理性情绪行为疗法合并生物反馈疗法对医学生社交焦虑的干预效果

目的 探讨理性情绪行为疗法合并生物反馈疗法对医学生社交焦虑的干预效果.方法 58名社交焦虑的医学生,采用随机数字法分成4组,即对照组、行为组、反馈组、综合组.其中对照组未干预,行为组采用理性情绪行为疗法、反馈组采用肌电生物反馈、综合组采用理性情绪行为疗法与肌电生物反馈相结合的方法 分别进行干预,于干预前后分别对各组学生社交焦虑水平进行评估.结果 干预后行为组、反馈组和综合组社交回避及苦恼问卷(SAD)总分[(11.33±5.43)分、(10.75±3.57)分、(7.50±3.42)分]和因子分分别低于对照组[SAD总分(18.08±3.82)分].差异具有显著性(F=13.81,7.80,10.22,P＜0.01).干预后综合组SAD总分下降最为明显,与行为组和反馈组相比差异有显著性(F=10.74,P＜0.01).综合组和行为组下降的社交回避因子分高于反馈组(F=7.46,P=0.01).综合组和反馈组下降的社交苦恼因子分高于行为组(F=15.49,P＜0.01).结论 3种干预方法 对于降低社交焦虑水平均有一定疗效;理性情绪行为疗法合并生物反馈疗法的效果最为显著.     

电影课干预对农村儿童心理健康及价值观的影响

目的 探讨电影课干预对农村儿童心理健康及价值观的影响.方法 以电影课的干预方式对安徽两所小学5年级的学生以及两所中学初中2年级的学生进行干预,共438名学生,分为干预组(n=188)与对照组(n=250).结果 五年级干预组和对照组抑郁、状态与特质焦虑前后测组间差异不显著,而价值观前后测评分差值为[干预组(2669.5±22216.43)分,对照组(316.57±1410.83)分],且组间差异显著(t_(价值观)=10.721,P=0.000);初二干预组和对照组抑郁、状态与特质焦虑、价值观前后测组间差异均显著[分别为(t_(抑郁)=2.046,P=0.043;t_(状态焦虑)=3.507,P=0.001;t_(特质焦虑)=3.392,P=0.001;t_(价值观)=5.022,P=0.000)].2所小学干预组的五年级学生在抑郁情绪、状态与特质焦虑情绪的干预效果不显著,而价值观的干预效果显著(F=91.62,P=0.000);2所中学干预组的初中2年级学生在抑郁情绪、状态与特质焦虑情绪和价值观方面的干预效果达到了显著[分别为(F=7.86,P:0.005;F=12.32,P:0.000;F=10.47,P=0.001;F=28.34,P=0.000)].结论 以电影课为心理干预方式,能够有效促进初中学生的心理健康水平,并帮助他们树立正确的价值观.由于电影课的可操作性强,这一干预方法应该成为促进农村儿童心理健康发展的有效方法.     

焦虑障碍患者生活事件、应对方式及社会支持状况调查

目的 探讨焦虑障碍患者生活事件、应对方式及社会支持的现状.方法 采用生活事件量表、简易应对方式问卷、社会支持评定量表对50例广泛性焦虑症患者(GAD),44例强迫症患者(OCD)、23例社交焦虑障碍患者(SAD)以及99例正常人进行评定.结果 患者组生活事件总分[GAD组(22.46±18.44)分;OCD组(23.68±28.31)分;SAD组(17.22±14.97)分;正常对照组(6.64±9.71)分,F =14.216,P =0.000]和负性生活事件得分[GAD组(18.76±17.99)分;OCD组(20.02±24.98)分;SAD组(12.00±13.16)分;正常对照组(4.56±7.51)分,F =14.391,P =0.000]均显著高于正常对照组;患者组积极应对方式得分( F =16.505,P =0.000)均显著低于正常对照组,广泛性焦虑症组、社交焦虑症组消极应对方式得分显著高于正常对照组;患者组社会支持总分( F =26.506,P =0.000)及客观社会支持( F =7.494,P =0.000)、主观社会支持( F =26.985,P =0.000)和社会支持利用度得分( F =13.931,P =0.000)均低于正常对照组.结论 1.焦虑障碍患者普遍经历了比较多的或者影响比较大的应激性生活事件,更加倾向于采用消极应对方式,社会支持比较匮乏;2. 焦虑障碍的发生发展可能与此类人群的生活事件、应对方式、社会支持情况相关.     

