创伤康复期患者应激障碍与心理弹性的相关研究

目的 调查创伤康复期患者创伤后应激障碍(post traumatic stress disorder,PTSD)发生率、心理健康水平与心理弹性的关系.方法 采用创伤后应激障碍症状清单-平民版(PTSD checklist-civilian version, PCL-C)、成人心理弹性量表(resilience scale for adults,RSA)、症状自评量表(symptom checklist 90,SCL-90)、艾森克人格问卷(eysenck personality questionnaire, EPQ)、应对方式问卷对重庆市3所三甲医院康复科2008年12月至2010年3月158名的创伤康复期患者进行问卷调查.以PTSD总分38分划界,将患者分为PTSD阳性组和阴性组.结果 ①创伤康复期患者PTSD总分≥38分比例为34.18%,PTSD阳性组和阴性组在心理弹性(t=-4.744,P=0.000)、人格的神经质(t=3.549,P=0.001)及应对方式的合理化(t=2.502,P=0.013)方面差异有显著性.②创伤康复期患者SCL-90量表中躯体化、抑郁、焦虑、恐惧、偏执和精神性因子分均显著高于全国常模(P<0.05),SCL-90阳性组在心理弹性的自我认知和未来计划上得分显著低于阴性组(P<0.05),在EPQ的神经质因子得分显著高于阴性组(P<0.01),在应对方式上的自责、幻想、退避、合理化因子得分显著高于阴性组(P<0.05).③PTSD总分与RSA总分显著负相关,与SCL-90总分、神经质和合理化应对方式3个因素显著正相关(r值分别为:-0.343、0.390、0.362和0.170),SCL-90总分和RSA总分共能解释PTSD总分的28.8%.结论 创伤康复期患者创伤后应激障碍发生率较高,低心理弹性、低心理健康水平是PTSD的重要预测因素.     

Correlation between mental health and coping style in gynecological cancer patients

目的 调查妇科癌症患者创伤后应激障碍发生率、心理健康水平与心理弹性的关系.方法 采用创伤后应激障碍症状清单-平民版(PTSD checklist-civilian version,PCL-C)、心理弹性量表(connor-davidson resilience scale,CD- RISC)、症状自评量表(symptom checklist 90,SCL-90)、艾森克人格问卷(Eysenck personality questionnaire,EPQ)、应对方式问卷对181例三甲医院的妇科癌症患者进行问卷调查.结果 ①妇科癌症患者的PTSD总分为(30.75±11.28)分,PTSD总分≥38分者41例(22.65％),总分≥45分者20例(11.05％),总分≥50分者11例(6.08％).②PTSD阳性组在心理弹性的总分上显著低于PTSD阴性组(P＜0.05).③妇科癌症患者SCL-90阳性组在心理弹性总分上显著低于SCL-90阴性组(P＜0.01).在人格(EPQ)的神经质得分显著高于阴性组(P＜0.01),在应对方式的自责、退避、合理化因子得分上显著高于阴性组(P＜0.05).④PTSD总分与SCL-90总分、自责、退避应对方式3个因素成正相关,与心理弹性(CD)总分、解决问题、求助、合理化应对方式4个因素成负相关.SCL-90总分与PTSD总分、自责、幻想、退避应对方式4个因素成正相关,与CD总分、外向性、合理化应对方式3个因素成负相关.结论 妇科癌症患者创伤后应激障碍发生率较高,低心理弹性、低心理健康水平、消极的应对方式是创伤后应激障碍的重要预测因素.     

妇科癌症患者心理健康和应对方式的相关研究

目的调查妇科癌症患者创伤后应激障碍发生率、心理健康水平与心理弹性的关系。方法采用创伤后应激障碍症状清单-平民版(PTSD checklist-civilian version,PCL-C)、心理弹性量表(connor-davidson resilience scale,CD-RISC)、症状自评量表(symptom checklist 90,SCL-90)、艾森克人格问卷(Eysenck personality questionnaire,EPQ)、应对方式问卷对181例三甲医院的妇科癌症患者进行问卷调查。结果①妇科癌症患者的PTSD总分为(30.75±11.28)分,PTSD总分≥38分者41例(22.65%),总分≥45分者20例(11.05%),总分≥50分者11例(6.08%)。②PTSD阳性组在心理弹性的总分上显著低于PTSD阴性组(P<0.05)。③妇科癌症患者SCL-90阳性组在心理弹性总分上显著低于SCL-90阴性组(P<0.01)。在人格(EPQ)的神经质得分显著高于阴性组(P<0.01),在应对方式的自责、退避、合理化因子得分上显著高于阴性组(P<0.05)。④PTSD总分与SCL-90总分、自责、退避应对方式3个因素成正相关,与心理弹性(CD)总分、解决问题、求助、合理化应对方式4个因素成负相关。SCL-90总分与PTSD总分、自责、幻想、退避应对方式4个因素成正相关,与CD总分、外向性、合理化应对方式3个因素成负相关。结论妇科癌症患者创伤后应激障碍发生率较高,低心理弹性、低心理健康水平、消极的应对方式是创伤后应激障碍的重要预测因素。     

