精神分裂症与心境障碍交替发作47例临床分析

目的:探讨精神分裂症和心境障碍交替发作这一特殊病例群体的演变规律和可能的诊断归属问题。方法:在15年间住院3次或以上,诊断为精神分裂症或心境障碍的638例病历中筛选出有精神分裂症和心境障碍诊断变更的81例,按中国精神障碍分类与诊断标准第3版分别再诊断,符合要求者作为研究组,共47例(7.4%)。结果:精神分裂症→心境障碍组36例,最后诊断为精神分裂症14例(38.9%),诊断为心境障碍22例(61.1%);心境障碍→精神分裂症组11例,最后诊断为心境障碍7例(63.6%),精神分裂症4例(36.4%);心境障碍→精神分裂症组的最后诊断与初次诊断的一致率显著高于精神分裂症→心境障碍组(P<0.05)。结论:本类型精神障碍在现象学层面是一个独立的疾病单元,其生物学特性以及临床特征可能与心境障碍存在更大关联,有待大样本前瞻性研究。建议在精神疾病分类方案与诊断标准中有其正式的归属。     

Deprescripción en personas mayores: es el momento de pasar a la acción

El uso de fármacos conlleva innegables beneficios en las personas mayores, pero no está exento de efectos indeseables. La deprescripción es el proceso de revisión sistemática de la medicación con el objetivo de lograr la mejor relación riesgo-beneficio en base a la mejor evidencia disponible. Este proceso es especialmente importante en mayores polimedicados, sobretratados, frágiles, con enfermedades terminales y en el final de la vida.La deprescripción debe hacerse de forma escalonada, estableciendo un seguimiento estrecho por si aparecen problemas tras la retirada. En la toma de decisiones es muy importante contar con la opinión del paciente y de los cuidadores, valorando los objetivos del tratamiento según la situación clínica, funcional y social del enfermo.Existen múltiples herramientas para facilitar a los clínicos la tarea de seleccionar qué fármacos deprescribir (criterios Beers, STOPP-START…). Los grupos farmacológicos más susceptibles de intervención son: antihipertensivos, antidiabéticos, estatinas, benzodiacepinas, antidepresivos, anticolinérgicos, anticolinesterásicos y neurolépticos.Palabras clave: Polifarmacia, Envejecimiento, Comorbilidad, Prescripción inadecuada, Efectos adversos, Deprescripción     

多索茶碱治疗老年肺功能下降患者的疗效观察

目的：观察多索茶碱对老年肺功能下降患者的临床疗效。方法将134例肺功能下降的老年患者随机分为观察组和对照组各67例。在常规内科治疗的基础上,观察组加用多索茶碱治疗,对照组给予氨茶碱治疗,比较2组的治疗效果和不良反应发生情况。结果观察组治疗总有效率为89．55％高于对照组的67．16％,差异有统计学意义（P＜0．05）。治疗前2组各项肺功能指标差异均无统计学意义（P＞0．05）;2组治疗后各项肺功能指标均较治疗前显著升高,且观察组升高幅度大于对照组,差异均有统计学意义（ P＜0．05）。2组患者治疗后血气分析各指标均较治疗前有所改善（P＜0．05）,且观察组治疗后PCO2低于对照组,PO2、SaO2高于对照组（P＜0．05）;观察组不良反应发生率低于对照组,差异有统计学意义（ P＜0．01）。结论多索茶碱治疗老年肺功能下降效果较好,不良发生发生率较低,安全性较好。     

儿童药物性血尿1056例临床分析

目的:探讨儿童药物性血尿的原因和机制,提出预防措施,促进临床合理用药。方法:对2005-2010年国内公开发表的医药期刊报道的1056例儿童(≤16岁)药物性血尿进行统计、分析。结果:本研究中药物性血尿共涉及5类药物41个品种,以抗微生物药、解热镇痛抗炎药和抗感冒药为主,且与年龄、给药剂量、给药途径等有关。结论:充分认识药物性血尿产生的原因,安全、合理地使用药品,积极采取预防措施,对避免或减少儿童药物性血尿的发生有重要的临床意义。     

349例药物不良反应报告分析

目的：观察药品不良反应（ADR）发生情况,探讨药品不良反应发生因素,总结药品不良反应发生规律,促进合理用药。方法：选取349例药品不良反应报告作为研究对象,从患者年龄、性别、药品种类、给药途径、器官损害表现及程度等方面进行统计分析。结果：经调查分析,年龄较大人群有170例（48．71％）,静脉注射、口服给药引起的ADR分别有161例（46．13％）、177例（50．72％）,中药制剂类不良反应发生率为32．95％。结论：增强合理用药意识,完善防范处理方案,指导患者合理服用药物,同时加强ADR监测,保障用药安全。     

保胎灵胶囊临床应用不良反应调查研究

目的：探讨保胎灵胶囊临床应用效果及不良反应发生情况.方法：选取2 700例诊断为先兆早产的孕妇为研究对象.将其随机分为20岁以下组（A组）,21～30岁组（B组）,31岁以上组（C组）三组,每组900例.以同期收治的一般资料差异无显著性的500例先兆早产产妇为对照组.A、B、C组采取保胎灵胶囊联合盐酸利托君治疗,对照组采取盐酸利托君治疗.比较各组患者分娩后成功保胎率、孕期延长时间以及不良反应情况.结果：A、B、C三组产妇在成功保胎率、孕期延长时间、不良反应方面,组间比较差异无统计学意义（P＞0.05）;A、B、C三组产妇在成功保胎率、孕期延长时间、不良反应方面均优于对照组,差异具有统计学意义（P＜0.05）.结论：保胎灵胶囊联合盐酸利托君治疗先兆早产,可以提高保胎率,延长孕期时间,有利于新生婴儿的预后,是一种提高产科质量安全有效的治疗方法,而且其不良反应发生情况和产妇年龄无直接联系,临床上值得推广使用.     

