家庭功能状况对产妇抑郁的影响

目的 探讨家庭功能状况对产妇抑郁的影响，为实施针对性心理护理提供依据。方法 对100例初产妇，采用Smilkstein家庭功能评估问卷及自评抑郁量表（SDS）调查分析其家庭功能及抑郁症状发生情况。结果 家庭功能状态中高功能家庭80例（80．00％），发生抑郁27例（33．75％）；一般家庭18例（18．00％），发生抑郁4例（22．22％）；失职家庭2例（2．00％），发生抑郁1例（50．00％）。32例抑郁产妇中轻度抑郁状态21例（65．60％），中度11例（34．40％）。结论 需加强对高功能家庭、产妇抑郁状态、相关因素的认识和教育，为产妇创造轻松愉快、和谐的家庭环境，促进产妇的身心健康。     

560例产妇产后初期心理状态调查

采用心理、社会(家庭)因素调查表、焦虑自评量表(SAS)及抑郁自评量表(SDS),对560例产妇产后第3天心理状态进行调查.结果产妇产后心理状态不稳定,焦虑、抑郁状态发生率为21.79%,其与生理(分娩)、社会(家庭)因素密切相关.提示及时发现产后异常心理状态,实施干预措施,对产妇身心健康十分重要.     

家庭功能对产妇分娩方式及产程进展的影响

目的 了解产妇家庭功能与产妇分娩方式及产程进展的关系.方法 对168例住院初产妇采用家庭功能量表评估其家庭功能,并观察产妇分娩方式及产程进展情况.结果 168例产妇家庭功能中,114例(67.9%)认为家庭功能良好;54例(32.1%)认为家庭功能障碍;家庭功能良好者要求剖宫产率、第一产程时间显著高于、短于家庭功能障碍者(均P＜0.01),产后2h出血量少(P＜0.01).结论 强化产妇家庭功能及家庭成员对产妇心理支持,有利于产程进展,减少产后2h出血量,促进产妇身心健康.     

老年高血压患者家庭功能与抑郁的对应关系研究

目的 探讨老年高血压患者家庭功能与抑郁的对应关系.方法 采用家庭关怀度指数量表和老年抑郁量表(GDS)对整群便利抽样法抽取的莆田市415例老年高血压患者进行调查.结果 家庭功能良好、一般和障碍者分别占58.7%、29.16%和12.77%,抑郁发生率为42.17%;家庭功能良好者GDS得分显著低于家庭功能一般和障碍者(均P＜0.01);抑郁和家庭功能呈正相关(P＜0.01).对应分析显示中重度抑郁对应家庭功能障碍,轻度抑郁对应家庭功能一般,无抑郁对应家庭功能良好.结论 家庭功能越低,老年高血压患者抑郁发生率越高;应采取相应措施提高家庭功能,降低老年高血压患者抑郁发生.     

癌症患者术前知情状况及其满意度与抑郁的相关性分析

目的 探讨癌症患者术前出现抑郁的原因,为预防患者发生抑郁提供依据.方法 采取方便抽样方法对58例癌症患者手术前知情状况、对知情的满意度及抑郁状况进行问卷调查.结果 癌症患者术前的知情状况与获得信息满意度呈显著正相关(r=0.571,P＜0.01);满意度与抑郁状态呈显著负相关(r=-0.468,P＜0.01);知情状况与抑郁状态呈显著负相关(r=-0.450,P＜0.01).术前癌症患者抑郁的总发生率为44.83%,其中轻度15例(57.69%)、中度7例(26.93%)、重度4例(15.39%).结论 癌症患者术前知情程度越高,满意度越高,抑郁程度越低.临床护理工作中应加强心理护理,为患者提供尽可能多的信息,满足他们对信息的需求,减少对癌症的恐惧和陌生感,以减少抑郁的发生.     

