【摘要】 目的 研究综合医院心理咨询初诊患者的特征。 方法 对2007年1月1日-2009年12月31日初诊患者的性别、年龄、居住地、学历、职业、咨询目的与疾病分布等特征进行统计分析。 结果 共纳入1 933例初诊患者，女性略多于男性（男女比1∶1.1）；年龄3~75岁，以青少年（10~19岁，34.5%）和青年（20~29岁，29.7%）为主；当地居民居多（66.0%），外地居民亦占较大比例（34.0%）；学历主要分布在中学（初中:21.5%；高中:35.6%）和大学（33.6%）；职业分布以学生比例最大（40.0%），其次为无固定职业者（14.9%），专业技术人员（12.5%），商业、服务人员（9.4%），办事人员和有关人员（7.7%）。患者中有心理问题的健康人占27.5%，以亲子教育咨询（53.4%）和婚恋咨询（41.5%）为主；患精神障碍的患者占72.5%，以心境障碍（30.6%）、神经症（23.1%）和精神分裂症（10.1%）为主，新确立的精神障碍网络成瘾占1.1%。 结论 综合医院心理咨询初诊患者来源广泛，需要更加关注青少年、学生和无固定职业者的心理问题。【Abstract】 Objective To investigate the characteristics of the new clients from the psychological counseling clinic in general hospital. Methods The clients’ data were prospectively analyzed from the successively registered database of the counseling clinic from January 1, 2007 to December 31, 2009. The data included sex, age, habitation, educational background, career, problems, and diagnosis of the new clients. Results A total of 1 933 clients were included in the study, and the sex ratio was 1∶1.1(male∶female). The age ranged from three to 75 years old. The clients aging from 10 to 29 yeas old accounted for 64.2%. Sixty-six percent of the clients were local residents. The education backgrounds of them were middle school (21.5%), high school (35.6%), and graduate (33.6%). Forty percent of the clients were students and 14.9% had no regular works. Special technician, business and service workers, and office workers accounted for 12.5%, 9.4%, and 7.7%, respectively. The percentage of healthy clients was 27.5%, whose main problems were child education (53.4%), and marriage relationship (41.5%). And 72.5% of the clients suffered from mental disorders, with mood disorder (30.6%), neurosis (23.1%), and schizophrenia (10.1%). Internet addiction, as a new established mental disorder in China, accounted for 1.1%. Conclusion At present, the clients of counseling clinic in general hospital are more widespread, and more attention should be paid to the young, the students, and the people without regular work.
目的:观察A型肉毒毒素(BTXA)对面肌痉挛(HFS)患者痉挛程度的改善和生存质量的影响。方法: 对68例HFS患者进行局部注射BTXA,治疗前及治疗后1个月分别对患者的痉挛程度进行判定和使用世界卫生组织生存质量评定量表简表(WHOQOL-BREF)评价生存质量。 结果: 97.04%的HFS患者在BXTA治疗后1个月痉挛明显改善缓解,而且患者在WHOQOL-BREF的生理领域、心理领域、社会关系领域、总的健康状况和总的生存质量的评分均明显高于治疗前,差异有统计学意义(Plt;0.01)。 结论: 局部注射BTXA可迅速缓解或消除HFS患者肌肉痉挛,提高患者的生存质量。
ObjectivesTo systematically review the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage.MethodsPubMed, EMbase, The Cochrane Library, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of plasminogen activator assist external ventricular drainage in cerebral hemorrhage from inception to March 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 23 RCTs involving 1 560 patients were included. The results of meta-analysis showed that, compared with the blank control or placebo, the addition of plasminogen activator urokinase after puncture and drainage could improve the clinical efficacy (RR=1.36, 95%CI 1.26 to 1.47, P<0.000 01), shorten removal time of hematoma (MD=−3.37, 95%CI −3.89 to −2.85, P<0.000 01), reduce postoperative re-bleeding rate (Peto OR=0.30, 95%CI 0.18 to 0.51, P<0.000 01), reduce the incidence of intracranial infection (Peto OR=0.47, 95%CI 0.25 to 0.87, P=0.02), and reduce mortality (Peto OR=0.45, 95%CI 0.27 to 0.76, P=0.003). The differences were statistically significant between two groups.ConclusionsCurrent evidence shows that the combination with urokinase can improve curative effect of hypertension cerebral hemorrhage patients with external ventricular drainage. In reducing hemorrhage, intracranial infection and mortality, urokinase also has great curative effect. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
To understand the current situation of community epilepsy management in China, summarize the experience of international community epilepsy management, and provide reference for strengthening community epilepsy management in China. Summarize the current situation of epilepsy development in China, summarize and analyze the international experience of community epilepsy management in the United States, Australia, Britain and other countries, as well as the reference significance for domestic community epilepsy management. According to the evaluation criteria of community epilepsy management, it is suggested that the Chinese government should increase its support, formulate various strategic objectives, strengthen publicity and health education, improve patients' self-management support, explore the prevention and control mode of promoting epilepsy management in urban and rural communities, strengthen the training of medical service teams and design a reasonable referral system.
