甲状腺癌手术患者实施术前心理干预护理的效果

目的探究甲状腺癌手术患者术前心理干预护理的临床效果。方法选取60例甲状腺癌手术患者,随机分为对照组、观察组,每组30例;对照组予以围术期传统护理,观察组提供术前心理干预护理;观察两组患者的焦虑自评量量表(SAS)评分、抑郁自评量量表(SDS)评分、认知度评分、治疗依从性评分、护理满意度评分及生理指标变化情况。结果观察组护理后,SAS评分,SDS评分均低于对照组(P0.05);观察组认知度评分,治疗依从性评分,护理满意度评分均高于对照组,且生理指标变化情况亦优于对照组(P0.05)。结论甲状腺癌手术患者予以术前心理干预护理,可更好地改善患者焦虑、抑郁情绪,提高疾病认知度及治疗依从性,有利于患者心率、血压的调整。     

情感智能干预对颌面部骨折患者的负性情绪和康复效果的影响

目的探讨情感智能干预对颌面部骨折患者的焦虑抑郁情绪,治疗依从性及康复效果的影响。方法选取我院2015年5月1日～2017年5月31日收治的70例颌面部骨折患者,按照随机数字表的方法分为观察组(n=35)和对照组(n=35),对照组患者给予常规护理干预措施,观察组在常规护理的基础上加以实施情感智能干预。分别对两组患者干预前后的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分、患者的治疗依从性、肿胀消退时间和术后住院时间进行比较。结果两组患者干预前SAS和SDS评分组间差异不明显(P0.05);干预后两组患者的SAS和SDS评分均明显低于干预前,且观察组低于对照组(P0.05);干预后观察组患者的治疗总依从率为91.43%,显著高于对照组患者的71.43%(P0.05);观察组患者的肿胀消退时间和术后住院时间亦短于对照组(P0.05)。结论在常规护理基础上,合并情感智能干预可以更好地改善颌面部骨折患者的焦虑、抑郁情绪,提高患者的治疗依从性,加快了恢复进程,值得推广。     

家庭行为认知干预用于COPD合并抑郁焦虑情绪患者的疗效

目的探讨家庭行为认知干预用于慢性阻塞性肺疾病(Chronic obstructive pulmonary disease,COPD)合并抑郁焦虑情绪患者的效果。方法选择2015年1月至12月在我院接受治疗的140例合并抑郁焦虑情绪的COPD患者,用随机数表法分为对照组和干预组,每组各70例。对照组给予常规的COPD护理干预,干预组在对照组的基础上给予家庭行为认知干预。结果干预前两组患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分组间对比无明显差异(P0.05),干预后两组患者的SAS和SDS评分均出现明显下降,且干预组患者的SAS和SDS评分低于对照组,上述差异均有统计学意义(P0.05)。干预前两组患者的第1秒用力呼气量(FEVl)、第1秒用力呼气容积占预计值百分比(FEVl/FVC)和用力肺活量(FVC)等肺功能指标比较,差异无统计学意义(P0.05),干预后两组患者的肺功能指标与干预前相比均明显改善,且干预组患者的肺功能指标明显优于对照组,差异有统计学意义(P0.05)。干预前两组患者的圣乔治呼吸问卷(SGRQ)评分中症状部分、活动能力、疾病影响和总分组间差异无统计学意义(P0.05),干预后两组患者的上述指标评分均明显下降,且干预组患者的评分低于对照组,生活质量更高,差异有统计学意义(P0.05)。干预前两组患者缩唇呼吸、腹式呼吸和全身性呼吸体操等康复训练的依从性相近(P0.05),干预后两组患者的依从性均出现提高,且干预组患者的依从性高于对照组,差异有统计学意义(P0.05)。结论在常规护理干预措施的基础上增加家庭行为认知干预,可以更明显改善COPD合并抑郁焦虑情绪患者的不良情绪,提高康复训练依从性,从而提高肺功能和生活质量。     