孕期家庭亲密度适应性对产后抑郁的影响

目的探讨孕期家庭亲密度适应性对产后抑郁的影响,为采取有效措施降低产后抑郁提供参考。方法采用家庭亲密度适应性量表和爱丁堡产后抑郁量表对224例妇女,分别于产前(孕28周至产前)及产后6周进行调查。结果45例(20.09%)产妇发生产后抑郁;抑郁组实际亲密度和实际适应性评分显著低于无抑郁组,亲密度不满意程度和适应性不满意程度评分显著高于无抑郁组(P<0.05,P<0.01);孕期实际亲密度、实际适应性、亲密度不满意程度和适应性不满意程度为产后抑郁的影响因素(均P<0.05)。结论孕期家庭亲密度适应性差可导致产后抑郁。护理人员应在产前或孕前护理健康教育工作中宣传家庭亲密度预防产后抑郁的重要性,降低产妇产后抑郁发生率。     

脑卒中患者抑郁状态与生活自理能力相关性调查

目的 探讨脑卒中患者抑郁状态与生活自理能力的相关性.方法 对100例脑卒中患者采用脑卒中后抑郁多模式诊断量表、功能独立性评定量表(FIM)及照顾者情况问卷进行调查.结果 59.0%患者存在不同程度的抑郁;抑郁程度越重,FIM评分越低(均P＜0.01);亲属照顾者抑郁发生率及抑郁程度显著低于和轻于护工照顾者(均P＜0.05).结论 脑卒中患者抑郁发生率高,抑郁越重生活自理能力越差,亲属照顾可有效预防或减轻抑郁的发生及其程度.     

产妇分娩体验与产后抑郁的相关性研究

目的 了解产妇分娩体验及产后抑郁状况,并分析二者之间的相关性.方法 对产后42 d常规检查的282例产妇采用中文版分娩体验量表和爱丁堡产后抑郁量表进行调查.结果 产妇分娩体验总分(2.73±0.44)分,自我能力维度(2.70±0.61)分、参与感维度(2.62±0.58)分、专业支持维度(3.00±0.58)分、自我感知维度(2.47±0.58)分.产妇抑郁得分(7.39±4.21)分,有产后抑郁症状者31例(10.99％).分娩体验与产后抑郁呈负相关(P＜0.01),自我能力和自我感知维度与产后抑郁得分呈负相关(均P＜0.01).结论 产妇分娩体验水平还有待改善,高水平的分娩体验能够降低产妇发生产后抑郁风险,特别需注意加强产妇自我能力和自我感知方面的体验.     

维持性血液透析患者抑郁情绪影响因素调查分析

目的探讨维持性血液透析患者抑郁情绪发生的影响因素,为临床护理提供依据.方法采用抑郁自评量表(SDS)和家庭支持Apgar问卷对362例维持性血液透析患者进行调查.结果维持性血液透析患者抑郁发生率为53.87%,显著高于普通人群;抑郁情绪的发生与患者透析时间、性格、经济状况、自理能力及家庭支持状况密切相关(均P<0.01).结论维持性血液透析患者抑郁的发生与多种因素有关,及早进行心理护理能减少患者抑郁情绪的发生,提高患者的生活质量.     

HIV感染者和艾滋病患者抑郁状态与社会支持的相关性研究

目的 探讨HIV感染者和艾滋病患者(PLWHA)的抑郁状态与社会支持状况,以及二者之间的相关性.方法 采用Zung抑郁自评量表(SDS)、社会支持评定量表(SSRS)对82例PLWHA进行问卷调查.结果 PLWHA的SDS评分(42.81±9.24)分,显著高于常模(P<0.01);50例(60.98%)存在抑郁状态;SSRS得分30.06±4.02,显著低于常模(P<0.01).PLWHA抑郁与社会支持呈负相关(均P<0.01);婚姻状况、文化程度、感染方式、病程及医疗费用支付方式影响SDS及SSRS得分(P<0.05,P<0.01).结论 PLWHA抑郁发生率高.社会支持水平较低;护理人员应采取有效干预措施提高PLWHA的社会支持水平,以改善其抑郁状态,提高其生活质量.     

初产妇女配偶产后抑郁的影响因素

目的分析初产妇女的配偶产后抑郁状况,探讨影响及预测其抑郁状况的相关因素。方法应用问卷调查方法,在妇女产后3个月对初产妇的配偶进行问卷调查。应用Logisitic回归分析产后配偶抑郁的关联因素,应用ROC曲线分析婚姻质量、育儿压力及人际信任对产后配偶抑郁的预测效果。结果本研究共纳入研究对象812例,发生产后抑郁97例,产后抑郁情绪发生率11.95%。饮酒(OR=1.852,P=0.002)、轮班工作(OR=1.447,P=0.011)、育儿压力大(OR=2.742,P<0.001)、女性户主(OR=2.419,P=0.011)、每日数字媒体应用时间长(OR=3.028,P<0.001)、原生家庭排行高(OR=2.682,P=0.023)是导致产后配偶抑郁的危险因素;婚姻质量高(OR=0.392,P<0.001)、人际信任状况好(OR=0.627,P=0.025)、自有住房(OR=0.419,P=0.006)是产后配偶抑郁的保护因素。婚姻质量对产后男性配偶抑郁的影响大于育儿压力和人际信任,其ROC-AUC为0.742。结论建议相关医疗机构应加强对产后男性配偶心理问题的评估与管理,降低其产后抑郁率。     