社交焦虑大学生对面容表情图片的注意偏向研究

目的 研究不同试验情景下不同社交焦虑水平的大学生对威胁性面容表情图片的注意偏向.方法 根据在社交回避及苦恼量表上的得分从500名大一学生中筛选出23名高分组被试和24名低分组被试,并将被试随机分入威胁性(预先被告知要发表演讲)和非威胁性试验情景,完成点探测试验,记录注意偏向得分(ABS).结果 在威胁性试验情景下,社交焦虑高、低分组被试的ABS分别为(-2.63±1.83)ms、(0.42±1.36)ms,差异有显著性(t=4.641,P=0.000);在非威胁性试验情景下,社交焦虑高、低分组被试的ABS分别为(-0.41±1.56)ms、(0.47±0.67)ms,差异无显著性(t=1.732,P=0.106).社交焦虑个体在威胁性、非威胁性试验情景下的ABS分别为(-2.63±1.83)ms、(-0.41±1.56)ms,差异有显著性(t=3.122,P=0.005);而低分组被试在威胁性、非威胁性试验情景下的ABS分别为(0.42±1.36)ms、(0.47±0.67)ms,差异无显著性(t=0.124,P=0.903).社交焦虑和试验情景的交互作用对注意偏向得分的影响有统计学意义(F=6.881,P=0.012);社交焦虑和试验情景的主效应因素均差异有显著性(F=20.429,P=0.000)、(F=6.413,P=0.015).结论 社交焦虑大学生回避威胁性面容表情图片,而且在威胁性试验情景下,这种回避倾向更为明显.     

正念防复吸疗法对女性戒毒人员稽延性戒断症状的干预研究

目的 探讨正念防复吸疗法对女性劳教人员稽延性戒断症状的改善效果.方法 选取劳动教养管理所4个大队的戒毒人员120名,每队30人.以大队为单位,采用掷硬币法将4个大队分配到干预组和对照组,干预组成员接受正念防复吸疗法,对照组不参加.用五因素正念量表和阿片类稽延性戒断症状评定量表测量正念水平和稽延性戒断症状,用t检验、x2检验、重复测量资料的方差分析来处理数据.结果 方差分析结果显示:正念在观察(F=27.87,P=0.000)、描述(F=15.10,P=0.000)维度以及正念总分(F=12.05,P=0.001)上,组间和时间有交互作用,干预组的效果好于对照组.稽延性戒断症状在渴求症状(F=7.53,P=0.007)和睡眠症状(F=4.40,P=0.038)两个维度上,组间和时间有交互作用.干预组的睡眠症状改善好于对照组,干预组干预前(5.7±4.0)分,干预后(3.5±3.1)分;对照组前测(4.3±3.6)分,后测(3.7±3.5)分.躯体症状(F=14.89,P=0.000)在干预前后有所改善.各个指标的组间主效应没有统计学差异.结论 正念防复吸疗法能够提高正念水平、改善戒毒者的睡眠症状.隔离戒毒可以改善戒毒者的症状.     

认知行为综合干预对成人正畸患者焦虑水平及口腔健康相关生活质量的影响

目的 探讨认知行为干预对成人正畸患者焦虑状态及口腔健康相关生活质量的影响.方法 将成人正畸焦虑患者152例采用分段随机分组的方法分为干预组与对照组,两组各76例.干预组采用直丝弓矫治技术治疗并合并认知行为综合干预,对照组仅用直丝弓矫治技术治疗,采用状态-特质焦虑量表（STAI）与口腔健康相关生活质量影响程度量表（OHRQoL-UK）对患者进行评定并对两组治疗前后STAI、OHRQoL-UK评分进行统计学分析.结果 1.认知行为干预前对照组S-AI[（58.74± 11.05）分、T-AI（53.06±11.77）分]与干预组S-AI[（59.52±12.28）分、T-AI（52.45± 10.32）分]差异无统计学意义（P＞0.05）,认知行为干预3个月及6个月后干预组S-AI[（50.37±9.18）分,（35.65±8.92）分]低于对照组[（56.62±10.52）分,（54.13±10.03）分]（P＜0.01）;干预6个月后干预组T-AI[（47.92±6.82）分]低于对照组[（51.52±7.41）分]（P＜0.05）;2.OHRQoL-UK总分正畸治疗前两组差异无统计学意义,正畸治疗完成后干预组（58.27±13.43）高于对照组[（51.99± 11.69）分]（P＜0.01）;3.正畸治疗后OHRQoL-UK评分与S-AI、T-AI评分呈负相关（r=-0.192～-0.459,P＜0.05）.结论 认知行为综合干预能有效缓解成人正畸患者的焦虑状态并可以提高正畸治疗后的口腔健康相关生活质量.     

心理干预及信息支持对子宫全切患者的积极影响分析

目的 探讨在子宫全切患者护理干预期间给予心理护理和信息支持的效果.方法 将2008年9月～2011年8月收治的54例子宫全切患者随机分为两组,对照组患者给予常规护理,实验组患者在对照组护理干预基础上加强心理护理和信息支持,对比两组患者护理干预后10天的焦虑抑郁状态.结果 实验组患者护理后焦虑状态为(41.02±8.55)分,抑郁状态为(40.03±6.22)分,均低于对照组患者,P＜0.05,差异有统计学意义.结论 对子宫全切患者给予心理护理和信息支持,能够更好地降低患者的紧张和焦虑状态,提高其生活质量,值得在临床护理工作中应用.     

