尿毒症患者首次血液透析前后的抑郁状况评估

目的评估尿毒症患者首次血液透析前后的抑郁状况,探讨抑郁发生的影响因素。方法选取2013年6月-2014年12月大连市某医院肾内科收治的78例尿毒症患者作为研究对象,采用Zung氏抑郁自评量表(SDS)和社会支持量表(SSRS)对患者首次血液透析前后的抑郁状况以及社会支持情况进行评估。结果月收入≤1 000元的尿毒症患者首次血液透析前1日SDS评分为(64.32±5.97)分,月收入为1 001~3 000元的尿毒症患者首次血液透析前1日SDS评分为(58.48±12.13)分,月收入3 000元的尿毒症患者首次血液透析前1日SDS评分为(57.19±8.16)分,3组比较差异有统计学意义(F=5.162,P=0.014)。有并发症的尿毒症患者首次血液透析前1日SDS评分为(61.73±8.91)分,无并发症的尿毒症患者首次血液透析前1日SDS评分为(53.17±4.38)分,2组比较差异有统计学意义(t=2.527,P=0.027)。不同性别、年龄、婚姻状况、文化程度、付费方式尿毒症患者首次血液透析前1日的SDS评分比较,差异无统计学意义。尿毒症患者首次血液透析前1周和透析后1周的SDS评分分别为(53.2±11.62)分和(44.8±16.32)分,透析前1周与透析后1周的SDS评分比较,差异有统计学意义(t=7.41,P0.01)。尿毒症患者首次血液透析前1周和透析后1周的抑郁发生率分别为37.18%和23.07%,以轻度和中度抑郁为主。尿毒症患者社会支持总分为(37.94±7.68)分,主观支持分维度得分为(23.36±5.17)分,客观支持分维度得分为(8.71±3.46)分,支持利用度分维度得分为(7.72±2.51)分,均与首次血液透析前1周SDS评分呈负相关。结论应重视对尿毒症患者首次血液透析前后的抑郁状况进行评估,以便尽早给予针对性干预,避免中度和重度抑郁的出现,进而提高尿毒症患者的生活质量。     

合并抑郁症状的肺肿瘤术后过渡期患者社会人口学和疾病特征

目的分析合并抑郁症状的肺肿瘤术后过渡期患者社会人口学与疾病特征及其影响因素,为临床干预提供参考。方法连续收集2018年5—10月在西安市某三级甲等医院进行手术治疗的肺肿瘤患者213例,使用抑郁自评量表(SDS)评定抑郁症状,按照SDS评分将患者分为抑郁组和非抑郁组,进行组间比较分析,采用多因素logistic回归分析合并抑郁的相关危险因素。结果肺肿瘤术后过渡期抑郁症状的发生率为52.1%,不同性别、医疗费别、有吸烟史、肿瘤类型、术后疼痛性质的患者抑郁症状的发生率差异有统计学意义(P0.05),自费医疗(OR=3.908,95%CI:1.893～8.071)、恶性肿瘤(OR=4.770,95%CI:2.060～11.046)及术后持续疼痛(OR=4.051,95%CI:1.972～8.322)与肺肿瘤术后过渡期抑郁症状显著相关。结论肺肿瘤患者术后过渡期普遍存在抑郁情绪,医护人员不仅要针对患者病情严密观察,还要及时做好心理疏导和健康教育,从而有效改善患者的不良情绪反应,促使其早日恢复到最佳状态。     