海南国际旅游岛旅游区居民心理应激影响因素调查

目的：调查海南国际旅游岛旅游区居民心理应激影响因素,为旅游区居民进行心理干预和心理健康教育提供科学依据。方法采用创伤后应激障碍量表(PCL-C)、社会支持评定量表(SSRS)、艾森人格量表(EPQ)、症状自评量表(SCL-90),在2013年1月至2015年12月间对海南国际旅游岛旅游区居民5114名进行问卷调查。结果①创伤后应激障碍(PTSD)阳性率为69.73%(3566/5114);②有无创伤后应激障碍两组间SCL-90总分、EPQ各因子得分和SSRS总分进行比较,结果显示差异均有统计学意义(P<0.05);③多重线性回归分析,进入回归模型的因素有SCL-90总分、E量表分、N量表分、P量表分、SSRS总分;④通径分析结果表明,N量表分对PCL-C总分的总效应最强(0.838),其次是SCL-90总分(0.200),在直接效应中SSRS总分的效应为(-0.260),位居第二。结论影响PTSD发生的危险因素有心理症状、艾森克人格,PTSD的保护因素有社会支持。     

创伤后应激患者心理弹性水平的研究

目的:通过对创伤人群心理弹性水平的研究,探析不同创伤结局人群心理弹性差异,为降低创伤人群创伤后应激障碍的发病率,促进其精神心理健康转归,建立有效可行的干预模型提供理论依据。方法:采用整群分层抽样法抽取各大综合性医院的住院患者549名,进行问卷调查,探析心理弹性水平。再将创伤后应激障碍筛查结果阳性的患者作为病例组,阴性的患者作为对照组,比较两组心理弹性差异。结果:不同年龄段的个体心理弹性得分有显著差异,随着年龄的增高,心理弹性显著提高,差异有统计学意义(P<0.05,P<0.01);婚姻状况在个人强度分量表上的得分差异有统计学意义(P<0.05,P<0.01);不同职业人群的心理弹性得分在未来组织风格分量表上的差异有统计学意义(P<0.05)。Logistic回归分析表明:心理弹性的各因子得分及总分与PTSD的发病呈显著相关(P<0.01,OR=1.976),心理弹性得分较低的个体PTSD发病率明显高于心理弹性高的个体。结论:①个体心理弹性与创伤后应激障碍的发病有着密切的联系,心理弹性较低的个体比心理弹性高的个体更易患PTSD,可视为PTSD发病的高危人群;②随着年龄的增长,人生阅历的丰富,家庭及事业的稳定,个体的心理弹性也在不断增强。     

公交系统恐怖袭击应激障碍流行病学调查

目的 探索公交系统遭受恐怖袭击对受害者、家属心理状态的影响.方法 在公交车爆炸事件后第20天和第44天对72人(其中受害者27人,家属26人,市民19人)进行了灾害自评量表(SRQ-20)、创伤后应激障碍(PTSD)测评量表(PCL-17)、焦虑自评量表(SAS)、抑郁自评量表(SDS)、应付方式量表(CSS)等调查.结果 受害者与家属的ASD(急性应激障碍)发生率分别为50%、12.50%;PTSD的发生率分别为33.33%、25%;女性PTSD的发生率(46%)与SAS、SDS的评分显著高于男性(16.7%);而市民中无一人符合DSM-IV的ASD或PTSD诊断标准;女性的PTSD总分及SAS、SDS的评分显著高于男性(P＜0.05,P＜0.05,P＜0.01);烧伤的面积和深度与PTSD过度唤起评分正相关(r=0.589,P=0.016);受害者的应付方式与PTSD总分负相关(r=-0.523,P＜0.05);受害者的SAS、SDS、SRQ评分与PTSD总分显著相关(r=0.853,0.787,0.745,P＜0.01);年龄、受教育程度与PTSD总分无显著相关.结论 在公交系统受恐怖袭击的爆炸事件对受害者及其家属的心理状态造成显著的影响,女性受影响的比率、程度比男性更为显著;与PTSD高相关的因素为预防和减轻PTSD提示了可能的途径.     

