从循证医学看目前冠心病的药物治疗

为使冠心病患者尽可能达到最优化的药物治疗,结合最近几年出现的大型临床研究,分析了不同冠心病患者应采取的合理药物治疗措施及可能带来的益处,并针对我国现状,提出了相应的解决方案.     

老年人合并冠心病的血压控制

高血压病和冠心病是与年龄密切相关的心血管疾病.老年人(包括年龄在80岁以上的)同时存在此两种疾病的情况正在逐渐增加.流行病学研究已经证明,高血压和冠心病有密切的联系.老年高血压患者药物的选择仍有一定的争议,而在合并冠心病时合理治疗的临床研究也不多.本文根据目前循证医学资料提出了可用于老年高血压合并冠心病患者合适的降压策略和冠心病的药物治疗.     

遵循指南,恰当进行冠心病的介入治疗

如何遵循指南,结合冠心病患者实际情况和具体病变.恰如其分地为患者实施经皮冠状动脉介入治疗(PCI).使获益最大化,而风险最低化,是每一位心血管介入医生的追求和面临的问题.应正确和严格选择冠心痛患者PCI适应证,合理运用PCI的各种手段,牢固树立冠心病全面治疗观念.PCI仅仅是冠心病全面治疗的一个组成部分,必要的介入、外科治疗和合理药物治疗的联合应用,是心血管疾病治疗的发展方向.     

遵循指南，恰当进行冠心病的介入治疗

如何遵循指南,结合冠心痛患者实际情况和具体病变,恰如其分地为患者实施经皮冠状动脉介入治疗（PCI）,使获益最大化,而风险最低化,是每一位心血管介入医生的追求和面临的问题。应正确和严格选择冠心病患者PCI适应证,合理运用PCI的各种手段,牢固树立冠心病全面治疗观念。PCI仅仅是冠心病全面治疗的一个组成部分,必要的介入、外科治疗和合理药物治疗的联合应用,是心血管疾病治疗的发展方向。     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗。现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述。     

危重冠心病患者介入治疗的法学思考——从法律学的角度探讨介入治疗的临床适应症

冠心病是目前严重威胁我国人民健康的一种常见病,由于种种原因一部分晚期冠心病患者,来诊时已经失去介入手术和外科搭桥的最佳时机,而且对于这部分病人来讲,药物治疗往往无效,他们的治疗应何去何从,是目前医学界极具争议的话题。试从法律学的角度,探讨危重冠心病患者介入治疗的可能性及必要性,为临床工作提供法律指导。     

从指南看冠心病降脂治疗的现状及分析

层出不穷的试验研究和不断更新的指南使人们对冠心病防治的认识不断加深,但指南的实施和普及却不理想,大多数冠心病患者并未真正受益于降脂治疗.现就NCEP-ATP指南的更新和目前冠心病患者降脂治疗的现状、主要影响因素(患者的依从性、医务工作者的医疗质量、药物有效性以及效价比与经济条件)及可能的改善措施做一综述.     

危重冠心病患者介入治疗的法学思考--从法律学的角度探讨介入治疗的临床适应症

冠心病是目前严重威胁我国人民健康的一种常见病,由于种种原因一部分晚期冠心病患者,来诊时已经失去介入手术和外科搭桥的最佳时机,而且对于这部分病人来讲,药物治疗往往无效,他们的治疗应何去何从,是目前医学界极具争议的话题.试从法律学的角度,探讨危重冠心病患者介入治疗的可能性及必要性,为临床工作提供法律指导.     

冠心病治疗方法的比较思考

冠心病是严重影响人类健康的疾病。冠心病的治疗方法主要为:药物治疗、介入治疗及冠状动脉旁路移植术等。通过比较各种治疗方法,说明药物治疗是基础,在此基础上,合理选择介入治疗和冠状动脉旁路移植术。     

冠心病治疗方法的比较思考

冠心病是严重影响人类健康的疾病.冠心病的治疗方法主要为:药物治疗、介入治疗及冠状动脉旁路移植术等.通过比较各种治疗方法,说明药物治疗是基础,在此基础上,合理选择介入治疗和冠状动脉旁路移植术.     

