居家脑卒中患者家庭支持干预对居家诊疗认可度的探讨

目的探讨居家脑卒中患者家庭支持干预与居家诊疗认可度。方法将420例居家脑卒中患者按社区随机分为干预组(n=218)和对照组(n=202)。对照组按照传统的居家处理诊治过程,干预组患者及家庭成员以医疗延伸服务及社区居家医疗的方式实施健康促进教育,建立家庭支持环境,干预健康管理过程。结果通过2组患者问卷调查对居家诊疗认可度进行比较,干预组明显优于对照组。结论居家患者家庭支持状况直接影响脑卒中患者的居家诊疗感受。     

老年痴呆患者激越行为的现状调查及影响因素分析

目的 调查老年痴呆患者激越行为的现状,探讨其影响因素。方法 采用激越行为评估表、简易精神状态量表(MMSE)及痴呆患者和照顾者一般资料调查表对某三甲医院108例住院老年痴呆患者进行调查,并对结果进行分析。结果 老年痴呆患者激越行为的平均(1.43±0.48)分,处于1周少于1次状态;患者精神智力处于中、重度水平。混合型痴呆患者、重度痴呆患者、患病时间1～3a的痴呆患者激越行为评分明显高于其他组(均P0.05)。患者性别、婚姻、子女数量对痴呆患者激越行为评分均无影响(P0.05)。多元回归分析结果显示,精神智力、痴呆类型、病情程度3个变量共解释了54.8%(调整R2=0.548)的变异量。结论 老年痴呆患者激越行为处于一般水平,平均每周少于1次状态。激越行为表现为多样性,与精神智力、痴呆类型、病情程度有关。应重视老年痴呆患者早期认知评估和干预训练,护理人员应关注痴呆患者激越行为的表现,加强痴呆患者激越行为的管理。     

对精神病房中具有痴呆症状患者的护理现状分析

痴呆多发生于老年期 ,发病率高。由于痴呆患者的临床特殊性 ,客观要求护理人员应根据其特殊性实施护理 ,但由于种种原因 ,精神病院病房中具有痴呆症状或达到痴呆诊断标准的患者通常与其他患者混住在一起 ,致该类患者得不到相应的特别护理。为此 ,作者对其护理现状作如下分析 ,并报道于后。1　资料与方法1 1　对象　作者就北京市三所精神病专科医院老年病房中具有痴呆症状或达到痴呆诊断标准的患者在老年病房的分布及老年科护士关于痴呆患者管理的知识方面进行调查。1 2　测试工具　①以简易智力检查表 (ｍｉｎｉｍｅｎｔａｌｓａｔｅｅｘａ…     

CHADS_2评分对房颤患者血管性痴呆的预测价值

目的评估CHADS_2评分是否可作为房颤患者血管性痴呆发生风险分层的有用指标。方法从2010年9月-2013年12月在南方医科大学附属普宁华侨医院共纳入776例房颤的患者,随访记录发展成为血管性痴呆的患者,评估CHADS_2评分与血管性痴呆的关系。结果共发现65例患者发生血管性痴呆,发生血管性痴呆的患者年龄较大,并且高血压病、糖尿病、脑卒中和慢性肾病的发病率较高;发生血管性痴呆的患者的BMI值和收缩压显著高于未发生血管性痴呆的患者;CHADS_2评分越高,将来患者发展成血管性痴呆的比例越高,风险越大;在多变量分析中CHADS_2评分是血管性痴呆发生的独立危险因素(风险比1.64,95%置信区间1.21～1.79,P=0.009)。结论 CHADS_2评分是房颤患者血管性痴呆发病的有用预测指标。     

中国居家脑卒中患者的照护现况及对策

脑卒中是全球致残、致死的主要原因,且脑卒中患者的发病部位和疾病种类多样,脑卒中患者的照护需求呈多元化,中国平均住院日的缩短使脑卒中患者的居家照护至关重要。但目前面临社区医护人员短缺、照护信息系统不完善、家庭支持能力待提高、社会支持系统不健全等问题。本文将对中国居家脑卒中患者的照护需求、照护形式、照护资源作一综述,阐述目前居家脑卒中患者的照护现状及对策,以期为降低居家脑卒中患者的疾病复发率和再入院率、提高居家脑卒中患者的自护能力、生活质量、减轻家庭、社会负担等提供参考和依据。     

