中风发病后6～9月的生命质量

目的比较发病后6～9月的中风患者与正常对照的健康差异,以明确针对中风患者的社区卫生服务应着手解决的健康问题.方法对150例中风后6～9月的患者及按照性别、年龄、居住环境进行1:1配对的正常对照,采用SF-36进行健康自评,比较其不同领域的健康状况.结果患者生命质量在躯体功能、生理性角色功能受限、社会功能、活力4个领域(P＜0.01)随年龄的增加而降低.男性生命质量在总体健康(P=0.017)、躯体功能(P=0.015)、活力和精神健康(P＜0.01)等4个领域好于女性.患者与对照比较,除了疼痛(P=0.289)领域外,患者生命质量的各个领域均差于对照(P≤0.001).结论患者在发病后6～9月时,除了存在严重的躯体功能障碍之外,还有严重的心理、社会功能障碍以及角色功能障碍.其中,精神健康和女性患者是工作重点.     

SF—36评价中风患者生命质量的信度和效度

目的 评价SF－36生命质量量表在中风患者中的信度和效度。方法 效度评价采用结构效度和判别效度。采用ADL、IADL、闲暇活动、社会支持、健康预测对SF－36的8个领域通过回归分析进行结构效度评价。采用神经功能缺损程度评价量表MESSS对SF－36进行判别效度的评价。信度采用重测信度法、内部一致性分析（Cronbach'α系数）。用自填法结合小人访谈法,由150例中风患者自己做出健康评价。结果 整个测量的重测相关系数均大于0．6（各领域P＜0．01）。内部一致性Cronbach'α系数除活力和精神健康两个领域为0．7－0．8以外,其他6个领域的内部一致性均很好（α＞0．8）。在结构效度评价中,回归分析的结果与事先的假设具有相当的一致性。SF－36的8个领域除疼痛领域以外,不同的神经功能缺损程度间均有显著差异（P＜0．05）。结论 采用自填法结合个人访谈,使用SF－36评价中风患者的生命质量是有效的、可靠的。     

抑郁症患者应对方式与童年受虐经历的关系

目的：探讨抑郁症患者应对方式与童年受虐经历之间的关系。方法采用病例对照研究,对80例成年抑郁症患者及80例配比健康对照进行回顾性问卷调查。包括自设一般情况问卷了解其人口学资料、童年期创伤性经历问卷（CTQ‐SF）评估童年受虐情况和特质应对方式量表（TCSQ）评估应对方式,运用 t检验、非参数Mann‐Whitney U检验、Spearman相关分析和多元线性逐步回归分析抑郁症患者应对方式的特点及其与童年受虐经历的相关性。结果（1）抑郁症病例组的消极应对方式分值显著高于健康对照组（t＝9．13,P＜0．01）,而其积极应对方式分值显著低于健康对照组（t＝－12．01,P＜0．01）;有受虐经历的抑郁症病例组消极应对分显著高于有受虐经历的健康对照组（ Z＝－6．134,P＜0．01 ）,而其积极应对方式分显著低于健康对照组（Z＝－5．452,P＜0．01）;抑郁症组中有受虐经历的患者消极应对分显著高于无受虐经历患者（Z＝－2．159,P＜0．05）,积极应对分值两者之间无明显差异。（2）抑郁症患者童年受虐经历与其消极应对方式呈显著正相关,与其积极应对方式呈显著负相关（r＝0．562,P＜0．01;r＝－0．333,P＜0．05）。（3）抑郁症患者消极应对水平能够被童年受虐待总分和躯体因子共同解释占34．4％（P＜0．01）。结论童年受虐经历明显影响抑郁症患者的应对方式,且虐待程度越重,尤其有躯体虐待,其消极应对越明显。     

度洛西汀治疗躯体形式障碍的Me t a分析

目的：探讨度洛西汀治疗躯体形式障碍的疗效。方法：用Meta分析对5项度洛西汀与其他抗抑郁剂治疗躯体形式障碍对照研究的文章进行再分析,评价其合并效应量大小和综合显著性检验。结果：度洛西汀治疗前后的自身对照,合并效应量d＝2．87,95％CI（2．55,3．12）,综合显著性检验（x2＝17．34,P＜0．01）,提示度洛西汀治疗躯体形式障碍前后症状学变化有非常显著性差异,效应极强;度洛西汀与对照药在第2周末和治疗结束后的组间比较,分别为d＝0．67,95％CI（0．52,0．94）,x2＝6．77,P＞0．05;d＝0．42,95％CI（0．22,0．76）,x2＝1．44,P＜0．01,提示度洛西汀起效快,两组疗效相仿。结论：度洛西汀与对照药的疗效相仿,但起效快。     

冠心病患者生命质量／患者报告结局的影响因素分析

目的：探讨冠心病患者生命质量／患者报告结局影响因素,为提高冠心病患者的生命质量提供科学依据。方法采用SF－36量表对冠心病患者生命质量／患者报告结局进行测定,收集123例冠心病患者的生命质量资料,应用统计描述、t检验、方差分析、多元逐步回归方法分析冠心病患者生命质量／患者报告结局的影响因素。结果在单因素分析中,性别对生理功能、精神健康有统计学意义（ P＜0．05）,年龄对生理功能、生命力、躯体综合组分有统计学意义（ P＜0．01）,民族对生理职能有统计学意义（ P＜0．05）,文化程度对MH有统计学意义（P＜0．05）,经济状况对PF、VT有统计学意义（P＜0．05）,医疗形式对生理功能、躯体疼痛、一般健康状况和躯体综合组分有统计学意义（ P＜0．05）;多元回归分析中,年龄、职业和医疗形式在躯体综合组份上有影响,其回归系数为－8．99、－6．68和－12．18,文化程度在心理综合组份上有影响,其回归系数为2．33。结论性别、年龄、民族、职业、经济状况和医疗形式是影响躯体健康方面的重要因素,性别、年龄、经济状况和文化程度是影响心理健康方面的重要因素。     

