对比分析两种进路手术方法治疗食管癌患者的临床疗效

目的:对比分析两种进路手术方法治疗食管癌患者的临床疗效。方法:回顾性分析60例食管癌患者的临床资料,分为观察组(30例)和对照组(30例)。对照组患者被给予胸腹颈三切口行胃食管左颈部吻合术,观察组患者被给予左胸联合左颈部胃食管弧形切口外翻颈部吻合术治疗,观察两组患者的治疗效果。结果:观察组患者的手术时间(2.79±1.22)h低于对照组(4.33±1.51)h,观察组患者的手术失血量(201.23±4.54)ml低于对照组(460.23±5.12)ml,观察组患者的住院时间(11.68±2.09)d低于对照组(16.87±3.04)d,观察组的住院费用(13753.1±232.1)元低于对照组(27753.2±320.1)元,观察组的并发症发生率(10.00%)低于对照组(30.00%),均P<0.05,具有统计学差异。结论:左胸联合左颈部胃食管弧形切口外翻颈部吻合术治疗食管癌的临床优势显著。     

青年脑出血的病因及危险因素分析

目的探讨青年脑出血的危险因素及病因。方法回顾分析我院2008-01—2014-01收治的青年脑出血患者的临床资料。结果青年脑出血共779例,男性多于女性。病因从高到底依次为高血压、不明原因、血管畸形、妊娠/产褥期、瘤卒中、血液系统疾病、烟雾病和系统性红斑狼疮。危险因素为高血压、血脂异常、饮酒、心脑血管病家族史、吸烟、糖尿病和既往卒中史。18~31年龄组与32~45年龄组比,脑血管畸形发病比例明显增高(P0.05)。32~45年龄组与18~31年龄组比较,高血压脑出血比例明显增高(P0.05)。结论年龄增长脑出血比例增加,男性多于女性;高血压是主要病因,其次是脑血管畸形;高血压史、吸烟饮酒、血脂异常可能与青年脑出血有关。     

双侧大脑前动脉梗死区临床特点及发病机制探讨

目的探讨双侧大脑前动脉分布区梗死的临床特点和机制。方法回顾分析3例急性双侧ACA分布区脑梗死患者的临床特点和头MRI、MRA等资料。结果 3例患者均有脑血管病危险因素,包括高血压、糖尿病、吸烟、高HCY等。临床症状包括淡漠、欣快、不同程度肢体瘫痪和尿便障碍。存在严重的动脉硬化和(或)血管变异。结论情感障碍、肢体瘫痪和尿便障碍是主要临床表现,ACA解剖变异伴ICA/ACA局部狭窄或双侧ACA和MCA严重狭窄是双侧ACA分布区梗死发病的重要因素。     

男性骨质疏松症的诊断与评估筛选

骨质疏松症是以低骨量为特征,表现为骨微观结构破坏,骨骼脆性增加,导致骨折风险,特别是脊柱、髋部、腕部、肱骨以及骨盆骨折风险增加的一种常见病。世界卫生组织通过骨密度测定,     

