目的 观察补阳还五汤加减治疗社区脑卒中后疲劳患者的临床疗效.方法 本研究于2016年6月～2018年6月将符合入组标准的63例北京社区脑卒中患者,随机分为对照组和治疗组.对照组接受内科常规药物对症治疗.治疗组在补阳还五汤的基础上根据患者的症状进行加减.4周后对患者的疲劳严重度、生存质量和日常生活能力进行评分,与治疗前评分进行比较分析.结果 入组的脑卒中后疲劳患者经过治疗后,疲劳严重度评分、生存质量评分和日常生活能力评分均较治疗前改善(P<0.05);补阳还五汤治疗组患者在改善疲劳严重度评分、日常生活能力评分方面优于对照组(P<0.05),两组在改善生存质量改善方面效果相近(P>0.05).结论 应用补阳还五汤加减治疗脑卒中后疲劳,能显著改善患者的疲劳程度和日常生活能力,提高生存质量,对临床指导具有较好的参考意义.

Objective To explore the practical effect of family doctor service on promoting hierarchical diagnosis and treatment in Fangzhuang community.Methods By equidistant random sampling method,587 patients with type 2 diabetes mellitus who signed contract with family doctors in Fangzhuang Community Health Service Center from 2011 to 2015 were selected as the study subjects.Their data taking type 2 diabetes mellitus and its complications as first diagnosis were extracted from the Beijing Management Center of Medical Insurance Affairs.A statistical analysis of these data including times of outpatient visiting and hospitalization,outpatient costs of medical care and medical insurance fund,hospitalization costs of medical care and medical insurance fund in primary health care institutions,secondary hospitals and tertiary hospitals was conducted in this study.Results From 2011 to 2015,there was significant difference in the per capita number of outpatient visit between primary health care institutions and tertiary hospitals among patients who had signed contract (P<0.05);there were no significant differences in the per capita number of outpatient visit and per capita number of hospitalization in secondary hospitals,and the per capita number of hospitalization in tertiary hospitals among the research subjects (P>0.05).From 2011 to 2015,there was significant difference in outpatient costs of medical care per capita between primary health care institutions and tertiary hospitals among the subjects (P<0.05);there were no significant differences in the per capita costs of medical care and hospitalization in secondary hospitals,and the per capita costs of hospitalization in tertiary hospitals among the research subjects (P>0.05).From 2011 to 2015,there was significant difference in the per capita costs of outpatient medical insurance fund between primary health care institutions and tertiary hospitals among the subjects (P<0.05);there were no significant differences in the per capita costs of outpatient and hospitalization medical insurance fund in secondary hospitals,and the per capita costs of hospitalization medical insurance fund in tertiary hospitals among the subjects (P>0.05).Conclusion The family doctor service in Fangzhuang community has effectively reduced the number of outpatient visit and saved medical expenses to a certain extent of patients with type 2 diabetes mellitus,and has a positive significance in achieving initial diagnosis in community and promoting hierarchical diagnosis and treatment system.

Objective To observe the effectiveness of Traditional Chinese Medicine (TCM) integrated treatment programon prevention and treatment of cognitive impairment after stroke in commnity.Methods 160 patients with mild and moderate cognitive impairment after stroke were randomly divided into two groups.80 cases(4 cases fell off) in intervention group were treated by TCM integrated treatment program, and 80 cases(6 cases fell off) in control group were treated by medicine and rehabilitation.The Mini Mental Status Examination (MMSE), the Montreal Cognitive Assessment scale (MoCA) and Activities of Daily Living (ADL) before and after 3 months intervention and 1 year after stroke were conducted to evaluate the clinical curative effect.Results The scores of MMSE, MoCA and ADL after 3 months intervention and 1 year after stroke were increased in two groups (P<0.05).The scores of MMSE, MoCA and ADL1 year after stroke were higher than those after 3 months intervention in two groups (P<0.05).The scores of MMSE, MoCA and ADL after 3 months intervention and 1 year after stroke were higher than those in control group at the same period (P<0.05).The improvement of cognitive function was positively correlated with the improvement of daily living activity.Conclusion TCM integrated treatment program can increase MMSE, MoCA and ADL on cognitive impairment after stroke in community, can improve the level of cognitive function and daily living activities in a certain extent, and comprehensively improve the patient's quality of life.

目的观察银丹心脑通软胶囊联合多奈哌齐对老年性痴呆患者的临床疗效。方法 98例老年性痴呆患者随机分为治疗组(50例)和对照组(48例)。治疗组给予银丹心脑通软胶囊1.2g,每日3次。同时联合多奈哌齐5mg,每天一次,1月后改为10mg,每天一次。对照组单纯采用多奈哌齐,用法同前。治疗24周前后,评价简易智能精神状态评估量表(MMSE)、日常生活功能量表(ADL)、长谷川痴呆量表(HDS),并进行对比研究。结果与对照组比较,治疗组MMSE、ADL、HDS评分指标均有统计学意义(P<0.05)。结论银丹心脑通胶囊和多奈哌齐联合治疗老年性痴呆可有效改善患者认知、行为能力,达到良好的治疗效果。

目的观察银杏叶联合多奈哌齐治疗老年性痴呆的临床疗效。方法将102例老年性痴呆患者随机分为治疗组(52例)和对照组(50例),治疗组给予银杏叶片19.2 mg每日3次口服。同时联合多奈哌齐5 mg每日1次口服,1个月后改为10 mg每日1次口服。对照组单纯采用多奈哌齐,用法同前。治疗24周后评价简易智能精神状态评估量表(MMSE)、日常生活功能量表(ADL)、长谷川痴呆量表(HDS)并测定血液流变学指标,进行对比研究。结果与对照组比较,治疗组的MMSE、ADL、HDS评分和血液流变学指标均有显著改善(P均<0.05)。结论银杏叶和多奈哌齐联合治疗老年性痴呆可有效改善患者认知、行为能力和降低血液黏度,从而取得良好的治疗效果。