帕金森病伴抑郁障碍的临床特征分析

目的 了解帕金森病伴抑郁障碍的临床特征.方法 采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、汉密尔顿抑郁量表24项版本(HAMD24)和汉密尔顿焦虑量表(HAMA)对确诊的35例帕金森病伴抑郁障碍患者(研究组)及35例抑郁症患者(对照组)进行评定及比较.结果 两组患者SDS、HAMD24、HAMA总分间差异无统计学意义(P＞0.05).研究组患者SAS总分[(55.9±11.6)分]及HAMD24中体质量[(0.6±0.4)分]、认知障碍[(3.9±1.7)分]、昼夜变化[(0.69±0.28)分]因子分与对照组[分别为(50.1±12.3)分、(1.2±0.4)分、(5.1±1.9)分和(1.32±0.39)分]比较,差异均有统计学意义(t值分别为2.01、6.20、2.61和6.30,P<0.01).结论 帕金森病伴抑郁障碍具有独特的临床特征,即无明显的生物学症状,焦虑症状相对较多.     

人格特征对肺癌围手术期患者心理健康状况的影响

目的 探讨人格特征对肺癌围手术期患者心理健康状况的影响.方法 以97名中南大学湘雅二医院普胸外科肺癌围手术期患者作为研究对象,采用自制的一般资料问卷、艾森克人格问卷成人版、抑郁自评量表、焦虑自评量表、症状自评量表对他们的一般资料、人格特征以及心理状况进行调查.结果肺癌围手术期患者症状自评量表中总分[( 153.28±41.98)分]、躯体化[(1.78±0.42)分]、强迫症状[(1.96±0.52)分]、抑郁[(1.77±0.67)分]、焦虑[(1.82±0.56)分]、敌对[(1.68±0.87)分]、恐怖[(1.44±0.75)分]、精神病性因子[(1.56±0.51)分]均高于中国常模(p＜0.05).艾森克人格问卷中P量表得分[( 10.96±2.65)分]高于国内常模[(5.84±3.27)分](P＜0.001);神经质维度、精神质维度与症状自评量表各因子分均呈正相关.结论 肺癌围手术期患者心理状态较差,人格方面喜欢独处,不关心他人,心理状态与人格特征之间存在相关性,且人格特征的内外向维度和神经质维度可以预测负性心理的发生.     

惊恐障碍患者的述情障碍

目的探讨惊恐障碍患者的述情障碍及其相关因素.方法采用多伦多述情障碍量表、汉密尔顿焦虑量表、汉密尔顿抑郁量表对伴或不伴广场恐怖的47名惊恐障碍患者和37名健康对照者进行评估.结果(1)伴或不伴广场恐怖的惊恐患者TAS因子Ⅱ分[分别为(3.30±0.70)分和(3.13±0.75)分]高于正常对照组[(2.58±0.67)分](均P＜0.05),伴广场恐怖的惊恐患者的TAS总分[(75.4±10.1)分]高于对照组[(66.3±8.9)分](P＜0.01),两患者组的因子Ⅰ、Ⅲ和Ⅳ分与对照组之间的差异无显著性(P＞0.05),两患者组TAS及四个因子之间的差异亦无显著性(P＞0.05);(2)伴与不伴广场恐怖的惊恐患者的HAMA和HAMD得分[HAMA分别为(17.0±6.13)分和(18.6±7.94)分,HAMD分别为(13.0±6.2)分和(15.3±6.96)分]均高于对照组[分别为(0.94±1.22)分和(1.08±0.27)分](P＜0.001);(3)伴或不伴广场恐怖的惊恐障碍的TAS因子Ⅱ得分与病程及HAMA和HAMD的相关关系无显著性(P＞0.05).结论伴与不伴广场恐怖的惊恐障碍患者均存在述情障碍,以认识和区别情绪和躯体感受的能力欠缺明显,与其病程和焦虑抑郁状态无相关;其描述情感、幻想及外向型思维的能力可能未受损害.     

脑卒中患者睡眠障碍及影响因素研究

目的观察脑卒中患者睡眠障碍发生情况及可能的影响因素.方法对入选病例分别采用匹兹堡睡眠质量指数(PSQI)、神经功能缺损程度评分(NDS)、改良Barthel指数(MBI)、汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)进行测评.结果在154例脑卒中患者中,睡眠障碍患者(PSQI总分＞7分者)92例(59.7%).睡眠障碍患者与非睡眠障碍患者在平均年龄[(68.6±11.7)岁vs(60.2±11.3)岁,P＜0.01]、女性百分比[68.6%vs 31.4%,P＜0.01]、HAMD[(13.6±8.2)分vs(5.3±2.4)分,P＜0.01]、HAMA[(8.3±1.2)分vs(3.5±0.8)分,P＜0.05]、MBI[(58.7±14.3)分vs(70.2±15.6)分,P＜0.01]及NDS[(19.1±6.3)分vs(12.6±5.4)分,P＜0.01]评分方面比较,均差异有显著性(P＜0.05或＜0.01).多元逐步回归分析显示,睡眠障碍与患者的日常生活能力、抑郁状态、神经功能缺损程度、脑卒中的部位及病变范围大小密切相关.结论脑卒中患者睡眠障碍较为常见,改善睡眠有助于患者的神经功能缺损康复和生活质量提高.     