Selective Lumbar Epidural Block in Labour. A Clinical Analysis

Segmental epidural analgesia (T₁₀-T₁₂) was performed in 418 parturients, using a 4–6 ml dose of 0.5% bupivacaine, with or without adrenaline. Seventy per cent of parturients were primiparas and 30% had histories, or signs, of possible uteroplacental insufficiency. Our aim was to relieve pain during the long passive opening phase, so that mothers would be rested and active at the beginning of the second phase, but also to avoid abolishing the bearing-down reflex, the absence of which causes an increased frequency of instrumental delivery. The analgesia during the opening phase was of good quality in 89% of primiparas, and 84% of multiparas. The onset of analgesia was rapid (3–5 min) and the duration was on average 2 1/2 h. The incidence of foetal heart rate changes, during the 30 min after epidural, was 5%. The second phase was less than 30 min in about 90% of cases. About 90% of parturients delivered spontaneously, and the frequency of instrument delivery was only 7.4%. Caesarean section was required in 3.7%. Slight, but rapidly correctable, hypotension occurred in 16.5%, and in two cases the hypotension led to more serious complications. This stresses the importance of the availability and competence of both the anaesthetic and obstetric teams. There were no maternal or neonatal mortalities, and the Apgar scores compared well with the figures for the normal material in our obstetric unit.     

Accidental dural puncture,postdural puncture headache,intrathecal catheters,and epidural blood patch: revisiting the old nemesis

One of the controversial management options for accidental dural puncture in pregnant patients is the conversion of labor epidural analgesia to continuous spinal analgesia by threading the epidural catheter intrathecally. No clear consensus exists on how to best prevent severe headache from occurring after accidental dural puncture. To investigate whether the intrathecal placement of an epidural catheter following accidental dural puncture impacts the incidence of postdural puncture headache (PDPH) and the subsequent need for an epidural blood patch in parturients. A retrospective chart review of accidental dural puncture was performed at Hutzel Women’s Hospital in Detroit, MI, USA for the years 2002–2010. Documented cases of accidental dural punctures (N = 238) were distributed into two groups based on their management: an intrathecal catheter (ITC) group in which the epidural catheter was inserted intrathecally and a non-intrathecal catheter (non-ITC) group that received the epidural catheter inserted at different levels of lumbar interspaces. The incidence of PDPH as well as the necessity for epidural blood patch was analyzed using two-tailed Fisher’s exact test. In the non-ITC group, 99 (54 %) parturients developed PDPH in comparison to 20 (37 %) in the ITC [odds ratio (OR), 1.98; 95 % confidence interval (CI), 1.06–3.69; P = 0.03]. Fifty-seven (31 %) of 182 patients in the non-ITC group required an epidural blood patch (EBP) (data for 2 patients of 184 were missing). In contrast, 7 (13 %) of parturients in the ITC group required an EBP. The incidence of EBP was calculated in parturients who actually developed headache to be 57 of 99 (57 %) in the non-ITC group versus 7 of 20 (35 %) in the ITC group (OR, 2.52; 95 % CI, 0.92–6.68; P = 0.07). The insertion of an intrathecal catheter following accidental dural puncture decreases the incidence of PDPH but not the need for epidural blood patch in parturients.     

Indicators of long-term family functioning following severe traumatic brain injury in adults

This study investigated the degree of association between four sets of predictor variables (demographic, injury-related, patient functioning, and caregiver functioning variables) and the criterion variable of long-term family functioning following severe traumatic brain injury (TBI). Thirty families participated in the study and a minimum of 3 .5 years had elapsed since the time of injury. The mean length of post-traumatic amnesia (PTA) for the brain-injured individuals was 92 .4 days. Data collection took place in the family home and both the brain-injured family members and primary caregivers were involved. Standard regression analyses revealed that two sets of variables accounted for a significant amount of variance in long-term family functioning. The largest amount of variance, 55% (44% adjusted), was accounted for by the caregivers' self-report variables which measured caregivers' depression, social support, and coping as well as caregivers' perceptions of patient competency. Overall, measures of severity of injury (PTA), residual neurobehavioural function, and adequacy of social support for caregivers proved to be reliable and significant indicators of family functioning. These findings are discussed with respect to their implications for service delivery and long-term provision of support for caregivers of severely brain-injured individuals living with their families.     