甘肃省70538例居家重性精神疾病患者管理效果评价

目的掌握甘肃省重性精神疾病患者居家管理的干预现状,并对管理效果做出评价,为今后对重性精神疾病患者更好地进行社区康复管理、救治救助奠定基础。方法依据重性精神疾病管理治疗工作规范(2012年版)和国家基本公共卫生服务规范(2011年版),对甘肃省2015年1月至2016年4月期间,通过普查和线索调查筛查出疑似患者并确诊,然后进行随访,进一步收集和分析其接受随访管理(在管)、治疗、服药、危险行为发生情况等信息。结果甘肃省共计确诊重性精神疾病患者70538例,其中在管患者占81.08%(57195例)。在管、非在管和失访的重性精神疾病患者中,治疗率为69.92%(48009/68663),其中双相情感障碍的治疗率(76.00%)最高(均P0.001)。在管居家患者的服药率为42.16%(24113/57195),规律服药率为24.74%(14150/57195),其中偏执性精神病的服药率(51.98%)最高(均P0.001),癫痫所致精神障碍的规律服药率(31.02%)最高(均P0.001)。结论目前甘肃省重性精神疾病居家管理率、治疗率、在管居家患者的服药率和规律服药率均低于全国平均水平,在普及精神疾病防治知识和提高医务人员对重性精神疾病规范化治疗能力等方面需大力加强。     

血管性痴呆的神经影像学进展

痴呆是导致老年人残疾的主要疾病之一。其中有半数的痴呆患者可能是由于脑血管疾病引起或者与之有关。痴呆的诊断仍然以临床表现为主要依据,但是现代神经影像学的发展促进了痴呆临床诊断和治疗研究的深入。血管性痴呆(vasculardementia,VD)为一异源性痴呆综合征,其受以下因素的影响:血管条件、血管相关结构的改变(如脑梗死、脑萎缩、白质病变)和患者个体条件(如年龄、教育、遗传因素)。血管性痴呆有3种主要亚型,即皮质性痴呆(多发梗死性痴呆)、皮质下痴呆(小血管性痴呆)和关键部位梗死性痴呆。皮质性痴呆和关键部位梗死性痴呆常由于大血管…     

血尿酸在血管性痴呆患者中的临床诊疗价值

目的探讨血管性痴呆的发病危险因素。方法测定50例血管性痴呆患者及50例正常体检者的血尿酸水平,根据颈动脉硬化程度将血管性痴呆患者进行分组,采用临床痴呆量表(clinical dementia rating,CDR)对血管性痴呆患者评分。结果血管性痴呆患者血尿酸水平较正常对照组高,且血尿酸水平随着颈动脉硬化程度而递增(P0.05)。血管性痴呆的严重程度与血尿酸水平呈负相关(P0.05)。结论高尿酸血症可能是血管性痴呆的发病危险因素。     

痴呆患者疼痛评估研究进展

疼痛是老年痴呆患者常见问题,严重时会引发精神行为症状。痴呆患者的疼痛评估需要 自评、他评相结合,现就痴呆患者疼痛的自我报告及观察性评估进行综述,为评价痴呆患者的疼痛干预 效果提供参考。     

痴呆行为障碍量表信度和效度检验

国外文献报道:70％-90％的痴呆患者在病程中的一定时间内会出现行为方面的问题[1-3]。国内盛氏等调查发现,几乎所有的痴呆病人都会出现或多或少的行为障碍[4]。因此对痴呆患者行为障碍有效而可靠的评定在临床和科研工作中显得越来越重要。痴呆行为障碍量表(dementia behavior disturbance scale,DBD)是通过与痴呆患者的照料者会谈,评定病人近一周来与痴呆有关的行为和精神症状,该量表评定内容单一,主要与痴呆的行为和精神症状有关[5.6]。为验证DBD是否适合在我国使用,本研究将DBD翻译后的中文版本进行信度和效度的检验,希望能成为评定我国痴呆患者行为及精神症状的有效工具。     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

Bibliography of officers of department of mental hygiene

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