三合一心理干预对下肢静脉血栓患者治疗依从性及负性情绪的影响

目的探讨三合一心理干预对下肢静脉血栓患者治疗依从性及负性情绪的影响。方法将120例下肢静脉血栓患者根据抽签法随机分为观察组(n=60)及对照组(n=60),对照组治疗期间给予常规性护理,观察组治疗期间应用三合一心理干预,对比分析两组患者治疗情况及负性情绪。结果观察组干预后SDS评分、SAS评分显著均低于对照组(P0.05)。观察组患者治疗依从性、血栓消失、血栓范围减少、血栓长度变短及满意率显著高于对照组(P0.05),而术后疼痛比例显著低于对照组(P0.05)。结论三合一心理干预可有效减轻下肢静脉血栓患者焦虑、抑郁情绪,提高患者治疗依从性,增强患者治疗效果。     

认知行为干预对PICC置管肝肺疾病患者负性情绪、生活质量及并发症的影响

目的探讨认知行为干预对PICC置管肝肺疾病患者负性情绪、生活质量及并发症的影响。方法选取2012年6月至2016年5月期间我院收治的PICC置管肝肺疾病患者82例,分为观察和对照两组,各41例。对照组行常规护理干预,观察组行认知行为干预,对比两组干预后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分、干预前后生活质量评分和并发症发生率情况。结果观察组干预后SAS和SDS评分低于对照组,差异有统计学意义(P0.05);观察组干预后躯体功能、认知功能、情绪功能、角色功能、社会功能和总体健康评分高于对照组,观察组干预后疼痛、疲乏和恶心呕吐评分低于对照组,差异有统计学意义(P0.05);观察组并发症发生率低于对照组,差异有统计学意义(P0.05)。结论认知行为干预可明显减轻行PICC置管肝肺疾病患者负性情绪,提高其生活质量,降低并发症发生率。     

心理护理干预对急性冠脉综合征患者的影响

目的探讨心理护理干预在急性冠脉综合征护理中的运用效果。方法收集2013年9月~2014年12月我院心内科收治并确诊的急性冠脉综合征患者82例,按随机数字表法将其分成对照组和观察组,每组各41例。对照组给予院内常规护理,观察组则在对照组的基础上给予心理护理干预,比较两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量量表(QOL)评分及依从性的差异。结果两组患者实施个护理干预前SAS、SDS和QOL评分,组间比较差异无统计学意义(P0.05)。护理干预后两组SDS和SAS评分均降低,QOL评分及均升高,治疗依从性均改善,差异具有统计学意义(P0.05)。且护理后观察组上述指标均优于对照组,差异具有统计学意义(P0.05)。结论心理护理干预能显著改善急性冠脉综合征患者的焦虑抑郁情绪,有效提高其生活质量及依从性,具有重要临床价值。     

心理干预对肠造口患者焦虑抑郁及生活质量的影响

目的探讨以认知重构为主的心理干预对肠造口患者术后焦虑抑郁心理及生活质量的影响。方法用随机数字表法将90例肠造口手术患者分为对照组与观察组,每组各45例,对照组采取常规护理,观察组在对照组基础上加以认知重构为主的心理干预,比较两组患者干预前后SDS评分、SAS评分、应对方式评分及生活质量情况。结果两组干预后SDS、SAS评分均较干预前显著下降,SF-36量表各项评分较干预前显著上升(P0.05);观察组干预后SDS评分、SAS评分、自责、退避评分均明显低于对照组,问题解决、求助、合理化评分及SF-36量表各项评分均明显高于对照组,两组比较差异有统计学意义(P0.05)。结论以认知重构为主的心理干预能明显缓解肠造口患者术后焦虑、抑郁心理,有效改善其应对方式,有利于患者术后康复及生活质量的提高。     

自发性脑出血患者康复期延续护理方案的研究

目的研究自发性脑出血患者实施康复期延续护理方案的效果。方法选择在我院接受治疗的174例自发性脑出血病患,以数字法随机分为观察组和对照组各87例,对照组实施常规护理,观察组实施延续护理。比较2组护理后SAS、SDS评分以及满意度、依从性、生活质量等指标。结果 2组干预前SAS、SDS评分无显著差异,干预后观察组SAS、SDA评分均显著低于对照组,依从性调查得分高于对照组,满意度显著高于对照组,干预后生活质量评定所有项目均显著高于对照组,差异均有统计学意义(均P0.05)。结论自发性脑出血病患在康复期实施延续护理方案能有效降低焦虑、抑郁症状,有效提高护理满意度。并且对病患依从性、生活质量有很大程度的提高,值得临床应用。     