影响阿尔茨海默病患者家庭照料者生活质量的相关因素分析

目的：探讨阿尔茨海默病（AD）患者家庭照料者的生活质量及其影响因素。方法采用自制一般情况问卷、WHO生活质量测定简表（WHOQOL‐BREF）、Zarit照料负担量表（ZBI）、社会支持评定量表（SSRS）等对64名AD患者的家庭照料者进行调查。结果（1）AD患者照料者的生活质量总的主观感受得分显著低于健康状况总的主观感受得分（t＝－2．217,P＝0．030）。生理领域、心理领域得分与中国常模比较,差异无统计学意义（ t＝－0．252、－1．994,P＝0．801、0．050）;社会领域、环境领域得分与常模比较,差异有统计学意义（ t＝－3．830、3．658,P＜0．05）。（2）有配偶、亲子关系差、有躯体疾病及患者精神行为症状较重的照料者生活质量较低（P＜0．05）。（3）照料者的生活质量总分与照料负担总分呈负相关（r＝－0．433,P＜0．05）,与社会支持总分呈正相关（ r＝0．346,P＜0．05）。（4）婚姻状况、亲子关系、躯体疾病、社会支持是生活质量的主要影响因素（ r2＝0．409）。结论加强对有配偶、亲子关系较差、身体情况不良的AD照料者的社会支持和心理干预,有助于改善生活质量。     

抑郁症患者述情障碍与功能性躯体不适的关系

目的了解抑郁症患者功能性躯体不适症状的特征,并探讨抑郁症患者述情障碍与功能性躯体不适症状之间的关系。方法选用多伦多述情障碍量表20项中文版（TAS －20）、患者健康问卷（PHQ －15）和汉密尔顿抑郁量表17项版本（HAMD －17）,对113例抑郁症患者（抑郁症组）和100例健康志愿者（对照组）进行评定。结果（1）抑郁症组 TAS －20总分及各因子分、 PHQ －15总分及各条目分均显著高于对照组（均 P ＜0．05）;（2）根据 PHQ 总分将功能性躯体不适分为轻、中、重度,抑郁症组 TAS －20总分、情感辨别不能因子分和外向性思维因子分均依次升高（P ＜0．05）;（3）情感辨别不能因子主要与四肢躯干疼痛及疲劳症状呈正相关（r ＝0．211,r ＝0．434,均P ＜0．05）,外向性思维因子与头部及消化系不适呈正相关（r ＝0．192,r ＝0．388,均 P ＜0．05）;（4）多元线性回归分析显示,情感辨别不能（β＝0．220,95％CI 20．55～22．28）、外向性思维（β＝0．216,95％CI 21．32～22．76）和 HAMD －17总分（β＝0．334,95％CI 21．54～23．79）为功能性躯体不适的影响因素（R 2＝0．238）。结论抑郁症患者存在严重而广泛的功能性躯体不适症状,情感辨别不能和外向性思维可能对部分症状的产生具有影响。     

功能性消化不良患者的生活质量评分调查

目的调查进行功能性消化不良患者的生活质量评分。方法76例FD患者接受了“健康调查简易量表”评估，并与对照组（39例）比较。结果FD患者的躯体性功能、角色受限、社会性功能、心理健康情况、角色心理状况、活力／精力、身体疼痛和综合健康情况等条目评分均明显低于对照组（P均〈0．05或0．01）。结论FD患者有明显的生活质量下降。     

5—HT6受体基因多态性与持续性躯体形式疼痛障碍的关联分析

目的：探讨中国汉族人群中5－羟色胺（5－HT6）受体基因C267T多态性与持续性躯体形式疼痛障碍的相互关系。方法：应用聚合酶链式反应（PCR）－限制性片段长度多态性（RFLP）技术,在51例持续性躯体形式疼痛障碍患和60例正常对照中观察了5－HT6受体基因多态性的分布,结果：5－HT6受体基因的C／T基因型与持续性身体形式疼痛障碍之间存在负关联（OR＝0．43,Z＝2．05,P＜0．05）,结论：从整体看,5－HT6受体基因多态性与持续性体形式疼痛障碍的发生有关。     

乙状结肠代阴道成形术后人工阴道分泌功能的变化及术后生活质量的评估

目的：观察乙状结肠代阴道成形术后人工阴道分泌功能的变化,评估患者术后生活质量。方法选取38例行乙状结肠代阴道成形术后患者为研究对象,依据手术后年限分为观察组A（术后时间≤5年）、观察组B（术后时间＞5年）,另选取19例阴道正常女性作对照组研究。比较3组阴道分泌功能、性生活质量与生活质量。结果（1）分泌功能：观察组A和正常对照组MUC2、AQP2、AQP9、CFTR的表达比较差异无统计学意义（ P＞0．05）;观察组B MUC2、AQ92、CFTR明显低于观察组A与正常对照组,AQP2明显低于观察组A与正常对照组（P＜0．05）;（2）性生活质量：3组对象欲望、性兴奋、性高潮、阴道润滑、性满意度、总分等FSFI评分比较差异无统计学意义（P＞0．05）;（3）生活质量：3组躯体健康、躯体角色功能、躯体疼痛、生命活力、社会功能、情绪角色、心理健康、总体健康等SF－36评分比较差异无统计学意义（ P＞0．05）。结论乙状结肠代阴道成形术可提高患者生活质量,人工阴道分泌功能随手术年限逐渐减弱。     

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.     

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…     

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.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Dr.Zhang Ren's Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

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.