精神分裂症患者及家属、医生对知情同意具体程序态度的初步分析

目的分析精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度，以指导今后知情同意的实施。方法所有样本均来自中南大学湘雅二医院，共计55名患者，46名家属，61名医生。采用知情同意态度问卷，来调查精神科医生、精神分裂症患者及其家属对知情同意具体程序的态度。结果患者、家属、精神科医生非参数检验结果表明，共计有17项条目存在显著性差异。比如条目4“签写一份接受医疗服务的知情同意书，其目的是”，67．4％的家属，59．2％的患者，90．2％的医生选择第3项“既保护医生又保护患者”，仅21．7％的家属，26．5％的患者，1．6％的医生选择第2项“保护患者”。结论目前精神分裂症患者、家属以及精神科医生对知情同意具体程序的态度存在明显差异。     

老年胼胝体压部FLAIR序列异常高信号发生机制的探讨

目的在磁共振液体衰减翻转恢复（FLAIR）序列图像，胼胝体压部出现高信号通常被认为是病理变化。本研究的目的是分析这种病理改变在老年患者中的发生率及其可能的病理机制，并综述该MR表现的鉴别诊断。方法回顾性复习132例疑诊神经系统疾病的患者（男56例，女76例，年龄9～90岁，平均59岁）的FLAIR序列图像。分别观察胼胝体压部、深部脑白质改变、梗死及脑萎缩的情况。结果在132例患者中，33例（平均年龄59岁）患者的FLAIR像上胼胝体压部可见异常高信号改变，这种异常改变与年龄、脑白质的异常、脑萎缩及认知障碍的表现显著相关。结论FLAIR像上胼胝体压部高信号在老年患者中是常见的表现，多见于有认知障碍的老年患者。其病理变化通常被称之为“脑白质疏松症”。了解该异常表现发生的机制及该表现的鉴别诊断可避免不必要的有创诊断和治疗。     

三级医院病人就诊流向探讨

研究通过对包括专科医院在内的多家三级医院住院病人资料的分析，将疾病种类按ICD－9编码分为19类，研究各类疾病应往低级别医院分流的比例。结果表明：各大类疾病的分流比例不同，分流比例较高的主要是常见病和多发病，总的分流比大约在60％左右。     

住院精神病人院内感染的部位及高峰时间分析

目的　探讨精神科住院病人院内感染的部位及高峰时间。方法　采用圆形统计法对 1997年 1月～2 0 0 2年 12月间每月院内感染人数作圆形统计分析。结果　精神科住院病人院内感染以呼吸系统最多见 ,占5 6 4 8% ;感染高峰时间具有显著性差异 (Y =0 14 5 ,P <0 0 5 ) ,高峰时间约为 12月 17日 (按季节为初冬 )。结论　在感染高峰季节应加强对院内感染的监控和防治     

阴道毛滴虫与沙眼衣原体共生关系的初步探讨

目的 :为了探讨阴道毛滴虫与沙眼衣原体共生、协同致病的关系 ,对南通市公安局收容教育所非淋菌性阴道炎、尿道炎 (后称非淋患者 )患者以及本市某国营纺织厂同龄纺织女工阴道毛滴虫的寄生情况进行了 6个月以上的连续性观察。方法 :对 2 0 0 1年到 2 0 0 3年期间南通市公安局收容教育所非淋患者 1983例女性和随机抽样国营纺织厂纺织女工 2 84人分别采用生理盐水涂片法镜检阴道毛滴虫滋养体。结果 :非淋患者阴道毛滴虫滋养体的平均阳性检出率为 2 0 .6 8% (41/1983) ,明显高于正常对照组 (1.0 6 % ,3/2 84 ) ,差异显著 (X2 =2 5 .2 9,P <0 .0 0 1) .其中沙眼衣原体感染者 ,阴道毛滴虫滋养体的阳性检出率有增高趋势。结论 :非淋患者中沙眼衣原体感染时 ,其阴道毛滴虫阳性检出率高于其他患者。同时选择部分病例采用单纯抗非淋病治疗和抗非淋病与抗滴虫同时治疗进行比较并跟踪追访 6个月 ,缓解和消除症状后者明显优于前者 ,少数不规范治疗或擅自放弃治疗的人 ,延误病情或使病程迁延而转为慢性 ,给根治来一定的难度。建议注意阴道毛滴虫与沙眼衣原体共同感染协同致病的情况 ,要鉴别病原体 ,联合用药 ,提高疗效。     

Identifying the affected hemisphere by 1H-MR spectroscopy in patients with temporal lobe epilepsy and no pathological findings in high resolution MRI

Up to 30% of patients with temporal lobe epilepsy (TLE) remain without remarkable changes in MRI. In this study we investigated the role of (1)H-MR spectroscopy ((1)H-MRS) in lateralizing the affected hemisphere in the mentioned patient group. Twenty-two consecutive patients diagnosed with TLE were investigated by high resolution MRI and (1)H-MRS. We examined the incidence and diagnostic accuracy of temporal metabolite alterations determined by Linear Combination of Model Spectra (L C Model) via water reference. Metabolite values of each hemisphere of TLE patients were compared with healthy controls. Results of metabolite alterations were related to intensive video EEG focus localization. Reduction of N-acetylaspartate + N-acetylaspartyl-glutamate (tNAA) in the affected hemisphere revealed identification in six of nine patients (66%) with unilateral TLE. Group comparison revealed a significant reduction of tNAA (6.1+/-0.8*) in the involved temporal lobe compared with controls (6.67+/-0.4*, P=0.026). Choline levels were significantly increased in the affected hemisphere (1.42+/-0.17*) compared with healthy controls (1.22+/-0.17*, P=0.035). The results of our study show that (1)H-MRS is able to identify the affected hemisphere of MRI negative TLE patients and can be used as an additive tool in multimodal focus localization.     

创建良好的心理环境提供全方位优质服务

医院为患者创建温馨、舒畅的心理环境是当前医院改革中亟待解决的极其重要的任务之一。本文从①充分了解患者的心理需求；②注意患者的不良心理因素；③注意医务人员的不良因素三个方面阐述医院如何为患者创造良好心理环境及其重要性。并重点强调自觉培养自身良好的心理素质，保持稳定良好心态及自控力，尊重、理解患者，学习、实践与患者的沟通技巧，增强责任感，树立良好的白衣天使形象等要素是创建的基础。     

A randomized controlled trial of sedation in the critically ill

A randomized controlled trial comparing: a) a combination of oral chloral hydrate and promethazine to b) a continuous intravenous midazolam infusion, for maintenance sedation in critically ill children, was carried out. The level of sedation was assessed four hourly using a specifically devized sedation scale. Forty-four children entered the study of whom two were subsequently excluded. The number of satisfactory assessments (desired and actual levels of sedation equal) was significantly greater in the chloral hydrate and promethazine group (Chi-squared P <0.01; confidence intervals of the difference 0.06 to 0.20). The number of assessments at level 5 on the sedation scale (patient restless/distressed) was significantly greater in the midazolam group (Chi-squared P <0.05). The total number of satisfactory assessments in the two groups were only 61 and 48% respectively, suggesting that sedation can be considerably improved. Chloral hydrate and promethazine are more effective than midazolam as maintenance sedation in critically ill children. It is possible to prospectively study the efficacy of sedative drugs in critically ill children.