王净净从虚、痰、瘀、毒论治难治性癫痫经验

本文总结王净净教授治疗难治性癫痫经验。王教授认为难治性癫痫的病因病机多为虚、痰、瘀、毒交夹,治疗主以益气补肾、祛痰化瘀、解毒止痫,其实质是扶正气、祛顽邪、安神定窍,临床取得较好效果。

柴胡疏肝散加味治疗脑卒中后焦虑障碍的临床疗效及其对心率变异性的影响

目的观察柴胡疏肝散加味治疗脑卒中后焦虑障碍患者临床疗效及其对心率变异性(HRV)的影响。方法根据纳入、排除标准选取2015年9月-2017年2月于湖南中医药大学第二附属医院脑病门诊及住院部诊断为脑卒中后焦虑障碍的患者90例,随机分为中药组(45例)和对照组(45例)。对照组口服氢溴酸西酞普兰片,中药组在对照组基础上加用柴胡疏肝散加味,两组均治疗6周。比较两组治疗前、治疗2周、治疗4周、治疗6周汉密尔顿焦虑量表(HAMA)、精神性焦虑因子、躯体性焦虑因子评分,治疗后临床疗效,治疗前、治疗6周HRV[时域指标:24 h内全部窦性心律(NN)R-R间期标准差(SDNN),24 h内每5 min NN R-R间期平均值标准差(SDANN),24 h内相邻R-R间期差值的均方根(RMSSD),24 h内相邻NN R-R间期差值>50 ms占百分比(PNN50)。频域指标:低频功率(LF),高频功率(HF),LF/HF]。结果治疗方法与时间在HAMA评分及其因子评分上存在交互作用(P<0.05);时间在HAMA评分及其因子评分上主效应显著(P<0.05);治疗方法在HAMA评分、精神性焦虑因子评分上主效应显著(P<0.05);治疗方法在躯体性焦虑因子评分上主效应不显著(P>0.05)。治疗4、6周中药组患者HAMA评分、精神性焦虑因子评分低于对照组(P<0.05)。治疗2、4、6周两组患者HAMA评分、精神性焦虑因子评分低于治疗前(P<0.05),治疗4、6周两组患者躯体性焦虑因子评分低于治疗前(P<0.05)。中药组患者临床疗效优于对照组(P<0.05)。治疗6周,中药组患者SDNN、SDANN、PNN50、HF高于对照组(P<0.05);治疗6周,中药组患者LF、LF/HF低于对照组(P<0.05)。结论柴胡疏肝散加味治疗脑卒中后焦虑障碍疗效确切,可改善HRV。

基于中医传承辅助平台分析历代治疗痫证方剂的组方规律分析

目的:应用中医传承辅助平台(V2.5)分析和总结历代治疗痫证方剂的组方用药规律,为临床运用中医药治疗痫证提供参考依据。方法:收集历代治疗痫证方剂相关的文献,运用中医传承辅助平台建立方剂数据库,并应用中医传承辅助平台中集成的数据挖掘方法,分析方剂用药规律。结果:对历代治疗痫证773首方剂记录进行了分析,用药频次居前者有朱砂、人参、牛黄、麝香、全蝎、甘草、黄芩、大黄、天麻和防风等,并发现核心药物组合22个,挖掘出新处方共11个。结论:历代治疗痫证方剂用药以补虚安神、豁痰开窍、息风止痉、祛邪解毒为主。

Effect of acupuncture plus Tai Ji Quan on the recovery of neurological function and depression state in post-stroke depression patients

