妊娠期肝内胆汁淤积症与血清甘胆酸的关系

检测了７４例正常足月妊娠妇女和５６例妊娠期肝内胆汁淤积症（ＩＣＰ）患血清甘胆酸（ＣＧ）的浓度，结果ＩＣＰ患血ＣＧ浓度显升高（１３．５２±９．５４ｍｇ／Ｌ），为正常孕妇（２．６７±１．９２ｍｇ／Ｌ）的５～１０倍，根据血ＣＧ浓度将ＩＣＰ患分为〈１０、１０～２０，〉２０ｍｇ／Ｌ３组，将３组胎儿出生情况与正常组相对照，结果显示血ＣＧ浓度〈１０ｍｇ／Ｌ组羊水胎粪污染率及新生儿窒息率与正常组无差异，而     

消化道恶性肿瘤确诊初期患者社会支持与生命质量的调查

目的 调查消化道恶性肿瘤确诊初期的患者半年中的社会支持和生命质量变化。方法 采用社会支持评定量表和CARES-SF对146名患者的社会支持和生命质量进行为期半年的追踪调查。结果 消化道恶性肿瘤确诊初期患者的生命质量为中等，其中婚姻关系维度、性关系维度得分半年后下降。患者所获得的社会支持最多的是情感支持，其次是实际支持，信息支持为第三位。情感支持大多来源于家庭成员，信息支持大多来源于医务人员。患者大多很少参与社交活动。在半年中情感支持、实际支持、信息支持的变化模式不一。诊断初期的患者不能有效地利用社会支持。结论 应对确诊初期患者加强咨询，以充分识别和利用社会资源。应持续评估患者的生命质量和社会支持，并制订干预方案，提高消化道恶性肿瘤确诊初期患者的社会支持程度，最终提高其生命质量。     

Comparison of self-reports and biological measures for alcohol, tobacco, and illicit drugs consumption in psychiatric inpatients

BACKGROUND: Asking psychiatric in-patients about their drug consumption is unlikely to yield reliable results, particularly where alcohol and illicit drug use is involved. The main aim of this study was to compare spontaneous self-reports of drug use in hospitalized psychiatric patients to biological measures of same. A secondary aim was to determine which personal factors were associated with the use of tobacco, alcohol, and illicit drugs as indicated by these biological measures. METHODS: The consumption of substances was investigated using biological measures (urine cotinine, cannabis, opiates, cocaine, amphetamines and barbiturates; blood carbohydrate-deficient transferrin [CDT] and gamma-glutamyl transferase [GGT]) in 486 consecutively admitted psychiatric patients, one day following their hospitalization. Patients' self-reports of alcohol, tobacco and illicit drugs consumption were recorded. Socio-professional and familial data were also recorded. RESULTS: The results show a low correlation between biological measures and self-reported consumption of alcohol and illicit drugs. Fifty-two percent of the patients under-reported their consumption of illicit drugs (kappa=.47). Patients with schizophrenia and personality disorders were more likely to disclose their illicit drug consumption relative to patients suffering from mood disorders and alcohol dependence. Fifty-six percent of patients underreported alcohol use, as evaluated by CDT (kappa=.2), and 37% underreported when using the CDT+GGT measure as an indicator. Smoking appeared to be reported adequately. In the study we observed a strong negative correlation between cannabis use and age, a strong correlation between tobacco and cannabis use, and correlations between tobacco, cannabis and alcohol consumption. CONCLUSION: This study is the first to compare self-reports and biological measures of alcohol, tobacco and illicit drug uses in a large sample of inpatients suffering from various categories of psychiatric illnesses, allowing for cross-diagnosis comparisons.     

老年病人鼻饲方法的改进

目的探讨增加置管深度并抬高床头对预防老年鼻饲病人食物反流的效果。方法将 5 75例需鼻饲的卧床老年病人按鼻饲医嘱时间顺序及不平衡指数最小原则分成三组 ,分别给予教科书中的常规置管深度置管 (对照组 )、置管深度延长 10cm(观察 1组 )、置管深度延长 10cm并抬高床头 30～ 45°(观察 2组 )进行鼻饲。结果三组病人食物反流率比较 ,P <0 .0 1;观察 1、2组分别与对照组比较 ,P <0 .0 5、P <0 .0 1;观察 1组与观察 2组比较 ,P <0 .0 1。增加置管深度并抬高床头其食物反流率最低 ,仅增加置管深度次之 ,常规置管最高。结论增加置管深度并抬高床头可显著降低老年鼻饲病人食物反流发生率。     

