高血压治疗：百年历程、日益细化

人类对高血压的治疗是百年以来医学的重要成就。越来越多的证据表明,有效控制高血压是降低相关疾病发病、死亡、致残的重要手段。医学对高血压治疗药物、手段、方案的探索尚未止步,许多正在进展中。     

高血压联合用药与靶器官保护

高血压是造成心血管疾病最重要的可逆性危险因素之一,但大多数患者仍未采取合适治疗,或未达到合适的血压控制目标.循证医学证实,联合使用降压药物不仅是控制血压达标的主要手段,而且是保护靶器官的重要措施,可明显减少心、脑、肾等重要靶器官损害,降低心血管疾病的发病率、病死率和致残率.高血压的联合用药应得到高度重视.     

高血压联合用药与靶器官保护

高血压是造成心血管疾病最重要的可逆性危险因素之一,但大多数患者仍未采取合适治疗,或未达到合适的血压控制目标。循证医学证实,联合使用降压药物不仅是控制血压达标的主要手段,而且是保护靶器官的重要措施,可明显减少心、脑、肾等重要靶器官损害,降低心血管疾病的发病率、病死率和致残率。高血压的联合用药应得到高度重视。     

医学与艺术:临床医学和医学人文学关系探索

医学与艺术是医学人文学研究的重要课题.医学与艺术有着广泛的联系,涉及对临床医学性质的争论,医学人文学对临床医学教育与实践的作用,艺术对医学的表现与理解,以及作为治疗康复手段的艺术.     

艺术在临床医学中的价值——自我完善与人性化服务的必由之路

医学与艺术是医学人文学研究的重要领域,本文将对医学与艺术的本质进行论述.并详细阐明艺术在现代临床医学中的应用:不仅可以提高医生的人文素养,使诊疗过程更具人性化;同时,艺术作品更能形象的描述、解释和表现临床医学.艺术还能成为临床医疗活动的康复和治疗手段,如:音乐疗法、绘画疗法等.加强艺术教育、艺术修养才能使医者达到自我完善的要求,在临床实践中更能体现个性化、以人为本的宗旨,更有效地达到治疗目标.     

医学发展之道

医疗方式是生存方式的一个重要方面.自然生存中的医学是自然医学,技术生存中的医学是技术医学.相对于自然医学,技术医学在手段上进步了,却离人性更远了.医学将向人文医学发展,力图实现自然、技术与人的和谐.     

医学的转型与医学整合

防控慢性病迫切需要医学的转型.当代医学需要实现的转型是全面的,其中包括医学目标、医学观、医学方法学、医学服务手段和服务体制的转型;实现医学转型的关键是推进医学整合,而以临床医学的整合及临床医学与预防医学的整合最为重要和迫切.     

高龄老年高血压患者的降压治疗策略

80岁以上高龄老年高血压患者的降压治疗随着人口老龄化而越来越受关注.评估高龄高血压患者降压治疗的获益与风险,在循证医学基础上进行个体化治疗,依据全身情况和耐受程度调整血压控制水平,慎重选择药物,平稳缓慢降压,将使高龄高血压患者最大程度受益.     

精神因素与高血压病关系初探

高血压是一种高发病,目前仍是一种危害人类健康的主要疾病之一。研究高血压病的发病,治疗和预防,对保护人类的健康具有重要的作用。当今医学,已从医学生物模式转化为社会心理医学生物模式,综合探讨高血压病的发病原因以及治疗, 预防的措施是临床医学的一项十分迫切的任务。在此,我就精神因素与高血压病的发病、治疗、预防关系谈一点自己的看法,以求医学界和心理学界的同志们给予指正。     

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.     

感染性休克患者术前应用盐酸戊乙奎醚的临床疗效

观察盐酸戊乙奎醚在感染性休克患者中作为术前药应用的临床疗效。感染性休克手术患者40例,随机分为2组：实验组术前30min肌注盐酸戊乙奎醚lmg,对照组肌注东莨菪碱0．3mg。于各时间点检测血乳酸值、血气（PaO2、PaCO2）及胃黏膜二氧化碳分压（PgCO2）。结果示实验组血乳酸下降、PaO2上升,PgCO2一PaCO...     

Validation of the Poisoning Severity Score (PSS) in suicidal behavior by self‐poisoning

Intentional self‐poisoning is the leading method of suicidal behavior leading to medical attention worldwide. The medical severity of self‐poisoning events has major treatment, prognostic, and medico‐legal implications, yet measures of severity are limited. The Poisoning Severity Score (PSS) is a widely used scale but validation data are limited, particularly in the study of suicidal behavior per se. The sample was a consecutive series of intentional self‐poisoning patients aged 13 to 65 treated at a large university medical center (n = 673). PSS scores, with a range 0 (none) to 4 (death), were calculated along with other structured clinical data and analyzed in a series of linear regressions adjusted for age and sex. Higher PSS scores were consistently associated with greater medical morbidity and more intensive acute medical treatments, and nearly all effect sizes were large. Results support the validity of the PSS in hospital‐treated self‐poisoning patients.     

Method of Suicide in the Mentally Ill: A National Clinical Survey

Comparisons of psychiatric patients who die by suicide using different methods are scarce. We aimed to establish the methods of suicide used by those who are currently or have recently been in contact with mental health services in England and Wales (N = 6,203), and describe the social and clinical characteristics of suicides by different methods. We found that hanging, self‐poisoning, and jumping (from a height or in front of a moving vehicle) were the most common methods of suicide, accounting for 79% of all deaths. The implications of these and other findings are discussed.     