抑郁症患者依恋类型、述情障碍与防御方式的相关性研究

目的 探讨抑郁症患者的依恋类型、述情障碍及其防御方式的关系.方法 采用修订版成人依恋量表(AAS-1996)、多伦多述情障碍量表(TAS)及防御方式问卷(DSQ),对32名抑郁症患者和80名对照组被试进行评定.结果抑郁症患者的依恋类型与对照组差异有统计学意义(x2 =47.6,P＜0.01),前者偏向不安全型依恋,后者偏向安全型依恋.抑郁症患者的不成熟防御机制[(5.47±1.13)分]和中间型防御机制得分[(4.93±0.56)分]高于对照组[分别为(3.79±1.09)分和(4.20±1.00)分;P＜0.01].抑郁症患者的述情障碍总分[ (76.88±8.94)分]、因子Ⅰ[(3.34±0.77)分]和因子Ⅱ得分[(3.64±0.51)分]均高于对照组[分别为(65.70±7.98)分、(2.41±0.78)分和(2.65±0.55)分;P＜0.01],因子Ⅲ得分[(2.51±0.78)分]低于对照组[(3.14±1.03),P＜0.01].抑郁症患者成人依恋的亲近、焦虑因子与述情障碍存在一定的相关.抑郁症患者成人依恋3个因子与防御方式存在一定相关.结论 抑郁症患者的依恋可能通过影响防御方式间接导致抑郁情绪;此外,抑郁会导致述情障碍,不同依恋特点的抑郁症患者表现出不同的述情障碍.     

中职生学习倦怠状况及其与人格特征关系

目的了解中等职业学校学生(中职生)的学习倦怠状况,并分析学习倦怠与人格特征的关系.方法以maslach倦怠问卷-学生量表(MBI-SS)量表为基础加上访谈得到的条目构成学习倦怠量表,结合大五人格量表和中国人性格量表对北京市二所职业学校604名中学生进行测试,对变量进行方差分析.结果学习倦怠总分及各因子在性别、是否担任班干部、年级、母亲文化程度、班主任年龄和考试排名等变量上差异有显著性.将被试按照学习倦怠总分、学习疏远、学习疲倦、低学习效能得分的27%分组,分成高分组与低分组,结果学习倦怠总分及各因子高分组的神经质[(3.20±0.53)分]、面子[(8.98±3.10)分]、防御性[(7.25±2.84)分]得分高于低分组[分别为(2.78±0.59)分,(7.20±3.25)分,(5.88±3.17)分],外倾性[(3.22±0.51)分]、开放性[(2.76±0.35)分]、宜人性[(3.24±0.46)分]、严谨性[(3.13±0.47)分]与和谐性[(9.96±2.69)分]得分低于低分组[分别为(3.50±0.51)分,(2.94±0.36)分,(3.50±0.45)分,(3.61±0.61)分,(11.20±2.04)分],在人情取向与灵活性得分方面除低学习效能高分组灵活性高于低分组外,其它方面差异无显著性.结论中职生的学习倦怠要引起高度重视.     

外来务工人员子女儿童行为和情绪问题的对照研究

目的 了解外来务工人员子女行为与情绪问题特征.方法 随机分层整群抽取佛山市外来务工子女642名与本地儿童585名进行对照研究,采用儿童行为评定量表(CBCL)、儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表评定儿童行为和焦虑抑郁情绪.结果 外来务工子女组和对照组在CBCL量表的行为总分[(25.49±5.16)分,(21.93±4.96)分]及退缩[(2.58±1.73)分,(1.89±1.32)分]、焦虑抑郁[(3.07±1.87)分,(1.93±1.15)分]、社交问题、攻击行为、内向性行为、社交分、学校分等因子方面差异有显著性,2组在焦虑、抑郁总分及广泛性焦虑、社交恐怖和学校恐怖等因子方面差异有显著性.结论 外来务工子女有较多的行为问题和焦虑抑郁情绪,有必要对他们进行心理行为干预.     