脑卒中偏瘫后遗症期老年患者抑郁的治疗研究

目的 评价道家认知疗法对脑卒中偏瘫后遗症期老年患者抑郁及生活质量的影响.方法 77例脑卒中偏瘫后遗症期伴发抑郁的老年患者,按随机数字表法分为常规治疗组(38例)和综合治疗组(39例),常规治疗组采用抗抑郁剂联合一般支持性心理治疗,综合治疗组在此基础上进行道家认知治疗,两组均治疗8周,随访6个月.于治疗前,治疗后2、4、8周末及随访期末,采用汉密尔顿抑郁分级量表(HAMD)、脑卒中专用生活质量量表(SS-QOL)分别对患者的抑郁症状及生活质量进行评定,并进行统计学分析.结果 常规治疗组治疗后HAMD评分逐渐下降,治疗后8周[(22.35±4.69)分]与治疗前[(29.62±5.95)分]比较差异有统计学意义(t=6.425,P＜0.01);随访期末HAMD评分[(24.48±4.12)分]又升高,与治疗后8周比较差异有统计学意义(t=2.014,P＜0.05),但较治疗前HAMD评分仍显著降低(t=4.836,P＜0.01).常规治疗组SS-QOL评分在治疗后逐渐升高,治疗后8周[(105.39±25.84)分]与治疗前[(86.63±23.84)分]比较差异有统计学意义(t=4.933,P＜0.01);随访期末SS-QOL评分[(96.09±21.37)分]较治疗后8周又有所下降(t=2.543,P＜0.05),但较治疗前仍显著升高(t=2.790,P＜0.05).综合治疗组治疗后HAMD评分持续下降,治疗后8周[(20.08±4.60)分]及随访期末[(15.21±3.42)分]与治疗前[(30.14±4.92)分]比较差异均有统计学意义(t=8.341、15.443,P＜0.01),并且随访期末HAMD评分显著低于治疗后8周(t=4.724,P＜0.01).综合治疗组治疗后SS-QOL评分呈逐渐升高趋势,治疗后8周[(117.56±26.22)分]及随访期末[(126.57±21.82)分]较治疗前[(86.54±23.90)分]显著升高(t=6.716、8.916,P＜0.01);随访期末SS-QOL评分也较治疗后8周显著升高(t=2.378,P＜0.05).综合治疗组治疗后8周及随访期末HAMD评分显著低于常规治疗组同时间点评分(t=2.118,P＜0.05;t=8.405,P＜0.01),SS-QOL评分显著高于常规治疗组同时间点评分(t=3.123,P＜0.05;t=6.580,P＜0.01).结论 抗抑郁剂联合一般支持性心理治疗或在此基础上进行的道家认知治疗均可不同程度地改善脑卒中偏瘫后遗症期老年患者的抑郁症状,提高其生活质量.道家认知疗法起效虽慢,但远期疗效好.

Abstract：

Objective To evaluate the effects of Taoist cognitive psychotherapy on depression of aged patients with cerebral stroke hemiplegia convalescence. Methods Seventy-seven hemiplegia convalescence patients with depression were divided into general treatment group (38 patients, received general back-up psychology therapy) and combined treatment group (39 patients, received general back-up psychology therapy and Taoist cognitive psychotherapy) by random digits table. All patients were treated for 8 weeks and followed up for 6 months. Two groups were evaluated with HAMD and SS-QOL before treatment and at the end of the 2 weeks,4 weeks, 8 weeks and 6 months after treatment. The results were analyzed with statistics. Results In general treatment group, the HAMD scores were gradually decreased, and the HAMD scores of patients after 8 weeks' treatment were significantly lower than those before treatment[(22.35 ± 4.69)scores vs. (29.62 ± 5.95 ) scores,t = 6.425 ,P ＜ 0.01]. At the end of 6 months after treatment, the scores increased [(24.48 ± 4.12 ) scores vs. (22.35 ± 4.69 ) scores, t = 2.014, P ＜ 0.05], but they were lower than those before treatment(t = 4.836, P ＜ 0.01 ). At the end of 6 months after treatment, the SS-QOL scores were lower than those after 8 weeks' treatment (t =2.543,P ＜0.05),but they were higher than those before treatment (t = 2.790,P ＜ 0.05 ). In combined treatment group, the HAMD scores decreased continuously,and the scores after 8 weeks' treatment [(20.08 ± 4.60) scores] and 6 months' treatment [( 15.21 ± 3.42)scores] were significantly lower than those before treatment [( 30.14 ± 4.92 ) scores] (t = 8.341,15.443, P ＜0.01). Meanwhile,the HAMD scores after 6 months'treatment were significantly Iower than those after 8 weeks' treatment (t =4.724,P ＜ 0.01 ). The SS-QOL scores after 8 weeks' treatment [( 117.56 ± 26.22)scores] and 6 months' treatment [(126.57 ±21.82) scores] were significantly higher than those before treatment[(86.54 ± 23.90) scores] (t = 6.716,8.916,P ＜ 0.01 ) ,and there was significantly difference(t=2.378,P ＜ 0.05). The HAMD scores of combined treatment group after 8 weeks' and 6 months' treatment were significantly lower than those of general treatment group at the same time(t = 2.118, P ＜ 0.05 ;t = 8.405,P＜ 0.01 ) ,and SS-QOL scores were significantly higher than those of general treatment group at the same time (t = 3.123,P ＜ 0.05 ;t = 6.580,P ＜ 0.01 ). Conclusions General back-up psychology therapy combined with Taoist cognitive psychotherapy can improve depression and life quality of cerebral stroke hemiplegia convalescence in aged patients. The effects of Taoist cognitive psychotherapy is slower, but it is more beneficial in the long time.     