正念认知训练对神经外科患者ICU综合征的干预效果

目的评价正念认知训练在神经外科患者ICU综合征中的应用效果。方法选取2017-03-2018-02郑州市中心医院神经外科入住ICU的96例综合征患者,对照组为常规护理干预,观察组辅以正念认知训练。干预前后采用五因素正念问卷(five facet mindfulness questionnaire,FFMQ)、焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)对2组患者进行评定,并进行对比分析。治疗后评估2组患者的护理满意度。结果干预前2组FFMQ、SAS、SDS评分对比差异无统计意义(P0.05);干预后2组FFMQ、SAS、SDS评分与治疗前对比差异有统计学意义(P0.05),且观察组各项评分较对照组改善更为显著,差异有统计学意义(P0.05)。观察组患者护理满意度调查评分高于对照组,差异有统计学意义(P0.05)。结论常规护理辅以正念认知训练干预较常规护理效果好,因人而异的个体化护理干预患者的满意度更高。     

健康教育联合心理护理对大面积烧伤患者心理状态的疗效

目的探讨健康教育联合心理护理对于改善大面积烧伤患者心理状态的效果观察。方法选取2013年1月至2016年1月来我院烧伤科接受治疗的大面积烧伤患者66例,按随机数字表地方法分为观察组(n=33)和对照组(n=33),予以对照组常规的护理方法,予以观察组健康教育联合心理护理措施。采用焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分对两组患者的心理状态进行评估和比较,并对两组患者的护理效果以及患者对疾病认知度进行对比和分析。结果干预前,观察组患者与对照组患者的SAS(抑郁自评量表)评分以及SDS(抑郁自评量表)评分差异无统计学意义(P0.05),干预后的评分明显低于干预前,且观察组患者的SAS评分以及SDS评分显著优于对照组(P0.05);教育后的观察组患者的掌握情况显著优于对照组(P0.05);且观察组的护理效果亦显著优于对照组,差异具有统计学意义(P0.05)。结论健康教育联合心理护理可以有效改善大面积烧伤患者不良的心理状态,并且在一定程度上提升了患者对疾病的认知,以及促进了护理效果,其值得临床推广应用。     

Factors associated with satisfaction with care among patients with epilepsy

OBJECTIVE: The purpose of the work described here was to determine those variables associated with satisfaction with care among patients with epilepsy. METHODS: We interviewed patients followed at a tertiary epilepsy center. Predictor variables included age, gender, race, education, income, insurance, seizure frequency, and Quality of Life in Epilepsy-10 inventory (QOLIE-10) results. Target variables were the subscales of the Short Form Patient Satisfaction Questionnaire (PSQ-18). We used univariate analysis to identify those variables significantly associated with the subscales and multiple linear regression to determine those independently significant. RESULTS: The study population comprised 193 patients. Lower education and better QOLIE-10 scores were independently associated with general satisfaction with care. The mental health scale was associated with general satisfaction with care. Lower educational level was the only variable independently associated with patient satisfaction with communication, the financial aspect of care, and time spent with physician. CONCLUSION: Lower educational level and better quality of life are the main variables associated with higher general satisfaction with care among patients with epilepsy.     

Treatment with rituximab in patients with polyneuropathy with anti-MAG antibodies

Journal of Neurology -     

Surgical Outcome in Patients with Epilepsy with Occult Vascular Malformations Treated with Lesionectomy

Summary: Purpose: This retrospective study reports the long-term surgical outcome of patients with medically refractory epilepsy and vascular malformations who were treated with lesionectomy. A detailed analysis of surgical failures had been performed in an attempt to define predictors of surgical success and failure.
Methods: Fifteen patients with medically intractable epilepsy and angiographically occult vascular malformations (AOVMs) were treated surgically with lesionectomy at Duke University Medical Center. Lesionectomy consisted of removal of the AOVM and surrounding hemosiderin-stained brain only, without the use of electrocorticography (ECoG) to guide resection.
Results: Eleven (73%) patients are seizure free after lesionectomy. Three showed no significant improvement, and one patient died, presumably after a seizure. Age of onset, duration of seizures, age at resection, and gender did not affect outcome. All patients with neocortical AOVMs in whom EEG findings correlated with the site of the lesion were seizure free after lesional resection. Treatment failures were associated with the presence of multiple intracranial lesions, poorly localized or diffuse EEG findings, discordant positron emission tomography (PET) imaging, or with a lesion in close proximity to the limbic system.
Conclusions: Lesionectomy, with removal of surrounding hemosiderin-stained brain, can be considered the procedure of choice in carefully selected patients with epilepsy with occult vascular malformations.     