ObjectiveTo systematically evaluate the effect of repeated transcranial magnetic stimulation (rTMS) in treating epilepsy.MethodsThe randomized controlled trials (RCTs) of rTMS for epilepsy and related diseases were collected from PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP, and Wanfang databases by computer. The retrieval time was from establishment to June 2019. Two researchers independently screened the literature, extracted the data and evaluated the deviation risks of the included studies. RevMan5.3 software was used for Meta analysis.ResultsA total of 21 RCTs were included, including 1 587 patients. The results showed that rTMS assisted antiepileptics drugs (AEDs) could improve the effective rate of epilepsy treatment [RR=1.28, 95% CI (1.19, 1.37)], significantly reduced HAMA, HAMD and NFDS scores in the treatment of patients with epilepsy combined with anxiety and depression [MD=−3.94, 95% CI (−4.25, −3.63)], and improve DQ and GMFM-88 scores in children with cerebral palsy combined with epilepsy [MD=7.95, 95% CI (7.00, 8.90)]. In addition, using rTMS will not cause additional adverse reaction [peto OR=0.52, 95% CI (0.31, 0.84)].ConclusionsThe current evidence showed that rTMS combined AEDs can improve the efficient of AEDs therapy. When treat anxiety depression comorbidity, it can significantly reduce the anxiety depression score. In addition in children with cerebral palsy merger, it can improve muscle strength and development. And rTMS will not cause additional adverse reactions. Limited by the quantity and quality of the selected studies, the conclusions need to be verified by more high-quality studies.
Epilepsy is one of the chronic central nervous system diseases that can occur repeatedly for a long time. About 70 million people worldwide suffer from epilepsy. Two thirds of epileptic patients do not receive proper treatment because of inadequate health care services and social discrimination based on cultural beliefs. Effective health management mode can reduce the morbidity and mortality of patients and improve the quality of life of patients. This article divides management modes into five types: Hospital-based health management model, community-based health management model, family health management model, self-health management model and health management model based on network technology. By referring to relevant literature, the research status of epilepsy health management model at home and abroad was summarized, which provides reference for the health management and reasonable intervention of patients with epilepsy.
Objective To evaluate the safety and efficacy of venlafaxine and carbamazepine on painful peripheral diabetic neuropathy. Methods This was a randomized, parallel-group, double-blind, double-dummy clinical trial. 132 patients a venlafaxine group (n=66) and a carbamazepine group (n=66) with painful peripheral diabetic neuropathy were recruited from 3 clinical centers. The venlafaxine group took venlafaxine 25 mg plus one dummy carbamazepine tablet twice a day and the carbamazepine group took carbamazepine 0.1 g plus one dummy venlafaxine tablet twice a day both for 2 weeks. The primary efficacy measurement consisted of a numeric pain intensity scale and the secondary measurement assessed quality of life. Results One hundred and nineteen patients completed the trial. Venlafaxine was superior to carbamazepine in improving mean pain intensity scores at 5,7,10 and 14 days by per-protocol analysis (P=0.02, P=0.03, P=0.003 and P=0.001 respectively). The effects of venlafaxine on the improvement in the total quality of life scores were better than those of carbamazepine at 10 and 14 days (P=0.02 and P=0.01 respectively). Sleep interference and mood were improved by both venlafaxine and carbamazepine, but the efficacy of venlafaxine was superior to that of carbamazepine. The common adverse events of venlafaxine included mild gastrointestinal discomfort, dizziness and somnolence. The frequency of adverse events in the venlafaxine group was about 43.9% (4 patients withdrew because of adverse events) and in the carbamazepine group about 25.76% (2 patients withdrew because of adverse events) (P =0.06). Conclusions Venlafaxine and carbamazepine are effective in the treatment of painful diabetic neuropathy, venlafaxine is superior to carbamazepine in improving pain and quality of life. Both drugs may be safe and well tolerated.
Objective To evaluate efficacy and safety of domestic Nateglinide tablet in comparison with domestic Repaglinide in Type 2 diabeties. Methods A multi-centre, double-blind, dummy trial was conducted.Two hundred and thirty type 2 diabetic patients recuited from 5 clinical centers were randomly allocated into Group A (domestic Repaglinide, 1.0 mg tid, n =115) and Group B (domestic Nateglinide, 90 mg tid, n =115).The trial consisted of a 4 weeksequilibrated period followed by 12 weeks treatment course. Results Ninety seven percent of patients(223) completed the trial (110 in Group A and 113 in Group B). The mean of fasting blood glucose (FBG) in both Group A and B was decreased statistically (P＜ 0.000 1) after 2, 6 and 12 weeks duration. At week 12, the mean FBG in Group A and B was reduced by 1.68±1.81 mmol/L (17.27%) and 1.17±1.67 mmol/L (12.53%) respectively with statistically significant difference between the two groups (P=0.017 7). The mean of 120 minutes postprandial blood glucose (PBG) also lowered markedly in 2, 6, and 12 weeks in both groups. At the end of therapy, PBG of 30, 60, 120 minutes were reduced significantly, mean of 120 minutes PBG was reduced 3.95±3.25 mmol/L (26.12%), and 3.81±3.05 mmol/L (26.22%) respectively in Group A and B , the differences in reduction between Group A and B had no statistical significance (P =0.726 9). In Group A and B, the mean of Alc was reduced significantly after 12 weeks duration. At week 12, the mean of Alc in Group A and B was lowered by 1.21% and 0.68% respectively, with statistical difference between the two groups (P =0.002 3). Though fasting insulin level in both groups had no change after 12 weeks duration, the insulin level at 30, 60 and 120 min increased significantly in both groups (P＜0.000 1). It suggested that both Nateglinide and Repaglinide promoted insulin secretion in early phase with maximal value at 60 min in Repaglinide group and 30 min in Nateglinide group, respectively. The adverse reaction rate in Group A including hypoglycemic reaction, thrombocytopenia and recrudescence of HBV was 4.5% when compared to only one case of thrombocytopenia in Group B (0.87%). Conclusions Both domestic Nateglinide and Repaglinide have similar effect on reducing postprandial blood glucose, but Repaglinide has ber effect on reducing FBG and A1c than Nateglinide. The results suggest that both domestic Nateglinide and Repaglinide are safe and generally well-tolerated in type 2 diabetic patients.