Diary reports on emotional experiences in the onset of a psychosocial transition: becoming drug‐free

The process of becoming drug free is viewed as a psychosocial transition in the life of drug addicts. A specific form of treatment of heroin addiction within residential communities is based on the importance of interpersonal relationships for change. Well‐being of 65 drug addicts during the first 2 weeks in a residential community is explored using a time‐sampling diary which was completed four times a day. The influence of subjects' history, situational context, and motive activation on well‐being and emotions is investigated. Results show that well‐being and emotions differ mainly according to subjects' history, but not — at least at the beginning of treatment within the community — according to situations. This is interpreted as a ‘state of shock’ in the new environment and highlights the necessity for special individual care for subjects with a long drug career. Copyright © 2001 John Wiley & Sons, Ltd.     

非酒精性脂肪肝的治疗策略

非酒精性脂肪肝是一种无过量饮酒史,与遗传-环境-代谢应激相关性疾病,导致肝相关性患病率和病死率升高的主要原因之一。非酒精性脂肪肝的发病机制尚未完全明确,也无疗效理想的治疗药物。治疗策略主要是减肥,合理控制血糖和血脂并去除其他引起肝病的病因,酌情选用相关药物辅助治疗。     

Correspondence between attitudes and drinking and drug behavior: youth subculture over time

In a longitudinal study, the researcher utilized both nonparticipant observational data and quantified interview data to analyze the correspondence between attitudes of the "youth subculture" theories and overt behavioral patterns. The data were collected in an upper-middle-class, predominantly white, Southern California beach community. An initial cohort of 23 males was followed from 1971 through 1981. A separate sample of males, aged 14 to 21, was observed from the summer of 1975 through December, 1981. All subjects were interviewed at the close of the project. The interview schedule included items regarding drug use, sexual activity, employment, and school patterns as well as attitudes reflective of pleasure-seeking and deferred gratification. Subjects are classified according to degree of drug use and analyzed according to several other variables. It is found that the older cohort, analyzed qualitatively, fit the theoretical implications of the model involved both as to attitudes and behavior. However, with the end of the Vietnam War and an increased influence of the "Jesus Movement," this group did become slightly more conservative in attitudes regarding politics and religion. The heavier drug users in the later sample are similar in behavior patterns to the older cohort. However, the more recent group of heavy users express extremely conservative views regarding morality, religion and politics. Specific attitudinal measures indicate no relationship between degree of drug use and youth subculture attitudes. The attitudes measured regarding pursuit of pleasure and immediate gratification did not appear to be consistent with actual overt behavior.     

Concurrent performances: reinforcement by different doses of intravenous cocaine in rhesus monkeys

Different doses of intravenous cocaine reinforced the lever pressing of rhesus monkeys under two-lever concurrent or concurrent-chain schedules. Under the concurrent procedure, responding produced drug reinforcers arranged according to independent variable-interval 1-min schedules. Under the concurrent-chain procedure, responding in the variable-interval link led to one of two mutually exclusive, equal-valued, fixed-ratio links; completion of the ratio produced a drug reinforcer. Under both procedures, responding on one lever produced a constant dose of 0.05 or 0.1 mg/kg/injection, while on the other lever, dose was systematically varied within a range of 0.013 to 0.8 mg/kg/injection. Preference, indicated by relative response frequency on the variable-dose lever during the variable-interval link, was always for the larger of the doses. Relative response frequencies on the variable-dose lever roughly matched relative drug intake (mg/kg of drug obtained on variable lever divided by mg/kg of drug obtained on both levers). For many dose comparisons, responding occurred and reinforcers were obtained almost exclusively on the preferred lever. Overall variable-interval rates generally were lower than with other reinforcers, and these low rates, under the experimental conditions, may have occasioned the exclusive preferences.     

精神分裂症治疗的理性思辩

神经解剖、神经生化的研究进展为阐明精神分裂症的病理机制提供了基础,但在精神分裂症的发病中遗传学、环境中的生物学和社会心理因素亦不容忽视.依循系统论的整体性、稳定性观点,采取药物、心理与心理社会康复治疗的综合治疗是目前的最佳方案.     