Children with ADHD and motor dysfunction compared with children with ADHD only

The purpose of this study was to identify group differences in children with attention-deficit-hyperactivity disorder and motor dysfunction (ADHD-MD) and ADHD only, and to evaluate the medication responsiveness of ADHD-MD. Sixty-three children (49 males and 14 females; mean age 9 years 10 months, SD 2 years 10 months) underwent a triple blind, placebo-controlled crossover study evaluating two dose levels of methylphenidate (0.3 mg/kg and 0.5 mg/kg [corrected], twice daily) and placebo. Forty-nine trials were completed. Nineteen were children with ADHD-MD, 44 had ADHD only. Behavior and functioning were assessed at home and at school. Treatment effects were assessed using the Abbreviated Symptom Questionnaire for Parents and Teachers. Children with ADHD-MD were more likely to have severe ADHD-combined type and other neurodevelopmental and behavioral problems. Both groups of children had a linear dose response to medication (placebo, low, high) and there was no evidence of a group by dose interaction or an overall group effect at home or school. The lack of group effect suggests that these children responded to medication like the other subgroups.     

Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism in women with bipolar disorder.

BACKGROUND: Preliminary evidence suggests that valproate is associated with isolated features of polycystic ovarian syndrome (PCOS), while contradictory data support an association between epilepsy and PCOS. The development of PCOS features after initiation of valproate was therefore examined in women with bipolar disorder using a standardized definition of PCOS. METHODS: Three hundred women 18 to 45 years old with bipolar disorder were evaluated for PCOS at 16 Systematic Treatment Enhancement for Bipolar Disorder sites. A comparison was made between the incidence of hyperandrogenism (hirsutism, acne, male-pattern alopecia, elevated androgens) with oligoamenorrhea that developed while taking valproate versus other anticonvulsants (lamotrigine, topiramate, gabapentin, carbamazepine, oxcarbazepine) and lithium. Medication and menstrual cycle histories were obtained, and hyperandrogenism was assessed. RESULTS: Among 230 women who could be evaluated, oligoamenorrhea with hyperandrogenism developed in 9 (10.5%) of 86 women on valproate and in 2 (1.4%) of 144 women on a nonvalproate anticonvulsant or lithium (relative risk 7.5, 95% confidence interval [CI] 1.7-34.1, p = .002). Oligoamenorrhea always began within 12 months of valproate use. CONCLUSIONS: Valproate is associated with new-onset oligoamenorrhea with hyperandrogenism. Monitoring for reproductive-endocrine abnormalities is important when starting and using valproate in reproductive-aged women. Prospective studies are needed to elucidate risk factors for development of PCOS on valproate.     

血管内栓塞治疗未破裂脑动静脉畸形并发癫痫患者的预后分析

目的分析血管内栓塞治疗未破裂脑动静脉畸形(CAVM)并发癫痫患者的预后情况。方法选择2013年3月至2017年6月收治的符合诊断标准的CAVM并发癫痫发作患者49例为研究对象,分析血管内栓塞治疗后患者的临床症状、生活质量(QOLIE-31)改善情况。结果患者经血管内栓塞治疗后,QOLIE-31各项指标(除了药物影响)评分均明显提高,高于治疗前(P0.05);Spetzler-Martin分级与Engel分级的I~II级例数多于治疗前(P0.05),同时Spetzler-Martin分级I~II级生活质量评分(76.04±18.33)分明显高于III~V级的(65.65±16.76)分(P0.05);Engel分级I~II级的生活质量评分(75.25±17.78)分明显高于III~V级的(66.23±13.22)分(P0.05);血管内栓塞比例80%的生活质量总评分(78.37±18.87)分明显高于栓塞比例80%的(64.16±16.92)分(P0.05);术后患者的头疼症状中重度例数明显低于治疗前(P0.01);患者的NIHSS评分和MRS评分均明显低于治疗前,头疼症状的生活质量评分高于治疗前(均P0.05)。结论血管内栓塞能明显改善未破裂脑动静脉畸形并发癫痫患者的头疼症状、癫痫发作情况、神经功能缺损,提高血管内栓塞比例能够提高患者生活质量。