学点心理治疗知识(二十一) 询者中心疗法

询者中心疗法也称咨客中心疗法或患者中心疗法。该疗法倡导"以人为本"、"以咨客为中心"的理念,它同精神分析对潜意识的关注和行为主义对学习过程的强调不同,本疗法将着重解决当事者意识领域中的冲突,重视人的自我实现理想,发挥人的内在潜能,实现高层次的心理需求,属于人本主义的范畴。心理治疗学家提出的以自我概念为中心的自我理论,包括理想自我和现实自我。前者是一个人所希望的和未来的自我,后者是目前状况中的自我,     

儿童中心游戏疗法心理疏导的个案介绍

儿童中心游戏疗法是由爱思莲(V AxIine)根据人本主义心理学家罗杰斯的自我人格理论创造的一种儿童心理疗法,是以罗杰斯的人本主义心理学理论为指导思想,以游戏为媒介,以儿童为对象的一种心理治疗技术[1]。2010年7～8月,笔者对1     

儿童中心游戏疗法心理疏导的个案介绍

儿童中心游戏疗法是由爱思莲（V Axline）根据人本主义心理学家罗杰斯的自我人格理论创造的一种儿童心理疗法,是以罗杰斯的人本主义心理学理论为指导思想,以游戏为媒介,以儿童为对象的一种心理治疗技术。2010年7-8月,笔者对1例来我院就诊的儿童进行儿童中心游戏疗法心理疏导,取得良好的效果,现报告如下。     

两种认知行为疗法的比较——试论理情疗法与现实疗法的异同

在心理咨询的历史舞台上,精神分析疗法、行为疗法和人本主义疗法先后占据了主导的地位.本世纪70年代,伴随着认知治疗家的成功以及行为治疗家的观念转变,认知行为疗法成为了心理咨询领域又一个新的理论取向.认知行为疗法作为一种心理治疗体系,其流派众多,在理论、操作上各有侧重.鉴于此,本文试图从理论基础、治疗过程以及治疗策略等方面对该流派中比较有代表性的理情疗法与现实疗法做一个比较.     

正念疗法在糖尿病患者中的应用进展

<正>念疗法是一种新兴的心理疗法,近年来逐渐应用到慢病领域中。随着当今糖尿病患者心理问题不断出现,在糖尿病患者中应用正念疗法将是一个新的研究趋势。本文主要介绍了正念疗法的概念、机制与内容,并总结归纳了正念疗法在糖尿病患者中应用的国内外相关进展,主要包括正念减压疗法、正念认知疗法、接纳与承诺疗法及正念饮食疗法等,以期为今后临床实践提供依据。     

全方位整合心理疗法的基本理论与方法

当前 ,国外的心理疗法已达 2 5 0种以上。但是认真研究一下 ,却发现良莠不齐。真正起主导作用的不过精神分析、行为治疗、人本主义心理治疗及认知治疗等几种。然而它们的弊端也是显而易见的[1] 。此外由于我国的社会历史、文化和习俗的差异使国外的心理疗法难以适应和推广普及。因此 ,在学习借鉴国外心理疗法的基础上 ,寻找适合我国国情、民情的心理疗法已成为心理医生、全科医生等共同努力的目标之一。1　全方位整合心理疗法的成因精神分析和行为治疗是心理疗法中国内外起主导作用的两大主要疗法。能否通过一种方式使这两大主要疗法充分发…     

我国刺血疗法研究现状及思考

分析了我国刺血疗法临床、机理研究现状.临床研究包括刺血针具应用情况、刺血临床有效病种、刺血部位、操作方法、出血量的掌握以及临床研究方法等;机理研究包括刺血疗法对血液指标、血管功能的影响,对脑的保护作用及内分泌免疫调节的作用等.认为目前我国刺血疗法存在问题包括:中医刺血疗法理论体系尚待建立;临床应用有待进一步扩大;临床研究质量亟需进一步提高;机理研究有待深化.提出应建立一套中医理论指导下的刺血理论体系,按照规范化、标准化、现代化的要求,科学开展刺血临床治疗规律研究,深入探讨其作用机理、起效机制.     

近5年中西医治疗三叉神经痛研究进展

临床上中西医治疗三叉神经痛的方法诸多,西医治疗包括手术、药物;中医治疗包括针刺、艾灸、电针、推拿、中药、穴位注射、穴位埋线、穴位贴敷及其他中医药联合疗法,现将治疗三叉神经痛的中西医疗法进行归纳整理,综述如下。     

美西华盛顿州7成以上癌症患儿求助于替代疗法

2001年10月,美国《预防医学》杂志报道了由Neuhouser 博士领导的、NCI 和 Hutchinson 癌症研究中心资助的一项调查,披露了替代疗法在癌症患儿中的使用情况。此项调查通过电话访问了西华盛顿州75名活着的癌症患儿(18岁以下)的家长。这些患儿均是在1997年2月～1999年12月期间患上癌症的。为了使调查更为合理,研究者将替代疗法细分为3类,第1类包括针刺、按摩、自然疗法和顺势疗法;第2类为食品补充剂治疗,包括维生素、矿物质、草药或其他补充剂;第3类为其他疗法,包括饮食疗法、运动疗法、身心融合疗法和能量介入疗法。     

痔病非手术治疗现状

现代医学认为痔是肛垫病理性肥大、移位及直肠末端黏膜和肛管皮肤下静脉丛发生扩张和屈曲所形成的柔软静脉团。各种非手术疗法的目的,旨在阻断部分痔核血供,修复损伤的黏膜组织以止血;或是促进痔周围组织纤维化,将脱垂的肛管直肠黏膜固定在直肠壁的肌层,以固定松弛的肛垫,达到防止脱垂的目的。痔病非手术疗法包括药物治疗和物理治疗。药物治疗包括:中医药治疗和西药治疗。中医药治疗包括:内服,熏洗坐浴,外敷,肛塞,注射等,为Ⅰ、Ⅱ期内痔首选;西药治疗包括:内服药、外用药。器械疗法包括:套扎法、铜离子电化学疗法、激光、红外线凝固、冷冻等物理疗法。     

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…     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.