自控腰硬联合分娩镇痛不同的停泵时机对产程和分娩结局的影响

目的探讨自控腰硬联合分娩镇痛麻醉下,初产妇分娩过程中不同的停泵时机对产程、分娩结局和产妇满意度的影响。方法选择2013年4月-2013年12月间符合条件的初产妇120例,按先后顺序分到A、B、C三组,每完成10个另起一组,每组40例,腰硬联合麻醉分娩镇痛,A组宫口开全停泵,不再开泵;B组宫口开全停泵,胎儿娩出后立即开泵;C组一、二、三产程持续镇痛,三组均于第三产程结束,会阴缝合术毕结束镇痛并拔硬外镇痛管。观察比较产妇基本情况、镇痛效果（VAS）评分、第1、2、3产程时间、产后2h内出血量、缩宫素使用、剖宫产率、钳产率、羊水性质、产妇满意度,新生儿Apgar评分。结果三组间产后2h出血、新生儿Apgar评分、第三产程时间差异无统计学意义;A、B组产妇分娩痛比例较c组增加,会阴缝合痛或不适者较C组多,C组产妇满意度较A、B组增加,差异有统计学意义,A、B组间各项指标间差异无统计学意义。结论不同的停泵时机不增加第二产程,不影响新生儿Aparg评分,不增加产后出血,持续用药组增加缩宫素使用率,差异有统计学意义（P〈0．05）,可能增加剖宫产趋势,但可提高产妇满意度。     

ST-segment depression and myocardial contractility during Cesarean section under spinal anesthesia

PURPOSE: To evaluate myocardial contractility during ST segment depression in healthy parturients during Cesarean section (CS). METHODS: Forty-seven consecutive term parturients undergoing elective CS under spinal anesthesia were studied. The ST segment was recorded continuously on leads II and V5 using a Holter monitor. Myocardial performance was evaluated by measuring cardiac index (CI), heart rate (HR), pre-ejection period (PEP), ventricular ejection time (VET), systolic time ratio (STR, PEP/VET), and ejection fraction (EF) with an impedance cardiograph. RESULTS: Fourteen patients (30%) developed ST segment depression within 15 min after delivery and the remaining 33 (70%) did not (controls). Seven patients developed a 1 mm change, five patients a 2 mm change and the remaining two a 3 mm change in the ST segment. Compared with pre-anesthesia values, the mean HR increased from 103 +/- 10 to 116 +/- 10 (ISD) bpm (P = 0.001), CI from 4.7 +/- 0.7 to 5.6 +/- 1.7 L.min-1 (P = 0.01), EF from 0.58 +/- 0.08 to 0.66 +/- 0.05 (P = 0.01) and STR decreased from 0.26 +/- 0.06 to 0.2 +/- 0.04 (P = 0.01) during ST segment depression. At this time, CI, HR and EF were greater and STR smaller than values obtained 15 min after delivery in the control subjects. CONCLUSION: ST-segment depression occurring during CS is associated with a hyperkinetic myocardial contractile state.     

Anästhesiologische Versorgung von HIV-positiven Schwangeren zur elektiven Sectio caesarea

OBJECTIVE: Worldwide, 50 million people are infected with the human immunodeficiency virus (HIV), and 43% are women. Perinatal vertical transmission of HIV accounts for most new pediatric cases. Elective Cesarean delivery, combined antiretroviral therapy perioperatively and abandonment of breast-feeding postoperatively reduces vertical HIV transmission. However, the incidence of maternal and neonatal morbidity perioperatively is relatively unknown. The goal of the present study was to prospectively record perioperative maternal and neonatal complications in the largest HIV positive collective undergoing elective Cesarean section with spinal anesthesia published to date. METHODS: From 1999-2001, 54 HIV positive parturients were enrolled in this study. All parturients received IV zidovudine therapy (2 mg/kg body weight) perioperatively. Spinal anesthesia was performed using 60 mg of 4% hyperbaric mepivacaine plus 5 microg sufentanil intrathecally. Sensory, analgesic and motor block characteristics, the incidence of maternal hypotension, postoperative maternal complications as well as neonatal outcome were recorded. RESULTS: Short-term hypotension occurred in 65% of the parturients. Intraoperatively, one parturient died following amniotic fluid embolism. In 17% of the parturients, postoperative complications headed by wound healing impairment, bronchitis and pneumonia requiring prolonged antibiotic therapy were observed. To date, after a minimum observation period of 8 months, only one infant (1.8%) is HIV positive. CONCLUSION: Intrathecal mepivacaine combined with sufentanil in HIV positive parturients undergoing elective Cesarean section is an appropriate anesthetic option. Postoperative maternal morbidity was 17%. Neonatal outcome showed no evidence of neonatal depression.     