Objective：To observe the therapeutic efficacy of acupuncture plus Tai Ji Quan （Tai Chi） in recovering the neurological function and treating depression state in post-stroke depression patients,together with a 12-month follow-up.Methods：A total of 105 eligible post-stroke depression patients were randomized into an acupuncture plus Tai Ji group （53 cases） and a control group （52 cases） based on their visiting sequence.The patients all received routine treatment and rehabilitation training for stroke.In addition,the control group was given oral administration of citalopram hydrobromide tablets,1 month as a course of treatment,for 3 courses in total.Meanwhile,the acupuncture plus Tai Ji group received acupuncture and practiced Tai Ji Quan,for 1 month and 12 months respectively.Before the intervention,after 1-month intervention and 12 months later,the National Institute of Health stroke scale （NIHSS）,Barthel index （BI） and Hamilton depression rating scale （HAMD） were adopted for efficacy evaluation.Results：Prior to the intervention,there were no significant differences in HAMD,NIHSS and BI scores between the two groups （all P〉0.05）;after 1-month intervention,there were significant between-group differences in NIHSS,BI and HAMD scores （P〈0.05 or P〈0.01）;the 12-month follow-up revealed significant between-group differences in NIHSS,BI and HAMD scores （all P〈0.01）.In the treatment of stroke,the total effective rate was 84.4% in the acupuncture plus Tai Ji group,significantly higher than 68.9% in the control group （P〈0.05）;in the treatment of depression,the total effective rate was 86.7% in the acupuncture plus Tai Ji group,significantly higher than 77.8% in the control group （P〈0.05）.Conclusion：Acupuncture plus Tai Ji Quan can produce a significant efficacy in improving the limb motor function and depression in post-stroke depression patients.

精准医学时代癫痫的中西医研究及思考

精准医学是近年来新的医学概念和医学模式,它主要包括精准化基因生物和临床信息数据库的建立、多种组学研究及精准医学的应用转化。癫痫病机复杂,治疗手段局限,更需要个体化、精准化治疗。近年来,癫痫的精准防治包括癫痫生物信息数据库的构建、癫痫基因组学研究及癫痫诊疗技术的发展;中医药在癫痫的精准治疗方面前景广阔,目前主要集中在中医信息库建设、多组学研究辨证研究、中医成果转化等方面。文章介绍了精准医学的含义和癫痫的精准医学方向研究进展,以期为癫痫的精准治疗提供参考。

归脾汤加味治疗脑卒中后抑郁伴焦虑共病临床疗效观察

目的:观察归脾汤加味治疗脑卒中后抑郁伴焦虑共病(PSCAD)的临床疗效及安全性评估。方法:将80例PSCAD患者随机分为中药组(40例)和对照组(40例)。对照组口服艾司西酞普兰片,中药组用归脾汤加味加减。两组均观察6周。治疗前后进行汉密尔顿抑郁量表(HAMD)评分、汉密尔顿焦虑量表(HAMA)评分进行评分,测定血清5-HT、NE、BDNF水平,观察临床疗效,以不良反应量表(TESS)评估安全性。结果:治疗2周后,中药组HAMD评分低于对照组(P<0.05,P<0.01),治疗4周后,中药组HAMA评分低于对照组(P<0.05,P<0.01);患者血清5-HT、NE、BDNF水平均较治疗前升高(P<0.01),中药组高于对照组(P<0.05,P<0.01)。治疗6周后,两组疗效比较,中药组优于对照组(P<0.05);与对照组比较,中药组能减少失眠、肌强直、震颤、食欲减退等方面不良反应(P<0.05)。结论:归脾汤加味治疗脑卒中后抑郁伴焦虑共病是一种安全有效的疗法。

Effect of combining acupuncture and auricular point sticking on heart rate variability in patients with post-stroke depression

Objective:To investigate the effect of combining acupuncture and auricular point sticking on heart rate variability(HRV)in patients with post-stroke depression(PSD).Methods:A total of 80 cases with PSD were randomized into a treatment group and a control group.The control group was intervened by oral administration of paroxetine hydrochloride,whereas the treatment group received acupuncture plus auricular point sticking base on the same oral administration.The Hamilton depression rating scale(HAMD)and HRV were measured before and after treatment in both groups.Results:The individual and global scores of HAMD significantly dropped after 8 weeks of treatment in both groups(all P〈0.05).In the treatment group,anxiety/somatization factor,sleep disturbance,hopelessness factor,cognition factor and global score were significantly different from those in the control group(all P〈0.05).The 24 h standard deviation of all normal-to-normal R-R interval(SDNN),standard deviation of 5-minute average of normal R-R intervals(SDANN),root mean square of successive differences(RMSSD),percent of differences between adjacent normal R-R intervals 50 ms(PNN50)and high frequency(HF)were increased while low frequency(LF)and LF/HF decreased significantly after 8 weeks of treatment in both groups(P〈0.05).All items in the treatment group were significantly different from those in the control group(all P〈0.05).Conclusion:Combining acupuncture and auricular point sticking can enhance the conventional medical treatment for HRV in patients with PSD.