老年高血压合并抑郁患者甲状腺激素水平变化分析

目的了解老年高血压合并抑郁患者甲状腺激素水平的变化。方法选择老年高血压患者73例,分为高血压合并抑郁组(合并组)28例,高血压无合并抑郁组(对照组)45例,并对其进行汉密尔顿抑郁量表及血清甲状腺激素水平检测,比较2组甲状腺激素水平和低T_3综合征发生率。结果合并组患者游离三碘甲状腺原氨酸低于对照组(P<0.01),低T_3综合征发生率高于对照组(39.29%vs 17.78%,P<0.05)。结论老年高血压合并抑郁患者游离三碘甲状腺原氨酸降低,容易发生低T_3综合征,应定期检测甲状腺功能。     

Occurrence of clinical depression during combination therapy with pegylated interferon alpha or natural human interferon beta plus ribavirin

Aim: The onset of depression symptoms during pegylated interferon α plus ribavirin (PEG‐IFN/RBV) combination therapy has led to treatment discontinuation in some cases. In the present study, we conducted a questionnaire survey during treatment to determine whether natural human interferon β plus ribavirin (IFNβ/RBV) therapy is associated with a lower incidence of depression symptom onset compared with PEG‐IFN/RBV therapy. Methods: Seventy‐seven patients with chronic hepatitis C received PEG‐IFN/RBV (PR) or IFNβ/RBV (FR) therapy. A questionnaire survey was administered at the start of treatment, and at 4 and 12 weeks, using the Beck Depression Inventory II (BDI‐II) and the Pittsburgh Sleep Quality Index (PSQI). Results: BDI‐II scores in the PR group increased at 4 and 12 weeks, but remained unchanged in the FR group. At 12 weeks, the mean BDI‐II score and incidence of abnormalities with a BDI‐II score of ≥14 were significantly lower in the FR group than in the PR group. BDI‐II scores during IFNβ/RBV therapy in 11 patients currently using antidepressants remained unchanged up to 12 weeks. None of these 11 patients required addition or dose increases of antidepressants, and there was no evidence of worsened depression symptoms. Nine PR patients had BDI‐II scores of ≥14 and PSQI scores of ≥11 at 12 weeks. Conclusions: IFNβ/RBV therapy was associated with a lower incidence of depression symptom onset during treatment. In patients already diagnosed with depression, there was no evidence that IFNβ/RBV therapy caused any worsening of symptoms, indicating that IFNβ/RBV therapy is safe for patients with depression.     

右美托咪啶在老年直肠癌患者根治术全麻诱导前的应用研究

为探讨老年直肠癌患者根治术全麻诱导前应用右美托咪啶（DEX）的效果,将2011年7～9月于全麻下行直肠癌根治术的60例老年患者随机分为观察组和对照组,每组30例。观察组于麻醉诱导前静脉泵注DEX0．4μg／kg,对照组静脉泵注等量生理盐水,对比两组患者静脉泵注DEX或生理盐水前（T0）、全麻诱导前（T1）、气管插管后1min（T2）及手术结束时（T3）的平均动脉压（MAP）和心率（HR）,以及术中丙泊酚、苯磺顺阿曲库铵用量及七氟烷浓度。结果显示,L、L时两组MAP和HR比较差异均无统计学意义,P〉0．05;T1、T2时观察组MAP和HR均比对照组低,P〈0．05。观察组术中丙泊酚用量、七氟烷浓度明显小于对照组,P〈0．05。结果表明,老年患者行直肠癌根治术全麻诱导前静脉泵注DEX可减少麻醉药用量,降低麻醉药使用浓度,提高患者麻醉的安全性。     