恢复期精神分裂症合并抑郁症状患者心理健康状况调查及不同心理干预效果分析

目的调查恢复期精神分裂症合并抑郁症状患者心理健康状况及不同心理干预效果。方法以武汉市精神卫生中心2014年1月-2016年6月收治的125例恢复期精神分裂合并抑郁症状患者为研究对象,先通过抑郁自评量表(SDS)、自行设计的心理影响因素调查表了解患者心理健康状况,随后按照入院顺序将患者分为观察组(63例)与对照组(62例),观察组给予系统支持性心理干预,对照组则采取常规心理干预,比较两组干预前后SDS评分、简明精神病量表(N-BPRS)及干预3个月后生活质量问卷(GQOL1-74)评分情况。结果 125例恢复期精神分裂合并抑郁症状患者中有轻中度抑郁症状占96.00%,重度抑郁症状占4.00%;其心理健康状况调查显示:害怕疾病不能治愈占96.80%,害怕被家人嫌弃占46.40%,认为回归社会困难占82.40%,认为会受到歧视占76.00%,感觉前途无望占80.00%;与干预前比较,两组干预后SDS评分、N-BPRS评分均显著下降(P0.05),且观察组上述指标评分均显著低于对照组(P0.05);观察组干预后躯体健康、社会功能及心理健康评分均显著高于对照组(P0.05)。结论精神分裂症并抑郁症状患者多存在心理健康问题,给予系统支持性心理干预能明显缓解患者精神病及抑郁症状,改善其生活质量。     

功能性消化不良合并抑郁焦虑患者的临床心理干预及其效果

目的 探讨心理干预在功能性消化不良(FD)合并抑郁焦虑治疗中的作用.方法 将96例FD合并抑郁焦虑患者随机分为常规治疗组(对照组)和常规治疗加心理干预组(治疗组),每组各48例,对照组给予抗消化不良治疗,治疗组在此基础上结合心理干预治疗.治疗前后对两组患者进行抑郁自评量表(SDS)和焦虑自评量表(SAS)评分,并计算FD症状积分,对两组疗效及评分进行比较.结果 治疗组FD总有效率为83.33%(40/48),对照组FD总有效率为45.83%(22/48),两组比较差异有统计学意义(X~2=17.20,P<0.01);治疗组FD症状积分和SAS、SDS评分均明显好于对照组,差异有统计学意义(P<0.05);治疗组的SAS、SDS评分较治疗前有显著降低,而对照组改变不明显.结论 心理干预能明显改善FD合并抑郁焦虑患者的消化不良症状和抑郁焦虑症状.     

黛力新治疗女性更年期功能性消化不良的临床研究

目的:探讨黛力新治疗女性更年期功能性消化不良的疗效及安全性。方法:以症状自评量表(SCL-90)、Zung氏抑郁自评量表(SDS)、焦虑自评量表(SAS)对65例女性更年期功能性消化不良(FD)患者进行问卷调查,评测患者心理障碍发生情况。有焦虑或抑郁的患者32例,予以黛力新治疗4周,比较治疗前后症状改善程度及焦虑和抑郁评分。结果:更年期女性FD患者的躯体症状、抑郁、焦虑的积分较高,与同龄健康人比较差异有显著性意义(P<0·05);经黛力新治疗后症状改善明显,与治疗前相比SDS,SAS评分差异有显著性意义(P<0·05);无明显不良反应发生。结论:精神心理因素可能与女性更年期FD的发病有关,对此类患者应加强心理治疗。黛力新对伴有焦虑和抑郁的FD患者疗效确切,安全性好。     

心理干预对乳腺癌化疗患者心理状态效果观察

目的:探讨心理干预对乳腺癌首次化疗患者心理状态的效果.方法:采用焦虑自评量表(SAS)及抑郁自评量表(SDS),对30例术后首次化疗的乳腺癌女性患者进行心理干预.在干预前后进行心理状况测评,然后比较护理干预前后效果.结果:30例乳腺癌首次化疗的女性患者均有不同水平的焦虑、抑郁情绪,心理干预后焦虑、抑郁评分均下降,两者相比较差异有统计学意义(P<0.01).结论:心理干预能改善乳腺癌首次化疗患者焦虑、抑郁心理,促进患者积极参与治疗,提高疾病的愈后.     