阿托伐他汀钙对颈动脉粥样硬化斑块及C反应蛋白的影响

目的：探讨阿托伐他汀钙对颈动脉粥样硬化斑块及CRP的影响。方法选择76例颈动脉粥样硬化斑块患者,采用数字表法随机分为观察组和对照组各38例,对照组仅给予常规治疗,观察组在对照组基础上给予阿托伐他汀钙治疗,比较治疗后两组颈动脉粥样硬化斑块的面积大小及血浆CRP变化情况。结果观察组治疗后斑块大小为（0．069±0．021）cm2,颈动脉内膜中层厚度（IMT）为（1．29±0.28）mm,均显著小于治疗前（t＝7．538、7．132,均P＜0．05）,亦均明显小于对照组治疗后（t＝7．131、6．372,均P＜0．05）;观察组治疗后CRP为（3．54±1．92）mg/L,明显低于治疗前,治疗前后差异有统计学意义（t＝6.831,P＜0．05）,且明显低于对照组治疗后（t＝7．125,P＜0．05）。结论对于颈动脉粥样硬化斑块的患者而言,应用阿托伐他汀钙治疗,不仅可有效缩小斑块面积,还可降低CRP,值得在临床中进一步应用。     

医源性老年期神经质性焦虑抑郁障碍76例报告

目的 探讨一类医源性老年期神经质性焦虑抑郁障碍的发病原因、临床特点及治疗方法.方法 对76例以头部不适为主诉、伴有明显情绪障碍的老年患者,进行艾森克人格问卷(EPQ)N量表24个项目及医学应对方式问卷(MCMQ)测评,给予为期4周的抗焦虑及心理治疗,在治疗开始前及用药1周末、2周末、4周末及6月末随访时分别进行Zung...     

高压氧对脑梗死早期肢体运动功能康复的影响

脑梗死是中老年人常见病之一,致残率高,目前尚缺乏有效的治疗措施。我们近几年在脑梗死的早期治疗中增加了高压氧疗法,经观察比较,取得了较好的效果,现报道如下。     

依达拉奉治疗急性脑出血疗效观察

目的 观察依达拉奉注射液对急性脑出血的临床疗效.方法 将170例急性脑出血患者随机分为治疗组和对照组,治疗组在常规治疗的基础上,给予依达拉奉注射液30 mg加生理盐水100 mL静滴,30 min内滴完,2次/d,2周为1个疗程.观察14 d时2组脑血肿、脑水肿的变化、疗效评定、神经功能缺损程度（CSS）及日常生活活动量（ADL）评分,并进行统计学分析.结果 2周后治疗组与对照组相比脑血肿和脑水肿体积比较差异均有统计学意义（P＜0.05）;治疗组显效率和有效率分别为50.0%和87.5%,高于对照组的22.6%和61.3%（P＜0.05）;治疗组与对照组在治疗14 d的CSS及ADL评分差异有显著统计学意义（P＜0.01）.结论 依达拉奉能促进血肿吸收,抑制水肿形成,可明显促进脑出血患者神经功能康复,临床应用安全有效.     

心理干预对脑卒中患者康复效果的临床分析

目的分析脑卒中偏瘫患者的心理特点及进行一定的心理干预对其功能康复的影响。方法将180例符合脑卒中诊断标准的偏瘫患者按随机原则分为对照组与治疗组,每组各90例。对照组给予神经科常规药物治疗与康复训练,治疗组在此基础上给予相应的心理干预。采用症状自评量表（SCL-90）与WHO生存质量表（WHOQOL-100）评价对两组患者的心理健康水平影响。结果治疗前两组SCL-90评分比较,差异无统计学意义（P〉0．05）;心理干预3个月后,治疗组SCL-90评分为（120．3±21．2）,明显低于干预前（133．1±34．1）及治疗后对照组（132．4±33．5）,两者比较,差异有统计学意义（P〈0．05）,而对照组治疗前、后比较差异无统计学意义（P〉0．05）。治疗组SCL-90与WHOQOL-100量表治疗前、后比较差异均有统计学意义（P〈0．05）;治疗组治疗后两项指标均优于对照组（P〈0．05）。结论脑卒中患者在常规治疗的基础上给予及时适当的心理干预可提高功能康复的效果,提高生存质量。