以夫妻为中心的心理干预对孕产妇心理状况影响的系统评价

目的 系统评价以夫妻为中心的心理干预对孕产妇心理状况的影响。 方法 检索PsycINFO、PubMed、Embase、CINAHL、Web of Science、The Cochrane Library、中国知网和万方数据库,纳入以夫妻为中心的心理干预对孕产妇心理状况影响的随机对照试验。采用RevMan5.4软件进行Meta分析,通过敏感性分析和亚组分析探索异质性的可能来源,并评估结果的稳健性。 结果 共纳入17篇文献,包括3 123名孕产妇。Meta分析结果显示,以夫妻为中心的心理干预显著降低抑郁症状发生率［RR=0.45,95%CI（0.33,0.60）,P＜0.05］,并降低孕产妇抑郁、焦虑、压力水平（均P＜0.05）。干预跨度的亚组分析结果显示,分娩前干预组、分娩前后干预组与对照组抑郁、焦虑得分的差值存在统计学差异（均P＜0.05）。 结论 以夫妻为中心的干预对改善孕产妇的抑郁、焦虑和压力状况具有积极作用,但由于各研究间的异质性,有待大样本、多中心、高质量的随机对照研究进一步验证其效应量。     

小针刀疗法干预治疗老年性骨质疏松症的疗效观察

目的 观察小针刀疗法缓解老年性骨质疏松症患者腰背痛的疗效。方法 将46例患者随机分为治疗组和对照组各23例,治疗组选择西药治疗加小针刀疗法方案,对照组采用单纯西药治疗方案,治疗组疗程为4周,对照组疗程为6周,采用视觉模拟评分法(VAS)评价治疗前后得分对腰背痛进行量化动态观察,依据“Barthel指数评定法”对老年性骨质疏松症日常生活活动能力(ADL)进行观察,评价小针刀疗法干预治疗老年性骨质疏松症的临床效果。结果 视觉模拟评分法(VAS )评价显示对于疼痛治疗组治疗后2周、一疗程与治疗前均明显差异(P<0.05),同时与对照组有明显差异(P < 0. 05)优于对照组。日常生活活动能力(ADL)评价显示治疗组治疗后2周、一疗程与治疗前有明显差异(P<0.05),同时与对照组有明显差异(P<0.05)优于对照组。结论 小针刀松疗法对老年性骨质疏松症腰背痛有明确的缓解疼痛、改善证候的作用,且见效快、创伤小、不良反应少、操作简单。     

理气开郁法板块方镇痛作用的动态分析

目的：探讨理气开郁法中药板块方的镇痛作用特点。方法：将150只清洁级昆明种小鼠,按体重随机区组法分为15组,包括对照组,柴郁汤、芍甘汤、痛泻要方、金铃子散高中低剂量各组,吗啡和布洛芬组,采用45℃、50℃、55℃水浴引致小鼠疼痛模型,动态测定痛阈潜伏期,用药前测定基础痛阈。采用重复测量设计的方差分析。结果：柴郁汤、芍甘汤和痛泻要方的镇痛作用以高剂量更明显;柴郁汤对45℃、50℃、55℃水浴的痛阈潜伏期均有延长作用,柴郁汤高、中剂量在多个时间点上显示出较好的镇痛作用。结论：柴郁汤的镇痛作用较强,作用特点类似于中枢镇痛药或兼有中枢性镇痛作用;芍药甘草汤、痛泻药方、金铃子散属于作用于外周的镇痛药。     

慢性应激抑郁型黄褐斑动物模型建立与现有模型的比较研究

目的:建立并验证慢性应激抑郁型黄褐斑动物模型,并与现有其他模型进行比较。方法:在注射黄体酮同时,进行慢性轻度不可预见的应激刺激,并紫外线局部照射。结果:黄体酮+紫外线+慢性应激抑郁法造模较其他方法更能导致皮肤丙二醛(Malondialdehyde,MDA)升高和超氧化物歧化酶(Superoxidedismutase,SOD)降低以及皮肤黑素细胞的增加,并且具有抑郁症的行动学表现。与空白组比较,经慢性轻度不可预见性应激刺激的动物体重显著下降,敞箱试验中穿格次数、理毛时间和次数、直立次数得分显著下降,液体消耗试验中糖水消耗和糖水偏爱百分比明显下降,而纯水消耗显著提高。结论:黄体酮+紫外线+慢性应激抑郁法建立的抑郁型黄褐斑豚鼠多因素模型获得成功。与现有其他模型比较,其皮肤MDA、SOD与皮肤黑素细胞等客观指标的变化也更加接近人类黄褐斑的病变。     