新疆维吾尔族与汉族抑郁症患者临床特征的对照研究

目的 探讨维、汉族抑郁症临床特征及其有关变量上的差异.方法 了解一般情况,采用汉密尔顿抑郁量表(HAMD)、症状自评量表(SCL-90)和明尼苏达多项人格调查表(MMPI)对维族97例、汉族129例抑郁症患者进行测试.结果 维族组发病年龄、总病程[分别为(31.35±10.69)岁,(40.06±54.37)月]小于汉族组[分别为(34.94±12.09)岁,(60.15±73.65)月],差异有显著性(P＜0.05).临床HAMD测试维族组睡眠障碍因子分、体质量减轻因子分、认识障碍因子分[分别为(3.84±1.12)分,(0.55±0.99)分,(0.61±0.60)分]高于汉族组[分别为(3.34±1.56)分,(0.29±0.79)分,(0.40±0.43)分],维族组绝望感因子分[(1.15±1.02)分]低于汉族组[(1.54±0.99)分],差异有显著性(P＜0.05).SCL-90测试,维族组躯体化症状因子分[(2.52±0.85)分]较汉族组[(2.14±0.84)分]更高,差异有显著性(P＜0.01).MMPI测试2组有8个量表T分同时高于70分,6个量表T分同时低于70分.结论 民族文化对抑郁症发病规律、临床特征有影响,对抑郁症人格特征影响很小,不同民族抑郁症具有共同的人格特征.     

抑郁症患者短期治疗前后述情障碍的研究

目的 探讨抑郁症患者短期治疗后述情障碍的变化及治疗后述情障碍的影响因素.方法 采用多伦多述情量表(TAS)中文版、Beck抑郁自评量表(BDI),对80例抑郁症患者于治疗前后(新型抗抑郁剂3周以上)进行评定,并与95名健康志愿者(对照组)比较.结果 (1)治疗前抑郁症组TAS与BDI评分均显著高于对照组(P<0.01).重度抑郁组TAS因子I、II及总分均高于轻、中度抑郁组(P<0.05);中度抑郁组仅TAS因子II得分高于轻度抑郁组(P<0.05).(2)治疗后抑郁症患者TAS总分[(52.73±9.41)分]、因子I[(17.88±5.61)分]、因子II[(13.08±3.42)分]、BDI总分[(8.74±7.27)分]较治疗前均降低[分别为 (58.45±10.17)分、(21.56±5.45)分、(16.64±3.35)分、(23.86±9.27)分;P<0.01].治疗后抑郁症组TAS因子I[(17.88±5.61)分]、因子III[(21.78±4.01)分]、总分[(52.73±9.41)分]仍高于对照组[分别为(15.90±4.26)分、(19.09±3.03)分、(48.04±8.79)分;P<0.01].(3)治疗后抑郁总分、服务满意度、治疗信心、对疾病的了解依次进入TAS总分的回归方程.结论 抑郁症存在明显的述情障碍,抑郁总分等是述情障碍的重要影响因素,短期治疗可降低述情障碍的严重程度.述情障碍可能既是一种人格特质,又是对抑郁的一种反应.     

汶川地震安置点灾民抑郁症状及影响因素分析

目的 评估汶川地震后第2周安置点灾民的抑郁症状及影响因素.方法 对江油市太平镇安置点灾民随机抽样后,利用汉密尔顿抑郁量表(HRSD)、斯坦福急性应激反应量表(SASRQ)、应激反应问卷(SRQ)及自编调查问卷进行评估,225名灾民完成调查.结果 29.33%的灾民存在抑郁症状,11.11%的灾民有自杀观念.HRSD总分[(15.67±11.12)分]与SASRQ总分(r=0.725,P<0.01)及SRQ总分呈正相关(r=0.767,P<0.01).不同年龄组的HRSD总分、焦虑与躯体化、阻滞、睡眠障碍、绝望感的差异有显著性(F=4.94,P<0.01),LSD多重检验显示儿童组的HRSD总分[(10.35±9.17)分]与青少年组[(16.86±11.82)分]、中年组[(19.31±11.94)分]、老年前期组[(20.04±11.19)分]的差异有显著性(P<0.05).女性灾民的睡眠障碍[(3.27±2.25)分]比男性[(2.59±2.27)分]严重,差异有显著性(t=2.145,P=0.033).亲人遇难组的HRSD总分[(22.82±13.99)分]高于仅经济损失组[(14.51±10.06)分],差异有显著性(t=3.308,P=0.002).以HRSD总分为因变量的线性回归分析结果 显示,SRQ、烦扰程度、是否受伤、SASRQ进入回归方程(R=0.870,F=95.307,P<0.01).结论 灾民在地震发生后第2周存在明显的抑郁症状,与急性应激症状密切相关,儿童的抑郁症状相对较轻,灾后心理干预应关注女性、亲人遇难等特殊人群.     

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…     

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.     

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.     

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.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…