患者个性特征和心理状态对夫精人工授精治疗结局的影响

目的比较分析夫精人工授精(IUI)治疗后妊娠妇女与未妊娠妇女在治疗前后个性特征和心理状态测试结果,探讨IUI治疗结局与患者个性特征和心理状态之间的相互关系。方法选取2007年1月至2008年7月在浙江省舟山市妇幼保健院生殖中心接受IUI治疗的84例不孕妇女,以IUI治疗后是否妊娠为标准分为妊娠组和未妊娠两组,比较其在治疗前进行的艾森克人格调查表(EPQ)、90项症状自评量表(SCL-90)测试及焦虑自评量表(SAS)和抑郁自评量表(SDS)测试数据。结果IUI治疗后,妊娠组妇女与未妊娠组妇女的EPQ测定及SAS评分结果比较,差异无统计学意义;SCL-90测试结果显示:未妊娠组妇女的强迫症状、人际关系障碍、抑郁得分明显高于妊娠组妇女,P均0.05。未妊娠组妇女SDS评分明显高于妊娠组妇女(P0.05)。结论本研究发现,在相同治疗条件下,治疗前抑郁水平高、人际关系障碍及强迫症状明显的患者IUI妊娠率低。     

文拉法新治疗脑血管病伴发焦虑抑郁症状

目的评价文拉法新治疗脑血管病伴发焦虑抑郁症状的疗效。方法42例病人服文拉法新,治疗前和治疗后采用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)进行分析;治疗前后采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、副反应量表(TESS)评分进行分析。结果治疗后37例(88%)量表分值明显下降。治疗前后各因子配对比较(SAS,SDS,HAMD,HAMA等)差异有统计学意义(P<0.01),用药后疗效在2~4周最为明显;4~6周趋于平缓。未发生严重不良反应。结论文拉法新能减轻脑血管意外伴发焦虑抑郁症状,提高病人生存质量及功能康复。     

联合帕罗西汀治疗功能性消化不良伴焦虑抑郁障碍临床疗效观察

目的观察帕罗西汀治疗功能性消化不良(FD)伴焦虑、抑郁障碍的临床疗效。方法将80例功能性消化不良伴焦虑、抑郁障碍患者随机分为两组,观察组40例,常规治疗基础上联合帕罗西汀;对照组40例,仅给予常规治疗。观察期均为4周,观察治疗前与治疗4周末FD症状评分、Zung抑郁自评量表(SDS)评分及焦虑自评量表(SAS)评分的变化,并进行对比分析。结果治疗4周末,观察组SAS评分(40.37±5.54)比治疗前评分(55.88±4.32)低,也比对照组(56.75±5.57)低,差异有统计学意义(P<0.01);观察组SDS评分(41.83±5.43)比治疗前评分(55.76±4.61)低,也比对照组(57.04±4.92)低,差异有统计学意义(P<0.01)。而对照组治疗前后SAS、SDS评分差异无统计学意(P>0.05)。两组疗效比较:观察组显效22例,有效15例,无效3例,总有效率为92.5%,比对照组(总有效率为70.0%)高,两组差异有统计学意义(2χ=8.407,P<0.05)。结论常规治疗基础上联合帕罗西汀,既能显著改善FD症状,又能有效控制功能性消化不良患者的焦虑、抑郁障碍,疗效优于常规治疗。     

类风湿性关节炎患者精神因素的调查分析与干预治疗

目的调查类风湿性关节炎(RA)患者的精神状态,并观察患者使用黛力新及定期心理咨询前后的抑郁症状和生命质量的改变。方法采用抑郁自评量表(SDS)对60例患者进行评定,对具有抑郁症的49例患者采用黛力新及定期心理咨询治疗,并完成治疗前后的RA患者生命质量表评分。结果81.6%的RA患者具有抑郁症状,经治疗3个月后,抑郁自评量表、类风湿生命质量评分有明显改善。结论RA患者中存在明显的抑郁症状,通过抗抑郁治疗和心理咨询,能改善RA患抑郁状态,提高生命质量。     

心脏介入治疗中电离辐射损伤与防护措施的研究(综述)

综述了介入治疗中电离辐射所致自由基对生物大分子损伤及所致自由基对细胞生物学的影响,从不同角度来研究辐射损伤自由基学说的机理,并简述目前手术中的防护现状,探讨新的防护措施。     

