我国全科医学教育培养规格、教学内容和教学方法探讨

我国全科医学教育培养规格、教学内容和教学方法探讨韩岫廷，刘连忠，吕治昌（吉林卫生管理干部学院长春１３００６１）１我国开展全科医学教育应遵循的原则１．１学习国外经验必须结合我国实际，不能照搬国外全科医学教育的模式。１．２开展不同层次、不同形式的全科医生...     

利培酮口服液合用氯硝西泮与氟哌啶醇针剂肌内注射治疗精神分裂症急性激越症状疗效和安全性的研究

Objective To compare the efficacy and safety between risperidone oral solution combination clonazepam oral and haloperidol IM injection on controlling psychotic agitation in patients of acute schizophrenia or schizophrenic-affective disorder and to explore the possibility of decreasing efficacy of 6 week acute treatment from switching IM injection to oral.Method Altogether 205 patients exhibiting agitation were randomly assigned to receive either oral treatment with risperidone oral solution puls clonazepam ( n = 104) or intramuscular injection treatment with haloperidol ( n = 101 ).The primary efficacy outcome measure was the change in scores based on PANSS-EC in session Ⅰ ( the first five days), and the response rate based on the PANSS score in session Ⅱ ( the following 6 weeks).Safety was evaluated using the Simpson-Angus Scale (ASA), Barnes Akathisia Scale (BAS), adverse events and lab test.Result Mean acute-agitation score improvement was significant after 5 day treatment in both groups (P ＜0.01 ) and were similar in both groups ( P ＞ 0.05).While the cooperation was better and the advert events, especially extrapyramidal symptoms was lower in risperidone oral solution groups than that in haloperidol IM injection group(P ＜0.05).The mean PANSS-EC and PANSS scores remained stable after switching from IM injection to oral.The efficacy was not differenct in both groups after 6 week treatment (P ＞ 0.05).There was no significant difference at the rate of total advert events ( P ＞ 0.05 ) while there were yet significantly higher rates of extrapyramidal symptoms in switching drug group than that in oral group ( P ＜ 0.05 ).Conclusion Risperidone oral solution plus oral clonazepam has similar therapeutic effect to haloperidol IM injection in the treatment of acute agitation, but risperidone oral solution plus clonazepam has better compliance and tolerability.The illness is stable after switching from haloperidol IM injection to risperidone oral solution, in the following 6 week treatment.     

星状神经节阻滞联合鲁南欣康治疗耐药性心绞痛的临床研究

目的观察星状神经节阻滞(SGB)联合鲁南欣康治疗耐药性心绞痛的有效性.方法65例耐药性心绞痛病人随机分为Ⅰ组(SGB联合鲁南欣康药物治疗)35例、Ⅱ组(单纯鲁南欣康药物治疗).观察并记录治疗前后患者疼痛情况和2年内心血管相关事件发生情况.结果Ⅰ组有效率为100%,Ⅱ组有效率为67%,两组相比有显著性差异(P＜0.05);治疗后2年内发生心脑血管缺血性相关事件Ⅰ组远低于Ⅱ组(P＜0.05);再住院的病例Ⅱ组远高于Ⅰ组,具有显著性差异(P＜0.01).结论SGB联合鲁南欣康药物治疗耐药性心绞痛优于单纯鲁南欣康药物治疗.     

利培酮口服液合用氯硝西泮与氟哌啶醇针剂肌内注射治疗精神分裂症急性激越症状疗效和安全性的研究

目的 比较利培酮口服液合用氯硝西泮与氟哌啶醇针剂肌内注射(以下简称肌注)对精神分裂症急性激越症状的疗效和安全性,以及由氟哌啶醇肌注换利培酮口服(以下简称换药组)对急性期疗效的影响.方法 205例伴有急性激越症状的精神分裂症患者按随机数字表方法分为利培酮口服液组(104例)和氟哌啶醇肌注组(101例).研究分为急性激越症状疗效评价(治疗前5 d)和换药后急性期疗效评估(治疗6周)2个阶段.以阳性和阴性症状量表兴奋因子(PANSS-EC)及阳性和阴性症状量表(PANSS)总分作为主要疗效评价指标.安全性评估采用锥体外系副反应量表(Simpson-Angus Rating Scale,SAS)和静坐不能评定量表(Barnes Akathisia Scale,BAS)评定锥体外系症状、记录不良事件和实验室检查.结果 治疗前5 d利培酮口服液组和氟哌啶醇肌注组的急性激越症状都有明显改善(P＜0.01),2组间疗效差异无统计学意义(P＞0.05);利培酮口服液组合作程度好于氟哌啶醇肌注组(P＜0.05),锥体外系不良反应低于氟哌啶醇肌注组(P＜0.05).由氟哌啶醇肌注换利培酮口服后,治疗6周末口服组和换药组疗效及总体不良事件发生率比较差异均无统计学意义(P均＞0.05),但锥体外系不良反应换药组高于口服组,差异有统计学意义(P＜0.05).结论 利培酮口服液合用氯硝西泮口服治疗精神分裂症急性激越症状与氟哌啶醇肌注疗效相当,但利培酮口服液合作程度好,锥体外系不良反应发生率低.由氟哌啶醇肌注换利培酮口服对急性期疗效无明显影响.     

