by alcohol, neither meal significantly reduced impairment and there was no effect of meal type on performance in the placebo condition. However, alcohol increased rated intoxication and the high carbohydrate meal reduced this effect. Subjects who had consumed high protein meals had more negative affect 2 h after alcohol than did subjects who had consumed high carbohydrate meals or fasted. It is concluded that there is only a weak relationship between BAL and performance impairment and food has only limited effects on impairment, although it reduces BAL.     

Increased risk of hospitalization related to motor vehicle accidents among people taking zolpidem: a case-crossover study

Background

Several epidemiological and experimental studies have found a positive association between the risk of motor vehicle accidents (MVAs) and use of zopiclone and benzodiazepines. There is, however, little evidence of any risk of MVA attributable to the use of zolpidem 1 day before such accidents. We attempted to determine whether the use of zolpidem 1 day before is associated with an increased risk of an MVA.

Methods

Using a 1-million-person randomly sampled cohort from the Taiwan National Health Insurance reimbursement database, 12 929 subjects were identified as having been hospitalized between 1998 and 2004 due to an MVA. Using a case–crossover design, we selected the day before an MVA as the case period for each subject, and the 91st, 182nd, and 273rd days before the case period as 3 retrospective control periods. Conditional logistical regression models were constructed to calculate the odds ratio (OR) of having an MVA and the exposure of zolpidem 1 day before. We calculated doses of benzodiazepines, zopiclone, and zolpidem based on their defined daily dose.

Results

The adjusted OR for involvement in an MVA after taking 1 defined daily dose of zolpidem was 1.74 (95% confidence interval: 1.25–2.43). There were also positive effects for different washout periods and cumulative doses at 7, 14, 21, and 28 days before the occurrence of an MVA.

Conclusions

Use of zolpidem 1 day before might be associated with an increased risk of MVA. Thus, precautionary warnings should be provided when prescribing zolpidem.Key words: zolpidem, benzodiazepines, motor vehicle accidents, case–crossover design, pharmacoepidemiology     

Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women

As memory and concentration impairments are a frequent complaint in post-menopausal women, this well-defined population was selected to investigate the effect on mood and cognition of chronic treatment with Gincosan. In a double-blind placebo controlled study, post-menopausal women aged 51-66 were randomly assigned to 12 weeks' treatment with Gincosan (320mg/day), containing 120mg Ginkgo biloba, and 200mg Panax ginseng (n = 30), or matched placebo (n = 27). They were given measurements of mood, somatic anxiety, sleepiness, and menopausal symptoms and a battery of cognitive tests before treatment and after 6 and 12 weeks of treatment. There were no significant effects of Gincosan treatment on ratings of mood, bodily symptoms of somatic anxiety, menopausal symptoms, or sleepiness or on any of the cognitive measures of attention, memory or frontal lobe function. Thus, after chronic administration, Gincosan appeared to have no beneficial effects in post-menopausal women.     

Gincosan (A Combination of Ginkgo biloba and Panax ginseng ): The Effects on Mood and Cognition of 6 and 12 Weeks' Treatment in Post-menopausal Women

Abstract

As memory and concentration impairments are a frequent complaint in post-menopausal women, this well-defined population was selected to investigate the effect on mood and cognition of chronic treatment with Gincosan. In a double-blind placebo controlled study, post-menopausal women aged 51-66 were randomly assigned to 12 weeks' treatment with Gincosan (320 mg/day), containing 120 mg Ginkgo biloba , and 200 mg Panax ginseng ( n =30), or matched placebo ( n =27). They were given measurements of mood, somatic anxiety, sleepiness, and menopausal symptoms and a battery of cognitive tests before treatment and after 6 and 12 weeks of treatment. There were no significant effects of Gincosan treatment on ratings of mood, bodily symptoms of somatic anxiety, menopausal symptoms, or sleepiness or on any of the cognitive measures of attention, memory or frontal lobe function. Thus, after chronic administration, Gincosan appeared to have no beneficial effects in post-menopausal women.     

The effects of alcohol and other drugs on psychomotor performance and cognitive function.

The effects of four doses of alcohol (0.25 g/kg-1 g/kg) and placebo on a standard test battery of cognitive and psychomotor performance are described. The tests included critical flicker fusion threshold, choice reaction time, tracking and memory scanning. The results of this experiment are compared with those of a number of similar studies which examined the effects of other psychoactive substances. Using relative effect sizes, the behavioural toxicity of alcohol is compared with the effects of these other drugs on psychomotor performance and cognitive function.     

Zolpidem Use and Risk of Fracture in Elderly Insomnia Patients

Objectives

To evaluate the risk of fractures related with zolpidem in elderly insomnia patients.

Methods

Health claims data on the entire South Korean elderly population from January 2005 to June 2006 were extracted from the Health Insurance Review and Assessment Service database. We applied a case-crossover design. Cases were defined as insomnia patients who had a fracture diagnosis. We set the hazard period of 1 day length prior to the fracture date and four control periods of the same length at 5, 10, 15, and 20 weeks prior to the fracture date. Time independent confounding factors such as age, gender, lifestyle, cognitive function level, mobility, socioeconomic status, residential environment, and comorbidity could be controlled using the casecrossover design. Time dependent confounding factors, especially co-medication of patients during the study period, were adjusted by conditional logistic regression analysis. The odds ratios and their 95% confidence intervals (CIs) were estimated for the risk of fracture related to zolpidem.

Results

One thousand five hundred and eight cases of fracture were detected in insomnia patients during the study period. In our data, the use of zolpidem increased the risk of fracture significantly (adjusted odds ratio [aOR], 1.72; 95% CI, 1.37 to 2.16). However, the association between benzodiazepine hypnotics and the risk of fracture was not statistically significant (aOR, 1.00; 95% CI, 0.83 to 1.21). Likewise, the results were not statistically significant in stratified analysis with each benzodiazepine generic subgroup.

Conclusions

Zolpidem could increase the risk of fracture in elderly insomnia patients. Therefore zolpidem should be prescribed carefully and the elderly should be provided with sufficient patient education.     

Effects of tyrosine,phentermine, caffeine D-amphetamine,and placebo on cognitive and motor performance deficits during sleep deprivation

Cognitive and motor performance are critical in many circumstances and are impaired by sleep deprivation. We administered placebo, tyrosine 150 mg/kg, caffeine 300 mg/70 kg, phentermine 37.5 mg and D-amphetamine 20 mg at 15.30 h following overnight sleep deprivation and compare their effects on cognitive and motor performance in healthy young men. Tests of visual scanning, running memory, logical reasoning, mathematical processing, the Stroop task, four-choice serial reaction time, time wall take, pursuit tracking, visual vigilance, Trails (B) task and long-term memory were evaluated at standardized intervals before, during and after sleep deprivation and drugs. Performance decrements with sleep deprivation occurred in visual scanning, running memory, logical reasoning, mathematical processing, the Stroop test, the time wall test, tracking and visual vigilance. Interestingly, with sleep deprivation some tests improved and others did not deteriorate. Improvements with medication following sleep deprivation were seen in running memory, logical reasoning, mathematical processing, tracking and visual vigilance. Although less effective than D-amphetamine, tyrosine improved performance on several tests. We conclude that all drugs tested improved at least some aspects of cognitive and motor performance after sleep deprivation. As a naturally occurring amino acid, and thus amenable to nutritional strategies, tyrosine may deserve further testing.