Prolactin responses to haloperidol in drug-free and treated schizophrenic patients

Summary The prolactin response to 5 mg haloperidol i.m. was studied in 12 schizophrenic patients in a drug-free state and after a month treatment with haloperidol, as a possible index of dopamine receptor sensitivity and occupancy. Blood samples were taken at times 0, 60, 90 and 120 minutes. The increase in PRL observed in the drug-free state disappeared after drug treatment. The PRL plasma levels after treatment with 60 mg haloperidol per os were higher than the maximal PRL responses after 5 mg i.m. The increases in baseline PRL caused by the treatment correlated positively to the reduction in the BPRS score. The test was also performed in a group of 11 patients chronically treated with haloperidol during a daily dose of 60 mg, and 15 days after reduction of the dose to 30 mg. PRL increases after 5 mg haloperidol i.m. were observed only after reduction of the dose. It is suggested that the prolactin response to haloperidol is an index of the occupancy of receptors that are involved in the PRL releasing mechanisms, and could be used to verify their blockade by the neuroleptics, especially in patients that do not respond positively to drug treatment.     

老年患者静脉穿刺常见困难及对策

静脉穿刺是临床常用的护理操作技术。老年人由于各器官生理性老化 ,经常合并多种疾病 ,患病率高 ,患病时间长 ,致使静脉穿刺次数多 ,因此静脉穿刺比较困难。对临床上常遇到的静脉穿刺困难进行分析并给予相应解决方法 ,经过多年实践 ,遵照这些方法 ,穿刺成功率达 97%以上 ,为患者解除了病痛     

单纯性肥胖患儿血清载脂蛋白AI及B含量的改变

测定了３０例单纯性肥胖患儿（年龄７岁～１２岁）和３０例同龄健康儿童的血清载脂蛋白ＡＩ（ａｐｏＡＩ）、Ｂ（ａｐｏＢ）ａｐｏＢ／ａｐｏＡＩ比值，甘油三酯（ＴＧ）和总胆固醇（ＴＣ）。结果肥胖患儿组血清ａｐｏＡＩ明显低于健康儿童组，ａｐｏＢ、ａｐｏＢ／ａｐｏＡＩ、ＴＧ明显高于健康儿童组，差异均非常显著（Ｐ＜０．０１）。肥胖患儿组ＴＣ虽然高于健康儿童组，但差异不显著（Ｐ＞０．０５）。     

Ethical Issues in Psychotherapy

Abstract: The goal of psychotherapy is not only the dissolution of the symptoms, but also to attempt to bring about an improvement in adaptability and deepening the achievement of self-understanding. The nature of psychotherapy is based on the relationship between the therapist and patient. Such a goal and nature mean that some kinds of psychotherapy are beyond the medical model. In this paper ethical issues in psychotherapy are discussed as follows. 1) some complicated matters in informed-consent, 2) the hit or miss techniques of the poorly trained therapist, 3) the protection of privacy, 4) the sexual misconduct of therapists with patients, 5) special consideration for child-adolescent patients.     

老年急性心肌梗塞37例临床分析

对３７例老年急性心肌梗塞与５０例老年前期急性心肌梗塞病人进行临床对比分析．结果显示：部分老年急性心肌梗塞病人发病不典型，并发症多，死亡率高，这可能与并发室颤、房室或束支传导阻滞、心衰等有关．     

紧急纤维支气管镜在老年高危患者中的应用

目的　研究紧急纤维支气管镜 (纤支镜 )在老年高危患者中的应用。方法　老年急危重症患者 77例 ,其中急性生理和慢性健康评估 (APACHEⅡ )计分 >14分者 65例。所有患者共行 10 2例次紧急纤支镜操作 ,其中肺泡灌洗、气道分泌物吸引 76例次 ;纤支镜引导下经鼻气管插管 19例次 ;异物吸出 6例次。结果　 10 2例次紧急纤支镜操作抢救总有效率为 80 .3 % ,无危及生命的并发症发生。结论　紧急纤维支气管镜是抢救急危重症患者呼吸道病变紧急处理的有力武器 ,高龄严重心、肺功能障碍不是纤支镜操作的禁忌证