洪灾后11～15岁儿童创伤后应激障碍发生率及其影响因素

目的 评估洪灾后青少年创伤后应激障碍症状及其影响因素.方法 在抚顺特大洪灾后1个月,选取受灾较为严重地区六所学校的1000名学生.使用加州大学创伤后应激障碍反应指数修改版（UCLA PTSD RI）进行测查.结果 （1）洪灾1个月后,青少年PTSD阳性发生率为4.4％,亚PTSD发生率为9.0％;（2）PTSD各因子的发生率依次为闯入症状23.6％,回避症状7.7％,高警觉症状21.7％.（3）年级能够显著预测闯入、回避、高警觉和PTSD总分（P＜0.01）;父母的感情关系对闯入、回避、高警觉和PTSD总分均有显著预测作用（P＜0.05）;留守状况以及创伤暴露情况能够显著预测闯入、回避、高警觉以及PTSD总分（P＜0.05）.结论 洪灾后青少年亚PTSD发生率相对较高,需特别关注青春期早期、父母有外出务工以及灾害发生时创伤暴露较为严重的学生.     

集训期野战部队新兵心理弹性、心理健康与心理应激关系的交叉滞后分析

目的 了解集训期间新兵心理弹性及心理健康状况,考察心理弹性与心理健康、军人心理应激水平相互之间的预测作用.为部队新兵的心理选拔和心理健康教育提供科学依据.方法 2011年1月新兵到达某部队开始进行集训前(前测)及集训2个月后(后测),采用Connor-Davidson回弹力问卷(CD-RISC)、症状自评量表(SCL-90)、军人心理应激自评问卷(PSET)、生活满意度量表(SWLS)、积极情感消极情感量表(PANAS)对来自不同地区的650名新兵进行调查.结果 ①中国新兵心理弹性状况较好,2次测验的CD总分分别为(61.60±14.36)分和(61.41±14.55)分;②2次测试野战部队新兵心理健康(SCL-90)状况良好.③交叉滞后相关分析表明,在同步相关一致的前提下,心理弹性(前测)能显著正向预测心理健康(后测)(β=0.070,P＜0.05),心理健康(前测)对心理弹性(后测)无显著的预测意义(β=-0.015,P＞0.05).心理弹性(前测)能显著正向预测军人心理应激水平(后测)(β=0.075,P＜0.05),军人心理应激水平(前测)对心理弹性(后测)无显著的预测意义(β=-0.017,P＞0.05).④与高心理弹性组相比,低心理弹性组新兵有更高的SCL-90总分和心理应激总分,更少的正性情绪、更多的负性情绪和更低的生活满意度.结论 集训期间野战部队新兵心理弹性状况较好.新兵心理弹性对其集训期间心理健康、心理应激具有较好的预测作用.     

武汉火神山医院新型冠状病毒肺炎患者创伤后应激障碍发生情况及影响因素分析

目的 探讨武汉火神山医院新型冠状病毒肺炎(COVID 19)患者创伤后应激障碍(PTSD)发生情况及影响因素.方法 选取2020年3月1-26日在武汉火神山医院住院治疗的COVID-19患者55例为研究对象.采用一般人口学调查表、PTSD自评量表平民版(PCL-C)、简易应对方式问卷(SCSQ)、领悟社会支持量表(PSSS)对患者进行问卷调查,并对影响因素进行单因素和多因素分析.结果 患者PTSD总分(40.24±12.11)分,其中19例(34.5％)有明显PTSD症状,15例(27.3％)有一定程度PTSD症状,21例(38.2％)无明显PTSD症状.患者PTSD总分和消极应对呈正相关(r=0.277,P＜0.05),与家庭支持呈负相关(r=-0.296,P＜0.05),与其他支持呈负相关(r=-0.294,P＜0.05).结论 消极应对是COVID-19患者PTSD的危险因素.     

创伤后应激障碍检查表-平民版在地震灾区初中生中的信效度

目的 检验创伤后应激障碍检查表-平民版(The PTSD Checklist Civilian Version,PCL-C)在地震后初中生中的信效度.方法 采用PCL-C中文版,Rosenberg自尊量表和SCL-90对560名汶川大地震受灾初中生进行了测试,间隔约9周后,307人参加了重测.结果 首先,PCL-C中文版全量表克隆巴赫alpha系数为0.888,再体验、回避和过度唤起或高警觉三个因子的alpha系数分别为0.734,0.789,0.722.重测相关系数分别为再体验0.40(P＜0.01),回避0.45(P＜0.01),过度唤起或高警觉0.448(P＜0.01),全量表0.535(P＜0.01).其次,PCL总分及三个因子与自尊存在较低的负相关(r=-0.192～-0.299,P＜0.01),与SCL-90总分和SCL-90中的抑郁、焦虑和精神病性因子存在中等以上的显著正相关(r=0.563～0.775,P＜0.01).最后,实证效度的结果显示,PCL-C筛查阳性组比筛查阴性组在SCL-90的9个因子和总分上的得分要高,且达到了统计学显著水平(P＜0.001).结论 创伤后应激障碍检查表平民版在地震受灾的初中生群体中具有良好信效度,可用于PTSD症状严重程度的评估.     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.