Important determinants of quality of life in a peritoneal dialysis population in Turkey

Background: Patients' health-related quality of life (HRQoL) is an important indicator for predicting the effectiveness of treatment, morbidity, and mortality. The aim of this study was to determine the level of HRQoL and the most important factors affecting HRQoL in patients receiving peritoneal dialysis (PD). Methods: This cross-sectional study was performed with 156 patients, 30 of whom (19.2%) had automated PD (APD), were over 18 years of age, and were followed up at the Erciyes University Continuous Ambulatory Peritoneal Dialysis (CAPD) Unit during the previous year. HRQoL, depression, and fatigue were measured by means of the Short Form-36 (SF-36), Beck Depression Inventory (BDI), and Fatigue Severity Scale (FSS), respectively. Results: The mean mental component summary (MCS) score was 42.1 ± 11.9 and physical component summary (PCS) score was 39.1 ± 11.2, which was lower than MCS. Depression was the strongest predictor for both diminished mental (β = ?24.4, p < 0.001) and physical (β = ?16.5, p < 0.001) HRQoL. Fatigue was the next strongest predictor for diminished physical HRQoL only (β = ?7.74, p < 0.001). Depression and fatigue accounted for 37% of physical HRQoL impairment. Depression as a sole factor was responsible for 31% of mental HRQoL impairment. Age, hospitalization, total cholesterol, serum albumin levels, and Kt/V urea had affected the SF-36 in some domains score but not in all. Conclusion: HRQoL in our PD patients can be evaluated at a slightly poor level compared to the results of previous studies. Impaired HRQoL is more closely associated with depression and fatigue. Depression was the strongest predictor of both mental and physical HRQoL. Fatigue was the next strongest predictor for physical HRQoL only.     

Sleep Disturbance in Chronic Hemodialysis Patients: The Impact of Depression and Anemia

Background. Many patients with end-stage renal disease who are undergoing chronic hemodialysis suffer from sleep disturbance. This paper was designed to study the severity and prevalence of sleep disorders and the factors affecting the syndromes in this unique patient group. Methods. We conducted this study by the use of questionnaires. Included in this study were a total of 245 patients at our center who had end-stage renal disease (ESRD) and who received hemodialysis thrice weekly for more than three months. Their demographic data and biochemical and hematologic parameters were analyzed. All patients were asked to complete two questionnaires (in a Chinese version) of the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory second edition (BDI-II), either by themselves or with assistance from the medical staff. Results. One hundred and sixty-four patients completed both questionnaires with a response rate of 70.4%. Their mean age was 57.9 ± 11.8 (ranging from 23.1 to 83.7) years old. They had been receiving hemodialysis for an average of 49.1 ± 50.9 months before the study. The male to female ratio was 77:87. Seventy six (46.3%) patients had diabetes mellitus. The prevalence of sleep disturbance was 74.4% (122/164), defined as PSQI scores >5. The poor sleepers had higher BDI scores and a higher ratio of females comparing to the good sleepers. By a multivariate analysis, the BDI scores and female sex were the independent predictors of the patients being poor sleepers. In analyzing the poor sleepers, the BDI scores, durations of hemodialysis and hemoglobin levels were the independent factors for predicting the global PSQI scores. Conclusion. The questionnaire showed a high prevalence of insomnia in the dialytic population. The study also attributes a predictive role in sleep quality to gender, depression, dialytic duration, and hemoglobin levels. The data indicate that in the management of insomnia in this patient group, anemia and depression, both of which are potentially correctable, should be assessed.