帕利哌酮与阿立哌唑治疗男性精神分裂症患者疗效及对性功能的影响对照

目的:研究帕利哌酮治疗男性精神分裂症患者的疗效及对性功能的影响。方法:将78例已婚男性精神分裂症患者分别给予帕利哌酮(38例)与阿立哌唑(40例)治疗,在基线时及8周末采用阳性与阴性症状(PANSS)量表、个人和社会功能量表(PSP)及简明男性性功能量表评价临床疗效及性功能,检测血清泌乳素(PRL)水平。结果:治疗8周末,2组有效率无显著性差异(P>0.05);2组间PANSS评分无统计学意义(P>0.05),帕利哌酮组PSP评分明显高于阿立哌唑组(P<0.01);帕利哌酮组的性欲、性唤起、性高潮及性功能总分均显著低于基线值(P<0.01),阿立哌唑组性功能各因子无明显下降;治疗第8周末,帕利哌酮组的泌乳素(PRL)水平明显高于基线时水平,高于阿立哌唑组(P<0.01)。结论:帕利哌酮治疗男性精神分裂症疗效与阿立哌唑相当,社会功能恢复优于阿立哌唑,但可能导致性功能下降。     

利培酮口服液合用氯硝西泮与氟哌啶醇针剂肌内注射治疗精神分裂症急性激越症状疗效和安全性的研究

Objective To compare the efficacy and safety between risperidone oral solution combination clonazepam oral and haloperidol IM injection on controlling psychotic agitation in patients of acute schizophrenia or schizophrenic-affective disorder and to explore the possibility of decreasing efficacy of 6 week acute treatment from switching IM injection to oral.Method Altogether 205 patients exhibiting agitation were randomly assigned to receive either oral treatment with risperidone oral solution puls clonazepam ( n = 104) or intramuscular injection treatment with haloperidol ( n = 101 ).The primary efficacy outcome measure was the change in scores based on PANSS-EC in session Ⅰ ( the first five days), and the response rate based on the PANSS score in session Ⅱ ( the following 6 weeks).Safety was evaluated using the Simpson-Angus Scale (ASA), Barnes Akathisia Scale (BAS), adverse events and lab test.Result Mean acute-agitation score improvement was significant after 5 day treatment in both groups (P ＜0.01 ) and were similar in both groups ( P ＞ 0.05).While the cooperation was better and the advert events, especially extrapyramidal symptoms was lower in risperidone oral solution groups than that in haloperidol IM injection group(P ＜0.05).The mean PANSS-EC and PANSS scores remained stable after switching from IM injection to oral.The efficacy was not differenct in both groups after 6 week treatment (P ＞ 0.05).There was no significant difference at the rate of total advert events ( P ＞ 0.05 ) while there were yet significantly higher rates of extrapyramidal symptoms in switching drug group than that in oral group ( P ＜ 0.05 ).Conclusion Risperidone oral solution plus oral clonazepam has similar therapeutic effect to haloperidol IM injection in the treatment of acute agitation, but risperidone oral solution plus clonazepam has better compliance and tolerability.The illness is stable after switching from haloperidol IM injection to risperidone oral solution, in the following 6 week treatment.     

社会心理应激与自杀

自杀者比一般人群有更多的应激 ,本文初步探讨了自杀者中常见的生活事件类型、生活事件与自杀的关系以及针对生活事件的干预措施     

强制戒毒人群自杀意念调查及护理对策

采用问卷调查法对96例强制戒毒者的自杀意念发生情况进行调查。结果吸毒前自杀意念发生率为16.7％,吸毒后自杀意念发生率为66.7％,吸毒前后比较,P<0.01,差异有极显著性意义,提示吸毒行为对自杀意念的产生有极大影响,对吸毒者进行脱毒治疗时应进行相关的护理干预。     

中国特色精神科日间医院的探索

现阶段我国精神分裂症、双相障碍等重性精神病导致的精神残疾康复手段缺乏,抑郁症、焦虑症等的心理咨询和治疗亦不完善,医院的精神科非常需要成立专业的心理治疗部门。精神科的日间医院是一种创新的医疗服务,患者白天到医院接受心理康复治疗,晚上回家和家人一起生活,是患者从医院回归社会的一个中转站。本文即对此新的医疗模式进行探讨。     

齐拉西酮辅助治疗不同病程抑郁症的临床研究

目的 观察齐拉西酮对于不同病程的抑郁症的增效作用和不良反应.方法 选取我院就诊的病程少于等于24个月的抑郁症患者（甲组）110例随机分别给予单用艾司西酞普兰（甲组单用组）和齐拉西酮合并艾司西酞普兰（甲组合用组）治疗,观察12周;选取病程大于24个月的111例抑郁症患者（乙组）随机分别给予单用艾司西酞普兰（乙组单用组）和齐拉西酮合并艾司西酞普兰（乙组合用组）治疗,观察12周.于治疗前及治疗后第1、2、4、8、12周分别用汉密尔抑郁量表（HAMD）及临床总体印象量表（CGI）评定疗效,治疗中需处理的不良反应症状量表（TESS）评定不良反应及安全性.结果 （1）甲组单用组和合用组HAMD评分从治疗后第1周末开始与治疗前比较均明显降低（P＜0.05,P＜0.01）;且两组HAMD评分在治疗各时点比较均无显著性差异（P＞0.05）.乙组单用组HAMD评分在治疗后第2、4、8、12周末较治疗前明显减低（P ＜0.05,P＜0.01）;而合用组在在治疗后各时点与治疗前比较均明显降低（P＜0.05,P＜0.01）;治疗后合用组HAMD评分各时点均低于单用组（P＜0.05,P＜0.01）.（2）治疗后第12周末乙组两组有效率比较,存在显著性差异（P＜0.01）.（3）甲组单用组出现的不良反应较合用组少（P＜0.01）,两组在头痛头昏、焦虑激越、肝功能异常、恶心呕吐、便秘方面,合用组明显高于单用组（P＜0.05,P＜0.01）;乙组单用组与合用组无显著性差异（P＞0.05）.结论 对于病程较短（少于等于24个月）的抑郁症患者,建议单用艾司西酞普兰治疗;对病程较长（大于24个月）的患者,建议将齐拉西酮作为增效剂与艾司西酞普兰合用.