盐酸戊乙奎醚对输尿管痉挛的预防作用

为了评价盐酸戊乙奎醚对输尿管镜手术中输尿管痉挛的预防作用,将60例拟行经尿道输尿管镜手术的患者随机分为两组,试验组和对照组,每组30例。两组患者均接受硬膜外阻滞,试验组于术前给予盐酸戊乙奎醚0.02mg／kg静脉注射,对照组则接受等量的生理盐水注射。记录术中输尿管痉挛的发生情况,外科医生对手术条件的评分以及术后患者的口干情况。结果显示,试验组输尿管痉挛发生率明显低于对照组,外科医生评分则高于对照组,但术后试验组患者的口干较为明显。提示盐酸戊乙奎醚能够预防输尿管镜手术中输尿管痉挛的发生。     

急性一氧化碳中毒高压氧治疗的中美指南比较

急性一氧化碳（carbonmonoxide,CO）中毒是中美最常见的意外中毒原因之一。高压氧能促进碳氧血红蛋白解离,加速体内CO排出,明显缩短CO半清除时间,是治疗急性CO中毒的一种重要治疗方法。比较中美现有急性CO中毒治疗指南及推荐意见。发现其中在高压氧治疗应用的适应证、具体方案、治疗费用等方面有很大差异。我们对此差异进行比较分析,为临床治疗及科研提供参考,也对通过进一步研究以充分证实高压氧治疗急性CO中毒的有效性,制订高压氧治疗最佳方案提出展望。     

Failure of Retrospective Inference in Rats' Taste Aversion

Three experiments explored the possibility of retrospective inference in the rat. Experiment 1 revealed that poisoning of an element of a taste compound after single compound poisoning enhanced aversion to the other element, and that presentation of an element without poison after the compound poisoning reduced aversion to the other element. These results were opposite to those predicted by retrospective inference. Experiment 2 eliminated some confounding variables and examined the effect of element poisoning after compound poisoning. The result again was opposite to what the retrospective view predicts. The results, however, accorded with the idea that within-compound learning was established during compound presentation, and subsequent poisoning or nonpoisoning of one element affected response to the other element via the within-compound learning. In Experiment 3, the possibility of within-compound learning was reduced by using sequential presentation of tastes, but there was no indication of retrospective inference even under this condition.     

对农药残留标准的再认识

伴随着工农业生产的迅速发展,化学农药应用范围也越来越广,由此引发了农药中毒及农药残留标准等问题。有机磷农药是目前全世界范围内使用最广、用量最大的一类杀虫剂,有机磷农药可以引起急性中毒、慢性神经毒性等危害。以有机磷农药为例,探讨农药危害和农药残留标准中的几个问题。     

Suicidal Intent and Method of Self‐Harm: A Large‐scale Study of Self‐Harm Patients Presenting to a General Hospital

Data from the Oxford Monitoring System for Attempted Suicide (2004–2011) were used to study hospital presentations for self‐harm in which Suicidal Intent Scale (SIS) scores were obtained (N = 4,840). Regression of medians was used to control for the confounding effect of age and gender. Higher estimated median SIS scores were associated with increasing age, male gender, self‐poisoning versus self‐injury, multiple methods of self‐harm versus self‐injury alone, use of gas (mainly carbon monoxide), dangerous methods of self‐injury (including hanging, gunshot), and use of alcohol as part of the act. For self‐poisoning patients, there was a correlation between the number of tablets taken and the total SIS score. Compared with self‐poisoning with paracetamol and paracetamol‐containing compounds, self‐poisoning with antipsychotics was associated with a lower median SIS score while antidepressants had the same estimated median as paracetamol. Use of alcohol within 6 hours of self‐harm was associated with lower SIS scores. In conclusion, certain methods of self‐harm, particularly dangerous methods of self‐injury and self‐poisoning with gas, were associated with high intent and should alert clinicians to potential higher risk of suicide. However, apart from use of gas, suicidal intent cannot be inferred from type of drugs used for self‐poisoning.     

Effects of trophic poisoning with methylmercury on the appetitive elements of the agonistic sequence in fighting-fish (Betta splendens)

The aggressive display in Betta splendens is particularly prominent, and vital to its adaptation to the environment. Methylmercury is an organic variation of Hg that presents particularly pronounced neuro-behavioral effects. The present experiments aim to test the effect of acute and chronic poisoning with methylmercury on the display in Bettas. The animals were poisoned by trophic means in both experiments (16 ug/kg in acute poisoning; 16 ug/kg/day for chronic poisoning), and tested in agonistic pairs. The total frequency of the display was recorded, analyzing the topography of the agonistic response. The methylmercury seems to present a dose- and detoxification-dependent effect on these responses, with a more pronounced effect on motivity in acute poisoning and on emotionality in the chronic poisoning. It is possible that this effect could be mediated by alteration in the mono-amino-oxidase systems.     

Avoiding Type II error in assessing lead toxicity plaintiffs

This article discusses statistical parallels between excessive conservatism and insufficient conservatism in rendering forensic opinions. The elements of a tort are reviewed and their relation to psychological and psychiatric opinions is also discussed, as are psychometric and clinical approaches to assessment of impairment and causation in individual lead poisoned children. It is argued that assessments in lead poisoning cases consisting solely of cranial nerve examinations result in considerable Type II Error. Sources of Type II Error in research using analysis of covariance techniques to study the toxic effects of lead include variance stealing, use of excessive numbers of covariates, lack of attention to interactions, and use of covariates that are actually substitute measures of lead ingestion. When experts cite nonsignificant findings of studies of low-level lead exposure, it inappropriately negates lead effects in more severely lead poisoned plaintiffs. In true experimental studies where there is no ambiguity regarding causation, the destructive effects of lead are quite clear. © 1998 John Wiley & Sons, Ltd.