简议常用中药注射剂的不良反应

近年来,随着中药注射剂的快速发展,其所引发的不良反应也逐年增加。中药注射剂大多由复方组成,有效成分尚不清楚,制备中混杂微量不纯成分,存放过程发生质量变化,导致不溶性微粒增加等而引发不良反应。     

Can acupuncture enhance therapeutic effectiveness of antidepressants and reduce adverse drug reactions in patients with depression? A systematic review and meta-analysis

BackgroundSome depressed patients receive acupuncture as an adjunct to their conventional medications.ObjectiveThis review aims to provide evidence on whether acupuncture can enhance the therapeutic effectiveness of antidepressants for treating depression, and explore whether acupuncture can reduce the adverse reactions associated with antidepressants.Search strategyEnglish and Chinese databases were searched for randomized controlled trials (RCTs) published until December 1, 2021.Inclusion criteriaRCTs with a modified Jadad scale score ≥ 4 were included if they compared a group of participants with depression that received acupuncture combined with antidepressants with a control group that received antidepressants alone.Data extraction and analysisMeta-analysis was performed, and statistical heterogeneity was assessed based on Cochran’s Q statistic and its related P-value. Primary outcomes were the reduction in the severity of depression and adverse reactions associated with antidepressants, while secondary outcomes included remission rate, treatment response, social functioning, and change in antidepressant dose. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to evaluate the overall quality of evidence in the included studies.ResultsThis review included 16 studies (with a total of 1958 participants). Most studies were at high risk of performance bias and at low or unclear risk of selection bias, detection bias, attrition bias, reporting bias, and other bias. Analysis of the 16 RCTs showed that, compared with antidepressants alone, acupuncture along with antidepressants reduced the Hamilton Depression Rating Scale-17 (HAMD-17) scores (standard mean difference [SMD] ?0.44, 95% confidence interval [CI] ?0.55 to ?0.33, P < 0.01; I² = 14%), Self-rating Depression Scale (SDS) scores (SMD ?0.53, 95% CI ?0.84 to ?0.23, P < 0.01; I² = 79%), and the Side Effect Rating Scale (SERS) scores (SMD ?1.11, 95% CI ?1.56 to ?0.66, P < 0.01; I² = 89%). Compared with antidepressants alone, acupuncture along with antidepressants improved World Health Organization Quality of Life-BREF scores (SMD 0.31, 95% CI 0.18 to 0.44, P < 0.01; I² = 15%), decreased the number of participants who increased their antidepressant dosages (relative risk [RR] 0.32, 95% CI 0.22 to 0.48, P < 0.01; I² = 0%), and resulted in significantly higher remission rates (RR 1.52, 95% CI 1.26 to 1.83, P < 0.01; I² = 0%) and treatment responses (RR 1.35, 95% CI 1.24 to 1.47, P < 0.01; I² = 19%) in terms of HAMD-17 scores. The HAMD-17, SDS and SERS scores were assessed as low quality by GRADE and the other indices as being of moderate quality.ConclusionAcupuncture as an adjunct to antidepressants may enhance the therapeutic effectiveness and reduce the adverse drug reactions in patients receiving antidepressants. These findings must be interpreted with caution, as the evidence was of low or moderate quality and there was a lack of comparative data with a placebo control.Systematic review registration: INPLASY202150008.     

推拿手法安全性的研究进展

中医推拿疗法是一种传统的、有效的理疗方法。在临床实践中具有独特的优势。它可以弥补许多疾病和损伤的药物治疗的不足,具有不可替代的疗效。推拿是部位和手法的综合作用,意外事件的发生主要是因为有的医者求效心切,不关注治疗部位和手法,疗效不明显,而且增加了患者的痛苦并危及患者的健康。本文试从施术部位和手法的不同,分析推拿操作中的意外事件,总结产生损伤的原因,并厘清操作要点,以期指导临床推拿操作的安全实施。     

阿托伐他汀致不良反应24例文献分析

目的:了解阿托伐他汀致不良反应的情况,促进临床安全合理用药。方法:采用文献计量学方法,对国内公开报道的24例阿托伐他汀致不良反应病例进行总结性分析。结果:阿托伐他汀致单纯性横纹肌溶解症7例,横纹肌溶解并发肾功能衰竭1例,横纹肌溶解并发多器官功能衰竭1例,肌病3例;致肝功能异常6例;致血小板减少性紫癜2例;致过敏反应2例;致过敏性休克1例;致指关节疼痛1例。24例患者中,5例为行冠状动脉支架植入术患者,1例为低钾血症伴高血压和冠心病者,1例为冠状动脉综合征伴慢性肾功能不全者,其他均为冠心病、高胆固醇血症患者,超过60岁的16例(占66.67%),停药及相应治疗后22例(占91.67%)恢复正常,2例(占8.33%)死亡。结论:阿托伐他汀引发的肝功能异常、肌病等不良反应不容忽视。