Childhood thin GBM disease: review of 22 children with family studies and long-term follow-up

Thin glomerular basement membrane (GBM) disease is generally known to have a good renal prognosis, although renal insufficiency has sometimes been reported and the overlap with Alport syndrome implies that a good prognosis cannot be guaranteed. In order to shed light on long-term prognosis of thin GBM disease we have retrospectively evaluated 22 children with persistent haematuria and biopsy-proven thin GBM. Mean follow up was 7 years (range 2–17 years), mean age at onset was 7 years (range 1.5–15). Biopsies were performed a mean of 3.8 years after detection of hematuria. The light microscopy (LM) and immunofluorescence (IF) findings were essentially unremarkable in all of the children, while electron microscopy (EM) showed thinning of the GBM in all cases and no changes characteristic of Alport syndrome. The family history was positive for renal disease in 17 (77.3%) patients with hematuria in 8 (36.3%) families, and hematuria with renal failure (RF) or deafness in 9 (40.9%). It was completely negative for renal disease in 4 (18.2%) and unavailable in 1 (4.5%). Four patients (18%) showed a decline in renal function after 6, 8, 9 and 12 years of follow-up, and 1 of these also developed hearing impairment. None developed hypertension.Our study suggests that thin GBM disease is not always benign and a child with thin GBM should never be assigned such a prognosis, especially if there is a family history of renal impairment or deafness, where careful follow-up is needed due to the risk of late onset renal failure.     

产妇会阴侧切术后切口感染病原菌分布及相关因素

目的探讨产妇会阴侧切术后切口感染病原菌的分布特征,分析影响产妇会阴侧切切口感染的危险因素,为会阴侧切切口感染的防治提供依据。 方法选择2014年3月至2018年10月重庆市开州区人民医院产科收治的461例会阴侧切产妇为研究对象进行回顾性分析,依据细菌培养结果分为感染组（46例）和未感染组（415例）。统计会阴侧切后切口感染病原菌种类和构成比,采用Logistic非条件回归分析产妇会阴侧切切口感染的危险因素。 结果入组产妇会阴侧切切口感染率为9.98%（46/461）;共检出菌株43株,其中革兰阴性菌占53.49%（23/43）,革兰阳性菌占39.53%（17/43）。大肠埃希菌和表皮葡萄球菌为会阴侧切切口感染主要致病菌,检出率分别为25.58%和23.26%。54.35%（25/46）产妇存在两种或两种以上病原菌感染。单因素分析结果显示,产妇会阴侧切术后切口感染与产妇BMI、阴道产检次数、胎膜早破、产程、切口长度、助产士工作年限、术后住院时间、妊娠期合并糖尿病、生殖道感染有关（P均< 0.05）,而与产妇年龄、是否为初产妇、是否急诊分娩无关（P均> 0.05）。Logistic回归分析结果显示,产妇BMI （OR = 2.282、95%CI：1.958～8.265、P < 0.001）、阴道产检次数（OR = 1.855、95%CI：1.065～4.682、P = 0.002）、胎膜早破（OR = 2.085、95%CI：1.730～7.165、P < 0.001）、生殖道感染（OR = 2.732、95%CI：2.015～10.562、P = 0.015）、妊娠期合并糖尿病（OR = 3.337、95%CI：2.356～12.526、P < 0.001）、产程（OR = 1.714、95%CI：1.305～4.928、P < 0.001）均为产妇会阴侧切切口感染的独立危险因素。 结论受多种因素影响,产妇会阴侧切切口感染发生率较高,大肠埃希菌和表皮葡萄球菌为主要致病菌。临床应对增加切口感染发生率的危险因素采取针对性措施进行干预,以降低会阴侧切术后切口感染的发生。