ICU镇静药物的选择：苯二氮卓还是非苯二氮卓

2013年美国危重症医学会新发布的镇静、镇痛、谵妄治疗指南中指出,苯二氮卓类镇静药物的使用是ICU重症患者谵妄发生的独立危险因素,推荐ICU镇静优先采用非苯二氮卓类镇静药物以改善临床预后.的确,大量的研究表明以右美托咪定为代表的非苯二氮卓类药物相比苯二氮卓类镇静药,能明显缩短重症患者机械通气时间、ICU住院时间、减少ICU费用,并减少ICU谵妄的发生.然而事物总有两面性,ICU镇静不只是单凭药物调整便能顺理成章完成的事情.相比依据指南盲从简单的停用某种药物,建立完整的疼痛、躁动、谵妄评估系统,制定个体化镇静计划,保证机械通气有效性显得更为重要.     

海洛因成瘾者的脑灰质密度下降

本研究对海洛因成瘾者（n=34）和无毒品依赖的正常被试（n=34）进行磁共振脑结构扫描,用基于体素的形态学测量（VBM）方法分析被试间灰质密度的差异,并考察了海洛因成瘾者用药时间与灰质密度之间的关系。结果表明,同正常对照组相比,海洛因成瘾者其额叶和颞叶下部的灰质密度显著下降。进一步分析显示,用药时间短于5年的成瘾者其灰质密度下降不明显,而用药时间5年以上的患者其灰质密度下降非常显著。本文讨论了上述结果的潜在临床价值和理论意义。     

The offensive nature of maternal aggression in mice: Effects of fluprazine hydrochloride

The phenylpiperazine fluprazine hydrochloride was used to test the hypothesis that maternal aggression in laboratory mice reflects offensive motivation. Lactating females (n = 8 per condition) tested for aggression following drug treatment (1.0 mg/kg and 5.0 mg/kg of fluprasine) were significantly less aggressive than saline controls according to all measures used. The findings support the hypothesis that maternal aggression is offensive in nature, and provide no evidence that maternal attack is a mixture of offensive and defensive tendencies.     

Oral self-administration of pentobarbital by rhesus monkeys: relative reinforcing effects under concurrent fixed-ratio schedules.

During daily 3-hr sessions, orally delivered pentobarbital solutions and water, or two separate pentobarbital solutions, were concurrently available to rhesus monkeys according to fixed-ratio schedules of mouth contacts with a spout. First water, and then each of four "comparison-concentration" pentobarbital solutions (0.0625, 0.25, 1, and 4 mg/mL), was successively available from one spout for a block of sessions under a fixed-ratio-64 (three monkeys) or fixed-ratio-16 (one monkey) schedule. Under an identically sized fixed-ratio schedule, deliveries of a "standard-concentration" pentobarbital solution were concurrently available from a second spout. The concentration of the standard solution remained unchanged throughout testing of the series of comparison solutions. Each of three pentobarbital concentrations (4, 1, and 0.25 mg/mL) in turn served as the standard concentration. Within each pair of concurrently available solutions, the higher drug concentration maintained more behavior than the lower concentration. Thus when monkeys were provided with concurrent access to different pentobarbital concentrations, relative reinforcing effects were directly related to drug concentration. Further, the amount of behavior maintained by a particular drug concentration was dependent on the concentration of the concurrently available drug solution. Thus, the relative effectiveness of a reinforcer in maintaining behavior is a function of both the reinforcer's magnitude and the availability of alternative reinforcers in the environment.     

乙肝肝硬化患者的抗病毒治疗

乙肝肝硬化是HBV感染的最终结局之一。目前的研究证明,抗病毒治疗能使肝脏组织学获得改善甚至逆转肝硬化的病情。多种核苷（酸）类似物及干扰素的临床应用,使乙肝肝硬化的抗病毒治疗取得较大进展,但患者仍需长期甚至终生治疗。因此,应遵循个体化的治疗原则,针对患者病情、药物特点、不良反应、患者经济承受能力,选择强效、低耐药且较经济...