Radiation related morbidities and their impact on quality of life in head and neck cancer patients receiving radical radiotherapy

Although 50-70% of head and neck cancer patients in India receive radiotherapy (RT), radiation-related acute and late morbidities and their impact on quality of life (QOL) are infrequently reported. Acute and late radiation morbidities and QOL were assessed in a prospective longitudinal study of 45 patients with head and neck cancers receiving radical RT to a dose of 7000 cGy in conventional fractionation. Grade II acute morbidities experienced by the largest percent of the sample during the course of RT pertained to the mucosa (66.4%), salivary gland (84%), and oesophagus (53%). These morbidities led to an increase in the symptom scores of appetite loss (76.46), fatigue (65.75) and pain (44.77). This increase in the symptom scores consequently led to a significant decline in physical, social and emotional functioning as well as global health status score during the course of RT (p < 0.001). Scores improved after 1 month of RT but did not reach the pre-RT value. Future studies may consider correlating QOL assessment to significant patient and disease related parameters such as performance status, weight loss, stage and site of disease.     

Medical care-seeking and health-risk behavior in patients with head and neck cancer: the role of health value, control beliefs and psychological distress

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.     

42例头颈部肿瘤患者放疗临床护理应用

探讨整体护理再头颈部肿瘤患者放疗中的护理效果。选择42例头颈部肿瘤放疗患者作为研究对象，分为研究组与对照组，各21例。对照组实施常规医护引导与对症护理，研究组整体护理。护理后，研究组患者整体生活质量水平及满意度均明显高于对照组（P<0.05），具有统计学意义。整体护理对头颈部肿瘤放疗患者能进一步提升患者生活质量水平，满意度较高，值得广泛推广应用。     

锥形束CT图像引导系统在放射治疗中的应用

目的：研究锥形束CT（CBCT）图像引导系统在精确放射治疗中提高摆位的精度,减少摆位的不确定性的作用。方法：对头颈部肿瘤患者（30例）和胸部肿瘤患者（40例）用CBCT扫描,其中头颈部肿瘤患者扫描90次,胸部肿瘤患者扫描113次,统计患者前后、头脚及左右方向的摆位偏差。结果：对于头颈部肿瘤患者前后方向的最大偏差值为6 mm,3个方向中〉3 mm偏差的均在10%以下;对于胸部肿瘤患者的头脚方向摆位误差最大,〉5 mm的达21.51%。前后方向的误差≤5 mm,左右方向〉5 mm的为4.53%。结论：采用CBCT图像引导系统对患者体位实时修正,极大的提升了放射治疗的精度和疗效。相对于电子射野影像验证系统（EPID）,CBCT对患者的累积剂量的影响更小,图像分辨率更高,图像匹配更精确,但是和普通螺旋CT相比,其分辨率和扫描范围还需要更进一步的提高。     

放疗后复发宫颈癌介入栓塞治疗的研究

目的：探讨放疗后复发宫颈癌介入栓塞治疗的方式、时机、药物及栓塞剂的选择。方法：对于放疗后复发宫颈癌患者介入栓塞化疗的临床应用和研究进展进行归纳总结。结果：放疗后复发宫颈癌介入栓塞治疗应选择在手术或放疗前进行,选用以铂类为主的联合化疗及可以缓释药物的栓塞剂。结论：宫颈复发癌应给介入栓塞化疗先行的积极的综合治疗。     