心理护理干预对宫外孕患者术后焦虑状态的影响

目的探讨心理护理干预对宫外孕患者术后焦虑状态的影响。方法选取2011年10月～2012年6月入住广东省惠州市中心人民医院的宫外孕并行输卵管切除术患者307例,将其分为对照组（153例）和观察组（154例）。采用自制问卷和Zung焦虑自评量表（SAS）对患者术后第1天焦虑状态及其相关焦虑情绪进行调查,给予对照组常规护理,给予观察组心理护理干预,术后护理第7天再进行复查,对两组护理效果进行分析。结果对照组和观察组两组护理前SAS评分[（55.62±11.13）、（55.41±12.02）分]及焦虑相关情绪比较,差异无统计学意义（P〉0.05）,护理后比较,差异有统计学意义（P〈0.05）。观察组给予心理护理干预前后SAS评分[（54.23±12.03）、（43.75±11.25）分]及焦虑相关情绪比较,差异有统计学意义（P〈0.05）,对照组术后常规护理前后SAS评分[（55.62±11.13）、（54.23±12.03）分]及焦虑相关情绪比较,差异无统计学意义（P〉0.05）。对照组与观察组患者对护理服务的满意度（48.37%、98.05%）比较,差异有统计学意义（χ^2=4.70,P=0.001）。结论心理护理干预可有效改善宫外孕患者术后焦虑状态及其相关的不良情绪,在临床护理干预中应重视患者的心理护理,以提高患者的生活质量。     

基于认知行为疗法的线上课堂对预防产后抑郁的效果评价

  目的  探讨基于认知行为疗法的线上课堂对预防产后抑郁的作用。  方法  收集2019年6月—2020年1月产科门诊产检的孕妇80例,按照随机数字表法分为观察组和对照组, 各40例,对照组采用常规产前检查、产科常规护理、产后随访,观察组基于认知行为疗法的线上课堂对孕妇的认知行为进行干预。分别于干预前、产后42 d采用一般状况调查表、爱丁堡产后抑郁量表、焦虑自评量表、压力知觉量表,产后42 d应用育儿胜任感量表进行问卷调查。  结果  在干预前,2组在抑郁状态、焦虑情绪、压力评分上差异均无统计学意义(均P>0.05);在产后42 d,观察组抑郁评分(6.85±3.83)显著优于对照组的抑郁评分(9.13±4.91),差异具有统计学意义(P < 0.05);在焦虑状态上,观察组(28.88±9.63)显著优于对照组(36.12±9.18),差异具有统计学意义(P < 0.05);在压力评分上,观察组的压力评分(20.20±7.43)显著优于对照组(25.12±10.54),2组差异具有统计学意义(P < 0.05);对照组的养育胜任感得分是75.33±10.65,观察组的养育胜任感得分是81.20±9.35,2组比较,差异具有统计学意义(t=-2.622,P=0.011)。  结论  基于认知行为疗法的线上课堂可有效提高产妇的育儿胜任感、降低育儿压力,缓解焦虑情绪,预防产后抑郁症的发生。      

认知行为疗法和团体游戏联合放松训练在青少年唇腭裂患者心理干预中的应用

  目的  探讨认知行为疗法、团体游戏联合放松训练在青少年唇腭裂患者心理干预中的应用效果。  方法  选取2019年3月—2020年3月期间蚌埠医学院第一附属医院治疗的29例青少年唇腭裂患者作为研究对象,采用随机数字表法分为对照组和观察组,分别实施常规心理疏导及认知行为疗法、团体游戏联合放松训练的心理干预方法,比较2组患者干预前后心理状态、自我接纳水平和应对方式。  结果  实施干预后,观察组SCL-90评分为(192.88±24.03)分,明显低于干预前[(233.29±43.88)分],差异有统计学意义(P < 0.05),且观察组SCL-90评分低于对照组[(214.00±30.88)分,t=-2.072,P=0.048];在接纳自我方面,观察组总分及各因子分均高于对照组,其中观察组总分为(47.18±4.64)分,对照组为(36.08±3.18)分,2组比较差异有统计学意义(t=7.164,P < 0.001);在应对方式方面,观察组积极因子分[(13.52±1.19)分]高于对照组[(10.86±1.19)分, t=5.901,P < 0.001],消极因子分[(3.36±0.84)分]低于对照组[(5.62±0.96)分,t=-6.702,P < 0.001]。  结论  认知行为疗法、团体游戏联合放松训练可以改善青少年唇腭裂患者心理状态;可以帮助患者以积极的方式应对困难,促进自我接纳。      

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.