Disclosure of a cancer diagnosis in Thai patients treated with radiotherapy

Although radiotherapy usually implies a cancer diagnosis, no available study has been reported as to what proportion of Thai patients treated with radiotherapy know their diagnosis and how they want related information revealed. We questioned 106 patients in order to determine the proportion who knew their cancer diagnosis, and interviewed patients who knew the diagnosis and relatives of patients both who knew and did not know it with semi-structured questionnaires concerning how they wanted to be told. Sixty-seven patients (63.2%) knew their cancer diagnosis. Multivariate analysis showed that the patients with the following characteristics were inclined to know their diagnosis: younger than 70 years old, head and neck or gynecological cancer, no previous treatment before radiotherapy, no accompanying relatives during the treatment, and patients with relatives who wanted to disclose the information. 97.0% of patients who knew the diagnosis indicated that they had really wanted to know, 89.5% and 73.3%, respectively of relatives who accompanied patients who knew and did not know it expressed the same wish. No demographic factors could predict who wanted to be told the diagnosis. The majority of patients and relatives who wanted the diagnosis disclosed wanted to know all related information before treatment. They wanted to hear this directly from the doctor in the presence of their relatives.     

Differences in immune status between well-nourished and malnourished head and neck cancer patients

Malnutrition is reported to occur in approximately 30% of head and neck cancer patients. Also, impaired immunocompetence is described as a common phenomenon in this patient group. The purpose of this study was to assess the possible relationship between malnutrition and some prognostically important immune parameters in head and neck cancer patients. Thirty-two malnourished (recent weight loss >/= 10%) and 34 well-nourished patients undergoing curative treatment for advanced head and neck cancer were studied prospectively, and six parameters of their immune status (leucocytes, lymphocytes, lymphocyte phenotyping, monocytes, HLA-DR expression on monocytes and serum interleukin-10) were determined on the day of panendoscopy. Reference values for monocytes, HLA-DR expression and interleukin-10 were obtained from 43 healthy controls. Although the number of monocytes was elevated in both patient groups, the HLA-DR expression on these monocytes was significantly lower in the malnourished than in the well-nourished and control groups. Tumor stage, tumor localization, recurrence after initial radiotherapy, age and gender were not correlated to HLA-DR expression. No relationships emerged between nutritional status and lymphocyte subsets. Malnourished head and neck cancer patients show a significantly lower HLA-DR expression on monocytes than well-nourished ones and healthy controls. According to the literature this would imply an increased risk for postoperative complications. Indeed, postoperative complications occur more frequently in malnourished than in well-nourished patients.     

Symptom distress,current concerns and mood disturbance after diagnosis of life-threatening disease

This study describes the level of symptom distress, current concerns and mood disturbance in persons with a diagnosis of one of two life-threatening diseases at two occasions. The sample included 56 lung cancer patients and 65 heart attack patients who completed interviews at 1 and 2 months post diagnosis. Data were obtained using a modified version of the McCorkle and Young Symptom Distress Scale, the Weisman and Worden Inventory of Current Concerns and the Profile of Mood States.One conclusion that can be drawn from the study is that the plight of newly diagnosed lung cancer patients appears to be bleaker than that of heart attack patients. Cancer patients experienced more symptom distress of all kinds than heart attack patients. They also reported more health and existential concerns and they suffered more mood disturbances, on the average, than heart attack patients did. The most striking finding of the mean differences analysis was that, although symptom distress remained the same between occasions for both groups, both kinds of patients reported fewer concerns and better mood at the second interview. Although the plight of neither type of patient improved, patients reported being in better spirits and less worried at the second measurement occasion. This reduction in concerns and mood disturbance between interviews suggests that patients assimilate that their situation is not as immediately life-threatening as they had feared.     

规范化护理评估在头颈部肿瘤放疗致毒副反应中的应用

目的 探讨规范化护理评估在头颈部肿瘤患者放疗致毒副反应中的应用效果。方法 选取2016年1月-2018年1月在我院肿瘤科行头颈部放疗的恶性肿瘤患者144例，随机分为观察组（n=72）和对照组（n=72），观察组应用规范化护理评估对病人进行预见性的护理，对照组采取常规护理；比较两组病人放射性损伤副反应。结果 观察组使用规范化护理评估，放射性口腔炎、放射性皮炎、张口困难、放射性食管炎和放射性鼻烟粘膜炎的发生率低于对照组（P<0.05）。结论 头颈部肿瘤患者放疗期间采用规范化护理评估给予相应预见性护理，患者放疗所致毒副反应程度显著降低。